Renal Disease Patients Research Articles

P1239SHORT- AND LONG-TERM OUTCOME OF END-STAGE RENAL DISEASE PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Abstract Background and Aims End-stage renal disease (ESRD) patients frequently have the coronary artery disease. However, the short- and long-term outcome of ESRD patients with acute myocardial infarction (AMI) is little known. The aim of this study was to clarify it. Method Using the database of the Osaka Acute Coronary Insufficiency Study (OACIS), 8702 consecutive AMI patients (male: 75.2%, mean age: 66.9±12.2yrs) from 2002 to 2013 were analyzed. We classified these patients into two groups, those with ESRD [ESRD group (n=271)] and without ESRD [No-ESRD group (n=8431)] and examined in-hospital or long-term all-cause mortality. ESRD was defined as eGFR<15ml/min/1.73m2. Results ESRD group had higher frequency of diabetes (59.3% vs 37.8%, p<0.01), hypertension (90.1% vs 63.3%, p<0.01), Killip class≧2 (40.1% vs 21%, p<0.01), multi-vessel disease (69.3% vs 50.8%, p<0.01), and lower frequency of peak CK>3000 (21.7% vs 32.4%, p<0.01) than No-ESRD group. Mean follow-up period was 1041±721 days. In hospital mortality of ESRD group was 27% and No-ESRD group 7.2%. In patients who discharged alive (8027 patients), 1-year mortality of ESRD group was 12.2% and No-ESRD group 3.3%, 3-year mortality of ESRD group was 29.3% and No-ESRD group 8.7%. Kaplan-Meier analysis revealed that the all-cause mortality (log-rank p<0.01) was significantly higher in ESRD group than No-ESRD group. In ESRD patients who discharged alive (203patients), Cox univariate analysis after multiple imputation revealed that peak CK>3000 was significantly associated with an increased risk of mortality (Hazard ratio 2.67, 95% confidence interval 1.18to 6.07, p=0.031). Conclusion In patients with AMI, ESRD was significantly associated with worse short- and long-term outcome, suggesting that careful treatment might be required in ESRD patients with AMI, especially had peak CK>3000.

P1263ASSOCIATION OF LEFT VENTRICULAR HYPERTROPHY AND ADIPOCYTOKINES IN PATIENTS ON DIALYSIS

Abstract Background and Aims Cardiovascular (CV) disease events are the major cause of death in end-stage renal disease (ESRD) patients on dialysis. Left ventricular hypertrophy, myocardial stress and disturbances in nutritional status are common findings in ESRD patients on dialysis. The adipokines, adiponectin and leptin, are known as important mediators of cardiometabolic risk in obesity, although their role in ESRD patients is poorly clarified. N-terminal pro B-type natriuretic peptide (NT-proBNP) is synthesized within cardiac myocytes, in response to cardiac wall stress. Our aim was to study the association of left ventricular hypertrophy with adipokines (adiponectin and leptin), myocardial stress (ProBNP) and nutritional status (BMI and albumin) in ESRD patients on dialysis. Method This study included 196 ESRD patients on dialysis (hemodiafiltration and high-flux hemodialysis). LVH was defined by a value of LVMI > 115 g/m2 in men and 95 g/m2 in women. Patients were divided into two groups - LVH (n=131) and non-LVH (n=65). Left ventricular mass (LVM) was evaluated through echocardiographic studies, corrected for body surface area and the values are presented as LVM index (LVMI). LVMI, clinical and analytical variables (age, body mass index, dialysis vintage, dialysis adequacy, albumin, adiponectin, leptin, NT-proBNP and hemoglobin concentration) were evaluated. Results The prevalence of LVH was 66.8%; LVH patients presented significantly higher levels for NT-proBNP, and significantly lower levels for hemoglobin, when compared with non-LVH patients; a trend towards (P=0.052) lower leptin values were observed. No differences were observed between groups, for age, BMI, dialysis vintage, URR, Kt/V, eKt/V, ultrafiltration volume, albumin and adiponectin. In LVH patients, we found that LVMI presented significant positive correlations with NT-proBNP and with adiponectin; and, significant negative correlations with markers of dialysis adequacy (URR and eKt/V) and leptin. Conclusion Our data suggest that a higher LVMI in ESRD patients is associated with higher myocardial stress, with lower leptin and higher adiponectin levels, showing no association of these adipokines with increased cardiovascular risk and with worsening of left ventricular hypertrophy. Further studies are needed to understand the roles of these adipokines, considering the controversial association with left ventricular hypertrophy, a cardiovascular risk condition. Acknowledgments: The work was supported by UIDB/04378/2020 with funding from FCT/MCTES through national funds, by North Portugal Regional Coordination and Development Commission (CCDR-N)/NORTE2020/Portugal 2020 (Norte-01-0145-FEDER-000024) and by REQUIMTE-Rede de Química e Tecnologia-Associação in the form of a researcher (S. Rocha) – project Dial4Life co-financed by FCT/MCTES (PTDC/MEC-CAR/31322/2017) and FEDER/COMPETE 2020 (POCI-01-0145-FEDER-031322).

