Frequent Hemodialysis Research Articles

Transitioning from Frequent High-Flux Hemodialysis to Frequent Online Hemodiafiltration: Successive Paradigm Shifts towards Optimal Dialysis Therapy

Transitioning from Frequent High-Flux Hemodialysis to Frequent Online Hemodiafiltration: Successive Paradigm Shifts towards Optimal Dialysis Therapy

Clinical Evidence of Frequent Home Hemodialysis Therapy in the Gulf Cooperation Council (GCC) Countries: A Preliminary Study of a Unique Experience

Clinical Evidence of Frequent Home Hemodialysis Therapy in the Gulf Cooperation Council (GCC) Countries: A Preliminary Study of a Unique Experience

Association of Diabetes with Changes in Blood Pressure during Hemodialysis: A Secondary Analysis of the Frequent Hemodialysis Network Daily Trial

Plain Language SummaryAmong patients requiring maintenance hemodialysis (HD), those with diabetes experience higher rates of cardiovascular mortality, compared to those without diabetes. Intra-dialytic hypotension is common among patients receiving maintenance HD, but data on differential patterns of peri-HD blood pressure (BP) control according to the presence or absence of diabetes remain sparse. In this post hoc analysis of the Frequent Hemodialysis Network Daily Trial, we observed that patients with diabetes (vs. none) had similar pre- and post-HD but lower nadir, systolic BP. Further, we observed that the risk of intra-dialytic hypotension associated with diabetes was higher among patients with higher pre-HD BP. Knowledge of diabetes status and assessment of the pre-HD systolic BP may help identify patients at higher risk for intra-dialytic hypotension.

#1928 Stepwise incremental hemodialysis and low-protein diet supplemented with keto-analogues to preserve residual kidney function: a pilot study

Abstract Background and Aims Studies have demonstrated that chronic dialysis with residual kidney function (RKF) had better survival rates in comparison to those with diminished or absent RKF and are also further associated with improved cardiovascular outcomes. Thus, the strategic preservation of RKF following the initiation of hemodialysis or during transitional periods emerges as a crucial consideration. Compelling evidence suggests that more frequent hemodialysis may contribute to an accelerated decline in RKF, contrasting with the beneficial effects of a low-protein diet (LPD) supplemented with keto-analogues, which has been shown to delay the progression of kidney function decline in the chronic kidney disease (CKD) non-dialysis population. Our pilot study aims to investigate the impact of a stepwise incremental hemodialysis with LPD supplemented with keto-analogues approach on the preservation of RKF after the need to initiate dialysis. Method This open-label, randomized controlled trial (RCT) pilot study employed a 1:1 allocation ratio (Groups 1 and 2) and included 30 patients in CKD stage V non-dialysis, aged ≥18 years, with an eGFR of 5-10 ml/min/1.73 m² as per the CKD-EPI equation, and a urine output of ≥800 ml/day. Exclusion criteria comprised patients with active infection or inflammation, indicated by C-reactive protein (CRP) levels exceeding 10 mg/L, individuals with cancer, or those with a body mass index (BMI) ≥35 kg/m². Group 1 underwent once-weekly hemodialysis (HD) initiation lasting 4 hours, coupled with a low-protein diet (LPD) of 0.6 g/kg/day supplemented with keto-analogues (0.12 g/kg/day) on non-dialysis days and a regular protein diet (1.0 g/kg/day) on dialysis days. In contrast, Group 2 underwent twice-weekly HD initiation (4 hours each) and maintained a regular protein diet (1.0 g/kg/day) every day. A stepwise incremental approach to HD frequency (once to twice per week in Group 1 and twice to thrice per week in Group 2) was implemented if renal kidney function (RKF) fell below 3 ml/min/1.73 m², eqKt/V was ≤1.2/session, Kru was <3 mL/min, ultrafiltration rate exceeded 15 ml/kg/hour, serum potassium was >5.5 mEq/L, and serum phosphate or serum albumin were outside the ranges of >5.5 mg/dL and <3.5 g/dL, respectively. The study spanned a duration of 12 months. Results A total of 30 patients were enrolled in the study and randomized into Group 1 (N = 15) and Group 2 (N = 15). There were no significant differences in baseline characteristics, including age (58.0 ± 19.3 vs 61.9 ± 16.8 years; p = 0.638), BMI (24.0 ± 3.8 vs 23.5 ± 3.6 kg/m²; p = 0.751), eGFR (6.9 ± 1.4 vs 6.2 ± 1.9 mL/min/1.73 m²; p = 0.241), urine volume (2226 ± 729 vs 1690 ± 986 mL/day; p = 0.128), and serum albumin (3.8 ± 0.3 vs 3.6 ± 0.3 g/dL; p = 0.123). In both groups, urine volume decreased over 12 months but Group 1 exhibited significantly higher urine volumes compared to Group 2 at M6 (1697 ± 442 vs 1063 ± 480; p = 0.01), M9 (1453 ± 522 vs 918 ± 404; p = 0.02), and M12 (1119 ± 429 vs 768 ± 367; p = 0.03). Consistent with urine volume, there were significant differences in creatinine clearance (CCr) at M6 (3.9 ± 0.5 in Group 1 vs 2.7 ± 1.8 in Group 2; p = 0.05) and M9 (3.5 ± 0.3 in Group 1 vs 1.9 ± 0.9 in Group 2; p = 0.01). In Group 1, there was a need to increase the rate of dialysis to twice/week in 5 patients at average of 3.6 months after start of study. No significant differences in hospitalization, adverse effects, and patient survival were observed between the two groups. The body weight of all participant were well maintained and no sign of malnutrition. Conclusion Stepwise incremental HD initiated as once-weekly hemodialysis coupled with LPD with keto-analogue supplementation better preserved urine output and CCr compared with twice weekly HD on a regular protein diet. In a period of 12 months after initiation of dialysis, we demonstrated that this stepwise strategy was feasible.

