ArticlePDF Available

SAT-248 MAINTAINING A BALANCED BONE HEALTH BY OPTIMUM MANAGEMENT OF RENAL OSTEODYSTROPHY IN THE HEMODIALYSIS POPULATION

Authors:
A median weekly dose of etelcalcetide was 15 mg (7.522.5 mg) and
did not differ between naïve patients or switched from cinacalcet.
After the switch of treatment, none of the patients developed
clinical intolerance or new adverse effects. Etelcalcetide was more
effective than cinacalcet in controlling secondary hyperparathyroidism.
The dose conversion factor for the switch was [etelcalcetide/week] ¼
0.277[mg cinacalcet/day], indicating that single dose of etelcalcetide
(2.5 mg per session) is functionally slightly less than single dose of
cinacalcet (30 mg per day).
Conclusions: These results indicate that the signs of assumed autono-
mous parathyroid glands adenoma could predict therapeutic response
of etelcalcetide better than PTH level.
SAT-245
RELATIONSHIP BETWEEN NEUTROPHIL-TO-
LYMPHOCYTE RATIO AND PLATELET-TO-
LYMPHOCYTE RATIO WITH ERYTHROPOIETIN
RESISTANCE IN HEMODIALYSIS PATIENTS
GOLUBOVIC, S*
1
, Knezevic, V
1,2
, Azasevac, T
1,2
, Bozic, D
1,2
,
Celic, D
1,2
, Mitic, I
1,2
1
Clinical Center of Vojvodina Department of Nephrology and clinical
immunology Novi Sad Serbia,
2
University of Novi Sad Medical Faculty Novi
Sad Serbia
Introduction: Erythropoiesis stimulating agents (ESA) have become a
standard treatment of anemia in end stage renal disease. One of the most
common factors contributing to resistance to ESA therapy is inam-
mation. Neutrophil to lymphocyte ratio (NLR) and platelet to
lymphocyte ratio (PLR) have recently been identied as new markers of
inammation in end stage renal disease, however their association with
ESA therapy has not been investigated. We aimed to determine the
relationship between PLR, NLR and ESA responsiveness.
Methods: We performed a cross sectional study including 90 patients on
maintenance hemodialysis undergoing ESA therapy at the Department of
Nephrology and clinical immunology, Clinical Center of Vojvodina in
Novi Sad Serbia. Data on patient demographics, dry weight, body mass
index, duration of HD (months), complete blood count, biochemistry,
NLR, and PLR were recorded in all patients. ESA hyporesponsiveness
index (EHRI) was calculated as the weekly dose of erythropoietin divided
by kilograms of body weight divided by the hemoglobin level
Results: Hemoglobin levels were strongly negatively correlated with
logarithmically converted EHRI (logEHRI) (r¼-0.50, p #0,00), whereas
both NLR and PLR were positively correlated with logEHRI ( r¼0.30
p#0,00, and r¼0.36 p#0.00). Comparison of NLR and PLR among 25th,
50th and 75th percentile of EHRI revealed a strong positive correlation
in all three groups. Posthoc analysis showed that there is a difference
between NLR and 25
th
and 50
th
percentile (p¼0,00) as well as between
25 and 75
th
percentile (p¼0,00) while there was no difference between
the 50
th
and 75
th
percentile. When it comes to TLR there was a sta-
tistical difference in all percentile groups (p¼0,00). A slightly stronger
correlation was identied between PLR and logEHRI compared to NLR
and logEHRI
Conclusions: NLR and PLR present simple and universally accessible
methods and bear a great potential to be clinically used as new prog-
nostic markers of erythropoietin therapy response
SAT-246
THE EFFECT OF DENOSUMAB
ON OSTEOPOROSIS IN PATIENTS
WITH HEMODIALYSIS
Han, SY*
1
, Jo, HA
2
, Han, KH
2
1
Inje University Ilsan-Paik Hospital Internal Medicine Goyang Korea- Re-
public Of,
2
Inje University- Ilsan-Paik Hospital Internal Medicine Goyang
Korea- Republic Of
Introduction: The incidence of fractures is much higher in patients with
chronic kidney disease(s), especially hemodialysis, than people without
CKD. Although osteoporosis is an important risk factor for a fracture, it
is unclear what optimal treatment for osteoporosis in patients with
hemodialysis is (can be). Recent KDIOG guideline recommends evalu-
ation of osteoporosis using (a) bone densitometry to predict incident
fractures in patients with CKD. We determined the effectiveness of
denosumab, which is a RANKL inhibitor to prevent the development of
osteoclast, based on combined results of a bone densitometry and
biomarkers in patients with hemodialysis.
