bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1104THE ROLE OF THERAPEUTIC PLASMA EXCHANGE COMBINED WITH HEMODIALYSIS IN MANAGEMENT OF POISONING AND INTOXICATION
Authors: VanSickle Judith 
Published: June 2020

Abstract

Background and Aims
Background: Poisonings, intoxications, and drug overdoses are common occurrences and rapid lowering of the toxin level is key of all effective therapies. Therapeutic plasma exchange (TPE) has several unique characteristics that allow it to be a potentially effective therapy in rapidly achieving this goal with large molecular weight, protein-bound molecules that have a small volume of distribution. Ibuprofen is a commonly used anti-inflammatory, antipyretic, and analgesic drug. The number of reported ibuprofen overdoses (IO) has increased. Although the vast majority of IOs are not consequential, large ingestion can cause severe metabolic acidosis (MA) resulting in multi-organ failure and death. TPE has been reported as solo intervention in IO, however frequently with remaining renal dysfunction. We report two cases of massive IO that responded well to prompt combined TPE with continuous renal replacement therapy (CRRT).

Method
Literature and chart review of cases of IO in our institute treated with TPE+CRRT.

Results
Case 1: A 17 year old male presented to the Emergency Department (ED) following intentional IO in coma with serum pH of 7.09, cardiorespiratory failure and acute kidney injury (AKI). Urine drug screen was positive for only ibuprofen. He reportedly took 1381 mg/kg. Supportive care was unsuccessful, therefore TPE+CRRT was soon initiated. After two days of treatment the patient was able to be extubated, maintained normal cardiovascular status and renal function. The patient fully recovered.
Case 2: A 17 year old female presented to the ED following intentional IO with serum pH of 6.9, cardiorespiratory failure, AKI, arrhythmia and bilateral leg compartment syndrome. Urine drug screen was positive for ibuprofen. The estimated ibuprofen exposure was above 2000 mg/kg. The initial ibuprofen serum plasma level was 330 µg/mL (therapeutic range is 10-50 µg/mL). Initial Supportive care was unsuccessful and TPE+CRRT was immediately started. Plasma ibuprofen level was normal after the 3rd TPE+CRRT. The patient fully recovered.

Conclusion
Intentional IO may result in major morbidity and mortality. TPE is more efficient in removing drugs with a high protein binding and/or a low volume of distribution, such as ibuprofen. In settings of massive overdose, hemodialysis may provide additional removal of unbound portion, as well corrects acidosis and allows provision of optimal nutrition. Combined TPE+CRRT is beneficial and may facilitate recovery. To our knowledge this is the first pediatric report of severe IO successfully treated with combined therapy.
P1107CENTRALIZED CONTROL OF HEMODIALYSIS PROCEDURES AND CORRECTION OF CKD COMPLICATIONS WITH BI TOOLS
Authors: Galchenkov Aleksei , Malkoch Andrey , Novitskiy Vladimir , Parfenov Vadim 
Published: June 2020

Abstract

Background and Aims
Life expectancy of patients with terminal stage of chronic kidney disease depends on the quality of dialysis therapy and timely and adequate correction of dialysis complications. The goal of this work is to improve the treatment quality for dialysis patients in a setting of multi-facility hospital by employing of Business intelligence (BI) tools for centralized control of diagnostic and treatment process.

Method
We have created a system for centralized control of patients’ condition, using Microsoft Power BI platform. This system allows to analyze the process of hemodialysis procedure as well as treatment of hypertension, anemia and mineral bone disorder. The system generates various reports that may include parameters of a specific patient, single clinic, or multi-facility hospital for the period from arbitrary date to the day, previous to the report generation date.
The effect of system usage was assessed on 288 patients from 30 hemodialysis facilities of “Nefrosovet” private organization, for the period of 6 month.

Results
Before deployment of the system, target value of Kt/V (1.4) was reached or exceeded in 49% of hemodialysis procedures, median duration of hemodialysis procedure was 227±18 minutes (mean total duration per week - 683 minutes). As the result of usage of centralized control and prescription correction system, target values of Kt/V was reached or exceeded in 65% of hemodialysis procedures, median duration of hemodialysis procedure increased to 238±11 minutes (mean total duration per week - 714 minutes). Before the start of the study, hypotensive episodes were registered in 34% of hemodialysis procedures, and hypertensive episodes were registered in 22% of hemodialysis procedures. As the result of centralized control of hemodialysis procedures, number of procedures with hypotensive episodes reduced to 28%, and number of procedures with hypertensive episodes reduced to 17%. Number of patients with blood hemoglobin value in target range of 100-120 g/l, increased from 1617 patients (56%) to 2051 patients (71%). Number of patients with blood ferritin value in target range of values, increased from 1013 patients (35%) to 1386 patients (48%). Number of patients with TSAT value in target range of values, increased from 873 patients (30%) to 1097 patients (38%). We have also noticed an increase in number of patients with target values of calcium and phosphorus metabolism parameters: calcium corrected for albumin – from 1992 (69%) to 2165 (75%) patients, phosphorus – from 693 (24%) to 982 (34%) patients, intact parathyroid hormone (iPTH) – from 635 (22%) to 837 (29%) patients.

