Nephrology Service Research Articles

Paradigms of megapolis nephrology in a changing world: status, problems and prospects of development of the nephrological service of St. Petersburg

The course of the COVID-19 pandemic has led to a critical increase in the burden on virtually all major branches of the health care system in our country and abroad. The aim of this article is to analyse the activities of the different parts of the city nephrol­ogy service in Saint-Petersburg and to consider promising ways to improve it. The nephrology service for the adult population in St. Petersburg includes: outpatient service; inpatient service - 183 beds in 24-hour inpatient departments of the city; dialysis service - 10 dialysis units in municipal medical organizations, 5 in federal institutions, and 8 centers/departments operating in the framework of private-public partnership. The number of patients on dialysis programme decreased by 10.5 % to 1,839 in 2021. These changes are likely due to an increase in mortality among these patients in 2020 and 2021 which is a consequence not only of COVID-19 but also of the adverse impact of the pandemic on the health system. The proportion of patients treated as outpatients in private dialysis centres increased during the three-year period. The incidence of arteriovenous fistula formation in primary vascular access decreased from 33.2 % to 14.2 % in 2020 compared with 2019. At the same time, the use of temporary central venous catheters as primary vascular access for renal replacement therapy has increased significantly from 43.0 % to 61.9 %. The development of the nephrology service is largely determined by its funding. To compensate the costs of medical in­ stitutions in the city for conducting renal replacement therapy it is necessary to increase the tariffs of compulsory health insurance (CHI) by at least 50 %. In the medical organizations of Saint-Petersburg municipal and federal subordination the share of "artificial kidney" devices that have used up their resource is 32.2 %, and in a number of medical institutions it exceeds 50 %.

Importance of physical exercise prescription in patients with chronic kidney disease: results of the survey of the Grupo Español Multidisciplinar de Ejercicio Físico en el Enfermo Renal [Spanish Multidisciplinary Group of Physical Exercise in Kidney Patients] (GEMEFER)

IntroductionDespite the benefits of physical exercise (PE) for patients with chronic kidney disease (CKD), the number of Nephrology services that have PE programs is limited. ObjectivesTo describe the degree of knowledge of PE benefits in patients with CKD among professionals, as well as the level of implementation and characteristics of PE programs in Nephrology services in Spain. MethodsA questionnaire on the degree of knowledge and prescription of PE in patients with CKD was designed and sent to members of the Spanish Nephrology and Nephrology Nursing Societies, as well as to physiotherapists and professionals in the Sciences of Physical Activity and Sport (PASS). Results264 professionals participated. 98.8% agreed on the importance of prescribing PE, but only 20.5% carry out an assessment of functional capacity and 19.3% have a PE program for patients with CKD in their centre. The most frequent programs are performed for haemodialysis patients and strength and aerobic resistance exercises are combined. A physiotherapist or a PASS usually participates in its prescription. The main barriers were the absence of human and/or physical resources and the lack of training. ConclusionsHealthcare workers know the benefits of PE in patients with CKD. However, the implementation of these programs in Spain is low, motivated by the lack of resources and training of professionals. We must establish strategies to guarantee an adequate functional capacity within the care of our patients.

The Roth Net at 40 years: celebrating the spirit of innovation

The Roth Net at 40 years: celebrating the spirit of innovation

Association of the End-Stage Renal Disease Treatment Choices Payment Model With Home Dialysis Use at Kidney Failure Onset From 2016 to 2022

