Post Hemodialysis Research Articles

Co-relation Between Calcium-Phosphorus Product and Hypertension in End-Stage Renal Disease Patients.

ObjectiveIn our study, we evaluated the relation between calcium-phosphorus (Ca-P) product and various measurements of pre and post-dialysis blood pressure (BP) in hemodialysis (HD) patients.MethodsThis is a prospective, observational, cross-sectional study in which patients undergoing maintenance HD for > six months were enrolled through non-probability consecutive sampling during a six-month period from October 2020 to March 2021. Linear regression analysis was done to study the effect of the Ca-P product for each parameter of BP and regression coefficients were acquired.ResultsThere was a total of 111 patients in our study, of which 59 (53.2%) were male. The mean age was 50.1± 14.4. The most common comorbid was hypertension (98.2%). The mean HD vintage of patients was 5.7 ± 5.8 years. On linear regression analysis, the Ca-P product was strongly correlated with pre-HD diastolic BP (DBP) (0.7) and post-HD mean arterial pressure (MAP) (0.7) while a moderate correlation was present with pre (0.59) and post (0.64) HD systolic BP (SBP), post-HD diastolic BP (0.68), and pre-HD MAP (0.68). On the other hand, the Ca-P product was not correlated with pre and post-HD pulse pressure (0.06 and 0.1, respectively). When the independent effect of serum calcium (Ca), phosphorus (P), and parathyroid hormone on BP was studied, P had a significant correlation with pre and post-HD SBP, DBP, and MAP.ConclusionOur study demonstrates a significant association of the Ca-P product and an independent high P level with pre and post-dialysis SBP, DBP, and MAP while no association was found with pulse pressure.

Description of Serum Urea and Creatinine Levels Pre Hemodialysis and Post Hemodialysis at Royal Prima Hospital in Chronic Kidney Disease

Chronic Kidney Failure describes as the gradual loss of kidney functionand it is irreversible, to replace the loss of kidney function a therapy tokidney function is needed, which is hemodialysis. The objective of thisresearch is to know the levels of ureu and creatinine serum for prehemodialysis and post hemodialysis at RSU Royal Prima Medan. Themethods that are being used for this research is descriptive with 54 patientsas samples. The results of this research is loss of urea and creatinine serumlevel, with the average of urea level for pre hemodialysis is 128.11 mg/dL,and the average of urea level for post hemodialysis is 43.26 mg/dL with1,8% patient with low urea level, 50% with normal urea level, and 48.2%with high urea level. The average of creatine level for pre hemodialysis is11.56 mg/dL, and the average of creatine levels is 4.3 mg/dL, with all of thepatient still have a high creatinine levels. The conclusion is there is drop forboth urea and creatinen serum level, but the urea level for half of the patientdid not go down to normal, and for the creatinine level there is none of thepatient creatinine level that go down to normal.

Francisella philomiragia bacteremia in an immunocompromised patient: a rare case report

BackgroundFrancisella philomiragia is a very rare opportunistic pathogen of humans which causes protean diseases such as pneumonia and other systemic infections. Subsequent failure of prompt treatment may result in poor prognosis with mortality among infected patients.Case presentationThe present report describes a case of F. philomiragia bacteraemia first reported in Malaysia and Asian in a 60-year-old patient with underlying end-stage renal disease (ESRF) and diabetes mellitus. He presented with Acute Pulmonary Oedema with Non-ST-Elevation Myocardial Infarction (NSTEMI) in our hospital. He was intubated in view of persistent type I respiratory failure and persistent desaturation despite post haemodialysis. Blood investigation indicated the presence of ongoing infection and inflammation. The aerobic blood culture growth of F. philomiragia was identified using the matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) mass spectrometry (Score value: 2.16) and confirmed by 16S Ribosomal DNA (16S rDNA) sequencing. He was discharged well on day 26 of admission, after completing one week of piperacillin/tazobactam and two weeks of doxycycline.ConclusionClinical suspicion should be raised if patients with known risk factors are presenting with pneumonia or pulmonary nodules especially as these are the most common manifestations of F. philomiragia infection. Early diagnosis via accurate laboratory identification of the organism through MALDI-TOF mass spectrometry and molecular technique such as 16S rDNA sequencing are vital for prompt treatment that results in better outcomes for the afflicted patients.

