Comparison of Citrate Dialysate in Pre- and Post-Dilution Online Hemodiafiltration: Effect on Clot Formation and Adequacy of Dialysis in Hemodialysis Patients

Background: Intradialytic hypotension (IDH) and hypertension (IDHTN) are associated with poor outcomes in hemodialysis patients. However, there is currently no real-time predictive model for dual outcomes. This study aims to develop an explainable deep learning model using a sequence-to-sequence-based attention network to simultaneously predict IDH and IDHTN. Methods: Electronic health records of 11,110 hemodialysis patients were utilized, comprising 302,774 sessions. The data was divided into training (70%), validation (10%), and test (20%) sets using randomization. IDH-1 was defined as nadir systolic blood pressure (BP) <90 mmHg, IDH-2 as a decrease in systolic BP ≥ 20 mmHg and/or a decrease in mean arterial pressure ≥ 10 mmHg, and IDHTN as an increase in systolic BP ≥ 10 mmHg within 1 hour. The temporal fusion transformer (TFT)-based model was developed and compared with other machine learning models, including recurrent neural network, light gradient boosting machine, random forest, and logistic regression, in terms of model performance measured by receiver operating characteristic curve (AUROC) and area under the precision-recall curves (AUPRC). Results: The TFT-based model outperformed other models with AUROCs of 0.953 (0.952–0.954), 0.892 (0.891


Effect of Antioxidants on Oxidative Stress, Endothelial Dysfunction, Inflammatory Markers, and Carotid Intima Media Thickness in Maintenance Hemodialysis and Renal Transplant Patients
Himanish Goswami, Mitul Bora.Apollo Hospitals Guwahati, Guwahati, India.
Background: Cardiovascular disease (CVD) is a major cause of morbidity and mortality in dialysis patients.Various non-traditional factors have been proposed for the increased incidence of CVD.N-acetylcysteine (NAC) serves as an antioxidant, acts on atherosclerosis and also improves the endothelial functions.This study was designed to assess the effects of three months of NAC therapy on oxidative stress, endothelial dysfunction, inflammatory markers and carotid intima media thickness in maintenance hemodialysis and renal transplant patients.
Methods: Doppler was done to assess endothelial function by flow mediated dilatation (FMD) of the brachial artery and carotid arterial intima media thickness (CIMT).Brachial artery was imaged during reactive hyperemia (endothelium-dependent, flow-mediated dilatation, FMD) and during nitroglycerine-mediated dilatation (NMD, endothelium-independent).Oxidants (Melondialdehyde, MDA) and antioxidants (Total Antioxidant Status) were measured.NAC 1200 mg was given in two divided doses for three months.Parameters were repeated after three months of NAC therapy.
Conclusions: CKD patients have endothelial dysfunction and oxidative stress which begins early, progresses during dialysis and persists after renal transplantation.With three months of therapy, NAC significantly reduces the oxidative stress, inflammatory markers and improves the endothelial function.Results: In the vitamin C solution the initial cumulative dose of heparin 1818±659.28iu (24 iu/kgrBW) to 3323.52±1467.79iu (44 iu/kgr/BW) at 12 months.With no observed thrombotic events or bleeding tendency, the heparin dose was significantly reduced from classically recommended doses (loading dose 30-50 IU/kgBW and then 10 IU/kgBW/hour).A corresponding observation was also noted in pure CD (29 iu/ kgrBW beginning-39 iu/kgrBW end).Hb and Hct increased significantly (10.63±1.55start-11.79±0.91 end, p<0.05, 32.25±4.45start-36.5±2.92end, p<0.05) with constant weekly dose of erythropoietin (14000±9500 iu start-14000±10000 iu end, p=NS) and constant ferritin levels (526.73±498.72 iu start-690.44±470.32 iu end, p=NS).The above notice was combined with a significant reduction in monthly iron administration (200 mg monthly final dose).In CD without Vitamin-C we had corresponding observations with a consistently significantly higher dose of monthly iron administration (400-500 mg final dose).

TH-PO262 Poster
Conclusions: Our findings suggest that the use of both solutions provides anticoagulation with a significant decrease in heparin while simultaneously increasing hemoglobin with a fixed dose of erythropoietin.The addition of vitamin C is associated with reduced monthly iron intake.Background: Citrate dialysate (CD) has been used successfully in conventional hemodialysis and continuous renal replacement therapy but has never been compared between pre-and post-dilution online hemodiafiltration (oL-HDF).Therefore, we investigated the efficacy, metabolic changes, and quality of life of citrate anticoagulation for oL-HDF in the maintenance of hemodialysis patients in both modes.

TH-PO263 Poster
Methods: Eight dialysis patients were treated with CD for 4 weeks in each phase.The visual clotting scores were investigated as the primary endpoints.The adequacy of dialysis, laboratory parameters, and quality of life were measured as secondary objectives.
Results: The mean clotting scores in the pre-dilution mode were significantly lower than in the post-dilution and all phases except in the heparin-free phase (P < 0.001 in baseline phase, P = 0.001 in phase 1, and P = 0.023 in phase 2).The quality of life related to physical in the post-dilution mode was significantly higher than in the pre-dilution mode in baseline and phase 1 (P = 0.014 and 0.004 at baseline and phase 1, respectively).The metabolic changes were not different in both modes.
Conclusions: Citrate dialysate allows decrease or discontinuation of anticoagulation in both the pre-and post-dilution mode of oL-HDF without significant side effects.
Thursday Hemodialysis: Volume, Metabolic Complications, Clinical Outcomes Experience Comparing the Use of Citric Acid Solution (CD) with L-Ascorbic Acid (Vitamin C) to Simple Citric Solution in Patients with ESRD Under Hemodialysis (HD) Ioannis Griveas.Noseleutiko Idryma Metochikou Tameiou Stratou, Athens, Greece.Background: The purpose of the study is to record the experience of comparing the use of CD solution with Vitamin-C in relation to the use of pure CD solution in patients with ESRD under HD.Methods: 45 patients with ESRD under HD (40 new entrants) receiving CD solution with vitamin-C (2g/lt) for a period of 12 months were compared with 26 patients (18 new entrants) of the same weight who received plain CD solution.Changes in heparin dose as well as the anemia profile of the patients were recorded.
Thursday Hemodialysis: Volume, Metabolic Complications, Clinical Outcomes Comparison of Citrate Dialysate in Pre-and Post-Dilution Online Hemodiafiltration: Effect on Clot Formation and Adequacy of Dialysis in Hemodialysis Patients Thananda Trakarnvanich.Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.