bluuebunny/crossref_metadata_2025 huggingface dataset:
P1295OBSERVATION ON THE EFFECT OF DIGOXIN COMBINED WITH BENAZEPRIL HYDROCHLORIDE ON THE MAINTENANCE OF CHRONIC HEART FAILURE IN HEMODIALYSIS PATIENTS
Authors: Feng Shidong , Jing Rui
Published: June 2020

Background and Aims

To observe the effect of digoxin combined with benazepril hydrochloride on the heart structure and function of chronic heart failure in patients with maintenance hemodialysis.

Method

Choose 36 patients with maintenance hemodialysis, chronic heart failure (NYHA II - III) from 2016 to 2017 in our department. The patients were randomly divided into three groups: control group 1: digoxin (0.125mg/ day), control group 2: benapril hydrochloride (20mg/ day), and observation group: digoxin (0.125mg/ day) + benapril hydrochloride (20mg/ day), with 12 people in each group. There was no statistical difference in the clinical baseline data of the three groups of patients. The experiment mainly observed left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDV), serum troponin T, I (TnT, TnI), and serum n-terminal brain natriuretic peptide precursor (NT-proBNP), human component bioelectrical impedance analysis (BCM), the blood pressure. No other RAAS inhibitors were allowed for all patients. The observation period was 1 year.

Results

1. According to the findings of cardiac ultrasound, LVEF value increased significantly and LVEDV decreased significantly in the observation group. There was a statistical difference between the observation group and the control group (P<0.05), while there was no statistical difference between the two control groups. 2. Serum examination showed that TnT, TnI, nt-probnp were significantly decreased in the observation group, there was a statistical difference between the observation group and the two control groups (P<0.05), there was no statistical difference between the two control groups. 3. During the observation period, there was no significant difference in the incidence of hyperkalemia among the three groups (P >0.05).

Conclusion

A large dose of benazepril hydrochloride combined with a small dose of digoxin, had significant effect on the cardiac structure and function of chronic heart failure in patients with maintenance hemodialysis.
P1296CARDIAC COMPLICATIONS OF ARTERIOVENOUS FISTULAS IN PATIENTS WITH END-STAGE RENAL DISEASE
Authors: Breik Nessrine , Jbeli Hela , Fattoum Safa , Ouertani Imen , Ben kaab Badreddine , Mami Ikram , Ben Fatma Lilia , Beji Soumaya , Smaoui Wided , Benhmida Fethi , Rais Lamia , Zouaghi Mohammed Karim
Published: June 2020

Background and Aims

Current literature suggests the arteriovenous fistula (AVF) to be the preferred type of vascular access for hemodialysis. However, AVFs have significant and potentially deleterious effects on cardiac functions particularly in the setting of preexisting heart disease. The aim of this study is to compare the clinical and echocardiographic evolution after creation of a proximal AVF and a radial AVF.

Method

We conducted a retrospective descriptive study including all chronic hemodialysis patients through AVF. Group 1 (G1) included patients with proximal AVF and group 2 (G2) patients with radial AVF.

Results

Twenty-four patients were collected in G1 and the average age was 55 years. G2 included 13 patients with a mean age of 44 years. Systolic blood pressure decreased after AVF creation in both groups (G1: 62.5%, G2: 45%, NS). A dyspnea was noted in 70% of cases of G1 and 38.4% of cases of G2 (NS). The interventricular septum was thickened in 20.8% of cases of G1 and 38.4% of G2 (NS). Left ventricular (LV) dilatation was observed in both groups with LV diastolic telegram diameter increase of 58% in G1 versus 10% in G2 (p = 0.04). A decrease in LV ejection fraction was found in 62.5% in G1 and 46.1% in G2 (p = 0.066). The major cardiac complications in G1 were acute coronary syndrome in 5 patients and atrial fibrillation in 4 cases after an average of 60 months and 35 months, respectively. No cardiac complications were noted in G2.

Conclusion

AVFs remain the preferred type of vascular access for chronic hemodialysis therapy because they are associated with better long-term patency and fewer complications compared with synthetic grafts. Its seat will depend on the vascular state and the cardiac status of the dialysis patient.
P1303ASSOCIATION BETWEEN PULSE PRESSURE AND EXTRACELLULAR TO INTRACELLULAR WATER RATIO IN HEMODIALYSIS PATIENTS
Authors: Ekart Robert , Keber Gasper , Dvorsak Benjamin , Knehtl Masa , Hojs Radovan
Published: June 2020

Background and Aims

Optimal fluid management is a challenge in patients with end-stage kidney disease (ESRD) on maintenance hemodialysis (HD). Multifrequency bioimpedance spectroscopy (MBIS) is a non-invasive method to estimate body composition, including estimates of extracellular water (ECW) and intracellular water (ICW) and the ratio between both spaces (ECW/ICW). Pulse pressure is a significant risk factor of cardiovascular disease and death in general and dialysis population. Our study aimed to analyse the correlation between systolic, diastolic and pulse pressure with body composition status in ESRD patients before HD.

Method

We performed a retrospective single-centre cohort study in 93 HD patients. The body composition was measured using the portable whole-body MBIS device, Body Composition Monitor-BCM(®) (Fresenius Medical Care, Bad Homburg, Germany). Blood pressure was measured with OMRON monitors.

Results

The mean age of patients was 64 ± 13 years, mean dialysis vintage 63 (1-352) months, 61% were men, all patients had arteriovenous fistula as vascular access. Sixty-nine (74.2%) patients were fluid overload (FO) with > 1.1 L overhydration. Other data are presented in table 1. We found a statistically significant correlation between the pulse pressure and ECW/ICW ratio (r=0.258; P=0.033) in FO patients. In contrast, there was no significant correlation between systolic, diastolic blood pressure and ECW/ICW ratio in FO patients.

