bluuebunny/crossref_metadata_2025 huggingface dataset:
MO816PULSE PRESSURE IS AN INDEPENDENT PREDICTOR OF THE RISK OF RECURRENT ALL-CAUSE HOSPITALIZATION IN CHRONIC HEMODIALYSIS PATIENTS
Authors: Mermelstein Ariella , Cherif Alhaji , Zhang Hanjie , Ye Xiaoling (Janice) , Kotanko Peter , Raimann Jochen
Published: May 2021

Background and Aims

Pre - and peri-dialytic systolic blood pressures (SBP) have been linked to heightened cardiovascular morbidity and mortality in hemodialysis (HD) patients. High pulse pressure (PP) is clinically associated with increased arterial stiffness and atrial fibrillation, while low PP is associated with cardiac insufficiency. We studied the relationship between PP and all-cause hospitalization in patients undergoing maintenance HD.

Method

This retrospective cohort study was performed in HD patients from January 2015 to May 2020. To be included in the study, patients were required to be 18 or older, dialysis vintage of at least a year, and must have received treatment within the first 30 days after dialysis initiation. We developed Cox proportional hazards models with spline corrected terms for recurrent all-cause hospitalizations. 95% confidence interval (CI) were also computed. Further, we stratified the patient population into 4 SBP categories, namely: SBP < 120, 120 ≤ SBP < 150, 150 ≤ SBP < 180, and SBP ≥ 180 mmHg, and investigated the mediating effects of SBP on hospitalization risk.

Results

We studied 2453 HD patients (age 58.9±16.1 years, 58% male) dialyzed between January 2014 and October 2018 in Renal Research Institute facilities. We observe that PPs between 45 and 70 mmHg were associated with lower risk of recurrent hospitalization (Figure 1a), possibly driven by the behavior of SBPs between 120 to 180 mmHg (Figure 1c-e). No statistically significant association was seen between PP and hospitalization for patients with SPB <120mmHg and >180mm (Figures 1b-d). A decreasing trend with PP greater than 90mmHg is noted but rendered negligible, and a statistical artifact caused by a case mix at these unusually high levels. The lack of significant associations between inflammatory (NLR) and nutritional (Albumin and phosphorus) factors renders PP a significant and independent predictor of recurrent hospitalization adding to the current knowledge in the field.

Conclusion

Our analysis found associations between PP (with and without SBP stratification) and the risk of recurrent hospitalization and all-cause mortality. Even after adjustment for hospitalization risk and other clinical, inflammatory, and nutritional parameters at baseline PP remained an independent predictor of recurrent hospitalizations. Further investigations into the relationship are needed to better understand the mediating effects of PP as a driver of hospitalization and mortality risk.
MO817ALDOSTERONE ANTAGONISTS FOR PATIENTS WITH CHRONIC KIDNEY DISEASE REQUIRING DIALYSIS
Authors: Hasegawa Takeshi , Nihiwaki Hiroki , Ota Erika , Levack William , Noma Hisashi
Published: May 2021

Background and Aims

Patients with chronic kidney disease (CKD) undergoing dialysis are at a particularly high risk of cardiovascular mortality and morbidity. This systematic review and meta-analysis aimed to evaluate the benefits and harms of aldosterone antagonists, both non-selective (spironolactone) and selective (eplerenone), in comparison to control (placebo or standard care) in patients with CKD requiring haemodialysis or peritoneal dialysis.

Method

We searched the Cochrane Kidney and Transplant Register of Studies up to 29 July 2019 using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register Search Portal and ClinicalTrials.gov. We included individual and cluster randomised controlled trials (RCTs), cross-over trials, and quasi-RCTs that compared aldosterone antagonists with placebo or standard care in patients with CKD requiring dialysis. We used a random-effects model meta-analysis to perform a quantitative synthesis of the data. We used the I2 statistic to measure heterogeneity among the trials in each analysis. We indicated summary estimates as a risk ratio (RR) for dichotomous outcomes with their 95% confidence interval (CI). We assessed the certainty of the evidence for each of the main outcomes using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) approach.

Results

We included 16 trials (14 parallel RCTs and two cross-over trials) involving a total of 1,446 patients. Among included studies, 13 trials compared spironolactone to placebo or standard care and one trial compared eplerenone to a placebo. Most studies had an unclear or high risk of bias. Compared to control, aldosterone antagonists reduced the risk of all-cause death for patients with CKD requiring dialysis (9 trials, 1,119 patients: RR 0.45, 95% CI 0.30 to 0.67; moderate certainty of evidence). Aldosterone antagonist also decreased the risk of death due to cardiovascular disease (6 trials, 908 patients: RR 0.37, 95% CI 0.22 to 0.64; moderate certainty of evidence) and cardiovascular and cerebrovascular morbidity (3 trials, 328 patients: RR 0.38, 95% CI 0.18 to 0.76; moderate certainty of evidence). While aldosterone antagonists had an apparent increased risk of gynaecomastia compared with control (4 trials, 768 patients: RR 5.95, 95% CI 1.93 to 18.3; moderate certainty of evidence), the elevated risk of hyperkalaemia due to aldosterone antagonists was uncertain (9 trials, 981 patients: RR 1.41, 95% CI 0.72 to 2.78; low certainty of evidence).

