bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1057UNTARGETED 1H NMR-BASED SERUM METABOLIC PROFILE ANALYSIS OF PATIENTS TREATED WITH HIGH VOLUME HEMODIAFILTRATION (HDF)
Authors: Flores Andressa , Manfron Schiefer Elberth , Sassaki Guilherme , Menezes Leociley , Fonseca Renato , Cunha Regiane , Canziani Maria Eugenia , Guedes Murilo , Moreno-Amaral Andrea N , Souza Wesley , Silva Pecoits Filho Roberto Flavio , Stinghen Andréa E M 
Published: June 2020

Abstract

Background and Aims
Uremic toxins (UTs) accumulate in the circulation of patients with chronic kidney disease (CKD), contributing to poor outcomes. One of the main objectives of renal replacement therapies is the removal of UTs, and while HD is restricted to the clearance of low molecular weight UTs, hemodiafiltration (HDF) adds efficiency to the removal of medium molecular weight UTs through the association of diffusion and convection methods. Metabolomic analysis from nuclear magnetic resonance (NMR) spectra offers efficient data about metabolites profile, indicating the main features of HDF, and possibly highlighting the positive effects of this modality. Thus, the aim of the present study is to evaluate the profile of metabolites in the circulation of a cohort of patients undergoing HDF.

Method
From 97 individuals participating in the HDF arm of a randomized control trial (ClinicalTrials.gov Identifier: NCT02787161), we randomly (using Python language; NumPy library) selected 6 patients (mean age 49, 6 males, 44% diabetics, average duration of 245 minutes, blood flow of 400 mL/min, target convective volume of 22 L per treatment). Patient’s serum samples were collected in the beginning of the study (baseline) and 6 months. The samples were prepared with deuterium oxide, sodium trimethylsilylpropanesulfonate as internal standard (ð=0.0 ppm), and further submitted to 1H NMR spectra recorded with Bruker 600 MHz AVANCE III spectrometer in order to identify the patient’s metabolomic profile. Data was evaluated with t-test and results were then compared with the Human Metabolome Database (HMDB) for descending order of the Jaccard similarity score.

Results
A total of 50 metabolites were investigated. Interestingly, 2 metabolites were significantly (P&lt;0.05) reduced in the serum after 6 months compared to baseline, acetate (3.3 ± 0.1) % and dimethylglyoxal (7.6 ± 0.1) % (Figure 1). In order to confirm the presence of these metabolites in human serum, further studies will be conducted with 2D 1H-13C-HSQCed NMR.

Conclusion
We observed a reduction of acetate and dimethylglyoxal levels after six months of HDF treatment, in comparison to baseline, most likely as a consequence of the increase in clearance of these molecules. Hypothetically these changes in solute removal could explain the positive effects of HDF on clinical outcomes, and further studies should address this potential benefit of the modality.
P1067CONDUCTIVITY BASED ONLINE MONITORING OF PREDIALYTIC HYPONATREAMIA AS DIAGNOSTIC TOOL IN HEMODIALYIS
Authors: Harlos Joachim , Maierhofer Andreas , Canaud Bernard 
Published: June 2020

Abstract

Background and Aims
Hyponatremia in dialysis patients is a strong indicator of poor outcome in dialysis patients that requires early detection to facilitate clinical workup and management. However, plasma sodium concentration as determined by lab methods (Na-Lab) is measured at the best monthly in clinical practice.
Recently, online monitoring of predialytic plasma Na (pPlNa) as estimated from dialysate conductivity using an electrolyte model has become available at every hemodialysis session, thus providing an unprecedented close and almost continuous monitoring of this crucial indicator. This could be used as diagnostic tool to identify changes in patient status and alert earlier the physician.

Method
In a monocentric retrospective clinical study in 114 patients on maintenance hemodialysis (&gt;90% online postdilution HDF) for whom online pPlNa was available for a period of at least 12 months at least once a week, kinetics of pPlNa were analyzed. For 10 patients with hyponatremic episodes as manifested in pPlNa, the agreement between time course of pPlNa and Na-Lab and the correlation to the manifestation of clinical findings was explored.

Results
Time course of pPlNa and Na-Lab showed very good agreement. Hyponatremia onset was clinically related to diagnoses such as fluid overload and congestive heart failure, diarrhea secondary to inflammatory bowel disease, sepsis, liver cirrhosis, cancer and use of loop diuretics.

