bluuebunny/crossref_metadata_2025_split huggingface dataset:
SO055PROBIOTIC BIO-THREE DECREASES SERUM PHOSPHATE LEVELS WITH INVOLVEMENT OF BACTERIA IN GUT MICROBIOMA IN HEMODIALYSIS PATIENTS: A PROSPECTIVE, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTOLLED STUDY
Authors: Ogawa Tetsuya , Hosoda Yumi , Horimoto Ai , Nishizawa Yoko , OMAE KIYOTSUGU , Nagano Nobuo 
Published: June 2020

Abstract

Background and Aims
Recent studies revealed that the importance of the gut microbioma in the development and progression of CKD. Dysbiosis of the intestinal microbiota increases uremic toxin, which damage the epithelial tight junctions and increase the permeability of the intestinal wall via endotoxemia and systemic inflammation. Some articles reported that probiotics reduced the uremic toxin and decreased inflammation biomarkers in CKD patients, while others reported no remarkable changes. Meanwhile, we have already reported that oral administration of Bifidobacterium longum in a gastro-resistant seamless capsule decreases serum phosphate levels in patients receiving haemodialysis. The aim of this study is to evaluate the efficacy of probiotics by changes of serum data, including inflammation and intestinal flora in patients receiving hemodialysis.

Method
A 6-month prospective, randomized, double-blind, placebo-controlled study was conducted at three hemodialysis centers. As probiotic therapy, of three-combination probiotics (Bio-Three) tablets, each containing 2 mg of lactomin (Streptococcus faecalis T-110), 10 mg of Clostridium butyricum TO-A, and 10 mg of Bacillus mesentericus TO-A, were used. The patients receiving hemodialysis were randomly assigned to the Bio-Three group (n=37) and the placebo group (n=36). In both the Bio-Three group and the placebo group, patients orally received 6 tablets 3 times daily. We evaluated the effect of probiotic on the ratio of CRP to albumin as an inflammatory biomarker, other serum data and gut microbioma before and 6 month after the start of treatment. The gut microbioma composition was analyzed by a 16s rRNA gene-based sequencing protocol.

Results
The ratio of CRP to albumin did not change before and after treatment in both groups. The serum phosphate levels in the Bio-Three group significantly decreased after 6-month treatment, while did not change in the placebo group. In a 16s rRNA gene-based sequencing protocol analysis, the ratio of Firmicutes, Actinomycetales and Neisseriaies significantly changed after 6 month treatment in the only probiotic group. Meanwhile, serum phosphate levels were positively correlated with the number of genus Haemephilus and gunus Neisseria in the only probiotic group. Furthermore, serum phosphate levels were negatively correlated with the number of genus Bifidobacterium in the only probiotic group.

Conclusion
In this study, three-combination probiotics did not decrease systemic inflammation in hemodialysis patients. Meanwhile, three-combination probiotics might decrease serum phosphate levels, and the specific bacteria in the gut microbioma might contribute to the decrease of serum phosphate levels.
SO057BETA-BLOCKERS ARE ASSOCIATED WITH REDUCED MORTALITY IN PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION AND ADVANCED CHRONIC KIDNEY DISEASE: COHORT STUDY
Authors: Fu Edouard L , Uijl Alicia , Dekker Friedo W , Lund Lars H , Savarese Gianluigi , Carrero Juan Jesus 
Published: June 2020

Abstract

Background and Aims
Beta-blockers reduce mortality and morbidity in patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, patients with advanced chronic kidney disease (CKD) were underrepresented in landmark trials. We evaluated if beta-blockers are associated with improved survival in patients with HFrEF and advanced CKD.

Method
We identified 3906 persons with an ejection fraction &lt;40% and advanced CKD (eGFR &lt;30 mL/min/1.73m2) enrolled in the Swedish Heart Failure Registry during 2001-2016. The associations between beta-blocker use, 5-year all-cause mortality, and the composite of time to cardiovascular (CV) mortality/first HF hospitalization were assessed by multivariable Cox regression. Analyses were adjusted for 36 variables, including demographics, laboratory measures, comorbidities, medication use, medical procedures, and socioeconomic status. To assess consistency, the same analyses were performed in a positive control cohort of 12,673 patients with moderate CKD (eGFR &lt;60-30 mL/min/1.73m2).

