bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1487EFFECT OF PREDIALYSIS FLUID OVERLOAD ON SLEEP QUALITY IN HEMODIALYSIS PATIENTS
Authors: Ismail Haitham , Abdallah Hussein , Emara Ahmed , Ahmed Mohamed Arafa 
Published: June 2020

Abstract

Background and Aims
Sleep disorders are common among end stage renal disease (ESRD)patients undergoing hemodialysis (HD). The etiology of sleep disorders in these patients is known to be multifactorial. However, the role of hydration status in sleep disorders in HD patients is not well studied. Therefore, our aim was to study the effect of predialysis fluid overload on sleep quality in HD patients.

Methods
This cross-sectional study included 100 prevalent HD patients from HD unit of El Sahel teaching hospital. fluid status and fluid compartments [total body water (TBW)], extracellular water (ECW)] and overhydration index (OH) were analyzed by a portable whole-body bio-impedance spectroscopy (Body Composition Monitor ‘BCM’) before mid-week dialysis session. Overhydration was defined as OH/ECW ≥15%. HD patients were then classified into 2 groups: Group 1 (non- overhydrated) and Group 2 (Overhydrated) according to OH/ECW. Sleep quality were assessed in all patients by Pittsburgh Sleep Quality Index (PSQI) questionnaire. Patients with Concurrent diagnosis of either obstructive sleep Apnea or psychiatric disorder and patients on any medications which affect the sleep pattern were excluded.

Results
our study included 100 HD patients (49 male, 51 female - mean age 49.3 ±11). 42 patients (42%) had overhydration (i.e. Group 2). Poor sleep quality (defined as PSQI score ≥5) was reported in 57% (n=57) of HD patients included in our study. Poor sleep quality was significantly higher in the HD patients with overhydrated (Group 2). Total PSQI scores were significantly higher in overhydrated patients (Group2) compared to non-overhydrated patients (Group1) (7.92±3.32 vs 4.83±2.27, P= &lt;0.001). The component scores 1, 2, 3, 4, 6 and 7 of the PSQI showed significant differences between the overhydration and non-overhydration groups with higher values (i.e poor sleep quality) in overhydrated patients (Group2). Moreover, there was significant positive correlation between total PSQI score and overhydration index (OH/ECW %) in all HD patients included in the study (r=0.283, P= 0.004).

Conclusion
We may conclude from our study that sleep disorders are prevalent in HD patients. Predialysis fluid overload in HD patients may be associated significantly with poor sleep quality.
P1493CORRELATION BETWEEN END-DIALYSIS OVER-WEIGHT IN INITIAL STAGE OF HEMODIALYSIS AND PROGNOSIS IN INCIDENT HEMODIALYSIS PATIENTS
Authors: Zhang Ping , Wang Ying , Yao Xi , Chen Shaohua , Xu Chunping , Lu Hulin , Chen Jianghua 
Published: June 2020

Abstract

Background and Aims
The volume factor of maintenance hemodialysis patients is closely related to the prognosis. We hypothesized that the excess weight after dialysis (end-dialysis over-weight, edOW) is an important factor of volume impact survival in hemodialysis (HD) patients. The purpose of this study was to analyze the relationship between edOW and long-term prognosis of patients with maintenance hemodialysis.

Method
This retrospective study observed incident hemodialysis patients who treated in Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University from January 1, 2008 to April 30, 2017, three times a week for at least one year. The end point of follow-up was death, abdominal dialysis, kidney transplantation, transfer or until April 30, 2018. The general data of the patients included age, gender, BMI, primary renal disease, CVD, first hemodialysis access, albumin(Alb), Haemoglobin(Hb), blood pressure, heart rate, ultrafiltration rate(UFR), interdialytic weight gain IDWG, end -dialysis overweight (edOW). Cox multivariate regression was used to analyze the relationship between edow and all-cause mortality and cardiovascular mortality.

