Dialysis Population Research Articles

#5615 VALIDITY AND ADEQUACY OF ANIMAL MODELS IN HAEMODIALYSIS RESEARCH: A SYSTEMATIC REVIEW

Abstract Background and Aims with the worldwide dialysis population growing rapidly, improving haemodialysis (HD) outcomes is crucial and HD innovations are urgently needed. Prior to clinical application, novel HD technologies must undergo extensive preclinical testing. However, to date there is no consensus on the induction method of kidney failure in animal models nor which animal species is most suitable for research on HD innovations. Moreover, there is no consensus on which parameters should be used to validate adequate induction of kidney failure and functioning of novel HD devices. Using a systematic review approach, we summarized available literature of HD in kidney failure animal models. Method we performed a systematic search on PubMed and Embase for relevant studies up to February 4th 2022. After removal of duplicates, 5723 abstracts were screened for eligibility by three independent reviewers (JdV, KW and MK). Inclusion was based on publication of a HD intervention in an animal model with adequate (acute or chronic) kidney failure (independent of induction method). Detailed in- and exclusion criteria were registered in PROSPERO 2022 CRD42022307144. Data from individual reports, including animal species and sex, kidney injury parameters and HD details, were extracted in a pre-set data extraction form. Future efforts will focus on risk of bias and key quality indicators. Results of the 5723 abstracts screened, 195 records were included as full text and 41 full text articles were included for data-extraction (Figure 1). Current data extraction is completed for 31 articles (75%). Publication years range from 1973 to 2021 with over half (16/31) published after 2000. HD experiments were most frequently performed on dogs (45%), followed by rats (29%), goats (13%), pigs (10%), and sheep (3%) respectively. Parameters such as weight (81% reported), sex (58%) and age (29%) were not systematically reported. Most studies (67% of records reporting sex) used male animals only. Dog models were found in older studies, with no records after 2009. Other large animal studies were almost exclusively (88%) performed from the year 2007 onwards. Independent of animal species, studies mainly used acute kidney injury (AKI) models (84%), induced by bilateral nephrectomy (48%) or bilateral ureteral ligation (29%). The majority confirmed kidney failure by an increase in BUN and/or plasma creatinine. In AKI models, dialysis was on average initiated on AKI day 2 ± 0.8, and generally either HD (61%) or veno-venous hemofiltration as a single session (35%) was applied. Except for one clearance study, dialysis efficiency was reported as reduction ratios of BUN and/or plasma creatinine. Conclusion both large and small animal models have been used in HD research and preclinical validation of dialysis innovations. The use of dogs to test HD innovations has seen a sharp decline over the past decades, possibly resulting from a shift in public ethical perception. However, large animal models such as goat, sheep and pigs remain popular. A pressing issue appears the overall lack of adequate ARRIVE guideline adherence for reporting of animal parameters. We found no apparent improvement in reporting over time, emphasizing the need for clear guidelines to drive innovative HD research. Further (quantitative) analysis and meta-analysis are ongoing.