Headache Associated with Hemodialysis in Patients with End-Stage Renal Disease in India: A Common Yet Overlooked Comorbidity.

Background:Headache is a frequently encountered symptom among patients undergoing hemodialysis.Aim:The aim of this study was to elucidate the prevalence of hemodialysis associated headache (HDH), its possible etiology, its effect on the patients and steps taken in the management of the condition in Indian patients with end-stage renal disease (ESRD).Methods and Materials:A cross-sectional study was carried out amongst 128 consenting patients with ESRD on regular hemodialysis at a tertiary care medical teaching hospital over a period of 3 months to assess for prevalence of HDH and factors related to it. The pre hemodialysis serum electrolytes level, pre and post hemodialysis systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded. Visual analogue scale (VAS) and patient health questionnaire-9 (PHQ9) was administered to the patients. t Test and Chi-square test were applied to find the association between HDH and various postulated factors and a regression analysis was performed.Results:Among 128 patients, 48 (37.5%) (men 18 [37.5%], women 30 [62.5%]) were found to have HDH. The mean headache severity scores on (VAS) was 4.5 ± 1.74. Patients having HDH had their mean PHQ9 scores 7.56 ± 4.51. Most patients had headaches in the first hour of dialysis and were located in the frontal and temporal part of the head. No statistically significant difference was found in the electrolyte levels between patients having HDH and without HDH. The headache was moderate in most but needed a paracetamol tablet to relieve the headache.Conclusion:Nearly one-third of patients undergoing dialysis have HDH, and it is associated with mild to moderate depression. The factors leading to HDH and its management need to be evaluated further to improve the quality of life of patients with ESRD on dialysis.

MO662EFFECT OF ARTERIOVENOUS VASCULAR ACCESS ON BIOIMPEDANCE MEASUREMENTS IN HEMODIALYSIS PATIENTS

Abstract Background and Aims Fluid management remains a major problem in hemodialysis (HD) patients, partly because of the lack of objective assessment methods. Many methods have been proposed to estimate the fluid status in HD patients and bioimpedance has established as one of the most popular clinical tools. Resistance to alternate current was found to be lower in the arteriovenous (AV) access-bearing side compared with the non-access side in post-HD bioimpedance measurements. We hypothesized this difference between access and non-access sides can be seen in both pre- and post-HD measurements of arms and whole body. The aim of the study was to investigate whether this variation between access and non-access sides could affect single-side whole body measurements. Method Pre- and post-HD bioimpedance measurements with two 8-point devices (InBody 770 and Seca mBCA 514) were performed in 11 HD patients with functioning AV access in the arm (8 male, pre-HD 75.4 ± 13.6 kg, post-HD 72.8 ± 13.5 kg). Values of resistance at 5 kHz (R5) in the arm and whole body (R5 of arm + trunk + leg on the same side) were extracted. Whole-body extracellular water (ECW) was calculated using whole-body R5 by the Xitron equation* to evaluate how measuring only one side of the body can affect the fluid volume calculation. Results The R5 of the arm on the access side was lower compared with the non-access side both pre- and post-HD (P < 0.01), measured by InBody. The same was seen with the Seca but did not reach statistical significance (Table 1). The estimated whole-body ECW was higher on the access side for InBody (P < 0.01). With Seca, the same trend was seen but remained non-significant. While the difference in ECW between both arms reported by InBody was small, the impact on calculated whole-body ECW was much larger with a difference between sides of 0.50 ± 0.82 L pre HD and 0.55 ± 0.81 L post HD. Conclusion InBody appears to pick up the difference in fluid status between the access and non-access side with greater precision than Seca. The large contribution of the arm to whole-body resistance amplifies the impact of the presence of an AV access on whole-body ECW estimations based on single-side wrist-to-ankle bioimpedance measurements. Eight-point bioimpedance devices (like the tested InBody and Seca) measure both sides of the body, so, choice of measurement side does not enter the picture.

Incidence of Paradoxical Neurosensory Detachment in Diabetic Eyes Undergoing Hemodialysis for End-Stage Renal Disease.

