bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1540EFFECT OF ONLINE HEMODIAFILTRATION ON ANEMIA AND NUTRITIONAL STATUS ON MAINTENANCE HEMODIALYSIS PATIENTS
Authors: Jeong Hyeyun , Lee Yu Ho , Lee So-Young , Yang Dong Ho 
Published: June 2020

Abstract

Background and Aims
The global prevalence and incidence of maintenance dialysis are increasing. Among the modalities of RRT, maintenance hemodialysis (HD) has been a major method worldwide for patients with end-stage renal disease (ESRD). The recent introduction of online-hemodiafiltration (OL-HDF) may offer major advantages in clearing molecules of various sizes, reducing HD-associated amyloidosis and chronic inflammation. Because this modality has been officially approved for ESRD patients, the number of patients worldwide undergoing OL-HDF therapy have consistently increased. However, evidence of clinical effects of OL-HDF is scarce. In this study, we investigated changes in laboratory values over more than 12 months after switching to OL-HDF.

Method
The present study included data from a K-cohort (CRIS no. KCT0003281) of prospectively enrolled adult patients with ESRD undergoing hemodialysis in 6 tertiary hospitals in South Korea. A total of 435 patients was recruited, and 339 patients were on HD at the beginning of the study period. Among the 339 patients, 182 were followed up for more than 24 months. During the follow-up period, 135 patients remained on HD and 47 switched to HDF. However, 3 of the 47 who switched to HDF later returned to HD. We compared clinical parameters in 44 patients who switched to OL-HDF and 135 patients who remained on HD (Figure 1). We used a paired t-test to compare baseline and 24-month follow-up results.

Results
The mean age of the study subjects was 61.2 ± 12.2 years, and 62.6% were male. The duration of dialysis was 2.9 ± 4.4 months. In the group that was switched from HD to OL-HDF, the levels of Hgb and serum albumin increased significantly (10.46 ± 1.03 vs. 11.08 ± 0.82, P = 0.001, and 3.73 ± 0.29 vs. 3.87 ± 0.30, P = 0.001, respectively). Although the normalized protein catabolic rate (nPCR) decreased from baseline after 24 months, the change was not significant (1.07 ± 0.25 vs. 1.03 ± 0.21, P = 0.433). Calcium and calcium-phosphorus products also increased significantly after OL-HDF therapy (8.32 ± 0.75 vs. 8.75 ± 0.80, P &lt; 0.001 and 41.89 ± 12.62 vs. 50.80 ± 20.79, P = 0.013, respectively).
To determine possible confounding effects of clinical factors, we conducted a linear regression analysis with multiple adjustments for changes in various laboratory values after HDF conversion. Conversion to HDF resulted in elevation of serum calcium and albumin levels, both of which were significant even after adjustment for baseline demographics, inflammation, and dialysis duration.

Conclusion
In conclusion, long-term OL-HDF treatment over 12 months or longer was associated with no detrimental effects on anemia or nutritional status. To investigate the effects of OL-HDF therapy, evaluating more parameters over a longer follow-up period with a larger number of patients is needed.
Figure 1.
P1542DIALYSIS MODALITY AND OUTCOMES IN GERIATRIC END STAGE RENAL DISEASE (ESRD) PATIENTS. AN ASIAN SINGLE CENTER EXPERIENCE
Authors: Supayah Jeevita , Wong Hin Seng , Lee Fei Yee , Yakob Suryati 
Published: June 2020

Abstract

Background and Aims
The prevalence of CKD increases with age and more elderly patients are on maintenance dialysis as advanced age is no longer an impediment. The selection of dialysis modality can be difficult for the simultaneous benefit and burden of individual modality on top of the complexity of co-morbidity and quality of life.
To study the survival outcomes based on dialysis modality in geriatric ESRD patients

Method
The cohort of geriatric patients (aged &gt; 65 years) with ESRD who were referred to our pre-dialysis clinic from 1st January 2016 to 31st December 2018 and started on maintenance dialysis were identified via the hospital information system. Demographics, co-morbidities, dialysis modalities and clinical outcome in terms of survival were obtained from the hospital electronic medical record. Glomerular filtration rates (eGFR) were calculated using the CKD-EPI formula in mls/min/1.73m2. The statistical analysis was done using SPSS version 23.

