bluuebunny/crossref_metadata_2025 huggingface dataset:
MO678: Telemonitoring in Peritoneal Dialysis. Benefits in Clinical Events and Quality of Life. A Retrospective Multicenter Study
Authors: Javier Centellas Pérez Francisco , Devesa Such Ramon , García Isabel , Vera Manel , Flores Carmen , Muñoz de Bustillo Eduardo , Manzano Diana , Alonso Valente Rafael , Prats Mercedes , Pedro Morais Jose , Díez Ojea Beatriz , Luis Quirós Ganga Pedro , Ortega Cerrato Agustin , Pérez Martínez Juan
Published: May 2022

BACKGROUND AND AIMS

Telemonitoring (RM), applied in automated peritoneal dialysis (APD), has shown both clinical and quality of life (QoL) benefits, although current evidence is limited.

The aim of this study is to analyse the number of significant interventions in a 3-month period (unscheduled consultations and teleconsultations, ) as well as clinical consequences (hospitalizations) and QoL, measured by the EuroQol-5D questionnaire in cohort of RMAPD patients.

METHOD

Retrospective multicenter exploratory cohort study analysed three cohorts of patients in RMAPD: incident (3 months in technique) versus prevalent with 6 months to 1 year in technique versus prevalent with more than 1 year in technique.

Both the baseline characteristics of the patients and the number of significant interventions in a 3-month period were analysed: (unscheduled consultations and teleconsultations,) as well as clinical consequences (hospitalizations) and QoL, measured by the EuroQol-5D questionnaire. The variables have been expressed as mean and standard deviation, as well as an ANOVA test to make comparisons between variables, as well as non-parametric for non-normal variables.

RESULTS

Analysis of 100 patients in RMAPD from 10 different Spanish centers, classified as: incident (group 0), prevalent 6 months to 1 year (group 1), prevalent >1 year (group 2), the variables analysed are presented in the form of table (Fig. 1):

From the results analysed, no significant differences were found between the variables analysed, except in the number of unscheduled teleconsultations, significantly higher in group 0 compared to group 2 (P < 0.05).

Interestingly, the patients manifested a good perceived QoL in all groups (M: 0.88, EUROQol-5D).

CONCLUSION

Despite the limitations of this study, the results allow us to consider telemonitoring as a useful technique in patients in APD since:
MO706: The Peritoneal Equilibration Test at the Start of Peritoneal Dialysis and Patient Outcome. Analysis in the Presence of Competing Events
Authors: Calatayud Emma , Beltrán Sandra , Vizcaíno Belén , Molina Pablo , González Moya Mercedes , Asuncion Sancho Calabuig Maria , Valero Alejandro , Montesa Marín María , Gonzalez-Rico Miguel
Published: May 2022

BACKGROUND AND AIMS

The success of peritoneal dialysis (PD) depends on the integrity of the peritoneal membrane. The most common peritoneal functional alteration is an impaired ultrafiltration caused by fast peritoneal solute transfer rate. This situation can be present at start of PD and compromise the durability of the membrane through the stay on PD. If the patient leaves PD for another reason, as in the case of a kidney transplant, it affects the probability of a membrane dysfunction appearance. It is known as a competitive event. The aim of this study was to determine whether baseline peritoneal transport status was a risk factor of mortality and technique failure in a cohort of Spanish PD patients using a statistical competing risk model.

METHOD

The multicenter retrospective cohort study included adult patients of the Levante Registry PD Work Group in Spain who started PD between February 1993 and June 2020. All patients needed to have a peritoneal equilibration test (PET) performed within the first 6 months after PD start. Patients were followed until technique failure, transplantation, renal function recovery, death, or until September 2020. Peritoneal transport status was considered both as a continuous (D/PCr4h) and as a categorical variable, according to the four groupings of D/PCr values defined by Twardoski. We analysed the effect of peritoneal transport over mortality, peritonitis and technique failure by a competing risk model. Kidney transplantation and renal function recovery were considered competing events.

RESULTS

A total of 4848 patients were enrolled. Baseline PET measurements were available in 2.307 (47.6%). The median follow-up time was 22.2 months (IQR 11.5–40.5). The main characteristics according to the peritoneal transport status are summarized in Table 1. When peritoneal membrane transport was analysed as a continuous variable, D/PCr was an independent risk factor of technique failure. The hazard ratio subdistribution for technique failure was 1.08 [(1.01; 1.16), P-value = 0.018] for every 0.1 increase in D/P Cr ratio. This effect disappeared when the use of icodextrin was included in the model. Baseline peritoneal transport was not associated with a higher mortality or peritonitis risk.

CONCLUSION

Basal peritoneal transport rate is an independent risk factor for death-censored technique failure in the Levante DP incident population. The use of icodextrin in these patients seems to mitigate this negative effect and may improve the outcomes in PD in patients with initial fast transport. Conventional methods for survival analysis ignoring the competing events may be inappropriate this cohort of patients.
MO708: Association of Atherogenic Index of Plasma (AIP) with Mortality in Chinese and Swedish End-Stage Kidney Disease Patients: Results from Two Cohorts
Authors: Ryu Kakei , Chen Zhimin , Rashid Tony Qureshi Abdul , Suliman Mohamed , Peter Barany Franz , Heimbürger Olof , Chen Jianghua , Stenvinkel Peter , Lindholm Bengt
Published: May 2022

BACKGROUND AND AIMS

Atherogenic index of plasma (AIP), a logarithmically transformed ratio of triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C), is a biomarker of dyslipidemia and cardiovascular disease (CVD) risk. However, its applicability in end-stage kidney disease (ESKD) is not clear. We examined the association of AIP with all-cause and CVD mortality in two cohorts of ESKD patients, one from China and one from Sweden.

