Duration Of Dialysis Treatment Research Articles

The combined effect of leucine-enriched essential amino acid supplements and locomotion training on physical functions and quality of life in hemodialysis patients

BackgroundLocomotive syndrome (LS) is a condition of reduced mobility (locomotive organ impairment) that is associated with reduced quality of life (QOL) in patients undergoing hemodialysis (HD), and effective interventions for patients with LS undergoing HD are unclear. We conducted a clinical trial to assess the effects of exercise and oral nutritional supplementation (ONS) on QOL in this cohort.MethodsThis study was an open-label, randomized controlled trial. The participants were patients with LS undergoing HD. The intervention period was 3 months. The primary outcome was a change in the physical component summary (PCS) of QOL, and the secondary outcomes were changes in other QOL scores, physical function, body composition, and nutritional status assessed by using the geriatric nutritional risk index. Participants were divided into the locomotion training (LT) and LT + ONS groups. Both groups were instructed on LT that comprised one-leg standing and squats to be carried out four or more times per week. The ONS consisted of 3 g leucin-rich essential amino acids and 800 IU vitamin D per pack, and the participants in the LT + ONS group received one pack of the supplement per day.ResultsIn total, 40 individuals undergoing HD were included in the study; 3 patients in the LT + ONS group were excluded from the analysis because of hospitalization and incomplete assessment. The median age was 73 years (interquartile range: 62–80 years), 23 participants were men (62%), and the duration of dialysis treatment was 6 years (interquartile range: 3–16 years). The change in PCS of the LT + ONS group did not differ from that in the LT group [LT + ONS: −1.6 (−5.3, 6.8) versus LT: −0.1 (−5.3, 6.2), p = 0.94]. In contrast, the LT + ONS group showed maintenance in mental health (MH) and improvement of the two-step value.ConclusionsThe LT + ONS group did not show an effect on PCS in QOL compared with only LT in patients with LS undergoing HD. However, maintenance of MH and improvement of two-step value were confirmed in the LT + ONS group. Future research is need to confirm whether leucine-rich essential amino acids and vitamin D help mental health and physical function in patients with LS undergoing HD with larger sample sizes and long-term interventions.Clinical trial registration University Hospital Medical Information Network Center (UMIN 000032457).

Relationship between altered taste and smell with malnutrition among hemodialysis patients.

Alterations in taste and smell are among the most distressing symptoms experienced by haemodialysis patients. There is limited research on the relationship between these two symptoms and malnutrition in haemodialysis patients. This study aimed to investigate alterations in taste and smell in hemodialysis patients and their relationship with malnutrition. This cross-sectional study was carried out with 149 hemodialysis patients at the dialysis centers of three state hospitals. The Taste and Smell Dysfunction Questionnaire was used to assess the changes in patients' taste and smell, and the Prognostic Nutritional Index (PNI), as well as the Controlling Nutritional Status (CONUT) tool, were utilized to evaluate their nutritional status. A substantial percentage (45.6%) of patients reported an altered sense of smell, and 40.2% reported an altered sense of taste. The aspect of taste that was most abnormal was bitterness (46.7%); 53.0% of the patients were at moderate risk of malnutrition by PNI score, and 14.8% were categorized as malnourished by CONUT score. Malnutrition was related to dialysis vintage: a 1-year increase in vintage was associated with an increased risk of malnutrition (OR: 1.17, 95% CI 1.02-1.32, p < 0.001). Altered taste was associated with malnutrition: one-unit increase in the standard deviation of the taste subdimension score was associated with a relative risk of malnutrition (OR: 6.89, 95% CI 1.67-28.39, p < 0.001). A one-unit increase in the standard deviation of the smell subdimension was associated with relative risk of malnutrition (OR: 1.35, 95% CI 1.10-1.64, p < 0.001). Malnutrition was found in a significantpercentage of hemodialysis patients. Altered taste and smell and the durationof dialysis treatment were significantly associated with malnutrition scores It isrecommended that healthcare professionals regularly assess alterations in tasteand smell in hemodialysis patients, as these alterations may be associated withmalnutrition, and manage these alterations accordingly.

Digital addiction in children with end-stage kidney disease on regular hemodialysis: a cross-sectional study

