bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1563THE ANALYSIS OF RISK FACTORS FOR THE PATIENTS EXPERIENCED VENOUS NEEDLE DISLODGEMENT OR BLEEDING DURING DIALYSIS
Authors: Wu Hsiu Wen , Lin HsuanMing , Chen KuanYu , Lin YuChih , Hu HsiangWei 
Published: June 2020

Abstract

Background and Aims
A puncture of vascular access is commonly used in clinical treatment, such as hemodialysis or central venous catheters. At this time, leakage or infection associated with Venous needle dislodgement(VND) is a high risk of fatality, especially for patients with restlessness, impaired cognition, isolation, or home dialysis. At present, a few studies believe that many risk factors are associated with venous needle dislodgment and bleeding, including difficult needle fixation, restlessness, unconsciousness, or abnormal movement. However, only a few studies are focusing on patient disease, medication, and other risk assessments. Therefore, this study aims to explore the risk factors of patients with venous needle dislodgment and bleeding and hope to establish the risk classification.

Method
This study was a prospective study conducted in the hemodialysis room of Tainan Regional Hospital. Before starting to collect the venous needle dislodgment and bleeding data, we performed a training program for medical and nursing staff, including venous puncture, fixation, puncture site assessment, and management. During the three months from July 2019 to 2019/9, we collected clinical data were collected, including patient sex, gender, diseases, records of dialysis access blockage, anticoagulant dose, and a high-risk assessment record (eight risk factors). Finally, we analyzed the data and compared the data between the two groups of patients who experienced needle dislodgement and bleeding. We applied statistical software STATA, chi_square, z-test. P&lt;0.05 was defined as significant.

Results
Seventy patients were included in this study, with an average age of 63.23 (± 1.2 years) and 45 males (64.28%). In 2019 / 7-9, there were a total of 32 patients with 72 venous needle dislodgment and bleeding. The patients with the condition as below were considered high-risk patients. In terms of gender, whether it is a high risk, diabetes, high blood pressure, whether to use sleeping pills, diabetic hypotension, whether to use warfarin or to use anticoagulant doses are all not statistically significant. The proportion of patients with vascular-access and undergoing percutaneous transluminal angioplasty was 35.2% (11) in high-risk patients and 10.3% (4) in low-risk patients, p &lt;0.01.

Conclusion
Before data collection in this study, a standardized training program was performed for medical care and vascular access monitoring. However, there were no new risk factors were found. This research model can provide a new direction for further research.
P1567THE ANNUAL VARIATION OF CRA/ALBUMIN RATIO IS AN ACCURATE PROGNOSTIC FACTOR IN DIALYSIS PATIENTS
Authors: Yasuda Kaoru , Takahashi Hiroshi , Morozumi Kunio , Maruyama Shoichi 
Published: June 2020

Abstract

Background and Aims
Protein energy wasting (PEW) is a distinctive malnutrition status in hemodialysis(HD) patients, and it is closely related to poor prognosis. We previously reported that CRP/Alb ratio is useful marker for assessment of malnutrition status in HD patients. However, the value of CRP/Alb ratio calculated by CRP and serum albumin level is considered to be varied over time, and correlation between the amount of change and the prognosis is uncertain. The purpose of this study is to investigate the effect of the changing in CRP/Alb ratio within a certain period of time on prognosis of dialysis patient.

Method
320 patients who were received stable dialysis therapy were enrolled in the study. It was analyzed that the relation between the changing in CRP/Alb ratio within one year and the prognosis. Furthermore, patients were divided by the values of CRP/Alb (&gt;0.35) and ΔCRP/Alb ratio (&gt;0.05) as a threshold (4 groups of 2 × 2), and analyzed for the prognostic value.

