bluuebunny/crossref_metadata_2025 huggingface dataset:
P1515IMPACT OF POLYPHARMACY ON ALL-CAUSE MORTALITY, ALL-CAUSE HOSPITALIZATION AND CARDIOVASCULAR EVENTS IN INITIAL JAPANESE HEMODIALYSIS PATIENTS
Authors: Toida Tatsunori , Toida Reiko , Ebihara Shou , Uezono Shigehiro , Komatsu Hiroyuki , Sato Yuji , Fujimoto Shouichi
Published: June 2020

Background and Aims

Polypharmacy (PP) is common in end-stage chronic renal disease patients, largely because of the existence of multiple comorbid conditions. PP has the potential for harm and benefits, and the association between PP and mortality and morbidity in hemodialysis patients currently remains unclear. We examined the association of PP and the risk of clinical outcomes, such as all-cause mortality, all-cause hospitalization and cardiovascular events, in initial hemodialysis patients at admission and discharge.

Method

Study design: Cohort study.

Setting: Participants: One hundred and fifty-two initial hemodialysis patients (female vs. male, 88 vs. 64; mean age, 70.3 years) were enrolled between February 2015 and March 2018 at the Nobeoka Prefectural Hospital and Chiyoda Hospital.

Predictor: Patients were divided into 2 groups according to PP (6 or more drug prescriptions, or less) during admission and discharge for the initiation of hemodialysis.

Outcomes: All-cause mortality, all-cause hospitalization and cardiovascular events (hospitalization due to stroke, ischemic heart disease or peripheral artery disease) during the mean 2.8-year follow-up.

Measurements: Hazard ratios (HRs) were estimated using Cox’s model for the relationships between PP and the clinical outcomes, and adjusted for potential confounders, including age, sex, body mass index, systolic and diastolic blood pressure, Charlson comorbidity risk index, hemoglobin, serum levels of albumin, albumin-corrected Ca, phosphate, parathyroid hormone, C-reactive protein and NT-proBNP; and use of erythropoietin stimulating agents. The group with 5 or less drug prescriptions was set as reference.

Results

Among the patients in this cohort study, the number of prescribed drugs per patient averaged 7.4 at admission and 6.9 at discharge for initial hemodialysis. One hundred (65.8%) and 94 patients (61.8%) had PP at admission and discharge, respectively. During follow-up, 20 patients died, 71 patients were hospitalized and 25 patients had cardiovascular events. PP at admission is significantly associated with cardiovascular events (HR 8.50, 95%CI 1.45-49.68). Furthermore, PP at discharge is significantly associated with all-cause hospitalization and cardiovascular events (HR 1.95, 95%CI 1.01-3.70; HR 53.16, 95%CI 2.70-104.62, respectively). However, PP is not significantly associated with all-cause mortality at admission or discharge.

Conclusion

Among Japanese patients starting hemodialysis, PP may be associated with clinical outcomes. However, it remains unclear whether PP is the direct cause of the outcomes or is simply a marker for increased risk of outcomes.
P1516DEMONSTRATION OF FLUID REMOVAL ACCURACY USING THE SC+ HAEMODIALYSIS SYSTEM
Authors: Buckberry Clive , Komenda Paul , Heyes Keith , Westenbrink Eric , Wallace Mark , Milad John
Published: June 2020

Background and Aims

Fluid management is an integral component for managing patients to correct abnormalities in plasma composition and maintain fluid balance. Consequently, accurate fluid removal during treatment is a critical design element of haemodialysis machines. The SC+ haemodialysis system developed by Quanta Dialysis Technologies, is a small, simple-to-use dialysis system designed to improve patient access to self-care and home haemodialysis. This paper describes the design, evaluation and performance of the flow balance and ultrafiltration module of SC+ to deliver specified fluid removal in accordance with the international technical standards for haemodialysis defined in IEC 60601-2-16 using a number of unique proprietary technologies.

Method

SC+ uses volumetric flow balancing chambers which are contained within a single use disposable cartridge. During normal operation of SC+, dialysis fluid flows through the cartridge in discrete packets. This is achieved by the application of pneumatic pressure and vacuum to manipulate a flexible PVC membrane that, in turn, opens and closes a sequential series of valves and pump cavities that constitute the flow balance chambers.

Proof of system performance was undertaken using a range of dialysers and venous pressures, with and without ultrafiltration, to quantify the net fluid removal error, in order to simulate a range of patient conditions in typical clinical practice.

Results

In total, the tests comprised 22 separate runs on multiple machines, with 88 individual

30-minute measurement samples, taken over a range of environmental conditions, dialyser types (with differing KuF), dialysate flowrates, and venous pressures.

Across all results, there was a mean error of 7.4g/hour rate error, (max allowed is 100g/hr) of positive flow from the blood to the dialysate side with a standard deviation of 19.88g/hr. The maximum permissible rate stated in IEC 60601-2-16 is +/-100g/hr.

In specific detail, without ultrafiltration the flow balance error was measured as 2.2g/hr with a deviation of 19.0g/hr, and with ultrafiltration the mean error was 12.8g/hr with a standard deviation of 19.5g/hr.

Conclusion

It has been demonstrated that flow balance error and fluid removal attainable with the SC+ haemodialysis system lies well within the acceptable standards permitted for haemodialysis machines. This essential performance parameter as defined within IEC 60601-2-16 has been demonstrated across a range of clinically relevant parameters at dialysate flow rates of up to 500ml/min
P1517SURVIVAL ON DIALYSIS: SWITZERLAND IN COMPARISON WITH OTHER COUNTRIES - A FOLLOW UP
Authors: Winzeler Rebecca , Ambühl Patrice Max
Published: June 2020

Background and Aims

Survival in dialysis patients is substantially reduced compared to the general population. The aim of the present analysis was to compare the survival of Swiss dialysis patients with other countries with an additional year of follow up and a higher number of patients.

