Non-dialysis Group Research Articles

POS-576 OUTCOMES OF GERIATRIC PATIENTS WITH CHRONIC KIDNEY DISEASE STAGE 5 : SINGLE CENTRE EXPERIENCE

Globally, the number of elderly persons with stage 5 chronic kidney disease (CKD) is rising. It's still unclear whether dialysis will benefit geriatric patients with advanced CKD. The decision to start dialysis or to follow a non-dialysis treatment plan is complex and difficult. This study aims to investigate how modality selection affects geriatric patient survival and to explore the associated risk factors. The pre-dialysis clinic database was used to identify geriatric patients (age > 65 years) with an eGFR of 15 mls/min/1.73m2 who were followed up in the nephrology clinic from January 1 to December 31 2016. Demographics, comorbidities, dialysis modality, clinical outcome, and laboratory data were obtained from hospital electronic medical reports. Patients were then followed up till 31stDecember 2018. Survival was calculated from the time when eGFR was <15 mls/min/1.73m2 until death or the end of the study. A total of 97 patients were identified during this study period. Sixty-one (62.9%) patients opted for long term dialysis (LTD) whilst the remaining 37.1% (n=36) opted for non-dialysis (ND) pathway. Patients in the ND group were older with median(IQR) age of 74.5(8) years compared to LTD patients with median age of 70.0(6) (P<0.001). One and two-year survival rates were 67.2% and 62.2% in the LTD group and 66.7% and 60.7% in the ND (p =0.815). Further analysis of patients who chose LTD found that 47.5% (n=29) started dialysis in a timely manner, with mean eGFR of 7.4ml/min/1.73m2, while 52.4% (n=32) crashed-landed with mean eGFR of 5.9ml/min/1.73m2. Patients who crash-landed had the lowest survival rate when compared to patients who started dialysis in a timely manner and those who chose the ND course, as shown in the table below. Mean time of decline in eGFR 15mls/min/ 1.73m2to death or study end was 22.5±12.7 months for those on LTD and 20.8±11.9 months for those managed conservatively (P=0.303). Comorbidities and age did not have a significant impact on survival. Tabled 1No. of patientsNo. of events1 Year Survival %2 Years Survival %P-valueLTD with timelyinitiated dialysis29589.786.10.002LTD butcrash-landed321946.940.6Non-dialysis treatment361566.760.7 Open table in a new tab In this study, geriatric patients who chose dialysis had similar survival to those who chose non-dialysis treatment. If opted for long-term dialysis treatment, it must be started in a timely manner to maximize the survival advantage as crash-lander had the lowest survival rate.

The absence of urinary diversion in radical cystectomy avoids early complications in hemodialysis patients

Background: Patients with end-stage renal disease who receive dialysis are considered a high-risk group for perioperative complications following anesthesia and surgery. However, for patients with anuria who will undergo radical cystectomy (RC), a urinary diversion is unnecessary. This study aimed to identify a safe surgical strategy by comparing oncologic outcomes and early complication rates in dialysis and nondialysis patients after RC. Materials and Methods: This study included 85 patients with primary urothelial cell carcinoma of the bladder who underwent RC at the Chang Gung Memorial Hospital, Keelung, Taiwan. Twenty-eight of these patients underwent regular hemodialysis. Overall survival and recurrence-free survival were compared to evaluate the oncologic outcomes. Complications at 3 months were graded using the Clavien–Dindo classification. Results: The overall survival and recurrence-free survival differences between dialysis and nondialysis patients were not significant (P = 0.686; P = 0.528). The degree of muscle-invasive disease was an independent factor affecting overall survival. The overall complication rates in the dialysis and nondialysis groups were 36% and 84%, respectively (P < 0.001). The major complication (Grades III–V) was 16% in the dialysis group and 28% in the nondialysis group (P = 0.241). The most common early complications were urinary tract infection and bowel kinetics change, and both were significantly lower in the dialysis group. A lower re-admission rate was also observed in the dialysis group. Conclusion: Lower rates of early complications and acceptable survival outcomes were observed in dialysis patients. Surgery can be conducted more aggressively, with confidence in suitable cases.

Mucocutaneous manifestations in patients with chronic kidney disease

Background Cutaneous manifestations in chronic kidney disease (CKD) can affect quality of life and can vary across regions, races, and nutritional status of patients. Objective To study the prevalence of mucocutaneous manifestations in patients with CKD and compare between dialysis and nondialysis patients. Patients and methods This was a cross-sectional study from North-East India. A total of 210 patients with CKD were included, with 61 patients in dialysis group and 149 in the nondialysis group. A comprehensive history, detailed examination, and all the relevant investigations were done. Results There was a male predominance in this study, and the mean age was 49.85±12.5 years. Diabetes mellitus (42.9%) was the most common cause of CKD. Cutaneous involvement was seen in 142 (67.61%) patients, with predominance in dialysis patients (60/61) (98.36%) as compared with nondialysis patients (80/149) (55.03%). Xerosis (58.09%) was the most common skin change seen in 122 patients, being more in the dialysis group as compared with the nondialysis group (73.8 vs. 51.7%; P=0.0034). This was followed by pallor (36.19%) of the skin and mucosa. Pruritus (35.23%) was seen in 74 patients, being more in dialysis patients. Cutaneous infections were seen in 57 patients. Absent lunula (14.26%) and half-and-half nail (12.85%) were the most common nail changes. Mucosal changes were seen in 28 (13.33%) patients. Hair changes were seen in 16.67% of patients, with predominant affection in dialysis patients. Conclusion Xerosis, pruritus, skin pallor, absent lunula, xerostomia, macroglossia, and infections were the most common mucocutaneous manifestations in this study. Xerosis, pruritus, absent lunula, and hair changes were more common in dialysis patients.

