Maintenance Hemodialysis Population Research Articles

Relationship between carotid-femoral pulse wave velocity and prognosis in maintenance hemodialysis patients.

Carotid-femoral pulse wave velocity (Cf-PWV) can well predict the prognosis of the general population. However, whether Cf-PWV can be used as a prognostic indicator in maintenance hemodialysis (MHD) patients remains mysterious. The present study endeavored to explore the prognostic value of Cf-PWV among the MHD population. Patients who received MHD and underwent Cf-PWV examination at the hemodialysis center of Zhejiang Provincial People's Hospital between March 1, 2017 and October 15, 2019 were enrolled. Relevant clinical data were collected from these patients, who were subsequently followed up for a minimum of 1 year. During the follow-up period, the occurrence of all-cause death was recorded as a prognostic indicator. Based on the predetermined inclusion and exclusion criteria 178 patients were included in the final analysis. These patients were categorized into 2 groups based on Cf-PWV values: group 1 (Cf-PWV < 13.8 m/s), and group 2 (Cf-PWV ≥ 13.8 m/s). Thirty-four patients succumbed to their conditions within a median follow-up period of 23.3 months. Kaplan-Meier survival analysis revealed that the median survival time of group 2 was significantly shorter than group 1 (log-rank test, χ2 = 12.413, P < .001). After adjusting for various factors, including age, cardiovascular disease, peripheral arterial diastolic pressure, central arterial diastolic pressure, albumin, blood urea nitrogen, serum creatinine, left ventricular ejection fraction, 25 hydroxyvitamin D3, C-reactive protein and serum phosphorus, it was found that Cf-PWV ≥ 13.8m/s was an independent risk factor for all-cause mortality in MHD patients (relative risk = 3.04, 95% confidence interval [CI] = 1.22-7.57; P = .017). A high level of Cf-PWV (≥13.8 m/s) is an independent risk factor for all-cause death in MHD patients.

Fatigue by the Chalder Questionnaire and post-hemodialysis recovery in a population of predominantly African descent: The PROHEMO.

A high prevalence of fatigue and a positive association between fatigue and post-hemodialysis recovery have been reported in predominantly white populations of maintenance hemodialysis (MHD) patients. The present study evaluates associations between self-reported fatigue by the 11-item Chalder Fatigue Questionnaire (CFQ-11) and the need for post-hemodialysis recovery in a predominantly African-descent MHD population. A total of 233 patients (94% Black or Mixed-Race) participating in the "Prospective Study of the Prognosis of Patients on Maintenance Hemodialysis" (PROHEMO), Salvador, Brazil were recruited for this cross-sectional study. The CFQ-11 was used to measure fatigue: <4 for absent or mild, ⩾4 for moderate to severe. Patients were also asked if they needed some time to recover after the hemodialysis. Logistic regression was used to estimate odds ratio (OR) of the association with adjustments for age, sex, race, educational level, economic class level, diabetes, hearth failure, and hemoglobin. Mean age was 51.5 ± 12.5 years. Moderate to severe fatigue (⩾4 points) was observed in 70.8% (165/233), and absent or mild fatigue (<4 points) in 29.2% (68/233). Compared to patients with fatigue scores <4 (20.6%), the need for post-hemodialysis recovery was 2.5 times greater in patients with fatigue scores ⩾4 (52.7%). The covariate-adjusted logistic regression OR was 4.60, 95% CI: 2.27, 9.21. This study in MHD patients of predominantly African descent supports self-reported fatigue assessed by the CFQ-11 as a relevant predictor of the need for post-hemodialysis recovery. The results offer a rationale for investigating whether interventions to prevent fatigue reduce the need of post-hemodialysis recovery.

