bluuebunny/crossref_metadata_2025 huggingface dataset:
MO741TUMOR NECROSIS FACTOR ALPHA AND MAGNESIUM ARE LINKED TO CARDIAC VALVE CALCIFICATION IN DIABETIC HEMODIALYSIS PATIENTS
Authors: Susla Oleksandr , Litovkina Zoriana , Mysula Ihor , Gozhenko Anatoliy
Published: May 2021

Background and Aims

The processes of cardiac valve calcification (CVC) in diabetic hemodialysis (HD) patients are not fully understood. In this context, it is reasonable to complex and comprehensively research the activity of chronic inflammation and magnesium (Mg) imbalance as cardiovascular risk factors in end-stage renal disease (ESRD). The main purpose of the current study was to determine the relationship of tumor necrosis factor alpha (TNF-α) and Mg levels with the presence and severity of CVC in diabetic patients with ESRD.

Method

We enrolled 136 patients undergoing HD (male/female, 78/58;age, 53.9±1.0 years; HD duration, 47.6±4.2 month) in this observational cross-sectional study. The study was performed in accordance with the provisions of the Declaration of Helsinki last revision. Depending on the presence of type 2 diabetes mellitus (T2DM) all subjects were divided into two groups: the 1st one – non-diabetic patients (n=88); the 2nd one – diabetic patients (n=48). Presence of CVC was detected by ultrasound. The mitral (MVC) and aortic (AVC) valve calcification degree were scored as follows: 1, no calcification; 2, valve thickening without calcification; 3, valve annulus or cusps calcification. Serum content of TNF-α as one of the key proinflammatory cytokine was determined by enzyme-linked immunosorbent assay. Serum Mg concentration was estimated by biochemical method. Data are expressed as means±SEM. Used nonparametric statistics methods: Mann-Whitney U-test, χ2-test, Spearman’s rank R correlations.

Results

In diabetic HD patients TNF-α content was higher (13.86±1.34 vs. 8.73±0.60 ng/L; Z=3.04, p=0.002) whereas Mg concentration (0.87±0.02 vs. 1.00±0.02 mmol/L; Z=4.91, p<0.001) – lower compared to non-diabetic ones, and in 2nd group indices of TNF-α and Mg were related (Rs=-0.68, p<0.001). CVC was detected in 66.6% of T2DM patients with predominance of calcification of both valves (35.4%) over isolated MVC (20.8%) and AVC (10.4%). Combined MVC and AVC in the 2nd group was observed 2.6 times more often (χ2=8.78, p=0.003) than in the 1st one. For the first time it was established that in diabetic patients with ESRD the presence of CVC closely associated with indices of TNF-α (Rs=0.51, p<0.001) and Mg (Rs=-0.57, p<0.001). The MVC as well as AVC degree were related with the content of TNF-α (Rs=0.49, p<0.001; Rs=0.52, p<0.001) and Mg concentration (Rs=-0.47, p<0.001; Rs=-0.50, p<0.001) respectively.

Conclusion

(1) T2DM in HD patients is characterized with an increase of serum TNF-α activity and simultaneous decreased of Mg content. (2) In diabetic patients with ESRD, both MVC and AVC are closely linked with the TNF-α accumulation and hypomagnesemia. (3) Chronic inflammation and Mg deficiency can be important factors of CVC progression and very high cardiovascular risk in diabetic HD patients.
MO742PRELOAD DEPENDENCE OF PULMONARY HAEMODYNAMICS AND RIGHT VENTRICULAR PERFORMANCE: AN ECHOCARDIOGRAPHIC STUDY IN PATIENTS ON HAEMODIALYSIS
Authors: Gual-Capllonch Francesc , Graterol Fredzzia , Soler Majoral Jordi , Bancu Ioana , Ferrer-Sistach Elena , Teis Albert , Santiago-Vacas Evelyn , Vallejo Nuria , Juncà Gladys , Bayes-Genis Antonio
Published: May 2021

Background and Aims

Haemodynamic cardiac changes in haemodialysis are associated with adverse cardiovascular outcomes and and they are difficult to measure. Systolic pulmonary artery pressure (SPAP) and right heart adaptation in relation to pre-existing preload are often disregarded. To determine volume-related changes in the pulmonary-right ventricle (RV) unit and the preload-dependence of its components, we analysed pulmonary haemodynamics and right ventricular performance, taking advantage of the plasma volume removal associated to haemodialysis (HD).

Methods and results

Fifty-three stable patients on chronic HD with LVEF >50% and without heart failure were recruited (mean age 63.0±12.4 years; 31.2% women; hypertension in 89% and diabetes in 53%) and evaluated just before and after HD (mean ultrafiltration volume 2.4±0.7l). SPAP from both times were available in 39 patients. After HD, SPAP decreased (42.2±12.6 to 33.7±11.6 mmHg, p<0.001) without modification of non-invasive pulmonary vascular resistance (1.75±0.44 to 1.75±0.40 eWU, p=0.94). Age and drop in the E/e’ ratio were the variables associated with greater reduction in PASP (p=0.022 and p=0.049, respectively). A significant reduction of right chamber sizes was observed, along with a diminution in measures of RV contractility, excluding RV longitudinal strain. Functional tricuspid regurgitation (FTR) diminution was observed in 26% of patients, occurring in every case with more than mild FTR. On multivariate analyses, left atrial size was the only predictor of pulmonary hypertension (defined as SPAP >40 mmHg) (OR 1.29 (1.07–1.56), p=0.006).

