bluuebunny/crossref_metadata_2025 huggingface dataset:
MO635: Early Diabetic Kidney Disease in Type 2 Diabetes Mellitus Patients is Associated with A Particular Ganglioside Profile, Identified by High-Resolution Tandem Mass Spectrometry:A Pilot Study
Authors: Suteanu-Simulescu Anca , Ica Raluca , Sarbu Mirela , Munteanu Cristian , Gadalean Florica , Vlad Adrian , Velciov Silvia , Anca Gluhovschi Cristina , Bob Flaviu , Jianu Catalin , Cretu Octavian , Oana Milas Livia , Mogos Maria , Patruica Mihaela , Lavinia Balint , Silvia Ienciu , Diana Zamfir Alina , Petrica Ligia
Published: May 2022

BACKGROUND AND AIMS

Metabolic biomarkers are of high importance for the identification of early renal involvement in the course of type 2 diabetes mellitus (DM). Gangliosides, which are complex cell type-specific glycosphingolipids, consist of a sialylated oligosaccharide chain attached to a ceramide of different composition with respect to the sphingoid base and fatty acid residues [1]. Gangliosides play a major role in the pathogenesis of diabetic kidney disease (DKD). The aim of the study was to assess the pattern of urinary gangliosides in patients with type 2 DM.

METHOD

The urine gangliosidome of 30 type 2 DM patients (10 normo-, 10 micro-, and 10 macroalbuminuric) has been investigated in a cross-sectional pilot study, by a comparative assay with 10 healthy controls. Following the optimization of urine ganglioside extraction procedure [2, 3], we have determined the composition of native ganglioside mixtures from the 24-h collected urine samples using a modern bioanalytical platform based on nanoelectrospray ionization (nanoESI) high-resolution mass spectrometry (HR MS) on an Orbitrap instrument.

RESULTS

HR MS screening and fragmentation analysis by tandem MS revealed that: (i) the urinary gangliosidome of type 2 DM patients contains a significantly higher number of distinct species differing in either their glycan or ceramide structure than the controls; (ii) the ganglioside urinary level was significantly increased in normoalbuminuric patients compared with healthy control subjects; (iii) the gangliosidome of macroalbuminuric patients is characterized by an elevated overall sialic acid content than normo- and microalbuminuric diabetics and more complex structures, including fucosylated, O-GalNAc- and CH3COO--modified compounds; (iv) the degree of sialylation of species presented correlations with the level of albuminuria and renal function; (v) further detailed structural analysis of a type GQ1(d18:1/18:0) species (identified only in macroalbuminuric patients) demonstrated that the present isomer is of type D (all four syalic acids are linked to the inner galactose).

CONCLUSION

HR MS by tandem MS methods, using an Orbitrap instrument, are a reliable tool for the identification of a particular ganglioside profile in the urine of type 2 DM patients. The sialylated species and those altered by peripheral attachments to the glycan core might be considered useful indicators of early DKD.
MO638: Direct Oral Anticoagulants in Patients with Atrial Fibrillation and Obesity, Type Two Diabetes, CKD
Authors: Abdullaev Sherzod , Igamberdieva Ranokhon
Published: May 2022

BACKGROUND AND AIMS

We aimed to estimate the clinical characteristics and outcomes of rivaroxaban and warfarin in patients with nonvalvular atrial fibrillation (NVAF) and concurrent obesity, type two diabetes (T2D) and chronic kidney disease (CKD).

METHOD

A multicenter prospective cohort study, where consecutive eligible rivaroxaban or warfarin treated patients with NVAF concurrent obesity, T2D and CKD, were registered. Patients were also required to be ≥18 years of age, and have obesity, which was defined as BMI ≥30 kg/m2 diabetes and CKD. Patients were followed-up for clinical events over a mean period of 1 year. Primary outcome was a composite of 1-year mortality, stroke or systemic embolism, major bleeding and myocardial infarction, end-stage kidney disease, while secondary outcomes included those components separated. Treatment cohorts were matched using propensity scores and were compared for stroke/systemic embolism (SE) and major bleeding using Cox proportional hazards models.

RESULTS

A total of 194 (n = 103, rivaroxaban; n = 91, warfarin) matched pairs of NVAF patients with obesity, T2D and CKD who initiated treatment with rivaroxaban or warfarin were included. Prior to matching, rivaroxaban patients were younger than warfarin patients (mean age, 67.9 versus 69.2 years) and had lower mean scores for the QCI, CHA2DS2-VASc and HAS-BLED. In the intent-to-treat analysis, patients receiving rivaroxaban had a significant 19% reduction in the composite risk of stroke or SE compared with those receiving warfarin [HR 0.85 (95% CI 0.77–0.90)]. The risk of each component of the composite outcome was lower in the rivaroxaban cohort versus the warfarin cohort with significant differences for ischemic stroke and hemorrhagic stroke. The difference in SE was not statistically significant. Outcome rates were lower in the as-treated sensitivity analysis, with significant reductions in the composite outcome of stroke/SE risk observed for rivaroxaban versus warfarin [HR 0.70 (95% CI 0.61–0.80)]. Ischemic stroke and hemorrhagic stroke risks were also significantly lower with rivaroxaban versus warfarin in the as-treated sensitivity analysis. The risk of major bleeding was similar between the rivaroxaban cohort and the warfarin cohort [HR 0.91 (95% CI 0.79–1.06)].

