bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1289CIRCULATING HIGH SENSITIVITY CARDIAC TROPONIN-T WAS AN IMPORTANT PREDICTIVE MARKER FOR CARDIOVASCULAR EVENTS IN HEMODIALYSIS PATIENTS
Authors: Lee Su-Chu , Wu Ping-Hsun , Lin Yi-Ting , Wu Pei-Yu , Chen Szu-Chia , Kuo Mei-Chuan , Chiu Yi wen 
Published: June 2020

Abstract

Background and Aims
High sensitivity cardiac troponin-T (hs-cTnT) are prognostic markers in patients with stable cardiovascular (CV) disease but limited study investigated the CV outcome association in asymptomatic patients receiving hemodialysis (HD). We evaluated the prognostic value of hs-cTnT in predicting CV events in stable HD patients.

Method
A total of 341 stable HD patients was included in this prospective cohort study. Baseline hs-cTnT was measured by Roche hs-cTnT assays. Patients were followed up for 3 years or until first CV event, which was defined a composite endpoint of acute coronary syndrome, ischemic stroke, or hospitalization for heart failure. Cox proportional hazards model was used to determine independent predictors of CV events. The importance of hs-cTnT compared to other clinical parameters was evaluated by random forests algorithm in Gini index.

Results
The HD patients enrolled in this study was 59.2 ± 11.5 87 years old, 53.4% male, 42.5% had diabetes, 76.8% had hypertension, 17.6% had coronary artery disease, and 9.1% had cerebrovascular disease. In multivariate Cox regression analysis, the circulating hs-cTnT levels were independent associated with CV events (HR 2.31; 95% CI 1.21-4.40; p-value=0.011) after adjusting for confounders. Multivariable model showed prognostic significance, with the c-statistics of 0.75. The addition of baseline hs-cTnT to established risk factors improved risk prediction of CV events (c-statistics of 0.76; integrated discrimination improvement = 0.02, P = 0.049). Gini index demonstrated hs-cTnT was more important than other clinical parameters for CV events prediction.

Conclusion
Circulating hs-cTnT levels independently predicted CV events in chronic HD patients. CV risk in HD patients could be stratified according to hs-cTnT levels. The results suggest the useful property of hs-cTnT as an end-organ damage marker reflecting subclinical cardiac injury.
P1295OBSERVATION ON THE EFFECT OF DIGOXIN COMBINED WITH BENAZEPRIL HYDROCHLORIDE ON THE MAINTENANCE OF CHRONIC HEART FAILURE IN HEMODIALYSIS PATIENTS
Authors: Feng Shidong , Jing Rui 
Published: June 2020

Abstract

Background and Aims
To observe the effect of digoxin combined with benazepril hydrochloride on the heart structure and function of chronic heart failure in patients with maintenance hemodialysis.

Method
Choose 36 patients with maintenance hemodialysis, chronic heart failure (NYHA II - III) from 2016 to 2017 in our department. The patients were randomly divided into three groups: control group 1: digoxin (0.125mg/ day), control group 2: benapril hydrochloride (20mg/ day), and observation group: digoxin (0.125mg/ day) + benapril hydrochloride (20mg/ day), with 12 people in each group. There was no statistical difference in the clinical baseline data of the three groups of patients. The experiment mainly observed left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDV), serum troponin T, I (TnT, TnI), and serum n-terminal brain natriuretic peptide precursor (NT-proBNP), human component bioelectrical impedance analysis (BCM), the blood pressure. No other RAAS inhibitors were allowed for all patients. The observation period was 1 year.

Results
1. According to the findings of cardiac ultrasound, LVEF value increased significantly and LVEDV decreased significantly in the observation group. There was a statistical difference between the observation group and the control group (P&lt;0.05), while there was no statistical difference between the two control groups. 2. Serum examination showed that TnT, TnI, nt-probnp were significantly decreased in the observation group, there was a statistical difference between the observation group and the two control groups (P&lt;0.05), there was no statistical difference between the two control groups. 3. During the observation period, there was no significant difference in the incidence of hyperkalemia among the three groups (P &gt;0.05).

