bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1545LOW SOCIOECONAMIC STATUS INCREASES MORTALITY RISK IN KOREAN MAINTENANCE HEMODIALYSIS PATIENTS: A LONGITUDINAL COHORT STUDY USING HEMODIALYSIS QUALITY ASSESSMENT DATA
Authors: Lee Young-Ki , Park Hayne Cho , Cho Ajin , Kim Do Hyoung , Kim Juhee , Yoon Jong-Woo , Kwon Young Eun , Ryu Dong-Ryeol 
Published: June 2020

Abstract

Background and Aims
The number of hemodialysis (HD) patients and their medical expenses are growing rapidly in Korea due to entry into aging society and accompanying diseases such as diabetes and hypertension. Whether low socioeconomic status (SES) affect poorer HD survival is controversial with most reports come from the USA. Therefore, this study was performed to evaluate the effect of SES upon mortality in Korean maintenance HD patients using periodic HD quality assessment data.

Method
The HD quality assessment has been performed periodically by Health Insurance review and Assessment Service (HIRA) since 2001. We used 4th and 5th HD quality assessment data from the year of 2013 and 2015 respectively for collecting demographic and clinical data. The 4th survey was a sample survey while the 5th survey was a complete enumeration survey. We also collected data on patient comorbidity using the diagnosis codes from the health insurance claims database. The mortality data was collected until Dec 2017. As a proxy indicator reflecting SES, we classified subjects as a Medical Aid (MA) recipients (“low” SES) or a National Health Insurance (NHI) beneficiary (“middle/high” SES). We analyzed mortality risk based on SES using Cox proportional hazard model.

Results
A total of 21,786 HD patients from 4th survey and 35,454 HD patients from 5th survey were included in the analysis. The ratio between NHI beneficiary and MA recipient was 76.7% versus 23.3%. Mean age of the subjects was 59.0 years old in 4th survey and 60.3 years old in 5th survey. The MA recipients were younger and showed higher proportion of male, shorter duration of HD, lower body mass index (BMI), higher systolic and diastolic blood pressures before HD compared to the NHI beneficiary. The NHI beneficiary demonstrated higher proportion of diabetes, hypertension, cerebrovascular accidents, and dementia compared to the MA recipients. Two groups did not differ in dialysis efficiency presented as single pool Kt/V. A total of 7,173 deaths occurred in 2013 participants, while 7,306 deaths occurred in 2015 participants. After adjusting for age, gender, Charlson’s comorbidity index, BMI, presence of atrial fibrillation, serum albumin, and serum creatinine, MA recipients showed significantly higher mortality risk compared to the NHI beneficiary (hazard ratio 1.162; 95% confidence interval 1.092-1.237, p&lt;0.001 in 4th survey and hazard ratio 1.078; 95% confidence interval 1.013-1.146, p=0.017 in 5th survey).

Conclusion
Low SES independently increased mortality risk in Korean maintenance hemodialysis patients.
P1548THE VALUE OF BEING A NETWORK: CLINICAL GOVERNANCE AND DIALYSIS CLINIC PERFORMANCE MANAGEMENT IS ASSOCIATED WITH IMPROVED PATIENTS SURVIVAL
Authors: Neri Luca , Ion Titapiccolo Jasmine , Bellocchio Francesco , Arkossy Otto , Garbelli Mario , Stuard Stefano 
Published: June 2020