P0832FINAL OUTCOME OF CKD STAGE 5 PATIENTS WHO CHOSE PALLIATIVE TREATMENT-EXPERIENCE FROM ONE MEDICAL CENTER IN TAIWAN

Abstract Background and Aims Taiwan has a high incidence and prevalence of ESRD (end stage renal disease) in the world and all the medical expenses are covered by national insurance. Therefore, many old ESRD(end stage renal disease) patients received dialysis even had multiple co- morbidity. However, still some old late CKD patients withhold dialysis and chose palliative treatment. This study elucidate the experience of final outcome for those late CKD patients who chose palliative treatment in Taiwan. Method We enrolled 137 CKD stage 5 patients (age: 80.2±8.8 y/o, male/female:85/52) who were interested about palliative treatment since Oct, 2010 till July 2019. We reviewed their co-morbidity to calculate Modified Charlson comorbidity index by medical record and record their laboratory data at enrollment. The differences between two groups were calculated using a Chi-square test for categorical variables and a Mann-Whitney test for continuous variables. All statistical tests were two-tailed and a P value of less than .05 was considered a significant difference. Results After fully discussion, 82(59.9%) patients can accept palliative treatment, 46(33.6%) refuse palliative treatment, 9(6.6%) patients cannot decided palliative treatment or not at first. 79 patient died during study period, median survival time is 163 days. 22 death patients(27.8%) received dialysis before end of life. 10 patients (12.2%) who asked palliative treatment at first and changed their mind to received dialysis. 80% of these patients receive dialysis by double lumen catheter. For those refuse palliative treatment, 43 patient received dialysis and 24(55.8%) patients received dialysis by temporary catheter. These percentage is much higher(55.8%) than other CKD stage 5 patients (26.6%) following at our hospital. Only 13 patient(16.5%) died at home, 24 patients(30.4%) diet at hospice ward and 39(49.4%) patients diet at ordinary ward or intensive care unit. Older age, lower albumin and higher Charlson comorbidity index are found in mortality patients. The median survival time for those patients received dialysis is 467 days. Conclusion After fully explanation, only 59.9% patients can accept withhold dialysis and 12.2% regret later. Those who had interested in palliative treatment had higher percentage to use double lumen catheter for first dialysis. The median survival time for those patients who ever think about withhold dialysis is only 467 days even receiving dialysis. To minimize suffering before end of life and decrease medical expense burden, we still need to do more effort to popularize the concept of withhold dialysis in older and multiple comorbidity patients.

MO017ANTITHROMBOTIC THERAPIES AND CLINICAL OUTCOME OF ATRIAL FIBRILLATION IN ADULT HD-PATIENTS: LARGE LONG-TERM COHORT STUDY ON GERMAN NETWORK DATA

Abstract Background and Aims ESRD (end stage renal disease) patients on hemodialysis (HD) with persistent atrial fibrillation (AF) are at high risk for cardio-vascular events, severe bleeding and rapid vascular/valvular calcification. In such patients standard vitamin-K based oral anticoagulation (VK-OAC) is debated, since prospective OAC studies are missing and smaller short-term register data showed conflicting results. Our study evaluated risk-factors, use of anticoagulants and clinical long-term outcome in a large representative German HD-cohort. Method After informed consent, we analysed pseudonymized benchmarking data (2013-2018) of 16226 adult chronic HD patients treated in a German outpatient dialysis network (Verband Deutsche Nierenzentren, DN) based on quarterly electronically transmitted data. Diagnoses were coded by “International Classification of Diseases (ICD)” and drugs via “Anatomical Therapeutical Chemical (ATC)” codes. Results At baseline in 2013, 2812 (17%) HD-patients had AF as coded diagnosis. AF-prevalence increased significantly (p<0.001) with age (< 65 yrs: 7%; 65-<75 yrs: 22% >75 yrs: 34%) without gender differences. Baseline CHA2DS2-Vasc (4.0/1.5) and HAS-Bled (3.2/0.9) risk scores indicated high risk for embolism and bleeding. Median observation time was 2.1 yrs (Range: 0–6 yrs.). Apart from dialysis-related heparin-supply four main approaches were applied: No active therapy, standard VK-OAC+/- aspirin/clopidogrel (VK-OAC+/-Asp/Clop), heparin-based therapy (Heparin+/-Asp/Clop) or only anti-thrombocyte drugs (Asp/Clop). Baseline risk scores were not related to any adverse events. Outcome data are shown in the Table: event rates were low (8.8%) and comparable for all anticoagulant therapies, especially for cerebral adverse events (3.8%, range 3.3-4.5%). Patients on any anti-thrombotic therapy had similar outcome rates as patients without anticoagulant therapy. The latter had fewer overall bleeding events (3.8% vs. 5.0%; NS). Finally, overall actual 6-yr mortality rates were high (55.8%; median survival 4.4 yrs) and significantly (p<0.001) lower for patients without anti-coagulant therapy (48.9%; median survival 6.0 yrs) than for patients on anti-coagulant therapy (59.5%; median survival 4.0 yrs) with highest mortality on VK-OAC based therapy (60.3%; p<0.001). Conclusion De-novo cerebral event-rates were rather low (<0.8%/yr) and similar for all anti-thrombotic therapies and even for patients with no active therapy, suggesting major beneficial impact of regular dialysis-related heparin-supply. Since actual 6-yr mortality was high and survival was significantly better in patients without anticoagulants than for VK-OAC or other active therapy, we need prospective studies comparing anticoagulants even with no drugs and/or new interventional approachs (i.e. left atrial appendage closure) to provide valid future guidelines.

P1315PREDICTABILITY OF SONOGRAPHICALLY DETERMINED IMMEDIATE POST-OPERATIVE BLOODFLOW AND VEIN DIAMETER ON PRIMARY RADIOCEPHALIC FISTULA SHORT AND LONGTERM OUTCOMES

