Background: Acute kidney injury (AKI) worsens outcomes in low- and middle-income countries, largely due to delayed diagnosis and limited access to renal replacement therapy. Its true epidemiology remains unclear, partly due to delayed biochemical testing. In a prior phase of our work, we evaluated point-of-care creatinine (POC Cr) technology and its use in implementing a clinical algorithm to select patients at risk of AKI in a Nigerian hospital emergency department. In this study, POC Cr was used in a large primary care health center in Nigeria. METHODS:The study was conducted at Ozuoba Model Comprehensive Primary Health Care Centre in Nigeria, where renal function tests are rarely available and external laboratory results typically take over 48 h. POC Cr testing was introduced for high-risk adults using the clinical algorithm developed in the previous phase of this programme and for children with suspected severe illness based on clinical judgement or reduced urine output. Adjusted POC Cr values were calculated (POC Cr - 27.2 µmol/L), and AKI was staged using KDIGO criteria, with baseline creatinine defined as 100 µmol/L for adults and age-specific norms for children. RESULTS:A total of 424 patients were tested using POC Cr, comprising 301 adults and 123 children. Malaria was the most frequent diagnosis, accounting for 293 cases (61.1%). The median adjusted POC Cr across the entire cohort was 72.8 µmol/L (interquartile range [IQR]: 36). Among adult patients, AKI was diagnosed in 2 out of the 301 individuals (0.6%), one stage 1 and one stage 2, both of whom had malaria. In the paediatric group, the median age was 5 years (IQR: 7), with females comprising 65% of the cohort. Malaria was diagnosed in 69.9% of the children. AKI was identified in 70 out of 123 children (56.9%), with AKI stage 1 in 25 (20.3%), stage 2 in 26 (21.2%), and stage 3 in 19 children (15.4%). Among the 70 paediatric AKI cases, 49 (70%) had malaria. The highest prevalence of AKI was seen in children under 5 years of age, with the incidence declining steadily and reaching zero beyond age 12. CONCLUSION:Our study found that more than half of paediatric patients diagnosed with malaria at a primary health care level had AKI, highlighting AKI as a common complication of malaria in young children. These findings emphasise the need for further research to support informed potential updates to WHO malaria treatment guidelines to incorporate the KDIGO definition of AKI, particularly in the context of paediatric care in low-resource settings. .

ABSTRACT Patients referred to specialist hypertension clinics often have complex disease characterized by secondary causes, treatment resistance and coexisting kidney disease. Real‐world outcome data in this setting remain limited. We conducted a retrospective cohort study of 199 patients attending a tertiary hypertension clinic between January 2017 and December 2023. Baseline demographics, comorbidities, antihypertensive therapy, and blood pressure (BP) were recorded. BP changes were assessed annually for up to 3 years. Subgroup analyses examined outcomes by age, sex, diabetes, chronic kidney disease, obesity, resistant hypertension, secondary hypertension, and baseline systolic BP. Cardiovascular events were identified from clinical records. Mean age of patients was 44.1 ± 14.0 years and 61.3% were male. Secondary hypertension was present in 32.7% and resistant hypertension in 17.2%. Median follow‐up was 13.8 months (IQR 4.7–30.1), with follow‐up BP available for 146 patients. Mean baseline BP was 156/97 mmHg. At final follow‐up, significant reductions were observed, with mean systolic and diastolic BP decreases of −13.6 and −8.8 mmHg, respectively (both p < 0.001). BP improvements were consistent across clinical subgroups. Qualitative urine antihypertensive drug screening identified medication non‐adherence in a subset of patients, with targeted interventions associated with subsequent BP improvement. Cardiovascular events were infrequent (6.5%). This study shows that specialist hypertension care achieves substantial BP reductions in complex real‐world patients. Objective assessment of medication adherence appears clinically valuable, although BP control remains challenging and residual cardiovascular risk persists. Larger multicenter studies with longer follow‐up are needed to define predictors of cardiovascular outcomes and optimize care pathways.

