bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1278DIALYSIS IN TREATMENT OF CONGESTIVE HEART FAILURE
Authors: Ristovska Vesna 
Published: June 2020

Abstract

Background and Aims
The advanced congestive heart failure (CHF), may provoke functional kidney disturbances with insufficient and resistant to conservative therapy water excretion. The treatment of the chronic renal failure (CRF) with active dialysis related to ultrafiltration (UF), may overcome the renal diuretics resistance with diuresis restoration and oedema elimination. The aim of the study was to define the indications for active, discontinued UF in setting of the CHF refractory to drugs, especially in the treatment of oedema.

Method
We investigated 12 patients, mean age 62,4+/-5,3 years, with incipient renal failure, but advanced congestive heart failure. Seven of them were males and 5 females. The indication for discontinued UF, was the severe expressed heart failure, reduced diuresis and initial renal insufficiency. In all investigated patients, before and after each UF procedure, the serum sodium and potassium, blood urea nitrogen (BUN), creatinin and osmolality were detected. The body weight, abdominal and crural parameters were noted before and after dialysis.

Results
The recovery was achieved in 10 patients with CHF, but 2 patients out of 12 have not demonstrated satisfactory response to UF. The biochemical features encountered to CHF patients suggest chronic hyponatriemia, hypokalemia and hypovolemia. Proteinuria range 1,2 to 3,6 g/l, was present in 6 patients. The clinical data were performed with oedema formation, reduced diuresis and dispnea. Mean UF rate achieved after several dialysis was 12,4+/- 7,6, lit.

Conclusion
Chronic heart failure in chronic renal patients, with severe oedemas is an indication for UF therapy, even if the values of BUN and creatinin are not increased. Reduction of the body weight and the extracellular volume, contribute for improved survival in these patients. However the risk of complications is high and not always with successful treatment.
P1281CLINICAL CHARACTERISTICS OF OBSTRUCTIVE SLEEP APNEA HYPOPNEA SYNDROME IN MAINTENANCE HEMODIALYSIS PATIENTS
Authors: Qin Yan , Yuan Dan , Huang Rong , Li Xuemei 
Published: June 2020

Abstract

Background and Aims
To explore the clinical characteristics of obstructive sleep apnea hypopnea syndrome (OSAHS) in maintenance hemodialysis patients.

Method
42 patients with maintenance hemodialysis in our hemodialysis center from April 2019 to December 2019 were enrolled for night-time sleep breathing monitoring. The patients were divided into the OSAHS group(n=25) and the non-OSAHS group(n=17) defined by AHI. The OSAHS group was further divided into a mild group (n=14) and a moderate-severe group (n=11). The clinical datas, sleep breathing monitoring datas, and echocardiographic parameters of the OSAHS group and the non-OSAHS group, the mild OSAHS group, and the moderate-severe OSAHS group were compared.

Results
1. There were no differences in gender, age, dialysis age, spKt / V, BMI, TBW, ECW, ICW, E / I ratio, Ca, P, HB, and diastolic blood pressure between the the OSAHS group and the non-OSAHS group. 2. Incidence of left ventricular concentric hypertrophy (84.0% VS 47.1%, P = 0.011), left ventricular wall thickness (12.0 VS 10.2, P = 0.029) and systolic blood pressure (147.0 ± 9.6 VS 139.4 ± 13.8, P = 0.041) ) in OSAHS group was significantly higher than the non-OSAHS group; 3: There was no statistical difference in serum carbon dioxide binding capacity (CO2CP) between the two groups (23.1 ± 2.7 VS 23.8 ± 2.6, P = 0.392), but the daily intake of sodium bicarbonate in the OSAHS group was higher than that of the non-OSAHS group (2.5 ± 1.0 VS 1.5 ± 0.5, P = 0.004); the CO2CP of the moderate-severe OSAHS group was lower than that of the mild group (21.7 ± 2.2 VS 24.2 ± 2.7, P = 0.019 ), the left ventricular wall thickness was significantly higher than the mild group (11.4 ± 1.4 VS 12.6 ± 1.1, P = 0.025).

