bluuebunny/crossref_metadata_2025 huggingface dataset:
#1904 Prevalence of osteoporosis in dialysis dependent CKD patients: a cross sectional study from India
Authors: Sharma Jay Kumar , Bunger Deepak , Chaturvedi Alok
Published: May 2024

Background and Aims

Chronic kidney disease (CKD) is associated with the development of mineral bone disorder (MBD), osteoporosis, and fragility fractures. However, the data on prevalence of Osteopenia and osteoporosis in Chronic kidney disease in India is scarce

This multicentric, cross sectional study was done to assess the prevalence of osteoporosis in dialysis dependent chronic kidney disease patients.

Method

This study was conducted in CKD patients on maintenance hemodialysis. Osteoporosis and osteopenia were confirmed on the basis of T-scores using portable- Heel Ultrasound Bone Densitometer.

Results

A total of 1033 Dialysis patients were screened during August 2022 to December 2022. More than half (56%) of the patients were male. The prevalence of osteoporosis and osteopenia was observed to be 17% and 66%, respectively. Mean T- Score observed in overall population was -1.71 + .0.85, while it was -1.66 + 0.86 and -1.77 + 0.83 in males and females respectively. The maximum T- score observed in males was 2.0 and in females it was 4.0. In females, the minimum T-score was -4.3 while in males it was -2.51. Overall, 16.5% of males and 18% of females were osteoporotic. Among geriatric males (>60 years), average T-score was -1.55 + 0.42 while in geriatric female it was 1.78 + 0.80

Conclusion

This data of Osteopenia and osteoporosis should be alarming as osteopenia itself is considered a very serious risk factor for the development of osteoporosis. Early intervention for diagnosis and timely initiation of treatment of osteoporosis is recommended for the CKD population to prevent complications like fractures and falls.
#2473 Renal failure in the emergency department: indications for emergency hemodialysis
Authors: Hedhli Hana , Hajji Roua , Jemai Mouna , Jouini Sarra , Mahrsia Chaima , Othmani Safia
Published: May 2024

Background and Aims

kidney failure is a frequent reason for emergency department (ED) visits. Patients may require emergency hemodialysis and this situation may increases mortality risk.

We set out to study the clinical relevance and biological characteristics of patients with renal failure presenting to the emergency department with an indication for emergency hemodialysis.

Method

A prospective observational study conducted in ED conducted over a 6-month period. Patients were included if they were 18 years or older and suffering from acute or chronic renal insufficiency defined by creatinine clearance (CrCL) calculated by MDRD<60 ml/min. Information is recorded on demographics, clinical profile, clinical presentation, laboratory, causes of for emergency hemodialysis and in-hospital complications.

Results

Eighty one patients were enrolled, among them 61.7% patients had an indication for emergency hemodialysis. Mean age was 61± 12, sex-ratio=1,7. Sixty seven patients (82.7%) were known to have a chronic kidney failure and 17.3 % were discovered at the emergency department at the same hospitalisation period. Clinical profile (%): Anuric patients (11.1), preserved diuresis (40.7). Clinical presentation (%): deterioration of general condition (35.8), dyspnea and chest pain (21) and fever (17.3). Clinical examination showed a peripheral oxygen saturation between 70 and 100% with a mean of 94.81, a respiratory rhythm mean of 20 cycles/min, a systolic blood pressure mean of 134.61 mmHg and a diastolic blood pressure mean of 70 mmHg. biological exams showed that kalemia was between 2.4 and 8.6 and 45 of those patients had kalemia more or equal to 5.5. Twelve per cent of these patients had hyperkalemia signs on the electrocardiogram. The average were 28 mmol/l with a maximum of 83.3 mmol/l. Creatinine values were between 185 et 2620 μmol/l with a median of 81. The value of Ph was between 7.04 and 7.53 with a median of 7.29 mm Hg. The value of HCO3- value was between 4.6 and 28.4 with a median of 14.2.

Causes of emergency hemodialysis were acidosis in 12 cases, severe anemia with blood transfusion in 4 cases, hyperkalemia in 10 cases, acute pulmonary oedema in 5 cases and acute renal failure in 6 cases .the evolution of the patients was marked by improvement of 61.7% of the patients, only 3 of the 81 patients died during the hospitalization.

Conclusion

This study showed that the causes of emergency dialysis can be avoided by improving care and educating patients to improve the prognosis.
#1839 Evaluating the severity of restless legs syndrome in chronic kidney disease patients across different renal replacement therapies
Authors: Rroji (Molla) Merita , Shehaj Larisa
Published: May 2024

Background and Aims

Restless Legs Syndrome (RLS) is increasingly recognized as a significant comorbidity in chronic kidney disease (CKD) patients. This cross-sectional study evaluates the risk and severity of RLS in CKD patients across various renal replacement therapies (RRT).

Method

A total of 167 CKD patients were assessed, including those on hemodialysis (HD) (39%), peritoneal dialysis (PD) (22%), with kidney transplants (19%), and those with non-dialyzed CKD stages IV-V (20%)—the International Restless Legs Syndrome Study Group (IRLS) questionnaire measured RLS severity. Severity scales were categorized into mild (0-10), moderate (11-20), severe (21-30), and very severe (31-40). PTH, P, Ca, ALP, and Mg serum concentrations, as well as vascular calcification, were measured as MBD biomarkers. The Adragaos score was applied to graphs of the hands and pelvis to evaluate vascular calcification. Statistical analyses focused on differences in RLS severity across RRT modalities and associated risk factors.