Effects of active vitamin D on insulin resistance and islet β-cell function in non-diabetic chronic kidney disease patients: a randomized controlled study

PurposeThe purpose of the study is to observe the effects of active vitamin D supplementation on insulin resistance and islet β-cell function (HOMA-β) in patients with non-diabetic chronic kidney disease (NDCKD).MethodsA total of 134 patients with NDCKD who met the inclusion criteria were enrolled in the prospective controlled study and categorized as such: 60 patients in the non-dialysis (ND) group; 36, hemodialysis (HD) group; and 38, peritoneal dialysis (PD) group. Each group was divided into two equal-numbered subgroups for vitamin D supplementation. Those in the experimental subgroups received calcitriol 0.5 ug/day orally, and were followed-up for 6 months. A total of 117 patients were followed-up, including 57 patients in the ND group; 29, HD group; and 31, PD group. Changes in the insulin resistance index (HOMA-IR) and HOMA-β index were calculated and compared at the time of enrollment and after 1, 3, and 6 months of intervention.Results(1) Mean HOMA-IR value: In the ND group, mean HOMA-IR value of the experimental group significantly decreased compared with that of the control group after 3 months of intervention (P = 0.02). In the HD and PD groups, there was no statistical difference between the experimental and control groups (P > 0.05). (2) Mean HOMA-β index: In the ND group, mean HOMA-β index of the experimental group was higher than that of the control group after 1 month of active vitamin D treatment (P = 0.03), and, with an extended intervention time, the index gradually increased (P < 0.001). In the HD group, mean HOMA-β index of the experimental group was higher than that of the control group after 3 months of active vitamin D treatment (P = 0.01). Among PD patients, mean HOMA-β index of the patients in the experimental group was higher than that of the control group after 6 months of active vitamin D treatment (P = 0.02).ConclusionsActive vitamin D supplementation improved insulin resistance and HOMA-β after 6 months in ND patients, but only improved HOMA-β in the dialysis patients, with no significant effect on insulin resistance.

Corneal endothelial changes in patients with chronic kidney disease

Purpose The aim of this study was to assess the effect of chronic kidney disease and duration of hemodialysis on the corneal endothelium. Patients and methods This case–control study included 78 participants who were divided into three groups: group I: the dialyzed group, group II: the nondialyzed group, and group III: age-matched control group. The endothelial cell density (ECD), average area of endothelial cells, SD, coefficient of variation, percentage of hexagonal cells, and central corneal thickness (CCT) were compared between the three groups. The effect of blood urea, serum creatinine, and duration of dialysis on corneal endothelium was studied in the dialyzed group. Results The ECD was statistically significantly less in the dialyzed group compared with the nondialyzed and control groups (2345.19±307.34, 2428.46±349.38, and 2481.23±286.16 cells/mm2, respectively, P&lt;0.001). In addition, the percentage of hexagonal cells was significantly less in the dialyzed group compared with the nondialyzed and control groups (41.27±9.73, 69.42±6.16, and 68.54±5.58%, respectively, P&lt;0.001). Meanwhile, the following parameters were significantly higher in the dialyzed group than the nondialyzed and control groups: average area of endothelial cells area (434.23±63.20, 420±66.98, and 408.08±48.80 µm2, respectively, P&lt;0.001), SD (170.96±48.19, 127±36.18, and 117±20.56, respectively, P&lt;0.001), and coefficient variation of size (39.35±7.52, 31.88±7.07, and 30.54±5.82%, respectively, P&lt;0.001). There was no statistically significant difference in the CCT between the three groups (536.19±55.24, 543.42±37.80, and 539.85±38.44 µm, respectively, P=0.84). A significant negative correlation was found between ECD and the blood urea (P=0.005) and creatinine levels (P=0.03), while the correlation with coefficient variation of size, hexagonality, and CCT was not statistically significant. Conclusion Patients with chronic kidney disease have endothelial cell changes that may compromise the results of intraocular surgery. Awareness among physicians about these changes may help better planning of intraocular surgeries when needed.