BackgroundChronic kidney disease has a detrimental impact on the overall quality of life (QoL) in children. The regular visits to doctors, prolonged reliance on medication, frequent hospital stays, and changes in their physical appearance increase their vulnerability to developing psychiatric problems and hinder their daily activities and social interactions, resulting in isolation, poor peer relations, and low self-esteem. These factors may compel these children to depend on digital media to find connections, regulate emotions, and cope with their illnesses. The study aims to determine the prevalence of electronic addiction among minors undergoing regular hemodialysis for end-stage kidney disease (ESKD) while simultaneously assessing their parental styles and psychological adaptation.A total of 60 subjects were enrolled in the study and divided into two groups. Group A: Thirty patients undergoing regular hemodialysis for ESKD. Group B: Thirty healthy subjects of matching age and sex. All the recruited participants were subjected to semi-structured clinical interviews according to our institute’s sheets, Child Behavior Checklist (CBCL), Digital Addiction Scale for Children (DASC), Parent Authority Questionnaire (PAQ), and Psychological Adaptation Scale.ResultsPatients patients had a significantly higher prevalence of digital addiction compared to healthy subjects, with an average score of (87.00 ± 21.23) in dialysis patients against (53.00 ± 25.20) in normal participants, demonstrating significant differences (p< 0.001). There was a significant correlation between the duration of dialysis treatment and the prevalence of digital addiction (r = -0.415, p-value = 0.023). A significant inverse correlation was found between digital addiction and the emotional subtype of the psychological adaption rating (r= -0.375, p= 0.041).ConclusionThe findings revealed that dialysis patients have a higher incidence of digital addiction. Prolonged dialysis duration was significantly associated with increased digital addiction among patients.

Immune Response after Anti-SARS-CoV-2 mRNA Vaccination in Relation to Cellular Immunity, Vitamin D and Comorbidities in Hemodialysis Patients.

In the global threat of SARS-CoV-2, individuals undergoing maintenance dialysis represent a vulnerable population with an increased risk of severe COVID-19 outcomes. Therefore, immunization against SARS-CoV-2 is an essential component of healthcare strategy for these patients. Existing data indicate that they tend to exhibit a reduced immune response to vaccines compared to the general population. Our study aimed to assess both humoral and cellular immune responses following two doses of an anti-SARS-CoV-2 mRNA vaccine, an ability to maintain adequate antibody titers over time, and potential relations with vitamin D, comorbidities and other factors in hemodialysis patients based on a single center experience. A total of 41/45 patients (91.1%) responded to the second dose of the anti-SARS-CoV-2 mRNA vaccine. The titer of anti-SARS-CoV-2 IgG class antibodies and levels of T cells three to four weeks after vaccination were lower in dialysis patients than in healthy controls. Antibodies titer in dialysis patients had a positive correlation with B lymphocytes and was related to cardiovascular diseases. The level of CD4+ cells had a negative correlation with hemodialysis vintage, as did the vitamin D level with post-vaccination seroconversion and decline in anti-SARS-CoV-2 antibodies titer during six months after vaccination. Hemodialysis patients had decreased amounts of CD4+ and CD8+ cells and lower levels of anti-SARS-CoV-2 antibodies than healthy controls. Therefore, chronic hemodialysis could lead to diminished cellular immunity and humoral immune response to the anti-SARS-CoV-2 mRNA vaccination and reduced protection from COVID-19. Comorbidity in cardiovascular diseases was associated with a lower level of specific anti-SARS-CoV-2 antibody titer. Vitamin D may be important in maintaining stable levels of anti-SARS-CoV-2 antibodies, while the duration of dialysis treatment could be one of the factors decreasing anti-SARS-CoV-2 antibody titer and determining lower CD4+ cell counts.

Structural Equation Modeling of Treatment Adherence Based on General Health and Demographic Characteristics in Patients Undergoing Hemodialysis

Background: A complete adherence to treatment is essential for patients undergoing hemodialysis treatment. This health behavior is the product of various overlapping variables that may change over time. Objectives: This study aimed to investigate treatment adherence based on general health and demographic characteristics among hemodialysis patients. Methods: This was a descriptive-correlation research conducted based on structural equation modeling. The population included all patients with chronic kidney disease in Tehran, Iran, of whom 200 patients undergoing hemodialysis admitted to 2 medical centers from September to March 2022 were selected by convenience sampling. The data were collected using the General Health Questionnaire (GHQ) and End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ). The data were analyzed using correlation analysis and path analysis in SPSS v. 19 and SmartPLS v. 3. Results: The results showed the direct and significant effect of general health (P = 0.001) and age (P = 0.017) on treatment adherence. However, sex, marital status, level of education, and duration of dialysis treatment had no significant effect on treatment adherence. Conclusions: Considering the power of general health and age in predicting treatment adherence, these two variables can be included in training, clinical, and psychological interventions.

Hepatitis E Virus (HEV) Infection among Hemodialysis Patients from Southern Bulgaria.

Viral hepatitis B and C are widely recognized problems in hemodialysis (HD) patients. There have been increasing reports of the importance of the hepatitis E virus (HEV) in recent years, but the worldwide data on the seroprevalence of HEV among them are conflicting. The aim of the present study was to assess the seroprevalence of HEV in HD patients and to analyze the predictors of seropositivity. This study was conducted in 2020 in the central part of southern Bulgaria. A total of 225 patients were enrolled. An enzyme-linked immunosorbent assay for the determination of anti-HEV IgM/IgG was used. All patients were tested for the presence of HEV RNA. Anti-HEV IgM alone and anti-HEV IgG alone were found in 6 (2.7%) and 14 (6.2%) patients, respectively, and in 4 (1.8%) patients, they were found simultaneously. All patients were HEV RNA-negative. The overall HEV seroprevalence was 10.7% (24/225). The binominal logistic regression analysis of available predictors confirmed the role of vascular access and a duration of dialysis treatment over 5 years as predictors significantly associated with increased risk for HEV, and the consumption of bottled water with lower levels of HEV IgG seroprevalence among hemodialysis patients. The accumulated data are the basis for comparative analysis in subsequent trials in the same dialysis centers and for enhancing the range of screening markers used in this particular patient group.

