bluuebunny/crossref_metadata_2025 huggingface dataset:
P1360ARTERIOVENOUS FISTULA MATURATION DELAY - ENDOVASCULAR TREATMENT IS A VALID APPROACH
Authors: Nogueira Rui , Oliveira Nuno , Ferreira Emanuel , Belmira Ana , Alves Rui
Published: June 2020

Background and Aims

Arteriovenous fistula is the optimal vascular access for hemodialysis as it has the best long-term patency rate and the lowest complication rate among hemodialysis vascular accesses. However, its occasional delayed maturation poses a challenge. Surgery has been advocated as the best treatment option. We proposed to evaluate the results of endovascular approach of arteriovenous fistula’s maturation delay in our hospital.

Method

We conducted a retrospective study, selecting patients referenced to our diagnostic and therapeutic angiography unit due to arteriovenous fistula delayed maturation, between April 2017 and October 2019. Physical examination and echography were used to confirm arteriovenous fistula delayed maturation.

Results

Thirty patients were referenced. Nine were excluded as maturation delay was not confirmed. Three patients were excluded due to extensive outflow stenosis since they were proposed to new vascular access creation. The other 18 patients were subjected to percutaneous endovascular treatment. Mean patient’s age was 65 years old. Twelve patients (66,7%) had forearm fistulas and the remaining (33,3%) had arm fistulas. Fourteen patients (77,7%) had maturation delay due to peri-anastomotic stenosis. The mean follow-up time was 14 months, (minimum - 3 months; maximum - 33 months). Seventeen fistulas (94,4%) were salvaged, although 3 (16,7%) needed a second intervention. Primary and secondary patencies at 3, 6 and 12 months were 77,8% vs. 94,4%, 69,2% vs. 92,3% and 75% vs. 100%, respectively. Arm fistulas had 83,3% of primary and secondary patencies. Forearm fistula’s primary and secondary patencies were 66,7% vs. 91,6%, 57,1% vs. 100% and 60% vs. 100%, at 3, 6 and 12 months, respectively. When maturation failure was due to peri-anastomotic stenosis, primary and secondary patencies were 71,4% vs. 92,9%, 66,7% vs. 100% and 66,7% vs. 100% at 3, 6 and 12 months, respectively.

Conclusion

Even though we are still lacking consensus about the best treatment option for fistula’s maturation delay, current guidelines suggest that, at least in delayed maturation due to peri-anastomotic stenosis, surgery may be the best treatment. Our results point out that endovascular treatment is a good treatment option for arteriovenous fistulas with maturation delay, mainly in the arm fistulas. Even though surgical treatment appears to have better primary patency, a step by step approach seems to be a valid approach, as our secondary patency shows.
P1365HEMODIALYSIS CATHETER-RELATED BLOODSTREAM INFECTIONS : A CASE SERIES
Authors: Amal Ouni , Ben salem Meriem , Mojaat Malek , Mayssa Hadj Brahim , Manel Ben salah , Hammouda Mouna , Insaf Handous , Ahmed Ltaief , Fawzi Hawala , Jaafer Ines , Sabra Aloui , Skhiri Habib
Published: June 2020

Background and Aims

the recourse to catheter among patients on hemodialysis is frequent due to many reasons. It is highly associated to a risk of infection in comparison to AVF. The aim of our study was to determine the clinical and bacteriological parameters in patients hospitalized for dialysis catheter related bloodstream infections.

Method

We conducted a retrospective descriptive study based on the data of patients hospitalized for hemodialysis catheter-related bloodstream infection in the department of nephrology in Fattouma Bourguiba University hospital between January 2013 and February 2018. Data concerning the bacteriological exams were obtained from our bacteriology laboratory.

Results

50 patients were included with a mean-age of 56 years old. 74% were women, 30% diabetic and 18% considered immunodepressed. The indications for the placement of catheter were: 21 patients waiting for the creation of AVF, 16 patients with a dysfunction of AVF, 6 patients with AKI and 7 patients with inadequate veins for the creation of AFV. The IJV was the site of insertion in 74% of patients (with 4 % of tunneled catheters).

26 % of patients developed a septic choc, and 74 % developed a sepsis. The culture of the specimen of catheters was positive in 32 patients (64%). Staphylococcus aureus was isolated in 14 patients (28%) with MSSA among 8 patients and enterobacteria among 8 patients. Hemoculture was only positive in 13 patients. The catheter was removed in the majority of cases except in 6 patients in whom there was no other venous access. The evolution was favourable in 80 % of patients. 5 patients developed an infective endocarditis as a secondary localization.

Conclusion

The AVF remains the best vascular access for hemopadialysis patients. The recourse to catheters must be considered as a last choice because of the risk of infections which frequently necessitates the hospitalization with an increase in mortality.
P1366THE ROLE OF A NEPHROLOGIST IN THE CREATION OF VASCULAR ACCESS FOR HEMODIALYSIS
Authors: Fomenko Gennadii
Published: June 2020

Background and Aims

The creation of vascular access: has it anything to do with a nephrologist ? At first glance, the concept of vascular access is the responsibility of surgical specialists. However, a nephrologist has started executing some of the common intensive treatment methods, using the equipment and techniques, specific to the field of dialysis. In this case, a nephrology specialist sets up different kinds of vascular access, namely the AV (arteriovenous) fistula, the AV graft, and the venous catheter; he/she is, therefore, responsible for its assessment and congruent correction.

Method

the usage of statistical data, gathered by the medical specialists of the dialysis unit of the Regional Chernihiv Hospital; the analysis of the possible nephrologist’s contribution to the creation of vascular access in patients with kidney diseases.

