Duration Of Dialysis Research Articles

Incidence of Acute Pulmonary Edema Before and After the Systematic Use of Ultrasound B-Lines

Introduction: Acute pulmonary edema (APE) due to fluid overload is considered the most feared complication in hemodialysis patients. Various diagnostic tests have been proposed to assess the fluid status in patients with end-stage kidney failure (ESKF); among these, lung ultrasound (measuring the number of B-lines) is emerging as a promising tool to identify pulmonary congestion in this patient population. Methods: We compared the incidence of APE before and after the implementation of lung ultrasound as a routine practice in our unit. The pre (from 1 January 2007 to 31 December 2008)- and post (from 1 January 2017 to 31 December 2018)-B-line implementation periods included 98 and 108 hemodialysis patients, respectively. By accurately reviewing their electronic medical records, all episodes of APE were collected. The 10-year interval between the two periods was specifically chosen to ensure no overlap between patients of the two cohorts whereas the single-center design was adopted to minimize the influence of center effect on the study results. Results: APE episodes occurred more frequently in patients from the pre-B-line implementation group (18/98, i.e., 18.4%) compared with those from the post B-line implementation group (6/108, i.e., 5.5%) (p = 0.004). An analysis based on repeated APE events showed that the incidence rate of APE was significantly higher during the pre-implementation period (2.0 APE episodes per 100 person-months, 95% CI: 1.4–2.7) than during the post-implementation period (0.3 APE episodes per 100 person-months, 95% CI: 0.1–0.7), with an incidence rate ratio (post- versus pre-) of 0.17 (95% CI: 0.07–0.40; p < 0.001). The odds of experiencing APE episodes were 74% lower (odds ratio: 0.26, 95% CI: 0.10–0.69) in patients from the post B-line implementation period compared with those from the pre-implementation period. Notably, adjusting for potential confounders did not affect the strength of this association, which remained statistically significant (p ≤ 0.030). Finally, dominance analysis indicated that the implementation of B-lines was the primary factor explaining the difference in APE episodes between the two periods, followed by dialysis duration and intra-dialysis weight gain. Conclusions: The systematic use of lung ultrasound (a simple, easy-to-learn, rapid and non-invasive method, easily performed at the patient’s bed) in everyday clinical practice was associated with a drastic reduction in episodes of APE in hemodialysis patients. Further observational and interventional studies are needed to confirm these results.

Unraveling the association between chronic inflammatory demyelinating polyradiculoneuropathy and peritoneal Dialysis

BackgroundChronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a rare disease seen in the general population and has been reported as showing an increased incidence in the peritoneal dialysis (PD) population, as documented in case reports.MethodsWe conducted a case-control study using data from the Taichung Veterans General Hospital electric medical record database from the years 2010 to 2023. We defined cases as CIDP with End-stage kidney disease (ESKD) and controls as without CIDP. A logistic regression analysis was used to investigate the association between CIDP and dialysis modality, age, gender, dialysis duration, plasma potassium > 5.5 mEq/L and < 2.5 mEq/L, and intact parathyroid hormone (i-PTH) > 613 pg/mL.ResultsOur findings suggest that PD may be a risk factor in the ESKD population (Odds ratio: 5.125, C.I.: 1.078 ~ 24.372, p = 0.040) according to logistic regression analysis. Dialysis duration, gender, diabetes mellitus, HbA1c > 7%, hypokalemia, hyperkalemia, and hyperparathyroidism did not show an association with CIDP.ConclusionThere seems to be an association between PD and CIDP in this case-control study. Possible mechanisms may involve systemic inflammation induced by peritoneal dialysate exchange or the content of the dialysate. Further studies are still needed.

Frequencies or Absolute Numbers? Cluster Analysis of Frequencies and Absolute Numbers of B-Cell Subsets in Dialysis Patients Who Are Candidates for Kidney Transplantation Reveals Different Profiles

Background: Detailed characterization of B cells in dialysis patients who are candidates for kidney transplant is still lacking, with little information on how dialysis duration and modality impact B cell subsets. Methods: Cluster analysis of flow cytometry determined the frequencies and absolute numbers of B-cell subsets and divided the cohort of 78 candidates into two distinct clusters, one with shorter and one with longer dialysis duration. Results: The immune profiles of the clusters differed depending on whether frequencies or absolute counts were considered. In long-term dialysis patients, the frequency of total memory, double negative and marginal zone B cells increased, while the frequency of naive and regulatory B cells decreased. This pattern was reversed in short-term dialysis patients, with a decrease in memory and an increase in naive and regulatory populations. The B subset number decreased significantly in long-term dialysis patients, while it increased significantly in short-term dialysis patients. The dialysis modality affected the frequency-based subset immune profiles. Conclusions: It is important to determine whether the evaluation is based on frequencies or absolute numbers. The different distribution of B cell subsets in the clusters, in terms of frequencies and absolute numbers, was influenced by dialysis duration. Modality and age only influenced the frequencies.