IntroductionOcular fluid dynamics are known to improve during hemodialysis, and the improvement of uremia after dialysis may lead to osmotic pressure changes in the retina, which eventually affect retinal edema. Recent studies using optical coherence tomography (OCT) to assess the effect of hemodialysis on macular thickness have shown variable results with a majority of them finding a decrease in retinal thickness. Paradoxical neurosensory retinal detachment (NSD) may be defined as the accumulation of subretinal fluid under the macula in patients who are on continuous HD. The purpose of the study was to find out the incidence of paradoxical neurosensory detachment in diabetic eyes undergoing hemodialysis (HD) and its management.MethodsThis was a cross-sectional, prospective study involving end-stage renal disease (ESRD) patients secondary to diabetes. This study evaluated the changes in macular thickness in diabetic retinopathy patients with and without diabetic macular edema (DME) by spectral-domain optical coherence tomography (SD-OCT) 60 minutes before and after HD for ESRD.ResultsSixty-three eyes (36 patients) were included, with a mean age of 58.2±9.8 years. Seven eyes had paradoxical NSD at presentation with an incidence of 11.11%. Eyes with DME (Group A) showed a significant reduction in central macular thickness (CMT) by 28±2μm post HD, compared to eyes without DME (Group B) where CMT decreased by 15±2μm (p=0.003). Massive subretinal fluid accumulation (paradoxical NSD) with mean CMT 675.57±69.41μm recovered to 250.71±46.79μm at the final follow-up. Five eyes underwent an intravitreal dexamethasone implant (DEX-I, Ozurdex; Allergan, Dublin, Ireland) to achieve the resolution of SRF, whereas two eyes improved spontaneously by nine months.ConclusionHemodialysis results in a decrease of macular thickness in diabetic eyes with or without DME. Paradoxical neurosensory detachment can develop in eyes of patients undergoing HD chronically. Intravitreal dexamethasone implant (DEX-I, Ozurdex; Allergan, Dublin, Ireland) results in early amelioration of such a complication.

Electrocardiography in post hemodialysed chronic kidney disease patients

Background: Chronic kidney disease (CKD) is associated with higher risk of cardiovascular events and Electrocardiographic changes are common in CKD patients. Electrocardiography (ECG) is cheap and easily available investigation that could pick up abnormalities of heart. Our study focuses on electrocardiographic changes seen within 24 hours in post hemodialysis CKD patients.Methods: It is a cross sectional, observational study of 298 CKD patients who underwent hemodialysis at tertiary care facility of VIMSAR, Burla during the period between November 2018 to November 2020. 12 leads ECG of these patients were taken post hemodialysis and abnormalities were interpreted.Results: Total number of patients included in the study were 298 with mean age distribution of 47±8.4 years. Mean Serum urea level was 126 mg/dl. Creatinine levels ranged between 5-10 mg/dl. Left ventricular hypertrophy (LVH) and left atrial enlargement (LAE) were seen in 14.76% and 8.3% of patients respectively. Atrial fibrillation was present in 4.3% of patients. Left axis deviation (LAD 7%), right axis deviation (RAD 6%), atrial ectopics (2.6%) and tall T waves (7.3%) were the other ECG changes observed.Conclusions: ECG changes are common in CKD patients in post hemodialysis state, so it becomes important to monitor these changes in these patients for early detection of any cardiac abnormalities.

BLOOD PRESSURE DURING HEMODIALYSIS AS PREDICTOR OF MORTALITY IN END-STAGE RENAL DISEASE PATIENTS

Objective: High blood pressure (BP) and consequential cardiovascular complications remain the leading cause of death in hemodialysis (HD) patients. Aim of this study is to link BP variations during HD with a 1 year mortality. Design and method: We conducted a cohort study in tertiary reference dialysis center. Patients undergoing HD were enrolled. Systolic, diastolic and mean arterial BP were measured before, every hour during and after HD procedure. These patients were observed for 12 months and mortality rate was evaluated. Mean values of measurements were compared across the groups. Furthermore, these measurements were included in univariate and multivariate regression analysis, determining their potency to predict 1 year mortality. Results: Study enrolled 99 patients. Mean age of patients was 58.7 ± 14.4 years, more than a half of them were men 51 (51.5%) with median time on HD for 4,5 [2,0–8,5] years. Mortality rate was 15.2 % (n = 15). All of the BP measurements were significantly lower in deceased group, except of BP before HD. (Table 1). Univariate regression analysis revealed that all of these pressures were linked to 1 year mortality, however, after application of stepwise forward selection model in multivariate analysis the most potent predictor was eluded to be MAP of the 1st HD hour (OR CI95% p), tripling the risk of mortality per every decrease of 10mmHg. However, the difference in precipitated risk of mortality for 2nd h, 3rd h and post HD MAP was minimal. Conclusions: One year mortality in HD patients is substantial. Blood pressure during and post HD is a more potent predictor of mortality than a blood pressure measured before the procedure. Further studies should investigate the application of intradialytic BP for the timely intervention.