Tubulointerstitial nephritis with uveitis (TINU) syndrome is a rare disorder characterised by the simultaneous or sequential occurrence of acute tubulointerstitial nephritis and uveitis, in the absence of systemic disease. Its true prevalence is likely underestimated, as renal and ocular manifestations may not appear concurrently. We conducted a retrospective case series of patients diagnosed with TINU at a single tertiary centre between 2016 and 2025. Clinical, biochemical, histopathological and ophthalmological data were reviewed. Long-term renal and ocular outcomes were assessed. Ten patients (female:male 6:4) were identified, with a median age at diagnosis of 41 years (range 15-67). Renal disease preceded uveitis in 60% of cases, with a mean interval of 5.6 months. At presentation, 70% had serum creatinine > 200 μmol/L and one patient required transient dialysis. All renal biopsies demonstrated tubulointerstitial nephritis with preserved glomeruli. All patients were treated with systemic corticosteroids, with topical therapy for uveitis. Renal relapse occurred in 60% of patients, often during steroid tapering, and required prolonged corticosteroid therapy or mycophenolate mofetil. At final follow-up (median 44 months), 50% had chronic kidney disease (eGFR < 60 mL/min). Relapsing disease was more frequent in females and patients under 18 years. At last follow-up, mean serum creatinine was 89 μmol/L, with 50% of patients having CKD G3a. Ophthalmologic data (n = 6) showed bilateral anterior uveitis in all cases, with intermediate involvement in three. Two developed steroid-induced intraocular hypertension. Ocular relapse occurred in six patients and frequently paralleled renal disease activity. We herein report one of the longest median follow-up durations (44 months) among biopsy-proven cohorts of interstitial nephritis. Our cohort spans a broader age range (15-67 years) than traditionally described with an adult predominance. Despite a 60% relapse rate, response to steroids and immunosuppression was good. Proteinuria at presentation was noted in individuals who developed subsequent CKD supporting the need for follow up and proteinuria management where relevant.

BackgroundSocioeconomic deprivation is an established determinant of adverse health outcomes. However, UK-specific data examining its impact on peritoneal dialysis (PD) outcomes remains generally unknown. This study evaluated associations between socioeconomic deprivation and clinical outcomes among patients receiving PD at a single UK center over a 10-year period.MethodsThis retrospective observational study included 648 adult patients who underwent PD catheter insertion between January 2015 and December 2024. Socioeconomic deprivation was assessed using the Index of Multiple Deprivation (IMD), with study cohorts categorized into quintiles from the least to the most deprived. Primary outcomes included all-cause mortality, transfer to hemodialysis (HD), and kidney transplantation. Secondary outcomes included cardiovascular events and PD-related infections, that is, peritonitis and exit-site infections. A 1:1 propensity score matching was performed to match for age, ethnicity, and smoking history to compare between the most deprived quintiles (MDQ) (i.e., quintiles 1 and 2) and the least deprived quintiles (LDQ) (i.e., quintiles 4 and 5). Cox proportional hazards models were used to evaluate associations between socioeconomic deprivation and outcomes.ResultsOf the 648 patients included, 41.7% resided in quintile 1. Patients in LDQ were significantly younger (median = 54 [IQR 42-67] vs. 64 [51-74] years, p < 0.001) and more likely to belong to ethnic minority backgrounds (24% vs. 7.7%, p < 0.001) compared to those in MDQ. Across all quintiles, no significant associations were observed between deprivation and all-cause mortality, transfer to HD, or kidney transplantation. In the propensity-matched cohort (n = 298), all-cause mortality was significantly higher among patients from MDQ compared to the LDQ (39.6% vs. 24.8%, p = 0.006). Social deprivation was noted to be an independent risk factor associated with all-cause mortality in the matched cohort (adjusted HR 2.08, 95% CI 1.37-3.10, p = 0.001). No significant associations were identified in relation to cardiovascular events, transfer to HD, kidney transplantation, or PD-related infections.ConclusionIn a propensity score-matched cohort from this single-center study, socioeconomic deprivation was independently associated with increased mortality among patients receiving PD. No significant associations were observed between socioeconomic deprivation with transfer to HD or kidney transplantation and PD-related infection complications.

