bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1412CARDIO PULMONARY AND CKD-MBD INTERACTIONS IN HEMODIALYSIS PATIENTS
Authors: Dalili Nooshin 
Published: June 2020

Abstract

Background and Aims
Emerging evidence suggests that pulmonary hypertension (PHT) is closely associated with cardiac, pulmonary, and mineral bone diseases in hemodialysis patients. Previous results indicated that extra osseous calcifications might be a risk factor for PHT although results in human studies about this association have been conflicting. Multiple factors including abnormal calcium phosphate levels, uremia and inflammation are known to be important in vascular calcification development. In hemodialysis patients’ vascular calcifications may be evaluated by different techniques. The utilization of plain X-ray for screening vascular calcifications has been suggested by KDOQI and KDIGO .In this study, we examined the association between PHT, peripheral vascular calcification by plain X-Ray score, and echocardiographic parameters in hemodialysis patients.

Method
Chronic (&gt; 6 months) hemodialysis patients (150) on a three times per week dialysis schedule were studied. Two-dimensional trans thoracic echocardiography was performed before dialysis. Global systolic function was evaluated by left ventricular ejection fraction (LVEF). Systolic pulmonary arterial pressure (SPAP) was recorded. Pulmonary hypertension was defined as, pulmonary artery pressure (PAP) greater than 35 mm Hg based on European Society of Cardiology Guideline. Vascular calcification score is evaluated in plain X-ray of pelvis and hands. Each film is divided into four sections. Any vascular calcification either in an irregular or linear pattern is considered. The presence of vascular calcifications in each section is rated as 1 and its absence as 0. Final score is the sum of all sections and ranges from 0 to 8.Demographic data and lab results including Calcium (Ca), Phosphorous (P), Ca X P product, 25OH-vitD and iPTH were collected for all enrolled patients. The effects of different peripheral vascular calcification scores in plain X-Ray, structural heart abnormalities in echocardiography and Ca-P-iPTH- vit D axis disorders on the development of pulmonary hypertension were evaluated to elucidate cardio, pulmonary and CKD-MBD interactions.

Results
Hemodialysis patients had a high prevalence of PHT (30%), which warrants special attention to this important complication in hemodialysis population. Severe peripheral VCs (VCs &gt;3) were independent risk factor for PHT. In addition to the old age, duration of hemodialysis, and mitral valve disease, the presence of higher Ca- P product was another independent predictor of PHT in chronic hemodialysis patients.

Conclusion
Prevalence of PHT in dialysis patients seems to be high, and is closely associated with peripheral VC, mineral bone disorders and structural heart abnormalities suggesting further a strong cardio pulmonary renal interaction.
P1415PARATHYROIDECTOMY IMPROVES MUSCULAR FUNCTION BUT NOT MUSCLE MASS IN HEMODIALYSIS PATIENTS WITH SEVERE HYPERPARATHYROIDISM
Authors: Crispilho Shirley , Duque Eduardo J , Avesani Carla , R Pereira Rosa Maria , De Sá-Pinto Ana Lúcia , Jorgetti Vanda , Stenvinkel Peter , Lindholm Bengt , Motta Rosilene , Moyses Rosa 
Published: June 2020

Abstract

Background and Aims
Increased levels of parathyroid hormone (PTH) are associated with a negative impact on the bone-muscle axis including sarcopenia with muscle weakness and muscle atrophy and osteoporosis, and it is possible that treating hyperparathyroidism (HPT) can ameliorate these disturbances. However, the effects of parathyroidectomy (PTX) on muscle mass, strength and performance, and physical activity have not been thoroughly investigated. This study aims to evaluate the impact of PTX on muscle (mass, strength, and performance), physical activity, body fat and resting energy expenditure (REE) in patients on hemodialysis with severe HPT.

Method
We are prospectively evaluating muscle mass strength, performance and physical activity of 30 patients before and after 6 months of PTX by using Actigraph GT3X accelerometer, timed-up-and-Go (TuG), Sit-to-Stand-to-Sit (STS) and muscle strength tests [handgrip (HGS), supine (SP) and leg press (LP)]. Body composition changes were assessed by dual-energy x-ray absorptiometry (DXA), and REE was examined by indirect calorimetry.