#4894 EFFICIENCY AND SAFETY OF AN ASSISTED HOME HEMODIALYSIS PROGRAM IN THE STATE OF QATAR: A RETROSPECTIVE STUDY

Abstract Background and Aims Home hemodialysis (HHD) usually done as self-care by patient themselves through a portable haemodialysis (HD) machine under training and monitoring by dialysis team. HHD offers greater patient autonomy, cost benefits, treatment-related flexibility, and improved quality of life compared to traditional in-centre HD. Uptake of HHD is limited by patient motivation, cognitive and/or physical barriers, as well as lack of support of family and community. Assisted HHD (AHHD) is a new concept where dialysis team provides HD at home. Usually, it is done by a visiting dialysis nurse using mobile HD machine. Its use is limited due to financial and logistical restriction. We like to present our unique experience in providing AHHD in the State of Qatar. Planning for our AHHD program started in July 2020. Because of COVID-19 pandemic, it faced many challenges and delays. We started first patient in July of 2021. In our program, we use traditional HD machine (not portable) with connection set up in the house in a dedicated room. Special training was provided to AHHD staff regarding the special care needed for home setting (including social, complication of home dialysis settings, decision making, follow up of protocols and policies, etc.) Method We performed a retrospective study between July 1st, 2021 - December 31st, 2022. Our primary objectives were efficiency and safety of AHHD, and secondary objective was cost effectiveness. We included adult chronic HD patients (on HD >3 months) using ambulance (or eligible for it) with functional dialysis access. We excluded patients who are not suitable for home environment (psychiatric illness, aggressive behaviour, etc.). Data were collected from our national electronic health record system. Results 946 patients screened for the program. 237 were eligible (exclusion mostly due to lack of national insurance coverage or not meeting mobility/transport criteria). 121 patients refused to participate (mostly for feeling safer in the clinic setting or improper home environment), 40 patients were undecided, and 76 patients accepted and started AHHD. Age was 73+/-11 years. We had 32 males and 44 females. Mean follow up period were 7 months. 12 patients died and 2 patients returned to dialysis centre during follow up period. Only 15 out of the total 126 hospitalizations were related to dialysis (mostly due to volume overload and non-compliance with dialysis schedule and time). We had 55 patients with permcath and 21 with AV fistulas. We had 8 incidents of dialysis catheter malfunction (6 required tissue plasminogen activator installation in the house setting and only two needed catheter exchange (one had catheter related infection)). No reported significant access bleeding or hypotension episodes. We had 20 technical incidents during the study related to electricity or water supply failures. All incidents were resolved without much interruption of treatment. The program overall was cost effective and reduced cost by over 25% (mostly related to saving of ambulance cost). Patients and their families were very satisfied with the program overall. Conclusion We present a unique successful program related to providing AHHD. Targeting certain dialysis population showed great care, safety, cost saving, better QOL and satisfaction.

#5367 CLINICAL SIGNIFICANCE OF NORMO-HYDRATION STATE IN PERITONEAL DIALYSIS PATIENTS

Abstract Background and Aims The assessment of fluid status in dialysis patients is of paramount importance. Managing persistent volume overload and instability during dialysis is a significant challenge, with concomitant symptomatic and asymptomatic intradialytic hypotension (IDH) that results in dialysis-induced myocardial ischemia (cardiac stunning) and long patient recovery times.Our aim was to estimate the status of hydration in our peritoneal dialysis population by body composition monitoring (BCM) device to modify our pharmacological and dialysis policy and to evaluate echocardiographic parameters of the RV functions in patients with end-stage renal disease (ESRD) undergoing PD. Method We used a Fresenius Body Composition Monitor (BCM), a whole-body bioimpedance spectroscopy (50 frequencies, 5–1,000 kHz), to assess the body composition of 35 patients on peritoneal dialysis in our centre..We measured body weight, 24 h diuresis and performed a BCM session. Analysed results of echocardiography focused on RV (tricuspid annular plane systolic excursion (TAPSE). As per statistics, comparisons between 2 groups done by students t test, Mann Whitney U test or Wilcoxon test. Correlation between data was done by Pearson or spearman correlation. And lastly categorical variables were assessed by fisher's exact, and Chi squared test. Results Average age was 47 years old (SD 9,45 t-test p = 0,1154:). Gender distribution was 54,3% of our patients were female. 8,6% of our patients were anuric, 91,4% had residual urine (more than 1 litre). TAPSE value were average 23,17 mm (±4,5).We measured over-hydration in 8 cases by BCM that followed dialysis policy modification. In 8 PD patients we measured more than 2 L volume overload (VO) with BCM followed by dialysis policy modification (fluid intake restriction, diuretic dose increasing, frequent solution exchange). Conclusion Our data raised the importance of regular echocardiography to identify it. More attention should be focused on improving BP and volume control and identifying treatment strategies that effectively lower further deterioration in PD patients. One way of doing this is monitoring with BCM. With this clinician can manage persistent overload in CAPD patients, to better modify the dialysis regime, restrict fluid intake and use diuretics, to all in all preserve LV and RV function, and to prevent deterioration of the peritoneal membrane, and most importantly improve their survival.

