Adult End-stage Renal Disease Research Articles

Evaluation of the Current Status of Home Hemodialysis in the Middle East Then Perspectives and Possibilities of Home Hemodialysis in Egypt

Abstract Background Chronic kidney disease (CKD) is a growing worldwide epidemic. The incidence and prevalence of end-stage renal disease (ESRD) are expected to continue to increase. The most recent United States Renal Data System (USRDS) reports indicate that the incident dialysis population has grown older, has more comorbid conditions than previous years, and is starting dialysis with higher levels of residual kidney function (RKF). Aim of the Work This study was done to evaluate the current status of home hemodialysis in the Middle East, then to study the perspectives and future possibilities of home hemodialysis in Egypt. It was carried out during the last 2 years; 2019 and 2020. It included 2 parts: Patients and Methods A retrospective and prospective study on 100 patients that was randomly selection and was adult ESRD patients (age > 18 years) either were treated and maintained on home hemodialysis during the last 5 years or will be treated and maintained on home hemodialysis during the period from march 2019 to march 2020. Results HD patients with volume overload or those with cardio-renal syndrome were found to better tolerate excessive UF with the use of home HD machines than that with the usual in-center machines. SLED and SCUF modes were very effectively managed with the use of these simple HD machines. It was noticed that the loss of residual renal functions in new HD patients, was significantly less with the use of home HD than with the usual in-center HD. This was related to less dialysate exposure other than the use of ultrapure dialysate. Conclusion The psychological status was significantly improved in those patients with having their sessions at their homes without any added stressors related to in-center HD. Even new ESRD patients who are too reluctant to start HD, were better convinced to start home HD. Home HD is a gentle and benign mode of HD with less reported intra-dialytic complications; attributed to the use of ultrapure dialysate solutions other than the treated tap/well water used in center HD.

The effect of oral sodium bicarbonate on the improvement of interdialytic acidosis and hyperkalemia in prevalent hemodialysis patients

Background Uremic toxins closely fit the saw-toothed profile including electrolytes, such as potassium, which is statistically associated with peri-dialytic morbidity and mortality. Acidosis follows a similar inverse pattern, with the bicarbonate levels gradually falling during the inter-dialytic period, before rapid supplementation during dialysis. Observational studies of clinical outcomes support the view that acidosis is harmful, showing that, after adjustment for comorbidity, pre-dialysis bicarbonate levels (HCO3) below 22 mmol/l are associated with excess mortality. The aim of this work is to study the effect of oral sodium bicarbonate supplementation on improvement of interdialytic acidosis, and hyperkalemia in patients on regular hemodialysis (HD). Patients and methods This was a one-arm interventional study that was conducted on a group of 50 adult end-stage renal disease patients on regular HD 3 times weekly at least for 3 months. Results Our study population’s mean ages were 41.8 ± 10.5 years, with male predominance 58%. PH value before and after sodium bicarbonate supplementation was 7.29 ± 0.07 and 7.38 ± 0.05, respectively, with level change 0.09 ± 0.06, which was statistically significant. Bicarbonate levels before and after sodium bicarbonate supplementation were 18.0 ± 1.8 and 23.4 ± 2.1(mmol/l), respectively, with level change 5.4 ± 1.7 (mmol/l), which was statistically significant. Also, potassium level (K) before and after sodium bicarbonate supplementation was 5.4 ± 0.5 and 5.0 ± 0.4 (mmol/l) respectively with level change –0.4 ± 0.3 (mmol/l), which was statistically significant. Regarding interdialytic body weight before and after sodium bicarbonate supplementation was 75.6 ± 6.5 and 75.5 ± 6.7 (kg), respectively, its change was –0.1 ± 0.5 (kg), which was statistically nonsignificant. As regards systolic blood pressure before and after sodium bicarbonate supplementation was 123.8 ± 11.4 and 125.6 ± 14.3 (mmHg), respectively, its change was 1.8 ± 9.4 (mmHg), which was statistically nonsignificant. Diastolic blood pressure before and after sodium bicarbonate supplementation was 76.0 ± 7.6 and 77.0 ± 8.1 (mmHg), respectively, and its change was 1.0 ± 9.5 (mmHg), which was statistically nonsignificant. Conclusion Oral sodium bicarbonate supplementation is effective in correcting interdialytic metabolic acidosis (PH and bicarbonate level) and hyperkalemia in HD patients without causing any significant increase in interdialytic body weight or systolic-diastolic blood pressure.