Assessment of Hemorrhagic Risk in Maintenance Hemodialysis Population using Different Clinical Tools

BACKGROUND: End stage kidney disease (ESKD) patients receiving maintenance hemodialysis (HD) face an elevated bleeding risk. There are the factors such as body mass index (BMI), comorbidities, and medications such as antiplatelet, anticoagulants, and nonsteroidal anti-inflammatory drugs that increase the bleeding risk. The validity of bleeding risk assessment tools in the ESKD population needs to be studied. MATERIALS AND METHODS: This was a prospective, observational study in a HD unit at a tertiary care teaching hospital in Ajman. Sixty adult patients on regular maintenance HD sessions were included in the study. Severity of bleeding was categorized based on the World Health Organization (WHO) classification. Each patient’s risk of bleeding was assessed monthly using 9 different bleeding risk assessment tools (HASBLED, ATRIA, HEMORR2HAGES, ORBIT, IMPROVE, OBRI, S2TOP-BLEED, intracranial-B2 LEED3S, and Glasgow Blatchford Score for gastrointestinal bleeding) for 6 months’ period. Patients were categorized into low- and high-risk groups according to their risk scores. The predictive power of risk assessment tools was assessed by calculating its sensitivity and specificity. Receiver operating characteristic (ROC) curve was plotted, and the area under the curve was estimated for each risk assessment tool. Logistic regression model was also done using the SPSS software version 29. RESULTS: The mean age of the study group was 56 years, and the average BMI was 27 kg/m2. A total of 20 bleeding events were reported among ten patients (16.7%). The WHO category 1 and WHO category 2 bleeding were observed in 15 and 5 bleeding events, respectively. None had category 3 or 4 bleeding. Bleeding risk was found to be associated with ethnicity and obesity but not to other patient demographic factors or medication use. Based on sensitivity, specificity, positive predictive value, negative predictive value, and the area under the ROC curve, HEMORR2HAGES score showed better prediction of bleeding risk compared to the other tools used. CONCLUSION: In conclusion, most of the risk assessment tools showed poor predictive value in the maintenance HD population. Existing bleeding risk tools may not be helpful in dialysis patients. A more valid bleeding risk tool needs to be developed for the ESKD patient population.

Evolution of Clinical Characteristics and Prognosis of Maintenance Hemodialysis Population: A Single-Center Retrospective Study

Evolution of Clinical Characteristics and Prognosis of Maintenance Hemodialysis Population: A Single-Center Retrospective Study

Frailty and Adverse Outcomes After SARS-CoV-2 Infection in Elderly Patients on Maintenance Hemodialysis: A Cohort Study.

Frailty is an important geriatric syndrome associated with aging and adverse events, especially in patients with severe infection. To help guide prognosis for elderly patients undergoing maintenance hemodialysis (MHD) who experience acute infection, this study investigated whether baseline (pre-infection) frailty may be associated with adverse outcomes in elderly patients undergoing MHD who suffer SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection. Patients (aged ≥60 y) receiving MHD had been assessed for overall frailty and the 5 frailty components based on the Fried Frailty Phenotype scale within 3 months prior to SARS-CoV-2 infection. There were 59 and 98 patients in the frail and non-frail groups, respectively. Three months after SARS-CoV-2 infection, 21 (13.4%) and 45 (28.7%) patients had died or were in hospital. The multivariate COX proportional risk model suggested that the all-cause mortality rate in patients judged overall frail or with low activity was significantly higher compared with that of the non-frail (P = 0.049; 0.003). The multivariate logistic regression analysis showed that hospitalization 3 months after SARS-CoV-2 infection was associated with both overall frailty and low activity (OR 2.276, 95% CI: 1.034-5.010, P = 0.041; OR 2.809, 95% CI: 1.311-6.020, P = 0.008, respectively). Overall frailty and specifically low activity were significantly associated with all-cause mortality and hospitalization in this elderly MHD population after SARS-CoV-2 infection. Early assessment of frailty and effective interventions are recommended to improve the prognosis of patients receiving MHD who are at higher risk of acute infection.

Could long-term dialysis vintage and abnormal calcium, phosphorus and iPTH control accelerate aging among the maintenance hemodialysis population?