Is COVID-19 that different in hemodialysis patients?: A single-center experience

Coronavirus disease 2019 (COVID-19) has affected millions worldwide, and in particular the care of patients on maintenance hemodialysis. These patients are thought to be at high risk of severe SARS-CoV-2 infection due to their older age and multiple comorbidities. The aim of this study was to compare hemodialysis and non-dialysis COVID-19 patients and find possible risk factors for mortality in hemodialysis patients. We developed a single-center retrospective cohort study, from March 1st to December 31st, 2020, that included maintenance hemodialysis patients hospitalized with laboratory confirmed SARS-CoV-2 infection, and age and sex propensity matched non-dialysis patients also hospitalized with a laboratory confirmed SARS-CoV-2 infection (1:1). A total of 34 hemodialysis patients were included, 70.6% male, mean age 76.5 years and on maintenance hemodialysis for 3.0 [0.5-23] years. At admission, 50.0% needed oxygen supply. Median hospital stay duration was 11.0 [5.8-17.0] days, and 38.2% developed bacterial superinfection. Maintenance hemodialysis patient mortality rate was 32.4%. When matched to the non-dialysis group, the hemodialysis group developed more often respiratory insufficiency (50.0% vs 8.8%, p&lt;0.001) and had higher ferritin (1658.0 vs 623.5, p=0.004) and troponin T (130.0 vs 31.0, p&lt;0.001) levels, whereas the non-dialysis group had higher transaminases levels. There was no statistical difference regarding hospitalization time, bacterial superinfection, or mortality between groups. When the logistic regression was performed, only bacterial superinfection was a predictor for mortality in hemodialysis COVID-19 patients (0.01 [0.00-0.26]). There was no difference in hospital stay nor in death rate between hemodialysis and non-dialysis COVID-19 patients. Despite these results, we must emphasize that mortality in the dialysis group was particularly high, with up to 32% of in-hospital mortality, and that bacterial superinfection has been shown to be an independent predictor of mortality. These results highlight the importance of interventions, such as full vaccination coverage, to mitigate the burden of COVID-19 in hemodialysis patients.

The survival nomograms for anti-neutrophil cytoplasmic antibody-associated glomerulonephritis patients with a follow-up of more than one year.

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis with kidney injury, manifested as ANCA-associated glomerulonephritis (AAGN), often portends a poor prognosis of renal function and life survival in long term. A cohort of 339 AAGN patients were enrolled retrospectively. These patients survived and were followed up for at least 12 months after diagnosis in our centre. Multivariate Cox regression analysis and nomogram models were performed to determine the risk factors associated with renal survival and patient survival. The median follow-up time of all 339 patients was 65.2 (IQR 45.1, 91.3) months and the median age was 61(IQR 53, 69) years. In order to analyse the impact of the factors on renal survival, we divided the patients into 2 groups: non-dialysis group (204 patients without dialysis at the final visit) and dialysis group (135 patients with maintaining dialysis). The patients in dialysis group had lower haemoglobin level, lower eGFR level, lower platelets count, more daily urine protein, and higher Birmingham Vasculitis Activity Score (BVAS) at admission than those in non-dialysis group. Multivariate Cox regression revealed that low haemoglobin (HR=0.977, 95%CI 0.965-0.990, p<0.001), low eGFR (HR=0.957, 95%CI 0.941-0.973, p<0.001) and high proteinuria (HR=1.139, 95%CI 1.055-1.230, p=0.001) at admission were independent risk factors for developing maintaining dialysis. A nomogram was established based on the results of multivariate Cox analysis and the internal bootstrap resampling approach showed the C-index of the nomogram was 0.83. Then we divided all patients into death group (n=99) and survival group (n=240). The patients in death group had older age, more hypertension, more chronic lung disease, lower platelets count, lower serum albumin, higher BVAS and lower eGFR at admission than those in survival group. Multivariate Cox regression revealed that the status of maintaining dialysis (HR 3.51, 95% CI 1.91-6.47, p<0.001) and old age (HR 1.07, 95% CI 1.04-1.09, p<0.001) were independent risk factors for all-cause mortality. Again, a nomogram was established and the C-index was 0.74. We analysed the independent risk factors for maintaining dialysis and all-cause mortality in AAGN patients with a follow-up of more than 12 months. The two proposed nomograms were of predictive value.

Response Rates to Hepatitis B Vaccine in Children with Chronic Kidney Disease on Maintenance Hemodialysis