Results

During 2017-2019, 332 catheterizations were performed, during each of them vascular access was established:

Conclusion

1. A nephrologist, in collaboration with a vascular surgeon, is particularly interested in the creation of vascular access in a patient with chronic kidney disease at the pre-dialysis stage;

2. In most cases, a nephrologist can set up temporary or permanent vascular access in patients with chronic kidney disease or acute kidney injury, which improves the quality of hemodialysis by making him an active participant of the treatment process.
P1369ACUTE EXTRACORPOREAL DIALYSIS USING TWO-WAY PICC POWER INJECTABLE IN YOUNG CHILDREN
Authors: Annicchiarico Petruzzelli Luigi , Serio Vittorio , Luongo Ilaria , Molino Daniela , Minale Bruno , Lepore Lorenza , Ascione Serena , Lubrano Carmen , Malgieri Gabriele , Pecoraro Carmine
Published: June 2020

Background and Aims

Acute extracorporeal dialysis is a short treatment, performed by a central venous catheter of large size, ensuring high flow. These devices have limitations: high caliber, excessive length, impossibility of tunneling and exit-site location in the supraclavicular region, with a subsequent high risk of dislocation and contamination. The authors report a new approach to dialytic central venous catheters selection in children.

Method

From January 2013 to December 2017, 16 children weighing less than 15 kg needed acute extracorporeal dialysis. Patients received an ultrasound guided percutaneous implantation of a two-way PICC power injectable catheter, in the right internal jugular vein or in the anonymous right vein. The device size always respected the ratio of 1/3; the catheters were cut to be adapted to child height, and subclavear tunnelizations and stabilizations were ensured. The hemodialysis was performed with the Prismaflex Gambro system. The effectiveness of treatment was evaluated by recirculation test and by measuring the KT/Vat the third hour, expressing the dialysis adequacy.

Results

Two-way power injectable central venous catheter,sized from 5 to 7 Fr and long from 8 to 15 cm were used. The recorded blood flow ranged from 4.7ml/min/kg to 7ml/min/kg; a KT/V variable from 0.5 to 1 was detected; the recycling rate was between 32% and 40%. No catheter related complications were observed.

Conclusion

In children weighing less than 15 kg, PICC power injectable have lower blood flow and higher recirculation rate compared to traditional dialysis catheters. However, the dialytic adequacy was suitable for an acute hemodialysis treatment. In addition, these catheters are available in a wide range of calibers and result more adaptable to the venous system of younger children.
P1376IRON MANAGEMENT IN A HAEMODIALYSIS POPULATION POST-PIVOTAL
Authors: Kenou Djotsa Rosiane , Macdougall Iain C , Ford Martin
Published: June 2020

Background and Aims

IV iron plays a critical role in the management of anaemia in haemodialysis patients. The PIVOTAL trial recently generated new insights in this context, and suggested potential harm associated with under-treatment with IV iron.

To perform a prospective cross-sectional survey of iron management in a single-centre haemodialysis population in light of the results from the PIVOTAL trial.

Method

During June 2019, we prospectively measured haemoglobin, serum ferritin and transferrin saturation in a prevalent haemodialysis population at a tertiary renal centre. The current dose of IV iron sucrose was also recorded. Extrapolating from the PIVOTAL trial results (best outcomes in the high-dose group with a mean ferritin of around 650 ng/ml and a TSAT of around 26%), we arbitrarily and conservatively defined under-treatment with iron as a ferritin level ≤500 ng/ml and a TSAT ≤25%.

Results

A total of 587 patients were identified, 581 of whom had a ferritin result available. Of these, 358 (62%) had a ferritin level ≤500 ng/ml and 295/527 (56%) had a TSAT ≤25%. For the 527 patients in whom both ferritin and TSAT measurements were available, 204/527 (39%) were defined as under-treated. Of the 587 patients, 111/582 (19%) were not receiving IV iron. 71/582 (12%) were on 100 mg monthly, 48/582 (8%) were on 200 mg monthly, 339/582 (58%) were prescribed 400 mg iron sucrose/month and 14/582 (2%) were on ≥ 400 mg. The iron dose was not available in 5 patients. Of the 204 undertreated population, 22 (11%) were not on IV iron. 17/204 (8%) were on 100 mg/month, 16/204 (8%) on 200 mg/month, 137/204 (61%) on 400 mg/month, and 11/204 (2%) on > 400 mg monthly. Of the patients defined as undertreated, the haemoglobin ranged from 63 to 151 g/l with a mean of 109.8 g/l and a median of 111 g/l. 30 patients had a haemoglobin less than 100 g/l and 92 patients had a haemoglobin less than 110 g/l. 24/204 patients were not on an ESA (one patient was on Daprodustat) with a mean dose of 12,200 U/week.

Conclusion:

Our current iron protocol is under-dosing a significant proportion of patients. This protocol requires review in light of the PIVOTAL study since it is likely significant cost savings could be achieved as a result of using lower doses of ESA therapy, along with the cardiovascular benefits seen in the higher dose arm of the trial.
P1379PLATELET/LYMPHOCYTE RATIO AS A MARKER OF ERYTHROPOIETIN RESPONSIVENESS IN END-STAGE RENAL DISEASE
Authors: Golubović Sonja , Azasevac Tijana , Živković Siniša , Ljubiäiä‡ Bojana , Knezevic Violeta , Celic Dejan
Published: June 2020

Background and Aims

Neutrophil/Lymphocyte Ratio (NLR) and Platelet/Lymphocyte Ratio (PLR) are closely associated with increased inflammation in end-stage renal disease, which often contributes to the severity of anemia in these patients. Erythropoiesis stimulating agents (ESA) have become a standard treatment of anemia in hemodialysis patients. Since some patients do not respond well to erythropoietin therapy (EPO) the aim of this study is to investigate if NLR and PLR as markers of increased inflammation, could be associated with resistance to EPO therapy.

Method

A total of 90 patients (36 females, 54 males; mean age 60,45 ±11,58) undergoing maintenance hemodialysis and who received recombinant human EPO therapy were examined. Patients' clinical characteristics, laboratory data, dialysis adequacy and the applied doses os EPO were examined in a period of 3 months. EPO hyporesponsiveness index (EHRI) was calculated as the weekly dose of EPO divided by kilograms of body weight divided by the hemoglobin level.

