Urea Reduction Rate Research Articles

Cephalic arch stenosis: an analysis of outcome by type of first intervention

BackgroundCephalic arch stenoses (CAS) occur in near 70% of elbow arteriovenous fistulas. Percutaneous transluminal angioplasty (PTA) remains first-line treatment despite documented stent-grafts (SG) efficacy. The study aim is to report long-term outcomes based on initial treatment of CAS.MethodsRetrospective review of 12-year data in single tertiary centre. Outcomes included technical success, rupture rate, primary patency (PP), dialysis performance; categorical variables assessed via χ2 or Fisher’s; nonparametric tests used for skewed data. Kaplan–Meier analysis used for PP and cumulative patency. Cox proportional hazard regression model to assess explanatory variables in PP.ResultsOne hundred one brachio- and radiocephalic fistulas with CAS were included. SG as first intervention had higher success than PTA (85% vs 61%, p = 0.003). Rupture occurred in 9/85 (10.6%) PTA vs 0% in SG (p = 0.046). In a subgroup with poor urea reduction rate (URR), both PTA and SG improved dialysis performance post-intervention (p = 0.002). SG demonstrated better PP than PTA (79,73,60% patency at 3, 6, 9 months; versus 71,51,47%; p = 0.195) and cumulative patency (73,61,61% at 1, 2, 3 years; versus 60,34,26%; p < 0.001). Of the variables analyzed, technical success of PTA was the only discriminating factor (coeff.-1.01; RR 35%, p = 0.035). Accesses that underwent secondary stenting performed better than primarily stented CAS (p = 0.01).ConclusionsSG superiority is confirmed in CAS, particularly when angioplasty is unsuccessful. While PTA has short-lived benefits, it can improve dialysis performance. Other than higher success rate, primary CAS stenting did not have advantages compared to post-PTA stenting in our study. Other factors related to inflow, outflow, conduit characteristics are presumed to be involved in access longevity.

Adequacy of haemodialysis and associated factors among patients with end-stage kidney disease in Tanzania

ObjectivesAdequate haemodialysis helps maintain normal renal function by removing toxins and other waste products in patients with end-stage kidney disease. This study was aimed at determining the prevalence and predictors of adequacy of haemodialysis and outcomes in patients with end-stage kidney disease. MethodsThis longitudinal analytical hospital-based study was conducted at two dialysis centres in Dodoma city, Tanzania, between February and July of 2020. Adequacy of haemodialysis was measured with single-pool (sp) Kt/V and urea reduction rate (URR) formulae. Binary logistic regression and multivariable analysis were used to assess the independent predictors of adequacy of haemodialysis. ResultsThe analysis included 100 patients with a mean age of 50.6 ± 15.0 years. The prevalence of adequacy of haemodialysis according to URR and sp-Kt/V was 72 % and 75 %, respectively. Having <12 months since dialysis initiation (AOR = 7.3, 95 % CI = 0.11–0.90, p = 0.032), fewer than three dialysis sessions per week (AOR = 6.9, 95 % CI = 1.52–31.49, p = 0.013) and severe anaemia (AOR = 2.2, 95 % CI = 0.26–0.93, p = 0.033) were predictors of inadequate haemodialysis, according to the URR formula. Having fewer than three dialysis sessions per week was significantly associated with inadequate haemodialysis (AOR = 5.6, 95 % CI = 1.47–19.66, p = 0.011), according to the sp-Kt/V formula. The mortality rate was 11.2 %, and cardiovascular disease and uremic syndrome were responsible for most deaths. ConclusionThis study indicated a high percentage of adequacy of haemodialysis among patients with end-stage kidney disease. Having fewer than three dialysis sessions per week, late initiation of dialysis after diagnosis of end-stage kidney disease and severe anaemia were predictors of inadequate haemodialysis among patients.

Hemodialysis in Brazil: differences across geographic regions regarding demographics, laboratory parameters and drug prescription.