Results
The majority (89%) of individuals with HFrEF and advanced CKD received treatment with beta-blockers. Median (IQR) age was 81 (74-86) years, 36% were women and median eGFR was 26 (20-28) mL/min/173m2. During 5 years of follow-up, 2086 (53.4%) individuals had a subsequent HF hospitalization, and 2954 (75.6%) individuals died, of which 2089 (70.1%) due to cardiovascular causes. Beta-blocker use was associated with a significant reduction in 5-year all-cause mortality [adjusted hazard ratio (HR) 0.86; 95% confidence interval (CI) 0.76-0.96)] and CV mortality/HF hospitalization (HR 0.87; 95% CI 0.77-0.98). The magnitude of the associations between beta-blocker use and outcomes was similar to that observed for HFrEF patients with mild/moderate CKD, with adjusted HRs for all-cause mortality and CV mortality/HF hospitalization of 0.85 (95% CI 0.78-0.91) and 0.88 (95% CI 0.82-0.96), respectively.

Conclusion
Despite lack of trial evidence, the use of beta-blockers in patients with HFrEF and advanced CKD was high in routine Swedish care, and was independently associated with reduced mortality to the same degree as HFrEF with moderate CKD.
SO065TYPE OF EXERCISE INTERVENTION AND MUSCLE FUNCTIONS IN CHRONIC HEMODIALYSIS PATIENTS
Authors: Rogowski Łukasz , Dziubek Wioletta , Mariusz Kusztal , Bulinska Katarzyna , Gołębiowski Tomasz , Klinger Marian , Magdalena Krajewska , Wozniewski Marek 
Published: June 2020

Abstract

Background and Aims
Decreased exercise capacity due to muscle weakness and exercise intolerance reduces the ability to perform activities of daily living in patients with end-stage kidney disease. Data on exercise type in dialysis population and its muscle effects are scarce. We aimed to determine the impact of training type (strength, resistance and mixed) on cardiovascular performance, muscle function (strength-speed parameters, electrophysiological function of muscles) in patients on hemodialysis maintenance.

Method
Eighty six dialysis patients underwent claster randomisation and were assigned to an exercise intervention groups: A - controlled endurance training during haemodialysis using rotors (MOTOmed letto2), B - controlled force training (resistance), C - Tai Chi training on non dialysis days. Intervention lasted 6 months, 3 times a week (A, B) and 2 times a week (C) for 60 minutes. The outcome measures were spiroergometry (VO2/VO2max), strength of the lower limbs and electromyographic examination. Values at the baseline and 6 months later were compared.

Results
45 patients completed intervention period and were analysed. Mean age in group A was 64±12y (n-16), in B was 60,5±10y. (n-15) and in C – 68,5±9y. (n-14). Patients did not differ markedly between groups in term of sex, BMI, dialysis vintage and comorbidities.
After 6 months of training, VO2 and VO2max increased significantly only in group B (resistance training) Δ12.7 % for VO2 and 12.9% for VO2max but not in A and C group (Fig.1.). Regarding force torque of quadriceps (ΔPT) in isometric conditions the highest peak values were measured in group B (resistance training), namely increase by 13.6% (p=0.0004) in right (R) and 14% (p&lt;0.0001) in left (L); in group A (endurance) 3.2% in R and 3.7% in L; in group C (Tai Chi group) by 7% (p&lt;0.05) in R and 6.8% (p&lt;0.05) in L. In terms of changes in electrophysiological function of right (QEMG_R) and left (QEMG_L) quadriceps, there were increases: for group A by 10.5% (p&lt;0.0001) and 9.6% (p&lt;0.05); B 9.7% (p=0.0002) and 20.1% (p=0.0001); for C by 4.5% and 6.2% for R and L, respectively (Fig.2).
In groups B and C significant increases in static force moments (Δ%PT) was associated with increases in electrophysiological action (Δ%QEMG), but in group A increase in EMG activity did not correspond with rise in muscle force (Fig.2).