Results

Obtained results show a statistically significant correlation of moderate-intensity between EHRI and NLR ( r = 0.497, p < 0.01) as well as a negative correlation of moderate-intensity between EHRI and hemoglobin levels (Hgb) (r = -0.403, p < 0.01). When it comes to the connection of NLR and PLR with logarithmically converted EHRI values, the results show that there is no statistically significant correlation between NLR and EHRI. Comparison of PLR among 25th, 50th and 75th percentile of EHRI showed that PLR levels increased going from the 25th towards the 75th percentile (p < 0.01). Post hoc analysis indicated that there is also a statistically strong connection for the 25th i 50th percentile (<0 .05) and furthermore for the 50th and 75th percentile (< 0.05).

Conclusion

PLR was found to be superior to NLR in terms of evaluating ESA therapy resistance. PLR could be used as a predictor of ESA therapy response.
P1385BOLUS FERRIC CARBOXYMALTOSE ADMINISTRATION COULD BE A GOOD OPTION FOR IRON MAINTENANCE THERAPY IN HD FACILITIES WITHOUT REGULAR MEDICAL ASSISTANCE
Authors: Brunati Chiara , Vergani Denise , Gervasi Francesca , Montoli Alberto , Minetti Enrico
Published: June 2020

Background and Aims

In 2013, the European Medicines Agency (EMA) claimed that iron preparations should be exclusively given in an environment where resuscitation facilities are available and, therefore, the iron administration was highly discouraged without the presence of a doctor. What this means is that in dialysis centres without regular medical presence the dose of iron administered might be inadequate. Ferric carboxyimaltose (FCM) allows to administer high single doses of iron with an excellent safety profile.

Method

We compare the effect of a maintenance iron therapy in two groups of prevalent and clinical stable hemodialysis patients; the former (A; n=19pts) was treated with iron gluconate (FG) in low refracted doses (i.e. 60 mg one or two times a week) while the latter (B;n=20 pts) was treated with FCM in high doses (i.e. 200 mg once or twice a month). The groups have been followed up for one year. All treated patients in the two groups had similar and “adequate” basal iron parameters according to European Clinical Guideline (Serum Ferritin(SF) ≥200 mic/l and transferrin saturation(TS) ≥20%) (see Table 1). The therapy was administered in order to maintain SF between 200-500 mic/l and TS between 20-40%. Erythropoietin dose (Epo) was evaluated considering the erythropoietin resistance index (ERI =EPO/weight/Hb).

Results

Table 1 show the results at the start and end follow up. The mean monthly iron dose was similar between the two groups at the end of follow up (144±100 mg group A vs 157±81 mg group B). In group A there was a more significant increase in the TS with a non-significant trend to an increase in SF. Six pts of group A had an overshooting of SF (1164±360mc/L) vs 3 pts in group B (SF 830±30 mc/L).

No significant differences in pre and post therapy ERI could be recorded.

Conclusion

A therapy with a high single doses of FCM could be a positive solution to treat patients in dialysis centres without regular medical presence.
P1387IRON CITRATE BLOCKS THE PROGRESSION OF CALCIUM DEPOSITION BY REVERTING APOPTOSIS AND AUTOPHAGY IN VSMCS
Authors: Ciceri Paola , Falleni Monica , Tosi Delfina , Martinelli Carla , Cozzolino Mario Gennaro
Published: June 2020

Background and Aims

Cardiovascular disease is the first cause of mortality in chronic kidney disease (CKD) induced by vascular calcification. Since, in advanced CKD, iron based phosphate binders have been proposed to treat hyperphosphatemia, we studied, in high-phosphate (Pi) calcified VSMC, the effect of iron citrate (iron) on the progression of calcium deposition.

Method

We treated VSMCs with 5 mM Pi and iron citrate to evaluate Ca deposition by Alizarin Red destaining, DNA fragmentation by ELISA, gene expression by RT-PCR and protein expression by Western blot.

Results

High-Pi calcification was blocked when iron was added from day 7 to 15 (1.30±0.03vs0.61±0.02; OD/mg protein; day 15; PivsPi+Fe, p<0.01). Since iron added prophylactically prevented apoptosis and potentiated autophagy we studied the role of these two processes in the therapeutic protocol. Adding iron from day 7 to day 11 decreased apoptotic cell number (17.3±2.6vs11.6±1.6; Annexin V; % positive cells; day 11; PivsPi+Fe; p<0.05, figure). To confirm the effect of iron on apoptosis, we demonstrated its action in blocking the H2O2-induced increase in calcification when added from day 7 to day 14 (1.37±0.03 vs. 0.96±0.05; H2O2+Pi day 7-14 vs Fe+H2O2+Pi day 7-14; day 14; OD/mg protein; p<0.01). We then investigated the mechanism of the anti-apoptotic effect by studying the pro-survival axis GAS6/AXL, finding that iron treatment from day 9 to day 14 counteracted the protein down-regulation, and induced their de-novo synthesis. Supporting the effect of therapeutic added iron on apoptosis we found a decrease in apoptotic nuclei both in VSMCs and aortic rings after iron treatment from day 7 to 15 (3.8±0.2vs2.3±0.3 and 4.0±0.3vs2.2±0.2; apoptotic nuclei; arbitrary score; day 15; PivsPi+Fe; VSMCs and aortic rings; p<0.05). Moreover, iron added from day 9 to day 15 potentiated autophagic flux and increased the number of autophagosomes with damaged mitochondria.

Conclusion

Iron exerts an anti-apoptotic and pro-autophagic effect on established calcified VSMC when simil-osteoblastic transformation was already occurred.
P1388ASSESSING BONE TURNOVER IN CHRONIC KIDNEY DISEASE: SHOULD WE MEASURE NON-OXIDIZED PTH
Authors: Ursem Stan , Heijboer Annemieke , D'Haese Patrick , Behets Geert , Vervloet Marc , Evenepoel Pieter
Published: June 2020

Background and Aims

Parathyroid hormone (PTH) is a key regulator of bone turnover. PTH can be oxidized in vivo, which impacts biological activity. Variable PTH oxidation may be hypothesized to contribute to the rather poor correlation of PTH with indices of bone turnover. Non-oxidized PTH may better reflect the hormonal function than currently measured intact PTH (iPTH). Therefore, we investigated whether n-oxPTH would be superior compared to iPTH as indicator of bone turnover in ESRD.

