bluuebunny/crossref_metadata_2025 huggingface dataset:
P1415PARATHYROIDECTOMY IMPROVES MUSCULAR FUNCTION BUT NOT MUSCLE MASS IN HEMODIALYSIS PATIENTS WITH SEVERE HYPERPARATHYROIDISM
Authors: Crispilho Shirley , Duque Eduardo J , Avesani Carla , R Pereira Rosa Maria , De Sá-Pinto Ana Lúcia , Jorgetti Vanda , Stenvinkel Peter , Lindholm Bengt , Motta Rosilene , Moyses Rosa
Published: June 2020

Background and Aims

Increased levels of parathyroid hormone (PTH) are associated with a negative impact on the bone-muscle axis including sarcopenia with muscle weakness and muscle atrophy and osteoporosis, and it is possible that treating hyperparathyroidism (HPT) can ameliorate these disturbances. However, the effects of parathyroidectomy (PTX) on muscle mass, strength and performance, and physical activity have not been thoroughly investigated. This study aims to evaluate the impact of PTX on muscle (mass, strength, and performance), physical activity, body fat and resting energy expenditure (REE) in patients on hemodialysis with severe HPT.

Method

We are prospectively evaluating muscle mass strength, performance and physical activity of 30 patients before and after 6 months of PTX by using Actigraph GT3X accelerometer, timed-up-and-Go (TuG), Sit-to-Stand-to-Sit (STS) and muscle strength tests [handgrip (HGS), supine (SP) and leg press (LP)]. Body composition changes were assessed by dual-energy x-ray absorptiometry (DXA), and REE was examined by indirect calorimetry.

Results

At 6 months after PTX, 11 patients who already completed the protocol, showed a significant drop in PTH [1445 (1363-1937) vs. 54 (23-132) pg/mL; p = 0.002] and alkaline phosphatase [306 (235-744) vs. 77.5 (52-100] U/L); p = 0.002], a significant increase of number of steps/day [4321 (3384 – 6317) vs. 5950 (3918 – 7159); p = 0.04] and improvements of strength tests: HGS (27 ±14 vs. 31 ±15 kg; p = 0.01); SP (27 ±15 vs. 31 ±17 kg; p = 0.01] and LP [27 (2-36) vs. 36 (24-89) kg; p 0.04]. In addition, there was a significant reduction of TuG [10 (8-15) vs. 8 (7-11) seconds; p = 0.01], and a tendency towards STS improvement [6 (0-7) vs. 8 (7-11); p = 0.06]. A significant increase in body weight (66 ± 12 vs. 68 ± 14 Kg; p = 0.02), body mass index [24 (21–26) vs. 26 (21–28) kg/m2; p 0.001], and bone mineral content (BMC) [1.8 (1.3-2) vs. 2.1 (1.7-2.7); p=0.002] was seen. However, lean body mass (LBM) decreased [40.4 (38-55) vs. 39 (37-51) Kg; p=0.001], whereas fat mass (FAT) increased [18 (17-28) vs. 24 (17–30) kg; p = 0.02]. No change was noted in skeletal muscle index (SMI) and in REE [1580 (1193–1988) vs. 1473 (1326 - 1786) kcal/day; p = 0.7). We noticed a tendency toward an increase in IGF-1 levels [180 (141-207) vs. 223 (151-281) µg/L; p = 0.08], but no significant variation was found in serum albumin, insulin and HOMA index.

Conclusion

In hemodialysis patients with secondary hyperparathyroidism undergoing PTX, there were marked improvements of muscular function and bone mass, but not of muscle mass. Our findings suggest that PTH-associated sarcopenia is mediated not only by a decrease in muscle mass but also by muscle dysfunction. The long-term effect of PTX on muscle status remains to be further examined.
P1422CATHEPSIN-K IS A POWERFUL DIAGNOSTIC BIOMARKER IN PARATHYROIDECTOMIZED DIALYSIS PATIENTS
Authors: Bolignano Davide , Greco Marta , Provenzano Michele , Tripolino Omar , Vita Caterina , Leonardi Giuseppe , Chiarella Salvatore , Donato Cinzia , Russo Emilio , Fuiano Giorgio , Foti Daniela , Andreucci Michele , Coppolino Giuseppe
Published: June 2020

Background and Aims

Cathepsin-K (Cts-K) is a lysosomal cysteine protease mainly involved in bone remodeling and resorption. Although it is largely released by lung cells, osteoclasts and macrophages, increasing current evidence suggests that the parathyroids may somewhat regulate Cts-K balance. We therefore analyzed Cts-K in a cohort of 85 chronic HD patients (mean age 67+/-12, median dialysis vintage 3.2 yrs), also including some individuals who were previously parathyroidectomized.

Method

Cts-K serum levels were measured before a mid-week dialysis session together with standard biochemical parameters. Twenty-six healthy subjects matched for age and gender served as controls. Patients were further stratified according to whether they were parathyroidectomized or not.

Results

Cts-K levels were statistically higher in HD patients than in controls (median 340, IQR 170-835 vs. 190 IQR 20-120 pg/mL, p<0.0001) and significantly associated with ALP (r=0.50, p<0.001), CRP (r=0.46,p<0.001) and PTH (r=0.24,p=0.02). Patients with previous parathyroidectomy (n=8) had significantly lower levels of Cts-K (942.3 vs 46.2 pg/mL, p<0.0001). At ROC analyses, Cts-K showed an excellent diagnostic profile in distinguishing parathyroidectomized patients (AUC 0.977, best Cts-K cutoff< 100 pg/mL; sens. 100%, spec. 93%; Figure 1). Of note, although slightly inferior, the AUC of Cts-K was not statistically different to that of PTH (p=0.11 for comparison of ROC curves).

