bluuebunny/crossref_metadata_2025 huggingface dataset:
MO709ASSOCIATION BETWEEN SERUM ELASTIN-DERIVED PEPTIDES AND ABDOMINAL AORTIC CALCIFICATION IN PERITONEAL DIALYSIS PATIENTS: A CROSS-SECTIONAL STUDY
Authors: Jingyuan Cao , Shizhu Zhao , Guoyuan Lu
Published: May 2021

Background and Aims

Peritoneal dialysis (PD) patients experience accelerated arterial aging, which is characterized by elastin degradation. Although elastin-derived peptides (EDPs) have been reported to be associated with vascular diseases, studies on the association between serum EDPs and abdominal aortic calcification (AAC) in PD patients remain limited.

Method

126 eligible PD patients were included and first grouped by the presence of AAC by an abdominal computed tomography (CT) scan. Patients with AAC were then grouped into severer and non-severer group according to the annularity of calcification. Logistic regression analysis was conducted to analyze the association between EDPs and AAC or severer AAC. Nomograms were generated to evaluate individualized risk of AAC and severer AAC.

Results

Serum EDPs were significantly elevated in PD patients compared with healthy controls (interquartile ranges: 37.65-55.02 versus 24.23-39.20 ng/mL; p<0.001), and gradually increased as AAC worsens. Moreover, EDPs had the most excellent discriminatory power to differentiate AAC compared with other mineral metabolism markers. After adjustment for potential variables, higher EDPs were associated with greater risk of developing AAC (Odds ratio: 1.056, 95%CI: 1.010-1.103) and severer AAC (Odds ratio: 1.062, 95%CI: 1.004-1.123). Receiver operating curve analysis (ROC) revealed that a combination of EDPs substantially improved the accuracy of diagnostic performance for AAC and severer AAC. Nomogram demonstrated exceptional ability in recognizing PD patients with susceptibility to AAC or severer AAC.

Conclusion

Serum EDPs can predict the presence and severity of AAC in PD patients, indicating the possible roles to recognize PD patients at risk for developing AAC and severer AAC.
MO710GALECTIN-3, IS IT A NEW PLAYER IN PERITONEAL INFLAMMATION AMONG PATIENTS UNDERGOING PERITONEAL DIALYSIS?
Authors: Einbinder Yael , Cohen-Hagai Keren , Benchetrit Sydney , Zitman-Gal Tali
Published: May 2021

Background and Aims

Peritoneal dialysis (PD) is a common used method for renal replacement therapy. Prolonged PD treatment causes structural and functional changes in the peritoneal membrane which are attributed to local inflammatory process in the peritoneal cavity. Galectin-3 (Gal-3) is a galactoside-binding lectin with pro-inflammatory and pro-fibrotic effects. The aim of this study was to assess correlation between Gal-3 serum and dialysate effluent levels with peritoneal membrane transport characteristics.

Method

Gal-3 levels in serum and dialysate effluent were measured simultaneously in prevalent PD patients in morning visit or during peritoneal equilibration test (PET). Gal-3 levels were correlated with clinical and laboratory parameters. Interlukin (IL) -6 levels were measured in dialysate effluent. Gal-3 mRNA and protein expression were evaluated after exposure of primary endothelial cell culture to several dialysate solutions.

Results

37 PD patients were included in the study; mean age was 65.7±13.1 years, mean dialysis vintage was 17.5±13 months. Gal-3 levels in dialysate effluent correlated with peritoneal equilibration test (PET) results (0.663, p=0.005) and effluent IL-6 levels (0.674, p=0.002) but not with serum Gal-3 levels or dialysis vintage. Patients with high PET results had higher effluent Gal-3 levels as compared average low PET results. In multivariate regression analysis effluent IL-6 level was the most dominant predictor of effluent Gal-3 levels. Gal-3 mRNA and protein expression in primary endothelial cell culture were not affected by stimulation with dialysate solutions.

Conclusion

Our study demonstrated presence of Gal-3 within the dialysate effluent in PD patients. Gal-3 levels correlated with peritoneal membrane transport characteristics and effluent IL-6 levels suggesting a role in the inflammatory process within the peritoneal cavity.
MO711COMPARISON OF PERITONEAL DIALYSIS EFFICACY MARKERS IN DIABETIC AND NON-DIABETIC PATIENTS
Authors: Carvão João , Fernandes Adriana Paixão , Veríssimo Rita , Calça Rita , Martins Ana Rita , Matias Patricia , Branco Patricia
Published: May 2021

Background and Aims

Diabetes mellitus (DM) is the leading cause of end-stage kidney disease. Peritoneal dialysis (PD) is an effective and convenient modality of renal replacement therapy, however in diabetic patients, higher technique failure is feared. This cross sectional study aimed to investigate if diabetic patients are good candidates for peritoneal dialysis in terms of dialysis efficacy and volume overload management when compared with non-diabetic patients.

Method

We conducted a cross-sectional study including 60 patients with end-stage kidney disease currently in peritoneal dialysis. Echocardiography was performed using HDI 5000, allowing M-mode, two-dimensional measurement. Peritoneal equilibration test exam was used to evaluate transport rate and dialysis efficacy. A multifrequency bioimpedance (BIA) analyzer was used. Overhydration (OH) was defined as an extra-cellular water (ECW)/total body water (TBW) over 15%. Clinical and biochemical variables were also explored.

Results

A total of 60 patients completed evaluation. Overall, 60% (n=36) were males with a mean age of 55,8 ± 15,3 years, BMI 25.9 ± 3.9 kg/m2, 31,7% (n=19) had DM. Median PD vintage was 21 months, automated PD 30%, 8.3% (n=5) were anuric and 10% (n=6) were overhydrated. The median serum N-terminal pro b-type natriuretic peptide (NT-proBNP) level was 1071 pg/mL. Left ventricule (LV) mass index and LV ejection fraction were 129.0 ± 51.1 g/m2 and 62.8 ± 13.0%, respectively. The median excess volume overload was 0.9L.