Conclusion
Clinicians should pay attention to the early diagnosis and prevention of OSAHS in maintenance hemodialysis patients. Because the dialysis population is different from the general population of OSAHS patients, the serum CO2CP of this population is negatively correlated with the degree of OSAHS, and clinicians need to pay particular attention to the amount of sodium bicarbonate to correct acidosis.
P1292DECREASES IN ANGIOGENIC T CELLS ARE PREDICTIVE BIOMARKERS OF VASCULAR DYSFUNCTION AND ATHEROSCLEROSIS IN CHRONIC KIDNEY DISEASE
Authors: Carrillo-Lopez Natalia , Rodriguez-Carrio Javier , Ulloa Catalina , Martín-Carro Beatriz , Rodriguez-Suarez Carmen , Arcidiacono Maria Vittoria , Fernandez-Mariño Belinda , Cannata-Andia Jorge B , Suarez Ana , Dusso Adriana S 
Published: June 2020

Abstract

Background and Aims
The stratification of early cardiovascular (CV) risk is a major unmet need in chronic kidney disease (CKD). Since angiogenic T-cells are emerging mediators of vascular homeostasis and have been linked to CV disease (CVD), this study evaluated the frequency of circulating angiogenic T-cells in CKD patients undergoing peritoneal dialysis (CKD-5D) and their potential as predictive biomarkers of CVD.

Method
In 30 peritoneal dialysis patients and 16 matched healthy controls (HC), we quantified: Vascular calcification (by Kauppila Index); left carotid intima media thickness (lc-IMT by ultrasound), carotid adventitial vasa vasorum density (an early marker of atherosclerosis stage, by Superb Microvascular Ultrasound Image), pulse wave velocity (a marker of vascular stiffness and dysfunction, using the Complior Analyzer), angiogenic T cell frequency in blood (by Flow cytometry) and the traditional 10-year CVD risk (using the SCORE chart).

Results
As expected, CKD-5D patients exhibited higher Kauppila index (p&lt;0.001), lcIMT (p=0.010) and adventitial vasa vasorum density (p=0.008) than HC. Angiogenic-T cell frequency was decreased in CKD compared to HC (1.68(1.05) vs. 3.33(1.44)%, p&lt;0.001). In CKD-5D patients, angiogenic-T cell frequency was not associated with blood pressure, cholesterol levels or time on dialysis (all p&gt;0.05) and did not correlate with Kauppila (r=-0.350, p=0.080) or lcIMT (r=-0.154, p=0.600), but strongly associated negatively with both pulse wave velocity (r=-0.734, p&lt;0.001) and with adventitial vasa vasorum (newly formed vasa vasorum) number: r=-0.640, p=0.006; or density: r=-0.813, p&lt;0.001). Angiogenic-T cell levels paralleled pulse wave velocity (B[95% CI]: -0.083[-0.155, -0.010], p=0.028; R2=0.531) and adventitial vasa vasorum -15.049[-26.705, -3.392], p=0.015; R2=0.598) and improved the prediction model over that of the SCORE chart (R2=0.360 and R2=0.336, respectively).

Conclusion
Angiogenic-T cell frequency was decreased in CKD-5D patients and could be considered as biomarkers of vascular dysfunction and early atherosclerosis stage.
P1304FIBROBLAST GROWTH FACTOR (FGF23) AND CARDIOVASCULAR MORTALITY IN DIALYSIS PATIENTS: A 10 YEAR PROSPECTIVE SINGLE CENTER STUDY
Authors: Demirtaş Gülay , Turgut Sadan , Ozdem Sabahat , Suleymanlar Gultekin , Yılmaz Üstün , Ersoy Fevzi F 
Published: June 2020

Abstract

Background and Aims
The aim of the study is to evaluate whether circulating fibroblast growth factor 23 (FGF23) predicts cardiovascular mortality in dialysis patients, independent of markers of calcium-phosphate metabolism and cardiovascular risk factors.