Background Nonattendance at scheduled hemodialysis (HD) sessions is a frequent form of treatment nonadherence. Psychosocial factors are known contributors, yet the psychological profiles of frequent non-attenders remain underexplored. We conducted a retrospective analysis of patients with recurrent HD nonattendance, defined as missing more than four dialysis sessions during the two-year study period, who were referred to renal psychology services.Methods Data were extracted from psychological case notes using a structured pro forma designed by the renal psychology team, and included reason for referral, preexisting mental health issues and history of adverse childhood experiences (ACEs). Information recorded by the dialysis nurses on the electronic patient record on the day of nonattendance for all patients referred to psychology was retrieved and analyzed to identify and categorize recurring themes. Descriptive analysis was conducted for both datasets.Results Of 464 patients in the original cohort, 54 met criteria for frequent nonattendance. Twenty-two (40.7%) were referred to psychology, of whom 17 engaged with at least one session. Fifteen out of 17 (88%) of these patients had preexisting mental health conditions, primarily depression (n = 12, 71%) and anxiety (n = 8, 47%). Confirmed or possible adverse childhood experiences were identified in 88% of assessed patients. Nursing records cited concurrent illness, limited disease understanding, family obligations, and logistical barriers as common reasons for missed sessions.Conclusions This study underscores the need for early, integrated psychological assessment within the dialysis care pathway. A trauma-informed, multidisciplinary model may improve access to support and sustain adherence over time and should be prospectively investigated.

INTRODUCTION:Nonattendance for prescribed hemodialysis (HD) sessions is a form of nonadherence that compromises the delivery of life-sustaining HD therapy and is associated with severe morbidity and mortality. In this study, we aimed to assess the characteristics and outcomes of HD nonattenders in a single renal center in the North West of England. METHODS:HD patients followed by the renal team at our unit between December 2020 and September 2022 were included in this study. Dialysis nonattendance data were retrieved from the incident reports (DATIX) between December 2020 and November 2022, excluding dialysis nonattendance due to concurrent hospitalization. The cohort was split into group 1: no dialysis nonattendance; group 2: two or fewer dialysis nonattendances; and group 3: more than two dialysis nonattendances for comparative analysis. All patients were followed up for outcomes including all-cause mortality, transplantation, and hospitalizations until the study endpoint date of 12/31/2023. Predictors of dialysis nonattendance were identified using logistic regression. RESULTS:Of the 464 patients, dialysis nonattendance was noted in 149 (32%) patients, of which 79 (17%) had two dialysis nonattendance episodes and 70 (15%) had more than two dialysis nonattendance episodes. Over a median follow-up of 35 months, patients in group 3 had a higher hospitalization episode (4 vs. 1 day, p < 0.001) and lower kidney transplantation rates (4.3% vs. 13%, p = 0.038) compared to patients in group 1. In multivariate regression analysis, younger age (OR: 0.97; 95% CI: 0.95-0.98; p = 0.001), history of smoking (OR: 2.01; 95% CI: 1.12-3.62; p = 0.019), alcohol excess history (OR: 3.49; 95% CI: 1.87-6.49; p < 0.001) and history of mental health illness (OR: 3.01; 95% CI: 1.61-5.62; p = 0.001) were significant predictors of dialysis nonattendance. CONCLUSION:Skipping HD is a common phenomenon associated with mental health issues and is associated with increased morbidity. Further research is required to understand the psychosocial determinants of nonadherence and effective models of intervention developed to improve outcomes.

