Outcomes In Maintenance Hemodialysis Patients Research Articles

The association between physical activity and cardiovascular events, tumors and all-cause mortality in patients with maintenance hemodialysis with different nutritional status

The current research focuses on the effects of nutritional supplementation and exercise on dialysis patients, but whether physical activity (PA) can reduce the risk of adverse outcomes for patients with different nutritional status is not clear. The maintenance hemodialysis (MHD) patients were recruited from April 2021 to April 2022. The information of PA was obtained from the international physical activity questionnaire (IPAQ). The outcomes were cardiovascular death, myocardial infarction, stroke, heart failure, atrial fibrillation, tumor and all-cause death. We used COX proportional risk model to estimate the association between PA and the outcomes of MHD patients. Patients are classified into two groups based on geriatric nutritional risk index (GNRI) and classified by age, and we used COX proportional risk model to estimate the association of PA and outcomes in subgroups. The isotemporal substitution model (ISM) was used to estimate the effects of replacing light physical activity (LPA) with moderate physical activity (MPA) or vigorous physical activity (VPA) on risk of cardiovascular events, tumors, and all-cause death in different subgroups. The effects of PA on ankle-brachial index (ABI) and body fat content were analyzed in different IPAQ groups. A total of 241 maintenance hemodialysis patients were included, 105 peoples developed cardiovascular death, myocardial infarction, stroke, heart failure, atrial fibrillation, tumor and all-cause death (43.6%). The median follow-up time was 12 months. MPA reduced the risk of outcome in MHD patients or high GNRI patients (40% vs 39%).In MHD patients who was under 65 years with high GNRI, MPA reduced cardiovascular death, myocardial infarction, stroke, heart failure, atrial fibrillation, tumor and all-cause death by 55%.PA reduced the risk of cardiovascular event by 65%, but did not reduce the risk of tumor or all-cause death. Replacing LPA with VPA did not improve clinical outcomes. It actually increases the risk of heart failure 0.4%. MPA reduced the risk of cardiovascular death, myocardial infarction, stroke, heart failure, atrial fibrillation, tumor, all-cause death in MHD patients under 65 years, while VPA had no health benefit.Trial registration: ChiCTR210050998.

Clinical Characteristics of 427 Unvaccinated Chinese Adult Patients with Maintenance Hemodialysis Infected with the SARS-CoV-2 Omicron Variant: A Retrospective Study

Background: Maintenance hemodialysis (MHD) patients constitute a distinctive population characterized by unique traits, such as hemodialysis-related immune disturbances, and increased vulnerability to infections, heart failure, particularly severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite considerable research on MHD patients with coronavirus disease 2019 (COVID-19), there is limited information available on the clinical characteristics and outcomes of unvaccinated adult MHD patients infected with the SARS-CoV-2 Omicron variant. Methods: A retrospective investigation was conducted in a cohort of 427 unvaccinated MHD patients diagnosed with SARS-CoV-2 Omicron infection. The clinical symptoms, laboratory results, and treatment regimens were comprehensively examined. Multivariate regression identified independent risk factors for disease severity, and two-month follow-up assessments were conducted. Results: The cohort exhibited a spectrum of disease severity, with 37.5% classified as mild, 35.3% as common, 22.5% as severe, and 4.7% as critical. Serum C-reactive protein level, procalcitonin level, and bicarbonate concentration are related to the severity of the disease. Tailored treatment strategies—including nutritional support, hemodialysis management, anti-bacterial interventions, and more—were implemented. There was a 5.6% mortality rate, with a higher prevalence of deaths in the critical subtype. Independent risk factors for disease severity included fever, age, cycle threshold values (Ct values) of ORF1ab gene, and arterial oxygen partial pressure. Follow-up assessments revealed a median duration of 11 days for the negative nucleic acid of SARS-CoV-2. Twelve patients presented a second positive ORF1ab gene during follow-up but remained asymptomatic. Conclusion: These findings suggest the intricate clinical characteristics and outcomes of MHD patients with the SARS-CoV-2 Omicron infection. Tailored treatment strategies, continuous surveillance, and understanding prognostic factors are imperative for managing this high-risk population. Further research is warranted to validate these findings.

