bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1308PHOSPHATE-LOWERING USING SUCROFERRIC OXYHYDROXIDE: CALCIFICATION PROPENSITY (T50) IN HEMODIALYSIS PATIENTS. POST-HOC ANALYSES OF A RANDOMIZED, CONTROLLED CLINICAL TRIAL
Authors: Thiem Ursula , Marculescu Rodrig , Pasch Andreas , Haller Maria , Cejka Daniel 
Published: June 2020

Abstract

Background and Aims
Lowering serum phosphate with sucroferric oxyhydroxide (SO) therapy reduces calcification propensity (measured with the T50 test) in hemodialysis patients (Cejka et al. Abstract FR-PO149, ASN Kidney Week 2019). Intriguingly, we observed considerable inter-patient variability for changes in T50 in response to SO treatment, despite similar reductions in serum phosphate.

Method
Post-hoc analysis of a randomized, controlled cross-over study investigating the effects of serum phosphate lowering using oral phosphate binder therapy with SO on calcification propensity (T50). Patients with changes of serum phosphate of approximately -0.5 mmol/l between phosphate binder wash-out and high dose (2000 mg/d) SO and were selected and classified as “responders” (showing profound changes in T50) and “non-responders” (showing very little change in T50). Data are shown as means ± SD.

Results
“Responders” (N=4) and “non-responders” (N=4) showed similar degrees of lowering of serum phosphate with high-dose SO treatment (-0.47 ± 0.06 vs. -0.49 ± 0.01 mmol/l). “Responders” showed marked increases in T50 (+108 ± 26 min), but “non-responders” did not (+6 ± 24 min). When comparing other laboratory parameters during the wash-out phase between “responders” and “non-responders”, no obvious difference in single parameters or pattern of laboratory parameters was apparent for ionized calcium (1.11 ± 0.1 vs. 1.01 ± 0.1 mmol/l), phosphate (1.76 ± 0.31 vs. 2.06 ± 0.47 mmol/l), T50 (285 ± 82 vs 271 ± 38 min), albumin (3.9 ± 0.2 vs. 4.1 ± 0.4 g/dl), magnesium (1.07 ± 0.17 vs. 0.98 ± 0.14 mmol/l), bicarbonate (22.0 ± 3.6 vs. 24.1 ± 3.0 mmol/l), iPTH (301 ± 156 vs. 463 ± 303 pg/dl) or iFGF23 (6903 ± 9480 vs. 1097 ± 927 pg/ml).

Conclusion
Similar degrees of phosphate lowering do not lead to a similar improvements in T50. T50 “responders” versus “non-responders” cannot be identified using current standard laboratory parameters.
P1333PULSE WAVE ANALYSIS UNDER THE CONDITIONS OF HIGH ARTERIAL FLOW: ASSESSMENT OF SHUNT FUNCTION AND REACTIVE HYPEREMIA
Authors: Mueller Niklas , Streis Joachim , Müller Sandra , Pavenstädt Hermann Josef , Reuter Stefan , Busch Veit 
Published: June 2020

Abstract

Background and Aims
Fistula-creation as well as reactive hyperaemia increase local arterial blood flow. We wanted to analyse the impact of these haemodynamic changes on pulse wave (PW) morphology to assess fistula- and endothelial function.

Method
We conducted a clinical pilot study including 56 patients with functioning forearm fistula. PW morphology in the A. brachialis was assessed tonometrically at the non-fistula and fistula arm using the SpygmoCor® device. We also performed a PW analysis on the non-fistula arm under the condition of reactive hyperaemia (possible in 43 patients). Duplex-sonography was used as a complementary and reference method.

Results
In comparison to measurements under physiologic conditions, both the fistula arm (a) and the non-fistula arm with reactive hyperemia (b) showed marked differences in the pulse wave morphology (figure). The changes in PW morphology were most prominent in the area of the diacrotic notch and could be assessed as the differences of the sum of the mean slope (Δλ in mmHg/ms) between the diacrotic notch and the main preceding and subsequent inflexion point. Measurement with duplex-sonography confirmed increased peak blood flow velocity in the arteria brachialis (ΔVmax in cm/s) under both conditions.
Statistical significance could be proved for Δλ and for ΔVmax (table). Finally, bivariate regression analysis revealed a correlation of Δλ with ΔVmax (figure; c: p=0.001 and r=-0,483 for interarm-differences of the fistula and non-fistula arm; d: p= 0.030 and r=-0.343 for the differences between the physiologic state and reactive hyperaemia at the non-fistula arm).

