bluuebunny/crossref_metadata_2025 huggingface dataset:
MO651DIABETES CARE IN HAEMODIALYSIS TREATMENT : ADVANCES IN 2020
Authors: Dillmann Clementine , Tollard Clemence , Chantrel Yoann-Francois , Mountassir Hanane , Brokhes-Lecalvez Sophie , Fall-Mostaine Fatema , Takla Zafer , Fickl Rocsana , BABICI Daniela , Serb Liviu , Kessler Laurence , Chantrel Francois
Published: May 2021

Background and Aims

Management of diabetes and follow-up of haemodialysis patients are still poorly standardized. The objective of this study is to establish a descriptive inventory of all routine parameters for monitoring diabetes and glycemic control by Continuous Glucose Monitoring (CGM).

Method

The study recruited 32 diabetic patients in a medical dialysis unit. Glycemic control was assessed using CGM (FreeStyle Free Pro®) over at least 11 days with measurement of: mean blood glucose level, percentage of blood glucose level: < 70 mg/dl (TBR), between 70 and 180 mg/dl (TIR), and > 180 mg/dl (TAR). The results are expressed in average or median [25-75 percentiles]. SPSS® statistical analyses compared extra and per dialytic periods.

Results

Patients’ mean age was 71±8 years, diabetes duration was 21±6.5 years (87.5% T2DM), mean weight was 77±13kg, HbA1c was 7±0.98%, 98% had a high risk of foot injury (Grade 2 and 3) . Only 46.8% of the patients were followed by a diabetes specialist and 84.3% were treated with insulin and 18.75% received oral medication while only 50% performed self blood glucose-monitoring. The average blood glucose level was 133±13 mg/dl (∼1000 measurements). CGM results for 32 patients over the total period were: TIR at 70% [58-76], TAR at 15% [4.6-29], and TBR at 9.6% [3.7-20].Per-dialytic TIR (84%; [76-93]) was significantly higher (p=0.02) than extra-dialytic TIR (68%; [56-75]). Per-dialytic TAR (5.5%; [0.0-10.7]) was significantly lower (p<0.01) than extra-dialytic TAR (14%; [3.6-29]). TBR did not vary significantly.

Conclusion

The majority of patients were treated with insulin but only 50% performed self- of blood glucose. Hypoglycaemia was lower during dialysis period. 98% of patients had a high risk of foot injury. CGM could be a usefull tool for the evaluation of glycemic profile of haemodialysis patients, and allows a better adjustment of their treatment.
MO655PROTEINURIA DECREASE AFTER SGLT2I : WHAT CAN WE EXPECT?
Authors: Moliz Candela , Casillas Esther , Lopes Martín Vanessa , Martin Irene , Viera Elizabeth , Fernandez Lucas Milagros , Villacorta Javier
Published: May 2021

Background and Aims

The effect of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in reducing proteinuria secondary to type II diabetic nephropathy is well known. However, in daily practice we might have the impression that those patients who present with a higher proteinuria at the beginning of SGLT2i treatment might not reach an equal decrease of proteinuria compared to those with lower initial proteinuria (under 1g/24h). To verify this hypothesis we analysed the evolution of our patients depending on the initial proteinuria.

Method

A retrospective analysis of 40 patients who had initiated treatment with SGLT2i was carried out. At the beginning of treatment, 23 patients presented proteinuria over 1 gram/24h and the other 17 presented less than 1g/24h. The decrease of proteinuria after 6 months of follow-up was analysed in each group. The variations in serum creatinine, haemoglobin and glycosylated haemoglobin were also examined.

A second analysis depending on initial glomerular filtration rate (Under and over 60 ml/min) was also performed.

Results

In table 1 the basal characteristics of this population are shown. Analysis of the complete population showed a significant decrease of proteinuria (Initial mean proteinuria was 1636+/-1513 mg/24h vs final mean proteinuria of 1320+/-1480mg/24h, p=0.015).

Furthermore, the analysis by groups depending on initial proteinuria revealed that both groups had a significant reduction of proteinuria after 6 months:

A second exam depending on initial GFR was carried out, proving that those with lower initial GFR maintained a significant decreased of proteinuria after 6 months of treatment.

Conclusion

In our cohort, against our hypothesis, we didn´t observe lower reduction of proteinuria when we started the treatment with proteinuria above 1 g/24h. We can consider that the effect of SGLT2i doesn’t decreased in patients with higher initial proteinuria. Therefore, we should always consider and offer this therapeutic option to our ND patients.
MO639THE ASSOCICATION BETWEEN SERUM INTERLEUKIN 1 BETA AND HEPARAN SULFATE IN DIABETIC NEPHROPATHY PATIENTS
Authors: Jiang Liqiong
Published: May 2021

Background and Aims

The global diabetes mellitus (DM) prevalence in 2019 is estimated to be 9.3%. Approximately 20% to 40% of patients with DM develop diabetic nephropathy (DN). DN is the leading cause of end stage renal disease (ESRD). Inflammation is considered to be an important mechanism in the development of DM and persists for a long time before the occurrence of DN. Many studies demonstrated that decrease of endothelium glycocalyx (EG) was negatively correlated with proteinuria. Whether EG damage induced by inflammasome in DM patients leads to the occurrence of micro albuminuria (MA) and accelerating the progress of DKD is rarely studied.

Method:

This prospective, observational cohort study screened 300 diagnosed diabetic patients from departments of nephrology and endocrinology of our hospital. The exclusion criteria were: type 1 diabetes; acute infections; usage antibiotics within 3 months; kidney disease before; heart failure; malignancy. Finally 70 patients were invited to this study and were divided into type 2 DM (T2DM) group and type 2 diabetic nephropathy (T2DN) group. T2DM group were defined as patients with normal MA and without diabetic retinopathy (n=35). T2DN group were defined as patients with increased MA and diabetic retinopathy (n=35). Laboratory data were measured via routine laboratory methods. Heparan sulfate (HS) and interleukin 1 beta (IL-1β) were noted as EG biomarker and inflammasome biomarker respectively. Serum samples of patients were collected, and serum IL-1β and HS were measured by ELISA. SPSS 18.0 was used for all statistical analyses.

