Urea Reduction Rate Research Articles

Prevalence and association of depression with uremia in dialysis population: a retrospective cohort analysis.

Depression may hamper the immune system and nutritional status, which leads to poor outcomes of treatment. It is very common in dialysis patients. There are the numbers of parameters affected by the depression of patients and available studies are not enough to define the association between biological parameters and depression in the dialysis population. The purposes of the study were to find the prevalence of depression and association of it with the biochemical abnormalities in the dialysis patients.The selected battery of tests (clinician-administered questionnaires) were applied to dialysis patients (test cohort, n = 298) and caregivers (control cohort, n = 202) for establishing depression. The demographic and clinical conditions of participants were also collected. Univariate analysis followed by multiple regression analysis was performed for demographical parameters, clinical conditions, and laboratory results for the detection of association of them with depression. The abnormal test considered as more than 2 SD of mean below the normal value. Out of all tests, at least 2 abnormal tests were considered as mild depression. More than half of abnormal parameters among all tests were considered as moderate depression and all abnormal parameters were considered as severe depression.There was a significant difference for all the test between dialysis patients and the caregivers (P < .0001 for all). The half (153 out of 298) of dialysis patients were depressive and clinically asymptomatic. 70 (23%) dialysis patients were mild depressive, 45 (15%) dialysis patients were moderate depressive, and 38 (13%) dialysis patients were severely depressive. Serum phosphate (P = .023), level of parathyroid hormone (P = .021), and urea reduction rate (P = .048) were directly associated with depression.Biochemical abnormalities (serum phosphate level, parathyroid hormone, and urea reduction rate) were independent predictors of depression in the dialysis population.Level of evidence: III.

Increased Serum Leptin Level Predicts Bone Mineral Density in Hemodialysis Patients.

Background Leptin acts through the adipose-bone axis to regulate bone mineral density (BMD). This study evaluated the relationship between BMD and serum leptin levels in patients on hemodialysis. Methods In this cross-sectional study including 98 hemodialysis patients, BMD was measured using dual energy X-ray absorptiometry of the lumbar vertebrae (L2–L4), and serum leptin levels were determined using an enzyme immunoassay. Results There were 25 (25.5%), 13 (13.3%), and 60 (61.2%) patients with osteopenia, osteoporosis, and normal BMD, respectively. Advanced age (P=0.017); decreased body mass index (BMI, P < 0.001); body height (P < 0.001); prehemodialysis body weight (BW, P < 0.001); post-hemodialysis BW (P < 0.001); waist circumference (P < 0.001); and triglyceride (P=0.015), albumin (P=0.004), and leptin levels (P=0.017) were associated with lower lumbar T scores, whereas increased urea reduction rate (URR, P=0.004) and fractional clearance index for urea (Kt/V, P=0.004) were associated with lower lumbar T scores. The multivariable forward stepwise linear regression analysis with adjustment for sex; age; body height; prehemodialysis BW; BMI; waist circumference; logarithmically transformed triglycerides (log-triglycerides), albumin, creatinine, and leptin (log-leptin) levels; URR; and Kt/V indicated that high serum level of log-leptin (R2 change = 0.184; P < 0.001), increased prehemodialysis BW (R2 change = 0.325; P=0.008), male sex (R2 change = 0.048; P=0.001), young age (R2 change = 0.044; P=0.012), and increased serum albumin level (R2 change = 0.017; P=0.044) were significantly and independently associated with lumbar BMD. Conclusions Advanced age and female sex were associated with poor BMD, whereas increased BW, serum albumin, and leptin levels were positively associated with BMD in patients on hemodialysis.

