Measuring the Concentration of Serum Syndecan-1 to Assess Vascular Endothelial Glycocalyx Injury During Hemodialysis

Glycocalyx is present on the surface of healthy endothelium, and the concentration of serum syndecan-1 can serve as an injury marker. This study aimed to assess endothelial injury using serum syndecan-1 as a marker of endothelial glycocalyx injury in patients who underwent hemodialysis. In this single-center, retrospective, observational study, 145 patients who underwent hemodialysis at the Gifu University Hospital between March 2017 and December 2019 were enrolled. The median dialysis period and time were 63 months and 3.7 h, respectively. The serum syndecan-1 concentration significantly increased from 124.6 ± 107.8 ng/ml before hemodialysis to 229.0 ± 138.1 ng/ml after hemodialysis (P < 0.001). Treatment with anticoagulant nafamostat mesylate inhibited hemodialysis-induced increase in the levels of serum syndecan-1 in comparison to unfractionated heparin. Dialysis time and the change in the syndecan-1 concentration were positively correlated. Conversely, the amount of body fluid removed and the changes in the syndecan-1 concentration were not significantly correlated. The reduction in the amount of body fluid removed and dialysis time inhibited the change in the syndecan-1 levels before and after hemodialysis. In conclusion, quantitative assessment of the endothelial glycocalyx injury during hemodialysis can be performed by measuring the serum syndecan-1 concentration, which may aid in the selection of appropriate anticoagulants, reduction of hemodialysis time, and the amount of body fluid removed.

Measuring The Concentration of Serum Syndecan-1 To Assess Vascular Endothelial Glycocalyx Injury During Hemodialysis

Glycocalyx is present on the surface of healthy endothelium, and the concentration of serum syndecan-1 can serve as an injury marker. This study aimed to evaluate the hemodialysis-associated changes in the serum syndecan-1 concentration. This was a single-center, retrospective, observational study. Between March 2017 and December 2019, 145 patients who underwent hemodialysis at the Gifu University Hospital were enrolled. The median dialysis period and dialysis time were 63 months and 3.7 hours, respectively. The serum syndecan-1 concentration increased from 124.6 ± 107.8 ng/mL before hemodialysis to 229.0 ± 138.1 ng/mL after hemolysis (P < 0.001). Treatment with anticoagulant nafamostat mesylate inhibited hemodialysis-induced increase in the levels of serum syndecan-1 in comparison to unfractionated heparin. Dialysis time and the change in concentration of syndecan-1 were positively correlated, whereas the amount of body fluid removed and changes in the concentration of syndecan-1 were not correlated. The reduction in amount of body fluid removed and dialysis time inhibited the change in of syndecan-1 levels before and after hemodialysis. In conclusion, quantitative assessment of the endothelial glycocalyx injury during hemodialysis can be done by measuring the concentration of serum syndecan-1 which may aid in the selection of appropriate anticoagulants, hemodialysis time, and the amount of body fluid removed.

MODEL REGRESI COX PROPORTIONAL HAZARD PADA DATA KETAHANAN HIDUP PASIEN HEMODIALISA

Cox regression is a type of survival analysis that can be implemented with proportional hazard models or duration models. In the survival analysis data, there is a possibility that the data has ties, so it is necessary to use several approaches in estimating the parameters, namely the breslow, efron, and exact approaches. In this study, the Cox proportional hazard regression was used as a method of analysis for knowing the factors that influence the survival time on chronic kidney patients undergoing hemodialysis therapy. Based on the analysis that has been done, the best model is obtained with an exact approach and the factors that influence the survival time of hemodialysis patients are systolic blood pressure, hemoglobin level, and dialysis time. Hemodialysis patients who have high systolic blood pressure have a chance of failing to survive 12,950 times than normal systolic blood pressure.While the hemodialysis patient hemoglobin level increases, the hemodialysis patients chances of failing to survive is 0,6681 times less. Hemodialysis patients who received dialysis therapy with a dialysis time of more than four hours had 0.237 times the chance of failing to survive than patients with a dialysis time of less than or equal to 4 hours.Keywords: Cox Regression ,Survival, Ties, Hemodialysis.