Conclusion

Based on moderate certainty of the evidence, aldosterone antagonists could reduce the risk of all-cause and cardiovascular death and morbidity due to cardiovascular and cerebrovascular disease but increase the risk of gynaecomastia in patients with CKD requiring dialysis.
MO656CORRELATION BETWEEN CHANGES IN THE BODY FLUID VOLUME CALCULATED BY THE URIC ACID KINETIC MODEL AND CHANGES IN THE BODY WEIGHT*
Authors: Nakai Shigeru , Ozawa Kiyoshi , Shibata Kazuhiko , Shinzato Takahiro
Published: May 2021

Background and Aims

Uric acid (UA) is a solute unable to cross the cell membranes in general tissues by any of simple diffusion, facilitated diffusion or active transport. These facts imply that UA distribution volume (UDiV) equals to the extracellular fluid volume (ECFV). We have developed a method for calculating UDiV from serum uric acid levels before and after hemodialysis based on a uric acid kinetic model (Shinzato T, Int J Artif Organs 2020). Urea is evenly distributed throughout the body fluids. Therefore, the total body fluid volume (TBFV) can be calculated by using the same method as the calculation of UDiV for the serum urea level. The remaining body fluid volume, which is TBFV minus UDiV, is considered to reflect the intracellular fluid volume (ICFV). In this study, we clarified the relationship between the amount of change over time in UDiV and ICFV calculated by the uric acid kinetic model and the amount of change over time in the actual body weight of hemodialysis patients.

Method

Subjects were 1,101 patients with chronic maintenance hemodialysis. UDiV and ICFV before and after dialysis were calculated for two time points, December 2019 and June 2020.

Results

The amount of change in UDiV per body during the dialysis session showed a very good correlation with the amount of body weight change during the same dialysis (UDiV change = 0.950 x body weight change - 0.158, R-square 0.90, p < 0.0001). The amount of change in ICFV during the 6 months from December 2019 to June 2020 showed a good correlation with the amount of change in post-dialysis body weight during the same period (ICFV change = 0.270 x post-dialysis body weight change + 0. 240, R-square 0.21, p <0.0001).

Conclusion

These results suggest that the body fluid volume calculated by the uric acid kinetic model has high accuracy.
MO668EXTRACORPOREAL REMOVAL OF MYOGLOBIN IN PATIENTS WITH RHABDOMYOLYSIS AND SEVERE ACUTE KIDNEY INJURY: COMPARISON OF HIGH AND MEDIUM CUT-OFF MEMBRANE AND AN ADSORBER CARTRIDGE
Authors: Jerman Alexander , Andonova Milena , Peršič Vanja , Gubensek Jakob
Published: May 2021

Background and Aims

Severe rhabdomyolysis often causes acute kidney injury (AKI). If severe, AKI significantly reduces myoglobin removal through the kidneys. Given molecular size of myoglobin, extracorporeal removal using newer hemodialysis membranes and adsorption techniques is possible, although its role on clinically significant outcomes is not yet fully established. We aimed to compare the efficacy of high cut-off (HCO) membrane, medium cut-off (MCO) membrane and Cytosorb® adsorber on myoglobin removal.

Method

In this retrospective study we included 15 patients with AKI and concomitant rhabdomyolysis with severely increased myoglobin (>20.000 µg/L), who underwent at least one extracorporeal procedure with the intention of extracorporeal myoglobin removal. There were 28 procedures performed: 13 HCO (Theralite®, Gambro) dialysis, 9 MCO (Theranova®, Gambro) dialysis and 6 adsorber (Cytosorb®, Cytosorbents) procedures. Serum myoglobin and albumin levels were recorded from the time frame of up to 12 hours prior to and up to 12 hours after the index procedure and reduction rates (RR) for myoglobin were calculated. Albumin levels were compared before and after procedure as a safety parameter.

Results

Treatment duration differed significantly and was the longest for Cytosorb® adsorber (median 11 h) and the shortest for MCO membrane (median 5 h). Pre-treatment serum myoglobin levels were comparable across the groups. Reduction in myoglobin during procedure was significant for HCO and MCO and borderline significant in adsorber group, with respective median RR of 0.64, 0.54 and 0.50 (p = 0.83). Routine albumin substitution was implemented only in HCO group, but serum albumin levels were stable in all subgroups.

Conclusion

In this preliminary observational study we found comparable effectiveness of a novel MCO and ‘standard’ HCO dialysis membrane for serum myoglobin removal in patients with severe AKI. Cytokine adsorber showed borderline effectiveness, but the number of procedures in this group was small. MCO dialysis is associated with lower costs and no need for albumin supplementation and therefore might be the optimal mode of treatment of severe rhabdomyolysis-associated AKI. For patients with multiorgan failure requiring cytokine removal and severe myoglobinemia, hemoadsorption can reduce cytokine and myoglobin levels simultaneously.
MO672HIGH FLUX VERSUS LOW FLUX HEMODIALYSIS: A PRE-POST STUDY
Authors: Zaidan Nadim , Nourie Nicole , Finianos Serge , Nehme Chelala Dania , Azar Hiba
Published: May 2021

Background and Aims

High flux hemodialysis has largely replaced low flux hemodialysis in developed countries. Clinical trials, in particular the Hemo and the MPO studies, conducted many years ago, showed that the survival benefit was mainly for patients on long term hemodialysis for the first one and for high risk patients with low albumin level (less than 40g/dl) for the latter. Moreover, the effect on hematopoiesis or mineral balance is not unequivocally established in the literature. In Lebanon, following the recommendations of the ministry of health, we switched patients undergoing hemodialysis at our center from low to high flux starting April 2019. We aimed in this study to assess the effect of this switch on hemoglobin level, dose of ESA used, mineral metabolism parameters and nutritional parameters.

Method

This is an observational pre-post study where each patient is his own control. Subjects included are adults on chronic hemodialysis for more than 6 months at Hotel Dieu de France University Hospital. Patients who needed transfusion for bleeding, admission to the hospital or parathyroidectomy during the study period were excluded from the study. Demographic parameters, medical history and laboratory values were extracted from the patients’ files.

Paired t- test was used to compare values obtained in the 6 months on low flux compared to the 6 months on high flux hemodialysis.