The Relationship Between Oxidative Stress and Osteoporosis in Chronic Dialysis Patients / Kronik Diyaliz Hastalarında Oksidatif Stres ile Osteoporoz Arasındaki İlişki

Aim: End Stage Renal Disease (ESRD) patients are subjected to enhanced oxidative stress (OS), and osteoporosis (OP) is an important cause of morbidity in patients with ESRD. Although it is controversial, in many studies made in population without renal disease, OS is related to increased OP risk. In recent study we aimed to investigate the association between OS and OP in dialysis patients. Materials and methods: Sixty two patients on maintenance dialysis programme were included into the study. Total oxidant status (TOS), lipid hydroperoxides (LOOH), and total antioxidant capacity (TAC) and bone mineral density was measured. Demographic and biochemical parameters were recorded. Patients were divided as group 1: Hemodialysis and group 2: Peritoneal Dialysis and compared. Results: Twentynine of 62 patients were on HD and 33 were on PD. In Bone mineral density BMD T–scores while there was no statistically significant difference between two groups at femur neck, according to lumbar spine among HD patients T score was better then PD patients. Mean serum concentration of LOOH was 6.07±2.91 and 5.82±2.20 µmolH2O2Eq/L, TOS was 8.89±5.89 and 7.62±3.99 µmol H2O2Eq/L, and the TAC was 1.01±0.20 and 0.93±0.16 mmolTroloxEq/L in group 1 and in group 2 respectively. Among all patients there was a positive correlation between TAC and T score in FN. There was no correlation between TOS and T-scores. Conclusion: Although enhanced OS and reduced antioxidant capacity in dialysis patients we did not find any effect of OS on OP. This result may be due to low OP rate in our patients and this novel topic needs further large scale studies in dialysis population.

Serological Response to SARS-CoV-2 Vaccine in Hemodialyzed Patients and the Association with Later COVID-19 Positivity

Background: The effectiveness of the COVID-19 vaccine may differ in hemodialysis patients. The aim of this prospective multicenter study was to determine the degree of serological response to the SARS-CoV-2 vaccine in the population of dialysis patients and its association with later SARS-CoV-2 infections. Methods: A blood sample was taken for the determination of COVID-19 serological status (IgG antibodies) in 706 dialysis patients 16 weeks after vaccination with the second dose (Pfizer-BioNTech). Results: Only 314 (44.5%) hemodialyzed patients had a satisfactory response to the COVID-19 vaccine. Eighty-two patients (11.6%) had a borderline response, while 310 patients (43.9%) had an unsatisfactory (negative) post-vaccinal antibody titer. A longer dialysis vintage had an increased odds ratio (OR) of 1.01 for the occurrence of COVID-19 positivity after vaccination. In the group of subsequently positive patients, 28 patients (13.6%) died from complications of COVID-19. We have found differences in mean survival time between patients with and without appropriate responses to vaccination in favor of patients with a satisfactory serological response. Conclusions: The results showed that the dialysis population will not have the same serological response to the vaccine as the general population. The majority of dialysis patients did not develop a severe clinical picture or die at the time of positivity for COVID-19.

Patient and Health Care Professional Perspectives on Addressing Obesity in ESKD

Obesity is common among patients with end-stage kidney disease (ESKD) and is a pervasive barrier to kidney transplantation. Patient perspectives about barriers to weight loss and patient and health care professionals' viewpoints about optimal obesity management in ESKD are needed. Qualitative study using a descriptive phenomenological approach to understand ESKD patients' lived experiences with obesity and weight loss and patients' and health professionals' perceptions about optimal obesity care for ESKD patients. Between October 2020 and December 2021, we conducted 90-minute semistructured interviews with 40 ESKD patients with obesity (body mass index [BMI]≥30kg/m2) and 60-minute interviews with 20 ESKD health care professionals. Deductive and inductive thematic analysis of interviews. Among patients with ESKD, the median age was 55 (IQR, 46-63) years, median BMI was 39.5 (IQR, 35.3-41.6) kg/m2, and median dialysis vintage was 5 (IQR, 3-8) years; 58% were female, and 46% were non-Hispanic White. Among health care professionals, 50% were renal dietitians, 20% were nephrologists, and the remainder were transplant professionals (surgeons, nephrologists, and dietitians). ESKD patients described unique weight loss challenges, including (1) conflicting tenets of "kidney-friendly" versus popular diets, (2) fatigue due to dialysis that affects dietary choices, and (3) perceived pressure and unrealistic expectations from health professionals to lose weight for kidney transplantation. Professionals and patients described a lack of transparent and honest communication about obesity and unclear roles and responsibilities for obesity counseling. Lack of caregiver perspectives and potential lack of transferability to overall dialysis population given overrepresentation of patients with severe obesity and previous weight loss surgery. Obesity interventions for ESKD patients should be tailored to meet the unique challenges reported by patients with ESKD. Clarifying ESKD health professionals' roles and responsibilities for obesity care would help to ensure that patients have consistent and effective support to manage obesity. Adults with coexisting obesity and end-stage kidney disease (ESKD) are often required to lose weight for kidney transplantation. Yet there is little knowledge about barriers to healthy weight loss in this population. In this study, we conducted interviews with 40 ESKD patients with coexisting obesity and 20 ESKD health care professionals to learn about opportunities to improve obesity-related health care in ESKD. Patients reported that fatigue and dialysis affected dietary choices, and fluid and food restrictions hampered weight loss. Professionals described a lack of training, comfort, and time to address obesity. Patients and professionals reported a lack of open communication about obesity management. Improving obesity-related education and clinical communication should be prioritized to improve care for patients with ESKD and obesity.