Impact of Haemodialysis on Coagulation Profile in Chronic Kidney Disease

Background
 Chronic kidney disease (CKD) with its high prevalence, morbidity and mortality is an important public health problem. Considering the nature of the haemodialysis process, it has a considerable impact on the coagulation profile. To find out the variations in Platelet count, Prothrombin time (PT), International Normalised Ratio (INR) and Activated Partial Thromboplastin Time (aPTT) before and after haemodialysis patients.
 Materials and Methods: 
 This prospective observational study of Coagulation profile and platelet count in pre and post hemodialysis patients with chronic renal failure was conducted on 150 CKD patients in the Department of Pathology, SRM Medical College Hospital & Research Centre. p value <0.05 was considered to be statistically significant.
 Results
 In this study, there was significant reduction in platelet count from mean 2.29 cells/cu.mm in pre dialysis to 2.03 cell/cu.mm in post dialysis. There was a significant prolongation in both PT and aPTT values in post dialysis
 Conclusion
 These findings expose CKD patients to higher risk of bleeding disorders, which may have a role in increasing the rate of patient mortality and morbidity. In the light of this study, there is a need for nephrologist to monitor the coagulation profile and platelet count of CKD patients on dialysis, and treat any derangements in the same, so as to improve outcome for these patients.

Description of Serum Urea and Creatinine Levels Pre Hemodialysis and Post Hemodialysis at Royal Prima Hospital in Chronic Kidney Disease

Chronic Kidney Failure describes as the gradual loss of kidney function and it is irreversible, to replace the loss of kidney function a therapy to kidney function is needed, which is hemodialysis. The objective of this research is to know the levels of ureu and creatinine serum for pre hemodialysis and post hemodialysis at RSU Royal Prima Medan. The methods that are being used for this research is descriptive with 54 patients as samples. The results of this research is loss of urea and creatinine serum level, with the average of urea level for pre hemodialysis is 128.11 mg/dL, and the average of urea level for post hemodialysis is 43.26 mg/dL with 1,8% patient with low urea level, 50% with normal urea level, and 48.2% with high urea level. The average of creatine level for pre hemodialysis is 11.56 mg/dL, and the average of creatine levels is 4.3 mg/dL, with all of the patient still have a high creatinine levels. The conclusion is there is drop for both urea and creatinen serum level, but the urea level for half of the patient did not go down to normal, and for the creatinine level there is none of the patient creatinine level that go down to normal.

Description of Serum Urea and Creatinine Levels Pre Hemodialysis and Post Hemodialysis at Royal Prima Hospital in Chronic Kidney Disease

A B S T R A C TChronic Kidney Failure describes as the gradual loss of kidney function and it isirreversible, to replace the loss of kidney function a therapy to kidney function isneeded, which is hemodialysis. The objective of this research is to know the levels ofureu and creatinine serum for pre hemodialysis and post hemodialysis at RSU RoyalPrima Medan. The methods that are being used for this research is descriptive with54 patients as samples. The results of this research is loss of urea and creatinineserum level, with the average of urea level for pre hemodialysis is 128.11 mg/dL, andthe average of urea level for post hemodialysis is 43.26 mg/dL with 1,8% patient withlow urea level, 50% with normal urea level, and 48.2% with high urea level. Theaverage of creatine level for pre hemodialysis is 11.56 mg/dL, and the average ofcreatine levels is 4.3 mg/dL, with all of the patient still have a high creatinine levels.The conclusion is there is drop for both urea and creatinen serum level, but the urealevel for half of the patient did not go down to normal, and for the creatinine levelthere is none of the patient creatinine level that go down to normal.