#2057 Sex differences in bioimpedance-spectroscopy-derived fluid status and body composition of maintenance hemodialysis patients

Abstract Background and Aims Bioimpedance-spectroscopy-(BIS)-derived estimates of fluid status and body composition are associated with mortality in patients undergoing maintenance hemodialysis (HD). Previously, thresholds for improved survival were identified for volume overload (VO, <2.5 L), VO relative to extracellular water (VO/ECW, <15%), lean tissue index (LTI, 15-20 kg/m2) and fat tissue index (4-15 kg/m2). However, these thresholds did not distinguish between sexes. Considering current efforts to untangle differences between male and female kidney disease patients, we aimed to analyze BIS data stratified by sex. Method We retrospectively evaluated pre-HD BIS measurements using the whole-body “Body Composition Monitor” device (Fresenius Medical Care). Measurements were conducted at the “Vienna Dialysis-Center”, a large tertiary dialysis center in Vienna, Austria. Continuous variables were described as medians and interquartile ranges and compared between sexes using Wilcoxon tests. Differences in proportions of males and females within the above-mentioned target ranges of body composition parameters were tested using Chi-Square tests and Fisher's exact tests. Results In November 2022, the Vienna Dialysis-Center cared for 304 patients, 159 of whom underwent BIS measurements. A total of 137 patients remained for analysis after excluding erroneous results (62% male, 38% female). The median [interquartile range] age among analyzed male and female patients was 60.0 years [48.0; 72.0] and 65.5 years [57.8; 75.3], and the median dialysis vintage was 28.9 months [12.1; 52.7] and 27.2 months [14.8; 61.9], respectively. VO (2.7 vs 1.9 L, p = 0.025), LTI (13.4 vs. 11 kg/m2, p < 0.001) and FTI (11.1 vs. 14.2 kg/m2, p = 0.036) differed significantly between males and females but VO/ECW did not (14.3 vs. 12%, p = 0.4). 27.1% of males (n = 23) were within 15-20 kg/m2 LTI compared to 7.7% of females (n = 4, p = 0.007). Differences in the proportions of male and female patients within optimal ranges of VO (43.5% vs. 61.5%, p = 0.062) and FTI (67.9% vs. 50.0%, p = 0.058) were close to reaching statistical significance. Conclusion We discovered relevant differences in fluid status and body composition among patients undergoing maintenance HD not only in absolute numbers, but also in the proportion of patients within the optimal range of LTI. Considering sex differences in body composition but (on average) equal mortality among HD patients, optimum target ranges of BIS measurements may differ between sexes. Our findings from this relatively small cohort call for large-scale sex-specific analyses of fluid status, body composition and outcomes in maintenance HD patients.

Relationship between effective blood flow rate and clinical outcomes in maintenance hemodialysis patients: a single-center study

The association between blood flow rate (BFR) and clinical outcomes in patients undergoing maintenance hemodialysis (MHD) is inconclusive. This retrospective study included 175 patients undergoing MHD treatment between July 2015 and March 2022, divided into two groups based on time-averaged effective blood flow rate (eBFR) median value. We investigated arteriovenous fistula (AVF) outcomes and the association of eBFR with all-cause mortality and new major adverse cardiovascular events (MACE). Mean ± SD and median time-averaged eBFR values were 276 ± 24 and 275 mL/min, respectively. After adjusting for relevant factors including age, sex, vintage, diabetes, CVD, receiving hemodiafiltration (HDF) treatment and spKt/V, Cox models indicated a low time-averaged eBFR (≤ 275 ml/min) was associated with increased risks of all-cause mortality (hazard ratio [HR] 14.18; 95% confidence interval [CI], 3.14–64.1) and new MACE (HR 3.76; 95% CI, 1.91–7.40) in MHD patients. Continuous Cox models demonstrated each 20 ml/min increase in eBFR linked to a 63% decrease in the risk of all-cause mortality (HR: 0.37, 95% CI: 0.23–0.59) and a 38% decrease in the occurrence of new MACE (HR: 0.62, 95% CI: 0.46–0.84). There was no significant difference in AVF outcomes between the two groups. Our study noted higher eBFR (>275 mL/min) is associated with lower risks of both all-cause mortality and new MACE compared with low eBFR (≤275 mL/min). Increased eBFR is not associated with a higher risk of AVF failure.

Clinical characteristics and outcomes of maintenance hemodialysis patients with COVID-19 during the Omicron wave of the pandemic in Beijing: a single center retrospective study

