bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1201THE AGING OF THE IMMUNE SYSTEM AND FRAGILITY: TWO FEATURES IN PERITONEAL DIALYSIS AND END-STAGE RENAL DISEASE PATIENTS
Authors: Caro Espada Paula Jara , Ceprian Costoso Noemi , YUSTE CLAUDIA , Valero Gemma , Fernandez-Vidal Maria , Seroukh Nadia , Morales Enrique , Vida Carmen , Carracedo Julia 
Published: June 2020

Abstract

Background and Aims
Chronic kidney disease (CKD) is associated with premature immune aging and increased inflammatory activity leading into endothelial damage and macrophage senescence (CD14+CD16+).
Objective. To evaluate the influence of CKD in senescent immune cells, and its relationship with fragility in patients with nondialysis CKD (ND-CKD) and Peritoneal Dialysis (PD).

Method
A descriptive transversal study analysing lymphocyte absolute counts and subpopulations in 74 CKD patients (36 DP, 38 ND-CKD) compared with 10 healthy subjects (HS). We also assessed immunoglobulin levels, C3 and C4 fragment complement, Edmonton fragility score and the percentage of proinflammatory blood monocytes with the CD14+CD16+ phenotype.

Results
PD patients presented more absolute lymphopenia compared with LCC and HS (PD 1194,2, 1589 ND-CKD and 1802 HS; p &lt;0,001, respectively). This lymphopenia is also maintained in CD3, CD4, CD8 and NK cells. Lower CD4 lymphocytes levels were significantly correlated with higher fragility and incidence of peripheral vascular disease in uremic patients. Senescent macrophage was correlated with CD3 and CD4 lymphocytes all the cohorts (ND-CKD, PD and HS).

Conclusion
PD patients presented changes in immune system compared with healthy population, that could explain accelerated senescence. Accelerated senescence is associated with more fragility and endothelial damage. There are necessary more studies to identify the role premature aging in ND-CKD and to establish the differences between renal replacement modalities.
P1203DEGREE OF FUNCTIONAL DEPENDENCE IN PATIENT IN SUBSTITUTE RENAL TREATMENT IN HGUCR
Authors: CASTRO FERNÁNDEZ MARIA PAZ , PICCONE SAPONARA LUIS GUILLERMO , Carreno Agustin , Siedel Diego , URIBE HEREDIA NANCY GIOVANNA , VALLE DOMINGUEZ CASIMIRO , OLAZO GUTIERREZ ELIANA , SANCHEZ ESCUDERO PATRICIA , VILLABON OCHOA PAOLA , VOZMEDIANO POYATOS MARIA DEL CARMEN 
Published: June 2020

Abstract

Background and Aims
Elderly patients and comorbidity present more frequently deterioration of their cognitive and / or functional capacity, and consequently worse quality of life related to health and the need for help to perform their basic activities. It has been described in the literature that peritoneal dialysis (PD) is a protective factor in the patient's survival against hemodialysis (HD). Quality of life is an important parameter in patients undergoing renal replacement therapy, which influences the choice of dialysis modality. We analyzed and compared the degree of functional dependence of patients on PD versus HD.

Method
Descriptive and cross-sectional study. A total of 84 patients belonging to the General University Hospital of Ciudad Real were included. Demographic variables (age, sex), associated comorbidity, etiology of CKD, among others, were collected. To assess the degree of dependence, the Barthel index and Lawton and Brody were performed. Statistical analysis with SPSS 25.0. Categorical variables are expressed as percentages and have been compared using the Chi2 test. Quantitative variables are expressed as mean +/- standard deviation, and the T-student was used to compare them. Statistical significance for a value of p &lt;0.05.

Results
Of the 84 patients, 40.5% received PD and 59.5% HD. 60.7% were male and 39.3% female, with an average age of 60.90 years. 75% were hypertensive, 38.1% diabetic, 61.9% dyslipidemic, 27.4% obese and 61.9% had peripheral vasculopathy. The most frequent causes of CKD were diabetic nephropathy (22.6%), glomerular etiology (21.4%), unfiltered (20.2%) and nephroangiosclerosis (14.3%), among others. The degree of functional dependence according to the Barthel index was 63.1.9% for total independence, 29.8% mild dependence, 4.8% moderate dependence and 1.2% total dependence; and for the Lawton and Brody index, 42.9% total independence, 14.3% mild dependence, 27.4% moderate dependence, 11.9% severe dependence and 3.6% total dependence. When comparing the degree of functional dependence between both dialysis techniques, we observed that patients in PD had a lower degree of functional dependence compared to patients in HD, these differences being statistically significant (Lawton and Brody 73.5% in PD vs. 22% in HD, p &lt;0.001 and Barthel index 85.3% in PD vs 48% in HD, p = 00.4).