WCN24-2514 Cost-Effectiveness of Less Frequent Hemodialysis Compared with Incremental Peritoneal Dialysis in Colombia

WCN24-2514 Cost-Effectiveness of Less Frequent Hemodialysis Compared with Incremental Peritoneal Dialysis in Colombia

Is the cost of the new home dialysis techniques still advantageous compared to in-center hemodialysis? An Italian single center analysis and comparison with experiences from western countries.

Potential advantages of home dialysis remained a questionable issue. Three main factors have to be considered: the progressive reduction in the cost of consumables for in-Center hemodialysis (IC-HD), the widespread use of incremental Peritoneal Dialysis (PD), and the renewed interest in home hemodialysis (H-HD) in the pandemic era. Registries data on prevalence of dialysis modalities generally report widespread underemployment of home dialysis despite PD and H-HD could potentially provide clinical benefits, improve quality of life, and contrast the diffusion of new infection among immunocompromised patients. We examined the economic impact of home dialysis by comparing the direct and indirect costs of PD (53 patients), H-HD (21 patients) and IC-HD (180 patients) in a single hospital of North-west Italy. In order to achieve comparable weekly costs, the average weekly frequency of dialysis sessions based on the dialysis modality was calculated, the cost of individual sessions per patient per week normalized, and the monthly and yearly costs were derived. As expected, PD resulted the least expensive procedure (€ 23,314.79 per patient per year), but, notably, H-HD has a lower average cost than IC-HD (€ 35,535.00 vs. € 40,798.98). A cost analysis of the different dialysis procedures confirms the lower cost of PD, especially continuous ambulatory PD, compared to any extracorporeal technique. Among the hemodialysis techniques, home bicarbonate HD showed the lowest costs, while the weekly cost of Frequent Home Hemodialysis was found to be comparable to In-Center Bicarbonate Hemodialysis.

Association of Bioimpedance Parameters with Increases in Blood Pressure during Hemodialysis.

