bluuebunny/crossref_metadata_2025 huggingface dataset:
P1230CHANGES IN CKD-MBD-REALTED MARKERS AND MIDDLE MOLECULAR WEIGHT SOLUTES (Β2MG, Α1MG)IN PATIENTS ON PD-HD COMBINATION THERAPY
Authors: TOMO Tadashi , Sato Takashi , Minaguchi Jun
Published: June 2020

Background and Aims

According to a survey by the Japanese Society for Dialysis Therapy (as of December 31, 2017), among the 9,090 patients that underwent peritoneal dialysis (PD) in Japan, 1,765 patients were treated with PD in combination with once-weekly hemodialysis (HD) or hemodiafiltration (HDF) (PD-HD/HDF combination therapy); these patients accounted for 19.4% of the overall PD population. It has been confirmed that middle-molecular-weight solutes, such as β2MG, α1MG, that cannot be effectively removed by PD can be removed by HD/HDF in PD-HD/HDF combination therapy. In this study, we examined the changes in CKD-MBD-related markers (phosphorus, PTH, FGF-23 [molecular weight 32,000 Da], Fetuin-A [molecular weight 59,000 Da]) and middle-molecular-weight solutes (β2MG [molecular weight 11,800 Da] and α1MG [molecular weight 32,000 Da]) in nine patients on PD-HD combination therapy.

Method

We recruited nine patients (four men, five women) on PD-HD combination therapy with an underlying disease of chronic glomerulonephritis. The patients had a mean age of 66.2 years and a mean dialysis period of 49.1 months on PD alone and 32.1 months on PD combined with HD. The PD protocol included 2 L bag × 4/day (5 days, Monday–Friday; no therapy on Saturday and Sunday), and the HD protocol included 4 hours QB at 200 mL/min, QD at 500 mL/min, and Dialyzer Polysulfone (Asahi Medical Japan) every Saturday. Blood was collected before and after HD and before the next HD (1 week later) to measure CKD-MBD-related markers and middle-molecular-weight solutes. Kits to measure FGF-23 (Millipore, US) and Fetuin-A (Biovendor, Czech) were used.

Results

The levels of the different markers and solutes were as follows: phosphorus (mg/dL) (mean before HD: 5.31, mean after HD: 2.28 (P < 0.01), and mean before the next HD: 5.53); iPTH (pg/mL) (mean before HD: 131.9, mean after HD: 98.8, and mean before the next HD: 125.9); FGF-23 (pg/mL) (mean before HD: 785.3, mean after HD: 576.1 (P < 0.01), and mean before the next HD: 897); Fetuin-A (μg/mL) (mean before HD: 427.9, mean after HD: 423.1, and mean before the next HD: 428.75); β2MG (mg/L) (mean before HD: 36.31, mean after HD: 13.23 (P < 0.01), and mean before the next HD: 36.11); and α1MG (mg/L) (mean before HD: 141.9, mean after HD: 130.4, and mean before the next HD: 114.8).

Conclusion

β2MG and phosphorus levels were significantly decreased when PD was combined with HD, confirming that HD was able to eliminate them. Furthermore FGF-23 (molecular weight 32,000 Da) significantly decreased after HD but α1MG (molecular weight 30,000 Da) did not, suggesting that the decrease in FGF-23 was caused by the decrease in blood phosphorus concentration.
P1242THE RELATIONSHIP BETWEEN INTRADIALYTIC HYPOTENSION AND DIFFERENT BRAIN COMPONENTS VOLUME/ COGNITIVE FUNCTION IN MAINTENANCE HEMODIALYSIS PATIENTS
Authors: Zheng Ke , Qian Yujun , Lin Tianye , Han Fei , Feng Feng , Zhu Yicheng , Li Xuemei
Published: June 2020

Background and Aims

Intradialytic hypotension (IDH) is common in maintenance haemodialysis patients, which is associated with disabling symptoms and interrupted treatment. Blood pressure fluctuations during haemodialysis may affect cerebral perfusion and subsequently brain atrophy and cognitive impairment. This study aimed to explore the correlation of IDH with brain atrophy and cognitive impairment.

Method

IDH was defined when the patients showed obvious hypotension symptoms during the dialysis procedure, such as dizziness, sweating or loss of consciousness, accompanied by blood pressure decrement, and needed to be treated by clinicians in the past one year. All patients received 3.0T MRI examination and cognitive function evaluation. We used the voxel-based morphometry (VBM) method to evaluate the changes of brain multi-component volume. All of the brain region (including gray and whiter matter, brain nuclei, ect.) volumes were measured by calculating the total number of voxels in each image data, with resampling voxel size of 1 mm. A wide range of cognitive tests was administered to evaluate cognitive function, including MMSE, MoCA, Philadelphia word learning test, Boston Naming Test, and trial making test. The cognitive function and brain multi-component volume of were compared between patients with and without IDH (IDH and no-IDH groups), and the correlation between brain volume and IDH was investigated by regression analysis.

Results

Totally 119 maintenance haemodialysis patients enrolled our study. 22 dialysis patients had the experience of IDH, and the prevalence is 18.5%. The patients with IDH had higher prevalence of diabetes and longer dialysis vintage (40.9% vs 16.5, p=0.011; 70.0 vs 41.0 months, p=0.054), they also had a lower post-dialysis SBP and DBP.

The MMSE scores and MoCA scores of patients with IDH and without IDH were similar (29.0 vs 29.0, p= 0.621; 23.5 vs 24.0, p= 0.273).

