Cohort Of Dialysis Patients Research Articles

Multidimensional assessment of physical function for people in dialysis: the Rehabilitation in hEmodialysis Area Centro Toscana (REACT) Study.

BACKGROUNDː Physical performance is poorly addressed in dialysis patients, due to several clinical and organizational barriers. In this study we investigated the physical functional status of a cohort of dialysis patients, using a multidimensional assessment. METHODSː Four hundred and forty-six individuals from 8 hemodialysis centers (176 females), mean age 67.5±14.1 years, and dialysis vintage 62 ± 72.1 months, were assessed by a multidimensional battery including Short Form Health Survey (SF12), Elderly Falls Screening Test (EFST), Short Physical Performance Battery (SPPB), and handgrip strength test (HST). Individuals were stratified into 3 groups (poor, moderate and good performers) according to the SPPB score. Functional assessments were performed by staff nurses, with the support of physiotherapists and nephrologists. RESULTSː According to SPPB 53,4% of dialysis patients showed a severe physical impairment. A significant difference emerged among the 3 SPPB groups for age, HST, EFST and SF12. The main predictors of the SPPB score group were age (p=0,0001) EFST (p=0,028 moderate performers and p=0,0001 poor performers) dominant HST(p=0,04 moderate performers) and SF12 physical (p=0,003 moderate performers and p=0,0001 poor performers) . Each age groups showed physical performance comparable to healthy general population of ten years older. CONCLUSIONSː Our results confirmed the severe impairment of physical function in ESKD population. The multidimensional assessment showed that SPPB test is an effective tool to stratify dialysis population. Moreover, EFST, HST and SF12 may contribute to the definition of a tailored physical activity program based on patient characteristics.

Impact of Serum Phosphate on Hemoglobin Level: A Longitudinal Analysis on a Large Cohort of Dialysis Patients

Background/Objectives: Phosphate is a macro-element involved in all cellular energetic processes. As about 90% of the phosphate filtered by the glomerulus is excreted by kidneys, the impairment of renal function and the consequent over-secretion of parathyroid hormone and fibroblast growth factor 23 results in the increase in the serum phosphate levels. The association between phosphate and hemoglobin is controversial, as both direct and indirect relationships have been reported. The present study aims to investigate the relationship between phosphate and hemoglobin in a large prospective, longitudinal cohort including dialysis patients from the Sicilian Registry of Nephrology, Dialysis, and Transplantation. Methods: In this prospective cohort study, we included 6263 hemodialysis patients to achieve a total of 120,462 repeated measurements of serum phosphate and hemoglobin over time. The longitudinal association between phosphate and hemoglobin was analyzed by univariate and multivariate Linear Mixed Models. Results: The mean age was 66 ± 16 years and the median dialysis vintage was 5 months [IQR: 2–16]. Mean and median values of hemoglobin and phosphate were 10.7 g/dL (SD 1.3 g/dL) and 4.6 mg/dL [IQR 3.9–5.5 mg/dL], respectively. The multivariate model, adjusted for potential confounders, confirmed the positive association between serum phosphate and hemoglobin [adjβ = 0.13, 95%CI 0.03–0.23, p = 0.01)]. These results were confirmed in analyses stratified for the use of phosphate binders. Conclusions: In our large cohort of dialysis patients, we found a linear, direct relationship between phosphate and hemoglobin levels. As a reduction in phosphate is associated with a parallel reduction in hemoglobin levels, hypophosphatemia can accentuate anemia in dialysis patients. Our results generate the hypothesis that monitoring serum phosphate in clinical practice might provide a better management of anemia.

Cardiovascular and All-Cause Mortality Is Affected by Serum Magnesium and Diet Pattern in a Cohort of Dialysis Patients.

