bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1513EDEMA SCORE OF CHRONIC KIDNEY DISEASE (CKD) 5D PATIENTS SHOW DIFFERENT CORRELATION WITH NON-CKD PATIENTS AND ARE STRONGLY INFLUENCED BY THE SERUM ALBUMIN VALUE ; PROPENSITY SCORE MATCHING ANALYSIS
Authors: Murakami Takuya , Saito Osamu , Saito Takako , Ueno Koushi , Akimoto Tetsu , Nagata Daisuke 
Published: June 2020

Abstract

Background and Aims
Previously studies reported bioelectrical impedance analysis (BIA) method is useful for body fluid evaluation, especially for evaluation of edema in CKD patients. However, it is still unelucidated what factor affects edema score in CKD patients. In this study, we investigated the factors that determine edema score of CKD 5D patients and reported new findings on the differences from non-CKD patients by using propensity score matching analysis.

Method
We measured the edema score of 117 CKD 5D patients and 303 non-CKD patients using the BIA method and analyzed the relationship with clinical laboratory factors. The edema score was expressed as the ratio of the total body weight (TBW) to the extracellular water (ECW) and was measured with InBody 20® (InBody Japan). All patients with CKD 5D were undergoing hemodialysis and the data were measured immediately after dialysis treatment.

Results
There were differences between CKD 5D patients and non-CKD patients in age, sex, and BMI. Since these factors were estimated to affect edema scores, we performed propensity score matching with age and sex, BMI in CKD 5D patients and non-CKD patients.
After performing propensity score matching, the differences of age, sex, and BMI between the two groups disappeared. The number of patients became 70 in both groups.
By analyzing the model, the edema score of CKD 5D patients indicated significantly higher than that of non-CKD patients (CKD 5D; 0.400±0.012 v. s. non-CKD; 0.389±0.008, P&lt;0.001).
Edema score and factor which indicated significant difference by single regression analysis were examined using stepwise multiple regression analysis. As a result, we clarified that muscle mass is the most influential factor (p&lt;0.0001), and age is the next (p=0.025) on edema score in non-CKD patients, however, in CKD 5D patients, serum albumin level is the most influential factor, and no significant influence was found in muscle mass and age (p=0.0006).

Conclusion
For CKD 5D patients, the edema score is defined by serum albumin, and serum albumin value has much greater influence than age. It is known that low level of serum albumin is associated with poor prognosis in CKD 5D patients. From these results, it was suggested that edema score could be a better prognostic factor than ageing for CKD 5D patients.
P1515IMPACT OF POLYPHARMACY ON ALL-CAUSE MORTALITY, ALL-CAUSE HOSPITALIZATION AND CARDIOVASCULAR EVENTS IN INITIAL JAPANESE HEMODIALYSIS PATIENTS
Authors: Toida Tatsunori , Toida Reiko , Ebihara Shou , Uezono Shigehiro , Komatsu Hiroyuki , Sato Yuji , Fujimoto Shouichi 
Published: June 2020

Abstract

Background and Aims
Polypharmacy (PP) is common in end-stage chronic renal disease patients, largely because of the existence of multiple comorbid conditions. PP has the potential for harm and benefits, and the association between PP and mortality and morbidity in hemodialysis patients currently remains unclear. We examined the association of PP and the risk of clinical outcomes, such as all-cause mortality, all-cause hospitalization and cardiovascular events, in initial hemodialysis patients at admission and discharge.

Method
Study design: Cohort study.
Setting: Participants: One hundred and fifty-two initial hemodialysis patients (female vs. male, 88 vs. 64; mean age, 70.3 years) were enrolled between February 2015 and March 2018 at the Nobeoka Prefectural Hospital and Chiyoda Hospital.
Predictor: Patients were divided into 2 groups according to PP (6 or more drug prescriptions, or less) during admission and discharge for the initiation of hemodialysis.
Outcomes: All-cause mortality, all-cause hospitalization and cardiovascular events (hospitalization due to stroke, ischemic heart disease or peripheral artery disease) during the mean 2.8-year follow-up.
Measurements: Hazard ratios (HRs) were estimated using Cox’s model for the relationships between PP and the clinical outcomes, and adjusted for potential confounders, including age, sex, body mass index, systolic and diastolic blood pressure, Charlson comorbidity risk index, hemoglobin, serum levels of albumin, albumin-corrected Ca, phosphate, parathyroid hormone, C-reactive protein and NT-proBNP; and use of erythropoietin stimulating agents. The group with 5 or less drug prescriptions was set as reference.

