bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1494THE NEGATIVE EFFECT OF SELENIUM DEFICIENCY ON THYROID HORMONE IMPAIRMENT AND CARDIOVASCULAR DISEASE IN CHRONIC HEMODIALYSIS PATIENTS
Authors: KIM SO MI , Cho Jong Tae , Lee Yong-Moon , Lee Eun Kyoung , Jeon Ji Hyun , Lee Hwa Young 
Published: June 2020

Abstract

Background and Aims
Selenium is an essential trace element. It has been known to protect the cardiovascular disease(CVD) and thyroid disease by protecting the oxidative stress using selenium-dependent glutathione peroxidase. Chronic hemodialysis(HD) patients are more likely to have selenium deficiency compared to healthy subjects. Therefore, we investigated the degree of selenium deficiency in HD patients and try to analyze the effect of selenium deficiency on thyroid hormone impairment and its correlation with CVD.

Method
A total of 183-chronic HD patients were enrolled. Serum selenium level was assessed before HD using inductively coupled plasma-mass spectrometry. Based on tertile of selenium, the patients were divided into three groups: low-, intermediate-, and high- group. The presence of thyroid hormone impairment and cardiovascular disease were evaluated.

Results
The value of serum selenium in first and second tertile of subjects was 80.64 and 94.84 g/dL, respectively. Thyroid dysfunction and CVD with respect to serum selenium levels are summarized in Table 1. Although the prevalence of hypothyroidism was not different among the three groups, instances of subclinical hypothyroidism was higher in the lower selenium group than those in the other groups (34% vs. 15% vs. 8%; P=0.005). Moreover, total thyroid dysfunction was significantly higher in the lower selenium group (38% vs. 18% vs. 15%; P=0.005). The prevalence of ischemic heart disease was most prevalent in the lower selenium group among the three groups, (49% vs. 25% vs. 22%; P=0.002). The prevalence of total CVD was highest in the lower selenium groups. (57% vs. 33% vs. 26%; P=0.001). In the analysis of the relationship between thyroid dysfunction and CVD, The prevalence of IHD was highest in the lower selenium group with thyroid dysfunction(p=0.039)

Conclusion
This study showed that selenium deficiency is associated with thyroid hormone impairment and thyroid disease. And the thyroid hormone impairment showed the synergistic negative effect on CVD in HD with selenium deficiency patients.
P1497INCIDSENCE OF CANCER IN HEMODIALYSIS-TREATED PATIENTS
Authors: Katzir Ze'ev , Merkin Lusia , Brenner Ronen 
Published: June 2020

Abstract

Background and Aims
In recent decades, there has been an increase in the incidence and prevalence of patients with end stage renal disease (ESRD) worldwide. Previous studies have shown an increased incidence of malignancies among ESRD patients, compared to age-matched controls, although it was unclear whether different etiologies of ESRD ( diabetes, hypertension, cystic disease) confer different risk ratio.
Our present study intends to re-examine relationships between ESRD, classified according to the etiology of renal disease, cancer incidence and types of malignancies in hemodialysis treated patients.

Method
We conducted a retrospective study, analyzing hemodialysis (HD) treated patients over the age of 18 at the Wolfson Medical Center in Holon, Israel, from 2008-2017. Patients diagnosed with cancer prior to dialysis or with history of transplantation were excluded.
Data on etiology of chronic kidney disease and ESRD, comorbidities and cancer diagnosis was collected from patients' files and verified using the Israeli National Cancer Registry.
A single, multivariate survival analysis was conducted to examine the relationship between the various predictors and the incidence of cancer.

Results
The study included 333 patients, 211 (63.4%) were males, mean age 67.2±13.1 years. The median follow was 4 years (95% CI: 2-6.5). Twenty eight (8.4%), developed primary malignancy during hemodialysis, annual rate: 2.1%, Vs 0.35% age-adjusted annual rate in Israeli general population. The average age of all patients diagnosed with cancer over the study period was higher than that of patients without cancer (72.3±7.7 Vs 66.7±13.4 years. P=0.001).
The most common sites of malignancy were colon (33%), bladder (16.7%), kidney (10%) and prostate (10%). Older age was the only risk factor associated with the onset of malignancy. No statistically significant relationship was found between ESRD etiology, comorbidities and occurrence of malignancy.