Conclusion

Rapid volemic changes determined by rapid fluid removal during hemodialysis; may affect FTR grading, RV size and contractility, with RV longitudinal strain being less variable than conventional parameters. SPAP decreases after HD, and this reduction is related to age and greater diminution of the E/e′ ratio.
MO743FACTORS AFFECTING CEREBRAL OXYGENATION IN HEMODIALYSIS PATIENTS: ARTERIAL STIFFNESS, MENTAL ACTIVITIES, SMOKING
Authors: Piotr Olczyk , Kusztal Mariusz , Gołębiowski Tomasz , Krzysztof Letachowicz , Madziarska Katarzyna , Szymczak Anna , Magdalena Krajewska
Published: May 2021

Background and Aims

A significant deterioration of cognitive function in hemodialysis patients is observed in elderly and non-elderly patients. One of possible explantation is significant changes in the circulatory system caused by regular lower cerebral regional saturation of oxygen (rSO2) during dialysis. We aimed to identify the factors affecting the cerebral rSO2 in HD patients during session.

Method

27 patients out of 80 hemodialysed in center patients were recruited for the study (exclusion criteria: significant vision defect, fistula in the dominant hand, previous stroke, other neurological diseases impaired cognitive functions). The mean age of the patients was 51 ±18 y, BMI 25.5±5, dialysis vintage was 2.3 y; 6 with DM and 22 with HT. During the study, each patient completed battery of cognitive function tests (MOCA, Beck's Scale) including computer based assessment validated for elderly (Cognifit), arterial stiffness surrogates (PWV, Aix75 using IEM Mobil-O-Graph) and the saturation (rSO2) of frontal lobes were measured (INVOS 5100c system). Patient regular passive or active (reading, crosswords solving, electronic games) behaviour during sessions was noticed.

Results

Factors showed correlations with rSO2 are displayed in table. Lack of correlations between rSO2 and HD vintage, diabetes or BMI was observed. Patients mentally active during dialysis showed significant (p<0.05) higher rSO2 (60 vs 53% left, 58 vs 49% right), Cognifit score (368 vs 233) and PWV (6,3 vs 9,3 m/s) when compared to passive patient behavior (sleeping, watching TV).

Conclusion

Significant differences in cerebral oxygenation in hemodialysis patients correlated with cognitive functions. In HD patients, cerebral rSO2 was affected by multiple factors, including non modifiable factors: arterial stiffness, age and modifiable factors – active mental activity during session and smoking. Furthermore, this is the first report describing lower levels of rSO2 in HD patients with significant central arterial stiffness (Figure).
MO748CORONARY ARTERY CALCIUM SCORE IN ASYMPTOMATIC PATIENTS RECEIVING CHRONIC HAEMODIALYSIS
Authors: Kusic Milicevic Jovana , Vidakovic Radosav , Andjelkovic Apostolovic Marija , Apostolovic Branislav , Ostojic Ana , Markovic Rodoljub , Djurkovic Veselinka , Trbojević Stanković Jasna , Jemcov Tamara , Dragovic Gordana
Published: May 2021

Background and Aims

Vascular calcification has been reported to be an independent predictor of all-cause mortality and cardiovascular (CV) events in patients with end-stage renal disease. Even in previously asymptomatic patients, early years of haemodialysis (HD) are associated with high CV morbidity and mortality rates. Thus, it is important to precisely and timely identify individuals at risk of coronary artery disease (CAD) who would benefit from further CV treatment. Coronary artery calcium score (CACS) is an accurate tool for noninvasive assessment of CAD. This study aimed to evaluate CACS in asymptomatic HD patients in early years of treatment.

Method

This multicentric observational study included 60 patients receiving chronic HD for less than 4 years, with neither signs nor symptoms of CV disease. All patients underwent multislice computed tomography to identify coronary artery calcifications according to the standard procedure. CACS was calculated by the Agatston method individually for the left main, left circumflex, left anterior descending, and right coronary arteries and then summed to calculate the total CACS for each patient. Patients were distributed based on CACS: group 1 with CACS = 0, group 2 with CACS ranging from 1 to 400, and group 3 with CACS > 400.

Results

Nine patients (89% men) had CACS = 0, 34 (47% men) had CACS 1-400, and 17 (76.5% men) had CACS > 400 (χ2 = 7.467; p = 0.024). The mean age was 51±7, 61±12 and 64±8 years in groups 1, 2 and 3, respectively (p = 0.016). Patients in group 1 were significantly younger than patients in group 2 (p = 0.046) and group 3 (p = 0.012). The highest percentage of men was observed in group 1 (x2 = 7,668; p = 0.022). Other investigated demographic characteristics (dialysis vintage, body mass index, smoking history, family CV history, systolic and diastolic blood pressure), comorbidities (hypertension, diabetes, hyperparathyroidism, hyperlipidemia) and therapy (angiotensin converting enzyme inhibitors, angiotensin receptor blockers, statins, vitamin D, CaCO3, dialysate-magnesium concentration) did not differ significantly between the investigated groups. CACS showed statistically significant negative correlation with the serum iron (σ = - 0.351; p = 0.007), while other laboratory parameters (including calcium phosphate product) did not show statistically significant correlations.

Conclusion

Older age and low serum iron are associated with higher CACS in asymptomatic patients in the early years of HD. Therefore, these patients should be closely monitored for the early signs of CV disease.
MO749CATHETER ABLATION FOR ATRIAL FIBRILLATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE AND ON DIALYSIS - A META-ANALYSIS
Authors: Chung Isaac , Khan Yasir , Kondapally Rao , Sohal Manav , Banerjee Debasish
Published: May 2021

Background and Aims

Atrial fibrillation (AF) is common in chronic kidney disease (CKD) patients and is difficult to treat with antiarrhythmics and anticoagulants due to abnormal metabolism and increased side effects. Catheter ablation if successful may be a safer alternative. This review evaluates the efficacy of catheter ablation therapy in CKD and haemodialysis (HD) patients.