The Centers for Medicare & Medicaid Services designed a mandatory payment model to incentivize home dialysis use: the End-Stage Renal Disease Treatment Choices (ETC). Outpatient dialysis facilities and health care professionals providing nephrology services were randomly assigned to ETC participation at the hospital referral region level. To assess the association between ETC and home dialysis use in the incident dialysis population in its first 18 months of implementation. A cohort study with controlled, interrupted time series analysis of the US End-Stage Renal Disease Quality Reporting System database was conducted, using generalized estimating equations. All adults initiating home-based dialysis in the US between January 1, 2016, and June 30, 2022, without a prior kidney transplant were included in the analysis. Prior to vs after ETC onset in January 1, 2021, and random assignment to ETC participation of facilities and health care professionals involved in patient care. Percentage of patients started on incident home dialysis and yearly change in percentage initiating home dialysis. A total of 817 177 adults initiated home dialysis during the study period, of whom 750 314 were included in the study cohort. The cohort included 41.4% women; 26.2% of the patients were Black, 17.4% were Hispanic, and 49.1% were White. Approximately half (49.6%) of the patients were aged at least 65 years. A total of 31.2% received care from health care professionals assigned to ETC participation, and 33.6% had Medicare fee-for-service coverage. Overall, home dialysis use increased from 10.0% in January 2016 to 17.4% in June 2022. Home dialysis use increased more in ETC markets than in non-ETC markets after January 2021 (by 1.07%; 95% CI, 0.16%-1.97%). The rate of increase in home dialysis use in the entire cohort nearly doubled after January 2021 to 1.66% per year (95% CI, 1.14%-2.19%) compared with before 2021, when the rate was 0.86% per year (95% CI, 0.75%-0.97%), but the difference in rate of increase in home dialysis use was not significant between ETC and non-ETC markets. This study noted that, although the overall rate of dialysis use at home was greater after ETC implementation, the increase occurred more among patients in ETC markets than among those in non-ETC markets. These findings suggest that federal policy and financial incentives affected care for the entire incident dialysis population in the US.

Von Hippel-Lindau Disease: Case Report of a Rare Condition

Introduction: Von Hippel-Lindau disease (VHL) also known as familial cerebello-retinal angiomatosis is an inherited disease caused by mutation of a gene, characterized by a variety of benign and malignant tumors in different parts of the body [1]. VHL disease is classified as: type 1 which is presented as hemangioblastoma at the level of the central nervous system (CNS), renal cancer and type 2, which is subdivided into A characterized by (retinal angioma, CNS hemangioma, renal cancer), B characterized by (hemangioblastoma, renal cancer, pheochromocytoma) and C characterized by isolated pheochromocytoma [2]. Clinical Case: A 32-year-old female patient of Jehovah's Witness religion with a clear family history of Von Hippel-Lindau disease, who at 28 years of age was admitted to the Neurosurgery Department with a severe headache; therefore, a basic cranial CT was performed with evidence of an infratentorial lesion in the left cerebellar hemisphere causing obstructive hydrocephalus due to compression of the fourth ventricle. It is complemented with brain MRI when there is evidence of an image compatible with hemangioblastoma that exerts mass effect. Through the Nephrology Service, renal ultrasound shows a non-vascularized mass; therefore, simple and contrast CT urogram is requested to rule out malignancy, nephroprotective scheme is placed to prevent CIN, Merhan Score of 2, low risk of 7.5%. In simple and contrast CT urogram, the findings described suggest left renal neoplasm, to be correlated with histopathological study, BOSNIAK type I renal cysts, right ovarian cyst. Conclusions: The treatment of Von Hippel-Lindau disease, due to all its clinical manifestations, is a challenge that should be approached in a multidisciplinary manner. Early detection of tumors means a more effective early management, also alerts family trees with high risk of suffering it.

Renal medicine in the intensive care unit: a narrative review.

Kidney disease, both acute and chronic, is commonly encountered on the intensive care unit. Due to the role the kidneys play in whole body homeostasis, it follows that their dysfunction has wide-ranging implications and can affect prescribing and therapeutic management. This narrative review discusses the pathophysiology of acute kidney injury and chronic kidney disease, and how this relates to critically unwell patients. We cover several aspects of the management of renal dysfunction on the critical care unit, exploring some of the recurrent themes within the literature, including type and timing of kidney replacement therapy, management of acute kidney injury, as well as discussing how novel biomarkers for acute kidney injury may help to identify patients suffering from acute kidney injury as well as risk stratifying these patients. We discuss how early involvement of specialist nephrology services can improve outcomes in patients with kidney disease as well as offer valuable diagnostic and specialist management advice, particularly for patients with established end stage kidney disease and patients who are already known to nephrology services. We also explore some of the ongoing research questions that need to be answered within this arena.