Conclusion
Among our cohort of patients on chronic hemodialysis, annual cancer incidence rate is 6 times higher than age matched controls in the Israeli general population. Older age is a risk factor associated with onset of malignancy. We did not found associations between ESRD etiology, comorbidities and cancer incidence.
This study constitutes a platform for a longer period multicenter study.
P1507COMPETING RISKS MODELING IN PERITONEAL DIALYSIS: THE URGE FOR A CHANGE IN SURVIVAL ANALYSIS METHODOLOGY
Authors: Malho Guedes Anabela , Calças Roberto , Domingos Ana , Jerónimo Teresa , Neves Pedro , Martins Rosário , Dias Sara 
Published: June 2020

Abstract

Background and Aims
Survival analysis is a cornerstone in medical research. For this purpose Kaplan-Meier is the most widely used statistical test, but the presence of competing risks violates the fundamental assumption that the censoring mechanism is independent of survival time. This leads to overestimation of the cumulative probability of cause-specific failure. Cumulative incidence estimate and competing risks analysis are preferred. The purpose of this study was to compare different survival analysis methods: Kaplan-Meier and cumulative incidence function estimates in a cohort of Peritoneal Dialysis (PD) patients.

Method
The survival of 115 incident patients on PD in a university hospital was evaluated after establishing 2 cohorts: patients starting renal replacement therapy with PD (PD first; n=85) and patients switching to PD on the first 6 months of dialysis (PD transfer; n=30). Kaplan-Meier, cumulative incidence function, cause-specific and subdistribution hazards were performed. The event of interest was death and the competing risk events were transfer to hemodialysis and renal transplantation.

Results
Besides higher residual renal function (RRF) and kt/V in the PD first group, there were no other significant differences between groups. There were 22 deaths. PD first group had a better survival with both Kaplan-Meier (log-rank test, p=0.013) and cumulative incidence function (p=0.021) approaches. The Cox regression model showed, as protecting variables, higher albumin (HR=0.174; CI95% 0.054-0.562), higher RRF (HR=0.785; CI95% 0.666-0.925) and PD first (HR=0.350; CI95% 0.132-0.927). Higher Charlson Index predicted worse outcome (HR=1.459; CI95% 1.159-1.835). PD as first dialysis therapy was associated with 65.0 % lower risk of death comparing with PD transfer. The subdistribution multivariable model found higher Charlson Index (HR=1.389; CI95% 1.118-1.725) and lower RRF (HR=0.798; CI95% 0.680-0.936) were statistically associated with death, but not PD transfer or albumin. This result differs from the obtained using the cause-specific hazard model. Analyzing the competing events, patients submitted to renal transplantation had a lower Charlson Index.

Conclusion
The probability of death was overestimated by the Kaplan-Meier method. The bias of Kaplan-Meier is especially great when the hazard of the competing risks is large. This study consisted on a statistical critical analysis of a real medical example, broader clinical conclusions related with “PD first initiative” should be cautious in this context.
It is primordial to recognize the presence of competing risks in studies with multiple outcomes, as in Peritoneal Dialysis studies, to estimate cumulative incidence and yield more accurate results. This study shows how different conclusions are attained with different statistical methodology and its relevance in clinical context.
P1509SEVERITY OF PRURITUS IN HEMODIALYSIS PATIENTS: RELATIONSHIP TO UREMIC TOXINS AND DIALYSIS MODALITY
Authors: Yamamoto Suguru , Tanaka Takahiro , Omori Kentaro , Ei Isei , Kitamura Nobutaka , Narita Ichiei 
Published: June 2020

Abstract

Background and Aims
Pruritus is a complication that can impair the quality of life of patients with chronic kidney disease (CKD). A previous report has suggested that the severity of pruritus is correlated with high serum concentrations of β2-microglobulin, calcium, and phosphorus, however recent developments in hemodialysis (HD), especially use of high-flux membrane and online hemodiafiltration (OLHDF), may improve the severity of pruritus. Protein-bound uremic toxins (PBUTs), such as indoxyl sulfate and p-cresyl sulfate, are known to be factors associated with atherosclerosis and impaired bone metabolism in CKD and may also be associated with pruritus, especially in those undergoing dialysis treatments. The aim of our study was to assess the severity of pruritus using a new tool, the 5D-itch scale (5D), as well as its relation to circulating PBUTs and dialysis modality in patients with end-stage kidney disease.

Method
This was a prospective cohort multicenter study, wherein we analyzed the baseline data. The 5D score (5–25 points) was measured in maintenance dialysis patients. The serum concentrations of indoxyl sulfate, p-cresyl sulfate, phenyl sulfate and hippuric acid were measured with mass spectrometry before a dialysis session. The correlations of the 5D scores with serum PBUTs, dialysis modality (HD or OLHDF) and the other background factors were assessed with Spearman correlation coefficients and the generalized linear model.

