bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1466SYSTEMATIC LITERATURE REVIEW OF CLINICAL EVIDENCE FOR THE BODY COMPOSITION MONITOR IN DIALYSIS AND CKD
Authors: Raddatz Agnieszka , Moissl Ulrich , Ray Alistair , Eichinger Christian , Wabel Peter 
Published: June 2020

Abstract

Background and Aims
The Body Composition Monitor (BCM) is a bioimpedance spectroscopy device to monitor the hydration status of dialysis and CKD patients. NICE (UK) reported only limited evidence on the clinical effectiveness in its Diagnostic Guidance 29. The aim of this work was to provide a structured review of the available evidence up to September 2018 grouped by the most important clinical outcomes (fluid overload, blood pressure, mortality and cardiovascular events).

Method
MEDLINE, Embase and Cochrane databases were interrogated from 2006 to September 2018. Search and review of identified studies was conducted in compliance with the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Results
Of 4497 articles identified, 843 were included for full-text review; 424 were full publications and were selected for further analysis. Eight randomized controlled trial (RCT) studies and 150 observational studies met the predefined inclusion criteria; of these, observational studies that recruited at least 100 patients and additionally reported important clinical outcomes such as mortality, cardiovascular (CV) events or hospitalization were selected. Two further RCTs were identified by supplementary searches, giving a total of 10 RCTs (total 2.156 patients) and 41 observational studies (total 168.453 patients) included in this review.
The data was grouped by reported outcomes and for each outcome it was analyzed if an effect of BCM-monitored fluid management, or an association between BCM assessment and the respective outcome could be shown. A meta-analysis of the results was not conducted.

Reduction of fluid overload
RCTs have shown that BCM-monitored fluid management and subsequent alteration of dialysis parameters can lead to effective reduction of fluid overload.

Lowering of blood pressure
RCTs have indicated that BCM-monitored fluid management can effectively lower blood pressure.

Impact on mortality / association with mortality
Multiple observational studies have shown a strong association between BCM measurements and mortality. One RCT demonstrated that mortality outcomes can be significantly improved in HD patients with BCM-guided fluid management, while two RCTs reported no significant difference in mortality outcomes.

Impact on Cardio Vascular (CV) related events
Multiple observational studies have indicated that BCM measurements can predict CV events. One RCT indicated that CV events can be reduced by BCM-monitored fluid management, and two further RCTs indicated that using BCM guidance was at least as good as conventional fluid management.

Conclusion
There is a strong body of evidence for various important outcomes covering a large patient basis - additional evidence is needed in well designed randomized controlled trials e.g. to demonstrate the effect of reducing BCM determined dehydration.
P1467DEMOGRAPHY OF THE DIALYSIS POPULATION IN SWITZERLAND IN 2018
Authors: Winzeler Rebecca , Ambühl Patrice Max 
Published: June 2020

Abstract

Background and Aims
The national Swiss Dialysis Registry (srrqap) has been established originally in the year 2006. However, participation is substantial only since 2013, when data collection became mandatory by law. The primary aim of the srrqap is to provide quality control and quality improvement for dialysis therapy in Switzerland. In the present analysis, select demographic characteristics of the Swiss dialysis population are given.

Method
All medical establishments in Switzerland (both public and private; N=92) providing chronic treatment by either hemo- and/or peritoneal dialysis, had to provide relevant data for the year 2018. All individuals being on chronic dialytic therapy in the year 2018 were enrolled (N=4646). For patients alive on December 31 2018, data were gathered from this date or closest to this date. For patients who died during 2018 or were being transplanted, data refer to time of event, or to a date closest to the event.

Results
The median age of dialysis patients in 2018 increased almost by one year compared to 2016. More than fifty percent of the patients were older than 71 years, and nearly ¼ were beyond 80 years. No relevant differences were found between female and male patients regarding mean age (68.6 vs. 68.3 years, respectively). However, women‘s dialysis vintage is significantly higher than men’s (54.4 vs. 45.7 months, respectively) and they are significantly less comorbid than men (4.2 vs. 4.7).