Knowledge, attitude, and practices regarding renal diets among predialysis chronic kidney disease in Lucknow, India

Background: There is a paucity of data with respect to the knowledge, attitude, and practices (KAP) of patients with predialysis chronic kidney disease (CKD) regarding dietary restrictions and advice. The primary objective of the study was to assess KAP and its determinants in adult predialysis CKD patients visiting outpatient nephrology services. Methods: An existing KAP questionnaire used earlier in CKD dialysis population was utilized with modification for use in the region of interest. The total score was 55, knowledge score had three domains with 10 food items, and attitude and practice scores had seven and six questions, respectively. Adult patients with CKD not on dialysis were selected for the study, provided they were regularly visiting outpatient nephrology and dietetics services. Other sociodemographic, anthropometric, medication use, and laboratory variables were also noted, after the administration of the structured questionnaire by the same investigator in the local language. Results: A total of 111 patients were recruited to the study, with median age of 47 years, 60% of males, 70% from rural areas, up to 50% illiterate, >80% unemployed, and >60% belonging to lower socioeconomic status. Despite these, the majority (>70%) had adequate knowledge, though median attitude and practice score percentages were lower at 64% and 66%, respectively. Higher practice scores correlated significantly with higher serum albumin, higher socioeconomic status, and reduced phosphate binder use. Conclusion: The present study population, which was under regular nephrology and dietetics outpatient follow-up, showed adequate knowledge regarding renal diet, but required improvement in attitudes and practices, for which novel approaches need to be applied with team effort.

Hemodiyaliz Hastalarının Manevi Durumlarının Umutsuzluk Düzeylerine Etkisi

Aim: This study was conducted descriptively to determine the effects of the spiritual orientation of hemodialysis patients on their levels of hopelessness. 
 Method: The study sample consisted of 100 hemodialysis patients treated at Ondokuz Mayıs University Health Application and Research Center (OMUHARC) hemodialysis unit, nephrology service and City Health Center affiliated to OMUHARC between July 2017 and May 2018. The data were collected using patient introductory information forms, Spiritual Orientation Scale (SOS) and Beck Hopelessness Scale (BHS). The compliance of the data to normal distribution was examined using the Shapiro Wilk test. Kruskal Wallis and Mann Whitney U tests were used to compare data that did not conform to normal distribution. Spearman correlation analysis was used to examine the relationship between the sub-dimensions of the scales. 
 Result: The patients' average age was 56.7±14.4, 59% were male, 80% were married, 53% were diagnosed with chronic renal failure 1-5 years ago, 75% had been receiving hemodialysis treatment for 1-5 years and 63% had another chronic disease. The mean total score of SOS was 99.57±15.51. The mean BHS total score was 5.68 ± 4.43; while the emotions and expectations about the future sub-dimension mean total score was 1.2 ± 1.29, that of the motivation loss sub-dimension was 2.56±1.89, whereas that of the hope sub-dimension was 1.91±1.82. A moderately negative significant correlation was found between SOS and BHS (r: -0.385, p

A nurse-led home-based exercise program for patients with chronic kidney disease.

Exercise programs in patients with kidney disease improve functional capacity and health-related quality of life, but the implementation of exercise programs in nephrology services is not an easy task. To evaluate the effectiveness of a home-based exercise program in patients with chronic kidney disease (CKD) stages 4-5 (with or without dialysis). A 12-week prospective observational cohort design study was carried out with patients with renal failure who undertook a home-based exercise program. Registered data included: (a) biochemical parameters; (b) functional capacity tests, that is, short physical performance battery, sit to stand to sit 10, and 6-min walking test; (c) handgrip strength; (d) health-related quality of life; (e) satisfaction; and (f) adherence. The quantitative variables were expressed by means and standard deviation, and qualitative variables, by percentage. The comparison of quantitative data between baseline and at 12 weeks of the same group was carried out using the Wilcoxon test for nonparametric-related variables and the chi-square test for categorical variables using contingency tables. Fifty-three patients were included (mean age=67.4 years). The functional capacity tests showed a significant improvement in the short physical performance battery (8.3 ± 2.8 vs. 9.5 ± 2.6 points), the sit to stand to sit 10 (35.8 ± 17.7 vs. 31.8 ± 15.3s), and the 6-min walking test (355.0 ± 106.1 vs. 386.4 ± 113.6 meters), mainly in CKD stage 5. There were no significant differences in handgrip and health-related quality of life. Regarding the degree of program satisfaction, 70% of the patients were very satisfied with being able to participate in the program, and 64% considered that they had more strength after completing the home-based exercise program. The implementation of a home-based exercise program results in improved functional capacity in patients with CKD stage 5. Moreover, this exercise program is safe, and patients were satisfied.

