bluuebunny/crossref_metadata_2025 huggingface dataset:
MO819: The Negative Impact of Reuse of Dialyzers on Survival Rates of Dialysis Patients
Authors: Sharapov Olimkhon
Published: May 2022

BACKGROUND AND AIMS

Until 2019, in Uzbekistan, disposable dialyzers for dialysis were reused several times due to underfunding of the system. But in 2018, the President of the Republic of Uzbekistan Shavkat Mirziyoyev signed a decree on improving the nephrological and dialysis services in the country. After that, there is a sharp increase in funding and attention to the provision of hemodialysis care to the population of our country. Thanks to this Resolution, since 2019, in all regions of Uzbekistan, only disposable dialyzers are used for hemodialysis.

To prospectively study the negative impact of the reusable use of disposable dialyzers on dialysis patients in Uzbekistan.

METHOD

The study took place in three dialysis centers in the country at different levels. Our observation of 165 (90 men and 75 women) patients took place for 2 years: from the beginning of 2018 to the end of 2019. The average age of the patients was 49.7 ± 14.1 years. During the first 12 months (before the release of the decree of the President of the Republic and funding), dialysis patients underwent multiple uses of dialyzers. The next 12 months were completely switched to single use. The average age of the patients was 48.1 ± 14.3 years. The average duration of hemodialysis was 37 (6–252) months. Survival was assessed using the Kaplan–Meier method. The confidence interval was determined by Greenwood.

RESULTS

During the 24 months of observation, out of 165 patients, 29.1% (n = 48) patients died, 70.9% (n = 117) survived (of which 11 patients underwent Tx). During 1 year of follow-up (the period of repeated use of disposable dialyzers), 21.2% (n = 35) patients died, 78.8% (n = 130) survived and continued to receive hemodialysis (6 patients Tx). A total of 68.6% (n = 24) of patients died from cardiovascular complications. The survival rate for 1 year (miltiple use period) was S(t) = 0.796 [95% confidence interval (95% CI) 0.736–0.856]. Over the next 12 months (single use period), out of 124 patients continuing to receive hemodialysis, 10.5% (n = 13) patients died, 89.5% (n = 111) patients survived (5 patients Tx). A total of 53.8% (n = 7) of these deceased patients died from CVD. The survival rate at the second year (single use period) was S(t) = 0.894 [95% CI 0.839–0.948].

CONCLUSION

Compliance with the standards for hemodialysis, in particular, the single use of disposable dialyzers for hemodialysis sessions, leads to a decrease in the lethality of dialysis patients. The transition from multiple to single use of disposable dialyzers in one dialysis center in Uzbekistan showed a significant increase in survival of 12.3%.
MO856: Immunogenicity and Adverse Events After Vaccination With GAM-COVID-VAC (Sputnik V) in Patients on Maintenance Haemodialysis Compared With Healthy Controls: A Preliminary Report
Authors: Parshina Ekaterina , Tolkach Alexey , Ivanov Andrey , Kislyy Pavel
Published: May 2022

BACKGROUND AND AIMS

Recent studies evaluated safety and efficacy of vaccines against coronavirus disease (COVID-19), but none of them are currently approved in Russia. Here, we report results on immunogenicity of the recombinant adenovirus (rAd) 26 and rAd5 vector-based COVID-19 vaccine Gam-COVID-Vac (Sputnik V, developed by Gamaleya National Research Centre, Russia) in patients, receiving maintenance haemodialysis (HD). We aimed to compare the strength of humoral and cellular immunity after 2 doses of Gam-COVID-Vac in patients receiving HD and individuals with normal kidney function.

METHOD

The prospective cohort study (NCT: 04 805 632) included 23 patients treated with maintenance HD and 28 volunteers with normal kidney function. All participates were adult, had been fully vaccinated with Gam-COVID-Vac vaccine and had no prior history of suspected or confirmed COVID-19. Subjects were excluded if they had a history of confirmed SARS-CoV-2 infection, had underlying autoimmune disease, malignancies or concomitant immunosuppressive therapy. In all participants the levels of specific IgG were quantified at 4 weeks after second vaccine dose administration using a semi-quantitative SARS-CoV-2 S1 IgG enzyme-linked immunosorbent assay. In all subjects, specific CD4+ and CD8+ T-lymphocyte responses (count of spots to spike structural peptide of SARS-CoV-2 virus in IGRA test) were evaluated at the same timepoint. All the participants were asked to report adverse events (AEs) following first and second vaccine administration, included general malaise, fever, myalgia, headache, allergic reactions and injection site reactions.

RESULTS

Overall, the incidence of vaccine-associated AEs was less in HD patients than in healthy controls: 32% versus 75% after both first and second vaccine administrations, RR = 0.46 (95% confidence interval 0.24–0.79), P = 009 (Table 1). The most commonly reported AE in both groups was pain in the injection site. No severe or serious AEs occurred in both patients and healthy controls. The seroconversion rate in 4 weeks after second vaccine shot reached 100% (28 of 28) in healthy subjects and 87% (20 of 23) in patients receiving HD. IgG levels did not differ between groups: 4.7 [Q1-Q3: 3.37; 6.25] in HD patients versus 5.5 [Q1-Q3: 3.3; 7.2] in controls, P = 0.219 (Figure 1A). The T-test result was positive in 70% (16 of 23) of HD patients and in 79% (22 of 28) of controls. The magnitude of T-cell response was comparable between groups: 30 spots [Q1-Q3: 11; 48] in HD patients versus 30 spots [Q1-Q3: 14; 51] in controls, P = 0.745 (Figure 1B).