Abstract Background and Aims Vascular access (VA) guidelines recommend radio-cephalic (RC) over upper arm autogenous arteriovenous fistulas (AVF) as first line VA for hemodialysis in end stage renal disease (ESRD) patients. RCAVFs generally have inferior maturation and patency rates predicated on a lower feeding arterial blood flow (BF) and outflow vein calibre (VC). However studies on postoperative BF and VC as predictors of AVF outcomes, so far are confounded by their focus on early outcomes only, heterogeneity of AVFs studied, variable timing of assessment and use of non-standardised outcome definitions. Our aim was therefore to assess the accuracy and influence of immediate post-operative BF and VC on both early and longterm outcomes in a homogenous cohort of primary RCAVFs using standardised definitions and outcome measures as mandated by VA guidelines. Method This was a prospective study conducted in multi-ethnic Asian ESRD patients who had their primary RCAVFs created between October 2013 and October 2014 under regional anesthesia at Khoo Teck Puat hospital Singapore. All AVFs were assessed immediately after surgery for brachial artery BF and outflow VC using doppler ultrasound. A 10MHz linear probe and GE Logic e R7 machine were used exclusively by a single operator. Receiver operating characteristic (ROC) curves were generated to determine the optimal BF and VC cut-off for AVF maturation. Maturation was defined as BF>600mL/min, VC>6mm and vein depth <6mm at 6 weeks post-op. An area under the curve (AUC)> 0.7 was considered clinically significant. Kaplan–Meier analysis was used to evaluate the AVF primary and secondary patency based on best BF and VC cut-offs. Cox regression statistics was used to determine AVF hazard factors. Results Fifty-seven primary RCAVFs were created and included in the study. The baseline characteristics are shown in Table 1. Sonography- based non-assisted maturation at 6 weeks was 56%. ROC identified 410 mL/min and 42mm as the best BF and VC cut-off respectively to most accurately predict 6-week maturation. The sensitivity, specificity, positive predictive value and negative predictive value were 75%, 61%, 44% and 86% for BF at 410 mL/min and 69%, 61%, 41% and 83% for VC at 42mm respectively. Survival analysis (Fig. 1 and 2) showed that AVFs with VC≥42 mm compared to <42mm had significantly greater 6 months, 1-year, 2-year and 4-year primary and secondary patency rates. There was no significant difference in patency rates between AVFs with BF≥410 and <410mL/min. Cox proportional regression hazard analysis showed that diabetes (HR 2.26, CI 1.02-4.99, p= 0.04) and maturation (HR 0.47, 95% CJ 0.24-0.89, p=0.02) as significant contributed to the variability of primary patency. Only VC (HR 0.28, 95% CI 0.13-0.063, p=0.002) impacted significantly towards secondary patency. Conclusion An immediate post-op BF≥410mL/min and VC≥42mm can predict early RCAVF outcome in the form of nonassisted maturation, but only VC accurately impact on longterm AVF survival. VA surveillance efforts should therefore target RCAVFs with post-op VC <42mm for timely intervention and maintenance of longterm patency.

P0176REGULATION OF OXALATE HOMEOSTASIS BY OXALATE-DEGRADING ACTIVITY IN FECAL MICROBIOTA IN DIALYSIS PATIENTS

Abstract Background and Aims Despite evidence suggesting that a lack of fecal oxalate-degrading bacteria colonization is a risk factor for calcium oxalate stone formation, little is known about the oxalate-degrading activity (ODA) in fecal microbiota in end-stage renal disease (ESRD) patients. In addition, to date, there has been a general lack of research on the effect of fecal ODA on oxalate homeostasis in dialysis patients. The present pilot cross-sectional study was performed to compare the oxalate homeostasis profiles depending on ODA in fecal microbiota in ESRD patients. Method The data of a cross-sectional pilot study examining ODA in fecal microbiota, plasma oxalate concentration (POx) and urinary oxalate excretion (UOx) in 32 ESRD patients were represented in this study. Among the patients, there were 21 hemodialysis (HD) patients and 11 peritoneal dialysis (PD) patients. The average age of the patients was 52.5 [39; 65] years. The redoximetric titration with KMnO4 was adopted to evaluate total ODA in fecal microbiota. The results were expressed in % oxalate degradation per 0.01 g of feces. POx concentration and UOx excretion were measured spectrophotometrically using a commercially available kit (MAK-315, Sigma, Spain) and an oxalate oxidase/peroxidase reagent (BioSystems, Spain), respectively. Predialysis plasma samples were collected from HD patients. For further analysis, the patients were allocated to 2 groups according to ODA in feces. Group 1 included the patients with ≥ 1 % oxalate degradation per 0.01 g of feces. Group 2 included the patients with negative ODA (≤ 0 % /0.01 g). For the statistical analysis, we used the nonparametric Kruskal-Wallis test. The median (Me) and interquartile ranges [Q25; Q75] were calculated. The Spearman test was used for the correlation analysis. Univariate logistic regression analysis was used for predicting hyperoxalemia. All statistical analyses were performed using MedCalc. Results ODA in fecal microbiota ranged from -23 to 24 %/0.01 g of feces in ESRD patients and was statistically higher in HD patients compared with PD patients (3.2 [-0.5; 16] vs -4 [-6.5; 6.2], p=0.05). Negative ODA in fecal microbiota (≤ 0 % /0.01 g) was observed in 5/21 (23.8%) HD patients and 7/11 (63.6%) PD patients (χ2=3.9, p=0.04). Consequently, it might be associated with the negative effects of peritoneal dialysis solution. High POx concentration and low UOx excretion were diagnosed in patients with negative ODA in fecal microbiota (Group 2): 30.7 [25.5; 41.5] vs 50 [43.3; 75.5] μmol/L, p=0.01 and 60.9 [51; 65] vs 34.2 [24.4; 39] mg/d, p=0.0002, respectively (Fig. 1). Fecal ODA was directly associated with daily UOx excretion (r=0.85; p<0.0001) (Fig. 2) and had an inverse correlation with POx concentration (r=-0.36; p=0.04) (Fig. 3). In univariate logistic regression analysis, negative fecal ODA was determined as an independent risk factor for high POx concentration (OR: 40; 95% CI: 4.8-331, p<0.0001). Conclusion Our pilot cross-sectional study firstly demonstrated a close association between ODA in fecal microbiota and oxalate homeostasis in ESRD patients: less ODA in fecal microbiota was, higher POx concentration and lower UOx excretion occurred. We suppose that the potential significance of our findings provides preliminary information on the feasibility and necessity of further research in this area.