Conclusion

Only pulse pressure and not systolic or diastolic blood pressure values measured before HD are associated with ECW/ICW ratio in FO patients.
P1305CARDIAC OUTPUT AND ESTIMATED UPPER BODY BLOOD FLOW
Authors: Raimann Jochen , Derk Gwendolyn , Fox Maria , Poozhikunnel Elizabeth , Thijssen Stephan , Wilund Kenneth , Kotanko Peter
Published: June 2020

Background and Aims

Cardiopulmonary monitoring during hemodialysis has the potential to improve dialysis adequacy, prevent adverse events, improve quality of dialysis patients’ lives and reduce mortality risks. Under stable conditions the knowledge of upper body oxygen consumption, the difference between arterial and venous oxygen saturation (ScvO2) and hemoglobin concentrations allow the calculation of estimated UBBF (eUBBF; Rosales 2019). We studied the association between eUBBF and cardiac output during hemodialysis.

Method

In patients with a central venous catheter as the vascular access, we simultaneously measured intradialytic central-venous oxygen saturation and hemoglobin levels once per minute using the Crit-Line Monitor (Fresenius Medical Care North America, Waltham, USA). Concomitantly we measured cardiac output (CO) using the Task Force Monitor (CNSystems, Graz, Austria). We depicted CO and eUBBF as box-whiskers in 5 minute periods from 20 to 180 minutes, tested the minute-level time series for stationarity using the Dickey-Fuller test, employed differencing to make the time series stationary, and tested for linear associations using cross-correlations and determined if the CO time series was useful to predict the eUBBF time series using the Granger Causality test.

Results

We studied 13 patients (59±14 years, 5 (38%) male, 93±22 kg pre-dialysis weight 170±7 cm tall) during 34 hemodialyses. CO and UBBF was 4.7±1.0 and 1.3±0.4 L/min, and showed a small trend downward for CO during hemodialysis. Cross-correlations showed no remarkable correlations for all treatments, Granger causality index was less than 20% in 8 treatments however without clearly discernible patterns.

Conclusion

Despite variability in the CO the eUBBF remains stable, a dynamic which pathophysiologically appears plausible. While testing for linear associations yielded no significant relationships, based on the Granger causality test there nevertheless appears to be some form of a relationship which requires some further investigation which will need to also include aspects such as fluid overload, body temperature and total peripheral resistance. Based on this data, cardiopulmonary monitoring appears possible and yields a reliable continuous overview of the hemodynamic status of a patient.
P1309RIGHT VENTRICULAR-PULMONARY ARTERIAL UNCOUPLING IN PATIENTS ON CHRONIC HEMODIALYSIS WITH SEVERE RIGHT VENTRICULAR REMODELING
Authors: Romero-González Gregorio , Diaz-Dorronsoro Agnes , De la Fuente Ana , Ravassa Susanna , Garcia-Fernandez Nuria , Martin-Moreno Paloma Leticia , Lavilla Javier , González Omar , Rojas Miguel A , Lorenzo Ignacio , García-Trigo Isabel , Ania Noelia , Osácar Elena , Sabalza Ana , Amézqueta Pilar , López Begoña , González Arantxa , Diez Javier
Published: June 2020

Background and Aims

Patients on chronic hemodialysis (HD) may present right ventricular (RV) dysfunction and increased pulmonary artery pressure (PA). The aim of the current study is to describe the RV-PA coupling in chronic patients on HD.

Method

This study explored the adequacy of RV-PA coupling in 41 patients on HD. They underwent a comprehensive transthoracic Doppler echocardiography, and were stratified in accordance with the severity of RV remodeling defined by the presence of RV dilation (tricuspid annulus ≥40 mm) and RV systolic dysfunction (tricuspid annulus systolic excursion plane [TAPSE] <17 mm). RV-PA coupling was estimated by the TAPSE to PA systolic pressure (TAPSE:PASP) ratio.

Results

Three groups of patients were identified: No RV remodeling (Group 1, n=26), mild-to-moderate RV remodeling (Group 2, n=11) and severe RV remodeling (Group 3, n=4). Compared to patients from Groups 1 and 2, patients from Group 3 exhibited significant lower TAPSE values (p<0.001), a tendency to higher PASP values (p=0.054) and significant lower TAPSE:PASP ratio values (p=0.012). C-reactive protein levels and were directly correlated with PASP (r=0.405, p=0.017) and inversely with TAPSE (r=-0.311, p=0.041) and the TAPSE:PASP ratio (r= -0.392, p=0.015) in all patients. These echocardiographic parameters were not correlated with other biochemical, hemodynamic or anthropometric parameters.

Conclusion

These findings suggest that RV-PA coupling is markedly decreased in HD patients with severe RV remodeling. The role of systemic inflammation in RV remodeling and RV-PA uncoupling in HD patients warrants further studies.
P1328EFFECTIVENESS OF MUSIC FOR ALLEVIATING PAIN DURING HAEMODIALYSIS ACCESS CANNULATION: A MULTI-FACILITY, SINGLE-BLIND, RANDOMISED CONTROLLED TRIAL
Authors: Ikenoue Tatsuyoshi , Kishida Masatsugu , Yamada Yosuke , Kitamura Mineaki , Inayama Emi , Takahashi Kanae , Shintani Ayumi
Published: June 2020

Background and Aims

Repeated needle pain during haemodialysis (HD) access cannulations is a serious problem for HD patients. Although the efficacy of music for alleviating pain and anxiety is well established, there is insufficient scientific evidence related to its effectiveness in alleviating pain during access cannulations during HD. This study aimed to investigate the effects of music on reducing pain during access cannulating in HD patients.