Characteristics of the patient with hemodialysis from 26 hospitals in Hanoi by 2020

A kidney transplant has become an option for many people with end-stage kidney failure. However, not all patients are likely to receive a kidney transplant. This study is conducted to identify some characteristics of patients with renal transplant indications for kidney transplantation from 26 hospitals in Hanoi. According to the research results, in 2020, Hanoi has 3,220 patients on dialysis with the average age of 54, mainly from 46-65, more males than females. More than 95% of the causes of dialysis are chronic glomerulonephritis, hypertension, and diabetes; up to 65% of the dialysis time is over 5 years, blood type O patients account for 43% and 25% of dialysis patients with hepatitis C. Out of a total of 3,220 patients, 2,400 (74%) of patients have indicated a kidney transplant with an average age of nearly 49 years, of which men (55%) are more than women (45%); dialysis time less than 5 years accounts for the highest percentage with 43%, 25% of patients with indicated kidney transplantation are HCV positive; chronic kidney failure due to chronic glomerulonephritis and hypertension, diabetes are two main groups of causes, accounting for 94% of dialysis patients who are indicated for transplant.

FC 097INTERMITTENT HEMODIALYSIS WITHOUT ANTICOAGULATION

Background and Aims Dialysis therapy of patients at increased risk of bleeding is a well-known clinical problem. Systemic anticoagulation with heparin increases the risk of severe hemorrhage. Alternative strategies include the use of heparin-coated dialysis membranes, regional citrate anticoagulation, airless dialysis tubing, flushing the dialyzer with saline and earlier regional heparin anticoagulation with protamine reversal. However, either special devices (e.g. airless or heparin coated tubing) are needed, or the procedures are complex and require additional time and personnel resources for administration and monitoring. Current data on heparin-free dialysis are rare. After a pilot study from 282 dialysis sessions we reviewed 949 dialysis protocols from 2.5 years of 480 hospitalized and outpatient dialysis patients who were treated without systemic anticoagulation due to an increased risk of bleeding or a manifest hemorrhage. The duration of each dialysis session and the number of dialyses with or without clotting were evaluated. Method A total of 949 dialysis sessions of 480 patients were reviewed from October 2017 to January 2021. Dialysis were performed with Fresenius 4008/5008 (FX80,FX50, KF-210) and Gambro Artis (Poly170H, Theranova). All dialysis sessions were performed via AV-fistula with double-needle puncture or via single- or double-lumen central venous catheters (CVC). No additional technical devices or procedures were used beside standard hemodialysis or hemodiafiltration. Some of the patients had coagulopathies (sepsis, liver cirrhosis), thrombocytopenia or were on systemic anticoagulant therapy (vitamin K antagonists, DOAKs, heparin independent from dialysis therapy). The primary outcome was the need to interrupt the dialysis session because of clotting events due to a complete coagulation of the circuit, a partial coagulation of the circuit or a significant rise in the venous pressure. Results In 81 procedures (8.5%) systemic clotting made a discontinuation of the dialysis session necessary. In only 10 sessions (1%), the dialysis treatment had to be continued with new tubing and filter. More than one change of a system was never necessary. In the other 71 sessions, dialysis had to be stopped with retransfusion 5 minutes until 1.5 hours before the scheduled end of therapy, and therapy was considered as clinically sufficient. The frequency of clotting did not correlate with dialysis time (Fig.1.). Regarding the venous access clotting happened in 14.6% of acute CVC, in 12.6% of tunneled CVCs and in 9.4 % of AV-fistulas or -grafts, (Fig 2). Conclusion Dialysis without anticoagulation can be performed routinely with modern synthetic filters and dialysis concentrates. Patients at high risk of bleeding, with manifest hemorrhage or before surgery can undergo dialysis treatment for up to five hours without complications. In the present study clotting did not correlate with dialysis time. Patient-specific factors, as the venous access seem to play a more important role. In summary additional cost intensive devices, personnel intensive procedures and complex treatment protocols are only rarely needed to perform heparin-free dialysis for patients at risk.

