Dialysis Time Research Articles

The Effect of Using Fluid Balance Application on Interdialytic Weight Gain in Stage V Chronic Kidney Disease Patients Undergoing Hemodialysis

Chronic Kidney Disease (CKD) grade V is a condition that requires the patient to undergo hemodialysis for the rest of his life. Often hypervolemia occurs between two times of dialysis. Hypervolemia can lead to emergency conditions such as pulmonary edema and cardiac arrest. Interdialytic Weight Gain (IDWG) is an indicator of fluid intake during the interdialytic period. Calculating fluid balance per 24 hours helps patients with CKD grade V in controlling fluid intake. The purpose of this study was to identify the effect of using a fluid balance application on IDWG status in grade V CKD patients undergoing hemodialysis. This study used a quasi experiment, with one group pre and posttest design. 24 respondents were selected by consecutive sampling technique. Statistical analysis using a paired t-test showed that there was an effect of using a fluid balance application on IDWG status in grade V CKD patients undergoing hemodialysis (p value = 0.000). The application of fluid balance can be applied to patients with CKD grade V because it is effective in controlling hypervolemia

Etiological diagnostic value of metagenomic next-generation sequencing in peritoneal dialysis-related peritonitis

Objective: To explore the etiological diagnostic value of metagenomic next-generation sequencing (mNGS) in peritoneal dialysis (PD)-related peritonitis. Methods: The study was a retrospective cohort study. The clinical data of patients with PD-related peritonitis who were treated and underwent microbial cultivation and mNGS test at the same time from June 2020 to July 2021 in the Affiliated Drum Tower Hospital, Medical School of Nanjing University were analyzed. The positive rate, detection time and consistency between mNGS test and traditional microbial culture were compared. Results: A total of 18 patients with age of (50.4±15.4) years old and median dialysis time of 34.0 (12.4, 62.0) months were enrolled in the study, including 11 males and 7 females. Pathogenic microorganisms were isolated in 17 patients by mNGS test, with a positive rate of 17/18, which was higher than 13/18 of microbial culture, but the difference was not statistically significant (P=0.219). Both mNGS test and microbial culture isolated positive pathogenic bacteria in 12 patients, and mNGS test isolated the same types of pathogenic bacteria as microbial cultivation did in 11 patients. In five patients with negative microbial culture, mNGS test also isolated pathogenic microorganisms, including 3 cases of Staphylococcus epidermidis, 1 case of Mycobacterium tuberculosis and 1 case of Ureaplasma urealyticum. In 1 patient, microbial culture isolated pathogenic bacteria (Escherichia coli) whereas mNGS test did not. The detection time of mNGS was 25.0 (24.0, 27.0) h, which was significantly shorter than 89.0 (72.8, 122.0) h of microbial culture (Z=3.726, P<0.001). Conclusions: mNGS test can improve the detection rate of pathogenic microorganisms in PD-related peritonitis and greatly shorten the detection time, and has good consistency with microbial culture. mNGS may provide a new approach for pathogen identification of PD-related peritonitis, especially refractory peritonitis.

Assessing Tissue Hydration Dynamics Based on Water/Fat Separated MRI.