Results
Totally 469 patients male, 64% were enrolled, with an average age of 56.9 ± 17.1 years. During the follow-up period, 102 patients died. The main cause of death was cardiovascular and cerebrovascular events, accounting for 44.7%. The mean value of edow was 0.28 ± 0.02 kg. Kaplan-Meier(Log-rank test) survival analysis showed that the long-term survival rate of the group with edow ≤ 0.28kg was better than that of the group with edow &gt; 0.28kg (P = 0.042), and the cardiovascular mortality of the group with edow &gt; 0.28kg was significantly higher than that of the group with edow ≤ 0.28kg (P = 0.001). Cox multivariate regression analysis showed that edow was an independent risk factor for all-cause death in hemodialysis patients (P = 0.025, AhR = 1.541, 95% CI 1.057-2.249), and also an independent risk factor for CVD death in hemodialysis patients (P = 0.007, AhR = 1.929, 95% CI 1.198-3.107).

Conclusion
EdOW is an independent risk factor of long-term all-cause and cardiovascular death in hemodialysis patients.
P1495LOW DIASTOLIC BLOOD PRESURE WITH LOW MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION WOULD DETERIORATE CARDIOVASCULAR MORTALITY IN THE PATIENTS WITH MAINTENANCE HEMODIALYSIS
Authors: OMAE KIYOTSUGU , Horimoto Ai , Higuchi Chieko , Hosoda Yumi , Tamura Tomomi , Nishizawa Yoko , Ogawa Tetsuya 
Published: June 2020

Abstract

Background and Aims
In dialysis patients, many literatures have shown the association between predialytic hypotension and poor prognosis. Particularly, decrease in diastolic blood pressure (DBP) will be involved myocardial injury because of reduced coronary blood-flow. Such myocardial damage would also be caused by decreased oxygen-supply capacity. Mean corpuscuar hemoglobin-concentration (MCHC) is a hemoglobin concentration per 1% hematocrit (Ht) and could be considered as an indicator of peripheral oxygen-supply. In several literatures, low MCHC had been associated with increased all-cause mortality in non-dialysis patients with congestive heart-failure. In dialysis patients with low Ht between 32 to 35%, low DBP and low MCHC could additively act on myocardial damage. In this study, we examined the relation between the stratified groups by DBP and MCHC and cardiovascular mortality using Yoshikawa clinic dialysis-database (YCD).

Method
A total of 407 dialysis patients registered in YCD enrolled in this study from April 2006 and on. The cut-off values (COVs) of predialytic DBP and MCHC on cardiovascular death (CVD) were determined from the Receiver Operating Characteristic (ROC) curve. According to these COVs, the whole cohort was divided into 4 groups, group HH (high DBP and high MCHC), group HL (high DBP and low MCHC), group LH (low DBP and high MCHC), and group LL (low DBP and low MCHC). Their survival analysis was estimated by the Kaplan–Meier method, and a log-rank test was used to examine the differences between the survival curves. The prognostic factors for CVD were extracted from background factors, including predialytic DBP, MCHC and above-mentioned grouping, using Cox-regression model.

Results
In 407 patients, mean predialytic DBP and time-averaged MCHC were 73.3 mmHg and 31.5 % respectively. During observation period of 5.1 years 163 patients died, among that 94 were CVD. The COVs of DBP and MCHC were 79 mmHg and 31.16 %, respectively. According to these COVs, 407 patients were divided into 64 of group HH, 65 of group HL, 171 of group LH and 107 patients of group LL. On the survival curve, the group LL had the highest mortality rate, followed by the group HL. The group HH showed the lowest mortality rate. In multivariate analysis, category variables LL and HL were extracted as prognostic factors for CVD. Their Hazard ratio were 1.960 and 3.863, respectively. Age, intradialytic hypotension, DBP, Kt/V, serum sodium, CRP and blood glucose were extracted as the other prognostic factors.