There was no difference in gray matter and white matter between IDH and no-IDH groups. But as for some important brain nuclei and parts associate with emotion and vision, like amygdala, cuneus and posterior cingulate, patient with IDH were smaller than patients without IDH (1.6±0.2 vs 1.7±0.2 mm3, p=0.009; 6.9±0.8 vs 7.4±1.0 mm3, p=0.031; 6.9±0.8 vs 7.4±0.9 mm3, p=0.024). The multiple-regression analysis showed that IDH was significantly associated with the volume atrophy of amygdala, cuneus and posterior cingulate (β=-0.12, p=0.009; β=-0.48, p=0.031; β=-0.48, p=0.026).

Conclusion

IDH was not rare in maintained dialysis patients. IDH may cause some specific brain components atrophy which may relative to emotion and visual changes in dialysis patients but was not associated with cognitive impairment and cognitive relative brain components.
P1255DIASTOLIC BLOOD PRESSURE IS ASSOCIATED WITH BRAIN ATROPHY IN HEMODIALYSIS PATIENTS: A SINGLE CENTER CASE CONTROL STUDY
Authors: Cohen-Hagai Keren , Fanadka Feda , Grumberg Tania , Topaz Guy , Nacasch Naomi , Greenberg Meidad , Zitman-Gal Tali , Benchetrit Sydney
Published: June 2020

Background and Aims

Brain atrophy (BA) is a common finding in neuroimaging of hemodialysis (HD) patients, representing a parenchymal cerebral damage. Likely contributing factors to BA are age, chronic hypertension, diabetes mellitus and other cardiovascular risk factors of atherosclerosis that are also common among HD patients. BA may also occur due to focal ischemia and hypoperfusion during HD. However, data on optimal blood pressure (BP) in these patients are limited. The goal of this study was to determine whether the prevalence and severity of BA would be higher among HD patients with lower BP.

Method

A blinded neuroradiologist graded BA of all HD patients who underwent brain non-contrast computerized tomography (CT) from 2015 to 2017 in our institution. Age-and sex-matched patients with normal kidney function who underwent brain CT during the same period and technique served as the control group

Results

A total of 280 patients were included in this retrospective study, with average BP of 140/70 mmHg among HD patients and 142/75 mmHg in the control group. BA was more common in dialysis patients and its severity increased with age and traditional cardiovascular risk factors. We observed a significant negative correlation between diastolic BP (DBP) at dialysis initiation and BA. Average DBP decreased with increasing severity of BA. These findings were observed in both HD and non-CKD patients.

Conclusion

Brain atrophy was associated with lower DBP, which may induce cerebral hypoperfusion and ischemia. This finding should discourage over-treatment of hypertension in hemodialysis patients.
P1256THE ASSOCIATION PROTEIN-ENERGY WASTING AND INFLAMMATION STATUS WITH MORTALITY AFTER LOWER EXTREMITIES REVASCULARIZATION IN PATIENTS ON HAEMODIALYSIS
Authors: Takahashi Hiroshi , Kumada Yoshitaka , Ishii Hideki , Umemoto Norio , Ito Ryuta , Yuzawa Yukio , Tsuboi Naotake
Published: June 2020

Background and Aims

Although lower extremity revascularization has been commonly performed in chronic haemodialysis (HD) patients with peripheral artery disease (PAD), poorer prognosis still remains major problems in such population. Recently, protein-energy wasting (PEW) or malnutrition have been considered to be strongly associated with chronic inflammation and advanced atherosclerosis in HD patients. We investigated the association of geriatric nutritional risk index (GNRI) as a surrogate marker of the PEW, C-reactive protein (CRP) and these joint role with prediction of amputation and/or mortality after lower extremity revascularization in chronic HD patients.

Method

We enrolled a total of 862 HD patients (age 67±10 years, diabetes 62.9%, critical limb ischemia 53.5%) who successfully underwent lower extremity revascularization (552 with endovascular therapy and 310 with bypass surgery). Patients were divided into tertiles according to GNRI levels; tertile 1 (T1): <80.0, T2: 80.0-96.6and T3: >96.6, and CRP levels; T1: <2.0mg/l, T2: 2.0-12.6mg/l and T3: >12.6mg/l, respectively. They were followed up for up to 8 years.

Results

During follow-up period (median: 43 months), 63 (7.3%) patients needed major amputation and 202 (23.4%) patients died. Kaplan-Meier analysis shows that amputation-free survival rates for 8 years were 47.5%, 51.6% and 66.5% in T1, T2 and T3 of GNRI, and were 65.8%, 58.7% and 33.2% in T1, T2 and T3 of CRP, respectively (p<0.0001 in both). After adjustment for age, previous coronary artery disease and critical limb ischemia as covariates with p<0.05 by univariate analysis, declined GNRI [hazard ratio (HR) 2.18, 95% confidence interval (CI) 1.57-3.07, p<0.0001 for T1 vs. T3] and elevated CRP (HR 1.78, 95%CI 1.24-2.59, p=0.0016 for T3 vs. T1) were identified as independent predictors of amputation and/or mortality. In the combined setting of both variables, the risk of amputation and/or mortality was 3.77-fold higher (95%CI 1.97-7.69, p<0.0001) in theT1 of GNRI with T3 of CRP than in the T3 of GNRI with T1 of CRP. Similar results were obtained for amputation and mortality, respectively (Figure).

Conclusion

Among HD patients undergoing lower extremity revascularization, those with pre-procedural declined GNRI and elevated CRP frequently experienced amputation and/or mortality, furthermore, combination of both variables could stratify the risk of amputation and/or mortality.
P1259RELATIONSHIP BETWEEN NT-PROBNP AND ELECTROCARDIOGRAPHIC FINDINGS IN PREVALENT HEMODIALYSIS PATIENTS
Authors: Fujimoto Shouichi , Sato Yuji , Kikuchi Masao , Inagaki Hiroko , Hayashi Toshihide , Joki Nobuhiko
Published: June 2020

Background and Aims

There are several reports showing on the relationship between electrocardiographic (ECG) findings and prognosis in dialysis patients. We recently reported that among various ECG findings, T-wave of lead aVR (aVRT) amplitude revealed the strongest and significant association with cardiovascular disease (CVD) events and all-cause mortality in prevalent dialysis patients (Ther Apher Dial, 2017). We also reported that BNP level was significantly associated with CVD-related mortality and all-cause mortality in our cohort study (Ren Fail, 2018; Sci Rep, 2019). On the other hand, BNP levels have been reported to be higher among elderly and women and lower in people with higher body mass index. However, there is no report showing the correlation between NT-proBNP and ECG findings.

