bluuebunny/crossref_metadata_2025 huggingface dataset:
P1463EARLY VASCULAR ACCESS CREATION IS NOT ASSOCIATED WITH BETTER OUTCOME IN PATIENTS AFTER CHRONIC DIALYSIS INITIATION
Authors: Iwata Yukimasa , Okushima Hiroki , Takatsuka Taisuke , Yoshimura Daisuke , Kawamura Tomohiro , Ueda Yoshiyasu , Shoji Tatsuya , Hayashi Terumasa
Published: June 2020

Background and Aims

Although initiation of chronic hemodialysis with central venous catheters are associated with higher mortality compared to that with arteriovenous fistula, the association between the timing of vascular access (VA) creation and outcome after dialysis initiation is not fully investigated. Thus, we conducted single center retrospective cohort study on incident hemodialysis patients to investigate the effect of VA types and timing of VA creation on all-cause and cardiovascular mortality after dialysis initiation.

Method

A total of 1052 patients with accurate clinical data and outcomes was extracted from 1069 patients who started chronic hemodialysis treatment at Osaka General Medical Center between 2006 and 2015. Clinical status at dialysis initiation, all-cause and cardiovascular mortality were compared by three patient groups categorized by VA types and timing of VA creation: temporary catheter (TC) group, dialysis initiation with TC; early VA (EVA) group, dialysis was initiated more than one month after VA creation; late VA (LVA) group, dialysis was initiated within one month after VA creation. Cox proportional hazards analysis was used to examine predictive factors for outcomes.

Results

Median age was 70 years and 64% of patients were male. Patient number of each group was 285 (27%), 441 (42%), and 326 (31%) for TC, EVA, and LVA groups, respectively. Although there was no significant difference in eGFR at dialysis initiation among three groups ([median] 5.4 vs. 5.4 vs. 5.4 mL/min/1.73m2, respectively, P=0.881), hemoglobin and albumin were lower in TC group compared to EVA and LVA groups (hemoglobin [median] 8.3 vs. 9.5 vs. 8.9 g/dL, respectively, P<0.001; albumin [median], 3.0 vs. 3.5 vs. 3.2 g/dL, respectively, P<0.001). Kaplan-Meier curves revealed significant difference among three groups for all-cause (P<0.001) and cardiovascular mortality (P<0.001). On multivariate Cox proportional hazards analysis, timing of VA creation was not associated with all-cause and cardiovascular mortality. Although temporary catheter usage at dialysis initiation was significantly associated with all-cause mortality (HR, 1.91; 95%CI, 1.30-2.83; P=0.001), it was not associated with cardiovascular mortality (HR, 1.64; 95%CI, 0.79-3.43; P=0.186).

Conclusion

Timing of VA creation was not associated with all-cause and cardiovascular mortality, whereas hemodialysis initiation with TC was significantly associated with increased all-cause mortality.
P1463AMORTALITY AND HOSPITALIZATION PATTERNS IN ELDERLY HEMODIALYSIS PATIENTS. A LARGE SAUDI STUDY
Authors: Moussa Ayman , Abderrahim Ezzedine , Dridi Afef , Jubran Ibrahim , Alobaili Saad , Alahmadi Salwa , Albadr Wisam
Published: June 2020

Background and Aims

The aim of the study was to analyze hospitalization and mortality parameters in Saudi elderly patients undergoing hemodialysis for end stage renal disease.

Method

The study population included all patients admitted at Davita-KSA clinics to continue renal replacement by hemodialysis during the period October 2014-December 2018. Two groups were identified according to age at admission to Davita clinics: Group 1 (age>=65 years), Group 2 (age<65 years). Zero time data, including demographic and clinical characteristics were recorded at admission. Also, all deaths and morbid events necessitating hospital admission were regularly recorded during the follow-up period.

Annual mortality and hospitalization rates with the corresponding confident intervals were calculated as appropriate. Survival rates were calculated according to actuarial method logistic regression was used to identify factors influencing hospitalization and mortality.

Results

Elderly patients represented 23.84% of 3508 included patients (G1),). The sex ratio was of 1.07 Vs. 1.21 in control group (NS). ESRD was attributed to diabetes in 52.7% of elderly patients Vs. 36.3% in others (<0.0001). The median duration of HD before joining Davita-clinics was of 6.5 months in G1 Vs. 11.5 months in G2 (p<0.0001). There is no significant difference between the 2 groups regarding vascular access type, BMI and hemoglobin rate.

The proportion of patients who were hospitalized was of 30.8% in G1 Vs. 24.6% in G2 (p<0.0006) corresponding to an annual rate of 37.33% (CI, 95%: [33.93-40.73]) in G1 Vs. 25.64 (CI, 95%: [24.14-27.15]) in G2. The annual rate of hospital stay was of 4.38 days per patient in G1 (CI, 95%: [4.26-4.49]) Vs. 3.11 in G2 (CI, 95%: [3.06-3.16]). The annual mortality rate was 13.36% in G1 (CI, 95%: [11.32-15.38]) Vs. 5.33% in G2 (CI, 95%: [4.64-6.01]). Survival rates in Group 2 were of 98.6, 95.4, 90.5 and 78.6% at 3, 12, 24 and 48 months respectively Vs. 96.1, 89.3, 78.8 and 55.8% in G1 (p<0.0001).

Adjusted hospitalization and mortality risks were of 1.271 (CI, 95%: [1.065-1.516]; p<0.008) and 2.257 (CI, 95%: [1.794-2.841]; p<0.0001) in elderly patients compared to other patients.