Brazil has a vast territory divided into five geographic regions with important differences in sociodemographic indices. We aimed to present and compare socio-demographic characteristics, biochemical results, and drug prescription of patients on chronic hemodialysis (HD) treatment in the five geographic regions. We evaluated data from the Brazilian Dialysis Registry of all adult patients undergoing chronic HD in 2021. Variables included sociodemographic characteristics, serum levels of phosphate, calcium, and albumin, hemoglobin, urea reduction rate, and prescription of phosphate binders, erythropoietin, and intravenous iron. Data from the North and Northeast regions were combined into one group. A total of 13,792 patients (57.9 ± 16.0 years old, 58.5% male, median HD vintage of 31 (11-66) months) from 73 dialysis centers were analyzed. Regional distribution was 59.5% in the Southeast; 21.7% in the South; 5.9% in the Midwest; and 12.9% in the North/Northeast. Sociodemographic features, biochemical results, and medication prescriptions differed across regions. The prevalence of elderly patients was lower in the Midwest and North/Northeast. The South region had the highest prevalence of hyperphosphatemia (41.2%) and urea reduction rate <65% (24.8%), while anemia and hypoalbuminemia were more prevalent in the Southeast, 32.7% and 11.6%, respectively. We found differences in socio-demographics, clinical features, and drug prescriptions across Brazilian geographic regions. Some findings reflect the socio-demographic diversity of the country, while others deserve further elucidation.

Impact on health outcomes of hemodialysis patients based on the experience level of registered nurses in the hemodialysis department: a cross-sectional analysis.

The aim of the study is to improve the policy of health authorities regarding registered nurses (RNs) staffing by understanding how the health outcomes of hemodialysis (HD) patients vary depending on the level of HD nursing experience of at least 2 years. The study included 21,839 patients who started maintenance HD for 3 months in early 2013 in the same medical institutions. Demographic variables such as sex, age, and causes of HD; institutional variables such as type of institution and number of RNs; and health outcomes such as HD adequacy, systolic and diastolic blood pressure (SBP, DBP), hemoglobin (Hb), and serum albumin were collected through web-based questionnaires. To determine the relationship between variables, t-test, chi-square test, and ANOVA were employed. Binary logistic regression was used to examine the odds ratio. Institutions with 100% of experienced RNs with at least 2 years of experience in HD units were found to have higher NKF K-DOQI criteria satisfaction rate than Institutions with <50% of experienced RNs with at least 2 years of experience in HD units for all health outcomes, except DBP (42.9% vs. 38.8%, p < .001) and Hb (27.8% vs. 24.4%, p < .001). Four of the six health-related variables-HD adequacy (Kt/v, urea reduction rate, URR), SBP, and serum albumin-were higher in institutions with 100% of experienced RNs than those with less than 50%. In order to improve HD patients' health outcomes, HD institutions should prioritize recruiting RNs who are proficient in HD care. A higher proportion of skilled RNs results in a higher ability to prepare for emergencies and early detection of patient complications. RNs with extensive experience in HD nursing, therefore, promote quality management of HD patients.

The Significance of Neutrophil-to-Lymphocyte Ratio as an Inflammatory Marker of COVID-19 in Hemodialysis Patients

Abstract Background One of the emerging -rapidly spreading- leading causes of pneumonia worldwide is a novel Corona virus, severe acute respiratory syndrome (SARS-CoV-2) causing coronavirus disease 2019. (COVID 19). ESRD patients are at high risk for COVID 19 associated morbidity and mortality. Aim To determine the significance of Neutrophil-to-Lymphocyte Ratio (NLR) as an inflammatory marker of COVID 19 in ESRD patients. Patients and Methods This is a prospective cohort study conducted on 84 ESRD patients on maintenance hemodialysis, receiving their treatment at Ain Shams University Hospitals from February 2021 till the end of July 2021. The study population was divided into 2 groups: Group 1: 42 ESRD patients who tested positive by reverse transcription polymerase chain reaction (RT-PCR) for SARSCoV-2 on nasopharyngeal swab samples or by typical COVID 19 radiological images on thoracic computed tomography scan. Group 2: 42 ESRD patients who tested negative by RT-PCR for SARS-CoV2 on nasopharyngeal swab samples or by normal images on thoracic computed tomography scan. Results Our data revealed that a higher level of NLR in COVID 19 group with a cut off value of 5.26. NLR was the most specific (95.24%) and sensitive (76.19%) predictor of COVID 19 among other hematological parameters. Also, NLR has a significant positive correlation with the mortality of the COVID group. Compared to the lymphocyte and neutrophil counts, NLR alone was positively correlated with the CRP in the COVID group. Our data stated that the use of anticoagulation and antiviral significantly improved the outcome of the COVID 19 patients on maintenance hemodialysis. Our study showed that COVID 19 ESRD patients had a significantly higher D dimer, LDH, CRP and hyperferritinemia than the non- COVID 19 ESRD patients. The COVID group in our study had significant hypoalbuminemia, anemia and reduced urea reduction rate (URR). Conclusion NLR, neutrophilia and lymphopenia are considered predictors of COVID 19 disease in ESRD patients. However, NLR has the highest sensitivity and specificity. Higher levels of NLR were attributed to higher mortality in ESRD patients with COVID 19 disease.

