Renal Replacement Therapy In Patients Research Articles

P0772CLINICAL CHARACTERISTICS OF THE UK CHINESE POPULATION WITH KIDNEY FAILURE: A UK RENAL REGISTRY ANALYSIS

Abstract Background and Aims Data from the UK Renal Registry (UKRR) has shown that 0.5% of those in the UK with kidney failure are of Chinese ethnicity. The UK Chinese population is growing. Ethnic differences in cause of renal disease and dialysis rates have been described in UK individuals of White, South Asian, and Black ethnicity. However, the clinical demographics of the UK Chinese population with renal disease have not previously been investigated. The China Kidney Disease Network and the Hong Kong Renal Registry have reported the main cause of chronic kidney disease in their populations is diabetes, but the causes of renal disease in other Chinese diaspora have not been well described. We investigated the clinical characteristics of the UK Chinese population on renal replacement therapy (RRT) as compared with the UK White RRT population in this UKRR analysis. Method Data on all adult patients >=18 years who started RRT between 1/1/97 and 31/12/16 were extracted from the UKRR. Patients with ethnicity recorded as anything other than “Chinese” or “White” were excluded from analysis. Patients with ethnicity data missing were also excluded. Socioeconomic status was measured using country-specific Index of Multiple Deprivation (IMD) quintiles derived from patients’ postcodes (1= most deprived, 5= least deprived). The Chi-square (*) and Mann-Whitney U (**) tests were used to compare baseline characteristics between Chinese and White ethnic groups. Results The dataset comprised of 92,857 incident RRT patients, of which 0.5% (n=501) were of Chinese ethnicity and 76% (n=70,575) were White. Clinical characteristics of the UK Chinese population as compared to the UK White population are presented in Table 1. UK Chinese patients were younger at start of RRT than white patients (61.4 years vs 65.6 years, p<0.001**). Any difference in the proportion of male patients (60.7% vs 63.0%, p=0.29*) or socioeconomic status (p=0.75*) between the two groups was consistent with chance. There were marked differences in the causes of renal disease: UK Chinese patients had more diabetic renal disease (29% versus 20%, p<0.001*) and glomerulonephritis that white patients (21% vs 13%, p<0.001*) There was modest evidence that more UK Chinese patients started RRT on peritoneal dialysis (PD) compared to the White population (26% vs 23%, p=0.01*) Conclusion We found evidence that the UK Chinese RRT population differs from the UK White RRT population. To our knowledge, this is the first study describing renal disease in the UK Chinese population, and one of the first to describe disease in the Chinese diaspora. Our finding of a greater burden of diabetes in the UK Chinese RRT population compared to the White RRT population may reflect the high prevalence of diabetes in the UK Chinese, as in mainland China and Hong Kong. Further investigation is needed to understand the causes behind the higher burden of glomerulonephritis in the UK Chinese population. The increased rates of PD in UK Chinese patients may be associated with lower average Body Mass Index (BMI) in the Chinese population. The quantity of missing BMI data in the UKRR dataset prevented investigation of this association. Hong Kong has had a successful “PD first” policy for >30 years. Familiarity with this as a mode of dialysis may have led to higher rates of PD in the UK Chinese population. Studies from Hong Kong have also suggested that lower dialysis volumes are required for Chinese PD patients, and that high transporter status is less common in their population. It would be beneficial to elucidate whether this is also the case in UK Chinese patients.

MO076LONGITUDINAL CHANGES AND OUTCOME OF HIGH BLOOD PRESSURE IN EUROPEAN CHILDREN ON RENAL REPLACEMENT THERAPY

Abstract Background and Aims Few studies have focused on trends of hypertension (HTN) and status of blood pressure (BP) control over time in children on renal replacement therapy (RRT). In this study, we aimed to evaluate the 5-year trend in BP antihypertensive medications (AHs) use, as well as the association between HTN and mortality among RRT patients enrolled within the ESPN/ERA-EDTA Registry. Method 25.223 BP measurements from 5.032 patients who started RRT before 20 years of age, between 2007-2016, were included. Mixed models were used to analyse trends of BP, the JointPoint regression to assess prevalence of uncontrolled HTN (uHTN) over time, and multivariable Cox proportional hazard models to evaluate association of BP with mortality. Results Mean systolic BP (SBP) at RRT initiation was 1.66(+0.15), 1.05(+0.15) and 1.09(+0.08) SDS in HD, PD and transplanted (Tx) patients, respectively, while it was 1.41(+0.19), 1.12(+0.18), and 0.79(+0.06) SDS in the corresponding RRT categories after 5 years. Patients on HD showed a significant decrease in the prevalence of uHTN over time (57.1% at dialysis start vs 41.4% after 5 years; annual percentage change [APC] -4%; 95% CI: -5.7;-2.2; p<0.05), coupled with a significant reduction in AHs use (APC -3.5%; 95% CI: -6.7;-0.2). PD patients showed a similar reduction in uHTN prevalence (APC -4.9%; 95% CI: -7.2;-2.6; p<0.05), but a significant increase in AHs use (APC +3.6%; 95% CI: 0.6;6.6; p<0.05). After 5 years, Tx patients showed a significant reduction in both prevalence of uHTN (APC -4.8%; 95% CI: -7.8;-1.7; p<0.05) and use of AHs (APC -2.2%; 95% CI: -4.1;-0.3%; p<0.05). Having uHTN was not associated with mortality (HR 0.95; 95% CI: 0.68-1.33). Conclusion A more adequate control of BP over time seemed to be obtained in children on RRT. Findings in PD patients suggest that this requires a progressive increase in the use of AHs.