Association between apathy in patients with maintenance dialysis and hospitalization or mortality: a prospective cohort study.

Patients receiving maintenance dialysis experience increased rates of hospitalization and mortality. Apathy is associated with reduced quality of life and increased hospitalization, institutionalization, and death. Whether apathy contributes to poor outcomes in population undergoing maintenance dialysis remain unknown. We conducted a prospective cohort study of maintenance dialysis population who were consecutively recruited at the Dialysis Center of Shanghai General Hospital between July 2017 and August 2018 and were followed up for 3 year. Apathy status was measured by the Apathy Evaluation Scale. The study outcomes were the occurrence of death and first hospitalization. A total of 647 participants included in this study, 274 (42.3%) had a current apathy and 373 (57.7%) were not. During the follow-up period, 394 (60.9%) were hospitalized, and 169 (26.1%) died. Kaplan-Meier analysis showed that the risks of hospitalization and mortality were significantly higher in individuals with apathy than in those without apathy (both p < 0.001). Apathy at baseline was associated with hospitalization and death both in univariate analysis and in all multivariable models (all p < 0.001). Apathy was highly prevalent and independently correlated with an increased risk of poor outcomes in patients with maintenance dialysis.

Representation of Racial and Ethnic Minorities in Nephrology Clinical Trials: A Systematic Review and Meta-Analysis.

Racial and ethnic disparities in clinical trial enrollment are well described. However, whether these disparities are present in nephrology randomized clinical trials has not been previously reported. We performed a systematic review and meta-analysis of 380 randomized clinical trials involving different aspects of kidney disease published between 2000 and 2021. Our results indicate that worldwide reporting of race and ethnicity is poor and that White individuals account for most of the randomized participants with decreased enrollment of Black participants in more recent trials. However, trials conducted in the United States have representation of Black and Hispanic participants consistent with the population prevalence of disease and under-representation of Asian participants. Under-representation of racial and ethnic minorities in clinical trials could worsen disparities, but reporting and enrollment practices in nephrology randomized clinical trials have not been described. PubMed was searched to capture randomized clinical trials for five kidney disease-related conditions published between 2000 and 2021 in ten high-impact journals. We excluded trials with <50 participants and pilot trials. Outcomes of interest were the proportion of trials reporting race and ethnicity and the proportions of enrolled participants in each race and ethnicity category. Among 380 trials worldwide, race was reported in just over half and ethnicity in 12%. Most enrolled participants were White, and Black individuals accounted for ≤10% of participants except in dialysis trials where they accounted for 26% of participants. However, Black participants were enrolled at high proportions relative to disease and population prevalence in US CKD, dialysis, and transplant trials representing 19% of participants in AKI, 26% in CKD, 44% in GN, 40% in dialysis, and 26% in transplant trials. Enrollment of Asian participants was low worldwide except in GN trials with marked under-representation in US CKD, dialysis, and transplant trials. Hispanic individuals represented only 13% of participants in US dialysis trials compared with 29% of US dialysis population. More complete reporting of race and ethnicity in nephrology trials is needed. Black and Hispanic patients are well-represented in kidney disease trials in the United States. Asian patients are poorly represented in kidney trials both globally and in the United States.

