Outcomes In Hemodialysis Patients Research Articles

Efficacy of Applying a Structured Checklist on Safety Outcomes of Hemodialysis Patients

Efficacy of Applying a Structured Checklist on Safety Outcomes of Hemodialysis Patients

Impact on health outcomes of hemodialysis patients based on the experience level of registered nurses in the hemodialysis department: a cross-sectional analysis.

The aim of the study is to improve the policy of health authorities regarding registered nurses (RNs) staffing by understanding how the health outcomes of hemodialysis (HD) patients vary depending on the level of HD nursing experience of at least 2 years. The study included 21,839 patients who started maintenance HD for 3 months in early 2013 in the same medical institutions. Demographic variables such as sex, age, and causes of HD; institutional variables such as type of institution and number of RNs; and health outcomes such as HD adequacy, systolic and diastolic blood pressure (SBP, DBP), hemoglobin (Hb), and serum albumin were collected through web-based questionnaires. To determine the relationship between variables, t-test, chi-square test, and ANOVA were employed. Binary logistic regression was used to examine the odds ratio. Institutions with 100% of experienced RNs with at least 2 years of experience in HD units were found to have higher NKF K-DOQI criteria satisfaction rate than Institutions with <50% of experienced RNs with at least 2 years of experience in HD units for all health outcomes, except DBP (42.9% vs. 38.8%, p < .001) and Hb (27.8% vs. 24.4%, p < .001). Four of the six health-related variables-HD adequacy (Kt/v, urea reduction rate, URR), SBP, and serum albumin-were higher in institutions with 100% of experienced RNs than those with less than 50%. In order to improve HD patients' health outcomes, HD institutions should prioritize recruiting RNs who are proficient in HD care. A higher proportion of skilled RNs results in a higher ability to prepare for emergencies and early detection of patient complications. RNs with extensive experience in HD nursing, therefore, promote quality management of HD patients.

Effect of Incremental Hemodialysis on Residual Kidney Function and Other Laboratory Parameters in End Stage Renal Disease Patients Starting Dialysis

Abstract Background Residual kidney function (RKF) in patients with end-stage renal disease plays a critical role in dialysis adequacy, quality of life, and survival by maintaining fluid and metabolic homeostasis, mitigating mineral abnormalities, optimizing uremic toxin clearance, and sustaining higher production of endogenous vitamin D and erythropoietin. Endogenous clearance conferred by RKF is associated with greater survival than dialysis clearance per se, and at a certain RKF level, higher dialysis dose may not influence clinical outcomes in both peritoneal and hemodialysis patients. Furthermore, randomized controlled trials (RCTs) have shown inconsistent results in terms of clinical benefit of higher dialysis dose or frequency, and they may accelerate RKF decline. Aim of the Work To detect the effect of twice – weekly HD on patients starting dialysis regarding laboratory parameters and preservation of kidney function. Patients and Methods This prospective cohort study included 30 patients from multiple convienant dialysis units in 10th of Ramadan and Mushtoul Elsouq city to initiate twice-weekly hemodialysis, the patient should meet the first (urine output &amp;gt;600 ml/day) and the last criteria (KRU &amp;gt; 3 ml/minute/1.73 m2)d, plus most (five out of nine). Patients were examined for these criteria every month for 3 months. Regarding baseline data, this study patients had a mean age of 49.6 ± 8.7 years old, with a range from 32 to 65 years old, with male predominance (70 %), the mean weight of the studied patients was 79.9± 10.31 kg, with a range from 55 to 105 Kg, and their height ranged from 160 to 185 cm, the main etiology of ESRD was hypertension in 46.7 % of the studied patients, followed by DM in 30% then DM with hypertension in 16.7%. Results The study shows that there's highly significant increase in serum PTH and bicarbonate all over the study period, there's significant increase in serum phosphorus level, there's highly significant increase in serum albumin, there's highly significant increase in Hemoglobin all over the study period. There's highly significant increase in serum calcium, there's highly significant increase in Serum Potassium, there's highly significant decrease in Serum Creatinine, Urea before and urea after dialysis all over the study period. This study showed that there's highly significant increase in renal KT/V, there's highly significant increase in RKF, there's highly significant decrease in urine Urea and there's no statistically change in dry weight of patients all over the study. Conclusion In conclusion, in our selected cohort of incident hemodialysis patients with measured RKF, the incremental hemodialysis regimen that starts with twice-weekly schedule upon transition to dialysis is associated with greater preservation of the RKF in the first 3 months and may be safely implemented among incident hemodialysis patients with substantial RKF.