Objective Aging is a complex process of physiological dysregulation of the body system and is common in hemodialysis patients. However, limited studies have investigated the links between dialysis vintage, calcium, phosphorus, and iPTH control and aging. The purpose of the current study was to examine these associations. Methods During 2020, a cross-sectional study was conducted in 3025 hemodialysis patients from 27 centers in Anhui Province, China. Biological age was calculated by a formula using chronological age and clinical indicators. The absence of the target range for serum phosphorus (0.87–1.45 mmol/L), corrected calcium (2.1–2.5 mmol/L) and iPTH (130–585 pg/mL) were identified as abnormal calcium, phosphorus, and iPTH control. Results A total of 1131 hemodialysis patients were included, 59.2% of whom were males (669/1131). The mean (standard deviation) of actual age and biological age were 56.07 (12.79) years and 66.94 (25.88), respectively. The median of dialysis vintage was 4.3 years. After adjusting for the confounders, linear regression models showed patients with abnormal calcium, phosphorus, and iPTH control and on hemodialysis for less than 4.3 years (B = 0.211, p = .002) or on hemodialysis for 4.3 years or more (B = 0.302, p < .001), patients with normal calcium, phosphorus, and iPTH control and on hemodialysis for 4.3 years or more (B = 0.087, p = .013) had a higher biological age. Conclusion Our findings support the hypothesis that long-term hemodialysis and abnormal calcium, phosphorus, and iPTH control may accelerate aging in the hemodialysis population. Further studies are warrant to verify the significance of maintaining normal calcium-phosphorus metabolism in aging.

#4287 GASTROINTESTINAL SYMPTOMS IN PATIENTS RECEIVING HEMODIALYSIS: PREVALENCE, SEVERITY AND ASSOCIATED FACTORS

Abstract Background and Aims Gastrointestinal (GI) symptoms are common among patients with chronic renal failure, especially in those treated with maintenance hemodialysis (HD), and may adversely affect patients'' quality of life. A variety of GI symptoms has been reported, but previous studies present conflicting results regarding their association with age, sex, comorbidities, concomitant medications and dialysis modality. This study aimed to assess the prevalence and severity of GI symptoms in the maintenance HD population and explore possible associated factors. Method A total of 188 stable patients (55.3% male, 53.7% ≥65 years of age, age range 24–85, 30.9% with diabetes, 19.9% smokers) from three HD centres were enrolled in this observational cross-sectional study. Gastrointestinal symptoms were assessed by the self-administered Gastrointestinal Symptoms Rating Scale (GSRS). The scale includes 15 items graded by a 7-point Likert scale that can be grouped into five dimensions: abdominal pain syndrome, reflux syndrome, indigestion syndrome, diarrhoea syndrome, and constipation syndrome. A dimension score is calculated as the mean value of the items belonging to the specific syndrome, and the final score is the mean of dimension scores. Standard blood analyses, Kt/V, body mass index (BMI) and malnutrition-inflammation score (MIS) were determined in all patients. Other relevant demographic and clinical data were obtained from the patient's medical records. The results were analyzed with SPSS software, version 22 (IBM Corporation, New York, USA). Results The average BMI was 25.04±4.29. Half of the patients (50.3%) were overweight, 45.3% had normal weight, and 4.3% were underweight. The average MIS was 5.64±2.87. The average number of symptoms per patient was 4.01±3.20 (range 0 – 15). At least one GI symptom was reported by 84.6% of patients (33.0% reported 1 – 3 symptoms, and 49.5% reported 4 or more symptoms). The mean GSRS scores for eating dysfunctions were 1.59±1.08 for reflux, 1.74±0.98 for abdominal pain, 1.75±1.14 for constipation, 1.94±1.01 for indigestion, and 1.38±0.90 for diarrhoea. Total GSRS was 1.70±0.61. Elderly patients had a significantly lower overall number of GI symptoms (3.49±2.83 vs 4.57±3.51; p = 0.023), lower abdominal pain score (1.60±0.96 vs 1.91±1.09; p = 0.031), and indigestion score (1.74±0.85 vs 2.18±1.15; p = 0.005), but higher constipation (1.94±1.27 vs 1.54±0.96;p = 0.017) score than individuals under 65 years of age. Patients smoking cigarettes and those longer on HD had a significantly higher overall number of GI symptoms (3.44±0.56 vs 3.10±0.25; p = 0.035 and 3.78±2.99 vs 2.46±2.23; p = 0.016 respectively). Average abdominal pain score was significantly higher in non-diabetic (1.87±1.04 vs 1.44±0.75; p = 0.002) and underweight (2.62±1.51 vs 1.71±0.94 vs 1.65±0.90; p = 0.023) compared to diabetic, normal weight and overweight patients respectively. Patients taking ASA or NSAIDs had significantly higher total GSRS scores (1.84±0.72 vs 1.60±0.50; p = 0.016 and 1.88±0.64 vs 1.65±0.59; p = 0.044 respectively). Sex, dialysis adequacy and malnutrition-inflammation status were not significantly related to any of the GSRS dimensions. Conclusion The present study demonstrates a high prevalence of GI symptoms in maintenance HD patients and identifies age, cigarette smoking, diabetes, dialysis vintage, and certain medications as important elements to consider when addressing specific groups of GI symptoms in this population.