Optimal fluid status is an important issue in hemodialysis. Clinical evaluation of volume status and different diagnostic tools are used to determine hydration status in these patients. However, there is still no accurate method for this assessment. To propose and evaluate relative lean water signal (LWSrel ) as a water-fat MRI-based tissue hydration measurement. Prospective. A total of 16 healthy subjects (56 ± 6 years, 0 male) and 11 dialysis patients (60.3 ± 12.3 years, 9 male; dialysis time per week 15 ± 3.5 hours, dialysis duration 31.4 ± 27.9 months). A 3 T; 3D spoiled gradient echo. LWSrel , a measurement of the water concentration of tissue, was estimated from fat-referenced MR images. Segmentations of total adipose tissue as well as thigh and calf muscles were used to measure LWSrel and tissue volumes. LWSrel was compared between healthy subjects and dialysis patients, the latter before and after dialysis. Bioimpedance-based body composition monitor over hydration (BCM OH) was also measured. T-tests were used to compare differences between the healthy subjects and dialysis patients, as well as changes between before and after dialysis. Pearson correlation was calculated between MRI and non-MRI biomarkers. A P value <0.05 was considered statistically significant. The LWSrel in adipose tissue was significantly higher in the dialysis cohort compared with the healthy cohort (246.8% ± 60.0% vs. 100.0% ± 10.8%) and decreased significantly after dialysis (246.8 ± 60.0% vs. 233.8 ± 63.4%). Thigh and calf muscle volumes also significantly decreased by 3.78% ± 1.73% and 2.02% ± 2.50% after dialysis. There was a significant correlation between changes in adipose tissue LWSrel and ultrafiltration volume (r=87), as well as with BCM OH (r=0.66). MRI-based LWSrel and tissue volume measurements are sensitive to tissue hydration changes occurring during dialysis. 2. Stage 3.

PS-BPR03-4: STAGED RESECTION OF SUSPECTED BILATERAL PHAEOCHROMOCYTOMA IN A PATIENT WITH END-STAGE KIDNEY DISEASE ON HAEMODIALYSIS

Objective: Phaeochromocytoma is a rare finding in the dialysis population. The usual complexities of its management are complicated by diagnostic considerations of anuria and catecholamine variability in relation to dialysis, as well as reduced margins of error in perioperative fluid balance. To date, available case reports detailing management of phaeochromocytoma in dialysis patients have described unilateral lesions. We describe the management of a haemodialysis patient with resistant hypertension secondary to suspected bilateral phaeochromocytoma, to undergo staged surgical resection. We report on the surgical outcomes of the initial staged resection as well as the effect of dialysis timing (pre- and post-dialysis) on laboratory plasma metanephrine measurements. Design and Methods: Case Report A 73-year-old male on home haemodialysis presents with resistant hypertension. He has a background of end-stage kidney disease (ESKD) secondary to hypertensive nephrosclerosis, vascular disease, and Type 2 diabetes mellitus. CT imaging performed for back pain incidentally revealed contrast-enhancing lesions in the left and right adrenal glands, measuring 5.5 cm and 1.4 cm respectively (Figure 1A). PET-CT demonstrated FDG-avid lesions in bilateral adrenal glands with marked activity on PET Gallium Dotatate study, consistent with neuroendocrine tumours (Figure 1B). In the context of resistant hypertension, these were favoured to represent phaeochromocytomas. Plasma normetanephrine levels were consistent with this diagnosis at 6,600pmol/L (Ref &lt; 1,079pmol/L). Blood pressure was not adequately controlled with the original anti-hypertensive regimen (irbesartan, lercanidipine, atenolol, and prazosin), with systolic values of 170–210mmHg, and was altered in the work-up for surgical resection of the lesions. Maximum alpha-receptor blockade was achieved with high-dose phenoxybenzamine (300 mg/day), and a beta-blocker (propranolol) and calcium-channel blocker (nifedipine) were added to attain pre-operative systolic blood pressures of 140–160mmHg with expected postural falls. Preoperative fluid status was adjusted via haemodialysis ultrafiltration, balancing the risks of intraoperative hypotension with anaesthetic considerations of potential pulmonary oedema. Results: The patient underwent laparoscopic resection with initial removal of the left adrenal lesion (Figure 1C), confirmed on histopathology to be phaeochromocytoma (Figure 1D). Blood pressures intraoperatively were maintained with minimal vasopressor support, and postoperatively with no support, consistent with expected outcomes in a staged resection of suspected bilateral phaeochromocytomas. A right adrenalectomy is planned in two months. Conclusion: This is the first reported case of suspected bilateral phaeochromocytoma in an ESKD patient on haemodialysis, and highlights the associated complexities of diagnosis and management. We demonstrate staged resection of bilateral lesions can be a safe approach in this high-risk population.

