bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO663THE UTILITY OF SMART SCALES TO MONITOR BODY COMPOSITION IN HEMODIALYSIS PATIENTS
Authors: Cordero Lucia , Rivero Martínez Marta , Caro Espada Paula Jara , Gutiérrez Elena , Mérida Evangelina , Aubert Lucia , Sandino Pérez Justo , Yuste Claudia 
Published: May 2021

Abstract

Background and Aims
Overhydration (OH) is an independent predictor of mortality on hemodialysis (HD). The gold standard to assess OH is BCM monitor from Fresenius®, however BCM is a hospital hold device limiting its use. New smart scales have emerged as household devices reporting daily body composition data.

Objective
To determine if Renpho ES-CS20M® could be useful on a 52 HD patient to estimate body composition data.

Method
72 body composition assessments (BCA) during mid-week HD session were performed. Each BCA included: (1) Predialysis Renpho measurement, (2) Predialysis BCM monitor measurement, (3) Postdialysis Renpho measurement. To track the fluid balance during the HD session: (1) we recorded ultrafiltration, (2) food or fluid intake was not allowed, and (3) none of the HD patients urinated during the HD session. If any intravenous fluids were needed during the HD session, we subtracted them off from UF.

Results
Data from 52 HD patients were studied (age 58.8 ± 16.8 years, 56.9 % males, 14.7% diabetics), with a mean pre-HD weight of 70.0 ± 13. 4 Kg, overhydration of 1.7 ± 1.5 L and urea distribution volume of 31.7 ± 5.7 L. The mean ultrafiltration during HD session was -1.8 ± 0.9 L. Renpho estimated a Pre – HD hydration of 34.25 ± 6.02 Kg vs 33.4 ± 5.7 Kg by BCM, showing a good concordance between methods (ICC 0.788 [0.67-0.86], B -0.58, p &lt;0.01). Renpho poorly estimated pre – HD lean tissue mass at 45.4 ± 6.9 Kg compared with 33.8 ± 8.0 Kg by BCM. Although Renpho was able to provide a moderate concordant estimation of fat tissue mass (33.8 ± 8.0 % with Renpho vs 34.7 ± 9.6%), the bias proportion was unacceptable. Post- HD hydration by Renpho was not able to reproduce the ultrafiltracion achieved during the HD session (pre-HD 34.25 ± 6.02 Kg vs post-HD 34.08 ± 6.00 Kg).

Conclusion
Renpho has a proportional bias estimating predialysis hydration compared with BCM monitor, but is not able to assess changes produced with ultrafiltration or other parameters of body composition (as lean or fat tissue mass). Although smart scales are unacurate to assess body composition on HD patients, they could be useful on the follow up of them changing the accuracy for frequency.
MO664DYNAMIC ASSESSMENT OF INTERLEUKIN-6 DURING HEMODIALYSIS AND MORTALITY IN COVID 19
Authors: Muñoz Ramos Patricia , Giorgi Martin , Gil Giraldo Yohana , De Santos Antonio , Núñez Almudena , Barril Guillermina , Quiroga Borja 
Published: May 2021

Abstract

Background and Aims
The impact of the newly discovered severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease-19 (COVID-19) in hemodialysis patients remains poorly characterized. Some hemodialysis techniques reduce systemic inflammation but their impact on COVID-19 has not been addressed. The aim of this prospective study was to evaluate factors associated to mortality in COVID-19 hemodialysis patients, including the impact of reducing interleukin-6 using a cytokine adsorbent filter.

Method
This is a prospective single-center study including 16 hemodialysis patients with COVID-19. All were dialyzed using a polymethyl methacrylate (PMMA) filter. Interleukin-6 levels were obtained before and after the first admission hemodialysis session and at one week. Also we collected serum samples from 8 patients of our unit as controls: 4 in online hemodiafiltration (OLHDF) and 4 in high-flux hemodialysis Baseline comorbidities, laboratory values, chest X-ray and treatments were recorded and compared between survivors and non-survivors.