Method
A prospective observational study at Akdeniz University Medical Center including 51 peritoneal dialysis patients and 27 hemodialysis patients was undertaken from 01/2009 to 12/2019. Plasma C-terminal FGF23 concentrations in addition to other measures of mineral metabolism were performed at baseline. Patients were followed for all-cause mortality, cardiovascular mortality, non-fatal MI, non-fatal stroke, coronary revascularization, heart failure hospitalization and atrial fibrillation.

Results
The mean age of patients 48± 15 years. During a ten year follow up period, there were 47 deaths. The median plasma FGF23 level was 321 pg/ml (interquartile range 51-1784 pg/ml). Patients were stratified by their baseline FGF23 levels according to the tertiles. Cumulative survival analysis by tertiles of FGF23 were made with the Kaplan-Meier survival curve. Kaplan Meier analysis with log-rank did reveal a significant difference between the groups (p=0,048).

Conclusion
Higher FGF23 levels are associated with an increased incidence of cardiovascular mortality in dialysis patients, independent of other markers of calcium-phosphate metabolism and cardiovascular risk factors.
P1306EFFECT OF A SUPERVISED PERI- DIALYTIC EXERCISE PROGRAM ON SERUM ASYMMETRIC DIMETHYLARGININE IN MAINTENANCE HEMODIALYSIS PATIENTS
Authors: Ammar Yaser , Awad Ahmad 
Published: June 2020

Abstract

Background and Aims
End-stage renal disease (ESRD) patients treated with maintenance hemodialysis (MHD) have high cardiovascular disease morbidity and mortality. Accumulation of asymmetric dimethylarginine (ADMA), an endogenous nitric oxide synthase inhibitor, has been strongly implicated in endothelial dysfunction, premature atherosclerosis, vascular events and mortality. Regular physical exercise effectively decreased serum ADMA in several studies. This potential should be explored among MHD patients.

Method
Forty four middle-aged ESRD patients treated with thrice-weekly MHD for &gt;6 months completed a 6 months regimen of peri-dialytic lower limb exercise comprising pre-dialytic 10-12 stretching cycles and 20-30 minutes of intra-dialytic pedalling cycles. Plasma ADMA, CRP, other laboratory parameters and overall physical activity level were assessed initially and at the end of the study.

Results
S.ADMA increased from a median of 2375 to 3000 ng/mL (P=0.016). 31 patients sustained an increase in S.ADMA (ADMA_Inc), whereas 13 patients had a declining or stable S.ADMA (ADMA_Dec). Compared with ADMA_Inc, ADMA_Dec patients had significantly higher Kt/V (P=0.02), significantly higher grade of basal general physical activity level (P=0.017) and significantly less intra-dialytic hypotension episodes (IDHs) (P=0.019). The increase in S.ADMA and the post- study S.ADMA level had statistically significant positive correlations with number of IDHs (r=0.401,P=0.007 and r=0.305,P=0.044, respectively).

Conclusion
A 6 months program of combined aerobic and resistance peri-dialytic exercise failed to reduce S.ADMA in most MHD patients studied. A modest S.ADMA decline, however, occurred in patients with higher basal exercise level, higher Kt/V, and less IDHs. A potential benefit of peri-dialytic exercise in decreasing S.ADMA may be promoted by a multidisciplinary approach targeting increased physical activity, improved dialysis efficiency and prevention of IDHs.
P1321PLASMATIC OSTEOPONTIN: A PREDICTOR OF VASCULAR ACCESS DYSFUNCTION IN HEMODIALYSIS PATIENTS
Authors: Sadaghianloo Nirvana , Julie CONTENTI , Sandor Vido , Joseph Carboni , Sophie Bonnet , Declemy Serge , Mazure Nathalie M 
Published: June 2020

Abstract

Background and Aims
Despite recommendations for a close follow-up of arteriovenous fistulas (AVF), thombosis rate reaches 10% each year. Conventional follow-up modalities remain a burden for hemodialysis patients. We tested the hypothesis that osteopontin (OPN), a pro-inflammatory molecule related to intimal hyperplasia, could be a biological marker of stenosis, and could thereby allow a screening of patients at risk for AVF dysfunction.