Comparative histological and clinical differences between children and adults in IgA nephropathy

IgA nephropathy (IgAN), as an autoimmune-mediated kidney disease worldwide, is considered an important cause of end-stage renal disease in adults. The most important diagnostic method in the patients is the evaluation of the biopsy findings. To date, several studies have examined different histopathological findings in patients with IgAN with an attempt to find out the relationship between morphologic findings with outcome and disease progression. Although there have been limited reports of IgAN in children, the Oxford scoring system is currently the most widely used IgAN classification and is validated for use in children and adults. In this review, we examined the most frequently published pathological findings on IgAN with a focus on Oxford classification between adults and children and attempted to highlight the key differences. The main purpose of this study was to assess the prognosis of patients with IgAN in childhood and adulthood, with emphasis on pathological risk factors for disease progression. Our results indicated that acute glomerulonephritis in children was predominantly reported more than chronic lesions. In addition, mesangial and endocapillary lesions were more common in children than in adults. In contrast, glomerular sclerosis, tubular atrophy/interstitial fibrosis, and atherosclerotic lesions were more common in older individuals.

Outcomes of Kidney Transplantation Among COVID-19 Recovered Patients in a Single Transplant Center

The COVID-19 pandemic significantly lowered kidney transplantation (KT) rates worldwide, and studies regarding outcomes of patients who developed COVID-19 infection before KT are limited, especially in low to middle-income countries. To determine the 1-year graft and patient survival of kidney transplant recipients who recovered from COVID-19 infection before KT. We retrospectively reviewed all adult end-stage renal disease patients who underwent KT at the National Kidney and Transplant Institute from June 2020 through October 2021. Transplant parameters, graft and patient survival, pretransplant COVID-19 infection, and post-KT infectious complications were recorded. Data was analyzed using two-tailed descriptive statistical tests. Of the 219 recipients, 23 (11%) had COVID-19 infection within 1 to 16 months before KT. The mean age of KT recipients was 36 years (range, 25-57), and 61.9% had chronic glomerulonephritis as primary renal disease. The mean duration from COVID-19 recovery to KT was 79 days (range, 21-207). There was no significant difference in the 1-year biopsy-proven acute rejection in the 2 groups, at 4.5% vs 12.5% for the COVID-19 and non-COVID-19 group, respectively. Both the 1-year graft and patient survival were similar in the COVID-19 and non-COVID-19 groups at 98.4% vs 100% and 100% vs 98.44%, respectively. There was no significant difference in biopsy-proven acute rejection, 1-year graft, and patient survival among patients who had a prior COVID-19 infection vs those who did not. Kidney transplantation appears safe when performed at least 1 month from COVID-19 infection.

Genetic Diagnosis of Adult Hemodialysis Patients With Unknown Etiology

Kidney disease of unknown etiology accounts for 1 in 10 adult end-stage renal disease (ESRD) cases worldwide. The aim of this study is to clarify the genetic background of patients with chronic kidney disease (CKD) of unknown etiology who initiated renal replacement therapy (RRT) in adulthood. This is a multicenter cross-sectional cohort study. Of the 1164 patients who attended 4 dialysis clinics in Japan, we first selected patients who started RRT between the ages of 20 and 49 years. After excluding patients with apparent causes of CKD (e.g., diabetic nephropathy, polycystic kidney disease (PKD) with family history, patients who underwent renal biopsy), 90 patients with CKD of unknown cause were included. The 298 genes associated with CKD were analyzed using capture-based targeted next-generation sequencing. Of the 90 patients, 10 (11.1%) had pathogenic variants in CKD-causing genes and 17 (18.9%) had variant of unknown significance (VUS). Three patients had PKD1 pathogenic variants, and 1 patient had PKD1 and COL4A4 pathogenic variants. In addition, 2 patients were diagnosed with atypical hemolytic uremic syndrome (aHUS) due to C3 or CFHR5. One patient each was diagnosed with Alport syndrome due to COL4A4 and COL4A3 variants, nephronophthisis due to NPHP1 variants, Fabry disease due to GLA variants, and autosomal-dominant tubulointerstitial kidney disease due to UMOD variants. Genetic diagnoses were not concordant with clinical diagnoses, except for patients with PKD1 variant. This largest study on genetic analysis in hemodialysis-dependent adults revealed the presence of undiagnosed inherited kidney diseases.