Abstract
Introduction. In order to help facilitate the uptake of best clinical practices, improve outcomes, enhance efficiency and reduce costs, few healthcare organizations have introduced Continuous Quality Improvement (CQI) programs. Since September 2014, dialysis centers belonging to the EMEA Fresenius Medical Care (FME) network have introduced a CQI policy called Medical Peer Review (MPR) based on key performance indicators (KPI) related to patient’s clinical status. We exploit the quasi-experimental setting generated by the introduction of FMC CQI policy, to evaluate the association between improvement in intermediate outcomes (key performance indicators) and prolonged survival among dialysis patients registered in the EMEA FME network.
Methods. We conducted a historical cohort study. We included adult patients on chronic dialysis with less than 90 days between renal replacement therapy (RRT) initiation date and first treatment date in FME clinics. We compared KPI target achievement (P-BSC score) and 2-year mortality for patients enrolled prior to MPR-CQI policy onset (Cohort A) and a cohort of patients enrolled after MPR-CQI policy onset (Cohort B). Structural Equation model was adopted to estimate the association of MPR-CQI policy on patients’ survival through changes in intermediate outcomes (P-BSC score).
Results. The Cohort A and Cohort B consisted of 2397 and 1873 patients, respectively. We observed no difference across groups concerning the distribution of age (63.1 vs 62.8 years), gender (59% vs 60% males) and body mass index (27.6 vs 26.4 kg/m2); Cohort A showed lower Charlson’s comorbidity index (3.3±1.5 vs 3.8±1.9, p&lt;0.01) and higher dialysis vintage (32.9±27.0 vs 21.3±22.2 days, p-value&lt;0.01) compared to Cohort B. P-BSC scores over the 6-month ascertainment period was 5.25±1.47 in the pre CQI-MPR policy cohort, while it was significantly higher (6.67±1.63) in the post CQI-MPR policy cohort. Mediation analysis demonstrated a strong indirect effect of CQI-MPR implementation on mortality trough improvement of P-BSC rating score occurring in the post-implementation era (OR=0.70, p&lt;0.001)
Conclusion. We showed that, after discounting for potential unmodifiable confounding factors and potential unmeasured selection/chronological bias, improvement of intermediate outcomes and performance indicators occurred after MPR-CQI policy implementation, was associated to a strong improvement in survival.
Figure:
P1551FAMILY SUPPORT IS CRUCIAL FOR DIALYSIS PATIENTS TREATMENT ADHERENCE AND QUALITY OF LIFE
Authors: Trajcheska Lada , Rambabova Bushljetikj Irena , Selim Gjulsen , Sikole Aleksandar , Spasovski Goce , Spasovska Vasilova Adrijana , Milenkova Mimoza , Canevska Aleksandra , Nikolov Igor 
Published: June 2020

Abstract

Background and Aims
Non-compliant dialysis patients are at increased risk of mortality. Compliance depends on patient demographics, educational level and income. Family support and marital status might also influence the patients compliance, as well as the quality of life. Missed/shortened dialysis sessions, adherence to prescribed medications, excessive phosphate serum values and interdialytic weigh gain, smoking and adherence to medical investigations provide indicators of non-compliance. Aim: To assess the impact of family support on different compliance indicators in the dialysis patients.

Method
In this observational study 134 dialysis patients were scored for different indicators of compliance from 0-2 and summary scores of compliance were assessed. Clinical and laboratory data were obtained from the previous two years. Patients with mean IDWGs &gt;4.5% of body weight (BW) and/or phosphorous level above 1.6 mmol/L were scored with 1, patients with IDWG/BW more than 5.7% and/or 2.0 for mean phosphorous level were scored with 2. Summary scores of non-compliance were also assessed. Patients were scored for quality of life with SF-36 questionnaire. Patients non-adherence was analysed for predictors in multivariate analysis.

Results
Estimated rates of noncompliance varied: Medical investigations 63%, phosphorous 33, IDWG 22, therapy 14%, HD treatment 9%. When the complete dietary fluid, medications and treatment regimen were studied noncompliance rate was 73%, and when adherence to medical investigations was added the rate rose up to 87%. Patients with family support above median level (≥25) were significantly more often men (0.049), with diabetes (p=0.014), lower socioeconomic status (0.001) and married (0.003). The quality of life scores were significantly worse in the low family supported patients (56.73±26.15 vs 39.23±24.05, p=0.0001). They also scored worse in overall non-compliance scores 2.04±1.71 vs 2.97±2.06, p= 0.007). In the multivariate analysis the non-compliance was predicted most powerfully in patients with younger age, low social status and lower family support (β=-0.202, p=0.023, β=0.220, p=0.036, β=-0.175, p=0.019, respectively).

Conclusion
Family support is crucial for dialysis patients adherence to treatment and Quality of life. Efforts should be done to recognize the patients real needs and adequately help those confronting dialysis burden and improve their quality of life.
P1554AEFFECT OF HAEMODILUTION ON THYROID FUNCTION BEFORE AND AFTER HAEMODIALYSIS IN PATIENT WITH END-STAGE RENAL DISEASE
Authors: Sanai Toru , Okamura Ken , Ikeda Yuji , Miyazono Motoaki , Onoue Tomorow , Fukumitsu Toma , Shimamatsu Kazumasa , Kitazono Takanari 
Published: June 2020

Abstract

Background and Aims
To study the factors involved in the low thyroid hormones in end - stage renal disease (ESRD), we compared thyroid function before and after hemodialysis (HD).

Method
The serum free thyroxine (fT4), free triiodothyronine (fT3), and thyroid - simulating hormone (TSH), thyroxine binding globulin (TBG) and thyroglobulin (Tg) levels were measured before and after HD in 12 patients with chronic glomerulonephritis (CGN, age; 48.7 ± 11.8 [mean ± SD]) and 11 patients with diabetic nephropathy (DN, age; 57.6 ± 6.5), comparing with controls (n = 13, age; 40.9 ± 11.3).