Method

Thirty patients with a wide range of bone turnover, as assessed by bone histomorphometry (BHM), were selected from an ongoing, prospective observational study in patients with ESRD (NCT01886950), that underwent bone biopsy. Both iPTH (Cobas, Roche Diagnostics, Rotkreuz, Switzerland) and n-oxPTH (A1112; Immundiagnostik AG, Bensheim, Germany) and in addition bone turnover markers (bone-specific alkaline phosphatase (BSAP), P1NP and tartrate-resistant acid phosphatase 5b (TRAP5b)) were assessed in blood samples taken at the time of the bone biopsy. Descriptive statistics, Pearson correlation, regression analysis and ROC curves were used to assess the discriminative ability of n-oxPTH vs iPTH to detect bone turnover.

Results

n-oxPTH and iPTH were strongly correlated (r=0.96; p<0.001) and n-oxPTH values were on average 87% lower than iPTH values. Bone turnover, assessed by BHM (both static and dynamic measures) were strongly correlated with n-oxPTH and iPTH, e.g. bone formation rate r=0.65; p<0.001 and r=0.69; p<0.001, respectively. Bone turnover markers (BSAP, P1NP and TRAP5b) were also strongly and similarly associated with n-oxPTH and iPTH. The AUROC values for discriminating between low/non-low turnover for n-oxPTH and iPTH were 0.81; p<0.01 and 0.86; p<0.01, respectively (Figure 1A). For high/non-high turnover the AUROC was 0.88; p<0.01 and 0.90; p<0.01, respectively (Figure 1B).

Conclusion

n-oxPTH was not superior compared to iPTH in discriminating between high/non-high and low/non-low turnover and also showed no stronger correlation to biomarkers of bone turnover. Therefore, we conclude that there is no added value of n-oxPTH for evaluating bone disease in ESRD patients receiving dialysis, using the currently available method. Since this method cannot distinguish partially form completely oxidized PTH, we cannot definitely rule out the possibility that oxidation of PTH has impact on bone turnover .
P1402USE OF ROMOSOZUMAB FOR OSTEOPOROSIS IN HEMODIALYSIS PATIENTS
Authors: Kiyosumi Rie , Ikeda Naofumi
Published: June 2020

Background and Aims

Recently, the importance of osteoporosis and chronic kidney disease-mineral bone disorder (CKD-MBD) has been highlighted as a cause of increased fracture risk in dialysis patients. However, many osteoporosis drugs require careful administration or are contraindicated in dialysis patients, and evidence for their use in dialysis patients is scarce. Here, we administered the new human anti-sclerostin antibody preparation romosozumab to hemodialysis patients with osteoporosis, and examined changes in bone density, bone metabolism markers and other values.

Method

Romosozumab was administered once per month to 12 hemodialysis patients (mean age: 72.6 ± 9.4 years old; 4 males, 8 females) who were diagnosed with osteoporosis while visiting our hospital and who had no history of cardiovascular complications in the preceding year. Bone density YAM value was measured every 3 months by dual energy X-ray absorptiometry (DXA). TRACP-5b, BAP, P1NP and whole-PTH values were measured every month as bone metabolic markers. Values at the start of observation were regarded as pre-dosing values and the mean values during the 6 months after administration were measured as post-treatment values. The results were then compared.

Results

At 6 months after the start of treatment, no change was seen in bone density of the proximal femur compared to the pre-dosing value. In contrast, lumbar spine bone density YAM value (%) was significantly improved, from 63.8% ± 9.4% to 70.9% ± 5.2% (P = 0.012). Regarding bone metabolism markers, mean value of bone resorption marker TRACP-5b after the start of administration did not significantly differ from that at the start of observation. BAP value increased significantly from 16.2 ± 8.7 to 25.2 ± 11.0 (p < 0.01) while whole-PTH significantly increased from 103.5 ± 52.8 to 236.1 ± 100.8 (p < 0.01). In addition, serial time changes for each bone metabolic marker, whole-PTH value, and corrected Ca value during the observation period are also reported.

Conclusion

Romosozumab may improve bone density in dialysis patients with osteoporosis.
P1403PLASMA OSTEOPONTIN LEVELS DIRECTLY CORRELATE WITH INTACT PARATHYROID HORMONE AND ALKALINE PHOSPHATE LEVELS IN END STAGE RENAL DISEASE
Authors: Bansal Vinod , Druck Aleksander , Bontekoe Emily , Patel Dimpi , Hoppensteadt Debra , Fareed Jawed
Published: June 2020

Background and Aims

Bone turnover disorders and reduction in bone mineral density are commonly observed in end stage renal disease (ESRD) patients. Osteopontin (OPN) is a glycol-phosphoprotein that stimulates osteoclast adhesion to bone. OPN may play a significant role in the pathways involved in bone turnover disorders. The objective of this study was: (1) to identify plasma levels of OPN in ESRD and normal populations, and (2) to elucidate if relationships exist between OPN and iPTH, and OPN and alkaline phosphatase.

Method

Plasma levels of OPN were measured via commercially available enzyme linked immunosorbent assays (ELISAs) in ESRD patients (n=92). A chart review was conducted on these patients to identify levels of intact parathyroid hormone (iPTH) and alkaline phosphatase at time of plasma draw. Additionally, levels of total calcium, albumin, calcium corrected for albumin, phosphorus, ferritin, white blood cell count (WBC), and platelet count (PLT CT) were identified at time of plasma draw via the chart review. OPN levels were also measured in normal control patient plasma (n = 49) purchased from George King Bio-Medical, Inc., Overland Park, KS.