Results
During the observation period (median 71 months), 138 patients were died (43.1%). Baseline CRP/albumin ratio, both of continuous value and cut-off value of 0.34 as median, was identified as an independent predictor for 7-year mortality. The CRP / Alb ratio at one year increased from 0.40 (0.46-1.7) to 0.47 (0.22-1.48) (p = 0.0040). The 7-year survival rate was 44.7% in the group with increased ΔCRP / Alb ratio and 57.0% in the group with non-increased (p = 0.020). The adjusted hazard ratio was 1.45 (95% CI 1.02-2.06, p = 0.037, increase group vs non-increase group). On combined setting of each predictors, mortality risk was clearly stratified, and patients with high and increased CRP/albumin ratio had 2.84-fold (95%CI 1.65-5.03) higher risk of mortality compared to patients with low and no-increased CRP/albumin ratio

Conclusion
The increasing rate of CRP/Alb ratio were strong predictors of mortality as well as the baseline CRP/Alb ratio levels, and both of them additively improved the predictability for mortality in chronic HD patients.
P1569ADIPONECTIN IS ASSOCIATED WITH DECLINE IS SKELETAL MUSCLE MASS AND BONE MINERAL CONTENT IN PATIENTS ON HEMODIALYSIS
Authors: Ogawa Hiroshi , Koga Toshimitsu , Fuwa Daisuke , Tamaki Hirofumi , Nanbu Takayuki , Kojima Yuko , Ota Yoshihiro , Sato Azumi , Kindaichi Akihiro , Hiraga Keiko 
Published: June 2020

Abstract

Background and Aims
Patients on hemodialysis are prone to undernutrition, malnutrition-inflammation-atherosclerosis (MIA) syndrome, and protein-energy wasting (PEW). One of the major adipocytokines adiponectin (ADPN) is involved in anti-arteriosclerotic and anti-inflammatory processes. However, ADPN is implicated in muscle weakness and loss of muscle mass in the elderly in addition to sarcopenia.
At the 2019 ERA-EDTA Congress, we announced that total plasma ADPN levels in patients on hemodialysis (HD) showed a significant inverse correlation with BMI, body fat in percentage, mass and estimated skeletal muscle mass, and ADPN may be involved in sarcopenia in patients on HD. Herein, we investigated the association of ADPN level with sarcopenia in patients on HD using a method different from the one used in our previous study. We examined the relationship between total plasma ADPN level and the rate of change in estimated skeletal muscle mass, bone mineral content, and body fat mass over 5 years after the plasma ADPN measurement. Furthermore, we analyzed whether an elevated ADPN level was predictive of a subsequent decline in these parameters.

Method
Total plasma ADPN levels were measured using ELISA (Bio Vendor-Laboratorni Medicina a.s., Czech Republic) in 42 male patients on HD (age: 51.1 ± 9.0 years, dialysis vintage: 144.8 ± 99.2 months, BMI: 21.8 ± 3.2, dry BW: 62.0 ± 10.9 kg, dialysis time: 15.6 ± 3.1 hours/week). The estimates of skeletal muscle mass, bone mineral content, and body fat mass were made using multi-frequency bioelectrical impedance analysis (MFBIA) within the same year when total plasma ADPN level were first measured in 2011 as well as in 2016. We then calculated the rates of change in the estimated skeletal muscle mass, bone mineral content, and body fat mass over the 5 years and correlated these parameters with the total plasma ADPN measurements.

Results

Conclusion
Total plasma ADPN levels inversely correlate with larger rates of decrease in estimated skeletal muscle mass and bone mineral content in patients on HD. This suggests that ADPN may play a role in the decline in skeletal muscle mass and bone mineral content over time in patients on HD.
P1571WEEKLY VERSUS MONTHLY ORAL CHOLECALCIFEROL ON OXIDATIVE STRESS AND INFLAMMATORY MARKERS IN HEMODIALYSIS PATIENTS: A PROSPECTIVE RANDOMIZED TRIAL
Authors: Alshahawey Mona , ElWakeel Lamia , El Said Tamer , Sabri Nagwa 
Published: June 2020

Abstract

Background and Aims
Vitamin D deficiency is now considered a global problem in general population, but it seemed to be more prominent in chronic kidney disease (CKD) patients, especially those on regular hemodialysis. Being a key regulator in mineral metabolism, there’s also emerging evidences linking vitamin D deficiency with inflammation and oxidative stress, which are both recognized as constant threats to cardiovascular outcomes in hemodialysis patients. However, data is still limited regarding an exact treatment protocols or regimens for vitamin D supplementation in such category.

