Chinese Maintenance Hemodialysis Patients Research Articles

Phase angle as an indicator of depression in maintenance hemodialysis patients

Introduction: Depression is a common psychiatric problem in maintenance hemodialysis (MHD) patients. Recent studies have begun to explore the relationship between body composition and depression. Phase angle (PhA), a core parameter for assessing body composition, has been observed to be associated with frailty and cognitive dysfunction. The aim of this study was to investigate the association between PhA and depression in MHD patients. Methods: This multicenter, cross-sectional study included 843 MHD patients from seven dialysis centers in Shanghai, China. Depressive symptoms were evaluated using the Patient Health Questionnaire (PHQ-9), with a score of ≥10 indicating depression. PhA was measured by bioelectrical impedance analysis. Nutritional status was assessed by Malnutrition inflammation score (MIS) . Multivariable logistic regression models were used to investigate the association between PhA and depression. Restricted cubic spline (RCS) analysis was utilized to examine the association. Receiver operating characteristic (ROC) curve was used to identify the cut-off value of PhA for depression. Results: 15.2% of patients (62.8% male, median age 66 years) had depression. Median PhA level (interquartile range, IQR) of depressed patients was 4.4° (3.9-4.9°) for males and 3.9° (3.2-4.7°) for females. There was a significant decrease in the prevalence of depression with increasing quartiles of PhA levels. In multivariable logistic regression analyses, after adjusting for age, sex, education level, spkt/v, dialysis vintage, Charlson comorbidity index, hemoglobin and serum albumin, lower PhA levels (lowest quartile group) were significantly associated with depressive symptoms (adjusted odds ratio, 2.19; 95% confidence interval, 1.07 to 4.48), compared to higher PhA levels (highest quartile group). RCS analysis showed a relatively inverse linear association between PhA and depression. The optimal cut-off value of PhA for depression was 4.9° for males and 3.5° for females. Subgroup analyses validated the findings across patient characteristics, including age, sex, diabetes, education and malnutrition. Conclusion: Our findings indicated an inverse association between PhA and depressive symptoms in Chinese MHD patients, suggesting that PhA could serve as a valuable indicator for assessing the risk of depression in this population. Further studies are needed to explore the potential of PhA as a prognostic tool and its implications for intervention strategies.

Trajectories and influencing factors of psychological resilience among Chinese patients with maintenance hemodialysis

ObjectiveTo identify distinct trajectories of psychological resilience among Chinese patients with maintenance hemodialysis, explore influencing factors and inform the formulation of corresponding interventions. MethodsThis was a multi-center longitudinal study with a 6-month follow-up. With convenience sampling, a total of 231 patients with maintenance hemodialysis were recruited between September 2020 and July 2021. Patients’ characteristics, including sociodemographic information, social support and family resilience was collected through structured questionnaires as potential baseline influencing factors of psychological resilience trajectories. Psychological resilience was evaluated using the 25-item Chinese version of the Conner and Davidson resilience scale. Latent class growth modeling was conducted to identify homogeneous subgroups with distinct trajectories of psychological resilience. Univariable and multinomial logistic regression analysis were used to examine whether baseline influencing factors were associated with trajectories in patients with maintenance hemodialysis. ResultsFive distinct psychological resilience trajectory groups were identified: declining group (n = 20, 8.7 %), rising group (n = 17, 7.4 %), moderate-stable group (n = 128, 55.4 %), high-stable group (n = 7, 3.0 %) and low-stable group (n = 59, 25.5 %). High-stable group and moderate-stable group were combined into the well-psychological resilience group for multinomial logistic regression analysis. The multinomial logistic regression analysis showed that influencing factors associated with trajectories of psychological resilience were age, religion, monthly household income per capita, and baseline family resilience. ConclusionsThe results highlight the heterogeneity in the development of psychological resilience among Chinese patients with maintenance hemodialysis. There is a need for healthcare professionals to screen for trajectories of psychological resilience in Chinese maintenance hemodialysis patients and prepare individual mental healthcare interventions.

Relationship of serum total cholesterol and triglyceride with risk of mortality in maintenance hemodialysis patients: a multicenter prospective cohort study