Conclusion
In our experience, the degree of functional dependence in patients in PD is lower compared to patients in HD with less comorbidity, being able to condition the choice of the technique of renal replacement therapy.
P1204PHROPHYLATIC GENTAMICIN - A THERAPEUTIC WEAPON IN THE COMBAT OF EXIT SITE INFECTIONS IN PERITONEAL DIALYSIS
Authors: Abrantes Ana , Ferrer Francisco , Martins GonÇAlves HernÂNi Ricardo , Vila Lobos Ana 
Published: June 2020

Abstract

Background and Aims
Infection-related complications, such as exit-site infection (ESI) and peritonitis, are one of the main causes of technique failure and dropout in patients under peritoneal dialysis. Several studies have demonstrated the positive effect of daily topical antibiotics (AB) in preventing ESI. The aim of this study is to demonstrate the impact of topical gentamicin (TG) in preventing ESI, between 2009 and 2019, in a single-center of a medium-sized hospital in Portugal.

Method
Descriptive and retrospective analysis was performed. Demographic data, comorbidities, type of catheter placement and PD prescription were collected. For each patient, it was determined the time free of prophylactic AB (NTG) and under topical gentamicin (ophthalmic formula, once a day, applied on exit site). ESI cases were identify.

Results
Eighty-five patients were included, with a mean age of 53.2 ± 14.6 years; 69.5% were male. Cardiovascular comorbidities, like arterial hypertension and diabetes, were highly prevalent (88.2% and 76.5% respectively). Chronic glomerulonephritis and diabetes were the main causes of CKD (19; 22.4%; 15; 17.6%). More than 80% of the patients had previous Nephrology follow up. Percutaneous approach was the first option to catheter placement in 70.6% of the cases and DPA was performed in 53,0%. Every patient started the PD program free of prophylactic AB (n=85); 35 patients started TG at some point. Forty episodes of ESI were recorded, 39 (97.5%) in the NTG group. Staphylococcus aureus was the most frequently identified organism (16; 41.0%), followed by Staphylococcus epidermis (5; 12.5%) and Corynebacterium (5; 12.5%). The Kaplan-Meier analysis demonstrated that patients in TG were associated with better free-time of first peritonitis ((705 vs 985 days; p=0.001). The multivariate Cox regression model confirmed a 14 times higher risk of ESI in NTG group (HR 14.4; 95% CI 1.97-105.45; p=0.001).

Conclusion
Although mupirocin is still the first option in many centers, some studies have demonstrated a benefic role of gentamicin in reducing ESI, not only by Pseudomonas species but also Staphylococcus aureus. The results of our study confirmed that topical daily gentamicin is highly effective preventing ESI in PD patients. Despite of the concern with the gentamicin-resistant infections, just one patient developed ESI under gentamicin, and the identified microorganism was the Staphylococcus epidermidis.
P1216EPIDEMIOLOGY OF HYPERTENSION IN PERITONEAL DIALYSIS USING CLINIC AND AMBULATORY BLOOD PRESSURE MONITORING
Authors: Vaios Vasilios , Georgianos Panagiotis , Vareta Georgia , Karpetas Antonios , Ntounousi Evangelia , Dimitriadis Chrysostomos , Papagianni Aikaterini , Zebekakis Pantelis , Liakopoulos Vassilios 
Published: June 2020

Abstract

Background and Aims
Earlier studies that were based on routine clinic blood pressure (BP) recordings suggested that the prevalence of hypertension is lower in patients on peritoneal dialysis (PD) than in those receiving maintenance hemodialysis. These studies, however, did not incorporate the “gold-standard” method of ambulatory BP monitoring (ABPM). The aim of the present study was to quantify the prevalence and control of hypertension in a cohort of 81 peritoneal dialysis (PD) patients using clinic and ambulatory BP recordings.

Method
Triplicate BP recordings were obtained after a 5-minute seated rest at clinic with the validated monitor HEM-705 CP (Omron, HealthCare). 24-hour ABPM was subsequently performed with the Mobil-O-Graph device (IEM, Germany). Hypertension was defined as (i) average clinic BP ≥140/90 mmHg or antihypertensive drug use and (ii) 24-hour BP ≥130/80 mmHg or current use of antihypertensive drugs.

