bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1213ROLE OF PERITONEAL PHOSPHORUS TRANSPORT IN PERITONEAL DIALYISIS REGIMEN FOR THE MANAGEMENT OF HYPERPHOSPHATEMIA
Authors: Xipell Marc , Guillen Olmos Elena , Rodas Lida , Broseta Jose J , Mayordomo Angeles , Bonache Debora , Maduell Francisco , Vera Manel 
Published: June 2020

Abstract

Background and Aims
The ratio D/P-Creatinine (DP-Cr) obtained by the peritoneal equilibrium test (PET) is the most widely used parameter to characterize the type of peritoneal membrane transport, and it is used to determine the dialysis regimen for ultrafiltration (UF). It has been suggested that net UF influences the final clearance of solutes, so guiding ultrafiltration by D/P-Phosphorus (DP-P) instead of DP-Cr could have some added value in the management of hyperphosphatemia. The objective of this study is to define if there is a correlation between DP-P and DP-Cr, and if these are related to the clearance of phosphorus (P) and creatinine (Cr).

Method
retrospective analysis of PETs performed during 2016 and 2017 in our center. DP-Cr and DP-P were calculated, and in patients with 24h effluent sample the day of the PET, it was also analyzed weekly Kt/V-urea, and peritoneal Cr and P clearance (CrCl and PCl, respectively). Statistical analysis was done using t-Student test for independent data and Pearson correlation coefficient, with SPSS Statistical Package program v.23, establishing a significance level of p&lt;0.05.

Results
68 PETs were analyzed in 54 patients, mean age 60.4 years (SD 17), predominantly men (69% vs 31%). The mean plasma P, DP-Cr and DP-P were respectively 4.5 mg/dL (SD 1.2), 0.74 (SD 0.12) and 0.71 (SD 0.17). The correlation coefficient DP-P/DP-Cr showed a significant relationship (r=0.84, p&lt;0.001), which was maintained when analyzing patients according to phosphorus levels: DP-P/DP-Cr with P&lt;5 mg/dL (r=0.81); and P≥5 mg/dL (r=0.93) (p&lt;0.001).Patients in DP-P ≥50th percentile had P levels of 4.2 (± 1.05), and those in&lt;50th percentile had levels of 4.88 (± 1.38) (p &lt;0.031). Moreover, in patients with 24h effluent analyzed the day of the PET (n=35), the average PCl and CrCl was 4.1 and 2.85 ml/min, with statistical significant correlation (r=0.92, p&lt;0.001).However, in these patients no relationship was found between DP-Cr and CrCl (r=0.068, p=0.7), nor between DP-P and PCl (r=0.052, p=0.7).

Conclusion
The DP-P/DP-Cr high correlation suggests that both parameters could be useful to classify the type of peritoneal transport. However, although patients with higher DP-P had better control of hyperphosphatemia, thus suggesting a direct positive relationship between DP-P and PCl, our data showed no correlation between them.
P1215INVERSE ASSOCIATION BETWEEN DIALYSATE OXALATE REMOVAL AND INTRAPERITONEAL INFLAMMATION IN PERITONEAL DIALYSIS PATIENTS
Authors: Stepanova Natalia , Driianska Victoria , Snisar Lyudmyla , Lebid Larysa 
Published: June 2020

Abstract

Background and Aims
Due to inadequate oxalate removal, hyperoxalemia is a well-established feature in end-stage renal disease (ESRD) patients. Considering the fact that oxalate is primarily removed by kidneys in healthy individuals, we hypothesized that oxalate elimination in peritoneal dialysis (PD) patients could be compensated by PD effluent (PDE). In addition, its dialysate concentration could be associated with intraperitoneal inflammation.
In the present study, we investigated oxalate excretion in PDE and its association with intraperitoneal inflammation in PD patients.

Method
We performed a cross-sectional single-center observational study involving 30 PD patients (17 women and 13 men). The average age was 48.3 ± 9.2 years. Among them, there were 11 (37%) diabetics and 19 (63%) non-diabetic patients. The mean time on PD was 32 [18.5-47] months.
Parameters of dialysis adequacy, cytokines concentration and oxalate removal levels with PDE were determined. The spectrophotometric method was performed for determining oxalate concentration in PDE using oxalate oxidase/peroxidase reagent (BioSystems, Spain). The ELISA method was used for the determination of interleukin-6 (IL-6) and monocyte chemoattractant protein-1 (MCP-1) measurements in dialysate.
For the statistical analysis, we used Kruskal-Wallis’s t-test and Spearman's rank correlation test. The median (Me) and interquartile ranges [Q25 - Q75] were calculated according to abnormal distribution. All statistical analyses were performed using MedCalc.

