bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1241CALCIFICATIONS IN DIFFERENT VASCULAR BEDS ACROSS THE SPECTRUM OF CHRONIC KIDNEY DISEASE INCLUDING CALCIFIC UREMIC ARTERIOLOPATHY: ARE SKIN PUNCH BIOPSIES USEFUL?
Authors: Roendbjerg Anne Kristine , Rix Marianne , Gyldenløve Mette , Krustrup Dorrit , Vejborg Ilse , Lönn Lars , Pasch Andreas , Skov Lone , Hansen Ditte 
Published: June 2020

Abstract

Background and Aims
Accelerated vascular calcification in different vascular beds is common in patients with chronic kidney disease (CKD). A severe form of vascular calcifications is calcific uremic arteriolopathy (CUA) presenting with painful ischemic skin lesions and high mortality. The prognostic value of skin biopsies in relation to CUA is unclear and the prevalence of skin vascular calcifications in different stages of CKD is sparsely described.
The aim of the study was to describe the occurence of small vesssel vascular calcifications in unaffected skin biopsies in relation to calcifications in other vascular beds across the spectrum of CKD including CUA.

Method
A cross-sectional cohort (total, n=39) comprising dialysis patients with current or previous CUA (CKD5D+CUA, n=9), dialysis patients without CUA (CKD5D-CUA, n=12), patients with CKD stage 3-4 (CKD3-4, n=12), and healthy kidney controls (control, n=6). The presence of vascular calcifications in the dermis and subcutis were assessed in 4 mm punch biopsies of unaffected skin from the lateral thigh. The presence of vascular calcification was evaluated by H&E, von Kossa and Alizarin staining. The presence of breast arterial calcifications (BAC) was evaluated by mammography, the abdominal aortic calcification score (AAC) by lateral lumbar X-ray and calcification propensity was measured by T50 reflecting the calcification propensity in blood.

Results
None of the included patients showed vascular calcifications in skin biopsies.
Declining kidney function was associated with presence of BAC, increased AAC and reduced T50 (Table).
No significant difference was found between CKD5D+CUA and CKD5D-CUA regarding BAC (p=1.000), AAC (p=0.815) or T50 (p=0.165). CKD5D+CUA compared to all other groups had no difference in BAC (p=0.109) and AAC (p=0.141) but reduced T50 (p=0.004). Dialysis patients (CKD5D±CUA) had significant more BAC (p=0.003), higher AAC (p&lt;0.001) and lower T50 (p&lt;0.001).

Conclusion
No vascular calcifications were found in punch biopsies from unaffected skin in patients with different stages of CKD including CUA. Despite imaging verified vessel calcification by BAC and AAC and increased calcification propensity by T50. This suggest that conventional punch biopsies cannot be used to identify skin vascular calcification and thereby patients at risk for developing CUA.
P1250LOW SERUM URIC ACID LEVEL AND LEFT VENTRICULAR HYPERTROPHY : THE NEW PARADOXICAL ASSOCIATION IN HEMODIALYSIS PATIENTS
Authors: SELIM GJULSEN , Kabova Angela , Bexheti Blerim , Janevski Zoran , Spasovska Vasilova Adrijana , Milenkova Mimoza , Canevska Aleksandra , Vrevezoska Bojana , Muharremi Shkelqim 
Published: June 2020

Abstract

Background and Aims
The association between serum uric acid (UA) and left ventricular hypertrophy (LVH) is controversial in chronic kidney disease, whereas in hemodialysis (HD) patients has not been studied until now. Thus, we evaluated the relationship of baseline and time-averaged UA with echocardiographic LVH over a 5-year period in HD patients.

Method
This longitudinal study was conducted on 225 prevalent HD patients over a 5-year period. Patients were stratified into 3 groups according to their baseline and time-averaged UA levels: lower group (UA&lt;400µmmol/l), intermediate/reference group (UA between 400-450µmol/l) and higher group (UA&gt;450µmol/l). Echocardiography was performed on a non-dialysis day and the presence of LVH was defined based on the left ventricular mass index (LVMI) &gt;131 and &gt;100 g/m2, for men and women, respectively. The patients were followed during a 60 month period.

