bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1358THE MONITORING OF FIRST LEVEL IN DIAGNOSIS OF COMPLICATION OF VASCULAR ACCESS: MULTICENTRIC STUDY ON 900 HEMODIALIZED PATIENTS WITH FOLLOW UP TO 5 YEARS
Authors: Satta Ersilia , Romano Carmine , Alfarone Carmelo , Gentile Sandro , Russo Domenico 
Published: June 2020

Abstract

Background and Aims
Vascular Access (VA) is the lifeline of hemodialysis patient. The universal goal of access monitoring is to identify access stenosis and enable intervention prior to thrombosis; thereby, maximizing access longevity and minimizing morbidity. The advent and use of techniques including dynamic and static venous pressure monitoring, physical examination, access flow measurement, imagining and combined imaging and flow monitoring by duplex ultrasound demonstrate that it is possible to predict which accesses are at high risk for future thrombosis.
Currently arteriovenous fistula (AVF) and arteriovenous graft (AVF) have been recognized as the permanent access. This study takes advantage of the opportunity to utilize data from 19 associated Dialysis Clinics to examine trends in VA use, trends in patient characteristics and practice associated with VA.
Determine the status quo of the overall information related to the VA to start a five years follow up study with the aims to reduce VA complications 8stenosis and thrombosis) and related hospitalization days to improve patient’s quality of life.

Method
VA data were collected for each patient at study entry. Practice pattern data from the facility medical director, nurse manager and VA surgeon were also analyzed. We have developed a mask on the management database to implement the first level monitoring of access and collected data at each treatment (Fig.1)

Results
Average age of 801 patients enrolled was 73,5 years. Native AVF was used by 79%, AVG by 2% and CVC by 19%. As the age increase as well as he use of CVC move from 6% (15-39(years) to 50,5% in patients with more than 85 years. Most frequent complications were: Thrombosis 16,5 %, Infectios 5,5%. Related VA hospitalization days are 28,7 % of total days. Average dialysis goals achieved were: QB 290 ml/Min; blood processed 69,7 L; KT/V:1,35.

Conclusion
By interpreting collecting data for specific performance measures using accurate reports allow health care professionals to highlight the VA performance/inefficiences and provide correct information to the clinical staff to support them in their daily clinical practice and decision making.
P1368EVOLUTIVE PROFILE OF HEMODIALYSIS VASCULAR ACCESSES
Authors: Aya Mechri , Mohamed Chermiti , Gorsane Imen , Zied Elloumi 
Published: June 2020

Abstract

Background and Aims
Arterio-venous fistula (AVF) is considered to be the first choice vascular access for hemodialysis (HD). Hemodialysis catheter (KT) may be a temporary or permanent alternative. The aim of our work was the study of indications, and complications’ contributing factors of KT, and to identify complications and predictive factors of AVF survival.

Method
It’s a retrospective, descriptive, analytic, and multicentric study interesting AVF and KT created in patients with end stage renal disease and who have been treated with hemodialysis in the four hemodilysis centers of the KEF governorate in Tunisia over the period from 01/07/18 to 31/12/18.

Results
We have studied 288 AVF and 148 KT that were created in 205 patients averaging 58.14 ±15.56 years in age [25-93 years]. The sex ratio was 1.5. Diabetic nephropathy was the most common (25.9%). For the KT, the main indication was the wait of AVF creation (68.9%). The overall incidence of immediate complications was 11.5%. Dysfunction was reported in 23.6% of cases with obesity (p=0.035) and tunneled type of KT (p=0.045) as contributing factors. KT infection, occuring in 39.2% of cases, was promoted by prolonged duration of use (p=0.041) and hemoglobin level &lt;8 g/dl (p=0.039). The use of an antiseptic lock reduces infections’ risk (p=0.011). For the AVF, the most common complications were thrombosis (36.2%), aneurysm (29.9%) and stenosis (22.6%). The survival rates were 60% at 2000 days. The AVF impairing factors were diabetes (p=0.05), obesity (p=0.05), the anterior AVF creation (p=0.011), AVF grafts (p=0.016) and the use of an anticoagulant therapy (p=0.0001). An antiplatelet therapy improved AVF patency (p=0.02).