BackgroundThe clinical manifestations and prognosis of hemodialysis patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) during the Omicron wave of the pandemic infection were still unclear. This study investigated the clinical characteristics of patients undergoing maintenance hemodialysis (MHD) infected with it.MethodsThis retrospective single-center study included 151 patients undergoing MHD. Healthcare workers were selected as control group were assessed from December 1, 2022 to March 31, 2023. Clinical data, laboratory test results, treatment protocols, and prognoses were collected and analyzed.ResultsThe study population included 146 patients with MHD, 93 (63.7%) of whom were infected with SARS-CoV-2. The number of non-severe, severe, and critical cases was 84 (90.3%), 4 (4.3%), and 5 (5.3%), respectively. Six patients (6.5%) died during the study period. The main symptoms of SARS-CoV-2 infection, including fever, cough, and fatigue, were less common in patients with MHD than the controls. During SARS-CoV-2 infection, the C-reactive protein (2.9 vs. 11.8 mg/dl, p < 0.0001) and ferritin levels(257.7 vs. 537 ng/l, p < 0.0001) were elevated. The hemoglobin(113vs 111 g/L, p = 0.0001) and albumin levels(39.4 vs. 36.1 g/L, p < 0.0001) decreased. Generally, it took two months for the hemoglobin levels to recover. Positivity rate for SARS-COV-2 serum immunoglobin G (IgG) antibodies and IgG titers were lower in dialysis patients than the controls. Age was positively associated with disease severity, while age and hyponatremia were associated with death.ConclusionsPatients with MHD and COVID-19 were primarily classified as non-severe. SARS-CoV-2 infection would soon lead to the increase of inflammation related acute response protein in dialysis patients, and then lead to the decrease of hemoglobin and albumin. About 9.6% in HD patients were severe cases and had poor prognosis. Advanced age and hyponatremia were associated with disease severity and prognosis.

Serum ferritin and neutrophil-to-lymphocyte ratio predict all-cause mortality in patients receiving maintenance hemodialysis: a prospective study.

Introduction: Maintenance hemodialysis is an effective treatment for end-stage renal disease patients. A critical factor contributing to the deterioration and death of maintenance hemodialysis patients is inflammation. Therefore, we focused on two inflammatory markers, serum ferritin and neutrophil-to-lymphocyte ratio, to speculate whether they could predict the prognosis of maintenance hemodialysis patients. Patients and methods: We followed 168 patients with maintenance hemodialysis from July 2019 to July 2022 with the endpoint of all-cause death or follow-up completion. Receiver operating characteristic curves were plotted to assess the values of serum ferritin, neutrophil-to-lymphocyte ratio and serum ferritin combined with neutrophil-to-lymphocyte ratio to predict the outcomes of maintenance hemodialysis patients. Kaplan-Meier survival curves were constructed to compare survival rates over time. Results: Receiver operating characteristic curves demonstrated that the best cut-off value of serum ferritin for predicting the prognosis of maintenance hemodialysis patients was 346.05μg/L, and that of neutrophil-to-lymphocyte ratio was 3.225. Furthermore, a combination of both had a more excellent predicting value than either index (p < 0.05). Kaplan-Meier survival curve analyses revealed that low serum ferritin levels and low neutrophil-to-lymphocyte ratio had a higher probability of survival than high ferritin levels and high neutrophil-to-lymphocyte ratio, separately. Conclusion: Elevated serum ferritin and neutrophil-to-lymphocyte ratio are closely related to all-cause mortality among maintenance hemodialysis patients, for which they may be predictors of all-cause mortality. Additionally, the combination of the two has a much higher predictor value for the prognosis of maintenance hemodialysis patients.

Association between body iron content and clinical outcomes in maintenance hemodialysis patients

Association between body iron content and clinical outcomes in maintenance hemodialysis patients

#4153 OUTCOMES OF COVID-19 INFECTION AMONG MAINTENANCE HEMODIALYSIS PATIENTS – EXPERIENCE FROM THE FIRST COVID-19 HOSPITAL IN SERBIA

