Initial Nephropathy Research Articles

#801 Impact of delayed graft function on cardiovascular events in kidney transplant recipients

Abstract Background and Aims Acute kidney injury (AKI) increases long-term cardiovascular risk in non-transplanted patients. Delayed graft function (DGF) mimics AKI in kidney transplant recipients, yet its impact on their cardiovascular risk remains unclear. Method We investigated the impact of DGF on cardiovascular morbidity and mortality in kidney transplant recipients using data from patients across 17 French centres from the Astre and Divat cohorts. Included patients were aged 18 years or older, transplanted between 2008 and 2022, with follow-up until 31/03/2023. DGF was defined as the need for hemodialysis within the first week following renal transplantation. The primary outcome was the impact of DGF on the occurrence of a cardiovascular event (composite endpoint including cardiovascular death, coronary artery disease, stroke, heart failure), adjusted for conventional cardiovascular risk factors and glomerular filtration rate at 3 months. Analyses were performed using univariate and multivariate Cox models. Results Among the 19, 837 patients transplanted during the inclusion period, 3, 794 experienced DGF (19.1%). In the multivariate Cox model, DGF was strongly associated with cardiovascular risk (adjusted Hazard Ratio [HR] = 1.37, P < .0001), independently of renal function. Other significantly associated variables included age, duration of dialysis, expanded criteria donors, diabetes, dyslipidemia, smoking, initial nephropathy, and various cardiovascular comorbidities. The effect of DGF was predominantly observed in men, patients over 40, and those at lower cardiovascular risk. DGF was associated with independent cardiac outcomes, such as cardiovascular death (HR 1.31), coronaropathy (HR 1.51), heart failure (HR 1.61 and arrhythmia (HR 1.38), but not with stroke (HR 0.99) nor peripheral artery disease (HR 0.97). Conclusion DGF is an independent risk factor for the occurrence of cardiovascular events in kidney transplant recipients. Strategies aimed at minimizing DGF could potentially reduce cardiovascular complications in these patients.

ARTERIAL HYPERTENSION IN CHRONIC HEMODIALYSIS

Objective: High blood pressure is widespread among individuals undergoing hemodialysis and is considered a significant contributor to the elevated cardiovascular mortality observed in this population. The aim of our study was to assess the prevalence of HTN and investigate its contributing factors. Design and method: This is a retrospective descriptive and analytic study conducted within our hemodialysis unit, including 70 patients. For each participant, the following clinical data were collected: age, gender, personal medical history, initial nephropathy, dialysis vintage, and evolution Results: Our study revealed a hypertension (HTN) prevalence of 51,4%. Among them, 63,9% were male, resulting in a sex ratio of 1,76. The mean age was 49.1 years (range: 21-86 years). undetermined nephropathy was the predominant initial nephropathy (39%). The average blood pressure of hypertensive patients was 159 mmHg for systolic (142-189 mmHg). Diabetic patients were more hypertensive with no statistically significant difference. Hypertensive patients exhibited a larger waist circumference, lower hemoglobin levels, and a lower left ventricular ejection fraction (LVEF) with no statistically significant difference. hypertensive patients were more prone to cardio vascular events such Cerebrovascular Accidents (2% of patients), transient ischemic attacks (2% of patients), and coronary artery disease (11% of patients). Conclusions: In summary, our study emphasizes the importance of investigating hypertension and its related factors, aiming to contribute insights for better cardiovascular health management.

HIGH BLOOD PRESSURE IN HEMODIALYSIS: PREVALENCE AND PROGRESSION

Objective: High blood pressure (hypertension) is frequently found in chronic hemodialysis patients. It affects the prognosis by increasing the morbidity and mortality of patients. The objective of our study was to assess the prevalence of hypertension and to study its evolutionary profile in chronic hemodialysis patients at the University Hospital of Béjaia Design and method: This is a three-year retrospective cross-sectional study of 40 patients who have been chronic hemodialysis patients for at least one year and are over 18 years of age. For each patient, we recorded age, sex, initial nephropathy, date of start of hemodialysis, blood pressure balance, fluid status and different treatments prescribed. Results: We included 40 haemodialysis patients: 24 men and 16 women. The average age of our population was 54.37± 15.33 years. The duration of hemodialysis was 08.17± 7.5 years. High blood pressure was found in 67.5%. All of our patients were on antihypertensive therapy at the start of dialysis. After 3 years of evolution, 55% of patients had reached the blood pressure target, 30% had a correct blood pressure without any therapy and 15% had not reached the blood pressure targets despite triple therapy. Blood pressure balance in dialysis patients; Of course, it depends on adherence to treatment and hygienic and dietary rules, but also on effective dialysis and strict control of fluid balance in order to fight against volo-dependent hypertension. Conclusions: The control of hypertension in dialysis patients is essential and must include, in addition to adherence to treatment and dietary rules, adequate dialysis and strict control of dry weight, which must be assessed and adjusted periodically.

