Complication Of Hemodialysis Research Articles

Intradialytic Hypotension: An Often Neglected and Common Hemodialysis Complication Affecting Quality of Life in Patients

The Article Abstract is not available.

Summary of Complications in Maintenance Hemodialysis Using Tunneled Cuffed Catheters (TCC) in Our Hospital

Summary of Complications in Maintenance Hemodialysis Using Tunneled Cuffed Catheters (TCC) in Our Hospital

Simulation-based assessment of zwitterionic pendant group variations on the hemocompatibility of polyethersulfone membranes

In the realm of hemodialysis, Polyethersulfone (PES) membranes dominate due to their exceptional stability and mechanical properties, capturing 93% of the market. Despite their widespread usage, the hydrophobic nature of PES introduces complications in hemodialysis, potentially leading to severe adverse reactions in patients with end-stage renal disease (ESRD) through protein fouling. Addressing this issue, our study focused on enhancing hemocompatibility by modifying PES surfaces with zwitterionic materials, known for their hydrophilicity and biological membrane compatibility. We investigated the functionalization of PES membranes utilizing various zwitterions in different ratios. Utilizing molecular docking, we examined the interactions of three zwitterionic ligands—carboxybetaine methacrylate (CBMA), sulfobetaine methacrylate (SBMA), and (2-(methacryloyloxy)ethyl) phosphorylcholine (MPC)—with human serum proteins. Our analysis revealed that a 1:1 ratio of phosphobetaine and sulfobetaine exhibits the lowest affinity energy towards serum proteins, denoting an optimal hemocompatibility without the limitations associated with increased zwitterion ratios. This pivotal finding offers a new pathway for developing more efficient and safer hemodialysis membranes, promising improved care for ESRD patients.

Sarcopenia is associated with increased major adverse cardiovascular event incidence in maintenance hemodialysis patients: a prospective cohort study and mediation analysis.

Few studies have investigated the relationship between sarcopenia and the incidence of major adverse cardiovascular events (MACE), which are common complications in maintenance hemodialysis (MHD) patients. This study thus explored the association between sarcopenia and MACE in a prospective cohort with mediation analysis. Adult MHD patients in Jiangdu People's Hospital in December 2019 were screened. The exposure was sarcopenia, as defined by the 2019 Asian Working Group. The primary endpoint was the occurrence of MACE, defined as the composite of all-cause mortality or hospital admission with a primary diagnosis of acute myocardial infarction, stroke, or heart failure during a 3-year follow-up period. Multivariate Cox regression analyses were used to test the association between sarcopenia and subsequent MACE incidence. Mediation analyses were used to investigate whether potential mediators influenced the association between sarcopenia and MACE. Of the 230 patients enrolled, 57% were male, with a median age of 57 years (interquartile range [IQR]: 50 to 66), and a median dialysis vintage of 67 months (IQR: 32 to 119). The prevalence of sarcopenia was 45.2%. The presence of sarcopenia was significantly correlated with age (Spearman's r = 0.47, p < 0.001), C-reactive protein (Spearman's r = 0.13, p = 0.044), serum albumin (Spearman's r = -0.22, p < 0.001), 25(OH) vitamin D (Spearman's r = -0.26, p < 0.001), and coronary artery calcification score (Spearman's r = 0.20, p = 0.002). Over the 3-year follow-up period, MACE were observed in 59/104 (56.7%) patients with sarcopenia and 38/126 (30.2%) patients without sarcopenia (log-rank p < 0.001). After accounting for potential confounders, patients with sarcopenia presented a 66% (4-168%, p = 0.035) increase in their risk of MACE incidence as compared to non-sarcopenic individuals. However, adjusted mediation analyses did not detect any indication of a causal mediation pathway linking the effects of sarcopenic status on coronary artery calcification score, C-reactive protein, serum albumin, or 25(OH) vitamin D levels to MACE outcomes. Conversely, sarcopenia exhibited a potential direct effect (average direct effect range: -1.52 to -1.37, all p < 0.05) on MACE incidence. These results revealed that the presence of sarcopenia was associated with a higher incidence of MACE in MHD patients. The putative effects of sarcopenia on this cardiovascular endpoint are possibly not mediated by any causal pathways that include vascular calcification, inflammation, hypoalbuminemia, or vitamin D.

Geriatric nutritional risk index and quality of life among elderly hemodialysis patients: a cross-sectional study.

