Type Of Renal Replacement Therapy Research Articles

Vertebral fractures in patients with CKD and the general population: a call for diagnosis and action.

Vertebral fractures (VFs) are the most common osteoporotic fractures in the general population, and they have been associated with high mortality, decreased quality of life, and high risk of subsequent fractures, especially when recent, multiple, or severe. Currently, VF diagnosis and classification determine fracture risk and the most appropriate anti-osteoporotic treatment. However, VFs are clearly underdiagnosed, especially in patients with chronic kidney disease (CKD), and CKD-associated osteoporosis has been disregarded until recently. VFs are associated with higher morbidity and mortality, and their prevalence and incidence differ depending on the grade of renal dysfunction (CKD G1-G5) and/or the type of renal replacement therapy (dialysis or transplantation). In addition to classical risk factors [such as higher age, female sex, reduced bone mineral density, diabetes and steroid use], various other factors have been associated with an increased risk of VFs in CKD, including CKD grade, haemodialysis vintage, time since renal transplantation, low or high intact parathyroid hormone and phosphate levels, and/or vitamin D and K1 deficiencies. Importantly, several clinical societies have recently modified their algorithms according to the fracture risk classification (including the presence of VFs) and determined the most appropriate anti-osteoporotic treatment for the general population. However, there are no specific guidelines addressing this topic in patients with CKD despite an important paradigm shift regarding the prognostic value of bone mineral density in 2017 after the publication of the CKD-Mineral and Bone Disorder Kidney Disease: Improving Global Outcomes guidelines. A proactive attitude towards diagnosis, treatment, and research is proposed to avoid therapeutic nihilism.

#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 >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 >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.

Mobile Apps for Patients with Peritoneal Dialysis: Systematic App Search and Evaluation.

Peritoneal dialysis (PD) is one type of renal replacement therapy. If patients have problems during the dialysis process, healthcare providers may not be able assist the patients immediately. mHealth can provide patients with information and help them to solve problems in real-time, potentially increasing their willingness to choose PD. The objectives of this study were to conduct a comprehensive review of free mobile applications for patients with PD on the Internet and to recommend suitable mobile applications to facilitate patient self-management and health. We conducted a systematic search for PD mobile applications on Google Play and the Apple iTunes Store from 3 to 16 June 2023. A total of 828 identifiable mobile applications were initially identified, and ultimately, 21 met the inclusion criteria. The Mobile App Rating Scale (MARS) assessment of the applications revealed the highest score in the functionality domain, followed by the aesthetics, information, app-specific, subjective quality, and engagement domains, respectively. In the comprehensive self-management of PD, the highest percentage was related to disease-related information. The findings of this study suggest that some applications, with the highest quality, can be recommended to patients for use in English or traditional Chinese.

7. ANALYSIS OF THE RESULTS OF LAPAROSCOPIC TUNNELLED PERITONEAL DIALYSIS CATHETER PLACEMENT

Abstract Introduction Peritoneal dialysis is a type of renal replacement therapy that improves quality of life and empowers patients with advanced chronic kidney disease. The best method of peritoneal dialysis catheter (PDC) placement remains to be defined. Methods Retrospective observational study from October 2019 to March 2023, aiming to analyse the results of this new technique for PDC placement in our centre. Results The study consisted of 45 patients, 66.7% of whom were men. The study comprised 45 patients, with 66.7% being men. The mean age was 57 years, and the mean BMI was 27.9 kg/m2, with 82.8% of the patients classified as ASA III. In 66.7% of cases, it was the first catheter to be placed. Of the surgeries conducted, 41 involved initial placements, and 4 involved laparoscopic repositioning, the latter following a previously unsuccessful Alpha manoeuvre. In 6 cases, an associated surgery was performed. The mean duration of surgery was 34 minutes, with a median length of stay of 24 hours. In 3 patients, catheter malfunction occurred, with 2 requiring laparoscopic repositioning and the remaining one laparoscopic replacement. Additionally, 3 other patients experienced infectious complications, which were treated conservatively. No major complications or laparoscopy conversions were noted. The mean follow-up from surgery was 15.4 months, with 42.2% of PDCs being removed after a mean of 11.5 months, and renal transplantation being the most common reason for removal (79%). Conclusion In our centre, tunnelled PDC placement has proven to be safe and effective, with a low percentage of infections, relocations or replacements, and it is considered the technique of choice for patients capable of undergoing surgery under general anaesthesia.

