Type Of Dialysis Research Articles

Is chronic kidney disease predictive of coronary artery bypass grafting after acute coronary syndrome? A systematic review and meta-analysis

Abstract Background Coronary artery bypass grafting (CABG) provides superior long-term outcomes to percutaneous coronary intervention (PCI) for multi-vessel coronary artery disease. People with chronic kidney disease (CKD) are at increased risk of multi-vessel coronary artery disease, and experience greater morbidity and mortality following acute coronary syndrome (ACS). Purpose To determine whether CKD affects choice of revascularisation strategy after ACS. Methods We searched EMBASE, MEDLINE, SCOPUS, CENTRAL and the NIHR’s website of funded studies to identify articles referring to ACS and invasive coronary management in high-income countries over the past 12 years until 29th September 2023. Full text articles were included if data on rates of CABG were reported in people with and without CKD who were revascularised following ACS. CKD was defined as one or more recording of an estimated glomerular filtration rate (eGFR) <60mls/min/1.73m2, however proxies for this were accepted. Risk of bias was assessed via ROBINS-E. Random effect meta-analyses estimated the odds ratios for CKD and CABG, stratified by ACS type and receipt of dialysis. Certainty of evidence was assessed according to GRADE. Results Initial searches generated 15,138 articles, of which 13 observational studies were included in this review (8,021,743 participants). Amongst people revascularised following ACS, those with CKD were more likely to receive CABG than those without kidney disease (OR for the average exposure effect 1.47 (95% CI 1.30-1.66)). The likelihood of CABG in people with CKD receiving dialysis and those with CKD not receiving dialysis were similar as the 95% confidence intervals demonstrate (ORs 1.25 (95% CI 1.00-1.57) and 1.41 (1.19-1.67) respectively). The effect of CKD on increased likelihood of CABG appeared greater following ST-elevation myocardial infarction (STEMI) than non-ST elevation ACS (NSTE-ACS) (OR 1.53 (95% CI 1.27-1.83) versus 1.10 (0.98-1.25) respectively, p=0.003). Certainty of the evidence was low for receipt of CABG in people with CKD not receiving dialysis, and moderate for all other outcomes. Conclusion In high-income countries, CKD is associated with increased receipt of CABG amongst people revascularised following ACS. This finding is likely explained by the greater prevalence of multi-vessel coronary artery disease in this population. It is however unclear why the association between CKD and receipt of CABG is stronger in those with STEMI compared to NSTE-ACS, and whether this accurately reflects differential need between the two groups.Figure 1Figure 2

Long-term outcomes in rapamycin on renal allograft function: a 30-year follow-up from a single-center experience

ObjectivesTo evaluate long-term renal graft prognosis and the role of rapamycin from a single-center in China over a 30-year follow-up.MethodsThis study enrolled a total of 654 patients who underwent kidney transplantation between 1989 and 2020. The basic characteristics of the included patients were collected. Graft survival was described and compared using Kaplan-Meier curves (K-M curves). Both continuous and categorical variables were included in a multivariate Cox proportional-hazards model. Patients were divided into rapamycin-based quadruple immunosuppression regimen group (rapa group, n = 41) and conventional tacrolimus-based triple immunosuppression regimen group (control group, n = 218). The indication biopsy results of the two groups were further reviewed to compare the incidence of rejection, acute rejection, and banff score.ResultsThe overall 5, 10, 15, 20-year graft survival rate of our center is 87.5%, 62.4%, 46.4% and 20.9%, respectively. The median survival time after surgery is 14 years. Multiple Cox regression analysis identified BMI (p = 0.035), dialysis type (p < 0.001), immunosuppressants (p < 0.01), urine albumen (p < 0.001), globulin (p = 0.041), and blood glucose (p = 0.002) as risk factors. The 20-year, 10-year and 5-year AUC is 0.78, 0.75 and 0.75. The combination of FK506 and rapamycin was further suggested by the model to effectively improve the graft prognosis (p < 0.01, HR = 0.763). The K-M curve showed that the long-term survival rate of renal grafts in the rapa group was significantly better than that in the conventional group (p < 0.001). In addition, indication biopsy records revealed a lower possibility of immune rejection in the rapa group than that in the conventional group (p < 0.001). Banff score indicated that rapa group had less vascular inflammation in the transplanted kidney.ConclusionsIn this study, a 30-year follow-up was performed in a single center, and a total graft 20-year survival rate of 20.9% was reported. The prognostic model and subgroup analysis suggested that FK506 combined with rapamycin could effectively improve the prognosis of renal transplantation, which could be explained by reduced acute rejection and less vascular inflammation.