Development of Immunity to Hepatitis B Virus Following Hepatitis B Vaccination in Hemodialysis Patient

Background: Hepatitis B infection is common in Dialysis population. Hemodialysis patients have high risk of hepatitis B virus transmission not only due to frequent blood or blood product transmission, decreased response to Hepatitis B vaccine and length on hemodialysis but also due to their immunosuppressed state. Hepatitis B vaccination has the potential to reduce the risk of HBsAg infection in dialysis units. Effective vaccination, blood donor screening, the use of erythropoietin and the isolation of HBV carriers have successfully regulated HBV infection in hemodialysis units (1). This study aims to assess the immunity to HBV the seroconversion of HBsAg infection in hemodialysis unit. This retrospective observational study evaluated serological markers, hepatitis B vaccination status and co morbidities which can affect the immunity levels of patients undergoing hemodialysis. The patient’s data were collected from laboratory investigations and patient record for analysis. Out of 153 CKD-5D patients on maintenance hemodialysis, 39 patients had anti HBs titer &lt;10U/ml, 30 patients had anti HBs titer between 10-100U/ml, 38 patients had anti HBs titer between100-1000 U/ml, 21 patients had anti HBs titer &gt;1000U/ml and 24 patients didn’t check their titer value. Hypertension was the common co morbidity followed by anaemia and diabetes mellitus.

Microbiota analysis in the hemodialysis population - Focusing on Enterobacteriaceae.

Infection is a recognized risk factor for mortality among hemodialysis (HD) population, including infection caused by Enterobacteriaceae. We aimed to investigate Enterobacteriaceae in gut microbiota among HD patients and to analyze associations between microbiota and clinical parameters. This prospective study of microbiota analysis in HD patients was conducted in April-May 2019. A control group without recent antibiotic use or hospitalization was used for comparison. Stool samples underwent 16S rRNA sequencing, using Greengenes 16S rRNA database for microbiota analysis. Among 96 hemodialysis (HD) patients, mean age was 61.9±0.8 years and mean duration of HD was 6.5±0.7 years. No significant differences were found in alpha diversity between HD and control groups (HD group 949.5, controls 898; p=0.16) although significant between-group differences were found in beta diversity (p<0.001). At phylum level, HD group had a higher abundance of Firmicutes and Proteobacteria, but lower abundance of Bacteriodetes. At genus level, Escherichia-Shigella complex increased among HD patients who had hospitalization with 1 year (median 0.024 vs 0.004, p=0.054) and Klebsiella was associated with emergency room visit within 1 year among HD patients (p=0.002). Alpha diversity in HD patients is not lower than that in healthy controls but significant between-group differences are found in microbiota composition according to beta diversity, due to decreased Bacteriodetes and increased Firmicutes and Proteobacteria. Deeper microbiota analyses for Enterobacteriaceae are necessary. Whether change in dietary components can help to decrease mortality among dialysis population warrants further research.

Hemosiderosis in chronic dialysis patients: Monitoring the response to deferasirox by quantitative hepatic magnetic resonance imaging.

Hemosiderosis of chronic dialysis has always been a frequent phenomenon in dialysis; formerly related to blood transfusions before the advent of Erythropoiesis Stimulating Agents (ESA), it is currently in connection with the use of massive doses of injectable iron, to ensure the full therapeutic efficacy of ESA. Few studies have looked at the therapeutic aspect of iron chelators in the dialysis population. We followed 31 dialysis patients treated for secondary hemosiderosis with deferasirox (DFX) at the dose 10mg/kg/day, by hepatic MRI from September 2017 to September 2021, in order to evaluate the efficacy of iron chelators on the reduction of liver iron concentration (LIC). The diagnosis of hemosiderosis was carried for a value of the LIC > 50 μmol/g of dry liver. Chelation resulted in a significant reduction in liver iron burden as measured by liver MRI: (201.4 ± 179.9 vs. 122.6 ± 154.3μmol/g liver) (p=0.000) and in mean ferritin level: (2058.8 ± 2004.9 vs. 644.2 ± 456.6ng/mL) (p=0.002). A gain of 1.1g/dL in mean hemoglobin level: (10.5 ± 1.6 vs. 11.6 ± 2.0g/dL) (p=0.006). A significant increase in mean albumin level: (43 ± 5.5 to 46.2 ± 6.1g/L) (p=0.04). The therapeutic response was clearly influenced by the cause of overload, longer in polytransfused patients (p=0.023) and the degree of overload assessed by MRI (p=0.003) and ferritin level (p=0.04). DFX, prescribed at a dose of 10mg/kg/day, resulted in a significant reduction in hepatic iron burden as measured by liver MRI and ferritin. The therapeutic response was clearly influenced by blood transfusions and the degree of iron overload.

