bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO842: Maintenance of Humoral Response During a Three-Dose Immunization Program With MRNA SARS-COV-2 Vaccines in the Haemodialysis Population
Authors: Jesus Broseta Monzo Jose , Rodríguez Espinosa Diana , Cuadrado Elena , Guillen-Olmos Elena , Rodríguez Néstor , Maduell Francisco 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The COVID-19 pandemic continues to be a worldwide health issue. Among haemodialysis (HD) patients, many countries opted for a three-dose immunization scheme with mRNA vaccines, as some patients did not produce a sufficient humoral response after the second one, and most developed a rapid decline in antibody levels over the months following vaccination.

METHOD
This observational, prospective, multi-centre study evaluated the humoral response, clinical outcomes (breakthrough infections, hospital admissions, severe COVID-19 and mortality), and their potential associated factors by determining the presence and levels of IgG antibodies to the receptor-binding domain of the S1 spike antigen of SARS-CoV-2 (anti-S1-RBD IgG) before and after each of the three doses of SARS-CoV-2 mRNA vaccines with either the mRNA-1273 (Moderna) or BNT162b2 (Pfizer) in 153 patients from three dialysis units affiliated to Hospital Clínic of Barcelona (Spain).

RESULTS
Unlike the general population, where most individuals seroconverted after one dose, HD patients required two doses to produce a positive anti-S1-RBD IgG response in most of them. Moreover, their antibody levels waned significantly three and 6 months after vaccination (see Figure 1). The decline in antibody levels was accompanied by seroreversion in 32% of patients. Notably, despite the precipitous drop, there was a low incidence of breakthrough infections (5.9%), with only one case of severe COVID-19 that required ICU admission and no deaths up until receiving the third vaccine dose. The administration of the third dose achieved seroconversion in 3 out of 4 non- or weak responders to two doses. Active cancer and immunosuppressive treatment were related to a worse humoral response.

CONCLUSION
Every haemodialysis patient should receive a third-dose vaccination scheme, with a booster dose three or 6 months after receiving the second one. Despite the lack of data, immunosuppressed and active cancer patients may benefit from more frequent vaccine boosters. Further monitoring of antibody levels will be needed to assess the maintenance of the humoral response in these patients.
MO870: The Legacy Effect of a Home Walking Exercise Program in Kidney Failure Patients on Dialysis
Authors: Mallamaci Francesca , D'arrigo Graziella , Manfredini Fabio , Lamberti Nicola , Torino Claudia , Luigi Tripepi Giovanni , Zoccali Carmine 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The EXCITE trial (JASN 28: 1259–1268, 2017) in dialysis patients showed that a 6-month home walking exercise program increases the walking distance covered during the 6 min walking test (6MWT), improves the response to the 5 times sit-to-stand test (5STS) and the cognitive function and quality of social interaction scores of the KDQOLSF-SF™ questionnaire.

METHOD
In this post-trial study embedded in the EXCITE trial, we tested the response to the 6MWT and the 5STS tests and the KDQOLSF-SF™ from the 6th month (end of the trial) to the 36th month.

RESULTS
Among the 227 patients of the EXCITE trial cohort, 162 underwent at least three out four testing visits (baseline, 6, 18 and/or 36 month) contemplated by the study protocol and 89 all four testing visits. In the primary analysis by the linear mixed model, the gain in walking distance achieved at 6th month in the exercise group {between-arms difference: +36 m, [95% confidence interval (95% CI): 22–51]; P &lt; 0.001} was maintained at the 18th month (between-arms difference: +37 m, 95% CI: 19–57; P &lt; 0.001) to reduce to 23 m (95% CI: –4 to 49 m; P = 0.10) at 36th month. Overall, the post-trial difference in walking distance trajectories between the two study arms was highly significant (P = 0.004). Furthermore, the walking distance changes at the 6th (r = 0.34; P = 0.018) and 18th month (r = 0.30; P = 0.043) were directly related with number of structured exercise sessions completed during the trial (i.e. the first 6 months). No such an effect was registered in the response to the 5STS or in quality of life as measured by the KDQOLSF-SF™.