Creating KidneyPal: A Specialty-Aligned Palliative Care Service for People with Kidney Disease.

Patients with kidney disease have notable unmet palliative care needs and represent an underserved population for specialty palliative care teams. We designed a specialty-aligned interprofessional palliative care service called KidneyPal that is aimed at improving delivery of palliative care to patients with kidney disease through focus groups and iterative improvement cycles. We iteratively measured the development of KidneyPal through clinical process metrics: percent of the inpatient nephrology census followed by KidneyPal, patient demographics, consult origin, clinician feedback, and self-reported team interventions. KidneyPal saw 314 unique patients from January 2019 to January 2021. The majority of consultations came from nephrology services though the source of consultation changed over time. We consulted on an average of 13.5% of the entire inpatient nephrology patient hospital census with highest involvement with patients on the inpatient nephrology hemodialysis service (mean of 29.9%). KidneyPal was rated highly by surveyed nephrology clinicians and provided high rates of psychosocial support and goals of care interventions. The creation of KidneyPal led to us to serve a new cohort of patients with specialty palliative care. We grew over time to serve the full range of patients with kidney disease as defined by our nephrology service lines. We succeeded in doing so by embedding in nephrology and building relationships with those caring for people with kidney disease while tailoring our service and interventions over time.

Risk of COVID-19 and Cost Burden in End-Stage Renal Disease Patients and Policy Implications for Managing Nephrology Services during the COVID-19 Pandemic.

The aim of this study was to evaluate the risk of COVID-19 in end-stage renal disease (ESRD) patients, the cost burden of the COVID-19 pandemic on the management of ESRD and the cost of catheter infections. In this multicentre, retrospective study, data were obtained from the records of four dialysis centres providing care for ESRD patients in Northern Cyprus. Of the 358 ESRD patients that were receiving haemodialysis (HD) 13 were diagnosed with COVID-19. The average cost of HD treatment per patient was $4822.65 in 2019 and $3759.45 in 2020 (p ≤ 0.001). The average control cost of HD treatment per patient was $618.80 in 2019 and $474.03 in 2020 (p ≤ 0.001). The outpatient treatment costs of catheter infections were not significantly different in 2019 (before) compared to 2020 (after) the pandemic ($54.61 in 2019 compared to $54.74 in 2020, p = 0.793). However, the inpatient treatment costs were significantly greater before the pandemic compared to after the pandemic ($315.33 in 2019 compared to $121.03 in 2020, p = 0.015). The costs for monitoring COVID-19 transmission in patients having ESRD management were significantly higher in HD compared to in peritoneal dialysis (PD) and transplants. Since there is a high risk of transmission of infections in the hospital environment during a pandemic, it is important to implement alternative ESRD management methods, such as enhancing transplants in populations, switching to PD, and implementing home dialysis programmes to reduce the risk of infection and associated complications, as well as the health costs associated with infection monitoring.

