bluuebunny/crossref_metadata_2025 huggingface dataset:
P1180EVOLUTION OF SERUM B2MICROGLOBULIN LEVELS IN INCIDENT PERITONEAL DIALYSIS PATIENTS
Authors: Barbieri Diego , DELGADO ANDRÉS FELIPE , García-Prieto Ana , Vega Almudena , Abad Esttebanez Soraya , Muñoz de Morales Alejandra , Carbayo Javier , González-Rojas Ángela , Acosta Barrios Adriana , Goicoechea Marian
Published: June 2020

Background and Aims

Retention of ß2microglobulin (ß2M), an uremic toxin in the middle molecular range, has been associated with cardiovascular morbidity and mortality in dialysis patients. Although ß2M levels are usually measured in hemodialysis patients, this practice is not common among peritoneal dialysis (PD) patients. The aim of this study is to evaluate the evolution of serum ß2M levels in incident PD patients.

Method

Prospective, observational study including incident PD patients in our hospital from January 2015 to October 2019. Patients with cardiorrenal syndrome or patients coming from hemodialysis were excluded. Serum ß2M levels were collected before starting PD and during follow up. Weekly KtV, residual renal function and cardiovascular events were also collected during follow up.

Results

We included 30 patients with a mean age of 57 +/- 17 years. 56.3% were male and 15.6% were diabetic. Mean follow up was 19.8 +/- 16.9 months. 18 patients were on continous ambulatory PD and 12 in automated PD. Mean serum ß2M levels before starting PD were 12.8 +/- 6.6 mg/l and they remained stable during follow up (12.9 +/- 5.2 mg/l, 15 +/- 4.2 mg/l, 14.3 +/- 6.9 mg/l, 10.2+/- 4.5 mg/l at month 6, 12, 24 and 36, respectively; p NS). No differences in serum ß2M levels were observed between continous ambulatory PD and automated PD. Serum ß2M levels were inversely and significantly correlated with weekly KtV (r= -0.943; p 0.009) and residual renal function (r= -0.829; p 0.042). One cardiovascular event was recorded during follow up.

Conclusion

Serum ß2M levels remain stable during follow up in our cohort of incident PD patients and is significantly and inversely correlated with weekly KtV and residual renal function. Serum ß2M levels monitoring could be helpful in these patients and would yield important information in this population.
P1183EFFECT OF DECREASE IN GLUCOSE GRADIENT ON CHANGE IN INTRAPERITONEAL VOLUME USING SEGMENTAL BIOIMPEDANCE DURING PET
Authors: Zhu Fansan , Abbas Samer R , Bologa Roxana , Levin Nathan W , Kotanko Peter
Published: June 2020

Background and Aims

The aim of this study was to investigate relationship of glucose gradient dynamics with change in intraperitoneal volume (IPV) measured by segmental bioimpedance analysis (SBIA).

Method

Ten PD patients (age 59±8.8 years, 7 females, 5 Blacks, weight 69.8±12.4 kg) were studied during standard peritoneal equilibrium test (PET). Dialysate glucose concentration (D) was measured hourly throughout the PET. IPV was monitoring continuously using SBIA (Hydra 4200; Zhu et al, Kidney Blood Press Res 2019). Hourly IPV was used to calculate (1) the difference between two conservative hours (ΔIPVt = IPVt+1 - IPVt; t=0, 1, 2 and 3) and (2) the IPVt / IPV0 ratio vs. the concurrent Dt/D0.

Results

IPVs were successfully measured in nine patients (1 high transporter, 6 high-average, 2 low-average). Ultrafiltration volume (UFV, 0.55±0.17 L) at the end of dwell was measured by SBIA. ΔIPV1(0.26±0.17 L) was positive during the first hour of dialysate dwell in 7 patients, their corresponding ΔD1 (calculated as D1 – D0) was -902±278 mg/dL. However, 2 patients (1 high and 1 high-average transporter) showed negative ΔIPV1(-0.13±0.1 L) and a ΔD1 of -861±367 mg/dL. The relationship between IPVt/ IPV0 and Dt/D0 is shown in Fig.1 (a) – (i). The figures indicate the dynamics of IPV and glucose concentration changes in all 9 patients.

Conclusion

Peak IPV appears at different time points and is associated with different glucose gradients. These findings may represent specific, individual characteristics of the peritoneal membrane. Since first hour ΔIPV represents almost half of total UFV at the end of dwell, it could emerge as an important indicator of peritoneal membrane characteristics. Monitoring IPV using SBIA provides a useful tool for further investigation.
P1195ASSESSMENT OF BODY FLUID VOLUME USING THE BIOIMPEDANCE METHOD IN PERITONEAL DIALYSIS PATIENTS
Authors: Moriishi Misaki , Kawanishi Hideki , Shintaku Sadanori , Tsuchiya Shinichiro
Published: June 2020

Background and Aims

ppropriate maintenance of body fluid balance in peritoneal dialysis (PD) patients is important for the amelioration of cardiovascular complications and prognosis. In recent years, the usefulness of body fluid measurement with the bioimpedance method in PD patients has been reported. Meanwhile, peritoneal permeability plays an important role in maintaining body fluid balance in PD patients. In the present study, we examined the correlation between peritoneal permeability and body fluid volume in PD patients.

Method

A total of 58 patients who were undergoing PD at our hospital (42 men and 16 women; mean age, 68 ± 16.2 years; mean dialysis history, 63.5 ± 144.9 months; 25 DM and 35 non-DM patients). Overhydration (OH), total body water (TBW) volume, extracellular water (ECW) volume, and lean tissue mass (LTM) were measured using a body composition analyzer (BCM Fresenius Medical Care Japan). At the same time, peritoneal permeability was measured with fast peritoneal equilibration test to determine the dialysate-to-plasma ratio for creatinine (D/P-Cr), and its correlations with sex, age, age at the time of introduction of dialysis, dialysis history, diabetes history, brain natriuretic peptide (BNP) level, high-sensitivity troponin I (hsTnI) level, blood pressure, body weight, residual kidney function, and ultrafiltration were examined.