#6348 HFR USING A HIGH-FLUX DIALYZER (SUPRA-H) AS NEW EFFECTIVE ALTERNATIVE TO ON-LINE HEMODIAFILTRATION: A SINGLE SESSION ANALYSIS

Abstract Background and Aims Hemodiafiltration with regeneration of the ultrafiltrate (HFR) is a highly biocompatible dialysis technique that combines convection, diffusion, and adsorption. SUPRA-H is a new HFR system which uses a high-flux dialyzer in the diffusive stage to improve large uremic toxin removal. The aim of our study was to compare the toxin removal of the SUPRA-H system with high-volume online-hemodiafiltration (OL-HDF). Method In an open, randomized, cross-over, single-center, controlled study, 16 adult chronic hemodialysis patients were treated with SUPRA-H or OL-HDF. Hemodialysis sessions were delivered with Flexya dialysis monitor (Medtronic) in the middle-week session, lasting four hours. OL-HDF session was performed in post-dilution mode with the same high-flux dialyzer (Phylter HF17G, Medtronic) as that used in the diffusive stage of the SUPRA-H system. All other dialysis parameters were kept constant in both study arms. The reduction rate (RR) of urea, creatinine, phosphate, β2-microglobulin (β2mglob), kappa (κFLC) and lambda (λFLC) free light chains, interleukin-6 (IL-6) p-Cresyl sulfate, indoxyl sulfate and albumin, was intraindividually compared for the two dialysis types with linear mixed models. Results Whereas urea RR was significantly lower, SUPRA-H had significantly higher RR for κFLC (Median: 58.63%, IQR: 49.91-70.24) than those obtained with OL-HDF (Median: 51.97%, IQR: 37.12-62.71); p = 0.03). The RRs for the other large and protein-bound uremic toxins tended to be higher with the SUPRA-H system (Figure 1). There were no significant differences in the RRs for creatinine, phosphate, IL-6, and albumin. Conclusion The new HFR system SUPRA-H, appears to be a potential technologic step ahead in terms of improved large molecule removal for dialysis patients, and might contribute to a more adequate dialysis therapy.

Mean Urea Reduction Ratio among Patients Undergoing Hemodialysis at a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Chronic kidney disease is a major cause of mortality with a prevalence of 6%. Over the past half-century, hemodialysis has been the most preferred modality of treatment for sustaining the life of patients with end-stage kidney disease. Despite hemodialysis being freely available, achieving adequacy in hemodialysis is a challenging task. Inadequate dialysis is responsible for the high mortality. This study aimed to find out the mean value of the urea reduction ratio among patients undergoing hemodialysis at a tertiary care centre. This was a descriptive cross-sectional study conducted from 15 January 2023 to 15 April 2023. Ethical approval was taken from Institutional Review Committee (Reference number: UCMS/IRC/044/23). Patients aged >18 years, undergoing maintenance hemodialysis and giving informed and written consent were included in the study. Urea reduction rate and single-pool Kt/V were estimated. Convenience sampling method was used. Among 100 patients, the mean urea reduction ratio among the study population was 25.24±15.59%. Males represented 62 (62%) of the study population. The mean age was 47.9±14.74 years. Hypertension and Diabetes mellitus was found to be the leading cause of end-stage kidney disease with 61 (61%) and 27 (27%) respectively. The mean value of spKT/V was 0.73±0.162. The mean urea reduction ratio was found to be lower than the other studies done in similar settings. chronic kidney disease; dialysis; hemodialysis.

Anxiety Level and Dialysis Adequacy of Patients Chronic Kidney Diseases During Covid-19 Pandemic in Indonesia

There was a conflicting result of previous studies about the correlation between anxiety and dialysis adequacy. The aim of this study was to evaluate the association of anxiety level with dialysis adequacy and uncover the association of age, leucocyte, and hemoglobin with anxiety and dialysis adequacy in chronic kidney disease patients undergoing hemodialysis during the Covid-19 pandemic. A cross-sectional study was conducted on 139 patients with chronic kidney disease at a hospital in Semarang, Indonesia. The anxiety was measured by Hamilton Rating Scale for Anxiety. Urea reduction rate (URR) was calculated using a standard formula to measure dialysis adequacy. Hemoglobin and leucocyte were analyzed in the laboratory. The Pearson correlation test was used in the study. There was no significant correlation between age, hemoglobin, and leucocyte with anxiety (p&gt;0.005) and dialysis adequacy (P&gt;0.005). There was a significant correlation between anxiety and dialysis adequacy (r= -0.207; p=0.014).