Assessment of Cardio-Pulmonary and Renal Dysfunction As Well As Overall Outcomes in Sickle Cell Patients: A Community Hospital-Based Experience

Background: Improvements in medical care for Sickle Cell Disease (SCD) patients in the USA has led to increased survival rates, however, management of comorbidities associated with end organ damage remains challenging. ASH 2019 guidelines do not recommend obtaining screening echocardiogram in asymptomatic SCD patients but suggest management of confirmed Pulmonary Arterial Hypertension (PAH) with specific therapies. For those with Chronic Kidney Disease (CKD) or End Stage Renal Disease (ESRD) requiring dialysis, it is recommended to treat with combination of hydroxyurea and erythropoiesis-stimulating agents as well as consider early referral to transplant nephrology. Our study was aimed to assess the correlation between various characteristics, underlying comorbidities with cardio-pulmonary and renal dysfunction as well as overall outcomes in SCD patients treated at the Henry Ford Hospital sickle cell clinic. Methods: A retrospective chart review of 105 patients between June 2013-June 2022 was performed. Baseline characteristics including gender, ethnicity, BMI, presence or absence of various comorbidities such as acute chest syndrome, Congestive Heart Failure (CHF), PAH, Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE), CKD, ESRD requiring dialysis, use of medications such as folic acid, hydroxyurea and newer therapies including voxelotor, crizanlizumab and L-glutamine were obtained. Frequency of ER visits, hospitalizations and blood transfusion requirements were noted. Patients were divided in 2 groups- SS Disease including Sickle/Thalassemia (ST) and SC disease. Continuous variables were compared via ANOVA/Kruskal Wallace Test and categorical variables were compared via Chi Squared Test/Fisher's Exact Test. Results: In our study, 49.5% were females, 95% were African-American. SS/ST disease type was seen in majority (62.8%) followed by SC disease and 2 patients had sickle cell trait. SS/ST patients were noted to have elevated HbS, reticulocyte count and LDH levels as expected compared to SC disease, whereas those with SC disease were noted to have higher BMI levels likely due less complications. SS/ST patients were more significantly noted to have diagnosis of CHF (p=0.020) as well as CKD (p=0.029). Interestingly, ESRD requiring dialysis was only seen in SS/ST patients. 69.6% of all patients underwent an echocardiogram evaluation and 28.7% of those had a diagnosis of PAH. In our study, 23.8% with PAH were started on newer therapies. 88.5% of all patients were compliant with folic acid treatment and 34.2% were started on hydroxyurea with significantly higher treatment in those with CHF and elevated HbS levels. Overall, 15.9% patients were started on newer therapies and their use was noted to be significantly higher in patients with CKD and ESRD (p=0.011 and p=0.029 respectively). Hospitalizations were less frequent in patients with SC disease compared to SS/ST although not statistically significant (p=0.80) and frequency of ER visits was not significantly different between both groups. Also, patients were less frequently hospitalized if they received chronic simple transfusions on outpatient basis. Conclusion: SS disease patients at our institution had increased likelihood of developing CHF as well as CKD. Of note, those with CKD or ESRD were also more likely to be placed on newer therapies. Based on these findings, we have developed a multidisciplinary management care plan alongside nephrology service. In our study, about a third of total patients did not have an echocardiogram evaluation, however, 28% of those who had an echocardiogram were noted to have PAH. Therefore, we think that use of screening echocardiogram in all SCD patients could help with early diagnosis of PAH and prompt referral to pulmonary medicine team to prevent potential complications. Use of hydroxyurea was noted to be significantly higher in those with CHF and newer therapies were more frequently used in patients with CKD and ESRD in our patients. These results encourage better utilization of such therapies in SCD patients with other comorbidities as well as those who have frequent hospitalizations to improve outcomes in the future. SCD related end organ damage is increasing in incidence with improvement in survival rates and poses a challenge which demands a multidisciplinary system-based care approach. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Pseudo Bartter Syndrome in anorexia nervosa.

