Ergonomic intervention program for office workers: a case study about its effect in computer vision syndrome and musculoskeletal discomfort

This study aims to develop and implement an ergonomic intervention program at the workplace of knowledge workers, and to evaluate its impact on the reduction of Computer Vision Syndrome (CVS) and musculoskeletal symptoms. 84 workers were part of the study (mean age 43.2 ± 9.7 years). The intervention included training, delivery of a packaging of artificial tears, and adjustments in workstations. It was conducted intensively along 6 weeks. Data was collected on-site, with questionnaires administered pre-intervention, 2 months after, and 4 months after. Participants exhibited behavioural changes, especially in workplace adjustments and visual rest. By the intervention's end, over 90% had correctly adjusted screens and adopted appropriate postures, while 42.7% adhered to the 20x20x20 rule. CVS severity and prevalence decreased, but not significantly across the three time points. Significant improvements were observed in upper back and neck musculoskeletal symptoms at the end of workdays. Findings suggest that an ergonomic intervention program can benefit employees by reducing visual and musculoskeletal symptoms.

Fibrosis of Peritoneal Membrane, Molecular Indicators of Aging and Frailty Unveil Vulnerable Patients in Long-Term Peritoneal Dialysis

Peritoneal membrane status, clinical data and aging-related molecules were investigated as predictors of long-term peritoneal dialysis (PD) outcomes. A 5-year prospective study was conducted with the following endpoints: (a) PD failure and time until PD failure, (b) major cardiovascular event (MACE) and time until MACE. A total of 58 incident patients with peritoneal biopsy at study baseline were included. Peritoneal membrane histomorphology and aging-related indicators were assessed before the start of PD and investigated as predictors of study endpoints. Fibrosis of the peritoneal membrane was associated with MACE occurrence and earlier MACE, but not with the patient or membrane survival. Serum α-Klotho bellow 742 pg/mL was related to the submesothelial thickness of the peritoneal membrane. This cutoff stratified the patients according to the risk of MACE and time until MACE. Uremic levels of galectin-3 were associated with PD failure and time until PD failure. This work unveils peritoneal membrane fibrosis as a window to the vulnerability of the cardiovascular system, whose mechanisms and links to biological aging need to be better investigated. Galectin-3 and α-Klotho are putative tools to tailor patient management in this home-based renal replacement therapy.

Real-Time Blink Detection as an Indicator of Computer Vision Syndrome in Real-Life Settings: An Exploratory Study

With the increase in the number of people using digital devices, complaints about eye and vision problems have been increasing, making the problem of computer vision syndrome (CVS) more serious. Accompanying the increase in CVS in occupational settings, new and unobstructive solutions to assess the risk of this syndrome are of paramount importance. This study aims, through an exploratory approach, to determine if blinking data, collected using a computer webcam, can be used as a reliable indicator for predicting CVS on a real-time basis, considering real-life settings. A total of 13 students participated in the data collection. A software that collected and recorded users' physiological data through the computer's camera was installed on the participants' computers. The CVS-Q was applied to determine the subjects with CVS and its severity. The results showed a decrease in the blinking rate to about 9 to 17 per minute, and for each additional blink the CVS score lowered by 1.26. These data suggest that the decrease in blinking rate was directly associated with CVS. These results are important for allowing the development of a CVS real-time detection algorithm and a related recommendation system that provides interventions to promote health, well-being, and improved performance.

Alpha-klotho and peritoneal membrane status: A hypothesis generating study

BACKGROUND

Long-term success of peritoneal dialysis relies on the integrity of the peritoneal membrane. This proof-of-concept study addressed the hypothesis that fibrosis is already present in the membrane at pre-dialysis and that the membrane status is related to the individual's uraemic fingerprint.

METHODS

A clinical-mechanistic, transversal, single-centre study was conducted. Pre-dialysis peritoneal biopsies were scored considering the submesothelial compact zone thickness (STM), vasculopathy and inflammation. We investigated if the membrane status could be inferred from a panel of proteins (α-Klotho, Galectin-3, FGF21, FGF23, Tweak, TNFα and hsPCR) in blood.

RESULTS

A total 58 incident patients aged 56 ± 15 years old were included, 31% female, 55% hypertension, 29% diabetic and 24% obese. Person-to-person STM was found to be highly variable and 38% of patients were fibrosis positive. Both α-Klotho (Spearman r = -.7491, p < 0.001) and FGF21 (Spearman r = -.5102, p < 0.001) were negatively associated with STM. α-Klotho, but not FGF21, was able to discriminate fibrosis from nonfibrosis with/without inflammation and vasculopathy. PLS models identified α-Klotho as the protein most relevant for fibrosis. α-Klotho was independently associated with fibrosis of the peritoneal membrane (OR = .991 (.896-.997), p = 0.002).

CONCLUSION

Before the start of dialysis in incident patients, some patients already present fibrosis of the peritoneal membrane and other patients do not. Our findings suggest that α-Klotho may be implicated in fibrosis of the peritoneal membrane.

Membranous nephropathy after a recent SARS-CoV-2 infection

SARS-CoV-2 infections can induce kidney injury and glomerulopathy, with the most common pathology findings being acute tubular injury and collapsing glomerulopathy.Here we describe a rare case of membranous nephropathy in a man in his late 70s presented with nephrotic syndrome and rapidly progressive kidney dysfunction 1 month after SARS-CoV-2 infection. Phospholipase A2 receptor antibodies were positive. He was treated with rituximab, with proteinuria control. We review the cases reported in the literature.