CONCLUSION

Patients receiving HD develop efficient humoral and cellular immune responses after complete vaccination against COVID-19 with Gam-COVID-Vac vaccine, which is comparable with those in healthy adults.
MO858: Early Morning Haemodynamic Changes and Left Ventricular Hypertrophy and Mortality In Haemodialysis Patients
Authors: Mallamaci Francesca , Tripepi Rocco , Torino Claudia , Luigi Tripepi Giovanni , Sarafidis Pantelis , Zoccali Carmine
Published: May 2022

BACKGROUND AND AIMS

Amplified early morning increase in BP, a phenomenon accompanied by a parallel rise in heart rate (HR), is a marker of high cardiovascular risk in the general population. The early morning changes in these parameters have not been investigated in the haemodialysis population.

METHOD

In a pilot, single centre, study including a series of 58 haemodialysis patients we measured the pre-awakening BP and HR surges and the nocturnal dipping of the same parameters as well as other established indicators of autonomic function (weighted 24h systolic BP and HR variability) and tested their relationship with the left ventricular mass index (LVMI) and with the risk of death over a median follow up of 40 months.

RESULTS

The pre-awakening HR surge (r = –0.46; P = 0.001) was inversely associated with LVMI and the risk of death [HR (1 unit): 0.89, 95% confidence interval: 0.83–0.96; P = 0.001] while the corresponding BP surge largely failed to associate with these outcomes. The link between the pre-awakening HR surge with LVMI and death was robust and largely independent of established risk factors in the haemodialysis population, including the nocturnal dipping of BP. Weighted 24 h systolic BP and HR variability did not correlate with LVMI (all P > 0.11) nor with the risk of death (P > 0.11) and these parameters were also independent of the nocturnal dipping of systolic BP and HR.

CONCLUSION

This pilot study suggests that the low early morning changes in HR, likely reflecting enhanced sympathetic activity, entail a high risk for LVH and mortality in the haemodialysis population.
MO871: COVID-19 in Dialysis Patients, a South African Experience
Authors: Clark Chevon , Katz Ivor
Published: May 2022

BACKGROUND AND AIMS

The first documented case of SARS-CoV-2 infection was diagnosed in South Africa on the 5 March 2020 and a pandemic declared on the 25 March 2020. Patients on dialysis are at increased risk for COVID-19 infection due to their high burden of comorbidities, impaired immune response, need to attend dialysis and the higher incidence of severe disease. In this study, we evaluated the prevalence, clinical management and outcome of dialysis patients and dialysis healthcare workers who tested positive for COVID-19. Further, the study aimed to provide insight into strategies to minimize COVID-19 spread in outpatient dialysis facilities.

METHOD

A retrospective cohort study was conducted on 1382 chronic dialysis patients and 292 healthcare workers from 69 chronic haemodialysis centres and 17 home therapy divisions who have tested COVID-19 positive from the 5 March 2020 until the 26 July 2021.

RESULTS

From the 1382 chronic dialysis patients who tested positive during the study, the mean age was 57.5 ± 12.7 years of age; 61.3% of patients were male and 38.7% female. COVID-19 re-infection was prevalent in 3.5% (n = 48) of the chronic dialysis patient population within the study duration. The overall 28-day mortality rate for patients testing COVID-19 positive was 13.1% (n = 181). The mean age of patients succumbing to COVID-19 was 63.6 ± 11.1 years of age. A further, 292 healthcare workers tested positive during the study duration, 63.4% (n = 185) were frontline healthcare staff (nurses or clinical technologists) and 22.9% (n = 67) were support services and 13.7% (n = 40), were administrative staff. Only one staff member succumbed to COVID-19 (0.3%). At the end of the study duration 69% of healthcare workers and 27.6% of patients had been vaccinated.

CONCLUSION

The COVID-19 pandemic has had a significant impact on chronic dialysis patients. Dialysis patients are associated with more adverse clinical outcomes and increased mortality. In South Africa, better vaccination rates and more dosing and appropriate preventative strategies remain our strongest defense to mitigate excess cases and death.
MO877: Dynamics of SARS-COV-2-Spike-Reactive Antibody and T-Cell Responses in Chronic Kidney Disease Patients Within 3 Months After Covid-19 Full Vaccination
Authors: Panizo Gonzalez Nayara , Albert Eliseo , Gimenez-Civera Elena , Solano Rivera Camila , Jesús Puchades Montesa Maria , Gandia Lorena , D'marco Luis , Maria Pérez-Baylach Carmen , Bonilla Begoña , Sancho Asunción , Gavela Eva , Gonzalez-Rico Miguel , Montomoli Marco , Fernanda Alvarado Maria , Torregrosa Maicas Isidro , Navarro David , Luis Gorriz Teruel Jose
Published: May 2022

BACKGROUND AND AIMS

Little is known regarding the dynamics of antibody and T-cell responses in chronic kidney disease (CKD) following COVID-19 vaccination.

METHOD

Prospective observational cohort study including 144 participants on haemodialysis (HD) (n = 52), peritoneal dialysis (PD) (n = 14), kidney transplantation (KT) (n = 30) or advanced chronic kidney disease not on dialysis (ACKD), and healthy controls (n = 18). Anti-Spike(S) antibody and T-cell responses were assessed at 15 days (15D) and 3 months (3M) after vaccination.

