Undergoing Maintenance Dialysis Research Articles

Prevalence of coronary artery calcification in patients with end-stage renal disease undergoing dialysis and the association of various risk factors with the development of coronary artery calcification in this patient population

Background: Patients with end-stage renal disease (ESRD) on dialysis exhibit a significantly higher risk of coronary artery calcification (CAC) than age-matched normal individuals, contributing to elevated cardiovascular morbidity and mortality. Aims and Objectives: This study designed to assess the prevalence of CAC in ESRD patients on dialysis and identify associated risk factors. Materials and Methods: Fifty ESRD patients undergoing maintenance dialysis and twenty normal subjects were included in this cross-sectional observational study. Serum calcium, phosphate, and parathyroid hormone were measured in all ESRD patients and normal controls. Multi Row Spiral Computed Tomography was performed to determine CAC scoring (CACS). Results: CACS was significantly higher in ESRD patients compared to normal subjects (mean CACS: 91.4±32.7 vs. 7.75±9.5 Agatston units, P<0.05). Elevated levels of calcium phosphate products, serum leptin, intact parathyroid hormone (iPTH), presence of diabetes mellitus, and longer duration of dialysis were correlated with increased incidence of CACS in ESRD patients, as indicated by higher odd’s ratios ranged from 1.10 to 6.93. Conclusion: CAC is highly prevalent in ESRD patients on dialysis, emphasizing the need for stringent risk factor management. Our findings suggest that controlling calcium phosphate product, serum leptin, age, iPTH levels, and duration of dialysis may reduce CAC burden in this population, potentially mitigating cardiovascular risk and improving outcomes.

Multisystem Imaging Manifestations of Kidney Failure.

Kidney failure (KF) refers to a progressive decline in glomerular filtration rate to below 15 ml/min per 1.73 m2, necessitating renal replacement therapy with dialysis or renal transplant. The hemodynamic and metabolic alterations in KF combined with a proinflammatory and coagulopathic state leads to complex multisystemic complications. The imaging hallmark of systemic manifestations of KF is bone resorption caused by secondary hyperparathyroidism. Other musculoskeletal complications include brown tumor, osteosclerosis, calcinosis, soft-tissue calcification, and amyloid arthropathy. Cardiovascular complications and infections are the leading causes of death in KF. Cardiovascular complications include accelerated atherosclerosis, cardiomyopathy, pericarditis, myocardial calcinosis, and venous thromboembolism. Neurologic complications such as encephalopathy, osmotic demyelination, cerebrovascular disease, and opportunistic infections are also frequently encountered. Pulmonary complications include edema and calcifications. Radiography and CT are used in assessing musculoskeletal and thoracic complications, while MRI plays a key role in assessing neurologic and cardiovascular complications. CT iodinated contrast material is generally avoided in patients with KF except in situations where the benefit of contrast-enhanced CT outweighs the risks and in patients already undergoing maintenance dialysis. At MRI, group II gadolinium-based contrast material can be safely administered in patients with KF. The authors discuss the extrarenal systemic manifestations of KF, the choice of imaging modality in their assessment, and imaging findings of complications. ©RSNA, 2024 Supplemental material is available for this article.

Early Detection of Inflammation and Malnutrition and Prediction of Acute Events in Hemodialysis Patients through PINI (Prognostic Inflammatory and Nutritional Index).

Protein-energy wasting and inflammation are major risk factors for complications in hemodialysis patients. As these risk factors are triggered by a pro-inflammatory state, oxidative stress and hemodynamic dysfunction, which overlap in hemodialyzed subjects, we aimed to assess the efficacy of a cost-effective and straightforward screening tool, the Prognostic Inflammatory and Nutritional Index (PINI), in regularly screening maintenance hemodialysis (MHD) patients, to detect early signs of inflammation and malnutrition. A 12-month follow-up was carried out on a cohort of 102 adult patients undergoing maintenance dialysis, during which the Prognostic Inflammatory and Nutritional Index (PINI) was calculated using the formula alpha1-Acid Glycoprotein (AGP) × C-reactive protein (CRP)/albumin (ALB) × transthyretin (TTR). A PINI score < 1 was considered normal. The patients were stratified based on their PINI score: 66 patients (64.70%) had a normal score, below 1, while 36 patients (35.30%) had a PINI score ≥ 1. Despite the absence of clinical evidence of inflammation at enrollment, the latter group exhibited higher levels of CRP. During the follow-up period, all patients with a PINI score ≥ 1 experienced at least one acute event, compared to only 6% of patients with a normal PINI score, which presented COVID-19 infection as an acute event. The evaluation of the PINI can effectively identify the silent malnutrition-inflammation syndrome and predict the risk of acute events. This straightforward test appears to be a rapid tool that is independent of the examiner's experience and subjectivity, thereby potentially reducing hospitalization costs.