Method

MEDLINE and Embase databases were searched with the following search terms: “(atrial fibrillation AND (chronic kidney disease OR renal failure OR renal function OR dialysis) AND ablation)” for journal articles of any language until December 2020. Two authors abstracted the data independently. Risk ratios were derived using random-effects meta-analysis.

Results

Of the initially identified 520 studies, 5 and 3 observational studies on CKD and HD patients respectively were found reporting AF recurrence rates. During a mean (SD) follow-up of 25.5 (9.8) months, CKD patients had a higher risk of AF recurrence compared to patients without CKD (RR 2.34, 95% CI 1.36-4.02, p<0.01). The heterogenicity test showed there were significant differences between individual studies (I2 = 91%, 95% CI 82.2%-95.6%, p<0.01). In a mean (SD) follow-up of 40.3 (20.8) months, HD patients may be at a higher risk of AF recurrence compared to healthy non-dialysis AF patients (RR 1.21, 95% CI 0.64-2.30, p=0.55). Heterogeneity analysis showed the studies were heterogeneous (I2 92.3%, 95% CI 80.8%-96.9%, p <0.01).

Conclusion

Our meta-analysis suggests patients with CKD and patients on HD are more likely to have AF recurrences after catheter ablation compared to AF patients who are otherwise healthy. However, more robust evidence from randomized controlled trials comparing catheter ablation and pharmaceutical rhythm therapy are urgently needed to guide therapy in this difficult to treat population.
MO723EFFICACY AND SAFTY OF DAPAGLIFLOZIN FOR HEART FAILURE: A SYSTEMIC REVIEW
Authors: Wang Zhe
Published: May 2021

Background and Aims

Dapagliflozin is an inhibitor of sodium-dependent glucose transporters 2, which is a new drug for diabetes mellitus. Recent researches indicated that among patients with heart failure, the risk of worsening heart failure or death from cardiovascular causes was lower among those who received dapagliflozin than those who received placebo, regardless of the presence or absence of diabetes. This systematic review aimed to evaluate efficacy and safety of dapagliflozin for heart failure.

Method

According to the collaborative search strategy, MEDLINE(1966-2020.9), Embase(1974-2020.9), Chinese Wanfang database(1996-2020.9),CNKI(1979-2020.9), the clinical control test database of Cochrane Library and were searched. Only randomized controlled trials (RCT) were included in this research. Quality assessment and data extraction were conducted by two independent investigators. Meta-analysis was conducted by Stata 11.0.

Results

A total of 5 RCTs were identified which met the inclusion criteria, including 5998 patients. Compared with control group, dapagliflozin was associated with a lower risk of cardiovascular mortality/hospitalization for heart failure composite events (HR=0.73, 95%CI 0.64∼0.83, P<0.001), cardiovascular mortality (RR=0.80, 95%CI 0.68∼0.93, P=0.005), hospitalization for heart failure (HR=0.68, 95%CI 0.58∼0.80, P<0.001), and all-cause mortality (RR=0.80, 95%CI 0.70∼0.92, P=0.002). Dapagliflozin also increased the Kansas city cardiomyopathy questionnaire (KCCQ), without increasing the risk of major hypoglycemia, volume depletion, renal adverse event and amputation.

Conclusion

Dapagliflozin could effectively lower the risk of mortality and hospitalization for heart failure, as well as improve the quality of life among patients with heart failure.
MO724IS INDIVIDUALIZED DIALYSATE SODIUM REASON FOR BETTER SURVIVAL IN HEMODIALYSIS PATIENTS?
Authors: Eftimovska-Otovikj Natasha , Petkovikj Natasha , Stojceva-Taneva Olivera
Published: May 2021

Background and Aims

We are uncertain about whether dialysate sodium improves overall health and well-being for people on haemodialysis, since there are a mixture of probably good and bad effects. Dialysate sodium is one of the most easy changeable parameter which can inﬂuence hemodynamic stability, echocardiography and laboratory parameters. The aim of the study was to investigate whether dialysis patients will have some beneﬁcial effects of dialysate sodium set up according to serum sodium.

Method

77 nondiabetic subjects (41men; 36women) performed 12 months hemodialysis (HD) sessions with dialysate sodium concentration setup at 138 mmol/L, followed by additional 24 month ssessions wherein dialysate sodium was set up according to pre-HD serum sodium concentration. Interdialytic weight gain (IDWG), echocardiography, laboratory parameters and survival were analysed.

Results

Sodium individualization resulted in signiﬁcantly lower IDWG by using individualized sodium according to pre HD serum sodium compared to standard dialysate sodium (2.17±0.79 vs 1.93±0.64 kg, p<0,001). In all patients we confirmed positive sodium gradient and univariate regression analysis showed that by increasing the sodium gradient by 1 mmol/L, IDWG increased by an average of 0.189% and 7,1% changes in IDWG can be explain by changing of the sodium gradient. Echocardiography analysis showed an increase of 2.04 mm of left ventricular diastolic diameter (LVDD) by increasing the sodium gradient for 1mmol/L and signiﬁcantly increased left ventricular mass (LVM) of 35.69 gr by 1kg increase of IDWG. Laboratory analysis showed statistical significant increase in Kt/V, URR (urea reduction rate), serum albumin and hemoglobin by using individualized dialysed sodium compared to standard dialysate sodium, respectively (1.50±0.24 vs 1.36±0.22; 70.80±5.24 vs 67.00±6.23%; 38.23±3.80 vs 34.46±2.53 g/L; 120.32±10.14 vs 114.62±10.34 g/L, p<0.001). We confirmed significant decrease in serum potassium, with no change in other electrolities (5.62±0.60vs 5.15±0.94). During the study, 7 patients died and binary logistic regression univariate analysis showed that significant predictors of mortality in patients dialyzed with individualized sodium dialysis according to pre-HD plasma sodium concentrations were Kt/V, URR, and CRP (C reactive protein). Analysis showed that patients with Kt/V lower than 1,2 have 8.8 times higher risk for death compared to patients with Kt/V>1,2, URR lower than 65% have 10,9 times higher risk compared to URR>65% and CRP higher than 10 mg/L have 10.2 times higher risk for death compared to patients with CRP lower than 10 mg/L

