Calders, Patrick

Eloot, Sunny

Van Biesen, Wim

Van Craenenbroeck, Amaryllis

Vanden Wyngaert, Karsten

Ghent University Academic Bibliography

exercise has a few potential risks, including hypotension, muscle and joint pain, andlaceration. Therefore, intradialytic exercise must be safely performed to avoid hypoten-sion and orthopedic problems are tolerated.SP403 FUNCTIONAL IMPAIRMENT AND RISK OF FALLING IN THEHEMODIALYSIS UNITKarsten Vanden Wyngaert2, Amaryllis Van Craenenbroeck1,4, Sunny Eloot3,Wim Van Biesen3, Patrick Calders21Nephrology, Antwerp University Hospital, Antwerp, Belgium, 2Rehabilitation Sciencesand Physiotherapy, Ghent University, Ghent, Belgium, 3Nephrology, Ghent UniversityHospital, Ghent, Belgium and 4Nephrology, University of Antwerp, Edegem, BelgiumINTRODUCTIONANDAIMS: Patients with end stage renal disease are confrontedwith impaired physical functioning and higher fall rates than the general population. Amyriad of factors partly underlie this observation, including muscle dysfunction, neu-ropathy, renal anemia and cardiovascular complications. The identification of possiblyreversible factors is essential for the development of preventive and therapeutic strat-egies with the ultimate goal of improving patients’ prognosis. This study explores theseverity of functional impairment and risk of falling in a representative sample ofFlemish hemodialysis (HD) patients, as well as their relation with various biomarkersandmedication use.METHODS: In 114 prevalent adult dialysis patients (n¼76 Ghent, n¼38 Antwerp),comorbidity, routine serum biology and drug intake were related tomuscle force(quadriceps, handgrip force), functional capacity (6-MinuteWalking Test, Sit ToStand Test) and risk of falling (Tinetti and Sit To Stand Test).RESULTS:Mean age of the subjects (68%male) was 67.46 15.9 years with a mediandialysis vintage of 26 months (10.5 - 56). Forty six percent of patients suffered from dia-betes, and 70% had a history of cardiovascular disease. On average, patients took 86 4medications a day. Quadriceps force was severely impaired (< 72% of predicted) in87% and handgrip strength in 36% of the studied dialysis patients. There was a negativecorrelation between quadriceps force and dialysis vintage (r¼-0.193). Moreover, quad-riceps force related with serum calcium (r¼0.326), fT4 (r¼0.269) and PTH levels (r¼-0.201). Functional capacity was severely diminished (6-MWT<350m) in 58% of thepatients. 6-MWT adjusted for gait impairments using Tinetti-test was related tometa-bolic acidosis (serum anion gap, r¼-0.308), freeT4 (r¼0.331) and PTH level (r¼-0.234). Fifty-six percent of the patients had a higher risk of falling (STS> 15s). Patientswith a higher risk of falling were more anemic, had stronger impairment of ironhomeostasis and were longer on dialysis. Daily drug intake correlated with functionalcapacity (6MWT, r¼-0.246) and risk of falls (STS, r¼-0.345). As expected, patientswith multipele comorbidities (cardiovascular, musculoskeletal, diabetes) showed amore severe functional impairment compared to their counterparts based on 6-MWT,STS and Tinetti.CONCLUSIONS:More than 50% of the studied HD patients suffer from severe func-tional impairment and increased risk of falling. The observed relationships withmarkers of CKD-MBD, thyroid state andmetabolic acidosis merit furtherinvestigation.SP404 RISK EQUATIONS FOR PREDICTING ESRD IN IGANEPHROPATHY:MULTI-CENTER RISK ASSESSMENT STUDYIN CHINESEXie Jingyuan8, Lv Jicheng2, Wang Weiming8, Li Guisen3, Liu Zhangsuo4,Chen Hongyu5, Xu Feifei6, Sun Jing7, Ouyang Yan1, Zhang Xiaoyan1,Yang Meng1, Shi Manman1, Zhang Wen1, Ren Hong1, Zhang Hong2, Chen Nan11Department of Nephrology, 1.Institute of Nephrology, Department of Nephrology,Shanghai Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai,China, 2Renal Division, 2.Renal Division, Department of Medicine, Peking University FirstHospital, Beijing, China, 3Renal Division, 3.Renal Division, Sichuan Academy of MedicalSciences and Sichuan Provincial People’s Hospital, Chengdu, China, 4Department ofNephrology, 4.Department of Nephrology, The First Affiliated Hospital of ZhengzhouUniversity, Zhengzhou, China, 5Department of Nephrology, 5.Department ofNephrology, Hangzhou Hospital of Traditional Chinese Medicine, Zhejiang ChineseMedical University, Hangzhou, China, 6Department of Nephrology, 6.Department ofNephrology, the First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China,7Renal Division, 7.Renal Division, The 455 Hospital of Chinese People’s Liberation Army,Shanghai, China and 8Department of Nephrology, Institute of Nephrology, School ofMedicine, Shanghai Jiaotong University, Shanghai, ChinaINTRODUCTIONANDAIMS:Accurate prediction of end stage renal disease (ESRD)risk at the time of diagnosis of IgA nephropathy (IgAN) is critical for patient manage-ment. The aim of this study is to develop and validate risk equations for