Results
During the 5-year follow-up, 81 patients died (36%), and the main causes of death were cardiovascular (CV) related (70%). Survival analysis show that patients with time-averaged UA&lt;400 µmmol/l had a significantly higher all cause (log rank, p=0.003) and CV mortality (log rank, p=0.004) rate, compared to those with time-averaged UA between 400-450 µmmol/l and time-averaged UA&gt;450µmol/l, but this difference was not statistically significant in terms of baseline UA level. A negative correlation was observed between LVH and time-averaged UA (r=-0.26, p=0.001), but not with LVH and baseline UA. Patients in lower time-averaged UA group had significantly higher LVMI compared to patients in intermediate and higher group (153.10± 59.89, 131.62±40.99, 131.19±44.49 g/m2, p=0.029), but from the lowest to the highest baseline UA levels, LVH was not significantly different (146.99±59.20, 141.38±37.52, 126.85±42.48 g/m2, p=0.07). Unadjusted odd ratio of LVH risk in the lower time-averaged UA compared to the reference time-averaged UA group was 3.11 (95% CI=1.38-7.05; p=0.006); and after adjustment for age, gender, diabetes and CV disease, ORs for LVH persisted significant only in the lower time-averaged UA group (OR = 2.82, 95% CI = 1.16–6.88, P = 0.002). On the contrary, baseline UA did not affect unadjusted and adjusted LVH.

Conclusion
In HD patients the prolonged exposure to hypouricemia is associated with LVH. This paradoxical association can only be explained by the hypothesis that uremic milieu in HD patients changes the influence of uric acid. However, these results should be the subject of further research.
P1252ASSOCIATIONS OF SERUM SCLEROSTIN AND DKK-1 PROTEIN WITH FUTURE CARDIOVASCULAR EVENTS AND MORTALITY IN HEMODIALYSIS PATIENTS; A PROSPECTIVE COHORT STUDY
Authors: STAVRINOU EIRINI , Sarafidis Panteleimon , Loutradis Charalampos , Memmos Evangelos , Faitatzidou Danai , Giamalis Panagiotis , Koumaras Charalampos , Karagiannis Asterios , Papagianni Aikaterini 
Published: June 2020

Abstract

Background and Aims
Sclerostin and Dickkopf-1 (Dkk-1) protein are inhibitors of the canonical Wnt/β-catenin bone pathway. Sclerostin but not Dkk-1 is associated with increased arterial stiffness. This study examined the prognostic significance of serum sclerostin and Dickkopf-related protein-1 (Dkk-1) levels for cardiovascular outcomes and mortality in hemodialysis patients.

Method
Serum sclerostin and Dkk-1 levels were measured with ELISA in 80 hemodialysis patients that were followed-up for a median of 45 months. Several factors that could interfere in the association of sclerostin and Dkk-1 with outcomes (including carotid-femoral pulse-wave-velocity (PWV), parathyroid hormone, calcium-phospate product and others) were assessed at baseline The primary end-point was a combination of all-cause death, non-fatal myocardial infarction, non-fatal stroke, coronary revascularization, hospitalization for decompensated heart failure and new-onset atrial fibrillation. Secondary end-points included cardiovascular and all-cause mortality.

Results
Cumulative freedom from the primary endpoint was significantly lower for higher tertiles of sclerostin (77.8%, 69.2%, and 40.7% for tertiles 1 to 3 respectively; log-rank-p=0.004). The corresponding risk for the primary outcome was gradually increasing for higher tertiles of sclerostin (Tertile 3: HR: 3.847, 95%CI: 1.502-9.851). No significant association was evident between sclerostin and all-cause mortality, whereas higher sclerostin levels presented a trend towards higher risk for cardiovascular mortality. Dkk-1 levels exhibited no association with the risk of the primary or the secondary endpoints. In stepwise Cox regression modeled analysis, sclerostin levels were associated with the primary outcome, independently of PTH, calcium-phosphate product, serum albumin, CRP and PWV levels (HR: 2.921, 95%CI: 1.401–6.090; p=0.004).