#6067 GUT MICROBE-DERIVED UREMIC TOXIN TRIMETHYLAMINE N-OXIDE CONTRIBUTES TO CARDIAC REMODELING IN PATIENTS ON HEMODIALYSIS

Abstract Background and Aims It is well established that cardiovascular pathology is the leading cause of increased morbidity and mortality in chronic kidney disease patients, especially in the terminal stage. This is explained by high prevalence of both traditional and non-traditional cardiovascular risk factors, among which inflammation, intestinal dysbiosis and microbe-derived uremic toxins such as indoxyl sulfate, p-cresyl sulfate, trimethylamine-N-oxide (TMAO) are recently considered the most significant. However, the potential underlying mechanisms of these findings have not been fully elucidated. Here we aimed to investigate the association of serum TMAO with echocardiographic parameters of cardiac remodeling in patients receiving hemodialysis treatment. Method One hundred and forty (85M, 55F) clinically stable patients on dialysis were studied. The median (interquartile range) age was 56,5 (46,2-60,5) years, median duration of dialysis treatment – 48 (14,5-97) months, 39 (27,9%) were diabetic, 109 (77,9%) had high blood pressure, 39 (27,9%) – previous history of ischemic heart disease, including 8 (5,7%) suffered a myocardial infarction. All patients underwent transthoracic echocardiography (General Electric Vivid E95 device) with the registration of standard parameters. The determination of TMAO in serum was performed by LC/MS using a Shimadzu-8060 system combined with a Shimadzu LC-20AD liquid chromatograph. Statistical analysis was performed with STATISTICA 14.0 program. Non-parametric Spearman's rank correlation method was used to evaluate the associations between serum TMAO level and echocardiographic parameters. Value of p&amp;lt;0.05 was considered statistically significant in all analyses. Results Median serum TMAO was 5244 (3588-8701) ng/ml. Echocardiography data: end-systolic left ventricular (LV) size is 38,2±0,6 mm, end-systolic LV volume – 62,0±4,4 ml, end-diastolic LV size – 55,8 ±1,3 mm, end-diastolic LV volume – 111,5±19,7 ml, ejection fraction (according to Simpson method) – 53,2±7,2%, shortening fraction – 28,9±4,4%, inter-ventricular septum thickness – 11,6±0,2 mm, posterior wall thickness – 11,9 ± 0,1 mm, LV mass index – 142,8±4,6 g/m2, LV mass – 298,6±8,8 g, relative wall thickness – 0,43±0,3, number of patients with LV remodeling or hypertrophy – 98 (70%). LV diastolic function parameters (n = 113): E – 0,69±0,2 m/s, A – 0,79±0,2 m/s, E/A (early (E) to late (A) ventricular filling ratio) – 0,89±0,2, deceleration time (DT) – 211±52 ms, number of patients with diastolic disfunction – 104 (74,3%). Statistically significant correlation was fount between TMAO concentration and end-diastolic LV volume (r = 0,315; р = 0,028), LV mass (r = 0,409; р = 0,011) and DT (r = 0,272; р = 0,041). TMAO levels in individuals with LV myocardial hypertrophy and diastolic dysfunction was significantly higher than without these abnormalities (Mann–Whitney U-test р = 0,037 and р = 0,043, correspondingly). Conclusion Our results suggest that elevated TMAO may contribute to cardiac remodeling in hemodialysis patients through the myocardial fibrosis and hypertrophy. The pathophysiological mechanisms of TMAO must be investigated further for a better understanding of its role in cardiovascular disease progression and to develop therapeutic interventions against uremic toxicity.

Natural Acquired Immunity Against Haemophilus influenzae Type-B in Patients Undergoing Hemodialysis Jahrom, Iran, 2022