Nutritional problems are considered one of the main complications of hemodialysis, and the geriatric nutritional risk index (GNRI) is a new instrument for assessing geriatric nutritional status. The present study sought to evaluate the relationship between the GNRI and quality of life (QOL) among elderly hemodialysis patients. In the present analytical cross-sectional study, 110 hemodialysis individuals were selected by applying a simple random sampling method, among whom 57 and 53 were males and females, respectively (mean: 70.3±6.93 years). Demographic characteristics, GNRI, and QOL status were determined. The data were analyzed using SPSS 20 software and descriptive statistics, Pearson's correlation, ANOVA, independent sample t-tests, and multiple linear regression analysis. The mean GNRI and mean total QOL were respectively obtained 93.903±11.067 and 20.95 ± 4.89. Among females, a significant direct relationship was observed between GNRI and total QOL (P = 0.010, r = 0.352), autonomy (P = 0.004, r = 0.389), and pleasure (P = 0.015, r = 0.333), while GNRI was not directly and significantly related to QOL in males (P = 0.161, r = 0.188). Due to the presence of a significant association between Geriatric GNRI and QOL among elderly hemodialysis patients, particularly among females, highlighting the importance of addressing nutritional status in optimizing well-being.

Personalized prediction of intradialytic hypotension in clinical practice: Development and evaluation of a novel AI dashboard incorporating risk factors from previous and current dialysis sessions

BackgroundIntradialytic hypotension (IDH) is one of the most common and critical complications of hemodialysis. Despite many proven factors associated with IDH, accurately predicting it before it occurs for individual patients during dialysis sessions remains a challenge. PurposeTo establish artificial intelligence (AI) predictive models for IDH, which consider risk factors from previous and ongoing dialysis to optimize model performance. We then implement a novel digital dashboard with the best model for continuous monitoring of patients’ status undergoing hemodialysis. The AI dashboard can display the real-time probability of IDH for each patient in the hemodialysis center providing an objective reference for care members for monitoring IDH and treating it in advance. MethodsEight machine learning (ML) algorithms, including Logistic Regression (LR), Random Forest (RF), Support Vector Machine (SVM), K Nearest Neighbor (KNN), Light Gradient Boosting Machine (LightGBM), Multilayer Perception (MLP), eXtreme Gradient Boosting (XGBoost), and NaiveBayes, were used to establish the predictive model of IDH to determine if the patient will acquire IDH within 60 min. In addition to real-time features, we incorporated several features sourced from previous dialysis sessions to improve the model’s performance. The electronic medical records of patients who had undergone hemodialysis at Chi Mei Medical Center between September 1, 2020 and December 31, 2020 were included in this research. Impact evaluation of AI assistance was conducted by IDH rate. ResultsThe results showed that the XGBoost model had the best performance (accuracy: 0.858, sensitivity: 0.858, specificity: 0.858, area under the curve: 0.936) and was chosen for AI dashboard implementation. The care members were delighted with the dashboard providing real-time scientific probabilities for IDH risk and historic predictive records in a graphic style. Other valuable functions were appended in the dashboard as well. Impact evaluation indicated a significant decrease in IDH rate after the application of AI assistance. ConclusionThis AI dashboard provides high-quality results in IDH risk prediction during hemodialysis. High-risk patients for IDH will be recognized 60 min earlier, promoting individualized preventive interventions as part of the treatment plan. Our approachis believed to promise an excellent way for IDH management.

Proximalization of arterial inflow for treatment of hemodialysis access-induced distal ischemia

ObjectiveHemodialysis access-induced distal ischemia (HAIDI) is a known complication of hemodialysis (HD) access. Distal revascularization and interval ligation (DRIL) is the preferred treatment for HAIDI by many surgeons. Proximalization of arterial inflow (PAI) is a promising alternative technique that, unlike DRIL, preserves the native arterial inflow. The purpose of this study is to report our experience with PAI on a series of 64 patients. MethodsThis is a single-center, retrospective cohort study of patients with both arteriovenous (AV) fistulas and grafts who underwent PAI for HAIDI from 2017 to 2023. A 4 × 7 tapered polytetrafluoroethylene (PTFE) graft was used to connect HD access inflow to the axillary artery in the majority of cases. The primary outcome of the study is resolution of HAIDI (complete, partial, or no resolution). Secondary outcomes include functional patency (primary and secondary) and 30-day complications following PAI. ResultsOf the 71 patients identified to have had PAI between May 2017 to August 2023, seven were lost to follow-up. In total, 64 patients were included, with an average age of 65 years (standard deviation, 15 years), 59.4% (38/64) female, and 37.5% (24/64) African American. The study population was notable for numerous comorbid conditions including 95.3% (61/64) hypertension; 50% (32/64) coronary artery disease; 79.7% (51/64) diabetes; and 43.8% (28/64) smoking history. Following PAI intervention for HAIDI, 55 of 64 patients (85.9%) experienced complete resolution of ischemic symptoms; five of 64 patients (7.8%) had partial resolution; two of 64 patients (3.1%) had no resolution, and two of 64 patients (3.1%) had unknown resolution. Primary patency at 1, 12, and 24 months was 94%, 81%, and 71%, respectively. Secondary patency at 1, 12, and 24 months was 97%, 87%, and 84%, respectively. The 30-day complication rate was 10.9% (7/64), with five of 64 (7.8%) thromboses, one of 64 (1.6%) thrombosis and infection, and one of 64 (1.6%) upper extremity swelling secondary to central venous stenosis (resolved with angioplasty of central venous system). Failure rate due to thrombosis at 12 and 24 months was 14% (9/64) and 15.6% (10/64), respectively. ConclusionsOur study, the largest case series of PAI to date, demonstrates that PAI is a reliable option for HAIDI intervention and has comparable safety and efficacy results to DRIL, despite the use of a synthetic graft. Furthermore, PAI has the added benefit of maintaining the native arterial pathway. Further investigation of PAI is warranted as a promising alternative to DRIL for HAIDI management.

