Chronic Dialysis Patients Research Articles

Effect of hemodiafiltration and hemodialysis on mortality of patients with end-stage kidney disease: a meta-analysis

IntroductionPrevious randomized controlled trials (RCTs) and meta-analyses comparing Hemodiafiltration (HDF) with conventional hemodialysis (HD) on the effectiveness of HDF for mortality in end-stage renal disease (ESRD) patients have yielded contrasting results. Importantly, we sought to compile the available information to provide the most up-to-date and reliable evidence.MethodsWe systematically searched PubMed, Embase and Cochrane Library for RCTs up to January 14, 2024. Review Manager 5.3 software was used to analyze relevant data and evaluate the quality of evidence.ResultsOur study involved 10 randomized controlled trials with 4654 chronic dialysis patients. Compared to hemodialysis, hemodiafiltration demonstrated a reduction in all-cause mortality (relative risk [RR] 0.84, 95% confidence intervals [CI] 0.72–0.99, P = 0.04) and cardiovascular mortality (RR 0.74, 95% CI 0.61–0.90, P = 0.002). However, it did not reduce the rate of sudden death (RR 0.92, 95% CI 0.64–1.34, P = 0.68) and infection-related mortality (RR 0.70, 95% CI 0.47–1.03, P = 0.07). A subgroup analysis revealed that HDF demonstrated superiority over high-flux hemodialysis in terms of all-cause mortality, while not over low-flux hemodialysis (RR 0.81, 95% CI 0.69–0.96, P = 0.01; RR 0.93, 95% CI 0.77–1.12, P = 0.44, respectively). Furthermore, a subgroup analysis for convection volume found that hemodiafiltration with a convection volume of 22 L or more reduced all-cause and cardiovascular mortality (RR 0.76, 95% CI 0.65–0.88, P = 0.0002, RR 0.73, 95% CI 0.54–0.94, P = 0.01, respectively).ConclusionIn maintenance hemodialysis patients, hemodiafiltration can reduce mortality compared to conventional hemodialysis. Furthermore, this effect is more pronounced in HDF with high convection volume.

Impact of convective clearance on intra-dialytic potassium removal in chronic dialysis patients.

Hyperkalemia is frequently encountered and associated with cardio-vascular mortality in chronic hemodialysis (HD) patients. While online hemodiafiltration (OL-HDF) is thought to offer clinical benefit over high-flux HD, the impact of convective clearance on intra-dialytic potassium removal is unknown. Chronic dialysis patients undergoing outpatient HD or OL-HDF at a single center attached to a university hospital were recruited in a prospective observational study. Spent dialysate along with clinical and biological variables were collected during a single mid-week session. We included 141 patients, with 21 treated with HD and 120 with OL-HDF. Mean age was 65.7 ± 15.6 years with 87 (61.7%) men. Mean intra-dialytic potassium removal was 69.9 ± 34.2 mmol. Patients on OL-HDF and HD have similar intra-dialytic potassium removal, with mean values of 69.1 ± 34.2 and 74.3 ± 35.0, respectively. In multivariate analysis, factors associated with intra-dialytic potassium removal were (decreasing order of effect size): dialysate potassium (β -15.5, p < 0.001), pre-HD serum potassium (β 9.1, p < 0.001), and session time (β 7.8, p = 0.003). In OL-HDF patients, substitution flow was not associated with potassium removal. In chronic dialysis patients, convective therapy provided by OL-HDF does not affect potassium removal when compared with high-flux HD. Moreover, the importance of convective volume is not associated with potassium clearance in OL-HDF. Overall, session length and serum-to-dialysate potassium gradient are the main determinants of potassium clearance regardless of dialysis modality. Those results should inform clinicians on the optimal therapy in chronic dialysis patients in the era of OL-HDF.

Tidal Versus Intermittent Peritoneal Dialysis in Chronic Peritoneal Dialysis Patients: Randomized, Open-Label, Prospective Control Study.

Tidal peritoneal dialysis (TPD) provides better fluid flow mechanics and is more comfortable for the patient, owing to fewer alarms and less pain during inflow and outflow. The long-term characteristics of patients with TPD were not evident. In this randomized controlled follow-up study, we aimed to explore the characteristics of patients with TPD, compared to IPD. A total of 85 patients were randomized to either IPD or 70% TPD between January 2019 and December 2020, and all patients were followed up on December 2021. The characteristics of patients between the two groups were analyzed using a t-test or chi-square as appropriate. The overall survival and technical survival were analyzed using Kaplan-Meier analysis. Forty-two patients were assigned to IPD, and 43 patients were assigned to TPD. The basal characteristics of patients were not different between the two groups. In an average of 16 months of follow-up, 19 patients died, and 25 patients dropped out of peritoneal dialysis. The two groups had no difference in overall survival and technical survival. TPD was associated with high urine volume (p = 0.001), lower blood urea nitrogen (p = 0.002), lower phosphorus (p = 0.004), and fewer cycler alarms (p < 0.001). The chance of patients reporting abdominal fullness was higher in patients with TPD (p = 0.001). In the randomized, controlled, follow-up study, TPD may preserve residual renal function and is associated with lower urea nitrogen and phosphorus in chronic peritoneal dialysis patients. TPD is associated with fewer cycler alarms but may increase the chance of patients reporting abdominal distension.

