bluuebunny/crossref_metadata_2025 huggingface dataset:
#442 Hyperparathyroidism, serum phosphorus and dietary intake in hemodialysis patients: is there a novel relationship?
Authors: Garagarza Cristina , Valente Ana , Queirós Cátia , Neto Inês , Sebastião Joana , Gomes Melanie , Ferreira Manuel Anibal A
Published: May 2024

Background and Aims

Hyperparathyroidism (HPTH), classified when intact parathyroid hormone (iPTH) serum levels are above 585 pg/mL, is a common complication in patients undergoing maintenance hemodialysis (HD). Despite there is little evidence about the relationship between iPTH levels and nutritional status, the intervention frequently focusses on appropriate management of mineral and bone markers, being the decrease of serum and dietary phosphorus some of the targets. The aim of this study was to investigate the association between iPTH, serum phosphorus levels and dietary intake.

Method

This was a cross-sectional, multicenter, observational study with 561 patients on HD treatment from 37 dialysis centers across Portugal. Clinical parameters, body composition and dietary intake (obtained from a Food Frequency Questionnaire) were assessed. For the analysis, patients were divided in 3 groups depending on their iPTH levels: a) iPTH<130, b) iPTH between 130-585 and c) iPTH >585 pg/mL. The association between PTH, serum phosphorus and dietary intake was analyzed with linear regression models. A p-value lower than 0.05 was considered statistically significant.

Results

Patients’ mean age was 68 ± 14 years, median HD vintage was 65 (IQR: 43-106) months and 58.8% were men. From the whole sample, 13.9% presented a iPTH <130 pg/mL, 59.3% between 130-585 pg/mL and 23.2% >585 pg/mL. Patients with higher iPTH levels were those with longer HD vintage (p = 0.021) and lower age (p = 0.002). At the same time, showed higher serum phosphorus (p = 0.005), serum calcium (p = 0.027), Ca/P product (p < 0.001), albumin (p = 0.016) and caffeine intake (p = 0.009). In addition, a lower dietary intake of phosphorus (p = 0.044), fiber (p = 0.047), riboflavin (p = 0.031) and folate (p = 0.011) were observed in patients with higher iPTH levels. In the linear regression models, higher serum phosphorus predicted higher iPTH levels, even in the adjusted model (p = 0.019). However, a lower phosphorus intake was a predictor of higher iPTH levels, also in the model adjusted to age, gender, serum phosphorus, dialysis adequacy (Kt/V) and dialysis vintage (p = 0.035). The same result was observed when considering the dietary fiber intake in the model (p = 0.048). No significant differences in body composition parameters were found.

Conclusion

Our results bring new data on the relationship between dietary intake and iPTH values. Despite higher serum phosphorus was observed in patients with HPTH, an opposite association was noted regarding dietary phosphate and fiber as lower intakes predicted higher iPTH values. Moreover, a poorer dietary intake, considering riboflavin and folate was observed in the HPTH group.
#2028 Efficacy and safety of sucroferric oxyhydroxide versus sevelamer carbonate: a systematic review and meta-analysis
Authors: Georgopoulos Christos , Duni Anila , Stamellou Eleni , Kitsos Athanasios , Gouva Charikleia , Ntounousi Evangelia
Published: May 2024

Background and Aims

Hyperphosphatemia is a common and clinically significant complication in severe chronic kidney disease (CKD), associated with higher cardiovascular adverse events and higher mortality rates. High serum phosphate is also associated with a heightened risk of cardiovascular issues such as hypertension, left ventricular hypertrophy, atherosclerosis, and vascular calcifications. Phosphate binders are commonly used in patients receiving renal replacement therapy (RRT), aiming to reduce and maintain serum phosphorus. This study aims to examine the efficacy and safety of sucroferric oxyhydroxide versus sevelamer carbonate in patients receiving RRT.

Method

Data sources included MEDLINE(PubMed), Scopus, and the Cochrane Central Register of Controlled Clinical Trials with the search cut-off in October 2023. We examined RCTs that comparing sucroferric oxyhydroxide versus sevelamer carbonate in the adult population receiving RRT. Data extraction followed the PICOS protocol and bias risk was assessed using the Rob-2 tool. We performed a meta-analysis combining the data from RCTs, using R-studio. The primary endpoint of this study is the change in the serum phosphorus levels from baseline to end of treatment. Secondary outcomes included changes in serum intact parathormone (i-PTH) levels from baseline to end of treatment as well as the adverse events ratio during the study period. Given the prevalence of gastrointestinal side effects for both drugs, which often leads to drug discontinuation or patient non-adherence, a separate analysis focused on gastrointestinal-related adverse events.

Results

Inclusion criteria were met by 5 RCTs. No statistically significant difference was found in serum phosphorus reduction between the two groups {MD: −0.07 mmol/l,95% CI-random effects: −0.15 to 0.02}. Similarly, serum i-PTH reduction showed no statistically significant difference between the two drugs {MD = −1.53 mg/dl, 95% CI = (−4.45, 1.4), p = 0.26, random effects model}. Adverse events were comparable between the groups (OR: 1.11, 95% CI: 0.65-1.88, random effects model). However, further analysis of gastrointestinal adverse evets indicated a 60% increase with sevelamer carbonate {OR: 1.60, 95% CI 1.31-1.97, common(fixed) effect model}. Funnel plot examination for both continuous and dichotomous outcomes revealed a high chance for small study effect and publication bias.

