Hemodialysis Facilities Research Articles

Impact of first-wave COronaVIrus disease 2019 infection in patients on haemoDIALysis in Alsace: the observational COVIDIAL study.

BackgroundThere are only scarce data regarding the presentation, incidence, severity and outcomes of coronavirus disease 2019 (COVID-19) in patients undergoing long-term haemodialysis (HD). A prospective observational study was conducted in eight HD facilities in Alsace, France, to identify clinical characteristics of HD patients with COVID-19 and to assess the determinants of the risk of death.MethodsAll HD patients tested positive for COVID-19 from 5 March to 28 April 2020 were included. Collected data included patient characteristics, clinical features at diagnosis, laboratory data, treatments and outcomes.ResultsAmong 1346 HD patients, 123 tested positive for COVID-19. Patients had a median age of 77 years (interquartile range 66–83), with a high number of comorbidities (3.2 ± 1.6 per patient). Symptoms were compatible in 63% of patients. Asthenia (77%), diarrhoea (34%) and anorexia (32%) were frequent at diagnosis. The delay between the onset of symptoms and diagnosis, death or complete recovery was 2 (0–5), 7 (4–11) and 32 (26.5–35) days, respectively. Treatment, including lopinavir/ritonavir, hydroxychloroquine and corticosteroids, was administered in 23% of patients. The median C-reactive protein (CRP) and lymphocyte count at diagnosis was 55 mg/L (IQR 25–106) and 690 Ly/µL (IQR 450–960), respectively. The case fatality rate was 24% and determinants associated with the risk of death were body temperature {hazard ratio [HR] 1.96 [95% confidence interval (CI) 1.11–3.44]; P = 0.02} and CRP at diagnosis [HR 1.01 (95% CI 1.005–1.017); P < 0.0001].ConclusionsHD patients were found to be at high risk of developing COVID-19 and exhibited a high rate of mortality. While patients presented severe forms of the disease, they often displayed atypical symptoms, with the CRP level being highly associated with the risk of death.

The Cumulative Rate of SARS-CoV-2 Infection in Chinese Hemodialysis Patients

BackgroundThere is a paucity of information regarding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients undergoing maintenance hemodialysis. We aimed to estimate the cumulative attack rate of SARS-CoV-2 in hemodialysis patients in China using a serological test.MethodsWe enrolled all hemodialysis patients from 8 hemodialysis facilities in Honghu and Jingzhou of Hubei province and Guangzhou and Foshan of Guangdong province in China. We screened these patients for SARS-CoV-2 infection by both a reverse-transcriptase polymerase chain reaction (RT-PCR) test for viral RNA and a serological test for IgG and IgM antibodies. Data on demographics and clinical characteristics were collected via case report forms. We also enrolled the health care workers from the participating hospitals and compared the seropositive rate between hemodialysis patients and health care workers in the same region.ResultsAmong 1542 hemodialysis patients, 5 (0.32%) and 51 (3.3%) were tested positive by the RT-PCR test and the serological test, respectively. The seropositive rate in Hubei (3.6%) was higher than that in Guangdong (2.8%), although the difference was not statistically significant (P = 0.5). Most of the seropositive patients were asymptomatic. Independent risk factors for SARS-CoV-2 infection were being older than 65 years, having manifestation of lung infection in imaging examinations, and having a lower level of serum albumin. In comparison, the seropositive rate in 3205 health care workers was 1.2%，which was significantly lower than that observed in the hemodialysis patients (P < .001).ConclusionThe cumulative rate of SARS-CoV-2 infection in hemodialysis patients in China was high at 3.3%. Serological test detected 10 times more cases of SARS-CoV-2 infection than the RT-PCR test and should be the preferred tool for estimating the prevalence of coronavirus disease 2019 (COVID-19).