P1660ACCESS TO KIDNEY TRANSPLANTATION IN THE UK CHINESE POPULATION: A UK RENAL REGISTRY ANALYSIS

Abstract Background and Aims Previous UK Renal Registry (UKRR) analyses and the Access to Transplantation and Transplant Outcome Measures (ATTOM) study have shown ethnic disparity in access to kidney transplants in the UK, but access to transplantation for the UK Chinese population has not been investigated In this UKRR analysis, we compared the likelihood of kidney transplantation between the UK White and UK Chinese renal populations, aiming to investigate whether there was evidence of ethnic disparity in access to kidney transplantation for this specific ethnic group. Method Data on all adult patients >=18 years who started renal replacement therapy (RRT) between 1/1/97 and 31/12/16 were extracted from the UKRR. Patients with ethnicity recorded as anything other than “Chinese” or “White” were excluded from analysis. Patients with ethnicity data missing were also excluded. Patients aged >= 75 years at the start of RRT were excluded because of the high prevalence of comorbidity which decreases the likelihood of transplantation and the very small proportion of patients receiving a kidney transplant in the UK in this age group. Socioeconomic status (SES) was measured using country-specific Index of Multiple Deprivation (IMD) quintiles derived from patient postcodes (1= most deprived, 5= least deprived). The independent variable of interest was Chinese ethnicity (Chinese vs White). Multivariable logistic regression models were used to investigate the relationship between Chinese ethnicity and being listed on the deceased donor transplant waiting list i) at start of RRT ii) 2 years after start of RRT iii) pre-emptive kidney transplantation, iv) kidney transplantation at 3 years after start of RRT, and v) living-donor kidney transplantation. The models were run unadjusted and then adjusted for the confounders, specified a priori, age, sex, primary renal disease and SES. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using robust standard errors to account for clustering by renal centre. Results The dataset comprised of 92,857 incident RRT patients. 0.5% (n=501) were of Chinese ethnicity, 76% (n=70,575) were White. The findings of the multivariable logistic regression analyses are presented in Table 1. Even after adjustment for potential confounders UK Chinese patients had lower odds of being waitlisted at the start of RRT (OR 0.71, [95% CI 0.54-0.94]) but were more likely to be waitlisted at 2 years (OR 1.28, [95% CI 1.02-1.61]) compared to White patients. UK Chinese individuals were also less likely to receive a pre-emptive kidney transplant (OR 0.47, [95% CI 0.29-0.78]), less likely to be transplanted within 3 years of starting RRT (OR 0.69, [95% CI 0.52-0.92]) or have a living-donor kidney transplant(LDKT) (OR 0.39, [95% CI 0.26-0.59]) compared to White patients. Conclusion This is the first study that has shown that UK Chinese renal patients are less likely to have the opportunity to receive a living or deceased kidney transplant. Future research needs to test whether later presentation or more rapid progression of renal disease could explain these observations. The higher odds of transplant listing at 2 years suggests fitness for transplantation is not a significant barrier. The reasons why this ethnic group are less likely to receive a LDKT is also not well understood. Understanding whether these disparities reflect modifiable policy, health system or donor/recipient level barriers will help ensure equitable access to transplantation.

Characteristics and Clinical Outcomes of Prolonged Continuous Renal Replacement Therapy in Critically Ill Pediatric Patients.