Objective The relationship between serum total cholesterol (TC) and triglyceride (TG) levels and mortality in maintenance hemodialysis (MHD) patients remains inconsistent. We aimed to explore the individual and combined association of TC and TG levels with the risk of mortality in Chinese MHD patients. Methods 1036 MHD patients were enrolled in this multicenter, prospective cohort study. The serum levels of total cholesterol and triglycerides were measured at baseline. The primary outcome was all-cause mortality and secondary outcome was cardiovascular disease (CVD) mortality. Results During a median follow-up duration of 4.4 years (IQR= 2.0–7.9 years), 549 (53.0%) patients died, and 297 (28.7%) deaths were attributed to CVD. Compared with patients with TC levels in the first three quartiles (<182.5 mg/dL), a significantly higher risk of all-cause mortality was found in participants with TC in the fourth quartile (hazard ratio [HR], 1.43; 95% confidence interval [CI], 1.17–1.76). However, a significantly lower risk of all-cause mortality was observed in participants with TG in the fourth quartile (≥193.9 mg/dL) (HR, 0.78; 95%CI: 0.63–0.98), compared with participants with TG in the first three quartiles. Similar trends were observed in CVD mortality. When analyzed jointly, patients with lower TC (<182.5 mg/dL) and higher TG (≥193.9 mg/dL) levels had the lowest risk of all-cause mortality and CVD mortality. Conclusions: In MHD patients in southern China, higher TC levels were associated with higher risk of mortality, while higher TG levels were related to lower risk of mortality. Patients with lower TC and higher TG levels had the best survival prognosis.

The Relationship Between Fracture and Mortality in a Chinese Maintenance Hemodialysis Patients Cohort.

Patients on maintenance hemodialysis have an increased risk of fracture. However, the relationship between fracture and poor prognosis is not clear. A total of 182 maintenance hemodialysis patients were enrolled in the study. The relationship between fracture and poor prognosis (cardiovascular events, stroke, malignancy and 5-year all-cause mortality) were analyzed. 21 of 182 patients had a history of fracture at the time of enrollment. 26 patients had a new fracture after enrollment. A total of 57 fractures occurred in 47 patients, the most common fracture site was the rib. Patients with fracture group had a higher proportion of elderly and female, higher serum phosphorus and B-type natriuretic peptide and lower hemoglobin, albumin, and potassium compared with those without fracture. Age (OR=3.809, 95% CI: 1.064-8.966, p=0.038), hemoglobin (OR=0.961, 95% CI: 0.925-0.997, p=0.035), and serum phosphorus (OR=3.325, 95% CI:1.104-10.019, p=0.033) were the independent risk factors of new fractures in MHD patients. The incidence of malignancy and 5-year all-cause mortality in patients with fracture was higher than those without fracture (p<0.05). But there was no significant difference in the incidence of acute myocardial infarction or stroke. 25.8% of maintenance hemodialysis patients had at least one fracture, with rib fractures accounting for the highest proportion. Age, hemoglobin and serum phosphorus were the independent risk factors of new fractures. The incidence of malignancy and 5-year all-cause mortality in patients with fracture was higher than those without fracture, but there was no significant difference in the incidence of acute myocardial infarction and stroke.

Association of intradialysis blood sodium level, blood pressure variability, and hydration status with hemodialysis-related headache: a prospective cohort study

ObjectiveTo identify primary factors contributing to hemodialysis-related headache (HRH) in maintenance hemodialysis (MHD) patients.MethodsAdult outpatients receiving MHD were prospectively enrolled from a hemodialysis (HD) center of a tertiary hospital in China. Twelve dialysis sessions were successively monitored for each patient. HRH is defined as having at least three headache episodes that begin during HD and resolve within 72 h of HD session completion. Blood gas analysis during headache episodes and body composition analysis after dialysis were conducted. Hour-to-hour vital sign variability during dialysis was assessed using the metric of average real variability (ARV). Multivariable logistic regression analysis was conducted to explore the factors triggering HRH.ResultsA total of 95 Chinese MHD patients were enrolled, with 92 patients (60.9% were males) included in the final analysis. The mean age of the 92 patients was 59.3 ± 17.5 years, and the median dialysis vintage was 27.1 (12–46.2) months. Among them, 12 patients (13%) complained of 42 headache attacks, and eight (8.7%) were diagnosed with HRH. For eight patients with HRH, headache occurred 100.3 ± 69.5 min after the start of dialysis, with a mean VAS score of 4.3 ± 1 points. The quality of headaches was dull (six patients), pulsating (one patient), or stabbing pain (one patient); all the headaches were bilateral, with one having concomitant vomiting. The intradialysis headache duration and the whole headache duration were 98.8 ± 68.1 and 120 (65–217.5) minutes, respectively. Younger age (OR = 0.844, 95% CI 0.719–0.991, p = 0.039), decreased blood sodium level (OR = 0.309 in the range of 133–142 mmol/L, 95% CI 0.111–0.856, p = 0.024), increased ARV of intradialysis systolic blood pressure (OR = 3.067, 95% CI 1.006–9.348, p = 0.049) and ratio of overhydration to dry weight (OR = 1.990, 95% CI 1.033–3.832, p = 0.040) were found to be independent risk factors for HRH.ConclusionsThis study suggested a significant attribution of blood sodium, hydration status and blood pressure variability to HRH.

