bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1360ARTERIOVENOUS FISTULA MATURATION DELAY - ENDOVASCULAR TREATMENT IS A VALID APPROACH
Authors: Nogueira Rui , Oliveira Nuno , Ferreira Emanuel , Belmira Ana , Alves Rui 
Published: June 2020

Abstract

Background and Aims
Arteriovenous fistula is the optimal vascular access for hemodialysis as it has the best long-term patency rate and the lowest complication rate among hemodialysis vascular accesses. However, its occasional delayed maturation poses a challenge. Surgery has been advocated as the best treatment option. We proposed to evaluate the results of endovascular approach of arteriovenous fistula’s maturation delay in our hospital.

Method
We conducted a retrospective study, selecting patients referenced to our diagnostic and therapeutic angiography unit due to arteriovenous fistula delayed maturation, between April 2017 and October 2019. Physical examination and echography were used to confirm arteriovenous fistula delayed maturation.

Results
Thirty patients were referenced. Nine were excluded as maturation delay was not confirmed. Three patients were excluded due to extensive outflow stenosis since they were proposed to new vascular access creation. The other 18 patients were subjected to percutaneous endovascular treatment. Mean patient’s age was 65 years old. Twelve patients (66,7%) had forearm fistulas and the remaining (33,3%) had arm fistulas. Fourteen patients (77,7%) had maturation delay due to peri-anastomotic stenosis. The mean follow-up time was 14 months, (minimum - 3 months; maximum - 33 months). Seventeen fistulas (94,4%) were salvaged, although 3 (16,7%) needed a second intervention. Primary and secondary patencies at 3, 6 and 12 months were 77,8% vs. 94,4%, 69,2% vs. 92,3% and 75% vs. 100%, respectively. Arm fistulas had 83,3% of primary and secondary patencies. Forearm fistula’s primary and secondary patencies were 66,7% vs. 91,6%, 57,1% vs. 100% and 60% vs. 100%, at 3, 6 and 12 months, respectively. When maturation failure was due to peri-anastomotic stenosis, primary and secondary patencies were 71,4% vs. 92,9%, 66,7% vs. 100% and 66,7% vs. 100% at 3, 6 and 12 months, respectively.

Conclusion
Even though we are still lacking consensus about the best treatment option for fistula’s maturation delay, current guidelines suggest that, at least in delayed maturation due to peri-anastomotic stenosis, surgery may be the best treatment. Our results point out that endovascular treatment is a good treatment option for arteriovenous fistulas with maturation delay, mainly in the arm fistulas. Even though surgical treatment appears to have better primary patency, a step by step approach seems to be a valid approach, as our secondary patency shows.
P1365HEMODIALYSIS CATHETER-RELATED BLOODSTREAM INFECTIONS : A CASE SERIES
Authors: Amal Ouni , Ben salem Meriem , Mojaat Malek , Mayssa Hadj Brahim , Manel Ben salah , Hammouda Mouna , Insaf Handous , Ahmed Ltaief , Fawzi Hawala , Jaafer Ines , Sabra Aloui , Skhiri Habib 
Published: June 2020

Abstract

Background and Aims
the recourse to catheter among patients on hemodialysis is frequent due to many reasons. It is highly associated to a risk of infection in comparison to AVF. The aim of our study was to determine the clinical and bacteriological parameters in patients hospitalized for dialysis catheter related bloodstream infections.

Method
We conducted a retrospective descriptive study based on the data of patients hospitalized for hemodialysis catheter-related bloodstream infection in the department of nephrology in Fattouma Bourguiba University hospital between January 2013 and February 2018. Data concerning the bacteriological exams were obtained from our bacteriology laboratory.

Results
50 patients were included with a mean-age of 56 years old. 74% were women, 30% diabetic and 18% considered immunodepressed. The indications for the placement of catheter were: 21 patients waiting for the creation of AVF, 16 patients with a dysfunction of AVF, 6 patients with AKI and 7 patients with inadequate veins for the creation of AFV. The IJV was the site of insertion in 74% of patients (with 4 % of tunneled catheters).
26 % of patients developed a septic choc, and 74 % developed a sepsis. The culture of the specimen of catheters was positive in 32 patients (64%). Staphylococcus aureus was isolated in 14 patients (28%) with MSSA among 8 patients and enterobacteria among 8 patients. Hemoculture was only positive in 13 patients. The catheter was removed in the majority of cases except in 6 patients in whom there was no other venous access. The evolution was favourable in 80 % of patients. 5 patients developed an infective endocarditis as a secondary localization.