Paralleling improved outcomes in critically ill patients, survival for pediatric acute kidney injury has improved. Continuous renal replacement therapy is the preferred modality to optimize fluid and electrolyte management as well as nutritional support for children developing acute kidney injury in the PICU. However, some patients remain too fragile for transition to intermittent renal replacement therapies and require continuous renal replacement therapy for a prolonged period. Characteristics of this cohort and factors impacting outcomes are not well known. We aimed to describe the characteristics of pediatric patients requiring prolonged continuous renal replacement therapy and evaluate the factors impacting hospital survival. Retrospective chart review. Tertiary PICU. Children requiring prolonged continuous renal replacement therapy. Prolonged continuous renal replacement therapy was defined as continuous renal replacement therapy dependence greater than or equal to 28 days. Primary outcome was hospital mortality. None. From 2013 to 2016, 344 patients received continuous renal replacement therapy, 36 (10%) received continuous renal replacement therapy for greater than or equal to 28 days. Seventeen patients (47%) were female. Overall mortality was 44% (16/36); 69% (11/16) of nonsurvivors died of sepsis. Pediatric Logistic Organ Dysfunction score was significantly higher in nonsurvivors. Mortality rate was significantly higher in patients who were neutropenic at continuous renal replacement therapy start. Neutropenia (defined as absolute neutrophil count < 1,500/mm) at continuous renal replacement therapy start was the only independent predictor of mortality. One in four survivors did not recover renal function and remained dialysis dependent. Prolonged continuous renal replacement therapy patients are at high risk of nonrecovery of renal function and require close monitoring. The majority of nonsurvivors in the study group died from sepsis. Neutropenia at continuous renal replacement therapy initiation was associated with increased risk of mortality. Progression of underlying disease process could explain the higher death rate in patients with neutropenia; however, inadequate treatment of infectious complications could be another explanation to explore further in future studies.

Hemodialysis treatment in patients with severe electrolyte disorders: Management of hyperkalemia and hyponatremia.

Significant deviations of serum potassium and sodium levels are frequently observed in hospitalized patients and are both associated with increased all‐cause and cardiovascular mortality. The presence of acute or chronic renal failure facilitates the pathogenesis and complicates the clinical management. In the absence of reliable outcome data in the context of dialysis prescription, requirement of renal replacement therapy in patients with severe electrolyte disturbances constitutes a therapeutic challenge. Recommendations for intradialytic management are based on pathophysiologic reasoning and clinical observations only, and as such, heterogeneous and limited to expert opinion level. This article reviews current strategies for the management of severe hyperkalemia and hyponatremia in hemodialysis patients.

Timing of Initiation of Renal Replacement Therapy in Sepsis-Associated Acute Kidney Injury.

Sepsis-associated acute kidney injury (SA-AKI) is a major issue in medical, surgical and intensive care settings and is an independent risk factor for increased mortality, as well as hospital length of stay and cost. SA-AKI encompasses a proper pathophysiology where renal and systemic inflammation play an essential role, surpassing the classic concept of acute tubular necrosis. No specific treatment has been defined yet, and renal replacement therapy (RRT) remains the cornerstone supportive therapy for the most severe cases. The timing to start RRT, however, remains controversial, with early and late strategies providing conflicting results. This article provides a comprehensive review on the available evidence on the timing to start RRT in patients with SA-AKI.

Is There Decreasing Public Interest in Renal Transplantation? A Google TrendsTM Analysis.

Background and objectives: Renal transplantation is the preferred form of renal replacement therapy for the majority of patients with end stage renal disease (ESRD). The Internet is a key tool for people seeking healthcare-related information. This current work explored the interest in kidney transplantation based on Internet search queries using Google TrendsTM. Design, setting, participants, and measurements: We performed a Google TrendsTM search with the search term “kidney transplantation” between 2004 (year of inception) and 2018. We retrieved and analyzed data on the worldwide trend as well as data from the United Network for Organ Sharing (UNOS), the Organización Nacional de Trasplantes (ONT), the Eurotransplant area, and the National Health Service (NHS) Transplant Register. Google TrendsTM indices were investigated and compared to the numbers of performed kidney transplants, which were extracted from the respective official websites of UNOS, ONT, Eurotransplant, and the NHS. Results: During an investigational period of 15 years, there was a significant decrease of the worldwide Google TrendsTM index from 76.3 to 25.4, corresponding to an absolute reduction of −50.9% and a relative reduction by −66.7%. The trend was even more pronounced for the UNOS area (−75.2%), while in the same time period the number of transplanted kidneys in the UNOS area increased by 21.9%. Events of public interest had an impact on the search queries in the year of occurrence, as shown by an increase in the Google TrendsTM index by 39.2% in the year 2005 in Austria when a person of public interest received his second live donor kidney transplant. Conclusions: This study indicates a decreased public interest in kidney transplantation. There is a clear need to raise public awareness, since transplantation represents the best form of renal replacement therapy for patients with ESRD. Information should be provided on social media, with a special focus on readability and equitable access, as well as on web pages.

