bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1265INTRA-DIALYTIC RELEASE OF EXTRACELLULAR VESICLES (EVS) IS INDEPENDENT OF THE MODE OF DIALYSIS A COMPARISON BETWEEN STANDARD HEMODIALYSIS (SHD), COOL HD (CHD), LOW-VOLUME HEMODIAFILTRATION (LVHDF) AND HIGH-VOLUME HDF (HVHDF): THE HOLLANT STUDY
Authors: Rootjes Paul A , De Roij van Zuijdewijn Camiel , Nubé Menso J , Wijngaarden Gertrude , Nieuwland Rienk , Hajji Najat , Hau Chi , Grooteman Muriel 
Published: June 2020

Abstract

Background and Aims
Treatment with high-volume HDF is associated with a better survival than standard HD. The underlying mechanism is unknown, but may depend on a lower level of intra-dialytic tissue damage. We compared tissue injury, as measured by the release of EVs during four dialysis treatment modalities.

Method
Chronic hemodialysis (CHD) patients were included in an open, cross-over, randomized fashion (n=14). EV release was measured by a calibrated flow cytometer (Apogee A-60) after antibody labeling. EVs are defined as cell-derived particles with a diameter &lt;1.000nm and a refraction index (RI) &lt;1.42. Two HD modalities were studied: sHD, t dialysate 36,5°C (sHD) and cHD, t dialysate 35,5°C and two HDF modalities (t dialysate 36,5°C): lvHDF with a convection volume (CV) &lt;15 L/session and hvHDF with a CV &gt;23 L/session.To establish the cellular origin of EVs, EVs were labelled with (anti-) CD45 (leukocytes), CD62e (activated endothelial cells), CD62p (activated platelets), CD144 (vascular endothelial cadherin), CD61 (platelets), CD235a (erythrocytes) and connexin-43 (myocardial and endothelial cells), and with the general EV marker lactadherin. Differences between the 4 dialysis modalities were investigated by comparing pre- and post-dialysis and the delta (post- minus pre-dialysis) EV concentrations by Friedman’s test.

Results
As shown in the figures below, CD61, lactadherin and CD144 increased during the 4 modalities (1=sHD,2=cHD,3=lvHDF,4=hvHDF). The overall increase (sum of all modalities) in connexin-43. In Table 1, the concentrations of EVs before- and after dialysis are shown with a p-value for the difference (post- minus pre-dialysis). No significant differences were found in pre- and post-dialysis and delta EV concentrations between the 4 dialysis modalities (data not shown).

Conclusion
From this analysis the following conclusions can be drawn: 1) except for CD62e, which declined, all measured EVs increased significantly during dialysis (Table 1). 2) Although not all EVs increased similarly during the 4 modalities (Fig 1), in terms of tissue damage no modality appears more advantageous than the other.
P1270INCREASED SCLEROSTIN, BUT NOT DKK-1 PROTEIN, IS ASSOCIATED WITH ELEVATED PULSE WAVE VELOCITY IN HEMODIALYSIS SUBJECTS
Authors: STAVRINOU EIRINI , Sarafidis Panteleimon , Koumaras Charalampos , Loutradis Charalampos , Giamalis Panagiotis , Tziomalos Konstantinos , Karagiannis Asterios , Papagianni Aikaterini 
Published: June 2020

Abstract

Background and Aims
Sclerostin and Dickkopf-1 (Dkk-1) protein are inhibitors of the canonical Wnt/β-catenin bone pathway. Pilot data suggest that sclerostin may be involved in vascular changes in CKD, but data on Dkk-1 effects are scarce. This is the first study investigating simultaneously the associations of sclerostin and Dkk-1 with arterial stiffness in hemodialysis patients.

Method
80 patients on chronic hemodialysis had carotid-femoral pulse wave velocity (PWV), central BP and wave reflections evaluated with applanation tonometry (Sphygmocor) in a mid-week non-dialysis day. Serum levels of sclerostin and Dkk-1 were measured with ELISA. A large set of demographic, co-morbid, laboratory and drug parameters were used in the analyses.

Results
Subjects with PWV&gt;9.5 m/sec (high arterial stiffness group, n=40) were older, had higher BMI, higher prevalence of hypertension, diabetes and coronary-heart-disease and higher peripheral SBP, central SBP, C- reactive protein and serum sclerostin (p=0.02), but similar Dkk-1 compared to subjects with low PWV. When dichotomizing the population by sclerostin levels, those with high sclerostin had higher PWV than patients with low sclerostin levels (10.63±2.71 vs 9.77±3.13, p=0.048). Increased sclerostin (&gt;200 pg/ml) was significantly associated with increased PWV (&gt;9.5 m/s) (HR:2.778, 95%CI:1.123-6.868, per pg/ml increase); this association remained significant after stepwise adjustment for Dkk-1, iPTH and calcium x phosphate product. In contrast, no association was noted between Dkk-1 and PWV (HR: 1.000, 95%CI: 0.416-2.403).

