Hemodialysis Therapy Research Articles

MO250: COVID-19 Associated Collapsing Variant of Focal Segmental Glomerulosclerosis: A Case Series of 7 Patients from a Single UK Centre

BACKGROUND AND AIMSCases of collapsing glomerulopathy in association with COVID-19 infection have been reported worldwide, frequently referred to as COVAN (COVID-19 Associated Nephropathy). Affected patients are almost exclusively of Black ethnicity, likely associated with APOL-1 renal risk variants. There remains a paucity of data on patient outcomes, however, and it is unclear how the natural history of this disease may vary from HIV-associated nephropathy (HIVAN) and other non-viral causes of collapsing FSGS.Here, we present a case series of seven patients with presumed COVAN from a single tertiary UK renal centre; highlighting patient demography, biopsy findings, clinical management and short-term renal outcomes.METHODWe identified all adult patients presenting to our centre with nephrotic syndrome and a renal biopsy demonstrating collapsing glomerulopathy, in association with a positive COVID-19 PCR swab result. Detailed case note reviews were undertaken using electronic health records to extract data relevant to patient demography, co-morbidities, COVID -19 symptoms, renal biopsy findings, treatment and biochemical parameters, both at the time of presentation and during follow-up at 1, 3, 6 and 12 months respectively (where available).RESULTSIn total, we identified seven patients with presumed COVAN. Three of the seven patients were male, median age was 60 years (range 25–80 years). Six of the seven patients were of Black ethnicity and one patient was of South Asian ethnicity (renal transplant recipient with donor ethnicity unknown). All seven patients had a background of hypertension, 5/7 had known chronic kidney disease (CKD), 5/7 had type 2 diabetes mellitus (T2DM) and 4/7 were obese (BMI > 30). In the vast majority of cases, associated COVID-19 symptoms were mild.All patients had profound nephrotic syndrome at the time of renal biopsy, with median urine ACR 1085 mg/mmol (range 682–1380 mg/mmol) and median serum albumin 15 g/L (range 8–20 g/L). Two of seven patients had mild AKI (stage 1) and 5/7 patients had severe AKI (stage 3), with 3 of these patients receiving acute haemodialysis therapy.Management of glomerulopathy was supportive in all cases, including diuresis and anticoagulation (two patients received a short course of oral dexamethasone for their COVID-19 symptoms). ACE inhibitors/angiotensin receptor blockers were re-introduced in two patients and newly commenced in two further patients during follow-up.At 6 months follow-up, one patient remained dialysis dependant and one patient had ongoing decline in renal function (renal transplant recipient); all other patients achieved at least partial remission, with > 50% reduction in urine ACR and some (but not complete) recovery in renal function (Fig. 1).There were no viral particles identified on direct examination of renal biopsy specimens, but 4/7 biopsies exhibited tubulo-reticular inclusions, suggesting an interferon-driven systemic inflammatory process.CONCLUSIONIn this case series of seven COVAN cases from a single tertiary UK centre, we noted that in keeping with reports from North America, Black ethnicity patients were disproportionately affected. Partial remission was achieved in most of our cases with supportive treatment only; however, ongoing monitoring of this cohort is required to better understand longer-term patient outcomes. Testing for APOL-1 gene mutations and molecular testing of biopsy samples for this cohort is also ongoing to facilitate better insights into pathophysiology and risk factors associated with this novel disease.

MO801: Use of the Anemia Control Model is Associated With Improved Hemoglobin Target Achievement, as Well as Lower Rates of Inappropriate ESA USE And Severe Anemia Among Dialysis Patients