Conclusion

Individualization of dialysate sodium according to pre HD serum sodium concentration result in better IDWG control, improvement of fluid overload and regression of left ventricular hypertrophy, better dialysis adequacy and higher survival compared to standard dialysate sodium.
MO761THE CONTRIBUTION OF HIGH-PHOSPHORUS IN EXTRACELLULAR MATRIX ACCUMULATION OF VALVULAR CALCIFICATION IN CHRONIC KIDNEY DISEASE
Authors: Wang Liting , Zhang Yuxia , Wang Yujia , Tang Rining
Published: May 2021

Background and Aims

The characteristics of valvular calcification (VC) in early stage are extracellular matrix (ECM) accumulation and muti-cells activation. In our previous work, we found high-phosphorus (HP) diet aggravated ECM accumulation in both aortic valve and mitral valve in rats with chronic kidney disease (CKD). However, the underlying mechanism of HP contribution in ECM accumulation of CKD-induced VC is still unknown.

Method

canine valvular interstitial cells (VICs), valvular endothelial cells (VECs) and human umbilical vein endothelial cells (HUVECs) were used in this study. CKD mice (C57b and Tek-EGFP-PolyA) was build by 0.2% adenine-diet for 6 weeks and HP diet/NP diet for 10 weeks.

Results

As for VICs, HP induced qVICs transfer into aVICs, not oVICs, which was characterized with upregulated level of smoothelin and viemitin. There was no calcium accumulation was observed, suggesting that VICs do not have the ability to synthesize calcium crystals under pure HP intervention. As for VECs, aVICs activated by HP induced VECs EndMT in a transwell-assay, which was characterized with decreasing protein levels of endothelial markers (CD31, vWF, VE-cadherin) and increasing protein levels of mesenchymal makers (α-SMA, FSP1, N-cadherin). Then, IL-8 was found as the main factor releasing from VICs to induce VECs EndMT. In vitro, the concentration of IL-8 in the lower chamber could reach 2-4ng/ml. Reparixin was used to inhibit IL-8 receptor of VECs, which could relive aVICs-induced EndMT. In vivo, the expression of valve CXCL-2 (the mouse IL8 functional homolog) was increased in HP-diet compared with NP-diet, though the serum level of CXCL-2 was similar between two groups. AAV9-sm22a-CXCL-2 and Reparixin could inhibit VECs EndMT by inhibiting VICs relasing CXCL-2 and inhibiting VECs IL-8 receptor in CKD mice of Tek-EGFP-PolyA respectively. Then, IL-8 was found to induced VECs EndMT by miR-214-3p/PTEN/Akt pathway. Inhibiting EndMT by blocking IL-8/miR-214-3p could alleviate ECM accumulation.

Conclusion

HP could induce qVICs transfer into aVICs, and aVICs could cause VECs EndMT via IL-8/miR-214-3p/PTEN/Akt pathway. Both take part in ECM accumulation in CKD-induced VC.
MO762RELATIONSHIP BETWEEN INFLAMMATION AND PERIPHERAL ARTERIAL DISEASE MEASURED BY ANKLE-BRACHIAL INDEX IN CHRONIC HEMODIALYSIS PATIENTS
Authors: Parodis Yanet , Monzon Tania , Valga Francisco , Anton-Perez Gloria
Published: May 2021

Background and Aims

Peripheral arterial disease (PAD) is very common in patients with chronic kidney disease. There are predisposing factors such as high blood pressure, diabetes mellitus, and dyslipidemia that are highly prevalent in this population. The ankle-brachial index (ABI) is a widely validated diagnostic method for the diagnosis of PAD. A value below 0.9 is suggestive of this pathology. On the other hand, inflammation is a phenomenon that favors development of atherosclerosis and therefore could be another predisposing factor for PAD. There are emerging markers of inflammation such as the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) that have an excellent correlation with classic markers such as C-reactive protein (CRP). The objective of our study was to determine whether there is a relationship between ABI values and the degree of inflammation in patients.

Method

A retrospective observational cross-sectional study was conducted in our prevalent hemodialysis population between April-May 2019. ABI was measured through the Microlife WatchBP Office ABI™ device. The sample was divided into two groups using 0.9 as a cut-off point: group 1 (ABI <0.9) and group 2 (ABI> 0.9). Inflammatory ratios (NLR, PLR and SII) and other parameters of bone kidney disease such as serum calcium, bicarbonate, phosphorus, parathyroid hormone (PTH), magnesium and vitamin D were determined.

Results

100 patients with chronic kidney disease on chronic hemodialysis belonging to our Avericum Negrin center were analyzed. 42% (N = 42) of the sample were women and 42% (N = 42) were diabetic. The etiology of kidney disease was: 12% (N = 12) renal nephroangiosclerosis, 35% (N = 35) diabetic nephropathy, 14% (N = 14) chronic glomerulonephritis, 8% (N = 8) polycystic kidney disease, 17% (N = 17) unknow and 14% (N = 14) others. 19% (N = 19) had a central venous catheter as vascular access. The mean values of inflammatory and renal bone disease parameters are described in Table 1. The values of PLR and SII index were significantly higher in patients with ABI <0.9. (Figures 1 and 2).