Echocardiographic Changes in Prevalent Hemodialysis Population Based on Cardiac Symptomatology

BACKGROUND: Despite the prevalence of cardiovascular complications in hemodialysis (HD) patients, routine screening for asymptomatic individuals remains underexplored in clinical practice, particularly beyond those assessed for kidney transplantation. This study aimed to investigate echocardiographic changes in prevalent HD patients, irrespective of symptomatic presentation. SUBJECTS AND METHODS: A prospective, single-center study spanning 36 months included 79 HD patients. Grouping was based on cardiac symptomatology assessed with the New York Heart Association (NYHA) classification: group 1 comprised 18 asymptomatic patients (NYHA class I), while group 2 included 61 patients with moderate cardiac symptoms (NYHA classes II and III). Routine laboratory analyses, miRNA 133, hydration, and nutritional parameters were assessed, with echocardiography performed a day post-HD. RESULTS: Demographic data, HD quality, blood pressure, therapy, and most echocardiographic indicators showed no significant differences. Asymptomatic patients exhibited noteworthy cardiac structural and functional abnormalities: 55.5% had left ventricular hypertrophy (LVH), and 72.2% had increased left atrial volume index (LAVi). Concentric hypertrophy was observed in 7/18 asymptomatic patients, while 15/61 symptomatic patients demonstrated concentric left ventricle remodeling. In comparison to group 2, group 1 displayed higher hemoglobin, uric acid, and miRNA 133 concentrations, along with better hydration control and higher lean tissue index. All these dependent variables show statistically significant relation to the NYHA: approximately 13% of the variance in Hb levels and 18% of the variance in miRNA can be explained by NYHA classification. CONCLUSION: This study advocates for routine echocardiographic and cardiac examinations for all HD patients from the treatment's onset, irrespective of symptoms. Maintaining optimal volume, nutrition, urate concentrations, and hemoglobin is crucial for comprehensive cardiac care in this population. Additionally, exploring whether interventions targeting these non-cardiac factors could alleviate symptoms and improve quality of life in symptomatic HD patients would be worthwhile.

The prevalence and risk of mortality associated with intradialytic hypertension among patients with end-stage kidney disease on haemodialysis: A systematic review and meta-analysis.

Intradialytic hypertension (IDHTN) is a common but less frequently recognised complication of haemodialysis. However, it is associated with increased overall mortality in patients on haemodialysis. This systematic review and meta-analysis aimed to determine the prevalence of IDHTN and associated mortality risk in the global haemodialysis population. A systematic search of PubMed and EMBASE was undertaken to identify articles with relevant data published between 1990 and 2023. The pooled prevalence of IDHTN in the global haemodialysis population was determined using the DerSimonian-Laird random-effects meta-analysis. The pooled hazards ratio for mortality in patients with IDHTN was also computed from the studies that reported mortality among haemodialysis patients with IDHTN. The study protocol was registered with PROSPERO (CRD42023388278). Thirty-two articles from 17 countries were included, with a pooled population of 127,080 hemodialysis patients (median age 55.1 years, 38.2% females). Most studies had medium methodological quality (53.1%, n = 17). The overall pooled prevalence of IDHTN was 26.6% [(95% CI 20.2-33.4%), n = 27 studies, I2 = 99.3%, p<0.001 for heterogeneity], with significant differences depending on the definition used. The pooled proportion of haemodialysis sessions with IDHTN was 19.9% [(95% 12.5-28.6%, n = 8 studies, I2 = 99.3%, p<0.001 for heterogeneity)] with significant differences across the different definition criteria. The p-value for the Begg test was 0.85. The median pre-dialysis blood pressure was not significantly associated with IDHTN. The pooled hazard ratio for mortality was 1.37 (95% CI 1.09-1.65), n = 5 studies, I2 = 13.7%, and p-value for heterogeneity = 0.33. The prevalence of IDHTN is high and varies widely according to the definition used. A consensus definition of IDHTN is needed to promote uniformity in research and management. The increased mortality risk forecasted by IDHTN highlights the need for optimal blood pressure control in patients on hemodialysis.