Context: Patients with chronic kidney disease (CKD) are mostly immunocompromised and more prone to infections. Risk of acquisition of infections is increased during dialysis. Hepatitis B virus (HBV) infection remains a major issue among hemodialysis patients and long-term complications of HBV infection in children are more. Following a regular vaccination schedule and maintenance of adequate antibody titer are the important ways to prevent HB infection in the hemodialysis population. Aims: The aim of this study was to compare the seroconversion rate of hepatitis B vaccine in children with CKD between maintenance dialysis and nondialysis group. Materials and Methods: This interventional study was carried out in the Department of Pediatric Nephrology, Bangladesh Institute of Child Health and Dhaka Shishu (Children) Hospital, from July 2018 to December 2019. Total 36 previously diagnosed advanced stages of patients with CKD were enrolled in the study. Patients were divided into two groups: Group A: maintenance hemodialysis (MHD) patients and Group B: nondialytic patients. Baseline antiHBs titer was done in both groups. In each group, 18 patients were enrolled. Patients who had mean baseline antiHBs &gt;10 mIU/mL (seroconversion) were considered as primary response and patients who had mean antiHBs titer &lt;10 mIU/mL were considered as nonseroconversion. Patients of both groups who had mean antiHBs titer 0.00 mIU/mL were given secondary vaccination by three doses of recombinant hepatitis B vaccine (20 μg) intramuscularly in a 0, 1, and 2 months of schedule. Patients who had mean antiHBs titer &gt; 0.00 but &lt;10 mIU/mL were vaccinated by a single booster dose (20 μg). Four weeks after completion of the vaccination, seroconversion (antiHBs titer &gt;10–100 mIU/mL) and seroprotection (antiHBs titer &gt;100 mIU/mL) rates were measured by immunometric technique in both groups and compared between the groups. Statistical analysis used: Statistical analysis was performed by the Statistical Package for the Social Sciences (SPSS) software program, version 20.0 for Windows (SPSS, Chicago, Illinois). The quantitative observations were indicated by frequencies and percentages. Fisher's exact test was used to determine the association between categorical variables; Kruskal–Wallis test and unpaired t test were used to determine the association between continuous variables. Results: In this study, all enrolled patients (100%) had developed seroconversion (&gt;10 mIU/mL). In Group A only 1 patient (9%) had seroprotection level and total 11 patients had mean antiHBs titer 46.66 ± 10.90 mIU/mL, whereas in Group B 6 patients (54%) had seroprotection level with mean antiHBs titer 326.15 ± 123.27 mIU/mL. Therefore, more seroprotection level was observed in Group B and the difference between Groups A and B was statistically significant (P = 0.0176). Conclusion: It may be concluded from the study that the immune response of the hepatitis B vaccine was significantly lower in MHD than nondialysis group patients, so it was realized that hemodialysis had effects on reduction of antiHBs titer.

TO EVALUATE COGNITIVE PERFORMANCE IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Background: In people with chronic kidney disease (CKD), cognitive decline is one of the major causes for poor outcome in terms of quality of life and survival rate. Previous studies have found an association between cardiovascular disease and psychiatric disorders in people with CKD. Physicians should keep in mind that the psychiatric changes and cognitive decline seen in all stages of CKD is to be detected early in the course of the disease, for timely management of it and for better outcome in terms of survival rate.&#x0D; Aim: The goal of this study is to evaluate cognitive performance in patients with chronic renal disease&#x0D; Material and Method: The study was conducted from March 2019 to april 2021 in department of general medicine and nephrology clinic at KDMCH, Mathura. Between March 2019 to april 2021, baseline data were obtained. The study included 108 participants (58 with CKD and 50 with ESKD). ESKD patients were ‘CKD patients with dialysis’. Various tests were used to assess brain function.&#x0D; Results: ESKD patients had significantly lower scores on the 3MS, TMT-A and TMT-B trials, with a difference between TMT-A and B than CKD patients. In ESKD patients, the numbers less than 3MS of speech and fluency memory, as well as visuo-position and structure, were significantly lower. ESKD patients had the highest number of patients with psychiatric disorders, as measured by the outpatient testing scores listed above 3MS, TMT-A, and TMT-B. ESKD patients had significantly higher levels of depression than CKD patients.&#x0D; Conclusion: Higher cognitive decline was found in the ESKD group in comparision to non-dialysis CKD group. Also ESKD was associated with higher rates of cerebro-vascular disease, cardio-vascular disease and peripheral artery disease.&#x0D; Keywords: Chronic Kidney Disease, ESKD, eGFR and cognitive impairment