CONCLUSION
In dialysis patients the benefits of a 6-months structured walking program outlast the duration of the intervention and postpone the loss of walking performance, which naturally occurs in this population.
MO879: Prevalence, Recurrence and Seasonal Variation of Hyperkalaemia in Patients Receiving Thrice-Weekly Haemodialysis
Authors: Tsiagka Dimitra , Georgianos Panagiotis , Pikilidou Maria , Vaios Vasilios , Minasidis Elias , Karpetas Antonios , Roumeliotis Stefanos , Metallidis Simeon , Liakopoulos Vassilios , Zebekakis Pantelis 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Prospective cohort studies have shown that among patients on haemodialysis, hyperkalaemia is strongly associated with excess risk for cardiovascular-related hospitalizations and sudden cardiac death [1–4]. However, the actual burden of hyperkalaemia, the rates of its recurrence and seasonality in its variation still remain unclear.

METHOD
Between June 2020 and May 2021, 1786 mid-week predialysis serum potassium (sK) measurements were retrospectively recorded from 149 patients receiving thrice-weekly haemodialysis in a single-centre in Thessaloniki, Greece. The prevalence, recurrence and seasonal variation of hyperkalaemia were assessed using three prespecified sK thresholds (≥5.1, ≥5.5 and ≥ 6.0 mmol/L).

RESULTS
At baseline (June 2020), 60.4%, 42.2% and 13.4% of patients had sK levels ≥ 5.1, ≥5.5 and ≥ 6.0 mmol/L, respectively. At any time-point during the 1-year-long follow-up, 85.2%, 69.8% and 38.9% of patients experienced at least 1 hyperkalaemic episode at the sK threshold of ≥ 5.1, ≥5.5 and ≥ 6.0 mmol/L, respectively. Of the 104 patients experiencing an initial sK elevation ≥ 5.5 mmol/L, hyperkalaemia at the same threshold reoccurred in 60.6% at month-1, in 47.1% at month-2 and in 46.1% at month-3 of follow-up. Seasonal variation was also observed, with the prevalence of hyperkalaemia to be significantly higher in summer. In multivariate logistic regression analysis, shorter delivered haemodialysis &lt; 4 h/session {odds ratio (OR): 2.568; [95% confidence interval (95% CI): 1.045–6.313]} and the use of a high versus a low K concentration in the dialysate (OR: 14.646; 95% CI: 2.727–78.647) were the two factors that were associated with a significantly higher odds of hyperkalaemia at any time-point of the follow-up period.

CONCLUSION
The present study shows that among patients receiving conventional thrice-weekly haemodialysis, the rates of hyperkalaemia prevalence and recurrence are very high, reflecting the large unmet need to identify more effective potassium-lowering therapeutic interventions in this high-risk population.
MO882: Heterologous versus Homologous Triple Anti-Covid-19 Vaccine Regimens in Patients on Maintenance Hemodialysis
Authors: Meijers Björn , Goedgezelschap Annelien , Peeters Domien , van der Veen Annelien , Verbinnen Margo , Vermeersch Pieter , J.F. Stas Koenraad , Kuypers Dirk 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Vaccination against COVID-19 is a promising strategy to reduce the risk for severe COVID-19. Patients on maintenance haemodialysis have a less robust immunoresponse than the general population. Triple vaccination might improve immunogenicity, and might benefit patients having a poor initial response. The aim of the current study was to evaluate the humoral response to heterologous (a combination of different vaccine types) versus homologous (three identical vaccines) triple vaccination against COVID-19.

METHOD
We analyzed serological response to homologous (3 times mRNA-based vaccine) versus heterologous (adenoviral vectored plus mRNA vaccines) triple regimens in samples from patients on maintenance dialysis (NCT04378686). We measured IgG anti–S (spike) SARS-CoV-2 antibody levels using the IgG II Quant assay (Abbott). Samples were collected between 6 and 12 weeks after both the second and the third vaccine dose.

