bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1500SEASONAL VARIATIONS AND VARIATIONS DUE TO OTHER CAUSES IN CLINICAL AND LABORATORY PARAMETERS IN HEMODIALYSIS PATIENTS
Authors: KAWAHARA KAZUHIKO 
Published: June 2020

Abstract

Background and Aims
In hemodialysis patients, seasonal variations and changes in dialysis prescription affect laboratory data, blood pressure, and body weight. We examined whether these fluctuations were due to seasonal variations or other causes. Although there are some reports on seasonal changes in hemodialysis patients, there are few reports on observations over multiple years in the same stable patients.

Method
We studied 65 patients on hemodialysis (36 males and 29 females; average age, 67.7 years; average duration of HD therapy, 13.8 years). The observation period was three years from January 2016 to December 2018; laboratory data and dialysis-related indicators, blood pressure, dry weight, and interdialysis weight gain were examined retrospectively. We excluded cases with dialysis time less than 4 h and patients who were hospitalized during the observation period. Differences in statistical analysis were tested with repeated-measures ANOVA or Friedman test.

Results
Factors that showed an influence on the laboratory parameters in hemodialysis patients more than twice in the same season in the three-year observation period were serum urea nitrogen (UN), serum creatinine (Cr), serum potassium (K), serum inorganic phosphorus (IP), and serum total bilirubin (T-Bil), serum creatine kinase (CPK), serum glycoalbumin (GA), normalized protein catabolic rate (nPCR), % creatinine production rate (% CGR), systolic blood pressure (sBP), diastolic blood pressure (dBP), and inter-dialytic weight gain (p&lt;0.05). In contrast, the serum albumin concentration (Alb), serum magnesium (Mg), serum parathyroid hormone-INTACT (iPTH), and standardized dialysis amount of urea (KT/Vurea) exhibited gradual changes during the observation period (p&lt;0.05).

Conclusion
There were indeed seasonal variations with UN, Cr, K, IP, T-Bil, CPK, GA, nPCR, %CGR, sBP, dBP, and inter-dialytic weight gain. However, Alb, Mg, iPTH, KT/Vurea changed owing to dialysis prescription and medicines.
P1505COMORBIDITY AND AGE OF DIALYSIS PATIENTS OUTPERFORMS FRAILTY BURDEN AS A PREDICTOR FOR MORTALITY
Authors: Milenkova Mimoza , Spasovska Vasilova Adrijana , Canevska Aleksandra , Pushevski Vladimir , SELIM GJULSEN , Sikole Aleksandar , Rambabova Bushljetikj Irena , Trajcheska Lada , Spasovski Goce 
Published: June 2020

Abstract

Background and Aims
The life expectancy in dialysis patients depends on patients’ age and comorbidities. Frailty in elderly patients is a state of impaired homeostasis with loss of physiologic reserve and a consequent impaired responses to dialysis burden. In this study we assessed the impact of age, comorbidities and frailty on dialysis patients’ survival.

Method
The study enrolled 162 prevalent patients on chronic hemodialysis with mean dialysis vintage of 100 months, 55% were women and 21 % had diabetes. Patients were divided into three groups by the Khan Comorbidity index score, highest score was considered worse. Frailty was assessed by presence of 3 or more symptoms (unintentional weight loss, feeling exhausted, weak grip strength, slow walking speed and low physical activity) and expressed as absolute number. Estimates of five years life expectancy were assessed by Kaplan Meier survival log-rank test and Cox regression hazard model.

Results
There were 26 (16%) with lowest score, 85 (52%) with medium score and worst highest score in 51 (31%). During the 5 years of follow up 69(43%) patients died of all-cause mortality. There were no deaths in the group with lowest score and mortality rates in the intermediate and worse score group increased by double (0; 30%; 69%, respectively). Significantly higher mean life expectancy was found in lower Khan Score groups: 60mo; 48.40 ± 18.51; 32.44 ± 22.06, log-rank: p &lt; 0.012. Patients that scored worse had four folds higher risk for death HR 4.2 (95% CI: 2.72 – 6.36), p=0.0001. In the multivariate model Khan Score was a more powerful predictor of mortality than frailty in elderly, with HR 3.2 (95% CI: 2.88 – 5.41), p=0.0001.