The APSY-SED study: protocol of an observational, longitudinal, mixed methods and multicenter study exploring the psychological adjustment of relatives and healthcare providers of patients with cancer with continuous deep sedation until death

BACKGROUND

Since 2016, France is the only country in the World where continuous deep sedation until death (CDSUD) is regulated by law. CDSUD serves as a response to refractory suffering in palliative situations where the patients' death is expected to occur in the following hours or days. Little is known on the psychological adjustment surrounding a CDSUD procedure for healthcare providers (HCPs) and relatives. Our study aims to gather qualitative and quantitative data on the specific processes behind the psychological adjustment of both relatives and HCPs, after the administration of CDSUD for patients with cancer.

METHODS

The APSY-SED study is a prospective, longitudinal, mixed-methods and multicenter study. Recruitment will involve any French-speaking adult cancer patient for who a CDSUD is discussed, their relatives and HCPs. We plan to include 150 patients, 150 relatives, and 50 HCPs. The evaluation criteria of this research are: 1/ Primary criterion: Psychological adjustment of relatives and HCPs 6 and 13 months after the death of the patient with cancer (psychological adjustment = intensity of anxiety, depression and grief reactions, CDSUD-related distress, job satisfaction, Professional Stress and Professional experience). Secondary criteria: a)occurrence of wish for a CDSUD in patients in palliative phase; b)occurrence of wish for hastened death in patients in palliative phase; c)potential predictors of adjustment assessed after the discussion concerning CDSUD as an option and before the setting of the CDSUD; d) Thematic analysis and narrative account of meaning-making process concerning the grief experience.

DISCUSSION

The APSY-SED study will be the first to investigate the psychological adjustment of HCPs and relatives in the context of a CDSUD procedure implemented according to French law. Gathering data on the grief process for relatives can help understand bereavement after CDSUD, and participate in the elaboration of specific tailored interventions to support HCPs and relatives. Empirical findings on CDSUD among patients with cancer in France could be compared with existing data in other countries and with results related to other medical fields where CDSUD is also conducted.

TRIAL REGISTRATION

This protocol received the National Registration Number: ID-RCB2021-A03042-39 on 14/12/2021.

Strategies to prevent SARS-CoV-2 transmission in hemodialysis centres across Europe - Lessons for the future

Background

Early reports on the pandemic nature of COVID-19 directed the nephrology community to develop infection prevention and control guidance. We aimed to make an inventory of strategies that dialysis centres followed to prevent infection with COVID-19 in the first pandemic wave.

Methods

We analyzed IPC measures taken by hemodialysis centres treating patients presenting with COVID-19 between March 1, 2020 and July 31, 2020 and that completed the European Renal Association COVID-19 Database centre questionnaire. Additionally, we made an inventory of guidelines published in European countries to prevent spread of SARS-CoV-2 in dialysis centres.

Results

Data from 73 dialysis units located in and bordering Europe were analyzed. All participating centres implemented IPC measures to mitigate the impact of SARS-CoV-2 during the first pandemic wave. Measures mentioned most often included triage with questions before entering the dialysis ward, measuring body temperature, hand disinfection, masking for all patients and staff, and personal protective equipment for staff members. These measures were also recommended in most of the 14 guidelines that were identified in the inventory of national guidelines and were also scored as being among the most important measures by the authors of this paper. Heterogeneity existed between centres and national guidelines regarding the minimal distance between dialysis chairs and recommendations regarding isolation and cohorting.

Conclusions

Although variation existed, measures to prevent transmission of SARS-CoV-2 were relatively similar across centres and national guidelines. Further research is needed to assess causal relationships between measures taken and spread of SARS-CoV-2.

CAD in kidney transplant recipients: a real-world assessment pre-ISCHEMIA-CKD

Background

The ISCHEMIA-CKD trial has shown that an initial invasive strategy, as compared to conservative treatment, did not reduce the risk of death and non-fatal myocardial infarction, nor did it improve quality-of-life in patients with advanced chronic kidney disease (CKD) and coronary artery disease (CAD) with moderate-to-severe ischemia. Similar findings were reported in patients with CKD enlisted for kidney transplantation (KT). We aimed to evaluate screening and treatment CAD strategies in patients who ultimately underwent KT at our center.

Methods

This is a single-center study of consecutive patients who received a KT from 2015 to 2020. Obstructive CAD was defined whenever one of the following criteria was met: lesion with a stenosis &gt;70% (or &gt;50%, if left main disease) or CAD requiring revascularization, as per the Heart Team discussion. CAD evaluation refers to non-invasive or invasive coronary angiography and/or stress testing, irrespective of clinical scenario.

Results

A total of 324 patients underwent KT [mean age 55±12 years; 65.1% male; CKD most often due to hypertensive or diabetic nephropathy and polycystic kidney disease – 41.8%; median time from renal replacement therapy (RRT) to KT – 60 (40–88) months]. A flow-chart summarizing CAD diagnosis over time is depicted in Figure 1. Overall, 119 (36.7%) patients had CAD evaluation prior to KT, of whom 21 underwent myocardial revascularization – 8, 12 and 1 patients with acute coronary syndrome (ACS), chronic coronary syndrome (CCS) and silent ischaemia, respectively. At a median time of 46 (25–66) months after KT, 36 (11.1%) more patients had CAD evaluation, of whom 8 underwent percutaneous myocardial revascularization – 6 and 2 for ACS and CCS, respectively. Those with obstructive CAD were older (64 vs 54 years-old; p&lt;0.001), with a higher burden of cardiovascular (CV) risk factors (p&lt;0.001) and more likely to have had a CV death (9.5 vs. 1.0%; p=0.025) or CV hospitalization (38.1 vs. 13.4%; p=0.007). CAD status (revascularized vs. non-revascularized) was not associated with improved major outcomes at follow-up. We found no strong predictors of CAD requiring revascularization post-KT, including time from RRT to KT. There were no patients with refractory angina, left main disease or reduced left ventricular ejection fraction (&lt;40%) in need of myocardial revascularization over follow-up.

