bluuebunny/crossref_metadata_2025 huggingface dataset:
P1268MIXING ARTIFICIAL INTELLIGENCE AND CLINICAL OUTREACH TO REDUCE RISK OF FLUID OVERLOAD HOSPITALIZATION IN PATIENTS WITH END-STAGE RENAL DISEASE
Authors: Willetts Joanna , Long Andrew , Rivenbark Amanda , Hymes Jeffrey , Usvyat Len A , Chaudhuri Sheetal , Maddux Franklin
Published: June 2020

Background and Aims

Fluid overload is associated with increased morbidity and mortality in hemodialysis (HD) patients. In-patient treatment of fluid overload was previously estimated to occur at a rate of 13.7 episodes/100 patient-years and estimated to cost $266 million over a 2.5-year period (Arneson 2010). We developed a model to predict which patients treated at a large dialysis provider are at imminent risk of hospitalization due to fluid overload and may benefit from additional interventions.

Method

We built a machine learning (ML) model using clinical and HD treatment data to identify which patients have the highest risk of hospital admission for fluid overload within 7 days of the current outpatient dialysis treatment. Next, we partnered with a team of remote nurses who perform chart reviews, needs identification, and communication outreach when warranted with the goal to reduce hospital admissions. Patients were identified from the ML model and displayed in a worklist on a computer dashboard, ranked by their risk score on that day. The computer dashboard also contained relevant clinical information to enhance the patient review process.

Results

Model results from prospective data (> 9M predictions in a two-month period) show the model has an area under the receiver operating curve (AUROC) of 0.79, sensitivity of 65%, and specificity of 78% (Figure 1). Weekly chart reviews increased 18% from 26 weeks before the pilot compared to 14 weeks after the pilot began; total communication outreach increased 31% across the same time frame. Further, the nurses using the dashboard anecdotally reported that the dashboard reduced the amount of time required to decide to perform a chart review or perform communication outreach.

Conclusion

Our predictive model successfully identifies patients at high risk for fluid overload hospital admissions. Understanding the nurse workflow, how they manage this patient population, and which components can be made more efficient enabled them to increase the number of chart reviews and communication outreach.
P1278DIALYSIS IN TREATMENT OF CONGESTIVE HEART FAILURE
Authors: Ristovska Vesna
Published: June 2020

Background and Aims

The advanced congestive heart failure (CHF), may provoke functional kidney disturbances with insufficient and resistant to conservative therapy water excretion. The treatment of the chronic renal failure (CRF) with active dialysis related to ultrafiltration (UF), may overcome the renal diuretics resistance with diuresis restoration and oedema elimination. The aim of the study was to define the indications for active, discontinued UF in setting of the CHF refractory to drugs, especially in the treatment of oedema.

Method

We investigated 12 patients, mean age 62,4+/-5,3 years, with incipient renal failure, but advanced congestive heart failure. Seven of them were males and 5 females. The indication for discontinued UF, was the severe expressed heart failure, reduced diuresis and initial renal insufficiency. In all investigated patients, before and after each UF procedure, the serum sodium and potassium, blood urea nitrogen (BUN), creatinin and osmolality were detected. The body weight, abdominal and crural parameters were noted before and after dialysis.

Results

The recovery was achieved in 10 patients with CHF, but 2 patients out of 12 have not demonstrated satisfactory response to UF. The biochemical features encountered to CHF patients suggest chronic hyponatriemia, hypokalemia and hypovolemia. Proteinuria range 1,2 to 3,6 g/l, was present in 6 patients. The clinical data were performed with oedema formation, reduced diuresis and dispnea. Mean UF rate achieved after several dialysis was 12,4+/- 7,6, lit.

Conclusion

Chronic heart failure in chronic renal patients, with severe oedemas is an indication for UF therapy, even if the values of BUN and creatinin are not increased. Reduction of the body weight and the extracellular volume, contribute for improved survival in these patients. However the risk of complications is high and not always with successful treatment.
P1281CLINICAL CHARACTERISTICS OF OBSTRUCTIVE SLEEP APNEA HYPOPNEA SYNDROME IN MAINTENANCE HEMODIALYSIS PATIENTS
Authors: Qin Yan , Yuan Dan , Huang Rong , Li Xuemei
Published: June 2020

Background and Aims

To explore the clinical characteristics of obstructive sleep apnea hypopnea syndrome (OSAHS) in maintenance hemodialysis patients.

Method

42 patients with maintenance hemodialysis in our hemodialysis center from April 2019 to December 2019 were enrolled for night-time sleep breathing monitoring. The patients were divided into the OSAHS group(n=25) and the non-OSAHS group(n=17) defined by AHI. The OSAHS group was further divided into a mild group (n=14) and a moderate-severe group (n=11). The clinical datas, sleep breathing monitoring datas, and echocardiographic parameters of the OSAHS group and the non-OSAHS group, the mild OSAHS group, and the moderate-severe OSAHS group were compared.

Results

1. There were no differences in gender, age, dialysis age, spKt / V, BMI, TBW, ECW, ICW, E / I ratio, Ca, P, HB, and diastolic blood pressure between the the OSAHS group and the non-OSAHS group. 2. Incidence of left ventricular concentric hypertrophy (84.0% VS 47.1%, P = 0.011), left ventricular wall thickness (12.0 VS 10.2, P = 0.029) and systolic blood pressure (147.0 ± 9.6 VS 139.4 ± 13.8, P = 0.041) ) in OSAHS group was significantly higher than the non-OSAHS group; 3: There was no statistical difference in serum carbon dioxide binding capacity (CO2CP) between the two groups (23.1 ± 2.7 VS 23.8 ± 2.6, P = 0.392), but the daily intake of sodium bicarbonate in the OSAHS group was higher than that of the non-OSAHS group (2.5 ± 1.0 VS 1.5 ± 0.5, P = 0.004); the CO2CP of the moderate-severe OSAHS group was lower than that of the mild group (21.7 ± 2.2 VS 24.2 ± 2.7, P = 0.019 ), the left ventricular wall thickness was significantly higher than the mild group (11.4 ± 1.4 VS 12.6 ± 1.1, P = 0.025).