Results
The serum fT4, fT3 and TBG levels were low before HD but increased almost in parallel with the increase in hematocrit and albumin levels after HD in both ESRD groups. The serum TSH level was high before HD but decreased after HD and Tg level remained almost unchanged. In DN, serum fT4 levels was almost the same, but fT3 levels was lower with slightly higher TSH level, compared with CGN.

Conclusion
Significantly lower fT4, fT3 and TBG levels in ESRD before HD seemed to be due to hemodilution and almost corrected after HD. The TSH level was promptly normalized with elevated fT4, and Tg levels remained unchanged probably due to the balance between corrected hemodilution and rapid response to decreased TSH stimulation. It may better to evaluate thyroid function after HD in ESRD. Accelerated senile changes were suggested in DN.
P1561PREVALENCE OF DEPRESSION IN PATIENTS ON MAINTENANCE HAEMODIALYSIS AND FEASIBILITY OF GROUP BASED COGNITIVE BEHAVIOURAL THERAPY - A SINGLE CENTRE EXPERIENCE
Authors: Ahmed Ishthiaque , Srinivas Ganesh , Gooutham Diwakar , V. M Annapandian 
Published: June 2020

Abstract

Background and Aims
The reported prevalence of depression in dialysis population ranges from 20-45%, which varies across regions. Limited data are available on association with co-morbidities, clinical symptoms and quality of life, especially from India. Present study was aimed to explore the prevalence of depression in patients on maintenance haemodialysis, quality of life and feasibility of group based cognitive behavioural therapy (CBT) in this set of patients.

Method
This is a single centre prospective study conducted at a tertiary care referral hospital, Bangalore, India, over the period of 22 months (Dec-2017 to Apr-2019). Patients aged &gt;18 years and on maintenance haemodialysis for &gt;6 months were included in the study. Any patients with known psychiatric illness or substance abuse were excluded. Beck depression inventory (BDI) score and quality of life by kidney disease quality of life short form-36 (KDQOL-SF) were used for diagnosis of depression. Group based CBT is offered to patients with mild to moderate depression.

Results
A total of 100 (85 males) patients were studied, the mean±SD age was 54.0±12.9 years (range, 23-76). Forty-six (46%) patients had depression (mean BDI score 35.04±10.8), out of whom, 8 (17.4%) had mild depression, 6 (13.1%) had moderate depression, 14 (30.4%) had severe depression and 18 (39.1%) people had extreme levels of depression. Females, unemployed and retired persons, low socioeconomic status and frequent dialysis related complications are more prone for depression.
Age, dialysis vintage, duration from diagnosis to dialysis, associated co-morbid conditions, frequency of emergency dialysis requirement, hospitalization rates did not significantly differ in both groups. Low serum phosphate levels and high Kt/V values had association with depression, while haemoglobin, serum albumin and serum calcium levels did not have association with depression. We were unable to complete the group based CBT due to medical and social reasons.

Conclusion
Depression is common in haemodialysis patients, patients with depression had poor medication compliance and lower quality of life. Group based CBT is not feasible due to high attrition rates.
P1572EFFECTIVENESS OF COENZYME Q10-MICELLE COMPARED WITH COENZYME Q10 ON TACROLIMUS-INDUCED RENAL INJURY
Authors: Cui Sheng , Luo Kang , Quan Yi , Lim Sun Woo , Yang Chul-Woo 
Published: June 2020

Abstract

Background and Aims
We and others have recently demonstrated that Coenzyme Q10 (CoQ10) has protective effects against diabetes mellitus and various types of renal injury. This study investigated whether CoQ10-micelle treatment would affords superior renoprotection compared with CoQ10 in the governing tacrolimus (Tacrolimus)-induced renal injury in the rats.

Method
Male adult Sprague-dawley Rats were treated daily with Tacrolimus (1.5mg/kg/day, subcutaneous), CoQ10 (20mg/kg/day, oral), and CoQ10-micelle (20 mg/kg/day, oral) for 4 weeks. The effects of CoQ10 orCoQ10-micelle on Tac-induced renal injury were assessed in terms of renal function, histopathology, oxidative stress and apoptotic cell death.