Method

A prospective, multi-facility, single-blind, crossover, randomised controlled trial was conducted. The intervention included listening to Mozart and a white-noise control condition. Patients were randomly allocated to either an ‘Early-group’ or a ‘Later-group’. All patients who underwent cannulation wore headphones without sound in the first and third weeks (No-sound period). The Early-group received cannulation while listening to Mozart’s Sonata for Two Pianos in D major (K.448) during the second week (Music period), and white noise during the fourth week (White noise period). The Later-group received cannulation while listening to white noise first, followed by Mozart in the fourth week. During each period, the music or no-music protocol started 8 minutes prior to the cannulation, and participants finished listening after HD began. The Visual Analogue Scale (VAS) was used to measure pain and anxiety during cannulation and the VAS scores for pain and anxiety were compared for the music and no-music settings. We evaluated the ratio of outcome measures between the music and white noise periods with the repeated measure mixed effect regression. We analysed the effects according to the intention-to-treat principle. Two-sided-significance-level was set at 0.05.

Results

In total, one hundred and twenty-one patients were enrolled in this study, across four facilities. The median age was 64 years, and there were 84 males (69.4%). Sixty-five patients (53.7%) used analgesics for alleviating pain. The median VAS pain score was 28 and VAS anxiety score was 19 in No-sound period. The Mozart music setting had a 12.2% (95% confidence interval (CI): 2.3 to 21.1, p=0.017) lower VAS score than the white noise setting. On the other hand, there was no significant difference in the VAS anxiety score between the two groups, that is the Mozart music setting had a 7.96% (95% CI: -4.70 to 18.4, p=0.172) reduction compared to the white noise setting.

Conclusion

We examined the effects of Mozart’s music on alleviating pain using scientific methods. The music appears to reduce pain of access cannulation in HD patients. Although the trial assessed the effects of music using a single musical composition, the study did not clarify the effects of music on the physical, emotional, and cognitive status of patients. Further studies in this direction are required.
P1330ACCURACY OF CARDIOPULMONARY RECURCULATION ASSESSEMENT IN HD PATIENTS
Authors: Zulkarnaev Aleksei , Stepanov Vadim , Strugaylo Ewgenii , Fominykh Natalia , Rogozin Vasily
Published: June 2020

Background and Aims

cardiopulmonary recirculation (CRP) is one of the most informative instrumental parameters, which are widely used to predict adverse cardiovascular events. The CRP is calculated on the basis of two indirectly measured estimates. We observe a significant variability in CRP, the reason for which we have tried to explain.

Method

The prospective study included 88 patients with native AVF. At the first stage, we evaluated the inter- and inner-observer agreement of AVF volume blood flow (Qa) measurement with color duplex ultrasound. Two specialists with 5-7 years of experience measured Qa twice on the brachial artery, twice on fistula vein, after that - twice measured cardiac output before HD and one time after HD. Ultrafiltration during HD was 1.9±0,5 l.

Results

We observed good concordance between measurements on the brachial arteria by one specialist (fig 1A) and by two specialists (fig. 1B). There was poor concordance between the brachial artery and the fistula vein, even if the measurement was performed by one specialist (fig. 1C). Qa measurement on the fistula vein has a low repeatability, even if the measurement was performed by one specialist: the variance is very high (fig. 1 D).

We observed a good concordance between measurements (fig. 2A) and between specialists (fig. 2B) in CO assessment.

The main pitfalls of CPR-based cardiovascular risk stratification are related to the fact that CO changes significantly after HD (fig. 3A), while Qa values remain relatively stable (fig. 3B): the QA before and after HD difference is statistically significant, but it is minimal.

Median CO decrease was 13.4% (maximum 26.6%), while median of Qa decrease was 1.7% (maximum 6.1%).

This leads to a significant increase of the CPR value after HD, which can reach 40%(!) in some patients (absolute increase – 0.11).

Conclusion

Qa assessment should be performed on the brachial artery. After HD, there is a significant decrease in cardiac output (even with moderate ultrafiltration) with relatively stable AVF volume blood flow. This leads to a significant increase of CPR value after HD in some patients. Assessment of CPR before HD may lead to underestimation of cardiovascular risk.
P1340CATHETER-RELATED BLOODSTREAM INFECTIONS IN HEMODIALYSIS: ANALYSIS OF PATIENT- AND CATHETER- ASSOCIATED RISK FACTORS
Authors: Zanoni Francesca , Pavone Laura , Binda Valentina , Tripepi Giovanni Luigi , D'Arrigo Graziella , Scalamogna Antonio , Messa Piergiorgio
Published: June 2020

Background and Aims

Tunneled central venous catheter (T CVC) use is rising among patients undergoing chronic hemodialysis (HD) and non-tunneled (NT) CVCs are often used for HD initiation in late referral chronic kidney disease (CKD) or acute kidney injury (AKI). Catheter-related bloodstream infections (CRBSI) are a major complication of CVC use. This study examines potential patient- and CVC- related factors associated with CRBSI incidence and its microbiological features.

Method

In this retrospective single-center study, 413 patients undergoing an extracorporeal treatment (HD or Plasma Exchange) between February 1st 2014 and January 31st 2017 with 561 CVCs were recruited. Clinical data at study entry and CVC type are summarized in table 1. All bloodstream infections (BSI) occurring during the observation period were recorded and classified into CRBSI or non-CRBSI (nCRBSI), and their infecting agents collected. An incidence rate ratio (IRR (95% CI)) was calculated to assess the association between CRBSI incidence rate (IR), expressed as events/1000 catheter-days, and each clinical variable or CVC type. Significant associations at the univariate analyses were investigated with multivariate cox models.

