Anemia Control Research Articles

Pregnancy in patients with chronic kidney disease undergoing dialysis.

Women with chronic kidney disease are less likely to become pregnant and are more susceptible to pregnancy complications when compared to patients with normal kidney function. As a result, these are considered high-risk pregnancies, both maternal and fetal. Over the years, there has been an increase in the incidence of pregnancies in dialysis patients, and an improvement in maternal and fetal outcomes. It is believed that the optimization of obstetric and neonatal care, the adjustment of dialysis treatment (particularly the increase in the number of hours and weekly frequency of dialysis sessions), and the use of erythropoiesis-stimulating agents have provided better metabolic, volume, blood pressure, electrolyte, and anemia control. This review article aims to analyze pregnancy outcomes in chronic kidney disease patients undergoing dialysis and to review nephrological medical management in this scenario. Due to the growing interest in the subject, clinical recommendations for care practice have become more consistent in both drug and dialysis management, aspects that are addressed in this review.

Genome-wide local ancestry and the functional consequences of admixture in African and European cattle populations.

Bos taurus (taurine) and Bos indicus (indicine) cattle diverged at least 150,000 years ago and, since that time, substantial genomic differences have evolved between the two lineages. During the last two millennia, genetic exchange in Africa has resulted in a complex tapestry of taurine-indicine ancestry, with most cattle populations exhibiting varying levels of admixture. Similarly, there are several Southern European cattle populations that also show evidence for historical gene flow from indicine cattle, the highest levels of which are found in the Central Italian White breeds. Here we use two different software tools (MOSAIC and ELAI) for local ancestry inference (LAI) with genome-wide high- and low-density SNP array data sets in hybrid African and residually admixed Southern European cattle populations and obtained broadly similar results despite critical differences in the two LAI methodologies used. Our analyses identified genomic regions with elevated levels of retained or introgressed ancestry from the African taurine, European taurine, and Asian indicine lineages. Functional enrichment of genes underlying these ancestry peaks highlighted biological processes relating to immunobiology and olfaction, some of which may relate to differing susceptibilities to infectious diseases, including bovine tuberculosis, East Coast fever, and tropical theileriosis. Notably, for retained African taurine ancestry in admixed trypanotolerant cattle we observed enrichment of genes associated with haemoglobin and oxygen transport. This may reflect positive selection of genomic variants that enhance control of severe anaemia, a debilitating feature of trypanosomiasis disease, which severely constrains cattle agriculture across much of sub-Saharan Africa.

Factors related to surgical site infection in spinal instrumentation surgery: a retrospective study in Japan.

A retrospective study. To identify factors involved in surgical site infections (SSIs) after spinal instrumentation surgery performed at a single institution. SSIs after spinal instrumentation surgery are a serious complication. Despite reports on risk factors for SSIs in spine surgery, limited studies are related to spinal instrumentation surgery. In total, 828 patients (338 males and 490 females; mean age, 65.0 years) who underwent spinal instrumentation surgery from 2013 to 2021 in Kyorin University School of Medicinewere retrospectively investigated. Patients were divided into the SSI (group I) and non-SSI (group N) groups. Patient characteristics, comorbidity, laboratory, and surgical factors were investigated. Univariate analysis was performed for each item, and multivariate logistic regression analysis was performed for items with significant differences. Fifteen patients (1.85%) had SSIs. Univariate analysis revealed significant differences between groups I and N in history of steroid use, serum albumin, C-reactive protein, number of fixed vertebrae, and perioperative blood transfusion. Multivariate logistic regression analysis showed that a history of steroid use (odds ratio [OR], 5.38; 95% confidence interval [CI], 1.41-20.49; p=0.014), serum albumin (OR, 0.34; 95% CI, 0.13-0.84; p=0.020), and perioperative blood transfusion (OR, 5.85; 95% CI, 1.46-23.50; p=0.013) were independent risk factors for SSIs. The results of this study indicate that preoperative nutritional intervention, appropriate management of anemia, and intraoperative and postoperative bleeding control may decrease the incidence of SSIs. However, this study has several limitations, including its retrospective design, analysis of a few SSI cases, and inclusion of various surgical approaches and disease types. Future studies that address these limitations are desirable.