Atopic Dermatitis and the Risk of Infection in End-Stage Renal Disease.

Background and Objectives: Atopic dermatitis (AD), also known as eczema, is a common chronic inflammatory skin condition affecting 16.5 million adults in the United States. AD is characterized by an impaired epidermal barrier that can predispose individuals to infection. End-stage renal disease (ESRD) is also commonly complicated by infections due to chronic vascular access and immune-system dysfunction, possibly related to uremia. Multiple studies have reported that renal disease is a common comorbidity in adults with atopic dermatitis. The aim of this study was to determine whether AD is a risk factor for certain infections in patients with ESRD. Materials and Methods: Using the United States Renal Data System, a retrospective cohort analysis was conducted on adult ESRD patients initiating dialysis between 2004 and 2019 to investigate associations between infections and AD in this population. Results: Of 1,526,266 patients, 2290 were identified with AD (0.2%). Infectious outcomes of interest were bacteremia, septicemia, cellulitis, herpes zoster, and conjunctivitis. In all infectious outcomes except for conjunctivitis, patients with the infectious outcomes were more likely to carry a diagnosis of AD. After controlling for demographic and clinical covariates, AD was associated with an increased risk of cellulitis (adjusted relative risk (aRR) = 1.39, 95% confidence interval (CI) = 1.31-1.47) and herpes zoster (aRR = 1.67, CI = 1.44-1.94), but not with bacteremia (aRR = 0.96, CI = 0.89-1.05), septicemia (aRR = 1.02, CI = 0.98-1.08), or conjunctivitis (aRR = 0.97, CI = 0.740-1.34). Conclusions: Overall, after controlling for demographic and clinical covariates and adjusting for person-years-at-risk, AD was associated with an increased risk for some, but not all, infections within the population of patients with ESRD.

Abstract 26 — Clinical Characteristics of Familial Mediterranean: Fever in Hemodialysis Patients

Introduction Familial Mediterranean fever (FMF) is an inherited genetic disorder characterized by recurrent episodes of fever, serositis, arthritis, and skin rash. Uncontrolled disease can lead to amyloid A disposition, nephrotic syndrome and progressive renal failure. Recurrence of AA amyloidosis post kidney transplantation has been reported. Long-term colchicine therapy will reduce the FMF attacks and risk of AA amyloidosis. Although there is high prevalence of FMF in MENA region, the data of end stage renal disease (ESRD) in FMF is limited. We report our center experience. Method A retrospective chart review study was conducted at Tawam Hospital over 12 years (January 2010 to January 2023). We included adult ESRD on hemodialysis with FMF disease and studied their management outcomes. Descriptive analysis was used. Results 1900 ESRD patients were on hemodialysis during study period, and only two patients were diagnosed with FMF and renal amyloidosis. Case 1: A 60-year-old male patient from Syria who is known to have FMF and polycystic kidney disease leading to ESRD. He underwent successful LRD kidney transplantation in 2009. He was on mycophenolic acid: 540 mg, BID, prednisolone: 5 mg, tacrolimus: 1 mg am, 0.5 mg and colchicine 0.5 mg BID. He developed progressive renal allograft dysfunction with evidence of nephrotic syndrome. The renal biopsy revealed recurrence of AA amyloidosis due to FMF in kidney allograft in 2018. He had decline in renal function over years was initiated on hemodialysis on 2022. He developed two attacks of FMF peritonitis while on hemodialysis that responded well to steroid/colchicine therapy. Case 2: 48 years old male, from Egypt, known to have irritable bowel syndrome. He presented to our hospital with bilateral lower limb edema, and progressive shortness of breath for one month. Investigations revealed heavy proteinuria (8.98 g/g Creat) and acute kidney injury. Serology and autoimmune workup were negative. Kidney biopsy showed renal amyloidosis, and chronic tubulointerstitial nephritis with severe interstitial fibrosis (60%). History taken again and was positive for FMF in his uncle. Genetic study and clinical confirmed the diagnosis of FMF. He was started on colchicine, but developed ESRD within 8 months and initiated on hemodialysis. He had attacks of FMF. Conclusion Renal amyloidosis in FMF patient leads to progressive renal failure despite colchicine therapy. In our dialysis cohort over 12 years, only two FMF patients were identified. Colchicine therapy is required in ESRD-FMF in order to managed FMF attacks and prevent other organ AA amyloidosis.

