bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1417ALTERED CATHEPSIN-K LEVELS REFLECT SEVERITY OF MINERAL BONE DISEASE AND INFLAMMATION IN CHRONIC HEMODIALYSIS PATIENTS
Authors: Coppolino Giuseppe , Greco Marta , Leonardi Giuseppe , Provenzano Michele , Tripolino Omar , Arcidiacono Valentina , Donato Cinzia , Chiarella Salvatore , Russo Emilio , Foti Daniela , Fuiano Giorgio , Andreucci Michele , Bolignano Davide 
Published: June 2020

Abstract

Background and Aims
Mineral bone disease (MBD) and chronic inflammation are key triggers of the exceeding cardiovascular risk that characterizes dialysis patients. Cathepsin-K (Cts-K) is a lysosomal cysteine protease involved in bone remodeling and resorption, whose expression is promoted particularly by inflammation and whose involvement in bone and cardiovascular disorders has previously been demonstrated. We set out to undertake an exploratory, observational study to assess the possible clinical significance of Cts-K in dialysis patients.

Method
Eighty-five chronic HD patients (mean age 67±12, median dialysis vintage 3.2 yrs) with stable dry weight were studied. Cts-K was measured in peripheral blood samples before a mid-week dialysis session together with standard biochemical parameters. Twenty-six healthy subjects, matched with HD patients for age and gender, served as controls.

Results
Cts-K was statistically higher in HD patients than in controls (median 340, IQR 170-835 vs. 190 IQR 20-120 pg/mL, p&lt;0.0001). At univariate analyses, Cts-K levels were significantly associated with ALP (r=0.50, p&lt;0.001), CRP (r=0.46, p&lt;0.001), PTH (r=0.24,p=0.02), presence of diabetes (r=0.28,p&lt;0.001),peripheral vasculopathy (r=0.20, p=0.05) and dialysate calcium concentration (r=-0.28,p&lt;0.001). In a multivariate model including all univariate predictors (R2=61%, p&lt;0.001) only ALP (β=0.70,p&lt;0.001), CRP (β=0.49,p&lt;0.001) and dialysate calcium concentration (β -0.40,p=0.04) remained significantly associated with Cts-K levels. Interestingly, Cts-K levels were significantly higher among individuals who were under active calcimimetic therapy (n=28; p&lt;0.001) but significantly lower among those who previously underwent parathyroidectomy (n=8; p&lt;0.001) (Figure 1).

Conclusion
Cathepsin-K is a biomarker at the crossroads of bone and inflammatory disorders in chronic hemodialysis patients. Future research is needed to clarify the exact pathophysiological role of this protein and to test its potential usefulness as a marker for managing MBD therapy and complications.
P1419U- SHAPED ASSOCIATION OF SERUM PARATHYROID HORMONE AND COGNITIVE DYSFUNCTION IN MAINTENANCE HAEMODIALYSIS PATIENTS
Authors: Ammar Yaser 
Published: June 2020

Abstract

Background and Aims
Primary hyperparathyroidism (HPT) is linked with several cognitive and affective disorders in the general population that tend to improve following parathyroidectomy. Most end- stage renal disease (ESRD) patients treated with maintenance haemodialysis (MHD) have 2ry/3ry HPT encompassing a broad range of serum intact parathyroid hormone (S. iPTH) values. They commonly suffer some degree of cognitive dysfunction (CODY) that impairs medication adherence and quality of life. This CODY results from the interplay of multiple factors, including HPT. However, relative hypoparathyroidism may as well cause CODY in the setting of adynamic bone disease and increased cerebrovascular calcification. Therefore, the relationship between S. iPTH and CODY in MHD patients needs to be clearly characterized across the whole spectrum of iPTH values.

Method
Seventy two stable ESRD patients (39 males, median age 50y) treated with thrice weekly low flux MHD for &gt; 6 months underwent Montreal cognitive assessment- basic version (MoCA-B) and pre-dialysis assessment of S. iPTH, vitamin D3, alkaline phosphatase, urea, creatinine, calcium, phosphorus and haemoglobin (Hb).

Results
CODY, defined by a MoCA-B score &lt; 24/30, occurred in 37/72 (51%) patients. MoCA-B score had a statistically significant positive correlation with Hb level. A quadratic inverted U-shaped curve provided the best estimate for the relation between S. iPTH and MoCA-B score (P = 0.019, Figure). Among patients in the highest S. iPTH tertile, S. iPTH has a statistically significant negative linear correlation with MoCA-B score (r = - 0.565, P = 0.004). This correlation was attenuated but persisted after controlling for Hb level (r = - 0.516, P = 0.012).