METHOD

In 1276 Chinese incident peritoneal dialysis (PD) patients (median age 50 years, 56% males) and 559 Swedish ESKD patients starting on dialysis (n = 392) or undergoing hemodialysis (n = 109) or PD 58 (median age 58 years, 62% males), baseline AIP and other biochemical and metabolic biomarkers were analysed in relation to mortality during follow-up period of up to 5 years. All-cause and CVD mortality risk were analysed with competing-risk regression models with transplantation as competing risk adjusting for age, sex, smoking, diabetes, serum albumin, hemoglobulin and calendar year.

RESULTS

Chinese patients [median (IQR) BMI 21 (19–23) kg/m2 TG 1.4 (1.0–1.8) and HDL-C 1.0 (0.9–1.3) mmol/L] compared with Swedish patients [median (IQR) BMI 24 (22–28)] kg/m2 TG 1.6 (1.2–2.2) and HDL-C 1.2 (1.0–1.6) mmol/L] were significantly younger (P < 0.01) and had lower BMI (P < 0.01), TG (P < 0.001), HDL-C (P < 0.001), and Framingham risk score (P < 0.01) while sex distribution was similar. ‘Chinese patients’: After median 3.6 years of follow-up, all-cause mortality rate was 16%, and 91 (46%) of the 199 deaths were caused by CVD. The highest tertile of AIP was associated with higher all-cause [sub-hazard ratio sHR (95% CI) 1.52 (1.05); Fig. 1A] and CVD mortality [sHR 1.82 (1.02–3.27); Fig. 1B] risk, after adjusting for confounders. ‘Swedish patients’: After median 2.1 years of follow-up, all-cause mortality rate was 36%, and 89 (44%) of the 204 deaths were caused by CVD. The highest tertile of AIP was associated with lower all-cause [sHR 0.66 (0.47–0.94); Fig. 2A] and CVD mortality [sHR 0.59 (0.35–0.97); Fig. 2B] risk after adjusting for confounders.

CONCLUSION

The highest tertile of AIP was independently associated with higher mortality risk in Chinese ESKD patients while it was associated with lower mortality risk in Swedish ESKD patients suggesting that AIP is context dependent, which limits is usefulness as a risk-assessment tool for predicting clinical outcomes in ESKD patients.
MO717: Prevalence and Management of Non-Valvular Atrial Fibrillation in Peritoneal Dialysis. Results of a Multicentric Survey
Authors: Perez-Bernat Elisa , Cases Aleix , Gonzalez-Rico Miguel , Montomoli Marco , Moncho Francesc , Fernanda Alvarado Maria , Solano Rivera Camila , Emilio Sanchez-Alvarez J. , Ortega Cerrato Agustin , Luis Gorriz Teruel Jose
Published: May 2022

BACKGROUND AND AIMS

Among patients with chronic kidney disease, the incidence and prevalence of nonvalvular atrial fibrillation (NVAF) increases as renal function decreases, detecting a prevalence of up to 27% in hemodialysis patients. However, its prevalence among patients on peritoneal dialysis (PD) has been less studied.

The aim of the study is to analyse the prevalence of NVAF and characteristics related to its management in PD patients older than 18 years.

METHOD

An observational, cross-sectional, multicenter and retrospective study was carried out through a survey and request for variables sent through a Google questionnaire to PD units in our country. A total of 1403 patients from 30 PD units were included.

RESULTS

The mean prevalence of NVAF in the study was 13.2%, median 11.7% (interquartile range: 6.1–19.4). A total of 60% of the centers had a prevalence >10%.

A total of 57.6% (n = 17) used the CHADS2 or CHAS2-VASC score to calculate the risk of stroke/thromboembolism in their patients with NVAF. A total of 43.3% (n  = 13) do not use it. In these cases, 15.3% (n = 2) do not calculate it because they treat all patients with NVAF and the remaining 84.6% (n = 11) do not use it because the cardiologist uses it and delegates it to them.

Regarding the decision to start anticoagulant treatment in NVAF: in 60% of the centers (n = 18) the cardiologist indicates anticoagulation, in 36.7% (n = 11) the indication is made jointly (cardiologist and nephrologist) and only in 3.3% (n = 1) the indication is made by the nephrologist.

A total of 72.5% of the patients with NVAF (135/186) received anticoagulant treatment. Of these, 28 (20.7%) received direct-acting anticoagulants and 107 (79.3%) received acenocoumarol. Among direct-acting anticoagulants, the most frequent regimens were: apixaban 2.5 mg/12 h (86%), and edoxaban 30 mg/24 h (7%). A total of 5.9% (11/186) of patients with NVAF did not receive anticoagulant or antiplatelet treatment.

A total of 90% of the centers (n = 27) are familiar with the technique of percutaneous appendage closure for the treatment of NVAF, but it is not available in five of them. This technique has been performed in 17 of the patients with NVAF.

CONCLUSION

The prevalence of NVAF in PD patients is high. The management of these patients is carried out mainly by cardiologists with little participation of nephrologists. Most patients receive anticoagulant treatment with coumarin drugs. The data from this analysis, as well as the limited data from the literature, indicate that an adequate format, a consensus document, as well as more data from observational studies (and especially from randomized controlled trials) are needed to adequately address this common complication in patients with DP.
MO725: The Risk of Hypertension and Atrial Fibrillation in Hemodialysis Patients
Authors: Al-Sayyari Abdulla
Published: May 2022

BACKGROUND AND AIMS

This study aims to evaluate the prevalence of and the association between hypertension (HTN) in and AF in hemodialysis patients.

METHOD

All patients receiving hemodialysis for at least 6 months were included in the study. Demographic, hemodynamic and laboratory data were retrieved from the BestCare system, and the main outcomes were the pre/post-dialysis blood pressure measurements and the presence of AF. The data were analyzed using the SPSS program. For determination of independent effect of laboratory variables, multiple logistic regression was used to evaluate the independent effect of the laboratory.