Impact of therapeutic education on the choice of renal replacement therapy. Moroccan monocentric experience

Therapeutic patient education (TPE) is gaining importance in the management of patients with chronic kidney disease (CKD). The objective of this study is to assess the interest of TPE in the acquisition of knowledge concerning CKD and renal replacement therapy, as well as the orientation of the patients towards a personalized choice of treatment. Patients with a minimum stage 4 CKD were prospectively included between November 2016 and February 2020. We proposed TPE sessions on CKD and its treatment to all patients. We explained the theoretical part through a slideshow about the definition of end-stage renal disease, its symptoms and the various methods of renal replacement therapy. A “basket” of essential material to illustrate a session of hemodialysis (HD) or peritoneal dialysis (PD) was used to achieve the practical part of the study. Data was collected using two questionnaires: the first one, at the start of the session, included the socio-demographic and clinical characteristics of the patients and evaluated their level of basic knowledge, and the second one, at the end of the session, assessed the evolution of knowledge after TPE, leading to a therapeutic choice. The mean age of the 211 included patients was 55.59 years old (SD=15.47). Male to female ratio was 0.73. The level of education was low in 69% of the cases of whom 23.7% were employees. The glomerular filtration rate (GFR) was between 15 and 30mL/min in 56.8% of the cases. Initial nephropathy was known in 60% of patients while the stage of CKD was unknown in 66.4%. Before TPE, patients with a good level of overall knowledge were around 29%, rising to 73% after TPE. A significant correlation was found between the level of education of the patients and their knowledge score before and after TPE. The choice of renal replacement therapy was taken for PD, TR and HD respectively in 36%, 19% and 11.8% of the cases, while 33.2% asked for time to think. Elderly and/or low educated patients most often remained undecided; moreover those who are young and/or educated prefer TR. During the follow-up period, 46% of patients started renal replacement therapy (36.5% started HD, 8.1% PD and 1.4% KT). The choice made by our patients was respected in 42% of the cases: in all the patients who chose HD; in 36% of those who chose PD, and 19% of those who chose kidney transplantation (KT). The final therapeutic modality was strongly linked to the following parameters: age, GFR and level of education. This study highlighted the insufficient level of patients’ information about CKD and its treatment and allowed the patients to express their choice of their replacement therapy, which is a complicated process that must ­integrate the opinion of the nephrologist and the patient’s preference to lead to an ­optimal organization of the therapeutic modality.

Status Report of Renal Transplant Patients in Niger

Kidney transplantation is the treatment of choice for end-stage chronic kidney disease. It improves quality of life and increases life expectancy. At present, Niger is one of the poorest countries in the world does not practice kidney transplantation; thus, patients continue to be referred to other countries for transplantation. This descriptive cross-sectional study was carried out at the Nephrology Department of the National Hospital Amirou Boubacar Diallo in Niamey, Niger over a 5-month period. It included all patients that had benefited from kidney transplantation with the aim to evaluate patient and graft survival. We identified 25 patients. The male to female ratio was 2:1. The average age was 45.4 years ± 11.1 years. The average age of donors was 36.1 years ± 12.6 years with a clear male predominance (17 males to 8 females); all of them were related-donors with 72% of them being brothers or sisters. The causative nephropathy was undetermined in 80% of patients. Sixty-four percent of patients had their kidney transplant in Maghreb, including 16% in Tunisia. The complications were mostly medical (68%), as 20% were immunologic; 8% infectious; 16% metabolic; 20% cardiovascular, and 4% were related to recurrence of the initial nephropathy. Surgical complications involved 6 patients (24%): 5 were vascular cases and one was a urological case. With a median follow-up of 5 years, the patients' survival was 84%, the graft survival was 56%, and death-censored graft survival was 67%. In Niger, after kidney transplantation, the patients' survival is satisfactory, whereas the graft survival is not, mostly due to inadequate follow-up check-ups and prohibitive prices of immunosuppressants.

Epidemiological profile and perception of patients on chronic hemodialysis through a Moroccan prospective cohort study

Introduction: End-stage kidney disease (ESKD) is a major global public health problem. Knowledge of its epidemiology is crucial for its prevention and the optimal care. Objectives: The objective was to study the epidemiological characteristics of patients on chronic hemodialysis, their outcomes and explore their perceptions of therapeutic modalities, through a prospective cohort. Patients and Methods: A prospective study conducted between February 2019 and January 2020, at two public hemodialysis centers in Oujda, Morocco. Results: Around 183 patients were enrolled. The mean age was 53±17 years. The initial nephropathy was undetermined in 37% of cases and dominated by diabetes in 25.7%. About 43% of patients had pre-dialytic nephrology follow-up. Only 32% patients initiated their hemodialysis by an arterialvenous fistula (AVF). The mean hemoglobin rate was 10.3±1.8 g/dL. Moreover, 74 % of patients were under erythropoietin. Serum calcium, phosphorus, vitamin D, and parathormone were within target ranges in 67%, 52%, 61%, and 51% of cases, respectively. Since, 80% of patients were not clearly informed about therapeutic modalities. The majority of patients opted for kidney transplantation (KT), with two major constraints preventing its realization, consisting the lack of related living donors and financial resources. Besides, 29% of patients were hospitalized for cardiovascular and infectious causes during the study year. The survival rate at 1 and 5 years after the start of dialysis was 97.2% and 95% respectively. Conclusion: Early detection of chronic kidney diseases in high-risk people, their rigorous follow-up and early referral to the nephrologist would improve the quality of care. The promotion of KT and PD would better meet the hemodialysis patients’ needs with better outcomes and lower costs.