Results
The prevalence of hypertension was 92.6% with clinic BP recordings and 93.8 with ABPM. In all, 75 participants (92.6%) were receiving therapy with an average of 2.4 antihypertensive medications. The rates of adequate control of hypertension were 49.3% with the use of clinic BP recordings and 39.5% with ABPM, respectively. In all, 6.2% of participants were classified as normotensives, 33.3% had concordant control of hypertension with both techniques, 40.7% had concordant lack of control confirmed by both techniques, 5% had “white coat” hypertension and 14.8% had masked uncontrolled hypertension.

Conclusion
This study suggests that the burden of hypertension among patients on PD is very high and that the wider use of ABPM is important to confirm the BP control status of these patients.
P1229PREVALENCE OF LIPID DISORDERS IN PERITONEAL DIALYSIS PATIENTS
Authors: Fattoum Safa , Samia Barbouch , Mariem Hajji , Mesbahi Tasnim , Nessrine Braiek , Gorsane Imen , Amel Harzallah , Fathi Ben Hmida , Mondher Ounissi , Taieb Ben Abdallah 
Published: June 2020

Abstract

Background and Aims
Lipid disorders are common in end stage renal disease patients. Renal replacement therapies and especially peritoneal dialysis (PD) results in further alteration rather than correction of lipidemia. The aim of this study is to precise the prevalence of the different lipid disorders of PD patients.

Method
It’s a retrospective study conducted in our PD unit in December 2019. We collected all data concerning clinical characteristics of all patients currently in PD, as well as incidence of different lipid disorders.

Results
There were 90 patients with an average age of 45 years (extremes: 20.5 years and 80.6 years). The sex ratio is 1.25. Fourteen were diabetic (15.5%). All patients were on Automated PD (APD) except one on Continuous Ambulatory PD (CAPD). The average duration of PD was 40.5 months. The causal nephropathy was glomerular in 26,6 % (diabetic in 14 patients (15,5%)), hypertensive 13,3%,, interstitial in 16,66%., and undetermined in 27,7%. The average Charlson score was 3,2.
The average serum level of total cholesterol (TC) was 4,96 mmol/L, of triglycerides (TG) was 1,7mmol/L, of HDL-cholesterol(HDLc) was 0,93 mmol/L, and of LDL-cholesterol(LDLc) was 3,05 mmol/L.
Fifty one patients had dyslipidaemia: 13 had isolated hypercholesterolemia, 19 had isolated hypertriglyceridemia, and 19 had hypercholesterolemia and hypertriglyceridemia.
All dyslipidemic patients were on hypolipemic diet. Twelve (13,3%) were taking statin, no one was taking fibrate.

Conclusion
Chronic dialysis patients have several cardiovascular risk factors due to renal failure and comorbidities often associated. Dyslipidemia is a modifiable risk factor. It must be screened and treated to reduce morbidity and mortality.
P1231ASSISTED PERITONEAL DIALYSIS IN ESRD PATIENTS
Authors: Tosic Dragovic Jelena , Dimkovic Nada , Majster Zdenka , Damjanovic Tatjana , Bulatovic Ana , Naumovic Radomir 
Published: June 2020

Abstract

Background and Aims
Peritoneal dialysis is an important form of treatment for patients with end stage chronic kidney failure requiring renal replacement therapy but its use may be limitted by growing number of elderly and disabled patients. Often, they choose an assisted peritoneal dialysis (assCAPD) as first option, that can be performed by relative or a nurs. The aim of this research was to analyse differences between two groups of patients (CAPD vs. assCAPD) in order to establish if two variants are comparable in regard of patients outcome.

Method
We analysed 61 patient divided into two groups (ass CAPD, N= 16 and CAPD, N= 45) who were dialysed in Zvezdara University hospital for more than 3 months and correlated number of peritonitis, exit site infections and overall mortality rates between two groups during the period of 60 months. Assistance was provided on the volontary basis by family member.

Results
Patients in assCAPD group were unsignificantly older (68+11vs. 60 + 12 years) and had higher comorbidity score. The groups were homogeneous according the presence of diabetes mellitus, CRP and PTH levels. There were no significant difference between the two of groups in the number of peritonitis (p=0,77), exit site infections (p=0,37) and overall survival (p= 0,74, Figure 1.).