Conclusion
These results suggest that low MCHC level would deteriorate prognosis on dialysis patients with predialytic low-DBP. MCHC level could become a new treatment-target in the low DBP group in the future.
P1496TRENDS IN THE INCIDENCE AND PREVALENCE OF END-STAGE RENAL DISEASE PATIENTS WITH HEMODIALYSIS IN ENTIRE KOREAN POPULATION: A NATIONWIDE POPULATION-BASED STUDY
Authors: Choi Hong Sang , Kim Chang Seong , Bae Eun hui , Ma Seong Kwon , Kim Soo Wan 
Published: June 2020

Abstract

Background and Aims
Data on the epidemiology and temporal trends of end-stage renal disease (ESRD) with hemodialysis are not well established in the entire Korean population. We aimed to estimate the incidence and prevalence of ESRD with hemodialysis in Korea between 2002 and 2017.

Method
Using the National Health Insurance Service database, we analyzed entire Korean population from 2002 to 2017. Hemodialysis patients was identified by using rare incurable disease codes (V001) or prescription of medical fee code of hemodialysis (O7020, O7021). We only included patients who have been maintained hemodialysis more than 90 days from the date of dialysis initiation to exclude short-term dialysis due to acute kidney injury or patients who converted to peritoneal dialysis or kidney transplantation.

Results
During the 16-year follow-up, the number of hemodialysis patients in Korea has steadily increased from 11,251 in 2002 to 67,486 in 2017. The mean age of hemodialysis patients has gradually increased from 55.57±13.31 years in 2002 to 62.13±13.23 years in 2017. Overall, the number of men tended to be somewhat higher than that of women, and the proportion of men increased slightly from 55.56% in 2002 to 58.45% in 2017. The proportion of diabetic patients increased rapidly from 23.84% to 47.84%, and the percentage of hyperlipidemic patients rose from 18.9% to 86.7%, while the percentage of hypertensive patients did not show a significant increase. The number of incident hemodialysis patients increased significantly from 4,406 in 2003 to 12,134 in 2014 and then decreased to 8,090 in 2017. In the incident patients, the increase in the proportion of male patients and the increase in diabetes and hyperlipidemia were observed in similar manner with prevalent patients.

Conclusion
The incidence and prevalence of hemodialysis in Korea gradually increased from 2002 to 2017. The proportion of men, diabetes and hyperlipidemia among patients with hemodialysis also increased continuously. These findings may contribute as groundwork for epidemiological studies of hemodialysis in Korea.
P1498ASSOCIATIONS OF HEALTH LITERACY WITH DEPRESSION AND ANXIETY IN DIALYSED PATIENTS IN SLOVAKIA
Authors: Skoumalová Ivana , Rosenberger Jaroslav , Madarasova Geckova Andrea 
Published: June 2020

Abstract

Background and Aims
Depression and anxiety is common in dialysed patients (Ng et al., 2015; de Brito et al., 2019) and associated with decreased quality of life, worse health outcomes and increased mortality (Schouten et al., 2019, Lopes at al., 2002). Health literacy (HL) as the ability to gain access, understand, and use information to promote and maintain good health (WHO, 1998) may be hampered by emotional problems such as depression and anxiety. The aim of our study is to examine the association of HL with depression and anxiety in dialysed patients in Slovakia.

Method
Cross-sectional study on 542 dialysed patients (mean age = 63.6, males = 60.7%) was conducted in 20 dialysis clinics in Slovakia from January to November 2018. Socio-demographic data, data on 9 domains of HL and data on depression and anxiety were collected by questionnaires. Hierarchical cluster analysis was used to create three clusters of patients (low, moderate, high HL). Depression and anxiety was dichotomized as 0-no/low symptoms and 1-moderate/severe symptoms. Association of HL clusters with depression and anxiety was analysed using logistic regression adjusted for age and gender.

