bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1367THE RELATIONSHIP OF SERUM PHOSPHORUS LEVEL AND ARTERIOVENOUS FISTULA DYSFUNCTION IN MAINTENANCE HEMODIALYSIS
Authors: Kim Hyung-Jong , Lee Mi Jung 
Published: June 2020

Abstract

Background and Aims
It is known that maintenance of function of arteriovenous fistula (AVF) is very important in the management of hemodialysis (HD) patients. Therefore, identifying a risk factor for decreased vascular access flow has a clinical relevance in real world practice. Although hyperphosphatemia plays a crucial role in the pathogenesis of vascular calcification, there is lack of studies evaluating the effect of hyperphosphatemia on AVF. This study investigated the impact of serum phosphorous (P) on vascular access flow in HD patients.

Method
Sixty-two maintenance HD patients who visited dialysis unit of Bundang CHA Medical Center from November 2016 to December 2017 were included in this study. Serum P levels were determined every month and time-averaged serum P was calculated. All patients had left arm AVF (side to side anastomosis) and vascular access flow was assessed by Transonic HD 03. Decreased vascular access flow was defined as less than 600 mL/min.

Results
The mean age was 57.9 ± 12.1 years, 32 patients (51.6%) were men. The mean serum P levels were 5.1 ± 1.1 mg/dL and the vascular access flow was 1,071.4 ± 504.2 mL/min. Decreased vascular access flow was observed in 14 of 62 patients (22.6%). In univariate analysis, higher serum P was significantly associated with decreased vascular access flow (odds ratio [OR]=2.089, 95% confidence interval [CI]=1.159-3.766, P=0.014). But there was no significant association of dialysis blood flow rate, ejection fraction on echocardiography and serum calcium (Ca) levels with vascular access flow. Multivariable analysis indicated that higher serum P was independently associated with greater risk of decreased vascular access flow (OR=4.012, 95% CI=1.651-9.711, P=0.002). Old age, reduced EF, low dialysis blood flow rate and higher serum Ca was not associated with vascular access flow.

Conclusion
This study demonstrated that higher serum P was the independent risk factor for decreased vascular access flow in maintenance HD patients. Serial monitoring of serum P may be helpful to stratify the risk of vascular access dysfunction in these patients.
P1396EFFECT OF MIXED VERSUS ANIMAL-BASED LOW PHOSPHORUS DIETS IN DIALYSIS PATIENTS ON INTACT FGF23 LEVELS: A RANDOMIZED CLINICAL TRIAL
Authors: Ramirez-Sandoval Juan C , Atilano-Carsi Ximena , Sánchez-Silva Jorge , Arce-Santander Celene , Cruz Cristino , Basulto-Sosa Pamela , Tamez-Pedroza Luis , García de León Miguel , Espinosa-Cuevas Ángeles , Correa-Rotter Ricardo 
Published: June 2020

Abstract

Background and Aims
The FGF23-lowering effect of different phosphate-sources (vegetable versus animal) in low-phosphorus diets are scarcely known. In this trial, we assess the effect on intact FGF23 (iFGF23) of two low-phosphorus diets, animal versus mixed (vegetable + animal), in dialysis patients.

Method
A randomized, two-center, open-label, clinical trial was performed. Subjects on stable dialysis for &gt;6 months with P&gt;4.5 mg/dL were randomized into a mixed-based (3 ounces equivalent of animal protein + 3 ounces equivalent of legumes) vs. animal-based (6 ounce equivalent of animal protein) low phosphorus diet with equivalent nutrients (phosphorus &lt;1000 mg/day; protein=1.3 g/kg/day). The primary outcome was the difference in serum iFGF23 change (ELISA) after 12 wks. We excluded patients who modified their dialysis dose, phosphate binder, or vitamin D prescription during trial.