Conclusions

Obstructive CAD was uncommon in our cohort of patients who received a KT, most of whom with asymptomatic or mildly (monthly angina) symptomatic CCS or non-fatal ACS. These findings, together with the most recent evidence, may argue against routine CAD screening in all patients being enlisted for KT. Notwithstanding, randomized evidence is eagerly awaited to further guide treatment decisions in the post-ISCHEMIA-CKD era.

Funding Acknowledgement

Type of funding sources: None.

Pantoea in Peritoneal Dialysis: A Rare Cause of Peritonitis

Peritonitis is the most common complication of peritoneal dialysis (PD) and an important cause of PD failure. There are numerous etiological agents, mostly bacteria. Pantoea spp is a rare cause of peritonitis.

We describe three cases of Pantoea peritonitis in three PD patients. Previous reports have identified risk factors such as close contact with plants and animals. We review the typical clinical presentation and prognosis. It is fulcral to teach patients about the risks regarding proximity to plants and animals to prevent this type of infection.

Long-term outcomes in patients with potential reversible causes of bradycardia

Funding Acknowledgements

Type of funding sources: None.

Introduction

Hyperkalemia and negative chronotropic drugs are well known causes of reversible bradycardia. Their synergic combination may result in BRASH syndrome (Bradycardia, Renal failure, Atrioventricular blockade, Shock, and Hyperkalemia), a consequence of the vicious cycle between bradycardia, renal failure and worsening hyperkalemia, leading ultimately to multiorgan dysfunction. In potentially reversible bradycardia, drug discontinuation or metabolic correction is recommended before permanent pacemaker (PPM) implantation.

Objectives

To determine the long-term prognosis in patients with potentially reversible symptomatic bradycardia.

Methods

We retrospectively reviewed 176 patients who presented to the emergency department with symptomatic bradycardia, between January 2015 and August 2016. Patients without any reversible cause of bradycardia were excluded. Participants were stratified into three groups according to the reversible causes of bradycardia: patients with hyperkalemia, with or without acute renal injury (ARI) (group 1); patients taking negative chronotropic drugs, with or without ARI (group 2); patients with BRASH syndrome (combination of hyperkalemia and negative chronotropic drugs, with or without ARI) (group 3). The primary endpoint was PPM implantation after discharge. Secondary endpoints included: bradycardia-related rehospitalization, heart failure (HF) hospitalization, all-cause mortality and a composite of all the previous endpoints.

Results

A total of 105 patients were included (52.4% female; mean age 79.8±8.6 years). Group 1 was comprised by 15 patients (14.3%), group 2 by 69 patients (65.7%) and group 3 by 21 patients (20%, figure 1). The incidence of each event is presented in figure 2. During a mean follow-up of 3.2±2.1 years, PPM was implanted in 60 patients (57.1%) – 51 during hospital stay (85%) and 9 after discharge (15%). Across all groups, approximately 50% of the patients needed PPM implantation at some point, without significant differences between groups (p=0.508). Group 3 had the lowest need of in-hospital PPM (38.1%) but the highest bradycardia-related readmissions (9.5%). Nevertheless, post-discharge PPM implantation was still higher in group 1 (33.3%), followed by group 3 (22.2%). There were no significant differences in the post-discharge PPM implantation rate between groups (p=0.76). In groups 1 and 3 the composite endpoint (73.3% and 76.2%, respectively) was significantly more frequent than in group 2 (44.9%, p=0.046 and p=0.012, respectively).

Conclusions

Nearly half of the patients with an episode of reversible bradycardia needed a PPM at some point. Given the advanced age of most patients with bradycardia secondary to metabolic derangement and/or drug toxicity, it is possible that this unveils underlying conduction system disease, which is likely to recur without PPM implantation.

MO671: Should We Undergo Peritoneal Dialysis in Malnourished Chronic Kidney Disease Patients?

BACKGROUND AND AIMS

The implementation of peritoneal dialysis (PD) in end-stage renal disease has been associated with various long-term pathophysiologic changes, which result in adverse consequences, such as malnutrition, occurring in 30–50% of patients. Specific factors to PD might be associated with poor oral intake as continuous absorption of glucose from PD solutions and abdominal fullness induced by the dialysate can suppress appetite.

There are several accepted strategies for stratifying malnutrition in PD, such as laboratory markers [serum albumin and normalized protein catabolic ratio (nPCR)] and the recent use of bioimpedance spectroscopy (BIS) (with low lean tissue index).

We aimed to evaluate if PD patients with a poor nutritional status at the beginning of the technique had worse outcomes (peritonitis, PD failure, hospitalizations, and death).

METHOD

We studied a cohort of incident patients from a single PD unit between 1 July 2011 and 31 August 2021, who had one BIS measurement and a peritoneal equilibration test in the first 3 months after the start of PD. We also collect laboratory data within 6 months from the BIS evaluation (serum albumin). Besides demographic parameters, we evaluated established endpoints (peritonitis, PD failure, hospitalizations and death).