predictingESRD in IgA Nephropathy at the time of kidney biopsy.METHODS: It was a multicenter retrospective cohort study. Totally 2,155 biopsy-diag-nosed primary IgAN patients were enrolled. Clinical and histologic (Oxford classifica-tion) characteristics were collected at time of renal biopsy. The primary outcome wastime to ESRD defined by a need for renal replacement therapy (dialysis or renaltransplantation). The association of baseline candidate predictors with the primaryoutcome was tested by using Cox proportional hazards models.RESULTS: The discovery cohort consisted of 934 IgAN cases. The patients followed foramean of 56.3 months (range 12-300months). The validation cohort was an independ-ent cohort consisting of 1,221 additional patients with amean follow-up time of 47.8months (range 12-204 months). In total, there were 212 events of ESRD in the com-bined cohort. The best clinical predictive model (Model CLIN) of ESRD included fivevariables: age, gender, eGFR, hemoglobin, and urine protein. The best combined pre-dictive model (Model CLIN-PATH) included two clinical variables (age, eGFR) andtwo histological variables (Oxford-M and T). Bothmodels had comparable perform-ance in the discovery [C-statistic: 0.88 (0.85-0.92) and 0.89 (0.85-0.93)] and the valida-tion cohort [C-statistic: 0.86 (0.83-0.90) and 0.83 (0.77-0.89)] in predicting ESRD at 10year. In the validation cohort, theModel CLIN performed similar to a previously pro-posedMEST score-basedmodel [C-statistics: 0.82 (0.75-0.88)] and outperformed apreviously three-variable model with eGFR, urine protein, andMAP [C-statistics:0.82(0.77-0.87)] [integrated discrimination improvement 7% (3%-10%); net reclassifi-cation improvement 0.58 (0.37-0.80)] and a previously four-variable model witheGFR, serum albumin, hemoglobin and systolic blood pressure [C-statistics: 0.85(0.81-0.89)] [IDI 5%(2%-9%); NRI 0.48 (0.25-0.70)].CONCLUSIONS:We provide new kidney failure risk prediction equations based onthe regression coefficients from the best performing models in our study. The new pre-diction tools are simple, accurate, and readily applicable to clinical practice.SP405 HEMODYNAMIC PARAMETERS CORRELATE WITH CA ANDPTH LEVELS IN CHRONIC HD PATIENTS 65þWITHOUTPHYSICAL DISABILITYMariusz Kusztal1, Maciej Kanafa1, Anna Szymczak1, Tomasz Golebiowski1,Krzysztof Letachowicz1, Marian Klinger11Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław,PolandINTRODUCTIONANDAIMS: Enough physical activity in general population,according toWHO recommendations, improve cardiovascular health (e.g. reducesarterial stiffness), but there is still no strong evidence for older dialysis population.Primary aim of the study was to compare cardiovascular health parameters of patients65þ on hemodialysis maintenance with different level of physical activity. Secondaryaim was to find correlates between hemodynamic parameters, METs, sitting time andbiochemistries.METHODS:Design: cross-sectional multicentre study in patients aged>65 y, withBarthel score>90 (physical disability excluded), on HDmaintenance>1 year, withoutinfection and hospitalization in last 4 weeks. Measures: adult physical activity levelswere obtained in Nov.2017 from the International Physical Activity Questionnaire-Short Form (IPAQ), expressed inMETs and sitting time in last 7 days. Cardiovascularhemodynamic parameters (sysBP, diaBP, centralBP, HR, CO, CI, PVW, Axi) weremeasured non invasively (Mobil-O-Graph - I.E.M. GmbH) after volume normalizationby HD session. Ca-P, PTH, HGB were also analysed. Energy expenditure below600METs as recorded by the IPAQ-SF formed low activity group.RESULTS: 91 of 212 HD patients met study criteria and only 79 properly completedIPAQ. Table 1 displays comparison between normal (>600METs) and low activity(<600METs) groups. The groups differedmainly in sitting time. Significant correla-tions were found between hemodynamic parameters and Ca, PTH, namely cardiac out-put (CO) & Ca (r -0,41, p¼,002), Aix & Ca (r 0,29, p¼,04), TVR (total vascularresistance) &Ca (r 0,32, p¼,02), cardiac index & Ca (r -0,36, p¼,008), cardiac index &PTH (r 0,36, p¼,01) and PWV& PTH (r 0,31,p¼,04).CONCLUSIONS: Low physical activity (as compared to normal) in older HD patientsdid not affect hemodynamic parameters and biochemistry results. Higher concentra-tion of calcium was associated with lower cardiac output and index, increased resist-ance in arteries; whereas PTH level affected arterial stiffness and CI.Nephrology Dialysis Transplantation Abstractsdoi:10.1093/ndt/gfy104 | i483Downloaded from https://academic.oup.com/ndt/article-abstract/33/suppl_1/i483/4998368by Ghent University useron 20 July 2018

Functional impairment and risk of falling in the hemodialysis unit

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Functional impairment and risk of falling in the hemodialysis unit

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