The value of multi-modal ultrasound in the assessment of sarcopenia in maintenance hemodialysis patients

IntroductionSarcopenia is one of the common complications in maintenance hemodialysis (MHD) patients and is associated with poor prognosis. We aimed to study the validity and reliability of ultrasound in the assessment of sarcopenia in MHD patients. MethodsMHD patients were categorized into the sarcopenia group and the non-sarcopenia group according to the diagnostic criteria of the Asian Working Group on Sarcopenia (AWGS) 2019. Ultrasonography of the left medial head of the gastrocnemius muscle was performed in MHD and healthy controls to obtain muscle thickness (MT), pinnation angle (PA), fascicle length (FL), cross-sectional area (CSA), echo intensity (EI), elastic modulus (E), shear wave velocity (SWV), and microvascular velocity (MV). Compare the differences in ultrasound parameters among different groups, and determine the cut-off values suitable for diagnosing sarcopenia in MHD patients. ResultsThe MT, CSA, PA, and MV in the sarcopenia group were lower than those in the non-sarcopenia group and the control group; while the EI was higher, the FL of the sarcopenia group was lower than that of the non-sarcopenia group, while the E and SWV of the sarcopenia group were higher than those of the control group. Receiver operating characteristic curve analyses indicated that ultrasound combined index had a good diagnostic value, model Y = 13.511−0.121*MT-0.609*CSA-0.172*PA+0.011*EI-2.205*MV(P < 0.05), with a cut-off value of 0.69. ConclusionsMulti-modal ultrasound is a safe, non-invasive, and real-time imaging examination method, and can provide information on muscle structure, stiffness, and perfusion, which is expected to be a promising potential tool for predicting sarcopenia in MHD patients.

Valor de la ecografía multimodal en la evaluación de la sarcopenia en pacientes en hemodiálisis de mantenimiento

IntroductionSarcopenia is one of the common complications in maintenance hemodialysis (MHD) patients and is associated with poor prognosis. We aimed to study the validity and reliability of ultrasound in the assessment of sarcopenia in MHD patients. MethodsMHD patients were categorized into the sarcopenia group and the non-sarcopenia group according to the diagnostic criteria of the Asian Working Group on Sarcopenia (AWGS) 2019. Ultrasonography of the left medial head of the gastrocnemius muscle was performed in MHD and healthy controls to obtain muscle thickness (MT), pinnation angle (PA), fascicle length (FL), cross-sectional area (CSA), echo intensity (EI), elastic modulus (E), shear wave velocity (SWV), and microvascular velocity (MV). Compare the differences in ultrasound parameters among different groups, and determine the cut-off values suitable for diagnosing sarcopenia in MHD patients. ResultsThe MT, CSA, PA, and MV in the sarcopenia group were lower than those in the non-sarcopenia group and the control group; while the EI was higher, the FL of the sarcopenia group was lower than that of the non-sarcopenia group, while the E and SWV of the sarcopenia group were higher than those of the control group. Receiver operating characteristic curve analyses indicated that ultrasound combined index had a good diagnostic value, model Y=13.511-0.121*MT-0.609*CSA-0.172*PA+0.011*EI-2.205*MV (p<0.05), with a cut-off value of 0.69. ConclusionsMulti-modal ultrasound is a safe, non-invasive, and real-time imaging examination method, and can provide information on muscle structure, stiffness, and perfusion, which is expected to be a promising potential tool for predicting sarcopenia in MHD patients.

Pengaruh Aromaterapi Lavender untuk Kualitas Tidur Pada Pasien Hemodialisa RS PKU Muhammadiyah Yogyakarta

Chronic Kidney Disease (CKD) is defined when kidney damage lasts more than 3 months. Chronic Kidney Disease (CKD) is a disease with various causes in the form of structural or functional abnormalities, accompanied by a decrease in glomerular filtration rate (GFR). People with chronic kidney disease and kidney failure often require kidney replacement therapy or hemodialysis. Sleep disorders are one of the complications of hemodialysis and often occur in patients with chronic kidney disease and over a long period of time. This can affect the quality of sleep of people with chronic kidney disease, both in terms of quantity and duration of sleep, which ultimately affects the individual's daily function. Non-pharmacological methods such as aromatherapy are important to relieve, prevent or treat certain diseases using natural plant spices or aromatic essential oils. Lavender aromatherapy belongs to the Lamiaceae family and its scientific name is Lavandula angustifolia. Inhaling lavender oil is a simple method that has been proven to have a positive effect on various symptoms, especially in hemodialysis patients with sleep disorders.