Abstract BACKGROUND AND AIMS Renal anemia management remains challenging for the nephrologist. Chronic inflammation, EPO resistance, uremia, malnutrition, iron deficiency, dialysis modalities, bleeding, infections, hydration status all interfere with erythropoiesis and erythrocytes half-life. Since 2013, >100 clinics in the FMC Nephrocare network have been using the Anemia Control Model (ACM), an artificial-intelligence based, certified medical device, decision support tool, to assist nephrologists in optimizing the monthly ESA and iron dose based on the specific characteristics of the patient and the amount of ESA dose already taken in the last 90 days. Based on this widespread experience, we sought to evaluate the real-world effectiveness of the use of ACM to facilitate hemoglobin target achievement among dialysis patients. METHOD In this historical cohort study, we analyzed electronic health records (EHR) of adult patients receiving in-center hemodialysis therapy in Fresenius Medical Care European dialysis clinics between 1 January 2015 and 31 December 2018 registered in the European Clinical Database (EuCliD®). We compared the rate of target achievement between patients treated with the ESA dose, suggested by ACM, against three control groups of patients treated in clinics without ACM and stratified by different target achievement rates for hemoglobin (Hb in the range of 10–12 g/dL or > 12 g/dL without ESA administration) (Fig. 1). To decrease indication bias, we matched patients belonging to the four comparison groups by a propensity-score assessing the likelihood of receiving the same dose suggested by ACM based on patients’ characteristics (i.e. demographic, comorbidities, anemia-related biomarkers and dialysis vintage). Centers where Hb target achievement < 70% were classified as Tier 1 centers; centers where Hb target achievement was between 70% and 80% were classified as Tier 2 centers, and centers where Hb target achievement was >80% were classified as Tier 3 centers. Performance was evaluated in the month before the index date for all the patients in any given clinic. For each matched group, the index date corresponds to the date of dose suggestion (ACM group) or to the last Hb assessment date (for all matched patients belonging to other three control groups). The study endpoints were Hb target achievement, inappropriate ESA administration (ESA administration despite Hb > 12 g/dL) and severe anemia (Hb < 9 g/dL). All endpoints have been evaluated in the month following the index date. RESULTS After matching, we obtained four groups accounting for 8 5512 patient-months each. There were negligible differences in patients’ characteristics across the four matched groups (Table 1). In the ACM group, the Hb target achievement rate was 87.52/100 patient-months 95% confidence interval (95% CI): 86.89–88.15], inappropriate ESA use rate was 4.13/100 patient-months (95% CI: 3.99–4.27) and the incidence of severe anemia was 2.14/100 patient-months (95% CI: 2.04–2.24); the Hb target achievement rate ratio (95% CI) was 1.18 (1.17–1.2), 1.08 (1.07–1.09), 1.01 (1–1.02) for ACM versus Tier 1 centers, ACM versus Tier 2 centers and ACM versus Tier 3 centers, respectively. Rate ratio for inappropriate ESA administration were 0.37 (0.36–0.39), 0.49 (0.47–0.51), 0.66 (0.64–0.69) for ACM versus Tier 1 centers, ACM versus Tier 2 centers and ACM versus Tier 3 centers, respectively. The risk ratios for severe anemia were 0.43 (0.41–0.46), 0.65 (0.62–0.7), 0.95 (0.89–1.02) for ACM versus Tier 1 centers, ACM versus Tier 2 centers and ACM versus Tier 3 centers, respectively. CONCLUSION In this matched historical cohort study, we observed an increased hemoglobin target achievement rate, decreased inappropriate ESA usage and a decreased incidence of severe anemia among patients treated according to ACM suggestions. Target achievement rate among patients treated according to ACM suggestions was 87%. The magnitude of the effect in favor of ACM was larger in centers with a lower target achievement rate.

MO537: Effects of COVID-19 on Mineral and Bone Disease Outcomes in Hemodialysis Patients: A Retrospective Study From Qatar

BACKGROUND AND AIMSManagement of end-stage renal disease (ESRD) on dialysis has been challenging during the COVID19 epidemic. Staff illness led to a shortage of manpower that affected patient care. We established a specialty nursing management for mineral and bone disease (MBD) in the ambulatory dialysis service in Qatar in 2016. We are presenting a retrospective study about the effects of the COVID-19 epidemic on MBD outcomes in ambulatory dialysis patients in the State of Qatar.METHODA retrospective cohort study in all adult patients with ESRD on chronic hemodialysis therapy (>1 month) in ambulatory dialysis clinics in the State of Qatar. Data collected were patient's characteristics, laboratory and diagnostic investigations for each patient through our electronic data system (nationwide). We focused on parathyroid hormone (PTH), calcium and phosphorus levels done routinely on monthly basis. The study duration was 31 months (January 2019–September 2021).RESULTSWe included 623 patients. Age was 56 ± 11 years old and 61% were male. The main comorbidities were diabetes mellitus (63%), hypertension (92%) and cardiovascular disease (22%). The percentage of patients with PTH levels within targets ranged from 63 to 74%. It was stable before and during the first wave of COVID-19 in Qatar (March–June 2020) then dropped afterward briefly for 3 months (October–December 2020) (74% versus 63% respectively P = 0.0003). PTH level in target improved afterward and also during the second wave of COVID-19 (February–May 2021) but then dropped again for 3 months (July–September 2021) [72% versus 66% respectively P = 0.02 (graph below with details)]. Patients with phosphorus and calcium in the target were mostly stable [79% (77–83%) and 76% (74–79%), respectively].CONCLUSIONOur retrospective study regarding the effect of the COVID-19 epidemic on MBD outcomes in hemodialysis (HD) showed a temporary drop in PTH level in the target without affecting calcium and phosphorus targets. The delayed drop after COVID-19 waves in PTH in target could be related to the routine quarterly measurement of PTH. We think that establishing a solid management system for MBD led to reasonably stable outcomes despite all challenges during the COVID-19 epidemic.