CONCLUSION

In NVAF patients with comorbidities of obesity, T2D and CKD, who initiated rivaroxaban had a significantly lower risk of stroke/SE compared with patients initiating warfarin. The risk of major bleeding was not significantly different between treatment groups. Patients receiving rivaroxaban had a significantly higher rate of adherence to treatment, supporting the use of rivaroxaban as an alternative to warfarin in NVAF patients with comorbidities of obesity, T2D and CKD.
MO650: In Vitro Performance Evaluation of a Filter Used for Hemodiafiltration by Using Β-Lactoglobulin
Authors: Sekiguchi Masaya , Kurihara Yoshitaka , Shigeta Yoshimi , Kobayashi Kozue , Kokubo Kenichi , Kubota Masaru
Published: May 2022

BACKGROUND AND AIMS

Filters currently used for hemodiafiltration (HF) can remove sufficiently low to middle molecular weight solutes, like urea to β2 microglobulin (molecular weight: 11.800). Therefore, the removal rate of α1 microglobulin (α1-MG; molecular weight: 33.000) and albumin leakage are used as a guide to select a filter and to set appropriate operating conditions. Since α1-MG is very expensive, in vitro performance evaluation of the filters using α1-MG is not practical. In the present study, we aimed to investigate whether β-lactoglobulin (β-LG), which has a molecular weight of 18.400 and forms dimer (molecular weight: 36.800) under physiological conditions, can be used as a marker solute in the 30.000 molecular weight region.

METHOD

HF experiments were performed using 1.8 L of porcine whole blood (hematocrit: 30 ± 3%,  total protein concentration: 6.5 ± 0.5 g/dL). The sieving coefficients of β-LG, separated from milk by membrane separation (untreated), made whey containing β-LG by acid treatment of milk and pH adjusted (acid-treated) and powdered reagent, were measured in porcine blood. In addition, HF experiments with permeate recycle were performed using three filters with different pore sizes (MFX-S, MFX-E and MFX-M; Nipro) at a blood flow rate of 250 mL/min and filtration flow rate of 42 mL/min for 240 min. The concentration of β-LG was measured by an enzyme-linked immunosorbent assay.

RESULTS

The sieving coefficient of acid-treated or powdered reagent β-LG added to the blood was almost equal to that of untreated β-LG. When the powdered reagent β-LG was treated with mercaptoethanol, the sieving coefficient became larger, meaning that the β-LG is tightly bound by disulfide bonds to form a stable dimer. In HF experiments using three filters with different pore sizes, the filter with a larger pore size resulted in lower transmembrane pressure. The sieving coefficients of β-LG decreased with time and were 0.15 ± 0.024,  0.39 ± 0.023,  0.75 ± 0.064 (mean ± SD, n = 3) at 60 min for MFX-M, MFX-E and MFX-S, respectively, indicating that the difference in filter performance was able to classify in the sieving coefficient of β-LG.

CONCLUSION

β-lactoglobulin existed stably as a dimer and was able to classify the performance of filters used for hemodiafiltration as a marker solute in the 30.000 molecular weight region.
MO666: Telemonitoring in Automated Peritoneal Dialysis. Analysis of the First 3 Months of the RM-APD 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 , Luis Quirós Ganga Pedro , Díez Ojea Beatriz , Pérez Martínez Juan , Ortega Cerrato Agustin
Published: May 2022

BACKGROUND AND AIMS

The use of remote monitoring programs in peritoneal dialysis (RMAPD) has been related to favorable clinical events, as well as possible reductions in healthcare costs, although the medical literature is scarce.

METHOD

Prospective, multicenter, longitudinal 2-year study of cohorts to evaluate the number of significant interventions: face-to-face consultations and unscheduled teleconsultations, number of kilometers (km) saved, as well as clinical consequences (hospitalizations, peritonitis) in a cohort of patients in automated peritoneal dialysis with and without exposure to RMAPD. The data are presented in terms of mean, standard deviation and percentage.

RESULTS

The results of the first 3 months of analysis are shown, in descriptive terms, of incident patients in RMAPD versus No RMAPD, corresponding to 10 Spanish centers participating in the study. The data are shown in the Tables 1 and 2.

CONCLUSION

In this first quarterly exploratory analysis, despite its limitations, it is evident:

Although these results are promising, they still need to be confirmed during the follow-up of the patients over time and checked whether they are also related to other clinical and therapy parameters: time in therapy, technique abandonment rate, dialysis dose, peritonitis rate, hospitalizations and quality of life of the patient.
MO670: Angiotensin Converting Enzyme Blockers, Angiotensin Receptor Blockers and Statins are Associated with a Reduction of Inflammation Markers Without Modification of the Peritoneal Membrane Transport Status in Peritoneal Dialysis
Authors: Zeiler Matthias , Silvestri Simona , Fioravanti Gilda , Pietro Lorenzo D I , Polci Rosaria , Fioravanti Giuseppe , Santarelli Stefano
Published: May 2022

BACKGROUND AND AIMS

Therapy with angiotensin converting enzyme inhibitors (ACE) and angiotensin receptor blockers (ARB) as well as statins might protect the peritoneal membrane and vessels in peritoneal dialysis. The aim of this study was to analyse the effect of treatment on peritoneal transport and inflammation markers.

METHOD

The first two peritoneal equilibration tests in adult peritoneal dialysis patients, respectively, 6 and 12 months after dialysis start, were analysed for this retrospective study. Use of ACE, ARB and statins was registered. Serum C reactive protein (sCRP), blood leukocyte and platelet count were used as inflammation markers. Data sets of 220 examinations were acquired. Mann–Whitney U-test was performed for the comparison of therapy groups. Median patient age was 67 years.

RESULTS

A total of 84 measurements (38.2%) were without ACE and ARB, whereas 93 measurements (423%) without statins. Dialysate to plasma (D/P) creatinine in patients without ACE, ARB and statins was 0.64 (all median values, n = 41), respectively, in patients under therapy with ACE, ARB and statins 0.66 (n = 52).