Outcomes of arteriovenous graft vs. fistula for haemodialysis access in the elderly: A systematic review and meta‑analysis.

The impact of the type of vascular access on the outcomes in the elderly haemodialysis patients is still unclear. The goal of the present study was to compare survival outcomes in elderly haemodialysis patients who received either arteriovenous graft (AVG) or arteriovenous fistula (AVF). A systematic literature search was performed in EMBASE, Cochrane, MEDLINE, ScienceDirect and Google Scholar databases for papers published from January 1954 until January 2022. Risk of bias in the selected publications was assessed by Newcastle Ottawa scale or Cochrane risk of bias tool depending on the study design. Meta-analysis was carried out using the random-effects model. Data were reported as pooled odds ratio (OR) or hazard ratio (HR) with 95% confidence interval (CI). A total of 12 studies were included in the analysis. The majority of the studies had poor quality. Elderly patients receiving AVG had significantly worse survival rate compared with patients that received AVF for the haemodialysis access, with a pooled HR of 1.38 (95% CI, 1.24-1.53; I2=79.9%). Pooled HR for access survival was 1.60 (95% CI, 1.54-1.66; I2=0%). Pooled OR for primary patency rate, maturation failure and infections were 1.81 (95% CI, 0.73-4.49; I2=79.2%), 0.33 (95% CI, 0.12-0.91; I2=70.4%) and 9.74 (95% CI, 2.60-36.49; I2=52.4%), respectively. These results suggested that in elderly patients undergoing haemodialysis, AVG was associated with reduced overall survival and access survival, and higher infection rate, compared with AVF. Notably, AVG was also associated with a lower risk of maturation failure, presenting a potential advantage in specific patient populations (study registration: PROSPERO, no. CRD42022313199).

Neutrophil-Lymphocyte Ratio as Predictor of Mortality in Regular Hemodialysis Patients at Tabanan General Hospital

The risk of mortality in chronic kidney disease (CKD) patients is higher than in normal population. Inflammation has an important role in the high mortality in CKD patients undergoing hemodialysis (HD). The neutrophil lymphocyte ratio (NLR) is a simple parameter and has been widely associated with poor outcomes in HD patients but has not been widely implemented in Indonesia, especially in Bali. This research prospectively analyzed survival of 186 patients aged 18-90 years undergoing regular HD 2x/week for at least 3 months. NLR was calculated by dividing the absolute number of neutrophils and lymphocytes. The Survival test was performed by the Kaplan-Meier method and compared with the log-rank test. Univariate and multivariate tests were performed to assess the prognostic impact of NLR and other clinical factors on all-cause mortality in HD patients. Mortality was found higher in the group with high NLR values (p-value 0.003). High NLR was significantly associatedwith all-causemortality (HR 3.206; 95% CI 1.467 – 7.004; p value 0.003) and remained an independent factor on mortality in routine HD patients after adjustment toothervariables(aHR 2.696, 95% CI 1.176 –6.182, p-value: 0.019). Inconclusion, HighNLR is independently associated with all-cause mortality in CKD patients undergoing regular HD. NLR can be used as an inflammation marker that is considered easy and affordable and can be used to help determine populations that require special attention in order to reduce the mortality of patients with HD.

COVID-19 among Hospitalized Chronic Hemodialysis Patients: Clinical Features and Predictors of Mortality

Objectives: Chronic hemodialysis patients have an increased susceptibility to COVID-19 infection, and worse outcomes compared to the general population. This study aims to describe the clinical course and outcomes of hemodialysis patients with COVID-19 infection, and to describe predictors of mortality. Methods: This retrospective observational study included adult chronic hemodialysis patients hospitalized to a tertiary care center with COVID-19 infection between January 1, 2020 and December 31, 2022. Data about their clinical features at time of diagnosis, and rate of complications were collected.

