bluuebunny/crossref_metadata_2025 huggingface dataset:
P1438IMPACT OF HOSPITALIZATION ON BODY COMPOSITION OF DIALYSIS PATIENTS
Authors: Guinsburg Adrian , Kohn Tuli Alejandro , Dalmeida Eurfronio , Barra Ana Beatriz , Machuca Eduardo , Olivares Orlando , Arango Javier , Gomez Canabal María Ines , Briones Leonor , Lopera Maria , Resk Maria Mercedes , Caseiro Mauro , Berbessi Juan Carlos
Published: June 2020

Background and Aims

Patients with CKD are at higher risk of hospitalization (hosp) and this event is a known marker of prognosis. In this study we aim to describe hospitalizations in LatinAmerica and the impact on body composition as measured by multifrequency bioimpedance.

Method

All hospitalizations from Fresenius Medical Care clinical database (EuCliD®) registered in dialysis patients from Argentina, Brasil, Chile, Colombia, Ecuador and Perú during calendar year 2018 were included into the analysis. For each hospitalization we reviewed main reason (ICD10 code), duration and outcome (discharge or death). Body composition was measured using multifrequency bioimpedance (BMC®). On patients with BCM data available in the 30 days prior to hospitalization and before 15 days after discharge values pre and post hospitalization were recorded (BCM data, lab data, treatment data). Pre and post data were compared using Student t test for paired samples. All values expressed as mean ± standard deviation (SD).

Results

During all calendar year 2018, a total of 23,347 hospitalizations from 44,228 patients were recorded.  Mean age was 61.4 ± 16.1 / Male 56.4% / diabetes 38.7%. Accounting for time at risk, hosp rate was 0.74 hosp/pt-year at risk. Mean stay at hospital was 10.9 ± 14.4 days (7.6 days/pt-yr). 35.24% of patients suffer at least one hosp during the year.

Reasons for hospitalization are indicated in table 1:

Conclusion:

Hospitalization in dialysis patients is a frequent event. It has a significant impact on Hb, Ca, P and Albumin levels. Although net patient's weight is significantly reduced, real decrease in muscular and fat mass may be masked by increase in excess water (overhydration) as shown in our results. An early BCM measurement and dry weight adjustment after discharge may be a helpful tool for patient management optimization.
P1443USE OF WRIST-BASED MONITORING DEVICE AMONG HEMODIALYSIS PATIENTS - A FEASIBILITY STUDY
Authors: Han Maggie , Preciado Rojas Priscila , Thwin Ohnmar , Tao Xia , Tapia Leticia , Rivera-Fuentes Lemuel , Hakim Mohamad , Patel Amrish , Grobe Nadja , Thijssen Stephan , Kotanko Peter
Published: June 2020

Background and Aims

Pervasive sensing technologies allow healthcare providers to gain additional insights into patient’s status outside the clinical setting. In order to adopt widespread use of remote monitoring devices we must first study the feasibility of their use. We aim to quantify how long patients will use a wearable device before requiring an intervention to maintain the use of the device.

Method

In-center hemodialysis (HD) patients were enrolled from 4 clinics in New York City starting in May 2018 and followed for a period of up to 1 year. Patients ≥18 years, on HD ≥3 months, able to walk, owning a smartphone, mobile tablet or PC were enrolled. They were provided with a wrist-based monitoring device (Fitbit Charge 2). Participants were instructed on how to use the device, and sync data to their smartphone, mobile tablet, or PC. If a patient failed to sync data for 7 consecutive days, a text message or email reminder was sent from the research staff. We evaluated time to first notification using Kaplan Meier time-to-event analysis. Predictors of time to first intervention was assessed via univariate Cox Regression. Patients were censored at the end of the observation period (January 6, 2020). Socio-economic parameters such as living situation, marriage status, employment status, race, and education level were collected at the beginning of the study.

Results

125 patients were enrolled into our study. 7 patients were screen-failed after enrollment. At enrollment patients were 54±12 years old with a dialysis vintage of 5.6±5.8 years. 37% lived alone, 56% were single, 59% unemployed, 64% were African-American, and 42% had an education level of some college or higher. 82% of the patients required a text message reminder to continue wearing/syncing the device. Mean and median time to first reminder were 101 days (95% CI 80 to 123) and 50 days (95% CI 35 to 70 days), respectively. The probability of being on the study without intervention is shown in Figure 1. Predictors of time to first intervention were chosen a priori and included gender, age, living situation, and education level. None of these parameters were significant predictors of time to first intervention.

Conclusion

We found that most patients will require at least some intervention or counseling to maintain the use of a wrist-based wearable device for remote patient monitoring. While most patients require an intervention before approximately 2 months into wear, the patients who can maintain use independently after that point are likely to do so for longer.
P1449MORTALITY RISK ASSOCIATED WITH ACETIC ACID BASED AND CITRIC ACID BASED BICARBONATE HEMODIALYSIS: A HISTORICAL COHORT STUDY
Authors: Neri Luca , Bellocchio Francesco , Canaud Bernard , Stuard Stefano , Chazot Charles
Published: June 2020

Background

Citric Acid Based Bicarbonate Dialysate (CiD) is increasingly used in hemodialysis to improve hemodynamic tolerance and hemocompatibility associated with Acetic Acid Based Bicarbonate dialysis (AcD). We sought to evaluate the mortality risk associated with different dialysate acidifiers.

Methods

We conducted a multicenter, historical cohort study; all adult incident hemodialysis patients registered in EMEA Fresenius Medical Care network since January 1st 2014 to October 31st 2018 were enrolled. We recorded dialysate acidifier composition for each dialysis session. In the primary analysis (intention-to-treat population), patients were assigned to the exposed group if they received CiD in more than 70% of sessions during the first three months (CiD70%), whereas non-exposed received no CiD at all. In the secondary analysis, exposure was assessed on a monthly basis for the whole duration of the follow up.