Method

Incident dialysis patients (hemo- or peritoneal dialysis; N=4525) from the Swiss dialysis registry were followed up from 2014 on until December 31, 2018 (mean follow up days=684). Deaths occurring during this time (N=976) were recorded and survival was examined using the Kaplan Meier method, censored for transplantation.

Results

Characteristics of the dialysis population stratified according to survival status are provided in Table 1.

Dialysis patients in Switzerland have an approximately 8% higher survival in the first and second year after start of dialysis compared to other European countries (Annual ERA-EDTA Report 2016). In the oldest age group, it amounts to up to 13 and 14%, in the first and in the second year, respectively. The proportion in survival rates between genders is similar in Switzerland, as well as in Europe. Dialysis patients aged younger than 45 years have a worse survival in Switzerland compared to other European countries.

Conclusion

The markedly better survival in dialysis patients in Switzerland compared to other European countries could be confirmed with an additional year of follow up and more patients. Also, causes of death vary widely among European countries. With an additional year of follow up, data to analyze 5-year survival probability will be available for comparison with the ERA-EDTA report. In addition, we will be able to verify whether dialysis patients under 45 years in Switzerland have an increased mortality or whether this is due to the small number of patients in these two age groups.
P1520PULMONARY HYPERTENSION AS NEW RISK FACTOR FOR MORTALITY IN HEMODIALYSIS
Authors: RAMIREZ MARMOLEJO ROBERTO , MUÑOZ ZAPATA LUIS MIGUEL , Garcia Blanco Laura
Published: June 2020

Background and Aims

The prevalence of pulmonary hypertension HTP in patients receiving dialysis therapy is not completely clear, it is an independent risk factor for cardiovascular mortality, which indicates the serious need to sensitize the clinic with this comorbidity and maintain an active search for it.

Objective: Raise awareness about the prevalence of HTP in a hemodialysis population and identify the associated risk factors.

Method

Descriptive, retrospective study, in which echocardiograms of the patient (peritoneal dialysis PD and hemodialysis HD) in renal facility were reviewed, at least 12 months in therapy, Nice 2013 classification were used for the diagnosis of HTP, multivariate analysis (echocardiograHTPic, demograHTPic, clinical and biochemical variables) was performed and the statistical significance of P <0.05 with the X2 method was searched for the associated risk factors.

Results

24 male patients (45%), 75% with systemic hypertension, 34% with diabetes mellitus T2, on average 5 years on dialysis (+/- 2.7), age of 64 years (+/- 13.6) and 3 very elderly patients (> 85y); 35 patients (66%) on hd and 18 (34%) on PD. 51% had fistula ArterioVenosa (FAV). 100% of patients in hd with KtVe> 1.25 and 73% in pd with KtV> 1.7.

Regarding the HTP, 27 positive patients were found (51%), the significant (p <0.05), were: hd 54% vs 44% PD, having a 76% central catheter with HTP vs 33% with fav, and patients with severe vs mild Hiperparatiroidism

The severity of HTP, in hd vs pd was more severe, PSP average of pressures in the positive 43mmHg vs 34.3mmHg respectively (p <0.033)

Conclusion

HTP is a comorbidity that impoverishes the cardiovascular prognosis and its management must be specific, especially due to the preference of calcium antagonists over the use of renin angiotensin system blockers. The prevalence of PHT in the hemodialysis population is very high, which makes the clinician an active search and effective treatment, especially in patients with catheters. Hyperparathyroidism plays a role within the remodeling mechanisms of the pulmonary arterial endothelium, aggravating this situation and increasing mortality
P1523TREATMENT OF ADVANCED NON-SMALL CELL LUNG CANCER IN DIALYSIS PATIENTS; FINDINGS FROM OSAKA CANCER REGISTRY DATA
Authors: KIDA NANAMI , Tsubakihara Yoshiharu , Morishima Toshitaka , Sato Ryo , Miyashiro Isao
Published: June 2020

Background and Aims

Recent advances in dialysis technic for end-stage renal disease have resulted in a longer survival. Consequently, they have an increased risk of suffering from various neoplastic diseases. The survival outcome and treatment rate in non-small cell lung cancer(NSCLC) patients on dialysis has not been well evaluated. In patients with unresectable stage disease, chemotherapy may best be started soon after the diagnosis of unresectable NSCLC has been made. The aim of this study was to investigate the practice pattern and survival rate in advanced NSCLC patients on dialysis.

Method

This retrospective study used population-based cancer registry data from Osaka Prefecture, Japan and administrative claims data produced under the Diagnosis Procedure Combination reimbursement system. We performed record linkage between these datasets to obtain patient-level information on dialysis, cancer diagnoses, treatment, and vital statuses. Patients who were diagnosed with advanced NSCLC between 2010 and 2015 and were at the age of 80 years or younger. We calculated the performance proportions of chemotherapy (including molecular-targeted drugs) in dialysis patients and non-dialysis chemotherapy. In addition, we computed one-year survival rate of patients in dialysis patients who underwent chemotherapy and who did not undergo.

Results

We identified 42 dialysis patients with a median age of 71 years and 18,425 non-dialysis patients with a median age of 70 years who were diagnosed with advanced NSCLC. Dialysis patients (n=11, 26.2 %) were less likely to receive chemotherapy when compared with non-dialysis patients (n=12247, 66.3%). Among dialysis patients, there was no significant difference in 1-year survival rate between the receipt (40.0%) and the non-receipt (29.6%) of chemotherapy (Log-rank test, p=0.41).