Results

The mean OH was 2.53 ± 2.44 L, and 8 patients (13.8%) had an OH of ≤1.1 L. The results of the multivariate analysis revealed that OH positively correlated with the presence or absence of diabetes, ultrafiltration, D/P-Cr, BNP level, hsTnI level, TBW, and ECW, but showed no correlation with sex, dialysis history, age, age at the time of introduction of dialysis, residual renal function, or LTM. Furthermore, the subjects were assigned to D/P-Cr ≥ 0.65 and ≤0.65 groups. In the former, OH correlated with diabetes and male sex by being negatively correlated with age and age at the time of introduction of dialysis and positively correlated with BNP level, hsTnI level, TBW, and ECW. However, in the D/P-Cr ≤ 0.65 group, OH positively correlated with BNP level and ECW.

Conclusion

Our results suggest that youth, complications of DM, and men are at risk for fluid overload in PD patients with increased peritoneal permeability.
P1196AN INIHIBITOR OF KRUPPEL-LIKE FACTOR 5 SUPPRESSES PERITONEAL FIBROSIS IN MICE
Authors: Muta Kumiko , Nakazawa Yuka , Obata Yoko , Inoue Hiro , Torigoe Kenta , Nishino Tomoya
Published: June 2020

Background and Aims

We presented previously that Am80, a synthetic retinoic acid receptor α specific agonist, inhibited the expression of Krüppel-like transcription factor 5 (KLF5) and reduced peritoneal fibrosis in mice. Now, we examined further detail about the mechanism to inhibit peritoneal fibrosis.

Method

Peritoneal fibrosis was induced by intraperitoneal injection of chlorhexidine gluconate (CG) into peritoneal cavity of ICR mice. Am80 was administered orally for every day from the start of CG injection. After 3 weeks of treatment, peritoneal tissues were examined using serial sections by immunohistochemistry to identify what kind of cells expressed KLF5. We also examined the effect of Am80 to inhibit peritoneal fibrosis in vitro.

Results

While KLF5 was expressed in the thickened submesothelial area of CG injected mice, Am80 treatment reduced KLF5 expression and remarkably attenuated peritoneal thickening. The numbers of transforming growth factor β positive cells, α-smooth muscle actin (αSMA) or F4/80 positive cells were significantly decreased in Am80 treated group. KLF5 was expressed in αSMA, F4/80 or CD31 positive cells.

Conclusion

These results indicate the KLF5 might not only associate phenotypical differentiation from fibroblasts to myofibroblasts but also regulate inflammatory responses and angiogenesis in peritoneal fibrosis model. Am80 can suppress peritoneal fibrosis through inhibiting these mechanisms. In vitro experiments are ongoing.
P1199THE IMPORTANCE OF DETERMINING ALPHA-2-MACROGLOBULIN CONCENTRATITON IN PATIENTS ON PERITONEAL DIALYSIS
Authors: Baralic Marko , Bontic Ana , Pavlovic Jelena , Lausevic Mirjana , Gajic Selena , Kravljaca Milica , Brkovic Voin , Milinkovic Marija , Karadzic Vidna , Kezic Aleksandra , Radovic' Milan
Published: June 2020

Background and Aims

To determine the concentration of Alpha-2-macroglobulin (α2M) and its activity in patients treated with peritoneal dialysis (PD) and healthy subjects (H).

Method

a cross-sectional study included 50 PD and 30 H, in which the concentration of active α2M molecules was determined. The measurement is based on covalent binding of α2M and trypsin and zymography with gelatin incorporated into the electrophoretic gel.

Results

The intensity of proteolytic bands seen with native α2M was analyzed in relation to the concentration of α2M in patients with PD with less and / or more than three peritonitis. Linear dependence was only visible in the case of the upper range, which originates from the intact α2M-trypsin complex. The highest coefficient of variation is calculated for the smallest α2M concentration (4.2%). The signal intensities originating from α2M (H) were higher compared to PD, with the PD group being lower in patients with higher peritonitis, and the difference was more pronounced as concentration increased, resulting in a lower slope of dependence. The proposed method can reliably measure the amount of α2M originating in a group H, while the quantification of α2M in PD groups that may have structurally altered α2M can be seen more for condition estimation than for accurate measurements. The zymographic test in this experiment allows us to investigate the relationship of the concentration, structure and function of α2M in different pathological conditions, as well as in the presence of modifying agents that can accompany them.

Conclusion

A simple method for the determination of α2M concentration and function by zymography has been developed, which can be used to examine residual α2M activity after partial denaturation or structural modification due to disease.
P1218OUTCOME OF RENAL REPLACEMENT THERAPY IN LEPTOSPIROSIS ASSOCIATED AKI - PERITONEAL DIALYSIS VS HEMODIALYSIS
Authors: Alex Sunu
Published: June 2020

Background and Aims

Leptospirosis is a common zoonotic disease and acute kidney injury(AKI) is very commonly associated with it, often seen as a marker of disease severity. Renal replacement therapy(RRT) is often required in patients with clinical indications like uremia, oliguria, pulmonary edema and hyperkalemia. The two classical modalities employed for RRT are hemodialysis and peritoneal dialysis. We designed this study to evaluate the clinical outcome among patients with leptospirosis associated AKI requiring dialysis.

Method:

Basic clinical and demographic parameters of our patients were studied. The dialysis modality for each patient was decided based on their predominant clinical presentation. The duration of dialysis dependency and hospitalization along with final clinical outcome in terms of renal recovery or death were recorded. Appropriate statistical methods were used for analysis of results

Results

Thirty two patients underwent renal replacement therapy for leptospirosis associated AKI. Among them 22 received hemodialysis and 10 received peritoneal dialysis. Mortality in our group was 12.5%. Multiorgan involvement, need for mechanical ventilation and oliguric AKI were observed to be predictors of mortality along with hyperbilirubinemia, hypoalbuminemia, hyperkalemia and elevated creatinine phosphokinase levels. Peritoneal dialysis was observed to be associated with a shorter duration of dialysis dependency and hospitalization, however no significant impact on mortality was noticed.