Results

The cohort comprised 82 males and 85 females, averaging 58 years. Primary disease etiologies included nephroangiosclerosis (24%), diabetic nephropathy (12%), chronic pyelonephritis (24%), chronic glomerulonephritis (24%), and ADPKD (7%). RLS prevalence was 53.8%, with significant differences in IRLS scores across groups (p ≤ 0.001). HD patients showed a mean IRLS score of 21.8 ± 12.3, with 55% reporting severe or severe symptoms. PD patients scored 16.06 ± 13.02; non-dialyzed CKD patients scored 6.41 ± 6.04; and transplant recipients scored 3.1 ± 4.7. No correlation was found between RLS severity and age or time on RRT. However, significant correlations were observed between RLS severity with HD modality, and the high Adragaos score. Multivariate analysis showed high serum phosphorus p=0.018 and markers of inflammation as a risk factor for RLS severity (CRP levels p=0.034; ferritin (p=0.048).

Conclusion

This study underscores the disproportionately higher severity of RLS in HD patients, necessitating tailored management strategies for this subgroup. The significant association between RLS severity and calcification and inflammation markers in CKD patients, particularly those on HD, suggests that RLS severity should be a key consideration in the clinical management of CKD. Addressing RLS in these patients may improve their quality of life and influence the outcomes of their renal replacement therapy.
#1397 Predictive factors for bioprosthetic valve stenosis and prognostic factors for survival following TAVR in hemodialysis patients with severe AS
Authors: Masuyama Satoshi , Mizui Masayuki , Maeda Koichi , Shimamura Kazuo , Sakaguchi Yusuke , Sakata Yasushi , Miyagawa Shigeru , Isaka Yoshitaka
Published: May 2024

Background and Aims

Transcatheter aortic valve replacement (TAVR) is a promising option for the treatment of severe aortic valve stenosis (AS) in patients undergoing hemodialysis. Although the incidence of bioprosthetic valve deterioration (SVD) after TAVR has been reported to be lower than after surgical aortic valve replacement (SAVR), hemodialysis itself is still associated with a high risk of SVD. Until now, the factors that determine the prognosis of TAVR in hemodialysis patients were unknown. We previously reported that preoperative hypomagnesemia was correlated with an increase in postoperative mean aortic valve pressure gradient (MPG), an index of bioprosthetic valve stenosis as one of the indicators of SVD, in hemodialysis patients (Ren Fail. 2022 Dec;44(1):1083-1089). However, the study had a limited sample size of 24 cases, which raised concerns about statistical power. Therefore, we re-evaluate predictors of SVD and life expectancy in a larger number of post-TAVR hemodialysis patients.

Methods

From April 2012 to November 2021, all 100 hemodialysis patients treated with TAVR at Osaka University Hospital were included in the analysis. Pre- and post-operative demographic and laboratory data were analyzed by linear mixed-effects model and cox proportional hazards model.

Results

During the follow-up period (maximum 7 years), 4 out of 100 patients required re-TAVR (valve-in-valve) due to valve stenosis. The MPG increased over time with the lower preoperative serum Mg concentration (linear mixed-effects mode; +1.40 mmHg/year per 1mg/dl lower in Mg, p=0.006). However, serum calcium, phosphate, and intact PTH levels had no significant effect on the increase in MPG. In addition, a higher preoperative left ventricular ejection fraction (LVEF) was associated with a lower risk of death in a multivariate Cox proportional hazards model (hazard ratio [HR] 0.97 per 1% increase in LVEF; P=0.02).

Conclusions

Consistent with our previous report, preoperative hypomagnesemia was associated with increased MPG after TAVR. In addition, preoperative low cardiac function (LVEF<40%) may be a risk factor for postoperative mortality in dialysis patients.

This was a single-center observational study, and the number of patients was still small, so our data may not be necessarily applicable to every patient. Further research is needed to identify a prognostic predictor of SVD and mortality, that will lead to the prevention of adverse outcomes in hemodialysis patients.
#2524 Impact of sevelamer hydrochloride on fibroblast growth factor-23 levels in patients undergoing hemodialysis
Authors: Ahmed Fatma Abdelrahman , Khalil Amr , Elsaid Tamer
Published: May 2024

Background and Aims

Serum intact fibroblast growth factor 23 (FGF23) levels are progressively increased in relation to the severity of kidney dysfunction. High serum intact FGF23 concentration is associated with the increased cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD). Clinically, phosphate binders are commonly used to reduce serum intact FGF23 levels in CKD patients by lowering serum phosphate levels. Reduction of high intact FGF23 concentration is a strategy, possibly improving the consequences of CKD. We aimed to Assessing the Impact of Sevelamer Carbonate on Fibroblast Growth Factor-23 Levels.

Method

This case-control study enrolled 100 pre-existing hemodialysis patients, evenly divided into two groups of 50. Group I received a specific sevelamer hydrochloride (Renagel)® dose (2 tablets every 8 hrs), while Group II served as the control group and did not receive (Renagel)®. All patients received the same modality of dialysis with a consistent dialysate calcium concentration. Additionally, they received comprehensive dietary phosphate counseling as part of the standard dietary education provided to our dialysis patients. The levels of phosphorus, calcium, alkaline phosphatase, and FGF23 were assessed in all individuals at the beginning of the study (baseline) and again following 3 months of sevelamer therapy.