Conclusion

Dialysis patients might receive suboptimal treatment for advanced NSCLC. Further studies are needed to assess whether chemotherapy improves survival outcomes in dialysis patients with advanced NSCLC.
P152590 DAY MORTALITY DATA OF PATIENTS INITIATING MAINTENANCE HEMODIALYSIS AT A TERTIARY CARE FACILITY IN PAKISTAN
Authors: Asif Sonia , Saleem Mohammad , Qayyum Ahad
Published: June 2020

Background and Aims

Mortality of end stage renal disease patients is 10 to 30 times higher than that of the general population. Timing of death related to dialysis vintage remains unclear. Mortality risk among hemodialysis patients may be highest soon after initiation of hemodialysis, the reason for which remains elusive. Additionally mortality on initiating hemodialysis is related to arteriovenous vascular access.

Poor planning for dialysis initiation may contribute to hemodialysis catheter use and the associated high rate of infections. This study was carried out to determine the 90-day mortality in patients starting maintenance hemodialysis at a tertiary care facility in Pakistan.

Method

This is a cross sectional study which included all consecutive patients who initiated maintenance hemodialysis at Bahria Town Hospital Lahore. A total of 485 participants were included and the collected data was entered into the SPSS software and their mortality rate was calculated within 90 days after initiation of maintenance hemodialysis. Additionally 90-day mortality based on type of vascular access at initiation was also noted.

Results

The mean age of the participants included in the study was 44 with 50% of the patients were male. The 90-day mortality of patients initiating maintenance hemodialysis at our centre was found to be 37%. 90% of the patients initiating maintenance hemodialysis started through a double lumen temporary dialysis catheter. Amongst these patients the mortality rate was 39%. 10% of the patients initiating maintenance hemodialysis started through an arteriovenous fistula. Amongst these the mortality rate was 19%.

Conclusion

Our study showed that the mortality rate is high in patients undergoing hemodialysis with in first 90 days. Early planning for permanent vascular access may result in a reduction of mortality.
P1536EVOLUTION OF A COHORT OF PATIENTS UNDERGOING HOME ONLINE HEMODIAFILTRATION DURING A THREE YEAR FOLLOW UP PERIOD
Authors: Garcia-Prieto Ana , Vega Almudena , Abad Esttebanez Soraya , Barbieri Diego , DELGADO ANDRÉS FELIPE , Goicoechea Marian
Published: June 2020

Background and Aims

Online haemodiafiltration (OL- HDF) is the gold standard therapy in hemodialysis, as it has shown to reduce all-cause mortality in hemodialysis patients. Frequent hemodialysis has also shown to improve survival and quality of life. Home hemodialysis facilitates frequent therapy, and it is possible to perform OL-HDF at home, althought there is lack of evidence on its use. We report the evolution of a cohort of patients undergoing home OL-HDF during a 3 year follow up period.

Method

We designed a prospective, descriptive study to determine the evolution of prevalent and incident patients in home OL-HDF since 2016. Demographic and clinical variables were collected, including those related to hemodialysis technic and its potential complications.

Results

Three patients with a mean age of 47 years underwent home OL-HDF during follow up. All patients were males and caregiver was the couple in all cases. Two patients had an arteriovenous fistula (AVF) and one had a catheter. After a mean training period of 2.5 months at hospital, they started home OL- HDF with the assitance of a nephrologist, a nurse and a technician in the first session at home. We used the “5008-home”®FMC monitor and the AquaC®FMC for water treatment. Water cultures allways fulfilled the criteria for ultrapurity. Dialysis scheme was 2 hour sessions daily, 6 days a week.

During a mean follow up of 15 months, one patient received a kidney transplant. None needed hospitalization. One patient attended the emergency room once for fluid overload and needed ultrafiltration. The patient with catheter needed a catheter replacement due to hole infection. No vascular access problems were recorded in patients with AVF. Regarding dialysis efficacy, mean week KtV was over 2.1 in all cases and mean convective volumen achieved was 94 l/week.

Conclusion

In our experience, home OL-HDF is a safe and effective technic.
P1539THE INFLUENCE OF DIFFERENT HEMODIALYSIS FREQUENCY ON MHD PATIENTS WAS ANALYZED BASED ON THE DATA OF THREE CONSECUTIVE YEARS
Authors: Liu Hua , He Quan , Wei Limin , Shi Kehui , Wang Meng , Xue Jinhong , Chen Lei , Sun Lingshuang , Wei Meng , Jiang Hongli
Published: June 2020

Background and Aims

By analyzing the follow-up data of patients on maintenance hemodialysis (MHD) in the department of blood purification of the first affiliated hospital of Xi'an Jiaotong university from 2016 to 2018, the effects of different dialysis frequency on patients were compared and the continuous improvement of clinical quality was promoted.

Method

The general data of MHD patients in our center from 2016 to 2018 and annual laboratory monitoring indicators [including hemoglobin (HGB), calcium (Ca), phosphorus (P), parathyroid hormone (iPTH), serum albumin (ALB)] and their control rates were analyzed, and the differences in the above indicators of patients with hemodialysis frequency (2-times weekly, 5-times in two weeks and 3-times weekly) were compared.

Results

The proportion of patients older than 60 years old and the proportion of autologous arteriovenous fistula (AVF) increased year by year, while the use of the cuffed-tunneled catheter (TCCs) decreased. All indicators except iPTH have increased their control rates. Among the different dialysis frequencies: the average value of HGB and Ca was the highest at 3 times/week, and the control rate of P was not much different among the three groups. ALB was significantly lower in patients with 2 times/week than in other frequency groups (P<0.05). The average age of 3 times / week patients was significantly lower than 2 times / week and 5 times / 2 weeks (P <0.05).

