Kidney Disease Stage Research Articles

INDICATORS OF QUALITY OF LIFE OF PATIENTS WITH CHRONIC KIDNEY DISEASE STAGE II-IV

Relevance. Chronic diseases have a long duration and a rather slow progression, and people who have such diseases want not only to live longer but also to live better. Therefore, quality of life (QOL) is one of the most important health issues for the treatment of chronic diseases.
 Objective: to determine the features of QOL in patients with chronic kidney disease (CKD) stage II-IV.
 Materials and methods. In 171 patients with CKD of II-IV centuries, in addition to general clinical and laboratory studies, QOL was studied using a questionnaire to assess the quality of life of SF-36. The questionnaire contains 36 questions of the main module, supplemented by multi-point scales aimed specifically at patients with CKD. The answers were evaluated in points - from 0 to 100. The higher the score, the better the patient's QOL. The total components were also calculated: physical total component, mental total component, total points. The obtained research data were subjected to statistical processing, which included parametric (t-test for samples with unrelated variants) and non-parametric (Mann-Whitney method) methods, correlation analysis was used.
 Results. Most QOL indicators worsen significantly with the progression of CKD. The indicators of total QOL, as well as the indicator "the impact of the disease on everyday life" are most significantly reduced. Age correlates as much as possible with most indicators of QOL in patients with CKD. With age, the QOL of patients decreases, but the manifestations of the disease increase and the mental and physical condition of patients deteriorate. QOL parameters are probably directly and moderately correlated with hemoglobin levels. Most QOL parameters are significantly moderately correlated with systolic blood pressure and diastolic blood pressure. It is assumed that the correction of anemia and blood pressure control, in addition to a positive effect on disease progression and the occurrence and development of complications, will also improve QOL. There were no significant differences in the assessment of QOL in men and women.
 Conclusions. QOL indicators decrease with the progression of CKD. Age, hemoglobin level, blood pressure affect QOL.

PROTON PUMP INHIBITORS AND THE RISK OF CHRONIC KIDNEY DISEASES: A CRITICAL REVIEW

Proton pump inhibitors (PPIs) are most widely used medications for acid related gastrointestinal disorders. Accessible evidence based studies suggest that the increased use of PPI is linked to a greater risk of developing kidney diseases. This review aims to determine the association of kidney disease with the use of proton pump inhibitor with various study designs. PubMed, Scopus and Google Scholar databases as well as a reference list of relevant articles were systematically searched for studies by using the following search terms; ‘proton pump inhibitors’, ‘acute kidney injury’, ‘chronic kidney disease’ and ‘end stage renal disease’. Both observational and randomized controlled trials (RCTs) exploring the association of PPI use with kidney disease were eligible for inclusion. A total of 8 articles, including 9 studies (n = 794,349 participants) were identified and included in the review. Majority of the studies showed a higher risk of kidney outcomes in patients taking PPIs, with effect higher of acute kidney injury (4-to 6-fold) compared with chronic kidney disease and end stage renal disease (1.5-to 2.5-fold). However, the studies suggest that the strength of evidence is weak and could not prove causation. The risk increased considerably with the use of high dose of PPIs and prolonged duration of exposure necessitates the monitoring of renal function. Exercising vigilance in PPI use and cessation of proton pump inhibitor when there is no clear indication may be a reasonable approach to reduce the population burden of kidney diseases.

Yersinia enterocolitica Infection in Patients Undergoing Intermittent Hemodialysis

End-stage renal disease is the last stage of chronic kidney disease and affects more than 2 million patients worldwide. The infection-related hospitalization is an important cause of excess morbidity and mortality in this group of patients. Yersinia enterocolitica (YE) is one of the bacteria that hemodialysis (HD) patients can occasionally be infected with. The most common symptoms are fever and mild diarrhea, which is self-limited. However, in HD patients, especially in iron overloaded cases, severe watery or bloody diarrhea can occur. The consumption of undercooked food by patients should sensitize the physician to the possibility of YE infection. Clinically, YE is difficult to diagnose due to nonspecific symptoms and the relatively low prevalence of yersiniosis, compared to other causative pathogens in dialysis patients. There is little information about yersiniosis in HD patients. For this reason, this review aims to summarize the current knowledge on YE infection in HD patients, with the main objective of expounding the problems in identifying, diagnosing, and treating yersiniosis in HD patients.