MO909MULTICENTER EPIDEMIOLOGICAL STUDY OF MALNUTRITION INFLAMATION IN DIALYSIS “EMID” IN SPANISH DIALYSIS CENTERS

Background and Aims There is a high prevalence of malnutrition (PEW) in patients on dialysis (HD-PD). There is no single tool to diagnose it, varying the percentage according to the one used. Aim To assess prevalence of malnutrition-inflammation by MIS scale (malnutrition-inflammation-score) in HD or PD patients of Spanish dialysis units. Method We evaluated 2937 patients on dialysis (HD+PD) in Spain were evaluated on the MIS scale strata (Kalantar-Zadeh 1999) also analyzing: Common data Age, sex, dialysis time, Charlson-I., RRF, albumin,prealbumin,Kt/V transferrin, CRP, DM , Specific-HD HD type, AVF or Catheter , Specific-PD PD-type, transport type. Statistical analysis with SPSS.23 software, using parametric and non-parametric test. Results We evaluate 2748 HD patients, median age 71 (RIC20), 65.90% male, median MIS 6 (RIC4), DM 36.91%, T in HD 36m (RIC54), FRR 35.44% , Charlson Index 7 (RIC4) and 186 in PD (62.96% men), median -age 62 (RIC 24), median-MIS 4 (RIC 2), T in PD of 18.5 m (RIC 23.5),DM 30.77%, FRR 79.89%, I Charlson 5 (RIC 4), In PDA 99pac-52.38%. Prevalence of global malnutrition (MIS&gt;2) was 89% considering HD+DP and 50% when MIS&gt;5 (table 1) In PD the higher normonutrides greater Kt/V in manual vs automatic not the malnourished ones. FRR significantly in greater % in normonutrides. No differences in malnutrition depending on carrier type. CRP sig major in MIS&gt;2 and &gt;5 In HD, Normo versus malnourished and with MIS&gt;5 significant difference: HD type, CRP, HD Type, AVF vs catheter, age,sex. The prescription for Oral supplement was low and higher in HD 12.4% vs DP 6.3%. Conclusions 1.- There is a high prevalence of malnutrition on dialysis being higher in HD. 2.- In PD, FRR major and CRP minor in well-nourished versus malnourished. 3.- In HD: Normo versus malnourished and with MIS&gt;5 significant difference: HD type, CRP,Charlson I. AVF vs catheter, age,sex. 4.- There is a percentage of malnourished patients with very low percentage of oral supplement.

The Impact of Blood Flow Rate and Duration of Dialysis Session on Nutritional Status in Hemodialysis Patients

BACKGROUND: Blood flow rate (BFR) and time of dialysis are important determinants of dialysis adequacy. This study aimed to determine the impact of higher BFR and longer dialysis time on nutritional status in chronic hemodialysis (HD) patients. METHODS: Real-world evidence (RWE) studies of 3 HD units in different hospitals that differ in BFR and/or dialysis time. Group I, HD 5 hr and BFR 200-250 mL/min; group II, HD 4 hr and BFR 270-320 mL/min, and group III, HD 4 hr and BFR 200-250 mL/min. All HD units use the same dialysate flow and dialysis frequency. Nutritional status was assessed using a 3-point scale Subjective Global Assessment. RESULTS: A total of 233 chronic HD patients were included, mean of age was 52 &plusmn; 12.9 years, 46.5% were male. There are 69.5% on SGA class A, 27.5% on SGA class B, and 3% on SGA class C. The proportion of SGA class A in group II was highest compared to group II and III (93.5% vs 79.0% vs 32.1% (p &lt;0.05). There was no SGA class C in group II, whereas 2.4% in group I and 7.4% in group III. In group II there was lower interdialytic weight gain (IDWG) and less use of anti-hypertensive drugs compared to group III (p &lt;0.05). CONCLUSION: Our study showed that higher BFR and longer dialysis time are associated with better nutritional status in chronic HD patients. A higher BFR seems to have a more substantial impact compared to a longer dialysis time. Keywords: blood flow rate, dialysis time, subjective global assessment, nutritional status

THE CORRELATION BETWEEN BONE MINERAL DISORDERS AND SOME CLINICAL AND SUBCLINICAL FACTORS IN THE PATIENTS WITH DIALYSIS CHRONIC KIDNEY DISEASE