COVID-19 in peritoneal dialysis patients in a Tunisian center

IntroductionThe impact of COVID-19 on patients with chronic kidney disease is poorly understood. Given the co morbidity and immunosuppressed state of these patients, mortality could be higher than that in the general population, especially in patients on dialysis therapy.DescriptionDescribe the clinical manifestations and outcomes of SARS-CoV-2 infection in peritoneal dialysis patients.MethodsThis is a retrospective study including peritoneal dialysis patients in a Tunisian center; data and clinical characteristics of patients on peritoneal dialysis who have been infected with the new corona virus between March 2020 and October 2021 were collected.ResultsAmong 36 patients on peritoneal dialysis, 11 (30%) had COVID-19 infection during this period. The average age was 40 ranging from 18 to 82 years old. Sex ratio was at 1.8. As for initial nephropathy, it was diabetic in 45.45%, vascular in 18.18%, interstitial in 18.18%, lupus in 9.09% and undetermined in 9.09% of cases. Severe forms were noted in 54.54% of cases with a mortality rate among infected patients of 45.45%.ConclusionMortality due to COVID-19 seems to be increased in peritoneal dialysis patients and special measures must be applied to prevent the transmission of the virus and limit its damage in this vulnerable population.

Comparison of the Impact of Conventional Hemodialysis and Hemodiafiltration Techniques on the Evolution of Certain Mineral Bone Parameters in Chronic Hemodialysis Patients

Objective: The aim of this study was to compare the impact of conventional hemodialysis (HDC) and hemodiafiltration (HDF) techniques on the evolution of the parameters of phosphocalcic metabolism in chronic hemodialysis patients.
 Methods: This is a retrospective, descriptive and analytical study carried out in the hemodialysis center of Agadir medico-surgical center during 2015. The total number of patients is 34, 18 were treated by HDC ie 52.9% of cases. Also, 16 patients underwent HDF, ie 47.1% of cases. With each of the 2 techniques, the following parameters were measured: To assess the PTH level, we performed 3 measurements. To evaluate calcium, phosphorus, albumine and CRP levels, 7 measurements were taken. The data were entered via Excel and analyzed through Jamovi 1.6.9 software. We used the Wilcoxon or the Mann-Whitney test for the means. The factors associated with the variation of the studied parameters were analyzed in univariate and multivariate analyzes using the binary logistic regression model.
 Results: Our population was made up of 41.2% women and 58.8% men. Their average age was 55 ± 11 years. Also, 82.3% of cases had a normal build, 11.7% were overweight and 6% were moderately obese. The distribution of patients according to the causal nephropathy of chronic renal insufficiency presented a predominance of diabetic nephropathy (32.3%) followed by vascular pathology in 10 patients (29.4%). There was no statistically significant difference in the evolution of the levels of the parameters studied (PTH, calcium, phosphorus, albumin and CRP levels) over time. Univariate analysis showed that only the initial nephropathy factors: other nephropathy-vascular nephropathy (p= 0.028; OR=0.060; IC95% [0.004-0.734]) and diabetic nephropathy-vascular nephropathy (p= 0.011; OR=0.050; IC95% [0.004-0.508]) were associated with the variation of the studied parameters. The same factors also emerge in the multivariate analysis: other nephropathy-vascular nephropathy (p= 0.034; OR=0.044; IC95% [0.002-0.791]) and diabetic nephropathy-vascular nephropathy (p= 0.009; OR=0.032; IC95% [0.002-0.429]).
 
 Conclusion: According to our results, it seems that there are no significant differences in the evolution of some mineral bone parameters studied with the HDC and HDF techniques.

THE RENIN-ANGIOTENSIN SYSTEM INHIBITORS IN HAEMODIALYSIS: CARDIOPROTECTIVE? TO WHAT EXTENT?

