bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1028EFFECTS OF CANAGLIFLOZIN ON MAJOR ADVERSE CARDIOVASCULAR OUTCOMES IN PATIENTS WITH DIFFERENT BASELINE LEVELS OF TYPE 2 DIABETES MELLITUS DISEASE SEVERITY: RESULTS FROM THE CANVAS PROGRAM
Authors: Young Tamara , Li Jing-wei , Kang Amy , Heerspink Hiddo , Hockham Carinna , Arnott Clare , Neuen Brendon , Zoungas Sophia , Mahaffey Kenneth W , Perkovic Vlado , De Zeeuw Dick , Fulcher Gregory , Neal Bruce , Jardine Meg 
Published: June 2020

Abstract

Background and Aims
Patient with type 2 diabetes mellitus (T2DM) included in trials of sodium-glucose cotransporter 2 inhibitors are heterogeneous in terms of disease severity. We assessed the effects of canagliflozin compared to placebo on cardiovascular and renal outcomes in the CANVAS program according to severity of T2DM as indicated by intensity of treatment, duration of diabetes and glycaemic control.

Method
We compared effects on major adverse cardiovascular events ([MACE], defined as cardiovascular death, non-fatal myocardial infarction or non-fatal stroke) according to three indicators of T2DM severity at study baseline: number of oral glucose lowering treatments or insulin therapy (0-1, 2, 3+, insulin), duration of diabetes (&lt;10, 10-16, &gt;16 years) and HbA1c (&lt;7.0, 7.0-7.5, 7.5-8.0, 8.0-8.5, 8.5-9, &gt;9.0%). We also assessed effects on other pre-specified cardiovascular outcomes, and an adjudicated composite of end-stage kidney disease, renal death or sustained 40% decline in estimated glomerular filtration rate. We assessed for constancy of hazard ratios across subgroups by fitting an interaction term that tested for linear trend.

Results
Of 10,142 participants in the CANVAS Program, 1011 experienced a MACE during a mean follow-up of 3.6 years. Event rates for MACE were higher in those with longer duration of diabetes and higher HbA1c at baseline. The effect of canagliflozin on MACE in the overall population (HR 0.86, 95 % CI 0.75-0.97) was consistent irrespective of the number of glucose lowering treatments (p=0.509), duration of diabetes (p=0.174) and baseline HbA1c (p =0.314). Effects were also consistent across different levels of T2DM disease severity for all other outcomes studied.

Conclusion
Higher event rates were observed in those with longer disease duration and higher HbA1c. The proportional risk reductions achieved with canagliflozin were comparable regardless of diabetes duration, number of therapies or HbA1C at baseline.
P1029SAFETY AND EFFICACY OF LONG-TERM ADMINISTRATION OF DPP-4 INHIBITORS IN PATIENTS WITH NEW ONSET DIABETES AFTER KIDNEY TRANSPLANTATION
Authors: Mpratsiakou Adamantia , Papasotiriou Marios , Tsiotsios Konstantinos , Ntrinias Theodoros , Papachristou Evangelos , Goumenos Dimitrios 
Published: June 2020

Abstract

Background and Aims
New onset diabetes (NODAT) is a common complication after kidney transplantation. The available treatment options in this patient population have limitations due to reduced renal function, possible interactions with immunosuppressive drugs and side effects such as hypoglycemic events. The aim of this study was to investigate the long term safety and efficacy profile of dipeptidyl peptidase-IV (DDP-4 inhibitors) administration in renal transplant recipients with NODAT.

Method
The study included 12 patients treated with DPP-IV inhibitors monotherapy as well as 5 patients receiving insulin monotherapy as initial treatment immediately after NODAT diagnosis. All patients were monitored at every scheduled outpatient visit and for 12 months after diagnosis by measuring glycosylated hemoglobin (HbA1c), serum creatinine (eGFR calculation with CKD-EPI formula), plasma immunosuppressive trough levels, serum lipids, blood pressure, and body weight. The mean values of the aforementioned parameters for the last six months of follow up were compared to the ones at diagnosis.

