Single Dialysis Research Articles

Provision of renal-specific nutrition knowledge for changing dietary practice in Bangladeshi hemodialysis patients.

Studies show that provision of nutrition knowledge help renal patients make informed food choices. This study aimed to evaluate the impact of nutrition knowledge for changing dietary practice among Bangladeshi dialysis patients. Following development of a renal-specific nutrition booklet, a pilot study was conducted among 50 hemodialysis patients from a single dialysis setting. Demographic, anthropometric, clinical, biochemical, dietary data, and a 10-item MCQ on renal-specific nutrition information were collected before and 3 months after the provision of the booklet. 52% of the participants were male, 54% had twice weekly dialysis, age 53 ± 12 years, and dialysis vintage was 46 ± 25 months. Serum potassium and phosphorous, dietary potassium, phosphorous, and phosphorous to protein ratio were significantly reduced after the provision of the booklet. Additionally, patients consuming >3 meals/day increased to 66% while adherence to renal-specific cooking method and vegetable preference were significantly increased to 70% and 62%, respectively. Provision of knowledge via renal-specific nutrition booklet was able to improve patients' dietary practice and enhance their dietary adherence to renal specific recommendations. The booklet was developed using locally available food items in local language and was found beneficial in low-resource settings where overall health care facilities, including nutrition support are limited.

Percutaneous Single Stitch Peritoneal Dialysis Catheter Insertion Using the Seldinger Technique: Boost for Interventions by Nephrologist

Percutaneous Single Stitch Peritoneal Dialysis Catheter Insertion Using the Seldinger Technique: Boost for Interventions by Nephrologist

Validity and reliability of the Patient-Reported Outcomes Measurement Information System (PROMIS®) using computerized adaptive testing in patients with advanced chronic kidney disease.

The Patient-Reported Outcomes Measurement Information System (PROMIS®) has been recommended for computerized adaptive testing (CAT) of health-related quality of life. This study compared the content, validity, and reliability of seven PROMIS CATs to the 12-item Short-Form Health Survey (SF-12) in patients with advanced chronic kidney disease. Adult patients with chronic kidney disease and an estimated glomerular filtration rate under 30mL/min/1.73m2 who were not receiving dialysis treatment completed seven PROMIS CATs (assessing physical function, pain interference, fatigue, sleep disturbance, anxiety, depression, and the ability to participate in social roles and activities), the SF-12, and the PROMIS Pain Intensity single item and Dialysis Symptom Index at inclusion and 2 weeks. A content comparison was performed between PROMIS CATs and the SF-12. Construct validity of PROMIS CATs was assessed using Pearson's correlations. We assessed the test-retest reliability of all patient-reported outcome measures by calculating the intraclass correlation coefficient and minimal detectable change. In total, 207 patients participated in the study. A median of 45 items (10 minutes) were completed for PROMIS CATs. All PROMIS CATs showed evidence of sufficient construct validity. PROMIS CATs, most SF-12 domains and summary scores, and Dialysis Symptom Index showed sufficient test-retest reliability (intraclass correlation coefficient≥0.70). PROMIS CATs had a lower minimal detectable change compared with the SF-12 (range, 5.7-7.4 compared with 11.3-21.7 across domains, respectively). PROMIS CATs showed sufficient construct validity and test-retest reliability in patients with advanced chronic kidney disease. PROMIS CATs required more items but showed better reliability than the SF-12. Future research is needed to investigate the feasibility of PROMIS CATs for routine nephrology care.