Patients were divided in 2 groups (diabetic and non-diabetic). No differences were found between the 2 groups in terms of time in PD, peritoneal transportation, dialysis efficacy, diuresis, hemoglobin, albumin, normalized protein catabolic rate, hydration status, weight, body mass index, arterial hypertension, chronic heart failure, LV ejection fraction, LV mass index, CA-125 value, clinical signs of fluid overload, systolic and diastolic blood pressure. However, diabetic patients were younger (51,6 versus 58,0; p=0,02), more likely to have peripheral arterial disease (42,1 versus 7,3%, p=0,03), ischemic heart disease (52,6 versus 7,3%, p<0,001) and had higher levels of NT-proBNP (5932 versus 4216 pg/mL, p=0.04).

However, when using a multivariable analysis, in a model adjusted to age, residual dialysis, efficacy of dialysis, diabetic patients did not have a significant difference in volume overload, dialysis efficacy and markers of cardiac dysfunction when compared with non-diabetic patients.

Conclusion

In this population, diabetes was associated with higher levels of NT-proBNP, however it did not translate in higher fluid overload, lower dialysis efficacy or worst cardiac dysfunction, when compared with non-diabetic patients. We conclude that PD is able to control hydration status, dialysis efficacy and cardiac dysfunction in diabetic patients with similar efficiency as in non-diabetic patients.
MO717EFFECT ON BLOOD PRESSURE OF UNCOMPENSATED 130 MM SODIUM DIALYSATE IN CAPD PATIENT WITH RESISTANT HYPERTENSION
Authors: Borrelli Silvio , Bonomini Mario , Arduini Arduino , Palumbo Roberto , Vecchi Luigi
Published: May 2021

Background and Aims

In peritoneal dialysis (PD) blood pressure (BP) control is largely unsatisfied mainly due to sodium retention. Currently, sodium removal in PD patients depends substantially on ultrafiltration. Lowering sodium in PD solution might improve sodium removal by diffusion, though the real benefit of low PD solution remains still undetermined.

Method

In this case report, we used a novel uncompensated glucose-based PD solution (DextroCore LS, Iperboreal Pharma, Italy) containing 130 mM sodium to treat resistant hypertension in 78-year-old female treated by CAPD (3 dwells glucose 1.5% a day, Na 132).

Results

At baseline, Ambulatory BP monitoring (ABPM) showed 24h-BP (152/81 mmHg), diurnal BP (151/83 mmHg) and nocturnal BP (153/75 mmHg), with inversion of circadian rhythm in systolic BP (systolic night/day ratio: 1.02), despite the use of three anti-hypertensive (doxazosin 4mg, amlodipine 10 mg, telmisartan 80 mg) and diuretic (furosemide 250 mg) at adequate doses. She had no signs of hypervolemia. We switched from standard PD (132 mM/L) to low sodium PD solution using 1.5% glucose bags with sodium concentration of 130 mM. CAPD schedule was confirmed. Second ABPM after six months reported a reduction 24h BP (131/73 mmHg), diurnal (134/75 mmHg) and nocturnal BP (122/67 mmHg), with restoring of circadian BP rhythm. No change in body weight, UF and residual diuresis was found. Diet and therapy prescriptions were unmodified. No side effects were reported.

Conclusion

Six-months PD treatment with uncompensated glucose-based PD solution containing 130 mM sodium in all daily dwells has allowed to reduce systolic BP (-16 mmHg) in a CAPD patient affected by resistant hypertension, with no change in ultrafiltration and residual diuresis.
MO718ROLE OF CT-PERITONEOGRAPHY IN THE PATIENT WITH GENITAL EDEMA AND PERITONEAL DIALYSIS
Authors: Centellas Pérez Francisco Javier , Ortega Cerrato Agustin , Pérez Martínez Juan , Llamas Fuentes Francisco
Published: May 2021

Background and Aims

Genital edema is a frequent complication in those patients who are on peritoneal dialysis, generally secondary to the increase in intra-abdominal pressure that it entails. It occurs late after the implantation of the peritoneal catheter (after 30 days of implantation).

The typical clinical manifestation of this condition is basically subcutaneous edema in the genital area, accompanied by pain and UF failure.

The diagnosis must be made by using an imaging test, mainly CT-peritoneography.

Method

A series of clinical cases of PD patients who consulted for genital edema is reviewed, analyzing the role of peritoneography

Results

CASE 1

A 76-year-old male, 15 days after the start of the technique, consulted for right scrotal edema. It was decided to suspend CAPD and start hospital intermittent IPD with low volumes. A CT-peritoneography was requested, which revealed a right peritoneal-vaginal duct and a left inguino-scrotal leak. Surgical correction of the anatomical defect was performed without incident, with subsequent return of the patient to CAPD.

CASE 2

A 78-year-old man, 15 days after the start of the technique, consulted for bilateral scrotal edema. A CT-peritoneography was performed, which showed that the leak of peritoneal fluid to the scrotum was due to bilateral inguinal hernia. Subsequently, inguinal hernioplasty of the surgical defect was performed without complications.

Conclusion

Genital edema, as a complication of patients with CAPD, appears in approximately 4-10% of them. CT-peritoneography is the diagnostic technique of choice.

To do this, 150 ml of nonionic iodinated contrast, with a concentration of 300 mg/ml, are diluted in approximately 2 liters of dialysis solution, which are introduced into the peritoneal cavity of the patient 2 h before performing the CT.