Conclusion
With a coverage of 100% for both centers and patients, the data gathered can be considered highly representative. The incidence of dialysis therapy in Switzerland with 95.9 pmp is clearly lower than in most other countries. In 2018, 3789 prevalent patients (443.7 pmp) were dialyzed in Switzerland. The number of dialysis patients with diabetes increased by almost 1% from 2017, reaching 37.4%.
P1470PREGNANCY IN HEMODIALYSIS: EXPERIENCE OF HEMODIALYSIS CENTERS IN SOUTHERN TUNISIA DURING 34 YEARS
Authors: Gouja Dorsaf , Selma Toumi , Olfa Zini , Hanen Chaker , Najla Dammak , Ikram Agrebi , Soumaya Yaich , Kammoun Khawla , Mohamed Ben hmida 
Published: June 2020

Abstract

Background and Aims
Women with chronic kidney disease are much less likely to become pregnant and pregnany has always been considered as a challenging event both for the mother and the fetus. The challenge is harder in patients undergoing dialysis.
The main objective of our work is reporting our experience of pregnancy’s cases in hemodialysis centers in southern Tunisia.

Method
It was a retrospective study looked at 25 spontaneous pregnancies in 19 patients treated with periodic hemodialysis in different hemodialysis centers in southern Tunisia over a period of 34 years. All pregnancies were spontaneous and are counted even spontaneous or voluntary abortions during the 1st and 2nd trimester of pregnancy

Results
The maternal age at the onset of pregnancy was, on average, 35.63 years ± 5.62 (between 23 and 44 years). Our study included 19 patients from southern Tunisia, 6 of them belonged to the governorate of Medenine. Hypertension was present in 7 patients (37%). The average duration of hemodialysis before conception is 4.56 years ± 3.55 (1 - 17 years). Seven patients (37%) had residual diuresis of: 1 liter per 24h in 2 cases, 500ml per 24h in other cases and the rest of the patients were anuric. All our patients were anemic before pregnancy with a mean hemoglobin level at 8 ± 1.54 g / dl (5.1 - 10.6 g / dl) with erythropoietin use in 12 (48%), folate in 11 cases (44%), intravenous iron in 11 cases (44%) and transfusion in 6 cases (24%).In our series, the average urea level was 22.19 ± 4.29 mmol / L .The urea level was lower or equal to 20 mmol / L in 8 cases (42%) and greater than 20 mmol / L in 11 cases (58%). Among the 25 pregnancies, 16 (64%) resulted in the birth of a live child: 4 intra-uterine malformations, 4 early abortions and one voluntary termination of pregnancy. There were 2 deaths within 28 days after birth.
Pregnancy was considered a success if it resulted in the birth of a newborn surviving at least 28 days. Thus, the success rate was estimated at 56%. Among the maternal complications, hypertension was the most frequently complication (35% of cases). There were 2 cases of hemorrhage’s delivery as obstetrical complication. Among fetal complications, prematurity was frequent and was present in 15 cases (60%): 10 cas (40%) of average prematurity, 4 cases (16%) of great prematurity and 1 case (4%) of extreme immaturity. Hydramnios was found in 3 cases (16%). Intra-uterine growth retardation was found in 13 cases (52%) and 6 cases of death (24%) were described.

Conclusion
Pregnancy during chronic end stage renal failure is rare but possible. The chance of giving birth to a live child has increased in parallel with advances in hemodialysis techniques and early weight-bearing. Thus, a successful pregnancy in woman on dialysis requires collaboration among nephrologists, dialysis unit staff and obstetricians.
P1476IRON PARAMETERS PREDICT CARDIOVASCULAR EVENTS IN MAINTENANCE HEMODIALYSIS PATIENTS
Authors: Yonemoto Sayoko , Hamano Takayuki , Sakaguchi Yusuke , Wada Atsushi , Masakane Ikuto , Nitta Kosaku 
Published: June 2020

Abstract

Background and Aims
Previous studies revealed the association between iron deficiency and thromboembolic events, whereas the association between high serum ferritin and poor prognosis of cerebral haemorrhage was reported in the general population. Since few reports have revealed the relationship between iron parameters and cardiovascular events in hemodialysis (HD) patients so far, our purpose was to examine whether iron parameters predict cardiovascular events in HD patients based on the nation-wide database of patients undergoing dialysis in Japan.

Method
We enrolled 126,560 patients aged between 20 and 100 who had been on maintenance HD more than 1 year and three times weekly at the end of 2012. We divided baseline transferrin saturation (TSAT) levels into 3 categories (T1: &lt;20, T2: 20-25, T3: &gt;25%) and serum ferritin levels into quartile (Q1: &lt;31, Q2: 31-73, Q3: 73-158, Q4: &gt;158 ng/mL). The study outcomes were new onset of myocardial infarction (MI), cerebral infarction (CIF), and cerebral haemorrhage (CHM) and death due to these three diseases between 2012 and 2013. We performed multivariate logistic regression for the incident events and also employed Cox proportional hazards analyses for death. Multiple imputation method with 5 data sets was performed for missing values.