FC087: Effectiveness of Covid-19 Vaccines in a Large European Haemodialysis Cohort

BACKGROUND AND AIMSTo date, no large-scale study has evaluated the effectiveness of COVID-19 vaccines in hemodialysis patients. We sought to evaluate the effectiveness of vaccines against SARS-CoV-2 infections and death in haemodialysis patients registered in the Fresenius Medical Care (FMC) Nephrocare network.METHODIn this historical, 1:1 matched cohort study, we analysed electronic health records (EHR) of individuals receiving in-center haemodialysis therapy in FMC European dialysis clinics from 1 December 2020, to 31 May 2021 (study period). For each vaccinated patient, an unvaccinated patient was selected among patients registered in the same country and attending a dialysis session within +/–3 days from the vaccination date. Matching without replacement was based on demographics, clinical characteristics, past COVID-19 infections and a risk score representing the local (dialysis centre) background risk of infection at each vaccination date. The infection risk score was calculated from an artificial Intelligence model predicting the risk of COVID-19 outbreak in each clinic over a 2-week prediction horizon. The infection risk score was based on trends in regional COVID-19 epidemic metrics, FMC COVID-19 reporting system and clinical practice patterns. The index date was the date of the first vaccination for the vaccinated and the matching treatment date for the unvaccinated controls. To overcome violation of the proportional hazard assumption, we estimated the effectiveness of the COVID-19 vaccines in preventing infection and mortality rates as 1—hazard ratio estimated from a time-dependent extended Cox regression stratified by country and vaccine type.RESULTSWe included 44 458 patients, 22 229 vaccinated and matched 22 229 unvaccinated. Distribution of covariates was balanced across study arms after matching (Figure 1A). In the effectiveness analysis on mRNA vaccines, we observed 850 SARS-CoV-2 infections and 201 COVID19-related deaths among the 28 110 patients (14 055 vaccinated and 14 055 unvaccinated) during a mean follow up time of 44 ± 40 days. In the effectiveness analysis of viral-vector vaccines, we observed 297 SARS-CoV-2 infections and 64 COVID19-related deaths among 12 888 patients (6444 vaccinated and 6444 unvaccinated) during a mean a follow-up time of 48 ± 32 days (Figure 1B). We observed 18.5/100 patient-year and 8.5/100 patient-year fewer infections and 5.4/100 patient-year and 5.2/100 patient-year fewer COVID-19-related deaths among patients vaccinated with mRNA and viral-vector vaccines respectively, as compared to matched unvaccinated controls. The effectiveness of COVID-19 vaccines concerning both symptomatic infections and COVID-related death along the follow up period is shown in Figure 2.CONCLUSIONIn this matched, historical cohort study, we observed a strong reduction in both SARS-CoV-2 symptomatic infection and COVID-19-related death among dialysis patients receiving an mRNA vaccine. Despite seemingly less protective against symptomatic infections, we observed similar reduction in COVID-19 mortality rate among patients receiving a viral-carrier vaccine.FIGURE 1A:Forest Plot demonstrating covariate distribution balance between exposure groups. Effect Sizes calculated as Cohen's d or Cromer's Negative coefficient indicates that mean or relative frequency was greater among vaccinated patients. Effect Size 0.12 negligible Effect Size-0.1-0.2: small.FIGURE 1B:Absolute frequency and incidence density (95% confidence intervall of events across exposure groups.FIGURE 2:Effectiveness (1-HR) estimates by vaccine type concerning symptomatic, documented infection and COVID-19 related death. Estimates were obtained from extended, cox regression with time-varying covariate.

MO791: Vascular Access of Incident Hemodialysis Patients with Diabetes Mellitus in Catalonia: Analysis of Data from the Catalan Renal Registry (1997–2020)