Clinical impact of fluoropolymer-based drug-eluting stent thrombosis in femoropopliteal artery occlusive lesions.

Endovascular treatment (EVT) is recommended for superficial femoral artery (SFA) lesions, and good results have been reported after implantation of drug-eluting stents (DES) for SFA. However, the major concern after implantation is acute thrombosis during the follow-up period, resulting in major amputation and major adverse limb events. In this study, we examined the incidence and outcome of acute thrombosis after DES implantation in the SFA. DES implantation for a femoropopliteal lesion was performed in 288 patients at multiple centers in Japan from 2019 to 2021. A total of 25 patients (8.6%) with DES acute occlusion were analyzed retrospectively. The primary endpoint was amputation-free survival (AFS) after acute occlusion. The median patient age was 77years, with 48% having diabetes, 40% undergoing maintenance dialysis, and 66% having chronic limb-threatening ischemia (CLTI). The mean time from initial DES implantation to acute occlusion was 153.5 ± 177.6days, with a median of 104days. EVT was performed in 18 patients (72%), surgical revascularization in 3 (12%), and conservative treatment in 4 (16%). Two deaths within 30days were both due to sepsis. No major amputation or major adverse cardiovascular events occurred within 30days. The 1-year rates of patency and freedom from target lesion revascularization after DES thrombosis were 22.9% and 48.8%, respectively. AFS at 1 year was 55.1%. Acute DES occlusion is relatively frequent, and the outcome is poor. Therefore, the indication of DES implantation for a complex SFA lesion may require careful consideration. Further investigation may be needed in DES implantation for a complex SFA lesion.

Immune Response after Anti-SARS-CoV-2 mRNA Vaccination in Relation to Cellular Immunity, Vitamin D and Comorbidities in Hemodialysis Patients.

In the global threat of SARS-CoV-2, individuals undergoing maintenance dialysis represent a vulnerable population with an increased risk of severe COVID-19 outcomes. Therefore, immunization against SARS-CoV-2 is an essential component of healthcare strategy for these patients. Existing data indicate that they tend to exhibit a reduced immune response to vaccines compared to the general population. Our study aimed to assess both humoral and cellular immune responses following two doses of an anti-SARS-CoV-2 mRNA vaccine, an ability to maintain adequate antibody titers over time, and potential relations with vitamin D, comorbidities and other factors in hemodialysis patients based on a single center experience. A total of 41/45 patients (91.1%) responded to the second dose of the anti-SARS-CoV-2 mRNA vaccine. The titer of anti-SARS-CoV-2 IgG class antibodies and levels of T cells three to four weeks after vaccination were lower in dialysis patients than in healthy controls. Antibodies titer in dialysis patients had a positive correlation with B lymphocytes and was related to cardiovascular diseases. The level of CD4+ cells had a negative correlation with hemodialysis vintage, as did the vitamin D level with post-vaccination seroconversion and decline in anti-SARS-CoV-2 antibodies titer during six months after vaccination. Hemodialysis patients had decreased amounts of CD4+ and CD8+ cells and lower levels of anti-SARS-CoV-2 antibodies than healthy controls. Therefore, chronic hemodialysis could lead to diminished cellular immunity and humoral immune response to the anti-SARS-CoV-2 mRNA vaccination and reduced protection from COVID-19. Comorbidity in cardiovascular diseases was associated with a lower level of specific anti-SARS-CoV-2 antibody titer. Vitamin D may be important in maintaining stable levels of anti-SARS-CoV-2 antibodies, while the duration of dialysis treatment could be one of the factors decreasing anti-SARS-CoV-2 antibody titer and determining lower CD4+ cell counts.

Correlation analysis between left ventricular global longitudinal strain and major adverse cardiovascular event occurrence in patients with end-stage renal disease.

