bluuebunny/crossref_metadata_2025 huggingface dataset:
#624 The impact of hemoadsorption in patients with borderline chronic kidney disease undergoing coronary artery bypass grafting
Authors: Gunaydin Serdar , Karaca Okay Guven , Simsek Erdal
Published: May 2024

Background and Aims

With an annual incidence of up to 30%, cardiac surgery–associated acute kidney injury (CSA-AKI) may be one of the most underappreciated yet frequent complications and renal protective adjustments are crucial. We evaluated the impact of hemoadsorption as adjunctive therapy on clinical outcome in Kidney Disease Improving Global Outcomes (KDIGO) G2/A2) patients undergoing coronary artery bypass grafting (CABG).

Method

During a three-year period, 40 patients undergoing CABG with borderline chronic kidney disease (KDIGO-G2/A2) were treated with adjunctive hemoadsorption therapy and were compared by propensity score-matched 40 patients (KDIGO G2/A2) (Control). Primary endpoints were the need for renal replacement therapy (RRT)/dialysis and/or worsening of KDIGO stage in the perioperative period. Secondary endpoints were the change in inflammatory biomarkers, vasopressor requirement and ICU/hospital stay. In the study group, a 300 mL hemoadsorber (Cytosorbents Inc, NJ) was used for the entire duration of cardiopulmonary bypass (CPB). All patients were prepared via enhanced recovery after surgery (ERAS) protocol and surgical procedures were performed under moderate hypothermia with pulsatile flow and ultrafiltration. Patients with septic shock, limited life expectancy and refused to give consent were excluded.

Results

After institutional ethics committee approval was obtained, written informed consent was received from each patient. No significant difference was noted between groups in demographic, operative data and preoperative baseline laboratory. At the end of CPB; s-Creatinine (mg/dL) (1.85 ± 0.6 vs 2.751 ± 0.6; p = 0.035), NT-proBNP (pg/L) (130 ± 30 vs 180 ± 40; p = 0.04), IL-6 (pg/mL) (8.2 ± 4 vs 22.2 ± 4; p = 0.012) and myoglobulin (pg/L) (210 ± 75 vs 310 ± 80; p = 0.04) levels were significantly lower in the study group versus control. Clinical outcome is summarized in Figure.

Conclusion

This pioneering study demonstrated the additional protective effects of hemoadsorption in patients with borderline chronic kidney disease (KDIGO-G2/A2) undergoing CABG. Elimination of inflammatory parameters might be a complementary mechanism resulting in lesser worsening of kidney function/need of RRT and ICU stay. These findings require validation in large, multicenter trials.
#2188 Challenges in lipid control in the advanced chronic kidney disease clinic: findings from a cross-sectional study
Authors: Monzo Jose Jesus Broseta , Legarra María Iraola , Moncada Marina , Rodríguez Diana , Rodas Lida , Baldellou Néstor Fontsere , Vera Manel , Guillen Marta Arias , Cases Aleix , Maduell Francisco
Published: May 2024

Background and Aims

Chronic kidney disease (CKD) is associated with lipid metabolism disruptions and heightens cardiovascular (CV) risk. International guidelines categorize CKD patients into high CV risk (LDL target < 70 mg/dL and a reduction >50% from baseline) for CKD G3b A1, CKD G3a A2, and CKD G2 A3; and very high CV risk (LDL target < 55 mg/dL and a reduction >50% from baseline) for CKD G4 and G5, CKD G3b A2-3, and those with type 2 diabetes and G3a A2-3, G3b regardless of UACR, or UACR > 300 mg/g regardless of eGFR. This cross-sectional study aims to evaluate the challenges of achieving LDL targets in advanced CKD patients, focusing on statin use.

Method

A cross-sectional study enrolled 312 patients with advanced CKD. Collected data included demographics, renal function stage, albuminuria/proteinuria, diabetes, and cardiovascular history. Documented statin use specified type and potency. Statistical analysis employed descriptive measures.

Results

Of the 312 patients, 207 were males, with a mean age of 69.18 ± 10.26 years, mean eGFR of 27.54 ± 12.22, and LDL of 86.64 ± 32.9. The majority had a history of diabetes (158) and previous cardiovascular disease (100). 69.6% used statins, with atorvastatin being the most common (165), followed by simvastatin (26), pravastatin (11), rosuvastatin (10), and pitavastatin (5). Statin potency varied, with high potency in 49.4%, moderate in 49.2%, and low in 1.4%. Only 19.6% of patients achieved adequate lipid control per guidelines.

Conclusion

This study underscores the high prevalence of dyslipidemia and the challenges in achieving LDL targets in advanced CKD patients. Despite the presence of cardiovascular risk factors, including a history of cardiovascular events, the majority did not attain adequate lipid control, highlighting the imperative to address therapeutic inertia to prevent LDL detrimental consequences. Specific strategies are warranted, focusing on mitigating statins’ underutilization and low potency. Additionally, consideration of adjunct therapies such as ezetimibe and bempedoic acid is crucial. Exploring novel agents like iPCSK9 or inclisiran emerges as promising avenues for safer and more effective alternatives in this population at high cardiovascular risk.
#2703 Venous chambers vary in the reduction capacity of air microbubbles: a randomized study of chronic haemodialysis patients
Authors: Forsberg Ulf , Jonsson Per , Stegmayr Bernd
Published: May 2024

Background and Aims

The extracorporeal circuit (ECC) enables haemodialysis (HD) of patients. When the blood passes the ECC air contamination occurs, and consequently microbubbles (MBs) enter into the patient. MBs are verified at autopsy of HD patients and are covered by clots manifested as microemboli that are deposited within the lung, heart and brain tissue. A venous chamber is inserted in the ECC to reduce air contamination. However, venous chambers in clinical use have limited capacity in eliminating MBs from entering the return bloodline. In an in vitro study, the Emboless® chamber showed better results in comparison to models commonly used clinically (the best of the clinical models was the Fresenius 5008). Our aim was to determine if the Emboless® venous chamber differed in its capacity to limit MB exposure compared to the Fresenius 5008 (F5008) during HD and hemodiafiltration (HDF).