Conclusion
Differences in muscle strength and functions were observed after 6 months of various type of exercise intervention in dialysis patients. Resistance training during dialysis showed the largest improvement in cardiorespiratory function and isometric leg muscle strength.
SO07118F-SODIUM FLUORIDE POSITRON EMISSION TOMOGRAPHY AND BONE HISTOMORPHOMETRY - COMPARISON BETWEEN ONLY BONE TURNOVER -BASED AND EXPERT EVALUATION -BASED CLASSIFICATION OF RENAL OSTEODYSTROPHY
Authors: Aaltonen Louise Caroline , Koivuviita Niina , Seppänen Marko , Burton Inari , Kröger Heikki , Metsarinne Kaj Peter 
Published: June 2020

Abstract

Background and Aims
The diagnosis and the differentiation of renal osteodystrophy (ROD) are challenging. Bone biopsy is the golden standard, but it is invasive and not available in every center.
Bone turnover rate is defined by bone formation rate and/or activation frequency. Adynamic bone disease is defined as low turnover bone with reduced osteoblast- and osteoclast activities. Hyperparahyreoid bone disease or osteitis fibrosa is defined as high turnover bone with osteoclast- and osteoblast activities and fibrosis.
18F- Sodium Fluoride positron emission tomography (18F-NaF PET) is a noninvasive imaging technique that allows assessment of regional bone turnover.
The aim was to assess how well bone turnover –based classification of ROD correlates with the classification determined by an expert histomorphometrist (HK), and how these correlate with 18F-NaF PET analysis

Method
A total of 24 dialysis patients underwent a 18F-NaF PET scan. Fluoride activity was measured at the anterior iliac crest and in the lumbar region. An iliac crest bone biopsy was obtained within 4 weeks from the PET-scan. The diagnosis of bone histomorphometry was determined based on turnover-mineralization-volume (TMV) classification. Firstly, bone turnover was assessed using bone formation rate and activation frequency. Secondly, also other histomorphometric parameters (eg. osteoid volume, osteoid surface, resorption surface, mineralized surface, osteoblast and osteoclast surfaces and peritrabecular fibrosis) were also taking into account for classification of ROD by a histomorphometrist.

Results
Based on bone turnover parameters only, 12% of the patients had high turnover and 64% low turnover. When the diagnosis of renal osteodystrophy was made by a histomorphometrist, 40% had hyperparathyreoid bone/osteitis fibrosa and 24% adynamic bone disease or ostemalasia.
18F-NaF PET´s sensitivity to recognize hyperparathyreoid bone disease was 80% end specificity 100% (cut-of value 0.055).18F-NaF PET´s sensitivity to recognize adynamic bone disease was 100% and specificity 61% (cut-of value of fluoride-activity 0.038)

Conclusion
18F-NaF PET works well as a diagnostic tool, when the diagnosis of ROD is based on the histopathological evaluation. It remains unknown how variations in normal bone turnover rate can be detected in CKD patients by 18F-NaF PET and if treatment decisions of ROD can be made only based on bone turnover.
SO072INCIDENCE OF FRACTURES BEFORE AND AFTER DIALYSIS INITIATION AMONG INCIDENT DIALYSIS PATIENTS
Authors: Iseri Ken , Carrero Juan Jesus , Evans Marie , Felländer-Tsai Li , Berg Hans , Runesson Björn , Stenvinkel Peter , Lindholm Bengt , Qureshi Abdul Rashid Tony 
Published: June 2020

Abstract

Background and Aims
The incidence of fractures is markedly higher in dialysis patients than in pre-dialysis patients, but it is not clear to what extent the initiation of dialysis as such is associated with accelerated fracture incidence or if fracture rates are already increasing prior to dialysis start among incident dialysis patients. Here we investigated the temporal pattern of occurrence of a first major osteoporotic fracture (MOF) among incident dialysis patients in the pre-dialysis period and in the period following dialysis initiation.