Method

From our Miyazaki Dialysis Cohort, we extracted patients who had both ECG findings and NT-proBNP data and did not have atrial fibrillation. We examined the relationship between log NT-proBNP level and various ECG findings using Spearman analysis as a cross-sectional study.

Results

We analyzed 519 hemodialysis patients (44.1% women, mean age was 66.1 years old, median dialysis vintage was 105 months) without atrial fibrillation. Diabetes mellitus was the underlying disease in 25.0% and a history of CVD was found in 25.2% of all patients. Median and IQR (25-75 percentile) of NT proBNP was 4150 (1980-8960). Log NT-proBNP level was significantly correlated with aVRT magnitude (mV), electrical left ventricular high voltage (mV), QTc time (ms), and T-wave amplitude of I lead (mV) (r=0.289, p<0.01; r=0.248, p<0.01; r=0.271, p<0.01; r=-0.282, p<0.01, respectively). However, log NT-proBNP did not show significant correlation with heart rate, PR interval and QRS duration. These significant correlations between these ECG findings and log NT-proBNP were higher in men compared with women.

Conclusion

Although some ECG findings and BNP level are factors associated with CVD events and death, there was also a significant correlation between these two factors. There has been no report showing the relationships between these two factors, and it may be useful in considering BNP levels in dialysis patients.
P1262VASCULAR CALCIFICATION OF ABDOMINAL AORTA AND COMMON ILIAC ARTERY AFTER KIDNEY TRANSPLANTATION
Authors: Nakai Kentaro , Yamamoto Shutaro , Tomooka Haruka , Inoue Megumi , Kohara Chiaki , Shukuri Tomoya , Takae Keita , Nishiki Takehiro , Motoyama Kentaro , Mitsuiki Koji
Published: June 2020

Background and Aims

Vascular calcification is a risk factor for cardiovascular disease and mortality in dialysis and transplant patients. Previous studies have shown that coronary artery calcification correlates with cardiovascular mortality. However, it is not known whether vascular calcification of the abdominal aorta and common iliac artery (CIA) may impact clinical outcomes after kidney transplantation. The aim of this study was to identify the risk factors of vascular calcification after kidney transplantation.

Method

In this retrospective study, we assessed 100 patients who underwent kidney transplantation between 2008 and 2017. Of these, 62 patients received a computed tomography (CT) scan of the abdomen twice with an interval of at least 6 months. We examined the characteristics of vascular calcification of the abdominal aorta and iliac artery and divided the patients into three groups based on dialysis modality before transplantation: hemodialysis (HD group), peritoneal dialysis (PD group) and preemptive kidney transplantation (PEKT group). Then, we identified the risk factors for the progression of calcification. Abdominal aortic calcification was assessed based on the aortic calcification index (ACI), and calcification of CIA was assessed based on the maximal thickness of calcification.

Results

At baseline, abdominal aortic calcification was present in 66% of patients, and the median ACI was 10 [0-30]. Calcification of the CIA was present in 62% of patients, and maximal thickness of the CIA was 2.4 mm [0-4.6]. The mean duration of follow-up was 68 ± 29 months, and the mean interval of CT was 40 ± 29 months. After kidney transplantation, the progression rate of ACI and maximal thickness of CIA were 1.6 ± 2.5 per year and 0.17 ± 0.41 mm per year, respectively. The maximal thickness of CIA calcification was significantly higher, and ACI tended to be higher in the HD group than in the PEKT group. Age, male gender, diabetes mellitus and dialysis vintage were the independent variables related to both ACI and maximal thickness of CIA calcification. The progression rates of ACI and maximal thickness of CIA were comparable among the three groups in terms of dialysis modality. Age and rejection within the first 6 months were independent risk factors for ACI progression, and diabetes mellitus was an independent risk factor for progression of maximal thickness of CIA. No significant association was found between the progression of vascular calcification and dialysis-related parameters, including dialysis modality and vintage.

Conclusion

This study suggests that dialysis vintage was the independent variable related to calcification of the abdominal aorta and common iliac artery, whereas dialysis modality was not a significant predictor of vascular calcification and its progression in these blood vessels.
P1267EFFECT OF SODIUM AND ULTRAFILTRATION MODELING VERSUS LOW TEMPERATURE DIALYSATE IN PREVENTION OF INTRADIALYSIS HYPOTENSION: A SINGLE CENTRE STUDY FROM INDIA
Authors: Tiwari Vaibhav , Gupta Anurag , Anand Yogeshman , Bhargava Vinant , Malik Manish , Gupta Ashwani , Bhalla A K , Rana Devinder Singh
Published: June 2020

Background and Aims

Symptomatic intradialytic hypotension is the most frequent complication in patients receiving hemodialysis. It complicates 5 to 30 percent of all dialysis treatments. In our study, we aimed to compare the effect of sodium and ultrafiltration modeling versus low-temperature dialysate on the occurrence of intradialytic hypotensive episodes.

Method

Single center, prospective, randomized trial. Patients with chronic kidney disease (CKD) stage V on maintenance hemodialysis (HD) for at least twice weekly for a minimum of 3 months were observed for the occurrence of ≥1 intradialytic hypotensive episode per month. After full filling the inclusion and exclusion criteria, patients were randomized 1:1 ratio into two groups based on computer-generated randomization numbers allotted to them by the dialysis coordinator.