Conclusion

Cathepsin-K may represent a potential candidate biomarker for diagnosing and managing MBD complications, particularly those related to parathyroid dysfunction. Its exact biological role in these conditions deserves further examination.
P1452PATIENT SURVIVAL ON HOME DIALYSIS MODALITIES
Authors: Bitar Wisam , Helve Jaako , Rauta Virpi , Honkanen Eero Olavi , Finne Patrik
Published: June 2020

Background and Aims

Many studies have compared survival of patients on peritoneal dialysis and hemodialysis, but knowledge on survival differences between various types of home dialysis is limited. Therefore, our study aimed to assess the associated survival in CAPD, APD and home HD.

Method

During 2004 to 2017, 1640 patients aged 18 years or older started RRT in Helsinki University Hospital. Patients who were on one of the home dialysis modalities at 90 days (n=536), have been studied. The follow up endpoint was either death or the end of 2019. A research database was established and extensive data were systematically collected from the patient files, comprising 35 different comorbidities, laboratory results, primary renal disease, and renal replacement therapy-related factors. Study design was intention-to-treat, and patients were analyzed in the home dialysis modality group they were at 90 days after onset of RRT. Patient survival was compared between patients on CAPD, APD, and home HD using Kaplan-Meier curves and Cox regression.

Results

Characteristics of home HD and APD patients at the start of dialysis and proportion of patients who received a kidney transplant during follow-up were similar (Table), whereas patients on CAPD had higher median age, more comorbidities, and received a kidney transplant less frequently. The probability of surviving 5 years was 56% for CAPD, 88% for APD, and 90% for home HD patients (Figure). Relative risk of death associated with APD was 0.96 (95% CI 0.60–1.5), and that of CAPD was 3.7 (2.4–5.7) as compared to home HD. After adjustment for age and number of comorbidities, the relative risks were 0.82 (0.39–1.7) and 2.5 (1.2–5.0), respectively. Additional adjustments for other possible confounding factors listed in the Table did not change the results. Censoring for kidney transplantation did not alter the conclusion.

Conclusion

APD and home HD patients had similar characteristics and comparable survival. CAPD patients were older, had more often comorbid conditions, and their prognosis was worse even after adjustment for confounders.
P1454CIRCULATING ENDOTOXIN AND MARKERS OF INFLAMMATION: ASSOCIATES WITH PHYSICAL ACTIVITY AND THE EFFECT OF A SIX MONTH PROGRAMME OF CYCLING DURING DIALYSIS (INTRADIALYTIC CYCLING)
Authors: March Daniel , Lai K B , Highton Patrick , Churchward Darren , Young Hannah , Dungey Maurice , Graham-Brown Matthew , Smith Alice , Bishop Nicolette , Szeto C C , Burton James
Published: June 2020

Background and Aims

Individuals with end-stage kidney disease receiving haemodialysis have elevated levels of circulating endotoxin as a result of changes to the intestinal barrier. These elevated levels are believed to play a role in the high levels of inflammation in this population. Programmes of cycling during dialysis (Intradialytic cycling (IDC)) can provide benefits to individuals receiving haemodialysis, but it is unclear how they may effect circulating levels of endotoxin. Therefore, the primary aim of this study is to investigate the effect of a 6-month programme of IDC on circulating endotoxin. Further aims are to investigate the associations between levels of physical activity and levels of circulating endotoxin and markers of inflammation in haemodialysis patients.

Method

This is a secondary analysis of the CYCLE-HD randomised controlled trial (ISRCTN11299707). Participants were randomised to either a 6-month programme of IDC (thrice weekly, moderate intensity cycling at RPE 12-14) in addition to usual care (n=46), or usual care (n=46) only. At baseline and 6 months blood samples were collected from the arterial needle immediately prior to haemodialysis therapy and following centrifugation stored at -80°C. Endotoxin, interleukin (IL)-6, IL-10, tumour necrosis factor-α (TNF-α) and high sensitivity C-reactive protein (Hs-CRP) were quantified using immunoassays. Levels of physical activity were measured using an accelerometer. Participants were instructed to wear the accelerometer for 7 days at baseline, and steps per day were calculated by dividing total steps by number of days worn .

Results

Steps per day data and endotoxin and inflammatory data was available for n=81 participants at baseline. There was a significant negative association between number of steps per day and IL-6 (P=0.001, R=-0.361), Hs-CRP (P<0.0001, R=-0.450) and Endotoxin (P=0.032, R=-0.238) levels. The effect of a 6-month programme of IDC on endotoxin levels and the inflammatory markers are presented in Table 1.

Conclusion

Higher levels of physical activity were associated with lower levels of circulating endotoxin, IL-6 and Hs-CRP in individuals receiving haemodialysis. A 6-month programme of IDC did not result in increases in circulating endotoxin, indicating that this physiological stress does not result in changes to the intestinal barrier in haemodialysis patients. Lastly, IDC did not appear to increase circulating markers of inflammation.
P1465DEPRESSION AND HEALTH RELATED QUALITY OF LIFE AMONG ELDERLY HAEMODIALYSIS PATIENTS
Authors: Mooppil Nandakumar , Aithal Seema , Singh Tripti , Ibakkanavar Rajiva
Published: June 2020

Background and Aims

The reported prevalence of depression is around 20-30% among dialysis patients according to the literature. Previous studies have shown a strong negative correlation between depression and kidney disease related quality of life (KDQOL) scores in ESRD patients. In this study we examined the relationship between depression and KDQOL scores of a racially diverse cohort of elderly haemodialysis (HD) patients. Additionally we investigated the predictors of depression among this cohort.

Method

Prevalent HD patients aged 65 years and above who were dialyzing in our institution were included in this cross-sectional study. The Geriatric depression scale (GDS-15) and KDQOL-SFTM version 1.3 were the instruments used to derive depression and KDQOL domain scores respectively. The predictor variable was depression status based on a cut-off of 5 and patients were categorized into 2 groups – depression (Yes)-GDS≥5 and depression (No)–GDS<5. The impact of socio-demographic factors and lab parameters was compared using chi square test for categorical variables and Independent T test/Mann Whitney U test for continuous variables. The 3 main KDQOL domains – physical composite summary (PCS) score, mental composite summary (MCS) score and Kidney disease composite summary (KDCS) score were compared using Independent T test among the depression status groups. Multivariate logistic regression was used to determine the predictors of depression among this elderly HD cohort.

