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Background and Aims Chronic Kidney Disease (CKD) is the 12th leading cause of death worldwide and a high societal burden. Cost-of-illness studies of CKD are scarce in developing countries. Identifying factors associated with the highest cost can help decision makers adapt health policies and sustain kidney health services, especially in limited resources' settings. This study aims to estimate the cost of illness of CKD in Lebanon, from the early stages of CKD until dialysis and kidney transplant and identify cost components related to the highest financial burden. Method This is a cross-sectional study of all CKD patients who presented to two nephrology clinics during the first two weeks of November 2020. The sample size required for the study to be representative was 154 patients. The medical and administrative records were reviewed to collect the demographics and CKD characteristics of patients as well as the direct medical costs (medications, diagnostic tests, hospitalizations, inpatient care, outpatient care), direct non-medical costs (transportation) and indirect costs (productivity losses) for one year between 1st June 2019 and 1st June 2020. Kruskal Wallis test was used to compare the costs between different CKD stages and categories. The study got the approval of the ethics committee of Saint-Joseph University. Results The sample included a total of 160 patients: 102 non-dialysis CKD patients, 40 hemodialysis, 8 peritoneal dialysis and 10 kidney transplant patients. Their mean age was 66.74 ±15.36 years, 57.5% were males and 42.5% diabetics. The mean number of daily medications was 8.75 ±3.38, mean frequency of blood tests per year 6.86 ±6.4 and mean number of hospital admissions per year 0.79 ±1.43. The mean total annual cost of CKD per patient across all categories was assessed at 19,900,164 ±27,893,591 Lebanese Pounds (1 $USD= 1515 LP in 2019). Statistical analysis showed a higher total cost among dialysis patients compared to other categories of CKD (p Conclusion Similar to previous studies from other countries, this cost of illness analysis showed a high burden of dialysis annual costs compared to non-dialysis CKD and transplant patients. It revealed as well a great burden of medications' costs at the level of dialysis and transplantation. It is thus crucial that governments and health policies in low- and middle-income countries target interventions that prevent end-stage kidney disease, reduce medications' costs and most of all create programs that encourage kidney transplantation.

Background and Aims High flux hemodialysis has largely replaced low flux hemodialysis in developed countries. Clinical trials, in particular the Hemo and the MPO studies, conducted many years ago, showed that the survival benefit was mainly for patients on long term hemodialysis for the first one and for high risk patients with low albumin level (less than 40g/dl) for the latter. Moreover, the effect on hematopoiesis or mineral balance is not unequivocally established in the literature. In Lebanon, following the recommendations of the ministry of health, we switched patients undergoing hemodialysis at our center from low to high flux starting April 2019. We aimed in this study to assess the effect of this switch on hemoglobin level, dose of ESA used, mineral metabolism parameters and nutritional parameters. Method This is an observational pre-post study where each patient is his own control. Subjects included are adults on chronic hemodialysis for more than 6 months at Hotel Dieu de France University Hospital. Patients who needed transfusion for bleeding, admission to the hospital or parathyroidectomy during the study period were excluded from the study. Demographic parameters, medical history and laboratory values were extracted from the patients’ files. Paired t- test was used to compare values obtained in the 6 months on low flux compared to the 6 months on high flux hemodialysis. Results Seventy four patients received sequentially both techniques (45 males and 29 females). Mean age was 66 years, mean dialysis vintage 65 months, diabetic and vascular diseases were the most frequent causes of ESRD found in 27 and 15% of the cases. Hemoglobin level significantly increased from 11 +/- 0.82 to 11.26 +/- 0.67 mg/dl (p=0.04) with a non-significant trend towards a lower ESA dose: 11620 UI/week (+/-2275 UI) in the first period versus 10860 UI/week (+/-2609 UI) during the second period (p=0.15). Ferritin levels were higher in the second part of the study (416 v/s 476 ng/ml) which may have contributed to the increase in hemoglobin. Phosphorus level decreased from 1.55 to 1.48 mmol/l (p=0.008) at the same doses of binders and practically stable levels of calcium and PTH. Most interestingly, albumin level increased from 38 to 40.3 g/dl (p Conclusion Assuring quality ultrapure water is still a challenge in many developing countries. Lack of firm evidence on beneficial effect in terms of mortality may delay sanitary authorities from imposing high flux hemodialysis. In our study, switching from low to high flux hemodialysis showed positive impact on phosphorus levels but most interestingly increased albumin levels a major predictor of mortality in hemodialysis patients.

Background and Aims Coffee with its major component caffeine can enhance alertness and decrease tiredness and headache. Headache was reported in 40 to 75 % of hemodialysis patients. Caffeine circulates unbound in the blood and passes the dialysis membrane. Some authors suggested that headache can result from caffeine withdrawal. This study aims to compare the incidence of headache and hypotension between patients taking or not coffee during dialysis. Method This is a randomized double-blind multicenter trial. Patients of three hemodialysis units were included. Patients with atrial fibrillation were excluded. 156 patients were randomized to two groups, group A was given 80 cc of coffee and group B 80 cc of decaffeinated coffee in the middle of the session for 12 consecutive sessions. Ultrafiltration rate was fixed to a maximum of 13 ml/kg/h. The primary outcome was the incidence of headache and the secondary incidence of hypotension. This clinical trial received the approval of the ethics committee of Saint-Joseph University (HDF-1463) and was registered on ClinicalTrials.Gov (NCT04057313). Results A total of 139 patients completed the trial (6.4% vs 15.4 % of withdrawal in groups A and B respectively). Baseline characteristics are summarized in Table 1. The number of sessions with headache was not significantly different between group A and B (34% vs 37% respectively, p=0.522), nor the number of sessions with hypotension (27% vs 26% respectively, p= 0.539). In a subgroup analysis, headache was higher in group B (p=0.06) in two categories of patients: those with the highest potassium dialysate (K=2) and the non-hypertensive patients. Conclusion Headache occurred in 34 to 37% of dialysis sessions. There was no difference in headache or hypotensive episodes between patients in the coffee versus decaffeinated group.