Abstract Background and Aims Patients on maintenance hemodialysis (HD) might be particularly vulnerable to severe COVID-19 due to their older age and numerous comorbidities. Furthermore, their specific treatment regimen substantially exposes them to the risk of infection. The abrupt onset of the novel coronavirus disease (COVID-19) pandemic required prompt action and immediate reorganization of healthcare services while maintaining the necessary standard of treatment for chronic patients. In this study, we aimed to analyze clinical features and risk factors for poor outcomes in maintenance HD patients with COVID-19. Method We analyzed data for 226 maintenance HD patients (67.7% male, age range 25 – 90 years, time on dialysis 6 – 278 months) who contracted COVID-19 in their original dialysis units and were therefore transferred for further HD treatment to the first hospital in Serbia transformed to exclusively admit COVID-19 patients at the onset of the epidemic. According to the local protocol, all patients were hospitalized while being dialyzed. Data were collected from clinical charts and patient histories for the period between March 19, 2020, and March 19, 2022, and analysed with SPSS software, version 22 (IBM Corporation, New York, USA). Results A total of 1384 HD treatments were performed in 226 patients (6.12±4.50, range 1 – 34 per patient). Most patients (98.7%) had at least one comorbidity: hypertension (68.1%), diabetes (26.1%), cardiovascular disease (16.4%), cerebrovascular disease (7.5%), malignancy (9.3%), chronic respiratory disease (4.0%) or autoimmune disease (1.8%). The average number of comorbidities was 1.9±1.0 (range 0 – 4). Only 2.2% of all patients were vaccinated. Most patients (78.0%) had bilateral pneumonia upon admission, 15.3% had normal pulmonary X-ray, 5.1% had unilateral pneumonia and 1.7% had ARDS. 34% of the patients required mechanical ventilation. Fifty-seven patients (25.2%) received corticosteroid therapy, 5.3% were treated with chloroquine, 2.7% received antiviral therapy and 1.8% were administered IL6 antagonist. The overall mortality rate was 39.4%. Patients who died were significantly older (67.6±12.4 vs 63.2±12.7; p = 0.012), more often had cardiovascular disease (p = 0.046) and bilateral pneumonia (p&amp;lt;0.001), had worse CT severity score (13.0±5.1 vs 9.2±5.0; p&amp;lt;0.001) and required invasive mechanical ventilation (p&amp;lt;0.001) and had fewer HD treatments performed during hospitalization (5.1±4.8 vs 6.8±4.2; p = 0.007). They also had significantly higher white blood cells count (8.3±5.3 vs 5.6±2.9; p&amp;lt;0.001), serum urea (24.9±12.0 vs 21.1±8.4 mmol/L; p = 0.01), LDH (119.8±95.5 vs 63.9±72.9 IU/L; p&amp;lt;0.001), CRP (157.8±239.1 vs 61.1±94.8 mg/dL; p = 0.008), IL-6 (14.9±36.0 vs 2.8±7.3 pg/mL; p = 0.004), and Ddimer (372.3±294.1 vs 240.7±101.5 ng/mL; p&amp;lt;0.001). Multiple logistic regression showed a significant association between mortality and older age (OR 1.11, 95% CI 1.04-1.18, p = 0.001), need for mechanical ventilation (OR 43.1, 95% CI 9.5-198.6; p&amp;lt;0.001), higher CT severity score (OR 1.16, 95% CI 1.07 – 1.25; p&amp;lt;0.001), fewer HD procedures performed (OR 0.80, 95% CI 0.69-0.93; p = 0.003), and higher D-dimer levels (OR 1.00, 95% CI 1.00 - 1.01; p = 0.012). Conclusion Maintenance HD patients are considered a high-risk population for contracting COVID-19 and developing a severe form of the disease. Older age, higher CT severity score

The impact of chronic pre-dialysis hyponatremia on clinical outcomes in maintenance hemodialysis patients

ObjectiveChronic pre-dialysis hyponatremia is not rare in maintenance hemodialysis (MHD) patients. However, the association between chronic pre-dialysis hyponatremia and mortality is uncertain due to multiple potential confounders such as hyperglycemia, fluid overload, and malnutrition. This study aimed to more comprehensively evaluate the association between chronic pre-dialysis hyponatremia and clinical outcomes in MHD patients.MethodsWe analyzed the data of 194 MHD patients with regular real-time measurements of pre-dialysis serum sodium from July 2015 to March 2021. Hyponatremia was defined as SNa ≤ 135 mmol/L and normonatremia as SNa > 135 mmol/L and < 145 mmol/L. We evaluated the association of baseline pre-dialysis serum sodium (SNa) and time-averaged SNa (TASNa) levels with all-cause mortality or new major adverse cardiovascular events (MACE) in MHD patients. Furthermore, the SNa levels were glucose, serum albumin, and fluid overload adjusted. The associations between SNa levels and all-cause mortality or new MACE were analyzed using time-varying Cox regression models.ResultsAmong the total of 194 patients, 24 patients died and 45 new MACE occurred during a mean 35.2-month follow-up period. The baseline pre-dialysis SNa level was 137.1 ± 2.8 mmol/L (127–144 mmol/L). Kaplan–Meier survival analysis showed that there were no significant differences in all-cause mortality or new MACE between hyponatremia and normonatremia groups according to baseline pre-dialysis SNa or glucose-corrected SNa (gcSNa). The mean values of both TASNa and time-averaged glucose-corrected SNa (TAgcSNa) were 136.9 ± 2.4 mmol/L and 138.3 ± 2.0 mmol/L, respectively. Kaplan–Meier survival analysis showed that patients with pre-dialysis hyponatremia had higher all-cause mortality or new MACE compared with normonatremia patients whether grouped on TASNa or TAgcSNa. Cox models showed an increased risk of all‐cause mortality and new MACE in MHD patients with pre-dialysis hyponatremia based on TASNa or TAgcSNa. Even after full adjustment including time-dependent age and dialysis vintage, gender, diabetes, time-averaged weight gain (TAWG), and serum albumin, patients with pre-dialysis hyponatremia based on TASNa (HR 2.89; 95% CI 1.18–7.04; model 3) or TAgcSNa (HR 5.03; 95% CI 1.87–13.57; model 3) had approximately twofold or fourfold greater risk of all-cause mortality, respectively, compared with those with normonatremia. The risk of new MACE was also significantly elevated in patients with pre-dialysis hyponatremia based on TASNa (HR 3.86; 95% CI 2.13–7.01; model 1) or TAgcSNa (HR 2.43; 95% CI 1.14–5.15; model 1). After adjustment for time-dependent age and dialysis vintage, gender, diabetes, TAWG, and serum albumin, patients with pre-dialysis hyponatremia based on TASNa (HR 2.33; 95% CI 1.16–4.68; model 3) had a higher risk of new MACE compared with those with normonatremia.ConclusionsPre-dialysis time-averaged hyponatremia is independently associated with increased risks of all-cause mortality or new MACE in MHD patients. The baseline SNa level is not a predictor of clinical outcomes due to its variation over time. Hyperglycemia, fluid overload, and malnutrition do not have a significant impact on the risk association between chronic hyponatremia and all-cause mortality or new MACE in MHD patients.