Method

Twenty chronic HD patients were included in a cross-over randomized study to compare the Emboless® to the F5008 venous chamber during HD. Each patient underwent a total of four dialyses divided into two paired series. This resulted in 80 studied dialyses, of which 32 included HDF. Dialyzers, blood-pump speed, HD or HDF, and ultrafiltration was the same between the pairs. MBs (20-500 µm, merged in intervals of 5 µm) were measured with an ultrasound device adjusted for HD (BCC200, GAMPT) at the ‘inlet’ and ‘outlet’ of the venous chamber. Measurements of MBs were done in the HD mode during the first 30 minutes, and if HDF was prescribed the measurement proceeded for another 30 minutes after the switch to the HDF mode (time was extended if fewer than 1000 MBs were detected at the inlet). The percentage of change in the ‘outlet’ versus ‘inlet’ counts was compared (paired Wilcoxon test). A total reduction was equal to −100%, while an increase (+) of MBs (worsening) was expressed as an unlimited percentage. If a diameter of an MB was without counts, it was not included in the analysis.

Results

For patients during HD, the median change of MBs in the outlet versus the inlet bloodline was −39% with the F5008 (n = 3807) and −76% with the Emboless® (n = 3805) venous chambers (p < 0.001, Fig. 1). For patients during HDF, the median change of MBs in the outlet versus the inlet bloodline was −28% with the F5008 (n = 1549) and −70% with the Emboless® (n = 1517) venous chambers (p < 0.001, Fig. 2).

Conclusion

Fewer MBs and subsequently fewer microemboli entered the patient using the Emboless® compared to the Fresenius 5008 venous chamber during HD, as well as during HDF. In considering previous autopsy studies, our results support less patient tissue damage when using the Emboless® venous chamber.
#2972 Comparison cTPE & DFPP in PIDC patients for procedure time, clinical, biological tolerance and microcosting estimation: lymphapheresis study
Authors: Moranne Olivier , Chkair Sihame , Pambrun Emilie , Ahmadpoor Pedram , Messikh Ziyad
Published: May 2024

Background and Aims

Therapeutic plasmapheresis (TP) is an established therapy in different pathology according to international guidelines. There is different method of TP such as single plasma exchange (SPE) and Double plasmafiltration (DFPP) defined as non selective or semi selective method. Centrifugal (cSPE) and Filtration-membrane based (mSPE) are two different methods of SPE. These methods were already compared but few data exist about comparison of cSPE and DFPP. Objective of this ancillary study is to compare procedure time, biological variation and microcosting of patients treated with cSPE vs DFPP in a prospective single case study (Moranne O BMC neurology 2022).

Method

Lymphapheresis study included 5 patients with idiopathic CIPD treated with chronic TP with regular interval time and clinically stable. Vascular access was central venous catheter (CVC) for 2 patients and peripheral venous access (PVA) for 3 others. cSPE or DFPP was randomized at inclusion then patient was alternatively treated for 6 consecutive session by SPEc (Comtec, FMC KABI) or DFPP (HF 440 Infomed) sessions for a total of 30 session. The target plasma TPV) volume to be processed was 1.5 of total plasma volume and was not modified during the study. Anticoagulation was non fractionated heparin for DFPP with CVC and regional citrate for others. For each session replacement fluid was 100% human serum albumin (HSA) 4% for cSPE and 500 mls HSA for DFPP. We compare cSPE and DFPP considering each patient for (i) time session (including time preparation, time device and time before living) (ii) clinical tolerance (iii) biological tolerance (variation before and after session of Hb, Platelet, Fibrinogen) and (iv) microcosting. Quantitative values were described with median interquartile and compared with mixed model regression analysis.

Results

Patients have median age of 62 [56-68] years with 100% male and a BMI of 27 [23-31]. Patients were treated alternatively with 15 session of cSPE and 15 session of DFPP without difference of TPV between session (4500 mls) but significant higher blood volume process because of lower plasma fraction filtration with DFPP. Time session was not different between TP method but depend on vascular access. No difference was observed for clinical tolerance and Hemoglobin variation between methods. However a significant higher decreased of platelet and fibrinogen was observed during session with cSPE vs DFPP. The quantity of SHA infused during session was significantly higher with cSPE vs DFPP (180 g vs 20 g). Finally according to hospital's perspectives the cost is not very different between cSPE and DFPP but depends on specific material resources and pharmaceutical products of methods.

Conclusion

We show some differences between methods.
#1465 Enhancing vascular access planning in CKD: validating the 40% KFRE threshold in a French retrospective cohort study
Authors: Ingwiller Maxime , Keller Nicolas , Krummel Thierry , Prinz Eric , Steinmetz Lydie , Hannedouche Thierry , Florens Nans
Published: May 2024

Background and Aims

The optimal timing for dialysis vascular access creation remains a complex clinical decision, balancing the risk of early intervention against the prospect of starting dialysis with a central venous catheter. This study sought to compare the predictive capabilities of the Kidney Failure Risk Equation (KFRE) and estimated Glomerular Filtration Rate (eGFR) in determining the appropriate timing for arteriovenous fistula (AVF) creation in patients with advanced chronic kidney disease (CKD).