COVID-19: The Perspective Of Nephrology

Increasing insight into the clinical phenotype and mechanisms of SARS-CoV-2 infections and COVID-19 has identified damage of the kidneys as a key player in the course of the disease. This manuscript summarizes the current knowledge on direct viral infection of kidney tissue, proteinuria and acute kidney injury in COVID-19, and management of patients on chronic dialysis as well as after kidney transplantation. Direct infection of podocytes and proximal tubular cells by SARS-CoV-2 has been confirmed and results in proteinuria and hematuria at an early stage of COVID-19. In this context, any kidney affection is a predictor of worse outcomes among COVID-19 patients irrespective of the initial presentation and increases the risk of acute kidney injury. Specific therapies for kidney damage and acute kidney injury within COVID-19 that could be generally recommended are currently lacking. Patients on chronic hemodialysis in particular are at risk for contracting SARS-CoV-2 infections as indicated by outbreaks and super-spreading events in hemodialysis facilities. Immunosuppressive therapy after kidney transplantation needs to be adapted upon diagnosis of COVID-19 depending on the severity of the initial presentation.

Korean clinical practice guidelines for preventing transmission of coronavirus disease 2019 (COVID-19) in hemodialysis facilities.

Coronavirus disease 2019 (COVID-19) is a highly contagious viral disease that is caused by the novel virus Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). COVID-19 has become pandemic since December 2019, when the first case developed in Wuhan, China. Patients receiving hemodialysis are more vulnerable to viral transmission because their immune functions are impaired and they receive treatment within a narrow space. Calling on previous experience with Middle East Respiratory Syndrome during the 2015 outbreak, the joint committee of the Korean Society of Nephrology and the Korean Society of Dialysis Therapy quickly formed a COVID-19 task force team to develop a manual before the first index case was diagnosed in the hemodialysis unit. This special article introduces clinical practice guidelines to prevent secondary transmission of COVID-19 within hemodialysis facilities, which were developed to protect patients, healthcare workers, and caregivers from this highly transmissible virus. The areas of infection control covered by these guidelines include standard precautions, performing dialysis therapy for confirmed or suspected cases, performing cohort isolation for contact patients, and disease monitoring and contact surveillance. We hope these guidelines help healthcare workers and hemodialysis patients around the world cope with the COVID-19 pandemic.

Staff Nurses’ Perception of the Hemodialysis Unit as Practice Environment and Patients’ Perception of Nurse Caring Behaviors and their Level of Satisfaction

Background: Despite the concomitant rise of kidney diseases and hemodialysis services nationwide, the Philippines still lacks research on hemodialysis nursing care quality. Using nursing-sensitive indicators under the Nursing Role Effectiveness Model, this study aimed to describe hemodialysis nurses’ perception of their unit as practice environment; patients’ perception of nurse caring behaviors based on Jean Watson’s 10 Caritas Processes; patients’ level of satisfaction on nursing care; and determine the association between perceived nurse caring behaviors and satisfaction levels.&#x0D; Methodology: This descriptive cross-sectional study purposely selected seven free-standing hemodialysis centers in Metro Manila. Ninety-four nurses were surveyed via complete enumeration using the Practice Environment Scale of Nursing Work Index (PES-NWI) while 345 randomly selected patients answered the Caring Factor Survey-Tagalog (CFS-T) and Patient Satisfaction of Nursing Care Quality Questionnaire-Tagalog (PSNCQQ-T). Pearson’s correlation was used to analyze the gathered data.&#x0D; Results: The study revealed that nurses perceived their respective work unit as a favorable practice environment while hemodialysis patients perceived nurse caring behaviors as practiced to a great extent and their satisfaction with nursing care as very good. The study also revealed a significant positive correlation between the process and outcome indicators (r=0.64, p=&lt;0.0001).&#x0D; Conclusion: The study reflected positive nursing-sensitive indicators in hemodialysis. However, hemodi alysis facilities should improve nurse staffing, spiritual nurse caring behavior, and facilitate a more healing environment while maintaining their current favorable qualities.