Results
At 6 months after PTX, 11 patients who already completed the protocol, showed a significant drop in PTH [1445 (1363-1937) vs. 54 (23-132) pg/mL; p = 0.002] and alkaline phosphatase [306 (235-744) vs. 77.5 (52-100] U/L); p = 0.002], a significant increase of number of steps/day [4321 (3384 – 6317) vs. 5950 (3918 – 7159); p = 0.04] and improvements of strength tests: HGS (27 ±14 vs. 31 ±15 kg; p = 0.01); SP (27 ±15 vs. 31 ±17 kg; p = 0.01] and LP [27 (2-36) vs. 36 (24-89) kg; p 0.04]. In addition, there was a significant reduction of TuG [10 (8-15) vs. 8 (7-11) seconds; p = 0.01], and a tendency towards STS improvement [6 (0-7) vs. 8 (7-11); p = 0.06]. A significant increase in body weight (66 ± 12 vs. 68 ± 14 Kg; p = 0.02), body mass index [24 (21–26) vs. 26 (21–28) kg/m2; p 0.001], and bone mineral content (BMC) [1.8 (1.3-2) vs. 2.1 (1.7-2.7); p=0.002] was seen. However, lean body mass (LBM) decreased [40.4 (38-55) vs. 39 (37-51) Kg; p=0.001], whereas fat mass (FAT) increased [18 (17-28) vs. 24 (17–30) kg; p = 0.02]. No change was noted in skeletal muscle index (SMI) and in REE [1580 (1193–1988) vs. 1473 (1326 - 1786) kcal/day; p = 0.7). We noticed a tendency toward an increase in IGF-1 levels [180 (141-207) vs. 223 (151-281) µg/L; p = 0.08], but no significant variation was found in serum albumin, insulin and HOMA index.

Conclusion
In hemodialysis patients with secondary hyperparathyroidism undergoing PTX, there were marked improvements of muscular function and bone mass, but not of muscle mass. Our findings suggest that PTH-associated sarcopenia is mediated not only by a decrease in muscle mass but also by muscle dysfunction. The long-term effect of PTX on muscle status remains to be further examined.
P1422CATHEPSIN-K IS A POWERFUL DIAGNOSTIC BIOMARKER IN PARATHYROIDECTOMIZED DIALYSIS PATIENTS
Authors: Bolignano Davide , Greco Marta , Provenzano Michele , Tripolino Omar , Vita Caterina , Leonardi Giuseppe , Chiarella Salvatore , Donato Cinzia , Russo Emilio , Fuiano Giorgio , Foti Daniela , Andreucci Michele , Coppolino Giuseppe 
Published: June 2020

Abstract

Background and Aims
Cathepsin-K (Cts-K) is a lysosomal cysteine protease mainly involved in bone remodeling and resorption. Although it is largely released by lung cells, osteoclasts and macrophages, increasing current evidence suggests that the parathyroids may somewhat regulate Cts-K balance. We therefore analyzed Cts-K in a cohort of 85 chronic HD patients (mean age 67+/-12, median dialysis vintage 3.2 yrs), also including some individuals who were previously parathyroidectomized.

Method
Cts-K serum levels were measured before a mid-week dialysis session together with standard biochemical parameters. Twenty-six healthy subjects matched for age and gender served as controls. Patients were further stratified according to whether they were parathyroidectomized or not.

Results
Cts-K levels were statistically higher in HD patients than in controls (median 340, IQR 170-835 vs. 190 IQR 20-120 pg/mL, p&lt;0.0001) and significantly associated with ALP (r=0.50, p&lt;0.001), CRP (r=0.46,p&lt;0.001) and PTH (r=0.24,p=0.02). Patients with previous parathyroidectomy (n=8) had significantly lower levels of Cts-K (942.3 vs 46.2 pg/mL, p&lt;0.0001). At ROC analyses, Cts-K showed an excellent diagnostic profile in distinguishing parathyroidectomized patients (AUC 0.977, best Cts-K cutoff&lt; 100 pg/mL; sens. 100%, spec. 93%; Figure 1). Of note, although slightly inferior, the AUC of Cts-K was not statistically different to that of PTH (p=0.11 for comparison of ROC curves).

Conclusion
Cathepsin-K may represent a potential candidate biomarker for diagnosing and managing MBD complications, particularly those related to parathyroid dysfunction. Its exact biological role in these conditions deserves further examination.
P1452PATIENT SURVIVAL ON HOME DIALYSIS MODALITIES
Authors: Bitar Wisam , Helve Jaako , Rauta Virpi , Honkanen Eero Olavi , Finne Patrik 
Published: June 2020

Abstract

Background and Aims
Many studies have compared survival of patients on peritoneal dialysis and hemodialysis, but knowledge on survival differences between various types of home dialysis is limited. Therefore, our study aimed to assess the associated survival in CAPD, APD and home HD.

