Different clinical impact of hyperuricemia according to etiologies of chronic kidney disease: Gonryo Study

Background Hyperuricemia is highly prevalent in chronic kidney disease (CKD) patients, but the evidence for a relationship between uric acid (UA) and clinical outcomes in CKD patients is limited and inconsistent. We hypothesized that UA has a different impact on clinical outcomes according to the underlying disease causing CKD. Methods This study prospectively investigated the associations between UA and renal and non-renal outcomes according to the underlying disease causing CKD in 2,797 Japanese patients under the care of nephrologists. The patients were categorized into four groups: primary renal disease (n = 1306), hypertensive nephropathy (n = 467), diabetic nephropathy (n = 275), and other nephropathy (n = 749). The renal outcome was defined as end-stage renal disease (ESRD), and the non-renal outcome was defined as a composite endpoint of cardiovascular events (CVEs) and all-cause mortality. Results During a median 4.8-year follow-up, 359 (12.8%) patients reached the renal outcome, and 260 (9.3%) reached the non-renal outcome. In the all-patient analysis, hyperuricemia was not associated with the risks for renal and non-renal outcomes, but in primary renal disease (PRD) and hypertensive renal disease (HTN) patients, hyperuricemia was significantly associated with non-renal outcomes. Per 1 mg/dl higher UA level, multivariable adjusted hazard ratio was 1.248 (95% CI: 1.003 to 1.553) for PRD, and 1.250 (1.035 to 1.510) for HTN. Allopurinol did not reduce the risks for renal and non-renal outcomes, both in all patients and in the subgroup analysis. Conclusions The effect of hyperuricemia on clinical outcomes in CKD patients varies according to the underlying disease causing CKD. Hyperuricemia is an independent risk factor for non-renal outcomes in primary renal disease and hypertensive renal disease patients. Allopurinol did not decrease the risks for renal and non-renal outcomes.

Covid-19 epidemic in the dialysis units of the french speaking part of Belgium : special insight into patients on home dialysis

In the French-speaking part of Belgium, between march and end of may 2020, 284 patients have suffered a Covid-19 infection, 7,9% of the prevalent dialysis population. Some of them have been diagnosed through rt-PCT as they were symptomatic, others, asymptomatic, being diagnosed by swab viral culture. Fifty two patients died (18% of the positive patients). The vast majority of them were patients on hemodialysis, only ten cases have been observed in patients on home dialysis techniques. Primary renal disease were diabetes or renal hypertensive disease in more than 50% of the patients and the most important comorbidities were cardiac ischemic or congestive disease, autonomy problems, cancer and smoking habits.

P15185 YEAR ALL-CAUSE MORTALITY ACCORDING TO PRIMARY RENAL DISEASE IN HEMODIALYSIS PATIENTS

Background and Aims The Korean Society of Nephrology (KSN) collected data of end-stage renal disease registry since 1985 and internet registry program was available since 2001. We explored the hypothesis that the 5-year mortality of hemodialysis patients was different depending on primary renal disease. Method From 2004 to 2015, in total, 32,163 patients starting hemodialysis were determined. The cause of primary renal disease were divided to diabetic nephropathy (49.9%, n=16,038), hypertensive nephrosclerosis (18.5%, n=5,958), histologically confirmed glomerulonephritis 3.3% (n=1,067), cystic kidney disease (2.0%, n=656) and the miscellaneous (26.3%, n=8,444). The miscellaneous included renal tuberculosis, interstitial nephritis, lupus nephritis, kidney tumor. Results The 5-year mortality of hemodialysis patients was 16.9 % (N=5,435) and ratio of unknown state was 24.9 % (N=7,996). The mortality of diabetic nephropathy, hypertensive nephrosclerosis, histologically confirmed glomerulonephritis, cystic kidney disease and the miscellaneous were 27.1% (n=3,323), 17.0% (n=768), 8.4% (n=62), 13.9% (n=67), and 19.7% (n=5,435), respectively. Kaplan-Meier survival analysis showed that diabetic nephropathy was worst survival rate following hypertensive sclerosis, cystic kidney disease and the miscellaneous, while histologically confirmed glomerulonephritis showed highest survival rate (log-rank p < 0.001). After adjusting for confounders, cox-proportional regression analysis revealed that 5-year mortality was associated with diabetic nephropathy compared hypertensive nephrosclerosis (HR, 1.62 CI, 1.17-2.24) while histologically confirmed glomerulonephritis was not significant. Conclusion The overall mortality was associated with primary renal disease in hemodialysis paitents. This result suggests that hemodialysis patients with diabetic nephropathy require further medical attention.

Primary Failure of the Arteriovenous Fistula in Patients with Chronic Kidney Disease Stage 4/5

BACKGROUND: An Arteriovenous fistula (AVF) is a creation of the natural blood vessels. It is a “gate of life” for the patients on hemodialysis. AIM: The study aimed to analyze the predictors for primary failure of AVF such as gender, age, number and location of AVF, and primary renal disease in patients with chronic kidney disease (CKD) stage 4/5.MATERIAL AND METHODS: The medical records of 178 created arteriovenous fistulae in patients with CKD stage 4/5, were retrospectively studied. Primary failure of AVF was defined as thrombosis or inability for cannulation of AVF within 3 months. Adequate maturation of AVF was defined as successful cannulation of AVF treatment and blood flow of > 600 ml/min.RESULTS: The mean age of the patients was 59.75 ± 14.65 years, and 65.16% (116/178) were men. Adequate maturation of AVF was achieved in 83.71% (149/178). Primary failure of AVF occurred in 16.29% (29/178) of the created fistulae, while 10.11% (18/178) had early thrombosis. The distal arteriovenous fistulae were significantly more frequently created in male patients (51 vs 18; p = 0.015). The female patients were significantly older than the male patients (63.27 vs 57.86 years; p = 0.018). CONCLUSION: Male gender was associated with better maturation of AVF. The age, number and location of AVF, and primary renal disease in patients with CKD stage 4/5 were not associated with primary failure of AVF.

Estimating risk of encapsulating peritoneal sclerosis accounting for the competing risk of death

BackgroundRisk of encapsulating peritoneal sclerosis (EPS) is strongly associated with the duration of peritoneal dialysis (PD), such that patients who have been on PD for some time may consider elective transfer to haemodialysis to mitigate the risk of EPS. There is a need to determine this risk to better inform clinical decision making, but previous studies have not allowed for the competing risk of death.MethodsThis study included new adult PD patients in Australia and New Zealand (ANZ; 1990–2010) or Scotland (2000–08) followed until 2012. Age, time on PD, primary renal disease, gender, data set and diabetic status were evaluated as predictors at the start of PD, then at 3 and 5 years after starting PD using flexible parametric competing risks models.ResultsIn 17 396 patients (16 162 ANZ, 1234 Scotland), EPS was observed in 99 (0.57%) patients, less frequently in ANZ patients (n = 65; 0.4%) than in Scottish patients (n = 34; 2.8%). The estimated risk of EPS was much lower when the competing risk of death was taken into account (1 Kaplan–Meier = 0.0126, cumulative incidence function = 0.0054). Strong predictors of EPS included age, primary renal disease and time on PD. The risk of EPS was reasonably discriminated at the start of PD (C-statistic = 0.74–0.79) and this improved at 3 and 5 years after starting PD (C-statistic = 0.81–0.92).ConclusionsEPS risk estimates are lower when calculated using competing risk of death analyses. A patient’s estimated risk of EPS is country-specific and can be predicted using age, primary renal disease and duration of PD.