Prospective Study of Associations Between Testosterone, Mortality, and Health Outcomes Among Adults Undergoing Hemodialysis

Prospective Study of Associations Between Testosterone, Mortality, and Health Outcomes Among Adults Undergoing Hemodialysis

#4098 PATIENT ACUITY AND CARDIOVASCULAR OUTCOME IN HEMODIALYSIS PATIENTS: A KOREAN NATIONWIDE COHORT STUDY

Abstract Background and Aims Patients acuity has been reported to be associated with poor outcome in hospitals. However, the effect of the patient acuity of hemodialysis center on the prognosis of individual patients is not well known. In this study, the association between the severity of illness in hemodialysis facility and major adverse cardiac and cerebrovascular event (MACCE) in patients undergoing hemodialysis was investigated. Method 15,633 participants receiving hemodialysis in the primary health care center who participated in the Periodic Hemodialysis Quality Assessment by Health Insurance Review &amp; Assessment Service (HIRA) were examined. The main predictor was severity-to-nurse ratio, defined as a sum of Charlson comorbidity index of all patients divided by the number of nurses in each hemodialysis facility. The primary and secondary outcome were MACCE, and all-cause mortality, respectively. Results During a median follow-up of 5.5 years, MACCE and all-cause mortality occurred in 7,966 (51.0%) and 6,536 (41.8%) participants. Participants with higher severity-to-nurse ratio tended to have higher incidence rate of MACCE. The hazard ratios (HRs) of MACCE for the second, third, and highest quartiles compared with the lowest quartile of severity-to-nurse ratio were 1.05 (95% confidence intervals [CI], 0.98-1.11; P = 0.151), 1.07 (95% CI, 1.00-1.14; P = 0.053), and 1.08 (95% CI, 1.00-1.16; P = 0.040). When treating severity-to-nurse ratio as a continuous variable, MACCE risk increased by 1% per 1 increase in severity-to-nurse ratio (HR, 1.01; 95% CI, 1.00 - 1.02; P = 0.003). Compared to the lowest quartile group, the HRs of all-cause mortality for second, third and fourth quartile were 1.12 (95% CI, 1.04-1.19; P = 0.002), 1.11 (95% CI, 1.03-1.19; P = 0.005), and 1.16 (95% CI, 1.07-1.25; P&amp;lt;0.001), respectively. Conclusion As the part of the Joint Project on Quality Assessment Research by HIRA, the present study showed that the patient acuity was strongly associated with an increased risk of poor outcomes in hemodialysis patients.

#5608 THE INFLUENCE OF AMBULATORY BP ON THE ASSOCIATIONS OF SEX WITH CARDIOVASCULAR EVENTS AND MORTALITY IN DIALYSIS PATIENTS: A PROSPECTIVE COHORT STUDY

Abstract Background and Aims Male patients with pre-dialysis CKD have worse ambulatory BP control than females and this is associated with higher mortality risk. Male hemodialysis patients have higher ambulatory BP levels compared to females. The aim of this study was to investigate the influence of ambulatory BP on the associations of sex with cardiovascular events and mortality in hemodialysis individuals. Method 129 male and 91 female hemodialysis patients with valid 48-hour ABPM were followed prospectively for 53.4±31.1 months. The primary endpoint was cardiovascular mortality; the secondary endpoint was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, resuscitation after cardiac arrest, hospitalization for heart failure, coronary or peripheral revascularization procedure. Results Cumulative-freedom from the primary endpoint was significantly lower for women (logrank-p = 0.032), while cumulative-freedom from the secondary endpoint did not differ significantly between the two groups (logrank-p = 0.644). The crude risk for cardiovascular mortality was significantly higher for women (HR = 1.613, 95% CI [1.037, 2.509]). The crude risk for the combined cardiovascular endpoint was not different between the two genders (HR = 0.918, 95% CI [0.638, 1.320]). After adjusting for other risk factors (age, diabetes, dialysis vintage, coronary disease) no significant differences in the risk for both the primary and the secondary endpoint were observed between women and men (primary: HR = 1.464 (95% CI [0.929, 2.307]), secondary: 0.866 (95% CI [0.596, 1.260])). After additional adjustment for 44-hour ambulatory BP the above relationships did not alter (primary: HR = 1.498, 95% CI [0.947, 2.368]), secondary: (HR = 0.911, 95%CI [0.625, 1.327])). Conclusion In contrast to patients with pre-dialysis CKD, ambulatory BP does not appear to significantly influence the relationship between gender and adverse cardiovascular outcomes in hemodialysis patients.