Effectiveness of Three Doses of mRNA COVID-19 Vaccines in the Hemodialysis Population during the Omicron Period.

Coronavirus disease 2019 (COVID-19) vaccine effectiveness studies in the hemodialysis population have demonstrated that two doses of mRNA COVID-19 vaccines are effective against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and severe complications when Alpha and Delta were predominant variants of concern. Vaccine effectiveness after a third dose versus two doses for preventing SARS-CoV-2 infection and severe COVID-19 in the hemodialysis population against Omicron is not known. We conducted a retrospective cohort study in Ontario, Canada, between December 1, 2021, and February 28, 2022, in the maintenance hemodialysis population who had received two versus three doses of mRNA COVID-19 vaccines. COVID-19 vaccination, SARS-CoV-2 infection, and related hospitalization and death were determined from provincial databases. The primary outcome was the first RT-PCR confirmed SARS-CoV-2 infection, and the secondary outcome was a SARS-CoV-2-related severe outcome, defined as either hospitalization or death. A total of 8457 individuals receiving in-center hemodialysis were included. At study initiation, 2334 (28%) individuals received three doses, which increased to 7468 (88%) individuals by the end of the study period. The adjusted hazard ratios (aHR) for SARS-CoV-2 infection (aHR, 0.58; 95% confidence interval [CI], 0.50 to 0.67) and severe outcomes (hospitalization or death) (aHR, 0.40; 95% CI, 0.28 to 0.56) were lower after three versus two doses of mRNA vaccine. Prior infection, independent of vaccine status, was associated with a lower risk of reinfection, with an aHR of 0.44 (95% CI, 0.27 to 0.73). Three-dose mRNA COVID-19 vaccination was associated with lower incidence of SARS-CoV-2 infection and severe SARS-CoV-2-related outcomes during the Omicron period compared with two doses.

Rescue use of Pegylated Interferon in Dialysis Patient who Failed to Respond Sofosbuvir.

Rescue use of Pegylated Interferon in Dialysis Patient who Failed to Respond Sofosbuvir.

Age-based comparison of vascular access outcomes in maintenance hemodialysis population.

The hemodialysis population is aging, worldwide. In Israel, more than half of the dialysis population is older than 68 years. The policy for vascular access among this population is still a matter of debate, with several studies demonstrating conflicting results. This study compared vascular access outcomes across age groups (<65, 65-75, >75 years) in a single hemodialysis center in Israel. This was a retrospective, single center analysis of all vascular accesses created in adult hemodialysis patients in our institution, from January 1, 2006, through December 31, 2012. Patient characteristics, primary and secondary access failure, and complications were collected from electronic medical records. Follow-up was until death or up to 5 years. A total of 612 vascular accesses created among maintenance hemodialysis patients were included, of which 196 were in patients >75 years, 184 in patients 65-75 years, and 232 in patients <65 years. Mean age of the >75 years group was 80.5 ± 4.3 years and 60.7% were men. Vascular access site was the most important predicator for primary access failure (odds ratio for primary failure of radiocephalic arteriovenous fistula was 3.5 (95% CI 2.1-6), whereas age did not affect the primary failure rate (odds ratio 1.5, p = 0.648). Radiocephalic fistulas were more prone to secondary failure than other vascular access sites were. Complications were slightly more common in the oldest group. Eight percent of the patients >75 years died before access was used. In our cohort, age did not affect vascular outcomes, whereas VA site seemed to be the most important parameter in primary and secondary VA failures. Our results support considering VA on an individual basis and supply valuable information regarding complication and failure rates of VA among patients >75 years.