Results

We enrolled 10,121 incident patients during the study period. Of them, 371 met criteria for inclusion in CiD70%. After propensity score matching mortality was 11.43 (95%CI: 8.86 - 14.75) and 12.04 (95%CI: 9.44 - 15.35) deaths/100 person-years, in the CiD0% and CiD70% groups respectively (p=0.80). A similar association trend was observed in the secondary analysis.

Conclusions

We did not observe evidence of increased mortality among patients exposed to CiD in a large European cohort of dialysis patients despite physicians were more inclined to prescribe CiD to subjects with worse medical conditions.
P1460MEDIATORS OF THE IMPACT OF HOURLY NET ULTRAFILTRATION RATE ON MORTALITY IN CRITICALLY ILL PATIENTS RECEIVING CONTINUOUS RENAL REPLACEMENT THERAPY
Authors: Naorungroj Thummaporn , Neto Ary Serpa , Zwakman-Hessels Lara , Yanase Fumitaka , Eastwood Glenn , Bellomo Rinaldo
Published: June 2020

Background and Aims

During continuous renal replacement therapy (CRRT), a high net ultrafiltration (NUF) rate is associated with increased mortality. However, it is unknown what might mediate its putative effect on mortality. This study aims to investigate whether the relationship between early (first 48h) NUF and mortality is mediated by fluid balance (FB), hemodynamic instability or low potassium or phosphate blood levels.

Method

We performed a retrospective, observational study in patients treated with CRRT within 14 days of ICU admission who survived >48 hours. The primary outcome was hospital mortality. We applied multiple mediation analysis to identify possible mediators of NUF’s putative impact on mortality.

Results

We studied 347 patients [median (interquartile range) age: 64 (53–71) years and Acute Physiology and Chronic Health Evaluation (APACHE) III score: 73 (54–90)]. After adjustment for confounders, compared with a NUF<1.01 ml/kg/h, a NUF rate > 1.75 mL/kg/h was associated with significantly greater mortality (adjusted odds ratio [aOR], 1.15 [95%CI, 1.03 to 1.29]; p = 0.011). Adjusted univariable mediation analysis found no suggestion of a causal mediation effect for blood pressure, vasopressor therapy, or potassium levels, but identified a possible effect for FB (average causal mediation effect (ACME), 0.95 [95%CI, 0.90 to 0.99]; p = 0.062) and percentage of phosphate measurements with hypophosphatemia (ACME, 0.96 [95%CI, 0.92 to 1.00]; p = 0.055). However, on multiple mediator analysis, such variables lost any suggestion of a significant effect. In contrast, NUF rate remained associated with mortality even in their presence (average direct effect, 1.24 [95%CI, 1.11 to 1.40]; p < 0.001).

Conclusion

An early NUF greater than 1.75 mL/kg/h was independently associated with increased hospital mortality. Its putative effect was not mediated by FB, low blood pressure, vasopressor use, hypokalemia or hypophosphatemia.
P1466SYSTEMATIC LITERATURE REVIEW OF CLINICAL EVIDENCE FOR THE BODY COMPOSITION MONITOR IN DIALYSIS AND CKD
Authors: Raddatz Agnieszka , Moissl Ulrich , Ray Alistair , Eichinger Christian , Wabel Peter
Published: June 2020

Background and Aims

The Body Composition Monitor (BCM) is a bioimpedance spectroscopy device to monitor the hydration status of dialysis and CKD patients. NICE (UK) reported only limited evidence on the clinical effectiveness in its Diagnostic Guidance 29. The aim of this work was to provide a structured review of the available evidence up to September 2018 grouped by the most important clinical outcomes (fluid overload, blood pressure, mortality and cardiovascular events).

Method

MEDLINE, Embase and Cochrane databases were interrogated from 2006 to September 2018. Search and review of identified studies was conducted in compliance with the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Results

Of 4497 articles identified, 843 were included for full-text review; 424 were full publications and were selected for further analysis. Eight randomized controlled trial (RCT) studies and 150 observational studies met the predefined inclusion criteria; of these, observational studies that recruited at least 100 patients and additionally reported important clinical outcomes such as mortality, cardiovascular (CV) events or hospitalization were selected. Two further RCTs were identified by supplementary searches, giving a total of 10 RCTs (total 2.156 patients) and 41 observational studies (total 168.453 patients) included in this review.

The data was grouped by reported outcomes and for each outcome it was analyzed if an effect of BCM-monitored fluid management, or an association between BCM assessment and the respective outcome could be shown. A meta-analysis of the results was not conducted.

Reduction of fluid overload

RCTs have shown that BCM-monitored fluid management and subsequent alteration of dialysis parameters can lead to effective reduction of fluid overload.

Lowering of blood pressure

RCTs have indicated that BCM-monitored fluid management can effectively lower blood pressure.

Impact on mortality / association with mortality

Multiple observational studies have shown a strong association between BCM measurements and mortality. One RCT demonstrated that mortality outcomes can be significantly improved in HD patients with BCM-guided fluid management, while two RCTs reported no significant difference in mortality outcomes.

Impact on Cardio Vascular (CV) related events

Multiple observational studies have indicated that BCM measurements can predict CV events. One RCT indicated that CV events can be reduced by BCM-monitored fluid management, and two further RCTs indicated that using BCM guidance was at least as good as conventional fluid management.

Conclusion

There is a strong body of evidence for various important outcomes covering a large patient basis - additional evidence is needed in well designed randomized controlled trials e.g. to demonstrate the effect of reducing BCM determined dehydration.
P1467DEMOGRAPHY OF THE DIALYSIS POPULATION IN SWITZERLAND IN 2018
Authors: Winzeler Rebecca , Ambühl Patrice Max
Published: June 2020

Background and Aims

The national Swiss Dialysis Registry (srrqap) has been established originally in the year 2006. However, participation is substantial only since 2013, when data collection became mandatory by law. The primary aim of the srrqap is to provide quality control and quality improvement for dialysis therapy in Switzerland. In the present analysis, select demographic characteristics of the Swiss dialysis population are given.

