Impact of Intradialytic Fiber Clotting on Dialyzer Extraction and Solute Removal: A Randomized Cross-Over Study

Previous studies revealed the importance of biocompatibility, anticoagulation strategy, and dialysis mode and duration on fiber blocking at the end of a hemodialysis session. The present study was set up in ten hemodialysis patients to relate fiber patency to dialyzer extraction and removal of small and middle molecules. With only 1/4th of the regular anticoagulation dose, and using a Solacea™ 19H and FX800 CorDiax dialyzer, fiber patency was quantified using 3D micro-CT scanning for different dialysis durations (i.e. 60, 120 and 240min). While Solacea™ showed good performance in all test sessions, fiber blocking in the FX800 CorDiax did not follow a linear process during dialysis, but was rather accelerated near the end of dialysis. Dialyzer extraction ratios were correlated with the percentages of open fibers. While the fiber blocking process affected extraction ratios (i.e. for phosphorus and myoglobin in the FX800 CorDiax), it had only minor impact on the removal of toxins up to at least 12kDa.

Outbreak of SARS-CoV-2 in hospitalized hemodialysis patients: an epidemiologic and genomic investigation

We performed an epidemiological investigation and SARS-CoV-2 genome sequencing to define the source and scope of an outbreak in a cluster of hospitalized patients. Lack of appropriate respiratory hygiene led to SARS-CoV-2 transmission to patients and healthcare workers during a single hemodialysis session, highlighting the importance of infection prevention precautions.

42. Outbreak of SARS-CoV-2 in Hospitalized Hemodialysis Patients: an Epidemiologic and Genomic Investigation

Background Healthcare-associated transmission of SARS-CoV-2 is relatively rare and may be difficult to quantify. We performed an epidemiological investigation and SARS-CoV-2 genome sequencing to define the source and scope of a SARS-CoV-2 outbreak in a cluster of hospitalized patients Methods We conducted an outbreak investigation after identifying hospital-onset COVID-19 in patients receiving hemodialysis in January 2021. Electronic medical record review, staff interviews, review of employee schedule logs, and contact tracing were used to determine the outbreak timeline and identify exposed healthcare workers (HCW). SARS-CoV-2 genomes were sequenced from residual nasopharyngeal swab samples from 6 individuals in the outbreak investigation and compared to sequences from 14 patients in the same facility, 54 patients in nearby facilities, and 375 publicly available sequences from individuals in the state of Georgia. Results Eight patients with hospital-onset COVID-19 were identified (Cases 1-8); all were receiving hemodialysis and 5 were bedded in a single inpatient nursing unit. Among 53 potentially exposed HCW, 29 underwent testing and 5 were positive (Cases 9-13). The suspected index patient (Case 1) was found to have been coughing and inconsistently wearing a mask during a hemodialysis session on the same day that 6 of the 7 other patients and one HCW (Case 10) were in close proximity in the hemodialysis unit (Figure 1A). Further investigation revealed lack of use of curtain barriers in the hemodialysis bays, inconsistent use of personal protective equipment by HCW, and overcrowding of staff breakrooms. Among the 6 samples available for phylogenetic analysis, SARS-CoV-2 sequences from 5 (4 patients and 1 HCW, Case 9) were identical and at least 4 SNPs removed from the next closest sequence in this study, supporting a transmission cluster (Figure 1B). The sequence from the sixth sample (HCW Case 10) was phylogenetically distinct, indicating an independent source of infection. Figure 1 Exposure and onset of symptoms for the 6 cases in the outbreak with samples available for SARS-CoV-2 sequencing. Four patients with hospital-onset COVID-19 (Cases 1-4) were receiving hemodialysis and bedded in a single inpatient nursing unit, with two exposed healthcare workers (Cases 9-10). (A). Phylogenetic tree of SARS-CoV-2 genomes from individuals in this outbreak investigation (red), as well as 14 patients in the same facility and 54 patients in nearby facilities between 12/12/2020 and 1/13/2021 (blue). These were aligned with 375 publicly available sequences from individuals in the state of Georgia from the same time period using MAFFT. A maximum-likelihood phylogenetic tree was generated under a generalized time-reversible model with 1,000 bootstrap replicates using IQtree v2.0.3 and visualized and annotated using Interactive Tree of Life (iTOL) v4 (B). Conclusion Lack of appropriate respiratory hygiene led to SARS-CoV-2 transmission during a single hemodialysis session, based on clinical and genomic epidemiology. Use of appropriate PPE for both patients and HCW and other infection prevention measures are critical to prevent SARS-CoV-2 transmission. Disclosures All Authors: No reported disclosures

Effects of interdialytic interval on heart rate variability in chronic hemodialysis patients: a cross-sectional study