Results

A total of 1034 elderly HD patients (mean age 72.1±5.6 years, 55.9% male, 65.7% Chinese, 65.8% diabetic and mean vintage of 5.8±5.6 years) were included in the study. The prevalence of depression was 18.1% among this elderly HD cohort. The patients with depressive symptoms were predominantly non-ambulant, with high medical dependency and increased hospital admissions in the past year compared to the non-depressed group. There were no statistically significant differences in the age, race, gender, diabetic status and dialysis vintage between the groups with and without depression. The group with depression had significantly lower PCS, MCS and KDCS domain scores compared to the group without depression (p<0.001). Mobility status was identified as an independent predictor of depression - ambulant patients were 53% (OR-0.47, 95%CI 0.31-0.70, p<0.001) less likely to be depressed compared to non-ambulant HD patients (p<0.001). Mean scores for KDQOL dimensions like sleep and social support were significantly lower among patients with depression (p<0.001).

Conclusion

Elderly haemodialysis patients with depression had significantly lower mean health related quality of life scores compared to patients without depression. Mobility status was an important predictor of depression among our elderly cohort. Regular screening and management of depression should be part of the routine care of the elderly HD patients so as to improve their quality of life and dialysis outcomes.
P1481STRAIN REPOLARISATION ON ECG, NOT LEFT VENTRICULAR MASS, ASSOCIATES WITH CARDIOVASCULAR OUTCOMES IN A PROSPECTIVE COHORT OF HAEMODIALYSIS PATIENTS
Authors: Skampardoni Sofia , Chiu Diana Y Y , Kalra Philip A , Green Darren
Published: June 2020

Background and Aims

Cardiovascular disease is common in chronic and end stage kidney disease. Left ventricular hypertrophy (LVH) has been identified as contributor to cardiovascular risk in this population. The aim of the study was to assess whether the combined use of electrocardiography and echocardiography in assessing LVH in a haemodialysis population can provide improved risk stratification.

Method

Prospective study of 192 prevalent maintenance haemodialysis ( HD) patients 12 lead ECGs were performed on a mid week non –dialysis day. Electrocardiographic strain was defined as a down slopping convex ST segment with inverted T waves in leads V5 and / or V6. Transthoracic echocardiographic was performed immediately after ECG .LV mass was indexed to body surface area (LVMIBSA). LVH was determined if LVMI >116g/m2 for male patients, and >100g/m2 for female patients. The primary study endpoint was major cardiac events (MACE). A secondary endpoint was all cause mortality.

Results

192 patients included in the final analysis, 137 (71.4%) male.. The mean ejection fraction (EF) was 60.6± 11.1 % and the mean LVMI (BSA) was 115.0± 36.8 g/m2. During a mean follow up period of 2.4 ± 1.0 years, 50 patients reached a MACE end point and 62 patients died. On univariate Cox regression analysis, the factors associated with MACE were the presence of ECG strain (HR 2.961, CI: 1.254 – 6.990, p= 0.013)) URR (HR 0.968, CI: 0.942 – 0.994, p=0.015) and history of CAD (HR: 2.397 CI: 1.363 -4.2515, p= 0.002). In multivariate Cox regression analysis adjusting for baseline cardiovascular phenotype and dialysis parameters ECG strain remained significantly associated with MACE.

Conclusion

The presence of electrocardiographic strain increases the risk for MACE independently of LVH in haemodialysis patients. ECG strain has potential to be a simple bedside prognostic biomarker and even therapeutic target in haemodialysis patients.
P1482MORTALITY RATE AND RELATED RISK FACTORS IN THE CHINA DIALYSIS OUTCOMES AND PRACTICE PATTERNS
Authors: Zhao Xinju , Niu Qingyu , Gan Liangying , Zuo Li
Published: June 2020

Background and Aims

Mortality risk for maintenance hemodialysis (MHD) patients varies by country and ethnicity. Here, mortality rate and its related risk factors in Chinese HD patients from Dialysis Outcomes and Practice Patterns Study (DOPPS) were studied.

Method

Data from the China DOPPS phase 5 (2012-2015) were used. All included patients were followed to the end of the study. Patients’ demographics, primary cause of end stage renal disease (ESRD), comorbidities, abstracted dialysis prescription, laboratory values, date of death, and causes for death were analyzed. All-cause mortality (per 100 patient-years) was calculated. We examined clinical and laboratory differences between died and survived patients. Cox regression was used to explore risk factors of death, accounting for facility clustering and adjusted for case-mix (age, sex, vintage, and comorbid conditions), and laboratory values (albumin, hemoglobin, white blood count, sodium).

Results

There were 1427 MHD patients were enrolled. The mean age at dialysis initiation was 59.4±14.9 years (table 1). The median follow-up time was 1.9 years (IQR 1.1-2.1). There were total 205 deaths. The overall mortality rate was 8.8 per 100 patient-years. Death from cardiovascular disease (CVD) occurred in 50.2% of the patients. Compared with survived patients, patients with mortality were older (58.5 Vs. 70.0 y), more likely with diabetes, with lower pre-dialysis albumin level (Pre-ALB) or hemoglobin level (Pre-HGB), with lower pre or post dialysis diastolic blood pressure (DBP), with some comorbidities and less likely with fistula as their blood access (table 2). Cox regression revealed that risk factors for higher mortality were older age, lower Pre-ALB level, higher pre-dialysis DBP and with CHF, hepatitis, hypertension, and lung disease.