Serum total indoxyl sulfate levels and all-cause and cardiovascular mortality in maintenance hemodialysis patients: a prospective cohort study

BackgroundThe association between serum total indoxyl sulfate (tIS), and cardiovascular disease (CVD) and all-cause mortality is a matter of debate. In the current study we sought to determine the association, if any, between serum tIS, and all-cause and CVD-associated mortality in patients on maintenance hemodialysis (MHD).MethodsA prospective cohort study was conducted involving 500 MHD patients at Dalian Municipal Central Hospital from 31 December 2014 to 31 December 2020. Serum tIS levels were measured at baseline and classified as high (≥44.16 ng/ml) or low (< 44.16 ng/ml) according to the “X-tile” program. Besides, the associations between continuous serum tIS and outcomes were also explored. Predictors were tested for colinearity using variance inflation factor analysis. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression models. Restricted cubic spline model was performed to assess dose-response relationships between tIS concentration and all-cause and CVD mortality.ResultsDuring a 58-month median follow-up period, 224 deaths (132 CVD deaths) were documented. After adjustment for potential confounders, the serum tIS level was positively associated with all-cause mortality (HR = 1.02, 95% = 1.01–1.03); however, we did not detect a significant association when tIS was a dichotomous variable. Compared with the MHD population with a serum tIS level < 44.16 ng/ml, the adjusted HR for CVD mortality among those with a serum tIS level ≥ 44.16 ng/ml was 1.76 (95% = 1.10–2.82). Furthermore, we also noted the same association when the serum tIS level was a continuous variable.ConclusionThe serum tIS level was associated with higher risk of all-cause and CVD mortality among MHD patients. Further prospective large-scale studies are required to confirm this finding.

A Metabolomics Approach to Biomarker Discovery Reveals That Tocotrienols Have Potential Beneficial Impact on Maintenance Hemodialysis Population

ObjectivesCardiovascular disease is considered major comorbidity in the maintenance hemodialysis (MHD) population. A dietary supplement such as tocotrienols have shown to improve cardiovascular health in these patients. In our study, we hypothesized that the tocotrienols may possess potential beneficial impacts on MHD patients by improving their metabolomic profile. MethodsChanges in plasma metabolomic profile of the MHD patients with or without tocotrienol rich fraction (TRF) supplements (300 mg/day) for 12 months period on plasma metabolomic profile of the US (n = 85) and Malaysian (n = 80) MHD was investigated using 1H-NMR based metabolomics approach followed by Receiver Operating Characteristics (ROC) curve based biomarker model validation. ResultsPartial linear square discriminant analysis showed a significant difference in the metabolomic profile of the MHD patients between the placebo and the TRF supplemented groups over 12 months in both US and Malaysian cohorts. According to metabolite identification and quantification proline, 4-hydroxyproline, ornithine, glutamate, 4-aminobutyrate, 3-aminoisobutyrate, acetoacetate, and 3-hydroxybutyrate were found to be significantly (p < 0.05) altered between the placebo group and TRF groups over 12 months. The biomarker models created using these key metabolites had shown good predictive accuracy (Area under the ROC curve > 0.8) in both cohorts with high sensitivity (79% and 78%) and specificity (84% and 80%) in the US and Malaysian cohorts, respectively. Further model validation relied on the permutation test with 1000 permutations (p < 0.001), validating the predictive ability of the created biomarker models in both cohorts. The biomarker meta-analysis revealed that trans-4-hydroxyproline, proline, acetoacetate, ornithine, 3-hydroxybutyrate, 3-aminoisobutyrate, and glutamate had similar expression patterns in both cohorts. ConclusionsMetabolites linked to arginine and proline metabolism and synthesis and degradation of ketone bodies pathways were altered in MHD patients over 12 months. TRF modulated these changes in a favorable direction, indicating the potential beneficial impact of TRF supplements in these patients. These metabolites may serve as biomarkers for kidney disease and/or for evaluating the efficacy of TRF supplementation in MHD patients. Funding SourcesPEMANDU, Malaysia