Evaluation of hemodialysis adequacy using urea reduction rate and related factors in Iranian patients’ undergoing hemodialysis in Guilan, Iran

Introduction: Dialysis quality is an important factor in reducing inability and mortality in chronic kidney failure patients and can enhance their life quality and social activity. Objectives: The aim of this investigation was to examine the efficacy of dialysis based on urea reduction rate (URR) and the associated factors in hemodialysis patients due to the lack of clarity on the adequacy of dialysis. Patients and Methods: This multicenter cross-sectional study was conducted on 344 hemodialysis patients over 18 years and referred to seven dialysis centers in Guilan, Iran. The adequacy of dialysis was obtained using URR (&gt;65%) criteria. Results: The mean URR of studied patients was 63 ±10.4%. The desirable dialysis adequacy was reached in 45.9% of the patients. There was a significant negative association between URR and BMI (r= -0.155, P =0.005). Patients who had normal calcium levels had significantly higher URR adequacy than patients with abnormal calcium levels ( P &lt;0.001). The URR criterion was contrariwise associated to blood pressure before and after dialysis ( P &lt;0.05). There was a significant association between the length of the time, patients underwent dialysis (in year) and URR (R=125, P =0.023). Conclusion: This study indicated that URR is a desirable criterion for dialysis adequacy, which was associated with blood pressure, serum calcium level and body mass index (BMI). These findings suggest providing treatment strategies based on these findings to enhance the effect of dialysis adequacy.

Estimation of Urea Reduction Ratio in Dialysis Patients Per Session and Adequacy of Dialysis

Background: Chronic kidney disease is a condition in which the kidney is no more able to remove waste from the body. Through hemodialysis, the excess water and waste from the blood are removed such as urea and creatinine. The urea reduction ratio is a measure of the proportionate reduction in urea blood nitrogen throughout dialysis. It is an acceptable, easy and simple method globally to find dialysis adequacy that how much urea is removed from the body. Our study was aimed at assessing the targets to achieve the urea reduction ratio (URR), in chronic kidney disease patients who underwent hemodialysis. Methods: The pre-dialysis and post-dialysis blood samples were collected from 80 hemodialysis patients. A Performa was filled, blood pressure was monitored before mid and at the end of the session, weight was monitored and ultrafiltration for the adequacy of the dialysis. The urea reduction ratio (URR) was calculated by (pre dialysis urea – post-dialysis urea) divided by pre-dialysis urea and it is expressed in percentage. Results: The mean urea reduction rate (URR) was 74% (adequate URR is &gt;65%). The results of the pre-dialysis and post-dialysis serum urea levels. There was a significant reduction in these parameters, thus suggesting the adequacy of the dialysis. There was the achievement of the target goal. But the inadequacy was also seen at 54.7%. Conclusion: The targeted urea reduction ratio was achieved in the setup of Khyber teaching hospital, but for inadequacy, they need a lot of follow-up and supervision. Keywords: Urea reduction ratio, dialysis, hemodialysis, chronic kidney disease

Effect of the Dietary Protein Intake on Urea Reduction Rate in Patients on Maintenance Hemodialysis in Merjan Teaching Hospital

Background: Chronic kidney disease (CKD) constitutes a major health problem worldwide. The mainstay of nutritional treatment in patients undergoing maintenance hemodialysis is the provision of an adequate amount of protein and energy. Objective: The present study aims to assess the correlation of protein consumption with dialysis adequacy in patients on hemodialysis. Materials and Methods: A cross-sectional study was conducted at the Dialysis Unit of Merjan Hospitals, Babil Governorate, Iraq on 64 hemodialysis patients from April to August 2021. The tools used for the data collection were anthropometry, medical information, and 24-h dietary recalls. A descriptive analysis was performed. Results: The food intake was evaluated and compared with the recommended intake. The patients’ average energy intake was 18.7 ± 7.2 kcal/kg/day, which represents 53.4% of the recommended daily energy intake for dialysis patients. About 75% of the consumed energy was provided by carbohydrates, 12.2% was provided by fats, and the rest 14.6 was provided by protein. The average dietary intake of protein was 0.71 ± 0.29 g/kg/day. Only 7.8% of the patients had met the Recommended Dietary Allowance (RDA) of protein intake. In the study sample, the measures of the delivered dose of hemodialysis therapy are directly correlated to the amount of consumed protein per kilogram body weight. But this correlation is only significant for patients who consume 1.2 g/kg body weight or less. Conclusion: The energy and protein intake were significantly low when compared with specific recommendations for individuals in hemodialysis; a dietician has an important role in providing nutritional education to the patients to improve the nutrient intake.