Results
A total of 145 geriatric ESRD patients were initiated on chronic dialysis. The cohort was predominated by male with 77 patients (53.1%). The mean age was 72.5±5.2 years. Majority had multiple comorbidities with 95% having hypertension, 82.8% with diabetes, 65.5% and 32.8% having dyslipidemia and ischemic heart disease, respectively. The mean eGFR at point of referral and dialysis initiation were 12.5±4.9 mls/min/1.73m2 and 6.57±2.33 mls/min/1.73m2 respectively. Mean duration to initiate dialysis from first review was 6.7±5.8 months.
Majority opted for hemodialysis (HD) with 106 patients (73.1%). 74% patients in the HD cohort initiated dialysis via a catheter and remainder with an arteriovenous fistula (AVF). 39 patients (27.1%) opted for peritoneal dialysis (PD) and all were initiated via tenckhoff catheter. Mean eGFR at dialysis initiation were 6.44±2.47 (HD) and 6.9±1.9(PD) respectively.
At 6 months, all PD patients survived and 18.2% of HD patients died with statistically significance difference at p=0.003. No survival predictors were identified.

Conclusion
PD modality has advantage in survival outcome in geriatric ESRD patients.
P1546UK ANNUAL THERAPY COST OF DIALYSIS WITH THE QUANTA SC+ PERSONAL HAEMODIALYSIS SYSTEM
Authors: Ferguson Thomas , Komenda Paul , Harper Gerard , Milad John 
Published: June 2020

Abstract

Background and Aims
The number of patients receiving dialysis is increasing in the United Kingdom, costing the National Health Service (NHS) over 500 million GBP annually. New personal haemodialysis systems are being developed, such as the Quanta SC+, that are smaller and simpler to use by patients while providing the clearances of conventional systems. Increasing uptake of lower intensity assistance and full self-care dialysis may provide economic benefits to the public health payer. In addition, promotion of every other day dialysis (3.5x weekly) may improve costs to the health system by helping to close the “post-weekend effect” with increased emergency department use and hospitalisations following the long interdialytic gap. As such, we aimed to describe the annual therapy costs of using SC+ in the UK for 3x weekly and 3.5x weekly dialysis regimens, both for self-care haemodialysis provided in-centre and at home in comparison to dialysis provided with conventional machines from the perspective of the health care system.

Method
Cost minimisation approach. Costs for human resources, equipment, and consumables were sourced from the dialysis machine developer (Quanta Dialysis Technologies). Other costs, such as facility expenses, dialysis-related drugs, avoided emergency department and hospitalisation events, and utilities were taken from a review of the literature. Costs are provided in 2018 GBP.

Results
Therapy provided as self-care in-centre or full self-care at home were found to have similar costs (£33,721 in-centre versus £33,836 at home for the 3x weekly regimen). Costs increased to £37,238 for self-care in-centre and £35,557 at home for the 3.5x weekly regimen. A comparator cost of £39,416 was established for dialysis provided with conventional machines in-hospital 3x weekly. For each dialysis patient, the health care system is anticipated to save £3,666 in costs associated with excess hospital stays and £2,176 in costs associated with excess emergency department visits.

Conclusion
In the UK, SC+ offers cost savings when used both for self-care in-centre and full self-care at home in comparison to dialysis provided in the clinic using conventional machines.
P1550ACCESS TO KIDNEY TRANSPLANTATION IN A NON-PROFIT FACILITY IN GERMANY
Authors: Kemmner Stephan , Arns Wolfgang , Von Gersdorff Gero , Bach Rolf Dieter , Fischereder Michael 
Published: June 2020

Abstract

Background and Aims
Recent studies demonstrate that US patients undergoing chronic dialysis treatment for end stage renal disease (ESRD) at for-profit facilities had a lower access to kidney transplantation than patients at non-profit facilities. However, even at non-profit facilities only around 20% of patients were placed on the kidney transplantation waiting list. At first glance, this number appears rather low, as kidney transplantation is the only way to curatively treat ESRD.
We want to compare these figures with a recently performed survey in Germany.

Method
We analyzed the status of transplant evaluation in the largest non-profit facility in Germany, the Kuratorium für Dialyse und Nierentransplantation e.V. (kfh, www.kfh.de). In total, the transplant status was assessed in 16,705 patients.

Results
Out of these only 19.4% of patients (n=3241) are on the kidney transplant waiting list, comparable to recently performed US studies. The reason why patients are not waitlisted are multifaceted as seen in attached figure. Due to severe comorbidities about 50% are considered too sick to benefit from transplantation, in turn representing the complex and high multi-morbidity of patients with ESRD. On the other hand, approximately 10% of dialysis patients actively decline listing for renal transplantation at least at some point.