Group 1: Underwent dialysis with sodium and Ultrafiltration modeling (Linearly decreasing dialysate sodium from 141 mmol/L to 128 mmol/L and linearly decreasing ultrafiltration rate).

Group 2: Underwent dialysis with low-temperature dialysate (36 degrees Celsius).

Primary outcome was number of hypotensive episodes per month. Secondary outcomes were interdialytic weight gain and ultrafiltration volume per session.

Results

A total of 320 patients were observed for 3 months in our centre. Intradialytic hypotension was found in 18.75 % of patients. Diabetic nephropathy (61.66%) was the leading cause of end-stage renal disease in these patients. There was no significant difference between the two groups in mean arterial blood pressure, hemoglobin, cardiac status, and serum albumin before dialysis. Both groups had a similar incidence of intradialytic hypotensive episodes (P >0.05). Interdialytic weight gain and ultrafiltration volume removed per session were also similar in both groups.

Conclusion

Sodium and ultrafiltration modeling and low-temperature dialysate were both equally effective in the prevention of intradialytic hypotensive episodes.
P1271PARADOXICAL EFFECT OF ALDOSTERONE ON CARDIOVASCULAR OUTCOME IN MAINTENANCE HEMODIALYSIS PATIENTS
Authors: Lee Young-Ki , Choi Sun Ryoung , Park Hayne Cho , Kim Do Hyoung , Cho Ajin , Kim Juhee , Yoon Jong-Woo , Noh Jung-Woo , Kang Min-Kyung
Published: June 2020

Background and Aims

Patients with end-stage renal disease have an increased risk of cardiovascular (CV) mortality and left ventricular diastolic dysfunction (LVDD) is known to contribute to its high occurrence. Although high serum aldosterone level is involved in the development of CV complications in general population, this association is unclear in patients undergoing hemodialysis (HD). We aimed to determine the impact of serum aldosterone on LVDD and CV mortality among HD patients.

Method

We performed a prospective cohort study of maintenance HD patients without CV disease. Patients were divided into two groups according to the median level of serum aldosterone (44 ng/dL). All patients underwent echocardiography to evaluate diastolic dysfunction. Proportions of LVDD and CV mortality were compared between high and low aldosterone groups.

Results

We enrolled a total of 60 adult patients (mean age 57.9±12.1 years, male 30.0%). Low aldosterone group had an increased left ventricular diastolic dimension compared with high aldosterone group (52.2±8.4 vs. 50.3±5.2 mm, p=0.033). The E/è ratio (19.5±7.5 vs. 14.6±5.2, p=0.024) was significantly higher among patients in low aldosterone group compared to high aldosterone group. There were no significant differences either in ejection fraction, LVMI, or the proportion of LVH between two groups. Low log-aldosterone (odds ratio 0.403; 95% confidence interval 0.188-0.862) and large left atrial dimension (1.308; 1.114-1.536) were independent risk factors for LVDD. In addition, cox regression analysis demonstrated that low log-aldosterone was an independent predictor of CV mortality in HD patients (hazard ratio 0.505; 95% confidence interval 0.294-0.869, p=0.014).

Conclusion

Low serum aldosterone was not only associated with LVDD but also an independent predictor of CV mortality among HD patients.
P1273EFFECTS OF ABDOMINAL AORTIC CALCIFICATION PROGRESSION ON OUTCOMES IN MAINTENANCE HEMODIALYSIS PATIENTS
Authors: Wang Zhe
Published: June 2020

Background and Aims

Vascular calcification is the risk factor for cardiovascular event, cardiovascular mortality and all-cause mortality in maintenance hemodialysis (MHD) patients. We investigated the effects of abdominal aortic calcification (AAC) progression on outcomes in MHD patients.

Method

111 patients who were on MHD between Jun. 2014 and Oct. 2014 in the dialysis center and finished the AAC examination at baseline and two years later were included prospectively. We evaluated the progression of AAC by AAC score (AACs) at baseline and two years later. According to the change of AACs, the patients were divided into rapid AAC progression group (change of AACs>median) and non-rapid AAC progression group (change of AACs≤median). We investigated the effects of AAC progression on outcomes in MHD patients in the follow-up period. Kaplan-Meier analysis was used to compare their survival rate. Uni- and multivariable Cox proportional hazard regression models were used to determine the risk factors of all-cause mortality, cardiovascular mortality and cardiovascular events.

Results

The presence of AAC was 78.4% (87/111), rapid AAC progression was seen in 54 patients, and non-rapid AAC progression was seen in 57 patients. The mean follow-up duration was 27.9(27.1, 28.0) months. Kaplan-Meier analysis showed that patients in rapid AAC progression group had a higher risk of mortality as compared to patients in non-rapid AAC progression group (P=0.017). Multivariate Cox regression analysis demonstrated that high baseline AACs (HR=1.135, 95%CI∼1.001∼1.286, P=0.048), hypoproteinemia (HR=0.789, 95%CI 0.640∼0.972, P=0.026) were independent risk factors for all-cause mortality. High baseline AACs (HR=1.187, 95%CI 1.038∼1.356, P=0.012), low spKt/V (HR=0.103, 95%CI 0.013∼0.801, P=0.030) were independent risk factors for cardiovascular mortality. Low spKt/V (HR=0.018, 95%CI 0.003∼0.115, P=0.000), hypoproteinemia (HR=0.736, 95%CI 0.608∼0.890, P=0.002) were independent risk factors for cardiovascular events.