Conclusion

CVD constituted half of the death reasons for Chinese dialysis patients. Our analysis highlighted that there are some modifiable risk factors for patients’ survival. Attention should be paid to patients who were older, with lower Pre-ALB level, higher pre-dialysis DBP and with CHF, hepatitis, hypertension, and lung disease.
P1490AGAIT SPEED AND HANDGRIP STRENGTH AS PREDICTORS OF ALL-CAUSE MORTALITY AND CARDIOVASCULAR EVENTS IN HEMODIALYSIS PATIENTS
Authors: Lee Yu Ho , Jeong Hyeyun , Yang Dong Ho , Lee So-Young , Kim Jin Sug , Jung Su Woong , Hwang Hyeon Seok , Moon Ju-Young , Jeong Kyung Hwan , Lee Dong-Young , Ko Gang Jee , Lee Hong Joo , Kim Yang-Gyun
Published: June 2020

Background and Aims

Low physical performance in patients undergoing maintenance hemodialysis is associated with a high mortality rate. We investigated the clinical relevance of gait speed and handgrip strength, the two most commonly used methods to assess physical performance.

Method

We obtained data regarding gait speed and handgrip strength from 277 hemodialysis patients and evaluated their relationship with baseline parameters, mental health, plasma inflammatory markers, and major adverse clinical outcomes. Low physical performance was defined by the recommendations suggested by the Asian Working Group on Sarcopenia.

Results

The prevalence of low gait speed and handgrip strength were 28.2% and 44.8%, respectively. Old age, low serum albumin levels, high comorbidity index, and impaired cognitive functions were associated with low physical performance. Patients with isolated low gait speed exhibited a general trend for worse quality of life than those with isolated low handgrip strength. Gait speed and handgrip strength showed very weak correlations with had different determinant factors (older age, the presence of diabetes, and lower serum albumin for low gait speed, and lower body mass index, and the presence of previous cardiovascular events for low handgrip strength). Patients with low gait speed and handgrip strength had elevated levels of plasma endocan and matrix metalloproteinase-7 and the highest risk of all-cause mortality and cardiovascular events among the groups (adjusted hazard ratio of 2.72, p = 0.024).

Conclusion

Gait speed and handgrip strength reflected distinctive aspects of patient characteristics and that their combination improved the prediction of adverse clinical outcomes in hemodialysis patients. Gait speed seems to be a better indicator for poor patient outcomes compared with handgrip strength.
P1492HUMAN FACTORS TESTING OF THE QUANTA SC+: DEMONSTRATING EASE OF USE WITH MINIMAL UPFRONT TRAINING IN HEALTH CARE PRACTITIONERS AND PATIENTS
Authors: Compton Kathryn , Edwards Christian , Komenda Paul , Bose Amit , Milad John
Published: June 2020

Background and Aims

Quanta Dialysis Technologies has developed a compact, powerful personal haemodialysis system intended for home and self-care use designed in collaboration with patients and healthcare practitioners. Human factors testing is necessary to demonstrate ease of use with minimal up-front training.

Method

In compliance with FDA guidance and EU standards, the user interface of the system was evaluated through human factors testing to assess the safe and effective use of SC+. This included a series of user-based tasks whereby representative users independently setup SC+ into a simulated treatment, managed alarms to resolution and external SC+ cleaning/disinfection.

All participants received an introduction to SC+ and completed a competency sign off at the end of training. 17 healthcare professionals (6 renal nurses, 8 dialysis technicians, 1 patient care technician) received up to 4 hours of structured training followed by a 1-day learning decay period. In addition, 10 lay users (8 dialysis patients, 2 caregivers) received between 5.5 and 7.5 hours training followed by a 2-day learning decay period.

Results

Between the two user groups, there were a total of 8,110 opportunities for use errors to occur. Despite minimal training and representative learning decay, only 4 significant use events were observed requiring some user manual enhancements. Other use errors captured were minor or could not be mitigated further due to clinical practices and shared inherent risks across all haemodialysis systems.

Conclusion

The results of the human factors testing demonstrated that healthcare practitioners, patients and caregivers successfully operated SC+ independently with a high level of use safety, despite minimal training and learning decay. The SC+ user interface is optimized for safe and effective use under FDA guidance and EU standards.
P1494THE NEGATIVE EFFECT OF SELENIUM DEFICIENCY ON THYROID HORMONE IMPAIRMENT AND CARDIOVASCULAR DISEASE IN CHRONIC HEMODIALYSIS PATIENTS
Authors: KIM SO MI , Cho Jong Tae , Lee Yong-Moon , Lee Eun Kyoung , Jeon Ji Hyun , Lee Hwa Young
Published: June 2020

Background and Aims

Selenium is an essential trace element. It has been known to protect the cardiovascular disease(CVD) and thyroid disease by protecting the oxidative stress using selenium-dependent glutathione peroxidase. Chronic hemodialysis(HD) patients are more likely to have selenium deficiency compared to healthy subjects. Therefore, we investigated the degree of selenium deficiency in HD patients and try to analyze the effect of selenium deficiency on thyroid hormone impairment and its correlation with CVD.

Method

A total of 183-chronic HD patients were enrolled. Serum selenium level was assessed before HD using inductively coupled plasma-mass spectrometry. Based on tertile of selenium, the patients were divided into three groups: low-, intermediate-, and high- group. The presence of thyroid hormone impairment and cardiovascular disease were evaluated.