P1116IS DIALYSIS ADEQUACY AMELIORATED AFTER INCREASING DIALYSATE FLOW RATE IN CHRONIC HEMODIALYSIS? - ONE YEAR FOLLOW-UP

Abstract Background and Aims Hemodialysis (HD) adequacy, as measured by single pool (sp) Kt/V and urea reduction rate (URR), has been reported to be ameliorated after increasing dialysate flow rate (DFR). However, this is a matter of controversy as no benefit has been observed with dialyzers incorporating features to enhance dialysate flow distribution. We investigated the effect of increasing DFR on dialysis adequacy and on various laboratory parameters. Method Twenty-three patients, M/F=20/3, aged 65(44-89) years, dialyzed thrice weekly for 50(6-274) months, using polysulfone low flux dialyzers, participated in an annual randomized cross-over study. Patients were dialyzed with DFR of 500 ml/min and 700 ml/min for 6 consecutive months respectively, according to their usual dialysis prescription and with ultrafiltration volumes according to clinical need. Blood was sampled before and at the end of midweek sessions at the beginning of the first, 7th and 13rd month for urea, creatinine, potassium, sodium, albumin, total Ca and phosphate (sP). URR, spKt/V, corrected for albumin Ca(sCa) and sCa x sP product (CaxP) values were calculated. Results Under both 500 and 700 ml/min DFRs used, the expected post-dialysis alterations were found: decreased values in serum urea (respectively 161,5±38,0 to 49,9±20.1-p&amp;lt;0,001 and 140,3±30 to 56,0±20.4 mg/dl-p&amp;lt;0,001), creatinine (respectively 10,2±2 to 3.9±1,2-p&amp;lt;0,001 and 10,2±3,3 to 4,1±1,6 mg/dl-p&amp;lt;0,001), potassium (respectively 5,2±0,7 to 3,7±0,3 mM-p&amp;lt;0,001 and 5,3±0,6 to 3,9±0,3mM-p&amp;lt;0,001) and phosphate (respectively 5,4±1,7 to 2,9±0,6-p&amp;lt;0,001 and 5,7±1,6 to 2,6±0,6 mg/dl-p&amp;lt;0,001); increased values in serum albumin (respectively 4,3±0,4 to 4,7±0,4 g/dl-p=0,001 and 4,2±0,3 to 4,7±0,4 g/dl-p&amp;lt;0,001) and sCa (9,1±0,7 to 11,3±0,9 mg/dl-p&amp;lt;0,001 and 8,7±0,6 to 9,9±0,7 mg/dl-p&amp;lt;0,001). After increasing DFR from 500 to 700 ml/min we observed no reductions in pre-dialysis serum urea and creatinine levels or URR (68,6±8,1% to 69,9±7,9%-p=NS) and Kt/V (1,41±0,4 to 1,42±0,3-p=NS) values. However, under DFR of 700ml/min post-dialysis sCa, sP and sCa x sP product values were always lower compared with those under DFR of 500 ml/min (respectively 9,9±0.7 vs 10,8±0.8 mg/dl-p&amp;lt;0,001, 2,6±0,6 vs 2,9±0,6 mg/dl-p=0,02 and 25,6±6,2 vs 30,9±6,7 mg2/dl2-p&amp;lt;0,001). Conclusion DFR increase from 500 to 700 ml/min did not lead to favorable effects on dialysis adequacy but resulted in post-dialysis amelioration of serum calcium and phosphate levels and may be useful in cases of hypercalcemia, hyperphosphatemia and calcifications. DFR increase utility needs further investigation in patients with disorders of calcium-phosphate metabolism.

P1421SERUM OSTEOPROTEGERIN LEVEL IS NEGATIVELY ASSOCIATED WITH BONE MINERAL DENSITY IN PATIENTS UNDERGOING HEMODIALYSIS

Abstract Background and Aims Osteoprotegerin, a potent osteoclast activation inhibitor, decreases bone resorption and positively affects bone mineral density (BMD). Our aim was to evaluate the relationship between BMD and fasting serum osteoprotegerin concentration in hemodialysis patients. Method Fasting blood samples were obtained from 75 chronic hemodialysis patients. BMD was measured by dual energy X-ray absorptiometry in lumbar vertebrae (L2-L4). Serum osteoprotegerin levels were measured using a commercial enzyme-linked immunosorbent assay. Results A total of 7 patients (9.3%) had osteoporosis and 20 patients (26.7%) had osteopenia in hemodialysis patients. Older age (p = 0.023), increased serum osteoprotegerin (p &amp;lt; 0.001), urea reduction rate (URR, p = 0.021), Kt/V (p = 0.027), while decreased height (p &amp;lt; 0.001), body weight (p &amp;lt; 0.001), body mass index (BMI; p &amp;lt; 0.001), and logarithmically transformed triglyceride (log-triglyceride, p = 0.020) was significantly correlated with low lumbar T-score cut-off points between groups (normal, osteopenia, and osteoporosis) in hemodialysis patients. Female patients had lower lumbar BMD than male hemodialysis patients (p = 0.002). Univariate linear regression analysis indicated lumbar BMD were positively correlated with height (p &amp;lt; 0.001), body weight (p &amp;lt; 0.001), BMI (p &amp;lt; 0.001), log-triglyceride (p = 0.004), creatinine (p = 0.016), while negatively correlated with age (p = 0.001), alkaline phosphatase (p = 0.016), URR (p = 0.012), Kt/V (p = 0.013), and osteoprotegerin (p &amp;lt; 0.001) among the hemodialysis patients. Multivariate forward stepwise linear regression analysis of the significant variables revealed that female hemodialysis patient (adjusted R2 change = 0.040; p = 0.003), body weight (adjusted R2 change = 0.126; p = 0.001), kt/V (adjusted R2 change = 0.024; p = 0.034) and osteoprotegerin (adjusted R2 change = 0.332; p &amp;lt; 0.001) were the independent predictors of lumbar BMD values in the hemodialysis patients. Conclusion Our study results revealed that increased serum osteoprotegerin levels were independently associated with decreased BMD in the lumbar spine, and with increased risk of osteoporosis in hemodialysis patients.

