bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1461FRAILTY IN PREVALENT HEMODIALYSIS PATIENTS. APLICATION OF FRAILTY INDEX BASED ON GERIATRIC INTEGRAL ASSESSMENT (IF-VIG)
Authors: Anton-Perez Gloria , Henriquez Fernando , Sánchez Ana Yurena , Valga Francisco , Monzon Tania 
Published: June 2020

Abstract

Background and Aims
Frailty is defined as a state of greater vulnerability with less compensatory mechanisms to stressors and is related to worse health outcomes, with the estimated prevalence in the general population&gt; 65 years of approximately 10% and is still higher in population with Chronic Renal Disease (CKD) (26-73%). The Frailty Index based on the Geriatric Integral Assessment (IF-VIG) has been described as a simple tool, fast, with discriminative capacity and predictive (with high correlation with mortality) in geriatric population, but its application in Hemodialysis population has not been reported. We study the frailty in prevalent population in Hemodialysis (HD) applying the IF-VIG, its variables associated and its complications.

Method
observational and prospective, non-interventional study, 361 prevalent patients on hemodialysis in Las Palmas, of the centers of AVERICUM and the Hemodialysis Unit at C.H.U.I.M.I. Demographic and clinical data, related to the technique and dose of dialysis, the Malnutrition-Inflammation Scale (MIS) biochemical parameters and anthropometric parameters were collected.

Results
361 patients, 65% were men, 55% diabetics. Median age: 67 years (57-76), average time in HD o 40 months (20-77). 45% were dialyzed with Central Venous Catheter (CVC) as vascular access (AAVV). The median Charlson Comorbidity Index was 8 (6-9), 242 patients (69% of the population studied) had some degree of malnutrition according to the Malnutrition-Inflammation Scale (MIS), presenting a MIS ≥ 5. A total of 239 patients (66% of the population) were fragile (IF-VIG ≥ 0.20). The clinical variables predictive of frailty were age, sex, comorbidity, the use of CVC as AAVV in HD, the time in the technique and the dialysis dose measured as the average Kt of the last 12 sessions. Table 1. Exitus and hospitalizations were significantly more frequent in the fragile population.

Conclusion
The prevalence of frailty by applying IF-VIG in HD population is very high (66%), including 54% of patients &lt;65 years. The factors associated with frailty in our population were male sex, age, comorbidity, time in the technique, dose of dialysis measured by Kt and the use of CVC as AAVV in HD. Up to 69% of fragile patients are malnourished according to the MIS scale, presenting an MIS ≥5. Exitus and hospitalizations are significantly more frequent in fragile patients. Early identification of fragile patients in HD and the reversible factors associated with this entity would lead to an early multidisciplinary approach, with the aim of reducing the morbidity and mortality of this population.
P1463EARLY VASCULAR ACCESS CREATION IS NOT ASSOCIATED WITH BETTER OUTCOME IN PATIENTS AFTER CHRONIC DIALYSIS INITIATION
Authors: Iwata Yukimasa , Okushima Hiroki , Takatsuka Taisuke , Yoshimura Daisuke , Kawamura Tomohiro , Ueda Yoshiyasu , Shoji Tatsuya , Hayashi Terumasa 
Published: June 2020

Abstract

Background and Aims
Although initiation of chronic hemodialysis with central venous catheters are associated with higher mortality compared to that with arteriovenous fistula, the association between the timing of vascular access (VA) creation and outcome after dialysis initiation is not fully investigated. Thus, we conducted single center retrospective cohort study on incident hemodialysis patients to investigate the effect of VA types and timing of VA creation on all-cause and cardiovascular mortality after dialysis initiation.

Method
A total of 1052 patients with accurate clinical data and outcomes was extracted from 1069 patients who started chronic hemodialysis treatment at Osaka General Medical Center between 2006 and 2015. Clinical status at dialysis initiation, all-cause and cardiovascular mortality were compared by three patient groups categorized by VA types and timing of VA creation: temporary catheter (TC) group, dialysis initiation with TC; early VA (EVA) group, dialysis was initiated more than one month after VA creation; late VA (LVA) group, dialysis was initiated within one month after VA creation. Cox proportional hazards analysis was used to examine predictive factors for outcomes.