Results
556 subjects were screened, only 57 subjects (37 hemodialysis[HD] and 18 peritoneal dialysis[PD]) were randomized. Age, sex, phosphate-binders use, and other baseline characteristics were similar between groups. Baseline iFGF23 levels were 7394 (IQR 2379-16629) and 6859 (1543-17521) ng/mL in mixed-based and animal-based groups respectively (p=0.62). Both groups had a significant decrease in iFGF23 after 12 weeks of intervention (iFGF23 change: -285 [IQR -3002 to 227] ng/mL, p&lt;0.001, and -182 [IQR -9323 to 228] ng/mL, p&lt;0.001); there were not significant differences in iFGF23-decrease between both diets (Figure, p:0.78). Serum phosphorus in the mixed-based and the animal-based declined by -0.66 (95% confidence interval [95% IC], -1.39 to -0.04] mg/dL and -0.21 (95% IC -0.81 to 0.38) respectively (p=0.14). There was a trend between the decrease in observed phosphorus and iFGF23 (rho = 0.265, p=0.058). There were no differences between groups in the change of serum Ca, albumin, PTH, and other biochemical parameters.

Conclusion
Dietary phosphorus restriction for 12 weeks with animal-based or mixed-based phosphorus sources similarly decreases iFGF23 concentration in HD or PD patients.
P1429EVALUATION OF PARATHYROIDECTOMY IN PERSISTENT HYPERARATHYROIDISM AFTER RENAL TRANSPLANTATION: A SINGLE-CENTER RETROSPECTIVE STUDY
Authors: Zhang Ping , Lu Hulin , Chen Jianghua 
Published: June 2020

Abstract

Background and Aims
To investigate the efficacy of parathyroidectomy (PTX) in the treatment of persistent hyperparathyroidism (PHPT) after renal transplantation and the effect of PTX on renal allograft function.

Method
This single-center retrospective study enrolled 31 patients who underwent PTX for the treatment of PHPT after renal transplantation in the Kidney Disease Center of the First Affiliated Hospital of Zhejiang University from May 2010 to Oct. 2018. The changes of serum calcium, serum phosphorus, alkaline phosphatase, parathyroid hormone(PTH), serum creatinine, and estimated glomerular filtration rate (eGFR) in the preoperative and postoperative periods (1w, 1m, 3m, 6m,12m) were compared. The operative successful rate (12 m) and postoperative complications were calculated.

Results
The serum calcium before PTX was (2.78±0.18) mmol/L, which decreased significantly to (2.19±0.34) mmol/L at 1 week postoperatively (P&lt;0.01). The serum phosphorus before PTX was (0.76±0.16) mmol/L, which decreased significantly to (0.97±0.26) mmol/L at 1 week postoperatively (P&lt;0.01). The PTH before PTX was (276.00±200.60) pg/mL, which decreased significantly to (46.62±104.36) pg/mL at 1 week postoperatively (P&lt;0.01). The alkaline phosphatase before PTX was (261.59±236.95) U/L, which decreased significantly to (154.90±117.37) U/L at 3 months postoperatively (P&lt;0.01). No significant difference was found in postoperative serum creatinine or eGFR levels compared with the baseline. The operative successful rate was 90.3% at 12 months postoperatively. The incidence rates of postoperative transient hypocalcemia, persistent hypoparathyroidism, and hoarseness were 35.5%, 3.2% and 3.2% respectively. No persistent hypocalcemia, incision hemorrhage, incision infection, or surgery-related death happened.

Conclusion
PTX can quickly and effectively alleviate high calcium, low phosphorus, high PTH and high alkaline phosphatase after renal transplantation. PTX is effective and safe in the treatment of PHPT after renal transplantation, and has no effect on renal allograft function.
P1458CONSERVATIVE MANAGEMENT VERSUS DIALYSIS IN ESKD PATIENTS WITH HIGH COMORBIDITY AND FRAILTY
Authors: Oliveira João , Tavares Joana , Sala Inês , Freitas Joana , Santos Lascasas Josefina , Cabrita António 
Published: June 2020

Abstract

Background and Aims
ESKD population is increasingly older, frail and with cumulative comorbidities. Conservative management (CM) is a valid approach in selected cases but less well studied than the dialytic or transplant treatment. The objective of our study was to characterize our CM population and compare it with those who induced dialysis.