Intradialytic hypertension, defined as an increase in BP from pre- to post-hemodialysis (HD), affects 5%-15% of patients receiving maintenance HD and is associated with cardiovascular and all-cause mortality. Hypervolemia is believed to be a major etiological factor, yet the association of more objective biomarkers of volume status with intradialytic hypertension is not well described. In a post hoc analysis of the Frequent Hemodialysis Network Daily Trial ( n =234), using data from baseline, 1-, 4-, and 12-month visits ( n =800), we used random-effects regression to assess the association of bioimpedance estimates of volume (vector length) with post-HD systolic BP (continuous) and any increase in systolic BP (categorical) from pre- to post-HD. We adjusted models for randomized group; age; sex; self-reported race; Quételet (body mass) index; vascular access; HD vintage; hypertension; history of heart failure; diabetes; residual kidney function (urea clearance); pre-HD systolic BP; ultrafiltration rate; serum-dialysate sodium gradient; and baseline values of hemoglobin, phosphate, and equilibrated Kt/V urea. The mean age of participants was 50±14 years, 39% were female, and 43% were Black. In adjusted models, shorter vector length (per 50 Ω/m) was associated with higher post-HD systolic BP (2.9 mm Hg; 95% confidence interval [CI], 1.6 to 4.3) and higher odds of intradialytic hypertension (odds ratio 1.66; 95% CI, 1.07 to 2.55). Similar patterns of association were noted with a more stringent definition of intradialytic hypertension (>10 mm Hg increase from pre- to post-HD systolic BP), where shorter vector length (per 50 Ω/m) was associated with a higher odds of intradialytic hypertension (odds ratio 2.17; 95% CI, 0.88 to 5.36). Shorter vector length, a bioimpedance-derived proxy of hypervolemia, was independently associated with higher post-HD systolic BP and risk of intradialytic hypertension.

Association of Bioimpedance Parameters with Changes in Blood Pressure During Hemodialysis: A Secondary Analysis of the Frequent Hemodialysis Network (FHN) Daily Trial

Association of Bioimpedance Parameters with Changes in Blood Pressure During Hemodialysis: A Secondary Analysis of the Frequent Hemodialysis Network (FHN) Daily Trial

Interventions for fatigue in people with kidney failure requiring dialysis.

Fatigue is a common and debilitating symptom in people receiving dialysis that is associated with an increased risk of death, cardiovascular disease and depression. Fatigue can also impair quality of life (QoL) and the ability to participate in daily activities. Fatigue has been established by patients, caregivers and health professionals as a core outcome for haemodialysis (HD). We aimed to evaluate the effects of pharmacological and non-pharmacological interventions on fatigue in people with kidney failure receiving dialysis, including HD and peritoneal dialysis (PD), including any setting and frequency of the dialysis treatment. We searched the Cochrane Kidney and Transplant Register of Studies up to 18 October 2022 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal and ClinicalTrials.gov. Studies evaluating pharmacological and non-pharmacological interventions affecting levels of fatigue or fatigue-related outcomes in people receiving dialysis were included. Studies were eligible if fatigue or fatigue-related outcomes were reported as a primary or secondary outcome. Any mode, frequency, prescription, and duration of therapy were considered. Three authors independently extracted data and assessed the risk of bias. Treatment estimates were summarised using random effects meta-analysis and expressed as a risk ratio (RR) or mean difference (MD), with a corresponding 95% confidence interval (CI) or standardised MD (SMD) if different scales were used. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Ninety-four studies involving 8191 randomised participants were eligible. Pharmacological and non-pharmacological interventions were compared either to placebo or control, or to another pharmacological or non-pharmacological intervention. In the majority of domains, risks of bias in the included studies were unclear or high. In low certainty evidence, when compared to control, exercise may improve fatigue (4 studies, 217 participants (Iowa Fatigue Scale, Modified Fatigue Impact Scale, Piper Fatigue Scale (PFS), or Haemodialysis-Related Fatigue scale score): SMD -1.18, 95% CI -2.04 to -0.31; I2 = 87%) in HD. In low certainty evidence, when compared to placebo or standard care, aromatherapy may improve fatigue (7 studies, 542 participants (Fatigue Severity Scale (FSS), Rhoten Fatigue Scale (RFS), PFS or Brief Fatigue Inventory score): SMD -1.23, 95% CI -1.96 to -0.50; I2 = 93%) in HD. In low certainty evidence, when compared to no intervention, massage may improve fatigue (7 studies, 657 participants (FSS, RFS, PFS or Visual Analogue Scale (VAS) score): SMD -1.06, 95% CI -1.47, -0.65; I2 = 81%) and increase energy (2 studies, 152 participants (VAS score): MD 4.87, 95% CI 1.69 to 8.06, I2 = 59%) in HD. In low certainty evidence, when compared to placebo or control, acupressure may reduce fatigue (6 studies, 459 participants (PFS score, revised PFS, or Fatigue Index): SMD -0.64, 95% CI -1.03 to -0.25; I2 = 75%) in HD. A wide range of heterogenous interventions and fatigue-related outcomes were reported for exercise, aromatherapy, massage and acupressure, preventing our capability to pool and analyse the data. Due to the paucity of studies, the effects of pharmacological and other non-pharmacological interventions on fatigue or fatigue-related outcomes, including non-physiological neutral amino acid, relaxation with or without music therapy, meditation, exercise with nandrolone, nutritional supplementation, cognitive-behavioural therapy, ESAs, frequent HD sections, home blood pressure monitoring, blood flow rate reduction, serotonin reuptake inhibitor, beta-blockers, anabolic steroids, glucose-enriched dialysate, or light therapy, were very uncertain. The effects of pharmacological and non-pharmacological treatments on death, cardiovascular diseases, vascular access, QoL, depression, anxiety, hypertension or diabetes were sparse. No studies assessed tiredness, exhaustion or asthenia. Adverse events were rarely and inconsistently reported. Exercise, aromatherapy, massage and acupressure may improve fatigue compared to placebo, standard care or no intervention. Pharmacological and other non-pharmacological interventions had uncertain effects on fatigue or fatigue-related outcomes in people receiving dialysis. Future adequately powered, high-quality studies are likely to change the estimated effects of interventions for fatigue and fatigue-related outcomes in people receiving dialysis.