Method
A prospective, randomized trial was carried out to evaluate the effect of weekly versus, monthly oral cholecalciferol, on vitamin D (25(OH)D) levels, oxidative stress markers, inflammatory markers and secondary hyperparathyroidism in hemodialysis patients. Fifty eligible hemodialysis patients were randomly assigned to either Group A (Oral 50.000IU Cholecalciferol, once weekly) or Group B (Oral 200.000IU Cholecalciferol, once monthly), for 3 months. Serum levels of (25(OH)D), serum malondialdehyde (MDA), serum superoxide dismutase (SOD), serum high sensitive (hsCRP), calcium, phosphorus, and parathormone (PTH) levels, were all assessed at baseline and at the end of the study.

Results
Cholecalciferol significantly increased serum levels of 25(OH)D in both groups, with a higher significant increase (p = 0.003) in Group A vs. Group B. Only Group A had a significant decrease in both serum MDA and serum hsCRP levels (p &lt;0.001), while it had a significant higher increase (p = 0.011) in serum SOD when compared to Group B. Regarding PTH levels, a significant higher change from baseline ( -30 pg/mL vs. -3 pg/mL) was noticed in Group A vs. Group B. However, neither calcium nor phosphorus levels had a significant difference in both groups. No side effects were reported from both study groups.

Conclusion
Weekly (50.000 IU) oral cholecalciferol seems to be an effective safe option to replenish vitamin D levels in hemodialysis patients, with an ameliorating effect on oxidative stress, inflammation and PTH levels.
P1573EFFECT OF INFLAMMATION ON MUSCLE-BONE INTERACTIONS IN HEMODIALYSIS PATIENTS
Authors: Królikowski Jerzy , Górczewska-Królikowska Bogumila , Nowicki Michal 
Published: June 2020

Abstract

Background and Aims
Chronic hemodialysis patients show decreased muscle mass, low physical activity and chronic weakness. Hemodialysis treatments results in increased risk of inflammation, which impairs physical activity. The calcium-phosphate and bone metabolism, as well as muscle mass, are regulated by a range of factors like FGF-23 and its co-factor Klotho protein, myostatin, follistatin and sclerostin. Complex interactions between these cytokines and inflammation have been described.
The aim of the study was to assess the influence of inflammation on plasma concentrations of factors that regulate muscle and bone-mineral metabolism

Method
55 hemodialysis patients were divided into study group (32 patients) and the reference group (23 patients). The former were the patients who had inflammation confirmed by plasma CRP &gt;50 mg /L. Blood was collected before and after hemodialysis during the inflammation, and before hemodialysis after the resolution of inflammation

Results
Mean CRP in study group was 105.9±73.9 mg/l. The mean period between blood sampling during inflammation and resolution of inflammation was 15±7.9 days. Statistically significant increase of plasma cFGF-23 concentration was observed after hemodialysis. Its median concentration increased from 1992.8 RU/ml; IQR = [1350; 4320 RU/ml] before hemodialysis to 2421.3 RU/ml IQR = [1351; 7348 RU/ml] after HD (p = 0.001). Significant increase of sclerostin was observed after hemodialysis. Serum sclerostin increased from 1346.2 pg/ml IQR = [1034; 2243 pg/ml] before HD to 1583.8 pg/ml IQR = [1198; 2559 pg/ml] after HD (p = 0.002). Follistatin concentration increased from 2669 pg/ml IQR = [2129; 5702 pg/ml] before HD to 4220.5 pg/ml IQR = [2583; 6727 pg/ml] (p = 0.009). Hemodialysis had no significant effect on plasma Klotho protein, iFGF-23, FGF-21, and myostatin. After the resolution of inflammation there was statistically significant decrease in FGF-21 from 3591.4 pg/ml. IQR = [1174.3; 6,537.3 pg/ml] to 2454 pg/ml IQR = [1221.1; 3448.4 pg/ml] p = 0.006). There were significant changes of the concentration of Klotho protein, cFGF-23, iFGF-23, sclerostin, myostatin, follistatin after the resolution of inflammation vs. baseline.