Results
Patients receiving DPP-IV inhibitors were treated with either linagliptin (4 patients), sitagliptin (4 patients), vildagliptin (2 patients) or halogliptin (2 patients). These patients had a mean age of 59.4 ± 12 years, a mean HbA1c of 6.6% and a mean fasting glucose of 114.5 mg/dl at diagnosis. The mean HbA1c the last 6 months of one year of follow up after initiation of treatment, decreased to 6.1% (p=0.03). Renal function remained stable (mean eGFR from 58.8 to 61.7 ml/min/1.73m2, p=ns) while plasma tacrolimus levels did not appear to be affected (from 6.2 to 5.5 ng/dl, p=ns). Patients received a slightly reduced mean dose of tacrolimus during the last six months of follow up in comparison to the one at initiation of treatment (from 2.9 to 2.6 mg/24h, p=ns). No significant difference was shown in serum total, LDL, and HDL cholesterol before and after treatment, nevertheless, triglyceride levels were significantly reduced (from 214.4 to 174.9 mg/dl, p=0.0039). A decrease in body weight was observed (from 79.9 to 77.9 kg, p=ns) which was however not statistically significant. Finally, achieving the goal of lowering HbA1c levels was better in patients treated with DPP-IV inhibitors than in those treated with insulin (6.1% vs 7.1%, respectively, p=0.01).

Conclusion
Administration of DPP-IV inhibitors appears to be a safe and effective option for the treatment of NODAT in renal transplant recipients with the benefit of avoiding hypoglycemic episodes and possibly better diabetes control than with insulin therapy.
P1031CHADS2 AND CHAD2DS2-VASC SCORES IN THE PREDICTION OF PERIPHERAL ARTERIAL DISEASE IN DIABETIC PATIENTS
Authors: Chen Yi-Hsin 
Published: June 2020

Abstract

Background and Aims
Peripheral arterial disease (PAD) is more often seen in diabetic patients, accounting for 25-30%. Diabetic patients suffered more lower limb amputations in Unites States as high as 60% and patients with PAD suffer higher risk for amputations. We want to use CHADS2 and CHA2DS2-VASc scores to predict the risk of PAD in diabetic patients.

Method
We analysed data from the Taiwan National Health Insurance Research Database between January 1st, 2002 and December 31st, 2009. A total of 5,6732 diabetic patients were selected as the study cohort. The CHADS2 score and CHA2DS2-VASc score were calculated for each patient.

Results
During the follow-up period, 228 (0.4%) patients experienced new-onset PAD. The rate of PAD increased from 0.3% (CHADS2 score 1-2) to 1.4% (CHADS2 score 4-6) (p&lt;0.001). The rate of PAD increased from 0.2% (CHA2DS2-VASc score 1-3) to 3.5% (CHADS2 score 7-9) (p&lt;0.001). According to a multivariate analysis, the hazard ratio of each point increment in the CHADS2 score for predicting PAOD was 1.67 (p&lt;0.001), CHA2DS2-VASc score was 2.03(p&lt;0.001).

Conclusion
The CHADS2 and CHA2DS2-VASc scores are useful predictors of new-onset PAD in diabetic patients.
P1045MISALIGNED EXPECTATIONS ON INTEGRATIVE MEDICAL SERVICE FOR DIABETES AND DIABETIC KIDNEY DISEASE: A COMPARATIVE FOCUS GROUP SERIES OF PATIENTS AND PHYSICIANS
Authors: CHAN Kam Wa , Lee Pak Wing , Leung Crystal Pui Sha , Chan Gary Chi Wang , Chan Loretta Yuk Ying , Leung Joseph Chi Kam , Lam Tai Pong , Lai Kar Neng , Tang Sydney 
Published: June 2020

Abstract

Background and Aims
Difference of perspective between patients and physicians over integrative medicine (IM) research and service provision remains unclear despite significant use worldwide. We sought to explore the barriers and recommendations regarding IM service among diabetes and diabetic kidney disease (DKD) patients and physicians.

Method
A 10-group, 50-participant semi-structured focus group interview series was conducted. Twenty-one patients with diverse severity of disease, comorbidities and education levels; and 29 physicians (14 western medicine (WM) and 15 Chinese medicine (CM)) with diverse clinical experience, academic background and affiliation were purposively sampled from private and public clinics. The perspectives were qualitatively analysed by constant comparative method with grounded theory approach.