Conclusion

Clinicians should pay attention to the early diagnosis and prevention of OSAHS in maintenance hemodialysis patients. Because the dialysis population is different from the general population of OSAHS patients, the serum CO2CP of this population is negatively correlated with the degree of OSAHS, and clinicians need to pay particular attention to the amount of sodium bicarbonate to correct acidosis.
P1292DECREASES IN ANGIOGENIC T CELLS ARE PREDICTIVE BIOMARKERS OF VASCULAR DYSFUNCTION AND ATHEROSCLEROSIS IN CHRONIC KIDNEY DISEASE
Authors: Carrillo-Lopez Natalia , Rodriguez-Carrio Javier , Ulloa Catalina , Martín-Carro Beatriz , Rodriguez-Suarez Carmen , Arcidiacono Maria Vittoria , Fernandez-Mariño Belinda , Cannata-Andia Jorge B , Suarez Ana , Dusso Adriana S
Published: June 2020

Background and Aims

The stratification of early cardiovascular (CV) risk is a major unmet need in chronic kidney disease (CKD). Since angiogenic T-cells are emerging mediators of vascular homeostasis and have been linked to CV disease (CVD), this study evaluated the frequency of circulating angiogenic T-cells in CKD patients undergoing peritoneal dialysis (CKD-5D) and their potential as predictive biomarkers of CVD.

Method

In 30 peritoneal dialysis patients and 16 matched healthy controls (HC), we quantified: Vascular calcification (by Kauppila Index); left carotid intima media thickness (lc-IMT by ultrasound), carotid adventitial vasa vasorum density (an early marker of atherosclerosis stage, by Superb Microvascular Ultrasound Image), pulse wave velocity (a marker of vascular stiffness and dysfunction, using the Complior Analyzer), angiogenic T cell frequency in blood (by Flow cytometry) and the traditional 10-year CVD risk (using the SCORE chart).

Results

As expected, CKD-5D patients exhibited higher Kauppila index (p<0.001), lcIMT (p=0.010) and adventitial vasa vasorum density (p=0.008) than HC. Angiogenic-T cell frequency was decreased in CKD compared to HC (1.68(1.05) vs. 3.33(1.44)%, p<0.001). In CKD-5D patients, angiogenic-T cell frequency was not associated with blood pressure, cholesterol levels or time on dialysis (all p>0.05) and did not correlate with Kauppila (r=-0.350, p=0.080) or lcIMT (r=-0.154, p=0.600), but strongly associated negatively with both pulse wave velocity (r=-0.734, p<0.001) and with adventitial vasa vasorum (newly formed vasa vasorum) number: r=-0.640, p=0.006; or density: r=-0.813, p<0.001). Angiogenic-T cell levels paralleled pulse wave velocity (B[95% CI]: -0.083[-0.155, -0.010], p=0.028; R2=0.531) and adventitial vasa vasorum -15.049[-26.705, -3.392], p=0.015; R2=0.598) and improved the prediction model over that of the SCORE chart (R2=0.360 and R2=0.336, respectively).

Conclusion

Angiogenic-T cell frequency was decreased in CKD-5D patients and could be considered as biomarkers of vascular dysfunction and early atherosclerosis stage.
P1304FIBROBLAST GROWTH FACTOR (FGF23) AND CARDIOVASCULAR MORTALITY IN DIALYSIS PATIENTS: A 10 YEAR PROSPECTIVE SINGLE CENTER STUDY
Authors: Demirtaş Gülay , Turgut Sadan , Ozdem Sabahat , Suleymanlar Gultekin , Yılmaz Üstün , Ersoy Fevzi F
Published: June 2020

Background and Aims

The aim of the study is to evaluate whether circulating fibroblast growth factor 23 (FGF23) predicts cardiovascular mortality in dialysis patients, independent of markers of calcium-phosphate metabolism and cardiovascular risk factors.

Method

A prospective observational study at Akdeniz University Medical Center including 51 peritoneal dialysis patients and 27 hemodialysis patients was undertaken from 01/2009 to 12/2019. Plasma C-terminal FGF23 concentrations in addition to other measures of mineral metabolism were performed at baseline. Patients were followed for all-cause mortality, cardiovascular mortality, non-fatal MI, non-fatal stroke, coronary revascularization, heart failure hospitalization and atrial fibrillation.

Results

The mean age of patients 48± 15 years. During a ten year follow up period, there were 47 deaths. The median plasma FGF23 level was 321 pg/ml (interquartile range 51-1784 pg/ml). Patients were stratified by their baseline FGF23 levels according to the tertiles. Cumulative survival analysis by tertiles of FGF23 were made with the Kaplan-Meier survival curve. Kaplan Meier analysis with log-rank did reveal a significant difference between the groups (p=0,048).

Conclusion

Higher FGF23 levels are associated with an increased incidence of cardiovascular mortality in dialysis patients, independent of other markers of calcium-phosphate metabolism and cardiovascular risk factors.
P1306EFFECT OF A SUPERVISED PERI- DIALYTIC EXERCISE PROGRAM ON SERUM ASYMMETRIC DIMETHYLARGININE IN MAINTENANCE HEMODIALYSIS PATIENTS
Authors: Ammar Yaser , Awad Ahmad
Published: June 2020

Background and Aims

End-stage renal disease (ESRD) patients treated with maintenance hemodialysis (MHD) have high cardiovascular disease morbidity and mortality. Accumulation of asymmetric dimethylarginine (ADMA), an endogenous nitric oxide synthase inhibitor, has been strongly implicated in endothelial dysfunction, premature atherosclerosis, vascular events and mortality. Regular physical exercise effectively decreased serum ADMA in several studies. This potential should be explored among MHD patients.

Method

Forty four middle-aged ESRD patients treated with thrice-weekly MHD for >6 months completed a 6 months regimen of peri-dialytic lower limb exercise comprising pre-dialytic 10-12 stretching cycles and 20-30 minutes of intra-dialytic pedalling cycles. Plasma ADMA, CRP, other laboratory parameters and overall physical activity level were assessed initially and at the end of the study.