High-flux dialysis (HFD) membranes effectively remove small molecules during haemodialysis but have limited capacity in clearing middle molecules that may contribute to the uraemic milieu. Medium cut-off membranes (MCO) have the potential of removing a wide range of middle molecules. Our study aimed to compare the clearance rate (CR) of Fibroblast growth factor 23 (FGF-23) and other selected inflammatory cytokines between medium MCO and HFD membranes and investigate the intrasubject stability of these biomarkers. This prospective randomised case-crossover study recruited adult patients receiving regular haemodialysis. Twenty patients were randomised into two groups: Group A: to start with 1 week of thrice-weekly dialysis using HFD membrane followed by a 3-weeks washout period and then 1 week of dialysis with an MCO membrane; Group B, to start with 1 week of thrice-weekly dialysis using MCO membrane followed by a 3-weeks washout period then 1 week of dialysis with HFD membrane. Blood samples were taken before and after each dialysis session for analysis of the assessed biomarkers (FGF-23, interlukin-6 [IL-6], interlukin-18 [IL-18], high-sensitivity C-reactive protein [hsCRP] and dephosphorylated uncarboxylated matrix Gla protein [dp-ucMGP]). Average values over the 3 sessions in each arm were used for comparison between the membranes using Wilcoxon signed rank test and paired-t test depending on the distribution of the data. One-way repeated measures ANOVA or Friedman Repeated Measures Analysis of Variance tests were used for the intrasubject stability of the biomarkers depending on the distribution of the data. There was no significant difference in the CR when using MCO and HFD membranes for the assessed biomarkers: FGF-23 (0.31 vs 0.23], P = 0.242), IL-6 (0.19 vs 0.12, P = 0.215), IL-18 (−0.05 vs − 0.03, P = 0.704), dp-ucMGP (0.33 vs 0.33, P = 0.903) and hsCRP (−0.05 vs −0.08, P = 0.107). There was no significant intrasubject variability for all assessed biomarkers except in pre-dialysis high hsCRP levels when using HFD membrane. The use of MCO membranes for a short period did not substantially reduce FGF-23 levels or other selected inflammatory cytokines. There was no significant intrasubject variability for all assessed biomarkers apart from hsCRP.

Introduction: In contrast to high-flux dialysis (HFD) membranes, medium cut-off membranes (MCO) can potentially remove a wide range of middle molecules. Our study aimed to compare the clearance rate (CR) of fibroblast growth factor 23 (FGF-23) and other selected inflammatory cytokines between medium MCO and HFD membranes and investigate the intrasubject stability of these biomarkers. METHODS:This prospective randomised case-crossover study recruited 20 adult patients who were randomised into two groups: group A: to start with 1 week of thrice-weekly dialysis using HFD membrane followed by a 3-week washout period and then 1 week of dialysis with an MCO membrane. Group B followed the reverse sequence. Blood samples were taken before and after each dialysis session for the analysis of the assessed biomarkers (FGF-23, interleukin-6 [IL-6], interleukin-18 [IL-18], high-sensitivity C-reactive protein [hsCRP], and dephosphorylated uncarboxylated matrix Gla protein [dp-ucMGP]). Wilcoxon signed rank and paired t tests were used for comparison between the membranes. One-way repeated measures ANOVA or Friedman tests were used for the intrasubject stability of the biomarkers. RESULTS:The use of both MCO and HFD membranes resulted in a significant reduction of FGF-23 levels and other selected inflammatory cytokines. However, there was no significant difference in the CR: FGF-23 (0.31 vs. 0.23], p = 0.242), IL-6 (0.19 vs. 0.12, p = 0.215), IL-18 (-0.05 vs. -0.03, p = 0.704), dp-ucMGP (0.33 vs. 0.33, p = 0.903), and hsCRP (-0.05 vs. -0.08, p = 0.107). There was no significant intrasubject variability for all assessed biomarkers except in pre-dialysis high hsCRP levels when using HFD membrane. CONCLUSION:The use of both MCO and HFD membranes resulted in a significant reduction of FGF-23 levels and other selected inflammatory cytokines. However, the MCO membrane did not demonstrate a significant advantage over the HFD in the short term. There was no significant intrasubject variability for all assessed biomarkers apart from hsCRP. .