Results
Median age was 70 years and 64% of patients were male. Patient number of each group was 285 (27%), 441 (42%), and 326 (31%) for TC, EVA, and LVA groups, respectively. Although there was no significant difference in eGFR at dialysis initiation among three groups ([median] 5.4 vs. 5.4 vs. 5.4 mL/min/1.73m2, respectively, P=0.881), hemoglobin and albumin were lower in TC group compared to EVA and LVA groups (hemoglobin [median] 8.3 vs. 9.5 vs. 8.9 g/dL, respectively, P&lt;0.001; albumin [median], 3.0 vs. 3.5 vs. 3.2 g/dL, respectively, P&lt;0.001). Kaplan-Meier curves revealed significant difference among three groups for all-cause (P&lt;0.001) and cardiovascular mortality (P&lt;0.001). On multivariate Cox proportional hazards analysis, timing of VA creation was not associated with all-cause and cardiovascular mortality. Although temporary catheter usage at dialysis initiation was significantly associated with all-cause mortality (HR, 1.91; 95%CI, 1.30-2.83; P=0.001), it was not associated with cardiovascular mortality (HR, 1.64; 95%CI, 0.79-3.43; P=0.186).

Conclusion
Timing of VA creation was not associated with all-cause and cardiovascular mortality, whereas hemodialysis initiation with TC was significantly associated with increased all-cause mortality.
P1463AMORTALITY AND HOSPITALIZATION PATTERNS IN ELDERLY HEMODIALYSIS PATIENTS. A LARGE SAUDI STUDY
Authors: Moussa Ayman , Abderrahim Ezzedine , Dridi Afef , Jubran Ibrahim , Alobaili Saad , Alahmadi Salwa , Albadr Wisam 
Published: June 2020

Abstract

Background and Aims
The aim of the study was to analyze hospitalization and mortality parameters in Saudi elderly patients undergoing hemodialysis for end stage renal disease.

Method
The study population included all patients admitted at Davita-KSA clinics to continue renal replacement by hemodialysis during the period October 2014-December 2018. Two groups were identified according to age at admission to Davita clinics: Group 1 (age&gt;=65 years), Group 2 (age&lt;65 years). Zero time data, including demographic and clinical characteristics were recorded at admission. Also, all deaths and morbid events necessitating hospital admission were regularly recorded during the follow-up period.
Annual mortality and hospitalization rates with the corresponding confident intervals were calculated as appropriate. Survival rates were calculated according to actuarial method logistic regression was used to identify factors influencing hospitalization and mortality.

Results
Elderly patients represented 23.84% of 3508 included patients (G1),). The sex ratio was of 1.07 Vs. 1.21 in control group (NS). ESRD was attributed to diabetes in 52.7% of elderly patients Vs. 36.3% in others (&lt;0.0001). The median duration of HD before joining Davita-clinics was of 6.5 months in G1 Vs. 11.5 months in G2 (p&lt;0.0001). There is no significant difference between the 2 groups regarding vascular access type, BMI and hemoglobin rate.
The proportion of patients who were hospitalized was of 30.8% in G1 Vs. 24.6% in G2 (p&lt;0.0006) corresponding to an annual rate of 37.33% (CI, 95%: [33.93-40.73]) in G1 Vs. 25.64 (CI, 95%: [24.14-27.15]) in G2. The annual rate of hospital stay was of 4.38 days per patient in G1 (CI, 95%: [4.26-4.49]) Vs. 3.11 in G2 (CI, 95%: [3.06-3.16]). The annual mortality rate was 13.36% in G1 (CI, 95%: [11.32-15.38]) Vs. 5.33% in G2 (CI, 95%: [4.64-6.01]). Survival rates in Group 2 were of 98.6, 95.4, 90.5 and 78.6% at 3, 12, 24 and 48 months respectively Vs. 96.1, 89.3, 78.8 and 55.8% in G1 (p&lt;0.0001).
Adjusted hospitalization and mortality risks were of 1.271 (CI, 95%: [1.065-1.516]; p&lt;0.008) and 2.257 (CI, 95%: [1.794-2.841]; p&lt;0.0001) in elderly patients compared to other patients.