Ultrasound analysis of different forms of hemolytic uremic syndrome in children.

Hemolytic uremic syndrome (HUS) is the most common cause of acute kidney injury in children. It is mainly caused by Shiga toxin-producing enterohemorrhagic Escherichia coli (EHEC; STEC-HUS) and is more rarely caused by uncontrolled complement activation (cHUS). Renal replacement therapy is frequently required and kidney function recovers in the majority of patients. Ultrasound (US) is the preferred imaging modality for the evaluation of any renal failure. The aim of this study is the evaluation of US diagnostics in both HUS types at disease onset and in the course of the disease. Clinical, laboratory, and US data from the digital patient records of children admitted as inpatients with a diagnosis of HUS were recruited for a monocentric, retrospective analysis. STEC-HUS and cHUS were diagnosed when, in addition to the laboratory constellation, EHEC infection and complement system activation were verified, respectively. US examinations were performed by pediatricians with certified pediatric US experience. In total, 30 children with STEC-HUS (13/25 male; median age of disease onset 2.9 years; most prevalent EHEC serotype was O157) and cHUS (2/5 male; median age of disease onset 5.4 years; 3/5 with proven pathogenic variation) were included. Renal replacement therapy proportions were comparable in the STEC-HUS and cHUS patients (64% vs. 60%). The resistance index (RI) was elevated at disease onset in the patients with STEC-HUS and cHUS (0.88 ± 0.10 vs. 0.77 ± 0.04, p = 0.13) and was similar in the STEC-HUS subcohorts divided based on dialysis requirement (yes: 0.86 ± 0.1; no: 0.88 ± 0.1; p = 0.74). Total kidney size at disease onset displayed a positive correlation with dialysis duration (R = 0.53, p = 0.02) and was elevated in both HUS types (177% ± 56 and 167% ± 53). It was significantly higher in the STEC-HUS subcohort which required dialysis (200.7% vs. 145%, p < .029), and a regressor kidney size threshold value of 141% was indicated in the receiver operating characteristic analysis. A classification model using both US parameters sequentially might be of clinical use for predicting the need for dialysis in patients with STEC-HUS. The US parameters normalized over time. The US parameters of RI and total kidney size are valuable for the assessment of HUS at disease onset and during therapy, and may be helpful in the assessment of whether dialysis is required in patients with STEC-HUS.

Assessment of communication environment and health literacy of patients on chronic hemodialysis: a multicenter observational study (SMEL-HD study).

The ability to access health and medical information have implications for prognosis and quality of life. This study investigated the current communication environment and health literacy in chronic hemodialysis (HD) patients and their associations with patients' physical condition and clinical findings. This was a cross-sectional, single-arm, multicenter exploratory study. Data were collected from 211 patients (64 males) undergoing chronic HD at five facilities. This included a survey of communication environments, health literacy, dialysis management information, and clinical findings. Among the participants, 145 (68.7%) reported using the Internet. They primarily collected health-related as well as everyday life information through the Internet. Health literacy fell within the problematic range. In terms of e-Health literacy, "understanding" and "easy" showed a positive trend, while "accessing," "appraising," and "applying" were perceived as "difficult." Three groups were identified based on Internet usage: good communication environment (CE) group (134 participants), poor-CE group (56 participants), and a group that did not respond (21 participants). Grip strength, serum albumin level, and "information acquisition" were significantly lower in the poor-CE group. Health literacy increases as the duration of dialysis extends, and decreases with advancing age. Patients who used the Internet gained a wide range of information, including health-related information, for their daily lives. The use of ICT is lower among patients with decreased physical activity, and further investigation is desired into how actively encouraging these patients to collect health information via the Internet can enhance their health literacy.

Investigating the complex relationship and influencing factors of frailty on nutritional status in maintenance hemodialysis patients.