Conclusion

Leptospirosis is a disease of great epidemiological significance in our part of the county. Prompt initiation of RRT in indicated patients leads to an acceptable clinical outcome with good renal recovery. Peritoneal dialysis is slowly losing popularity, which may be revived with proper training of medical personnel and good patient selection.
P1219SLEEP AND PERITONEAL DIALYSIS
Authors: Menezes Maria Do Mar , Ferreira Ana Carina , Fernandes Vasco , Nolasco Fernando
Published: June 2020

Background and Aims

Sleep is considered a basic human need according to Maslow. It helps in the individual‘s physical and psychological recovery. Nowadays, sleep disturbances are an increasingly frequent reality and they interfere negatively with quality of life. Poor sleep quality has a negative impact on the individual’s health (attention, memory, Diabetes, Hypertension, immune system depression, mortality). Peritoneal dialysis (PD) may be an additional insult that is disturbing to its quality.

The aim of the study was to assess the quality and health of sleep in PD patients.

Method

We carried out a single-center study in 35 prevalent PD patients. We used the Pittsburgh Sleep Quality Scale (PSQI), which evaluates seven components (subjective quality, latency, duration, usual efficiency of sleep and sleep changes, medication use and daytime dysfunction) and which considers a good sleep quality when PSQI ≤5. We used a sleep health scale assessed by SATED PT (validated for the Portuguese population) and which considers 0 poor sleep health and 30 good sleep health.

Each patient answered both PSQI and SATED-PT questionnaires. Demographic and clinical variables were analyzed. Continuous variables are presented as means (standard deviation) or medians (interquartile range), depending on normality; categorical as frequencies. Univariate analysis was performed. STATA software was used and p <0.05 was considered significant.

Results

Our cohort has 18 (51%) women, 34 (97%) Caucasians, mean age 49 ± 15 years, median dialysis time of 20.5 (8-33) months; 4 (11%) had a history of attempted construction of arteriovenous fistula and 7 underwent a short period of hemodialysis before starting PD (median 60 months). Charlson's median score was 4 (2-5). 21 patients (60%) were on automated PD, 14 on manual, 18 on Baxter system and 17 on Fresenius system.

Regarding sleep quality, the average obtained on the PSQI scale was 7 ± 3.4 and 60% had values> 5. We found no correlations between these parameters and the demographic and clinical variables studied. We found that 36.4% of patients wake up earlier than expected, 43.8% get up to go to the bathroom, 30% have nightmares, 20% have pain while sleeping, 23.5% depend on sleeping medication, 34.3% have restless legs, all these parameters in a frequency greater than 3x week.

Regarding sleep health, the mean of the SATED scale was 22 ± 5.8 and only 2 patients (5.7%) had values <10. We found a negative correlation between the SATED value and time on dialysis (p = 0.03) and a positive correlation with BMI (p = 0.04). Only 1 patient with normal values lived alone (p = 0.03).

None of these scales (and respective sub-scales) correlated with the PD modality.

Conclusion

In conclusion, the majority of our patients have poor sleep quality but the small sample size limits further conclusions from this study.
P1222CLINICAL OUTCOMES AND MORTALITY IN PERITONEAL DIALYSIS: WHAT ABOUT ELDERLY PATIENTS?
Authors: Ayed Amel , Ben salem Meriem , Haouala Faouzi , BEN BETTAIEB Mohamed Zied , Chemli Imen , Letaief Ahmed , Hammouda Mouna , Sabra Aloui , Skhiri Habib
Published: June 2020

Background and Aims

The burden of elderly patients initiating dialysis regimens is increasing around the world due to rising life expectancies. However, little is known regarding the results of elderly patients treated with peritoneal dialysis (PD). Thus, the aim of this study is to determine the clinical outcomes and to evaluate the survival rates as well as the predictors of mortality among this group.

Method

This is a retrospective descriptive study performed in the PD unit in Monastir - Tunisia from 1990 till december 2017. All patients aged ≥ 65 years were included. The epidemiological and clinico-biological data as well as the complications were collected. Overall and technique survival rates were analyzed.

Results

Of the total 304 patients who began PD during the study period, 55 met our inclusion criteria. The prevalence of elderly patients was 18.1%. The mean age was 73 ± 5 years (65-86) with a male predominance (65.5%). Our patients were diabetic, hypertensive and cardiac in 45%, 64% and 33% respectively. Histories of hemodialysis necessity prior to PD use were present in 43.6 % of the patients. PD exchanges were performed by a member of the family in for 87.3% of cases and they often choose the CAPD (80%). Peritonitis rate was 17.92 patient-months. During the follow-up period, transfers to hemodialysis (15 patients) and death (39 patients) were the most common causes of withdrawal from PD. Frequent peritonitis, ultrafiltration failure warranted transfers to hemodialysis in 27% and 40% respectively. Causes of death were mostly not related to PD (87.2%) and they included cardiovascular events (28.2%), sepsis (20.5%) as well as neoplasma (15.4%). The mean patient survival time was 16.4 years versus 23.3 years in the other group. The survival rates were 96%, 93.5%, 86.9% and 76.6% at 1, 3, 5 and 10 years after peritoneal dialysis initiation, respectively. Advanced age (p 0.04) and occurrence of peritonitis (p 0.02) were predictors of mortality. The mean technique survival duration was 48.6±2.7 months. The technique survival rates were 78%, 62.6%, 53.5% and 41% at 1, 2, 3 and 4 years, respectively. Peritonitis was the primordial predictor of technique survival.

Conclusion

Mortality among elderly patients seems to be higher in our study. Infectious complications and cardiovascular events were the main causes of death. Advanced age and occurence of peritonitis represented the main predictive factors of mortality.
P1225PREVALENCE AND PROGNOSTIC SIGNIFICANCE OF DIABETES IN PERITONEAL DIALYSIS: TECHNIQUE AND PATIENT SURVIVAL
Authors: Ayed Amel , Ben salem Meriem , Haouala Faouzi , Sinda Ayed , Chemli Imen , Letaief Ahmed , Jafar Ines , Hammouda Mouna , Sabra Aloui , Skhiri Habib
Published: June 2020

Background and Aims

Diabetes in recent years is climbing up as the number one cause of chronic kidney disease (CKD). Clinical statistics suggest that Diabetics on peritoneal dialysis (PD) tend to have a poorer prognosis than others.