Results

The ESRD cohort showed a statistically significant elevation of OPN plasma levels (p < 0.0001, Mann-Whitney t-test) compared to the normal group. Spearman correlation tests revealed a significant positive correlation of OPN with iPTH (p < 0.0001; r = 0.5606, 95% confidence interval = 0.3968 to 0.6898) and OPN with alkaline phosphatase (p < 0.0001; r = 0.4381, 95% confidence interval = 0.2494 to 0.5948) in the ESRD cohort. No statistically significant correlations were identified between OPN and total calcium, calcium corrected for albumin, albumin, phosphorus, ferritin, WBC, and PLT CT (p > 0.05).

Conclusion

OPN levels are significantly elevated in ESRD patients. Furthermore, OPN levels were also found to be positively correlated with the bone turnover biomarkers iPTH and alkaline phosphatase. These studies suggest that hyperparathyroidism secondary to ESRD increases circulating iPTH, stimulating osteoblast and osteoclast activation and differentiation that increases alkaline phosphatase and OPN production, ultimately resulting in increased bone turnover.
P1406A CASE-CONTROL STUDY ON RISK FACTORS OF CALCIPHYLAXIS: DATA FROM CHINESE HEMODIALYSIS PATIENTS
Authors: Liu Yuqiu , Xie Xiaotong , Yang Canlin , Yang Xin , Zhang Xiao liang
Published: June 2020

Background and Aims

Calciphylaxis (CUA) is a rare but potentially fatal disease that is commonly occurred in dialysis patients. Since there is no data based on Chinese population, the study is aimed to investigate risk factors of CUA in Chinese hemodialysis patients.

Method

We retrospectively evaluated medical records of 20 hemodialysis patients who were newly diagnosed with CUA by skin biopsy admitted to Zhongda Hospital Southeast University from Oct.2017 to Dec.2018. Non-CUA dialysis patients with the same age and duration of dialysis were randomly selected as controls (Ratio=1:2).

Results

Most of CUA patients were male (80%) and elderly (55%), while 50% had a body mass index higher than 24. The mean time interval since start of dialysis to CUA diagnosis was 114.65±81.32 months, and the median time from appearance of skin lesion to diagnosis was 6 (2, 15) months. The incidence of hyperparathyroidism was higher in patients with CUA (80% vs 62.5%), but the differences of duration of elevated serum intact parathyroid hormone (iPTH) and its highest value were not significant compared with the controls. Warfarin therapy had no significant difference between two groups (15% vs 5%). Univariate logistic regression analysis indicated that male (OR 3.619, 95%CI 1.027-12.748), each 1 point increase in score of use of vitamin D and its analogues (OR 1.505, 1.029-2.201), each 1 mmol/L increase in corrected serum calcium level (OR 24.486, 1.570-381.873), each 1 mmol/L increase in serum phosphate level (OR 5.382, 1.767-16.389), each 1 pg/mL increase in iPTH level (OR 1.002, 1.000-1.003), each 1 g/L decline in serum albumin level (OR 1.181, 1.041-1.340), each 1 IU/L increase in serum alkaline phosphatase (ALP) level (OR 1.005, 1.000-1.009) and each 1 mg/L increase in hypersensitive c-reactive protein level (OR 1.029, 1.000-1.059) were significantly associated with CUA. Serum phosphate, albumin and ALP were still significant risk factors after multivariate analysis.

Conclusion

This is the first report of risk factors of CUA based on Chinese population. The results show that high levels of serum phosphate and ALP, low level of serum albumin are independent risk factors of CUA in Chinese hemodialysis patients. Unlike previous research from western countries, warfarin therapy didn’t show an increased risk in this study, propably because of the low exposure rate of it in China.
P1409HIP FRACTURE TRENDS IN SWEDISH GENERAL POPULATION AND DIALYSIS PATIENTS
Authors: Iseri Ken , Carrero Juan Jesus , Evans Marie , Felländer-Tsai Li , Berg Hans , Runesson Björn , Stenvinkel Peter , Lindholm Bengt , Qureshi Abdul Rashid Tony
Published: June 2020

Background and Aims

Hip fracture incidence rate is higher in dialysis patients than in general population. We investigated and compared temporal changes in age-standardized hip fracture incidence rate (ASRhip fracture) 2007-2016 in men and women in the dialysis population and in the general population.

Method

We used the population-based Swedish national database of fractures and the Swedish Renal Registry of ESRD patients to retrieve data on ASRhip fracture in the general population and among dialysis patients. The average annual percent change of the hip fracture incidence trend was evaluated by join-point regression analysis according to gender in the two databases.

Results

ASRhip fracture was about three times higher in Swedish dialysis patients as compared to the Swedish general population. In dialysis patients, rates have steadily declined during the recent decade when assessed in both sexes combined, and when analysed in women and men separately. A similar trend was also seen in the general population; however, the rate of decline was steeper in dialysis patients than in the general population. The most recent data on ASRhip fracture (for 2016) show that ASRhip fracture was similar among female and male dialysis patients whereas ASRhip fracture in the general population was higher in women than in men.

Conclusion

Hip fracture incidence is declining in the general population and even more so in dialysis patients. In contrast to the general population where hip fracture incidence in 2016 is higher among women than in men, there was no such difference between the two sexes among dialysis patients.
P1410IMPACT OF VITAMIN D SUPPLEMENTATION ON CKD-MBD HEMODIALYSIS PATIENTS - A PROSPECTIVE STUDY
Authors: Figueiredo Cátia Raquel , Valerio Alves Ana Rita , Gonçalves Hernâni , Lopes Karina , Sofia Flora , Vila Lobos Ana
Published: June 2020

Background and Aims

There are evidences suggesting that 50-90% of hemodialysis (HD) patients are vitamin D deficient [25(OH) D level <20 ng/mL] or insufficient (between 21 to 29 ng/mL). Recent guidelines recommend evaluation and supplementation low serum vitamin D levels in HD patients. However the effects of supplementation remains uncertain. Our aim was to evaluate the effect of supplementation on phosphocalcic metabolism and secondary hyperparathyroidism in HD patients of a hospital unit.