Conclusion

Our study demonstrated that Saudi elderly hemodialysis patients remain a group at high risk for hospitalization and mortality.
P1464ROUTINELY MEASURED CARDIAC TROPONIN I AND NT-PROBNP AS PREDICTORS OF MORTALITY IN JAPANESE HEMOLIALYSIS PATIENTS: THE DIALYSIS OUTCOMES AND PRACTICE PATTERNS STUDY
Authors: Eriguchi Masahiro , Tsuruya Kazuhiko , Lopes Marcelo , Bieber Brian , McCullough K P , Pecoits-Filho Roberto , Robinson Bruce , Pisoni Ronald , Kanda Eiichiro , Iseki Kunitoshi , Hirakata Hideki
Published: June 2020

Background and Aims

Due to the interplay of chronic kidney disease and the heart, it is common for myocardial damage and strain to be present in patients with end stage kidney disease. The cardiac biomarkers Troponin I (cTnI) and the N-terminal fragment of prohormone brain natriuretic peptide (NT-proBNP) are strongly predictive of heart failure in the general population, however the value of their routine measurement for stratification of risk in hemodialysis (HD) patients is unknown. International DOPPS data indicate that these cardiac biomarkers are measured in fewer than 2% of hemodialysis patients in real-world practice. We sought to test the associations of cTNI and NT-proBNP with death in a large HD cohort.

Method

We analyzed data from 1169 prevalent Japanese hemodialysis patients in DOPPS phase 5 (J-DOPPS; 2012-2015) where pre-dialysis levels of cTnI and NT-proBNP at study enrollment by protocol for all participants. We used Cox regression to test the association of the cardiac biomarkers with all-cause mortality, adjusting for potential confounders. We conducted stratified analyses to assess potential effect modification of individual clinical characteristics: age, systolic blood pressure, dialysis vintage, diabetes mellitus, cardiovascular disease, and heart failure (CHF).

Results

Median (interquartile range) cTnI and NT-proBNP levels were 0.018 [0.005, 0.04] ng/mL and 3432 [1580, 8017] pg/mL, respectively. There was a positive direct association between cTNI and NT-proBNP (Spearman correlation coefficient=0.58). We observed 174 deaths during a median [IQR] follow-up time of 2.8 [2.3, 2.9] years. Compared to the reference group of cTNI<0.01 the hazard ratio (HR) of death (95% CI) was 1.23 (0.57, 2.69) for cTNI ≥0.01 to 0.02; HR=1.94 (1.12, 3.37) for cTNI ≥0.02 to 0.04; and HR=3.65 (2.14, 6.23) forcTNI>0.04. Compared to the reference group of NT-proBNP <2000 pg/mL, HR= 1.20 (0.65, 2.23) for NT-proBNP ≥2000 to 4000 pg/mL; HR= 2.06 (1.22, 3.46) for NT-proBNP >4000 to 8000 pg/mL; and 3.23 (1.71, 6.09) for NT-proBNP > 8000pg/mL. For both variables associations with mortality were comparable in patients with and without heart failure (p values for interaction=0.07 and 0.19, for NT-proBNP and cTNI, respectively) and according to other stratification variables (the p values for interaction were >0.15 for all other stratified models).

Conclusion

Routinely measured (not by indication) NT-proBNP and Troponin I are strongly associated with mortality among prevalent Japanese HD patients. Routine evaluation of these cardiac biomarkers in HD patients with or without a previous diagnosis of CHF may help identify patients at risk of death who may have undetected heart failure or cardiac strain due to fluid overload.
P1468ASSESSING THE BURDEN OF CHRONIC PAIN IN PATIENTS UNDERGOING HAEMODIALYSIS: A CROSS-SECTIONAL OBSERVATIONAL STUDY
Authors: Bell Samira , Lambourg Emilie , Guthrie Greg , Murugan Krithi , Colvin Lesley , Traynor Jamie P
Published: June 2020

Background and Aims

Chronic pain is a global health problem estimated to affect between 20- 50% of the population and is associated with increased hospitalisations placing a significant burden on healthcare resources. The burden of chronic pain is thought to be especially high in patients undergoing renal replacement due to underlying co-morbidities such as diabetes, peripheral vascular disease and renal bone disease. There is, however, a lack of data out with the United States quantifying the burden in patients undergoing chronic dialysis. The aim of this study was to establish the burden of chronic pain through examination of prescribing records in patients undergoing chronic dialysis.

Method

We performed a cross sectional observational study in 2 Scottish health boards (together serving 1.9 of Scotland’s 5 million population). Data were collated on age, dialysis vintage, primary renal diagnosis and analgesia prescribing specifically examining whether patients were prescribed paracetamol, non-steroidal anti-inflammatory agents, opioids or gabapentinoids. Descriptive statistics were performed.

Results

721 patients receiving haemodialysis were included in the analysis (141 from the Tayside area and 580 from Greater Glasgow and Clyde). Mean age was 64 years old (SD 14.4) with a median time since commencing renal replacement therapy of 3 years (IQR 1.4-6.4). The primary renal diagnosis was diabetes for 28% of the patients, multisystem diseases for 21.6%, interstitial nephropathies for 21.5%, primary glomerulonephritis for 15.8%, and unknown or related to another disease for 10%. Of these 527 (73%) were prescribed a form of analgesia. 404 patients (56%) were prescribed paracetamol, 14 (1.9%) were prescribed a non-steroidal anti-inflammatory, 96 (35.4%) an opioid, 71 (9.8%) a combination of paracetamol with opioid, 170 (23.6%) a gabapentinoid and 100 (14%) were prescribed both a gabapentinoid and opioid. There was no difference in age between those receiving analgesia and those who were not (63.5 vs 65.2, p=0.13). However patients receiving opioids were significantly younger than those who were not prescribed any opioid (62.2 SD 13.9 vs 65 SD 14.5, p-value = 0.001; Wilcoxon rank sum test). There was no difference in percentage of patients receiving analgesia by primary renal diagnosis: Figure 1 (Chi-square test, p=0.1).

Conclusion

Prescribing rates of analgesia are high in patients undergoing chronic dialysis suggesting a high burden of chronic pain.