Abstract BACKGROUND AND AIMS End-stage kidney disease (ESKD) due to diabetes mellitus (DM) is the main known cause of kidney replacement therapy initiation in Catalonia. To analyse the use and results of vascular access (VA) in incident haemodialysis (HD) patients (pts) with DM types 1 (DM-1) and 2 (DM-2) over time in Catalonia METHOD Data from the Catalan Renal Registry of 14 954 ESKD pts ˃18 years of age starting HD therapy were examined for a 23-year period. RESULTS The characteristics of DM-2 pts (n = 4242) were different compared with DM-1 pts (n = 456) or non-DM pts (n = 10 256) regarding age (69.0 ± 9.8 versus 50.5 ± 14.5 versus 64.2 ± 15.3 years), cardiovascular disease (76.7% versus 60.3% versus 46.5%), overweight (body mass index ≥ 25 kg/m2: 68.4% versus 44.4% versus 50.4%) and statin use (52% versus 41.1% versus 33.8%) (for all comparisons, P < 0.001). Regarding the first VA used for starting HD, no differences were found in the percentage of fistulae AVF (44.7% versus 45.4% versus 46.2%, P = 0.27) but the distribution of tunnelled (40.8% versus 36.5% versus 34.7%) and non-tunnelled (59.2% versus 63.5% versus 65.3%) catheter was significant different in DM-2 pts (P < 0.001). Compared to non-DM pts (reference), the odds ratio for starting HD though an AVF, by using an adjusted multivariate logistic regression analysis, was 0.88 [95% confidence interval (95% CI): 0.67–1.15, P = 0.35) and 0.90 (95% CI: 0.81–0.99, P = 0.04) for DM-1 and DM-2 pts, respectively. By using a multivariate competing risk model, the hazard ratio (HR) of receiving a kidney graft (KG) within 5 years from starting HD, depending on the first VA used to start HD (AVF versus catheter), was: 2.14 (95% CI: 1.98–2.30, P < 0.001) for non-DM pts, 2.32 (95% CI: 1.63–3.30, P < 0.001) for DM-1 pts and 1.95 (95% CI: 1.65–2.30, P < 0.001) for DM-2 pts. Compared with non-DM pts starting HD by AVF (reference), the HR of receiving a KG within 5 years from starting HD though an AVF was 1.02 (95% CI: 0.76–1.37, P = 0.85) for DM-1 pts and 0.46 (95% CI: 0.40–0.53, P < 0.001) for DM-2 pts. Compared with non-DM pts starting HD by catheter (reference), the HR of receiving a KG within 5 years from starting HD through a catheter was 1.11 (95% CI: 0.90–1.38, P = 0.29) for DM-1 pts and 0.42 (95% CI: 0.38–0.47, P < 0.001) for DM-2 pts. The HR of pts’ survival within 5 years from starting HD, by applying a multivariate competing risk model depending on the first VA used to start HD (AVF versus catheter), was: 1.88 (95% CI: 1.76–2.01, P < 0.001) for non-DM pts, 1.58 (95% CI: 1.17–2.15, P = 0.003) for DM-1 pts and 1.54 (95% CI: 1.41–1.68, P < 0.001) for DM-2 pts. Compared with non-DM pts starting HD by AVF (reference), the HR of death within 5 years from starting HD through an AVF was 1.02 (95% CI: 0.83–1.24, P = 0.81) for DM-1 pts and 1.32 (95% CI: 1.23–1.41, P < 0.001) for DM-2 pts. Compared with non-DM pts starting HD with catheter (reference), the HR of death within 5 years from starting HD through a catheter was 1.22 (95% CI: 0.95–1.56, P = 0.12) for DM-1 pts and 1.70 (95% CI: 1.55–1.85, P < 0.001) for DM-2 pts. CONCLUSIONS i) The VA profile of incident DM-2 pts was different compared with DM-1 and non-DM pts due to the different types of catheter used for starting HD. ii) DM-2 pts showed an 11% lower probability of initiating HD through an AVF compared with non-DM pts. iii) Incident DM-1 pts with AVF and DM-2 pts with catheter showed the maximum and minimum probability to receive a KG within 5 years from starting HD, respectively. iv) Incident DM-2 pts with catheter and non-DM pts with AVF showed the maximum and minimum risk of dying within 5 years from starting HD, respectively.

An Optoelectronic Spectral Sensor for Monitoring the Elimination of Uremic Markers with Low and Middle Molecular Weight during Hemodialysis Therapy

An Optoelectronic Spectral Sensor for Monitoring the Elimination of Uremic Markers with Low and Middle Molecular Weight during Hemodialysis Therapy

Mass Transport in High-Flux Hemodialysis: Application of Engineering Principles to Clinical Prescription.

An understanding of the processes underlying mass transfer is paramount for the attainment of adequate solute removal in the dialytic treatment of patients with kidney failure. In this review, engineering principles are applied to characterize the physical mechanisms behind the two major modes of mass transfer during hemodialysis, namely diffusion and convection. The manner in which flow rate, dialyzer geometry, and membrane microstructure affect these processes is discussed, with concepts such as boundary layers, effective membrane diffusivity, and sieving coefficients highlighted as critical considerations. The objective is to improve clinicians' understanding of these concepts as important factors influencing the prescription and delivery of hemodialysis therapy.

Abstract 149: Type Viii Collagen Increases The Risk Of Arteriovenous Fistula Failure In End-stage Kidney Disease Patients