The Influence of Regular Hemodialysis on the Highly Sensitive Troponin-I Level in Children without Any Symptoms

Backgrounds: Cardiovascular diseases are still the prominent cause of death in cases of end-stage renal disease, cardiac troponin I (cTnI) can be used for detecting cardiac involvement in asymptomatic cases of end-stage renal disease on hemodialysis. Aim: Determine the direct cardiac consequence of dialysis treatments in children on hemodialysis by measuring high-sensitive troponin-I as a marker of myocardial injury. Subjects and Methods: This case-control study included thirty children with end-stage renal disease on regular hemodialysis; the study group was selected from the nephrology hemodialysis unit of Al-Zahraa Hospital, Al-Azhar University. Another group of thirty healthy children matches age and sex with the patient’s group as a control. Highly Sensitive cTnI (hsTnI) was measured pre and post hemodialysis with a sensitive assay; moreover, ECG, lipid profile including cholesterol, triglyceride, low and high-density lipoprotein (HDL) in the same line with routine investigations for those patients, we used bioimpedance for dry weight assessment in the hemodialysis (HD) group. Results: Children on (HD) have a significantly higher (hsTnI) pre-dialysis (0.250 ± 0.069 ng/ml) compared to post-dialysis (0.187 ± 0.004 ng/ml) with (p, 0.001). With no significant difference between post HD (0.187 ± 0.004 ng/ml) and the control group (0.189 ± 0.005) with (p, 0.090). cTnI is detected in (73.3%) of children pre-dialysis above the cut-off value compared to (3.31%) had a high-level post-dialysis. cTnI is positively correlated with systolic, diastolic blood pressure and heart rate with (r. 0.333, p, 0.001: r. 0.343, p, 0.001: r. 0.276, p, 0.033) respectively and (hsTnI) is negatively correlated with Hb and HDL (r. -0.333, p, 0.009: r. 0.324, p, 0.011). Meanwhile (hsTnI) is positively correlated with serum urea, creatinine, ph, PTH, serum ferritin and positively correlated with QT interval and QTC. Conclusion: cTnI levels rise significantly before hemodialysis, so those patients are exposed to silent myocardial injury pre HD, and fortunately, it is not persistent after hemodialysis except for a few of them had a high level. We strongly advised not to delay dialysis appointments; the nephrology team should aggressively treat those patients to prevent further myocardial damage.

A case of bilateral sequential optic neuropathy in a young adult post hemodialysis

A case of bilateral sequential optic neuropathy in a young adult post hemodialysis

SHORT TERM EFFECT OF HEMODIALYSIS ON PERIPAPILLARY RETINAL NERVE FIBER LAYER AND MACULAR THICKNESS

Objective: To determine the thicknesses of retinal nerve fiber layer (RNFL) and macula by fourier-domain (FD)optical coherence tomography (OCT) in diabetic patients with end-stage renal failure (ESRF) undergoinghemodialysis.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Pakistan Naval Ship, Shifa Karachi, from Jan 2019 to Jul 2019
 Methodology: Fifty four patients presenting to nephrology department who met the inclusion criteria wereincluded in the study. Macular and retinal nerve fibre layer thicknesses were compared pre and post 30 minutesof hemodialysis and their correlation (r=-0.89) with age, duration of hemodialysis and gender was examined. Pre hemodialysis temporal, inferior, average retinal nerve fibre layer thicknesses were observed thinner than Post hemodialysis.
 Results: Pre-hemodialysis macular thicknesses were thinner than post hemodialysis. Thinning of Macular andRNFL showed a negative relationship with age and duration of hemodialysis (r=-0.89 & -0.76). Temporal, superior quadrants and average retinal nerve fiber layer thickness values were found statistically different in pre and post 30 minutes hemodialysis examination (p-value = 0.002, 0.001 & 0.0021) while, nasal and inferior quadrants were found statistically insignificant. Whereas in macula, temporal and superior quadrants were found statistically significant (p-value=0.005 & 0.002) and nasal, Inferior and average thickness were found statistically insignificant (p-value = 0.0641, 0.0594 & 0.083).
 Conclusion: Macular and retinal nerve fiber layer thicknesses of patients receiving hemodialysis were lessthan the normal population. Age has no effect on these thinning. The duration of hemodialysis effects more than gender. Hemodialysis session causes a consistent.............