Conclusion

Abdominal aortic calcification progression may increase the risk of cardiovascular events and death in MHD patients. Severity of abdominal aortic calcification, adequacy of dialysis, and nutritional status are predictors of outcomes in MHD patients.
P1276EXPLORING POSSIBLE PREDICTORS OF STRUCTURAL DETERIORATION AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION IN HEMODIALYSIS PATIENTS
Authors: Masuyama Satoshi , Mizui Masayuki , Maeda Koichi , Kuratani Toru , Sakaguchi Yusuke , Sakata Yasushi , Sawa Yoshiki , Isaka Yoshitaka
Published: June 2020

Background and Aims

Transcatheter aortic valve implantation (TAVI) is an effective treatment for aortic stenosis (AS) in high-risk patients, such as those who are suffering ESRD on hemodialysis. We previously showed that long-term survival of hemodialysis patients underwent TAVI was lower than that of non-hemodialysis patients but was comparable with that of hemodialysis patients treated with surgical aortic valve replacement. It is known that hemodialysis is a high risk of the bioprosthetic structural valve deterioration (SVD) after valve replacement surgery. Consistently, higher incidence of re-TAVI operation due to restenosis was observed in hemodialysis patients than in non-hemodialysis patients (Odds ratio [OR]:29.4, p<0.001).

In this study, we aimed to identify predictors of SVD in post-TAVI hemodialysis patients.

Method

From April 2012 to December 2015, 24 patients on hemodialysis were selected to receive TAVI for the treatment of AS in Osaka University Hospital. Demographic and laboratory data at pre- and post-operation were compared between patients who underwent re-TAVI (valve-in-valve) (SVD group) and those who did not (no-SVD group).

Results

During the follow-up period (maximal 7 years), 4 out of 24 patients required re-TAVI (valve-in-valve) operation because of SVD. Although serum calcium, phosphate, and PTH levels before operation were comparable between SVD group and no-SVD group, serum magnesium levels were significantly lower in SVD group. Lower serum magnesium quartiles were associated with a higher risk of SVD (OR 5.83, p=0.036). While effective orifice area index (EOAi) of aortic valve at 1 week after TAVI was similar between the 2 groups, EOAi improvement at 1 month was significantly poorer in SVD group than in no-SVD group (1.70 ± 0.15 vs 2.50 ± 0.56, p = 0.049).

Conclusion

The higher incidence of re-TAVI due to SVD in hemodialysis patients could be related with pre-operative low magnesium levels and with one-month post-operative low EOAi improvement.

This was a single center observational study, and the number of patients was very small so that our data would not be necessarily applicable for every patient. Further investigation is necessary for identifying a prognostic predictor of SVD, which will lead to the prevention of unfavorable re-operation in hemodialysis patients.
P1277EFFECT OF HEMODIALYSIS ON PERIPAPILLARY CHOROIDAL THICKNESS AND OPTIC NERVE HEAD PARAMETERS MEASURED BY SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY
Authors: Lee Won June , Shin Yong Un , Seong Mincheol
Published: June 2020

Background and Aims

To investigate the effect of hemodialysis (HD) on peripapillary choroidal thickness (PCT) and optic nerve head (ONH) parameters by swept-source optical coherence (SS-OCT) and other ophthalmologic parameters in patients with end-stage kidney disease (ESKD).

Method

A prospective observational study was performed on 29 patients who underwent HD for ESKD. Detailed ophthalmologic examinations and SS-OCT were performed immediately before and after HD. The PCT were measured using the modification tool in the built-in OCT image viewer program. The ONH parameters including rim area (RA) and vertical cup-to-disc ratio (VCDR) were obtained using built-in software. Changes in PCT, and ONH parameters before and after HD were statistically analyzed.

Results

Average PCT significantly decreased from 127.3 ± 49.2 before HD to 117.1 ± 50.9 after HD (P<0.001). The RA increased and VCDR decreased significantly after HD (P=0.001 and P=0.027, respectively). Disc area did not show significant change after HD (P=0.648). Significant correlation was found between changes in PCT and changes in macular choroidal thickness (rho=0.547, P=0.002).

Conclusion

We observed significant decrease in PCT and significant changes in ONH parameters after HD. Our study suggest that HD can give influence on the ONH and its surrounding structure.
P1290RISK FACTORS FOR PROGRESSION OF CORONARY ARTERY CALCIFICATION OVER 5 YEARS IN HEMODIALYSIS PATIENTS
Authors: Alayoud Ahmed , Mounia Azizi , Marouan Jabrane , Arrayhani Mohammed
Published: June 2020

Background

Although progression of coronary artery calcification (CAC) has been established as an important marker for cardiovascular morbidity, very few studies have studied it in end-stage renal disease patients. Thus we examined and evaluate risk factors of calcification changes in dialysis patients.

Method

Among 28 hemodialysis (HD) patients, CAC was measured in Agatston units at baseline and after five years using the 64 multi-slice ultra-fast CT. The HD patients were classified as progressors or no progressors according to the change in the CAC score across these 2 measurements.

Results

Over an average 63 months follow-up, participants without CAC at baseline had no incident CAC .The progression of CAC was slow and was found only in 6 patients (21.4%) . It was significantly associated with several cardiovascular risk factors, namely, older age (p=0.03), diabetes (p=0.05), male sex (p=0.02), hypercholesterolemia (p = 0.05), anemia (p=0.017), inflammation (p=0.05), and hyperphosphataemia (p=0.012) . However, calcemia, parathormone levels, dialysis duration, tobacco, high blood pressure and dialysis dose did not seem to influence the progression of CAC in our series. A strong association was found between basal calcification scores and Delta increment at 5 years.

Conclusions

Our study suggests that CAC progression in dialysis is a complex phenomenon, associated with several risk factors with special regard to elevated basal scores. This progression can be avoided or slowed with appropriate management which must begin in the early stages of chronic kidney disease
P1291PULMONARY HYPERTENSION VERSUS PULMONARY CONGESTION IN HAEMODIALYSIS PATIENTS IN RELATION TO INCREASED INTER DIALYTIC WEIGHT GAIN
Authors: ElSharkawy Magdy , Khedr Lina , Abdel Rahman Ali , El Shimy Ahmed , Shebl Ahmed
Published: June 2020

Background and Aims

Volume overload is considered as an important clinical problem in HD patients. It is associated with morbid situations such as pulmonary hypertension and lung congestion. to assess the effect of increased (IDWG) on pulmonary hypertension, and lung congestion.