A Study to Analyse the Relation between Consanguineous Marriage and Type of Dialysis in Chronic Kidney Disease Subjects

A Study to Analyse the Relation between Consanguineous Marriage and Type of Dialysis in Chronic Kidney Disease Subjects

Super high-flux dialyzers improve survival in patients on hemodialysis: a cohort study of the Japanese Society for Dialysis Therapy (JSDT) Renal Data Registry

BackgroundIn Japan dialyzers are classified as type I, II, III, IV, or V on the basis of the β2-microglobulin clearance. In 2023, Type V dialyzers were defined as super high-flux membrane dialyzers. Herein, we investigate the association between dialyzer type and mortality.MethodsA cohort study was conducted using the Japanese Society for Dialysis Therapy Renal Data Registry database from 31 December 2017, to 31 December 2019. We enrolled 181,879 patients on hemodialysis who were divided into type I–V groups per the Japanese classification. We assessed the associations of each group with 2-year all-cause mortality using Cox proportional hazard models. Furthermore, propensity score matching analysis was performed.ResultsBy the end of 2019, 34,196 patients (18.8%) had died. The hazard ratio (95% confidence interval) was significantly higher in the type I (1.25 [1.12–1.39]), type II (1.21 [1.13–1.31]), and type III (1.07 [1.02–1.13]) groups and significantly lower in the type V group (0.86 [0.80–0.92] P < 0.0001) than in the IV group as a reference after adjusting for all confounders. The type V group had a significantly lower adjusted mortality risk regardless of Kt/V and was robust in several sensitivity analyses. Furthermore, the findings remained significant after propensity score matching.ConclusionsThis observational study revealed that hemodialysis performed using super high-flux dialyzers may reduce mortality rates regardless of Kt/V. However, to establish the efficacy of super high-flux dialyzers in improving outcomes, randomized controlled trials should be conducted.Trial registration number: UMIN000018641.

Predicting graft and patient outcomes following kidney transplantation using interpretable machine learning models

The decision to accept a deceased donor organ offer for transplant, or wait for something potentially better in the future, can be challenging. Clinical decision support tools predicting transplant outcomes are lacking. This project uses interpretable methods to predict both graft failure and patient death using data from previously accepted kidney transplant offers. Using more than 25 years of transplant outcome data, we train and compare several survival analysis models in single risk settings. In addition, we use post hoc interpretability techniques to clinically validate these models. Neural networks show comparable performance to the Cox proportional hazard model, with concordance of 0.63 and 0.79 for prediction of graft failure and patient death, respectively. Donor and recipient ages, the number of mismatches at DR locus, dialysis type, and primary renal disease appear to be important features for transplant outcome prediction. Owing to their good predictive performance and the clinical relevance of their post hoc interpretation, neural networks represent a promising core component in the construction of future decision support systems for transplant offering.

Numerical and experimental investigation of solute transports through different types of dialyzer membrane

The flow and mass transport through different membrane types from different hemodialyzers are investigated in a co-current direction to emphasize the effect of solute diffusion through the dialyzer membranes. The numerical model consists of the blood flowing in a hollow fiber surrounded by a dialysate flow, where the mass transport and fluid flow were simultaneously calculated. The high flux dialyzers considered in the present study are FINEFLUX FIX-210S eco, ELISIO-210HR, and PEPA FDY-21B, which differ mainly in characteristics of the membrane structure and surface. Urea and maltodextrin solutions are used as model solutes to consider the effect of molecular size difference. The numerically predicted outlet concentrations closely align with experimental values, where the variation between predicted and measured values remain below 10% across all dialyzer types for urea solutions, and specifically below 8% for maltodextrin solution. Among the various dialyzers tested, FINEFLUX membrane could provide the highest maltodextrin clearance (83.09 ml/min) and overall mass transfer area coefficient (KoA) (119.56 ml/min) potentially due to its fast-diffusion characteristic. In this co-current flow study, the results suggest that urea transport is primarily influenced by flow control with minimal impact from boundary layers, while maltodextrin transport is predominantly governed by diffusion control.

Effect of Chronic Kidney Disease on All-Cause Mortality After Hip Fracture Surgery: A Retrospective Cohort Study.

In this retrospective cohort study, we investigated: (1) The impact of comorbid chronic kidney disease (CKD) on postoperative mortality in patients with a hip fracture; (2) mortality variations by dialysis type, potentially indicating CKD stage; (3) the efficacy of different hip fracture surgical methods in reducing mortality for patients with CKD. This study included 25,760 patients from the Korean National Health Insurance Service-Senior cohort (2002-2019) who underwent hip fracture surgery. Participants were categorized as CKD and Non-CKD. Mortality rate was determined using a generalized linear model with a Poisson distribution. The effect size was presented as a hazard ratio (HR) through a Cox proportional-hazard model. During follow-up, we ascertained that 978 patients (3.8%) had CKD preoperatively. Compared to the Non-CKD group, the mortality risk (HR) in the CKD group was 2.17 times higher (95% confidence interval [CI], 1.99-2.37). In sensitivity analysis, the mortality risk of in patients who received peritoneal dialysis and hemodialysis was 6.21 (95% CI, 3.90-9.87) and 3.62 times (95% CI, 3.11-4.20) higher than that of patients who received conservative care. Mortality risk varied by surgical method: hip hemiarthroplasty (HR, 2.11; 95% CI, 1.86-2.40), open reduction and internal fixation (HR, 2.21; 95% CI, 1.94-2.51), total hip replacement (HR, 2.27; 95% CI, 1.60-3.24), and closed reduction and percutaneous fixation (HR, 3.08; 95% CI, 1.88-5.06). Older patients with CKD undergoing hip fracture surgery had elevated mortality risk, necessitating comprehensive pre- and postoperative assessments and management.