Scientometrics Analysis of Global Researches on Anemia

Background: Anemia is a condition in which the number of red blood cells or the hemoglobin concentration within them is lower than normal. This study aims to show the intellectual structure of knowledge regarding anemia and gives a comprehensive and up-to-date image of research in this area. Materials and Methods: This is a descriptive-analytical study with a scientometric approach. The PubMed database was searched for research publications indexed under "anemia" including 8484 records between 2011 and 2020. Data were analyzed using Co-word analysis, clustering methods, and strategic diagrams with the help of SPSS and Ucinet 6 software. Results: The keyword “Anemia Sickle Cell” and two pairs of frequently used keywords, namely “Anemia, Iron *Iron” were the most frequent in the research area. The results shaped the concepts of anemia in 9 clusters. The clusters "Hydroxyurea and sickle cell anemia", "Fetus transfusion", "Management of Thalassemia Major", "Hemolytic Uremic Syndrome", "Management and Control of Anemia", "Chronic Kidney Failure and Anemia", "Hematopoietic Stem Cell Transplantation" are topics that may be emerging or disappearing. The “Thalassemia and blood transfusion" are immature clusters. Conclusion: This study uses co-word networks that indicate important links between keywords of the research areas. Most research approaches are in the therapeutic aspects. Despite the importance of the effect of anemia on all levels of society, including economics, education, and other types of anemia, as well as its impact on learning and mental disorders, these subjects have not been given sufficient consideration.

Clinical Implementation Framework of Anemia Control Model in Singapore

Clinical Implementation Framework of Anemia Control Model in Singapore

Validating a portable device for groundwater iron measurement in Bangladesh

The mineral iron is essential for health at an optimum level. In Bangladesh iron is obtained from the drinking source groundwater, attributing largely to the good iron status in population. This groundwater iron poses two scenarios—predominantly high in many areas and predominantly low in other areas. Despite good iron status, burden of anemia in population is high. To control anemia, iron supplementation programs are operational against the backdrop of high iron status. This often leads to iron-associated side effects, plausibly due to excess iron, especially among the individuals exposed to high amount of iron from the drinking water. This geological phenomenon warrants the supplementation program to deliver different doses depending on the groundwater iron level. To enable that, the country needs an area-representative “mapping” of groundwater iron. However, such a mapping using the gold standard laboratory methods is expensive and logistically intensive. The aim of the study is to validate Handheld Colorimeter (HI721 Checker® HC), a portable device (“spot kit” device) to measure iron concentration in the drinking groundwater. The study was carried out in the rural Belkuchi upazila of the Sirajganj district in the Rajshahi division. In the study 25 tubewells were selected and categorized into five groups. Among them, four were categorized based on their iron concentration, low iron conc. (0-<1 mg/L), medium iron conc. (1-2 mg/L), high iron conc. (2-10 mg/L), very high iron conc. (>10 mg/L). One additional group was included for tubewell water that was used after filtering. The study compared the iron estimates measured in groundwater samples of the selected tube wells by the spot kit device and the same samples measured by atomic absorption spectrophotometry (AAS). There was a high agreement between the estimates by the spot kit and AAS (Kappa coefficient= 0.72, p <0.001; Lin’s concordance = 0.829, p < 0.001). Pitman's test of difference in variance exhibited that the two methods produced equally precise results (r=0.227, p=0.275). The study concluded that the Handheld Colorimeter (HI721 Checker® HC) was valid to measure the iron concentration of groundwater under field conditions. This device can facilitate testing processes, particularly in remote or resource-constrained areas where sophisticated testing methods (i.e: AAS) are unavailable and thus may help the re-design of the anemia control program in settings like Bangladesh with high and variable level of iron in the drinking groundwater.

Assessing the factors influencing the severity of anemia in tribal women of Malkangiri, Odisha, India

Background: Anemia is a serious public health concern with a high prevalence in tribal communities' women in India. Despite several implementations to strengthen the maternal health and nutrition program, anemia persists. Objectives: The objectives of this study were to estimate anemia prevalence and to examine the predictors of anemia among Koya and Matia tribal women in a district of Odisha, Malkangiri. Materials and Methods: For this study, a cross-sectional survey was conducted among 519 tribal (Koya- 326) and (Matia- 193) women aged 15-49 years. A pre-tested schedule was used to collect data on different demographic variables, and a Hemoglobin (Hb) meter was used to estimate Hb level. Prevalence of anemia among tribal women was estimated and Chi-Square and Multinomial logistics regression were used to find the association. Results: The mean hemoglobin value in the overall sample (n=519) was 7.86±1.77. The results showed that 34.35% of Koya and 33.67% of Matia were severely anemic, while 56.13% of Koya and 55.43% of Matia were moderately anemic, and mild anemia was reported to be 3.68 in Koya and 4.14 in Matia's women. Early marriage, women's age at first childbirth, parity, were major factors influencing the severity of anemia. Conclusion: The high prevalence of anemia among both communities' tribal women necessitates immediate action through targeted interventions to enhance and ensure widespread coverage of anemia control programs, especially in tribal areas.

Usage of the Anemia Control Model Is Associated with Reduced Hospitalization Risk in Hemodialysis.

