The Prevalence of Helicobacter Pylori Infection in Patients with Chronic Kidney Disease Undergoing Hemodialysis

The aim of this study was to analyze the prevalence of Helicobacter pylori infection and gastroduodenal lesions in Montenegrin patients with chronic kidney disease on hemodialysis. The study included 55 hemodialysis patients with dyspeptic symptoms and 50 control subjects with normal kidney function who had also dyspepsia. After dyspepsia assessment by an interview, all subjects underwent gastroduodenoscopy and histopathological analysis of biopsy specimens, taken from the corpus and antrum of the stomach. Helicobacter pylori was confirmed in 50.9% of corpus mucosa i.e. 60.6% of antrum mucosa of maintenance hemodialysis patients. There were no significantly differences in endoscopic findings of the stomach and bacterial presence between the two study groups of participants (p = 0.451), while duodenal lesions were prevalent in control subjects (p < 0.001). The atrophy of corpus mucosa was more common in hemodialysis patients (p = 0.007), especially in those who have been on hemodialysis for a longer time (p < 0.001) and had lower pH (p = 0.011). The prevalence of Helicobacter pylori infection shown an inverse relationship with dialysis duration. Contrary, a positive relationship between Helicobacter pylori and the concentration of bicarbonate was demonstrated (p = 0.031). The prevalence of Helicobacter pylori and atrophic mucosal changes in Montenegrin hemodialysis patients depends on dialysis duration and acid-base balance.

DETERMINANTS OF ADHERENCE TO TREATMENT AMONG HEMODIALYSIS PATIENTS IN MAKKAH CITY, KINGDOM OF SAUDI ARABIA

Background: Adherence of hemodialysis patients to medical instructions is considered crucial for a longer life expectancy and better quality of life. There is solid evidence that non-adherence to end-stage renal disease patients correlates with morbidity and mortality, is the norm for dialysis patients rather than the exception, multiple factors influence it and inconsistencies exist in findings of the relationships between risk factors and non-adherence. Despite the importance of this topic, there is remarkable paucity in the studies which identify factors associated with non-adherence in hemodialysis patients in Saudi Arabia. Aims and Objectives: The current study aims at ameliorating the adverse consequences of non-adherence among hemodialysis patients through providing scientific background and a better understanding of the factors associated with non-adherence. The objectives of this study were to determine factors related to non-adherence to fluid, diet, medication, and hemodialysis sessions among hemodialysis patients in Makkah city. Materials and Methods: The present study is a cross-sectional one, where a sample of 361 hemodialysis patients was selected randomly from hemodialysis centers in three governmental hospitals in Makkah in order to determine factors related to their non-adherence to treatment by using an end-stage renal disease-adherence questionnaire (ESRD-AQ) in addition to clinical examination and laboratory investigation for other data. Results: Younger (<30 years), unmarried, non-Saudis, those with chronic diseases other than hypertension and diabetes mellitus, and those with long dialysis duration (60+ months) were found more likely to be non-adherent to fluid. Females patients and those with short dialysis duration (<60 months) were found more likely to be non-adherent to diet and medications, respectively. Conclusion: Patients who had factors associated with non-adherence deserve special attention and support to improve their adherence behavior. The findings from this study can be used as a base for designing an intervention aimed to increase the adherence to treatment in end-stage renal disease patients who are undergoing hemodialysis in order to decrease the direct and indirect costs that appear as a consequence of non-adherence.

MO1011IDENTIFICATION OF EARLY BIOMARKERS OF PERITONEAL MEMBRANE DYSFUNCTION IN CHILDREN ON PERITONEAL DIALYSIS USING METABOLOMICS ANALYSIS -PRELIMINARY RESULTS OF AN ONGOING PROSPECTIVE STUDY

Background and Aims Peritoneal dialysis (PD) are the main renal replacement treatment for children and adolescents with end stage kidney disease (ESRD). Peritoneal fibrosis is a major complication in long-term PD patients. Aim of the present study is to record the metabolic "fingerprint" of children on PD and to investigate its correlation with PD history and dialysis adequacy as well as the emergence of potential biomarkers that could detect early or predict peritoneal dysfunction. Method Samples of serum, urine and peritoneal effluent collected from 15 children with ESRD on PD. At the same time and 6 months later was performed PET-test as well as assessment of KT/V and creatinine clearance. Samples were subjected to targeted metabolomic analysis of amino acids and derivatives. Regarding metabolic technologies used, all samples (peritoneal fluid, urine, blood) were analyzed by a hydrophilic interaction liquid chromatography coupled to mass spectrometry (HILIC-MS / MS) method previously developed and validated in our laboratory for the simultaneous determination of amino acids and their derivatives in biological fluids. Αalso, high flow analysis was carried out (LC-q-tof analysis – HPLC /MS ). Results Using (HILIC-MS / MS) method, we found out that peritoneal dialysis duration, presence or absence of diuresis and PD creatinine clearance values are associated with significant differences in the levels of several metabolites, including glycine, creatinine, proline and 4-hydroxyproline, leucine, valine, glutamine and glutamic acid. Using (LC-q-tof analysis – HPLC /MS) approximately 200 metabolites were analyzed in the aforementioned samples. Figure 1 illustrates the number of metabolites detected in each matrix, as well as the common metabolites between the three matrices. These metabolites were associated with peritoneal dialysis duration, creatine clearance and presence or absence of diuresis. Several metabolites showed statistical difference between the examined groups. In detail, regarding serum analysis, five metabolites, including hydroxy phenyl acetic acid, glutathione ox, glucosamine-6-P, indole acetic acid and riboflavin showed statistical difference between the examined groups based on PD vintage. Based on urine excretion four metabolites named histidine, shikimic acid, thiamine and methionine were statistically different. Concerning urine analysis, two metabolites namely uridine and itaconic acid showed statistical difference when patients sub grouped based on PD vintage. Peritoneal fluid analysis highlighted one metabolite, uridine, that levels are significantly lower in patients on PD therapy for more than 4 years while based on creatinine clearance levels subgroups, two metabolites, lactate and pantothenic acid present statistically significant difference. Conclusion Metabolomics may be a tool in the evaluation of patients with ESRD on PD as it appears to reflect the clinical phenotype of the patient and the functional phenotype of the peritoneal membrane. Our results are the preliminary results of an ongoing prospective study. Limitation of the study is the small sample of patients, which does not allow safe clinical interpretation.