Background and Hypothesis: Efficient arteriovenous access (VA) surveillance is vital for early identification of dysfunctional access, allowing timely intervention to prevent thrombosis. This study compares the efficacy of adding remote software surveillance to standard clinical care across our units. Methods: We conducted a 12-month prospective study on maintenance hemodialysis (HD) patients using Vasc-Alert software technology to assist clinical decision-making in 2 satellite HD units (Group 1) and standard care in the remaining 3 HD units (Group 2) . Patients with Vasc-alert derived high Access Risk Score (ARS) (≥7) underwent clinical assessment and were referred for fistulogram based on relevant Kidney Disease Outcome Quality Initiative (KDOQI) criteria. Data on referrals for fistulogram, subsequent VA events, access abandonment, and complication-free days- extended (CFD-extended) were collected.. VA survival analysis of post-intervention primary patency rate at 3 and 6 months was conducted. Results: There were 23 (28.1%) preemptive correction of stenosis and 6 (7.3%) thrombosis episodes in Group 1, compared to 40 (19.5%)and 21 (10.2%) in Group 2 (p value 0.155, 0.587),respectively). Amongst the thrombotic episodes, 83% of cases in Group 1 had been detected during surveillance and referred for diagnostic fistulogram +/- angioplasty but developed thrombosis whilst awaiting elective intervention compared to 19% in Group 2 (P value = 0.004). Median time from fistulogram request to thrombosed VA was 26 days (IQR 21-42 days).Group 1 exhibited better post-intervention primary patency rates and longer CFD compared to Group 2 (p value < 0.001, 0.002, respectively). Conclusion: Incorporating Vasc-Alert technology into VA clinical surveillance pathway was associated with improved early detection of high-risk VA, higher primary patency rates, and longer CFD-extended compared to standard of care. Improving elective interventional radiology (IR) capacity for timely intervention (< 3 weeks from referral) is crucial to materialise the benefits of enhanced surveillance in preventing acute thrombosis.

Depression and anxiety are commonly experienced by people with chronic kidney disease (CKD). This study aimed to evaluate person- and service-level factors associated with depression and anxiety symptoms. We sought to also understand utilisation of mental health treatments and preferences for future psychological support. An online survey recruited participants from six UK kidney services with varying levels of psychosocial provision. The survey was also advertised on social media. Participants completed screening questionnaires for depression and anxiety, alongside questions about mental health history, self-efficacy, treatment and support. The study included adults (18 years or older) living with CKD (stages 3b and above) or those receiving any form of Kidney Replacement Therapy (KRT), including individuals with a functioning kidney transplant. Eligible participants had to complete study measures and be proficient in reading and writing in either English or Welsh, as the survey was administered in these languages. This survey was developed with our Patient and Public Involvement group and was administered from January 2023 until 31st January, 2024 using Qualtrics and RedCap. Four hundred fifty-eight people completed the survey. Moderate-severe symptoms of depression and anxiety were 37.7

Acute kidney injury (AKI) is associated with poor health outcomes in low and middle-income countries due to delayed diagnosis and limited access to renal replacement therapy. However, its true burden remains poorly understood due to lack of timely biochemical testing. We previously evaluated the accuracy of point of care creatinine (POC Cr) technology [1] and its implementation using a clinical algorithm to identify patients at risk of AKI in the Hospital Emergency Department in Port Harcourt in Nigeria. In this phase of the project POC Cr was introduced in a large primary care health centre in Nigeria. The study took place at Ozuoba Model Comprehensive Primary Health Care Centre in Nigeria. Historically, decision making is based largely on clinical judgement and renal function tests when requested from external laboratories are reported in >48 hours. During this project POC Cr was performed for high-risk adult patients, using the clinical algorithm developed in the previous stage. Paediatric patients were tested with POC Cr based on diminished urine output or severity of clinical presentation as judged by the attending clinician. POC Cr was adjusted based on the evaluation phase as follows: POC Cr adjusted (a) = POC Cr −27.2 [1]. AKI stages were calculated based on KDIGO criteria using as baseline creatinine the upper limit of normal range (100 umol/L) in adults and based on upper limit of normal range according to age category for paediatric patients as proposed by the Paediatric Laboratory Medicine Network [2]. A total of 424 patients (299 adult and 125 paediatric patients), underwent POC Cr testing. The median age was 31 (range 0.1 to 97) years. Amongst these patients, malaria was the most common presenting diagnosis (293 patients 61.1%), followed by gastroenteritis (25 patients (5.8%) with gastroenteritis, upper respiratory tract infection (24 patients, 5.8%) , urinary tract infection ( 20 patients, 4.7%), and acute appendicitis (4 patients, 3%) . Median POC Cr(a) (for the total population was 72.8 umol/L, Interquartile Range (IQR) 310). In the 299 adult patients, median POC Cr(a) was 72.8 umol/L (IQR 310). Two cases of AKI (0.6%) were detected (one stage 1 and one stage 2), both associated with malaria. Amongst the 125 paediatric patients 70 (56%) cases of AKI were detected (AKI stage 1 was 20%, AKI stage 2 was 20.8% and AKI stage 3 was 15.2%) with 49 (70 % of AKI cases) with associated with malaria diagnosis. Out of the 125 paediatric patients assessed in the centre 88 (70.4%) were diagnosed with malaria and amongst those 49 (56%) had AKI (AKI stage 1:18%, AKI stage 2: 20.4% and AKI stage 3: 17%) (Fig. 1). The highest rates of AKI rate were observed in younger children declining to zero after the age of 12 (Fig. 2). AKI was identified in over half of paediatric patients diagnosed with severe malaria based on clinical assessment in our study highlighting AKI as common complication of malaria in young children. These findings emphasise the need to revise WHO malaria guidance [3] with incorporation of the KDIGO definition of AKI to support early detection and treatment.