Results

S.ADMA increased from a median of 2375 to 3000 ng/mL (P=0.016). 31 patients sustained an increase in S.ADMA (ADMA_Inc), whereas 13 patients had a declining or stable S.ADMA (ADMA_Dec). Compared with ADMA_Inc, ADMA_Dec patients had significantly higher Kt/V (P=0.02), significantly higher grade of basal general physical activity level (P=0.017) and significantly less intra-dialytic hypotension episodes (IDHs) (P=0.019). The increase in S.ADMA and the post- study S.ADMA level had statistically significant positive correlations with number of IDHs (r=0.401,P=0.007 and r=0.305,P=0.044, respectively).

Conclusion

A 6 months program of combined aerobic and resistance peri-dialytic exercise failed to reduce S.ADMA in most MHD patients studied. A modest S.ADMA decline, however, occurred in patients with higher basal exercise level, higher Kt/V, and less IDHs. A potential benefit of peri-dialytic exercise in decreasing S.ADMA may be promoted by a multidisciplinary approach targeting increased physical activity, improved dialysis efficiency and prevention of IDHs.
P1321PLASMATIC OSTEOPONTIN: A PREDICTOR OF VASCULAR ACCESS DYSFUNCTION IN HEMODIALYSIS PATIENTS
Authors: Sadaghianloo Nirvana , Julie CONTENTI , Sandor Vido , Joseph Carboni , Sophie Bonnet , Declemy Serge , Mazure Nathalie M
Published: June 2020

Background and Aims

Despite recommendations for a close follow-up of arteriovenous fistulas (AVF), thombosis rate reaches 10% each year. Conventional follow-up modalities remain a burden for hemodialysis patients. We tested the hypothesis that osteopontin (OPN), a pro-inflammatory molecule related to intimal hyperplasia, could be a biological marker of stenosis, and could thereby allow a screening of patients at risk for AVF dysfunction.

Method

Our prospective study (NCT03270358) compared the rate of plasmatic OPN between patients with a good-functioning AVF (control group, N= 39) and patients who required surgical or endovascular revision of their AVF because of a stenosis (stenosis group, N= 37). Blood samples were taken in the AVF, at the time of AVF cannulation in control patients, and at the time of AVF revision in stenosis patients. For each patient, blood from the contralateral arm was also analyzed as a between-subject control (paired t test). Cardiovascular risk factors, ongoing medications, and OPN rates (ELISA technique) were compared among the groups (uni- and multivariate analysis). The ROC curve determined sensitivity and specificity of the marker for the detection of stenosis.

Results

Patients' characteristics were similar between the 2 groups (mean age, 70 years; men, 63%; AVF duration; 39 months), apart from diabetes (control group, 33%; stenosis group, 57%; p=0.04). The rate of OPN was similar between the AVF arm and the contralateral arm (p=0.11), but significantly increased in the stenosis group compared to the control group (655 vs. 452 ng/mL, respectively, p=0.02). There was no statistically significant difference in OPN rate for diabetics and non diabetics (two-way ANOVA, p= 0.50). Sensitivity was 89% for a threshold >293ng/mL and specificity was 80% for a threshold >567ng/mL (AUC: 0.70; 95%CI: 0.57-0.81; p=0.004). Patients with an OPN rate ≥293ng/mL and those with an OPN rate ≥567ng/mL had respectively 8.87 and 15.62 higher odds to have a stenosis than patients with an OPN rate <293ng/mL (binomial regression, p<0.01).

Conclusion

Plasmatic OPN rate in hemodialysis patients can be measured simply, in a blood sample taken at the time of AVF cannulation, and is strongly correlated to the presence of a symptomatic AVF stenosis. This biomarker could help the physician choose which patient need a comprehensive examination of his/her AVF with duplex ultrasound or fistulogram.
P1322EFFECTS OF HAEMODIALYSIS ARTERIOVENOUS FISTULA CREATION ON CARDIAC STRUCTURE AND FUNCTION
Authors: Stoumpos Sokratis , Rankin Alastair , Hall Barrientos Pauline , Thomson Peter , Kasthuri Ram , Kingsmore David , Roditi Giles , Mark Patrick
Published: June 2020

Background and Aims

Arteriovenous fistula (AVF) is considered the preferred type of access for maintenance haemodialysis. The creation of an AVF may contribute to maladaptive cardiovascular remodelling. We conducted a study to evaluate the effect of AVF creation on cardiac structure and function in patients with end-stage renal disease (ESRD).

Method

In this prospective cohort study, patients with ESRD listed for AVF creation underwent cardiac magnetic resonance imaging at baseline and at 6 weeks. All participants had ultrasound measurements of AVF blood flow at 6 weeks. The primary outcome was the change in left ventricular (LV) mass. Secondary outcomes included changes in LV volumes, left atrial volume, LV ejection fraction, LV global longitudinal strain, cardiac output/index, and septal thickness.

Results

A total of 65 patients were enrolled, of whom 40 had an AVF creation and completed both scans. Patients were divided into 2 groups based on AVF blood flows: 22 in the high flow group (≥ 600mL/min) and 18 in the low flow group (< 600mL/min). On the second cardiac magnetic resonance scan, a mean increase of 7.4 g (95% CI, 1.1–13.7, P=0.02) was observed in LV mass; in the high flow group the mean increase was 15.5 g (95% CI, 7.3–23.8) compared with a small decrease of 2.5 g (95% CI, −10.6 to 5.6) in the low flow group (P=0.003). Significant increases in LV end-diastolic volumes, cardiac output, and cardiac index were also seen after AVF creation (P<0.04). No significant changes were observed in LV ejection fraction (P=0.52), LV end-systolic volumes (P=0.12), and LV global longitudinal strain (P=0.21).