Results
Among the patients in this cohort study, the number of prescribed drugs per patient averaged 7.4 at admission and 6.9 at discharge for initial hemodialysis. One hundred (65.8%) and 94 patients (61.8%) had PP at admission and discharge, respectively. During follow-up, 20 patients died, 71 patients were hospitalized and 25 patients had cardiovascular events. PP at admission is significantly associated with cardiovascular events (HR 8.50, 95%CI 1.45-49.68). Furthermore, PP at discharge is significantly associated with all-cause hospitalization and cardiovascular events (HR 1.95, 95%CI 1.01-3.70; HR 53.16, 95%CI 2.70-104.62, respectively). However, PP is not significantly associated with all-cause mortality at admission or discharge.

Conclusion
Among Japanese patients starting hemodialysis, PP may be associated with clinical outcomes. However, it remains unclear whether PP is the direct cause of the outcomes or is simply a marker for increased risk of outcomes.
P1516DEMONSTRATION OF FLUID REMOVAL ACCURACY USING THE SC+ HAEMODIALYSIS SYSTEM
Authors: Buckberry Clive , Komenda Paul , Heyes Keith , Westenbrink Eric , Wallace Mark , Milad John 
Published: June 2020

Abstract

Background and Aims
Fluid management is an integral component for managing patients to correct abnormalities in plasma composition and maintain fluid balance. Consequently, accurate fluid removal during treatment is a critical design element of haemodialysis machines. The SC+ haemodialysis system developed by Quanta Dialysis Technologies, is a small, simple-to-use dialysis system designed to improve patient access to self-care and home haemodialysis. This paper describes the design, evaluation and performance of the flow balance and ultrafiltration module of SC+ to deliver specified fluid removal in accordance with the international technical standards for haemodialysis defined in IEC 60601-2-16 using a number of unique proprietary technologies.

Method
SC+ uses volumetric flow balancing chambers which are contained within a single use disposable cartridge. During normal operation of SC+, dialysis fluid flows through the cartridge in discrete packets. This is achieved by the application of pneumatic pressure and vacuum to manipulate a flexible PVC membrane that, in turn, opens and closes a sequential series of valves and pump cavities that constitute the flow balance chambers.
Proof of system performance was undertaken using a range of dialysers and venous pressures, with and without ultrafiltration, to quantify the net fluid removal error, in order to simulate a range of patient conditions in typical clinical practice.

Results
In total, the tests comprised 22 separate runs on multiple machines, with 88 individual
30-minute measurement samples, taken over a range of environmental conditions, dialyser types (with differing KuF), dialysate flowrates, and venous pressures.
Across all results, there was a mean error of 7.4g/hour rate error, (max allowed is 100g/hr) of positive flow from the blood to the dialysate side with a standard deviation of 19.88g/hr. The maximum permissible rate stated in IEC 60601-2-16 is +/-100g/hr.
In specific detail, without ultrafiltration the flow balance error was measured as 2.2g/hr with a deviation of 19.0g/hr, and with ultrafiltration the mean error was 12.8g/hr with a standard deviation of 19.5g/hr.

Conclusion
It has been demonstrated that flow balance error and fluid removal attainable with the SC+ haemodialysis system lies well within the acceptable standards permitted for haemodialysis machines. This essential performance parameter as defined within IEC 60601-2-16 has been demonstrated across a range of clinically relevant parameters at dialysate flow rates of up to 500ml/min
P1517SURVIVAL ON DIALYSIS: SWITZERLAND IN COMPARISON WITH OTHER COUNTRIES - A FOLLOW UP
Authors: Winzeler Rebecca , Ambühl Patrice Max 
Published: June 2020

Abstract

Background and Aims
Survival in dialysis patients is substantially reduced compared to the general population. The aim of the present analysis was to compare the survival of Swiss dialysis patients with other countries with an additional year of follow up and a higher number of patients.

Method
Incident dialysis patients (hemo- or peritoneal dialysis; N=4525) from the Swiss dialysis registry were followed up from 2014 on until December 31, 2018 (mean follow up days=684). Deaths occurring during this time (N=976) were recorded and survival was examined using the Kaplan Meier method, censored for transplantation.