Serum Sclerostin Level Is Negatively Associated with Bone Mineral Density in Hemodialysis Patients.

Background and Objectives: Sclerostin and Dickkopf-1 (DKK1) modulate osteoblastogenesis, but their role in bone loss in hemodialysis (HD) patients is inconclusive. This study investigated relationships among lumbar bone mineral density (BMD), serum sclerostin, and DKK1 in HD patients. Materials and Methods: Blood samples were obtained from 75 HD patients. Dual-energy X-ray absorptiometry measured lumbar BMD of the lumbar vertebrae (L2–L4). Enzyme-linked immunosorbent assay revealed serum sclerostin and DKK1 concentrations. Results: There were 10 (13.3%), 20 (26.7%), and 45 (60%) patients defined as presenting with osteoporosis, osteopenia, or normal BMD, respectively. Age, alkaline phosphatase, urea reduction rate, fractional clearance index for urea, sclerostin level, and percentage of female patients are significantly negatively associated with the lumbar BMD and T-score, while the body mass index and waist circumference significantly positively associated with the lumbar BMD and T-score. Multivariate forward stepwise linear regression analysis indicated that serum sclerostin (β = −0.546, adjusted R2 change = 0.454; p < 0.001), age (β = −0.216, adjusted R2 change = 0.041; p = 0.007), and percentage of female HD patients (β = −0.288, adjusted R2 change = 0.072; p = 0.0018) were significantly negatively associated with lumbar BMD in HD patients. Conclusions: Advanced age, female gender, and serum sclerostin level, but not DKK1, were negatively associated with BMD in HD patients.

Relationship Between Depression and Its Severity with Dialysis Adequacy in Hemodialysis Patients in Ahvaz Teaching Hospitals

Background: Depression is a prevalent psychological disorder among hemodialysis patients and is associated with a variety of adverse outcomes. Dialysis adequacy also affects hemodialysis patients' survival rates. Objectives: This study aimed to investigate the prevalence of depression in hemodialysis patients and its association with dialysis adequacy. Methods: In this cross-sectional study, 205 individuals undergoing hemodialysis at Ahvaz teaching hospitals in 2019 were included. The depression level was determined using the Beck Depression Inventory (BDI-II) for the participants aged below 65 years and Geriatric Depression Scale (GDS) for the patients aged above 65 years. Dialysis adequacy measures, including the Kt/V and urea reduction rate (URR), were calculated using standard formulas. Results: In this study, 60.5% of the participants suffered from depression, and the overall prevalence of depression was 54.6% in individuals aged below 65 and 67% in those aged above 65 years. Among the patients with age below 65 years, 19 persons (17.6%) were suffering from mild depression, 22 individuals (20.4%) were suffering from moderate depression, and 18 individuals (16.7%) had severe depression. Among the patients aged above 65 years, moderate depression was found to affect 45 persons (46.4%), and 20 individuals (20.6%) had severe depression. The mean values of Kt/V and URR were not significantly correlated with depression scores (P &gt; 0.05). Conclusions: Depression is a common disorder among hemodialysis patients in Iran; however, it is not significantly associated with dialysis adequacy. However, the results of studies on the relationship between depression and dialysis adequacy cannot be analyzed simply.

The Relationship between Nutritional Status and Latent Tuberculosis in Routine Hemodialysis