MO881: Predictors of Mortality of COVID-19 in Haemodialysis Patients

BACKGROUND AND AIMSThe COVID-19 pandemic has disproportionately affected patients with pre-existing comorbidities, particularly dialysis patients. These patients appear to be more susceptible to severe forms of the infection, due to underlying, coexisting pathologies and their immunocompromised status. The aim of this study was to determine predictors of mortality in this population.METHODWe conducted an observational, retrospective, cohort study collecting data from the electronic medical records of a single dialysis centre at Hygeia Hospital Tirana, Albania. Baseline patient characteristics, including demographic, clinical and laboratory data were recorded. The receiver operating characteristic (ROC) analysis was used to determine predictors of mortality, their respective sensitivity, specificity and cut-off values.RESULTSOf 170 haemodialysis patients, 52 were diagnosed with COVID-19. The prevalence of COVID-19 infection in haemodialysis patients in our study was 30.5%. The mean age was 61.5 ± 12.3 years and 65.4% were men. The mortality rate in our cohort was 19.2%. Mortality rates were higher in patients with Diabetic Nephropathy (P < 0.04) and Peripheral Vascular Disease (P < 0.01). High BMI (P < 0.024), high RDW (P < 0.03), elevated C-reactive protein (P < 0.018) and elevated serum ferritin (P < 0.021) levels, were found to be risk factors for severe COVID-19 disease. ROC analysis identified lymphopenia and eosinopenia as the strongest predictors of mortality. AUC for lymphopenia was 0.739. It showed a sensitivity of 80% and a specificity of 85.7%, at a cut-off value of 13.15%. AUC for eosinopenia was 0.814. At a cut-off value of 0.185%, it revealed a sensitivity and specificity of 72.7% and 75%, respectively.CONCLUSIONOur study revealed that risk factors for the development of severe COVID-19 infection were high BMI, high RDW, elevated levels of C-reactive protein (CRP) and serum ferritin. Lymphopenia and eosinopenia were determined as the most important predictors of mortality, in our cohort. Early recognition during the course of the infection, of a declining tendency of lymphocyte and eosinophil counts is paramount, in identifying high-risk patients for severe disease and poor outcomes among haemodialysis patients.

MO649: Monitoring of Ionized Magnesium in Haemodialysis Patients: A Useful Tool to Allow a Personalized Prescription of Dialysate Composition

Abstract BACKGROUND AND AIMS In healthy subjects, normal values of magnesium (Mg) are in the range 0.75–0.95 mmol/L. In the circulation, 65–70% of the Mg is present in the free, ionized and dialyzable form (i.e. 0.45– 0.60 mmol/L), 20% is bound to proteins and 15% is complexed. In chronic kidney disease (CKD) dialysis patients, the dialysate Mg concentration is a major determinant of Mg balance. The aim of this study was to assess the systemic variations of ionized Mg (iMg), as well as that of ionized calcium (iCa), before and after a dialysis session. METHOD A total of 121 dialysis patients [median age = 70 (62.5–78.2) years; 74 male/46 female] in maintenance haemodialysis three times per week, for at least 6 months and with no residual function, were included. Patients were assigned to a single dialysis session with either control fluid (group 1: 3 mM acetate, 1.5 mM Ca, 0.5 mM Mg), or citrate dialysis fluid containing 0.5 mM Mg (group 2: 0.8 mM citrate, 0.3 mM acetate, 1.65 mM Ca) or 0.75 mM Mg (group 3: 0.8 mM citrate, 0.3 mM acetate, 1.65 mM Ca). Blood samples were drawn before and after the midweek dialysis sessions as part of the routine patient follow-up and quality assurance process. iMg and iCa concentrations were measured by direct ion-selective electrode on Nova Stat Profile Prime Plus® (Nova Biomedical). Total Mg (tMg) and Ca (tCa) were assessed by colorimetric method c702/Cobas 8000 analyzer (Roche). Dialytic balance was assessed by the median intra-dialytic difference between pre-dialysis and post-dialysis. RESULTS The use of all types of dialysates (whatever their composition was) was associated with a calcium load during the session (Table). In addition, an Mg loss was observed in both control and citrate dialysis fluid groups containing 0.5 mM Mg. The dialysis session induced a significant decrease in iMg (13 and 22% in group1 and group 2 respectively). By contrast, the use of citrate dialysis fluid with 0.75 mM Mg led to a positive balance with a median intra-dialytic increase of 0.08 and 0.02 mmol/L in tMg and iMg respectively (Table), corresponding to a median increase of 8 and 3% in tMg and iMg respectively. CONCLUSION The iMg fraction represents 70% of tMg in CKD stage 5D patients. While a dialysate Mg concentration at 0.5 mM leads to a negative balance, increasing the concentration to 0.75 mM significantly raises post-dialysis circulating Mg levels in these patients. Therefore, monitoring of iMg should allow a personalized prescription in dialysate Mg composition.

Strategies for optimizing urea removal to enable portable kidney dialysis: A reappraisal.