Conclusion
Despite of concerted efforts, much remained to be done to reduce the incidence of catheterization, the creation of AVF on time and the prevention of its complications.
P1378PROCESS NORMALIZATION AND CLINICAL OUTCOMES FOLLOWING IMPLEMENTATION OF THE ANEMIA CONTROL MODEL FOR PERSONALIZED ANEMIA MANAGEMENT
Authors: Neri Luca , Cattinelli Isabella , Bolzoni Elena , Barbieri Carlo , Ramos Sanchez Rosa , Stuard Stefano 
Published: June 2020

Abstract

Background and Aims
Anemia management is still challenging in a large share of dialysis patients. ESA resistance show wide variations across patients as well as fluctuations along time within the same patient. The Anemia Control Model (ACM) is a software application which can be integrated in electronic health record systems. ACM is based on an artificial neural network system trained on 1 million health records which simulates patient’s personalized dose-response relationship to ESA and Iron. Based on patients’ response forecast, ACM suggests the optimal drug dose recommendations to reach or maintain the hemoglobin level within target and to minimize the drug consumption. The ACM has earned medical device certification and it is currently used in 13 countries within the EMEA FMC network. Effectiveness and safety of ACM has been demonstrated in previous real-world evidence studies. We report ACM use and its clinical outcomes among hemodialysis patients registered in the Spanish FME Network

Method
We recorded all medical prescriptions and their clinical outcome for which an ACM recommendation was computed (ACM prescription). prescription occurred in 9 clinics located in Catalunya (Spain) from September 2017 to September 2018. We report dynamics of ACM suggestion acceptance rate, ESA consumption and Hb target achievement in the study period.

Results
There were 1189 active patients per month during the study period on average. ACM suggestion acceptance rate was 73,3%. ESA monthly consumption ranged from 234:7±281:9 – 310.2 ± 310:8 UI/Kg; 86% of patients receiving ESA doses according to ACM recommendations achieved or remained within Hb target range; on the contrary, when physicians rejected ACM recommendations and prescribed a different dosage, only 77% of patients reached or maintained the Hb level on target (p&lt;0.05).

Conclusion
Our study demonstrated that ACM suggestions were frequently accepted by physicians. Acceptance of ACM suggestion was associated with higher Hb target achievement.
P1381SWITCHING FROM IRON GLUCONATE TO FERRIC CARBOXYMALTOSE CAN BE ASSOCIATED WITH A BETTER CONTROL OF IRON STATUS AND ANEMIA IN HEMODIALYSIS PATIENTS?
Authors: Martone Massimiliano , Tosto Massimiliano , Mattei Piero Luigi , Berbecar Dorina , Bosco Manuela , Boer Emanuela , Milutinovic Neva 
Published: June 2020

Abstract

Background and Aims
Before evaluating any ESA treatment, International guidelines (NICE-2015, KDIGO-2012, ERBP–2013) suggest to administer iron first to patients with iron deficiency anemia and not still on ESA therapy. Moreover anemic CKD patients treated with ESA should be iron supplemented (unless ferritin is&gt; 800 mcg/l) to maximize the benefits of ESAs.
A recent retrospective study of switching iron sucrose to ferric carboxymaltose (FCM), conducted by Hofman et al., showed a better control of iron status in hemodialysis (HD) patients. New generation drugs, like carboxymaltose, may change the iron administration methods on dialysis, due to their different properties: therefore more experience is needed. In the following evaluation we report the results of switching from iron gluconate (our previous standard therapy) to FCM in HD patients.

Primary Endpoint
switching effects on iron parameters (TSAT, ferritin) and hemoglobin.