Impedance-derived phase angle is associated with muscle mass, strength, quality of life, and clinical outcomes in maintenance hemodialysis patients.

We aimed to evaluate the association between the phase angle and muscle mass, muscle strength, physical performance tests, quality-of-life scales, mood scales, or patient and hospitalization-free survival rates in hemodialysis (HD) patients. We included 83 HD patients. The patients were divided into tertiles based on phase angle value. The phase angle was measured using a bioimpedance analysis machine. Thigh muscle area per height squared (TMA/Ht2), handgrip strength (HGS), nutritional indicators, physical performance, quality-of-life, depression or anxiety status, and the presence of hospitalization or death regardless of cause were evaluated. In our study, no significant differences were observed in the serum albumin level and body mass index according to tertiles of phase angle. The phase angle tertiles were associated with TMA/Ht2 and HGS. The phase angle was also associated with physical performance measurements and depression or anxiety status. Subgroup analyses according to sex, age, and diabetes mellitus showed similar trends to those of the total cohort. Furthermore, the hospitalization-free survival rate and patient survival rate were favorable in patients with high values for the phase angle. The present study demonstrated that the phase angle is associated with muscle mass, strength, physical performance, quality-of-life scale, and hospitalization-free survival in maintenance HD patients.

Circulating miRNA-29b and Sclerostin Levels Correlate with Coronary Artery Calcification and Cardiovascular Events in Maintenance Hemodialysis Patients.

Objective Coronary artery calcification (CAC) is a common complication in end-stage renal disease (ESRD) patients undergoing maintenance hemodialysis (MHD), and the extent of CAC is a predominant predictor of cardiovascular outcomes in MHD patients. In this study, we sought to uncover the relationship between circulating miRNA-29b, sclerostin levels, CAC, and cardiovascular events (CVEs) in MHD patients. Methods This study recruited patients receiving MHD for at least three months in the Hainan General Hospital between January 2016 and June 2019, and all patients were followed up 24 months for CVEs. The serum level of sclerostin was determined by enzyme-linked immunosorbent assay (ELISA) and miRNA-29b expression by real-time qPCR (RT-qPCR). All patients received cardiac CT scans to evaluate CAC, and CAC scores were expressed in Agatston units. The MHD patients with CACs <100 were arranged into the CAC (<100) group, those with 100–400 CACs into the CAC (100–400) group, and those with CACs >400 into the CAC (>400) group. Net reclassification index (NRI) and integrated discrimination index (IDI) were calculated to assess the predictive performance of serum sclerostin level for the occurrence of CVEs. Results Compared with the CAC (<100) group, the CAC (>400) group had higher proportions of older patients, hypertension and diabetes mellitus patients, longer dialysis duration, higher mean arterial pressure (MAP), higher levels of high-sensitivity C-reactive protein (hs-CRP), alkaline phosphatase (ALP), and phosphate (P < 0.05). It was found that the CAC (100–400) and CAC (>400) groups exhibited higher serum levels of sclerostin but lower levels of miRNA-29b than the CAC (<100) group (P < 0.05) and the CAC (>400) group had a higher level of sclerostin and a lower level of miRNA-29b than the CAC (100–400) group (P < 0.05). The circulating level of miRNA-29b was negatively correlated with the serum level of sclerostin in MHD patients (r = −0.329, P < 0.01). The multivariate logistic regression analysis showed that hs-CRP, phosphate, sclerostin, and miRNA-29b were independent risk factors for CAC in MHD patients (P < 0.05, Table 2). ROC for prediction of CAC by sclerostin yielded 0.773 AUC with 95% CI 0.683–0.864 (P < 0.01). As depicted by Kaplan–Meier curves of CVE incidence in MHD patients according to median sclerostin (491.88 pg/mL) and median miRNA-29b (Ct = 25.15), we found that serum levels of sclerostin and miRNA-29b were correlated with the incidence of CVEs in MHD patients. When a new model was used to predict the incidence of CVEs, NRI 95% CI was 0.60 (0.16–1.03) (P < 0.05) and IDI 95% CI was 0.002 (−0.014 to 0.025) (P < 0.05), suggesting that sclerostin added into the old model could improve the prediction of the incidence of CVEs. Conclusions These data suggest that circulating miRNA-29b and sclerostin levels are correlated with CAC and incidence of CVEs in MHD patients. Higher sclerostin and lower miRNA-29b may serve as independent risk factors for the incidence of CVEs in MHD patients.