Identifying the Factors Affecting the Survival Rate of Kidney Transplant Patients in Isfahan Using Classification Techniques

Purpose: 10% of the world's population suffers from chronic kidney disease and millions of deaths occur annually due to lack of access to appropriate treatment in the world. Kidney transplantation is associated with several problems. These problems, including kidney rejection, the consequences of surgery, drug poisoning, and infectious diseases can reduce the chances of survival of these patients. The science of classification has been proposed in recent years to reduce medical errors due to inexperience, reduce the workload of physicians and provide a suitable model for making better decisions.&#x0D; Materials and Methods: The data set includes information about patients for whom kidney transplantation was performed in Isfahan. The data set includes 2554 patients and 38 attributes. The techniques used in this study will include random forest, Principal Component Analysis (PCA), and Support Vector Machine (SVM).&#x0D; Results: Among the studied techniques, PCA technique in three classes out of four classes had better performance than other techniques. The syndrome has the highest recurrence among traits. Five attributes include syndrome, blood type, dialysis time, weight, and age.&#x0D; Conclusion: The results showed that the PCA method in the case of non-numerical data has a good performance in identifying attributes. Also, five attributes that affect the survival rate of kidney transplant patients were identified.

Role of surface hydrophilicity on MR relaxivity of PEG coated- gadolinium oxide nanoparticles

The magnetic resonance (MR) contrast enhancement capabilities of gadolinium oxide nanoparticles (GONPs) have high dependency on its surface chemistry- as the solution properties such as colloidal stability and hydrodynamic diameter of nanoparticles which are prime regulatory parameter for MR relaxivity, are all governed by grafting density of surface material. However, the purification of synthesized surface coated nanoparticles, without compromising the surface properties, remains a major challenge. Among the various cleaning methods, dialysis is often used to remove the unwanted by-products produced during synthesis. However, the effect of dialysis time may significantly impact the surface properties and hence, the MR contrast properties of such nano-formulations. The aim of the present study is to evaluate the effect of dialysis time on surface chemistry and MR contrast enhancement properties of GONPs by comparing the proton relaxivity data. Ultra-small polyethylene glycol (PEG)-coated GONPs with an average particle diameter of 17 nm were synthesized using polyol method. The impact of dialysis time has been investigated systematically on the size distribution, hydrophilicity, magnetic properties, polymer grafting density and relaxometric properties of the as synthesized GONPs. A significant impact of dialysis time was observed on surface chemistry and hence, on the MR relaxivity of synthesized NPs. We evidenced a dramatic decrease in the proton relaxivities of GONPs with increase in dialysis time, which correlated well with the observed decrease in the grafting density of surface polymer. The results clearly indicate that the proton relaxivity of GONPs of similar size and same coating material depends on the surface coating thickness and hydrophilicity of the coating polymer. Overall, it is essential to optimize the accurate time duration of dialysis treatment as the prolonged dialysis may have negative effect on the relaxation times and hence on MR contrast enhancement properties of GONPs. This study is a strategic pathway to fine-tune the dialysis treatment of as-synthesized surface-capped GONPs for pre-eminent MR contrast imaging.

Comparison of hospitalization cause and risk factors between patients undergoing hemodialysis and peritoneal dialysis