Tissue sodium concentrations in chronic kidney disease and dialysis patients by lower leg sodium-23 magnetic resonance imaging.

Sodium-23 magnetic resonance imaging (23Na MRI) allows direct measurement of tissue sodium concentrations. Current knowledge of skin, muscle and bone sodium concentrations in chronic kidney disease (CKD) and renal replacement therapy patients is limited. In this study we measured the tissue sodium concentrations in CKD, hemodialysis (HD) and peritoneal dialysis (PD) patients with 23Na MRI of the lower leg and explored their correlations with established clinical biomarkers. Ten healthy controls, 12 CKD Stages 3-5, 13 HD and 10 PD patients underwent proton and 23Na MRI of the leg. The skin, soleus and tibia were segmented manually and tissue sodium concentrations were measured. Plasma and serum samples were collected from each subject and analyzed for routine clinical biomarkers. Tissue sodium concentrations were compared between groups and correlations with blood-based biomarkers were explored. Tissue sodium concentrations in the skin, soleus and tibia were higher in HD and PD patients compared with controls. Serum albumin showed a strong, negative correlation with soleus sodium concentrations in HD patients (r = -0.81, P < 0.01). Estimated glomerular filtration rate showed a negative correlation with tissue sodium concentrations (soleus: r = -0.58, P < 0.01; tibia: r = -0.53, P = 0.01) in merged control-CKD patients. Hemoglobin was negatively correlated with tissue sodium concentrations in CKD (soleus: r = -0.65, P = 0.02; tibia: r = -0.73, P < 0.01) and HD (skin: r = -0.60, P = 0.04; tibia: r = -0.76, P < 0.01). Tissue sodium concentrations, measured by 23Na MRI, increase in HD and PD patients and may be associated with adverse metabolic effects in CKD and dialysis.

Usefulness of prolonged renal replacement therapy in patients with acute kidney injury requiring dialysis

Acute kidney injury (AKI) requiring dialysis is becoming more common. Several types of renal replacement therapies have been used, including continuous, intermittent, and prolonged intermittent renal replacement therapy (PIRRT). There is no clear difference between those therapies in terms of patient survival. The aim of this study was to describe a form of PIRRT (shift continuous veno-venous hemodialysis [CVVHD]) and the results of this technique in a population of patients with AKI requiring dialysis in a tertiary care center. We studied 302 patients with AKI requiring dialysis over a 3-year period. All patients were treated in the intensive care unit. There were 1709 treatments in the study. Shift CVVHD was done for 8 h daily using NxStage machines, with a bicarbonate base dialysate at a rate of 5 L/h. Demographics and laboratory data were obtained from the electronic medical record. Dialysis data were obtained from the dialysis run sheets. Patient mortality was 51.3%.The dialysis time was close to 8 h and the blood flow was 310 (± 43) mL/min. The mean arterial pressure was stable before and after the dialysis. The total ultrafiltration averaged 2934 mL per treatment; the ultrafiltration rate was 4.1 (± 3.1) mL/kg/h, and the ultrafiltration per hour was 359 (± 257.8) mL/h. The average dialysate potassium used was 2.9 mEq/L. The dose of dialysis was 57 (± 19) mL/kg/h. The urea reduction ratio was 48% (± 15%), the standardized KT/V (a measure of dialysis dose obtained by urea kinetic modeling) was 3.5 (± 0.9), and the equivalent renal urea clearance (EKR) was 9.8 (± 4.1) mL/min. The method produced a consistent reduction in the levels of blood urea nitrogen, creatinine, potassium, and phosphorous. The delivered dose of dialysis was stable during the observation period. In conclusion, shift CVVHD is effective in treating patients with AKI requiring dialysis and has a survival similar to that of continuous therapies with less intensive use of resources.

Renal replacement therapy is independently associated with a lower risk of death in patients with severe acute kidney injury treated with targeted temperature management after out-of-hospital cardiac arrest