Conclusion
High serum sclerostin levels are associated with lower cumulative freedom and higher risk for a composite cardiovascular endpoint but not for all-cause mortality. Dkk-1 protein exhibited no association with the future risk of cardiovascular events.
P1258CLINICAL COMPARATIVE STUDY OF AORTIC ARCH CALCIFICATION IN PATIENTS WITH MAINTENANCE PERITONEAL DIALYSIS AND HEMODIALYSIS
Authors: Li Junhui , Wang Niansong 
Published: June 2020

Abstract

Background and Aims
Vascular calcification is known to be an important risk factor in patients with dialysis, However, the comparative study on vascular calcification between peritoneal dialysis (PD) and hemodialysis (HD) is less. The aim of this study was to analyze the presence, risk factors of aortic arch calcification (AAC), and compare the prognosis in maintenance PD and HD patients.

Method
Using retrospective analysis method, 177 patients with PD and 147 patients with HD were included in the study. The extent of AAC was evaluated by chest X-ray examination. The demographic characteristics and clinical data were collected and compared between PD group and HD group. Binary logistic regression analysis was performed to evaluate risk factors associated with the aortic arch calcification.

Results
The incidence of AAC in HD group (59.86%) was significantly higher than that in PD group (37.29%). Multivariate analysis showed that age, residual renal function (RRF) and serum phosphate were the independent risk factors for calcification of PD patients and the odds ratio (OR) values were 1.133, 1.039, 0.762 and 18.186, respectively. Similarly, age, RRF, calcium-phosphorus product and LDL were the risk factors of HD patients and their respective OR values were 1.125, 0.509, 2.755 and 3.221. Compared with patients without AAC, the presence of moderate-severe AAC was associated with greater risk of mortality, and the OR values were 17.833 and 20.056 in PD group and HD group, respectively.

Conclusion
Our findings suggest that the AAC was more common in HD patients. Older age and lower RRF are common independent risk factors for AAC in PD and HD patients. Moderate to severe AAC a ppears to be associated with increased risk of mortality.
P1272ECFECT OF MELATONIN ON DYSLIPIDEMIA IN HEMODIALYSIS PATIENTS
Authors: Zahed Nargesossadat , Pouyamehr Marjan , Taherkhani Adineh 
Published: June 2020

Abstract

Background and Aims
Cardiovascular disease is one of the major causes of death in hemodialysis patients.
Lipid metabolism abnormalities and increased inflammatory factors are related factors.
In recent studies melatonin inhibits dyslipidemia and reduces inflammatory factors by inhibiting LDL-c oxidation.
The purpose of this study was to evaluate the effect of melatonin supplement on hyperlipidemia and c reactive protein (CRP ) level in hemodialysis patients.

Method
In this clinical trial ,the inclusion criteria were as follows:age older than 18 years, undergoing dialysis for at least 3 months,triglyceride &gt;150mg/dL,HDL-c&lt;40 mg/dL in males, HDL-c&lt;50 mg/dL in females and serum CRP&gt;5 mg/l
Exclusion criteria were:
Patients with a history of stroke, myocardial infarction, peripheral vascular disease, malignancy, heart failure, liver cirrhosis, active liver disease, history of infection, hospitalization one month ago, hepatitis B and C.HIV, and taking corticosteroid, statin, Non-steroidal anti-inflammatory drugs.
Among 200 hemodialysis patients,only 28 patients fulfilled the inclusion criteria..
Patients were treated with Melatonin supplements 3 mg per day at bedtime during 12 weeks. Serum lipid profile and CRP level were measured after 12 weeks.
Five patients were excluded, 2 patients underwent kidney transplantation, and three patients did not cooperate.
Data were analyzed by SPSS 20 software. Normal distributed quantitative data were expressed as the mean ± SD and qualitative data was expressed as frequency and percentage.
Wilcoxon matched pairs test was used to compare the two groups according to the type of study that had no normal distribution and the number of participants (less than 30) and study type (pre-test and post-test). P &lt;0.05 was considered as the level of significance.