Conclusion
PW analysis under high flow conditions has the potential to be a new useful clinical tool in nephrology to monitor fistula- as well as endothelial function assessed by reactive hyperaemia. The findings should be verified in a trial with clinical endpoints.
P1347A DYNAMIC ULTRASOUND-IMAGING-BASED GUIDED TECHNIQUE TO TUNNELED DIALYSIS CATHETER BY MICROBUBBLES
Authors: Melo Erica , Silveira Marcelo , Souza Sérgio , Baptista Ana , Miranda Filipe , Nascimento Carolina , Coelho Fernanda , Dutra Fábio , Gomes Marcel , Reixeira Mauricio , Caldas Juliana , Messeder Octavio , Farias Augusto , Benigno Paulo , Passos Rogério 
Published: June 2020

Abstract

Background and Aims
In patients with end-stage renal disease (ESRD), the use of cuffed, tunneled dialysis catheters (TDCs) for hemodialysis has become integral to treatment plans. Fluoroscopy is a widely accepted method for the insertion and positioning of cuffed dialysis catheters, because it is easy to use, accurate and reliable, and has a relatively low incidence of complications. The purpose of our study was to evaluate the feasibility of tunneled hemodialysis catheter placement without the use of fluoroscopy but with a dynamic ultrasound-imaging-based guided technique.

Method
From January 2015 to December 2017, we performed an observational prospective cohort study of 56 patients with ERDS who required TDC placement.

Results
The overall success rate for ultrasound-guided central access was 100%, with a mean number of 1.16 (± 0.4) attempts per patient. There were no incidences of guide wire coiling/kinking, carotid puncture, pneumothorax, or catheter malfunction. Catheter flow during dialysis was 286 (± 38) ml/min. The total number of catheter days was 7,451, with a mean of 133 days and a range of 46 to 322 days. Life table analysis revealed primary patency rates of 100%, 96%, and 53% at 30, 60, and 120 days, respectively.

Conclusion
Dynamic ultrasound-based visualization of microbubbles in the right atrium is a highly accurate method to detect percutaneous implantation of large-lumen, tunneled, central venous catheters without the need for fluoroscopic guidance technology.
P1349CATHETER RELATED BACTERAEMIA AND EFFECTIVENESS OF UNIVERSAL MEASURES: 11-YEAR PROSPECIVE STUDY
Authors: Ibeas Jose , Rubiella Carolina , Gasch Blasi Oriol , Guitart Josep , Criado Eva , Pico Sandy , Lopez Tamara , Viudes Elena , Uroz Elisabeth , Sole Sara , Jimeno Valle , Mateos Alexis , Iglesias Ruben , Marcet Montserrat , Moya Carmen 
Published: June 2020

Abstract

Background and Aims
Tunnelled catheter-related bacteraemia (BRC) of the patient in chronic hemodialysis program results in high morbidity and mortality. Antibiotic catheter lock has been suggested to reduce the incidence of BRC in clinical trials.
Aim: To demonstrate the effectiveness of universal aseptic measures in obtaining an optimal BRC rate in a long-term single-centre study.

Method
Design: Prospective cohort study, single-centre. Follow-up time: 11 years (2008-2018) Tunneled catheters: Optiflow, Hemostar, Hemosplit, Equistream, Hemoglide (Bard Access Systems, New Jersey, USA) and Palindrome (Covidien, - Medtronic, Mansfield, Massachusets, USA). Days / catheter analyzed: 207,320. Catheter placement: Ultrasound-guided interventional radiology equipment, with fluoroscopy and universal aseptic measures + 1 single dose of Vancomycin / cefazolin. Follow-up: Nursing and Nephrology and Infectious physicians. Universal aseptic measures. Heparin lock. BRC is considered to be the presence of a positive blood culture after discarding another focus and related to the negative catheter or blood culture with no other focus than the catheter. All available samples at the time of bacteraemia are analyzed: blood, sputum, urine, faeces, pleural fluid, peritoneal fluid, cerebrospinal fluid, exudates, smears etc, and their results. The BRC rate x 1000 days / catheter is evaluated

Results
Results BRC 2008 to 2018: 0.57, 0.47, 0.31, 0.1, 0.43, 0.37, 0.42, 0.16, 0.2, 0.18 and 0.04 respectively. The evaluated catheters, follow-up days, catheter-related bacteraemias, germ typing and treatment are analyzed: antibiotic vs. catheter removal in Table 1.