A Comparative study of oxidant and Anti-oxidant parameters in Chronic Renal Failure, Haemodialysis (Pre &Post) and Controls

Chronic kidney disease (CKD) is featured by a progressive decline of kidney function and is mainly caused by chronic diseases such as diabetes mellitus and hypertension. CKD is a complex disease due to cardiovascular complications and high morbidity; however, there is no single treatment to improve kidney function in CKD patients. Since biological markers representing oxidative stress are significantly elevated in CKD patients, oxidative stress is receiving attention as a contributing factor to CKD pathology. Aim of our study is comparison of oxidant and anti oxidant parameters in chronic renal failure, Hemodialysis (pre and post) and control subjects. Materials and Methods: The present study was conducted on a patient group comprising of 50 patients diagnosed with CRF, 50 were pre hemodialysis, 50 were post hemodialysis (MHD). This patient group was compared to a healthy group including 100 controls. All the study participants were admitted in the department of Medicine [Nephrology department] at “Fathima Institute of Medical Sciences”, Kadapa. Andhra Pradesh. India. The obtained serum samples were used for biochemical analysis for estimating MDA, vitamin A and Glutathione Peroxidase (GPx). Conclusion: Our results reflects the primary mechanisms of oxidative stress and inflammation during hemodialysis which may cause of CVD development in hemodialysed patients.

Abstract 15474: New Onset Left Bundle Branch Block Secondary to Severe Hyperkalemia

Case presentation: A 79-year-old female with history of renal failure on hemodialysis (HD) presented with generalized weakness. Her last HD was 3 days ago. On examination, she was vitally stable. Blood tests demonstrated a potassium (K+) of 8.3 mmol/L, confirmed on repeat testing. ECG revealed wide QRS, tall T waves and a new left bundle branch block (Figure 1). She was immediately treated with calcium chloride, insulin, dextrose and polystyrene sulfonate. The patient was admitted to the ICU and underwent emergent HD. Repeat K+ post HD reversed to 4.0 mmol/L and ECG reflected normal sinus rhythm with resolution of ST-T wave changes (Figure 2). Discussion: Hyperkalemia can lead to cardiac arrhythmias and sudden death. The ECG changes are dependent on severity of hyperkalemia. It can vary from narrow based, peaked T waves to ventricular fibrillation. Hyperkalemia can also lead to interventricular conduction delays, which, with severity, can take the form of right or left bundle branch block (LLLB). The conduction delay from hyperkalemia usually lasts only in initial or terminal portions as opposed to throughout the QRS complex as seen in bundle branch block disease. Association of LLLB with hyperkalemia is an uncommon but important occurrence and has only scarcely been reported in literature. Its prevalence remains unknown. With the growing use of renin-angiotensin aldosterone system inhibitors, more patients are prone to experience life threatening electrolyte disturbances. A thorough knowledge of the ECG manifestations related to hyperkalemia is crucial to ensure emergent treatment. This may result in improved outcomes in such patients with cardiovascular and renal diseases.

Analysis of serum albumin levels in pre and post hemodialysis among Chronic Renal Failure (CRF) patients at Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia

Background: Chronic renal failure (CRF) is a clinical syndrome caused by a chronic decrease and gradual progression in kidney function. One of the complications of CRF can cause hypoalbuminemia. Hemodialysis can also cause hypoalbuminemia associated with inflammation and malnutrition due to loss of protein during dialysis. This study aims to analyze the albumin levels in pre and post hemodialysis CRF patients in Dr. Wahidin Sudirohusodo Hospital, Makassar.Methods: A retrospective study with cross sectional study design using secondary data obtained from the medical record was conducted among 50 patients at Dr. Wahidin Sudirohusodo Hospital, Makassar. Pre and post hemodialysis serum albumin levels of CRF patients from the Medical Record Installation were collected during September 2017 – 2018 period. Variables assessed in this study were gender, age, albumin levels, and the comparison of albumin levels based on gender. Data were analyzed using SPSS version 22 for Windows.Results: There were 52.0% male and 48.0% of female patients in this study. Most of the respondents were age 40-49 years old interval (30.0%). There was no significant difference in albumin levels between pre (3.07±0.63 g/dL) and post (3.05±0.54 g/dL) HD patients (p=0.665). Also, There was no significant difference in albumin levels in pre and post HD patients between male (p=0.434) and female (p=0.778).Conclusion: There were no significant differences between serum albumin levels pre and post hemodialysis in patients with CRF as well as based on gender.