Introduction: The arteriovenous fistula (AVF) is the lifeline for patients with end-stage kidney disease (ESKD) requiring hemodialysis therapy. The mechanism of “arterialization”, by which a vein transforms into an AVF after anastomosis, is one of the most understudied transformative processes in vascular biology despite the urgent need for new interventions to facilitate and accelerate fistula usability to improve the life of these patients. Hypothesis: Dysregulation of type VIII collagen biosynthesis increases the risk for failure in newly created AVFs Methods and Results: We first deciphered the transcriptional transformation of the pre-access vein after arterial anastomosis using paired venous samples from 38 CKD patients undergoing surgeries for two-stage AVF creation. A total of 3,637 transcripts were differentially expressed (DE) between veins and AVFs in pairwise analyses (log2FC ≥ 1 or ≤ -1, FDR <0.05). Gene set enrichment analyses revealed transcriptional activation of genes related to vasculature development, ECM remodeling, SMC migration, and endothelial cell (EC) proliferation and migration. Two hundred and eighty-four DE transcripts belonged to the matrisome family of genes. These included 20 collagens, 52 ECM glycoproteins, 10 proteoglycans, 58 ECM regulators, 27 ECM-affiliated proteins, 26 proteoglycan biosynthetic/modifying enzymes, and 91 secreted factors. Next, we sought to identify the changes in gene expression during the vein to AVF transformation that were relevant to maturation failure. Pairwise differential gene expression analyses conditional to outcome identified 102 DEGs in association with AVF failure (log2FC ≥ 1 or ≤ -1, FDR <0.05). Eight genes in this group increased more in AVFs that failed compared to those that matured. Accumulation of COL8A1 was confirmed around medial SMC by IHC. This finding was further validated using an independent tissue cohort, which demonstrated significantly higher collagen VIII deposition in stenotic areas from resected AVF fragments compared to adjacent non-stenotic tissues. Conclusions: Vascular accumulation of type VIII collagen in the AVF wall after anastomosis strongly increases the risk of failure.

Frailty among hemodialysis patients

Introduction: Hemodialysis patients have physical vulnerability due to the progressive decline of the body's systems. The physical changes in the patients can lead to haemostatics failure, known as frailty syndrome. The frail condition can cause maladaptive psychological responses due to changes that can cause anxiety in patients.Objective: This study aims to determine the prevalence of frailty in hemodialysis patients and to find out the different factor that correlates in frailty patients undergoing hemodialysis therapy.Method: This is a cross-sectional study involving 55 respondents who underwent hemodialysis therapy at the Jember Klinik Hospital. The instruments used in this study were the Edmonton Frail Scale (EFS) and the Hamilton Anxiety Rating Scale. Results: Moderate frailty was found in 23 patients (41.8%), followed by mild frailty in 18 patients (32.7%) and severe frailty in 14 patients (25.5%). In terms of anxiety, 18 patients (32.7%) had severe anxiety, 20 had moderate anxiety (36.4%), 12 (21.8%) had mild anxiety, and the other 7 (12.7%) were not anxious. The statistical analysis shows a significant difference in the average level of anxiety and the frailty status (p<0.001) among the patients. Conclusion: Frailty was highly prevalent in hemodialysis patients and had relations with anxiety and different sociodemographic characteristics of patients. The assessment of frailty should be considered when clinicians intervene and prevent worsening in patients.

Bifunctional Dalteparin/Enoxaparin coated nanosilver formulation to prevent bloodstream infections during hemodialysis

Catheter-related bloodstream infections (CRBSI) are the major concern of patients undergoing hemodialysis. The current study formulates bifunctional low molecular weight heparin (LMWH) coated nanosilver as an effective anticoagulant and antimicrobial/anti-biofilm agent. Nanosilver formulations were prepared using a microwave-assisted green synthesis approach and stabilized with pharmaceutically approved LMWH such as dalteparin (DL) and enoxaparin (EX) along with unfractionated heparin (HP) as a control. The obtained heparinized (HP/DL/EX) nanosilver was monodisperse, and the size ranged between 15 and 25 nm. DL/EX predominantly stabilized the nanosilver by primarily engaging their negatively charged sulfate groups. The obtained DL/EX coated nanosilver are hemocompatible, showed two times increase in their anticoagulation activity, and are highly potent in inhibiting/eradicating both mono- and polymicrobial biofilms. Henceforth, the observed biocompatible and enhanced bifunctional characteristics of DL/EX coated nanosilver can be used to replace the systemic antibiotics and can be an alternative catheter lock solution to prevent CRBSI in hemodialysis therapy.

A simultaneous pancreas-kidney transplantation for type 1 diabetes mellitus after a long-term of receiving hemodialysis renal replacement therapy. Clinical сase

At the present time, a simultaneous pancreas-kidney transplantation (SPKT) is an effective method of treatment for patients on renal replacement therapy by hemodialysis program in the outcome of the terminal stage of diabetic nephropathy. This method of treatment solves several problems: it reduces the severity of intoxication syndrome, contributes to the achievement of euglycemia in most cases, which certainly allows to slow the progression of micro- and macrovascular complications of diabetes. Despite of positive effect of euglycaemia and kidney function normalization, the accumulated metabolic memory legacy of long-term uncompensated diabetes mellitus is realized, which makes a posttransplantational rehabilitation of patients difficult. A duration of hemodialysis therapy is known as a cardiovascular events risk factor, which affects the surgery result and favorable posttransplant period. More often after successful SPKT microvascular diabetic complications are stabilized, but macrovascular diabetic complications, diabetic neuroosteoarthropathy and mineral and bone disease are progressed. That’s why is necessary to perform regular examination after SPKT by a team of specialists, including nephrologist, endocrinologist, cardiologist, ophthalmologist with correction of ongoing therapy. Therefore both the preparation of the patient for transplantation with the earliest possible placement on the waiting list and the post-transplant rehabilitation afterwards are extremely important.