Thus, the aim of this study is to determine the clinical outcomes and to evaluate the survival rates as well as the predictors of mortality among this group.

Method

It‘s a retrospective study carried out in the nephrology Department of Fattouma Bourguiba Hospital (Monastir, Tunisia) from 1990 to 2017 including 304 PD patients. We compared two groups: diabetic and non diabetic patients in term of survival and factors in correlation.

Results

A total of 110 diabetic versus 194 non diabetic patients were reported. The mean age of diabetic group was 55.14 ± 15 years with a sex ratio 2.33 (men/women). In addition to diabetes, comorbid diseases included hypertension (47.3%) and cardiopathy (32.7%). The mean Charlson score of diabetic group was 5.22±1.5 versus 2.72±1.23 in the other group. A total of 62.7% (n=69) of the patients performed PD with the help of another person mostly a member of the family. The PD modality often used was CAPD (71%). Only six patients made a compulsory choice to begin PD due to vascular access while sixty diabetics chose PD to maintain autonomy (54.5%). During the follow-up period, transfers to hemodialysis (40.9%) and death (53.6%) were the most common cause of withdrawal from PD. In total, 45 patients were transferred to hemodialysis because of infectious complications (31%), Ultrafiltration failure (31%), catheter dysfunction (27%), and psychological intolerance (11%). The death was unrelated to PD in 83% of cases mostly due to considerable burden of cardiovascular events (23 patients). The median survival of the diabetic patients was 15.8 years versus 20.8 years in non diabetic ones with significant difference between the 2 groups (p=0.0001). Diabetes was associated with worse prognosis (OR:147, p=0.0001). The median survival adjusted to the diabetes group was 180 months. Kaplan–Meier analysis showed that diabetes was associated with a significant increase in mortality (p=0.006). Global median survival of the technique was estimated to 68 months (95%, IC [47 ,90]), and it was correlated to the presence or the absence of diabetes. In fact, the technique survival among diabetic patients was estimated to 80% after 12 years and 25% after 20 years whereas, in the other group it approaches 90% and 35% respectively.

Conclusion

This study confirms the pejorative impact of diabetes in the technique and patient survival in DP. So, it stresses the importance of organizing appropriate care upstream to prevent the development of cardiovascular morbidities and infectious complications in DP.
P1226MITOCHONIC ACID 5 (MA-5) AMELIORATES CG-INDUCED PERITONEAL FIBROSIS IN MICE
Authors: Inoue Hiro , Obata Yoko , Suzuki Takehiro , Torigoe Miki , Torigoe Kenta , Suzuki Chitose , Abe Takaaki , Koji Takehiko , Nishino Tomoya
Published: June 2020

Background and Aims

Peritoneal fibrosis is one of important complications induced by long-term peritoneal dialysis. Mitochondrial dysfunction causes an increase of oxidative stress and depletion of ATP. Thus, it may be associated with a variety of disease including fibrosis in several organs. Recently, mitochonic acid 5 (MA-5) was synthesized and its therapeutic potential for mitochondrial dysfunction in kidney disease models has been reported. In this study, we investigated the effect of MA-5 for peritoneal fibrosis model in mice.

Method

Peritoneal fibrosis was induced by intraperitoneal injection of chlorhexidine gluconate (CG) every other day for 3 weeks in C57/BL6 mice. MA-5 was administered at 2 mg/kg by gavage every day from the initiation of CG injection. Control mice received only a vehicle (distilled water). After 3 weeks of treatment, the animals were sacrificed and the peritoneal tissues were collected. The peritoneal sections were stained with Masson’s trichrome for light microscopic examination and the fibrotic thickening of parietal peritoneum was measured on the randomly selected different regions on each section. The expressions of F4/80, which is a marker of macrophages, monocyte chemotactic protein 1 (MCP1), α-smooth muscle actin (α-SMA), and transforming growth factor-β (TGF-β) were evaluated by immunohistochemistry.

Results

The fibrotic thickening of parietal peritoneum was significantly attenuated in MA-5 treated mice compared with control mice (the thickness of submesothelial area: 100.24 +/- 13.67 vs 54.78 +/- 7.43 μm (p<0.05)). The numbers of TGF-β positive cells, α-SMA positive cells, MCP1 positive cells and infiltrating macrophages were significantly decreased in MA-5 treated mice than those in control mice.

Conclusion

These results suggest that MA-5 may have a therapeutic potential in the progression of peritoneal fibrosis as well as kidney disease models.
P1241CALCIFICATIONS IN DIFFERENT VASCULAR BEDS ACROSS THE SPECTRUM OF CHRONIC KIDNEY DISEASE INCLUDING CALCIFIC UREMIC ARTERIOLOPATHY: ARE SKIN PUNCH BIOPSIES USEFUL?
Authors: Roendbjerg Anne Kristine , Rix Marianne , Gyldenløve Mette , Krustrup Dorrit , Vejborg Ilse , Lönn Lars , Pasch Andreas , Skov Lone , Hansen Ditte
Published: June 2020

Background and Aims

Accelerated vascular calcification in different vascular beds is common in patients with chronic kidney disease (CKD). A severe form of vascular calcifications is calcific uremic arteriolopathy (CUA) presenting with painful ischemic skin lesions and high mortality. The prognostic value of skin biopsies in relation to CUA is unclear and the prevalence of skin vascular calcifications in different stages of CKD is sparsely described.

The aim of the study was to describe the occurence of small vesssel vascular calcifications in unaffected skin biopsies in relation to calcifications in other vascular beds across the spectrum of CKD including CUA.