Continuous Monitoring of Advanced Hemodynamic Parameters during Hemodialysis Demonstrated Early Variations in Patients Experiencing Intradialytic Hypotension.

Intradialytic hypotension (IDH) is a severe complication of hemodialysis (HD) with a significant impact on morbidity and mortality. In this study, we used a wearable device for the continuous monitoring of hemodynamic vitals to detect hemodynamic changes during HD and attempted to identify IDH. End-stage kidney disease patients were continuously monitored 15 min before starting the session and until 15 min after completion of the session, measuring heart rate (HR), noninvasive cuffless systolic and diastolic blood pressure (SBP and DBP), stroke volume (SV), cardiac output (CO), and systemic vascular resistance (SVR). Data were analyzed retrospectively and included comparing BP measured by the wearable devices (recorded continuously every 5 s) and the cuff-based devices. A total of 98 dialysis sessions were included in the final analysis, and IDH was identified in 22 sessions (22.5%). Both SBP and DBP were highly correlated (r > 0.62, p < 0.001 for all) between the wearable device and the cuff-based measurements. Based on the continuous monitoring, patients with IDH had earlier and more profound reductions in SBP and DBP during the HD treatment. In addition, nearly all of the advanced vitals differed between groups. Further studies should be conducted in order to fully understand the potential of noninvasive advanced continuous monitoring in the prediction and prevention of IDH events.

#360 Short-term treatment with medium cut-off dialyzers increases muscle mass with preserved fat tissue in maintenance HD patients

Abstract Background and Aims Protein-energy wasting is a significant complication of maintenance hemodialysis (HD) patients characterized by reduced fat or muscle mass and strength. The combination of non-modifiable general and disease-related factors, such as uremic toxin accumulation and systemic inflammation, is responsible for this condition. Medium cut-off (MCO) membranes are designed to provide clearance of large-middle molecular weight uremic toxins and inflammatory cytokines without causing loss of albumin. This study aimed to investigate the short-term effect of MCO dialyzers on fat tissues and muscle mass. Method We conducted a prospective, single-center cross-over study on maintenance HD patients treated with regular low-flux (LF) dialyzers. Fat tissues were measured with a skinfold caliper and mid-upper arm circumference. Muscle thickness and strength parameters from six different muscle groups were evaluated with ultrasound. The baseline (control) parameters were measured under LF dialyzers, and the measurements were repeated two weeks after switching to MCO dialyzers for the patients ordered by their clinicians according to the clinical indications. Results The median age was 69.5 (50.3,78.8) years, and 60% of the patients were female. Two weeks after switching to MCO, the Kt/Vs, urea reduction ratios, mean serum albumin, dry weight, and body mass index scores were similar. Mean skinfold thickness and mid-upper arm circumference were 15 mm (11,17) and 28mm (27,30) under LF and 16mm (14,19) and 28mm (27,30) under MCO dialyzers (p=0.82 and p=0.27). Rectus abdominis and external oblique muscle groups remained similar. Internal and external oblique muscle thickness were significantly increased (p=0.002 and p=0.001). Mean rectus femoris and gastrocnemius medialis (GKM) thicknesses were 1.19cm (0.99,1.33) and 1.16cm (0.9,1.4) under LF and 1.31cm (1.20, 1.40) and 1.24cm (0.95,1.40) under MCO dialyzers (p=0.002 and p=0.02). Mean GKM fibrile length and pennation angles were 2.4cm (2.2,2.8) and 20o (18,23) under LF and 2.7cm (2.4, 2.9) and 22o (19,24) under MCO dialyzers (p=0.007 and p=0.001). Conclusion Our study showed that MCO dialyzers increase muscle mass with preserved fat tissues in HD patients, short-term follow-up. This favorable effect might be due to the clearance of uremic toxins, which cannot be removed with conventional methods. If long-term studies support our findings, MCO dialyzers would be a milestone for the treatment of sarcopenia in HD patients.