Supporting the transition from pre-dialysis to end-stage renal failure

Renal replacement therapy (RRT) is a life-saving therapy for those with chronic kidney disease (CKD) stage 5 or end-stage renal failure (ESRF)—defined as an estimated Glomerular Filtration Rate of less than 15 ml/min/1.73 m2. RRT has a profound impact on quality of life (QoL), dependent on the preparation for and timing of therapy initiation; the mode of RRT selected; and the individual's age, health, and priorities. This article explores the transition to RRT, directed by the research question, ‘How does the evidence base inform clinical decision-making when supporting CKD patients’ transition from pre-dialysis to management of ESRF?'. The discussion of these critical decisions, including timing, modality and potential of dialysis to benefit the individual, is framed by their effect on QoL as dialysis is established. There are many other aspects concerning the transition to RRT, which are not discussed, but the reader is signposted to additional information sources.

Cognitive Status and Risk Factors for Cognitive Impairment in Dialysis Patients

The number of dialysis patients is increasing every year and is estimated to be more than 2 million, with an annual increase of 6–12% in dialysis programs. There is a high correlation between cognitive impairment and mortality in dialysis patients, which suggests the relevance of screening cognitive functions in dialysis patients using different neuropsychological scales.Aim of the study was to test the cognitive status and identify cognitive impairment in patients with terminal stage of chronic kidney disease treated using program hemodialysis, as well as to evaluate risk factors for cognitive impairment in this category of patients.Material and methods. 83 patients aged 28 to 78 years (mean age 56.7±13.7 years) were examined. The main group included 53 people who received program hemodialysis, of them 23 men and 30 women. The mean age of patients in this group was 58.3±13.3 years. The control group composed of 30 individuals without kidney diseases, including 13 men and 17 women. The mean age in the control group was 53.6±14.9 years. The MoCA and SLUMS scales were chosen for detecting cognitive impairment and assessment of neuropsychological status. We used mathematical methods of research data processing such as inductive statistics and correlation analysis.Results. Cognitive impairment was found to be significantly more frequent in dialysis patients (75.5–81.1% of cases, P=0.05) compared to those without kidney pathology. The SLUMS scale was shown to be more sensitive than MoCA (P=0.05, CI 95.0%). The risk factors of cognitive impairment in dialysis patients included increased dialysis duration, age (rs=–0.298) and low estimated urea dialysis adequacy index (Kt/V less than 1.2).Conclusion. A high risk of cognitive impairment is common in dialysis patients. For its timely detection, the screening neuropsychological test are recommended to be used by clinicians. Cognitive impairment, diagnosed by the tests, is an indication for a specialist consultation.

DWI as a biomarker of renal function in children with CKD: what is the potential?

BackgroundEvaluation of renal microstructure is pivotal for diagnosing and monitoring chronic renal disease. DWI has been proved to be practicable and reliable examination for the assessment of renal function and parenchymal damage in some renal diseases. Our aim is to appraise DWI sequence and ADC measurement as a potential tool of renal function assessment as well as establishing a possible relationship between the different CKD stages and the renal parenchymal ADC values changes.ResultsRegarding the cause of CKD, nine patients (45%) had glomerulonephritis, 5 patients (25%) had hemolytic uremic syndrome, 2 patients (10%) had lupus nephritis, 2 patients (10%) had nepheronophthisis, and 1 patient (1.5%) had infantile nepherosis, whereas the cause of CKD was unknown in 1 patient (1.5%).The stages of CKD were classified according to KIDGO guidelines: 6 patients (30%) were stage 1, 4 patients (20%) were stage 2, 3 patients (15%) were stage 3, 2 patients (10%) were stage 4, and 5 patients (25%) were stage 5. The patients’ group (group A) had a mean ADC value (1.85 × 10−3 ± 0.24) which was significantly lower than that of the control group (group B) (2.21 × 10−3 ± 0.12). As for the correlation between stage of CKD and ADC, we found it to be a moderate negative one with r’ value of − .655 and a significant p value of < 0.001.ConclusionDWI is recognized as a promising imaging tool that can take part in the assessment of the morphological and functional changes in diffuse renal parenchymal disease, hence playing an important role in the early diagnosis and staging of chronic kidney disease.

Association of Renal Clearance with Cerebral White Matter Vascular Disease in Hospitalized Veterans With and Without Delirium.