PMMA dialyzers modulate both humoral and cell-mediate immune response to anti-COVID-19 vaccine (BNT162b2) in a cohort of chronic hemodialyzed patients

Patients on hemodialysis (HD) have a high risk of death from COVID-19. We evaluated the humoral and cell-mediated immune response to BNT162b2 (Pfizer-BioNTech) vaccine in HD patients, comparing HD with Poly-methyl-methacrylate (PMMA) and HD with Polysulphone (PS). Samples were collected before vaccination (T0) and 14-days after the 2ndvaccine (T2) in a TG (TG, n = 16-Foggia) and in a VG (CG, n = 36-Novara). Anti-SARS-CoV-2-Ig were titrated in the cohort 2-weeks after the 2nddose of vaccine. In the Testing-Group, serum neutralizing antibodies (NAb) were assayed and PBMCs isolated from patients were thawed, counted and stimulated with SARS-CoV-2 IGRA stimulation tube set. All patients had a positive ab-response, except in a case. PMMA-patients had higher levels of anti-SARS-CoV-2 IgG (p = 0.031); VG data confirmed these findings (p < 0.05). NAb evaluation: PMMA patients passed the positive cut-off value, while in PS group only only 1/8 patient did not respond. PMMA patients showed higher percentages of anti-SARS-CoV-2 S1/RBD-Ig after a complete vaccine schedule (p = 0.028). Interferon-gamma release: PMMA patients showed significantly higher release of IFNγ (p = 0.014). The full vaccination course provided sufficient protection against SARS-CoV-2 across the entire cohort, regardless of dialyzer type. After vaccination, PMMA patients show a better immune response, both humoral and cellular, at the end of the vaccination course than PS patients.

#332 Dermatological manifestations in pediatric CKD patients

Abstract Background and Aims Chronic kidney disease (CKD), regardless of its cause, may be accompanied by various skin lesions. The most common symptom in children suffering from CKD is pruritus however other signs that may be seen are xerosis, skin hyperpigmentation, ecchymoses, acquired perforating dermatoses, nail lesions, calcinosis cutis, as well as eczematous lesions at the site of an arteriovenous fistula and skin infections. Data on different skin lesions in children with CKD is very limited; only few reports have been published discussing xerosis in pediatric patients and most studies were conducted on a small number of patients who needed renal replacement therapy . This study aimed primarily to screen the different dermatological manifestations in pediatric patients with CKD, in addition to studying the relationship of dermatological manifestations with the CKD stage, types of dialysis, various clinical and metabolic parameters. Method This was a cross sectional study, that was conducted at Pediatric Dialysis and Nephrology unit, Children's Hospital, Faculty of Medicine, Ain Shams University Hospital, Cairo, Egypt, during the period from February 2023 to August 2023, where 70 patients were enrolled in our study being divided into two groups: group 1 including CKD patients stages (2-4) and group 2 including CKD patients with stage 5 on regular hemodialysis. Detailed dermatological &amp; nail examination were conducted. Xerosis severity was assessed using a four-point xerosis assessment scale (0, normal skin, without any xerosis; 1, mild xerosis; 2, moderately dry skin with minimal flaking; 3, severe xerosis, heavy scaling visible), whereas pruritus was assessed using a visual analogue scale (VAS) on a scale of 1 (no itch) to 10 (worst possible itch). Laboratory data were withdrawn at the time of examination to correlate with different dermatological manifestation. Results In our study, xerosis was the most frequent dermatological manifestation (78.6%) following it pruritus (62.9%) then pallor (35.7%), hyperpigmentation (20%), hypertrichosis (10 %), nail and hair abnormalities (8.5%) &amp; post inflammatory hyperpigmentation (4.3%). The prevalence of xerosis was not affected by clinico-demographic data, CKD duration &amp; stage, type and duration of dialysis, the only significant relation was between efficacy of dialysis (Kt/V) and incidence of xerosis, where the higher dialysis efficacy rates were associated with low incidence rates of xerosis, in which effective hemodialysis contributes to better removal of uremic toxins, &amp; hence decrease the xerosis. Leukocytosis was noticed in xerotic &amp; pruritic patients, where xerosis &amp; impaired skin barrier in children with CKD pose a risk for different cutaneous infections &amp; inflammation, and hence pruritis. Conclusion Xerosis and pruritis are not uncommon dermatological manifestations among pediatric patients with chronic kidney disease, meanwhile the age of the patients and the underlying CKD etiology had no direct effect on skin changes. The most determinant factory affecting the xerosis was the hemodialysis efficacy, where higher efficacy was associated with less xerosis, meanwhile leukocytosis was associated with higher xerosis and pruritis. Further studies are needed to detect various skin manifestations in CKD patients with different CKD stages and correlate it with the used dialysis modalities.

