MO1050: Covid-19 Vaccination Improved Psychological Distress (Anxiety and Depression Scores) in Chronic Kidney Disease Patients: A Prospective Study

BACKGROUND AND AIMS

To our knowledge, the psychological impact of coronavirus disease (COVID-19) vaccination has not yet been evaluated for the general population nor for chronic kidney disease (CKD) patients.

The purpose of the study is to analyse the impact of vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on anxiety and depression scores in patients with different modalities of CKD.

METHOD

A total of 117 renal patients (50 haemodialysis patients, 13 peritoneal dialysis patients, 32 kidney transplants and 22 advanced CKD patients at pre-dialysis care) were evaluated for depression, anxiety, health-related quality of life (HRQOL) and perceived fears and resources with standardized (The Hospital Anxiety and Depression Scale; HADS) and self-reported questionnaires. The measure points were before vaccination and 15 days after vaccination.

RESULTS

The main finding of the study is that there is a decrease in the global mean of normal scores for anxiety and depression symptoms in CKD patients, post-vaccination. We did not find statistically significant differences in depression or anxiety scores, nor HRQOL differences between the treatment groups. The three main fears reported by the participants at baseline were those of adverse effects, not getting the vaccine and lack of information.

CONCLUSION

These findings highlight the potential interest of assessing psychological variables related to the impact of vaccination against SARS-CoV-2. New studies will be required to assess the impact of comprehensive vaccine coverage and its psychological impact.

P0623ACUTE RENAL FAILURE IN HAPOLIDENTICAL HEMATOPOIETIC CELL TRANSPLANTATION. TWO GRAFT VS HOST DISEASE (GVHD) PROFILAXIS PROTOCOL COMPARISON

Background and Aims

Haplo-hematopoietic cell transplantation (Haplo-HCT) assures a valid donor in short notice in over 95% of the patients with high risk haematological neoplasia. High doses of post-transplant cyclophosphamide, in combination with other inmunosupressive drugs like calcineurin inhibitors, rapamycine and micophenolate mofetil, is safe and useful in GVHD prevention.

The aim of the study was to analyze and compare acute kidney injury (AKI) in the first 100 days after transplantation, the characteristics of the patients who went on haplo-HCT, and prophylaxis for GVHD with cyclosporine (n=32) (group 1) or rapamycine (group 2), in combination with other immunossupresors.

Method

Fifty-two consecutive patients who recieved a Haplo-HCT at our institution between october/2012 and February/2019 were retrospectively reviewed.

Results

A total of 52 patients were included, 34 male (65.4%), with a median age median age of 52.8 years old (range 18-71). Co-morbidities: hypertension: 13 (25%), Diabetes: 13 (5.8%), previous neoplasia: 4(7.7%). 27 patients received previously platinum-based chemotherapy with and 50% had received a previous HCT. No chronic kidney disease (CKD) were present in any patient. Haematological diseases were :non Hodgkin lymphoma (28.8%), Hodgkin lymphoma (23.1%), acute myeloid leukemia (21.2%), myelodysplastic syndrome (13.5%), other (13.4%). 42 patients (80.8%) received reduced intensity conditioning. Major complications were: TMA: 7(13.5%), Sinusoidal Obstruction Syndrome: 3 (5.8%) and sepsis 27 (51.9%). During the first 100 days post-transplantation follow up, 26 patients (83.2%) in group 1 and 5 patients (25%) in group 2 developed AKI attending KDIGO classification (p<0.0005). At day 100 post-transplantation, 14.5% of survivors had renal failure, defined as increased of serum creatinine ≥ 0.3mg/dL with respect to their baseline. In group 2 none of the patients developed acute kidney injury (0%) at 100 days post-transplantation follow up.

Median serum Cr in survivors at day 100 was 0,65mg/dL in group 1 VS 0.62mg/dL in group 2, (p<0.001).

In the multivariate analysis, treatment with CI (p<0.01) and sepsis (p<0.05) were independent predictors of ARF.

Conclusion

Rapamycin use instead cyclosporine is associated with a significatively lower incidence of AKI in the first 100 days post-tansplantation in our group of patients. The findings of this study call for further research identifying if non cyclosporine group have similar results in term of prevention of GVHD and if this protocol has a better impact in renal function and surveillance in the follow up.

P0322OUR EXPERIENCE IN ELECTRONIC CONSULTATION FOR REDUCING WAITING LIST AND OPTIMIZING NEPHROLOGY HEALTHCARE

Background and Aims

Chronic kidney disease (CKD) is recognized as a health problem in the general population; as a result, there is a growing demand for specialist services. This is especially relevant in the Spanish health system which covers the entire population free of charge.

We describe our experience with new e-consultation software that allows specialists to provide clinical recommendations to primary care providers about non-subsidiary patients referred to our Nephrology Department. This system respects current protocols and is based on patient chart review without face-to-face visits, thus avoiding unnecessary time wastage in the healthcare system.