To assess the relation between renal function and delirium and to assess and compare the relation between cerebral white matter lesion (WML) and renal function as estimated by three formulas for the estimated glomerular filtration rate (eGFR) in older adult hospitalized veterans with and without delirium. Commonly used formulas to assess renal function-the four-variable Modification of Diet in Renal Disease (MDRD), the six-variable MDRD, and the Cockcroft-Gault eGFR equations-were used to assess renal function in 100 older adult hospitalized veterans with delirium (delirium group) and 100 hospitalized veterans without delirium (nondelirium group) that were age, sex, and race matched. WML location and volumes were assessed using brain computed tomography imaging for each of the 200 veterans in the study. One radiologist, blinded to the diagnoses of the veterans, examined head computed tomography scans for WML in the cortex, subcortex (frontal, temporal, parietal, occipital lobes), basal ganglia (globus pallidus, caudate, putamen), and internal capsule. WML were graded as not present, <1 cm, 1 to 2 cm, or >2 cm. Exploratory χ2 analyses were used to determine the association between the stage of chronic kidney disease and WML. Simple logistic regression analyses were then used to estimate the strength of association between the stages of kidney disease and WML for particular regions of the brain. The mean age of delirium group and nondelirium group veterans was 66 years. χ2 tests revealed no reliable relation between stages of renal disease and delirium. χ2 exploratory analyses of WML in brain regions by renal disease stages demonstrated significant differences in associations among the MDRD-4, MDRD-6, and Cockcroft-Gault formulas for measuring eGFR. The MDRD-4 formula was least associated with the presence or absence of WML. The Cockcroft-Gault estimation of eGFR was most associated with the presence or absence of WML. Simple logistic regressions showed notable increases in the association between stages of renal failure and WMLs in specific areas of the brain, with the MDRD-4 being the least associative with the fewest specific areas and the Cockcroft-Gault formula being the most associative with the most specific areas. The association between stages 2 through 5 of chronic kidney disease and WLM support the role of kidney function as a potential risk factor for WML in older adult military veterans. The Cockcroft-Gault formula is an important renal index of suspected WML and renal stages 2 through 5, superior to the MDRD-6 and MDRD-4, respectively, in association with WML in older adult military veterans.

Electrophoretic analysis (sds-page) of canine urinary proteins according to the stage of chronic kidney disease

ABSTRACT Glomerular proteinuria is characterized by the loss of high-molecular-weight proteins (HMWPs), while tubulointerstitial proteinuria is characterized by the loss of low-molecular-weight proteins (LMWPs). The objective was to assess the molecular weight of urinary proteins (MWUP) in dogs with naturally acquired CKD and determine the proportion of HMWPs and LMWPs according to CKD stage. Twenty-eight dogs with CKD were recruited and divided into 4 groups based on serum creatinine (Cr) levels (group1: Cr&lt;1,4, n=8; group2: 1,4&lt;Cr&lt;2,0, n=6; group3: 2,1&lt;Cr&lt;5, n=9; group4: Cr&gt;5,0, n=5). The control group consisted of 5 healthy dogs. The MWUP was determined by SDS-PAGE. The urinary protein-to-creatinine ratio (UP/C) was used to quantitatively assess proteinuria. The electrophoresis pattern revealed a proportionally greater loss of HMWPthan of LMWP in all groups with CKD and an increased loss of LMWP in group 4 (P&lt;0.05). These results suggest a predominance of glomerular injuries throughout all stages of CKD in these dogs and an increase in tubulointerstitial injury towards the end-stage of the disease. The results of the present study support the recommendation of SDS-PAGE as an effective technique for the qualitative assessment of proteinuria, as well as a method for assessing the severity and location of renal injury.

Impact of autologous stem cell transplantation on long term renal function and associated progression-free and overall survival in multiple myeloma

The long-term impact of Autologous hematopietic stem cell transplantation (ASCT) on renal function, and the impact of renal function on progression-free survival (PFS) and overall survival (OS) in patients with multiple myeloma are not known. We retrospectively reviewed the records of 885 patients at our institution. We used linear mixed effect models to study the change in estimated glomerular filtration rate (eGFR) and a joint model approach to assess associations between the eGFR, PFS and OS. Sensitivity analyses were conducted at days 0, 100, 180, and 365 post-SCT. eGFR post-ASCT was significantly lower than at day 0 but stabilized at approximately 80 mL/min/1.73 m2. There was no association between eGFR and PFS or OS.; However, relapsed disease and ISS stage were associated with shorter PFS and OS. This data suggests that although there is a modest decline in eGFR post-ASCT, it is not associated with an adverse impact on PFS or OS. KEY POINTS Advanced MM stage at diagnosis was associated with reduced eGFR at all stages of chronic kidney disease. eGFR was not associated with PFS or OS in any of the analyses, but disease-related factors prior to ASCT were all associated with reduced eGFR, PFS and OS. ASCT did not adversely impact kidney function and mitigated the risk of CKD on outcomes in MM.