Method
During 2004 to 2017, 1640 patients aged 18 years or older started RRT in Helsinki University Hospital. Patients who were on one of the home dialysis modalities at 90 days (n=536), have been studied. The follow up endpoint was either death or the end of 2019. A research database was established and extensive data were systematically collected from the patient files, comprising 35 different comorbidities, laboratory results, primary renal disease, and renal replacement therapy-related factors. Study design was intention-to-treat, and patients were analyzed in the home dialysis modality group they were at 90 days after onset of RRT. Patient survival was compared between patients on CAPD, APD, and home HD using Kaplan-Meier curves and Cox regression.

Results
Characteristics of home HD and APD patients at the start of dialysis and proportion of patients who received a kidney transplant during follow-up were similar (Table), whereas patients on CAPD had higher median age, more comorbidities, and received a kidney transplant less frequently. The probability of surviving 5 years was 56% for CAPD, 88% for APD, and 90% for home HD patients (Figure). Relative risk of death associated with APD was 0.96 (95% CI 0.60–1.5), and that of CAPD was 3.7 (2.4–5.7) as compared to home HD. After adjustment for age and number of comorbidities, the relative risks were 0.82 (0.39–1.7) and 2.5 (1.2–5.0), respectively. Additional adjustments for other possible confounding factors listed in the Table did not change the results. Censoring for kidney transplantation did not alter the conclusion.

Conclusion
APD and home HD patients had similar characteristics and comparable survival. CAPD patients were older, had more often comorbid conditions, and their prognosis was worse even after adjustment for confounders.
P1454CIRCULATING ENDOTOXIN AND MARKERS OF INFLAMMATION: ASSOCIATES WITH PHYSICAL ACTIVITY AND THE EFFECT OF A SIX MONTH PROGRAMME OF CYCLING DURING DIALYSIS (INTRADIALYTIC CYCLING)
Authors: March Daniel , Lai K B , Highton Patrick , Churchward Darren , Young Hannah , Dungey Maurice , Graham-Brown Matthew , Smith Alice , Bishop Nicolette , Szeto C C , Burton James 
Published: June 2020

Abstract

Background and Aims
Individuals with end-stage kidney disease receiving haemodialysis have elevated levels of circulating endotoxin as a result of changes to the intestinal barrier. These elevated levels are believed to play a role in the high levels of inflammation in this population. Programmes of cycling during dialysis (Intradialytic cycling (IDC)) can provide benefits to individuals receiving haemodialysis, but it is unclear how they may effect circulating levels of endotoxin. Therefore, the primary aim of this study is to investigate the effect of a 6-month programme of IDC on circulating endotoxin. Further aims are to investigate the associations between levels of physical activity and levels of circulating endotoxin and markers of inflammation in haemodialysis patients.

Method
This is a secondary analysis of the CYCLE-HD randomised controlled trial (ISRCTN11299707). Participants were randomised to either a 6-month programme of IDC (thrice weekly, moderate intensity cycling at RPE 12-14) in addition to usual care (n=46), or usual care (n=46) only. At baseline and 6 months blood samples were collected from the arterial needle immediately prior to haemodialysis therapy and following centrifugation stored at -80°C. Endotoxin, interleukin (IL)-6, IL-10, tumour necrosis factor-α (TNF-α) and high sensitivity C-reactive protein (Hs-CRP) were quantified using immunoassays. Levels of physical activity were measured using an accelerometer. Participants were instructed to wear the accelerometer for 7 days at baseline, and steps per day were calculated by dividing total steps by number of days worn .

Results
Steps per day data and endotoxin and inflammatory data was available for n=81 participants at baseline. There was a significant negative association between number of steps per day and IL-6 (P=0.001, R=-0.361), Hs-CRP (P&lt;0.0001, R=-0.450) and Endotoxin (P=0.032, R=-0.238) levels. The effect of a 6-month programme of IDC on endotoxin levels and the inflammatory markers are presented in Table 1.

