bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1224ROLE OF DIAGNOSTIC IMAGING DURING PERITONITIS IN PERITONEAL DIALYSIS PATIENTS
Authors: Lwin Khin Zar Li , Foo Marjorie , Htay Htay 
Published: June 2020

Abstract

Background and Aims
Peritonitis in peritoneal dialysis (PD) patients can be directly related to PD or secondary to intrabdominal infection (secondary peritonitis). The indication and role of imaging of abdomen during peritonitis in PD patients is unclear.

Method
This was a single center, retrospective study, including all the first episode of peritonitis in incident PD patients from the period of January 2013 to October 2017. Primary aim of the study was to identify the incidence of secondary peritonitis diagnosed by imaging of abdomen (defined as positive scan finding of intraabdominal lesions) in PD patients with peritonitis. Secondary outcomes were predictors for secondary peritonitis analyzed by multivariable logistic regression.

Results
There were total 527 incident PD patients during the study period. Of these, 153 patients (29%) developed at least one episode of peritonitis. The mean age of patients with peritonitis was 57.7 ± 3.4 years, 49 % were male, and 52% had diabetes mellitus. Out of 153, 78 patients (51%) underwent diagnostic imaging of abdomen to look for secondary peritonitis. Majority of them had contrast enhanced computed tomography (CT) scan (95%) and the remaining had non-contrast CT scan or ultrasound of abdomen. Of 78 patients who underwent scan, 12 patients (16%) were reported to have intra-abdominal lesions (secondary peritonitis) including colitis (n=2), pancreatitis (n=1), cholecystitis (n=4), appendicitis (n=1), intestinal obstruction (n=2), liver abscess (n=1), gastric cancer (n=1). According to the causative micro-organisms, the positive scan finding of intra-abdominal lesions was more commonly observed in Gram-negative peritonitis (n=7, 58%), followed by fungal/mycobacterial peritonitis (n=2, 17%), Gram-positive peritonitis (n=2, 17%), polymicrobial peritonitis (n=1, 8%), but none (0%) in culture negative peritonitis. Among patients with Gram-negative peritonitis who underwent the imaging of abdomen, only 12% (7/58) were reported to have intra-abdominal lesions. In multivariable logistic regression, the presenting symptoms including fever (odds ratio (OR) 1.51, 95% confidence interval (CI) 0.40 – 5.68), abdominal pain (OR 1.08, 95% CI 0.24 -1.78), presence of cloudy of effluent (OR 0.66, 95% CI 0.19 -2.29), hypotension on presentation (OR 3.61, 95% CI 0.75 -17.46) or effluent white cell counts on presentation (OR 0.99, 95% CI 0.93 -1.05) were not significantly associated with secondary peritonitis.

Conclusion
A considerable number of patients underwent imaging of abdomen during peritonitis regardless of causative organisms, only a few of them had intra-abdominal lesions. Future prospective study is needed to guide the role of imaging in PD patients during peritonitis.
P1227SURVIVAL OF PATIENTS TRANSFERRED FROM HEMODIALYSIS (HD) TO CHRONIC AMBULATORY PERITONEAL DIALYSIS (CAPD) DUE TO POOR ARTERIOVENOUS (AV) ACCESS
Authors: Qayyum Ahad 
Published: June 2020

Abstract

Background and Aims
This study was carried out to ascertain the 6 month survival of patients who were transferred from hemodialysis to peritoneal dialysis due to poor vascular access at tertiary care facility in Pakistan. PD remains an under-utilized and unpopular modality of renal replacement therapy. One of the major reasons for its unpopularity remains poor patient selection. Furthermore PD is used as a last resort when AV access for HD becomes impossible in Pakistan.

Method
This study was carried out over a 4 year period. All patients transferred from hemodialysis onto peritoneal dialysis were included in the study. A total of 23 patients of Pakistani decent were switched to peritoneal dialysis from hemodialysis because of poor AV access. All patients included in the study had undergone venograms and consultation with vascular surgeons to confirm that AV access henceforth was inadequate for hemodialysis to continue. After placement of the peritoneal dialysis catheter a 2 week rest period was given to each patient before CAPD was initiated. The 6 month survival of each patient from the point of being transferred to CAPD was noted.