Arteriovenous fistula creation by nephrologist and its outcomes: a prospective cohort study from Vietnam

BackgroundArteriovenous fistula (AVF) is the gold standard vascular access for effective hemodialysis. There is a growing interest in AVF creations performed by nephrologists to help reduce vascular surgeons’ workload and enhance the timely treatment of patients with end-stage renal disease (ESRD). However, little is known about the feasibility and effectiveness of this approach in the low-resource settings. We examined the AVF surgical success and failure rates and associated predictors as well as early complications of AVF creations by a trained nephrologist with supports from vascular surgeons in Vietnam.MethodsA prospective cohort study was conducted on all adult ESRD patients at the Hemodialysis Department of Thong Nhat Hospital between April 2018 and October 2020. Information on demographic characteristics, comorbidities, and AVF creations was collected using a standardized questionnaire. All patients were followed up until 18 weeks post-surgery.ResultsAmong 100 patients with a mean age of 61.22 ± 17.11 years old, male accounted for 54%. Common causes of ESRD included hypertension (57%) and diabetes (32%). Just more than half (52%) of them reported having an AVF creation prior to ESRD. The successful first-time AVF creation rate was 98% (13/99, 95%CI: 8.74–21.18%). The primary and secondary AVF failure rates were 13.13% (13/99, 95%CI: 8.74–21.18%) and 16.87% (14/83, 95%CI: 10.32–26.25%), respectively. Early complications included bleeding (1%) and early thrombosis of the anastomosis (2%). There was a statistically significant association between age and primary AVF failure (P = 0.005) and between operation time and secondary AVF failure (P = 0.038).ConclusionsAVF creations performed by well-trained and skilled interventional nephrologists with supports from vascular surgeons can result in favorable short- and long-term outcomes. It is important to follow up older patients and those with a long operation time to detect AVF failures. A standardized AVF creation training program and practice for nephrologists is needed to increase successful rates.

Subjective cognitive complaints in end-stage renal disease: a systematic review and meta-analysis

ABSTRACT Cognitive impairment is common in patients with end-stage renal disease (ESRD) and is associated with compromised quality of life and functional capacity, as well as worse clinical outcomes. Most previous research and reviews in this area were focused on objective cognitive impairment, whereas patients’ subjective cognitive complaints (SCCs) have been less well-understood. This systematic review aimed to provide a broad overview of what is known about SCCs in adult ESRD patients. Electronic databases were searched from inception to January 2022, which identified 221 relevant studies. SCCs appear to be highly prevalent in dialysis patients and less so in those who received kidney transplantation. A random-effects meta-analysis also shows that haemodialysis patients reported significantly more SCCs than peritoneal dialysis patients (standardised mean difference −0.20, 95% confidence interval −0.38 to −0.03). Synthesis of longitudinal studies suggests that SCCs remain stable on maintenance dialysis treatment but may reduce upon receipt of kidney transplant. Furthermore, SCCs in ESRD patients have been consistently associated with hospitalisation, depression, anxiety, fatigue, and poorer quality of life. There is limited data supporting a strong relation between objective and subjective cognition but preliminary evidence suggests that this association may be domain-specific. Methodological limitations and future research directions are discussed.