Portable hemodialysis has the potential to improve health outcomes and quality of life for patients with kidney failure at reduced costs. Urea removal, required for dialysate regeneration, is a central function of any existing/potential portable dialysis device. Urea in the spent dialysate coexists with non-urea uremic toxins, nutrients, and electrolytes, all of which will interfere with the urea removal efficiency, regardless of whether the underlying urea removal mechanism is based on urease conversion, direct urea adsorption, or oxidation. The aim of the current review is to identify the amount of the most prevalent chemicals being removed during a single dialysis session and evaluate the potential benefits of an urea-selective membrane for portable dialysis. We have performed a literature search using Web of Science and PubMed databases to find available articles reporting (or be able to calculate from blood plasma concentration)>5mg of individually quantified solutes removed during thrice-weekly hemodialysis sessions. If multiple reports of the same solute were available, the reported values were averaged, and the geometric mean of standard deviations was taken. Further critical literature analysis of reported dialysate regeneration methods was performed using Web of Science and PubMed databases. On average, 46.0g uremic retention solutes are removed in a single conventional dialysis session, out of which urea is only 23.6g. For both urease- and sorbent-based urea removal mechanisms, amino acids, with 7.7g removal per session, could potentially interfere with urea removal efficiency. Additionally for the oxidation-based urea removal system, plentiful nutrients such as glucose (24.0g) will interfere with urea removal by competition. Using a nanofiltration membrane between dialysate and oxidation unit with a molecular weight cutoff (MWCO) of ~200Da, 67.6g of non-electrolyte species will be removed in a single dialysis session, out of which 44.0g are non-urea molecules. If the membrane MWCO is further decreased to 120Da, the mass of non-electrolyte non-urea species will drop to 9.3g. Reverse osmosis membranes have been shown to be both effective at blocking the transport of non-urea species (creatinine for example with ~90% rejection ratio), and permissive for urea transport (~20% rejection ratio), making them a promising urea selective membrane to increase the efficiency of the oxidative urea removal system. Compiled are quantified solute removal amounts greater than 5mg per session during conventional hemodialysis treatments, to act as a guide for portable dialysis system design. Analysis shows that multiple chemical species in the dialysate interfere with all proposed portable urea removal systems. This suggests the need for an additional protective dialysate loop coupled to urea removal system and an urea-selective membrane.

Long-term outcomes of peritoneal dialysis catheters inserted by laparoscopic and percutaneous techniques in a single regional dialysis centre.

BackgroundMinimally invasive insertion of catheters for peritoneal dialysis can be performed laparoscopically or percutaneously under image guidance. In Geelong (Victoria, Australia) both methods are used. Our aim was to analyse the outcomes of all catheters inserted by both laparoscopic and percutaneous techniques and compare them against published studies from tertiary referral centres.MethodsData were collected retrospectively on all patients who had their catheter inserted (since 2006) within the Geelong regional service. We compared the outcomes of percutaneous catheter insertion under image guidance (percutaneous group, n = 29) with the laparoscopic catheter placement technique (laparoscopic group, n = 61). Perioperative, follow‐up and catheter outcome data were collected. There were no exclusion criteria. Analysis was performed using the unpaired student t‐test and chi‐squared test.ResultsNinety catheters were inserted between 2006 and 2017 in mostly male patients (63%) with a mean age of 60 ± 0.4 years. The most common aetiology of chronic kidney disease was diabetic nephropathy (34%). Percutaneous insertion required less operative time, shorter hospital stay and earlier initiation of peritoneal dialysis. In the longer term, percutaneous catheters were more likely to migrate and laparoscopic catheters were more durable but more often associated with peritonitis. Thirty‐day complication rates did not differ between both groups. No Clavien‐Dindo grade 3 or 4 complication was reported.ConclusionsLaparoscopic insertion of peritoneal dialysis catheters at our centre is performed safely and with patient outcomes comparable to published literature. Percutaneous insertion represents a safe and effective alternative based on the study findings.

A Large Single-Center Experience of Management of Aneurysmal Degeneration of Arteriovenous Fistulas for Hemodialysis

Aneurysmal degeneration (AD) is a known complication of autogenous arteriovenous fistulas (AVFs) created for hemodialysis. The surgical treatment options for AD to maintain autogenous AVF patency include plication, excision with primary anastomosis, and interposition graft or stent placement. The aim was to assess the outcomes of surgical modalities in the management of AD of autogenous AVFs at a single major dialysis access institution.