Conclusion
Anaemia and HPT are important contributors to the high prevalence of CODY in MHD patients. Both markedly high and relatively low (still above normal) S. iPTH levels are associated with lower MoCA-B scores, indicating a U- shaped relation between S. iPTH and CODY. Contrary to other populations, some degree of mild (permissible) HPT is most compatible with near normal cognitive function in MHD patients. Our results emphasize the recommendation of avoiding overzealous suppression of PTH secretion in these patients.
P1421SERUM OSTEOPROTEGERIN LEVEL IS NEGATIVELY ASSOCIATED WITH BONE MINERAL DENSITY IN PATIENTS UNDERGOING HEMODIALYSIS
Authors: Lu Chia-Wen , Hou Jia-Sian , Hsu Bang-Gee 
Published: June 2020

Abstract

Background and Aims
Osteoprotegerin, a potent osteoclast activation inhibitor, decreases bone resorption and positively affects bone mineral density (BMD). Our aim was to evaluate the relationship between BMD and fasting serum osteoprotegerin concentration in hemodialysis patients.

Method
Fasting blood samples were obtained from 75 chronic hemodialysis patients. BMD was measured by dual energy X-ray absorptiometry in lumbar vertebrae (L2-L4). Serum osteoprotegerin levels were measured using a commercial enzyme-linked immunosorbent assay.

Results
A total of 7 patients (9.3%) had osteoporosis and 20 patients (26.7%) had osteopenia in hemodialysis patients. Older age (p = 0.023), increased serum osteoprotegerin (p &lt; 0.001), urea reduction rate (URR, p = 0.021), Kt/V (p = 0.027), while decreased height (p &lt; 0.001), body weight (p &lt; 0.001), body mass index (BMI; p &lt; 0.001), and logarithmically transformed triglyceride (log-triglyceride, p = 0.020) was significantly correlated with low lumbar T-score cut-off points between groups (normal, osteopenia, and osteoporosis) in hemodialysis patients. Female patients had lower lumbar BMD than male hemodialysis patients (p = 0.002). Univariate linear regression analysis indicated lumbar BMD were positively correlated with height (p &lt; 0.001), body weight (p &lt; 0.001), BMI (p &lt; 0.001), log-triglyceride (p = 0.004), creatinine (p = 0.016), while negatively correlated with age (p = 0.001), alkaline phosphatase (p = 0.016), URR (p = 0.012), Kt/V (p = 0.013), and osteoprotegerin (p &lt; 0.001) among the hemodialysis patients. Multivariate forward stepwise linear regression analysis of the significant variables revealed that female hemodialysis patient (adjusted R2 change = 0.040; p = 0.003), body weight (adjusted R2 change = 0.126; p = 0.001), kt/V (adjusted R2 change = 0.024; p = 0.034) and osteoprotegerin (adjusted R2 change = 0.332; p &lt; 0.001) were the independent predictors of lumbar BMD values in the hemodialysis patients.

Conclusion
Our study results revealed that increased serum osteoprotegerin levels were independently associated with decreased BMD in the lumbar spine, and with increased risk of osteoporosis in hemodialysis patients.
P1424IMPACT OF DIRECTLY OBSERVED TREATMENT OF ONE ALFACALCIDOL ON MINERAL BONE DISORDER PROFILE IN DIALYSIS PATIENTS-A SINGLE UNIT PILOT STUDY
Authors: Baig Mirza Yasar , Chinnadurai Rajkumar , Chrysochou Tina 
Published: June 2020

Abstract
Impact of directly observed treatment of one-alfacalcidol on mineral bone disorder profile in dialysis patients- A single unit pilot study

Background and Aims
Secondary hyperparathyroidism (SHPT) is a common mineral bone disorder observed in patients with end-stage renal disease. Management of SHPT can be challenging mainly due to poor medication compliance. Directly observed treatment (DOT) has shown to improve management outcomes in other conditions like tuberculosis. We conducted a pilot study to investigate the impact of DOT with one alfacalcidol for SHPT in our cohort of dialysis patients.