Secondary Endpoints
switching effects on iron and ESA doses administered

Method
Study design: retrospective review of data from 106 HD patients from 2 Italian different dialysis centers, who were switched from iron gluconate to ferric carboxymaltose in a 1: 1 ratio.
Study duration: 9 months (3 months pre-switch, 6 months post-switch)
Treatment schedule: -ferritin &lt;100 ng/ml and/or TSAT &lt;20%: 100 mg of iron/weekly
-ferritin &lt;200 μg/l, or TSAT&lt;20%: 100 mg of iron/weekly
-ferritin 200–500 μg/l, and/or TSAT 20–30%: 100 mg of iron/every 2 weeks
-ferritin 500–800 μg/l and/or TSAT 30–50%: 100 mg of iron/monthly
-ferritin&gt; 800 μg/l and/or TSAT&gt;50%: no iron.
Hb, TSAT, Ferritin and PCR evaluation every 4 weeks.

Results
after switching from iron gluconate to FCM, Hb levels were stable or improved, reaching a significantly higher percentage of target patients (from 60% to 80% with Hb &gt; 10,5 g/l). The switch was also associated with a significant improvement of iron status, unrelated to iron dose: the percentage of patients with a target TSAT (TSAT &gt;=20%) has doubled after six months, moving from 30% to 70%, while the average consumption trend of FCM decreasing over time (-48% after six months). It was also shown a marked reduction in ESA consumption: the ESA dose was decreased on average by -1907 IU per patient/month.

Conclusion
The switch from iron gluconate to FCM is associated with a better control of iron status and iron anemia in CKD patients on hemodialysis. The treatment schedule proposed has guaranteed to reach the primary and secondary endpoints, underlining the importance and the effectiveness of a tailored therapeutic protocol.
P1391PROGRESSION OF CALCIFICATION AND ITS RISK FACTORS IN CHINESE DIALYSIS PATIENTS
Authors: Liu Zhihong 
Published: June 2020

Abstract

Background and Aims
The China Dialysis Calcification Study (CDCS) aims to investigate prevalence and progression of vascular calcification (VC) as well as predictive values of VC in Chinese dialysis patients. This abstract reports VC progression and its risk factors during 4-year follow-up.

Method
The CDCS is a nationwide, multicenter observational study. 1497 dialysis patients from 24 centers in China were enrolled from 2014-2015 and continuously followed up for 4 years. Coronary artery calcification (CAC), abdominal aortic calcification (AAC) and cardiac valve calcification (CVC) were assessed at baseline and 4-year follow-up. CAC was assessed by Agatston score measured by electron beam computed tomography or multi-detector computed tomography. AAC was assessed by Kauppila score measured by plain lateral lumbar radiograph. CVC was measured by echocardiography. Progression was defined by comparing VC images at baseline with those at 4-year. When CAC/AAC scores at 4-year were greater than baseline, CAC/AAC were considered progressed; when there were more cardiac valves involved at 4-year than baseline, CVC was considered progressed. Logistic progression model was used to investigate the risk factors for calcification progression.

Results
711 patients completed 4-year follow-up and 680 of them had calcification tests. Patients had the same type assessments (CAC, AAC or CVC) at both baseline and 4-year were included in analysis. At the 4-year follow-up, 89.4% (608/680) patients had at least one site vascular calcification (CAC, AAC or CVC), CAC affected the highest proportion of patients. Prevalence of CAC, AAC and CVC were 81.0% (517/638), 79.3% (310/391) and 45.6% (308/675), respectively. Progression of CAC was observed in 93.9% (368/392) patients with presence of baseline CAC, and 51.3% (123/240) patients without baseline CAC. CAC progression at 4-year follow-up was stratified by baseline CAC score (Figure1). Progression of AAC was observed in 96.5% (165/171) patients with presence of baseline AAC, and 63.8% (139/218) patients without baseline AAC. AAC progression at 4-year follow-up was stratified by baseline AAC score (Figure2). Progression of CVC from single to double cardiac valve calcification was observed in 33.3% (40/120) patients, and cardiac valve calcification occurred in 33.4% (162/485) patients without baseline CVC after 4-year follow-up. Multivariate logistic regression analysis results are showed in Figure3. Variables significantly increased the risk of calcification progression were baseline calcification score, abdominal obesity, hypertension, and calcium, phosphorous, iPTH during 4-year follow-up.