Number of patients receiving analgesia (in red) or not (in blue), depending on their primary renal diagnosis. 1=primary glomerulonephritis, 2=interstitial nephropathies, 3=multisystem diseases, 4=diabetic nephropathy, 5=not known or other
P1475THE THRESHOLD OF BECK DEPRESSION INVENTORY SCORE AS A POTENTIAL PREDICTOR OF ALL-CAUSE MORTALITY IN END-STAGE RENAL DISEASE PATIENTS WITH DIALYSIS IN CHINA
Authors: Liu Bo , Fu Sha , Liang Peifen , Li Jiajia , Han Qianqian , Yang Qiongqiong
Published: June 2020

Background and Aims

Depression is the most frequent psychologic problem among end-stage renal disease (ESRD) patients with dialysis. The Beck Depression Inventory (BDI) is considered to be the standard instrument for assessing symptoms of depression and screening for clinical depression. The level of BDI score associated with mortality in ESRD patients with dialysis remains controversial. High quality evidence is lacking, especially in China. The aim of our study is to evaluate the threshold of BDI score as a potential predictor of all-cause mortality in ESRD patients with dialysis in China.

Method

We conducted a retrospective cohort study involving adults who were treated with dialysis in the department of nephrology of Sun Yat-sen Memorial Hospital in Guangzhou, China between April 2006 to July 2017. Depression symptoms, sleep quality, health-related quality of life were assessed via the BDI- = 2 \* ROMAN \* MERGEFORMAT II, the Pittsburgh Sleep Quality Index (PSQI) and the 36-item Short Form Health Survey Questionnaire (SF-36) respectively. The primary endpoint of interest was all-cause mortality. Cox proportional hazards regression analysis was performed.

Results

109 dialysis patients with an mean age of 50.2 years provided complete responses to the BDI-II questionnaire. The median follow-up time for the cohort was 68.6 months until Dec 1, 2019. There were 21 deaths (19.3%). Univariate analyses indicated that age (RR=1.039, 95% CI 1.002, 1.076, P =0.039), PSQI score (RR=1.170, 95% CI 1.047, 1.306, P =0.005), pre-existent cardiovascular disease (RR=3.223, 95% CI 1.310, 7.932, P =0.011), pre-existent diabetes mellitus (DM) (RR=3.321, 95% CI 1.393, 7.919, P =0.007), and BDI score ≧17 (RR=4.247, 95% CI 1.730, 10.429, P =0.002) were significantly associated with an increased risk for all-cause mortality, while physical component summary (PCS) of SF-36 (RR=0.971, 95% CI 0.950, 0.992, P =0.007) and mental component summary (MCS) of SF-36 (RR=0.968, 95% CI 0.948, 0.988, P =0.002) with a decreased risk for all-cause mortality. In the multivariate Cox regression model, DM (RR=3.658, 95% CI 1.532, 8.733, P =0.003) and BDI score ≧17 (RR=4.454, 95% CI 1.808,10.974, P =0.001) were independent predictors of all-cause mortality.

Conclusion

This study revealed that BDI score ≧17 was a predictor of all-cause mortality in ESRD patients with dialysis. Further prospective trials will be required to determine whether the treatment of depression in dialysis patients would alter health-related outcomes, including survival.
P1477EFFECT OF INTRADIALYTIC EXERCISE IN A MEXICAN MAINTENANCE HEMODIALYSIS POPULATION
Authors: Chavez-Mendoza Carlos , MANZO-ARELLANO LUIS IGNACIO , SANTILLÁN-CERÓN AIRY , CASTILLO-JUÁREZ SAGRARIO , RAMÍREZ-SALGADO CÉSAR ULISES , RODRÍGUEZ-GARCÍA ADÁN
Published: June 2020

Background and Aims

The use of intradialytic exercise has been associated with improved clearance, oxygen consumption, quality of life, and physical performance. The aim of this study was to describe the association between of intradialytic exercise and some outcomes in a Mexican maintenance hemodialysis (HD) population.

Method

Observational comparative study that included 84 maintenance HD patients from one HD center in Mexico City. The population was grouped according to the intradialytic exercise local record. The aerobic intradialytic exercise protocol includes cycling for 30-45 min during the first 2 hours of the HD according to each patient’s ability. A retrospective registry of clinical and biochemical parameters was realized. Also, the hemodynamic parameters of the last six HD sessions for each patient was included. Data analysis was carried out through descriptive and inferential statistics.

Results

Of the total population, 45.2% were men (n= 38) and the mean age was 53.6 + 17 years. Fifty one percent (n= 43) had diabetes mellitus (DM), which resulted more prevalent in the subgroup of patients without intradialytic exercise (p=0.03) No differences between groups were present in age, history of previous peritoneal dialysis or kidney transplant. The rest of baseline data are shown in Table 1. The subgroup of patients who underwent intradialytic exercise presented higher levels of serum albumin (p=0.03) and lower levels of parathormone (p=0.03). A total of 504 HD sessions were analysed and intradialytic exercise was performed in 64.3% (n=324). Patients in the intradialytic exercise program presented high levels of systolic and diastolic blood pressure (graphic 1). Intradialytic hypotension occurred in 5.2% (n=26) and no differences are shown between groups (p=0.78). No mayor side effects were reported.

Conclusion

The intradialytic exercise could improve nutritional and bone-mineral status markers. The patients in an intradialytic exercise program presented higher levels of blood pressure.
P1479HIGHER FREQUENCY OF FRUIT INTAKE IS ASSOCIATED WITH LOWER RISK OF CONSTIPATION IN HEMODIALYSIS PATIENTS - A MULTI-CENTRE STUDY
Authors: Dos Santos Rafaela G , Malinovski Juliana , Scatone Natália , De Oliveira Jorgiane , Sczip Andrea , Moraes Jyana , NERBASS FABIANA
Published: June 2020

Background and Aims

Constipation is a multifactorial gastrointestinal disorder commonly found in hemodialysis (HD) patients. In this multi-centre cross-sectional study, we aimed to evaluate the prevalence and factors associated with constipation, including the frequency of dietary fiber sources intake.