#6242 CLINICAL CHARACTERISTICS OF HEMODIALYSIS PATIENTS FROM AFRICAN COUNTRIES OF PORTUGUESE OFFICIAL LANGUAGE: A PORTUGUESE COHORT

Abstract Background and Aims Chronic kidney disease (CKD) is a leading cause of morbidity and mortality worldwide, with African descendants being at increased risk of occurrence and progression to end-stage renal disease (ESRD). However, the burden of CKD and ESRD in African continent is still largely conjectural and access to treatment of CKD is restricted in those countries. Africa contributes to &amp;lt;10% of the total renal replacement therapy (RRT) patients worldwide, mainly due to the high costs associated. The purpose of this analysis was to describe the clinical characteristics and outcomes of patients from African Countries of Portuguese Official Language (ACPOL) who integrated the HD program of a tertiary hospital in Portugal. Method Retrospective analysis of 126 African patients who integrated the HD program of a tertiary hospital in Portugal, between January 2015 and December 2019. Last follow-up was ascertained in January 2021. Results Mean age was 49.9 ± 14.1 years, and 53.6% were male (n = 71). Hypertension was a comorbidity in 96.0% (n = 121). Twenty-one patients came from Angola (16.7%), 53 from Cape Verde (42.1%), 23 from Guinea-Bissau (18.3%), 20 from Saint Thomas and Prince (15.9%), and 9 from Mozambique (7.1%). Motive for referral to Portugal was RRT requirement in 93.7% of the cases (n = 118) and vascular access (VA) dysfunction in 6.3% (n = 8); these 8 patients with VA dysfunction were already on hemodialysis program before their evacuation to Portugal and they were mainly from Cape Verde (n = 4), Angola (n = 3), and one patient from Guinea-Bissau. At arrival, patients who initiated HD in our unit had mean serum creatinine 9.4 ± 4.4 mg/dL, urea 182.5 ± 109.1 mg/dL, Hb 9.6 ± 1.7 g/dL, serum albumin 3.6 ± 0.6 g/dL, PTH 491.7 ± 392.6 pg/mL. Patients referred due to VA dysfunction had mean Hb 10.1 ± 1.8 g/dL, serum albumin 3.7 ± 1.0 g/dL, PTH 918.9 ± 541.6 pg/mL. There were no statistically significant differences in both groups concerning country of origin, although hypoalbuminemia was more frequent in patients from Saint Thomas and Prince (50%) and Angola (42.9%). All patients started HD with a central venous catheter (CVC). During follow-up, CVC remained the vascular access in 51.6% (n = 65), arteriovenous fistula in 42.9% (n = 54), and arteriovenous graft in 5.6% patients (n = 7). Nine patients had exhaustion of VA for HD. Mean follow-up time was 70.5 ± 41.3 months, 1.6% of the patients transitioned to peritoneal dialysis (n = 2) and 15.1% were submitted to renal transplantation (n = 18). The mortality rate during follow-up was 14.3% (n = 18). Conclusion There are few studies about African patients undergoing HD and this is the first study presenting the clinical characteristics and outcomes of hemodialysis patients from ACPOL. These are young patients, almost all with hypertension, with a high prevalence of anemia, malnutrition, and secondary hyperparathyroidism. All patients started HD with CVC and several presented multiple access dysfunction. These data reinforce the urgent need of improvement and investment in African countries’ healthcare, especially on what concerns the ESRD, as it contributes to serious consequences in these patients’ survival and quality of life. With the cooperation protocol, Portugal provides these patients with RRT, treatment of the CKD complications, VA care, possibility of peritoneal dialysis and renal transplantation, ultimately improving their chance of survival and quality of life.

#3836 DETERMINATION OF PREDICTORS OF OUTCOMES FOLLOWING VASCULAR ACCESS CONVERSION: WHICH PATIENTS BENEFIT MOST?