Urgency for Kidney Palliative Care in Chinese Maintenance Hemodialysis Patients

The aim of this study is to understand nephrology medical staff's awareness of, basic knowledge of, practical ability of, and the barriers to palliative kidney care to patients on maintenance hemodialysis (HD) in mainland China. This cross-sectional descriptive study employed convenience sampling of medical staff (physicians and nurses) working in nephrology departments in mainland China. Independent predictors of self-assessment ability for palliative care (PC) were determined using multivariate binary logistic regression. Responses were received from medical staff in 28 provinces and 657 questionnaires were analyzed. Among the participants, 53.1% (349/657) were doctors, and only 4.3% claimed to be confident in providing PC to patients on HD. The average score of self-assessing ability for PC was 2.65 ± 1.15 (range 1-5). Among the 580 participants who experienced patient withdrawal from dialysis, only 16.0% reported that their patients had well-planned withdrawal from dialysis. Male (odds ratio [OR] [95% confidence interval [CI], 0.585 [0.34-0.99], P= 0.048), nurse (OR [95% CI], 1.81 [1.01-3.27], P= 0.047), more experience in dealing with deceased cases (OR [95% CI], 1.28 [1.02-1.61], P= 0.034), less experience of medical disputes before/after withdrawal from dialysis (OR [95% CI], 0.62 [0.40-0.98], P= 0.041), and PC training experiences (OR [95% CI], 2.33 [1.86-2.91], P< 0.001) were independently correlated with significant better self-assessing ability for PC. This study demonstrates that the nephrology medical staff had a positive attitude but lacked relative knowledge and training in PC. Institutionalized education, training models, practice guidelines for kidney PC, and guidelines for well-planned withdrawal from dialysis according to cultural background are urgently needed in mainland China.

Association of dietary fiber with subjective sleep quality in hemodialysis patients: a cross-sectional study in China

Background Poor sleep quality is a common problem among hemodialysis (HD) patients. Dietary fiber is a key component of a healthy diet and is beneficial for a variety of health outcomes; however, evidence of an association between dietary fiber consumption and subjective sleep quality has not been established among HD patients. Therefore, we determined the association between dietary fiber consumption and the subjective sleep quality in Chinese maintenance HD patients, taking into account fiber type and source. Methods Dietary intake was assessed with a validated food frequency questionnaire in a cross-sectional study including 741 maintenance HD patients between December 2021 and January 2022. The daily intake of dietary fiber was categorized into three groups. The lowest tertile was used as the reference category. Sleep quality of patients was accurately calculated using the Pittsburgh sleep quality index standard questionnaire. Multivariable logistic regression model and restricted cubic spline analysis were performed to assess the relationship between dietary fiber consumption and poor sleep quality. Results Compared with the lowest tertile group of dietary fiber intake, the highest tertile group had a lower prevalence of poor sleep quality. After adjustment for potential confounders, a higher intake of total dietary fiber (ORtertile 3 (T3) to tertile 1 (T1)= 0.51, 95% CI: 0.31–0.85), total insoluble dietary fiber (ORT3 to T1 =0.54, 95% CI: 0.33–0.89), and soluble dietary fiber in vegetables (ORT3 to T1 =0.61, 95% CI: 0.40–0.93) were associated with a lower prevalence of poor sleep quality. Furthermore, significant linear trends were also observed (p < 0.05). No significant interactions were observed in subgroup analyses. Conclusion A higher intake of dietary fiber was inversely associated with the poor sleep quality. These findings support the current recommendations that dietary fiber is essential for health and well-being.

The cross-cultural adaptation and psychometric evaluation of a learned helplessness scale for maintenance hemodialysis patients in China (LHS-MHD-C).

Learned helplessness (LH) is an important concept in nursing. This study aimed to adapt and translate the Arthritis Helplessness Indexscale into a Chinese version of an LH scale for maintenance hemodialysis patients in China (LHS-MHD-C), and to validate its psychometric properties. Data collected included LHS-MHD-C, as well as the Hospital Depression Scale (HADS-D), and the Beck Hopelessness Scale (BHS) for assessing LHS-MHD-C's criterion validity (predictive and concurrent, respectively). The expert consultation and the pilot study demonstrated semantic and conceptual equivalence and content validity (except for Item 3, the item content validity ranged from 0.82 to 1, and the scale content validity was 0.95). An exploratory factor analysis (n = 146) eliminated three items and accepted 11 items for the two factors, explaining 63.87% of the total variance. A CFA (n = 218) showed that the two-factors structure was consistent with the LH theory. The LHS-MHD-C can distinguish between maintenance hemodialysis(MHD) patients of different ages, education, working status, monthly income, and MHD duration. The scale had good concurrent validity with the BHS (r = .78, p < 0.01). Using the HADS-D as a criterion, the LHS-MHD-C showed a sensitivity of 86.2% and a specificity of 96.8%. A total score of 36.5 may be the best cut-off value for predicting MHD patients' depression. The scale showed good reliabilities (Cronbach's α value of .759, test-retest reliability of 0.772, and split-half reliability of 0.774). This study found that the LHS-MHD-C is a reliable and valid scale for assessing Chinese MHD patients' helplessness.