This retrospective study was designed to compare the cause of hospitalization and influencing factors between patients undergoing hemodialysis (HD) and peritoneal dialysis (PD). Baseline data and laboratory parameters of 192 dialysis patients (92 HD patients and 100 PD patients) were compared. Quantitative parameters with normal distribution were assessed using independent t-test or analysis of variance (ANOVA). Quantitative parameters with non-normal distribution were assessed by non-parametric test. Qualitative data were statistically compared using χ2 test. The number of patients with urban employee medical insurance (88 HD patients and 60 PD patients) and rural cooperative medical care (12 HD patients and 40 PD patients) significantly differed (P < .01). The hospitalization rate of PD patients was significantly higher than that of HD counterparts. The average length of hospital stay of PD patients was 10 days, remarkably longer than 8 days of HD patients (P < .01). The primary cause of hospitalization for HD patients was infection-related complications, followed by cardiovascular, cerebrovascular complications and dialysis access disorders. The primary cause of hospitalization for PD patients was infection-related complications, followed by dialysis access disorders, cardiovascular, and gastrointestinal complications. Compared with the HD group, the levels of hemoglobin, serum albumin, alkaline phosphatase, intact parathyroid hormone were significantly decreased, whereas serum urea nitrogen, serum creatinine, phosphorus levels and cardiothoracic ratio were remarkably increased in the PD group (all P < .01). The hospitalization rate of PD patients is relatively higher, and the length of hospital stay is longer. Extensive attention and efforts should be delivered to enhance the understanding of disease and lower the risk of complications for patients.

Effect of remote patient monitoring for patients with chronic kidney disease who perform dialysis at home: a systematic review

ObjectiveThe purpose of the systematic review was to assess the effectiveness of remote patient monitoring (RPM) follow-up compared with standard care, for patients with chronic kidney disease (CKD) who perform...

Timing of dialysis in acute kidney injury using routinely collected data and dynamic treatment regimes

Background and objectivesDefining the optimal moment to start renal replacement therapy (RRT) in acute kidney injury (AKI) remains challenging. Multiple randomized controlled trials (RCTs) addressed this question whilst using absolute criteria such as pH or serum potassium. However, there is a need for identification of the most optimal cut-offs of these criteria. We conducted a causal analysis on routinely collected data (RCD) to compare the impact of different pre-specified dynamic treatment regimes (DTRs) for RRT initiation based on time-updated levels of potassium, pH, and urinary output on 30-day ICU mortality.Design, setting, participants, and measurementsPatients in the ICU of Ghent University Hospital were included at the time they met KDIGO-AKI-stage ≥ 2. We applied inverse-probability-of-censoring-weighted Aalen–Johansen estimators to evaluate 30-day survival under 81 DTRs prescribing RRT initiation under different thresholds of potassium, pH, or persisting oliguria.ResultsOut of 13,403 eligible patients (60.8 ± 16.8 years, SOFA 7.0 ± 4.1), 5622 (63.4 ± 15.3 years, SOFA 8.2 ± 4.2) met KDIGO-AKI-stage ≥ 2. The DTR that delayed RRT until potassium ≥ 7 mmol/l, persisting oliguria for 24–36 h, and/or pH < 7.0 (non-oliguric) or < 7.2 (oliguric) despite maximal conservative treatment resulted in a reduced 30-day ICU mortality (from 12.7% [95% CI 11.9–13.6%] under current standard of care to 10.5% [95% CI 9.5–11.7%]; risk difference 2.2% [95% CI 1.3–3.8%]) with no increase in patients starting RRT (from 471 [95% CI 430–511] to 475 [95% CI 342–572]). The fivefold cross-validation benchmark for the optimal DTR resulted in 30-day ICU mortality of 10.7%.ConclusionsOur causal analysis of RCD to compare RRT initiation at different thresholds of refractory low pH, high potassium, and persisting oliguria identified a DTR that resulted in a decrease in 30-day ICU mortality without increase in number of RRTs. Our results suggest that the current criteria to start RRT as implemented in most RCTs may be suboptimal. However, as our analysis is hypothesis generating, this optimal DTR should ideally be validated in a multicentric RCT.