RESULTS

Anti-S antibodies at 15D and 3M were detectable in 95% (48/50)/98% (49/50) of HD patients, 93% (13/14)/100% of PD patients, 67% (17/26)/75% (21/28) of KT patients and 96% (25/26)/100% (24/24) of ACKD patients. Rates for healthy controls were 81% (13/16)/100% (17/17). Antibody levels decreased at 3M in HD (P = 0.04), PD (P = 0.008) and ACKD patients (P = 0.0009). In KT, patients levels increased (P = 0.04) between 15D and 3M,  although they were low at both time points.

Detectable T-cell responses notably increased at 3M in HD patients (P < 0.022). In PD, patients response increased by 15D (13/14; 93%) and 3M (9/9; 100%), while they were present in KT patients at 41% (12/27), 84% (22/26) and 96% (25/26) at baseline. Detectable T-cell responses in ACKD patients reached 80% (20/25) and 89% (17/19) at 15D and 3M,  respectively. whereas in healthy controls it was 67% and 89% at 15D and 3M.

CONCLUSION

 Most HD, PD and ACKD patients develop SARS-CoV-2-S antibody responses comparable to that of healthy controls, in contrast to KT recipients. Antibody waning at 3M was faster in HD, PD, ACKD patients. No differences in SARS-CoV-2 T-cell immunity responses were noticed across study groups.
MO894: Mortality and Hospitalization Impact of COVID Vaccination on Dialysis Patient in Latin America
Authors: Guinsburg Adrian , Inés Díaz Bessone Maria , Carlos Berbessi Juan
Published: May 2022

BACKGROUND AND AIMS

COVID-19 vaccination had showed high efficacy in general population. Given patients with kidney failure are at higher risk for death and hospitalization, it is important to understand efficacy of vaccines within this group. Our aim was to analyze the impact of COVID-19 vaccination in mortality and hospitalization for a large dialysis population from Fresenius Medical Care Latin America (FME LatAm).

METHOD

Patients undergoing hemodialysis (HD) or peritoneal dialysis (PD) in FME LatAm centers at any time between December 2020 and June 2021 were included. They were classified according to their vaccination status in June 2021 as Not Vaccinated (NV, patients who did not receive any dose), Incompleted Vaccinated (IV, incomplete dosing according to label) or Complete Vaccinated (CV, full scheme dosing according to label). Patient's risk started at December 2020 for NV or 15 days after last dose for IV and CV. Risk finished at death, hospitalization, lost to follow-up or end of the study. All-cause hospitalization and mortality rates were analyzed between groups during the observation period. Kaplan–Meier (KM) was used for univariate analysis while Cox regression models were constructed to control for several confounders. Values are expressed as mean ± SD.

RESULTS

A total of 41 728 patients from 257 centres in 6 countries (Argentina, Brazil, Chile, Colombia, Ecuador and Perú) were included. As expected, based on selection bias by vaccination policies at early stages of COVID pandemic, patients who received CV were older than IV and NV (CV: 62.5 ± 14.5 years; IV: 57.6 ± 14.8; NV: 54.6 ± 17.3; P < 0.0001). Similarly, prevalence of diabetes was higher in CV (CV: 22.6%; IV: 16%; NV: 16.8%; P < 0.0001). Survival analysis showed a significant difference between groups (log rank test = 115.9 P < 0.005), while hospitalizations showed similar differences (log rank test = 3022 P < 0.005), being patients with CV those with the lowest risk of death or hospitalization events (Figure 1). After adjusting for demographics and laboratory values, Cox regression models showed increased risk of death for NV {HR = 5.42, [95% confidence interval (95% CI): 3.96–7.44]} and IV (HR = 4.32, 95% CI: 3.15–5.91) and increased risk of hospitalization for NV (HR = 18.6, 95% CI: 15.9–21.7) and IV (HR = 1.8, 95% CI: 0.79–1.5) as compared with CV (Table 1).

CONCLUSION

CV patients showed better survival as compared with IV and NV in univariate models. While CV showed different demographics characteristics, multivariate models still showed, after control for age, gender, diabetic status and main lab values, a 5-fold increase in mortality risk and 18-fold increase in hospitalization risk for NV as compared with CV.

All efforts should be focused on vaccinating dialysis population to temper the impact of the disease.
MO900: Diuretic Prescription Patterns in Haemodialysis Patients: International Variation Reported in the Dopps
Authors: Tabibzadeh Nahid , Wang Dongyu , Karaboyas Angelo , Robinson Bruce , Young Eric , Schaeffner Elke , Jacobson Stefan , Vega Almudena , Al Rukhaimi Mona , Nitta Kosaku , Bieber Brian , Port Friedrich , Antonio Urena Torres Pablo
Published: May 2022

BACKGROUND AND AIMS

Loop diuretic use during maintenance haemodialysis (HD), including use of very high doses in Europe, is thought to maintain diuresis and reduce interdialytic weight gain, but is based on little evidence, with impact on clinical outcomes unclear. To help better inform international therapeutic strategies, we investigate regional variation in loop diuretic use and dosing strategies.

METHOD

This study included 71 756 HD patients from the international Dialysis Outcomes and Practice Patterns Study (DOPPS) phases 2–5 (2002–15), including 27 759 patients with dialysis vintage (time since HD initiation) <1 year. We report the proportion of patients in each country prescribed a diuretic (loop, thiazide or other) by dialysis vintage. Among patients with vintage < 1 year at enrollment and prescribed a loop diuretic, we report the distribution of loop diuretic dose (mg/day) by country. Doses of torsemide (4:1) and bumetanide (80:1) were converted to oral furosemide-equivalent dose.