Conclusion

Creation of AVF in adults with ESRD resulted in significant increase of LV myocardial mass early after surgery.
P1334PREOPERATIVE VOLUME STATUS IN VASCULAR ACCESS CREATION, A DESPISED INFLUENCE?
Authors: Guedes Marques Maria , Maia Pedro , Ponce Pedro
Published: June 2020

Background and Aims

The most common causes of early primary failures of a vascular access (VA) is related to small caliber vessels. Weight gain between dialyses expands both extracellular and blood volume, which may lead to rises in intravascular filling and vessels caliber. If patients presented after weekend, their weight and probably volemia would be higher.

Dry weight concept has evolved over time and nowadays incorporates objective measures of volume status like body bioimpedance spectroscopy (BIA) and lung ultrasound.

We hypothesized that preoperative volume status may influence vascular filling and vessels diameter with a significant impact on VA outcomes.

Method

A clinical, prospective, randomized, open-label, single-center crossover trial.

Inclusion criteria: age 18-80ys, under regular hemodialysis (3/week), no heart failure (CHF) and no acute pulmonar edema (APE) on the previous year.

Exclusion criteria: >3 sessions/week, CHF or APE.

Before the last-week session, patient’s clinical parameters were recorded. BIA and ultrasound vascular mapping were performed.

After this first evaluation, dry weight was increased 0,5 Kg, and after weekend, the same protocol was conducted.

Primary end point was to compare vein diameters.

Results

126 vessels were evaluated (84 veins and 42 arteries) from 21 patients. Mean age was 69±10y and 52% female.

Primary end point was achieved (Table 1). Other than humeral arterial blood flow, every parameters evaluated through ultrasound mapping significantly increased (p<0,05) after dry weight adjustment (>0,5 Kg) plus weekend weight gain.

After cross over, weight, overhydration (OH), extracellular water (ECW) and OH/ECW significantly increased (p<0,05), however, most patients had a mild-moderate OH (86-90%). Blood pressure and total body water haven’t changed significantly.

No complications were reported.

Conclusion

Some additional degree of OH comparing to midweek weight gain may be effective and safe in improving peripheral vascular conditions that are predictors of VA success.

The currently lack of evidence of vascular mapping may be due to the lack of evaluation of cofactors such as volemia. Therefore, BIA and lung ultrasound may be future tools that combined to vascular ultrasound could be a safe and effective way to optimize and evaluate preoperative conditions to improve VA outcomes.

Larger and multicentric studies are needed.
P1335MALNUTRITION, INFLAMMATION, AND ANEMIA SYNERGISTICALLY IMPACT VASCULAR ACCESS FAILURE IN PATIENTS WITH FIRST-TIME ARTERIOVENOUS FISTULA FORMATION
Authors: Hara Masaki , Saiki Naozumi , Suzuki Hiroki , Ubukata Masamitsu , Asao Rin , Nakamura Yuya , Nakamura Masayuki , Ohsawa Isao , Gotoh Hiromichi
Published: June 2020

Background and Aims

There are several reports that the initial (within one year) failure of vascular access (VA) is 2–53% in several countries. Malnutrition alone, inflammation alone, and anemia alone are factors that have a well-known relationship to VA failure. We believe that the relationship of these risk factors to VA failure is a complex one. Therefore, we evaluated whether the addition of these factors had a synergistic impact on VA failure.

Method

This longitudinal cohort study sought to confirm the effects of malnutrition, inflammation, and anemia on VA failure. We included 177 patients with chronic kidney disease (CKD) with first-time arteriovenous fistulas who were treated from January 2013 to December 2017. VA failure was defined as a new onset of VA obstruction or the need for percutaneous transluminal angioplasty. Albumin (Alb), C-reactive protein (CRP), and hemoglobin (Hb) were studied as indicators for malnutrition, inflammation, and anemia, respectively. Each highest (CRP) or lowest (Alb and Hb) interquartile range (IQR) group was assigned 1 point (as a risk score). The cumulative VA failure rate was analyzed by the Kaplan-Meier method, which stratified the study cohort into four groups according to the risk scores (0–3). We assessed whether the lowest IQR group of Hb and Alb, and the highest IQR group of CRP were associated with VA failure. To determine this, we used a univariable Cox proportional hazards regression analysis to calculate the hazard ratio (HR) and its 95% confidence interval (CI). A multivariable Cox proportional hazards regression analysis was used to evaluate the association between the risk score and VA failure, with adjustment for age, sex, presence or absence of diabetes mellitus, value of calcium phosphate products, preoperative vein diameter, and intraoperative vascular assessment scores.

Results

The average observational period was 1.6±1.4 years. The incidence of VA failure was 30.5% (54 patients). Cumulative VA failure was significantly higher in patients who had more than two risk scores, as compared to the patients who did not have any risk score (Figure). The univariate Cox regression analysis showed that Alb, CRP, and Hb were significantly associated with VA failure (HR, 2.00; 95% CI, 1.08–3.71 for Alb and HR, 2.21; 95% CI, 1.15–4.13 for CRP and HR, 1.96; 95% CI, 1.02–3.63 for Hb), respectively. The presence of more than two risk scores was significantly associated with VA failure (HR, 4.68; 95% CI, 1.07–18.5 for the patients with two risk scores and HR, 4.72; 95% CI, 1.32–17.2 for the patients with three risk scores).

Conclusion

Malnutrition, inflammation, and anemia independently and synergistically affect VA failure. In clinical settings, we need to be aware of the presence of malnutrition, inflammation, and anemia to better prevent VA failure.
P1338ELDERLY PATIENTS, UPPER LIMB ISOMETRIC EXERCISES AND ARTERIOVENOUS FISTULA MATURATION
Authors: Tapia González Irati , Esteve Simo Vicent , Ibañez Pallares Sara , Rubio Sandra , Moreno Guzman Fatima , Fulquet Nicolás Miquel , Pou Potau Mónica , Saurina Solé Anna , Duarte Gallego Verónica , Yeste Campos Montserrat , Ramírez de Arellano Serna Manel
Published: June 2020

Background and Aims: Introduction

Arteriovenous fistula (AVF) creation may be controversial in elderly population, given their comorbidities, reduced life expectancy and vascular access (VA) complications. Postoperative upper limbs isometric exercise improves AVF maturation. Nevertheless, scarce scientific evidence has been reported about their utility in elderly population until date.