Results
The mean age of patients included in the study was 58 years. 80% of the participants were known to have diabetes mellitus. 15 out of the 23 patients included in the study died within 6 months of starting peritoneal dialysis. 12 out of the 23 patients included had difficulties in achieving either required ultrafiltration or KT/V despite ensuring correct catheter placement and following standard CAPD good practices.

Conclusion
Patients being switched from hemodialysis to CAPD due to poor AV access carry a greater than 50% 6 month mortality rate. In a country where PD struggles to gain popularity, we need to be very selective in starting patients on this modality with a realization that PD cannot be kept as a last resort rather should be advocated as the first choice therapy. Only then can the true benefits of PD be exhibited.
P1236EFFECTS OF SACUBITRIL-VALSARTAN IN HEART FAILURE WITH PRESERVED EJECTION FRACTION IN PATIENTS UNDERGOING PERITONEAL DIALYSIS
Authors: Fu Sha , Xu Zhenjian , Lin Baojuan , Chen Junzhe , Huang Qiuyan , Xu Yanchun , Xu Anping , Chen Yangxin , Tang Ying 
Published: June 2020

Abstract

Background and Aims
Angiotensin receptor–neprilysin inhibitor (ARNI) sacubitril–valsartan is a landmark drug in heart failure with reduced ejection fraction (HFrEF), however, it remains unclear in patients with heart failure with preserved ejection fraction (HFpEF), especially the data of ARNI treatment on peritoneal dialysis (PD) patients with HFpEF are lacking. The present study was designed to determine the efficacy and safety of sacubitril–valsartan in patients with HFpEF undergoing peritoneal dialysis.

Method
We assigned end stage renal disease (ESRD)patients, receiving peritoneal dialysis for 3 months, with New York Heart Association (NYHA) class II to IV heart failure, left ventricular ejection fraction ≥ 50%, and elevated level of N-terminal pro–B-type natriuretic peptide (NT-proBNP) to receive sacubitril/valsartan treatment. Patients were regularly followed up after medication treatment. Wilcoxon matched-pair signed-rank (2 samples) tests were applied to investigate the alterations in Clinical and biochemical parameters as the efficacy before and after taking sacubitril–valsartan, and safety was also assessed.

Results
Twenty-one patients were recruited in this study. Compared with baseline levels, NT-proBNP levels (p=0.002) and heart rate (p=0.031) were markedly decreased after treatment with sacubitril/valsartan, signs and symptoms of heart failure (21/21 versus 15/21, p=0.021) and NYHA classification were notably improved after 3-12 months follow-up.

Conclusion
The present data suggested that sacubitril/valsartan treatment in the patients with HFpEF undergoing peritoneal dialysis was effective and safe, which is the first study about sacubitril/valsartan treatment for the PD patients with HFpEF, and it may bring the hope for these patients due to no other effective methods at present.
P1239SHORT- AND LONG-TERM OUTCOME OF END-STAGE RENAL DISEASE PATIENTS WITH ACUTE MYOCARDIAL INFARCTION
Authors: Kida Hirota , Hikoso Shungo , Sunaga Akihiro , Bolrathanak Oeun , Kojima Takayuki , Dohi Tomoharu , Kitamura Tetsuhisa , Okada Katsuki , Suna Sinichiro , Nakatani Daisaku , Mizuno Hiroya , Sakata Yasushi 
Published: June 2020

Abstract

Background and Aims
End-stage renal disease (ESRD) patients frequently have the coronary artery disease. However, the short- and long-term outcome of ESRD patients with acute myocardial infarction (AMI) is little known. The aim of this study was to clarify it.