Хроническая почечная недостаточность при болезни Фабри: общая выживаемость при использовании различных методов заместительной почечной терапии

To evaluate survival among patients with Fabry disease (FD) depending on the type of renal replacement therapy and to investigate the efficacy of dialysis screening in the early diagnosis of FD in relatives of probands.

#6869 CARDIAC ALTERATIONS FOUND IN PATIENTS WHO START DIALYSIS

Abstract Background and Aims The presence of cardiac structural alterations in patients with chronic kidney disease who start renal replacement therapy is frequent. In fact, the real prevalence of heart failure is not well known due to the masking of symptoms by frequent ultrafiltration. Despite this, most deaths in these patients occur due to cardiovascular events, especially non-atheroembolic events, which are closely related to heart failure and ventricular remodeling. This study aimed to describe the echocardiographic alterations present in patients who start renal replacement therapy. Method Cross-sectional study to evaluate the prevalence of structural abnormalities in transthoracic echocardiography performed in patients at the time of initiating renal replacement therapy in the prevalent group of patients in kidney replacement therapy program at Hospital Clínic de Barcelona. Demographic variables and baseline drugs for heart failure were also collected. Results We included 170 patients of 67.84 ± 15.92 years. 115 (67.6%) were men, and 55 were women (32.4%). Of these, 124 (72.9%) were on hemodialysis, 11 (6.5%) on home hemodialysis, and 35 (20.6%) on peritoneal dialysis. Transthoracic echocardiogram findings at the beginning of dialysis showed a left ventricular ejection fraction of 47.5 ± 10.6%. It was reduced in 21 (12.4%), slightly reduced in 9 (5.3%) and preserved in 125 (73.5%) of the patients. The estimated pulmonary artery systolic pressure was 28.5 ± 3.53 mmHg. The telediastolic diameter of the left ventricle was 5.5 ± 0.71 cm, that of the interventricular septum was 1.15 ± 0.27 cm, the diameter of the left atrium was 4.5 ± 1.27 cm, its volume was 95.05 ± 56.5 mL in the biplane section and 54.3 ± 28.28 mL in the four-chamber section. There were no significant differences between groups when analyzed by type of renal replacement therapy. Regarding valvulopathies, 47 (21.8%) had some degree of aortic stenosis, 68 (40%) had some degree of aortic insufficiency, 104 (62.2%) had some degree of tricuspid insufficiency, 118 (69.4%) some degree of mitral insufficiency. Regarding treatment, 50 (29.4%) of the patients had some RAASi, 60 (35.3%) had beta-blockers, and 2 (1.2%) had MRA. Conclusion The presence of structural alterations in the heart of patients initiating renal replacement therapy is practically universal and independent of the type of technique initiated. Nephrologists should become aware of these findings and seek ways to prevent and reverse these alterations as far as possible to achieve better clinical results in dialysis.

