Chronic Dialysis Patients Research Articles

Tuberculosis in Dialysis Patients in the Central Region of Morocco: What Is the Health-Care Delay?

Introduction: Due to the predominantly cellular immunosuppression, infections are frequent in chronic dialysis patients, in particular tuberculosis (TB). The main objective of our study is to evaluate tuberculosis healthcare delay in dialysis patients and to raise the diagnostic challenge in these patients.Material and methods: The study is retrospective and multicenter including tuberculosis cases of chronic dialysis patients either in hemodialysis (HD) or peritoneal dialysis (PD) in the central region of Morocco during a 10-year period between 2012 and 2021.Results: We included 94 patients, five of whom were in PD, with a mean age of 50.79 ± 16.72 years, and a sex ratio of 0.67. The time between the initiation of dialysis and the onset of the clinical and biological presentation was 50.3 ± 67.12 months. The most frequent initial manifestations were an alteration of the general state (85.1%), a biological inflammatory syndrome (83%) or a prolonged fever (70.1%). Among our 94 patients, the diagnosis was confirmed with bacteriological evidence only in 18 cases (19.1%), by identification of Koch's Bacillus (BK) in 13 cases, by molecular biology test (GeneXpert; Cepheid, Inc., Sunnyvale, CA, USA) in five cases. The diagnosis of tuberculosis was presumptive in most cases (79 cases), i.e. 80.9%. Twenty-one patients underwent the interferon gamma release essay test (QuantiFERON; Qiagen, Hilden, Germany) which was positive in 14 patients. Thirty-four (36.1%) cases had a histological diagnosis. The remaining patients were offered a trial treatment. Tuberculosis localization was mostly extra-pulmonary (75.5%): lymph node (23.4%), pleural (13.8%), peritoneal (13.8%), whereas it was pulmonary in 23 cases (24.5%).Most of our patients had a clear delay in management from symptom onset to initiation of anti-TB treatment 78.9% (time >21days) vs 21.1% (time ≤21days). The median time to management delay was 46.5 interquartile range (IQR) (28.5-90), the mean delay was 78.4 ± 87.9 (6-360). All patients were treated according to the RHZE/RH protocol (R: rifampicin, H: isoniazid Z: pyrazinamide and E: ethambutol), with a duration between six and 18 months. Side effects associated with anti-tuberculosis treatment were observed in half of the patients (51.1%). The evolution was favorable with remission and improvement of the general condition in 90% of cases. Two cases of resistance were noted in our series. The overall mortality was 7.7%.Conclusion: We have confirmed a delay in the diagnosis and treatment of tuberculosis in chronic dialysis patients. This can be explained by the often atypical or incomplete clinical and paraclinical presentation and the extra-pulmonary localizations, making diagnosis difficult in this population whose prognosis remains poor. It is therefore necessary to establish a diagnostic approach that is adapted to the specificities of these high-risk patients within the framework of a national tuberculosis control program.

Peri-procedural, 30-day and 1 year-outcomes in chronic dialysis patients undergoing transcatheter aortic valve implantation

Abstract Background Patients on chronic dialysis (CD) due to end-stage renal disease (ESRD) with symptomatic severe aortic stenosis eligible for transcatheter aortic valve implantation (TAVI) were excluded from randomized clinical trials. Our study aimed to investigate the outcomes of patients with chronic dialysis who underwent TAVI. Methods Single center analysis on prospectively collected data of all consecutive patients who underwent TAVI between January 2011 and December 2020 according to baseline renal function: chronic dialysis group (CD) and control group (CTRL). Procedural, 30-day and 1-year outcomes were assessed. Outcomes were defined in accordance with the VARC-3 criteria. Results A total of 875 patients underwent TAVI during the study period, of whom 22 (2.5%) were on chronic dialysis. Patients on CD were younger (median age 80 years, [IQR 73–84] vs 84 years, [IQR 80–87]; p<0.001), more likely to be men [365/863 (42.8%) vs 18/22 (81.8%); p<0.001] and more likely to have peripheral vascular disease [41/853 (4.8%) vs 7/22 (31.8%); p=0.031] and lower body mass index (median 24.1 kg/m2, [IQR 21.5–26.5] vs 26.3 kg/m2, [IQR 23.7–29.3]). Short-term major or life-threatening bleeding were significantly higher in CD patients (odds ratio [95% confidential interval]: 3.67 [1.50–8.96], p 0.005). In contrast, no differences were found regarding rates of vascular complications requiring intervention (OR [95% CI]: 1.35 [0.31–5.90], p=0.662), permanent pacemaker implantation (OR [95% CI]: 0.87 [0.25–2.98], p=1.000) or stroke (OR [95% CI]: 1.51 [0.20–11.64], p=0.504). Importantly, dialysis patients had significantly higher rates of in-hospital, 30-day and 1-year mortality rates (13.6 vs 2.1%, p<0.001; 18.9% vs 2.9, p<0.001 and 26.4% vs 10.7%, p<0.001, respectively). On multivariate analysis, after adjusting for age, gender, relevant co-morbidities, and procedure-related complications, CD remained independently associated with mortality at 1-year. Survival curves during follow up are presented in Figure 1. Conclusions Chronic dialysis patients submitted to TAVI had significantly higher rates of short-term life threatening and/or major bleeding, short-term and long-term mortality. Careful selection of patients who would benefit from TAVI among patients with ERDS requiring dialysis is necessary to prevent high rates of postprocedural complications and improve outcomes of this high-risk population. Funding Acknowledgement Type of funding sources: None.