#1351 Assessment of safety and efficacy of expanded hemodialysis in comparison to HDF

Abstract Background and Aims In end-stage kidney disease, solutes with a wide spectrum of molecular weight, called uremic toxins, are retained due to impaired kidney cleansing capacity. Particularly, the retention of toxins in the middle molecular weight range 15–45 kDa might negatively affects multiple organ systems and metabolic pathways. The removal of such large uraemic toxins is still a challenge. HDF has produced some results although large convective volume, optimal vascular access to increase the blood flow rate and strict water quality management are required. Medium Cut-Off, high Retention Onset membrane have been recently developed introducing the concept therapy called “expanded haemodialysis” (HDx). Furthermore, vitamin E-coated membrane has potential beneficial effects on inflammation and oxidative stress. Method A prospective longitudinal single-center study was conducted for 3 months among 18 chronic haemodialysis patients. Patients were randomly assigned into either HDF with high flux membrane or HDx with Theranova or ViE-X membrane. The primary goal was to assess albumin loss among the three types of dialyzers. Secondary goals included assessment of depurative efficacy for uraemic toxins and clinical outcomes. Throughout the treatment, a proportional part of the dialysis fluid was collected to quantify albumin loss. Blood samples were taken before and after dialysis session in order to calculate the Removal Ratio and at two different intradialytic timepoints from arterial and venous line of the circuit in order to calculate instantaneous clearance. Results Mean albumin loss was significantly higher in patients undergoing HDx with Theranova membrane (ANOVA, p&amp;lt;0.001) without any difference in serum albumin concentration among the three groups. Instantaneous clearance of small and middle molecules was significantly higher in patients undergoing HDF, but we didn't find differences in removal ratio. Reduction of Erythropoietin resistance index was observed in patients treated with ViE-X membrane but it was related to their lower dialysis vintage. Conclusion HDx with Theranova membrane was associated with higher albumin loss without any effect on pre-dialysis serum albumin. Moreover, patients treated Theranova membrane, in the presence lower Qb, lower convective dose and lower instantaneous clearance reached same dialysis efficacy compared to HDF.

#704 Albumin, inflammation and nutrition in hemodialisis patients in Colombia: a cohort study

Abstract Background and Aims Hypoalbuminemia is a well-identified risk factor for mortality in chronic hemodialysis patients. As a negative acute phase reactant, albumin levels could be associated with several factors that affect the patient on hemodialysis (HD), such as alterations in the rate of hepatic synthesis, an increase in the rate of catabolism, or an increase in losses due to the dialysis process. The objective of the present study is to analyze serum albumin values in repeated measurements over time in two cohorts, one with expanded HD (HDx) enabled by the medium cut-off membrane (MCO) Theranova and the other with high flux (HF) HD and estimate the relationship with other relevant variables. Method Cohort study, one with HDx enabled by Theranova® and the other with HF HD, adult prevalent HD patients (&amp;gt; 90 days) at Baxter Renal Care Services Colombia starting between September 1, 2017, and November 30, 2017, with follow-up for up to 48 months. Sociodemographic and clinical characteristics were summarized descriptively, and a mixed linear model with repeated measures was performed to evaluate the association between dialysis membrane and albumin levels, controlling for confounding variables. Results We evaluated 1092 patients (62% male): 533 in HF-HD vs. 559 in HDx (Table 1); the median age was 61 years, 42% had a history of diabetes, and 19% had cardiovascular disease. We found no differences in albumin levels over time when comparing Theranova versus HF HD patients, p-value = 0.789 (see Fig. 1). No association between serum albumin levels and the Theranova dialyzer was found with the linear mixed model with repeated measures when controlling for confounding variables, p-value= 0.198. On the other hand, we found that serum albumin was associated with inflammatory and nutritional variables such as C reactive protein, Ratio platelets/lymphocytes, and Protein Energy Wasting (PEW) (Table 2). Conclusion Variables including nutritional status and inflammation, age, and hospitalization events are associated with serum albumin levels varying over time. Variation in serum albumin levels over time are not associated with type of dialyzer (Theranova® vs HF).

#1080 Low-T3 syndrome: “endemic” in hemodialysis patients?