RESULTS

Our sample consisted of 304 HD patients; 162 (53%) were male and the mean age was 63 ± 18 years. One-fifth, 68 (20%) had AF of whom, 44 (64.7%) were male with mean age of 73 ± 12 years.

The mean age in the AF group was significantly higher in males 73(12) versus 61 (18) years (p = 0.001) The risk of AF increased by 0.4 [odd ratio 1.04, 95% confidence interval (95% CI) 1.02–1.06; P < 0.001] for every year of age and there were more males than fem ales (64.7% versus 35.3%; P = 0.032).

Almost two-thirds the entire sample (66.45%, n = 202) were hypertensive, with mean age of 64 ± 17 years and almost a third had a BMI in the obese category (28.7%, n = 58).

Male patients were 33% less likely to develop hypertension (odd ratio 0.77, 95% CI 0.47–1.24; P = 0.289).

Based on logistic regression analysis, the patients who had both HTN and diabetes were more likely to develop AF (odd ratio 7.12, 95% CI 0.91–55.1; P = 0.060), compared with patients who did not.

According to the logistic regression analysis, male patients were 33% less likely to develop hypertension (odd ratio 0.77, 95% CI 0.47–1.24; P = 0.289), and age had no effect OR = 1. In addition, with every increase of the Carlson comorbidity index score by two points, there was a 40% increased risk of developing HTN (odd ratio 2.47, 95% CI 1.17–5.18; P = 0.017).

According to the univariate analysis, having HTN before dialysis increased the risk of continuing anti-hypertensive therapy by 23% (odd ratio 1.37, 95% CI 0.81–2.36; P = 0.756). However, after adjusting the analysis for other cofactors, the odd ratio became less significant, suggesting that the risk increased only by 0.9% (odd ratio 1.09, 95% CI 0.60–1.99; P = 0.756).

Being a male was associated with a 54% (odd ratio 0.54, 95% CI 0.31–0.95; P = 0.019) decrease in the risk of developing HTN on hemodialysis.

Almost two-thirds (66.1%, n = 197) were hospitalized during the previous 12 months, the majority were due to dialysis-related infections. The mortality rate was 5.9% (Table 1).

CONCLUSION

The risk factors for the development of HTN and AF in HD patients were found to be increasing age for AF and female gender for hypertension. The presence of HT and DM increases the risk of developing AF 7-fold after hemodialysis.
MO735: Increased Serum Adipocyte Fatty Acid Binding Protein Level Associated with Endothelial Dysfunction in Patients Undergoing Hemodialysis
Authors: Tang Chi-Chong , Wang Chih-Hsien , Hsu Bang-Gee
Published: May 2022

BACKGROUND AND AIMS

Adipocyte fatty acid binding protein (A-FABP) is independently associated with atherosclerosis. Endothelial dysfunction is one of the causes of cardiovascular morbidity and mortality in patients with hemodialysis (HD). This study evaluated the correlation between serum A-FABP level and endothelial function measured by vascular reactivity index (VRI) in patients with HD.

METHOD

Fasting blood samples were obtained from 90 HD patients. A commercial enzyme immunoassay kit was used to measure A-FABP levels. The endothelial function and VRI were measured using a digital thermal monitoring (DTM) test (VENDYS). In this study, VRI < 1.0 was used as the poor vascular reactivity, 1.0 ≤ VRI < 2.0 was used as the intermediate vascular reactivity, and VRI ≥ 2.0 was used as the good vascular reactivity.

RESULTS

A total of 14 HD patients (15.6%) were categorized as poor vascular reactivity (VRI < 1.0), 38 HD patients (42.2%) were categorized as intermediate vascular reactivity (1.0 ≤ VRI < 2.0) and 38 HD patients had good vascular reactivity. Decreased pre-HD body weight (P = 0.016), post-HD body weight (P = 0.013), body mass index (P = 0.034), serum creatinine level (P = 0.010) and higher serum A-FABP level (P = 0.001) were associated with poor vascular reactivity. After multivariable forward stepwise linear regression analysis noted that serum creatinine level (β = 0.234, adjusted R2 change = 0.043; P = 0.019) was positively associated with, and serum A-FABP level (β = −0.347, adjusted R2 change = 0.152; P = 0.001) was negatively associated with VRI values in patients undergoing HD.

CONCLUSION

After adjusting for significant confounders, the serum A-FABP level was negatively correlated, and the serum creatinine level was positively correlated with VRI values in patients undergoing HD.
MO741: Poor Agreement between Physical Examination and Bioimpedance Spectroscopy in the Detection of Hypervolemia in Haemodialysis Patients
Authors: Tsikliras Nikolaos , Georgianos Panagiotis , Vaios Vasilios , Minasidis Elias , Karpetas Antonios , Chatzidimitriou Christos , Mavromatidis Konstantinos , Liakopoulos Vassilios , Zebekakis Pantelis , Balaskas Elias
Published: May 2022

BACKGROUND AND AIMS

Assessment of dry-weight among patients on haemodialysis is challenging in the absence of reliable markers to define overhydration (OH) [1, 2]. This study aimed to explore the value of two simple clinical signs, the presence of pedal oedema and crackles at pulmonary auscultation, in diagnosing hypervolemia, using the bioimpendence spectroscopy as a more objective method.

METHOD

In a cohort of 107 asymptomatic dialysis patients, the volume status was assessed with physical examination and bioimpedance spectroscopy shortly before the mid-week dialysis session [3]. Patients were also asked to perform home blood pressure (BP) monitoring with a validated, automatic device (HEM-705, Omron, Healthcare) [4] for 1 week in order to determine their BP control status.