EFFECTIVENESS OF USE DIALIZER REUSE ON UREA REDUCTION RATIO IN HEMODIALYSIS PATIENTS AT KARSA HUSADA BATU HOSPITAL

Chronic Kidney Disease (CKD) is an end-stage disease of the kidneys, the causes are multiple, can cause to uremia and cannot be renewed.Hemodialysis is a therapy for renal kidney disease. One of the appraisal adequacy of hemodialysis therapy is to use the URR (Urea Reduction Ratio) that assessment by measuring urea before and after hemodialysis therapy. Hemodialysis therapy uses a dialyser that can be used repeatedly in the same patient. The use of dialysers at Karsa Husada Batu Hospital can be used up to 7 times reuse. The research objective was to determine the effectiveness of using a reuse dialyzer to URR. This research design uses comparative descriptive appraisal is a difference between reuse to 1,3,5,7 and using a cross-sectional approach. Sampling using purposive sampling with a sample size of 26 respondents. The different test was used Kruskal Wallis by assessing the URR at the dializer in 1,3,5,7 reuse. Significance of 0.802 (p> 0.05) was obtained, which means that there is no significant difference in the URR value of chronic renal disease patients with hemodialysis therapy using dialyzer reuse to 1,3,5,7. For the URR assessment, it has decreased and increased but is still in normal limits. The dializer reuse up to seven can still be said to be effective in accordance with the guidelines for the management of End-Stage Renal Disease. It is hoped that there will be studies investigating the factors that affect the total volume dilation of dialyser reuse.keywords : Hemodialysis, Dialyzer Reuse , Urea Reduction Ratio

SIDE EFFECTS OF HEMODIALYSIS IN CHRONIC KIDNEY DISEASE (CKD) PATIENTS WITH ALOE VERA GEL

Patients with chronic kidney disease or Chronic Kidney Disease (CKD) really need action that can help replace the role of the kidneys in the body. One of the actions that can be taken is hemodialysis therapy, where this therapy is able to replace kidney function by filtering blood using a special machine at an unaffordable cost. However, hemodialysis also has side effects, one of which is skin problems such as xerosis, dry skin or xerosis, which is a skin disorder caused by loss of lipids and natural moisturizing factors in the stratum corneum. Problems that arise as a result of hemodialysis actions, of course, also require treatment such as providing moisturizers for xerotic skin. The method used in this research is a literature review study. Database searches via Pubmed, Science Direct, Elsevier, Jama, and Google Scholar. Based on searches and case study results from 5 articles, the effectiveness of aloe vera gel has been proven to overcome skin problems through research. It has been proven that aloe vera gel can moisturize the skin because aloe vera gel contains water with a water content of 99% and, besides that, it also contains glucomannans, amino acids, lipids, sterols and vitamins. Aloe vera gel is indeed effective for treating skin problems such as dry skin without having to spend a lot of money, so it can minimize cost overruns in patients undergoing hemodialysis therapy on a regular or even long-term basis. Keywords: Chronic Kidney Failure; Hemodialysis; Xerosis; Aloe Vera Gel

Pain, Anxiety, and Depression in Patients Undergoing Chronic Hemodialysis Treatment: A Multicentre Cohort Study

BackgroundPain is a considerable health concern that interferes with hemodialysis treatment outcomes and can lead to a patient developing anxiety and depression. AimsTo examine the perception of pain in patients on chronic hemodialysis therapy, and to analyze the relationship between their pain, anxiety, depression, and sociodemographic data. MethodThe research was conducted using a quantitative, observational, cross-sectional design. The study recruited 138 patients from multicentered hemodialysis units. A battery of questionnaires, including the visual analog scale (VaS) as pain intensity scale, the Hospital Anxiety and Depression Scale (HADS), and an ad hoc sociodemographic data questionnaire, were given to patients to answer during their hemodialysis sessions. A linear regression analysis was conducted to obtain the results. ResultsThe mean of pain to all participants was generally low, as per AVS scale (0-10) it was 3.6 (stanard deviation [SD] = 3.07). Women manifested lower levels of pain than men (p = .015). One in five participants in both sexes suffered from clinical anxiety and one in six participants in both sexes suffered from clinical depression. Women scored higher on both the anxiety (4.8 versus 4.2) and depression scale (6.8 versus 6.5). Those participants who manifested clinical anxiety were younger compared with those who did not (aged 56.8 versus 66.8 years). Finally, older patients (aged 68.5 years) manifested higher levels of depression. ConclusionsThe level of pain perceived by patients undergoing chronic hemodialysis therapy was generally low, especially in women. The study also demonstrated a positive association between levels of pain and anxiety and depression.