Anorexia nervosa is a psychiatric disorder with various non-psychiatric manifestations that arise from the self-imposed malnourishment and possible purging behaviors. These medical manifestations or complications may mimic non psychiatric disorders and difficult the diagnosis of an eating disorder. We report the case of a patient with a binge-eating/purging subtype of anorexia nervosa, whose purges consisted in diuretic abuse. She kept her purges secret and during more than 1year she was admitted several times in the emergency room for, sometimes life-threatening, hypokalemia. Furthermore, she consulted practitioners from different specialties and was hospitalized in a nephrology service to investigate chronic hypokalemia and other metabolic and hydroelectrolytic disturbances. A Bartter Syndrome was suspected, and she underwent genetic testing. Eventually she started psychiatric follow up and was admitted as an inpatient under the care of a specialized eating disorders unit. This patient presented a series of metabolic disturbances secondary to the diuretic abuse, that mimicked the manifestations of hereditary tubulopathies like Bartter Syndrome. Coincidentally it was found that the patient had a mutation in a gene linked to Bartter Syndrome, that wasn't enough to justify this diagnosis. So, a Pseudo Bartter Syndrome secondary to the diuretic abuse was evident. The focus on medical manifestations delayed the recognition of the anorexia nervosa and the associated diuretic abuse as the main cause of the electrolyte and metabolic disturbances. This case emphasizes the importance of being familiarized with the non-psychiatric manifestations of eating disorders, so they may be rapidly recognized and managed. Level V, Case Report.

Community Houses to Increase Access to Home Dialysis.

Community Houses to Increase Access to Home Dialysis.

The process of transition from pediatric to adult healthcare services for nephrological patients: Recommendations vs. reality-A single center experience.

Transitional care is an essential step for patients with kidney disease, and it is supported by policy documents in the United Kingdom and United States. We have previously described the heterogeneous situation currently found in Europe regarding certain aspects of transitional care: the written transition plan, the educational program, the timing of transfer to adult services, the presence of a coordinator and a dedicated off-site transition clinic. In line with the transition protocol “RISE to transition,” the objective of this paper is to describe the experience of the Bologna center in defining a protocol for the management of chronic kidney disease and the difficulties encountered in implementing it. We apply this model to various chronic diseases along the process of transfer to adult services. It begins when the patient is 14 years old and is complete by the time they reach 18. The family is continuously involved and all the patients in transitional care receive continuous medical care and psychological support. We identified a series of tests designed to measure various criteria: medical condition, psychological state, quality of life, and degree of patient satisfaction, which are repeated at set intervals during the transition process. The organization of the service provided an adequate setting for taking charge of the patients in the long term. The transition program implemented by the adult and pediatric nephrology services of the Bologna center has lowered the risk of discontinuity of care and greatly improved the patients’ awareness of responsibility for their own healthy lifestyle choices.

Referral criteria for chronic kidney disease: implications for disease management and healthcare expenditure—analysis of a population-based sample

BackgroundClinical practice guidelines recommend specialist referral according to different criteria. The aim was to assess recommended and observed referral rate and health care expenditure according to recommendations from:• Kidney Disease Improving Global Outcomes (KDIGO,2012)• National Institute for Health and Care Excellence (NICE,2014)• German Society of Nephrology/German Society of Internal Medicine (DGfN/DGIM,2015)• German College of General Practitioners and Family Physicians (DEGAM,2019)• Kidney failure risk equation (NICE,2021)MethodsData of the population-based cohort Study of Health in Pomerania were matched with claims data. Proportion of subjects meeting referral criteria and corresponding health care expenditures were calculated and projected to the population of Mecklenburg-Vorpommern.ResultsData from 1927 subjects were analysed. Overall proportion of subjects meeting referral criteria ranged from 4.9% (DEGAM) to 8.3% (DGfN/DGIM). The majority of patients eligible for referral were ≥ 60 years. In subjects older than 60 years, differences were even more pronounced, and rates ranged from 9.7% (DEGAM) to 16.5% (DGfN/DGIM). Estimated population level costs varied between €1,432,440 (DEGAM) and €2,386,186 (DGfN/DGIM). From 190 patients with eGFR < 60 ml/min, 15 had a risk of end stage renal disease > 5% within the next 5 years.ConclusionsApplying different referral criteria results in different referral rates and costs. Referral rates exceed actually observed consultation rates. Criteria need to be evaluated in terms of available workforce, resources and regarding over- and underutilization of nephrology services.