Method
Our prospective study (NCT03270358) compared the rate of plasmatic OPN between patients with a good-functioning AVF (control group, N= 39) and patients who required surgical or endovascular revision of their AVF because of a stenosis (stenosis group, N= 37). Blood samples were taken in the AVF, at the time of AVF cannulation in control patients, and at the time of AVF revision in stenosis patients. For each patient, blood from the contralateral arm was also analyzed as a between-subject control (paired t test). Cardiovascular risk factors, ongoing medications, and OPN rates (ELISA technique) were compared among the groups (uni- and multivariate analysis). The ROC curve determined sensitivity and specificity of the marker for the detection of stenosis.

Results
Patients' characteristics were similar between the 2 groups (mean age, 70 years; men, 63%; AVF duration; 39 months), apart from diabetes (control group, 33%; stenosis group, 57%; p=0.04). The rate of OPN was similar between the AVF arm and the contralateral arm (p=0.11), but significantly increased in the stenosis group compared to the control group (655 vs. 452 ng/mL, respectively, p=0.02). There was no statistically significant difference in OPN rate for diabetics and non diabetics (two-way ANOVA, p= 0.50). Sensitivity was 89% for a threshold &gt;293ng/mL and specificity was 80% for a threshold &gt;567ng/mL (AUC: 0.70; 95%CI: 0.57-0.81; p=0.004). Patients with an OPN rate ≥293ng/mL and those with an OPN rate ≥567ng/mL had respectively 8.87 and 15.62 higher odds to have a stenosis than patients with an OPN rate &lt;293ng/mL (binomial regression, p&lt;0.01).

Conclusion
Plasmatic OPN rate in hemodialysis patients can be measured simply, in a blood sample taken at the time of AVF cannulation, and is strongly correlated to the presence of a symptomatic AVF stenosis. This biomarker could help the physician choose which patient need a comprehensive examination of his/her AVF with duplex ultrasound or fistulogram.
P1322EFFECTS OF HAEMODIALYSIS ARTERIOVENOUS FISTULA CREATION ON CARDIAC STRUCTURE AND FUNCTION
Authors: Stoumpos Sokratis , Rankin Alastair , Hall Barrientos Pauline , Thomson Peter , Kasthuri Ram , Kingsmore David , Roditi Giles , Mark Patrick 
Published: June 2020

Abstract

Background and Aims
Arteriovenous fistula (AVF) is considered the preferred type of access for maintenance haemodialysis. The creation of an AVF may contribute to maladaptive cardiovascular remodelling. We conducted a study to evaluate the effect of AVF creation on cardiac structure and function in patients with end-stage renal disease (ESRD).

Method
In this prospective cohort study, patients with ESRD listed for AVF creation underwent cardiac magnetic resonance imaging at baseline and at 6 weeks. All participants had ultrasound measurements of AVF blood flow at 6 weeks. The primary outcome was the change in left ventricular (LV) mass. Secondary outcomes included changes in LV volumes, left atrial volume, LV ejection fraction, LV global longitudinal strain, cardiac output/index, and septal thickness.

Results
A total of 65 patients were enrolled, of whom 40 had an AVF creation and completed both scans. Patients were divided into 2 groups based on AVF blood flows: 22 in the high flow group (≥ 600mL/min) and 18 in the low flow group (&lt; 600mL/min). On the second cardiac magnetic resonance scan, a mean increase of 7.4 g (95% CI, 1.1–13.7, P=0.02) was observed in LV mass; in the high flow group the mean increase was 15.5 g (95% CI, 7.3–23.8) compared with a small decrease of 2.5 g (95% CI, −10.6 to 5.6) in the low flow group (P=0.003). Significant increases in LV end-diastolic volumes, cardiac output, and cardiac index were also seen after AVF creation (P&lt;0.04). No significant changes were observed in LV ejection fraction (P=0.52), LV end-systolic volumes (P=0.12), and LV global longitudinal strain (P=0.21).