Method
We present a retrospective study from a tertiary hospital, from 2014-2019. A total of 379 patients presented with dialytic indication at hospital admission and out of these 15.3% (G1, n=58) were managed conservatively. They were characterized using the modified Charlson comorbidity index (mCCI) and Clinical Frailty Scale (CFS). A survival comparison was made between CM population (G1), those who were placed on dialysis (G2, n=321) and a subset of these (G3, n=43) who were older (≥75 years) and with higher level of disability (CFS &gt;4 and mCCI &gt; 4).

Results
CM population was older (G1 vs G2 p &lt;0.01, G1 vs G3 p &lt;0.5), more frail (G1 vs G2 p &lt;0.01, G1 vs G3 p &lt;0.44), and with a higher comorbidity index (G1 vs G2 p &lt;0.01, G1 vs G3 p &lt;0.06). The option for CM was based on the existence of comorbidities associated with less than 6 month survival (n=13, 22.4%), functional detriment (n=33, 56.9%), cognitive status (n=15, 25.9%) or self-choice (n=12, 20.7%); 10.3% (n=6) already had an autologous vascular access implanted. There is a statistically significant (p&lt;0.01) survival benefit among those who begin dialysis even among the subgroup G3. The comparative survival rates between G1 and G3 was 19% (n=11) vs 86% (n=37) at 3 months, and 1.7% (n=1) vs 60.5% (n=26) at 1 year, respectively (p&lt;0.01).

Conclusion
In our study, dialysis prolonged survival for elderly ESKD patients with significant comorbidity and frailty. The choice between modalities was not an unmodifiable decision as evidenced by the number of patients in the CM group who had a vascular access. Despite these results we still believe that CM is an appropriate treatment option for whom dialytic therapy or transplantation is not expected to bring out benefit. A future focus on quality of life, psychosocial impact, and symptom burden, is needed to establish the true benefits of dialysis in these population.
P1469HOW LONG ELDERLY ESRD PATIENTS CAN UNDERGO DIALYSIS TREATMENT?; A NATIONWIDE POPULATION-BASED COHORT STUDY
Authors: Yang Yu Mi , Lee Seung Woo , Kwon Soon Kil , Nam Sang Won , Kim Hye-Young , Cho Hyunjeong , Kim Sun Moon 
Published: June 2020

Abstract

Background and Aims
Elderly population is increasing and the age starting dialysis treatment is also increasing.
It could be an ethical issue that we should do or not do start dialysis treatment in the oldest old people such as 10th decade.
We investigated duration of dialysis therapy via patients age using National Health Insurance calim data to know dialysis survival of patients via their age.

Method
Korean National Health Insurance Database was used and excerpted data from the insurance claim of ICD code of dialysis. We included all new patients starting dialysis more than 3 months between 2004 and 2013 and compared dialysis duration among the age group.
Patients on dialysis before 2003 were excluded, and patients on kidney transplantation were also excluded.

Results
Total 208,202 dialysis patients were included via dialysis insurance calim code from about 50,000,000 South Korean population during the year 2003 to 2015. 126,448 patients were excluded due to dialysis before 2003, &lt; 3 months of dialysis duration, kidney transplatation, and to have missing data.
Among the final 81,754 patients, 73,969 were hemodialysis and 7,785 were peritoneal dialysis. 47,798 were men and 33,956 were wemen.
Observed median dialysis duration of each aged group of 20-40, 41-50, 51-60, 61-70, 71-80, 81-90, and &gt;90 were 5.4 (2.2 - 18.3), 5.0 (1.8 - 17.7), 4.2 (1.5 - 15.1), 3.5 (1.2 - 12.6), 2.7 (0.9 - 10.1), 1.8 (0.5 - 7.1), 1.3 (0.3 - 4.9) years, respectively (p &lt; 0.0001).
Comparing with age under 40, dialysis survival hazard ratio of &gt; 40, &gt; 50, &gt; 60, &gt; 70, &gt; 80, and &gt; 90 were 1.493, 2.452, 3.762, 6.113, 9.787, and 15.326, respectively (p &lt; 0.0001). Survival probability of the patients by the age was demonstrated in the figure 1.
Lowest socio-econonic status and highest Charson-Comorbidity group showed highest hazard ratio of dialysis mortality, and peritoneal dialysis showed longer dialysis duration (HR 0.704, 95% CI of 0.69 - 0.74, p &lt; 0.0001).

