Non-dialysis Chronic Kidney Disease Research Articles

Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in Nondialysis Chronic Kidney Patients.

Background The Neutrophil-to-Lymphocyte Ratio (NLR) and the Platelet-to-Lymphocyte Ratio (PLR) are inflammatory biomarkers for several diseases, such as cancer and cardiovascular morbidities; however, there are currently few studies on kidney diseases. We aimed to evaluate nondialysis patients and determine the association of NLR and PLR with inflammation in these patients. Methods A prospective cross-sectional study was conducted with 85 patients at different stages of chronic kidney disease (CKD), treated at the Kidney Disease Prevention Center of the University Hospital of the Federal University of Maranhão. This study included adult nondialysis patients diagnosed with CKD. The participants' blood samples were collected for a high-sensitivity C-reactive protein (hs-CRP) test and blood count. They were divided into two groups according to the presence or absence of inflammation based on the hs-CRP value (<0.5 mg/dL). NLR and PLR were calculated based on the absolute number of neutrophils, lymphocytes, and platelets and were compared between them and with hs-CRP. Statistical analysis was performed using the Stata software, with the Shapiro–Wilk, Mann–Whitney, Spearman's Correlation, and receiver operating characteristic curve tests. This study was approved by the local ethics committee. Results The participants were categorized into two groups: with inflammation (n = 64) and without inflammation (n = 21). The mean age was 61.43 ± 14.63 y. The NLR and PLR values were significantly different between the groups with and without inflammation (p=0.045and p=0.004, respectively). However, only PLR showed a significant positive correlation with hs-CRP (p=0.015). The best cutoff point for NLR to detect inflammation was 1.98, with 76.19% sensitivity and 48.44% specificity. For PLR, it was 116.07, with 85.71% sensitivity and 51.56% specificity. There was no significant difference between the area under the NLR and PLR curve (0.71 vs. 0.64; p=0.186) for this population. Conclusions This study showed that PLR was positively correlated with hs-CRP in nondialysis CKD patients and can be used to identify inflammation in this population.

Association of Urinary Dickkopf-3 with Residual Renal Function Decline in Patients Undergoing Peritoneal Dialysis.

Background and Objectives: Urinary levels of dickkopf-3 (DKK-3) are associated with poor renal survival in patients with non-dialytic chronic kidney disease. However, it remains unknown whether urinary DKK-3 levels can predict residual renal function (RRF) decline in patients undergoing peritoneal dialysis (PD). Therefore, we investigated the correlation between urinary levels of DKK-3 and the subsequent rate of RRF decline in PD patients. Materials and Methods: This study included 36 PD patients who underwent multiple peritoneal equivalent tests during 2011–2021. The relationship between baseline clinical characteristics and the subsequent annual rate of Kt/V decline was investigated. Results: The annual rate of renal Kt/V decline was 0.29 (range: 0.05–0.48), which correlated with renal Kt/V (r = 0.55, p = 0.0005) and 24 h urinary DKK-3 excretion (r = 0.61, p < 0.0001). Similarly, 24 h urinary DKK-3 excretion (β = 0.44, p = 0.0015) and renal Kt/V (β = 0.38, p = 0.0059) were independently associated with the annual rate of renal Kt/V decline in multivariate analyses. Conclusions: Urinary DKK-3 assessment may help identify PD patients at a high risk of RRF decline.

Markers of cholesterol synthesis to cholesterol absorption across the spectrum of non-dialysis CKD: An observational study.

In dialysis patients, cholesterol‐lowering therapy with statins is less effective than in other high‐risk patients. This may be explained by a shift from cholesterol synthesis toward cholesterol absorption. In line, markers of cholesterol absorption—such as campesterol—better predict atherosclerotic cardiovascular events than markers of cholesterol synthesis—such as lathosterol—in dialysis patients. To test the association between markers of cholesterol absorption such as campesterol—and markers of cholesterol synthesis—such as lathosterol—against cardiovascular events in non‐dialysis CKD patients. Altogether 251 patients those not on lipid‐lowering agents were followed annually for the composite endpoint atherosclerotic cardiovascular disease (ASCVD) and all‐cause death. During follow‐up of 5.2 ± 2.1 years, 61 participants reached the primary endpoint atherosclerotic cardiovascular disease/all‐cause death [ASCVD/D], 47 participants suffered from ASCVD, and 46 participants died. In univariate Cox regression analysis, campesterol/lathosterol ratio did not significantly predict ASCVD/D (HR 0.643; 0.358–1.155; 3rd vs. 1st tertile), all‐cause death (HR 1.309; 0.604–2.838; 3rd vs. 1st tertile) nor ASCVD (HR 0.589; 0.311–1.118; 3rd vs. 1st tertile). We did not observe a shift from cholesterol synthesis to cholesterol absorption across the spectrum of non‐dialysis CKD. Campesterol/lathosterol ratio did not predict future ASCVD or all‐cause death in non‐dialysis CKD.

Clinical outcomes among patients with chronic kidney disease hospitalized with diabetic foot disorders: A nationwide retrospective study.

IntroductionDiabetic foot ulcerations or infections (DFUs/DFIs) are common complications of patients with diabetes. This study aimed to explore the impact of non‐dialysis and dialysis CKD on hospitalized patients with DFUs/DFIs.MethodsA retrospective cohort study was conducted using the National Inpatient Sample database for the years 2017 and 2018. Patients hospitalized for DFUs/DFIs were included in the study. The primary outcome was lower limb amputations. The secondary outcomes were inpatient mortality, sepsis, length of stay (LOS), total hospitalization charges (THC) and disposition.ResultsA total of 121,815 hospitalizations were included (26.1% non‐dialysis CKD; 8.4% dialysis CKD). There was no significant difference in amputation rates between those on non‐dialysis CKD (adjusted odds ratio [aOR]: 0.96; 95% confidence interval [CI]: 0.87–1.06) and dialysis CKD (aOR: 1.04, [95% CI: 0.91–1.12]) when compared to non‐CKD group. Dialysis CKD group had increased odds of undergoing major amputation (aOR: 1.74, [95% CI: 1.32–2.29]), in‐hospital mortality (aOR: 3.77 [95% CI: 1.94–7.31]), sepsis (aOR: 1.83 [95% CI: 1.27–2.62]), longer LOS (adjusted mean difference [aMD]: 1.46 [95 CI: 1.12–1.80) and higher THC (adjusted mean difference [aMD]: $20,148 [95% CI: $15,968‐$24,327]). Non‐dialysis CKD group had increased odds of sepsis (aOR: 1.36 [95% CI: 1.02–1.82]), less likely to be discharged home (aOR: 0.87 [95% CI: 0.80–0.95]), longer LOS (aMD: 0.91 [95% CI 0.69–1.13]) and higher THC (aMD: $20,148 [95% CI: $15,968–$24,327]).ConclusionPatients with CKD on dialysis had higher odds of undergoing major amputation. CKD increased the odds of in‐hospital morbidity and resource utilization, with the most significant is for those on dialysis.