Objective: The renin-angiotensin-aldosterone (RAAS) system is one of the most important systems in the pathogenesis of coronary heart disease. Its blockage constitutes a central pillar of cardiovascular therapeutics. Patients in end-stage renal disease or on dialysis are almost invariably excluded from trials evaluating antihypertensive treatments. Angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) are more cardioprotective than other antihypertensive agents in patients with chronic renal disease but whether this applies also to patients on dialysis is unknown. This study followed a cohort of haemodialysis patients over a median of three years, we analysed all-cause mortality and cardio-vascular admissions for patients under RAAS inhibitors. Design and method: Twenty-seven HD patients were cross-sectionally analysed in the following groups: G1: patients with hypertension under ACE or ARB treatment (n = 10), G2: patients with hypertension under another class (n = 7), G3: non-hypertensive patients (n = 10). Associations with all-cause and cardiovascular mortality were assessed over a median of 3 years of follow-up. Results: Overall we had three homogeneous groups, there was no significant difference between median ages (46,3 vs52,7 vs49,9), initial nephropathy or dialysis vintage (5,9 years vs 5,1 vs 11,4). In G1: 4 patients experienced cardiovascular events (40%), but none of them died of cardiovascular causes/complications. In G2: 4 patients had cardiovascular events (57%) amongst whom two died of its complications. In G3: two patients had cardiovascular events (20%) amongst whom one died. There was statistically no significant difference between our groups in terms of cardiovascular morbidity or mortality and in all-causes mortality. Nevertheless, patients under SRA inhibitors presented the lowest number of cardiovascular mortalities. Conclusions: In the study, we observed that patients with SRA inhibitors experienced less cardio-vascular related death, although it is not enough to conclude its cardioprotective status. Larger studies need to be carried to unveil its utility among haemodialysis patients.

POS-794 Conversion to sirolimus in kidney transplant patients: the main indications

The mTOR inhibitors (Sirolimus) has been used in kidney transplantation for very specific indications, essentially in case of neoplastic complications after transplantation secondary to calcineurin inhibitors.Then, the indications have been extended.To describe the different indications of sirolimus conversion in renal transplant patients in Tunisia, we carried out a multicenter study. This is a retrospective multicentric cross-sectional and analytical study performed over a period of 30 years (from 1986 to 2017), which collected all kidney transplant patients who received mTOR inhibitors during any time of their follow-up for a minimum period of 6 months. During study period, 89 patients were collected from the different Tunisian renal transplantation units. The majority of patients came from the SAHLOUL and CHARLES NICOLLES hospitals. The average age of patients at the time of transplantation was 34.71 years. Seventy percent were male. Initial nephropathy was indeterminate in 39 % of patients. All patients received sirolimus during their post-transplant follow-up with a mean of 3.13 +/- 4.73 years. The first indication (49% of cases) of Sirolimus initiation in our study was the diagnosis of neoplastic and pre-neoplastic lesions. Neoplastic lesions were noted in 36 patients (40%) and pre-neoplastic lesions in 08 patients. The most frequent neoplasia was Kaposi's sarcoma in diagnosed in 22.5% of patients. The second indication for switching to sirolimus was calcineurin inhibitors toxicity. In fact, 21 patients in our study had received Sirolimus because of calcineurin inhibitors toxicity. Tacrolimus toxicity was noted in 13 patients (15%) and Ciclosporin toxicity was found in 08 patients (9%). On the other hand, seven patients in our study had received Sirolimus after renal transplantation because of BK virus nephritis. Two patients had presented a thrombotic micro angiopathy related to tacrolimus requiring switching to Sirolimus. One patient presented with severe leuko-neutropenia with white blood cell count of 880/mm³ and neutrophils of 150/mm³. The etiological investigation was negative. In front of persistence of this leuko-neutropenia despite decreasing and then withdrawing MMF, a switch to Sirolimus was decided. In addition, Sirolimus was administered to one patient because of a primary CMV infection that occurred after 04 months of renal transplantation and was resistant to treatment with Foscavir and Ganciclovir. Furthermore, 13 patients had been programmed to be converted to Sirolimus. The conversion was decided, in 04 cases, in front of past history of lesions providing degeneration before the transplantation. These antecedents were: villous atrophy, a colloid thyroid nodule, Bourneville's tuberous sclerosis causing degeneration of skin nodules, and a mixed germ cell tumor. In 09 patients, the systematic conversion to Sirolimus was a part of a national protocol. Conversion from calcineurin inhibitor to sirolimus is one of the major thrusts of the current development of immunosuppression in kidney transplantation. The aim is to minimize the side effects of calcineurin inhibitors and ensure better graft and patient survival. According to our study, neoplastic complications and calcineurin inhibitors toxicity are the main indications of conversion to Sirolimus in Tunisia.

Genu valgum bilatéral pathologique dans un contexte d’hyperparathyroïdie secondaire à une maladie rénale chronique

Mineral bone disorders are common in patients with chronic kidney disease, particularly in hemodialysis patients. We report the case of a 21-year-old patient who has been chronically hemodialysed for 5 years for end-stage renal disease. While the initial nephropathy is undetermined, the patient has developped for the past 3 years, a progresssively worsening genu valgum with an inter-malleolar distance of 10 cm. Standard radiography of the lower limbs showed bone demineralization. There were no calcifications on blood vessels. Cardiac Doppler and supra-aortic trunk Doppler showed valvular and vascular calcifications. The biological check-up found secondary hyperparathyroidism with an intact parathormone at 910 pg/mL. A subtotal para-thyroidectomy was performed in January 2019. Pathological examination showed glandular hyperplasia. The evolution has been favorable and orthopedic management may be considered to correct the genu valgum. This is a rare case of late osteo-articular deformation in association with hyperparathyroidism secondary to renal failure. Etiological management was performed after the deformation was installed. Hence, this complication shows the interest of pre-emptive management of patients with chronic kidney disease. Received: April 29th, 2021 Accepted: June 18th, 2021