Conclusion
We concluded that dialysis durability by the age was rapidly decreased after 70 years old. As the longest patients survival of &gt; 90 years were less than 5 years, we should consider patients’ general performance when starting dialysis of oldest old patients.
P1478LOWERING PREVALENCE OF ALKALOSIS AND IMPROVING ADHERENCE TO BICARBONATE TARGETS AMONGST HAEMODIALYSIS PATIENTS THROUGH THE USE OF REDUCED DIALYSATE BICARBONATE
Authors: Tulley Caroline , Hull Richard , Ford Martin 
Published: June 2020

Abstract

Background and Aims
There is evidence that metabolic alkalosis in haemodialysis patients is harmful. Bommer et al demonstrated association between extremes of bicarbonate and clinical outcomes with significantly increased risk of mortality and hospitalisation with pre-dialysis serum bicarbonate &gt;27mmol/L and &lt;17mmol/L. No overall increased mortality risk was observed with moderate pre-dialysis acidosis (serum bicarbonate 19.1-23.0mmol/L).
2015 Renal Registry Data demonstrated 64.3% of haemodialysis patients overall had bicarbonates within target (18-24mmol/L) compared to 65.7% within our centre. Our reported mean pre-dialysis bicarbonate of 23.7mmol/L was above the mean serum bicarbonate 23.2mmol/L seen nationally. In addition, 33.7% of patients were alkalotic, with bicarbonates &gt;24mmol/L. Given concerns of adverse patient outcomes with extremes of bicarbonate, we aimed to investigate whether reducing our dialysate bicarbonate would culminate in overall attainment of bicarbonate targets.

Method
Mid-week pre-dialysis bicarbonate levels were measured from in centre haemodialysis patients once monthly, from May to August 2017, across 7 dialysis units within our renal service. Following this, in early 2018, we reduced dialysate bicarbonate concentration from 32mmol/L to 31mmol/L. Monthly midweek pre-dialysis bicarbonate levels were then re-measured in March and April 2019.

Results
Initial analysis of 2103 pre-dialysis bicarbonate levels across May to August 2017 demonstrated median monthly bicarbonate levels of 24.0–25.0mmol/L. 40.7–54.2% (n=199-322) were alkalotic with pre-dialysis bicarbonates &gt;24mmol/L across this period. Of note, 15-23% (n=66-120) had bicarbonate levels associated with increased mortality and hospitalisation (i.e. &lt;17mmol/L or &gt;27 mmol/L.
Subsequent analysis of 1070 bicarbonate levels in March and April 2019 demonstrated a reduction in median pre-dialysis bicarbonate to 22.0mmol/L. Similarly, the proportion of alkalotic patients fell to 11.9–15.3% (n=71-91). 5-9% (n=26-46) bicarbonates were &lt;17 or &gt;27mmol/L. In March 2019, 77.9% of patients had serum bicarbonates in target range compared to 65.7% reported in 2015 overall.

Conclusion
Initial findings demonstrated substantial alkalosis amongst our dialysis population. A simple measure of altering dialysate by 1mmol/L achieved reductions in overall alkalaemia, and in turn, reduced the percentage of patients with bicarbonate values theoretically correlating with increased mortality and hospitalization risk.
We have demonstrated that a small change in dialysate bicarbonate increased concordance with bicarbonate targets, without subsequent increased acidaemia. The extent to which adherence with such targets impacts on patient survival and morbidity remains an ongoing debate.
P1483INCIDENCE TRENDS IN CHRONIC DIALYSIS: AN IMPORTANT ASPECT, STILL UNDER-REPORTED
Authors: Mancini Elena , Santoro Antonio , Registro Emilia Romagna Gruppo di Lavoro 
Published: June 2020

Abstract

Background and Aims
Whereas the progressive increase in the incidence of advanced age patients on chronic dialysis is widely described, the incidence trend concerning younger age patients, a potentially useful datum for the health services programming, has been little investigated.