COVID-19 vaccine uptake rates, perceptions, and attitudes among dialysis patients: Experience across a national sample.

Dialysis patients are at increased risk of severe COVID-19 infection making vaccination a priority. We explored COVID-19 vaccine uptake and perceptions in our dialysis population, associated COVID-19 infection, and hospitalization rates. This is a single-center retrospective study using telephone questionnaires and hospital records to investigate COVID-19 vaccine uptake and attitudes behind vaccination status. A total of 230 patients were interviewed. Vaccine uptake was 97.8% (two doses) and 86.6% (booster dose), with 79.5% vaccinated at Renal Unit. Most (58.5%) cited healthcare worker advice as a contributing factor and 54% sought protection through vaccination. COVID-19 hospitalization was higher in unvaccinated and patients vaccinated with one dose, compared to two doses (63.2% vs. 20%, p=0.05) and booster dose (63.2% vs. 22.2%, p=0.02). Our dialysis population recognized the importance of COVID-19 vaccination. Intensive patient education and easy access to the COVID-19 vaccine may have facilitated vaccine uptake in these patients.

Unintentional Weight Loss In A Dialysis Population Diagnosed With COVID-19

Unintentional Weight Loss In A Dialysis Population Diagnosed With COVID-19

Comparison of bioimpedance equations and dual-energy X-ray for assessment of fat free mass in a Chinese dialysis population

Purpose Bioelectrical impedance analysis (BIA) is simple, noninvasive, inexpensive and frequently used for estimating fat free mass (FFM). The aims of this study were to evaluate the applicability of different BIA equations on FFM in Chinese subjects, and to compare the difference in hemodialysis and peritoneal dialysis patients with healthy controls respectively. Methods Dialysis patients and healthy adults were enrolled in this study, and the subjects were matched by age, gender, and the minimum sample size in each group was calculated using PASS. FFM estimated by BIA was calculated using equations of Kyle, Sun SS and Segal, and TBW/0.73. Dual-energy X-ray absorptiometry (DXA) method was set as reference method. Pearson’s correlation and Bland-Altman analysis were used to test the validity of the BIA equations. Results 50 hemodialysis (HD) patients, 52 peritoneal dialysis (PD) patients and 30 healthy adults aged 22–67 y were included in this study. Age, height, weight, BMI and gender did not differ significantly among HD, PD patients, and healthy controls (p > 0.05), but BIA parameters were quite different (p＜0.01). Bland-Altman analysis showed that in healthy volunteers, all equations showed good agreement with DXA measured. For dialysis patients, the FFM predictions of different equations showed differences between HD and PD patients, and the equations seemed more applicable for HD patients. Conclusion The equations developed by healthy subjects might be not appropriate for dialysis patients, especially peritoneal dialysis patients. It is recommended to develop a specific BIA equation from dialysis population.

Postoperative Outcomes of Femoral Neck Fracture Management in Dialysis-Dependent Patients

AbstractFemoral neck fractures are common in patients with chronic kidney disease (CKD) due to abnormalities of bone metabolism. In patients on dialysis, femoral neck fractures have been shown to occur at a younger age than in nondialysis patients. The purpose of this study was to compare the associated complication rates of femoral neck fractures among dialysis patients treated with total hip arthroplasty (THA) versus hemiarthroplasty (HA) as well as evaluate for any differences in outcomes compared to the nondialysis patient population. This was a retrospective cohort study performed using the National Surgical Quality Improvement Program database that included 54,328 patients with femoral neck fractures managed surgically from 2006 to 2016. One-thousand seventy patients were identified as dialysis-dependent. Demographics, medical comorbidities, perioperative complication rates, and mortality rates were collected. Data was first analyzed descriptively and with analysis of variance or chi-squared analyses as appropriate. Odds ratios were then calculated for perioperative outcomes and complications. Femoral neck fractures in patients on dialysis occurred at a significantly younger age (73.3 vs. 77.0, p &lt; 0.001) than nondialysis patients. In dialysis patients who underwent THA, complication rates, postoperative length of stay, readmission rates, and 1-year mortality were greater when compared to nondialysis patients. There were no significant differences in perioperative medical or surgical complication rates within the dialysis population when comparing THA to HA. Dialysis patients treated with THA for femoral neck fracture experience more complications compared to nondialysis patients. However, among dialysis patients treated with THA compared to HA, there were no significant differences in outcomes. THA is, therefore, a viable option for dialysis-dependent patients with femoral neck fractures who are otherwise medically stable.