The association of preoperative dialysis with troponin trends and short term outcomes among advanced kidney disease patients undergoing coronary artery bypass grafting

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Coronary artery disease continues to be the leading cause of death in patients with stage IV-V chronic kidney disease (CKD IV-V). However, the prognosis and early outcomes for advanced CKD patients undergoing coronary artery bypass grafting (CAB) worsen as the estimated glomerular filtration rate (eGFR) deteriorates. Therefore, we compared postoperative clinical outcomes and troponin trends in patients having advanced CKD according to preoperative dialysis status in a single centre experience. Methods A total of 51 patients with CKD IV and V who underwent CAB between 2016-2021 were included in the study. Data on patient characteristics and postoperative outcomes were collected retrospectively, and independently for our Society of Thoracic Surgeons database. Characteristics were compared between patients having CKD IV vs. CKD V. The differences in postoperative cardiac troponin trends and outcomes were evaluated between patients who did vs. did not undergo preoperative dialysis. The statistical analysis was conducted applying appropriate parametric or non-parametric (for skewed variables) testing methods, and a p value &amp;lt; 0.05 was considered to be statistically significant. Results 47% (24) of subjects had CKD IV, while the rest featured CKD V. Patients with CKD IV tended to be older (61.8 ± 9.2 vs. 56.3 ± 11.5 years, p = 0.07), more obese (BMI: 31.4 ± 6.8, 27.4 ± 4.9 kg/m2, p = 0.02) and had significantly higher preoperative GFR (23 ± 4.9 vs. 9 ± 3.3 mL/min, p &amp;lt; 0.001) (Table.1). When comparing patients who underwent preoperative dialysis vs. those who did not, troponin levels were the highest at 18h postoperative in both groups, however, troponin levels were comparable between both groups at all time points (Table.2). Although, there was no difference in hospital length of stay and mortality between these groups, patients who did not undergo preoperative dialysis had longer intensive care unit length of stay (ICU LOS). Conclusion In this single centre experience preoperative dialysis was not associated with a significant difference in trends of postoperative cardiac enzymes. Although preoperative dialysis was associated with shorter ICU LOS, complex pre-procedural surgical risk assessment remains paramount in reducing complications and mortality in this high-risk population. Abstract Figure. Abstract Figure.

The prognostic value of reduced global longitudinal strain (GLS) on cardiac outcomes in patients on peritoneal dialysis: a prospective study

Abstract Funding Acknowledgements Type of funding sources: None. Introduction This study aims to evaluate the capacity of left ventricular global longitudinal strain (GLS) in end stage renal failure patients on peritoneal dialysis (PD) to predict cardiovascular mortality and major adverse cardiac events (MACE). GLS has been an established parameter in detecting subclinical left ventricular systolic dysfunction in the setting of preserved ejection fraction (EF &amp;gt; = 50%). We hypothesized that reductions of GLS (i.e. less negative value) are associated with adverse cardiovascular outcome. Methods We prospectively recruited a total of 60 PD patients from a single dialysis center in a tertiary hospital. GLS was determined by two-dimensional speckle-tracking echocardiography, under Philips QLab system. A less negative value reflects underlying subclinical LV dysfunction. The primary outcome was 4-point MACE, which was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke and hospitalization for heart failure. Surrogate markers of inflammation (C-reactive protein [CRP], tumor necrosis factor [TNF]-alpha), nutrition (serum albumin), arterial stiffness (pulse wave velocity [PWV]), and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) were also measured. Results 16 (26.7%) and 34 (56.7%) PD patients had reduced GLS (≥ -18.3%) and left ventricular hypertrophy (LVH) respectively. In 12-month follow up, 4-point MACE occurred in 13.6% and 59.8% of normal and compromised GLS patients respectively (log-rank, P = 0.004), as illustrated by Kaplan-Meier curves (Fig 1). Patients with reduced GLS had higher proportion of uncontrolled blood pressure and higher prevalence of coronary artery disease. Their EF were significantly lower (53.6 ± 7.4% vs. 61.3 ± 4.1%, P= 0.001) compared with patients with normal GLS. In addition, GLS correlated with EF (r = -0.57, P &amp;lt;0.0001) and PWV (r= 0.33, P = 0.01). There was a trend towards an association between GLS and ln(CRP) (r= 0.25, P = 0.057), and ln(NT-proBNP) (r = 0.22, P= 0.09), respectively. Conclusions Subclinical LV systolic dysfunction was present in one-fourth of peritoneal dialysis patients despite having preserved EF. Reduced GLS (less negative than 18.3%, illustrated in Fig 2) is a strong predictor of poor cardiovascular prognosis among PD population. Abstract Figure 1 Abstract Figure 2

Risk Prediction for Delayed Allograft Function: Analysis of the Deterioration of Kidney Allograft Function (DeKAF) Study Data.