RESULTS

Diuretic use varied widely by country, ranging at vintage < 3 months from >80% in Germany and Sweden to < 35% in the US, Spain, and Gulf Cooperation Council (GCC) countries (Figure 1). The proportion of patients prescribed a diuretic decreased with dialysis vintage in all countries. At vintage >5 years, diuretic use was 30%–35% in Germany and Sweden and < 20% in other countries. In all countries, >90% of diuretic prescriptions were for loop diuretics. Loop diuretic dose varied widely across countries. Among patients with vintage < 1 year, median dose ranged from 400–500 mg/day in Belgium, France, Germany and Sweden to < 100 mg/day in the GCC, Japan, Spain and the US (Figure 2).

CONCLUSION

We observed substantial international differences in diuretic prescription patterns to HD patients, with usage and doses much higher in some European countries than the US, where high-dose formulations are not available. The potential impact of diuretic prescription patterns on outcomes, including residual urine volume, volume-related complications and others should be investigated.
MO903: Associations of Serum Sodium With Mortality in Patients on Maintenance Haemodialysis Treatment
Authors: Pinter Jule , Genser Bernd , Stuard Stefano , Canaud Bernard , Moissl Ulrich , Wanner Christoph
Published: May 2022

BACKGROUND AND AIMS

Chronic HD-patients have a 50% 5-year survival and unphysiological fluid and sodium shifts are key pathophysiological contributors. Several studies have shown that hyponatremia is associated with worse outcomes in haemodialysis patients. However, the association of all-cause mortality with volume status in hyponatremic patients is uncertain. Body composition monitoring has provided a more precise tool to estimate fluid status in dialysis patients. The primary aim of this international observational study performed in a large patient database (EUCLID5) was to quantify the association between salt exposure, fluid overload (FO) and mortality risk in haemodialysis patients.

METHOD

We included 71 706 incident haemodialysis patients from 1 January 2010 to 4 December 2020 in an extended Cox regression model for a time to death analysis. Exposure variables were defined as predialysis serum sodium and fluid overload (in liters as determined by the BCM—Body Composition Monitor using bioimpedance spectroscopy) on a monthly time grid. Effect modifiers, mediators, confounders and predictors were defined a priori. Adults were included with at least one valid BCM measurement within 3 months from first haemodialysis treatment and followed up until death or administrative censoring. All patients included in the study cohort were treated in the NephroCare–FMC dialysis centre network operating in 26 countries. Data were retrieved from the central EuCliD5 database.

RESULTS

In hyponatremic patients (serum sodium < 135 mmol/L),  the association to the risk of death doubled [(HR = 1.97 (1.82–2.12)] in overhydrated patients (relative FO defined as 13% in men, and 15% in women >90th percentile of physiological hydration), was increased by 56% [HR = 1.56 (1.27–1.93)] in underhydrated patients (<–7% <10th percentile of normohydration) and was modestly higher in states of isovolemia (–7%–13% in women and 15% in men). The associated risk of death in states of overhydration decreased [HR = 1.50 (1.27–-1.76)] when patients were hypernatremic (serum sodium >142 mmol/L),  (Table 1). Generally, the risk increased with rising FO and declining sodium concentration.

CONCLUSION

The observed associations to the risk of death reflecting the interplay between states of hypo-, iso- and hypernatremia and states of under, normal and over hydration deserve further study to understand the underlying complex mechanisms and identify therapeutic approaches. When assessing the risk level of different sodium concentrations, fluid status should be taken into account.
MO908: The Impact of The COVID-19 Pandemic on Hospitalization Rate of Patients With ESKD in a Tertiary University Hospital of Thessaloniki, Greece
Authors: Karlafti Eleni , Vaios Vasilios , Georgianos Panagiotis , Vareta Georgia , Leonidou Kalistheni , Varouktsi Garyfallia , Savopoulos Christos , Zebekakis Pantelis , Liakopoulos Vassilios
Published: May 2022

BACKGROUND AND AIMS

During the coronavirus disease-2019 (COVID-19) pandemic, the National Healthcare System of Greece was reorganized in order to cover the expected rise in hospitalizations of critically ill patients with COVID-19 infection. Accordingly, the aim of the present study was to explore whether the onset of the pandemic influenced the hospitalization rate of patients with end-stage kidney disease (ESKD) in a large tertiary university hospital in the metropolitan region of Thessaloniki, Greece.

METHOD

In this observational study, we retrospectively collected data regarding the hospitalizations of ESKD patients in the section of Nephrology of the first Department of Internal Medicine at the AHEPA University Hospital of Thessaloniki. We provide a comparative evaluation of the number of hospitalizations, demographic characteristics of patients and in-hospital outcomes between the 1-year-long period before (1 March 2019–29 February 2020) and the corresponding period after the onset of the COVID-19 pandemic (1 March 2020–28 February 2021).

RESULTS

Over the 1-year period before the onset of the pandemic, 149 ESKD patients with various complications were hospitalized in our department. During the control period, we recorded only 90 non-COVID-19 hospitalizations of ESKD patients (Table 1). There was no significant difference in the age and gender of patients who were hospitalized before and after the onset of the pandemic. Furthermore, the median duration of hospitalizations and the in-hospital mortality rate were comparable between the two periods. Over the 1-year-long period after the onset of the pandemic, our department provided care to 50 ESKD patients (32 males and 18 females) with COVID-19 infection who had a mean age of 66.3 ± 16.1 years. Of these, 33 patients (66%) were given discharge from the hospital, and the remaining 17 patients (34%) died.