Conclusion
The AVF remains the best vascular access for hemopadialysis patients. The recourse to catheters must be considered as a last choice because of the risk of infections which frequently necessitates the hospitalization with an increase in mortality.
P1366THE ROLE OF A NEPHROLOGIST IN THE CREATION OF VASCULAR ACCESS FOR HEMODIALYSIS
Authors: Fomenko Gennadii 
Published: June 2020

Abstract

Background and Aims
The creation of vascular access: has it anything to do with a nephrologist ? At first glance, the concept of vascular access is the responsibility of surgical specialists. However, a nephrologist has started executing some of the common intensive treatment methods, using the equipment and techniques, specific to the field of dialysis. In this case, a nephrology specialist sets up different kinds of vascular access, namely the AV (arteriovenous) fistula, the AV graft, and the venous catheter; he/she is, therefore, responsible for its assessment and congruent correction.

Method
the usage of statistical data, gathered by the medical specialists of the dialysis unit of the Regional Chernihiv Hospital; the analysis of the possible nephrologist’s contribution to the creation of vascular access in patients with kidney diseases.

Results
During 2017-2019, 332 catheterizations were performed, during each of them vascular access was established:

Conclusion
1. A nephrologist, in collaboration with a vascular surgeon, is particularly interested in the creation of vascular access in a patient with chronic kidney disease at the pre-dialysis stage;
2. In most cases, a nephrologist can set up temporary or permanent vascular access in patients with chronic kidney disease or acute kidney injury, which improves the quality of hemodialysis by making him an active participant of the treatment process.
P1369ACUTE EXTRACORPOREAL DIALYSIS USING TWO-WAY PICC POWER INJECTABLE IN YOUNG CHILDREN
Authors: Annicchiarico Petruzzelli Luigi , Serio Vittorio , Luongo Ilaria , Molino Daniela , Minale Bruno , Lepore Lorenza , Ascione Serena , Lubrano Carmen , Malgieri Gabriele , Pecoraro Carmine 
Published: June 2020

Abstract

Background and Aims
Acute extracorporeal dialysis is a short treatment, performed by a central venous catheter of large size, ensuring high flow. These devices have limitations: high caliber, excessive length, impossibility of tunneling and exit-site location in the supraclavicular region, with a subsequent high risk of dislocation and contamination. The authors report a new approach to dialytic central venous catheters selection in children.

Method
From January 2013 to December 2017, 16 children weighing less than 15 kg needed acute extracorporeal dialysis. Patients received an ultrasound guided percutaneous implantation of a two-way PICC power injectable catheter, in the right internal jugular vein or in the anonymous right vein. The device size always respected the ratio of 1/3; the catheters were cut to be adapted to child height, and subclavear tunnelizations and stabilizations were ensured. The hemodialysis was performed with the Prismaflex Gambro system. The effectiveness of treatment was evaluated by recirculation test and by measuring the KT/Vat the third hour, expressing the dialysis adequacy.

Results
Two-way power injectable central venous catheter,sized from 5 to 7 Fr and long from 8 to 15 cm were used. The recorded blood flow ranged from 4.7ml/min/kg to 7ml/min/kg; a KT/V variable from 0.5 to 1 was detected; the recycling rate was between 32% and 40%. No catheter related complications were observed.

Conclusion
In children weighing less than 15 kg, PICC power injectable have lower blood flow and higher recirculation rate compared to traditional dialysis catheters. However, the dialytic adequacy was suitable for an acute hemodialysis treatment. In addition, these catheters are available in a wide range of calibers and result more adaptable to the venous system of younger children.
P1376IRON MANAGEMENT IN A HAEMODIALYSIS POPULATION POST-PIVOTAL
Authors: Kenou Djotsa Rosiane , Macdougall Iain C , Ford Martin 
Published: June 2020

Abstract

Background and Aims
IV iron plays a critical role in the management of anaemia in haemodialysis patients. The PIVOTAL trial recently generated new insights in this context, and suggested potential harm associated with under-treatment with IV iron.
To perform a prospective cross-sectional survey of iron management in a single-centre haemodialysis population in light of the results from the PIVOTAL trial.

Method
During June 2019, we prospectively measured haemoglobin, serum ferritin and transferrin saturation in a prevalent haemodialysis population at a tertiary renal centre. The current dose of IV iron sucrose was also recorded. Extrapolating from the PIVOTAL trial results (best outcomes in the high-dose group with a mean ferritin of around 650 ng/ml and a TSAT of around 26%), we arbitrarily and conservatively defined under-treatment with iron as a ferritin level ≤500 ng/ml and a TSAT ≤25%.