Increased Serum Adipocyte Fatty Acid-Binding Protein Concentrations Are Associated with Aortic Stiffness in Nondialysis Diabetic Kidney Disease

BACKGROUND: Adipocyte fatty acid-binding protein (A-FABP) is a novel adipokine with proinflammatory properties that contributes to the development of cardiovascular disease. This cross-sectional study evaluated the correlation between serum A-FABP and aortic stiffness in patients with stages 3-5 nondialysis chronic kidney disease due to type 2 diabetes mellitus (T2DM). METHODS: Fasting blood samples were obtained from 96 patients with stages 3-5 nondialysis chronic kidney disease due to T2DM. Pressure applanation tonometry was used to measure the carotid-femoral pulse wave velocity (cfPWV). Patients with a cfPWV ＞ 10 m/s were defined as having increased aortic stiffness according to the guidelines of the European Society of Hypertension and European Society of Cardiology 2013. Serum A-FABP levels were determined using a commercial enzyme immunoassay. RESULTS: There were 53 (55.2%) patients in the aortic stiffness group, of which higher prevalence rates were found for the male sex (P = 0.015), older age (P = 0.025), higher systolic blood pressure (BP) (P = 0.001), diastolic BP (P = 0.037), urine albumin/creatinine ratio (P = 0.007), serum levels of total cholesterol (P = 0.030), low-density lipoprotein cholesterol (P = 0.043), and A-FABP (P ＜ 0.001) compared with the group with normal aortic stiffness. After adjusting for factors that are significantly associated with aortic stiffness based on multivariable logistic regression analysis, serum A-FABP (odds ratio, 1.487; 95% confidence interval, 1.210-1.829; P ＜ 0.001) was an independent predictor of aortic stiffness in patients with diabetes-associated stages 3-5 nondialysis chronic kidney disease. Multivariable regression analysis with forward stepwise selection revealed that the serum level of logarithmically transformed A-FABP (β = 0.587; adjusted R^2 change, 0.426; P ＜ 0.001) was positively associated with cfPWV in patients with diabetes-associated stages 3-5 nondialysis chronic kidney disease. CONCLUSION: After adjusting for significant confounders, the serum A-FABP level was positively correlated with cfPWV and was an independent predictor of aortic stiffness in patients with diabetes-associated stages 3-5 nondialysis chronic kidney disease.

Prevalence of hepatitis C virus infection in non-dialysis CKD patients: a multicentre study in renal clinics.

Chronic hepatitis C virus (HCV) infection is associated with a significant 31% higher risk of developing non-dialysis chronic kidney disease (ND-CKD) [1]. Furthermore, in patients with ND-CKD, HCV infection is associated with a faster decline of the estimated glomerular filtration rate (eGFR) over time and a higher risk of end-stage kidney disease compared with HCV-negative patients [2–5]. In the ND-CKD population, estimates of the prevalence of HCV infection are sparse and inconsistent and has been mainly evaluated by testing only anti-HCV antibodies without taking into account the active virus replication, assessed by nucleic acid testing (NAT) [6]. However, the wider use of direct antiviral agents (DAAs) as well as the spontaneous viral clearance make immunoassay testing insufficient for correctly estimating HCV prevalence among ND-CKD patients. Therefore we designed this observational multicentre study in order to estimate the prevalence of HCV in the ND-CKD population...

MO557EFFICIENCY OF FERRIC CARBOXYMALTOSE IN NON-DIALYSIS CKD PATIENTS AND ITS IMPACT ON KIDNEY FUNCTION: A PROSPECTIVE OBSERVATIONAL STUDY

Abstract Background and Aims Iron deficiency anemia occurs in the vast majority of patients with chronic kidney disease (CKD). The aim of this study was to investigate the efficacy of ferric carboxymaltose (FCM) iron deficiency anemia’s treatment in non-dialysis CKD patients and to clarify its impact on kidney function. Method Prospective observational study of non-dialysis CKD stage 3 to 5 patients, with anemia and iron deficiency treated with FCM from 01 January 2019 to 31 June 2020. FCM was administrated as a single IV infusion of 500mg or 1000mg. Baseline clinical, analytical and demographic data were recorded. FCM efficacy was evaluated by comparing hemoglobin (Hb), serum ferritin and transferrin saturation index (TSAT) 24 ± 8 weeks after the infusion with analytical values at baseline. Renal function was also assessed at baseline and at 24 ± 8 weeks using estimated glomerular filtration rate (eGFR), calculated by CKD-EPI formula. Statistical analysis was executed using SPSS (Version 23 for Mac OSX). Results The average age of 71 patients was 77.31 ± 9.68 years, 29 (40.8%) were male, 46 (64.8%) were diabetic and 41 (57.8%) had congestive heart failure. Sixteen (22.5%) patients had CKD stage 3, 41 (57.7%) stage 4 and 14 (19.7%) stage 5. Twenty-five (35.2%) patients were treated with 1000mg of FCM. At baseline, average hemoglobin level (Hb) was 10.16 ± 1.12g/dL, serum ferritin 83.25 ± 96.55µg/L, TSAT 14.48 ± 6.72mg/dL and eGFR 24.21± 13.09ml/min/1.73m2. At 24 ± 8 weeks, Hb showed an increase of 1.31 ± 1.49 g/dL (p=0.001) and TSAT 10.68 ± 10.40% (p=0.001). Serum ferritin showed also an increase of 4.75 ± 180.53µg/L but did not reach statistical significance. The increase in Hb was observed uniformly across all stages of CKD. A Pearson correlation revealed a positive correlation between the variation of Hb and eGFR during the study follow-up period (r=0.310, p=0.008). A subgroup analysis was performed, patients were classified in 2 groups according to FCM dose. At baseline, there was no age, comorbidities or eGFR difference among groups. Patients treated with 1000mg had lower Hb (p=0.03) and serum ferritin (p=0.01). At 24±8 weeks both groups showed increases in Hb (p=0.001) and TSAT (p=0.001). Patients treated with 1000mg showed also a significant increase in ferritin (p=0.004). The Pearson correlation confirmed a positive correlation between the variation of Hb and eGFR in the group of patients treated with 1000mg (r=0.467, p=0.019) but not in the group treated with 500mg. Conclusion FCM was effective in the treatment of iron deficiency anemia in non-dialysis CKD stage 3 to 5 patients. In our population, the increase of Hb levels correlated with an improvement in eGFR in patients treated with higher doses of FCM, suggesting a positive impact of FCM on kidney function.