BackgroundThe effect of renal replacement therapy (RRT) on the outcomes of severe acute kidney injury (AKI) after out-of-hospital cardiac arrest (OHCA) is uncertain. This study aimed to evaluate the association of RRT with 6-month mortality in patients with severe AKI treated with targeted temperature management (TTM) after OHCA.MethodsThis was a retrospective analysis of a prospectively collected multicentre observational cohort study that included adult OHCA patients treated with TTM across 22 hospitals in South Korea between October 2015 and December 2018. AKI was diagnosed using the Kidney Disease: Improving Global Outcomes criteria. The primary outcome was 6-month mortality and the secondary outcome was cerebral performance category (CPC) at 6 months. Multivariate Cox regression analysis was performed to define the role of RRT in stage 3 AKI.ResultsAmong 10,426 patients with OHCA, 1373 were treated with TTM. After excluding those who died within 48 h of return of spontaneous circulation (ROSC) and those with pre-arrest chronic kidney disease, our study cohort comprised 1063 patients. AKI developed in 590 (55.5%) patients and 223 (21.0%) had stage 3 AKI. Among them, 115 (51.6%) were treated with RRT. The most common treatment modality among RRT patients was continuous renal replacement therapy (111 [96.5%]), followed by intermittent haemodialysis (4 [3.5%]). The distributions of CPC (1–5) at 6 months for the non-RRT vs. the RRT group were 3/108 (2.8%) vs. 12/115 (10.4%) for CPC 1, 0/108 (0.0%) vs. 1/115 (0.9%) for CPC 2, 1/108 (0.9%) vs. 3/115 (2.6%) for CPC 3, 6/108 (5.6%) vs. 6/115 (5.2%) for CPC 4, and 98/108 (90.7%) vs. 93/115 (80.9%) for CPC 5, respectively (P = 0.01). The RRT group had significantly lower 6-month mortality than the non-RRT group (93/115 [81%] vs. 98/108 [91%], P = 0.04). Multivariate Cox regression analyses showed that RRT was independently associated with a lower risk of death in patients with stage 3 AKI (hazard ratio, 0.569 [95% confidence interval, 0.377–0.857, P = 0.01]).ConclusionDialysis interventions were independently associated with a lower risk of death in patients with stage 3 AKI treated with TTM after OHCA.

RENAL CELL CARCINOMA WITH ONCOCYTIC CELL TUMOR IN ASEMPTOMATIC DIALYSIS PATIENT

Kronik böbrek yetmezlikli ve renal replasman tedavisi gören hastalarda kardiyovasküler hastalıklar (%56), infeksiyonlar (%11.2) ve maligniteye (%8) bağlı artmış mortalite oranları söz konusudur. Diyaliz süresi uzadıkça malignite görülme oranı da artar. Diyaliz hastalarında renal hücreli karsinom (RCC) prevalansının genel popülasyona göre daha yüksek olduğu bilinmektedir. Edinilmiş kistik böbrek hastalığı (ACKD) sıklığı diyaliz süresi ile artar; CKD ile ilişkili RCC erkeklerde daha sık görülür; sıklıkla bilateral ve multisentriktir. Renal hücreli tümörlerden olan onkositom varyant bir tümör olarak kabul edilmesine rağmen histopatolojik olarak malign tümör özellikleri gösterebilir. Bu yazıda uzun süreden beri hemodiyaliz tedavisi gören ve yakınması olmayan hastada rastlantısal olarak saptanan renal kitleler anlatılmaktadır.

Continuous renal replacement therapy in patients with HIV/AIDS

BackgroundAcute kidney injury (AKI) is a common complication among human immunodeficiency virus (HIV)-infected patients resulting in increased morbidity and mortality. Continuous renal replacement therapy (CRRT) is a useful method and instrument in critically ill patients with fluid overload and metabolic disarray, especially in those who are unable to tolerate the intermittent hemodialysis. However, the epidemiology, influence factors of CRRT and mortality in patients with HIV/AIDS are still unclear in China. This study aims to study the HIV-infected patients admitted in Intensive Care Unit (ICU) and explore the influence factors correlated with CRRT and their prognosis.MethodsWe performed a retrospective case-control study in the ICU of the Beijing Ditan Hospital Capital Medical University. From June 1, 2005 to May 31, 2017, 225 cases were enrolled in this clinical study.Results122 (54.2%) patients were diagnosed with AKI during their stay in ICU, the number and percentage of AKI stage 1, 2 and 3 were 38 (31.1%), 21(17.2%) and 63(51.7%), respectively. 26.2% of AKI patients received CRRT during the stay of ICU. 56.25% CRRT patients died in ICU. The 28-day mortality was 62.5%, and the 90-day mortality was 75%. By univariate logistics analysis, it showed that higher likelihood of diagnosis for respiratory failure (OR = 7.333,95% CI 1.467–36.664, p = 0.015), higher likelihood of diagnosis for septic shock (OR = 1.005,95% CI 1.001–1.01, p = 0.018), and higher likelihood to use vasoactive agents (OR = 10.667,95% CI 1.743–65.271, p = 0.001), longer mechanical ventilation duration (OR = 1.011,95% CI 1.002–1.019, p = 0.011), higher likelihood for diagnosis for PCP (OR = 7.50,95% CI 1.288–43.687, p = 0.025), higher SOFA score at ICU admission (OR = 1.183,95% CI 1.012–1.383, p = 0.035), longer duration of CRRT (OR = 1.014,95% CI 1.001–1.028, p = 0.034) contributed to a higher mortality at ICU. The Cox Analysis for the cumulative survival of AKI 3 patients between the CRRT and non-CRRT groups shows no significant differences (p = 0.595).ConclusionsThere is a high incidence of AKI in HIV-infected patients admitted in our ICU. Patients with severe AKI were more prone to be admitted for CRRT and have a consequent poor prognosis.