Conclusion
We conclude that further research is needed to identify and break the mechanisms behind the low likelihood for access to kidney transplantation waiting list.
Distribution of patients with surveyed transplant status in the largest non-profit dialysis facility (kfh, www.kfh.de) in Germany
P1564SLEEP QUALITY ASSESSMENT ON HÉMODIALYSIS
Authors: Maha Cheikh , Soumaya Chargui , Fathi Ben hmida , Taieb Ben abdallah 
Published: June 2020

Abstract

Background and Aims
sleep disorders are a major public health problem, affecting the majority of patients with end-stage chronic kidney disease.
The purpose of this work is to assess the quality of sleep and identify the associated factors.

Method
This is a single-center cross-sectional study of 57 patients on conventional hemodialysis. Clinical screening was conducted using the Epworth Sleepiness Scale.

Results
The average age of the patients was 53.43 years (between 25 and 82 years), with a sex ratio of 1.08. The socio-economic level was considered bad in 70% of the cases. The main co-morbidities are hypertension in 50.8% of cases and diabetes in 24.5% of cases. The average seniority on hemodialysis was 7.47 years. 53% of patients had sleep disorders and they were insomnia in 39% of cases, daytime sleepiness in 59% of cases of which it was excessive (Epworth score&gt; 15) in 15% of cases, a syndrome restless legs in 3% of cases and obstructive sleep apnea with snoring in 13% of cases.

Conclusion
The prevalence of sleep disorders is higher in hemodialysis patients than in the general population, and they are associated with a non-negligible cardiovascular risk, hence the importance of early detection and adequate management, thereby improving the quality of life of these patients.
P1566SKELETAL MUSCLE MASS BY COMPUTED TOMOGRAPHY AT THE LEVEL OF THE THIRD LUMBAR VERTEBRA AND MORTALITY IN END-STAGE KIDNEY DISEASE
Authors: Sabatino Alice , Regolisti Giuseppe , Delsante Marco , Di motta Tommaso , Parmigiani Alice , Peyronel Francesco , Maggiore Umberto , Fiaccadori Enrico 
Published: June 2020

Abstract

Background and Aims
Protein-Energy Wasting (PEW) is highly prevalent in patients with end-stage kidney disease on chronic hemodialysis (ESKD-HD). In such clinical setting PEW is associated to poor outcomes. The assessment of nutritional status is essential for the identification of patients at risk for the development of PEW. In the contest of nutritional evaluation, increasing attention is currently paid to the assessment of muscle mass, which represent the major protein asset in the body. Currently available bedside tools used for the assessment of nutritional status are not accurate enough for the assessment o skeletal muscle mass. In this clinical setting, the use of “gold standard” imaging methods (such as CT sca, DEXA or MRI) could allow a more accurate assessment of body composition. The aim of our study was to assess the correlation between skeletal muscle mass on the level of the third lumbar vertebra (L3) assessed by CT scan with mortality in ESKD-HD.

Method
In a retrospective observational study, 1260 ESKD-HD patients undergoing chronic hemodialysis treatment were identified between 2008 and 2015 in the Dialysis Centers of the National Health Service in the province of Parma. Among these patients, those with at least one available abdomen CT scan after the patient had already been on dialysis for at least 6 months were enrolled. The CT images obtained at the level corresponding to the L3 were analyzed using a dedicated software, in order to extrapolate the data related to the quantity of skeletal muscle tissue.

Results
We enrolled 183 ESKD-HD patients, aged 68.8 (± 15.1) yrs, 64% (117/183) males, median hemodialysis vintage 43.9 (range 6 – 208) months. The cohort was characterized by a high comorbidity burden, with a median Charlson Comorbidity Index of 9 (range 2-17). Baseline skeletal muscle mass at L3 was 118.5 cm2 (± 30.6). Median follow-up was 65.6 (range 6.6 – 132.5) months. During follow-up, 67% (122/183) of patients died.
Patients were divided based on quartiles of muscle mass. Patients in the first quartile had 83% mortality, while mortality of patients in the fourth quartile was 52% (OR = 4.16 95% CI = 1.59 – 10.87; P = 0.003). Kaplan-Meier analysis identified significantly lower survival in patients in the first quartile of muscle mass compared to those in the fourth quartile (P = 0.03 at the Mantel-Cox Log-rank test) (Figure 1).