Conclusion
Serum sclerostin is associated with PWV independently of routine markers of CKD-MBD in hemodialysis patients. In contrast Dkk-1 has no association with arterial stiffness and is rather not pathophysiologically involved in relevant vascular changes.
P1284DIASTOLIC DYSFUNCTION IS A STRONG PREDICTOR OF MORTALITY IN DIALYSIS PATIENTS
Authors: Rista Elvana , Cadri Vilma , Akshija Ilir , Thereska Nestor , Strakosha Ariana , Barbullushi Myftar , Harja Endri 
Published: June 2020

Abstract

Background and Aims
The prevalence of cardiovascular disease in dialysis patients is quite high. This is the leading mortality cause and the main reason for hospital admissions in this population. Diastolic dysfunction is an important predictor of cardiovascular events.
The aim of this study is to calculate the prevalence of diastolic dysfunction (DD) and to identify any significant association of mortality and the grade of DD in chronic dialysis patients with preserved systolic function

Method
This is a prospective study of 310 consecutive patients who were enrolled from 2012-2019. All patients are dialysis dependent for chronic kidney disease (CKD) getting treatment at Nephrology-Dialysis &Transplantation Unit at Hygeia Hospital Tirana. LVH, diastolic dysfunction and cardiac valve pathology contributing to this were diagnosed by transthoracic echocardiography (TTE) criteria. DD was graded as: grade I (mild), grade II (moderate) and grade III (severe). The survival rate was analysed by Kaplan-Meier curves and Cox regression analysis.

Results
Mean age was 51.9±15.6 years; 62.6 % of pts were male, with a mean dialysis vintage of 49 months. 85 % of pts had preserved ejection fraction 50 % or more. LVH was observed in 79.1% of pts. LVED diameter (mm) 52±7 LVESd (mm) 33.7±6.8. Cardiac valve changes were diagnosed as follows: Aortic valve- 35% of patients resulted normal on ultrasound examination, 47% and 17% of pts had leaflet sclerosis and calcifications respectively with normal valve function. 25 % and 7% had some degree of aortic valve regurgitation and stenosis. Mitral valve examination resulted in 9% normal and in 84% of pts with some degree of regurgitation. Arterial hypertension was found in 95.1% of the patients. Diastolic dysfunction was detected in 55% of pts. Of them, 64.5% were deemed to have grade I diastolic dysfunction, 26.7% grade II, 8.7% grade III. During follow up, 25.5% of the patients with DD, died. The analysis of survival curve showed that grade III, 5.2 CI [3.86; 6.64], was associated with higher mortality compared with grade I 11.06 CI [10.01; 12.04] and grade II 11.65 CI [8.5; 14.8], p&lt;0.001.

Conclusion
Diastolic dysfunction is ubiquitous echocardiography finding in patients treated with hemodialysis. Grade of diastolic disfunction tend to predict mortality of dialysis patients. 7-year survival analysis shows grade III to be associated with high mortality rates. A multidisciplinary approach is needed in order to predict, prevent and treat these conditions to improve outcomes.
P1293WARFARIN INCREASES THE RISK OF VASCULAR CALCIFICATION IN HAEMODIALYSIS PATIENTS: A MULTICENTER CASE-CONTROL STUDY
Authors: Eren Sadioğlu Rezzan , Üstüner Evren , Ergün İhsan , Ecder Tevfik , Nergizoglu Gökhan , Keven Kenan 
Published: June 2020

Abstract

Background and Aims
Vascular calcifications (VC) are highly prevalent in maintenance haemodialysis patients and it is a recognized risk factor for increased mortality. Previous experimental studies showed the relation between warfarin which has been prescribed frequently in dialysis patients and VC. The aim of this study is to investigate the association between VC and warfarin use in haemodialysis patients.

Method
This was a cross-sectional, observational, multicenter study. VC were assessed using Adragao (AS; pelvis and hands) and Kauppila (KS; lateral lumbar spine) scores in 76 haemodialysis patients from six centers. There were 32 patients (4.5%) being treated with warfarin for at least 1 year out of a total 711 haemodialysis patients and we included 44 control patients with matching parameters of age, sex and dialysis vintage to the study. Clinical characteristics, concomitant treatments, laboratory results were recorded and possible risk factors related to VC were analyzed.