Results:

T2DN patients had higher serum IL-1β (27.85 vs. 21.35 pg/ml), higher HS (2.17 vs. 1.47 ng/ml), higher urea nitrogen (6.30 vs. 5.33 umol/L), higher CRP (2.03 vs. 0.81 mg/L), higher hemoglobin (128 vs. 141 g/L), higher neutrophil (4.1 vs. 3.4 × 109/L) and higher neutrophilic granulocyte percentage (63% vs. 56%) compared with T2DM patients (all P<0.05). Logistic regression analyses demonstrated serum HS was independently associated with T2DN. Furthermore in T2DN patients, serum IL-1β was positively correlated with HS (r = 0.6, P<0.01) and was and independent associated factor. The relationship of HS and IL-1β was not significant in T2DM patients.

Conclusion

T2DN patients had higher serum IL-1β and HS than T2DM patients in our study. In T2DN patients IL-1β was an independent associated factor of HS. The results suggested that the inflammasome may damage the EG in diabetic patients, which induced the occurrence of MA and accelerating the progress of DN.
MO641IMPACT OF MAGNESIUM AND L-CARNITINE ADMINISTRATION ON 3-YEAR SURVIVAL IN DIABETIC PATIENTS WITH END-STAGE RENAL DISEASE
Authors: Susla Oleksandr , Litovkina Zoriana , Bushtynska Olha
Published: May 2021

Background and Aims

According to population registries, the survival of diabetic patients with end-stage-renal disease (ESRD) remains low today. In this context, it is reasonable to develop new therapeutic strategies based on advances in science of the important role of magnesium (Mg) and L-carnitine deficiency (via inflammation and endothelial dysfunction) in mechanisms of cardiovascular remodeling, high morbidity and mortality rates. Thus, the purpose of the present study was to evaluate the effect of Mg and L-carnitine supplementation on 3-year survival and development of the cardiovascular complications in diabetic hemodialysis (HD) patients.

Method

48 type 2 diabetic ESRD patients were included in this prospective cohort study (male/female, 29/19; age, 59.9±0.6 years; HD duration, 34.8±4.8 month; diabetes mellitus duration, 174.7±7.1 month). The study was performed in accordance with the provisions of the Declaration of Helsinki last revision. Depending on the treatment programme, patients were divided into two groups: the 1st (main) group (n=24) in addition to basic treatment (hypoglycemic, antihypertensive therapy, according to indications - correction of anemia, hyperparathyroidism, hyperphosphatemia) was treated by combination of magnesium aspartate (0.5 g/day orally) and L-carnitine (1 g/day parenterally after each HD session (three times weekly); the 2nd (comparison) group (n=24) was only on the basic therapy. Complex treatment lasted 12-months; administration of L-carnitine was performed continuously throughout the year, while magnesium aspartate – by three 2-months’ courses/year. The follow up period in both groups was 36 months. Quantitative data are expressed as means±SEM, qualitative ones – as %. Kaplan-Meier method and Log-rank test were used to estimate survival of HD patients, χ2-test – to compare the frequency values.

Results

The cumulative proportion of survivors at the end of follow-up was 60.4%; however, after 36 months, the survival rate of diabetic HD patients who received a combination of magnesium aspartate and L-carnitine as part of their modified treatment was significantly higher (75 vs. 45.8%; Log-rank=2.07, p=0.038) compared to patients who were on basic therapy (Figure). Survival time in main and comparison groups was 31.9±1.7 and 26.4±2.2 months respectively. It is noteworthy, that throughout the year (from 10 to 22 months), no completed events were recorded in subjects who underwent Mg and L-carnitine supplementation.

Conclusion

(1) The combined use of magnesium aspartate and L-carnitine in addition to the basic 12-month treatment provides an effective reduction of cardiovascular complications and promotes 3-year survival of diabetic HD patients. (2) The results obtained substantiate the advisability of using repeated courses of Mg and L-carnitine administration 1 years after the end of the primary modified treatment to improve the prognosis in these ESRD patients.
MO788ERYPTOSIS AND PARATHORMONE IN PATIENTS WITH END STAGE RENAL DISEASE TREATED BY HEMODIALYSIS
Authors: Hefny Aya , El-Tahir Fatima , Fikry Abeer , Shendi Ali M
Published: May 2021

Background and Aims

Eryptosis (Red cell apoptosis) has been recognized as one of the mechanisms that mediate anaemia in patients with chronic kidney disease whether pre or on dialysis. Phosphorus (Ph) and parathormone (PTH) can be considered as uremic toxins which are associated with renal anaemia, and both were suggested to be associated with shortened red blood cell (RBC) life span. We aimed to assess the relation between each of PTH and phosphorus levels and eryptosis in a cohort of patients with end stage renal disease (ESRD) treated by haemodialysis.

Method

We studied a cohort of 85 patients with ESRD on conventional hemodialysis for at least 3 months. Blood was drawn prior to the mid-week dialysis session. Patients are dialysed on Fresenius 4008s machines. The percent of Annexin V-binding RBCs was assessed by flow cytometry in fresh blood samples and was used to indicate the percent of Eryptotic RBCs. Data were represented as median (interquartile range).

Results

The study included 85 patients on prevalent hemodialysis for a median of 8 (3-12) years, 52.9% females. Hypertension was the most common cause of ESRD (49.4%). The median hemoglobin was 10.9 (9.3 - 13) gm/dl and most patients received erythropoietin therapy (83/85) at a median dose of 8000 (4000 – 8000 units/weak). The median percent of Annexin V- binding RBCs was 2.3 (1.4 – 4.7%). On multilinear regression analysis, only PTH was independently associated with the percent of Annexin V- binding RBCs (standardized β= 0.630; 95.0% CI: 0.001 – 0.003; p<0.001). Patients were then stratified according to the PTH level into: low PTH (< 150 ng/dl; 25/85, 29.4%), target PTH (150 – 600 ng/dl; 33/85, 38.8%) and high PTH (> 600 ng/dl; 27/85, 31.8%) groups. The 3 groups differed significantly in the percent of Annexin V- binding RBCs (1.2 (0.7-1.7); 2.5 (1.8-3.6) and 4.8 (3.2-5.6) % respectively; p<0.001) (Figure). The percent of Annexin V- binding RBCs was similar in patients with high (>5.5) and target (<5.5 mg/dl) Ph levels (p=0.318). It was higher in patients with above-target CaXPh product (>55) than those with target CaXPh product (<55 mg2/dl2) (5 (2-5.4) % vs 2.3 (4.1 – 1.2) %), yet this was not statistically significant (p=0.068).