Contribution of Hepatitis B Contribution to Anemia in Dialysis Patients with Chronic Renal Failure, Iraq.

Chronic renal failure are caused by impaired kidney function; this organ is essential in the metabolism, filtration, and excretion of compounds. Human hepatitis B virus is common in dialysis patients with chronic renal failure, and chronic kidney disease (CKD) is also associated with anemia in dialysis patients. In this study, 50 (36 men and 14 women) dialysis patients from Imamian Al-Khademian city, with ages between 30 and 77 years, and a healthy group (control group) with ages ranging between 30 and 62 years, were evaluated. Detection of hepatitis B virus by a molecular technique of real-time PCR and the concentration of erythropoietin hormone detected by the ELISA technique. The results showed that the prevalence of dialysis patients aged 41-50 and 60-51 was 20% and 18%, respectively. The detection of Hepatitis B from the serum of dialysis patients' samples showed that HBV was seen in 15 (30%) of the 50 serum samples. The concentration of the erythropoietin hormone in dialysis patients' samples was lower than in the healthy groups (a control group). Also, the concentration of erythropoietin hormone was significantly lower in dialysis patients compared with the control group (P>0.05). Hepatitis B can affect chronic renal failure and dialysis patients' immunity. Also, people with hepatitis B have a lower level of the erythropoietin hormone, which is a major cause of anemia in dialysis patients.

A Description of Apixaban Dosing Patterns for Treatment or Prevention of Thrombotic Events in Hospitalized Patients on Dialysis.

Introduction: Apixaban is currently the only oral direct factor Xa inhibitor approved for treatment and prevention of venous thromboembolism (VTE) in patients on hemodialysis. Exclusion of dialysis patients from major clinical trials results in prescriber uncertainty regarding the optimal dose of apixaban for VTE treatment in this population. This study sought to characterize the variance in apixaban prescribing patterns for thrombotic indications other than atrial fibrillation. Methods: This retrospective, multi-center, descriptive study analyzed apixaban dosing patterns for hospitalized chronic dialysis patients with history of thrombosis. The primary outcome was incidence of deviation from manufacturer recommendations for dosing, assessed for either a new start or receipt prior to hospitalization. Secondary outcomes included observation of recurrent thrombotic and bleeding event rates during subsequent hospitalizations. Patients were analyzed into subgroups according to type of thrombotic indication for treatment. Data are reported with descriptive statistics. Results: A total of 101 patients were included. Deviations in recommended dosing were observed in 53 of 80 (66.2%) patients receiving apixaban for treatment of acute or chronic thrombosis. Of 44 patients started on apixaban during hospitalization for the indication of acute VTE, a dose deviation was observed in 79.5% of patients. Rates of rehospitalization for recurrent thrombotic events and bleeding were 11.8% and 9.9%, respectively. Conclusion: Variation in apixaban prescribing practices for the treatment of VTE in dialysis patients is common, suggesting an urgent need for prospective studies and updated dosing guidance to optimize safety with apixaban use in this population.

Identifying survival protective factors for chronic dialysis patients with surgically confirmed acute mesenteric ischemia.

BACKGROUNDMesenteric ischemia is significantly more common in end-stage kidney disease patients undergoing chronic dialysis than in the general population and is associated with high morbidity and mortality. However, reports on prognostic factors in this population are limited.AIMTo elucidate the in-hospital outcomes of acute mesenteric ischemia in chronic dialysis patients and to analyze protective factors for survival.METHODSThe case data of 426 chronic dialysis patients who were hospitalized in a tertiary medical center for acute mesenteric ischemia over a 14-year period were retrospectively reviewed. Of these cases, 103 were surgically confirmed, and the patients were enrolled in this study. A Cox regression analysis was used to evaluate the protective factors for survival.RESULTSThe in-hospital mortality rate among the 103 enrolled patients was 46.6%. Univariate analysis was performed to compare factors in survivors and nonsurvivors, with better in-hospital outcomes associated with a surgery delay (defined as the time from onset of signs and symptoms to operation) < 4.5 d, no shock, a higher potassium level on day 1 of hospitalization, no resection of the colon, and a total bowel resection length < 110 cm. After 1 wk of hospitalization, patients with lower white blood cell count and neutrophil counts, higher lymphocyte counts, and lower C-reactive protein levels had better in-hospital outcomes. Following multivariate adjustment, a higher potassium level on day 1 of hospitalization (HR 1.71, 95%CI 1.19 to 2.46; P = 0.004), a lower neutrophil count (HR 0.91, 95%CI 0.84 to 0.99; P = 0.037) at 1 wk after admission, resection not involving the colon (HR 2.70, 95%CI 1.05 to 7.14; P = 0.039), and a total bowel resection length < 110 cm (HR 4.55, 95%CI 1.43 to 14.29; P = 0.010) were significantly associated with survival.CONCLUSIONA surgery delay < 4.5 d, no shock, no resection of the colon, and a total bowel resection length < 110 cm predicted better outcomes in chronic dialysis patients with acute mesenteric ischemia.

