bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1093BENEFITS OF HOME HEMODIALYSIS
Authors: Todorov Sakic Verica , Djuric Zivka , Djuric Petar , Bulatovic Ana , Popovic Jovan , Naumovic Radomir , Dimkovic Nada 
Published: June 2020

Abstract

Background and Aims
Home hemodialysis (HOHD) has been available as a modality of renal replacement therapy since the 1960s, in our center since 1972. Despite better patients’ outcome provided by HOHD comparing to hospital hemodialysis (HHD), its adoption has been limited worldwide. The aim of this study was to compare anemia, nutrition, mineral metabolism and morbidity in patients on HOHD and HHD.

Method
we analyzed dialysis and uremia related complications and morbidity in 19 HOHD patients in comparison with patients on HHD (N= 57). Each HOHD patient was previously matched with three patients on HHD by sex, age and reason for end stage renal disease (ESRD). Patients on HHD were on dialysis 3x4 h per week while patients on HOHD had dialysis on consecutive days in duration of 5-6 hours. Also, patients on HOHD were more frequent on hemodiafiltration (HDF), 89.5% of them, as compared to HHD patients (only 21.4%).

Results
All patients on HOHD were using AVF as vascular access for HD, and most of the analyzed HHD patients (only 5.3% used AVG). As revealed by hemoglobin level (Hgb) patients on HOHD had significantly better anemia control than HHD patients (12±2.3 vs. 10.2±1g/dl, p=0.004), despite the lower ferritin level (94±117 vs. 256±175ng/ml, p=0,001) and less frequent use of erythropoietin-stimulating agents (ESA), (and only 31% on HOHD vs 80% patients on HHD, p=0,001). By analyzing patients that used ESA therapy, we revealed that HOHD patients had lower weekly dose of ESA (5333±3265 IU vs. 6068±4145 IU). The values of intact parathyroid hormone (iPTH), did not differ significantly between HOHD (311±419pg/ml ; min 5,25, max 1529) and HHD (233±212pg/ml; min 19,25, max 926), but higher percentage of patients in HOHD group underwent parathyroidectomy (63% vs. 3.5%). The average values of calcium, and phosphorus did not significantly differ between HOHD and HHD patients (2.4±0.3 vs. 2.3±0.2mmol/l; 1.5±0.5 vs. 1.6±0.5mmol/l, respectively). HOHD patients had significantly higher albumin level (43±4.5 vs. 40.6±4g/l, p=0,035). There was no difference in annual hospital admission rate (0.4±0.5 vs. 0.6±0.7, p=0.35) between groups, but HHD patients had longer in-hospital stay. (4.8±5.3 days for HOHD vs. 7.3±9.3 days for HHD; p=0.16). Vascular access complications were most frequent reason for hospitalization in both groups (37%), followed by cardiovascular complications 13.6%, in HOHD group and infectious complications in HHD group 24%.

Conclusion
Our study has shown that HOHD provides some advantages over HHD including better quality of life and better anemia and nutrition control, better control of parathyroid function and shorter in-hospital stay. More frequent and longer dialysis sessions may be possible reason including HDF.
P1102EVALUATION THE EFFICACY OF MEDIUM CUT- OFF MEMBRANE DIALYZERS AND COMPARISON WITH HIGH FLUX DIALYZERS IN CONVENTIONAL HEMODIALYSIS
Authors: Rambabova Bushljetikj Irena , Trajcheska Lada , Pushevski Vladimir , Biljali Sefedin , Balkanov Trajan 
Published: June 2020

Abstract

Background and Aims
Hemodialysis (HD) is the most widely used modality of renal replacement therapy. The high-flux dialyzers in standard hemodialysis offer numerous benefits for ESRD patients, such as, increasing the uremic toxins removal and improving patients survival, reduced patients admission and morbidity. A new class of membranes, medium cut-off (MCO) membranes, has been designed to achieve better removal capacities for middle and large middle molecules, as well as to ensure the retention of albumin in hemodialysis (HD) treatments. We evaluated the removal efficacy of Theranova® in standard HD in comparison with standard high- flux HD.