Conclusion
The usage of BI based centralized patients’ condition control system allows to improve adequacy of dialysis therapy and quality of CKD complications correction in dialysis patients.
P1115MEDICAL WASTE MANAGEMENT - HOW INDUSTRY CAN HELP US TO PROTECT ENVIRONMENT AND MONEY
Authors: Zawierucha Jacek , Prystacki Tomasz , Marcinkowski Wojciech , Malyszko Jolanta 
Published: June 2020

Abstract

Background and Aims
The global climate change and its consequences force us to remodel our processes and rethink current model of providing the HD treatments. One of the crucial point, which have massive impact on the environment and the economy is the waste management. Every HD session produces above 1 kg of medical waste, which should be properly stored and destroyed. Well thought out processes and our choices can improve dialysis unit budget as well as decrease CO2 emission produced during the waste incineration.
The aim of the study was was assessment of weight the different dialysers used during HD treatments and consequences of choice different types of filters.

Method
The weight of dialyser is the most crucial component of the medical waste produced during dialysis session. The authors checked the weight of different dialysers regularly used in dialysis centers in Poland. The Kern CM 320-IN scale was used for the measurement. The measurement accuracy was 0,1 g.
Also the filling volume of each dialyser has been taken into consideration.

Results
The dialysers were divided into four groups depending on the surface. 1,4m2 in group one, 1,5-1,6m2 in group two, 1.7-1,8m2 in group three and finally 2,0-2,2m2 in the group four. FX class dialysers were lightest in every group. The heaviest ones were Polyflux dialysers. Difference between the lightest and heaviest dialysers was about 95 g. Also the filling volume was lowest in FX class dialysers and the highest in case of Elisio dialysers. The difference was 20 ml.

Conclusion
The weight of different dialysis sets available on the market significantly differs. The decision-makers should take into account this fact as the additional quality feature. In extreme cases the weight difference reaches 95 g. In yearly perspective, the usage of the lighter dialysis set can cause the 17 millions kilograms decrease of medical waste and significant savings.
On the other hand modern HD machines like Fresenius 6008 machine, due to the dialysis set emptying function additionally decrease the mass of the medical waste about 150 g per one HD session, independently on the dialyser used.
P1121TOTAL PLASMA EXCHANGE (TPE) AND CITRATE CRRT IN A LOW-WEIGHT PEDIATRIC PATIENT WITH MACROPHAGE ACTIVATION SYNDROME (MAS): FEASIBILITY AND COMPLEXITIES OF BOTH TREATMENTS
Authors: Sagliocchi Alessandra , Ricci Davide , Caramelli Fabio , Mancini Elena 
Published: June 2020

Abstract

Background and Aims
Low-weight extracorporeal pediatric dialysis treatments remain a challenge due to their clinical and technical complexity.
Apart from some metabolic congenital disorders, the usual indications for CRRT in early pediatric patients and newborns are the same as for adults with acute kidney injury (AKI). But the implementation of TPE is still in the anecdotal stage.

Method
Clinical case: a 7-month female infant, weighing 5.7kg, in the neonatal intensive care unit with fever, lymphadenopathy, hepatosplenomegaly, pancytopenia, hyperferritinemia, hypertriglyceridemia, was diagnosed as having macrophage activation syndrome (MAS). She developed AKI and acute respiratory distress syndrome (ARDS), due to sepsis. Because of oliguria, ruling out administration of drugs and parental nutrition, and fluid overload (more than 20% of her body-weight), CRRT was started.

Results
CRRT lasted 22 days in continuous venovenous hemodiafiltration (CVVHDF), with regional citrate anticoagulation (Table 1). Mean filter patency: 26±17h. 43% of treatments were interrupted after CVC failure, 21% after clinical procedures, 7% after filter coagulation. There was in this case no citrate accumulation and satisfactory metabolic and electrolyte control were obtained (Figure 1).
After treatment of MAS failed with both i.v. immunoglobulins and corticosteroids, we considered TPE as a rescue therapy for the disease, even though we could not find a similar experience reported in the literature in such a small infant. We performed 3 TPE sessions, with heparin anticoagulation (Table 1), non-consecutively, with CRRT in between.

