bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1527SURVIVAL COMPARISON:HEMODIALYSIS VS PERITONEAL DIALYSIS: TEN YEARS OBSERVATIONAL STUDY
Authors: Terlizzi Vincenzo , Lucca Bernardo , Manenti Chiara , Gaggia Paola , Zubani Roberto , Pola Alessandra , Vizzardi Valerio , Sandrini Massimo , Movilli Ezio , Scolari Francesco 
Published: June 2020

Abstract

Background and Aims
Survival comparison between peritoneal dialysis (PD) and hemodialysis (HD) is still controversial. While some retrospective studies have shown better survival in PD, particularly in the first year, others have not identified this difference. The only RCT published so far showed a 3-year mortality rate similar between two groups. However, the number of patients was too small to provide sufficient statistical power to identify any survival differences between the two dialysis techniques. Aim of this study was to compare HD and PD in term of survival rate and factors possibly involved in a ten-years observational study.

Method
We retrospectively evaluated all the incident patients that started a dialytic treatment, either HD or PD, due to uremia from 01-01-2008 to 31-12-2018 at the U.O. Nephrology ASST Spedali Civili of Brescia. Exclusion criteria were: duration of dialysis treatment less than 3 months, and previous dialytic treatment or kidney transplantation. For each patient anthropometric, clinical-anamnestic data and comorbidities at dialysis start were recorded.

Results
One thousand and six patients were identified. 130 patients were excluded due to dialysis treatment less than 3 months. A total 876 patients were analyzed. 77% of patients started dialysis on HD while 23% chose PD. Age was significantly higher in HD patients (69±15 vs 65±16 years; p&lt;0.05). No differences were found in the incidence of: ischemic heart disease (HD 24%, PD 25%, p=0.90), diabetes (32% vs 32%, p=0.83), cancer (20% vs 17%, p=0.37), cardiac arrhythmia (20% vs 25%, p=0.08) and peripheral vascular disease (25% vs 25%, p=0.89). An increased incidence of COPD (HD 17% vs PD 8%, p&lt;0.05) and hypertension (73% vs 87%, p&lt;0.05) was present in PD patients. During follow-up, 17% of patients treated with PD shifted to HD due to catheter malfunction, recurrent infections, insufficient dialytic adequacy or ultrafiltration failure. Kidney transplants were performed more frequently in PD patients (HD 12%; PD 24%, p&lt;0.05). At an intention to treat analysis of the data, univariate analysis showed better survival in PD patients (p&lt;0.05, Figure 1). This difference was not confirmed at multivariate analysis (Figure 2), where age, cardiac arrhythmia, cirrhosis, diabetes and peripheral vascular disease were independently associated with an increased risk of mortality. No independent influence on mortality of the dialysis treatment modality was found.

Conclusion
This ten years observational study shows that HD and PD are similar in term of patient survival. Age and comorbidities seem to play the most important role in patient survival.
P1528EPIDEMIOLOGICAL SURVEY OF A POPULATION UNDERGOING URGENT HEMODIALYSIS
Authors: Felah Eya , Samia Barbouch , Mariem Hajji , Ben amor Shedha , Chargui Soumaya , Trabelsi Raja , Karoui Cyrine , Hedri Hafedh , Goucha Rym , Ounissi Mondher , Ben Hmida Fethi , Ben abdallah Taieb 
Published: June 2020

Abstract

Background and Aims
Urgent hemodialysis is a very common situation in nephrology and is burdened with high morbidity and mortality. The aim of this work is to study the epidemiological, etiological, clinico-biological and indications of dialysis emergencies, the parameters of the session and the potential complications.

Method
This is a descriptive study conducted over a period of 12 months (January – December 2017), including all patients who have been admitted to the nephrology department for urgent management in hemodialysis.

Results
Our study collected a total of 318 patients (sex ratio =1.52), the mean age 60.54 ± [18-95 years]. Patients came mainly from the emergency department (69.8%). 40.9 % of the patients were diabetic and 66,4 % hypertensive, 15.1% had coronary artery disease. Among patients, 80.9% had chronic renal insufficiency, of which 29.6% were end-stage (28% hemodialysis and 1.6% peritoneal dialysis). Urgent hemodialysis was undertaken for threatening hyperkalemia in 58.2% of cases, a poorly tolerated uremic syndrome in 50.8% acute pulmonary edema (APO) in 36.5% of cases, and anuria greater than 12h were the indication in 44.4% of cases and a severe metabolic acidosis in 11.3% of cases.
The average duration of the session was 3 hours. Ultrafiltration was necessary in 63.7% of the cases. The blood access was a femoral catheter in 80.6% of the cases. Blood transfusion was indicated in 13.8% of cases. Main complications were dominated by symptomatic arterial hypotension in 12.9% requiring stopping the session in half of cases hypoglycemia in 6.9%, neurological disorder in 6.6% chest pain in 3.5 %. After a year of follow up care, overall mortality was 40% in this population. On multivariate analysis, age (p=0.006) and neurological state according to the glasgow score (p=0.01) were retained as independent factors of mortality in this population.