Results

While baseline FGF-23 levels were not statistically different, a highly significant divergence emerged after 3 months of treatment. The sevelamer group experienced a remarkable 38.4% decrease in FGF-23, compared to a mere 0.5% change in the control group, highlighting the pronounced effect of sevelamer on this key protein. Analysis of PO4 levels revealed a remarkable difference between the groups following treatment. While initial PO4 measurements were statistically comparable, the sevelamer group experienced a significantly larger decrease compared to the control group (p < 0.001). Both baseline and follow-up FGF-23 levels displayed highly statistically significant positive correlations with PO4, PTH, alkaline phosphatase, and hsCRP.

Conclusion

This study found that non-calcium-based phosphate binders were associated with a substantial reduction in FGF-23 in hemodialysis patients. This finding suggests that utilizing such binders may offer protection against the adverse effects of high FGF-23 levels, which are prevalent in this population.
#1604 LACE index as predictors of 30 day rehospitalisation among patients on maintenance hemodialysis, cohort study
Authors: Alhomrany Mohammed , Fadlallah Ayman , Samson Jennifer , Boudalia Mohamed , Alharbi Ali
Published: May 2024

Background and Aims

Over 35% of patients on maintenance dialysis are readmitted to the hospital within 30 days of hospital discharge. Validated risk assessment tools such as the LACE index (Length of stay, Acuity of admission, Co-morbidities, and Emergency department visits) have been developed to identify patients at high risk of hospital readmission in non-dialysis patients but have not been tested in dialysis patients.

Method

Data was collected from electronic medical records of patients on maintenance hemodialysis in Diaverum outpatient clinics hospitalized during 2023. Data included Age, gender, duration of hospital stay, Charlson comorbidity index (CCS), urgent or planned, and cause of Hospitalization. Multivariable logistic regression models with 30-day readmission for the same reason as the dependent outcome were used to identify readmission risk factors and whether the LACE score validly predicts 30-day rehospitalization among our cohort.

Results

Among (4829) patients received dialysis in Diaverum Saudi Arabia during 2023. (1487) episodes of hospitalization were reported due to various reasons rate of hospitalization was 0.54 Episodes per patient-years at risk, and 372(25%) of hospitalized patients were re-hospitalized for the same reason within 30 days.

The proportion of patients with 30 days of rehospitalization for the same reason was higher in patients with post-initial discharge LACE index ≥10 in comparison to patients with LACE index<10, 348(32.6%) & 24(5.7) respectively P-VALUE<0.001. also significantly higher in patients ≥65years old than those younger 163(27.7%) &209(23.3%) respectively P-VALUE<0.05, those in high risk group (defined as those with higher comorbidity index ≥6 and/or lower Individual Patient Performance Score<75) than those who are not in high risk group 215(35%) & 157(17.9%) respectively P-VALUE<0.001.

Multivariate logistic regression including covariates significantly associated with higher 30-day rehospitalization to avoid confounder effect with model including ( age, gender, dialysis duration, body mass index, comorbidity index, diabetes, vascular access, cause of hospitalization and inclusion in high-risk group ) showed significantly higher rehospitalization in patients with post-initial discharge LACE index ≥10 in comparison to patients with LACE index<10 ODDS RATIO (95%CI) 7.95(5.1-12.5) P-VALUE<0.001. independent of other covariates in the model

Conclusion

LACE index at discharge is an independent predictor of (30) days re-hospitalization in patients on maintenance Hemodialysis. Further analysis needed for a specific model for HD patients taking into consideration the unique characteristics of this cohort of patients.
#658 Analysis of cerebral blood volume and flow changes in ESRD patients undergoing hemodialysis using functional near-infrared spectroscopy
Authors: Park Bong Soo , Kim Yang Wook , Park Sihyung , Lee Yoo Jin , Heo Chang Min , Yi Jiyae , Son Sung Hyun , Bae Hoyoon
Published: May 2024

Background and Aims

End stage renal disease (ESRD) patients undergoing hemodialysis experience diverse neurological complications. However, studies regarding how hemodialysis is related to these neurological problems are limited. This study investigated cerebral blood volume (CBV) and cerebral blood flow (CBF) during hemodialysis using functional near-infrared spectroscopy (fNIRS) to analyze cerebral hemodynamic changes.

Method

ESRD patients undergoing maintenance hemodialysis without a history of neurological disorders were enrolled prospectively. The fNIRS data were collected using a NIRSIT Lite device. The fNIRS values were recorded three times for each patient: before the start of hemodialysis (pre-HD), 1 h after the start of hemodialysis (mid-HD), and after the end of hemodialysis (post-HD). The average changes in oxy-hemoglobin (HbO2), deoxy-hemoglobin (HbR), total hemoglobin (HbT, calculated as HbO2 + HbR) concentrations, and in hemoglobin concentration difference (HbD, calculated as HbO2 – HbR) were analyzed. We then compared the differences in changes in HbO2, HbR, HbT, and HbD according to the hemodialysis period.