Results

During a cumulative follow-up time of 66686 catheter-days, 54 (IR: 0.81) CRBSI and 30 (IR: 0.45) nCRBSI events occurred. CRBSI had higher frequency of GRAM+ bacteria compared with nCRBSI (70% vs 33%, p<0.001). Among CRBSI, GRAM- bacteria were more frequent in patients with age <80y (16 (36%) vs 0, p=0.02), and T CVC (40% vs 18%, p=0.07).

At the univariate analysis, male sex, age <80y and AKI were associated with higher CRBSI IR (table 2). Compared with T Jugular CVC, higher CRBSI IR was associated with NT Jugular (IRR 6.45 (2.99-13.56), p<0.0001) and NT Femoral (IRR 12.90 (5.87-27.61), p<0.0001) CVC; T Femoral CVC was associated with higher non-significant IR (IRR 2.45 (0.93-5.85), p=0.07). At the multivariate analyses, factors associated with higher CRBSI IR were AKI (hazard ratio - HR 3.03 (1.38–6.67), p=0.006), NT CVC (HR 3.11 (1.30–7.41), p=0.01), and Femoral CVC (HR 2.63 (1.36–5.07), p=0.004).

Conclusion

Patients affected by AKI and use of NT or Femoral CVCs are independently associated with CRBSI risk.
P1352ULTRASOUD OR LANDMARKS FOR THE PLACEMENT OF HAEMODIALYSIS CATHETERS
Authors: BELLIK Nabil
Published: June 2020

Background and Aims

To compare the success and immediate complication rates of the anatomical landmark method (AL) and the ultrasound guided technique (EG) in the placement of haemodialysis catheters.

Method

This was a randomized prospective study on 285 patients requiring dialysis catheter in the University Hospital of Bab el Oued between November 2016 and november 2018.

Patients were randomized into two groups: EG and AL.

The EG group had their catheters inserted under ultrasound guided technique [1], whereas the AL group had their dialysis catheter inserted by anatomical landmarks technique.

Data were collected on demography, side of insertion.

Outcome measures included successful insertion, successful insertion at the first puncture, number of attempts, and complications.

Results

A total of 285 procedures (142 EG and 143 AL) were performed during the study.

The success rate was 52.4% in the ALT group as compared with 90.1% in the EG group (p <10-6) in the first procedure.

First attempt success rate was 24.4% in the AL group as compared with 53.5% in the EG group (p=0.0002).

The complication rate was 45.5% in the AL group and 19.7% in the EG group (p <10-6).

Conclusion

The use of ultrasound guidance in the placement of haemodialysis catheters significantly improves the success rate and success rate at the first puncture and significantly decreases the incidence of catheter insertion complications.
P1358THE MONITORING OF FIRST LEVEL IN DIAGNOSIS OF COMPLICATION OF VASCULAR ACCESS: MULTICENTRIC STUDY ON 900 HEMODIALIZED PATIENTS WITH FOLLOW UP TO 5 YEARS
Authors: Satta Ersilia , Romano Carmine , Alfarone Carmelo , Gentile Sandro , Russo Domenico
Published: June 2020

Background and Aims

Vascular Access (VA) is the lifeline of hemodialysis patient. The universal goal of access monitoring is to identify access stenosis and enable intervention prior to thrombosis; thereby, maximizing access longevity and minimizing morbidity. The advent and use of techniques including dynamic and static venous pressure monitoring, physical examination, access flow measurement, imagining and combined imaging and flow monitoring by duplex ultrasound demonstrate that it is possible to predict which accesses are at high risk for future thrombosis.

Currently arteriovenous fistula (AVF) and arteriovenous graft (AVF) have been recognized as the permanent access. This study takes advantage of the opportunity to utilize data from 19 associated Dialysis Clinics to examine trends in VA use, trends in patient characteristics and practice associated with VA.

Determine the status quo of the overall information related to the VA to start a five years follow up study with the aims to reduce VA complications 8stenosis and thrombosis) and related hospitalization days to improve patient’s quality of life.

Method

VA data were collected for each patient at study entry. Practice pattern data from the facility medical director, nurse manager and VA surgeon were also analyzed. We have developed a mask on the management database to implement the first level monitoring of access and collected data at each treatment (Fig.1)

Results

Average age of 801 patients enrolled was 73,5 years. Native AVF was used by 79%, AVG by 2% and CVC by 19%. As the age increase as well as he use of CVC move from 6% (15-39(years) to 50,5% in patients with more than 85 years. Most frequent complications were: Thrombosis 16,5 %, Infectios 5,5%. Related VA hospitalization days are 28,7 % of total days. Average dialysis goals achieved were: QB 290 ml/Min; blood processed 69,7 L; KT/V:1,35.

Conclusion

By interpreting collecting data for specific performance measures using accurate reports allow health care professionals to highlight the VA performance/inefficiences and provide correct information to the clinical staff to support them in their daily clinical practice and decision making.
P1368EVOLUTIVE PROFILE OF HEMODIALYSIS VASCULAR ACCESSES
Authors: Aya Mechri , Mohamed Chermiti , Gorsane Imen , Zied Elloumi
Published: June 2020

Background and Aims

Arterio-venous fistula (AVF) is considered to be the first choice vascular access for hemodialysis (HD). Hemodialysis catheter (KT) may be a temporary or permanent alternative. The aim of our work was the study of indications, and complications’ contributing factors of KT, and to identify complications and predictive factors of AVF survival.

Method

It’s a retrospective, descriptive, analytic, and multicentric study interesting AVF and KT created in patients with end stage renal disease and who have been treated with hemodialysis in the four hemodilysis centers of the KEF governorate in Tunisia over the period from 01/07/18 to 31/12/18.