Method

All medical establishments in Switzerland (both public and private; N=92) providing chronic treatment by either hemo- and/or peritoneal dialysis, had to provide relevant data for the year 2018. All individuals being on chronic dialytic therapy in the year 2018 were enrolled (N=4646). For patients alive on December 31 2018, data were gathered from this date or closest to this date. For patients who died during 2018 or were being transplanted, data refer to time of event, or to a date closest to the event.

Results

The median age of dialysis patients in 2018 increased almost by one year compared to 2016. More than fifty percent of the patients were older than 71 years, and nearly ¼ were beyond 80 years. No relevant differences were found between female and male patients regarding mean age (68.6 vs. 68.3 years, respectively). However, women‘s dialysis vintage is significantly higher than men’s (54.4 vs. 45.7 months, respectively) and they are significantly less comorbid than men (4.2 vs. 4.7).

Conclusion

With a coverage of 100% for both centers and patients, the data gathered can be considered highly representative. The incidence of dialysis therapy in Switzerland with 95.9 pmp is clearly lower than in most other countries. In 2018, 3789 prevalent patients (443.7 pmp) were dialyzed in Switzerland. The number of dialysis patients with diabetes increased by almost 1% from 2017, reaching 37.4%.
P1470PREGNANCY IN HEMODIALYSIS: EXPERIENCE OF HEMODIALYSIS CENTERS IN SOUTHERN TUNISIA DURING 34 YEARS
Authors: Gouja Dorsaf , Selma Toumi , Olfa Zini , Hanen Chaker , Najla Dammak , Ikram Agrebi , Soumaya Yaich , Kammoun Khawla , Mohamed Ben hmida
Published: June 2020

Background and Aims

Women with chronic kidney disease are much less likely to become pregnant and pregnany has always been considered as a challenging event both for the mother and the fetus. The challenge is harder in patients undergoing dialysis.

The main objective of our work is reporting our experience of pregnancy’s cases in hemodialysis centers in southern Tunisia.

Method

It was a retrospective study looked at 25 spontaneous pregnancies in 19 patients treated with periodic hemodialysis in different hemodialysis centers in southern Tunisia over a period of 34 years. All pregnancies were spontaneous and are counted even spontaneous or voluntary abortions during the 1st and 2nd trimester of pregnancy

Results

The maternal age at the onset of pregnancy was, on average, 35.63 years ± 5.62 (between 23 and 44 years). Our study included 19 patients from southern Tunisia, 6 of them belonged to the governorate of Medenine. Hypertension was present in 7 patients (37%). The average duration of hemodialysis before conception is 4.56 years ± 3.55 (1 - 17 years). Seven patients (37%) had residual diuresis of: 1 liter per 24h in 2 cases, 500ml per 24h in other cases and the rest of the patients were anuric. All our patients were anemic before pregnancy with a mean hemoglobin level at 8 ± 1.54 g / dl (5.1 - 10.6 g / dl) with erythropoietin use in 12 (48%), folate in 11 cases (44%), intravenous iron in 11 cases (44%) and transfusion in 6 cases (24%).In our series, the average urea level was 22.19 ± 4.29 mmol / L .The urea level was lower or equal to 20 mmol / L in 8 cases (42%) and greater than 20 mmol / L in 11 cases (58%). Among the 25 pregnancies, 16 (64%) resulted in the birth of a live child: 4 intra-uterine malformations, 4 early abortions and one voluntary termination of pregnancy. There were 2 deaths within 28 days after birth.

Pregnancy was considered a success if it resulted in the birth of a newborn surviving at least 28 days. Thus, the success rate was estimated at 56%. Among the maternal complications, hypertension was the most frequently complication (35% of cases). There were 2 cases of hemorrhage’s delivery as obstetrical complication. Among fetal complications, prematurity was frequent and was present in 15 cases (60%): 10 cas (40%) of average prematurity, 4 cases (16%) of great prematurity and 1 case (4%) of extreme immaturity. Hydramnios was found in 3 cases (16%). Intra-uterine growth retardation was found in 13 cases (52%) and 6 cases of death (24%) were described.

Conclusion

Pregnancy during chronic end stage renal failure is rare but possible. The chance of giving birth to a live child has increased in parallel with advances in hemodialysis techniques and early weight-bearing. Thus, a successful pregnancy in woman on dialysis requires collaboration among nephrologists, dialysis unit staff and obstetricians.
P1476IRON PARAMETERS PREDICT CARDIOVASCULAR EVENTS IN MAINTENANCE HEMODIALYSIS PATIENTS
Authors: Yonemoto Sayoko , Hamano Takayuki , Sakaguchi Yusuke , Wada Atsushi , Masakane Ikuto , Nitta Kosaku
Published: June 2020

Background and Aims

Previous studies revealed the association between iron deficiency and thromboembolic events, whereas the association between high serum ferritin and poor prognosis of cerebral haemorrhage was reported in the general population. Since few reports have revealed the relationship between iron parameters and cardiovascular events in hemodialysis (HD) patients so far, our purpose was to examine whether iron parameters predict cardiovascular events in HD patients based on the nation-wide database of patients undergoing dialysis in Japan.

Method

We enrolled 126,560 patients aged between 20 and 100 who had been on maintenance HD more than 1 year and three times weekly at the end of 2012. We divided baseline transferrin saturation (TSAT) levels into 3 categories (T1: <20, T2: 20-25, T3: >25%) and serum ferritin levels into quartile (Q1: <31, Q2: 31-73, Q3: 73-158, Q4: >158 ng/mL). The study outcomes were new onset of myocardial infarction (MI), cerebral infarction (CIF), and cerebral haemorrhage (CHM) and death due to these three diseases between 2012 and 2013. We performed multivariate logistic regression for the incident events and also employed Cox proportional hazards analyses for death. Multiple imputation method with 5 data sets was performed for missing values.