High-Volume Hemodiafiltration and Cool Hemodialysis Have a Beneficial Effect on Intradialytic Hemodynamics: A Randomized Cross-Over Trial of Four Intermittent Dialysis Strategies

IntroductionCompared to standard hemodialysis (S-HD), postdilution hemodiafiltration (HDF) has been associated with improved survival.MethodsTo assess whether intradialytic hemodynamics may play a role in this respect, 40 chronic dialysis patients were cross-over randomized to S-HD (dialysate temperature [Td] 36.5 °C), cooled HD (C-HD; Td 35.5 °C), and HDF (low-volume [LV-HDF)] and high-volume [HV-HDF], both Td 36.5 °C, convection volume 15 liters, and at least 23 liters per session, respectively), each for 2 weeks. Blood pressure (BP) was measured every 15 minutes. The primary endpoint was the number of intradialytic hypotensive (IDH) episodes per session. IDH was defined as systolic BP (SBP) less than 90 mmHg for predialysis SBP less than 160 mmHg and less than 100 mmHg for predialysis SBP greater than or equal to 160 mmHg, independent of symptoms and interventions. A post hoc analysis on early-onset IDH was performed as well. Secondary endpoints included intradialytic courses of SBP, diastolic BP (DBP) and mean arterial pressure (MAP).ResultsDuring S-HD, IDH occurred 0.68 episodes per session, which was 3.2 and 2.5 times higher than during C-HD (0.21 per session, P < 0.0005) and HV-HDF (0.27 per session, P < 0.0005), respectively. Whereas the latter 2 strategies showed similar frequencies, HV-HDF differed significantly from LV-HDF (P = 0.02). A comparable trend was observed for early-onset IDH: S-HD (0.32 per session), C-HD (0.07 per session, P < 0.0005) and HV-HDF (0.10 per session, P = 0.001). SBP, DBP, and MAP declined during S-HD (−6.8, −5.2, −5.2 mmHg per session; P = 0.004, P < 0.0005, P = 0.002 respectively), which was markedly different from C-HD (P < 0.01).ConclusionThough C-HD and HV-HDF showed the lowest IDH frequency and the best intradialytic hemodynamic stability, all parameters were most disrupted in S-HD. Therefore, the survival benefit of HV-HDF over S-HD may be partly caused by a more beneficial intradialytic BP profile.

Kleen enema Hypophosphatemia correction in hemodialysis patients.

Dialysis fluid (Dialysate) is a solution consisting of inorganic ions and glucose. Its constitution is almost physiologic. Dialysate is prepared by mixing two concentrates (either liquid or powder form). Two concentrates are labeled as acidic bath (Bath A) and basic bath (Bath B). Bath A contains sodium, chloride and glucose at physiologic concentration. While Bath B is bicarbonate solution contains bicarbonate slightly greater than physiologic concentration to treat metabolic acidosis.&#x0D; Just as therapeutic drugs, Dialysis fluid constituents can be adjusted as per individual patient's needs. Potassium and calcium baths are available to alter concentration of these ions. Phosphorous is normally not present in dialysate. Though hyperphosphatemia is one of the major clinical problem in renal failure, low serum phosphorous (PO4) is frequently encountered clinical entity. In chronic dialysis patient low PO4 is encountered as component of adynamic bone disease. Likewise, phosphorus dis balance is frequent electrolyte imbalance in critically ill patients with renal injury. Dialysis with low PO4 is always a challenge for nephrologist and intensivist.&#x0D; Case reports are available on treatment of symptomatic hypophsotemia using convention hemodialysis with poshphorous enriched dialysate fluid.

Fasting Ramadan in Chronic Kidney Disease (CKD), Kidney Transplant and Dialysis Patients: Review and Update.

Chronic kidney disease (CKD) is a common disease in the Islamic regions. Dehydration occurs after prolonged fasting, particularly in hot and humid climates. In the Arabic months’ calendar, Ramadan is a month of maximum given deeds, where Muslims are required to fast from dawn till sunset. Depending on where you live and when the Ramadan month falls, fasting might last anywhere from 10 to 20 hours or more. In certain circumstances, such as poorly controlled diabetes and advanced CKD patients who are allowed to break their fast, the Ramadan fasting amendment is viable. Some Muslims, however, continue fasting despite these circumstances, placing themselves at risk, which is not allowed in the Islamic religion.There are no medical recommendations that specify who should and should not fast. Nonetheless, the recommendations have been extracted from several published studies. The authors searched EMBASE, PubMed, Google Scholar, and Google for publications, research, and reviews. All authors debate and analyze the related articles. Each author was assigned a part or two of the topics to read, study, and summarize before creating the final draft of their given section. Then this comprehensive review was completed after discussion sessions.In conclusion, by the Islamic religion view, fasting Ramadan is mandatory for every wise adult person. People who have chronic diseases or that may deteriorate by fasting are exempted from fasting. It seems that fasting and the associated disease hours are determinant factors to fasting or not fasting. Up to our knowledge, there are no established guidelines for CKD patients and physicians to follow; however, the International Diabetes Federation and Diabetes and Ramadan (IDF-DAR) Practical Guidelines 2021 have been issued for CKD diabetic patients and fasting.