Conclusion
Our study demonstrated that Saudi elderly hemodialysis patients remain a group at high risk for hospitalization and mortality.
P1464ROUTINELY MEASURED CARDIAC TROPONIN I AND NT-PROBNP AS PREDICTORS OF MORTALITY IN JAPANESE HEMOLIALYSIS PATIENTS: THE DIALYSIS OUTCOMES AND PRACTICE PATTERNS STUDY
Authors: Eriguchi Masahiro , Tsuruya Kazuhiko , Lopes Marcelo , Bieber Brian , McCullough K P , Pecoits-Filho Roberto , Robinson Bruce , Pisoni Ronald , Kanda Eiichiro , Iseki Kunitoshi , Hirakata Hideki 
Published: June 2020

Abstract

Background and Aims
Due to the interplay of chronic kidney disease and the heart, it is common for myocardial damage and strain to be present in patients with end stage kidney disease. The cardiac biomarkers Troponin I (cTnI) and the N-terminal fragment of prohormone brain natriuretic peptide (NT-proBNP) are strongly predictive of heart failure in the general population, however the value of their routine measurement for stratification of risk in hemodialysis (HD) patients is unknown. International DOPPS data indicate that these cardiac biomarkers are measured in fewer than 2% of hemodialysis patients in real-world practice. We sought to test the associations of cTNI and NT-proBNP with death in a large HD cohort.

Method
We analyzed data from 1169 prevalent Japanese hemodialysis patients in DOPPS phase 5 (J-DOPPS; 2012-2015) where pre-dialysis levels of cTnI and NT-proBNP at study enrollment by protocol for all participants. We used Cox regression to test the association of the cardiac biomarkers with all-cause mortality, adjusting for potential confounders. We conducted stratified analyses to assess potential effect modification of individual clinical characteristics: age, systolic blood pressure, dialysis vintage, diabetes mellitus, cardiovascular disease, and heart failure (CHF).

Results
Median (interquartile range) cTnI and NT-proBNP levels were 0.018 [0.005, 0.04] ng/mL and 3432 [1580, 8017] pg/mL, respectively. There was a positive direct association between cTNI and NT-proBNP (Spearman correlation coefficient=0.58). We observed 174 deaths during a median [IQR] follow-up time of 2.8 [2.3, 2.9] years. Compared to the reference group of cTNI&lt;0.01 the hazard ratio (HR) of death (95% CI) was 1.23 (0.57, 2.69) for cTNI ≥0.01 to 0.02; HR=1.94 (1.12, 3.37) for cTNI ≥0.02 to 0.04; and HR=3.65 (2.14, 6.23) forcTNI&gt;0.04. Compared to the reference group of NT-proBNP &lt;2000 pg/mL, HR= 1.20 (0.65, 2.23) for NT-proBNP ≥2000 to 4000 pg/mL; HR= 2.06 (1.22, 3.46) for NT-proBNP &gt;4000 to 8000 pg/mL; and 3.23 (1.71, 6.09) for NT-proBNP &gt; 8000pg/mL. For both variables associations with mortality were comparable in patients with and without heart failure (p values for interaction=0.07 and 0.19, for NT-proBNP and cTNI, respectively) and according to other stratification variables (the p values for interaction were &gt;0.15 for all other stratified models).

Conclusion
Routinely measured (not by indication) NT-proBNP and Troponin I are strongly associated with mortality among prevalent Japanese HD patients. Routine evaluation of these cardiac biomarkers in HD patients with or without a previous diagnosis of CHF may help identify patients at risk of death who may have undetected heart failure or cardiac strain due to fluid overload.
P1468ASSESSING THE BURDEN OF CHRONIC PAIN IN PATIENTS UNDERGOING HAEMODIALYSIS: A CROSS-SECTIONAL OBSERVATIONAL STUDY
Authors: Bell Samira , Lambourg Emilie , Guthrie Greg , Murugan Krithi , Colvin Lesley , Traynor Jamie P 
Published: June 2020

Abstract

Background and Aims
Chronic pain is a global health problem estimated to affect between 20- 50% of the population and is associated with increased hospitalisations placing a significant burden on healthcare resources. The burden of chronic pain is thought to be especially high in patients undergoing renal replacement due to underlying co-morbidities such as diabetes, peripheral vascular disease and renal bone disease. There is, however, a lack of data out with the United States quantifying the burden in patients undergoing chronic dialysis. The aim of this study was to establish the burden of chronic pain through examination of prescribing records in patients undergoing chronic dialysis.