Results

The value of serum selenium in first and second tertile of subjects was 80.64 and 94.84 g/dL, respectively. Thyroid dysfunction and CVD with respect to serum selenium levels are summarized in Table 1. Although the prevalence of hypothyroidism was not different among the three groups, instances of subclinical hypothyroidism was higher in the lower selenium group than those in the other groups (34% vs. 15% vs. 8%; P=0.005). Moreover, total thyroid dysfunction was significantly higher in the lower selenium group (38% vs. 18% vs. 15%; P=0.005). The prevalence of ischemic heart disease was most prevalent in the lower selenium group among the three groups, (49% vs. 25% vs. 22%; P=0.002). The prevalence of total CVD was highest in the lower selenium groups. (57% vs. 33% vs. 26%; P=0.001). In the analysis of the relationship between thyroid dysfunction and CVD, The prevalence of IHD was highest in the lower selenium group with thyroid dysfunction(p=0.039)

Conclusion

This study showed that selenium deficiency is associated with thyroid hormone impairment and thyroid disease. And the thyroid hormone impairment showed the synergistic negative effect on CVD in HD with selenium deficiency patients.
P1497INCIDSENCE OF CANCER IN HEMODIALYSIS-TREATED PATIENTS
Authors: Katzir Ze'ev , Merkin Lusia , Brenner Ronen
Published: June 2020

Background and Aims

In recent decades, there has been an increase in the incidence and prevalence of patients with end stage renal disease (ESRD) worldwide. Previous studies have shown an increased incidence of malignancies among ESRD patients, compared to age-matched controls, although it was unclear whether different etiologies of ESRD ( diabetes, hypertension, cystic disease) confer different risk ratio.

Our present study intends to re-examine relationships between ESRD, classified according to the etiology of renal disease, cancer incidence and types of malignancies in hemodialysis treated patients.

Method

We conducted a retrospective study, analyzing hemodialysis (HD) treated patients over the age of 18 at the Wolfson Medical Center in Holon, Israel, from 2008-2017. Patients diagnosed with cancer prior to dialysis or with history of transplantation were excluded.

Data on etiology of chronic kidney disease and ESRD, comorbidities and cancer diagnosis was collected from patients' files and verified using the Israeli National Cancer Registry.

A single, multivariate survival analysis was conducted to examine the relationship between the various predictors and the incidence of cancer.

Results

The study included 333 patients, 211 (63.4%) were males, mean age 67.2±13.1 years. The median follow was 4 years (95% CI: 2-6.5). Twenty eight (8.4%), developed primary malignancy during hemodialysis, annual rate: 2.1%, Vs 0.35% age-adjusted annual rate in Israeli general population. The average age of all patients diagnosed with cancer over the study period was higher than that of patients without cancer (72.3±7.7 Vs 66.7±13.4 years. P=0.001).

The most common sites of malignancy were colon (33%), bladder (16.7%), kidney (10%) and prostate (10%). Older age was the only risk factor associated with the onset of malignancy. No statistically significant relationship was found between ESRD etiology, comorbidities and occurrence of malignancy.

Conclusion

Among our cohort of patients on chronic hemodialysis, annual cancer incidence rate is 6 times higher than age matched controls in the Israeli general population. Older age is a risk factor associated with onset of malignancy. We did not found associations between ESRD etiology, comorbidities and cancer incidence.

This study constitutes a platform for a longer period multicenter study.
P1507COMPETING RISKS MODELING IN PERITONEAL DIALYSIS: THE URGE FOR A CHANGE IN SURVIVAL ANALYSIS METHODOLOGY
Authors: Malho Guedes Anabela , Calças Roberto , Domingos Ana , Jerónimo Teresa , Neves Pedro , Martins Rosário , Dias Sara
Published: June 2020

Background and Aims

Survival analysis is a cornerstone in medical research. For this purpose Kaplan-Meier is the most widely used statistical test, but the presence of competing risks violates the fundamental assumption that the censoring mechanism is independent of survival time. This leads to overestimation of the cumulative probability of cause-specific failure. Cumulative incidence estimate and competing risks analysis are preferred. The purpose of this study was to compare different survival analysis methods: Kaplan-Meier and cumulative incidence function estimates in a cohort of Peritoneal Dialysis (PD) patients.

Method

The survival of 115 incident patients on PD in a university hospital was evaluated after establishing 2 cohorts: patients starting renal replacement therapy with PD (PD first; n=85) and patients switching to PD on the first 6 months of dialysis (PD transfer; n=30). Kaplan-Meier, cumulative incidence function, cause-specific and subdistribution hazards were performed. The event of interest was death and the competing risk events were transfer to hemodialysis and renal transplantation.

Results

Besides higher residual renal function (RRF) and kt/V in the PD first group, there were no other significant differences between groups. There were 22 deaths. PD first group had a better survival with both Kaplan-Meier (log-rank test, p=0.013) and cumulative incidence function (p=0.021) approaches. The Cox regression model showed, as protecting variables, higher albumin (HR=0.174; CI95% 0.054-0.562), higher RRF (HR=0.785; CI95% 0.666-0.925) and PD first (HR=0.350; CI95% 0.132-0.927). Higher Charlson Index predicted worse outcome (HR=1.459; CI95% 1.159-1.835). PD as first dialysis therapy was associated with 65.0 % lower risk of death comparing with PD transfer. The subdistribution multivariable model found higher Charlson Index (HR=1.389; CI95% 1.118-1.725) and lower RRF (HR=0.798; CI95% 0.680-0.936) were statistically associated with death, but not PD transfer or albumin. This result differs from the obtained using the cause-specific hazard model. Analyzing the competing events, patients submitted to renal transplantation had a lower Charlson Index.

Conclusion

The probability of death was overestimated by the Kaplan-Meier method. The bias of Kaplan-Meier is especially great when the hazard of the competing risks is large. This study consisted on a statistical critical analysis of a real medical example, broader clinical conclusions related with “PD first initiative” should be cautious in this context.

It is primordial to recognize the presence of competing risks in studies with multiple outcomes, as in Peritoneal Dialysis studies, to estimate cumulative incidence and yield more accurate results. This study shows how different conclusions are attained with different statistical methodology and its relevance in clinical context.
P1509SEVERITY OF PRURITUS IN HEMODIALYSIS PATIENTS: RELATIONSHIP TO UREMIC TOXINS AND DIALYSIS MODALITY
Authors: Yamamoto Suguru , Tanaka Takahiro , Omori Kentaro , Ei Isei , Kitamura Nobutaka , Narita Ichiei
Published: June 2020

Background and Aims

Pruritus is a complication that can impair the quality of life of patients with chronic kidney disease (CKD). A previous report has suggested that the severity of pruritus is correlated with high serum concentrations of β2-microglobulin, calcium, and phosphorus, however recent developments in hemodialysis (HD), especially use of high-flux membrane and online hemodiafiltration (OLHDF), may improve the severity of pruritus. Protein-bound uremic toxins (PBUTs), such as indoxyl sulfate and p-cresyl sulfate, are known to be factors associated with atherosclerosis and impaired bone metabolism in CKD and may also be associated with pruritus, especially in those undergoing dialysis treatments. The aim of our study was to assess the severity of pruritus using a new tool, the 5D-itch scale (5D), as well as its relation to circulating PBUTs and dialysis modality in patients with end-stage kidney disease.