Conclusion
A large dose of benazepril hydrochloride combined with a small dose of digoxin, had significant effect on the cardiac structure and function of chronic heart failure in patients with maintenance hemodialysis.
P1296CARDIAC COMPLICATIONS OF ARTERIOVENOUS FISTULAS IN PATIENTS WITH END-STAGE RENAL DISEASE
Authors: Breik Nessrine , Jbeli Hela , Fattoum Safa , Ouertani Imen , Ben kaab Badreddine , Mami Ikram , Ben Fatma Lilia , Beji Soumaya , Smaoui Wided , Benhmida Fethi , Rais Lamia , Zouaghi Mohammed Karim 
Published: June 2020

Abstract

Background and Aims
Current literature suggests the arteriovenous fistula (AVF) to be the preferred type of vascular access for hemodialysis. However, AVFs have significant and potentially deleterious effects on cardiac functions particularly in the setting of preexisting heart disease. The aim of this study is to compare the clinical and echocardiographic evolution after creation of a proximal AVF and a radial AVF.

Method
We conducted a retrospective descriptive study including all chronic hemodialysis patients through AVF. Group 1 (G1) included patients with proximal AVF and group 2 (G2) patients with radial AVF.

Results
Twenty-four patients were collected in G1 and the average age was 55 years. G2 included 13 patients with a mean age of 44 years. Systolic blood pressure decreased after AVF creation in both groups (G1: 62.5%, G2: 45%, NS). A dyspnea was noted in 70% of cases of G1 and 38.4% of cases of G2 (NS). The interventricular septum was thickened in 20.8% of cases of G1 and 38.4% of G2 (NS). Left ventricular (LV) dilatation was observed in both groups with LV diastolic telegram diameter increase of 58% in G1 versus 10% in G2 (p = 0.04). A decrease in LV ejection fraction was found in 62.5% in G1 and 46.1% in G2 (p = 0.066). The major cardiac complications in G1 were acute coronary syndrome in 5 patients and atrial fibrillation in 4 cases after an average of 60 months and 35 months, respectively. No cardiac complications were noted in G2.

Conclusion
AVFs remain the preferred type of vascular access for chronic hemodialysis therapy because they are associated with better long-term patency and fewer complications compared with synthetic grafts. Its seat will depend on the vascular state and the cardiac status of the dialysis patient.
P1303ASSOCIATION BETWEEN PULSE PRESSURE AND EXTRACELLULAR TO INTRACELLULAR WATER RATIO IN HEMODIALYSIS PATIENTS
Authors: Ekart Robert , Keber Gasper , Dvorsak Benjamin , Knehtl Masa , Hojs Radovan 
Published: June 2020

Abstract

Background and Aims
Optimal fluid management is a challenge in patients with end-stage kidney disease (ESRD) on maintenance hemodialysis (HD). Multifrequency bioimpedance spectroscopy (MBIS) is a non-invasive method to estimate body composition, including estimates of extracellular water (ECW) and intracellular water (ICW) and the ratio between both spaces (ECW/ICW). Pulse pressure is a significant risk factor of cardiovascular disease and death in general and dialysis population. Our study aimed to analyse the correlation between systolic, diastolic and pulse pressure with body composition status in ESRD patients before HD.

Method
We performed a retrospective single-centre cohort study in 93 HD patients. The body composition was measured using the portable whole-body MBIS device, Body Composition Monitor-BCM(®) (Fresenius Medical Care, Bad Homburg, Germany). Blood pressure was measured with OMRON monitors.

Results
The mean age of patients was 64 ± 13 years, mean dialysis vintage 63 (1-352) months, 61% were men, all patients had arteriovenous fistula as vascular access. Sixty-nine (74.2%) patients were fluid overload (FO) with &gt; 1.1 L overhydration. Other data are presented in table 1. We found a statistically significant correlation between the pulse pressure and ECW/ICW ratio (r=0.258; P=0.033) in FO patients. In contrast, there was no significant correlation between systolic, diastolic blood pressure and ECW/ICW ratio in FO patients.

Conclusion
Only pulse pressure and not systolic or diastolic blood pressure values measured before HD are associated with ECW/ICW ratio in FO patients.
P1305CARDIAC OUTPUT AND ESTIMATED UPPER BODY BLOOD FLOW
Authors: Raimann Jochen , Derk Gwendolyn , Fox Maria , Poozhikunnel Elizabeth , Thijssen Stephan , Wilund Kenneth , Kotanko Peter 
Published: June 2020

Abstract

Background and Aims
Cardiopulmonary monitoring during hemodialysis has the potential to improve dialysis adequacy, prevent adverse events, improve quality of dialysis patients’ lives and reduce mortality risks. Under stable conditions the knowledge of upper body oxygen consumption, the difference between arterial and venous oxygen saturation (ScvO2) and hemoglobin concentrations allow the calculation of estimated UBBF (eUBBF; Rosales 2019). We studied the association between eUBBF and cardiac output during hemodialysis.