Background: End stage renal disease (ESRD) patients who undergo hemodialysis treatment suffer from immune system disorders. The immunodeficiency of these patients makes them prone to various infections. Objectives: To investigate the prevalence of naturally acquired immunity against Haemophilus influenzae type-B (Hib) and its association with the duration of dialysis treatment, gender, and age of patients in hemodialysis patients in Jahrom city, Iran. Methods: This cross-sectional descriptive was conducted on ESRD patients undergoing hemodialysis treatment, referred to Jahrom Hemodialysis Center, June - August,2022. In order to determine the presence or absence of an immunity to Hib in the patients, the qualitative level of anti-Hib Polyribosyl-ribitol-phosphate (anti-Hib PRP) antibodies in the serum of the patients were determined using the ELISA test using a specialized commercial kit. SPSS-21 was used to analyze the data. The chi-square test, univariate and multivariable logistic regression were used for data analysis. Results: The prevalence of naturally acquired immunity to Hib in patients was 26.13% (10.22% short-term immunity, 15.91% long-term immunity). A significant relationship was found between the prevalence of long-term immunity to Hib in patients and the number of dialysis sessions three times and more per week (P &lt; 0.001). Conclusions: Considering that hemodialysis patients in Iran are not vaccinated against Hib, 26.13% prevalence of natural immunity against Hib indicates the same prevalence of Hib infection history in hemodialysis patients. A case-control study with a large sample size on hemodialysis patients is recommended to accurately determine the prevalence of Hib and to decide whether to implement a Hib vaccination program in these patients.

Evaluation of apo lipoprotein A-1 and some biochemical parameters in the blood of patients with chronic kidney disease

Aim: This study was designed to determine the level of serum Apolipoprotein A-I (ApoA-I), Cystatin C, and homocysteine among three groups - CKD patients without the end- stage renal disease (ESRD), patients with ESRD on hemodialysis and healthy controls. Materials and Methods: A retrospective, hospital-based study was carried out from 100 patients&#39; records from each group and serum Cystatin-C, homocysteine, apo-A1values were noted. Results: The duration of dialysis treatment was 31 [+ or -] 35 months. Paired t-test analyses showed a significant increase in mean urea and creatinine, uric acid, and Cystatin C among CKD patients which then declined significantly after hemodialysis. Serum Apo-A1 and homocysteine levels were significantly higher in both hemodialysis and pre-dialysis groups compared to control subjects. Conclusion: HD increases apoA1 and Cystatin C whereas decreases HCM and uric acid as both are antagonists that might play a vital role in the pathogenesis of related disorders in CKD Patients.

Role of surface hydrophilicity on MR relaxivity of PEG coated- gadolinium oxide nanoparticles

The magnetic resonance (MR) contrast enhancement capabilities of gadolinium oxide nanoparticles (GONPs) have high dependency on its surface chemistry- as the solution properties such as colloidal stability and hydrodynamic diameter of nanoparticles which are prime regulatory parameter for MR relaxivity, are all governed by grafting density of surface material. However, the purification of synthesized surface coated nanoparticles, without compromising the surface properties, remains a major challenge. Among the various cleaning methods, dialysis is often used to remove the unwanted by-products produced during synthesis. However, the effect of dialysis time may significantly impact the surface properties and hence, the MR contrast properties of such nano-formulations. The aim of the present study is to evaluate the effect of dialysis time on surface chemistry and MR contrast enhancement properties of GONPs by comparing the proton relaxivity data. Ultra-small polyethylene glycol (PEG)-coated GONPs with an average particle diameter of 17 nm were synthesized using polyol method. The impact of dialysis time has been investigated systematically on the size distribution, hydrophilicity, magnetic properties, polymer grafting density and relaxometric properties of the as synthesized GONPs. A significant impact of dialysis time was observed on surface chemistry and hence, on the MR relaxivity of synthesized NPs. We evidenced a dramatic decrease in the proton relaxivities of GONPs with increase in dialysis time, which correlated well with the observed decrease in the grafting density of surface polymer. The results clearly indicate that the proton relaxivity of GONPs of similar size and same coating material depends on the surface coating thickness and hydrophilicity of the coating polymer. Overall, it is essential to optimize the accurate time duration of dialysis treatment as the prolonged dialysis may have negative effect on the relaxation times and hence on MR contrast enhancement properties of GONPs. This study is a strategic pathway to fine-tune the dialysis treatment of as-synthesized surface-capped GONPs for pre-eminent MR contrast imaging.

A STUDY TO ASSESS THE EFFECTIVENESS OF STRETCHING EXERCISES ON LEVEL OF MUSCLE CRAMPS DURING HEMODIALYSIS AMONG CKD PATIENTS IN SELECTED HOSPITAL AT DEHRADUN (UTTARAKHAND)

A STUDY TO ASSESS THE EFFECTIVENESS OF STRETCHING EXERCISES ON LEVEL OF MUSCLE CRAMPS DURING HEMODIALYSIS AMONG CKD PATIENTS IN SELECTED HOSPITAL AT DEHRADUN (UTTARAKHAND)

MO780: Effect of Acupressure Applied to Li4 Point on Fistula Needle Pain Intensity in Haemodialysis Patients