Results
A total of 587 patients were identified, 581 of whom had a ferritin result available. Of these, 358 (62%) had a ferritin level ≤500 ng/ml and 295/527 (56%) had a TSAT ≤25%. For the 527 patients in whom both ferritin and TSAT measurements were available, 204/527 (39%) were defined as under-treated. Of the 587 patients, 111/582 (19%) were not receiving IV iron. 71/582 (12%) were on 100 mg monthly, 48/582 (8%) were on 200 mg monthly, 339/582 (58%) were prescribed 400 mg iron sucrose/month and 14/582 (2%) were on ≥ 400 mg. The iron dose was not available in 5 patients. Of the 204 undertreated population, 22 (11%) were not on IV iron. 17/204 (8%) were on 100 mg/month, 16/204 (8%) on 200 mg/month, 137/204 (61%) on 400 mg/month, and 11/204 (2%) on &gt; 400 mg monthly. Of the patients defined as undertreated, the haemoglobin ranged from 63 to 151 g/l with a mean of 109.8 g/l and a median of 111 g/l. 30 patients had a haemoglobin less than 100 g/l and 92 patients had a haemoglobin less than 110 g/l. 24/204 patients were not on an ESA (one patient was on Daprodustat) with a mean dose of 12,200 U/week.
Conclusion:
Our current iron protocol is under-dosing a significant proportion of patients. This protocol requires review in light of the PIVOTAL study since it is likely significant cost savings could be achieved as a result of using lower doses of ESA therapy, along with the cardiovascular benefits seen in the higher dose arm of the trial.
P1379PLATELET/LYMPHOCYTE RATIO AS A MARKER OF ERYTHROPOIETIN RESPONSIVENESS IN END-STAGE RENAL DISEASE
Authors: Golubović Sonja , Azasevac Tijana , Živković Siniša , Ljubiäiä‡ Bojana , Knezevic Violeta , Celic Dejan 
Published: June 2020

Abstract

Background and Aims
Neutrophil/Lymphocyte Ratio (NLR) and Platelet/Lymphocyte Ratio (PLR) are closely associated with increased inflammation in end-stage renal disease, which often contributes to the severity of anemia in these patients. Erythropoiesis stimulating agents (ESA) have become a standard treatment of anemia in hemodialysis patients. Since some patients do not respond well to erythropoietin therapy (EPO) the aim of this study is to investigate if NLR and PLR as markers of increased inflammation, could be associated with resistance to EPO therapy.

Method
A total of 90 patients (36 females, 54 males; mean age 60,45 ±11,58) undergoing maintenance hemodialysis and who received recombinant human EPO therapy were examined. Patients' clinical characteristics, laboratory data, dialysis adequacy and the applied doses os EPO were examined in a period of 3 months. EPO hyporesponsiveness index (EHRI) was calculated as the weekly dose of EPO divided by kilograms of body weight divided by the hemoglobin level.

Results
Obtained results show a statistically significant correlation of moderate-intensity between EHRI and NLR ( r = 0.497, p &lt; 0.01) as well as a negative correlation of moderate-intensity between EHRI and hemoglobin levels (Hgb) (r = -0.403, p &lt; 0.01). When it comes to the connection of NLR and PLR with logarithmically converted EHRI values, the results show that there is no statistically significant correlation between NLR and EHRI. Comparison of PLR among 25th, 50th and 75th percentile of EHRI showed that PLR levels increased going from the 25th towards the 75th percentile (p &lt; 0.01). Post hoc analysis indicated that there is also a statistically strong connection for the 25th i 50th percentile (&lt;0 .05) and furthermore for the 50th and 75th percentile (&lt; 0.05).

Conclusion
PLR was found to be superior to NLR in terms of evaluating ESA therapy resistance. PLR could be used as a predictor of ESA therapy response.
P1385BOLUS FERRIC CARBOXYMALTOSE ADMINISTRATION COULD BE A GOOD OPTION FOR IRON MAINTENANCE THERAPY IN HD FACILITIES WITHOUT REGULAR MEDICAL ASSISTANCE
Authors: Brunati Chiara , Vergani Denise , Gervasi Francesca , Montoli Alberto , Minetti Enrico 
Published: June 2020

Abstract

Background and Aims
In 2013, the European Medicines Agency (EMA) claimed that iron preparations should be exclusively given in an environment where resuscitation facilities are available and, therefore, the iron administration was highly discouraged without the presence of a doctor. What this means is that in dialysis centres without regular medical presence the dose of iron administered might be inadequate. Ferric carboxyimaltose (FCM) allows to administer high single doses of iron with an excellent safety profile.