Results
This study included 135 dialysis patients (98 HD and 37 OLHDF). The mean 5D score was 6.84 (±SD 3.14). The mean serum concentrations of indoxyl sulfate, p-cresyl sulfate, indole acetic acid, phenyl sulfate, and hippuric acid were 2.99 ± 1.40, 2.05 ± 1.54, 0.11 ± 0.08, 0.94 ± 0.71, and 4.52 ± 3.17 mg/dL, respectively. There was a significant correlation between the 5D score and dialysis modality (correlation coefficient = 0.24, p &lt; 0.01). Dialysis method was associated with the 5D score by the generalized linear model, and OLHDF was associated with a lower 5D score. There were no significant associations between the 5D score and serum concentrations of the various PBUTs (e.g., for indoxyl sulfate, the correlation coefficient was 0.11, p = 0.20)

Conclusion
Pruritus, as assessed by the 5D score, was associated with dialysis modality, but not with the serum concentration of PBUTs. Further studies will be needed to understand the mechanism of the effect of OLHDF on pruritus as well as the role of uremic toxins in the itchy skin in CKD patients.
P15185 YEAR ALL-CAUSE MORTALITY ACCORDING TO PRIMARY RENAL DISEASE IN HEMODIALYSIS PATIENTS
Authors: Kim Ha Yeon , Lee Jeong Ho 
Published: June 2020

Abstract

Background and Aims
The Korean Society of Nephrology (KSN) collected data of end-stage renal disease registry since 1985 and internet registry program was available since 2001. We explored the hypothesis that the 5-year mortality of hemodialysis patients was different depending on primary renal disease.

Method
From 2004 to 2015, in total, 32,163 patients starting hemodialysis were determined. The cause of primary renal disease were divided to diabetic nephropathy (49.9%, n=16,038), hypertensive nephrosclerosis (18.5%, n=5,958), histologically confirmed glomerulonephritis 3.3% (n=1,067), cystic kidney disease (2.0%, n=656) and the miscellaneous (26.3%, n=8,444). The miscellaneous included renal tuberculosis, interstitial nephritis, lupus nephritis, kidney tumor.

Results
The 5-year mortality of hemodialysis patients was 16.9 % (N=5,435) and ratio of unknown state was 24.9 % (N=7,996). The mortality of diabetic nephropathy, hypertensive nephrosclerosis, histologically confirmed glomerulonephritis, cystic kidney disease and the miscellaneous were 27.1% (n=3,323), 17.0% (n=768), 8.4% (n=62), 13.9% (n=67), and 19.7% (n=5,435), respectively. Kaplan-Meier survival analysis showed that diabetic nephropathy was worst survival rate following hypertensive sclerosis, cystic kidney disease and the miscellaneous, while histologically confirmed glomerulonephritis showed highest survival rate (log-rank p &lt; 0.001). After adjusting for confounders, cox-proportional regression analysis revealed that 5-year mortality was associated with diabetic nephropathy compared hypertensive nephrosclerosis (HR, 1.62 CI, 1.17-2.24) while histologically confirmed glomerulonephritis was not significant.

Conclusion
The overall mortality was associated with primary renal disease in hemodialysis paitents. This result suggests that hemodialysis patients with diabetic nephropathy require further medical attention.
P1519A TWICE-WEEKLY HEMODIALYSIS : A SINGLE CENTER STUDY
Authors: Bchir Sirine , Mojaat Malek , Ben salem Mariem , Amine Boukadida , Handous Insaf , Faouzi Haouala , Ahmed Ltaief , Hammouda Mouna , Aloui Sabra , Habib Skhiri 
Published: June 2020

Abstract

Background and Aims
Conventional hemodialysis consists of a thrice-weekly in-center Hemodialysis with a mean duration of 4 hours per session. The concept of incremental dialysis has allowed a better adjustment of its prescription guided by clinical and biological parameters. Thereby a twice-weekly regimen may maintain a good quality of life, a good survival rate and adequate dialysis in comparison to a thrice-weekly hemodialysis. The aim of our study was to investigate the profile of patients undergoing a twice-weekly regimen in our center.

Method
It is a monocenter transversal-descriptive study gathering patients on a twice-weekly regimen in the center of hemodialysis of Fattouma Bourguiba University Hospital in Monastir Tunisia.