Conclusion

This meta-analysis found that sucroferric oxyhydroxide and sevelamer carbonate are equally effective in controlling serum phosphorus and i-PTH levels. Sucroferric oxyhydroxide, however, demonstrated a more favorable profile regarding gastrointestinal adverse events. Our findings suggest sucroferric oxyhydroxide as a valuable alternative for RRT patients who have difficulty tolerating sevelamer carbonate.
#2352 Short-term effect of roxadustat combined with ESA treatment for anemia in patients undergoing hemodialysis with ESA hyporesponsiveness
Authors: Fu Ping , Xiang Ting , Zhou Li
Published: May 2024

Background and Aims

The efficacy of roxadustat combined with erythropoiesis-stimulating agent (ESA) on renal anemia in maintenance hemodialysis (MHD) patients is rarely reported, especially for those with ESA hyporesponsiveness. Our study aimed to observe the short-term efficacy of roxadustat combined with ESA for those patients when they were first treated with roxadustat converted from ESA.

Method

Retrospective data pertaining to MHD patients with ESA hyporesponsiveness from September 2019 to June 2022 were collected. All patients had been on ESA for more than 6 months and were first treated with roxadustat. 19 patients treated with roxadustat combined with ESA and 19 patients treated with roxadustat alone were paired for analysis from 108 patients by propensity score matching. Parameters related to anemia, iron metabolism and adverse events were recorded.

Results

The haemoglobin (Hb) level was significantly improved in patients treated with roxadustat combined with ESA after 1 month (7.8 ± 1.54 g/dL vs 8.96 ± 1.38 g/dL, p = 0.003), which was not found in patients treated with roxadustat alone (8.2 ± 1.28 g/dL vs 8.35 ± 1.54 g/dL, p = 0.652). Patients treated with roxadustat combined with ESA had a higher Hb response rate (47.4%) than those treated with roxadustat alone (15.8%) during the first month (p = 0.036). In addition, the level of serum iron was increased, and serum ferritin (SF) was decreased in both groups.

Conclusion

Roxadustat combined with ESA treatment might be more beneficial for improving renal anemia in MHD patients with ESA hyporesponsiveness during the first month of roxadustat therapy replacement.
#1555 The effects of different interdialytic intervals on cardiorespiratory fitness assessed with CPET in hemodialysis patients
Authors: Pella Eva , Boulmpou Aristi , Boutou Afroditi , Theodorakopoulou Marieta P , Haddad Nasra , Karpetas Antonios , Giamalis Panagiotis , Papagianni Aikaterini , Papadopoulos Christodoulos E , Vassilikos Vassilios , Sarafidis Pantelis
Published: May 2024

Background and Aims

Long interdialytic interval in thrice-weekly hemodialysis is associated with excess cardiovascular and all-cause mortality risk. Impaired cardiorespiratory fitness is a strong predictor of mortality in hemodialysis. This study investigated differences in cardiorespiratory fitness assessed with cardiopulmonary exercise testing (CPET) between the end of the 2-day and the 3-day interdialytic interval.

Method

A total of 28 hemodialysis patients, randomized in two different sequences of evaluation underwent CPET and spirometry examination at the end of the 2-day and the 3-day intervals. The primary outcome was the difference in oxygen uptake at peak exercise [VO2peak (ml/kg/min)] assessed with CPET. Volume status was assessed with interdialytic-weight-gain (IDWG), lung ultrasound, bioimpedance spectroscopy (BIS), and inferior vena cava measurements. A total of 14 age- and sex-matched controls were also evaluated.

Results

Hemodialysis patients at the end of both 2-day and 3-day intervals presented lower values in all major CPET parameters than controls. VO2peak (ml/kg/min) was significantly higher at the end of the 2-day than the 3-day interval (15.24 ± 4.18 vs 13.64 ± 2.76; p < 0.001); similar were the results for VO2peak (ml/min) (1188 ± 257 vs 1074 ± 224; p < 0.001) and VO2peak (%predicted) (58.9 ± 9.2 vs 52.3 ± 8.6; p < 0.001). Numerical but no statistically significant differences were detected in VO2-anaerobic-threshold(ml/kg/min) and VO2-anaerobic-threshold(ml/min) between the two time-points. Maximal work load (90.1 ± 23.2 vs 79.3 ± 25.1; p < 0.001), exercise duration, HR at peak exercise and oxygen pulse also showed lower values at the end of the 3-day interval. FEV1 levels were similar between the two evaluations. Generalized-linear-mixed-model analysis including IDWG as random covariate attenuated the observed differences in VO2peak (ml/kg/min). Changes in BIS-derived overhydration indexes were moderately correlated with changes of VO2peak (ml/kg/min).

Conclusion

The 3-day interval was associated with further impairment of VO2 at peak exercise. This effect was predominantly driven by excess fluid accumulation during the extra interdialytic day.
#1767 Effect of heart failure and atrial fibrillation on cardiorespiratory fitness in hemodialysis patients
Authors: Pella Eva , Boutou Afroditi , Boulmpou Aristi , Theodorakopoulou Marieta P , Karagiannidis Artemios , Haddad Nasra , Iatridi Fotini , Tsouchnikas Ioannis , Papadopoulos Christodoulos E , Vassilikos Vassilios , Sarafidis Pantelis
Published: May 2024

Background and Aims

Heart failure (HF) and atrial fibrillation (AF) are highly prevalent in hemodialysis. They are well-known significant modifiers of the disease associations with cardiovascular outcomes, but there is a lack of evidence regarding the effects of HF and AF on cardiorespiratory fitness. This study is the first to examine the possible association of the presence of HF and AF with exercise intolerance in patients undergoing hemodialysis.

Method

This analysis included 40 sex- and age-matched participants [10 hemodialysis patients with HF or AF, 10 hemodialysis patients without HF or AF, 10 patients with HF or AF without chronic kidney disease (CKD) and 10 healthy controls) that underwent CPET and spirometry examinations.