The Effect of Nutrition and Exercise on Body Composition, Exercise Capacity, and Physical Functioning in Advanced CKD Patients.

Patients with stages 4 and 5 chronic kidney disease (CKD), and particularly chronic dialysis patients, commonly are found to have substantially reduced daily physical activity in comparison to age- and sex-matched normal adults. This reduction in physical activity is associated with a major decrease in physical exercise capacity and physical performance. The CKD patients are often physically deconditioned, and protein energy wasting (PEW) and frailty are commonly present. These disorders are of major concern because physical dysfunction, muscle atrophy, and reduced muscle strength are associated with poor quality of life and increased morbidity and mortality in CKD and chronic dialysis patients. Many randomized controlled clinical trials indicate that when CKD and chronic dialysis are provided nutritional supplements or undergo exercise training their skeletal muscle mass and exercise capacity often increase. It is not known whether the rise in skeletal muscle mass and exercise capacity associated with nutritional support or exercise training will reduce morbidity or mortality rates. A limitation of these clinical trials is that the sample sizes of the different treatment groups were small. The aim of this review is to discuss the effects of nutrition and exercise on body composition, exercise capacity, and physical functioning in advanced CKD patients.

COVID-19 Pandemic in Dialysis Patients: The Swiss Experience.

BackgroundChronic dialysis patients are classified as patients with increased risk for COVID-19. Knowledge about the incidence and survival of chronic dialysis patients infected with SARS-CoV-2 in Switzerland - a high-income country with high density of relatively small dialysis centers - is scarce. We present the findings regarding incidence, survival and regional differences, compared to those of the general population in Switzerland.MethodsInformation on chronic dialysis patients who tested positive for SARS-CoV-2 between February 24, 2020 and February 28, 2022 were reported to the Swiss dialysis registry by all 94 Swiss dialysis centers. Hereafter, these results were linked with clinical characteristics from the Swiss dialysis registry.ResultsThroughout the study period 1,120 out of ~4,700 dialysis patients tested positive for SARS-CoV-2 in Switzerland: 96 cases occurred in the first wave, 472 in the second wave and 5 in between. During the first wave, Italian-speaking Ticino was most severely affected, with a 7-fold higher incidence of dialysis patients compared to the general Swiss population. In the second wave, the majority of cases were found in the French-speaking part of Switzerland, with a 2.5 times higher incidence vs. non-dialysis patients. A total of 123 deaths were recorded in the first two waves, of which COVID-19 was the main cause of death in 100 patients. This corresponds to a highly increased overall mortality rate of 17.5% compared to 1.7% in the general population. Age was identified as the only risk factor for mortality in dialysis patients. During the third, fourth and fifth wave, 61, 43 and 443 cases, respectively, were recorded, resulting in 6 (mortality rate 9.8%), 1 (mortality rate 2.3%) and 13 deaths (mortality rate 2.9%).ConclusionChronic dialysis patients in Switzerland were more likely to be infected by SARS-CoV-2 during the first and second wave than the rest of the population, but an inverse trend was observed during the third, fourth and fifth wave, probably thanks to vaccination. In addition, mortality is significantly increased compared to non-dialysis patients. In Swiss dialysis patients, age is the strongest risk factor for death.

Increases in methicillin-sensitive Staphylococcus aureus bloodstream infection incidence, 2016–2019

Background: Incidence of methicillin-sensitive Staphylococcus aureus (MSSA) bloodstream infections (BSIs) in the United States during 2012–2017 has been reported to have been stable for hospital-onset BSIs and to have increased 3.9% per year for community-onset BSIs. We sought to determine whether these trends continued in more recent years and whether there were further differences within subgroups of community-onset BSIs. Methods: We analyzed CDC Emerging Infections Program active, population- and laboratory-based surveillance data during 2016–2019 for MSSA BSIs from 8 counties in 5 states. BSI cases were defined as isolation of MSSA from blood in a surveillance area resident. Cases were considered hospital onset (HO) if culture was obtained &gt;3 days after hospital admission and healthcare-associated community-onset (HACO) if culture was obtained on or after day 3 of hospitalization and was associated with dialysis, hospitalization, surgery, or long-term care facility residence within 1 year prior or if a central venous catheter was present ≤2 days prior. Cases were otherwise considered community-associated (CA). Annual rates per 100,000 census population were calculated for each epidemiologic classification; rates of HACO cases among chronic dialysis patients per 100,000 dialysis patients were calculated using US Renal Data System data. Annual increases were modeled using negative binomial or Poisson regression and accounting for changes in the overall population age group, and sex. Descriptive analyses were performed. Results: Overall, 8,344 MSSA BSI cases were reported. From 2016–2019 total MSSA BSI rates increased from 23.9 per 100,000 to 28.5 per 100,000 (6.6% per year; P &lt; .01). MSSA BSI rates also increased significantly among all epidemiologic classes. HO cases increased from 2.5 per 100,000 to 3.2 per 100,000 (7.9% per year; P = .01). HACO cases increased from 12.7 per 100,000 to 14.7 per 100,000 (7.0% per year; P = .01). CA cases increased from 8.4 per 100,000 to 10.4 per 100,000 (6.7% per year; P &lt; .01) (Fig. 1). Significant increases in MSSA BSI rates were also observed for nondialysis HACO cases (9.3 per 100,000 to 11.1 per 100,000; 7.8% per year; P &lt; .01) but not dialysis HACO cases (1,823.2 per 100,000 to 1,857.4 per 100,000; 1.4% per year; P = .59). Healthcare risk factors for HACO cases were hospitalization in the previous year (82%), surgery (31%), dialysis (27%), and long-term care facility residence (19%). Conclusions: MSSA BSI rates increased from 2016–2019 overall, among all epidemiologic classes, and among nondialysis HACO cases. Efforts to prevent MSSA BSIs among individuals with healthcare risk factors, particularly those related to hospitalization, might have an impact on MSSA BSI rates.Funding: NoneDisclosures: None