Method
Four stable HD patients (M/F 1/4) were included in 12-weeks small observational pilot study in HD with Theranova® 400 (sup. 1.7 m2) and Theranova® 500 (sup. 2.0 m2) dialyzers. Each patient was assessed four times, T0 with standard high flux dialyzers, T1 at 1 month, T2 at second month and T3 at third month, by measuring pre and post-HD samples of: urea, creatinine, beta2-microglobilin (B2M), myoglobin, albumin and FLC-k, FLC-λ . Data are reported as mean ± standard deviation (SD). The removal rates of uremic toxins are expressed as percentages.

Results
The average removal rates for the uremic toxins with standard high-flux membranes were 18.4% for B2M, 14.3% for Myoglobin, 19.8 % for FLC-k and 17.4 % for FLC-λ. The data showed a higher average removal rate for all the uremic toxins with Theranova® dialyzers for B2M, Myoglobin, FLC-k and FLC-λ (62.7%, 56.9%, 63.5%, 54.6%, respectively) during the 3 months of follow up. The using of Theranova® dialyzers in standard HD was enough to significantly decrease the pre-dialysis value of Urea (17.72 ± 2.26 vs 13.75 ± 3.75, p=0.001), Creatinine (700.50 ± 315.07 vs 570.00 ± 206.64, p=0.021), B2M (40.90 ± 11.00 vs 29.00 ± 4.64, p=0.005), FLC-k (267.25 ± 113.28 vs 225.25 ± 100.62, p=0.018), FLC-λ (324.25 ± 116.12 vs 215.23 ± 64.44, p=0.011), Myoglobin ( 199.96 ± 124.41 vs 137.00 ± 83.14, p= 0.049). Finally, albumin retention was observed with Theranova® dialyzers, between T0 and T3 it increased significantly (40.50 ± 4.79 vs 42.25 ± 4.50, p=0.0001).

Conclusion
Compared to high-flux dialysis membranes, novel medium cut-off (MCO) membranes show greater permeability for larger middle molecules in mid -term report. But the long term analysis and larger number of patients is necessary to evaluate a clinical significance of this innovative therapy.
P1108FLUID DYNAMIC ASSESSMENT OF THERANOVA DIALYZER THROUGH CT IMAGING TECHNIQUE
Authors: Lorenzin Anna , Golino Gianlorenzo , Godi Llaria , De Cal Massimo , Ronco Claudio 
Published: June 2020

Abstract

Background and Aims
Inadequate removal of molecules between 5and50KDa, due to their restriction in diffusibility, may cause long-term complication in chronic hemodialysis patients. Medium Cut-off(MCO) is a new class of membranes with enhanced sieving properties and negligible albumin loss, thanks to its high molecular weight(MW) retention onset and MW cut-off value lower than albumin MW. MCO membrane used in HD allows to perform expanded hemodialysis (HDx), a technique based on high internal filtration(IF). Our previous study quantified the IF of Theranova dialyzer leveraging a nuclear imaging technique. In order to characterize the local distribution of the IF, an in vitro study assessing the fluid dynamics inside Theranova dialyzer was conducted through CT imaging technique.

Method
Dialyzers Theranova 400 and 500(Baxter, Deerfield, USA) were placed in vertical position in the CT gantry. Blood and dialysate were circulated in countercurrent at 300ml/min and 500 ml/min, respectively. The two compartments were analyzed separately, injecting the dye solution, for both filters. Longitudinal sections, 0.5cm thick, were recorded for 60seconds.

Results
In blood compartment, dye solution immediately after its entrance in the dialyzer demonstrates homogeneous progression, while different velocity profiles were observed among the fibers proceeding to the outlet port (Fig b). In dialysate compartment, dye solution is distributed in the periphery first (Fig d), then seeps in the fibers bundle and reaches the complete compartment filling.