Background: Hypomagnesaemia is associated with an increased overall mortality in patients with chronic kidney disease on dialysis (CKD-5D). Mediterranean-style diet (MD), having a high magnesium content, can serve as a form of dietary magnesium supplementation. We examined whether there is a potential link between increased Mediterranean Diet score (MDS) and elevated serum magnesium (sMg) to assess its impact on reducing mortality risk in CKD-5D patients. Methods: In this multi-center prospective observational study, 117 CKD-5D patients (66 on hemodialysis and 51 on peritoneal dialysis) with a mean age of 62 ± 15 years were studied for a median follow-up period of 68 months. After baseline assessment, including measurement of sMg and MDS, all patients were followed up for cardiovascular (CV) and all-cause mortality. Results: Forty deaths occurred, 58% of which were cardiovascular. Patients who were above the median value of sMg (2.2 mg/dL) had a 66% reduction in CV (crude HR, 0.34; 95% CI, 0.11-0.70), and 49% reduction in all-cause (crude HR, 0.51; 95% CI, 0.27-0.96) mortality, even after adjustment for age, malnutrition inflammation score, left ventricular mass index, peripheral vascular disease and diabetes. Similar results were obtained when sMg was analyzed as a continuous variable. sMg was associated directly with MDS (r = 0.230; p = 0.012). Conclusions: Higher sMg levels are strongly and independently associated with reduced CV and all-cause mortality in CKD-5D patients. A strong correlation exists between MDS and sMg. Elevated sMg levels, achieved through MD adherence, can significantly reduce CV mortality, implicating MD as a mediator of the association between sMg and CV mortality.

#2866 The CompAct-HD trial reports a persistent inflammatory profile in patients undergoing haemodialysis, acutely exacerbated with each treatment

Abstract Background and Aims Inflammation induced by haemodialysis (HD) treatment has been recognised for several decades. Despite significant advances in technology, there is evidence that incompatibility between the dialyser, a foreign surface, and the patients’ blood, results in activation of the immune system. With each session, blood-membrane interaction leads to a repetitive activation of the innate complement system and a subsequent inflammatory response. It is now widely acknowledged that the consequences of long-term inflammation include fibrosis and accelerated cardiovascular disease, a common cause of mortality in patients with renal failure. The aim of the CompAct-HD trial is to characterize complement activation and biomarker response to blood-membrane-circuit interaction during HD. Method For a single session, six timed intradialytic blood samples were collected from HD patients during standard treatment with ultrapure water and high flux “biocompatible” membranes. Complement activity potential was determined from timepoint 1 and inflammatory biomarkers from timepoints 2 to 6. Single time point samples were also collected from 7 healthy donors. Highly multiplexed assays enabled to determine 30 biomarkers of inflammation, including cytokines, chemokines, growth factors and complement proteins, from a single blood sample. Data analysis was performed using Microsoft® Excel Version 16.80 and GraphPad Prism 10.1.0. Results 354 patients were recruited from 8 dialysis units across Greater Manchester, UK. An interim analysis was performed on 150 HD patients receiving standard care as well as 7 healthy donors. Dialysis appears to generate an acute inflammatory response, that is, within 15 minutes of commencing treatment which does not appear to resolve by the end of the session. This heightened inflammatory state was observed in HD patients in comparison to healthy donors (Fig. 1) with most pronounced changes seen in cytokines IL-1β, IL-10, IL-12p40 and TNF-α during dialysis. Established markers such as IL-6 also showed a 6-fold increase at the 75th percentile. Similarly, an exaggerated intradialytic response was observed in complement proteins, including the terminal complement complex (TCC) C5b-9 and anaphylatoxin C5a with spikes of up to 7-fold and 10-fold respectively (Fig. 2). A session of HD was shown to cause a relative increase in complement proteins and inflammatory biomarkers. The magnitude of response seen in patients was variable (Fig. 3) with the greatest rise seen in the top quartile (above the Q3 boundary). Conclusion Our findings evidence a sharp inflammatory response to modern day HD treatment across a large cohort of dialysis patients. When compared to healthy donors, we observed heightened levels of inflammation in dialysis patients that is further exacerbated with each treatment session. This study shows that HD has a significant role to play in the chronic inflammatory state of patients with end stage renal failure. Furthermore, here we describe potential targets, in both cytokine and complement proteins, which could be the key to downregulation of inflammation. Using targeted therapeutics, we have an opportunity to deliver a more biocompatible treatment, improving patient outcomes.

Utilisation of intravenous iron and erythropoietin in dialysis patients: A prospective observational study

In this prospective observational study, the utilization of intravenous iron and erythropoietin in dialysis patients was thoroughly investigated. The study aimed to assess the effectiveness of these treatments in managing anaemia, a common complication in individuals undergoing dialysis. Anaemia is a significant concern in this population due to impaired erythropoiesis and iron deficiency resulting from renal dysfunction. The study followed a cohort of dialysis patients, tracking their response to intravenous iron supplementation and erythropoietin therapy over a specified period. Through regular monitoring and evaluation, the study sought to determine the impact of these interventions on haemoglobin levels, transfusion requirements, and overall patient outcomes. Additionally, the study likely analysed factors such as dosing regimens, adverse effects, and the need for additional interventions to achieve optimal haemoglobin levels. By conducting a prospective observational study, researchers aimed to provide valuable insights into the real-world effectiveness and safety of intravenous iron and erythropoietin in managing anaemia in dialysis patients, which could inform clinical practice and improve patient care strategies.