The long-term benefits of early intensive therapy in chronic diseases-the legacy effect.

The 'legacy effect' refers to the long-term benefits of intensive therapy that are observed long after the end of clinical trials and trial interventions in chronic diseases such as diabetes, hyperlipidaemia and hypertension. It emphasizes the importance of intensive treatment to prevent long-term complications and mortality. In chronic kidney disease (CKD), the legacy effect is evident in various studies. Long-term nephroprotection in diabetes is well documented in major studies in the early stages of diabetes, such as Diabetes Control and Complications Trial-Epidemiology of Diabetes Interventions and Complications (DCCT-EDIC), UK Prospective Diabetes Study (UKPDS) and Intensified Multifactorial Intervention in Patients with Type 2 Diabetes and Microalbuminuria (STENO-2). These studies highlight the importance of intensive glycaemic control in reducing microvascular complications, including nephropathy, in patients with recently diagnosed type 1 and type 2 diabetes. However, the legacy effect is less evident in patients with long-term, established diabetes. In chronic glomerulonephritis, studies on immunoglobulin A nephropathy showed that early immunosuppressive treatment could have long-term beneficial effects on kidney function in children and adults with CKD. The Frequent Hemodialysis (FH) and the EXerCise Introduction To Enhance Performance in Dialysis (EXCITE) trials indicated that frequent haemodialysis and a personalized walking exercise program could improve clinical outcomes and reduce the long-term risk of death and hospitalization. The legacy effect concept underscores the importance of intensive intervention in chronic diseases, including CKD. This concept has significant implications for public health and warrants in-depth basic and clinical research to be better understood and exploited in clinical practice. However, its limitations should be considered when interpreting long-term observational data collected after a clinical trial. Appropriate study designs are necessary to investigate an unbiased legacy effect.

Improved nursing home end-stage renal disease patient participation in physical therapy with onsite, more frequent dialysis.