Conclusion
The treatments were well tolerated, resulting in a large decrease in triglycerides and ferritin (MAS index, Figure 2).
Despite the death of the patient after ARDS worsened, we showed that even in a small critically ill infant, complex depurative treatments such as total plasma exchange are feasible. Highly skilled nephrologists and dialysis nurses are mandatory for treatment management.
P1146ENHANCED EXPRESSION OF THIOREDOXIN-INTERACTING-PROTEIN (TXNIP) MAY REGULATE OXIDATIVE DAMAGE IN PERITONEAL DIALYSIS PATIENTS
Authors: Oberacker Tina , Schricker Severin , Schanz Moritz , Alscher Dominik M , Ketteler Markus 
Published: June 2020

Abstract

Background and Aims
Glucose-based solutions used as peritoneal dialysis fluids influence the peritoneal membrane. Exposure to high glucose-based peritoneal dialysis solutions induces reactive oxygen species (ROS) production due to upregulation of TXNIP as shown by several studies in rats as well as in human primary cells. Enhanced expression of TXINP also regulates oxidative damage. Therefore the aim of this study was to investigate the expression of TXNIP and the extent of oxidative damage in human peritoneal biopsies.

Method
Human peritoneal biopsies of healthy controls, PD patients and patients with EPS were collected. TXNIP and thioredoxin-1 (TRX) mRNA expression was determined by qPCR. Protein expression and the extent of oxidative damage were examined by immunohistochemistry.

Results
Biopsies from the peritoneum of 7 healthy controls, 36 patients on PD without signs of EPS as well as of 12 patients with EPS were collected. The age of the healthy controls was higher (median 64.00 years, IQR: 53.00-70.00) than in the other subgroups (PD: median 60.50 years, IQR: 46.00-69.00 and EPS: median 51.00 years, IQR: 38.00-58.75). Furthermore, compared to the PD- (39 %) and EPS-group (33 %), there were more female participants in the control-group (86 %). Time on PD was longer in EPS patients (median 70.00 months) than in PD patients (median 33.50 months).
In a preliminary study, exposure to high glucose-based peritoneal dialysis solutions did not markedly influence the mRNA expression of TXNIP and TRX.
However, on protein level a significant glucose-related upregulation of TXNIP could be observed especially in PD patients. Interestingly, there was no glucose-related change in protein expression of its interacting partner and cellular anti-oxidant TRX.
To study the effect of TXNIP expression on the generation of oxidative damage, pH2AX positive nuclei were counted on peritoneal membrane sections. A slight increase of pH2AX positive nuclei upon exposure to dialysis solutions could be observed in the cohort analysed.

Conclusion
Here, we show for the first time a clear tendency for upregulation TXNIP in human peritoneal tissue after exposure to high glucose-based peritoneal dialysis solutions especially in PD patients. This increase in TXNIP expression may correlate with the accumulation of oxidative damage of macromolecules. Therefore, manipulation of TXNIP expression may be a promising therapeutic target to improve peritoneal membrane function.
P1149PERITONEAL MEMBRANE CHARACTERISTICS OVER TIME: A LONGITUDINAL STUDY
Authors: Balafa Olga , DUNI ANILA , Tseke Paraskevi , Rapsomanikis Karolos Pavlos , Oikonomou Margarita , Pappas Haralambos , Theodorou Ioanna , Ntounousi Evangelia 
Published: June 2020

Abstract

Background and Aims
Modified PET (use of 3.86% glucose dialysate instead of 2.27%) and temporal drainage at one hour allows a more complete study of peritoneal membrane transport, as it provides information about sodium sieving, free water transport (FWT) and ultrafiltration failure (UFF). Longitudinal data using this PET are sporadic. Aims of our study were a) longitudinal follow-up of the membrane function using modified PET b) evaluation of UFF and association with clinical and membrane characteristics.

Method
We analyzed all modified PET tests performed in our unit during the last 9 years. Patients who underwent the first test during the first year of treatment and then once a year were included. We estimated classic peritoneal transport parameters like D/P creatinine, D/D0 glucose and ultrafiltration (UF) at 4 hours. Moreover we calculated sodium seiving expressed as Dip/DPNa= (Dialysate sodium time 0/plasma sodium)-(Dialysate sodium time 1 hour/plasma sodium)], sodium removal (in one hour) and FWT. We collected clinical and lab data of the patients too.