Effective and Safety Analysis of Electroacupuncture Treatment for Restless Legs Syndrome in Maintenance Hemodialysis Patients

BACKGROUND: Restless legs syndrome (RLS) is a common complication in maintenance hemodialysis (MHD) patients. Current study was conducted to analysis the effectiveness and safety of electroacupuncture on 3 acupuncture points from lower limb meridians in the treatment of RLS.<br/> METHODS: A total of 7 MHD patients (5 Male and 2 Female) in our center with severe RLS symptom were enrolled. After one month of pharmacological washout period, patients received 12 sessions of electroacupuncture on three acupoints (Zusanli (ST36), Sanyinjiao (SP6) and Taichong (LR-3)) during HD. Severity of RLS symptoms and the sleep quality were evaluated by IRLSSG and ISI scores for 3 times (before, after and 1 month later of the electroacupuncture treatment).<br/> RESULTS: The average age of enrolled patients was 52.6±8.9 years, with median dialysis duration of 3.0 years. The hemoglobin level was 125.9±22.9 g/l. The IRLSSG score was significantly lower after electroacupuncture treatment (9.4±3.9) than that before treatment (17.3±4.7) (P <0.01). Both overall severity of RLS symptom average daily severity and frequency were significantly improved after electroacupuncture. It is also validated that the electroacupuncture treatment was contributed to sleep improvement in RLS patients after electroacupuncture treatment was discontinued for one month.<br/> CONCLUSION: Electroacupuncture on three lower limbs acupoints during MHD was as a safe and effective treatment for attenuating the symptoms of RLS and improvement of sleep quality in hemodialysis patients, and the therapeutic effect maintain for at least one month.

Clinical characteristics associated with the properties of gut microbiota in peritoneal dialysis patients

Background: Gut microbiota alters in patients with end-stage renal disease, which contributes to inflammation, atherosclerosis, and results in increased incidence of cardiovascular diseases. The present study investigated the potential clinical factors, which influence the gut microbial structure and function in patients undergoing peritoneal dialysis (PD). Methods: This is a cross-sectional study performed in 81 prevalent PD patients. Gut microbiota was assessed by high throughput sequencing of 16S ribosomal ribonucleic acid gene in fecal samples. Gas chromatography was conducted to measure stool short-chain fat acid (SCFA) concentrations. Demographic parameters and clinical characteristics, including dialysis regimen, residual renal function, nutrition, and inflammation, were retrieved and related to the properties of gut microbiota. Results: PD duration, peritoneal glucose exposure, and estimated glomerulus filtration rate (eGFR) were identified to be associated with microbial variations. Significant separation of microbial composition was shown between patients with short or long PD duration ( p = 0.015) and marginal differences were found between patients grouped by different levels of peritoneal glucose exposure ( p = 0.056) or residual renal function ( p = 0.063). A couple of gut bacteria showed different abundance at amplicon sequencing variant level between these patient groups ( p < 0.05). In addition, stool isobutyric and isovaleric acid concentrations were significantly reduced in patients with longer dialysis duration, higher peritoneal glucose exposure, or declined eGFR ( p < 0.05). Conclusions: This pilot study demonstrated that long dialysis duration, high peritoneal glucose exposure, and loss of residual renal function were associated with gut microbiota alteration and reduced branched-chain SCFA production in PD patients.

FACTORS AFFECTING NON-ADHERENCE TO TREATMENT OF HEMODIALYSIS PATIENTS IN MAKKAH CITY, KINGDOM OF SAUDI ARABIA

Background: Adherence of hemodialysis patients to medical instructions is considered crucial for a longer life expectancy and better quality of life. There is solid evidence that non-adherence of end-stage renal disease patients correlates with morbidity and mortality, is the norm for dialysis patients rather than the exception, multiple factors influence it and inconsistencies exist in findings of the relationships between risk factors and non-adherence. Despite the importance of this topic, there is remarkable paucity in the studies which identify factors associated with non-adherence in hemodialysis patients in Saudi Arabia. Objectives: To determine factors related to non-adherence to fluid, diet, medication, and hemodialysis sessions among hemodialysis patients in Makkah. Materials and Methods: The current study is a cross-sectional one, where a sample of 361 hemodialysis patients was selected randomly from hemodialysis centers in three governmental hospitals in Makkah in order to determine factors related to their non-adherence to treatment by using an end-stage renal disease-adherence questionnaire (ESRD-AQ) in addition to clinical examination and laboratory investigation for other data. Results: Younger (<30 years), unmarried, non-Saudis, those with chronic diseases other than hypertension and diabetes mellitus, and those with long dialysis duration (60+ months) were found more likely to be non-adherent to the fluid. Females patients and those with short dialysis duration (<60 months) were found more likely to be non-adherent to diet and medications, respectively. Conclusion: Patients who had factors associated with non-adherence deserve special attention and support to improve their adherence behavior. The findings from this study can be used as a base for designing an intervention aimed to increase the adherence to treatment in end-stage renal disease patients who are undergoing hemodialysis in order to decrease the direct and indirect cost that appear as a consequence of non-adherence.