Efficacy of Qigong Baduanjin on nutritional status and quality of life in patients on haemodialysis: study protocol for a prospective randomised controlled trial

IntroductionHaemodialysis (HD) patients usually engage in a low level of physical activities, which could impact the prognosis and mortality of this group. Fitness Qigong Baduanjin, a physical exercise from traditional...

SGLT-2 inhibitors in chronic peritoneal dialysis patients: a follow-up study

BackgroundSodium-glucose transporter-2 inhibitors (SGLT-2i) are recommended for use in patients with type 2 diabetes comorbid atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease. Limited reports are currently available for their use in dialysis patients. In an observational, retrospective follow-up study, we reported the clinical characteristics of chronic peritoneal dialysis (PD) patients on SGLT-2i.MethodsWe enrolled 50 diabetic chronic PD patients, and 11 continued SGLT-2i after PD treatment. We reported the patients’ ultrafiltration, HbA1c, urinary tract infection episodes, and venous CO2 during follow-up and compared the differences in these factors between patients with and without SGLT-2i.ResultsThe mean age of the patients was 65 ± 15 years, and 16 (32%) patients were female. The age, gender, heart failure, and primary kidney disease were not different between patients with and without SGLT-2i at enrollment. In an average of 31 months follow-up, patients with SGLT-2i had higher ultrafiltration (1322 ± 200 ml/day vs. 985 ± 415 ml/day, p = 0.013), hemoglobin (11.2 ± 1.7 vs. 10.2 ± 1.7 g/dl), white blood cell count (9.2 ± 3.7 vs. 7.4 ± 2.1 109/L), and a lower venous CO2 (p = 0.036). The urine amount, the overall survival, the technical survival, and the chance of UTI were not different between patients with and without SGLT2i.ConclusionSGLT-2i may increase ultrafiltration volume and hemoglobin levels in chronic PD patients. SGLT-2i did not increase urinary tract infection but was linked to subclinical metabolic acidosis.What was knownThe effect of SGLT-2i in chronic PD patients is not clear?This study addsSGLT-2i is associated with increased ultrafiltration, hemoglobin, white blood cell counts, and a decreased CO2 in PD patient.Potential impactSGLT-2i may increase ultrafiltration in PD patients.

Loss of Y Chromosome and Cardiovascular Events in Chronic Kidney Disease.

Chronic kidney disease represents one of the strongest risk factors for cardiovascular diseases, and particularly for heart failure. Despite improved pharmaceutical treatments, mortality remains high. Recently, experimental studies demonstrated that mosaic loss of Y chromosome (LOY) associates with cardiac fibrosis in male mice. Since diffuse cardiac fibrosis is the common denominator for progression of all forms of heart failure, we determined the association of LOY on mortality and cardiovascular disease outcomes in patients with chronic kidney disease. LOY was quantified in men with stable chronic kidney disease (CARE for HOMe study, n=279) and dialysis patients (4D study, n=544). The association between LOY and mortality, combined cardiovascular and heart failure-specific end points, and echocardiographic measures was assessed. In CARE for HOMe, the frequency of LOY increased with age. LOY >17% was associated with increased mortality (heart rate, 2.58 [95% CI, 1.33-5.03]) and risk for cardiac decompensation or death (heart rate, 2.30 [95% CI, 1.23-4.27]). Patients with LOY >17% showed a significant decline of ejection fraction and an increase of E/E' within 5 years. Consistently, in the 4D study, LOY >17% was significantly associated with increased mortality (heart rate, 2.76 [95% CI, 1.83-4.16]), higher risk of death due to heart failure and sudden cardiac death (heart rate, 4.11 [95% CI, 2.09-8.08]), but not atherosclerotic events. Patients with LOY >17% showed significantly higher plasma levels of soluble interleukin 1 receptor-like 1, a biomarker for myocardial fibrosis. Mechanistically, intermediate monocytes from patients with LOY >17% showed significantly higher C-C chemokine receptor type 2 expression and higher plasma levels of the C-C chemokine receptor type 2 chemokine (C-C motif) ligand 2, which may have contributed to increased heart failure events. LOY identifies male patients with chronic kidney disease at high risk for mortality and heart failure events.