Objectives

To assess the effect of a postoperative isometric exercises program on native VA maturation in our patients older than 75 years old with stages 5-5D chronic kidney disease.

Method

A 24 months prospective single-center study. After surgery, all patients were randomized to an isometric exercise group (EG) or a control group (CG). Isometric exercises protocolled programm, was performed in EG. CO received usual care. Demographical data, muscle strength using handgrip (HG) dynamometer, main Doppler ultrasound (DUS) measurements (outflow vein (OV) diameter and humeral artery blood flow rate (BFR), clinical and DUS maturation as well as medical (hematoma, stenosis, thrombosis, pseudoaneurysm, aneurysm) or surgical VA complications were assessed at 8 weeks postoperatively.

Results

27 patients. 14 EG, 13 CO. 74,1% men. Mean age 79,9±2,8 years. 59,2% Radiocephalic AVF. Demographic data, HG and DUS measurement at baseline were similar. A significant increase in HG was observed only in EG at the end of study (19,1±7,8 vs 22,9±9,7Kg, p=0,001). DUS measurements statistically increased for both groups (OV diameter: EG 3,1 ± 0,8 vs. 5,9 ± 1,7 mm; CG 2,9 ± 0,6 vs. 5,8 ± 1,4mm; humeral artery BFR: EG 150,7± 42,7 vs. 1165,0 ± 664,5 ml/min; CG 132,9± 30,3 vs. 1310,2 ± 691,8ml/min) at the end of study. EG group obtained highest clinical (CG 46,2% vs EG 78,6%;p=0,049) and DUS maturation (CG 30,8% vs EG 71,4%; p=0,041) at 8 weeks, significantly. Despite no significant differences, the number of complications was lower in the EG, mainly hematomas and significant stenosis.

Conclusion

The upper limb isometric exercises protocolled program improved clinical and DUS maturation in our elderly patients. With our results, isometric exercises should be guaranteed in elderly patients in order to obtain a correct maturation of the performed AVF. Further studies are required to support these outcomes in this population.
P1339ARTERIOVENOUS FISTULA AND BASILIC VEIN TRANSPOSITION IN ELDERLY PATIENTS ON HEMODIALYSIS: AN OBSERVATIONAL STUDY
Authors: Bhargava Vinant , Meena Priti , Satwik Ambrish , Srivastava Apurv , Bhalla A K , Gupta Ashwani , Malik Manish , Gupta Anurag , Bedi V S , Rana Devinder Singh
Published: June 2020

Background and Aims

With the increase in the line expectancy of chronic kidney disease in the older population (>60 years), the numbers requiring haemodialysis is progressively rising. The elderly population may be different from the younger in terms of non-suitable vessels for access creation, non-maturation, and vascular calcifications, and this may alter the outcomes of use of arteriovenous fistula (AVF). This study was conducted to analyse the outcomes of AVF in elderly patients (>60 years).

Method

Retrospective study was conducted in the Department of Nephrology at Sir Ganga Ram Hospital, New Delhi. Patients of more than 60 years of age in whom AVF was created from 1st January 2012 to 31st December 2016 were included in the study. Follow-up data of 3.5 years was analysed. The primary endpoint was to assess primary and secondary patency rates.

Results

A total of 300 patients were included in the study. The mean age was 63.8 years. Radiocephalic AVF (RCAVF) was the most common site of [69.8% (n = 210)], followed by brachiocephalic (BCAVF) in 25.2% (n = 75) and basilic vein transposition (BVT) in 5% (n = 15). At 12 months, overall survival of the AVF was 66.8%. At 42 months, the primary patency rate of RCAVF, BCAVF, and BVT was 50.6%, 52.6%, and 50.4% respectively. The commonest cause of access failure was thrombosis (20.4%) followed by non-maturation (9%). Vascular access abandonment was found least in BCAVF.

Conclusion

AVF remains the preferred vascular access for haemodialysis in the elderly population. Brachiocephalic AVF has higher primary and secondary patency rates. Thrombosis and failure of maturation are major concerns in the elderly AVF.
P1341FACTORS AFFECTING THE ATTAINMENT OF ADEQUATE BLOOD FLOW OF ARTERIOVENOUS FISTULA FOR HEMODIALYSIS
Authors: Gjorgjievski Nikola , Dzekova-Vidimliski Pavlina , Stojanoska Ana , Gjorgievska Julija , Dejanov Petar , SELIM GJULSEN , Nikolov Igor , Rambabova Bushljetikj Irena , Petronijevik Zvezdana , Muharremi Shqelkim , Spasovski Goce , Ivanovski Ninoslav , Sikole Aleksandar
Published: June 2020

Background and Aims

An arteriovenous fistula (AVF) remains the best choice of vascular access (VA) for hemodialysis (HD). The aim of our study was determination of factors associated with achieved adequate blood flow (BF) of AVF during 4-th week after creation

Method

: Created AVF in 63 patients with chronic kidney disease (CKD) stage 4, 5 and 5-HD were analyzed in the prospective single center study, from January 2019 to October 2019. Preoperative mapping of blood vessels by Doppler ultrasound (DUS) on the forearm was performed in all patients. All patients were undergoing surgical creation of new forearm AVF (radio-cephalic) by one doctor. The DUS was used for measuring the diameter size of artery radialis, artery brachialis and vein cephalica before creation of AVF and again on 1-st day, 2-nd and 4-th week after AVF creation. In addition the BF of AVF was also measured by DUS on 1-st day, 2-nd and 4-th week after AVF creation. The adequate BF of AVF for hemodialysis treatment was defined as ≥ 600 ml/min. Patient gender and age, hemodialysis vintage, diameter size of artery radialis, artery brachialis and vein cephalica before creation of AVF were analyzed as factors that were affecting the achieved BF of AVF during 4-th week after creation.