The paradoxical effect of aldosterone on cardiovascular outcome in maintenance hemodialysis patients.

BackgroundPatients with end-stage kidney disease face increased risk of cardiovascular events, and left ventricular diastolic dysfunction (LVDD) contributes to the high occurrence of cardiovascular mortality (CM). Although a high serum aldosterone (sALD) level is involved in the development of cardiovascular complications in the general population, this association is unclear in patients undergoing hemodialysis. We aimed to determine the impact of sALD on LVDD and CM among hemodialysis patients (HDPs).MethodsWe performed a prospective cohort study of maintenance HDPs without cardiovascular disease. The patients were divided into two groups according to the median level of sALD. All patients underwent baseline echocardiography to evaluate diastolic dysfunction (E/e' ratio > 15). The LVDD and CM rates were compared between the high and low aldosterone groups.ResultsWe enrolled a total of 60 adult patients (mean age, 57.9 ± 12.1 years; males, 30.0%). The low aldosterone group had an increased left ventricular diastolic dimension compared with the high aldosterone group (52.2 ± 8.4 mm vs. 50.3 ± 5.2 mm, respectively; p = 0.03). Low log-aldosterone (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.19–0.86) and large left atrial dimension (OR, 1.31; 95% CI, 1.11–1.54) were independent risk factors for LVDD at baseline. In addition, Cox regression analysis demonstrated that low sALD was an independent predictor of CM in HDPs (hazard ratio, 0.46; 95% CI, 0.25–0.85; p = 0.01) during follow-up.ConclusionLow sALD was not only associated with LVDD but was also an independent predictor of CM among HDPs regardless of their interdialytic weight gain.

Predialysis serum phosphate and intradialytic hypotension.

Intradialytic hypotension (IDH) is a common complication of hemodialysis (HD) and is associated with excess morbidity and mortality. Higher serum phosphate is associated with adverse cardiovascular outcomes in maintenance HD patients; however, its association with IDH has not previously been assessed. This is an analysis of a prospective cohort of 969 HD patients (80,968 HD sessions) receiving HD at a large dialysis organization (LDO) and a post-hoc analysis of 1838 HD patients (10,594 HD sessions) in the Hemodialysis study (HEMO), a multicenter randomized controlled trial that examined standard or high-dose HD and low-flux or high-flux membranes. Unadjusted and adjusted mixed effects regression models were fit to determine the association of pre-HD serum phosphate with IDH, defined as a nadir intra-HD systolic blood pressure (SBP) <90 mmHg. In the LDO cohort, baseline mean pre-HD serum phosphate was 5.2 ± 1.7mg/dl. IDH occurred in 15.6% of HD sessions. In the adjusted model, higher pre-HD serum phosphate (per 1mg/dl) was associated with a 12% increased risk of IDH (aOR 1.12, 95% CI 1.10-1.13, p <0.001). In exploratory models where pre-HD laboratory values were available, the effect estimate was attenuated but remained statistically significant (aOR 1.05; 95% CI 1.02-1.08; p <0.01). Participants in the highest (compared with the lowest) quartile of pre-HD serum phosphate had a 56% greater risk of IDH in the adjusted model (aOR Q4:Q1 1.56; 95% CI 1.44-1.68, p <0.001). The association of higher phosphate with IDH was consistent in the HEMO data. Higher pre-HD serum phosphate is independently associated with an increased risk of IDH. As HD may cause an acute decline in serum phosphate, future studies to investigate the mechanisms of this association are warranted.