Method

Prospective study with an 18 months follow-up period. HD patients were supplemented with 12000 IU cholecalciferol 3 times a week if vitamin D level under 30ng/mL and 4000 IU if above. Every 6 months (3 time points) vitamin D, bone alkaline phosphatase (AF), calcium (Ca2+), phosphorus (P+) and intact parathyroid hormone (iPTH) blood levels were measured. Demographic, analytical and clinical data, including diabetic status, were analyzed. Categorical variables are presented as frequencies and percentages, continuous variables as means and standard deviations, or medians and interquartile ranges (IQR) for variables with skewed distributions. Statistical analysis was performed using SPSS version 21 for Windows.

Results

Sixty patients completed the follow-up period. The average was 74.70±1.43 years, 65% (n=39) were male and 41.7% (n=25) were diabetic. The average HD time at point 3 (18 months) was 3.15±3.62 years.

A repeated measures ANOVA with a Greenhouse-Geisser correction showed that cholecalciferol supplementation significantly changed vitamin D blood levels along time (F(2.492;144.54)=26.832; p<0.001), with a statistically significant increase in vitamin D blood levels from time point 0 to point 3 (+8.27 ng/mL, p<0.001). There was also a significant reduction of phosphorus (-0.53mg/dL, p=0.017) and iPTH blood levels (-144.09 pg/nL p<0.001) in the same period. Seric calcium had a statistically significant increase from point 0 to 2 (+0.22 mg/dL, p=0.038). Using Pearson’s correlation, from point 0 to 3, we found a negative correlation between vitamin D and iPTH blood levels variation (Rs= -0.303, p=0.018) and a positive correlation between vitamin D and AF blood levels variation (Rs= 0.043, p=0.002).

Conclusion

Oral cholecalciferol supplementation increases significantly vitamin D blood levels and can be a good option in the management of secondary hyperparathyroidism and hypocalcemia. However, one of the limitations of our study was not to evaluate the use of medication such as P+ chelating agents and the small sample size. Therefore, large randomized clinical trials with clinically meaningful endpoints (fracture, hospitalization, parathyroidectomy, death) are still required to assess the usefulness of different vitamin D compounds for CKD and dialysis patients.
P1418BONE-DERIVED HORMONES, MINERAL METABOLISM, CARDIOVASCULAR DISEASE AND PATIENT OUTCOME IN END-STAGE RENAL PATIENTS
Authors: Ferreira Ana Carina , Mendes Marco , Silva Cecília , Cotovio Patrícia , Aires Inês , Navarro David , Correia Caeiro Pereira Fernando , Salvador Rute , Correia Bruna , Cabral Guadalupe , Nolasco Fernando , Ferreira Manuel Anibal A
Published: June 2020

Background and Aims

Chronic kidney disease-mineral and bone disorder (CKD-MBD) is frequent in end-stage renal disease ESRD (ESRD) patients, increasing morbid-mortality. The aim of this study was to analyse the associations between the new CKD-MBD players [alpha-klotho, fibroblast grow factor (FGF) 23, sclerostin] and the usual markers of the disease [parathyroid hormone (PTH), bone alkaline phosphatase (bAP), vitamin D (vitD), phosphorus (Pi), Calcium (Ca) and Magnesium (Mg)], as well echocardiographic findings [left ventricular mass index (LVMI) measured by Devereux formula, valvular calcifications], vascular calcifications and patients outcomes.

Method

We performed a prospective cohort study of a sample of ESRD patients listed for renal transplant. All patients were submitted to renal transplant and were followed for 12 months. Patient and graft survival were recorded. At inclusion, demographic and clinical data were collected, laboratorial evaluation, bone biopsy and X-ray of the pelvis and hands (Adragão score) were performed. Continuous variables are presented as medians and categorical variables as frequencies. Associations between variables were performed using Wilcoxon rank sum test and Spearman correlation test. STATA software was used and p < 0.05 was considered statistically significant.

Results

We included 85 patients. Mean age 50.1±12.7 years, 59 men (69.4%), 66 caucasian (77.6%). The median LVMI was 108.5 (92 – 129) g/m2, with 32 patients presenting LVH and 19 valvular calcifications. Median Adragão score was 1 (0 – 2). At the end of 12 months, 4 patients died and 5 had graft failure (non-primary function).

Alpha-klotho correlated with bAP (p=0.0006) and marginally with PTH and absence of valvular calcifications (p=0.05). FGF23 correlated with Pi (p<0.001), Ca (p=0.004), PTH (p=0.003), Mg (p=0.002), and inversely with bAP (p=0.003). There was a marginal association with Adragão score (p=0.06). We didn’t found correlations between FGF23 and alpha-klotho or dialysis vintage or echocardiographic characteristics.

Sclerostin correlated negatively with bAP (p=0.007) and PTH (p=0.04). The 3rd sclerostin tertile was associated with high scores of vascular calcifications (p=0.02). Lower levels of sclerostin were associated with patient survival at the end of 12 months (p=0.02).

Conclusion

From these 3 new bone-derived hormones, sclerostin, a bone formation inhibitor, seems to act as a risk factor for vascular calcifications and worse outcomes.
P1423INCREASED BLOOD FLOW RATE IN HIGH-FLUX HAEMODIALYSIS - IS IT RELEVANT FOR PHOSPHORUS REMOVAL IN HAEMODIALYSIS PATIENTS?
Authors: Smokovska Nikolina , Stojceva-Taneva Olivera , Nedelkoska Mence , Misovska Nadica , Josimovski Nikola , Vangelova Aleksandra
Published: June 2020

Background and Aims

High-flux haemodialysis (HD), beside other uremic solutes harmful for patients, controls the level of phosphorus, major factor for HD-related morbidity and mortality. First line in phosphorus control in HD patients is dietary phosphorus intake reduction, whereas its’ removal is undervalued by hemodialysis. The primary objective was to analyse whether change in the rate of blood flow is relevant in phosphorus removal in HD patients. Second objective was to evaluate other variables impacted by higher blood flow rates.