Conclusion
Comorbidities and age outperforms frailty burden as a predictor of mortality in dialysis patients.
P1535ANXIETY AND DEPRESSIVE DISORDERS IN HEMODIALYSIS PATIENTS
Authors: Chaabouni Emna , Jbali Hela , Ikram Mami , Mohamed Chermiti , Hanene El Kateb , Lamia Rais , Karim Zouaghi 
Published: June 2020

Abstract

Background and Aims
Dialysis impacts the patients' quality of life drastically, increasing the risk of mortality. Depression and anxiety are commonly reported among dialysis patients.
But little is known about their prevalence.
The aim of this study is to examine the prevalence of anxiety and depression and associated factors among patients receiving hemodialysis

Method
A cross-sectional study was carried out among 94 hemodialysis patients treated at four hemodialysis center in a mediterranean country during a period of two months . The patients were interviewed while undergoing their dialysis session using the Hospital Anxiety and Depression Scale (HAD). The score of HAD was correlated with demographic and clinical variables.

Results
Based on Hospital Anxiety and Depression Scale, 49 patients (52%) had symptoms of depression, 41 patients (43%) had mild symptoms of anxiety, whereas moderate or severe symptoms of anxiety were present in 30 patients (32%).
In univariate analysis, HAD score for symptoms of depression correlated significantly with age (p=0,012) and past medical history of hypertension (p=0,024). Anxiety correlated significantly with female gender (p=0,039), smoking (p=0,017) and coffee addiction (p=0,024).

Conclusion
These results underline the important prevalence of anxiety and depression in hemodialysis patients .
Strategic options are necessary to improve the diagnosis of anxiety and depressive disorders, potentially enhancing quality of life and medical outcome in hemodialysis patients.
P1541HEMODIALYSIS IN END-STAGE RENAL DISEASE PATIENTS OVER 75 YEARS OLD
Authors: Mesbahi Tasnim , Samia Barbouch , Safa Fattoum , Mariem Najjar , Hela Jebali , Wided Smaoui , Lamia Rais , Fethi Ben Hamida , Mohamed Karim Zouaghi , Taieb Ben Abdallah 
Published: June 2020

Abstract

Background and Aims
Over the last decade, the age of dialysis patients has been increasing steadily worldwide. The benefits of dialysis in older people with end stage renal disease (ESRD) are not clear. We will try to evaluate whether dialysis in older has survival advantage compared to younger people.

Method
It is a prospective descriptive and analytic study including 229 patients who initiated chronic hemodialysis during the period between January and June 2017. Patients were classified into two groups by age at dialysis initiation. Patients above 75 years of age were considered old (old group OG). Patients aged less then 75 years old were considered young (young group YG). Primary outcome was old patient’s survival during the first 3 and 12 months from the dialysis initiation.

Results
Among a total of 229 new patients who began dialysis treatment, 41 (17,9%) ESRD were above 75 years of age.The sex ratio was 0,95 and 1,54 in respectively in OG and YG (p = 0,167). Diabetes was present in 56% of the elderly and in 59% of the younger group (p = 0,72) and was more frequently the cause of ESRD in the two groups. The average of modified Charlson Comorbidity Index was 6,7 ± 2,3 and 3,9 ± 2,6 respectively in OG and YG(p = 10-3). Younger patients had been referred earlier to nephrologists than the older ones. In fact, glomerular filtration rate at the beginning of the follow up was 18,7 ± 8,9 ml/min/1,73 in OG and 25,4 ± 16,2 in YG (p = 0,004). There was no statically significant difference between the two groups in the frequency of the use of temporary catheters at dialysis initiation (p = 0,778) and the urgent or planned initiation of dialysis (p = 0,298). Younger patients required hospitalization to organize dialysis initiation more than older patients (51,6% VS 26,8%; p = 0,005). Compared with the group of younger patients, Cox model showed an incremental increase in mortality associated with older patients’ group during the first year of HD (p = 0,036). However, there was no difference between OG and YG in the mortality rate during the first 3 months of HD (p = 0,102).

Conclusion
We may conclude that life expectancy of patients who began dialysis above 75 years is significantly shorter than younger patients in the first year of HD. In the other hand, the difference between the 2 groups wasn’t significant regarding the conditions of dialysis initiation.
P1554TYPES OF INCIDENTS MANAGED AT TWO DIFFERENT MEDICAL LEVELS IN A LARGE MULTINATIONAL RENAL SERVICES PROVIDER NETWORK
Authors: Marrón Belén , Silva Israel , Lucas Carlos , Torok Marietta , Wollheim Charlotta , Akdeniz Filiz , Pearce Suzanne , Westesson Ulf , Macário Fernando 
Published: June 2020

Abstract

Background and Aims
Patient safety programs need a well-structured organization to facilitate proactive and fair reporting, prompt evaluation analysis and timely feedback followed by measure implementation and auditing.
To analyze all types of incidents in our network from Jan.1st to Sept. 30th, 2019 by two different levels (Corporate and Country) of medical management alert.