Results
No differences in peritoneal oxalate, IL-6, and MCP-1 excretion between diabetics and non-diabetic patients were observed (Table 1).
However, the higher dialysate oxalate concentration was, the lower residual renal function was observed (r = - 0.69; p &lt; 0.0001). Surprisingly, increased dialysate oxalate level was associated with low IL-6 (r = - 0.54; p = 0.002) (Fig. 1) and MCP-1 (r = - 0.7; p &lt; 0.0001) (Fig. 2) concentrations in PDE.

Conclusion
To the best of our knowledge, the association between PDE oxalate excretion and proinflammatory mediators’ concentrations in PD patients has never been reported before. We suppose that peritoneal oxalate excretion might be involved in the intraperitoneal inflammation process. Further studies are needed to determine the possible pathogenetic role of dialysate oxalate removal in the conditions of intraperitoneal inflammation in PD patients.
P1223PATIENT REMOTE MONITORING IN AUTOMATED PERITONEAL DIALYSIS: 2017-2019 CLINICAL EXPERIENCE IN A SINGLE CENTER
Authors: Amici Gianpaolo , Lo Cicero Antonina , Zuccolo Mery , Ferraro Mortellaro Rosella , Romanini Dino , Irlando Antonio , Celik Loijze , Velardita Alfonso 
Published: June 2020

Abstract

Background and Aims
We conducted an observational study in a group of patients in automated peritoneal dialysis (APD) to evaluate the impact of the introduction and the long-term use of a telemedicine system for remote patient monitoring (RPM, Claria Sharesource Baxter).

Method
From April 1 2017 to December 31 2019 (33 months) we followed 42 APD patients with RPM, sex F 20 M 22, age 70±14 years, on PD treatment for median 10 (IQR 3-23) months, distance from the center 18±14 km in mountain and hill area. Have been studied 505 months of RPM overall, per patient median 9 (IQR 3-19) months, corresponding to 11685 APD sessions overall, per patient median 206 (IQR 52-457) sessions.

Results
Have been registered 1125 alarms (red flags) overall, per patient median 9 (IQR 1-45) alarms, rate 2.2 alarms patient-month (0.1 alarms per session). Analyzing the causes of the alarms: “dwell time lost” (&gt;45 min) 1006 (89%), “drain anticipation” (&gt;2 times) 22 (2%), “fill or dwell bypass” (&gt;3 times) 15 (1%), “various causes” (&gt;10 times) 86 (8%). “Various causes” alarm group sums mainly slow drain for set kinking and insufficient drain volume. We count 195 remote modifications of dialysis program overall, median per patient 3 (IQR 1-7), rate 0.02 patient month with a ratio 0.2 modifications per alarm. Looking to program modification, the alarm type specifically linked to modifications has been insufficient drain volume of the “various causes” group (36 events, 18% of all modifications). We found a positive correlation between the number of treatments and alarms (r=0.534, p&lt;0.001). In the observation period the overall hospitalization days were 403, rate 0.8 days patient month, ratio 0.02 hospitalization days per APD RPM session and ratio 0.4 hospitalization days per alarm.

Conclusion
The study shows that APD with RPM improves patients’ follow-up changing the organization of the center. In the long term the telemedicine system shows the advantages of a careful and daily monitoring. The rates of alarm, change of prescription and hospitalization resulted very low in our experience.
P1228IMPROVEMENT OF BODY WEIGHT MANAGEMENT, BETA2-MICROGLOBULIN LEVEL AND RESISTANCE TO ERYTHROPOIESIS-STIMULATING AGENTS BY HYBRID PERITONEAL DIALYSIS PLUS HEMODIALYSIS THERAPY
Authors: Fukasawa Kanako , Fukasawa Mizuya 
Published: June 2020

Abstract

Background and Aims
Peritoneal dialysis (PD) has the advantages of not causing rapid changes in the body fluid levels or solute contents in the blood due to the continuous treatment on all days of the week, and of not needing the patients to visit the hospital 3 times a week or lie on a bed for 4 hours to receive treatment. PD alone can, however, not adequately remove all the uremic toxins and excess water, and the patients are likely to be resistant to erythropoiesis-stimulating agents (ESA). These drawbacks could be potentially improved if PD and hemodialysis (HD) were used together. The aims of the present study were to clarify the changes in the body weight, serum β2-microglobulin (β2MG) level, and resistance to ESA in PD patients switched from PD alone to PD-HD hybrid therapy (hybrid therapy).