P1054COMBINING A HEPARIN-GRAFTED DIALYZER WITH A CITRATE ENRICHED DIALYSATE OFFERS ADEQUATE HEMODIALYSIS EFFICACY AVOIDING SYSTEMIC ANTICOAGULATION: RESULTS OF THE NON-INFERIORITY RANDOMIZED EVOCIT STUDY

Abstract Background and Aims The combined use of a heparin-grafted membrane with a citrate enriched dialysate is an effective hemodialysis strategy with low circuit clotting rates while avoiding systemic anticoagulation. Whether this technique results in dialysis efficacy that is non-inferior to regular hemodialysis using systemic anticoagulation has not been investigated up to now. Method Prevalent hemodialysis (n=26) patients were recruited for a randomized crossover non-inferiority trial powered at &amp;gt;90% to detect a prespecified non-inferiority threshold of 10% spKt/Vurea (NCT03887468). Hemodialysis using a heparin-grafted dialyzer in combination with a 1.0 mmol/L citrate enriched dialysate (“evocit”) was compared to hemodialysis using a heparin-grafted dialyzer, systemic unfractionated heparin and regular bicarbonate-based dialysate (“evohep”). Each treatment arm lasted 4 weeks with a 3x4hours weekly hemodialysis regimen. All sessions were standardized with fixed blood- and dialysate flow rates. Biological analyses were done during midweek sessions. The primary endpoint was spKt/Vurea. Secondary endpoints included alternative adequacy markers, premature treatment termination, retransfusion failure and loss of total cell volume of the dialyzer after dialysis. Results A total of 617 hemodialysis sessions were performed: 307 sessions according to evocit and 310 sessions according to evohep protocol. Mean spKt/Vurea was 1.45±0.25 for evocit sessions and 1.50±0.26 for evohep sessions. In a paired analysis, mean of the difference in spKt/Vurea between both study arms was 0.05 with a 95%CI of 0.012-0.098 (p=0.01), the upper bound of the estimate lying within the prespecified non-inferiority threshold (i.e. &amp;lt;0.15). Processed blood volume was 75.4±3L vs 75.8±1.5L and online Kt was 47.3±5L vs 48.3±4L for all evocit and evohep sessions respectively. Urea reduction rate (RR) was 71.3±5.7 vs 72.3±5.8, bèta2microglobulin RR 37.1±8 vs 37.9±8 and myoglobin RR 30.9±9.8 vs 34.5±12.5 for midweek evocit and evohep sessions respectively. Circuit thrombosis leading to premature treatment end occurred in 13/307 (4.23%) of evocit sessions in 6/26 patients but in none of the evohep sessions (p=0.03). Treatment time of evocit sessions complicated with circuit thrombosis (n=13) was reduced with 36 minutes (IQR 20-46 minutes) without impact on effective treatment times overall (236±12 vs 238±4 minutes for evocit and evohep sessions respectively). Retransfusion failure occurred in 3/307 (0.98%) of evocit sessions and none of the evohep sessions. Dialyzers’ total cell volume was reduced with 17% (IQR 11-33%) and 9% (IQR 6-17%) (p&amp;lt;0.0001) after evocit and evohep sessions respectively. Conclusion Hemodialysis avoiding systemic anticoagulation using a heparin-grafted dialyzer with a citrate enriched dialysate is an adequate technique for maintenance hemodialysis offering spKt/Vurea results within recommended dose, and is not inferior to standard hemodialysis using systemic anticoagulation with heparin in terms of spKt/Vurea. Circuit clotting complications occurred at low frequency during evocit sessions and did not have clinically significant repercussions on dialysis efficacy.

P1552CAN WE GET ADEQUATE DIALYSIS WITH LIQUID AT 300 ML/MIN ?

Abstract Background and Aims The portable HD monitors achieve a good adaptation with HD dialysate at 200ml / min using the concept of saturation of the HD dialysate. We decrease from 800ml / min to 500ml / min with good adaptation some years ago. To assess the effectiveness of HD in both HD-standard and HDF-online with dialysate flow at 300ml / min by establishing approximate mathematical model of clearance. Methods We conducted an HD session with dialysate flow at a speed of 300ml / min, half week session to 52 patients in our unit. We value vascular access, session time, liters of blood-purified and total infusion in HDF online. We review HD monitor and dialyzer. We perform pre and postHD blood determinations: Urea, B2microglobulin, P and uric acid, assessing urea reduction rate (PRU), b2microglobulin reduction rate (PR2microg) with both dialysate flows at 300ml / min and 500ml / min. We also have evaluated the differences between the two methods. In the HD dialysate flow we determine at 300ml / min at 5, 10, 30, 45 and 60min (total dialysate collection in the first hour with sample of the mixture) urea, B2microg, Uric acid and P and at 2, 3 and 4 hours establishing a mathematical model with an approximation curve in both HD and online HDF. Results Five patients in standard HD (4h), 35 HDF online (4h) (x Liters infused 24.87 ± 2.79 l) and 12 short-daily HD (2h30min). 18 catheter and 34 FAV. Xliters purified blood = HD daily 54.41 ± 5.63l, HD standard 87.38 ± 6.01 and HDFonline 82.02 ± 16.13l. The xPRU = 76.17 ± 10.49%, PRB2microg = 73.82 ± 13.49, Kt / V = 1.52 ± 0.28. By scheme at 300ml / min of HD fluid flow: HDFonline xPRU = 81.54 ± 5.25, Standard HD = 78.01 ± 3.03, Daily HD = 60.19 ± 6.71; xPRb2microg HDFonline = 76.70 ± 14.76%, Standard HD 65.44 ± 11.81, Daily HD = 69.16 ± 6.49. Comparing the xPRU at 300ml / min of liquid vs 500ml / min we didn´t found significant differences, nor in the x preHD of urea and B2microglobulin. With the dialysate samples we obtain a polynomial model of order 7 allowing cuantitative adjustment of the curve.R2 0.9, observing in the first 2 hours the greater removing. Conclusions 1. The results are sufficient to consider the result of the removing in each scheme adequate. 2. The decrease in costs would be important (40% of water + energy saving and longer duration elements water treatment. 3. Further study are necessary.