MO871: COVID-19 in Dialysis Patients, a South African Experience

BACKGROUND AND AIMSThe first documented case of SARS-CoV-2 infection was diagnosed in South Africa on the 5 March 2020 and a pandemic declared on the 25 March 2020. Patients on dialysis are at increased risk for COVID-19 infection due to their high burden of comorbidities, impaired immune response, need to attend dialysis and the higher incidence of severe disease. In this study, we evaluated the prevalence, clinical management and outcome of dialysis patients and dialysis healthcare workers who tested positive for COVID-19. Further, the study aimed to provide insight into strategies to minimize COVID-19 spread in outpatient dialysis facilities.METHODA retrospective cohort study was conducted on 1382 chronic dialysis patients and 292 healthcare workers from 69 chronic haemodialysis centres and 17 home therapy divisions who have tested COVID-19 positive from the 5 March 2020 until the 26 July 2021.RESULTSFrom the 1382 chronic dialysis patients who tested positive during the study, the mean age was 57.5 ± 12.7 years of age; 61.3% of patients were male and 38.7% female. COVID-19 re-infection was prevalent in 3.5% (n = 48) of the chronic dialysis patient population within the study duration. The overall 28-day mortality rate for patients testing COVID-19 positive was 13.1% (n = 181). The mean age of patients succumbing to COVID-19 was 63.6 ± 11.1 years of age. A further, 292 healthcare workers tested positive during the study duration, 63.4% (n = 185) were frontline healthcare staff (nurses or clinical technologists) and 22.9% (n = 67) were support services and 13.7% (n = 40), were administrative staff. Only one staff member succumbed to COVID-19 (0.3%). At the end of the study duration 69% of healthcare workers and 27.6% of patients had been vaccinated.CONCLUSIONThe COVID-19 pandemic has had a significant impact on chronic dialysis patients. Dialysis patients are associated with more adverse clinical outcomes and increased mortality. In South Africa, better vaccination rates and more dosing and appropriate preventative strategies remain our strongest defense to mitigate excess cases and death.

MO655: Anti-Inflammatory Approach in Chronic Dialysis Patients with SARS-CoV-2: ATA or PMMA Dialyzers?