Results

Seventy four patients received sequentially both techniques (45 males and 29 females). Mean age was 66 years, mean dialysis vintage 65 months, diabetic and vascular diseases were the most frequent causes of ESRD found in 27 and 15% of the cases. Hemoglobin level significantly increased from 11 +/- 0.82 to 11.26 +/- 0.67 mg/dl (p=0.04) with a non-significant trend towards a lower ESA dose: 11620 UI/week (+/-2275 UI) in the first period versus 10860 UI/week (+/-2609 UI) during the second period (p=0.15). Ferritin levels were higher in the second part of the study (416 v/s 476 ng/ml) which may have contributed to the increase in hemoglobin. Phosphorus level decreased from 1.55 to 1.48 mmol/l (p=0.008) at the same doses of binders and practically stable levels of calcium and PTH. Most interestingly, albumin level increased from 38 to 40.3 g/dl (p<0.001). Finally urea reduction ratio increased from 73.1% to 74.5% with a p value of 0.001.

Conclusion

Assuring quality ultrapure water is still a challenge in many developing countries. Lack of firm evidence on beneficial effect in terms of mortality may delay sanitary authorities from imposing high flux hemodialysis. In our study, switching from low to high flux hemodialysis showed positive impact on phosphorus levels but most interestingly increased albumin levels a major predictor of mortality in hemodialysis patients.
MO673THE ASSOCIATION BETWEEN UREA KINETIC MODELING WITH ANXIETY AND DEPRESSION AMONG PATIENTS ON MAINTENANCE HEMODIALYSIS AT UST HOSPITAL: A CROSS- SECTIONAL STUDY
Authors: Balmes - Garcia Maureen , Pe Dexter Clifton , Catindig Joseree Ann , Baroque Gabriel Alejandro
Published: May 2021

Background and Aims

Depression and anxiety are common psychiatric disorders that affect patients with chronic kidney disease on maintenance hemodialysis. Possible explanation for the development of this mental disorders includes physical and emotional stress, time restrictions, functional limitations, co-morbidities, adverse effects of medications and lack of adherence to dialysis treatment and its efficacy. Studies have shown that by improving hemodialysis adequacy, as measured by the urea kinetic remodelling (Kt/V), the clinical symptoms of the patient improve as well as their psychological condition. This study aimed to evaluate the relationship between psychological symptoms and hemodialysis adequacy.

Method

This cross-sectional study was conducted on 87 hemodialysis patients at the University of Santo Tomas Hospital. Anxiety and depression was assessed using the validated Filipino version of Hospital Anxiety and Depression scale (HADS-P). Anxiety and depression was defined as score of 8. Descriptive statistics were used to summarize the general and clinical characteristics of the participants. Frequency counts and proportions were used as descriptors for nominal variables, median and range for ordinal variables, and mean and standard deviation for interval/ratio variables. Chi square test was used to assess the association between age, sex, marital status, duration of dialysis and Kt/V.

Results

The prevalence of anxiety and depression were 34.8% and 21.7%, respectively (n=87). This study identified that younger patients, those belonging to age 20-35 y/o were more depressed (33.3%) and anxious (66.7%). Similarly, females also tend to be more anxious (42.5%) and depressed (22.5%). On the other hand, single patients tend to be more anxious (41.7%) while married are more depressed (22.8%). As to educational status, post graduate patients were more anxious (66.7%) and those with low educational attainment were more depressed (50%). Newly initiated patients (<1 year) were more anxious (57.1%) and those with longer years on hemodialysis (4-6 years) being more depressed (30.4%). As to laboratory parameters, anemic patients are both anxious and depressed. Hypoalbuminemic patients were also anxious and depressed. Patients with adequate hemodialysis were more anxious and depressed.

Conclusion

Anxiety and depression are common psychiatric disorder that are associated with decrease quality of life. Addressing and including these conditions will help to improve their psychological condition.
MO674SHORT DAILY HOME HEMODIALYSIS PROGRAM, IN NEPHROCARE HEMODIALYSIS CENTER: REPORT STUDY
Authors: Hebibi Hadia , Attaf David , Ciroldi Magali , Cornillac Laure , Chazot Charles , Canaud Bernard
Published: May 2021

Background and Aims

Several studies showed that DHHD improved survival and quality of life and allowed a lower cost for health system. The aim of this study was to describe our first experience of DHHD in our dialysis center.

Method

We included 9 dialyzed patients trained on Nx Stage® machine (Fresenius Medical Care) from February to December 2020. Data was retrospectively obtained through review of our medical electronic records (Euclid®).

Results

Among 9 patients trained, 8 were installed at home, with an average follow up of 7 months. 6 patients were dialyzed in self hemodialysis facilities. The mean age was 45 years (28-71), 6 women, BMI: 24 kg/m2 (21-30), dialysis vintage: 5 years and 7 patients are on transplant list. The Charlson score was: 5 (4-8), 5 patients had a residual diuresis> 500 ml/d. The average training duration was 5 weeks (4-8). Our training program targeted the self-puncture of AVF and the self-assembly of the machine by the patient. 100% of AVF were cannulated through Buttonhole technique. 6 patients were dialyzed 6 times a week and only one patient needed anticoagulants. The blood pressure improved on the first days of DHHD (↓ 50% of drugs for 50% of patients). Hemoglobin level maintained between 10-12 g/dl with ↓ EPO. The mineral metabolism status was improved for all patients, with stopping of binders in one case. DHHD reduced symptoms like fatigue, cramping and post-dialysis recovery for all patients, and allowed for patients a better socio-professional integration. A medico-economic analysis is conducted.