Methods
The data of seven patients who were switched from PD alone to PD-HD hybrid therapy at our hospital were retrospectively analyzed to determine the changes in the body weight, serum β2MG level, dose of ESA (Darbepoetin Alfa) and the hemoglobin level before and at 3 months after the switch to hybrid therapy; in hybrid therapy, the patient received HD once a week and did not receive PD on that day. We also carried out a questionnaire survey to determine the changes in the feeling of well-being and quality of life of the patients after the switch to hybrid therapy.

Results and Discussion
The body weight decreased significantly from 67.4 ± 11.8 kg to 63.7 ± 8.7kg (p = 0.0345) after the switch from PD alone to PD-HD hybrid therapy, indicating that the control of the body fluids was much easier with hybrid therapy than with PD alone. The mean serum β2MG level in the patients decreased from 37.3 ± 11.6 μg/mL to 32.6 ± 5.9 μg/mL (p = 0.1607, not significant), ; in particular, in those patients in whom the serum β2MG levels were over 30 μg/mL, the level decreased significantly from 42.5 ± 8.7 μg / mL to 34.4 ± 6.1 μg / mL (p = 0.0337). The dose of ESA decreased significantly in all patients from 193 ± 74 μg/month to 69 ± 38 μg/month (p = 0.006), while the hemoglobin level remained unchanged (from 10.2 ± 1.7 g/dL to 11.2 ± 1.2 g/dL, p = 0.1406). In the questionnaire survey, almost all the patients expressed positive feelings about the switch of the treatment modality, such as “it became easier to go up the stairs,” “improved working efficiency,” and “comfortable feeling.” Since the peritoneum was allowed to rest once in a week, on the day of the HD, it could also preserve peritoneal functions. Therefore, hybrid therapy was also considered to be effective from the viewpoint of performing PD over the long term.

Conclusion
We can expect easier management of the body fluid, efficient β2MG removal, and improvement of ESA resistance by switching the dialysis treatment modality from PD alone to HD-PD hybrid therapy.
P1230CHANGES IN CKD-MBD-REALTED MARKERS AND MIDDLE MOLECULAR WEIGHT SOLUTES (Β2MG, Α1MG)IN PATIENTS ON PD-HD COMBINATION THERAPY
Authors: TOMO Tadashi , Sato Takashi , Minaguchi Jun 
Published: June 2020

Abstract

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

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

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

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

Abstract

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

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

Results
Totally 119 maintenance haemodialysis patients enrolled our study. 22 dialysis patients had the experience of IDH, and the prevalence is 18.5%. The patients with IDH had higher prevalence of diabetes and longer dialysis vintage (40.9% vs 16.5, p=0.011; 70.0 vs 41.0 months, p=0.054), they also had a lower post-dialysis SBP and DBP.
The MMSE scores and MoCA scores of patients with IDH and without IDH were similar (29.0 vs 29.0, p= 0.621; 23.5 vs 24.0, p= 0.273).
There was no difference in gray matter and white matter between IDH and no-IDH groups. But as for some important brain nuclei and parts associate with emotion and vision, like amygdala, cuneus and posterior cingulate, patient with IDH were smaller than patients without IDH (1.6±0.2 vs 1.7±0.2 mm3, p=0.009; 6.9±0.8 vs 7.4±1.0 mm3, p=0.031; 6.9±0.8 vs 7.4±0.9 mm3, p=0.024). The multiple-regression analysis showed that IDH was significantly associated with the volume atrophy of amygdala, cuneus and posterior cingulate (β=-0.12, p=0.009; β=-0.48, p=0.031; β=-0.48, p=0.026).

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

Conclusion
Although some ECG findings and BNP level are factors associated with CVD events and death, there was also a significant correlation between these two factors. There has been no report showing the relationships between these two factors, and it may be useful in considering BNP levels in dialysis patients.