bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1374DEVELOPMENT OF HEMOGLOBIN PREDICTION AND ERYTHROCYTE STIMULATING AGENT RECOMMENDATION ALGORITHM (HPERA) USING RECURRENT NEURAL NETWORK IN END-STAGE KIDNEY DISEASE PATIENTS
Authors: Yoo Tae-Hyun , Yun Hae-Ryong , Chang Jae Hyun 
Published: June 2020

Abstract

Background and Aims
The optimization of anemia management is a challenging task due to the complexities of underlying diseases and heterogeneous responses to erythropoiesis-stimulating agents (ESA) in patients with end-stage kidney disease (ESKD). Recent studies have shown that machine learning (ML) algorithms can be an effective tool to predict hemoglobin (Hb) levels and determine the ESA doses in these patients. However, most of the proposed ML approaches are not designed to handle multivariate longitudinal patient data. Thus, we developed Hb prediction and ESA doses recommendation algorithm (HPERA) using recurrent neural networks (RNN).

Method
A total of 466 participants, who underwent hemodialysis in 7 hospitals in the Republic of Korea, were included in the present study. We selected 15 variables from an extreme gradient boosting (XGBoost) algorithm. The outcome of the prediction algorithm was Hb levels in next month. In the recommendation algorithm, the outcome was the ESA dose for target Hb next month. Among various types of RNN families, gated recurrent units (GRU) were used to build both the prediction and recommendation algorithms. In addition to holding out a separate validation dataset, we used a Gaussian noise layer following each input layer to avoid overfitting. We also performed linear regression, multilayer perceptrons, and extreme gradient boosting with an extensive hyperparameter search to validate our GRU-based prediction algorithm. The performances of each model were evaluated in terms of the mean absolute error (MAE).

Results
The mean age of the study population was 57.8 years, 248 (53.2%) participants are male, and the mean observation period is 30.0 months. The best result of our prediction algorithm in terms of MAE was 0.59 g/dL and was obtained by two stacked GRU layers followed by a single hidden feedforward network with 6-month follow-up patient data. The best recommendation algorithm had 43.2 μg in MAE and this was obtained by one GRU layer followed by two layers of a feedforward network. The HPERA had a lower overall ESA dose (μg/months) [155 (80–240) vs. 140 (70–210), P&lt;0.001], decreased Hb difference (g/dL) [0.8 (0.4–1.4) vs. 0.6 (0.3–1.0), P&lt;0.001)], and had a higher success and a lower failure rates of reaching target Hb compared to those in real practice.

Conclusion
The GRU-based prediction model outperformed previous ML methodologies, though hyperparameter turning was much simpler. Using the HPERA showed the possibility of a reduced amount of ESA, decreased Hb difference, and increased the reaching rate of target Hb levels. Our study revealed a great potential direction of anemia management using ML in ESKD patients.
P1377ANEMIA MANAGEMENT IN DIALYSIS PATIENTS IN SWITZERLAND
Authors: Winzeler Rebecca , Ambühl Patrice Max 
Published: June 2020

Abstract

Background and Aims
Anemia is highly prevalent in dialysis patients and is associated with increased morbidity and mortality. The purpose of the present analysis is to evaluate current anemia management in dialysis patients in Switzerland collected from the Swiss Dialysis Registry (srrqap), which covers all dialysis patients in Switzerland.

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). To calculate survival probabilities, all deaths from incident dialysis patients between 2014 and 2018 were analyzed.
Results: 65 percent of all dialysis patients receive iron and EPO. Regardless of anemia management, 82% of patients reach target hemoglobin levels 10 g/dL. In 18% of patients inadequate management to reach Hb targets may be suspected.
The distribution of iron and EPO substitution is similar in all age groups. However, 26% of the age group 20-44 years receive EPO, but no iron, compared to only 15% in the other age groups.
Survival analysis by Cox regression adjusted for age, Charlson score and treatment modality revealed that patients with Hb levels equal or greater than 11 g/dl have the best survival (reference group). In comparison, patients in the Hb categories below 9, 9-9.9 and 10-10.9 g/dl have an odds ratio of 3.9, 2.0 and 1.3, respectively, to die.