Subsequently, a CT scan of the abdomen and pelvis including the perineum is performed, in the supine position and craniocaudal direction.
MO909MULTICENTER EPIDEMIOLOGICAL STUDY OF MALNUTRITION INFLAMATION IN DIALYSIS “EMID” IN SPANISH DIALYSIS CENTERS
Authors: Barril Guillermina , Nogueira Ángel , Cigarran Secundino , Latorre Juan , Sanchez Rosa , De Santos Antonio , Hadad-Arrascue Fernando , Romaniouk Igor , Anton-Perez Gloria , Thuissard Israel
Published: May 2021

Background and Aims

There is a high prevalence of malnutrition (PEW) in patients on dialysis (HD-PD). There is no single tool to diagnose it, varying the percentage according to the one used.

Aim

To assess prevalence of malnutrition-inflammation by MIS scale (malnutrition-inflammation-score) in HD or PD patients of Spanish dialysis units.

Method

We evaluated  2937 patients on dialysis (HD+PD) in Spain were evaluated on the MIS scale strata (Kalantar-Zadeh 1999) also analyzing:

Common data

Age, sex, dialysis time, Charlson-I., RRF, albumin,prealbumin,Kt/V transferrin, CRP, DM

, Specific-HD

HD type, AVF or Catheter

, Specific-PD

PD-type, transport type.

Statistical analysis with SPSS.23 software, using parametric and non-parametric test.

Results

We evaluate 2748 HD patients, median age 71 (RIC20), 65.90% male, median MIS 6 (RIC4), DM 36.91%, T in HD 36m (RIC54), FRR 35.44% , Charlson Index 7 (RIC4) and 186 in PD (62.96% men), median

-age 62 (RIC 24), median-MIS 4 (RIC 2), T in PD of 18.5 m (RIC 23.5),DM 30.77%, FRR 79.89%, I Charlson 5 (RIC 4), In PDA 99pac-52.38%.

Prevalence of global malnutrition (MIS>2) was 89% considering HD+DP and 50% when MIS>5 (table 1)

In PD the higher normonutrides greater Kt/V in manual vs automatic not the malnourished ones. FRR significantly in greater % in normonutrides. No differences in malnutrition depending on carrier type. CRP sig major in MIS>2 and >5

In HD, Normo versus malnourished and with MIS>5 significant difference: HD type, CRP, HD Type, AVF vs catheter, age,sex.

The prescription for Oral supplement was low and higher in HD 12.4% vs DP 6.3%.

Conclusions

1.- There is a high prevalence of malnutrition on dialysis being higher in HD. 2.- In PD, FRR major and CRP minor in well-nourished versus malnourished. 3.- In HD: Normo versus malnourished and with MIS>5 significant difference: HD type, CRP,Charlson I. AVF vs catheter, age,sex. 4.- There is a percentage of malnourished patients with very low percentage of oral supplement.
MO912INMUNE STATUS ON HAEMODIALYSIS PATTIENTS AFFECTED WITH COVID19 INFECTION
Authors: Sandino Pérez Justo , Utrero-Rico Alberto , Yuste Claudia , Gutierrez-Solis Elena , Morales Enrique , Mérida Evangelina , Gonzalez-Cuadrado Cecilia , Chivite-Lacaba Marta , Mancebo Esther , Paz-Artal Estela , Caro Espada Paula Jara
Published: May 2021

Background and Aims

End-stage renal disease patients on haemodialysis (HD) seem more likely to develop severe COVID19 disease. Over the course of COVID disease, we observed a poor tolerance to HD sessions with a marked tendency of clinical deterioration over them.

The objective is to evaluate changes on immunological system over HD session on patients affected with COVID19 compared with patients without COVID19.

Method

Fourteen HD patients were studied including 9 confirmed COVID19 infection and 5 healthy controls. Predialysis and postdialysis blood samples were compared to study alterations on immune status. We identified cytoKines by Luminex (CCL2, CXCL10, IL1Ra, IL10, IL12p70, TNFα, IL17Ra, IL6, IL7) and adaptive lymphocyte subsets (CD4/CD8 naïve, CD4/CD8 MC, CD4/CD8 MP, CD19, CD56). Monocyte subsets (CD14+CD16-, CD14+CD16+, CD14-CD16+) were detected from peripheral blood mononuclear cells (PBMC), as well as immune activation (CD11b, HLA-DR, CD86) and migration factors (CCR2, CCR5). The supernatant of isolated CD14+ cells after 4-hour stimulation with LPS where analysed by Luminex to measure cytokines (CCL2, CXCL10, GM-CSF, IL10, IL12p70, IL17Ra, IL6, IL7, TNFα).

Results

Patients with COVID19 presented predialysis: (1) higher plasmatic levels of IL12p70, TNFα e IL7, (2) lymphopenia and neutrophilia, (3) higher percentage of intermediate monocytes and lower of non-classical, (4) lower membrane expression of CCR2, HLA-DR y CD86 over Cd14+ cells, and (5) higher production of CCL2, GM-CSF, IL10, IL12p70 y IL17Ra by LPS stimulated monocytes compared with patients without COVID19. When analysed the fold-change between pre and postdialysis values, patients with COVID19 infection present a: (a) higher plasmatic levels of IL6, IL1Ra, CCL2 e CXCL10, (b) reductions of total lymphocites, (c) higher membrane expression of CCR2, CD33 y CD86 on CD14+ cells, and (d) higher production of TNFα, GM-CSF, IL10, IL17, IL6 e IL7 by LPS stimulated monocytes compared with patients without COVID19. No differences on lymphocite subset were found.

Conclusion

The clinical deterioration on COVID19 infected patients over HD session could be related with monocyte activation and pro-inflammatory cytokines secretion.
MO914INTRADIALYTIC RESISTANCE TRAINING HAS POSITIVE EFFECT ON SURVIVAL IN HEMODIALYSIS PATIENTS INDEPENDENTLY OF THEIR NUTRITION STATUS MEASURED BY BODY COMPOSITION MONITORING
Authors: Hudacek Marek , Zelko Aurel , Rosenberger Jaroslav
Published: May 2021

Background and Aims

Malnutrition is considered to be an independent predictor of mortality in hemodialysis population. Physical inactivity is also connected to worse outcomes, and patients are recommended to comply with at least some physical excercise.