MO615SUPPORT FOR CHRONIC KIDNEY DISEASE PATIENTS DURING COVID-19: PERSPECTIVES FROM PATIENTS, FAMILY AND HEALTHCARE PROFESSIONALS

Background and AimsPatients with non-dialysis chronic kidney disease (CKD patients) require specialised management, including routine clinical visits, laboratory measures, and medication adjustments. Inevitably, the COVID-19 pandemic has resulted in changes to delivery of care in a bid to prevent virus transmission in this clinically vulnerable group. The extent of the impact of any changes in support provision for patients is largely unknown. The study aimed to capture the views of CKD patients, family or other significant person in their lives (SO), and nephrology healthcare professionals (HCPs) on how patients’ healthcare needs were and could be supported during this time.MethodCKD patients, their SO (e.g., family member, friend) and HCPs from 10 secondary care sites across England were invited to take part in a bespoke online survey, as part of the DIMENSION-KD portfolio adopted study. Participants responded to yes/no and free-text questions about their satisfaction with available healthcare support (CKD, SO) and patients’ need for additional support (CKD, SO, HCP). Thematic analysis was applied to the free-text responses.Results230 CKD patients (mean age 63.8, SD 13.8 years), 67 SO (74% spouses), and 59 HCP of various specialties completed the survey between August and December 2020. 84% of CKD participants felt they could get the support they needed. The most frequent explanation (25%) was that direct contact with a member of their renal team was available when needed. Other explanations included 1. being monitored by the renal team, 2. continuation of regular appointments and having additional treatment when necessary, 3. an accessible local General Practice (GP), and 4. a particularly “helpful” nephrologist or “good relationships” with their doctors. All SO felt the patient could get the help they required. Their explanations were in line with those of CKD patients, i.e., readily available contact and access to the renal team (25%), followed by good relationship or highly positive experience with member(s) of the renal team, regularity of contact/ appointments, and GP accessibility. When asked about additional healthcare information and support they would like, “none” was the most common response by CKD patients (28%), followed by the need for reliable information around COVID-19 and renal conditions, access to local GP, and a reliable point of contact when kidney condition deteriorates. Similarly, for many SO there was no need for additional support, whilst the most often suggested type of support was provision of reliable information on COVID-19 and renal health. For HCP, accessible service and guidance (36%) and psychosocial support for patients (25%) were most frequently cited types of additional support that would benefit patients.ConclusionAn accessible point of contact for renal care and continuation of regular monitoring of some form emerged as key factors in CKD patient support across the three stakeholder groups. Some needs raised, such as limited access to GP, are relevant to local primary or secondary healthcare services, while practices adopted by some renal teams, such as a number for patients to ring when needed, seemed to offer reassurance and satisfaction among patients and their SO.

MO1036DEVELOPMENT OF A DIGITAL SELF-MANAGEMENT EDUCATION PROGRAMME TO IMPROVE HEALTH BEHAVIOURS IN PEOPLE WITH NON-DIALYSIS CKD

Background and AimsAppropriate disease and healthcare management are key behaviours for health optimisation in people with long-term conditions including CKD. Effective self-management of health requires appropriate knowledge, skills and confidence. Digital health interventions are potentially appealing tools to improve knowledge and self-management behaviours, as well as actively involving individuals in their healthcare, particularly in the post-COVID-19 era. However, the development strategies and processes behind such interventions are poorly defined. Here we describe the systematic development of a digital self-management programme for people living with non-dialysis CKD which includes novel approaches to improving self-management and health behaviours.MethodIntervention mapping (IM) was used to guide the development of a digital self-management programme called ‘My Kidneys and Me’ (MK&M) to ensure that it can be implemented in clinical practice. The development process was guided by the first four steps of IM: (1) establish multidisciplinary and patient and public involvement (PPI) steering groups to describe the context of the intervention and programme goals; (2) identify objectives and determinants at early design stages to maintain a focus on the strategies adopted; (3) generate the programme components underpinned by appropriate psychological theories and models; (4) develop the programme content and describe the iterative process of refining the content and format of the digital programme for evaluation and implementation. The last two steps (adoption, implementation, and evaluation plan) will be evaluated alongside a forthcoming trial.ResultsA multidisciplinary steering group was formed consisting of 23 healthcare professionals, researchers, and digital health experts who provided expertise in the clinical and psychosocial aspects of CKD, self-management, digital health, and behaviour change research. A PPI steering group of 12 patients and family members identified the needs and priorities of MK&M, providing feedback at relevant time points.As a result of previous literature and input from both steering groups, MK&M was developed with the aim to improve and maintain self-management behaviours, including to improve knowledge, promote self-care skill, increase self-efficacy, improve well-being, and increase physical activity. These target behaviours were translated into key programme goals: 1) increase patient activation; 2) reduce health risks; 3) manage symptoms; and 4) increase physical function.Based on patient input and needs, MK&M was designed to comprise educational (Learn about …) and behaviour change (How to …) sessions, health trackers (e.g. blood pressure, weight, fruit and veg consumption), symptom tracker, exercise trackers, goal setting features, and social support. For example, to improve symptom management behaviours, patients can use MK&M to: 1) learn about symptoms associated with CKD and strategies to help manage these symptoms; 2) learn how to recognise and keep track of their symptoms so that they can modify their lifestyle accordingly and speak to their healthcare professional if needed; 3) track their symptoms using a bespoke tool.ConclusionApplying the IM framework enabled us to systematically use theory, empirical evidence, and practical perspectives in the development of MK&M. Our evidence- and theory-based online self-management programme provides ongoing support and guidance to people with CKD. The efficacy of MK&M to improve patient self-management behaviour is being studied in a multi-site RCT in the UK.MO1036 Figure 1: My Kidneys & Me login page and home page

MO139INDOLE-3-ACETIC ACID CORRELATES WITH MONOCYTE TO HIGH-DENSITY LIPOPROTEIN (HDL) RATIO (MHR) IN CHRONIC KIDNEY DISEASE (CKD) PATIENTS AND MAY BE EFFICIENTLY REMOVED BY ACETATE-FREE BIOFILTRATION