Results
Sixteen patients were included (13 males, mean age 72±15 years). Four patients (25%) died. Factors associated to mortality were dialysis vintage (p=0.01), the presence of infiltrates in chest X-ray (p=0.032), serum C-reactive protein (p=0.05) and lactate dehydrogenase (p=0.02) at one week, the requirement of oxygen therapy (p=0.02) and the use of anticoagulation (p&lt;0.01). At admission, post-dialysis interleukin-6 levels were higher (p&lt;0.01) in non-survivors and these patients differed from survivors in the reduction of interleukin-6 levels during the dialysis session despite using a PMMA filter (survivors vs non survivors (25 [17-53]% vs -3 [-109-12] %, p=0.04).

Conclusion
In hemodialysis COVID-19 patients, a positive balance of interleukin-6 during the session was associated to higher mortality.
MO889COST OF ILLNESS OF CHRONIC KIDNEY DISEASE IN LEBANON: FROM THE SOCIETAL PERSPECTIVE
Authors: Aoun Mabel , Helou Elie , Sleilaty Ghassan , Nehme Chelala Dania 
Published: May 2021

Abstract

Background and Aims
Chronic Kidney Disease (CKD) is the 12th leading cause of death worldwide and a high societal burden. Cost-of-illness studies of CKD are scarce in developing countries. Identifying factors associated with the highest cost can help decision makers adapt health policies and sustain kidney health services, especially in limited resources' settings. This study aims to estimate the cost of illness of CKD in Lebanon, from the early stages of CKD until dialysis and kidney transplant and identify cost components related to the highest financial burden.

Method
This is a cross-sectional study of all CKD patients who presented to two nephrology clinics during the first two weeks of November 2020. The sample size required for the study to be representative was 154 patients. The medical and administrative records were reviewed to collect the demographics and CKD characteristics of patients as well as the direct medical costs (medications, diagnostic tests, hospitalizations, inpatient care, outpatient care), direct non-medical costs (transportation) and indirect costs (productivity losses) for one year between 1st June 2019 and 1st June 2020. Kruskal Wallis test was used to compare the costs between different CKD stages and categories. The study got the approval of the ethics committee of Saint-Joseph University.

Results
The sample included a total of 160 patients: 102 non-dialysis CKD patients, 40 hemodialysis, 8 peritoneal dialysis and 10 kidney transplant patients. Their mean age was 66.74 ±15.36 years, 57.5% were males and 42.5% diabetics. The mean number of daily medications was 8.75 ±3.38, mean frequency of blood tests per year 6.86 ±6.4 and mean number of hospital admissions per year 0.79 ±1.43. The mean total annual cost of CKD per patient across all categories was assessed at 19,900,164 ±27,893,591 Lebanese Pounds (1 $USD= 1515 LP in 2019). Statistical analysis showed a higher total cost among dialysis patients compared to other categories of CKD (p&lt;0.001), higher cost of medications in transplant patients (p&lt;0.001) and higher cost of technique modality in peritoneal dialysis patients (p&lt;0.001). These differences are summarized in Figure 1.

Conclusion
Similar to previous studies from other countries, this cost of illness analysis showed a high burden of dialysis annual costs compared to non-dialysis CKD and transplant patients. It revealed as well a great burden of medications' costs at the level of dialysis and transplantation. It is thus crucial that governments and health policies in low- and middle-income countries target interventions that prevent end-stage kidney disease, reduce medications' costs and most of all create programs that encourage kidney transplantation.
MO891HEMODIALYSIS PATIENTS AMID COVID-19 PANDEMIC: A COMPARISON BETWEEN FIRST AND SECOND WAVE
Authors: Lomonte Carlo , Lisi Piero , Corciulo Simone , Manno Elisabetta , Covella Bianca , Rossi Luigi , Teutonico Annalisa , Libutti Pasquale , Pepe Vito 
Published: May 2021

Abstract

Background and Aims
Data about HD patients and how to best dialyze them during the COVID-19 pandemic are scarce. The aim of the study is to describe the organizational model and clinical outcomes of patients confirmed COVID-19 needing renal replacement therapy, admitted in a COVID Hospital in Southern Italy during the first and second pandemic wave.