Use of ACE and ARB without statins resulted in D/P creatinine 0.64 (n = 54), whereas use of statins alone in D/P creatinine 0.63 (n = 48). The difference between groups was statistically not significant. There was a tendency of higher values of D/P creatinine (median 0.68) in patients under therapy with ACE and statins (Fig. A). sCRP was higher in patients without ACE, ARB and statins compared to patients with ACE, ARB or statins (0.60 versus 0.30 mg/dL, P < 0.05) (Fig. B). Furthermore platelet count was slightly higher in patients without ACE, ARB and statins (25 8000 versus 22 6000/mm3). Blood leukocyte count did not present significant differences (median values 6930 to 6855/mm3).

CONCLUSION

Our data suppose the absence of a protective effect of ACE, ARB and statins on peritoneal transport expressed by P/D creatinine despite reduced signs of systemic inflammation.
MO676: The Ratio Mean Platelet Volume/Platelet Count in Peritoneal Dialysis: Effect of Dialysis and Peritoneal Transport Status
Authors: Zeiler Matthias , Federico Antonio , Silvestri Simona , Fioravanti Giuseppe , Santarelli Stefano
Published: May 2022

BACKGROUND AND AIMS

Mean platelet volume (MPV) is gaining scientific interest with regard to cardiovascular risk stratification. The MPV/platelet count ratio seems to be more specific than MPV alone as a surrogate parameter for platelet activation. The MPV/platelet ratio might be of interest in peritoneal dialysis (PD) as the distribution and integrity of endothelial–platelet interaction in the abdominal space determines its function. The aim of the study was to evaluate the modification of MPV/platelet ratio due to dialysis and its association to peritoneal transport status.

METHOD

In 123 PD patients (median age 65 years) MPV and platelet count were measured together with anthropometric patient data and peritoneal function at catheter placement and after 6 months during the first peritoneal equilibration test (PET). MPV and platelet count were determined with a fully automated hematological analyser. Correlation analysis was performed.

RESULTS

The MPV/platelet ratio decreased significantly from 3.99% at placement to 3.50% at the first PET (median values, Wilcoxon test P < 0.001). Neither anthropometric data, nor creatinine clearance, nor BUN clearance, nor Kt/V (renal, peritoneal, total), nor erythrocyte sedimentation rate, nor C reactive protein were associated to MPV/platelet ratio. Only dialysate to plasma (D/P) urea and D/P creatinine were significantly correlated to MPV/platelet ratio (D/P urea r = 0.223, P = 0.01; D/P creatinine r = 0.199, P = 0.03). Slow transporters presented a significantly lower MPV/platelet ratio than average transporters (median values, 3.49% versus 3.83%, Mann–Whitney test P = 0.03).

CONCLUSION

PD is reducing significantly the MPV/platelet ratio. Differences in MPV/platelet ratio are reflected in the peritoneal transport status at 6 months after dialysis start. The reduction of the MPV/platelet ratio might respect a reduced platelet and endothelial activation even in the abdominal space.
MO685: Brain Oxygenation Assessed by Near-Infrared Spectroscopy During a Mental Task and a Mild Physical Stress in Hemodialysis and Peritoneal Dialysis
Authors: Faitatzidou Danai , Dipla Konstantina , Zafeiridis Andreas , Theodorakopoulou Marieta , Koutlas Aggelos , Polychronidou Georgia , Chalkidis Georgios , Dimitriadis Chrysostomos , Tsouchnikas Ioannis , Giamalis Panagiotis , Papagianni Aikaterini , Sarafidis Pantelis
Published: May 2022

BACKGROUND AND AIMS

Cognitive impairment is highly prevalent in end-stage kidney disease (ESKD) individuals. Brain oxygenation is a parameter that plays major role in cognitive function. This study aimed to examine for the first time changes in brain oxygenation during a mental and a mild physical task in hemodialysis (HD) and peritoneal dialysis (PD) patients.

METHOD

A total of 63 ESKD patients (≥18 years old) were enrolled in this cross-sectional study. Patients were allocated in two groups according to dialysis modality (n = 29 HD and n = 34 PD). All participants underwent a mental (countdown from 100 to 0 by 7, performed twice) and a mild physical task (a 3-min intermittent handgrip exercise at 35% of maximal handgrip strength). Changes in brain oxygenation [oxy—(O2Hb), deoxy—(HHb) and total—(tHb) hemoglobin] during the two tasks were continuously recorded via near-infrared spectroscopy (NIRS, Artinis).

RESULTS

Age, sex and dialysis vintage did not differ between the two groups. The average response in brain oxygenation during the mental task (O2Hb change from rest: 1.51 ± 1.68 versus 1.60 ± 1.82 μmol, in HD and PD, respectively, P = 0.841), as well as the duration needed for task completion (191.53 ± 124.27 versus 200.19 ± 118.84 s, P = 0.781) were similar between groups. Furthermore, the average response in brain oxygenation during the handgrip exercise also did not differ between the groups (O2Hb change 1.20 ± 1.03 versus 1.49 ± 0.95 μmol, respectively, P = 0.262). In the total cohort, the average response in brain oxygenation during handgrip exercise was inversely correlated with dialysis vintage (P < 0.05).

CONCLUSION

Dialysis modality does not appear to have an impact on brain oxygenation, as HD and PD patients presented similar responses during a mental and a mild physical task. Dialysis vintage may negatively affect brain oxygenation in ESKD individuals.
MO694: Analysis of Mechanical Complications in Urgent-Start Peritoneal Dialysis
Authors: Nardelli Luca , Scalamogna Antonio , Cicero Elisa , Tripodi Federica , Castellano Giuseppe
Published: May 2022

BACKGROUND AND AIMS

Peritoneal dialysis (PD) is an excellent, but underutilized dialysis technique. Thus, its implementation might depend on the chance to offer this modality of treatment to late referral patients. This approach has been recently named ‘urgent-start peritoneal dialysis’ (UPD). The major barrier to this practice is represented by the belief that peritoneal exchanges can be safely started at least 2 weeks after catheter insertion, due to the concern of early mechanical complications. The study investigated the efficacy and safety of an UPD approach in our PD program.