Conclusion

Patients with peripheral arterial disease (ABI <0.9) had higher PLR and SII values
MO726EFFICACY OF OPHTHALMIC EXAMINATIONS FOR PREDICTING VASCULAR CALCIFICATION IN MAINTENANCE HEMODIALYSIS PATIENTS
Authors: Park Woo Yeong , Kim Yaerim , Paek Jin Hyuk , Han Seungyeup , Kang Kyung Tae , Jang Ji Hye , Kim Yu Cheol , Jin Kyubok
Published: May 2021

Background and Aims

Vascular calcification is a risk factor for cardiovascular disease. In maintenance hemodialysis (MHD) patients, it has been reported that vascular calcification can be detected not only in coronary vessels, but also in ocular areas. Ophthalmic examinations can be used to more easily measure the degree of vascular calcification, but they are not sufficiently validated. Therefore, we aimed to investigate the association between ophthalmic findings and vascular calcification, and the prediction of the risk of cardiovascular disease in MHD patients.

Method

Thirty two MHD patients were enrolled. Conjunctival and corneal calcification (CCC) score was calculated based on the Tokuyama method, and the severity of CCC was graded between 0 and 5 by Porter and Crombie classification. The extent of invasion in the corneal limbus and center was identified using anterior ocular CT. Coronary calcium deposit was scored using CT, and cardiac function was investigated by echocardiogram. We divided the study population into three groups: mild (0-2 score), moderate (3-5 score) and severe (6-10 score) groups according to CCC scores.

Results

The mean coronary calcium scoring was 354.6 ± 765.8 in the mild group, 768.2 ± 594.0 in the moderate group, and 4034.9 ± 2981.0 (P<0.001). The mean extent of invasion in the corneal limbus and center was significantly higher in the severe group than in the mild and moderate groups (P<0.001). Ejection fraction and corrected calcium*phosphate were significantly higher in the severe group than in the mild and moderate groups (P<0.001 and P=0.036). The CCC score was positively associated with the coronary calcium scoring, the extent of invasion in the corneal limbus and center, and parathyroid hormone level. The extent of invasion in the corneal limbus and center was also positively associated with the coronary calcium scoring. The CCC score was only negatively associated with ejection fraction.

Conclusion

Our study showed that CCC score and the extent of invasion in the corneal limbus and center can predict the risk of cardiovascular disease in MHD patients.
MO728OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY (OCT-A) METRICS PREDICT INTRADIALYTIC HYPOTENSION EPISODES IN CHRONIC HEMODIALYSIS PATIENTS: A PILOT, PROSPECTIVE STUDY
Authors: Coppolino Giuseppe , Carnevali Adriano , Gatti Valentina , Battaglia Caterina , Randazzo Giorgio , Figlia Irma , Patella Gemma , Giannaccare Giuseppe , Scorcia Vincenzo , Andreucci Michele , Bolignano Davide
Published: May 2021

Background and Aims

In chronic hemodialysis (HD) patients, intradialytic hypotension (IDH) is a complication that increases mortality risk. The pathogenesis of this condition remains partly unexplained although dysfunctions of the nervous autonomous system and various factors related to the hemodialytic procedure like rapid or excessive ultrafiltration, excessive reduction in osmolality and reaction to the dialyzer membrane or machine tubing, seem to play a key role. The observation of ocular microcirculation gives us an exceptional chance to directly evaluate in vivo the reactions of human circulation to stress stimuli. Indeed, the ocular microcirculation is involved in systemic disease and early changes in vascular structures may predict the development of systemic vascular disorders. We run a pilot study to analyzing possible relationships between optical coherence tomography angiography (OCT-A) metrics and IDH and to evaluate whether OCT-A could represent a useful tool to stratify the hypotensive risk in dialysis patients.

Method

a total of 35 eyes (35 patients) being correctly analyzed. OCT-A was performed before and after a single dialysis session. Patients were then followed up to 30 days (10 HD sessions) and a total of 73 IDHs were recorded with 12 patients (60%) experiencing at least one IDH.

Results

Central choroid thickness (CCT), 6x6 mm whole vessel density (VD) of superficial capillary plexus (SPC) and 6x6 mm foveal VD of deep capillary plexus (DCP) were reduced after dialysis (Figure 1). At logistic regression analysis, IDH was positively associated with baseline foveal VD of SCP and DCP, while an inverse association was found with the choroid (Figure 2). In Kaplan-Meier analyses of patients categorized according to the ROC-derived optimal thresholds, CCT, the 3x3 foveal VD of SCP, the 3x3 mm and 6x6 mm foveal VD of DCP and the 6x6 mm foveal VD of SCP were strongly associated with a higher risk of IDH over the 30-days follow-up.

Conclusion

In our study, we demonstrated that HD patients experiencing frequent IDH episodes showed a different ocular pattern with respect to those not facing with this complication. Furthermore, a simple measurement of retinal and choroid parameters by OCT-A before a single dialysis session may help predicting the risk of following IDH in the short-term. In HD patients, a single OCT-A measurement may represent a non-invasive, rapid tool to evaluate the compliance of vascular bed to HD stress and to stratify the risk of IDH in the short term.
MO729LUNG ULTRASOUND GUIDED DRY-WEIGHT REDUCTION DECREASES CARDIAC CHAMBERS DIMENSIONS AND IMPROVES VENTRICULAR DIASTOLIC FUNCTION IN HEMODIALYSIS PATIENTS: LONG-TERM ANALYSIS OF A LUST SUB-STUDY
Authors: Loutradis Charalampos , Papadopoulos Christodoulos , Sachpekidis Vassilios , Ekart Robert , Krunic Barbara , Papadopoulou Dorothea , Papagianni Aikaterini , Mallamaci Francesca , Zoccali Carmine , Sarafidis Pantelis
Published: May 2021

Background and Aims

Left ventricular hypertrophy (LVH) and dysfunction are highly prevalent in hemodialysis patients and independently associated with adverse outcomes. Few interventions were shown to effectively reduce LVH in hemodialysis. This study examines the long-term effects of dry-weight reduction with a standardized lung-ultrasound-guided strategy on echocardiographic indices of left and right cardiac chambers in hemodialysis patients.