CONCLUSION

This single-centre observational study shows a significant reduction in non-COVID-19 hospitalizations of ESKD patients in a tertiary University Hospital of Thessaloniki after the onset of the pandemic. However, the demographic characteristics of patients who were hospitalized, the duration of in-hospital care and clinical outcomes were comparable between the pandemic and control periods.
MO910: Anti-COVID-19 Vaccination and Haemodialysis: Safety During the Haemodialysis Session
Authors: Odone Ludovica , Lugli Gianmarco , Bagalà Alfredo , Pirolo Biagio , Spatoliatore Giuseppe , Rosati Alberto
Published: May 2022

BACKGROUND AND AIMS

A complex interplay lies between COVID-19 infection and kidney disease. Patients with COVID-19 are at an increased risk of acute kidney injury (AKI), while CKD patients represent a population at a high risk of mortality from COVID-19 [1]. For 3 years, our hospital has been running an intradyalitic vaccination project (HBV, Haemophylus, Pneumococcus, Influenza) for haemodialysis patients. No data regarding the anti-COVID-19 vaccination administered during the dialysis session are available yet. This is a safety study aimed at defining the feasibility of this vaccination protocol.

METHOD

A total of 186 haemodialysis patients from 3 centres were vaccinated with the Spikevax-Moderna vaccine (Fig. 1). According to Italian law, patients with a COVID-19 infection in the previous 12 months received only one dose. The administration was performed between 1 and 2 h after the start of the dialysis session. Data regarding mild adverse events were collected. In 117 patients, a titration of the anti-RBD S1 antibodies of the virus spike antigen was performed 1 month after the completion of the vaccination [2]. Therefore, a new titration was obtained after 3 months in 50 patients.

RESULTS

Of the 117 patients, 65 (55.5%) were male, with a mean age of 69.2 ± 13.1 years. Of these, 25 patients (21.3%) showed mild adverse events without compromising dialysis administration. No serious adverse events took place. Seroconversion was noticed in 111 patients (94.9%) after 1 month, with a mean anti-RBD S1 antibody titer of 751.1 ± 610.5 BAU/mL. When a new titration was performed after 3 months, the titer decreased to 203.1 ± 134.3 BAU/mL (t-test; P = 0.005).

CONCLUSION

Intradialytic vaccination is a procedure with an excellent safety profile that may be implemented in dialysis settings. Further studies should be permormed to confirm these results.
MO914: Development of Antibody Response to SARS-COV-2 Vaccines in Haemodialysis Patients
Authors: Fuessl Louise , Lau Tobias , Paal Michael , Rau Simon , Arend Florian , Bruegel Mathias , Fischereder Michael , Schoenermarck Ulf
Published: May 2022

BACKGROUND AND AIMS

Previous data has shown a reduced immune response shortly after SARS-CoV-2 vaccinations in haemodialysis patients. We therefore investigated the long-term antibody response in patients from different outpatient dialysis centres at 4 weeks and 6 months after a complete vaccination against COVID-19. The results were compared with the humoral responses of non-dialysis subjects.

METHODS

We designed a retrospective multicentric cohort study, enrolling 106 haemodialysis patients and 50 non-dialysis patients after the SARS-CoV-2 vaccination. SARS-CoV-2 antibody testing was performed as part of routine clinical practice 4 weeks as well as 6 months after the immunization with chemiluminescence immunoassays designed to detect antibodies against the SARS-CoV-2 spike protein (Elecsys Anti-SARS-CoV-2 S, Roche Diagnostics, Mannheim, Germany). Testing was performed in the Institute of Laboratory Medicine of the University Hospital Munich. According to the manufacturer's specifications, anti-SARS-CoV-2 S titres >0.8 U/mL are considered reactive (sensitivity 98.8% and specificity 99.9%). Anti-SARS-CoV-2 S titres < 100 U/mL were defined as a low antibody response.

RESULTS

A total of 106 haemodialysis patients with a median age of 73 years received a SARS-CoV-2 vaccination (n = 105 mRNA, n = 1 AstraZeneca). Of these, 50 non-dialysis patients with a median age of 56 years received a SARS-CoV-2 vaccination (n = 45 mRNA, n = 5 mRNA/AstraZeneca). During the observational period, 8 haemodialysis patients and 2 non-dialysis patients additionally contracted a SARS-CoV-2 infection.

Between the two testings, an overall decrease in anti-SARS-CoV-2 S antibody titres was observed (haemodialysis patients from a median of 252 to 95 U/mL, non-dialysis patients from a median of 1621 to 441 U/mL). At 6 months after the complete vaccination, 99 (93%) haemodialysis patients still presented with a detectable anti-SARS-CoV-2 spike antibody response (>0.8 U/mL), comparable to 100% of the non-dialysis subjects. However, 60 (57%) haemodialysis patients showed low antibody response (<100 U/mL), whereas only 5 (10%) non-dialysis patients presented with low antibody response.

Patients with an additional infection showed an increased titre of antibodies during follow-up.

CONCLUSIONS

Our data suggest regular antibody testing as well as a need for booster vaccination in the vulnerable population of haemodialysis patients.
MO915: Factors Related to Chronic Kidney Disease–Associated Pruritus in Patients Undergoing Haemodialysis and its Effects on Quality of Life
Authors: Yüksel Emre , Ugur Yalcin Ahmet
Published: May 2022

BACKGROUND AND AIMS

Chronic kidney disease-associated pruritus (CKD-aP) is an often overlooked, common and debilitating problem for patients undergoing haemodialysis. Although the prevalance of CKD-aP has decreased over the years, it continues to be a problem associated with quality of life impairment, sleep disturbances, increased mortality and morbidity. With this study, we aim to investigate factors related to CKD-aP and its impact on patients’ quality of life.