MO831PROGNOSIS OF HEPATOCELLULAR CARCINOMA IN HEMODIALYSIS PATIENTS

Abstract Background and Aims The aim of this study was to compare the prognosis of hepatocellular carcinoma (HCC) between dialysis and non-dialysis patients. Method In this retrospective observational study, we examined consecutive patients with naïve localized HCC, who were treated with radiofrequency ablation (RFA) between February 2000 and December 2017. The patients were categorized into two subgroups based on whether they were on maintenance dialysis (Dialysis Group, n=458) or not (Non-dialysis Group, n=13), and were followed until December 2019. The primary endpoint was overall survival using Kaplan-Meier analysis. As for propensity score matching, we matched 13 pairs of cases by using age, sex, Child-Pugh score, tumor size, number of tumors and HCV positivity. We also compared causes of death between the 2 groups. Results The study cohort were aged 69.9±9.1 years and included 328 male patients (70%). Hepatitis B was positive in 37 patients (7.9%), C in 322 (68.4%) and co-infection of HBV and HCV was detected in 3 (0.6%). Ninety-five (20.2%) were heavy alcohol drinkers. In Dialysis Group, patients were younger (p=0.004), total bilirubin, AST, ALT levels were significantly lower and PT level was significantly higher. In the entire cohort, overall survival was comparable between Dialysis Group and Non-dialysis Group (5-year survival rate 55.2% vs 52.7%, respectively; p =0.144). In the propensity score matching analysis, however, Dialysis Group showed significantly worse overall survival than Non-dialysis Group (5-year survival rate 52.7% vs 92.3%, respectively; p =0.018). During the observational period, 255 (54%) patients died. As for causes of death, liver-related death occurred in 44% in Dialysis Group and 67% in Non-dialysis Group, whereas cardiovascular death was 22% in Dialysis Group and 5% in Non-dialysis Group. Procedure-related major complication in the first RFA session of each patient was 0% in Dialysis Group. Conclusion Prognosis of hepatocellular carcinoma was poorer in dialysis patients compared to non-dialysis ones, which may be explained by a higher rate of non-liver-related death in dialysis population. Since RFA, per se, has been safely preformed in dialysis patients, prognostic improvement may be expected by treating HCC in dialysis patients as aggressively as in non-dialysis cases.

Evaluation of changes in corneal endothelium in chronic kidney disease

Purpose:Chronic kidney disease (CKD) is an emerging health problem worldwide. In CKD corneal endothelial changes also occur probably due to accumulation of inflammatory cytokines and increased multiple toxic products. The aim of this study was to analyze the effect of CKD on corneal endothelium and correlate the findings with severity of disease with help of noninvasive technique.Methods:The study comprised 75 eyes of 75 cases divided into three groups with group A comprising of CKD cases on dialysis, group B of nondialysis CKD cases, and group C of controls. Each group had 25 cases each of either sex and between 15–80 age groups. All patients were investigated for blood urea, serum creatinine, and blood sugar and underwent complete ophthalmic examination of both eyes along with wide-field specular microscopy examination.Results:The majority of patients (33.3%) belonged to age range of 61–70 years with male predominance and the most common cause of CKD was found to be diabetes with 17 (34%) cases. We found normal corneal endothelial cell density (ECD) with the mean ECD of 2364.52 ± 397.72 mm2 in the dialysis group, 2467.8 ± 352.88 mm2 in nondialysis group, and 2521.68 ± 250.26 mm2 in the control group of patients. However, we found significant increase in coefficient of variation (CV) with 36 ± 5.8% in dialysis group, 37 ± 4.5% in nondialysis group and 32 ± 0.8% in controls (P = 0.001) and decreased hexagonality (Hx) with 47 ± 7.3% in dialysis group, 46 ± 4.7% in nondialysis group and 51 ± 6.7% in the controls (P = 0.031). This showed increased tendency of pleomorphism and polymegathism in corneal endothelial cells in CKD cases. No correlation was found between blood urea or serum creatinine levels with endothelial parameters in any group.Conclusion:CKD causes morphological changes like polymegathism and pleomorphism in corneal endothelium and hence these cases are more vulnerable and special care should be taken before any intraocular surgical procedure.

Using CPAP in COVID-19 patients outside of the intensive care setting: a comparison of survival and outcomes between dialysis and non-dialysis dependent patients

BackgroundSARS-CoV-2 (COVID-19) is a novel coronavirus associated with high mortality rates. The use of Continuous Positive Airway Pressure (CPAP) has been recognised as a management option for severe COVID-19 (NHS, Specialty guides for patient management during the coronavirus pandemic Guidance for the role and use of non-invasive respiratory support in adult patients with coronavirus (confirmed or suspected), https://www.nice.org.uk/guidance/ng159). We offered ward-based CPAP to COVID-19, dialysis patients not suitable for escalation to ICU. The aim of the study was to evaluate the use of CPAP for COVID-19 dialysis patients compared to non-dialysis COVID-19 patients outside of the intensive care setting. We further aimed to investigate factors associated with improved outcomes.MethodsData was collected from a single centre (Royal Preston Hospital, UK), from March to June 2020. Treatment outcomes were compared for dialysis and non-dialysis dependent patients who received CPAP with limitations on their escalation and resuscitation status. Kaplan-Meier survival curves and Cox regression models were used to compare outcomes. The primary study outcome was 30 day mortality. Confounders including length of admission, systemic anticoagulation and ultrafiltration volumes on dialysis were also analysed.ResultsOver the study period, 40 dialysis patients tested positive for COVID-19, with 30 requiring hospital admission. 93% (n = 28) required supplementary oxygen and 12% (n = 9) required CPAP on the ward. These patients were compared to a serial selection of 14 non-dialysis patients treated with CPAP during the same period. Results showed a significant difference in 30 day survival rates between the two groups: 88.9% in the dialysis group vs. 21.4% in the non-dialysis group. Statistical modelling showed that anticoagulation was also an important factor and correlated with better outcomes.ConclusionThis is to the best of our knowledge, the largest series of COVID-19 dialysis patients treated with CPAP in a ward-based setting. In general, dialysis dependent patients have multiple co-morbidities including cardiovascular disease and diabetes mellitus making them vulnerable to COVID-19 and not always suitable for treatment in ICU. We showed a significantly lower 30 day mortality rate with the use of CPAP in the dialysis group (11.1%) compared to the non-dialysis group (78.6%). Despite a small sample size, we believe this study provides impetus for further work clarifying the role of CPAP in treating COVID-19 dialysis dependent patients.