Results
We found that patients in low HL cluster and moderate HL cluster were more likely to have moderate/severe symptoms of depression and anxiety than patients in high HL cluster. Odds ratio (OR) for depression for low HL cluster: 7.60; 95% Confidence Interval (CI): 2.88 – 20.06; p&lt;0.000 and for moderate HL cluster: OR: 4.85; 95% CI: 1.87 – 12.56; p&lt;0.001. OR for anxiety for low HL cluster: 3.14; 95% CI:1.55 – 6.35; p&lt;0.001 and for moderate HL cluster: OR 2.16;95% CI: 1.10 – 4.24; p&lt;0.05.

Conclusion
Patients with lower levels of HL suffer from anxiety and depression more than patients with higher levels of HL. These findings point to the need of regular screening of emotional problems such as depression and anxiety and their treatment as they may hamper capacities of dialysed patients for self-management as well as effective treatment of the disease from the perspective of healthcare providers.
P1499FGF21 CORRELATES POSITIVELY WITH ARTERIOVENOUS FISTULA OCCLUSION IN HEMODIALYSIS PATIENTS
Authors: Wei Qing , Wang Bin , Zhang Xiao liang , Liu Bicheng 
Published: June 2020

Abstract

Background and Aims
Arteriovenous fistula occlusion lead to insufficient dialysis, increases the probability of hemodialysis complications, even life-threatening. Fibroblast growth factor 21 (FGF21) is increased progressively with a decline of renal function and higher plasma FGF-21 level can be used as a meaningful index to evaluate microinflammation, lipid metabolism and predict dialysis-related complications such as cardiovascular diseases in end stage renal disease patients. This study aimed to investigate the relationship and role of FGF21 in arteriovenous fistula occlusion in our hemodialysis patients cohort.

Method
We screened 802 HD patients in Nanjing Zhongda Hospital (n=450) and The First People’s Hospital of Changzhou (n=352) according to a strict inclusion criteria and exclusion criteria. We recorded demographic information, blood data before dialysis and serum FGF21 levels and counted the frequency of arteriovenous fistula occlusion in our hemodialysis cohort. We used bivariate correlation analyses to assess the correlation of the frequency of arteriovenous fistula occlusion with serum FGF21 and other clinical parameters. Stepwise multivariate linear regression analyses were employed to evaluate variables independently associated with the frequency of arteriovenous fistula occlusion. P &lt; 0.05 was considered to be statistically significant. SPSS Software, version 22.0 was used for all statistical analyses.

Results
In this cross-sectional study, of 802 hemodialysis patients screened, 76 were eligible. The median dialysis vintage was 6.4 years (range 0.5 to 23). Serum FGF21 levels were significantly positive associated with the frequency of arteriovenous fistula occlusion (r = 0.321, P = 0.005). In addition, the frequency of arteriovenous fistula occlusion was correlated with the level of hemoglobin (r = -0.277, P = 0.015), the level of albumin (r = -0.269, P = 0.019) and left ventricular mass (r = 0.272, P = 0.018). The result showed that serum FGF21 (β = 0.259, P= 0.022) and left ventricular mass (β = 0.223, P =0.048) were factors independently associated with the frequency of arteriovenous fistula occlusion in hemodialysis patients.

Conclusion
We reported for the first time that serum FGF21 and Left ventricular mass were independently associated with arteriovenous fistula occlusion. These findings provide a novel insight about FGF21 on arteriovenous fistula occlusion in hemodialysis patients and may indicate a new therapeutic target for arteriovenous fistula occlusion.
Figure 1. Correlation of serum FGF21 and LVMI with the frequency of arteriovenous fistula occlusion in HD patients.
P1503A MULTICENTER STUDY OF THE CLINICAL, LABORATORY CHARACTERISTICS AND POTENTIAL PROGNOSTIC FACTORS IN PATIENTS WITH AA AMYLOIDOSIS ON HEMODIALYSIS
Authors: Bilgic Ece , Ergün İhsan , Ecder Tevfik , Nergizoğlu Gökhan , Keven Kenan 
Published: June 2020