SAT-352 THE EFFECT OF IMMUNOLOGICAL RISK ASSESSMENT ON GRAFT AND PATIENT SURVIVAL BEFORE KIDNEY TRANSPLANTATION

Kidney transplantation is the most successful renal replacement therapy for patients with end stage renal disease (ESRD), which offers improving quality of life and survival advantage. In our center, since 1970 complement-dependent cytotoxicity cross match, since 2002 standard panel reactive antibody screening (PRA-class I and II) and since December 2015 flow cytometry crossmatch (FCM-XM) assay and detection of anti-HLA antibodies with more specific methods and measuring mean fluorescence intensity (MFI) titers have been performed pretransplant cadaver and living kidney recipients. The aim of this study was to evaluate the immunological/non-immunological complications, graft and patients survivals and the factors affecting survival in kidney transplant recipients who underwent transplantation between January 1993 and March 2018. 630 patients who underwent kidney transplantation were enrolled. Group I include 148 patients who were just tested with CDC-XM, group II include 96 patients who were tested with CDC XM and PRA screening and group III include 96 patients who were tested with FCM-XM and detailed PRA. Patients’ demographic features, laboratory and transplantation data were compared. Graft and patient survival and factors affecting them were analyzed. Also after determining the differences of these groups patients were matched based on the propensity score match analysis after that analyzes were repeated. Comprasion of patient and transplantation characteristics is shown at Table 1. The mean follow-up period was 113±85 months in group I, 92±45 months in group II, and 25±8 months in group III (p<0.001). The rate of cadaveric donor were similar in each group. The mean number of HLA mismatches was 2±1 in group I, 3±2 in group II, and 3±1 in group III (p<0,001). It has been observed that the number of PRA positive recipients increased in recent periods with known PRA status (p=0,001). The rate of given induction treatment and maintenance immunosuppressive treatment regimens also changed over time. While the average creatinine and glomerular filtration rate (GFR) at discharge was similar in groups (p=0.852), GFR was lower in group I than the other two groups during the follow-up (p<0.001). Acute rejection rate was highest in group I and least in group II (p<0.001). Graft survival was higher in the other period than in the tested only with CDC-XM period (group I) (p=0.019) and patient survival was also higher in group II and III in each years during follow-up (p<0,05). After matching the age, sex, donor type and HLA mismatch number of the patients with propensity score, 48 patients in group I, 55 patients in group II and 51 patients in group III were matched and the analyzes were repeated. After analysis, graft and patient survival were higher in group II and III than in group I. With improvements in immunological risk assessment, the use of related tests before renal transplantation and since 2000s the development of immunosuppressive theraphy have positively affected graft and patient survival in kidney transplant patients in our center, although transplantations were made to higher-risk patients recent years. Detailed assessment of immunological risk and individualization of pretransplant evaulation and induction and maintenance therapies may also have played a role in improving graft and patient survival.

SUN-221 RATES OF HOSPITALISATION IN THE FIRST YEAR AFTER COMMENCEMENT OF RENAL REPLACEMENT THERAPY- SINGLE CENTRE EXPERIENCE

Renal replacement therapy (RRT) patients are known to have large number of comorbidities and hence, have high hospitalisation rates. The primary aim of the present study was to compare rates of hospitalisation in year one of incident dialysis patients treated with peritoneal dialysis (PD) or with haemodialysis (HD). We performed retrospective review of all the patients who commenced RRT during April 2013 to March 2016. We collected demographic data, date of commencement of RRT, starting modality, first contact date with renal services, type of access, Charlson’s comorbidity score (CCS) and the details regarding hospital admission within the first year of starting RRT including data about switching modality from electronic patient records. Data was analysed using SPSS V24. 200 patients commenced RRT over 3 year from April 2013-March 2016. Median age of starting RRT was 61.7 years (IQR: 21), 66% (n=132) were males and majority were whites (83.5%). Median CCS was 5 (IQR: 3) and 41.5% were diabetics. 107 patients commenced RRT on HD and rest of 93 on PD. During the one-year follow up period after starting RRT, there were 434 admissions in 130 (65%) patients. 70 (65.4%) of 107 HD and 60 (64.5%) of 93 PD patients were admitted atleast once during the first year of RRT. Median number of admissions were 2.5 (IQR: 3) and cumulative in-patient days in 1 year were 12 (IQR: 27). On comparison of patients groups by starting modality, HD patients were older (65 years; IQR 23 years) as compared to PD patients (58.7 years; IQR 16 years) (P=0.003). There were 236 admissions in HD group and 198 in PD group, however there were more admissions related to medical issues (32% in HD vs 19 % in PD) in HD group vs more admissions related to dialysis issues (9% in HD vs 13% in PD) in PD group. CCS was higher in HD at 6 (IQR 3) as compared to PD patients which was 5 (IQR 3) (P= 0.017). Median number of admission HD vs PD were 2 (IQR: 2) vs 3 (IQR: 3) (P = 0.801) and cumulative days of admission in HD vs PD were 13 (IQR: 27) vs 10.5 (IQR: 23) (P=0.504). Burden of hospitalisation is high in renal replacement therapy population. Even though there was significant difference in the age and comorbidity index of the patients in both admitted HD and PD groups, there was no difference in the number of admission and the hospital days between groups. Further work is required to explore factors contributing the above.