Results

During a 1-year follow-up, a total of 2,087 MI (373 deaths), 2,930 CIF (283 deaths), and 1,371 (359 deaths) CHM occurred. After adjustment for demographic and clinical factors, odd ratios (ORs) for MI and CIF were significantly higher among patients with T1 of TSAT than those with T3 (OR; 1.19 (95% confidence interval (CI), 1.07-1.33), 1.16 (95% CI, 1.06-1.27, respectively), and serum ferritin levels were not associated with those outcomes. On the other hand, TSAT was not associated with CHM, however, stepwise increase of OR with the increase of ferritin quartile was observed; patients with Q4 of ferritin had the highest risk for CHM (OR; 1.32 (95% CI, 1.12-1.57) as compared to Q1). In the multivariable Cox regression models, the hazard ratios (HRs) for death due to MI and CIF of the patients with T1 of TSAT were 1.28 (95% CI, 1.00-1.65) and 1.40 (95% CI, 1.06-1.86) as compared to T3, respectively. HR for death due to CHM in patients with Q1-Q4 of ferritin was 1.00 (Reference), 1.59 (95% CI, 1.12-2.25), 1.90 (95% CI, 1.35-2.67), 1.61 (95% CI, 1.13-2.29), respectively (Figure). Furthermore, high dose of erythropoietin stimulating agents was a risk factor of all three cardiovascular events and mortality.

Conclusion

Low TSAT levels predicted MI and CIF and high serum ferritin levels predicted CHM in HD patients. These results suggest that functional iron deficiency could affect thromboembolic events, while increase in storage iron could affect microvascular fragility.
P1485SEVELAMER USE IS ASSOCIATED WITH DECREASED VITAMIN K LEVELS IN HEMODIALYSIS PATIENTS: RESULTS FROM VITAMIN K ITALIAN (VIKI) STUDY
Authors: Fusaro Maria , Aghi Andrea , Khairallah Pascale , Gallieni Maurizio , Cozzolino Mario Gennaro , Russo Domenico , Mereu Maria Cristina , Ravera Maura , Tripepi Giovanni Luigi , Nickolas Thomas
Published: June 2020

Background and Aims

Sevelamer (S) is a phosphate binding drug used to treat hyperphosphatemia in patients with CKD. Our aim was to evaluate the hypothesis that the use of (S) could interfere with Vitamin K absorption in hemodialysis (HD) patients of VIKI study.

Method

We tested this hypothesis in VIKI, a cross-sectional study of 387 hemodialysis patients, we established the prevalence of vitamin K deficiency and to assessed the relationship between vitamin K status, vertebral fractures, vascular calcification. We determined serum concentrations of vitamin 25(OH)D; alkaline phosphatase (ALP); vitamers K1, MK4, MK5, MK6, MK7; osteocalcin (BGP) and Matrix Gla Protein (MGP). We highlighted that MK4 deficiency was the strongest predictor of aortic calcification (OR, 2.82; 95% CI, 1.14–7.01) while vitamin K1 deficiency was the strongest predictor of vertebral fractures fractures (OR: 2.94; 95% CI, 1.38–6.26).

Results

163 of 387 patients (42.1%) were treated with Sevelamer. There were no differences in levels of 25(OH)D, K1, MK5, MK6 and MK7 among patients treated with and without Sevelamer. Remarkably, the prevalence of MK4 deficiency was higher in Sevelamer treated patients (13.5% vs 5.4%, p=0.005). Sevelamer treated patients also had higher median levels of ALK (89 UI/L vs 77.5 UI/L, p=0.001) and total BGP (210 mcg/L vs 152 mcg/L, p=0.002) and lower median levels of total MGP (16.4 nmol/L vs 20.3 nmol/L, p=0.037) (Table 1 and Figure 1). In multivariable logistic regression, the odds ratio of MK4 deficiency (dependent variable) in patients treated with compared to without Sevelamer was ∼3-fold higher (OR: 2.64, 95% CI: 1.25-5.58, p=0.011) after adjustment for confounders of Vitamin K levels, including older age, previous myocardial infarction, type of HD, ALP, PTH, MGP, BGP, cholesterol and albumin.

Conclusion

These data support the hypothesis that Sevelamer could interfere with MK4 absorption in HD patients. Longitudinal interventional studies are needed to prove the causal nature of these associations.
P1506IMPROVEMENTS IN MICROVASCULAR AND MACROVASCULAR DIABETES-RELATED COMPLICATIONS IN DIALYSIS PATIENTS
Authors: Dea Kofod , Almdal Thomas Peter , Sørensen Vibeke Rømming , Feldt-Rasmussen Bo , Hornum Mads
Published: June 2020

Background and Aims

Newer data suggests that there has been a substantial reduction in the incidence of diabetic complications over the past 30 years. However, little is known about whether this reduction also applies to patients with diabetes and end stage renal disease. The present study examined the current prevalence and the changes in microvascular and macrovascular diabetes-related complications in dialysis patients.

Method

The study was carried out as a cross-sectional study of all 119 diabetic patients in chronic dialysis at our department during June 2019. Data on diabetes-related complications was obtained from the patients’ electronic medical records and compared with a historic control group of all 38 diabetic dialysis patients examined in 2004.

Results

Currently, 12.3% had foot ulcer, while 40.3% had a history of foot ulcer. Lower extremity amputations were seen in 19.3%, with 7.6 % being amputated above-knee level. Development of Charcot foot was seen in 3.4%, and 64.1% had diabetic retinopathy (27.2% with proliferations), 27.2% had maculopathy, and 18.4% had a visual acuity lower than 0.3. A total of 31.1% had atrial fibrillation or flutter, 14.3% had angina pectoris and 20.2% had a history of myocardial infarction. A history of stroke or transient ischemic attack was observed in 21.8% and 6.7%, respectively. Compared with data from the 2004 cohort, we found a significant reduction in the prevalence of current foot ulcers (p=0.013), proliferative retinopathy (p=0.007) and visual acuity lower than 0.3 (p=0.028).