Conclusion
Higher levels of physical activity were associated with lower levels of circulating endotoxin, IL-6 and Hs-CRP in individuals receiving haemodialysis. A 6-month programme of IDC did not result in increases in circulating endotoxin, indicating that this physiological stress does not result in changes to the intestinal barrier in haemodialysis patients. Lastly, IDC did not appear to increase circulating markers of inflammation.
P1481STRAIN REPOLARISATION ON ECG, NOT LEFT VENTRICULAR MASS, ASSOCIATES WITH CARDIOVASCULAR OUTCOMES IN A PROSPECTIVE COHORT OF HAEMODIALYSIS PATIENTS
Authors: Skampardoni Sofia , Chiu Diana Y Y , Kalra Philip A , Green Darren 
Published: June 2020

Abstract

Background and Aims
Cardiovascular disease is common in chronic and end stage kidney disease. Left ventricular hypertrophy (LVH) has been identified as contributor to cardiovascular risk in this population. The aim of the study was to assess whether the combined use of electrocardiography and echocardiography in assessing LVH in a haemodialysis population can provide improved risk stratification.

Method
Prospective study of 192 prevalent maintenance haemodialysis ( HD) patients 12 lead ECGs were performed on a mid week non –dialysis day. Electrocardiographic strain was defined as a down slopping convex ST segment with inverted T waves in leads V5 and / or V6. Transthoracic echocardiographic was performed immediately after ECG .LV mass was indexed to body surface area (LVMIBSA). LVH was determined if LVMI &gt;116g/m2 for male patients, and &gt;100g/m2 for female patients. The primary study endpoint was major cardiac events (MACE). A secondary endpoint was all cause mortality.

Results
192 patients included in the final analysis, 137 (71.4%) male.. The mean ejection fraction (EF) was 60.6± 11.1 % and the mean LVMI (BSA) was 115.0± 36.8 g/m2. During a mean follow up period of 2.4 ± 1.0 years, 50 patients reached a MACE end point and 62 patients died. On univariate Cox regression analysis, the factors associated with MACE were the presence of ECG strain (HR 2.961, CI: 1.254 – 6.990, p= 0.013)) URR (HR 0.968, CI: 0.942 – 0.994, p=0.015) and history of CAD (HR: 2.397 CI: 1.363 -4.2515, p= 0.002). In multivariate Cox regression analysis adjusting for baseline cardiovascular phenotype and dialysis parameters ECG strain remained significantly associated with MACE.

Conclusion
The presence of electrocardiographic strain increases the risk for MACE independently of LVH in haemodialysis patients. ECG strain has potential to be a simple bedside prognostic biomarker and even therapeutic target in haemodialysis patients.
P1482MORTALITY RATE AND RELATED RISK FACTORS IN THE CHINA DIALYSIS OUTCOMES AND PRACTICE PATTERNS
Authors: Zhao Xinju , Niu Qingyu , Gan Liangying , Zuo Li 
Published: June 2020

Abstract

Background and Aims
Mortality risk for maintenance hemodialysis (MHD) patients varies by country and ethnicity. Here, mortality rate and its related risk factors in Chinese HD patients from Dialysis Outcomes and Practice Patterns Study (DOPPS) were studied.

Method
Data from the China DOPPS phase 5 (2012-2015) were used. All included patients were followed to the end of the study. Patients’ demographics, primary cause of end stage renal disease (ESRD), comorbidities, abstracted dialysis prescription, laboratory values, date of death, and causes for death were analyzed. All-cause mortality (per 100 patient-years) was calculated. We examined clinical and laboratory differences between died and survived patients. Cox regression was used to explore risk factors of death, accounting for facility clustering and adjusted for case-mix (age, sex, vintage, and comorbid conditions), and laboratory values (albumin, hemoglobin, white blood count, sodium).

Results
There were 1427 MHD patients were enrolled. The mean age at dialysis initiation was 59.4±14.9 years (table 1). The median follow-up time was 1.9 years (IQR 1.1-2.1). There were total 205 deaths. The overall mortality rate was 8.8 per 100 patient-years. Death from cardiovascular disease (CVD) occurred in 50.2% of the patients. Compared with survived patients, patients with mortality were older (58.5 Vs. 70.0 y), more likely with diabetes, with lower pre-dialysis albumin level (Pre-ALB) or hemoglobin level (Pre-HGB), with lower pre or post dialysis diastolic blood pressure (DBP), with some comorbidities and less likely with fistula as their blood access (table 2). Cox regression revealed that risk factors for higher mortality were older age, lower Pre-ALB level, higher pre-dialysis DBP and with CHF, hepatitis, hypertension, and lung disease.