Historia natural de la poliquistosis renal autosómica dominante en Córdoba: utilidad de una base de datos para agrupar familias y mutaciones

Autosomal dominant polycystic kidney disease (ADPKD) is one of the main causes of end-stage renal disease. Today, the knowledge of its genetic base has made it possible to develop strategies that prevent the transmission of the disease. ObjectivesThe objective of the study was to analyze the natural history of ADPKD in the Province of Córdoba and to design a database that allows families and different mutations to be grouped. Patients and methodsAll patients (n=678) diagnosed with ADPKD followed up in the Cordoba nephrology service are included. Various clinical variables (age and sex), genetic variables (mutation in PKD1, PKD2) and the need for renal replacement therapy (RRT) were retrospectively analyzed. ResultsThe prevalence was 61 cases per 100,000 inhabitants. Median renal survival was significantly worse in PKD1 (57.5 years) than in PKD2 (70 years) (Log-rank p=0.000). We have genetically identified 43.8% of the population, detecting mutations in PKD1 in 61.2% and in PKD2 in 37.4% of cases. The most frequent mutation was detected in PKD2 (c.2159del) in 68 patients belonging to 10 different families. The one with the worst renal prognosis was detected in PKD1 (c.9893G>A). These patients required RRT at a median age of 38.7 years. ConclusionsThe renal survival of ADPKD in the Province of Córdoba is similar to that described in the literature. Mutations in PKD2 were detected in 37.4%. Our strategy allows us to know the genetic bases of our population with a great saving of resources. This is essential to be able to offer primary prevention of ADPKD through preimplantation genetic diagnosis.

Long-term complications of primary distal renal tubular acidosis.

The clinical manifestations of primary distal renal tubular acidosis usually begin in childhood, but the disease is caused by a genetic defect that persists throughout life. This review focuses on the complications of distal tubular acidosis that occur or remain long-term such as nephrocalcinosis and urolithiasis, growth impairment, bone mineralization, severe hypokalemia, kidney cysts, and progressive kidney failure, as well as other persistent manifestations that occur independent of acidosis but are associated with some inherited forms of the disease. The pathogenic factors responsible for kidney failure are discussed in particular because it is a complication to which different publications have recently drawn attention and which affects a high percentage of adults with primary distal renal tubular acidosis. The need to maintain optimal metabolic control of the disease and scheduled clinical follow-up throughout life and the importance of organizing protocols for the transition of patients to adult nephrology services are emphasized.

MO916: Anxiety and Depression Among Dialysis Centre Staff and Haemodialysis Patients During the COVID-19 Pandemic

BACKGROUND AND AIMSIn Moscow, the nephrological service is organized as follows: (1) specialize centres of haemodialysis in which patients with COVID-19 are treated and (2) ordinary departments of haemodialysis, in which there are no patients with coronavirus infection, but patients with COVID-19 are identified in them and these patients are sent for treatment to specialize departments. This study was aimed at examining the level of anxiety and depression in patients on haemodialysis in comparison with a group of medical staff (doctors and nurses) working in the ordinary department of haemodialysis during the COVID-19 pandemic. Also, we were compared both groups with the level of anxiety and depression in the general population of healthy people who lived in the era of the COVID-19 pandemic, based on the results of meta-analysis of 2189 current studies of depressive disorders during the pandemic [1].METHODWe used the Hospital Anxiety and Depression Scale (HADS) to evaluate the level of anxiety and depression. Before the study, informed consent was taken from all responders to participate in the study, as well as permission to publish the results. In this study, we included 40 stable patients receiving haemodialysis (15 women and 25 men). The average age was 58.6 years (45–84 years). Time spent on haemodialysis: up to 1 year: 9 patients; up to 5 years: 16 patients; and >5 years: 15 patients. Average 4.9 years (1–20 years). The main causes leading to the end stage of renal failure were: polycystic disease (24%), type 2 diabetes mellitus (20%), hypertension (16%), glomerulonephritis (23%) and others (17%). The group of medical staff consisted of 43 people (16 doctors and 27 nurses). The ratio of men and women is 1: 3 and 1: 5.7, respectively. The average age of doctors is 50.3 ± 15.6 years; nurses 34.1 ± 8.2 years.For comparison, we used materials from the meta-analysis [1], where the prevalence of depression was 15.97% and anxiety was 15.15% as the consequence of the COVID-19 pandemic for the mentally healthy population.RESULTSIn the group of patients, anxiety and depression were detected in 16 patients (40%), in 4 patients (10%) ––clinically significant. By the time spent on haemodialysis: up to 1 year: 4 patients (without clinically significant manifestations); up to 5 years: 7 patients (3 with clinically significant manifestations); and >5 years: 6 patients (1 with clinically significant manifestations). In the group of medical staff, anxiety and depression were detected in 13 people (32.5%), of which clinically significant in 4 people (9.3%). Anxiety and depression were found in 6 doctors (37.5%) (2 men and 4 women) and in 7 nurses (25.9%) (1 man and 6 women). Clinically significant manifestations were noted in 2 doctors and 2 nurses. In the group of patients, anxiety and depression were observed in 1 young patient, in 5 middle-aged patients and in 10 elderly patients (60–74 years old). In the group of medical workers, an increased level of anxiety and depression were observed in 10 young people and in 3 middle-aged people.CONCLUSIONPatients on haemodialysis and dialysis centre staff, the levels of anxiety and depression were twice times higher compared with the data of anxiety and depression in healthy populations during the COVID-19 pandemic. Patients on haemodialysis and medical staff had same level of anxiety and depression. The level of anxiety and depression among doctors was significantly higher than in nurse; this difference can be explained by a small sample, as well as a higher level of education among doctors and a tendency to reflect.