Results

VO2peak (ml/min/kg) showed a graded increase between hemodialysis patients with HF or AF, hemodialysis patients without HF or AF, non-CKD patients with HF or AF and controls (13.17 ± 2.45 vs 15.26 ± 3.29 vs 19.64 ± 5.84 vs 25.11 ± 6.94 ml/min/kg, p < 0.001); VO2peak (ml/min) followed the same pattern (1172 ± 197 vs 1269 ± 314 vs 1817 ± 583 vs 1952 ± 592 ml/min respectively, p = 0.001). VO2peak (%predicted), VO2AT (ml/kg/min), VO2AT (ml/min) and maximal work load significantly differ between the study groups, with a tendency for higher values from hemodialysis patients to non-CKD patients with HF or AF and to healthy controls. FEV1 and FVC levels were similar between the study groups. In the whole population, VO2peak (ml/kg/min) showed a positive correlation with hemoglobin (r = 0.663, p < 0.001) and negative correlations with high-sensitivity cardiac troponin I (r = −0.493, p = 0.001) and BNP (r = −0.479, p = 0.002).

Conclusion

Hemodialysis patients have low exercise tolerance, and the presence of HF or AF is associated with further decreased values of VO2peak, the most important determinant of cardiorespiratory fitness.
#220 Acute vascular response to hemodialysis as measured by serum syndecan-1 and endothelin-1 levels, as well as vascular stiffness
Authors: Csiky Botond , Sági Balázs , Kun Szilard , Sulyok Endre
Published: May 2024

Background and Aims

End-stage kidney disease (ESKD) patients on chronic hemodialysis (HD) have very high cardiovascular risk. Acute vascular changes during dialysis mediated partially by factors of the endothelium may have a crucial role in the cardiovascular (CV) disease of HD patients.

Aim

To study acute vascular changes during HD measured by applanation tonometry and to assess the role of syndecan-1 (SDC-1), endothelin-1 (ET-1), and traditional and non-traditional CV risk factors in these changes.

Method

29 consecutive chronic HD patients (median age: 65.6 ± 10.4 years; 52% men) were included in the study. Pre-, mid-, and post-HD plasma SDC-1 and ET-1 levels and routine biochemical parameters were measured. Applanation tonometry (SphygmoCor, AtCor Medical) was performed before HD.

Results

As assessed by trend analysis, SDC-1 levels increased significantly during HD (p = 0.004). ET-1 levels were decreasing during HD. Male patients had significantly higher ET-1 levels than women. Patients were divided into 2 groups based on their pulse wave velocity (PWV): PWV ≥12 m/s and PWV <12 m/s. Pre-HD and mid-HD SDC-1 levels were significantly higher in the group with PWV ≥12 m/s (10.174 ± 2.568 vs. 7.928 ± 1.794 ng/ml, p = 0.013, and 10.319 ± 3.482 vs. 8.248 ± 1.793 ng/ml, p = 0.044, respectively). Post-HD ET-1 levels were significantly higher in the patient group having PWV ≥12 m/s (10.88 ± 3.00 vs. 8.05 ± 3.48 pg/l, p = 0.027). Patients having PWV ≥12 m/s had significantly higher pre-HD peripheral and aortic systolic blood pressure than the patients having lower PWV (147.4 ± 73.3 vs. 134.1 ± 72.2 mmHg, p = 0.038, and 130.7 ± 16.6 vs. 122.5 ± 14.9 mmHg, p = 0.016, respectively). Mid-HD and post-HD blood pressures were not different. We found a positive correlation between total cholesterol and the decrease in SDC-1 levels during HD (r = 0.539; p = 0.008). Pre-, mid-, and post-HD SDC-1 correlated significantly with the ultrafiltration volume during HD (r = 0.432, p = 0.019; r = 0.377, p = 0.044; and r = 0.401, p = 0.012, respectively).

Conclusion

SDC-1 and ET-1 may contribute to the vascular changes observed during HD, and they have correlations with some traditional and non-traditional CV risk factors.
#521 Increasing levels of aortic peak wave velocity along with prolonged higher CaxP product is associated with mortality in peritoneal dialysis
Authors: Korucu Berfu , Colak Ayse , Bildaci Yelda Deligoz , Oktan Mehmet Asi , Cavdar Caner , Deger Serpil Muge
Published: May 2024

Background and Aims

Valvular calcification is concordant with vascular calcification and develops faster in end-stage renal disease patients than in the average population. There are contradictory reports about the pathophysiology and the predictive value of valvular calcification regarding mortality in this patient population. Aortic peak wave velocity (Vmax) measurement is a non-invasive and reliable marker for the diagnosis of valve calcification. Our study analyzes cardiovascular risk prediction effect of increasing levels of Vmax at different time points in peritoneal dialysis (PD) patients.

Method

We conducted a retrospective, single-center study of incident PD patients under follow-up between January 1992 and January 2023 in our clinic. Demographics, laboratory, and echocardiographic findings were obtained from medical records. Patients without a baseline echocardiography were excluded. ΔVmax is defined as the last Vmax minus baseline Vmax levels. The patients were divided into two subgroups: Vmax-stable and Vmax-increased.

Results

The baseline demographics, laboratory, and clinical characteristics, including daily elemental calcium and calcitriol usage, were similar between Vmax-stable and Vmax-increased groups. Baseline calcium (Ca), phosphate (P), and annual CaXP levels were significantly higher in Vmax-increased group [p = 0.01, p = 0.02, and (F(1,27) = 10.415, p = 0.003), respectively]. Cardiovascular mortality was 9.8% in Vmax-stable group and 26.8% in Vmax-increased group (p = 0.02).

Conclusion

During a follow-up of 20 years, increasing Vmax values were associated with higher CaxP levels in PD patients. Increased Vmax levels, along with higher CaxP levels, are associated with cardiovascular mortality. Even without clinical manifestations, Vmax follow-up is a non-invasive, easily accessible method and might identify the high-risk group regarding cardiovascular mortality in the PD population.
#341 Dialysis modality patterns across six continents in Apollo Dial DB
Authors: Croft Kaitlyn , Wolf Melanie , Jiao Yue , Winter Anke , Nikam Milind , Stuard Stefano , Guinsburg Adrian , Koulechov Kirill , Mcguigan Stuart , Usvyat Len , Larkin John , Maddux Frank
Published: May 2024

Background and Aims

Data is often collected during kidney dialysis treatments, providing data on a large scale and at a constant flow. As multinational datasets are scarce, Apollo Dial DB was created by a global provider that contains longitudinal observational data across six continents. This database is fully anonymised and can be used to better understand modality practice of global patients from a variety of healthcare systems for quality improvement and research efforts. Our aim was to detail patterns of dialysis modalities used among patients treated in 40 countries across six continents represented in the first version of the global database.