Results
Seven subthemes regarding barriers towards IM service were identified including finance, service access, advice from medical professionals, uncertainty of service quality, uncertainty of CM effect, difficulty in understanding CM epistemology and access to medical records. Patients underreported the use of CM due to the concern over neutrality of medical advice among physicians. Practical issues including inconvenience of access to service, frequent follow-up, use of decoction and long-term financial burden were identified as key obstacles among patients. Regarding research design, WM physicians emphasized standardization and reproducibility while CM physicians emphasized personalization. Some CM-related outcome measurements were suggested as abstract and non-communicable. Both WM and CM physicians acknowledged the discordance in epistemology should be addressed by pragmatic approach.

Conclusion
Further assessment on IM should be pragmatic to balance between standardisation, reproducibility and real-world practice. Evidence-based IM programs and research should merge with existing infrastructure.
P1071WITHIN-PATIENT RELATIONSHIPS BETWEEN ULTRAFILTRATION AND FLUID GAINS IN HAEMODIALYSIS PATIENTS
Authors: Nguyen Mai , Corbett Richard , Duncan Neill , Ashby Damien 
Published: June 2020

Abstract

Background and Aims
Despite the now-widespread use of haemodialysis treatment, optimal fluid management in long-term dialysis patients remains challenging. Whilst the between-patient factors affecting target weight and ultrafiltration have been well studied, little is known regarding the within-patient factors affecting these relationships.

Method
Dialysis data for a group of stable haemodialysis patients, from 4 dialysis units, were analysed over a period of one year. All weights and volumes are expressed as percentage of target weight.

Results
From 100 patients (aged 28–89, mean 65.4, 54% male) observed over a year, complete data were available for 15530 dialysis sessions, and 13027 combinations of dialysis session plus the following inter-dialytic interval.
Mean arterial pressure dropped by 3.5(+/-14.6)mmHg during dialysis, with a significant correlation (p&lt;0.05) between pressure drop and ultrafiltration volume in 26 patients (mean R=0.09, mean regression gradient 3.2).
In 87 patients, inter-dialytic fluid gain correlated strongly (p&lt;0.05) with the previous dialysis session’s ultrafiltration volume (mean R=0.37, mean regression gradient 0.20) suggesting a significant role of ultrafiltration volume in driving subsequent fluid intake behaviour (thirst).
Unsurprisingly, more fluid was gained over longer inter-dialytic intervals: mean(sd) weight at the start of dialysis was 103.2(1.0)% after a 3-day gap and 102.5(1.0)% after a 2-day gap, with this difference being significant (p&lt;0.05) in 87 patients. However, fluid gain was non-linear, diminishing during longer inter-dialytic intervals: mean(sd) daily inter-dialytic fluid gain was 1.13(0.38)% during the 3-day gap vs 1.21(0.53)% during the 2-day gap (p&lt;0.05 in 36 patients), implying that at least a third of patients consume less fluid during the 3rd post-dialysis day.

Conclusion
Inter-dialytic fluid gain is strongly dependent on ultrafiltration during the previous dialysis session, and diminishes during the inter-dialytic interval. Large ultrafiltration volumes, which have historically been perceived as the inevitable result of large fluid intakes, are actually a cause of thirst and large fluid intakes in haemodialysis patients. These data, derived from within-patient analyses, strongly challenge our conventional understanding of dialytic fluid management.
P1076HEMODYNAMIC TOLERANCE TO INTERMITTENT DIALYSIS IN CRITICALLY ILL PATIENTS: THE CLINICAL JUDGMENT OF HIPERVOLEMIA IS ABLE TO PREDICATIT?
Authors: Melo Erica , Silveira Marcelo , Dutra Fábio , Baptista Ana , Miranda Filipe , Nascimento Carolina , Coelho Fernanda , Teixeira Maurício , Gomes Marcel , Souza Sérgio , Benigno Paulo , Messeder Octavio , Farias Augusto , Caldas Juliana , Passos Rogério 
Published: June 2020

Abstract

Background and Aims
Evaluation and management of fluid balance are a key challenge in caring for the critically ill requiring renal replacement therapy. As intradialytic hypotension is a common complication and can be associated ultrafiltration rate. Usually the nephrologist and critical care physician have relied in their subjective clinical judgment and clinical data to calculate ultrafiltration. The aim of this study was to assess the prediction of clinical judgment of fluid overload and other clinical and dialysis data as predictors of hemodynamic tolerance to intermittent dialysis.