Abstract Background and Aims In hemodialysis patients, low-T3 syndrome is more prevalent than in the general population and was found to be associated with malnutrition and inflammation. Although evidence suggest that low free T3 (fT3) levels predict cardiovascular and all-cause mortality, low-T3 syndrome is usually not treated. The aim of this single-center retrospective observational study was to determine the prevalence of thyroid axis derangements and examine the relationship between thyroid hormones and biochemical and clinical variables in our hemodialysis (HD) patients cohort. Method Patients on thrice-weekly maintenance HD for at least 6 months were enrolled. Patients taking amiodarone, levothyroxine or methimazole were excluded. Data about age, sex, ethnicity, hemodialysis vintage, type of dialysis (bicarbonate dialysis/online hemodiafiltration/acetate-free-biofiltration/hemofiltration with endogenous reinfusion/expanded hemodialysis) were obtained from medical records and values of fT3, fT4, TSH, albumin, LDL, hemoglobin—routinely checked for every patient during hemodialysis sessions—were acquired. Continuous variables are expressed as median and IQR or mean ± SD and categorical variables as absolute value or percentage. The normality of data distribution was tested by Sapiro-Wilk test. Correlations were studied with Pearson and Spearman. T-test and Mann-Whitney U test were performed to compare continuous and categorical variables. Statistical significance was reached with p &amp;lt; 0.05. Results A total of 57 patients on thrice-weekly maintenance HD were enrolled. Most of them were male (70.2%), Caucasians (89.5%), with a mean age of 69 ± 14 years and with a median dialytic vintage of 63 [29; 113] months. Hypertension was the most frequent comorbidity and more than half of the patients was either affected by ischemic, hypertensive or dilatative cardiomyopathy. Most of the patients underwent bicarbonate hemodialysis (42.1%) and overall 57.9% of the study population was treated by convective techniques. Hemoglobin, albumin, LDL cholesterol, fT3 and fT4 values was normally distributed, while those of TSH and PCR were not. A very high prevalence of low-T3 syndrome (75%) was found, 5 patients showed subclinical hypothyroidism and only in a minority of patients thyroid function tests were normal (12%) (Fig. 1). A significant negative correlation between fT3 and age (p = 0.041) and a positive one between TSH and dialytic vintage (p = 0.017) were found (Table 1). In addition, a significant positive correlation between albumin and fT3 was detected, supporting the known association between low T3 and malnutrition. Interestingly, PCR negatively correlated with fT3 and positively with fT4. Patients treated by diffusive techniques showed no statistically significant difference of thyroid hormone levels compared to convective therapies (Table 1). Conclusion Low-T3 syndrome affects the great majority of patients in our hemodialysis population, with a prevalence even higher than that provided by literature. Our investigations confirm that older patients seem to show lower fT3 levels and a longer hemodialysis vintage may correlate with higher TSH levels. The association with inflammation was also confirmed. Considering the known impact on cardiovascular and all-cause mortality already demonstrated, it is important to routinely check thyroid hormones in HD. In addition, further studies should be performed in order to establish the possible impact of the therapeutic correction of this hormonal derangement on hemodialysis patients’ mortality and cardiovascular outcomes.

#2771 Peritoneal dialysis after kidney graft loss … and now, what?

Abstract Background and Aims The evolution of peritoneal dialysis (PD) as renal replacement therapy (RRT) after graft loss is not well defined. Method Retrospective analysis of the Andalusian Renal Registry of patients who received their first kidney transplant (KT) in Andalusia (Spain) and returned to dialysis between 1978-2023. Patients who lost follow-up and those who underwent preemptive re-KT were excluded of the study. We compared clinical characteristics and evolution between those who started hemodialysis (HD) and peritoneal dialysis (PD) after graft loss. Secondly, we analyzed technique and patient survival in those who started PD post-KT versus patients on PD as their first renal replacement therapy (RRT) We performed multivariate analysis for PD technique and patient survival risk factors using Cox regression. Results During this period, we followed 11868 KT recipients in Andalusia. Of these, 3148 (26.52%) lost the graft: 2768 started HD and 298 PD. 82 patients underwent preemptive re-KT. Patients who returned to DP were younger (p &amp;lt; 0.001) and glomerulonephritis as cause of chronic kidney disease (CKD) was more frequent (p = 0.019). The pre-KT RRT was HD in 96.3% of patients starting HD post-KT and PD in 48.3% of patients who returned to PD after KT (p &amp;lt; 0.001). Survival of patients in the HD group was lower than those who started PD (p = 0.026). In the multivariate analysis, older age when dialysis restarted, male sex and diabetes were risk factors for patient death and not the type of dialysis. When comparing only the post-KT PD group (n = 298) versus patients on PD as their first RRT (n = 5312), patients on the first group were younger (57.1 vs. 41.9; p &amp;lt; 0.001) and time on PD was longer (24.4 vs. 19 months; p &amp;lt; 0.001). The causes of PD drop-out also varied between groups (p &amp;lt; 0.001). During this period, 269 post-KT PD patients left the technique mainly due to re-KT (34.3%) and in the PD group as the first RRT, there were 4919 technique drop-outs, mainly due to transfer to HD (35.3%) and death (30%). The percentage of peritonitis was higher in the post-KT PD group, although without significant differences (post-KT PD 27.9% vs. PD as first RRT 23.25%; p = 0.061). Survival of the DP technique in post-KT PD group was 78.2% at 1 year and 38.5% at 5 years, and 77.7% and 42.1% respectively in the DP group as the first DP RRT (p = 0.059). In the multivariate analysis, patient age and diabetes as a cause of CKD, behaved as risk factors for patient survival. Conclusion Almost half of the patients starting PD after KT had been on PD prior to transplantation. They tend to have more peritonitis although survival of the technique and complications were very similar to those observed in patients on PD as first RRT.