Methods: A bone densitometry, dual-energy x-ray absorptiometry, was
performed in 78 hemodialysis patients. Thirty-four patients had oste-
oporosis, dened as T-score less than -2.5. Nine patients were excluded
for denosumab treatment due to the possibility of low turnover (N¼3),
poor oral hygiene (N¼2), poor general condition (N¼2), and refusal of
treatment (N¼2). Twenty-ve patients (10 male, 15 female, 70.010.3
years old) who consented denosumab treatment were enrolled. They
had following underlying disorders: 11 diabetes, 8 hypertension, 4
glomerulonephritis, 1 lupus, and 2 of unknown origin. Mean duration
of maintenance hemodialysis was 69.145.2 months, mean Kt/V was
1.80.3.
Results: The level of C-terminal telopeptide, a bone resorption marker,
was signicantly decreased from 2.171.03 to 1.390.86 (P¼0.01) 6
months after denosumab treatment. The level of bone specic alkaline
phosphatase, a bone formation marker, was also signicantly decreased
from 58.627.1 to 31.311.2 (P<0.001) after the treatment, However,
the level of osteocalcin did not show big difference.
The level of area BMD and T-score of total hip bone were increased
by 2.95% and 3.7% a year after the treatment, respectively. Those of
femur neck tended to increase from 0.4640.05 to 0.5020.07 (P¼0.10)
and -3.14 0.54 to -2.830.65 (P¼0.11). However, there were no
changes in lumbar spines.
Three patients showed numbness related to hypocalcemia. Two
patients suffered from sustained hypocalcemia for 2 months after the
treatment. In order to prevent such symptoms after the treatment,
active prevention with calcium and calcitriol were applied to all pa-
tients who were given denosumab treatment.
Conclusions: In conclusion, denosumab could improve bone density in
hemodialysis patients. Active prevention could eliminate hypocalce-
mia-related symptoms.
SAT-247
RISK FACTORS OF INSOMNIA IN CHRONIC
HEMODIALYSIS PATIENT IN MOHAMMAD
HOESIN HOSPITAL PALEMBANG INDONESIA
HUSIN, N*
1
1
RS MOHAMMAD HOESIN INTERNAL MEDICINE PALEMBANG Indonesia
Introduction: Insomnia is the inability to fall asleep or stay asleep and
wake up earlier characterized by poor sleep quality and could cause
poor quality of life. A recent survey has shown that insomnia is still a
very common problem in maintenance hemodialysis patients. There are
many factors involved in insomnia. This research aimed to identify and
analyze factors that may affect insomnia on chronic hemodialysis pa-
tients in Mohammad Hoesin Hospital Palembang.
Methods: This research used analytic observational method with cross-
sectional approach. The sample of the research was chronic hemodial-
ysis patients in Mohammad Hoesin Hospital Palembang within period
of November-December 2018 that fullled the inclusive criteria. Data
were analyzed using univariate analysis and presented as frequency
distribution table. Data were also analyzed using bivariate and multi-
variate analysis to gain the understanding of involving factors. This
study involved 71 chronic hemodialysis patients that meets the inclu-
sion criteria, 62 (87.3%) of them experienced insomnia.