Conclusion

Patients with ESRD treated by hemodialysis express high rates of eryptosis. Parathormone excess in those patients may result in further eryptosis enhancement, and this represents a potential pathogenic mechanism linking hyperparathyroidism with the anemia of CKD. Larger interventional studies are thus warranted to further explore the association between parathormone and eryptosis.
MO791HIGH-SENSITIVITY CARDIAC TROPONIN I CORRELATES WITH THE CARDIAC DYSFUNCTION AND WITH THE SEVERITY OF ANEMIA IN DIALYSIS PATIENTS
Authors: Vita Caterina , Bolignano Davide , Presta Pierangela , Zicarelli Mariateresa , Figlia Irma , Cianfrone Paola , Arcidiacono Valentina , Comi Alessandro , Coppolino Giuseppe , Fuiano Giorgio , Andreucci Michele
Published: May 2021

Background and Aims

Several evidences demonstrate that chronic dialysis treatment alters troponin levels, even in the absence of an acute myocardial event, although the underlying causes remain largely unclear. In this small pilot study, we aimed at analyzing high sensitivity troponin T (HsTnT) in a cohort of dialysis patients to identify the potential clinical predictors.

Method

HsTnT levels were measured together with common laboratory and clinical parameters in 39 chronic dialysis patients (middle age: 65±12 aa; 82% M; 30 in hemodialysis and 9 in peritoneal dialysis). The patients underwent also a complete echocardiography assessment.

Results

HsTnT levels were higher than normal reference values (median 46.1 ng/L IQR 33.5-84.3),but showing no differences between hemodialysis and peritoneal dialysis patients (p=0.19). At correlation analyses, HsTnT were strongly associated with beta2-MCG (R=0.43; p=0.008), Hemoglobin (r=-0.47; p=0.002) and, in particular, with some echocardiography parameters such as ejection fraction (R=-0.29; p=0.05), E/E’ratio (R=0.56; p=0.006) and LAVI (R=0.41; p=0.05) Figure 1.

Conclusion

In a small cohort of dialysis patients, high HsTnt levels were at the crossroad between the severity of functional heart dysfunction and anemia. Larger studies are advocated to further clarify the role of HsTnT as a potential biomarker reflecting the anemic cardiorenal syndrome which characterizes uremic subjects.
MO806SAFETY OF INTRAVENOUS PARICALCITOL TREATMENT IN CHINESE HEMODIALYSIS PATIENTS: A REAL-WORLD DATABASE ANALYSIS
Authors: Wang Niansong , Jiang Gengru
Published: May 2021

Background and Aims

The aim of this analysis based on the real-world database was to observe the effect of paricalcitol on the safety profile in Chinese hemodialysis (HD) patients with secondary hyperparathyroidism (SHPT) under routine clinical practice.

Method

From the Better Life for Future database, a total of 668 Chinese hemodialysis patients from 104 dialysis centers between January 2015 and May 2019 were included in the analysis set. Intact parathyroid hormone (iPTH), total serum calcium (Ca), phosphate (P), dosage of intravenous (IV) paricalcitol (Zemplar®) were analyzed and discussed via retrospective analysis of the database during the treatment.

Results

Patients were divided into five groups according to the duration of follow-up. Median iPTH levels decreased from 1183 pg/ml at baseline to 676 pg/ml at the final visit, or 30.88% (p < 0.0001). Serum Ca levels shown significantly increased just in the group of Month 12–24 (P=0.0479) (Table 2). The incidence of hypercalcemia for three consecutive blood draws was significantly lower than the incidence of hypercalcemia for at least once or two draws in all groups (Table 3). Subgroup analyses of patients with hyperphosphatemia showed a rapid phosphate reduction, within the first few weeks, along with the reduction in the iPTH level (Figure 1).

Conclusion

This is the first national retrospective real-world observational study since intravenous paricalcitol is available in China since 2014. This study adds valuable information to real-world data investigating the use of paricalcitol in Chinese HD patients and demonstrated the use of paricalcitol as an effective and well-tolerated treatment for the control of PTH during its use in routine practice. The occurrence of hypercalcemia is mostly transient, followed by continuous treatment, the blood calcium level tends to be stabilized, and the blood phosphorus level will be improved with the control of PTH.
MO807CORRELATIONS BETWEEN THE INFLAMMATORY AND THE BIOCHEMICAL BONE PROFILE OF PATIENTS ON HEMODIALYSIS
Authors: Khairallah Pascale , Nickolas Thomas , Panagoutsos Stylianos , Pasadakis Ploumis , McCann Fiona , Fraser William , Vargemezis Vassilis , Pazianas Michael
Published: May 2021

Background and Aims

End stage kidney disease (ESKD) is associated with a malnutrition-inflammation complex that results in several endocrine, musculoskeletal, and metabolic abnormalities. Despite the known resultant derangements from this process, few studies have evaluated the associations between inflammation and skeletal status in ESKD patients. Our goal is to evaluate correlations between inflammatory and biochemical bone profile within and between dialysis patients and a healthy cohort.

Method

This analysis is a cross-sectional evaluation of a cohort of 40 dialysis patients and 20 healthy controls.