Conclusion
Creation of AVF in adults with ESRD resulted in significant increase of LV myocardial mass early after surgery.
P1334PREOPERATIVE VOLUME STATUS IN VASCULAR ACCESS CREATION, A DESPISED INFLUENCE?
Authors: Guedes Marques Maria , Maia Pedro , Ponce Pedro 
Published: June 2020

Abstract

Background and Aims
The most common causes of early primary failures of a vascular access (VA) is related to small caliber vessels. Weight gain between dialyses expands both extracellular and blood volume, which may lead to rises in intravascular filling and vessels caliber. If patients presented after weekend, their weight and probably volemia would be higher.
Dry weight concept has evolved over time and nowadays incorporates objective measures of volume status like body bioimpedance spectroscopy (BIA) and lung ultrasound.
We hypothesized that preoperative volume status may influence vascular filling and vessels diameter with a significant impact on VA outcomes.

Method
A clinical, prospective, randomized, open-label, single-center crossover trial.
Inclusion criteria: age 18-80ys, under regular hemodialysis (3/week), no heart failure (CHF) and no acute pulmonar edema (APE) on the previous year.
Exclusion criteria: &gt;3 sessions/week, CHF or APE.
Before the last-week session, patient’s clinical parameters were recorded. BIA and ultrasound vascular mapping were performed.
After this first evaluation, dry weight was increased 0,5 Kg, and after weekend, the same protocol was conducted.
Primary end point was to compare vein diameters.

Results
126 vessels were evaluated (84 veins and 42 arteries) from 21 patients. Mean age was 69±10y and 52% female.
Primary end point was achieved (Table 1). Other than humeral arterial blood flow, every parameters evaluated through ultrasound mapping significantly increased (p&lt;0,05) after dry weight adjustment (&gt;0,5 Kg) plus weekend weight gain.
After cross over, weight, overhydration (OH), extracellular water (ECW) and OH/ECW significantly increased (p&lt;0,05), however, most patients had a mild-moderate OH (86-90%). Blood pressure and total body water haven’t changed significantly.
No complications were reported.

Conclusion
Some additional degree of OH comparing to midweek weight gain may be effective and safe in improving peripheral vascular conditions that are predictors of VA success.
The currently lack of evidence of vascular mapping may be due to the lack of evaluation of cofactors such as volemia. Therefore, BIA and lung ultrasound may be future tools that combined to vascular ultrasound could be a safe and effective way to optimize and evaluate preoperative conditions to improve VA outcomes.
Larger and multicentric studies are needed.
P1335MALNUTRITION, INFLAMMATION, AND ANEMIA SYNERGISTICALLY IMPACT VASCULAR ACCESS FAILURE IN PATIENTS WITH FIRST-TIME ARTERIOVENOUS FISTULA FORMATION
Authors: Hara Masaki , Saiki Naozumi , Suzuki Hiroki , Ubukata Masamitsu , Asao Rin , Nakamura Yuya , Nakamura Masayuki , Ohsawa Isao , Gotoh Hiromichi 
Published: June 2020

Abstract

Background and Aims
There are several reports that the initial (within one year) failure of vascular access (VA) is 2–53% in several countries. Malnutrition alone, inflammation alone, and anemia alone are factors that have a well-known relationship to VA failure. We believe that the relationship of these risk factors to VA failure is a complex one. Therefore, we evaluated whether the addition of these factors had a synergistic impact on VA failure.

Method
This longitudinal cohort study sought to confirm the effects of malnutrition, inflammation, and anemia on VA failure. We included 177 patients with chronic kidney disease (CKD) with first-time arteriovenous fistulas who were treated from January 2013 to December 2017. VA failure was defined as a new onset of VA obstruction or the need for percutaneous transluminal angioplasty. Albumin (Alb), C-reactive protein (CRP), and hemoglobin (Hb) were studied as indicators for malnutrition, inflammation, and anemia, respectively. Each highest (CRP) or lowest (Alb and Hb) interquartile range (IQR) group was assigned 1 point (as a risk score). The cumulative VA failure rate was analyzed by the Kaplan-Meier method, which stratified the study cohort into four groups according to the risk scores (0–3). We assessed whether the lowest IQR group of Hb and Alb, and the highest IQR group of CRP were associated with VA failure. To determine this, we used a univariable Cox proportional hazards regression analysis to calculate the hazard ratio (HR) and its 95% confidence interval (CI). A multivariable Cox proportional hazards regression analysis was used to evaluate the association between the risk score and VA failure, with adjustment for age, sex, presence or absence of diabetes mellitus, value of calcium phosphate products, preoperative vein diameter, and intraoperative vascular assessment scores.

