bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO871: COVID-19 in Dialysis Patients, a South African Experience
Authors: Clark Chevon , Katz Ivor 
Published: May 2022

Abstract

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

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

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

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

Abstract

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

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

RESULTS
Anti-S antibodies at 15D and 3M were detectable in 95% (48/50)/98% (49/50) of HD patients, 93% (13/14)/100% of PD patients, 67% (17/26)/75% (21/28) of KT patients and 96% (25/26)/100% (24/24) of ACKD patients. Rates for healthy controls were 81% (13/16)/100% (17/17). Antibody levels decreased at 3M in HD (P = 0.04), PD (P = 0.008) and ACKD patients (P = 0.0009). In KT, patients levels increased (P = 0.04) between 15D and 3M, although they were low at both time points.
Detectable T-cell responses notably increased at 3M in HD patients (P &lt; 0.022). In PD, patients response increased by 15D (13/14; 93%) and 3M (9/9; 100%), while they were present in KT patients at 41% (12/27), 84% (22/26) and 96% (25/26) at baseline. Detectable T-cell responses in ACKD patients reached 80% (20/25) and 89% (17/19) at 15D and 3M, respectively. whereas in healthy controls it was 67% and 89% at 15D and 3M.

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

Abstract

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

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

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

CONCLUSION
CV patients showed better survival as compared with IV and NV in univariate models. While CV showed different demographics characteristics, multivariate models still showed, after control for age, gender, diabetic status and main lab values, a 5-fold increase in mortality risk and 18-fold increase in hospitalization risk for NV as compared with CV.
All efforts should be focused on vaccinating dialysis population to temper the impact of the disease.
MO900: Diuretic Prescription Patterns in Haemodialysis Patients: International Variation Reported in the Dopps
Authors: Tabibzadeh Nahid , Wang Dongyu , Karaboyas Angelo , Robinson Bruce , Young Eric , Schaeffner Elke , Jacobson Stefan , Vega Almudena , Al Rukhaimi Mona , Nitta Kosaku , Bieber Brian , Port Friedrich , Antonio Urena Torres Pablo 
Published: May 2022

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

RESULTS
A total of 106 haemodialysis patients with a median age of 73 years received a SARS-CoV-2 vaccination (n = 105 mRNA, n = 1 AstraZeneca). Of these, 50 non-dialysis patients with a median age of 56 years received a SARS-CoV-2 vaccination (n = 45 mRNA, n = 5 mRNA/AstraZeneca). During the observational period, 8 haemodialysis patients and 2 non-dialysis patients additionally contracted a SARS-CoV-2 infection.
Between the two testings, an overall decrease in anti-SARS-CoV-2 S antibody titres was observed (haemodialysis patients from a median of 252 to 95 U/mL, non-dialysis patients from a median of 1621 to 441 U/mL). At 6 months after the complete vaccination, 99 (93%) haemodialysis patients still presented with a detectable anti-SARS-CoV-2 spike antibody response (&gt;0.8 U/mL), comparable to 100% of the non-dialysis subjects. However, 60 (57%) haemodialysis patients showed low antibody response (&lt;100 U/mL), whereas only 5 (10%) non-dialysis patients presented with low antibody response.
Patients with an additional infection showed an increased titre of antibodies during follow-up.

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

Abstract

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

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

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

CONCLUSION
In our study, we identified residual urine output, xerosis, neuropathic pain, HD membrane type, interdialytic weight gain, Kt/V, ALT and TIBC as factors related to CKD-aP. The strong relationship between itch severity and neropathic pain scores was especially notable. More research in this field may be beneficial for identifying new therapeutic targets for CKD-aP.