BACKGROUND: Malnutrition in chronic kidney disease (CKD) patients undergoing hemodialysis (HD) interferes with the natural and adaptive immune response, consequently, increasing the latent tuberculosis (TB) reactivation. AIM: This study therefore aims to determine the relationship between nutritional status and latent TB in routine HD, using interferon gamma release assays (IGRA), to screen for latent TB. METHODS AND STUDY DESIGN: This study has an analytical observation cross-sectional design, and was conducted on 120 CKD-HD patients aged 18 years and above, and has been undergoing HD twice weekly for over 3 months, without malignancy, human immunodeficiency virus/acquired immunodeficiency syndrome, history of TB, or radiological evidence at the HD Unit of the Dr. Hasan Sadikin Hospital, Bandung, Indonesia, between March and May 2020, and not currently receiving immunosuppressant or TB therapy. In addition, the age, gender, history of Bacille Calmette-Guerin vaccine, CKD etiology, length of HD, HD adequacy, TB contact history, number of family members, smoking status, body mass index, albumin, malnutrition inflammation score, triceps skinfold thickness (TST), biceps skinfold thickness, suprailiac skinfold thickness (SIST), mid-upper arm circumference (MAC), and normalized protein catabolic rate between positive and negative IGRA groups, of each patient, were determined. RESULTS: In this study, all the patients met the inclusion and exclusion criteria. Based on the IGRA test, 47 patients (39.17%) tested positive, and 68 (56.67%) tested negative, while the results for the remaining 5 (4.16%) were indeterminate. The malnutrition inflammation score (MIS) score with positive IGRA 23.3 (20.0–26.7) was discovered to differ insignificantly (p value of 0.252) from the negative counterpart 20.0 (16.7–28.4). Meanwhile, in the HD adequacy assessment based on urea reduction rate, a statistically significant difference (p = 0.042) occurred between the positive 70.45 (65.70–76.61) and negative 74.15 (70.71–77.33) IGRA groups. In the smoking status, the positive and negative IGRA were discovered to differ significantly (30 (63.8% vs. 28 (41.2% p = 0.017) OR 2.521 (1.172–5.425). However, in the history of contact with TB patients, the positive and negative IGRA did not differ significantly (4.3% vs. 11.8% p = 0.160). Furthermore, there was a significant difference in TST and MAC, between MIS &gt;5 and MIS ≤5 (p &lt; 0.05). CONCLUSION: The assessment of nutritional status level, TST, MAC, smoking status, and adequate HD is crucial for CKD patients with routine HD, as these factors present risks of latent TB.

Serum Osteoprotegerin Level Is Negatively Associated with Bone Mineral Density in Patients Undergoing Maintenance Hemodialysis.

Background and Objectives: Osteoprotegerin (OPG), a potent osteoclast activation inhibitor, decreases bone resorption and plays a role in mediating bone mineral density (BMD). Our aim was to evaluate the relationship between BMD and serum OPG in maintenance hemodialysis (MHD) patients. Materials and Methods: Fasting blood samples were obtained from 75 MHD patients. BMD was measured by dual-energy X-ray absorptiometry in lumbar vertebrae (L2–L4). The WHO classification criteria were applied to define osteopenia and osteoporosis. A commercial enzyme-linked immunosorbent assay was used to measure serum OPG values. Results: Among all MHD patients, seven (9.3%) and 20 patients (26.7%) were defined as osteoporosis and osteopenia, respectively. Female patients had lower lumbar BMD than males (p = 0.002). Older age (p = 0.023), increased serum OPG (p < 0.001) urea reduction rate (p = 0.021), Kt/V (p = 0.027), and decreased body mass index (p = 0.006) and triglycerides (p = 0.020) were significantly different between the normal, osteopenia, and osteoporosis groups. Lumbar spine BMD was positively correlated with body mass index (BMI) (p < 0.001) but negatively correlated with OPG (p < 0.001) and age (p = 0.003). After grouping patients into T scores < −1 and < −2.5, female sex and OPG (adjusted odds ratio [aOR] 1.022, 95% confidence interval [C.I.] 1.011–1.034, p < 0.001) were predictors of T scores < −1, whereas only OPG was predictive of T scores < −2.5 (aOR 1.015, 95% C.I. 1.005–1.026, p = 0.004) by multivariate stepwise logistic regression analysis. The areas under the curve for predicting T scores < −1 or < −2.5 were 0.920 (95% C.I. 0.834–0.970, p < 0.001) and 0.958 (95% C.I. 0.885–0.991, p < 0.001), respectively. Conclusions: Increased serum OPG negatively correlated with lumbar BMD and could be a potential biomarker predictive of osteoporosis in MHD patients.

Frequency of Helicobacter pylori in patients hemodialysis its correlation with demographic and biochemical factors; a single center study

Introduction: Hemodialysis is one of the most common methods of treating chronic kidney disease (CKD). The start time of dialysis is determined depending on the clinical findings and subjective and objective parameters. However, factors such as patient perception and anxiety related to starting dialysis can modify these parameters. Patients on hemodialysis often have gastrointestinal complications; however, it is unclear whether Helicobacter pylori infection is more prevalent in these patients. Objectives: The aim of this study was to investigate the relative frequency of levels of H. pylori antibody in hemodialysis patients and its relationship with demographic and biochemical factors of hemodialysis patients in a hemodialysis center. Patients and Methods: The present study is a cross-sectional and the target population of patients is the hemodialysis center of Amin hospital in 2019. The sampling method was a non-probabilistic sampling. The sample size in the present study was 85 people. The collected information was entered into SPSS software version 22 and analyzed with appropriate statistical tests. The significance level in the present study was less than 0.05. Results: In total, 85 patients participated in the present study, of which 68% were men and the rest were women. The cut-off point and the positive and negative border of laboratory results for H. pylori were 18.8 U/mL. The mean level of H. pylori antibody was 87.353 ± 104.17 U/mL. In this study, significant relationship between the level of H. pylori antibody and Parathyroid hormone (PTH) was detected. PTH level was lower in patients with a positive result for H. pylori. No further relationship was detected between H. pylori infection and biochemical parameters and blood indices, as well as Kt/V and urea reduction rate (URR) was detected. Additionally, there was no significant difference in the mean level of H. pylori antibody between men and women. Accordingly, there was no significant correlation between H. pylori antibody level and age of patients, duration and number of dialysis sessions and body mass index. Conclusion: Based on the findings of the present study, mean level of PTH was significantly lower in patients with a positive result for H. pylori. No significant relationship was observed between H. pylori infection with other demographic and biochemical factors.