Method
We performed a cross sectional observational study in 2 Scottish health boards (together serving 1.9 of Scotland’s 5 million population). Data were collated on age, dialysis vintage, primary renal diagnosis and analgesia prescribing specifically examining whether patients were prescribed paracetamol, non-steroidal anti-inflammatory agents, opioids or gabapentinoids. Descriptive statistics were performed.

Results
721 patients receiving haemodialysis were included in the analysis (141 from the Tayside area and 580 from Greater Glasgow and Clyde). Mean age was 64 years old (SD 14.4) with a median time since commencing renal replacement therapy of 3 years (IQR 1.4-6.4). The primary renal diagnosis was diabetes for 28% of the patients, multisystem diseases for 21.6%, interstitial nephropathies for 21.5%, primary glomerulonephritis for 15.8%, and unknown or related to another disease for 10%. Of these 527 (73%) were prescribed a form of analgesia. 404 patients (56%) were prescribed paracetamol, 14 (1.9%) were prescribed a non-steroidal anti-inflammatory, 96 (35.4%) an opioid, 71 (9.8%) a combination of paracetamol with opioid, 170 (23.6%) a gabapentinoid and 100 (14%) were prescribed both a gabapentinoid and opioid. There was no difference in age between those receiving analgesia and those who were not (63.5 vs 65.2, p=0.13). However patients receiving opioids were significantly younger than those who were not prescribed any opioid (62.2 SD 13.9 vs 65 SD 14.5, p-value = 0.001; Wilcoxon rank sum test). There was no difference in percentage of patients receiving analgesia by primary renal diagnosis: Figure 1 (Chi-square test, p=0.1).

Conclusion
Prescribing rates of analgesia are high in patients undergoing chronic dialysis suggesting a high burden of chronic pain.
Number of patients receiving analgesia (in red) or not (in blue), depending on their primary renal diagnosis. 1=primary glomerulonephritis, 2=interstitial nephropathies, 3=multisystem diseases, 4=diabetic nephropathy, 5=not known or other
P1475THE THRESHOLD OF BECK DEPRESSION INVENTORY SCORE AS A POTENTIAL PREDICTOR OF ALL-CAUSE MORTALITY IN END-STAGE RENAL DISEASE PATIENTS WITH DIALYSIS IN CHINA
Authors: Liu Bo , Fu Sha , Liang Peifen , Li Jiajia , Han Qianqian , Yang Qiongqiong 
Published: June 2020

Abstract

Background and Aims
Depression is the most frequent psychologic problem among end-stage renal disease (ESRD) patients with dialysis. The Beck Depression Inventory (BDI) is considered to be the standard instrument for assessing symptoms of depression and screening for clinical depression. The level of BDI score associated with mortality in ESRD patients with dialysis remains controversial. High quality evidence is lacking, especially in China. The aim of our study is to evaluate the threshold of BDI score as a potential predictor of all-cause mortality in ESRD patients with dialysis in China.

Method
We conducted a retrospective cohort study involving adults who were treated with dialysis in the department of nephrology of Sun Yat-sen Memorial Hospital in Guangzhou, China between April 2006 to July 2017. Depression symptoms, sleep quality, health-related quality of life were assessed via the BDI- = 2 \* ROMAN \* MERGEFORMAT II, the Pittsburgh Sleep Quality Index (PSQI) and the 36-item Short Form Health Survey Questionnaire (SF-36) respectively. The primary endpoint of interest was all-cause mortality. Cox proportional hazards regression analysis was performed.