BACKGROUND AND AIMSHigh flux haemodialysis membranes may modulate the cytokine storm of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but their impact in chronic haemodialysis (CHD) patients is not assessed [1, 2]. The aim of the study was the evaluation of asymmetric cellulose triacetate (ATA) and polymethylmethacrylate (PMMA) dialyzers on inflammatory markers in CHD patients with SARS-CoV-2.METHODA prospective, observational study on CHD patients (age ≥18 years) affected by SARS-CoV-2 was carried out. Patients were enrolled from March 2020 to May 2021 and dialysis was performed at S. Orsola University Hospital (Bologna, Italy) Dialysis Unit. Mechanical ventilation at diagnosis was exclusion criteria. Pre- and post-dialysis C-reactive protein (CRP), procalcitonin (PCT) and interleukin-6 (IL-6) were determined at each session and corrected for haemoconcentration during the complete SARS-CoV-2 period.Patients who underwent online haemodiafiltration (OLHDF) with PMMA dialyzer (Filtryzer BG-U™, Toray, surface area 2.1 m2 cut-off 20 kDa, KUF 43 mL/h/mmHg) were compared with those who underwent OLHDF with ATA dialyzer (SolaceaTM Nipro, surface area 2.1 m2 cut-off 45 kDa, KUF 72 mL/h/mmHg). The primary endpoint was to assess the differences in the reduction ratio/session (RR) of CRP, PCT and IL-6.RESULTSA total of 74 patients were enrolled, 48 were treated with ATA and 26 were with PMMA (420 versus 191 dialysis sessions). The main results are shown in Table 1. Median IL-6RR% was higher for ATA [17.08%, interquartile range (IQR) −9.0 to 40.0 versus 2.95%, IQR −34.63 to 27.32]. CRP and PCT showed higher RR with ATA in comparison to PMMA. When IL-6RR > 25% was the dependent variable in the multiple logistic regression analysis only ATA showed a significant correlation [odds ratio (OR) 1.891, 95% confidence interval (95% CI) 1.273–2.840, P = .0018) while higher CRP favoured the risk of lower IL6RR (OR 0.9101, 95% CI 0.868–0.949, P < 0.0001) (Table 2).CONCLUSIONIn SARS-CoV-2 CHD patients treated with OLHDF, ATA showed a better anti-inflammatory profile than PMMA, in particular regarding IL-6 RR.Table 1.Clinical features and outcomes of ATA versus PMMA. Standard deviation (SD), Interquartile range (IQR) ATA (48) PMMA (26) P Age, years, mean (SD)67.67 (15.48)69.46 (16.37).6421Male, n (%)34 (71)17 (66).7930HD age, months, median (SD)47.00 (13.75–89.75)27.50 (14.25–71.50).3653Charlson Comorbidity Index, median (IQR)4.00 (3.00–5.00)5 (3.00 –7.25).2549Arteriovenous Fistula, n (%)39 (81)14 (54) .0166 Central venous catheter, n (%)9 (9)12 (46)Interstitial pneumonia, n (%)29 (60)20 (77).2008Pre-HD IL-6 pg/mL, median (IQR)14.50 (5.75–41.43)13.90 (5.80–34.10).6386IL-6 RR%, median (IQR)17.08 (−9.0–40.0)2.95 (−34.63–27.32) <0.001 IL-6 RR% based on pre-dialysis IL-6 level (median, IQR) 1st tertile23.55 (−8.96–47.40)3.72 (−51.66–30.08) .0013 2nd tertile16.69 (−9.79–39.39)2.18 (−24.03–25.95) .0405 3rd tertile12.99 (−8.73–35.75)1.14 (−34.70–31.33) .0501 CRP RR%, median (IQR)7.77 (2.47–13.77)4.80 (−2.65–11.38) .0017 PCT RR%, median (IQR)77.38 (70.92–82.97)54.59 (42.62–63.16) <0.0001 Variables at diagnosis, median (IQR) IL6 pg/mL20.30 (9.10–62.10)22.60 (9.80–56.35).8763 CRP mg/dL3.88 (0.77–143.70)3.30 (0.33–9.98).4134 PCT pg/mL1.60 (0.72–2.77)0.95 (0.53–1.48) .0388 Death, n (%)8 (17)5 (19).7604Table 2.Multiple logistic regression with IL-6 RR > 25% as outcome. Odds Ratio (OR), Confidence interval (CI) OR 95% CI p ATA1.8911.273–2.840 .0018 IL-6 pre-HD1.0031.001–1.007 .0123 CRP pre-HD0.91010.8682–0.9496 < 0.0001 PCT pre-HD0.95280.8644–1.008.2270Ferritin1.0000.9998–1.000.7697

MO909: Dialysis After Contrast Agent Administration in Patients on Chronic Haemodialysis: It is a Common Clinical Practice?

Abstract BACKGROUND AND AIMS Though the current dialysis population is characterized by a better survival, there is a greater burden of cardiovascular comorbidities. These two factors together expose patients to a greater number of diagnostic and therapeutic contrast tests. The European Society of Urogenital Radiology (ESUR) Guidelines on Contrast Agents 10.0 report that there is no need for urgent dialysis after intravascular iodinated contrast agent administration based on the results of the only study that addressed this problem, conducted in 10 patients by Younathan CM and published in the American Journal of Roentgenology in 1994. As far as the use of gadolinium contrast agent in dialysis patients, the recommendation is to try to perform the contrast agent injection prior to and close to the haemodialysis session, and an extra haemodialysis session to remove the contrast agent as soon as possible after it has been administered is recommended. It is now a well-known phenomenon that when there are low-level recommendations, the behaviour of nephrologists is not homogeneous. METHOD We have created a very simple survey (only 10 questions) to explore the behaviour of Italian nephrologists with respect to the administration of contrast agents in dialysis patients. The main information we wanted to obtain concerned the attitude towards the need for a dialysis session after the administration of a contrast agent (iodate or gadolinium), the timing respect to the contrast examination and the duration of the dialysis session. A total of 50 Italian nephrologists of 50 dialysis centres, respectively, responded to the questionnaire. The average number of chronic dialysis patients treated per single centre was 94 (median 80, interquartile range 46–135), meaning that these are representative of a population of at least 5000 haemodialysis patients. RESULTS After intravascular iodinated contrast agent, according to the ESUR guidelines 9 nephrologists (18%) do not perform an additional dialysis, while 34 nephrologists ( 68%) carry out an additional dialysis session (or organize the contrast examination to coincide with the scheduled dialysis session) (Fig. 1). A total of 32 nephrologists (64%) perform a specific dialysis session after magnetic resonance with gadolinium, as indicated in the ESUR guidelines (Fig. 2). In both cases (iodinated contrast agent or gadolinium), 28 nephrologists (56%) schedule the dialysis session within 4 h of the contrast examination (at least 2 h of treatment or complete dialysis session if possible). Remarkably, 10 nephrologists (20%) do not organize a specific dialysis section after MR with gadolinium (Fig. 2). CONCLUSION Our data confirm that in Italy, the majority of nephrologists still carry out an additional dialysis session after the administration of an iodinated contrast agent to avoid the potential risk of delay and adverse effects (intravascular volume expansion, pulmonary edema, depression of myocardial contractility and arrhythmias). Haemodialysis is an expensive procedure, in particular when performed as a nonscheduled emergent treatment at odd hours of the day or night. Further studies are needed to clarify this controversial point.