For end-stage renal disease (ESRD) patients residing in skilled nursing facilities (SNFs), the logistics and physical exhaustion of life-saving hemodialysis therapy often conflict with rehabilitation goals. Integration of dialysis care with rehabilitation programs in a scalable and cost-efficient manner has been a significant challenge. SNF-resident ESRD patients receiving onsite, more frequent hemodialysis (MFD) have reported rapid post-dialysis recovery. We examined whether such patients have improved Physical Therapy (PT) participation. We conducted a retrospective electronic medical records review of SNF-resident PT participation rates within a multistate provider of SNF rehabilitation care from January 1, 2022 to June 1, 2022. We compared three groups: ESRD patients receiving onsite MFD (Onsite-MFD), ESRD patients receiving offsite, conventional 3×/week dialysis (Offsite-Conventional-HD), and the general non-ESRD SNF rehabilitation population (Non-ESRD). We evaluated physical therapy participation rates based on a predefined metric of missed or shortened (<15 min) therapy days. Baseline demographics and functional status were assessed. Ninety-two Onsite-MFD had 2084 PT sessions scheduled, 12,916 Non-ESRD had 225,496 PT sessions scheduled, and 562 Offsite-Conventional-HD had 9082 PT sessions scheduled. In mixed model logistic regression, Onsite-MFD achieved higher PT participation rates than Offsite-Conventional-HD (odds ratio: 1.8, CI: 1.1-3.0; p < 0.03), and Onsite-MFD achieved equivalent PT participation rates to Non-ESRD (odds ratio: 1.2, CI: 0.3-1.9; p < 0.46). Baseline mean ± SD Charlson Comorbidity score was significantly higher in Onsite-MFD (4.9 ± 2.0) and Offsite-Conventional-HD (4.9 ± 1.8) versus Non-ESRD (2.6 ± 2.0; p < 0.001). Baseline mean self-care and mobility scores were significantly lower in Onsite-MFD versus Non-ESRD or Offsite-Conventional-HD. SNF-resident ESRD patients receiving MFD colocated with rehabilitation had higher PT participation rates than those conventionally dialyzed offsite and equivalent PT participation rates to the non-ESRD SNF-rehabilitation general population, despite being sicker, less independent, and less mobile. We report a scalable program integrating dialysis and rehabilitation care as a potential solution for ESRD patients recovering from acute hospitalization.

Low-Volume Home Haemodialysis and In-Centre Haemodialysis: Comparison of Dialysis Adequacy in Obese Individuals.

Background Although frequent low-flow, low-volume haemodialysis using the NxStage System One is now well-established as an option for home therapy of end-stage chronic kidney disease, its ability to deliver adequate dialysis in people with high BMI remains questionable. This doubt may lead to obese individuals being denied the potential benefits of this modality. To establish if this doubt is justified, we compared dialysis adequacy in two groups of obese individuals; one receiving standard thrice-weekly in-centre haemodialysis and the other receiving frequent haemodialysis at home using the NxStage System One. Methods This is a retrospective observational cohort study of 105 adult dialysis patients with obesity (BMI ≥ 30 kg/m2). All had been on dialysis for at least six months. Fifty-five patients receiving in-centre haemodialysis were compared with 50 patients receiving home haemodialysis using NxStage System One. Dialysis adequacy (standard Kt/V calculated by the Daugirdas equation) was compared between the two groups. The clinical characteristics, laboratory test results, and treatment regimens of each group were also compared. Results The in-centre haemodialysis group was older (63.6 ± 12.8 years vs. 58.5 ± 10.9 years, p=0.033) and had a higher Charlson comorbidity score (5.9 ± 2.1 vs. 4.5 ± 2.5, p=0.003). Standard Kt/V was significantly higher in the home haemodialysis group (2.4 ± 0.5) than in the in-centre haemodialysis group (2.2 ± 0.2) (p = 0.006). The mean serum inorganic phosphate was significantly lower in the home haemodialysis group than in the in-centre haemodialysis group (1.6 ± 0.4 mmol/l vs. 1.8 ± 0.5 mmol/l, p = 0.010). There were no statistically significant differences in the usage of antihypertensives, phosphate binders, or erythropoiesis-stimulating agents between the two groups. Conclusions In this study, dialysis adequacy (expressed as standard Kt/V) was superior to that of standard thrice-weekly in-center haemodialysis delivered by frequent low-volume home haemodialysis using the NxStage System One. Hesitancy about recommending frequent low-volume home haemodialysis to obese individuals is therefore unjustified.