Factors influencing the patient education performance of hemodialysis unit nurses

ObjectiveThis study aimed to identify the perceptions, barriers, and facilitators of patient education and factors influencing the performance of patient education among hemodialysis unit nurses. MethodsThis study used a descriptive correlational design in which a total of 262 nurses from 27 hemodialysis facilities in six provinces in the Republic of Korea participated. Self-administered questionnaires were used to identify the perceptions, barriers, facilitators, and performance of patient education. Data were analyzed using a t-test, one-way ANOVA, Pearson’s correlation, and stepwise multiple regression. ResultsFactors influencing patient education performance were nurses’ total clinical experience, perceptions, working experience in a hemodialysis unit, facilitators, number of nurses in the hemodialysis unit, and barriers. These variables accounted for 37.2 % of the variance in the final model. ConclusionNurses’ performance in patient education was significantly influenced by perceptions, facilitators, and barriers. Nurses’ total clinical experience, working experience in a hemodialysis unit, and number of nurses in the unit also influenced patient education performance. Practice implicationsA nurse training program should be developed to reinforce nurses’ patient education competency.

P1221THE VOXEL-BASED SPECIFIC REGIONAL ANALYSIS SYSTEM FOR ALZHEIMER’S DISEASE (VSRAD) BY MAGNETIC RESONANCE IMAGING SCAN IN PERITONEAL DIALYSIS (PD) PATIENTS, COMPARED WITH HEMODIALYSIS (HD) PATIENTS WITH ALZHEIMER’S DISEASE

Abstract Background and Aims Japan is currently moving towards an unprecedented aging society and chronic dialysis patients as well. As Aging population increases, in chronic dialysis patients as well, Mild cognitive impairment (MCI) and dementia cases are on the rise, and increasing burden on existing dialysis facilities. Our hospital has not only the outpatient department of Internal medicine, but also peritoneal and hemodialysis facilities, and Regional Dementia Center. We have accepted chronic dialysis patients, in our medical center and elderly ward, who are usually unable to maintain hospitalization or outpatient maintenance dialysis with cognitive impairment by collaborating with psychiatrists. Rehabilitation was instructed in all the patients by physiotherapists for the purpose of improving ADL. We investigated the current status of our PD patients, HD patients who experienced PD, and HD patients with Alzheimer’s type dementia (AZ). Method A: Nine cases of hemodialysis (HD), who subsided peritoneal dialysis (PD), (including 2 DM cases:22%), Average age 75.4± 9.1 years old, 4 males, 5 females; average dialysis duration 322± 126 M:(HD-PD). B: Thirteen cases of PD, (including DM 3 cases: 23%), 6 males, 7 females; average age 71.6± 10.9 years old, average dialysis duration 286± 139 M:(PD). C: Fifteen cases of hemodialysis (HD) who was diagnosed as AZ (including 8 DM cases: 53%), Average age 76.6± 8.5 years old, 9 males, 6 females; average dialysis duration 53.9± 66.1 M:(HD-AD). We examined blood pressure (BP), and laboratory data. Analysis of the body fluid status; extracellular water/ total body water (ECW/TBW; IN BODYR), Skeletal muscle index (SMI) was performed. Average Z-score points of MRI (assessment of hippocampus atrophy evaluation) and total brain atrophy was investigated by VSRAD. Results About 13 PD and 9 HD who experienced PD cases, there were 4 MCI cases, and no Alzheimer type dementia, or cerebrovascular dementia. About PD cases, average Hasegawa’s formula expression average (HDS-R): 28.8±1.8, average BMI: 22.3± 2.9, average skeletal muscle mass index (SMI): 6.6± 1.0 kg/m2, average Lipid ratio (%): 24.3± 7.8, average Z-score points of MRI : 1.02± 0.5 and total Brain atrophy was 4.3± 2.7 %. About HD-PD cases, one case had slight cerebrovascular dementia, and 2 cases are MCI; average Z-score was 1.2± 1.0 total Brain atrophy was 3.8± 1.4 %. Average SMI: 5.9± 1.3 kg/m2, average BMI:20.7± 3.8, average Lipid ratio (%): 21.9± 8.1. Two cases died of malnutrition and sepsis. About 15 HD patients with Alzheimer type (AZ-type) dementia, average HDS-R: 10.4± 9.3, average BMI: 18.9± 2.2, average SMI: 4.7± 1.0 kg/m2, average Lipid ratio (%): 23.5± 6.1, average Z-score points of MRI: 2.6± 0.9 and total Brain atrophy was 9.3± 5.7 %. One-year survival rate of HD patients with AZ was about 20% after transferring to our hospital. The data of SMI and LP% was relatively reserved in PD and HD-PD, but significantly low from that of HD-AZ, and therefore it might not be effective in rehabilitation because of muscle weakness in HD-AZ. There were almost no HD cases with overhydration (ECW/TBW). Almost all dialysis patients had simple some old cerebral infarctions by simple CT examination. Conclusion By CT and MRI image findings, almost PD cases had old low-density area in CT and no acute cerebral infarctions in MRI. The hippocampal atrophy and total brain atrophy of PD and HD-PD was extremely mild, but was very severe in HD-AZ. There were no cases with severe cognitive impairment between PD and HD-PD even if undergoing for over ten years.