Conclusion
The homogeneous dye profile immediately after its entrance in blood compartment demonstrated a good design of the inlet port; the optimal dye distribution reached in both blood and dialysate compartments ensure that IF phenomenon is equally achieved in both central and peripheral regions of the dialyzer.
P1111MULTI ORGAN SUPPORT WITH EXTRACORPOREAL CARBON DIOXIDE REMOVAL (ECCO2R) AND CONTINUOUS RENAL REPLACEMENT THERAPY (CRRT) WITH CITRATE ANTICOAGULATION IN THE CLINICAL SETTING OF DIFFICULT WEANING FROM MECHANICAL VENTILATION
Authors: Ricci Davide , Sagliocchi Alessandra , Siniscalchi Antonio , Ranieri Marco , Mancini Elena 
Published: June 2020

Abstract

Background and Aims
Prolonged mechanical ventilation is associated with the risk of difficult weaning due to the onset of muscle weakness. A disproportion occurs between the respiratory workload and the muscular force, which leads to failure of the ventilatory pump and hypercapnia. Some early experiences suggest that ECCO2R facilitates weaning from the ventilator in patients with a high risk of failure.

Method
Clinical case: a 49 year-old man with a) recent orthotopic liver transplantation (cryptogenic cirrhosis), b) acute renal injury (AKI) on continuous veno-venous hemofiltration (CVVH) and c) acute respiratory distress syndrome (ARDS) requiring prolonged mechanical ventilation. After unsuccessful attempts at weaning from the ventilator, a lung membrane was inserted in series, before the hemofilter, on the CRRT circuit in order to remove CO2 and so reduce the workload of the respiratory muscles (Fig. 1). The patient was then extubated. We used citrate anticoagulation due to the presence of contraindications to systemic heparin (high bleeding risk, thrombocytopenia).

Results
ECCO2R + CRRT treatment requires a relatively high blood flow (300-350 ml / min) in order to extract a significant amount of CO2, but, the more the blood flow increases, the more citrate must be infused, and the more the metabolic load increases. The patient developed mild alkalosis as an initial sign of citrate accumulation (Table 1), but it was self-limiting. During ECCO2R we actually obtained the desired decrease in respiratory muscle effort (decrease in respiratory rate from 24 to 18 per minute and a maximum negative value of esophageal pressure from -8 to -4 cmH2O) and the treatment was interrupted after 36 hours. Mechanical ventilation was restored due to a complication independent of ECCO2R (massive pneumothorax). The patient tolerated the treatment for 36 hours.

Conclusion
ECCO2R proved an efficient and relatively simple technology helping respiratory function recovery. Due to the very frequent association of AKI and ARDS, leading to a high mortality rate, nephrological care in intensive care units should include this new treatment. Moreover, reduction of the inflammatory pathway secondary to mechanical ventilation could also benefit the evolution of AKI.
P1119ASSOCIATION OF VARIOUS RISK FACTORS WITH HEMODIALYZER SET CLOT INCIDENCES WHEN USING LOW DOSE UF- HEPARIN OF 400 IU BOLUS AND 400 IU INFUSION IN MAINTENANCE DIALYSIS SESSION : A CASE CONTROL STUDY
Authors: Umair Farrukh , Aftab Azib , Awan Safia , Amin Imrana 
Published: June 2020

Abstract

Background and Aims
Efforts were made in the past to reduce the use of heparin as anticoagulation to escape from the its Sid effects like Bleeding and HIT among others. We use Low dose UF -heparin use with bolus of 400 IU and 400 IU/hour infusion as an anticoagulation in hemodialysis patients. Set clot incidences were comparable to other studies. The objectives of this study is to see aassociations of different risk factors with hemodialyzer set clot incidences using Low dose heparin Infusion protocol in maintenance haemodialysis session.

Method
Data were obtained from the outpatient haemodialysis unit at tertiary care Hospital in Karachi, Pakistan. UF-low dose heparin 400 I.U bolus and 400 I.U maintenance infusion protocol were given to all patient. Case to control ratio was approximately 1:4. 300 cases of set clot were taken and 1200 control sessions without set clot outcome were matched for heparin use taken from the dialysis unit. The crude odds ratios (OR’s) and adjusted ORs (aORs) for various risk factors were obtained using conditional logistic regression.