Delayed graft function (DGF) of a kidney transplant results in increased cost and complexity of management. For clinical care or a DGF trial, it would be ideal to accurately predict individual DGF risk and provide preemptive treatment. A calculator developed by Irish et al has been useful for predicting population but not individual risk. We analyzed the Irish calculator (IC) in the DeKAF prospective cohort (incidence of DGF = 20.4%) and investigated potential improvements. We found that the predictive performance of the calculator in those meeting Irish inclusion criteria was comparable with that reported by Irish et al. For cohorts excluded by Irish: (a) in pump-perfused kidneys, the IC overestimated DGF risk; (b) in simultaneous pancreas kidney transplants, the DGF risk was exceptionally low. For all 3 cohorts, there was considerable overlap in IC scores between those with and those without DGF. Using a modified definition of DGF-excluding those with single dialysis in the first 24 h posttransplant-we found that the calculator had similar performance as with the traditional DGF definition. Studying whether DGF prediction could be improved, we found that recipient cardiovascular disease was strongly associated with DGF even after accounting for IC-predicted risk. The IC can be a useful population guide for predicting DGF in the population for which it was intended but has limited scope in expanded populations (SPK, pump) and for individual risk prediction. DGF risk prediction can be improved by inclusion of recipient cardiovascular disease.

Kinetics of atrial and brain natriuretic peptides during hemodialysis are regulated in association with different cardiac functional changes.

The blood levels of atrial and brain natriuretic peptides (ANP and BNP) are both increased markedly in hemodialysis patients, but the kinetics of the two are not always parallel. The present study investigated the association of changes in ANP and BNP levels before and after dialysis with changes in cardiac function in hemodialysis patients. A total of 57 patients (mean age 64years, 47 males and 10 females) on maintenance hemodialysis with sinus rhythm were enrolled. Blood samples were taken at the beginning and end of dialysis, and plasma levels of ANP and BNP were measured. Changes in cardiac function during dialysis were examined by echocardiography performed just before and after dialysis. Both plasma ANP and BNP concentrations decreased significantly after hemodialysis, but the rate of decrease in BNP [mean ± SD, 555 ± 503 to 519 ± 477pg/mL (-6.4%), P = 0.011] was much smaller than that in ANP [233 ± 123 to 132 ± 83pg/mL (-43.4%), P < 0.001]. As for the relation to the changes in echocardiographic parameters before and after dialysis, the decrease in inferior vena cava diameter had a close correlation with the decrease in ANP (r = 0.528, P < 0.001), but not BNP. In contrast, the decrease in left ventricular end-diastolic volume index was correlated only with the decrease in BNP (r = 0.297, P = 0.035). The peak velocity ratio of early diastolic to atrial filling decreased with preload reduction by dialysis, and its decrease was more strongly correlated with the decrease in BNP (r = 0.407, P = 0.002) than that in ANP (r = 0.273, P = 0.040). These results demonstrated that in hemodialysis patients, the decrease in plasma ANP by a single dialysis was essentially caused by blood volume reduction, while BNP decrease was mainly induced by the reduction of left ventricular overload. Our findings indicate that the kinetics of both peptides during dialysis are regulated by different cardiac and hemodynamic factors.

Patient and Clinician Perspectives on the use of Remote Patient Monitoring in Peritoneal Dialysis.

Background:Numerous factors influence patient recruitment to, and retention on, peritoneal dialysis (PD), but a major challenge is a perceived “inaccessibility” to treating clinicians. It has been suggested that remote patient monitoring (RPM) could be a means of improving such oversight and, thereby, uptake of PD.Objective:To describe patient and clinician perspectives toward RPM and the use of applications (Apps) suitable for mobiles, tablets, or computers to support the provision of PD care.Design:Qualitative design using semi-structured interviews.Setting:All patient participants perform PD treatment at home under the oversight of an urban PD unit in Sydney, Australia. Patient and clinician interviews were conducted within the PD unit.Participants:14 participants (5 clinicians [2 nephrologists, 3 PD nurses] and 9 patients treated with PD).Methods:Semi-structured interviews were conducted using interview guides tailored for clinician and patient participants. Transcripts were coded and analyzed by a single researcher using thematic analysis.Results:Six themes were identified: perceived benefits of RPM implementation (offering convenience and efficiency, patient assurance through increased surveillance, more complete data and monitoring adherence), uncertainty regarding data governance (protection of personal data, data reliability), reduced patient engagement (transfer of responsibility leading to complacency), changing patient-clinician relationships (reduced patient-initiated communication, the need to maintain patient independence), increased patient and clinician burden (inadequate technological literacy, overmanagement leading to frequent treatment changes), and clinician preference influencing patient behavior.Limitations:The interviews were conducted in English only and with participants from a single urban dialysis unit, which may limit generalizability.Conclusions:For patients and clinicians, advantages from the use of RPM in PD may include increased patient confidence and assurance, improved treatment oversight, more complete data capture, and overcoming barriers to data documentation. Careful patient selection and patient and clinician education may help to optimize the benefits of RPM, maintain patient independence, and reduce the risks of patient disengagement. The use of an App may support RPM; however, participants expressed concerns about increasing the burden on some patients through the use of unfamiliar technology.Human Research Ethics Committee Approval Number:CH62/6/2019-028