Results: The bivariate analysis showed signicant results between
chronic pain, hemodialysis schedule and stress (p ¼0,000; p ¼0,013; p
¼0,007. Based on multivariate analysis showed that chronic pain (p ¼
0.017) had a signicant effect on the occurrence of insomnia (p <0.05),
while stress (p ¼0.239), hemodialysis schedule (p <0.217).
Conclusions: The hemodialysis schedule has a signicant relationship
with the occurrence of insomnia and morning hemodialysis schedule,
Chronic pain, and stress are risk factor for the occurrence of insomnia
on chronic hemodialysis patients
SAT-248
MAINTAINING A BALANCED BONE HEALTH
BY OPTIMUM MANAGEMENT OF RENAL
OSTEODYSTROPHY IN THE HEMODIALYSIS
POPULATION
JAWANDHIYA, P*
1
, Billa, V
1
, Bichu, S
1
, Tilve, P
1
, Usulumarty, D
2
1
Bombay Hospital Institute Of Medical Sciences Nephrology Mumbai India,
2
Sushrut Hospital and research centre Nephrology Mumbai India
Introduction: Renal Osteodystrophy (ROD) form an important and gener-
ally unrecognised problem in the dialysis population. The impact of this
ISN WCN 2020, ABU DHABI, UAE
Kidney International Reports (2020) 5, S1S392 S105
disorder on fracture risk and vascular calcication has been well docu-
mented. However this aspect of their medical care often gets overlooked
despite the availability of powerful diagnostic and therapeutic interventions
AIM: To evaluate the prevalence of Renal Osteodystrophy in the he-
modialysis population and the effects of specic therapeutic in-
terventions, both medical and surgical. and their outcomes.
Methods: This was a retrospective, cross sectional study of patients at a
single haemodialysis centre. Patients were divided into two groups
based upon their iPTH levels - iPTH <100pg/dl and >1000pg/dl rep-
resenting low turnover & high turnover bone disease respectively.
Patient with low turnover bone disease were treated with either low
calcium bath, or Injection Teriparatide or both and stopping there
calcium and active vitamin D supplement. Bone mineral density (BMD)
was evaluated with a densitometry scan (DEXA) done pre treatment and
after 6 months to see the effect of treatment with Teriparatide. Patients
with high turnover bone disease were treated with Cinacalcet, Injection
Vitamin D3 or both. Parathyroid surgery was done in patients who
were refractory to medical treatment for 3 months
Results: A total of 152 patients were evaluated. 21 patients had iPTH
<100pg/ml (13.8%). 31 patients had iPTH >1000 (20.4%). The ex-
tremes of the CKD ROD spectrum aficted 34% patients.
For the low PTH group, the mean values for iCa, PO4, iPTH and
ALP pretreatment were 1.220.062, 4.882.058, 68.933.18,
162.472.74 respectively. The posttreatment values were 1.150.09
(p¼0.12), 4.831.93(p¼0.95), 128.2285.17(p<0.0001) &
117.7548.61(p¼0.031) respectively.
Out of 31 patients with iPTH>1000, 6 were on vitamin D, 1 patient
was on Cinacalcet only and 16 were on combination therapy. 4 un-
derwent parathyroidectomy.
Mean pretreatment value of iCa, PO4, iPTH & ALP in the medically
treated group were 1.10.11, 5.480.83, 1327.023169.58 and
159.7662.76 respectively. The values after treatment were 1.15
0.23, 5.80.89, 469.66 366.9(p<0.0001) and 131.2244.47(p¼0.10)
respectively.
Out of 4 patients who underwent surgery, mean value of iPTH pre
& post surgery 1384433.97 & 666.25308.73.
Conclusions: Signicant Renal Osteodystrophy exists in a third of the
dialysis patients.
Medical management is successful in the majority of patients. A
small proportion are successfully treated with parathyroidectomy.