RELATION BETWEEN SERUM FERRITIN AND LEFT VENTRICULAR FUNCTIONS IN HEMODIALYSIS PATIENTS

Background: Cardiovascular disease is still the most common cause of morbidity and mortality in hemodialysis patients. High serum ferritin is correlated with mortality and cardiovascular outcome in maintenance hemodialysis patients. Objective: To evaluate relationship between serum ferritin level and left ventricular functions and cardiovascular outcomes in hemodialysis patients. Patients and methods: Sixty hemodialysis (HD) patients from Clinic of Internal Medicine Department, Al-Sayed Galal University Hospital, Cairo, Egypt between December 2019 and June 2020. Were enrolled Left ventricular mass (LVM), Left ventricular mass index (LVMi) and Left ventricular mass/height 2.7 (LVM/Ht2.7) were evaluated with transthoracic echocardiography. Patients were classified into two groups according to serum ferritin into 30 patients with serum Ferritin < 800 ng/ml (Group A), and 30 patients with serum Ferritin ≥ 800 ng/ml (Group B). Results: We found statistically significant difference (p-value < 0.05) between studied groups as regard LVESD and LVM/Ht2.7, and statistical significant difference (p-value < 0.001) between studied groups as regard LVEDD and LVMI. The LVEDD, LVMI, LVESD and LVM/Ht2.7 values were significantly higher in group B (High Ferritin) compared with group A (Low ferritin). Conclusion: High serum ferritin level (≥ 800 μg/L) was positively associated with left ventricular hypertrophy in hemodialysis patients.

Clinical features and outcome of maintenance hemodialysis patients with COVID-19 from a tertiary nephrology care center in Romania

Background There is limited information about the clinical characteristics, treatment and outcome of maintenance hemodialysis patients with COVID-19. Moreover, regional differences are also conceivable since the extend and severity of outbreaks varied among countries. Methods In this retrospective, observational, single-center study, we analyzed the clinical course and outcomes of 37 maintenance hemodialysis patients (median age 64 years, 51% men) hospitalized with COVID-19 from 24 March to 22 May 2020 as confirmed by real-time PCR. Results The most common symptoms at admission were fatigue (51%), fever (43%), dyspnea (38%) and cough (35%). There were 59% mild/moderate patients and 41% severe/critical patients. Patients in the severe/critical group had a significantly higher atherosclerotic burden since diabetic kidney disease and vascular nephropathies were the most common primary kidney diseases and eighty percent of them had coronary heart disease. Also, Charlson comorbidity score was higher in this group. At admission chest X-ray, 46% had ground-glass abnormalities. Overall, 60% patients received hydroxychloroquine, 22% lopinavir–ritonavir, 11% tocilizumab, 24% systemic glucocorticoids, and 54% received prophylactic anticoagulation. Seven (19%) patients died during hospitalization and 30 were discharged. The main causes of death were cardiovascular (5 patients) and respiratory distress syndrome (2 patients). In Cox regression analysis, lower oxygen saturation, anemia and hypoalbuminemia at admission were associated with increased mortality. Conclusions In conclusion, we observed a high mortality rate among maintenance hemodialysis patients hospitalized for COVID-19. Anemia, lower serum albumin and lower basal oxygen saturation at admission were factors associated with poor prognosis.

Plasma and Erythrocytes Lipidomic Analysis of Adverse Cardio-Cerebrovascular Outcome in Maintenance Hemodialysis Patients

Plasma and Erythrocytes Lipidomic Analysis of Adverse Cardio-Cerebrovascular Outcome in Maintenance Hemodialysis Patients

Paradoxical Effect of Aldosterone on Cardiovascular Outcome in Maintenance Hemodialysis Patients

Paradoxical Effect of Aldosterone on Cardiovascular Outcome in Maintenance Hemodialysis Patients

Effect of Ultrafiltration Rate in Long Interdialytic Interval Hemodialysis Session versus Average Weekly Ultrafiltration Rate on Mortality Rate and Adverse Cardiovascular Outcomes in Maintenance Hemodialysis Patients

Objective: Cardiovascular events are more commonly observed during hemodialysis sessions after a long interdialytic interval compared to average weekly hemodialysis sessions, and ultrafiltration rate (UFR) was reported to be associated with cardiovascular outcomes. Whether the UFR during hemodialysis sessions after a long interdialytic interval is a better predictor of cardiovascular outcome than the average weekly UFR is unknown.Methods: The charts of patients aged &gt;18 years with end-stage renal disease that received hemodialysis treatment Siriraj Hospital during January 2008 to December 2017 were retrospectively reviewed.Results: Two hundred and forty-one patients (52.8% females) were included. During the median time follow-up of 54 months, the rate of adverse cardiovascular outcomes was 7.26 events/100-patient-years, and the mortality rate was 8.40 deaths/100-patient-years. Mean UFR was significantly higher in the long interdialytic interval hemodialysis sessions than in the average weekly UFR sessions (14.07±5.29 vs.13.13±5.14 ml/h/kg, p&lt;0.001). Compared with UFR of ≤10 ml/h/kg, the adjusted hazard ratio (HR) for mortality in the UFR &gt;13 ml/hour/kg subgroup was 1.29 (95% CI: 0.65-2.56) and 1.05 (95% CI: 0.55-2.03) in the long interdialytic interval hemodialysis sessions and the average weekly UFR, respectively. The adjusted HR for adverse cardiovascular outcome in the UFR &gt;13 ml/h/kg subgroup was 1.32 (95% CI: 0.64-2.80) and 0.72 (95% CI: 0.36-1.35) in the long interdialytic interval hemodialysis sessions and the average weekly UFR, respectively.Conclusion: This study revealed the UFR in long interdialytic hemodialysis sessions to be more strongly associated with adverse cardiovascular outcomes and all-cause mortality than the average weekly UFR.