Conclusion
Anemia management to reach Hb target levels following KDIGO guidelines seems to be adequately implemented among dialysis patients in Switzerland. In 18% of patients treatment might be optimized to achieve Hb targets. As expected, patients with Hb levels equal or greater than 11 g/dl have better survival rates compared to patients with lower Hb values.
P1380A SYSTEM FOR FORECASTING OF DRUG DOSAGE FOR ANEMIA CORRECTION IN PATIENTS ON CHRONIC DIALYSIS
Authors: Zinovev Dmitriy , Novitskiy Vladimir , Malkoch Andrey 
Published: June 2020

Abstract

Background and Aims
Anemia is a most common complication of CKD in patients on chronic dialysis. Adequacy of anemia correction directly affects both patient’s life quality and patient’s long-term survival. The most important aspect of anemia correction is drug therapy. In this work, we present a system for forecasting of iron supplements and ESA (Epoetin alfa) dosage, that is based on logical rules and artificial intelligence (AI) models.

Method
As an input dataset, system uses patient’s anthropomorphic parameters, results of laboratory studies, and information on previous drug therapy. The output of the system are dosages of ESA an iron supplements that have to be administered in order to bring the patient’s hemoglobin as close as possible to target range of values (100-120 g/l). The system consists of two sequentially triggering forecasting models (for ESA and for iron supplements), where each model is a combination of logical rules and artificial neural network, that has been trained on a data, collected in more than 20 “Nefrosovet” hemodialysis clinics for the period of 3 years.
The effect of system usage was examined for the group of 356 hemodialysis patients with median follow-up time of 4 month. The primary end-point was a number of patients in target range of hemoglobin values (100-120 g/l).

Results
During the study we determined that as a result of using the dose forecasting system, number of patients in target range of hemoglobin values significantly increased from 239 patients at the beginning of system employment to 266 patients at the end of the study (p=.0318). Furthermore, we observed that there was a concomitant effect of system usage – significant reduction of average monthly ESA dosage from 14300 IU at the beginning of system employment to 13900 IU at the end of the study (p=.0331).

Conclusion
Employment of automated drug dosage forecasting system based on logical rules and AI models, allows to improve the efficiency of anemia correction in hemodialysis patients and reduce the dosage of administered ESA, which, in turn, reduces the risk of possible complications and treatment cost.
P1389MAJOR OSTEOPOROTIC FRACTURES AFTER INITIATION OF DIALYSIS: INCIDENCE, PREDICTORS AND ASSOCIATION WITH MORTALITY
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
Major osteoporotic fractures (MOF) are common in dialysis patients. We investigated incidence, predictors and clinical outcomes associated with first MOF occurring after initiation of dialysis (MOFfirst).

Method
In Swedish Renal Registry of 9714 incident (2005 -2016) dialysis patients (median age 68 years, 67% men), we identified all MOFfirst in hip, spine, humerus and forearm. Using flexible parametric hazard models and Fine-Gray analysis, we estimated incidence, mortality rates and predictors of MOFfirst, and, in time-dependent analysis, risk of all-cause and cardiovascular disease (CVD) mortality following MOFfirst.

Results
During median follow-up of 2.2 years, the crude incidence rate of MOFfirst (n=835) was 24/1000 patient-years (pt-yrs) and that of hip fractures (n=470) 13/1000 pt-yrs. The multivariate-adjusted fracture incidence rates increased gradually after dialysis initiation and were 47% higher among women. Female sex, higher age, presence of comorbidities, and previous history of MOF (MOFprevious) were associated with increased risk for MOFfirst, whereas peritoneal dialysis as compared to hemodialysis was associated with decreased fracture risk. The adjusted fracture incidence rate of MOFfirst during the first 90 days following dialysis initiation was higher in patients with MOFprevious than in those without MOFprevious. MOFfirst independently predicted increased all-cause mortality (sub-distribution hazard ratio, sHR, 1.67(95%CI 1.47-1.91) and CVD-related mortality (sHR 1.49 (95%CI 1.22-1.84). Adjusted mortality rate following hip fractures was higher than for other types of MOF. Spline curves showed that mortality following MOFfirst was highest during the first 6 months of follow-up.