Does Adequate Hemodialysis Prevent Symptoms?: A National Cross-Sectional Survey.

The aim of this study was to identify the relationship between dialysis adequacy and the incidence of symptoms in subjects treated with HD. This descriptive and cross-sectional study was conducted at two HD centers. The data were collected with the 'Descriptive Characteristics Form of the Participants' and the 'Dialysis Symptom Index (DSI)'. The study was reported according to the STROBE Declaration. The study was completed with 120 patients. The most common symptom reported was feeling tired or decreased energy and the least common was difficulty concentrating. No statistically significant relationship was found between DSI results and the Kt/V or urea reduction rate levels used to evaluate dialysis adequacy. Dialysis-related symptoms can also be seen in patients with adequate dialysis levels. It is therefore necessary to query the symptoms experienced by the patients at regular intervals.

SAT-232 HEMODIALYSIS IN CHILDREN AND ADOLESCENTS: A SYSTEMATIC REVIEW

Hemodialysis (HD) in children is often utilized in situations such as acute or chronic kidney disease, severe electrolyte imbalance, toxicities, and hyperammonemia. Proper HD in children require careful manipulation of technical parameters including blood and dialysate flow rate, type/size of dialyzer and dialysate composition. Although general principles of hemodialysis are similar between adults and children, there are several unique aspects of HD inherent to the pediatric population. Issues of hemodynamic stability, obtaining ideal vascular access and preventing complications from HD can prove challenging in this patient population. In this systematic review, we evaluate the existing literature regarding the use of hemodialysis in children and young adults (ages 1-20 years). Furthermore, we summarize this data to compile guidelines for best practice. A systematic search of all relevant studies and abstracts was conducted using several electronic databasesby utilizing appropriate key words by an expert hospital librarian. Eligible studies included children aged 1-20 years with acute or chronic indications for hemodialysis. Studies prior to Jan 1990 or on continuous renal replacement therapy, peritoneal dialysis, modified forms of hemodialysis (nocturnal, hemodiafiltration, etc.) were excluded. In addition, studies that were non-English or involved < 5 patients were excluded. Titles and abstracts were screened by two independent reviewers, followed by a full text review of included articles. Data on HD indications, specific parameters of the HD protocol, including dialysate composition, dialysate flow, blood flow, urea reduction rate and ultrafiltration goals were collected. We also collected data regarding medications, anticoagulation and blood transfusions required along with outcomes such as mortality and kidney transplantation. Preliminary results of this systematic search returned a total number of 16,196 papers. After screening for relevant titles and abstracts, and exclusion based on criteria defined above, a total of 102 papers remained. Further assessment of full text of articles led to inclusion of 55 papers in this review. Results showed that congenital abnormalities, glomerulopathy and obstructive uropathy were some of the most common indications of HD. The mean age of HD was 12.7 ±2.9 years. Mean dialysis session duration was 223.7 ±65.6 min/session, with 3.2 ±0.6 sessions/week. Mean dialysate flow was 480±46.8 ml/min and mean blood flow was 192.5±65.5 ml/min. A subset of studies (n=5) reported mean blood flow relative to body weight as 4.7±0.5 ml/kg/min. Mean urea reduction ratio was 44.9±30.0%. Most common types of vascular access were central venous catheters and arteriovenous fistulas. The most common complications were access-related infection and thrombosis. From studies with reported outcomes, 7.68% of children died and 42% were transplanted. The use of HD in children presents unique challenges due to age-related differences in physiology, risk of complications and increased emphasis on long-term health. This systematic review summarizes the available literature on HD, in terms of indication, technical aspects and outcomes. Ultimately, this data can help to guide safe, effective HD treatment in children and in formulating guidelines for best practice.

Lower Serum Fibroblast Growth Factor 21 Levels are Associated with Normal Lumbar Spine Bone Mineral Density in Hemodialysis Patients.

Recent evidence has indicated that fibroblast growth factor 21 (FGF21) regulates longitudinal bone growth, with increased FGF21 levels leading to bone loss. The present study evaluated the relationship between bone mineral density (BMD) and serum FGF21 levels in patients undergoing hemodialysis (HD). We analyzed blood samples from 95 patients undergoing HD and measured BMD using dual-energy X-ray absorptiometry of the lumbar vertebrae (L2–L4). Serum FGF21 concentrations were determined using a commercially available enzyme-linked immunosorbent assay kit. Thirteen (11.6%) patients were found to have osteoporosis, 27 (28.4%) osteopenia, and 57 patients had normal BMD. Advanced age and decreased body mass index, height, body weight, waist circumference, and triglyceride level were associated with lower lumbar T-scores, as were increased alkaline phosphatase, urea reduction rate, fractional clearance index for urea, and FGF21 levels. Low log-FGF21, increased body mass index, increased pre-HD body weight, and increased logarithmically transformed triglycerides (log-TG) were found to be significantly and independently associated with lumbar BMD by multivariate forward stepwise linear regression analysis with adjustment for significant confounders. We conclude that high serum FGF21 level is negatively associated with BMD in patients undergoing HD.