Conclusion
The clinical examples show that due to the good agreement of the time course of online monitoring of pPlNa and Na-Lab, pPlNa can be used as adjuvant diagnostic tool for the early detection of onset and progression of morbid events. Due to its routine availability variations in pPlNa could be used to timely trigger clinical workup and investigations.
P1077PERSISTENCE OF CIRCULATING RESIDUAL HEPARIN IN ESRD PATIENTS UNDERGOING MAINTENANCE HEMODIALYSIS
Authors: Bansal Vinod , Mazariegos Melissa , Grewal Arjun , Bajwa Jasdeep , Bontekoe Emily , Hoppensteadt Debra , Iqbal Omer , Fareed Jawed 
Published: June 2020

Abstract

Background and Aims
ESRD patients who receive routine maintenance hemodialysis are administered with unfractionated heparin to prevent thrombotic complications. The hemostatic dysregulation along with detectable levels of circulating heparin may cause them to be in a hypocoagulable state. The purpose of this study is to determine the circulating levels of heparin in ESRD patients and its characterization using heparinase digestion methods.

Method
Blood plasma samples collected at routine pre-dialysis sessions from 95 ESRD patients undergoing maintenance hemodialysis were analyzed for the presence of residual heparin utilizing standard laboratory methods such as aPTT, Anti-Xa and Anti-IIa activities On a centrifugal analyzer (ACL-Elite: Instrumentation Laboratory, Bedford, MA). The levels of heparin were calculated in terms of units per ml relative to the USP reference standard. Heparinase digestion was used to confirm the presence of heparin.

Results
Blood plasma samples collected at routine pre-dialysis sessions from 95 ESRD patients undergoing maintenance hemodialysis were analyzed for the presence of residual heparin utilizing standard laboratory methods such as aPTT, Anti-Xa and Anti-IIa activities On a centrifugal analyzer (ACL-Elite: Instrumentation Laboratory, Bedford, MA). The levels of heparin were calculated in terms of units per ml relative to the USP reference standard. Heparinase digestion was used to confirm the presence of heparin.

Conclusion
The presence of residual heparin was demonstrated by both clot- based and amidolytic assays in the plasma samples collected from ESRD patients prior to their next-dialysis session. Since these samples were obtained 3 days following the last dialysis session the presence of significant levels of heparin was surprising. Upon heparinase treatment of these samples, the aPTT and the anti-Xa and IIa tests were restored to near normal levels. Our studies confirm the presence of residual heparin in pre-dialysis plasma samples obtained from ESRD patients. The Anti-IIa activity was greater pre-heparinase and it was not decreased to the same extent as Anti-Xa after heparinase digestion. These results suggest that heparin found in ESRD patient’s plasma is of high molecular weight origin with delayed clearance.
P1080INCREASE OF POST DIALYSIS HEMOGLOBIN CONCENTRATION IS MORE APPROPRIATELY EXPLAINED BY PLASMA VOLUME CHANGE THAN INTRADIALYTIC WEIGH LOST
Authors: Babalj Banskolieva Elena , Grozdanovski Risto , Spaseska Gjurovska Katerina , Ilievski Marko , Filipovska Biljana , Gelev Sasho , Oncevski Angel 
Published: June 2020

Abstract

Background and Aims
It is well known that haemoglobin significantly increases after haemodialysis and it is associated with the rate of weight loss during dialysis. However, it has been shown that the increase in haemoglobin is not always proportional to the rate of body weight loss during haemodialysis (ultrafiltration). The purpose of the study was to investigate the correlation between haemoglobin changes, body weight loss and plasma volume changes during haemodialysis

Method
A prospective study was performed on 92 patients in mid-week treatments. Pre-dialysis and post-dialysis haemoglobin and weight were measured. 27 patients were excluded because clinical instability, no change or a decrease in Hb and low pre-dialysis haemoglobin (&lt; 9 g/dL). The correlation was statistically significant between %ΔPV and ΔHb in both groups (R2=0.59), whereas the correlation between %ΔBW and ΔHb was lower (R2=0.19). So, analysis show that only 19% of the variability in haemoglobin is explained by %ΔBW, and that 59% of the variability in haemoglobin is explained by %ΔPV.