Method
This prospective observational study was conducted on 21 end stage renal disease patients on dialysis from a single centre who were commenced on one alfacalcidol on dialysis days under direct observation .All patients had not shown any improvement in PTH despite increase in one alfacalcidol either admitted to or were suspected to have medication non-adherence. Serum bone mineral profile including parathormone (PTH), corrected calcium, phosphate and alkaline phosphatase were recorded before and after initiation of DOT. Treatment outcome was measured by comparing the mean change in the biochemical profile prior DOT initiation and at the lowest PTH value achieved on DOT. Data was analysed by paired t test using SPSS software.

Results
The mean age of our sample at the time of commencing DOT therapy was 52 years. Our sample had a predominance of males (67%) and Asian ethnicity (62%). 71% had a history of hypertension and 43% were diabetic. DOT one alfacalcidol therapy produced a significant reduction in the mean PTH value (pre-DOT- 92.2 vs post DOT-36.1 pmol/L, p&lt;0.001). There was a significant rise in the corresponding mean corrected calcium levels (pre-DOT- 2.22 vs post-DOT-2.45 mmol/L, p=0.001) (table–1). Over a mean follow up of 8 months, a significant reduction in the one alfacalcidol dose requirement was observed in 52.38% of our cohort.

Conclusion
DOT one alfacalcidol therapy produced a significant improvement in the mineral bone profile in our cohort of dialysis patients. DOT approach can help to improve the outcomes in dialysis patients with poor compliance.
P1427ROLE OF ETECALCETIDE IN THE MANAGEMENT OF SECUNDARY HYPERPARATHYROIDISM
Authors: Moliz Candela , Canllavi Elisabeth , Redondo Beatriz , Fernandez-Vidal Maria , Bada Bosch Teresa , Trujillo Hernando , Aubert Lucia , Sandino Justo , Gutiérrez Vilchez Elena , Mérida Evangelina 
Published: June 2020

Abstract

Background and Aims
Secondary Hyperparathyroidism (SHPT) is a complication of chronic kidney disease (CKD). Etelcalcetide is the first intravenous calcimimetic authorized for the treatment of SHPT in haemodialysis (HD). It has proven to be effective in lowering parathyroid hormone (PTH), with an acceptable and comparable safety profile. The aim of this descriptive study was to evaluate the results of using etelcalcetide in patients on HD with SHPT.

Method
Thirty patients on HD received etelcalcetide were enrolled (figure 1). The minimum observation period was 6 months. Fifteen (50%) were previously with cinacalcet (group 1) and 15 (50%) received etelcalcetide at onset (group 2). We analyzed change of serum iPTH, calcium (Ca) and phosphorus (P) in both cohorts; as well as the dosage of calcium carbonate, non-calcium (phosphate binders) and / or vitamin D analogs. The presence of adverse effects were also recorded.

Results
Thirty patients on HD received etelcalcetide were enrolled (figure 1). The minimum observation period was 6 months. Fifteen (50%) were previously with cinacalcet (group 1) and 15 (50%) received etelcalcetide at onset (group 2). We analyzed change of serum iPTH, calcium (Ca) and phosphorus (P) in both cohorts; as well as the dosage of calcium carbonate, non-calcium (phosphate binders) and / or vitamin D analogs. The presence of adverse effects were also recorded.
In global, serum iPTH levels were significantly decreased during therapy compared to baseline levels. When comparing both groups, we found a significant decrease of Ca, P and iPTH in group 2. However, we only found significant decrease of Ca in group 1 (figure 2). When we analyzed the reducton of PTH &gt;30% in both groups, we observed that 46.6% of patients treated with etecalcetide compared to 33.3% of patients treated with cinacalcet, achieved this reduction in PTH. The dosage of calcium binders (33.3% pretreatment vs 56.7% at the end of follow-up, p 0.054), non-calcium binders (40% pretreatment vs 63.3% at the end of follow-up, p 0.02) and vitamin D analogues (56,7% pretreatment vs 66,7% at the end of follow-up, p 0,3) were increased when etelcalcetide treatment was started. No changes were made in dialysate calcium concentration. Six patients, presented hypocalcemia (Ca &lt; 7.5 mEq/l).