Results
During a 1-year follow-up, a total of 2,087 MI (373 deaths), 2,930 CIF (283 deaths), and 1,371 (359 deaths) CHM occurred. After adjustment for demographic and clinical factors, odd ratios (ORs) for MI and CIF were significantly higher among patients with T1 of TSAT than those with T3 (OR; 1.19 (95% confidence interval (CI), 1.07-1.33), 1.16 (95% CI, 1.06-1.27, respectively), and serum ferritin levels were not associated with those outcomes. On the other hand, TSAT was not associated with CHM, however, stepwise increase of OR with the increase of ferritin quartile was observed; patients with Q4 of ferritin had the highest risk for CHM (OR; 1.32 (95% CI, 1.12-1.57) as compared to Q1). In the multivariable Cox regression models, the hazard ratios (HRs) for death due to MI and CIF of the patients with T1 of TSAT were 1.28 (95% CI, 1.00-1.65) and 1.40 (95% CI, 1.06-1.86) as compared to T3, respectively. HR for death due to CHM in patients with Q1-Q4 of ferritin was 1.00 (Reference), 1.59 (95% CI, 1.12-2.25), 1.90 (95% CI, 1.35-2.67), 1.61 (95% CI, 1.13-2.29), respectively (Figure). Furthermore, high dose of erythropoietin stimulating agents was a risk factor of all three cardiovascular events and mortality.

Conclusion
Low TSAT levels predicted MI and CIF and high serum ferritin levels predicted CHM in HD patients. These results suggest that functional iron deficiency could affect thromboembolic events, while increase in storage iron could affect microvascular fragility.
P1485SEVELAMER USE IS ASSOCIATED WITH DECREASED VITAMIN K LEVELS IN HEMODIALYSIS PATIENTS: RESULTS FROM VITAMIN K ITALIAN (VIKI) STUDY
Authors: Fusaro Maria , Aghi Andrea , Khairallah Pascale , Gallieni Maurizio , Cozzolino Mario Gennaro , Russo Domenico , Mereu Maria Cristina , Ravera Maura , Tripepi Giovanni Luigi , Nickolas Thomas 
Published: June 2020

Abstract

Background and Aims
Sevelamer (S) is a phosphate binding drug used to treat hyperphosphatemia in patients with CKD. Our aim was to evaluate the hypothesis that the use of (S) could interfere with Vitamin K absorption in hemodialysis (HD) patients of VIKI study.

Method
We tested this hypothesis in VIKI, a cross-sectional study of 387 hemodialysis patients, we established the prevalence of vitamin K deficiency and to assessed the relationship between vitamin K status, vertebral fractures, vascular calcification. We determined serum concentrations of vitamin 25(OH)D; alkaline phosphatase (ALP); vitamers K1, MK4, MK5, MK6, MK7; osteocalcin (BGP) and Matrix Gla Protein (MGP). We highlighted that MK4 deficiency was the strongest predictor of aortic calcification (OR, 2.82; 95% CI, 1.14–7.01) while vitamin K1 deficiency was the strongest predictor of vertebral fractures fractures (OR: 2.94; 95% CI, 1.38–6.26).

Results
163 of 387 patients (42.1%) were treated with Sevelamer. There were no differences in levels of 25(OH)D, K1, MK5, MK6 and MK7 among patients treated with and without Sevelamer. Remarkably, the prevalence of MK4 deficiency was higher in Sevelamer treated patients (13.5% vs 5.4%, p=0.005). Sevelamer treated patients also had higher median levels of ALK (89 UI/L vs 77.5 UI/L, p=0.001) and total BGP (210 mcg/L vs 152 mcg/L, p=0.002) and lower median levels of total MGP (16.4 nmol/L vs 20.3 nmol/L, p=0.037) (Table 1 and Figure 1). In multivariable logistic regression, the odds ratio of MK4 deficiency (dependent variable) in patients treated with compared to without Sevelamer was ∼3-fold higher (OR: 2.64, 95% CI: 1.25-5.58, p=0.011) after adjustment for confounders of Vitamin K levels, including older age, previous myocardial infarction, type of HD, ALP, PTH, MGP, BGP, cholesterol and albumin.