Results
The mean age was 61.16 ± 13.11 year. The men were 52 (56%). The mean pre-dialysis Hb was 11.31 ± 1.16 g/dL, the mean post-dialysis Hb level was 12.53 ± 1.47 g/dL. The mean absolute change of haemoglobin (ΔHb g/dL) and percent of change of haemoglobin (%ΔHb) were 1.22 ± 0.76 and 9.44 ± 5.31, respectively. Average percent of weight change (%ΔBW) was - 2.44 ± 1.01. Percent of plasma volume change was - 9.22 ± 5.46. The patients were divided in two groups according post-dialysis haemoglobin level: Group A with haemoglobin Hb &lt; 13 g/dL (64 patients) and group B with Hb ≥13 g/dL (28 patients).
The mean time average haemoglobin concentration (TAC Hb) in all patients was 11.68 ± 1.11 g/dL.(Predicted Hb TAC was calculated according Krisper′s formula)
In both groups there was an increase in %ΔHb, but in the group with post dialysis Hb ≥ 13 g/dL, %ΔHb was greater than in group B with post dialysis Hb &lt; 13 g/dL (13.08 ± 5.11 versus 7.87± 4.61, P = 0.000) despite the relatively small difference of %ΔBW between the two groups (- 2.85 ± 0.95 versus - 2.23 ± 1.02; P = 0.010). However, the difference in %ΔPV between the two groups was significant (- 12.90 ± 5.63 versus - 7.61 ± 4.57; P &lt; 0.000).

Conclusion
The intradialytic changes in haemoglobin levels are predominantly determined by changes in plasma volume. Changes in body weight are of little predictive value in evaluation of variation of haemoglobin levels. TAC Hb determination should be performed in patients with large variations in plasma volume, because the plasma volume has very little effect on TAC Hb.
P1087HOME HEMODIALYSIS THROUGH THE YEARS
Authors: Todorov Sakic Verica , Djuric Zivka , Djuric Petar , Bulatovic Ana , Tosic Dragovic Jelena , Naumovic Radomir , Dimkovic Nada 
Published: June 2020

Abstract

Background and Aims
Outcome of dialysis patients differ considerably across the globe and many studies confirmed that home-based treatments offer some advantages, not only in regard of quality of life but also regarding of patients’ outcome. History of home hemodialysis (HOHD) in our country dates from 1971. and since that time many patients were treated with this dialysis modality. HOHD changed over the time together with general improving of dialysis techniques and we aimed to analyze the results of treatment of our population treated by HOHD during different time points.

Method
We analyzed patients characteristics, dialysis and uremia-related complications and survival of patients on HOHD during three different time points: 2001. (No=70), 2011. (No=29) and 2019. (No=22).

Results
The most frequent reason for ESRD in 2001, 2011 and 2019. was glomerulonephritis (48%, 45%, 36% respectively), followed by polycystic kidney disease 24% in 2011. and 36% in 2019. Diabetes mellitus (DM) was rarely cause of ESRD: in 2001. 2.1%; 4.5% in 2019. and none in 2011. In 2001. the patients were more frequently treated using high flux membranes (HF) as compared to HDF (87.1% vs.12.9%), and through years this changed in favor of HDF (48% vs. 52% in 2011, and 13.6% vs. 86.4% in 2019). Anti HCV prevalence was 27.4%, 38%, 27%, in 2001, 2011. and 2019. respectively. Anemia status was better controlled in recent years revealed by Hb level: 10.5±2.0 g/dl in 2001, 12.1±1.6 in 2011. and 11.9±2.3 in 2019. with almost similar percentage of patients treated with ESA (31%, 28% and 36% respectively). In 2001, parathyroid hormone level (iPTH) was 379±236 pmol/l and only 20% of patients underwent parathyroidectomy while in 2011. and in 2019. parathyroidectomy was performed in 69% and 59% of patients respectively. Therefore, in 2011. and in 2019. mean iPTH level was 33.8±48.5 and 40±46.2pmol/l respectively. Kaplan-Mayer analysis confirmed ten-year survival of 42% for period 1982-2001, and the most frequent reasons for death were infection and cardiovascular diseases. During the period 2011. to 2019., ten-year survival was 88% and cardiovascular diseases led to death in most of the cases.

Conclusion
our results have shown that HOHD treatment improved through the years considering patients’ survival, anemia status and secondary hyperparathyroidism treatment. Apart from HDF, the other factors have to be taken into consideration.
P1120QUANTIFICATION OF ACID-BASE TRANSPORT IN HEMODIALYZERS
Authors: Mauro Pietribiasi , Waniewski Jacek , Leypoldt John (Ken) 
Published: June 2020

Abstract

Background and Aims
Quantification of bicarbonate and dissolved carbon dioxide (CO2) transport in hemodialyzers can be described by the product of a dialysance (D) and their respective concentration differences between dialysate and plasma. It is typically assumed that D values are constant for a given hemodialyzer and flow conditions; however, this approach neglects the chemical interconversion of bicarbonate and dissolved CO2 within blood. We assessed the validity of this approach by developing a comprehensive mathematical model of acid-base transport in hemodialyzers.