Method
We compare the effect of a maintenance iron therapy in two groups of prevalent and clinical stable hemodialysis patients; the former (A; n=19pts) was treated with iron gluconate (FG) in low refracted doses (i.e. 60 mg one or two times a week) while the latter (B;n=20 pts) was treated with FCM in high doses (i.e. 200 mg once or twice a month). The groups have been followed up for one year. All treated patients in the two groups had similar and “adequate” basal iron parameters according to European Clinical Guideline (Serum Ferritin(SF) ≥200 mic/l and transferrin saturation(TS) ≥20%) (see Table 1). The therapy was administered in order to maintain SF between 200-500 mic/l and TS between 20-40%. Erythropoietin dose (Epo) was evaluated considering the erythropoietin resistance index (ERI =EPO/weight/Hb).

Results
Table 1 show the results at the start and end follow up. The mean monthly iron dose was similar between the two groups at the end of follow up (144±100 mg group A vs 157±81 mg group B). In group A there was a more significant increase in the TS with a non-significant trend to an increase in SF. Six pts of group A had an overshooting of SF (1164±360mc/L) vs 3 pts in group B (SF 830±30 mc/L).
No significant differences in pre and post therapy ERI could be recorded.

Conclusion
A therapy with a high single doses of FCM could be a positive solution to treat patients in dialysis centres without regular medical presence.
P1387IRON CITRATE BLOCKS THE PROGRESSION OF CALCIUM DEPOSITION BY REVERTING APOPTOSIS AND AUTOPHAGY IN VSMCS
Authors: Ciceri Paola , Falleni Monica , Tosi Delfina , Martinelli Carla , Cozzolino Mario Gennaro 
Published: June 2020

Abstract

Background and Aims
Cardiovascular disease is the first cause of mortality in chronic kidney disease (CKD) induced by vascular calcification. Since, in advanced CKD, iron based phosphate binders have been proposed to treat hyperphosphatemia, we studied, in high-phosphate (Pi) calcified VSMC, the effect of iron citrate (iron) on the progression of calcium deposition.

Method
We treated VSMCs with 5 mM Pi and iron citrate to evaluate Ca deposition by Alizarin Red destaining, DNA fragmentation by ELISA, gene expression by RT-PCR and protein expression by Western blot.

Results
High-Pi calcification was blocked when iron was added from day 7 to 15 (1.30±0.03vs0.61±0.02; OD/mg protein; day 15; PivsPi+Fe, p&lt;0.01). Since iron added prophylactically prevented apoptosis and potentiated autophagy we studied the role of these two processes in the therapeutic protocol. Adding iron from day 7 to day 11 decreased apoptotic cell number (17.3±2.6vs11.6±1.6; Annexin V; % positive cells; day 11; PivsPi+Fe; p&lt;0.05, figure). To confirm the effect of iron on apoptosis, we demonstrated its action in blocking the H2O2-induced increase in calcification when added from day 7 to day 14 (1.37±0.03 vs. 0.96±0.05; H2O2+Pi day 7-14 vs Fe+H2O2+Pi day 7-14; day 14; OD/mg protein; p&lt;0.01). We then investigated the mechanism of the anti-apoptotic effect by studying the pro-survival axis GAS6/AXL, finding that iron treatment from day 9 to day 14 counteracted the protein down-regulation, and induced their de-novo synthesis. Supporting the effect of therapeutic added iron on apoptosis we found a decrease in apoptotic nuclei both in VSMCs and aortic rings after iron treatment from day 7 to 15 (3.8±0.2vs2.3±0.3 and 4.0±0.3vs2.2±0.2; apoptotic nuclei; arbitrary score; day 15; PivsPi+Fe; VSMCs and aortic rings; p&lt;0.05). Moreover, iron added from day 9 to day 15 potentiated autophagic flux and increased the number of autophagosomes with damaged mitochondria.

Conclusion
Iron exerts an anti-apoptotic and pro-autophagic effect on established calcified VSMC when simil-osteoblastic transformation was already occurred.
P1388ASSESSING BONE TURNOVER IN CHRONIC KIDNEY DISEASE: SHOULD WE MEASURE NON-OXIDIZED PTH
Authors: Ursem Stan , Heijboer Annemieke , D'Haese Patrick , Behets Geert , Vervloet Marc , Evenepoel Pieter 
Published: June 2020

Abstract

Background and Aims
Parathyroid hormone (PTH) is a key regulator of bone turnover. PTH can be oxidized in vivo, which impacts biological activity. Variable PTH oxidation may be hypothesized to contribute to the rather poor correlation of PTH with indices of bone turnover. Non-oxidized PTH may better reflect the hormonal function than currently measured intact PTH (iPTH). Therefore, we investigated whether n-oxPTH would be superior compared to iPTH as indicator of bone turnover in ESRD.