Correlation of Venous Oxygen Saturations from Noninvasive Hematocrit Monitoring Using Blood Gas Measured Oximetry in Chronic Pediatric Hemodialysis Patients

Introduction: Noninvasive hematocrit monitoring (NIVHM) during pediatric hemodialysis (pedHD) provides data in real time regarding changes in hematocrit and blood volume and also provides venous oxygen saturations. The latter has been proposed to indicate changes in tissue oxygen consumption. It is not known how well NIVHM oxygen saturations (O2sat) approximate blood gas measured oximetry saturation (mO2sat) in the course of pedHD. We aimed to assess the validity and reliability of NIVHM O2sat compared to mO2sat. Methods: This is a prospective study in 15 patients <21 years old with >90 days on hemodialysis (HD) without congenital heart disease. HD access was fistula (AVF) in 4 patients and tunneled catheters in the remainder. Pulse oximetry (spO2) was continuously monitored; mO2sat was measured via oximetry in a blood gas analyzer and NIVHM O2sat values collected at the start, middle, and end of HD treatment. Results: A total of 45 dyad measurements were obtained. NIVHM O2sat correlated well with mO2sat (R = 0.89, p < 0.0001); the same was seen at pre, mid, and post HD time points (R = 0.86–0.95, p < 0.001). NIVHM O2sat was lower than mO2sat; with catheter as access, the difference was 9.3 ± 8.6 (CI: 12.3–6.22, p < 0.0001) and with AVF was 2.1 ± 0.78 (CI: 2.6–1.7, p < 0.0001). Bland-Altman analysis demonstrated the difference but did not show any systematic bias. Continuous monitor of spO2 showed no hypoxia. Discussion/Conclusion: Intradialytic NIVHM O2sat correlates well with mO2sat but yield lower values. Future studies can include NIVHM O2sat changes as a surrogate for central venous O2 saturation changes and potentially yield useful information regarding tissue oxygen consumption in pedHD patients.

Effects of Chronic Kidney Disease on Liver Enzymes Activity During Pre and Post Hemodialysis

Background: Worldwide chronic kidney disease is one of the primary public health problems. This study aimed to find the activity of liver enzymes alanine aminotransferase, aspartate transaminase, alkaline phosphatase, and Gamma-glutamyl transferase in the patient's serum before and after dialysis in Chronic kidney disease.&#x0D; Materials and Methods: This was a case-control study including 68 cases with chronic kidney disease coming for hemodialysis at dialysis centers and 140 healthy individuals as control. Serum samples were used for the analysis of serum urea and creatinine, liver enzymes aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and gamma-glutamyl transferase using ErbaChem-300 liquid Chemistry autoanalyzer. Pearson’s bivariate correlation analysis and ANOVA were used to correlate variables between the controls and cases. p &lt; 0.05 was considered to be statistically significant.&#x0D; Results: Urea and creatinine levels were significantly higher in both pre and post-hemodialysis as compared to healthy controls with a p-value (p &lt; 0.001). Alanine aminotransferase and aspartate transaminase levels were significantly lower in both pre and post-hemodialysis as compared to healthy controls. On the other hand, serum alkaline phosphatase levels were significantly higher in pre and post hemodialysis as compared to healthy control. Moreover, serum gamma-glutamyl transferase levels were significantly higher in pre and post hemodialysis as compared to healthy control.&#x0D; Conclusion: The study showed differences in the level of liver enzymes in pre and post hemodialysis in chronic kidney disease.