MO955RENAL TRANSPLANTATION IN PATIENTS WITH LOW URINARY TRACT ABNORMALITIES

Abstract Background and Aims Kidney transplantation is the only curative treatment for chronic kidney failure that allows to restaure a normal quality of life for patients. In case of abnormalities of the lower urinary tract, there is a risk of recurrence of renal failure due to urodynamic disturbances. The objective of our study is to analyze the profile of transplanted patients with urodynamic abnormalities and to study their impact on the graft. Method Our study was conducted within our Nephrology Department, including renal transplant patients during the period from 2007 to 2020 and who underwent a pre-transplant urodynamic evaluation. Patients with vesical or sphincteral abnormalities were selected, their demographic characteristics, graft survival and infectious complications compared to patients without vesico-sphincteral abnormalities were studied. Results Of 209 kidney transplant patients during the period 2007-2020, 54 had undergone a pre-transplant urodynamic assay, which resulted in 32 patients having an abnormality: 12 cases of vesical hypertonia or hypotonia, 12 cases of sphincteral hypertonia and 9 patients had vesico-sphincteral dyssynergy. In this group with vesical abnormalities, the average age was 24 years, with extremes of 7 and 49 years, 19 were male versus 13 females. Initial nephropathy was tubulointerstitial in 75% of cases with reflux nephropathy in 17 patients. Comparing this group (G1) to the group of patients with no vesico-sphincteral abnormalities (G2), there was more graft reflux 34.4% in G1 compared to 18.2% in G2 (p= 0.16), more urological complications (p=0.2), more urinary tract infections, 0.55 episodes per patient per year in G1 versus 0.98 in G2 (p=0.21). For the graft function, there was no statistically significant difference between the 5-year creatinine post-transplant averages. Conclusion Vesico-sphincteral abnormalities are frequently found in young patients with pre-transplant NIC, they are not responsible for more post-transplant complications or significant graft failure

MO893ASSESSMENT OF PHYSICAL ACTIVITY IN CHRONIC HEMODIALYSIS PATIENTS IN THE NEPHROLOGY AND HEMODIALYSIS DEPARTEMENT CHU IBN ROCHD

Abstract Background and Aims Physical activity is often reduced in chronic hemodialysis patients. Studies having evaluated hemodialysis reveal a significant sedentary lifestyle. which is associated with excess mortality. Conversely, the benefits in terms of morbidity and mortality from physical activity are numerous. The fight against sedentary lifestyles in hemodialysis patients must be one of the objectives of healthcare teams. For this reason, our study aims to assess physical inactivity using a physical activity score from DIJON in chronic hemodialysis patients and to identify the factors linked to a decrease in physical activity in them and to propose programs aimed at to encourage PA as well as exercises adapted to the hemodialysis patient. Method This is a descriptive and analytical cross-sectional study conducted during the month of January 2020, in the nephrology and hemodialysis department of CHU IBN ROCHD. We used the Dijon questionnaire translated into Arabic to measure the PA taking into account daily, sports or leisure activities. The PA level benchmarks are 0–10 (low), 10–20 (medium), and 20–30 (high). Results Our study included 71 patients. The average age was 46.5 years with extremes ranging from 16 to 93 years, there is a slight male predominance with a sex ratio of 1.1. Initial nephropathy was undetermined nephropathy in 53.5%, glomerular in 29.5%, diabetic in 7% and hypertensive in 1.4%. The age of the periodic hemodialysis treatment in our patients varied from 1 month to 44 years, with an average duration of 17.3 years. 91.5% of patients had an arteriovenous fistula as a vascular approach, 8.4% of patients were dialyzed on a catheter. The overall level of physical activity was high only in 4.5% of patients, while it was low in 61.3% and moderate in 34% of patients. The study of the relationship between the decrease in physical activity and different demographic, clinical and paraclinical parameters had revealed that the decrease in physical activity was significantly correlated with seniority on hemodialysis, gender, l he advanced age, the different degrees of anemia, and the cardiovascular affections, on the other hand no significant correlation was found between the decrease in physical activity and hypocalcemia, hyperphosphatemia, and hyperparathyroidism. Conclusion Our results show that the level of physical activity is linked to many parameters, some of which can be modified. Prescribing an adapted and personalized program would improve the prognosis related to co-morbidities and the quality of life of our patients.