The aim of this study was to evaluate the survival of hemodialysed patients, taking into account the nutritional status, assessed by Body Composition Monitor. In addition, analysed the impact of three months intradialytic resistatance training.

Method

It was a prospective study of patients undergoing hemodialysis from three hemodialysis departments. Patients from two departments underwent three months intradialytic resistance training while those from the third department served as controls. Cox multivariate regression analysis was used to analyse patient survival depending on performing intradialytic resistance training and their nutritional status.

Results

The group of 90 patients included 35 women, 55 men (61%) with a mean age of 62.6 years, and a mean dialysis program duration of 49.1 months. 31 patients completed whole three months interdialytic training. In total, 80% of participants survived the follow-up period of two years. Cox regression analysis showed a statistically significant effect of the intervention: the patients who had been training had a benefit in survival (HR 4.4; 95%CI 1.003;19.267; p=0,05). The stratification by nutritional status did not change this model, it was always crucial whether patients exercised or not. Malnourished patients had also a better survival when they were training.

Conclusion

Malnourished hemodialysed patients have higher mortality compared to well-nourished patients. Intradialytic resistance training brings survival benefit and might reduce the adverse effects of malnutrition. Therefore we recommend this intervention even in malnourished hemodialysed patients.
MO916THE EFFECT OF EXTENDED HAEMODIALYSIS ON NUTRITIONAL PARAMETERS: A SYSTEMATIC REVIEW
Authors: Majlessi Alireza , March Daniel , Burton James
Published: May 2021

Background and Aims

Individuals who receive haemodialysis have a high mortality rate, up to 20% within one year of starting dialysis and just under 50% at 5 years. One of the risk factors that contributes to this high mortality rate is the nutritional status of haemodialysis patients; improving this will be a key element of risk mitigation. Extended haemodialysis may improve nutritional outcomes through better clearance and reduced dietary restrictions and medications. The aim of this systematic review is to provide an up to date assessment of trials of extended haemodialysis reporting the following nutritional outcomes: Lean body mass, body mass index, protein intake and energy intake, nutritional status assessed by the subjective global assessment and PEW scores, and circulating markers of appetite.

Method

No limits on language were set, and databases were searched from inception to December 2020 using a predefined search strategy. Inclusion criteria were; randomised and non-randomised trials of extended haemodialysis (defined by >15 hours per week of total haemodialysis time), with a comparator group which received conventional in-centre haemodialysis (usually <=12 hours per week of hemodialysis time). The following databases were searched: Medline, EMBASE, CINAHL, Cochrane Controlled Register of Trials (CENTRAL), the Web of Science Core Collection,PROSPERO, Clinicaltrials.gov,  the ISCRTN Registry and Conference Proceeding Citation Index, National Health Service Centre for Reviews and Dissemination: Health Technology Assessment (HTA), and Database of Abstracts of Reviews of Effects (DARE).  Additional internet searches (i.e Google Scholar) were also conducted. Search results were compiled in Endnote and studies were screened for title and abstract.

Results

Searches identified 9251 records. After removing duplicates 6190 records were screened for title and abstract against inclusion criteria, leaving 22 papers for full text screening. A further 17 records were removed following full text screening. Of the remaining 5 papers, one was a randomised controlled trial and four were prospective, non-randomised trials. All studies investigated nocturnal haemodialysis (one with the additional of short daily), three were in-centre and two were at home. Range of duration for the included studies was 2-18 months. Outcomes of interest measured included lean body mass, protein and carbohydrate intake, body mass index, dry lean mass and water soluble vitamin levels. Of these trials, only one reported a statistically significant increase in an outcome of interest (lean body mass). One study also reported cross-sectional data highlighting Vitamin-C deficiency in half of their nocturnal haemodialysis population.

Conclusion

There is insufficient high-quality evidence assessing the effect of extended haemodialysis on nutritional parameters. Further research is required to understand the impact of novel dialysis prescriptions on these clinical parameters.
MO917INFLAMMATORY PARAMETERS IMPROVEMENT WITH CITRATE COMPARED TO ACETATE DIALYSATE
Authors: Broseta Monzo Jose Jesus , López Romero Luis Carlos , Rodríguez Diana , Guillen Olmos Elena , Sánchez-Pérez Pilar , Hernandez Jaras Julio
Published: May 2021

Background and Aims

The relation between inflammation and cardiovascular disease is well established. Dialysis patients are at a higher risk of cardiovascular death, mostly attributed to cardiovascular disease. This study evaluated the potential benefits of citrate (CD) vs. acetate dialysate (AD) regarding the patients’ inflammatory status.

Method

Single-center, cross-over, prospective study, with a follow-up of a total of 24 dialysis sessions, 12 with each dialysate. Blood samples were taken on the twelfth dialysis session with each type of dialysate. Every patient acted as its own control. The pre-dialysis parameters analyzed were procalcitonin (PCT), high-sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6).

Results

Pre-dialysis hsRCP [AD: 4,32 (1,27 – 12,16) vs. CD: 4,08 (0,98 – 8,65) mg/L, p = 0,031], PCT [AD: 0,44 (0,28 – 0,74) vs. CD: 0,38 (0,29 – 0,44) ng/mL, p = 0,037], and IL-6 [AD: 13,7 (7,85 – 29,03) vs. CD: 11,8 (5 – 27,13) pg/mL, p = 0,029] are significativly higher after twelve dialysis sessions with AD vs. CD.