Conclusion
Low muscle mass by CT scan appears to be associated with an increased risk of mortality in ESKD on chronic hemodialysis.
P1568EFFECTS OF VOLUME STATUS ON BODY COMPOSITION IN INCIDENT PERITONEAL DIALYSIS PATIENTS
Authors: Kang Seok Hui , Park Jong Won , Cho Kyu Hynag , Do Jun Young 
Published: June 2020

Abstract

Background and Aims
Volume control is the most important issue in peritoneal dialysis (PD). Inadequate fluid removal or high water intake leads to overhydration, which result in malnutrition. Sarcopenia (SP) as a result of malnutrition is more prevalent in PD than in the general population, and is associated with high mortality and low quality of life in PD patients. The aim of the present study was to evaluate the effects of volume status on body composition in incident PD patients.

Method
This retrospective study was performed at a tertiary medical center from January 2001 to March 2015. All incident PD patients who survived ≥1 year after PD initiation were considered eligible. 366 incident PD patients were finally included and divided into 3 tertiles according to the time-averaged-edema index (TA-EI). Edema index was calculated by dividing extracellular water values by total body water values. The mean of the EI values at 1 month and 1 year was defined as TA-EI. The body composition parameters measured using bioimpedance analysis included the EI, fat mass index (FMI, kg/m2), and appendicular muscle mass index (AMMI, kg/m2). dFMI and dAMMI were defined as delta values for each variable. The cutoff value for sarcopenia (SP) was defined as previously reported (The cutoff value for SP was defined as AMMI ≤ 7.0 kg/m2 in men and ≤ 5.7 kg/m2 in women). Patients with AMMI below the cut-off values were defined as having SP.

Results
The number of participants in the low, middle, and high tertiles was 126, 100, and 140, respectively. The TA-EI in the low, middle, and high tertiles was 0.384 ± 0.006, 0.398 ± 0.003, and 0.413 ± 0.009, respectively (P &lt; 0.001). A high volume status was associated with high solute clearance, peritoneal albumin loss, and glucose absorption through the peritoneal membrane, which led to high dialysate glucose. In addition, volume status was inversely associated with increases in AMMI, but was not associated with changes in FMI. SP as a categorical variable was positively associated with a high volume status. On subgroup analyses, TA-EI had the greatest negative correlation coefficients for dAMMI.

Conclusion
Overhydration in PD patients was associated with decrease in muscle mass indices and the development of SP.
P1576THE EFFECT OF CHANGING DIETARY PHOSPHORUS-PROTEIN RATIO ON NUTRITIONAL STATUS OF HEMODIALYSIS PATIENTS
Authors: Wang Song , Tian Xinkui , Lu Xinhong , Liu Hanmin , WANG YUE 
Published: June 2020

Abstract

Background and Aims
To investigate the effect of changing dietary phosphorus-protein ratio on the nutritional status of maintenance hemodialysis patients.

Method
Hemodialysis patients who had average serum phosphorus ≥1.78 mmol/L for three consecutive months were enrolled in this self-controlled trial. Patients received low phosphorus diet instruction for 4 weeks as baseline, followed by changed the diet of staple foods with the same amount of low protein rice for 10 weeks. The difference of protein intake between the low protein rice and staple foods was replaced by low phosphorus whey. Then the patients reverted to staple food for 8 weeks. Serum phosphorus, albumin and nutritional status before and after dietary changes were observed and analyzed.

Results
29 patients completed the study. At baseline dietary phosphorus-protein ratio was (15.85±3.29) mg/g, and serum phosphorus was (2.05±0.32) mmol/L. After switch to low protein rice and low phosphorus whey for 10 weeks, dietary phosphorus-protein ratio decreased to (12.18±2.45) mg/g (p&lt;0.001). Simultaneously serum phosphorus decreased to (1.87±0.44) mmol/L (p=0.048). Nutritional status evaluation showed the patients’ serum albumin increased significantly compared with baseline (42.29±3.51 vs. 39.84±3.23 g/L, p&lt;0.001), as well as dry body weight (65.09±15.30 vs. 64.71 ± 15.07 kg, p=0.030), upper arm muscle circumference (22.57±2.83 vs 22.00±3.03 cm, p=0.013), and the grip strength (27.89±7.82 vs. 26.54±7.90 kg, p=0.032). Subjective global assessment (SGA) and serum lipid level did not change significantly after the food change.

