MO870HYPOCHLOREMIA IS ASSOCIATED WITH A GREATER INCIDENCE OF PNEUMONIA IN CHRONIC HEMODIALYSIS PATIENTS WITH COVID-19: A CENTER'S EXPERIENCE

Abstract Background and Aims Recently, serum chloride has gained greater importance in the assessment of patients with heart failure and sepsis. Hypochloremia has been associated with higher mortality. On the other hand, COVID-19 pandemic continues to be, to date, a threat to public health. Patients with cardiovascular comorbidity or chronic kidney disease are particularly vulnerable. There are some studies that show a trend towards a lower serum chloride concentration in patients with a positive PCR test for SARS-CoV-2. Therefore, the objective of our study was to determine if there is a relationship between serum chloride levels at the time of diagnosis and a greater tendency to develop COVID-19 pneumonia in chronic hemodialysis patients. Method Retrospective cohort study. We analyzed the serum chloride, C-reactive protein (CRP), procalcitonin, neutrophil-lymphocyte (NLR) and platelet-lymphocyte (PLR) ratios of 11 chronic hemodialysis patients with a positive SARS-CoV-2 TMA PCR test during the second wave of the pandemic in our hospital (August-December 2020). We collected the length of hospital stay, the diagnosis of pneumonia (yes/no) and the final state of the infection (cure or death). The patients were divided into two groups taking the median serum chloride as the cut-off point (1: <97 mEq / L and 2:> 97mEq / L) Results The mean age was 57 ± 13 years and 36.36% (N = 4) were women. All patients required hospital admission and mean hospitalization time was 19 ± 13 days. 3 patients (27.3%) died. The medians of the parameters were the following: serum chloride 97 mEq / L (IQR 94-99); CRP 29.04 mg / L (IQR 8.53-76.13); NLR 4.13 (IQR 2.67-8.48) and PLR 244.06 (IQR 208.08-320). 81.8% (N = 9) had COVID-19 pneumonia. Group 1 patients (Chloride <97 mEL / L) had a higher incidence of pneumonia (p = 0.049) (Figure 1) and a greater tendency to be admitted to the Intensive Care Unit (ICU) (p = 0.029). Despite not reaching statistical significance, there was also a higher mortality in patients with lower chloride levels. Conclusion Chronic hemodialysis patients with SARS-CoV-2 infection and lower serum chloride levels at hospital admission were more likely to develop pneumonia.

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P1592HYPOCHLOREMIA AND INFLAMMATION: RELATIONSHIP BETWEEN SERUM CHLORIDE LEVELS AND NEUTROPHIL-TO-LYMPHOCYTE RATIO IN INCIDENT CHRONIC HEMODIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1592 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Francisco Valga ◽

Tania Monzon ◽

Fernando Henriquez ◽

Gloria Anton-Perez

Keyword(s):

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Neutrophil To Lymphocyte Ratio ◽

High Rate ◽

Cardiovascular Comorbidity ◽

Lymphocyte Ratio ◽

Reactive Protein ◽

Serum Chloride ◽

Lower Chloride ◽

Underlying Mechanisms

Abstract Background and Aims Recently the role of chloride in patients with heart failure has been reevaluated. Some studies have linked it to higher mortality in these patients, being more important, even, than sodium. On the other hand, some authors have found a higher mortality in patients with low chloride levels and sepsis. The underlying mechanisms in both cases are unknown. Some authors attribute it to concomitance with metabolic alkalosis, however, this is not a reason that fully explains these findings. Neutrophil-to-Lymphocyte Ratio (NLR) is an emerging marker of inflammation comparable to established ones such as C-reactive protein, ferritin, etc. It is also a good biomarker of mortality in certain populations such as cancer, cardiovascular and renal. Patients with chronic kidney disease on hemodialysis have high cardiovascular comorbidity and a high rate of inflammation. However, there are no studies that correlate chloride levels to inflammation markers, such as NLR, in this population. Therefore, the aim of our study was to determine if there is a relationship between chloride and NLR in our population of patients on chronic hemodialysis. Method Restrospective cohort study. We analyzed the values of chloride and NLR of 396 incident patients on hemodialysis over a period of 3 years (between 2016 and 2019). The patients were divided into three groups, depending on the levels of chloride (tertiles): (1: <100, 2: 100.1-103, 3> 103.1 mEq / l). In each group the average of NLR was calculated. Results The mean age in our sample was 64.73 ± 0.57 years, 39.7% were women (N = 157). The average of NLR was 3.84 ± 2.65 and chloride was 101.03 ± 3.91. We found that patients in the lower chloride level tertile were associated with a higher NLR levels (p <0.012). (Figure 1) Conclusion Incident hemodialysis patients with lower chloride levels had higher NLR values. These findings suggest a greater tendency to inflammation in these patients.