Abstract Background and Aims Indole-3-acetic acid (IAA, also called auxin) is a protein-bound indolic uremic toxin deriving from tryptophan metabolism by the intestinal bacteria. Previous studies have shown that increased IAA is associated with enhanced tissue factor synthesis in endothelial and peripheral blood mononuclear cells, oxidative stress and endothelial inflammation with resulting higher risk of thrombotic events and both cardiovascular and all-cause mortality. An emerging biomarker of cardiovascular disease is the monocyte to high-density lipoprotein (HDL) ratio (MHR). Its prognostic value is related to the ability of monocytes to release several cytokines involved in inflammation and atherogenesis and to the protective role of HDL through removal of cholesterol from peripheral tissues and suppression of both monocyte progenitor cell proliferation and differentiation and monocyte activation. In this single-centre cross-sectional observational study, we investigated the potential association of IAA with MHR and other markers of cardiovascular risk in a cohort of patients with CKD and evaluated the effect of a single midweek dialysis session with AFB (Acetate-free Biofiltration) technique on IAA serum concentrations. Method We enrolled 61 non-dialysis CKD adult patients and 6 dialysis patients treated with AFB technique. IAA levels were measured using an enzyme-linked immunosorbent assay (ELISA) kit (Cat. number abx150354; Abbexa Ltd, Cambridge, UK). Post-dialysis IAA levels were corrected for haemoconcentration. Results In the whole cohort of 67 patients, IAA was directly related to creatinine (ρ = 0.247; P = 0.0441), potassium (r = 0.2871; P = 0.0185), Ca x P product (ρ = 0.256; P = 0.0365) and MHR (ρ = 0.321; P = 0.0082). After adjustment for creatinine, the correlation between IAA and potassium became not significant (r = 0.1968; P = 0.1133). Stratifying patients according to the history of cardiovascular disease, in the 40 patients with previous cardiovascular events IAA levels correlated significantly with uric acid (r = 0.3952; P = 0.0116) and MHR (ρ = 0.380; P = 0.0157). In the remaining 27 patients without history of cardiovascular disease, IAA only correlated with potassium (r = 0.3912; P=0.0481) and, though borderline significantly, with creatinine (ρ = 0.349; P = 0.0805). To assess whether IAA would independently predict MHR values, we evaluated potential correlations of MHR with risk factors for cardiovascular disease. MHR was related with fibrinogen (ρ = 0.426; P = 0.0010), arterial hypertension (ρ = 0.274; P = 0.0251), C-reactive protein (ρ = 0.332; P = 0.0061), gender (ρ = -0.375; P = 0.0017; 0 = male, 1 = female), and CKD stage (ρ = 0.260; P = 0.0337). A multiple regression analysis identified IAA as an independent predictor of MHR. Lastly, IAA levels were higher in dialysis patients compared to non-dialysis CKD patients (97.44 ± 21.58 versus 65.08 ± 24.38 ng/ml respectively; P = 0.0026) and it was significantly removed by a single AFB session (97.44 ± 21.58 versus 54.59 ± 21.74 ng/ml; P = 0.0028) with a reduction ratio of 43.80 ± 17.47%. Conclusion This study shows a statistically significant association between IAA and MHR. Based on previous experimental studies, such relationship could be explained by the activation of the transcription factor aryl hydrocarbon receptor. Indeed, IAA is a potent ligand of aryl hydrocarbon receptor and the latter has proinflammatory and proatherogenic activities and can reduce HDL levels. Moreover, AFB efficiently removes IAA during a single dialysis session. Prospective studies with appropriate sample size and sufficiently long period of observation are required to evaluate if decreasing IAA levels, through targeted therapeutic strategies in non dialysis CKD patients or by optimization of dialysis techniques and prescriptions in patients receiving renal replacement therapy, may reduce MHR levels and cardiovascular events and improve clinical outcomes and survival.

MO889COST OF ILLNESS OF CHRONIC KIDNEY DISEASE IN LEBANON: FROM THE SOCIETAL PERSPECTIVE

Abstract Background and Aims Chronic Kidney Disease (CKD) is the 12th leading cause of death worldwide and a high societal burden. Cost-of-illness studies of CKD are scarce in developing countries. Identifying factors associated with the highest cost can help decision makers adapt health policies and sustain kidney health services, especially in limited resources' settings. This study aims to estimate the cost of illness of CKD in Lebanon, from the early stages of CKD until dialysis and kidney transplant and identify cost components related to the highest financial burden. Method This is a cross-sectional study of all CKD patients who presented to two nephrology clinics during the first two weeks of November 2020. The sample size required for the study to be representative was 154 patients. The medical and administrative records were reviewed to collect the demographics and CKD characteristics of patients as well as the direct medical costs (medications, diagnostic tests, hospitalizations, inpatient care, outpatient care), direct non-medical costs (transportation) and indirect costs (productivity losses) for one year between 1st June 2019 and 1st June 2020. Kruskal Wallis test was used to compare the costs between different CKD stages and categories. The study got the approval of the ethics committee of Saint-Joseph University. Results The sample included a total of 160 patients: 102 non-dialysis CKD patients, 40 hemodialysis, 8 peritoneal dialysis and 10 kidney transplant patients. Their mean age was 66.74 ±15.36 years, 57.5% were males and 42.5% diabetics. The mean number of daily medications was 8.75 ±3.38, mean frequency of blood tests per year 6.86 ±6.4 and mean number of hospital admissions per year 0.79 ±1.43. The mean total annual cost of CKD per patient across all categories was assessed at 19,900,164 ±27,893,591 Lebanese Pounds (1 $USD= 1515 LP in 2019). Statistical analysis showed a higher total cost among dialysis patients compared to other categories of CKD (p&amp;lt;0.001), higher cost of medications in transplant patients (p&amp;lt;0.001) and higher cost of technique modality in peritoneal dialysis patients (p&amp;lt;0.001). These differences are summarized in Figure 1. Conclusion Similar to previous studies from other countries, this cost of illness analysis showed a high burden of dialysis annual costs compared to non-dialysis CKD and transplant patients. It revealed as well a great burden of medications' costs at the level of dialysis and transplantation. It is thus crucial that governments and health policies in low- and middle-income countries target interventions that prevent end-stage kidney disease, reduce medications' costs and most of all create programs that encourage kidney transplantation.