Conclusion
Major osteoporotic fractures are common and associated with increased mortality in incident dialysis patients.
P1393A SYSTEM FOR FORECASTING OF DRUG DOSAGE FOR BONE MINERAL DISORDERS CORRECTION IN PATIENTS ON CHRONIC DIALYSIS
Authors: Zinovev Dmitriy , Novitskiy Vladimir , Malkoch Andrey 
Published: June 2020

Abstract

Background and Aims
Bone and mineral disorders (BMD) is a common complication of CKD in patients on chronic dialysis. Timely and adequate correction of BMD is the most important aspect of patient's treatment. This work presents a system for forecasting of phosphate-binding agents (PBA) dosage and vitamin D receptor activators (VDRA) dosage. The system consists of sequentially triggering artificial neural network forecasting models (separate model for each drug type).

Method
As an input dataset, system uses patient’s results of laboratory studies (blood calcium, phosphate and PTH) for the period of 6 months, information on previous drug therapy and data on adequacy of patient’s dialysis therapy. The output of the system are dosages of PBA an VDRA that have to be administered in order to bring the patient’s parameters as close as possible to target range of values (2.1-2.5 mmol/l for calcium, 0.87-1.5 mmol/l for phosphate and 150-300 pg/ml for PTH). The system consists of two sequentially triggering forecasting models (for PBA and for VDRA), where each model is an artificial neural network, that has been trained on a data, collected in more than 20 “Nefrosovet” hemodialysis clinics for the period of 3 years.
The effect of system usage was examined for the group of 356 hemodialysis patients with median follow-up time of 3 month. The primary end-points were a number of patients in target range of values With respect to calcium (2.1-2.5 mmol/l), phosphate (0.87-1.5 mmol/l) and PTH (150-300 pg/ml).

Results
During the study we determined that as a result of using the dose forecasting system, number of patients in target range of values significantly increased with respect to calcium (from 178 to 209, p=.0196), phosphate (from 99 to 152, p=.0000), and PTH (from 83 to 109, p=.0281).

Conclusion
Employment of automated drug dosage forecasting system based on artificial neural network models, has a positive effect on BMD correction quality, which, in turn, reduces the risk of possible complications.
P1397LONG-TERM EFFICACY AND SAFETY OF ETELCALCETIDE IN HEMODIALYSIS PATIENTS WITH SEVERE SECONDARY HYPERPARATHYROIDISM
Authors: Massimetti Carlo , Micarelli David , Feriozzi Sandro 
Published: June 2020

Abstract

Background and Aims
Currently the therapeutic strategies most frequently used in the treatment of secondary hyperparathyroidism (SHPT) are represented by vitamin D receptors activators (VDRAs) and cinacalcet. However, both drugs have side effects that limit their use. Recently, in the treatment of SHPT has been introduced the etelcalcetide, a second generation calcimimetic given intravenously (i.v.). This new route of administration could improve adherence to therapy and reduce gastrointestinal side effects. The aim of the study was to evaluate the efficacy and safety of the etelcalcetide in hemodialysis (HD) patients with SHPT inadequately controlled with traditional therapy (cinacalcet and/or VDRAs), or who had side effects with cinacalcet, or that were not adherent to cinacalcet therapy.

Method
For this purpose we have selected 28 HD patients with inadequate control of SHPT (PTH &gt; 500 pg / ml; range 502-2148 pg/ml). Serum albumin-corrected calcium (sCa), phosphate (P), calcium–phosphate product (Ca x P), and PTH were assessed monthly. Baseline 19 patients were taking stable doses of active vitamin D analogs and all patients were taking phosphate binders. Etelcalcetide was administered three times a week after each hemodialysis session. The starting dose was 2.5 or 5.0 mg and then adjusted between 2.5 and 10.0 mg according to sCa and PTH levels. Treatment was temporarily withheld for sCa &lt;7.5 mg/dl, or symptomatic hypocalcemia and was subsequently resumed at a lower dose. The primary endpoint was a PTH reduction &gt; 30% compared to baseline levels.

Results
At present 12 months have passed since the beginning of etelcalcetide therapy. In most patients PTH levels were reduced immediately after the start of therapy. After 12 months we observed a reduction &gt; 30% in 82% of patients, meanly -54% with a range between – 22% and – 81%. On average PTH levels decreased from 1167±444 to 558±310 pg/ml (P&lt;.001). Serum calcium significantly reduced already after one month of therapy settling on stable levels from the third month onward, sCa decreased from 9.7±0.4 to 9.2±0.5 mg/dl (P&lt;.01). However, the percentage of patients treated with calcium salts rose from 21% at baseline to 44% at F-U, mean dose at F-U 1.8 ± 0.9 g/d, while the percent of patients treated with VDRAs increased from 68% to 91%. Serum phosphate decreased from 6.4±1.4 to 4.6±1.3 mg/dl (P&lt;.001), Ca x P decreased from 60±13 to 42±12 mg2/dl2 (P&lt;.001). The median average dose of etelcalcetide at F-U was 6.2 ± 1.7 mg/HD, with a range of 2.5-10.0 mg/HD. Throughout the study, the only side effect was asymptomatic hypocalcemia that required the use of calcium salts. There were no gastrointestinal adverse effects.