Method
Mass balance relationships in a hemodialyzer were defined using a one-dimensional model with counter-current flows of blood and dialysate. The molecular biochemistry of bicarbonate, dissolved CO2, and non-bicarbonate buffer in both plasma and erythrocytes, together with carbaminohemoglobins within erythrocytes, was assumed to be in equilibrium as described by Rees and Andreassen (Crit Rev Biomed Eng 2005). The model equations were solved numerically, and optimal mass transfer-area coefficients for bicarbonate and dissolved CO2 were determined by comparing model predictions with the data from Sombolos et al (Artif Organs 2005). The latter data included measured concentrations of bicarbonate and dissolved CO2 in plasma and dialysate inlet and outlet flows at a blood flow rate of 300 mL/min, dialysate flow rate of 700 mL/min, and dialysate bicarbonate concentration of 32.5 mEq/L. Base excess of blood was assumed as -5 mEq/L. Model simulations then evaluated the effect of the plasma bicarbonate concentration at the blood inlet (assuming constant mass transfer-area coefficients and flow rates) on D for both bicarbonate (Dbic) and dissolved CO2 (DCO2). D values were calculated as the loss of the molecule from the dialysate divided by the difference in inlet concentrations of dialysate and plasma.

Results
Optimal mass transfer-area coefficients for bicarbonate and dissolved CO2 were 396 and 1360 mL/min, respectively. Simulation results at different plasma bicarbonate concentrations at the blood inlet ([Bicarbonate]) as expected during a typical hemodialysis treatment are tabulated:

Conclusion
Quantification of acid-base transport in hemodialyzers requires dialysance values for bicarbonate and dissolved CO2 that are not constant but instead are dependent on the plasma bicarbonate concentration at the blood inlet for a given hemodialyzer at fixed blood and dialysate flow rates.
P1122VIRAL INFECTIONS :VHC, VHB AND VIH IN HEMODIALYSIS
Authors: MADIOU Ali 
Published: June 2020

Abstract

Background and Aims
Viral infections, especially those caused by hepatitis B and C viruses are common in chronic hemodialysis patients. The hepatitis C virus is the main cause of post-transfusion hepatitis. The main objective of this study is to determine the prevalence of hepatitis B and C and HIV in chronic hemodialysis patients at the TIZI OUZOU University Hospital Center, as well as the main risk factors for contamination, in chronic hemodialysis patients treated at the from our center.

Method
This retrospective study carried out on 149 chronic hemodialysis patients consisted in searching for anti-HCV, anti-HIV antibodies and the HBs antigen and in determining the possible causes of contamination, in particular the age of the hemodialysis and history of blood transfusion. The characteristics studied for all patients are: demographic characteristics, initial nephropathy, seniority on hemodialysis, the concept of hemodialysis outside our center at the time of dialysis or for a limited period during follow-up ( vacation…), the notion of transfusion; patients are considered to be multi-transfused when they have received more than four transfusions, the search for hepatitis B and C virus infection by ELISA, the concept of hepatic cytolysis: a transaminase level that exceeds 1.5 times normal, vaccine status, HIV serology

Results
The average age of our 149 patients varies between 19 and 82 years with a male predominance (92 men and 57 women) and an average duration of dialysis of 90 months. The predominant etiology of IRCT is vascular nephropathy. We also note other causes including glomerular, diabetic and tubulointerstitial nephropathies. The etiology was largely undetermined. Hepatic serology C is positive in 5% of patients. None of our patients tested positive for HBS. No case of HIV infection has been noted.
The prevalence of hepatitis B and C in hemodialysis patients varies from country to country but remains higher than in the general population (HCV: 2.7-22.2% in the DOPPS register). In our series the prevalence is around 5% lower than that reported in other regional and international studies.

Conclusion
In hemodialysis, the risk of infection is very high, on the one hand due to access to regular blood and on the other hand due to the alteration of the immune defenses induced by chronic renal failure. Nosocomial transmission plays a very important role. It is strongly linked to the age of dialysis. Compliance with hygiene measures is a very essential element; isolation of the infected patient is no longer recommended
P1123HEMOPERFUSION COMBINED WITH CRRT IN SEPTIC SHOCK AKI PATIENTS CAUSED BY OSTEOFASCIAL COMPARTMENT SYNDROME
Authors: Sheng Xiaohua , Wang Niansong , Huang Weifeng , Yu Gang , Bao Hongda , Liu Yumei , Fei Yang 
Published: June 2020

Abstract

Background and Aims
Although Osteofascial compartment syndrome is rare, it can cause severe complications, including septic shock and acute kidney injury. Most commonly found on the palmar side of the forearm and lower leg. This article reported two cases of septic shock with acute kidney injury caused by osteofascial compartment syndrome, and explored the application of hemoperfusion combined with continuous renal replacement therapy in these two severe patients.