Assessment of Antibody Titers after 6 Months of Vaccination against SARS-COV-2 in Patients with CKD Stage 4, 5 and CKD 5d

Background: Since the pandemic of COVID-19 started from December 2019, remarkable numbers of infections and deaths associated with COVID-19 have been recorded worldwide. Chronic kidney disease patients are particularly at high risk of infections due to impairments in the innate and adaptive immune systems. Adequate humoral (antibody) and cellular (T cell-driven) immunity are required to minimize pathogen entry and promote pathogen clearance to enable infection control. Vaccination can generate cellular and humoral immunity against this specific pathogen. COVID-19 prevention through successful vaccination is therefore paramount in chronic kidney disease population. But vaccination efficacy is diminished in these patients because premature ageing of the immune system and chronic systemic low- grade inflammation are the main causes of immune alteration in these patients. Therefore, it is urgently necessary to establish a different vaccination strategy for chronic kidney disease and dialysis patient in terms of the dose and administration time. Aims: This study aimed to assessment of antibody titers after vaccination against SARS-COV-2 in patients with chronic kidney disease stage 4, 5 on conservative management and maintenance haemodialysis. Methods: This prospective observational comparative was conducted in Nephrology department of Dhaka Medical College Hospital. Selectionof patients was done by purposive sampling according to inclusion and exclusion criteria. Total 135 patients distributed in three groups: 45 patients of chronic kidney disease (CKD) stage 4, 5 on conservative management, 45 patients on maintenance haemodialysis (MHD) and 45 healthy controls were approached for the study who were receiving SARS-COV-2 vaccination. Demographic, clinical and laboratory data were collected initially. At first a pre vaccination sample or 1st sample was taken for antibody measurement. Then participants from all groups were given 2 doses MODERNA vaccine containing 100 µg in 0.5 ml each in 28 days apart. Then after 14 days of 1st dose of vaccination the 2nd samples were taken, 3rd samples were taken 14 days after the 2nd dose vaccination. Study populations were subdivided into two groups according to pre vaccination SARS-COV-2 antibody titer; seropositive- positive response before vaccination and seronegative- negative response before vaccination. They were also divided into two groups according to quantitive antibody response; positive response- values ≥10 DU/mL were positive Negative response- values of &lt;10 DU/mL were negative. Result: Seroconversion rate was around 20% among study participants before vaccination. 14 days after the 1st dose of vaccination, 90.04% patients had positive immune response in CKD stage 4, 5 on conservative management group whereas in MHD group 84.82% responded to vaccination and immune response in control group was 100%. Immune response is 100% among all the groups after 14 days of 2nd dose of vaccination but the concentration of antibody differs significantly among the study groups. Responders were comparatively younger with normal BMI. Conclusion: Haemodialysis patients as well as patients with chronic kidney disease stage 4, 5 on conservative management showed a favorable but profoundly lower early antibody response, which decreased substantially during follow-up.

Invasive Listeriosis in End-Stage Kidney Disease (ESKD) Patients Receiving Long-Term Dialysis: A 21-Year Case Series.

Listeriosis is caused by the facultative anaerobic bacterium Listeria monocytogenes. Infection from Listeria-contaminated food or water is the main etiology. If Listeria travels outside the intestines, it can cause invasive listeriosis, such as sepsis, meningitis, and meningoencephalitis. Invasive illness is especially dangerous for pregnant women and their newborns, elderly people, and people with compromised immune systems or medical conditions such as end-stage kidney disease (ESKD) patients receiving long-term dialysis. Describe the manifestations and hospital outcomes of invasive listeriosis and identify the risk factors for in-hospital and one-year mortality in ESKD patients receiving long-term dialysis. This retrospective observational study examined hospitalized patient records at a Taiwanese tertiary medical center from August 1, 2000, to August 31, 2021. ESKD patients on chronic dialysis were identified with invasive listeriosis by blood culture and discharge diagnosis. Over 21 years, we accurately recorded 26 cases. ESKD patients on chronic dialysis with invasive listeriosis have a poor prognosis. Only 53.8% of chronic dialysis patients with invasive listeriosis survived their first hospital episode. 42.3% of hospitalized ESKD patients with invasive listeriosis survived one year later. In univariate analysis, shock, tachypnea (RR ≥ 22), respiratory failure, qSOFA score ≥ 2, and lower initial platelet count were linked to greater in-hospital mortality rates. ESKD patients with invasive listeriosis have a grave prognosis. Our research reveals that an early blood sample for a bacterial culture may identify invasive listeriosis in chronic dialysis patients with fever, nausea or vomiting, confusion, and respiratory distress. This study is the first to identify a lower platelet count and qSOFA score ≥ 2 as markers of high-risk invasive listeriosis in ESKD patients.