Adequacy of Hemodialysis and Its Associated Factors among Patients Undergoing Chronic Hemodialysis in Dar es Salaam, Tanzania.

The worldwide prevalence of maintenance hemodialysis continues to rise. An adequate delivery of hemodialysis dose as measured by Kt/V or urea reduction ratio is a crucial determinant of clinical outcome for chronic hemodialysis patients. The aim of this study was to assess the adequacy of hemodialysis and its associated factors among patients undergoing chronic hemodialysis in Dar es Salaam. This was a cross-sectional study done on patients undergoing chronic hemodialysis in four dialysis centers in Dar es Salaam. Sociodemographic information and treatment characteristics were collected. Urea reduction rate and single-pool Kt/V were calculated to determine the adequacy of hemodialysis. The data were analyzed and any associated factors for inadequate hemodialysis were determined using a chi-square test and a logistic regression analysis. A total of 143 patients participated in the study. Males represented 65.7% of the study population. The mean age (±SD) was 51.7 ± 1.2 years. Only 34.3% (based on urea reduction ratio (URR)) and 40.6% (based on Kt/V) of patients received adequate hemodialysis. The univariate analysis showed that males were more likely to have inadequate dialysis (65.6% versus 48.0%, p=0.048 based on Kt/V). Patients using hemodialyzers with dialyzer surface area less than 1.4 m2 received significantly less hemodialysis dose than those with more than 1.4 m2 (69.0% versus 41.2%, p=0.02, by URR) (62.7% versus 35.3%, p=0.03, by Kt/V criteria). Patients who had hemoglobin <10 g/dl received significantly inadequate hemodialysis dose as compared to patients with hemoglobin ≥10 g/dl by Kt/V criteria (69.8% versus 51.3%, p=0.03). None of the factors acquired significance in the multivariate analysis. The proportion of patients receiving an adequate hemodialysis dose is low (34.3% based on URR and 40.6% based on Kt/V). Male gender, dialyzer surface area of <1.4 m2, and hemoglobin level of <10 g/dl were associated with an inadequate delivered dose of hemodialysis in the univariate analysis but not in the multivariate analysis. This study can increase awareness about the importance of measuring hemodialysis adequacy and giving the correct hemodialysis dose to achieve the intended benefit.

Effect of improving dialysis adequacy on the right ventricular functions

Background Right ventricular dysfunction (RVD) is a common finding in hemodialysis (HD) patients especially those who are inadequately dialyzed. The aim of this study is to evaluate the effect of improving dialysis adequacy, anemia, and hypertension treatment on the RV function in a cohort of HD patients. Patients and methods The study included 60 HD patients admitted in Mansoura University Hospital, Nephrology Unit. Assessment of patients included complete clinical evaluation, estimation of Kt/V, urea reduction rate, and RV function assessed by echocardiography; all were done at the beginning of the study and 6 months after initiation of protocols of therapy needed for improvement of dialysis adequacy, anemia, and hypertension. Tissue Doppler imaging-derived myocardial performance index was used as the main index of RVD. Results The study results revealed an increased prevalence of RVD in maintenance HD patients. Moreover, this study showed a significant improvement of the mean tissue Doppler-derived myocardial performance index in the studied patients at the end of the study (after improvement of Kt/V, anemia, and hypertension), compared with initial values at the start of the study, from 0.54±0.03 to 0.48±0.02, respectively, with significant P value of 0.001. Conclusion RVD is common among HD patients, but improving dialysis adequacy together with proper management of hypertension and anemia plays an essential role in the improvement of RVD.

Active Smoking is Associated with Lower Dialysis Adequacy in Prevalent Dialysis Patients.