P1403PLASMA OSTEOPONTIN LEVELS DIRECTLY CORRELATE WITH INTACT PARATHYROID HORMONE AND ALKALINE PHOSPHATE LEVELS IN END STAGE RENAL DISEASE

Abstract Background and Aims Bone turnover disorders and reduction in bone mineral density are commonly observed in end stage renal disease (ESRD) patients. Osteopontin (OPN) is a glycol-phosphoprotein that stimulates osteoclast adhesion to bone. OPN may play a significant role in the pathways involved in bone turnover disorders. The objective of this study was: (1) to identify plasma levels of OPN in ESRD and normal populations, and (2) to elucidate if relationships exist between OPN and iPTH, and OPN and alkaline phosphatase. Method Plasma levels of OPN were measured via commercially available enzyme linked immunosorbent assays (ELISAs) in ESRD patients (n=92). A chart review was conducted on these patients to identify levels of intact parathyroid hormone (iPTH) and alkaline phosphatase at time of plasma draw. Additionally, levels of total calcium, albumin, calcium corrected for albumin, phosphorus, ferritin, white blood cell count (WBC), and platelet count (PLT CT) were identified at time of plasma draw via the chart review. OPN levels were also measured in normal control patient plasma (n = 49) purchased from George King Bio-Medical, Inc., Overland Park, KS. Results The ESRD cohort showed a statistically significant elevation of OPN plasma levels (p < 0.0001, Mann-Whitney t-test) compared to the normal group. Spearman correlation tests revealed a significant positive correlation of OPN with iPTH (p < 0.0001; r = 0.5606, 95% confidence interval = 0.3968 to 0.6898) and OPN with alkaline phosphatase (p < 0.0001; r = 0.4381, 95% confidence interval = 0.2494 to 0.5948) in the ESRD cohort. No statistically significant correlations were identified between OPN and total calcium, calcium corrected for albumin, albumin, phosphorus, ferritin, WBC, and PLT CT (p > 0.05). Conclusion OPN levels are significantly elevated in ESRD patients. Furthermore, OPN levels were also found to be positively correlated with the bone turnover biomarkers iPTH and alkaline phosphatase. These studies suggest that hyperparathyroidism secondary to ESRD increases circulating iPTH, stimulating osteoblast and osteoclast activation and differentiation that increases alkaline phosphatase and OPN production, ultimately resulting in increased bone turnover.

P1487EFFECT OF PREDIALYSIS FLUID OVERLOAD ON SLEEP QUALITY IN HEMODIALYSIS PATIENTS

Abstract Background and Aims Sleep disorders are common among end stage renal disease (ESRD)patients undergoing hemodialysis (HD). The etiology of sleep disorders in these patients is known to be multifactorial. However, the role of hydration status in sleep disorders in HD patients is not well studied. Therefore, our aim was to study the effect of predialysis fluid overload on sleep quality in HD patients. Methods This cross-sectional study included 100 prevalent HD patients from HD unit of El Sahel teaching hospital. fluid status and fluid compartments [total body water (TBW)], extracellular water (ECW)] and overhydration index (OH) were analyzed by a portable whole-body bio-impedance spectroscopy (Body Composition Monitor ‘BCM’) before mid-week dialysis session. Overhydration was defined as OH/ECW ≥15%. HD patients were then classified into 2 groups: Group 1 (non- overhydrated) and Group 2 (Overhydrated) according to OH/ECW. Sleep quality were assessed in all patients by Pittsburgh Sleep Quality Index (PSQI) questionnaire. Patients with Concurrent diagnosis of either obstructive sleep Apnea or psychiatric disorder and patients on any medications which affect the sleep pattern were excluded. Results our study included 100 HD patients (49 male, 51 female - mean age 49.3 ±11). 42 patients (42%) had overhydration (i.e. Group 2). Poor sleep quality (defined as PSQI score ≥5) was reported in 57% (n=57) of HD patients included in our study. Poor sleep quality was significantly higher in the HD patients with overhydrated (Group 2). Total PSQI scores were significantly higher in overhydrated patients (Group2) compared to non-overhydrated patients (Group1) (7.92±3.32 vs 4.83±2.27, P= <0.001). The component scores 1, 2, 3, 4, 6 and 7 of the PSQI showed significant differences between the overhydration and non-overhydration groups with higher values (i.e poor sleep quality) in overhydrated patients (Group2). Moreover, there was significant positive correlation between total PSQI score and overhydration index (OH/ECW %) in all HD patients included in the study (r=0.283, P= 0.004). Conclusion We may conclude from our study that sleep disorders are prevalent in HD patients. Predialysis fluid overload in HD patients may be associated significantly with poor sleep quality.

P1581IMPACT OF ACHIEVING LDL CHOLESTEROL LOWER THAN 100 MG/DL WITH STATINS, ON LIPID PROFILE AND INFLAMMATION IN END-STAGE RENAL DISEASE PATIENTS

Abstract Background and Aims Dyslipidemia is common in chronic kidney disease (CKD) and cardiovascular disease (CVD)-related events are the main causes of death in end-stage renal disease (ESRD) patients on dialysis. Concerning lipid management, clinical practice emphasized treatment escalation to achieve specific low-density lipoprotein cholesterol (LDLc) targets, which implies repeated LDLc evaluations, and enhancement of statin doses or combination of lipid-lowering therapies. However, the LDLc target is not consensual, with some entities suggesting 100 mg/dl and others a more conservative level. It has been hypothesized that lipoprotein’s quality (size, composition and functionality) may be more important than their total circulating levels, as CVD risk factor. Our aim was to evaluate and compare, in ESRD patients on dialysis and under statins treatment, the levels of lipoprotein fractions and subfractions and inflammatory markers, between patients who achieved LDLc levels < 100 mg/dl and those who did not achieve that target. Method We studied 110 ESRD patients on dialysis (high-flux hemodialysis or hemodiafiltration) and under statin therapy; 87 presented a LDLc < 100 mg/dl (group 1) and 23 a value > 100 mg/dl (group 2); levels of high-sensitivity C-reactive protein (hsCRP), interleukin(IL)-6, lipid profile including lipoprotein fractions/subfractions, and oxidized LDL (oxLDL) were evaluated. Results Group 1, as compared to group 2, presented lower values of total cholesterol (TC), triglycerides, oxLDL, TC/high-density lipoprotein cholesterol (HDLc) and LDLc/HDLc ratios. Concerning lipoprotein fractions/subfractions, group 1 presented significantly higher larger and intermediate LDL, and a trend towards lower small LDL (P=0.063), higher large HDL (P=0.069) and lower small HDL (P=0.080); no significant alterations were found for very-low-density lipoprotein and intermediate-density lipoprotein. Regarding inflammatory markers, no significant differences were observed between the 2 groups. Conclusion Patients who achieved the LDLc < 100 mg/dl target presented a better non-conventional lipid profile, including lower oxLDL levels and an increase in larger (less atherogenic) LDL subfractions. According to our data, a lower LDLc level associates with a better lipid profile; the benefits of this improvement on HDL fractions and CVD-related events in ESRD patients on dialysis needs to be better clarified.