#4543 EFFECT OF COMORBIDITIES ON HEALTHCARE EXPENDITURES FOR PATIENTS ON KIDNEY REPLACEMENT THERAPY IN A FRENCH COHORT

Abstract Background and Aims End stage kidney disease (ESKD) is associated with a substantial economic burden. In France, the cost of care for such patients represents 2.5% of the total French healthcare expenditures, but serves less than 1% of the population. These patients’ healthcare expenditures are high because of the specialized and complex treatment needed as well as the presence of multiple comorbidities. This study aims to describe and assess the effect of comorbidities on healthcare expenditures (direct medical cost and non-medical costs including transportation and compensatory allowances) for patients with ESKD in France, while considering the modality and duration of renal replacement therapy (RRT). Method This retrospective observational study included adults who started RRT for the first time between 2012 and 2014 in France and were followed for 5 years. Linear models were built to predict mean monthly cost (MMC) by integrating first the time duration in the cohort, then patient characteristics and finally the duration of use of each treatment modalities. A complementary analysis stratified on age group was also performed. The variables included in this analyses were: body mass index, age, sex, RRT modality, time in the cohort, coronary artery disease, heart failure, chronic respiratory disease, active cancer, diabetes, lower-limb arterial disease, HIV/AIDS, abdominal aneurism, rhythm disorders, stroke or transient ischemic attack, liver disease, mobility limitations. All RRT modalities available in France were also included: renal transplant (RT), hemodialysis (HD) in center, HD in self-care unit, HD in out-center, HD at home, assisted continuous ambulatory peritoneal dialysis (aCAPD), non-assisted continuous ambulatory dialysis (naCAPD), assisted automated peritoneal dialysis (aAPD), non-assisted automated peritoneal dialysis (naAPD). Results A total of 22,506 patients were included in the study. The mean MMC was 6,391€ (95% CI 6,345-6,438 €). The comorbidities with the highest effect on MMC were inability to walk +1,434€ (95% CI 1,434-1,434€), lower-limb arterial disease stage III-IV 777€ (95% CI 777-777€), active cancer +594€ (95% CI 594-594€), HIV positivity +507€ (95% CI 507-507€), and diabetes +395€ (95% CI 395-395€). Other comorbidities were also positively associated with MMC. KT and naAPD were negatively associated with the MMC by -161€ (95% CI -161 - -161€) and -2€ (95% CI -2 - -2€). The remaining RRT modalities were positively associated with the MMC. Hemodialysis in center had the highest effect on the MMC, adding 291€ (95% CI 291-291€). An age-stratified analysis showed an interaction between age groups and comorbidities. The presence of diabetes, cancer and respiratory disease had a great impact on MMC in younger patients. Conclusion This study confirms the importance of considering patient characteristics, comorbidities and type of RRT when assessing healthcare expenditures for patients with ESKD. Better care of comorbidities prior to RRT could reduce cost for individual patients as well as potentially reduce the incidence of patients in ESKD. Even though the Euro value is specific to France, other countries might benefit from evaluating and anticipating healthcare costs for patients in RRT by assessing patient comorbidities.

Clinicopathological Results of Percutaneous Transplant Kidney Biopsies: Single Center Nine Years' Experience

Background: Based on clinical criteria alone, the cause of graft dysfunction cannot be accurately predicted in 40-70% of cases. Therefore, renal allograft biopsy is still the gold standard for accurate diagnosis. We performed this study to evaluate the causes of renal graft dysfunction detected in renal allograft biopsies in our center.
 Methods: The results of 90 patients who underwent renal allograft biopsy between May 2013 and June 2022 from kidney transplant patients were evaluated retrospectively.
 Results: It was determined that 92 biopsies were performed from 90 patients and all were ‘cause’’ biopsies. The mean age was 40.03±14.29 years. 82 of the kidney transplants were from living donors. 21 patients had preemptive transplantation. The type of renal replacement therapy before transplantation was hemodialysis in 52 patients, PD in 3 patients, PD and HD in 3 patients. The reason for biopsy was high creatinine in 67 patients, proteinuria in 23 patients, and BKV viremia in 2 patients. The mean discharge creatinine value was 1.64±1.11mg/dl, and the mean creatinine before biopsy was 3.06±2.07mg/dl. Although there was kidney tissue in one of the allograft biopsies, there was no glomeruli. The mean number of cores taken was 2.94±0.61, and the number of glomeruli was 21.33±11.64. In one of the 92 biopsies performed, bleeding requiring transfusion developed. No other biopsy-related complications were observed. Graft loss was observed in 46 of 90 patients during the follow-up period.
 Conclusions: Evaluation of serum creatinine and urinalysis may be useful in predicting histological graft diagnosis, but an allograft biopsy is necessary for definitive diagnosis.

RENAL11: Novel Clog-Based Switch to Surveille Peritoneal Dialysate for Peritonitis