MO859: Factors Affecting Immune Response to Hepatitis B Vaccination Among Chronic Hemodialysis Patients in Saudi Arabia

Abstract BACKGROUND AND AIMS It is well established that patients on chronic hemodialysis (HD) have an increased risk of hepatitis B virus (HBV) infection and reduced response to HBV vaccines compared with the general population.1 While advances in immunology and vaccinology have evolved several HBV vaccine modifications to enhance immunogenicity2; there is need to identify modifiable clinical factors that may help enhance response to HBV vaccines in the chronic HD population. This multi-center study aims to document the response to HBV vaccine among chronic HD patients across DaVita centers in Saudi Arabia and to identify the factors that independently affect the response of HD patients to the HBV vaccine. METHOD Patients eligible for HBV vaccination among our patient cohort who had received a full course of HBV vaccination (Engerix-B®, GlaxoSmithKline, United Kingdom) in all DaVita Clinics in Saudi Arabia were included in the analysis. We excluded patients who did not complete the vaccine protocol or had missing data and who were treated by immunosuppressive drugs. Levels of the antibody to the surface antigen (anti-HBs) were measured about 2 months after the last dose of the vaccine using enzyme-linked immunoassay methods. The age (in years), dialysis vintage, hepatitis C infection, diabetic status, mean albumin, parathyroid hormone (PTH), ferritin and hemoglobin levels 2 months prior to and during the 6 months of completing the vaccination protocol were recorded. Response to HBV vaccine was recorded as ‘no response’ if anti-HBs was &amp;lt; 10 mIU/L; ‘weak response’ if the anti-HBs level is between 10–99.9 mIU/L, and ‘good response’ when ≥ 100 mIU/L. Univariate and multivariate ordinal logistic regression models were used to identify the factors independently associated with response to HBV vaccine. RESULTS We had 509 patients with a mean age of 54.1 ± 15.1 years, 252 (49.5%) being female. Diabetes mellitus was the etiology of kidney failure in 60.5% of the patients. Most (91.1%) had concomitant hypertension and 4.3% were positive for hepatitis C virus infection. BMI was at least 30 kg/m2 in 26.1% of the study population. Immune response occurred in 374 {73.5%, [95% confidence interval (95% CI) 69.4–77.3%]}. Good response occurred in only 53.1% (95% CI 48.6%–57.4%). The factors independently associated with response to HBV vaccination were age, mean albumin, PTH, ferritin levels and BMI (Table 1). Diabetic status and Kt/v did not predict vaccine response. CONCLUSION A complex interaction of inflammatory markers, nutritional status, bone mineral disease parameters affects the response to HBV vaccines. Improving chronic dialysis patients’ albumin and PTH levels may increase the likelihood of achieving a good response to HBV vaccines.

MO484: Gender Differences in the Incidence of End-Stage of Renal Disease in Okinawa

Abstract BACKGROUND AND AIMS The incidence of chronic kidney disease (CKD) and its progression to end-stage renal disease (ESRD) differ between genders, so it can be surmised that the incidence of ESRD is different between males and females. Acceptance of dialysis therapy may not necessarily be equal to the incidence of ESRD. Factors such as socio-economic conditions of the family, residential area, risk factors and compliance to the treatment of CKD are not equal among gender. We accessed the gender difference in incidence of ESRD and its risk factors in Okinawa, Japan, a major ESRD epidemic area. METHOD The Okinawa Dialysis Study (OKIDS) registry included all chronic dialysis patients treated in Okinawa, Japan, since 1971. We defined the ESRD as those who survived at least one month on scheduled dialysis therapy (hemodialysis and peritoneal dialysis) to exclude acute kidney injury. We analyzed the annual incidence of ESRD by gender for 30 years from 1971 to 2000. The incidence rate of ESRD was calculated as the number of incident dialysis patients divided by the census population of the previous year in each gender and expressed per million population (pmp). The number of dialysis facilities increased from 1 (1971) to 50 (2000). The census population was increased from 939 742 (1971) to 1 318 220 (2000) in Okinawa. RESULTS A total of 5264 patients, 2981 males and 2265 females, have initiated maintenance hemodialysis during the study period. The incidence rate of ESRD increased from 8.9 to 370 pmp in males and from 0 to 227 pmp in females between 1971 and 2000. The growth was fast and consistent throughout the period in males, while in females, the growth has become slower since 1990. After age-standardized, a similar trend was observed, which increased from 41 to 224 pmp in males and from 36 to 154 pmp in females between 1975 and 2000. For males and females, the age-specific incidence rate in the 60–79 year and &amp;gt;80 year groups increased rapidly, and that in the 40–59 year group increased gradually, whereas in the 0–39 year group have been flat. The age-specific rate in the 60–79 year and &amp;gt;80 year groups for males continued to increase throughout the period, while that for females peaked between 1990 and 1995. In the cause-specific incidence rate, the following trends were observed in males and females. The incident rate caused by chronic glomerular nephropathy increased from the 1970s to the 1980s and then leveled off, while that by diabetic nephropathy increased from the 1980s and that by nephrosclerosis increased from the 1990s. The marked growth was seen in the incident rate caused by diabetic nephropathy for both males and females. The rate increased 31 times for males and 12 times for females in the 20 years from 1981 to 2000. The age- and cause-specific incidence rate has risen remarkably among male diabetic nephropathy in &amp;gt;60 years. CONCLUSION In Okinawa, the incidence rate of ESRD has increased significantly in males compared with females, and the gender difference has been widening. It was suggested that the increase in the number of males with diabetic nephropathy over the age of 60 contributed to this widening of the gender difference.

