MO840: A Survey on the Impact of Pruritus Associated With Chronic Kidney Disease (CKD-AP) In the Quality of Life of Patients Undergoing Haemodialysis in Spain

BACKGROUND AND AIMS

Chronic kidney disease (CKD) patients can be affected by pruritus. In Spain, CKD associated pruritus (CKD-aP) affects 60% of CKD patients on haemodialysis (HD). CKD-aP severely impacts in physical and mental health of patients, resulting in sleep disturbance, depressed mood, increased risk of infection and a low quality of life [1]. In Spain, there is a lack of data regarding CKD-aP patient's quality of life (QoL). The aim of the study is to determine how CKD-aP affects the HD patients’ QoL in Spain.

METHOD

The study was structured in two phases: The first phase involved the design and the validation (by a multidisciplinary panel of 9 experts) of a survey to assess CDK-aP patient's QoL. The second phase consisted in sending the survey to CKD patients and subsequent results analysis.

RESULTS

The survey was structured in 10 domains with 25 questions that collected relevant aspects of the CKD-aP patients’ QoL.

A total of 189 HD patients answered the survey, 97 (51%) of whom had CKD-aP. The main results are showed in Table 1.

CKD-aP HD patients reported a health status significantly lower than HD patients without pruritus (mean = 46 versus 53 out of 100, respectively, P-value = 0.02). Moreover, the health status worsened when increasing severity of pruritus (mild = 51/100; moderate = 48/100; severe = 32/100). Out of 10, 6 CKD-aP patients suffer from it always or sometimes a day. A total of 30% of patients reported pruritus throughout the day, while 29% suffer from it at night. 39% of CKD-aP patients, of which 39% have severe pruritus and 62% moderate, reported having difficulty falling asleep sometimes a week or more. A total of 44% of patients experienced irritability once a week or more, 32% frustration, 21% distress, 11% depression and 7% embarrassment. In addition, pruritus limits patients’ daily and social activities (12% patients were limited once a week or more), preventing them from doing sports, housework, going to restaurants and/or engaging in cultural activities. It also alters patients’ cognitive function, leading to a lack of concentration and/or confusion (22% patients had an altered cognitive function once a week or more). 10% of patients had infections or fistula damage due to scratching. 62% of CKD-aP patients were not treated for pruritus, and of those treated, 47% were dissatisfied with their treatment.

CONCLUSION

This study shows that CKD-aP is a distressing condition with a huge impact in CKD HD patients’ QoL in Spain. However, there is an unmet need in terms of treatment, meaning that new treatments for CKD-aP are necessary to improve patients’ QoL.

FC001: Humoral Response to Third Dose of Sars-Cov-2 Vaccines in the CKD Spectrum: The Sencovac Study

BACKGROUND AND AIMS

There is incomplete information on the impact of a third dose of the SARS-CoV-2 vaccine in advance chronic kidney disease (CKD). The aim of the present analysis was to evaluate the kinetics of humoral response in the CKD spectrum (KT, HD, PD and ND-CKD) 6 months after completing the initial vaccine schedule. Some patients of each group received a third dose before 6 months, providing a pragmatic insight into real-world responses to different vaccine schedules in patients with advanced CKD not on dialysis, on dialysis or in KT recipients.

METHOD

The SENCOVAC study describes the humoral response and safety of different SARS-CoV-2 vaccines in a real-world setting in 3687 CKD patients: 787 kidney transplant (KT), 319 peritoneal dialysis (PD), 2297 haemodialysis (HD) and 284 non-dialysis-CKD (ND-CKD) patients. Anti-Spike antibodies were assessed in an efficacy analysis at 28 days (n = 1755), 3 months (n = 1386), and 6 months (n = 1018, of whom 628 had received a third vaccine dose). Adverse events (AEs) were registered during follow-up, including SARS-CoV-2 infections in the safety analysis.