Method
In patients with a central venous catheter as the vascular access, we simultaneously measured intradialytic central-venous oxygen saturation and hemoglobin levels once per minute using the Crit-Line Monitor (Fresenius Medical Care North America, Waltham, USA). Concomitantly we measured cardiac output (CO) using the Task Force Monitor (CNSystems, Graz, Austria). We depicted CO and eUBBF as box-whiskers in 5 minute periods from 20 to 180 minutes, tested the minute-level time series for stationarity using the Dickey-Fuller test, employed differencing to make the time series stationary, and tested for linear associations using cross-correlations and determined if the CO time series was useful to predict the eUBBF time series using the Granger Causality test.

Results
We studied 13 patients (59±14 years, 5 (38%) male, 93±22 kg pre-dialysis weight 170±7 cm tall) during 34 hemodialyses. CO and UBBF was 4.7±1.0 and 1.3±0.4 L/min, and showed a small trend downward for CO during hemodialysis. Cross-correlations showed no remarkable correlations for all treatments, Granger causality index was less than 20% in 8 treatments however without clearly discernible patterns.

Conclusion
Despite variability in the CO the eUBBF remains stable, a dynamic which pathophysiologically appears plausible. While testing for linear associations yielded no significant relationships, based on the Granger causality test there nevertheless appears to be some form of a relationship which requires some further investigation which will need to also include aspects such as fluid overload, body temperature and total peripheral resistance. Based on this data, cardiopulmonary monitoring appears possible and yields a reliable continuous overview of the hemodynamic status of a patient.
P1309RIGHT VENTRICULAR-PULMONARY ARTERIAL UNCOUPLING IN PATIENTS ON CHRONIC HEMODIALYSIS WITH SEVERE RIGHT VENTRICULAR REMODELING
Authors: Romero-González Gregorio , Diaz-Dorronsoro Agnes , De la Fuente Ana , Ravassa Susanna , Garcia-Fernandez Nuria , Martin-Moreno Paloma Leticia , Lavilla Javier , González Omar , Rojas Miguel A , Lorenzo Ignacio , García-Trigo Isabel , Ania Noelia , Osácar Elena , Sabalza Ana , Amézqueta Pilar , López Begoña , González Arantxa , Diez Javier 
Published: June 2020

Abstract

Background and Aims
Patients on chronic hemodialysis (HD) may present right ventricular (RV) dysfunction and increased pulmonary artery pressure (PA). The aim of the current study is to describe the RV-PA coupling in chronic patients on HD.

Method
This study explored the adequacy of RV-PA coupling in 41 patients on HD. They underwent a comprehensive transthoracic Doppler echocardiography, and were stratified in accordance with the severity of RV remodeling defined by the presence of RV dilation (tricuspid annulus ≥40 mm) and RV systolic dysfunction (tricuspid annulus systolic excursion plane [TAPSE] &lt;17 mm). RV-PA coupling was estimated by the TAPSE to PA systolic pressure (TAPSE:PASP) ratio.

Results
Three groups of patients were identified: No RV remodeling (Group 1, n=26), mild-to-moderate RV remodeling (Group 2, n=11) and severe RV remodeling (Group 3, n=4). Compared to patients from Groups 1 and 2, patients from Group 3 exhibited significant lower TAPSE values (p&lt;0.001), a tendency to higher PASP values (p=0.054) and significant lower TAPSE:PASP ratio values (p=0.012). C-reactive protein levels and were directly correlated with PASP (r=0.405, p=0.017) and inversely with TAPSE (r=-0.311, p=0.041) and the TAPSE:PASP ratio (r= -0.392, p=0.015) in all patients. These echocardiographic parameters were not correlated with other biochemical, hemodynamic or anthropometric parameters.

Conclusion
These findings suggest that RV-PA coupling is markedly decreased in HD patients with severe RV remodeling. The role of systemic inflammation in RV remodeling and RV-PA uncoupling in HD patients warrants further studies.
P1328EFFECTIVENESS OF MUSIC FOR ALLEVIATING PAIN DURING HAEMODIALYSIS ACCESS CANNULATION: A MULTI-FACILITY, SINGLE-BLIND, RANDOMISED CONTROLLED TRIAL
Authors: Ikenoue Tatsuyoshi , Kishida Masatsugu , Yamada Yosuke , Kitamura Mineaki , Inayama Emi , Takahashi Kanae , Shintani Ayumi 
Published: June 2020

Abstract

Background and Aims
Repeated needle pain during haemodialysis (HD) access cannulations is a serious problem for HD patients. Although the efficacy of music for alleviating pain and anxiety is well established, there is insufficient scientific evidence related to its effectiveness in alleviating pain during access cannulations during HD. This study aimed to investigate the effects of music on reducing pain during access cannulating in HD patients.