Results

Thirty hemodialysis patients were analyzed. Between the Pre-HD and Post-HD periods, there were significant differences in changes in HbO2 (0.005 ± 0.001 µM vs. 0.015 ± 0.004 µM, p=0.046) and HbT (0.006 ± 0.001 µM vs. 0.016 ± 0.008 µM, p=0.029). Additionally, between Pre-HD and Post-HD periods, HbD tended to increase; however, this was not statistically significant (0.005 ± 0.001 µM vs. 0.014 ± 0.004 µM, p=0.094).

Conclusion

We demonstrated that during one hemodialysis session, the relative change in CBV increased post-HD compared with pre-HD. These results are expected to help understand the mechanisms underlying the effects of hemodialysis on brain function.
#1371 Cutaneous manifestations in hemodialysis patients and assessment of the changes in quality of life after 12 weeks of treatment by dermatologist
Authors: Park Ji In , Jeong Jin Seon , Kwon Jung , Kim Hee Jeong , Her Young , Lee Young , Lee Sunhwa , Baek Hyunjeong
Published: May 2024

Background and Aims

Cutaneous manifestations are frequently found in end-stage kidney disease (ESKD) and disturbing quality of life of patients under maintenance hemodialysis. Even dialysis patients frequently visit the hospital, they do not receive active dermatologic care. The aim of this study is to assess the cutaneous manifestations of hemodialysis patients and to investigate changes in quality of life before and after active treatment by dermatologists.

Method

A 12-weeks, prospective study was conducted with two centers of hemodialysis. Patients in one center received dermatologic intervention and patients in another center received supportive management by nephrologist. Patients scored their quality of life using questionnaires, Dermatology Life Quality index (DLQI) and Skindex-29, on start of study and 12 weeks later. Patients were matched between two groups according to propensity score. Simple and multiple linear regression were used to identify associations of dermatologic treatment and improvement of quality of life.

Results

A total of 120 patients from two dialysis centers were included in this study, of whom 65 as intervention group and 55 of control group. About 93.8% of patients had dermatologic manifestations, and pallor and xerosis accounted for the most proportion. Improvement in quality of life as assessed by the DLQI were confirmed after 12 weeks in overall population. However, the active intervention by a dermatologist did not affect the improvement of quality of life significantly.

Conclusion

Patients treated with dermatologic intervention by dermatologist had not improved in quality of life compared with control group. It is important for a nephrologist to carefully assess skin issues of patients with ESKD and provide the best possible treatment.
#2594 Patient-reported inter- and intradialytic symptoms in HD & HDF patients
Authors: Pham Ngoc , Cromm Krister , Zhang Yan , Schappert Anna , Liegl Gregor , Fischer Kathrin I , Fischer Felix , Rose Matthias
Published: May 2024

Background and Aims

Patients on hemodialysis (HD) experience a wide range of symptoms during and between dialysis that negatively affect their well-being. Addressing these symptoms, particularly from the patient's perspective, is a crucial component in the treatment. Our findings suggest a beneficial effect of hemodiafiltration (HDF) over hemodialysis (HD) on mortality and quality of life. This study aimed to investigate the differences in symptom severity between patients on HD and HDF.

Method

Patient-reported outcomes data of 1264 hemodialysis patients were extracted from CONVINCE, an international randomized controlled trial comparing high-dose hemodiafiltration with high-flux hemodialysis, including baseline and quarterly follow-up data up to 24 months. Symptoms were assessed using the CONVINCE peridialytic symptoms questionnaire covering inter- as well as intradialytic symptoms (see Table 1) with items scored between 0-100, higher scores indicating fewer symptoms. Prevalence and scores of all inter- and intradialytic symptom items at baseline and during follow-up visits were assessed and compared between HD and HDF groups. The association of changes of symptom scores over time with dialysis modality (HD vs. HDF) was assessed by Mixed Models for Repeated Measures (MMRM).

Results

MMRM analyses showed no significant main effects of dialysis modality on symptoms at the p <.05 level. However, descriptive statistics and plots indicated higher scores for most symptoms in the HDF group. The highest score differences between HDF and HD group over all timepoints were found for itchy skin (2.09 [95% CI −0.09-4.26]), numbness in hands or feet (2.03 [95% CI −0.22-4.28]), being washed out or drained (1.88 [95% CI −0.23-3.99]) and lack of appetite (1.73 [95% CI −0.03-3.50]). Plots for these symptoms can be found in Fig. 1. Furthermore, no significant interactions were found between dialysis modality and time, indicating that the rate of change in symptom scores did not differ significantly between the HDF and HD group.

Conclusion

No statistically significant differences in patient-reported symptoms between HDF and HD patients were found. We may not have the granularity of data to fully explore factors which may have contributed to the positive effects of HDF that have been reported previously. This might be due to the method of symptom assessment used or specific issues with perception of symptom burden. Our results highlight the complexity of symptom management in dialysis patients and underscore the need for future symptom assessments to allow for personalized treatment strategies that further optimize patient care.
#1114 Rate and reasons for peritoneal dialysis dropout following haemodialysis to peritoneal dialysis switch: a systematic review and meta-analysis
Authors: O'neill Stephen , Sun Xingge , Mckeaveney Clare , Shields Joanne , Chan Chi Peng , Henderson Matthew , Fitzell Fiona , Noble Helen
Published: May 2024

Background and Aims

Patient outcomes can be influenced by dialysis initiation and subsequent modality choices. This systematic review and meta-analysis aimed to explore the rate and reasons for peritoneal dialysis (PD) dropout following a haemodialysis (HD) to PD switch.