RESULTS
A total of 302 patients received three vaccine doses. 94 patients received a heterologous regimen of the adenoviral vectored AZD1222 (2 doses) and the mRNA-based BNT162b2 (1 dose). The remaining 208 patients received a triple mRNA vaccine regimen of either BNT162b2 (n = 149) or mRNA-1273 (n = 59). Triple vaccine regimens resulted in significant elevation of anti-S titers, as compared with the conventional prime-boost (double) vaccination. A substantially and significantly larger fraction of patients reached the threshold for neutralizing antibodies after triple vaccination, as compared with after double vaccination. The yield of a third dose of mRNA-1273 is less than the yield of a third dose of BNT162b2. This, however, mainly reflects the initial significant better response to mRNA-1273. In multivariate analysis, a past episode of COVID-19 was a strong modulator of the response after double vaccination, and after triple vaccination.

CONCLUSION
Both heterologous and homologous triple vaccine regimens significantly augment the humoral response against SARS-CoV-2. The higher the ininitial response to the double prime-boost regimen, the lower the yield of a third vaccine dose. It seems prudent to prioritize vaccination of dialysis patients using mRNA-based vaccines when available.
MO886: Outcomes in Incident Patients Treated With Incremental Haemodialysis as Compared With Thrice-Weekly Haemodialysis and Peritoneal Dialysis: The Geneva Experience
Authors: Jaques David , Haidar Fadi , Dufey Anne , Ponte Belén , Carballo Sebastian , de Seigneux Sophie , Saudan Patrick 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Preservation of residual kidney function (RKF) in maintenance haemodialysis (HD) patients is associated with better survival and quality of life. RKF may be better preserved with an incremental HD (frequency &lt; 3x/week) regimen in patients starting HD. Since 2013, incremental HD is routinely used at our centre.

METHOD
Incremental HD was implemented in incident HD patients with a urine output of &gt;600 mL/day, a urea clearance (KRU) ≥2 mL/min and an interdialytic weight gain &lt; 2.5 kg. Patients were clinically assessed every week and a 24-h urine collection was ordered every other month in order to measure RKF.

RESULTS
From January 2013 to December 2020, 296 patients started chronic dialysis, with 162 on thrice-weekly HD, 63 on incremental HD and 71 on peritoneal dialysis (PD). Patients on incremental HD did not differ from those on thrice-weekly HD or PD in terms of age, gender and comorbidity score. Diuresis, eGFR and KRU at incremental HD initiation were 1842 ± 749 mL/day, 6.7 ± 3.1 mL/min and 4.0 ± 1.8 mL/min, respectively. Among patients on incremental HD, four could retrieve a sufficient RKF to become dialysis-independent and two were transplanted. Among the 57 remaining patients on incremental HD, median duration until transition to a thrice-weekly HD regimen or death was 10 (6–20) months. Within the first year of dialysis, median survival and hospital-free days were higher in patients starting with incremental HD as compared with thrice-weekly HD: 91% versus 77%, P = 0.02 and 348 (316–362) versus 338 (295–354) days; P = 0.03.

CONCLUSION
These preliminary results show that incremental HD can be implemented in incident HD patients as long as regular clinical and RKF assessments are found adequate. A median duration of 10 months before transition to thrice-weekly HD can be expected in this setting. Results of randomised clinical trials assessing long-term survival and quality of life in incremental HD are awaited prior to its large-scale implementation.
MO930: Does Oral Sodium Bicarbonate Improve Protein Metabolism and Regeneration in Esrd Patients on Maintenance Hemodialysis?
Authors: Ali Ala , Rashid Zina 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Uremic metabolic acidosis with decreased bicarbonate levels is frequent in hemodialysis patients, and its correction is one of the goals to achieve adequate dialysis. Unfortunately, the bicarbonate delivered through the dialysate may be inadequate to correct the whole acid load. Most hemodialysis data show that about 50% of patients fail to meet a bicarbonate level within the normal range before each dialysis session. Furthermore, low predialysis bicarbonate levels of &lt;22 mmols/L have been linked with increased malnutrition, inflammation and all-cause mortality in hemodialysis patients.
This study investigates whether oral sodium bicarbonate supplementation in acidotic hemodialysis patients will improve normalized protein catabolic rate (nPCR) and serum albumin as indicators of nutritional adequacy.