Abstract Background and Aims Optimal arteriovenous access monitoring and surveillance aims for early detection of dysfunctional access, enabling pre-emptive referral for angioplasty or surgery to prevent access loss or thrombosis. Here we compared the addition of remote software surveillance to standard clinical care in our units. Method From January–December 2023 we conducted a 12-month prospective study of maintenance hemodialysis (HD) patients. We used Vasc-Alert software technology to assist clinical decision making for vascular access (VA) surveillance in 2 out of 5 HD units. In these units, vascular access risk score was calculated using Vasc-Alert software platform from routinely collected data from the dialysis procedure as previously described [1]. Patients with high Vasc-Alert access risk score (≥7) underwent clinical assessment and were referred for fistulogram if they met the relevant KDOQI criteria [2]. The following variables were collected from all 5 HD units: baseline permanent VA prevalence, subsequent VA events (stenosis or thrombosis), access abandonment (i.e. unsalvageable access loss), complication free days (CFD)-extended over one year (defined as days without serious vascular access events, radiological or surgical intervention, VA infection, hospitalisation or use of central venous catheter). Data was collected on patients who were pre-emptively referred for diagnostic fistulogram ± angioplasty but thrombosed while awaiting intervention. Median time interval from the date of fistulogram request till the date of confirmed thrombosed access was calculated. Comparison between HD units with Vasc-Alert use (Group 1) or without (Group 2) was performed using appropriate statistical tests depending on the type and distribution of the data. Survival analysis of post-intervention primary patency rate was conducted at 3 and 6 months defined as the time from the index procedure until the next access thrombosis or reintervention [3]. Results There were 81 (53.6%) patients with permanent VA in group 1and 201 (59.3%) patients in group 2at the start of the study. We recorded 23 (28.4%) episodes of stenosis and 6 (7.4%) episodes of thrombosis in Group 1 and 40 (19.9%) episodes of stenosis and 21 (10.4%) episodes of thrombosis in Group 2 (p value 0.121 and 0.432, respectively). In Group 2, 11 patients (5.5%) developed repeated stenosis and 2 patients (1%) repeated thrombosis. In Group 1, 5 /6 (83%) cases preemptively referred for diagnostic fistulogram ± angioplasty developed thrombosis whilst awaiting elective intervention, compared with 4/21 (19%) in group 2 (p value = 0.008) (Fig. 1). The median time interval from the date of fistulogram request till date of thrombosed VA was 26 days with Interquartile range (IQR 25-75%) of 21-34 days. Group 1 had better post-intervention primary patency rate of VA (Fig. 2) and longer CFD-extended compared to group 2 (p values < 0.001 and 0.002 respectively) (Table 1). Conclusion Our study shows that integrating Vasc-Alert technology into the VA surveillance program was associated with improved early detection of high-risk access, higher primary patency rates and CFD-extended. Additionally, our data emphasizes the need to enhance interventional radiology capacity for timely access intervention, to realise the true potential of Vasc-Alert technology in prevent access thrombosis.