Conclusion
Hemodialysis modulates the concentration of factors involved in regulation of calcium-phosphate metabolism, bone turnover and muscle growth and strength. The resolution of inflammation in hemodialysis patients leads to the decrease of plasma FGF-21 concentration.
P1574EFFECTS OF BRAZILIAN GREEN PROPOLIS EXTRACT (EPP-AF) ON INFLAMMATION IN HEMODIALYSIS PATIENTS
Authors: Silveira Marcelo , Teles Flavio , Melo Erica , Borges Valeria , Miranda Filipe , Dutra Fábio , Berretta Andresa , Cezar Rodrigo , Silva Jéssica , Santos Hayna , Benigno Paulo , Passos Rogério 
Published: June 2020

Abstract

Background and Aims
End-stage chronic kidney disease is associated with the condition of chronic inflammation, impacting increased cardiovascular mortality in this specific population. Patients on hemodialysis are known to be predisposed to several factors that predispose to inflammation: dialysis membranes, central venous catheters, oxidative stress, fluid overload, sodium overload, uraemic toxins. Propolis, a natural resin produced by bees from plant materials, has anti-inflammatory, immunomodulatory, and anti-oxidant properties. The aim of this study was to evaluate the impact of Brazilian green propolis extract on inflammation in hemodialysis patients. Here we present preliminary results of the trial NCT04072341.

Method
We performed a prospective trial, open-label 9-week crossover study examining the effect of Brazilian green propolis (250mg/day, in capsules) on inflammation in hemodialysis patients. We included patients over 18 years, under intermittent hemodialysis (thrice per week), on hemodialysis for at least 1 month and until now 37 patients were included. We excluded pregnant women, cancer carried and patients who developed infection or underwent any surgical procedure during the study period. Each period was 4 weeks in duration with a 1-week washout period in between. The primary end point was change in serum level of high-sensitivity c-reactive protein (HsCRP). Secondary end point evaluated the safety of propolis use in hemodialysis patients.

Results
Their mean age was 58.6 ± 15.2 years (mean ± SD), and 22 (59.4%) were men. The proportion of patients with hypertension was 14 (37.8%) and diabetes was 9 (24.3%). The number of patients using arteriovenous fistula were 26 (70.2%). The HsCRP presented (mean ± SE) 5.31 ± 1.02 mg/L at baseline, 4.26 ± 0.76 mg/L after propolis period and 4.56 ± 1.32 mg/L in control period, p = 0.0042. Safety parameters were analyzed such as amylase, aspartate aminotransferase (AST) and creatine phosphokinase (CPK); there was no difference between them before and after the use of propolis. None of the participants reported any adverse effects or allergic reactions during the treatment.

Conclusion
Patients on hemodialysis have an increased inflammatory state. For the best of our knowledge it was the first clinical trial who demonstrated the safety of propolis in hemodialysis patients. Brazilian green propolis demonstrated a tendency to reduce inflammation in these patients.
P1579PREVALENCE OF PROTEIN-ENERGY WASTING IN HEMODIALYSIS PATIENTS IN THE EUROPEAN REGION OF THE RUSSIAN FEDERATION
Authors: Jakovenko Alexander , Rumyantsev Aleksander 
Published: June 2020

Abstract

Background and Aims
One of the complications of hemodialysis therapy (HD) is the development of protein-energy wasting (PEW), which is an independent predictor of morbidity and mortality in this cohort of patients. The prevalence of PEW in hemodialysis patients in different regions of the world varies from 15% to 75% but has not been practically studied in the Russian Federation.
To assess the prevalence of protein-energy wasting in hemodialysis patients in the European region of the Russian Federation.