Muscle strength performed better than muscle mass in identifying cognitive impairment risk in maintenance hemodialysis patients.

The association between muscle mass and cognitive impairment (CI) is conflicting. We aimed to evaluate and compare the associations of muscle strength, muscle mass and CI risk in maintenance hemodialysis (MHD) patients. We conducted a multicenter, cross-sectional study. Cognitive function was assessed with the Mini-Mental State Examination (MMSE) score. Muscle strength was assessed by hand grip strength (HGS), muscle mass was assessed by lean tissue mass (LTM). Education status was divided into two groups: lower education status (senior middle school and below) and higher education status (high school and above). Multivariable logistic regression models and subgroup analyses were performed. Receiver-operating characteristic (ROC) analyses were conducted to compare their predictive power in discriminating CI. 2827 adult MHD patients were included in our final analysis. Patients in the lowest quartile of HGS was 2.82-fold as likely to have CI as compared to those in the highest quartile, while participants in the lowest quartile of LTM group were 1.52-fold as likely to have CI, when compared with the highest quartile group of LTM after adjusting for age, gender and education level. The association persisted in all subgroups except for women and well-educated participants. There was a significant interaction between HGS and education status on CI and age played an interactive role in the association between LTM and incident CI (P for interaction < 0.05). The AUC value of the HGS was significantly higher than that of LTM (0.69 VS 0.63, P < 0.001). Muscle strength performed better than muscle mass in identifying individuals at high risk of CI, particularly in male and less educated Chinese MHD patients. Level V, cross-sectional study.

Diet-Related Inflammation is Associated with Malnutrition-Inflammation Markers in Maintenance Hemodialysis Patients: Results of a Cross-Sectional Study in China Using Dietary Inflammatory Index.

PurposeThis cross-sectional study aimed to explore the association between the inflammation potential of the diet and malnutrition-inflammation status in Chinese maintenance hemodialysis (MHD) patients.MethodsDietary Inflammatory Index (DII) was computed based on a semi-quantitative food frequency questionnaire. Malnutrition-inflammation status was assessed by six indexes, including C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), hemoglobin (HB), albumin (ALB) and malnutrition-inflammation score (MIS). Multivariable linear regression and logistic regression were employed adjusting for covariables including age, gender, body mass index and dialysis vintage.ResultsA total of 161 Chinese MHD patients with an average age of 60.0 ± 13.6 years were enrolled. The median (IQR) DII score among participants was 0.60 (−0.80, 2.32), revealing a generally pro-inflammatory diet. DII was positively associated with MIS score (β= 0.61, 95% CI: 0.51, 0.69, p < 0.0001) and CRP (β = 0.54, 95% CI: 0.46, 0.63, p < 0.0001). A negative relationship between DII and NLR (β = −0.37, 95% CI: −0.61, −0.13, p = 0.008) was found in the most anti-inflammatory diet. Multivariable logistic regression showed that each unit increase in DII was linked with 3.06 (95% CI: 1.39, 6.69, p = 0.005) times increased odds of MIS.ConclusionDiet with a higher DII score may act as a potential trigger contributing to the development of malnutrition-inflammation status. Further studies for verification and for developing strategies to decrease the dietary inflammation burden are warranted.

Soluble α-Klotho as a potential predictor of all-cause mortality in Chinese maintenance hemodialysis patients

IntroductionThis study aimed to clarify the potential association of serum soluble α-klotho levels with all-cause mortality in Chinese patients on maintenance hemodialysis (MHD).Material and methodsThe present study is a single -center prospective cohort study. It comprised 134 MHD patients which were divided into two groups according to the median level of serum α -klotho: 68 patients representing the low soluble α-klotho group (&lt; 1.15 ng/ml and equivalent to 1.15 ng/ml) and 66 patients representing the high soluble α -klotho group (&gt;1.15 ng/ml). These patients were followed up for 36 months. The three-year all-cause mortality rate, overall survival (OS) and cardio-cerebrovascular mortality were observed. The potential risk factors of all-cause mortality in MHD patients were investigated by Cox regression models.ResultsThe 3-year all-cause mortality rates in low soluble α-klotho group were significantly higher than those in high soluble α-klotho group (33.82% vs. 16.67%, P=0.039). The difference of the 3-year cardio-cerebrovascular mortality rates between the two groups was non-significant (26.47% vs. 15.15%, P=0.107). The Kaplan-Meier analysis showed that the differences in the rates of OS and cardio-cerebrovascular death free survival between the two groups were significantly different (all P&lt;0.05). The Cox regression analyses revealed that low soluble α-klotho level was an independent predictor of all-cause mortality in MHD patients after adjusting for potential confounding factors.ConclusionsLow serum soluble α-klotho levels was associated with increased risk of all-cause mortality in Chinese MHD patients.