P1488RECOVERY OF LOW TRIIODOTHYRONINE CAN IMPROVE MORTALITY IN HEMODIALYSIS PATIENTS

Abstract Background and Aims Low circulating triiodothyronine (T3) levels are the most frequently encountered thyroid functional test derangement in end-stage renal disease (ESRD) patients on hemodialysis. Low T3 is known as independent predictive value for all-cause mortality and, particularly, for cardiovascular-related death in patients with ESRD on hemodialysis. This study investigated that recovery of low T3 level to normal can lower mortality in ESRD patients on hemodialysis. Method We have constructed the 500 K-cohort of ESRD patients attending the hemodialysis center of 6 tertiary hospitals of South Korea to evaluate the mortality of the ESRD patients since 2016. From this prospective cohort, we invited patients with ESRD from June 2016 to May 2019 The participants were divided into four groups based on the change of the T3 level: normal group showed the normal T3 continuously, low group showed the low T3 continuously, recovery group showed the low T3 change to normal and decrease group showed the normal T3 change to low. We evaluate relationships between change of the T3 level and mortality. Statistical analysis was carried out by using SPSS. Results Of the total 500 patients in K-cohort, 333 patients were enrolled with detailed thyroid hormone profile including T3 level. 167 (50.2 %) patients out of the 333 patients showed low T3 level initially. Normal group include 126 patients(37.8%), low group include 135 patients(40.5%), recovery group include 32 patients(9.6%) and decrease group include 40 patients(12.0%). Patients with the low T3 level were older and more diabetic compare to those with normal T3 level. They had lower K-MMSE score than the others, Low T3 group had lower free T4 level but thyroid stimulating hormone(TSH) showed no significant different comparing normal T3 group. The mortality of normal group was lowest and that of decrease group was highest. The mortality of recovery group recovered to similar with that of the normal group and mortality of decrease group was highest. Lowering of T3 level would affect to mortality than low T3 level continuously. Conclusion Therefore, the change of T3 level is significantly associated with the mortality. Recover lower T3 to normal level can lower the mortality.

P1570INTERLEUKIN-6 (RS1800795) AND PENTRAXIN 3 (RS2305619) GENETIC POLYMORPHISMS AND THEIR RELATION WITH INFLAMMATION AND ALL-CAUSE MORTALITY IN ESRD PATIENTS ON DIALYSIS

Abstract Background and Aims Chronic inflammation plays an important role in progression and outcome of chronic kidney disease (CKD) patients. The interleukin-6 (IL-6) polymorphism, rs1800795, is a single nucleotide polymorphism (SNP) in the promoter region (-174G/C) that regulates gene transcription and affects the levels of this cytokine. Genetic variants in the promotor region have been associated with a poor outcome in several pathologies, namely in coronary artery disease. Pentraxin 3 (PTX3) is an inflammatory protein, produced locally by different cell types (e.g. mononuclear phagocytes, dendritic cells, fibroblasts and endothelial cells). PTX3 polymorphism, rs2305619, is a SNP (+281A>G) in the intron 1 of PTX3 gene. PTX3 polymorphisms have been described as risk factor for development of coronary artery disease and for an impairment of kidney function. Our aim was to determine the allelic frequencies of IL6 and PTX3 in end-stage renal disease (ESRD) patients and controls, as well as their relationship with the inflammatory response. Method We studied 289 ESRD patients on hemodialysis (high-flux hemodialysis or hemodiafiltration) and 22 healthy individuals, matched for gender, body mass index, and, as far as possible, for age. Real-Time PCR TaqMan SNP genotyping assays were used to assess allelic frequencies of IL6 (rs1800795) and PTX3 (rs2305619). We evaluated the circulating levels of PTX3, growth differentiation factor (GDF)-15, high-sensitivity C-reactive protein (hsCRP), IL-6, tumor necrosis factor-alpha (TNF-α), soluble TNF receptor 2 (sTNFR2), hepcidin and transferrin, using commercially available kits. Deaths occurring along 1-year follow-up period were recorded and mortality rates were evaluated for homozygous and heterozygous alleles. Results Compared to controls, all inflammatory biomarkers were significantly higher in ESRD patients. Allelic frequencies in ESRD patients and controls were similar for both SNPs, IL-6 -174G/C and PTX3 +281A>G, considering the homozygous and the heterozygous alleles. For the IL-6 -174G/C, the CC patients, compared to GG and heterozygous patients, showed significantly higher GDF-15 and CRP concentrations and significantly lower values of transferrin; moreover, we found that CC patients presented a trend towards higher mortality rate (21%, 10% and 7% for CC, GG and GC, respectively; P=0.072). For PTX3 +281A>G polymorphism, the AA patients, compared to GG and heterozygous patients, presented higher hsCRP; no significant differences were found in mortality rate between different allele carrier groups (P=0.703). Conclusion Although no differences were found in the allelic frequencies between controls and ERSD patients, the CC patients for IL6 polymorphism (rs1800795) and AA patients for PTX3 polymorphism (rs2305619), showed an enhanced inflammatory response; the association of the IL6 polymorphism with a higher mortality needs further studies.