METHOD

We conducted a cross-sectional study of in-centre HD patients in the city of Eskişehir, Turkey. A total of 298 patients undergoing HD for >3 months were enrolled in the study. We analysed demographic characteristics, routine laboratory values, interdialytic weight gain, residual urine output, xerosis, 5D itch scale scores (multidimensional itch-related questionnaire), VAS score (ranging from no itching to the worst itching imaginable) and LANSS score (neuropathic pain assessment scale) of enrolled patients.

RESULTS

Mean age of 298 patients was 64.6 ± 13.2 and 52% of patients were male. Pruritus prevalence in the study group was 45%. The 5D scores were higher among patients with < 200 mL residual urine output versus patients with >500 mL residual urine output (P = .034). The 5D scores were higher among patients with xerosis (P < .001). The 5D scores were again higher among patients with a LANSS score of ≥ 12 (P < .001). The 5D scores were lower among the low-flux membrane group versus the high-flux membrane group (P = .001). The 5D scores were correlated with interdialytic weight gain (r = 0.124; P = .033), Kt/V (r = –0.228; P < .001), ALT levels (r = 0.135; P = .02), total iron binding capacity (r = .13; P = .025) and VAS scores (r = 0.969; P < .001). There were no statistically significant correlations between 5D scores and age, body mass index, HD duration, creatinine, BUN, calcium, phosphorus, calcium-phosphorus product (CAxP) and other routinely tested laboratory values.

CONCLUSION

In our study, we identified residual urine output, xerosis, neuropathic pain, HD membrane type, interdialytic weight gain, Kt/V, ALT and TIBC as factors related to CKD-aP. The strong relationship between itch severity and neropathic pain scores was especially notable. More research in this field may be beneficial for identifying new therapeutic targets for CKD-aP.
MO923: Electronic Medication Record Accuracy and Clinical Pharmacist Intervention in Haemodialysis Outpatient Settings
Authors: England Gillian , Davin Dawn , Lavin Peter , Wall Catherine , Deasy Evelyn , Mellotte George J
Published: May 2022

BACKGROUND AND AIMS

Haemodialysis (HD) units in Ireland operate a national electronic Kidney Disease Clinical Patient Management System (KDCPMS). KDCMPS is not always used as the primary electronic patient record (EPR) but in conjunction with other electronic and paper record systems across the healthcare setting.

HD patients on average have 6 comorbidities and have the largest pill burden for any chronic disease; consuming 19 oral doses/day, comprising of 12 different medicines [1, 2]. Frequent medication changes, polypharmacy, comorbidities and non-adherence, increase the risk of drug-related problems (DRPs). In the HD population, DRPs are prevalent at a rate of 1 for every three medication exposures and can elicit negative outcomes, including worsening morbidity, mortality and increased healthcare expenditure [3].

In this study setting, KDCPMS information accuracy has not been examined to date. This study aims to describe medication discrepancies within KDCPMS records of HD outpatients.

METHOD

This prospective, observational study was conducted in the HD unit of Tallaght University Hospital, Dublin.

Medicine reconciliation was conducted to identify KDCPMS discrepancies, followed by medication review to document DRPs. Recommendations were issued by the clinical pharmacist to resolve DRPs.

RESULTS

All KDCPMS records examined contained intentional and unintentional discrepancies (n = 36). Unintentional discrepancies corresponding to 8.8 discrepancies per patient (5.13SD) were observed.

A total of 143 DRPs were identified in 34 patients (94.4%) (Table 1). Out of these, 65% of pharmacist recommendations were accepted (n = 93), 22.4% were rejected (n = 32), 8.4% (n = 12) were referred to the renal multidisciplinary team (MDT) and 4.2% were not actioned (n = 6).

Discrepancies and DRPs by therapeutic area are shown in Fig. 1. Parenteral anticoagulants and thrombolytics were the most common undocumented intentional discrepancies (48.6%, n = 50/103) followed by iron (32%, n = 33/103).

A total of 16 (44.4%) patients had at least one medicine de-prescribed. New prescriptions were issued for 26 patients (72.2%) for 81 medicines.

CONCLUSION

KDCPMS contains inaccuracies that could lead to systemic error. Robust clinical governance supported by the national policy is required to improve the accuracy of information contained in KDCPMS and support its use as the primary platform for renal patients. Specialist clinical pharmacists working collaboratively within the renal MDT reduce discrepancies, improve KDCPMS accuracy and resolve DRPs. Enhanced pharmaceutical care by specialist pharmacists should be supported within national models of care for chronic disease management to enhance patient outcomes.
MO951: Chemerin as A Predictor of Poor Outcome in Kidney Transplant Recipients—is There A Relationship With Anemia?
Authors: Batko Krzysztof , Koc- Żorawska Ewa , Zorawski Marcin , Dumnicka Paulina , Banaszkiewicz Małgorzata , Woziwodzka Karolina , Krzanowski Marcin , Gołasa Paulina , Kurnik Anna , Panek Agnieszka , Małyszko Jacek , Malyszko Jolanta , Krzanowska Katarzyna
Published: May 2022

BACKGROUND AND AIMS

Chemerin is an adipokine and novel biomarker of cardiovascular disease in patients with chronic kidney disease, which has been associated with renal, metabolic and inflammatory parameters. Data on chemerin in transplant patients are scarce.

METHOD

One hundred twenty-seven kidney transplant recipients were enrolled in the present study. Biochemical testing of serum samples was performed at baseline, and subsequent follow-up of kidney function was performed. Subjects were followed for a median of 58 months (Q1, Q3; 32, 63) during which a composite primary endpoint of hemodialysis or all-cause death was assessed.