Results
109 dialysis patients with an mean age of 50.2 years provided complete responses to the BDI-II questionnaire. The median follow-up time for the cohort was 68.6 months until Dec 1, 2019. There were 21 deaths (19.3%). Univariate analyses indicated that age (RR=1.039, 95% CI 1.002, 1.076, P =0.039), PSQI score (RR=1.170, 95% CI 1.047, 1.306, P =0.005), pre-existent cardiovascular disease (RR=3.223, 95% CI 1.310, 7.932, P =0.011), pre-existent diabetes mellitus (DM) (RR=3.321, 95% CI 1.393, 7.919, P =0.007), and BDI score ≧17 (RR=4.247, 95% CI 1.730, 10.429, P =0.002) were significantly associated with an increased risk for all-cause mortality, while physical component summary (PCS) of SF-36 (RR=0.971, 95% CI 0.950, 0.992, P =0.007) and mental component summary (MCS) of SF-36 (RR=0.968, 95% CI 0.948, 0.988, P =0.002) with a decreased risk for all-cause mortality. In the multivariate Cox regression model, DM (RR=3.658, 95% CI 1.532, 8.733, P =0.003) and BDI score ≧17 (RR=4.454, 95% CI 1.808,10.974, P =0.001) were independent predictors of all-cause mortality.

Conclusion
This study revealed that BDI score ≧17 was a predictor of all-cause mortality in ESRD patients with dialysis. Further prospective trials will be required to determine whether the treatment of depression in dialysis patients would alter health-related outcomes, including survival.
P1477EFFECT OF INTRADIALYTIC EXERCISE IN A MEXICAN MAINTENANCE HEMODIALYSIS POPULATION
Authors: Chavez-Mendoza Carlos , MANZO-ARELLANO LUIS IGNACIO , SANTILLÁN-CERÓN AIRY , CASTILLO-JUÁREZ SAGRARIO , RAMÍREZ-SALGADO CÉSAR ULISES , RODRÍGUEZ-GARCÍA ADÁN 
Published: June 2020

Abstract

Background and Aims
The use of intradialytic exercise has been associated with improved clearance, oxygen consumption, quality of life, and physical performance. The aim of this study was to describe the association between of intradialytic exercise and some outcomes in a Mexican maintenance hemodialysis (HD) population.

Method
Observational comparative study that included 84 maintenance HD patients from one HD center in Mexico City. The population was grouped according to the intradialytic exercise local record. The aerobic intradialytic exercise protocol includes cycling for 30-45 min during the first 2 hours of the HD according to each patient’s ability. A retrospective registry of clinical and biochemical parameters was realized. Also, the hemodynamic parameters of the last six HD sessions for each patient was included. Data analysis was carried out through descriptive and inferential statistics.

Results
Of the total population, 45.2% were men (n= 38) and the mean age was 53.6 + 17 years. Fifty one percent (n= 43) had diabetes mellitus (DM), which resulted more prevalent in the subgroup of patients without intradialytic exercise (p=0.03) No differences between groups were present in age, history of previous peritoneal dialysis or kidney transplant. The rest of baseline data are shown in Table 1. The subgroup of patients who underwent intradialytic exercise presented higher levels of serum albumin (p=0.03) and lower levels of parathormone (p=0.03). A total of 504 HD sessions were analysed and intradialytic exercise was performed in 64.3% (n=324). Patients in the intradialytic exercise program presented high levels of systolic and diastolic blood pressure (graphic 1). Intradialytic hypotension occurred in 5.2% (n=26) and no differences are shown between groups (p=0.78). No mayor side effects were reported.

Conclusion
The intradialytic exercise could improve nutritional and bone-mineral status markers. The patients in an intradialytic exercise program presented higher levels of blood pressure.
P1479HIGHER FREQUENCY OF FRUIT INTAKE IS ASSOCIATED WITH LOWER RISK OF CONSTIPATION IN HEMODIALYSIS PATIENTS - A MULTI-CENTRE STUDY
Authors: Dos Santos Rafaela G , Malinovski Juliana , Scatone Natália , De Oliveira Jorgiane , Sczip Andrea , Moraes Jyana , NERBASS FABIANA 
Published: June 2020

Abstract

Background and Aims
Constipation is a multifactorial gastrointestinal disorder commonly found in hemodialysis (HD) patients. In this multi-centre cross-sectional study, we aimed to evaluate the prevalence and factors associated with constipation, including the frequency of dietary fiber sources intake.