Sarcopenic Obesity Versus Nonobese Sarcopenia in Hemodialysis Patients: Differences in Nutritional Status, Quality of Life, and Clinical Outcomes

Sarcopenia and sarcopenic obesity (SO) are linked to unfavorable prognosis in maintenance hemodialysis (MHD) populations. We tested whether nonobese sarcopenia and SO, as different stages of extreme protein-energy wasting, have different prognoses. In this prospective observational study, 261 MHD patients were recruited from October 2010 to April 2012 and followed until October 2020. Two definitions were used to diagnose sarcopenia: the European Working Group on Sarcopenia in Older People consensus and the Foundation for the National Institutes of Health (FNIH) Biomarkers Consortium criteria. Obesity was determined as the percentage of total body fat, ≥27% for men and ≥38% for women. Data for all-cause and cardiovascular morbidity and mortality, baseline nutrition markers, inflammation and oxidative stress, adipokines, body composition parameters, handgrip strength, and quality of life (QoL) scores were measured. According to European Working Group on Sarcopenia in Older People, 115 (44.1%) patients were sarcopenic and 120 (46.0%) according to FNIH definitions. Of them, 28.4% and 34.5% were SO, respectively. Higher levels of albumin, creatinine, uric acid, leptin, phase angle, better nutritional scores, and lower adiponectin levels characterized SO patients compared with nonobese sarcopenic patients regardless of indexing method. Better QoL scores were noted in SO compared with nonobese sarcopenic patients using the FNIH sarcopenia criteria. The hazard of all-cause death, cardiovascular death, and first cardiovascular event for patients with SO was lower compared with the nonobese patients after multivariate adjustments. Statistical significance of these associations disappeared after including fat mass in multivariate models. MHD patients with SO have better nutritional status and prognosis for cardiovascular events, all-cause and cardiovascular disease mortality, and possibly better QoL compared with nonobese sarcopenic MHD patients. The better prognosis appears to be entirely due to the excess fat, which is protective in sarcopenic MHD patients similar to that described in the entire MHD population.

Serum Galectin-3 levels and all-cause and cardiovascular mortality in maintenance hemodialysis patients: a prospective cohort study

BackgroundHigher serum galectin-3 levels are related to adverse outcomes in different disease states. However, the association of galectin-3 with mortality in the maintenance hemodialysis (HD) population has not been fully described. Thus, we aimed to assess the predictive significance of galectin-3 for all-cause and cardiovascular (CV) mortality through a Chinese maintenance HD population.MethodsA prospective cohort study was conducted in five hundred and six patients with end-stage renal disease who underwent hemodialysis at Dalian Central Hospital before December 31, 2014. Serum galectin-3 levels were measured at baseline and classified as high (> 8.65 ng/ml) or low (≤ 8.65 ng/ml) according to the “X-tile” program. Primary and secondary outcomes were all-cause and CV mortality, respectively. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated by the Cox proportional hazards regression models.ResultsDuring the median follow-up of 60 months, there were 188 all-cause deaths and 125 CV deaths. Compared with maintenance HD population with galectin-3 ≤ 8.65 ng/ml, the adjusted HR for all-cause mortality among those with galectin-3 > 8.65 ng/ml was 1.59 (CI: 0.96–2.65, p = 0.07). Furthermore, multivariable analysis showed that maintenance HD patients with galectin-3 > 8.65 ng/ml had a 2.13-fold higher risk of CV death than those with galectin-3 ≤ 8.65 ng/ml (HR = 2.13, 95% CI 1.07–4.26).ConclusionGalectin-3 is an independent predictor of CV mortality in maintenance HD patients.

Fatigue Prevalence and Associations with Non-Diuretic Anti-Hypertensive Medications in the Maintenance Hemodialysis Population

Fatigue Prevalence and Associations with Non-Diuretic Anti-Hypertensive Medications in the Maintenance Hemodialysis Population

Risk factors for the mortality of hemodialysis patients with COVID-19: A multicenter study from the overall hemodialysis population in Wuhan.