Method

This observational cross sectional study was conducted at on 60 HD patients, that were divided into Group I: 30 patients with an IDWG < 3.5% and, Group II: 30 patients with an IDWG > 3.5% of their dry weight. Pulmonary artery pressure was measured by echo and patients classified according to PAP into mild, moderate and severe pulmonary hypertension. Lung congestion in all patients was measured by lung ultrasound and patients classified into minimal, mild, moderate and severe lung congestion.

Results

Our study showed that pulmonary hypertension prevalence was 30% while lung congestion was 100%. Patients with increased IDWG > 3.5% (group 2) had pre HD higher PAP than those with IDWG < 3.5% (group 1) and patients with IDWG > 3.5% had more change in their PAP post HD session than those with IDWG < 3.5% but no significant difference between the change after the HD session in both groups. HD duration is an important factor in PH development over years. There is a significant relation anemia and hypercalcemia with PH. Patients with more increased IDWG > 3.5 % (group 2) had higher pulmonary congestion than those with IDWG < 3.5% (group 1) and patients with IDWG < 3.5% had more change in their lung congestion level after the HD session than those with IDWG > 3.5% but no statistical significance between the change in both groups. There was a significant relation between HD therapy duration with pulmonary congestion measured prior to the session.

Conclusion

on the short term increased IDWG affect lung congestion more than pulmonary hypertension.
P1294AMBULATORY BLOOD PRESSURE PROFILE IN PERITONEAL DIALYSIS COMPARED TO HEMODIALYSIS AND CHRONIC KIDNEY DISEASE PATIENTS
Authors: Alexandrou Maria Eleni , Loutradis Charalampos , Kouris Nikolaos , Sarris Dimitrios , Schoina Maria , Tzanis Georgios , Dimitriadis Chrysostomos , Sachpekidis Vasileios , Papadopoulou Dorothea , Gkaliagkousi Eugenia , Papagianni Aikaterini , Parati Gianfranco , Sarafidis Panteleimon
Published: June 2020

Background and Aims

Hypertension is highly prevalent in dialysis patients and is often poorly controlled. Data on the ambulatory blood pressure (BP) profile of patients undergoing peritoneal dialysis (PD) are scarce. The aim of this study is to compare the ambulatory BP profile of PD patients with that of hemodialysis (HD) and to pre-dialysis CKD patients.

Method

38 patients undergoing PD were matched in a 1:2 ratio for age, gender and dialysis vintage with 76 HD patients and in a 1:1 ratio for age and gender with 38 CKD stages 2-4 patients. Patients under PD and HD underwent 48-hour and CKD patients 24-hour ambulatory BP monitoring. BP levels were compared for the 48hour, 1st and 2nd 24hour, daytime and nighttime periods. Two-way mixed ANOVA analysis for repeated measurements was used to evaluate the effect of dialysis modality and time on ambulatory BP in PD and HD.

Results

During all periods studied, SBP and DBP were numerically higher but not statistically different in PD than in HD patients. SBP was significantly higher in PD or HD compared with predialysis CKD (PD:138.38±20.97; HD:133.75±15.5; CKD:125.52±13.4 mmHg, p=0.003; PD vs CKD: p=0.003; HD vs CKD: p=0.041 accordingly); significant differences were also evident during the daytime and nighttime periods. DBP displayed a similar trend in the total period studied (PD:82.34±15.22; HD:80.47±11.13; CKD:76.81±7.82 mmHg, p=0.108), but the difference significant only during the second nighttime period. Repeated-measurements analysis showed no effect of dialysis modality and no interaction between modality and time on ambulatory BP during all periods studied.

Conclusion

Average BP levels are similar between PD and HD patients, but higher for both groups compared to CKD counterparts. The dialysis modality had no significant effect on ambulatory BP profile.
P1297PULMONARY HYPERTENSION VERSUS PULMONARY CONGESTION IN HAEMODIALYSIS PATIENTS IN RELATION TO INCREASED INTERDIALYTIC WEIGHT GAIN
Authors: ElSharkawy Magdy , Khedr Lina , El Shimy Ahmed , Abdel Rahman Ali , Shebl Ahmed
Published: June 2020

Background and Aims

Volume overload is considered as an important clinical problem in HD patients. It is associated with morbid situations such as pulmonary hypertension and lung congestion. to assess the effect of increased (IDWG) on pulmonary hypertension, and lung congestion.

Method

This observational cross sectional study was conducted at on 60 HD patients, that were divided into Group I: 30 patients with an IDWG < 3.5% and, Group II: 30 patients with an IDWG > 3.5% of their dry weight. Pulmonary artery pressure was measured by echo and patients classified according to PAP into mild, moderate and severe pulmonary hypertension. Lung congestion in all patients was measured by lung ultrasound and patients classified into minimal, mild, moderate and severe lung congestion.

Results

Our study showed that pulmonary hypertension prevalence was 30% while lung congestion was 100%. Patients with increased IDWG > 3.5% (group 2) had pre HD higher PAP than those with IDWG < 3.5% (group 1) and patients with IDWG > 3.5% had more change in their PAP post HD session than those with IDWG < 3.5% but no significant difference between the change after the HD session in both groups. HD duration is an important factor in PH development over years. There is a significant relation anemia and hypercalcemia with PH. Patients with more increased IDWG > 3.5 % (group 2) had higher pulmonary congestion than those with IDWG < 3.5% (group 1) and patients with IDWG < 3.5% had more change in their lung congestion level after the HD session than those with IDWG > 3.5% but no statistical significance between the change in both groups. There was a significant relation between HD therapy duration with pulmonary congestion measured prior to the session.