Method

This systematic review conducted searches in four databases, including Medline, PubMed, EMBASE, and Cochrane. The protocol was registered on PROSPERO (study ID: CRD42023405718). Outcomes included the rate and reasons for PD dropout and the mortality difference in two groups (PD first group versus HD to PD group). The Critical Appraisal Skills Programme (CASP) checklist and the GRADE tool were used to assess the quality of evidence.

Results

4971 papers were detected, and 13 studies were included. On meta-analysis, there was no statistically significant difference in PD dropout in the PD first group (OR: 0.81; 95%CI: 0.61, 1.09; I2=83%; P=0.16), however, there was a statistically significant reduction in the rate of mortality (OR: 0.48; 95%CI: 0.25, 0.92; I2=73%; P=0.03) compared to the HD to PD group. Causes for PD dropout differed between the two groups, with psychosocial reasons more common in the HD to PD group. However, inadequate dialysis and peritonitis were the main reasons for PD dropout across both groups.

Conclusion

Compared to the PD first group, a previous HD history may not impact PD dropout rates for patients, but it could increase mortality in the HD to PD group. Reasons for PD dropout differed between the two groups, but there were no statistically significant differences. Exploring psychosocial reasons for PD dropout is a valuable area for future research.
#3109 Sarcopenia in peritoneal dialysis patients
Authors: Carnevale Andreia , Domingos Diogo , Matias Patrícia , Calça Rita , Branco Patrícia , Gaspar Maria Augusta
Published: May 2024

Background and Aims

Sarcopenia is considered a frequent cause of morbidity and mortality among patients with chronic kidney disease (CKD). In clinical practice, tools such as handgrip strength and bioelectrical impedance analysis (BIA) can help us diagnose sarcopenia and possibly predict clinical outcomes. However, the outcomes associated with this diagnosis in the population of patients under peritoneal dialysis (PD) and the consequent importance of the implementation of these tools is not clear.

Method

Single-centre retrospective study with patients who started peritoneal dialysis (PD) between January 1st 2017 and December 31st 2023, with a follow-up of 18 months or until technique dropout. Demographic, clinical data and outcomes were collected. Muscle strength (measured by handgrip strength with a dynamometer) and muscle mass (estimated through BIA-derived lean tissue index (LTI)) were also evaluated. Sarcopenia was considered when low strength (handgrip strength values <27 kg and <16 kg for men and women, respectively) and loss of muscle mass (LTI <10th percentile, relative to an age and gender-matched healthy population) were present.

Results

Fifty-three patients were included, with 66% male and a mean age of 58 ± 15 years. Comorbidities included hypertension in 88.7%, diabetes mellitus (DM) in 26.4% and coronary artery disease (CAD) in 17.0%. PD vintage was 23 months (IQR 21) and most were on continuous ambulatory peritoneal dialysis (75.5%). Median Clinical Frailty Score (CFS) was 2 (IQR 1). Mean LTI was 13.2 ± 2.7 kg/m2 and average handgrip strength was 28.4 ± 8.8 kg in the right arm and 26 kg (IQR 13) in the left. Reported outcomes of number of peritonitis, outer peritoneal catheter infection, hospitalizations and MACE (Major Adverse Cardiovascular Events) episodes were low. There were 3 reported deaths during follow-up.

Six patients were considered sarcopenic, with 66% male and a mean age of 58.1 ± 14.9 years, with DM in 50%, hypertension in 100% and CAD in 33.3%. Median LTI was 9.4 (IQR 1.2), with left and right median hand grip of 24 (IQR 10) and 26 (13), respectfully. Outcomes were also low, with no statistically significant difference between sarcopenic and non-sarcopenic patients.

Conclusion

Despite being considered an indication of higher morbidity and mortality, the diagnosis of sarcopenia was not associated with worse outcomes in patients under peritoneal dialysis.
#2189 Percutaneous peritoneal dialysis catheter implantation
Authors: Soler Laura Boix I , Suárez Gabriel Manuel González , Devia Claudia Marcela Castillo , Álvarez Saltos Jehimy Jean , Cantalejo Leyre Garcia , Alemany Nadia Martín , Martínez Jordi Calabia
Published: May 2024

Background and Aims

There are three main techniques to implant a peritoneal dialysis catheter (PDC): percutaneously, laparoscopically or through open surgery; and current guidelines recommend individualising according to previous abdominal surgeries and anaesthetic risk. Recent metanalysis show the percutaneous technique to be safe, non-inferior in catheter survival, and with an equal incidence in mechanic complications (within <3 months after implantation) and infectious complications (within <1 month after implantation) to laparoscopic technique.

On the other side, as the percutaneous PDC implantation is a minimal intervention that requires neither surgery room nor over 24h hospitalisation, it allows for a lower waiting time to PDC implantation, a shorter period until usage, and it's economically efficient. Considering these benefits and its non-inferiority described in the literature, our centre started using this technique since 2018. In this study we analyse our results.

Method

This is an observational retrospective unicentric study, which included the first PDC implantation in adult patients between January 2019 and August 2023, were we analysed the mechanical and infectious complications associated with the implantation technique. All PDC were double-cuff straight Tenckhoff, placed using Seldinger technique with radioscopy. A single dose of prophylactic antibiotic was used. We considered as mechanic complication all those non-infectious incidences that required repositioning or replacement of the PDC within 3 months of implantation (excluding those patients whose catheter was removed because of kidney transplantation, death by other reasons non related to the procedure, or trespass to haemodialysis); and we considered as infectious complications all those peritonitis diagnosed the first month after implantation.