IntroductionMaintenance hemodialysis (MHD) patients are highly threatened in the novel coronavirus disease 2019 (COVID‐19) pandemic, but evidence of risk factors for mortality in this population is still lacking.MethodsWe followed outcomes of the overall MHD population of Wuhan, including 7154 MHD patients from 65 hemodialysis centers, from January 1 to May 4, 2020. Among them, 130 were diagnosed with COVID‐19. The demographic and clinical data of them were collected and compared between survivors and nonsurvivors.ResultsCompared to the corresponding period of last year, the all‐cause mortality rate of the Wuhan MHD population significantly rose in February, and dropped down in March 2020. Of the 130 COVID‐19 cases, 51 (39.2%) were deceased. Advanced age, decreased oxygen saturation, low diastolic blood pressure (DBP) on admission, and complications including acute cardiac injury (HR 5.03 [95% CI 2.21–11.14], p < 0.001), cerebrovascular event (HR 2.80 [95% CI 1.14–6.86], p = 0.025) and acute respiratory distress syndrome (HR 3.50 [95% CI 1.63–7.51], p = 0.001) were identified as independent risk factors for the death of COVID‐19. The median virus shedding period of survivors was 25 days, longer than the general population.ConclusionsMaintenance hemodialysis patients are a highly vulnerable population at increased risk of mortality and prolonged virus shedding period in the ongoing COVID‐19 pandemic. Advanced age, decreased oxygen saturation, low DBP on admission, and complications like acute cardiac injury are parameters independently associated with poor prognosis.

MO877PREVALENCE AND PERSISTENCE OF COVID-19 ANTIBODIES IN NEW YORK CITY HEMODIALYSIS CLINIC

Background and AimsDialysis patients are at higher risk for severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection. Longevity of antibody response to SARS-CoV-2 infection remains unclear. It is reported that maintenance hemodialysis (MHD) patients can mount an antibody response that is similar in intensity and timing to the non-dialysis population. We aim to investigate the prevalence and persistence of antibodies in hemodialysis patients.MethodWe measured IgG and IgM antibodies in MHD patients as part of a quality improvement project. Four New York City dialysis clinics participated in this study. Strict policy of RT-PCR testing was implemented in clinics for patients with signs and symptoms of Coronavirus Disease 2019 (COVID-19). Initial antibody testing was done on June 10 and July 13, 2020 (phase 1) and retesting was done for previously positive patients between December 9 and 17, 2020 (phase 2). Upon obtaining verbal consent, 3.5 ml of pre-dialysis blood samples were taken via vascular access. SARS-CoV-2 antibodies were determined using the emergency use authorized Diazyme DZ-Lite SARS-CoV-2 IgM / IgG CLIA assays with 100% sensitivity and 98% specificity. Detection of formed immune-complexes is achieved with N-(4-amino-butyl)-N-ethyl-isoluminol; the luminescence signal is reported as units per ml (AU/ml), values ≥ 1.00 AU/ml are considered as “reactive” and < 1.00 AU/ml as “non-reactive.”ResultsA total of 429 MHD patients were studied in phase 1. Antibodies were present in 130 (30.3%) and only 55 patients with Covid-19 diagnosis confirmed by RT-PCR test were reactive for IgG antibodies. The time to antibody testing was 73 days (median 77; range 30-111) days. In the phase 2 antibody testing, IgG antibodies were only detected in 47 patients (85.5%) 242 days (median 245, range 204 to 268) after clinical diagnosis of Covid-19. Between the two phases of antibody testing, the luminescence signal declined by 40.9 AU/mL (95% confidence interval 31.5 to 50.3) from 54.1±45.3 to 13.2±20.9 AU/mL (P<0.0001 by paired t-test; Figure 1). In univariate logistic regression, a higher number of days between clinical diagnosis of COVID-19 and the second antibody measurement was associated with a lower seropositivity rate (odds ratio 0.929, 95% confidence interval 0.864 to 0.998, P=0.044). Antibody persistence was not associated with age, gender, race, and ethnicity.MO877 Figure 1: Quantitative change of IgG antibodies over time.The antibody tests were done on average 171 days (range 154 to 189) apart. The quantitative luminescence signal declined by 40.9 AU/mL (95% confidence interval 31.5 to 50.3) from 54.1±45.3 to 13.2±20.9 AU/mL (P<0.0001 by paired t-test).ConclusionWe observed that about 6 out of 7 MHD patients maintain SARS-CoV-2 antibodies over 6-9 months but there is a significant decline of IgG level. The time between clinical diagnosis and IgG testing was associated with IgG decline. Follow up study to understand antibody dynamics in MHD population is a crucial step once vaccines become available.