Results

We have studied 288 AVF and 148 KT that were created in 205 patients averaging 58.14 ±15.56 years in age [25-93 years]. The sex ratio was 1.5. Diabetic nephropathy was the most common (25.9%). For the KT, the main indication was the wait of AVF creation (68.9%). The overall incidence of immediate complications was 11.5%. Dysfunction was reported in 23.6% of cases with obesity (p=0.035) and tunneled type of KT (p=0.045) as contributing factors. KT infection, occuring in 39.2% of cases, was promoted by prolonged duration of use (p=0.041) and hemoglobin level <8 g/dl (p=0.039). The use of an antiseptic lock reduces infections’ risk (p=0.011). For the AVF, the most common complications were thrombosis (36.2%), aneurysm (29.9%) and stenosis (22.6%). The survival rates were 60% at 2000 days. The AVF impairing factors were diabetes (p=0.05), obesity (p=0.05), the anterior AVF creation (p=0.011), AVF grafts (p=0.016) and the use of an anticoagulant therapy (p=0.0001). An antiplatelet therapy improved AVF patency (p=0.02).

Conclusion

Despite of concerted efforts, much remained to be done to reduce the incidence of catheterization, the creation of AVF on time and the prevention of its complications.
P1378PROCESS NORMALIZATION AND CLINICAL OUTCOMES FOLLOWING IMPLEMENTATION OF THE ANEMIA CONTROL MODEL FOR PERSONALIZED ANEMIA MANAGEMENT
Authors: Neri Luca , Cattinelli Isabella , Bolzoni Elena , Barbieri Carlo , Ramos Sanchez Rosa , Stuard Stefano
Published: June 2020

Background and Aims

Anemia management is still challenging in a large share of dialysis patients. ESA resistance show wide variations across patients as well as fluctuations along time within the same patient. The Anemia Control Model (ACM) is a software application which can be integrated in electronic health record systems. ACM is based on an artificial neural network system trained on 1 million health records which simulates patient’s personalized dose-response relationship to ESA and Iron. Based on patients’ response forecast, ACM suggests the optimal drug dose recommendations to reach or maintain the hemoglobin level within target and to minimize the drug consumption. The ACM has earned medical device certification and it is currently used in 13 countries within the EMEA FMC network. Effectiveness and safety of ACM has been demonstrated in previous real-world evidence studies. We report ACM use and its clinical outcomes among hemodialysis patients registered in the Spanish FME Network

Method

We recorded all medical prescriptions and their clinical outcome for which an ACM recommendation was computed (ACM prescription). prescription occurred in 9 clinics located in Catalunya (Spain) from September 2017 to September 2018. We report dynamics of ACM suggestion acceptance rate, ESA consumption and Hb target achievement in the study period.

Results

There were 1189 active patients per month during the study period on average. ACM suggestion acceptance rate was 73,3%. ESA monthly consumption ranged from 234:7±281:9 – 310.2 ± 310:8 UI/Kg; 86% of patients receiving ESA doses according to ACM recommendations achieved or remained within Hb target range; on the contrary, when physicians rejected ACM recommendations and prescribed a different dosage, only 77% of patients reached or maintained the Hb level on target (p<0.05).

Conclusion

Our study demonstrated that ACM suggestions were frequently accepted by physicians. Acceptance of ACM suggestion was associated with higher Hb target achievement.
P1381SWITCHING FROM IRON GLUCONATE TO FERRIC CARBOXYMALTOSE CAN BE ASSOCIATED WITH A BETTER CONTROL OF IRON STATUS AND ANEMIA IN HEMODIALYSIS PATIENTS?
Authors: Martone Massimiliano , Tosto Massimiliano , Mattei Piero Luigi , Berbecar Dorina , Bosco Manuela , Boer Emanuela , Milutinovic Neva
Published: June 2020

Background and Aims

Before evaluating any ESA treatment, International guidelines (NICE-2015, KDIGO-2012, ERBP–2013) suggest to administer iron first to patients with iron deficiency anemia and not still on ESA therapy. Moreover anemic CKD patients treated with ESA should be iron supplemented (unless ferritin is> 800 mcg/l) to maximize the benefits of ESAs.

A recent retrospective study of switching iron sucrose to ferric carboxymaltose (FCM), conducted by Hofman et al., showed a better control of iron status in hemodialysis (HD) patients. New generation drugs, like carboxymaltose, may change the iron administration methods on dialysis, due to their different properties: therefore more experience is needed. In the following evaluation we report the results of switching from iron gluconate (our previous standard therapy) to FCM in HD patients.

Primary Endpoint

switching effects on iron parameters (TSAT, ferritin) and hemoglobin.

Secondary Endpoints

switching effects on iron and ESA doses administered

Method

Study design: retrospective review of data from 106 HD patients from 2 Italian different dialysis centers, who were switched from iron gluconate to ferric carboxymaltose in a 1: 1 ratio.

Study duration: 9 months (3 months pre-switch, 6 months post-switch)

Treatment schedule: -ferritin <100 ng/ml and/or TSAT <20%: 100 mg of iron/weekly

-ferritin <200 μg/l, or TSAT<20%: 100 mg of iron/weekly

-ferritin 200–500 μg/l, and/or TSAT 20–30%: 100 mg of iron/every 2 weeks

-ferritin 500–800 μg/l and/or TSAT 30–50%: 100 mg of iron/monthly

-ferritin> 800 μg/l and/or TSAT>50%: no iron.

Hb, TSAT, Ferritin and PCR evaluation every 4 weeks.