Method

Our Nephrology department covers the metropolitan area of Valencia with 341,972 citizens attended by 16 primary care centers. The Community IT software system allows all doctors (hospitals and primary care) to access the patient's medical records including laboratory, radiology, anthropometric data and treatments. A mailbox, developed as part of the Hospital General’s IT system, receives all proposed referrals from primary care doctors to our department. A nephrologist then decides if the e-consultation requires an in-person visit or can be answered as a non face-to-face visit. Thus, patient’s appointments are scheduled in less than one week (mean 3.8±4.5 days) and the outpatient visit in less than 14 days.

The main referral criteria were: albumin/creatinine ratio> 300 mg/g, eGFR<30 ml/min/1.73 (<45 in <70 years), renal progression, resistant hypertension in CKD patients, electrolyte abnormalities and renal anemia. Patients with conditions that do not meet referral criteria are attended and given the appropriate recommendations via e-consultation. The patient is not required to present at the hospital. We describe the results of e-consultations from 1St September 2017 to 31st December 2019.

Results

A total of 2641 consultations were submitted between September, 2017 to December, 2019 (807 in 2017, 861 in 2018 and 903 in 2019). Of these, 285 (12%) were answered as non face-to-face visit (6% of the 2017 e-consultations, 11% from 2018 and 24% from 2019).

The characteristics of the 285 non face-to-face e-consultations: mean age: 68.9 ±19.5 years, female: 61.4%, diabetics: 31.2%. The main reasons for referral were: mild/low eGFR (35%), mild albuminuria (10%), administrative questions related to treatments (10%), mild hypertension (4%), mild electrolyte disturbances (2%), subacute renal dysfunction resolved (10%) (mostly NSAIDs), non-nephrology causes (mainly urological) (8%), non-renal pathology (simple renal cysts, other) (10%) and other causes (11%). The re-consult rate was 2% within the first year.

Regarding patients referred with low eGFR, the mean age was 76 ± 14 years (range: 19-98), female sex: 73.9%, eGFR: 39±11 ml/min/1.73m2, serum creatinine 1.4 ± 0.4 mg/dL. Urine alb/creat ratio: 49±127 mg/g. Thirty five percent of them were between 70-79 years and 48% were> 80 years old. For those patients referred with mild albuminuria: mean age was: 57±21 years, male sex: 61%, diabetics: 31%, eGFR: 77±18 ml/min/1.73m2, serum creatinine 0.87±0.27 mg/dL. Urine alb/creat ratio: 83 ± 54 mg/g (range 33-128).

There was a 17 day waiting list to attend an outpatient nephrology clinic in 2016 (previous to the initiation of the e-consultation period). On the contrary, during the study period it was 14 days in 2017 and 4 days each in both 2018 and 2019.

Conclusion

Our experience shows that non-face-to-face e-consultation for patients with mild renal pathology promotes the effective management of patients who do not meet remission criteria according to established protocols. It also prevents the remission of a significant percentage of patients, reduces the waiting list and optimizes the healthcare system’s resources.

New mutation in female patient with renal variant of Fabry disease and HIV

We describe the case of a 27-year-old woman with a family history of Anderson-Fabry disease (AFD). Urinary sediment presented microhematuria and 0.9 g/24 hours proteinuria. The alpha-galactosidase A measurement in fibroblasts showed partial deficit of the enzyme, which was compatible with being a carrier of the illness. Renal biopsy gave evidence of kidney lesions from Fabry disease. Genetic study revealed mutation C52Y or Cys52Tyr, which has not been previously described and had also been detected in the father of the patient. During follow-up, the presence of hypergammaglobulinemia revealed an underlying HIV disease. She is now awaiting enzymatic substitution treatment.

Evolution and phylogenetic utility of the period gene in Lepidoptera

Evolution and phylogenetic utility of the period gene are explored through sequence analysis of a relatively conserved 909-bp fragment in 26 lepidopteran species. Taxa range from tribes to superfamilies, primarily within the putative clade Macrolepidotera plus near outgroups, and include both strongly established and problematic groupings. Their divergence dates probably range from the late Cretaceous through much of the Tertiary. Comparisons within the same set of closely related species show that amino acid substitutions in period occur 4.9 and 44 times as frequently as they do in two other nuclear genes--dopa decarboxylase and elongation factor-1 alpha, respectively. In contrast, rates of observed synonymous substitution are within 60% of each other for these three genes. Synonymous changes in period approach saturation by the family level, whereas nonsynonymous and amino acid divergences across the Macrolepidoptera are less than half the maximal values reported for this gene. Phylogenetic analyses of period strongly supported groupings at the family level and below. In contrast to previous analyses at this level with other nuclear genes, much of the information lies in nonsynonymous change. Relationships up to the superfamily level were recovered with decreasing effectiveness, and little, if any, signal was apparent regarding relationships among superfamilies. This could reflect rapid radiation of the superfamilies, however, rather than saturation in the period locus; thus, period, in combination with other genes, remains a plausible candidate for approaching the difficult problems of lepidopteran family and superfamily relationships.