The Effectiveness of Strengthening Exercise on Improving Physical Function in Chronic Dialysis with Comorbidity: A Case Study

BACKGROUND: Individuals living with End stage renal disease (ESRD) on long term hemodialysis (HD) generally has a sedentary life style. This leads to reduction of physical function and poor quality of life. Exercise intervention improves muscular strength, physical fitness and Quality of life (QOL) in maintained hemodialysis Individuals. CASE SCENARIO: A 67-year-old female presented with chronic hemodialysis period was carried on wheelchair with the help of relative as she was referred to physiotherapy department with chief complain of weakness in both lower limb and difficulty in walking for 1 year. In this case along with chronic dialysis related dysfunction, patient had atherosclerosis had an acute coronary event and she was on AKT since last one year as she was having pott’s spine. METHODOLOGY: In our evaluation, she had full range of motion of lower limb with muscle weakness by manual muscle testing (MMT=3-4/5), Reduced balance and physical performance by short physical performance battery (SPPB=4/12), and partially dependent for functional activity by functional independent measure (FIM= 81/126). In Physiotherapy intervention: Exercise program started with active exercise, cycling, balance and gait training. Progressively in active exercise increased weight with weight cuff, increase cycling time and task specific balance activities with independent walking each week. RESULT: After four week of intervention improvement in muscle strength (MMT=4-5/5), balance (SPPB=7/12), minimal assistance in functional activities (FIM=109/126). CONCLUSION: Individualized strengthening exercise program improve physical function and muscle strength in chronic dialysis patient. Keywords: Hemodialysis, physical function, muscle strength.

Study of Upper Gastrointestinal Endoscopic Findings in Chronic Kidney Disease and Dialysis Patients at Zagazig University Hospitals

Study of Upper Gastrointestinal Endoscopic Findings in Chronic Kidney Disease and Dialysis Patients at Zagazig University Hospitals

Sarcopenia in chronic dialysis patients

Sarcopenia in chronic dialysis patients

Calcium-Free Dialysate Hemodialysis: A Simplified Approach.

Intermittent hemodialysis (HD) in high-bleeding-risk patients presents a challenge as circuit anticoagulation using heparin is contraindicated in such cases. Recently, the use of calcium-free citrate-containing dialysate with calcium supplementation emerged as a viable alternative to heparin-circuit anticoagulation. This is a retrospective, monocentric study to evaluate dialysis efficacy using calcium-free citrate-containing dialysate with calcium reinjection into the venous line in hemodialysis patients at risk of bleeding. A total of 53 patients were analyzed: 52 had a temporary contraindication to systemic anticoagulation (active bleeding or surgical intervention), and 1 chronic HD patient had prolonged bleeding time due to inoperable arteriovenous fistula stenosis. Only 7 out of 79 dialysis sessions performed were prematurely terminated (vascular access dysfunction). The median dialysis time was 240 min (range: 150-300). The chronic dialysis patient had 108 sessions with no premature termination. Frequent monitoring of ionized calcium was performed throughout the dialysis sessions: levels remained stable at T0 and T + 60 min (1.08 ± 0.08 mmol/L) and slightly increased at the end of the dialysis session (1.19 ± 0.13 mmol/L), remaining within normal limits. Target postfilter ionized calcium <0.4 mmol/L was achieved in all sessions (0.31 ± 0.07 mmol/L). There were no cases of symptomatic hypo-/hypercalcemia and no need for calcium infusion rate adjustment throughout the sessions. Hemodialysis with calcium-free citrate-containing dialysate and calcium reinjection into the venous line is efficient and safe in HD patients with contraindications to systemic anticoagulation.

Comparative analysis of the incidence and mortality of COVID-19 in Korean end-stage kidney disease patients: hemodialysis, peritoneal dialysis, and transplantation.

Patients with end-stage kidney disease (ESKD) are more susceptible to viral epidemics and are known to have higher incidence and death rates of coronavirus disease 2019 (COVID-19) compared to the general population. We determined COVID-19 incidence and mortality among chronic hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KT) patients in Korea. We conducted a retrospective cohort study and data regarding Korean ESKD adults (aged ≥18 years) were obtained from the National Health Insurance Service of Korea from October 2020 to December 2021. We examined and compared the incidence of COVID-19-related infections and deaths among the patients receiving HD, PD, and KT. Of all ESKD patients, 85,018 (68.1%) were on HD, 8,399 (6.7%) on PD, and 31,343 (25.1%) on KT. The COVID-19 incidence was 1.3% for HD, 1.2% for PD, and 1.5% for KT. COVID-19 mortality was 16.3% for HD, 12.2% for PD, and 4.7% for KT. PD patients had a lower incidence of infection compared to HD patients (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.607-0.93), but KT patients had a significantly higher risk of infection (OR, 1.28; 95% CI, 1.13-1.44). Compared with HD, the risk of COVID-19-related death was not different for PD patients but was significantly lower for KT patients (hazard ratio, 0.55; 95% CI, 0.35-0.88). COVID-19 incidence was lower in PD patients than in HD patients, but mortality was not different between them. KT was associated with a higher risk of COVID-19 infection but lower mortality compared to HD.