Method
Using the database of the Osaka Acute Coronary Insufficiency Study (OACIS), 8702 consecutive AMI patients (male: 75.2%, mean age: 66.9±12.2yrs) from 2002 to 2013 were analyzed. We classified these patients into two groups, those with ESRD [ESRD group (n=271)] and without ESRD [No-ESRD group (n=8431)] and examined in-hospital or long-term all-cause mortality. ESRD was defined as eGFR&lt;15ml/min/1.73m2.

Results
ESRD group had higher frequency of diabetes (59.3% vs 37.8%, p&lt;0.01), hypertension (90.1% vs 63.3%, p&lt;0.01), Killip class≧2 (40.1% vs 21%, p&lt;0.01), multi-vessel disease (69.3% vs 50.8%, p&lt;0.01), and lower frequency of peak CK&gt;3000 (21.7% vs 32.4%, p&lt;0.01) than No-ESRD group. Mean follow-up period was 1041±721 days. In hospital mortality of ESRD group was 27% and No-ESRD group 7.2%. In patients who discharged alive (8027 patients), 1-year mortality of ESRD group was 12.2% and No-ESRD group 3.3%, 3-year mortality of ESRD group was 29.3% and No-ESRD group 8.7%. Kaplan-Meier analysis revealed that the all-cause mortality (log-rank p&lt;0.01) was significantly higher in ESRD group than No-ESRD group. In ESRD patients who discharged alive (203patients), Cox univariate analysis after multiple imputation revealed that peak CK&gt;3000 was significantly associated with an increased risk of mortality (Hazard ratio 2.67, 95% confidence interval 1.18to 6.07, p=0.031).

Conclusion
In patients with AMI, ESRD was significantly associated with worse short- and long-term outcome, suggesting that careful treatment might be required in ESRD patients with AMI, especially had peak CK&gt;3000.
P1243ABSOLUTE BLOOD VOLUME VARIATIONS INFLUENCED BY DIALYSATE TEMPERATURE DURING HAEMODIALYSIS
Authors: Álvarez Nadal Marta , Martin Irene , Viera Ramírez Elizabeth , Fernandez Lucas Milagros 
Published: June 2020

Abstract

Background and Aims
Intradialytic hypotension is a common complication in haemodialysis. Vascular refilling occurs to preserve haemodynamic stability. Recent studies report a feasible and noninvasive method to determine absolute blood volume, which would allow us to estimate vascular refilling during haemodialysis. During years, it has been proposed that lowering the dialysate temperature could improve intradialytic hypotension outcomes in patients undergoing chronic haemodialysis. The objective of this study is to analyze if lowering dialysate temperature modifies variations in absolute blood volume during haemodialysis.

Method
The study was performed in 51 patients under haemodialysis treatment. During two different sessions, relative blood volume was assessed using dialysate temperatures of 35.5ºC (cool dialysate) and 36.5ºC (neutral dialysate). Absolute blood volume and vascular refilling were calculated using Kron et al methodology (Hemodial Int. 2016;20(3):484–91). Intradialytic hypotension was defined as a systolic blood pressure below 85 mmHg or a drop of pressure above 20 mmHg accompanied by symptoms. Statistical analysis was performed using paired t-Test or Wilcoxon rank sum.

Results
31 episodes of intradialytic hypotension were observed, 14 under cool dialysate and 26 during neutral dialysate. We did not found statistically differences in absolute blood volume or in refilling volume between cool and warm dialysate temperature. In the group of patients with intradialytic hypotension (Table 1) we observed lower drop in absolute blood volume in the 35.5ºC dialysate group (0.59 L) versus 36.5ºC group (0.72 L). Although no statistically significant differences were found in vascular refilling volumes, when cool dialysate was used refilling tended to be higher.