Results
In a prelimary part of the study the incidence of set clot was 7% (309/4000 sessions) Age, dialysis vintage, hemoglobin level, Blood flow rate and type of anti-platelet therapy were significantly associated to the incidence of set clot. Among patients having age &gt; 40 yrs. the odds of set clot were 2.8 (95% CI= 1.8-4.3) as compare to the patients with age ≤ 40 yrs. The odds of set clot were 0.268(95% CI=0.081-.88) among patients with hemodialysis vintage less than 1 year as compare to those who have more than 1 year. Blood flow rate &lt;350 ml/min have an odds of 1.03(95%CI=0.76-1.40) of set clot incident as compare to BFR&gt;350 ml/min. Those patients with Hemoglobin &lt; 9 gm/dl have odds of set clot of 0.67(95%CI =0.48-0.92) as compare to hemoglobin &gt; 9 gm/dl. Off all patients ,60.36% patients were either on aspirin or clopidogrel while around 9.58% were on combine antiplatelets therapy. The odds of set clot were 4.6 (95% CI =1.9-10.8) among patients on Combine antiplatelet therapy as compare to no antiplatelet therapy.

Conclusion
Age, low Blood flow rate and combine antiplatelet therapy (aspirin and clopidogrel) are positively associated with set clot accidents in dialysis sessions. Dual anti platelet therapy patients are given in ischemic heart disease patients hence Blood flow pumps are kept at lower speed which can increase the risk of set clot. Lesser duration on Hemodialysis (i.e. less than 1 year) and low hemoglobin levels are protective for incidence of set clot in our study population.
P1125IS THE SURPRISE QUESTION USEFUL AS A PREDICTOR OF MORTALITY IN HEMODIALYSIS PATIENTS?
Authors: Estifan Kasabji Jorge , Lucas Cristina , Sastre Arancha , De León Benjamin , Barnes Carmen , Monfa Elena , Barcia Veronica 
Published: June 2020

Abstract

Background and Aims
among the predictors of hemodialysis mortality, the “surprise” question (SQ) (Would you be surprised if this patient died within the next 6 or 12 months?) is a subjective variable, based on the patient's medical history, experience and knowledge. Recognized as a useful tool to identify a patient with a high risk of early mortality in Hemodialysis.

Objective
to assess a prognostic model of early mortality, based on clinical - biochemical parameters and the prediction of the clinician attending the patient.

Method
SQ is performed on 4 nurses and 4 nephrologists of the hospital hemodialysis unit, the Karnofsky Performance Scale Index of the patients is collected (KPSI 0: normal activity, KPSI 1: Unable to work, frequent medical attention, KPSI 2 : Unable to self-care, requires special care), and prospectively analyzed mortality at 6 and 12 months.

Results
The prevalent population studied in Hemodialysis is 180 patients, average age 69 years ± 14.1 (R 27-94), According to sex (Male 69%-Female 31%), the follow-up of the study was 1 year, we had 11 deaths 6 months and 17 deaths at 12 months, total 28 patients (15.7%).
The distribution of patients according to nurses and nephrologists staff (table 1) and patients characteristics (Table 2)
Conclusion: T he surprise question is a specific and sensitive instrument to predict sort-term survival in dialysis population especially in those with older age, more comorbid illnesses, lower functional status and hypoalbuminemia. of the analyzed factors; Karnofsky Index, age, surprise question and albumin have significant predictive value for mortality at 6 and 12 months.
We observed that the surprise question for nephrologists Staff is closer to prediction than nursing, and with a high negative predictive value for the “group of NO surprise”
P1126PLASMAPHERESIS TREATMENT FOR SEVERE PEMPHIGUS: 10 YEARS' EXPERIENCE OF A SINGLE CENTER IN CHINA
Authors: Liu Yan , Ma Jie , Wang Haiyun , Fan Xiaohong , Zheng Ke , Chen Limeng , Li Xuemei , Li Xuewang , Qin Yan 
Published: June 2020

Abstract

Background and Aims
Pemphigus is a potentially life-threatening autoimmune bullous disorder. The pathogenesis involves with IgG antibodies against desmogleins (Dsg) (Dsg 1 and Dsg 3) on epithelial cell surface. Systemic corticosteroid is considered as the basis of the treatment for pemphigus. As an interventional treatment, plasmapheresis was introduced for treating severe or refractory pemphigus. The literature in this field is limited. This study aimed to review our 10 years’ experience in a single center.