Conclusion
1. The use of universal measures only, without the use in the antibiotics lock or anticoagulants other than heparin, can achieve a bacteraemia rate related to the optimal catheter, being cost / effective and avoiding possible resistance to antibiotics and side effects of other anticoagulant drugs.
2. Antibiotic sealing should be reserved for cases of difficult epidemiological control of BRC.
P1355NEW SURGICAL TECHNIQUE TO CONTROL EXCESS VASCULAR ACCESS BLOOD FLOW
Authors: IKEDA KIYOSHI 
Published: June 2020

Abstract

Background and Aims
During dialysis, if blood flow rate increases above 1500ml/min. there is an increase in pulsation and a high possibility of heart failure.
In the long run, it can cause valvular disease and arrhythmia. In EDTA 2015, we presented a method of blood flow suppression for dialysis patients who had heart failure caused by excessive blood flow. However, within one year, 30% of the cases had relapsed. To solve this problem, we were able to prevent the recurrence of excess blood flow through improvement measures with a new device. Report including theoretical mechanisms.
During vascular access excessive shunt blood flow creates a heavy load on cardiac function. Performing blood flow control surgery on dialysis patients with heart failure symptoms improves said function. Depending on the surgical method, it may recur. For this reason, we devised a surgical method that theoretically considers recurrence suppression.

Method
Clinical symptoms before surgery were based on trial hemodialysis patients with significant arrhythmia and shortness of breath at the time of exertion (6 males 4 females) using EPTFE of 4mm in diameter and 4cm in length or more replaced veins extended from anastomosis. (As shown in Poiseuille's law, it is necessary to replace veins with a shunt of smaller diameter but longer length than the vein being replaced.) The point of insertion at the anastomosis portion of the artery is 4mm. In order to connect to the larger section of the vein to the other end, it is cut diagonally to make the connection secure. During the operation, blood flow was monitored using ultrasound. The central side of the tibia artery was also tied off in some cases to control blood flow.

Results
Blood flow was reduced to 787 ml/min immediately after surgery from 1970ml/min before surgery, 1007ml after 6 months, and 721 ml/min after one year. Symptoms of arrhythmia disappeared in two patients during surgery and in all cases shortness of breath during exertion disappeared the day after surgery. Cardiac index improved three months after surgery in three cases. In none of the cases did we observe the complete rekindling of blood flow after one year. The average blood flow was less than 63% of the rate before surgery.

Conclusion
Replacement of 4cm or more length sections of veins with a 4mm diameter graft was useful in improving cardiac function in dialysis patients with heart failure.
P1361IS THE INFLAMMATORY STATE A DETERMINING FACTOR OF THE PRIMARY PERMEABILITY OF ARTERIOVENOUS FISTULES?
Authors: PICCONE SAPONARA LUIS GUILLERMO , CASTRO FERNÁNDEZ MARIA PAZ , URIBE HEREDIA NANCY GIOVANNA , Carreno Agustin , ANAYA FERNANDEZ SARA , DIAZ LÓPEZ MARIA , SANCHEZ ESCUDERO PATRICIA , Siedel Diego , FERNANDEZ MELERO ALICIA , VOZMEDIANO POYATOS MARIA DEL CARMEN 
Published: June 2020

Abstract

Background and Aims
Clinical practice guidelines recommend an arteriovenous fistula (AVF) as the preferred vascular access for hemodialysis and are associated with a lower incidence of morbidity and mortality. However, primary vascular access (AV) failure is not uncommon. Low-grade inflammation is present in ERCT. We identify the inflammatory parameters that influence the primary permeability of vascular access for hemodialysis.

Method
Cross-sectional study; We include all the AVs performed in the HGUCR. We evaluate the initial operation after the creation of the AV. Demographic variables (age, sex), aetiology of CKD and associated comorbidity were collected. Statistical analysis with SPSS 25.0. Categorical variables are expressed as percentages and are compared using the Chi2 Test. Quantitative variables are expressed as mean ± standard deviation and the t-student was used to compare them. We performed a multivariate analysis to determine those factors involved in the primary failure of the VA. Statistical significance for a value of p &lt;0.05.

Results
600 VA performed on 466 patients were reviewed between October 2009 and December 2019. 492 autologous VA (86.8%) and 75 prosthetic VA (13.2%) were performed. The mean age of the patients was 65.3 ± 14.2 years and 66.2% were male. The most frequent etiology of CKD was diabetic nephropathy (29.9%), followed by non-affiliated (18%) and glomerulonephritis (16.5%). 90.8% of the patients had arterial hypertension (HT), diabetes mellitus (DM) 48%. 77.2% of AV presented primary permeability. In the univariate analysis using Chi2 and T student, statistical age (p = 0.017), HT (p = 0.002), statin treatment (p = 0.002), antiplatelet therapy (p = 0.001), low ferritin levels (p = 0.011) and PCR (p = 0.019). When performing a multivariate analysis, the high CRP figures (OR: 0.64 95% CI 0.42-0.98 p = 0.043) and ferritinemia (OR: 1.04 95% CI 1.01-1.06 p = 0.013) are predictive factors of primary AV failure.