Results

Significant differences were found between the dialysis and healthy cohort in biochemical bone profile, inflammatory markers and adipokine levels. Dialysis patients with low vs. high PTH (cutoff 50 pg/mL) had differences in bone turnover markers but no differences in inflammatory or adipokine levels (Table 1). More specifically, bone-specific alkaline phosphatase (BSAP), osteocalcin (OCN) and osteoprotegerin (OPG) were positively correlated with insulin-like growth factors but this correlation was not present after adjustment for parathyroid hormone (PTH) levels. C-terminal cross-linking telopeptide (CTX) positively correlated with IGF1 (p-value 0.02, 95% CI (0.14-1.69)) and with IGFBP3 (p-value 0.007 and 95% CI (0.31- 1.84)) after multivariate adjustment for PTH, albumin and sex. Adiponectin positively correlated with IGFBP3 and this remained significant after adjustment for PTH, albumin and sex (p=0.02). IL6, IL8 and TNF did not correlate with bone turnover markers or with adipokine levels after multivariate adjustments.

Conclusion

In this cross-sectional study, significant differences were found between the dialysis and healthy cohort in biochemical bone profile, inflammatory markers and adipokine levels. In the dialysis cohort, inflammatory markers did not correlate with bone turnover markers or with adipokine levels in dialysis patients. Dialysis patients with high vs. low PTH (cutoff 50 pg/mL) had higher levels of bone formation and bone resorption markers. Inflammatory and adipokine levels did not differ between those with high vs. low PTH.
MO795CALCIUM BALANCE AND CKD-MBD PARAMETERS DIFFERENCES OF CITRATE VS. ACETATE DIALYSATE
Authors: Broseta Monzo Jose Jesus , López Romero Luis Carlos , Rodríguez Diana , Guillen Olmos Elena , Sánchez-Pérez Pilar , Hernandez Jaras Julio
Published: May 2021

Background and Aims

Dialysate composition is an essential feature of hemodialysis treatment. The use of acetate as the dialysate buffer and its calcium concentration are still topics of debate. Calcium transfer during dialysis sessions is related to short-term (hemodynamic tolerance and arrhythmias) and long-term effects (cardiovascular calcification and mortality). This study aims to identify the potential benefits derived from acetate-free dialysis by using citrate as a buffer in terms of calcium balance and CKD-MBD biomarkers.

Method

We performed a prospective crossover study that analyzed 24 dialysis sessions, 12 with each dialysate buffer, on every patient. Ionized calcium and CKD-MBD parameters were analyzed with each acidifier. Both dialysates had a calcium concentration of 1.5 mml/L. The remaining hemodialysis patients’ parameters were unchanged during the study period.

Results

No differences were found between pre-dialytical ionized calcium (iCa) (1,11 ± 0,12 vs. 1,08 ± 0,12 mmol/L) in both groups. However, we identified a significant iCa increase in the sessions were acetate dialysate was used, both in immediate (1,29 ± 0,07 mmol/L) and in 30-minutes post-dialytical blood analysis (1,22 ± 0,07 mmol/L). Whereas iCa levels remained stable during the immediate (1,07 ± 0,06 mmol/L) and 30-minutes post-dialytical analysis (1,08 ± 0,11 mmol/L) when using citrate. On the other hand, pre-dialysis albumin-corrected total calcium was higher with acetate (8,9 ± 0,6 vs. 8,31 ± 0,75 mg/dL, p = 0,003) and PTH was lower with acetate (169 vs. 267 pg/mL, p < 0,001).

Conclusion

Acetate-free dialysis using citrate as an acidifier stabilizes iCa levels during dialysis sessions while maintaining a neutral or negative effect in calcium balance. This analytical benefit may translate into better cardiovascular long-term outcomes.
MO798ORAL CALCITRIOL USE, VERTEBRAL FRACTURES AND VASCULAR CALCIFICATION IN HEMODIALYSIS PATIENTS: RESULTS FROM VITAMIN K ITALIAN (VIKI) STUDY
Authors: Fusaro Maria , Aghi Andrea , Politi Cristina , Nickolas Thomas , Cianciolo Giuseppe , La Manna Gaetano , Gasperoni Lorenzo , Mereu Maria Cristina , Gallieni Maurizio , Ravera Maura , Giannini Sandro , Sella Stefania , Arcidiacono Gaetano , Tripepi Giovanni Luigi
Published: May 2021

Background and Aims

In patients with Chronic Kidney Disease (CKD) mineral, bone, and calcific cardiovascular abnormalities are associated to adverse clinical outcomes, including fractures, cardiovascular events and mortality. Vitamin D hormonal system along with alteration levels that occur in calcium, phosphate, PTH, FGF23/Klotho are the main responsible of the bone and vascular metabolism changes, particularly in hemodialysis (HD) patients that experienced the very negative clinical consequences (decreased bone mass, increased fragility fractures and vascular calcification). In the setting of a comparative effectiveness study, we investigated the effect of oral calcitriol on fractures in HD patients taking into account a series of potential confounders.

Method

We conducted a secondary analysis of the VIKI database, a cross-sectional study involving 387 HD patients from 18 Italian dialysis centers. Routine biochemistry and bone biochemical markers such as vitamin K levels, VKDPs, vitamin 25(OH)D, ALP, PTH, Ca, P, osteocalcin (BGP), Matrix Gla Protein (MGP) were assessed. The presence of Vertebral Fractures (VF) and Vascular Calcification (VC) was determined through spine radiograph. Reduction of >20% of vertebral body height was considered a VF. The severity of the vertebral fractures was estimated as mild, moderate and severe (reduction: 20-25%, 25-40% or >40%, respectively). VC were quantified by measuring the length of calcific deposits along the arteries (mild 0,1-5 cm, moderate 5,1-10 cm and severe >10 cm).

Results

177 out 387 patients (45.7%) were treated with oral calcitriol. Oral calcitriol-treated and untreated patients did not differ as for Ca, P, PTH, Albumin, BGP, MGP, and ALP. The prevalence of VF was significantly lower in patients receiving oral calcitriol than in those untreated (48.6% vs 61%, P=0.015), whereas the presence of aortic and iliac calcifications was similar between the two groups (aortic: 81.9% vs 79.5% respectively, P=0.552; iliac: 52.0% and 59.5%, P=0.167). No significant between-groups differences were observed in terms of calcification severity. In a multivariable logistic regression analysis, after adjustment for all potential confounders, oral calcitriol was associated with a marked reduction (-40.2%) of the odds of fractures (OR: 0.598, 95% CI: 0.363-0.985, P=0.043) (see Table).