Results
A total of 23 patients completed the treatment protocol.Baseline demographic characteristics of patient are shown in Table 1.Parcipitant was composed of 13 male and 10female .The participants’ mean age was 30.6± 11.6.Etiology of ESRD was diabetes in 13(56/5%)and hypertension in5(21.7%)patients and other causes was 5(21/7%).
After treatment mean total cholesterol levels decreased from 139.95 ± 35.49 mg/dL to 131.13 ± 34.96 mg/dL (p value =0.194 ) which was not statistically significant. But the decrease in serum triglyceride level was statistically significant ,from 242.08 ± 101.05 mg/dL decreased to 178.00 ± 48.02 mg/dL (pvalue = 0.004).HDL-c increased significantly after treatment from 36.20 ±7.08 mg/dL to 40.16 ±4.35mg/dL (pvalue =0.032).
Serum CRP levels did not decreased.The limitations of our study were the small sample size and short duration of the investigation.

Conclusion
Melatonin supplement improves triglyceride and HDL-c in hemodialysis patients but has no effect on total cholesterol-c and CRP in hemodialysis patients.
P1274THE CHARACTER OF CARDIAC REMODELING AND VALVE CALCIFICATION IN TYPE 2 DIABETIC PATIENTS WITH END-STAGE RENAL DISEASE
Authors: Susla Oleksandr , Shved Mykola , Litovkina Zoriana , Danyliv Svitlana , Gozhenko Anatoliy 
Published: June 2020

Abstract

Background and Aims
Systematic analysis of cardiac remodeling features in type 2 diabetic patients with end-stage renal disease (ESRD) is important both in stratification of cardiovascular risk and in choice of adequate treatment strategies. The lack of number and fragmentation of studies, the ambiguity of their data regarding the problem of myocardial reconstruction and cardiac valve calcification (CVC) under these conditions have substantiated the need for this study, its relevance and purpose.

Method
136 ESRD patients on chronic hemodialysis (HD) were included in this observational cross-sectional study (men, 78; age, 53.9±1.0 years; HD duration, 47.6±4.2 months). The study was performed in accordance with the provisions of the Declaration of Helsinki last revision. Depending on the presence/absence of diabetic nephropathy (DN) all patients were divided into two groups: the 1st one – without DN (n=88); the 2nd one – with DN (n=48). A complete ultrasound examination of the cardiac structure and function including CVC analysis was performed. Data are presented as means±SEM. Mann-Whitney U-test was used for comparison of the quantitative variables, χ2-test – qualitative ones.

Results
Left ventricular (LV) hypertrophy (93.8 vs. 78.4%, р=0.020) and eccentric hypertrophy (47.9 vs. 28.4%, р=0.023) were diagnosed more often in patients with DN than those without diabetes. Prevalence of pseudonormal and restrictive types of LV diastolic dysfunction (62.5 vs. 28.4%, p&lt;0.001), systolic dysfunction (27.1 vs. 9.1%, p=0.006) and pulmonary hypertension (PH) (64.6 vs. 35.2%, p=0.001) were significant in the 2nd group. CVC (66.6 vs. 38.6%, р=0.002), combined calcification of mitral (MV) and aortal (AV) valves (35.4 vs. 13.6%, p=0.003), stenoses of MV (16.7 vs. 3.4%, p=0.007) and AV (39.6 vs. 15.9%, p=0.004), and insufficiency of MV (66.7 vs. 44.3%, p=0.013) and AV (35.4 vs. 14.8%, p=0.006) were recorded more often in HD patients with DN. LV myocardial mass index (181.0±7.2 vs. 155.0±5.3 g/m2, p=0.001) as well as right ventricle (RV) diameter (2.80±0.09 vs. 2.47±0.04 cm, p=0.003) were also greater in the 2nd group.