High-Throughput Vascular Screening by ARTSENS Pen During a Medical Camp for Early-Stage Detection of Chronic Kidney Disease.

Intervention in the early stages of cardiovascular and kidney diseases is proven to be more effective in preventing disease progression. Large artery stiffness measurement can be a potential early predictor of future risks. The purpose of the study reported in this work was to demonstrate the feasibility of our ARTSENS® Pen device as a high-throughput vascular screening tool for risk assessment. The study was performed during a medical camp conducted for awareness and early-stage detection of kidney diseases. Screening procedures included biosample tests and blood pressure measurements. Alongside, various clinically relevant measures of the arterial stiffness were evaluated using the ARTSENS® Pen, by measuring vessel wall dynamics via our proprietary image-free ultrasound algorithms. Stiffness measurement from the left common carotid artery on 85 participants could be completed within 4 hours, employing two units of ARTSENS® Pen; this also includes time taken for all the procedures enlisted in the study protocol. The associations of carotid stiffness indices with age-, gender-, and risk factor-dependent variations were established.

ASSESSMENT OF KIDNEY FUNCTIONAL RESERVE ON THE BACKGROUND OF ANTI-AGGREGATE THERAPY IN CHRONIC KIDNEY DISEASE II-III STAGE

The article presents the results of a study to assess the functional reserve of the kidneys against the background of a comparative study of antiaggregant therapy dipyridamole and allthrombosepin in 50 patients with a relatively early stage of chronic kidney disease. Studies have shown that long-term administration of allthrombosepin to patients has resulted in better maintenance of kidney functional reserves. Therefore, our research has once again confirmed that diphtheridamol, which is widely used as an antiaggregant drug in chronic kidney disease, does not lag behind the domestic raw material allthrombosepin

Problems of quantitative estimation of excretory kidney function based on creatinin

This review presents the possibility of using serum creatinine as an endogenous indicator of the functional state of the kidneys. The results of scientific research are analyzed, which shows the information content of the use of this indicator for assessing glomerular filtration rate (GFR). The features of laboratory methods for determining serum creatinine are considered. Particular attention is paid to information about the errors and variability of measurements of standardized methods obtained in laboratories of different countries. In addition to the physiological reasons that make serum creatinine an imperfect marker for GFR, there are analytical measurement errors, which, in turn, can also distort true results. Since the relationship between serum creatinine and GFR is hyperbolic, analytical errors will affect not only the accuracy of the calculation equations based on it. The introduction of standardization of routine methods for measuring serum creatinine from a reference sample improved the assessment of GFR by reducing the bias of the results of measuring creatinine from its true value. To increase the accuracy and reliability of standardized methods, it is necessary to continue research in this direction. In real clinical practice, all the limitations and assumptions of a specific method of measuring creatinine should be taken into account in order to avoid incorrect interpretation of the results when assessing the functional ability and staging of chronic kidney disease. For prospective observation of a specific patient, the same GFR calculation formula and the same method for measuring serum creatinine should be used.

Neurological Complications and Associated Risk Factors in Children Affected with Chronic Kidney Disease.

To investigate the correlation between chronic kidney disease (CKD) and the development of neurological disease among pediatric patients in Saudi Arabia. The present retrospective study recruited patients admitted to King Abdulaziz University Hospital during 2018. We reviewed electronic records to collect data on essential demographics including age, gender, and nationality; history of prior CNS disease or related symptoms; results of neurological physical examination; and findings of radiological investigations such as abdominal ultrasound, dimercaptosuccinic acid scan, micturating cystourethrogram, diethylene triamine pentaacetic acid scan, brain computed tomography, and magnetic resonance imaging. The most commonly diagnosed renal pathologies were neurogenic bladder and cystic kidney disease. The most common neurological manifestation was seizure disorder. Males were more frequently affected with neurological sequelae than females. The prevalence of neurological disorders was higher in patients over two years old. The most frequently observed stage of chronic kidney disease was stage 5. Most children who were affected with a neurological disorder required hemodialysis as part of their management plan. Patients with chronic kidney disease are at a high risk of neurocognitive defects. The type of management and renal diagnosis are significant factors that should be considered when anticipating central nervous system involvement in the case of chronic kidney disease.