The management of anemia in chronic kidney disease (CKD-An) presents significant challenges for nephrologists due to variable responsiveness to erythropoietin-stimulating agents (ESAs), hemoglobin (Hb) cycling, and multiple clinical factors affecting erythropoiesis. The Anemia Control Model (ACM) is a decision support system designed to personalize anemia treatment, which has shown improvements in achieving Hb targets, reducing ESA doses, and maintaining Hb stability. This study aimed to evaluate the association between ACM-guided anemia management with hospitalizations and survival in a large cohort of hemodialysis patients. This multi-center, retrospective cohort study evaluated adult hemodialysis patients within the European Fresenius Medical Care NephroCare network from 2014 to 2019. Patients treated according to ACM recommendations were compared to those from centers without ACM. Data on demographics, comorbidities, and dialysis treatment were used to compute a propensity score estimating the likelihood of receiving ACM-guided care. The primary endpoint was hospitalizations during follow-up; the secondary endpoint was survival. A 1:1 propensity score-matched design was used to minimize confounding bias. A total of 20,209 eligible patients were considered (reference group: 17,101; ACM adherent group: 3108). Before matching, the mean age was 65.3 ± 14.5 years, with 59.2% men. Propensity score matching resulted in two groups of 1950 patients each. Matched ACM adherent and non-ACM patients showed negligible differences in baseline characteristics. Hospitalization rates were lower in the ACM group both before matching (71.3 vs. 82.6 per 100 person-years, p < 0.001) and after matching (74.3 vs. 86.7 per 100 person-years, p < 0.001). During follow-up, 385 patients died, showing no significant survival benefit for ACM-guided care (hazard ratio = 0.93; p = 0.51). ACM-guided anemia management was associated with a significant reduction in hospitalization risk among hemodialysis patients. These results further support the utility of ACM as a decision-support tool enhancing anemia management in clinical practice.

Epidemiology of Anaemia in Children under Five in Uganda: Current Trends, Challenges, and Strategic Approaches

Anaemia in children under five years old is a significant public health issue in Uganda, affecting over half of the vulnerable population and posing challenges to their health and development. The issue is influenced by nutritional deficiencies, infectious diseases, socioeconomic factors, and limited healthcare access. Clinical manifestations include pallor, fatigue, and developmental delays, and early detection is difficult due to non-specific symptoms, resource constraints, and cultural practices. The impact of anaemia on child health and development is profound, affecting physical growth, cognitive and motor skills, and overall well-being. Nutritional interventions, such as iron supplementation, fortified foods, and dietary education, are crucial for managing anaemia. Effective healthcare responses and policies, including routine screenings, treatment programs, and community outreach, are also necessary. Preventive measures and treatment programs are crucial for combating malaria and other infectious diseases. Community-based approaches, including training health workers and implementing grassroots education programs, are essential for improving anaemia management. Addressing gender dynamics and socioeconomic determinants is vital for reducing anaemia rates. Monitoring and evaluation frameworks are essential for assessing the effectiveness of anaemia control programs and guiding future efforts. In conclusion, a coordinated approach integrating nutritional, healthcare, environmental, and socioeconomic strategies is necessary to combat anaemia in Uganda. Through continued efforts and collaboration, the burden of anaemia can be mitigated, leading to improved health outcomes for children under five. Keywords: Anaemia, Children, Uganda, Current Trends, Challenges, Strategic Approaches

Combined Injection for Control of Iron-Deficiency Anemia and Coccidiosis in Piglets Decreases Stress at Management Time.

The aim of the present study was to assess the short-term behavioral and physiological responses of piglets to different treatment protocols for the control of iron-deficiency anemia (IDA) and cystoisosporosis. Piglets were treated with either (1) an injection of iron combined with an oral application of toltrazuril (TLZ) by drenching or (2) a combination injection of TZL + gleptoferron; the behavior of the piglets was then evaluated. For this study, 288 piglets were divided into three experimental groups: 96 piglets were kept untreated (control group); 96 piglets received an oral administration of a generic TZL-based anticoccidial agent (20 mg/kg BW) along with intramuscular administration of iron dextran (200 mg/mL; 1 mL/piglet) at the same handling (oral + parenteral group, O + P); and 96 piglets received an intramuscular application of the combination product (parenteral group, P). For each treated piglet, the total handling time, flight reaction, and the intensity and frequency of vocalizations were determined using the methodology described by Scollo et al. (2020). Piglets in the O + P group were found to emit more screams during treatment administration than animals in the P group (21.05% vs. 8.42% of animals; p < 0.05). Piglets in the O + P group reacted worse to manipulation and oral administration because a higher percentage of animals continued to fidget even after handling (32.63% vs. 12.63%; p < 0.05). Differences in growth performance between the groups were not observed in our study (p > 0.05). In conclusion, the administration of a combination product reduced stress during administration, as indicated by reduced vocalizations and reactions to manipulation.

Delivery platforms for reaching adolescents with nutrition interventions in low- and middle-income countries.