Abstract Background and Aims Conversion from central venous catheter (CVC) to arteriovenous fistula or graft (non-CVC) associates with favorable outcomes in hemodialysis (HD) patients. However, the “fistula first” paradigm has been debated and counter-proposed as “right access for the right patient at the right time and for the right reason”, indicating a shift towards precision medicine in vascular access care. It is unclearly how to classify patients into those suitable for conversion from CVC to non-CVC and which subgroups benefit most. Many factors (such as demographic, clinical and laboratory features) have been proposed to predict non-CVC failure after conversion and adverse outcomes. Due to confounding and potential biases it is difficult to shed light on which patients would benefit most from conversion. We investigated which factors are likely to be most helpful in the prediction of consequent benefit from conversion. Method We studied 54 potential predictors of incident HD patients undergoing conversion from CVC to non-CVC, between Jan. 2016 and Dec. 2019. Predictors included demographic and clinical variables such as comorbidities, drug history, and lab parameters. First, feature importance was assessed to separate weak from strong predictors using the Boruta algorithm. Second, important and tentative features were utilized in a subsequent machine learning workflow. Our main outcome was the predictive performance of different machine learning classification algorithms to predict re-conversion to central venous catheter and mortality within 1 year after conversion. Performance was quantified as accuracy, sensitivity, and Area under the receiver operating characteristics curve (AUC ROC). We compared insights from Machine learning algorithms to multivariate logistic regression models with selected inputs based on published literature (sex, age, BMI, diabetes, inflammation, blood pressure). Results After exclusion of patients with missing data, 38,151 out of 73,031 incident US HD patients were studied. Of these, 25,470 (66.8%) experienced no major adverse outcome within 1 year after access conversion, 3,683 (9.7%) underwent re-conversion, 7,779 (20.4%) did not survive the observational period, and 1,219 (3.2%) required re-conversion and did not survive the follow-up period. Post HD systolic blood pressure, history of a previous non-CVC that failed, and anthropometric characteristics (height, weight) had most weight in the prediction of re-conversion to CVC, according to the Boruta algorithm. Ethnicity and age were found to be the most important predictors of mortality. Classification based on the absence/presence of any major adverse outcomes resulted in a predictive accuracy between 0.70 and 0.54, depending on the respective algorithm. Sensitivity and ROCAUC had maxima of 0.58 and 0.69, respectively. However information gain by including all additional values had no remarkable effect on the predictive qualities (Table 1). Logistic regression for re-conversion in survivors only resulted in an accuracy of 0.78 and sensitivity of 0.29. Limiting predictors to 6 published predictors of our studied outcomes in the context resulted in an accuracy of 0.77 and sensitivity of 0.22 (Figure 1a and b). Conclusion Prediction of re-conversion and mortality within 1 year after catheter-to-arteriovenous access conversion is accurately feasible based on demographic and clinical features but discrimination of those benefiting most comes with low predictive accuracy. It remains reasonable to assume that not all patients will truly benefit from conversion, the inability to identify those that do not based on retrospective medical records data, again emphasizes “Fistula first” (if surgically feasible) and the need for investigation into molecular and genetic risk determinants.

High facility-level serum potassium variability associated with mortality in hemodialysis patients: results from Chinese Dialysis Outcomes and Practice Patterns Study (DOPPS)

The role of facility-level serum potassium (sK+) variability (FL-SPV) in dialysis patients has not been extensively studied. This study aimed to evaluate the association between FL-SPV and clinical outcomes in hemodialysis patients using data from the China Dialysis Outcomes and Practice Patterns Study (DOPPS) 5. FL-SPV was defined as the standard deviation (SD) of baseline sK+ of all patients in each dialysis center. The mean and SD values of FL-SPV of all participants were calculated, and patients were divided into the high FL-SPV (>the mean value) and low FL-SPV (≤the mean value) groups. Totally, 1339 patients were included, with a mean FL-SPV of 0.800 mmol/L. Twenty-three centers with 656 patients were in the low FL-SPV group, and 22 centers with 683 patients were in the high FL-SPV group. Multivariate logistic regression analysis showed that liver cirrhosis (OR = 4.682, 95% CI: 1.246–17.593), baseline sK+ (<3.5 vs. 3.5 ≤ sK+ < 5.5 mmol/L, OR = 2.394, 95% CI: 1.095–5.234; ≥5.5 vs. 3.5 ≤ sK+ < 5.5 mmol/L, OR = 1.451, 95% CI: 1.087–1.939), dialysis <3 times/week (OR = 1.472, 95% CI: 1.073–2.020), facility patients’ number (OR = 1.088, 95% CI: 1.058–1.119), serum HCO3 – level (OR = 0.952, 95% CI: 0.921–0.984), dialysis vintage (OR = 0.919, 95% CI: 0.888–0.950), other cardiovascular disease (OR = 0.508, 95% CI: 0.369–0.700), and using high-flux dialyzer (OR = 0.425, 95% CI: 0.250–0.724) were independently associated with high FL-SPV (all p < .05). After adjusting potential confounders, high FL-SPV was an independent risk factor for all-cause death (HR = 1.420, 95% CI: 1.044–1.933) and cardiovascular death (HR = 1.827, 95% CI: 1.188–2.810). Enhancing the management of sK+ of hemodialysis patients and reducing FL-SPV may improve patient survival.