Given the high prevalence and significant challenges of frailty, a state of increased vulnerability to adverse health outcomes, among maintenance hemodialysis (MHD) patients, this cross-sectional study aimed to investigate its prevalence and explore its association with nutritional status and other relevant factors. The study involved 290 MHD patients with an average age of 52.98 ± 13.65 years. Frailty assessments, nutritional evaluations, and medical status measurements were performed. Data analysis involved descriptive statistics, correlation analyses, and multivariate logistic regression. Among the patients, 70.3% were identified with frailty (16.9% frail, 53.4% pre-frail). Frailty was more prevalent in female patients compared to males and correlated positively with age, marital status, caregiving needs, comorbidities, dialysis duration, and higher nutritional risk scores. Negative correlations were observed with serum albumin, hemoglobin, body weight, and height. A significant prevalence of frailty was found in MHD patients, with notable associations to various demographic, clinical, and nutritional factors.

Clinical features and risk factors for outcome in hemodialysis patients with COVID-19 after complete liberalization of epidemic control in China.

Patients undergoing hemodialysis (HD) are highly vulnerable during the COVID-19 pandemic. We aimed to investigate the risk factors associated with the severity of COVID-19 and death after the complete liberalization of epidemic control in China. We followed the outcomes of the HD patients of Central Hospital of Dalian University of Technology, from December 6, 2022 to January 8, 2023. The non-contrast enhanced chest computed tomography (CT) was performed on all COVID-19-infected hospitalized patients. We recorded the patient's clinical characteristics, demographic features, vaccination history, treatments, and lung lesions. Odds ratios and 95% confidence intervals were calculated using logistic regression models to identify independent risk factors for COVID-19-related severity and mortality. This study included a total of 858 hemodialysis patients, of which 660 were infected with COVID-19. The mean age was (55.61±14.61) years, with a median (interquartile range) dialysis duration of 44.5 (69.5) months. Over half (60%) of the study participants were male, and the majority had hypertension as a comorbidity. Multivariable analysis revealed that age, pre-dialysis diastolic pressure, fever, white blood cell (WBC) count, potassium, β2-microglobulin level and calcium were independent risk factors for disease severity, while platelets, urea nitrogen and creatinine were identified as independent protective factors. Furthermore, total iron- binding capacity and vaccination were found to be independent protective factors against mortality, and WBC count was an independent risk factor for in-hospital mortality (p &lt; 0.05). The most frequent CT finding among hospitalized patients with chest symptoms was patchy shadow or pleural effusion, observed in 64.8% of cases. More than half of the patients exhibited bilateral lung lesions, and over 60% involved two or more lobes. The majority of HD patients are susceptible to COVID-19. Demographic, clinical features and laboratory indicators can be used to predict the severity and mortality associated with COVID-19. Our findings will assist clinicians in identifying markers for the early detection of high mortality risk in HD patients with COVID-19.

Clinical outcomes in peritoneal dialysis with refractory peritonitis: significance of the day 5 cell count.

Peritoneal dialysis-associated peritonitis is a common and severe complication of peritoneal dialysis, associated with high morbidity and mortality. However, there's a lack of research on refractory peritonitis, which is difficult to manage and has a poor prognosis. Our study aimed to investigate factors affecting clinical outcomes in peritoneal dialysis patients with refractory peritonitis over a 12-year period at a medical faculty hospital in Turkey. We conducted a retrospective study at a single center from January 2009 to December 2020, involving 135 patients with 236 episodes of refractory peritonitis. The average age of the patient cohort was 53.0 ± 15.9years, and 72 (53.4%) of the patients were male. The leading identified causes of end-stage kidney disease were glomerulonephritis, hypertensive glomerulosclerosis, and diabetic nephropathy. Data on microbiological etiology, dialysate white blood cell counts, and patient demographics were analyzed to identify catheter removal risk factors. Statistical significance was set at p ≤ 0.05. Comparative analysis between patients with and without catheter loss revealed no significant differences in gender, age, presence of diabetes, prior hemodialysis, or duration of peritoneal dialysis. However, multivariate logistic regression analysis showed thata dialysate white blood cell count exceeding 1000/mm3 on day 5and hospitalization had a positive associationwith catheter loss, while the presence of gram-positive bacterial growth had an inverse correlation. Our study shows that fifth-day dialysate white blood cell count predicts refractory peritonitis outcomes. Future research should focus on developing tools to manage catheter removal proactively and enhance patient prognosis.