Results
We identified 32 patients with a sex ratio of 2.2 (22 men and 10 women) with a mean age of 48,96 +/- 13,74 years. Regarding the intitial nephropathy, a chronic glomerulopathy was seen in 16 patients, a chronic tubulo-interstitial nephritis In 5 patients, and kidney polykystosis among 3 patients and in 8 patients the initial nephropathy remained undetermined. The indications for a twice-weekly HD regimen were: defavourable socio-economic conditions in 9 patients, a medical reason in 17 patients and a rejection of thrice-weekly regimen in 6 patients. The mean diuresis was 850 +/- 560 cc/24h and only one patient with anuria. The mean interdialytic weight gain was 2, 64 +/- 0, 83 Kg. Normal blood pressure and volemia were reported in 27 patients (84, 37 %). The mean number of anti-hypertensive drugs used was 1,5 per patient. The mean percentage of Urea reduction was 68, 8 % and a mean Kt/V of 1.26. The average of both kalemia and calcemia was respectively 5.27 mmol/l and 1, 94 mmol/l and the mean dosage of phosphoremia was 1, 63 mmol/l. The average of PTH and Hemoglobine was respectively 403 pg/ml and 9, 97 g/dl.

Conclusion
According to these results, a twice-weekly hemodialysis should be guided by the residual kidney function, clinical status (volemia), cardiovascular symptoms and comorbidities, biological parameters (Hemoglobine, potassium, phosphore) and the nutritional state. By meeting the above criteria, many studies have shown that a twice-weekly regimen or incremental dialysis help preserve the residual kidney function with a good quality of life.
P1521LRG-1 LEVEL PREDICTS 5-YEAR MORTALITY IN ESRD
Authors: Yang Feng-Jung 
Published: June 2020

Abstract

Background and Aims
Plasma Leucine-Rich alph-2-Glycoprotein 1(LRG1) is an new biomarker for inflammatory and angiogenetic diseases. whether levels of plasma LRG1 correlate with the co-morbidities of End stage renal disease (ESRD) patients is unknown.

Method
Plasma LRG-1 and high-sensitivity C-reactive protein were analyzed by ELISA in samples from 169 hemodialysis patients from the Immunity in ESRD study (iESRD study). Baseline co-morbidities were recorded through chart review of medical history.

Results
High level of LRG 1 showed high mortality in the ESRD. In multivariate-adjusted logistic regression models, higher LRG1 was significantly associated with 5 year mortality after adjusting for gender, hemoglobin, diabetes, hypertension, and level of C-reactive protein.

Conclusion
LRG1 is a possible poor prognosis marker in ESRD. Higher LRG-1 showed high prevalent CAD and PAOD in our study before. The role of LRG1 and the associated cardiovascular diseases should be analyzed the mechanism in this patient population.
P1526HOW TO DEAL WITH PREGNANCY IN DIALYSIS? A CENTER EXPERIENCE ABOUT 7 CASES
Authors: BENHAMOU Ramia , Chettati Meriem , Fadili Wafaa , Laouad Inass 
Published: June 2020

Abstract

Background and Aims
Outcomes of pregnancy in patients with end-stage renal disease (ESRD) have long been considered to be extremely poor, and the literature concerning pregnancy while on dialysis is rather meagre. We reported our center experience about pregnancy management in patients on hemodialysis: how to deal with hypertension, ultrafiltration rate, dose dialysis in order to improve maternal and fetal outcome.

Method
We reported pregnancy outcomes of 7 pregnancies in the Tensift Region Pregnancy registry between March 2015 and March. 2019 The primary outcome was the live birth rate and secondary outcomes included gestational age and birth weight.

Results
We reported 7 pregnant women cases on hemodialysis. Mean age of our patients was 29,5 ±6,57 years. It was the first pregnancy for 3 patients (42,9%). In about half of patients dialysis was initiated during their pregnancy. The mean duration of pregnancy was 35±1,2 weeks and mean fetal weight was 1,950 ±0,353 kg. All patients were dialyzed over 20 hours per week. The mean urea value was 0,46 ±0,04g/L. Two patients needed anti hypertensive drugs (33,3%) mainly nicardipine. The live birth rate of our cohort (71,4%), all vaginal delivery, was significantly higher than the rate in the American cohort (61.4%). In your series we reported one fetal death at 28 SA explained by tocolysis failure for preterm labor. At 9 months all children had good cognitive and psychomotor involvement.

Conclusion
We conclude that pregnancy may be safe and feasible in women with ESRD receiving intensive hemodialysis. A multidisciplinary medical care with obstetricians is highly recommended. Despite a trend of increasing live birth rate over recent decades, pregnancies on dialysis high risk, with increased rates of adverse of adverse pregnancy outcomes including pregnancy loss.
P1530QUALITY OF LIFE AND MORTALITY IN PATIENTS UNDERGOING HEMODIALYSIS
Authors: Kang Gun Woo , Kim Seoung Gyu , Lee In Hee , Ahn Ki Sung 
Published: June 2020

Abstract

Background and Aims
The mortality of patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD) is higher than the general population. And it is well known that quality of life (QOL) falls immediately after receiving HD. However, studies on the relationship between reduced QOL and mortality in HD patients were very rare. This study aims to observe the correlation between impaired QOL and mortality in HD patients and to identify risk factors that affect mortality.