Conclusion
Our results confirm that in hemodialysis etelcalcetide therapy is effective and safe in the control of SHPT refractory to conventional therapy over a 1-year treatment period.
P1408PAIN MANAGEMENT IN CALCIPHYLAXIS: A KNOWLEDGE,ATTITUDE AND PRACTICE SURVEY AMONG PHYSICIANS
Authors: Chinnadurai Rajkumar , Miller Mary , Lowney Aoife , Sinha Smeeta 
Published: June 2020

Abstract

Background and Aims
Calciphylaxis is a rare disease usually seen in patients with end-stage renal disease. Pain is a hallmark of this disease and can be extremely difficult to control. Anecdotal data suggests that pain management in calciphylaxis is unsatisfactory with differing practice, variable across the United Kingdom (UK) and also around the world. This knowledge, attitude and practice (KAP) survey aims to gather information on the current practice in the management of pain in patients with calciphylaxis.

Method
A pre-tested online questionnaire was circulated among physicians (renal and palliative care) involved in the management of pain in calciphylaxis. (https://www.gmann.co.uk/ website/calciphylaxis-pain-management-survey.cfm). The questionnaire included a mix of open-ended questions and questions with drop down options.

Results
One hundred and six clinicians responded to the survey of which 60 (57%) respondents were from palliative medicine and the remainder 46 (43%) were from renal medicine. There were 31 (30%) respondents, across both specialties who had not encountered any patients with a diagnosis of calciphylaxis (renal-2, palliative care-29). 18% of renal physicians refer patients to palliative care team, 32% refer to pain team and 50% refer to both. Only 3% of the palliative medicine respondents indicated that they’d received a referral from the renal team at the time of diagnosis. Opioids were the preferred initial drug of choice for the management of all types of pain although the preferred drug varied with the specialities (Fig–1). Paracetamol was universally selected as the preferred first-choice adjuvant agent for management of all types of pain. Additional procedures to aid pain management (epidural analgesia and nerve blocks) were used by 6.6% of respondents. A majority (83%) felt the presence of infection impacts on the effectiveness of pain control. The importance of advanced care planning was also highlighted with 72% undertaking advanced care planning discussions often or most of the times.

Conclusion
In conclusion, there was wide variation in the current practice of management of pain in calciphylaxis, with variation between renal specialists and palliative care specialists. Referral to pain specialists is not universal despite the severe nature of the pain experienced by patients with calciphylaxis. The data generated will enable to us to develop practice guidelines to support complex pain management in a group of patients with multiple comorbidities.
P1413EFFECT OF PULSE ORAL VERSUS INTRAMUSCULAR VITAMIN D REPLACEMENT IN HEMODIALYSIS PATIENTS WITH VITAMIN D DEFECIENCY
Authors: Shaarawy Abdelbassit , Anwar Waleed , Abdelmoneim Behairy Said Maha , Khedr Lina , Elsharabasy Reem , Mahmoud Zinab 
Published: June 2020

Abstract

Background and Aims
Low 25-hydroxyvitamin D (25(OH)D) level is common in patients with chronic kidney disease and hemodialysis (HD) patients . It has been associated with high bone turnover, secondary hyperparathyroidism (SHPT), and decreased bone mineral density (BMD). We aimed to investigate the efficacy of equivalent doses of pulse oral cholecalciferol (25,000 IU weekly for 12 weeks) versus single intramuscular cholecalciferol (300,000 IU) in correcting serum 25 (OH) D levels in HD patients.