MO206MALE SEX IS ASSOCIATED WITH IN-HOSPITAL DEATH IN NON-DIALYSIS CKD PATIENTS WITH COVID-19

Background and AimsCoronavirus disease (COVID-19), caused by Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) can lead to significant organ injury. CKD has been associated with increased mortality in previous epidemics, and male sex has been correlated with worse outcomes during COVID-19 in the general population. Our aim was to describe the differential effect of sex as a risk factor for in-hospital mortality among non-dialysis CKD subjects.MethodMulticenter, observational cohort study including 136 adult patients with CKD and 136 age- and sex-matched controls who required admission for COVID-19 in three academic hospitals in Spain. Viral infection was confirmed by real-time RT-qPCR and/or serologic testing in all cases. Disease severity on admission was classified according to the WHO—China Joint Mission Report on COVID-19. The presence of CKD was defined as sustained eGFR <60 and >15 ml/min/1.73m2 within the 6 months prior to COVID-19 hospitalization. Demographic and clinical data were gathered from medical records. Outcomes were recorded during the following 28 days after admission. We applied Cox proportional hazards models, adjusted for age, sex, hypertension, diabetes and severe or critical disease at presentation.ResultsDue to the matched design, no differences were found regarding age and sex between cohorts. CKD patients suffered more frequently from hypertension and diabetes and presented higher 28-day mortality after hospital admission due to COVID-19 compared with age- and sex-matched controls (40.4 vs. 24.3%; P=0.004). In adjusted Cox regression analysis among CKD patients, only age (HR: 1.087, 95% CI: 1.047-1.128) and male sex (HR: 1.883, 95% CI: 1.045-3.391) were independent predictors of 28-day mortality. Comparatively, among patients without CKD, only age acted as an independent predictor for 28-day mortality (HR: 1.082, 95% CI: 1.033-1.133). None of the variables included in adjusted regression was able to predict ICU admission in any of the cohorts.ConclusionMale sex is associated with increased mortality, but not with ICU admission, after hospitalization due to COVID-19 among non-dialysis CKD patients. That effect was not observed among hospitalized controls without CKD.

MO490SYMPTOM BURDEN AND ITS IMPACT ON QUALITY OF LIFE IN PATIENTS WITH MODERATE TO ADVANCED CKD

Abstract Background and Aims It is generally considered that the early stages of CKD are asymptomatic, and that CKD becomes apparent once kidney function is significantly impaired, but large-scale studies in real-world non-dialysis CKD patients under nephrology care are still scarce. We evaluated symptom burden and its impact on quality of life in patients with moderate to advanced CKD. Method 4423 patients with CKD Stage 3 to 5 from Brazil (N=548), France (N=2691), and the US (N=1184) enrolled in the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps) from 2013-2019 completed the Kidney Disease Quality of Life (KDQOL) questionnaire at baseline to assess how much they were bothered by 13 symptoms. Response options ranged from “not at all” to “extremely” bothered. From these Symptoms/Problems of Kidney Disease items, a score was calculated, ranged from 0 to 100, and analyzed in 3 categories: low (≥90), intermediate (66-90), or high symptom burden (&amp;lt;66). Poisson regressions were used to estimate prevalence ratios for each symptom and to study associations between CKD stage and a high symptom burden before and after adjusting for demographics and major comorbidities. Multiple linear regression accounting for clustering at the clinic level was used to examine associations between high symptom burden and physical and mental component summary (PCS and MCS, respectively) scores, with lower scores indicating poorer quality of life. Results Patients (mean age 68±13 years, 40% women, mean eGFR at baseline 30.4±12.2 mL/min/1.73m²) were very much to extremely bothered by a number of symptoms, the prevalence of three of which - washed out or drained, nausea or upset stomach, and lack of appetite – significantly increased in more advanced CKD stages before and after adjusting for confounders (Figure). Nearly one in four patients reported a high symptom burden, which was more prevalent in women, those with obesity, anemia, or albumin&amp;lt;3.5 g/dL; it was also more common in France than in the US and Brazil. In adjusted models, as compared to patients with low symptom burden, those with high symptom burden had a worse quality of life with PCS and MCS scores 14.6 (95% confidence interval [95% CI], 15.7 to 13.5) and 7.2 (95% CI, 8.3 to 6.1) points lower, respectively. Conclusion Our findings demonstrate a high symptom burden even in nondialysis CKD stages 3-5 with a substantial impact on physical and mental health-related quality of life. Several symptoms, particularly fatigue, and gastrointestinal symptoms, appeared to worsen with increasing CKD stage, independent of patient comorbidities.

MO612THE ROLE OF MECHANICAL MUSCLE POWER IN PHYSICAL DYSFUNCTION: A MODEL FOR TAILORING RESISTANCE-BASED REHABILITATION IN CHRONIC KIDNEY DISEASE

Abstract Background and Aims Individuals living with CKD are characterised by adverse changes in physical function. Knowledge of the factors that mediate impairments in physical functioning is crucial for developing effective interventions that preserve mobility and future independence. Mechanical muscle power describes the rate of performing work and is the product of muscular force and velocity of contraction. Muscle power has been shown to have stronger associations with functional limitations and mortality than sarcopenia in older adults. In CKD, the role of mechanical muscle power is poorly understood and is overlooked as a target in many rehabilitation programmes, often at the expense of muscle mass or strength. The aims of this study were to 1) explore the prevalence of low absolute mechanical power, low relative mechanical power, and low specific mechanical power in CKD; and 2) investigate the association of mechanical power with the ability to complete activities of daily living and physical performance. Method Mechanical muscle power (relative, allometric, specific) was calculated using the sit-to-stand-5 (STS5) test as per previously validated equations. Legs lean mass was derived from regional analyses conducted using bioelectrical impedance analysis (BIA). Physical performance was assessed using two objective tests: usual gait speed and the ‘time-up-and-go’ (TUAG) test. Self-reported activities of daily living (ADLs) were assessed via the Duke Activity Status Index (DASI). Balance and postural stability (postural sway and velocity) was assessed using a FysioMeter. Sex-specific tertiles were used to determine low, medium and high levels of relative STS power and its main components. Results 102 participants with non-dialysis CKD were included (mean age: 62.0 (±14.1) years, n=49 males (48%), mean eGFR: 38.0 (±21.5) ml.min.1.73m2). The mean estimated relative power was 3.1 (±1.5) W.kg in females and 3.3 (±1.3) W.kg in males. Low relative power was found in 35/102 (34%) patients. Relative power was a significant independent predictor of self-reported ADLs (via the DASI) (B=.413, P=.004), and performance on the TUAG (B=-.719, P&amp;lt;.001) and gait speed (B=.404, P=.003) tests. Skeletal muscle mass was not associated with the DASI or any of the objective function tests Conclusion Patients presenting with low muscle power would benefit from participation in appropriate interventions designed to improve the physiological components accounting for low relative muscle power. Assessment of power can be used to tailor renal rehabilitation programmes as shown in Figure 1. Incorporation of power-based training, a novel type of strength training, designed by manipulating traditional strength training variables and primarily movement velocity and training intensity may present the best strategy for improving physical function in CKD.