Method

Retrospective study was conducted enrolling 80 patients from a single center in a period of 12 months. In the first six months, all patients were on lower blood flow rate (LBFR group) than the same patient group was switched to a higher blood flow rate in the following six months (HBFR group). Demographic, clinical and laboratory variables were collected and intra/inter-patient group analysis was performed.

Results

Forty-seven patients were male, and 41.3% were female. Mean age of the study population was 61.2±13.47 years (males 60.3±13.38, females 62.4±13.68). Mean dialysis vintage was 63.31±66.57 months. The average real blood flow rate in LBFR group was 290.75±19.65 ml/min (median 285.34 ml/min), 344.87±9.12 ml/min in HBFR group (median 339 ml/min), p=0.0002. The level of phosphorus in LBFR group was 1.52±0.03 mmol/L, and 1.45±0.04 in HBFR group, p=0.007. Other variables that significantly showed improvement following the increase of blood flow rate were eKT/V (p=0.0006), urea clearance (p=0.02) and transferrin saturation (p=0.04). The level of post-HD urea (p=0.02) and body surface area (p=0.04) were decreased. Weekly EPO dosage decrease in HBFR group (p=0.02) was not correlated with increased iron sucrose administration (LBFR group 59.99±36.18 mg/wk, HBFR group 65.8±28.7, p=0.45). There were no significant changes related to cardiac function; systolic (p=0.44) and diastolic pressure (p=0.36), mean arterial (p=0.43) and pulse pressure (p=0.26) remained in reference range. Also, the average dose of calcium-based phosphate binders did not change significantly (p=0.34).

Conclusion

This study showed that increased blood flow rate in HD patients reduces phosphorus and EPO consumption, improves urea clearance without significant impact on cardiac function and calcium overload with calcium-based phosphate binders.
P1426EFFECTIVENESS AND SAFETY OF ETELCALCETIDE IN THE LONG TERM IN CLINICAL PRACTICE IN HEMODIALYSIS PATIENTS WITH SECONDARY HYPERPARATHYROIDISM
Authors: Diaz Campillejo Rosa , Ruiz Calero Cendrero Rosa María , Olivera Azevedo Lilia , Rodriguez Sabillon Jorge Alberto , Ruiz Jimenez Belen , Fernandez Solis Maria Antonia , Galan Gonzalez Maria Josefa , Cancho Castellano Barbara , Martín Hidalgo Barquero Maria Victoria , Barroso-Hernandez Sergio
Published: June 2020

Background and Aims

: Secondary hyperparathyroidism (HPT) is a frequent complication in hemodialysis (HD) patients. Until now we had oral Vit / D analogues and oral Cinacalcet for treatment. The appearance of Etelcalcetide brings new treatment possibilities. Apart from clinical trials there are few long-term results in usual practice. Our goal is to evaluate results with the use of Etelcalcetide after more than a year of treatment in clinical practice of HD.

Method

We carry out a prospective descriptive study for 15 months with patients with HPT-HD, the ones who were with Cinacalcet and had not responded or had intolerance were changed to Etelcalcetide. Patients without prior treatment with calcimimetics were also included. Treatment with Vit D analogues and phosphate binders is treated according to usual clinical practice.

Results

We studied 25 HD patients, 12 men and 13 women with a mean age of 59.5 ± 13.6 years, 11 began de novo calcimimetic treatment and in 14 Cinacalcet was modified to Etelcalcetide due to lack of response or poor oral tolerance. Starting dose 2.5 mg post-dialysis, mean final dose 7.5 mg. We observed a reduction of PTH ≥30% in 80% of patients and a decrease ≥50% in 52%, Figure 1 shows the decrease over 15 months. The calcium corrected to albumine (Cac) decreased 4.8% ± 8 compared to baseline. The majority of patients present mild hypocalcemia (Cac between 7.5 and 8.3 mg / dl) and asymptomatic. There are no differences with P. Patients with PTH in range according to KDIGO went from 8% to 63%. No serious clinical manifestations of hypocalcemia or symptoms of digestive intolerance or other side effects appeared. 

Conclusion

Etelcalcetide in the long term significantly improves the control of HPT in HD with a high safety profile. IV administration facilitates compliance without having followed serious side effects in 15 months of follow-up.
P1445ESPECIALLY HYPOKALEMIA IS A RISK FACTOR FOR ALL-CAUSE MORTALITY IN INCIDENT HEMODIALYSIS PATIENTS
Authors: De Rooij Esther , Dekker Friedo W , Le Cessie Saskia , De Fijter Johan W , Hoogeveen Ellen K
Published: June 2020

Background and Aims

Both hypo- and hyperkalemia can potentially induce fatal cardiac arrhythmias in the general population. However, little is known about the effect of potassium as a modifiable risk factor in hemodialysis (HD) patients. Therefore, we investigated the relation between serum potassium level and all-cause mortality in incident HD patients and whether there is an optimum serum potassium level to pursue.

Method

All incident HD patients (>18 y) from the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD), a prospective multi-center cohort study, were included. These patients were followed from the start of their first dialysis treatment until death, transplantation or a maximum of 2 years. Serum potassium levels were obtained at fixed 6-month time intervals and divided into six categories: ≤ 4.0, > 4.0 - ≤ 4.5, > 4.5 - ≤ 5.0, > 5.0 - ≤ 5.5 (reference), > 5.5 - ≤ 6.0 and > 6.0 mmol/L. Using a Cox proportional-hazards model with serum potassium category as a time-dependent variable, hazard ratios (HR) for all-cause mortality were calculated, adjusted for baseline age, sex, current smoking, diabetes and residual kidney function.