Method

A cross-sectional cohort (total, n=39) comprising dialysis patients with current or previous CUA (CKD5D+CUA, n=9), dialysis patients without CUA (CKD5D-CUA, n=12), patients with CKD stage 3-4 (CKD3-4, n=12), and healthy kidney controls (control, n=6). The presence of vascular calcifications in the dermis and subcutis were assessed in 4 mm punch biopsies of unaffected skin from the lateral thigh. The presence of vascular calcification was evaluated by H&E, von Kossa and Alizarin staining. The presence of breast arterial calcifications (BAC) was evaluated by mammography, the abdominal aortic calcification score (AAC) by lateral lumbar X-ray and calcification propensity was measured by T50 reflecting the calcification propensity in blood.

Results

None of the included patients showed vascular calcifications in skin biopsies.

Declining kidney function was associated with presence of BAC, increased AAC and reduced T50 (Table).

No significant difference was found between CKD5D+CUA and CKD5D-CUA regarding BAC (p=1.000), AAC (p=0.815) or T50 (p=0.165). CKD5D+CUA compared to all other groups had no difference in BAC (p=0.109) and AAC (p=0.141) but reduced T50 (p=0.004). Dialysis patients (CKD5D±CUA) had significant more BAC (p=0.003), higher AAC (p<0.001) and lower T50 (p<0.001).

Conclusion

No vascular calcifications were found in punch biopsies from unaffected skin in patients with different stages of CKD including CUA. Despite imaging verified vessel calcification by BAC and AAC and increased calcification propensity by T50. This suggest that conventional punch biopsies cannot be used to identify skin vascular calcification and thereby patients at risk for developing CUA.
P1250LOW SERUM URIC ACID LEVEL AND LEFT VENTRICULAR HYPERTROPHY : THE NEW PARADOXICAL ASSOCIATION IN HEMODIALYSIS PATIENTS
Authors: SELIM GJULSEN , Kabova Angela , Bexheti Blerim , Janevski Zoran , Spasovska Vasilova Adrijana , Milenkova Mimoza , Canevska Aleksandra , Vrevezoska Bojana , Muharremi Shkelqim
Published: June 2020

Background and Aims

The association between serum uric acid (UA) and left ventricular hypertrophy (LVH) is controversial in chronic kidney disease, whereas in hemodialysis (HD) patients has not been studied until now. Thus, we evaluated the relationship of baseline and time-averaged UA with echocardiographic LVH over a 5-year period in HD patients.

Method

This longitudinal study was conducted on 225 prevalent HD patients over a 5-year period. Patients were stratified into 3 groups according to their baseline and time-averaged UA levels: lower group (UA<400µmmol/l), intermediate/reference group (UA between 400-450µmol/l) and higher group (UA>450µmol/l). Echocardiography was performed on a non-dialysis day and the presence of LVH was defined based on the left ventricular mass index (LVMI) >131 and >100 g/m2, for men and women, respectively. The patients were followed during a 60 month period.

Results

During the 5-year follow-up, 81 patients died (36%), and the main causes of death were cardiovascular (CV) related (70%). Survival analysis show that patients with time-averaged UA<400 µmmol/l had a significantly higher all cause (log rank, p=0.003) and CV mortality (log rank, p=0.004) rate, compared to those with time-averaged UA between 400-450 µmmol/l and time-averaged UA>450µmol/l, but this difference was not statistically significant in terms of baseline UA level. A negative correlation was observed between LVH and time-averaged UA (r=-0.26, p=0.001), but not with LVH and baseline UA. Patients in lower time-averaged UA group had significantly higher LVMI compared to patients in intermediate and higher group (153.10± 59.89, 131.62±40.99, 131.19±44.49 g/m2, p=0.029), but from the lowest to the highest baseline UA levels, LVH was not significantly different (146.99±59.20, 141.38±37.52, 126.85±42.48 g/m2, p=0.07). Unadjusted odd ratio of LVH risk in the lower time-averaged UA compared to the reference time-averaged UA group was 3.11 (95% CI=1.38-7.05; p=0.006); and after adjustment for age, gender, diabetes and CV disease, ORs for LVH persisted significant only in the lower time-averaged UA group (OR = 2.82, 95% CI = 1.16–6.88, P = 0.002). On the contrary, baseline UA did not affect unadjusted and adjusted LVH.

Conclusion

In HD patients the prolonged exposure to hypouricemia is associated with LVH. This paradoxical association can only be explained by the hypothesis that uremic milieu in HD patients changes the influence of uric acid. However, these results should be the subject of further research.
P1252ASSOCIATIONS OF SERUM SCLEROSTIN AND DKK-1 PROTEIN WITH FUTURE CARDIOVASCULAR EVENTS AND MORTALITY IN HEMODIALYSIS PATIENTS; A PROSPECTIVE COHORT STUDY
Authors: STAVRINOU EIRINI , Sarafidis Panteleimon , Loutradis Charalampos , Memmos Evangelos , Faitatzidou Danai , Giamalis Panagiotis , Koumaras Charalampos , Karagiannis Asterios , Papagianni Aikaterini
Published: June 2020

Background and Aims

Sclerostin and Dickkopf-1 (Dkk-1) protein are inhibitors of the canonical Wnt/β-catenin bone pathway. Sclerostin but not Dkk-1 is associated with increased arterial stiffness. This study examined the prognostic significance of serum sclerostin and Dickkopf-related protein-1 (Dkk-1) levels for cardiovascular outcomes and mortality in hemodialysis patients.

Method

Serum sclerostin and Dkk-1 levels were measured with ELISA in 80 hemodialysis patients that were followed-up for a median of 45 months. Several factors that could interfere in the association of sclerostin and Dkk-1 with outcomes (including carotid-femoral pulse-wave-velocity (PWV), parathyroid hormone, calcium-phospate product and others) were assessed at baseline The primary end-point was a combination of all-cause death, non-fatal myocardial infarction, non-fatal stroke, coronary revascularization, hospitalization for decompensated heart failure and new-onset atrial fibrillation. Secondary end-points included cardiovascular and all-cause mortality.