Experience of permacath placement in patients with end stage renal failure in a tertiary hospital

Background &amp; objective: Renal failure patients often need hemodialysis to optimize the deranged fluid and electrolyte balance in their blood. It involves drawing patients’ venous blood, route it through the hemodialysis (HD) machine and pump it back into the blood circulation. Frequent HD is conveniently performed through large bore, double lumen catheters and to prevent infection it is tunneled for a few centimeters. We conducted this retrograde study to determine the frequency of complications of tunneled permacath insertions in patients with end stage renal disease (ESRD) undergoing hemodialysis in our tertiary hospital Methodology: This retrograde descriptive study was conducted at Department of Anesthesiology, Fauji Foundation Hospital, Rawalpindi. from 1st Jan, 2019 – 1st Jan 2023. We searched and included data from the patient records of 804 patients in whom permacath was inserted for hemodialysis under ultrasound guidance and follow-up was done for 8 weeks. Data was retrieved and stored on a Performa and was analyzed on SPSS version 16. Results: Out of 812 permanent catheters passed in 804 patients, 19% had complications. The most common complication was catheter thrombosis (8%), followed by local site bleeding (5%), infection (3%), arterial prick (2%) and hematoma formation (1%). Conclusion: Tunneled permacath central venous catheter can be used in patients undergoing hemodialysis until maturation of arteriovenous fistula. It is quite a safe procedure under ultrasound guidance, but strict vigilance is required to prevent short-term and long-term complications. Key words: Central Venous Catheters; Renal Dialysis; Thrombosis; Hematoma; Kidney Failure, Chronic; Fluoroscopy; Ultrasonography. Citation: Ali L, Ali T, Mustafa SI, Qureshi AA. Experience of permacath placement in patients with end stage renal failure in a tertiary hospital. Anaesth. pain intensive care 2022;27(2):726−730; DOI: 10.35975/apic.v27i2.2357 Received: June 24, 2023; Revised: September 26, 2023; Accepted: November 15, 2023

Management of Intermittent Hemodialysis in the Critically Ill Patient.

Intermittent hemodialysis remains a cornerstone of extracorporeal KRT in the intensive care unit, either as a first-line therapy for AKI or a second-line therapy when patients transition from a continuous or prolonged intermittent therapy. Intermittent hemodialysis is usually provided 3 days per week in this setting on the basis that no clinical benefits have been demonstrated with more frequent hemodialysis. This should not detract from the importance of continually assessing and refining the hemodialysis prescription (including the need for extra treatments) according to dynamic changes in extracellular volume and other parameters, and ensuring that an adequate dose of hemodialysis is being delivered to the patient. Compared with other KRT modalities, the cardinal challenge encountered during intermittent hemodialysis is hemodynamic instability. This phenomenon occurs when reductions in intravascular volume, as a consequence of ultrafiltration and/or osmotic shifts, outpace compensatory plasma refilling from the extravascular space. Myocardial stunning, triggered by intermittent hemodialysis, and independent of ultrafiltration, may also contribute. The hemodynamic effect of intermittent hemodialysis is likely magnified in patients who are critically ill due to an inability to mount sufficient compensatory physiologic responses in the context of multiorgan dysfunction. Of the many interventions that have undergone testing to mitigate hemodynamic instability related to KRT, the best evidence exists for cooling the dialysate and raising the dialysate sodium concentration. Unfortunately, the evidence supporting routine use of these and other interventions is weak owing to poor study quality and limited sample sizes. Intermittent hemodialysis will continue to be an important and commonly used KRT modality for AKI in patients with critical illness, especially in jurisdictions where resources are limited. There is an urgent need to harmonize the definition of hemodynamic instability related to KRT in clinical trials and robustly test strategies to combat it in this vulnerable patient population.