Chronic Pain and Quality of Life in Maintenance Hemodialysis Patients in China: A Multicenter, Cross-Sectional Study.

PurposePatients undergoing maintenance hemodialysis (MHD) frequently experience chronic pain, which can severely affect their quality of life (QOL). The objective of this study was to evaluate the prevalence of chronic pain in MHD patients and examine the factors associated with QOL.Patients and MethodsA cross-sectional questionnaire-based survey was conducted between October 2020 and April 2021, 1204 MHD patients from nine hemodialysis units were screened for chronic pain in Chengdu, China, and 296 MHD patients with chronic pain were enrolled in this study. We analyzed data on clinicodemographic characteristics, pain interference and severity (Brief Pain Inventory), QOL (Medical Outcomes Study 36-item Short Form Health Survey - mental component summary [MCS] and physical component summary [PCS]), pain self-efficacy (Pain Self-Efficacy Questionnaire), and social support (Social Support Rating Scale).ResultsThe prevalence of chronic pain in MHD patients was 26.74% in this study. The most common areas of pain were lower back (63.5%), lower limbs (55.0%), and head (33.5%), 36.5% did not implement any measures to relieve it. Of the patients who did receive pain treatment or medication, 56.9% reported that the measures they took had less than half of the pain relief. MHD patients with chronic pain had poor QOL based on scores on the MCS (53 ± 16.76) and PCS (40.56 ± 13.81). Stepwise multiple regression identified age, financial strain, pain interference, social support, and pain self-efficacy as independent predictors of QOL. Pain self-efficacy was significantly associated with social support (r = 0.5, p < 0.01), MCS (r = 0.69, p < 0.01), and PCS (r = 0.8, p < 0.01). The mediating effects of pain self-efficacy were 70.31% on the relationship between social support and MCS, and 75.62% on the relationship between social support and PCS.ConclusionChronic pain is prevalent and undermanaged in Chinese MHD patients, resulting in worse QOL. Healthcare providers should focus on pain management and the impact of psychosocial factors on patient QOL. Further research should deepen our understanding of how pain self-efficacy mediates the relationship between social support and QOL.

Dietary protein intake and the risk of all-cause and cardiovascular mortality in maintenance hemodialysis patients: A multicenter, prospective cohort study

ObjectivesThe association between dietary protein intake (DPI) and mortality in people receiving maintenance hemodialysis (MHD) remains uncertain. We aimed to explore the relationship of DPI with all-cause and cardiovascular (CV) mortality, and to examine the possible modifiers for the associations, in Chinese MHD patients. MethodsThis multicenter prospective cohort study was conducted in eight outpatient dialysis centers in South China. We enrolled 1044 MHD patients in 2014 and 2015. The DPI was assessed using a 3-d 24-h dietary recall. Using Cox proportional hazard models, we estimated the hazard ratios (HRs) with their corresponding 95% confidence intervals (CIs) for all analyzed end points. ResultsDuring a median follow-up of 45 mo, there were 354 (33.9%) deaths, 210 of which were CV related. Compared with patients with a DPI of 1.0 to < 1.4 g/kg ideal body weight (IBW)/d, a significantly higher risk of all-cause mortality was found in those with a DPI < 1.0 g/kg IBW/d (adjusted HR, 1.84; 95% CI, 1.42–2.38) or ≥ 1.4 g/kg IBW/d (adjusted HR, 1.49; 95% CI, 1.00–2.22). Similar trends were found for CV mortality. Moreover, we found a significantly stronger positive association between DPI (≥ 1.4 versus 1.0 to < 1.4 g/kg IBW/d) and all-cause mortality in women (adjusted HR, 2.05; 95% CI, 1.00–4.22) than in men (adjusted HR, 0.89; 95% CI, 0.49–1.63; P for interaction = 0.0487). ConclusionIn Chinese MHD patients, a DPI of 1.0 to < 1.4 g/kg IBW/d was associated with lower risks of all-cause and CV mortality.

The Role of Socioeconomic Status, Family Resilience, and Social Support in Predicting Psychological Resilience Among Chinese Maintenance Hemodialysis Patients.

Objectives: Evidence regarding the possible influence of social factors on psychological resilience among maintenance hemodialysis patients is scarce. The aim of this study was to explore the relationship among socioeconomic status, family resilience, and social support, and psychological resilience among Chinese maintenance hemodialysis patients.Methods: This cross-sectional study was conducted in the hemodialysis centers of three comprehensive hospitals in China from September to December 2020 using convenience sampling. Two hundred fifty-eight patients receiving maintenance hemodialysis were investigated using a sociodemographic questionnaire, the Chinese version of the Medical Outcomes Study-Social Support Survey (MOS-SSS), Chinese Family Resilience Assessment Scale (C-FRAS), and Chinese version of the Conner and Davidson resilience scale (CD-RISC).Results: Maintenance hemodialysis patients reported a low level of physical resilience, with a score of (58.92 ± 15.27). Hierarchical linear regression analysis showed that education level (β = 0.127, p = 0.018), maintenance of a positive outlook by the family (β = 0.269, p = 0.001), positive social interaction support from the family (β = 0.233, p = 0.002), and tangible support (β = −0.135, p = 0.037) were significantly associated with psychological resilience.Conclusion: SES, family resilience and social support may be potential predictive factors of psychological resilience. Interventions to improve the family resilience and social support may be beneficial to promote the psychological resilience of Chinese maintenance hemodialysis patients.