Results

We analysed a total of 147 patients, 71.4% were male, mean age was 61 years old, and mean kidney function at implantation time was 11.5 ml/min/1.73 m2. We found a total of 8.1% of mechanical complications (33% required repositioning and 66% required replacement) and 5.4% infectious complications. There were no deaths related to percutaneous PDC technique.

Conclusion

In this study we observe that mechanic or infectious complications associated with percutaneous PDC technique are similar to those published in the literature: ISPD guidelines recommend the incidence of peritonitis associated to catheter implantation to be less than 5%. And though there is no clear percentage of mechanical complications that are considered acceptable or unavoidable, many studies report a survival of 76-86% PDC at 90 days of implantation in percutaneous and laparoscopic procedures, without significant differences between them.
#2241 Validation of a new formula for total body water in peritoneal dialysis patients
Authors: Ramos Ana Rita , Duarte Rui , Alves Rita Valerio , Gonçalves Hernâni , Santos Paulo
Published: May 2024

Background and Aims

Peritoneal dialysis (PD) adequacy, assessed primarily by Kt/V, is crucial in routine clinical practice for detecting issues with PD treatment. This metric relies on urea levels and its volume (V) distribution, classically equivalent to total body water (TBW). TBW estimation, commonly achieved through the Watson and Watson (WW) formula, lacks dialysis patients in its original study, it also excluded patients with water metabolism disturbances, raising concerns about its generalizability to this population. Responding to this need, a new formula (NF) for calculating TBW in PD patients was developed in our center, with the aim of improving the correlation between administered Kt/V and clinical outcomes. Consequently, this study seeks to validate the proposed formula by applying it to a population.

Method

A prospective study conducted at a single center within PD program involved the collection of data on adequacy and Body Composition Monitoring (BCM) spanning from May 2023 to January 2024.

TBW was calculated using the WW formula and the proposed new formula (TBW BI=0.36*Height+0.241*weight−9.675*BSA−26.234 for man and TBW BI=0.36*Height+0.241*weight−9.675*BSA−28.926 for woman).

Categorical variables are presented as frequencies and percentages, continuous variables as means and standard deviations, or medians and interquartile ranges for variables with skewed distributions. A p-value < 0.05 was considered significant. Both formulas were subjected to correlation analysis with BCM TBW to assess mean differences using a paired-samples T test. Additionally, the resulting Kt/V values were compared, along with an examination of concordance in the detection of Kt/V values below 1.7.

Results

66 measurements were collected from 36 PD patients. 29.2% (n = 10) were female, and the mean age was 59.7 years. Both formulas exhibited strong correlations with BCM TBW (WW: ρ = 0.949 and NF: ρ = 0.953, p < 0.001). BCM TBW showed a significant difference from WW TBW (34.8 vs. 38.1 liters, p < 0.001), but not when compared to the new formula (34.8 vs. 33.9, p = 0.06). The resulting BCM-derived Kt/V significantly differed from both formulas, with a larger mean difference compared to the WW formula (BCM: 2.71 vs. WW: 2.42, p < 0.001, and vs. the new formula: 2.77, p = 0.04). There was a perfect association between the use of NF and identification of BCM derived KtV measurements under the 1.7 target (Phi = 1, p < 0.001), an association that was strong for WW (Phi = 0.69, p < 0.001).

Conclusion

Errors in quantifying PD adequacy can lead to delayed detection of technical issues or inappropriate adjustments to already adequate prescriptions. We present a novel formula, specific for the PD population, reducing errors in PD quantification, particularly in settings where BCM is not available.
#2519 Technical complications assessment of the novel SILENCIA© APD cycler
Authors: Martin Ovidio Manuel Jimenez , Perplies Stefan , Busink Ellen , Boeger Sophie
Published: May 2024

Background and Aims

A new gravimetric peritoneal dialysis (PD) cycler, SILENCIA (Fresenius Medical Care, Bad Homburg, Germany), has been reported to achieve not only an adequate dialysis dose, but it is proposed also to be easy to use, cost-effective, and silent. In this study, we explored the alarms, cautions and number of terminated treatments due to potential errors and malfunctions of this new cycler.

Method

Over a period of 6 months, technical related device data was collected remotely, via a cloud-based infrastructure, including a Gateway and a Card Reader. The technical related data was then analyzed and visualized in a Dashboard. In special occasions, e.g., in case of device issues additional further technical data was collected on-site at patients’ home by a Service Technician.

Results

In total, 1860 technical related device data sets were collected in 3 different countries (Chile, Ecuador, and Turkey) from the treatments of 18 PD patients. 15 out of 32 patients were between 31 and 50 years old, and the mean PD duration was 2.14 years (n = 32). In total 9 alarms (5 per 1000 treatments) occurred, 5 being related to software bugs, 4 undetermined. 99.5% of the treatments were performed without alarms. In average, 5.3 cautions per 1000 treatments were observed, 94.7% due to blocked tubing system. Power failures only occurred in 4% of the treatments, with an average duration of 38.6 minutes. During power failures, the device does not wake up patients, proceeds as the power is back and treatment stays within schedule due to FlexPoint. A detailed list of alarms, cautions and power failures is presented in Table 1.