Timely monitoring parameters of CKD ROD is essential to mitigate the
morbidity of this condition.
SAT-249
CLINICALLY RULING IN ACUTE CORONARY
SYNDROMES IN END-STAGE RENAL DISEASE
PATIENTS ON HAEMODIALYSIS IN A LIMITED
RESOURCE SETTING
KASHEM, TS*
1
, Begum, NAS
1
, Aren, MSU
1
, Rashid, HU
1
,
Ahmad, MS
2
1
Kidney Foundation Hospital and Research Institute Nephrology Dhaka
Bangladesh,
2
Dr.Nizam Medical Center Academic Medicine Dhaka
Bangladesh
Introduction: Kidney Foundation, Bangladesh is a not-for-prot orga-
nisation that caters mainly to the needs of the lower income group of
renal patients in this low to middle income nation, where the health
expenditure is predominantly out of pocket. Due to nancial con-
straints, many patients cannot afford regular dialysis, let alone cover
the costs of investigations that may be required as a course of treat-
ment. In patients with End-stage Renal Disease (ESRD) the risk of Acute
Coronary Syndrome (ACS) is high; add to this the established atypical
presentation of ACS in the South Asian patient and the chance of
missing an evolving myocardial infarction is high. The concern of
treating ACS in this group of patient also exists as anticoagulation in-
creases the risk of bleeding. To limit the use of serum Troponin in these
patients, we look at the effectivity of using clinical judgment in ruling
in ACS.
Methods: A retrospective cohort study was conducted over the period
of two months on patients who were admitted to Kidney Foundation
requiring haemodialysis. Patients were selected based on requiring a
serum Troponin either for worrying clinical features on presentation, or
due to ECG changes consistent with ACS. High sensitivity Troponin I
was used and calculated in pg/ml. ACS patients requiring treatment
were identied after being reviewed by a cardiologist with access to
ECGs, Troponin values and echocardiography. Patients were then
grouped against the troponin result by clinical features, ECG changes
and a combination of the two, and then compared (Table 1).
tables and figures.
Results: Although a clear overlap between Troponin positive ACS and
the criteria of clinical features and ECG changes exist (Figure 1), there is
also a degree of independence.84% of patients with ECG changes had
positive troponins as compared to 78% of patients with positive clinical
features. 2 by 2 comparison tables of clinical suspicion, ECG changes
and a combination of the two were tested for specicity and positive
predictive values among other statistics (Table 2). A combination of
ECG changes and clinical features was more specic (78.57%) than
individual criteria, but ECGs alone had a better positive predictive
value (87.5%).
Conclusions: A combination of clinical gestalt and ECG changes can be
used effectively to rule in ACS and potentially remove the need of
performing expensive Troponin tests on patients prior to commencing
treatment. It is more than likely that specicity will improve by
training physicians to take a focused cardiac history and interpret the
more subtle changes in the ECG when managing the End-stage renal
disease patient on haemodialysis.
SAT-250
FAR INFRARED THERAPY: EFFECTS ON
VASCULAR ACCESS BLOOD FLOW, KT/V AND
NEEDLING PAIN IN HEMODIALYSIS PATIENTS
KHALID, SF*
1
, Abd Ghani, NH
2
, Wan Ibrahim, WMZ
3
, Ghazalli, MF
1
,
Mushahar, L
1
1
Hospital Tuanku Jaafar Nephrology Seremban Malaysia,
2
Hospital Tampin
Nephrology Tampin Malaysia,
3
Hospital Jelebu Nephrology Jelebu
Malaysia
Introduction: Well-Functioning vascular access is necessary for
achieving adequate and high-quality dialysis. Other than that, minimal
ISN WCN 2020, ABU DHABI, UAE
S106 Kidney International Reports (2020) 5, S1S392
ResearchGate has not been able to resolve any citations for this publication.
ResearchGate has not been able to resolve any references for this publication.