Application of evidence based practice: Interdialytic weight gain (IDWG) management intervention in hemodialysis patients at Arifin Hospital, Riau

The physical problem that is often experienced by hemodialysis (HD) patients and is difficult to overcome is the problem of excess fluid. This can be seen from the patient's weight gain between dialysis times or called interdialytic weight gain (IDWG). A high IDWG is associated with a higher risk of cardiovascular causes of death and increased morbidity. The application of evidence based practice in the form of IDWG management interventions has been proven to be able to overcome excessive weight gain between the two HD or IDWG times. The purpose of this community service is to increase the knowledge and skills of HD patients regarding evidence based practice in the form of IDWG management interventions. The method of implementing community service activities is in the form of training packaged with HD patients on IDWG management with lectures, questions and answers, and demonstrations. The resulting impact is an increase in the knowledge and skills of HD patients regarding IDWG management with a standard percentage of IDWG weight gain of 22% and IDWG weight loss &gt;3.5% of 14% after implementing IDWG management. In addition, the patient has been able to apply techniques to overcome thirst and xerosemia. Nurses and the patient's family must take part in providing support for patient compliance in implementing IDWG management so that patients can avoid complications from excess fluid problems which can ultimately improve the patient's quality of life.

PH-responsive in situ gelling properties of thiolated citrus high-methoxyl pectin and its potential gel mechanism

pH-responsive in situ gelling properties of thiolated citrus high-methoxyl pectin (TCHMP) were investigated in this study. The gelation capacity results revealed that the in situ gelation behavior of TCHMP only occurred when the pH value was higher than 6.25. The gel strength increased from 26.63 g to 42.77 g as the pH value increased from 7.4 to 8.9. Rheological measurements confirmed that the apparent viscosity and viscoelasticity of TCHMP were highly dependent on pH value and dialysis time. Compared with the control group, the apparent viscosity of TCHMP dialyzed in phosphate-buffered saline (PBS) of pH 8.9 for 180 min increased 695-fold. During the dialysis process of TCHMP at different pH values (7.4–8.9), the final thiol groups content decreased and the final disulfide bonds content increased with the increase in pH value. This illustrates that the mechanism of in situ gelation is mainly the oxidation of thiol-thiol groups to form disulfide bonds. These results can put forward new insights into the pH-responsive in situ gelling properties of TCHMP and provide a theoretical basis for the application of TCHMP in neutral and alkaline gel systems.

Oncological Screening of Kidney Tumors After Renal Transplantation

Among renal transplant recipients, renal cell carcinoma in the native kidneys represents the most common solid tumor. At the Department of Surgery, Transplantation and Gastroenterology of Semmelweis University annual control abdominal ultrasound examination is recommended for transplant patients. Our goal was to evaluate the effectiveness of the ultrasound screening program at our institute and to learn about the characteristics of shrunken kidney tumors. Retrospectively, we processed the results of abdominal and pelvic ultrasound examinations of 1687 kidney transplant patients, which were performed at our institute between January 1, 2012 and December 31, 2016. A total of 26 tumors were detected during the abovementioned period of time, of which 18 were renal cancers. Renal cancer was significantly (P=0.029) more common in men. Seventeen renal cancers were classified as stage I and one as stage IV disease. The mean time of dialysis was 37.73 ± 24.37 months. The mean time between kidney transplantation and tumor recognition was 7.9 ± 6.29 years. The 5-year survival was 66%; however, it should be noted that only 1 patient lost his life due to his tumor disease. The mean time between the last 2 ultrasound examinations was 27.8 ± 23.89 months. Only 57% of tumors were detected by screening. No significant differences in tumor size, stage, and survival could be detected between screened and nonscreened renal cancer patients. Ultrasound examination at least every 2 years is an effective tool for the early detection of renal cell carcinoma of the shrunken kidneys.