POS-617 GERIATIC HEMODIALYSIS PATIENTS: PREVALENCE AND RISK FACTORS

The elderly dialysis population has grown in hemodialysis (HD) population over the years and mortality is higher in this group of patients. The purpose of this study was to evaluate quality of life, course of hemodialysis sessions and mortality in elderly patients undergoing HD. This retrospective cohort study enrolled 21 patients (10 male and 11 female with a sex ratio= 1.5 ) who were started on hemodialysis between 2001 and 2019 . Data collected included demographics, Clinical Status, vascular access type, and metabolic parameters. All the patients included in this study gave their consent . Data were entered and analyzed using SPSS software. Chi-squared test with a level of significance of 0.05 was used for the qualitative variables. In this elderly patient’s sample, the average sample age was 68 years; with age ranging between 65 years and 80 years. The mean duration of dialysis was 51 months; with the duration ranging between 1 month to 240 months. The average number of hemodialysis sessions per week was 2 sessions and the session length was three hours and a half. Eleven patients (52.3%) had hypertension, 9 patients (42.8%) had diabetes mellitus and 10 (47.6%) patients had coronary artery disease. The initial nephropathy was diabetic nephropathy, vascular nephropathy and indeterminate nephropathy in respectively 19%, 57% and 23.8% of cases. The mean duration of follow-up was 216 months. During the 18 years study period, 2 patients (4.7%) died. The cause of death was myocardial infarction. Four patients were suffering from dementia 33.3%. Although most patients (68.7%) had arteriovenous fistula . A temporary hemodialysis catheter was the main vascular access initiating dialysis for 33.3% of patients .The hemodialysis sessions were often interrupted and the most common causes were hypoglycemia, hypotension, chest pain in respectively 47.6%, 66.6% and 47.6% of cases. Seven patients (33.3%) had a regular physical activity however, the rest of the patients were completely sedentary. Elderly patients included in this study had difficulty following diet and fluid restriction and the use of emergency hemodialysis was observed in 38% of cases. Anemia, hypoalbuminemia and hyperparathyroidism were noted in respectively 56% , 28% and 34% of cases . Death occurred in 2 cases and the causes were hypotension (p=0.03) and anemia (p=0.002) were independent risk factors of geriatric mortality. Hemodialysis in elderly patients need an adequate management and special cares.

POS-784 VESICO-URETERAL REFLUX POST RENAL TRANSPLANTATION,A DESCRIPTIVE STUDY

The vesico-ureteral reflux (VUR) is a urological complication frequently encountered in post renal transplantation (RT), reaching 10 to 15% in some series. The objective of our study is to determine the prevalence of VUR after RT, to study the characteristics of the affected population and the impact on graft function. A retrospective descriptive study of all kidney transplant patients between 2007 and 2018 who were diagnosed with a VUR after RT. The characteristics of the initial nephropathy, the mode of revealing of the reflux, the consequences on renal function and the recurrence of urinary tract infections were studied for each . Among the 209 kidney transplants, 31 patients had a RVU, making it a prevalence of 14,8 %, with a sex ratio of 1,58 : 19 men and 12 women. The mean age at the time of transplantation was 28,33 years old. For initial nephropathy, 22 had chronic interstitial nephropathy (71%) including 8 secondary to reflux nephropathy, 19,4% had a glomerular desease and 3,2 % had a vascular cause. Before transplantation, patients had an average hemodialysis duration of 2.6 years with extremes ranging from a few months to 10 years, 13 patients were already oligo-anuric. As for VUR on graft, it was diagnosed with an average delay of 11.5 months post TR [3 months;36months] in front of recurrent urinary tract infections in 10 patients, pyelocalicial dilation seen on renal ultrasound in 4 cases and unexplained creatinine increase in 6 cases. VUR on renal graft is seen in patients of different sex and age with a variable duration of hemodialysis and residual diuresis, but in post-transplantation, it is the recurrence of urinary tract infections that should make the diagnosis suspected.

POS-531 LIPID PROFILE AND CARDIOVASCULAR RISK IN CHRONIC HEMODIALYSIS PATIENTS

Dyslipidemia is a major risk factor for the occurrence of atherosclerosis and cardiovascular diseases. Associated with chronic renal failure, the cardiovascular risk becomes very high. Hence the interest of screening lipid disorders in patients with end-stage renal failure at the hemodialysis stage. We conducted an observational study of the prevalence of lipid disorders in hemodialysis patients in our unit with assessment of their cardiovascular risk in correlation with the Framingham score. The survey involved 40 patients with an average age of 48,775 years [25-78]. The sex ratio was 0.81. Initial nephropathy was dominated by vascular nephropathy in 15 hemodialysis patients, followed by glomerular nephropathy in 13 patients, and tubule-interstitial nephropathy in the remaining 12. The prevalence of dyslipidemia was 52.5%. Lipid disorders were, in decreasing order of frequency; an isolated hypertriglyceridemia at 52.38%; mixed dyslipidemia associating hypercholesterolemia and hypertriglyceridemia at 47.61%. However, 47.5% did not have lipid disorders. Cardiovascular risk assessment according to the Framingham score revealed a high risk in 12.5% of patients who were predominantly male smokers with physical inactivity, a moderate risk in 20% and a low risk in the majority with a frequency of 67.5%. This survey found a high prevalence of dyslipidemia with an important cardiovascular risk. This should lead to develop a better strategy to prevent cardiovascular diseases. Dyslipidemia should be detected and treated in patients with predisposing factors because they are at high cardiovascular risk. The lipid profile should not be interpreted according to laboratory standard but according to target values.