MO044HIGH DIETARY PHOSPHATE INTAKE ENHANCES INTACT FGF23 AND CAUSES ACUTE TUBULAR INJURY WITH SEVERE INFLAMMATION AND FIBROSIS IN UNTREATED MICE

Abstract Background and Aims In early stages of chronic kidney disease (CKD) rising levels of the phosphaturic hormone fibroblast growth factor (FGF) 23 maintain the phosphate homeostasis, whereas in end-stage kidney disease hyperphosphatemia manifests. Both elevated FGF23 and phosphate levels contribute to CKD progression and are associated with an increased mortality in CKD patients. So far, it is unknown whether high inorganic phosphate uptake causes renal injury as well in the absence of CKD. Therefore, we analyzed the effects of a long-term high phosphate diet (HPD) on the renal function in healthy mice. Method We studied the effects of a 2% HPD compared to a 0.8% normal phosphate diet (NPD) fed to healthy male C57BL/6 mice. After six month, blood pressure and metabolic serum and urine parameters were measured. The renal function was characterized by histology, flow cytometry and gene expression analysis. Additionally, we investigate the effects of elevated FGF23 and phosphate on mouse proximal tubular cells (mPT) in vitro. Results Feeding of a HPD for 6 months significantly increased systolic blood pressure (95 vs 79 mmHg; p=0.003), plasma creatinine (0.33±0.01 vs 0.29±0.02 mg/dL; p=0.004), C-term FGF23 (1991±394 vs 309±56 pg/mL; p&amp;lt;0.0001), intact FGF23 (1701±429 vs 191±30 pg/mL; p&amp;lt;0.0001) and urinary phosphate excretion (1732±968 vs 520±123 mg/dL; p=0.0005) compared to NPD controls, whereas serum phosphate (14.3±5.3 vs 13.4±2.9 mg/dL; p=0.68) and parathyroid hormone levels (417±104 vs 544±187 pg/mL; p=0.51) remained unchanged. The HPD caused acute tubular injury in the renal cortex with loss of polarity of proximal tubular epithelial cells and enhanced renal fibrosis and inflammation demonstrated by PAS and Picrosirius red staining. These histological pathologies were associated with a 100-fold increase of KIM-1 and a 7-fold increase of NGAL mRNA expression in the kidneys of HPD mice compared to the NPD group. In HPD mice, flow cytometry analysis showed a reduced storage of Ly6Chi monocytes in the spleen, whereas Ly6Chi monocytes, granulocytes, macrophages, B-cells, and CD4+ T-cells (each p&amp;lt;0.05) were significantly induced in the kidney compared to NPD-fed mice. Histological staining’s displayed an accumulation of B- and T-cells in regions of tubular injury in HPD mice. Furthermore, the HPD significantly enhanced the mRNA expression of the chemotactic markers for monocytes Il34 and Ccl2 and inflammatory cytokines Tnfα and Il1β. Whether enhanced phosphaturia directly or HPD-mediated increase of intact FGF23 cause the renal toxicity is currently investigated in mPTs. Conclusion Chronic high phosphate load induces kidney injury in the proximal tubules with severe inflammation and fibrosis in healthy mice. Our results suggest that a controlled dietary intake of inorganic phosphate is not only important for CKD patients but also for the general population.

P0097IDENTIFICATION OF TWO NOVELS SINGLE NUCLEOTIDE VARIANTS OF THE COMPLEMENT GENES IN A PATIENT WITH THE ASSOCIATION OF PREGNANCY ATYPICAL HEMOLYTIC UREMIC SYNDROME AND C3 GLOMERULOPATHY