Conclusion
For hemodialysis patients, changing dietary phosphorus-protein ratio by combination of low protein rice and low phosphorus whey could effectively decrease serum phosphorus level, and improve serum albumin, as well as muscle mass and muscle strength.
P1577DOES VITAMIN E -COATED MEMBRANES INFLUENCE ON MARKERS OF OXIDATIVE STRESS IN HEMODIALZSIS PATIENTS WITH HOMOZYGOUS GST M1 GENE DELETION?
Authors: Djuric Petar , Suvakov Sonja , Markovic Dragana , Jovanovic Djurdja , Jankovic Aleksandar , Bulatovic Ana , Tosic Dragovic Jelena , Marinkovic Jelena , Naumovic Radomir , Simic Tatjana , Dimkovic Nada 
Published: June 2020

Abstract

Background and Aims
Increased free radicals production and down-regulated antioxidant enzymes activities contribute to protein, lipid and DNA oxidative damage particularly in HD patients lacking for GSTM1 enzyme activity. At the same time, those patients exhibit higher mortality rate than those with active GSTM1 genotype. It has been shown that vitamin E-coated membranes (VitEM) may decrease oxidative stress and inflammatory status in overall HD patients. Therefore, for the first time we analyzed VitEM dialyzers in patients who are homozygote for GSTM1 gene deletion and in whom anti-oxidative and anti-inflammatory benefit could be the greatest.

Method
GSTM1 genotypes were determined by PCR in 170 chronic HD patients. Those with GSTM1-null genotype were randomized and 80 were included in the study. Forty of them were dialyzed for three months with VitEM, while other forty were dialyzed with high-flux polysufone membranes of the same surface. Markers of protein and lipid oxidative damage, inflammation (thiol groups, malondialdehyde (MDA), Interleukin-6 (IL-6)), together with plasma antioxidant activity (glutathione peroxidase (GPX), superoxide dismutase (SOD)) were determined at the start and at the end of the study.

Results
Seventy-five patients’ finished the study. There were no significant differences in baseline characteristics between the two groups (age, sex, body weight, dialysis vintage, vascular access, presence of diabetes, dialyzers surface, Kt/V and CRP). Also, there were no significant differences at baseline markers of protein and lipid oxidative damage, inflammation and plasma antioxidant activity. After three months of therapy, GPX, MDA, thiol groups increased significantly in both groups, but without statistical significance between groups (Table 1). SOD did not change significantly during three month period. IL-6 increased in control group, at the same time decreased in VitEM group, but without statistical significance.

Conclusion
Vitamin E-coated membranes did not influence markers of oxidative stress in HD patients with GSTM1-null genotype. Further studies in the field are required.
P1580LONGITUDINAL CHANGES IN BODY COMPOSITION ARE ASSOCIATED WITH ALL-CAUSE MORTALITY IN PATIENTS ON PERITONEAL DIALYSIS
Authors: Song Young Rim , Kim Sung Gyun , Lee Hyung-Seok , Kim Hyung Jik 
Published: June 2020

Abstract

Background and Aims
Peritoneal dialysis (PD) is associated with a number of adverse body compositional changes, including fat gain and muscle wasting. Whether body compositional changes are associated with the long-term prognosis is uncertain. The purpose of this study was to analyze the effects of longitudinal changes in body composition on all-cause mortality in PD patients.

Method
PD patients were subjected to bioimpedance spectroscopy (BIS) and handgrip strength (HGS) at baseline and after 2 years. Among 160 patients, 131 patients were tested with a repeat BIS and HGS. Lean tissue index (LTI) loss and fat tissue index (FTI) gain were defined as a 10% decline in LTI and a 10% gain in FTI, respectively after 2 years.

Results
The prevalence of sarcopenia at baseline was 13.8%. After 2 years, LTI loss and FTI gain were observed in 40 (30.5%) and 58 (44.3%) patients, respectively. Baseline clinical factors did not predict longitudinal body compositional changes, and there was a negative association between changes in the LTI and FTI (r = –0.574, p &lt; 0.001). Low LTI and low HGS at baseline were significant predictors of all-cause mortality after adjusting for demographic and biochemical parameters, but not when cardiovascular factors were included in the multivariate analysis. However, LTI loss and FTI gain were independent risk factors for all-cause mortality after adjusting for demographic, biochemical, and cardiovascular parameters.

Conclusion
In PD patients, longitudinal changes in LTI and FTI were more strongly associated with all-cause mortality than single values in LTI and FTI.