Conclusion

Even in the medium term, the use of citrate instead of acetate as the dialysate acidifier, reduces the measured inflammatory parameters and could therefore be considered a more biocompatible dialysate option.
MO918INFECTIOUS COMPLICATIONS IN HEMODIALYSIS: INTERSET OF NEUTROPHIL TO LYMPHOCYTE AND PLATELETS TO LYMPHOCYTE RATIOS
Authors: Lahouimel Rania , Salma Toumi , Abid Hanen , Kharrat Emna , Saai Amira , Agerbi Ikram , Dammak Najla , Chaker Hanen , Kammoun Khaoula , Yaich Soumaya , Benhmida Mohammed
Published: May 2021

Background and Aims

Infectious complications represent the leading cause of death among the dialysis population, prompting early diagnosis and increased vigilance. Neutrophil-to-lymphocyte and platelets-to-lymphocyte ratios are newly emerging as more accessible and simple markers for the detection of the onset of infections. The objective of our study is to prove the value of these markers in the diagnosis of infections in hemodialysis patients.

Method

This is a cross-sectional study spread over one year including 85 chronic hemodialysis patients with duration of at least 6 months. patients with hemopathies, tumors, or with a history of hospitalization during the 3 months before the study were excluded. CRP was used as a biomarker of infections and N / L; P / L ratios were calculated to study the correlation between the two biomarkers. Based on the literature reviews, the threshold of the N / L ratio and the P / L ratio admitted for our stydy were respectively : > = 2.5 and > = 150.

Results

The mean age of our patients was 49 ± 19 years with a predominance of women (55%) .The average duration in hemodialysis was 67.2 months. An infectious complication was noted in 22% of our patients whose distribution was as follow: 4% as a pulmonary infection with 3 coronavirus cases, 6% a sepsis, one case of abscess of the nephrectomy compartment.The median value of the CRP was 37±10mg/l We found a positive correlation between the 2 ratios associated (RNL and RPL) and infection with (p = 0.03) . We noted throw this study that patients with both high ratios RPL> 150 and RNL> 2.5 have significantly elevated values of CRP.

Conclusion

N/L and P/L ratios are easy-to-calculate markers that are of great benefit to the hemodialysis population. We have shown through this study the existence of a positive correlation between the N/L and P/L ratios and the occurrence of infections in hemodialysis patients. We therefore encourage the use of this ratios to be included as markers to detect infections occurence.
MO903THE ASSOCIATION BETWEEN VITAMIN K, CALCIUM, PHOSPHORUS LEVELS AND NUTRITIONAL STATUS IN HEMODIALYSIS PATIENTS
Authors: Małgorzewicz Sylwia , Puchalska-Reglińska Ewelina , Konieczna Lucyna , Krzanowska Katarzyna , Debska-Slizien Alicja
Published: May 2021

Background and Aims

Vascular calcification is highly prevalent in dialysis patients. The most common postulated cause, apart from calcium and phosphorus disorders, is sub-clinical vitamin K deficiency. It results in the failure of the GLA-matrix protein (MGP) to undergo carboxylation. The lack of functional carboxylated MGP may contribute to increased vascular calcification. Aim: We assessed the relationships between vitamin K, MGP, calcium, phosphorus levels and nutritional status in hemodialysis patients.

Method

The study included 58 hemodialysis patients in stable clinical condition (mean age 64.1 ± 15.6 yr) . We determined plasma levels of: vitamin K1 and K2 (LC-MS method), GLA -matrix protein (ucMGP and cMGP), osteocalcin (ELISA methods), parathyroid hormone (iPTH), calcium (Ca), phosphorus (P), CRP and routine biochemistry. Echocardiography was performed and BMI was calculated. Nutritional status was assessed by SGA and s-albumin – malnutrition was diagnosed based SGA ≤5 and s-albumin ≤ 38g/l. FFQ-6 was used to dietary assessment. Patients with HPT (n=17; 32%) were treated by active vitamin D/paricalcitrol and calcium carbconicum.

Results

Malnourished patients (n=11; 20%) presented statistically significantly higher CRP, age and lower phosphorus, iPTH, BUN, creatinine, cholesterol and potassium. Also, malnourished patients presented significantly higher ucMGP and lower cMGP and lower both vitamin K forms in comparison to well-nourished (ucMGP 18.9 vs 13.2 ng/dl; p=0.0005; cMGP 150.1 vs 332.4 ng/dl; p=0.0002). Diet in both groups malnourished and well-nourished not differ significantly, though malnourished patients ate less amount of nutrients. Additionally, phosphorus level positively correlated with Kt/V, SGA and vitamin K2 (R Spearman =- 0.3;p=0.01,R Spearman = 0.4;p=0.05;R Spearman = 0.3; p=0.001, respectively).

Conclusion

Vitamin K deficiency, as expressed by high ucMGP levels is associated with nutritional status. Low albumin and chronic inflammation might increase risk of calcification in spite relatively low iPTH and phosphorus levels.
MO904DIETARY PATTERNS IN HEMODIALYSIS PATIENTS: RELATIONSHIP WITH CLINICAL AND NUTRITIONAL PARAMETERS
Authors: Garagarza Cristina , Valente Ana , Caetano Cristina , Ramos Inês , Sebastião Joana , Pinto Mariana , Oliveira Telma , Ferreira Anibal , Sousa Guerreiro Catarina
Published: May 2021

Background and Aims

Nutritional recommendations for hemodialysis (HD) patients focus on the achievement of a sufficient energy and protein intake without exceeding phosphorus, potassium, sodium and/or fluids intake limits. This study aimed to identify different dietary patterns of HD patients and analyze their relationship with clinical and nutritional parameters.

Method

This was a longitudinal prospective multicenter study with 582 HD patients from 37 dialysis centers. Dry weight, Kt/V, serum potassium, phosphorus, calcium, sodium, creatinine and C-reactive protein were measured. Dietary intake was obtained using the Food Frequency Questionnaire. Dietary patterns were derived from principal component analysis based on 20 food groups which were adjusted for total energy intake. Linear regression was used to analyze patterns and the variables of interest. All statistical tests were performed using SPSS 26.0 software. A p-value lower than 0.05, was considered statistically significant.