Abstract BACKGROUND AND AIMS Arteriovenous fistula (AVF) is the most reliable method for vascular access, which is vital for haemodialysis patients. To perform haemodialysis therapy, AVF cannulation is by puncture with thick needles three to four times a week. Patients usually feel pain while a needle is inserted into the fistula [1]. This acute pain can be relieved by acupressure, which is a non-pharmacological application method. It is stated in the literature that acupressure is especially effective in acute pain management. This study was designed to evaluate the effect of acupressure application to the LI4 point on the severity of acute pain caused by fistula needle insertion in patients with antecubital arteriovenous fistula [2–3]. METHOD This study was conducted as a randomized controlled experimental study in a total of 64 patients who received haemodialysis treatment between 15 November 2021 and 5 January 2022 in the Dialysis Centre of a foundation university in Turkey. Inclusion criteria for the study; have an antecubital fistula; ≥18 years; can speak Turkish, not using analgesics in the last 6 h; no extremity pain; no bleeding or coagulation problems and volunteering to participate in the study. In the study, data were collected using the patient identification form and the Visual Analogue Scale (VAS) for measuring the pain intensity of the individual. In the experimental group, in the first dialysis session of the week, a needle was inserted into the patient's arteriovenous fistula by the nurse, and the pain intensity was measured with VAS. In the second and third sessions of the same week, finger acupressure was applied for 3 min before the fistula needle insertion and the patient's pain intensity was evaluated with VAS after needle insertion. Fistula needle insertion was performed by the same nurse in all patients. Descriptive statistics, including mean, standard deviation, frequency distribution; Wilcoxon, Mann–Whitney U and Friedman test were used. P &amp;lt; 0.05 was considered as significant level. RESULTS In this study, data were found to be similar in terms of age, gender, education level, duration of dialysis treatment and VAS mean score. While there was no decrease in the severity of acute pain during fistula needle insertion of the patients in the control group, there was a significant decrease in the mean acute pain severity scores experienced by the patients in the experimental group, whose LI4 point acupressure was applied during fistula needle insertion (P &amp;lt; 0.05) (Table). CONCLUSION The results of this study support the effectiveness of LI 4 acupressure point can be conducted as an effective and low-cost way to reduce the acute pain of needle insertion in fistulas in dialysis patients. In addition, the results provide a practical reference to acute pain management for dialysis nurses.

MO937: Relationship Between Nutritional Status and Zonulin Level in Patients With End-Stage Renal Disease on Dialysis

Abstract BACKGROUND AND AIMS Protein energy wasting (PEW) is currently considered as one of the most important and independent predictors of an unfavourable prognosis in patients receiving haemodialysis treatment. The insufficient intake of nutrients and energy can be related to the ̏leaky gut̎ syndrome. Zonulin secretion has been shown to be dependent and is followed by an increase in gut permeability secondary to the disassembly of the protein ZO-1 from the tight junctional complex. Thus, the serum zonulin level may be considered as a biomarker of impaired intestinal barrier function. Тhe aim of our study was to evaluate the relationship between PEW and intestinal permeability, estimated by the level of serum zonulin, in patients receiving hemodialysis treatment. METHOD This was a case-control study involving 148 participants (123 haemodialysis patients and 25 control subjects). Patients diagnosed with infectious illness, unstable blood pressure, clinically active gastrointestinal disease, past history of abdominal operation and taking antibacterial, nonsteroidal anti-inflammatory and laxatives drugs were excluded. The presence of PEW was carried out by the International Society of Renal Nutrition and Metabolism (ISRNM) diagnostic criteria, which requires that patients meet at least one criterion in three of the four proposed categories: altered biochemical laboratory tests, loss of body mass, loss of muscle mass and decreased protein or energy intake. Bioimpedance measurements were obtained with an InBody720 equipment (Biospace, Korea). Plasma concentration of zonulin was assessed by ELISA using commercially available kit (BlueGene Biotech, Shanghai, China). RESULTS This study included 123 (75 men and 48 women) clinically stable patients undergoing haemodialysis in our centre. The average age was 59 years (49–67 years), and the mean duration of dialysis treatment was 36 (24–53) months. Given the absence of generally accepted reference values for serum zonulin levels, haemodialysis patients parameters were compared with the data of 25 healthy volunteers (13 men and 12 women) with an average age of 49 years (41.5–55). Zonulin level was significantly higher in the haemodialysis patients as compared with the healthy control 236.1 (190.3–310.9) ng/mL versus 190.6 (156.3–231.4) ng/mL, P &amp;lt; 0.01. Of the total population, 27 patients (22%) met the diagnostic criteria of PEW. The subgroup analysis between those with PEW and without PEW showed a statistically significant difference in serum zonulin concentration: 311.1 (282.6–406) versus 223.7 (182.8–271) ng/mL, respectively, P &amp;lt; 0.0001. Among subjects with PEW, there was a significant correlation between zonulin level and serum albumin (r = –0.404; P = 0.018), body mass index (r = –0.281; P = 0.021), body fat mass index (r = –0.55; P = 0.019), skeletal muscle mass index (r = –0.395; P = 0.007), erythrocyte sedimentation rate (r = 0.199; P = 0.04) and C-reactive protein (r = 0.642; P &amp;lt; 0.001). In the meantime, there was no significant interaction between zonulin and age, duration of dialysis treatment, Kt/V, shoulder muscle circumference, triceps skinfold, haemoglobin, total cholesterol, transferrin and lymphocyte levels (all P-values &amp;gt; 0.05). CONCLUSION Our study shows that PEW in haemodialysis patients could be associated with the increased intestinal permeability. Thus, different strategies that attenuate intestinal barrier disruption may be a potential therapeutic tool for the prevention and treatment of PEW. Limitation of the present study was the limited sample of participants, which probably influenced the significance of statistical tests. Further clinical studies are needed in a larger population as well as their prospective follow-up to enhance the understanding of this topic.