Method
The Regional Dialysis Registry of Emilia-Romagna (a region in the north of Italy, near 4,460,000 inhabitants) has been active for 24 years. We analysed the changing incidence in dialysis over time, as a function of 6 different age brackets (excluding the extreme ages, &lt;20 and &gt;90, due to the small numbers involved).
The study considered only hemodialysis patients, not peritoneal dialysis, due to small numbers, and in order to collect data from a more homogeneous population.
For each year from 1994 to 2017, we extracted the percentage incidence on dialysis of each age bracket [(number of cases per bracket/overall number of incident patients)%].
We then carried out a correlation analysis as a function of time.

Results
The incidence on dialysis turned out to change over time with statistical significance in each one of the age brackets except 70-80. The incidence-time association was positive for the brackets 70-80 and 80-90, and negative for the remaining age brackets (Table 1).
A scissor-like trend appeared evident when comparing the most advanced ages with the youngest ones (Figure 1).

Conclusion
Besides the well-known increase in old patients on chronic dialysis, it should be noted that, on the contrary, younger patients have tended to decrease significantly, at least in our Region. Even bearing in mind the limits of a Registry study, these data may support the value of health programs for the early diagnosis of nephropathy, because prompt pharmacological treatment (at least for glomerular or post-infective, or congenital/hereditary diseases) could reduce the attainment of ESRD and account for the results observed in the lower age-brackets.
P1488RECOVERY OF LOW TRIIODOTHYRONINE CAN IMPROVE MORTALITY IN HEMODIALYSIS PATIENTS
Authors: Lee Hong Joo 
Published: June 2020

Abstract

Background and Aims
Low circulating triiodothyronine (T3) levels are the most frequently encountered thyroid functional test derangement in end-stage renal disease (ESRD) patients on hemodialysis. Low T3 is known as independent predictive value for all-cause mortality and, particularly, for cardiovascular-related death in patients with ESRD on hemodialysis. This study investigated that recovery of low T3 level to normal can lower mortality in ESRD patients on hemodialysis.

Method
We have constructed the 500 K-cohort of ESRD patients attending the hemodialysis center of 6 tertiary hospitals of South Korea to evaluate the mortality of the ESRD patients since 2016. From this prospective cohort, we invited patients with ESRD from June 2016 to May 2019 The participants were divided into four groups based on the change of the T3 level: normal group showed the normal T3 continuously, low group showed the low T3 continuously, recovery group showed the low T3 change to normal and decrease group showed the normal T3 change to low. We evaluate relationships between change of the T3 level and mortality. Statistical analysis was carried out by using SPSS.

Results
Of the total 500 patients in K-cohort, 333 patients were enrolled with detailed thyroid hormone profile including T3 level. 167 (50.2 %) patients out of the 333 patients showed low T3 level initially. Normal group include 126 patients(37.8%), low group include 135 patients(40.5%), recovery group include 32 patients(9.6%) and decrease group include 40 patients(12.0%). Patients with the low T3 level were older and more diabetic compare to those with normal T3 level. They had lower K-MMSE score than the others, Low T3 group had lower free T4 level but thyroid stimulating hormone(TSH) showed no significant different comparing normal T3 group. The mortality of normal group was lowest and that of decrease group was highest. The mortality of recovery group recovered to similar with that of the normal group and mortality of decrease group was highest. Lowering of T3 level would affect to mortality than low T3 level continuously.