Adolescents in low- and middle-income countries (LMICs) are a vulnerable population given increased nutritional needs as puberty approaches. School-based nutrition programs exist in some settings, but the comprehensive provision of nutrition services requires knowledge of the mechanisms to reach out-of-school adolescents. A comprehensive scopingreview was performed using formal and informal search strategies to landscape all potential delivery platforms with nutrition services to reach adolescents. Peer-reviewed studies, institutional strategies, program evaluations, and programmatic reports in LMICs were reviewed, including gray literature. A total of 87 out of 270 identified publications and reports describing nutrition programs for adolescents were identified. Although nutrition programs targeted at adolescents were sparse, various innovative and inclusive delivery platforms were included, such as school feeding programs, school-based anemia control, and nutrition-friendly school initiatives; health facility-based, youth-friendly health and nutrition services; social safety nets targeted at adolescents; community-based approaches targeting youth development and peer education within youth centers and faith-based settings; and technology-based platforms, including digital health services and mass media communication sensitization and mobilization efforts. Existing delivery mechanisms and platforms in health and other sectors that target adolescents offer great potential to extend nutrition interventions to this vulnerable yet hard-to-reach population.

Impact of iron tablet administration and nutritional counseling: Hemoglobin level improvement in anemic pregnant women

Background: According to the 2013 Riskesdas, the prevalence of anemia in Indonesia was 37.1%. Data from the Pariaman City Health Office showed that the prevalence of anemia in 2014 was 43.1%. This study aims to determine the effect of iron (Fe) tablets and nutritional counseling on hemoglobin levels in pregnant women with anemia in the Pariaman City area in 2016. Methods: This study is a quantitative study using a quasi-experimental design. The study population consisted of third-trimester pregnant women with anemia, divided into two groups: the Fe tablet group (n=20) and the Fe tablet plus nutritional counseling group (n=20). Data analysis was performed using univariate and bivariate analysis with the Dependent T-Test statistical test. Findings: The results showed that the average knowledge score in the Fe group was 0.3, while in the Fe plus nutritional counseling group it was 1.4. The average change in knowledge scores between the two groups showed a significant increase (p=0.002). The average attitude score in the Fe group was 2.15, while in the Fe plus nutritional counseling group it was 2.75. The average change in attitude scores between the two groups was not significant (p=0.205). The average action score in the Fe group was 1.050, while in the Fe plus nutritional counseling group it was 2.7. The average change in action scores between the two groups showed a significant increase (p=0.002). The average difference in hemoglobin levels in the Fe group was 0.280, while in the Fe plus nutritional counseling group it was 0.690. The average change in hemoglobin levels between the two groups showed a significant increase (p=0.008). Conclusion: It can be concluded that the provision of Fe supplementation and nutritional counseling results in a higher increase in hemoglobin levels compared to Fe tablets alone. It is hoped that nutritionists in the field will be more active in providing nutritional counseling to pregnant women with anemia to increase their knowledge about anemia. Novelty/Originality of this article: This study proposes an integrated nutritional intervention model combining Fe tablets with a community-based interactive nutritional counselling program. This model can increase the effectiveness of anaemia control programs in pregnant women by combining supplementation and education.

Knowledge and practice of essential nutrition actions among pregnant women in Ibadan, South-western Nigeria

Background: Maternal nutrition during the first 1,000 days has important influences on children’s nutrition and pregnancy outcomes. This study therefore assessed the knowledge, attitude and practice of essential nutrition actions among pregnant women utilizing antenatal care services in Ibadan municipality, South-western Nigeria. Methods: A descriptive cross-sectional study was conducted among pregnant women (15-49 years) receiving antenatal care (ANC) services across selected private and public health facilities. A semi-structured questionnaire was used to collect data on optimal dietary intake, prevention and control of anaemia and promotion of supportive lifestyle and care, according to the essential nutrition actions framework. Results: The mean age of respondents was 29.85±4.89 years while the mean gestational age of pregnancy at respondents’ ANC booking was 18.33±6.12 weeks. About one-third (33.60%) of the respondents had poor knowledge scores (mean knowledge score 5.70±1.50 out of 10), with no significant difference across type of health facility. Mean attitude score was 13.76±2.44 out of 20, while practice was generally poor (mean practice score 4.80±1.34 out of 10). Respondents attending larger tertiary hospitals for ANC had higher knowledge and practice compared to those who attended smaller primary health care centers/mission homes. Additionally, the time of booking, parity, and type of antenatal care center were statistically significant to knowledge and practice (p&lt;0.05). Conclusions: Antenatal care is still a valid platform for delivering maternal knowledge and encouraging practice of essential nutritional actions. It is recommended that expertise in tertiary hospitals be diffused to lower cadre of health care facilities to further strengthen ANC service delivery.