To explore the correlation between left ventricular global longitudinal strain (LVGLS) and major adverse cardiovascular event (MACE) occurrence in patients with end-stage renal disease (ESRD). From January 2019 to December 2023, ESRD patients undergoing maintenance dialysis and LVGLS measurement admitted to the First People's Hospital of Lanzhou City were selected as subjects. They were followed up for 12months to record the occurrence of MACEs, and divided into MACE group and non-MACE group according to MACE presence or absence. A total of 158 ESRD patients were included, with 32 patients in the MACE group and 126 patients in the non-MACE group. In the MACE group, high-sensitivity C-reactive protein (hs-CRP) level, peak troponin T (TNT) and the ratio of early diastolic mitral inflow velocity to early diastolic septal mitral annulus velocity (E/e') were higher, while hemoglobin, left ventricular ejection fraction (LVEF) and absolute LVGLS were lower compared with the non-MACE group (P < 0.05). Multivariate COX regression analysis revealed that LVGLS (HR = 1.06, 95% CI 1.02-1.10) and hs-CRP (HR = 1.17, 95% CI 1.23-1.31) were independent predictors of MACE occurrence in ESRD patients (P < 0.05). The area under the ROC curve (AUC) for MACE occurrence within 12months was 0.83 (95% CI 0.74-0.95), with a sensitivity of 89.9% and a specificity of 76.8%. The MACE-free survival rate in the high LVGLS group was higher compared to the low LVGLS group (P < 0.05). Reduced LVGLS is an independent risk factor for MACE occurrence in ESRD patients within 12months and a good prognostic indicator.

Estimation of lifetime productivity loss from patients with chronic diseases: methods and empirical evidence of end-stage kidney disease from Taiwan

ObjectiveStudies that examine the broad allocation of resources, regardless of who bears the costs, should ideally estimate costs from a societal perspective. We have successfully integrated survival rates, employment ratios, and earnings to address the significant challenge of evaluating societal value through productivity assessments of patients with end-stage kidney disease (ESKD) in Taiwan.MethodsUsing a theoretical framework, we interconnected two nationwide databases: the Taiwan National Health Insurance (NHI) and the Taiwan Mortality Registry from 2000 to 2017. Due to the statutory retirement age of 65, we collected data on all patients (83,358) aged 25–64 years diagnosed with ESKD and undergoing maintenance dialysis. We estimated the lifetime survival function through a rolling extrapolation algorithm, which was then combined with the monthly employment ratio and wages to calculate the lifetime employment duration and productivity up to the legal retirement age of ESKD patients. These were compared with sex-, age-, and calendar year-matched referents to determine the loss of employment duration and productivity of ESKD patients.ResultsESKD patients experienced a loss of approximately 25–56% in lifetime employment duration and a larger loss of about 32–66% in lifetime productivity after adjustments for different age, sex, and calendar year. The annual productivity loss per male (female) ESKD patient relative to that of the age-and calendar year-matched referent ranges from 75.5% to 82.1% (82.3% to 90.3%). During the periods when they are able to work (over the on-the-job duration) male ESKD patients lose between 34 and 56% of their income, and female ESKD patients lose between 39 and 68% of their income, compared to the age-and calendar year-matched referents. The loss of lifetime productivity is a combination of reduced lifetime employment duration, functional disability, absenteeism, and presenteeism at the workplace. The loss related to presenteeism is implied by the reduced wages.ConclusionsIn addition to the loss of employment duration, we have empirically demonstrated the lifetime loss of productivity in patients with ESKD, also indicating the “presenteeism” resulted from inability to perform their job with full capacity over long-term periods.

Epidemiology of tobacco use in dialysis patients in France and survey of nephrologists' involvement in counseling ontobacco discontinuation.

Tobacco smoking is an independent risk factor for chronic kidney disease (CKD) and increases morbidity and mortality in CKD patients. The primary objective of the study was to investigate the epidemiology of smoking in patients undergoing maintenance dialysis in France. A second objective was to assess the involvement of nephrologists in supportingpatients forsmoking cessation. Data on the smoking history of prevalent patients on maintenance dialysis in France between 2010 and 2020 were obtained from the REIN database (Renal Epidemiology and Information Network),updated by all French nephrology and dialysiscenters. As for the support to smoking discontinuation, a questionnaire on smoking cessation assistance was sent to all members of the French Society of Nephrology, Dialysis and Transplantation (SFNDT). The proportion of current smokers among patients on maintenance dialysis was 10.4% in 2010, 11.2% in 2015 and 11.6% in 2020. A total of 228 nephrologists among the 790 members of the SFNDT participated in the survey (28.9%). Most respondents were women (57.3%), worked at a public hospital (61.1%), were under 40years of age (51.3%) and had no history of smoking (60.8%). The majority reported asking patients about their smoking status and offering brief advice. Among respondents, 72.8% offered help with smoking cessation, 46.3% referred their smoking patients to a tobacco specialist, 51.8% reported prescribing drugs to quit tobacco, and 81.6% requested further training in howtosupport patients forsmoking cessation. Smoking cessation training for nephrologists and dedicated programs for patients in nephrology units could improve our practices and decrease the high prevalence of smoking in patients with ESKD.