Method
645 hemodialysis patients were examined in 9 hemodialysis centers in 5 regions of the European part of the Russian Federation. Among the patients there were 345 women and 300 men, the average age was 56.8 ± 12.8 years. The duration of hemodialysis therapy was 8.4 ± 5.3 years. The diagnosis of PEW was established in accordance with the criteria: biochemical criteria (serum albumin &lt; 3.8 g per 100 ml; serum prealbumin (transthyretin) &lt; 30 mg per 100 ml; serum cholesterol &lt; 100 mg per 100 ml); low body weight, reduced total body fat, or weight loss; a decrease in muscle mass; and low protein or energy intakes. The level of blood albumin was determined using the BCG method (bromocresol green). Estimation of protein and calorie intake was performed using 3-day food diaries filled out by patients.

Results
Insufficient protein intake according to the International Society of Renal Nutrition and Metabolism (ISRNM) recommendations was observed in 5.5 % of patients, calories in 4.1 %, combined deficiency in protein and calorie intake in 2.7% of patients. The prevalence of PEW was 51.2 %. The relationship between age and gender was not identified. The lowest prevalence of PEW is observed in patients with a hemodialysis therapy experience of fewer than 5 years (25,4 %) and gradually increasing by 2.5 times in patients with survival rates on HD for more than 10 years (χ2 = 22,580 р = 0.0001).

Conclusion
The prevalence of protein-energy wasting in hemodialysis patients in the European region of the Russian Federation is 51,2 %.
P1586SARCOPENIA IN HEMODIALYSIS PATIENTS
Authors: Negri Armando Luis , Abdala Ruben , Del Valle Elisa , Bridoux Pablo , Gonzalez Paganti Luciana , Bravo Marina , Sintado Luis , Di Rienzo Paula , Schiavelli Omar R , Zanchetta Maria B 
Published: June 2020

Abstract

Background and Aims
Sarcopenia is the loss of skeletal muscle mass and function that occurs with aging. These modifications lead to greater morbidity and mortality as a result of falls, hospitalization, depression and dependence among others. Chronic Kidney disease (CKD) and hemodialysis (HD) produce a favorable environment for the development of sarcopenia. Objective: to study the prevalence of sarcopenia and its different components (muscle mass, strength and physical performance) using EWGSOP 2018 proposed criteria.

Method
cross-sectional study evaluating 100 adult HD patients. We evaluated: Grip strength (GS) with Jamar Hydraulic Hand Dynamometer (three determinations in the arm without fistula); Appendicular lean mass (ALM) by DXA (GE LUNAR Prodigy Advance) and physical performance: Gait-speed (Time needed to perform a 4-meter walk on a flat surface) and the sit-stand test

Results
58 males (M) and 42 females (F). Mean age for M was 54.3 years and 58 years for F. The prevalence of sarcopenia was 18% in the whole group, 10% in M and 20% in F. In M 33% had low GS and 26% low ALM. In M GS correlated with ALM, Albumin and weight p&lt;0.05 (R 2 0.41); ALM correlated with weight r 0.75, height r 0.64 and GS r 0.46 (p&lt;0.05). In F, 27% had low GS, 54% low ALM, and 17% poor physical performance. In F, GS correlated positively with ALM; ALM correlated positively with: weight r 0.78, height r 0.66, GS r 0.59 and sit-stand r 0.40 (p&lt;0.5). Patients with lower grip strength had a higher prevalence of falls in the last year (40% two or more falls) p=0.03.