Results

Patients’ mean age was 67.8±17.7 years and median HD vintage was 65 (43-104) months. Three different dietary patterns were identified: “Western” (31.3% of the patients) with high intake of soft drinks, home-made fried potatoes, caffeinated drinks, red and processed meat, and low intake of fruit and vegetables soup; “Mediterranean” (33.5% of the patients) with high intake of vegetables, beans, fish, olive oil, eggs, and low intake of milk and milk products. Finally, “Low animal protein” (35.2% of the patients) with high intake of whole grain bread, cookies and sweets, vegetables soup and low intake of white bread, rice, pasta and potatoes. Regarding clinical parameters, the Mediterranean pattern was predictor of a higher dry weight (p=0.001), higher creatinine (p=0.032) and lower serum calcium (p=0.024), whereas Western pattern predicted higher phosphorus (p=0.006), sodium (p=0.014) and creatinine (p=0.001). Low animal protein pattern predicted lower creatinine levels (p=0.011). After adjusting for age, gender, presence of diabetes, HD vintage and Kt/V, serum calcium was the only parameter which remained statistical significant within the Mediterranean pattern. Comparing the nutritional parameters studied, the Mediterranean pattern was the strongest predictor of a higher intake of protein (%) (p<0.001), folate (p<0.001), vitamin B12 (p<0.001), vitamin B6 (p<0.001), vitamin C (p<0.001), vitamin D (p<0.001), potassium (p=0.015) and omega 3 fatty acids (p<0.001) and a lower intake of carbohydrates (%) (p<0.001), calcium (p<0.001) and sodium (p=0.006).

Conclusion

Three different dietary patterns were identified in these HD population. The pattern which was closer to the well-known Mediterranean diet was associated with a better nutritional intake profile, which, at least theoretically, are associated with better clinical outcomes.
MO775CONTROL OF BONE DISEASE ASSOCIATED WITH CHRONIC KIDNEY DISEASE AS A PREDICTOR OF PRIMARY PERMEABILITY AFTER THE CREATION OF THE VASCULAR ACCESS
Authors: Piccone Saponara Luis Guillermo , Castro Fernández Maria Paz , Uribe Heredia Nancy Giovanna , Carreno Agustin , Anaya Fernandez Sara , Olazo Gutierrez Eliana , Ferrer García Guillermo , Sanchez Escudero Patricia , García Conejo Gloria , Romero Barragán Maria del Pilar , Vozmediano Poyatos Maria del Carmen
Published: May 2021

Background and Aims

Clinical practice guidelines recommend an arteriovenous fistula (AVF) as the preferred vascular access for hemodialysis. Patency of the arteriovenous access is important for effective hemodialysis. However, maintaining the patency of the AVF remains a challenge. We determined those independent prognostic factors for the patency of the AVF at the time of its creation.

Method

Cross-sectional study; We include all AVFs performed at the HGUCR in the last 2 decades. Demographic variables (age, sex), etiology of CKD and associated comorbidity were collected. We determine the factors involved in the primary patency of AVFs. Statistical analysis with SPSS 25.0. Categorical variables are expressed as percentages and are compared using the Chi2 test. Quantitative variables are expressed as mean ± standard deviation and the Mann Whitney Student-T/U was used to compare them. Statistical significance for a value of p <0.05.

Results

622 AVFs performed in 482 patients were reviewed. 86.8% were autologous. The mean age was 65.4±14 years; 66.6% were male. The most frequent etiologies of CKD were diabetic nephropathy (30.2%), unknown (18%), and glomerulonephritis (16.6%). 91.2% had arterial hypertension (HBP) and diabetes mellitus (DM) 47.9%. 48.7% received antiplatelet therapy and 15.6% anticoagulation prior to the creation of the AVF. 27% presented primary failure. The univariate analysis showed statistical significance for the qualitative variables HTA (p=0.002), treatment with statins (p<0.01) and antiplatelet (p<0.01), and for the quantitative variables fibrinogen (p=0.048), serum phosphorus (p=0.001), CRP (p=0.004), triglycerides (p=0.05), ferritin (p=0.006) and age (p=0.05). When performing a multivariate analysis using logistic regression, HTA (OR: 0.46 95% CI 0.22-0.95 p = 0.036), high phosphorus levels (OR: 1.22 95% CI 1.08-1, 49 p = 0.004) and statin treatment (OR: 0.58 95% CI 0.36-0.96 p = 0.004) are predictors of primary VA failure.

Conclusion

In our study, HTA and antiplatelet therapy prior to the creation of the VA behave as protective factors for primary failure, with high phosphorus levels being an independent factor for primary failure of AVFs.
MO776THE USE OF HAND GRIP DEVICE IN ELDERLY PATIENTS ON ARTERIOVENOUS FISTULA MATURATION PROCESS
Authors: Tapia González Irati , Esteve Vicent , Ibañez Sara , Rubio Sandra , Moreno Guzman Fatima , Fulquet Nicolás Miquel , Duarte Gallego Verónica , Pou Potau Mónica , Saurina Solé Anna , Ramírez de Arellano Serna Manel
Published: May 2021

Introduction

The indication of creation arteriovenous fistula(AVF) may be controversial in elderly population with advanced chronic kidney disease (CKD). Postoperative exercises improve maturation. However, sometimes these exercises could be difficult to perform in the elderly CKD patients. The hand grip device is easy to use, inexpensive and able to increase the muscles of the hand and foream. Nevertheless, scarce scientific evidence has been reported about the role of hand grip device on AVF maturation process in elderly population.