Hepatitis C Infection in Hemodialysis Patients, Makkah, Saudi Arabia

Hepatitis C virus (HCV) infection is the most common cause of chronic liver disease in the world and evaluation of the epidemiology of HCV infection was made possible by the development of a serological assay to detect antibodies to epitopes of HCV. Hemodialysis (HD) is considered to be one of the main risk factors of HCV transmission. The prevalence of antibodies to HCV (anti-HCV) in patients undergoing maintenance dialysis therapy (MDT) was found to be one of the highest among different risk groups and there is wide variation in the prevalence of HCV infection among different dialysis units and countries. Therefore, the prevalence of anti-HCV was studied in patients undergoing MDT. The current study is a cross section one, where a sample of 361 HD patients were selected randomly from HD centres in three governmental hospitals in Makkah city and they were subjected to assessment for the prevalence of anti-HCV by using questionnaires in addition to clinical measurements. The overall prevalence of anti-HCV among HD patients was 49.9% according to clinical measurements and questionnaires. The overall prevalence of anti-HCV among HD patients in Makkah city (49.9%) was comparable to that reported from other parts of the Kingdom of Saudi Arabia (KSA) and it is almost similar to the already reported positivity rate of (43.2%) from the eastern region of KSA and southern regions of KSA (45.5%). However, Strict adherence to universal precautions as recommended by the Centre for Diseases Control (CDC), meticulous regular disinfection of HD machines, Strict isolation of HCV-positive patients, dedicated dialysis machines and nursing staff at new dialysis set-up could possibly be the reasons of relatively low anti-HCV positivity at the current study than that reported by Shaheen et al., from four centres in the western region of KSA, (72.3%) and that by Huraib et al., in their multi-centre study in KSA, (68%) as well as the mean national rate. On the other hand, the use of more sensitive third generation enzyme - linked immunosorbent assay (ELISA) technique, long duration on HD, multiple blood transfusions, patients with dialysis treatment in multi-centres, factors related to infrastructure, environment and operational system might be responsible for the high prevalence of anti-HCV found in this study than that reported by Saeed et al., from Riyadh and those observed in the central region of KSA. Although routes of transmission are still unclear, early detection of all infected patients is mandatory for HCV prophylaxis in HD patients. Furthermore, an intensive educational program for staff members, HD patients and proper evaluation of the HD situation are needed. Thus, observation of appropriate preventive measures by all HD-centres is paramount.

The Relationship between Nutritional and Biochemical Markers with Growth Parameters in Adolescents with Chronic Kidney Disease on Maintenance Dialysis

Background: Adolescents with chronic kidney disease (CKD) undergoing maintenance dialysis often experience challenges related to nutritional and biochemical markers, which can impact their growth parameters. Understanding the association between these markers and growth outcomes is crucial for optimizing the management of CKD in this population. Objectives of the study: The objective of this study is to investigate the relationship between nutritional and biochemical markers and growth parameters in adolescents with CKD undergoing maintenance dialysis in a cross-sectional single-center setting. Methodology: Participants recruited for this study were children aged 12–18 years diagnosed with CKD 5 undergoing maintenance dialysis. The assessed nutritional and biochemical markers included dry weight, body mass index (BMI), caloric and protein intake, normalized protein catabolic rate (nPCR), total body fat percentage, muscle mass, serum albumin, blood urea nitrogen, serum creatinine, and C-reactive protein. Results: Twenty-six children were enrolled in the study (male: female – 1:1.6). Thirteen participants were from each treatment group (peritoneal dialysis and hemodialysis). Among them, twenty (76.9%) exhibited stunting, defined as a height percentile below the third percentile for the group’s population. Notably, patients with stunting showed a significant decrease in dry weight (37.4 kg vs. 54.7 kg, P &lt; 0.01) and BMI (17.3 kg/m2 vs. 22.3 kg/m2, P = 0.03). Serum creatinine levels were notably lower among patients with stunting compared to those with normal height percentiles (728 μmol/L vs. 969 μmol/L, P &lt; 0.01). Using bioelectrical impedance, muscle mass was noted to be significantly reduced in those with stunting compared to children with normal growth. Furthermore, a significant association was observed between nPCR and protein intake (P = 0.010). Conclusion and Recommendation: This study reveals a high prevalence of stunting in pediatric CKD patients on maintenance dialysis, suggesting compromised nutritional status. CKD patients with stunting exhibit reduced muscle mass and lower serum creatinine levels. Additionally, nPCR appears to be a useful marker for assessing protein adequacy. These findings highlight the need for early and regular monitoring of growth parameters, comprehensive biochemical assessments, and further research to enhance outcomes in pediatric CKD patients.