Conclusion
It seems that in selected groups of patients the use of cool dialysate could improve absolute blood volume stability during HD treatments, although further studies are needed.
P1244MILD DIFFERENCES IN CARDIAC CALCIFICATION BETWEEN WILD TYPE AND SCLEROSTIN KNOCKOUT MICE WITH CKD
Authors: De Maré Annelies , D'Haese Patrick , Verhulst Anja 
Published: June 2020

Abstract

Background and Aims
Ectopic soft tissue calcifications, especially cardiovascular calcifications, are frequently observed in patients with chronic kidney disease (CKD) and are associated with increased morbidity and mortality. Sclerostin, a well-known inhibitor of bone formation, shows significantly increased serum levels in CKD patients. Since the process of ectopic calcification shares many similarities with physiological bone formation, we investigated a possible role for sclerostin in ectopic calcification development.

Method
CKD was induced in wild type (WT) (n=21) and sclerostin knockout (Sost ko) mice (n = 21), both on a C57Bl6/J background, by the alternate administration of a 0.30% and 0.15% adenine supplemented diet, containing 1% phosphate. A normal renal function control group receiving standard mouse chow (WT C57Bl6/J n = 8) was also included in the study. Serum creatinine and phosphate levels were measured at the start and end of the study to assess CKD development. At sacrifice, the calcium content of the kidneys, heart and aorta was determined by flame atomic absorption spectrometry.

Results
The adenine-supplemented diet led to a clear induction of CKD in both the Sost ko and wild type mice, as reflected by increased serum creatinine (0.38 ± 0.09 mg/dL in control mice vs 0.65 ± 0.18 mg/dL in adenine-exposed mice, p&lt;0.0001) and phosphate levels (9.12 ± 1.16 mg/dL in control mice vs 19.03 ± 3.11 mg/dL in adenine-exposed mice, p&lt;0.0001). The Sost ko and WT mice receiving the adenine diet, developed the same degree of renal failure, since there were no differences in serum levels of creatinine (p=0.0507) and phosphate (p=0.4890). Significantly higher amounts of calcium were measured in the kidney (0.05 ± 0.01 mg/g wet tissue vs 3.70 ± 2.00 mg/g wet tissue, p&lt;0.0001) and the heart (0.03 ± 0.01 mg/g wet tissue vs 0.07 ± 0.04 mg/g wet tissue, p&lt;0.0001) of adenine-exposed mice, compared to mice receiving the control diet. Furthermore, Sost ko mice had a significantly higher calcium content in the heart compared to the WT mice with renal failure (0.05 ± 0.03 mg/g wet tissue in WT mice vs 0.08 ± 0.05 mg/g wet tissue in Sost ko mice, p = 0.0029). No differences were observed in aortic calcium content between control mice and mice with renal failure.

Conclusion
In this study we managed to develop a mouse model of CKD-induced soft tissue calcification in the heart and kidneys of the animals, however no calcifications developed in the aorta. The higher calcium content that was observed in the heart of Sost ko mice compared to WT mice, might be an indication of a protective function of sclerostin during ectopic cardiac calcification
P1245AORTIC ARCH CALCIFICATION AND PROGNOSIS IN HEMODIALYSIS PATIENTS
Authors: Hashiba Toyohiro , Honda Tomoko , Kishi Satoru , Takenaka Yuto , Furuse Satoshi , Nishio Kyosuke , Masaki Kazunobu , Kano Tatsuya , Mise Naobumi 
Published: June 2020

Abstract

Background and Aims
Aortic arch calcification (AAC) is associated with poor survival in dialysis patients, but long-term prognosis has not been examined well.

Method
In the present study, we investigated the prognostic impact of AAC among 321 chronic hemodialysis patients (211 males, 64±11 ages, dialysis history 10±8 years). ACC in chest X-ray was evaluated in 2012 and the patients were followed up for 7 years. The degree of AAC was classified into 4 categories as follows: Grade 0, no visible calcification; Grade 1, small spots of calcification or single thin calcification of the aortic knob; Grade 2, one or more areas of thick calcification; and Grade 3, circular calcification of the aortic knob.