Sickle cell anaemia control mission: Implementation of a comprehensive care model in Anuppur, Madhya Pradesh.

Background & objectives Sickle cell disease (SCD) is a common genetic disorder, predominantly found in the tribal population of India. The examples of models providing comprehensive care and management to individuals with SCD in public health facilities are sparse. The Sickle Cell Anaemia Control Mission is one such model implemented by Jan Swasthya Sahyog, a non-profit organization in collaboration with the National Health Mission in the Anuppur district of Madhya Pradesh. This article aimed to identify the key learnings from this programme that can guide the public health system strengthening with respect to SCD. Methods The Sickle Cell Anemia Control Mission Programme included door to door screening for anaemia, SCD and blood group. SCD cases were included in the programme and other individuals with Anemia were referred for further care. Care for individuals with SCD included counselling, provision of hydroxyurea, regular follow up of clinical parameters and management of complications. Care for individuals with SCD was provided through monthly patient support group (PSG) meetings and regular outpatient /in-patient care at public health facilities. Quantitative data on programme design, screening and patient management collected during programme implementation were used for analysis. Results A total of 39421 persons were screened in 18 months (August 2018-March 2020). Of these 81.9 per cent persons were anaemic, 16.9 per cent had sickle cell trait and 779 (1.98%) had SCD. Eighty-six already diagnosed individuals joined the programme for care. People from all caste categories were diagnosed with SCD. Out of 865 individuals with SCD, 157 underwent regular 9-11 months follow up and showed improvement in clinical symptoms and drug compliance. Interpretation & conclusions Central India has a significant burden of anaemia and SCD. This study found that SCD is present in non-tribals as well. PSGs are an efficient way to deliver non-emergency care for chronic diseases such as SCD.

Prevalence of Iron Deficiency Anemia and Iron Deficiency Without Anemia Among Moderate and Severely Acute Malnourished Children.

Iron deficiency remains one of the globally recognized leading causes of morbidity and mortality in children, among developing countries like India as compared to the Western world. To estimate the prevalence of iron deficiency anemia (IDA) and iron deficiency without anemia (IDWA) among malnourished children. This cross-sectional study was conducted in the Department Of Pediatrics, Tertiary Care Hospital, Western Rajasthan. Demographic data and serum samples were collected and analyzed. Hematological and biochemical values were determined for 300 children aged 6 months to 59 months. A total of 93.9% of severe acute malnutrition (SAM) children and 83.24% of moderate acute malnutrition (MAM) children had anemia as perWHO definition, with moderate anemia (47.66%) being the predominant type of anemia. About 64% of children showed iron deficiency with a prevalence of IDA and IDWA being 94.27% and 5.72%, respectively. The mean values of serum ferritin, serum iron, serum total iron binding capacity (TIBC), and transferrin saturation in children with IDWA were 8.34±2.85, 17.43±7.57, 454.09±40.76, and 4.09±1.44, respectively. The proportion of anemic children in both SAM and MAM groups was very high. Our study shows that more than 60% of the MAM and SAM children were iron deficient. We recommend future measures for the prevention and control of anemia, including increased coverage of nutritional supplementation, fortification programs, and supplement iron in this sub-group (IDWA) to take care of their symptoms due to iron deficiency even before the development of overt IDA.

#1235 Comparative effect on bone remodeling and inflammation biomarkers of citrate dialysate and bicarbonate dialysate in HDF-OL patients