P1312EFFECT OF KIDNEY TRANSPLANTATION RATE ON THE ARTERIOVENOUS FISTULA RATE IN PREVALENT HEMODIALYSIS PATIENTS: ANALYSIS OF DATA FROM THE CATALAN RENAL REGISTRY (1997-2017)

Abstract Background Kidney transplantation (KT) is considered to be the best option of renal replacement therapy (RRT) for most end-stage renal disease (ESRD) patients (pts). Furthermore, arteriovenous fistula (AVF) is considered to be the best vascular access (VA) for most hemodialysis (HD) pts. Aims To analyze the effect of KT rate on the AVF rate in prevalent HD pts. In addition, the likelihood of receiving a kidney graft (KG) over time according to the first VA used to start HD program was also evaluated Method Data from the Catalan Registry of ESRD pts treated with either KT or HD were examined for a 20-year period Results The functioning KG rate increased progressively from 40.5% (n=2211) in 1997 to 57.0% (n=6149) in 2017 and, conversely, the AVF rate in prevalent HD patients decreased progressively from 86.0% (n=2609) to 63.2% (n=2546) during the same period (for both comparisons, p < 0.001). The characteristics of all prevalent HD pts dialyzed in 1997 (n=3104) vs 2017 (n=4205) were different regarding age 62.6±15.3 vs 70.3±14.2 yr, diabetic nephropathy (DN) 13.2% vs 21.8% and cardiovascular disease (CD) 67.6% vs 75.8% (for all comparisons, p<0.001). On December 31, 2017 (maximum KT rate), the characteristics of KG recipients were different compared with prevalent HD pts dialyzed through either an AVF or a tunneled catheter (n=1145): age 57.4±14.5 vs 69.9±13.8 vs 72.0±14.6 yr, DN 9.5% vs 21.7% vs 22.5%, CD 38.6% vs 74.3% vs 83.7% (for all comparisons, p<0.001). By analyzing the likelihood of prevalent pts performing HD through an AVF, we saw it was lower in pts with DN (OR: 0.86; 95% CI: 0.79-0.94, p=0.001) and it decreased progressively as they got older (reference >74 yr): <44 yr (OR:1.55, 95% CI: 1.41-1.70, p<0.001), 45-64 yr (OR: 1.47, 95% CI: 1.38-1.56, p<0.001) and 65-74 yr (OR: 1.22, 95% CI: 1.17-1.28, p<0.001). This probability was higher in males (OR: 1.84, 95% CI: 1.73-1.95, p<0.001), pts with polycystic kidney disease (OR: 1.54, 95% CI: 1.35-1.77, p<0.001) and pts without CD (OR: 1.32; 95% CI: 1.27-1.38, p<0.001) and it increased according to the time on RRT (reference < 1 month): >12 m (OR: 2.39, 95% CI: 2.17-2.64, p<0.001). In addition, this likelihood decreased progressively as the percentage of patients with a functioning KG increased (reference >55%): 40-45% (OR: 3.26, 95% CI: 3.05-3.48, p<0.001), 45-50% (OR: 1.82, 95% CI: 1.73-1.92, p<0.001) and 50-55% (OR: 1.27, 95% CI: 1.21-1.33, p<0.001). The rate of prevalent HD pts waitlisted for KT and dialyzed through AVF decreased progressively from 94.5% (639/676, 1997) to 77.9% (491/630, 2017). In parallel, but always remaining at a lower level, the rate of prevalent HD patients not waitlisted for KT and dialyzed through AVF also decreased progressively from 83.6% (1970/2357) to 60.5% (2055/3399) during the same period (for all comparisons, p<0.001). Considering the prevalent HD pts during the period 2014-2017 (n=4029), significant differences were observed between HD pts waitlisted (n=630, 15.6%) and not-waitlisted (n=3399, 84.4%) for KT regarding age (58.2±12.9 vs 72.8±13.1 yr), DN (16.2% vs 23.0%), CD (59.5% vs 80.5%) and distribution of AVF (77.9% vs 60.5%) or tunneled catheter (16.5% vs 30.6%) (for all comparisons, p<0.001). During the period 2012-2014, incident pts starting HD through an AVF (n=1026) had a significant higher likelihood of receiving a KG over time (HR: 1.68, 95% CI: 1.41-2.00, p<0.001) in comparison to pts who initiated HD through a catheter (n=1408). Conclusion 1) The fall of prevalent HD pts with AVF over time could be associated with a progressive worsening of their clinical profiles along with the increasing rate of KG recipients. 2) In addition to some demographic and clinical characteristics of prevalent HD pts, the annual KT rate was also a determining factor in their AVF rate. 3) Starting HD program through an AVF was independently associated with a greater likelihood of receiving a KG over time as compared to starting HD through a catheter.

P1419U- SHAPED ASSOCIATION OF SERUM PARATHYROID HORMONE AND COGNITIVE DYSFUNCTION IN MAINTENANCE HAEMODIALYSIS PATIENTS

Abstract Background and Aims Primary hyperparathyroidism (HPT) is linked with several cognitive and affective disorders in the general population that tend to improve following parathyroidectomy. Most end- stage renal disease (ESRD) patients treated with maintenance haemodialysis (MHD) have 2ry/3ry HPT encompassing a broad range of serum intact parathyroid hormone (S. iPTH) values. They commonly suffer some degree of cognitive dysfunction (CODY) that impairs medication adherence and quality of life. This CODY results from the interplay of multiple factors, including HPT. However, relative hypoparathyroidism may as well cause CODY in the setting of adynamic bone disease and increased cerebrovascular calcification. Therefore, the relationship between S. iPTH and CODY in MHD patients needs to be clearly characterized across the whole spectrum of iPTH values. Method Seventy two stable ESRD patients (39 males, median age 50y) treated with thrice weekly low flux MHD for > 6 months underwent Montreal cognitive assessment- basic version (MoCA-B) and pre-dialysis assessment of S. iPTH, vitamin D3, alkaline phosphatase, urea, creatinine, calcium, phosphorus and haemoglobin (Hb). Results CODY, defined by a MoCA-B score < 24/30, occurred in 37/72 (51%) patients. MoCA-B score had a statistically significant positive correlation with Hb level. A quadratic inverted U-shaped curve provided the best estimate for the relation between S. iPTH and MoCA-B score (P = 0.019, Figure). Among patients in the highest S. iPTH tertile, S. iPTH has a statistically significant negative linear correlation with MoCA-B score (r = - 0.565, P = 0.004). This correlation was attenuated but persisted after controlling for Hb level (r = - 0.516, P = 0.012). Conclusion Anaemia and HPT are important contributors to the high prevalence of CODY in MHD patients. Both markedly high and relatively low (still above normal) S. iPTH levels are associated with lower MoCA-B scores, indicating a U- shaped relation between S. iPTH and CODY. Contrary to other populations, some degree of mild (permissible) HPT is most compatible with near normal cognitive function in MHD patients. Our results emphasize the recommendation of avoiding overzealous suppression of PTH secretion in these patients.