Abstract Background and Aims Studies showed that early thrombectomy of dialysis vascular access (VA) is associated with better outcomes [1], especially for native VA [2]. Timely treatment of VA thrombosis within 24-48 hours is recommended by GIRFT to minimize access loss and requirement for dialysis line insertion [3]. Our centre has approximately 430 HD patients but has no on-site vascular surgery or vascular access interventional radiology (IR) service. Wait time for elective VA surgery or fistuloplasty is >8 weeks and VA surveillance is based on routine clinical monitoring. VA prevalence is 62% AV fistula (AVF), 2% AV graft (AVG), 36% central venous catheter (CVC). Fistula thrombectomy is provided at another centre, with increasing waiting times over recent years due to shortage of interventional radiologists. This study evaluates adherence to GIRFT recommendations for patients at our centre requiring thrombectomy and will identify potential local strategies to reduce fistula thrombosis and CVC use. Method In a 24-months’ retrospective cohort analysis of maintenance HD patients with permanent VA, we obtained data on: Results 44 patients with permanent VA developed VA thrombosis. The median waiting time for thrombectomy was 8 days (Fig. 1). Post-intervention primary patency rate was 71% at 3-months and 60% at 6-months (Fig. 2). 61% of patients required hospital admission with a 12-day median length of stay, with total inpatient admission days of 403 days over 2 years (2022-2023), and total cost of £246,065 (Figs. 3 and 4). The median CFD-extended was 356 days, i.e. 9 days/patient/year with VA-related complications (Fig. 5). Conclusion This study shows that our centre's VA thrombectomy service falls far outside the GIRFT recommendation of intervention within 24-48 hours. The high associated rates of CVC use, inpatient bed days and avoidable costs place a heavy burden on patient outcomes and NHS resources. The ideal solution of an on-site thrombectomy service is difficult to achieve due to lack of vascular IR support. In response to this study, we now aim to reduce thrombosis rates by training additional interventional nephrologists in elective fistuloplasty, implementing a robust VA surveillance to improve early detection of malfunctioning VA suitable for elective intervention and improving staff education on fistula care.

Background: Early identification of dysfunctional arteriovenous haemodialysis (HD) vascular access (VA) is important for timely referral and intervention. Method: We retrospectively calculated VA risk score using Vasc-Alert surveillance software technology from HD treatment sessions in 2 satellite HD units over 18 months. We included in the analysis HD patients dialysing with arteriovenous fistula or graft (AVF/G) with available Vasc-Alert data for >= 2 months. For group one (eventful) that included patients who developed vascular access thrombosis or stenosis over the study period, we collected Vasc-Alert risk score 2 months prior to the event and, for group two (uneventful), over 5 consecutive months. Vasc-Alert technology utilises routinely collected data during HD to calculate VA risk score and triggers an alert if the score is >= 7 in 3 consecutive dialysis sessions. Patients with >2 alerts (vascular access score >= 7) per month were considered to have positive alerts. Results: From 140 HD patients, 81 patients dialysed via AVF/G. 77/81 had available Vasc-Alert data and were included in the final analysis. Out of 17 eventful patients, 11 (64.7%) had positive alerts 2 months prior to the vascular event. Out of the 60 patients without vascular events, 20 patients (33.3%) had positive alert. Vasc-Alert's sensitivity and specificity for vascular events were 64.7% and 66.6%, respectively. Within the 6 patients with thrombosed access, 2 patients (33.3%) detected by Vasc-Alert were not detected with clinical monitoring. Conclusion: Vascular access risk score can be a useful non-invasive vascular access surveillance method to assist clinical decision making. (c) 2024 The Author(s).Published by S. Karger AG, Basel