Conclusion

In northwest China, the hemodialysis frequency to twice per week for most. The results of this study suggest that compared with the higher frequency, the major differences in the control rates are in albumin hemoglobin and serum calcium.
P1544SHARED DECISION MAKING FOR TREATMENT OPTIONS FOR ELDERLY PATIENTS ON DIALYSIS
Authors: Kato Akihisa , Saka Yosuke , Naruse Tomohiko
Published: June 2020

Background and Aims

The numbers of elderly patients on dialysis are increasing rapidly around the world. The quality of life (QOL) should be emphasized rather than survival for such patients. Shared decision making (SDM) regarding dialysis treatment options is one way to increase patient satisfaction with treatment, which should result in a better QOL. Thus, we investigated whether SDM affects the lives of elderly patients after dialysis initiation.

Method

We retrospectively collected clinical information about patients aged ≥ 80 years who started dialysis at our hospital between January 2013 and December 2017. The experience of SDM was defined as whether patients participated in a multidisciplinary approach to decision making about dialysis treatment options. Mortality rates, length of hospital stay and place of death during 2 years after dialysis initiation were determined.

Results

Among 124 patients, 40 participated in SDM. Functional activity, dementia, and daily assistance did not differ between patients with and without SDM. Participants in SDM were more likely to select PD (SDM vs. non-SDM: 50.0% vs. 3.6%; p < 0.001). Mortality rates did not differ between patients with and without SDM, but the rate of hospitalization for > 240 days was higher among patients without SDM (with vs. without SDM: 0.0 vs. 15.5%; p = 0.009). Among 70 deceased patients within two years, 59 died in hospital. Patients without SDM died in hospital more frequently (with vs. without SDM: 66.7% vs. 91.8%; p = 0.006).

Conclusion

Shared decision making reduced long-term hospitalization and death in hospital, indicating that more desirable home care therapy should be available for elderly patients on dialysis.
P1545LOW SOCIOECONAMIC STATUS INCREASES MORTALITY RISK IN KOREAN MAINTENANCE HEMODIALYSIS PATIENTS: A LONGITUDINAL COHORT STUDY USING HEMODIALYSIS QUALITY ASSESSMENT DATA
Authors: Lee Young-Ki , Park Hayne Cho , Cho Ajin , Kim Do Hyoung , Kim Juhee , Yoon Jong-Woo , Kwon Young Eun , Ryu Dong-Ryeol
Published: June 2020

Background and Aims

The number of hemodialysis (HD) patients and their medical expenses are growing rapidly in Korea due to entry into aging society and accompanying diseases such as diabetes and hypertension. Whether low socioeconomic status (SES) affect poorer HD survival is controversial with most reports come from the USA. Therefore, this study was performed to evaluate the effect of SES upon mortality in Korean maintenance HD patients using periodic HD quality assessment data.

Method

The HD quality assessment has been performed periodically by Health Insurance review and Assessment Service (HIRA) since 2001. We used 4th and 5th HD quality assessment data from the year of 2013 and 2015 respectively for collecting demographic and clinical data. The 4th survey was a sample survey while the 5th survey was a complete enumeration survey. We also collected data on patient comorbidity using the diagnosis codes from the health insurance claims database. The mortality data was collected until Dec 2017. As a proxy indicator reflecting SES, we classified subjects as a Medical Aid (MA) recipients (“low” SES) or a National Health Insurance (NHI) beneficiary (“middle/high” SES). We analyzed mortality risk based on SES using Cox proportional hazard model.

Results

A total of 21,786 HD patients from 4th survey and 35,454 HD patients from 5th survey were included in the analysis. The ratio between NHI beneficiary and MA recipient was 76.7% versus 23.3%. Mean age of the subjects was 59.0 years old in 4th survey and 60.3 years old in 5th survey. The MA recipients were younger and showed higher proportion of male, shorter duration of HD, lower body mass index (BMI), higher systolic and diastolic blood pressures before HD compared to the NHI beneficiary. The NHI beneficiary demonstrated higher proportion of diabetes, hypertension, cerebrovascular accidents, and dementia compared to the MA recipients. Two groups did not differ in dialysis efficiency presented as single pool Kt/V. A total of 7,173 deaths occurred in 2013 participants, while 7,306 deaths occurred in 2015 participants. After adjusting for age, gender, Charlson’s comorbidity index, BMI, presence of atrial fibrillation, serum albumin, and serum creatinine, MA recipients showed significantly higher mortality risk compared to the NHI beneficiary (hazard ratio 1.162; 95% confidence interval 1.092-1.237, p<0.001 in 4th survey and hazard ratio 1.078; 95% confidence interval 1.013-1.146, p=0.017 in 5th survey).

Conclusion

Low SES independently increased mortality risk in Korean maintenance hemodialysis patients.
P1548THE VALUE OF BEING A NETWORK: CLINICAL GOVERNANCE AND DIALYSIS CLINIC PERFORMANCE MANAGEMENT IS ASSOCIATED WITH IMPROVED PATIENTS SURVIVAL
Authors: Neri Luca , Ion Titapiccolo Jasmine , Bellocchio Francesco , Arkossy Otto , Garbelli Mario , Stuard Stefano
Published: June 2020

Introduction. In order to help facilitate the uptake of best clinical practices, improve outcomes, enhance efficiency and reduce costs, few healthcare organizations have introduced Continuous Quality Improvement (CQI) programs. Since September 2014, dialysis centers belonging to the EMEA Fresenius Medical Care (FME) network have introduced a CQI policy called Medical Peer Review (MPR) based on key performance indicators (KPI) related to patient’s clinical status. We exploit the quasi-experimental setting generated by the introduction of FMC CQI policy, to evaluate the association between improvement in intermediate outcomes (key performance indicators) and prolonged survival among dialysis patients registered in the EMEA FME network.