RESULTS

Among the patients included in the efficacy analysis, KT recipients presented lower anti-Spike antibody titers than other CKD cohorts at 28 days and 3 months (P < .001 for all). A total of 943 patients [249 (26%) KT, 108 (11%) PD, 511 (54%) HD and 75 (8%) ND-CKD] had negative baseline anti-Spike antibodies. Again, at 28 days or 3 months, KT recipients developed lower anti-Spike antibody titers than PD (P < .001), HD (P < .001) and ND-CKD (P< .001) patients. At 6 months, patients that had received a third vaccine dose had higher anti-Spike antibody titers than those without the third dose [1837 (507–9726) UI/mL versus 80 (19–409) ml/UI; P < .001] and this was evident in all CKD cohorts. Anti-Spike titers after the third dose were higher in patients boosted with mRNA-1273 than with BNT162b2 [1710 (322–9615) versus 472 (34–2094); P < .001). At 6 months, in patients that had received a third dose, a positive humoral response (anti-Spike antibodies > 36 UI/mL) was achieved in 584 (93%): 94 (80%) of 118 KT recipients, 20 (100%) of 20 patients on PD, 436 (96%) of 455 patients on HD and 34 (97%) of 35 patients with ND-CKD (Fig. 1). Among patients without humoral response 3 months after completing the initial vaccination schedule, 72 (69%) seroconverted after the third dose (62% KT, 76% HD, 100% ND-CKD, all PD patients had a positive humoral response at 3 months). Independent predictors of a positive humoral response at 6 months were not-KT (HR for KT 0.26, P = .011), third dose (HR 22.9, P < .001), initial mRNA-1273 (HT 1.78, P = .017) and humoral response at 3 months (HR 26.2, P < .001). Breakthrough SARS-CoV-2 infections occurred in 1.1% of patients, and mortality was 14.6%, none after the third dose.

CONCLUSION

In the CKD spectrum, anti-Spike antibody titers continued to decrease from 3 to 6 months after complete vaccination, and KT recipients presented higher rates of negative humoral response at 6 months. A third dose of mRNA vaccine increased anti-Spike antibody titers but was still insufficient to spur a humoral immune response in at least 38% of KT recipients and 24% of patients on HD that lacked anti-SARS-CoV-2 antibodies 3 months post-initial vaccination. New strategies are urgently needed to protect CKD patients that remain negative for anti-SARS-CoV-2 antibodies, given the high mortality of breakthrough SARS-CoV-2 infections.

FC 026COVID-19 IMPACT ON ELDERLY HEMODIALYSIS POPULATION: RESULTS FROM THE SPANISH COVID-19 CKD WORKING GROUP REGISTRY

Background and Aims

Age and chronic kidney disease have been described as mortality risk factors for coronavirus disease 2019 (COVID-19). Currently, an important percentage of patients in hemodialysis are elderly. This study aimed to investigate the impact of COVID-19 in this population and to determine risk factors associated with mortality.

Method

Data was obtained from the Spanish COVID-19 CKD Working Group Registry, that included patients in renal replacement therapy (dialysis and kidney transplantation) infected by COVID-19. From March 18, 2020, to August 27, 2020, 1165 patients on hemodialysis affected by COVID-19 were included in the Registry. A total of 328 patients were under 65 years-old and 837 were 65 years old or older (elderly group).

Results

Mortality was 18.6% higher (95% confidence interval (CI): 13.8%-23.4%) in the elderly hemodialysis patients compared to the non-elderly group (see figure). Death from COVID-19 infection was increased 5.5-fold in hemodialysis patients compared to mortality in the general population for a similar period, and there was an age-associated mortality increase in both populations (see figure 1). In multivariate Cox regression analysis, age (hazard ratio (HR) 1.58, 95% CI: 1.31-1.92), dyspnea at presentation (HR 1.61, 95% CI: 1.20-2.16), pneumonia (HR 1.76, 95% CI: 1.12-2.75) and admission to hospital (HR 4.13, 95% CI: 1.92-8.88) were identified as independent mortality risk factors in the elderly hemodialysis population. Treatment with glucocorticoids reduced the risk of death (HR 0.71, 95% CI: 0.51-0.98) in aged patients on hemodialysis.

Conclusion

Mortality is dramatically increased in elderly hemodialysis patients affected by COVID-19. Age, dyspnea at presentation, pneumonia or hospitalization are factors associated with a worse prognosis, after adjusting dialysis population to other confounding factors. Treatment with glucocorticoids could be a therapeutic option for this specific population.

P1052EXPANDED HEMODIALYSIS (HDX) DOES NOT AFFECT EPIGENETIC INTERCELLULAR SIGNALS INVOLVED IN INFLAMMATION AND CARDIOVASCULAR DISEASE

Background and Aims

Epigenetic signals play a principal role in homeostasis, but also may promote diseases including cardiovascular diseases (CVDs) when are altered. Extracellular vesicles (EVs) or plasma circulating DNA and RNA may have relevant functions in both physiological and pathophysiological contexts related to the epigenetic intercellular communication. Thus, changes in the endothelial or platelet EVs, or the plasma circulating methylated DNA may contribute to the chronic inflammation and the subsequent CVDs in chronic kidney disease patients, particularly when are in hemodialysis (HD). Dialysis membranes do not usually allow the passage of molecules larger than 30-40 kDa. However, the new system of expanded hemodialysis (HDx) with a medium-cut-off membrane (MCO), due to its characteristics, could alter the plasma content of these EVs and DNA methylation, and thereby, promote the development of CVDs. Therefore, our study evaluates whether global plasma DNA methylation and EVs content are modified during an HDx session.