RESULTS

There were included 91 PD patients. The mean age of patients was 65.40 $ \pm $ 13.88 years with a median dialysis vintage of 24 (IQR 14–31.61) months; 59.3% were male and 28% had diabetes. During the follow-up period, 5.5% of the cohort died, 56% were hospitalized and 47.3% had at least one episode of peritonitis. Furthermore, the transfer to hemodialysis occurred in 18 cases (19.8%) and 15 (16.5%) received a renal transplant.

There was no difference in nutritional markers median in patients that had clinical endpoints versus those who had not (Table 1). In a multivariable analysis, neither nPCR, nor albumin nor lean tissue index were predictors of peritonitis, PD failure or hospital admissions.

CONCLUSION

In this study, we found that malnourished patients, prevalent in PD, did not have worse clinical endpoints (higher rate of infections, hospital admissions and PD failure). Although adequate nutrition has been deemed vital to the success of PD, this modality of renal replacement therapy did not result in worse outcomes, despite the malnutrition markers at the beginning of PD. Further studies are warranted to evaluate the positive impact of PD in nutrition status.

MO686: Effectiveness of SARS-CoV-2 Vaccination in Peritoneal Dialysis Patients

BACKGROUND AND AIMS

Chronic kidney disease (CKD) patients, especially those on renal replacement therapy, have a higher risk of infection and worse clinical outcomes after coronavirus disease 2019 (COVID-19) than the general population. Thus, this population must be promptly immunized against COVID-19. We aimed to assess the humoral response after two doses of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) vaccine in peritoneal dialysis (PD) patients. We also aimed to identify potential factors associated with vaccine response and the prevalence of COVID-19 in a PD unit.

METHOD

We conducted a single-center, retrospective study to evaluate the immunogenicity in terms of antibody response after COVID-19 vaccination. Three types of vaccine [BNT162b2 messenger RNA vaccine (Pfizer-BioNTech), messenger RNA-1273 (Moderna) and ChadOx1 nCoV-19/AZD1222 (AstraZeneca)] were administered in the PD unit. The detection of anti-spike IgG antibodies (with a cutoff of 0.8 U/mL) was done at least after 21 days of the two vaccine doses. We also evaluated the presence of COVID-19 infections, hospital admissions (including in intensive care unit) and deaths.

RESULTS

This study enrolled 70 prevalent patients. We excluded patients with only one vaccine dose (n = 4), those who did not consent to the collection (n = 5) or were vaccinated before starting PD (n = 11). Among the 50 patients included, the mean age was 59 $ \pm $ 15 years, 60% were male and the dialysis vintage was 22.1 (IQR 6–34.3) months. Six (12%) patients were receiving immunosuppressive therapy and 16 (32%) had diabetes. The mean interval between administration of the second vaccine dose and antibodies evaluation was 7.2 $ \pm $ 0.7 months. Overall, after two doses, there was a significant increase in antibody level, with median of 1495 (IQR 37.8–546.8) U/mL. Only two (4%) patients did not increase their antibody level (remained seronegative). History of immunosuppressive therapy was associated with no response after two doses (91.7% versus 8.3%, P = 0.012). There were two COVID-19 infections after the complete vaccination, with mild symptoms (one with hospital admission). Furthermore, there were no intensive care unit admissions or deaths.

CONCLUSION

We found that immunization against COVID-19 was effective in generating an overall humoral response and in preventing severe disease in CKD patients on PD, which emphasizes the importance of the vaccination against COVID-19 in this population. These results also suggest the impact of the immunosuppressive therapy on vaccine response in PD patients.

MO689: Relationship between Peritoneal/Renal Function and Nutritional Status in Peritoneal Dialysis Patients

BACKGROUND AND AIMS

The positive impact of nutritional status on the health and treatment adequacy of peritoneal dialysis (PD) patients has been well established. There are several accepted strategies for stratifying malnutrition in PD, such as laboratory markers [serum albumin and normalized protein catabolic ratio (nPCR)] and the recent use of bioimpedance spectroscopy (BIS). The aim of this study was to assess the nutritional status of PD patients upon the start of the therapy. We also aimed to establish a potential relationship between peritoneal/renal function, obtained by a peritoneal equilibration test (PET), and nutritional markers.

METHOD

We studied a cohort of patients from a single PD unit between 1 July 2011 and 31 August 2021, who had one BIS measurement and a PET in the first 3 months after the beginning of PD. We also collect laboratory data within 6 months from the BIS reading (albumin, C-reactive protein and phosphorus). Demographic parameters (age, dialysis vintage, presence or absence of diabetes mellitus) and body mass index were also evaluated.

RESULTS

The study included 91 incident PD patients. The mean age of patients was 65.40 $ \pm $ 13.88 years, 59.3% were male and 28% had diabetes. Regarding baseline renal and peritoneal parameters, weekly total kt/v median was 1.99 (IQR 0.99–2.59) residual renal function (eGFR) median 3.2 (IQR 2.12–7.75) mL/min/1.73 m2 daily diuresis median 1500 (IQR 1000–2100), fluid removal (FR) median 2.23 (IQR 1.86–2.65) L/day and 41.8% had a dialysate/plasma (D/P) creatinine higher than 0.77.