Improved Quality of Life in Postdilution Compared to Predilution Hemodiafiltration in a European Cohort of Dialysis Patients

Improved Quality of Life in Postdilution Compared to Predilution Hemodiafiltration in a European Cohort of Dialysis Patients

Long-term safety and efficacy of left atrial appendage occlusion in dialysis patients with atrial fibrillation: a multi-center, prospective, open label, observational study.

The prevalence of atrial fibrillation (AF) in end stage kidney disease (ESKD) patients undergoing dialysis is high, however, the high risk of bleeding often hampers with a correct anticoagulation in ESKD patients with AF, despite high thromboembolic risk. Left atrial appendage (LAA) occlusion is a anticoagulation (OAT) for thromboembolism prevention in AF populations with high hemorrhagic risk. The purpose of the study was to evaluate the efficacy and safety of LAA occlusion in a cohort of dialysis patients undergoing the procedure (LAA occlusion cohort, n=106), in comparison with two other ESKD cohorts, one taking warfarin (Warfarin cohort, n=114) and the other without anticoagulation therapy (No-OAT cohort, n=148). After a median follow-up of 4 years, a Cox regression model, adjusted for possible confounding factors, showed that the hazard ratios (HRs) of thromboembolic events in the LAA occlusion cohort were 0.19 (95%CI 0.04-0.96; p=0.045) and 0.16 (95%CI 0.04-0.66; p=0.011) as compared with Warfarin and No-OAT cohorts, respectively. The HR of bleeding in the LAA occlusion cohort was 0.37 (95%CI 0.16-0.83; p=0.017) compared to Warfarin cohort, while there were no significant differences between the LAA occlusion and the No-OAT cohort (HR 0.51; 95%CI 0.23-1.12; p=0.094). Adjusted Cox regression models showed lower mortality in patients undergoing LAA occlusion as compared with both the Warfarin cohort (HR 0.60; 95%CI 0.38-0.94; p=0.027) and no-OAT cohort (HR 0.52; 95%CI 0.34-0.78; p=0.002). Thromboembolic events in the LAA occlusion cohort were lower than expected according to the CHA2DS2VASc score (1.7 [95%CI 0.3-3.0] vs 6.7 events per 100 person/years, p<0.001). In ESKD patients with AF, LAA occlusion is safe and effective and is associated with reduced mortality compared with OAT or no therapy.

The impact of vascular access type on survival in haemodialysis: time for a paradigm shift? A prospective cohort study.

Although arteriovenous autologous fistula is the vascular access of choice due to better long-term outcome than central venous catheters, the use of central venous catheters is increasing. Our study aims to describe the survival and epidemiological features of a cohort of dialysis patients with a focus on the role of vascular access. Our study comprises a follow-up period from 2001 to 2020in a single center. Descriptive analysis was performed on baseline data. Moreover, we analysed predictive variables of death with univariable and multivariable logistic regressions. Predictors of survival were analysed by univariable and multivariable Cox regression. Our analysis includes 754 patients undergoing chronic haemodialysis. In the multivariable logistic regression, the use of tunnelled catheters resulted protective against death from any cause (Odds Ratio 0.43; p = 0.017). In the multivariable Cox analysis, being "late referral" was associated with decreased survival in the first 6monthssince haemodialysis start (Hazard Ratio 3.79; p = 0.001). In the subgroup of elderly (age ≥ 75years) patients (n = 201/472) with a follow up of 7-60months, multivariable logistic regression showed thattunnelled catheters at the start of haemodialysis were associated with lower mortality (Odds Ratio, 0.25; p = 0.021), whereas vascular disease was found to be the main risk factor for death (Odds Ratio, 5.11; p = 0.000). Moreover, vascular disease was confirmed as the only independent risk factor by Cox analysis (Hazard Ratio, 1.58; p = 0.017). In our cohort, mortalitywas found to be moreclosely associated with comorbidities than withthe type of vascular access. Tunnelled central venous catheters might be a viable option for haemodialysis patients.

Long-term outcomes of aortic valve replacement in dialysis patients - a nationwide retrospective cohort study.