Comparison of presepsin and procalcitonin for prognosis of infectious complication of acute necrotizing pancreatitis

Among renal transplant recipients, renal cell carcinoma in the native kidneys represents the most common solid tumor. At the Department of Surgery, Transplantation and Gastroenterology of Semmelweis University annual control abdominal ultrasound examination is recommended for transplant patients. Our goal was to evaluate the effectiveness of the ultrasound screening program at our institute and to learn about the characteristics of shrunken kidney tumors.Retrospectively, we processed the results of abdominal and pelvic ultrasound examinations of 1687 kidney transplant patients, which were performed at our institute between January 1, 2012 and December 31, 2016.A total of 26 tumors were detected during the abovementioned period of time, of which 18 were renal cancers. Renal cancer was significantly (P = 0.029) more common in men. Seventeen renal cancers were classified as stage I and one as stage IV disease. The mean time of dialysis was 37.73 ± 24.37 months. The mean time between kidney transplantation and tumor recognition was 7.9 ± 6.29 years. The 5-year survival was 66%; however, it should be noted that only 1 patient lost his life due to his tumor disease. The mean time between the last 2 ultrasound examinations was 27.8 ± 23.89 months. Only 57% of tumors were detected by screening. No significant differences in tumor size, stage, and survival could be detected between screened and nonscreened renal cancer patients.Ultrasound examination at least every 2 years is an effective tool for the early detection of renal cell carcinoma of the shrunken kidneys.

Application of regional citrate anticoagulation in patients at high risk of bleeding during intermittent hemodialysis: a prospective multicenter randomized controlled trial

Safe and effective anticoagulation is essential for hemodialysis patients who are at high risk of bleeding. The purpose of this trial is to evaluate the effectiveness and safety of two-stage regional citrate anticoagulation (RCA) combined with sequential anticoagulation and standard calcium-containing dialysate in intermittent hemodialysis (IHD) treatment. Patients at high risk of bleeding who underwent IHD from September 2019 to May 2021 were prospectively enrolled in 13 blood purification centers of nephrology departments, and were randomly divided into RCA group and saline flushing group. In the RCA group, 0.04 g/mL sodium citrate was infused from the start of the dialysis line during blood draining and at the venous expansion chamber. The sodium citrate was stopped after 3 h of dialysis, which was changed to sequential dialysis without anticoagulant. The hazard ratios for coagulation were according to baseline. A total of 159 patients and 208 sessions were enrolled, including RCA group (80 patients, 110 sessions) and saline flushing group (79 patients, 98 sessions). The incidence of severe coagulation events of extracorporeal circulation in the RCA group was significantly lower than that in the saline flushing group (3.64% vs. 20.41%, P<0.001). The survival time of the filter pipeline in the RCA group was significantly longer than that in the saline flushing group ((238.34±9.33) min vs. (221.73±34.10) min, P<0.001). The urea clearance index (Kt/V) in the RCA group was similar to that in the saline flushing group with no statistically significant difference (1.12±0.34 vs. 1.08±0.34, P=0.41). Compared with saline flushing, the two-stage RCA combined with a sequential anticoagulation strategy significantly reduced extracorporeal circulation clotting events and prolonged the dialysis time without serious adverse events.

Community Houses to Increase Access to Home Dialysis.

Community Houses to Increase Access to Home Dialysis.

An update review on hemodynamic instability in renal replacement therapy patients.

Hemodynamic instability in patients undergoing kidney replacement therapy (KRT) is one of the most common and essential factors influencing mortality, morbidity, and the quality of life in this patient population. Decreased cardiac preload, reduced systemic vascular resistance, redistribution of fluids, fluid overload, inflammatory factors, and changes in plasma osmolality have all been implicated in the pathophysiology of hemodynamic instability associated with KRT. A cascade of these detrimental mechanisms may ultimately cause intra-dialytic hypotension, reduced tissue perfusion, and impaired kidney rehabilitation. Multiple parameters, including dialysate composition, temperature, posture during dialysis sessions, physical activity, fluid administrations, dialysis timing, and specific pharmacologic agents, have been studied as possible management modalities. Nevertheless, a clear consensus is not reached. This review includes a thorough investigation of the literature on hemodynamic instability in KRT patients, providing insight on interventions that may potentially minimize factors leading to hemodynamic instability.