Erythropoietin resistance in patients with regular hemodialysis in Sohag university hospital

Background: A definite anemia [hemoglobin (HB) 10-12 g/dl] or the need for significantly higher Erythropoietin (EPO) dosages of epoetin alfa are symptoms of EPO resistance, respectively. The recommended restorative goal is to maintain HB levels between 11 and 12 g/dl. Fe deficiency, concurrent inflammation, inadequate dialysis, hyperparathyroidism, hemolysis, vitamin B12, and folate deficiency are the main causes of EPO resistance. The objective of this study was to evaluate patients who receive frequent hemodialysis for EPO resistance. Methods: This study was performed at Sohag University Hospital on 50 hemodialysis patients compared to 40 healthy adult subjects from June 2021 to January 2022. Serum EPO was analyzed by enzyme-linked immunosorbent assay and Angiotensin Converting Enzyme (ACE) rs1799752 polymorphism was assessed using the Genomic TaqMan genotyping test. Results: This study found insignificant relation between EPO Resistance Index (ERI) and diverse ACE genotype groups and para thyroid hormone. A further significant direct proportional relationship was found between ERI and Ferritin. EPO and parathyroid hormone did not show any significant relationship. Conclusion: Considering the non-critical connection between ERI and our components, it is vital to enhance the treatment of anemic patients with chronic kidney diseases to recognize the potential causes of resistance and ponder other variables for resistance before proposing an expanded EPO-stimulating agent administration.

Efficacy and Safety of Gum Arabic on Renal Failure Patients: Systematic Review and Meta-analysis

Background: Chronic Renal Failure (CRF) is a long-term disease caused by progressive kidney dysfunction due to many reasons leading to a significant rise in serum levels of creatinine and urea reaching the advanced stage where the patient goes for frequent hemodialysis. This study aims to discuss the evaluation of the efficacy of gum Arabic (GA) supplementation on the serum level of creatinine, urea, sodium, and potassium in CRF patients. Methods: Four databases PubMed, Web of Science, Scopus, and the Cochrane Library were searched for clinical trials assessment of gum Arabic intervention in CRF patients. Animal trials and experimental protocols were excluded. Screening of data and data extraction were done by two reviewers independently of each other. Meta-analysis was conducted on the selected studies using RevMan and the resulting description was summarized through the Forest plot tool on the efficacy of GA on 4 variables, creatinine, urea, sodium, and potassium in CRF patients. Results: From 574 studies searched, only 4 studies were included in this systemic review and meta-analysis. Although one of the studies had proved the objectives of the review but it was removed from the meta-analysis due to the heterogeneity caused by its inclusion. Conclusion: The few studies included in the current review revealed significant efficacy of GA treatment on the serum level of creatinine, urea, and sodium, but not potassium.

Abstract 11743: Impact of Chronic Kidney Disease / End Stage Renal Disease on Aortic Dissection: Results From the Nationwide Readmission Database

Introduction: Prior literature has shown that in-hospital and postoperative renal failure are independent mortality predictors in acute aortic dissection (AAD). However, there is limited data on chronic kidney disease (CKD) and end-stage renal disease (ESRD) as pre-existing outcome predictors with AAD Methods: The Nationwide Readmission Database was analyzed from 2016 to 2019 for adult patients admitted with a primary diagnosis of AAD. Patients were assessed for CKD and ESRD. Outcomes were measured for the effect of renal dysfunction on 30-day readmission, inpatient mortality, and length of stay (LOS). Results: Aortic dissection occurred in 45,481 patients over the study period, of which 4727 were readmitted. The mean age was 64 years, and logistical regression analysis revealed that patients with ESRD admitted with AAD were 58% more likely to be readmitted (95% CI [1.29 - 1.93], p&lt;0.001) within 30 days than those without (Figure 1). Notably, ESRD patients had a 30% reduction (95% CI 0.57 - 0.86) in in-patient mortality (Figure 2). Mean LOS was also higher for ESRD patients (6.7 days, 95% CI 5.09 - 8.38) while lower for CKD stage 3-5 (-1.06 days, 95% CI -1.62 --0.50) compared with those without renal disease. Discussion: We observed that patients with ESRD and AAD have higher readmission rates and LOS. However, decreased mortality rates compared with patients with CKD stages 3-5 were observed that could be attributed to increased exposure to healthcare interventions secondary to frequent hemodialysis follow-ups, compared with CKD stages 3-5. Early stages of CKD were excluded, given the possibility of a lack of coding in electronic medical records.