Brain-type natriuretic peptide levels and invasive hemodynamic parameters in dialysis dependent patients

BackgroundPulmonary hypertension (PH) is associated with increased mortality in patients with end-stage renal disease (ESRD). The prevalence of PH within ESRD as measured by right heart catheterization (RHC) is poorly described, and the correlation of BNP to pulmonary artery pressure (PAP) is unknown. MethodsThe renal transplant database at our center was used to identify adult ESRD patients from July 2013 to July 2015 who had a plasma BNP level measurement and invasive hemodynamic assessment by RHC within a 1-month period. Pulmonary hypertension was defined as a mean pulmonary artery pressure (PAP) ≥ 25 mmHg. Multivariate linear regression analysis was used to identify correlations between BNP and RHC parameters. To estimate the utility of BNP in the screening of PH, a receiver-operating characteristic (ROC) curve was generated. ResultsEighty-eight patients were included in the study of which 43 had PH. Compared to patients without PH, BNP was significantly higher within the PH cohort (1619 ± 2602 pg/ml vs. 352 ± 491 pg/ml). A statistically significant association (r [86] = 0.60, p<0.001) between plasma BNP and mean PAP was identified. ROC curve indicated an acceptable predictive value of BNP in PH with a c-statistic of 0.800 (95% CI 0.708 – 0.892). ConclusionsIn ESRD patients being considered for renal transplantation, PH is highly prevalent and BNP levels are elevated and significantly correlated with higher PAP. BNP may be a useful non-invasive marker of PH in these patients.

P8.038: Prevalence of Genetic Mutations Associated With Kidney Disorders in Renal Transplant Recipients – Single Centre Experience

Introduction: End-stage renal disease (ESRD) of undetermined etiology is highly prevalent and constitutes a significant clinical challenge, particularly in the context of kidney transplantation. Underlying renal conditions leading to ESRD are extremely heterogeneous and the prevalence of hereditary nephropathies among adults with ESRD is less known. To date, less than 10% of adult ESRD is thought to be genetic. Genetic analysis often reveals the cause of kidney failure in patients with unknown kidney disease. For patients awaiting renal transplantation, genetic testing prior to kidney transplant may help to understand the outcome in these patients. We studied the prevalence of genetic mutations related to kidney disease in renal transplant (RTx) recipients. Methods: It was a Single Centre, Observational, Cohort Study. Between October 2019 & July 2021, 123 RTx recipients were analyzed using Multiplex Ligation-dependent Probe Amplification (MLPA) and clinical exome sequencing for mutations related to kidney disease. Results: Mean age was 36±12 years, 96 (78%) were Males. 88 (71.5%) were undetermined and 35 (28.4 %) had established cause of CKD. 8 patients had structural or hereditary kidney disease and 27 were non-hereditary including DKD, Glomerulopathy, Obstructive uropathy and CTID diagnosed by kidney biopsy and clinical and radiological presentations. 17/88 (19.3%) patients with undetermined CKD on renal biopsy showed Glomerulosclerosis (6), CGN (8) & TMA (2). one had advanced renal damage. 32/88 (36.36%) patients had genetic mutations related to kidney disease. 20 were structural congenital or hereditary kidney disease & 10 had a mutation for Glomerulopathies. Mutations related to complement regulatory genes were found in 84/123 (68.2%). 6 patients had congenital or hereditary kidney disease, 12 were DKD, 5 were Glomerulopathy, 2 had Obstructive Kidney disease and 1 had CTID. Homozygousity and heterozygosity were seen in 14 (16.8%) and 10 (12%) patients respectively. 67/88 (80.7%) also showed CFHR1/CFHR3 gene complex duplication, reported as a variant of uncertain significance. 1 patient had a mutation for the PLG gene, previously been implicated in the pathogenesis of ahus. Conclusion: This study demonstrates 82.9% (102/123) prevalence of the genetic mutation in RTx recipients. Genetic analysis provides the etiology in 35 patients with undetermined kidney disease. The significance of complementary regulatory gene related mutation remained uncertain.