RESULTS

Patients were stratified according to low or high chemerin concentrations based on median values of 94.43 ng/mL (Q1, Q3; 83.4, 122.2). In patients with high chemerin, estimated mean glomerular filtration (eGFR) was significantly reduced (50.7 versus 62.7, P = 0.004), while mean hemoglobin concentrations were significantly lower (12.63 versus 14.78, P  < 0.001). There was a weak correlation between chemerin and IL-6 (R = 0.26; P = 0.003). Cardiometabolic comorbidities, body mass index, waist–hip ratio, sex and age did not differ across groups. In a multiple linear regression model including eGFR and IL-6, only hemoglobin concentration (P  < 0.001) was significantly associated with chemerin concentrations. All-cause survival was poor in the group of patients with high chemerin at baseline (see Figure 1). Thirty-three patients met the primary endpoint in the high chemerin group, as opposed to 14 low chemerin subjects (52.4% versus 21.9%, P  < 0.001).

CONCLUSION

The findings of the present study are in line with earlier reports in chronic kidney disease cohorts. Serum chemerin concentrations remain significantly tied not only to kidney function but also, surprisingly, hemoglobin levels. It remains to be established whether pathogenic pathways that lead to anemia are tied to chemerin concentrations and may translate into poor outcome following kidney transplant.
MO973: Optimization of Erythropoietin Stimulating Agents for Post-Transplant Anemia in Kidney Recipients: Prospective Randomized Controlled Trial
Authors: Alotaibi Torki , Ashry Ahmed Gheith Osama , MA Halim Medhat , Maher Nagib Ayman , Hasaneen Ahmed Aboatya Aboatya Hasaneen , S.H. Mahmoud Tarek , Nair Prasad , Atta Ahmed , Abdelmonem Mohamed , Nampoory Narayanam
Published: May 2022

BACKGROUND AND AIMS

Many studies suggested that chronic allograft nephropathy might progress faster in patients with PTA, but whether full correction of anemia improves renal outcomes is unknown. We aimed to assess the impact of full correction of chronic anemia in renal transplant recipients with stable graft function on patient and graft outcome along one year follow-up.

METHOD

We enrolled 247 kidney recipients with stable graft function to be assessed for anemia. Eligible patients were randomized to achieve target hemoglobin between 11:12 g/dL (group 1, n = 183) or 13:15 g/dl (in group 2, n = 64) using erythropoietin receptor stimulating agents (ESA). Monthly clinical and laboratory evaluation of kidney graft function was carried out. Quality of life was assessed at the start and 12 months.

RESULTS

More females were found in group 1 (68.9%) versus (50%) in group 2 (P = 0.007), and the original disease was chronic glomerulonephritis (37.5%) followed by diabetic nephropathy (DN) (15.7%) in group 2; but DN patients predominate in group 1(P = 0.005). The studied groups were comparable regarding pretransplant comorbidities. Most patients received thymoglobulin as induction and most of them were maintained on cyclosporine. We did not find any significant difference between the two groups concerning posttransplant diabetes, BK viremia or malignancies (P  > 0.05); however, better graft function was observed in group 2 at 6 months (P  < 0.05). We found that required ESA doses were significantly higher in patients of group 1 from the sixth month. Group 1 showed higher mean blood pressure (P = 0.003) while group 2 showed higher mean albumin (P  < 0.05). Graft outcome was comparable in both groups (P = 0.125), but mortality cases were significantly higher in group 1 (16 cases, 8.7%) (P = 0.005).

CONCLUSION

Full correction of PTA in renal transplant recipients had no positive impact on graft outcome but it was associated with better patient survival possibly due improved cardiovascular risk.
MO989: Ap'tx: Preliminary Results of A Randomized Controlled Trial on Telemedicine Implementation in Kidney Transplantation
Authors: Mariat Christophe , Alamartine Eric , Maillard Nicolas , Dinic Miriana
Published: May 2022

BACKGROUND AND AIMS

Telemedecine is a matter of growing interest in transplantation. However, its real added value is uncertain. In 2018, we have started to study the medico-economic impact of a less stringent on-site follow-up of our kidney transplant recipients (KTR) using Ap'Telecare®. We present here the first report focusing on KTR with a 2 years follow-up.

METHOD

The Ap'Tx study (NCT03750331) is a prospective controlled randomized trial testing the hypothesis that monitoring stable KTR (at least 3 months after transplantation) with Ap'Telecare® is non inferior as compared to a conventional follow-up in terms of the occurrence of graft dysfonction (defined as a decrease in eGFR of 20% or more). On-site consultation scheduling was two times less frequent for KTR followed by Ap'Telecare®. Secondary endpoints are the impact of a remote follow-up by Ap'Telecare® on medical workload, economic saving and quality of life.

RESULTS

Five hundred and ninety KTR have been randomized so far with 256 of them having a follow-up of 2 years. Among all KTR approached to participate in the study, 37% were not included mainly due to the impossibility to access internet (44%) or to mastered the app (36%). After randomization, 11% of KTR were considered as noncompliant in adequately using Ap'Telecare®. Over the 2-year study duration, graft dysfunction occurred in 8.5% and 12% of KTR in the Ap'telecare® and conventional arm, respectively (not significant). Medical time dedicated to handling daily lab results was decreased by a factor 3 for KTR using Ap'Telecare®.