Results

: The average age of patients was 61.31 ± 12.9 years. From all patients, 60.31% (38/63) were men. The adequate BF of AVF (≥600 ml/min) during 4-th week after creation was achieved in 43.54% (27/63) of created AVFs. The blood flow of AVF measured in male gender was significantly higher compared to the blood flow of AVF measured in female gender (576.03 ml/min vs 375.12 ml/min, p=0.004). The age of the patients and hemodialysis vintage were not significantly associated with achieved adequate BF of AVF during 4-th week after creation of AVF. The adequate BF of AVF was achieved in blood vessels with bigger diameter size. The diameter size of the blood vessels with achieved adequate BF was significantly higher compared to the diameter size of the blood vessels without adequate BF (artery radialis : 2.45 mm vs 2.03 mm, p=0.000; artery brachialis: 4.78 mm vs 4.06 mm, p=0.001 and vein cephalica: 3.12 mm vs 2.83 mm, p=0.018).

Conclusion

The gender and the diameter size of artery radialis, artery brachialis and vein cephalica before creation of AVF were significantly associated with achieved adequate BF of AVF (≥600 ml/min) during 4-th week after creation of AVF.
P1342OUTCOME OF ELDERLY PATIENTS AFTER PREDIALYSIS VASCULAR ACCESS CREATION
Authors: Bhat Dr Sanjay , Srivastava Alok , Ahmad Nisar , Rai Priyanka , Singh R P , Srivastava Rohit , ROY A K , Fatima Jalees
Published: June 2020

Background and Aims

Guidelines to create vascular access for elderly patients is guided by a number of factors i.e. competing risk of death, high rate of arteriovenous fistula (AVF) maturation failure, and poor vascular access outcomes, influencing the outcomes in this population . Does early creation of AVF in elderly patients with advanced CKD influence dialysis outcomes needs evaluation.

Method

We conducted a retrospective study among elderly (> 65 years ) who chose to create a permanent vascular access before dialysis initiation were identified between Jan 2014-Jan 2017 in Tertiary care hospital, Lucknow and assessed in 43 elderly patients (aged ≥65 years) with CKD undergoing predialysis AVF .

Results

They were observed for the frequencies of dialysis initiation, death before dialysis initiation, and dialysis-free survival for 2 years after vascular access creation. 45.6 % were diabetic, 78.9% were hypertensive, and 14.2 % had peripheral vascular disease. In all, 67% of patients with predialysis AVF initiated dialysis within 1 years of access placement, but the overall risk of dialysis initiation was modified by patient age. Only one half of patients initiated dialysis with a functioning AVF, 47.9% of AVFs were created <90 days before dialysis initiation. The primary patency rates were 42.7% at one year and 37.8 % at 2 years. Catheter dependence at dialysis initiation was more common in patients receiving predialysis AVF. In conclusion, most elderly patients with advanced CKD who received predialysis vascular access creation initiated dialysis within 1 year. As a consequence of late predialysis placement or maturation failure, almost one half of patients receiving AVFs initiated dialysis with a catheter.

Conclusion

Insertion of an AVF closer to dialysis initiation may serve as a “catheter-sparing” approach and allow delay of permanent access placement in selected elderly patients with CKD.
P134410 YEARS EXPERIENCE WITH HEMODIALYSIS TUNNELED CATHETERS
Authors: Ancarani Paolo , Amidone Marco , Baratto Elena , Matrisciano Antonella
Published: June 2020

Background and Aims

A well functioning vascular access ( VA) is vital for hemodialysis (HD) patients. To date a native arteriovenous fistula ( NAVF) remains the gold standard but patients vascular characteristics are often not optimal for vascular surgery. A tunneled central venous catheter (tCVC) are becoming increasingly used as permanent dialysis access and are also competitive to NAVF for the easy and safe insertion tecnique. Our retrospective study observe, during a 10 years period, infection rate of tCVC, bacteriologic analysis and cause of removal.

Method

From January 2010 to December 2019, 176 tCVC were placed in 158 patients ( mean age 74 +/- 18) . All tCVC were inserted by nephrologist in internal giugular vein (IGV), subclavian vein (SV) and femoral vein (FV) using ultasonographic guide. Standards protocols, according to European Renal Best Practice (2010) detailing all aspects of preventive care were used. Each tCVC was followed until it was removed or until the end of the study. 62110 days was the follow up period. 143 tCVC wew placed in IGV ( 81,5%), 22 in FV ( 11,5 %) and 11 in SV (7%). The diagnosis of infection was based on clinical evidence and positive blood culture or positive exit site swab, with no sign of other infection site. We considered a tCVC disfunction in case of blood flow less than 250 ml/m'. Event rates were calculated per 1000 catheters days.

Results

Mean tCVC duration was 353 days. We observed a progressive increment in CVC prevalence during the observational period ( from 15% in 2010 to 39% in 2019). Catheter replacement recurred in 19 patients and the main cause of replacement was loss of patency ( 0,3 per 1000 catheter days). We observed 63 catheter related bloodstream infection (CRBI) and 71 exit site/tunnel infection (ESI/TI). Incidence for CRBI was 1 per 1000 catheter days and ESI/TI was 1,14 per 1000 catheter days. In CRBI the most common organism isolated were MRSA (40%) and MSSA (26%) . In ESI/TI the most common organism isolated was Staphilococcus epidermidis (39.5%) . We used systemic antibiotics, local therapy and lock therapy with a 93% resolution without removal. 12 tCVC were removed for recurrent CRBI ( 0,19 per 1000 catheter days).

At the end of the observation 25 tCVC were still in use.

Conclusion

Our data showed an high survival rate of tCVC in hemodialysis patients. We observed CRBI and ESI/TI rates at the lower limits of the data reported in the literature. Infections were successfully treated conservately in most cases. Careful nursing protocol may reduced the frequency of infection and an early diagnosis can facilitate the rescue of the tCVC with systemic/lock therapy or local therapy. We consider in an elderly population with many comorbidities the use on tCVC recommended especially in patients with poor native peripheral vessels, in patients with steal syndrome high risk and also with a low life expectancy.
P1348EFFECT OF CILOSTAZOL ON ARTERIOVENOUS FISTULA IN HEMODIALYSIS PATIENTS
Authors: JEON JAE WAN , Ham Young Rok , Kim Haeri , Choi Wonjung , Na Ki Ryang , CHOI DAE EUN , Lee Kang Wook
Published: June 2020

Background and Aims

Permanent vascular access is important in patients requiring hemodialysis. However, among patients requiring hemodialysis, even if arteriovenous fistula surgery is performed, many are unable to undergo hemodialysis with vascular access due to maturation failure.