Method
This prospective observational single-center study was performed in critically ill patients with acute kidney injury undergoing intermittent hemodialysis. Before hemodialysis, clinical judgement of Hypervolemia from nephrologists and intensivists were assessed and posterior-anterior views of chest-X-rays done within three hour before of beginning of dialysis were collected for measurement of vascular pedicle width (VPW). Factors predicting intradialytic hypotension were identified by multiple logistic regression analysis.

Results
248 AKI patients requiring intermittent dialysis were considered eligible. The clinician judgement of hypervolemia was not different between hypotensive and non hypotensive sessions. Multiple logistic regression showed that the size of VPW was independently associated with the development of hypotension during IHD session. A VPW value of &gt; 70 mm had an 86.1 % sensitivity, 55 % specificity for identifying non hypotensive sessions with an area under the curve (AUC) = 0.81, 95 % CI 0.75–0.84, p &lt; 0.001.

Conclusion
Clinical judgment of hypervolemia and other clinical and demographic variables that are used by nephrologists and critical care physicians at bedside did not predict hypotensive hemodialysis sessions. The high predictive ability of VPW measurement can help physicians to avoid inductive and deductive thinking and may assist critical thinking.
P1084LONG TERM EVALUATION OF THE EXPANDED HEMODIALYSIS (HDX) ON DIALYSIS ADEQUACY, ANEMIA AND QUALITY OF LIFE
Authors: Gernone Giuseppe , Partipilo Francesca , Detomaso Francesco , Pepe Vito , Pietanza Stefania , Mitrotti Adele 
Published: June 2020

Abstract

Background and Aims
The High-Flux (HF) dialyzer in standard hemodialysis (HD) allow the removal of a wider spectrum of uremic toxin. However, the HD can remove mostly low molecular weight solutes while the HDF can remove solutes around 15kDa, so-called Middle Molecules (MM), improving morbidity and mortality by exchange volumes &gt;23L per session. The new medium cut-off (MCO) filter Theranova® is designed to expand the removal of toxins up to 45kDa in HD compared to HF membranes (HemoDialysis eXpanded, HDx) even with conventional blood flows and without exchange fluid infusion. The aim of this study is to evaluate the performance of HDx and its impact on anemia and quality of life (QoL) in haemodialysis patients.

Method
11 stable HDs patients were enrolled (M/F 8/3, age 70.8±9) with Qb ≤300 ml/min in a 12 months observational case-control study. Each patient was evaluated first with HF filter (T0) and then in HDx for 12 months (T12). At T0-T6-T12 were evaluated: urea, phosphate (P), beta2-microglobulin (B2m), myoglobin (Myo), free light-chains k and λ (FLC- K and FLC- λ), C-Reactive Protein (CRP), hemoglobin (Hb) and albumin as well. Furthermore Kt/V, dose of EPO, ERI and SF-36 questionnaire were evaluated at the beginning and end of observation. We treat HD patients accordingly to the KDIGO Guideline for Anemia in CKD. The values have been reported as mean ±SD.

Results
HDx (Qb = 275 ± 41 ml/min, TT 215 ± 21 m) shows a significant increase in KT/V (T0 1,33 ± 0,19; T12 1,57 ± 0,16; p = 0.001) with relevant RR of: Urea 73.5%; P 58.4%; B2m 66,1 % (p&lt; 0.05); Myo 55,1% (p&lt; 0.05); FLC-k 64.1 % (p&lt; 0.05); FLC-λ 59.9% (p&lt; 0.05). There is a significant reduction at 12months for PCR (Tab.1). HDx reduced ERI [T0 10.1 ± 11.2; T6 4.1 ± 5.3 (p &lt;0.05); T12 6±9.8] and EPO dose [T0 8182 ± 9141; T6 3545 ± 4547 (p &lt;0.05); T12 5273±8912], keeping the Hb unchanged. QoL is significantly improved (ISF: T0 27.3 ± 10.1; T12 40.2 ± 8.4 p = 0.0001) (ISM: T0 43.8 ± 14.2; T12 51.1 ± 9.8 p = 0.001).