Transplantation of Patients With Long Dialysis Vintage in the Current Deceased Donor Kidney Allocation System (KAS)

In 2014 the wait-time calculation for deceased donor kidney transplantation in the United States was changed from the date of first waitlisting to the date of first maintenance dialysis treatment with the aim of minimizing disparities in access to transplantation. This study examined the impact of this policy on access to transplantation, patient survival, and transplant outcomes among patients treated with maintenance dialysis for a prolonged duration before waitlisting. Retrospective cohort study. Patients identified in the US Renal Data System between 2008 and 2018 aged 18-70 years and in the 95th percentile of dialysis treatment duration (≥6.5 years) before waitlisting. Waitlisting for transplantation before versus after implementation of the policy. Time from date of waitlisting to deceased donor transplantation and death, and from date of transplantation to all cause graft loss. Univariate and multivariable time to event analyses. Patients waitlisted after the policy change had a higher likelihood of deceased donor transplantation (HR, 3.12 [95% CI, 2.90-3.37]) and lower risk of death (HR, 0.74 [95% CI, 0.63-0.87]). The risk of graft loss was lower in the post-kidney allocation system (KAS) cohort (HR, 0.66 [95% CI, 0.55-0.80]). The proportion of adult patients treated with dialysis≥6.5 years who were never waitlisted for transplantation remained high (73%) and did not decrease after the policy implementation. Cannot determine causality in this observational study. The policy change was associated with an increase in deceased donor transplantation and marked improvement in patient survival for patients waitlisted after long periods of dialysis treatment without decreasing the utility of available deceased donor kidney supply. The policy was not associated with increased waitlisting of this disadvantaged population.

Exploring the Meaning in Life and the Influencing Factors among Patients Undergoing Hemodialysis in Macau.

IntroductionThe meaning in life (ML) is a significant predictor of the physical and mental health of patients with chronic diseases, and its construct is culturally specific.As a group between normal people and the patients with advanced cancer, patients with End-Stage Kidney Disease (ESKD) who are undergoing hemodialysis (HD) are often outside of research focus on ML.ObjectivesThis study was to investigate the status of ML of patients on HD in Macau of China and to analyze the influence of social-demographic characteristics and disease-related factors on their ML. The study findings would inform the development of evidence-based interventions in nursing care for this patient population.MethodsThis study employed a cross-sectional survey design. Eligible participants were recruited by convenient sampling from the largest HD center in Macau in January 2020. The participants’ social-demographic and disease-related characteristics were collected, and their ML status was assessed by the Meaning in Life Scale for Hemodialysis Patients (MLSHP). SPSS 22.0 software was used to analyze the data.ResultsQuestionnaires were distributed to 249 potential participants who were patients on HD, and 238 patients replied to the questionnaires effectively. The effective response rate was 95.58% (238/249). The average score of ML for the patients was 93.75 ± 10.00, which was 72% of the total score of 130 on the ML scale. Gender, religious belief, duration of dialysis treatment, and symptom-related distress had impacts on ML levels (p < .05), with religious belief being a particularly strong predictor (p < .001).ConclusionThe level of ML for patients on HD in Macau is relatively high. Different demographic or disease-related factors impact participants’ ML, supporting or contradicting previous studies. While the study findings are meaningful under the local cultural contexts, they have implications for nurses in other places to develop evidence-based interventions for patients on HD.

Frequency of the necessity of dentoalveolar surgery or conservative treatment in patients before kidney transplantation depending on the duration of dialysis and causative nephrological disease

ObjectivesThis retrospective study evaluates intraoral surgical and conservative treatment need in patients with a chronic kidney end-stage disease, depending on the duration of dialysis treatment and the causative nephrological disease.Material and methodsThis study is based on data of patients referred to the Department of Oral and Maxillofacial Surgery of the University Hospital Erlangen, Germany, prior to kidney transplantation between January 2015 and March 2020. The necessity for oral surgical or dental therapy was determined by clinical and radiological examinations. Data on renal replacement therapy, cause of underlying renal disease, lifestyle, and general health were collected.ResultsData of N = 89 patients demonstrated that surgical treatment need depends on dialysis duration (p = 0.042). Patients, who had been dialyzing for 2 to 3 years showed the highest need for surgical intervention (80.0%; p = 0.024), followed by dialysis patients with a dialysis time of more than 3 years (48.1%). Similarly, dialysis patients in the second or third year of dialysis had the highest need for conservative treatment (73.3%; p > 0.05), followed by 55.6% of dialysis patients in the third year of dialysis.ConclusionsOperative and conservative treatment is essential to optimize subsequent kidney transplantation. The greatest necessity could be detected for patients in the second and third years of dialysis.Clinical relevanceOral health addressing surgical and conservative treatment need depends on the duration of dialysis in patients with a chronic kidney end-stage disease.