Method

This was a prospective cohort multicenter study, wherein we analyzed the baseline data. The 5D score (5–25 points) was measured in maintenance dialysis patients. The serum concentrations of indoxyl sulfate, p-cresyl sulfate, phenyl sulfate and hippuric acid were measured with mass spectrometry before a dialysis session. The correlations of the 5D scores with serum PBUTs, dialysis modality (HD or OLHDF) and the other background factors were assessed with Spearman correlation coefficients and the generalized linear model.

Results

This study included 135 dialysis patients (98 HD and 37 OLHDF). The mean 5D score was 6.84 (±SD 3.14). The mean serum concentrations of indoxyl sulfate, p-cresyl sulfate, indole acetic acid, phenyl sulfate, and hippuric acid were 2.99 ± 1.40, 2.05 ± 1.54, 0.11 ± 0.08, 0.94 ± 0.71, and 4.52 ± 3.17 mg/dL, respectively. There was a significant correlation between the 5D score and dialysis modality (correlation coefficient = 0.24, p < 0.01). Dialysis method was associated with the 5D score by the generalized linear model, and OLHDF was associated with a lower 5D score. There were no significant associations between the 5D score and serum concentrations of the various PBUTs (e.g., for indoxyl sulfate, the correlation coefficient was 0.11, p = 0.20)

Conclusion

Pruritus, as assessed by the 5D score, was associated with dialysis modality, but not with the serum concentration of PBUTs. Further studies will be needed to understand the mechanism of the effect of OLHDF on pruritus as well as the role of uremic toxins in the itchy skin in CKD patients.
P15185 YEAR ALL-CAUSE MORTALITY ACCORDING TO PRIMARY RENAL DISEASE IN HEMODIALYSIS PATIENTS
Authors: Kim Ha Yeon , Lee Jeong Ho
Published: June 2020

Background and Aims

The Korean Society of Nephrology (KSN) collected data of end-stage renal disease registry since 1985 and internet registry program was available since 2001. We explored the hypothesis that the 5-year mortality of hemodialysis patients was different depending on primary renal disease.

Method

From 2004 to 2015, in total, 32,163 patients starting hemodialysis were determined. The cause of primary renal disease were divided to diabetic nephropathy (49.9%, n=16,038), hypertensive nephrosclerosis (18.5%, n=5,958), histologically confirmed glomerulonephritis 3.3% (n=1,067), cystic kidney disease (2.0%, n=656) and the miscellaneous (26.3%, n=8,444). The miscellaneous included renal tuberculosis, interstitial nephritis, lupus nephritis, kidney tumor.

Results

The 5-year mortality of hemodialysis patients was 16.9 % (N=5,435) and ratio of unknown state was 24.9 % (N=7,996). The mortality of diabetic nephropathy, hypertensive nephrosclerosis, histologically confirmed glomerulonephritis, cystic kidney disease and the miscellaneous were 27.1% (n=3,323), 17.0% (n=768), 8.4% (n=62), 13.9% (n=67), and 19.7% (n=5,435), respectively. Kaplan-Meier survival analysis showed that diabetic nephropathy was worst survival rate following hypertensive sclerosis, cystic kidney disease and the miscellaneous, while histologically confirmed glomerulonephritis showed highest survival rate (log-rank p < 0.001). After adjusting for confounders, cox-proportional regression analysis revealed that 5-year mortality was associated with diabetic nephropathy compared hypertensive nephrosclerosis (HR, 1.62 CI, 1.17-2.24) while histologically confirmed glomerulonephritis was not significant.

Conclusion

The overall mortality was associated with primary renal disease in hemodialysis paitents. This result suggests that hemodialysis patients with diabetic nephropathy require further medical attention.
P1519A TWICE-WEEKLY HEMODIALYSIS : A SINGLE CENTER STUDY
Authors: Bchir Sirine , Mojaat Malek , Ben salem Mariem , Amine Boukadida , Handous Insaf , Faouzi Haouala , Ahmed Ltaief , Hammouda Mouna , Aloui Sabra , Habib Skhiri
Published: June 2020

Background and Aims

Conventional hemodialysis consists of a thrice-weekly in-center Hemodialysis with a mean duration of 4 hours per session. The concept of incremental dialysis has allowed a better adjustment of its prescription guided by clinical and biological parameters. Thereby a twice-weekly regimen may maintain a good quality of life, a good survival rate and adequate dialysis in comparison to a thrice-weekly hemodialysis. The aim of our study was to investigate the profile of patients undergoing a twice-weekly regimen in our center.

Method

It is a monocenter transversal-descriptive study gathering patients on a twice-weekly regimen in the center of hemodialysis of Fattouma Bourguiba University Hospital in Monastir Tunisia.