Conclusion

A significant association was found between oral calcitriol and lower VF rate in HD patients. Such an effect remained significant also after data adjustment for a large series of potential confounders. Further prospective and interventional studies are needed to confirm these findings.
MO733RISK FACTORS FOR INFECTIVE ENDOCARDITIS IN PATIENTS RECEIVING HAEMODIALYSIS- A PROPENSITY MATCHED COHORT STUDY
Authors: Al-Chalabi Saif , Tay Tricia , Chinnadurai Rajkumar , Kalra Philip A
Published: May 2021

Background and Aims

Infective endocarditis (IE) is a serious infective complication that usually results in prolonged hospitalisation and is associated with high morbidity and mortality. It is sometimes difficult to promptly diagnose infective endocarditis when a patient receiving hemodialysis presents with signs and symptoms of bacteremia, a delay which can lead to worse outcomes. In this study, we aimed to identify the risk factors that can predict infective endocarditis in haemodialysis patients with bacteremia.

Method

This retrospective observational study was conducted on all patients diagnosed with infective endocarditis (IE) and receiving maintenance hemodialysis between 2005 and 2018 in Salford Royal Hospital and its satellite dialysis units (catchment population of 1.5 million). The IE patients were propensity score matched in a 1:2 ratio with similar hemodialysis patients without IE but with bacteremia between 2011 and 2015. Propensity scores were generated by using binary logistic regression analysis incorporating age, gender, diabetes status, and dialysis vintage as variables. Logistic regression analysis was used to predict the risk factors associated with developing IE. Statistics were performed using SPSS version-24.

Results

We had a sample of 105 patients (35 IE vs 70 bacteremia). The median age of the patients was 65 years with a predominance of males (60%). 43% were diabetic, 11.5% were receiving immunosuppression and 72% had a catheter for dialysis access. IE patients had higher peak C-reactive protein (CRP) during admission compared to patients with bacteremia and no IE (253 mg/l vs 152 mg/l, p=0.001). Patients who developed IE had a longer duration of dialysis catheter use than the bacteremia group (150 vs 19 days; p<0.001) (table 1). There was no significant difference between causative microorganisms in both groups. Staphylococcus aureus caused most cases (54% in IE and 47% in bacteremia). Our study showed clearly that patients who had IE had longer hospital stay (45 vs 18 days, p=0.001) with a far higher 30-day mortality rate (54.3% vs 17.1%, p<0.001). Logistic regression analysis showed previous valvular heart diseases (OR: 20.1; p<0.001), a higher peak CRP (OR:1.01; p=0.001), and a longer duration of catheter use (OR: 1.01; p=0.035) as significant predictors for infective endocarditis (table 2).

Conclusion

Bacteremia in patients receiving hemodialysis through a catheter as access should be actively investigated with a high index of suspicion for IE particularly those having valvular heart diseases, hypertension, higher peak CRP, and those with a longer duration of dialysis catheter usage. Work up may need to include invasive investigations such as transesophageal echocardiogram to confirm or reliably rule out this devastating condition.
MO736ELECTROCHEMICAL SKIN CONDUCTANCE BY SUDOSCAN: A NEW TOOL TO PREDICT INTRA-DIALYTIC HYPOTENSION
Authors: Reach Pauline , Touzot Maxime , Lombardi Yannis , Maheas Catherine , Sacco Emmanuelle , Fels Audrey , Beaussier Hélène , Urena Torres Pablo Antonio , Chatelier Gilles , Ridel Christophe , Zuber Mathieu
Published: May 2021

Background and Aims

Intradialytic hypotension (IDH) is a common complication in hemodialysis (HD) patients. It is associated with multiple risk factors including cardiac dysfunction and alterations of the peripheral autonomic nervous system. To which extent, dysautonomia may contributed to the occurrence of IHD remains elusive. We sought to investigate the clinical utility of Sudocan®, a device that quantify dysautonomia, in the prediction of IDH.

Method

We conducted a prospective monocentric study in adult HD patients from July 2019 to February 2020. Dysautonomia was assessed by the measurements of hand and foot Electrochemical Skin Conductance (ESC) by Sudocan®, before and after the end of HD. A pathological hand ESC was defined by an ESC value < 40 μs in Caucasian or < 30 μs in afro-American and Caribbean patients, and a pathological foot ESC by a value < 50 μs in Caucasian or < 30 μs in afro-American and Caribbean patients.

Arterial blood pressure (BP) was monitored before, every thirty minutes and after the end of the HD session. The primary end point was the incidence of IDH, according to the NKD/K-DOQI definition, during the 3 month-period study.

Results

A total of 176 HD patients (64 ±14 years old) were enrolled. Mean pre-dialysis hand and foot ESC were 45±20 μS and 54±22 μS, respectively. Thirty-five and 40% of patients had a pathological ESC at the hand and foot, respectively. Forty-Six IDH occurred during the study period. Logistic regression showed that a pathological hand ESC was associated with an increased risk of IDH [OR=0.39, IC95% (0.15-0.97), p= 0.04]. The cumulative risk incidence of IHD during the study was 2.17 [IC95% (1.21-3.89), p= 0.01] and 1.89 [IC95% (1.06-2.38), p= 0.03], with a pathological hand and foot ESC, respectively.