Objectives: To investigate the correlation between the concentration in blood of bone minerals: Phosphorus, calcium, PTH, vitamin D, β2 microglobulin, aluminium with some clinical and subclinical factors in patients with dialysis chronic kidney patients. Materials and Methods: Descriptive cross-sectional study, include 163 patients with dialysis chronic kidney disease, from January 2017 to December 2018 at the Department of Haemodyalysis, District 2 Hospital, Ho Chi Minh City. Results: Serum phosphorus is negatively correlated with age r = - 0.342; positively correlated with albumin: r = 0.156, urea: r = 0.328, creatinine: r = 0.175, calcium x phosphorus index: r = 0.809,PTH: 0.273. Corrected serum calcium is negatively correlated with albumin: r = - 0.917, Hb: r = - 0.369, urea: r = - 0.178, creatinine: r = - 0.188, calcium x phosphorus index: r = 0.492. Plasma PTH positively correlated with dialysis time: r = 0.336, β2 microglobulin: r = 0.247; negatively correlated with Aluminum: r = - 0.161. Serum vitamin D negatively correlated with age: r = - 0.166, β2microglobulin: r = - 0.231. Serum aluminium positively correlated with diastolic blood pressure: r = 0.207 and systolic: r = 0.209. Serum β2 microglobulin positively correlated with dialysis time: r = 0.233, urea: r = 0.168; negatively correlated with Aluminum: r = - 0.224. Conclusion: Some bone mineral in dialysis patients are correlated with age, dialysis time, blood pressure, albumin, urea, creatinine. There is also a intercorrelation between bone minerals. Therefore, it is necessary to screen for bone mineral disorders and correlations as recommended by KDOQI, KDIGO. Key words: End-stage chronic kidney disease, dialysis, correlation, bone mineral disorders

P0005TIME-VARYING DIALYSATE BICARBONATE CONCENTRATIONS CAN REDUCE PEAK INTRADIALTIC SERUM BICARBONATE CONCENTRATIONS

Background and Aims Hemodialysis (HD) treatments using bicarbonate-containing dialysis solutions can result in large intradialytic increases in serum bicarbonate concentration, potentially inducing intradialytic alkalemia. It has been suggested that a time-varying, compared with a constant, dialysate bicarbonate concentration may limit the intradialytic increase in serum bicarbonate concentration (Tobvin & Sherman, Semin Dial 2016). We tested this hypothesis using a mathematical model of bicarbonate transport during HD. Method We used the H+ mobilization model describing bicarbonate transport during HD (Sargent et al, Semin Dial 2018) to compare intradialytic serum bicarbonate concentrations when using constant or time-varying dialysate bicarbonate concentrations that deliver the same total amount of buffer base to the patient during the HD treatment. We employed this model to evaluate different time-varying dialysate bicarbonate concentration profiles that started at a high value and then decreased as a step function with a 10-minute timing resolution. Dialysis time was 210 minutes, dialysis solutions were assumed to contain acetate at 3 mEq/L, and all kinetic parameters were assumed to be identical to those reported by Sargent et al (Semin Dial 2018). All results with time-varying dialysate bicarbonate concentrations were compared to a constant dialysate concentration of 32 mEq/L. Results Example results comparing time-varying (36.0 mEq/L for the initial 40 min, 31.2 mEq/L thereafter) and constant (32 mEq/L) dialysate bicarbonate concentrations are shown in the figure. The time-varying dialysate bicarbonate concentration lowered the peak intradialytic serum bicarbonate by 0.4 mEq/L for approximately one-half of the treatment. Similar reductions in the peak intradialytic serum bicarbonate concentration could be achieved if the initial high dialysate bicarbonate concentration was 37.6 mEq/L for 30 min or 40.8 for 20 min. The optimal initial high dialysate bicarbonate concentrations and the reduction in the peak intradialytic serum bicarbonate concentrations were somewhat dependent on the assumed patient-dependent H+ mobilization coefficient. Conclusion We conclude that a time-varying dialysate bicarbonate concentration can lower the peak intradialytic serum bicarbonate concentrations while delivering the same total amount of buffer base to the patient. Whether this approach will yield improved patient outcomes requires further evaluation.