Electrostatic loading and photoredox-based release of molecular cargo from oligoviologen-crosslinked microparticles.

Although on-demand cargo release has been demonstrated in a wide range of microparticle platforms, many existing methods lack specific loading interactions and/or undergo permanent damage to the microparticle to release the cargo. Here, we report a novel method for electrostatically loading negatively charged molecular cargo in oligoviologen-crosslinked microparticles, wherein the cargo can be released upon activation by visible light. A water-in-oil (W/O) emulsion polymerization method was used to fabricate narrowly dispersed microparticles crosslinked by a dicationic viologen-based dimer and a poly(ethylene glycol) diacrylate. A zinc-tetraphenyl porphyrin photocatalyst was also polymerized into the microparticle and used to photochemically reduce the viologen subunits to their monoradical cations through a visible-light-mediated photoredox mechanism with triethanolamine (TEOA) as a sacrificial reductant. The microparticles were characterized by microscopy methods revealing uniform, spherical microparticles 481 ± 20.9 nm in diameter. Negatively charged molecular cargo (methyl orange, MO) was electrostatically loaded into the microparticles through counteranion metathesis. Upon irradiation with blue (450 nm) light, the photo-reduced viologen crosslinker subunits lose positive charges, resulting in release of the anionic MO cargo. Controlled release of the dye, as tracked by absorption spectroscopy, was observed over time, yielding release of up to 40% of the cargo in 48 h and 60% in 120 h in single dynamic dialysis experiment. However, full release of cargo was achieved upon transferring the microparticles to a fresh TEOA solution after the initial 120 h period.

Efficacy of Supra-HFR in Removing FGF23 and Cytokines: A Single Session Analysis.

Supra hemodiafiltration with reinfusion of the endogenous ultrafiltrate (Supra-HFR) is a dialysis technique used to improve uremic toxin removal in the range of the middle molecular weight molecules. Supra-HFR does not require the preparation and online infusion of high-purity dialysis water because it allows the production of an endogenous ultrafiltrate that undergoes detoxification through an adsorbing resin. We investigated the ability of Supra-HFR to remove fibroblast growth factor 23 (FGF23), interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-alpha), interleukin 8 (IL-8), and transforming growth factor alpha (TGF-alpha) after a single session dialysis in nine patients affected by end stage renal disease (ESRD). The same patients underwent a single session of online hemodiafiltration (OL-HDF) to evaluate possible differences in FGF23 and IL-6 levels. A significant reduction in FGF23 was observed with both Supra-HFR (p=0.001) and OL-HDF. As for TNF-alpha and TGF-alpha, which were measured using Supra-HFR only, their percentage values were significantly lower at the end of dialysis than at the start (p=0.0028 and p=0.03, respectively). This did not change with post-dialysis rebound. Supra-HFR was found to have no effect on IL-6 and IL-8. Interestingly, the removal rate for FGF23 and IL-6 was similar to that observed with OL-HDF. Supra-HFR was not superior to OL-HDF, with suboptimal convective volume in the removal of the molecules tested, especially FGF23, which is considered a large middle molecular weight uremic toxin.