Progression of Aortic Arch Calcification Is Associated with Overall and Cardiovascular Mortality in Hemodialysis.

Background Vascular calcification is common and associated with unfavorable outcomes among patients with end-stage renal disease (ESRD). Nevertheless, little is known whether the progression of vascular calcification outweighs the baseline calcification in association with overall and cardiovascular (CV) mortality in hemodialysis (HD) patients. Methods This study included 140 maintenance HD patients. Vascular calcification was assessed using the aortic arch calcification (AoAC) score measured from chest radiographs at the baseline and the second year of follow-up. Progression of vascular calcification (ΔAoAC) was defined as the difference between the two measurements of AoAC. The association of ΔAoAC with overall and CV mortality was evaluated using multivariate Cox regression analysis. Results During the mean follow-up period of 5.8 years, there were 49 (35%) overall mortality and 27 (19.3%) CV mortality. High brachial-ankle pulse wave velocity was positively correlated with ΔAoAC, whereas old age was negatively correlated with ΔAoAC. In multivariate adjusted Cox analysis, increased ΔAoAC (per 1 unit), but not baseline AoAC, was significantly associated with overall mortality (HR, 1.183; 95% CI, 1.056–1.327; p = 0.004) and CV mortality (HR, 1.194; 95% CI, 1.019–1.398; p = 0.028). Conclusion Progression of AoAC outperformed the baseline AoAC in association with increased risk of overall and CV mortality in HD patients. A regular follow-up of chest radiograph and AoAC score assessments are simple and cost-effective to identify the high-risk individuals of unfavorable outcomes in maintenance HD patients.

P1273EFFECTS OF ABDOMINAL AORTIC CALCIFICATION PROGRESSION ON OUTCOMES IN MAINTENANCE HEMODIALYSIS PATIENTS

Abstract Background and Aims Vascular calcification is the risk factor for cardiovascular event, cardiovascular mortality and all-cause mortality in maintenance hemodialysis (MHD) patients. We investigated the effects of abdominal aortic calcification (AAC) progression on outcomes in MHD patients. Method 111 patients who were on MHD between Jun. 2014 and Oct. 2014 in the dialysis center and finished the AAC examination at baseline and two years later were included prospectively. We evaluated the progression of AAC by AAC score (AACs) at baseline and two years later. According to the change of AACs, the patients were divided into rapid AAC progression group (change of AACs&amp;gt;median) and non-rapid AAC progression group (change of AACs≤median). We investigated the effects of AAC progression on outcomes in MHD patients in the follow-up period. Kaplan-Meier analysis was used to compare their survival rate. Uni- and multivariable Cox proportional hazard regression models were used to determine the risk factors of all-cause mortality, cardiovascular mortality and cardiovascular events. Results The presence of AAC was 78.4% (87/111), rapid AAC progression was seen in 54 patients, and non-rapid AAC progression was seen in 57 patients. The mean follow-up duration was 27.9(27.1, 28.0) months. Kaplan-Meier analysis showed that patients in rapid AAC progression group had a higher risk of mortality as compared to patients in non-rapid AAC progression group (P=0.017). Multivariate Cox regression analysis demonstrated that high baseline AACs (HR=1.135, 95%CI∼1.001∼1.286, P=0.048), hypoproteinemia (HR=0.789, 95%CI 0.640∼0.972, P=0.026) were independent risk factors for all-cause mortality. High baseline AACs (HR=1.187, 95%CI 1.038∼1.356, P=0.012), low spKt/V (HR=0.103, 95%CI 0.013∼0.801, P=0.030) were independent risk factors for cardiovascular mortality. Low spKt/V (HR=0.018, 95%CI 0.003∼0.115, P=0.000), hypoproteinemia (HR=0.736, 95%CI 0.608∼0.890, P=0.002) were independent risk factors for cardiovascular events. Conclusion Abdominal aortic calcification progression may increase the risk of cardiovascular events and death in MHD patients. Severity of abdominal aortic calcification, adequacy of dialysis, and nutritional status are predictors of outcomes in MHD patients.