Conclusion

The results of this study demonstrate that SILENCIA supports PD treatment with a low number of alarms and cautions, which may help to achieve a smooth therapy for the patients, especially considering that the treatments are mainly performed during the night.
#2055 Variations in free water transport condition ultrafiltration capacity since basal times
Authors: Morales Byron Andrés Chiliquinga , Gomez Astrid Rodriguez , Montero Maria Elisa Casado , Varas Carmen Martin , Garcia Leonardo Calle , Gutiérrez Paulo García , Garrote Pablo Luis Sánchez , Alonso Carlos Santos , Losada Maria Nieves , Luis Maria Jose Fernandez-Reyes
Published: May 2024

Background and Aims

There is great variability in free water carrying capacity (FFWC) in incident patients, but the extent to which this variability impacts inherent ultrafiltration failure (UF) is unknown. The peritoneal equilibration test (PET) with 3.86% glucose allows measurement of permeability (D/Pcr), standard UF (UFs) and sodium screening (CriNa) as an indirect measure of TAL.

Our objectives were to determine to what extent variations in free water transport condition a related ultrafiltration failure. To assess, according to the variables studied, whether or not the patient`s comorbidities or anthropometric data influenced our study.

Method

We conducted a study in 58 incident patients in our hospital between 2009-2023 in which we evaluated D/Pcr, UFs and CriNa in PET -3.86. We recorded the dialysis pattern and daily UF.

Results

The PET -3.86% results were evaluated (Table 1), showing the clinical and peritoneal transport characteristics of the total patients and the comparison between patients with CriNa lower or higher than the median. The patients with lower CriNa were older and had lower UFs and UFd.

We found a correlation between CriNa and UFs (0.39, p = 0.002) and daily UF (0.318, p = 0.05).

In the multiple regression analysis, CriNa and D/Pcr maintain the correlation with UFs independently. While only CriNa maintains the correlation with daily UF, despite there being no differences in the use of DPA or icodextrin.

Conclusion

On analyzing the results, we found that the intrinsic variations of the membrane, in the free water transport capacity, justify part of the ultrafiltration capacity measured both in kinetics and daily ultrafiltration. As for age, we found that the older the patient is, the lower the sodium sieving, at least initially. With this study we emphasize the importance of assessing variations in free water transport capacity using the peritoneal equilibrium test as a tool.
#2368 GHRH levels and AhR expression in CKD patients before and after kidney transplantation
Authors: Hernandez Leah , Sartirana Elisa , Almoussaui Asrah , Arefin Samsul , Barany Franz Peter , Wennberg Lars , Witasp Anna , Cantaluppi Vincenzo , Stenvinkel Peter , Kublickiene Karolina
Published: May 2024

Background and Aims

Chronic kidney disease (CKD) is an irreversible decline in renal function where kidney transplantation (KT) is the optimal therapeutic intervention. We aim to investigate the role and activation of the uremic toxin receptor aryl hydrocarbon receptor (AhR) in the microvasculature, particularly its implication in the blood-brain barrier impairment. We will also explore the potential role of growth hormone-releasing hormone (GHRH) as a biomarker reflecting the resolution of uremia-induced inflammation, early vascular ageing (EVA) phenotype, and potential enhancement in central nervous system (CNS) function post-KT.

Method

Resistance arteries from KT patients and non-CKD controls were isolated and expression of AhR was analysed by immunohistochemistry. The study used plasma samples from 60 KT patients, and levels of GHRH were measured at baseline and two years after transplantation using ELISA.

Results

Following KT, our initial findings indicate a decrease in levels of DBP, Lp(a), creatinine, homocysteine, phosphate, and troponin T among KT patients. Conversely, there was an increase in albumin, HBA1c, calcium and NfL post-transplantation. The expression of AhR in the resistance arteries of KT patients (2.6%) was notably lower compared to non-CKD controls (9.7%). Plasma concentrations of GHRH were significantly higher (p < 0.0001) in CKD-5 patients two years post-KT (2.94 ng/mL, IQR 2.60-3.43) compared to baseline (2.32 mg/L, IQR 1.84-3.24). This elevated trend in GHRH levels post-KT was observed in both sexes, with males (p < 0.0001) and females (p 0.0084) showing higher levels—males (3.0 ng/mL, IQR 2.6-3.5) and females (2.8 ng/mL, IQR 2.4-3.5)—compared to baseline level of males (2.4 ng/mL, IQR 1.8-3.2) and females (2.2 ng/mL, 1.9-3.3). No significant difference in GHRH levels was observed when assessing extreme EVA phenotypes based on the presence or absence of calcification or fibrosis.