#2598 Risk of vascular access complications in haemodialysis patients initiating dialysis with arteriovenous fistula or arteriovenous graft

Abstract Background and Aims Patients (pts) with end-stage kidney disease (ESKD) rely on successful vascular access (VA) for continual hemodialysis (HD) treatments. Possible VA complications are numerous and complex, which makes them difficult to study. We developed a comprehensive VA complication metric to evaluate VA complications holistically. The goal of this analysis was to describe the risk of having high VA complications in in-center hemodialysis (ICHD) pts whose initial VA included arteriovenous fistula (AVF) or arteriovenous graft (AVG), and who have been successfully receiving regular dialysis care for at least 2 years. Method Adult ICHD pts, with Charlson Comorbidity Index &amp;lt;8, who initiated treatment at one of the clinics of a large dialysis organization between Jan 2016 and Dec 2021, received continuous treatment for ≥2 years, remained on ICHD until censored, and whose initial VA included an AVF or an AVG were investigated. Pts could be censored by death, transplant, discharge from FKC, or study end. Initial VA was determined by use of either AVF or AVG during ICHD treatments in the 90-120 days after initiation of ICHD. Individual-level vascular access complication rates (VACR) were defined as the sum of a patient's VA complication events divided by their duration of follow-up until censor date. VA complication events include: hospitalization due to VA problems or VA infection, VA infections not requiring hospitalization, VA removal due to infection, symptoms of VA infection, symptoms of thrombosis/stenosis, documented stenosis, documented thrombosis, cannulation issues, bacteremia, sepsis. The threshold for high VACR was the highest quintile values. Logistic regression was used to determine the risk of having a high VACR by demographic and comorbid conditions. Results Analyses included 94,208 pts who met our inclusion criteria. The mean VACR for the population was 2.7 VA complications per patient per year (PPY). Pts whose VACR was in the highest quintile, ≥4.34 PPY, were categorized as having high VACR. Table 1 shows the risk of having high VACR by demographic characteristics and comorbid conditions present at ICHD initiation. In general, we observed lower or neutral risk of having high VACR in the demographic characteristics we examined. However, older patients as well as patients with higher BMI had an increase in risk of having high VACR. We observed significant increased risk of having high VACR in diabetic pts (20%), pts with cerebrovascular disease (35%), pts with COPD (10%), pts with Congestive Heart Failure (21%), patients with dementia (22%), and patients with history of myocardial infarction (26%). Conclusion We observed that being older, having increased BMI, or having several comorbid conditions are associated with increased risk of having high VACR in successful ICHD patients who initiated dialysis with an AVF or AVG. Multivariate analyses to further explore these associations are warranted.

#826 Protein-energy wasting and sarcopenia in assessing the outcomes and quality of dialysis

Abstract Background and Aims Sarcopenia is one of the serious complications of long-term hemodialysis (HD) therapy and is one of the independent predictors of morbidity and mortality in this population. Sarcopenia is associated with low physical activity, depression and low social adaptation. There are few estimates of the sarcopenia prevalence in HD patients, and they fit into the range of 15-30% in the general group and 45-60% among patients over 60 yo. The aim: in a prospective study, to clarify the prevalence, outcomes and risk factors of sarcopenia in comparison with protein and energy wasting (PEW) severity data. The results of the first year follow-up of the first cohort in the ongoing study are presented below. Method In the group of 99 prevalent patients of single HD center (vintage 26.4; 21.8-93.3 months; age 55±17 years, HD/HDF for 4-4.5 hours three-time weekly; Kt/V 1.57±0.31), the prevalence of sarcopenia was estimated (muscle mass was assessed anthropometrically and by bioimpedance (BIA), BodyStat 5000). The presence of sarcopenia was assessed by EWGSOP2 criteria, muscle strength - by wrist expander. The reference values for men and women were &amp;gt;27 kg and &amp;gt;16 kg. The PEW degree was assessed by 24-point scale (BMI, arm circumference, skin-fat fold above the triceps, arm muscle circumference, total protein, albumin, transferrin, absolute lymphocytosis; max 3 point for each). Obesity was established at BMI &amp;gt;30 kg/m² or according to the fat mass index &amp;gt;9 kg/m² in men and &amp;gt;13 kg/m² in women. The quality of life was assessed by KDQOL-SF™ after exclusion of patients with significant depression by the Beck scale. Results The muscle mass indices calculated anthropometrically (IMMA) and by bioimpedance (IMMB) were well correlated: IMMA=0.15+1.06×IMMB, R²=76%; diagnostic efficacy (in detecting sarcopenia) IMMA to IMMB was 86%. The prevalence of PEW by stage: absent (scores of all assessed scales - 3) – 59%, grade 1 (average score ≥2 and &amp;lt;3) – 32%, grade 2 (average score ≥1 and &amp;lt;2); in one patient, PEW was classified as severe (average score of scales &amp;lt;1). In the univariate and in the multiple adjusted analysis (for age, gender, provided dialysis dose and average ultrafiltration, hemoglobin and phosphate levels), the degree of PEW or the presence of PEW was not associated with the risk of death. At the same time, the phase angle (PA) of bioimpedance had such a link: the PA increase in by 1° was associated with a 24.4% reduction in the risk of death (95%CI 3.9-40.4%; p=0.022), and the inclusion of the same set of variables in the regression analysis model as for the PEW only weakened, but did not eliminated the link (OR decrease by 26.9%; 0.3-46.4%; p=0.048). The risk of death was not associated with obesity. Sarcopenia was detected in 52% of patients. It was not associated with the presence (severity) of PEW in women, but in men it was 1.48 times more common in the presence of PEW (p=0.049); in the entire group, the higher prevalence of sarcopenia in the presence of PEW (by 34%) did not reach significance (p=0.3). In multiple regression analysis, the presence of sarcopenia was associated with a 1.95-fold higher risk of death (95% CI 1.001-3.809; p=0.050). In the presence of sarcopenia, the quality of life scores were significantly lower for the scales of Physical functioning, Energy, and Physical Composite Score. The higher prevalence of sarcopenia among men than in women remains unexplained. It is possible that uniform thresholds for muscle mass and muscle strength are not suitable for all populations and require clarification. Conclusion Sarcopenia is the feature of more than half of HD patients and is significantly associated with an increased risk of death. PEW and sarcopenia, including partially similar indicators in their estimates, turned out to be poorly related in HD patients, and sarcopenia is more closely associated with hard outcomes than PEW. A separate assessment of these conditions and a search for contributing factors for its development/progression are required in prospective studies. One of the key objectifying indicators of the PEW and sarcopenia assessment could be the phase angle of bioimpedance associated with both clinical predictors and outcomes.