Abstract Background and Aims Hemodialysis (HD) treatment increases the inflammatory state of chronic kidney disease (CKD), which is associated with dysregulation of mineral bone metabolism. Reduced inflammation and increased bone formation have been described in Hemodiafiltration (HDF) compared with conventional HD. On the other hand, HD and OL-HDF using citrate-enriched dialysate are known to be safe and anti-inflammatory. However, the effects of post-dilution OL-HDF with citrate dialysate compared to bicarbonate dialysate on biomarkers of bone formation and resorption have not been studied. We aimed to compare the effect of bone remodeling markers and inflammation of different dialysates (citrate vs bicarbonate) in post dilution OL- HDF treatment. Method A total of 33 patients on conventional HD with bicarbonate citrate were included. At month 1, 18 patients, who did not require individualized adjustment of the dialysate composition such as potassium, were changed to HD with citrate dialysate and 15 patients remained with bicarbonate dialysate. By the second month, however, all patients were on OL-HDF with no change in buffer dialysate. Pre-dialysis blood samples were taken in both treatment groups at baseline (prior to the initiation of citrate dialysate in 18 patients), and at the first, second and fifth months after the introduction of citrate. Measurements of mineral homeostasis (calcium, phosphate, magnesium, parathyroid hormone, intact parathyroid hormone), inflammation (interleukin-6, β2-microglobulin, C-reactive protein) and bone remodeling markers (carboxy-terminal crosslinked telopeptide of type 1 collagen (CTX), as a biomarker of bone resorption and procollagen type 1 N-terminal pro-peptide (P1NP), as a biomarker of bone formation) were performed. All samples were collected before a mid-week dialysis session. Mineral homeostasis measurements were also performed before and after HD at the first and second month of the switch to citrate dialysate. Normally distributed data were presented as mean (standard deviation, SD) and median (interquartile range). Intra-subjects comparisons were analyzed using paired sample t-test or Wilcoxon signed-rank test. Comparisons between groups were analyzed using Mann-Whitney U test. Statistical analyses were performed using the SPSS (version 15.0, Chicago, IL, USA). p-value &amp;lt; 0.05. Results Overall, 75.7% (n = 25) of the subjects were male, the median age was 69 years (SD: 12) and 39.3% suffered diabetes (n = 13). Patients on citrate and bicarbonate dialysates were comparable for age, sex, comorbidities, months on dialysis and anemia control. Baseline mineral, bone remodeling and inflammation markers before HD, were also comparable in both groups. Only patients on bicarbonate dialysate had higher β2-microglobulin levels at baseline. Changes in serum levels of mineral, bone remodeling and inflammatory biomarkers at 5 months compared to baseline for both groups are shown in Table 1. After 5 months of follow-up, a 22% trend-reduction (p = 0.08) in P1NP as bone formation biomarker was observed in patients on citrate dialysate compared to those on bicarbonate dialysate. In addition, the fold change observed in CTX as parameter of bone resorption was attenuated in the citrate dialysate group (11% vs 116% in the bicarbonate dialysate group, p &amp;lt; 0.001). β2-microglobulin levels decreased significantly in both groups at 5 months but It is explained by the known effect of OL-HDF treatment on the inflammatory state of dialysis patients. Conclusion In patients on OL-HDF treatment the use of the citrate as dialysate may provide a benefit in bone remodeling by reducing bone resorption and trend to balance the bone formation/resorption. However, our results are in line with previous studies, where caution should be adopted in patients with very high parathyroid hormone levels, as this may be enhanced by reduced mineral turnover.

#3094 Prevalence and risk factors for progression and mortality in patients with advanced chronic kidney disease

Abstract Background and Aims Chronic kidney disease (CKD) is a growing health concern worldwide. Prevalence and risk factors for its progression are highly relevant, given that Portugal has the highest incidence and prevalence rates of dialysis in Europe. With this study, we aimed to estimate the prevalence of patients with CKD stage 4 and 5 in a tertiary center in Portugal, as well as to evaluate risk factors for progression and mortality. Method We evaluated all patients followed in the Nephrology outpatient clinic at a tertiary center in Portugal during the year 2021, and selected those with CKD stage 4 and stage 5, based on estimated glomerular filtration rate (eGFR) using CKD-EPI formula. Primary endpoints were CKD progression or mortality after 1 year of follow-up. Progression was defined as initiating renal replacement therapy (RRT) or transition from stage 4 to stage 5 CKD. Results We evaluated 4381 patients, of which 1083 (24.7%) were included with CKD stage 4 (n = 856) and CKD stage 5 (n = 227). There was a predominance of males (52.7%), with a mean age of 74.6 ± 12.5 years. We observed a high prevalence of hypertension (94%), diabetes mellitus (46.2%), dyslipidemia (81%), heart failure (34%) and past history of major cardiovascular events (21%). At one year follow-up 108 patients died, 116 lost follow-up, and 256 (26.5%) had CKD progression, of which 179 (18.5%) initiated renal replacement therapy. 33.5% of patients initiating dialysis had a definitive access, mostly in stage 5 CKD (40 vs. 25%, p &amp;lt; 0.05). Risk factors for progression (versus stability) in univariate analysis were male gender (64.5 vs. 50.1, p &amp;lt; 0.001), younger age (68 vs. 75 years, p &amp;lt; 0.001) and lower eGFR (16 vs. 22 mL/min). Progression occurred in 51% of stage 5 CKD vs. 26.5% stage 4. Worse laboratory control of anemia, hyperparathyroidism, acidosis, and albuminuria (urinary albumin/creatinine ratio 1242 vs. 302 mg/g, p &amp;lt; 0.01) were identified risk factors for progression. In multivariate analysis, predictors for CKD progression were younger age (OR: 0.97, CI: 0.95-0.99, p = 0.02), male gender (OR: 2.82, CI: 1.43-5.57, p = 0.003), lower eGFR (OR: 0.80, CI: 0.74-0.86, p &amp;lt; 0.001), lower hemoglobin levels (OR: 0.62, CI: 0.48-0.79, p &amp;lt; 0.001), and proteinuria (OR: 1.44, CI: 1.22-1.53, p 0.003). Regarding mortality, no statically significant differences were observed between CKD stage 4 and 5, and in multivariate analysis the only independent risk factors for death were older age and heart failure, which increased 3.4 times mortality risk (OR: 3.40, CI: 1.48-7.83, p = 0.04). Conclusion Our data show a high prevalence of CKD and traditional risk factors, with an annual progression rate of 26.5%. Anemia and proteinuria were identified as modifiable risk factors for progression. In older patients with heart failure, the mortality risk was found to be higher than progression risk, highlighting the importance of cardiovascular protection and consideration of conservative management in this particular subset of patients.