Conclusion
In our cohort, etelcalcetide has shown to be effective in reducing serum iPTH. In addition, etecalcetide was noninferior to cinacalcet reducing PTH&gt;30%. An increase in the use of vitamin D analogues, calcium binders and non-calcium binders has been observed, probably due to the hypocalcemia.
P1438IMPACT OF HOSPITALIZATION ON BODY COMPOSITION OF DIALYSIS PATIENTS
Authors: Guinsburg Adrian , Kohn Tuli Alejandro , Dalmeida Eurfronio , Barra Ana Beatriz , Machuca Eduardo , Olivares Orlando , Arango Javier , Gomez Canabal María Ines , Briones Leonor , Lopera Maria , Resk Maria Mercedes , Caseiro Mauro , Berbessi Juan Carlos 
Published: June 2020

Abstract

Background and Aims
Patients with CKD are at higher risk of hospitalization (hosp) and this event is a known marker of prognosis. In this study we aim to describe hospitalizations in LatinAmerica and the impact on body composition as measured by multifrequency bioimpedance.

Method
All hospitalizations from Fresenius Medical Care clinical database (EuCliD®) registered in dialysis patients from Argentina, Brasil, Chile, Colombia, Ecuador and Perú during calendar year 2018 were included into the analysis. For each hospitalization we reviewed main reason (ICD10 code), duration and outcome (discharge or death). Body composition was measured using multifrequency bioimpedance (BMC®). On patients with BCM data available in the 30 days prior to hospitalization and before 15 days after discharge values pre and post hospitalization were recorded (BCM data, lab data, treatment data). Pre and post data were compared using Student t test for paired samples. All values expressed as mean ± standard deviation (SD).

Results
During all calendar year 2018, a total of 23,347 hospitalizations from 44,228 patients were recorded.  Mean age was 61.4 ± 16.1 / Male 56.4% / diabetes 38.7%. Accounting for time at risk, hosp rate was 0.74 hosp/pt-year at risk. Mean stay at hospital was 10.9 ± 14.4 days (7.6 days/pt-yr). 35.24% of patients suffer at least one hosp during the year.
Reasons for hospitalization are indicated in table 1:
Conclusion:
Hospitalization in dialysis patients is a frequent event. It has a significant impact on Hb, Ca, P and Albumin levels. Although net patient's weight is significantly reduced, real decrease in muscular and fat mass may be masked by increase in excess water (overhydration) as shown in our results. An early BCM measurement and dry weight adjustment after discharge may be a helpful tool for patient management optimization.
P1443USE OF WRIST-BASED MONITORING DEVICE AMONG HEMODIALYSIS PATIENTS - A FEASIBILITY STUDY
Authors: Han Maggie , Preciado Rojas Priscila , Thwin Ohnmar , Tao Xia , Tapia Leticia , Rivera-Fuentes Lemuel , Hakim Mohamad , Patel Amrish , Grobe Nadja , Thijssen Stephan , Kotanko Peter 
Published: June 2020

Abstract

Background and Aims
Pervasive sensing technologies allow healthcare providers to gain additional insights into patient’s status outside the clinical setting. In order to adopt widespread use of remote monitoring devices we must first study the feasibility of their use. We aim to quantify how long patients will use a wearable device before requiring an intervention to maintain the use of the device.

Method
In-center hemodialysis (HD) patients were enrolled from 4 clinics in New York City starting in May 2018 and followed for a period of up to 1 year. Patients ≥18 years, on HD ≥3 months, able to walk, owning a smartphone, mobile tablet or PC were enrolled. They were provided with a wrist-based monitoring device (Fitbit Charge 2). Participants were instructed on how to use the device, and sync data to their smartphone, mobile tablet, or PC. If a patient failed to sync data for 7 consecutive days, a text message or email reminder was sent from the research staff. We evaluated time to first notification using Kaplan Meier time-to-event analysis. Predictors of time to first intervention was assessed via univariate Cox Regression. Patients were censored at the end of the observation period (January 6, 2020). Socio-economic parameters such as living situation, marriage status, employment status, race, and education level were collected at the beginning of the study.

Results
125 patients were enrolled into our study. 7 patients were screen-failed after enrollment. At enrollment patients were 54±12 years old with a dialysis vintage of 5.6±5.8 years. 37% lived alone, 56% were single, 59% unemployed, 64% were African-American, and 42% had an education level of some college or higher. 82% of the patients required a text message reminder to continue wearing/syncing the device. Mean and median time to first reminder were 101 days (95% CI 80 to 123) and 50 days (95% CI 35 to 70 days), respectively. The probability of being on the study without intervention is shown in Figure 1. Predictors of time to first intervention were chosen a priori and included gender, age, living situation, and education level. None of these parameters were significant predictors of time to first intervention.