Results

after switching from iron gluconate to FCM, Hb levels were stable or improved, reaching a significantly higher percentage of target patients (from 60% to 80% with Hb > 10,5 g/l). The switch was also associated with a significant improvement of iron status, unrelated to iron dose: the percentage of patients with a target TSAT (TSAT >=20%) has doubled after six months, moving from 30% to 70%, while the average consumption trend of FCM decreasing over time (-48% after six months). It was also shown a marked reduction in ESA consumption: the ESA dose was decreased on average by -1907 IU per patient/month.

Conclusion

The switch from iron gluconate to FCM is associated with a better control of iron status and iron anemia in CKD patients on hemodialysis. The treatment schedule proposed has guaranteed to reach the primary and secondary endpoints, underlining the importance and the effectiveness of a tailored therapeutic protocol.
P1391PROGRESSION OF CALCIFICATION AND ITS RISK FACTORS IN CHINESE DIALYSIS PATIENTS
Authors: Liu Zhihong
Published: June 2020

Background and Aims

The China Dialysis Calcification Study (CDCS) aims to investigate prevalence and progression of vascular calcification (VC) as well as predictive values of VC in Chinese dialysis patients. This abstract reports VC progression and its risk factors during 4-year follow-up.

Method

The CDCS is a nationwide, multicenter observational study. 1497 dialysis patients from 24 centers in China were enrolled from 2014-2015 and continuously followed up for 4 years. Coronary artery calcification (CAC), abdominal aortic calcification (AAC) and cardiac valve calcification (CVC) were assessed at baseline and 4-year follow-up. CAC was assessed by Agatston score measured by electron beam computed tomography or multi-detector computed tomography. AAC was assessed by Kauppila score measured by plain lateral lumbar radiograph. CVC was measured by echocardiography. Progression was defined by comparing VC images at baseline with those at 4-year. When CAC/AAC scores at 4-year were greater than baseline, CAC/AAC were considered progressed; when there were more cardiac valves involved at 4-year than baseline, CVC was considered progressed. Logistic progression model was used to investigate the risk factors for calcification progression.

Results

711 patients completed 4-year follow-up and 680 of them had calcification tests. Patients had the same type assessments (CAC, AAC or CVC) at both baseline and 4-year were included in analysis. At the 4-year follow-up, 89.4% (608/680) patients had at least one site vascular calcification (CAC, AAC or CVC), CAC affected the highest proportion of patients. Prevalence of CAC, AAC and CVC were 81.0% (517/638), 79.3% (310/391) and 45.6% (308/675), respectively. Progression of CAC was observed in 93.9% (368/392) patients with presence of baseline CAC, and 51.3% (123/240) patients without baseline CAC. CAC progression at 4-year follow-up was stratified by baseline CAC score (Figure1). Progression of AAC was observed in 96.5% (165/171) patients with presence of baseline AAC, and 63.8% (139/218) patients without baseline AAC. AAC progression at 4-year follow-up was stratified by baseline AAC score (Figure2). Progression of CVC from single to double cardiac valve calcification was observed in 33.3% (40/120) patients, and cardiac valve calcification occurred in 33.4% (162/485) patients without baseline CVC after 4-year follow-up. Multivariate logistic regression analysis results are showed in Figure3. Variables significantly increased the risk of calcification progression were baseline calcification score, abdominal obesity, hypertension, and calcium, phosphorous, iPTH during 4-year follow-up.

Conclusion

In the 4 years follow-up, progression of calcification is common among dialysis patient, and is associated with higher baseline severity, medical history and disease management.
P1395FIBROLAST GROWTH FACTOR 21 CORRELATES POSITIVELY WITH AND PREDICTS TO OSTEOPOROSIS IN HEMODIALYSIS PATIENTS
Authors: Zhu Lili , Wang Bin , Liu Bicheng
Published: June 2020

Background and Aims

Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) has been recognized as a common complication and arises early in the course of CKD. Osteoporosis can be one form of renal osteodystrophy, one component of the bone abnormalities of CKD-MBD. Fibroblast growth factor 21 (FGF21) is increased progressively with a decline of renal function and higher FGF21 levels predict high all-cause mortality in hemodialysis patients. In recent studies, FGF21 has been approved to exert an inverse effect on bone mineral density. Hence, our study was performed to investigate the relationship and role of FGF21 in osteoporosis in our hemodialysis (HD) patients cohort.

Method

We screened HD patients in Nanjing Zhongda Hospital and The First People’s Hospital of Changzhou according to a strict inclusion criteria and exclusion criteria. We recorded demographic information, blood data before dialysis and serum FGF21, FGF23 levels and measured the CT-attenuation values (in Hounsfield units (HU)) of trabecular bone in L1 on axial images to evaluate the severity of osteoporosis. We used univariate analyses to compare the differences between two groups. Meanwhile, bivariate correlation analyses were performed to assess the correlation of L1 attenuation with serum FGF21, FGF23 and other clinical parameters. Stepwise multivariate linear regression analyses were employed to evaluate variables independently associated with attenuation values. We constructed ROC curves to calculate the AUC and compared the prognostic value of every independently associated factor or united factor to osteoporosis. All analyses were two-tailed, and a P < 0.05 was considered to be statistically significant. SPSS Software, version 18.0 was used for all statistical analyses.

Results

339 HD patients from two big HD centers in China that met our standards were screened. The mean age of HD patients was 56.79 ± 15.60 years. 339 HD patients were divided into two groups osteoporosis (n = 98) and non-osteoporosis (n = 241) on the basis of HU level (L1 attenuation ≤ 135 HU). Remarkably, serum FGF21 were higher in osteoporosis compared to non- osteoporosis in HD patients (median 640.86 pg/ml vs. 245.46 pg/ml, P < 0.01). We also divided HD patients into two groups according to tertiles of serum FGF21 levels. Moreover, attenuation levels were negative associated independently with serum FGF21 (r=-0.136, P<0.05). To evaluate the different values of independent associated or united factors in predicting osteoporosis, receiver operating characteristic (ROC) curves was constructed. The area under the curve (AUC) for FGF21 combined with age yielded a marked increment (AUC=0.836, P=0.000) with a good sensitivity (93.8%).