Early prediction of hemodialysis complications employing ensemble techniques

Background and objectivesHemodialysis complications remain a critical threat among dialysis patients. They result in sudden termination of the session which impacts the efficiency of dialysis. As intra-dialytic complications are the result of the interplay of multiple factors, artificial intelligence can aid in their early prediction. This research aims to compare different machine learning tools for the early prediction of the most frequent hemodialysis complications with high performance, using the fewest predictors for easier practical implementation.MethodsFifty different variables were recorded during 6000 hemodialysis sessions performed in a regional dialysis unit in Egypt. The filter technique was used to extract the most relevant features. Then, five individual classifiers and three ensemble approaches were implemented to predict the occurrence of intra-dialytic complications. Different subsets of 25, 12 and 6 from the 50 collected features were tested.ResultsRandom forest yielded the highest accuracy of 98% with the least training time using 12 features in a balanced dataset, while the gradient boosting allowed obtaining the highest F1-score of 94%, 92%, and 78% in the prediction of hypotension, hypertension, and dyspnea, respectively, in imbalanced datasets.ConclusionApplying different machine learning algorithms to big datasets can improve accuracy, reduce training time and model complexity allowing simple implementation in clinical practice. Our models can help nephrologists predict and possibly prevent dialysis complications.

The effectiveness and safety of mRNA (BNT162b2) and inactivated (CoronaVac) COVID-19 vaccines among individuals with chronic kidney diseases

The effectiveness and safety of mRNA (BNT162b2) and inactivated (CoronaVac) COVID-19 vaccines among individuals with chronic kidney diseases

Top of basilar artery infarction

Rationale: The posterior circulation represents 20% of blood supply to the brain, and its occlusion, commonly by embolism, causes brainstem, cerebellar, and lower cerebral infarctions. The clinical presentation varies from mild symptoms to severe neurological deficits or death. The duration of intervention is vital, commonly with antithrombotic drugs or through intervention. Patient concerns: The first case was a 36-year-old-female admitted due to snakebite. On admission, she developed acute kidney injury, sepsis, and compartment syndrome, for which she underwent fasciotomy, improved, and was discharged. Two days later, she presented with sudden onset of left-sided weakness. The second was an 85-year-old male with hypertension and end-stage renal disease on regular hemodialysis who presented with high-grade continuous fever associated with rigor, confusion, and decreased level of consciousness for 2 days. The third case was a 30-year-old woman admitted to the emergency department because of an abrupt loss of consciousness that occurred when she was going to the bathroom; she was unable to speak, swallow, or move her limbs. There was no fever, sphincteric disturbance, or seizure. She had a history of severe chronic bifrontal headache that started 4 months prior to elective cesarean section. Diagnosis: The patients were diagnosed as top of basilar artery infarction. Interventions: The first patient received enoxaparin, intravenous fluids, proton-pump inhibitors, antibiotics, and rivaroxaban. The second patient received intravenous antibiotics, dual antiplatelet therapy, enoxaparin, blood transfusions, and frequent hemodialysis sessions. The third patient received intravenous fluids, antibiotics, and oral anticoagulants (rivaroxaban 15 mg twice daily for 2 weeks then 20 mg once daily). Outcomes: The 3 patients were discharged following pharmacological treatment. The first and third cases showed improvement in their symptoms. However, the second patient developed bilateral epistaxis and bleeding after medication and did not show improvement in his symptoms; however, he died due to intradialytic hypotension. Lessons: We reported 3 Sudanese patients who had complicated medical sequelae due to top basilar artery occlusion, received anticoagulants and supportive therapy, and showed variable recovery over weeks, with the exception of 1 patient who died after follow-up.