Clinical Course and Factors Correlated with Severe Morbidity and Mortality in Patients with Coronavirus Disease 2019 Undergoing Maintenance Dialysis in Kanagawa, Japan.

Objective Patients undergoing maintenance dialysis are at a higher risk of morbidity and mortality due to severe coronavirus disease 2019 (COVID-19) than the general population. However, longitudinal data regarding this subpopulation of patients are lacking. We therefore examined the prognosis of patients with COVID-19 undergoing maintenance dialysis between 2020 and 2023. In addition, we explored the factors correlated with COVID-19 severity, focusing on the transition thereof throughout the observational period. Methods The primary outcome was the progression to severe or fatal COVID-19. We evaluated the correlation between the primary outcome and baseline demographic and clinical characteristics of patients. Patients undergoing maintenance dialysis who were hospitalized for mild-to-moderate COVID-19 between February 2020 and April 2023 were enrolled at four institutions in Kanagawa, Japan. Results Of the 173 patients, 7 (4.0%) developed severe COVID-19, and 12 (6.9%) died. The severe/death cohort was significantly older, with a higher percentage of unvaccinated patients than the non-severe cohort (58.2% and 25.0%, respectively; p=0.016). Thymus and activation-regulated chemokine levels on admission were lower in the severe/death cohort than in the non-severe cohort, albeit not to a statistically significant degree (148±84 mg/dL and 342±657 pg/mL, respectively; p=0.082). A multivariate logistic regression analysis revealed that the odds ratio for severe morbidity or death was 0.23 (95% confidence interval: 0.07-0.75) for vaccinated patients. Conclusion In patients undergoing maintenance dialysis, the severity rate of COVID-19 is approximately 10%. Vaccination was correlated with a reduced risk of severe COVID-19.

Application of genetic risk score for in-stent restenosis of second- and third-generation drug-eluting stents in geriatric patients

BackgroundThe second-and third-generation drug-eluting stents (DESs) in-stent restenosis (ISR) genetic risk score (GRS) model has been previously validated. However, the model has not been validated in geriatric patients. Therefore, we conducted this study to test the feasibility of the DES-ISR GRS model in geriatric patients with coronary artery disease (CAD) in Taiwan.MethodsWe conducted a retrospective, single-center cohort study and included geriatric patients (age ≥ 65 years) with CAD and second-or third-generation DES(s) deployment. Patients undergoing maintenance dialysis were excluded. ISR was defined as ≥ 50% luminal narrowing on the follow-up coronary arteriography. The DES-ISR GRS model included five selected exonic single-nucleotide polymorphisms (SNPs): CAMLG, GALNT2, C11orf84, THOC5, and SAMD11. The GRS was defined as the sum of the five selected SNPs for the risk allele.ResultsWe enrolled 298 geriatric patients from January 2010 and December 2019 in this study. After propensity score matching, there were 192 geriatric patients with CAD in the final analysis, of which 32 patients had ISR. Patients were divided into two groups based on their GRS values: low (0–2) and high (≥ 3) GRS. A high GRS was significantly associated with DES-ISR in geriatric patients.ConclusionThose geriatric patients with a high GRS had significantly higher second-or third-generation DES ISR rates. The five SNP-derived DES-ISR GRS model could provide genetic information for interventional cardiologists to treat geriatric patients with CAD.Trial registrationThe primary study protocol was registered with clinicaltrials.org. with registration number: NCT03877614; on March 15, 2019. (http://clinicaltrials.gov/ct2/show/NCT03877614)

Lupus activity and outcomes in lupus patients undergoing maintenance dialysis.