Suggestions for the prevention of Clostridioides difficile spread within outpatient hemodialysis facilities

Clostridioides difficile infections (CDIs) cause substantial morbidity and mortality. Patients on maintenance hemodialysis are 2 to 2.5 times more likely to develop CDI, with mortality rates 2-fold higher than the general population. Hospitalizations due to CDI among the maintenance hemodialysis population are high, and the frequency of antibiotic exposures and hospitalizations may contribute to CDI risk. In this report, a panel of experts in clinical nephrology, infectious diseases, and infection prevention provide guidance, based on expert opinion and published literature, aimed at preventing the spread of CDI in outpatient hemodialysis facilities.

Vascular calcification by conventional X-ray and mortality in a cohort of predominantly African descent hemodialysis patients.

There is a lack of studies describing the prevalence of vascular calcification (VC) and its association with mortality in maintenance hemodialysis (MHD) patients of African descent. We investigated if a VC score based on the number of calcified vascular beds was associated with mortality in MHD patients. We analyzed data from 211 MHD patients enrolled from January 2010 to January 2011 in the prospective cohort study, "The Prospective Study of the Prognosis of Chronic Hemodialysis Patients (PROHEMO)," developed in Salvador, BA, Brazil. VC was evaluated using radiographs of the hands, abdomen, hip, and chest; the score was calculated by the number of calcified sites as 0 (absence of calcification), 1 (one calcified site), 2 (two sites), 3 (⩾3 sites). We used Cox's regression to estimate the hazard ratio (HR) and 95% confidence interval (CI) of associations between VC and mortality with adjustments for age and comorbidities. VC was detected in 114 (54.0%) patients; 37 (17.5%) with a VC score = 1; 21 (10%) with VC score = 2 and 56 (26.5%) with VC score = 3. Compared with VC score = 0, the adjusted hazard of death was 2.67 (95% CI: 1.12, 6.33) for patients with VC score = 1; HR = 2.89 (95% CI: 0.95, 7.63) for VC score = 2; and HR = 3.27 (95% CI: 1.47, 7.28) for VC score = 3. The present study in an African descent MHD population provides support for the VC score based on conventional radiography as a prediction tool for the clinical practice. As shown, the VC score was monotonically and independently associated with mortality.

Vascular access related aneurysms in patients on maintenance hemodialysis

Background and Aims: Arterio-venous (AV) access has been considered as an Achilles heel in the management and outcomes of End Stage Renal Disease (ESRD) patients on Maintenance Hemodialysis (MHD). Vascular Access Related Aneurysms (VARA) significantly impact the functional status of the AV access and thus affects the patients' outcomes. Our study was taken up in this context. This study was conducted to decipher the anatomical, functional, imaging, complications and management aspects of VARA. Methods: A cross-sectional, observational study was done on 429 patients of ESRD on MHD in our institute. The clinical aspects, demographics, imaging aspects were stressed followed by management. Both descriptive and inferential statistics were used and aP value Results: Total number of study participants were 429. Of them, 48 patients developed AVF aneurysms (11.1%). The mean age of the patients was 52.9 years with a male: female ratio of 34: 14. Majority of them were ESRD due to diabetic nephroathy (62.5%). Morphologically majority of them were saccular (69%) while rest of them were fusiform (31%) None of our patients had downstream stenosis, and thrombus was seen in 5 patients (10.4%), complications secondary to rupture of AVF with hemorrhage, was seen in 6.25% (n = 3). Conclusions: We found VARA in 11.6% of our MHD population predominantly in men, in their middle age. They were more common in diabetic ESRDS. Aneurysmal rupture was seen in 6.25%. Our study highlights the importance of periodic evaluation for aneurysms and necessary management.