Method

A retrospective cohort of 238 patients referred for ultrasound vascular mapping from April 2013 to June 2023 was analyzed. Data on patient characteristics, laboratory results, and clinical outcomes were collected. The 4-variable and 8-variable KFRE and eGFR were assessed for their ability to predict end-stage kidney disease (ESKD) within a 2-year period. Discrimination was evaluated using receiver operating characteristic (ROC) curves, and calibration was assessed graphically. Net benefit decision curves were utilized to compare the net benefit of the KFRE models at various threshold probabilities.

Results

The cohort comprised 238 patients with an average age of 65.2 years and a mean eGFR of 13.3 mL/min/m²73. During the median 10.7-month follow-up, 178 patients (74.8%) progressed to ESKD, and 21 (9.2%) died prior to reaching ESKD. At the 1-year mark, the probability of progressing to ESKD was 77.6% (95% CI, 69.9-85.3%) when a 40% threshold for the 4-variable KFRE was applied, compared to 65.8% (95% CI, 58.3-73.3%) with an eGFR threshold of 15 mL/min/m²73. Discrimination analysis demonstrated a superior predictive performance for the 8-variable KFRE at 6 months, with a C-statistic of 0.82 (95% CI: 0.76-0.88). At 1 year, both KFRE models showed strong predictive abilities, with C-statistics of 0.835 (95% CI: 0.78-0.89) for the 4-variable KFRE and 0.82 (95% CI: 0.76-0.875) for the 8-variable KFRE. Sensitivity and specificity analyses underscored the benefits of utilizing the 40% KFRE threshold for predicting ESKD over the eGFR threshold.

Conclusion

The study demonstrates that both the 4-variable and 8-variable KFRE are valuable tools for predicting the need for vascular access in pre-dialysis patients, outperforming eGFR alone. The 8-variable KFRE, in particular, provides a significant improvement in 6-months ESKD prediction, with potential implications for clinical decision-making and patient management in advanced CKD. These findings advocate for the incorporation of KFRE in the clinical evaluation process for timely and appropriate vascular access planning.
#540 Investigation of vascular sound visualization system using electronic stethoscope
Authors: Naganuma Toshihide , Shin Kentaro , Takemoto Yoshiaki , Uchida Junji
Published: May 2024

Background and Aims

The routine evaluation of VA involves visual, palpatory, and auscultatory examinations, as well as monitoring of venous pressure and other parameters. Surveillance indices include Flow Volume (FV) and Resistance Index (RI) obtained by Doppler ultrasound (DU) and Access Blood Flow (Qa) obtained by the Ultrasound Dilution Method (UDM) are well known. On the other hand, the MSS-U11C electronic stethoscope (Fig. 1) and dedicated application (Fig. 2) developed by Pioneer Inc. converts vascular sound into digital data and calculates the INDEX value obtained from the sound intensity (dB) analyzed by the vascular sound visualization system. In this study, we examined the correlation between INDEX values and conventional surveillance indices.

Method

1. Eighty-three cases in which INDEX, FV, RI, and Qa were simultaneously measured in hemodialysis patients with AVF at the Artificial Kidney Department of Osaka Metropolitan University Hospital were included. 2. The measurement site for INDEX was just above the anastomosis of the AVF. 3. FV and RI were measured using a KONICA MINOLTA SONIMAGE HS2 diagnostic ultrasound system with the brachial artery as the measurement site. 4. Measurements were expressed in Median [IQR], and for statistical examination, Pearson's correlation coefficient was used for the correlation of each measurement, transformed to the natural logarithm to satisfy the assumption of normality of the residuals. The significance level for all hypothesis tests was 5%. For statistical analysis, R version 4.2.1 (https://www.r-project.org/foundation/) with the “rms” and “RcmdrPlugin.EZR ” packages were used. 5. This study protocol was conducted in accordance with the Principles of the Declaration of Helsinki. The ethics review boards of Osaka Metropolitan University approved the study (No. 2021-243). Opt-out consent was obtained instead of written informed consent.

Results

INDEX showed a significant positive correlation with Qa and FV (R = 0.449, P = 0.002 / R = 0.484, P < 0.001, respectively), INDEX showed a significant negative correlation with RI (R = −0.336, P = 0.002).

Conclusion

INDEX measurement using an electronic stethoscope is a monitoring index and showed a positive correlation with FV and Qa, which are established surveillance indices, and a weak negative correlation with RI. In Japan, FV and RI are commonly used as surveillance indices, but it has been reported that these indices can be underestimated or overestimated depending on the skill of the examiner, and that Qa requires specialized equipment and cannot be measured depending on the puncture site. We believe that monitoring by stethoscope is influenced by subjective factors of staff members, which may lead to differences in evaluation, but INDEX could become a more quantitative and standardized indicator. In addition, the electronic stethoscope could be used without any difference compared to the stethoscope currently in clinical use.
#1228 MOTS-c improves CV and mortality risk prediction in chronic hemodialysis patients: a prospective, multicenter cohort study
Authors: Musolino Michela , Presta Pierangela , Duni Anila , Zicarelli Mariateresa , Arena Roberta , Pappas Efthymios , Andreucci Michele , Coppolino Giuseppe , Ntounousi Evangelia , Bolignano Davide
Published: May 2024

Background and Aims

Cardiovascular disease (CVD) is the leading cause of death in patients with end stage kidney disease (ESKD), especially in those undergoing chronic hemodialysis (HD), but correct risk prediction in this setting is often complicated.