Method

Prevalent HD patients from four dialysis clinics in Southern Brazil were invited to participate (at least 80% of eligible patients from each clinic). Patients were interviewed by the researchers and answered a questionnaire that comprised ROMA III criteria questions to assess constipation status, use of medications and life habits. A food frequency questionnaire (FFQ) with the main dietary fiber sources (fruits, vegetables, legumes, whole grains cereals and seeds) was applied with seven frequency possibilities (from never to more than twice a day). To estimate the weekly frequency of intake, answers were transformed into a score. Every score point corresponded to one time per week (ex.: score 7 = seven times per week). Demographical and laboratory data were obtained from medical records. Univariate analysis was used to compare participants according to constipation status and variables with P<0.20 were included in the regression analysis model.

Results

305 HD patients were included (male: 51%; age: 52.2 ± 14.7 years old; HD vintage: 46 (19 – 82) months). Ninety-three participants had constipation (30.5%). Median (interquartile) FFQ scores were: fruits: 6 (2-14); vegetables: 6 (3-10); legumes: 3 (1-7); whole-grain: 0 (0-1) and seeds: 0 (0-0). In univariate analysis, participants with constipation were significantly older (55.1 ± 14.8 versus 51.0 ± 14.5 years old; P=0.02), had lower literacy (5 (5-11) versus 8 (4-13) years at school; P=0.007), higher prevalence of diabetes (41 versus 23%; P=0.002) and lower total beverage intake (15 (12-20) versus 17 (12-24) ml/kg/day; P=0.04). The logistic regression analysis model also included body mass index; wheelchair need; sedentarism; fruits score and seeds score (all with P<0.20 in the univariate analysis).The independent predictors of constipation were diabetes (OR=1.96 (95%IC 1.07-3.6);P=0.03) and fruits intake score (OR=0.95 (95%IC 0.91-0.99);P=0.04)

Conclusion

Almost one-third of participants had constipation, and usual intake of fiber food sources was low. The independent determinants of constipation were diabetes and a lower frequency of fruit intake. Nutritional counselling to increase fiber intake sources can potentially decrease the prevalence of constipation of this population.
P1484PROGRESSION OF AORTIC ARCH CALCIFICATION IS ASSOCIATED WITH OVERALL AND CARDIOVASCULAR MORTALITY IN HEMODIALYSIS
Authors: Chen Hung-Chun , Chiu Yi-Wen , Chang Jer-Ming , Chen Szu-Chia
Published: June 2020

Background and Aims

Vascular calcification is common and associated with unfavorable outcomes among patients with end-stage renal disease (ESRD). However, little is known whether the progression of vascular calcification outweights the baseline calcification in association with overall and cardiovascular (CV) mortality in hemodialysis (HD) patients.

Method

This study included 140 maintenance HD patients. Vascular calcification was assessed using aortic arch calcification (AoAC) score measured from chest radiographs at the baseline and the second year of follow-up. Progression of vascular calcification (△AoAC) was defined as the difference between the two measurements of AoAC. The association of △AoAC with overall and CV mortality was evaluated using multivariable Cox regression analysis.

Results

During the mean follow-up period of 7.8 years, there were 49 (35%) overall mortality and 27 (19.3%) CV mortality. High brachial-ankle pulse wave velocity was positively correlated with △AoAC, whereas old age and high hemoglobin were negatively correlated with △AoAC. In multivariate adjusted Cox analysis, increased △AoAC (per 1 unit), but not baseline AoAC, was significantly associated with overall mortality (HR, 1.183; 95% CI, 1.056–1.327; p = 0.004) and CV mortality (HR, 1.194; 95% CI, 1.019–1.398; p = 0.028).

Conclusion

Progression of AoAC outperformed the baseline AoAC in association with increased risk of overall and CV mortality in HD patients. Regular follow-up of chest radiograph and AoAC score assessments are simple and cost-effective to identify the high-risk individuals of unfavorable outcomes in maintenance HD patients.
P1487EFFECT OF PREDIALYSIS FLUID OVERLOAD ON SLEEP QUALITY IN HEMODIALYSIS PATIENTS
Authors: Ismail Haitham , Abdallah Hussein , Emara Ahmed , Ahmed Mohamed Arafa
Published: June 2020

Background and Aims

Sleep disorders are common among end stage renal disease (ESRD)patients undergoing hemodialysis (HD). The etiology of sleep disorders in these patients is known to be multifactorial. However, the role of hydration status in sleep disorders in HD patients is not well studied. Therefore, our aim was to study the effect of predialysis fluid overload on sleep quality in HD patients.

Methods

This cross-sectional study included 100 prevalent HD patients from HD unit of El Sahel teaching hospital. fluid status and fluid compartments [total body water (TBW)], extracellular water (ECW)] and overhydration index (OH) were analyzed by a portable whole-body bio-impedance spectroscopy (Body Composition Monitor ‘BCM’) before mid-week dialysis session. Overhydration was defined as OH/ECW ≥15%. HD patients were then classified into 2 groups: Group 1 (non- overhydrated) and Group 2 (Overhydrated) according to OH/ECW. Sleep quality were assessed in all patients by Pittsburgh Sleep Quality Index (PSQI) questionnaire. Patients with Concurrent diagnosis of either obstructive sleep Apnea or psychiatric disorder and patients on any medications which affect the sleep pattern were excluded.