Results
Characteristics of the dialysis population stratified according to survival status are provided in Table 1.
Dialysis patients in Switzerland have an approximately 8% higher survival in the first and second year after start of dialysis compared to other European countries (Annual ERA-EDTA Report 2016). In the oldest age group, it amounts to up to 13 and 14%, in the first and in the second year, respectively. The proportion in survival rates between genders is similar in Switzerland, as well as in Europe. Dialysis patients aged younger than 45 years have a worse survival in Switzerland compared to other European countries.

Conclusion
The markedly better survival in dialysis patients in Switzerland compared to other European countries could be confirmed with an additional year of follow up and more patients. Also, causes of death vary widely among European countries. With an additional year of follow up, data to analyze 5-year survival probability will be available for comparison with the ERA-EDTA report. In addition, we will be able to verify whether dialysis patients under 45 years in Switzerland have an increased mortality or whether this is due to the small number of patients in these two age groups.
P1520PULMONARY HYPERTENSION AS NEW RISK FACTOR FOR MORTALITY IN HEMODIALYSIS
Authors: RAMIREZ MARMOLEJO ROBERTO , MUÑOZ ZAPATA LUIS MIGUEL , Garcia Blanco Laura 
Published: June 2020

Abstract

Background and Aims
The prevalence of pulmonary hypertension HTP in patients receiving dialysis therapy is not completely clear, it is an independent risk factor for cardiovascular mortality, which indicates the serious need to sensitize the clinic with this comorbidity and maintain an active search for it.
Objective: Raise awareness about the prevalence of HTP in a hemodialysis population and identify the associated risk factors.

Method
Descriptive, retrospective study, in which echocardiograms of the patient (peritoneal dialysis PD and hemodialysis HD) in renal facility were reviewed, at least 12 months in therapy, Nice 2013 classification were used for the diagnosis of HTP, multivariate analysis (echocardiograHTPic, demograHTPic, clinical and biochemical variables) was performed and the statistical significance of P &lt;0.05 with the X2 method was searched for the associated risk factors.

Results
24 male patients (45%), 75% with systemic hypertension, 34% with diabetes mellitus T2, on average 5 years on dialysis (+/- 2.7), age of 64 years (+/- 13.6) and 3 very elderly patients (&gt; 85y); 35 patients (66%) on hd and 18 (34%) on PD. 51% had fistula ArterioVenosa (FAV). 100% of patients in hd with KtVe&gt; 1.25 and 73% in pd with KtV&gt; 1.7.
Regarding the HTP, 27 positive patients were found (51%), the significant (p &lt;0.05), were: hd 54% vs 44% PD, having a 76% central catheter with HTP vs 33% with fav, and patients with severe vs mild Hiperparatiroidism
The severity of HTP, in hd vs pd was more severe, PSP average of pressures in the positive 43mmHg vs 34.3mmHg respectively (p &lt;0.033)

Conclusion
HTP is a comorbidity that impoverishes the cardiovascular prognosis and its management must be specific, especially due to the preference of calcium antagonists over the use of renin angiotensin system blockers. The prevalence of PHT in the hemodialysis population is very high, which makes the clinician an active search and effective treatment, especially in patients with catheters. Hyperparathyroidism plays a role within the remodeling mechanisms of the pulmonary arterial endothelium, aggravating this situation and increasing mortality
P1523TREATMENT OF ADVANCED NON-SMALL CELL LUNG CANCER IN DIALYSIS PATIENTS; FINDINGS FROM OSAKA CANCER REGISTRY DATA
Authors: KIDA NANAMI , Tsubakihara Yoshiharu , Morishima Toshitaka , Sato Ryo , Miyashiro Isao 
Published: June 2020

Abstract

Background and Aims
Recent advances in dialysis technic for end-stage renal disease have resulted in a longer survival. Consequently, they have an increased risk of suffering from various neoplastic diseases. The survival outcome and treatment rate in non-small cell lung cancer(NSCLC) patients on dialysis has not been well evaluated. In patients with unresectable stage disease, chemotherapy may best be started soon after the diagnosis of unresectable NSCLC has been made. The aim of this study was to investigate the practice pattern and survival rate in advanced NSCLC patients on dialysis.