Improved durability of modern biologic prostheses and growing experience with the transcatheter valve-in-valve technique have contributed to a substantial increase in the use of bioprostheses in younger patients. However, discussion of prosthetic valve selection in dialysis patients remains scarce as the guidelines are updated. This study aims to compare long-term outcomes between propensity score-matched cohorts of dialysis patients who underwent primary aortic valve replacement with a mechanical prosthesis or a bioprosthesis. Longitudinal data of dialysis patients who underwent primary aortic valve replacement between 1 January 2001 and 31 December 2018, were retrieved from the National Health Insurance Research Database. A total of 891 eligible patients were identified, of whom 243 ideally matched pairs of patients were analyzed. There was no significant difference in all-cause mortality (hazard ratio 1.11, 95% CI: 0.88-1.40) or the incidence of major adverse prosthesis-related events between the two groups (hazard ratio 1.03, 95% CI: 0.84-1.25). In patients younger than 50 years of age, using a mechanical prosthesis was associated with a significantly longer survival time across 10 years of follow-up than using a bioprosthesis (restricted mean survival time) at 10 years: 7.24 (95% CI: 6.33-8.14) years for mechanical prosthesis versus 5.25 (95% CI: 4.25-6.25) years for bioprosthesis, restricted mean survival time difference 1.99 years, 95% CI: -3.34 to -0.64). A 2-year survival gain in favor of mechanical prostheses was identified in dialysis patients younger than 50 years. The authors suggest mechanical prostheses for aortic valve replacement in these younger patients.

#4363 MULTINATIONAL COMPARATIVE EFFICACY OF 6 DIFFERENT COVID-19 VACCINES FOR THE PREVENTION OF BREAKTHROUGH INFECTION AND MORTALITY IN HD PATIENTS

Abstract Background and Aims COVID-19 vaccines induce specific immune responses to reduce COVID-19 infections and severe complications. Dialysis patients exhibit increased COVID-19-related incidence rates and mortality due to poor immune responses. We studied retrospectively the efficacy of 6 different COVID-19 vaccines as well as the combination of vaccines for the prevention of new COVID-19 infections and related mortality in a large multi-national hemodialysis cohort. Method All patients from 22 countries in Europe, Asia, Africa, and South America, 18 years or older, registered within in the network of a multi-national dialysis provider on January 31st 2021, were included into the study. We analyzed the incidence of symptomatic COVID-19 in HD patients with vaccination status after 2 doses of 6 different SARS-CoV-2 vaccines in comparison to HD patients who did not receive any vaccine. Patients were screened for COVID-19 symptoms at each dialysis visit and SARS-CoV-2 PCR tests were performed in all symptomatic patients. All PCR-confirmed COVID-19 infections, and deaths occurring between January 31st, and July 15th, 2021 were analyzed. Results were stratified by vaccine type and compared to unvaccinated patients. Data are presented as incidence rate ratios per 1000 patient days and odds ratios vs. no vaccine (95% CI). Results Of 38342 eligible patients registered on the index date, 2413 were excluded due to a positive SARS-CoV-2 PCR within 3 months before baseline and 26 were excluded due to unclear vaccination data. The remaining 35903 patients were analyzed. 7816 patients (21.7%) had received a single vaccine dose and 18853 patients (52.5%) had received two doses of any COVID-19 vaccine (Vaxzevria 3180 and 1321, Comirnaty 2823 and 13116, Spikevax 185 and 1521, Sputnik V 1194 and 432, Sinovac 266 and 1722, Sinopharm 168 and 416, or any combination of two different vaccines 325). The 9119 patients (25.4%) who remained unvaccinated during the observational period showed an incidence rate of 0.74/1000 patient days. In the cohort of patients vaccinated two times, 232 developed Covid-19. The lowest incidence rate ratio was observed in patients that had received Spikevax 0.06 (0.02-0.14). By contrast, patients after Sinopharm, Sinovac, and Sputnik V exhibited highest incidence rate ratios 0.53 (0.21-1.09), 0.46 (0.34-0.61), 0.68 (0.34-1.23), respectively. The largest sub-cohort of 13116 patients, who had received Comirnaty, however, had an incidence rate ratio of 0.15 (0.12-0.17). Albeit incidence rates and ratios were heterogenous, all vaccines including Sputnik V showed a significant efficacy to reduce mortality compared to no vaccine. Conclusion Combinations of different vaccines and two doses of mRNA-based vaccines very effectively prevented breakthrough infections. Despite considerable differences in preventing COVID-19 infections, all vaccines effectively reduced mortality, compared to no vaccines, in this high-risk dialysis patient cohort.