Silent COVID-19 in haemodialysis facilities in Cantabria, Spain: an ecological study.

Silent COVID-19 in haemodialysis facilities in Cantabria, Spain: an ecological study.

Hemodialysis with Cohort Isolation to Prevent Secondary Transmission during a COVID-19 Outbreak in Korea.

Health care-associated infections during previous coronavirus epidemics involving severe acute respiratory syndrome and Middle East respiratory syndrome resulted from human-to-human transmission in hemodialysis (HD) facilities. The effect of a strategy of HD with cohort isolation-separate dialysis sessions for close contacts of patients with confirmed coronavirus disease 2019 (COVID-19)-on the prevention of secondary transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in HD units is unknown. Our multicenter cohort study of an HD with cohort isolation strategy enrolled close contacts of patients with confirmed COVID-19, including patients on HD and health care workers in HD units. Close contacts had been identified by epidemiologic investigation and tested negative on an immediate screening test for SARS-CoV-2. As of March 14, 11 patients on HD and 7 health care workers from 11 HD centers were diagnosed as having COVID-19. The immediate screening test was performed in 306 people, and among them, 302 close contacts with negative test results were enrolled. HD with cohort isolation was performed among all close contacts for a median of 14 days in seven centers. During cohort isolation, nine patients showed symptoms but tested negative for SARS-CoV-2. Two health care workers in the HD units (0.66% of the total group) were diagnosed at the termination test for SARS-CoV-2. The transmission of COVID-19 can be controlled without closure of HD centers by implementing preemptive activities, including early detection with rapid testing, cohort isolation, collaboration between institutions, and continuous monitoring of infection. Our strategy and experience may provide helpful guidance for circumstances involving the rapid spread of infectious diseases such as COVID-19.