RESULTS

Patients within the high tertile of pre-dialysis OH had longer dialysis vintage, lower serum albumin and higher home systolic BP, despite the more aggressive treatment with a higher average number of antihypertensives daily. In receiver-operating-characteristic (ROC) curve analysis, pedal oedema [area under curve (AUC): 0.534, 95% confidence interval (95% CI) 0.416–0.651] and pulmonary crackles (AUC: 0.551; 95% CI 0.432–0.671) had limited accuracy in the diagnosis of pre-dialysis OH > 2.2 L. The agreement of pedal oedema (Cohen's k-coefficient: 0.065) and pulmonary crackles (Cohen's k-coefficient: 0.122) with bioimpedance spectroscopy in the detection of hypervolemia was poor. In multivariate linear regression analysis, longer dialysis vintage (β: 0.306; P<0.001) and higher home systolic BP (β: 0.287; P<0.01) were the two factors that were independently associated with pre-dialysis OH.

CONCLUSION

This diagnostic-test study showed that among asymptomatic hemodialysis patients, pedal oedema and pulmonary crackles in physical examination had limited discriminatory power in the detection of hypevolemia, as assessed more objectively with the method of bioimpedance spectroscopy.
MO743: The Influence of Ambulatory Blood Pressure on the Associations of Intradialytic Hypertension with Future Cardiovascular Events and Mortality in Haemodialysis Patients
Authors: Theodorakopoulou Marieta , Iatridi Foteini , Eleni Alexandrou Maria , Karpetas Antonios , Bikos Athanasios , Raptis Vasileios , Tsouchnikas Ioannis , Giamalis Panagiotis , Papagianni Aikaterini , Sarafidis Pantelis
Published: May 2022

BACKGROUND AND AIMS

Patients with intradialytic hypertension (IDH) have higher mean 44-h ambulatory blood pressure (BP) levels than patients without the phenomenon. IDH is associated with an increased risk of cardiovascular and all-cause mortality. Whether the excess risk for mortality in patients with IDH depends on the BP rise during dialysis per se or on elevated 44-h ambulatory BP is not known. This is the first study evaluating the association of IDH with cardiovascular events and all-cause mortality before and after adjustment for ambulatory BP and other cardiovascular risk factors.

METHOD

A total of 242 haemodialysis patients underwent 48-h ABPM with Mobil-O-Graph-NG and were followed for a median of 45.7 months. IDH was defined as: SBP rise ≥ 10 mmHg from pre- to post-dialysis and post-dialysis SBP ≥ 150 mmHg. The primary end-point was all-cause mortality; the secondary endpoint was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, resuscitation after cardiac arrest, hospitalization for heart failure, coronary or peripheral revascularization procedures.

RESULTS

During follow-up, a total of 122 patients died; 69 due to cardiovascular causes. Cumulative freedom from both the primary and secondary endpoints was significantly lower for patients with IDH (log rank-P = 0.048/0.022, respectively). The risk for all-cause mortality was significantly higher for patients with IDH [HR = 1.566, 95% confidence interval (95% CI) (1.001, 2.450)]; similarly, the risk for the combined cardiovascular endpoint was higher for these individuals [HR = 1.675, 95% CI (1.071, 2.620)]. The observed associations attenuated after adjustment for 44-h SBP [all-cause mortality: HR = 1.529, 95% CI (0.952, 2.457)] and combined cardiovascular endpoint: HR = 1.388 95% CI (0.866, 2.225). After additional adjustment for age, interdialytic weight gain, dialysis vintage, 44-h pulse wave velocity, history of coronary artery disease, diabetes mellitus and heart failure the respective HRs were 1.409 [95% CI (0.851, 2.332)] and 1.435 [95% CI (0.879, 2.343)].

CONCLUSION

Patients with IDH presented higher risk for death and cardiovascular outcomes. Sustained high BP levels during the 44-h interdialytic period and not only intradialytic BP rise per se may be participating in the excess risk of this condition.
MO753: Marinobufagenin Predicts Intradialytic Hypotension Episodes in Prevalent Haemodialysis Patients
Authors: Carullo Nazareno , Greco Marta , Presta Pierangela , De Rosa Salvatore , Crugliano Giuseppina , Sabatino Jolanda , Arena Roberta , Andreucci Michele , Indolfi Ciro , Foti Daniela , Coppolino Giuseppe , Bolignano Davide
Published: May 2022

BACKGROUND AND AIMS

Intradialytic hypotension (IDH) is a sudden and often dangerous complication of chronic haemodialysis (HD) treatment that may occur in ∼20%–30% of HD sessions. The pathogenesis of IDH is acknowledged to be multifactorial, as it might depend from an impaired vascular refilling capacity, excessive absolute fluid removal, an impaired sympathetic nerve response to volume loss or inadequate peripheral arterial vasoconstriction. This makes the prediction of IDH extremely challenging in the majority of cases.

METHOD

In this pilot, prospective study, we aimed at evaluating the clinical predictors of IDH in a small cohort of prevalent HD patients, with a particular focus on marinobufagenin (MBG), an endogenous cardiotonic steroid whose blood levels have previously been found notably altered in various cardiovascular disorders and body fluid status alterations.

RESULTS

MBG levels in HD patients were significantly higher than in controls (0.75 ± 0.29 versus 0.59 ± 0.19 nnmol/L; P = 0.03), remained unchanged throughout a single HD session and were not correlated with the absolute or partial fluid loss achieved. During a 30-day follow-up, 19 patients (65.5%) experienced at least one IDH (73 total episodes). An inverse correlation was found between baseline MBG and the number of IDH (R = –0.55; P = 0.001). HD patients experiencing IDH presented remarkably lower baseline MBG as compared with others (0.65 ± 0.28 versus 0.94 ± 0.21 nmol/L;  P = 0.008) In these individuals, there was an apparent increase in MBG levels after the first hour of dialysis [0.72 (0.56–1.00) versus 0.65 ± 0.28 nmol/L;  P = 0.04], while such levels progressively decreased throughout the rest of the session, being even more reduced at HD end as compared with baseline [0.45 (0.24–0.95) versus 0.65 ± 0.28 nmol/L;  P = 0.04]. At Kaplan–Meier analyses, HD patients with lower MBG manifested a 4-fold to6-fold increased risk of IDH during follow-up (crude HR ranging from 4.37 to 6.68), depending on the time-point measurement of MBG. At Cox regression analyses, MBG measured at different time points resulted the strongest time-dependent predictor of IDH among all the variables considered (HR ranging from 0.068 to 0.155; P=0.002 to <0.0001).