Prevalence of coronary artery calcification in patients with end-stage renal disease undergoing dialysis and the association of various risk factors with the development of coronary artery calcification in this patient population

Background: Patients with end-stage renal disease (ESRD) on dialysis exhibit a significantly higher risk of coronary artery calcification (CAC) than age-matched normal individuals, contributing to elevated cardiovascular morbidity and mortality. Aims and Objectives: This study designed to assess the prevalence of CAC in ESRD patients on dialysis and identify associated risk factors. Materials and Methods: Fifty ESRD patients undergoing maintenance dialysis and twenty normal subjects were included in this cross-sectional observational study. Serum calcium, phosphate, and parathyroid hormone were measured in all ESRD patients and normal controls. Multi Row Spiral Computed Tomography was performed to determine CAC scoring (CACS). Results: CACS was significantly higher in ESRD patients compared to normal subjects (mean CACS: 91.4±32.7 vs. 7.75±9.5 Agatston units, P&lt;0.05). Elevated levels of calcium phosphate products, serum leptin, intact parathyroid hormone (iPTH), presence of diabetes mellitus, and longer duration of dialysis were correlated with increased incidence of CACS in ESRD patients, as indicated by higher odd’s ratios ranged from 1.10 to 6.93. Conclusion: CAC is highly prevalent in ESRD patients on dialysis, emphasizing the need for stringent risk factor management. Our findings suggest that controlling calcium phosphate product, serum leptin, age, iPTH levels, and duration of dialysis may reduce CAC burden in this population, potentially mitigating cardiovascular risk and improving outcomes.

The Prevalence and Associated Factors of Hepatitis B and C Virus in Hemodialysis Patients in Ibb Governorate, Yemen.

Introduction Hepatitis C virus (HCV) and hepatitis B virus (HBV) among patients receiving hemodialysis (HD) remain a major public health problem. However, information is limited about these infections among HD patients in Yemen. This study aimed to estimate the prevalence and associated risk factors of HBV and HCV infections among HD patients in the Ibb governorate, Yemen, and to identify the risk factors for infections in such patients. Methods A cross-sectional study of 374 patients with renal failure who regularly underwent HD at the Al-Thawra Hospital in Ibb city, Yemen, was performed after they agreed to participate and signed informed consent. Enzyme-linked immunoassay (ELISA) was used to test the serum levels of anti-HCV antibodies and hepatitis B surface antigen (HBsAg). Patient data (demographic characteristics and risk factors) were collected via an interview questionnaire and medical records. Logistic regression analysis and chi-square tests were used to analyze the results. Results The overall prevalence of HCV was 31% (n=116), whereas that of HBV was 6.15% (n=23). Three (0.8%) patients had both HCV and HBV. The logistic regression analysis revealed a significant association between an increased number of units of blood transfused (OR = 3.1; 95% CI: 1.7-5.6; p< 0.001), a long duration of dialysis (OR = 3.2; 95% CI: 1.9-5.2; p = 0.001), and HCV infection in HD patients. On the other hand, a history of cupping therapy (Hijama) was significantly associated (OR = 3.4; 95% CI: 1.3-8.77; p < 0.011) with HBV infection in HD patients. Conclusion HCV and HBV infections are more common among HD patients in Yemen than in most Middle Eastern countries. However, the current prevalence rates are declining compared with previously published data among Yemeni HD patients. The duration of HD and number of blood units were independent risk factors for HCV infection, and patients with a history of cupping were identified as having an increased risk of HBV infection. These findings underscore the need to implement strict infection control in HD units.

Impact of Mental Health Literacy on Mental Health and Renal Function in Dialysis Patients: A Cross-Sectional Study

Aim: This article aims to assess Mental Health Literacy (MHL) in dialysis patients and examine their impact on anxiety, depression and physical health. Material and Method: The study was conducted in the Hemodialysis Unit of Karaman Training and Research Hospital between March and June 2024. A total of 87 patients who met the inclusion criteria and agreed to participate were included in the study. Data were collected using a semi-structured sociodemographic form, Mental Health Literacy Scale, Hamilton Depression Scale and Hamilton Anxiety Scale. Biochemical parameters were obtained from electronic patient records. Results: The frequency of depression was 45%. There was no significant difference in MHL points among individuals with and without depression. Furthermore, no correlation was found between MHL and duration of disease or dialysis. A significant relationship was found between Total and Resource subscale scores of MHL and estimated glomerular filtration rate (eGFR). Conclusion: The frequency of depression was higher in dialysis patients than in the general population. Albeit no significant difference in MHL was observed between patients diagnosed with depression and those without, the significant relationship between MHL and eGFR suggests that interventions to increase MHL may have positive effects on disease progression.