POS-091 PREVALENCE AND DETERMINANTS OF ERECTILE DYSFUNCTION IN HEMODIALYSIS PATIENTS

The prevalence of erectile dysfunction (ED) among patients with end-stage renal disease (ESRD) is not known.There are many reasons to expect a high prevalence of ED in hemodialysis (HD) populations (atherosclerosis, heart disease, diabetes, medications...).The aim of this study was to determine the prevalence of DE and the correlation between sexual dysfunction and the clinical and biological profiles of chronic renal failure patients on hemodialysis at the University Hospital of Monastir. We conducted a descriptive and analytical study that included one hundred men aged 18 years or older, treated with chronic HD for six months. All patients answered a personal questionnaire on their sexuel activity. We studied clinical parameters such as age, comorbidities, hemodialysis duration, initial nephropathy and biological parameters such as hemoglobin, prolactin, vitamin D level and testosterone. The mean age was 50+/-2.6 years. 48% were hypertensive and 39% had diabetes mellitus. Diabetic nephropathy (36%) and nephrosclerosis (48%) were the most frequent initial nephropathies. The mean duration of dialysis was 72 + /-6.8 months. The prevalence of ED was 70%. Subjects younger than 50 years had a prevalence of ED of 34%, while in subjects 50 years or older, it was 90%.Twenty one percent had severe ED. Ageing, diabetes, anemia, vitamin D deficiency and low serum testosterone level correlated significantly with the appearance of sexual dysfunctions.There was no significant correlation between years of hemodialysis and ED (p = 0,345). Some clinical factors and biological disorders may help to understand the pathogenesis of sexual dysfunction.The optimization of biological and hormonal surveillance and management of intervening factors may be resolve this problem.

POS-810 SECONDARY HYPERPARATHYROIDISM: A CARDIOVASCULAR RISK FACTOR FOR KIDNEY DISEASE

Cardiovascular disease is the leading cause of death and accounts for the majority of morbidity in chronic hemodialysis patients. In addition, hyperparathyroidism is a common complication in these patients and may be responsible in the long term for impaired heart structure and function. The aim of our study was to evaluate the correlation between Hypertrophic cardiomyopathy and hyperparathyroidism in CKD. This retrospective comparative cohort study enrolled 32 patients (17 male and 15 female with a sex ratio= 1.13) who were started on hemodialysis. Data collected included demographics, Clinical Status and metabolic parameters.Patients are divided into two groups. The first group contains the patients with hypertophic cardiomyopathy and the second group without it.All the patients included in this study gave their consent. Data were entered and analysed using SPSS software. Chi-squared test with a level of significance of 0.05 was used for the qualitative variables.Hyperparathyroidism is defined by a rate greater than nine times the upper limit. The mean age was 50 years old with age ranging between 23 years and 80 years.The mean duration of dialysis was 7 years (range: 6 months to 33 years). The average number of hemodialysis sessions per week was 2 sessions and the session length was three hours and a half. Sixteen patients (50%) had hypertension, 9 patients (28.1%) had diabetes mellitus. The initial nephropathy was diabetic nephropathy, vascular nephropathy, glomerular nephropathy, interstitial nephropathy and indeterminate nephropathy in respectively 15.6%, 25%, 9.3% and 21.8% of cases. During this years of follow-up,2patients (6.25%) died. The cause of death was arrhythmia and septic shock. The average level of Parathyroid hormone (PTH) was 875 Pg/ml; range 469 Pg/ml to 469 Pg/ml. Hyperphosphatemia and hypocalcemia were noted in respectively 25% and 37.5% of cases.The mean of calcium and phosphorus 2.06mmol / L and 1.66mmol / L, respectively. Three patients had surgical parathyroidectomy. All this patients have associaeted hypertrophic cardiomyopathy.The average left ventricular ejection fraction was 60.9%. Hypertrophic cardiomyopathy was noted in 19 patients (39.5%). Seventeen (89.47%) of them have hyperparathyroidism.A significant inverse correlation between serum PTH and the percentage of LV ejection fraction was observed (P= 0.001). A significant correlation of serum PTH with LVH was also found (P= 0.04). Secondary hyperparathyroidism is common in advanced CKD, and first-line medical therapy includes the use of vitamin D agents and calcimimetics. Some patients need parathyroidectomy for medically refractory. Prevention of LVH requires the early detection and correction of specific and non-Cardiovascular risk factors.