Objectives

To evaluate the efficacy of a hand grip training program on AVF maturation in our patients older than 75 years old with stages 5-5D CKD.

Methodology

A 15 months prospective study. After surgery, all patients were randomized to hand grip group (HG) or control group (CG). HG performed a training program using a hand grip device. CO received usual care. Demographics data, upper limb muscle strength (ULMS), Doppler ultrasound (DUS), measurements (outflow vein (OV) diameter and humeral artery blood flow rate (BFR), DUS and clinical AVF maturation as well as VA related complications (hematoma, stenosis, thrombosis, pseudoaneurysm, aneurysm) were assessed at 4 and 8 weeks postoperatively.

Results

29 patients. 16 HG, 13 CO. 69% men. Mean age 80,5±2,9 years. 41,4% Radiocephalic AVF. Demographic data, ULMS and DUS measurement at baseline were similar. A significant increase was observed in ULMS only in HG at the end of study (18,8±6,5 vs 21,3±7,1Kg, p=0,005). DUS measurements statistically increased for both groups (OV diameter: CG 2,9 ± 0,6 vs. 5,8 ± 1,4mm; HG 2,9 ± 0,8 vs. 7,2 ± 2,2 mm; humeral artery BFR: CG 132,9± 30,3 vs. 1310,2 ± 691,8ml/min; HG 128,1± 28,9 vs. 1530,7 ± 708,9 ml/min) at the end of study. HG group obtained highest clinical (CG 21,4% vs HG 78,6%;p=0,018) and DUS maturation (CG 27,8% vs HG 72,2%; p=0,011) at 4 weeks and highest clinical (CG 20% vs HG 80%;p=0,007) and DUS maturation (CG 25% vs HG 75%; p=0,002) at 8 weeks, significantly. Despite no significant differences, the number of complications was lower in the HG, mainly significant stenosis (CG 60% vs HG 40%; p=0,428).

Conclusions

The hand grip device is a useful, safety and easy to use training device to improve the AVF maturation in elderly patients. This device results a novel therapeutic option for the AVF maturation in elderly patients. Further studies are required to support these outcomes in this population.
MO779DETECTION OF INTRADIALYTIC SLEEP APNEA IN HEMODIALYSIS PATIENTS
Authors: Paneque Galuzio Paulo , Cherif Alhaji , Tao Xia , Thwin Ohnmar , Preciado Rojas Priscila , Cato Matthew , Thijssen Stephan , Kotanko Peter
Published: May 2021

Background and Aims

Sleep apnea syndrome (SAS) has emerged as an important cardiovascular risk factor in hemodialysis (HD) patients. In patients with SAS, high-frequency oscillations of arterial oxygen saturation (SaO2) and arousal can be used to characterize repetitive respiratory cessation. Although these repetitive patterns have been observed in SAS patients, it has not been studied during HD treatment. In this study, we aim to detect intradialytic SAS in HD patients to provide novel prognosticators of adverse events related to SAS.

Method

We use the Crit-Line® monitor to record SaO2 at 1 Hz frequency, and video recording to capture periods of wakefulness for the entire treatment session (3.5±0.5hr). We developed a recurrent-based time-series analysis to characterize the desaturation and arousal in SaO2. For each patient, we compute four metrics, namely: (i) the probability of recurrence for any given state (recurrent rate, RR), (ii) systemic predictability (determinism, DET), (iii) occurrence of laminar state (LAM), and (iv) permutation entropy to quantify complexity. These four quantities were used to detect episodes of SAS in patients while undergoing HD treatments.

Results

We study 16 HD patients with arterio-venous vascular access. Their age was 54±11 years, 63% were males and 69% were African Americans. SaO2 was measured during two HD sessions per patient. The mean SaO2 was 94.3±2.1%. We observe distinguishable patterns in which periods of awake and asleep are differentiated. Figure 1 shows a typical SaO2 annotated with the period of awake and asleep (shaded area in Fig. 1A), during which the four metrics decrease during the corresponding period where the patient is asleep (Fig. 1B-C). Figure 1D-E shows the consistency of the metrics in all 16 patients, in which DET and entropy are analyzed around the onset of sleep. We observe monotonically decreasing trends around the episode of sleep, suggesting that these results are sensitive to the sleep states, and potentially to an episode of intradialytic SAS.

Conclusion

Our preliminary analysis suggests that DET, LAM, RR, and entropy may contain characteristic properties that could be used to detect the onset of intradialytic SAS, which are characterized by the high-frequency oscillatory patterns in SaO2. Further studies are needed to identify SAS-related desaturation and arousal detected in the SaO2 measurement. The predictive power of these features and their relationships to clinical outcomes warrants further investigation.
MO780SURVIVAL STUDY OF ARTERIOVENOUS FISTULAS CREATED IN A HIGH RESOLUTION HOSPITAL
Authors: Piccone Saponara Luis Guillermo , Castro Fernández Maria Paz , Uribe Heredia Nancy Giovanna , Carreño Parrilla Agustín , Anaya Fernandez Sara , Ferrer García Guillermo , García Conejo Gloria , Ugarte Cámara Marina , Valle Dominguez Casimiro , Romero Barragán Maria del Pilar , Vozmediano Poyatos Maria del Carmen
Published: May 2021

Background and Aims

Clinical practice guidelines recommend an arteriovenous fistula (AVF) as the ideal vascular access for hemodialysis. Autologous AVFs have higher primary, assisted primary and overall survival, associated with lower morbidity and mortality compared to prosthetic AVFs. However, primary failure of AVFs function is not uncommon, above all due to the vascular pathology of patients on hemodialysis (HD). We determined the survival rates in a series of vascular accesses created in a high-resolution hospital.