Conclusion
In the 4 years follow-up, progression of calcification is common among dialysis patient, and is associated with higher baseline severity, medical history and disease management.
P1395FIBROLAST GROWTH FACTOR 21 CORRELATES POSITIVELY WITH AND PREDICTS TO OSTEOPOROSIS IN HEMODIALYSIS PATIENTS
Authors: Zhu Lili , Wang Bin , Liu Bicheng 
Published: June 2020

Abstract

Background and Aims
Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) has been recognized as a common complication and arises early in the course of CKD. Osteoporosis can be one form of renal osteodystrophy, one component of the bone abnormalities of CKD-MBD. Fibroblast growth factor 21 (FGF21) is increased progressively with a decline of renal function and higher FGF21 levels predict high all-cause mortality in hemodialysis patients. In recent studies, FGF21 has been approved to exert an inverse effect on bone mineral density. Hence, our study was performed to investigate the relationship and role of FGF21 in osteoporosis in our hemodialysis (HD) patients cohort.

Method
We screened HD patients in Nanjing Zhongda Hospital and The First People’s Hospital of Changzhou according to a strict inclusion criteria and exclusion criteria. We recorded demographic information, blood data before dialysis and serum FGF21, FGF23 levels and measured the CT-attenuation values (in Hounsfield units (HU)) of trabecular bone in L1 on axial images to evaluate the severity of osteoporosis. We used univariate analyses to compare the differences between two groups. Meanwhile, bivariate correlation analyses were performed to assess the correlation of L1 attenuation with serum FGF21, FGF23 and other clinical parameters. Stepwise multivariate linear regression analyses were employed to evaluate variables independently associated with attenuation values. We constructed ROC curves to calculate the AUC and compared the prognostic value of every independently associated factor or united factor to osteoporosis. All analyses were two-tailed, and a P &lt; 0.05 was considered to be statistically significant. SPSS Software, version 18.0 was used for all statistical analyses.

Results
339 HD patients from two big HD centers in China that met our standards were screened. The mean age of HD patients was 56.79 ± 15.60 years. 339 HD patients were divided into two groups osteoporosis (n = 98) and non-osteoporosis (n = 241) on the basis of HU level (L1 attenuation ≤ 135 HU). Remarkably, serum FGF21 were higher in osteoporosis compared to non- osteoporosis in HD patients (median 640.86 pg/ml vs. 245.46 pg/ml, P &lt; 0.01). We also divided HD patients into two groups according to tertiles of serum FGF21 levels. Moreover, attenuation levels were negative associated independently with serum FGF21 (r=-0.136, P&lt;0.05). To evaluate the different values of independent associated or united factors in predicting osteoporosis, receiver operating characteristic (ROC) curves was constructed. The area under the curve (AUC) for FGF21 combined with age yielded a marked increment (AUC=0.836, P=0.000) with a good sensitivity (93.8%).

Conclusion
In conclusion, elevated FGF21 level has a positive relationship with the incidence of osteoporosis in HD patients. Simultaneously, FGF21 in combination with age can be a predictive parameter of osteoporosis in HD patients.
P1400ASSOCIATION BETWEEN MEAN SERUM MAGNESIUM LEVEL DURING THE FIRST 3 YEARS OF HEMODIALYSIS AND THE RISK OF SUBSEQUENT BONE FRACTURES
Authors: Fujii Takayuki , KOSHIZAKA JUNYA , YAMAUCHI NOBUAKI , MORIMOTO MAYU , TERASAKI NORIKO , TANAKA HIROAKI , SUZUKI SATOSHI 
Published: June 2020

Abstract

Background and Aims
Serum magnesium levels are an important factor associated with vital prognosis, cardiovascular disease, and vascular calcification in hemodialysis patients. Moreover, low serum magnesium levels are reportedly associated with an increased risk of hip fractures. Previously we reported that mean magnesium level during the first 3 years of hemodialysis was associated with all-cause mortality in ERA-EDTA 2018. Here, we investigated whether mean magnesium level during the first 3 years of hemodialysis can predict fracture risk.