P1107CENTRALIZED CONTROL OF HEMODIALYSIS PROCEDURES AND CORRECTION OF CKD COMPLICATIONS WITH BI TOOLS

Abstract Background and Aims Life expectancy of patients with terminal stage of chronic kidney disease depends on the quality of dialysis therapy and timely and adequate correction of dialysis complications. The goal of this work is to improve the treatment quality for dialysis patients in a setting of multi-facility hospital by employing of Business intelligence (BI) tools for centralized control of diagnostic and treatment process. Method We have created a system for centralized control of patients’ condition, using Microsoft Power BI platform. This system allows to analyze the process of hemodialysis procedure as well as treatment of hypertension, anemia and mineral bone disorder. The system generates various reports that may include parameters of a specific patient, single clinic, or multi-facility hospital for the period from arbitrary date to the day, previous to the report generation date. The effect of system usage was assessed on 288 patients from 30 hemodialysis facilities of “Nefrosovet” private organization, for the period of 6 month. Results Before deployment of the system, target value of Kt/V (1.4) was reached or exceeded in 49% of hemodialysis procedures, median duration of hemodialysis procedure was 227±18 minutes (mean total duration per week - 683 minutes). As the result of usage of centralized control and prescription correction system, target values of Kt/V was reached or exceeded in 65% of hemodialysis procedures, median duration of hemodialysis procedure increased to 238±11 minutes (mean total duration per week - 714 minutes). Before the start of the study, hypotensive episodes were registered in 34% of hemodialysis procedures, and hypertensive episodes were registered in 22% of hemodialysis procedures. As the result of centralized control of hemodialysis procedures, number of procedures with hypotensive episodes reduced to 28%, and number of procedures with hypertensive episodes reduced to 17%. Number of patients with blood hemoglobin value in target range of 100-120 g/l, increased from 1617 patients (56%) to 2051 patients (71%). Number of patients with blood ferritin value in target range of values, increased from 1013 patients (35%) to 1386 patients (48%). Number of patients with TSAT value in target range of values, increased from 873 patients (30%) to 1097 patients (38%). We have also noticed an increase in number of patients with target values of calcium and phosphorus metabolism parameters: calcium corrected for albumin – from 1992 (69%) to 2165 (75%) patients, phosphorus – from 693 (24%) to 982 (34%) patients, intact parathyroid hormone (iPTH) – from 635 (22%) to 837 (29%) patients. Conclusion The usage of BI based centralized patients’ condition control system allows to improve adequacy of dialysis therapy and quality of CKD complications correction in dialysis patients.

COVID-19 and Impending Shortage of Haemodialysis Facilities due to the Rising Incidence of Acute Kidney Injury Requiring Renal Replacement Therapy.

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P1532PARATHYROID HORMONE SERUM LEVELS AND MORTALITY AMONG HEMODIALYSIS PATIENTS IN THE GULF COOPERATION COUNCIL COUNTRIES: RESULTS FROM THE DOPPS (2012-2018)

Abstract Background and Aims The prospective Dialysis Outcomes and Practice Patterns Study (DOPPS) has collected data since 2012 in all six Gulf cooperation council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, United Arab Emirates). Here, we report the relationship of PTH with mortality in this largest GCC hemodialysis patient cohort studied to date. Method Data were from randomly-selected national samples of hemodialysis facilities in GCC DOPPS phases 5 and 6 (2012-2018). PTH descriptive findings and case-mix adjusted PTH/mortality Cox regression analyses were based on 1825 and 1422 randomly-selected hemodialysis patients, respectively. Results Mean patient age was 55 years (median dialysis vintage = 2.1 years). Median PTH ranged from 259 pg/mL (UAE) to 437 pg/mL (Kuwait), with 22% having PTH &amp;lt;150 pg/mL, 24% (PTH 150-300), 34% (PTH 301-700), and 20% (PTH &amp;gt;700) pg/mL. Patients with PTH &amp;gt;700 pg/mL were younger, on dialysis longer, less likely to be diabetic, have urine&amp;gt;200 mL/day, prescribed 3.5 mEq/L dialysate calcium, had higher mean serum creatinine and phosphorus levels, lower white blood cell counts, and more likely to be prescribed cinacalcet, phosphate binders, or IV vitamin D. A “U-shaped” PTH/mortality relationship was observed with &amp;gt;2-fold and 1.5 fold higher adjusted HR of death at PTH&amp;gt;700 pg/mL and &amp;lt;300 pg/mL, respectively, compared to PTH 301-450 pg/mL. Conclusion Secondary hyperparathyroidism is highly prevalent among GCC hemodialysis patients, with a strong U-shaped PTH/mortality relationship seen at PTH &amp;lt;300 and &amp;gt;450 pg/mL. Future studies are encouraged for further understanding this PTH/mortality pattern in relationship to unique aspects of the GCC hemodialysis population.