Single peritoneal dialysis centre observations of treatment adequacy, anemia treatment, inflammation, mineral bone disease, and peritonitis rate – In patients undergoing continuous ambulatory peritoneal dialysis versus automated peritoneal dialysis

Purpose: Peritoneal dialysis was introduced to our centre in 1998. The aim of our retrospective analysis was to evaluate the difference in treatment adequacy, erythropoietin requirements, serum haemoglobin, serum C–reactive protein (CRP) and serum intact parathyroid hormone (i–PTH) levels, and episodes of peritonitis in patients switching from continuous ambulatory peritoneal dialysis (CAPD) to automated peritoneal dialysis (APD). We introduce peritoneal dialysis as a method of treatment for end–stage renal disease and the results of a retros-pective analysis.&#x0D; Methods: From May 1998 to December 2013, we retrospectively reviewed 12 patients (9 males and 3 females; mean age, 52.8±11.7 years) who switched from CAPD to APD. According to the peritoneal equilibration test, 75% of the patients were high transporters. We compared thetwo periods regarding peritoneal treatment adequacy number (Kt/V), erythropoietin requirements, serum haemoglobin, and CRP and i–PTH levels. We analysed the episodes of peritonitis during the CAPD and APD periods.&#x0D; Results: The average time spent on CAPD was 747.1±1028.2 days, and the average time spent on APD was 1300.0±1042.0 days. For the CAPD period, the mean Kt/V was 2.13±0.43, the mean haemoglobin value was 117.8±6.2 g/l, the mean erythropoietin requirement was 5290.1±4641.4 IU/week, the mean CRP value was 8.7±9.3 mg/l, and the mean i–PTH value was 580.2±445.9 pg/ml. For the APD period, the mean Kt/V was 2.24±0.35, the mean haemoglobin value was 117.1±8.6 g/l, the mean erythropoietin requirement was 4829.9±4976.6 IU/week, the mean CRP value was 9.1±8.3 mg/l, and the mean i–PTH value was 550.5±400.0 pg/ml. When comparing the two treatment modalities with a paired samples test, we found no significant differences regarding time spent (p=0.273), Kt/V (p=0.159), haemoglobin concentration (p=0.804), erythropoietin requirements (p=0.303), and CRP (p=0.886) and i–PTH levels (p=0.802). Further, no difference in the rate of peritonitis episodes between both modalities was found.&#x0D; Conclusion: Both peritoneal dialysis modalities are equal with respect to treatment adequacy, erythropoietin requirements, serum haemoglobin concentration, CRP and i–PTH levels, and peritonitis episodes.

Results of the implementation of a triage system of vascular access performance in haemodialysis patients: experience of a single dialysis centre.

Routine systems for monitoring vascular access (VA) performance are lacking. We developed a vascular accesstriage system to evaluate the monthly performanceof the access, developed a specific score and assessed the association betweenscore improvement and clinical outcomes. Vascular access was triaged (Green, Yellow or Red) according to a score generated by dialytic and clinical parameters in all patients who, from 1/1/2014 to 31/03/2014, had been receiving haemodialysis treatment for at least 3 consecutive months in our Unit and who were then followed up for 4 years. We enrolled 130 patients, 78 with arteriovenous fistula (AVF) and 52 with tunnelled central venous catheter (CVC). During a median of29 ± 11months of follow up (range 3-46months), 28 deaths and 303 hospitalizations (lasting 16 ± 30days) were recorded. Vascular accesstriagescores improved over time(2014 vs 2015 vs 2016 vs 2017) in the population with an AVF(Green from 25% to 58% to 77% to 79%, Yellow from 65% to 39% to 18% to 20% and Red from 10% to 3% to 5% to 1%, respectively; χ2 p < 0.01) but not in the CVC group (Green 58% to 57% to 80% to 92%; Yellow 37% to 36% to 20% to 8%; Red 5% to 7% to 0%; χ2 = n.s). Blood pressure and dialysis efficiency improved in the population as a whole and in the two subgroups (AVF and CVC) separately. AVF and CVC populations, stratified separately according to median VA score, had different event-free follow-up, which was higher (p = 0.0085) in patientswith lower scores in the AVF population only. The vascular accessmonitoring system improved the vascular accessscore as well as someclinical and dialytic parameters. Green triage in AVF patients identify those with better outcomes, in agreement with the commonly recognized clinical value of a well-functioning vascular access.

Effect of Central Dialysis Fluid Delivery System (CDDS) on IL6 &amp; CRP Levels in Prevalent Haemodialysis Patients