Abstract Background and Aims Advances in the past 2 decades have shown atypical hemolytic uremic syndrome (aHUS) to be a disorder of the alternative pathway of complement. Most aHUS cases involve sequence variations in genes encoding complement proteins The term pregnancy associated aHUS (P-aHUS) refer to the thrombotic microangiopathy (TMA) that result from uncontrolled complement activation during pregnancy or the postpartum period. P-aHUS is a devastating systemic disease, with high maternal mortality and morbidity rates, in the pre-eculizumab era. The term ‘C3 glomerulopathy’ (C3GN) encompasses a heterogeneous spectrum of immune-mediated nephropathies that share a common pathological feature, glomerular deposition of C3. This entity may progress to advanced stages of chronic kidney disease and shares a common genetic risk factors with aHUS. Even more, some authors even suggest that C3GN and aHUS represent two forms of a disease spectrum with a common pathogenic principle. Here, we report this rare association and describe the family genetic variants that could cause it Method We describe the clinical and laboratoy data of a patient with the association of aHUS and C3 Glomerulopathy. A genetic study was performed and her available relatives were also screened for mutations/polymorphisms in aHUS-associated complement genes. After extracting gDNA from whole blood (Wizard Genomic DNA Purification Kit, Promega), PCR products of coding sequences and intronic flanking regions of complement genes were sequenced by ABI PRISM 310 Genetic Analyzer (Applied Biosystems). In silico analysis for pathogenicity was completed with Polyphen2-HDIV, PhyloP/Phastcons (MutationTaster), SIFT and PANTHER. All the participants provided informed written consent Results In 3/2012 a 27-year-old patient, with no family history, started his current illness one month after his first natural birth, with acute renal failure and microangiopathic hemolytic anemia, demonstrating a severe TMA in a renal biopsy. Laboratory results showed low C3 serum levels, but C4 were normal, haptoglobine was undetectably low, and all ADAMTS13 parameters were normal. Her urine tests showed also glomerular hematuria and proteinuria in the nephrotic range. She was treated with plasmapheresis and fresh frozen plasma with hematological improvement, but hemodialysis was required for more than 3 months. Despite partial recovery of renal function, six months later reappeared anemia and developed severe arterial hypertension, congestive heart failure and progressive renal insufficiency. Diagnosis of aHUS was made and start treatment with eculizumab with progressive recovery of renal function in the following months. Nevertheless the C3 serum levels persisted low and the proteinuria and hematuria did not change even after long term treatment with eculizumab. Retrospectively, her urynalisis before the pregnant showed proteinuria and hematuria, and a revision of a renal biopsy revealed the presence of dominant C3 deposits in the immunofluorescence, and electrondense deposits in the electronic microscopy, suggesting the diagnostic of C3GN. In a genetic study two novel single nucleotide variants were founded (CFH c.575G&amp;gt;A, p.C192Y (exon 5) (NM_000186), predicted to be pathogenic by 4 of 5 available pathogenicity prediction programs; and CFI c.1189G&amp;gt;T, p.V397L (exon 11) (NM_000204), predicted pathogenic by 0 of 6 available pathogenicity prediction programs). (Figure 1) Conclusion We present here the family genetic bases of a patient who developed a C3GN and a aHUS with a different response to treatment with eculizumab. In this case we identified two novel genetic variants in the CFH and CFI genes in a patient with aHUS, who inherited one variant from each parent. Although the CFI variant is predicted to be benign, the CFH variant is predicted to be damaging. It is located in exon 5, which encodes a portion of the factor H protein implicated in binding to C3b

P1331OPTIMAL PLANNING OF VASCULAR ACCESS IS CALLED FOR IN WOMEN. AVF ARE MORE INTERVENED AND ABANDONED DESPITE LESS CO-MORBIDITY