Results
Of the patients, 47% were females, mean age was 65.8 ± 9 years, 23% were diabetics, their mean dialysis vintage was 68.39 ± 38.5 months and mean Kt/V 1.66 ± 0.27. No significant differences in clinical characteristics and basic laboratory results were found between control and warfarin group. In warfarin group, median Kauppila score was higher than control [11 vs 6.5, (25%-75% percentile, 5 vs 15), P=0.032] and percentages of Kauppila score &gt;6 patients were higher, as well (76,6% vs 50%; P=0.029). Median Adragao score was not significantly different between two groups [7 vs 6, (%25,%75 percentile 6 vs 8), P=0.177]. Logistic regression analysis revealed that warfarin treatment was independently associated with Kauppilla scores of &gt;6 (OR 3.28, 95% CI 1.17-9.22, P=0.024).

Conclusion
The results of this study showed that warfarin is a strong risk factor for vascular calcifications, especially in aorta of haemodialysis patients.
P1300CARDIOVASCULAR COMPLICATIONS IN HEMODIALYSIS PATIENTS
Authors: Fadwa Helaoui 
Published: June 2020

Abstract

Background and Aims
Cardiovascular complications are the leading cause of morbidity and mortality among dialysis patients. We aim to determine the cardiac damage showed by trans-thoracic ultrasound and to identify the various factors associated with it.

Method
Fourty chronic hemodialysis patients have benefited of transthoracic ultrasound during this year (2019). Clinical findings were collected from patients’ medical files. Data collected included demographics, Clinical Status and echocardiographic parameters. All the patients included in this study gave their consent. Data were collected and analysed using SPSS software. Chi-squared test with a level of significance of 0.05 was used for the qualitative variables.

Results
The mean age of our population is 53.1 (range: 26-78) with a sex ratio equal to 0.9. 72.5% of patients are hypertensive; 27.5% of patients are diabetic. Only 2 patients to be coronary. In this study, 11 patients remained asymptomatic while 29 patients (75.5%) presented with cardiac symptomatology: 39.7% complained of chest pain, 27.5% presented with acute dyspnea and 24,1% a pericardial rub. Rhythm disorders were objectified in electrocardiography in 3 patients (1 ventricular extrasystole and 2 cardiac arrhythmia by atrial fibrillation). Twenty percent of the cardiac ultrasounds performed are without abnormalities. Cardiac ultrasound revealed the presence of valvulopathies in 40% with 20% valve calcifications. Left ventricular hypertrophy is evident in 55% of patients, 45% of whom are hypertensive. Segmental hypokinesia was observed in 27.5% and pulmonary hypertension was observed in 37.5%. Cardiac ultrasound also showed dilated right cavities in 22.5% of cases and dilated left cavities in 32.5%. Dilatation of the inferior vena cava is observed only in 3 patients. Pericarditis is highlighted in 37.5% of which 36.3% are of medium abundance and 18.1% are of great abundance without signs of compression. Clinical data were correlated with echocardiographic findings. A correlation was found between left venticular hypertrophy and hypervolemia (p=0.001) and between perdialytic hemodynamic instability and ischemic cardiopathy (p=0.04) as well as pulmonary hypertension and vascular access dysfunction (p=0.02).

Conclusion
Cardiovascular complications are very common in chronic hemodialysis population. The left ventricular hypertrophy is the main cause of heart disease with predominance of high blood pressure as an associated comorbidity.
P1307HEMORRHAGIC VERSUS ISCHEMIC RISK IN PATIENTS WITH ATRIAL FIBRILLATION ON HEMODIALYSIS
Authors: Sousa Mariana , Bravo Pedro , Santos Cristina , Ramos Aura 
Published: June 2020

Abstract

Background and Aims
Patients with renal replacement therapy and atrial fibrillation (AF) have a particularly high risk of both stroke and bleeding, but no high-quality evidence-based recommendations exist to properly manage these patients. Therefore, we aim to evaluate the ischaemic versus the haemorrhagic risk in a hemodialysis (HD) population.

Method
We selected patients that started hemodialysis in our hospital between 2011 and 2015. Only incident patients that were on regular hemodialysis treatment for more than 3 months were considered. Both patients that already had AF before HD, or developed AF during the follow-up, were included. At the time of AF diagnosis or beginning of HD, the risk factors were analyzed based on CHA2 DS2 -VASC and HAS-BLED scores. The outcomes were hemorrhagic events (only the events that needed hospitalization were taken into account), ischaemic events (i.e. that result from embolic arterial ischaemia) and death related to any of these events.