Conclusion
HDx effectively removes uremic toxins up to 45kDa, even with Qb &lt;300 ml/min, without reducing serum albumin and with interesting results on inflammation. Reduction of ERI and improvement of QoL are encouraging and suggest the use of HDx even in patients who cannot benefit from convective techniques because of vascular access or intolerance to high volumes of exchange.
P1095USE OF CYTOKINE ADSORBING MEMBRANES IN PATIENTS WITH ACUTE RENAL FAILURE IN INTENSIVE CARE UNITS
Authors: Jakopin Eva , Hren Martin , Knehtl Masa , Dvorsak Benjamin , Hojs Nina , Zorman Tadej , Stropnik Galuf Tina , Sinkovic Andreja , Svensek Franci , Borovsak Zvonko , Wagner Kovacec Jozica , Ekart Robert , Hojs Radovan , Bevc Sebastjan 
Published: June 2020

Abstract

Background and Aims
Use of cytokine adsorbents has been proposed as a novel therapeutic approach in sepsis management. Our aim was to evaluate laboratory markers, clinical parameters and SOFA (Sequential Organ Failure Assessment) score in patients who were treated with cytokine adsorbing membrane (CytoSorb®, CytoSorbents Corp. New Jersey, USA) and continuous veno-venous haemodialysis.

Method
We included adult patients with septic shock and acute renal failure. We retrospectively collected laboratory results (leukocytes, thrombocytes, C-reactive protein, procalcitonin, lactate, urea, creatinine, bilirubin, PaO2), clinical parameters (mean arterial pressure (MAP), FiO2, residual diuresis), SOFA score and vasopressor use at the beginning and at the end of the procedure.

Results
We included 69 patients, 51 men, aged 56.6 ± 15 years. 51 patients had 1 procedure, 14 patients had 2 procedures, 3 patients had 3 procedures and 1 patient had 4 procedures. Median time from admission to initiation of procedure was 47 hours, median treatment time was 23.6 hours.
We discovered significant improvement in procalcitonin (35.36 ± 37.33 ng/mL vs. 24.25 ± 31.18 ng/mL; p&lt;0.001), creatinine (345.06 ± 174.65 μmol/L vs. 233.11 ± 108.82 μmol/L; p&lt;0.0001), SOFA score (14.20 ± 2.64 vs. 12.69 ± 3.52; p&lt;0.001) and FiO2 (48.17 ± 21.17 % vs. 44.63 ± 21.45 %; p=0.020).
Patients with more than 1 procedure showed statistically significant reduction in lactate level (5.40 ± 4.74 mmol/L vs. 2.46 ± 1.74 mmol/L; p=0.010) and vasopressin dose (1.26 ± 1.61 vs. 0.88 ± 3.2 IU/h; p=0.022).

Conclusion
We observed potential beneficial effect of adsorptive membrane use in septic patients. According to our results two or more procedures were associated with improved laboratory markers and lower vasopressor requirement.
P1099EVALUATION OF THE DEPURATION OF SOLUTES IN THE MIDDLE TO HIGH MOLECULAR WEIGHT RANGE WITH DIFFERENT TECHNIQUES OF HAEMODIALYSIS
Authors: Cancho Castellano Barbara , Diaz Campillejo Rosa , López Arnaldo Cristina , Valladares Alcobendas Julián , Ruiz Calero Cendrero Rosa María , Martín Hidalgo Barquero Maria Victoria , López Gómez Juan M , García Yun Purificación , Olivera Azevedo Lilia , García de Vinuesa Calvo Elena , Robles-Perez Nicolas-Roberto 
Published: June 2020

Abstract

Background and Aims
Haemodialysis is the most commoly used replacement therapy for chronic kidney disease. We are looking for new solutions to remove solutes in the middle to high molecular weight range. Our objective is to evaluate and compare the purification of small and middle to high molecular weight between 15-45 KDa with Haemodyafiltration On Line postdilutional (HDF-OL-post) technique, Haemodialysis High-Flux (HD-HF) and Haemodialysis Expanded (HDx) using specific high permeability membranes: in the first two techniques polyphenylene membranes (1.7m2) and in the HDx technique cut point membranes PAEs/PVP (1.7 m2).