Method
We retrospectively analyzed 17 patients with severe pemphigus who were unresponsive to high-dose prednisone and received double-filtration plasmapheresis (DFPP) treatment between January 2010 and January 2020. The information on demographic characteristics, clinical and laboratory data, treatment regimens, and clinical outcomes were collected.

Results
1. Clinical characteristics: Among 17 patients, 11 patients had pemphigus vulgaris (PV), 3 patients had pemphigus foliaceus (PF), 2 patients had paraneoplastic pemphigus (PNP) and 1 patient had pemphigus herpetiform (PH). The mean age of patients was 47.8±10.0 years; 8 male patients and 9 female patients. All seventeen patients were suffering from severe pemphigus and had a period of at least one week of high-dose prednisone (1∼1.5mg/kg/d), but they were unresponsive to corticosteroid and immunosuppressants treatment. 2. As an adjuvant therapy, they received DFPP treatment with 1 to 4 sessions for each patient. Most of the patients (7 patients) received 2 sessions every other day, 5 patients received 3 sessions, 4 patients just received 1 session and only one patient received 4 sessions. For each session, the exchange volume was 1∼1.5 plasma equivalent. After DFPP treatment, the titers of Dsg antibodies significantly decreased (p&lt;0.001, Figure 1), Nikolsky’s sign became negative and no new blisters appeared. The erosions showed reepithelialization and started healing gradually. The dosage of corticosteroid could begin to taper down rapidly in 1 to 2 weeks. On discharge, the dosage of prednisone was 0.8-1mg/kg/d. 3. As to adverse events, 4 patients had transient hypotension during the procedure, but they could recover spontaneously after parameter adjustment. No major adverse events happened.

Conclusion
Plasmapheresis is an effective and relatively safe treatment for severe pemphigus. Plasmapheresis can also contribute to the dosage reduction of steroid to avoid more drug-related side effect.
P1133XYLITOL-BASED PERITONEAL DIALYSIS SOLUTIONS MITIGATED IN VITRO MESOTHELIAL AND ENDOTHELIAL TO MESENCHYMAL TRANSITION
Authors: Masola Valentina , Arduini Arduino , Bonomini Mario , Gambaro Giovanni , Zaza Gianluigi 
Published: June 2020

Abstract

Background and Aims
Fibrosis, angiogenesis and microvascular alteration are main pathogenetic mechanisms involved in the progressive loss of the peritoneal ultrafiltration capacity in patients undergoing peritoneal dialysis (PD). Main cause of this condition is the continuous peritoneal exposure to hyperosmotic and hyperglycaemic agents. High glucose level activates the Mesothelial to Mesenchymal Transition (MMT) and the Endothelial-to-Mesenchymal (EndMT) program, which are responsible for the development of fibrosis/chronic peritoneal damage. Moreover, the high glucose content of PD solution may induce the VEGF production with consequent neo-angiogenesis. Therefore, the introduction of more biocompatible solutions in clinical practice is necessary for preserving the long-term peritoneal membrane. To this purpose we tested the in vitro effects of a new commercially available PD solutions containing xylitol, carnitine and reduced glucose, at comparable osmotic strength (XyloCore).

Method
Human vein microvascular endothelial cells (HMVEC) were cultured in EGM™-2MV medium (Lonza) and Human peritoneal mesothelial cell line (HMrSV5) were cultured in Dulbecco's Modified Eagle Medium (DMEM; Gibco) containing 10% fetal bovine serum. Cells were cultured to confluence and then treated for 3 hours with serum free medium, XyloCore 0.7 (0.5% Glucose, 0.7% Xylitol and 0.02% L-carnitine), XyloCore 1.5 (0.5% Glucose, 1.5% Xylitol and 0.02% L-carnitine) and commercially available glucose-based solutions (Fixioneal) 1.36% and 2.27% Glucose. Gene expression of MMT/EndMT, apoptosis, inflammation, extracellular remodeling and angiogenesis markers was evaluated by real-time PCR. Cell viability was assayed by MTS assay.