P1105CAN BETTER EFFICACY OF MIDDLE WEIGHT MOLECULES REMOVAL IN DIALYSIS PATIENTS TREATED WITH MEDIUM CUT-OFF MEMBRANES PREDICT SUPERIORITY OVER CONVENTIONAL HIGH FLUX DIALYSERS?

Background and Aims During last two decades there was a significant improvement in dialysis field, especially with introducement of high flux haemodialysis and on-line haemodiafiltration. In recent years, expanded haemodialysis has emerged as a new attempt to imrove effectiveness of dialysis. These so called medium cut-off membranes (MCO), allow removal of wider range of uremic toxins, especially middle weight molecules, most of which have important role in chronic inflammation and mortality. The aim of this prospective pilot study was to evaluate the effectiveness of middle molecules and other uremic toxins removal in patients treated with medium cut-off membrane (Theranova 500tm, Baxter), compared with patients on conventional high flux dialysis programme. Method We examined 10 patients on chronic haemodialysis programme, five of them dialyzed with Theranova 500tm dialyser for one year, and other five patients dialyzed with high flux membranes (polysulfone membrane, 1.8m2) during the same period. Patients were matched according to their age, sex, main disease, and the beginning of dialysis. Analyzed laboratory parameters were urea, creatinine, calcium, phosphorus, PTH, and hemoglobin, on the beginning of the study and after one year follow up, while hepcidin and β2 microglobulin levels were measured only in the end of follow up period. We used descriptive and analytic statistical methods (T test for independent and dependent means). Results Patients were divided in two groups, Group 1 - dialyzed with Theranova, and Group 2- patients on high flux haemodialysis, both followed during one year period (Group 1: 63.2±7.01 years, 3 males and 2 women, one of them with polycystic kidney disease (PCKD), the other four with hypertension as main disease, median dialysis time 54.6±8.32 months, Group 2: 63±6 years, 3 males, 2 women, main disease in one was PCKD, in other four hypertension, median dialysis time 53.6±17.98months). Our patients didn’t differ statistically in basic examined laboratory parameters on the beginning of examination (mean urea 21.38±2.15 vs. 27.44±3.93 mmol/ (p&gt;0.05), mean creatinine 936±88.5 vs. 927.6±98.8µmol/L, mean albumin 40±2.54 vs 39.8±2.77g/L (p&gt;0.05), mean calcium 2,24±0.16 vs 2.21±0.17mmol/L (p&gt;0.05), mean phosphorus level 1,84±0.39 vs 1.67±0.56mmol/L (p&gt;0.05), mean parathyroid hormone level 266.16±279.64 vs 236.14±43.99pg/mL (p&gt;0.05), and mean hemoglobin 122.2±5.72 vs 106.4±8.62g/L (p&gt;0.05). In patients on high flux haemodialysis programme there was no significant change in examined parameters during one year follow-up (for all examined parameters p value was &gt;0.05). After switching the first group on Theranova dialysers for one year there was small but statistically significant rise in urea (23.26±2.02mmol/L, p&lt;0.05), and also statistically significant decrease in serum creatinine level (840.2±75.34µmol/L, p&lt;0.05) in this group, while other parameters were not statistically significant. Comparing two groups after one year follow up, there was statistically significant higher level of hemoglobin in the first group (112.2±7.46 vs. 102g/L ±4.47, p&lt;0.05), and statistically significant decrease of beta-2 microglobuline (27.41±2.58 vs. 33.82± 2.47ng/mL, p&lt;0.05) and hepcidin (75.64±32.2 vs 100.26±10.58ng/mL, p&lt;0.05), while other parameters didn’t show statistical significance. Conclusion Our results implicate better clearance of middle weight molecules (B2M, hepcidin) in patients treated with Theranova 500 tm membrane, which could suggest anti-inflammatory effect of medium cut-off membranes, additionaly with the higher hemoglobin level after one year treatment, comparing to conventional high flux dialysis. Our results are promising, but need to be confirmed in larger randomized trials.