Method

Apollo Dial DB, a global anonymised dialysis database, contains demographics, diagnoses, laboratories, medications, treatments, quality of life, and outcomes from six continents and 40 countries. Data was harmonised from different electronic systems and anonymised based on logic established in a re-identification risk assessment. Data is consolidated and stored in a central cloud environment. The initial version of the dataset contains data on more than 360 variables from January 2018 to March 2021 and will be updated periodically.

Results

The first version of the Apollo Dial DB includes data on 543,169 patients, with 4.6% from Asia-Pacific (AP), 13.9% from Europe, Middle East, and Africa (EMEA), 7.0% from Latin America (LA), and 74.5% from North America (NA) countries. Most of the patients included in the database are between 45-64 years old at the initiation of dialysis. Overall, Apollo Dial DB contains information on 140,016,249 dialysis treatment observations. Depending on the region, different treatment patterns could be observed (Table 1 and Fig. 1). In EMEA a higher proportion of patients received hemodiafiltration with post-dilution, especially in Northern and Southern Europe as well as in South Africa. Peritoneal dialysis was more frequently used in LA and NA than in other regions. CCPD was mainly used in NA, whereas CAPD was common in LA and EMEA. For a more detailed look across the six continents Fig. 1 illustrates incentre hemodialysis modality patterns on a minor world region level. For incentre hemodialysis treatments, the majority of treatments from the minor regions in AP, LA, and NA had HD treatments. However, the majority treatments from EMEA minor regions are receiving incentre HDF treatments.

Conclusion

In a descriptive analysis, we defined modality treatment patterns in major world regions. These findings act as benchmarks for the nephrology community and expand upon scarce point prevalent information on modality practice patterns used throughout the world [1]. Apollo Dial DB offers opportunities for investigators to conduct global analytics and advance the state of the art.
#1513 Update on the peritonitis trend in central Spain
Authors: Lozano Claudia Yuste , Portoles Jose , Espada Paula Jara Caro , Vega Almudena , Luis Maria Jose Fernandez-Reyes , Perpen Antonio Carlos Fernández , Sanchidrian Silvia Gonzalez , López Paula
Published: May 2024

Background and Aims

Peritonitis is one of the most common and severe complications associated with peritoneal dialysis (PD) traditionally cited as the primary cause of catheter loss and discontinuation of the dialysis technique. Nevertheless, the incidence and severity of peritonitis has been significantly reduced over time. Therefore, we aimed to update the current impact of peritonitis in PD patients.

Method

We performed an observational, multi-centre, prospective cohort including 3,037 patients who started PD between 2003-2020 followed for a median of 1.6 [0.8-2.9] years.

Results

We observed 2 941 episodes of peritonitis, with a peritonitis rate (PR) of 0.46 episodes per patient year and a mean of 2.6 years CI 95% [2.4-2.8] to first peritonitis episode. As expected, gram-positive organism was identified in the 69.3% of the cases, followed by gram-negative (19.6%) and sterile culture (15.6%). The usual course of the peritonitis is favourable, with complete recovery in the 76.4% of the cases, whereas just the 37.6% require admission during a median of 5 [3-9] days, with a peritonitis recurrence of 11.2%. A fatal peritonitis (resulted in PD cessation) was observed in 11.7% of the patients with an overall mortality of 0.7% (considering all the deaths within the 90 days after peritonitis). Factors associated with a 90-days mortality rate related to PD rate were age > 65 years (OR 2.99 [1.84-4.85]), Charlson index (OR 1.19 [1.07-1.33]), and the type of microorganism: fungus (OR 9.8 [4.16-23.43], multi-bacterial (OR 7.97 [0.91-69.88] and gram- negative OR (2.41 [1.45, 3.99]). Comparing patients who developed peritonitis (P) (N = 1230) vs patients who not developed peritonitis (NP) (N = 1807), P patients were older (P 59 ± 15.5 years vs NP 55 ± 15.5 years, p < 0.001) and associated higher comorbidity (such as Charlson index, cardiovascular and diabetes mellitus history) than NP patients. P patients more commonly had a prior history of renal replacement therapy (kidney transplant P 9.2% vs NP 6.9% and hemodialysis 18.8% vs 17.1%) compared with NP patients.

PR has significantly decreased over three consecutive 5-year periods: from 0.51 [0.48-0.54] peritonitis cases per year during 2003-2008 to 0.45 [0.43-0.48] during 2009-2014 (p 0.03), and further dropping to 0.41 [0.38-0.44] for the period 2015-2020 (p < 0.001).

Conclusion

Over the past 17 years, the incidence and severity of peritonitis have significantly reduced, despite PD patients becoming older and associated high comorbidities.
#2771 Peritoneal dialysis after kidney graft loss … and now, what?
Authors: Alonso Marta , Villanego Florentino , Amaro José Manuel , Torrado Julia , Singh Arshdeep , Vigara Luis Alberto , Lopez Juan Manuel Cazorla , Quirós Pedro Luis , Castro Pablo , Mazuecos Auxiliadora
Published: May 2024

Background and Aims

The evolution of peritoneal dialysis (PD) as renal replacement therapy (RRT) after graft loss is not well defined.