Conclusion
CVD constituted half of the death reasons for Chinese dialysis patients. Our analysis highlighted that there are some modifiable risk factors for patients’ survival. Attention should be paid to patients who were older, with lower Pre-ALB level, higher pre-dialysis DBP and with CHF, hepatitis, hypertension, and lung disease.
P1490AGAIT SPEED AND HANDGRIP STRENGTH AS PREDICTORS OF ALL-CAUSE MORTALITY AND CARDIOVASCULAR EVENTS IN HEMODIALYSIS PATIENTS
Authors: Lee Yu Ho , Jeong Hyeyun , Yang Dong Ho , Lee So-Young , Kim Jin Sug , Jung Su Woong , Hwang Hyeon Seok , Moon Ju-Young , Jeong Kyung Hwan , Lee Dong-Young , Ko Gang Jee , Lee Hong Joo , Kim Yang-Gyun 
Published: June 2020

Abstract

Background and Aims
Low physical performance in patients undergoing maintenance hemodialysis is associated with a high mortality rate. We investigated the clinical relevance of gait speed and handgrip strength, the two most commonly used methods to assess physical performance.

Method
We obtained data regarding gait speed and handgrip strength from 277 hemodialysis patients and evaluated their relationship with baseline parameters, mental health, plasma inflammatory markers, and major adverse clinical outcomes. Low physical performance was defined by the recommendations suggested by the Asian Working Group on Sarcopenia.

Results
The prevalence of low gait speed and handgrip strength were 28.2% and 44.8%, respectively. Old age, low serum albumin levels, high comorbidity index, and impaired cognitive functions were associated with low physical performance. Patients with isolated low gait speed exhibited a general trend for worse quality of life than those with isolated low handgrip strength. Gait speed and handgrip strength showed very weak correlations with had different determinant factors (older age, the presence of diabetes, and lower serum albumin for low gait speed, and lower body mass index, and the presence of previous cardiovascular events for low handgrip strength). Patients with low gait speed and handgrip strength had elevated levels of plasma endocan and matrix metalloproteinase-7 and the highest risk of all-cause mortality and cardiovascular events among the groups (adjusted hazard ratio of 2.72, p = 0.024).

Conclusion
Gait speed and handgrip strength reflected distinctive aspects of patient characteristics and that their combination improved the prediction of adverse clinical outcomes in hemodialysis patients. Gait speed seems to be a better indicator for poor patient outcomes compared with handgrip strength.
P1492HUMAN FACTORS TESTING OF THE QUANTA SC+: DEMONSTRATING EASE OF USE WITH MINIMAL UPFRONT TRAINING IN HEALTH CARE PRACTITIONERS AND PATIENTS
Authors: Compton Kathryn , Edwards Christian , Komenda Paul , Bose Amit , Milad John 
Published: June 2020

Abstract

Background and Aims
Quanta Dialysis Technologies has developed a compact, powerful personal haemodialysis system intended for home and self-care use designed in collaboration with patients and healthcare practitioners. Human factors testing is necessary to demonstrate ease of use with minimal up-front training.

Method
In compliance with FDA guidance and EU standards, the user interface of the system was evaluated through human factors testing to assess the safe and effective use of SC+. This included a series of user-based tasks whereby representative users independently setup SC+ into a simulated treatment, managed alarms to resolution and external SC+ cleaning/disinfection.
All participants received an introduction to SC+ and completed a competency sign off at the end of training. 17 healthcare professionals (6 renal nurses, 8 dialysis technicians, 1 patient care technician) received up to 4 hours of structured training followed by a 1-day learning decay period. In addition, 10 lay users (8 dialysis patients, 2 caregivers) received between 5.5 and 7.5 hours training followed by a 2-day learning decay period.

Results
Between the two user groups, there were a total of 8,110 opportunities for use errors to occur. Despite minimal training and representative learning decay, only 4 significant use events were observed requiring some user manual enhancements. Other use errors captured were minor or could not be mitigated further due to clinical practices and shared inherent risks across all haemodialysis systems.

Conclusion
The results of the human factors testing demonstrated that healthcare practitioners, patients and caregivers successfully operated SC+ independently with a high level of use safety, despite minimal training and learning decay. The SC+ user interface is optimized for safe and effective use under FDA guidance and EU standards.