Conclusion

The findings of this study indicate that there has been a reduction in current foot ulcers and eye complications over the past 15 years among diabetic dialysis patients, whereas the prevalence of amputations, cardiovascular and cerebrovascular complications remains high.
P1508COGNITIVE IMPAIRMENT A RISK FACTOR FOR NON ADHERENCE TO MEDICAL MANAGEMENT AMONG PATIENTS ON MAINTENANCE HEMODIALYSIS
Authors: Shehaj Larisa , Rroji (Molla) Merita
Published: June 2020

Background and Aims

Patients with chronic kidney disease (CKD) are at substantially higher risk for developing cognitive impairment (CI) compared with the general population. Subtle changes can impact engagement with healthcare, comprehension, decision-making, and medication adherence. The Montreal Cognitive Assessment (MoCA) test was reported to represent a suitable cognitive screening tool for hemodialysis patients. Our study aimed to assess the prevalence of CI in CKD patients undergoing hemodialysis, socio-demographic and patient-related variables affecting CI and relationship with medical adherence.

Method

Out of 65 patients in the HD unit, 58 patients (mean age 59.16±10.61 years old and meantime in therapy 6.93±5.03 years) accepted to participate in the study. The Montreal Cognitive Assessment (MoCA) scale was administered to patients. Patients with a MoCA global score 24/30 were considered cognitively impaired. Descriptive analysis was done for the socio-demographic and clinical variables.

Results

The mean total MoCA score for all the patients were 22.77679±3.8. Thirty seven patient 63.7% were evaluated with CI where 67.5 % with Mild CI (MCI) and 32.5% with severe CI (SCI) under 20 points). MoCA subscale analysis revealed that the mean score for visuospatial/executive domain and attention were the lowest with 5.38±1.3 /8max and 2.82±1.67/6 max and scores for orientation were the highest 5.94±0.59/6 max. MCI was related to vintage to dialysis (p < .00001) and education years (p<0.05) but not with age (p>0.05) and gender (p>0.05) where severe CI was related to age and comorbidity ( p<0.05 and P<0.01, respectively. We found a strong association between low scores and medical adherence (p<0.001).

Conclusion: In hemodialysis, we have a relatively high prevalence of CI and screening for impairment should be considered in all adults with ESRD. Older age, vintage on dialysis, and comorbidity were associated with lower scores. The visuospatial/executive domain and attention were mostly affected. The association between low scores and medical adherence show a high risk for this group of patients.
P1511MODELO PREDICTIVO DE SUPERVIVENCIA DE INTELIGENCIA ARTIFICIAL (BOSQUE ALEATORIO) EN HEMODIALISIS. DATOS DEL REGISTRO ANDALUSINA DE ENFERMEDADES RENALES. SICATA
Authors: Benítez Sánchez Manuel , Martín Guillermo , Sacaluga Luis Gil , Cortes Maria Jose Garcia , García Marcos Sergio , Bayo Magalena Palomares , Morales Ana , Ojeda Raquel , Novillo Carolina Lancho
Published: June 2020

Background and Aims

Random Forest (RF) is an analytical technique of Artificial Intelligence (AI) that consists of an assembly of trees built by bootstrapping (resampling with replacement). In each node a subset of predictor variables is selected and for them the best cut point is determined. Each division of the tree is based on a random sample of the predictors. The trees are as long as possible. In the construction of each RF tree a part of the observations is not used (37% approx.). It is called an out-of-bag (OOB) sample and is used to obtain an honest estimate of the predictive capacity of the model. So it does not require validation. In each analysis, a few hundred Regression or classification trees are carried out, depending on whether the response variable is numerical or qualitative respectively. The result is an average of the repeated predictions of the model (Bagging). RF allows to calculate the importance of the predictor variables, which can be used later to be included in a multivariate regression model.

Method

We analyzed 14750 records between 2011 and 2014 contained in Information System of the Autonomous Transplant Coordination of Andalusia (SICATA) a system that includes clinical-epidemiological variables, about anemia, bone bone metabolism, adequacy of dialysis and vascular access. 1911 patients presented the event of interest (exitus). Three predictive and explanatory models of survival are developed: 1-RF. 2-.Multivariate Logistic Regression. 3- Multivariate Logistic Regression that includes the important variables of the previous RF model. We compare them in terms of accuracy (AUC of the ROC curve).

Results

AUC of the ROC curve of the multivariate model without prior RF was: 0.75 AUC of the ROC curve of the multivariate model with previous RF was: 0.81. AUC of the ROC curve of the Random Forest model: 0.98

Conclusion

The Random Forest model has a 98% discrimination in the mortality of patients on Hemodialysis, far superior to the classic multivariate analyzes. The Multivariate Logistic Regression performed with the important RF variables improves the AUC of the previous model 0.81 vs. 0.75.
P1524ABSOLUTE BLOOD VOLUME AND VASCULAR REFILLING IN HAEMODIALYSIS PATIENTS
Authors: Álvarez Nadal Marta , Viera Ramírez Elizabeth , Martin Irene , Ruíz-Roso López Gloria , Delgado Yagüe María , Fernandez Lucas Milagros
Published: June 2020

Background and Aims

The imbalance between UF and reﬁlling rate is considered a major cause for intradialytic hypotension. Recent studies report a feasable and noninvasive method to estimate vascular refilling by determining absolute blood volume. It was the aim of this study to analyze absolute blood volume in a group of haemodialysis patients and to examine vascular reﬁlling volume.

Method

Thirty stable chronic HD patients were studied (36,7% female, 63,3% male), aged 71,07 ± 13,31 years. Dialysis duration and UF requirements were based on physician prescription. Vascular refilling was calculated as: VREF = VUF – ΔV, where ΔV is the difference between absolute blood volume at the beginning and the end of dialysis. Relative blood volume monitor (BVM) was used. Hemodial Int. 2016;20(3):484–91.