Conclusion
In our study, high CRP decreases the probability of primary functioning of AVFs by 36% and elevated ferritin levels are predictors of primary failure after adjusting for age and sex in the multivariate model.
P1362AN EXPERIENCE WITH PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY IN ARTERIO-VENOUS FISTULA DYSFUNCTION SECONDARY TO VASCULAR STENOSIS
Authors: Ahmed Khan Mohammed Shoeb , Mukthar Faiz , Kumar K Vinod , Prasannan Bipi , Nair Rohit P V , Sadananda Arjun , Unni V Narayanan 
Published: June 2020

Abstract

Background and Aims
Arterio-venous fistula (AVF) is the life line of a hemodialysis patient. Dialysis Outcomes and Practice Study (DOPPS) showed that one year patency for AVF in the USA is 68% and 83% in Europe. The maintenance of the vascular pathways are vital. Vascular stenosis in native AVF at the anastomotic sit, venous cannulation zone, outflow vein or the central vein can lead to loss of AVF. Stenosis necessitate vascular intervention or creation of a “de novo” AVF. The number of possible vascular access sites are limited.
Aim : To evaluate the outcome of percutaneous transluminal angioplasty (PTA) in arterio-venous fistula due to vascular stenosis.

Method
This is a retrospective study of two years (02.05.17 to 02.05.19). Records of patients admitted to our hospital were obtained from hospital archives and images from the hospital radiology archive system. Demographic characteristics, duration of dialysis, stenosis or occlusion level, patency rates of AVF were evaluated. All procedures were performed by interventional radiologists in a hybrid cath lab. Antegrade, retrograde, or both antegrade and retrograde punctures were used, depending on the site of the stenosis as deemed on preoperative ultrasound. A complete angiogram from the proximal arteriovenous anastomosis to the central venous outflow was performed in all cases. A successful percutaneous balloon angioplasty was defined when there was no more than 30% residual stenosis (KDOQI). Primary patency rates were assessed at six months and one year.

Results
Total number of patients studied were 16. The average age was 66.6 years. All were hypertensive and diabetics comprised 75% of study group. Coronary artery disease was established in 81.25%, and two patients were known to have chronic liver disease. Most common type of AVF was the left brachio-cephalic (62.5%), followed by radio-cephalic (37.5%). Average dialysis vintage of AVF at the time of procedure was one year. Previously failed AVF was present in two patients. There were 18 vascular stenosis in 16 patients. The most common site of stenosis was the venous cannulation zone (62.5%), followed by anastomotic site stenosis (31.5%) and central vein stenosis (18.75%). Successful PTA was done in 12 patients. There were no complications; hemodialysis was resumed within 24 hours after the procedure. The primary patency rate at three months was 100%, six months was 75% and at one year it was 37.5%. Four patients were lost to follow up. Mean follow up was 9.41 ±6.79 months. None underwent a repeat PTA.

Conclusion
Percutaneous transluminal angioplasty is effective for salvaging arterio-venous fistula in majority of hemodialysis patients.
P1370UNPOPULAR SOLUTIONS FOR VASCULAR ACCESS DIFFICULTIES IN HEMODIALYSIS PATIENTS: A CASE SERIES
Authors: Attiya Ahmed Mohamed Naguib , Elshahat Samar , Galalah Ibrahim , Elmowafy Ahmed , Eldahshan Khaled , Elwasif Salwa , Refaie Ayman 
Published: June 2020

Abstract

Background and Aims
Vascular access remains a significant challenge for patients on chronic hemodialysis (HD) and often requires creative thinking to preserve and construct durable long-term access. While AVFs continue to remain the gold standard for vascular access, HD access remains an ongoing challenge for surgeons and patients.