Providing Continuous Renal Replacement Therapy in Patients on Extracorporeal Membrane Oxygenation.

A 34-year-old male was admitted for respiratory failure due to H1N1 influenza. His hypoxia worsened despite maximal ventilator support and thus initiated on venovenous extracorporeal membrane oxygenation (VV-ECMO). Whereas this stabilized his respiratory and hemodynamic status, his creatinine

Seasonal variations in cause-specific mortality and transition to renal replacement therapy among patients with end-stage renal disease

Despite some studies showing seasonal variations in mortality and the transition to renal replacement therapy in patients with end-stage renal disease, detailed evidence is still scarce. We investigated seasonal variations in patients with end-stage renal disease using a large Japanese database for dialysis patients. We compared the fractions of all-cause and cause-specific mortality and the transition to renal replacement therapy among seasons and performed a mixed-effects Poisson regression analysis to compare the mortality among seasons after adjustment for some variables. The initiation of hemodialysis was highest in winter and lowest in summer. Seasonality in the initiation of peritoneal dialysis and transition to kidney transplantation differed from hemodialysis. All-cause mortality was highest in the winter and lowest in the summer. Death from coronary artery disease, heart failure, cerebral hemorrhage, and infectious pneumonia had similar seasonality, but death from cerebral infarction, septicemia, or malignant tumor did not have similar seasonality. In conclusion, the initiation of hemodialysis, all-cause mortality, and mortality from coronary heart disease, heart failure, cerebral hemorrhage, and infectious pneumonia were significantly highest in winter and lowest in summer. However, the initiation of peritoneal dialysis, transition to kidney transplantation, or mortality from cerebral infarction, septicemia, or malignant tumor did not have similar seasonal variations.

Timing of renal replacement therapy for patients with acute kidney injury: A systematic review and meta-analysis.

Acute kidney injury is associated with high mortality, and the optimal time to start renal replacement therapy for acute kidney injury is unknown despite several randomised controlled trials on the subject. We performed a systematic review and meta-analysis to assess the effect of earlier initiation of renal replacement therapy for acute kidney injury on mortality and reported secondary outcomes. All literature in databases EMBASE, MEDLINE and CENTRAL was searched from January 1970 to March 2019 using terms related to renal replacement therapy, timing and randomised controlled trials. All randomised controlled trials with 25 or more adult participants suffering from acute kidney injury comparing timing of renal replacement therapy were included. The results of the selected studies were pooled and expressed in terms of risk ratios (RR) and 95% confidence intervals (95% CI) using a random effects model. A total of 7008 records were identified; 94 were selected for full text review of which 10 were included in the final meta-analysis. The 10 studies comprised 1956 participants (989 'early' group; 967 'late' group) with 918 total deaths; the analysis demonstrated no significant differences between the 'early' and 'late' renal replacement therapy groups (RR = 0.98 (95% CI = 0.84, 1.15)) for mortality. No significant differences between groups were evident for period-wise mortality; dialysis dependence; recovery of renal function; length of intensive care unit or hospital stay; or number of renal replacement therapies, mechanical ventilation and vasopressor-free days. Current evidence does not support the use of early renal replacement therapy for patients with acute kidney injury. Data from ongoing and future randomised controlled trials are required to strengthen the evidence base in the area.