FC 067WHEN TO INITIATE DIALYSIS TO REDUCE MORTALITY AND CARDIOVASCULAR EVENTS IN ADVANCED CKD: A NATIONWIDE COHORT STUDY

Abstract Background and Aims There is currently no direct evidence to inform a specific glomerular filtration rate (GFR) to initiate maintenance dialysis. Previous studies are limited by the number of kidney function thresholds compared, immortal time or lead time biases, or small sample sizes. The only randomised trial (IDEAL) found no difference between early versus late start, but confidence intervals were wide. Method Nationwide observational cohort study using data from the Swedish Renal Registry between January 1, 2007 and December 31, 2016, with follow-up until June 1, 2017. Included individuals were receiving nephrologist care and had an eGFR between 10-20 ml/min/1.73m2. A randomized trial was emulated using the cloning, censoring and weighting method. Our primary analysis compared late (at an eGFR 5-7 ml/min/1.73m2 [eGFR5-7]), intermediate (eGFR7-10) and early (eGFR10-14) dialysis initiation to validate our analytical methods by comparison with IDEAL. Our secondary analysis compared fifteen dialysis initiation strategies with eGFR values ranging between 4 and 19 ml/min/1.73m2 in increments of 1 ml/min/1.73m2. Study outcomes were 5-year all-cause mortality and major adverse cardiovascular events (MACE; composite of cardiovascular death, non-fatal myocardial infarction and stroke). Adjusted hazard ratios [HR] and cumulative survival proportions were estimated using a dynamic marginal structural model. Results Among 10,290 individuals with advanced CKD (median age 73 years; 36% women; median eGFR 16.8 ml/min/1.73m2), 3725 individuals initiated dialysis, 4160 died and 2446 experienced MACE. In trial emulation, the 5-year mortality risk was 53.0% for eGFR5-7, 50.3% for eGFR7-10 and 49.7% for eGFR10-14. Compared with eGFR5-7, the 5-year absolute mortality risk difference was -2.7% (95% CI, -4.6% to -0.7%) for eGFR7-10 and -3.3% (95% CI, -5.2% to -1.3%) for eGFR10-14, with a HR of 0.97 (0.94-0.99) and 0.96 (0.94-0.99), respectively. The 5-year absolute MACE risk differences were -1.1% (95% CI, -3.8% to 2.1%) for eGFR7-10 and -3.6% (95% CI, -6.0% to -1.0%) for eGFR10-14 compared with eGFR5-7, with a HR of 1.00 (0.97-1.04) and 0.96 (0.97-1.00), respectively. When analysing fifteen eGFR thresholds, initiation at eGFR15-16 was associated with the largest reduction in mortality (absolute difference, -5.9% [95% CI, -8.0% to -3.1%]; HR, 0.88 [95% CI, 0.85-0.92]) and MACE (absolute difference, -4.5% [95% CI, -7.6% to -1.4%]; HR, 0.92 [95% CI, 0.89-0.97]), compared with eGFR4-5. This -5.9% absolute risk difference translates to a mean postponement of death of 1.8 months over 5-years of follow-up. However, dialysis would need to be initiated on average 14 months earlier. Conclusion Early dialysis initiation was associated with a modest reduction in mortality and cardiovascular events. Such a reduction may not outweigh the burden of longer dialysis treatment duration for the patient.