Method
We analyzed data from Swedish Renal Registry (SRR) and identified 9041 incident dialysis patients (2005 -2015; age 67 years, 67% men). We identified all first MOF (MOFfirst) in hip, spine, humerus and forearm during 12 months before and after dialysis initiation. Using flexible parametric hazard models and Fine-Gray analysis accounting for competing risk of death and renal transplantation, we estimated adjusted fracture incidence rates and predictors of MOFfirst.

Results
During the whole follow-up period, there were 361 fractures including 196 hip fractures. The crude incidence rate of MOFfirst (n=157) before dialysis initiation was 17/1000 patient-years and after initiation of dialysis the incidence rate of MOFfirst increased to 24/1000 patient-years. Overall the adjusted MOFfirst incidence rates increased from 6 months before initiation of dialysis, fluctuated, and stabilized at a higher rate than that of the baseline rate after 12 months. The adjusted hip fracture rate rose steeply 3 months before dialysis initiation, declined 3 months after dialysis initiation, fluctuated, and then became stabilized. On the contrary, the adjusted incidence rates of other fractures, i.e., non-hip fractures, appeared to be stable all the time, before as well as after initiation of dialysis. Female gender, higher age and previous history of MOF had a negative impact on fracture incidence rates before and after dialysis initiation.

Conclusion
We conclude that the incidence of MOFfirst is increasing already from 6 months prior to dialysis initiation among incident dialysis patients, and that there is a further increase following dialysis initiation. For hip fracture, which was the most common MOF, the temporal pattern of incidence rates was compressed to a high risk period lasting from 3 months before to 3 months after dialysis initiation, underlining the need of increased attention to prevent hip fractures in incident dialysis patients during this critical period.
SO073IRON-RELATED PARAMETERS AND ANTI-ANAEMIC THERAPY IN HAEMODIALYSIS PATIENTS TREATED WITH SUCROFERRIC OXYHYDROXIDE: A 1-YEAR RETROSPECTIVE EUROPEAN CLINICAL DATABASE (EUCLID) ANALYSIS
Authors: Carey-George Jayne , Gurevich Konstantin , Ramos Sanchez Rosa , Chazot Charles , Ferreira Anibal , Di Benedetto Attilio , Feuersenger Astrid , Wolf Melanie , Arens Hans-Juergen , Walpen Sebastian , Stuard Stefano 
Published: June 2020

Abstract

Background and Aims
This retrospective analysis of data from the European Clinical Database (EuCliD®) evaluated changes in iron-related parameters and use of concomitant anti-anaemic therapies in European haemodialysis (HD) patients treated with sucroferric oxyhydroxide (SFOH). Previous Phase 3 clinical studies and non-clinical studies have indicated that there is minimal iron absorption from SFOH. This study aimed to evaluate the changes in iron-related parameters among patients treated with SFOH in the real-world setting.

Method
De-identified patient data were extracted from a clinical database (EuCliD®) for adult HD patients newly prescribed SFOH routinely for up to 1 year (1 Jan 2015–1 Jan 2019). Levels of serum ferritin, transferrin saturation (TSAT) and haemoglobin were compared between baseline (BL; 3-month period before starting SFOH) and each quarterly period in the year after starting SFOH treatment (Q1–Q4). Proportions of patients receiving intravenous (IV) iron and erythropoiesis-stimulating agent (ESA) therapies, in addition to their mean weekly doses, during each quarter were recorded.