Method
Prevalent HD patients from four dialysis clinics in Southern Brazil were invited to participate (at least 80% of eligible patients from each clinic). Patients were interviewed by the researchers and answered a questionnaire that comprised ROMA III criteria questions to assess constipation status, use of medications and life habits. A food frequency questionnaire (FFQ) with the main dietary fiber sources (fruits, vegetables, legumes, whole grains cereals and seeds) was applied with seven frequency possibilities (from never to more than twice a day). To estimate the weekly frequency of intake, answers were transformed into a score. Every score point corresponded to one time per week (ex.: score 7 = seven times per week). Demographical and laboratory data were obtained from medical records. Univariate analysis was used to compare participants according to constipation status and variables with P&lt;0.20 were included in the regression analysis model.

Results
305 HD patients were included (male: 51%; age: 52.2 ± 14.7 years old; HD vintage: 46 (19 – 82) months). Ninety-three participants had constipation (30.5%). Median (interquartile) FFQ scores were: fruits: 6 (2-14); vegetables: 6 (3-10); legumes: 3 (1-7); whole-grain: 0 (0-1) and seeds: 0 (0-0). In univariate analysis, participants with constipation were significantly older (55.1 ± 14.8 versus 51.0 ± 14.5 years old; P=0.02), had lower literacy (5 (5-11) versus 8 (4-13) years at school; P=0.007), higher prevalence of diabetes (41 versus 23%; P=0.002) and lower total beverage intake (15 (12-20) versus 17 (12-24) ml/kg/day; P=0.04). The logistic regression analysis model also included body mass index; wheelchair need; sedentarism; fruits score and seeds score (all with P&lt;0.20 in the univariate analysis).The independent predictors of constipation were diabetes (OR=1.96 (95%IC 1.07-3.6);P=0.03) and fruits intake score (OR=0.95 (95%IC 0.91-0.99);P=0.04)

Conclusion
Almost one-third of participants had constipation, and usual intake of fiber food sources was low. The independent determinants of constipation were diabetes and a lower frequency of fruit intake. Nutritional counselling to increase fiber intake sources can potentially decrease the prevalence of constipation of this population.
P1484PROGRESSION OF AORTIC ARCH CALCIFICATION IS ASSOCIATED WITH OVERALL AND CARDIOVASCULAR MORTALITY IN HEMODIALYSIS
Authors: Chen Hung-Chun , Chiu Yi-Wen , Chang Jer-Ming , Chen Szu-Chia 
Published: June 2020

Abstract

Background and Aims
Vascular calcification is common and associated with unfavorable outcomes among patients with end-stage renal disease (ESRD). However, little is known whether the progression of vascular calcification outweights the baseline calcification in association with overall and cardiovascular (CV) mortality in hemodialysis (HD) patients.

Method
This study included 140 maintenance HD patients. Vascular calcification was assessed using aortic arch calcification (AoAC) score measured from chest radiographs at the baseline and the second year of follow-up. Progression of vascular calcification (△AoAC) was defined as the difference between the two measurements of AoAC. The association of △AoAC with overall and CV mortality was evaluated using multivariable Cox regression analysis.

Results
During the mean follow-up period of 7.8 years, there were 49 (35%) overall mortality and 27 (19.3%) CV mortality. High brachial-ankle pulse wave velocity was positively correlated with △AoAC, whereas old age and high hemoglobin were negatively correlated with △AoAC. In multivariate adjusted Cox analysis, increased △AoAC (per 1 unit), but not baseline AoAC, was significantly associated with overall mortality (HR, 1.183; 95% CI, 1.056–1.327; p = 0.004) and CV mortality (HR, 1.194; 95% CI, 1.019–1.398; p = 0.028).

Conclusion
Progression of AoAC outperformed the baseline AoAC in association with increased risk of overall and CV mortality in HD patients. Regular follow-up of chest radiograph and AoAC score assessments are simple and cost-effective to identify the high-risk individuals of unfavorable outcomes in maintenance HD patients.