CONCLUSION

Findings obtained suggest that altered MBG in prevalent HD patients may reflect a diverse vascular and haemodynamic tolerance to HD stress, eventually leading to recurrent IDH episodes. Further studies are needed to confirm the prognostic capacity of MBG for identifying HD patients at high risk of IDH, particularly those with apparently optimal fluid status.
MO756: Roxadustat Versus Erythropoietin: Comparison of Efficacy in Reversing Ventricular Remodeling in Dialysis Patients with Anemia
Authors: Wang Mengying , MA Kunling
Published: May 2022

BACKGROUND AND AIMS

Renal anemia is one of the main complications of dialysis patients, which has been identified as an important independent risk factor for left ventricular hypertrophy and progression of heart failure, as well as adverse cardiovascular outcomes. Recent studies suggest that hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) Roxadustat represents a novel pharmacological treatment for renal anemia. This study aimed to compare the role of the Roxadustat and erythropoietin in reversing ventricular remodeling in dialysis patients with anemia.

METHOD

This was a retrospective cohort study that compared the treatment of Roxadustat and recombinant human erythropoietin (rhEPO) in dialysis patients for at least 24 weeks from January 2016 to October 2021. A total of 182 participants underwent echocardiography at least twice every 6 months. Baseline and follow-up examinations focused on the change of cardiac structure and function (doppler echocardiography), clinical and biochemical parameters and blood pressure. Participants were treated with oral iron supplements and controlled blood pressure (target value ≤ 130/80 mmHg).

RESULTS

Compared with baseline, left ventricular mass index (LVMI) decreased from 139.8 ± 36.0 to 126.5 ± 35.0 g/m2 (P<0.001) in the Roxadustat hemodialysis subgroup after 6-month treatment. Left ventricular end-diastolic diameters (LVEDd) and left ventricular wall thickness (LVPWT) were both significantly improved (from 5.13 ± 0.66 to 4.92 ± 0.65 cm; P= 0.002, and from 1.12 ± 0.17 to 1.07 ± 0.13 cm; P = 0.033, respectively). There was significant difference in LVMI before and after treatment in rhEPO group (from baseline 134.3 ± 36.8 to 131.8 ± 37.5 g/m2). There was greater reduction in LVMI from baseline to 6 months in Roxadustat group (–13.3 ± 22.4 g/m2 versus –5.02 ± 21.3 g/m2 for Roxadustat versus rhEPO; P= 0.028). In the peritoneal dialysis subgroups, Roxadustat also caused a significant improvement in LVMI and LVEDd (from baseline 133.9 ± 28.0 to 118.5 ± 28.2 g/m2; P= 0.001; from baseline 5.12 ± 0.55 to 4.86 ± 0.58 cm; P = 0.002). In addition, Roxadustat increased hemoglobin, serum albumin level and TIBC, and reduced the level of blood pressure, low density lipoprotein, TC and SF in Roxadustat hemodialysis subgroup. However, there were significant differences in the changes of systolic blood pressure, diastolic blood pressure and TIBC between the two hemodialysis groups.

CONCLUSION

In addition to the efficacy in the treatment of renal anemia, Roxadustat was found to be closely associated with improvement of LV diastolic function in dialysis patients. Our findings may provide new insights into anemia management in dialysis patients. Prospective clinical trials are necessary to further evaluate the role of Roxadustat or other HIF-PHIs in reversing ventricular remodeling.
MO761: Real-Time Prediction of Intradialytic Hypotension using Machine Learning and Cloud Computing Infrastructure
Authors: Zhang Hanjie , Chaudhuri Sheetal , Pickering Aaron , Usvyat Len A , Larkin John , Waguespack Peter , Kuang Zuwen , Kooman Jeroen , Maddux Frank , Kotanko Peter
Published: May 2022

BACKGROUND AND AIMS

Intradialytic hypotension (IDH) is a frequent complication of chronic hemodialysis that could lead to serious clinical outcomes and can be difficult to predict. We used machine learning (ML) and cloud computing infrastructure to develop and evaluate a model that enables real-time IDH prediction.

METHOD

Data were analyzed from six dialysis clinics (Fresenius Kidney Care, Waltham, MA, United States) between January 2020 and November 2020. Data included demographic, clinical, treatment and laboratory were obtained from the electronic health record. The intradialytic data such as systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate and blood flow rate were transferred in real time to Amazon Web Services (AWS, Amazon Web Services, Inc., Seattle, WA, United States) using secure Internet of Things software. Data were randomly divided into model training (80%) and testing (20%) sets. IDH was defined as SBP less than 90 mmHg. A ML tool known as an extreme gradient boosting algorithm (XGBoost) was used. Each time when an intradialytic SBP was measured, the model, which was hosted in AWS, would enable real-time prediction (in less than a minute) of patients who were at risk of IDH within the next 15–75 min. Area under the receiver operating characteristic curve (AUROC) was used to measure the model's performance. Shapley values were calculated to derive variables that were considered highly predictive of IDH.