The mitochondrial open reading frame of 12S rRNA type-C (MOTS-s) is a peptide encoded by mitochondrial DNA, mainly expressed by cardiac and skeletal muscle tissues, which may prevent CVD thanks to its remarkable anti-oxidant capacities. From a clinical point of view, altered circulating MOTS-c levels predict worsen CV outcomes, particularly among diabetic individuals or post-AMI patients. Mitochondrial dysfunction is highly pervasive in HD patients. Starting from this background, we aimed at evaluating the clinical significance and predictive usefulness of measuring circulating MOTS-c in a multicenter cohort of chronic HD patients, beyond common cohort-related risk factors.

Method

We conducted a prospective, observational study on 94 chronic HD patients. The study endpoint was a composite of all-cause/CV mortality and non-fatal CV events. We identified the cohort-related predictors of the endpoint by logistic and Cox-regression analyses and built prognostic models based on such variables. Performance of such models was tested before and after the inclusion of MOTS-c.

31 healthy patients were employed as controls. MOTS-c was measured in serum using a commercially available ELISA kit.

Results

MOTS-c levels were more elevated in HD patients than in controls (36.7 [24.9-49.9] vs. 13.8 [10.4-28.7] ng/mL; p < 0.001; Fig. 1) and independently correlated with a history of ischemic heart disease (β = 0.213; p = 0.03), LVMi (β = 0.185; p = 0.05) and phosphate plasma concentration (β = −0.201; p = 0.05). Of note, MOTS-c levels were even more increased in the 53 individuals experiencing the endpoint during a median 26.5. months follow-up (p = 0.01; Fig. 2).

MOTS-c predicted the endpoint at either multivariate logistic (OR 1.020; 95% CI 1.011-1.109; p = 0.03) or Cox-regression analyses (HR 1.004; 95% CI 1.000-1.025; p = 0.05) and the addition of this peptide to multivariate models including the other, cohort-related risk factors (age, LVMi, E/e’, diabetes, pulse pressure) remarkably improved the calibration, risk variability explanation (+3%), discrimination (ROC-AUC from 0.727 to 0.743; C-index from 0.658 to 0.700) and, particularly, the overall reclassification capacity (NRI 15.87%; p = 0.01).

Conclusion

Circulating MOTS-c balance is altered in chronic HD patients. In these individuals, MOTS-c may add significant information to improve CV and mortality risk prediction, on top of traditional and uremia-specific, cohort-related risk variables. Future investigations are needed to extend this preliminary observation in wider HD cohorts.
#1105 Prognosis of dialysis patients with obstructive sleep apnea syndrome diagnosed by polysomnography
Authors: Nakamura Kei , Iseki Kunitoshi , Iseki Chiho , Moromizato Takuhiro , Takara Chikashi , Nakamura Hiroshi
Published: May 2024

Background and Aims

Obstructive Sleep Apnea Syndrome (OSA) is common among CKD, in particular dialysis patients. However, it is not yet studied in a large polysomnography (PSG) database. Randomized controlled trials (RCTs) proved the effectiveness of continuous positive airway pressure (CPAP) for the SAS-related symptoms, but not for lowering the mortality risk of all-cause and cardiovascular disease. However, the effect of CPAP on mortality risk is not examined among dialysis patents.

Method

We identified dialysis patients by reviewing medical records in the Okinawa Nakamura Clinic (ONSLEEP). (J Clin Sleep Med 2021). In the ONSLEEP, a total of 10,856 Japanese patients received PSG from September 1990 to December 2010. We defined patients who were on CPAP more than one month as CPAP user. Patients qualified and eligible for CPAP but refused it were assigned as CPAP non-users. Median observation was 6.6 years. We studied 9,841 PSG patients after excluding those with insufficient data, age<20 years, and central SAS. Among them, we found 195 dialysis patients: 16 (1.0%) dialysis patients with AHI<5/hour in 1,665 subjects and 164 (2.5%) in 8,176 OSA patients. Mortality rate was compared between CPAP users and nonusers by multivariate logistic analysis adjusted for age, gender, body mass index (BMI), and apnea hypopnea index (AHI).

Results

Among the OSA dialysis patients (men 127, women 37), there were 116 (2.6%) in the CPAP users and 48 (2.2%) in the CPAP non-users, respectively. Number of deaths was 65 (39 CPAP users, 26 CPAP non-users) during the follow-up. The death rate was 33.6% in the CPAP users and 54.2% in the CPAP non-users, respectively. CPAP users showed better survival after starting dialysis; hazard ratio (HR) 0.52 and 95% confidence interval (CI) of 0.31 to 0.88 (P = 0.015). Age was also a significant predictor of death; HR (95% CI) 1.04 (1.02-1.06, P < 0.0001).

Conclusion

Dialysis patients with OSA showed better survival by use of CPAP. In dialysis patients, screening of OSA is recommended if they complained sleep problems such as insomnia, daytime sleepiness, headache, and fatigue. Also, we need further study for those CPAP nonusers.
#1252 Non-standardized definition of chronic dialysis within German health claims data results in varying estimates for incidence and mortality
Authors: Ebert Natalie , Bothe Tim , Fietz Anne-Katrin , Mielke Nina , Freitag Julia , Schaeffner Elke
Published: May 2024

Background and Aims

Chronic dependency on dialysis in patients with chronic kidney failure (CKF) demands invasive, high-risk, and costly treatments. At present, there is no standardized definition for dialysis-dependent CKF within German health claims data from statutory health insurance (SHI) funds.

Method

Random samples from four year tranches (2012, 2014, 2016, 2018), each with 62,200 individuals aged ≥70 years, of German health claims data of the SHI AOK Nordost were analysed. Four literature-based definitions of dialysis-dependent CKF (1–4) and a newly developed definition, based on a billing logic with criteria required for monetary reimbursement for chronic dialysis treatments in patients with CKF by SHIs, were selected. The definitions were compared with regard to sociodemographic and clinical characteristics, dialysis-dependent CKF prevalence and incidence (standardized by year-, age group-, and sex-specific weights for Northeast-Germany), overall mortality, and direct health care costs.