Results

In total, 1278 HD patients were included. At baseline, mean (±SD) age was 64 (±14) years, 60% were men, 23% were current smokers, 21% had diabetes and the median (interquartile range) residual kidney function was 3.0 (1.5-4.8) ml/min/1.73m2. Mean (±SD) serum potassium level was 4.8 (±0.8) mmol/L. The prevalence of the six potassium categories was: 10%, 19%, 26%, 22%, 15% and 8%, respectively. A total of 298 (23%) deaths was observed during 2 years of follow-up. After multivariable adjustment the HR (95% CI) for any death according to the six potassium categories were: 2.5 (1.5-4.3), 1.9 (1.2-3.0), 1.6 (1.0-2.5), 1 (reference), 1.3 (0.8-2.2) and 1.7 (1.0-3.0).

Conclusion

We found a U-shaped relation between serum potassium and all-cause mortality in incident hemodialysis patients. Especially, low serum potassium was a 2.5-fold stronger risk factor for all-cause mortality compared to normal serum potassium. Our results indicate an optimum serum potassium level between 5.0 - 5.5 mmol/L, emphasizing that potassium lowering therapy should be used with caution in hemodialysis patients.
P1459PREVALENCE AND CONTROL OF HYPERTENSION AMONG PATIENTS ON HEMODIALYSIS USING PREDIALYSIS, POSTDIALYSIS AND HOME BP RECORDINGS
Authors: Tsikliras Nikolaos , Georgianos Panagiotis , Vaios Vasilios , Kousouls Varvara , Anagnostara Aggelina , Chatzidimitriou Christos , Mavromatidis Konstantinos , Liakopoulos Vassilios , Zebekakis Pantelis , Balaskas Elias
Published: June 2020

Background and Aims

Earlier studies provided considerably variable estimates on the prevalence and control rates of hypertension in hemodialysis because of their heterogeneity in definitions and blood pressure (BP) measurement techniques applied to detect hypertension.

Method

In the present study, 116 clinically stable hemodialysis patients from 3 dialysis centers of Northern Greece underwent home BP monitoring for 1 week with the validated automatic device HEM-705 (Omron, Healthcare). Routine BP recordings taken before and after dialysis over 6 consecutive sessions were also prospectively collected and averaged. Hypertension was defined as: (i) 1-week averaged home BP ≥135/85 mmHg; (ii) 2-week averaged predialysis BP ≥140/90 mmHg; (iii) 2-week averaged postdialysis BP ≥130/80 mmHg. Participants on treatment with ≥1 antihypertensives were also classified as hypertensives.

Results

The prevalence of hypertension was 88.8% by home, 86.2% by predialysis and 91.4% by postdialysis BP recordings. In all, 96 participants (82.7%) were being treated with an average of 1.7 antihypertensive medications. Among drug-treated participants, 32.6% were controlled by home, 50.5% by predialysis and 45.3% by postdialysis BP recordings. In multivariate logistic regression analysis, greater use of antihypertensive medications and postdialysis overhydration, assessed with bioimpendence spectroscopy, were both independently associated with higher odds of inadequate home BP control.

Conclusion

This study shows that epidemiology of hypertension in hemodialysis differs considerably between routine dialysis-unit and home BP recordings. Since greater antihypertensive drug use and postdialysis overhydration appeared to be the major determinants of inadequate home BP control, then management of hypertension should be initially relied on strategies targeting to control volume overload.
P1461FRAILTY IN PREVALENT HEMODIALYSIS PATIENTS. APLICATION OF FRAILTY INDEX BASED ON GERIATRIC INTEGRAL ASSESSMENT (IF-VIG)
Authors: Anton-Perez Gloria , Henriquez Fernando , Sánchez Ana Yurena , Valga Francisco , Monzon Tania
Published: June 2020

Background and Aims

Frailty is defined as a state of greater vulnerability with less compensatory mechanisms to stressors and is related to worse health outcomes, with the estimated prevalence in the general population> 65 years of approximately 10% and is still higher in population with Chronic Renal Disease (CKD) (26-73%). The Frailty Index based on the Geriatric Integral Assessment (IF-VIG) has been described as a simple tool, fast, with discriminative capacity and predictive (with high correlation with mortality) in geriatric population, but its application in Hemodialysis population has not been reported. We study the frailty in prevalent population in Hemodialysis (HD) applying the IF-VIG, its variables associated and its complications.

Method

observational and prospective, non-interventional study, 361 prevalent patients on hemodialysis in Las Palmas, of the centers of AVERICUM and the Hemodialysis Unit at C.H.U.I.M.I. Demographic and clinical data, related to the technique and dose of dialysis, the Malnutrition-Inflammation Scale (MIS) biochemical parameters and anthropometric parameters were collected.

Results

361 patients, 65% were men, 55% diabetics. Median age: 67 years (57-76), average time in HD o 40 months (20-77). 45% were dialyzed with Central Venous Catheter (CVC) as vascular access (AAVV). The median Charlson Comorbidity Index was 8 (6-9), 242 patients (69% of the population studied) had some degree of malnutrition according to the Malnutrition-Inflammation Scale (MIS), presenting a MIS ≥ 5. A total of 239 patients (66% of the population) were fragile (IF-VIG ≥ 0.20). The clinical variables predictive of frailty were age, sex, comorbidity, the use of CVC as AAVV in HD, the time in the technique and the dialysis dose measured as the average Kt of the last 12 sessions. Table 1. Exitus and hospitalizations were significantly more frequent in the fragile population.

Conclusion

The prevalence of frailty by applying IF-VIG in HD population is very high (66%), including 54% of patients <65 years. The factors associated with frailty in our population were male sex, age, comorbidity, time in the technique, dose of dialysis measured by Kt and the use of CVC as AAVV in HD. Up to 69% of fragile patients are malnourished according to the MIS scale, presenting an MIS ≥5. Exitus and hospitalizations are significantly more frequent in fragile patients. Early identification of fragile patients in HD and the reversible factors associated with this entity would lead to an early multidisciplinary approach, with the aim of reducing the morbidity and mortality of this population.