COVID-19 in patients with chronic kidney disease stage 5

The study aimed to determine the frequency of COVID-19, specific of process and the mortality rate among dialysis patients with COVID-19.&#x0D; Materials and methods: The retrospective study included 764 patients with CKD VD, who received dialysis treatment at the Kyiv City Center for Nephrology and Dialysis, which is the clinical base of the Institute of Nephrology of the National Academy of Medical Sciences since September 1, 2020. until December 31, 2020. 155 patients were diagnosed with coronavirus disease. The study was conducted in two stages. In the first stage, dialysis patients with coronavirus disease were divided into groups depending on the severity of the disease.&#x0D; The second stage of the study was determined the influence of age, duration of dialysis treatment, gender, cause of chronic kidney disease VD, obesity, diabetes mellitus and cardiovascular pathology on the course of coronavirus disease, as well as complications and mortality from COVID-19 among the dialysis population.&#x0D; Results: 155 cases of COVID-19 were registered among 764 dialysis patients. Mild coronavirus disease was diagnosed in 38 (24.5%) patients, moderate and severe in 64 (41.3%) and 53 (34.2%) patients, respectively. Oxygen support was required for 76 patients (79%), and artificial lung ventilation was used for 17 (10.9%) patients. Factors associated with severe coronavirus disease in this category of patients were found to be obesity (BMI&gt; 30 kg / m2), diabetes mellitus, concomitant cardiovascular disease, and the need for oxygen support. In this category of patients, obesity (BMI&gt;30 kg/m2), cardiovascular disease, diabetes mellitus and require supplement oxygen are associated with severe Coronavirus disease COVID-19. There was no significant effect on the severity of coronavirus disease in the age of patients and duration of dialysis treatment. The duration of treatment in patients with diabetes was significantly higher (p &lt;0.05), a direct strong correlation between BMI and duration of treatment was demonstrated.&#x0D; Survival was significantly higher in the group of patients who did not require oxygen support (78% vs. 56%) and had a BMI &lt;30 kg / m2 (87% vs. 37%).&#x0D; Conclusions: the incidence of coronavirus disease among the dialysis cohort was 20.2% of cases. Patients treated with peritoneal dialysis had a significantly lower incidence. Severe coronavirus disease has been associated with obesity, cardiovascular disease, and the need for oxygen support. Men were more likely to have COVID-19 than women. There is no connection between the severe course of coronavirus disease with the age of patients and the duration of dialysis treatment. The duration of treatment of Coronavirus disease in the group of patients with diabetes and high BMI was longer. The following complications predominated in patients with COVID-19: thrombosis of arteriovenous fistula and atrial fibrillation. &#x0D; During the study period, 20 (12.9%) deaths were registered. Patient survival was higher in the group of patients without oxygen support and with a lower BMI.

Patient-reported symptoms during dialysis: the effect of pre-dialysis extracellular water and change in extracellular water post-dialysis

BackgroundQuality of life for haemodialysis (HD) patients may be affected by symptoms during dialysis treatments, and patient groups have highlighted the need to improve post-dialysis fatigue and dialysis-related symptoms. As changes in extracellular water (ECW) may lead to cramps and other symptoms, we wished to determine whether there was an association between ECW and intra-dialytic symptoms.MethodsWe reviewed the hospital records of HD patients who completed a self-reported intra-dialytic symptom questionnaire, using a visual analogue scale, who had contemporaneous pre- and postdialysis bioimpedance ECW measurements adjusted to height (aECW).ResultsWe studied dialysis sessions of 506 patients, 314 (62.1%) male, 226 (44.7%) diabetic, mean age 64.6 ± 15.7 years, weight 69.9 ± 17.4 kg, and duration of dialysis treatment 26 (9.6–60.1) months. We divided patients into three groups according to pre-dialysis aECW, and total dialysis symptom scores were greater for those in the lower tertile (25 (10–41) vs middle 18 (8.5–34) vs upper 20 (7–31), p < 0.05). Only feeling cold, dizziness, and low blood pressure were statistically different between the three pre-dialysis aECW groups, and there was no difference in post-dialysis recovery times.We analysed the effect of the fall in aECW pre-to post-dialysis. Patients in the group with the greatest fall in aECW did not report more intra-dialytic symptoms or longer recovery times.ConclusionWe found that patients starting dialysis with lower relative ECW were more likely to report intra-dialytic symptoms than those with greater amounts of fluid to remove, and most commonly reported symptoms were associated with intra-vascular volume depletion.

Povezanost ishoda transplantacije bubrega s obilježjima primatelja i darivatelja

Aim: Although kidney transplantation is the best method of replacing renal function, there is still a need to improve long-term outcomes. The aim of this study was to determine the independent association of recipient and donor demographic factors, underlying renal disease, duration of dialysis treatment, tissue typing mismatch, and sensitization with transplant outcomes in a contemporary cohort of kidney transplant patients. Patients and methods: The study included patients who had a kidney transplantation at Clinical Hospital Merkur from June 2007 to the end of 2018. Transplant outcomes were monitored until December 31, 2019. The minimum follow-up time was 1 year. Data were collected using reports from the Eurotransplant Network Information System (ENIS) application (&lt;a target="_blank" rel="nofollow" href="http://www.eurotransplant.org)"&gt;www.eurotransplant.org)&lt;/a&gt;. Survival is shown by Kaplan-Meier curves. The association of survival with specific recipient and donor characteristics was analyzed by univariate and multivariate Cox regression. Results: In the period from June 2007 to the end of 2018, 480 kidneys were transplanted in 472 patients. The 10-year patient survival was 72%. Ten-year renal survival censored for the death of renal function patients was 93%. In the multivariate analysis, only recipient age at transplantation, diabetes as the cause of underlying renal disease and duration of dialysis remained independently associated with patient survival. Conclusion: Long-term graft survival is excellent after kidney transplantation. Long-term patient survival can be improved by prevention, early detection and intensive treatment of chronic diseases.