Conclusion
A significant proportion of dialysis patients had sarcopenia. Low hand grip strength was associated with a higher prevalence of falls. Recognizing sarcopenia in dialysis patients would allow us to develop strategies to prevent falls and other complications.
P1587EFFECT OF INTERMITTENT FASTING IN RAMADAN ON BODY COMPOSITION AND NUTRITIONAL PARAMETERS IN PATIENTS ON MAINTENANCE HEMODIALYSIS
Authors: Nassar Mohammed Kamal , El-kannishy Ghada , Abdelrazik Eman , Sayed-Ahmed Nagy 
Published: June 2020

Abstract

Background and Aims
Intermittent fasting has been demonstrated to have many potential health-promoting effects. Intermittent fasting regimens were proven to influence metabolic regulation and chronic inflammation. Fasting during the month of Ramadan can be considered as a model of intermittent fasting among Muslims. In general, there is a shortage of studies in the context of the effect of Ramadan fasting in patients on maintenance hemodialysis (HD). The present study aimed to assess the effects of fasting in Ramadan on body composition as well as nutritional and inflammation parameters in patients on chronic HD.

Method
This prospective observational study included 68 patients on maintenance HD for more than six months in Mansoura Nephrology and Dialysis Unit (MNDU). The study was performed in Ramadan 1440 Hijri when the fasting hours ranged from 15 to 16 hours. Patients’ nutritional status was assessed by malnutrition inflammation score (MIS). Anthropometric measurements, including body weight, height, mid arm circumference (MAC) and triceps skin fold thickness (TSF), were measured. Body composition was assessed by bioelectrical impedance. All of the aforementioned methods were performed before start of Ramadan and repeated three weeks after the end of the holy month in patients who fasted.

Results
Forty–five patients (66%) fasted more than 18 days during the month of Ramadan. The mean age of patients who fasted was 47.33±14.86 years with a median duration of HD of 35 months (IQR 14.5-74.5). After Ramadan, weight gain was observed in patients who fasted. However, the increase in body mass index (BMI) was statistically insignificant (28.7±6.06 vs 29.04±6.09kg/m? p=0.073). On the other hand, visceral fat was significantly reduced after Ramadan (p&lt;0.0001). MIS score improved with lower score estimated after Ramadan; however, the difference was insignificant (p=0.059).

Conclusion
Fasting in Ramadan in HD patients was associated improvement of the metabolic profile evident by decrease in visceral fat. The effect of intermittent fasting on inflammation and nutritional parameters in patients on maintenance hemodialysis needs further investigations.
P1594INSULIN-LIKE GROWTH FACTOR-1 IS ASSOCIATED WITH MUSCLE STRENGTH IN PATIENTS ON HEMODIALYSIS
Authors: CHANG YU-KANG , Lim Paik Seong 
Published: June 2020

Abstract

Background and Aims
Muscle strength is a solid predictor of outcome for hemodialysis (HD) patients. In this study, our aim is to investigate the relationship between muscle strength and six potential muscle biomarkers including irisin, myostatin, myonectin, antichymotrypsin, urotensin II and insulin-like growth factor 1 (IGF-1).

Method
The cohort of prevalent HD patients in Tungs’ Taichung MetroHarbor Hospital were participated in our cross-sectional clinical study. The serum muscle markers were determined using standardized enzyme-linked immunosorbent assay methods. The muscle strength was accessed by handgrip strength (HGS) on arm without vascular access before dialysis session.

Results
A total of 175 patients were enrolled in this study with an average age of 59.2 and among them 84 were males (48.0%). Among the six potentially associated with muscle strength viz HGS, we found that only IGF-1 level (r=0.180, p=0.017) correlated positively with HGS. In the multivariate regression analysis, IGF-1 was also significantly correlate with HGS after adjusted for patients’ demographics [RR (95%CI)=0.091 (0.015-0.167)]. In addition, increased IGF level was correlated positively to irisin levels.

Conclusion
Our study suggested that IGF-1 was associated with HGS. The role of IGF-1 signaling in the induction of muscle atrophy in uremic patients is not fully understood.

Figure
Future research is required to obtain more detailed insight and may help to alleviate skeletal muscle atrophy in these patients.