Results
Calcification gravity was Grade 0 in 88 patients (27%), Grade 1 in 145 (45%), Grade 2 in 54 (17%) and Grade 3 in 34 (11%). All-cause mortality was significantly worse in patients with higher AAC grade (Grade 0: 19% (n=17), Grade 1: 35% (n=51), Grade 2: 46% (n=25), Grade 3: 71% (n=24); p &lt; 0.0001). Univariate analysis showed AAC grade, age, cardiothoracic ratio, ischemic heart disease, cerebral vascular disease, albumin, hemoglobin, C-reactive protein and use of non-Ca phosphorus binders were significantly associated with all-cause mortality. In multivariate analysis, Grade 3 AAC, age and ischemic heart disease were independent risk factors for all-cause mortality.(Figure)

Conclusion
In our dialysis patients, higher gravity of AAC was independently associated with all-cause mortality. Gravity of AAC in chest X-ray is useful to predict prognosis of dialysis patients.
P1246CEREBRAL TISSUE REGIONAL OXYGEN SATURATION AND BLOOD PRESSURE IN HEMODIALYSIS PATIENTS
Authors: Spanos Georgios , Paschou Styliani , Dontsios Christos , Fragkidis Stylianos , Bantis Christos , Armentzoiou Livia Karmen , Tsantekidou Ellada , Bamichas Gerasimos 
Published: June 2020

Abstract

Background and Aims
Patients undergoing hemodialysis (HD) often develop cerebral disease complications. Cerebral tissue regional oxygen saturation (rSO2) through near-infrared spectroscopy (NIRS) is a non-invasive method for cerebral tissue oxygenation monitoring. The aim of the study was to investigate the relationship between rSO2 and hemodialysis in stable HD patients. Additionally, we wanted to investigate how blood pressure during HD is associated with rSO2.

Method
This is a single centre cross-sectional study in clinically stable HD patients. Cerebral rSO2 was monitored at the forehead 10min before, during and 10min after HD, using an INVOS 5100C device (Medtronic, United Kingdom).

Results
Thirty-nine stable HD patients (23 men and 16 women; mean age, 62.4 ± 14.6 years were recruited. Dialysis vintage was 65.7 ± 72.1 months, 9 patients had diabetes mellitus, 12 had vascular disease while 14 were smokers. The baseline rSO2 levels (49.6±9.1 %) were significantly lower in HD patients compared with historic results on healthy subjects. We found no difference in rSO2 results in patients with diabetes mellitus, vascular disease or smoking. Although we found a decrease (figure) in rSO2 when patients start dialysis (10min before vs 10min after starting dialysis 49.6±9.1 vs 48.1±9.9 %, p=0.021) rSO2 value returned to baseline after dialysis (10min before vs 10min after dialysis 49.6±9.1 vs 49.9±5.9 %, p=ns. Systolic blood pressure scientifically dropped during the first hour of dialysis (146.7 ± 21.1 vs 137.3 ± 24.6, p=0.03) and systolic blood pressure drop correlated with rSO2. Three patients developed hypotensive episodes requiring iv fluids but these hypotensive episodes had no correlation with rSO2 variations.

Conclusion
Cerebral rSO2 decreases while patients are on dialysis but return to baseline after dialysis. Blood pressure variations correlate with rSO2 levels but rSO2 do not forecast hypotensive episodes on dialysis.
P1266SERUM MALONDIALDEHYDE-MODIFIED LOW-DENSITY LIPOPROTEIN LEVEL IS A RISK FOR AORTIC STIFFNESS IN MAINTENANCE HEMODIALYSIS PATIENTS
Authors: Hou Jia-Sian , Lu Chia-Wen , Hsu Bang-Gee 
Published: June 2020

Abstract

Background and Aims
Circulating oxidized malondialdehyde LDL (MDA-LDL) induced macrophage apoptosis, the release of higher levels of matrix metalloproteinases and TNF-α, therefore, act as a marker of oxidative stress and are associated with atherosclerotic cardiovascular diseases. We evaluated the association between serum MDA-LDL levels and aortic stiffness in patients with hemodialysis (HD).