Aggressive Quarantine Measures Reduce the High Morbidity of COVID-19 in Patients on Maintenance Hemodialysis and Medical Staff of Hemodialysis Facilities in Wuhan, China

Introduction: Maintenance hemodialysis (MHD) patients are highly vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Medical staff of dialysis facilities without sufficient biosecurity protection are susceptible once exposed to asymptomatic coronavirus disease 2019 (COVID-19) patients. This study evaluated the epidemiological characteristics of COVID-19 in all MHD patients and medical staff of dialysis facilities in Wuhan, China. Methods: We collected COVID-19 morbidity and mortality data from MHD patients and medical staff from 52 hemodialysis centers in Wuhan. Then, we analyzed the symptoms and signs of patients and staff in our hospital (Tongji Hospital in Wuhan), and chest CT, SARS-CoV-2 nucleic acid detection and laboratory tests were performed. After aggressive quarantine of the COVID-19 patients, we followed up on the prognosis of them. Results: We analyzed the hemodialysis data from Wuhan and found that 10% of MHD patients and 6.0% of medical staff were suspected of COVID-19. Further detection of SARS-CoV-2 nucleic acid showed that 1.7% of MHD patients and 2.9% of medical staff were confirmed as having COVID-19. In our facility, 18.9% (46/244) of patients and 9.5% (6/63) of medical staff were suspected of COVID-19. Among them, 2.9% (7/244) of MHD patients and 4.8% (3/63) of medical staff tested positive for SARS-CoV-2 were confirmed as having COVID-19. Interestingly, 87.0% of MHD patients suspected of COVID-19 did not have obvious symptoms, but the CT screening showed features of viral pneumonia. There were no significant differences in symptoms, CT findings, comorbidity and laboratory findings of SARS-CoV-2 nucleic-acid-positive and -negative patients. We followed up these patients and found that 57 patients with COVID-19 died (COVID-19 mortality 8.9%). Two patients from our dialysis center with COVID-19 (mortality 4.3%) died. No new infections occurred in our dialysis center after aggressive quarantine was initiated. Conclusions: The SARS-CoV-2 infection rates in MHD patients and medical staff in dialysis facilities were both high in Wuhan. Frequent chest CT and SARS-CoV-2 nucleic acid detection were needed to screen COVID-19 patients in dialysis facilities. Through the lessons of this experience on the aggressive diagnosis and quarantine measures of COVID-19 patients, we hope medical staff avoid more infections in serious epidemic areas.

Viral hepatitis in patients on hemodialysis

Hepatitis B and hepatitis C (HCV) prevalence are higher in people on hemodialysis (HD) than the general population. Through implementation of prevention interventions including vaccines, serologic screening, and post-exposure management, transmissions linked to HD have decreased dramatically. In this manuscript, we review epidemiology of viral hepatitis, summarize current screening and vaccine recommendations, and appraise the available data about efforts to decrease incidence within HD facilities, including isolation of people with viral hepatitis within HD units. Also included is a discussion of the highly effective all-oral HCV treatment options and treatment for HCV in people awaiting kidney transplant.

Delivering Safe and Effective Hemodialysis in Patients with Suspected or Confirmed COVID-19 Infection: A Single-Center Perspective from Italy.

New “Severe Acute Respiratory Syndrome Coronavirus 2” (SARS-CoV-2) is responsible for a clinical entity named Coronavirus Disease 2109 (COVID-19) by the World Health Orgazination, which is now a pandemic (1). In Europe, Italy was the first, and so far the largest, epicenter of the epidemic. It is now clear that many asymptomatic and paucisymptomatic patients went undetected, causing significant diffusion of the disease. Asymptomatic infections are common: among 634 confirmed patients on board the “Diamond Princess” cruise ship, 306 were symptomatic and 328 asymptomatic at the time of testing (2). It is now clear that when a patient with atypical severe pneumonia was diagnosed as COVID-19 in a small city, Codogno, in a previously healthy 38-year-old man, on February 20, 2020, more patients with undetected COVID-19 were present in Northern Italy. In addition to the cluster around Codogno, about 50 km south of Milan, which was promptly put under strict lockdown, two additional relevant clusters emerged near the cities of Bergamo and Brescia. The delay in enforcing a lockdown in the latter areas is probably one of the leading causes of the more severe outbreak now affecting these provinces. Extensive testing in the initial phase of disease diffusion was adopted in the Italian Veneto area, resulting in better containment of new cases. A nationwide lockdown measure was passed by the Italian government when Northern Italy, which has the highest concentration of well organized hospitals in the country, started showing signs of difficulty handling the rapid increase of patients in need of treatment in intensive care units (ICUs). A comparison of Chinese and Italian data on COVID-19 may be of interest to other countries where the disease is now spreading. The Chinese Center for Disease Control and Prevention described the characteristics of a large cohort of COVID-19 patients (3), showing that …

Lessons from the Experience in Wuhan to Reduce Risk of COVID-19 Infection in Patients Undergoing Long-Term Hemodialysis.