Association between serum advanced oxidation protein products and mortality risk in maintenance hemodialysis patients

BackgroundThe association between serum advanced oxidation protein products (AOPP) and mortality risk remains equivocal. We aimed to assess the correlation of serum AOPP levels with the risk of all-cause mortality in hemodialysis (HD) patients.MethodsA total of 1394 maintenance HD patients with complete data on AOPP and related parameters were included from China Collaborative Study on Dialysis (CCSD), a multi-center, prospective cohort study. The primary outcome was all-cause mortality, the secondary outcome was cardiovascular disease (CVD) mortality.ResultsDuring a median follow-up duration of 5.2 years (IQR, 2.1–5.4), all-cause mortality occurred in 492 (31.4%) participants. Overall, there was a reversed L-shaped association between serum AOPP and all-cause mortality in HD patients (P for nonlinearity = 0.04), with an inflection point at 87 µmol/L. Accordingly, there was no significant association between serum AOPP and all-cause mortality (per SD increment; HR, 0.94; 95%CI, 0.84, 1.05) in participants with AOPP < 87 µmol/L. However, there was a positive relationship of serum AOPP and all-cause mortality (per SD increment; HR, 1.24; 95%CI, 1.08, 1.42) in those with AOPP ≥ 87 µmol/L. Moreover, a similar trend was found for CVD mortality.ConclusionsElevated serum AOPP levels were associated with higher risk of all-cause mortality in Chinese maintenance HD patients.

MO800EFFICACY AND SAFETY OF CINACALCET IN CHINESE MAINTAINANCE HEMODIALYSIS PATIENTS WITH DIFFERENT STAGES OF SECONDARY HYPERPARATHYROIDISM: RESULTS OF ACTIVE STUDY

Abstract Background and Aims Secondary hyperparathyroidism (SHPT), as a common complication in advanced chronic kidney disease (CKD) has become a global public health problem. Published literatures showed higher risk of bone fracture, cardiovascular events and all-cause mortality was associated with uncontrolled SHPT in patients with CKD. Cinacalcet, a calcimimetic agent was reported to reduce intact parathyroid hormone (iPTH) levels in patients with SHPT. However, there is no large-cohort study and stratified analysis of cinacalcet based on the level of iPTH in China. The ACTIVE study was designed to test the efficacy and safety of cinacalcet in treating Chinese maintenance hemodialysis patients with mild-to-severe SHPT, as well as to investigate the benefit of long-term, continuous medication with cinacalcet in the real-world setting. Method ACTIVE study was a phase IV, open-label, multicenter clinical trial including two phases: Phase 1 was a cohort study with 32 weeks’ follow-up. Phase 2 was a real-world study of 20 additional weeks in which patients who completed the cohort study decided independently whether to continue taking cinacalcet at their own cost. Eligible maintenance hemodialysis (MHD) patients with baseline iPTH ≥300 pg/mL from April 2017 to September 2019 in 23 centers in China were treated with cinacalcet orally. Patients were grouped based on their iPTH level as mild (300-600 pg/mL), moderate (600-900 pg/mL) or severe (≥900 pg/mL) SHPT. Results 911 patients were screened and of 750 eligible patients, 275 were identified as mild, 224 were considered as moderate and left 251 were grouped as severe SHPT. The number of people who completed all 52-week follow-up in the mild, moderate and severe SHPT groups were 184 (66.91%), 164 (73.21%), and 166 (66.14%), respectively(Fig 1). The baseline and interim analysis results was published on 2020 EDTA. The number of patients achieving iPTH target (150-300 pg/mL) was 85 (31.02%) in mild group, 56 (25.00%) in moderate group and 27 (10.76%) patients in severe group at 20-week visit, and the proportion of patients achieving iPTH target was 33.94% (n=93), 24.11% (n=54) and 13.55% (n=34) at 32-week visit. The trends of the proportion of patients achieving iPTH target increased in all 3 different groups (Fig 2). The number of patients who reached both targets of serum calcium (Ca2+) and serum phosphorus (P) in the mild, moderate and severe SHPT group was 61 (22.26%), 42 (18.75%), 37 (14.74%) at 20-week visit, and 44 (16.06%), 34 (15.18%), 41 (16.33%) at 32-week visit, respectively. At the end of the 20th and the 32nd week of treatment, serum Ca2+×P and fibroblast growth factor-23 (FGF-23) decreased significantly compared with their baseline values (Table 1). In the extension 32-52 weeks study, the corresponding proportion of patients who achieved iPTH target in the three SHPT groups was 11.41%, 6.06%, and 4.81%, respectively. The safety analysis showed the most common treatment-related AE were hypocalcemia, hyperlipidemia and loss of appetite. This study is sponsored by Kyowa Kirin China Pharmaceutical Co., Ltd. Conclusion Oral cinacalcet HCl was effective and safe in reducing iPTH in patients receiving HD with mild-to-severe SHPT.