CONCLUSION

This preliminary report of Ap'Tx suggest that a partial and reasonable remote follow-up of selected KTR is both feasible and safe. Determining the nature of factors associated with a wider implementation of Ap'Telecare® is important.
MO993: Incidence of Ptld and Its Relationship with Cmv-Serostatus Positivity Among Childhood and Adulthood Population: A Registry Data Study
Authors: Kaies Ibrahim Elsayed Ali Hatem , Mohamed Mahmoud , Briggs David , Krishnan Nithya
Published: May 2022

BACKGROUND AND AIMS

It is unknown how the epidemiology of post-transplant lymphoproliferative disease (PTLD) and its relationship with CMV infection differ between adult and pediatric kidney transplant recipients. In addition, with current advancements in immunosuppressive therapy, the incidence of PTLD has changed dramatically. The aim of our study is to elucidate the relationship between PTLD and CMV infection. Moerover, to assess the incidence of PTLD among Adult and pediatric renal transplant patients in the current era.

METHOD

All renal transplant patients registered in the Organ Procurement and Transplantation Network between 2005 and 2019 were retrospectively reviewed. Patient were followed up till December 2020. Patients who had multiple organ transplant or those with previous renal transplants were excluded from the study. Data about recipient factors (age, sex ethnicity, diabetes, CMV serostatus, and EBV serostatus), donor factors (living or deceased), transplant factors (PRA, Cold ischemia time, HLA mismatches, induction and immunosuppressive therapy) were reviewed. Incidence rate of PTLD at one year and five years post-transplant were calculated among the Adult and Pediatric population. Univariate and Multivariate cox-hazard regression models were performed to assess the relationship between CMV serostatus and occurrence of PTLD.

RESULTS

About 10 947 pediatric renal transplant patients were included. About 315 pediatric patients developed PTLD during the follow-up time (2.88%). About 50.55% of PTLD occurred within the first-year post-transplant. 60% occurred within two-year post-transplant, while 80.63% of them occurred within five years post-transplant. CMV recipient infection was not associated with PTLD occurrence in the pediatric population (HR = 0.88, Pvalue = 0.81, 95% confidence interval ranged between 0.66 and 1.18). Proportional hazard assumption was not violated with P = 0.55. Among the adult population, 1990/277 955 developed PTLD (0.77%). About 25.77% of PTLD among the adult population occurred within the first-year post-transplant. About 39.39% of PTLD in the adult occurred within two-year post-transplant. About 66.55% of PTLD in the adult occurred within five-years post-transplant. CMV recipient positive serostatus was associated with a protective effect against occurrence of PTLD (HR = 0.82, Pvalue <0.01, 95% confidence interval ranged between 0.73 and 0.94). The most common type of PTLD among the pediatric and adult population was monomorphic PTLD ( 40% and 34%, respectively).

CONCLUSION

PTLD is a rare complication of renal transplantation in the current era. The risk of development of PTLD is highest during the first-year post-transplant. CMV recipient positive serostatus has a protective effect against development of PTLD.
MO1038: Haematologic Factors Associated with Favourable Long-Term Outcomes in Paediatric Patients with Chronic Kidney Disease on Maintenance Haemodialysis
Authors: Klervi Golhen , Gotta Verena , Atkinson Andrew , Marsenic Olivera , Pfister Marc
Published: May 2022

BACKGROUND AND AIMS

In children with chronic kidney disease (CKD), anaemia is defined as haemoglobin (Hb) <11–13.0 g/dL, depending on the patient's age and gender. Previous exploratory machine learning in a subpopulation of CKD-5 patients suggested an increased mortality risk with Hb < 10.5 g/dL and increased red blood cell distribution width (RDW) >15%. The objective was to evaluate such associations in a traditional time-to-event analysis in a larger population.

METHOD

Retrospective analysis of a cohort of patients < 30 years of age who started chronic haemodialysis (HD) in childhood (≤19 years) and received thrice-weekly HD (2004–2016) in outpatient DaVita centres. Survival at 5 years while remaining on HD was investigated by non-parametric analysis (Kaplan–Meier) stratified by terciles of mean individual Hb and RDW, respectively. A sensitivity analysis was carried out for different subpopulations (<6y/6y–12y/>12y at the initiation of HD).

RESULTS

A total of 493 patients were included with Hb and RDW terciles of < 10.7/10.7–11.5/>11.5 g/dL and < 14.6/14.6–15.7/>15.7%, respectively. Age at initiation of HD was < 6 years: n = 66, 6–12 years: n = 173, >12 years: n = 1254. Both Hb and RDW terciles showed strong associations with survival distributions (P < .001 for both, log-rank test). Estimated 5-year survival [95%confidence interval (95%CI)] by Hb terciles was 85.1% (81.1–89.3%) (Hb < 10.7 g/dL) versus 94.9% (92.5–97.4%) (>10.7–11.5 g/dL) and 93.8% (90.8–97.0%) (>11.5 g/dL) and for RDW 98.6% (97.1–100%) (<14.6%) versus 94.1% (91.3–96.9%) (14.6–15.7%) and 84.2% (80.1–88.6%) (>15.7%). Sensitivity analyses confirmed significant associations in patients > 12 years (P < .001 for both Hb/RDW) and for RDW in 6–12 years patients (P = .03 versus P = .14 for Hb).

CONCLUSION

This analysis confirmed strong associations between haematologic factors and survival in our population. Clinical utility of RDW in HD management and its physiological interpretation such as the importance of specific anaemia forms, or treatment-induced RDW increase in patients requiring more intense treatment remains to be investigated, with potential impacts on existing guidelines for prescribing iron and epoetin therapy. Further studies will also include the time variation trajectories of Hb and RDW.