Method

Cross-sectional study; We include all AVFs performed during the last 20 years. Demographic variables (age, sex), etiology of CKD and associated comorbidity were collected. We determine the primary, assisted and global survival times. Statistical analysis with SPSS 25.0. Categorical variables are expressed as percentages and are compared using the Chi2 test. Quantitative variables are expressed as mean ± standard deviation and the Mann Whitney Student-T/U was used to compare them. We performed a kaplan-Meier analysis determining primary, assisted and overall survival. Statistical significance for a value of p <0.05.

Results

622 AVFs performed in 482 patients were reviewed. 86.8% were autologous. The mean age was 65.4±14 years; 66.6% were male. The most frequent etiologies of CKD were diabetic nephropathy (30.2%), unknown (18%), and glomerulonephritis (16.6%). 91.2% had arterial hypertension (HBP) and diabetes mellitus (DM) 47.9%. 48.7% received antiplatelet therapy and 15.6% anticoagulation prior to the creation of the AVF. 27% presented primary failure. In the survival analysis using the Kaplan Meier test, the mean time to perform angioplasty in dysfunctional AVFs was 14.6±1.37 months and to perform a thrombectomy 17.6±1.31 months. The overall survival of AVFs was 41.9±2 months. When assessing the type of AVF, we observed a longer survival for autologous (31.5±1.8) vs prosthetic (21.8±3.6) (p = 0.03 log Rank 4.73).

Conclusion

In our study, autologous AVFs have better survival compared to prosthetic ones. Of the AVFs created, primary survival at one year (requiring angioplasty) was 64%, assisted primary survival (requiring thrombectomy) was 42%, and overall survival 24%.
MO764AVF VOLUME BLOOD FLOW REDUCTION AS THE FIRST STAGE OF TREATMENT OF CENTRAL VEIN STENOSIS IN HD PATIENTS
Authors: Zulkarnaev Aleksei , Stepanov Vadim , Vatazin Andrey , Parshina Ekaterina , Novoseltseva Mariya , Chursinova Julia
Published: May 2021

Background and Aims

It is well-known that central vein stenosis (CVS) significantly reduces the time of AVF functioning. At the same time, according to current guidelines (KDIGO, European Vascular Surgery Society, European Best Clinical Practice), only clinically significant CVS should be treated. Often, CVS becomes clinically manifest due to a significant increase of AVF volume blood flow (Qa) through the matured dialysis access. Aim: to assess the effect of Qa reduction on the CVS clinical course.

Method

We performed a retrospective study included 56 patients who underwent Qa reduction as the first step of treatment, and 62 patients who received endovascular interventions without Qa reduction (balloon angioplasty supplemented with stenting if necessary).

Blood flow reduction was performed using banding under intraoperative ultrasound control.

Results

Surgical banding leads to a clinically obvious and statistically significant decrease in Qa in all patients – fig. 1. In contrast, after endovascular intervention most of the patients show a modest but statistically significant increase in Qa - fig. 2. All surgeries were performed to reduce the severity of clinical manifestations of CVS. AVF was better available for immediate cannulation after endovascular interventions than after banding: RR=4,537 [95%CI 1,416; 14,84], p=0,0116. However, the probability of successful cannulation at the third postoperative HD session did not differ between groups: RR=3.024 [95%CI 0.674; 13.67], p=0.2126. Taking in consideration these findings, we can conclude that the short-term results of Qa reduction are satisfactory.

After Qa reduction in case of recurrence of CVS symptoms or absence of their complete resolving, we supplemented the treatment with endovascular interventions. Both primary and secondary patency were significantly better than in the case of endovascular interventions without Qa reduction – fig. 3.

Moreover, in patients who underwent endovascular interventions without Qa reduction, higher Qa values were associated with decrease of the primary and secondary patency – fig. 4. So, increasing or maintaining large Qa values after endovascular intervention may be an important risk factor for CVS relapse and AVF function loss.

Conclusion

Qa is an important factor of CVS clinical manifestation. When determining treatment strategy, it is necessary to evaluate Qa first and reduce it, if necessary. Manage of Qa allows to transfer manifest CVS into its subclinical course, which itself leads to improved treatment results.

Endovascular interventions are the preferred treatment of CVS with clinical manifestations in a case of underlying normal or suboptimal Qa.
MO785CAUSES OF THE DELAY IN CREATING PERMANENT VASCULAR ACCESS IN HEMODIALYSIS PATIENTS
Authors: Al-Sayyari Abdulla
Published: May 2021

Background and Aims

Many patients start HD with central venous catheter (CVC) which has multiple complications This study aims at identifying the physicians’ perspectives regarding the reasons of delayed AVF creation

Method

This is a cross-sectional questionnaires-based survey designed at discovering the physicians' opinions and perception about the reasons for the delay in the creation of permanent vascular access and patient’s factors, physicians factors, and hospital factors leading to this delay,

Results

There was a total of 212 participants, of whom 131 (61.8%) were of consultant level.

The three most important factors associated with delay in AVF creation were “denial of kidney disease or the need of AVF” (76.4%), “dialysis fears and practical concern” (75.9%) and “the patient refusing to undergo AVF surgery” (73.1%). Significantly fewer consultants (42.7%) than below consultants (45.7%) pointed out that “patient noncompliance with nephrology appointments” was a significant factor (p=0.046).

The most important physicians & hospital factors was “insufficient conduction of pre-dialysis care and education about AVF initiation to the patient (63.7%)

The respondents were asked to choose one of four possible factors that they felt was the main factor in delaying AVF creation. Over two thirds (68.4%) chose the patient factor as the main factor There was no significant difference in this response whether the respondents were consultants or below consultants (p=0.8))

Conclusion

The most agreed on factors associated with AVF creation delay are the denial of the need for dialysis, fear of dialysis and practical concern, insufficient conduction of pre-dialysis care and education about AVF initiation to the patient, and late referral to a nephrologist. a validated approach to patients' selection and referral to vascular access creation that could be applied on different types of patient in different regions is required .