Method

This is the report of the 12-month trial phase of a randomized controlled trial in 71 clinically euvolemic, hemodialysis patients with hypertension. Patients were randomized (1:1 ratio) in the active group (23 male and 12 female), following dry-weight reduction guided by the total number of US-B lines prior to a mid-week dialysis session and the control group (24 male and 12 female), following standard-of-care treatment. Among several assessments, participants underwent two-dimensional and tissue-Doppler echocardiographic (TDI) at baseline and study-end.

Results

During follow-up dry-weight reduction took place in more patients in the active compared with the control group (71.4% vs 22.2%; p<0.001). Left atrial (LA) surface (-1.37±4.50 vs 1.28±5.00 cm2; P=0.006) and LA volume index (-3.22±11.82 vs 4.76±12.83 ml/m2; P=0.009) decreased in the active and increased in the usual-care group. Left ventricle (LV) diastolic (-0.94±11.45 vs 6.58±13.92 ml/m2; P=0.015) and systolic (-0.89±7.11 vs 3.38±7.89 ml/m2; P=0.018) volume index decreased only in the active group. LV mass index slightly decreased in the active (134.21±44.75 vs 133.57±45.51; P=0.844) and was marginally increased in the control group (134.21±40.96 vs 143.77±50.04 g/m2; P=0.089). Right ventricular (RV) systolic pressure was stable in the active (23.74±13.76 vs 24.35±12.99; P= 0.795) and significantly increased in the usual-care group (26.24±12.95 vs 31.20±16.13 mmHg; P=0.028). Reductions in LV A wave were greater in the active compared to the usual-care group (-4.98±15.11 vs 2.23±21.71 m/s; P=0.009). Changes in LV systolic and RV diastolic function indices were not different between the two groups.

Conclusion

Over 12 months, a lung-ultrasound-guided strategy for dry-weight reduction can effectively decrease cardiac chamber dimensions, prevent LVMi increase and improve LV diastolic and RV systolic function.
MO825PERSONALIZING TREATMENT IN END-STAGE KIDNEY DISEASE: DECIDING BETWEEN HAEMODIAFILTRATION AND HEMODIALYSIS BASED ON INDIVIDUALIZED TREATMENT EFFECT PREDICTION
Authors: Van Kruijsdijk Rob , Vernooij Robin , Bots Michiel , Peters Sanne , Dorresteijn Jannick , Visseren Frank L J , Blankestijn Peter J , Debray Thomas
Published: May 2021

Background and Aims

An individual participant data (IPD) meta-analysis of four randomized controlled trials (RCTs) demonstrated that hemodiafiltration (HDF) reduced overall mortality compared to hemodialysis (HD) in patients with end-stage kidney disease (ESKD). It remains, however, difficult to translate these average results into clinical practice as absolute treatment effects may substantially differ between individuals. The aim of this study was to develop and validate a treatment effect prediction model to determine which patients would benefit the most from HDF or HD in terms of all-cause mortality.

Method

We used an IPD meta-analysis based on four RCTs comparing HDF with HD on mortality endpoints to derive a Royston-Parmar model for prediction of absolute treatment effect of HDF based on pre-specified patient and disease characteristics. Validation of the model with regard to model discrimination, calibration and net benefit was performed using internal-external cross validation.

Results

The median predicted gain in median survival was 44 (Q1-Q3: 44-46) days for every year of treatment with HDF compared to HD. The overall gain in median survival with HDF ranged from 2 to 48 months (Figure). Patients who benefited most from HDF were younger, less likely to have diabetes or a cardiovascular history and had higher serum creatinine and albumin levels. Internal-external cross validation showed adequate calibration and discrimination. Decision curve analysis indicated that prediction-based treatment allocation improved the net clinical benefit compared to treating all with patients HDF or treating all with HD.

Conclusion

Although overall mortality is reduced by HDF compared to HD in ESKD patients, the absolute survival gain can vary greatly between individuals. Our results indicate that the effects of HDF on survival can be predicted using a combination of readily available patient and disease characteristics, which could guide shared decision-making.
MO833PSYCHOLOGICAL REPERCUSSIONS OF THE LOCKDOWN AND THE COVID-19 EPIDEMIC IN HEMODIALYSIS PATIENTS AND CAREGIVERS IN FRANCE
Authors: Prezelin-Reydit Mathilde , Guerraoui Abdallah , Dolley-Hitze Thibault , Vendrely Benoît , Chantrel François , Kolko-Labadens Anne , Azzouz Lynda , Bouillier Marc , Pelletier Solenne , Fessi Hafedh , Vigneau Cécile , Combe Christian , Caillette-Beaudoin Agnes , Chauveau Philippe , Lasseur Catherine , Idier Laetitia
Published: May 2021

Background and Aims

The health crisis linked to the COVID-19 epidemic has required lockdown measures in France and changes in practices in dialysis centers. The objective was to assess the depressive and anxiety symptoms during lockdown in hemodialysis patients and their caregivers, to assess their coping strategies during this period and to assess the symptoms of depression, anxiety and post traumatic stress beyond confinement.