Conclusion

A pathological hand ESC, as assessed by a simple, non-invasive test, such as Sudoscan®, is associated with an increased risk of IDH.
MO738CLINICAL IMPACT OF ORAL ANTICOAGULATION THERAPY ON MORTALITY, EMBOLIC AND HEMORRHAGIC EVENTS IN CHRONIC HEMODIALYSIS PATIENTS WITH ATRIAL FIBRILLATION
Authors: Dimitrijevic Zorica , Salinger Sonja , Tasic Danijela , Stojanovic Miomir , Paunovic Karolina , Mitic Branka
Published: May 2021

Background and Aims

A balance between embolic and bleeding risk is challenging in patients on chronic hemodialysis (HD). Embolic prevention with oral anticoagulation is the cornerstone for managing patients with atrial fibrillation (AF). However, there is a lack of specific recommendations for the use of antithrombotic therapy in HD patients with AF, and data about the efficacy and safety of oral anticoagulation in those patients are limited. Anticoagulation may exacerbate the hemorrhagic tendency; therefore, its potential benefits must be carefully weighed against hemorrhagic complications. We aimed to analyze the impact of oral anticoagulation on mortality, embolic and hemorrhagic events in chronic hemodialysis patients with AF.

Method

We used data from 106 hemodialysis patients [median age of 72 years (IQR 59–79) and 74.8% of the male gender] diagnosed with AF between 2016 and 2019. An analysis was performed to match the baseline characteristics of patients treated or not with oral vitamin K antagonists (OAK). The impact of oral anticoagulation in the embolic and hemorrhagic risk was assessed by a competitive risk analysis, with death being the competitive event. For embolic risk, we have considered a stroke, pulmonary or peripheral embolism, including arteriovenous fistula thrombosis. For bleeding risk, we have considered major bleeding according to the ISTH definition.

Results

More than half of HD patients with AF were anticoagulated (65.1%; n=69). During a median follow-up of 27.6 months (IQR 11.8-42.9 months), 33 patients died (31.1%), 21 presented embolic events (19.8%), and 19 had a major bleeding event (17.9%). In total, we recorded eight cerebral bleedings, ten gastrointestinal bleedings, and one urogenital bleeding. Of those, eleven (57.9%) were observed in orally anticoagulated patients (p=0.066). Patients with bleeding events had a higher prevalence of arterial hypertension (p=0.012), diabetes mellitus (p=0.002), advanced age (p=0.03) lower platelets count (p<0.001) and lower hemoglobin (p=0.04). After propensity-score matching, anticoagulation therapy was associated with lower mortality rate (HR 0.86, 95% CI 0.71-0.92; p=0.004) and embolic events (HR 0.78, 95% CI 0.69-0.88; p=0.003), but more bleeding events (HR 1.83, 95% CI 1.34-2.91; p=0.002).

Conclusion

Among HD patients with AF, oral anticoagulation was associated with lower all-cause mortality. Although survival free of embolic events was significantly higher in patients with anticoagulation, the risk of major bleeding was almost twice than in non-anticoagulated patients. Patients who experienced bleeding events did not show worse outcomes. This study strengthens the role of low hemoglobin and platelet counts as well as comorbidities on increased bleeding risk.
MO739EX VIVO THROMBOCYTE FUNCTION IN HEMODIALYSIS PATIENTS
Authors: Bonell Vera , Lorenz Georg , Kessler Thorsten , Heemann Uwe , Schmaderer Christoph , Kemmner Stephan
Published: May 2021

Background and Aims

Coagulation disorders with both risk for bleeding and thrombotic events are common in hemodialysis (HD) patients. Altered thrombocyte counts and function may account for that. Here, we sought to better characterize thrombocyte function in hemodialysis patients.

Method

Platelet function was investigated using the Multiplate analyzer (Roche) based on impedance aggregometry. Adenosine diphosphate (ADP) was used to induce platelet aggregation and area under the curve (AUC) was used as primary endpoint. Platelet counts and C-reactive protein (CRP) levels were measured. Hospitalization was the primary clinical outcome. Pearson regression was used to test for associations of thrombocyte function and the primary endpoint.

Results

In total 60 chronic HD patients undergoing dialysis 3 times per week, and 67 healthy controls were included. In general, HD patients presented with significantly lower thrombocyte numbers compared to healthy controls (Median: 221 vs. 245 G/l, p=0.029). Further, thrombocyte function as determined by AUC was significantly altered in HD patients versus healthy controls (Median: 455 vs. 677 AU*min, p<0.001; figure 1) with a significant correlation for platelet count and platelet function (r=0.42, p=0.001).

Platelet function also correlated with the inflammatory state as seen by systemic CRP levels (r=0.28, p=0.033). Regarding the clinical outcome, platelet function correlated with hospitalization rates for infectious disease (r=0.27; p=0.040) and cardiovascular events (r=0.30; p=0.022). In case of hospitalization rates for infectious disease this correlation remained stable irrespective of adjustment for thrombocyte counts (r=0.27, p=0.036).

Conclusion

Lower platelet counts and altered function in HD patients was associated with risk of hospitalization and markers of inflammation in this cohort. The Multiplate analyzer appeared to be a valid and easily accessible method to assess thrombocyte function. Further studies are needed to determine whether assessment of thrombocyte function in clinical routine should be used to stratify risk in the vulnerable population of HD patients.
MO722PHOSPHATE-BINDER THERAPY WITH SUCROFERRIC OXYHYDROXIDE REDUCES ENDOGENOUS CALCIPROTEIN PARTICLE FORMATION AND CRYSTALLIZATION IN A POST-HOC ANALYSIS OF A RANDOMIZED CONTROLLED TRIAL IN DIALYSIS PATIENTS
Authors: Thiem Ursula , Hewitson Tim D , Toussaint Nigel D , Haller Maria C , Pasch Andreas , Cejka Daniel , Smith Edward
Published: May 2021

Background and Aims

Calcification propensity of serum can be measured with the so-called T50-test, which integrates the complex biological interplay of promoters and inhibitors of calciprotein particle formation in blood into a single readout. Calcification propensity is associated with the risk for cardiovascular events and death in dialysis patients. As we have recently demonstrated in a randomized, controlled, cross-over study in 39 chronic hemodialysis patients with hyperphosphatemia, lowering serum phosphate with high-dose phosphate-binder therapy with 2000 mg/d of sucroferric oxyhydroxide (SO) over two weeks reduces calcification propensity as determined by the T50-test compared to a two-week wash-out phase. Based on these results, we hypothesized that SO would influence endogenous calciprotein particle (CPP) formation and crystallization, i.e. conversion from primary to secondary CPP.

