In recent years, it has been demonstrated that many tissues not only express the vitamin D receptor (VDR) but also may possess 1-␣-hydroxylase and are therefore capable of the production of 1, 25-dihydroxyvitamin D, which may act locally. Such tissues include the prostate; the colon; the breast; macrophages; and cells of the vasculature, pancreas, and potentially other sites. The role of this extrarenal 1-␣-hydroxylase, with the production of 1,25-dihydroxyvitamin D in these tissues, is not well understood, but a variety of in vitro studies indicate that this process may be involved in the regulation of cell growth and differentiation (1).

Only a shorter interval between transplantation and the acute rejection episode correlated with a good response to PE.

Introduction:The rate of hospitalization represents a morbidity indicator in HD patients. The study aimed to evaluate hospitalization patterns in a large HD cohort.Methods: All DaVita-KSA HD patients from October 2014 to December 2019 were included. Demographical and clinical characteristics and hospitalization data were recorded. Less than 24 h admission was excluded. Overall and cause-specific hospitalization rates were calculated. Results: During the follow-up period, 3982 patients with a mean age of 52.5 ± 16.8 years, 2667 hospitalizations were recorded in 34.1% of the patients and 45.6% had repeated admissions. Infectious causes accounted for 26.6% of all recorded causes vs. 15.6% for cardiovascular complications. The median hospital stay length was 11 days, while the overall annual hospitalization rate of 34.9% and the annual duration of 3.7 days per patient. Hospitalized patients had a higher risk of mortality (p < 0.001). Conclusion: Infectious complications were the leading cause of hospitalization and had the longest hospital stay.

BACKGROUND AND AIMS It is well established that patients on chronic hemodialysis (HD) have an increased risk of hepatitis B virus (HBV) infection and reduced response to HBV vaccines compared with the general population.1 While advances in immunology and vaccinology have evolved several HBV vaccine modifications to enhance immunogenicity2; there is need to identify modifiable clinical factors that may help enhance response to HBV vaccines in the chronic HD population. This multi-center study aims to document the response to HBV vaccine among chronic HD patients across DaVita centers in Saudi Arabia and to identify the factors that independently affect the response of HD patients to the HBV vaccine. METHOD Patients eligible for HBV vaccination among our patient cohort who had received a full course of HBV vaccination (Engerix-B®, GlaxoSmithKline, United Kingdom) in all DaVita Clinics in Saudi Arabia were included in the analysis. We excluded patients who did not complete the vaccine protocol or had missing data and who were treated by immunosuppressive drugs. Levels of the antibody to the surface antigen (anti-HBs) were measured about 2 months after the last dose of the vaccine using enzyme-linked immunoassay methods. The age (in years), dialysis vintage, hepatitis C infection, diabetic status, mean albumin, parathyroid hormone (PTH), ferritin and hemoglobin levels 2 months prior to and during the 6 months of completing the vaccination protocol were recorded. Response to HBV vaccine was recorded as ‘no response’ if anti-HBs was &lt; 10 mIU/L; ‘weak response’ if the anti-HBs level is between 10–99.9 mIU/L, and ‘good response’ when ≥ 100 mIU/L. Univariate and multivariate ordinal logistic regression models were used to identify the factors independently associated with response to HBV vaccine. RESULTS We had 509 patients with a mean age of 54.1 ± 15.1 years, 252 (49.5%) being female. Diabetes mellitus was the etiology of kidney failure in 60.5% of the patients. Most (91.1%) had concomitant hypertension and 4.3% were positive for hepatitis C virus infection. BMI was at least 30 kg/m2 in 26.1% of the study population. Immune response occurred in 374 {73.5%, [95% confidence interval (95% CI) 69.4–77.3%]}. Good response occurred in only 53.1% (95% CI 48.6%–57.4%). The factors independently associated with response to HBV vaccination were age, mean albumin, PTH, ferritin levels and BMI (Table 1). Diabetic status and Kt/v did not predict vaccine response. CONCLUSION A complex interaction of inflammatory markers, nutritional status, bone mineral disease parameters affects the response to HBV vaccines. Improving chronic dialysis patients’ albumin and PTH levels may increase the likelihood of achieving a good response to HBV vaccines.

Background and Aims The aim of the study was to analyze hospitalization and mortality parameters in Saudi elderly patients undergoing hemodialysis for end stage renal disease. Method The study population included all patients admitted at Davita-KSA clinics to continue renal replacement by hemodialysis during the period October 2014-December 2018. Two groups were identified according to age at admission to Davita clinics: Group 1 (age&gt;=65 years), Group 2 (age&lt;65 years). Zero time data, including demographic and clinical characteristics were recorded at admission. Also, all deaths and morbid events necessitating hospital admission were regularly recorded during the follow-up period. Annual mortality and hospitalization rates with the corresponding confident intervals were calculated as appropriate. Survival rates were calculated according to actuarial method logistic regression was used to identify factors influencing hospitalization and mortality. Results Elderly patients represented 23.84% of 3508 included patients (G1),). The sex ratio was of 1.07 Vs. 1.21 in control group (NS). ESRD was attributed to diabetes in 52.7% of elderly patients Vs. 36.3% in others (&lt;0.0001). The median duration of HD before joining Davita-clinics was of 6.5 months in G1 Vs. 11.5 months in G2 (p&lt;0.0001). There is no significant difference between the 2 groups regarding vascular access type, BMI and hemoglobin rate. The proportion of patients who were hospitalized was of 30.8% in G1 Vs. 24.6% in G2 (p&lt;0.0006) corresponding to an annual rate of 37.33% (CI, 95%: [33.93-40.73]) in G1 Vs. 25.64 (CI, 95%: [24.14-27.15]) in G2. The annual rate of hospital stay was of 4.38 days per patient in G1 (CI, 95%: [4.26-4.49]) Vs. 3.11 in G2 (CI, 95%: [3.06-3.16]). The annual mortality rate was 13.36% in G1 (CI, 95%: [11.32-15.38]) Vs. 5.33% in G2 (CI, 95%: [4.64-6.01]). Survival rates in Group 2 were of 98.6, 95.4, 90.5 and 78.6% at 3, 12, 24 and 48 months respectively Vs. 96.1, 89.3, 78.8 and 55.8% in G1 (p&lt;0.0001). Adjusted hospitalization and mortality risks were of 1.271 (CI, 95%: [1.065-1.516]; p&lt;0.008) and 2.257 (CI, 95%: [1.794-2.841]; p&lt;0.0001) in elderly patients compared to other patients. Conclusion Our study demonstrated that Saudi elderly hemodialysis patients remain a group at high risk for hospitalization and mortality.