Method

Retrospective analysis of the Andalusian Renal Registry of patients who received their first kidney transplant (KT) in Andalusia (Spain) and returned to dialysis between 1978-2023. Patients who lost follow-up and those who underwent preemptive re-KT were excluded of the study. We compared clinical characteristics and evolution between those who started hemodialysis (HD) and peritoneal dialysis (PD) after graft loss. Secondly, we analyzed technique and patient survival in those who started PD post-KT versus patients on PD as their first renal replacement therapy (RRT) We performed multivariate analysis for PD technique and patient survival risk factors using Cox regression.

Results

During this period, we followed 11868 KT recipients in Andalusia. Of these, 3148 (26.52%) lost the graft: 2768 started HD and 298 PD. 82 patients underwent preemptive re-KT.

Patients who returned to DP were younger (p < 0.001) and glomerulonephritis as cause of chronic kidney disease (CKD) was more frequent (p = 0.019). The pre-KT RRT was HD in 96.3% of patients starting HD post-KT and PD in 48.3% of patients who returned to PD after KT (p < 0.001). Survival of patients in the HD group was lower than those who started PD (p = 0.026). In the multivariate analysis, older age when dialysis restarted, male sex and diabetes were risk factors for patient death and not the type of dialysis.

When comparing only the post-KT PD group (n = 298) versus patients on PD as their first RRT (n = 5312), patients on the first group were younger (57.1 vs. 41.9; p < 0.001) and time on PD was longer (24.4 vs. 19 months; p < 0.001). The causes of PD drop-out also varied between groups (p < 0.001). During this period, 269 post-KT PD patients left the technique mainly due to re-KT (34.3%) and in the PD group as the first RRT, there were 4919 technique drop-outs, mainly due to transfer to HD (35.3%) and death (30%). The percentage of peritonitis was higher in the post-KT PD group, although without significant differences (post-KT PD 27.9% vs. PD as first RRT 23.25%; p = 0.061).

Survival of the DP technique in post-KT PD group was 78.2% at 1 year and 38.5% at 5 years, and 77.7% and 42.1% respectively in the DP group as the first DP RRT (p = 0.059). In the multivariate analysis, patient age and diabetes as a cause of CKD, behaved as risk factors for patient survival.

Conclusion

Almost half of the patients starting PD after KT had been on PD prior to transplantation. They tend to have more peritonitis although survival of the technique and complications were very similar to those observed in patients on PD as first RRT.
#1125 CAPD in ESRD and CLD patients with refractory ascites: a 12-month follow-up study
Authors: Tiwari Vaibhav , Bhalla A K , Bhargava Vinant , Gupta Anurag , Malik Manish , Gupta Ashwani , Rana Devinder Singh
Published: May 2024

Background and Aims

Refractory ascites secondary to chronic liver disease among ESRD patients are a major source of morbidity and mortality. Hemodialysis is frequently interrupted due to intradialytic hypotension and other complications which make ultrafiltration removal among CLD patients, a big challenge. This results in sub-optimal clearance which translates into poor quality of life along with recurrent admissions. CAPD in these patients is effective in providing a good clearance as well as removal of ascites with adequate ultrafiltration removal.

There is a lack of data regarding the feasibility, safety, and clinical outcomes of CAPD among CLD patients with ascites. We conducted a study with objectives to evaluate serum albumin levels at baseline and 12 months, and to determine peritonitis rates and dialysis modality suitability in CLD patients.

Method

 

Study Design

A retrospective cohort study.

Study Population

All hemodialysis patients with refractory ascites due to CLD. Refractory ascites was defined as the need for >5 therapeutic paracentesis in the last 3 months after optimal clinical, dietary and fluid management.

All CLD patients were extensively counselled regarding high protein intake. Each patient visited either the Nephrologist or PD Nurse, renal dietician at least once in 4-6 weeks.

Results

Over a period of five years, 34 patients were included in the analysis to assess the efficacy of Continuous Ambulatory Peritoneal Dialysis (CAPD) for ascites management in chronic liver disease. Baseline characteristics are presented in Table 1. The frequency of ascites drainage prior to CAPD was every 3.4 weeks. Open catheter insertion was performed in 31 out of 34 patients. Serum albumin levels increased from 2.98 ± 0.4 g/dL at baseline to 3.1 ± 0.28 g/dL at 12 months (p = 0.21) (Fig. 1). Child-Pugh Score and MELD score remained stable. Bacterial peritonitis episodes were higher at 12 months (3 vs 9; p = 0.04). PD-related complications at one year included one omental wrap, three pericatheter leaks, and one umbilical hernia. At the 12-month follow-up, 32 patients survived. One patient died from myocardial infarction, and another experienced severe hepatic encephalopathy and aspiration pneumonia.

Conclusion

PD was well tolerated in patients with refractory ascites, presenting no additional hypoalbuminemia risk. Continuous multidisciplinary monitoring for malnutrition remains critical. Peritonitis risk was elevated relative to SBP in HD patients yet was on par with typical PD rates, without an increase in hospital admissions.
#2495 Renal and peritoneal protective effects of SGLT2 Inhibitors in incident peritoneal dialysis (PD) patients
Authors: Ishioka Kunihiro , Mitomo Ayaka , Maruyama Haruka , Hagiwara Takayuki , Yamano Mizuki , Mochida Yasuhiro , Oka Machiko , Maesato Kyoko , Moriya Hidekazu , Ohtake Takayasu , Hidaka Sumi , Kobayashi Shuzo
Published: May 2024

Background and Aims

The renoprotective effect of SGLT2 inhibitors has been evaluated in several large studies, but renal function of the subject is defined as eGFR≥20-30 mL/min/1.73 m2 or higher in most studies. On the other hand, SGLT2 is expressed in the peritoneum, and there have been reports of decreased glucose absorption and improvement of ultrafiltration injury with SGLT2 inhibitors in animal studies. However, there are very few reports on the protective effects of SGLT2 inhibitors on renal and peritoneal function in PD patients. In the present study, we retrospectively evaluated the renal and peritoneal protective effects of SGLT2 inhibitors in patients undergoing PD.