Abstract

Background and Aims
While, AL amyloidosis is more common in western countries, the most common type of amyloidosis is AA amyloidosis in eastern Mediterranean region including Turkey. Although worse prognosis has been attributed to the AL amyloidosis, AA amyloidosis can also be related to higher mortality under renal replacement therapies. However, there are no sufficient data regarding etiology, clinical presentation and prognostic factors of AA amyloidosis. The objective of our study is to evaluate the clinical, laboratory characteristics and possible predictive factors related to mortality in patients with AA amyloidosis undergoing hemodialysis (HD).

Method
This multicenter, cross-sectional study was a retrospective analysis of 2100 patients on HD and carried out in 14 selected hemodialysis centers throughout Turkey. Thirty-two patients with biopsy proven AA amyloidosis and thirty-two control patients without AA amyloidosis undergoing HD were included between October 2018 and October 2019. There was no significant difference between the groups in terms of the age and dialysis vintage. Causes of AA amyloidosis, treatment (colchicine and/or anti-interleukin 1 (IL) treatment; canakinumab or anakinra) and number of Familial Mediterranean Fever (FMF) attacks in the last year in case of FMF, systolic and diastolic blood pressures, biochemical values such as mean CRP, hemoglobin, serum albumin, phosphorus, calcium, PTH, ferritin, transferrin saturation, total cholesterol levels and EPO dose, erythropoietin resistance index (ERI), interdialytic fluid intake, body mass indexes, heparin dosage, UF volume and Kt/V data in the last year were collected by retrospective review of medical records.

Results
Prevalence of AA amyloidosis was found 1.87% in HD centers. In amyloidosis and control groups, 56% and 53% were male, mean age was 54±11 and 53±11 years, mean dialysis vintage was 104±94 and 107±95 months, respectively. FMF was the most common cause of AA amyloidosis (59.5%). All FMF patients received colchicine and the mean colchicine dose was 0,70 ±0,30 mg/day. 26,3 % of FMF patients were unresponsive to colchicine and anti-IL-1 treatment was used in these patients. In AA amyloid and control groups, ERI were 7,88±3,78 and 5,41±3,06 IU/kg/week/g/dl, respectively, (p=0.008). Additionally, higher CRP values (18,78±18,74 and 10,61±10,47 mg/L, p=0.037), lower phosphorus (4,68±0,73 mg/dL vs 5,25±1,04, p=0.014), total cholesterol (135±42 vs 174±39 mg/dL, p&lt;0.01) and serum albumin (3,67±0,49 mg/dL, 4,03±0,22, p&lt;0.01) were observed in patients with AA amyloidosis compared to the control group.

Conclusion
In this study, we found that long term prognostic factors including higher inflammation, malnutritional parameters and higher ERI were more frequent in AA amyloidosis patients under hemodialysis treatment.

Figure
Demographic, clinical and laboratory characteristics of patients
P1504RELATIONSHIP OF LOW BODY MASS INDEX AND SURVIVAL IN HEMODIALYSIS PATIENTS
Authors: Kim Ha Yeon , Lee Jeong Ho 
Published: June 2020

Abstract

Background and Aims
Malnutrition is common in patients with hemodialysis and major risk factor of mortality. The Korean Society of Nephrology (KSN) collected data of end-stage renal disease registry since 1985. We evaluated whether body mass index (BMI) can affect mortality in patient with hemodialysis.

Method
From 2004 to 2015, a total of 32,163 patients starting hemodialysis were included. The patients were divide four groups according quartiles of BMI measurement.