METHOD

Between 1 January 2009 and 31 December 2019 all prevalent patients needing UPD at our institution were included in the study. During this period, 242 peritoneal catheters were inserted in 222 patients (Table 1). One hundred forty-eight catheters were positioned semi-surgically, while 94 were inserted surgically. In all patients, an anti-leakage/dislocation suture was made. PD was started within 24 h from catheter placement and peritoneal exchange scheme characterized by progressively increasing volume was used; early and late mechanical complications were also analysed. Finally,  all the causes of PD technique and catheter failure were reported.

RESULTS

The early incidence of leakages, catheter dislocations, omental wrappings, bleeding, peritonitis and exit-site infections was 11/242 (4.5%), 5/242 (2%), 3/242 (1.2%), 2/242 (0.8%), 6/242 (2.5%) and 4/242 (1.6%), respectively (Table 2). No bowel perforations were observed. The long-term leakage rate and catheter dislocation were 0.016 and 0.019 episodes/patient-year, respectively (Table 3). The survival of the catheter at 3, 6, 12, 24, 36 and 48 months was 93.6, 91.2, 84.8, 77.4, 65.5 and 59.3%, respectively (Fig. 1). The technique survival at 3, 6, 12, 24,  36 and 48 months was 97.2, 94.9, 87.6, 78.9, 66.6 and 60.0%, respectively (Fig. 2). The main cause of PD dropout was represented by infectious complications (nearly 40%) and mechanical complications (17.5%) leading to catheter failure (Fig. 3). No significant difference in the first catheter survival among the semi-surgical and the surgical arm was observed (HR 0.88 [CI 0.54–1.45], P = 0.62 [Fig. 4]).

CONCLUSION

A tight seal between deep cuff and surrounding tissue (double-purse string technique) with a low-volume exchange scheme allows starting UPD soon after catheter insertion minimizing mechanical complications. In patients without previous abdominal interventions semi-surgical technique is as effective as the surgical procedure in preventing early mechanical complications.
MO726: Skin Autofluorescence Profile in Tunisian Hemodialysis Patients with and Without Heart Failure
Authors: Ajimi Khawla , Sabra Aloui , Denden Ghada , Ben Tekaya Nawres , Ben Salem Meriem , Ben Salah Manel , Letaief Ahmed , Hammouda Mouna , Skhiri Habib , Kerkeni Mohsen
Published: May 2022

BACKGROUND AND AIMS

Cardiovascular disease (CVD) is the main reason for morbidity and mortality of patients in hemodialyis. Skin autofluorescence (SAF), a noninvasive measurement method, reflects tissue accumulation of advanced glycation end products (AGEs) that have been implicated in CVD as a strong marker. The aim of this study was to evaluate the SAF profile in hemodialysis patients and to assess the association between SAF and heart failure.

METHOD

In a cross-sectional study, we included 60 hemodialysis (HD) patients who were divided into two groups: a HD group without heart failure (n = 42) and a HD group with heart failure (n = 18). Skin AGE accumulation was measured by the AGE reader device and clinical data was obtained.

RESULTS

HD patients showed an SAF value at 2.90 (2.40–3.60). HD patients with diabetes mellitus has an increased SAF levels compared with HD patients without diabetes [3.20 (2.90–3.95) versus 2.70 (2.30–3.30) AU, P = 0.021, respectively]. Furthermore, HD patients with heart failure showed a significant increased SAF levels compared with HD patients without heart failure [3.65 (2.90–4.12) versus 2.60 (2.30–3.20) AU; P < 0.001, respectively]. SAF was associated with age, gender and duration of dialysis. The ROC analysis indicated that SAF at 3.05 AU was the optimal cut-off point for the presence of heart failure (P < 0.001).

CONCLUSION

SAF might be a rapid and helpful tool in clinical practice as a potential marker for evaluating and screening heart failure in HD patients non-invasively and might be used as a predictor for clinicians.
MO729: Chronic Heart Failure in Haemodialysis Patients
Authors: Borodulina Ekaterina , Shutov Alexander M
Published: May 2022

BACKGROUND AND AIMS

Left ventricular hypertrophy (LVH) and chronic heart failure (CHF) develop before the initiation of renal replacement therapy in most patients. Haemodialysis significantly changes the clinical of CHF. But the problem of CHF in haemodialysis patients remains extremely urgent because CHF is one of the most important causes of the development of life-threatening heart rhythm disturbances, which are the direct cause of death in haemodialysis patients. The aim of this study was to investigate the prevalence of symptomatic (NYHA Class II-IV) CHF in haemodialysis patients.

METHOD

Haemodialysis patients (n = 159; 77 males, 82 females, mean age was 55.6 ± 12.5 years) were studied. Echocardiography and Doppler echocardiography were performed according to the criteria of the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Left ventricular mass index (LVMI) was calculated. Left ventricular ejection fraction (LVEF) was measured by the echocardiographic Simpson method. The parameters of left ventricular diastolic function were evaluated by Doppler echocardiography. CHF was diagnosed according to criteria of the guidelines for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (2016). In addition, the assessment of CHF was carried out according to the ADQI heart failure in ESRD classification system (Table 1).

RESULTS

LVH was diagnosed in 116 (73%) patients. LVMI was 123.23 ± 22.32 g/m2. Concentric left ventricular hypertrophy was revealed in 106 (66.7%) patients, eccentric left ventricular hypertrophy was in 10 (6.3%) patients, concentric left ventricular remodelling was in 34 (21.4%) patients. Left atrial volume index > 34 mL/m2 was identified in 98 (61.6%) patients. E/e’≥13 was determined in 31 (19.5%) patients. Only 6 (3.8%) patients had LVEF˂50%. Symptoms of CHF were found in 49 (30.8%) patients. Class 2R was in 4 (2.5%) patients, class 2NR was in 36 (22.6%) patients, class 3R was in 1 (0.6%) patient and class 3NR was in 8 (5%) patients.