Results

Cumulative freedom from the primary endpoint was significantly lower for higher tertiles of sclerostin (77.8%, 69.2%, and 40.7% for tertiles 1 to 3 respectively; log-rank-p=0.004). The corresponding risk for the primary outcome was gradually increasing for higher tertiles of sclerostin (Tertile 3: HR: 3.847, 95%CI: 1.502-9.851). No significant association was evident between sclerostin and all-cause mortality, whereas higher sclerostin levels presented a trend towards higher risk for cardiovascular mortality. Dkk-1 levels exhibited no association with the risk of the primary or the secondary endpoints. In stepwise Cox regression modeled analysis, sclerostin levels were associated with the primary outcome, independently of PTH, calcium-phosphate product, serum albumin, CRP and PWV levels (HR: 2.921, 95%CI: 1.401–6.090; p=0.004).

Conclusion

High serum sclerostin levels are associated with lower cumulative freedom and higher risk for a composite cardiovascular endpoint but not for all-cause mortality. Dkk-1 protein exhibited no association with the future risk of cardiovascular events.
P1258CLINICAL COMPARATIVE STUDY OF AORTIC ARCH CALCIFICATION IN PATIENTS WITH MAINTENANCE PERITONEAL DIALYSIS AND HEMODIALYSIS
Authors: Li Junhui , Wang Niansong
Published: June 2020

Background and Aims

Vascular calcification is known to be an important risk factor in patients with dialysis, However, the comparative study on vascular calcification between peritoneal dialysis (PD) and hemodialysis (HD) is less. The aim of this study was to analyze the presence, risk factors of aortic arch calcification (AAC), and compare the prognosis in maintenance PD and HD patients.

Method

Using retrospective analysis method, 177 patients with PD and 147 patients with HD were included in the study. The extent of AAC was evaluated by chest X-ray examination. The demographic characteristics and clinical data were collected and compared between PD group and HD group. Binary logistic regression analysis was performed to evaluate risk factors associated with the aortic arch calcification.

Results

The incidence of AAC in HD group (59.86%) was significantly higher than that in PD group (37.29%). Multivariate analysis showed that age, residual renal function (RRF) and serum phosphate were the independent risk factors for calcification of PD patients and the odds ratio (OR) values were 1.133, 1.039, 0.762 and 18.186, respectively. Similarly, age, RRF, calcium-phosphorus product and LDL were the risk factors of HD patients and their respective OR values were 1.125, 0.509, 2.755 and 3.221. Compared with patients without AAC, the presence of moderate-severe AAC was associated with greater risk of mortality, and the OR values were 17.833 and 20.056 in PD group and HD group, respectively.

Conclusion

Our findings suggest that the AAC was more common in HD patients. Older age and lower RRF are common independent risk factors for AAC in PD and HD patients. Moderate to severe AAC a ppears to be associated with increased risk of mortality.
P1272ECFECT OF MELATONIN ON DYSLIPIDEMIA IN HEMODIALYSIS PATIENTS
Authors: Zahed Nargesossadat , Pouyamehr Marjan , Taherkhani Adineh
Published: June 2020

Background and Aims

Cardiovascular disease is one of the major causes of death in hemodialysis patients.

Lipid metabolism abnormalities and increased inflammatory factors are related factors.

In recent studies melatonin inhibits dyslipidemia and reduces inflammatory factors by inhibiting LDL-c oxidation.

The purpose of this study was to evaluate the effect of melatonin supplement on hyperlipidemia and c reactive protein (CRP ) level in hemodialysis patients.

Method

In this clinical trial ,the inclusion criteria were as follows:age older than 18 years, undergoing dialysis for at least 3 months,triglyceride >150mg/dL,HDL-c<40 mg/dL in males, HDL-c<50 mg/dL in females and serum CRP>5 mg/l

Exclusion criteria were:

Patients with a history of stroke, myocardial infarction, peripheral vascular disease, malignancy, heart failure, liver cirrhosis, active liver disease, history of infection, hospitalization one month ago, hepatitis B and C.HIV, and taking corticosteroid, statin, Non-steroidal anti-inflammatory drugs.

Among 200 hemodialysis patients,only 28 patients fulfilled the inclusion criteria..

Patients were treated with Melatonin supplements 3 mg per day at bedtime during 12 weeks. Serum lipid profile and CRP level were measured after 12 weeks.

Five patients were excluded, 2 patients underwent kidney transplantation, and three patients did not cooperate.

Data were analyzed by SPSS 20 software. Normal distributed quantitative data were expressed as the mean ± SD and qualitative data was expressed as frequency and percentage.

Wilcoxon matched pairs test was used to compare the two groups according to the type of study that had no normal distribution and the number of participants (less than 30) and study type (pre-test and post-test). P <0.05 was considered as the level of significance.

Results

A total of 23 patients completed the treatment protocol.Baseline demographic characteristics of patient are shown in Table 1.Parcipitant was composed of 13 male and 10female .The participants’ mean age was 30.6± 11.6.Etiology of ESRD was diabetes in 13(56/5%)and hypertension in5(21.7%)patients and other causes was 5(21/7%).

After treatment mean total cholesterol levels decreased from 139.95 ± 35.49 mg/dL to 131.13 ± 34.96 mg/dL (p value =0.194 ) which was not statistically significant. But the decrease in serum triglyceride level was statistically significant ,from 242.08 ± 101.05 mg/dL decreased to 178.00 ± 48.02 mg/dL (pvalue = 0.004).HDL-c increased significantly after treatment from 36.20 ±7.08 mg/dL to 40.16 ±4.35mg/dL (pvalue =0.032).

Serum CRP levels did not decreased.The limitations of our study were the small sample size and short duration of the investigation.