#780 “In vivo” difference in ultrafiltration coefficient between two same membrane dialyzers: bigger surface area accounts for better dialysis outcomes?

Abstract Background and Aims Ultrafiltration coefficient (KUF) is a measure of dialyzer permeability to water, given by manufacturers, and expressed in milliliters/hour/mmHg of pressure gradient. Most dialyzers used at this moment are classified as high-flow as having a KUF &amp;gt;20 mL/h/mmHg. KUF value of a dialyzer is an “in vitro” measure which does not correlate with “in vivo” measure, stated to be 5-30% less than theoretical KUF. According to this statement, we wanted to study differences between theoretical and real KUF of two dialyzers with the same membrane composition and different surface area. For this task, we chose 2 dialyzers of usual use in our dialysis unit: FX CorDiax 1000 and FX CorDiax 80 (®FMC). These dialyzers have a main difference in Surface area: 2.3 and 1.8 m2, respectively, and have a theoretical KUF of 76 and 64 mL/h/mmHg. Also, both dialyzers differ in intern diameter (210 vs 185 µm). Method A prospective, not randomized trial was conducted. Inclusion criteria were patients in chronic dialysis at our center, in postdilutional online hemodiafiltration with a FX1000 dialyzer. All patients were informed and accepted freely signing an informed consentment. On 2 consecutive weeks, the intermediate dialysis session of the week was performed in a DBB-EXA dialysis monitor (®Nikkiso), first with a FX CorDiax 1000 and next week with a FX CorDiax 80, with habitual patient dialysis parameters (240 minutes). Blood tests were taken previous and after the session to evaluate clearance differences between both filters. During the session, pressure and flow data was recorded, with an “in vivo” KUF measurement given by the monitor. Results Dialysis sessions were performed in 12 patients who met inclusion criteria. Data results are shown in Table 1. Significant differences between FX CorDiax 1000 and FX CorDiax 80 were observed in prefilter pressure (p 0.008), convective volume (p 0.034), prolactin reduction ratio (p 0.012), “in vivo” KUF/ “in vitro” KUF ratio (p 0.002). “In vivo” KUF graphic given by the monitor showed a logarithmic function curve, with a stabilization between the 2nd and 3rd hour of the session. Conclusion In our study, measurement of “in vivo” KUF by Nikkiso monitor showed a slow decrease after 2nd hour of session, probably related with protein cake of membrane pores. “In vivo” KUF measure was approximately a 40-45% of theoretical value given by manufacturer. The “in vivo” KUF/ “in vitro” KUF ratio was higher for the smaller dialyzer, which probably means a higher optimization of its surface area with usual dialysis sessions. Convective volume and prolactin reduction ratio, as parameters of dialysis efficacy, are higher in the dialyzer with higher surface area and inner intern diameter.

#1151 The prevalence and disease burden of CKD associated pruritus in Danish dialysis patients and current treatment practices—preliminary results