Elevated Serum Procalcitonin Levels in Chronic Kidney Diseases Patients Undergoing Renal Therapy

Introduction: Inflammation is an established mortality risk factor in chronic kidney disease patients and particularly in patients on dialysis. Objectives: The main objective of the study is to find the role of procalcitonin in chronic kidney diseases patients undergoing renal therapy. Material and methods: This cross sectional study was conducted Holy Family Hospital, Rawalpindi during November 2021 to June 2022. The data was collected with the permission of ethical committee of hospital. Baseline characteristics of patients were collected, including age, gender, BMI, history of diseases and time of dialysis. Results: The data was collected from 200 patients. There were 88 (44.0%) male and 112 (57.0%) female patients. The mean age for male was 45.9 ± 11.7 years and for female 49.8 ± 14.1 years. The PCT level in CKD patients (0.45 ± 0.70 ng/mL) was significantly higher as compared to reference value of healthy control subjects. Significance increase in the value of BUN, Na, K, CRP and BUN is also observed in CKD patients. Practical implication: PCT must be measured in CKD patients especially for dialysis patients. Conclusion: It is concluded that PCT levels were significantly high in CKD patients, thus PCT is a valuable marker for early diagnosis of CKD or patients undergoing HD. Keywords: CKD, PCT, CRP, Inflammation, Dialysis, Diagnosis

Predictor of Mortality in Patients Undergoing Urgent Versus Planned Dialysis. A Study from DHQ Hospital, Faisalabad

Objective: Outcomes for urgent versus planned dialysis patients vary according to the literature. The current study aims to study the clinical outcomes of patients undergoing urgent dialysis compared to planned dialysis in a single center at the nephrology department of the DHQ hospital in Faisalabad. Methodology: In this analysis we selected sixty patients who meet the inclusion criteria from September 2019 to September 2021 and further divided the selected patients into two groups. The urgent dialysis group (Group UD) and the Planned dialysis group (Group PD) according to the pre-defined criteria. Each group had the equal number of age and sexed match patients (thirty patients each group). The follow up period after the initiation of dialysis was six months. The co morbid conditions, laboratory parameters and deaths in six months follow up period was noted in both groups. Results: The mean age in Group UD was 57.5 years and in Group PD was 62.5 years. The male in Group UD was 21 as compared to group PD consisted of 19 males (p=0.17). The most common cause of urgent renal dialysis was found to be volume overload (52%). The UD group did not have the history of proper nephrologist consultation and zero percent of participant had AV fistula at the time of first dialysis. During the follow-up period, there was significantly higher death rate in Group UD as compared to the Group PD (43.3% versus 26.6%, p= 0.003). The urgent initiation group had considerably lower levels of albumin, hemoglobin, and hematocrit but significantly greater levels of phosphorus and C-reactive protein. Multivariable logistic regression analysis found urgent dialysis initiation to be an independent risk factor for survival (HR 2.96; 95% CL 1.48–4.64; P = 0.01). Similarly, the older age, lower albumin, elevated levels of CRP and absences of vascular access were also found the significant predictor of mortality. Conclusion: Based on the results of our study we can conclude the urgent initial of dialysis may be the independent risk factor for one year mortality along with older age, higher CRP, and lower albumin levels. we also noted that the lack of nephology care and volume overload was the main reason of urgent dialysis. Keywords: Urgent Dialysis, mortality, Risk factors, hemodialysis, end stage renal disease.

Evaluation of complications in urgent start peritoneal dialysis: Single-center experience.