Background: Quickly triaging patients on Peritoneal Dialysis (PD) for infection is critical for patient-health outcomes. The best methods of detection, such as blood panels or sample culture, are not suited for quick point-of-care applications. The current detection method is by visual inspection of the fluid by the patient who looks for ‘cloudiness’ in the spent dialysate. Peritoneal dialysis, a type of renal replacement therapy for patients with end-stage renal disease (ESRD), has a survival advantage for the first two years of use over hemodialysis (HD). Other advantages of PD over HD include higher patient satisfaction and lower costs. The main shortcoming of PD is the patients’ increased susceptibility to peritonitis due to the permanent catheter that provides access to the peritoneal cavity for fluid exchanges. The infection can create life-threatening situations for patients. Importantly, for most patients using PD, repeated peritonitis can result in peritoneal membrane failure, necessitating a switch to HD with its associated disadvantages. Preemptive monitoring is currently not available in clinical practice of PD. The current detection method is by visual inspection of the fluid by the patient who looks for ‘cloudiness’ in the spent dialysate. Progress has been made to reduce the incidence of peritonitis, but detection remains problematic. Methods: To achieve this goal, we have developed a novel switch to detect the presence of dangerous levels of WBC in spent peritoneal dialysate (see Figure 1). Since the sensitivity of a clog-based sensor is dependent on the permeability of its membranes, incorporating highly permeable silicon nanomembranes into a white blood cell detector will produce a highly sensitive WBC detector. Spent Dialysate from peritoneal dialysis fluid exchanges (spike the dialysate with varying amounts of WBCs) is pushed at 200 µL/min into the top channel with the top outlet open to the atmosphere. The inlet of the bottom channel is closed, and the outlet pulls at 100 µL/min through the membrane. If the membrane is clogged the transmembrane pressure (recorded for the duration of the experiment at ~0.5-second intervals) will increase. Results: We have preliminary data demonstrating that membranes with 4-µm wide microslit pores block the passage of WBCs while allowing all other cells and proteins in whole blood to pass. Figure 2 shows the pressure increase across the membrane when subjected to varying concentrations of white blood cells in spent dialysate. The slope of the pressure indicates the WBC count. The primary innovation comes from the use of microporous membranes as a fouling-based sensor; using membranes with pores tuned to be just slightly smaller than the size of leukocytes, we will see a change in the transmembrane pressure (under a steady flow rate) as the WBCs block pores which correlates to the WBC concentration.Figure 1. a: Schematic showing WBC-detection switch. Pressure transducers report pressure increase as cells clog the membrane. b: WBCs are drawn to the micropores by transmembrane flow.Figure 2. Transmembrane pressure slope correlates with the white blood cell concentration in the dialysate.

Effect of comorbidities on healthcare expenditures for patients on kidney replacement therapy considering the treatment modality and duration in a French cohort.

End-stage kidney disease (ESKD) is associated with a substantial economic burden. In France, the cost of care for such patients represents 2.5% of the total French healthcare expenditures but serves less than 1% of the population. These patients' healthcare expenditures are high because of the specialized and complex treatment needed as well as the presence of multiple comorbidities. This study aims to describe and assess the effect of comorbidities on healthcare expenditures (direct medical cost and non-medical costs including transportation and compensatory allowances) for patients with ESKD in France while considering the modality and duration of renal replacement therapy (RRT). This study included adults who started RRT for the first time between 2012 and 2014 in France and were followed for 5years. Generalized linear models were built to predict mean monthly cost (MMC) by integrating first the time duration in the cohort, then patient characteristics and finally the duration of use of each treatment modalities. Comorbidities with the highest effect on MMC were inability to walk (+ 1435€), active cancer (+ 593€), HIV positivity (+ 507€) and diabetes (+ 396€). These effects vary according to age or treatment modalities. This study confirms the importance of considering patient characteristics, comorbidities and type of RRT when assessing healthcare expenditures for patients with ESKD.

Prognosis Factors of Patients Undergoing Renal Replacement Therapy.

Survival in patients with end-stage kidney disease (ESKD) on renal replacement therapy (RRT) is less than that of the general population of the same age, and depends on patient factors, the medical care received, and the type of RRT used. The objective of this study is to analyze the factors associated with survival in patients undergoing RRT. We conducted a retrospective observational study of adult patients with an incident of ESKD on RRT in Andalusia from 1 January 2008 to 31 December 2018. Patient characteristics, nephrological care received, and survival from the beginning of RRT were evaluated. A survival model for the patient was developed according to the variables studied. A total of 11,551 patients were included. Median survival was 6.8 years (95% CI (6.6; 7.0)). After starting RRT, survival at one year and five years was 88.7% (95% CI (88.1; 89.3)) and 59.4% (95% CI (58.4; 60.4)), respectively. Age, initial comorbidity, diabetic nephropathy, and a venous catheter were independent risk factors. However, non-urgent initiation of RRT and follow-up in consultations for more than six months had a protective effect. It was identified that renal transplantation (RT) was the most influential independent factor in patient survival, with a risk ratio of 0.13 (95% CI (0.11; 0.14)). The receiving of a kidney transplant was the most beneficial modifiable factor in the survival of incident patients on RRT. We consider that the mortality of the renal replacement treatment should be adjusted, taking into account both modifiable and nonmodifiable factors to achieve a more precise and comparable interpretation.