Effects of Hemodialysis on Prognosis in Individuals with Comorbid ERSD and ICH: A Retrospective Single-Center Study

End-stage renal disease (ESRD) is one of the most critical risk factors of intracerebral hemorrhage (ICH). We aimed to investigate the effects of maintenance hemodialysis on hematoma volume, edema volume, and prognosis in patients with comorbid ESRD and ICH. Patients with comorbid ESRD and ICH were divided into two groups based on whether receiving maintenance hemodialysis. Hematoma and perihemorrhagic edema (PHE) volumes and relative edema ratio after admission were assessed on head computed tomography scans. During the initial diagnosis, the dialysis group had lower PHE volume (16.41 vs 35.90 mL, P=0.010), total volume of hematoma and edema (31.58 vs 54.58 mL, P=0.013), and relative edema ratio (0.57 vs 0.92, P=0.033) than the non-dialysis group. In addition, the peak PHE volume (36.68 vs 84.30 mL, P < 0.001), peak total volume of hematoma and edema (53.45 vs 127.69 mL, P=0.011), and peak relative edema ratio (1.12 vs 1.92, P=0.001) within one week after onset were lower in the dialysis group than in the non-dialysis group. The dialysis group had a higher in-hospital mortality rate than the non-dialysis group (40% vs 10%, P=0.007). At 1-year follow-up, the two groups had similar 1-year-mortality rates and modified Rankin Scale. Hemodialysis can prevent the enlargement of edema and reduce PHE volume shortly after onset. Although dialyzed patients had a higher in-hospital mortality rate, hemodialysis did not affect 1-year survival rate and functional neurologic scales.

Comparison of muscle strength between hemodialysis patients and non-dialysis patients with chronic kidney disease.

[Purpose] Muscle weakness in patients with chronic kidney disease is associated with several disease-related factors, and this study aimed to examine whether hemodialysis is one of risk factors for muscle weakness in patients with chronic kidney disease. [Participants and Methods] We conducted a cross-sectional study with 74 non-dialysis and 84 hemodialysis patients. Muscle strength evaluations were performed by measuring isometric knee extensor muscle strength and grip strength. Each evaluation item was compared between the hemodialysis and non-dialysis groups, and multiple regression analysis was performed to determine the factors associated with muscle strength. In addition, the correlation between lower-extremity muscle strength and grip strength was examined in each group. [Results] Isometric knee extensor muscle strength was significantly lower in the hemodialysis group than in the non-dialysis group. Grip strength was also significantly lower in the hemodialysis group than in the non-dialysis group. Hemodialysis was determined to be an independent risk factor associated with lower limb muscle strength as well as grip strength. The positive correlation between isometric knee extensor muscle strength and grip strength was almost the same in the groups. [Conclusion] Hemodialysis treatment was an independent risk factor for muscle weakness. Regular monitoring of grip strength may facilitate better management with physical therapy in hemodialysis patients.

Formation of Calcified Nodule as a Cause of Early In-Stent Restenosis in Patients Undergoing Dialysis.

BackgroundDialysis is an independent risk factor for in‐stent restenosis (ISR) after stent implantation in coronary arteries. However, the characteristics of ISR in patients undergoing dialysis remain unclear, as there are no histological studies evaluating the causes of this condition. The aim of the present study was to investigate the causes of ISR between patients who are undergoing dialysis and those who are not by evaluating tissues obtained from ISR lesions using directional coronary atherectomy.Methods and ResultsA total of 29 ISR lesions from 29 patients included in a multicenter directional coronary atherectomy registry of 128 patients were selected for analysis and divided into a dialysis group (n=8) and a nondialysis group (n=21). Histopathological evaluation demonstrated that an in‐stent calcified nodule was a major histological characteristic of ISR lesions in the dialysis group and the prevalence of an in‐stent calcified nodule was significantly higher in the dialysis group compared with the nondialysis group (75% versus 5%, respectively; P<0.01). On the other hand, the prevalence of an in‐stent lipid‐rich plaque was significantly lower in the dialysis group compared with the nondialysis group (0% versus 43%, respectively; P=0.03). In all cases with an in‐stent calcified nodule, the underlying calcification before stent implantation was moderate to severe. When tissue characteristics were stratified according to duration post–stent implantation, an in‐stent calcified nodule in the dialysis group was mainly observed within 1 year after stent implantation.ConclusionsIn‐stent calcified nodules are a common cause of ISR in patients undergoing dialysis and are observed within 1 year after stent implantation, suggesting different causes of ISR between patients undergoing dialysis and those who are not.