#1533 The relationship between the severity of anemia, the level of inflammation markers and the dose of epoetin in patients in pre-dialysis stages of CKD

Abstract Background and Aims Inflammation is known to be an important factor associated with hemoglobin variability in patients with anemia of chronic disease. However, the question remains whether high levels of C-reactive protein, a widely used marker of inflammatory activity, and other inflammatory markers predict less stable anemia control in patients with CKD. The purpose of this study was to establish the relationship between the severity of anemia with the levels of inflammatory markers (C-reactive protein, IL-6) and the dose of epoetin in patients with pre-dialysis stages of CKD. The purpose of our study was to study the age-related characteristics of the nutritional status in patients with CKD of the dialysis stages who are on parenteral nutrition. Method 180 patients (96 men and 84 women) with CKD as a result of nephropathies of diabetic and non-diabetic etiology were examined. Chronic pyelonephritis was diagnosed in 96 patients, chronic glomerulonephritis - in 73, polycystic kidney disease - in 11 patients. Glomerular filtration rate was calculated based on serum creatinine concentration using the CKD-EPI formula (2011). The patients were divided into 2 groups, depending on the achievement of the target hemoglobin value. Thus, group 1 included patients with CKD C3, C4, whose hemoglobin concentration was above 110 g/l (n = 101). Group 2 included patients whose hemoglobin concentration was less than 110 g/l in at least one analysis (n = 79). Results In the examined patients, a significant correlation was found between the range of hemoglobin concentration and the range of CRP concentration (p &amp;lt; 0.05), as well as between the range of hemoglobin concentration and the variation in the percentage of hypochromic erythrocytes (p &amp;lt; 0.05), between the range of hemoglobin concentration and the variation of ferritin ( p &amp;lt; 0.05). The change in the percentage of hypochromic erythrocytes also correlated with the change in IL-6 (p &amp;lt; 0.05) and the change in CRP ( p &amp;lt; 0.05). We found an association between the average weekly dose of epoetin and the levels of CRP, IL-6 and TNF-α. Patients with TNF-α levels ≥2 ng/mL and IL-6 ≥40 ng/mL required a significantly higher dose of epoetin than patients with lower levels of these markers (128 U/kg per week versus 57 U/kg at week). Conclusion The establishment of a relationship between inflammatory markers and hemogram and iron parameters suggests that inflammation had an indirect effect on the increase in hemoglobin through its effect on iron metabolism. The results of the study indicate the presence of diabetic and non-diabetic etiology of systemic inflammation in CKD, more so in the group of patients with type 2 diabetes mellitus.

#2742 Artificial intelligence accurately approximates MGPE dose response relationship in a North American Dialysis Population

Abstract Background and Aims The Anemia Control Model (ACM) is a certified medical device aimed at optimizing the management of CKD-related anemia among patients on dialysis. ACM is based on an artificial neural network (ANN) trained on over 900’000 patients treated in the European Nephrocare Network. Over the years, ACM has offered physicians hundreds of thousands of erythropoietin stimulating agent (ESA) and intravenous iron dosing suggestions and ensured high hemoglobin target achievement rate while minimizing drug use. However, evidence concerning its validity in non-European samples is still limited. Apollo Dial DB is the largest, fully anonymized, collaborative, international database of dialysis patients. The database includes detailed clinical information of more than 500,000 patients over millions of patient-months of observation with an extensive representation over geographies as well as ethnic groups. Given its detailed medical information and size, the database may offer unprecedented opportunities to develop and test equitable and fair decision support systems based on artificial intelligence. In this study we sought to re-train and validate and assess the accuracy of the ACM in an ethnically diverse sample of North American dialysis patients in Apollo Dial DB. Method We constructed the cohort for training and validation of this new ACM version by including a random sample of patients treated in the North American Fresenius Medical Care Dialysis Network. The sample accounted for 20% of the entire North American Section of the Apollo Dial DB dataset. Each patient history has been segmented in a collection of patient-months, which was the unit of analysis. The initial cohort was split in 3 datasets for training (70%), validation (20%) and test (10%). The input variables included laboratory test results, body weight, treatment data, age, sex, and previous ESA and iron prescription. The outcome of interest was the variation in serum hemoglobin concentration over 1 month of follow up. We compared the accuracy of the original ACM based on ANN (baseline model) with a newly trained algorithm based on high-performance light GBM. Results We included 44,220 patients followed by 2,277,276 patient-months overall. The mean age=60.9 ± 13.4, 59.2% were male, 56.4% were Caucasians, 32.2% African American, 3.2% Asians and 8.2% were others. At baseline, mean Hb= 10.9 ± 1.2. The original EMEA version of the Anemia Control Model (ACM) was still accurate in North American patients (mean absolute error, MAE = 0.65 g/dL). The fine-tuned light GBM model achieved a 16% reduction in error rate (MAE = 0.55 g/dL; Fig. 1). No difference in MAE was observed across sex and ethnic groups. Conclusion This study demonstrates the excellent predictive performance of the original ANN-based ACM in the North American dialysis population. Fine tuning by re-training ACM on the dataset further improved the accuracy of the model with substantial equivalence in performance across different demographics, thus ensuring algorithmic fairness. ACM is a promising tool for anemia management in ethnically diverse dialysis population and different healthcare settings.