BACKGROUND:Dialysis adequacy measured by single pool Kt/V (spKt/V) lower than 1.2 or urea reduction rate (URR) lower than 65% is associated with a significant increase in patient mortality rate. Patients’ adherence to the medical treatment is crucial to achieve recommended targets for spKt/V. Smoking is a recognized factor of non-adherence.AIM:In this study we sought to assess the association of active smoking and dialysis adequacy.METHODS:A total of 134 prevalent dialysis patients from one dialysis center were included in an observational cross-sectional study. Clinical, laboratory and dialysis data were obtained from medical charts in previous 6 months. The number of missed, on purpose interrupted or prematurely terminated dialysis sessions was obtained. Dialysis adequacy was calculated as spKt/V and URR. Patients were questioned about current active smoking status. T-test and Chi-Square test were used for comparative analysis of dialysis adequacy with regard to smoking status.RESULTS:The majority of patients declared a non-smoking status (100 (75%)) and 34 (25%) were active smokers. Male gender, younger age and shorter dialysis vintage were significantly more often present in the active smokers ((9 (26%) vs 25 (73%), p = 0.028; 57.26 ± 12.59 vs 50.15 ± 14.10, p = 0.012; 118.59 ± 76.25 vs 88.82 ± 57.63, p = 0.030)), respectively. spKt/V and URR were significantly lower and Kt/V target was less frequently achieved in smokers ((1.46 ± 0.19 vs. 1.30 ± 0.021, p = 0.019; 67.14 ± 5.86 vs. 63.64 ± 8.30, p = 0.002; 14 (14%) vs. 11 (32%), p = 0.023), respectively. Shorter dialysis sessions, larger ultra filtrations and higher percentage of missed/interrupted dialysis session on patients’ demand were observed in smokers (4.15 ± 0.30 vs. 4.05 ± 0.17, p = 0.019; 3.10 ± 0.78 vs. 3.54 ± 0.92, p = 0.017; 25 (0.3%) vs. 48 (1.8%), p = 0.031), respectively.CONCLUSION:Active smokers, especially younger men, achieve lower than the recommended levels for dialysis adequacy. Non-adherence to treatment prescription in smokers is a problem to be solved. Novel studies are recommended in patients on dialysis, to further elucidate the association of dialysis adequacy with the active smoking status.

Seasonal variation of biochemical parameters of hemodialysis patients in a tropical climate area

The results of hemodialysis laboratory tests guide the monitoring of the patient’s health conditions, nutritional status and the quality of the procedure. The objective is to analyze the seasonal variations of biochemical parameters of hemodialysis patients in a tropical area of Brazil. This is a longitudinal epidemiological study of the seasonal variation of repeated measurements for hemoglobin, hematocrit, calcium, potassium, phosphorus, glucose, glutamic-pyruvic transaminase, pre- and postdialysis urea, KtV, and urea reduction rate in hemodialysis patients in the city of Caceres, Brazilian Pantanal in the year 2014, in the savannah tropical climate area. January was used as the reference month and linear mixed effects regression models were used. All laboratory variables analyzed presented significant seasonal variation in at least two months in 2014. Hemoglobin and hematocrit displayed the lowest values in autumn and the highest in winter. Calcium remained stable and showed two high peaks in autumn and winter. Phosphorus, potassium and glutamic-pyruvic transaminase showed higher values in autumn and lower values in spring. KtV, urea reduction rate, predialysis and postdialysis urea, had the lowest peaks in winter and the highest in spring. Glucose showed instability with a high peak in spring and a lower peak in autumn. It is concluded that the biochemical parameters of chronic renal patients on hemodialysis display seasonal variations related to climatic seasonal variation in a tropical savannah climate area in Brazil. The variations observed tend to become inverted in the months with higher and lower temperatures.

SAT-060 SERUM IRISIN LEVEL IS POSITIVELY ASSOCIATED WITH BONE MINERAL DENSITY IN PATIENTS ON CHRONIC HEMODIALYSIS

Irisin is a circulating hormone-like myokine and plays an important role in the control of bone metabolism. It is interesting to investigate whether serum irisin level is correlated with bone mineral density (BMD) in chronic hemodialysis (HD) patients. Blood samples were obtained from 80 chronic HD patients. BMD was measured by dual energy X-ray absorptiometry of the lumbar vertebrae (L2–L4). Serum irisin concentrations were determined using a commercially available enzyme-linked immunosorbent assays. Ten (12.5%) HD patients had osteoporosis, 19 HD patients (23.8%) had osteopenia, and 51 HD patients had normal BMD. Advanced age (P = 0.031), female HD patients (P = 0.001), decreased height (P = 0.010), body weight (P = 0.002), body mass index (BMI, P = 0.010), serum irisin level (P < 0.001), was associated, while increase alkaline phosphatase (ALP, P = 0.010), urea reduction rate (URR, P = 0.018), fractional clearance index for urea (Kt/V, P = 0.020), was associated with lower lumbar T-scores. Multivariable forward stepwise linear regression analysis with adjustment for the significant variables indicated that high serum level of irisin (β = 0.462, adjusted R2 change = 0.218; P < 0.001), height (β = 0.387, adjusted R2 change = 0.163; P < 0.001), and BMI (β = 0.186, adjusted R2 change = 0.026; P = 0.034) were significantly and independently associated with lumbar BMD among the HD patients. In this study, height, BMI and serum irisin level is positively associated with lumbar BMD in chronic HD patients.

MON-098 Losses of Amino Acid in the Pre- and Post-dilution of On-line HDF under the Same Reduction Rate of β2-microglobulin