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Evaluation of Assays for Measurement of Serum (Anti)oxidants in Hemodialysis Patients

BioMed Research International ◽

10.1155/2014/843157 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 6

Author(s):

Tatjana Ruskovska ◽

Eugene H. J. M. Jansen ◽

Risto Antarorov

Keyword(s):

Oxidative Stress ◽

Statistical Significance ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Total Serum ◽

Antioxidant Assays ◽

Hemodialysis Session ◽

Anti Oxidant ◽

Oxidant Status ◽

Healthy Persons

Background. Various biomarkers and assays have been used for assessment of (anti)oxidant status in hemodialysis patients, including those intended for measurement of serum total (anti)oxidants, most often as a part of panel biomarkers.Methods. Serum (anti)oxidant status was measured in 32 chronically hemodialyzed patients and in 47 healthy persons, using two oxidations and three antioxidant assays.Results. The patients before the hemodialysis session have had higher values of total oxidants in comparison to the healthy persons, with a further increase during the hemodialysis. These findings were confirmed with both oxidation assays, but they differ in the percentage of increase and the statistical significance. All three antioxidant assays showed significantly higher values of the total serum antioxidants in the patients before the hemodialysis session in comparison to the healthy persons, and their significant decrease during the hemodialysis. However, the assays differ in the percentage of decrease, its statistical significance, and the correlations with uric acid.Conclusion. The variability of results of total (anti)oxidants which are obtained using different assays should be taken into account when interpreting data from clinical studies of oxidative stress, especially in complex pathologies such as chronic hemodialysis.

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Lower serum albumin level is associated with increased risk of hospital admission and length of stay in hospital among incident hemodialysis patients by using overdispersed model

Therapeutic Apheresis and Dialysis ◽

10.1111/1744-9987.13552 ◽

2020 ◽

Author(s):

Koray Uludag ◽

Gulsah Boz ◽

Ali Ihsan Gunal

Keyword(s):

Length Of Stay ◽

Serum Albumin ◽

Hospital Admission ◽

Serum Albumin Level ◽

Hemodialysis Patients ◽

Albumin Level ◽

Lower Serum ◽

Increased Risk

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Survival of Vascular Accesses in Chronic Hemodialysis Patients

Blood Purification ◽

10.1159/000512119 ◽

2020 ◽

pp. 1-8

Author(s):

Abraham Santos-Ontiveros ◽

Ivonne Reyes-Sánchez ◽

Emmanuel Hernández-Luevano ◽

Martin E. Vega-Cruz ◽

Edna C. González-Marín ◽

...

Keyword(s):

Software Package ◽

Statistical Significance ◽

Computer Software ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Anatomical Site ◽

Kaplan Meier ◽

Risk Of Mortality ◽

The Mean ◽

Mean Differences

Background/Aims: Vascular access (VA) is the highest risk factor for blood infections, hospitalization, and mortality of patients undergoing hemodialysis (HD). The risk of mortality while using a catheter is greater than that while using grafts. The objective of this article is to know the survival rate in relation to the type of VA. Methods: A retrospective cohort of HD patients was studied. The data gathered included age, gender, first VA at the surrogate site, days between the first and second access, number of accesses, and anatomical site of VA placement. Mean differences were estimated using χ2 or Student’s t test. Survival was calculated using the Kaplan-Meier curves and included in tables. Statistical significance was established as p < 0.05. The statistical computer software package SPSSw v25 was used for the analysis. Results: A total of 896 patients were included with a mean age of 47.88 years (SD ± 16.52), the duration of the first VA was 398.81 days (±565.79), the mean number of VAs used was 2.26 (±1.15), and the median time undergoing HD was 728.73 days. The duration of catheter placement was 330.42 days, and 728.60 days for fistula use (p = 0.001). The mean number of days of renal replacement was 611.59 days for catheter and 1,495.25 days for internal arteriovenous fistula (IAVF) patients (p = 0.001). Conclusions: The survival of the initial VA is greater for the IAVF, followed by the tunneled catheters and the lowest by the non-tunneled catheters, which continue to be frequently used in our setting.