Lean tissue index was low in 36.3% and fat tissue index was high in 52.2%. Serum albumin median was 3.7 (IQR 3.3–4) g/dL and nPCR median 0.84 (IQR 0.72–1.04) g/kg/day. Hypervolemic patients had significantly lower lean tissue index (13.77 ± 3.25 versus 16.87 ± 3.82, P = 0.003). In a univariate analysis, patients with nPCR &lt; 1.2 g/kg/day (79.1% from the complete cohort with no age difference) had lower baseline weekly total kt/v (2.17 ± 0.43 versus 6.62 ± 4.45, P &lt; 0.001, lower daily diuresis (1261 ± 753 versus 1687 ± 958, P = 0.047), lower FR (2.05 ± 0.57 versus 2.40 ± 0.80, P = 0.043), and also significantly lower D/P creatinine (0.74 ± 0.1 versus 0.97 ± 0.27, P &lt; 0.001). Furthermore, patients with serum albumin &lt;3.8 g/dL had a lower ultrafiltration proof (326 ± 192 versus 511 ± 267, P = 0.028) and those with low lean tissue index had a lower daily diuresis (1405 ± 825 versus 1823 ± 1025, P = 0.045). In a multivariate analysis, patients with nPCR &lt; 1.2 g/kg/day were older [exp (B) 0.19, 95% CI 0.8–0.9, P = 0.012] and had lower weekly total kt/v [exp (B) 0.18, 95% CI 0.6–0.9, P = 0.017].

CONCLUSION

This study showed some relationships between kidney/peritoneal function parameters and body composition parameters. The level of nPCR, a measure of nutritional status, was significantly and positively associated with indicators of dialysis adequacy (kt/v), daily diuresis and, also with transport type. Further research regarding nutrition must be undertaken to help improve health outcomes in PD patients.

MO1000: Differences in Humoral Response After SARS-COV-2 Vaccination Between Kidney Transplant and Peritoneal Dialysis Patients: What is the Impact of Immunosuppression?

BACKGROUND AND AIMS

Patients on renal replacement therapy are reported to have altered humoral immunity, which is demonstrated by a decreased response to different vaccines. However, in kidney transplant (KT) patients, vaccines are even less immunogenic in terms of antibody response. Therefore, these patients have a higher risk of critical infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which makes them eligible for early vaccination. The aim of this study was to compare the humoral response after complete vaccination against SARS-CoV-2 between KT patients and peritoneal dialysis (PD) patients.

METHOD

We conducted a single-center, retrospective study, which included 67 KT recipients and 49 prevalent PD patients. Patients were excluded if they had previously known SARS-CoV-2 infection or positive anti-nucleocapsid IgG or IgM antibodies. Completion of vaccination was defined as two doses of a messenger RNA vaccine (BNT162b2 messenger RNA vaccine [Pfizer-BioNTech] or messenger RNA-1273 [Moderna]), two doses of viral vector vaccine ChadOx1 nCoV-19/AZD1222 (AstraZeneca) or one dose of JNJ-78 436 735 (Janssen) vaccine. Anti-spike (anti-S) IgG antibodies were measured, at least, 21 days after the completion of vaccination and before receiving a `booster’ dose. A value of anti-S &gt;0.8 U/mL was considered positive. Immunogenicity of the vaccine, measured by anti-spike IgG antibodies, was compared between KT recipients and PD patients.

RESULTS

The mean age of the population was 58.8 ± 13.6 years and 62.0% were males (similar between the two groups). The median interval between completion of vaccination and serologic analysis was 4.1 months in KT patients and 7.1 months in PD patients. In KT patients, the median anti-S level was 1.50 U/mL (IQR 0.0–27.3) versus 97.0 U/mL (IQR 34.5–447.0) in PD patients (P &lt; .001). In the KT group, there were 31 (46.3%) non-responders (patients without detectable levels of anti-S), while in the second there were only two (4.1%). In KT patients, anti-S levels were not associated with time since transplant or immunosuppressive induction therapy. In PD patients, anti-S levels were not associated with time since the beginning of PD. In both groups, anti-S levels were not associated with age, gender, type of administered vaccine or interval between completion of vaccination and serologic analysis.

CONCLUSION

We found a significant difference in humoral responses to the vaccine between PD and KT transplant patients with no previous exposure to SARS-CoV-2. In PD patients, the vaccine seemed to be effective. On the contrary, KT patients had a significantly weaker rising of anti-S titers, with a high proportion of patients not responding to the vaccine. This study emphasizes the negative impact of immunosuppression on humoral responses, reinforcing the need for a `booster’ dose in this group of patients.

Exploring the Experiences of Members of the International Food Safety Authorities Network: An Interpretative Phenomenological Analysis

ABSTRACT

The International Food Safety Authorities Network (INFOSAN) is a global network of national food safety authorities from 190 countries, managed jointly by the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO) that aims to facilitate the rapid exchange of information during food safety incidents. A three-phase study of INFOSAN was launched in 2019 to characterize and examine the network as a functional community of practice and determine its value systematically and rigorously from its members' perspectives. The first two phases of the study involved analyzing the INFOSAN Community Website and surveying of all of its members. The main objective of this third and final phase of the study was to understand the experiences of a small group of INFOSAN members as they relate to various dimensions of membership. A qualitative methodology was used to provide a deeper understanding of members' experiences and supplement the results from the first two quantitative study phases. Interviews were conducted with 10 INFOSAN members from 10 geographic regions, transcribed verbatim, and analyzed using interpretative phenomenological analysis. The results offer an understanding of INFOSAN members' experiences in the context of what participation in this global network means to them and relate to five themes concerning trust, learning, health protection, sense of community, and future potential. The findings suggest that focusing on outreach to sustain personal interest, training to improve technical capacity, and advocacy to obtain political buy-in are ways in which the INFOSAN Secretariat could enable participation and create value at the individual, organizational, and national level, respectively. Such engagement could translate into more effective international communication during urgent food safety incidents and fewer cases of foodborne illness worldwide.