High Erythropoiesis Resistance Index Is a Significant Predictor of Cardiovascular and All-Cause Mortality in Chinese Maintenance Hemodialysis Patients.

Background Renal anemia is a common complication of hemodialysis patients. Erythropoietin (EPO) hyporesponsiveness has been recognized as an important factor to poor efficacy of recombinant human erythropoietin in the treatment of renal anemia. More importantly, increased erythropoiesis resistance index (ERI) may be associated with inflammation and increased mortality. Objective The objective of this research was to investigate correlated factors of EPO responsiveness and to clarify the relationships between EPO hyporesponsiveness and cardiovascular mortality and all-cause mortality among maintenance hemodialysis patients. Methods This prospective cohort study enrolled 276 maintenance hemodialysis patients for a 55-month follow-up to investigate the factors related to ERI and its relationship to all-cause mortality and cardiovascular mortality. Results ERI was positively correlated with predialysis serum high-sensitivity C-reactive protein (r = 0.234, p < 0.001), alkaline phosphatase (r = 0.134, p = 0.028), and ferritin (r = 0.155, p = 0.010) and negatively correlated with albumin (r = −0.206, p < 0.001) and creatinine (r = −0.232, p < 0.001). As multiple linear regression showed, predialysis serum albumin, high-sensitivity C-reactive protein, ferritin, and creatinine were independent correlated factors of ERI (p < 0.05). Kaplan–Meier curves showed that the cumulative incidences of both cardiovascular mortality and all-cause mortality were significantly higher in patients with ERI > 11.04 IU/kg/w/g/dL (both p < 0.01). The high ERI group was significantly associated with higher risk for all-cause mortality (OR 1.781, 95% CI 1.091 to 2.910, p = 0.021) and cardiovascular mortality (OR 1.972, 95% CI 1.139 to 3.417, p = 0.015) after adjusting for confounders. Conclusions Predialysis serum albumin, high-sensitivity C-reactive protein, ferritin, and creatinine were independent correlated factors of EPO responsiveness among maintenance hemodialysis patients. Patients with higher ERI values had a higher all-cause mortality rate and cardiovascular mortality rate.

P1512THE RELATIONSHIP AMONG ANXIETY, DEPRESSION AND FRAILTY IN MAINTENANCE HEMODIALYSIS PATIENT

Abstract Background and Aims The population undergoing maintenance hemodialysis (MHD) is increasing dramatically worldwide, particularly in China. MHD patients have a high prevalence of frailty, which can cause increased vulnerability to adverse health outcomes, such as psychological disorders and reduced health-related quality of life. Both psychological disorders and frailty are prevalent and burdensome in MHD patient. However, the relationships between these entities are unclear. The aim of this study was to investigate the prevalence and associations between frailty and psychological disorders in Southern Chinese MHD patients. Method A multicenter, cross-sectional and observational investigation was conducted at 4 hemodialysis centers. Frailty was evaluated with the Tilburg Frailty Indicator (TFI) and it was used as the self-reported questionnaire. Anxiety symptoms was assessed by the Self-Rating Anxiety Scale (SAS), depressive symptoms was assessed by the Self-Rating Depressive Scale(SDS). The sociodemographic and clinical characteristics of the patients who complete the scales were collected. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) software version 20.0 for Windows. Results Of the 623 patients visiting each institution, 300 were enrolled in this study. The mean age was 61.95±13.64 years, with mean duration of HD 30.7 (43.39±2.36) months.116 patients (38.7%) were female and 133 (44.3%) had diabetic kidney disease. In total, there were 225 patients (75%) were evaluated as frailty (Fig 2). The prevalence of frailty increased steadily with age and was more prevalent in the diabetes mellitus patients. A multivariate logistic regression analysis revealed that the factors independently associated with frailty were the following: age (odds ratio [OR] =1.053, 95% confidence interval [CI] 1.026∼1.08), Charlson comorbidity index (CCI) (OR = 1.705, 95% CI 1.378∼2.109, P&amp;lt;0.001), diabetes mellitus (DM) (OR =2.107, 95% CI 1.035∼4.288), SAS (OR = 1.157, 95% CI 1.062∼1.26), SDS(OR = 1.094, 95% CI 1.028∼1.165). The number of subjects with frailty increased steadily with age. Among the elderly subjects, the population ≥ 75 years old had the highest prevalence of frailty (Fig 1). Furthermore, 50% of ≤45 years old patients were frailty, even though frailty is a geriatric syndrome. There was no relationship between the duration of HD and frailty status. Anxiety and depression symptoms by SAS and SDS were identified in 52.6% and 72.0% of MHD patients. MHD patients with both anxiety and depression generally had higher frailty score. The coexisting frailty and psychological disorder were present in 45.0% patients (Fig 2). There was an additive effect of psychological disorder and frailty on nutritional status. For the groups with frail and psychological conditions and no frail and no psychological conditions, both serum albumin (36.27±3.66, 37.76±3.51 g/L, respectively, p=0.02) and creatinine (842.94±282.97, 1028.84±332.64, respectively, p&amp;lt; 0.0001) decreased; overall SAS score was 55.36±3.87, 42.59±3.69, respectively (p&amp;lt; 0.0001), and SDS score was 65.05±6.50,58.50±9.03, respectively (p&amp;lt; 0.0001). Conclusion This study demonstrated that anxiety and depressive symptoms are associated with prevalent frailty in Southern Chinese MHD patients. Older age, diabetes mellitus, CCI and lower serum albumin were associated with frailty among patients on MHD. anxiety and depressive symptoms are independent risk factors of frailty. In addition, age and diabetes are also independent risk factors for frail. And physical frailty should receive more attention in mental health care planning for Chinese MHD patients.