Epidemiological investigation of iron deficiency among preschool children in 10 provinces, autonomous regions, or municipalities in China

Objective: To understand the current status of anemia, iron deficiency, and iron-deficiency anemia among preschool children in China. Methods: A cross-sectional study was conducted with a multi-stage stratified sampling method to select 150 streets or townships from 10 Chinese provinces, autonomous regions, or municipalities (East: Jiangsu, Zhejiang, Shandong, and Hainan; Central: Henan; West: Chongqing, Shaanxi, Guizhou, and Xinjiang; Northeast: Liaoning). From May 2022 to April 2023, a total of 21 470 children, including community-based children aged 0.5 to<3.0 years receiving child health care and kindergarten-based children aged 3.0 to<7.0 years, were surveyed. They were divided into 3 age groups: infants (0.5 to<1.0 year), toddlers (1.0 to<3.0 years), and preschoolers (3.0 to<7.0 years). Basic information such as sex and date of birth of the children was collected, and peripheral blood samples were obtained for routine blood tests and serum ferritin measurement. The prevalence rates of anemia, iron deficiency, and iron-deficiency anemia were analyzed, and the prevalence rate differences were compared among different ages, sex, urban and rural areas, and regions using the chi-square test. Results: A total of 21 460 valid responses were collected, including 10 780 boys (50.2%). The number of infants, toddlers, and preschoolers were 2 645 (12.3%), 6 244 (29.1%), and 12 571 (58.6%), respectively. The hemoglobin level was (126.7±14.8) g/L, and the serum ferritin level was 32.3 (18.5, 50.1) μg/L. The overall rates of anemia, iron deficiency, and iron-deficiency anemia were 10.4% (2 230/21 460), 28.3% (6 070/21 460), and 3.9% (845/21 460), respectively. The prevalence rate of anemia was higher for boys than for girls (10.9% (1 173/10 780) vs. 9.9% (1 057/10 680), χ2=5.58, P=0.018), with statistically significant differences in the rates for infants, toddlers and preschoolers (18.0% (475/2 645), 10.6% (662/6 244), and 8.7% (1 093/12 571), respectively, χ2=201.81, P<0.01), and the rate was significantly higher for children in rural than that in urban area (11.8% (1 516/12 883) vs. 8.3% (714/8 577), χ2=65.54, P<0.01), with statistically significant differences in the rates by region (χ2=126.60, P<0.01), with the highest rate of 15.8% (343/2 173) for children in Central region, and the lowest rate of 5.3% (108/2 053) in Northeastern region. The prevalence rates of iron deficiency were 33.8% (895/2 645), 32.2% (2 011/6 244), and 25.2% (3 164/12 571) in infants, toddlers, and preschoolers, respectively, and 30.0% (3 229/10 780) in boys vs. 26.6% (2 841/10 680) in girls, 21.7% (1 913/8 821), 40.0% (870/2 173), 27.1% (2 283/8 413), 48.9% (1 004/2 053) in Eastern, Central, Western, and Northeastern regions, respectively, and each between-group showed a significant statistical difference (χ2=147.71, 29.73, 773.02, all P<0.01). The prevalence rate of iron-deficiency anemia showed a significant statistical difference between urban and rural areas, 2.9% (251/8 577) vs. 4.6% (594/12 883) (χ2=38.62, P<0.01), while the difference in iron deficiency prevalence was not significant (χ2=0.51, P=0.476). Conclusions: There has been a notable improvement in iron deficiency and iron-deficiency anemia among preschool children in China, but the situation remains concerning. Particular attention should be paid to the prevention and control of iron deficiency and iron-deficiency anemia, especially among infants and children in the Central, Western, and Northeastern regions of China.