RESULTS

We obtained data from 42 546 hemodialysis sessions involving 693 patients and 355 693 intradialytic observations. IDH occurred in 17% of the treatments. Our model reasonably predicted IDH, achieving an AUROC of 0.89. Top three predictors of IDH within the next 15–75 min were last intradialytic SBP, IDH rate of the last 10 treatments and mean nadir SBP of the last 10 treatments (Fig. 1).

CONCLUSION

Our study clearly shows the possibility of predicting IDH within the next 15–75 min using ML and cloud computing infrastructure, it suggests that the tool has the potential to assist clinicians to intervene proactively in patients at risk for IDH in real time.
MO776: Central Tunnelled Catheter Implantation by a Multidisciplinary Nephrology and Radiology Team: 10-Year Experience
Authors: Rodríguez Farré Neus , Núñez Delgado Sara , Calaf Forn Francesc , Pelegrí Martínez Laura , Rap Copindean Oana , Sánchez Escuredo Anna , Cabrera López Cristina , Giménez Torrecilla Isabel , Ibernon Vilaro Meritxell , Pilar Ruiz Valverde Maria
Published: May 2022

BACKGROUND AND AIMS

Insertion of tunnelled central venous catheters (TCVC) in patients with chronic kidney disease requiring haemodialysis is a technique of increasing interest in interventional nephrology. Ambulatory placement by a multidisciplinary team of nephrologists and radiologists reduces immediate complications among these patients.

METHOD

Retrospective study of TCVC implantation from 2011 to 2021. The ultrasound-guided technique was used for localization and venipuncture. Correct catheter location and venous anatomy were subsequently checked by fluoroscopy. Early adverse events (30 days post-placement) were recorded.

RESULTS

A total of 427 TCVC were placed in 344 patients during this period. Out of these 248 (58.07%) were primary placements (PP) and 179 (41.92%) guidewire exchanges over previous catheter (GE). A total of 406 (95.08%) TCVC were placed in the internal jugular and 374 (87.59%) TCVC with right laterality. During the follow-up period, early minor complications were recorded in 23 procedures (5.39%), 15 of which (3.51%) required catheter replacement. Patients with GE developed more complications (P 0.039), being venous stenosis, the main complication described (Figure).

A total of 61 patients required successive catheter placements: 48 (78.69%) underwent two procedures and 13 (21.31%) more than three procedures, for a total of 83 TCVC. There were no differences in the number of early complications between the first (10) and successive (14) placements (P 0.94). Catheter durability was similar in subsequent procedures (355 ± 62.3 days at first placement versus 459 ± 60.3 days in successive placements, P 0.24).

CONCLUSION

Multidisciplinary TCVC implantation guarantees good effectiveness of the technique. The performance of subsequent procedures is safe and durable in patients with CKD.
MO782: Evaluation of Acceleromet Reuse for Method of Measurement for Turbulent Blood Flow in Arteriovenous Fistulas in Haemodialysis Patients
Authors: Damsgaard Oliver , Hagstrup Christensen Jeppe , Schmidt Samuel
Published: May 2022

BACKGROUND AND AIMS

Haemodialysis (HD) is the primary treatment for end-stage renal disease. HD therapy requires access to the vascular system. This can be achieved through surgically constructing an arteriovenous fistula (AVF). Post-surgery up to 30% of patients experience dysfunction of the AVF, which may lead to a chronically damaged AVF and render the patient without HD treatment [1]. At present no satisfactory post-surgery monitoring of the AVF exist and, therefore, malfunction of the AVF is recognized too late at a time where no rescue is possible. The functionality of the AVF is normally assessed by auscultation of the murmurs produced by the blood flow. Narrowing of the AVF caused by thrombosis or stenosis causes changes in the blood flow, thus causing changes in the murmurs [2]. The changes in murmurs have not been widely studied but may be of importance to gain knowledge on AVF malfunction. This could be used in developing a method for monitoring the AVF post-surgery.

METHOD

Acoustic recordings was obtained from 21 patient post AVF-surgery at Aalborg University Hospital. Recordings were made with a Silicon Designs 1521 accelerometer encapsulated in a 3D printed box, attached to the skin using double adhesive tape 2–5 cm proximal to the AVF. A total of 11 patients were recorded twice resulting in a total of 32 recordings. Data were sampled at 5000Hz. All data processing and analysis were performed using MATLAB 2021b (MathWorks Inc.). Every recording was manually analysed and labelled with or without audible murmurs. Before processing every recording was split into segments of 3 sec length resulting in a total of 697 segments. Data was processed with a signal processing method [wavelet packet decomposition (Daubechies 4)] to analyse if the frequencies of the sounds differed between recordings with and without murmurs. Energy of the wavelet scales (Scale Energy) was calculated for each frequency band. The scale energy was then log-transformed using natural logarithm to make data normally distributed, and converted to decibel (dB).

RESULTS

A total of 654 segments contained murmurs and 43 segments did not contain murmurs. In all frequency bands, murmurs resulted in a significant change in energy level (P < 0.05).

CONCLUSION

This study shows AVF murmurs results in a significant change in acoustic energy across all frequency bands. This demonstrates that accelerometers can be used to quantify murmurs from AVFs post-surgery.
MO783: Reduction of the Incidence of Dialysis Catheter-Associated Bacteraemia in Intensive Care Units after Systematic Application of Taurolock in the Sealing of the Catheter
Authors: Del Risco Zevallos Jimena , Molina-Andujar Alicia , Piñeiro Gaston , Fernando Quintana Porras Luis , Blasco Miquel , Morata Laura , Soriano Alex , Poch Esteban
Published: May 2022

BACKGROUND AND AIMS

Dialysis catheter-associated bacteraemia in Intensive Care Units (ICUs) increases morbidity and mortality, prolongs hospital admission and increases admission costs. TauroLock™ is a lock solution containing (cyclo)-taurolidine (1.35%) and citrate (4%). (Cyclo)-taurolidine has broad antimicrobial activity against gram-positive and gram-negative bacteria and fungi. The objective of this study was to analyse the effect of systematic sealing of haemodialysis catheters in the ICUs of the Hospital Clínic de Barcelona on the incidence of bacteraemia associated with haemodialysis catheters (BACH).