Method

We sent, during lockdown period, between April and May 2020, self-questionnaires to voluntary subjects (patients and caregivers), treated by hemodialysis or who worked in hemodialysis in one of the 14 participating centers in France. We analyzed their perception of dialysis sessions (beneficial or worrying), their stress level (VAS rated from 0 to 10), their anxiety and depressive symptoms (HADS). Factors associated with stress, anxiety and depression were analyzed with multiple logistic regression models. We will look for associations between coping strategies, participant characteristics and symptoms of stress, anxiety and depression using chi-square tests. A second questionnaire was sent out in October to collect symptoms of depression, anxiety and post-traumatic stress beyond confinement. Symptoms will be described and factors associated with stress, anxiety and depression will be analyzed with multiple logistic regression models.

Results

669 patients and 325 caregivers agreed to participate. 70% of participants found it beneficial to come to dialysis during confinement. The proportions of subjects with a stress level ≥ 6 linked to the epidemic, confinement, fear of contracting COVID-19 and fear of infecting a loved one were respectively 23.9%, 26.2%, 33.4% and 42%. 39.2% presented with certain (13.7%) or doubtful (19.2%) anxious symptoms. 21.2% presented a certain (7.9%) or doubtful (13.3%) depressive symptomatology. Age, gender, history of psychological disorders and perception of dialysis sessions were associated with levels of stress, anxiety and depression. 685 subjects participated in the second part of the study (68.9% of the participants of the first part). Analyzes of this data are in progress.

Conclusion

During the lockdown period, in France, the majority of hemodialysis patients and caregivers found it beneficial to come to dialysis. One in 3 subjects had anxiety symptoms and one in 5 subjects had depressive symptoms. It will be interesting to investigate if there was an association between the coping strategies implemented by the participants and their level of stress, anxiety and depression during confinement and to analyze the evolution of the anxiety-depressive symptoms over time.
MO835AFTERMATH OF FORTNIGHTLY UNIVERSAL TESTING FOR SEVERE ACUTE RESPIRATORY CORONA VIRUS-2 INFECTION IN MAINTENANCE IN HEMODIALYSIS PATIENTS
Authors: Prasad Narayan , Patel Manas Ranjan , Bhadauria Dharmendra , Kaul Anupama , Kushwaha Ravi Sankar
Published: May 2021

Background and Aims

Asymptomatic maintenance hemodialysis patients with SARS-COV-2are missed with pre-dialysis screening without testing. The possible ideal strategy of testing each patient before each shift with RT-PCR was not feasible. We aimed to study the effectiveness of fortnightly screening with RT -PCR for SARS-CoV-2 in curbing transmission.

Method

Between July 1, 2020, and September 30, 2020, all 273 patients receiving hemodialysis were subjected to fortnightly testing for SARS-Cov-2 in the unit to detect asymptomatic patients. The cost and effectiveness of universal testing in preventing transmission were analyzed using Susceptible-Infectious-Removed (SIR) modeling assuming R0 of 2.2.

Results

Of 273 MHD patients, 55 (20.1%) got infected with SARS-CoV-2 over three months. Six (10.9%) were symptomatic, and 49 (89.1%) asymptomatic at the time of testing. Six (10.9%) asymptomatic patients develop symptoms later; and 43 (78.2%) remained asymptomatic. A total of 7(6.1%) HCWs also tested positive for the virus. With an assumption of R0 2.2 and isolation of symptomatic patients only, all 273 patients could have been affected by September 30, 2020; with the isolation of both symptomatic patients and those testing positive after pre-dialysis screen, only 52 (19%) infections could have been prevented. However, at the end of the study period, 218 (80%) patients remained uninfected of SARS-CoV-2. Fortnightly universal testing is cost-effective, and SIR modeling proved effective in preventing person-to-person transmission.

Conclusion

Repeated universal testing in maintenance hemodialysis patients detected 89% of asymptomatic SARS-CoV-2 patients over three months and appeared to be an effective strategy to prevent person-to-person transmission in the dialysis unit.
MO839URGENCY OF RENAL REPLACEMENT THERAPY INITIATION AS A PREDICTOR FOR POOR PROGNOSIS IN PATIENTS WITH KIDNEY DISEASE
Authors: Vishnevskii Konstantin , Suchkov Viktor
Published: May 2021

Background and Aims

It is known that mortality from COVID-19 among patients with kidney disease is significantly higher than in general population. The worst prognosis is seen for patients receiving renal replacement therapy (RRT). At the same time, many patients undergo an urgency start of hemodialysis (HD) while suffering from COVID-19. The aim of the study was to determine the significance of the RRT urgency for the prognosis in patients with COVID-19.

Method

A retrospective analysis of case histories for 253 patients who received RRT at the infectious ward of St. Petersburg State Healthcare Institution City Hospital No. 15 from May to December 2020 was performed. All patients had a diagnosis of COVID-19, confirmed by PCR and/or clinical symptoms. Urgency RRT was performed in case of detection of indications, both in acute kidney injury (AKI), and in the diagnosis of end-stage chronic kidney disease (esCKD). Kaplan-Meier curves and multivariate Cox regression were used to perform cohort analyzes of survival and relative risk of death. For the calculations, the applied statistical software package SPSS 21.0, SPSS Ink (USA) was used.

Results

Of the 253 treated patients, 197 were patients with chronic outpatient HD, in 56 HD therapy was started urgently: 45 for AKI, 11 for esCKD. Totally 83 patients died. The overall mortality rate was 33%, while in outpatient HD group it was 18% and in the urgent HD start group - 84%. After adjusting for gender and age the fact of the urgency of starting RRT was an independent risk factor that increased the probability of death by 2.5 times (95% Cl 1.6÷3.9) compared to outpatients HD (Log Rank: P<0.001, Fig. 1). The patients age over 60 was also a factor significantly worsening the prognosis (Log Rank: P <0.001).