Risk of Glaucoma in Patients Receiving Hemodialysis and Peritoneal Dialysis: A Nationwide Population-Based Cohort Study.

This paper investigated the incidence and risk of newly diagnosed glaucoma after the initiation of maintenance dialysis in Taiwan. A case–control study was conducted using the National Health Insurance Research Database (NHIRD) in Taiwan. There were 3949 patients with dialysis in the study group and 78,980 non-dialysis subjects matched by age and sex in the comparison group. The incidence of newly diagnosed glaucoma after the initiation of maintenance dialysis was analyzed based on the diagnostic code for glaucoma. Patients with dialysis had a higher risk of glaucoma (adjusted hazard ratio (aHR): 1.270; 95% confidence interval (CI): 1.035–1.560) than patients without dialysis. The incidence rate of glaucoma was 8.18 per 10,000 person months in the dialysis group, which was higher than that in the non-dialysis group (5.01 per 10,000 person months). Patients with dialysis exhibited a significantly higher risk of angle-closure glaucoma (ACG) (aHR: 1.550; 95% CI: 1.074–2.239). In contrast, there was no significant risk of developing open-angle glaucoma or normal-tension glaucoma in dialysis patients. Our data suggest that dialysis patients are more susceptible to ACG. Regular ophthalmic examinations may be useful in patients with dialysis to identify high-risk individuals with glaucoma, and preventive measures can be applied to avoid permanent vision loss as soon as intraocular pressure (IOP) elevation is identified.

Effect of renal dialysis on mortality and complications following hip fracture surgery in elderly patients: A population based retrospective cohort study.

Hip fractures in older patients requiring dialysis are associated with high mortality. The primary aim of this study was to evaluate the specific burden of dialysis on 30-day mortality following hip fracture surgery. The secondary aim was to determine the burden of dialysis on overall survival as well as several postoperative complications.A retrospective cohort study was conducted using data from the Korean National Health Insurance Research Database. Patients were aged ≥65 years and underwent hip fracture surgery during the period from 2009 to 2015. To construct a matched cohort, each dialysis patient was matched to 4 non-dialysis patients based on age, sex, hospital type, anesthesia type, and comorbidities. Survival status was determined 30 days after surgery and at the end of the study period.In total, 96,289 patients were identified. Among them, 1614 dialysis patients were included and matched to 6198 non-dialysis patients. During the 30-day postoperative period, there were 102 mortality events in the dialysis group and 127 in the non-dialysis group, for an adjusted hazard ratio of 3.12 (95% confidence interval, 2.42–4.09). Overall, by the end of the study period, there were 1120 mortality events in the dialysis group and 2731 in the non-dialysis group, for an adjusted hazard ratio of 1.97 (95% confidence interval, 1.83–2.1). These findings may be limited by the characteristics of the administrative database.The 30-day mortality rate was 3-fold higher in the dialysis group than in the non-dialysis group, while the overall mortality rate was approximately 2-fold higher in the dialysis group than in the non-dialysis group. These findings suggest that caution in the perioperative period is required in dialysis patients undergoing hip fracture surgery. The results of our study represent only an association between dialysis and mortality. Further studies are necessary to investigate the possible causal effect of dialysis on mortality and complications after hip fracture surgery.

P0471DIALYSIS TREATMENT AT THE TIME OF DIAGNOSIS PREDICTS OUTCOMES IN ANCA ASSOCIATED VASCULITIS PATIENTS - DATA FROM CROATIAN REFERRAL CENTER