Patients who were urgent start peritoneal dialysis (USPD) were evaluated in terms of complications. The data from 102 patients (43 males and 59 females, mean age 58.18± 15.3 years) who were on peritoneal dialysis with a placed catheter between January 2014 and June 2019 in our Nephrology clinic was evaluated. The patients were divided into three groups according to the starting time of peritoneal dialysis. The development of complications between the groups (peritonitis, leakage, hernia), hemodialysis return time and overall survival times were compared. There was no difference between the groups in terms of survival and complications. Diabetes, advanced age, albumin values were found to be risk factors for mortality, while no differences were found between the groups in terms of complications and mortality. USPD can be recommended for both because it provides a permanent dialysis option and because it leads to fewer complications than urgent start HD.

331.3: Characteristics, Demographics and Outcomes of Kidney Transplant Recipients With Extreme Dialysis Vintage &gt; 10 Years. A National UNOS Database Review 2000-2021

Introduction: Prolonged dialysis times (DT) have been associated with inferior outcomes. Nevertheless, rarely suitable candidates with extreme dialysis vintage are transplanted. We aimed to review the characteristics, demographics and outcomes of such patients. Methods: We used United Network for Organ Sharing registry data to assess outcomes for patients who were on dialytic therapy for a minimum of 10 years, who received a kidney alone transplant from Jan 1 2000 – Dec 31 2021. Pediatrics, multi-organ transplants and those without a confirmed dialysis start date were excluded. Results: During the study period, a total of 361,029 kidney alone transplants were performed, of which 70.3% were patients who were on dialysis at the time of transplant. Out of the 253,841 dialysis patients, transplanted, 962 (0.37%) patients met our criteria. The majority of transplants (78.7%) in these 962 cases were performed after Dec, 2014 when the new KAS allocation which credits waitlist time from chronic dialysis initiation was implemented. There was no difference in graft survival for race, gender, but DM and DGF were independant predictors of inferior survival (p<0.05). Conclusions: The present study is the first to look at the granular details of this unique group of patients who receive a transplant after a minimum of 10 years of dialysis. Although outcomes may be somewhat inferior to standard outcomes of patients with shorter dialysis times, carefully selected candidates can still have reasonable successful outcomes. - Recipient Characteristics Mean Age at Time of Transplant (yrs) 49.9+/-10.5 (18-75) Race (AA/Whites/Hispanics) (%) 41.9/ 21.1/ 24.7 Gender (M/F) (%) 53.5/ 38.5 Re-Transplants (%) 38.5 Deceased Donor/ Living Donor Transplants (%) 97.3/ 2.7 Etiology of ESRD (DM/HTN/Other) (%) 24.8/ 20.7/ 54.5 CPRA (0-20, 20-80, 80-97, 98-100) (%) 31.8/ 19.6/ 12.7/ 35.9 Zero Mismatch (%) 5.7 PVD (%) 5.2 MedianDialysis Time (yrs) 12.4 (10-32) Dialysis Time (10-15yrs/ 15-20yrs/ > 20 yrs) (%) 76.7/ 16.4/ 6.8 Donor Characteristics Mean Donor Age (yrs) 36.4 +/-13.9 (1-69) Donor Race (Whites/AA/Hispanics) (%) 52/ 18.6/ 22.6 Donor Gender (M/F) (%) 61.9/ 38.1 DCD (%) 16.4 ECD (%) 6.3 KDPI Median 38 KDPI > 85 (%) 1.8 Donor HTN/ DM (%) 21.5/ 4.3 Median Cold Ischemia Time (hrs) 16 Kidneys Pumped (%) 34.5 Donor PHS Increased Risk (%) 15 Transplant Outcomes DGF (%) 34.7 Acute Rejection within 1 year (%) 9.8 Mean Length of Stay (days) 7.7+/- 9.1 Patient Death within 30 days n (%) 8 (0.8) Graft Failure Within 30 days n (%) 25 (2.5) Graft Survival (%) 1yr/ 3yr/ 5yr/ 10 yr 92/ 80/ 70/ 41 Patient Survival (%) 1yr/ 3yr/ 5yr/ 10yr 96/ 88/ 80/ 50