Method

Among the patients who received PD at our hospital, 8 patients who continued SGLT2 inhibitors and underwent peritoneal equilibrium testing (PET) at the time of induction and 1 year after induction were assigned to the SG group, and 32 patients who received PD without SGLT2 inhibitors were assigned to the control group. PET data, PD drainage volume, urine output, renal • peritoneal • total Kt/V, and renal • peritoneal • total weekly CCr at the time of PD induction and 1 year after PD induction were compared retrospectively.

Results

Among the 40 patients, the median age was 64 years (interquartile range 52-71), with 33% males, and the median eGFR at PD induction was 5.25 ml/min/1.73 m2. The most common cause of end-stage renal failure was diabetic nephropathy (37.5%), followed by chronic glomerulonephritis (15.0%) and nephrosclerosis (12.5%). At the time of induction of peritoneal dialysis, there were no significant differences between the SG group and the control group in PET data, PD drainage volume, urine output, renal • peritoneal • total Kt/V and weekly CCr. However, at one year after PD induction, urine volume, renal • total Kt/V, and renal weekly CCr were higher in the SG group. Total weekly CCr at 1 year of PD induction was significantly higher in the SG group (p = 0.03). Multivariate linear regression analysis showed that SGLT2 inhibitors were independently associated with total weekly CCr at 1 year after PD induction (p = 0.04).

Conclusion

Our results suggest that SGLT2 inhibitors may have renal and peritoneal protective effects in patients undergoing PD induction. For CKD stage G4 and 5 patients scheduled for PD induction in the future, proactive continuation of SGLT2 inhibitors may be effective in preserving renal and peritoneal function.
#1821 Baroflex sensitivity and hemodynamic responses during physical and mental tests: a comparative study between HD and PD patients
Authors: Faitatzidou Danai , Theodorakopoulou Marieta P , Dipla Konstantina , Koutlas Aggelos , Karagiannidis Artemios , Georgiou Areti , Dimitriadis Chrysostomos , Pateinakis Panagiotis , Papagianni Aikaterini , Zafeiridis Andreas , Sarafidis Pantelis
Published: May 2024

Background and Aims

Cardiac arrhythmias and sudden death are the leading causes of mortality in end-stage kidney disease (ESKD) and autonomic dysfunction is considered to play a predominant role. This is the first study to compare baroreflex sensitivity (BRS) and hemodynamic responses after mental- and physical-stimulation maneuvers between hemodialysis (HD) and peritoneal (PD) patients.

Method

68 ESKD patients (34 HD and 34 PD patients matched for age, sex, and dialysis-vintage) were included. Continuous recordings from Finometer-PRO at rest and during mental-arithmetic, orthostatic, and handgrip-exercise tests were used for calculation of BRS and hemodynamic responses in each individual.

Results

The two groups were similar in terms of age, sex, dialysis vintage and major comorbidities. BRS during mental (HD 3.59 ± 2.62 vs PD 5.50 ± 9.40 ms/mmHg, p = 0.280) and physical stress tests (orthostatic: HD 3.23 ± 2.42 vs PD 2.07 ± 2.69 ms/mmHg, p = 0.777) was similar between HD and PD patients. During mental test, both groups presented increases in SBP/DBP levels compared to rest (SBP HD: 156.3 ± 27.7 vs 142.7 ± 20.0 mmHg, p < 0.05; PD: 158.0 ± 25.6 vs 143.1 ± 23.6 mmHg, p < 0.05, respectively), but without significant between-group differences (p = 0.853/p = 0.611 respectively for SBP/DBP). Similarly, no significant between-group differences were noted in stroke volume, cardiac output, and total peripheral resistance during the same testing period. The mean SBP levels during the orthostatic test were significantly decreased compared to rest in both groups (HD: 135.4 ± 26.8 vs 142.2 ± 20.1 mmHg; p < 0.05; PD 135.3 ± 21.9 vs 143.1 ± 23.6 mmHg; p < 0.05), but the overall response was not different between-groups (p = 0.937). Similarly, the responses to the other hemodynamic parameters were similar between HD and PD. Finally, the hemodynamic responses during handgrip exercise and recovery were not differed between HD and PD.

Conclusion

BRS and hemodynamic responses to mental and physical stress tests were similar between HD and PD patients, suggesting that ANS function in ESKD is not affected by dialysis modality.
#1156 Outcomes after kidney transplantation in ANCA-associated vasculitis
Authors: Brilland Benoit , Dekervel Marine , Traversat Priscille , Piccoli Giorgina , Henry Nicolas , Gatault Philippe , Thierry Antoine , Bertrand Dominique , Golbin Leonard , Anglicheau Dany , Duveau Agnès , François Augusto Jean
Published: May 2024

Background and Aims

ANCA-associated vasculitis with glomerulonephritis (AAV-GN) can lead to end-stage kidney disease (ESKD), requiring replacement therapy with dialysis or kidney transplant (KT). Few large studies evaluated the outcome of these patients after KT. Our aim was to describe, in comparison with a control group, the occurrence of the following events: delayed graft function recovery, graft survival, relapse, acute rejection, overall survival; and to study the risk factors associated with these events.

Method

This was a retrospective, multicenter (6 French centers), observational study including patients who received a KT between 2005 and 2023 for ESKD secondary to AAV-GN. Each vasculitis case receiving a KT was matched with 2 controls, matched on gender, center, recipient age (±5 years) and transplant period (±1 year). Event-free survival and the associated risk factors were analyzed.