Conclusion
In type 2 diabetic patients with ESRD occurs maladaptive cardiac remodeling with predominance of unfavourable (especially eccentric) types of LV hypertrophy, RV dilatation, PH, severe LV diastolic and systolic dysfunction, and widespread combined calcification of MV and AV with the valve defects. The identification of risk factors for the progression of the pathological reconstruction of myocardium and CVC in HD patients with DN will be the subject of our further research.
P1279INSULIN RESISTANCE IN HEMODIALYSIS PATIENS
Authors: Filinyuk Pavel , Rumyantsev Aleksander 
Published: June 2020

Abstract

Background and Aims
insulin resistance (IR) is a decrease in the biological response of sensitive tissues to insulin. IR is known as an adverse risk factor in cardiovascular disease, which largely determines the prognosis of patients receiving hemodialysis (HD). But this issue is not well understood. For the screening of IR, special indices have been developed that characterize the sensitivity of tissues to insulin. The aim of the study was to compare the methods of screening for IR in patients receiving HD in relation to the markers of systemic inflammation and atherogenic dyslipidemia (AtD).

Method
124 patients receiving HD for 75.4 ± 44.5 months were examined including 66 men and 58 women aged 57.6 ± 13.6 years. For IR screening, the Homeostatic Model Assessment-1 and 2 indices (HOMA-1 and HOMA-2), the Quantitative Insulin Sensitivity Check Index (QUICKI) and triglycerides / glucose (Tri/G) were used. Patients were examined in accordance with the recommendations of KDIGO. Data analysis was carried out using “STATISTICA 10.0”.

Results
fasting insulin levels were elevated in 19% of patients. But, the calculated indices were consistent with the idea that IR is much more common. So, the IR index in the HOMA -1 model was increased in 47%, in the HOMA -2 model - in 33%, in the QUICKI model - in 36%, the TriH indicator - in 91%. The sensitivity of peripheral tissues in the HOMA-1 and HOMA-2 models was equally reduced by 35-40%.
The results of the correlation analysis between indicators of IR and plasma concentration of C-reactive protein and lipid profile are presented in table 1.
Informativeness of IR indicators depending on the presence of obesity is presented in table 2
We were also interested in whether insulin resistance affects the development of clinical manifestations of atherosclerosis, cardiac arrhythmias, and heart failure. An analysis of this relationship did not reveal. Only the IR index in the HOMA-1 model with a value of more than 2.7 units was associated with a 4.5-fold increase in the risk of developing clinical manifestations of atherosclerotic lesions (χ2 = 4.582 p = 0.032). Statistically significant it was only in men. Given our data, perhaps IR is one of the reasons for the higher morbidity and mortality of men at HD.

Conclusion
a comparison of IR models allows us to distinguish HOMA-2 as the most accurate index. The highest correlation with systemic inflammation and AtD was in the HOMA-1 and HOMA-2 indices.
P1286THE RELATIONSHIP BETWEEN PROTEIN-BOUND UREMIC TOXINS AND TARGET CARDIOVASCULAR PROTEINS IN HEMODIALYSIS PATIENTS
Authors: Kuo Mei-Chuan , Wu Ping-Hsun , Lin Yi-Ting , Chiu Yi wen , Hwang Shang-Jyh , Huang Jiun-Chi , Chen Szu-Chia , Lee Su-Chu , Liang Shih-Shin 
Published: June 2020

Abstract

Background and Aims
Uremic toxins are crucial non-traditional risk factors for cardiovascular disease in patients with chronic kidney disease (CKD). Indoxyl sulfate (IS) and p-cresyl sulfate (PCS) were associated with all-cause and cardiovascular mortality in CKD patients, but possible mechanisms have not been fully elucidated. Herein, we explored the association between protein-bound uremic toxins and 181 cardiovascular-specific proteins in patients receiving hemodialysis (HD).