METHOD

BACH episodes of patients who underwent intermittent haemodialysis (IHD) during ICU admission were reviewed. The period analysed as pre-Taurolock™ was from 2010 to 2014 and post-TauroLock™ from 2015 to 2018. Patients who only received renal replacement therapy with continuous techniques were excluded.

RESULTS

A total of 279 patients received IHD in the pre-TauroLock™ period and 331 in the post-TauroLock™ period. The number of BACH in the pre-TauroLock™ period was 18 (6.45%) and 9 (2.72%) in the post-TauroLock™ period. All infections were from percutaneous catheters (acute patients) except three catheters that were tunnelled. In the pre-TauroLock™ period, femoral catheters predominated (61.1%) while in the post-TauroLock they were jugular (66.7%). There was no association between the location of the catheter and the incidence of BACH. Of the 27 patients with BACH, 14 (51.8%) were men with a mean age of 63 years, with no significant differences between the two groups. The most frequent reasons for admission to the ICU in the pre-TauroLock™ period were post-cardiac surgery, cardiogenic, septic or hypovolemic shock and acute myocardial infarction (3 patients per group) and in the post-TauroLock™ period, septic shock and pancreatitis (3 and 2 patients respectively). The most frequent isolated bacteria were Gram-positive (in total 48.38%: pre-TauroLock™ 47.61% and post-TauroLock™ 50%), with a global predominance of staphylococcus epidermidis (32.25%) (Table). There were no significant differences in the median days from the start of haemodialysis to bacteraemia (23.5 pre-TauroLock™ versus 21 post-TauroLock™). There were also no significant differences between the days of ICU stay in the BACH in both groups or in mortality, being the overall mortality of 70.4%.

CONCLUSION

In our cohort, the systematic application of TauroLock™ in the sealing of dialysis catheters in critically ill patients reduces the incidence of BACH in ICUs.
MO786: Monitoring of Arterio-Venous Fistula Maturation using Central-Venous Oxygen Saturation and Estimated Upper-Body Blood Flow: Impact on Catheter Residence Time
Authors: Rosales Merlo Laura , Zhang Hanjie , (Janice) Ye Xiaoling , Chan Brenda , Mateo Marilou , Jhonson Seth , Kotanko Peter
Published: May 2022

BACKGROUND AND AIMS

In hemodialysis patients, assessment of arterio-venous fistula (AVF) maturation is key to reduce the residence time of central venous catheters (CVC). We have introduced the use of central-venous oxygen saturation (ScvO2) and estimated upper-body blood flow (eUBBF) as means to monitor AVF maturation [1]. We now report CVC residence time in patients with and without ScvO2-based AVF maturation monitoring.

METHOD

We studied hemodialysis patients in who ScvO2-based AVF maturation monitoring was implemented within the framework of a clinical quality improvement project (QIP). ScvO2 and hematocrit were measured with Crit-Line (Fresenius Medical Care, Waltham, MA). eUBBF was computed as described previously [1]. We used time-to-event analysis to compare the CVC residence time post-AVF creation between patients who participated in the QIP (intervention group) and non-QIP patients (control group). Both groups were dialyzed in the same geography. Patients were censored at the time of death, change of dialytic modality, transplantation, lost to follow up, recovery of kidney function and end of the observation period (15 November 2021).

RESULTS

The intervention group comprised 44 patients [age 57 ± 17 years; 27 (61%) males]. In five patients, two AVF were created; in 34 (69%) CVC were removed. The control group comprised of 378 patients (age 59 ± 15 years, 61% males). CVC was removed in 199 (53%) control patients. In the intervention group, CVC were removed 125 days [95% confidence interval (95% CI): 102–171] after AVF creation. In the control group, this time was 236 days (95% CI: 173–404) (P < 0.0003; log rank test; Figure).

CONCLUSION

Compared to controls, the CVC residence time post AVF-creation was shortened significantly— by about 3.6 months—in patients who participated in a QIP that used ScvO2-baseed assessment of AVF maturation. Measurement of ScvO2 and computation of eUBBF are simple, non-invasive means to track AVF maturation, trigger timely interventions and AVF cannulation and shorten CVC residence time.
MO788: Ethanol Lock Solution for Prophylaxis of CRBSI of Non-Tunnelled Catheters in Haemodialysis Patients
Authors: Sharma Manjuri , Dange Shruti , Pegu Gayatri , Kharbuli Indakiewlin , Kumar Doley Prodip , Gope Manas , Brijesh Singh K
Published: May 2022

BACKGROUND AND AIMS

Prevention of catheter related blood stream infection (CRBSI) is a major challenge in hemodialysis (HD) patients. Efficacy of 70% ethanol as a catheter lock solution for the treatment of tunnelled cuff catheter's (TCC's) CRBSI is widely studied [1, 2]. Prophylactic use of ethanol lock was limited to small number of studies especially involving paediatric and home parenteral nutrition (HPN) patients [3] and studies in chronic HD patients with TCCs [4, 5]. But its role in prophylaxis of CRBSI for non-tunnelled catheter (NTC's) is less explored.

METHOD

We conducted a single centre prospective study from May 2019 to May 2020. A total of 62 patients of end-stage renal disease (ESRD) requiring NTC's for the initiation of HD in emergency or maintenance of HD while waiting for the creation or maturation of an already created arteriovenous fistula (AVF) or for TCC insertion were included. The study population was divided into two groups, Group A (n = 31) received 70% ethanol with heparin 2000 IU as a catheter lock solution. Group B (n = 31) received standard heparin 2000 IU as a catheter lock.