FC 007CKD DERIVED MUSCLE CELLS RETAIN PHENOTYPIC CHARACTERISTICS OF UREIC SARCOPENIA: THE NEXT STEP IN CELLULAR MODELLING FOR THERAPEUTIC SCREENING

Abstract Background and Aims Skeletal muscle wasting and dysfunction is a debilitating co-morbidity for people who suffer from kidney disease. To date research has sought to understand the mechanisms by which this occurs, in order to inform the prescription of required interventions in order to counteract such effects. Though progress has been made through in-vivo physiology research, the lack of an in-vitro translational model which replicates the phenotype noted in this patient group has hindered progression. The aim of the work presented was to systematically define a human derived skeletal muscle model with cells derived from people with kidney disease, in order to provide a test bed for the future screening of novel therapeutics and the investigation of the dynamic processes involved in the unwanted characteristics observed in this population. Method Skeletal muscle biopsies were taken from the vastus lateralis of non-dialysis dependent CKD patients (CKD; n=12) and Controls (CON; n=12), matched for age, sex, ethnicity and physical activity levels. Biopsy samples were subject to an enzymatic digestion method to enable the isolation of the muscle derived cells required for cellular experimentation. Once taken through the cell cycle, cells were plated into experimental wells and proliferated for 5 days or until confluent. Once confluent cells were differentiated through serum restriction to form mature myotubes (muscle fiber like structures) for a minimum of 7 days. Sampling time points were taken throughout to allow for the analysis of markers of proliferation, myogenic capacity, maturation, inflammation, protein synthesis and protein degradation. Further experiments were conducted on mature myotubes, where myotubes from both donor groups were exposed to either 0.4nM or 100nM of IGF-1 and p-Akt and protein synthesis quantified to investigate the presence of anabolic resistance in CKD derived cells. Results We report here that muscle cells derived from CKD patients have significantly higher levels of markers of proliferation (p = 0.041) and myogenic capacity (p = 0.034). Regarding myotube maturity, lower ratios of mature Myosin Heavy Chains were noted in CKD derived cells in comparison with CON derived cells (p = 0.012). On analysis of rates of protein synthesis and degradation in mature myotubes, no differences were noted in the rate of protein synthesis or the p-Akt in basal conditions (p &amp;gt; 0.05), however, significant elevations were noted in both protein degradation rates (p = 0.014) and the mRNA gene expression levels of E3-ligases (p = 0.016). On analysis of the experimentation investigating anabolic resistance, a degree of anabolic resistance was noted with inhibited p-Akt (p = 0.019) and protein synthesis (p ≤ 0.001) noted in cells derived from CKD cells in comparison to CON cells, when exposed to both doses of IGF-1. Conclusion Here we describe for the first time a human derived, disease specific model of uremic sarcopenia with many of the phenotypic traits noted in this population being maintained, such as elevated protein degradation and anabolic inhibition. This work not only provides a translational mechanistic insight into the cellular underpinnings of uremic sarcopenia but will allow for the future screening of novel therapeutics, in order manipulate the dynamic processes which lead to the debilitations noted in CKD populations.

MO496PRESCRIPTION OF DIRECT ORAL ANTICOAGULANTS TO PATIENTS WITH MODERATE TO ADVANCED CKD : TOO LITTLE OR JUST RIGHT?

Abstract Background and Aims Prescription of anticoagulants in patients with chronic kidney disease (CKD) is challenging, since these patients are at high risk of thromboembolic episodes, but are also prone to bleeding events. Based on a number of pivotal trials, four direct oral anticoagulants (DOACs) have been approved for use in non-valvular atrial fibrillation (AF) since 2010. These DOACs have now supplanted vitamin K antagonists (VKAs) as first-line treatment in non-CKD patients. Following post-hoc analyses of randomized clinical trials of DOACs in CKD patients performed between 2011 and 2016, a 2018 Kidney Disease Improving Global Outcomes Controversies Conference stated that although there is not enough evidence to recommend DOACs in patients with advanced CKD, these medications are safer than VKAs and not inferior for stroke preventing in patients with AF and an estimated glomerular filtration rate (eGFR) between 30 and 50 ml/min/1.73 m2. Here, in a study of stage 3 to 5 CKD patients, we sought to describe multinational prescription patterns for oral anticoagulants in general and for VKAs vs. DOACs in particular. Method We analyzed data from the international CKD Outcomes and Practice Patterns Study (CKDopps) of non-dialysis CKD patients ≥ 18 years of age with an eGFR &amp;lt;60 mL/min/1.73 m² at study enrollment. Participants were selected from national samples of nephrologist-run CKD clinics in Brazil, France, Germany, and the USA between January 2013 and April 2019. The CKDopps is ongoing, and at least 3 years (for the USA, Germany, and Brazil) or 5 years (for France) of prospective follow-up are planned. We assessed prescription patterns for oral anticoagulants regardless of indication at baseline and during follow-up. Results Of the 8154 patients enrolled, 7092 had drug prescriptions data available at baseline, and 1080 (15%) of these had at least one prescription of an oral anticoagulant. At baseline, VKAs were the most frequently prescribed oral anticoagulants (n=984, 91%), and only 97 of the 1080 patients (9%) were on DOACs (91 on a direct factor Xa inhibitor and 6 on a direct thrombin inhibitor). This low DOAC prescription rate was observed in France, the USA, Brazil and Germany. There was an upward trend in DOAC prescription (relative to VKAs) over the course of the study. Over a median [interquartile range] follow-up period of 3 years [1.5-4.5], 287 incident oral anticoagulant prescriptions were reported, 177 started on VKAs and 110 started on DOACs. Among the patients receiving a VKA at baseline, only 44 switched to a DOAC. Conclusion In an international sample of non-dialysis CKD patients (eGFR &amp;lt;60 mL/min/1.73 m²), we observed low prescription of direct oral anticoagulants (9%) at baseline, relative to vitamin K antagonists (91%) across countries included in the analysis. However, there was an upward trend in DOAC prescriptions (relative to VKAs) over the course of the study. In view of the risk of significant adverse events associated with VKAs, the prescription of DOACs should be encouraged - particularly for CKD stage 3 patients and future studies of risk/benefit comparing VKAs and DOACs are necessary in CKD patients.

MO560IS SERUM ERYTHROPOIETIN CORRELATED WITH IRON METABOLISM AND INFLAMMATION IN NON-DIALYSIS CHRONIC KIDNEY DISEASE PATIENTS WITH ANEMIA?