Conclusion

on the short term increased IDWG affect lung congestion more than pulmonary hypertension.
P1308PHOSPHATE-LOWERING USING SUCROFERRIC OXYHYDROXIDE: CALCIFICATION PROPENSITY (T50) IN HEMODIALYSIS PATIENTS. POST-HOC ANALYSES OF A RANDOMIZED, CONTROLLED CLINICAL TRIAL
Authors: Thiem Ursula , Marculescu Rodrig , Pasch Andreas , Haller Maria , Cejka Daniel
Published: June 2020

Background and Aims

Lowering serum phosphate with sucroferric oxyhydroxide (SO) therapy reduces calcification propensity (measured with the T50 test) in hemodialysis patients (Cejka et al. Abstract FR-PO149, ASN Kidney Week 2019). Intriguingly, we observed considerable inter-patient variability for changes in T50 in response to SO treatment, despite similar reductions in serum phosphate.

Method

Post-hoc analysis of a randomized, controlled cross-over study investigating the effects of serum phosphate lowering using oral phosphate binder therapy with SO on calcification propensity (T50). Patients with changes of serum phosphate of approximately -0.5 mmol/l between phosphate binder wash-out and high dose (2000 mg/d) SO and were selected and classified as “responders” (showing profound changes in T50) and “non-responders” (showing very little change in T50). Data are shown as means ± SD.

Results

“Responders” (N=4) and “non-responders” (N=4) showed similar degrees of lowering of serum phosphate with high-dose SO treatment (-0.47 ± 0.06 vs. -0.49 ± 0.01 mmol/l). “Responders” showed marked increases in T50 (+108 ± 26 min), but “non-responders” did not (+6 ± 24 min). When comparing other laboratory parameters during the wash-out phase between “responders” and “non-responders”, no obvious difference in single parameters or pattern of laboratory parameters was apparent for ionized calcium (1.11 ± 0.1 vs. 1.01 ± 0.1 mmol/l), phosphate (1.76 ± 0.31 vs. 2.06 ± 0.47 mmol/l), T50 (285 ± 82 vs 271 ± 38 min), albumin (3.9 ± 0.2 vs. 4.1 ± 0.4 g/dl), magnesium (1.07 ± 0.17 vs. 0.98 ± 0.14 mmol/l), bicarbonate (22.0 ± 3.6 vs. 24.1 ± 3.0 mmol/l), iPTH (301 ± 156 vs. 463 ± 303 pg/dl) or iFGF23 (6903 ± 9480 vs. 1097 ± 927 pg/ml).

Conclusion

Similar degrees of phosphate lowering do not lead to a similar improvements in T50. T50 “responders” versus “non-responders” cannot be identified using current standard laboratory parameters.
P1333PULSE WAVE ANALYSIS UNDER THE CONDITIONS OF HIGH ARTERIAL FLOW: ASSESSMENT OF SHUNT FUNCTION AND REACTIVE HYPEREMIA
Authors: Mueller Niklas , Streis Joachim , Müller Sandra , Pavenstädt Hermann Josef , Reuter Stefan , Busch Veit
Published: June 2020

Background and Aims

Fistula-creation as well as reactive hyperaemia increase local arterial blood flow. We wanted to analyse the impact of these haemodynamic changes on pulse wave (PW) morphology to assess fistula- and endothelial function.

Method

We conducted a clinical pilot study including 56 patients with functioning forearm fistula. PW morphology in the A. brachialis was assessed tonometrically at the non-fistula and fistula arm using the SpygmoCor® device. We also performed a PW analysis on the non-fistula arm under the condition of reactive hyperaemia (possible in 43 patients). Duplex-sonography was used as a complementary and reference method.

Results

In comparison to measurements under physiologic conditions, both the fistula arm (a) and the non-fistula arm with reactive hyperemia (b) showed marked differences in the pulse wave morphology (figure). The changes in PW morphology were most prominent in the area of the diacrotic notch and could be assessed as the differences of the sum of the mean slope (Δλ in mmHg/ms) between the diacrotic notch and the main preceding and subsequent inflexion point. Measurement with duplex-sonography confirmed increased peak blood flow velocity in the arteria brachialis (ΔVmax in cm/s) under both conditions.

Statistical significance could be proved for Δλ and for ΔVmax (table). Finally, bivariate regression analysis revealed a correlation of Δλ with ΔVmax (figure; c: p=0.001 and r=-0,483 for interarm-differences of the fistula and non-fistula arm; d: p= 0.030 and r=-0.343 for the differences between the physiologic state and reactive hyperaemia at the non-fistula arm).

Conclusion

PW analysis under high flow conditions has the potential to be a new useful clinical tool in nephrology to monitor fistula- as well as endothelial function assessed by reactive hyperaemia. The findings should be verified in a trial with clinical endpoints.
P1347A DYNAMIC ULTRASOUND-IMAGING-BASED GUIDED TECHNIQUE TO TUNNELED DIALYSIS CATHETER BY MICROBUBBLES
Authors: Melo Erica , Silveira Marcelo , Souza Sérgio , Baptista Ana , Miranda Filipe , Nascimento Carolina , Coelho Fernanda , Dutra Fábio , Gomes Marcel , Reixeira Mauricio , Caldas Juliana , Messeder Octavio , Farias Augusto , Benigno Paulo , Passos Rogério
Published: June 2020

Background and Aims

In patients with end-stage renal disease (ESRD), the use of cuffed, tunneled dialysis catheters (TDCs) for hemodialysis has become integral to treatment plans. Fluoroscopy is a widely accepted method for the insertion and positioning of cuffed dialysis catheters, because it is easy to use, accurate and reliable, and has a relatively low incidence of complications. The purpose of our study was to evaluate the feasibility of tunneled hemodialysis catheter placement without the use of fluoroscopy but with a dynamic ultrasound-imaging-based guided technique.