Conclusion
We found that most patients will require at least some intervention or counseling to maintain the use of a wrist-based wearable device for remote patient monitoring. While most patients require an intervention before approximately 2 months into wear, the patients who can maintain use independently after that point are likely to do so for longer.
P1449MORTALITY RISK ASSOCIATED WITH ACETIC ACID BASED AND CITRIC ACID BASED BICARBONATE HEMODIALYSIS: A HISTORICAL COHORT STUDY
Authors: Neri Luca , Bellocchio Francesco , Canaud Bernard , Stuard Stefano , Chazot Charles 
Published: June 2020

Abstract

Background
Citric Acid Based Bicarbonate Dialysate (CiD) is increasingly used in hemodialysis to improve hemodynamic tolerance and hemocompatibility associated with Acetic Acid Based Bicarbonate dialysis (AcD). We sought to evaluate the mortality risk associated with different dialysate acidifiers.

Methods
We conducted a multicenter, historical cohort study; all adult incident hemodialysis patients registered in EMEA Fresenius Medical Care network since January 1st 2014 to October 31st 2018 were enrolled. We recorded dialysate acidifier composition for each dialysis session. In the primary analysis (intention-to-treat population), patients were assigned to the exposed group if they received CiD in more than 70% of sessions during the first three months (CiD70%), whereas non-exposed received no CiD at all. In the secondary analysis, exposure was assessed on a monthly basis for the whole duration of the follow up.

Results
We enrolled 10,121 incident patients during the study period. Of them, 371 met criteria for inclusion in CiD70%. After propensity score matching mortality was 11.43 (95%CI: 8.86 - 14.75) and 12.04 (95%CI: 9.44 - 15.35) deaths/100 person-years, in the CiD0% and CiD70% groups respectively (p=0.80). A similar association trend was observed in the secondary analysis.

Conclusions
We did not observe evidence of increased mortality among patients exposed to CiD in a large European cohort of dialysis patients despite physicians were more inclined to prescribe CiD to subjects with worse medical conditions.
P1460MEDIATORS OF THE IMPACT OF HOURLY NET ULTRAFILTRATION RATE ON MORTALITY IN CRITICALLY ILL PATIENTS RECEIVING CONTINUOUS RENAL REPLACEMENT THERAPY
Authors: Naorungroj Thummaporn , Neto Ary Serpa , Zwakman-Hessels Lara , Yanase Fumitaka , Eastwood Glenn , Bellomo Rinaldo 
Published: June 2020

Abstract

Background and Aims
During continuous renal replacement therapy (CRRT), a high net ultrafiltration (NUF) rate is associated with increased mortality. However, it is unknown what might mediate its putative effect on mortality. This study aims to investigate whether the relationship between early (first 48h) NUF and mortality is mediated by fluid balance (FB), hemodynamic instability or low potassium or phosphate blood levels.

Method
We performed a retrospective, observational study in patients treated with CRRT within 14 days of ICU admission who survived &gt;48 hours. The primary outcome was hospital mortality. We applied multiple mediation analysis to identify possible mediators of NUF’s putative impact on mortality.

Results
We studied 347 patients [median (interquartile range) age: 64 (53–71) years and Acute Physiology and Chronic Health Evaluation (APACHE) III score: 73 (54–90)]. After adjustment for confounders, compared with a NUF&lt;1.01 ml/kg/h, a NUF rate &gt; 1.75 mL/kg/h was associated with significantly greater mortality (adjusted odds ratio [aOR], 1.15 [95%CI, 1.03 to 1.29]; p = 0.011). Adjusted univariable mediation analysis found no suggestion of a causal mediation effect for blood pressure, vasopressor therapy, or potassium levels, but identified a possible effect for FB (average causal mediation effect (ACME), 0.95 [95%CI, 0.90 to 0.99]; p = 0.062) and percentage of phosphate measurements with hypophosphatemia (ACME, 0.96 [95%CI, 0.92 to 1.00]; p = 0.055). However, on multiple mediator analysis, such variables lost any suggestion of a significant effect. In contrast, NUF rate remained associated with mortality even in their presence (average direct effect, 1.24 [95%CI, 1.11 to 1.40]; p &lt; 0.001).

Conclusion
An early NUF greater than 1.75 mL/kg/h was independently associated with increased hospital mortality. Its putative effect was not mediated by FB, low blood pressure, vasopressor use, hypokalemia or hypophosphatemia.