Why Do Not All Living Kidney Donor Candidates Are Accepted for Donation? A Pediatric Center Experience

BackgroundLiving donor kidney transplantation is the best type of renal replacement therapy for patients with end-stage renal disease. Living kidney donors (LKDs) undergo an extensive evaluation before donating, and many potential LKDs are declined. This study aimed to define the reasons for the decline in LKD candidates referred to our center. MethodsWe retrospectively analyzed clinical data of all potential LKDs evaluated between January 2001 and December 2021 at our institution,Western National Medical Center, Pediatric Hospital. Data were obtained by review of an electronic database. ResultsA total of 1332 potential LKDs were evaluated, 796 (59.7%) successfully donated; 20 (1.5%) had a complete evaluation, were accepted for donation, and were on the waiting list for intervention; 56 (4.2%) continued in the evaluation process; 200 (15%) were discharged from the program due to administrative aspects, death (donor or receptor), or cadaveric renal transplantation in order of frequency; 56 (4.2%) withdraw by personal choice; and 204 (15.3%) were rejected for donation. Donor-related reasons included medical contraindications (n = 134, 65.7%), anatomic contraindications (n = 38, 18.6%), immunologic barriers (n = 18, 8.8%), and psychological reasons (n = 11, 5.4%). ConclusionsDespite the large number of potential LKDs, a significant proportion did not proceed for donation for different reasons; in our description, it represents 40.3%. The largest proportion is because of donor-related causes, and most of the reasons result from the candidate's unnoticed chronic diseases.

Global Perspectives in Acute Kidney Injury: Spain.

Global Perspectives in Acute Kidney Injury: Spain.

Efficacy and safety of booster vaccination against SARS-CoV-2 in dialysis and renal transplant patients: systematic review and meta-analysis.

Patients under renal replacement therapy are at an increased risk of severe infection with SARS-CoV-2, and have been known to have impaired response to standard vaccination. This systematic review and meta-analysis aims at evaluating the efficacy of booster dose vaccination in this population. A systematic review has been conducted to find trials on the booster dose vaccination in kidney transplant recipients (KTRs) or patients under dialysis. Data of seroconversion rates at different timepoints, especially 1month prior and post-booster dose vaccination have been collected and analyzed. Effects of different factors including type of renal replacement therapy (RRT), vaccine type and brands, magnitude of response to the standard vaccination, and immunosuppression drugs on the response rates have been investigated. Meta-analyses were performed using software Stata v.17. Overall 58 studies were included. Both RRT patient subgroups represented significant seroconversion, post- (versus pre-) booster dose vaccination, but only in KTRs the booster dose seroconversion surpassed that of the standard protocol. T-cell response was also significantly augmented after booster vaccination, with no difference between the RRT subgroups. mRNA and vector vaccine types had comparable immunogenicity when employed as boosters, both significantly higher than the inactivated virus vaccine, with no significant disparity regarding the vaccine brands. Patients with poor response to standard vaccination had a significant response to booster dose, with dialysis patients having stronger response. The differential effects of vaccine types and brands in the poor responders was similar to that of the overall RRT population. No rejection episodes or graft failure post-booster vaccination was reported. In patients under RRT, booster dose vaccination against SARS-CoV-2 is safe and efficacious determined by significant seroconversion, and therefore, it should be considered to be implemented in all these patients. Since in the KTR patients, the third dose vaccination significantly increased the seroconversion rates even beyond that of the standard protocol, three dose vaccine doses is recommended to be recognized as the standard vaccination protocol in this population. The same recommendation could be considered for dialysis patients, due to their augmented risk of breakthrough infection.

Management of renal replacement therapy among adults in French intensive care units: A bedside practice evaluation

BackgroundThis study aimed to investigate renal replacement therapy (RRT) practices in a representative nationwide sample of French intensive care units (ICUs). MethodsFrom July 1 to October 5 2021, 67 French ICUs provided data regarding their ICU and RRT implementation. We used an online questionnaire to record general data about each participating ICU, including the type of hospital, number of beds, staff ratios, and RRT implementation. Each center then prospectively recorded RRT parameters from 5 consecutive acute kidney injury (AKI) patients, namely the indication, type of dialysis catheter used, type of catheter lock used, type of RRT (continuous or intermittent), the RRT parameters initially prescribed (dose, blood flow, and duration), and the anticoagulant agent used for the circuit. ResultsA total of 303 patients from 67 ICUs were analyzed. Main indications for RRT were oligo-anuria (57.4%), metabolic acidosis (52.1%), and increased plasma urea levels (47.9%). The commonest insertion site was the right internal jugular (45.2%). In 71.0% of cases, the dialysis catheter was inserted by a resident. Ultrasound guidance was used in 97.0% and isovolumic connection in 90.1%. Citrate, unfractionated heparin, and saline were used as catheter locks in 46.9%, 24.1%, and 21.1% of cases, respectively. ConclusionsPractices in French ICUs are largely compliant with current national guidelines and international literature. The findings should be interpreted in light of the limitations inherent to this type of study.