Method

From January 2015 to December 2017, we performed an observational prospective cohort study of 56 patients with ERDS who required TDC placement.

Results

The overall success rate for ultrasound-guided central access was 100%, with a mean number of 1.16 (± 0.4) attempts per patient. There were no incidences of guide wire coiling/kinking, carotid puncture, pneumothorax, or catheter malfunction. Catheter flow during dialysis was 286 (± 38) ml/min. The total number of catheter days was 7,451, with a mean of 133 days and a range of 46 to 322 days. Life table analysis revealed primary patency rates of 100%, 96%, and 53% at 30, 60, and 120 days, respectively.

Conclusion

Dynamic ultrasound-based visualization of microbubbles in the right atrium is a highly accurate method to detect percutaneous implantation of large-lumen, tunneled, central venous catheters without the need for fluoroscopic guidance technology.
P1349CATHETER RELATED BACTERAEMIA AND EFFECTIVENESS OF UNIVERSAL MEASURES: 11-YEAR PROSPECIVE STUDY
Authors: Ibeas Jose , Rubiella Carolina , Gasch Blasi Oriol , Guitart Josep , Criado Eva , Pico Sandy , Lopez Tamara , Viudes Elena , Uroz Elisabeth , Sole Sara , Jimeno Valle , Mateos Alexis , Iglesias Ruben , Marcet Montserrat , Moya Carmen
Published: June 2020

Background and Aims

Tunnelled catheter-related bacteraemia (BRC) of the patient in chronic hemodialysis program results in high morbidity and mortality. Antibiotic catheter lock has been suggested to reduce the incidence of BRC in clinical trials.

Aim: To demonstrate the effectiveness of universal aseptic measures in obtaining an optimal BRC rate in a long-term single-centre study.

Method

Design: Prospective cohort study, single-centre. Follow-up time: 11 years (2008-2018) Tunneled catheters: Optiflow, Hemostar, Hemosplit, Equistream, Hemoglide (Bard Access Systems, New Jersey, USA) and Palindrome (Covidien, - Medtronic, Mansfield, Massachusets, USA). Days / catheter analyzed: 207,320. Catheter placement: Ultrasound-guided interventional radiology equipment, with fluoroscopy and universal aseptic measures + 1 single dose of Vancomycin / cefazolin. Follow-up: Nursing and Nephrology and Infectious physicians. Universal aseptic measures. Heparin lock. BRC is considered to be the presence of a positive blood culture after discarding another focus and related to the negative catheter or blood culture with no other focus than the catheter. All available samples at the time of bacteraemia are analyzed: blood, sputum, urine, faeces, pleural fluid, peritoneal fluid, cerebrospinal fluid, exudates, smears etc, and their results. The BRC rate x 1000 days / catheter is evaluated

Results

Results BRC 2008 to 2018: 0.57, 0.47, 0.31, 0.1, 0.43, 0.37, 0.42, 0.16, 0.2, 0.18 and 0.04 respectively. The evaluated catheters, follow-up days, catheter-related bacteraemias, germ typing and treatment are analyzed: antibiotic vs. catheter removal in Table 1.

Conclusion

1. The use of universal measures only, without the use in the antibiotics lock or anticoagulants other than heparin, can achieve a bacteraemia rate related to the optimal catheter, being cost / effective and avoiding possible resistance to antibiotics and side effects of other anticoagulant drugs.

2. Antibiotic sealing should be reserved for cases of difficult epidemiological control of BRC.
P1355NEW SURGICAL TECHNIQUE TO CONTROL EXCESS VASCULAR ACCESS BLOOD FLOW
Authors: IKEDA KIYOSHI
Published: June 2020

Background and Aims

During dialysis, if blood flow rate increases above 1500ml/min. there is an increase in pulsation and a high possibility of heart failure.

In the long run, it can cause valvular disease and arrhythmia. In EDTA 2015, we presented a method of blood flow suppression for dialysis patients who had heart failure caused by excessive blood flow. However, within one year, 30% of the cases had relapsed. To solve this problem, we were able to prevent the recurrence of excess blood flow through improvement measures with a new device. Report including theoretical mechanisms.

During vascular access excessive shunt blood flow creates a heavy load on cardiac function. Performing blood flow control surgery on dialysis patients with heart failure symptoms improves said function. Depending on the surgical method, it may recur. For this reason, we devised a surgical method that theoretically considers recurrence suppression.

Method

Clinical symptoms before surgery were based on trial hemodialysis patients with significant arrhythmia and shortness of breath at the time of exertion (6 males 4 females) using EPTFE of 4mm in diameter and 4cm in length or more replaced veins extended from anastomosis. (As shown in Poiseuille's law, it is necessary to replace veins with a shunt of smaller diameter but longer length than the vein being replaced.) The point of insertion at the anastomosis portion of the artery is 4mm. In order to connect to the larger section of the vein to the other end, it is cut diagonally to make the connection secure. During the operation, blood flow was monitored using ultrasound. The central side of the tibia artery was also tied off in some cases to control blood flow.

Results

Blood flow was reduced to 787 ml/min immediately after surgery from 1970ml/min before surgery, 1007ml after 6 months, and 721 ml/min after one year. Symptoms of arrhythmia disappeared in two patients during surgery and in all cases shortness of breath during exertion disappeared the day after surgery. Cardiac index improved three months after surgery in three cases. In none of the cases did we observe the complete rekindling of blood flow after one year. The average blood flow was less than 63% of the rate before surgery.

Conclusion

Replacement of 4cm or more length sections of veins with a 4mm diameter graft was useful in improving cardiac function in dialysis patients with heart failure.