Lupus activity has long been considered to decline after initiation of maintenance dialysis (MD). This assumption is based on limited historical data. We aimed to describe the natural history of lupus in patients undergoing MD. We assembled a national retrospective cohort of lupus patients who started dialysis between 2008 and 2011, included in the REIN registry with a 5-year follow-up. We analysed healthcare consumption from the National Health Data System. We evaluated the proportion of patients 'off-treatment' (i.e. receiving 0-5 mg/d of corticosteroids, without any immunosuppressive therapy) after the start of MD. We describe the cumulative incidences of non-severe and severe lupus flares, cardiovascular events, severe infections, kidney transplantation and survival. We included 137 patients (121 females and 16 males), with a median age of 42 years. The proportion of patients 'off-treatment' at dialysis initiation was 67.7% (95% CI: 61.8, 73.8%), and increased to 76.0% (95% CI: 73.3, 78.8) at 1 year and 83.4% (95% CI: 81.0, 85.9%) at 3 years, with a lower proportion in younger patients. Lupus flares mainly occurred in the first year after MD initiation, and at 12 months 51.6% of patients had presented a non-severe lupus flare and 11.6% a severe lupus flare. In addition, 42.2% (95% CI: 32.9, 50.3%) and 23.7% (95% CI: 16.0, 30.7%) of patients at 12 months had been hospitalized for cardiovascular events or infections, respectively. The proportion of lupus patients off-treatment increases after MD initiation, but non-severe and severe lupus flares continue to occur, mainly during the first year. This calls for the continued follow-up of lupus patients by lupus specialists after dialysis initiation.

Effects of sacubitril-valsartan in patients undergoing maintenance dialysis

Objectives Data on angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril-valsartan (SV) in patients undergoing maintenance dialysis is scarce. Our study aimed to investigate the effect of SV on patients undergoing dialysis. Methods We retrospectively reviewed the data of end-stage kidney disease (ESRD) patients undergoing either peritoneal dialysis (PD) or hemodialysis (HD) in our center. A total of 51 patients receiving SV treatment were enrolled in the SV group. Another 51 age and sex-matched patients on dialysis without SV treatment were selected as the control group. All the patients were regularly followed up in the dialysis clinic. Their clinical, biochemical, and echocardiographic parameters were all recorded at baseline and during follow-up. The effect and safety of SV were further analyzed. Results A total of 102 ESRD patients on dialysis (51 patients in the SV group and 51 patients in the control group) were finally enrolled. The median follow-up time was 349 days (interquartile range [IQR]: 217–535 days). The level of B-type natriuretic peptide (BNP) (median [IQR] before and after SV treatment: 596.35 pg/ml [190.6–1714.85] vs. 188.7 pg/ml [83.34–600.35], p < 0.001) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) (median [IQR]: 6316.00 pg/ml [4552.00–28598.00] vs. 5074.00 pg/ml [2229.00–9851.00], p = 0.022) were significantly decreased after treatment with SV. The variant rate of left ventricular ejection fraction (LVEF) was significantly higher in the SV group compared to the control group, especially in the PD subgroup. No significant difference was found in other echocardiographic parameters between SV and control group. Subgroup analysis of the PD group showed an increase in daily PD ultrafiltration (median [IQR]: 400 ml/d [200-500] vs. 500 ml/d [200–850], p = 0.114) after SV treatment. Variant rate of overhydration (OH) measured by the body composition monitor (BCM) of the SV group were significantly different from the control group (median [IQR]: −13.13% [−42.85%–27.84%] vs. 0% [−17.95%–53.85%], p = 0.049). The rate of hyperkalemia was slightly higher but without significant difference before and after the introduction of SV (19.6% vs. 27.5%, p = 0.350). No event of hypotension and angioedema were observed. Conclusions SV might have a cardio-protective role in ESRD patients undergoing dialysis, especially in PD patients. Serum potassium should be monitored during the treatment.

#5019 MORTALITY FOR COVID-19 IN UNDERGOING MAINTENANCE DIALYSIS PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Background and Aims Since December 2019, patients undergoing maintenance dialysis have been significantly affected by COVID-19, facing higher risk of death than general population. However, current evidences assess the mortality of patients with COVID-19 remains incomplete. We performed meta-analyses of overall mortality in dialysis patients after SARS-CoV-2 infection. In addition, this study investigated the differences among different races,viral variants, hemodialysis and peritoneal dialysis with COVID-19. At the same time, the mortality rate of dialysis patients with the COVID-19 after vaccination was also observed. Method We performed a meta-analysis with literature searching in PubMed, EMBASE, Web of Science and Cochrane databases, published between December 1, 2019 and January 10,2023. Two authors separately screened the titles and abstracts of the documents and ruled out irrelevant articles. Fixed effects model and random effects model were used for calculating heterogeneity. Results A total of 83 studies included 7278 died from confirmed COVID-19 cases in a pool of 42925 dialysis patients. Overall mortality of COVID-19 in dialysis patients was 22% (95%Confidence Interval [CI]:19%-25%, p&amp;lt;0.01; I2 = 96.74%) from 2020 to 2022. In subgroup analysis, compared with ancestral COVID-19 (23%,95%CI:20%-25%,p&amp;lt;0.01; I2 = 93.01%) and alpha variant (30%, 95% CI:21%-54%,p&amp;lt;0.01;I2 = 95.35%),omicron variant (4%,95%CI:0-14%,p = 0.09; I2 = 0) had a lower morality significantly (Figure 1). The mortality for Asian and non-Asian were 20% (95% CI:16%-25%,p&amp;lt;0.01;I2 = 96.6%) and 24% (95%CI:20%-27%,p&amp;lt;0.01; I2 = 96.32%) respectively. The odds of death for maintenance hemodialysis and peritoneal dialysis were similar (odd ratio [OR] 1.30,95%CI:0.88-1.93,p = 0.191,I2 = 0). Furthermore, we also compared vaccination with unvaccination, and found out that vaccination was associated with lower mortality (OR = 0.18, 95%CI:0.11-0.28,p&amp;lt;0.01;I2 = 71.4%) (Figure 2). Conclusion Patients undergoing maintenance dialysis with COVID-19 have a higher morality. These findings suggest that the mortality of omicron variant may be lower than other variants. In our study, there's no significant difference in mortality between hemodialysis and peritoneal dialysis patients with COVID-19. Moreover, vaccines have a good protective effect on dialysis patients.