Method

Using 194 patients who underwent arteriovenous fistula surgery, a cilostazol group (n = 107) and a control group (n = 87) were compared and analyzed for the occurrence of vascular complications.

Results

In the cilostazol group, there were less vascular complications (36.4% vs. 52.9%; p = 0.022), especially maturation failure (2.8% vs. 11.5%; p = 0.016). However, there was no significant difference between the cilostazol group and control group regarding percutaneous transluminal angioplasty (PTA) requirement nor frequency and interval to PTA after vascular surgery. The frequency of reoperations due to vascular injury after the start of hemodialysis after maturation was also significantly lower in the cilostazol group.

Conclusion

These results suggest that vascular access patients may benefit from postoperative cilostazol therapy.
P1351MARKERS FOR AVF DYSFUNCTION; A RETROSPECTIVE ANALYSIS
Authors: Wã¤rme Anna Vb , Stegmayr Bernd , Nasic Salmir , Hadimeri Henrik
Published: June 2020

Background and Aims

The native Arterio venous fistula (AVF) is the recommended first choice for regular hemodialysis treatment. However, its patency is mainly limited due to stenosis and thrombosis, leading to insufficient dialysis, costly interventions, subsequent in-hospital care and follow ups.

Primary aim: To find medical or laboratory markers associated with dysfunctional AVF.

Method

Retrospective analysis of radiologic examinations and medical records was made due to clinical suspicion of AVF dysfunction (cases) from two hospitals during 2006-2014. Comparison was made with data from 52 patients without complications (controls) with repeated blood sampling during the same period. Differences between groups were calculated with Mann- Whitney test and paired statistics with Wilcoxon U test before and after examination.

Results

Mean age in both groups was 65 years. In 153 patients 473 radiological examinations were performed due to clinical suspicion of dysfunction. Angiography and PTA were made when suitable according to guidelines. In 171 of these examinations no intervention was performed. Cases versus controls had lower access flow (599±442 vs 1140±523, p<0.001), blood pump speed (291±49 vs 313±34, p<0.001), PTH (31±39 vs 39±29 pmol/L, p=0,021), Ca-phosphate product (3.9±1.1 vs 4.2±1.0, p=0.025), C-reactive protein (17±25 vs 24±38, p=0.004) and, higher in regard to recirculation (5.1±11 vs 0.5±3.4, p<0.001), HbA1c (52±16 vs 47±17, p=0.027), dose of tinzaparin (14330±8000 vs 12743±5400U/week, p= 0.025), weekly dose of erythropoietin stimulating agent (ESA, 8900±7100 vs 4900±4600U/week, p<0,001), and higher weekly iron supplement dosing (60±61 vs 41±54mg/week, p<0.001). Alfa- and Beta-blockers against hypertension were more often used among cases.

Conclusion

The reason for AVF problems in cases showed limited disturbances in Ca-phosphate hemostasis and inflammation. Instead, it seems that higher dosing of ESA and LMWH (as indicator of clotting) are factors that could be associated with development of AVF malfunction.
P1353IS AGE RISK FACTOR FOR TUNNELED VASCULAR CATHETER OUTCOMES?
Authors: Bajcetic Sanja , Jankovic Aleksandar , Djuric Petar , Stopić Bojan , Naumovic Radomir , Dimkovic Nada
Published: June 2020

Background and Aims

According to previous data, the prevalence of tunnelled cuffed vascular catheters (TCC) is more frequent in elderly as compared to younger HD patients. Still, it is not clear if elderly have decreased survival of TCC as compared with survival in younger.

Method

During the period from January 2010 to June 30, 2015, 110 permanent catheters were implanted in 64 patients (1.72 catheters per patient, 51.6% male mean age 67±12years, 20 diabetics). Out of all patients, 44 (68.7%) were older than 65 years, 12 (27.3%) were diabetic and 11 (25%) were previously treated with peritoneal dialysis. In the age-based subpopulations we compared the incidence of infections, thrombosis, chemical removal of thrombus by actilysis and TCC outcome.

Results

Reasons for TCC placement in elderly were inability of the second option and exhausted vascular approach and these reasons were found to be significantly more frequent compared to patients younger than 65 years (p = 0.020 ). Primary position of TCC was right jugular vein in both groups (39.1%, No = 25 vs 14.1% No = 9), more commonly in group of elderly patients, but there was no significant difference in the initial TCC position depending on the age structure of the patient (Hi square = 1.720, p = 0.886). The overall incidence of infections was 3.44 episodes per 1000 catheter days and patients' age did not affect TCC replacement, infection, thrombosis and inflammation. In the group of elderly, 27 patients had catheter infection (61.4%), 10 (22.7%) had catheter thrombosis and actilysis resolved thrombosis in 6 (13.6%) patients without significant difference as compared with younger patients. Catheter-induced bacteraemia were more common in TCC over 65 years (47 TCC vs. 12 TCC) but without statistical significance (p = 0.062). Similarly, exit site infection, was more common (14 TCC vs. 4 TCC) for those older than 65 years but also without statistical significance. Thrombosis of TCC occurred in 7 patients with TCC younger than 65 years and in 20 TCC in cohort of elderly (Hi square = 0.033, p = 0.535) (Table 1). Regarding treatment outcome, 19 (43.2%) elderly patients died while being treated with TCC, 12 patients (27.3%) changed treatment modality to peritoneal dialysis, 4 patients (9.1%) received arteriovenosus graft (AVG) and 9 patients had functional TCC at the end of follow up (20.5%) and no significant difference was found in the outcome compared to younger patients.