Method
Our institution has tracked all incidents under a structured process program for the last 10 years, according to 4 incident types (Patient related, Staff-visitors, Products and Equipment) and 54 subcodes. Incidents are considered as serious when they may be life-threatening or result in death, impaired body function/structure and/or are deemed serious based on appropriate medical judgment. Communication to Health Authorities applies in accordance with local country regulations. “Serious incidents” are immediately notified to the Corporate Office and to each Country Medical lead, whilst different codes may generate alerts into Corporate or Country.

Results
A total of 68.399 incidents (2.7 incident/patient/year) were reported during Q1-Q3 2019. Total incidents/1000 treatments were 17.1 (12.1 were patients related incidents). Causes for alerts at corporate level (n=65) were: cardiorespiratory arrest (28%); unexpected death (15%); seroconversion (9%); hemolysis (8%), severe hypotension (6%) and air embolism (3%). Reported incidents at country level (n=655) were almost half ascribed to equipment [water supply, power failure and flooding (41%)], medication errors (36%), venous needle dislodgment (19%) and Injuries (3%).

Conclusion
Despite continuous efforts to get better results, there is room for improvement on better staff compliance with our standard operating procedures especially regarding medications and venous needle dislodgment risk assessment.
P1555REVERSIBLE AKI AND HEART INVOLVEMENT RESULTING FROM AMANITA PROXIMA POISONING TREATED WITH HAEMODIALYSIS: A SINGLE-CENTER CASE SERIES
Authors: Leonardi Giuseppe , Di Renzo Brigida , Covella Patrizia , Spinelli Alessandra , Flores Antonio , Montanaro Alessio , De Giorgi Annarita , Balestra Cosima , Mariotti Amalia , Schiavone Palmira , Marangio Massimo , Coppolino Giuseppe , Vernaglione Luigi 
Published: June 2020

Abstract

Background and Aims
Worldwide, amatoxin-containing mushrooms account for &gt;95% of mushroom poisoning-related death. Recently, Amanita species not containing amatoxin, such as Amanita Proxima, have been implicated in poisonings resulting in acute kidney injury. Allenic norleucine has been isolated from these fungi and accounts for their nephrotoxicity. AKI is characterized by interstitial nephritis on renal biopsy and resolves over weeks. Here we report several case of AKI associated with cardiac involvement. We aimed to describe improvement of cardiac output and resolution of AKI after replacement dialysis treatment.

Method
From January 2013 to January 2020, eight consecutive patients with AKI from Amanita Proxima poisoning were enrolled in a large Italian community hospital. We collected clinical data including hepatic, cardiac and renal function parameters. In all the cases studied, in addition to renal failure, there were a worsening of cardiac function.

Results
We identified 8 patients suffering from Amanita Proxima intoxication, with a mean age of 57.8±24.5 years (62.5% were female). All patients presented preliminary gastrointestinal symptoms occurred within 24 hours from the mushroom intake and suddenly developed kidney injury and underwent replacement dialysis treatment using standard bicarbonate dialysis. At baseline, patients' mean eGFR was 7±2.3 mL/min/1.73m, with a mean BUN of 124±41 mg/dl, AST 52,6±42,5 IU/L, ALT 115,5±105,7 IU/L,. Cardiac involvement was also found in all cases, evidenced by ECG alteration (62,5%), an increase in myocardial necrosis enzymes (87,5%) and a reduction in the ejection fraction (50%) of about 15 percent. In 25% of cases, typical chest pain was also found. Mean troponin was 3,82±7,31 ng/ml, myoglobin 243,55±275,18 ng/ml CPK 187,6±42 IU/L and CK-MB of 13,72±14,96 IU/L. Kidney failure and cardiac impairment was successfully resolved in 87.5% of poisonings. At the end of treatment all renal and cardiac parameters significantly decreased (P&lt;0.001): mean eGFR was 57±24 mL/min/1.73m, mean BUN was 69±12.7 mg/dl, AST 23,57±9,77 IU/l, ALT 25±10,64 IU/L. Mean troponin was 0,04±0,03 ng/ml, myoglobin 111,8±93,39 ng/ml, CPK 68,33± IU/L and CK-MB 0,66± 0,61 IU/L.
Only one patient died for intoxication-related complication. The mean number of dialysis treatments to achieve the resolution of renal failure was eight.