Previous studies showed that long interdialytic interval of chronic hemodialysis increased risk of sudden cardiac death compared to short interdialytic interval. Diabetes mellitus (DM) and autonomic dysfunction are the strong adverse predictors of survival in ESRD patients. We aimed to compare autonomic function between long and short interdialytic interval of chronic hemodialysis in patients with and without DM. One-hundred sixty-three patients receiving chronic hemodialysis were enrolled. The electrocardiogram recording was performed twice in each patient during 4-h hemodialysis session after long and short interdialytic intervals to assess heart rate variability (HRV). Mean age was 61.4 ± 14.3 years. HRV parameters during hemodialysis did not differ between long and short interdialytic interval in overall population. Nevertheless, in 82 (50.3%) patients, SDNN (47.4 ± 23.8 vs. 43.4 ± 19.5 ms, P = 0.039), ASDNN (24.8 ± 14.3 vs. 22.7 ± 12.3 ms, P = 0.025), LF (8.4 ± 6.8 vs. 7.6 ± 6.6 ms2, P = 0.040) increased after long interdialytic interval. The greater change of SDNN, ASDNN, VLF and LF between long and short interdialytic intervals was noted in DM, compared to non-DM patients. We demonstrated that there was no difference of HRV parameters after short and long interdialytic interval. However, there was greater autonomic alteration observed in DM than non-DM patients between 2 interdialytic intervals.

THE I NFLUENCE OF INTRАDIАLYTIC HYPOTENSION ON THE FUNCTIONING OF АRTERIOVENOUSFISTULА

Introduction. Nowadays hemodialysis is the most widespread way of treatment concerning the end-stage renal disease. The variant of choice as for permanent vascular access for hemodialysis is arteriovenous fistula. An actual problem is the deterioration of the patency of arteriovenous fistula. According to the research, most patients do not know about the risks associated with intradialytic hypotension. Under these conditions, research with determining the level of critical intradialytic hypotension is particularly relevant. Purpose of the work is to study and evaluate intradialytic hypotension as a risk factor for thrombosis of arteriovenous fistulas. Materials and methods. 60 patients were examined with end-stage renal disease, receiving of hemodialysis. Among these patients a thrombosis of arteriovenous fistula appeared in the long term (7.5 (3.0–17.6) months) after the surgery. The average age of patients was (54.1 ± 11.8) years; there were 30 (50%) men, 30 (50%) women. Results. According to the results of our study, 38 (63 %) patients had hypotension at the end of the hemodialysis session. Conclusions. Blood hypotension is one of the main predictors of thrombosis of arteriovenous fistula in the late postoperative period. A decrease in systolic blood pressure on 35.0 (25.0–50.0) mm Hg to 100.0 (90.0–110.0) mm Hg is critical for the patency of arteriovenous fistula. Adequate control and correction of blood pressure (in particular, during a hemodialysis session) can prevent thrombosis of arteriovenous fistula.

Use of non-invasive intracranial pressure pulse waveform to monitor patients with End-Stage Renal Disease (ESRD)

End-stage renal disease (ESRD) is treated mainly by hemodialysis, however, hemodialysis is associated with frequent complications, some of them involve the increased intracranial pressure. In this context, monitoring the intracranial pressure of these patients may lead to a better understanding of how intracranial pressure morphology varies with hemodialysis. This study aimed to follow-up patients with ESRD by monitoring intracranial pressure before and after hemodialysis sessions using a noninvasive method. We followed-up 42 patients with ESRD in hemodialysis, for six months. Noninvasive intracranial pressure monitoring data were obtained through analysis of intracranial pressure waveform morphology, this information was uploaded to Brain4care® cloud algorithm for analysis. The cloud automatically sends a report containing intracranial pressure parameters. In total, 4881 data points were collected during the six months of follow-up. The intracranial pressure parameters (time to peak and P2/P1 ratio) were significantly higher in predialysis when compared to postdialysis for the three weekly sessions and throughout the follow-up period (p<0.01) data showed general improvement in brain compliance after the hemodialysis session. Furthermore, intracranial pressure parameters were significantly higher in the first weekly hemodialysis session (p<0.05). In conclusion, there were significant differences between pre and postdialysis intracranial pressure in patients with ESRD on hemodialysis. Additionally, the pattern of the intracranial pressure alterations was consistent over time suggesting that hemodialysis can improve time to peak and P2/P1 ratio which may reflect in brain compliance.