THE INFLUENCE OF AMBULATORY BLOOD PRESSURE ON THE ASSOCIATIONS OF SEX WITH CARDIOVASCULAR EVENTS AND MORTALITY IN PATIENTS UNDERGOING HEMODIALYSIS: A PROSPECTIVE COHORT STUDY

Objective: Male patients with pre-dialysis CKD have worse ambulatory BP control than females and this is associated with higher mortality risk. Male hemodialysis patients have higher ambulatory BP levels compared to females. The aim of this study was to investigate the influence of ambulatory BP on the associations of sex with cardiovascular events and mortality in hemodialysis individuals. Design and method: 129 male and 91 female hemodialysis patients with valid 48-hour ABPM were followed prospectively for 53.4±31.1 months. The primary endpoint was cardiovascular mortality; the secondary endpoint was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, resuscitation after cardiac arrest, hospitalization for heart failure, coronary or peripheral revascularization procedure. Results: Cumulative-freedom from the primary endpoint was significantly lower for women (logrank-p = 0.032), while cumulative-freedom from the secondary endpoint did not differ significantly between the two groups (logrank-p = 0.644). The crude risk for cardiovascular mortality was significantly higher for women (HR = 1.613, 95% CI [1.037, 2.509]). The crude risk for the combined cardiovascular endpoint was not different between the two genders (HR = 0.918, 95% CI [0.638, 1.320]). After adjusting for other risk factors (age, diabetes, dialysis vintage, coronary disease) no significant differences in the risk for both the primary and the secondary endpoint were observed between women and men (primary: HR = 1.464 (95% CI [0.929, 2.307]), secondary: 0.866 (95% CI [0.596, 1.260])). After additional adjustment for 44-hour ambulatory BP the above relationships did not alter (primary: HR = 1.498, 95% CI [0.947, 2.368]), secondary: (HR = 0.911, 95%CI [0.625, 1.327])). Conclusions: In contrast to patients with pre-dialysis CKD, ambulatory BP does not appear to significantly influence the relationship between gender and adverse cardiovascular outcomes in hemodialysis patients.

Pre-existing serum indoxyl sulfate and COVID-19 outcomes in patients undergoing hemodialysis: A retrospective cohort study

Patients undergoing hemodialysis (HD) are at increased risk of severe complications from COVID-19 due to compromised immune function and comorbidities. This retrospective study aimed to investigate the association between pre-existing serum indoxyl sulfate (IS) concentrations and COVID-19 outcomes in HD patients.&#x0D; Methods. Data on pre-existing IS and proinflammatory cytokines, such as interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and tumor necrosis factor-alpha (TNF-α) were extracted from an existing patient database. The patients were followed up for 1.5 years and compared according to median serum IS concentration: low-IS (&lt; 22.2 μg/mL) and high-IS (≥22.2 μg/mL) groups. The primary outcomes focused on assessing the risk and severity of COVID-19 infection.&#x0D; Results. A total of 56 patients aged 62 (56-67) years with a dialysis vintage of 37.5 (30-168) months were included in the analysis. Serum levels of IS were significantly correlated with Kt/V values (p = 0.043), arterial hypertension (p = 0.001), IL-6 (p = 0.023), MCP-1 (p = 0.023), and TNF-α (p = 0.033) concentrations. Elevated serum IS levels were significantly associated with an increased risk of COVID-19 infection (p &lt; 0.0001) and a higher likelihood of hospitalization (p = 0.03). Patients with higher IS levels exhibited more severe lung involvement (p &lt; 0.0001) and a greater need for respiratory support (p = 0.004). A serum IS concentration of 21.5 μg/mL was the optimal threshold for predicting COVID-19 infection in HD patients (sensitivity of 83.4% and specificity of 92.3%, p &lt; 0.0001).&#x0D; Conclusion: Our study highlights the detrimental impact of serum IS on COVID-19 infection and its clinical outcomes in patients undergoing HD. Further research is warranted to elucidate the underlying mechanisms and explore potential therapeutic strategies targeting IS in this population.