Abstract Background and Aims Both the relative erythropoietin (Epo) deficiency and its relationship with serum hemoglobin (Hb) are widely postulated in chronic kidney disease (CKD), but the influence of chronic inflammation and iron status on serum Epo levels is still a matter of debate, with yet divergent reported results. Therefore, we aimed to assess the determinants of serum Epo in non-dialysis CKD patients. Method Fifty-two adults with CKD and anemia (defined as Hb &amp;lt;12g/dL), in stable clinical condition, never treated with erythropoiesis-stimulating agents (ESA) entered this cross-sectional, single-center study. Diabetes mellitus, active infectious and inflammatory diseases, malignancy, anemia of other causes than CKD, current immunosuppressive therapy, iron supplementation and blood transfusions in the previous six months were exclusion criteria. The subjects were mostly men (56%), elderly (two thirds over 60 years), with advanced CKD [71% in CKD stages G4-G5, median estimated glomerular filtration rate – eGFR 14.5 (95%CI 16 to 25) mL/min], moderate anemia [Hb 9.8 (95%CI 9.2 to 9.9) g/dL], and mild to moderate inflammation [C-reactive protein 6 (95%CI 9.2 to 18.4) mg/L]. Serum Epo was assessed by ELISA (Abcam® 119522). Complete blood count, reticulocyte index, peripheral blood smear, bone marrow aspiration (Perls’ stain), serum ferritin, and transferrin saturation, were used to investigate anemia and iron metabolism. Parameters of kidney disease (CKD etiology, eGFR and proteinuria), demographic data (age, gender), C-reactive protein, serum albumin, and serum hepcidin-25 (Hep-25, Bachem® commercial ELISA kit) were also analyzed. Results The median serum Epo of the whole cohort was 4.8 (95%CI 5.1 to 9.9) mU/mL. According to median Epo, subjects were clustered in Group 1 (below median, G1) and Group 2 (above median, G2). Estimated GFR and serum Hep-25 were lower in G1 than in G2 [10.6 (95%CI 9.7 to 20.8) vs. 26 (95%CI 19.1 to 32.8) mL/min, p=0.004, and 62.6 (95%CI 51.0 to 85.1) vs. 95.4 (95%CI 77.0 to 108.5) ng/mL, p=0.03, respectively]. All the other investigated parameters were similar in the two groups. In bivariate analysis (Spearman rank correlation), serum Epo was positively associated only with eGFR (rs=0.40, p=0.003). Marginal associations with the percentage of bone marrow sideroblasts, as marker of the iron available for erythropoiesis (rs=0.25, p=0.08), erythrocyte mean corpuscular hemoglobin concentration (rs=−0.26, p=0.07), and reticulocyte index (rs=0.24, p=0.09) were observed. Conversely, serum Epo was not related to hemoglobin, indices of iron stores (e.g. serum ferritin and iron content in bone marrow macrophages), inflammation and nutritional status (e.g. C-reactive protein and serum albumin). In a model of multiple linear regression which explained 14% of serum Epo variation, eGFR was the only determinant: Beta 0.14 (95%CI 0.05 to 0.23), p=0.004. Also, a binary logistic multiple regression model predicting serum Epo lower or higher than the median retained the eGFR as an independent predictor, while serum hepcidin showed only borderline significance: Conclusion Kidney function is the main determinant of endogenous erythropoietin level in moderately anemic patients with advanced CKD, ESA or iron naive, while serum hepcidin-25 seems to exert a limited influence.

MO474PCSK9 LEVELS AND MARKERS OF INFLAMMATION, OXIDATIVE STRESS AND ENDOTHELIAL DYSFUNCTION IN A POPULATION OF NON-DIALYSIS CHRONIC KIDNEY DISEASE PATIENTS: IS THERE AN ASSOCIATION?

Abstract Background and Aims Proprotein convertase subtilisin / kexin 9 (PCSK9) plays an important role in lipid metabolism while available literature regarding its involvement in the pathogenesis of atherosclerosis and in the expression of genes associated with apoptosis and inflammation is constantly increasing. Patients with chronic kidney disease (CKD) experience disproportionately increased cardiovascular morbidity and mortality due to dyslipidemia, accelerated atherosclerosis, inflammation, oxidative stress and other risk factors. In the present cross-sectional study, we investigated the possible association of serum PCSK9 levels with markers of inflammation, oxidative stress and endothelial damage in patients with CKD. Method Ninety-two patients with CKD stage II-ΙV (eGRF CKD-EPI 47.3 ±25.7ml/min/1,73m2, mean age 66 years, 51 men) were included. Plasma PCSK9 levels were correlated with comorbidities (arterial hypertension; diabetes mellitus, history of cardiovascular disease), renal function indices (eGFR, proteinuria – UPR/24h), lipid parameters (LDL-cholesterol, HDL-cholesterol, triglycerides, Lp (a), APO-A1, APO-B), as well as soluble biomarkers of inflammation, oxidative stress and endothelial damage (hs-CRP, fibrinogen, 8-epiPGF2a, ox-LDL, IL-6, TNF-α, sICAM-1, sVCAM-1). Results The mean plasma value of PCSK9 was 278.1ng/ml. PCSK9 levels showed direct correlation with serum triglycerides (p = 0.03), Lp(a) (p = 0.01), and sICAM-1 levels (p = 0.03). There was no significant correlation between PCSK9 levels and indices of renal function, other lipid profile parameters, inflammatory markers or co-morbidities. Multiple regression analysis showed a significant effect of the Lp(a) on PCSK9 levels, for each unit of higher Lp(a), an increase by 3.082 is expected (95% CI: 0.935 - 5.228, p=0.006). At the same time, patients receiving statins are expected to have on average 63.8ng/ml higher PCSK9 values compared to patients not receiving statins (95% CI: 14.6 - 113.5 p=0.012). Conclusion Plasma levels of PCSK9 in non-dialysis CKD patients are correlated with endothelial dysfunction and lipid metabolism parameters. Statin intake increases PCSK9 levels significantly in this patient population. PCSK9 levels are not correlated with the severity of kidney disease. Major prospective studies are necessary to investigate the role of PCSK9 in the atherosclerotic cardiovascular outcome in CKD

MO154ASSESSMENT OF MILD COGNITIVE IMPAIRMENT IN PRE-DIALYSIS CHRONIC KIDNEY DISEASE AND ITS ASSOCIATION WITH INFLAMMATION AND CHANGES IN MRI: WHAT THE EYES DON´T SEE