Immunogenicity of the Two mRNA SARS-CoV-2 Vaccines in a Large Cohort of Dialysis Patients.

Chronic kidney disease patients, especially those on hemodialysis, are at the highest risk of a severe course and death from COVID-19. Moreover, they appear to have suboptimal response in both cellular and humoral immunity after vaccination. The present study investigated humoral and cellular response and safety after two doses of either of the two authorized mRNA vaccines in a cohort of 310 patients on maintenance dialysis. The antibody response rate was 94.5%, with a median (25th, 75th) antibody titer of 3478 (1236, 8141) AU/mL. Only mild adverse effects were observed. Only vaccine type was independently associated with immunogenicity. Α statistically significant difference in favor of mRNA1273 versus BNT162b2 vaccine was observed. Antibody positivity (100% vs. 94.3%, p &lt; 0.001), median (25th, 75th) antibody levels: 9499 (6118, 20,780) AU/mL vs. 3269 (1220, 7807) AU/mL (p &lt; 0.001). Among the 65 patients tested for T-cell response, 27 (41.5%) had a positive one with a median (25th, 75th) antibody titer of 6007 (3405, 12,068) AU/mL, while 38 with no T-cell response presented a lower median (25th, 75th) antibody titer of 1744 (850, 4176) AU/mL (p &lt; 0.001). Both mRNA vaccines are safe for dialysis patients and can trigger humoral and cellular responses, although with lower titers than those that have been reported to healthy individuals.

Association between kidney retransplantation and survival according to age in the French national cohort of dialysis patients

The mean age of patients returning to dialysis after a first kidney transplantation (KT) has increased in the past decades. We aimed to assess the association between second KT (2KT) and survival according to age at the time of return to dialysis. Data of 5334 patients registered in the French Renal Epidemiology and Information Network (REIN) (mean age 56.6 ± 13.6 years) who returned to dialysis after a first KT were collected. The association of 2KT with death was assessed using a propensity score‐based analysis taking into account baseline and follow‐up variables. In relisted patients (3272 patients, 61.3%), retransplantation was associated with better overall survival in comparison with patients who remained in dialysis (adjusted HR 0.75 [0.63–0.89], p = .0009). The survival advantage conferred by retransplantation gradually declined with increasing age (adjusted HR 0.41 [0.24–0.70] in patients <50, HR 0.94 (0.69–1.27) in patients aged 70 or older, p for interaction 0.034 for age considered as a continuous variable). 2KT is associated with better survival as opposed to remaining on dialysis after a first kidney graft failure. Nevertheless, this survival benefit is age dependent and diminishes with increasing age. The risk/benefit ratio should be comprehensively assessed in the oldest patients when relisting is considered.

FC 101: The Impact of Vascular Access Types on Survival in Hemodialysis: Time for a Shift in Paradigm? A Prospective Cohort Study

Abstract BACKGROUND AND AIMS Despite arteriovenous native fistula (AVF) is the vascular access (VA) of choice due to a better outcome than central venous catheter (CVC) [1], catheter use is still common among haemodialysis (HD) patients. Our study aims to describe the survival and epidemiological features of a cohort of dialysis patients with a focus on the role of VA type. METHOD Our cohort comprises a prospective follow-up conduced from 2001 to 2020, which led to recruit 754 patients in HD. We identified a subgroup of patients survived less than 7 months (n 124) and a subgroup of patients survived more or equal than 7 months and up to 60 months (n = 472). In addition to this, every subgroup was subdivided into two different age groups, including patients of age ≤74 years old and those ≥75 years old. Other analysed characteristics were demographic features and baseline clinical data, like primary cause of ESKD, co-morbidities at the beginning of the HD treatment and type of VA both at start of HD and at the end of the follow-up. Starting HD without planning, namely being ‘late referral’, was also considered. Descriptive analysis was performed on baseline data. Moreover, we analysed predictive variables of death for any cause with Univariate and Multivariate Logistic Regression. Predictors of survival were analysed through univariate and multivariate Cox regression. RESULTS At the multivariate logistic regression, the use of tunnelled CVC at the start of HD resulted protective against death from any cause (aOR, 0.43; P = 0.017) in the whole cohort (n = 754). In the subgroup analysis of patients (n = 124) with a follow-up &amp;lt; 7 months, malignancy (aOR, 4.57; P = 0.002), severe cardiomyopathy (aOR, 4.35; P = 0.001) and vascular disease (aOR, 3.22; P = 0.008) were estimated as significantly predictors of death. At the multivariate Cox analysis, being ‘late referral’ was associated with decreased survival within 6 months (aHR, 3.79; P = 0.001). In the subgroup of elderly (≥75 years old; n = 201/472) survived within 7–60 months, multivariate logistic regression showed that the use of tunnelled CVC at the start of HD (Figure 1) resulted even more protective against death (aOR 0.25; P = 0.021). Moreover, vascular disease resulted as the main risk factor for death (aOR 5.11; P = 0.000), and it was confirmed as the only independent risk factor at the COX analysis (aHR 1.58; P = 0.017; see Figure 2). CONCLUSION Vascular disease is the main risk factor for death in haemodialysis patients. Furthermore, cardiovascular disease influences patient outcome more than the VA type, confirming the assumption that the choice of VA might be influenced by several issues as age and comorbidities [2, 3]. In the short-term survival subgroup, neither VA nor age emerged to be predictor of mortality, suggesting that health status before starting maintenance HD might explain an important part of the risk often attributed to catheter use.[4] Moreover, starting RRT without proper planning (‘late referral’) was extremely relevant in determining short-term survival. Tunnelled CVC might be the option of choice as VA, specifically in the elderly with vascular disease. In conclusion, our long-term experience suggests that the choice of VA should not necessarily follow the ‘fistula first’ approach, but it should be based on dialytic life expectancy and comorbidities.