Conclusion

DHHD improved blood pressure, anemia, mineral status and quality of life. Through economy in medicaltransport and better socio-professional integration DHD provides savings for the health system
MO677RRT DURING COVID 19 EPIDEMIC. EXPIRIENCE OF ONE CENTER
Authors: Strazmester Majstorovic Gordana , Knezevic Violeta , Azasevac Tijana , Markovic Mira , Veselinov Vladimir , Mitic Igor
Published: May 2021

Background and Aims

The incidence of Acute kidney injuri AKI during Covid 19 infection is 3 – 15%, up to 50% for patients (pts) with Acute respiratory distress syndrome ARDS.

Method

From March till December 2020. Department for hemodialysis in Novi Sad did 184 renal replacement therapy (RRT) procedures (proc) on 65 Covid 19 positive pts.

Results

There were 73,85% men and 26,15% women (p < 0,01), with average (avs.) age of 65,8 years (SD 9,20). Most of them were admitted directly to the Intensive care unit, 64,62% (p < 0,01). The length of stay in hospital ranged from 2 - 61 days (avs. 15,86; SD 11,19). The most common comorbidities were hypertension (86,1%), diabetes (33,8%), coronary disease (30,8%) and chronic obstructive pulmonary disease (21,5%). Most common indication for RRT was acutisation of chronic kidney disease (CKD) 43,08% (p < 0,01) followed by pre-existing end stage renal disease (ESRD) 29,23% and AKI 27,69%. RRT was started 1 - 31 days after the admittance (avs. 8,51; SD 7,33). 57 intermittent hemodialysis proc (30,98%) were done on 13 pts (14,06%) who were hemodynamicly and respiratory stable. The decision to initiate CRRT was made upon the renal indications, the presence of ARDS or significant volume load. A total of 127 CRRT proc (69,02%) were done on 57 pts (87,5%). The most of them were CVVHDF (74,02%) and the rest CVVHD (25,98%). Most commonly used membrane was oXiris 47,24% (p < 0,001) followed by EMIC2 25,98%, Kit 8 17,32% and ST-150 9,45%. Most CRRT proc (89,76%) were done with heparin as an anticoagulant and 10 proc (7,87%) in 5 pts using citrate. 3 proc (2,36%) in 2 pts were done without using anticoagulant. The procedurès duration had to depend on the number of devices, the number of pts requiring CRRT and the number of available trained medical workers. The average achieved length of proc was 712 min. (11 h and 52 min.) (SD 435,07). Most patients had 1 (49,12%; p< 0,001) or 2 (30,69%) CRRT proc, up to 9 (avs. 2,23; SD 1,95). The average achieved ultrafiltration was 2716,41 ml (SD 1016,82). In 23 pts (40,35%) 26 CRRT proc (20,47%) had to be stopped earlier, because of circuit clotting (9,45%; p < 0,001), deterioration of hemodynamic instability/respiratory insufficiency (7,09%), device malfunction (2.36%) and RRT need for another pts (1,58%). ARDS has developed 42 pts (64,61%). The need for vasoactive support had 41 pts (63,08%). 51 pts (78,46%) requiring RRT died.

Conclusion

Comparing group of pts who survived with group of those who died, greater number of pts with ESRD was in the first group. In survivor group, RRT was started earlier with greater number and shorter duration of proc. In the group of pts who died, there were more ARDS and vasoactive support need. They had a higher levels of CRP, leukocyte count and the neutrophil to lymphocyte ratio.
MO658POLYVINYLPYRROLIDONE IN HEMODIALYSIS MEMBRANES: IMPACT ON PLATELET LOSS DURING HEMODIALYSIS
Authors: Zawada Adam , Melchior Pascal , Erlenkötter Ansgar , Delinski Dirk , Stauss-Grabo Manuela , Kennedy James
Published: May 2021

Background and Aims

Hydrophilic modification with polyvinylpyrrolidone (PVP) increases the biocompatibility profile of synthetic dialysis membranes. However, PVP may be eluted into patient’s blood, which has been discussed as a possible cause for adverse reactions rarely occurring with synthetic membranes. We now investigated the content of PVP and its elution from the blood-side surface from commercially available dialyzers, including the novel FX CorAL with α-tocopherol-stabilized, PVP-enriched membrane, and link the results to the level of platelet loss during dialysis as a maker of biocompatibility.

Method

Six synthetic, PVP containing, dialyzers (FX CorAL, FX CorDiax [Fresenius Medical Care]; Polyflux, THERANOVA [Baxter]; ELISIO [Nipro]; xevonta [B. Braun]) were investigated in the present study. The content of PVP on blood-side surface was determined with X-ray photoelectron spectroscopy (XPS). The amount of elutable PVP was measured photometrically after 5h recirculation. The level of platelet loss was evaluated in an ex vivo recirculation model with human blood.

Results

Highest PVP content on the blood-side surface was found for the polysulfone-based FX CorAL (26.3%), while the polyethersulfone-based THERANOVA (15.6%) had the lowest PVP content. Elution of PVP was highest for the autoclave steam sterilized THERANOVA (9.1 mg/1.6m² dialyzer) and Polyflux (9.0 mg/1.6m² dialyzer), while the lowest PVP elution was found for the INLINE steam sterilized FX CorAL and FX CorDiax (< 0.5 mg/1.6m² dialyzer, for both). Highest platelet loss was found for xevonta (+164.4% compared to the reference) and the lowest for the FX CorAL (-225.2%) among the polysulfone-based dialyzers; among the polyethersulfone-based dialyzers, THERANOVA (+95.5%) had the highest and ELISIO (-52.1%) the lowest platelet loss.