Results

All definitions of dialysis-dependent CKF resulted in varying estimates of 12-month prevalence (0.33–0.61%) and six-month incidence (0.058–0.100%). Depending on the definition, 27.6% to 61.8% of incident individuals had a preceding acute kidney injury (AKI). Survival probabilities of individuals with dialysis-dependent CKF ranged from 70.2% to 88.1% and 60.5 to 81.3% after three and six months, respectively (Fig. 1). After stratification, survival probabilities differed less between the definitions in individuals without a preceding AKI. Monthly health care cost ranged from 6,010 to 9,606 EUR and varied strongly in out- and inpatient treatment costs depending on the definition. Cost was highest in inpatients with preceding AKI.

Conclusion

Due to a non-standardized definition of dialysis-dependent CKF in claims data we found varying case numbers, mortality, and health care costs, most probably in large part explained by the discrepant inclusion of individuals with short-term dialysis treatment due to AKI.
#82 Serum zinc level is associated with aortic arch calcification in patients with incident dialysis
Authors: Saka Yosuke , Naruse Tomohiko
Published: May 2024

Background and Aims

Aortic calcification is one of predictors of cardiovascular (CVD) events. Several studies show association between zinc deficiency and aortic calcification in patients with chronic kidney disease (CKD). However, there are few studies in patients with advanced CKD. Therefore, we investigated associations between serum zinc (s-Zn) levels and aortic arch calcification (AAC) in patients with incident dialysis.

Method

We analyzed data from 776 consecutive patients with CKD who started dialysis at our hospital between January 2013 and December 2022. We excluded 71 patients who were supplemented with zinc or who were not measured laboratory data including serum zinc at the time of dialysis initiation. AAC is graded from 0 (no calcification) to 3 on chest X-ray, as follows: grade 0, no visible calcification; grade 1, < 50% calcification in the arch; grade 2, > 50% calcification; grade 3, circumferential calcification. We defined grade 2 or 3 as severe calcification.

Results

The median s-Zn levels were 51, 47 and 44 μg/dL in patients with grade 0, 1 and 2-3 on AAC, respectively (p < 0.0001). The optimal cutoff value for s-Zn levels was 48 μg/dL in receiver operating characteristic (ROC) curves analysis. In multivariate analysis, low s-Zn level (s-Zn < 48 μg/dL) was independently associated with AAC [OR 2.36 (95% CI 1.55–3.60), p < 0.0001)], especially with severe AAC [OR 4.59 (95% CI 2.46–8.59), p < 0.0001)]. Addition to s-Zn level in a model with established factors on AAC improved the C-index (0.812 to 0.824, p = 0.0181), net reclassification improvement (NRI) (0.397, p < 0.0001) and integrated discrimination improvement (IDI) (0.020, p < 0.0001). More robust findings for the C-index (0.856 to 0.878, p = 0.0077), NRI (0.591, p < 0.0001) and IDI (0.045, p < 0.0001) were observed on severe AAC.

Conclusion

Low s-Zn level was independently associated with severity of AAC, also in patients with incident dialysis.
#570 A study of QTc time trends and factors affecting QTc changes during dialysis
Authors: Mimura Yasuyuki , Kuma Akihiro , Tasaka Mariko , Suwabe Atsuko , Nanami Masayoshi , Nakanishi Takeshi , Kuragano Takahiro
Published: May 2024

Background and Aims

Several studies have revealed the relationship between an abnormal QTc interval and mortality with sudden death in patients undergoing haemodialysis (HD). The QTc interval in HD is regulated by several factors, such as electrolytes, pH, and drugs. However, few studies have investigated the changes in the QTc interval during HD sessions and the determining factors. Therefore, we investigated the relationship between changes in electrolytes and QTc interval during HD.

Method

In this cross-sectional study, 53 patients undergoing maintenance HD were enrolled. Electrocardiogram and blood samples were obtained two days after dialysis. QTc was measured every hour from the start of the HD session, and blood samples were collected at the start, 2 h after, and at the end of the HD session. At the start of the HD session, we measured the blood levels of urea nitrogen, creatinine, β2-microglobulin (β2MG), HCO3-, albumin, intact-parathyroid hormone, phosphorus, Ca, Mg, and K. Blood Ca, Mg, K, and HCO3- levels were evaluated at the start, 2 h after, and at the end of the HD session. The relationship between changes in the QTc interval and various parameters was analysed by Spearman correlation analysis and multiple regression analysis.

Results

The patients were aged 37–91 (median; 71.5) years, and the duration of dialysis was 1–402 months (median; 2 months). Of the patients, 40.4% were diagnosed as the prolonged QTc interval (≥460 ms) at the start of HD (median; 455 ms). Conversely, 15.9% of patients at 2 h after the start of HD (median; 444 ms) and 8.4% of patients at end of HD (447 ms) were normalized in QTc interval. The peak change in the QTc interval occurred 2 h after start of HD. Thus, we estimated the factors that affected the change in QTc 2 h after the start of dialysis (ΔQTc2h). The duration of HD treatment (r = 0.312, P = 0.025) and serum levels of β2MG (r = 0.324, P = 0.019) were positively correlated with ΔQTc2h. The 2-h change in corrected Ca (ΔcCa2h) (r = −0. 31, P = 0.03) and intact-PTH (r = −0.30, P = 0.035) were negatively correlated with ΔQTc2h. We found no significant correlation between ΔQTc2h and changes in K and Mg. According to the multiple regression analysis, ΔcCa2h (β = −0.293, P = 0.033) and β2MG (β = 0.271, P = 0.042) were significant predictors of ΔQTc2h.