Conclusion

The reason for placement of TCC in elderly is the inability of other treatment options and exhaustion of vascular access. Concerning catheter related complication and outcome, there was no significant difference between the elderly and younger patient.
P1356PACLITAXEL-COATED BALLOON ANGIOPLASTY FOR STENOSIS OF ARTERIOVENOUS FISTULA IN PATIENTS UNDER HEMODIALYSIS: 18TH MONTH FOLLOW-UP
Authors: GRIVEAS IOANNIS , VOURLIOTAKIS GEORGIOS , KANDOUNAKIS IOANNIS
Published: June 2020

Background and Aims

The recording of the experience of the use of paclitaxel-coated balloons in patients with End Stage Renal Disease under hemodialysis (HD) exhibiting narrowing in arteriovenous fistulas (AVF).

Method

20 patients with ultrasonographically confirmed AVF dysfunction were subjected after angiographic screening to prosthesis with a simple angioplasty balloon, and then a balloon drug gradually released the drug paclitaxel. After the damage was restored (one-day clinic), arteriovenous communication was used immediately. The degree of vascular stenosis, blood flow to it and kt / V before and after recovery were assessed by ultrasound. At the same time, the clinical course of the patient and the vestibule of the vessel were monitored for 18 months.

Results

In the 20 patients of the study, since the damage was recovered, AVF was immediately treated without any problems. After angioplasty the degree of stenosis of the responsible vessel was statistically significantly reduced from 69.85% to 27.38% (p <0.05). Flow volume increased statistically significantly from 690.47 mils / min to 942.67 mils / min (p <0.05). The kt / v of patients improved from 1.25 to 1.6. During the 18th -month follow-up, the clinical course of the patients was stable, no problems related to vascular access appeared. Restenosis occurred to two patients, one of each received another successful angioplasty.

Conclusion

Drug-releasing balloons can be a useful therapeutic option for patients with AVF stenosis due to accelerated endothelial hyperplasia. The use of paclitaxel-coated balloons helps reduce the risk of restenosis of arteriovenous anastomoses and is a safe, time consuming, minimal invasive and immediate solution to AVF management.
P1357SODIIUM BICARBONATE CAN REPLACE THE HEPARIN AS “CATHETER LOCK SOLUTION” OF CENTRAL CATHETERS (CVC) FOR HEMODIALYSIS (HD)?
Authors: Corciulo Roberto , Zazzera Pierfelice , Misceo Fernanda , Corciulo Simone , Lomonte Carlo , Libutti Pasquale
Published: June 2020

Background and Aims

The CVC often faces thrombosis and/or infection and currently there are no interventions that guarantee the efficiency of the CVC and the absence of bacterial infections. Recently Adel S. El-Hennawy et al. NDT, 2019, have shown that the use of sodium bicarbonate as “catheter lock solution” (SBCLS) in HD patients has a local anticoagulant effect and reduces the frequency of thrombosis and infections. Therefore, we wanted to use SBCLS in the management of our dialysis patients who needed HD treatment through CVC.

Method

The study included n. 15 HD patients (8M and 7F) with a CVC (see tab.1), whose CVC were previously medicated with heparin or citrate. At the time of the introduction of the SBCLS, patients showed no signs of CVC thrombosis or bacteremia; 2 patients had previously had haemorrhagic complications, 3 had malfunctioning thrombotic CVC. The observation period was 2379 days (mean 158 ± 50). Upon the conclusion of HD treatment, each port of all two-port catheters was flushed and locked with 10 mL of SBCLS (NaHCO3 at 8.4% -pH 7-8.5) and approximately 2 mL of the injected solution remained locked within the catheter. One patient who was allergic to heparin was included in the study.

Results

At the end of the study, only 3 patients had thrombotic problems with CVC and none had infections. However, none of the enrolled patients had to replace the CVC. The treatment was well tolerated by all patients who did not present complications.

Conclusion

In our short and brief experience, SBCLS has proved effective and safe in the prevention of thrombosis and infection of CVC. SBCLS appears to be an effective alternative to heparin and citrate in the management of CVC in the absence of bleeding complications. Finally SBCLS is a valid medical solution in patients allergic to heparin.
P1359PATTERNS OF CENTRAL VENOUS OBSTRUCTION AND OUTCOMES OF ENDOVASCULAR INTERVENTIONS IN CKD PATIENTS ON HAEMODIALYSIS
Authors: Mathur Rajendra , Kalita Dibyajyoti , Mukund Amar
Published: June 2020

Background and Aims

Central Venous Obstruction (CVO) is one of the major causes of morbidity in Chronic Kidney Disease (CKD) patients on maintenance Hemodialysis (HD).

The aim of the study was to assess the patterns of CVO and the role of Endovascular interventions to restore the patency of vascular access in patients on HD with CVO.

Method

We report 15 cases of CVO in HD patients between April 2015 to April 2018. Data regarding patients’ basic information, primary disease, dialysis duration, access at initiation, number and sites of central venous catheterizations, vascular segments stenosed or thrombosed, type of endovascular interventions done and outcomes were collected from electronic record system.

Results

Out of 15 cases of CVO, 11 had the first dialysis with a temporary catheter either to Internal Jugular vein or femoral vein. The average time of presentation to our hospital from initiation of dialysis was 14.8 months. 8 patients presented with symptomatic SVC obstruction. The most common site of CVO was left Brachio-cephalic vein followed by right brachio-cephalic, right subclavian and left subclavian vein. 12 patients underwent Percutaneous Transluminal Angioplasty (PTA) and 3 required bare metal stenting (BMS) along with PTA. One patient required repeat PTA after 4 months. 11 patients did not require further procedure in the mean follow up period of 110 days. PTA was found to be successful in 11 out of 12 cases. Post PTA 9 patients underwent tunneled HD catheter insertion.

Conclusion

Patients of CKD who present late to the nephrologists require HD to be initiated through temporary catheters to central veins. Repeated central venous catheterization is associated with CVO. Endovascular intervention is an effective modality for maintaining HD access patency in such cases.