P1475THE THRESHOLD OF BECK DEPRESSION INVENTORY SCORE AS A POTENTIAL PREDICTOR OF ALL-CAUSE MORTALITY IN END-STAGE RENAL DISEASE PATIENTS WITH DIALYSIS IN CHINA

Abstract Background and Aims Depression is the most frequent psychologic problem among end-stage renal disease (ESRD) patients with dialysis. The Beck Depression Inventory (BDI) is considered to be the standard instrument for assessing symptoms of depression and screening for clinical depression. The level of BDI score associated with mortality in ESRD patients with dialysis remains controversial. High quality evidence is lacking, especially in China. The aim of our study is to evaluate the threshold of BDI score as a potential predictor of all-cause mortality in ESRD patients with dialysis in China. Method We conducted a retrospective cohort study involving adults who were treated with dialysis in the department of nephrology of Sun Yat-sen Memorial Hospital in Guangzhou, China between April 2006 to July 2017. Depression symptoms, sleep quality, health-related quality of life were assessed via the BDI- = 2 \* ROMAN \* MERGEFORMAT II, the Pittsburgh Sleep Quality Index (PSQI) and the 36-item Short Form Health Survey Questionnaire (SF-36) respectively. The primary endpoint of interest was all-cause mortality. Cox proportional hazards regression analysis was performed. Results 109 dialysis patients with an mean age of 50.2 years provided complete responses to the BDI-II questionnaire. The median follow-up time for the cohort was 68.6 months until Dec 1, 2019. There were 21 deaths (19.3%). Univariate analyses indicated that age (RR=1.039, 95% CI 1.002, 1.076, P =0.039), PSQI score (RR=1.170, 95% CI 1.047, 1.306, P =0.005), pre-existent cardiovascular disease (RR=3.223, 95% CI 1.310, 7.932, P =0.011), pre-existent diabetes mellitus (DM) (RR=3.321, 95% CI 1.393, 7.919, P =0.007), and BDI score ≧17 (RR=4.247, 95% CI 1.730, 10.429, P =0.002) were significantly associated with an increased risk for all-cause mortality, while physical component summary (PCS) of SF-36 (RR=0.971, 95% CI 0.950, 0.992, P =0.007) and mental component summary (MCS) of SF-36 (RR=0.968, 95% CI 0.948, 0.988, P =0.002) with a decreased risk for all-cause mortality. In the multivariate Cox regression model, DM (RR=3.658, 95% CI 1.532, 8.733, P =0.003) and BDI score ≧17 (RR=4.454, 95% CI 1.808,10.974, P =0.001) were independent predictors of all-cause mortality. Conclusion This study revealed that BDI score ≧17 was a predictor of all-cause mortality in ESRD patients with dialysis. Further prospective trials will be required to determine whether the treatment of depression in dialysis patients would alter health-related outcomes, including survival.

P1521LRG-1 LEVEL PREDICTS 5-YEAR MORTALITY IN ESRD

Abstract Background and Aims Plasma Leucine-Rich alph-2-Glycoprotein 1(LRG1) is an new biomarker for inflammatory and angiogenetic diseases. whether levels of plasma LRG1 correlate with the co-morbidities of End stage renal disease (ESRD) patients is unknown. Method Plasma LRG-1 and high-sensitivity C-reactive protein were analyzed by ELISA in samples from 169 hemodialysis patients from the Immunity in ESRD study (iESRD study). Baseline co-morbidities were recorded through chart review of medical history. Results High level of LRG 1 showed high mortality in the ESRD. In multivariate-adjusted logistic regression models, higher LRG1 was significantly associated with 5 year mortality after adjusting for gender, hemoglobin, diabetes, hypertension, and level of C-reactive protein. Conclusion LRG1 is a possible poor prognosis marker in ESRD. Higher LRG-1 showed high prevalent CAD and PAOD in our study before. The role of LRG1 and the associated cardiovascular diseases should be analyzed the mechanism in this patient population.

Avaliação do risco cardiovascular e da severidade da doença renal em pacientes em hemodiálise

Objetivo:analisar o risco cardiovascular (RCV) e a severidade da doença renal em pacientes em hemodiálise (HD).Método:estudo investigativo,transversal e quantitativo,com amostra de 54 pacientes em HD.Foram utilizados o Escore de Risco de Framingham (ERF) para calcular o RCV e o Índice de Severidade da Doença Renal (ISDR). Resultados:os dados apontaram para médio e alto RCV (61,10%) segundo o ERF.Os fatores de risco mais prevalentes pelo ERF foram hipertensão arterial,sedentarismo e consumo elevado de sódio.De acordo com o ISDR,foram identificados 81,48% dos pacientes com alto e médio risco de severidade da DRC. As variáveis mais evidentes no ISDR foram a diminuição visual e acesso para a diálise.Houve associação estatística entre o ERF e o consumo elevado de sódio e entre o ERF e o ISDR.Conclusão:O médio e alto risco cardiovascular e médio e alto risco de severidade da doença renal foram prevalentes nos pacientes renais em HD do estudo.Deve-se priorizar o atendimento multidisciplinar,através do levantamento de estratégias para minimizar riscos e promover a adesão ao tratamento, a fim de melhorar a sobrevida e qualidade de vida dessa população.

Quantified Vascular Calcification at the Dialysis Access Site: Correlations with the Coronary Artery Calcium Score and Survival Analysis of Access and Cardiovascular Outcomes.