Results

369 patients were included, including 123 with AAV-GN and 246 control patients. The median post-KT follow-up for all patients was 58 months. There was no difference in the occurrence of DGF between the groups (18 vs 17%, p = 0.9). In univariable analysis, graft survival was lower in the AAV-GN group compared to the controls (76% vs 81% at 10 years, p = 0.017) (Fig 1A). 10 patients experienced a relapse after KT. ANCA positivity at the time of transplantation appeared to be correlated with relapse. There was no difference in the incidence of acute rejection between the groups (p = 0.44). In univariable analysis, overall survival tended to be lower in AAV-GN patients compared to controls (62% vs 73% at 10 years, p = 0.084) (Fig. 1B).

Conclusion

Kidney transplantation is an interesting option for patients with AAV-GN: the relapse rate is low, and the occurrence of acute rejection is comparable to a population of control patients. However, in AAV-GN, graft survival and overall survival appear to be poorer than in control patients. Comparison with a matched AAV-GN population remaining on dialysis would be of interest to go further.
#1462 Muscle mass, muscle strength, and health-related quality of life in kidney transplant recipients results of the TransplantLines Biobank & cohort study
Authors: Knobbe Tim J , Lenis Gijs M M , van der Vossen Dirk A J , Wentink Jory , Kremer Daan , Quint Evelien E , Gomes-Neto António W , Pol Robert , Berger Stefan P , Franssen Casper F M , Bakker Stephan J L , Post Adrian
Published: May 2024

Background and Aims

Muscles play a vital role in nearly every aspect of daily living, and kidney transplant recipients (KTR) often experience reduced muscle mass and strength, potentially contributing to their diminished health-related quality of life (HRQoL). We aimed to investigate the potential relationship of muscle mass and muscle strength with physical HRQoL in KTR.

Method

Data of stable KTR (≥1 year after transplantation) enrolled in the TransplantLines Biobank and Cohort Studies were used. Muscle mass was assessed using both appendicular skeletal muscle mass (via bioimpedance analysis) indexed to height squared (ASMI) and 24-hour urinary creatinine excretion rate indexed to height squared (CERI). Muscle strength was assessed using handgrip strength indexed to height squared (HGSI). HRQoL was assessed using the physical component score derived from the Short Form 36 questionnaire.

Results

A total of 751 KTR (61% male, mean age 56 ± 13 years) at a median of 3 years after transplantation were included. Mean ASMI was 7.5 ± 1.2 kg/m2, mean CERI was 4.1 ± 1.1 mmol/24 h/m2 and mean HGSI was 12.4 ± 3.4 kg/m2. The mean physical HRQoL score was 70 ± 21. Lower ASMI, CERI and HGSI were all associated with lower physical HRQoL, independent of potential confounders. Both associations were best characterized by a significant non-linear relationship (see Figure). Below median values, ASMI, CERI and HGSI were each associated with physical HRQoL, whereas above median values, associations were far less pronounced. When associations of ASMI, CERI and HSGI were adjusted for each other, associations of below median values of ASMI and CERI with physical HRQoL materially weakened, while those of HGSI remained strongly associated. Compared to the 50th percentile, a decrease to the 10th percentile was associated with a decrease in physical HRQoL of 6.0% for ASMI (P = 0.006), of 5.1% for CERI (P = 0.006) and 13.2% for HGSI (P < 0.001), whereas an increase to the 90th percentile was associated with an increase in physical HRQoL of only 1.3% for ASMI (P = 0.22), of 3.6% for CERI (P = 0.05) and −0.4% for HGSI (P = 0.73).

Conclusion

Our findings suggest that low muscle mass and muscle strength are potentially modifiable risk factors for impaired physical HRQoL. Both muscle mass and muscle strength were complementarily associated with HRQoL. However, muscle strength was most strongly associated with physical HRQoL. The non-linear nature of the associations implies that KTR with low muscle mass or strength may particularly benefit from (p)rehabilitation interventions to improve HRQoL.
#1742 Hybrid-immunity protection against SARS-CoV-2 reinfection on kidney transplant recipients
Authors: Couceiro Carlos , Favà Alexandre , Semper Laura Calatayud , Montero Nuria , Coloma Ana , Manonelles Anna , Codina Sergi , Oliveras Laia , Lino Luis , Melilli Edoardo , Luzón Maria Angeles Dominguez , Garrit Josep Maria Cruzado
Published: May 2024

Background and Aims

Scarce data is available about the impact of hybrid immunity (vaccination plus infection) in immunocompromised patients. Several studies report a greater immunological response in hybrid individuals compared to those who are vaccinated-only, but no study has evaluated its clinical implication. We aimed to investigate the protection of hybrid immunity against SARS-CoV-2 infection, relative to the vaccine-only acquired immunity in a population of kidney transplant recipients over a omicron SARS-CoV-2 wave.

Method

This observational retrospective cohort study was done on kidney transplant recipients vaccinated with three or four doses against SARS-CoV-2, at Bellvitge University Hospital, Spain. All participants were interviewed to ascertain if they have suffered a natural infection. Data was also obtained from clinical records database of our institution and the Catalan Transplant Organisation. Incidence of SARS-CoV-2 infection and COVID-related hospitalisation and death in the hybrid cohort was compared with the incidence in the vaccine cohort, using Cox proportional hazard regressions models.

Results

1338 kidney transplant recipients participated in the study, 544 (40.7%) out of them were hybrid at the start of the study. 341 infections, 46 hospitalisations and 14 deaths were recorded during follow-up. The overall adjusted hazard ratio for SARS-CoV-2 infection was 0.30 (95% CI 0.23-0.40) and 0.11 (95% CI 0.03-0.35) for hospitalization in the hybrid cohort versus the vaccine cohort. No death occurred in the hybrid cohort during the follow-up.