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Serum Lipoprotein (a) and Coronary Artery Disease in Uremic Patients on Chronic Hemodialysis

The International Journal of Artificial Organs ◽

10.1177/039139889401700107 ◽

1994 ◽

Vol 17 (1) ◽

pp. 41-45 ◽

Cited By ~ 5

Author(s):

D. Docci ◽

G. Manzoni ◽

R. Bilancioni ◽

C. Delvecchio ◽

C. Capponcini ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Serum Concentration ◽

Statistical Significance ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Lipoprotein A ◽

Increased Risk ◽

The Difference ◽

Artery Disease

There is convincing clinical and experimental evidence to support the notion that lipoprotein(a) [Lp(a)] is atherogenic. Patients undergoing chronic hemodialysis have an increased risk of atherosclerotic cardiovascular complications. In the present study, we investigated the possible relation between the alteration, if any, in serum Lp(a) and coronary artery disease in such patients. The mean serum concentration of Lp(a) tended to be higher in the 64 hemodialysis patients than in the 30 normal controls (15.1 ± 15.2 vs. 9.7 ± 10.4 mg/dl). However the difference did not reach statistical significance. The prevalence of levels above 30 mg/dl was 14% (9/64) and 10% (3/10), respectively, and the difference was also not statistically significant. Eleven hemodialysis patients with coronary artery disease had a significantly higher mean serum concentration of Lp(a) than the unaffected 53 (33.7 ± 18.4 vs. 11.1 ± 11.2 mg/dl, p < 0.001). Elevated levels were present in 63.6% (7/11) and 3.8% (2/53), respectively (p<0.01). Other parameters of lipid metabolism were not different between the two groups. We observed statistically significant positive correlations of Lp(a) to total cholesterol, LDL cholesterol and apolipoprotein B in controls, in hemodialysis patients as a whole and in those without coronary artery disease. No such correlations were obtained when hemodialysis patients with coronary artery disease were analysed separately. It is concluded that firstly, high serum levels of Lp(a) in hemodialysis patients are strongly associated with coronary artery disease, as well as in the general population; and secondly, abnormalities in the metabolism of Lp(a) may underlie atherogenesis in these patients, independently of alterations in other lipid constituents

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Clinically Distinct Subtypes of Acute Kidney Injury on Hospital Admission Identified by Machine Learning Consensus Clustering

Medical Sciences ◽

10.3390/medsci9040060 ◽

2021 ◽

Vol 9 (4) ◽

pp. 60

Author(s):

Charat Thongprayoon ◽

Pradeep Vaitla ◽

Voravech Nissaisorakarn ◽

Michael A. Mao ◽

Jose L. Zabala Genovez ◽

...

Keyword(s):

Machine Learning ◽

Acute Kidney Injury ◽

Hospital Admission ◽

Clustering Analysis ◽

Kidney Injury ◽

Consensus Clustering ◽

Serum Bicarbonate ◽

Lower Serum ◽

Serum Chloride ◽

Cluster 2

Background: We aimed to cluster patients with acute kidney injury at hospital admission into clinically distinct subtypes using an unsupervised machine learning approach and assess the mortality risk among the distinct clusters. Methods: We performed consensus clustering analysis based on demographic information, principal diagnoses, comorbidities, and laboratory data among 4289 hospitalized adult patients with acute kidney injury at admission. The standardized difference of each variable was calculated to identify each cluster’s key features. We assessed the association of each acute kidney injury cluster with hospital and one-year mortality. Results: Consensus clustering analysis identified four distinct clusters. There were 1201 (28%) patients in cluster 1, 1396 (33%) patients in cluster 2, 1191 (28%) patients in cluster 3, and 501 (12%) patients in cluster 4. Cluster 1 patients were the youngest and had the least comorbidities. Cluster 2 and cluster 3 patients were older and had lower baseline kidney function. Cluster 2 patients had lower serum bicarbonate, strong ion difference, and hemoglobin, but higher serum chloride, whereas cluster 3 patients had lower serum chloride but higher serum bicarbonate and strong ion difference. Cluster 4 patients were younger and more likely to be admitted for genitourinary disease and infectious disease but less likely to be admitted for cardiovascular disease. Cluster 4 patients also had more severe acute kidney injury, lower serum sodium, serum chloride, and serum bicarbonate, but higher serum potassium and anion gap. Cluster 2, 3, and 4 patients had significantly higher hospital and one-year mortality than cluster 1 patients (p < 0.001). Conclusion: Our study demonstrated using machine learning consensus clustering analysis to characterize a heterogeneous cohort of patients with acute kidney injury on hospital admission into four clinically distinct clusters with different associated mortality risks.