Conclusion

PVP content and elution differs between commercially available dialyzers and was found to be linked to the membrane material and sterilization method. The amount of non-eluted PVP on the blood-side surface may be an important determinant for the hemocompatibility of dialyzers.
MO663THE UTILITY OF SMART SCALES TO MONITOR BODY COMPOSITION IN HEMODIALYSIS PATIENTS
Authors: Cordero Lucia , Rivero Martínez Marta , Caro Espada Paula Jara , Gutiérrez Elena , Mérida Evangelina , Aubert Lucia , Sandino Pérez Justo , Yuste Claudia
Published: May 2021

Background and Aims

Overhydration (OH) is an independent predictor of mortality on hemodialysis (HD). The gold standard to assess OH is BCM monitor from Fresenius®, however BCM is a hospital hold device limiting its use. New smart scales have emerged as household devices reporting daily body composition data.

Objective

To determine if Renpho ES-CS20M® could be useful on a 52 HD patient to estimate body composition data.

Method

72 body composition assessments (BCA) during mid-week HD session were performed. Each BCA included: (1) Predialysis Renpho measurement, (2) Predialysis BCM monitor measurement, (3) Postdialysis Renpho measurement. To track the fluid balance during the HD session: (1) we recorded ultrafiltration, (2) food or fluid intake was not allowed, and (3) none of the HD patients urinated during the HD session. If any intravenous fluids were needed during the HD session, we subtracted them off from UF.

Results

Data from 52 HD patients were studied (age 58.8 ± 16.8 years, 56.9 % males, 14.7% diabetics), with a mean pre-HD weight of 70.0 ± 13. 4 Kg, overhydration of 1.7 ± 1.5 L and urea distribution volume of 31.7 ± 5.7 L. The mean ultrafiltration during HD session was -1.8 ± 0.9 L. Renpho estimated a Pre – HD hydration of 34.25 ± 6.02 Kg vs 33.4 ± 5.7 Kg by BCM, showing a good concordance between methods (ICC 0.788 [0.67-0.86], B -0.58, p <0.01). Renpho poorly estimated pre – HD lean tissue mass at 45.4 ± 6.9 Kg compared with 33.8 ± 8.0 Kg by BCM. Although Renpho was able to provide a moderate concordant estimation of fat tissue mass (33.8 ± 8.0 % with Renpho vs 34.7 ± 9.6%), the bias proportion was unacceptable. Post- HD hydration by Renpho was not able to reproduce the ultrafiltracion achieved during the HD session (pre-HD 34.25 ± 6.02 Kg vs post-HD 34.08 ± 6.00 Kg).

Conclusion

Renpho has a proportional bias estimating predialysis hydration compared with BCM monitor, but is not able to assess changes produced with ultrafiltration or other parameters of body composition (as lean or fat tissue mass). Although smart scales are unacurate to assess body composition on HD patients, they could be useful on the follow up of them changing the accuracy for frequency.
MO664DYNAMIC ASSESSMENT OF INTERLEUKIN-6 DURING HEMODIALYSIS AND MORTALITY IN COVID 19
Authors: Muñoz Ramos Patricia , Giorgi Martin , Gil Giraldo Yohana , De Santos Antonio , Núñez Almudena , Barril Guillermina , Quiroga Borja
Published: May 2021

Background and Aims

The impact of the newly discovered severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease-19 (COVID-19) in hemodialysis patients remains poorly characterized. Some hemodialysis techniques reduce systemic inflammation but their impact on COVID-19 has not been addressed. The aim of this prospective study was to evaluate factors associated to mortality in COVID-19 hemodialysis patients, including the impact of reducing interleukin-6 using a cytokine adsorbent filter.

Method

This is a prospective single-center study including 16 hemodialysis patients with COVID-19. All were dialyzed using a polymethyl methacrylate (PMMA) filter. Interleukin-6 levels were obtained before and after the first admission hemodialysis session and at one week. Also we collected serum samples from 8 patients of our unit as controls: 4 in online hemodiafiltration (OLHDF) and 4 in high-flux hemodialysis Baseline comorbidities, laboratory values, chest X-ray and treatments were recorded and compared between survivors and non-survivors.

Results

Sixteen patients were included (13 males, mean age 72±15 years). Four patients (25%) died. Factors associated to mortality were dialysis vintage (p=0.01), the presence of infiltrates in chest X-ray (p=0.032), serum C-reactive protein (p=0.05) and lactate dehydrogenase (p=0.02) at one week, the requirement of oxygen therapy (p=0.02) and the use of anticoagulation (p<0.01). At admission, post-dialysis interleukin-6 levels were higher (p<0.01) in non-survivors and these patients differed from survivors in the reduction of interleukin-6 levels during the dialysis session despite using a PMMA filter (survivors vs non survivors (25 [17-53]% vs -3 [-109-12] %, p=0.04).

Conclusion

In hemodialysis COVID-19 patients, a positive balance of interleukin-6 during the session was associated to higher mortality.
MO889COST OF ILLNESS OF CHRONIC KIDNEY DISEASE IN LEBANON: FROM THE SOCIETAL PERSPECTIVE
Authors: Aoun Mabel , Helou Elie , Sleilaty Ghassan , Nehme Chelala Dania
Published: May 2021

Background and Aims

Chronic Kidney Disease (CKD) is the 12th leading cause of death worldwide and a high societal burden. Cost-of-illness studies of CKD are scarce in developing countries. Identifying factors associated with the highest cost can help decision makers adapt health policies and sustain kidney health services, especially in limited resources' settings. This study aims to estimate the cost of illness of CKD in Lebanon, from the early stages of CKD until dialysis and kidney transplant and identify cost components related to the highest financial burden.

Method

This is a cross-sectional study of all CKD patients who presented to two nephrology clinics during the first two weeks of November 2020. The sample size required for the study to be representative was 154 patients. The medical and administrative records were reviewed to collect the demographics and CKD characteristics of patients as well as the direct medical costs (medications, diagnostic tests, hospitalizations, inpatient care, outpatient care), direct non-medical costs (transportation) and indirect costs (productivity losses) for one year between 1st June 2019 and 1st June 2020. Kruskal Wallis test was used to compare the costs between different CKD stages and categories. The study got the approval of the ethics committee of Saint-Joseph University.