Prevalence, Clinical Aspects, and Risk Factors of Aortic Stenosis Among Haemodialysis Patients Attending Nephrology Centre of Benghazi

Background: Cardiac valve calcifications (CVC) are common among patients on haemodialysis (HD). The valves most commonly involved are mitral and secondarily aortic valves. In Libya, there is a lack of research in this field. This is the author’s motivation to conduct this study, which has a significant impact on the health status of patients on HD. Objective: To identify aortic valve calcifications (AVC), prevalence of aortic stenosis (AS) in patients on HD, and to determine clinical aspects and risk factors that may lead to the development of AS. Patients and Methods: A cross-sectional study was conducted between May–November 2023 of adult patients on chronic HD who had received haemodialysis for more than 1 year. Patients with previous cardiac surgery, a history of endocarditis, or severe anaemia (haemoglobin &lt;7.5 mg/dL) were excluded. A sample of 48 patients were enrolled in the study, with all patients undergoing clinical, biochemical, and a trans-thoracic echocardiographic evaluation. Results: Patients were aged 31–60 years ±13.2 standard deviation. AS had a prevalence of 6.3%, mitral regurgitation had a prevalence of 33.3%, and CVC was detected in 60.4% of patients on chronic HD, with AVC seen in 52.1% and mitral valve calcification seen in 25%. Patients with AVC were more often females (58.6%). Diabetes was seen in 64.6% of cases, and autosomal polycystic kidney disease was seen in 25%. The authors found that dyspnoea was the most common symptom (66.7%), followed by palpitations (35.4%) and asymptomatic patients (27.1%). Clinically detected AS was observed in three individuals (6.3%). Surprisingly, patients did not exhibit significant differences in age, duration of dialysis, or comorbidities. However, hyperphosphatemia was detected in 56.25% of patients, and hyperparathyroidism was recorded in 64.50%. Conclusion: The study has shown that aortic stenosis is the second most common valvular lesion in patients on chronic HD, preceded by mitral valve regurgitation. However, asymptomatic AVC has the highest prevalence among patients on chronic HD. Hyperphosphatemia and hyperparathyroidism are major risk factors that enhance the calcification of cardiac valves. Value of the Research: Though it is a snapshot study, it addresses an important comorbidity in patients on chronic HD. Namely, prevalence of aortic stenosis, CVCs, and associated risk factors, which had been reported in many regional and global nephrology literature, but the national Libyan literature still lacks such chronic HD patients’ data.

The Time-Dependent Effect of Assistance on Peritoneal Dialysis Duration: An Analysis of Data from the French Language Peritoneal Dialysis Registry.

Key Points It is unknown whether the benefit of assisted peritoneal dialysis (PD) programs appears immediately after PD initiation or rather after some time spent on PD.The protective effect of assisted PD on the risk of transfer to hemodialysis was not constant over time; it started after the first 6 months on PD.Assisted PD programs should be sustainable for at least 6 months to observe their benefits. Background Peritoneal dialysis (PD) patient compliance is crucial for the prevention of complications. Assistance is associated with a lower risk of transfer to hemodialysis. As the risk of noncompliance increases over time, the protective effect of assistance on the risk of transfer to hemodialysis may not be immediate after PD initiation, but rather may appear after some time on PD. We aimed to analyze the time-varying effect of assistance on the risk of PD cessation. Methods This retrospective study was conducted using data from the French Language PD Registry of incident PD patients between 2002 and 2018. Because of nonproportional hazards, with a change in the effect of the assistance modality on the different outcomes appearing at 6 months after PD initiation, the associations between the assistance modality and the different outcomes were explored using time-dependent coefficient Cox regression. Results The study included 15,675 patients; 6717 deaths, 4973 transfers to hemodialysis, and 3065 kidney transplantations occurred. Both patients receiving nurse- and family-assisted PD had a lower risk of transfer to hemodialysis (mean cause-specific hazard ratio [cs-HR], 0.67; 95% confidence interval [CI], 0.62 to 0.72; and mean cs-HR, 0.75; 95% CI, 0.67 to 0.84). In the first 6 months after PD initiation, nurse-assisted PD patients had a greater risk of transfer to hemodialysis (&lt;6 months cs-HR, 1.18; 95% CI, 1.03 to 1.36) but had a lower likelihood afterward (≥6 months cs-HR, 0.57; 95% CI, 0.53 to 0.62). Family-assisted PD was not associated with the risk of transfer to hemodialysis in the first 6 months after PD initiation, and those patients had a lower risk of transfer to hemodialysis afterward (≥6 months cs-HR, 0.72; 95% CI, 0.63 to 0.82). Conclusions When implementing a national nurse-assisted PD program, its positive impact on PD duration should not be expected immediately after PD initiation. Assisted PD programs should be sustainable for at least 6 months to observe their benefits. Podcast This article contains a podcast at https://www.asn-online.org/media/podcast/K360/2024_10_31_KID0000000577.mp3