Abstract Background and Aims Mild cognitive impairment (MCI) consists of a decline of one or more cognitive domains, independent of functional impairment. There are common pathophysiological factors between chronic kidney disease (CKD) and MCI. The aim of this study was to evaluate the association of MCI in pre-dialysis CKD with inflammation markers and alterations of image exams (Nuclear Magnetic Resonance-MRI). Method Cross-sectional study, were evaluated non-dialysis CKD patients in categories 1 to 5 in a secondary care clinic, from 2013 to 2015. Inclusion Criteria: age ≥ 21 and ≤ 65 years and having signed the informed consent form. Non-inclusion criteria: previous history of stroke, degenerative and infectious diseases of the CNS, presence of delirium and / or psychotic disorders, previous history of mental retardation and cranioencephalic trauma, visual and auditory disorders that prevented the tests, HIV and / or AIDS, contraindication or intolerance to MRI. The project was approved by the Research Ethics Committee. MCI was assessed using the Montreal Cognitive Assessment (MoCA) and the estimated glomerular filtration rate (eGFR), using the CKDEPI formula. Socio-demographic and clinical data were collected from medical records. Laboratory data were collected a maximum of 3 months after the MoCA evaluation, as well as the measurement of IL4, IL6, IL17, TNF alpha and hs-CRP. The brain MRI scans were performed in a Siemens Avanto high-field device (1.5 Tesla), without the use of paramagnetic contrast. Fazekas scales were used to quantify white matter lesions, MTA scale to quantify hippocampal involvement, ACG scale for global cortical atrophy. Statistical analysis a descriptive analysis was performed, followed by a comparison of abnormal vs normal MoCA among all variables with the relevant tests; MoCA and eGFR were also correlated with all variables. Finally, we performed a linear regression using MoCA as a dependent variable, adjusting for relevant confounding variables. Results 111 patients were invited, 80 were included in the neuropsychological assessment and 56 patients performed all stages of the study. The mean age was 56.3 ± 8.3 years, 51.8% had an altered MoCA. Comparing those with altered vs normal MoCA, we observed that there were fewer years of schooling (p = 0.04), greater use of diuretics (p = 0.04) and AAS (p = 0.002); in addition to higher levels of IL6 (p = 0.02) and IL17 (p = 0.05) among those with altered MoCA. There was no correlation between MoCA and eGFR. MoCA correlated with IL6 (R-0.201, p = 0.04). There was a correlation between eGFR (IL4 (R- -0.467, p = 0.005; IL6 (R- -0.652, p &amp;lt;0.001); IL17 (R- -0.554, p = 0.001), TNF alpha (R- -0.684, p &amp;lt;0,001). There was no correlation between the findings in MRI and eGFR or MoCA. In a linear regression model, the variables IL17 and IL6 were independent predictors of lower values of MoCA (CI -0.031 to -0.002, p = 0.002; CI-0.012 to -0.001, p = 0.002). Conclusion The prevalence of changes in MoCA in this population was 51.8%, the eGFR was correlated with inflammation, MoCA was negatively correlated with IL6. There was no association between MRI findings and eGFR or inflammatory variables, and eGFR was not a predictor of MoCA values, while IL17 and IL6 were.

MO727EFFECT OF SACUBITRIL/VALSARTAN ON SERUM POTASSIUM AND BLOOD PRESSURE LEVELS OF DIALYSIS PATIENTS WITH HEART FAILURE

Abstract Background and Aims Heart failure is a frequent complication in patients with chronic kidney disease (CKD). As the kidney function declines, the incidence of heart failure and all-cause mortality increases. Heart failure is treated based on the ejection fraction and most of the treatments are often dependent on the renal function. The treatment guidelines of heart failure are not entirely applicable to those with CKD, since this population is usually not included in the randomized control trials. The introduction of neprilysin-inhibitor changed the paradigm of heart failure with reduced ejection fraction (HFrEF) treatment but the effects on dialysis patients is still under studied. Sacubitril/Valsartan is an ARNI that has been recommended as a treatment for symptomatic HFrEF. Monitoring of renal function and potassium is recommended for patients who will take Sacubitril/Valsartan and the two most common side effects are hyperkalemia and hypotension. This study evaluated the safety of Sacubitril/Valsartan by assessing the incidence of hyperkalemia and hypotension on patients undergoing maintenance dialysis - peritoneal or hemodialysis. The objective of the study was to compare the effect of losartan against sacubitril/valsartan on the systolic blood pressure (SBP), diastolic blood pressure (DBP), and serum potassium level across three time points (1st, 2nd, and 3rd month follow-up). Method This retrospective, cohort, single-center study of dialysis patients with HFrEF is designed to assess the safety of Sacubitril/Valsartan versus Losartan based on the blood pressure and serum potassium level. A total of 96 patients on dialysis diagnosed with HFrEF was included in the study. Half was prescribed with Sacubitril/Valsartan while half was prescribed with Losartan. Serum potassium, systolic and diastolic blood pressure were recorded at baseline and monthly on the first three months of follow-up. Baseline 2d echocardiography was also reviewed. Results There were 96 chronic kidney disease patients with HF; 48 were on peritoneal dialysis and 48 on hemodialysis. Per group, 24 were given Losartan and 24 were given Sacubitril/Valsartan for 3 months. The mean age was 47.5 (15.5) years and ranges from 19 to 78 years old. Sixty two percent were males. The most common diagnosis were glomerulonephritis (36.5%), hypertensive nephrosclerosis (27.1%) and diabetic nephropathy (26%). In this retrospective study, we found that there were no episodes of hypotension and hyperkalemia on both hemodialysis and peritoneal dialysis patients who were prescribed with Sacubitril/Valsartan. All the hemodialysis patients included in this study were maintained on thrice a week hemodialysis sessions and the peritoneal dialysis patients had at least 3 exchanges per day. There were no significant change at three points in time (1st, 2nd, and 3rd month follow-up) in the levels of systolic blood pressure (p-value= 0.780, 0.609, 0.926), diastolic blood pressure (p-value= 0.692, 0.206, 0.527), and serum potassium (p-value= 0.212, 0.084, 0.095) on patients maintained on Sacubitril/Valsartan compared to Losartan. There was no evidence of hyperkalemia or hypotension on dialysis patients taking both medications. Conclusion Sacubitril/Valsartan is recommended in the therapy for HFrEF because of the documented benefits in the non-CKD and non-dialysis CKD patients. In this study, Sacubitril/Valsartan is well tolerated and has same effect on the serum potassium and blood pressure compared to Losartan. We concluded that there was no episode of hyperkalemia and hypotension on dialysis patients taking both medications. For the first time, this study demonstrated that Sacubitril/Valsartan is safe to be used in dialysis patients.