The cases
This report is about 4 ESRD patients on chronic hemodialysis with multiple closed A-V fistulas (left and right radiocephalic then left and right brachiocephalic). Also, they suffered from catheter related blood stream infection (CRBSI) when central lines were inserted so the vascular sureon had to find solutions for them. First patient was 36-year old hemodialysis patient since 1995 2ry to posterior urethral valve. In 1994, he sought renal transplantation from his motivated brother who was the only available living related donor but unfortunately the surgeon discovered a congenital anomaly in the donor side during surgery. So the patient was maintained on hemodialysis. After multiple thrombosed AVF and recurrent episodes of CRBSI with central lines, the vascular surgeons inserted a synthetic graft on left chest wall between axillary artery and axillary vein 3 years ago and it is well functioning with efficient dialysis. The 2nd case (figure 1) is a 42-year old graft failure patient since 2005 and In view of high PRA, 2nd renal transplantation was not an option. After multiple thrombosed AVF and recurrent episodes of CRBSI with central lines, the vascular surgeons created a new fistula in lower extremities between right great saphenous vein and common femoral artery 2 years ago and it is still functioning. The 3rd case (figure 2) is about 14-year old child who received renal allo-transplantation from his father 8 years ago. Now, he is on chronic hemodialysis. First, he underwent peritoneal dialysis. But he suffered from recurrent peritonitis, so he was shifted to hemodialysis. Unfortunately, he suffered from CRBSI with catheters and multiple AVF were thrombosed. So, vascular surgeons performed arterio-arterial synthetic graft using right subclavian artery which is well functioning over 2 years. The 4th case (figure 3) is about 43-year old graft failure case on chronic hemodialysis with widespread thrombosis and difficult central line fixation. Also,AV fistulas had short survival. So, vascular surgeons decided to create AVF in lower extremities between right greater saphenous vein and superficial femoral artery 2 years ago. The patient after that received warfarin and the graft is functioning well till now.

Conclusion
Hemodialysis access remains an ongoing challenge for surgeons and patients lives.
P1373ERYTHROPOETIN RESISTANCE IN PRE-DIALYSIS PERIOD AND ITS RELATION TO PROGNOSIS IN JAPANESE INCIDENT DIALYSIS PATIENTS
Authors: MORINAGA Takatoshi , FUKATSU Atsushi , ITO Takeshi , TAMAI Hirofumi 
Published: June 2020

Abstract

Background and Aims
Erythropoiesis stimulating agents (ESA) are essential for better quality of life and longer life expectancy in end-stage kidney disease patients (ESKD). Resistance to ESA leads to worse prognosis in hemodialysis and peritoneal dialysis patients. Resistance to ESA exists in pre-dialysis period. We studied the clinical significance of pre-dialysis resistance to ESA by investigating the erythropoietin resistance index (ERI) in patients with ESKD prior to dialysis induction and its association with mortality and cause of death in three-year follow-up after dialysis initiation.

Method
Subjects included 1,420 patients in 17 centers participating in Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis (AICOPP) from Oct. 2011 to Sep. 2013. ESA responsiveness was estimated by using erythropoietin resistance index (ERI) (U/kg/week/g/dL), which was calculated as weekly weight-adjusted epoetin dose divided by the hemoglobin (Hb) concentration before starting dialysis. We excluded 302 patients because ERI was not available. Thus, 1,118 subjects were enrolled. Subjects were divided into four categories of ERI; ERI &lt; 5, 5≤ ERI &lt;10, 10≤ ERI &lt;15 and 15≤ ERI. Cumulative survival rates from all-cause, cardiovascular disease (CVD), infection and malignancy were compared by Kaplan-Meier method according to ERI categories. Three-year mortality was analyzed by logistic regression analysis adjusted by age, gender, Charlson comorbidity index (CCI), and ERI categories.

Results
During three-year follow-up period, 191 (17.1%) patients died. Age and female gender share were higher in proportion to ERI. Diabetes, coronary artery disease (CAD), and values of albumin (Alb) and brain natriuretic peptide (BNP) were not correlated with ERI (Table 1). Kaplan-Meier survival curve showed that patients with the highest ERI (15≤ ERI) had a higher all-cause mortality (Log rank test p=0.002, Figure 1). Concerning the cause of death, mortality from infection (p=0.023, Figure 2) and malignancy (p=0.031) were high in the highest ERI category, however there was no significant difference in each ERI category regarding CVD mortality (p=0.33). According to multivariate analysis analyses by logistic regression model, all-cause (odd ratio [OD]: 1.65, 95% confidence interval [CI]: 1.14-2.38, p=0.008) and infection-related mortality (OR: 2.13, 95% CI: 1.08-4.11, p=0.029) were significantly correlated with the highest ERI category, but unexpectedly CVD mortality was not (OR: 1.04, 95% CI: 0.59-1.75, p=0.90). Mortality from malignancy did not reach the significant level (OR: 1.92, 95% CI: 0.96-3.73, p=0.063) and may require longer observation period for analysis.

Conclusion
Pre-dialysis ERI is a prognostic marker in Japanese dialysis patients and predicts the susceptibility to infection.