Method

For this study, we selected 12 dialysis patients: HDx patients (n=6; dialyzed with MCO) and control group (n=6; dialyzed with other HD membranes). Before and after a dialysis session, plasma samples were obtained. EVs were isolated by ultracentrifugation, and the total number of EVs and platelet and endothelial-derived EVs were characterized and quantified by flow cytometry. RNA and DNA extraction and quantification were carried out using different kits and NanoDrop spectrophotometer. DNA methylation was assessed with a 5-methyl cytosine (5-mC) DNA assay kit.

Results

As shown in the figure, after a dialysis session with the HDx, no significant differences were observed in the total number of EVs, as well in the number of platelet- and endothelial-derived EVs, in comparison to those observed in HDx patients before the dialysis session. By contrast, patients dialyzed with other HD membranes presented differences in the number of total EVs and platelet and endothelial EVs, which decreased significantly (p&lt;0.05) after the dialysis session. Concerning DNA methylation, no statistically significant changes in total DNA 5-mC (%) were observed in both HDx and control patients after the dialysis session. However, a slight tendency to decrease methylated DNA was observed with the HDx compared to other HD membranes (control). Moreover, no significant changes in DNA and RNA % were observed after dialysis session in both HDx and control group.

Conclusion

To our knowledge, this is the first study to investigate the influence of the HDx technique on the content of plasma cellular EVs and DNA methylation status. HDx does not affect EVs levels, although it shows a tendency to purify plasma methylated DNA. Although this study was not designed to analyze the comparative effectiveness between different membranes, interestingly this effect in epigenetic signals was not observed with other HD membranes, where patients showed a marked reduction of EVs content. The differential activity of HDx about other HD membranes deserves further investigation.

Funding

(PI17/01029; PI19/00240; ISCIII-FEDER). Santander/UCM PR41/17-20964. Spanish Society of Nephrology 2018. UAH-GP2018-4

Acute effect of citrate bath on postdialysis alkalaemia

INTRODUCTION

The correction of metabolic acidosis caused by renal failure is achieved by adding bicarbonate during dialysis. In order to avoid the precipitation of calcium carbonate and magnesium carbonate that takes place in the dialysis fluid (DF) when adding bicarbonate, it is necessary to add an acid, usually acetate, which is not free of side effects. Thus, citrate appears as an advantageous alternative to acetate, despite the fact that its acute effects are not accurately known.

OBJECTIVE

To assess the acute effect of a dialysis fluid containing citrate instead of acetate on acid-base balance and calcium-phosphorus metabolism parameters.

MATERIAL AND METHODS

A prospective crossover study was conducted with twenty-four patients (15 male subjects and 9 female subjects). All patients underwent dialysis with AK-200-Ultra-S monitor with SoftPac® dialysis fluid, made with 3 mmol/L of acetate and SelectBag Citrate®, with 1 mmol/L of citrate and free of acetate. The following were measured before and after dialysis: venous blood gas monitoring, calcium (Ca), ionic calcium (Cai), phosphorus (P) and parathyroid hormone (PTH).

RESULTS

Differences (p<0.05) were found when using the citrate bath (C) compared to acetate (A) in the postdialysis values of: pH, C: 7.43 (0.04) vs. A: 7.47 (0.05); bicarbonate, C: 24.7 (2.7) vs. A: 27.3 (2.1) mmol/L; base excess (BEecf), C: 0.4 (3.1) vs. A: 3.7 (2.4) mmol/L; corrected calcium (Cac), C: 9.8 (0.8) vs. A: 10.1 (0.7) mg/dL; and Cai, C: 1.16 (0.05) vs. A: 1.27 (0.06) mmol/L. No differences were found in either of the parameters measured before dialysis.

CONCLUSION

Dialysis with citrate provides better control of postdialysis acid-base balance, decreases/avoids postdialysis alkalaemia, and lowers the increase in Cac and Cai. This finding is of special interest in patients with predisposing factors for arrhythmia and patients with respiratory failure, carbon dioxide retention, calcifications and advanced liver disease.