Conclusion
A greater prevalence of urgent hemodialysis is observed in our country testifying to the accessibility of this method of extrarenal replacement. Hyperkalemia, uremic syndrom and PAO are the main indications for urgent hemodialysis. Early diagnosis, prompt and relevant management of these patients will determine their prognoses in the short and medium term.
P1529MORTALITY PREDICTORS IN INCIDENT HEMODIALYSIS PATIENTS - HAVE HEY CHANGED IN TEN YEARS?
Authors: Figueiredo Cátia Raquel , Escoli Rachele , Gonçalves Hernâni , Lopes Karina , Sofia Flora , Vila Lobos Ana 
Published: June 2020

Abstract

Background and Aims
In the last years there has been an increase in elderly patients with multiple comorbidities inducing hemodialysis (HD). Since dialysis treatment itself may be associated with a further deterioration in functional status, nephrologists are increasingly careful in selecting these patients for HD. Concerned with this reality we tried to understood if early mortality predictors (in the first 6 months) in incident HD patients have changed in almost 10 years, in the same hospital HD unit.

Method
This is a retrospective observational study of incident HD patients between 01 January 2017 and 30 June 2019. We evaluated similar clinical, analytical and demographic data to those used to predict mortality in the same HD unit from 1 January 2010 to 30 September 2014. Logistic regression analysis was used to evaluate 6 month mortality predictors. Statistical analysis was performed using SPSS version 25 for Windows.

Results
The average age of 163 incident HD patients were 70.63±3.9 years (similar to the previous population: n= 235; 70.7 ± 14.9 years) and 57.1% were male. During this study we observed 26 (16%) deaths, 12 of which (46.15%) occurred in the first 6 months of hemodialysis. Pneumonia and cachexia were the major causes of mortality, unlike the previous population, in which majority of deaths were attributed to cardiovascular events. Between January 2010 to 30 September 2014 the strongest predictors of early mortality were dementia [adjusted odds ratio (OR) 15.94 (CI: 4.09–62.10)], central venous catheter use [(OR) 12.29; (CI: 3.54-42.65)], cancer [(OR) 4.64 (CI: 1.48-14.54)] and heart failure [(OR) 3.57 (CI: 1.08-11.75)]. Differently, in this study, the institutionalization and the presence of metastases were the predictors that showed a higher risk of death [p=0.005; adjusted odds ratio [(OR) 10.4 (CI: 2.017–49.9) and p=0.01; (OR): 14.9 (CI: 1.89-42), respectively]. Longer hospitalizations at the time of HD induction [(p=0.044; (OR):1.103; CI: 1.003-1.213)] and albumin values &lt;2.5 mg/dL [(p=0.03; (OR): 3.8 (CI: 1.14-13)] were also strong mortality predictors. which were not previously observed.

Conclusion
Nowadays, nephrologists are less liberal in initiating dialysis to elderly patients with dementia and cardiovascular comorbidities. However, the population is getting older and our recent mortality predictors may reflect the aging of chronic kidney disease patients, who have multiple comorbidities as cachexia, requiring institutionalization and longer hospitalizations. It is increasingly important to evaluate patients prior to dialysis initiation, so our goal is to create an adjusted mortality score in our HD unit to help make the decision about inducing or not HD in our patients.
P1531DIURETIC USE IN HEMODIALYSIS PATIENTS: BENEFIC ASSOCIATION WITH RESIDUAL RENAL FUNCTION AND ALL-CAUSE MORTALITY
Authors: Faria Maria do Sameiro , Valente Maria João , Rocha Susana , Coimbra Susana , Catarino Cristina , Rocha-Pereira Petronila , Bronze-da-Rocha Elsa , Oliveira José Gerardo , Madureira José , Fernandes João Carlos , Miranda Vasco M P , Belo Luís , Santos-Silva Alice 
Published: June 2020

Abstract

Background and Aims
In patients with end-stage renal disease (ESRD) on hemodialysis, the preservation of residual kidney function may result in a diversity of benefits in terms of survival and quality of life. The control of fluid and electrolyte homeostasis may play an important role in this setting. Elevated predialysis serum potassium is a common electrolyte disturbance that may worsen patient’s outcomes. Our aim was to study the impact of furosemide therapy in predialysis serum potassium levels, indicators of estimated residual renal function, and inflammatory markers, in ESRD patients under hemodialysis; moreover, we aimed to study the impact of furosemide-associated changes on mortality rate.