Risk factors for delayed kidney graft function from a deseased donor

Aim. To determine statistically significant risk factors for delayed renal graft function. To assess the impact of delayed kidney graft function on the development of other complications, graft and recipient survival.Material and methods. In 237 consecutive kidney transplant recipients (from June 2018 to December 2021), we assessed its function in the early postoperative period. Delayed function was considered to be the need for hemodialysis in the first week after surgery. Among the donor factors, the type of donor, age, body mass index, the presence of vasopressor support, the time the donor was in intensive care, and the maximum level of creatinine during the follow-up were evaluated. Recipient risk factors include age, gender, body mass index, presence/absence and amount of urine, presence of preformed anti-HLA antibodies and/or repeated kidney transplantation, number of mismatches for six HLA antigens, number of mismatches for HLA-DR, presence and type of renal replacement therapy, etiology of end stage kidney disease. Among the perioperative risk factors are the duration of cold preservation, the time of second warm ischemia, the volume of intraoperative blood loss, the intraoperatively determined renal arterial resistive index of the renal graft, and the maximum concentration of tacrolimus in the first 4 days after kidney transplantation. After that the relationship between the presence of delayed kidney graft function and the development of early postoperative complications was assessed and its effect on the long-term survival of grafts and recipients was analyzed.Results. Out of 237 cases, 9 showed no function of the transplanted kidney, and therefore the grafts were removed. The incidence of delayed renal graft function was 24.5% (58/237). According to the results of a univariate analysis, a statistically significant relationship with the development of delayed kidney graft function had donor body mass index (p=0.019), male gender of the recipient (p=0.048), recipient body mass index (p=0.038), amount of urine (p=0.003), anuria (p=0.002), presence of preformed antibodies (p=0.025), repeated transplantation (p=0.002), time of second warm ischemia (p=0.036), intraoperative renal arterial resistive index (p=0.004) and maximum tacrolimus concentration in the first 4 days (p=0.022). In the multivariate model, donor body mass index >30 kg/m2 and peak tacrolimus concentration >23 ng/mL in the first 4 days were statistically significant (p=0.018 and p=0.025, respectively). A trend towards statistical significance was noted in the presence of oligoanuria before kidney transplantation (p=0.066) and resistance index >0.75 after surgery (p=0.056). One-year renal transplant survival in the absence and presence of delayed kidney graft function was 92.4% and 87.7%, two-year survival was 89.4% and 76.1%, respectively. The effect of delayed kidney graft function on graft survival was statistically significant (p=0.01), while overall recipient survival did not differ between the groups.Conclusion. During the univariate analysis, we identified 9 statistically significant factors, of which at least 3 are potentially modifiable. In the multivariate model, the most significant modifiable risk factor was an increased concentration of tacrolimus, which prompted the authors to reconsider the existing immunosuppressive protocol at the City Clinical Hospital n.a. S.P. Botkin. We consider the search for modifiable statistically significant risk factors for patients, their analysis and implementation of preventive measures to be an important task for each kidney transplant center.

Association between urinary sodium excretion and hard outcomes in non-dialysis chronic kidney disease patients