High prevalence of hyperkalemia in Brazilian chronic dialysis patients and differences across geographic regions.

Hyperkalemia is a common multifactorial condition of people on chronic dialysis and is associated with mortality. We aimed to inform and discuss the prevalence of hyperkalemia in a large population of chronic dialysis patients in Brazil and its geographic regions. Prevalence of hyperkalemia (serum potassium ≥6.0 mEq/L) was assessed in the Brazilian Dialysis Survey (BDS) in July 2019, an online survey of voluntary participation in which all dialysis centers registered at the Brazilian Society of Nephrology were invited. Approximately one-third (n=263 of 805) of the Brazilian dialysis clinics participated. The prevalence of hyperkalemia in the whole population was 16.1% (n=7,457 of 46,193; 95%CI=15.8-16.5%,), and varied from 12.1% in the North to 18.7% in the Northeast. We found a high prevalence of hyperkalemia in a large Brazilian chronic dialysis population. A nationwide investigation of risk factors, treatment options, and whether this high prevalence contributes to dialysis mortality is warranted.

Association of the End-Stage Renal Disease Treatment Choices Payment Model With Home Dialysis Use at Kidney Failure Onset From 2016 to 2022

The Centers for Medicare & Medicaid Services designed a mandatory payment model to incentivize home dialysis use: the End-Stage Renal Disease Treatment Choices (ETC). Outpatient dialysis facilities and health care professionals providing nephrology services were randomly assigned to ETC participation at the hospital referral region level. To assess the association between ETC and home dialysis use in the incident dialysis population in its first 18 months of implementation. A cohort study with controlled, interrupted time series analysis of the US End-Stage Renal Disease Quality Reporting System database was conducted, using generalized estimating equations. All adults initiating home-based dialysis in the US between January 1, 2016, and June 30, 2022, without a prior kidney transplant were included in the analysis. Prior to vs after ETC onset in January 1, 2021, and random assignment to ETC participation of facilities and health care professionals involved in patient care. Percentage of patients started on incident home dialysis and yearly change in percentage initiating home dialysis. A total of 817 177 adults initiated home dialysis during the study period, of whom 750 314 were included in the study cohort. The cohort included 41.4% women; 26.2% of the patients were Black, 17.4% were Hispanic, and 49.1% were White. Approximately half (49.6%) of the patients were aged at least 65 years. A total of 31.2% received care from health care professionals assigned to ETC participation, and 33.6% had Medicare fee-for-service coverage. Overall, home dialysis use increased from 10.0% in January 2016 to 17.4% in June 2022. Home dialysis use increased more in ETC markets than in non-ETC markets after January 2021 (by 1.07%; 95% CI, 0.16%-1.97%). The rate of increase in home dialysis use in the entire cohort nearly doubled after January 2021 to 1.66% per year (95% CI, 1.14%-2.19%) compared with before 2021, when the rate was 0.86% per year (95% CI, 0.75%-0.97%), but the difference in rate of increase in home dialysis use was not significant between ETC and non-ETC markets. This study noted that, although the overall rate of dialysis use at home was greater after ETC implementation, the increase occurred more among patients in ETC markets than among those in non-ETC markets. These findings suggest that federal policy and financial incentives affected care for the entire incident dialysis population in the US.

Vaccination and mortality from COVID-19: a comparative study between hemodialysis, peritoneal dialysis, and non-dialysis adult population in Panama