Results

our study included 100 HD patients (49 male, 51 female - mean age 49.3 ±11). 42 patients (42%) had overhydration (i.e. Group 2). Poor sleep quality (defined as PSQI score ≥5) was reported in 57% (n=57) of HD patients included in our study. Poor sleep quality was significantly higher in the HD patients with overhydrated (Group 2). Total PSQI scores were significantly higher in overhydrated patients (Group2) compared to non-overhydrated patients (Group1) (7.92±3.32 vs 4.83±2.27, P= <0.001). The component scores 1, 2, 3, 4, 6 and 7 of the PSQI showed significant differences between the overhydration and non-overhydration groups with higher values (i.e poor sleep quality) in overhydrated patients (Group2). Moreover, there was significant positive correlation between total PSQI score and overhydration index (OH/ECW %) in all HD patients included in the study (r=0.283, P= 0.004).

Conclusion

We may conclude from our study that sleep disorders are prevalent in HD patients. Predialysis fluid overload in HD patients may be associated significantly with poor sleep quality.
P1493CORRELATION BETWEEN END-DIALYSIS OVER-WEIGHT IN INITIAL STAGE OF HEMODIALYSIS AND PROGNOSIS IN INCIDENT HEMODIALYSIS PATIENTS
Authors: Zhang Ping , Wang Ying , Yao Xi , Chen Shaohua , Xu Chunping , Lu Hulin , Chen Jianghua
Published: June 2020

Background and Aims

The volume factor of maintenance hemodialysis patients is closely related to the prognosis. We hypothesized that the excess weight after dialysis (end-dialysis over-weight, edOW) is an important factor of volume impact survival in hemodialysis (HD) patients. The purpose of this study was to analyze the relationship between edOW and long-term prognosis of patients with maintenance hemodialysis.

Method

This retrospective study observed incident hemodialysis patients who treated in Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University from January 1, 2008 to April 30, 2017, three times a week for at least one year. The end point of follow-up was death, abdominal dialysis, kidney transplantation, transfer or until April 30, 2018. The general data of the patients included age, gender, BMI, primary renal disease, CVD, first hemodialysis access, albumin(Alb), Haemoglobin(Hb), blood pressure, heart rate, ultrafiltration rate(UFR), interdialytic weight gain IDWG, end -dialysis overweight (edOW). Cox multivariate regression was used to analyze the relationship between edow and all-cause mortality and cardiovascular mortality.

Results

Totally 469 patients male, 64% were enrolled, with an average age of 56.9 ± 17.1 years. During the follow-up period, 102 patients died. The main cause of death was cardiovascular and cerebrovascular events, accounting for 44.7%. The mean value of edow was 0.28 ± 0.02 kg. Kaplan-Meier(Log-rank test) survival analysis showed that the long-term survival rate of the group with edow ≤ 0.28kg was better than that of the group with edow > 0.28kg (P = 0.042), and the cardiovascular mortality of the group with edow > 0.28kg was significantly higher than that of the group with edow ≤ 0.28kg (P = 0.001). Cox multivariate regression analysis showed that edow was an independent risk factor for all-cause death in hemodialysis patients (P = 0.025, AhR = 1.541, 95% CI 1.057-2.249), and also an independent risk factor for CVD death in hemodialysis patients (P = 0.007, AhR = 1.929, 95% CI 1.198-3.107).

Conclusion

EdOW is an independent risk factor of long-term all-cause and cardiovascular death in hemodialysis patients.
P1495LOW DIASTOLIC BLOOD PRESURE WITH LOW MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION WOULD DETERIORATE CARDIOVASCULAR MORTALITY IN THE PATIENTS WITH MAINTENANCE HEMODIALYSIS
Authors: OMAE KIYOTSUGU , Horimoto Ai , Higuchi Chieko , Hosoda Yumi , Tamura Tomomi , Nishizawa Yoko , Ogawa Tetsuya
Published: June 2020

Background and Aims

In dialysis patients, many literatures have shown the association between predialytic hypotension and poor prognosis. Particularly, decrease in diastolic blood pressure (DBP) will be involved myocardial injury because of reduced coronary blood-flow. Such myocardial damage would also be caused by decreased oxygen-supply capacity. Mean corpuscuar hemoglobin-concentration (MCHC) is a hemoglobin concentration per 1% hematocrit (Ht) and could be considered as an indicator of peripheral oxygen-supply. In several literatures, low MCHC had been associated with increased all-cause mortality in non-dialysis patients with congestive heart-failure. In dialysis patients with low Ht between 32 to 35%, low DBP and low MCHC could additively act on myocardial damage. In this study, we examined the relation between the stratified groups by DBP and MCHC and cardiovascular mortality using Yoshikawa clinic dialysis-database (YCD).

Method

A total of 407 dialysis patients registered in YCD enrolled in this study from April 2006 and on. The cut-off values (COVs) of predialytic DBP and MCHC on cardiovascular death (CVD) were determined from the Receiver Operating Characteristic (ROC) curve. According to these COVs, the whole cohort was divided into 4 groups, group HH (high DBP and high MCHC), group HL (high DBP and low MCHC), group LH (low DBP and high MCHC), and group LL (low DBP and low MCHC). Their survival analysis was estimated by the Kaplan–Meier method, and a log-rank test was used to examine the differences between the survival curves. The prognostic factors for CVD were extracted from background factors, including predialytic DBP, MCHC and above-mentioned grouping, using Cox-regression model.

Results

In 407 patients, mean predialytic DBP and time-averaged MCHC were 73.3 mmHg and 31.5 % respectively. During observation period of 5.1 years 163 patients died, among that 94 were CVD. The COVs of DBP and MCHC were 79 mmHg and 31.16 %, respectively. According to these COVs, 407 patients were divided into 64 of group HH, 65 of group HL, 171 of group LH and 107 patients of group LL. On the survival curve, the group LL had the highest mortality rate, followed by the group HL. The group HH showed the lowest mortality rate. In multivariate analysis, category variables LL and HL were extracted as prognostic factors for CVD. Their Hazard ratio were 1.960 and 3.863, respectively. Age, intradialytic hypotension, DBP, Kt/V, serum sodium, CRP and blood glucose were extracted as the other prognostic factors.