Vascular calcification is a major contributor to mortality in end-stage renal disease (ESRD) patients. In this study, we investigated whether there was a correlation between the coronary artery calcium score (CACS) and the vascular calcification score (VCS), and whether higher VCS increased the incidence of interventions and major adverse cardiac and cerebrovascular events (MACCE). ECG-gated CT, including vascular access and the coronary vessel, was taken. CACS and VCS were calculated by the Agatston method. A comparison of CACS and survival analysis according to VCS groups was performed. Using a cutoff of VCS = 500, 77 patients were divided into two groups. The vintage was significantly older in the higher VCS group. The median CACS was higher in the higher VCS group (21 [0, 171] vs. 552 [93, 2430], p < 0.001). The hazard ratio (HR) for interventions and MACCEs in the higher VCS group increased by 3.2 and 2.3, respectively. Additionally, a longer duration of hemodialysis and higher magnesium levels (>2.5 mg/dL) showed lower HRs for interventions (<1). We quantified VCS and found that it was associated with the CACS. Additionally, higher VCS increased the risk of access interventions and MACCE. VCS of the access site may be suggested as a biomarker to predict ESRD patients.

Coptis inhibited epithelial–mesenchymal transition and fibrogenesis of diabetic nephropathy through lncRNA CLYBL-AS2-miR-204-5p-SNAI1 axis

Diabetic nephropathy (DN) is one of the severe complications of diabetes. Nowadays, effective treatment for end-stage renal disease (ESRD) patients is still limited. HK-2 cells were stimulated with serum from phosphate-buffered saline (PBS) or Jiawei Shuilu Erxiandan (JSE)-treated DN mice, then long non-coding RNA (lncRNA) CLYBL-AS2 was discovered by RNA sequence, following the comparison of the serum from normal patients with DN patients to confirm the role of lncCLYBL-AS2. Next, we performed in vitro studies to explore the effect of lncCLYBL-AS2 in DN and its molecular mechanism. Coptis, as one of the components of JSE, could decrease the expression of lncCLYBL-AS2, which is increased in DN and correlated with the severity of DN. Knockdown/overexpression of lncCLYBL-AS2 inhibited/promoted the invasion and fibrogenesis of HK-2 cells. Furthermore, lncCLYBL-AS2 was negatively correlated with miR-204-4p with a positive correlation with SNAI1; eventually, CLYBL-AS2 regulated SNAI1 by binding to miR-204-5p, which accounted for the inhibition of epithelial–mesenchymal transition (EMT) and fibrogenesis. LncCLYBL-AS2 inhibited by Coptis improved EMT and fibrogenesis in HK-2 cells through miR-204-5p-SNAI1 axis, therefore, lncCLYBL-AS2 could serve as a potential diagnosis and therapeutic target for DN.

Long-term blood pressure behavior and progression to end-stage renal disease in patients with immunoglobulin A nephropathy: a single-center observational study in Italy.

Antihypertensive treatment by the use of RAAS inhibitors (RAAS-is) is of paramount importance in the management of slowly progressive IgA nephropathy (IgAN). With the aim of better understanding the relationship between BP behavior and progression, we looked at time-averaged SBP and time-averaged proteinuria and renal outcome in a single-center cohort of IgAN patients. Among 248 consecutive patients referred to the Clinic of Nephrology of San Martino Hospital from 1996 to 2018 for native renal biopsy with a diagnosis of IgAN, we retrospectively analyzed 145 with available data at baseline and during follow-up. All patients received Supportive Care, 39% were on RAAS-is alone, 45% plus steroids, and 16% plus steroids and immunosuppressors. Renal replacing treatment (RRT) was the primary endpoint. During a mean follow-up of 67 ± 6 months, 23% of study patients (n = 33) progressed to RRT and 6% (n = 9) died. Patients who reached the renal endpoint, had lower baseline eGFR and higher proteinuria and proteinuria indexed at baseline. Moreover, they had higher TA-SBP (139 ± 17 vs. 130 ± 13, P = 0.0016). The incidence of RRT was higher in IgAN patients in the highest time-averaged SBP tertile as compared with the others (32 vs. 23 vs. 9%, χ 6.8, P = 0.033). After adjusting for baseline SBP, baseline and time-averaged proteinuria indexed, MEST-C score, and treatment, the association between TA-SBP and RRT persisted. Time-averaged low BP values were independently associated to a decreased risk of renal progression in IgAN with no evidence of a J-curve relationship even at SBP levels below 125 mmHg.

Arterial Stiffness Assessed by Oscillometric Method in Kidney Transplant, Predialysis, and Dialysis Patients

IntroductionChronic kidney disease (CKD) is strongly associated with a higher risk of cardiovascular disease (CV). An important nontraditional risk factor of cardiovascular disease in renal patients is vascular stiffness, which currently can be evaluated by oscillometric measuring of pulse wave velocity (PWV) and heart rate–corrected augmentation index (AIx@75). AimThe aim of our study was to compare vascular stiffness between kidney transplant (KTx) recipients, patients on dialysis maintenance, and those in the predialysis period. Materials and methodsA cross-sectional study of 140 patients (52 in CKD stage 3-4; 37 in CKD stage 5 on hemodialysis maintenance [HD]; and 51 KTx recipients) had their PWV and AIx@75 measured with Mobil-O-Graph (IEM Gmbh, Stolberg, Germany) blood and pulse pressure monitor. ResultsKTx, HD, and CKD G3-4 were comparable in term of age, sex, body mass index, and diagnoses of diabetes mellitus and hypertension. The PWV was higher in the HD group than in the KTx and CKD G3-4 (9.4 m/s vs 8.4 m/s vs 7.9 m/s respectively; P < .05 for HD vs other groups), while the difference between the KTx and CKD G3-4 was not significant. AIx@75 values were similar in the HD and KTx groups (27.1 and 25.6; P > .05) and significantly lower in CDK G3-4 (17.8; P < .05). ConclusionsAccording to our results, the highest CV risk expressed by PWV (vascular stiffness) was found in hemodialysis patients. Although patients with CKD 3-4 and after KTx showed comparable large artery stiffness, transplant recipients additionally showed higher stiffness in smaller arteries as measured by heart rate-corrected AIx.