Method
10 chronic prevalent patients on haemodialysis, older than 18 years, without diuresis and stable, 60% males. Mean age 65.3±17.47 years. Time in HD, mean 49.5 months. Etiologies: 20% NAE, 30% ND, 10 % Glomerulopathies, 40% unaffiliated. Vascular Accesses: 50% FAVn, 20% FAVp, 30% CVC-T. They were evaluated for three consecutive weeks with analytics in the intermediate session, modifying the technique and the membrane, keeping the dialysis patient stable. Post-dialysis concentrations of solutes in the middle to high molecular weight range were corrected in relation to haemoconcentration. A comparison of the reduction percentages (RP%) of various molecules was performed. The possible normal distribution was studied in the continuous variables with the Shapiro-Wilk test and the comparison of means using the t-Student or Wilconson test as the most appropriate. SPSS statistical program 17.0.

Results
No serious adverse events or allergies were recorded. The comparative results between the three techniques are shown in the figure 1.

Conclusion
The mean reduction of medium molecules (β2-microglobulin, cystatin-C) was not lower in HDx compared to HDF-OL-post. From 20 KDa there is no greater capacity to reduce solutes in HDx in our sample than in the other techniques. Between the three techniques, the HDF-Ol-post is the one that shows a higher percentage of mean reduction of α1-acid glycoprotein and albumin.
P1103A RANDOMIZED CONTROLLED STUDY ON THE DIALYZERS WITH CELLULOSE TRIACETATE MEMBRANE AND WITH POLYSULFONE MEMBRANE FOR MAINTENANCE HEMODIALYSIS PATIENTS
Authors: Chen Zhang , Yun Yang , Liu Nai-quan , Zhou Guang-yu , Li De-tian 
Published: June 2020

Abstract

Background and Aims
With the continuous development and optimization of dialysis membrane materials, polysulfone (PS) as the third generation of dialysis membrane has replaced cellulose triacetate (CTA) and dominated the market because of its better biocompatibility. However, we found that the hypersensitivity to PS could be remitted by the application of CTA in clinical practice. Objective to compare the differences in toxin removal, hematological change and biocompatibility in maintenance hemodialysis (MHD) patients using CTA dialyzer and PS dialyzer.

Method
A total of 20 MHD patients treated in the Second Blood Purification Center of Shengjing Hospital from June 2017 to September 2017 were enrolled in this study. They were randomly divided into group CTA and group PS (n=10/each group). They were treated with regular hemodialysis of 4 hours/time and 3 times/week for one month. The clearances of creatinine (CR), blood urea nitrogen (BUN) and serum phosphorus (P), the changes of hemoglobin (Hb), platelet (PLT) and white blood cell (WBC), and the differences of C-reactive protein (CRP), IgE, complement 3 (C3), vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1) were compared between group CTA and group PS.

Results
Age (t=-0.735, P=0.465), gender (c2 =2.410, P=0.120), dialysis age (t=0.336, P=0.738) and primary diseases (c2 =3.817, P=0.701) had no statistical differences between the two groups. Before the hemodialysis with CTA dialyzer and PS dialyzer, there were no statistical differences in all of the parameters between the two groups (P&gt;0.05). After application of CTA dialyzer and PS dialyzer for one month, ①there were no statistical differences in CR, BUN and P, nor in the changes of the above indicators between the two groups (P&gt;0.05); ② there was a statistical difference in Hb change between the two groups (t=-2.282, P=0.027), with better improvement of anemia in group CTA; ③ there was a statistical difference in PLT (t=2.947, P=0.005) between the two groups, with slighter change in group CTA than in group PS (t= 2.219, P=0.031); ④there were no statistical significances in WBC, VCAM-1, ICAM-1, IgE, CRP and C3 between the two groups (P&gt;0.05).

Conclusion
①There were no significant difference in the clearances of small molecule toxins between CTA dialyzer and PS dialyzer. ② CTA was better than PS in the improvement of anemia. ③ The effect on PLT was less in group CTA than in group PS. ④ There were no significant differences in biocompatibility between CTA dialyzer and PS dialyzer.