Method
A prospective, multi-facility, single-blind, crossover, randomised controlled trial was conducted. The intervention included listening to Mozart and a white-noise control condition. Patients were randomly allocated to either an ‘Early-group’ or a ‘Later-group’. All patients who underwent cannulation wore headphones without sound in the first and third weeks (No-sound period). The Early-group received cannulation while listening to Mozart’s Sonata for Two Pianos in D major (K.448) during the second week (Music period), and white noise during the fourth week (White noise period). The Later-group received cannulation while listening to white noise first, followed by Mozart in the fourth week. During each period, the music or no-music protocol started 8 minutes prior to the cannulation, and participants finished listening after HD began. The Visual Analogue Scale (VAS) was used to measure pain and anxiety during cannulation and the VAS scores for pain and anxiety were compared for the music and no-music settings. We evaluated the ratio of outcome measures between the music and white noise periods with the repeated measure mixed effect regression. We analysed the effects according to the intention-to-treat principle. Two-sided-significance-level was set at 0.05.

Results
In total, one hundred and twenty-one patients were enrolled in this study, across four facilities. The median age was 64 years, and there were 84 males (69.4%). Sixty-five patients (53.7%) used analgesics for alleviating pain. The median VAS pain score was 28 and VAS anxiety score was 19 in No-sound period. The Mozart music setting had a 12.2% (95% confidence interval (CI): 2.3 to 21.1, p=0.017) lower VAS score than the white noise setting. On the other hand, there was no significant difference in the VAS anxiety score between the two groups, that is the Mozart music setting had a 7.96% (95% CI: -4.70 to 18.4, p=0.172) reduction compared to the white noise setting.

Conclusion
We examined the effects of Mozart’s music on alleviating pain using scientific methods. The music appears to reduce pain of access cannulation in HD patients. Although the trial assessed the effects of music using a single musical composition, the study did not clarify the effects of music on the physical, emotional, and cognitive status of patients. Further studies in this direction are required.
P1330ACCURACY OF CARDIOPULMONARY RECURCULATION ASSESSEMENT IN HD PATIENTS
Authors: Zulkarnaev Aleksei , Stepanov Vadim , Strugaylo Ewgenii , Fominykh Natalia , Rogozin Vasily 
Published: June 2020

Abstract

Background and Aims
cardiopulmonary recirculation (CRP) is one of the most informative instrumental parameters, which are widely used to predict adverse cardiovascular events. The CRP is calculated on the basis of two indirectly measured estimates. We observe a significant variability in CRP, the reason for which we have tried to explain.

Method
The prospective study included 88 patients with native AVF. At the first stage, we evaluated the inter- and inner-observer agreement of AVF volume blood flow (Qa) measurement with color duplex ultrasound. Two specialists with 5-7 years of experience measured Qa twice on the brachial artery, twice on fistula vein, after that - twice measured cardiac output before HD and one time after HD. Ultrafiltration during HD was 1.9±0,5 l.

Results
We observed good concordance between measurements on the brachial arteria by one specialist (fig 1A) and by two specialists (fig. 1B). There was poor concordance between the brachial artery and the fistula vein, even if the measurement was performed by one specialist (fig. 1C). Qa measurement on the fistula vein has a low repeatability, even if the measurement was performed by one specialist: the variance is very high (fig. 1 D).
We observed a good concordance between measurements (fig. 2A) and between specialists (fig. 2B) in CO assessment.
The main pitfalls of CPR-based cardiovascular risk stratification are related to the fact that CO changes significantly after HD (fig. 3A), while Qa values remain relatively stable (fig. 3B): the QA before and after HD difference is statistically significant, but it is minimal.
Median CO decrease was 13.4% (maximum 26.6%), while median of Qa decrease was 1.7% (maximum 6.1%).
This leads to a significant increase of the CPR value after HD, which can reach 40%(!) in some patients (absolute increase – 0.11).