#2812 Continuous blood pressure monitoring with a finger cuff is unreliable in chronic hemodialysis patients

Abstract Background and Aims Intradialytic hypotension (IDH) is the most common complication of hemodialysis (HD), which is often related to ultrafiltration. Due to the high prevalence of cardiovascular disease (CVD), compensatory mechanisms often fail. In clinical practice, BP is measured 2x/hour, while additional readings are only performed when symptoms arise. However, since IDH defined by a nadir systolic BP (SBP)&amp;lt;90 mmHg or &amp;lt;100 mmHg (depending on pre-dialysis SBP), regardless of symptoms, is most strongly associated with mortality, current BP measurement frequency may severely underestimate the true incidence of IDH. Continuous BP-monitoring may offer a solution to this issue. The Clearsight device (CSD) is a non-invasive continuous BP-monitoring system that measures arterial pressure and waveforms through a finger cuff by photoplethysmography. Yet, a compromised peripheral circulation may hamper its reliability in HD patients. This study aims to assess the agreement between intradialytic CSD-monitoring and standard oscillometric brachial arterial pressure (oBAP) assessment. Methods 40 Chronic HD patients were cross-over randomized to 4 modalities, each for 2 weeks: [standard HD (S-HD), cool HD (C-HD), low volume hemodiafiltration (LV-HDF) and high-volume HDF (HV-HDF)]. During one session of each second week, BP and heart rate (HR) were continuously recorded with the CSD (BMEYE/Edwards Lifesciences) and every 15 minutes with a brachial arterial cuff (contralateral of the fistula or graft, if applicable). Simultaneous measurements of SBP, diastolic BP (DBP) and HR were compared with descriptive statistics (mean difference [bias, BAP minus CSD], standard deviation (SD) and range) and Bland-Altman analysis. Bias was defined as the mean difference between oBAP and CSD, and 95% limits of agreement (LA) as the mean difference ±1.96 SD. Post-hoc, patients were stratified into tertiles of unexplained missing CSD-readings, to explore whether specific patient characteristics explain failed readings. Results 75% of patients was male, with a mean age 69.7 (±13.5 years) and median dialysis vintage 3.0 years (IQR 1.0-5.8). Diabetes mellitus and CVD were present in 48% and 73%, resp. Of the 2720 paired BP-measurements, 42% CSD and 6% of oBAP-readings were missing, leaving 36% of absent CSD-readings unexplained. Bland-Altman analysis, comparing oBAP and CSD-measurements, revealed a mean bias ± LA of 13.3 ± 44.5 mmHg for SBP, a mean bias ± LA of 13.3 ± 25.5 for DBP, and a mean bias ± LA of −0.03 ± 22.9 for HR. Surprisingly, the group with a high (&amp;gt;38%) proportion of unexplained missing CSD-values was significantly younger compared to the low (&amp;lt;21%) and intermediate group (21-38%) (p = 0.015), whereas no significant differences were observed with respect to dialysis vintage, diabetes mellitus or CVD. Conclusions 1) Compared to the oBAP method, finger cuff-monitoring shows poor precision and accuracy in BP-measurements, but good accuracy and poor precision in HR-readings; 2) 1/3 of readings failed for unknown reasons. Thus, CSD-monitoring is unsuitable for intradialytic hemodynamic monitoring in chronic HD patients.