Results

The sample included a total of 160 patients: 102 non-dialysis CKD patients, 40 hemodialysis, 8 peritoneal dialysis and 10 kidney transplant patients. Their mean age was 66.74 ±15.36 years, 57.5% were males and 42.5% diabetics. The mean number of daily medications was 8.75 ±3.38, mean frequency of blood tests per year 6.86 ±6.4 and mean number of hospital admissions per year 0.79 ±1.43. The mean total annual cost of CKD per patient across all categories was assessed at 19,900,164 ±27,893,591 Lebanese Pounds (1 $USD= 1515 LP in 2019). Statistical analysis showed a higher total cost among dialysis patients compared to other categories of CKD (p<0.001), higher cost of medications in transplant patients (p<0.001) and higher cost of technique modality in peritoneal dialysis patients (p<0.001). These differences are summarized in Figure 1.

Conclusion

Similar to previous studies from other countries, this cost of illness analysis showed a high burden of dialysis annual costs compared to non-dialysis CKD and transplant patients. It revealed as well a great burden of medications' costs at the level of dialysis and transplantation. It is thus crucial that governments and health policies in low- and middle-income countries target interventions that prevent end-stage kidney disease, reduce medications' costs and most of all create programs that encourage kidney transplantation.
MO891HEMODIALYSIS PATIENTS AMID COVID-19 PANDEMIC: A COMPARISON BETWEEN FIRST AND SECOND WAVE
Authors: Lomonte Carlo , Lisi Piero , Corciulo Simone , Manno Elisabetta , Covella Bianca , Rossi Luigi , Teutonico Annalisa , Libutti Pasquale , Pepe Vito
Published: May 2021

Background and Aims

Data about HD patients and how to best dialyze them during the COVID-19 pandemic are scarce. The aim of the study is to describe the organizational model and clinical outcomes of patients confirmed COVID-19 needing renal replacement therapy, admitted in a COVID Hospital in Southern Italy during the first and second pandemic wave.

Method

All the consecutive patients requiring chronic HD, during the first and second wave were considered. Due to local resources, we have implemented an organizational model based on the HD bedside with Genius system. The machine was prepared in the Dialysis Unit and then transferred to the COVID Hospital. After treatment, the monitor was sterilized and carefully cleaned with chlorine wipes and re-transferred into the dialysis Unit to be prepared for the next dialysis. Demographic data, clinical symptoms at presentation, and laboratory results were extracted by the electronic medical record. Patients hospitalized during the first wave (FW) and second wave (SW) were compared.

Results

From March 10 through December 31 2020, we enrolled a cohort of 40 patients (37.5% F), with COVID-19 infection requiring HD; 11 (27.5%) during first and 29 (72.5%) during second wave. The phenotype and clinical symptoms at the admission were not different between two groups. Compared to FW, the SW patients were younger (70.1±9.5 vs 77.3±5.9 years; p<0.03) with lower dialysis vintage (35±18 vs 60±48 months; p<0.05), and lower Charlson Comorbidity Index scores (2.8 ± 1.8 vs 5.09 ± 2.0; p<0.05). No differences were observed between the first and second wave as far as inflammatory markers IL6 (51.9 ± 44.8 vs 55.45 ± 40.52 pg/mL; ns) and C-reactive protein (4.74 ± 3.8 vs 6.70 ± 5.44 mg/L; ns) as well as the hospital stay (21.1±10 vs 24.4.8±10 days; ns) and in-hospital mortality (28.1% vs 18.2%; ns). Overall, 354 bedside treatments were performed; mean session time and mean weekly sessions were 3.64 ± 0.40 hours, and 3.4 ± 0.45 HD/week, with no differences between FW and SW patients.

Conclusion

Our data show that the higher spread of Sars-cov2 during the second wave has infected younger and less comorbid HD patients, with no significant differences in clinical and laboratory parameters. Our organizational model based on the HD bedside with the Genius system, allowed a personalized treatment with efficacy and safety for the patients and staff.
MO892DIALYSIS SERVICE MANAGEMENT DURING COVID-19 PANDEMIC IN EUROPEAN CITY AREA
Authors: Rimsevicius Laurynas , Jankevicius Feliksas , Motiejuniene Bilotiene Ausra , Miglinas Marius
Published: May 2021

Background and Aims

Many countries across Europe experience the second wave of CoVid-19 pandemic. Lithuania is a country situated on the eastern shore of the Baltic Sea. Until January 15, Lithuania had 165560 confirmed positive cases, 100495 recoveries, and 2376 deaths.

Method

In this abstract, we describe reorganization in dialysis service in Vilnius, the capital and largest city of Lithuania, with urban population of 700,275 inhabitants.

Results

At the pandemic start in March 2020, Vilnius had 3 public nephrology departments each running a hemodialysis unit, and 4 private hemodialysis centers, with total of 250 end-stage kidney disease patients. Vilnius University Hospital Santaros Klinikos, as the main hospital in the country and national CoVid-19 coordinator, restructured dialysis service in city area. Chronic hemodialysis programs in public hospitals were cancelled and patients were shifted to private centers. In the threat of infection and multiple outbreaks in two hospitals, nephrology units were closed and CoVid-19 negative nephrology patients were located in a satellite hospital in other city, whilst all city hospitals served as CoVid-19 centers. In Santaros Klinikos, we treated severe CoVid-19 patients who needed chronic or acute dialysis, while asymptomatic and mild to moderate-symptom patients carried their dialysis procedures in isolated shafts and/or facilities in private centers. In cases with unsatisfactory self-isolation, isolation sites were located in hotels or other premises provided by the municipal administration. Transportation to dialysis center was provided by municipality as well. Rapid antigen testing was set in a case of suspected outbreak or for all outpatient hemodialysis patients in some centers in circumstances of high community transmission. During the pandemic, we had ongoing transplant activities, continued wait-listing for kidney transplant and increased peritoneal dialysis program. Most peritoneal dialysis patients were trained at home by a mobile nurse team, also home visits we carried instead of inpatients visits. We started CoVid-19 vaccination during the first week of January for all dialysis patients and transplant recipients who had no contraindications and gave informed consent.