#4376 THE ASSOCIATION AMONG CAROTID IMT, PWV AND VASCULAR ACCESS FAILURE IN HEMODIALYSIS PATIENTS

Abstract Background and Aims Patients with chronic kidney disease (CKD) or end stage renal disease (ESRD) have an increased risk of cardiovascular mortality and morbidity. We aimed to compare the value of IMT with tests such as coronary CT and Pulse wave velocity(PWV) as predictors of cardiovascular risk in ESRD patients undergoing maintenance dialysis and examine their association with cardiovascular disease. Method We reviewed the participants’ medical records, including height, body weight, smoking status, alcohol intake, medication history, etiology of ESRD, HD vintage, and blood pressure which were measured during hemodialysis. Carotid dopplerwas performed by an skilledsonographer who are unaware of the aims of the study and blinded to the laboratory findings. For PWV measurement, Patients lie down, rest for at least 5 minutes, and prohibit smoking and coffee for 3 hours before the measurement. BaPWV is measured by recording pulse waves of both arm and both ankles from the pressure signal obtained by measuring 4-extremitiy blood pressure. Results One hundred patients were included, of whom 51 (50.5%) were men. The median age was 66years (interquartile range 58-76 years). The median vintage of hemodialysis was 47.5 months (range 31.3-89.1 months). There were no significant differences between high IMT groupand low IMT group in sex, hemodialysis vintage, end-stage renal disease etiology, and type of vascular access. However, age was significantly older in the high IMT group. IMT was significantly associated with PWV. (hazard ratio [HR] 2.109; 95% CI 1.037-4.291, P = 0.039). After adjusting for age, sex and presence of diabetes, IMT was independently associated with PWV (HR 2.110, 95% CI 1.036-4.298, P = 0.040). The risk of recurrent vascular access failure was higher in the high IMT group (HR 1.615, 95% CI 1.460-5.669, P = 0.034). Conclusion IMT was associated with PWV and recurrent access failure. Thus IMT may be suggested as a potential predictor of vascular access failure.

Association between apathy in patients with maintenance dialysis and hospitalization or mortality: a prospective cohort study.

Patients receiving maintenance dialysis experience increased rates of hospitalization and mortality. Apathy is associated with reduced quality of life and increased hospitalization, institutionalization, and death. Whether apathy contributes to poor outcomes in population undergoing maintenance dialysis remain unknown. We conducted a prospective cohort study of maintenance dialysis population who were consecutively recruited at the Dialysis Center of Shanghai General Hospital between July 2017 and August 2018 and were followed up for 3 year. Apathy status was measured by the Apathy Evaluation Scale. The study outcomes were the occurrence of death and first hospitalization. A total of 647 participants included in this study, 274 (42.3%) had a current apathy and 373 (57.7%) were not. During the follow-up period, 394 (60.9%) were hospitalized, and 169 (26.1%) died. Kaplan-Meier analysis showed that the risks of hospitalization and mortality were significantly higher in individuals with apathy than in those without apathy (both p < 0.001). Apathy at baseline was associated with hospitalization and death both in univariate analysis and in all multivariable models (all p < 0.001). Apathy was highly prevalent and independently correlated with an increased risk of poor outcomes in patients with maintenance dialysis.