Conclusion

We anticipated that QTc interval might be prolonged due to the decreased serum K and Mg levels via HD treatments. However, QTc levels during HD were shortened according to increased serum Ca levels. Among the electrolyte levels, the change in blood Ca was significantly correlated with the change in the QTc interval but not with the change in Mg and K. The study results suggest the importance of optimal dialysate electrolytes composition to prevent adverse events and premature death caused by abnormalities in the QTc interval.
#2708 Impact of dialysis modality on bone phenotype
Authors: Lloret Maria Jesus , Jørgensen Hanne Skou , Verhulst Anja , Bammens Bert , Claes Kathleen , Devusser Katrien , Meijers Björn , Van Craenenbroeck Amaryllis , De Loor Jetty , Cavalier Etienne , Evenepoel Pieter
Published: May 2024

Background and Aims

Literature data suggest that low bone turnover is the prevailing bone phenotype in patients treated with peritoneal dialysis (PD) and point to high sclerostin as the central culprit. Lack of adequate controls, diagnostic heterogeneity, and a changing mineral metabolism landscape and armamentarium call for a cautious interpretation and confirmation in contemporary patients.

Method

Laboratory parameters of mineral metabolism (biointact parathyroid hormone (PTH), fibroblast growth factor 23 [FGF23] and sclerostin), bone turnover markers (bone alkaline phosphatase [BALP], intact procollagen type I N-terminal propeptide [PINP], tartrate-resistant acid phosphatase 5b [TRAP5b]) and bone mineral density (BMD) were assessed in 636 non-diabetic kidney transplant candidates of whom 447 were treated with hemodialysis (HD) and 189 with PD. A bone biopsy was performed in 204 patients (n = 134 HD; n = 70 PD), with bone sclerostin expression assessed in a subset (n = 52).

Results

Patients treated with PD had lower levels of PINP (79.6 vs 99.5 ug/L; p < 0.01) and BALP (20.2 vs 23.7 ug/L; p = 0.04) compared to those treated with HD. Histomorphometric parameters of bone formation were numerically lower in patients treated with PD, but significance was not reached. Bone mineralization was impaired in HD patients (osteoid width: 7.90 vs 6.75 µM; p = 0.01; osteoid maturation: 9 vs 6 days; p = 0.03), while frank osteomalacia was rare in both modalities (6.0%, both groups). BMD was higher in patients treated with PD compared to HD at skeletal sites rich in cortical bone (Z-score midshaft radius −0.4 ± 1.3 vs −0.9 ± 1.7; p = 0.04). PTH levels were comparable (150 vs 144 pg/mL, PD vs HD), while patients treated with PD showed higher serum phosphate (4.9 ± 1.3 vs 4.5 ± 1.6 mg/dl; p < 0.01) and FGF23 levels (3852 pg/ml vs 2361 pg/ml; p = 0.01). Circulating (1.82 ng/mL, both groups) and bone tissue expression (205 ± 126 vs 206 ± 112 positive osteocytes per mm2) of sclerostin did not differ between groups.

Conclusion

Patients treated with PD present a lower bone turnover, better mineralization, and higher cortical BMD than counterparts treated HD. Overall, differences are marginal and most probably clinically irrelevant. We speculate that inferior phosphate control may be in the causal pathway.
#1736 Correlation between chronic kidney disease-mineral and bone disorder parameters and clinical events in hemodialysis patients
Authors: Rotondi Silverio , Palladino Gaia , Tartaglione Lida , Pasquali Marzia , Lai Silvia , Perrotta Adolfo Marco , Mazzaferro Sandro
Published: May 2024

Background and Aims

Patients with chronic kidney disease experience mineral and bone metabolism alterations, collectively known as Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD), linked to elevated cardiovascular mortality. A significant biochemical change is the development of secondary hyperparathyroidism—an adaptive response to uremic conditions that, when surpassing critical thresholds, becomes maladaptive, heightening clinical risk. Presently, optimal parathyroid hormone (PTH) values for hemodialysis (HD) patients lack a clear definition, with recent evidence challenging international guideline limits. This study aimed to evaluate the impact of PTH values on mortality in a population of patients in HD.

Method

A prospective observational study involving chronic hemodialysis patients commenced in January 2020, with a 40-month follow-up for mortality recording. Exclusion criteria comprised parathyroidectomy, primary hyperparathyroidism evidence, prior kidney transplant, or transplant plans within three months. Clinical and biochemical data, aligned with the 2017 KDIGO guidelines for PTH, calcium (Ca), and phosphorus (Ps) target values, were recorded. Our laboratory PTH values ranged from 25 to 88 pg/ml, and stable PTH values within 180 to 700 pg/ml were deemed adequate in HD patients. Patients were categorized based on the average of three values over 12 months for PTH, Ca, and Ps parameters.

Results

One hundred patients (average age: 71 ± 13.59) were enrolled. Seventy-seven percent achieved PTH targets (180-700 pg/ml), 73% for Ca, and 19% for phosphorus (Table 1). During follow-up, 36 deaths (36%) occurred. While percentages of target achievement were similar between survivor and non-survivor groups, non-survivor patients exhibited higher PTH values (423.08 ± 277 vs. 360.44 ± 214.92; p = 0.05) without differences in Ca and Ps levels between the two groups (Table 2). Stratifying based on the median PTH value (330 pg/ml) revealed higher mortality in patients with PTH > 330 pg/ml (Log-rank test p = 0.05) (Fig. 1).