Abstract Background and Aims Chronic kidney disease associated pruritus (CKD-aP) is rarely assessed by health care providers and potentially under-reported by patients despite the potential negative impact on health-related quality of life (HRQoL). Our aim was to investigate the prevalence of CKD-aP in a large cohort of Danish dialysis patients based on validated patient-reported outcome (PRO) instruments. A secondary aim was to investigate CKD-aP awareness among renal physicians including current treatment practices. Method The study was designed as a non-interventional, cross-sectional multicentre study. Chronic dialysis patients from four different regions in Denmark were invited to participate. CKD-aP was assessed with a one-page questionnaire containing Danish versions of two validated PRO instruments. The worst itch numeric rating scale (WI-NRS) was used for itch severity within the previous 24 hours (ranging from 0-10 with CKD-aP defined as WI-NRS score &amp;gt;4 which equals moderate to severe CKD-aP). The 5-D itch scale was used as a multidimensional measure of itching and HRQoL. The five dimensions of the 5-D itch scale (degree, duration, direction, disability, and distribution) were summed together to obtain total score ranging from 5 (no pruritus) to 25 (most severe). CKD-aP awareness and treatment practices among doctors and nurses were investigated with a simple self-invented questionnaire. Results We recruited 500 chronic dialysis patients of which 87% were treated with in-center haemodialysis (HD), 10% with peritoneal dialysis (PD) and 3% with home HD (HHD). Mean age ± SD was 65 ± 14 years and 64% were males. Fig. 1 shows WI-NRS and total 5-D itch score distribution according to dialysis modality. CKD-aP prevalence (based on WI-NRS score &amp;gt;4) was 19% (all patients regardless of dialysis modality) but tended to be higher among PD patients (29%) in comparison with HD (18%) and HHD (23%) as shown in Fig. 1. Odds ratio (OR) with logistic regression for CKD-aP based on WI-NRS score as a binary dependent variable (≤4 or &amp;gt;4) and dialysis modality yielded: OR (PD vs. HD): 1.83 (0.96-3.49) and OR (HHD vs. HD): 1.35 (0.36-5.03). No pruritus (WI-NRS score = 0) was found in 61% of patients and 20% had mild pruritus (WI-NRS score ≤4). WI-NRS score correlated significantly with total 5-D itch score (Spearman's rank correlation coefficient (all patients): ρ = 0.80; P &amp;lt; .001). Median total 5-D itch score (IQR) was 5 (5-10) based on all patients regardless of dialysis modality. Itch intensity over the past 2 weeks was rated moderate to unbearable by 23% and not present in 54% of patients. Itch duration was less than 6 hours in 91% of patients and 29% of patients had no change in itching over the past 2 weeks. Overall, the impact of CKD-aP on daily activities (leisure/social, housework/errands and work/school) was minimal in most patients but sleep disability (score &amp;gt;1) was found in 18%. Sleep disability was significantly associated with higher WI-NRS score. Perceived CKD-aP prevalence (based on 28 questionnaires) was 20-40% according to most physicians (54%), 25% estimated it to be lower and 21% expected it to be higher. Topical therapy with fatty cream was the preferred treatment by most physicians followed by increased dialysis and non-sedating antihistamines. Conclusion Roughly one out of five patients on chronic dialysis treatment suffers from moderate to severe CKD-aP. HRQoL is negatively affected by CKD-aP primarily manifested as sleep disturbance. Most physicians tend to overestimate CKD-aP prevalence and prescribe fatty cream as their preferred treatment.

#2570 Non-invasive blood pressure monitoring in dialysis patients using pulse wave velocity

Abstract Background and Aims Dialysis patients are at high risk of circulatory dysregulation and hypotension during treatment. Intradialytic hypotension (IDH) is a potentially life-threatening complication. The main causes are high ultrafiltration volumes and high ultrafiltration rates when patients tend to gain a lot of weight between dialysis treatments. A lack of patient compliance with regard to drinking volumes and a lack of residual diuresis are risk factors for this. Close circulatory monitoring and therapy settings to avoid absolute or relatively high UF rates to prevent IDH are frequently used. These are primarily the frequent non-invasive measurement of blood pressure using cuffs, the measurement of relative blood volume and the adjustment of ultrafiltration rates to these values. Prophylactically, the dialysis time can be extended, ultrafiltration profiles or ultrafiltration breaks can be planned, the dialysate temperature can be lowered and the composition of the dialysate can be adjusted. Despite all attempts, however, the incidence of IDH in everyday clinical practice is too high. The non-invasive measurements with cuffs are not carried out frequently enough, the measurement of the relative blood volume only covers a partial range, sudden changes in vascular tension or cardiac output are not recorded. Method The pulse wave velocity (PWV) is a well-known parameter for describing the propagation of the pressure wave after ejection of the heart beat volume in the arteries. The PWV is dependent on blood pressure, vessel wall tension and cardiac output. Changes in blood pressure can therefore be recognised by measuring the PWV. With the help of a measuring device (PESAS) for the ECG signal and peripheral pulse plethysmography, PWV can be measured non-invasively, continuously, for every heartbeat and, above all, hardly noticed by the patient. The PESAS allows the time-synchronised measurement of ECG and peripheral plethysmography curves and thus the determination of PWV. It is an experimental device. We would like to present a study showing the use of a measuring device (PESAS) in 15 prevalent dialysis patients for the detection of IDH. All study participants were examined during 3 dialysis treatments. Results The measurement of PWV in chronic dialysis patients during treatment is technically feasible. The measurement is tolerated by the patients. Changes in PWV could be detected in the patients during the course of dialysis; these were also dependent on the ultrafiltration rates. Individual patient reactions to volume withdrawal varied, with both increases and decreases in PWV being demonstrated. An acute change in PWV was usually associated with a drop in blood pressure. Continuous measurement allowed IDH events to be detected earlier than intermittent blood pressure measurement with cuffs. Sudden drops in blood pressure could be detected better and earlier with the PESAS system than by measuring the relative blood volume. Conclusion The PESAS system is suitable for monitoring dialysis patients to prevent IDH. Further adjustments and optimisation of the evaluation algorithms are necessary.