MO724IS INDIVIDUALIZED DIALYSATE SODIUM REASON FOR BETTER SURVIVAL IN HEMODIALYSIS PATIENTS?

Abstract Background and Aims We are uncertain about whether dialysate sodium improves overall health and well-being for people on haemodialysis, since there are a mixture of probably good and bad effects. Dialysate sodium is one of the most easy changeable parameter which can influence hemodynamic stability, echocardiography and laboratory parameters. The aim of the study was to investigate whether dialysis patients will have some beneficial effects of dialysate sodium set up according to serum sodium. Method 77 nondiabetic subjects (41men; 36women) performed 12 months hemodialysis (HD) sessions with dialysate sodium concentration setup at 138 mmol/L, followed by additional 24 month ssessions wherein dialysate sodium was set up according to pre-HD serum sodium concentration. Interdialytic weight gain (IDWG), echocardiography, laboratory parameters and survival were analysed. Results Sodium individualization resulted in significantly lower IDWG by using individualized sodium according to pre HD serum sodium compared to standard dialysate sodium (2.17±0.79 vs 1.93±0.64 kg, p&amp;lt;0,001). In all patients we confirmed positive sodium gradient and univariate regression analysis showed that by increasing the sodium gradient by 1 mmol/L, IDWG increased by an average of 0.189% and 7,1% changes in IDWG can be explain by changing of the sodium gradient. Echocardiography analysis showed an increase of 2.04 mm of left ventricular diastolic diameter (LVDD) by increasing the sodium gradient for 1mmol/L and significantly increased left ventricular mass (LVM) of 35.69 gr by 1kg increase of IDWG. Laboratory analysis showed statistical significant increase in Kt/V, URR (urea reduction rate), serum albumin and hemoglobin by using individualized dialysed sodium compared to standard dialysate sodium, respectively (1.50±0.24 vs 1.36±0.22; 70.80±5.24 vs 67.00±6.23%; 38.23±3.80 vs 34.46±2.53 g/L; 120.32±10.14 vs 114.62±10.34 g/L, p&amp;lt;0.001). We confirmed significant decrease in serum potassium, with no change in other electrolities (5.62±0.60vs 5.15±0.94). During the study, 7 patients died and binary logistic regression univariate analysis showed that significant predictors of mortality in patients dialyzed with individualized sodium dialysis according to pre-HD plasma sodium concentrations were Kt/V, URR, and CRP (C reactive protein). Analysis showed that patients with Kt/V lower than 1,2 have 8.8 times higher risk for death compared to patients with Kt/V&amp;gt;1,2, URR lower than 65% have 10,9 times higher risk compared to URR&amp;gt;65% and CRP higher than 10 mg/L have 10.2 times higher risk for death compared to patients with CRP lower than 10 mg/L Conclusion Individualization of dialysate sodium according to pre HD serum sodium concentration result in better IDWG control, improvement of fluid overload and regression of left ventricular hypertrophy, better dialysis adequacy and higher survival compared to standard dialysate sodium.

Serum Irisin Level Is Positively Associated with Bone Mineral Density in Patients on Maintenance Hemodialysis.