P1537HEMODIALYSIS EMERENGIES IN A NEPHROLOGY DEPARTEMENT : ABOUT 117 CASES

Abstract Background and Aims Hemodialysis (HD) emergencies in nephrology are very common. Prompt diagnosis and management are needed as it can be life-threatening. We aim to determine epidemiological, clinical, biological aspects as well as the etiological profile of our population. Method We conducted a cross-sectional study during 3 months (February, March and April 2019) collecting patients who underwent at least one session of HD at our nephrology department. Were included patients aged over 18 years old. Were excluded chronic dialysis patients presenting for their usual session. Data collection was conducted from HD registers. We collected the following parameters: age, gender, comorbidities, initial nephropathy, clinical data(blood pressure, pulmonary auscultation, diuresis, oxygen saturation),the current treatment and biological data( creatinin, kalemia, hemoglobin, and gasometry). Data were entered and analyzed using SPSS software. Chi-squared test with a level of significance of 0.05 was used for the qualitative variables. Results A total of 117 patients were included, mean aged 60.71 years old (range:28-90) with a sex ratio M/F at 1.3. Our population consists in 42 chronic HD patients(37.9%), 34 Patients with moderate to severe renal failure(RF) (29.9%) and 41 patients with acute kidney injury (AKI) (35%). Initial nephropathy causes were vascular in (40%), glomerular in(25%) and undetermined in(35%) of cases. Our patients had hypertension, diabetes, dyslipidemia in respectively (58%),(45%) and (7.6%). Twenty two chronic HD patients were anuric (48.8%). Seventy-nine patients were admitted from the emergency department(68%), 21 patients from the surgical and urology departments(18.4%),8 patients from the intensive care unit (7.6%) and 4 patients from other departments(4.2%). HD indications were acute pulmonary edema in (41.8%), metabolic acidosis in (41.8%), hyperkalemia in (37.6%), Uremic signs in (22.2%). Inadequate hyperkalaemic treatment was noted in( 22.7% )of cases. Conventional HD was performed with mean session duration of 3 hours. Ultrafiltration was required in 46 cases (36.8%) with an average of 1860ml(range:500-4000). Perdialytic complications were observed in(12.5%)of cases. Hypotension was the most common complication which leads to the interruption of the session in(5.9%)of cases. Disequilibrium syndrome was observed in 2 patients. Arrhythmia and acute cardiac failure were noted in 2 patients. Death occurred in 1 case caused by arrhythmia. Advanced age, anuria and underlying RF were independent risk factors of emergency dialysis with respectively (p=0.02, p=0.01 and p=0.05). Conclusion: Dialysis emergencies remain frequent in our country. Acute Pulmonary edema and metabolic acidosis were the main indications followed by hyperkalemia and anuria. Poor and delayed chronic renal failure management could explain the frequent use of emergency HD. The analysis of the causes and dialysis modalities in emergency situations, contributes to adopt a preventive strategy in order to identify high-risk patients and to optimize treatment protocols.

P1122VIRAL INFECTIONS :VHC, VHB AND VIH IN HEMODIALYSIS

Abstract Background and Aims Viral infections, especially those caused by hepatitis B and C viruses are common in chronic hemodialysis patients. The hepatitis C virus is the main cause of post-transfusion hepatitis. The main objective of this study is to determine the prevalence of hepatitis B and C and HIV in chronic hemodialysis patients at the TIZI OUZOU University Hospital Center, as well as the main risk factors for contamination, in chronic hemodialysis patients treated at the from our center. Method This retrospective study carried out on 149 chronic hemodialysis patients consisted in searching for anti-HCV, anti-HIV antibodies and the HBs antigen and in determining the possible causes of contamination, in particular the age of the hemodialysis and history of blood transfusion. The characteristics studied for all patients are: demographic characteristics, initial nephropathy, seniority on hemodialysis, the concept of hemodialysis outside our center at the time of dialysis or for a limited period during follow-up ( vacation…), the notion of transfusion; patients are considered to be multi-transfused when they have received more than four transfusions, the search for hepatitis B and C virus infection by ELISA, the concept of hepatic cytolysis: a transaminase level that exceeds 1.5 times normal, vaccine status, HIV serology Results The average age of our 149 patients varies between 19 and 82 years with a male predominance (92 men and 57 women) and an average duration of dialysis of 90 months. The predominant etiology of IRCT is vascular nephropathy. We also note other causes including glomerular, diabetic and tubulointerstitial nephropathies. The etiology was largely undetermined. Hepatic serology C is positive in 5% of patients. None of our patients tested positive for HBS. No case of HIV infection has been noted. The prevalence of hepatitis B and C in hemodialysis patients varies from country to country but remains higher than in the general population (HCV: 2.7-22.2% in the DOPPS register). In our series the prevalence is around 5% lower than that reported in other regional and international studies. Conclusion In hemodialysis, the risk of infection is very high, on the one hand due to access to regular blood and on the other hand due to the alteration of the immune defenses induced by chronic renal failure. Nosocomial transmission plays a very important role. It is strongly linked to the age of dialysis. Compliance with hygiene measures is a very essential element; isolation of the infected patient is no longer recommended