Malnutrition is Associated with Increased Morbidity and Death in Dialysis Patients Undergoing Endovascular Therapy for Peripheral Artery Disease

Revascularisation for peripheral artery disease (PAD) is increasingly common in dialysis patients. Patients with PAD who have undergone revascularisation are at high risk of subsequent complications. Malnutrition is an important modifiable risk factor for dialysis patients, yet few data exist on the prognostic impact of malnutrition on post-procedure long term outcomes. The objective was to assess the prevalence and prognostic association of malnutrition using the Controlling Nutritional Status (CONUT) score in a prospective cohort of dialysis patients undergoing endovascular therapy (EVT) for PAD. A total of 395 consecutive dialysis patients undergoing endovascular revascularisation for lower extremity PAD between 2005 and 2019 were examined for the primary outcome of all cause death. Secondary outcomes included major adverse limb events (MALEs), defined as acute limb ischaemia, major amputation, and clinically driven revascularisation; and major adverse cardiovascular events (MACEs). Nutritional status was assessed by CONUT score, a screening tool for malnutrition, incorporating albumin, cholesterol, and total lymphocyte count. According to the CONUT score, 40.8% of patients were moderately or severely malnourished. During a median follow up of 2.2 years, 218 (55.2%) patients died; 211 (53.4%) patients had MALEs, and MACEs occurred in 135 (34.2%) patients. Compared with normal nutritional status, severe malnutrition was associated with a significantly increased risk of all cause death (adjusted hazard ration [aHR] 4.83, 95% confidence interval [CI] 2.56 - 9.12) and MALEs (aHR 2.42, 95% CI 1.23 - 4.74) but not MACEs (aHR 1.81, 95% CI 0.74 - 4.40). Similar results were observed when the CONUT score was analysed as a continuous variable. Malnutrition is common in dialysis patients with PAD requiring endovascular therapy and is strongly associated with increased death and MALEs. Clinical trials are needed to evaluate whether nutritional interventions improve outcomes for dialysis patients after peripheral revascularisation.

Dialysis symptom index burden and symptom clusters in a prospective cohort of dialysis patients

BackgroundDialysis patients experience a high symptom burden, which may adversely impact their quality of life. Whereas other specialties emphasize routine symptom assessment, symptom burden is not well-characterized in dialysis patients. We sought to examine the prevalence and severity of unpleasant symptoms in a prospective hemodialysis cohort.MethodsAmong 122 hemodialysis patients from the prospective Malnutrition, Diet, and Racial Disparities in Chronic Kidney Disease (CKD) study, CKD-associated symptoms were ascertained by the Dialysis Symptom Index, a validated survey assessing symptom burden/severity (with higher scores indicating greater symptom severity), over 6/2020–10/2020. We examined the presence of (1) individual symptoms and symptom severity scores, and (2) symptom clusters (defined as ≥ 2 related concurrent symptoms), as well as correlations with clinical characteristics.ResultsSymptom severity scores were higher among non-Hispanic White and Hispanic patients, whereas scores were lower in Black and Asian/Pacific Islander patients. In the overall cohort, the most common individual symptoms included feeling tired/lack of energy (71.3%), dry skin (61.5%), trouble falling asleep (44.3%), muscle cramps (42.6%), and itching (42.6%), with similar patterns observed across racial/ethnic groups. The most prevalent symptom clusters included feeling tired/lack of energy + trouble falling asleep (37.7%); trouble falling asleep + trouble staying asleep (34.4%); and feeling tired/lack of energy + trouble staying asleep (32.0%). Lower hemoglobin, iron stores, and dialysis adequacy correlated with higher individual and overall symptom severity scores.ConclusionWe observed a high prevalence of unpleasant symptoms and symptom clusters in a diverse hemodialysis cohort. Further studies are needed to identify targeted therapies that ameliorate symptom burden in CKD.Graphical abstract