Conclusion

In conclusion, elevated FGF21 level has a positive relationship with the incidence of osteoporosis in HD patients. Simultaneously, FGF21 in combination with age can be a predictive parameter of osteoporosis in HD patients.
P1400ASSOCIATION BETWEEN MEAN SERUM MAGNESIUM LEVEL DURING THE FIRST 3 YEARS OF HEMODIALYSIS AND THE RISK OF SUBSEQUENT BONE FRACTURES
Authors: Fujii Takayuki , KOSHIZAKA JUNYA , YAMAUCHI NOBUAKI , MORIMOTO MAYU , TERASAKI NORIKO , TANAKA HIROAKI , SUZUKI SATOSHI
Published: June 2020

Background and Aims

Serum magnesium levels are an important factor associated with vital prognosis, cardiovascular disease, and vascular calcification in hemodialysis patients. Moreover, low serum magnesium levels are reportedly associated with an increased risk of hip fractures. Previously we reported that mean magnesium level during the first 3 years of hemodialysis was associated with all-cause mortality in ERA-EDTA 2018. Here, we investigated whether mean magnesium level during the first 3 years of hemodialysis can predict fracture risk.

Method

A retrospective cohort study was conducted in 283 patients who started hemodialysis at our hospital between March 2004 and the present and who could be followed for at least 3 years or had a fracture within 3 years. To assess the association between mean serum magnesium level during 3 years after the start of hemodialysis or until fracture and fracture risk, a multivariate analysis was performed using the Cox proportional hazard model with factors related to fractures as covariates, with all fractures such as hip fracture and spinal compression fracture as the outcome.

Results

The mean follow-up period was 6.1 years, and the mean age of patients was 64 years, with women accounting for 31%. Of all 283 patients, 62 developed fractures. A univariate analysis of factors associated with fractures revealed that high serum magnesium level was a significant fracture suppressor (hazard ratio [HR]: 0.31 [0.12–0.73]). Multivariate analysis conducted with significant factors in univariate analysis (mean serum albumin level, serum phosphorus level, hemoglobin level, C-reactive protein level, age, history of heart disease, history of bone fractures, and use or nonuse of phosphate binder during the 3 years) as the covariates revealed that the serum magnesium level was not significantly associated with bone fractures (HR: 0.95 [0.33–2.78]), whereas, old age, history of fractures, low albumin level, high CRP level, and nonuse of phosphate binder were significantly associated with fractures.

Conclusion

Serum magnesium levels during 3 years after the initiation of hemodialysis did not predict the risk of subsequent fractures, whereas a high level of inflammatory response, malnutrition, and nonuse of phosphate binder did.
P1405ETELCALCETIDE USE IN HEMODIALYTIC PATIENTS: A SINGLE CENTER EXPERIENCE
Authors: Covella Bianca , Rossi Luigi , Libutti Pasquale , Corciulo Simone , Manno Elisabetta , Lomonte Carlo
Published: June 2020

Background and Aims

Etelcalcetide is an injectable calcimimetic, utilized to treat secondary hyperparathyroidism. Recently introduced as alternative to cinacalcet, it acts on a different CaSR (Calcium Sensor Receptor) binding site. Outlined advantages are the intravenous formulation, which solves non adherence, the lower gastrointestinal side effects incidence. The main limitation is iatrogenic hypocalcemia. We show our experience to evaluate findings of our initial fieldwork in order to optimize drug efficacy, safety and tolerability

Method

We included 27 patients during 2018 (15 M and 12 F, Caucasian, mean age 60,7±13,7 years), followed for at least 6 months. Initial etelcalcetide dose was 15 mg in all patients. PTH, Calcium, Phosphorus monitoring was done every month. Concomitant drugs as phosphorus binders, Vitamin D or analogues, Calcium and the switch from cinacalcet were considered. Therapeutic variations and side effects were recorded. Data are registered at the beginning and the end of follow up.

Results

Starting values are: PTH 1298±545 pg/ml, Calcium 9,1±0,9, Phosphorus 5,1±1,4. 14 patients already took phosphorus binders, 10 paricalcitol. 12 patients were switched from Cinacalcet because of non-adherence or inefficacy, the other 15 patients never took calcimimetics. Mean values after 6 months are: PTH 661±469 pg/ml, Calcium 8,2±0,5 mg/ml, Phosphorus 4,1±1,6 mg/ml. These data point out a mean decrease in PTH value of 49%, reaching the therapeutic target in 18 patients, that is the 75% of the total population studied.

It have been necessary dose modifications in 15 patients (62.5%): 9 etelcalcetide dose variations (37,5%), 6 vitamin D and Calcium supplementation, both the changes in 5 of them. Side effects were hypocalcemia (14), pruritus (1), diarrhea (1), low platelet count (1), registered in 17 patients (63%), 3 of them withdrew therapy and then refused to start it again. It has to be said that thrombocytopenia, occurred after the follow up time (at 7th month), solve after etelcacetide withdrawal. Subgroup analysis pointed out a statistically significant correlation between drug efficacy and switch from cinacalcet, both in terms of extent of iPTH reduction (65% vs 42% - p value < 0,05 ) and of achievement of the therapeutic target (89% vs 66% - p value < 0,05), and between concomitant paricalcitol therapy at zero-time and lower hypocalcemia incidence (10% vs 76% - p value < 0,05).