Abstract Background and Aims Central venous catheter (CVC) increase the risk of infection, central stenosis, hospitalizations, morbidity, mortality and later arterio-venous (AV) access failure. Vascular access planning begins in the predialysis stage of Chronic Kidney Disease (CKD). An optimal timely referral to vascular surgeon is possible since 80 % of patients are known to kidney units before initiating hemodialysis (HD). Despite this, some 71 % (75% women and 68 % men respectively) of incident patients had a CVC as vascular access when starting HD in Sweden during 2017. Some reports have shown increased risk of AVF failure in women which has been contradicted by others. The aim of this study was to determine factors of importance for achieving a functioning fistula for women and men. Method Data from the national Swedish Renal Registry (SRR), that covers the disease progression from CKD phase to renal replacement therapy, was used as well as mandatory national registries. Data was extracted from 2011 to 2017 for, sex, age, primary renal diagnosis, number of CVC, patient phase, co-morbidity, socio-economic factors as well as interventions and complications. A Royston-Palmer model was used for hazard ratio (HR). Cumulative incidence plots were used for fistula patency. P value &amp;lt; .005 was considered significant Results The study included 5040 patients at baseline (33% women). The mean age, the time in dialysis before fistula placement and numbers of CVC did not differ between the sexes. Prevalence of polycystic kidney disease was the only primary diagnosis that differed between the sexes (10.7% among women versus 6.5% among men respectively p&amp;lt;.01). Cancer, hypertension and ischemic heart disease, was more prevalent among men (24.0 vs 19.1 p&amp;lt;.001, 80,9% vs 75.7, p&amp;lt;.001 and 25.3 vs 18.0 p&amp;lt;001). Education level were similar between the sexes whereas more men were married and born in Sweden as compared women (49.3 vs 41.6 p&amp;lt;.001 and 78.9 vs 73.0 p&amp;lt;.001). Age, diabetes and peripheral arterial disease increased the risk for reinterventions by 6% and 28% and 36% (HR 1.06 [1.03,1.15], 1.28[1.18,1.40], and 1.36[1.19,1.56] respectively. The risk for reintervention and abandonment was higher for women (HR 1.19 [95% CI: 1,09,1,56, and 1.42[1,26,1.60)]. Figure 1. shows cumulative incidence for primary patency in lower arm fistula for men and women. Incidence of secondary patency abandonment is higher for women with lower and upper arm AVF while no differences between men and women were observed for AV grafts. Conclusion When receiving the first fistulas, men present a higher co-morbidity as compared to women while age and time of dialysis with a CVC is similar between the sexes. Only 42% will receive an AVF in CKD phase with detriment for men. The consequence of placement in CKD phase could matter and needs to be further analysed. AVF confers a higher risk for reintervention and abandonment, particularly among women which may explain the higher use of CVC. This higher risk must be taken into account when planning for vascular access and follow up.

P1107CENTRALIZED CONTROL OF HEMODIALYSIS PROCEDURES AND CORRECTION OF CKD COMPLICATIONS WITH BI TOOLS

Abstract Background and Aims Life expectancy of patients with terminal stage of chronic kidney disease depends on the quality of dialysis therapy and timely and adequate correction of dialysis complications. The goal of this work is to improve the treatment quality for dialysis patients in a setting of multi-facility hospital by employing of Business intelligence (BI) tools for centralized control of diagnostic and treatment process. Method We have created a system for centralized control of patients’ condition, using Microsoft Power BI platform. This system allows to analyze the process of hemodialysis procedure as well as treatment of hypertension, anemia and mineral bone disorder. The system generates various reports that may include parameters of a specific patient, single clinic, or multi-facility hospital for the period from arbitrary date to the day, previous to the report generation date. The effect of system usage was assessed on 288 patients from 30 hemodialysis facilities of “Nefrosovet” private organization, for the period of 6 month. Results Before deployment of the system, target value of Kt/V (1.4) was reached or exceeded in 49% of hemodialysis procedures, median duration of hemodialysis procedure was 227±18 minutes (mean total duration per week - 683 minutes). As the result of usage of centralized control and prescription correction system, target values of Kt/V was reached or exceeded in 65% of hemodialysis procedures, median duration of hemodialysis procedure increased to 238±11 minutes (mean total duration per week - 714 minutes). Before the start of the study, hypotensive episodes were registered in 34% of hemodialysis procedures, and hypertensive episodes were registered in 22% of hemodialysis procedures. As the result of centralized control of hemodialysis procedures, number of procedures with hypotensive episodes reduced to 28%, and number of procedures with hypertensive episodes reduced to 17%. Number of patients with blood hemoglobin value in target range of 100-120 g/l, increased from 1617 patients (56%) to 2051 patients (71%). Number of patients with blood ferritin value in target range of values, increased from 1013 patients (35%) to 1386 patients (48%). Number of patients with TSAT value in target range of values, increased from 873 patients (30%) to 1097 patients (38%). We have also noticed an increase in number of patients with target values of calcium and phosphorus metabolism parameters: calcium corrected for albumin – from 1992 (69%) to 2165 (75%) patients, phosphorus – from 693 (24%) to 982 (34%) patients, intact parathyroid hormone (iPTH) – from 635 (22%) to 837 (29%) patients. Conclusion The usage of BI based centralized patients’ condition control system allows to improve adequacy of dialysis therapy and quality of CKD complications correction in dialysis patients.