Method
The study included 160 patients with ESRD undergoing HD during over 3 months. The QOL was evaluated using WHO Quality of Life-BREF (WHOQOL-BREF). The WHOQOL-BREF instrument comprises 26 items, which measure the following four domains: physical health (domain 1), psychological health (domain 2), social relationships (domain 3), and environment (domain 4). Univariate analysis was used to determine the relationship between comorbidities, sex, age, laboratory findings, and QOL and mortality in HD patients. Multivariate analysis was performed by cox proportional hazard regression. Expected survival at 5 and 10 years was determined by two-sample t-tests.

Results
The mean age was 58.1 years old. 95 patients (59.7%) received HD due to diabetes mellitus. 42 patients (26.4%) had been diagnosed with coronary heart disease. In univariate analysis, age, coronary heart disease, malignancy, comorbidities, and blood calcium level were positively correlated with mortality. In particular, the domain 1 and 2 of WHOQOL-BREF were negatively associated with mortality. The mean scores of domain 1 and 2 was 18.2±5.2 and 15.9±4.5 for survivors and 15.5±5.7 and 13.7±4.9 for deaths. Multivariate analysis identified the age, comorbidity, serum calcium, and domain 1 of WHOQOL-BREF were independent risk factors for mortality (Table 1). Additionally, predicting 5- and 10- year survival, mortality was correlation with older age, higher Charlson Comorbidity Index, lower serum calcium, and lower domain 1 of WHOQOL-BREF (Table 2).

Conclusion
The impaired QOL of patients with ESRD undergoing HD was closely related to mortality. In particular, low QOL in physical health domain significantly increased mortality. Therefore, in order to improve the survival of HD patients, we should be considered about QOL as well as medical problems
P1534EFFECT OF HIGH-FLUX DIALYZER MEMBRANE SURFACE AREA ON SURVIVAL IN CHRONIC HEMODIALYSIS PATIENTS
Authors: Takasawa Kazuya , Takaeda Chikako , Yamamura Yuta , Hunamoto Tomoaki , Ueda Norishi 
Published: June 2020

Abstract

Background and Aims
High-flux dialyzer membrane material has been shown to improve mortality in hemodialysis (HD) patients. However, little is known about the impact of surface area of dialyzer membrane on prognosis in HD patients. A retrospective analysis was undertaken to investigate whether the difference in high-flux dialyzer membrane area affects survival rate.

Method
We observed 119 patients (43 females, mean age; 68 years, and HD duration; mean 84.4 months) maintained on HD for up to 5 years and 7 months. All patients were divided into two groups according to the surface area of dialyzer membranes; S group, 39 patients treated with the dialyzer membrane area of &lt;1.5m2 (mean 1.0±0.1 m2) and L group, 80 patients treated with that of ≥1.5m2 (mean 2.0±0.2 m2). We analysed survival rate by Kaplan-Meier method.

Results
The patients were treated with four types of high-flux dialyzer membranes. S group included 21 patients with cellulose triacetate (CTA), 17 patients with polysulfone (PS) and 1 patient with polymethylmethacrylate. L group included 2 patients with CTA, 71 patients with PS and 7 patients with polyethersulfone (PES). Thirty-two patients, including 12 patients in S group and 20 patients in L group, had diabetes mellitus (DM). Survival rate was compared between the two groups, patients treated with CTA, PS and PES, and those with and without DM by Kaplan-Meier method. Type of dialyzer membranes used did not affect survival rate at the final observation (65.2% in CTA, 75% in PES and 50% in PS, p=0.26). The surface area of dialyzer membrane did not have a significant impact on mortality; survival rate at 3-year for S group, 71% vs L group, 77%, at 5-year for S group, 51% vs L group, 59%, and at the final observation for S group, 48%, vs L group, 58% (p=0.352). Among 32 diabetic patients, survival rate at the final observation did not differ between the two groups (S group, 33%, vs L groups, 45%, p=0.477). Among 87 non-diabetic patients (S groups; 27 patients), survival rate did not differ between the two groups at the final observation (S group, 56%, vs L group, 63%, p=0.575).

Conclusion
We conclude that difference in high-flux dialyzer membrane area is unlikely to affect survival rate in HD patients.