Background Irisin is a circulating hormone-like myokine that plays an important role in bone metabolism. We performed a cross-sectional study to investigate whether serum irisin levels correlated with bone mineral density (BMD) in patients on maintenance hemodialysis (MHD). Methods Blood samples were obtained from 80 patients on MHD, and serum irisin concentrations were determined using a commercially available enzyme-linked immunosorbent assay. BMD was measured by dual-energy X-ray absorptiometry of the L2–L4 vertebrae. Results In the study cohort, 10 (12.5%) and 19 (23.8%) patients had osteoporosis and osteopenia, respectively, and 51 (63.75%) patients had normal BMD. Lumbar T-score was negatively associated with body height (P=0.010), body weight (P=0.002), body mass index (BMI, P=0.010), and serum irisin (P < 0.001) and was positively associated with advanced age (P=0.031), female sex (P=0.001), alkaline phosphatase (ALP, P=0.010), urea reduction rate (P=0.018), and fractional clearance index for urea (P=0.020). Multivariable forward stepwise linear regression analysis revealed that high serum logarithmically transformed irisin (log-irisin, β = 0.450, adjusted R2 change = 0.258; P < 0.001), female sex (β = −0.353, adjusted R2 change = 0.134; P < 0.001), and serum ALP level (β = −0.176, adjusted R2 change = 0.022; P=0.049) were significantly and independently associated with lumbar BMD in patients on MHD. Conclusions In addition to female sex and serum ALP level, serum irisin level was positively associated with lumbar BMD in patients on MHD.

A novel method to rapidly calculate the urea clearance index and urea reduction rate based on parameters obtained during hemodialysis

BackgroundThe efficacy of hemodialysis (HD) is closely associated with patient survival time and quality of life. The classical method (CLM) to calculate the urea clearance index (Kt/V) and urea reduction rate (URR) requires multiple blood tests. A novel method that may be used as a noninvasive alternative to CLM is required. MethodsBased on the urea kinetic model, a new method, named the “assessment method” (ASM), was established to calculate blood urea nitrogen after HD, based on parameters obtained during HD. The consistency of the Kt/V and URR values between the ASM and CLM was evaluated in 41 patients from the China–Japan Friendship Hospital between September 2017 and December 2018. ResultsForty-one patients (24 males and 17 females; mean age, 55.7 ± 14.2 years) undergoing regular HD in our hospital were randomly selected for this study. The blood flow rate was 244.5 ± 19.6 mL/min and the dialysate flow rate was 500 mL/min. We obtained Kt/V (CLM = 1.40 ± 0.06, ASM = 1.37 ± 0.07) and URR (CLM = 68.6 ± 6.4%, ASM = 67.7 ± 7.2%) values. Paired t-test indicated no significant differences between the ASM- and CLM-derived values. The intraclass correlation coefficients were 0.907 and 0.916 for Kt/V and URR, respectively. Similarly, Bland–Altman plots suggested good concordance between the 2 methods. ConclusionsThe Kt/V and URR values calculated using the ASM and CLM were in significant agreement, and both can be used to effectively assess the adequacy of HD in patients undergoing maintenance HD. The ASM is an effective, rapid, inexpensive, and noninvasive alternative to the CLM for obtaining Kt/V and URR values. The ASM has good potential for clinical application, particularly for patients in areas of low socioeconomic status.

Meeting Treatment Goals in Patients on Extramural Dialysis in Health Social Security in Mexico

Introduction: For the majority of renal replacement therapy history, the main treatment option for patients with end-stage renal disease (ESRD) in Mexico has been peritoneal dialysis. However, the use of hemodialysis is overwhelmingly increasing, driving public health care institutions to subrogate this service. Even when the actual hiring model for subrogation is accurate, there is a lack of quality control points in the hemodialysis prescription, poor adherence to clinical practice guidelines, and a few or no record of outcomes in hemodialysis patients of these subrogated services. The objective of this work is to fill this information gap to allow for uniform and safe hemodialysis for patients of Mexico. Material and Methods: An observational and cross-sectional study was performed, including all patients receiving chronic hemodialysis treatment in subrogated units of Mexican Social Security Institute (IMSS) in the northern region of Mexico City. Clinical and biochemical data as well as hemodialysis dose by Kt/V and urea reduction rate were collected and evaluated. To determine distribution, mean or median and SD or interquartile range were used; for nominal variables, the difference in proportions was estimated using the χ² test; proportions were analyzed for biochemical values using the statistical package SPSS version 25. Results: In our study, >60% (485) of the patients were anemic with an average hemoglobin of 9.39 mg/dL (SD ± 1.83); serum calcium was found below 8.4 mg/dL in 51.3% (383) of patients, and only in 45.8% (342) was at an optimal level of this parameter. Only 33.5% of patients have arteriovenous fistula for dialysis access. The hemodialysis dose was optimal in >75% of patients. Conclusions: It is necessary to enhance and monitor treatment of comorbidities in patients with ESRD in subrogated hemodialysis units in México. We observed adequate prescription of hemodialysis in a majority of patients, achieving quality control points for removal of nitrogen products. Yet, there is a lack of quality control of comorbidities; therefore, we should aim to optimize treatment for mineral-bone disorder, anemia, and nutritional status.