#2225 Educational level and gender are associated with emotional well-being in a cohort of Dutch dialysis patients

Abstract Background and Aims Patients undergoing dialysis have an impaired health-related quality of life (HRQOL). There are conflicting data from small series whether patient-related factors such as educational level have an impact on experienced HRQOL. The aim of this study was to investigate the association between educational level and HRQOL in dialysis patients. Method In a single-center retrospective cross-sectional study HRQOL was measured using the Kidney Disease Quality of Life Short Form-36 (KDQOL-SF36) in prevalent chronic dialysis patients. Educational level was categorized into low, intermediate and high subgroups. Univariate and multivariate regression analyses were performed to assess the effects of age, gender, ethnicity, and dialysis vintage on the association between HRQOL and educational level. Results 129 chronic dialysis patients were included. The median age of the patients was 65.0 years and 58% of the patients were male. The median age did not differ between men and women (67.0 vs. 63.0 years, p = 0.673). Median dialysis vintage was 15.0 months. Patients with an intermediate educational level (OR: 4.37 [1.89-10.13]) and a high educational level (OR 4.13 [1.04-16.42]) had significantly higher odds of higher emotional well-being than patients with a low educational level. The odds for women compared to men were 2.83 [1.32-6.06] for better general health and 2.59 [1.15-5.84] for emotional well-being. There was no interaction between gender and educational level for both subdomains. Each year of increasing age was associated with decreased physical functioning (OR 0.94 [0.91–0.97]). Conclusion Low educational level and male sex were associated with worse emotional well-being compared to intermediate and high educational level and female sex in dialysis patients. Physical functioning decreased with increasing age.

#2434 Literature review on the burden of herpes zoster in patients with kidney disease—a need for earlier prevention

Abstract Background and Aims Kidney disease (KD), including end stage renal disease (ESRD), is a global health problem. Both are associated with impaired immune systems, which can lead to infections. Complications such as cardiovascular disease and various infections are leading causes of morbidity and mortality in KD patients. Notably, patients with KD have an increased risk of herpes zoster (HZ). While the link between ESRD and renal transplant with increased HZ risk is understood, knowledge gaps regarding the burden of HZ across the KD spectrum still exist. This review aims to describe the risk and impact of HZ across the KD spectrum in order to guide preventive care strategies for patients with renal diseases. Method A structured literature review was conducted in PubMed using a combination of keywords and Medical Subject Heading (MeSH) terms to identify studies related to HZ risk in adult KD patients aged ≥18 years published in the English language between 01/11/2003–31/10/2023. Data extracted from published studies included the burden of HZ infection in patients with KD (risk of HZ and related complications), impact of HZ on underlying KD, and the efficacy/effectiveness of HZ vaccines among patients with KD. Results A total of 47 studies were identified (Randomized controlled trials [RCT] = 2; observational studies = 45) in this review (Fig. 1). Included studies presented evidence from regions in Europe (n = 18), Asia (n = 17), North America (n = 7), South America (n = 1), multinational (n = 2) and Australia (n = 1); country not reported in one study. Evidence from observational studies (n = 37) reported a high risk of HZ infection and related complications, such as disseminated HZ, and recurrent HZ across the KD spectrum, including chronic KD, polycystic KD, hemodialysis, peritoneal dialysis and kidney transplant patients. Infection with HZ was reported to accelerate KD progression and increased the risk of ESRD and cardiovascular events. In general, for ESRD patients with an inpatient HZ diagnosis, mortality increased with age, followed by malnutrition and bacteremia/septicemia. Studies reporting vaccine efficacy (n = 2) and effectiveness results (n = 8) suggest that HZ vaccination was associated with a reduced risk of HZ when compared to unvaccinated individuals. Furthermore, the recombinant zoster vaccine (RZV) was found to be immunogenic in kidney transplant recipients, with immunogenicity persisting through 12 months post-vaccination. An RCT post-hoc analysis showed high vaccine efficacy in patients aged ≥50 years with medical conditions at enrollment, including KD, which was consistent with the overall population. A favorable benefit-risk profile was reported in randomized and observational studies. Studies evaluating the effectiveness of the zoster live-attenuated vaccine (ZVL) found a lower risk of HZ in patients with ESRD immunized against HZ compared to unvaccinated individuals. In many countries, vaccination guidelines specifically recommended immunization of people with KD to protect against HZ. However, ZVL is contraindicated for immunocompromised (e.g. kidney transplant) patients. Conclusion Findings indicate that HZ has a significant HZ burden across the KD spectrum, which may negatively impact renal disease progression. With effective vaccines offering durable protection against HZ and its complications, the immunization of renal patients at earlier stages could enhance healthcare management and patient outcomes.