Conclusion

These results suggest that low MCHC level would deteriorate prognosis on dialysis patients with predialytic low-DBP. MCHC level could become a new treatment-target in the low DBP group in the future.
P1496TRENDS IN THE INCIDENCE AND PREVALENCE OF END-STAGE RENAL DISEASE PATIENTS WITH HEMODIALYSIS IN ENTIRE KOREAN POPULATION: A NATIONWIDE POPULATION-BASED STUDY
Authors: Choi Hong Sang , Kim Chang Seong , Bae Eun hui , Ma Seong Kwon , Kim Soo Wan
Published: June 2020

Background and Aims

Data on the epidemiology and temporal trends of end-stage renal disease (ESRD) with hemodialysis are not well established in the entire Korean population. We aimed to estimate the incidence and prevalence of ESRD with hemodialysis in Korea between 2002 and 2017.

Method

Using the National Health Insurance Service database, we analyzed entire Korean population from 2002 to 2017. Hemodialysis patients was identified by using rare incurable disease codes (V001) or prescription of medical fee code of hemodialysis (O7020, O7021). We only included patients who have been maintained hemodialysis more than 90 days from the date of dialysis initiation to exclude short-term dialysis due to acute kidney injury or patients who converted to peritoneal dialysis or kidney transplantation.

Results

During the 16-year follow-up, the number of hemodialysis patients in Korea has steadily increased from 11,251 in 2002 to 67,486 in 2017. The mean age of hemodialysis patients has gradually increased from 55.57±13.31 years in 2002 to 62.13±13.23 years in 2017. Overall, the number of men tended to be somewhat higher than that of women, and the proportion of men increased slightly from 55.56% in 2002 to 58.45% in 2017. The proportion of diabetic patients increased rapidly from 23.84% to 47.84%, and the percentage of hyperlipidemic patients rose from 18.9% to 86.7%, while the percentage of hypertensive patients did not show a significant increase. The number of incident hemodialysis patients increased significantly from 4,406 in 2003 to 12,134 in 2014 and then decreased to 8,090 in 2017. In the incident patients, the increase in the proportion of male patients and the increase in diabetes and hyperlipidemia were observed in similar manner with prevalent patients.

Conclusion

The incidence and prevalence of hemodialysis in Korea gradually increased from 2002 to 2017. The proportion of men, diabetes and hyperlipidemia among patients with hemodialysis also increased continuously. These findings may contribute as groundwork for epidemiological studies of hemodialysis in Korea.
P1498ASSOCIATIONS OF HEALTH LITERACY WITH DEPRESSION AND ANXIETY IN DIALYSED PATIENTS IN SLOVAKIA
Authors: Skoumalová Ivana , Rosenberger Jaroslav , Madarasova Geckova Andrea
Published: June 2020

Background and Aims

Depression and anxiety is common in dialysed patients (Ng et al., 2015; de Brito et al., 2019) and associated with decreased quality of life, worse health outcomes and increased mortality (Schouten et al., 2019, Lopes at al., 2002). Health literacy (HL) as the ability to gain access, understand, and use information to promote and maintain good health (WHO, 1998) may be hampered by emotional problems such as depression and anxiety. The aim of our study is to examine the association of HL with depression and anxiety in dialysed patients in Slovakia.

Method

Cross-sectional study on 542 dialysed patients (mean age = 63.6, males = 60.7%) was conducted in 20 dialysis clinics in Slovakia from January to November 2018. Socio-demographic data, data on 9 domains of HL and data on depression and anxiety were collected by questionnaires. Hierarchical cluster analysis was used to create three clusters of patients (low, moderate, high HL). Depression and anxiety was dichotomized as 0-no/low symptoms and 1-moderate/severe symptoms. Association of HL clusters with depression and anxiety was analysed using logistic regression adjusted for age and gender.

Results

We found that patients in low HL cluster and moderate HL cluster were more likely to have moderate/severe symptoms of depression and anxiety than patients in high HL cluster. Odds ratio (OR) for depression for low HL cluster: 7.60; 95% Confidence Interval (CI): 2.88 – 20.06; p<0.000 and for moderate HL cluster: OR: 4.85; 95% CI: 1.87 – 12.56; p<0.001. OR for anxiety for low HL cluster: 3.14; 95% CI:1.55 – 6.35; p<0.001 and for moderate HL cluster: OR 2.16;95% CI: 1.10 – 4.24; p<0.05.

Conclusion

Patients with lower levels of HL suffer from anxiety and depression more than patients with higher levels of HL. These findings point to the need of regular screening of emotional problems such as depression and anxiety and their treatment as they may hamper capacities of dialysed patients for self-management as well as effective treatment of the disease from the perspective of healthcare providers.
P1499FGF21 CORRELATES POSITIVELY WITH ARTERIOVENOUS FISTULA OCCLUSION IN HEMODIALYSIS PATIENTS
Authors: Wei Qing , Wang Bin , Zhang Xiao liang , Liu Bicheng
Published: June 2020

Background and Aims

Arteriovenous fistula occlusion lead to insufficient dialysis, increases the probability of hemodialysis complications, even life-threatening. Fibroblast growth factor 21 (FGF21) is increased progressively with a decline of renal function and higher plasma FGF-21 level can be used as a meaningful index to evaluate microinflammation, lipid metabolism and predict dialysis-related complications such as cardiovascular diseases in end stage renal disease patients. This study aimed to investigate the relationship and role of FGF21 in arteriovenous fistula occlusion in our hemodialysis patients cohort.

Method

We screened 802 HD patients in Nanjing Zhongda Hospital (n=450) and The First People’s Hospital of Changzhou (n=352) according to a strict inclusion criteria and exclusion criteria. We recorded demographic information, blood data before dialysis and serum FGF21 levels and counted the frequency of arteriovenous fistula occlusion in our hemodialysis cohort. We used bivariate correlation analyses to assess the correlation of the frequency of arteriovenous fistula occlusion with serum FGF21 and other clinical parameters. Stepwise multivariate linear regression analyses were employed to evaluate variables independently associated with the frequency of arteriovenous fistula occlusion. P < 0.05 was considered to be statistically significant. SPSS Software, version 22.0 was used for all statistical analyses.