Early as compared to late initiation of twice-weekly hemodialysis and short-term survival among end-stage renal disease patients.

The impact of timing of hemodialysis (HD) for end-stage renal disease (ESRD) patients treated with twice-weekly HD remains unclear. We aimed to determine the effects of late initiation of HD on short-term mortality and hospitalization. A multicenter cohort study was conducted in 11 HD centers in Northeastern Thailand (HEmodialysis Network of the NorthEastern Thailand study group). We recruited adult ESRD patients who were treated with twice-weekly HD for more than 3 months and had data on eGFR at HD initiation. Clinical and laboratory values at the time of recruitment were recorded. Late and early (eGFR at start <5 and >5 ml/min/1.73 m2 ) initiations were defined. Outcomes were disease-related death (excluding any accidental deaths) and first hospitalization. Data analysis was performed by multivariable cox-regression analysis. A total of 407 patients who had data on eGFR at HD initiation (303 in late group and 104 in early group) were included for analysis. There were 56.8% male with a mean age of 55 years. During the 15.1months of follow-up, there were 27 (6.6%) disease-related deaths. The 1-year survival rate was similar among late and early initiation groups. The incidence density of first hospitalization in the late group was significantly lower than those in the early group (HR adjusted, 0.63; 95% CI, 0.40-0.99, p= 0.047). Among 303 patients who were in the late start group, patients with diabetes had a higher mortality rate (HR, 3.49; 95% CI, 1.40-8.70, p= 0.007) when compared to non-diabetic patients. Early initiation of HD at eGFR >5ml/min/1.73 m2 had no short-term survival benefit compared to the late group in ESRD patients treated with twice-weekly HD for at least 3 months in a resource-limited setting. A survival benefit from an early start of HD was found among diabetic patients.

148-LB: Glomerular Filtration Rate Trajectories in Children with Type 1 Diabetes

Background: While children with type 1 diabetes (T1D) may be at risk for chronic kidney disease (CKD) , data describing changes in kidney function from diagnosis is lacking. Currently, Canadian guidelines do not recommend routine monitoring of serum creatinine in these children. As part of a quality improvement initiative, we implemented routine serum creatinine monitoring. In this study, we describe estimated glomerular filtration rate (eGFR) trajectories in children with T1D. Methods: This longitudinal cohort study involved children with T1D followed in the Diabetes Clinic, who had ≥2 eGFR measurements. Data was collected from health records from 2016 to 2021. Annualized change in eGFR was calculated using the Bedside Schwartz equation, and a declining trajectory was defined a priori as &amp;lt;-3 ml/min/1.73m2 per year. Latent class mixed models were used to categorize eGFR trajectories, and patient characteristics were compared between trajectories. Results: Of the 307 participants, 46% were male; the median age at diagnosis and duration of T1D was 6.2 years and 6.9 years, respectively. Three eGFR trajectories were identified: stable-declining from normal baseline (93.8%) , rapidly declining from high baseline (4.5%) , and rapidly inclining from normal baseline (1.6%) . During their follow-up, 68 (22%) patients had an eGFR &amp;lt;90 ml/min/1.73 m2. Increasing BMI and blood pressure were observed in patients with a declining trajectory (46.9% of all patients) . Conclusion: Nearly half of children with T1D in this cohort had a declining eGFR trajectory. Notably, 22% of these children are at risk for CKD (eGFR &amp;lt;90 ml/min/1.73 m2) early in their T1D course. These findings, along with the steady rise in blood pressure, are concerning given the increased risk of CKD and end-stage renal disease in adults with T1D. These data suggest that careful monitoring of serum creatinine and blood pressure at baseline and regular intervals is warranted in children with T1D. Disclosure K. Favel: None. C. Mammen: None. C. Panagiotopoulos: Speaker's Bureau; Eli Lilly and Company. Funding BC Children's Hospital Research Institute, Canucks for Kids Fund Diabetes Legacy Grant (FAS #: F21-02506)

Loop and thiazide diuretic use and risk of chronic kidney disease progression: a multicentre observational cohort study

ObjectivesTo evaluate the association between diuretic use by class with chronic kidney disease (CKD) progression and onset of end-stage renal disease (ESRD).DesignRetrospective cohort study.SettingLarge integrated healthcare delivery system in Northern...