Conclusion

Melatonin supplement improves triglyceride and HDL-c in hemodialysis patients but has no effect on total cholesterol-c and CRP in hemodialysis patients.
P1274THE CHARACTER OF CARDIAC REMODELING AND VALVE CALCIFICATION IN TYPE 2 DIABETIC PATIENTS WITH END-STAGE RENAL DISEASE
Authors: Susla Oleksandr , Shved Mykola , Litovkina Zoriana , Danyliv Svitlana , Gozhenko Anatoliy
Published: June 2020

Background and Aims

Systematic analysis of cardiac remodeling features in type 2 diabetic patients with end-stage renal disease (ESRD) is important both in stratification of cardiovascular risk and in choice of adequate treatment strategies. The lack of number and fragmentation of studies, the ambiguity of their data regarding the problem of myocardial reconstruction and cardiac valve calcification (CVC) under these conditions have substantiated the need for this study, its relevance and purpose.

Method

136 ESRD patients on chronic hemodialysis (HD) were included in this observational cross-sectional study (men, 78; age, 53.9±1.0 years; HD duration, 47.6±4.2 months). The study was performed in accordance with the provisions of the Declaration of Helsinki last revision. Depending on the presence/absence of diabetic nephropathy (DN) all patients were divided into two groups: the 1st one – without DN (n=88); the 2nd one – with DN (n=48). A complete ultrasound examination of the cardiac structure and function including CVC analysis was performed. Data are presented as means±SEM. Mann-Whitney U-test was used for comparison of the quantitative variables, χ2-test – qualitative ones.

Results

Left ventricular (LV) hypertrophy (93.8 vs. 78.4%, р=0.020) and eccentric hypertrophy (47.9 vs. 28.4%, р=0.023) were diagnosed more often in patients with DN than those without diabetes. Prevalence of pseudonormal and restrictive types of LV diastolic dysfunction (62.5 vs. 28.4%, p<0.001), systolic dysfunction (27.1 vs. 9.1%, p=0.006) and pulmonary hypertension (PH) (64.6 vs. 35.2%, p=0.001) were significant in the 2nd group. CVC (66.6 vs. 38.6%, р=0.002), combined calcification of mitral (MV) and aortal (AV) valves (35.4 vs. 13.6%, p=0.003), stenoses of MV (16.7 vs. 3.4%, p=0.007) and AV (39.6 vs. 15.9%, p=0.004), and insufficiency of MV (66.7 vs. 44.3%, p=0.013) and AV (35.4 vs. 14.8%, p=0.006) were recorded more often in HD patients with DN. LV myocardial mass index (181.0±7.2 vs. 155.0±5.3 g/m2, p=0.001) as well as right ventricle (RV) diameter (2.80±0.09 vs. 2.47±0.04 cm, p=0.003) were also greater in the 2nd group.

Conclusion

In type 2 diabetic patients with ESRD occurs maladaptive cardiac remodeling with predominance of unfavourable (especially eccentric) types of LV hypertrophy, RV dilatation, PH, severe LV diastolic and systolic dysfunction, and widespread combined calcification of MV and AV with the valve defects. The identification of risk factors for the progression of the pathological reconstruction of myocardium and CVC in HD patients with DN will be the subject of our further research.
P1279INSULIN RESISTANCE IN HEMODIALYSIS PATIENS
Authors: Filinyuk Pavel , Rumyantsev Aleksander
Published: June 2020

Background and Aims

insulin resistance (IR) is a decrease in the biological response of sensitive tissues to insulin. IR is known as an adverse risk factor in cardiovascular disease, which largely determines the prognosis of patients receiving hemodialysis (HD). But this issue is not well understood. For the screening of IR, special indices have been developed that characterize the sensitivity of tissues to insulin. The aim of the study was to compare the methods of screening for IR in patients receiving HD in relation to the markers of systemic inflammation and atherogenic dyslipidemia (AtD).

Method

124 patients receiving HD for 75.4 ± 44.5 months were examined including 66 men and 58 women aged 57.6 ± 13.6 years. For IR screening, the Homeostatic Model Assessment-1 and 2 indices (HOMA-1 and HOMA-2), the Quantitative Insulin Sensitivity Check Index (QUICKI) and triglycerides / glucose (Tri/G) were used. Patients were examined in accordance with the recommendations of KDIGO. Data analysis was carried out using “STATISTICA 10.0”.

Results

fasting insulin levels were elevated in 19% of patients. But, the calculated indices were consistent with the idea that IR is much more common. So, the IR index in the HOMA -1 model was increased in 47%, in the HOMA -2 model - in 33%, in the QUICKI model - in 36%, the TriH indicator - in 91%. The sensitivity of peripheral tissues in the HOMA-1 and HOMA-2 models was equally reduced by 35-40%.

The results of the correlation analysis between indicators of IR and plasma concentration of C-reactive protein and lipid profile are presented in table 1.

Informativeness of IR indicators depending on the presence of obesity is presented in table 2

We were also interested in whether insulin resistance affects the development of clinical manifestations of atherosclerosis, cardiac arrhythmias, and heart failure. An analysis of this relationship did not reveal. Only the IR index in the HOMA-1 model with a value of more than 2.7 units was associated with a 4.5-fold increase in the risk of developing clinical manifestations of atherosclerotic lesions (χ2 = 4.582 p = 0.032). Statistically significant it was only in men. Given our data, perhaps IR is one of the reasons for the higher morbidity and mortality of men at HD.

Conclusion

a comparison of IR models allows us to distinguish HOMA-2 as the most accurate index. The highest correlation with systemic inflammation and AtD was in the HOMA-1 and HOMA-2 indices.
P1286THE RELATIONSHIP BETWEEN PROTEIN-BOUND UREMIC TOXINS AND TARGET CARDIOVASCULAR PROTEINS IN HEMODIALYSIS PATIENTS
Authors: Kuo Mei-Chuan , Wu Ping-Hsun , Lin Yi-Ting , Chiu Yi wen , Hwang Shang-Jyh , Huang Jiun-Chi , Chen Szu-Chia , Lee Su-Chu , Liang Shih-Shin
Published: June 2020

Background and Aims

Uremic toxins are crucial non-traditional risk factors for cardiovascular disease in patients with chronic kidney disease (CKD). Indoxyl sulfate (IS) and p-cresyl sulfate (PCS) were associated with all-cause and cardiovascular mortality in CKD patients, but possible mechanisms have not been fully elucidated. Herein, we explored the association between protein-bound uremic toxins and 181 cardiovascular-specific proteins in patients receiving hemodialysis (HD).