Methods. We conducted a historical cohort study. We included adult patients on chronic dialysis with less than 90 days between renal replacement therapy (RRT) initiation date and first treatment date in FME clinics. We compared KPI target achievement (P-BSC score) and 2-year mortality for patients enrolled prior to MPR-CQI policy onset (Cohort A) and a cohort of patients enrolled after MPR-CQI policy onset (Cohort B). Structural Equation model was adopted to estimate the association of MPR-CQI policy on patients’ survival through changes in intermediate outcomes (P-BSC score).

Results. The Cohort A and Cohort B consisted of 2397 and 1873 patients, respectively. We observed no difference across groups concerning the distribution of age (63.1 vs 62.8 years), gender (59% vs 60% males) and body mass index (27.6 vs 26.4 kg/m2); Cohort A showed lower Charlson’s comorbidity index (3.3±1.5 vs 3.8±1.9, p<0.01) and higher dialysis vintage (32.9±27.0 vs 21.3±22.2 days, p-value<0.01) compared to Cohort B. P-BSC scores over the 6-month ascertainment period was 5.25±1.47 in the pre CQI-MPR policy cohort, while it was significantly higher (6.67±1.63) in the post CQI-MPR policy cohort. Mediation analysis demonstrated a strong indirect effect of CQI-MPR implementation on mortality trough improvement of P-BSC rating score occurring in the post-implementation era (OR=0.70, p<0.001)

Conclusion. We showed that, after discounting for potential unmodifiable confounding factors and potential unmeasured selection/chronological bias, improvement of intermediate outcomes and performance indicators occurred after MPR-CQI policy implementation, was associated to a strong improvement in survival.

Figure:
P1551FAMILY SUPPORT IS CRUCIAL FOR DIALYSIS PATIENTS TREATMENT ADHERENCE AND QUALITY OF LIFE
Authors: Trajcheska Lada , Rambabova Bushljetikj Irena , Selim Gjulsen , Sikole Aleksandar , Spasovski Goce , Spasovska Vasilova Adrijana , Milenkova Mimoza , Canevska Aleksandra , Nikolov Igor
Published: June 2020

Background and Aims

Non-compliant dialysis patients are at increased risk of mortality. Compliance depends on patient demographics, educational level and income. Family support and marital status might also influence the patients compliance, as well as the quality of life. Missed/shortened dialysis sessions, adherence to prescribed medications, excessive phosphate serum values and interdialytic weigh gain, smoking and adherence to medical investigations provide indicators of non-compliance. Aim: To assess the impact of family support on different compliance indicators in the dialysis patients.

Method

In this observational study 134 dialysis patients were scored for different indicators of compliance from 0-2 and summary scores of compliance were assessed. Clinical and laboratory data were obtained from the previous two years. Patients with mean IDWGs >4.5% of body weight (BW) and/or phosphorous level above 1.6 mmol/L were scored with 1, patients with IDWG/BW more than 5.7% and/or 2.0 for mean phosphorous level were scored with 2. Summary scores of non-compliance were also assessed. Patients were scored for quality of life with SF-36 questionnaire. Patients non-adherence was analysed for predictors in multivariate analysis.

Results

Estimated rates of noncompliance varied: Medical investigations 63%, phosphorous 33, IDWG 22, therapy 14%, HD treatment 9%. When the complete dietary fluid, medications and treatment regimen were studied noncompliance rate was 73%, and when adherence to medical investigations was added the rate rose up to 87%. Patients with family support above median level (≥25) were significantly more often men (0.049), with diabetes (p=0.014), lower socioeconomic status (0.001) and married (0.003). The quality of life scores were significantly worse in the low family supported patients (56.73±26.15 vs 39.23±24.05, p=0.0001). They also scored worse in overall non-compliance scores 2.04±1.71 vs 2.97±2.06, p= 0.007). In the multivariate analysis the non-compliance was predicted most powerfully in patients with younger age, low social status and lower family support (β=-0.202, p=0.023, β=0.220, p=0.036, β=-0.175, p=0.019, respectively).

Conclusion

Family support is crucial for dialysis patients adherence to treatment and Quality of life. Efforts should be done to recognize the patients real needs and adequately help those confronting dialysis burden and improve their quality of life.
P1554AEFFECT OF HAEMODILUTION ON THYROID FUNCTION BEFORE AND AFTER HAEMODIALYSIS IN PATIENT WITH END-STAGE RENAL DISEASE
Authors: Sanai Toru , Okamura Ken , Ikeda Yuji , Miyazono Motoaki , Onoue Tomorow , Fukumitsu Toma , Shimamatsu Kazumasa , Kitazono Takanari
Published: June 2020

Background and Aims

To study the factors involved in the low thyroid hormones in end - stage renal disease (ESRD), we compared thyroid function before and after hemodialysis (HD).

Method

The serum free thyroxine (fT4), free triiodothyronine (fT3), and thyroid - simulating hormone (TSH), thyroxine binding globulin (TBG) and thyroglobulin (Tg) levels were measured before and after HD in 12 patients with chronic glomerulonephritis (CGN, age; 48.7 ± 11.8 [mean ± SD]) and 11 patients with diabetic nephropathy (DN, age; 57.6 ± 6.5), comparing with controls (n = 13, age; 40.9 ± 11.3).

Results

The serum fT4, fT3 and TBG levels were low before HD but increased almost in parallel with the increase in hematocrit and albumin levels after HD in both ESRD groups. The serum TSH level was high before HD but decreased after HD and Tg level remained almost unchanged. In DN, serum fT4 levels was almost the same, but fT3 levels was lower with slightly higher TSH level, compared with CGN.