Association between Intra- and Extra-Cellular Water Ratio Imbalance and Natriuretic Peptides in Patients Undergoing Hemodialysis

Natriuretic peptides are associated with malnutrition and volume overload. Over-hydration cannot simply be explained by excess extracellular water in patients undergoing hemodialysis. We assessed the relationship between the extracellular and intracellular water (ECW/ICW) ratio, N-terminal pro-B-type natriuretic peptide (NT-proBNP), human atrial natriuretic peptide (hANP), and echocardiographic findings. Body composition was examined by segmental multi-frequency bioelectrical impedance analysis in 368 patients undergoing maintenance dialysis (261 men and 107 women; mean age, 65 ± 12 years). Patients with higher ECW/ICW ratio quartiles tended to be older, were on dialysis longer, and had higher post-dialysis blood pressure and lower body mass index, ultrafiltration volume, serum albumin, blood urea nitrogen, and creatinine levels (p < 0.05). The ECW/ICW ratio significantly increased with decreasing ICW, but not with ECW. Patients with a higher ECW/ICW ratio and lower percent fat had significantly higher natriuretic peptide levels. After adjusting for covariates, the ECW/ICW ratio remained an independent associated factor for natriuretic peptides (β = 0.34, p < 0.001 for NT-proBNP and β = 0.40, p < 0.001 for hANP) and the left ventricular mass index (β = 0.20, p = 0.002). The ICW-ECW volume imbalance regulated by decreased cell mass may explain the reserve capacity for fluid accumulation in patients undergoing hemodialysis.

Meta-analysis of cancer risk among end stage renal disease undergoing maintenance dialysis.

Currently, there is no consensus on whether maintenance dialysis increases cancer risk in patients with end-stage renal disease (ESRD). Therefore, this study was to systematically evaluate the risk of cancer among ESRD patients undergoing maintenance dialysis. Related studies on the impact of maintenance dialysis on cancer risk were retrieved from PubMed, Embase, Cochrane Library, and other databases from their respective inceptions to 19 February 2021. ESRD patients receiving maintenance dialysis were classified into cancer including non-melanoma skin cancer (NMSC) and cancer excluding NMSC. Standardized incidence ratio (SIR) with its 95% confidence interval (95% CI) was calculated to assess cancer risk. Fourteen studies were included in the meta-analysis. The risk of cancer in patients undergoing maintenance dialysis (with or without NMSC) was significantly higher than controls both in cancer including NMSC (SIR = 1.38, 95% CI: 1.27-1.49, P < 0.001) and cancer excluding NMSC (SIR = 1.34, 95% CI: 1.23-1.47, P < 0.001). Subgroup results identified the higher risk of cancer incidence in both men and women receiving maintenance dialysis. Meanwhile, elevated excess risks were observed among patients with younger age and shorter follow-up time (P < 0.001). Meanwhile, the combined SIR of bladder, cervix, colorectum, kidney, liver, thyroid, tongue, and other cancers were all increased (P < 0.05). ESRD patients undergoing dialysis has higher risk of cancer.

Humoral response to vaccination against SARS-CoV-2 in patients undergoing dialysis

Patients undergoing maintenance dialysis have a higher mortality rate associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and response rates to vaccination against SARS-CoV-2 vary from 29.6% to 96.4% in such patients. This study aimed to assess the immunogenicity of SARS-CoV-2 vaccination in Korean patients undergoing dialysis. We enrolled 70 SARS-CoV-2-vaccinated patients undergoing dialysis, with 11 healthcare workers serving as healthy control subjects. Thirty-two patients had received a third vaccination, whereas 38 had received 2 vaccinations. The healthy control subjects completed the second vaccination. Immunoglobulin G (IgG) antibodies targeting the receptor-binding domain of the S1 subunit of the SARS-CoV-2 spike protein were measured The vaccination responder rates were 86% (37/43), 96% (26/27), and 91% (10/11) in the patients undergoing hemodialysis and peritoneal dialysis and healthy controls, respectively. IgG antibody levels were significantly higher when a third dose was administered, independent of the type of vaccine or the time interval between vaccination and the subsequent blood sampling date. When a third dose of vaccine was administered, there was no difference in IgG antibody levels between those receiving cross-vaccination or a single vaccine. There was no significant difference in IgG antibodies between healthy controls and patients undergoing dialysis. Patients on dialysis exhibited a sufficient antibody-related response to vaccination against SARS-CoV-2, even in those receiving cross-vaccination, and the antibody titer was higher after a third vaccination. Therefore, it is necessary to administer a third vaccine dose to Korean patients undergoing dialysis.