Method
A cross-sectional study was carried out on 289 adult patients on chronic dialysis therapy (hemodiafiltration and high flux hemodialysis). Patients were divided in 2 groups: the diuretic group (DG, n=116; 120.0 (IQR: 80-160) mg/daily median furosemide dose) and the non-diuretic group (NDG, n = 173), in which patients did not use furosemide. A large set of data was analyzed, encompassing hematological data, serum electrolyte parameters, inflammatory markers, dialysis adequacy, and biomarkers of residual kidney function. A 2-year follow up study was also performed by registering events of death (all-cause mortality).

Results
The DG patients, compared with NDG patients, presented: significantly lower predialysis serum potassium; more favorable blood biomarkers of kidney function - lower β-trace protein, cystatin C, creatinine and urea; greater residual glomerular filtration rate derived from equations with cystatin C, creatinine and creatinine–cystatin C; lower inflammation (significantly lower levels of high-sensitivity C-reactive protein); intradialytic ultrafiltration volume (L) was similar for the two groups. Mortality was significantly lower for DG patients, compared with NDG (13.6% versus 24.7%; P=0.029).

Conclusion
In ESRD patients under chronic dialysis, we found a significant association between current diuretic therapy and lower predialysis serum potassium levels, more favorable biomarkers of kidney function and a decreased inflammatory response that seem to contribute to a higher survival rate.
Acknowledgments: The work was supported by UIDB/04378/2020 with funding from FCT/MCTES through national funds, by North Portugal Regional Coordination and Development Commission (CCDR-N)/NORTE2020/Portugal 2020 (Norte-01-0145-FEDER-000024) and by REQUIMTE-Rede de Química e Tecnologia-Associação in the form of a researcher (S. Rocha) – project Dial4Life co-financed by FCT/MCTES (PTDC/MEC-CAR/31322/2017) and FEDER/COMPETE 2020 (POCI-01-0145-FEDER-031322).
P1532PARATHYROID HORMONE SERUM LEVELS AND MORTALITY AMONG HEMODIALYSIS PATIENTS IN THE GULF COOPERATION COUNCIL COUNTRIES: RESULTS FROM THE DOPPS (2012-2018)
Authors: Al Salmi Issa , Bieber Brian , AlRukhaimi Mona , AlSahow Ali , Shaheen Faissal , Al-Ghamdi Saeed M G , Al Wakeel Jamal , Al Ali Fadwa , Al Arriadi Ali , Hejaili Fayez , Al Maimani Yacoub , Fouly Essam , Robinson Bruce , Pisoni Ronald 
Published: June 2020

Abstract

Background and Aims
The prospective Dialysis Outcomes and Practice Patterns Study (DOPPS) has collected data since 2012 in all six Gulf cooperation council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, United Arab Emirates). Here, we report the relationship of PTH with mortality in this largest GCC hemodialysis patient cohort studied to date.

Method
Data were from randomly-selected national samples of hemodialysis facilities in GCC DOPPS phases 5 and 6 (2012-2018). PTH descriptive findings and case-mix adjusted PTH/mortality Cox regression analyses were based on 1825 and 1422 randomly-selected hemodialysis patients, respectively.

Results
Mean patient age was 55 years (median dialysis vintage = 2.1 years). Median PTH ranged from 259 pg/mL (UAE) to 437 pg/mL (Kuwait), with 22% having PTH &lt;150 pg/mL, 24% (PTH 150-300), 34% (PTH 301-700), and 20% (PTH &gt;700) pg/mL. Patients with PTH &gt;700 pg/mL were younger, on dialysis longer, less likely to be diabetic, have urine&gt;200 mL/day, prescribed 3.5 mEq/L dialysate calcium, had higher mean serum creatinine and phosphorus levels, lower white blood cell counts, and more likely to be prescribed cinacalcet, phosphate binders, or IV vitamin D. A “U-shaped” PTH/mortality relationship was observed with &gt;2-fold and 1.5 fold higher adjusted HR of death at PTH&gt;700 pg/mL and &lt;300 pg/mL, respectively, compared to PTH 301-450 pg/mL.