Conclusion

Significantly lower fT4, fT3 and TBG levels in ESRD before HD seemed to be due to hemodilution and almost corrected after HD. The TSH level was promptly normalized with elevated fT4, and Tg levels remained unchanged probably due to the balance between corrected hemodilution and rapid response to decreased TSH stimulation. It may better to evaluate thyroid function after HD in ESRD. Accelerated senile changes were suggested in DN.
P1561PREVALENCE OF DEPRESSION IN PATIENTS ON MAINTENANCE HAEMODIALYSIS AND FEASIBILITY OF GROUP BASED COGNITIVE BEHAVIOURAL THERAPY - A SINGLE CENTRE EXPERIENCE
Authors: Ahmed Ishthiaque , Srinivas Ganesh , Gooutham Diwakar , V. M Annapandian
Published: June 2020

Background and Aims

The reported prevalence of depression in dialysis population ranges from 20-45%, which varies across regions. Limited data are available on association with co-morbidities, clinical symptoms and quality of life, especially from India. Present study was aimed to explore the prevalence of depression in patients on maintenance haemodialysis, quality of life and feasibility of group based cognitive behavioural therapy (CBT) in this set of patients.

Method

This is a single centre prospective study conducted at a tertiary care referral hospital, Bangalore, India, over the period of 22 months (Dec-2017 to Apr-2019). Patients aged >18 years and on maintenance haemodialysis for >6 months were included in the study. Any patients with known psychiatric illness or substance abuse were excluded. Beck depression inventory (BDI) score and quality of life by kidney disease quality of life short form-36 (KDQOL-SF) were used for diagnosis of depression. Group based CBT is offered to patients with mild to moderate depression.

Results

A total of 100 (85 males) patients were studied, the mean±SD age was 54.0±12.9 years (range, 23-76). Forty-six (46%) patients had depression (mean BDI score 35.04±10.8), out of whom, 8 (17.4%) had mild depression, 6 (13.1%) had moderate depression, 14 (30.4%) had severe depression and 18 (39.1%) people had extreme levels of depression. Females, unemployed and retired persons, low socioeconomic status and frequent dialysis related complications are more prone for depression.

Age, dialysis vintage, duration from diagnosis to dialysis, associated co-morbid conditions, frequency of emergency dialysis requirement, hospitalization rates did not significantly differ in both groups. Low serum phosphate levels and high Kt/V values had association with depression, while haemoglobin, serum albumin and serum calcium levels did not have association with depression. We were unable to complete the group based CBT due to medical and social reasons.

Conclusion

Depression is common in haemodialysis patients, patients with depression had poor medication compliance and lower quality of life. Group based CBT is not feasible due to high attrition rates.
P1572EFFECTIVENESS OF COENZYME Q10-MICELLE COMPARED WITH COENZYME Q10 ON TACROLIMUS-INDUCED RENAL INJURY
Authors: Cui Sheng , Luo Kang , Quan Yi , Lim Sun Woo , Yang Chul-Woo
Published: June 2020

Background and Aims

We and others have recently demonstrated that Coenzyme Q10 (CoQ10) has protective effects against diabetes mellitus and various types of renal injury. This study investigated whether CoQ10-micelle treatment would affords superior renoprotection compared with CoQ10 in the governing tacrolimus (Tacrolimus)-induced renal injury in the rats.

Method

Male adult Sprague-dawley Rats were treated daily with Tacrolimus (1.5mg/kg/day, subcutaneous), CoQ10 (20mg/kg/day, oral), and CoQ10-micelle (20 mg/kg/day, oral) for 4 weeks. The effects of CoQ10 orCoQ10-micelle on Tac-induced renal injury were assessed in terms of renal function, histopathology, oxidative stress and apoptotic cell death.

Results

After 4 weeks of Tacrolimus treatment to rats caused renal dysfunction, typical pathologic lesions, and oxidative stress marker. The serum creatinine was reduced by Tac co-treatment with CoQ10 or CoQ10-micelle groups compared with the Tac and VH group (0.31 ± 0.03 in the VH group vs. 0.43 ± 0.041 in the Tac group vs.0.37 ± 0.031 in the Tac+CoQ10 group 0.30 ± 0.02123 in the Tac+CoQ10-micellegroup; 1P<0.05 vs. VH. 2P<0.05 vs. TAC. . 3P<0.05 vs. TAC+C.) The administration of CoQ10-micelle improved renal immunoreactivity, which was accompanied by reductions in oxidative stress and apoptosis. Assessment of the mitochondrial ultrastructure by electron microscopy revealed that tacrolimus co-treatment with CoQ10-micelle increased the size and number of mitochondria more than co-treatment with CoQ10, compared with that induced by TAC treatment alone.

Conclusion

These findings suggest that both CoQ10 and CoQ10-micelle effectively attenuates Tac-induced renal injury, and CoQ10-micelle provides more benefits than that of CoQ10.
P1588CAN L-CARNITINE SUPPLEMENTATION IMPROVE CARDIOPULMONARY FUNCTION? A RANDOMIZED CONTROLLED TRIAL IN HEMODIALYSIS PATIENTS
Authors: Yassari Fatemeh , Eslaminejad Alireza , Marashian Mehran , Dastan Farzaneh , Maleki Kazeri Farzaneh
Published: June 2020

Background and Aims

It is well known that L-Carnitine is a cardioprotective agent, which balances cardiac energy metabolism, by promoting mitochondrial β-oxidation and facilitating transport of long chain fatty acids into the mitochondrial matrix. It has been shown that L-Carnitine level in plasma and tissue is lower in hemodialysis patients and they may lose the benefits of this substance. As far as our knowledge, the effect of L-Carnitine on cardiopulmonary function has not been evaluated by ergospirometry up to now. The aim of this randomized clinical trial was to assess the effects of L-carnitine supplementation on cardiopulmonary Function in hemodialysis patients through ergospirometry.