Optimized approach to surgical treatment of proliferative diabetic retinopathy in patients with permanent hemodialysis

Purpose. Optimization and identification of key conditions for successful surgical treatment of PDR in patients with permanent hemodialysis. Material and methods. The results of surgical treatment of 8 patients (10 eyes) with PDR who received permanent hemodialysis were analyzed. All patients underwent surgery 18-20 hours after the hemodialysis session. 25G vitrectomy with phacoemulsification 1-5 days after intravitreal injection inhibitor of anti-VEGF. Results. In 9 cases, an improvement in visual functions was achieved. Visual acuity of 0.08-0.1 in 5 cases, 0.1-0.2 in 3 cases and 0.3 in one case on a single eye. Conclusions. The described stereotype is the optimal approach for the surgical treatment of PDR in patients with permanent hemodialysis. Key words: proliferative diabetic retinopathy, hemodialysis, vitrectomy.

Prevalence and correlates of malnutrition among hemodialysis patients at hebron governmental hospital, Palestine: cross-sectional study

Background Malnutrition is a usually observed condition among patients on hemodialysis and is considered one of sturdiest indicators of mortality and morbidity. Objectives The current study was performed to assess the prevalence of malnutrition, to verify whether functional status is associated with malnutrition, and to explore the probable factors related to malnutrition among a sample of hemodialysis patients at Hebron Governmental Hospital in West Bank, Palestine. Methods A cross-sectional study was conducted on hemodialysis patients in Hebron Governmental Hospital at Hebron city/Palestine. An interview-based questionnaire was used to obtain information related to socio-demographics, dialysis, medical history, lifestyle, anthropometric measurements, dietary data, and functional status. Renal inpatient screening tool (renal iNUT) was also utilized to screen hemodialysis patients for malnutrition. Furthermore, biochemical tests were obtained during the study period from medical files of the studied patients. Results A total of 153 patients, having a mean age of 50.1 ± 16.6 years, were involved in the final analysis. The results indicated that the prevalence of high risk of malnutrition (45.4 %). Moreover, high risk of malnutrition was significantly associated with occupation, and walking. It was further found that patients with high risk of malnutrition are more likely to had osteoporosis, unable to ambulate, didn’t feel that the amount of food they eat is enough. Our findings also figured out that some complications during hemodialysis session (e.g., headache, nausea, hypotension) and some hemodialysis side effects (e.g., itching, access site complication) were significantly correlated to malnutrition. Conclusions A high prevalence of malnutrition was revealed among hemodialysis using renal iNUT screening tool. Improving nutritional assessment methods for patients on hemodialysis is highly needed. Findings reveals that risk of malnutrition is associated with multiple factors such as osteoporosis, occupation, walking, ability to ambulate, certain complication during hemodialysis session, and some hemodialysis side effects. Further studies are highly recommended.

MO856IMPACT OF HEMODIALYSIS TIME PROLONGATION ON BLOOD PRESSURE CONTROL IN PREVALENT HEMODIALYSIS PATIENTS

Background and Aims Hypertension prevalence among ESRD patients range from 76% to 90%. Sodium & volume overload is among the main mechanisms. Increasing theduration of dialysis time, either by longer session hours or increased sessions, aiming at reducing the dry weight to achieve euvolemia, may be beneficial for individuals who failed to achieve target BP or ideal volume status during standard HD prescription hours.We aim to study the effect of increasing hemodialysis session time on blood pressure control. Method This observational study was conducted on 50 adult clinically stable hypertensive prevalent HD patients on thrice weekly maintenance HD. Patients with secondary causes of hypertension and Patients with decompensated medical conditions were excluded from our study.Patients were divided into 2 groups:(A) 25 patients who received longer session hemodialysis session (4.5hour) and (B) 25 patients HD who received the usual 4 hours session. Revision of antihypertensive medications&dosages,dry weight was reassessed regularly, andthey were instructed to restrict their salt intake as much as possible aiming at BP &lt;140/90mmHg.they werefollowed up for a period of 6 months assess changes of pre-dialysis blood pressure to monitor response. Results Patients in both groups were age matched, with male sex predominance (64%in groupA&56% in groupB). Patients in both groups underwent their HD sessions mostly through AVF (68% and 92% for group A and B respectively). Ultrafiltration volume declined significantly with longer HD sessions compared to conventional sessions (p-value &lt;0.001 vs 0.523). Longer HD session time session was associated with highly significant decline in mean SBP, (p-value &lt;0.001). Longer HD session time session was associated with highly statistically significant decline in mean DBP, (p-value &lt;0.001). The decline in mean perdialysis SBP & DBP was -17.27 &-9 mmHg, respectively and the rate of decline of postdialysis SBP & DBP was -6.45 & -12.38 mmHg, respectively at 6th month compared to values in 1st month of follow up period. Conclusion Longer HD session duration is associated with better improvement in UF volume, mean SBP&DBP, pre-dialysis SBP&DBP and post-dialysis SBP&DBP as well.