CONCLUSION

LVH was diagnosed in 73% haemodialysis patients. Most patients have left ventricular diastolic dysfunction. Symptoms of CHF were detected in 30.8% patients. These symptoms persist after RRT/UF in most patients.
MO745: Serum Endocan as a Risk Factor for Aortic Stiffness in Patients on Maintenance Hemodialysis
Authors: Huang Hsiang-Jung , Wu Tzu-Chiang , Lai Yu-Hsien , Lin Yu-LI , Hsu Bang-Gee
Published: May 2022

BACKGROUND AND AIMS

Endocan is secreted by the activated endothelium and plays a central role in inflammation and endothelial dysfunction, angiogenesis and vascular smooth muscle cell proliferation, it is associated with cardiovascular disease. This cross-sectional study aimed to assess the relationship between serum endocan levels and carotid–femoral pulse wave velocity (cfPWV) in patients on maintenance hemodialysis (HD).

METHOD

Blood samples and baseline characteristics were collected from 122 HD patients. Serum endocan concentrations were measured with an enzyme-linked immunosorbent assay kit. Aortic stiffness was defined as a cfPWV of more than 10 m/s.

RESULTS

Of the 122 HD patients, aortic stiffness was diagnosed in 53 (43.4%), and higher percentages of diabetes (P < 0.001) and hypertension (P = 0.030) were of older age (P = 0.007) and had higher systolic blood pressure (P = 0.011) and endocan levels (P < 0.001) in those with aortic stiffness than those without. After adjusting for factors significantly associated with aortic stiffness by multivariate logistic regression analysis, serum endocan [odds ratio (OR) 1.566, 95% confidence interval (95% CI) 1.224–2.002; P < 0.001], age (OR 1.040, 95% CI 1.001–1.080; P = 0.045), and diabetes (OR 4.067, 95% CI 1.532–10.798; P = 0.005) were independently associated with aortic stiffness in patients with chronic HD. Multivariable forward stepwise linear regression analysis also confirmed that the logarithmically transformed endocan level (β =0.405, adjusted R2 change = 0.152; P < 0.001) was an independent predictor of cfPWV values. The area under the receiver operating characteristic (ROC) curve predicting aortic stiffness by serum endocan level was 0.713 (95% CI 0.620–0.806; P < 0.001).

CONCLUSION

Serum endocan level positively correlates with cfPWV and is also an independent predictor of aortic stiffness in maintenance HD patients.
MO754: Impact of Calcium-to-Magnesium Ratio on Carotid Intima-Media Thickness—Cardiovascular Risk Assessment in Haemodialysis
Authors: Calças Marques Roberto , Afonso Rita , Borges Henrique , Carias Eduarda , Guilherme Patricia , Malho Guedes Anabela , Fragoso André , Silva Ana
Published: May 2022

BACKGROUND AND AIMS

Cardiovascular disease (CVD) is the leading cause of death in chronic kidney disease patients. The interaction between calcium and magnesium has been associated with several pathophysiological processes that occur in the vessel wall, such as endothelial dysfunction and vascular calcification. The aim of this study was to assess the relationship between calcium-to-magnesium (Ca: Mg) ratio and carotid intima-media thickness (CIMT), a widely used risk marker for CVD in the assessment of subclinical atherosclerosis. This study also aimed to establish the role of the Ca: Mg ratio as a predictor of cardiovascular mortality in haemodialysis (HD).

METHOD

Prevalent HD patients were enrolled in the longitudinal prospective study in a single tertiary centre. According to CIMT measured through B-mode ultrasound, the patients were divided into two groups: ≥0.9 mm (G1) and <0.9 mm (G2). Data from both groups were compared by Student's t-test. Partial correlation was used to assess the relationship between the variables under analysis and the CIMT, when controlled by dialysis time. The prevalence ratio of predictors of carotid thickening was calculated using a Poisson model with robust variance. Multivariable Cox regression analysis was performed to determine the predictive factors of cardiovascular death.

RESULTS

A total of 120 patients on HD were included with mean age 66.5 ± 13.97 years, 66.7% male. Magnesium (P < 0.001), Ca: Mg ratio (P < 0.001) and Adragão score (P <0.001) were statistically different between the two groups (Table 1). The partial correlation showed a strong positive association between CIMT and Ca: Mg ratio (r = 0.873; P <0.001) and a moderate association between CIMT and Adragão score (r = 0.614, P < 0.001), whereas there was a moderate negative correlation between CIMT and magnesium (r = –0.671, P <0.001). The Poisson model showed high prevalence of carotid thickening for higher values ​​of Ca: Mg ratio [aPR = 1.055, 95% confidence interval (95% Cl) 1.007–2.176] and Adragão score (aPR = 1.106, 95% Cl 1.006–1.351), and for lower magnesium values ​​(aPR = 0.462, 95% CI 0.248–0.861). Using the multivariate Cox model, age (HR = 1.045, 95% CI 1.012–1.084), Adragão score (HR = 1.078, 95% CI 1.006–1.234) and Ca: Mg ratio (HR = 1.154, 95% CI 1.098–2.236) were predictors of cardiovascular mortality.

CONCLUSION

In our population, the Ca: Mg ratio was a predictor of carotid thickening, so its monitoring can be useful to identify patients at higher cardiovascular risk. The Ca: Mg ratio was further validated as a predictor of cardiovascular mortality in HD patients. More studies are needed to better understand the relationship between this ratio and cardiovascular events.
MO755: Comparison of Techniques for Fluid Status Assessment in Chronic Hemodialysis Patients
Authors: Ekart Robert , Piko Nejc , Vodošek Hojs Nina , Jakopin Eva , Bevc Sebastjan , Hojs Radovan
Published: May 2022

BACKGROUND AND AIMS

Several methods have been developed to assess hydration status in chronic haemodialysis (HD) patients. The aim of this study was to compare multifrequency body bioimpedance spectroscopy (MBIS) with ultrasound lung comet scores (ULCs) and inferior vena cava diameters (IVCD) using ultrasound to estimate dry weight on the non-dialysis day.