Method
Prospective randomized open label Clinical trial. 40 prevalent HD patients with vitamin D deficiency were enrolled. Serum 25 hydroxy-vitamin D (25 (OH) D) level &lt; 20 ng/m and Serum parathyroid hormone level ( iPTH) &gt;100 pg/ml. Exclusion Criteria were serum calcium &gt; 10 .5mg/dl, Calcium phosphorus product ≥ 55, tertiary hyperparathyroidism and Parathyroidectomy among others. Patients were randomized equally into two groups. 36 patients were compliant and completed the study. Group I :17 HD patients received oral cholecalciferol 25000 IU weekly of (Vidrop® 2800 IU/ml ) for 12 weeks. Group II: 19 HD patients received a single intramuscular injection (IM) of cholecalciferol 300,000 IU (Devarol® 200000 IU/ ampoule). Vitamin D supplements were stopped if serum calcium &gt;10.5mg/dl or 25(OH) D level &gt; 100 ng /ml (toxic level) during study. Serum calcium (albumin-adjusted), phosphorus, 25(OH) D by ELISA, Alkaline phosphatase (ALP) and intact parathyroid hormone (iPTH) were monitored at baseline, 6 and 12 weeks of intervention. Both groups were maintained on their regular medications used to control mineral bone disorder as: alfacalcidol, sevelamer or a calcium-based chelator.

Results
Significant increase in serum 25(OH) D level in group II patients who received single dose IM Cholecalciferol after 12 w. Means of 25 (OH)D levels basal and 12 w of study were (10.54±5.14 and 13.45 ±5.72) ng/ml respectively. There was a significant increase in the mean of serum calcium basal and at 12 w (8.19±0.69 and 8.42 ±0.54) mg/dl respectively. No significant reduction in the iPTH level or any significant change in the serum phosphorus level was noticed.
compared to group I with oral vitamin D, there was an insignificant change in the mean of serum 25(OH) D basal and at 12 w were (11.91±6.13 and 9.30±5.29) ng/ml respectively, associated with insignificant increase in serum calcium and an insignificant change in either the level of phosphorus or iPTH level.

Conclusion
Cholecalciferol 300,000 IU IM single dose showed better response on serum 25 (OH) D and calcium levels as a treatment of hemodialysis patients with Vitamin D deficiency compared to weekly oral dose for 3 months.
P1416EFFECT OF SWITCH FROM CINACALCET TO ETECALCETIDE IN HEMODIALYSIS PATIENTS WITH A POOR CONTROL OF SECONDARY HYPERPARATHYROIDISM
Authors: Rivero Garcia Karen , Tamayo Arroyo Sebastian , Tamayo Sebastian , Martin-Centellas Jesus , Rodríguez Campón Alejandro , Fraile Gómez Pilar , Correa Marcano Luis , Tabernero Fernandez Guadalupe , Martin Arribas Alberto , Lerma Marquez Jose Luis , González Zhindon Gabriela , Menacho Miguel Jose Antonio , Heras Benito Manuel 
Published: June 2020

Abstract

Background and Aims
Patients on hemodialysis (HD) show a high incidence of secondary hyperparathyroidism (SHPT). An inadequate control of this condition increases morbidity and mortality, most of the times due to lack of adherence to the treatment. There is currently an available intravenous calciomimetic drug that could be an alternative to improve the prognosis and management of SHPT.

Objectives
To analyze the switch from cinacalcet to etelcalcetide in patients with a poor control of SHPT.

Method:
A descriptive observational study was carried out with patients on HD with iPTH levels over 400 pg/mL who had previously been treated with cinacalcet for at least 6 months and then with etelcalcetide for a year. The analysis assessed their basal characteristics, the evolution of their analytical parameters (calcium/phosphorus/iPTH) and their comorbidity, and a questionnaire was completed to observe their adherence to treatment.

Results
The study included 34 patients; average age 65±15 years (58% men); hemodialysis time 84±69 months. The main comorbidities were: 97% hypertension; 44% diabetes; and 47% heart disease. The average basal dose of cinacalcet was 62±26 mg/session, and the average dose of etelcalcetide was 2.8±2.6 mg/session. Over the 12 months of treatment with etelcalcetide a better control of iPTH was observed (from 681±279 to 291±190, p=0.004), with a decrease of iPTH by &gt;50% in 79% of the patients. There were no significant changes in the levels of albumin, calcium or magnesium, but a significant decrease was observed in the levels of phosphorus, Ca x P product and alkaline phosphatase. 44% of the patients showed hypocalcemia after 6 months of treatment, which was asymptomatic in all cases and was corrected with an increase in the oral administration of calcium (44%) or with a change of dialysate [Ca] concentration (50%). None of the patients reported clinical intolerance with etelcalcetide. Table 1:

Conclusion