Recovery of dialysis patients with COVID-19: health outcomes 3 months after diagnosis in ERACODA.

ABSTRACTBackgroundCoronavirus disease 2019 (COVID-19)-related short-term mortality is high in dialysis patients, but longer-term outcomes are largely unknown. We therefore assessed patient recovery in a large cohort of dialysis patients 3 months after their COVID-19 diagnosis.MethodsWe analyzed data on dialysis patients diagnosed with COVID-19 from 1 February 2020 to 31 March 2021 from the European Renal Association COVID-19 Database (ERACODA). The outcomes studied were patient survival, residence and functional and mental health status (estimated by their treating physician) 3 months after COVID-19 diagnosis. Complete follow-up data were available for 854 surviving patients. Patient characteristics associated with recovery were analyzed using logistic regression.ResultsIn 2449 hemodialysis patients (mean ± SD age 67.5 ± 14.4 years, 62% male), survival probabilities at 3 months after COVID-19 diagnosis were 90% for nonhospitalized patients (n = 1087), 73% for patients admitted to the hospital but not to an intensive care unit (ICU) (n = 1165) and 40% for those admitted to an ICU (n = 197). Patient survival hardly decreased between 28 days and 3 months after COVID-19 diagnosis. At 3 months, 87% functioned at their pre-existent functional and 94% at their pre-existent mental level. Only few of the surviving patients were still admitted to the hospital (0.8–6.3%) or a nursing home (∼5%). A higher age and frailty score at presentation and ICU admission were associated with worse functional outcome.ConclusionsMortality between 28 days and 3 months after COVID-19 diagnosis was low and the majority of patients who survived COVID-19 recovered to their pre-existent functional and mental health level at 3 months after diagnosis.

Prevalence of hepatitis B and vaccination response in patients with end-stage kidney disease on dialysis at a tertiary centre in the Eastern Cape province of South Africa

Introduction: Hepatitis B virus (HBV) infection remains a concern in dialysis populations where vaccination has been less successful than in the general population. Possible reasons for poor response to vaccination in this population include malnutrition, age, uraemia, dialysis vintage, human immunodeficiency virus (HIV) infection and the generalized immunosuppressive state of patients with chronic kidney disease (CKD).Methods: This retrospective point prevalent cohort study evaluated the prevalence of HBV infection in a dialysis population at a tertiary centre in South Africa where there is a high prevalence of HIV. In addition, antibody responses following natural HBV infection versus vaccination were examined in the same population as well as factors that may affect the HBV vaccination antibody response.Results: There were 107 study participants. The prevalence rate of chronic HBV was high at 6.5% (n = 7), whereas 48 (45%) patients demonstrated evidence of HBV exposure. Patients with naturally acquired immunity demonstrated a more robust and sustained antibody response over the study period, whereas booster dose(s) were required to achieve similar levels of protection in the vaccinated group. Only one (2.1%) of those requiring vaccination never achieved an adequate seroprotection response to vaccination at any time point during the study period. Older age was the only factor shown to reduce seroconversion after primary vaccination. Despite high HIV prevalence (23%), HIV status did not affect antibody response to vaccination.Conclusion: We therefore conclude that in a cohort of dialysis patients with high HBV prevalence, natural immunity provides sustained and adequate protection. HBV vaccination in this dialysis cohort was successful, but additional booster doses were frequently required to achieve adequate seroprotection, regardless of HIV status. Keywords: Hepatitis B, Dialysis, Prevalence, Vaccination, Immunity, Antibody

MO791HIGH-SENSITIVITY CARDIAC TROPONIN I CORRELATES WITH THE CARDIAC DYSFUNCTION AND WITH THE SEVERITY OF ANEMIA IN DIALYSIS PATIENTS