Results
After 4 weeks of Tacrolimus treatment to rats caused renal dysfunction, typical pathologic lesions, and oxidative stress marker. The serum creatinine was reduced by Tac co-treatment with CoQ10 or CoQ10-micelle groups compared with the Tac and VH group (0.31 ± 0.03 in the VH group vs. 0.43 ± 0.041 in the Tac group vs.0.37 ± 0.031 in the Tac+CoQ10 group 0.30 ± 0.02123 in the Tac+CoQ10-micellegroup; 1P&lt;0.05 vs. VH. 2P&lt;0.05 vs. TAC. . 3P&lt;0.05 vs. TAC+C.) The administration of CoQ10-micelle improved renal immunoreactivity, which was accompanied by reductions in oxidative stress and apoptosis. Assessment of the mitochondrial ultrastructure by electron microscopy revealed that tacrolimus co-treatment with CoQ10-micelle increased the size and number of mitochondria more than co-treatment with CoQ10, compared with that induced by TAC treatment alone.

Conclusion
These findings suggest that both CoQ10 and CoQ10-micelle effectively attenuates Tac-induced renal injury, and CoQ10-micelle provides more benefits than that of CoQ10.
P1588CAN L-CARNITINE SUPPLEMENTATION IMPROVE CARDIOPULMONARY FUNCTION? A RANDOMIZED CONTROLLED TRIAL IN HEMODIALYSIS PATIENTS
Authors: Yassari Fatemeh , Eslaminejad Alireza , Marashian Mehran , Dastan Farzaneh , Maleki Kazeri Farzaneh 
Published: June 2020

Abstract

Background and Aims
It is well known that L-Carnitine is a cardioprotective agent, which balances cardiac energy metabolism, by promoting mitochondrial β-oxidation and facilitating transport of long chain fatty acids into the mitochondrial matrix. It has been shown that L-Carnitine level in plasma and tissue is lower in hemodialysis patients and they may lose the benefits of this substance. As far as our knowledge, the effect of L-Carnitine on cardiopulmonary function has not been evaluated by ergospirometry up to now. The aim of this randomized clinical trial was to assess the effects of L-carnitine supplementation on cardiopulmonary Function in hemodialysis patients through ergospirometry.

Method
This randomized clinical trial was conducted on 46 chronic hemodialysis patients. The patients were divided into two groups. In both groups ergospirometry parameters (VE Max, VO2-Max, VCO2 Max, AT, VE/VCO2 Slope) were recorded for a 3-month period. During this period, one group received L-Carnitine at doses of 2 gr/day orally and the other group received only placebo. After three months, all of the mentioned parameters were rechecked and statistical analysis performed by SPSS software.

Results
Only CRP was different between the two groups increasing in placebo group significantly after 3 months (P = 0.018). No significant difference was detected in Cardiopulmonary factors. In terms of ergospirometry factors, PET-CO2 was the only parameter significantly increased in the treatment group (P = 0.026).

Conclusion
The present results indicate that L-Carnitine can improve cardiopulmonary function among hemodialysis patients.
P1590AMORPHOUS CPP AND CRYSTAL CPP OF HEMODIALYSIS PATIENTS
Authors: Nakamura Kimihiko , Nakayama Yuki , Hiroyoshi Toshiya , Isoyama Naohito , Fujikawa Kouki , Matsuyama Hideyasu , Kuro-o Makoto 
Published: June 2020

Abstract

Background and Aims
Serum calciprotein particles (CPP) are increased in CKD patients and correlated with vascular stiffness and calcification. CPPs are can be distinguished amorphous and crystal CPPs. Crystal CPPs are non-incubated CPPs and amorphous CPPs are the difference(Δ) incubated CPPs and non-incubated CPPs. In this study, we evaluated amorphous CPPs and crystal CPPs in hemodialysis (HD) patients.

Method
183 end stage renal disease patients undergoing HD (57.6% men, median age 71, dialysis period; 98.4 ± 87 months) were treated in single hospital. Serum CPP levels were measured by the gel filtration method. Incubated CPPs were incubated in 24°C, 24hous then were measured similarly. We assessed the association of serum calcium (Ca), phosphorus (P), intact-PTH, FGF21, LDL-cholesterol, CRP with CPP.

Results
In multivariate analysis, P remained significant independent factors for the non-incubated CPP levels. Ca, P remained significant independent factors for the incubated CPP levels. P remained significant independent factors for the Δ CPP levels.
The association of ΔCPP levels / the incubated CPP levels with clinical variables are examined. In multivariate analysis, hemoglobin remained significant independent factors.