Results
A total of 219 PETs were performed in 85 PD patients, (median age 64 years (range 18-45). The baseline membrane characteristics of the patients were: DP creatinine=0.74±0.11, D/D0glucose=0.28±0.08, DipDPNa=0.05±0.04, sodium removal=29,804 ±26,894 (mmol/L), FWT=214.9±194.7 ml and UF =655.1±265.5 ml. On multivariate regression analysis D/P creatinine, FWT and sodium removal were significant independent covariates accounting for 50% of the variability of ultrafiltration . The patients were followed-up for a median of 36 months (range 2.4-143).For the repeated measurements, the analysis showed that the observed values of D/Pcre,D/D0, Dip/DPNa, FWT and UF remained rather stable across the different time measurements. During the study, 23 out of 85 pts developed peritoneal UF failure (UFF). Analysis was performed using univariate random effects logistic time-series models and only D/D0 (OR=0.84, P=0.001), D/P Cre (OR=1.15, p&lt;0.001), urine volume (OR=1.26, p=0.027) and sodium removal (OR=0.99, p=0.003) were significantly associated with relative risk of UFF development.

Conclusion
Surprisingly, our patients present a stable membrane function over time. Possible explanations could be the low peritonitis rate and strict use of hypertonic glucose dialysates. Ultrafiltration failure was correlated with higher D/P creatinine and lower D/D0 glucose values, higher baseline urine volume and lower sodium sieving.
P1150BURDEN OF SYMPTOMS EVALUATION AND DETERMINANTS IN PERITONEAL DIALYSIS PATIENTS USING ESAS-R AND IPOS RENAL SCORE
Authors: Cacheira Eunice , Leite de Sousa Luís , Martins Ana Rita , Matias Patricia , Branco Patricia 
Published: June 2020

Abstract

Background and Aims
CKD patients are known to have a substantial burden of symptoms. Effort towards treatment modifications aiming to improve the quality of life in ESRD patients is growing among clinicians. ESAS-r and IPOS renal score are well known among conservative and palliative care physicians, used to evaluate the burden of symptoms in their renal patients. However, there are few studies including patients in chronic peritoneal dialysis. Using these tools, we aim to evaluate the symptoms and determine patient and treatment-related conditions associated with their burden in a PD population.

Method
We have conducted 73 phone interviews to the prevalent PD population in our centre. ESAS-r and IPOS renal (3-days patient version) questionnaires were answered by each patient/family caregiver. The population was then characterized according to gender, race, age, PD technique and duration, number of daily exchanges, patient autonomy, diabetes mellitus and cancer status, Charlson score and number of cardiac events and hospitalizations since PD beginning. Statistical analysis of data was carried out using SPSS®.

Results
We obtained a total of 63 answers to both questionnaires. Three were answered by a family caregiver. 60.3% of the patients were male, mean age 53 (±14.9) years. 15.9% were on automated PD, with mean number of daily exchanges of 3.45 (±0.7) and mean PD duration of 25.7 (±33.5) months. 38,1% were diabetic, six (9.5%) patients had cancer and mean Charlson score was 4.24 (±1.8). Only 3 patients were caregiver dependent for treatment. 31.3% had at least one hospitalization since PD beginning. Each patient reported a mean 3.1 (±2) number of symptoms on ESASr: renal. Mean IPOS-renal score was 9.5 (±6.4). In univariate analysis (t-student test), greater IPOS-renal score was associated with female gender only (p = 0.056; CI -0.07-6.1). In multivariate analysis (linear regression) the number of symptoms reported by each patient on ESASr renal was associated with number of hospitalizations during PD time (B = 0.46; CI(95%) 0.18-0.75; p = 0.02) in model adjusted to time of PD.

Conclusion
The majority of variables analysed do not have an association with IPOS renal score. The number of hospitalizations was associated with greater burden of symptoms, adjusted to PD time. Oddly, Charlson score, diabetes mellitus and cancer status had no relation to the symptoms reported or IPOS renal score. More modifiable patient and treatment-related variables can be studied to better characterize which interventions may ease the burden of symptoms in PD patients. Patients can answer these questionnaires periodically to help clinicians understand weather treatment modifications have a positive impact on their well-being.
P1164INTERVENTIONAL NEPHROLOGY SERVICE ENHANCES PERITONEAL DIALYSIS UTILISATION AND UPTAKE: EXPERIENCE FROM A SINGLE CENTRE IN SINGAPORE
Authors: Liu Yan Lun Allen 
Published: June 2020

Abstract

Background and Aims
Interventional nephrology (IN) is not having a well-defined role in peritoneal dialysis (PD) service provision. Impact to PD catheter outcomes, PD utilisation and uptake on integrated care approach under IN service was not known. Here we report the experience and outcomes of IN practice in PD service from a single centre in Singapore.