MO819: The Negative Impact of Reuse of Dialyzers on Survival Rates of Dialysis Patients

Abstract BACKGROUND AND AIMS Until 2019, in Uzbekistan, disposable dialyzers for dialysis were reused several times due to underfunding of the system. But in 2018, the President of the Republic of Uzbekistan Shavkat Mirziyoyev signed a decree on improving the nephrological and dialysis services in the country. After that, there is a sharp increase in funding and attention to the provision of hemodialysis care to the population of our country. Thanks to this Resolution, since 2019, in all regions of Uzbekistan, only disposable dialyzers are used for hemodialysis. To prospectively study the negative impact of the reusable use of disposable dialyzers on dialysis patients in Uzbekistan. METHOD The study took place in three dialysis centers in the country at different levels. Our observation of 165 (90 men and 75 women) patients took place for 2 years: from the beginning of 2018 to the end of 2019. The average age of the patients was 49.7 ± 14.1 years. During the first 12 months (before the release of the decree of the President of the Republic and funding), dialysis patients underwent multiple uses of dialyzers. The next 12 months were completely switched to single use. The average age of the patients was 48.1 ± 14.3 years. The average duration of hemodialysis was 37 (6–252) months. Survival was assessed using the Kaplan–Meier method. The confidence interval was determined by Greenwood. RESULTS During the 24 months of observation, out of 165 patients, 29.1% (n = 48) patients died, 70.9% (n = 117) survived (of which 11 patients underwent Tx). During 1 year of follow-up (the period of repeated use of disposable dialyzers), 21.2% (n = 35) patients died, 78.8% (n = 130) survived and continued to receive hemodialysis (6 patients Tx). A total of 68.6% (n = 24) of patients died from cardiovascular complications. The survival rate for 1 year (miltiple use period) was S(t) = 0.796 [95% confidence interval (95% CI) 0.736–0.856]. Over the next 12 months (single use period), out of 124 patients continuing to receive hemodialysis, 10.5% (n = 13) patients died, 89.5% (n = 111) patients survived (5 patients Tx). A total of 53.8% (n = 7) of these deceased patients died from CVD. The survival rate at the second year (single use period) was S(t) = 0.894 [95% CI 0.839–0.948]. CONCLUSION Compliance with the standards for hemodialysis, in particular, the single use of disposable dialyzers for hemodialysis sessions, leads to a decrease in the lethality of dialysis patients. The transition from multiple to single use of disposable dialyzers in one dialysis center in Uzbekistan showed a significant increase in survival of 12.3%.