Weekly pattern of dialysis unit blood pressure is a promising marker for prognosis evaluation in hemodialysis population.

Dialysis unit blood pressure (BP) pattern showed superiority in prognostic evaluation and interdialytic BP burden assessment. However previous studies mainly focused on the recurrent BP pattern within a session (intradialytic BP change or intradialytic BP slope), the clinical value of the weekly pattern of dialysis unit BP is unknown. We performed a prospective cohort study in adult end stage renal disease (ESRD) patients on thrice weekly hemodialysis (HD). The slope and the change of the postdialysis systolic BP (SBP) in the course of a week (post-SBP slope and post-SBP change) were used to characterize the weekly pattern of dialysis unit BP. Outcomes included all-cause mortality, cardiovascular mortality, and first cardiovascular event. We also measured the home BP in our cohort. One hundred and twenty-nine subjects were followed over a median of 31 months. Higher post-SBP slope (≥0.185) was independently associated with increased risk of all-cause mortality, cardiovascular mortality, and first cardiovascular event. Results were similar for increased post-SBP change. HD patients with a higher post-SBP slope or an increased post-SBP change also had significant increased interdialytic BP burden measured by home SBP on both dialysis days and non-dialysis days. Post-SBP slope and post-SBP change might be promising dialysis unit BP markers for prognostic evaluation and interdialytic BP burden assessment.

Effect of Hemodiafiltration Versus Hemodialysis on Cognitive Function Among Patients With End-Stage Renal Disease: A Multicenter Study.

Background: Cognitive impairment (CI) and dementia are common in patients with end-stage renal disease (ESRD) undergoing hemodialysis. Their cause is multifactorial. Our study is first to compare the impact of hemodialysis (HD) and online hemodiafiltration (HDF) on patients’ cognitive outcomes.Methods: This was a cross sectional, multicenter cohort study. Adult ESRD patients aged >18 years on regular high flux HD or online HDF were recruited in the study. Clinical, laboratory, daily activities and cognitive functions assessment were assessed in all the involved individuals.Results: A total of 241 patients were successfully recruited into the study: 164 treated with high flux HD and 77 treated with HDF. Hypertension and diabetes were the commonest associated comorbidities. 85.9% of patients were functionally independent with no significant difference between those on HD versus HDF. 81.3% of our patients showed different degrees of CI. HDF has no superiority in the improvement of cognitive functions. Age, vitamin D level and haemoglobin (Hb) were the most independent predictors of cognitive function impairment among HD patients.Conclusions: Cognitive function impairment is a common problem in hemodialysis and is associated with multiple risk factors. HDF showed no beneficial effect over HD. There is no superiority of online HDF versus high flux HD in improving cognitive functions.

Volunteering Experience among Older Adults with End-stage Renal Disease (ESRD)

ABSTRACT Living with End-stage Renal Disease (ESRD) can be stressful and associated with long-term psychological effects on older adults, especially when they have to undergo a lifetime treatment. Previous studies have documented numerous positive effects of volunteering as a potential intervention on health and well-being among older adults. However, there is limited understanding of the experience of older adults in volunteering while having ESRD. This study aimed to explore the experience often older adults with ESRD volunteering while battling with their illness. Several themes emerged from the data analysis regarding the experience of volunteerism among the older adult ESRD patients. The themes are pre-volunteerism experience, enriching and inspiring experience, volunteering experience as sources of support system, improvement of health and wellbeing experience, experience in discovering meaning in life, experience in repaying the good deed, and challenges in volunteerism participation. This study contributes to the literature and practices through the illumination of innovative intervention through volunteering for older adults with ESRD.

Prevalence of Depression and Sleep Disorders in Patients on Dialysis: A Cross-Sectional Study in Qatar.