Results

In this cross-sectional study, of 802 hemodialysis patients screened, 76 were eligible. The median dialysis vintage was 6.4 years (range 0.5 to 23). Serum FGF21 levels were significantly positive associated with the frequency of arteriovenous fistula occlusion (r = 0.321, P = 0.005). In addition, the frequency of arteriovenous fistula occlusion was correlated with the level of hemoglobin (r = -0.277, P = 0.015), the level of albumin (r = -0.269, P = 0.019) and left ventricular mass (r = 0.272, P = 0.018). The result showed that serum FGF21 (β = 0.259, P= 0.022) and left ventricular mass (β = 0.223, P =0.048) were factors independently associated with the frequency of arteriovenous fistula occlusion in hemodialysis patients.

Conclusion

We reported for the first time that serum FGF21 and Left ventricular mass were independently associated with arteriovenous fistula occlusion. These findings provide a novel insight about FGF21 on arteriovenous fistula occlusion in hemodialysis patients and may indicate a new therapeutic target for arteriovenous fistula occlusion.

Figure 1. Correlation of serum FGF21 and LVMI with the frequency of arteriovenous fistula occlusion in HD patients.
P1503A MULTICENTER STUDY OF THE CLINICAL, LABORATORY CHARACTERISTICS AND POTENTIAL PROGNOSTIC FACTORS IN PATIENTS WITH AA AMYLOIDOSIS ON HEMODIALYSIS
Authors: Bilgic Ece , Ergün İhsan , Ecder Tevfik , Nergizoğlu Gökhan , Keven Kenan
Published: June 2020

Background and Aims

While, AL amyloidosis is more common in western countries, the most common type of amyloidosis is AA amyloidosis in eastern Mediterranean region including Turkey. Although worse prognosis has been attributed to the AL amyloidosis, AA amyloidosis can also be related to higher mortality under renal replacement therapies. However, there are no sufficient data regarding etiology, clinical presentation and prognostic factors of AA amyloidosis. The objective of our study is to evaluate the clinical, laboratory characteristics and possible predictive factors related to mortality in patients with AA amyloidosis undergoing hemodialysis (HD).

Method

This multicenter, cross-sectional study was a retrospective analysis of 2100 patients on HD and carried out in 14 selected hemodialysis centers throughout Turkey. Thirty-two patients with biopsy proven AA amyloidosis and thirty-two control patients without AA amyloidosis undergoing HD were included between October 2018 and October 2019. There was no significant difference between the groups in terms of the age and dialysis vintage. Causes of AA amyloidosis, treatment (colchicine and/or anti-interleukin 1 (IL) treatment; canakinumab or anakinra) and number of Familial Mediterranean Fever (FMF) attacks in the last year in case of FMF, systolic and diastolic blood pressures, biochemical values such as mean CRP, hemoglobin, serum albumin, phosphorus, calcium, PTH, ferritin, transferrin saturation, total cholesterol levels and EPO dose, erythropoietin resistance index (ERI), interdialytic fluid intake, body mass indexes, heparin dosage, UF volume and Kt/V data in the last year were collected by retrospective review of medical records.

Results

Prevalence of AA amyloidosis was found 1.87% in HD centers. In amyloidosis and control groups, 56% and 53% were male, mean age was 54±11 and 53±11 years, mean dialysis vintage was 104±94 and 107±95 months, respectively. FMF was the most common cause of AA amyloidosis (59.5%). All FMF patients received colchicine and the mean colchicine dose was 0,70 ±0,30 mg/day. 26,3 % of FMF patients were unresponsive to colchicine and anti-IL-1 treatment was used in these patients. In AA amyloid and control groups, ERI were 7,88±3,78 and 5,41±3,06 IU/kg/week/g/dl, respectively, (p=0.008). Additionally, higher CRP values (18,78±18,74 and 10,61±10,47 mg/L, p=0.037), lower phosphorus (4,68±0,73 mg/dL vs 5,25±1,04, p=0.014), total cholesterol (135±42 vs 174±39 mg/dL, p<0.01) and serum albumin (3,67±0,49 mg/dL, 4,03±0,22, p<0.01) were observed in patients with AA amyloidosis compared to the control group.

Conclusion

In this study, we found that long term prognostic factors including higher inflammation, malnutritional parameters and higher ERI were more frequent in AA amyloidosis patients under hemodialysis treatment.

Figure

Demographic, clinical and laboratory characteristics of patients
P1504RELATIONSHIP OF LOW BODY MASS INDEX AND SURVIVAL IN HEMODIALYSIS PATIENTS
Authors: Kim Ha Yeon , Lee Jeong Ho
Published: June 2020

Background and Aims

Malnutrition is common in patients with hemodialysis and major risk factor of mortality. The Korean Society of Nephrology (KSN) collected data of end-stage renal disease registry since 1985. We evaluated whether body mass index (BMI) can affect mortality in patient with hemodialysis.

Method

From 2004 to 2015, a total of 32,163 patients starting hemodialysis were included. The patients were divide four groups according quartiles of BMI measurement.

Results

At baseline, mean age was 59.0 ± 14.3 years old, and 60.0% were men. The 5-year mortality of hemodialysis patients was 16.9 % (N=5,435) and ratio of unknown state was 24.9 % (N=7,996). The mean of BMI in each quartiles were 18.2 ± 1.2, 20.8 ± 0.5 22.8 ± 0.6, 26.4 ± 2.6 kg/m2 respectively. The mean of BMI between survivor and non-survivor were different (22.3 ± 3.3 vs. 21.5 ± 3.2 kg/m2). Cox-proportional regression multivariate analysis revealed that the 5-year all-cause mortality was associated with age (HR 1.04, CI 1.03-1.05), diabetes (HR 1.34, CI 1.07-1.7) coronary heart disease or heart failure (HR 1.3, CI 0.9-1.7), 2nd BMI quartile (HR 0.7, CI 0.5-0.9), 3rd BMI quartile (HR 0.6, CI 0.46-0.88), 4th BMI quartile (HR 0.59, CI 0.43-0.82), hypoalbuminemia (HR 2.9, CI 2.3-3.7) and anemia (HR 1.6, CI 1.2-2.0) .