Conclusion

Contrary to our initial expectation, the preliminary results indicate a downregulation in AhR expression within resistance vessels of CKD patients, implying modifications in AhR signaling within the uremic environment. The observed alteration in GHRH levels presents a promising avenue for further investigation focusing on its possible application as a biomarker for assessing CNS status in CKD patients undergoing KT. Prospective clinical application could involve the administration of GHRH agonists as a protective measure against cognitive impairment, considering its deficiency in CKD. Such supplementation holds promise to prevent further cognitive morbidity. The modulation in the levels of this hormone has the potential to significantly influence the treatment trajectory of CKD patients and enhance clinical outcomes.
#2314 Circulating immune complexes concentration and complement activation in sensitized kidney transplant recipients
Authors: Trivyza Maria Styliani , Tsakas Sotiris , Ntrinias Theodoros , Georgopoulou Georgia Andriana , Perdiki Panagiota , Papasotiriou Marios , Papachristou Evangelos , Goumenos Dimitrios
Published: May 2024

Background and Aims

Chronic antibody mediated rejection of the kidney transplant is the most common cause of graft loss in the late posttransplant period. Crucial in this process seems to be the role of classical pathway complement activation due to the formation of immune complexes. The formation of immune complexes is a benign process of a normally functioning immune system. In kidney transplant recipients (KTRs), the production of donor specific IgG/IgM antibodies (DSAs) against donor antigens (MHC molecules, ABO blood group antigens) leads to the attachment of immune complexes to cell membranes and subsequent tissue damage through complement activation. The attachment of C1q complement fragment to the immune complexes holds an important part in this process. This study aims to determine the levels of immune complexes as well as classical pathway complement activation in sensitized kidney transplant recipients.

Method

In this cross-sectional study 3 groups of KTRs were compared as to the levels of immunocomplexes concentration and classical pathway complement activation. Fourteen KTRs with preformed or de novo donor specific antibodies were compared to 28 kidney transplant recipients with no DSAs and to 22 subjects with no history of chronic kidney disease (controls). We used MicroVue Complement CIC-C1q EIA that is designed to detect immunocomplexes that bind to C1q in human serum or plasma. In order to estimate total classical pathway complement activation in serum, we used MicroVue Complement CH50 Eq EIA.

Results

Kidney function (eGFR) of KTRs with and without DSAs was similar (53.1 ± vs. 60.8 ± ml/min/1.73 m2, p = 0.54) but lower in comparison to controls (106.4 ml/min/1.73 m2, p < 0.001). We found a significantly higher concentration of C1q-immunocomplexes in the serum of KTRs with donor specific antibodies, in comparison to controls, as well as to the group of kidney transplant recipients with no DSAs (6.78 ± 2.7 vs. 4.83 ± 1.9 vs. 5.04 ± 1.2 μgEq/ml respectively, p = 0.0078). Furthermore, there was no significant difference of C1q-immunocomplexes between kidney transplant recipients with no DSAs and controls. Finally, a significant reduction of CH50 levels was observed in KTRs with DSAs as compared to controls and KTRs with no DSAs (39.2 ± 14.9 vs. 70.6 ± 34.3 vs. 67.9 ± 39.9 U/ml respectively, p = 0.003), which suggests higher levels of classical pathway complement activation. CH50 levels in KTRs with DSAs, who were further subcategorized in those with preformed and those with de novo DSAs were similar (39.68 ± 15.6 vs 39.08 ± 16.04 U/ml).

Conclusion

Kidney transplant recipients with donor specific antibodies have increased serum levels of immune complexes and increased classical pathway complement activation.
#1181 The relationship between renal ischaemia-reperfusion injury and circadian rhythm
Authors: Yamaguchi Misuhiro , Hitaka Yukihiro , Nakamura Kimihiko , Hiroyoshi Toshiya , Isoyama Naohito , Nagao Kazuhiro , Shiraishi Koji
Published: May 2024

Background and Aims

Kidney disease is a global health problem in which various aetiologies contribute to renal injury and dysfunction. Renal ischaemia-reperfusion injury (IRI) is a condition caused by early oxidative stress due to renal tissue ischaemia and a rapid immune response after reperfusion. Circadian rhythms are important regulators of metabolism and their disruption can lead to heart disease and fibrosis in various organs. Although recent reports have shed light on the impact of renal injury and disease on the renal circadian clock, the exact mechanisms by which circadian rhythm genes contribute to the progression of renal dysfunction in IRI and the onset of chronic kidney disease (CKD) are not fully understood.

Method

Male Wistar rats (8-9 weeks old, 250-280 g body weight) were used to establish the I/R model. To induce renal I/R injury, the left renal artery was clamped for 30 or 45 min and then removed to restore blood flow. Simultaneously, nephrectomy of the right kidney was performed; renal tissue and blood were collected 14 days after I/R. HE staining, Sirius red staining and immunostaining (F4/80 staining) were performed. Kidney tissue was RNA-seq'd and qPCR'd for circadian rhythm genes and fibrosis genes involved in kidney failure that were altered by I/R. Kidney tissue was also RNA-seq'd and qPCR'd for circadian rhythm genes and fibrosis genes involved in kidney failure. We also established an in vitro hypoxia-reoxygenation (H/R) model using single cell RPTECs and performed qPCR and Western blotting.

Results

In the IRI rat group, the expression of circadian repressor genes Nr1d1 and Nr1d2, which are important for reducing inflammation, decreased, while the expression of Bmal1 and Cry1, which regulate renal deterioration, increased. Using RNA-seq, we also identified the involvement of the TGFβ pathway in linking the circadian clock to kidney injury and fibrosis, and observed similar results in the H/R group using RPTEC cells in vivo.

Conclusion

Fibrosis and circadian rhythms were found to be closely related in renal IRI. The findings described here may help in the development of new therapeutic approaches to ameliorate the effects of renal IRI and improve the outcome of kidney disease, including kidney transplantation, offering hope to patients worldwide.