Conclusion

Results confirm etelcalcetide efficacy and suggest a correlation between concomitant paricalcitol therapy at baseline and lower hypocalcemia incidence and between greater efficacy and switch from cinacalcet. These data, if confirmed in larger sample, could be useful to guide the starting approach and the maintaining treatment with etelecalcetide.
P1411THE EFFICACY AND SAFETY OF THE SUCROFFERRIC OXYHYDXIDE IN HEMODIALYSIS PATIENTS : RESULTS OF A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL
Authors: Shutov Evgeny , Kotlyarova Galina , Lysenko Ksenia , Ryabinskaya Galina , Lashutin Sergey
Published: June 2020

Background and Aims

The treatment of hyperphosphatemia is the main goal in the treatment of mineral and bone disorders in patients with CKD. However, the results of the correction of hyperphosphatemia remain unsatisfactory. This is due to the absence of effective and safe medicines. In our prospective randomized controlled trial were evaluated the effects of a 16-week treatment with new phosphate binder - sucroferric oxyhydroxide and a sevelamer carbonate (“sevelamer”) on CKD-MBD parameters in patients on hemodialysis with hyperphosphatemia.

Method

After a 2-4-week washout period from previous phosphate binders, 50 stable patients with hyperphosphatemia (P > 5.5 mg / dl) were randomized at a 1: 1 ratio to receive sucroferric oxyhydroxide (n = 25) or sevelamer (n = 25) for treatment up to 16 weeks. In all patients were evaluated levels of P, Ca, PTH, ferritin, transferrin saturation, Hb, FGF-23, soluble Klotho, CRP - monthly. The dose of both medications was adjusted according to serum phosphate.

Results

Phosphate binder therapy of sucroferric oxyhydroxide was associated with a significant decrease in serum phosphate from 6.8 ± 1.5 to 5.27 ± 0.99 mg/dl (p <0.01); however, treatment with sevelamer did not decrease in the level of P: 6.32 ± 1.5 vs 6.35 ± 1.9 mgl/dl. The number of tablets was lower in the sucroferric oxyhydroxide group (mean ± SD 2.0 ± 1.5 tablets / day) compared with sevelamer (mean ± SD 6.1 ± 3.2 tablets / day). The average intact fibroblast growth factor-23 (FGF-23), PTH, transferrin saturation and ferritin did not significantly change in both groups. Klotho changed only in patients received sucroferric oxyhydroxide, an increase of 25% (р < 0.05) and we also noted in this group an increase in Hb level from 105.6 ± 15.7 to 111.9 ± 22.3 g/l (p <0.05) by the end of the study, simultaneously level of CRP significantly decreased (P < 0.01) by 50% . During the study, 6 patients in the group with sucroferric oxyhydroxide and 5 in the sevelamer group dropped out due to dyspeptic symptoms.

Conclusion

Sucroferric oxyhydroxide is a new effective phosphate binder with a comparable safety profile to a sevelamer. Treatment with this drug can significantly increase the level of Hb, and Klotho and reduce level of inflammation.
P1412CARDIO PULMONARY AND CKD-MBD INTERACTIONS IN HEMODIALYSIS PATIENTS
Authors: Dalili Nooshin
Published: June 2020

Background and Aims

Emerging evidence suggests that pulmonary hypertension (PHT) is closely associated with cardiac, pulmonary, and mineral bone diseases in hemodialysis patients. Previous results indicated that extra osseous calcifications might be a risk factor for PHT although results in human studies about this association have been conflicting. Multiple factors including abnormal calcium phosphate levels, uremia and inflammation are known to be important in vascular calcification development. In hemodialysis patients’ vascular calcifications may be evaluated by different techniques. The utilization of plain X-ray for screening vascular calcifications has been suggested by KDOQI and KDIGO .In this study, we examined the association between PHT, peripheral vascular calcification by plain X-Ray score, and echocardiographic parameters in hemodialysis patients.

Method

Chronic (> 6 months) hemodialysis patients (150) on a three times per week dialysis schedule were studied. Two-dimensional trans thoracic echocardiography was performed before dialysis. Global systolic function was evaluated by left ventricular ejection fraction (LVEF). Systolic pulmonary arterial pressure (SPAP) was recorded. Pulmonary hypertension was defined as, pulmonary artery pressure (PAP) greater than 35 mm Hg based on European Society of Cardiology Guideline. Vascular calcification score is evaluated in plain X-ray of pelvis and hands. Each film is divided into four sections. Any vascular calcification either in an irregular or linear pattern is considered. The presence of vascular calcifications in each section is rated as 1 and its absence as 0. Final score is the sum of all sections and ranges from 0 to 8.Demographic data and lab results including Calcium (Ca), Phosphorous (P), Ca X P product, 25OH-vitD and iPTH were collected for all enrolled patients. The effects of different peripheral vascular calcification scores in plain X-Ray, structural heart abnormalities in echocardiography and Ca-P-iPTH- vit D axis disorders on the development of pulmonary hypertension were evaluated to elucidate cardio, pulmonary and CKD-MBD interactions.

Results

Hemodialysis patients had a high prevalence of PHT (30%), which warrants special attention to this important complication in hemodialysis population. Severe peripheral VCs (VCs >3) were independent risk factor for PHT. In addition to the old age, duration of hemodialysis, and mitral valve disease, the presence of higher Ca- P product was another independent predictor of PHT in chronic hemodialysis patients.

Conclusion

Prevalence of PHT in dialysis patients seems to be high, and is closely associated with peripheral VC, mineral bone disorders and structural heart abnormalities suggesting further a strong cardio pulmonary renal interaction.