Conclusion
Therefore, the change of T3 level is significantly associated with the mortality. Recover lower T3 to normal level can lower the mortality.
P1489HEPATITIS B AND C IN DIALYSIS UNITS IN ALMATY
Authors: Yespotayeva Arina , Kabulbayev Kairat , Gaipov Abduzhappar , Amreyeva Zauresh , Mursalova Zhanar 
Published: June 2020

Abstract

Background and Aims
Patients getting maintenance haemodialysis (HD) are at higher risk for acquiring Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) infections than the general population. Strict infection control measures are essential to prevent nosocomial transmission. We aimed to investigate the incidence and prevalence of HBV and HCV infection in the HD population of Almaty dialysis units as well as risk factors for infection.

Method
All adult patients getting maintenance HD (n=700) in Almaty dialysis centres (n=4) were studied between May 2016 and December 2019. Testing for Hepatitis B surface antigen (HBsAg) and anti-HCV antibodies was performed at initiation of dialysis and every 3–6 months thereafter. Serological markers for HBV and HCV were determined with immunoenzymatic assay (ELISA).

Results
Participant median age was 40 years and 58% were male. 110 patients (34.9%) were sero-positive for HBV and/or HCV (anti-HCV positive 31.1%; HBsAg positive 2.6%; both positive 1.2%). Of the sero-positive patients 4.7% were known to be infected before the initiation of HD. The prevalence of HBV±HCV infection varied widely between HD centres from 0% to 75.9%. Sero-positive patients were younger, had longer time on dialysis and more previous blood transfusions. Wide variation in rates of newly acquired infections was observed between dialysis centres. All new HBV cases were referred from centres already treating HBV infected patients. New HCV infections were reported in most centres but the rate of HCV sero-conversion varied widely from 1.5% to 31%. Duration of dialysis, history of previous renal transplant and history of receiving HD in another centre in Almaty were significantly associated with sero-conversion. Major risk factors identified by a standard questionnaire in 302 of 270 patients were the number of blood transfusions individuals had received and duration of dialysis, the latter including patients who received no blood transfusions

Conclusion
HBV and HCV prevalence in our HD patients is still high. These data emphasize the need for stricter adherence to infection control, barrier precaution and preventive behaviors with all patients. In summary, the prevalence of HBV and HCV in our HD patients is still high. These data emphasize the need for stricter adherence to infection control, barrier precaution and preventive behaviors with all patients.
P1491INTRADIALYTIC HYPOTENSION AND PROGOSIS IN HEMODIALYSIS PATIENTS
Authors: Takenaka Yuto , Kishi Satoru , Nishio Kyosuke , Masaki Kazunobu , Hashiba Toyohiro , Huruse Satoshi , Mise Naobumi , Ogura Yoshiyasu 
Published: June 2020

Abstract

Background and Aims
The aim of this study was to investigate the prognostic impact of intradialytic hypotension (IDH).

Method
This study comprised 237 hemodialysis patients (158 males, 64±13 years old, dialysis vintage:110±88 months) in a community-based dialysis center. IDH was recorded in 12 consecutive hemodialysis sessions from February to April in 2014. The patients were divided into 2 groups: Group A, patients with IDH, and Group B, those without IDH, and all-cause mortality rates for 4 years were examined. IDH was defined as a rapid symptomatic fall of systolic blood pressure by at least 30 mmHg or that required medical intervention. Logistic regression was used to investigate the association between IDH and mortality.

Results
IDH was observed in 123 patients (52 %). The frequency of IDH was 3.8±3.1 times during 12 hemodialysis sessions in Group A. Mortality rates from all causes of death were significantly higher in Group A than in Group B (40 % and 17 % at 4 years, respectively, p &lt; 0.05). Univariate analysis showed that IDH, age, female, dry weight, ultrafiltration rate (UFR), serum albumin level, and serum hemoglobin level were significantly associated with all-cause mortality. In multivariate analysis, IDH, age, UFR, and serum hemoglobin level were independent risk factors for all-cause mortality (Table).

Conclusion
In our population, IDH was associated with a poor prognosis at 4 years.