Method
All the consecutive patients requiring chronic HD, during the first and second wave were considered. Due to local resources, we have implemented an organizational model based on the HD bedside with Genius system. The machine was prepared in the Dialysis Unit and then transferred to the COVID Hospital. After treatment, the monitor was sterilized and carefully cleaned with chlorine wipes and re-transferred into the dialysis Unit to be prepared for the next dialysis. Demographic data, clinical symptoms at presentation, and laboratory results were extracted by the electronic medical record. Patients hospitalized during the first wave (FW) and second wave (SW) were compared.

Results
From March 10 through December 31 2020, we enrolled a cohort of 40 patients (37.5% F), with COVID-19 infection requiring HD; 11 (27.5%) during first and 29 (72.5%) during second wave. The phenotype and clinical symptoms at the admission were not different between two groups. Compared to FW, the SW patients were younger (70.1±9.5 vs 77.3±5.9 years; p&lt;0.03) with lower dialysis vintage (35±18 vs 60±48 months; p&lt;0.05), and lower Charlson Comorbidity Index scores (2.8 ± 1.8 vs 5.09 ± 2.0; p&lt;0.05). No differences were observed between the first and second wave as far as inflammatory markers IL6 (51.9 ± 44.8 vs 55.45 ± 40.52 pg/mL; ns) and C-reactive protein (4.74 ± 3.8 vs 6.70 ± 5.44 mg/L; ns) as well as the hospital stay (21.1±10 vs 24.4.8±10 days; ns) and in-hospital mortality (28.1% vs 18.2%; ns). Overall, 354 bedside treatments were performed; mean session time and mean weekly sessions were 3.64 ± 0.40 hours, and 3.4 ± 0.45 HD/week, with no differences between FW and SW patients.

Conclusion
Our data show that the higher spread of Sars-cov2 during the second wave has infected younger and less comorbid HD patients, with no significant differences in clinical and laboratory parameters. Our organizational model based on the HD bedside with the Genius system, allowed a personalized treatment with efficacy and safety for the patients and staff.
MO892DIALYSIS SERVICE MANAGEMENT DURING COVID-19 PANDEMIC IN EUROPEAN CITY AREA
Authors: Rimsevicius Laurynas , Jankevicius Feliksas , Motiejuniene Bilotiene Ausra , Miglinas Marius 
Published: May 2021

Abstract

Background and Aims
Many countries across Europe experience the second wave of CoVid-19 pandemic. Lithuania is a country situated on the eastern shore of the Baltic Sea. Until January 15, Lithuania had 165560 confirmed positive cases, 100495 recoveries, and 2376 deaths.

Method
In this abstract, we describe reorganization in dialysis service in Vilnius, the capital and largest city of Lithuania, with urban population of 700,275 inhabitants.

Results
At the pandemic start in March 2020, Vilnius had 3 public nephrology departments each running a hemodialysis unit, and 4 private hemodialysis centers, with total of 250 end-stage kidney disease patients. Vilnius University Hospital Santaros Klinikos, as the main hospital in the country and national CoVid-19 coordinator, restructured dialysis service in city area. Chronic hemodialysis programs in public hospitals were cancelled and patients were shifted to private centers. In the threat of infection and multiple outbreaks in two hospitals, nephrology units were closed and CoVid-19 negative nephrology patients were located in a satellite hospital in other city, whilst all city hospitals served as CoVid-19 centers. In Santaros Klinikos, we treated severe CoVid-19 patients who needed chronic or acute dialysis, while asymptomatic and mild to moderate-symptom patients carried their dialysis procedures in isolated shafts and/or facilities in private centers. In cases with unsatisfactory self-isolation, isolation sites were located in hotels or other premises provided by the municipal administration. Transportation to dialysis center was provided by municipality as well. Rapid antigen testing was set in a case of suspected outbreak or for all outpatient hemodialysis patients in some centers in circumstances of high community transmission. During the pandemic, we had ongoing transplant activities, continued wait-listing for kidney transplant and increased peritoneal dialysis program. Most peritoneal dialysis patients were trained at home by a mobile nurse team, also home visits we carried instead of inpatients visits. We started CoVid-19 vaccination during the first week of January for all dialysis patients and transplant recipients who had no contraindications and gave informed consent.