Abstract Background and Aims Several evidences demonstrate that chronic dialysis treatment alters troponin levels, even in the absence of an acute myocardial event, although the underlying causes remain largely unclear. In this small pilot study, we aimed at analyzing high sensitivity troponin T (HsTnT) in a cohort of dialysis patients to identify the potential clinical predictors. Method HsTnT levels were measured together with common laboratory and clinical parameters in 39 chronic dialysis patients (middle age: 65±12 aa; 82% M; 30 in hemodialysis and 9 in peritoneal dialysis). The patients underwent also a complete echocardiography assessment. Results HsTnT levels were higher than normal reference values (median 46.1 ng/L IQR 33.5-84.3),but showing no differences between hemodialysis and peritoneal dialysis patients (p=0.19). At correlation analyses, HsTnT were strongly associated with beta2-MCG (R=0.43; p=0.008), Hemoglobin (r=-0.47; p=0.002) and, in particular, with some echocardiography parameters such as ejection fraction (R=-0.29; p=0.05), E/E’ratio (R=0.56; p=0.006) and LAVI (R=0.41; p=0.05) Figure 1. Conclusion In a small cohort of dialysis patients, high HsTnt levels were at the crossroad between the severity of functional heart dysfunction and anemia. Larger studies are advocated to further clarify the role of HsTnT as a potential biomarker reflecting the anemic cardiorenal syndrome which characterizes uremic subjects.

Parathyroid hormone levels after parathyroidectomy for secondary hyperparathyroidism.

The parathormone level after parathyroidectomy in dialysis patients are of interest. Low levels may require cryopreserved tissue implantation; however, the resection is necessary in case of recurrence. We analyzed post parathyroidectomy parathormone levels in renal hyperparathyroidism. Prospective observation of postoperative parathormone levels over defined periods in a cohort of dialysis patients that underwent total parathyroidectomy and immediate forearm autograft from 2008 to 2010, at a single tertiary care hospital. Of 33 patients, parathormone levels until 36 months could be divided into four patterns. Patients with stable function (Pattern 1) show relatively constant levels after two months (67% of the cases). Early function and later failure (Pattern 2) were an initial function with marked parathormone reduction before one year (18%). Graft recurrence (Pattern 3) showed a progressive increase of parathormone in four cases (12%). Complete graft failure (Pattern 4) was a nonfunctioning implant at any period, which was observed in one patient (3%). Parathormone levels of Pattern 3 became statistically different of Pattern 1 at 36 months. Patients that underwent the total parathyroidectomy and autograft present four different graft function patterns with a possible varied therapeutic management.

Recovery of kidney function in patients treated with maintenance dialysis-a report from the ERA-EDTARegistry.

Literature on recovery of kidney function (RKF) in patients with end-stage kidney disease treated with maintenance dialysis (i.e. >90 days) is limited. We assessed the incidence of RKF and its associated characteristics in a European cohort of dialysis patients. We included adult patients from the European Renal Association-European Dialysis and Transplant Association Registry who started maintenance dialysis in 1997-2016. Sustained RKF was defined as permanent discontinuation of dialysis. Temporary discontinuation of ≥30 days (non-sustained RKF) was also evaluated. Factors associated with RKF adjusted for potential confounders were studied using Cox regression analyses. RKF occurred in 7657 (1.8%) of 440 996 patients, of whom 71% experienced sustained RKF. Approximately 90% of all recoveries occurred within the first 2 years after Day 91 of dialysis. Of patients with non-sustained RKF, 39% restarted kidney replacement therapy within 1 year. Sustained RKF was strongly associated with the following underlying kidney diseases (as registered by the treating physician): tubular necrosis (irreversible) or cortical necrosis {adjusted hazard ratio [aHR] 20.4 [95% confidence interval (CI) 17.9-23.1]}, systemic sclerosis [aHR 18.5 (95% CI 13.8-24.7)] and haemolytic uremic syndrome [aHR 17.3 (95% CI 13.9-21.6)]. Weaker associations were found for haemodialysis as a first dialysis modality [aHR 1.5 (95% CI 1.4-1.6)] and dialysis initiation at an older age [aHR 1.8 (95% CI 1.6-2.0)] or in a more recent time period [aHR 2.4 (95% CI 2.1-2.7)]. Definitive discontinuation of maintenance dialysis is a rare and not necessarily an early event. Certain clinical characteristics, but mostly the type of underlying kidney disease, are associated with a higher likelihood of RKF.