Abstract Background Dialysis is a chronic inflammatory state due to both decreased renal clearance and increased production of procytokines, moreover extracorporeal factors, such as impurities in dialysis water,etc. The central dialysis fluid delivery system (CDDS) is a cost-effective, laborsaving, time-tested system with good microbial safety, which has been used for 45 years in many countries &amp; this study, studies the effect of (CDDS) on IL6 &amp; hs-CRP levels in prevalent hemodialysis patients. Aim of the Work To compare the effect of central dialysis fluid delivery system (CDDS) versus single-patient dialysis fluid delivery system (SPDDS) in purification of water that used in dialysate and its effect on inflammatory markers (hs-CRP &amp; IL-6) levels in prevalent hemodialysis patients. Patients and Methods A Case control study that was conducted on 100 patients of end-stage renal disease on hemodialysis in a university-affiliated hospital. Patients were classified into two groups, each included 50 patients; group (1) receiving regular dialysis by central dialysis fluid delivery system (CDDS), while group (2) receiving regular dialysis by single patient dialysis fluid delivery system (SPDDS) . Patients underwent full clinical assessment including thorough history taking, clinical examination, routine investigation, IL-6 and hsCRP testing to all patients. Results One hundred prevalent hemodialysis patients were included in this study. In this study, the levels of IL-6 and hs-CRP were found to be significantly higher in group 2 (SPDS) as compared to group 1 (CDDS). Conclusion In conclusion, central dialysis fluid delivery system (CDDS) seems to have a better effect on systemic inflammation (IL-6 and hsCRP) as compared with single-patient dialysis fluid delivery system (SPDDS). There is a statistically negative correlation between serum IL-6 and hsCRP levels with dry weight, Hemoglobin level, serum creatinine level &amp; serum albumin level for group (1) (CDDS). However, there is a statistically positive correlation between serum IL-6 and hsCRP levels with Total Leuckocytic Count (TLC), serum ferritin level, serum potassium level, weight gain and duration of dialysis for group (2) (SPDS).

Spike and neutralizing antibodies response to COVID-19 vaccination in haemodialysis patients.

BackgroundHumoral response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines needs to be evaluated in the fragile population of patients on maintenance haemodialysis (HD).MethodsWe analysed the antibody response to the spike (S) antigen of SARS-CoV-2 before and after each dose of the messenger RNA (mRNA) Comirnaty vaccine (BNT162b2; BioNTech & Pfizer) in patients from a single dialysis centre and detected the presence of neutralizing antibodies (Nabs).ResultsAmong the 90 vaccinated HD patients (mean age 69 years, 61% male), 19 (21%) had a history of SARS-CoV-2 infection. A seroconversion with anti-S immunoglobulin G antibodies (Sabs) was documented in 20% of patients after the first dose (early responders) and in 77% after the second dose, while 23% were non-responders. Cardiac disease, cirrhosis and gamma globulin levels were independently predictive of the absence of seroconversion. Nabs were detected in 15.4% of early responders after the first dose and in 84.6% of early responders and 57.9% of late responders after the second dose. Sab titres after the second dose were higher in patients with Nab than without Nab {598 [interquartile range (IQR) 246–882]) versus 134 [IQR 61–390]; P < 0.0001}. All patients with a history of SARS-CoV-2 infection developed both Sabs and Nabs and their titres for Sabs and Nabs were higher than in late responders.ConclusionsMost HD patients develop a substantial humoral response against SARS-CoV2, with Nabs, following the mRNA vaccine. Whether this immunity persists over time and is able to efficiently protect patients from coronavirus disease 2019 remains to be determined.

Comparison of intradialytic blood pressure metrics as predictors of all-cause mortality.

ABSTRACTBackgroundIntradialytic hypotension (IDH) has been reported to be an important prognostic factor in hemodialysis patients. However, a standard definition of IDH has not yet been determined.MethodsWe retrospectively analyzed blood pressure (BP) metrics obtained during serial dialysis sessions over a 90-day period from a single dialysis center from 2016 to 2017. The mean values and the frequency of specific values of BP were analyzed as predictors of 3-year mortality.ResultsA total of 430 patients who underwent maintenance dialysis were included. The mean age was 63.3 ± 12.4 years and 58.6% were male. A low minimum systolic blood pressure (SBP) <110 mmHg during dialysis was significantly associated with increased all-cause mortality. The frequency of a minimum SBP <100 mmHg was the most significant predictor of 3-year mortality, with an area under the curve (AUC) of 0.722. Furthermore, the frequency of a minimum SBP <100 mmHg significantly increased the predictability of mortality when combined with the presence of other clinical factors including age, body mass index and vascular access type (AUC 0.786 vs. 0.835; p = 0.005).ConclusionAmong the various intradialytic BP metrics, the frequency of a minimum SBP <100 mmHg is the most significant factor related to all-cause mortality. The guidelines for the management of blood pressure in dialysis patients should consider including a minimum SBP <100 mmHg as a definition for IDH.