Conclusion
In conclusion, the rapid release and adoption of recommendations and action plan helped to identify and locate CoVid-19 outbreaks in dialysis facilities. Dialysis service reorganization is needed to maintain ongoing treatment for chronic patients who vitally depend on renal replacement therapy. Private dialysis centers and municipality should assist with physical resources operating the patients flow. The growth of peritoneal dialysis program serves as a significant subsidiary factor when patients need more social distancing. Vaccination data and outcomes in end-stage renal disease patients is coming soon.
MO893ASSESSMENT OF PHYSICAL ACTIVITY IN CHRONIC HEMODIALYSIS PATIENTS IN THE NEPHROLOGY AND HEMODIALYSIS DEPARTEMENT CHU IBN ROCHD
Authors: Failal Imane , Ezzaki Sanae , Sayeh Marouane , Elkhayat Salma , Medkouri Ghizlaine , Ramdani Benyounes 
Published: May 2021

Abstract

Background and Aims
Physical activity is often reduced in chronic hemodialysis patients. Studies having evaluated hemodialysis reveal a significant sedentary lifestyle. which is associated with excess mortality. Conversely, the benefits in terms of morbidity and mortality from physical activity are numerous. The fight against sedentary lifestyles in hemodialysis patients must be one of the objectives of healthcare teams. For this reason, our study aims to assess physical inactivity using a physical activity score from DIJON in chronic hemodialysis patients and to identify the factors linked to a decrease in physical activity in them and to propose programs aimed at to encourage PA as well as exercises adapted to the hemodialysis patient.

Method
This is a descriptive and analytical cross-sectional study conducted during the month of January 2020, in the nephrology and hemodialysis department of CHU IBN ROCHD. We used the Dijon questionnaire translated into Arabic to measure the PA taking into account daily, sports or leisure activities. The PA level benchmarks are 0–10 (low), 10–20 (medium), and 20–30 (high).

Results
Our study included 71 patients. The average age was 46.5 years with extremes ranging from 16 to 93 years, there is a slight male predominance with a sex ratio of 1.1. Initial nephropathy was undetermined nephropathy in 53.5%, glomerular in 29.5%, diabetic in 7% and hypertensive in 1.4%. The age of the periodic hemodialysis treatment in our patients varied from 1 month to 44 years, with an average duration of 17.3 years. 91.5% of patients had an arteriovenous fistula as a vascular approach, 8.4% of patients were dialyzed on a catheter.
The overall level of physical activity was high only in 4.5% of patients, while it was low in 61.3% and moderate in 34% of patients. The study of the relationship between the decrease in physical activity and different demographic, clinical and paraclinical parameters had revealed that the decrease in physical activity was significantly correlated with seniority on hemodialysis, gender, l he advanced age, the different degrees of anemia, and the cardiovascular affections, on the other hand no significant correlation was found between the decrease in physical activity and hypocalcemia, hyperphosphatemia, and hyperparathyroidism.