Conclusion
Secondary hyperparathyroidism is highly prevalent among GCC hemodialysis patients, with a strong U-shaped PTH/mortality relationship seen at PTH &lt;300 and &gt;450 pg/mL. Future studies are encouraged for further understanding this PTH/mortality pattern in relationship to unique aspects of the GCC hemodialysis population.
P1533SURVIVAL ANALYSIS OH HAEMODIALYSIS PATIENTS: IMPACTO OF UREMIC TOXINS
Authors: Sargsyan Mari , Robles Juan , Cabello Pelegrin Sheila , Ferrer Balaguer Juana Maria , Rey Valeriano Juan , Jimenez Mendoza Sonia Cleofe , Egea Sancho Cristina , Villagrasa Villagrasa Tania , URIOL MIGUEL , Gomez Marques Gonzalo , Barcelo Martin Bernardino , Gasco Company Joan Manuel 
Published: June 2020

Abstract

Background and Aims
HEMO study showed that β2M level over time was predictive of all-cause mortality in haemodialysis patients (HD). Later studies suggested that protein-bound uremic toxins are associated with mortality in HD patients but with recent contrasting results.
Aim of study was to analyse β2M and indoxyl sulfate (IS) as predictor factors of mortality.

Method
5 years follow-up of 60 prevalent HD patients of our hospital. Demographic data was described. Baseline midweek pre-dialysis serum β2M was determined by nephelometry and total IS levels by high performance liquid chromatograph connected to a UV detector. We considered high serum β2M group as if was equal or higher than 27,5 mg/L. As to IS, patients were divided into quartiles (1q &lt;9,7 mg/L, 2-3q ≥9.7-26.5mg/L, 4q&gt;26.5 mg/L).
Survival curves were assessed using the Kaplan–Meier analysis at 1,2,3 and 5 years in univariate analysis for albumin (≥38 g/L or lower), β2M, and total IS groups, and evaluated by the proportional hazards Cox´s model. P -values &lt;0.05 were considered statistically significant.

Results
60 prevalent patients with mean vintage of 46,8 months (range 3-299 months). Mean age was 60±20 years. Males were more prevalent (53,3% vs 46,6%). 35% had diabetes. 51,6% underwent conventional hemodialysis (HD), 48,3% post-dilution haemodiafiltration, with mean convective volume of 23,8±2,8L. Mean eKt/V was 1,67±0,4, mean nPCR was 1±0,27g/kg/day. Only 8,3% of patients had urine volume&gt;500cc/24hours. Mean β2M level was 35,6±1,9mg/L (X±SE) and mean total IS level was 18,9±1,6mg/L.
The overall mortality at 5 years was 57%. Albuminemia lower than 38g/L was associated with mortality at 2, 3, and 5-years in univariate analysis (Cox´s F test p=0.03, figure 1). We found no difference in survival rate between patients with high or low serum β2M levels at 3- or 5-years analysis (Cox´s F test p=0.27). At 2 years analysis, patients in the lower β2M group had better survival (Cox´s F test p=0.04, Figure 1). There was no statistically significant association between albumin, β2M, IS level and all-cause mortality on Cox regression multivariate analysis. We observe no statistically significant association between IS levels and all-cause mortality neither on univariate, nor on multivariate analysis.

Conclusion
β2M &lt; 27,5 mg/l was associated with better survival at 2 years univariate analysis. IS had no statistically significant association with all-cause mortality in our cohort.
P1552CAN WE GET ADEQUATE DIALYSIS WITH LIQUID AT 300 ML/MIN ?
Authors: Barril Guillermina , Sobrino Pedro , Giorgi Martin , Nuñez Almudena , Santos Begoña , Pascual Natalia , Sanz Pilar , Cano Francisco , Nogueira Angel , Sanchez Tomero Jose Antonio 
Published: June 2020

Abstract

Background and Aims
The portable HD monitors achieve a good adaptation with HD dialysate at 200ml / min using the concept of saturation of the HD dialysate. We decrease from 800ml / min to 500ml / min with good adaptation some years ago.
To assess the effectiveness of HD in both HD-standard and HDF-online with dialysate flow at 300ml / min by establishing approximate mathematical model of clearance.