Conclusion

In conclusion, the rapid release and adoption of recommendations and action plan helped to identify and locate CoVid-19 outbreaks in dialysis facilities. Dialysis service reorganization is needed to maintain ongoing treatment for chronic patients who vitally depend on renal replacement therapy. Private dialysis centers and municipality should assist with physical resources operating the patients flow. The growth of peritoneal dialysis program serves as a significant subsidiary factor when patients need more social distancing. Vaccination data and outcomes in end-stage renal disease patients is coming soon.
MO893ASSESSMENT OF PHYSICAL ACTIVITY IN CHRONIC HEMODIALYSIS PATIENTS IN THE NEPHROLOGY AND HEMODIALYSIS DEPARTEMENT CHU IBN ROCHD
Authors: Failal Imane , Ezzaki Sanae , Sayeh Marouane , Elkhayat Salma , Medkouri Ghizlaine , Ramdani Benyounes
Published: May 2021

Background and Aims

Physical activity is often reduced in chronic hemodialysis patients. Studies having evaluated hemodialysis reveal a significant sedentary lifestyle. which is associated with excess mortality. Conversely, the benefits in terms of morbidity and mortality from physical activity are numerous. The fight against sedentary lifestyles in hemodialysis patients must be one of the objectives of healthcare teams. For this reason, our study aims to assess physical inactivity using a physical activity score from DIJON in chronic hemodialysis patients and to identify the factors linked to a decrease in physical activity in them and to propose programs aimed at to encourage PA as well as exercises adapted to the hemodialysis patient.

Method

This is a descriptive and analytical cross-sectional study conducted during the month of January 2020, in the nephrology and hemodialysis department of CHU IBN ROCHD. We used the Dijon questionnaire translated into Arabic to measure the PA taking into account daily, sports or leisure activities. The PA level benchmarks are 0–10 (low), 10–20 (medium), and 20–30 (high).

Results

Our study included 71 patients. The average age was 46.5 years with extremes ranging from 16 to 93 years, there is a slight male predominance with a sex ratio of 1.1. Initial nephropathy was undetermined nephropathy in 53.5%, glomerular in 29.5%, diabetic in 7% and hypertensive in 1.4%. The age of the periodic hemodialysis treatment in our patients varied from 1 month to 44 years, with an average duration of 17.3 years. 91.5% of patients had an arteriovenous fistula as a vascular approach, 8.4% of patients were dialyzed on a catheter.

The overall level of physical activity was high only in 4.5% of patients, while it was low in 61.3% and moderate in 34% of patients. The study of the relationship between the decrease in physical activity and different demographic, clinical and paraclinical parameters had revealed that the decrease in physical activity was significantly correlated with seniority on hemodialysis, gender, l he advanced age, the different degrees of anemia, and the cardiovascular affections, on the other hand no significant correlation was found between the decrease in physical activity and hypocalcemia, hyperphosphatemia, and hyperparathyroidism.

Conclusion

Our results show that the level of physical activity is linked to many parameters, some of which can be modified. Prescribing an adapted and personalized program would improve the prognosis related to co-morbidities and the quality of life of our patients.
MO877PREVALENCE AND PERSISTENCE OF COVID-19 ANTIBODIES IN NEW YORK CITY HEMODIALYSIS CLINIC
Authors: Thwin Ohnmar , Grobe Nadja , Ye Xiaoling (Janice) , Preciado Rojas Priscila , Tapia Silva Leticia M , Kotanko Peter
Published: May 2021

Background and Aims

Dialysis patients are at higher risk for severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection. Longevity of antibody response to SARS-CoV-2 infection remains unclear. It is reported that maintenance hemodialysis (MHD) patients can mount an antibody response that is similar in intensity and timing to the non-dialysis population. We aim to investigate the prevalence and persistence of antibodies in hemodialysis patients.

Method

We measured IgG and IgM antibodies in MHD patients as part of a quality improvement project. Four New York City dialysis clinics participated in this study. Strict policy of RT-PCR testing was implemented in clinics for patients with signs and symptoms of Coronavirus Disease 2019 (COVID-19). Initial antibody testing was done on June 10 and July 13, 2020 (phase 1) and retesting was done for previously positive patients between December 9 and 17, 2020 (phase 2). Upon obtaining verbal consent, 3.5 ml of pre-dialysis blood samples were taken via vascular access. SARS-CoV-2 antibodies were determined using the emergency use authorized Diazyme DZ-Lite SARS-CoV-2 IgM / IgG CLIA assays with 100% sensitivity and 98% specificity. Detection of formed immune-complexes is achieved with N-(4-amino-butyl)-N-ethyl-isoluminol; the luminescence signal is reported as units per ml (AU/ml), values ≥ 1.00 AU/ml are considered as “reactive” and < 1.00 AU/ml as “non-reactive.”