388 Efficacy of Fortified Synbiotic Dessert on Malnutrition and Oxidative Stress Outcomes in Hemodialysis Patients: A Randomized Double-Blind Controlled Trial

388 Efficacy of Fortified Synbiotic Dessert on Malnutrition and Oxidative Stress Outcomes in Hemodialysis Patients: A Randomized Double-Blind Controlled Trial

Healthcare providers' support and outcomes in hemodialysis patients: The mediating effect of health literacy

ObjectiveThis study aimed to identify the mediating effect of health literacy (HL) on the relationship between healthcare providers' support and outcomes in patients on hemodialysis. MethodsA convenience sample of 149 hemodialysis patients participated in a cross-sectional survey. Mediation analysis with the percentile bootstrap method was used to identify the mediating effect of HL on the relationship between healthcare providers' support and patient outcomes. ResultsHealthcare providers' support and HL were significant predictors of patient outcomes. HL mediated the relationship between healthcare providers' support and patient outcomes. ConclusionThe HL of hemodialysis patients is essential in the relationship between healthcare providers' support and patient outcomes. Patient educators should implement a multifaceted HL-tailored intervention strategy to improve the HL of hemodialysis patients. Practice implicationsHemodialysis patients’ HL is a crucial mediating factor in the relationship between healthcare providers' support and patient outcomes. A multifaceted HL-tailored intervention strategy is needed to improve HL and, thus, health outcomes among hemodialysis patients

Association of Hyperkalemia and Hypokalemia with Patient Characteristics and Clinical Outcomes in Japanese Hemodialysis (HD) Patients.

This study aimed to examine the characteristics and clinical outcomes of Japanese hemodialysis patients with dyskalemia. A retrospective study was conducted using a large Japanese hospital group database. Outpatients undergoing thrice-a-week maintenance hemodialysis were stratified into hyperkalemia, hypokalemia, and normokalemia groups based on their pre-dialysis serum potassium (sK) levels during the three-month baseline period. Baseline characteristics of the three groups were described and compared for the following outcomes during follow-up: all-cause mortality, all-cause hospitalization, major adverse cardiovascular events (MACE), cardiac arrest, fatal arrythmia, and death related to arrhythmia. The study included 2846 eligible patients, of which 67% were men with a mean age of 65.65 (SD: 12.63) years. When compared with the normokalemia group (n = 1624, 57.06%), patients in the hypokalemia group (n = 313, 11.00%) were older and suffered from malnutrition, whereas patients in the hyperkalemia group (n = 909, 31.94%) had longer dialysis vintage. The hazard ratios for all-cause mortality and MACE in the hypokalemia group were 1.47 (95% confidence interval [CI], 1.13-1.92) and 1.48 (95% CI, 1.17-1.86), respectively, whereas that of death related to arrhythmia in the hyperkalemia group was 3.11 (95% CI, 1.03-9.33). Thus, dyskalemia in maintenance hemodialysis patients was associated with adverse outcomes, suggesting the importance of optimized sK levels.

Association between Cognitive Impairment and Malnutrition in Hemodialysis Patients: Two Sides of the Same Coin.

Cognitive impairment and malnutrition are prevalent in patients on hemodialysis (HD), and they negatively affect the outcomes of HD patients. Evidence suggests that cognitive impairment and malnutrition may be associated, but clinical studies to assess this association in HD patients are lacking. The aim of this study was to evaluate the association between cognitive impairment evaluated by the Montreal Cognitive Assessment (MoCA) score and nutritional status evaluated by the malnutrition inflammation score (MIS) in HD patients. We enrolled 84 HD patients (44 males and 40 females; age: 75.8 years (63.5-82.7); HD vintage: 46.0 months (22.1-66.9)). The MISs identified 34 patients (40%) as malnourished; the MoCa scores identified 67 patients (80%) with mild cognitive impairment (MCI). Malnourished patients had a higher prevalence of MCI compared to well-nourished patients (85% vs. 70%; p = 0.014). MoCa score and MIS were negatively correlated (rho:-0.317; p < 0.01). Our data showed a high prevalence of MCI and malnutrition in HD patients. Low MoCA scores characterized patients with high MISs, and malnutrition was a risk factor for MCI. In conclusion, it is plausible that MCI and malnutrition are linked by common sociodemographic, clinical, and biochemical risk factors rather than by a pathophysiological mechanism.