Since December 2019, an outbreak of new coronavirus disease (coronavirus disease 2019 [COVID-19]) has developed into a world pandemic ([1][1]). The city of Wuhan in China, as one of the most seriously affected areas, is now out of the woods ([2][2]), and the aggressive quarantine performed by the

Management of Hemodialysis Patients with Suspected or Confirmed COVID-19 Infection: Perspective of Two Nephrologists in the United States.

The coronavirus disease 2019 (COVID-19) pandemic is unprecedented and information about the severe acute respiratory syndrome coronavirus 2 is evolving rapidly. New York is one of the epicenters of the COVID-19 outbreak in the United States, reporting >1000 confirmed cases as of March 17, 2020, and cases are escalating exponentially. The majority of cases are in Westchester County ( n =220) and New York City (NYC; n =463), which includes Bronx (1). The local index patient case was a Westchester man who became ill on February 22, was not associated with a recent travel exposure to a country on the watch list (China, Iran, South Korea, and Italy), or known to have had direct contact with a COVID-19–confirmed patient. At the present time it is estimated that community-wide transmission accounts for 87% of confirmed cases. Nephrologists in the Bronx have been handicapped in managing patients with ESKD during the early weeks of the COVID-19 pandemic due to the limitations of available rapid testing for severe acute respiratory syndrome coronavirus 2. Montefiore Medical Center, located in the north Bronx in close proximity to Westchester, has been one of the main tertiary care hospitals in NYC caring for persons under investigation (PUIs) and for COVID-19–confirmed patients. Our nephrology division’s clinical faculty care for approximately 850 patients with ESKD (approximately 800 on hemodialysis and approximately 50 on peritoneal dialysis) in 12 outpatient hemodialysis facilities (two Fresenius and 10 DaVita facilities) in the Bronx. We report our experience with caring for the ESKD population and patients who are hospitalized with AKI in the Bronx during the first 3 weeks of the local NYC COVID-19 pandemic. Strategies proposed for the prevention and management of COVID-19 transmission for patients with ESKD in the outpatient dialysis facilities have been dynamic. The American Society of Nephrology’s (ASN’s) Nephrologists Transforming …

SUN-184 Database Construction for Hemodialysis Patients in Sichuan Province

The incidence of hemodialysis(HD) is escalating dramatically in recent years, which brings about great challenge and also opportunities for Sichuan Quality Control Center of Renal Disease. In order to acquire general information, patient distribution, medical staff, medical equipments and the principle clinical indexes of HD patients, basing on previous experience in software designing, we initiated a provincial renal database, providing free HD software for the whole province. The provincial database was a web-based database, which was set up with free connections to the HD software. In order to help dialysis center in Sichuan. We provided a free software (Jiangsu Huibang Information Technology Co., Ltd.), which could pack the data and upload to the provincial database. We also provide a connection protocol for other HD software that was already installed in HD facilities. The provincial database did not open manually input function in order to reduce the tasks for HD staff. The database was set up in May 2018. The free HD software was open for application from May 2018. Survey and visit interview was carried out to help setting up the database. There were 171 HD centers (around 1/2 of HD centers in Sichuan Province) completing the installation of free HD software by April 2019, among which, 77 HD centers begun to upload data to provincial database. There were 11583 HD patients in the database, accounting for about 1/3 of the HD patients in the whole province. The mean age was 55 years for the reported patients with a female proportion of 41.46%. The proportion of HD patients within treatment target for hemoglobin, serum calcium level, serum phosphorus level and serum albumin was 37%, 52% and 58% and 84% in year 2018. A new strategy for setting up a provincial database from providing software in dialysis centers is an efficient way, which is not only good for dialysis quality control, but also is important for registry based studies.