BackgroundRestriction of sodium intake is routinely recommended for patients with chronic kidney disease (CKD). Whether or not sodium intake is associated with the progression of CKD and mortality remains uncertain. We evaluated the association between urinary sodium excretion (as a surrogate for sodium intake) with the occurrence of renal failure and mortality in patients with non-dialytic CKD.MethodsWe conducted a retrospective study of patients followed at a CKD clinic care hospital from October 2006 to March 2017. Adult patients with non-dialytic CKD were included. Using a time-to-event analysis, we examined the association of urinary sodium excretion as a categorical variable (categorized as quintiles: 1st quintile: 0.54–2.51 g; 2nd quintile: 2.52–3.11 g, 3rd quintile: 3.12–3.97 g, 4th quintile: 3.98–5.24 g and 5th quintile: 5.26–13.80 g) and the outcomes of interest. The primary outcome was defined as progression to end-stage renal disease requiring any type of renal replacement therapy. The secondary outcome was mortality.ResultsTwo hundred five patients were included in the study (mean follow up of 2.6 years) with a mean eGFR of 26 (19–41) ml/min/1.73m2. 37 patients (18%) required renal replacement therapy and 52 (25,3%) died. There was association between urinary sodium excretion and need for renal replacement therapy (adjusted HR 0.245; 95%CI 0.660–0.912). There was no association between urinary sodium excretion and mortality in adjusted models.ConclusionModerate sodium intake was associated with a lower risk of renal failure.

EE306 Cost-Effectiveness Analysis of Treatments in Chronic Kidney Disease in Mexico

To carry out a complete economic evaluation of the cost-effectiveness analysis type of the treatment alternatives for chronic kidney disease in Mexico, from the institutional point of view. Methodology: A Cost-effectiveness Analysis (ACE) was carried out as the main analysis, and a budget impact analysis as a secondary analysis in 2020. The use of resources was determined for adult patients (18 years or older) with renal failure who are in some type of renal replacement therapy (RRT), be it peritoneal dialysis, hemodialysis or kidney transplantation.

Impact of Renal Replacement Therapy on Mortality and Renal Outcomes in Critically Ill Patients with Acute Kidney Injury: A Population-Based Cohort Study in Korea between 2008 and 2015.

The outcomes depending on the type of renal replacement therapy (RRT) or pre-existing kidney disease in critically ill patients with acute kidney injury (AKI) have not been fully elucidated. All adult intensive care unit patients with AKI in Korea from 2008 to 2015 were screened. A total of 124,182 patients, including 21,165 patients with pre-existing kidney disease, were divided into three groups: control (no RRT), dialysis, and continuous RRT (CRRT). In-hospital mortality and progression to end-stage kidney disease (ESKD) were analyzed according to the presence of pre-existing kidney disease. The CRRT group had a higher risk of in-hospital mortality. Among the patients with pre-existing kidney disease, the dialysis group had a lower risk of in-hospital mortality compared to other groups. The risk of ESKD was higher in the dialysis and CRRT groups compared to the control group. In the CRRT group, the risk of ESKD was even higher in patients without pre-existing kidney disease. Although both dialysis and CRRT groups showed a higher incidence of ESKD, in-hospital mortality was lower in the dialysis group, especially in patients with pre-existing kidney disease. Our study supports that RRT and pre-existing kidney disease may be important prognostic factors for overall and renal outcomes in patients with AKI.

Impact of the Type of Dialysis on Time to Transplantation: Is It Just a Matter of Immunity?

Background: Renal transplantation represents the therapeutic gold standard in patients with end stage renal disease (ESRD). Still the role of pre-transplant dialysis in affecting time to transplantation has yet to be determined. We wanted to verify whether the type of renal replacement therapy (hemodialysis vs. peritoneal dialysis) affects time to transplantation and to identify clinical features related to the longer time to transplantation. Methods: We performed a retrospective single-center observational study on patients who had received a transplant in the Bologna Transplant Unit from 1991 to 2019, described through the analysis of digital transplant list documents for sex, age, body mass index (BMI), blood group, comorbidities, underlying disease, serology, type of dialysis, time to transplantation, Panel Reactive Antibodies (PRA) max, number of preformed anti Human Leukocyte Antigens (HLA) antibodies. A p-value < 0.05 was considered statistically significant. Results: In the 1619 patients analyzed, we observed a significant difference in time to transplant, PRA max and Preformed Antibodies Number between patients who received Hemodialysis (HD) and Peritoneal dialysis (PD). Then we performed a multiple regression analysis with all the considered factors in order to identify features that support these differences. The clinical variables that independently and directly correlate with longer time to transplantation are PRA max (p < 0.0001), Antibodies number (p < 0.0001) and HD (p < 0.0001); though AB blood group (p < 0.0001), age (p < 0.003) and PD (p < 0.0001) inversely correlate with time to transplantation. Conclusions: In our work, PD population received renal transplants in a shorter period of time compared to HD and turned out to be less immunized. Considering immunization, the type of dialysis impacts both on PRA max and on anti HLA antibodies.