Conclusion

Despite comparable target achievements for PTH, Ca, and Ps, deceased patients had elevated average PTH values, especially those exceeding 330 pg/ml, indicating a higher risk of death during our follow-up.

In line with recent literature, these findings underscore PTH's role as a uremic toxin, suggesting a revaluation of current PTH targets for hemodialysis patients
#2786 Effect of intradialytic virtual reality exercise program on lower limb muscle strength in patients on hemodialysis
Authors: Reboredo Maycon Moura , Pinton Marcelly Oliveira , Barros Fabrício , Silva Daniele Thomé , Gravina Emanuele Poliana Lawall , de Lima Souza Dias Ana Paula , de Lima Assis Maria Clara , Lucinda Leda Marília Fonseca , Segura-Orti Eva
Published: May 2024

Background and Aims

In patients on hemodialysis, muscle weakness is highly prevalent and may lead to frailty, limitation of mobility and functional impairment. Moreover, low muscle strength was associated with an increase in mortality risk in these patients. Despite the fact that some studies showed that resistance training improves muscle strength in patients on hemodialysis, the effects of virtual reality (VR) exercise should be confirmed. Therefore, the aim of this study was to evaluate the effects of an intradialytic non-immersive VR exercise program, performed at different times during the hemodialysis session, on lower limb muscle strength in patients on hemodialysis.

Method

A randomized clinical trial was conducted with patients aged ≥18 years who were undergoing hemodialysis treatment for at least 3 months. Patients were randomized into 2 protocols of exercise at different times during the hemodialysis session (first 2 hours and last two hours) for 3 months. The intradialytic exercise program in both groups consisted of a non-immersive VR game (Treasure Hunting) in which the patients try to catch treasures and avoid bombs by moving their lower limbs (hip flexion, abduction and adduction, and knee flexion and extension), with a progressive duration of 6 to 36 minutes. The difficulty level of the game was graduated according to the characteristics of each patient. The muscle strength of the hip flexion (HF), hip abduction (HA) and ankle extension (AE) was evaluated using a portable handheld dynamometer during hemodialysis session. Patients were advised to perform a 5 s maximum isometric contraction, and the peak values were recorded for 3 repetitions in both lower limbs. The mean muscle strength of 3 trials was recorded. Data were expressed as the median (interquartile range). The Mann‒Whitney U test was used for between-group comparisons. The Friedman test was conducted to evaluate the differences in medians among the muscle strength data at baseline, after 1, 2 and 3 months of exercise program.

Results

This study included 11 patients in the exercise within the first 2 hours group [50 (55-75) years, 55% male] and 11 patients in the exercise within the last 2 hours group [64 (58-72) years, 64% male]. Table 1 shows that muscle strength of the HA and AE increased significantly in the exercise within the first 2 hours group. Muscle strength of HF, HA and AE improved significantly in the exercise within the last 2 hours group. There were no significant differences between two groups.

Conclusion

This study suggests that an intradialytic non-immersive VR exercise program can improve lower limb muscle strength in patients on hemodialysis.
#941 Pentraxin-3 as a marker of coronary artery disease in hemodialysis patients
Authors: Milicevic Jovana Kusic , Vidakovic Radosav , Markovic Rodoljub , Apostolovic Marija Andjelkovic , Coric Vesna , Stankovic Jasna Trbojevic , Ercegovac Marija Pljesa , Jemcov Tamara , Dragovic Gordana
Published: May 2024

Background and Aims

Pentraxin-3 (PTX3), a novel inflammatory biomarker, has been recognized as a predictor of cardiovascular events in the general population, including coronary artery disease (CAD). Although PTX3 is elevated in dialysis patients, its potential diagnostic value for the estimation of CAD severity is still insufficiently studied. The aim of this study was to evaluate the association between PTX3 and CAD in hemodialysis patients.

Method

This cross-sectional study included 60 angina-free chronic hemodialysis patients (60% men, mean age 60 ± 11 years, mean dialysis vintage 26 ± 14 months). Coronary artery calcium score (CACS) and coronary computed tomography angiography (CCTA) were performed to evaluate CAD burden and stenosis severity, which was defined as significant if obstructing more than 50% of the vessel lumen. PTX3 was quantified using an enzyme-linked immunosorbent assay kit.

Results

Significant coronary artery stenosis was detected in 24 (40%) patients, of which the majority (17; 70.83%) had one-vessel disease. PTX3 was 194.82 ± 68.58 ng/mL in patients with significant CAD, whereas 83.55 ± 11.89 ng/mL in those without significant coronary artery stenosis (p = 0.028). PTX3 levels tend to increase in patients with CACS higher than 200 Agatston units, however statistically significant difference was not reached (p = 0.504). PTX3 levels correlated with age (p < 0.05) and c-reactive protein (p = 0.007), while negatively correlated with body mass index (p < 0.05).

Conclusion

PTX3 is significantly increased in hemodialysis patients with coronary artery disease. Further studies should elucidate if including PTX3 as a marker for detecting CAD prior to invasive imaging could improve cardiovascular risk stratification even in angina-free hemodialysis patients.
#2895 Erythropoietin Resistance Index (ERI) between mortality and metabolic changes in a cohort of hemodialysis patients. What acts below the surface?
Authors: Abinti Matteo , Alfieri Carlo Maria , Caldiroli Lara , Mattinzoli Deborah , Castellano Giuseppe , Vettoretti Simone
Published: May 2024

Background and Aims

The management of anemia in hemodialysis patients (HD-ps) is influenced by many factors, including inflammation, martial balance (MB) and mineral metabolism (MM). Recent data would identify the Erythropoietin Resistance Index (ERI) as an indicator of mortality risk in HD-ps. The objective of the present study was to evaluate the relationship of ERI with inflammation, MB and MM, as well as all-cause mortality in a cohort of HD-ps.