Usefulness of the heart rate variability test in predicting intradialytic hypotension in patients undergoing chronic haemodialysis.

Intradialytic hypotension (IDH) is the primary complication of haemodialysis (HD); however, its diverse pathophysiology and inconsistent definitions complicate its prediction. Despite attempts using the heart rate variability (HRV) test for IDH prediction, studies on its usefulness for predicting IDH diagnosed per the nadir 90 criterion are lacking. We aimed to evaluate HRV test efficacy and reproducibility in predicting IDH based on the nadir 90 criterion. Seventy patients undergoing HD participated in this multicentre prospective observational study. The HRV test was performed during non-HD periods and IDH was monitored during 12 HD sessions. IDH was diagnosed according to the nadir 90 criterion, defined as a decrease in systolic blood pressure of ≤90mmHg during HD. After monitoring, the HRV test was repeated. An HRV-IDH index was developed using multivariate logistic regression analysis employing HRV test parameters. The predictive power of the HRV-IDH index was analysed using the area under the receiver operating characteristics curve (AUROC). Reproducibility was evaluated using correlation analysis of two HRV tests on the same patient. There were 37 and 33 patients in the IDH and non-IDH groups, respectively. The HRV-IDH index predicted IDH occurrence with AUROCs of 0.776 and 0.803 for patients who had experienced at least one or repeated IDH episodes, respectively. Spearman's correlation coefficient for HRV-IDH indices was 0.859 for the first and second HRV tests. The HRV test holds promise for predicting IDH, particularly for patients with recurring IDH diagnosed based on the nadir 90 criterion.

Effect of two different techniques of arteriovenous fistula puncture on wound infection in haemodialysis patients.

Safe and effective arteriovenous fistula (AVF) puncture is very important to reduce the wound complications of haemodialysis (HD). For AVF puncture in dialysis patients, there is a lack of clarity and consistency regarding the relative advantage of buttonhole (BH) over rope-ladder (RL) cannulae in terms of wound complications. The study was published in several scientific databases including Cochrane Library, PubMed and Embase by October 2023. Data from all controlled trials looking at the effect of BH and RL on wound complications in haemodialysis patients were included. The articles were written in English, and they were about adult who had AVF while on dialysis. Studies with or without BH or RL treatment were excluded from the analysis. The data was analysed with RevMan5.3 software. Out of 215 trials, 9 were chosen for the final analysis. The study publication dates were between 2000 and 2023. Of these, 17 326 patients received AVF therapy. Among them, there were 3070 BH and 14 256 RL. In 9 studies, RL had a lower risk of postoperative wound infection compared to BH (OR, 3.38; 95% CI, 3.06, 3.73 p < 0.0001); In all 3 studies, there were no statistically significant differences in the risk of post operative bleeding in RL versus BH(OR, 0.76; 95% CI, 0.25, 2.33 p = 0.63). Our studies have demonstrated that RL trocars are superior to BH trocars in the prevention of wound infection.

The Effect of the Holy Quran Recitation on Inflammatory Markers in Hemodialysis Patients in Iran: A Randomized Clinical Trial.

Increased inflammation is a common complication in chronic hemodialysis (HD) patients. Addressing the psychological symptoms of patients may help reduce inflammation and its negative impact on the body. Considering the calming effects of listening to the Holy Quran, this may help reduce mental, psychological, and physical problems in Muslim patients. The present study sought to examine the effects of listening to Holy Quran recitation on the level of inflammatory markers in HD patients. This was a randomized controlled trial involving 50 HD patients at Kowsar Hospital in Semnan, Iran, in 2019-2020. The participants were divided into experimental and control groups using simple randomization by sealed envelopes. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and interleukin-6 (IL-6) levels in blood were measured before the intervention. The participants in the experimental group listened by headphones to the Holy Quran being recited three times a week, 20 min each time, for one month. For those in the control group, headphones were placed but on silent mode. At the end of the intervention one month later, inflammatory markers were measured again for participants in both groups. Data were analyzed in SPSS-16 using descriptive and inferential statistics (t test, Wilcoxon, and Mann-Whitney U). Mean IL-6 level decreased by 20.2pg/ml, mean ESR level by 16.8mm/hr, and mean CRP level by 19.9mg/dl in the experimental group, while these values increased in the control group. The between-group differences in the intervention and control groups at follow-up were significant for all three inflammatory markers (p < 0.05). Listening to the Holy Quran being recited is recommended as a complementary therapy for reducing systemic inflammation (as indicated by inflammatory markers) in Muslim HD patients.Trial registration: Iranian Registry of Clinical Trials, Trial No: IRCT20120109008665N9. Registered 4 Nov 2019.