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Clinical implications and outcome prediction in chronic hemodialysis patients with lower serum potassium×uric acid product

European Journal of Internal Medicine ◽

10.1016/j.ejim.2015.06.016 ◽

2015 ◽

Vol 26 (8) ◽

pp. 646-651 ◽

Cited By ~ 6

Author(s):

Ming-Yan Jiang ◽

Jyh-Chang Hwang ◽

Yi-Hua Lu ◽

Charn-Ting Wang

Keyword(s):

Uric Acid ◽

Serum Potassium ◽

Outcome Prediction ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Clinical Implications ◽

Lower Serum ◽

Acid Product

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MO852MANAGEMENT OF PATIENTS UNDERGOING CHRONIC HEMODIALYSIS DURING THE COVID-19 PANDEMIC: FONDAZIONE POLICLINICO A. GEMELLI’S EXPERIENCE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab098.0044 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Federica Urciuolo ◽

Nicola Panocchia ◽

Alessandro Naticchia ◽

Viola D'Ambrosio ◽

Silvia Barbarini ◽

...

Keyword(s):

Hospital Stay ◽

Statistical Significance ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

The Other ◽

Medium Size ◽

P Value ◽

Chronic Patients ◽

Dialysis Center ◽

The Mean

Abstract Background and aim COVID-19 (COronaVIrus Disease 19) is an acute respiratory disease caused by SARS CoV 2 virus. The correlation between SARS-CoV2 infection and comorbidities is complex; patients with multiple comorbidities present often with the most severe symptoms that could potentially lead to death. Patients undergoing hemodialysis are generally frail and immunodeficient. This leads to a greater risk of contracting infectious diseases. In the literature, the estimated incidence of SARS-CoV2 infection is 3.24% in chronic hemodialysis patients. Method Fondazione Policlinico A. Gemelli is a COVID hospital. During the pandemic patients from several dialysis centers converged in our hospital. FPG has two dialysis centers, one for outpatients and one for inpatients. Patients admitted for COVID-19 infection have been treated in three different settings: 1. isolation room within the dialysis center; 2. Bedside; 3. In a COVID-19 dialysis center. We retrospectively collected data of patients treated from March 2020 to January 2021 and analyzed the SARS-CoV2 incidence in our center’s chronic hemodialysis patients. Results 66 hemodialysis patients affected by COVID-19 have been treated in our hospital from March 2020 to January 2021, 60 patients undergoing chronic dialysis and 6 patients diagnosed with acute kidney injury (AKI) stage III non-intensive care unit. Among chronic patients, 64 underwent chronic hemodialysis and 2 patients underwent peritoneal dialysis. Median age was 68.19 (46 males, 20 females), all patients had multiple comorbidities: 37.8% of patients had diabetes mellitus; 72.7% cardiovascular diseases and 16.6% a positive clinical history for cancer. Among the 6 AKI cases, 3 patients regained total kidney function; the other 3 had to continue renal replacement therapy. The mean hospital stay length was 18.5 days with a mean time of COVID-19 infection of 21.23 days. The overall mean Charlson Comorbidty Index was 6.21. Among the 66 treated patients, 43 were diagnosed with COVID-19-related pneumonia, 14 had the infection, no pulmonary involvement, but presented with other complications, and 5 patients resulted positive although asymptomatic. Among the 116 hemodialysis outpatients, only 4 presented with SARS-CoV2 infection, 3 were contacts of a positive family member and 1 resulted positive during a hospital stay for Clostridium Difficile infection. All patients required hospitalization. 14 (21%) patients died. Among the deceased patients, the mean age was 76.90 years (9 males, 3 females), mean Charlson Comorbidity Index was 7.3, mean hospital stay length was 9 days. Among patients who survived the disease the mean age was 76.92 years (34 males, 14 females), mean Charlson Comorbidty Index was 5.87 and mean hospital stay length was 19.47 days. Statistical significance was reached for age (p value 0.005) and Charlson Comorbidty Index (p value 0.39), but not for mean hospital stay length (p value 0.13). All COVID-19 patients were treated with bicarbonate hemodialysis and a Theranova 400 Baxter® filter. This filter was chosen for its efficiency on medium-size molecules removal (between 25 kDa and 60 kDa) that may be associated with inflammation. Bedside treatments were performed using the Genius© Fresenius system. Each treatment lasted 180 minutes, in order to reduce the time of exposure to COVID-19 of medical staff and the risk of virus spread on one hand, but still ensuring an optimal and complication-free treatment to patients. Conclusion Our experience seems to confirm the national data collected so far, both in terms of patients’ outcomes and mortality rate. Our study confirms that age is a risk factor for mortality. How to properly manage chronic hemodialysis patients affected by COVID-19 remains a challenging and burdensome question. However, there is the need of new flexible solutions that guarantee the patients and the medical staff’s safety on one hand and a personalized management on the other.

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