Results

Absolute blood volume at the beginning of the dialysis was 6,27 ± 2,78 L (92,44 ± 32,66 ml/kg) and at the end 5,83 ± 2,77 L (85,94 ± 30,44 ml/kg). Ultrafiltration (UF) volume was 2,64 ± 0,82 L (11,14 ± 4,02 ml/kg/h). Vascular refilling was calculated as 2,24 ± 0,74 L, with a refilling fraction of 85,33 ± 11,07%. We found a strong correlation between reﬁlling volume and UF volume (r2 0,861) (Figure 1), and a mild correlation between reﬁlling volume and predialysis volume overload (r2 0,529).

Conclusion

Measurement of absolute blood volume is easy and noninvasive, and it allows us to study refilling volume. We found a strong correlation between UF volume and refilling volume.
P1527SURVIVAL COMPARISON:HEMODIALYSIS VS PERITONEAL DIALYSIS: TEN YEARS OBSERVATIONAL STUDY
Authors: Terlizzi Vincenzo , Lucca Bernardo , Manenti Chiara , Gaggia Paola , Zubani Roberto , Pola Alessandra , Vizzardi Valerio , Sandrini Massimo , Movilli Ezio , Scolari Francesco
Published: June 2020

Background and Aims

Survival comparison between peritoneal dialysis (PD) and hemodialysis (HD) is still controversial. While some retrospective studies have shown better survival in PD, particularly in the first year, others have not identified this difference. The only RCT published so far showed a 3-year mortality rate similar between two groups. However, the number of patients was too small to provide sufficient statistical power to identify any survival differences between the two dialysis techniques. Aim of this study was to compare HD and PD in term of survival rate and factors possibly involved in a ten-years observational study.

Method

We retrospectively evaluated all the incident patients that started a dialytic treatment, either HD or PD, due to uremia from 01-01-2008 to 31-12-2018 at the U.O. Nephrology ASST Spedali Civili of Brescia. Exclusion criteria were: duration of dialysis treatment less than 3 months, and previous dialytic treatment or kidney transplantation. For each patient anthropometric, clinical-anamnestic data and comorbidities at dialysis start were recorded.

Results

One thousand and six patients were identified. 130 patients were excluded due to dialysis treatment less than 3 months. A total 876 patients were analyzed. 77% of patients started dialysis on HD while 23% chose PD. Age was significantly higher in HD patients (69±15 vs 65±16 years; p<0.05). No differences were found in the incidence of: ischemic heart disease (HD 24%, PD 25%, p=0.90), diabetes (32% vs 32%, p=0.83), cancer (20% vs 17%, p=0.37), cardiac arrhythmia (20% vs 25%, p=0.08) and peripheral vascular disease (25% vs 25%, p=0.89). An increased incidence of COPD (HD 17% vs PD 8%, p<0.05) and hypertension (73% vs 87%, p<0.05) was present in PD patients. During follow-up, 17% of patients treated with PD shifted to HD due to catheter malfunction, recurrent infections, insufficient dialytic adequacy or ultrafiltration failure. Kidney transplants were performed more frequently in PD patients (HD 12%; PD 24%, p<0.05). At an intention to treat analysis of the data, univariate analysis showed better survival in PD patients (p<0.05, Figure 1). This difference was not confirmed at multivariate analysis (Figure 2), where age, cardiac arrhythmia, cirrhosis, diabetes and peripheral vascular disease were independently associated with an increased risk of mortality. No independent influence on mortality of the dialysis treatment modality was found.

Conclusion

This ten years observational study shows that HD and PD are similar in term of patient survival. Age and comorbidities seem to play the most important role in patient survival.
P1528EPIDEMIOLOGICAL SURVEY OF A POPULATION UNDERGOING URGENT HEMODIALYSIS
Authors: Felah Eya , Samia Barbouch , Mariem Hajji , Ben amor Shedha , Chargui Soumaya , Trabelsi Raja , Karoui Cyrine , Hedri Hafedh , Goucha Rym , Ounissi Mondher , Ben Hmida Fethi , Ben abdallah Taieb
Published: June 2020

Background and Aims

Urgent hemodialysis is a very common situation in nephrology and is burdened with high morbidity and mortality. The aim of this work is to study the epidemiological, etiological, clinico-biological and indications of dialysis emergencies, the parameters of the session and the potential complications.

Method

This is a descriptive study conducted over a period of 12 months (January – December 2017), including all patients who have been admitted to the nephrology department for urgent management in hemodialysis.

Results

Our study collected a total of 318 patients (sex ratio =1.52), the mean age 60.54 ± [18-95 years]. Patients came mainly from the emergency department (69.8%). 40.9 % of the patients were diabetic and 66,4 % hypertensive, 15.1% had coronary artery disease. Among patients, 80.9% had chronic renal insufficiency, of which 29.6% were end-stage (28% hemodialysis and 1.6% peritoneal dialysis). Urgent hemodialysis was undertaken for threatening hyperkalemia in 58.2% of cases, a poorly tolerated uremic syndrome in 50.8% acute pulmonary edema (APO) in 36.5% of cases, and anuria greater than 12h were the indication in 44.4% of cases and a severe metabolic acidosis in 11.3% of cases.

The average duration of the session was 3 hours. Ultrafiltration was necessary in 63.7% of the cases. The blood access was a femoral catheter in 80.6% of the cases. Blood transfusion was indicated in 13.8% of cases. Main complications were dominated by symptomatic arterial hypotension in 12.9% requiring stopping the session in half of cases hypoglycemia in 6.9%, neurological disorder in 6.6% chest pain in 3.5 %. After a year of follow up care, overall mortality was 40% in this population. On multivariate analysis, age (p=0.006) and neurological state according to the glasgow score (p=0.01) were retained as independent factors of mortality in this population.