Validity and Reliability of the International Physical Activity Questionnaire in Chinese Hemodialysis Patients: A Multicenter Study in China.

BackgroundThis study aimed to assess the reliability and validity of the International Physical Activity Questionnaire (IPAQ) in Chinese maintenance hemodialysis (MHD) patients. These findings could help increase the validity of future MHD physical activity (PA) studies, both within China and throughout the world.Material/MethodsA multicenter prospective cohort study including 320 patients was conducted in Zhejiang, China. Patients’ PA was assessed by analyzing answers to the International Physical Activity Questionnaire Chinese version (IPAQ-C) during hemodialysis, and comparing the results with 1 week of pedometer data.ResultsThe IPAQ-C had good internal reliability and test-retest stability (total ICC=0.84, 95%CI 0.76–0.89), and all PA-related variables correlated significantly between the IPAQ-C and pedometer data (r=0.280–0.561). When stratified by sex, there was a significant correlation for total PA (Spearman r=0.468 p<0.01 for women; Spearman r=0.603 p<0.01 for men) and intensity between pedometry and IPAQ-C. After adjustment for several factors, no relationships were observed among women, but significant relationships existed for men (total partial r=0.486 p<0.05, moderate PA partial r=0.358 p<0.05, walking partial r=0.465 p<0.05, vigorous PA not significant).ConclusionsThis is the first study to test the reliability and validity of the IPAQ-C in Chinese MHD patients. Overall, we conclude that IPAQ-C is a simple and reliable instrument for measuring PA in Chinese MHD patients, but possible sex and age bias should be considered when interpreting these results.

Handgrip Strength and Mortality in Maintenance Hemodialysis Patients

Background: Muscle strength assessment is a convenient clinical test that has shown to correlate with the nutritional status of dialysis patients. Articles written in English to investigate the association between Handgrip Strength (HGS) and mortality in Maintenance Hemodialysis (MHD) patients are mainly from Brazil and several other non-Asian countries. Objectives: This study aimed to examine the association of HGS with all-cause mortality in Chinese MHD patients. Methods: The current multicenter observational longitudinal study enrolled MHD patients from June 2015 to June 2016. The study setting was seven dialysis centers of tertiary general hospitals in Guizhou province, China. Patients were followed up until June 2018. The ROC curves were plotted to seek the best cutoffs for HGS to predict mortality in men and women. Survival analysis was done using the Kaplan-Meier survival curve and the Cox proportional hazard model. Results: We enrolled 857 MHD patients and followed up for 24.9 ± 10.2 months. During the follow-up, 204 (23.8%) patients died, 39 (4.6%) received renal transplantation, 18 (2.1%) switched to peritoneal dialysis, and 118 (11.7%) were transferred to nonparticipating dialysis units. The cutoff value of HGS to predict all-cause mortality was 12.4 kg for women and 25 kg for men. Utilizing the cutoffs to fit the survival curve of Kaplan-Meier, the correlation of HGS with mortality was verified for both genders. After adjustment for demographic and biochemical variables, HGS remained an independent predictor of all-cause mortality. Conclusions: Handgrip strength was strongly associated with all-cause mortality in patients receiving MHD. The cutoff values to predict all-cause mortality were 12.4 kg for women and 25 kg for men. Handgrip strength may be incorporated into clinical practice for assessing functional status and predicting prognosis in MHD patients.