Method
We postulated an IN-led, multidisciplinary collaborative model of care for end stage renal failure patients, who transited through a seamless care pathway from pre-dialysis counselling to insertion of PD catheter, could improve utilisation and increase uptake of PD as dialysis modality of choice. This approach was based on: 1. Interventional nephrologist-led PD catheter insertion service, 2. coordination of care (figure 1) and 3. early start of PD. Outcomes of IN involvement in PD access management and coordination of care were included in this study.

Results
From January 2015 to May 2019, a total of 140 PD catheter insertions were performed by interventional nephrologist (table 1). The prevalence of PD patients in our program was increased by 217% after initiation of IN service (figure 2). Annually, incident ESRF patients who chose PD as dialysis modality increased from 10% to 28% (figure 3). We had a very low PD catheter-related complication rate in reference to international standards (table 2). Catheter adjustment-free survival was 94% and 83% at 12 months and 36 months respectively (figure 4).

Conclusion
The multifaceted and holistic role of IN in PD translated into remarkable outcomes on PD utilisation and uptake. It also confirms the safety and efficacy of IN procedures in PD when performed by appropriately trained nephrologists.
P1168ABDOMINAL AORTIC CALCIFICATION SCORE MODIFIES THE PROGNOSTIC VALUE OF SERUM MAGNESIUM LEVELS ON ALL CAUSE MORTALITY IN PERITONEAL DIALYSIS PATIENTS
Authors: Giannakopoulos Panagiotis , Fokas Stavros , Drosataki Eleni , Tsotsorou Ourania , DUNI ANILA , Theodoridis Marios , Stylianou Kostas , Ntounousi Evangelia , Passadakis Ploumis , Katsoudas Spyros , Kyriazis Periklis , Bacharaki Dimitra , Vlahakos Demetrios 
Published: June 2020

Abstract

Background and Aims
Low serum Mg (s-Mg) concentration has been associated with an increased risk of death in both the general and dialysis populations. In peritoneal dialysis (PD) patients, an inverse correlation between s-Mg and abdominal aortic calcification (AAC), estimated by plain lateral lumbar x-rays, as Leena Kauppila (LK) score (range 0-24), is well documented. LK score of 0-4 has been associated with the best event free survival (CORD study CJASN 2011). Here, we explored the possibility whether AAC could modify the relationship between s-Mg and all-cause mortality in PD patients.

Method
We studied 95 stable PD patients, 51 men 44 women, with a mean age of 63 ±14 years. The degree of AAC was evaluated with on plain lateral abdominal radiographs, as LK score. After completion of baseline assessment, including s-Mg measurements, patients were followed up for all-cause mortality.

Results
The mean of s-Mg and AAC in the whole group were 2.25±0.47 mg/dl and 6.65 ± 5.94 respectively. There was an strong inverse correlation (rho = -0.225; p=0.029) between s-Mg and AAC. During a median follow-up period of 23 months, 16 (17%) deaths occurred. There was a 78% reduction of all-cause mortality for every 1 mg/dl of increase in s-Mg {crude HR: 0.22 (95% CI, 0.06 - 0.78)}. An interacting effect between s-Mg and AAC was significant (p=0.005) after controlling for main effects. Then, the association between s-Mg and all-cause mortality by subgroups of AAC: higher tertile vs all lower, was examined (cut-offs of the tertiles for AAC were 3 and 9). In patients grouped in the lower tertiles, s-Mg was a significant predictor of all-cause mortality, even after adjustment for univariate significant predictors of all-cause mortality: age, cardiovascular disease, PD vintage and malnutrition-inflammation score (MIS) {adjusted HR: 0.14 (95% CI, 0.02-0.0.98)}. On the contrary, patients with AAC in the higher tertile of the baseline distribution, s-Mg levels were not predictive of outcome in either crude or the adjusted models.

Conclusion
The predictive value of s-Mg in all-cause mortality in PD patients appears to be critically dependent on AAC score. Thus, sustaining higher sMg levels, as by using higher Mg dialysate concentration, may have beneficial effects on clinical outcomes only in patients without AAC or at least in those with early lesion development.