HIGHLIGHTS

MO823EARLY MORTALITY IN INCIDENT HEMODIALYSIS PATIENTS

Background and Aims

Chronic kidney disease (CKD) is known to have significant morbi-mortality worldwide. Patients with CKD and in particular those with ESRD normally carry a large burden of comorbidities and the beginning of hemodialysis leads to a higher risk of decompensation. In fact, annual mortality rates among hemodialysis patients is 10 to 30 times higher than those of the general population. Various studies have demonstrated that incident patients experience the higher mortality rate within the first 3 to 4 months of dialysis. Predicting early mortality is important to help the decision of initiating hemodialysis versus conservative care. Therefore we conducted a case control study to evaluate early mortality predictors in incident hemodialysis patients in our hemodialysis center.

Method

This is a retrospective case–control study, which to evaluate early mortality predictors in incident hemodialysis patients from January 2013 to December 2018. Descriptive statistics were calculated and expressed as mean (±standard deviation [SD]) or median (intraquartile range [IQR]) for parametric and non-parametric continuous variables and count (%) for categorical variables, respectively. We compared variables between survivors and non-survivors at 3 months after initiation of hemodialysis by using Student’s t-test, Mann-Whitney U test, or Fisher’s exact test where appropriate. Multivariate logistic regression was used to calculate the adjusted odds ratio (OR) with 95% confidence intervals (CI) for the variables associated with early mortality.

Results

From a total of 559 incident hemodialysis patients, 43 cases were identified (7.7%), and three controls were obtained for each case. From the 172 pts in the study mean (SD) age was 72.4 years (±14), 58.1% were male, and the most common etiologies of CKD were unknown etiology (22.1%, n=38) and diabetic nephropathy (16.9%, n=29). 34.4% (n=59) were dependent of assistance in daily living activities, median (IQR) Charlson Comorbidity Index was 8 (6.10). The non survivors compared to the survivors were older (78.8 ± 9.2 vs 70.3 ± 14.7, p &lt; 0,001), had more AKI or acute-on-chronic CKD (18 (41.9%) vs 18 (14%), p &lt;0,001), emergency start of hemodialysis (29 (67.4%) vs 48 (37.2%), p= 0.001), more catheter use as vascular access (38 (88.4%) vs 92 (71.3%), p=0.024), congestive heart failure (30 (69.8%) vs 32 (24.8%), p &lt; 0.001), ischemic cardiomyopathy (20 (46.5%) vs 30 (23.3%), p=0.004), COPD (13 (30.2%) vs 11 (8.5%), p&lt;0.001), peripheral vascular disease (14 (32.6%) vs 20 (15.5%), p=0.015), Charlson comorbidity index (10 (8-11) vs 7 (6-9), p&lt;0.001), dependence of assistance in daily living activities (22 (51.2%) vs 37 (28.7%), presence of nephrology appointments for &gt;3 months before ESRD (23 (53.5%) vs 102 (79.1%), p=0.01), eGFR (12.3 (6.1) vs 9.1 (4.2), p&lt;0.001), serum albumin (3.1 (2.9-3.5) vs 3.5 (3-3.8), p=0.002). A multivariable analysis was performed and the most suitable model to predict early mortality was age (p=0.003, OR 1.07, 95% C.I. 1.023-1.121), emergency start of hemodialysis (p&lt;0.001, OR 8.35, 95% CI 3.385-20.606), congestive heart failure (p=0.004, OR 3.65, 95% CI 1.519-8.776), peripheral vascular disease (p=0.035, OR 2.97, 95% CI 1.081-8.134). Hosmer-Lemeshow goodness-of-fit performed well (X2 6.67 DF 8; p =0.57), Nagelkerke R2 0.46; AUROC (95% CI) 0.86 (0.80-0.92).

Conclusion

The percentage of early mortality in our population (7.7%) was compatible with national and European rates. Our model identifies as independent mortality predictors age, emergency start of hemodialysis, congestive heart failure and peripheral vascular disease with an AUROC 0,86. This could help identify patients that could benefit from a more conservative care.

MO207END-OF-LIFE CARE IN NEPHROLOGY INPATIENTS - ARE WE GETTING IT RIGHT?

Background and Aims

Average life expectancy have been continuously increasing within the general population and, equally so, within Nephrology patients. End-of-life (EOL) care is part of non-oncologic palliative care provided by Nephrology. The aim of our study is to evaluate the quality of EOL care provided in Nephrology, and to determine potential areas of improvement.

Method

Retrospective single-centre analysis of all nephrology and kidney transplant inpatients dying between January 2019 and June 2020. Clinical records were reviewed for evidence of recognition of end of life, resuscitation plans, acute interventions in the 48 hours previous to death, comfort care plans and symptoms evaluation.

Results

A total of 83 patients were included. 19.6% of patients had chronic kidney disease, 60.2% were in haemodialysis, 14.5% were kidney transplanted patients and 3.6% had acute kidney injury. 89.2% of the admissions were for acute events, 5% for symptom control and 4.8% for diagnosis.