Conclusion

Hybrid immunity was associated with a lower incidence of SARS-CoV-2 infection and COVID-19 related hospitalisation. Hybrid immunity should be considered when stratifying the risk of SARS-CoV-2 infection and progression to severe COVID-19 in immunocompromised individuals, in order to better adjust immunosuppression, guide booster policies and prioritize outpatient treatments.
#1016 Kidney transplantation in highly sensitized patients with preformed donor-specific antibodies through personalized delisting strategies
Authors: Trujillo Hernando , Mancebo Esther , Monte Esther González , Polanco Natalia , García Sandra Sandra , Paz-Artal Estela , Andrés Amado
Published: May 2024

Background and Aims

This study explores a personalized delisting strategy enabling kidney transplantation in highly sensitized patients with preformed donor-specific anti-HLA antibodies (DSA) trying to minimize the risk of antibody-mediated rejection (ABMR).

Method

Retrospective single-centre analysis of 50 kidney transplant recipients with preformed DSA (preDSA) after employing a delisting strategy to enhance their access to transplantation, and without received a pre-transplant or immediate post-transplant desensitization protocol. The delisting approach focused on allowing less deleterious antibodies according to their mean fluorescence intensity (MFI), anti-HLA class and C1q study results. The strategy consisted on eliminating as prohibited HLA antigens those recognized by antibodies with the lowest MFI in the following order: 1st- MFI < 5000; 2nd- MFI < 10000; 3rd-Any MFI. Additionally, delisting prioritized a single locus in the following order: 1st- one of the HLA class I loci (A, B, or Cw); 2nd- the rest of the class I loci; 3rd- HLA-DP, followed by DR. C1q studies were performed before delisting and transplantation was contraindicated in the presence of DSA detected in the C1q assay. Two comparative cohorts included 50 sensitized recipients without pre-transplant DSA (SwoDSA) and 50 non-sensitized recipients (NS).

Results

The delisting strategy allowed transplantation with preformed DSA and demonstrated comparable rejection rates to SwoDSA and NS groups (16%, 14% and 8%, respectively; log-rank = 0.28). However, the occurrence of acute ABMR was 12% in the preDSA group, significantly higher than in SwoDSA (1%) and NS (0%) (log-rank = 0.0093). The immunological risk assumed in delisting correlated with ABMR incidence (patients with ABMR had significantly higher sum MFI [mean ± SD: 9301 ± 6340 vs 4492 ± 5641; p = 0.049]), emphasizing the importance of tailored strategies. DSA persistence after transplantation correlated with higher MFI and increased ABMR risk. Of note, 16% of preDSA patients developed de novo DSA versus only the 4% of SwoDSA and 0% of NS patients (p = 0.004). After a mean follow-up of 3.1 ± 2.1 years, the 1-, 3- and 5-year death-censored allograft survival rates were 100%, 90% and 78%, respectively, in the preDSA group; 98%, 84% and 84% in the SwoDSA group and 100% in NS group (log-rank = 0.02).

Conclusion

The present study demonstrates the feasibility and acceptable outcomes of kidney transplantation in highly sensitized patients with preformed DSA through a personalized delisting strategy without using desensitization protocols.
#2677 A propensity score-matched analysis of kidney replacement therapy outcomes for older adults stratified by frailty severity
Authors: Pontula Arya , Moore Louise R , Nixon Andrew C
Published: May 2024

Background and Aims

Older people living with frailty who receive kidney replacement therapy (KRT) experience higher mortality and hospital readmission compared to their non-frail counterparts [1–3]. Shared decision making with older people regarding the optimal KRT modality (haemodialysis [HD], peritoneal dialysis [PD], or kidney transplant [TX]) can present challenges due to the lack of research comparing KRT modalities stratified by frailty severity. The Hospital Frailty Risk Score (HFRS), which uses routinely collected clinical data to categorise frailty severity, has been shown to predict outcomes in advanced chronic kidney disease (CKD) [4]. However, the HFRS has not been used to compare outcomes across KRT modalities. This single-centre project aims to explore outcomes between KRT modalities for older people stratified by HFRS frailty severity.

Method

Adults aged 60 years or older starting KRT at our institution between December 2012 and January 2022 were included. HFRS was calculated at first estimated glomerular filtration rate (eGFR) result below 15 mL/min/1.73 m2 and at start of KRT. Patients were stratified by KRT modality and their frailty severity (categorized as low, intermediate, or high according to their HFRS score). TX patients were then matched to 1:2 to HD patients and 1:1 to PD patients, based on patient age, HFRS category, and Charlson Comorbidity Index (CCI) at KRT start. Outcomes of interest were hospital readmission and mortality, both overall and within 1 year of KRT initiation. Descriptive statistics compared HD, PD, and TX groups.

Results

Twenty TX, 20 PD, and 40 HD matched patients were included. Age (HD vs PD vs TX: 68.5 vs 67.6 vs 68.3 years, p = 0.50), proportion of males (57.5% vs 70.0% vs 55.0%, p = 0.66), and CCI (15.0 vs 13.0 vs 13.0, p = 0.95) were similar between cohorts. Frailty, as assessed by the HFRS, worsened or remained the same for most patients in all 3 cohorts between first eGFR < 15 and KRT start (81.0% vs 93.0% vs 83.0%, p = 0.61). All patients were either of low (85.0% vs 80.0% vs 85.0%) or intermediate (15.0% vs 20.0% vs 15.0%) frailty status at time of KRT start and the proportion of patients in each category did not vary with modality (p = 0.92).

Re-hospitalization within 1 year of starting KRT was similar between groups (32.5% vs 25.0% vs 10.0%, p = 0.12). Kaplan-Meier survival analyses also demonstrated similar survival among groups at 1 year (75.0% vs 95.0% vs 90.0%, log-rank p = 0.09), but better survival among TX patients overall (0.0% vs 66.1% vs 79.4%, log-rank p = 0.02). Overall and 1 year Kaplan-Meier survival for patients stratified by KRT modality and HFRS are shown in Fig. 1.

Conclusion

TX may optimize longer term survival for older people with low and intermediate frailty status and kidney failure. Furthermore, the HFRS appears to be a useful prognostic tool that could inform shared decision making with older patients regarding KRT modality choice.