Results

We identified 32 patients with a sex ratio of 2.2 (22 men and 10 women) with a mean age of 48,96 +/- 13,74 years. Regarding the intitial nephropathy, a chronic glomerulopathy was seen in 16 patients, a chronic tubulo-interstitial nephritis In 5 patients, and kidney polykystosis among 3 patients and in 8 patients the initial nephropathy remained undetermined. The indications for a twice-weekly HD regimen were: defavourable socio-economic conditions in 9 patients, a medical reason in 17 patients and a rejection of thrice-weekly regimen in 6 patients. The mean diuresis was 850 +/- 560 cc/24h and only one patient with anuria. The mean interdialytic weight gain was 2, 64 +/- 0, 83 Kg. Normal blood pressure and volemia were reported in 27 patients (84, 37 %). The mean number of anti-hypertensive drugs used was 1,5 per patient. The mean percentage of Urea reduction was 68, 8 % and a mean Kt/V of 1.26. The average of both kalemia and calcemia was respectively 5.27 mmol/l and 1, 94 mmol/l and the mean dosage of phosphoremia was 1, 63 mmol/l. The average of PTH and Hemoglobine was respectively 403 pg/ml and 9, 97 g/dl.

Conclusion

According to these results, a twice-weekly hemodialysis should be guided by the residual kidney function, clinical status (volemia), cardiovascular symptoms and comorbidities, biological parameters (Hemoglobine, potassium, phosphore) and the nutritional state. By meeting the above criteria, many studies have shown that a twice-weekly regimen or incremental dialysis help preserve the residual kidney function with a good quality of life.
P1521LRG-1 LEVEL PREDICTS 5-YEAR MORTALITY IN ESRD
Authors: Yang Feng-Jung
Published: June 2020

Background and Aims

Plasma Leucine-Rich alph-2-Glycoprotein 1(LRG1) is an new biomarker for inflammatory and angiogenetic diseases. whether levels of plasma LRG1 correlate with the co-morbidities of End stage renal disease (ESRD) patients is unknown.

Method

Plasma LRG-1 and high-sensitivity C-reactive protein were analyzed by ELISA in samples from 169 hemodialysis patients from the Immunity in ESRD study (iESRD study). Baseline co-morbidities were recorded through chart review of medical history.

Results

High level of LRG 1 showed high mortality in the ESRD. In multivariate-adjusted logistic regression models, higher LRG1 was significantly associated with 5 year mortality after adjusting for gender, hemoglobin, diabetes, hypertension, and level of C-reactive protein.

Conclusion

LRG1 is a possible poor prognosis marker in ESRD. Higher LRG-1 showed high prevalent CAD and PAOD in our study before. The role of LRG1 and the associated cardiovascular diseases should be analyzed the mechanism in this patient population.
P1526HOW TO DEAL WITH PREGNANCY IN DIALYSIS? A CENTER EXPERIENCE ABOUT 7 CASES
Authors: BENHAMOU Ramia , Chettati Meriem , Fadili Wafaa , Laouad Inass
Published: June 2020

Background and Aims

Outcomes of pregnancy in patients with end-stage renal disease (ESRD) have long been considered to be extremely poor, and the literature concerning pregnancy while on dialysis is rather meagre. We reported our center experience about pregnancy management in patients on hemodialysis: how to deal with hypertension, ultrafiltration rate, dose dialysis in order to improve maternal and fetal outcome.

Method

We reported pregnancy outcomes of 7 pregnancies in the Tensift Region Pregnancy registry between March 2015 and March. 2019 The primary outcome was the live birth rate and secondary outcomes included gestational age and birth weight.

Results

We reported 7 pregnant women cases on hemodialysis. Mean age of our patients was 29,5 ±6,57 years. It was the first pregnancy for 3 patients (42,9%). In about half of patients dialysis was initiated during their pregnancy. The mean duration of pregnancy was 35±1,2 weeks and mean fetal weight was 1,950 ±0,353 kg. All patients were dialyzed over 20 hours per week. The mean urea value was 0,46 ±0,04g/L. Two patients needed anti hypertensive drugs (33,3%) mainly nicardipine. The live birth rate of our cohort (71,4%), all vaginal delivery, was significantly higher than the rate in the American cohort (61.4%). In your series we reported one fetal death at 28 SA explained by tocolysis failure for preterm labor. At 9 months all children had good cognitive and psychomotor involvement.

Conclusion

We conclude that pregnancy may be safe and feasible in women with ESRD receiving intensive hemodialysis. A multidisciplinary medical care with obstetricians is highly recommended. Despite a trend of increasing live birth rate over recent decades, pregnancies on dialysis high risk, with increased rates of adverse of adverse pregnancy outcomes including pregnancy loss.
P1530QUALITY OF LIFE AND MORTALITY IN PATIENTS UNDERGOING HEMODIALYSIS
Authors: Kang Gun Woo , Kim Seoung Gyu , Lee In Hee , Ahn Ki Sung
Published: June 2020

Background and Aims

The mortality of patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD) is higher than the general population. And it is well known that quality of life (QOL) falls immediately after receiving HD. However, studies on the relationship between reduced QOL and mortality in HD patients were very rare. This study aims to observe the correlation between impaired QOL and mortality in HD patients and to identify risk factors that affect mortality.

Method

The study included 160 patients with ESRD undergoing HD during over 3 months. The QOL was evaluated using WHO Quality of Life-BREF (WHOQOL-BREF). The WHOQOL-BREF instrument comprises 26 items, which measure the following four domains: physical health (domain 1), psychological health (domain 2), social relationships (domain 3), and environment (domain 4). Univariate analysis was used to determine the relationship between comorbidities, sex, age, laboratory findings, and QOL and mortality in HD patients. Multivariate analysis was performed by cox proportional hazard regression. Expected survival at 5 and 10 years was determined by two-sample t-tests.

Results

The mean age was 58.1 years old. 95 patients (59.7%) received HD due to diabetes mellitus. 42 patients (26.4%) had been diagnosed with coronary heart disease. In univariate analysis, age, coronary heart disease, malignancy, comorbidities, and blood calcium level were positively correlated with mortality. In particular, the domain 1 and 2 of WHOQOL-BREF were negatively associated with mortality. The mean scores of domain 1 and 2 was 18.2±5.2 and 15.9±4.5 for survivors and 15.5±5.7 and 13.7±4.9 for deaths. Multivariate analysis identified the age, comorbidity, serum calcium, and domain 1 of WHOQOL-BREF were independent risk factors for mortality (Table 1). Additionally, predicting 5- and 10- year survival, mortality was correlation with older age, higher Charlson Comorbidity Index, lower serum calcium, and lower domain 1 of WHOQOL-BREF (Table 2).