METHOD

We evaluated MBIS, ULCs at 28 typical sites and IVCD during expiration in 40 HD patients. All measurements were performed on a non-dialysis day. For MBIS measurement, we used the Body Composition Monitor (Fresenius Medical Care, Bad Homburg, Germany), and for ULCs and IVCD, we used an ultrasound device (Esaote MyLabOmega, Genoa, Italy). Overhydration was defined as > 2L with MBIS, > 15 ULCs, and > 11.5 mm/m2 IVCD.

RESULTS

Mean age of patients was 65 (40–89) years, and 29 (72.5%) were men. Other descriptive data are in Table 1. We found a significant correlation between MBIS and ULCs (r = 0.464, P <0.003) and between MBIS and IVCD (r = 0.589, P <0.001). Multiple regression analysis with the MBIS as the dependent variable and ULCs, IVCD, albumin and haemoglobin as independent variables confirmed a statistically significant relationship between MBIS and IVCD (β = 0.436; P < 0.001). According to the overhydration criteria, 14 (35%) patients were overhydrated by MBIS, 8 (20%) patients by ULCs and 9 (22.5%) patients by IVCD. Only 4 (10%) patients met overhydration criteria simultaneously by all three methods (MBIS, ULCs and IVCD).

CONCLUSION

All methods were able to describe overhydration in HD patients on a non-dialysis day. The MBIS was associated with the IVCD.
MO769: Utility of Doppler Ultrasonography in the Evaluation of Arteriovenous Fistula, a Nephrologists Perspective
Authors: Gouthami Bendalam , Prasad Nagaraju Shankar , Attur Prabhu Ravindra , Rangaswamy Dharshan , Ramachandra Rao Indu , Vinayak Shenoy Srinivas , Bhojaraja Mohan V , Mulpuri Niharika
Published: May 2022

BACKGROUND AND AIMS

An arteriovenous (AV) fistula is preferred for long-term haemodialysis vascular access. AV fistula creation requires adequate arterial and venous anatomy to support its creation and a sufficient time interval to allow the AV fistula to mature prior to its use.  Failure to mature remains a problem highlighting the importance of the perioperative evaluation of the fistula. Ultrasound and colour doppler are a rapid, non-invasive and repeatable tools that can be used for the early diagnosis of vascular complications.

METHOD

A prospective, observational study was conducted at a tertiary hospital in South India. All the patients with arteriovenous fistulas made in the upper limb between the time period of June 2021–August 2021 were included. A preoperative doppler mapping and assessment of the upper lime was done by the nephrology team and two DUS exams in the post-operative period.

RESULTS

In our study, a total of 134 patients were evaluated with a mean age of 51.89 ± 13.7 years. The total number of males in the study was 115 (85.8%). The aetiology of end-stage renal disease (ESRD) was predominantly nondiabetic in origin seen in 56.7% of the patients. Ischaemic heart disease was seen in 36 patients. There were 116 brachiocephalic,18 radiocephalic AV fistulas in our group of patients. The overall success rate of the fistula was 79.9%. The average vein diameter in patients with successful AV fistula was 3.03 ± 1.05 mm and was 2.25 ± 0.9 mm in those who had a failed fistula. The average blood flow measurement in the proximal artery supplying the fistula was 479.42 ± 113.1 mL/min in the immediate post-op period and 1055.88 ± 227.6 mL/min at 6 weeks. There was a significant difference (P<0.05) in the blood flow measurement between those who achieved primary patency versus those with failure to mature.

CONCLUSION

It is essential for a practicing nephrologist to be acquainted with the technique of doppler to assess AV fistula to assess for maturity and to see for.
MO789: The Effect of Oral Vitamin K2 Versus K1 on Vascular Calcification in Hemodialysis Patients: A Randomized Controlled Trial
Authors: El Shinnawy Howayda , Elsaid Tamer , Farid Sarah , Shamseldin Ahmed , Ibrahim Sherin , Elsharabasy Reem
Published: May 2022

BACKGROUND AND AIMS

Vascular calcification is a common complication of end-stage renal disease and an important cause of cardiovascular diseases and mortality. Vitamin K is essential for the activation of matrix Gla protein (MGP), a powerful inhibitor of tissue calcification. However, there are limited data on the efficacy and safety of different vitamin K forms on vascular calcification in hemodialysis patients, most of whom are essentially vitamin K deficient.

METHOD

A prospective, randomized, placebo-controlled clinical trial, that included 120 eligible hemodialysis patients who were randomly assigned to one of three equal study groups: vitamin K1 (10 mg phytomenadione thrice-weekly), vitamin K2 (90 ug daily), or placebo for 3 months. Serum MGP, calcium, phosphorus, their product and intact parathyroid hormone (iPTH) levels were all assessed at baseline and at the end of the study.

RESULTS

MGP levels showed a significant increase in the vitamin K2 group (700%) compared with (78%) and (40%) in vitamin K1 and placebo groups respectively. No change was found in bone profile at 3 months compared with baseline at both of the treatment groups. No correlations between calcium, phosphorous and PTH and MGP levels at baseline or after treatment. None of the treatment group patients experienced any adverse effects.

CONCLUSION

Vitamin K supplementation was tolerable and effective in improving levels of a potent calcification inhibitor as MGP, with K2 form showing superiority over K1 in their impact on MGP levels among hemodialysis patients.
MO803: Cost-Effectiveness of Paricalcitol versus Calcitriol for Management of Secondary Hyperparathyroidism in Maintain Haemodialysis Patients in Beijing
Authors: Zhou Jiannan , Chen Gang
Published: May 2022

BACKGROUND AND AIMS

To compare the cost efficacy analysis and the effect on calcium and phosphorus variability of paricalcitol and calcitriol in the treatment of haemodialysis CKD-MBD patients in Beijing from the payer's perspective.