Conclusion
Amorphous CPPs and crystal CPPs could each be a prognostic factors.
Figure: Association of ΔCPP levels / incubated CPP levels with clinical variables.
Univariate Multivariate
P1592HYPOCHLOREMIA AND INFLAMMATION: RELATIONSHIP BETWEEN SERUM CHLORIDE LEVELS AND NEUTROPHIL-TO-LYMPHOCYTE RATIO IN INCIDENT CHRONIC HEMODIALYSIS PATIENTS
Authors: Valga Francisco , Monzon Tania , Henriquez Fernando , Anton-Perez Gloria 
Published: June 2020

Abstract

Background and Aims
Recently the role of chloride in patients with heart failure has been reevaluated. Some studies have linked it to higher mortality in these patients, being more important, even, than sodium. On the other hand, some authors have found a higher mortality in patients with low chloride levels and sepsis. The underlying mechanisms in both cases are unknown. Some authors attribute it to concomitance with metabolic alkalosis, however, this is not a reason that fully explains these findings. Neutrophil-to-Lymphocyte Ratio (NLR) is an emerging marker of inflammation comparable to established ones such as C-reactive protein, ferritin, etc. It is also a good biomarker of mortality in certain populations such as cancer, cardiovascular and renal. Patients with chronic kidney disease on hemodialysis have high cardiovascular comorbidity and a high rate of inflammation. However, there are no studies that correlate chloride levels to inflammation markers, such as NLR, in this population. Therefore, the aim of our study was to determine if there is a relationship between chloride and NLR in our population of patients on chronic hemodialysis.

Method
Restrospective cohort study. We analyzed the values of chloride and NLR of 396 incident patients on hemodialysis over a period of 3 years (between 2016 and 2019). The patients were divided into three groups, depending on the levels of chloride (tertiles): (1: &lt;100, 2: 100.1-103, 3&gt; 103.1 mEq / l). In each group the average of NLR was calculated.

Results
The mean age in our sample was 64.73 ± 0.57 years, 39.7% were women (N = 157). The average of NLR was 3.84 ± 2.65 and chloride was 101.03 ± 3.91. We found that patients in the lower chloride level tertile were associated with a higher NLR levels (p &lt;0.012). (Figure 1)

Conclusion
Incident hemodialysis patients with lower chloride levels had higher NLR values. These findings suggest a greater tendency to inflammation in these patients.
P1593THE ASSOCIATION BETWEEN THE ANCLE-BRACHIAL INDEX AND MARKERS OF INFLAMATION IN CHRONIC HEMODIALYSIS PATIENTS
Authors: Pasko Nevi , Strakosha Ariana , Dedej Arieta , Kapidani Loredana , Nasto Fjona , Rista Elvana , Cadri Vilma , Mumajesi Suela , Thereska Nestor 
Published: June 2020

Abstract

Background and Aims
Among hemodialysis patients, peripheral arterial disease (PAD) represents an important health care burden and has been associated with high mortality. The ancle-brachial index (ABI), is a reliable and noninvasive method used to asses PAD. The aim of this study was to evaluate the prevalence of PAD in patients undergoing chronic hemodialysis and the association with inflammation and malnutrition using serum C-reactive protein (CRP) and serum albumin as biomarkers.

Method
The study was conducted at different hemodialysis centers in patients receiving hemodialysis three times a week. We excluded patients with atrial fibrillation or who had been recently hospitalized. The ABI has been used as a diagnostic tool for PAD and measured before a hemodialysis session. A value of ABI less than 0.9 was considered abnormal. To better estimate the impact of malnutrition and inflammation we used the serum albumin, blood lipids values and serum C-reactive protein values defined by calculating the mean of the last three measurements.

Results
A total of 261 ESRD patients on maintenance hemodialysis were enrolled in the study. Mean age was 56.0 (±12) years, 58% were males, and 17.6% were diabetics. Mean time on hemodialysis was 5.9 (±6.7) years, with 24% of patients on dialysis for less than 3 years. Among our patients we found that the prevalence of PAD was 23.4%, of whom 58.1% were men. We found that age, diabetes, duration of hemodialysis, low serum albumin levels and high serum triglyceride levels were risk factors for PAD in hemodialysis patients. The multivariate analysis of our study has shown that a lower level of albumin and higher level of CRP were significantly associated with an ABI less than 0.9 (odds ratio, 4.54; 95% confidence interval, P = 0.017) after adjusting for demographic, clinical, biochemical and medication data. We did not find significant differences in serum calcium, phosphate or PTH levels between patients with PAD and those without it.

Conclusion
In conclusion, the present study showed high prevalence of PAD in patients on hemodialysis. The prevalence was higher in diabetics. Low albumin levels and C-reactive levels were independent risk factors of PAD. We found that early diagnosis and treatment of PAD could help to improve the quality of life of hemodialysed patients and postpone arterial complications in this group of patients.