Conclusion

A greater prevalence of urgent hemodialysis is observed in our country testifying to the accessibility of this method of extrarenal replacement. Hyperkalemia, uremic syndrom and PAO are the main indications for urgent hemodialysis. Early diagnosis, prompt and relevant management of these patients will determine their prognoses in the short and medium term.
P1529MORTALITY PREDICTORS IN INCIDENT HEMODIALYSIS PATIENTS - HAVE HEY CHANGED IN TEN YEARS?
Authors: Figueiredo Cátia Raquel , Escoli Rachele , Gonçalves Hernâni , Lopes Karina , Sofia Flora , Vila Lobos Ana
Published: June 2020

Background and Aims

In the last years there has been an increase in elderly patients with multiple comorbidities inducing hemodialysis (HD). Since dialysis treatment itself may be associated with a further deterioration in functional status, nephrologists are increasingly careful in selecting these patients for HD. Concerned with this reality we tried to understood if early mortality predictors (in the first 6 months) in incident HD patients have changed in almost 10 years, in the same hospital HD unit.

Method

This is a retrospective observational study of incident HD patients between 01 January 2017 and 30 June 2019. We evaluated similar clinical, analytical and demographic data to those used to predict mortality in the same HD unit from 1 January 2010 to 30 September 2014. Logistic regression analysis was used to evaluate 6 month mortality predictors. Statistical analysis was performed using SPSS version 25 for Windows.

Results

The average age of 163 incident HD patients were 70.63±3.9 years (similar to the previous population: n= 235; 70.7 ± 14.9 years) and 57.1% were male. During this study we observed 26 (16%) deaths, 12 of which (46.15%) occurred in the first 6 months of hemodialysis. Pneumonia and cachexia were the major causes of mortality, unlike the previous population, in which majority of deaths were attributed to cardiovascular events. Between January 2010 to 30 September 2014 the strongest predictors of early mortality were dementia [adjusted odds ratio (OR) 15.94 (CI: 4.09–62.10)], central venous catheter use [(OR) 12.29; (CI: 3.54-42.65)], cancer [(OR) 4.64 (CI: 1.48-14.54)] and heart failure [(OR) 3.57 (CI: 1.08-11.75)]. Differently, in this study, the institutionalization and the presence of metastases were the predictors that showed a higher risk of death [p=0.005; adjusted odds ratio [(OR) 10.4 (CI: 2.017–49.9) and p=0.01; (OR): 14.9 (CI: 1.89-42), respectively]. Longer hospitalizations at the time of HD induction [(p=0.044; (OR):1.103; CI: 1.003-1.213)] and albumin values <2.5 mg/dL [(p=0.03; (OR): 3.8 (CI: 1.14-13)] were also strong mortality predictors. which were not previously observed.

Conclusion

Nowadays, nephrologists are less liberal in initiating dialysis to elderly patients with dementia and cardiovascular comorbidities. However, the population is getting older and our recent mortality predictors may reflect the aging of chronic kidney disease patients, who have multiple comorbidities as cachexia, requiring institutionalization and longer hospitalizations. It is increasingly important to evaluate patients prior to dialysis initiation, so our goal is to create an adjusted mortality score in our HD unit to help make the decision about inducing or not HD in our patients.
P1531DIURETIC USE IN HEMODIALYSIS PATIENTS: BENEFIC ASSOCIATION WITH RESIDUAL RENAL FUNCTION AND ALL-CAUSE MORTALITY
Authors: Faria Maria do Sameiro , Valente Maria João , Rocha Susana , Coimbra Susana , Catarino Cristina , Rocha-Pereira Petronila , Bronze-da-Rocha Elsa , Oliveira José Gerardo , Madureira José , Fernandes João Carlos , Miranda Vasco M P , Belo Luís , Santos-Silva Alice
Published: June 2020

Background and Aims

In patients with end-stage renal disease (ESRD) on hemodialysis, the preservation of residual kidney function may result in a diversity of benefits in terms of survival and quality of life. The control of fluid and electrolyte homeostasis may play an important role in this setting. Elevated predialysis serum potassium is a common electrolyte disturbance that may worsen patient’s outcomes. Our aim was to study the impact of furosemide therapy in predialysis serum potassium levels, indicators of estimated residual renal function, and inflammatory markers, in ESRD patients under hemodialysis; moreover, we aimed to study the impact of furosemide-associated changes on mortality rate.

Method

A cross-sectional study was carried out on 289 adult patients on chronic dialysis therapy (hemodiafiltration and high flux hemodialysis). Patients were divided in 2 groups: the diuretic group (DG, n=116; 120.0 (IQR: 80-160) mg/daily median furosemide dose) and the non-diuretic group (NDG, n = 173), in which patients did not use furosemide. A large set of data was analyzed, encompassing hematological data, serum electrolyte parameters, inflammatory markers, dialysis adequacy, and biomarkers of residual kidney function. A 2-year follow up study was also performed by registering events of death (all-cause mortality).

Results

The DG patients, compared with NDG patients, presented: significantly lower predialysis serum potassium; more favorable blood biomarkers of kidney function - lower β-trace protein, cystatin C, creatinine and urea; greater residual glomerular filtration rate derived from equations with cystatin C, creatinine and creatinine–cystatin C; lower inflammation (significantly lower levels of high-sensitivity C-reactive protein); intradialytic ultrafiltration volume (L) was similar for the two groups. Mortality was significantly lower for DG patients, compared with NDG (13.6% versus 24.7%; P=0.029).

Conclusion

In ESRD patients under chronic dialysis, we found a significant association between current diuretic therapy and lower predialysis serum potassium levels, more favorable biomarkers of kidney function and a decreased inflammatory response that seem to contribute to a higher survival rate.