Results
From 302 incident patients on hemodialysis, 46 (15.23 %) were included. Mainly man (65%), with a mean age of 75 ± 10 years old. Most of the patients (63%) already had AF when they started hemodialysis. There was no significant difference between the incidence of ischaemic and haemorrhagic events (p=0.219). Three patients died of an ischemic event and two of haemorrhagic shock.Twenty one patients (45.6%) started oral anticoagulation. No difference was found between the proportion of haemorrhagic events between patients with oral anticoagulation and patients with no anticoagulation (p=0.157). Similarly, oral anticoagulation was not associated with any effect on the incidence of ischaemic events (p=0.366). The results after adjustment for the risk factors included in the HAS-BLED and CHA2 DS2-VASC scores were the same.
Previous stroke, transient ischaemic attack or thromboembolic event significantly increased the risk of an ischaemic event, when adjusted to oral anticoagulation, age, diabetes, vascular disease and hypertension (OR 6.78, C.I 95% 1.236-37.278, p=0.028). This risk factor was not associated with an increase of haemorrhagic events. No other risk factor included in the scores was associated with any significant effect in the outcomes.

Conclusion
As we know, AF increases the risk of ischaemic events in general population. However, in hemodialysis patients, we didn’t observe any difference between the incidence of ischaemic and haemorrhagic events. Therefore, the benefit of oral anticoagulation in such patients remains questionable. It is worth noting that patients with previous stroke, transient ischemic attack or thromboembolic event seem to have higher risk of new ischaemic events. In these patients, there may be some advantage in oral anticoagulation. Since this is a single center, retrospective, observational study, these results should be interpreted with caution.
P1310STUDY OF RISK FACTORS AND PREVALENCE OF PULMONARY HYPERTENSION IN CKD 5D PATIENTS ON HEMODIALYSIS
Authors: Nagaraju Shankar Prasad , Paramasivam Ganesh , Prabhu Ravindra Attur , Rangaswamy Dharshan , Rao Indu Ramachandra , Shenoy Srinivas Vinayak , Bhojaraja Mohan V , Guddattu Vasudeva 
Published: June 2020

Abstract

Background and Aims
Pulmonary hypertension (PH) in chronic kidney disease stage 5D (CKD5D) patients on haemodialysis (HD) is associated with increased morbidity and mortality. We studied the risk factors and prevalence of PH in patients on HD at our centre. We also studied its association with oxidative stress and markers of inflammation.

Method
After ethics committee clearance, we conducted a cross-sectional study on CKD5D patients at our centre from June 2016 to May 2017. Patients on maintenance HD for at least 3 months were included. Demographic, clinical, biochemical and trans-thoracic echocardiography details were collected. PH was defined as estimated mean pulmonary artery pressure (mPAP) greater than 25 mm Hg at rest. PH was further categorized into mild (mPAP b/w 25-40mmHg), moderate (mPAP b/w 40-60mmHg) and severe PH (mPAP &gt; 60mmHg). Serum thiol and C Reactive protein (CRP) were studied as markers of oxidative stress and inflammation respectively. Data was analysed using SPSS version 16.

Results
Out of 52 patients, 28 (54%) had PH. Twenty four out of these patients had mild PH (Figure 1). None had severe PH. The baseline characteristics of patients with and without PH are shown in Figure 2. No clinical or biochemical factors (p&gt;0.05) were found as significant risk factors in our study. CRP (p-0.76) (inflammatory marker) and Thiol levels (p-0.36) (oxidative stress marker) did not had any relationship with occurrence of PH. (Table 1).

Conclusion
CKD 5D patients on HD have high prevalence of PH. There were no identifiable risk factors. The prevalence of PH was not influenced by dialysis vintage, ultrafiltration, paratharmone levels, presence of co-morbidities, oxidative stress or inflammation.
P1327STATUS OF AV FISTULA AFTER SUCCESSFUL RENAL TRANSPLANT ; A SINGLE CENTRE STUDY
Authors: Sengupta Pratim , Sasmal Tarpan , Biswas Sumanta 
Published: June 2020

Abstract

Background and Aims
Functioning AV-Fistula is considered the Achilles hill of ESRD patients. After successful renal transplantation considering the risk of graft failure or recurrence of disease all attempts are made to preserve the functional AV fistula except few clinical situations like high output cardiac failure, steal phenomenon or large aneurysm with risk of rupture where voluntary closure of AVF is preferred. Even with care and attention a significant number of AV-Fistula closes spontaneously. In this retrospective study we analyzed the fate of AVF after successful renal transplantation.