In 72.3% of admissions, EOL was recognised. Most patients were unable to discuss EOL plans (67.5%), and the family was informed of the prognosis in only 61.4% of the cases.

At the time of dead: only 62.7% of patients had a clear resuscitation plan, 44.6% were on antibiotics and 26.5% died with nasogastric tube. Within 48h of death: invasive interventions were still being given in 42.2%, blood samples were taken in 69.9%; imaging was performed in 36.1% and 48.2% had a haemodialysis session. Comfort measure were provided to 53% and only 60.2% had evidence of symptom evaluation. 44.6% stopped invasive measures in the last 48h.

Recognition of EOL was associated with having a clear resuscitation plan (p&lt;0.001), comfort measures (p&lt;0.001), evidence of symptom evaluation (p=0.004), stopping invasive measures (p&lt;0.001), having less imaging (p=0.270) and discussing prognosis with the family (p&lt;0.001). Despite recognition of EOL, there was no difference in dying with nasogastric tube (p=0.404) or dying on antibiotics (p=0.134).

In a multivariable analysis (binary logistic regression), EOL recognition was associated with a clear resuscitation plan (Exp(B) 0.088, (CI 95%: 0.018-0.419) p=0.002), with discussion of prognosis with family ( Exp(B) 0.061 (CI 95%: 0.011-0.337) p=0.001), and with reduced body mass index (Exp(B) 0.870, (CI 95%: 0.763-0.991), p=0.037,); in a model adjusted to the age.

Conclusion

In our cohort, patient for whom EOL was recognized had better EOL care. In conclusion, there are still areas in which EOL care can be improved. Palliative care should be an investment area for training within the Nephrology core curriculum and awareness for EOL care is needed.

Auditory training app validation

Introduction One of the main hearing complaints is the difficulty to perceive speech in noisy environments. This complaint gets worse with ageing at which cognitive processing speed slows and/or when hearing loss is present. An auditory training can improve speech perception in adverse environments. The use of auditory training software on various digital platforms is becoming a reality.

Objectives To validate the auditory training app in European Portuguese with individuals aged between 55 and 64 years old with an approximate average of 20dB of hearing thresholds.

Methodology The sample consists in two groups of seven individuals without cognitive problems. One of the groups performed eight auditory training sessions with the application for a period of four weeks and the other group (the control group) did not perform any auditory training session. The evaluation was made in all the individuals with the filtered speech test. The training group was evaluated before, immediately after and after four weeks of the auditory training sessions and the control group was evaluated after four weeks.

Results Statistically there is a significant difference between before and immediately after the auditory training in the filtered speech test (p = 0.018). Four weeks after the end of the training the performance of each individual was the same. In the control group there were no significant differences between the two evaluation moments.

Conclusion The EVOLLU auditory training app promotes an improvement in the perception of the word in adverse environments that continues even after some time. This is a sign that individuals are applying that learning into their day to day living. The Evollu application can and should be used in the auditory training of individuals aged between 55 to 64 years old.

P724 The mysteries of sinus of Valsalva

Sinus of Valsalva aneurysms are a rare pathology that can be clinically silent during years and/or become suddenly symptomatic. We described 3 cases with different clinical presentation, complications and surgical treatment.

A 26-year-old male, competitive cyclist was admitted with a 1.5 month history of fatigue, palpitations, and nocturnal cough and sweating. At physical examination he was apyretic, blood pressure 157/49mmHg and radial pulse 96 bpm; jugular vein engorgement and continuous heart murmur, were noticed. Blood samples only revealed a mild raised BNP. EKG showed sinus tachycardia and right intraventricular conduction delay and the transthoracic echocardiography (TTE) revealed high velocity systolic-diastolic shunt (image) between a non-dilated right coronary sinus (RCS) and the right atrium (RA); moderate left ventricle dilation, severe right atrium and mild right ventricle enlargement with mild pulmonary hypertension and normal biventricular systolic function. He was referred to angioCT that showed a large communication between a non-dilated RCS and RA with signs of right ventricular overload. He was submitted to surgery, where ruptured aneurysm sac was found. Fistula closure, aneurysm sac suture and tricuspid annuloplasty were performed.

A 45-year-old male asymptomatic, with no relevant medical background went to a Cardiology consultation after detection of a holossistolic murmur in the physical exam. EKG showed sinus rhythm arrhythmia with a nonspecific intraventricular conduction delay and the TTE revealed a communication between a dilated noncoronary sinus (NCS) and RA; the biventricular systolic function was normal. He was referred to angioCT which confirmed the diagnosis. He was submitted to surgery where an exeresis and closure of the fistula was performed.

A 38-year-old male with no relevant medical background was admitted to emergence room for an intermittent anterior thoracic pain radiating to the neck (2 days of evolution). The EKG showed sinus tachycardia, incomplete right bundle branch block and the high-sensitivity troponin assays were negative. The TTE revealed severe sinus of Valsalva aneurysm, particularly of the NCS with mild aortic regurgitation. The patient performed transesophageal echocardiography and angioCT which excluded an acute aortic syndrome. He was oriented to surgery where a contained rupture of the RCS and a non-visualization of the ostium right coronary artery were detected, suggesting an intimal dissection. The patient was submitted to Bentall procedure and a bypass with internal mammary artery to right coronary artery.

In spite of the unclear etiology, all the cases had a good clinical and echocardiographic evolution at follow-up. The difficulty in making a timely diagnosis is related to the variability of clinical presentation and the need of high clinical suspicion. Echocardiography and angioTC have demonstrated its value, in providing a prompt diagnosis and appropriate management guidance.