Abstract Background and Aims Dialysis dependence and ESRD are known complications of ANCA associated vasculitis (AAV) with renal involvement. What is not so often discussed is the role of dialysis treatment at the time of diagnosis and how it affects patient outcomes as well as characteristics of such patients. We present data showing the importance of dialysis treatment at the time of diagnosis as the predictor of clinical outcomes. Method This study included 106 consecutive AAV patients with renal involvement in the period from 2007-2017. We performed renal biopsy on patients using automatic 16 Gauge needle. Light, immunofluorescent and electronic microscopy were performed. Primary outcomes were combined outcome progression to end-stage renal disease, defined as persistent (more than three months) need for renal replacement therapy or permanent reduction of EGFR to &amp;lt;15ml/minute (according to CKD EPI formula) and/or death (ESRDD), death (D) and ESRD alone, and disease relapse. Kaplan Meyer survival analysis and multivariate Cox proportional hazard regression analysis were used to explore difference between phenotypes and finding significant predictors regarding outcomes. Results Out of 106 patients (55,6% female, median age 61; IQR 51-70) there were 66 (61,1%) microscopic poliangitiis (MPA), 20 (18,5%) granulomatosis with angitiis and 20 (18,5%) with renal limited vasculitis (RLV). Out of those 14 (13%) were PR3-ANCA positive patients, 57 (52,8%) MPO ANCA positive, 5 (4,6%) PR3-ANCA+MPO-ANCA positive and 32 (29,6%) ANCA negative patients. Average serum creatinine (SCr) levels was 316,5 μmol/l (IQR 207,0-548,5), 24-hour proteinuria median was 1,7g/24h (IQR 0,8-2,8). According to the Berden classification 43 (39,8%) patients had crescentic, 19 (17,6%) focal, 34 (31,5%) mixed and 12 (11,1%) sclerotic class. Follow up time ranged from 1 to 127 months. Median follow up time was 21 months (IQR = 7-44). Median time to diagnosis was 3 months (IQR 2,0-6,0). Patients requiring dialysis treatment at the time of diagnosis were more often MPO – (p=0,04), had more severe anemia (p=0,001), higher CRP (p=0,003), and more pronounced hypoalbuminemia (serums albumin &amp;lt;30g/l; p=0,006).Such patients were older than those not requiring dialysis (p=0,055) na had shorter time to diagnosis (p=0,001). Clinically such patient s presented more often with RPGN (p&amp;lt;0,001) which is in a way expected thus having higher SCr levels (p=&amp;lt;0,001). Histologically dialysis treated patients predominantly had crescentic class, while non-dialysis group had focal class (p&amp;lt;0,001). Of note dialysis group had more acute tubular damage (p=0,007). Interestingly enough there was slightly more positive C3 deposition in dialysis group (p=0,09). In univariate analysis the need for acute dialysis at the time of diagnosis of AAV was significant predictor for combined ESRDD, D, ESRD and relapse rate. In multivariate analysis the need for acute dialysis at the time of diagnosis of AAV remained significant predictor for ESRD (HR = 4,674, 95% CI =1,996-10,946; p = &amp;lt; 0,001) and relapse rate (HR = 59,545, 95% CI =3,467-1022,665; p = 0,005). Conclusion The need for dialysis at the time of AAV diagnosis is a strong predictor for ESRD and relapse rate. It is also interesting to further study differences between patients needing dialysis at the time of diagnosis and those who don’t need it.

Outcomes of Laparoscopic Surgery in Colorectal Cancer Patients With Dialysis.

To investigate the outcomes of laparoscopic surgery in colorectal cancer patients with dialysis. Fourteen dialysis (dialysis group) and 567 non-dialysis (non-dialysis group) patients who underwent laparoscopic and open surgery for colorectal cancer between April 2008 and December 2015 were included. Short-term and long-term outcomes were compared between the groups. A 1:2 propensity score matching was performed to compare long-term outcomes. All the dialysis patients underwent laparoscopic surgery. There were no significant differences in operative outcomes and postoperative short-term outcomes between the two groups. In the whole cohort, overall survival of dialysis patients was shorter than that in the non-dialysis ones (p=0.020), while disease-free survival did not differ between the two groups. After matching, there was no significant difference between the groups in overall or disease-free survival. Laparoscopic colorectal cancer surgery for dialysis patients seems safe and feasible and associates with comparable short-term outcome and recurrence rate to non-dialysis patients.

Effect of chronic kidney disease on outcomes of total joint arthroplasty: a meta-analysis

BackgroundThis meta-analysis was conducted to evaluate the differences in preoperative comorbidities, postoperative mortality, the rate of periprosthetic joint infection (PJI), and revision rate after total joint arthroplasty (TJA) between patients with chronic kidney disease (CKD)(CKD group) and patients with normal kidney function (non-CKD group).MethodsWe searched MEDLINE, EMBASE, and the Cochrane Library for studies assessing the effect of CKD on TJA outcome. This meta-analysis included studies that (1) compared the outcomes of TJA between the CKD and non-CKD groups; (2) compared the outcomes of TJA based on CKD stage; and (3) evaluated the risk factors for morbidity or mortality after TJA. We compared the mortality, PJI, and revision rate between CKD and non-CKD groups, and between dialysis-dependent patients (dialysis group) and non-dialysis-dependent patients (non-dialysis group).ResultsEighteen studies were included in this meta-analysis. In most studies that assessed preoperative comorbidities, the number and severity of preoperative comorbidities were reported to be higher in the CKD group than in the non-CKD group. The risk of mortality was found to be higher in the CKD and dialysis groups compared with the respective control groups. In the studies based on administrative data, the unadjusted odds ratio (OR) of PJI was significantly higher in the CKD group than in the non-CKD group; however, no significant difference between the groups was noted in the adjusted OR. After total hip arthroplasty (THA), the risk of PJI was higher in the dialysis group than in the non-dialysis group. No significant difference was noted between the groups in the rate of PJI following total knee arthroplasty. The revision rate did not significantly differ between the CKD and non-CKD groups in the studies that were based on administrative data. However, the unadjusted OR was significantly higher in the dialysis group than in the non-dialysis group.ConclusionsPreoperative comorbidities and mortality risk were higher in the CKD and dialysis groups than in their respective control groups. The risk of revision was greater in the dialysis group than in the non-dialysis group, and the risk of PJI in the dialysis group became even greater after THA. Surgeons should perform careful preoperative risk stratification and optimization for patients with CKD scheduled to undergo TJA.