Patients with end-stage renal disease treated with dialysis have poor quality of life (QOL). Improving QOL in these patients with multiple comorbidities is a large challenge. We performed a cross-sectional study to evaluate the prevalence and associated factors of depression and sleep disorders in this population. Our primary aim was to evaluate QOL measures in dialysis patients in Qatar through a series of validated questionnaires mainly concerning depression and sleep disorders. Our secondary aim was to study the associations of age, sex, and comorbid conditions with the QOL measures. We hypothesized that end-stage renal disease (ESRD) patients on dialysis would have disturbed QOL due to both ESRD and dialysis and comorbidities. This prospective cross-sectional study included adult ESRD patients receiving either hemodialysis (HD) or peritoneal dialysis (PD) in the main tertiary dialysis unit in Qatar. We administered two surveys to evaluate depression (the Center for Epidemiologic Studies Depression Scale, http://www.bmedreport.com/archives/7139) and sleep disorders (the Pittsburgh Sleep Quality Index, https://www.sleep.pitt.edu/instruments/). We also reviewed patient demographics, comorbidities, and laboratory test results to evaluate any associated factors. We randomly studied 253 patients (62% on HD and 38% on PD). Overall, 48% of patients had depression, while 83.8% had sleep disorders. The PD had more poor sleepers than the HD group (89.1% versus (vs.) 75%, p=0.003). Most of our dialysis patients had poor sleep, but it was more significant in the elderly group 109 (90%) than in the young group 103 (78%) (p=0.009). Patients with diabetes mellitus (DM) had significantly more prevalence of poor sleep (131 (88.5%)) than those without DM (81 (77.1%), p=0.01). More female patients had depression than male patients (52% vs. 25%, p < 0.0001; odds ratio: 3.27 (95% confidence interval: 1.9–5.6), p < 0.0001). This is the first study in Qatar to evaluate depression and sleep disorders in patients on dialysis therapy.

Does Statin Therapy Reduce the Risks of Mortality and Major Adverse Cardiac and Cerebrovascular Events in Young Adults with End-Stage Renal Disease? Population-Based Cohort Study.

Among hemodialysis patients aged more than 40 years old, previous large-scale studies showed statin treatment had no effect on reducing cardiovascular adverse events. However, young-adult-onset end-stage renal disease (ESRD) patients have different physicosocial factors compared to older ESRD patients. The benefit of statins in such a specific group has not been well evaluated. Through the use of Taiwan’s National Health Insurance Research Database (NHIRD), young adult patients aged 20–40 with incident ESRD requiring permanent dialysis between 1 January 2003 and 31 December 2015 were identified. The enrollees were further divided into two groups depending on whether they received statin therapy for more than 90 days (statin group) or never received any statin (nonstatin group) in the first year after initiation of dialysis. Propensity score weighting (PSW) was used to balance the baseline characteristics between the two groups. After PSW, the statin group (n = 771) exhibited a higher rate of major adverse cardiac and cerebrovascular events (MACCEs) (2.65% vs. 1.44%, hazard ratio (HR): 1.87, 95% confidence interval (CI): 1.43–2.45), and acute myocardial infarction (1.51% vs. 0.30%, HR: 5.34, 95% CI: 3.40–8.39) compared to the nonstatin group (n = 1709). The risk of all-cause mortality, cardiovascular (CV) death. and stroke did not significantly differ between the two groups. Similar to older patients, this study demonstrated that statin therapy cannot offer any protective effects in reducing CV outcomes among young adult ESRD patients undergoing dialysis.

239 Cutaneous squamous cell carcinoma and mortality in end stage renal disease

Multiple factors related to immunosuppression are associated with cutaneous squamous cell carcinoma (cSCC), for example, the increased risk of cSCC observed in immunosuppressed organ transplant recipients, which in turn can lead to death. Patients with end-stage renal disease (ESRD) are known to have dysregulated immune systems; however, the impact of cSCC on mortality in ESRD has not been reported. Therefore, we addressed this question by analyzing the mortality of adult ESRD patients in the US Renal Data System between 2004 and 2014, excluding organ transplant recipients.