Method
Two young men, patient A was 38 years old and patient B was 44 years old. Hospitalized in June 2016 and February 2018, respectively. Previous healthy, after questioning, patient A had a history of type 1 diabetes and patient B had a history of gout. Patient A had a history of being beaten by his wife, patient B has no clear history of injury. Patient A showed swelling and pain in the right forearm and patient B showed swelling and pain in the right lower leg. After admission, they quickly developed shock, oliguria, acute kidney injury, multiple organ dysfunction. They were received fluid resuscitation, vasopressors, anti-infectives, respiratory support, nutritional support, and vital signs monitoring. Blood culture of patient A showed a case of group A hemolytic streptococcus, patient B showed streptococcus pyogenes and staphylococcus hemolytic. Patient A was performed CRRT for 3 days, combined with two hours hemoperfusion (HA-330, Jafron, Zhuhai City, China) on the first day of CRRT, once every 24 hours for two days. Patient B was performed CRRT for 16 days. combined with two hours hemoperfusion (HA-330, Jafron, Zhuhai City, China) on the first day of CRRT, once every 24 hours for two days. Both patients underwent multiple orthopaedic surgeries. Patient A underwent right upper limb amputation and patient B underwent right thigh amputation.

Results
After hemoperfusion, the amount of norepinephrine was significantly reduced, and the circulation became stable. Finally, two patients improved and were discharged from the hospital, and their renal function returned to normal.

Conclusion
Once the osteofascial compartment syndrome is diagnosed, the fascia should be decompressed immediately. After local incision and decompression, blood circulation is improved, and a large number of toxins from necrotic tissue enter the blood circulation, which can lead to serious complications such as sepsis, shock, acute kidney injury, and multiple organ failure. Renal replacement therapy and amputation surgery may save lives. Hemoperfusion can reduce the amount of norepinephrine, improve circulation and win surgical opportunities.
P1124A NOVEL ALGORITHM TO IDENTIFY PRESUMABLY FLUID OVERLOADED HEMODIALYSIS PATIENTS
Authors: Preciado Rojas Priscila , Zhang Hanjie , Kotanko Peter 
Published: June 2020

Abstract

Background and Aims
Adequate volume control is a major challenge in hemodialysis (HD) patients, as both fluid overload and depletion are associated with increased morbidity and mortality. In many cases, fluid overloaded patients may require further interventions, e.g. increasing ultrafiltration volume, treatment time or additional HD sessions to achieve their prescribed target weight. Relative blood volume (RBV) monitoring is widely used in HD patients, and past evidence suggests that flat RBV slopes indicate fluid overload [1,2]. The goal of this study was to develop an algorithm that would allow clinicians to identify presumably fluid overloaded HD patients based on a small number of consecutive RBV recordings.

Method
We based our analysis on the 842 prevalent HD patients enrolled in our previously published multicenter study [1], where RBV (Crit-Line®, Fresenius Medical Care, Waltham, MA) was assessed over a 6-month baseline period and all-cause mortality recorded during a median follow-up of 30.8 months; we found in this study that attainment of a RBV between 86 and 92% three hours into the HD session was associated with significantly better patient survival.
The goal of our current research was to develop an algorithm that would require an observation period much shorter than 6 months yet yield clinically meaningful sensitivity and specificity to identify (presumably fluid overloaded) patients with flat RBV profiles (“flat” being defined as RBV &gt; 92% at 3 hours.) We categorized patients in study [1] as either “positive” (their mean RBV at 3 hours was &gt;92%) or “negative”. We computed sensitivities and specificities relative to the “positive” and “negative” cases for 1 to 15 HD sessions and various rates of treatments with flat RBV curves (30, 40, 50 and 60%).

Results
Sensitivities, specificities, and Youden’s indices (= sensitivity + specificity – 1) for 1 to 15 treatments and across the different rates of “positive” RBV curves are shown (Figure 1). We found a sensitivity of 92%, a specificity of 80%, and a Youden’s index of 73% when &gt;=50% of 10 preceding treatments were “positive”. Based on these results we propose an RBV based algorithm to identify “positive” cases (i.e. patients with a flat RBV profile) (Figure 2).

Conclusion
Our algorithm requires only a small number (10) of RBV readings to identify presumably fluid overloaded patients with a clinically acceptable sensitivity (92%) and specificity (80%). It would be of interest to compare the performance of this algorithm with volume status as determined by bioimpedance; however, bioimpedance has not yet been approved for use in HD patients in the U.S.