Conclusions
The cases reported suggest that Amanita proxima have a potential severe cardiac toxicity that request a precise cardiac evaluation. Early identification of intoxication and rapid start of dialysis therapy are crucial for the resolution of heart damage.
P1565THE COMBINATION OF MALNUTRITION-INFLAMMATION AND LIMITATIONS IN FUNCTIONAL STATUS IS ASSOCIATED WITH A HIGH RISK OF MORTALITY IN HEMODIALYSIS PATIENTS: RESULTS FROM THE DIALYSIS OUTCOMES AND PRACTICE PATTERNS STUDY
Authors: Kanda Eiichiro , Lopes Marcelo , Karaboyas Angelo , Bieber Brian , Tsuruya Kazuhiko , Hirakata Hideki , Iseki Kunitoshi , Jacobson Stefan , Dasgupta Indranil , Robinson Bruce 
Published: June 2020

Abstract

Background and Aims
The malnutrition-inflammation-complex (MIC) is a risk factor for mortality and lower quality of life in haemodialysis (HD) patients. The identification of MIC and its risk factors, which include the limited ability to perform functional status (FS), is key to improve the patient experience on HD. Our study investigates the association of MIC and FS combinations with mortality in HD patients.

Method
We analysed data from a cohort of 5465 HD patients from Australia, France, Germany, Italy, Japan, New Zealand, Spain, Sweden, and United Kingdom, enrolled in the Dialysis Outcomes and Practice Patterns Study phases 4 (2009-2011) and 5 (2012-2015). MIC syndrome was defined as low serum albumin (&lt;3.8 g/dL) and high serum C-reactive protein (&gt;3mg/L in Japan; &gt;10 mg/L elsewhere). Poor functional status was defined as the sum of scores from the self-reported limitations in the Katz Index of Independence in Activities of Daily Living (score ranges from 0 to 5) and the Lawton-Brody Instrumental Activities of Daily Living Scale (score ranges from 0 to 8) less than 11. We investigated the association between combinations of MIC (+/-) and FS (low/high) with death, using Cox proportional hazards models adjusted for possible confounders including patient demographics, comorbidity history, catheter use, serum creatinine, phosphorus levels, WBC count, haemoglobin level, and time on dialysis therapy.

Results
The prevalence of different combinations were: MIC-/High FS 57%, MIC-/Low FS 24%, MIC+/High FS 9%, and MIC+/Low FS 10%. Patients with MIC-/high FS were younger, better nourished, and had lower prevalence of comorbidities. Compared to this reference group, the adjusted hazard ratios [HR (95% CI)] for all-cause mortality were 1.56 (1.24-1.98) for MIC-/ low FS, 1.75 (1.32-2.32) for MIC+/ high FS, and 2.97 (2.31-3.82) for MIC+/ low FS groups. The adjusted HRs for infection-related mortality were 1.57 (0.91, 2.71) for MIC-/low FS, 1.67 (0.84, 3.31) for MIC+/High FS, and 5.45 (3.15, 9.45) for MIC+/low FS groups.

Conclusion
The combination of MIC and low FS is a strong predictor of mortality, and infectious mortality in particular, in HD patients. Identification of patients with MIC and FS status may plausibly help to direct interventions to improve patients’ experiences and lessen adverse clinical outcomes in the HD setting.
P1578LOW ANKLE BRACHIAL INDEX, AND HIGH SERUM ALBUMIN WAS INDEPENDENTLY ASSOCIATE WITH HIGHER OF ISCHAEMIC MODIFIED ALBUMIN IN CHRONIC HAEMODIALYSIS PATIENTS
Authors: Nongnuch Arkom , Sappadungsuk Supawadee , Davies Nathan , Davenport Andrew 
Published: June 2020

Abstract

Background and Aims
Haemodialysis (HD) is one of the life-saving procedures which prolonged life of chronic kidney disease stage 5, however, the long-termed complications such as cardiovascular disease (CVD), immune and endothelial dysfunction are commonly occurred. The high incidence of CVD in haemodialysis patient associated with traditional and non-traditional risk factors. The novel non-traditional risk factors such as p-cresol, Advance Glycosylation End Products (AGEs), Ankle-Brachial Index (ABI), Cardio-Ankle Vascular Index (CAVI). The ischemic modified albumin (IMA) is the new marker for cardiovascular disease in various populations including haemodialysis. We aimed to explored the factors associate with higher IMA in chronic haemodialysis patients.