METHOD
An interventional study was conducted in a trusted hemodialysis unit in Baghdad, Iraq, from 1 September to 1 December 2021. A total of 50 adult prevalent hemodialysis patients were recruited. Out of 50 patients, 26 patients received oral sodium bicarbonate 500 mg/day, and 24 were matched controls. All patients had no significant residual renal function with thrice/week dialysis through arteriovenous fistulae.
Serum albumin and the normalized protein catabolism ratio were measured at baseline and 3 months. In addition, anthropometric measures and essential lab data were recorded, including pre-HD arterial pH, serum bicarbonate, serum creatinine, serum Na, k, body weight, interdialytic weight gain, predialysis systolic and diastolic blood pressure and spKt/V.

RESULTS
The mean age of the study group was 48.76 + 16.21 years with 27 females. The median dialysis duration was (3 years). We found no statistically significant difference in the nPCR and serum albumin between the two groups at 3 months.
There was a significant difference in the serum bicarbonate level in the intervention group with a P-value of 0.00. In addition, there were significant differences in arterial PH (P-value 0.008) and serum potassium (P-value 0.039) at 3 months. Serum potassium decreased in the intervention group to the range of (3.9–5.8 meq/L) in comparison to (4.2–6.7 meq/L) in the control group. There was no statistically significant interdialytic weight gain or change in systolic blood pressure at 3 months between the two groups (P-values 0.4 and 0.07), respectively.

CONCLUSION
Optimal dialysis dose and acidosis correction are not enough to achieve adequate protein metabolism, indicating poor protein intake by Iraqi HD patients, which mandates proper nutritional counseling.
MO935: A Propensity-Matched Study of The Effect of Short Daily Home Haemodialysis With Low Flow Dialysate on Nutritional Status and Body Composition
Authors: Vizcaíno Belén , Molina Pablo , Molina Mariola D , Lopez Herradon Ana , Rincon Bello Abraham , González Moya Mercedes , Beltrán Sandra , Calatayud Emma , Sancho Asunción , Maduell Francisco 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The present study tested the hypothesis that short daily home haemodilaysis (HDD) with low flow dialysate using the NxStage monitor (Fresenius Medical Care) could preserve muscle mass and prevent protein-energy wasting in HD patients, despite using low-flux, lactate-buffered dialysate.

METHOD
This 12-month, prospective, controlled study examined 25 consecutive, non-selected CKD stage 5 patients who initiated short daily HHD with low-flow dialysate (HHD group) in our centre, and were compared with data from 50 patients on high-flux HD (HF-HD group) and 50 patients on on-line haemodiafiltration (OL-HDF group) obtained from the Fresenius Medical Care clinical database EuCliD after matching for clinical characteristics and propensity scores. Changes in body composition were assessed by whole-body bioimpedance spectroscopy (BIS; Fresenius Medical Care) at baseline, months 3, 6 and 12, by experienced research staff blinded to all clinical and biochemical data of the patients. In order to control for potential variability and the effect of overhydration, all BIS analyses were performed before a mid-week dialysis session. Linear mixed-effects models were used for the analysis of the repeated measures data.

RESULTS
Compared with in centre HF-HD, patients assigned to HHD experienced a gradual improvement in LTM. These differences reached statistical significance at Month 6 and Month 12, with a relative difference of 2.76 kg [95% confidence interval (95% CI): 0.53–4.99; P = 0.01] and 3.08 kg (95% CI: 0.68–5.45; P = 0.01), respectively. Changes in fat inversely mirrored those of LTM, with a relative difference between groups of –3.29 kg (95% CI: –6.66–0.07; P = 0.05) at Month 12. No differences in hydration status or dry weight were noted between groups (Table 1). No significant changes in body composition were observed between the HDD and the OL-HDF groups (data not shown).