Method

To test this hypothesis, we conducted post-hoc analyses of the previously reported RCT (74% men, mean age 63±27 years, median dialysis vintage 24, IQR 16-36 months). Native serum CPP levels were measured by a fluorescent probe-based flow cytometric assay. Moreover, hydrodynamic radii (Rh) of secondary CPP formed after enrichment with exogenous calcium and phosphate was assessed by three-dimensional cross-correlation dynamic light scattering.

Results

Phosphate-binder therapy with SO lead to a reduction in serum phosphate levels from 2.28±0.5 mmol/l to 1.63±0.43 mmol/l (p<0.0001), accompanied by a significant reduction of endogenous calciprotein particle load and crystallization. Median (IQR) number of primary CPP decreased from 9.2x105 (7.7x105 - 12x105) particles/ml to 3.8 x105 (2.7x105 - 4.4x105) particles/ml (p<0.0001) and secondary CPP decreased from 5.4x104 (3.6x104 - 7.5x104) particles/ml to 3.2x104 (2.4x104 - 4.2x104) particles/ml (p<0.01, both by Wilcoxon matched-pairs test). Upon SO therapy we also observed a significant reduction of secondary calciprotein particle size as determined by Rh compared to phosphate-binder wash-out (214±55 nm vs. 231±52 nm, p<0.01 by paired t-test).

Conclusion

In chronic hemodialysis patients, lowering serum phosphate with SO is associated with a reduction in the load of primary and secondary CPP and a smaller size of secondary CPP.
MO740EFFECT OF DIPHOSPHONATES FOR VASCULAR CALCIFICATION IN CHRONIC KIDNEY DISEASE: A META-ANALYSIS
Authors: Yang Canlin , Xie Xiaotong , Xing Jie , Yang Xin , Zhang Xiao liang
Published: May 2021

Background and Aims

Vascular calcification is an independent predict factor of cardiovascular mortality and all-cause mortality in chronic kidney disease (CKD) patients. Animals experiments and clinical studies showed the inhibition effect of diphosphonates in vascular calcification, but the results of the studies remains controversial. This meta-analysis aims to evaluate the effects of diphosphonates on vascular calcification in patients with CKD.

Method

Randomized controlled trials (RCT) and non-RCTs of diphosphonates for the treatment of vascular calcification in CKD patients until September 2020 were searched in the database of PubMed, Embase, Cochrane library, CNKI and Wanfang. Literatures were screened according to the inclusion and exclusion criteria and quality was evaluated by two investigators independently. The standard deviation from mean (SMD) and 95% confidence interval (CI) were used to representthe counting data. Data extracted from the literatures were analyzed with Stata software (version 15.0).

Results

A total of 6 RCTs and 1 non-RCT with 272 patients were included, characteristics of the studies included are shown in Table 1. Meta-analysis indicated that diphosphonates inhibit vascular calcification in CKD [SMD =-0.297, 95% CI = (-0.591, -0.002), P = 0.049] (Figure 1). Etidronate is the most effective one in treating with vascular calcification (P = 0.020) (Figure 2). But there isn’t significant difference in aortic artery calcification and coronary artery calcification compared with the control group (P>0.05). There was no statistically significant difference in the change of blood calcium, blood phosphate, and serum parathyroid hormone between two groups (all P>0.05).

Conclusion

Diphosphonates can inhibit the progression of vascular calcification in CKD patients, and it hasn’t obvious effect on blood calcium, blood phosphate, and serum parathyroid hormone. Etidronate is the most promising therapeutic agent.
MO745CARDIOVASCULAR EFFECTS OF HIGH FLOW ARTERIO-VENOUSE FISTULA CLOSURE IN POST-KIDNEY TRANSPLANTATION PATIENTS
Authors: Iskhakov Rustam , Belavina Natalya , Ivanova Ekaterina , Klochkova Nataliya , Zeltyn-Abramov Eugene
Published: May 2021

Background and Aims

Presently, the dilemma of what to do with a functioning arterio-venous fistula (AVF) in post-kidney transplantation patients is a subject of debate. One of the arguments in favor of AVF closure is symptomatic congestive heart failure (CHF) due to AVF-induced cardiomyopathy. The subject of the study was the evaluation of the dynamics of some morpho-functional cardiac parameters in post-kidney transplantation patients with AVF-induced CHF before and after AVF closure.

Method

The results of prospective single center study are presented. 13 post transplantation patients with severe AVF-induced CHF (III-IV f.c. NYHA) were enrolled. Echocardiography (Echo), Doppler evaluation of AVF flow (Qa) and calculation of cardiopulmonary recirculation (Qa/CO) were performed simultaneously (split-protocol) at baseline together with estimation of creatinine plasma level. All patients underwent surgical closure of AVF. In 8 weeks after the closure, an assessment of CHF, Echo and creatinine plasma level were carried out in all enrolled patients. Statistical analysis was performed using the STATISTICA 13 software (T-test).

Results

The average age – 44 ±13 y, males 54%. All patients bore an upper arm proximal AVF. The average flow of AVF (Qa) – 3.4 ±1.4 L/min, average Qa/CO – 49 ±15%, Qa/CO was more than 30% in 92% of patients. The median of AVF vintage was 5 y (IR 3;10). In 8 weeks after AVF closure, complete clinical resolution of CHF, reduction of volumetric heart parameters, decrease of sPAP, improvement of diastolic function were observed. There was no significant difference in the serum creatinine value (1.85 ±0.66 mg/dL vs 1.97 ±0.95 mg/dL, p >0.05). The results of Echo data before and after AVF closure are presented in Table 1.

Conclusion

The surgical closure oh high flow AVF in post-kidney transplantation patients with AVF-induced CHF was resulted in significant improvement of morpho-functional cardiac parameters. The CHF due to AVF-induced cardiomyopathy should be considered as one of the indications to AVF closure in post-kidney transplantation patients.