Abstract P724 Figure. Ruptured aneurysm sac and fistula

Sentinel lymph node biopsy in cutaneous head and neck melanoma

PURPOSE

Sentinel lymph node biopsy (SLNB) is now a standard of care for cutaneous melanoma, but it is still controversial for cutaneous head and neck melanoma (CHNM). This study aims to confirm the feasibility, accuracy and low morbidity of SLNB in CHNM and evaluate its prognostic value.

METHODS

A monocentric and retrospective study on patients with CHNM treated in our tertiary care center (Gustave Roussy) between January 2008 and December 2012 was performed. The feasibility, morbidity and prognostic value of this technique were analysed.

RESULTS

One hundred and twenty-four consecutive patients were included. SLNB was realized in 97.6% of the cases. No significant post-operative morbidity was observed. Nineteen percents of patients had a positive SN while only 14.3% of complete lymph node dissections (CLND) had additional nodal metastasis. The risk of recurrence after positive SN was significantly higher (69.2 vs 30.8%, p = 0.043). The false omission rate was low with 7.1%. Overall survival and disease-free survival were better in the negative SN group (82 vs 49%, p < 0.001 and 69.3 vs 41.8%, p = 0.0131). The risk of recurrence was significantly higher in the positive SN group (p = 0.043) and when primary tumour was ulcerated (p = 0.031). Only the mitotic rate of the primary tumour was associated with SN positivity (p = 0.049).

CONCLUSION

As in other sites, SLNB status is a strong prognostic factor with comparable false omission rate and no superior morbidity.

Baseline gut microbiota predicts clinical response and colitis in metastatic melanoma patients treated with ipilimumab

Background

Ipilimumab, an immune checkpoint inhibitor targeting CTLA-4, prolongs survival in a subset of patients with metastatic melanoma (MM) but can induce immune-related adverse events, including enterocolitis. We hypothesized that baseline gut microbiota could predict ipilimumab anti-tumor response and/or intestinal toxicity.

Patients and methods

Twenty-six patients with MM treated with ipilimumab were prospectively enrolled. Fecal microbiota composition was assessed using 16S rRNA gene sequencing at baseline and before each ipilimumab infusion. Patients were further clustered based on microbiota patterns. Peripheral blood lymphocytes immunophenotypes were studied in parallel.

Results

A distinct baseline gut microbiota composition was associated with both clinical response and colitis. Compared with patients whose baseline microbiota was driven by Bacteroides (cluster B, n = 10), patients whose baseline microbiota was enriched with Faecalibacterium genus and other Firmicutes (cluster A, n = 12) had longer progression-free survival (P = 0.0039) and overall survival (P = 0.051). Most of the baseline colitis-associated phylotypes were related to Firmicutes (e.g. relatives of Faecalibacterium prausnitzii and Gemmiger formicilis), whereas no colitis-related phylotypes were assigned to Bacteroidetes. A low proportion of peripheral blood regulatory T cells was associated with cluster A, long-term clinical benefit and colitis. Ipilimumab led to a higher inducible T-cell COStimulator induction on CD4+ T cells and to a higher increase in serum CD25 in patients who belonged to Faecalibacterium-driven cluster A.

Conclusion

Baseline gut microbiota enriched with Faecalibacterium and other Firmicutes is associated with beneficial clinical response to ipilimumab and more frequent occurrence of ipilimumab-induced colitis.

Inflammatory gastrointestinal diseases associated with PD-1 blockade antibodies

BACKGROUND

Immune check-point blockade agents have shown clinical activity in cancer patients but are associated with immune-related adverse events that could limit their development. The aim of this study was to describe the gastrointestinal immune-related adverse events (GI-irAE) in patients with cancer treated with anti-PD-1.

METHODS

this is a retrospective study of consecutive adult patients who had a suspected GI-irAE due to anti-PD-1 antibodies between 2013 and 2016. Patients were recruited through a pharmacovigilance registry. Patients' data were reviewed by a multidisciplinary committee that included gastroenterologists, oncologists and a pathologist. Quantitative variables are described by median (range), qualitative variable by frequency (percentage).

RESULTS

Forty-four patients were addressed to a Gastroenterology unit for a suspected GI-IrAE. Twenty patients had a confirmed GI-irAE related to anti-PD-1, which occurred 4.2 months (0.2; 22.1) after the initiation of anti-PD-1. GI-IrAE incidence rate under anti-PD-1 treatment was estimated to be 1.5%. Among patients with GI-IrAE, main symptoms were diarrhoea (n = 16, 80%), abdominal pain (n = 13, 65%), nausea and vomiting (n = 11, 55%), intestinal obstruction (n = 1, 5%), and haematochezia (n = 2, 10%). No patient had colectomy. Four distinct categories of GI-irAE were observed: acute colitis (n = 8, 40%), microscopic colitis (n = 7, 35%), upper gastrointestinal tract inflammation (n = 4, 20%) and pseudo-obstruction (n = 1, 5%). Response rates to corticosteroids were 87.5% (7/8) in acute colitis, 57% (4/7) in microscopic colitis and 75% (3/4) in upper gastrointestinal tract inflammation. Median time to resolution was 36 days (6-172) in acute colitis, and 98 days (42-226) in microscopic colitis.

CONCLUSION

This study suggests that GI-irAE are different and less frequent with anti PD-1 than with anti CTLA-4.