Method

In the discovery phase, we investigated associations between circulating free form IS and PCS and cardiovascular-specific protein levels quantified by a proximity extension assay of 333 stable HD patients with correction for multiple testing. In the second phase, the independent association was assessed using multivariable-adjusted models. The associations of IS or PCS with cardiovascular-specific proteins levels on a continuous scale were also evaluated.

Results

Free form IS was negatively associated with six proteins (C-C motif chemokine 15, complement component C1q receptor, perlecan, bleomycin hydrolase, cluster of differentiation 166 antigen, and signaling lymphocytic activation molecule family member 5) and positively associated with one protein (fibroblast growth factor 23). Free form PCS was negatively associated with three proteins (C-C motif chemokine 15, complement component C1q receptor, and interleukin-1 receptor-like 2). Adjusting the multivariable models for classical cardiovascular risk factors at baseline yielded similar results.

Conclusion

Protein-bound uremic toxins (IS and PCS) were associated with several cardiovascular-specific proteins involved in cell adhesion, endothelial barrier function, inflammation, complement system, and phosphate homeostasis. Multiplex proteomics appears to be a promising way to explore novel aspects of uremic toxin pathophysiology.
P1287A COMPARATIVE STUDY OF BLOOD PRESSURE VARIABILITY INDICES BETWEEN PATIENTS UNDERGOING PERITONEAL DIALYSIS AND THOSE UNDER HEMODIALYSIS OR WITH CHRONIC KIDNEY DISEASE
Authors: Alexandrou Maria Eleni , Loutradis Charalampos , Sarris Dimitrios , Kouris Nikolaos , Schoina Maria , Tzanis Georgios , Dimitriadis Chrysostomos , Sachpekidis Vasileios , Papadopoulou Dorothea , Gkaliagkousi Eugenia , Papagianni Aikaterini , Parati Gianfranco , Sarafidis Panteleimon
Published: June 2020

Background and Aims

Blood pressure variability (BPV) indices have been independently associated with cardiovascular events and mortality in hemodialysis (HD) patients. Data on short-term BPV in patients on peritoneal dialysis (PD) are totally absent. This study examined short-term BPV parameters of patients undergoing PD in comparison to HD and pre-dialysis chronic kidney disease (CKD) patients.

Method

38 PD patients were matched for age, gender and dialysis vintage with 76 HD in 1:2 ratio patients and for age and gender with 38 patients with CKD stage 2-4 in 1:1 ration. BPV parameters [standard deviation (SD), weighted SD (wSD), coefficient-of-variation (CV) and average-real-variability (ARV)] were calculated from data from 48hour (PD, HD) and 24hour (CKD) ambulatory BP monitoring according to validated formulas.

Results

There were no significant differences in BPV indexes studied between PD and HD patients but all BPV indexes in these patients were numerically higher than those in CKD patients. Systolic ARV was significantly higher in PD or HD compared with predialysis CKD during the first and the second interdialytic 24hour periods, both daytime period and nighttime 2 (1st 24hour period: PD:11.86±3.19; HD:11.23±3.45; CKD:9.81±2.49, p=0.016, 2nd 24hour period: PD: 12.18±4.11; HD: 12.96±4.57; CKD: 9.81±2.49, p<0.001). Analysis of diastolic ARV and systolic and diastolic wSD showed similar results. Τhere were no differences with regards to dipping pattern and systolic and diastolic CV during all periods studied.

Conclusion

BPV indices are similar between PD and HD patients and higher compared to CKD counterparts. Despite what was theoretically expected, PD patients demonstrate high fluctuations in BP in the absence of abrupt shifts in volume.
P1289CIRCULATING HIGH SENSITIVITY CARDIAC TROPONIN-T WAS AN IMPORTANT PREDICTIVE MARKER FOR CARDIOVASCULAR EVENTS IN HEMODIALYSIS PATIENTS
Authors: Lee Su-Chu , Wu Ping-Hsun , Lin Yi-Ting , Wu Pei-Yu , Chen Szu-Chia , Kuo Mei-Chuan , Chiu Yi wen
Published: June 2020

Background and Aims

High sensitivity cardiac troponin-T (hs-cTnT) are prognostic markers in patients with stable cardiovascular (CV) disease but limited study investigated the CV outcome association in asymptomatic patients receiving hemodialysis (HD). We evaluated the prognostic value of hs-cTnT in predicting CV events in stable HD patients.

Method

A total of 341 stable HD patients was included in this prospective cohort study. Baseline hs-cTnT was measured by Roche hs-cTnT assays. Patients were followed up for 3 years or until first CV event, which was defined a composite endpoint of acute coronary syndrome, ischemic stroke, or hospitalization for heart failure. Cox proportional hazards model was used to determine independent predictors of CV events. The importance of hs-cTnT compared to other clinical parameters was evaluated by random forests algorithm in Gini index.

Results

The HD patients enrolled in this study was 59.2 ± 11.5 87 years old, 53.4% male, 42.5% had diabetes, 76.8% had hypertension, 17.6% had coronary artery disease, and 9.1% had cerebrovascular disease. In multivariate Cox regression analysis, the circulating hs-cTnT levels were independent associated with CV events (HR 2.31; 95% CI 1.21-4.40; p-value=0.011) after adjusting for confounders. Multivariable model showed prognostic significance, with the c-statistics of 0.75. The addition of baseline hs-cTnT to established risk factors improved risk prediction of CV events (c-statistics of 0.76; integrated discrimination improvement = 0.02, P = 0.049). Gini index demonstrated hs-cTnT was more important than other clinical parameters for CV events prediction.

Conclusion

Circulating hs-cTnT levels independently predicted CV events in chronic HD patients. CV risk in HD patients could be stratified according to hs-cTnT levels. The results suggest the useful property of hs-cTnT as an end-organ damage marker reflecting subclinical cardiac injury.