Method
The medical records 800 renal transplant recipients in last 15 years were analyzed with the objective to find out the outcome of AVF after transplant. Data were systematically charted and analyzed by SPSS V.23.01

Results
Out of 800 renal transplantation in last 15 years, excluding patients on CAPD or temporary catheter or AVgraft; 680 patients data were finally analyzed. Out of this 680 functioning AVF, 86 patients lost follow up and hence status of AVF could not be retrieved. Among rest 594 recipients, AV fistula was closed spontaneously in 184 cases (31.1%), and only 5 patients required planned AVF closure due to large aneurysm (2 cases), trauma and impending rupture (2 cases), cosmetic reason (1 cases). Incidence of spontaneous fistula closure was significantly higher among females than male recipients (p=0.001). Majority (62%) of the spontaneous closure occurred immediate post transplant period (within 7 days after transplant) and rest 26.4% within 1month and 9.2% in between 1 and 4 month. Only 2.4% fistula closed after 4 month of transplant. In the Tacrolimus era there is no significant difference in the rate of spontaneous closure with the patients who received cyclosporine (p=0.78). However among patient who received injectable cyclosporine the spontaneous closure was significantly higher (p=0.001). Factors which could be attributable to the rate of closure are, need of peripheral cannulation in perioperative period in the fistula arm (r2=0.89), operative time more than 2and half hr (r2=0.78), more than 2 unit of blood transfusion (r2=0.85) during operation and dialysis vintage through AVF less than 6 month (r2=0.77). There was no observed difference in rate of spontaneous closure among patients who received induction and who don’t (p=0.08). In subgroup analysis among induction with basiliximab or thymoglobulin there was no significant difference in spontaneous fistula closure (p=0.07).

Conclusion
Spontaneous closure of AV fistula observed in 31.1% patients with successful renal transplantation. It is more common in female recipients and 97.6% of spontaneous closure takes place within 4month of transplant. The factors which are attributable for spontaneous closure are cannulation in the fistula arm, injectable cyclosporine use, operative time more than 2and half hr, blood transfusion more than 2 units, during operation.
P1345CATHETER FAILURE AND MORTALITY IN HEMODIALYSIS PATIENTS WITH THE TUNNELLED-CUFFED CATHERTER TIP POSITIONED IN THE INFERIOR VENA CAVA
Authors: Cheng Lu , Gou Shen-Ju , Yi Jing , Ren Qian , Cui Tian-Lei , Fu Ping 
Published: June 2020

Abstract

Background and Aims
For patients with multiple central vein obstruction (CVO) and exhausted all options for arteriovenous accesses, how to establish a new effective vascular access is an urgent problem, and the key point to solve this problem is where to locate the tip of catheter. This study focused on these patients and investigated the safety and efficient of tunnelled cuffed catheter (TCC) with the tip placed in the inferior vena cava (IVC).

Method
Thirty-three maintenance haemodialysis patients with vascular access malfunction presented to West China Hospital of Sichuan University from March 2013 to December 2016 were included in this retrospective study and followed up until their catheter failure or death or until June 30, 2019. The short-term efficacy and safety of the procedure placing TCC tip in IVC were observed. The survival rates of TCC with catheter tip in IVC and patients were analysed.

Results
All thirty-three patients achieved adequate blood flow to complete the first session of haemodialysis after catheterization procedure and no obvious complications, such haemorrhage, arrhythmia and pulmonary embolism. The mean survival time of the TCC with catheter tip in IVC was 58.5 (95% CI 48.8–63.4) months by Kaplan–Meier analysis. The survival rates of TCC with catheter tip in IVC were 87, 83, 75, 71% in 1, 2, 3, 4 years, respectively. The highest incidence of catheter dysfunction was at 12 months after catheterization. The mean survival time of patients was 56.2 (95% CI 46.9–65.4) months by Kaplan–Meier analysis. The patient survival rates were 88, 82, 70, 67 % in 1, 2, 3, 4 years, respectively. The highest mortality was at 12 months after catheterization.

Conclusion
Our study suggested that placement of the tunnelled-cuffed catheter tip in the IVC was safety and efficacy in the end-stage haemodialysis patients who has exhausted vascular resources with CVO. The TCC with tip in the IVC was feasible to be a long-term vascular access for these patients.