We reported that amino acid loss occurred during pre-dilution on-line hemodiafiltration (Pre-HDF) was significantly less than those of hemodialysis. Since the amino acid kinetics during HDF therapy has not clearly been understood, we compared the amino acid losses that occur on performing Pre-HDF and post-dilution on-line HDF (Post-HDF) under the same reduction rate of β2-microglobulin (β2-MG) in the present study. We compared the total amino acid, total non-essential/essential/branched-chain amino acid amount into the total waste fluid, reduction rate of Urea, Cr and β2-MG and Kt/V (urea) between 9 patients undergoing Pre-HDF (7 males, 4 diabetic, mean age: 72.4±2.1 years) and the same patients receiving Post-HDF. The mean blood flow rate in the former and latter was 222±25 and 200±0 mL/min, respectively. The dialysate flow rate was 329±49 and 556±0 mL/min, respectively. The replacement fluid flow rate was 251±27 and 44±0 mL/min, respectively. The replacement fluid volume was 57±6 and 10±0 L, respectively. The reduction rate ofβ2-MG was same between the Pre-HDF and Post-HDF group (Pre-HDF: 80.9±4.0%, Post-HDF: 80.4±3.7%, P=0.545). In the Pre-HDF group, the total and total non-essential amino acid losses (4814.3±1055.6 and 3058.4±632.0 mg, respectively) were not significantly different from in the Post-HDF group (5257.3±698.9 and 3421.9±446.8 mg, respectively) (P=0.180 and 0.116, respectively). In the former, the total essential amino acid (1755.9±503.3 mg) was not significantly different from in the latter (1835.3±351.0 mg) (P=0.401) and also in the former, the branched-chain amino acid (780.2±224.2 mg) was not significantly in the latter (816.4±210.1 mg) (P=0.139). In the Pre-HDF group, the urea and Cr reduction rates were 69.5±7.4 and 63.2±6.7%, respectively. In the Post-HDF group, the values were 70.9±4.4 and 64.8±3.9%, respectively. The values showed no significant differences between the Pre-HDF and Post-HDF group (Urea: P=0.354, Cr: P=0.309). The Kt/V (urea) values in the former and latter were 1.46±0.28 and 1.45±0.19, respectively; there was no significant difference (p=0.862). Under the same reduction rate of β2-MG, the moderate volume Post-HDF (replacement fluid volume: around 10.0 L) is as favorable as the Pre-HDF as a blood purification method from the viewpoint of nutrition.

Tympanogram Findings in Hemodialysis Patients.

The aim of this study is to investigate whether changes in cerebrospinal fluid (CSF) pressure during the hemodialysis (HD) treatment are reflected on tympanometric measurements. The study was performed on 24 HD patients. The static compliance and absorbance values of the patients before and after HD were measured using a wideband tympanometry. The tympanogram tests were performed immediately before and at the end of the HD session. The static compliance values of the patients after HD were significantly lower than those before HD. This decrease significantly correlated with the adequacy of dialysis determined by urea reduction rate and Kt/V. The absorbance values showed a decrease in the band 343 and 727 Hz, but no significant difference was found in other frequencies. The static admittance and absorbance values were influenced by the HD process. This influence might be due to the increase in CSF pressure as a result of the removal of urea from blood during HD session.

Factors affecting inadequate response to HBV vaccine in hemodialysis patients: northeast anatolia survey with six hemodialysis centers

In hemodialysis patients Hepatitis B virus (HBV) infection is one of the problems. Because of HBV vaccine response is lower than in the general population, in this study it is aimed to determine the factors that may cause inadequate HBV vaccine response in hemodialysis patients. In study, HBsAg, anti-HBs, anti-HBc IgG data belonging to 278 patients were obtained from file and computer records. It was seen that seronegative cases had been given recombinant HBV vaccine. Anti-HBs titers were monitored 1month after vaccination was completed. According to this, the patients are divided into two groups. Those with anti-HBs < 10IU/mL were identified as non-responders and with anti-HBs ≥ 10IU/mL as responders. Factors such as age, serum albumin and urea reduction rate which may affect inadequate response to HBV vaccine were evaluated. As statistical examination, Chi-square test was used for the analysis of the data determined by counting, and logistic regression was used for statistically significant independent variables in chi-square test. p value of < 0.05 was considered statistically significant (Confidence interval: 95%). Out of 278 patients, according to exclusion criteria 81 patients were excluded. 13.2%(26/197) of HBV vaccinated patients had insufficient response. The inadequate response rate to HBV vaccination was found to be higher in patients with age ≥ 65 (p = 0.039), serum albumin < 3.5g/dL (p = 0.024) and urea reduction rate ≤ 65 (p = 0.028). No statistically significant relationship was found between inadequate response to HBV vaccine and anti-HCV positivity, presence of diabetes mellitus, anemia status, vitamin D therapy and vascular access pathway variability. We conclude that relatively high patient age, low albumin level and insufficient urea reduction rate may cause inadequate HBV vaccine response. Taking these factors into consideration may provide a useful insight for an adequate response to vaccination.

Relação entre eficiência da hemodiálise e estado nutricional em pacientes com doença renal crônica