Method
In the discovery phase, we investigated associations between circulating free form IS and PCS and cardiovascular-specific protein levels quantified by a proximity extension assay of 333 stable HD patients with correction for multiple testing. In the second phase, the independent association was assessed using multivariable-adjusted models. The associations of IS or PCS with cardiovascular-specific proteins levels on a continuous scale were also evaluated.

Results
Free form IS was negatively associated with six proteins (C-C motif chemokine 15, complement component C1q receptor, perlecan, bleomycin hydrolase, cluster of differentiation 166 antigen, and signaling lymphocytic activation molecule family member 5) and positively associated with one protein (fibroblast growth factor 23). Free form PCS was negatively associated with three proteins (C-C motif chemokine 15, complement component C1q receptor, and interleukin-1 receptor-like 2). Adjusting the multivariable models for classical cardiovascular risk factors at baseline yielded similar results.

Conclusion
Protein-bound uremic toxins (IS and PCS) were associated with several cardiovascular-specific proteins involved in cell adhesion, endothelial barrier function, inflammation, complement system, and phosphate homeostasis. Multiplex proteomics appears to be a promising way to explore novel aspects of uremic toxin pathophysiology.
P1287A COMPARATIVE STUDY OF BLOOD PRESSURE VARIABILITY INDICES BETWEEN PATIENTS UNDERGOING PERITONEAL DIALYSIS AND THOSE UNDER HEMODIALYSIS OR WITH CHRONIC KIDNEY DISEASE
Authors: Alexandrou Maria Eleni , Loutradis Charalampos , Sarris Dimitrios , Kouris Nikolaos , Schoina Maria , Tzanis Georgios , Dimitriadis Chrysostomos , Sachpekidis Vasileios , Papadopoulou Dorothea , Gkaliagkousi Eugenia , Papagianni Aikaterini , Parati Gianfranco , Sarafidis Panteleimon 
Published: June 2020

Abstract

Background and Aims
Blood pressure variability (BPV) indices have been independently associated with cardiovascular events and mortality in hemodialysis (HD) patients. Data on short-term BPV in patients on peritoneal dialysis (PD) are totally absent. This study examined short-term BPV parameters of patients undergoing PD in comparison to HD and pre-dialysis chronic kidney disease (CKD) patients.

Method
38 PD patients were matched for age, gender and dialysis vintage with 76 HD in 1:2 ratio patients and for age and gender with 38 patients with CKD stage 2-4 in 1:1 ration. BPV parameters [standard deviation (SD), weighted SD (wSD), coefficient-of-variation (CV) and average-real-variability (ARV)] were calculated from data from 48hour (PD, HD) and 24hour (CKD) ambulatory BP monitoring according to validated formulas.

Results
There were no significant differences in BPV indexes studied between PD and HD patients but all BPV indexes in these patients were numerically higher than those in CKD patients. Systolic ARV was significantly higher in PD or HD compared with predialysis CKD during the first and the second interdialytic 24hour periods, both daytime period and nighttime 2 (1st 24hour period: PD:11.86±3.19; HD:11.23±3.45; CKD:9.81±2.49, p=0.016, 2nd 24hour period: PD: 12.18±4.11; HD: 12.96±4.57; CKD: 9.81±2.49, p&lt;0.001). Analysis of diastolic ARV and systolic and diastolic wSD showed similar results. Τhere were no differences with regards to dipping pattern and systolic and diastolic CV during all periods studied.

Conclusion
BPV indices are similar between PD and HD patients and higher compared to CKD counterparts. Despite what was theoretically expected, PD patients demonstrate high fluctuations in BP in the absence of abrupt shifts in volume.