Methods
We conducted an HD session with dialysate flow at a speed of 300ml / min, half week session to 52 patients in our unit. We value vascular access, session time, liters of blood-purified and total infusion in HDF online. We review HD monitor and dialyzer.
We perform pre and postHD blood determinations: Urea, B2microglobulin, P and uric acid, assessing urea reduction rate (PRU), b2microglobulin reduction rate (PR2microg) with both dialysate flows at 300ml / min and 500ml / min. We also have evaluated the differences between the two methods.
In the HD dialysate flow we determine at 300ml / min at 5, 10, 30, 45 and 60min (total dialysate collection in the first hour with sample of the mixture) urea, B2microg, Uric acid and P and at 2, 3 and 4 hours establishing a mathematical model with an approximation curve in both HD and online HDF.

Results
Five patients in standard HD (4h), 35 HDF online (4h) (x Liters infused 24.87 ± 2.79 l) and 12 short-daily HD (2h30min). 18 catheter and 34 FAV. Xliters purified blood = HD daily 54.41 ± 5.63l, HD standard 87.38 ± 6.01 and HDFonline 82.02 ± 16.13l.
The xPRU = 76.17 ± 10.49%, PRB2microg = 73.82 ± 13.49, Kt / V = 1.52 ± 0.28. By scheme at 300ml / min of HD fluid flow: HDFonline xPRU = 81.54 ± 5.25, Standard HD = 78.01 ± 3.03, Daily HD = 60.19 ± 6.71; xPRb2microg HDFonline = 76.70 ± 14.76%, Standard HD 65.44 ± 11.81, Daily HD = 69.16 ± 6.49.
Comparing the xPRU at 300ml / min of liquid vs 500ml / min we didn´t found significant differences, nor in the x preHD of urea and B2microglobulin.
With the dialysate samples we obtain a polynomial model of order 7 allowing cuantitative adjustment of the curve.R2 0.9, observing in the first 2 hours the greater removing.

Conclusions
1. The results are sufficient to consider the result of the removing in each scheme adequate. 2. The decrease in costs would be important (40% of water + energy saving and longer duration elements water treatment. 3. Further study are necessary.
P1560ANXIETY AND DEPRESSION AMONG HEMODIALYSIS PATIENTS
Authors: Fadwa Helaoui 
Published: June 2020

Abstract

Background and Aims
Procedure of haemodialysis (HD) treatment is associated with an impaired quality of life in chronic kidney disease patients. It is due to changes in family, social and professional relationships. These changes can also lead to mental health problems. The purpose of our study is to determine the prevalence of depressive and anxiety disorders in hemodialysis patients.

Method
Fifty chronic hemodialysis patients were enrolled in our cross-sectional study during four months (September -October- November- December 2019). The HADS (Hospital Anxiety and Depression Scale) survey was used to assess depressive and anxiolytic disorder in our hemodialysis population. Were excluded patients aged less than 18 yearsold as well as kidney transplant patients and psychiatric patients.

Results
The mean age of our patients was 49.5 range (24-79).The sex ratio was 1.27. The prevalence of anxiety syndrome was 40% with a female predominance of 54.5% versus 54,5%. Depressive syndrome was noted in 48% of our patients with a male predominance of 58.3% versus 41,7%.
48% of our HD patients have shown depression in various degrees. It was about mild depression of 20,8% of pts, moderate depression of 41,6% of pts and severe depression of 37,5% of pts. Somatic symptoms of depression in our population were respectively noted in 52,8% of loss of energy, 57,5% fatigue, 63,4% sleep disturbances, and 38,5% changes in appetite. The most common psychological symptoms were: pessimism (79,1%), loss of interest in appearance (41,6%), psychomotor retardation (75%).
On the other hand, 37, 5% of patients felt cheerful and 16,6% still enjoy doing some activities. For patients with anxiety syndrom, we noted: concentration disturbance (45,4%), palpitations (50%), abdominal pain (59,09%) and headache (81,8%).
With regard to psychological symptoms, the most emphasized were: sudden feelings of panic (54,5%), worrying thoughts (72,7%),77,2% are feeling restless and 59,09% are feeling wound up.
On the other hand, 68,1% feel relaxed especially after the hemodialysis session. It seems that gender, marital status and HD duration did not influence significantly in occurrence of depression with respectively (p=0,08, p=0.1 and p= 0.08). Older patients were significantly more depressed in compared to younger patients (p= 0.003). Unemployed patients were significantly more depressed in relation to employed patients(p=0.01). Finally, as the educational level of patients increased, level of depression significantly decreased (p=0,04).

Conclusion
Depression is the most frequent psychological complication of hemodialysis (HD) patients. Our results showed a high prevalence of depressive symptoms among the study group. The exact prevalence of depression in dialysis patients is unclear because of different criteria utilized for diagnosis of depression. A close collaboration between nephrologists and psychiatrists is needed to ensure a better quality of life in HD patients.