Impact of hemodialysis center accreditation on patient mortality: Korean nationwide cohort study.

Since hemodialysis (HD) patients are prone to various complications and high mortality, they need to be treated in HD units with professional personnel, proper equipment, and facilities. The Korean Society of Nephrology has been conducting an HD unit accreditation program since 2016. This study was performed to evaluate whether a qualified dialysis center (QDC) reduced the mortality of HD patients. This longitudinal, observational cohort study included 31,227 HD from 832 facilities. HD units were classified into two groups: the hospitals that have been certified as QDC between 2016 and 2018 (n = 219) and hospitals that have never been certified as QDC (non-QDC, n = 613). Baseline characteristics and patient mortality were compared between QDC vs. non-QDC groups using Korean HD quality assessment data from 2018. Multivariate logistic regression and the Cox proportional hazards model were used to compare patient mortality between the two groups. Among study subjects, 30.6% of patients were treated at QDC and 69.4% were treated at non-QDC. The patients in the QDC were younger and had a longer dialysis duration, lower serum phosphorus and calcium levels, and higher hemoglobin and single-pool Kt/V levels compared to the patients from the non-QDC group. After adjusting for demographic and clinical parameters, QCD independently reduced mortality risk (hazard ratio, 0.897; 95% confidence interval, 0.847-0.950; p < 0.001). The HD unit accreditation program may reduce the risk of death among patients undergoing HD.

Trends in Patient Characteristics on the Japanese Waiting Lists for Deceased-Donor Kidney Transplantation. Are There no Eligibility or Ineligibility Criteria for Registration and Renewal?

BackgroundControversial issues in registering candidates for deceased-donor kidney transplantation (DDKT) comprise various factors, including age, life expectancy, and dialysis duration. We investigated patient characteristics on the waiting list and discussed suitable criteria in Japan, which has a long waiting period. MethodsThis study included 592 patients on the waiting list for DDKT at our institute between 1982 and 2023. We retrospectively reviewed patients’ medical charts and obtained their clinical information. Patient characteristics according to outcomes and eligibility criteria for applying for or renewing registration were investigated. No prisoners were used in the study, and the participants were neither coerced nor paid. ResultsApproximately 70%, 45%, and 14.5% of the registered patients were aged >60, >70, and 80 years, respectively. The number of patients aged ≥70 years gradually decreased over time. The median waiting periods of patients who underwent and interrupted DDKT were 13 and 7 years, respectively. Patients in their 70s with a >15-year dialysis period tended to have opportunities for DDKT. Living-donor kidney transplantation was performed in patients aged <60 years. Waiting patients were significantly younger and had a shorter dialysis duration. Advanced age at registration was associated with a significantly high risk of interruption. ConclusionsAdvanced age and longer dialysis periods were considered at registration because patients with these factors tended to experience interruptions despite the long waiting period and high cost. Although older patients can undergo DDKT, factors including surgical cost and risks are considered. Eligibility/ineligibility criteria should be established for DDKT waiting lists in Japan.

P091 PROENKEPHALIN CONCENTRATION AND ITS DETERMINANTS IN PATIENTS WITH END-STAGE KIDNEY DISEASE TREATED WITH HEMODIALYSIS AND PERITONEAL DIALYSIS