#2567 Protein-bound uremic toxins are better removed with short-daily Home Haemodialysis using low dialysate flow rate: randomized clinical trial results

Abstract Background and Aims Short daily home hemodialysis (HDD) with low dialysate flow rate has been shown in recent years as an attractive alternative for portable dialysis home use. Although the effectiveness of the technique for volume control and elimination of small solutes and middle molecules has been demonstrated, data are scarce for the elimination of protein-bound uremic toxins. The aim of this study was to compare the reduction ratios (RRs) of p-cresol sulfate (pCS) and indoxyl sulfate (IS) in the Physidia HHD system with high-volume online-hemodiafiltration (OL-HDF) treatment. Methods In an open, randomized, cross-over, single-center, controlled study, 40 adult chronic HD patients were treated with a 2.5 h-length HD session with low dialysate flow rate with the Physidia HDD system, and a 4 h-length OL-HDF session in post-dilution mode during two successive weeks. During the sessions, pre-HD and post-HD plasma samples were collected and single and weekly RRs of pC and IS were intraindividually compared for the two dialysis types with linear mixed models. Results Whereas single-session RRs of p-CS and IS were similar in both groups, weekly RRs of both protein-bound uremic toxins were significantly higher with the short-daily HDD Physida system than those obtained with OL-HDF (Table 1). Conclusion The short-daily home hemodialysis using low dialysate flow rate with the Physidia system appears to be a potential technologic step ahead in terms of improved protein-bound uremic toxins removal for dialysis patients, and might contribute to a more adequate dialysis therapy than in-center high-volume online-hemodiafiltration (OL-HDF) treatment.

#2106 Higher daily protein intake can reduce the risk of infections in kidney transplant recipients during the early post-transplant period

Abstract Background and Aims Kidney transplantation (KT) is considered the most effective treatment for end-stage renal disease (ESRD), and it significantly contributes to enhancing the quality of life and extending the survival of patients with ESRD. After kidney transplantation, the early and heavy use of immunosuppressants and glucocorticoids can affect the recipients' immune status to varying degrees, increasing the risk of postoperative infections caused by a wide range of pathogens. Thus, the prevention and management of infectious diseases are major factors contributing to improved outcomes in kidney transplantation. Protein-energy wasting (PEW) is commonly observed in uremic patients, and it may persist even after they have undergone kidney transplantation (KT). And PEW is a significant factor in the progression of chronic kidney disease (CKD). Providing appropriate dietary guidance and intervention is essential for enhancing the immune status of recipients, promoting a positive nitrogen balance in the body, minimizing infections, and safeguarding graft function. This study aimed to investigate the relationship between daily protein intake (DPI) and postoperative infections at 3 months post-transplant, which may establish a foundation for the early postoperative protein intake regimen, reducing the incidence of postoperative infections, and improving the early prognosis of kidney transplantation. Method This is a retrospective observational study. 176 kidney transplant recipients (KTRs) who underwent kidney transplant in West China Hospital from December 2021 to June 2022 were included and followed up regularly. 24-hour urine urea data were collected at months 1 and 3 post-transplant to calculate their DPI. These KTRs were further divided into two groups according to the recommended DPI for KTRs by the 2021 Practice Guidelines for the Nutritional Management of Chronic Kidney Disease, namely high intake group (Group 1, with DPI ≥ 1.4 g/kg·d, n = 66) and low intake group (Group 2, with DPI &amp;lt; 1.4 g/kg·d, n = 110). Occurrence of hospitalization and postoperative infections within 3 months were recorded. Multiple logistic regression was utilized to analyze the association between DPI and early postoperative infections at 3 months post-transplant. Results Mean DPI levels at month 1 post-transplant were 1.58 ± 0.22 g/kg·d in Group 1 and 1.02 ± 0.31 g/kg·d in Group 2, respectively (P &amp;lt; 0.05), this huge difference in DPI between the two groups continued to month 3. There was no significant difference in age, gender, pre-transplant body mass index (BMI), dialysis type and time, donor type, or the ratio of delayed graft function (DGF) between the two groups. There was a statistically significant difference in the percentage of hospitalization between the two groups during the postoperative period of 3 months (P = 0.027). Pneumonia was the most common reason of hospitalization after transplantation, followed by urinary tract infection. The results of multiple logistic regression analysis showed that higher DPI in the early post-transplant period was a protective factor for infection after kidney transplantation. Conclusion In the early post-transplant period, consuming higher levels of dietary protein may reduce the risk of infections and complications, and help preserve the function of the transplanted kidney.

#2736 Higher daily protein intake can reduce the risk of infections in kidney transplant recipients during the early post-transplant period