Method
This retrospective study used population-based cancer registry data from Osaka Prefecture, Japan and administrative claims data produced under the Diagnosis Procedure Combination reimbursement system. We performed record linkage between these datasets to obtain patient-level information on dialysis, cancer diagnoses, treatment, and vital statuses. Patients who were diagnosed with advanced NSCLC between 2010 and 2015 and were at the age of 80 years or younger. We calculated the performance proportions of chemotherapy (including molecular-targeted drugs) in dialysis patients and non-dialysis chemotherapy. In addition, we computed one-year survival rate of patients in dialysis patients who underwent chemotherapy and who did not undergo.

Results
We identified 42 dialysis patients with a median age of 71 years and 18,425 non-dialysis patients with a median age of 70 years who were diagnosed with advanced NSCLC. Dialysis patients (n=11, 26.2 %) were less likely to receive chemotherapy when compared with non-dialysis patients (n=12247, 66.3%). Among dialysis patients, there was no significant difference in 1-year survival rate between the receipt (40.0%) and the non-receipt (29.6%) of chemotherapy (Log-rank test, p=0.41).

Conclusion
Dialysis patients might receive suboptimal treatment for advanced NSCLC. Further studies are needed to assess whether chemotherapy improves survival outcomes in dialysis patients with advanced NSCLC.
P152590 DAY MORTALITY DATA OF PATIENTS INITIATING MAINTENANCE HEMODIALYSIS AT A TERTIARY CARE FACILITY IN PAKISTAN
Authors: Asif Sonia , Saleem Mohammad , Qayyum Ahad 
Published: June 2020

Abstract

Background and Aims
Mortality of end stage renal disease patients is 10 to 30 times higher than that of the general population. Timing of death related to dialysis vintage remains unclear. Mortality risk among hemodialysis patients may be highest soon after initiation of hemodialysis, the reason for which remains elusive. Additionally mortality on initiating hemodialysis is related to arteriovenous vascular access.
Poor planning for dialysis initiation may contribute to hemodialysis catheter use and the associated high rate of infections. This study was carried out to determine the 90-day mortality in patients starting maintenance hemodialysis at a tertiary care facility in Pakistan.

Method
This is a cross sectional study which included all consecutive patients who initiated maintenance hemodialysis at Bahria Town Hospital Lahore. A total of 485 participants were included and the collected data was entered into the SPSS software and their mortality rate was calculated within 90 days after initiation of maintenance hemodialysis. Additionally 90-day mortality based on type of vascular access at initiation was also noted.

Results
The mean age of the participants included in the study was 44 with 50% of the patients were male. The 90-day mortality of patients initiating maintenance hemodialysis at our centre was found to be 37%. 90% of the patients initiating maintenance hemodialysis started through a double lumen temporary dialysis catheter. Amongst these patients the mortality rate was 39%. 10% of the patients initiating maintenance hemodialysis started through an arteriovenous fistula. Amongst these the mortality rate was 19%.

Conclusion
Our study showed that the mortality rate is high in patients undergoing hemodialysis with in first 90 days. Early planning for permanent vascular access may result in a reduction of mortality.
P1536EVOLUTION OF A COHORT OF PATIENTS UNDERGOING HOME ONLINE HEMODIAFILTRATION DURING A THREE YEAR FOLLOW UP PERIOD
Authors: Garcia-Prieto Ana , Vega Almudena , Abad Esttebanez Soraya , Barbieri Diego , DELGADO ANDRÉS FELIPE , Goicoechea Marian 
Published: June 2020

Abstract

Background and Aims
Online haemodiafiltration (OL- HDF) is the gold standard therapy in hemodialysis, as it has shown to reduce all-cause mortality in hemodialysis patients. Frequent hemodialysis has also shown to improve survival and quality of life. Home hemodialysis facilitates frequent therapy, and it is possible to perform OL-HDF at home, althought there is lack of evidence on its use. We report the evolution of a cohort of patients undergoing home OL-HDF during a 3 year follow up period.

Method
We designed a prospective, descriptive study to determine the evolution of prevalent and incident patients in home OL-HDF since 2016. Demographic and clinical variables were collected, including those related to hemodialysis technic and its potential complications.