Method
A retrospective cohort study was conducted in 283 patients who started hemodialysis at our hospital between March 2004 and the present and who could be followed for at least 3 years or had a fracture within 3 years. To assess the association between mean serum magnesium level during 3 years after the start of hemodialysis or until fracture and fracture risk, a multivariate analysis was performed using the Cox proportional hazard model with factors related to fractures as covariates, with all fractures such as hip fracture and spinal compression fracture as the outcome.

Results
The mean follow-up period was 6.1 years, and the mean age of patients was 64 years, with women accounting for 31%. Of all 283 patients, 62 developed fractures. A univariate analysis of factors associated with fractures revealed that high serum magnesium level was a significant fracture suppressor (hazard ratio [HR]: 0.31 [0.12–0.73]). Multivariate analysis conducted with significant factors in univariate analysis (mean serum albumin level, serum phosphorus level, hemoglobin level, C-reactive protein level, age, history of heart disease, history of bone fractures, and use or nonuse of phosphate binder during the 3 years) as the covariates revealed that the serum magnesium level was not significantly associated with bone fractures (HR: 0.95 [0.33–2.78]), whereas, old age, history of fractures, low albumin level, high CRP level, and nonuse of phosphate binder were significantly associated with fractures.

Conclusion
Serum magnesium levels during 3 years after the initiation of hemodialysis did not predict the risk of subsequent fractures, whereas a high level of inflammatory response, malnutrition, and nonuse of phosphate binder did.
P1405ETELCALCETIDE USE IN HEMODIALYTIC PATIENTS: A SINGLE CENTER EXPERIENCE
Authors: Covella Bianca , Rossi Luigi , Libutti Pasquale , Corciulo Simone , Manno Elisabetta , Lomonte Carlo 
Published: June 2020

Abstract

Background and Aims
Etelcalcetide is an injectable calcimimetic, utilized to treat secondary hyperparathyroidism. Recently introduced as alternative to cinacalcet, it acts on a different CaSR (Calcium Sensor Receptor) binding site. Outlined advantages are the intravenous formulation, which solves non adherence, the lower gastrointestinal side effects incidence. The main limitation is iatrogenic hypocalcemia. We show our experience to evaluate findings of our initial fieldwork in order to optimize drug efficacy, safety and tolerability

Method
We included 27 patients during 2018 (15 M and 12 F, Caucasian, mean age 60,7±13,7 years), followed for at least 6 months. Initial etelcalcetide dose was 15 mg in all patients. PTH, Calcium, Phosphorus monitoring was done every month. Concomitant drugs as phosphorus binders, Vitamin D or analogues, Calcium and the switch from cinacalcet were considered. Therapeutic variations and side effects were recorded. Data are registered at the beginning and the end of follow up.