Conclusion
Our results show that the level of physical activity is linked to many parameters, some of which can be modified. Prescribing an adapted and personalized program would improve the prognosis related to co-morbidities and the quality of life of our patients.
MO877PREVALENCE AND PERSISTENCE OF COVID-19 ANTIBODIES IN NEW YORK CITY HEMODIALYSIS CLINIC
Authors: Thwin Ohnmar , Grobe Nadja , Ye Xiaoling (Janice) , Preciado Rojas Priscila , Tapia Silva Leticia M , Kotanko Peter 
Published: May 2021

Abstract

Background and Aims
Dialysis patients are at higher risk for severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection. Longevity of antibody response to SARS-CoV-2 infection remains unclear. It is reported that maintenance hemodialysis (MHD) patients can mount an antibody response that is similar in intensity and timing to the non-dialysis population. We aim to investigate the prevalence and persistence of antibodies in hemodialysis patients.

Method
We measured IgG and IgM antibodies in MHD patients as part of a quality improvement project. Four New York City dialysis clinics participated in this study. Strict policy of RT-PCR testing was implemented in clinics for patients with signs and symptoms of Coronavirus Disease 2019 (COVID-19). Initial antibody testing was done on June 10 and July 13, 2020 (phase 1) and retesting was done for previously positive patients between December 9 and 17, 2020 (phase 2). Upon obtaining verbal consent, 3.5 ml of pre-dialysis blood samples were taken via vascular access. SARS-CoV-2 antibodies were determined using the emergency use authorized Diazyme DZ-Lite SARS-CoV-2 IgM / IgG CLIA assays with 100% sensitivity and 98% specificity. Detection of formed immune-complexes is achieved with N-(4-amino-butyl)-N-ethyl-isoluminol; the luminescence signal is reported as units per ml (AU/ml), values ≥ 1.00 AU/ml are considered as “reactive” and &lt; 1.00 AU/ml as “non-reactive.”

Results
A total of 429 MHD patients were studied in phase 1. Antibodies were present in 130 (30.3%) and only 55 patients with Covid-19 diagnosis confirmed by RT-PCR test were reactive for IgG antibodies. The time to antibody testing was 73 days (median 77; range 30-111) days. In the phase 2 antibody testing, IgG antibodies were only detected in 47 patients (85.5%) 242 days (median 245, range 204 to 268) after clinical diagnosis of Covid-19. Between the two phases of antibody testing, the luminescence signal declined by 40.9 AU/mL (95% confidence interval 31.5 to 50.3) from 54.1±45.3 to 13.2±20.9 AU/mL (P&lt;0.0001 by paired t-test; Figure 1). In univariate logistic regression, a higher number of days between clinical diagnosis of COVID-19 and the second antibody measurement was associated with a lower seropositivity rate (odds ratio 0.929, 95% confidence interval 0.864 to 0.998, P=0.044). Antibody persistence was not associated with age, gender, race, and ethnicity.

Conclusion
We observed that about 6 out of 7 MHD patients maintain SARS-CoV-2 antibodies over 6-9 months but there is a significant decline of IgG level. The time between clinical diagnosis and IgG testing was associated with IgG decline. Follow up study to understand antibody dynamics in MHD population is a crucial step once vaccines become available.
MO896EMERGENCY HEMODIALYSIS DURING THE CORONAVIRUS PANDEMIC: ABOUT 68 CASES
Authors: Chemli Imen , Amal Ouni , Haoula Faouzi , Ben salem Meriem , Ben salah Manel , Handous Insaf , Letaief Ahmed , Hamouda Mouna , Aloui Sabra , Skhiri Habib 
Published: May 2021

Abstract

Background and Aims
The emergency hemodialysis is a very common situation in nephrology and is characterized by high morbi-mortality.
The aim of this work was to determine the indications for emergency hemodialysis, the clinical and paraclinical profiles of the patients, as well as the parameters of the session of hemodialysis and the perdialytic complications.

Method
This is a prospective descriptive and analytical study carried out over a period of 3 months (March 3, 2020 - June 6, 2020). This period coincides with the coronavirus pandemic. This study was included all patients who have undergone Emergency hemodialysis. The study was done in the hemodialysis unit of the nephrology department of the CHU Fattouma Bourguiba Monastir.