Conclusion
These data support the hypothesis that Sevelamer could interfere with MK4 absorption in HD patients. Longitudinal interventional studies are needed to prove the causal nature of these associations.
P1506IMPROVEMENTS IN MICROVASCULAR AND MACROVASCULAR DIABETES-RELATED COMPLICATIONS IN DIALYSIS PATIENTS
Authors: Dea Kofod , Almdal Thomas Peter , Sørensen Vibeke Rømming , Feldt-Rasmussen Bo , Hornum Mads 
Published: June 2020

Abstract

Background and Aims
Newer data suggests that there has been a substantial reduction in the incidence of diabetic complications over the past 30 years. However, little is known about whether this reduction also applies to patients with diabetes and end stage renal disease. The present study examined the current prevalence and the changes in microvascular and macrovascular diabetes-related complications in dialysis patients.

Method
The study was carried out as a cross-sectional study of all 119 diabetic patients in chronic dialysis at our department during June 2019. Data on diabetes-related complications was obtained from the patients’ electronic medical records and compared with a historic control group of all 38 diabetic dialysis patients examined in 2004.

Results
Currently, 12.3% had foot ulcer, while 40.3% had a history of foot ulcer. Lower extremity amputations were seen in 19.3%, with 7.6 % being amputated above-knee level. Development of Charcot foot was seen in 3.4%, and 64.1% had diabetic retinopathy (27.2% with proliferations), 27.2% had maculopathy, and 18.4% had a visual acuity lower than 0.3. A total of 31.1% had atrial fibrillation or flutter, 14.3% had angina pectoris and 20.2% had a history of myocardial infarction. A history of stroke or transient ischemic attack was observed in 21.8% and 6.7%, respectively. Compared with data from the 2004 cohort, we found a significant reduction in the prevalence of current foot ulcers (p=0.013), proliferative retinopathy (p=0.007) and visual acuity lower than 0.3 (p=0.028).

Conclusion
The findings of this study indicate that there has been a reduction in current foot ulcers and eye complications over the past 15 years among diabetic dialysis patients, whereas the prevalence of amputations, cardiovascular and cerebrovascular complications remains high.
P1508COGNITIVE IMPAIRMENT A RISK FACTOR FOR NON ADHERENCE TO MEDICAL MANAGEMENT AMONG PATIENTS ON MAINTENANCE HEMODIALYSIS
Authors: Shehaj Larisa , Rroji (Molla) Merita 
Published: June 2020

Abstract

Background and Aims
Patients with chronic kidney disease (CKD) are at substantially higher risk for developing cognitive impairment (CI) compared with the general population. Subtle changes can impact engagement with healthcare, comprehension, decision-making, and medication adherence. The Montreal Cognitive Assessment (MoCA) test was reported to represent a suitable cognitive screening tool for hemodialysis patients. Our study aimed to assess the prevalence of CI in CKD patients undergoing hemodialysis, socio-demographic and patient-related variables affecting CI and relationship with medical adherence.

Method
Out of 65 patients in the HD unit, 58 patients (mean age 59.16±10.61 years old and meantime in therapy 6.93±5.03 years) accepted to participate in the study. The Montreal Cognitive Assessment (MoCA) scale was administered to patients. Patients with a MoCA global score 24/30 were considered cognitively impaired. Descriptive analysis was done for the socio-demographic and clinical variables.

Results
The mean total MoCA score for all the patients were 22.77679±3.8. Thirty seven patient 63.7% were evaluated with CI where 67.5 % with Mild CI (MCI) and 32.5% with severe CI (SCI) under 20 points). MoCA subscale analysis revealed that the mean score for visuospatial/executive domain and attention were the lowest with 5.38±1.3 /8max and 2.82±1.67/6 max and scores for orientation were the highest 5.94±0.59/6 max. MCI was related to vintage to dialysis (p &lt; .00001) and education years (p&lt;0.05) but not with age (p&gt;0.05) and gender (p&gt;0.05) where severe CI was related to age and comorbidity ( p&lt;0.05 and P&lt;0.01, respectively. We found a strong association between low scores and medical adherence (p&lt;0.001).
Conclusion: In hemodialysis, we have a relatively high prevalence of CI and screening for impairment should be considered in all adults with ESRD. Older age, vintage on dialysis, and comorbidity were associated with lower scores. The visuospatial/executive domain and attention were mostly affected. The association between low scores and medical adherence show a high risk for this group of patients.
P1511MODELO PREDICTIVO DE SUPERVIVENCIA DE INTELIGENCIA ARTIFICIAL (BOSQUE ALEATORIO) EN HEMODIALISIS. DATOS DEL REGISTRO ANDALUSINA DE ENFERMEDADES RENALES. SICATA
Authors: Benítez Sánchez Manuel , Martín Guillermo , Sacaluga Luis Gil , Cortes Maria Jose Garcia , García Marcos Sergio , Bayo Magalena Palomares , Morales Ana , Ojeda Raquel , Novillo Carolina Lancho 
Published: June 2020