SUN-186 ORAL DISORDERS IN PATIENTS ON MAINTENANCE DIALYSIS IN CAMEROON: A TWO-CENTER STUDY

There is little attention to oral health in patients on maintenance hemodialysis (MHD) despite the contribution of some oral pathologies like periodontitis to chronic inflammation, malnutrition and adverse cardiovascular events. (Palmer et al, 2015). The aim of this study was to review oral lesions during chronic hemodialysis. This study was a descriptive cross-sectional study, conducted from January to march 2017 in two public hemodialysis facilities in Cameroon (Yaoundé and Ebolowa). We clinically screened all consenting patients on MHD for at least 6 months. Patients with complete edentulism were excluded. The research team included two dental surgeons and a nephrologist. Data was managed with the aid of the SPSS version 18.0 software. A value of p< 0.005 was considered significant. The study was approved by the ethics board of the different hospitals. In all, we included 200 patients (62.5% males). The mean age was 47±16 years (20-76). The median dialysis vintage was 23 months (6-156). About 7% (n=14) were tobacco smokers, 26 % (n=52) were diabetes, and 7% (n=14) were HIV positive. About 46% (n=68) of participants had never had a dental consultation, and 49.5% (n=99) brushed their teeth once daily. The prevalence of oral disorders was 92% (n=184); 114 (57%) had halitosis, and 105 (52.5%) had xerostomia. Spontaneous gingival bleeding (11%, n=22), mucosal ulcers (11.5%, n= 23), oral candidiasis (9.5%, n= 19) were the main mucosal lesions. Of the 80 (40%) participants with periodontitis, 41(52.5%) were moderate to severe. The prevalence of dental lesions was 28% (n=56) with enamel hypoplasia (57.1%, n=32), dental caries (32.1%, n=18), dental attrition (23.2%, n=13) and dental erosion (19.6%, n=11) being the lesions observed. Smoking (p=0.034), HIV infection (p=0.000) and dialysis duration >one year (p=0.001) were associated with mucosal disorders, whereas age > 40 years (0.046), and inadequate teeth brushing were associated with both periodontitis and dental disorders (p=0.005). In addition, periodontitis was associated with a history of diabetes (p=0.048) and smoking (p=0.034). Oral disorders are common in patients on maintenance hemodialysis in Cameroon suggesting a need to include active dental care in this population.

Effect of patient- and center-level characteristics on uptake of home dialysis in Australia and New Zealand: a multicenter registry analysis.

Home-based dialysis therapies, home hemodialysis (HHD) and peritoneal dialysis (PD) are underutilized in many countries and significant variation in the uptake of home dialysis exists across dialysis centers. This study aimed to evaluate the patient- and center-level characteristics associated with uptake of home dialysis. The Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry was used to include incident dialysis patients in Australia and New Zealand from 1997 to 2017. Uptake of home dialysis was defined as any HHD or PD treatment reported to ANZDATA within 6 months of dialysis initiation. Characteristics associated with home dialysis uptake were evaluated using mixed effects logistic regression models with patient- and center-level covariates, era as a fixed effect and dialysis center as a random effect. Overall, 54 773 patients were included. Uptake of home-based dialysis was reported in 24 399 (45%) patients but varied between 0 and 87% across the 76 centers. Patient-level factors associated with lower uptake included male sex, ethnicity (particularly indigenous peoples), older age, presence of comorbidities, late referral to a nephrology service, remote residence and obesity. Center-level predictors of lower uptake included small center size, smaller proportion of patients with permanent access at dialysis initiation and lower weekly facility hemodialysis hours. The variation in odds of home dialysis uptake across centers increased by 3% after adjusting for the era and patient-level characteristics but decreased by 24% after adjusting for center-level characteristics. Center-specific factors are associated with the variation in uptake of home dialysis across centers in Australia and New Zealand.