Conclusion

Higher quartiles of BMI was significantly associated with better survival rate in hemodialysis patients in Korea. Traditional risk factors of malnutrition, such as hypoalbuminemia, anemia were also independent risk factor for mortality. This result suggests that hemodialysis patients needed to nutritional support.
P1510INCIDENCE AND OUTCOME HEMODIALYSIS PATIENCE WITH HEPARIN INDUCED THROMBOCYTOPENIA - FOUR YEAR EXPERIENCE ZVEZDARA UNIVERSITY MEDICAL CENTER
Authors: Bulatovic Ana , Maslarevic Radovic Vesna , Markovic Katarina , Djuric Petar , Tosic Dragovic Jelena , Jankovic Aleksandar , Paunovic Marina , Damjanovic Tatjana , Majster Zdenka , Stankovic Popovic Verica , Naumovic Radomir , Dimkovic Nada
Published: June 2020

Background and Aims

Heparin-induced thrombocytopenia (HIT) is a potentially fatal adverse reaction after administration of unfractionated or fractionated heparin, which underlies the generation of antibodies to the heparin complex and platelet factor 4 (PF4). It occurs in 5% of patients treated with unfractionated heparin and 0.5 - 1.5% fractionated heparin. The aim of the study is to determine the incidence and outcome of hemodialysis patients with HIT over 4 years period.

Method

Our retrospective study analyzed patients who were tested for evidence of positive anti-heparin antibody in the period from 2015 to 2019 in Zvezdara University Medical Center. The diagnosis was confirmed by the 4T clinical scoring system, a positive antiheparin-PF4 ELISA test and a positive platelet aggregation test with heparin.

Results

During observation period, total of 54 tests were performed on HIT suspected patients, out of which 21 patients were positive. Out of them, 14 patients were on HD, and other 7 (geriatric, surgery and cardiology departments) received therapy due to peripheral thrombosis, AIM or arrhythmia. All patients treated at nephrology, started hemodialysis (HD) with unfractionated heparin, while others were treated with LMWH. 4T scoring showed that 64% of patients had a moderate risk of developing HIT, while high risk was assessed in 36% of patients. Thrombotic complications in the form of deep venous thrombosis had 50% of patients, pulmonary thromboembolism had 11% of patients. The greatest decrease in Tr was most commonly observed between 10th and 14th day (61% of patients) and 39% from 4th to 10th day from start of heparin administration. In addition to heparin withdrawal and treatment with alternative nonheparin anticoagulation (fondaparinoux), 5 patients needed plasma treatment. 11 patients on HD were transferred to peritoneal dialysis (PD), and 2 patients recovered renal function. Overall mortality was 52%, while in nephrology patients was below 30%.

Conclusion

HIT should be considered in patients at risk. It is necessary to abolish heparin treatment and use alternative method (PD) or alternative anticoagulation. Hemodialysis patients have better prognosis than other comparable patients.
P1513EDEMA SCORE OF CHRONIC KIDNEY DISEASE (CKD) 5D PATIENTS SHOW DIFFERENT CORRELATION WITH NON-CKD PATIENTS AND ARE STRONGLY INFLUENCED BY THE SERUM ALBUMIN VALUE ; PROPENSITY SCORE MATCHING ANALYSIS
Authors: Murakami Takuya , Saito Osamu , Saito Takako , Ueno Koushi , Akimoto Tetsu , Nagata Daisuke
Published: June 2020

Background and Aims

Previously studies reported bioelectrical impedance analysis (BIA) method is useful for body fluid evaluation, especially for evaluation of edema in CKD patients. However, it is still unelucidated what factor affects edema score in CKD patients. In this study, we investigated the factors that determine edema score of CKD 5D patients and reported new findings on the differences from non-CKD patients by using propensity score matching analysis.

Method

We measured the edema score of 117 CKD 5D patients and 303 non-CKD patients using the BIA method and analyzed the relationship with clinical laboratory factors. The edema score was expressed as the ratio of the total body weight (TBW) to the extracellular water (ECW) and was measured with InBody 20® (InBody Japan). All patients with CKD 5D were undergoing hemodialysis and the data were measured immediately after dialysis treatment.

Results

There were differences between CKD 5D patients and non-CKD patients in age, sex, and BMI. Since these factors were estimated to affect edema scores, we performed propensity score matching with age and sex, BMI in CKD 5D patients and non-CKD patients.

After performing propensity score matching, the differences of age, sex, and BMI between the two groups disappeared. The number of patients became 70 in both groups.

By analyzing the model, the edema score of CKD 5D patients indicated significantly higher than that of non-CKD patients (CKD 5D; 0.400±0.012 v. s. non-CKD; 0.389±0.008, P<0.001).

Edema score and factor which indicated significant difference by single regression analysis were examined using stepwise multiple regression analysis. As a result, we clarified that muscle mass is the most influential factor (p<0.0001), and age is the next (p=0.025) on edema score in non-CKD patients, however, in CKD 5D patients, serum albumin level is the most influential factor, and no significant influence was found in muscle mass and age (p=0.0006).

Conclusion

For CKD 5D patients, the edema score is defined by serum albumin, and serum albumin value has much greater influence than age. It is known that low level of serum albumin is associated with poor prognosis in CKD 5D patients. From these results, it was suggested that edema score could be a better prognostic factor than ageing for CKD 5D patients.