Results
We collected 68 patients, the majority are male (70%). The average age was 60 + -14.4 years. The original department was the emergency room in 42.6% of cases, the intensive care unit in 10.29% and a surgical department in 13.23% of cases. 40% of patients were diabetic and 22% had coronary insufficiency. 60.5% were a chronic renal failure, 16% were end-stage and 34% were on hemodialysis. The indications for emergency hemodialysis were acute lung edema, hyperkalaemia and metabolic acidosis in 31%, 50% and 50% of cases, respectively. Poorly tolerated uremia and anuria more than 12 hours were the indication in 11.8% and 10.3% of cases, respectively, drug or toxic intoxication (methanol) was in 5.9% of cases and hypercalcaemia in 4.4% of cases. The average duration of the sessions was 2.95 hours [2–4 hours]. Ultrafiltration was necessary in 44.11% of cases. Per-dialysis anticoagulation was used in 38.23% of patients. The vascular access was a femoral catheter in 67.6% of cases and an arteriovenous fistula in 28% of cases. The per-dialytic complications were hypotension in 10 cases (14.7%) and the session was stopped in 4 cases. hypoglycemia was noted in 2 cases (2.9%) and seizures in 2 cases. Cardiopulmonary arrest was reported in 2.9% of sessions.
The incidence of bleeding complications occurring within 72 hours after the hemodialysis session was 5.8%.The death rate was 13.2%.
Our univariate analysis concluded that diabetes, heart failure and coronary artery disease, history of gastrointestinal bleeding and active infection are risk factors for mortality.
The multivariate analysis showed that diabetes and a history of gastrointestinal bleeding was the two factors of mortality.

Conclusion
The confinement period has affected the medical activity in our department. So, it has increased the cases of emergency hemodialysis with more complications.
MO899PRURITUS IN CHRONIC HEMODIALYSIS PATIENTS ANDS ITS IMPACT ON QUALITY OF LIFE
Authors: Ghabi Faten , Toumi Salma , Amouri Asma , Chaker Hanen , Agerbi Ikram , Dammak Najla , Kammoun Khawla , Yaich Soumaya , Masmoudi Abdelrahmen , Benhmida Mohamed 
Published: May 2021

Abstract

Background and Aims
Pruritus is a common symptom in chronic hemodialysis patients, its intensity varies from patient to patient and which plays a major role in impairing their quality of life. Its pathophysiology is poorly understood and its management remains a challenge.
The main objective of our study is to estimate the frequency of pruritus in our population and its impact on their quality of life.

Material and methods
This is a cross-sectional study involving 53 patients carried out in the dialysis unit of the CHU Hédi chaker in sfax. The DLQI (Dermatology Life Quality Index), the Pittsburgh Sleep Quality Index (PSQI) and the verbal analogue scale to specify the intensity of pruritus were used to assess the impact of pruritus on quality of life.

Results
The mean age of our patients was 48 ± 28 years with a predominance of men (60%). The mean duration on hemodialysis was 5.4 years. The prevalence of pruritus was 28% of cases. Pruritus affects 75% of the body surface in 90% of patients, an intensity greater than or equal to 5 in 93.33% of cases on an intensity scale of 0 to 10, the impact was moderate on the quality of life according to the DLQI in 66.66% of the cases, 86.66% of the patients presented a nocturnal recrudescence of the pruritus, and an alteration of the quality of sleep was present in 73.33% of the cases according to the PSQI.
The Comparison of the groups with (G1) or without pruritus (G2) showed the predominance of hyperposphoraemia in the first group with averages of 1.92mmol / l and 1.4mmol / l respectively in G1 and G2

Conclusion
Pruritus remains the most frequent complaint for hemodialysis patients, which in our patients was linked mainly to hyperposphoraemia requiring optimization of phosphorus chelators and hemodialysis measures.