Background and Objective. Proenkephalin (PENK) has been recently shown to reflect glomerular dysfunction and predict new-onset acute kidney injury and heart failure. While previous studies investigated PENK utility in individuals with preserved renal function, PENK concentration in patients with end-stage kidney disease (ESKD) remained to be established. The study aimed to assess plasma PENK concentration in patients with end-stage kidney disease (ESKD) treated with hemodialysis (HD) and peritoneal dialysis (PD) and to investigate its correlation with heart failure. Additionally, we aimed to determine whether PENK is removed during a hemodialysis session. Methods. 88 patients with ESKD (41 females) undergoing HD (n=66, 75%) and PD (n=22, 25%) were enrolled in this cross-sectional study. Blood samples for PENK determination were collected before and at the end of the hemodialysis session in HD patients and at a single time point in PD patients. Plasma proenkephalin concentration was assessed using a sandwich ELISA immunoassay. Samples for measurement of creatinine, urea, and NT-proBNP were drawn simultaneously. Results. The median (IQR) plasma PENK concentration in the overall population was 1.492 ng/ml (1.071-4.380). Both median eGFR (5 mL/min/1.73 m2 [4-7] vs. 5 mL/min/1.73 m2 [4-8], p=0,856) and plasma PENK levels (1.368 ng/ml [1.068-4.030] vs. 1.706 ng/ml [1.211-5.858], p=0.305) did not differ significantly between HD and PD patients. In HD patients, median PENK concentration was significantly higher before than after hemodialysis (1.368 vs. 2.061; p=0.003). No correlation was found between PENK level and urea (p=0.192), eGFR (p=0.922), duration of dialysis (p=0.637), and residual urine output (p=0.784). Heart failure (p=0.961), EF (p=0.361), and NT-proBNP (p=0.949) were not associated with increased PENK concentration. Conclusions. Our study proved that PENK is not removed during hemodialysis session. PENK concentration does not reflect renal function and cardiac status in patients with ESKD. The fact that PENK is not removed by hemodialysis calls into question the usefulness of PENK as an everyday use biomarker in acute kidney injury.

Daily change of peritoneal ultrafiltration volume in patients with hybrid dialysis.

Hybrid dialysis is widely used in Japan. Although previous reports have shown the beneficial effects of hybrid dialysis, little is known about the daily change in peritoneal ultrafiltration volume in hybrid dialysis. A multicenter, cross-sectional study was conducted in 25 patients with hybrid dialysis. The primary outcome measure was the change in peritoneal ultrafiltration volume between after HD and before HD, according to PD prescription and PD holiday. The secondary outcome measure was the correlation between the difference in ultrafiltration volume and each factor. The total ultrafiltration volume and the ultrafiltration volume of glucose dialysate after HD increased from 970 ± 408 to 1151 ± 480 (p < 0.01) and from 576 ± 392 to 750 ± 517 (p < 0.01), respectively, compared with before HD. In contrast, the ultrafiltration volume of icodextrin dialysate did not change (from 470 ± 204 to 494 ± 242, p = 0.40). The difference in total ultrafiltration volume was correlated with the difference in glucose dialysate ultrafiltration volume and hybrid duration, but not with the difference in icodextrin dialysate ultrafiltration volume and peritoneal dialysis duration. This study showed that the peritoneal ultrafiltration volume for glucose dialysate increased after HD compared with before HD in patients with hybrid dialysis, whereas that for icodextrin dialysate did not change.

Hepatitis C Virus Seroprevalence and Genotypic Distribution Among Hemodialysis Patients at a Teaching and Training Hospital in Western Rajasthan, India.

Background Hepatitis C virus (HCV) infection is a chronic hepatotropic blood-borne infection. The transmission of HCV in patients undergoing hemodialysis (HD) is more common in comparison to the general population due to factors such as frequent blood transfusions, prolonged vascular access, and the potential for nosocomial infections. Western Rajasthan in India is home to numerous teaching and training hospitals that cater to a large number of HD patients. Understanding the seroprevalence and genotypic distribution of HCV in this specific patient population is crucial for assessing the extent of infection within this vulnerable group for targeted surveillance and developing effectively tailored treatment protocolsin healthcare settings. Hence, this study was conducted with an aim to determine seroprevalence, seroconversion, and genotypes of HCV in HD patients at a tertiary care hospital. Methods This was a cross-sectional observational study. The duration of the study was from July 2019 to March 2022. In this study, the patients undergoing maintenance HD due to chronic kidney disease (CKD) were recruited. The data collected include patients' demographics, etiology of CKD, underlying other co-morbidities, duration of dialysis, and biochemical and blood count parameters. The patients recruited at the start of the study were screened for anti-HCV antibodies by HCV enzyme-linked immune sorbent assay (ELISA). The anti-HCV antibody-negative patients were followed up for the detection of anti-HCV antibodies. At the end of the follow-up period, all anti-HCV antibody negative samples in the pool of five and all anti-HCV antibody positive samples were subjected to a real-time polymerase chain reaction (RT-PCR) of 5' untranslated region (5'UTR) and core region, followed by line probe assay (LiPA). Results In this study, after applying inclusion and exclusion criteria, a total of 109 patients were recruited, out of which 64 (58.7%) were males and 45 (41.3%) were females. The age range of participants was 11-88 years with a mean and standard deviation of 46.75 and 16.35 years, respectively. A total of 39 patients (20 on screening, 19 on follow-up) were detected anti- HCV antibody positive. By RT-PCR, 24 patients tested HCV RNA positive (10 on screening, 14 on follow-up). Among 24 HCV RNA-positive samples, LiPA showed, HCV genotype 1a (n=21), genotype 3b (n=1), and two samples were detected to be inconclusive. Conclusion The increasing duration of dialysis is significantly associated with acquiring HCV infection. The majority of the cases of CKD in this geographical region are due to hypertensive nephropathy. There can be discordance between antibody and viral RNA positivity in HCV infection. The predominant HCV genotype identifiedin the dialysis ward of tertiary care hospital was genotype 1a.