Комплексная оценка минерально-костных нарушений у женщин с оксалатной нефропатией в постменопаузе

A study was made of phosphorus-calcium metabolism, markers of bone metabolism, bone mineral density in 142 women in the early postmenopausal period, the patients with oxalate nephropathy at stage 2 of chronic kidney disease. It is proved that patients have signs of secondary hyperparathyroidism (hypocalcemia, hypercalciuria, increased parathyroid hormone) and a deficiency of 25 (OH) D3. Violation of bone metabolism is confirmed by a high level of β-Cross Laps and a decrease in bone mineral density. The probability of a 10-year risk of developing osteoporetic fractures in patients using the FRAX calculator is two times higher than in the control group. The conclusion was made that patients with oxalate nephropathy have a high risk of developing osteoporosis already in the early stages of chronic kidney disease.

P0673INVERSE ASSOCIATION OF TRANSFERRIN SATURATION WITH MORTALITY RISK IN CHRONIC KIDNEY DISEASE

Abstract Background and Aims Transferrin saturation (TSAT) is an indicator of iron deficiency or overload, but its relationship with mortality in patients with different stages of chronic kidney disease (CKD) is unclear. We investigated the association of TSAT with mortality in CKD patients. Method In 479 CKD patients (97 CKD3-4 patients, 298 CKD5 non-dialysis patients and 84 peritoneal dialysis patients; median age 58 years, 67% males, 33% cardiovascular disease, CVD, and 29% diabetes), biomarkers of iron status (plasma iron, TSAT, transferrin and ferritin), systemic inflammation (high sensitivity C-reactive protein, hsCRP, and interleukin-6, IL-6) and nutritional status were assessed. During median follow-up of 35.6 months, 139 (29%) patients died, and 176 (37%) patients underwent renal transplantation. Patients were stratified into low (n=157) and high (n=322) TSAT tertile groups. All-cause and CVD mortality risk were analyzed with competing risk regression with renal transplantation as competing risk. Results TSAT [median 23% (IQR 17-30%)] was negatively associated with presence of DM and CVD, body mass index, hsCRP, IL-6, Framingham´s CVD risk score (FRS), erythropoietin resistance index (ERI) and iron supplementation, and positively associated with hemoglobin, ferritin and s-albumin. In competing risk analysis, low tertile of TSAT was independently associated with increased all-cause mortality risk (sHR=1.50, 95%CI 1.05-2.14) after adjusting for CKD stages, 1-SD of FRS, 1-SD of hemoglobin, 1-SD of hsCRP, 1-SD of ESA dose and iron supplementation (Figure 1). Conclusion TSAT was inversely associated with mortality risk in CKD patients. When evaluating clinical outcomes of CKD patients, iron status using TSAT as a predictive marker, should be considered.

P1290RISK FACTORS FOR PROGRESSION OF CORONARY ARTERY CALCIFICATION OVER 5 YEARS IN HEMODIALYSIS PATIENTS

Abstract Background Although progression of coronary artery calcification (CAC) has been established as an important marker for cardiovascular morbidity, very few studies have studied it in end-stage renal disease patients. Thus we examined and evaluate risk factors of calcification changes in dialysis patients. Method Among 28 hemodialysis (HD) patients, CAC was measured in Agatston units at baseline and after five years using the 64 multi-slice ultra-fast CT. The HD patients were classified as progressors or no progressors according to the change in the CAC score across these 2 measurements. Results Over an average 63 months follow-up, participants without CAC at baseline had no incident CAC .The progression of CAC was slow and was found only in 6 patients (21.4%) . It was significantly associated with several cardiovascular risk factors, namely, older age (p=0.03), diabetes (p=0.05), male sex (p=0.02), hypercholesterolemia (p = 0.05), anemia (p=0.017), inflammation (p=0.05), and hyperphosphataemia (p=0.012) . However, calcemia, parathormone levels, dialysis duration, tobacco, high blood pressure and dialysis dose did not seem to influence the progression of CAC in our series. A strong association was found between basal calcification scores and Delta increment at 5 years. Conclusions Our study suggests that CAC progression in dialysis is a complex phenomenon, associated with several risk factors with special regard to elevated basal scores. This progression can be avoided or slowed with appropriate management which must begin in the early stages of chronic kidney disease