Abstract Background and Aims Kidney transplantation (KT) is considered the most effective treatment for end-stage renal disease (ESRD), and it significantly contributes to enhancing the quality of life and extending the survival of patients with ESRD. After kidney transplantation, the early and heavy use of immunosuppressants and glucocorticoids can affect the recipients' immune status to varying degrees, increasing the risk of postoperative infections caused by a wide range of pathogens. Thus, the prevention and management of infectious diseases are major factors contributing to improved outcomes in kidney transplantation. Protein-energy wasting (PEW) is commonly observed in uremic patients, and it may persist even after they have undergone kidney transplantation (KT). And PEW is a significant factor in the progression of chronic kidney disease (CKD). Providing appropriate dietary guidance and intervention is essential for enhancing the immune status of recipients, promoting a positive nitrogen balance in the body, minimizing infections, and safeguarding graft function. This study aimed to investigate the relationship between daily protein intake (DPI) and postoperative infections at 3 months post-transplant, which may establish a foundation for the early postoperative protein intake regimen, reducing the incidence of postoperative infections, and improving the early prognosis of kidney transplantation. Method This is a retrospective observational study. 176 kidney transplant recipients (KTRs) who underwent kidney transplant in West China Hospital from December 2021 to June 2022 were included and followed up regularly. 24-hour urine urea data were collected at month 3 post-transplant to calculate their DPI. These KTRs were further divided into two groups according to the recommended DPI for KTRs by the 2021 Practice Guidelines for the Nutritional Management of Chronic Kidney Disease, namely high intake group (Group 1, with DPI ≥ 1.4 g/kg·d, n = 66) and low intake group (Group 2, with DPI &amp;lt; 1.4 g/kg·d, n = 110). Occurrence of postoperative infections events within 3 months were recorded. Multiple logistic regression was utilized to analyze the association between DPI and early postoperative infections at 3 months post-transplant. Results Mean DPI levels at month 3 post-transplant were 1.75 ± 0.56 g/kg·d in Group 1 and 0.98 ± 0.24 g/kg·d in Group 2, respectively. There was no significant difference in age, gender, pre-transplant body mass index (BMI), dialysis type and time, donor type, or the ratio of delayed graft function (DGF) between the two groups. There was a statistically significant difference in the percentage of hospitalization for infections between the two groups during the postoperative period of 3 months (P = 0.027). Pneumonia was the most common reason of rehospitalization after transplantation, followed by urinary tract infection. The results of multiple logistic regression analysis showed that higher DPI in the early post-transplant period was a protective factor for infection after kidney transplantation. Conclusion In the early post-transplant period, consuming higher levels of dietary protein can reduce the risk of infections and complications, and help preserve the function of the transplanted kidney.

#3069 The effects of characteristics associated with dialysis on cognitive functions in patients with chronic kidney disease

Abstract Background and Aims Cognitive functions are affected in all stages of chronic kidney disease (CKD), regardless of age. This study aims to determine the effects of characteristics associated with dialysis (peritoneal dialysis (PD) or hemodialysis (HD)) on cognitive functions in patients with CKD. Method CKD patients who were followed up with PD or HD at least for six months from 3 different centers from Turkey were included in this study. For dementia screening, the AD8 dementia scoring system was used. The patients’ sociodemographic characteristics, dialysis types, dialysis access routes, weekly dialysis session numbers, dialysis adequacies, dry weights, and laboratory parameters were recorded. Results A total of 261 CKD patients, 142 of whom were male (54.4%), were included in the study (mean age: 54.46 SD: 15.297, 29.1% over 65 years of age). 151 (57.8%) of the patients were HD patients.HT (70.1%) and DM (28.7%) were the most common comorbidities. While 50% of peritoneal dialysis patients were monitored with APD, 34.4% of HD patients had a central venous catheter (CVC) for vascular access. In the study population there was no statistically significant difference in the prevalence of cognitive impairment between those over and under 65 years of age (&amp;lt;65 years of age 61%, &amp;gt;65 years of age 68%, p = 0.300). The prevalence of cognitive impairment was significantly higher in HD patients than in PD patients (p &amp;lt; 0.001). PD type was not related with cognitive impairment (p = 0.446). In HD patients under 65 years of age cognitive impairment was observed more frequently in the patients with CVC as vascular access (63% in patients &amp;lt;65 years of age with CVC, 32% in patients with AVF/AVG, p = 0.014). Conclusion Chronic kidney disease is one of the age-independent risk factors for cognitive impairment. In our study group cognitive impairment was similar in different age groups. Compared to HD patients, in PD patients less cognitive impairment was observed. In HD patients under 65 years of age using a CVC as vascular access was associated with more frequent cognitive impairment.

#1348 Acute kidney injury: evaluation of factors to predict the need of dialysis therapy