Method

This randomized clinical trial was conducted on 46 chronic hemodialysis patients. The patients were divided into two groups. In both groups ergospirometry parameters (VE Max, VO2-Max, VCO2 Max, AT, VE/VCO2 Slope) were recorded for a 3-month period. During this period, one group received L-Carnitine at doses of 2 gr/day orally and the other group received only placebo. After three months, all of the mentioned parameters were rechecked and statistical analysis performed by SPSS software.

Results

Only CRP was different between the two groups increasing in placebo group significantly after 3 months (P = 0.018). No significant difference was detected in Cardiopulmonary factors. In terms of ergospirometry factors, PET-CO2 was the only parameter significantly increased in the treatment group (P = 0.026).

Conclusion

The present results indicate that L-Carnitine can improve cardiopulmonary function among hemodialysis patients.
P1590AMORPHOUS CPP AND CRYSTAL CPP OF HEMODIALYSIS PATIENTS
Authors: Nakamura Kimihiko , Nakayama Yuki , Hiroyoshi Toshiya , Isoyama Naohito , Fujikawa Kouki , Matsuyama Hideyasu , Kuro-o Makoto
Published: June 2020

Background and Aims

Serum calciprotein particles (CPP) are increased in CKD patients and correlated with vascular stiffness and calcification. CPPs are can be distinguished amorphous and crystal CPPs. Crystal CPPs are non-incubated CPPs and amorphous CPPs are the difference(Δ) incubated CPPs and non-incubated CPPs. In this study, we evaluated amorphous CPPs and crystal CPPs in hemodialysis (HD) patients.

Method

183 end stage renal disease patients undergoing HD (57.6% men, median age 71, dialysis period; 98.4 ± 87 months) were treated in single hospital. Serum CPP levels were measured by the gel filtration method. Incubated CPPs were incubated in 24°C, 24hous then were measured similarly. We assessed the association of serum calcium (Ca), phosphorus (P), intact-PTH, FGF21, LDL-cholesterol, CRP with CPP.

Results

In multivariate analysis, P remained significant independent factors for the non-incubated CPP levels. Ca, P remained significant independent factors for the incubated CPP levels. P remained significant independent factors for the Δ CPP levels.

The association of ΔCPP levels / the incubated CPP levels with clinical variables are examined. In multivariate analysis, hemoglobin remained significant independent factors.

Conclusion

Amorphous CPPs and crystal CPPs could each be a prognostic factors.

Figure: Association of ΔCPP levels / incubated CPP levels with clinical variables.

Univariate Multivariate
P1592HYPOCHLOREMIA AND INFLAMMATION: RELATIONSHIP BETWEEN SERUM CHLORIDE LEVELS AND NEUTROPHIL-TO-LYMPHOCYTE RATIO IN INCIDENT CHRONIC HEMODIALYSIS PATIENTS
Authors: Valga Francisco , Monzon Tania , Henriquez Fernando , Anton-Perez Gloria
Published: June 2020

Background and Aims

Recently the role of chloride in patients with heart failure has been reevaluated. Some studies have linked it to higher mortality in these patients, being more important, even, than sodium. On the other hand, some authors have found a higher mortality in patients with low chloride levels and sepsis. The underlying mechanisms in both cases are unknown. Some authors attribute it to concomitance with metabolic alkalosis, however, this is not a reason that fully explains these findings. Neutrophil-to-Lymphocyte Ratio (NLR) is an emerging marker of inflammation comparable to established ones such as C-reactive protein, ferritin, etc. It is also a good biomarker of mortality in certain populations such as cancer, cardiovascular and renal. Patients with chronic kidney disease on hemodialysis have high cardiovascular comorbidity and a high rate of inflammation. However, there are no studies that correlate chloride levels to inflammation markers, such as NLR, in this population. Therefore, the aim of our study was to determine if there is a relationship between chloride and NLR in our population of patients on chronic hemodialysis.

Method

Restrospective cohort study. We analyzed the values of chloride and NLR of 396 incident patients on hemodialysis over a period of 3 years (between 2016 and 2019). The patients were divided into three groups, depending on the levels of chloride (tertiles): (1: <100, 2: 100.1-103, 3> 103.1 mEq / l). In each group the average of NLR was calculated.

Results

The mean age in our sample was 64.73 ± 0.57 years, 39.7% were women (N = 157). The average of NLR was 3.84 ± 2.65 and chloride was 101.03 ± 3.91. We found that patients in the lower chloride level tertile were associated with a higher NLR levels (p <0.012). (Figure 1)

Conclusion

Incident hemodialysis patients with lower chloride levels had higher NLR values. These findings suggest a greater tendency to inflammation in these patients.
P1593THE ASSOCIATION BETWEEN THE ANCLE-BRACHIAL INDEX AND MARKERS OF INFLAMATION IN CHRONIC HEMODIALYSIS PATIENTS
Authors: Pasko Nevi , Strakosha Ariana , Dedej Arieta , Kapidani Loredana , Nasto Fjona , Rista Elvana , Cadri Vilma , Mumajesi Suela , Thereska Nestor
Published: June 2020

Background and Aims

Among hemodialysis patients, peripheral arterial disease (PAD) represents an important health care burden and has been associated with high mortality. The ancle-brachial index (ABI), is a reliable and noninvasive method used to asses PAD. The aim of this study was to evaluate the prevalence of PAD in patients undergoing chronic hemodialysis and the association with inflammation and malnutrition using serum C-reactive protein (CRP) and serum albumin as biomarkers.

Method

The study was conducted at different hemodialysis centers in patients receiving hemodialysis three times a week. We excluded patients with atrial fibrillation or who had been recently hospitalized. The ABI has been used as a diagnostic tool for PAD and measured before a hemodialysis session. A value of ABI less than 0.9 was considered abnormal. To better estimate the impact of malnutrition and inflammation we used the serum albumin, blood lipids values and serum C-reactive protein values defined by calculating the mean of the last three measurements.