Method

An observational-retrospective study was performed on 100 HD-ps, excluding those with acute or chronic infections (3 months), neoplasia, or immunosuppressive therapy. Mortality was considered primary outcome along a 2-year follow-up (FU).

Results

HD-ps, predominantly males, had advanced mean age, good Hb values and fair biochemical control. ERI showed significant correlations with some elements of inflammation, MM and BM (Table 1), including c-terminal fragment of Fibroblast Growth Factor 23 (cFGF23). At multivariate, ERI remained influenced by cFGF23 (p = 0.009), iron (p = 0.002) and transferrin (p = 0.007). Furthermore, after 2 years of FU, 42% of HD-ps died. As shown in Table 2, HD-ps that faced the primary outcome (death) were older, had lower levels of albumin, hemoglobin and transferrin, and higher levels of IL6, parathormone (PTH), reactive C protein (PCR), and ERI (p < 0.035). In multivariate, ERI (p = 0.011), age (p = 0.001) and albumin (p = 0.010) remained significant for the outcome studied.

Conclusion

Our data, albeit on few HD-ps, show a possible association between ERI and mortality. ERI was found to be related to several factors, including cFGF23, itself a factor implicated in maintaining a baseline inflammatory state. The results suggest the possible presence of some pathological mechanisms that can act silently with a negative impact on survival. Certainly, increased numbers and a prospective design could better clarify the explored relationships in the future.
#372 Cross-sectional association between serum magnesium with cognition in patients undergoing hemodialysis: the Osaka Dialysis Complication Study
Authors: Shoji Tetsuo , Mori Katsuhito , Nakatani Shinya , Morioka Tomoaki , Fujii Hisaka , Emoto Masanori
Published: May 2024

Background and Aims

Impaired cognitive performance is common in patients with chronic kidney disease including those undergoing haemodialysis, although the mechanisms are not well understood by which chronic kidney disease affects cognitive function. Phosphate plays an important role in the development of aging phenotypes particularly in patients with chronic kidney disease. Phosphate toxicity is thought to be mediated by calciprotein particles, and a shorter T50 reflects a higher propensity of transformation of primary to secondary calciprotein particles. T50 is known to be affected by phosphate, fetuin-A, magnesium, and others. We examined possible relationship between cognitive function and CKD-MBD-related factors in patients undergoing haemodialysis.

Method

This was a cross-sectional study in 1207 patients on maintenance haemodialysis selected from the participants of Osaka Dialysis Complication Study (ODCS). Cognitive function was assessed by Modified Mini-Mental State examination (3MS). Associations of serum calcium, phosphate, intact PTH, magnesium, fetuin-A, and T50 with 3MS was examined by multiple regression models adjusted for age, sex, dialysis vintage, diabetic kidney disease, prior stroke, prior non-stroke cardiovascular disease, education level, SBP, DBP, Hb, BMI, serum albumin, and CRP.

Results

Serum magnesium and phosphate levels were significantly and positively associated with 3MS level independent of the potential confounders, whereas other factors were not.

Conclusion

We found positive associations of cognitive performance with serum magnesium and phosphate levels in haemodialysis patients, suggesting the roles of CKD-MBD-related factors in impaired cognition in this population.
#2196 Impact of intradialytic exercise on blood pressure and quality of life in hemodialysis patients: a randomized controlled trial
Authors: Ramadan Shaimaa R , Tawfik Mona , Abdelsalam Adel , Elshabrawy Nehal
Published: May 2024

Background and Aims

Hemodialysis is essential for end-stage renal disease (ESRD) patients, but they often face complications affecting their quality of life and cardiovascular health. Exercise has emerged as a potential adjunct therapy for improving outcomes in hemodialysis patients. This study aimed to examine the effects of exercise during dialysis on laboratory parameters, intradialytic blood pressure events, and quality of life in hemodialysis patients.

Method

An Egyptian dialysis center conducted a 6-month randomized controlled trial involving 80 hemodialysis patients. Patients were randomized into two groups: an intervention group (40 patients), which engaged in 30-minute exercise)in the form of 15 minutes for cycler and 15 minutes for hand grip (three times per week during dialysis sessions, and a control group (40 patients), which did not exercise. Laboratory investigations were performed before and after the intervention, measuring hemoglobin, serum sodium, potassium, calcium, phosphorus, and intact parathyroid hormone (iPTH). Intradialytic blood pressure events were recorded, and quality of life (QOL) was assessed using the Arabic version of the kidney disease and Quality of Life-Short Form 36 (KDQOL-SF™) Questionnaire.

Results

The intervention group exhibited a statistically significant reduction in inter-dialytic hypertension episodes compared to the control group (partial η² = .142, Cohen's f = .407). Additionally, the intervention group showed a significant increase in the physical composite score (partial η² = .178, Cohen's f = .465) accompanied by a significant decrease in the mental composite score (partial η² = .232, Cohen's f = .550) Moreover, The intervention group demonstrated a significant reduction in serum calcium levels post-intervention compared to the control group (partial η² = .069, Cohen's f = .272), with a positive correlation between the change in calcium level and the change in the physical composite score.

Conclusion

These findings indicate that exercise during haemodialysis may contribute to better blood pressure control and improved physical functioning. Incorporating exercise into the dialysis routine may serve as an effective approach to optimize the health and well-being of haemodialysis patients. Further research should focus on long-term effects and optimal exercise protocols to maximize these benefits.