METHOD

Patients were divided into the paricalcitol group and the calcitriol group, and both groups could be treated with a combination of cinacalcet. The treatment duration was 6 months, and the attainment endpoint was a mean iPTH ≤ 300 pg/mL in the 4th–6th month of treatment. Efficacy was the attainment rate of patients in both groups. The cost is the sum of medications and laboratory tests over a 6-month period. We evaluated incremental cost-efficacy analysis (ICER) and plotted to scatter plots of incremental cost-effects using nonparametric Bootstrap repeated sampling 1000 times. A one-way sensitivity analysis of factors affecting ICER was also performed, and a probabilistic sensitivity analysis of parametric random sampling was performed using Monte Carlo simulation. The calcium and phosphorus smoothing index (SI) was applied to assess the effect of treatment on calcium and phosphorus variability.

RESULTS

The effective rates in the two groups were 88.7% (paricalcitol group) and 56.5% (calcitriol group), respectively. The cost-effect basis analysis showed that the ICER of paricalcitol and calcitriol and was CNY 41 554.702. The single-factor sensitivity analysis showed that the price of paricalcitol is the most sensitive factor, and the probabilistic sensitivity analysis showed that paricalcitol was a more economical solution when the willingness to pay (WTP) was above CNY 32 500. There are no differences of the calcium and phosphorus SI between two groups.

CONCLUSION

Paricalcitol has an economic advantage when the 6-month WTP is CNY 32 500 or more per effective patient treated.
MO820: Comparison of All-Cause-Mortality Before and After COVID-19 Vaccination in a Hemodialysis Center
Authors: Yavari Vahideh
Published: May 2022

BACKGROUND AND AIMS

Control of COVID-19 outbreaks in hemodialysis wards has been a great challenge for dialysis ward managers during the pandemic. Besides, frequent patient education and provision of sanitation and prevention protocols, COVID-19 vaccination brought light to systematic control of COVID mortality. The aim of this study was to assess the effect of the COVID-19 vaccination on all-cause mortality in our hemodialysis ward.

METHOD

Crude and age-adjusted mortality rates of 2-time frames, i.e. 6 July–6 December 2020 and the same period in 2021 (before and four weeks after full vaccination against COVID-19 with Sinopharm (Beijing): BBIBP-CorV) were compared. The data were processed with SPSS software version 26.

RESULTS

From 6 July to 6 December 2020, the crude all-cause-morality rate of our hemodialysis center was 9.12% (23 out of 252 patients). Between 6 July 2021 and 5 December 2021, the crude all-cause-morality rate was 6.74% (17 out of 252 patients). The same result was found after age adjustment of the morality rates.

CONCLUSION

COVID-19 vaccination reduced the all-cause mortality in our hemodialysis ward, as reported in the general population. Further multi-center studies are encouraged to study the effect of vaccination on the number of severe cases and the rate of hospitalization in this group of patients.
MO824: Utility of Novel Wireless Mobile Ultrasound Technology Via Nephrologists in Egyptian Hemodialyis Patients
Authors: Fatthy Abdelnaeem Moataz , Abdelaziz Tarek , Eldewi Sameh , Abdelghany Reham
Published: May 2022

BACKGROUND AND AIMS

Ultrasound and ultrasound-guided procedures are being widely applied in the field of clinical and interventional nephrology [1]. Many nephrology training programs still lack structured ultrasound training. Handheld mobile ultrasound provides affordability and ease of usage of the techniques [2]. To test the feasibility of hand-held mobile ultrasound in detecting incidental asymptomatic arterio-venous (AV) access or parathyroid gland as well as assessing volume status and detection of pericardial effusion [3].

METHOD

We recruited 344 patients with end-stage renal disease undergoing regular hospital haemodialysis. Informed consents for the procedure were obtained from all patients. All patients have undergone post-session chest ultrasound, bedside cardiac ultrasound to detect pericardial effusion, neck ultrasound to detect parathyroid adenoma and arterio-venous access ultrasound scanning. All ultrasound scanning was done by the same operator using: high frequency head (curvilinear head) to examine parathyroid glands, AV access and lung ultrasound. Low frequency (linear head) to examine the abdomen and pelvis and to detect pericardial effusion.

RESULTS

Lung ultrasound scanning detected pleural effusion in 3 patients and an increase in the B line in 12 patients. Pericardial effusion was detected in one patient. Parathyroid adenoma in one patient. Native AVF access stenosis in three patients and pseudo-aneurysm of AVG in one patient.

CONCLUSION

The use of handheld mobile ultrasound via mobile application enabled an easy and fast way to scan a large number of haemodialysis patients and detect asymptomatic pleural effusion, pericardial effusion, AV access malfunction and parathyroid adenomas. The integration of mobile ultrasound techniques into the care of end-stage renal disease on haemodialysis may be of significant added on value.
MO844: Immune Response to SARS-COV-2 Vaccines Among Haemodialysis Patients
Authors: Perysinaki Garyfalia , Papadaki Panagiota , Passam Andreas-Michahl , Ntaountaki Irini
Published: May 2022

BACKGROUND AND AIMS

Haemodialysis patients (HD) exhibit a poor immune response to vaccines. The aim of this study was to identify anti–SARS-CoV-2 spike protein antibody production following SARS-CoV-2 vaccination [1], determine variables affecting the response and compare with HBV vaccination response.

METHOD

Single centre prospective observational study. A total of 56 HD patients fully vaccinated for SARS- coronavirus (two doses) were followed until the day of anti–SARS-CoV-2 spike protein antibody assessment. The significance of difference was tested using either the t-test or Mann–Whitney rank-sum for continuous variables and the Chi-squared test for categorical variables. The SPSS version 22 (IBM, Armonk, NY) was used.