Method
Cross sectional study 196 chronic haemodialysis patients were collected blood sample for Ischemic modified albumin (IMA), measured Ankle-Brachial Index (ABI), Cardio-Ankle Vascular Index (CAVI), and skin autofluorescence advanced glycosylation end products (SAF).

Results
53% were female, 21% were smoker, 57% were diabetes, 93% were hypertension, 33% were coronary artery disease, 12% on HDF. Mean Age were 69.2±13.2 year, ABI 1.1±0.15, CAVI 9.3±1.5, SAF 3.1±0.8 arbitrary unit, IMA 37.5±15.2 U/ml, and serum albumin 3.7±0.4 g/dl. In multivariate adjustment showed factors associate with higher IMA were low ABI (B co-efficiency -13.4, P=0.049) and high serum albumin (B co-efficiency 1.68, P=0.000002).

Conclusion
Lower ABI and high serum albumin associate with higher IMA. The finding underlines the association between the atherosclerosis, vascular endothelial function and cardiac injury in haemodialysis. These results should be confirmed and explored in larger and longer clinical trials.

Figure
Regression analysis of factors associate with IMA accumulation.
P1581IMPACT OF ACHIEVING LDL CHOLESTEROL LOWER THAN 100 MG/DL WITH STATINS, ON LIPID PROFILE AND INFLAMMATION IN END-STAGE RENAL DISEASE PATIENTS
Authors: Coimbra Susana , Reis Flávio , Nunes Sara , D. Viana Sofia , Valente Maria João , Rocha Susana , Catarino Cristina , Rocha-Pereira Petronila , Bronze-da-Rocha Elsa , Oliveira José Gerardo , Madureira José , Fernandes João Carlos , Faria Maria do Sameiro , Miranda Vasco M P , Belo Luís , Santos-Silva Alice 
Published: June 2020

Abstract

Background and Aims
Dyslipidemia is common in chronic kidney disease (CKD) and cardiovascular disease (CVD)-related events are the main causes of death in end-stage renal disease (ESRD) patients on dialysis. Concerning lipid management, clinical practice emphasized treatment escalation to achieve specific low-density lipoprotein cholesterol (LDLc) targets, which implies repeated LDLc evaluations, and enhancement of statin doses or combination of lipid-lowering therapies. However, the LDLc target is not consensual, with some entities suggesting 100 mg/dl and others a more conservative level. It has been hypothesized that lipoprotein’s quality (size, composition and functionality) may be more important than their total circulating levels, as CVD risk factor. Our aim was to evaluate and compare, in ESRD patients on dialysis and under statins treatment, the levels of lipoprotein fractions and subfractions and inflammatory markers, between patients who achieved LDLc levels &lt; 100 mg/dl and those who did not achieve that target.

Method
We studied 110 ESRD patients on dialysis (high-flux hemodialysis or hemodiafiltration) and under statin therapy; 87 presented a LDLc &lt; 100 mg/dl (group 1) and 23 a value &gt; 100 mg/dl (group 2); levels of high-sensitivity C-reactive protein (hsCRP), interleukin(IL)-6, lipid profile including lipoprotein fractions/subfractions, and oxidized LDL (oxLDL) were evaluated.

Results
Group 1, as compared to group 2, presented lower values of total cholesterol (TC), triglycerides, oxLDL, TC/high-density lipoprotein cholesterol (HDLc) and LDLc/HDLc ratios. Concerning lipoprotein fractions/subfractions, group 1 presented significantly higher larger and intermediate LDL, and a trend towards lower small LDL (P=0.063), higher large HDL (P=0.069) and lower small HDL (P=0.080); no significant alterations were found for very-low-density lipoprotein and intermediate-density lipoprotein. Regarding inflammatory markers, no significant differences were observed between the 2 groups.

Conclusion
Patients who achieved the LDLc &lt; 100 mg/dl target presented a better non-conventional lipid profile, including lower oxLDL levels and an increase in larger (less atherogenic) LDL subfractions. According to our data, a lower LDLc level associates with a better lipid profile; the benefits of this improvement on HDL fractions and CVD-related events in ESRD patients on dialysis needs to be better clarified.