Conclusion

The impaired QOL of patients with ESRD undergoing HD was closely related to mortality. In particular, low QOL in physical health domain significantly increased mortality. Therefore, in order to improve the survival of HD patients, we should be considered about QOL as well as medical problems
P1534EFFECT OF HIGH-FLUX DIALYZER MEMBRANE SURFACE AREA ON SURVIVAL IN CHRONIC HEMODIALYSIS PATIENTS
Authors: Takasawa Kazuya , Takaeda Chikako , Yamamura Yuta , Hunamoto Tomoaki , Ueda Norishi
Published: June 2020

Background and Aims

High-flux dialyzer membrane material has been shown to improve mortality in hemodialysis (HD) patients. However, little is known about the impact of surface area of dialyzer membrane on prognosis in HD patients. A retrospective analysis was undertaken to investigate whether the difference in high-flux dialyzer membrane area affects survival rate.

Method

We observed 119 patients (43 females, mean age; 68 years, and HD duration; mean 84.4 months) maintained on HD for up to 5 years and 7 months. All patients were divided into two groups according to the surface area of dialyzer membranes; S group, 39 patients treated with the dialyzer membrane area of <1.5m2 (mean 1.0±0.1 m2) and L group, 80 patients treated with that of ≥1.5m2 (mean 2.0±0.2 m2). We analysed survival rate by Kaplan-Meier method.

Results

The patients were treated with four types of high-flux dialyzer membranes. S group included 21 patients with cellulose triacetate (CTA), 17 patients with polysulfone (PS) and 1 patient with polymethylmethacrylate. L group included 2 patients with CTA, 71 patients with PS and 7 patients with polyethersulfone (PES). Thirty-two patients, including 12 patients in S group and 20 patients in L group, had diabetes mellitus (DM). Survival rate was compared between the two groups, patients treated with CTA, PS and PES, and those with and without DM by Kaplan-Meier method. Type of dialyzer membranes used did not affect survival rate at the final observation (65.2% in CTA, 75% in PES and 50% in PS, p=0.26). The surface area of dialyzer membrane did not have a significant impact on mortality; survival rate at 3-year for S group, 71% vs L group, 77%, at 5-year for S group, 51% vs L group, 59%, and at the final observation for S group, 48%, vs L group, 58% (p=0.352). Among 32 diabetic patients, survival rate at the final observation did not differ between the two groups (S group, 33%, vs L groups, 45%, p=0.477). Among 87 non-diabetic patients (S groups; 27 patients), survival rate did not differ between the two groups at the final observation (S group, 56%, vs L group, 63%, p=0.575).

Conclusion

We conclude that difference in high-flux dialyzer membrane area is unlikely to affect survival rate in HD patients.
P1540EFFECT OF ONLINE HEMODIAFILTRATION ON ANEMIA AND NUTRITIONAL STATUS ON MAINTENANCE HEMODIALYSIS PATIENTS
Authors: Jeong Hyeyun , Lee Yu Ho , Lee So-Young , Yang Dong Ho
Published: June 2020

Background and Aims

The global prevalence and incidence of maintenance dialysis are increasing. Among the modalities of RRT, maintenance hemodialysis (HD) has been a major method worldwide for patients with end-stage renal disease (ESRD). The recent introduction of online-hemodiafiltration (OL-HDF) may offer major advantages in clearing molecules of various sizes, reducing HD-associated amyloidosis and chronic inflammation. Because this modality has been officially approved for ESRD patients, the number of patients worldwide undergoing OL-HDF therapy have consistently increased. However, evidence of clinical effects of OL-HDF is scarce. In this study, we investigated changes in laboratory values over more than 12 months after switching to OL-HDF.

Method

The present study included data from a K-cohort (CRIS no. KCT0003281) of prospectively enrolled adult patients with ESRD undergoing hemodialysis in 6 tertiary hospitals in South Korea. A total of 435 patients was recruited, and 339 patients were on HD at the beginning of the study period. Among the 339 patients, 182 were followed up for more than 24 months. During the follow-up period, 135 patients remained on HD and 47 switched to HDF. However, 3 of the 47 who switched to HDF later returned to HD. We compared clinical parameters in 44 patients who switched to OL-HDF and 135 patients who remained on HD (Figure 1). We used a paired t-test to compare baseline and 24-month follow-up results.

Results

The mean age of the study subjects was 61.2 ± 12.2 years, and 62.6% were male. The duration of dialysis was 2.9 ± 4.4 months. In the group that was switched from HD to OL-HDF, the levels of Hgb and serum albumin increased significantly (10.46 ± 1.03 vs. 11.08 ± 0.82, P = 0.001, and 3.73 ± 0.29 vs. 3.87 ± 0.30, P = 0.001, respectively). Although the normalized protein catabolic rate (nPCR) decreased from baseline after 24 months, the change was not significant (1.07 ± 0.25 vs. 1.03 ± 0.21, P = 0.433). Calcium and calcium-phosphorus products also increased significantly after OL-HDF therapy (8.32 ± 0.75 vs. 8.75 ± 0.80, P < 0.001 and 41.89 ± 12.62 vs. 50.80 ± 20.79, P = 0.013, respectively).

To determine possible confounding effects of clinical factors, we conducted a linear regression analysis with multiple adjustments for changes in various laboratory values after HDF conversion. Conversion to HDF resulted in elevation of serum calcium and albumin levels, both of which were significant even after adjustment for baseline demographics, inflammation, and dialysis duration.

Conclusion

In conclusion, long-term OL-HDF treatment over 12 months or longer was associated with no detrimental effects on anemia or nutritional status. To investigate the effects of OL-HDF therapy, evaluating more parameters over a longer follow-up period with a larger number of patients is needed.

Figure 1.