Results
Our in vitro results demonstrated that XyloCore solutions, by influencing only partially the mesothelial and endothelial cells viability, demonstrated a good biocompatible profile. Then, gene expression analysis of HMVEC and HMrSV5 treated with XyloCore solutions revealed a significant down-regulation of transcripts encoding for MMT and EndMT biomarkers (Zinc finger protein SNAI1, TGF-beta, alpha-SMA and vimentin), and pivotal biological elements involved in apoptosis (Bcl-2), extracellular matrix remodeling (matrix metallopeptidases), inflammation (IL-1beta, IL-6) and angiogenesis (Vascular endothelial growth factor) compared to glucose-based solutions with comparable osmotic strength.

Conclusion
These in vitro results demonstrated, for the first time, that XyloCore solutions have a better biocompatible impact and less pro-fibrotic potentials compared to conventional glucose-based solutions. These effects, if confirmed in in vivo studies, could have interesting clinical potentials.
P1134HIGH PREVALENCE OF SLEEP-DISODERED BREATHING AND ITS ASSOCIATION WITH RENAL FUNCTION AMONG CHRONIC KIDNEY DISEASE PATIENTS (CKD1-5,HD AND PD) : A CROSS-SECTIONAL STUDY
Authors: Ota Kanji , Nakayama Yosuke , Yunosuke Yokota , Kodama Goh , Itou Sakuya , Fukami Kei 
Published: June 2020

Abstract

Background and Aims
Sleep-disordered breathing (SDB) is known as a novel risk factor for cardiovascular disease, and one of five adults suffer from SDB in general population. In non-dialysis chronic kidney disease (CKD) and hemodialysis (HD) patients, a high prevalence of SDB has been reported due to the excess accumulation of extracellular fluid. However, precise prevalence and associated factors of SDB in patients with peritoneal dialysis (PD) has not been known. This cross-sectional study aimed to investigate the prevalence and determinant factors associated with SDB in patients with CKD.

Method
This was a single-center retrospective cohort study recruited 334 patients with CKD stages 1-3a, 3b-5, HD, and PD enrolled from 2018 to 2020. All patients were hospitalized and received our CKD educational program, and did not have sleep complaints. The diagnosis and assessment of the severity of SDB were evaluated using PULSOX-Me300 and SAS2100 systems. The 3% oxygen desaturation index and SpO2 were measured during sleep. SDB was defined as 3% oxygen desaturation index (ODI)&gt;15.0 and SpO2&lt;92% in this study.

Results
Proportion of the patients with CKD1-3a, CKD3b-5, HD, and PD were 28%, 53%, 11%, and 8%, respectively. Thirty-one% of the patients were diagnosed with SBD in all CKD patients. In a generalized linear model, 3% ODI&gt;15.0 and SpO2&lt;92% were significantly correlated with apnea hypopnea index (p&lt;0.05, r=0.87 and p&lt;0.05, r=-0.45, respectively). Further, it became clear that the proportion of 3%ODI&gt;15 and SpO2&lt;92% was significantly higher in PD patients (50%) than in other CKD patients. Furthermore, 3% ODI was significantly correlated with BMI and HDL cholesterol levels in PD patients (p&lt;0.05, r=0.67 and p&lt;0.05, r=-0.54, respectively).

Conclusion
We reported for the first time that the prevalence of SDB was very high and that the severity of SDB was significantly associated with BMI in patients with PD. These findings suggest that the extracellular fluid overload and excess glucose exposure due to PD fluid might accelerate SDB in patients with PD. Further clinical studies are needed to determine whether PD-associated SDB might influence the development of cardiovascular disease in CKD patients.