Results

A total of 429 MHD patients were studied in phase 1. Antibodies were present in 130 (30.3%) and only 55 patients with Covid-19 diagnosis confirmed by RT-PCR test were reactive for IgG antibodies. The time to antibody testing was 73 days (median 77; range 30-111) days. In the phase 2 antibody testing, IgG antibodies were only detected in 47 patients (85.5%) 242 days (median 245, range 204 to 268) after clinical diagnosis of Covid-19. Between the two phases of antibody testing, the luminescence signal declined by 40.9 AU/mL (95% confidence interval 31.5 to 50.3) from 54.1±45.3 to 13.2±20.9 AU/mL (P<0.0001 by paired t-test; Figure 1). In univariate logistic regression, a higher number of days between clinical diagnosis of COVID-19 and the second antibody measurement was associated with a lower seropositivity rate (odds ratio 0.929, 95% confidence interval 0.864 to 0.998, P=0.044). Antibody persistence was not associated with age, gender, race, and ethnicity.

Conclusion

We observed that about 6 out of 7 MHD patients maintain SARS-CoV-2 antibodies over 6-9 months but there is a significant decline of IgG level. The time between clinical diagnosis and IgG testing was associated with IgG decline. Follow up study to understand antibody dynamics in MHD population is a crucial step once vaccines become available.
MO896EMERGENCY HEMODIALYSIS DURING THE CORONAVIRUS PANDEMIC: ABOUT 68 CASES
Authors: Chemli Imen , Amal Ouni , Haoula Faouzi , Ben salem Meriem , Ben salah Manel , Handous Insaf , Letaief Ahmed , Hamouda Mouna , Aloui Sabra , Skhiri Habib
Published: May 2021

Background and Aims

The emergency hemodialysis is a very common situation in nephrology and is characterized by high morbi-mortality.

The aim of this work was to determine the indications for emergency hemodialysis, the clinical and paraclinical profiles of the patients, as well as the parameters of the session of hemodialysis and the perdialytic complications.

Method

This is a prospective descriptive and analytical study carried out over a period of 3 months (March 3, 2020 - June 6, 2020). This period coincides with the coronavirus pandemic. This study was included all patients who have undergone Emergency hemodialysis. The study was done in the hemodialysis unit of the nephrology department of the CHU Fattouma Bourguiba Monastir.

Results

We collected 68 patients, the majority are male (70%). The average age was 60 + -14.4 years. The original department was the emergency room in 42.6% of cases, the intensive care unit in 10.29% and a surgical department in 13.23% of cases. 40% of patients were diabetic and 22% had coronary insufficiency. 60.5% were a chronic renal failure, 16% were end-stage and 34% were on hemodialysis. The indications for emergency hemodialysis were acute lung edema, hyperkalaemia and metabolic acidosis in 31%, 50% and 50% of cases, respectively. Poorly tolerated uremia and anuria more than 12 hours were the indication in 11.8% and 10.3% of cases, respectively, drug or toxic intoxication (methanol) was in 5.9% of cases and hypercalcaemia in 4.4% of cases. The average duration of the sessions was 2.95 hours [2–4 hours]. Ultrafiltration was necessary in 44.11% of cases. Per-dialysis anticoagulation was used in 38.23% of patients. The vascular access was a femoral catheter in 67.6% of cases and an arteriovenous fistula in 28% of cases. The per-dialytic complications were hypotension in 10 cases (14.7%) and the session was stopped in 4 cases. hypoglycemia was noted in 2 cases (2.9%) and seizures in 2 cases. Cardiopulmonary arrest was reported in 2.9% of sessions.

The incidence of bleeding complications occurring within 72 hours after the hemodialysis session was 5.8%.The death rate was 13.2%.

Our univariate analysis concluded that diabetes, heart failure and coronary artery disease, history of gastrointestinal bleeding and active infection are risk factors for mortality.

The multivariate analysis showed that diabetes and a history of gastrointestinal bleeding was the two factors of mortality.

Conclusion

The confinement period has affected the medical activity in our department. So, it has increased the cases of emergency hemodialysis with more complications.
MO899PRURITUS IN CHRONIC HEMODIALYSIS PATIENTS ANDS ITS IMPACT ON QUALITY OF LIFE
Authors: Ghabi Faten , Toumi Salma , Amouri Asma , Chaker Hanen , Agerbi Ikram , Dammak Najla , Kammoun Khawla , Yaich Soumaya , Masmoudi Abdelrahmen , Benhmida Mohamed
Published: May 2021

Background and Aims

Pruritus is a common symptom in chronic hemodialysis patients, its intensity varies from patient to patient and which plays a major role in impairing their quality of life. Its pathophysiology is poorly understood and its management remains a challenge.

The main objective of our study is to estimate the frequency of pruritus in our population and its impact on their quality of life.

Material and methods

This is a cross-sectional study involving 53 patients carried out in the dialysis unit of the CHU Hédi chaker in sfax. The DLQI (Dermatology Life Quality Index), the Pittsburgh Sleep Quality Index (PSQI) and the verbal analogue scale to specify the intensity of pruritus were used to assess the impact of pruritus on quality of life.

Results

The mean age of our patients was 48 ± 28 years with a predominance of men (60%). The mean duration on hemodialysis was 5.4 years. The prevalence of pruritus was 28% of cases. Pruritus affects 75% of the body surface in 90% of patients, an intensity greater than or equal to 5 in 93.33% of cases on an intensity scale of 0 to 10, the impact was moderate on the quality of life according to the DLQI in 66.66% of the cases, 86.66% of the patients presented a nocturnal recrudescence of the pruritus, and an alteration of the quality of sleep was present in 73.33% of the cases according to the PSQI.

The Comparison of the groups with (G1) or without pruritus (G2) showed the predominance of hyperposphoraemia in the first group with averages of 1.92mmol / l and 1.4mmol / l respectively in G1 and G2

Conclusion

Pruritus remains the most frequent complaint for hemodialysis patients, which in our patients was linked mainly to hyperposphoraemia requiring optimization of phosphorus chelators and hemodialysis measures.