Self-acceptance of patients that received hemodialysis

Introduction: Patients undergoing hemodialysis tend to have low self-acceptance; this will impact the willingness to undergo treatment and adherence to hemodialysis therapy to recover. This study aimed to determine the relationship between self-acceptance and compliance in undergoing hemodialysis at A. Yani Islamic Hospital in Surabaya. Methods: The research design is correlational analytic with a cross sectional approach. The population in this study were all patients who underwent hemodialysis at the A. Yani Islamic Hospital, Surabaya, with 80 patients and a sample size of 36 respondents using a simple random sampling technique. The independent variable in this study was self-acceptance, and the dependent variable was adherence to hemodialysis. The research instrument used a questionnaire. Data analysis used the chi-square test with a significant level of α = 0.05. Results: The results showed that most respondents who underwent hemodialysis (52.8%) had low self-acceptance, and most (58.3%) had low adherence. The chi-square test results showed p-value = 0.008, which means p < α, then H0 is rejected, indicating a relationship between self-acceptance and compliance with patients undergoing hemodialysis at the A. Yani Islamic Hospital Surabaya. Self-acceptance is directly proportional to the patient's compliance is undergoing hemodialysis. The higher the patient's self-acceptance caused the higher the patient's compliance in undergoing hemodialysis. Families can provide social support to increase the self-acceptance of patients undergoing hemodialysis. Conclusion: There is a significant relationship between self-acceptance and compliance of patients undergoing hemodialysis at A. Yani Islamic Hospital Surabaya.

Pulmonary hypertension among maintenance hemodialysis patients in Somalia: a hospital-based observational study

BackgroundThis study aims to examine the prevalence and related factors of pulmonary hypertension (PHT) in patients on hemodialysis (HD) at the only referral institution in Somalia. A total of one hundred and forty-three patients who had received regular HD therapy for at least three months and underwent transthoracic echocardiography (TTE) were included in the study. Patients with a systolic pulmonary artery pressure (sPAP) value > 35 mmHg at rest on TTE were considered having PHT. The relationship of TTE parameters, demographic, and clinic characteristics of participants with PHT were evaluated.ResultsThe number of patients with PHT was 73 (51%). The mean age was 54.2 ± 18.4 years. The majority of patients were 65 years of age or older. (n: 46, 32.2%) and 65 (45.5%) were male. Median sPAP was found to be 35 mmHg. Systolic pulmonary artery pressure was positively correlated with right atrium (RA) diameter (r: 0.6, p < 0.001) and negatively correlated with left ventricular ejection fraction (LVEF) (r: − 0.4, p < 0.001). In addition, LVEF, RA diameter, presence of pericardial effusion (PE) were found to be independent predictors of PHT.ConclusionsPulmonary hypertension has a relatively high prevalence in end-stage renal disease (ESRD) patients on regular HD. Besides, the presence of PE and certain right and left heart parameters were independently associated with PHT.

Continuous renal replacement therapy versus intermittent hemodialysis as first modality for renal replacement therapy in severe acute kidney injury: a secondary analysis of AKIKI and IDEAL-ICU studies

BackgroundIntermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT) are the two main RRT modalities in patients with severe acute kidney injury (AKI). Meta-analyses conducted more than 10 years ago did not show survival difference between these two modalities. As the quality of RRT delivery has improved since then, we aimed to reassess whether the choice of IHD or CRRT as first modality affects survival of patients with severe AKI.MethodsThis is a secondary analysis of two multicenter randomized controlled trials (AKIKI and IDEAL-ICU) that compared an early RRT initiation strategy with a delayed one. We included patients allocated to the early strategy in order to emulate a trial where patients would have been randomized to receive either IHD or CRRT within twelve hours after the documentation of severe AKI. We determined each patient’s modality group as the first RRT modality they received. The primary outcome was 60-day overall survival. We used two propensity score methods to balance the differences in baseline characteristics between groups and the primary analysis relied on inverse probability of treatment weighting.ResultsA total of 543 patients were included. Continuous RRT was the first modality in 269 patients and IHD in 274. Patients receiving CRRT had higher cardiovascular and total-SOFA scores. Inverse probability weighting allowed to adequately balance groups on all predefined confounders. The weighted Kaplan–Meier death rate at day 60 was 54·4% in the CRRT group and 46·5% in the IHD group (weighted HR 1·26, 95% CI 1·01–1·60). In a complementary analysis of less severely ill patients (SOFA score: 3–10), receiving IHD was associated with better day 60 survival compared to CRRT (weighted HR 1.82, 95% CI 1·01–3·28; p < 0.01). We found no evidence of a survival difference between the two RRT modalities in more severe patients.ConclusionCompared to IHD, CRRT as first modality seemed to convey no benefit in terms of survival or of kidney recovery and might even have been associated with less favorable outcome in patients with lesser severity of disease. A prospective randomized non-inferiority trial should be implemented to solve the persistent conundrum of the optimal RRT technique.