CO, cardiac output; CI, cardiac index; LV EDVi, left ventricular end-diastolic volume index; LV ESVi, left ventricular end-systolic volume index; LAVi, left atrial volume index; RAVi, right atrial volume index; TAPSE, tricuspid annular plane systolic excursion LVMi, left ventricular mass index; sPAP, systolic pulmonary arterial pressure; LVEF, left ventricular ejection fraction; Е/A ratio, E - peak early mitral inflow wave velocity, A - peak late mitral inflow wave velocity.
MO746CARDIAC REMODELING AND PULMONARY HYPERTENSION IN HEMODIALYSIS PATIENTS
Authors: Borodulina Ekaterina , Shutov Alexander M
Published: May 2021

Background and Aims

An important predictor of cardiovascular mortality and morbidity in hemodialysis patients is left ventricular hypertrophy. Also, pulmonary hypertension is a risk factor for mortality and cardiovascular events in hemodialysis patients. The aim of this study was to investigate cardiac remodeling and the dynamics of pulmonary arterial pressure during a year-long hemodialysis treatment and to evaluate relationship between pulmonary arterial pressure and blood flow in arteriovenous fistula.

Method

Hemodialysis patients (n=88; 42 males, 46 females, mean age was 51.7±13.0 years) were studied. Echocardiography and Doppler echocardiography were performed in the beginning of hemodialysis treatment and after a year. Echocardiographic evaluation was carried out on the day after dialysis. Left ventricular mass index (LVMI) was calculated. Left ventricular ejection fraction (LVEF) was measured by the echocardiographic Simpson method. Arteriovenous fistula flow was determined by Doppler echocardiography. Pulmonary hypertension was diagnosed according to criteria of Guidelines for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology.

Results

Pulmonary hypertension was diagnosed in 47 (53.4%) patients. Left ventricular hypertrophy was revealed in 71 (80.7%) patients. Only 2 (2.3%) patients had LVEF<50%. At the beginning of hemodialysis correlation was detected between systolic pulmonary arterial pressure and LVMI (r=0.52; P<0.001). Systolic pulmonary arterial pressure negatively correlated with left ventricular ejection fraction (r=-0.20; P=0.04). After a year of hemodialysis treatment LVMI decreased from 140.49±42.95 to 123.25±39.27 g/m2 (р=0.006) mainly due to a decrease in left ventricular end-diastolic dimension (from 50.23±6.48 to 45.13±5.24 mm, p=0.04) and systolic pulmonary arterial pressure decreased from 44.83±14.53 to 39.14±10.29 mmHg (р=0.002). Correlation wasn’t found between systolic pulmonary arterial pressure and arteriovenous fistula flow (r=0.17; p=0.4).

Conclusion

Pulmonary hypertension was diagnosed in half of patients at the beginning of hemodialysis treatment. Pulmonary hypertension in hemodialysis patients was associated with left ventricular hypertrophy, systolic left ventricular dysfunction. After a year-long hemodialysis treatment, a regress in left ventricular hypertrophy and a partial decrease in pulmonary arterial pressure were observed. There wasn’t correlation between arteriovenous fistula flow and systolic pulmonary arterial pressure.
MO747AN ASSESSMENT OF COMPLEXITY OF CARDIOVASCULAR SIGNALS USING ENTROPY IN HEMODIALYSIS SESSION AND GLUCOSE INJECTION DURING HEMODIALYSIS IN END STAGE RENAL DISEASE PATIENTS WITH AND WITHOUT DIABETES MELLITUS TYPE 2
Authors: Niemczyk Longin , Schneditz Daniel , Buszko Katarzyna , Wojtecka Anna , Saracyn Marek , Niemczyk Stanisław
Published: May 2021

Background and Aims

Few studies have focused on the imbalance of the autonomic nervous system during hemodialysis (HD), although it seems to be an important factor for the maintenance of blood pressure.

The aim of this work was to assess the impact of hemodialysis (HD) and glucose injection upon entropy of heart rate and blood pressure during HD session in end stage renal disease (ESRD) patients with and without diabetes mellitus (DM) type 2.

Method

21 patients without DM (NDO), in age 54,95 +/-13,08 y.o., and 10 DM patients, in age 69,70 +/- 8,27 y.o., were studied during HD. 30 minutes after dialysis begins, 40% glucose solution was administered in the amount of 0.5g/kg body dry-weight (constant rate of 1 mL/s). The cardiovascular signals were extracted from the recordings using Portapres® system. The analysis was performed using Amplitude Aware Permutation Entropy (AAPE). The parameters of AAPE were set as d=7, A=0.5. All statistical analysis were performed on significance level α=0.05. The comparisons between groups were conducted with Mann-Whitney test with Holm corrections. The comparisons in time points were performed using Friedman test with post-hoc (Wilcoxon test with Holm corrections). The calculations of AAPE and all statistical analysis were performed with Matlab R2020a and R.

Results

The results are presented in table.

It was found that AAPE(HR) tends to decrease during dialysis (NS) and increases only in the DM group after glucose injection (p=0.019); without difference between groups. There were no differences in AAPE of blood pressure between the groups, but hemodialysis reduces AAPE(fiSYS) in both groups (p<0.001 in both DM and NDO groups) and AAPE(fiDIA) in NDO (p<0.01). AAPE(TPR) is high before dialysis, and decreases during HD in both groups (p<0.0001). There is no effect of glucose injection on AAPE(HR) in both groups, but AAPE(fiSYS) and AAPE(fiDIA) increase in NDO (p<0.001, p<0.01, p<0.05 respectively); without difference between groups. AAPE(TPR) tends to increase after glucose injection (p<0.05 for NDO, NS for DM).

Conclusion

AAPE(HR)tends to decrease during HD, and glucose injections increase AAPE(HR) in DM patients. Hemodialysis reduce, and glucose injections increase AAPE of blood pressure especially in NDO. A weaker response to hemodialysis and glucose injection in diabetic patients may be caused by impairment of the autonomic system, and may have clinical impact – may leads to faint. Glucose administration does not prevent autonomic system disorders in patients with DM.