Conclusion
Family member provides very good assistance in peritoneal dialysis giving the results that are comparable to that of self-performing CAPD patients. This is therefore very successful treatmen option for a special population of ESRD patients who can not performe CAPD on their own.
P1232COMPUTED TOMOGRAPHIC PERITONEOGRAPHY - GUARANTYING SAFER SURGICAL STRATEGIES
Authors: Alves Pedro , Domingos Ana , Patrício Henrique , Ildefonso João , Malho Guedes Anabela , Bernardo Idalécio , Leão Neves Pedro 
Published: June 2020

Abstract

Background and Aims
Peritoneal Dialysis (PD) is currently the first option as renal replacement therapy to many patients, for several reasons, as personal flexibility, volemic management in cardiorenal patients, poor vascular access to dialysis, among others. Mechanical complications can be a drawback in these patients, which may occur during or after catheter placement. Abdominal wall hernias and dialysate leaks are relatively common and highly related to chronically increased intraperitoneal pressure. In this setting CT peritoneography is the technique of choice as it allows differentiation between a true hernia or a wall leakage.

Method
We describe a case of a 69-year-old man, with a personal history of polycystic kidney disease, colonic diverticulosis and hypertension, which opted for PD. The patient later developed a mechanical complication for which a proper diagnostic approach, namely through specific imaging, and surgical planning were essential.

Results
After 15 months without complications, it was detected a bulging in the periumbilical area, exacerbated by orthostatism. Changes in dialytic prescription included lower dialytic volumes during orthostatic period, with some improvements. The limitation of volumes and difficulty of drainage were limiting dialytic prescription and insufficient kt/V. An ultrasound (figure 1) and CT peritoneography (figure 2) were performed, revealing an hernial sac with peritoneal liquid leak, without any intestinal loop, approachable by minimally invasive surgery and local anesthesia.
Mini-laparotomy was performed, hernial sac was removed, without peritoneum aperture, with only a 4-day pause on PD technique.

Conclusion
CT peritoneography allowed the differentiation between this true hernia and a wall leakage, by providing accurate anatomical detail, allowing proper planning of surgical intervention. In this case, the patient had additional predisposing factors, namely polycystic kidney disease. Moreover, only a short pause on PD was necessary. Although some limitations exist, such as the use of iodinated contrast material and ionizating radiations, CT peritoneography is currently the gold standard for the evaluation of mechanical complications in PD; in addition to those mentioned, it is also useful for complications related to the catheter (kinking, entrapment, malposition), intrabdominal adhesions or loculated fluid collections.
P1247INTERDIALYTIC WEIGHT GAIN IN HEMODIALYSIS: EPIDEMIOLOGY AND OUTCOMES
Authors: Al Salmi Issa , Al Maimani Yacoub , Magdy Fady , Hannawi SUAD 
Published: June 2020

Abstract

Background and Aims
Interdialytic weight gain (IDWG) has been linked to various complications in hemodialysis (HD) patients, especially cardiovascular (CV) complications. We aimed to evaluate the effect of IDWG in HD patients on the rate of hospital admissions over a 12-month period, and the impact of high IDWG on the frequency of IDH.

Method
The study included 120 patients; who had been receiving HD for at least 3 months. The presence of various comorbidities has been recorded including. Laboratory data included; serum creatinine, serum albumin, and hemoglobin level. The estimated IDWG was calculated based on the average between pre- and post- dialysis weights that were recorded on 3 consecutive dialysis sessions.

Results
Among those who had IDWG ≥ 4%, 81% of these patients had at least one hospital admission due to volume overload or the need for extra HD session(s). On the other hand, only 19% of those having IDWG &lt; 4% had been admitted or got extra HD sessions (p&lt;0.001). Of those who were admitted (over 12 months) due to volume overload; 74.1 % had IDWG ≥ 4%, while 25.9% had IDWG &lt; 4% (p&lt; 0.001). Regarding IDH, 87% of patients having IDWG ≥ 4% had at least one episode of IDH/week. On the other hand, only 22.5% of those with IDWG &lt; 4% had one episode of IDH/week (p&lt;0.001). When analyzing those who had at least one IDH episode/week; 72.9% of them had IDWG ≥ 4%, while only 27.1% had IDWG &lt; 4% (p&lt;0.001).