W046 Vitamin D deficiency in chronic kidney disease and dialysis patients of Kathmandu valley

W046 Vitamin D deficiency in chronic kidney disease and dialysis patients of Kathmandu valley

Effect of the COVID-19 Pandemic on Kidney Transplant and on Chronic Dialysis Patients

BackgroundThe reported fatality rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients receiving maintenance dialysis or kidney transplant are higher than in the general population. The aim of this study was to evaluate the impact of SARS-CoV-2 infection in chronic dialysis patients (DPs) compared with kidney transplant recipients (KTxRs).MethodsA study evaluating 266 COVID-19-positive patients (112 DPs and 154 KTxRs) was conducted in a single center from March 1, 2020, to June 30, 2021. All patients were confirmed for COVID-19 infection by reverse transcription polymerase chain reaction or antigen test.ResultsKTxRs were younger (49 ± 12.4 vs 61 ± 14.6 years; P < .0001) and had significantly fewer coexisting disorders than the DPs. A higher percentage of KTxRs required hospitalization (70% vs 49.4%, P = .002) and intensive care unit admission (39% vs 25%, P = .01). The fatality rate was 24% in both groups.DiscussionThere is no consensus among studies about the higher fatality rate between KTxRs and DPs who develop COVID-19. In our study, we also did not find a different fatality rate.ConclusionIn spite of KTxRs being younger and having fewer coexisting disorders, compared with DPs, they presented a higher hospitalization and intensive care unit necessity rate but a similar fatality rate.

Impact of Moderna mRNA-1273 Booster Vaccine on Fully Vaccinated High-Risk Chronic Dialysis Patients after Loss of Humoral Response.

The long-term effect of protection by two doses of SARS-CoV-2 vaccination in patients receiving chronic intermittent hemodialysis (CIHD) is an urging question. We investigated the humoral and cellular immune response of 42 CIHD patients who had received two doses of SARS-CoV-2 vaccine, and again after a booster vaccine with mRNA-1273 six months later. We measured antibody levels and SARS-CoV-2-specific surrogate neutralizing antibodies (SNA). Functional T cell immune response to vaccination was assessed by quantifying interferon-γ (IFN-γ) and IL-2 secreting T cells specific for SARS-CoV-2 using an ELISpot assay. Our data reveal a moderate immune response after the second dose of vaccination, with significantly decreasing SARS-CoV-2-specific antibody levels and less than half of the study group showed neutralizing antibodies six months afterwards. Booster vaccines increased the humoral response dramatically and led to a response rate of 89.2% for antibody levels and a response rate of 94.6% for SNA. Measurement in a no response/low response (NR/LR) subgroup of our cohort, which differed from the whole group in age and rate of immunosuppressive drugs, indicated failure of a corresponding T cell response after the booster vaccine. We strongly argue in favor of a regular testing of surrogate neutralizing antibodies and consecutive booster vaccinations for CIHD patients to provide a stronger and persistent immunity.

A rare full-term delivery in a chronic peritoneal dialysis patient

We aimed to report the case of a 37 years old woman, caucasian, who got pregnant after seven months of dialysis initiation and had a full-term weeks successful delivery. We also reviewed and presented the reported cases of peritoneal dialysis pregnancies in the last 6 years. The patient started renal replacement therapy due to focal segmental glomerulosclerosis and chronic tubular nephritis. In the same year, she got pregnant and started pre-maternal care in the high-risk pregnancy program. Peritoneal dialysis prescription was adjusted according to the patient’s tolerance and laboratory parameters. No complications occurred during the first and second trimester. In the first quarter of the third trimester, an antihypertensive drug was initiated for maintenance of blood pressure. She delivered a healthy baby via spontaneous vaginal at 39 weeks. Birth was induced due to the advanced pregnancy time and the risk of worsening arterial pressure. Our experience showed that peritoneal dialysis is a viable option during pregnancy according to the patient's residual renal function and promotes a successful pregnancy period with the correct adaptations on peritoneal dialysis prescription. Collaboration and support amongst family, nephrologist and gynecologist doctors, multidisciplinary team and the patient are crucial to ensure treatment quality and successful outcomes.