Conclusion

Among patients with COVID-19 and kidney disease the urgency of RRT initiating is a factor that significantly worsens the prognosis, especially among patients of the older age group.
MO840ADAPTIVE DESIGN METHODS IN DIALYSIS CLINICAL TRIALS – A SYSTEMATIC REVIEW
Authors: Judge Conor , Murphy Robert , Reddin Catriona , Cormican Sarah , Smyth Andrew , O'Halloran Martin , O'Donnell Martin
Published: May 2021

Background and Aims

Adaptive design methods are intended to improve efficiency of clinical trials, and relevant to evaluating interventions in dialysis populations. We sought to quantify the use of adaptive design clinical trials in dialysis.

Method

We completed a full text systematic review and adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Our review utilised included a novel machine learning classifier and full text systematic review. We searched MEDLINE (Pubmed) and performed a detailed data extraction of trial characteristics and a narrative synthesis of the data.

Results

50 studies, available as 66 articles, were included after full text review. 31 studies were conducted in a dialysis population and 23 studies had renal replacement therapy as a primary or secondary outcome. Group sequential designs were the most common type of adaptive design method used in dialysis randomized clinical trials and in general adaptive designs usage is increasing over time. Acute Kidney Injury (AKI) was studied in 27 (54%) of trials, End Stage Kidney Disease (ESKD) was studied in 22 (44%) of trials and Chronic Kidney Disease (CKD) was studied in one trial (2%). The most common country of lead author was the United States of America in n=20 (40%) of studies. 26 (52%) studies were supported by public funding. 41 studies (82%) did not report their adaptive design method in the title or abstract and would not be detected by a standard systematic review involving title and abstract searches.

Conclusion

Adaptive design methods are infrequently used in dialysis randomized control trials.
MO845EUROQOL EQ-5D-3L IN DIALYSIS POPULATION IN COLOMBIA
Authors: Sanabria Mauricio , Vesga Jasmin , Rivera Angela , Ariza Juan Guillermo
Published: May 2021

Background and Aims

The EuroQol-5D (EQ-5D-3L) is a generic questionnaire to evaluate the quality of life related to health, and simultaneously facilitates the obtaining of preference values (utilities) In the economic evaluation of health interventions. Quality-adjusted life year (QALY) is a commonly used metric. Our objective is to evaluate the quality of life (QoL) and obtaining of utilities according the dialytic treatment.

Method

This was an observational, multicentre cross-sectional study. Prevalent patients on dialysis for at least 90 days, older than 18, at the Baxter Renal Care Services Colombia were included between August 2, 2019, to December 11, 2020. Socio-demographic and clinical characteristics of all patients were summarized descriptively, additionally, all categorical variables were compared with Pearson’s χ2 test or Fisher’s exact test and continuous variables were analysed with Student’s t-test or Mann Whitney U test. The difference in the QoL by domains will be evaluated using Pearson's χ2 test or Fisher’s exact test. The EQ VAS provides a quantitative measure of the patient’s perception of their overall health.

Results

A total 254 patients were evaluated, the median age was 55 years, 55% were men. At enrolment the median dialysis vintage 3.2 years, and 63% were in peritoneal dialysis treatment (Table 1). We did not find differences in the proportions by dialysis treatment when exploring each of the 5 dimensions of the QoL (Table 2). We observed that the patient´s perception of their overall health was similar median EQ VAS score 80 in HD and EQ VAS score 80 in PD (Figure 1). We did not find statistically significant differences in health status 11111, which represents not having problems in any dimension 46.8% versus 45.6%, HD and PD respectively, p-value= 0.855.

Conclusion

The quality of life reported by the patients and health status in haemodialysis was similar to peritoneal dialysis.
MO847PREVALENCE OF FATIGUE REPORTED BY PATIENTS ON HEMODIALYSIS THERAPY
Authors: Sanabria Mauricio , Doria Cesar Mauricio , Martinez Edward , Simon Carlos , Vesga Jasmin , Marin Magda
Published: May 2021

Background and Aims

Fatigue is a symptom with a high prevalence in patients on hemodialysis therapy due to uremic toxins, anemia, associated comorbidity, and hemodialysis treatment per se. Our objective is to evaluate the prevalence of fatigue reported by patients and their association with the nutritional status.

Method

This was a prospective observational, multicenter cohort study. Prevalent patients on HD therapy for at least 90 days, older than 18, at the Baxter Renal Care Services were included between September 1, 2017, to November 30, 2017 with one-year follow-up. Socio-demographic and clinical characteristics of all patients were summarized descriptively, the nutritional status was evaluated by protein Energy waste (PEW). Patient reported fatigue was measured with high flux membrane and medium cut-off membrane (Theranova). A generalized linear binomial multivariable model was conducted to assess the effect of PEW on fatigue symptom controlling for some confounding variables.

Results

We found that the fatigue reported by the patients has a prevalence of 55% [95% CI: 52.2 to 57.7] in our population, there are no statistical differences due to the use of different types of membranes p= 0.911, and neither did we find that the nutritional status is an independent factor that explains this symptom. If we find that women and diabetics have a higher risk of fatigue; RR=1.17 [95% CI: 1.06 to 1.29] and RR= 1.19 [95% CI: 1.00 to 1.42] respectively.

Conclusion

The fatigue is a prevalent symptom in the chronic hemodialysis population; being a woman and the diagnosis of diabetes are risk factors associated with this outcome. PEW and the type of dialysis membrane used were not associated with this symptom. Studies evaluating the recovery time from post-dialysis symptoms and its relationship with the type of membrane are necessary.