Method
A total of 155 patients with HD were enrolled in this study. Carotid-femoral pulse wave velocity (cfPWV) value was measured by a validated tonometry system (SphygmoCor). Patients with cfPWV &gt;10 m/s were used to define the aortic stiffness group, while values ≤ 10 m/s were regarded as the control group, according to the ESH-ESC 2013. Serum MDA-LDL levels were measured using a commercial enzyme-linked immunosorbent assay.

Results
68 patients (43.9%) had aortic stiffness and higher percentages of diabetes (p &lt; 0.001), hypertension (p = 0.017), and had older age (p = 0.038), higher systolic blood pressure (P = 0.021), serum MDA-LDL level (p &lt; 0.001) compared to subjects with control group. After adjusting for factors significantly associated with aortic stiffness by multivariable logistic regression analysis revealed that serum MDA-LDL levels (odds ratio (OR): 1.014, 95% confidence interval (CI): 1.007–1.021, p &lt; 0.001), diabetes (OR: 2.893, 95% CI: 1.300–6.437, p = 0.009), and hypertension (OR: 2.408, 95% CI: 1.066–5.436, p = 0.034) were the independent predictors of aortic stiffness in HD patients. Multivariable forward stepwise linear regression analysis also showed that serum logarithmically transformed MDA-LDL level (log-MDA-LDL, β = 0.404, adjusted R2 change = 0.265, p &lt; 0.001), diabetes (β = 0.233, adjusted R2 change = 0.055, p = 0.001), and hypertension (β = 0.132, adjusted R2 change = 0.014, p = 0.048) were the independent predictors of cfPWV values in HD patients. The area under the receiver-operating characteristic (ROC) curve predicting aortic stiffness by serum MDA-LDL level in HD patients was 0.721 (95% CI: 0.643-0.790, p &lt; 0.001).

Conclusion
In this study, high serum MDA-LDL level was positively associated with cfPWV values and thus was related to aortic stiffness in HD patients.
P1268MIXING ARTIFICIAL INTELLIGENCE AND CLINICAL OUTREACH TO REDUCE RISK OF FLUID OVERLOAD HOSPITALIZATION IN PATIENTS WITH END-STAGE RENAL DISEASE
Authors: Willetts Joanna , Long Andrew , Rivenbark Amanda , Hymes Jeffrey , Usvyat Len A , Chaudhuri Sheetal , Maddux Franklin 
Published: June 2020

Abstract

Background and Aims
Fluid overload is associated with increased morbidity and mortality in hemodialysis (HD) patients. In-patient treatment of fluid overload was previously estimated to occur at a rate of 13.7 episodes/100 patient-years and estimated to cost $266 million over a 2.5-year period (Arneson 2010). We developed a model to predict which patients treated at a large dialysis provider are at imminent risk of hospitalization due to fluid overload and may benefit from additional interventions.

Method
We built a machine learning (ML) model using clinical and HD treatment data to identify which patients have the highest risk of hospital admission for fluid overload within 7 days of the current outpatient dialysis treatment. Next, we partnered with a team of remote nurses who perform chart reviews, needs identification, and communication outreach when warranted with the goal to reduce hospital admissions. Patients were identified from the ML model and displayed in a worklist on a computer dashboard, ranked by their risk score on that day. The computer dashboard also contained relevant clinical information to enhance the patient review process.

Results
Model results from prospective data (&gt; 9M predictions in a two-month period) show the model has an area under the receiver operating curve (AUROC) of 0.79, sensitivity of 65%, and specificity of 78% (Figure 1). Weekly chart reviews increased 18% from 26 weeks before the pilot compared to 14 weeks after the pilot began; total communication outreach increased 31% across the same time frame. Further, the nurses using the dashboard anecdotally reported that the dashboard reduced the amount of time required to decide to perform a chart review or perform communication outreach.

Conclusion
Our predictive model successfully identifies patients at high risk for fluid overload hospital admissions. Understanding the nurse workflow, how they manage this patient population, and which components can be made more efficient enabled them to increase the number of chart reviews and communication outreach.