Abstract Background and Aims Community acquired Acute kidney injury (AKI) and leads to poor outcomes in low and middle-income countries due to delayed diagnosis however its epidemiology is poorly studied due to lack of biochemical diagnosis. Supported by the International Society of Nephrology, we evaluated the accuracy of point of care creatinine (POC Cr) technology using capillary samples [1] and its use implementing a clinical algorithm to select patients at risk of AKI for POC Cr testing in the Hospital Emergency Department in Port Harcourt in Nigeria. In this phase of the project POC Cr was used in a large primary care health centre for early detection and management of community acquired AKI. Method The study is conducted in Ozuoba Model Comprehensive Primary Health Care Centre. The centre has 4148 patient attendances per month (20.3% medical, 18.8% obstetrics and 60.8% paediatrics) with 11.1% considered acute requiring short admission at the centre usually for intravenous fluids. Historically, decision making is based largely on clinical judgement and renal function tests when requested from external laboratories are reported in > 48 hours. During this project POC Cr was offered on high-risk patients based on the clinical algorithm from the previous stage (Fig. 1) and patients with detected AKI were offered short admission for intravenous fluids and antibiotics. Results To date 54 patients have been screened with POC Cr. Median age is 25.5 years, minimum 2 months, maximum 85 years, interquartile range (48-10), 62% are females, 57% presented with malaria diagnosis and 9% with gastroenteritis. Mean (standard deviation) of POC Cr was 105 (54) µmol/L. There were 5 cases (9%) of AKI (Cr >150 µmol) detected in patients aged 5 months, 13 months, 7 years, 19 years and 31 years. All were treated with short admission and intravenous fluids and were discharged after clinical improvement. Knowledge of the presence of AKI altered management in all patients prompting short admission. Conclusion Community acquired AKI is common in young patients with malaria and early biochemical diagnosis can improve outcomes. The study continues to recruit and aims to investigate the characteristics of community acquired AKI in Africa and to contribute to the design of optimal and sustainable pathway for early detection and management of AKI.

Abstract Background and Aims Early identification of dysfunctional arteriovenous haemodialysis (HD) vascular access (VA) is important for timely referral and intervention. We evaluated the accuracy of remote monitoring technology of VA that uses access flow data routinely collected during HD treatment to predict stenotic/thrombotic vascular events. Method We retrospectively calculated access risk score in a blinded fashion using Vasc-Alert vascular access surveillance technology from all HD treatments sessions in 2 satellite HD units for 12 months. We included in the analysis HD patients dialysing with arteriovenous fistula or graft with available Vascalert data for ≥ 2 months. The Access Risk Score was calculated as average of the scores for every 3 consecutive HD treatments and a high-risk score (HRS) was defined as ≥ 7.1 Using the electronic patient records, we identified patients with significant vascular access events (thrombosis, angiographic stenosis requiring angioplasty or doppler with > 50% stenosis) and without vascular access event. Information for clinically detected malfunctioning fistula was retrieved from the last clinic letter and the last vascular access multidisciplinary meeting notes prior to the vascular event. For the event positive patients, we included in the analysis the Vasc-alert data 2 months prior to the event. For the negative group, we included Vasc-alert data for 5 consecutive months with 1 month follow up. For the analysis we considered HRS positive if ≥2 HRS were generated. Results Out of 141 patients with available Vasc-alert data there were 60 patients dialyzing via a tunneled line. Amongst 81 patients with arteriovenous fistula or graft, 58 had available Vasc-alert data for ≥ 2 months. Out of 12 event positive patients (4 patients with thrombosed access, 6 patients with stenosis requiring angioplasty and 2 patients with >50% on doppler referred and awaiting fistulogram),10 (83%) had ≥2 HRS generated 2 months prior to the vascular event (Median 8, IQR 6.75-8). Out of the 46 patients without vascular events, 15 patients (32.6%) had HRS ≥ 2 and 4 patients had only one HRS score. Patient characteristics by vascular event are presented in Table 1. The sensitivity and specificity of HRS ≥2 for detecting future vascular events were 83.3% and 67.4%, respectively. The positive and negative predictive value of HRS ≥2 was 40% and 93.9% respectively. History of prior access stenosis and clinically detected malfunctioning fistula were significantly associated with vascular access events (P value 0.002, < 0.001 respectively), and HRS≥2 discrete values (P value 0.007 and 0.005 respectively). Within the patients with thrombosed access, 2 patients (50%) detected by HRS were not detected with clinical monitoring. Conclusion Our results suggest that vascular access risk score can be a useful screening tool to assist clinical decision making for VA risk stratification. Prospective studies are required to evaluate its utility in the VA surveillance pathway.