Results
The cohort included 1,096 patients with recorded SFOH prescriptions (mean age: 60.6 years; 65.8% male). There were small, but significant increases in ferritin from BL to Q1–Q4 (P&lt;0.05 for all periods vs BL). There were also increases in TSAT (P&lt;0.05 at Q1 and Q2 vs BL) and haemoglobin (P&lt;0.001 at Q1 and Q3 vs BL) (Table). During the 1-year SFOH treatment period, the proportion of patients receiving IV iron therapy decreased (P&lt;0.05 at Q2 and Q3 vs BL) and there was a significant reduction in the mean weekly dose of IV iron administered (P&lt;0.05 at Q2 and Q3 vs BL). The use of ESA therapy also declined (P&lt;0.05 at Q3 and Q4) and there was a significant decrease in the mean weekly dose of ESA during the 1-year SFOH follow-up period (P&lt;0.05 for all periods vs BL).

Conclusion
This real-world study showed that SFOH treatment in routine clinical practice for up to 1 year was associated with small increases in iron-related parameters and decreases in the use and mean dose of concomitant anti-anaemic therapies in European HD patients. The results from this study indicate that SFOH treatment may be associated with the reduction in concomitant IV iron and ESA use in HD patients, in line with previous findings from the Phase 3 study.
SO077A PROSPECTIVE RANDOMIZED STUDY ON PRE-EMPTIVE IMMUNOSUPPRESSIVE TREATMENT IN LUPUS NEPHRITIS PATIENTS WITH ASYMPTOMATIC SEROLOGICAL REACTIVATION
Authors: Yap Desmond , Tang Colin Siu On , Chung Ho Yin , Chan Julia , Lo Joseph M W , So Benjamin Y F , Chan Daniel Tak Mao 
Published: June 2020

Abstract

Background and Aims
The optimal management for asymptomatic serological reactivation (ASR) in lupus nephritis (LN) patients remains undefined. Our previous retrospective study suggested that pre-emptive treatment with moderate increase of immunosuppression may reduce subsequent clinical flares.

Method
This prospective study randomized LN patients with ASR (defined as &gt;2-fold increase of anti-dsDNA to &gt;100 IU/mL, with or without change in complement level, and absence of clinical lupus exacerbation) to receive pre-emptive treatment (‘Pre-emptive’ group) or unchanged management (‘Control’ group). Pre-emptive treatment included increasing prednisolone dose to 0.5 mg/kg/D, and the dose of mycophenolate to 1g/D or azathioprine to 75 mg/D, then tapered over 12-16 weeks back to the original dosages.

Results
Thirty-four patients were randomized (17 in each group). Pre-emptive group showed lower anti-dsDNA and higher C3 levels after 12 weeks compared with Controls (90.3±58.3 IU/mL vs. 153.8±92.9 IU/mL, and 98.7±33.4 mg/dL vs. 81.8±26.2 mg/dL, respectively; p&lt;0.001 for both) (Figure 1). Pre-emptive group showed significantly lower incidence rates of all clinical flares and renal flares during subsequent 9 months of follow-up compared with Controls (11.7% vs 47.1%, p=0.01; and 0% vs 17.7%, p=0.03; respectively). Mean time-to-flare was 6.4±4.2 months and 5.2±3.4 months in Pre-emptive and Control groups respectively (p=0.77). There was no clinically significant adverse event.

Conclusion
Our results suggest that pre-emptive moderate increase of immunosuppressive treatment reduces the risk of disease flare in LN patients with ASR and is well tolerated.
SO081LITHIUM EXPOSURE AND OCCURENCE OF CHRONIC KIDNEY DISEASE IN THE IRISH HEALTH SYSTEM: A COHORT STUDY
Authors: Behan Mark , Browne Leonard , Austin Stack 
Published: June 2020

Abstract

Background and Aims
Lithium is implicated as a causative factor in the development and progression of chronic kidney disease (CKD). Few studies have assessed the independent impact of plasma levels and duration of lithium therapy on CKD progression. We examined the influence of lithium on CKD progression in the Irish health system.