Results
At baseline, mean age was 59.0 ± 14.3 years old, and 60.0% were men. The 5-year mortality of hemodialysis patients was 16.9 % (N=5,435) and ratio of unknown state was 24.9 % (N=7,996). The mean of BMI in each quartiles were 18.2 ± 1.2, 20.8 ± 0.5 22.8 ± 0.6, 26.4 ± 2.6 kg/m2 respectively. The mean of BMI between survivor and non-survivor were different (22.3 ± 3.3 vs. 21.5 ± 3.2 kg/m2). Cox-proportional regression multivariate analysis revealed that the 5-year all-cause mortality was associated with age (HR 1.04, CI 1.03-1.05), diabetes (HR 1.34, CI 1.07-1.7) coronary heart disease or heart failure (HR 1.3, CI 0.9-1.7), 2nd BMI quartile (HR 0.7, CI 0.5-0.9), 3rd BMI quartile (HR 0.6, CI 0.46-0.88), 4th BMI quartile (HR 0.59, CI 0.43-0.82), hypoalbuminemia (HR 2.9, CI 2.3-3.7) and anemia (HR 1.6, CI 1.2-2.0) .

Conclusion
Higher quartiles of BMI was significantly associated with better survival rate in hemodialysis patients in Korea. Traditional risk factors of malnutrition, such as hypoalbuminemia, anemia were also independent risk factor for mortality. This result suggests that hemodialysis patients needed to nutritional support.
P1510INCIDENCE AND OUTCOME HEMODIALYSIS PATIENCE WITH HEPARIN INDUCED THROMBOCYTOPENIA - FOUR YEAR EXPERIENCE ZVEZDARA UNIVERSITY MEDICAL CENTER
Authors: Bulatovic Ana , Maslarevic Radovic Vesna , Markovic Katarina , Djuric Petar , Tosic Dragovic Jelena , Jankovic Aleksandar , Paunovic Marina , Damjanovic Tatjana , Majster Zdenka , Stankovic Popovic Verica , Naumovic Radomir , Dimkovic Nada 
Published: June 2020

Abstract

Background and Aims
Heparin-induced thrombocytopenia (HIT) is a potentially fatal adverse reaction after administration of unfractionated or fractionated heparin, which underlies the generation of antibodies to the heparin complex and platelet factor 4 (PF4). It occurs in 5% of patients treated with unfractionated heparin and 0.5 - 1.5% fractionated heparin. The aim of the study is to determine the incidence and outcome of hemodialysis patients with HIT over 4 years period.

Method
Our retrospective study analyzed patients who were tested for evidence of positive anti-heparin antibody in the period from 2015 to 2019 in Zvezdara University Medical Center. The diagnosis was confirmed by the 4T clinical scoring system, a positive antiheparin-PF4 ELISA test and a positive platelet aggregation test with heparin.

Results
During observation period, total of 54 tests were performed on HIT suspected patients, out of which 21 patients were positive. Out of them, 14 patients were on HD, and other 7 (geriatric, surgery and cardiology departments) received therapy due to peripheral thrombosis, AIM or arrhythmia. All patients treated at nephrology, started hemodialysis (HD) with unfractionated heparin, while others were treated with LMWH. 4T scoring showed that 64% of patients had a moderate risk of developing HIT, while high risk was assessed in 36% of patients. Thrombotic complications in the form of deep venous thrombosis had 50% of patients, pulmonary thromboembolism had 11% of patients. The greatest decrease in Tr was most commonly observed between 10th and 14th day (61% of patients) and 39% from 4th to 10th day from start of heparin administration. In addition to heparin withdrawal and treatment with alternative nonheparin anticoagulation (fondaparinoux), 5 patients needed plasma treatment. 11 patients on HD were transferred to peritoneal dialysis (PD), and 2 patients recovered renal function. Overall mortality was 52%, while in nephrology patients was below 30%.

Conclusion
HIT should be considered in patients at risk. It is necessary to abolish heparin treatment and use alternative method (PD) or alternative anticoagulation. Hemodialysis patients have better prognosis than other comparable patients.