Conclusion
In HD patients, the frequency of hospital admission due to volume overload and the need for extra HD sessions is strongly related to the amount of IDWG (&gt; 4% in our patients), the same stands for the frequency of IDH. Thus, a control of IDWG in HD patient is of great importance, keeping in mind the importance the nutrition status of HD patients that may also impact IDWG.
P1257SERTRALINE ADMINISTRATION TO PREVENT INTRADIALYTIC HYPOTENSION: A RANDOMIZED, DOUBLE-BLINDED, PLACEBO-CONTROLLED, CROSSOVER STUDY (SLATAN STUDY)
Authors: Kusirisin Prit 
Published: June 2020

Abstract

Background and Aims
Intradialytic hypotension (IDH) is the most common intradialytic complication ranging from 15-50% in chronic hemodialysis patients and increases morbidity and mortality in this population. According to pathophysiology, various strategies have been applied to treat this condition. Autonomic dysfunction is the one of the factors leading to IDH and is commonly found in elderly and diabetes patients. The use of sertraline to improve autonomic function was done in some small studies but the benefits was inconclusive, especially in diabetic patients. This study aimed to clarify an efficacy of sertraline regarding IDH in hemodialysis patients.

Method
We conducted a single-center, randomized, double-blinded, placebo-controlled, crossover study on chronic hemodialysis patient who had IDH in at least 25% of their dialysis sessions. Each patient received either sertraline or placebo for 4 weeks and were crossed to the other group after washout period for 4 weeks. Sertraline was started at the dose of 50 mg/day during the first week and was increased to 100 mg/day from week 2 to week 4. Matching placebo was adjusted using the same protocol as sertraline. The primary outcome was an incidence of IDH. Secondary outcomes included an incidence of IDH in subgroup of the patients with and without diabetes, the changes of blood pressure during hemodialysis session, and incidence of adverse events. Intention-to-treat analysis was applied to all data analyses.

Results
A total of 37 patients were enrolled into the study (48.6% males, mean age of 64.0±15.5 years, mean dialysis vintage of 2.4±2.4 years). All patients in sertraline group completed the study; however, 4 patients in placebo group dropped out due to adverse effects. Baseline characteristics did not differ between both groups. By analysis of crossover design, an incidence of IDH in sertraline group was significantly lower than placebo group (2.5±2.3 episodes versus 4.2±2.7 episodes during study period of 4 weeks, p for treatment effect &lt;0.001, p for period effect = 0.802, and p for sequence effect = 0.811). In subgroup of diabetes patients, an incidence of IDH in sertraline group was 2.5±2.2 episodes versus 4.4±2.8 episodes in placebo group (p for treatment effect = 0.001, p for period effect = 0.491, and p for sequence effect = 0.382). However, there was no difference in incidence of IDH between the two groups in non-diabetes patients. There was no significant difference of adverse events between the two groups.

Conclusion
Among patients undergoing chronic hemodialysis with intradialytic hypotension, administration of sertraline significantly decreases intradialytic hypotension episodes. In addition, diabetes patients may confer more benefit from the treatment compared with non-diabetes status.
P1260INTRA CRANIAL AND HEART VALVES CALCIFICATIONS IN HEMODIALYSIS PATIENTS - INTERRELATIONSHIP AND CLINICAL IMPACTS
Authors: COHEN HAGAI KEREN , Fanadka Feda , Grumberg Tania , Topaz Guy , Nacasch Naomi , Greenberg Meidad , Zitman-Gal Tali , Benchetrit Sydney 
Published: June 2020

Abstract

Background and Aims
Arterial calcification is an integral component of active atherosclerosis and is an independent risk factor for cardiovascular disease. Intra-cranial calcification (ICC) in hemodialysis (HD) patients has a prevalence of about 90%, and its severity is correlated with age, hemodialysis vintage and mineral bone disease.
Heart valves calcifications are also considered as a local manifestation of atherosclerosis and have been associated with poor cardiovascular outcomes.
This study assessed the correlation between valvular and ICCs in hemodialysis patients and its clinical impact on mortality.

Method
A blinded neuroradiologist graded ICC of all HD patients who underwent non-contrast brain computerized tomography (CT) from 2015 to 2017 in our institution. Valvular calcifications were recorded according to echocardiography study. Only hemodialysis patients with available echocardiography and brain CT were included.

Results
This retrospective study included 119 hemodialysis patients (mean age 70.6±12.6 years, 57.1% male). Of the total cohort, 19 (16%) had no cardiac or brain calcifications and 65 (54.6%) had both valvular and intracranial calcifications. Considering the patients with no calcification as the reference group yielded adjusted odds ratios for all-cause mortality of 3.68 (95%CI 1.55-8.75) among patients with any brain calcifications, p=0.002. ICC was the most important predictor of mortality in the study cohort.

Conclusion
We found an independent association between ICC and the risk of death among hemodialysis patients. Assessing ICC in non-contrast CT may contribute to the risk stratification of HD patients. These calcifications are no less important than valvular calcifications are. Additional studies are needed to confirm these findings.