CONCLUSION
Short daily HHD with the NxStage system for 1 year compared with HF-HD increased muscle mass, supporting the hypothesis that short daily HHD with low-flow dialysate could benefit nutritional status and prevent protein-energy wasting in HD patients.
MO945: Disqualification of Donor and Recipient Candidates from The Living Kidney Donation Program: A German Single-Center Analysis
Authors: Sofia Grigorescu Vlass Melissa , Stangl Manfred , Sajin Isidora , Lemos Cerqueira Tiago , Illigens Ben , Schoenermarck Ulf , Meiser Bruno , Kemmner Stephan , Fischereder Michael 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Kidney transplantation is the best treatment option for patients with end stage kidney disease (ESKD) with a superiority of transplantation after living kidney donation (LKD) compared to deceased donation. However, a large part of potential donors and recipients are ineligible for LKD. Here, we analyze the leading causes for disqualification of prospective living donor-recipient pairs from the LKD program and the health-related consequences for ESKD patients excluded from the LKD program in a German tertiary transplant center.

METHOD
In this single-center retrospective cohort study we evaluated all candidates (potential donors and recipients) presenting for assessment of LKD from 2012 to 2020 at our transplant center. Thereby we focused on candidates excluded from the LKD program. Main reasons for disqualification were categorized as medical (donor-related), psychosocial, immunological, recipient-related and unknown.

RESULTS
Overall, 601 donor-recipient pairs referred to our transplant center for LKD assessment during the observation time. Out of those, 326 (54.2%) discontinued the program with 52 (8.7%) dropouts and 274 (45.6%) donor-recipient pairs being ineligible for LKD. Donor-related medical contraindications were the main reason for disqualification (139 out of 274 (50.7%) potential donors) followed by recipient-related contraindications (62 out of 274 (22.6%) of potential donor-recipient pairs). Only 77 out of 257 (29.9%) potential recipients excluded from the LKD program received a kidney transplant afterwards with a median waiting time of 2 (IQR: 1.0–4.0) years. Overall, 18 (7.0%) ESKD patients initially declined for LKD died in this period.

CONCLUSION
A large percentage of donor-recipient pairs disqualified from the German LKD program, mostly due to medical reasons related to the donor and with partly severe consequences for the potential recipients. For these, we need alternative concepts to make transplantation possible.
MO955: Serum Cystatin C in Renal Transplantation: Beyond GFR Estimation, A Prognosis Marker?
Authors: Ounoughi Lydia , Masson Ingrid , Alamartine Eric , Delanaye Pierre , Maillard Nicolas , Mariat Christophe 
Published: May 2022

Abstract

BACKGROUND AND AIMS
In renal transplantation, death with a functioning graft remains one of the main causes of graft loss. In the general population, renal function impairment is strongly associated with cardiovascular and all-cause mortality. Whether this association holds true for kidney transplant recipients (KTR) is unclear. This uncertainty is likely to be due, in part, to the fact that glomerular filtration rate (GFR) estimation based on serum creatinine (SCr) does not always provide an accurate evaluation of the graft function in KTR. As compared to SCr, we have previously shown in a large cohort of KTR that serum cystatin C (SCysC) is a much better marker of GFR.
Herein, we sought to study the ability of the 1-year-post-transplant renal function to predict all-cause mortality according to the methods used to assess GFR.

METHOD
Four hundred and ten consecutive KTR for whom a measurement of GFR by inulin clearance was available at 1 year post-transplant were included. SCr and ScysC were measured with standardized methods. The association of the 1-year inulin clearance value the 1-year MDRD Study equation value and the 1-year CKD-EPI ScysC equation value with all-cause mortality was studied by ROC analysis and Cox model.

RESULTS
During a median follow-up of 17 years, 131 KTR died. Mean (±SD) inulin clearance at 1-year-post-transplant was 47 (±13) mL/min/1.73 m2. Areas under the ROC curves were similar for inulin and CKD-EPI ScysC equation values (0.62 for both), and were both significantly superior to that of the MDRD equation (0.54, P &lt; 0.01). In Cox analysis, while all types of GFR evaluations were significantly associated to graft loss, only an inulin and a CKD-EPI ScysC equation values below 45 mL/min/1.73 m2 were associated with an excess risk of mortality (HR of 1.55, 1.45 and 1.01 for inulin, CKD-EPI ScysC and MDRD, respectively).

CONCLUSION
We conclude that ScysC-based GFR estimation might better predict KTR outcome as compared with a traditional SCr-based estimation. The one year-post transplant GFR value given by the CKD-EPI ScysC equation should be further evaluated as a potential surrogate marker for both graft and patient survival.