Method
Thirty patients with a wide range of bone turnover, as assessed by bone histomorphometry (BHM), were selected from an ongoing, prospective observational study in patients with ESRD (NCT01886950), that underwent bone biopsy. Both iPTH (Cobas, Roche Diagnostics, Rotkreuz, Switzerland) and n-oxPTH (A1112; Immundiagnostik AG, Bensheim, Germany) and in addition bone turnover markers (bone-specific alkaline phosphatase (BSAP), P1NP and tartrate-resistant acid phosphatase 5b (TRAP5b)) were assessed in blood samples taken at the time of the bone biopsy. Descriptive statistics, Pearson correlation, regression analysis and ROC curves were used to assess the discriminative ability of n-oxPTH vs iPTH to detect bone turnover.

Results
n-oxPTH and iPTH were strongly correlated (r=0.96; p&lt;0.001) and n-oxPTH values were on average 87% lower than iPTH values. Bone turnover, assessed by BHM (both static and dynamic measures) were strongly correlated with n-oxPTH and iPTH, e.g. bone formation rate r=0.65; p&lt;0.001 and r=0.69; p&lt;0.001, respectively. Bone turnover markers (BSAP, P1NP and TRAP5b) were also strongly and similarly associated with n-oxPTH and iPTH. The AUROC values for discriminating between low/non-low turnover for n-oxPTH and iPTH were 0.81; p&lt;0.01 and 0.86; p&lt;0.01, respectively (Figure 1A). For high/non-high turnover the AUROC was 0.88; p&lt;0.01 and 0.90; p&lt;0.01, respectively (Figure 1B).

Conclusion
n-oxPTH was not superior compared to iPTH in discriminating between high/non-high and low/non-low turnover and also showed no stronger correlation to biomarkers of bone turnover. Therefore, we conclude that there is no added value of n-oxPTH for evaluating bone disease in ESRD patients receiving dialysis, using the currently available method. Since this method cannot distinguish partially form completely oxidized PTH, we cannot definitely rule out the possibility that oxidation of PTH has impact on bone turnover .
P1402USE OF ROMOSOZUMAB FOR OSTEOPOROSIS IN HEMODIALYSIS PATIENTS
Authors: Kiyosumi Rie , Ikeda Naofumi 
Published: June 2020

Abstract

Background and Aims
Recently, the importance of osteoporosis and chronic kidney disease-mineral bone disorder (CKD-MBD) has been highlighted as a cause of increased fracture risk in dialysis patients. However, many osteoporosis drugs require careful administration or are contraindicated in dialysis patients, and evidence for their use in dialysis patients is scarce. Here, we administered the new human anti-sclerostin antibody preparation romosozumab to hemodialysis patients with osteoporosis, and examined changes in bone density, bone metabolism markers and other values.

Method
Romosozumab was administered once per month to 12 hemodialysis patients (mean age: 72.6 ± 9.4 years old; 4 males, 8 females) who were diagnosed with osteoporosis while visiting our hospital and who had no history of cardiovascular complications in the preceding year. Bone density YAM value was measured every 3 months by dual energy X-ray absorptiometry (DXA). TRACP-5b, BAP, P1NP and whole-PTH values were measured every month as bone metabolic markers. Values at the start of observation were regarded as pre-dosing values and the mean values during the 6 months after administration were measured as post-treatment values. The results were then compared.

Results
At 6 months after the start of treatment, no change was seen in bone density of the proximal femur compared to the pre-dosing value. In contrast, lumbar spine bone density YAM value (%) was significantly improved, from 63.8% ± 9.4% to 70.9% ± 5.2% (P = 0.012). Regarding bone metabolism markers, mean value of bone resorption marker TRACP-5b after the start of administration did not significantly differ from that at the start of observation. BAP value increased significantly from 16.2 ± 8.7 to 25.2 ± 11.0 (p &lt; 0.01) while whole-PTH significantly increased from 103.5 ± 52.8 to 236.1 ± 100.8 (p &lt; 0.01). In addition, serial time changes for each bone metabolic marker, whole-PTH value, and corrected Ca value during the observation period are also reported.

Conclusion
Romosozumab may improve bone density in dialysis patients with osteoporosis.