Results
The average observational period was 1.6±1.4 years. The incidence of VA failure was 30.5% (54 patients). Cumulative VA failure was significantly higher in patients who had more than two risk scores, as compared to the patients who did not have any risk score (Figure). The univariate Cox regression analysis showed that Alb, CRP, and Hb were significantly associated with VA failure (HR, 2.00; 95% CI, 1.08–3.71 for Alb and HR, 2.21; 95% CI, 1.15–4.13 for CRP and HR, 1.96; 95% CI, 1.02–3.63 for Hb), respectively. The presence of more than two risk scores was significantly associated with VA failure (HR, 4.68; 95% CI, 1.07–18.5 for the patients with two risk scores and HR, 4.72; 95% CI, 1.32–17.2 for the patients with three risk scores).

Conclusion
Malnutrition, inflammation, and anemia independently and synergistically affect VA failure. In clinical settings, we need to be aware of the presence of malnutrition, inflammation, and anemia to better prevent VA failure.
P1338ELDERLY PATIENTS, UPPER LIMB ISOMETRIC EXERCISES AND ARTERIOVENOUS FISTULA MATURATION
Authors: Tapia González Irati , Esteve Simo Vicent , Ibañez Pallares Sara , Rubio Sandra , Moreno Guzman Fatima , Fulquet Nicolás Miquel , Pou Potau Mónica , Saurina Solé Anna , Duarte Gallego Verónica , Yeste Campos Montserrat , Ramírez de Arellano Serna Manel 
Published: June 2020

Abstract

Background and Aims: Introduction
Arteriovenous fistula (AVF) creation may be controversial in elderly population, given their comorbidities, reduced life expectancy and vascular access (VA) complications. Postoperative upper limbs isometric exercise improves AVF maturation. Nevertheless, scarce scientific evidence has been reported about their utility in elderly population until date.

Objectives
To assess the effect of a postoperative isometric exercises program on native VA maturation in our patients older than 75 years old with stages 5-5D chronic kidney disease.

Method
A 24 months prospective single-center study. After surgery, all patients were randomized to an isometric exercise group (EG) or a control group (CG). Isometric exercises protocolled programm, was performed in EG. CO received usual care. Demographical data, muscle strength using handgrip (HG) dynamometer, main Doppler ultrasound (DUS) measurements (outflow vein (OV) diameter and humeral artery blood flow rate (BFR), clinical and DUS maturation as well as medical (hematoma, stenosis, thrombosis, pseudoaneurysm, aneurysm) or surgical VA complications were assessed at 8 weeks postoperatively.

Results
27 patients. 14 EG, 13 CO. 74,1% men. Mean age 79,9±2,8 years. 59,2% Radiocephalic AVF. Demographic data, HG and DUS measurement at baseline were similar. A significant increase in HG was observed only in EG at the end of study (19,1±7,8 vs 22,9±9,7Kg, p=0,001). DUS measurements statistically increased for both groups (OV diameter: EG 3,1 ± 0,8 vs. 5,9 ± 1,7 mm; CG 2,9 ± 0,6 vs. 5,8 ± 1,4mm; humeral artery BFR: EG 150,7± 42,7 vs. 1165,0 ± 664,5 ml/min; CG 132,9± 30,3 vs. 1310,2 ± 691,8ml/min) at the end of study. EG group obtained highest clinical (CG 46,2% vs EG 78,6%;p=0,049) and DUS maturation (CG 30,8% vs EG 71,4%; p=0,041) at 8 weeks, significantly. Despite no significant differences, the number of complications was lower in the EG, mainly hematomas and significant stenosis.

Conclusion
The upper limb isometric exercises protocolled program improved clinical and DUS maturation in our elderly patients. With our results, isometric exercises should be guaranteed in elderly patients in order to obtain a correct maturation of the performed AVF. Further studies are required to support these outcomes in this population.