Acknowledgments: The work was supported by UIDB/04378/2020 with funding from FCT/MCTES through national funds, by North Portugal Regional Coordination and Development Commission (CCDR-N)/NORTE2020/Portugal 2020 (Norte-01-0145-FEDER-000024) and by REQUIMTE-Rede de Química e Tecnologia-Associação in the form of a researcher (S. Rocha) – project Dial4Life co-financed by FCT/MCTES (PTDC/MEC-CAR/31322/2017) and FEDER/COMPETE 2020 (POCI-01-0145-FEDER-031322).
P1532PARATHYROID HORMONE SERUM LEVELS AND MORTALITY AMONG HEMODIALYSIS PATIENTS IN THE GULF COOPERATION COUNCIL COUNTRIES: RESULTS FROM THE DOPPS (2012-2018)
Authors: Al Salmi Issa , Bieber Brian , AlRukhaimi Mona , AlSahow Ali , Shaheen Faissal , Al-Ghamdi Saeed M G , Al Wakeel Jamal , Al Ali Fadwa , Al Arriadi Ali , Hejaili Fayez , Al Maimani Yacoub , Fouly Essam , Robinson Bruce , Pisoni Ronald
Published: June 2020

Background and Aims

The prospective Dialysis Outcomes and Practice Patterns Study (DOPPS) has collected data since 2012 in all six Gulf cooperation council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, United Arab Emirates). Here, we report the relationship of PTH with mortality in this largest GCC hemodialysis patient cohort studied to date.

Method

Data were from randomly-selected national samples of hemodialysis facilities in GCC DOPPS phases 5 and 6 (2012-2018). PTH descriptive findings and case-mix adjusted PTH/mortality Cox regression analyses were based on 1825 and 1422 randomly-selected hemodialysis patients, respectively.

Results

Mean patient age was 55 years (median dialysis vintage = 2.1 years). Median PTH ranged from 259 pg/mL (UAE) to 437 pg/mL (Kuwait), with 22% having PTH <150 pg/mL, 24% (PTH 150-300), 34% (PTH 301-700), and 20% (PTH >700) pg/mL. Patients with PTH >700 pg/mL were younger, on dialysis longer, less likely to be diabetic, have urine>200 mL/day, prescribed 3.5 mEq/L dialysate calcium, had higher mean serum creatinine and phosphorus levels, lower white blood cell counts, and more likely to be prescribed cinacalcet, phosphate binders, or IV vitamin D. A “U-shaped” PTH/mortality relationship was observed with >2-fold and 1.5 fold higher adjusted HR of death at PTH>700 pg/mL and <300 pg/mL, respectively, compared to PTH 301-450 pg/mL.

Conclusion

Secondary hyperparathyroidism is highly prevalent among GCC hemodialysis patients, with a strong U-shaped PTH/mortality relationship seen at PTH <300 and >450 pg/mL. Future studies are encouraged for further understanding this PTH/mortality pattern in relationship to unique aspects of the GCC hemodialysis population.
P1533SURVIVAL ANALYSIS OH HAEMODIALYSIS PATIENTS: IMPACTO OF UREMIC TOXINS
Authors: Sargsyan Mari , Robles Juan , Cabello Pelegrin Sheila , Ferrer Balaguer Juana Maria , Rey Valeriano Juan , Jimenez Mendoza Sonia Cleofe , Egea Sancho Cristina , Villagrasa Villagrasa Tania , URIOL MIGUEL , Gomez Marques Gonzalo , Barcelo Martin Bernardino , Gasco Company Joan Manuel
Published: June 2020

Background and Aims

HEMO study showed that β2M level over time was predictive of all-cause mortality in haemodialysis patients (HD). Later studies suggested that protein-bound uremic toxins are associated with mortality in HD patients but with recent contrasting results.

Aim of study was to analyse β2M and indoxyl sulfate (IS) as predictor factors of mortality.

Method

5 years follow-up of 60 prevalent HD patients of our hospital. Demographic data was described. Baseline midweek pre-dialysis serum β2M was determined by nephelometry and total IS levels by high performance liquid chromatograph connected to a UV detector. We considered high serum β2M group as if was equal or higher than 27,5 mg/L. As to IS, patients were divided into quartiles (1q <9,7 mg/L, 2-3q ≥9.7-26.5mg/L, 4q>26.5 mg/L).

Survival curves were assessed using the Kaplan–Meier analysis at 1,2,3 and 5 years in univariate analysis for albumin (≥38 g/L or lower), β2M, and total IS groups, and evaluated by the proportional hazards Cox´s model. P -values <0.05 were considered statistically significant.

Results

60 prevalent patients with mean vintage of 46,8 months (range 3-299 months). Mean age was 60±20 years. Males were more prevalent (53,3% vs 46,6%). 35% had diabetes. 51,6% underwent conventional hemodialysis (HD), 48,3% post-dilution haemodiafiltration, with mean convective volume of 23,8±2,8L. Mean eKt/V was 1,67±0,4, mean nPCR was 1±0,27g/kg/day. Only 8,3% of patients had urine volume>500cc/24hours. Mean β2M level was 35,6±1,9mg/L (X±SE) and mean total IS level was 18,9±1,6mg/L.

The overall mortality at 5 years was 57%. Albuminemia lower than 38g/L was associated with mortality at 2, 3, and 5-years in univariate analysis (Cox´s F test p=0.03, figure 1). We found no difference in survival rate between patients with high or low serum β2M levels at 3- or 5-years analysis (Cox´s F test p=0.27). At 2 years analysis, patients in the lower β2M group had better survival (Cox´s F test p=0.04, Figure 1). There was no statistically significant association between albumin, β2M, IS level and all-cause mortality on Cox regression multivariate analysis. We observe no statistically significant association between IS levels and all-cause mortality neither on univariate, nor on multivariate analysis.

Conclusion

β2M < 27,5 mg/l was associated with better survival at 2 years univariate analysis. IS had no statistically significant association with all-cause mortality in our cohort.