PurposeDialysis patients have a different response than the non-dialysis population to infection with COVID-19. This study evaluates the prevalence of infection and lethality in patients receiving hemodialysis or peritoneal dialysis in Panama, compared to non-dialysis adult population, and reports of adverse events of vaccination.MethodsThis is a prospective, multi-center cohort study of spatients aged 18 years or older and receiving in-center hemodialysis or ambulatory peritoneal dialysis in 13 centers in Panama from March 2021 to 2022. For comparison with general population, the study used an extended period of two years.ResultsA total of 1531 patients receiving dialysis treatment accepted to participate. PD patients represented an 18% of study patients. Lethality was higher in peritoneal dialysis patients with COVID-19 infection than in hemodialysis in the study group (p 0.02). Total deaths in dialysis patients for 2020 were 156 patients, before vaccination; 79 in 2021; and 25 for the first trimester of 2022. Lethality for the period of 2020–2022 was 9.3% for dialysis patients and 0.2% for non-dialysis population. There was no difference in symptoms in first dose, but with second dose, hemodialysis patients reported fewer symptoms than peritoneal dialysis patients (p < 0.0001).ConclusionNinety one percent of people in the country received BNT162b2 Pfizer BionTech vaccine. Lethality decreased from 30 to 5% once vaccination was available. There were no severe adverse effects and symptoms reported were less frequent than in general population, probably due to low reactogenicity in dialysis patients, or better tolerance to pain.

Risk factors and prognosis for latent tuberculosis infection in dialysis patients: A retrospective cohort study at a single tertiary care center.

Recent studies report that latent tuberculosis infection (LTBI) may lead to an increased risk of cardiovascular disease (CVD) that led us to hypothesize that LTBI may play an important role in major adverse cardiovascular events (MACE) in dialysis patients. A single-center retrospective cohort study was conducted. A total of 270 patients undergoing hemodialysis or peritoneal dialysis more than 3 months were included. The interferon enzyme-linked immunospot (IFN-γ ELISPOT) assay was used for the diagnosis of LTBI. Primary endpoints were MACE, including all-cause death and acute coronary syndrome (ACS). The association between LTBI and MACE was examined using multivariate Cox proportional hazards regression after adjusting for covariates and Kaplan-Meier survival analysis. In our study, the patients were classified into LTBI (n =47) or non-LTBI (n =223) groups. Independent risk factors for LTBI in dialysis population were prior tuberculosis (TB) history (odds ratio [OR] 4.817 [1.064-22.306]), tobacco use (OR 2.903 [1.155-7.299]), and older age (OR 1.027 [1.002-1.053]). After a median follow-up of 39 months, the incidence of active TB was 6.4% versus 0% in dialysis patients with and without LTBI, respectively (p = 0.005). Multivariate Cox analysis showed that LTBI was significantly associated with MACE (hazardratio[HR] 2.540 [1.490-4.350]) after adjustment for potential confounders. Prior TB history, tobacco use, and the elderly can be used to select cost-effective LTBI screening target groups in dialysis patients. LTBI is not only closely related to active TB but also an independent risk factor for higher incidence of MACE in dialysis population.

Fractures in CKD Patients—Risk Analysis in RRT Lombardy Patients

The increase in the number of patients with CKD starting dialysis treatment has become a major health problem in recent years. Osteoporosis is a typical feature of advanced age, which, in the dialysis population, is almost always accompanied by uremic osteodystrophy (CKD-MBD). These two factors are involved in the pathogenesis of fractures, which represent an important risk factor for the outcome of patients. The real consistency of fractures in CKD patients on kidney replacement therapy (KRT) requiring hospitalization in the Lombardy region (over 9,000,000 inhabitants) was analyzed using data from the regional administrative databases in the years 2011–2012. Among 8109 prevalent patients, 251 (45.8% women), with fractures after 1 January 2011, entered the analysis. A follow-up of two years (2011–2012) was considered to evaluate the incidence of more frequent fractures (femur, pelvis, hip, and spine) using ICD-9-CM codes. The most frequent sites of fractures were the femur (68.5%), hip and pelvis (47.4%), and vertebrae (12%). The patients on hemodialysis (HD) had more events than PD (3.3% vs. 1.4%; p = 0.03), while patients undergoing kidney transplantation (KTx) had a significantly lower percentage of fractures (0.6% vs. 3.3%; p &lt; 0.001). Observed mortality was very high: the estimated gross mortality rate for any cause was 25.9% at 90 days and 34.7% at 180 days. Diabetes, peripheral vasculopathy, and heart failure were associated with a numerical increase in fractures, although this was not significant. Proton pump inhibitor drugs (PPI), vitamin K antagonists, and diphosphonates were more frequently associated with fracture occurrence. The average total cost of fractured patients was 11.4% higher than that of non-fractured patients. On multivariate analysis, age &gt;65 years, female gender, PPI therapy, and cerebrovascular disease were found to be strongly associated with fractures in dialysis patients, whereas undergoing renal transplantation presented a reduced risk.