#1573 Effects of haemodialysis coupled with hemadsorption on uremic toxins removal, oxidative stress and cellular death.

Abstract Background and Aims The retention of middle-molecules and Protein Bound Uraemic Toxins (PBUT) in dialysis patients are directly linked to specific clinical complications such as anaemia, inflammation and cardiovascular disease leading to increased mortality. These toxins, not adequately cleared by current dialysis techniques, could be removed by adsorption as demonstrated in numerous studies on dialysis patients. Furthermore, in dialysis patients there's an increased inflammation and oxidative stress only partially attenuated by biocompatibility of newly developed membraned. This pathologic inflammatory response lead to tissue damage and cellular death. A particular form of programmed cellular death involving red blood cells is called Eryptosis and is detectable as changes in the morphology and in the shape of human erythrocytes. The aim of this study was to assess the safety of dialysis coupled with hemadsorption (HA+HD) in terms of biocompatibility and efficacy in terms of removal of middle-molecules and PBUTs. Method This was a preliminary analysis of a multicentre observational study that evaluated 4 dialysis session focusing on 7 chronic dialysis patients of our dialysis centre. Patients were treated with HA+HD with HA130 cartridge (Jafron) only in the early-week dialysis session and then returned to their usual prescription. Blood samples were taken before and after dialysis session in order to measure Eryptosis as a marker of biocompatibility and few uremic toxins to assess the efficacy of the treatment by using Removal Ratio. Eryptototic RBCs were identified by FS (cell volume dimension) and FITC_AnnexinV-binding (Beckman Coulter, Brea, CA, USA) using Navios Flow Cytometer (Beckman Coulter, Brea, CA, USA). A minimum 100.000 events were collected on each sample. Statistical analysis was performed using the SPSS Software package. A p-value of &amp;lt;0.05 was considered statistically significant. Results This study was carried out on 7 patients (4 women) with a mean age of 65.7 ± 11.5 years and a median dialysis vintage of 33 months (IQR 28-51). All patients had AVF with Qb of 330 ml/min. Dialysis length was 210 minutes. We didn't find any differences between Eryptosis values measured before and after dialysis (Table 1), and between different timepoints. We found significant reduction of PTH (pre: 391.5 ng/L, IQR 206.5-602.8 vs post: 162.0 ng/L, IQR 95.0-363.3; p=0.005) and β2-microglobulin (pre: 23.10 mg/L, IQR 22.1-24.1 vs post: 6.72 mg/L, IQR 6.2-8.3; p&amp;gt;0.005) throughout the dialysis session coupled with hemadsorption (Fig. 1). Conclusion In this preliminary analysis, we found that the association of Dialysis with Hemadsorption allows a great removal of middle molecular-weight uremic toxins without compromise biocompatibility and thus represent a better treatment option in patients with high retention of these toxins.

Educational level and gender are associated with emotional well-being in a cohort of Dutch dialysis patients

BackgroundPatients undergoing dialysis have an impaired health-related quality of life (HRQOL). There are conflicting data from small series on whether patient-related factors such as educational level have an impact on experienced HRQOL. The aim of this study was to investigate the association between educational level and HRQOL in dialysis patients.MethodsIn a single-center retrospective cross-sectional study HRQOL was measured using the Kidney Disease Quality of Life Short Form-36 (KDQOL-SF36) in prevalent chronic dialysis patients. Educational level was categorized into low, intermediate and high subgroups. Univariate and multivariate regression analyses were performed to assess the effects of age, gender, ethnicity, and dialysis vintage on the association between HRQOL and educational level.ResultsOne hundred twenty-nine chronic dialysis patients were included. Patients with an intermediate educational level had significantly higher odds of a higher emotional well-being than patients with a low educational level 4.37 (1.-89–10.13).A similar trend was found for a high educational level (OR 4.13 (1.04–16.42), p = 0.044) The odds for women compared to men were 2.83 (1.32–6.06) for better general health and 2.59 (1.15–5,84) for emotional well-being. There was no interaction between gender and educational level for both subdomains. Each year of increasing age significantly decreased physical functioning (OR 0.94 (0.91–0.97)).ConclusionsEducational level and sex were associated with emotional well-being, since patients with intermediate and high educational level and females had better emotional well-being in comparison to patients with low educational level and males. Physical functioning decreased with increasing age.