Results
Starting values are: PTH 1298±545 pg/ml, Calcium 9,1±0,9, Phosphorus 5,1±1,4. 14 patients already took phosphorus binders, 10 paricalcitol. 12 patients were switched from Cinacalcet because of non-adherence or inefficacy, the other 15 patients never took calcimimetics. Mean values after 6 months are: PTH 661±469 pg/ml, Calcium 8,2±0,5 mg/ml, Phosphorus 4,1±1,6 mg/ml. These data point out a mean decrease in PTH value of 49%, reaching the therapeutic target in 18 patients, that is the 75% of the total population studied.
It have been necessary dose modifications in 15 patients (62.5%): 9 etelcalcetide dose variations (37,5%), 6 vitamin D and Calcium supplementation, both the changes in 5 of them. Side effects were hypocalcemia (14), pruritus (1), diarrhea (1), low platelet count (1), registered in 17 patients (63%), 3 of them withdrew therapy and then refused to start it again. It has to be said that thrombocytopenia, occurred after the follow up time (at 7th month), solve after etelcacetide withdrawal. Subgroup analysis pointed out a statistically significant correlation between drug efficacy and switch from cinacalcet, both in terms of extent of iPTH reduction (65% vs 42% - p value &lt; 0,05 ) and of achievement of the therapeutic target (89% vs 66% - p value &lt; 0,05), and between concomitant paricalcitol therapy at zero-time and lower hypocalcemia incidence (10% vs 76% - p value &lt; 0,05).

Conclusion
Results confirm etelcalcetide efficacy and suggest a correlation between concomitant paricalcitol therapy at baseline and lower hypocalcemia incidence and between greater efficacy and switch from cinacalcet. These data, if confirmed in larger sample, could be useful to guide the starting approach and the maintaining treatment with etelecalcetide.
P1411THE EFFICACY AND SAFETY OF THE SUCROFFERRIC OXYHYDXIDE IN HEMODIALYSIS PATIENTS : RESULTS OF A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL
Authors: Shutov Evgeny , Kotlyarova Galina , Lysenko Ksenia , Ryabinskaya Galina , Lashutin Sergey 
Published: June 2020

Abstract

Background and Aims
The treatment of hyperphosphatemia is the main goal in the treatment of mineral and bone disorders in patients with CKD. However, the results of the correction of hyperphosphatemia remain unsatisfactory. This is due to the absence of effective and safe medicines. In our prospective randomized controlled trial were evaluated the effects of a 16-week treatment with new phosphate binder - sucroferric oxyhydroxide and a sevelamer carbonate (“sevelamer”) on CKD-MBD parameters in patients on hemodialysis with hyperphosphatemia.

Method
After a 2-4-week washout period from previous phosphate binders, 50 stable patients with hyperphosphatemia (P &gt; 5.5 mg / dl) were randomized at a 1: 1 ratio to receive sucroferric oxyhydroxide (n = 25) or sevelamer (n = 25) for treatment up to 16 weeks. In all patients were evaluated levels of P, Ca, PTH, ferritin, transferrin saturation, Hb, FGF-23, soluble Klotho, CRP - monthly. The dose of both medications was adjusted according to serum phosphate.

Results
Phosphate binder therapy of sucroferric oxyhydroxide was associated with a significant decrease in serum phosphate from 6.8 ± 1.5 to 5.27 ± 0.99 mg/dl (p &lt;0.01); however, treatment with sevelamer did not decrease in the level of P: 6.32 ± 1.5 vs 6.35 ± 1.9 mgl/dl. The number of tablets was lower in the sucroferric oxyhydroxide group (mean ± SD 2.0 ± 1.5 tablets / day) compared with sevelamer (mean ± SD 6.1 ± 3.2 tablets / day). The average intact fibroblast growth factor-23 (FGF-23), PTH, transferrin saturation and ferritin did not significantly change in both groups. Klotho changed only in patients received sucroferric oxyhydroxide, an increase of 25% (р &lt; 0.05) and we also noted in this group an increase in Hb level from 105.6 ± 15.7 to 111.9 ± 22.3 g/l (p &lt;0.05) by the end of the study, simultaneously level of CRP significantly decreased (P &lt; 0.01) by 50% . During the study, 6 patients in the group with sucroferric oxyhydroxide and 5 in the sevelamer group dropped out due to dyspeptic symptoms.

Conclusion
Sucroferric oxyhydroxide is a new effective phosphate binder with a comparable safety profile to a sevelamer. Treatment with this drug can significantly increase the level of Hb, and Klotho and reduce level of inflammation.