Abstract

Background and Aims
Random Forest (RF) is an analytical technique of Artificial Intelligence (AI) that consists of an assembly of trees built by bootstrapping (resampling with replacement). In each node a subset of predictor variables is selected and for them the best cut point is determined. Each division of the tree is based on a random sample of the predictors. The trees are as long as possible. In the construction of each RF tree a part of the observations is not used (37% approx.). It is called an out-of-bag (OOB) sample and is used to obtain an honest estimate of the predictive capacity of the model. So it does not require validation. In each analysis, a few hundred Regression or classification trees are carried out, depending on whether the response variable is numerical or qualitative respectively. The result is an average of the repeated predictions of the model (Bagging). RF allows to calculate the importance of the predictor variables, which can be used later to be included in a multivariate regression model.

Method
We analyzed 14750 records between 2011 and 2014 contained in Information System of the Autonomous Transplant Coordination of Andalusia (SICATA) a system that includes clinical-epidemiological variables, about anemia, bone bone metabolism, adequacy of dialysis and vascular access. 1911 patients presented the event of interest (exitus). Three predictive and explanatory models of survival are developed: 1-RF. 2-.Multivariate Logistic Regression. 3- Multivariate Logistic Regression that includes the important variables of the previous RF model. We compare them in terms of accuracy (AUC of the ROC curve).

Results
AUC of the ROC curve of the multivariate model without prior RF was: 0.75 AUC of the ROC curve of the multivariate model with previous RF was: 0.81. AUC of the ROC curve of the Random Forest model: 0.98

Conclusion
The Random Forest model has a 98% discrimination in the mortality of patients on Hemodialysis, far superior to the classic multivariate analyzes. The Multivariate Logistic Regression performed with the important RF variables improves the AUC of the previous model 0.81 vs. 0.75.
P1524ABSOLUTE BLOOD VOLUME AND VASCULAR REFILLING IN HAEMODIALYSIS PATIENTS
Authors: Álvarez Nadal Marta , Viera Ramírez Elizabeth , Martin Irene , Ruíz-Roso López Gloria , Delgado Yagüe María , Fernandez Lucas Milagros 
Published: June 2020

Abstract

Background and Aims
The imbalance between UF and reﬁlling rate is considered a major cause for intradialytic hypotension. Recent studies report a feasable and noninvasive method to estimate vascular refilling by determining absolute blood volume. It was the aim of this study to analyze absolute blood volume in a group of haemodialysis patients and to examine vascular reﬁlling volume.

Method
Thirty stable chronic HD patients were studied (36,7% female, 63,3% male), aged 71,07 ± 13,31 years. Dialysis duration and UF requirements were based on physician prescription. Vascular refilling was calculated as: VREF = VUF – ΔV, where ΔV is the difference between absolute blood volume at the beginning and the end of dialysis. Relative blood volume monitor (BVM) was used. Hemodial Int. 2016;20(3):484–91.

Results
Absolute blood volume at the beginning of the dialysis was 6,27 ± 2,78 L (92,44 ± 32,66 ml/kg) and at the end 5,83 ± 2,77 L (85,94 ± 30,44 ml/kg). Ultrafiltration (UF) volume was 2,64 ± 0,82 L (11,14 ± 4,02 ml/kg/h). Vascular refilling was calculated as 2,24 ± 0,74 L, with a refilling fraction of 85,33 ± 11,07%. We found a strong correlation between reﬁlling volume and UF volume (r2 0,861) (Figure 1), and a mild correlation between reﬁlling volume and predialysis volume overload (r2 0,529).

Conclusion
Measurement of absolute blood volume is easy and noninvasive, and it allows us to study refilling volume. We found a strong correlation between UF volume and refilling volume.