RESULTS

A total 56 patients, 62.5% males with a mean age 67.64 years and a median dialysis vintage 59 months were studied. Titers of antibodies were measured once in a median period of 138 days after the second vaccination and 76.8% of patients had a positive immune response. The same response, 76.5%, was exhibited for HBV vaccination. The age, gender, blood group, dialysis vintage, serum albumin, blood lymphocyte count, Kt/V and type of SARS-CoV-2 vaccine did not correlate with the immune response [2] (Table 1). Two females aged 81 and 50 years developed mild COVID at 140 and 118 days after the second vaccination, both with unknown antibodies at the time of infection.

CONCLUSION

Although the SARS-CoV-2 vaccination immune response is lower in HD patients than in the general population, it is the same as the response to HBV vaccination and from a clinical perspective it was protective against serious COVID in our population [3].
MO848: Platelet Thrombus Formation in Chronic Haemodialysis Patients Measured by the Total Thrombus-Formation Analysis System
Authors: Dimitrijevic Zorica , Wallen Håkan , Hosokawa Kazuya , Cvetkovic Tatjana , Mitic Branka , Tasic Danijela , Vrecic Tamara , Jovanovic Andriana , Jancic Nina , Agren Anna
Published: May 2022

BACKGROUND AND AIMS

Patients with end-stage renal disease (ESRD) receiving haemodialysis (HD) often experience bleeding. However, mechanisms behind this bleeding tendency are incompletely understood but may involve platelet dysfunction. We therefore studied platelet-dependent thrombus formation in flowing whole blood inside a microchip coated with collagen, and its association with circulating von Willebrand factor (VWF).

METHOD

Blood samples were obtained in 22 patients before and after HD. The area under the 10 min flow pressure curve in a microchip (AUC10) reflecting total platelet thrombogenicity was measured, using the Total Thrombus-formation Analysis System (T-TAS01). AUC10 < 260 indicates platelet dysfunction. VWF-antigen and measures of VWF-activity, i.e. VWF-RCo, VWF-CBA and latex-particle based VWF activity were also assayed.

RESULTS

VWF levels were moderately elevated and increased further after HD (P < 0.01 or lower). In contrast, AUC10 before and after HD was < 260 in 17/22 patients and < 130 in 15/22 patients, with no statistically significant difference in pre- versus post-HD measurements (median AUC10 in all patients 10.2 versus 20.3, respectively), altogether indicating reduced platelet thrombogenicity, but with some variability (5/22 patients with normal platelet responsiveness). AUC10 before and after HD correlated fairly well (r = 0.77, P < 0.001), and all VWF-related parameters (before versus after HD) were also correlated (r = 0.74 or higher; P < 0.0001). In contrast, no significant correlations were found between absolute values of AUC10 and any VWF-related parameters or between changes in values (i.e delta-values for differences between pre versus post HD).

CONCLUSION

Most ESRD-patients display moderate to severe platelet dysfunction as assessed by shear-induced collagen-dependent platelet thrombus formation with T-TAS01.Platelet thrombus formation under high shear, as measured by the collagen-coated PL-chip, is not importantly influenced by a moderate HD-induced increase in VWF. T-TAS01 should be further evaluated as a tool in the assessment of bleeding risk in patients on HD.
MO868: The Impact of Cognitive Impairment in Sleep Disorders in Haemodialysis and Peritoneal Dialysis Patients
Authors: Rroji (Molla) Merita , Shehaj Larisa
Published: May 2022

BACKGROUND AND AIMS

Patients undergoing dialysis have a higher cognitive impairment (CI) risk than the general population. We evaluated the association of cognitive function (CI) in haemodialysis (HD)and peritoneal dialysis patients (PD) and the relationship with restless leg syndrome (RLS) and hypersomnolence.

METHOD

This is a cross-section study evaluating 167 patients who met the inclusion criteria in the study. Of these, 39% were on Haemodialysis, 22% on Peritoneal Dialysis, 19% on Transplant and 20% with CKD stage IV-V. Cognitive impairment (CI) in the study population was assessed based on the MoCA test. Patients with a MoCA global score of 24/30 were considered cognitively impaired. The rating is classified: light, moderate, heavy and very heavy.The International Restless Legs Syndrome study group (IRLSSG) was used for evaluation of restless leg and the Epworth Sleepiness Scale is used as a The Epworth Sleepiness Scale is widely used in the field of sleep medicine as a subjective measure of a patient's sleepiness.

RESULTS

The frequency of CI based on the test classification was 20% mild, 61% moderate, 15% severe and 3% very severe. In the studied population, it was observed that there is a significant relationship between cognitive impairment and forms of renal replacement therapy (P < 0.001) and the etiology of the underlying disease, P = 0.0011). The multivariate linear regression test shows an independent relationship of CI with age, where each increase of 1 year in age leads to a decrease of 0.094 points of the MoCA test. Patients in the study were evaluated as having enough sleep (60.8% patients), mildly sleepy (10.1% patients) and sleepy (29.1% patients). In 59% of patients that responded positively for restless leg syndrome, the degree of severity was significantly correlated with dialysis treatment (P < 0.001) and not with time in dialysis. The comparison between the three tests performed in the studied population showed a positive correlation of sleepiness and restless leg syndrome (r = 0.32) and a negative correlation between CG and CK(r = –0.38).

CONCLUSION

In this study, we saw the impact of RRT on CI, RLS and Sleepiness, affecting the quality of life negatively. Cognitive function disorders negatively impact the independence of realizing essential life functions, thus reducing compliance with medical care. Sleep fragmentation in sleepiness can also affect CI through dysfunction in neural networks, particularly in the frontal lobes, probably reducing the efficiency of restorative processes in the prefrontal cortex leading to cellular and biochemical stress. RLS is associated with sleepiness, and both negatively affect the quality of life and emotional states like anxiety and depression.