Conclusion
Qa assessment should be performed on the brachial artery. After HD, there is a significant decrease in cardiac output (even with moderate ultrafiltration) with relatively stable AVF volume blood flow. This leads to a significant increase of CPR value after HD in some patients. Assessment of CPR before HD may lead to underestimation of cardiovascular risk.
P1340CATHETER-RELATED BLOODSTREAM INFECTIONS IN HEMODIALYSIS: ANALYSIS OF PATIENT- AND CATHETER- ASSOCIATED RISK FACTORS
Authors: Zanoni Francesca , Pavone Laura , Binda Valentina , Tripepi Giovanni Luigi , D'Arrigo Graziella , Scalamogna Antonio , Messa Piergiorgio 
Published: June 2020

Abstract

Background and Aims
Tunneled central venous catheter (T CVC) use is rising among patients undergoing chronic hemodialysis (HD) and non-tunneled (NT) CVCs are often used for HD initiation in late referral chronic kidney disease (CKD) or acute kidney injury (AKI). Catheter-related bloodstream infections (CRBSI) are a major complication of CVC use. This study examines potential patient- and CVC- related factors associated with CRBSI incidence and its microbiological features.

Method
In this retrospective single-center study, 413 patients undergoing an extracorporeal treatment (HD or Plasma Exchange) between February 1st 2014 and January 31st 2017 with 561 CVCs were recruited. Clinical data at study entry and CVC type are summarized in table 1. All bloodstream infections (BSI) occurring during the observation period were recorded and classified into CRBSI or non-CRBSI (nCRBSI), and their infecting agents collected. An incidence rate ratio (IRR (95% CI)) was calculated to assess the association between CRBSI incidence rate (IR), expressed as events/1000 catheter-days, and each clinical variable or CVC type. Significant associations at the univariate analyses were investigated with multivariate cox models.

Results
During a cumulative follow-up time of 66686 catheter-days, 54 (IR: 0.81) CRBSI and 30 (IR: 0.45) nCRBSI events occurred. CRBSI had higher frequency of GRAM+ bacteria compared with nCRBSI (70% vs 33%, p&lt;0.001). Among CRBSI, GRAM- bacteria were more frequent in patients with age &lt;80y (16 (36%) vs 0, p=0.02), and T CVC (40% vs 18%, p=0.07).
At the univariate analysis, male sex, age &lt;80y and AKI were associated with higher CRBSI IR (table 2). Compared with T Jugular CVC, higher CRBSI IR was associated with NT Jugular (IRR 6.45 (2.99-13.56), p&lt;0.0001) and NT Femoral (IRR 12.90 (5.87-27.61), p&lt;0.0001) CVC; T Femoral CVC was associated with higher non-significant IR (IRR 2.45 (0.93-5.85), p=0.07). At the multivariate analyses, factors associated with higher CRBSI IR were AKI (hazard ratio - HR 3.03 (1.38–6.67), p=0.006), NT CVC (HR 3.11 (1.30–7.41), p=0.01), and Femoral CVC (HR 2.63 (1.36–5.07), p=0.004).

Conclusion
Patients affected by AKI and use of NT or Femoral CVCs are independently associated with CRBSI risk.
P1352ULTRASOUD OR LANDMARKS FOR THE PLACEMENT OF HAEMODIALYSIS CATHETERS
Authors: BELLIK Nabil 
Published: June 2020

Abstract

Background and Aims
To compare the success and immediate complication rates of the anatomical landmark method (AL) and the ultrasound guided technique (EG) in the placement of haemodialysis catheters.

Method
This was a randomized prospective study on 285 patients requiring dialysis catheter in the University Hospital of Bab el Oued between November 2016 and november 2018.
Patients were randomized into two groups: EG and AL.
The EG group had their catheters inserted under ultrasound guided technique [1], whereas the AL group had their dialysis catheter inserted by anatomical landmarks technique.
Data were collected on demography, side of insertion.
Outcome measures included successful insertion, successful insertion at the first puncture, number of attempts, and complications.

Results
A total of 285 procedures (142 EG and 143 AL) were performed during the study.
The success rate was 52.4% in the ALT group as compared with 90.1% in the EG group (p &lt;10-6) in the first procedure.
First attempt success rate was 24.4% in the AL group as compared with 53.5% in the EG group (p=0.0002).
The complication rate was 45.5% in the AL group and 19.7% in the EG group (p &lt;10-6).

Conclusion
The use of ultrasound guidance in the placement of haemodialysis catheters significantly improves the success rate and success rate at the first puncture and significantly decreases the incidence of catheter insertion complications.