Method
We utilised data from the Irish Kidney Disease Surveillance System (IKDSS) to explore associations of lithium levels and duration of exposure with kidney function in a regional cohort. A retrospective cohort study was conducted between 1999 to 2014 from the Midwest Region. All adult patients with lithium levels were identified and followed longitudinally. Kidney function was assessed at baseline and longitudinally using serum creatinine and estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI. Patients with &lt; 2 lithium values, missing data on creatinine were excluded. The index date was the date of the first lithium blood test. Toxicity from lithium was defined as levels &gt;1.2mmol/L as per NICE guidelines while duration of treatment was calculated based on patient –years of exposure as determined by positive blood lithium levels. Relationships between baseline kidney function, lithium levels, duration of exposure and each patients most recent eGFR value on follow up were assessed using multiple linear regression

Results
We identified 1,978 patients exposed to lithium from 1999-2014, mean age was 47.4 (15.6), 45.1% were men, eGFR [median (IQR)] at baseline was 84.4 (32.1) ml/min1.73m and the median duration of exposure was 3.0 years (IQR=4 years). Frequency of lithium testing increased from 1.77 in 1999 to 2.66 in 2014. In multiple linear regression, the final eGFR on follow-up was significantly lower in older patients (-0.48 ml/min/1.73m per year increase in age), P&lt;0.001; in patients with elevated baseline lithium levels (-2.18 ml/min1.73m lower per unit increase), P&lt;0.05, with long duration of exposure (-1.42 ml/min/1.73m lower for each year on lithium), P&lt;0.001, and for patients with low GFR at baseline (P&lt;0.001). Together these variables explained 58% of the variation in the final model.

Conclusion
Both the magnitude of and the duration of lithium exposure are both independently associated with CKD progression among lithium users in the Irish health system. Higher baseline lithium values had a more deleterious impact on kidney function. Continued efforts should be expended in minimising the risks of lithium induced nephrotoxicity through switching to alternatives and dose reduction when over possible.

Funding
This study is funded by the Health Research Board and the Midwest Research and Education Foundation (MKid).
SO085CIRCULATING PCSK9 LEVEL PREDICTS RISK OF CARDIOVASCULAR EVENTS AND DEATH IN HEMODIALYSIS PATIENTS
Authors: Hwang Hyeon Seok , Kim Jin Sug , Kim Yang-Gyun , Lee So-Young , Ahn Shin Young , Lee Hong Joo , Lee Dong-Young , Lee Sang ho , Moon Ju-Young , Jeong Kyung Hwan 
Published: June 2020

Abstract

Background and Aims
Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a promising new target for prevention of cardiovascular (CV) events. However, the clinical significance of circulating PCSK9 is unclear in hemodialysis (HD) patients.

Method
A total of 353 HD patients were prospectively enrolled from June 2016 to May 2018 in a K-cohort. Plasma PCSK9 level was measured at the time of study enrollment. Patients were classified into three groups based on PCSK9 tertile. The primary endpoint was defined as composite of CV event and death from any cause.

Results
Plasma PCSK9 level was positively correlated with total cholesterol level in patients with statin treatment. However, PCSK9 was not related to plasma inflammatory (high-sensitivity C-reactive peptide, monocyte chemoattractant protein-1, interleukin-6) or calcification-related markers (osteoprotegerin and receptor activator of nuclear factor kappa-Β ligand). Multivariate linear regression analysis revealed that baseline statin treatment and serum glucose, albumin, and total cholesterol were independent determinants of circulating PCSK9 levels. In Cox-regression analysis, PCSK9 tertile 3 was associated with a 1.99-fold risk for composite events (95% CI, 1.08–3.66), and it was associated with a 2.26-fold risk for CV events (95% CI, 1.11–4.62) after adjustment for multiple variables. PCSK9 tertile 3 provides additional prognostic power to predict composite events in subgroups with higher levels of high-sensitivity C-reactive peptide and LDL.

Conclusion
In conclusion, higher circulating PCSK9 level independently predicted CV events and death in HD patients. These results suggest the importance of future studies regarding the effect of PCSK9 inhibition on reduction of CV events.