A small circulating miRNAs signature predicts mortality and adverse cardiovascular outcomes in chronic hemodialysis patients.

Chronic hemodialysis (HD) patients exhibit severe morpho-functional cardiac alterations, putting them at a high risk of death and adverse cardiovascular (CV) outcomes. Despite the fact that an unbalanced expression of various microRNAs (miRNAs) has been related to pathological cardiac remodeling and worse CV outcomes, scarce evidence exists on their role in this setting. We evaluated circulating levels of a selected miRNAs panel (30a-5p, 23a-3p, 451a and let7d-5p) in 74 chronic HD patients together with a thorough clinical and echocardiography assessment. Individuals were then prospectively followed (median 22months). The primary endpoint was a composite of all-cause and CV mortality and non-fatal CV events. Circulating levels of all miRNAs were lower in HD patients as compared with healthy controls and independently correlated to the severity of cardiac dysfunction. miRNA 30a-5p, 23a-3p and 451a expression was even lower in 30 subjects (40.5%) reaching the composite endpoint (P<.001), while no differences were reported for let7d-5p. The predictive value of these miRNAs was supported by univariate followed by multivariate Cox regression analyses [hazard ratio (HR) ranging from 0.943 to 0.995; P=.05 to .02] while Kaplan-Meier analyses confirmed a faster progression to the endpoint in individuals displaying miRNA levels below an optimal receiver operating characteristic-derived cut-off value (P ranging from .001 to <.0001; crude HRs 7.95 to 8.61). Lower circulating levels of miRNA 30-5p, 23a-3p and 451a in HD patients may reflect cardiac abnormalities and predict a higher risk of worse clinical outcomes in the short mid-term. Future studies on larger HD populations are needed to generalize these findings.

Clinical Outcomes in Patients on Hemodialysis with Congestive Heart Failure.

Congestive heart failure (CHF) is one of the common complications in patients with end-stage kidney disease. In the general population, CHF increases the risk of the death. However, there is no well-designed relevant study in the Chinese hemodialysis (HD) population addressing the risks associated with CHF. The aim of this study was to explore the impact of CHF on clinical outcomes in HD patients. Data from a prospective cohort study, the China Dialysis Outcomes and Practice Patterns Study (DOPPS) 5 (2012-2015), were analyzed. Demographic data, comorbidities, lab data, and death records were extracted. CHF was defined by the diagnosis records upon study inclusion. Our primary outcome was all-cause and cardiovascular (CV) mortality; secondary outcomes were all-cause and cause-specific hospitalization risk. Associations between CHF and outcomes were evaluated using Cox regression models. Stepwise multivariate logistic regression was used to identify the related risk factors, and subgroup analyses were carried out. Of 1,411 patients without missing CHF history information, 24.1% (340) had CHF diagnosis at enrollment. The overall mortality rates were 21.8% versus 12.0% (p < 0.001) in patients with and without CHF during follow-up, respectively. CHF was associated with higher all-cause mortality (adjusted HR: 1.72, 95% confidence interval [CI]: 1.17-2.53, p = 0.006), and the association with CV death was of similar magnitude (HR: 1.60, 95% CI: 0.91-2.81, p = 0.105). CHF patients had more episodes of hospitalization due to heart failure (HR: 2.93, 95% CI: 1.49-5.76, p < 0.01). However, compared with patients without CHF, the all-cause hospitalization risk was not much higher in CHF patients (HR: 1.09, 95% CI: 0.90-1.33, p = 0.39). Subgroup analysis found that the effect of CHF on all-cause mortality was stronger for male patients, patients with residual renal function, the elderly (≥60 years of age), patients with arteriovenous fistulae vascular accesses, nondiabetic patients, low-flux dialyzer users, and inadequately dialyzed patients (standardized Kt/V <2). In HD patients, CHF was found to be associated with a higher risk of all-cause mortality and cause-specific hospitalization risk. Further research is needed to identify opportunities to improve care for HD patients combined with CHF.