Acquired Cystic Kidney Diseases in Bangladeshi Rural Populations: A Cross- Sectional Investigation

Acquired cystic kidney disease (ACKD) is a condition characterized by the formation of numerous cysts in the kidneys. It is frequently associated with chronic kidney disease (CKD) and dialysis. Despite its clinical significance, little is known about its prevalence and characteristics among Bangladesh's rural people. Between January and June of 2023, a cross-sectional survey was done with 120 participants from various rural areas of Mymensingh Division, Bangladesh, to observe the prevalence, risk factors, and clinical characteristics of ACKD. Participants were screened for ACKD using ultrasonography. Demographic information, medical history, and pertinent clinical indicators were gathered. Significant connections between ACKD and possible risk variables were identified by statistical analysis. The median dialysis vintage was 33.3 [range:10.6-62.98] months. Renal cysts were seen in 62.5 % (n=74) of participants, 41.6% (n=50) were bilateral. The median [25th-75th percentile] number of cysts in the right kidney was 4 (range: 2-8) and 3 (range: 2-7.3) in the left kidney. ACKD was detected in 29.17% of the study participants. Individuals with a history of CKD and those on prolonged dialysis vintage had significantly greater prevalence. Male populations over 50 years with prolonged dialysis duration were identified as key risk factors for ACKD. ACKD is a significant health hazard in Bangladesh's rural populations, particularly for elderly persons with CKD and those undergoing dialysis. This study aims to investigate the prevalence, clinical characteristics, and associated risk factors of ACKD among rural populations in Bangladesh. Additional longitudinal studies are required to investigate the long-term impact of ACKD on renal function and overall health outcomes in local communities. CBMJ 2024 July: vol. 13 no. 02 P: 218-222

Seroprevalence and Seroconversion of Hepatitis B and C Viruses in Patients Undergoing Hemodialysis: A Cross-sectional Study.

Among hemodialysis patients, hepatitis B virus (HBV) and hepatitis C virus (HCV)infections contribute significantly to mortality and morbidity. Infection with these hepatotropic viruses in hemodialysis patients is due to their increased contact with blood and its derivatives. Additionally, not following the proper protocol for infection control, contaminated devices, and untrained personnel contribute to the nosocomial transmission of these infections. This cross-sectional study was planned to estimate the seroprevalence of hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus antibodies in patients to know the seroconversion rate for hepatitis B and hepatitis C and to evaluate the risk factors that contribute to seroconversion in patients undergoing hemodialysis at our center. This study included 185 patients with chronic kidney disease undergoing hemodialysis in our center. After giving informed consent, a blood sample from each patient was collected for testing for HBsAg and anti-HCV antibodies initially and then every month. Of the total 185 patients, five participants tested positive for HBV (2.7%), and 29 individuals tested positive for HCV (15.67%). During the study period, seroconversion for hepatitis C was observed in three patients (1.62%), and seroconversion for hepatitis B was observed in one patient (0.54%). An evaluation of the potential risk factors revealed that dialysis conducted outside the facility contributed significantly to HCV infection. Our study shows lower HBV rates but higher HCV rates. The demographic data of the patients and the duration of dialysis are related to the risk of infection. Dialysis within the same healthcare facilities reduces the transmission risk.