Results
Three patients with a mean age of 47 years underwent home OL-HDF during follow up. All patients were males and caregiver was the couple in all cases. Two patients had an arteriovenous fistula (AVF) and one had a catheter. After a mean training period of 2.5 months at hospital, they started home OL- HDF with the assitance of a nephrologist, a nurse and a technician in the first session at home. We used the “5008-home”®FMC monitor and the AquaC®FMC for water treatment. Water cultures allways fulfilled the criteria for ultrapurity. Dialysis scheme was 2 hour sessions daily, 6 days a week.
During a mean follow up of 15 months, one patient received a kidney transplant. None needed hospitalization. One patient attended the emergency room once for fluid overload and needed ultrafiltration. The patient with catheter needed a catheter replacement due to hole infection. No vascular access problems were recorded in patients with AVF. Regarding dialysis efficacy, mean week KtV was over 2.1 in all cases and mean convective volumen achieved was 94 l/week.

Conclusion
In our experience, home OL-HDF is a safe and effective technic.
P1539THE INFLUENCE OF DIFFERENT HEMODIALYSIS FREQUENCY ON MHD PATIENTS WAS ANALYZED BASED ON THE DATA OF THREE CONSECUTIVE YEARS
Authors: Liu Hua , He Quan , Wei Limin , Shi Kehui , Wang Meng , Xue Jinhong , Chen Lei , Sun Lingshuang , Wei Meng , Jiang Hongli 
Published: June 2020

Abstract

Background and Aims
By analyzing the follow-up data of patients on maintenance hemodialysis (MHD) in the department of blood purification of the first affiliated hospital of Xi'an Jiaotong university from 2016 to 2018, the effects of different dialysis frequency on patients were compared and the continuous improvement of clinical quality was promoted.

Method
The general data of MHD patients in our center from 2016 to 2018 and annual laboratory monitoring indicators [including hemoglobin (HGB), calcium (Ca), phosphorus (P), parathyroid hormone (iPTH), serum albumin (ALB)] and their control rates were analyzed, and the differences in the above indicators of patients with hemodialysis frequency (2-times weekly, 5-times in two weeks and 3-times weekly) were compared.

Results
The proportion of patients older than 60 years old and the proportion of autologous arteriovenous fistula (AVF) increased year by year, while the use of the cuffed-tunneled catheter (TCCs) decreased. All indicators except iPTH have increased their control rates. Among the different dialysis frequencies: the average value of HGB and Ca was the highest at 3 times/week, and the control rate of P was not much different among the three groups. ALB was significantly lower in patients with 2 times/week than in other frequency groups (P&lt;0.05). The average age of 3 times / week patients was significantly lower than 2 times / week and 5 times / 2 weeks (P &lt;0.05).

Conclusion
In northwest China, the hemodialysis frequency to twice per week for most. The results of this study suggest that compared with the higher frequency, the major differences in the control rates are in albumin hemoglobin and serum calcium.
P1544SHARED DECISION MAKING FOR TREATMENT OPTIONS FOR ELDERLY PATIENTS ON DIALYSIS
Authors: Kato Akihisa , Saka Yosuke , Naruse Tomohiko 
Published: June 2020

Abstract

Background and Aims
The numbers of elderly patients on dialysis are increasing rapidly around the world. The quality of life (QOL) should be emphasized rather than survival for such patients. Shared decision making (SDM) regarding dialysis treatment options is one way to increase patient satisfaction with treatment, which should result in a better QOL. Thus, we investigated whether SDM affects the lives of elderly patients after dialysis initiation.

Method
We retrospectively collected clinical information about patients aged ≥ 80 years who started dialysis at our hospital between January 2013 and December 2017. The experience of SDM was defined as whether patients participated in a multidisciplinary approach to decision making about dialysis treatment options. Mortality rates, length of hospital stay and place of death during 2 years after dialysis initiation were determined.

Results
Among 124 patients, 40 participated in SDM. Functional activity, dementia, and daily assistance did not differ between patients with and without SDM. Participants in SDM were more likely to select PD (SDM vs. non-SDM: 50.0% vs. 3.6%; p &lt; 0.001). Mortality rates did not differ between patients with and without SDM, but the rate of hospitalization for &gt; 240 days was higher among patients without SDM (with vs. without SDM: 0.0 vs. 15.5%; p = 0.009). Among 70 deceased patients within two years, 59 died in hospital. Patients without SDM died in hospital more frequently (with vs. without SDM: 66.7% vs. 91.8%; p = 0.006).

Conclusion
Shared decision making reduced long-term hospitalization and death in hospital, indicating that more desirable home care therapy should be available for elderly patients on dialysis.