Biocompatibility of Surface-Modified Membranes for Chronic Hemodialysis Therapy.

Hemodialysis is a life-sustaining therapy for millions of people worldwide. However, despite considerable technical and scientific improvements, results are still not fully satisfactory in terms of morbidity and mortality. The membrane contained in the hemodialyzer is undoubtedly the main determinant of the success and quality of hemodialysis therapy. Membrane properties influence solute removal and the interactions with blood components that define the membrane’s biocompatibility. Bioincompatibility is considered a potential contributor to several uremic complications. Thus, the development of more biocompatible polymers used as hemodialyzer membrane is of utmost importance for improving results and clinical patient outcomes. Many different surface-modified membranes for hemodialysis have been manufactured over recent years by varying approaches in the attempt to minimize blood incompatibility. Their main characteristics and clinical results in hemodialysis patients were reviewed in the present article.

Impella for Optimization in Patients with Renal Failure Requiring Left Ventricular Assisted Device Implantation

<h3>Purpose</h3> Renal failure is often considered as a barrier for Left Ventricular Assist Device (LVAD) implantation as outcomes are worse for patients who need chronic dialysis. Temporary mechanical support like Impella device has been used as a bridge to LVAD; however, the impact of such strategy on postoperative renal function is not well studied. In this study, we assess the impact of Impella support prior to LVAD implant on renal function. <h3>Methods</h3> Institutional IRB approval was obtained for a retrospective review of all patients who underwent LVAD from 2015 to 2020. We identified patients who required surgical Impella (5.0 or 5.5) support prior to LVAD implantation. The primary outcome was a change in renal function pre and post implantation. The secondary outcome included the need for hemodialysis or continuous renal replacement therapy. <h3>Results</h3> A total of 70 patients underwent LVAD implantation with 18.5% (n=13) patients bridged to LVAD with Impella. The average age of patients supported with Impella was 65.8 (24-76). 23% (n=3) of these patients had a normal Cr (creatinine) prior to Impella support and at time of discharge their average Cr was 0.63 mg/dL (0.5-0.81). 76.5% (n=10) patients had an AKI (Acute kidney injury) prior to Impella implantation with an average Cr of 2.5 mg/dL (1.41—4.68) with 5 patients having a diagnosis of chronic kidney disease at baseline. 8 of the 10 patients who had an AKI have achieved significant renal recovery with average Cr improvement of 1.4 mg/dL (0.35-2.35) with 3 achieving complete recovery. Despite a large operation, the other 2 had only a small decline in Cr 0.31 mg/dL (0.24-0.38). No patients required renal replacement therapy during hospitalization or at discharge or long-term hemodialysis. <h3>Conclusion</h3> Pre-implant impella support is associated with improved renal function following LVAD implantation and helped avoid renal replacement therapy. Further prospective studies for perioperative impact of impella support are warranted.

Effect of the Dietary Protein Intake on Urea Reduction Rate in Patients on Maintenance Hemodialysis in Merjan Teaching Hospital

Background: Chronic kidney disease (CKD) constitutes a major health problem worldwide. The mainstay of nutritional treatment in patients undergoing maintenance hemodialysis is the provision of an adequate amount of protein and energy. Objective: The present study aims to assess the correlation of protein consumption with dialysis adequacy in patients on hemodialysis. Materials and Methods: A cross-sectional study was conducted at the Dialysis Unit of Merjan Hospitals, Babil Governorate, Iraq on 64 hemodialysis patients from April to August 2021. The tools used for the data collection were anthropometry, medical information, and 24-h dietary recalls. A descriptive analysis was performed. Results: The food intake was evaluated and compared with the recommended intake. The patients’ average energy intake was 18.7 ± 7.2 kcal/kg/day, which represents 53.4% of the recommended daily energy intake for dialysis patients. About 75% of the consumed energy was provided by carbohydrates, 12.2% was provided by fats, and the rest 14.6 was provided by protein. The average dietary intake of protein was 0.71 ± 0.29 g/kg/day. Only 7.8% of the patients had met the Recommended Dietary Allowance (RDA) of protein intake. In the study sample, the measures of the delivered dose of hemodialysis therapy are directly correlated to the amount of consumed protein per kilogram body weight. But this correlation is only significant for patients who consume 1.2 g/kg body weight or less. Conclusion: The energy and protein intake were significantly low when compared with specific recommendations for individuals in hemodialysis; a dietician has an important role in providing nutritional education to the patients to improve the nutrient intake.