RESULTS

The primary endpoint of the study was the rate of CRBSI, in group A 6.5% (n = 2) it was significantly lower compared with group B 25.8% (n = 8), (P = 0.038) and when the CRBSI rate/1000 days was calculated, for group A it was 2.2/1000 catheter days and for group B it was 9.6/1000 catheter days (P = 0.04). The mean duration of catheter survival was not significantly different for group A (29.97 ± 6.7) days and group B (26.42 ± 8.04) days.

CONCLUSION

70% ethanol lock along with heparin may be safe and effective as a catheter lock for prophylaxis of CRBSI.
MO795: Management of Anemia in Hemodialysis Patients With Thalassaemia Minor
Authors: Nabil Hamouche , Mazighi Sara , Chettati Mariam , Fadili Wafaa , Lisri Mohamed , Laouad Inass
Published: May 2022

BACKGROUND AND AIMS

Thalassemia is a group of hemoglobinopathies characterized by the decrease or lack of β or α globin chain production (Hb) [1]. Minor thalassemia has little to no symptoms since the other gene is capable of compensating for the anomaly; however, it represents a rare cause of resistance to erythropoietin (EPO) in chronic hemodialysis patients (CHP) in multiple regions, particularly the Mediterranean region [2]. As a matter of fact, CHP suffering from minor thalassemia often take higher EPO doses to correct the anemia [3], even if all causes of EPO resistance are resolved; a recent Italian investigation indicated that EPO need in this population is almost double in comparison with other groups [4]. EPO résistance can be secondary to the quantitative anomalies of the hemoglobin chain, notably Hb A2 and Hb F, Biagio Di Lorio et al. reported a positive correlation between the percentage of Hb A2 and EPO doses [5], actually patients that had an Hb A2 >6% needed higher EPO doses and vice versa. The aims of this study were to evaluate the efficiency of different therapeutic means [Erythropoiesis-stimulating agents (ESA), blood transfusion (TS)] aiming to correct the anemia in CHP with minor thalassemia. To detect the correlation between quantitative anomalies in hemoglobin chains and EPO resistance.

METHOD

It's a descriptive multi-centric study, involves eight CHP suffering from minor thalassemia. The statistical analysis of the data was done through Excel using the correlation coefficient and SPSS using the P-value. A value <.05 was considered as significant.

RESULTS

The average value of hemoglobin was 7.35 g/dL, Ferritin (M: 964 ± 971 ng/L) and PTH levels (M: 433 ± 126 pg/mL). These results are detailed in Table 1. Electrophoresis was done for all our patients with an average of HbA à 96.2 ± 1.7%; HbA2 à 3.43 ± 1.41%; HbF à 0.35 ± 0.45%. We have noticed that a decreased percentage up to nul of Hb F fraction is correlated with the lowest Hb levels (Fig. 1). The main therapeutic mean in anemia patients is epoietin beta, the average dose given to patients is 300 UI/kg/week, 326UI/kg/s at 2 months, 233 UI/kg/s at 6 months and 326 UI/kg/s at 12 months. Figure 2 illustrates the response to the EPO during the maintenance phase. The Darbepoetin alpha (μg/Kg/s) is administered (depending on availability) to two patients out of the eight. One of the two was receiving a dose of 0.57 μg/kg/s for 8 weeks, the other one was receiving a dose 0.7 μg/kg/s for 8 weeks as well, with a different response in the two patients. CONCLUSION: The presence of minor thalassemia in chronic hemodialysis patients entails erythropoietin resistance and a serious case of anemia. In our study, the maximum EPO dose used was 500 UI/kg/s reaching a value of 9.7 g/dL of Hb.
MO808: Indoxyl-Sulphate and Cresyl Sulphate are Respectively Linked to Calcium-Phosphate Metabolism Variables and to Cardiovascular Morbidity in Hemodialysed Patients
Authors: Bologna Arianna , Edvige Foligno Nadia , Avino Monica , Del Mastro Teresa , Conte Ferruccio , Palmieri Nicola , Bisegna Sergio , Slaviero Giorgio , Arcidiacono Teresa , Vezzoli Giuseppe
Published: May 2022

BACKGROUND AND AIMS

Indoxyl sulphate (IS) and Cresyl sulphate (CS) are uremic toxins generated by the intestinal amino acid catabolism. Blood levels of these toxins increase in patients with CKD and are linked to cardiovascular events. Therefore, we studied the relationship between serum levels of free IS and CS and divalent ion metabolism variables and cardiovascular morbidity (stroke, heart failure, angor and myocardial infarction) in 139 haemodialysis patients (age 68 + 13 years, weight 65 + 13 kg,  dialysis vintage 69 + 71 months).

METHOD

We divided patients according to tertiles of free serum IS and CS.

RESULTS

Patients in the highest tertile of serum free IS showed shorter dialysis vintage and higher body weight gain between dialysis sessions than patients in the other two tertiles. Patients in the highest tertile of IS showed lower body weight and serum concentrations of alkaline phosphatase, 1,25(OH)2D and PTH compared with the lowest tertile. Serum PTH was also measured during 2 years after the baseline; it was higher in patients in the lowest than those in the highest tertile of serum free IS. No relationships of serum free CS concentrations with phosphate and calcium metabolism variables were observed.

Kaplan–Meier survival analysis shows an increased cardiovascular morbidity in patients in the CS highest tertile (blue line in the figure) compared with those in the lowest and middle tertiles taken together (red line; P = 0.01). This association was not found considering IS tertiles.

CONCLUSION

Our findings suggest that serum free IS may be associated with PTH and 1,25(OH)2D secretion, whereas free PCS may predict cardiovascular risk in haemodialysis patients. A point for future investigation could be the relationship between IS and adynamic bone disease.