AIMS: To verify the relationships between the dialysis adequacy index (Kt/V) and nutritional parameters of individuals with chronic renal disease on hemodialysis.METHODS: A retrospective study was performed at a hemodialysis institute. Data on sex, age, biochemical tests, dry weight, height, arm circumference (AC) and triceps skin fold (TSF) were collected from the medical charts. Nutritional risk index (NRI), body mass index (BMI), arm muscle circumference (AMC), corrected arm muscle area (AMAc), Kt/V and urea reduction rate (URR). The Mann-Whitney test and the Spearman correlation were used for the statistical analysis, and a p&lt;0.05 was considered significant.RESULTS: A total of 164 patients were evaluated, with a mean age of 58±14.4 years, of which 96 (59%) were male. The median time on hemodialysis was 35.0 (5-234). Among the 164 patients, 60 (37%) presented nutritional risk. In the evaluation of nutritional status, the mean values obtained were 25.0±4.5 kg/m2 for BMI, 99.0±12.3% for CB adequacy, 86.7±14.5% for WBC adequacy, 122.9±66.8% for CBA adequacy and 1.4±0.4 for Kt/V. The median adequacy for PCT was 107.8% (11.5%-305.4%). There was no correlation of Kt/V with serum albumin, CB, CMB, AMAc and NRI. Kt/V had a low positive correlation with time on hemodialysis (r = 0.2197) and a low negative correlation with PCT (r = -0.1692) and with BMI (r = -01970). The correlation between Kt/V and dry weight was moderate and negative (r = -0.3710) and between Kt/V and URR the correlation was strongly positive (r = 0.81129).CONCLUSIONS: Adequate dialysis efficiency and good nutritional status were observed in most patients of the evaluated sample, with significant correlations between dialysis adequacy and parameters of nutritional status assessment.

The relationship between dialysis adequacy and the rate of change in uric acid level by hemodialysis

Aim: Although one of the commonly used methods for determining dialysis adequacy is the urea kinetic model, it is not the gold standard. Different parameters are needed to determine dialysis adequacy. In our study, we investigated the relationship between urea reduction rate (URR) and Kt/V which are used to assess dialysis adequacy and the rate of change in uric acid, a purine metabolite, by hemodialysis.Methods: A total of 133 patients who had undergone hemodialysis treatment due to renal failure between March 2010 and September 2010 were evaluated retrospectively. Urea kinetic modeling was used to measure dialysis adequacy. The following formula was used to do this; Kt/V=-ln(R-0.008xT)+(4-3.5xR)xUF/W[R; postdialysis blood ureanitrogen (BUN)/predialysis BUN, T; duration of dialysis (hr), UF; total ultrafiltration during dialysis (L), W; patient weight after dialysis (kg)]. The urea reduction rate was calculated using the formula; URR(%)=100x(1-postdialysis BUN/predialysis BUN). Uric acid reduction rate (UARR) was calculated using the formula; UARR(%)=100x(1-Uric acid after/Uric acid before). The relationship between URR and Kt/V ratios which are used to assess dialysis adequacy and UARR is evaluated.Results: Median urea, uric acid and creatinine reduction rates were 72%, 74% and 63.9%, respectively. There was a statistically significant correlation between reduction rates of uric acid, creatinine and urea after dialysis (p&lt;0.001). There was a statistically significant relationship between URR and Kt/V which are used to assess dialysis adequacy,and UARR (p&lt;0,001). According to the ROC analysis in our study, we defined UARR value that will demonstrate dialysis adequacy as at least 65.8% (sensitivity 97.9% and specificity 82.6%, area under the ROC curve=0.880, p&lt;0.001).Conclusion: A significant relationship was found between the URR and Kt/V ratios which are used to assess dialysis adequacy and UARR. We also determined in our study that the UARR value that shows dialysis adequacy should be at least 65.8%. To our knowledge, this is the first study to evaluate the relationship between UARR and dialysis adequacy. However, thefindings need to be confirmed by large, prospective, clinical trials.

Decreased serum fatty acid binding protein 4 concentrations are associated with sarcopenia in chronic hemodialysis patients

BackgroundFatty acid binding protein 4 (FABP4) is found to play a role in skeletal muscle homeostasis. Since the dysregulation of FABP4 and sarcopenia are both highly prevalent in patients on chronic hemodialysis (HD), the correlation between them remains unknown. We aimed to examine this relationship in a cross-sectional study. MethodsA total of 120 chronic HD patients were recruited, and whose skeletal muscle mass, handgrip strength, and gait speed were assessed and blood samples were obtained. We grouped these participants into sarcopenia (n = 20) and non-sarcopenia groups according to European Working Group on Sarcopenia in Older People criteria. ResultsThe sarcopenia group exhibited lower weight (P < 0.001), height (P = 0.019), waist circumference (P < 0.001), body mass index (P < 0.001), body fat mass (P = 0.004), and lower serum triglycerides (P = 0.009), creatinine (P < 0.001), phosphorus (P = 0.013), intact parathyroid hormone (P = 0.012), and FABP4 concentrations (P = 0.005), and higher malnutrition–inflammation scores (MIS) (P = 0.031), urea reduction rates (P < 0.001), and fractional clearance index for urea (Kt/V) values (P < 0.001). Serum FABP4 concentrations (odds ratio (OR): 0.98, 95% confidence interval (CI): 0.96–0.99, P = 0.043), body fat mass (OR: 0.86, 95% CI: 0.77–0.97, P = 0.013), MIS (OR: 6.90, 95% CI: 1.31–36.36, P = 0.023), and Kt/V (each increase of 0.1, OR: 2.15, 95% CI: 1.29–3.57, P = 0.003) were independent predictors of sarcopenia in chronic HD patients. ConclusionsWe delineated the association between serum FABP4 concentrations and sarcopenia in chronic HD patients.