Results

A total of 261 ESRD patients on maintenance hemodialysis were enrolled in the study. Mean age was 56.0 (±12) years, 58% were males, and 17.6% were diabetics. Mean time on hemodialysis was 5.9 (±6.7) years, with 24% of patients on dialysis for less than 3 years. Among our patients we found that the prevalence of PAD was 23.4%, of whom 58.1% were men. We found that age, diabetes, duration of hemodialysis, low serum albumin levels and high serum triglyceride levels were risk factors for PAD in hemodialysis patients. The multivariate analysis of our study has shown that a lower level of albumin and higher level of CRP were significantly associated with an ABI less than 0.9 (odds ratio, 4.54; 95% confidence interval, P = 0.017) after adjusting for demographic, clinical, biochemical and medication data. We did not find significant differences in serum calcium, phosphate or PTH levels between patients with PAD and those without it.

Conclusion

In conclusion, the present study showed high prevalence of PAD in patients on hemodialysis. The prevalence was higher in diabetics. Low albumin levels and C-reactive levels were independent risk factors of PAD. We found that early diagnosis and treatment of PAD could help to improve the quality of life of hemodialysed patients and postpone arterial complications in this group of patients.
P1606TIM-3/GAL-9 AS PREDICTORS OF COMPOSITE OUTCOMES AFTER KIDNEY TRANSPLANTATION: A COHORT STUDY
Authors: Yan Lin , Bai Yangjuan , Li Yamei , Li Yi , Wang Xianding , Shi Yunying , Wang Lanlan
Published: June 2020

Background and Aims

T cell immunoglobulin and mucin domain (Tim-3) and its ligand, galectin-9 (Gal-9), play an important role in immune regulation. Serum soluble Tim-3 (sTim-3) and Gal-9 (sGal-9) were observed to be correlated with renal function after kidney transplantation in our previous study, but whether these two could predict the adverse outcomes after transplantation is unknown.

Method

91 recipients receiving kidney transplantation were enrolled in this cohort study. 20 of all recipients suffered composite outcomes after kidney transplantation within two years. 71 recipients had stable renal function during this period. The expressions of sTim-3 and sGal-9 before and one month after transplantation were measured by ELISA.

Results

The level of sTim-3 before transplantation was significantly higher in recipients with stable renal function than composite outcomes (Median: range, 2275: 840-4236 pg/ml vs 1589: 353-3094 pg/ml, P=0.002, shown in Figure 1). The level of sGal-9 after transplantation was significantly lower in stable group than composite outcome group (Median: range, 4869: 1418-13080 pg/ml vs 6852: 4128-10760 pg/ml, P=0.003, shown in Figure 1). Area under curve (AUC) of sTim-3 before transplantation was 0.737 (P=0.002, shown in Figure 2) through the analysis of receiver operating characteristic curve (ROC curve). AUC of sGal-9 after transplantation was 0.751 (P=0.003, shown in Figure 2). After survival analysis, the percentage of recipients free from composite outcomes was significantly lower in patients with low level of sTim-3 than high sTim3 (P<0.0001, shown in Figure 3), so was in patients with high sGal-9 than low sGal-9 (P=0.0004, shown in Figure 3).

Conclusion

Serum sTim-3 and sGal-9 could predict the adverse outcomes within two years after kidney transplantation.
P1609HLA EPITOPE MATCHING IN KIDNEY TRANSPLANTATION AND PRACTICAL APPLICATION
Authors: Rambabova Bushljetikj Irena , Spasovski Goce , Dimitrovski Koco
Published: June 2020

Background and Aims

HLA compatibility between donor and recipient is an important factor that influences graft outcomes after kidney transplantation. Increasing number of class I (HLA-AB) and class II (HLA-DR) mismatches are associated with an increased risk of acute rejection and graft loss. Recent developments have increased our understanding of the structural basis of HLA antigenicity and may allow accurate evaluation of the immunogenic potential of broad antigen HLA mismatches.

The immunogenicity of HLA antigens is determined by continuous and discontinuous short sequences of amino acids that form the antibody-accessible regions within each HLA allele known as epitopes. HLAMatchmaker, a computer algorithm that calculates the number of epitope mismatches between donors and recipients by considering each HLA allele as a combination of distinct epitopes known as triplets (continuous amino acid sequences) or eplets (closely located contiguous amino acid sequences).

Method

A total number of 55 adult patients with LDKT were included in the study. The inclusion criteria: first transplantation of one organ - kidney, use of living donor related or unrelated, emotionally related (spouses) donor. Data concerning donor - sex, age of the donor, type of donation (related or unrelated donor), and data concerning the recipients: sex, age, hemodialysis vintage, underlying disease, type of immunosuppressive therapy, were analyzed. The number of eplet HLA mismatches for each recipient and donor pair at HLA class I (HLA-AB) and class II (HLA-DR) loci was calculated using HLAMatchmaker (Version 1.2)

Results

In our study we have included 55 patients. 44 patients have related and 11 have unrelated donors. From the group of related donors 31 patients were haploidentycal, with 3 HLA miss match, in the group of unrelated donors-recipients 5 of them have 6 miss match. According HLA MM triplets Class 1 + 2 < or> 20 we have devided 2 groups, but no statistical difference on the graft function was observed in the follow up period.

Three acute rejections were reported in the group of patients with HLA miss match triplets Class 1 + 2> 20.

Conclusion

An increasing number of epitope HLA mismatches is associated with an increased risk of acute rejection. Triplet HLA mismatches may provide better risk stratification for acute rejection and graft survival among those who are otherwise classified as low immunological risk at the broad antigen level.