Efficacy of HA330 Hemoperfusion Adsorbent in Patients Followed in the Intensive Care Unit for Septic Shock and Acute Kidney Injury and Treated with Continuous Venovenous Hemodiafiltration as Renal Replacement Therapy

Introduction: Blood purification is an option for treatment of the source of sepsis when correcting patients’ septic shock-induced clinical status. We investigated the efficacy of HA330 hemoperfusion adsorbent application with renal replacement therapy in patients with septic shock and acute kidney injury. Methods: This prospective observational study involved 23 patients diagnosed with sepsis who underwent continuous venovenous hemodiafiltration and HA330 hemoperfusion for 2 h once daily for 3 days. The patients’ demographic data, comorbidities, lengths of intensive care unit and hospital stays, blood cell counts, blood biochemistry values, coagulation values, blood gas values, inflammatory markers, hemodynamic parameters, and inotropic medication use before and after each application of HA330 hemoperfusion were recorded. The effectiveness of HA330 hemoperfusion was evaluated by comparing the parameters on days 0 and 1, 1 and 2, and 2 and 3. Results: The pH increased significantly following the first application of HA330 hemoperfusion (p = 0.001), the C-reactive protein (CRP) and procalcitonin levels decreased significantly after the second application (p = 0.002 and 0.018, respectively), and the CRP level decreased significantly following the third application (p = 0.046). Conclusions: The application of HA330 hemoperfusion 2 h daily for 3 consecutive days improved level of CRP and heart rate, but had no effect on others or on the prognosis.

Renal Replacement Therapy in Patients With Stage IV Cancer Admitted to the Intensive Care Unit With Acute Kidney Injury at a Comprehensive Cancer Center Was Not Associated With Survival.

In patients with advanced cancer, prolongation of life with treatment often incurs substantial emotional and financial expense. Among hospitalized patients with cancer since acute kidney injury (AKI) is known to be associated with much higher odds for hospital mortality, we investigated whether renal replacement therapy (RRT) use in the intensive care unit (ICU) was a significant independent predictor of worse outcomes. We retrospectively reviewed patients admitted in 2005 to 2014 who were diagnosed with stage IV solid tumors, had AKI, and a nephrology consult. The main outcomes were survival times from the landmark time points, inpatient mortality, and longer term survival after hospital discharge. Logistic regression and Cox proportional regression were used to compare inpatient mortality and longer term survival between RRT and non-RRT groups. Propensity score-matched landmark survival analyses were performed with 2 landmark time points chosen at day 2 and at day 7 from ICU admission. Of the 465 patients with stage IV cancer admitted to the ICU with AKI, 176 needed RRT. In the multivariate logistic regression model after adjusting for baseline serum albumin and baseline maximum Sequential Organ Failure Assessment (SOFA), the patients who received RRT were not significantly different from non-RRT patients in inpatient mortality (odds ratio: 1.004 [95% confidence interval: 0.598-1.684], P = .9892). In total, 189 patients were evaluated for the impact of RRT on long-term survival and concluded that RRT was not significantly associated with long-term survival after discharge for patients who discharged alive. Landmark analyses at day 2 and day 7 confirmed the same findings. Our study found that receiving RRT in the ICU was not significantly associated with inpatient mortality, survival times from the landmark time points, and long-term survival after discharge for patients with stage IV cancer with AKI.

Incidence and Outcomes of Acute Kidney Injury Requiring Renal Replacement Therapy in Patients on Percutaneous Mechanical Circulatory Support with Impella-CP for Cardiogenic Shock.

Background: Acute kidney injury (AKI) complicating cardiogenic shock is associated with increased mortality. We hypothesize that renal replacement therapy (RRT) improves survival in cardiogenic shock supported by Impella-CP (Abiomed, Danvers, MA) complicated by AKI.Methods: A retrospective chart review identified 34 patients on Impella-CP for cardiogenic shock between January 2015 and December 2017. AKI was defined as an increase in serum creatinine≥0.3 mg/dL from baseline. Three groups were analyzed: AKI plus RRT, AKI minus RRT, and no AKI. Pre-existing dialysis patients were excluded. The only indication for RRT was AKI not responding to diuretics. Thirty-day mortality was analyzed.Results: There were 13 patients with no AKI, 9 with AKI plus RRT groups, and 12 with AKI minus RRT. Thirty-day mortality was similar between no AKI and AKI plus RRT groups [30.8% (4/13) vs.22.2% (2/9), p=0.48; relative risk [RR] 2.25 (95% confidence interval [CI] 0.22-22.1)]. Thirty-day mortality was higher in AKI minus RRT group compared to the no AKI group [75.0% (9/12) vs. 30.8% (4/13); p=0.03; RR 6.75 (95% CI 1.16-39.2)].Conclusion: In cardiogenic shock patients on Impella-CP, AKI minus RRT is associated with a higher 30-day mortality compared to patients without AKI and/or patients with AKI plus RRT. Short-term mortality may improve in cardiogenic shock patients with AKI who are treated with RRT.