P1435RELATIONSHIP BETWEEN INTRA-DIALYTIC OXYGEN EXTRACTION RATIO (OER) CHANGE AND IDH

Abstract Background and Aims Intradialytic hypotension (IDH) involves a reduced tolerance to hemodialysis (HD), a poor quality of life and is associated with mortality. Intradialytic monitoring systems (blood pressure, heart rate, volemia) are not able to identify patients at greater risk of IDH. IDH is a hemodynamic phenomenon and attention has recently been given to the evaluation of oxygen saturation to evaluate its role in IDH. Oxygen Extraction Ratio (OER), the ratio between SaO2 and ScvO2, is a parameter used to monitor parenchyma oxygen consumption and stress. Recent evidence showed that HD patients with a greater delta OER (ΔOER) during HD (threshold 40%)had higher mortality risk. OER could be a new monitoring instrument to measure hemodialysis induced sub-clinical parenchyma hypoxia and stress, two elements included in the pathogenesis of IDH. The aim of the study was to evaluate the relationship between OER and IDH incidence. Method Inclusion criteria: age ≥18 years, chronic HD treatment by means of permanent jugular CVC, no evidence of acute underlying illness. We evaluated OER ([(SaO2 − ScvO2)/SaO2] × 100) before HD and at 15’, 30’, 60’ and post HD in three HD sessions (HD OER sessions). For the statistic analysis we considered for each patient the median OER value obtained from the three HD OER sessions. Then we started the follow-up study with a minimum follow-up of three months and end follow-up of two years, to record IDH (defined according to K/DOQI guidelines) for each patient. We divided the population in two groups using as a threshold the median percentage number of IDH in our population and evaluate the differences between the obtained two groups in pre HD OER, Delta OER and intradialytic OER trends. Results During the follow-up period (mean 12 ± 1.2 months), we enrolled 28 patients with permanent jugular CVC: 13 males and 15 females, aged 74±2.6 years, HD vintage 46 ± 6.5 months. The HD OER sessions for each patient were asymptomatic. Pre HD OER was 34 ± 1.4, post HD OER 46 ± 1.8, with a Delta OER of 39 ± 5 %. OER change during HD was evident since after 15 minutes (OER% 15’: 40 ± 1.2 p&amp;lt;.001) and continued to increase progressively (OER% end HD 46 ± 1.8; p&amp;lt;.0001). During the follow up period we monitored 4342 HD sessions of which 186 with IDH, the median incidence of IDH was 3.6% of all HD sessions. We divided patients into two groups based on the median value of IDH incidence: (IDH % ≤ 3.6 and IDH % &amp;gt; 3.6). The two groups were not different for age (76 ± 2.4 vs 73 ± 3.0 years; p &amp;lt;ns), HD vintage (52 ± 8.6 vs 40 ± 4.0 months; p &amp;lt;ns), systolic (125 ± 3.2 vs 129 ± 4.0 mmHg; p &amp;lt;ns) and diastolic blood pressure (67 ± 2.2 vs 70 ± 2.2 mmHg; p &amp;lt;ns) and heart rate (70 ± 2.2 vs. 76 ± 2.3 bpm; p &amp;lt;ns) (Tab. 2). The IDH % &amp;gt;3.6 group had 159 IDH out of a total of 1911 sessions (9%), while IDH % ≤ 3.6 group had 27 IDH out of 2431 sessions (0.9%). Pre HD OER values were not different between the groups while the IDH % &amp;gt;3.6 group had greater delta OER% than the IDH % ≤ 3.6 group (43 ± 4.8 vs. 35 ± 3.0 %; p &amp;lt;.05) (Figure). Evaluating the OER trend during HD session a higher ΔOER% was found at 15 minutes of HD treatment in the IDH % &amp;gt; 3.6 group (ΔOER 20± 3.0 % vs. 8.0 ± 3.0 %; IDH % &amp;gt; 3.6 group vs. IDH % ≤ 3.6 group, p &amp;lt;.05), data confirmed at 30' (24 ± 3.0 % vs. 13 ± 5.0 %; p &amp;lt;.05), and post HD (43 ± 5.0 % vs 35 ± 3.0 %; p &amp;lt;.05), but not at 60 minutes of HD treatment (19 ± 4.0 % vs. 17 ± 4.6 %; p &amp;lt;ns). Conclusion Our data show that intradialytic ΔOER, representative of the extent of tissue hypoxic stress, identifies patients at greater risk of IDH. In particular, a ΔOER of 20% after the first 15 minutes of HD and of 43% at the end of the HD session characterizes the more hemodynamically fragile patients. The measurement of the OER can be a new and easy monitoring instrument to identify the most hemodynamically fragile patients already after the first 15 minutes of HD treatment.