Abstract Background and Aims Acute kidney injury (AKI) is a clinical syndrome with heterogeneous pathophysiological mechanisms, associated with higher morbidity and mortality risk. The existing evidence shows that an episode of AKI increases the risk of chronic kidney disease and end-stage kidney disease, with considerable effects on long term outcomes. Current risk prediction scores were mostly calculated in the setting of contrast induced nephropathy and cardiac surgery reporting the patient's risk of AKI immediately before and after the invasive procedure. To date, no scoring models are available to assess the risk of progression and necessity of renal replacement therapy (RRT) for patients in the course of AKI. Method A prospective observational cohort study was conducted enrolling patients with AKI treated within the Nephrology, Dialysis and Kidney Transplant Unit of IRCCS Azienda Ospedaliero-Universitaria di Bologna from January 2022 to July 2023. The inclusion criteria were: 1) age &amp;gt;18 years, 2) stage 3 AKI according to the current KDIGO guidelines or presence of urgent RRT indication (severe hyperkalemia, metabolic acidosis or fluid overload refractory to medical treatment). The indication for RRT was given based on clinical judgement. Type of RRT, dialyzer and ultrafiltration rate were applied according to the clinical features of the patient. The primary endpoint was the association between AKI features and RRT. Secondary endpoints were evaluation of patients treated with RRT for factors associated with renal recovery. Results We studied 56 patients. The mean age ± SD was 69.8 ± 15.3 years (range, 18-94) and 37 (66.1%) were males. 18 patients (32.1%) were treated with conservative therapy and 38 (67.9%) with RRT. The factors correlated with the necessity of RRT were previous cardiovascular disease (p = 0.002), diabetes mellitus (p = 0.017), Charlson score &amp;gt;5 (p = 0.035), volume overload (p = 0.002), urine output level (p = 0.033) and C reactive protein (CRP; p = 0.020). Multivariate analysis found significant association of cardiovascular disease (OR, 5.94; 95% CI, 1.45 to 24.34; p = 0.013) and elevated CRP (OR, 1.08; 95% CI, 1.00 to 1.16; p = 0.049) during AKI episode with the RRT need in the study cohort. Higher ultrafiltration rate during RRT was correlated with non recovery of kidney function (OR, 1.86; 95% CI, 1.09 to 3.14; p = 0.021). Conclusion Cardiovascular disease and higher CRP were associated with necessity of RRT. More intensive fluid removal during RRT resulted as negative predictor of kidney function recovery. Further studies with larger study samples and randomized design are necessary to confirm these findings.

#705 Survival of expanded hemodialysis and high-flux hemodialysis patients in Colombia: a cohort's study

Abstract Background and Aims Survival is a core outcome of hemodialysis (HD) therapy. Progressive improvement in the permeability and biocompatibility of membranes for HD, dialysis techniques and clinical processes around these therapies have been developed. Recently, expanded hemodialysis (HDx) enabled by the medium cut-off membrane Theranova® has demonstrated encouraging efficacy outcomes in terms of better clearance of medium molecules and better outcomes reported by patients when compared to high-flux hemodialysis membranes (HF HD). The objective of the present study is to compare survival in an HDx cohort versus an HF HD cohort at a 48-month follow-up. Method Cohort study, one group with expanded haemodialysis (HDx) enabled by Theranova® and the other with HF HD, adult prevalent HD patients (&amp;gt; 90 days) at Baxter Renal Care Services Colombia starting between September 1, 2017, and November 30, 2017, with follow-up for up to 48 months. The sociodemographic and clinical characteristics of all patients were summarized descriptively. A Fine-Gray regression model was performed to evaluate the factors associated with time to death from causes other than COVID-19, death attributable to COVID-19 cause is a competing risk. A sensitivity analysis was performed using different statistical methods, such as extended Cox regression and Cox regression, after adjusting for imbalance between the cohorts with the inverse probability of treatment weighting (IPTW) method. Results We evaluated 1092 patients, 533 in HF-HD vs 559 in HDx; the mean age 61 years; 42% had diabetes, and 19% had cardiovascular disease. All patients' sociodemographic and clinical characteristics are summarized descriptively by cohort arm (Table 1). A multivariate analysis was performed to evaluate the effect of demographic, clinical, and laboratory variables on the risk of death, adjusting for the competing risk of death from COVID-19 during four years of follow-up. Our results indicate that the Theranova dialyzer has a protective effect on mortality risk when controlling for confounding variables SHR = 0.75 [95% CI: 0.58 to 0.95, p-value = 0.019] (Table 2). The different sensitivity analyses report a statistically significant beneficial effect of Theranova versus HF dialyzer. See Table 3. Fig. 1 shows a difference in the survival functions according to the type of dialyzer. Conclusion HDx enabled by Theranova dialyzer was associated with an approximately 25% reduction in mortality risk compared to HF HD patients followed for up to 4 years; this effect was consistently observed using different survival analysis methods.

Treatment Patterns for End-Stage Kidney Failure in Patients With Systemic Lupus Erythematous.

This study aims to examine the treatment patterns of end-stage kidney disease (ESKD) among SLE patients and to compare the outcome of hemodialysis (HD) and peritoneal dialysis (PD). SLE patients identified from the national administration dataset in 2005-2021 were linked to the Australia and New Zealand Dialysis and Transplant Registry to identify ESKD cases. The adjusted odds ratio of having PD instead of HD as the first treatment for ESKD for Asian, Māori, and Pacific compared with European/others was estimated with the logistic regression model. The adjusted hazards ratio of all-cause mortality for patients having PD first compared with HD first was calculated. Two hundred ten ESKD patients with SLE were identified. Two thirds (137/210) of the ESKD patients had HD as the first treatment, and one third (68, 32.4%) had PD first. Around 60% of Asian patients had PD as the first treatment, compared with 30% in other ethnic groups. The adjusted odds ratio of having PD as the first treatment for Asian patients compared with European/others was 3.00 (95% confidence interval, 1.16-7.73). The adjusted hazards ratio of all-cause mortality for patients in the PD group compared with the HD group was 0.60 (95% confidence interval, 0.37-0.97). Asian patients with ESKD were more likely to have PD as the first treatment. The optimal dialysis type for ESKD patients with SLE might be different from ESKD patients caused by other diseases. ESKD patients with SLE receiving PD first had superior outcomes than patients receiving HD first.