bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1403PLASMA OSTEOPONTIN LEVELS DIRECTLY CORRELATE WITH INTACT PARATHYROID HORMONE AND ALKALINE PHOSPHATE LEVELS IN END STAGE RENAL DISEASE
Authors: Bansal Vinod , Druck Aleksander , Bontekoe Emily , Patel Dimpi , Hoppensteadt Debra , Fareed Jawed 
Published: June 2020

Abstract

Background and Aims
Bone turnover disorders and reduction in bone mineral density are commonly observed in end stage renal disease (ESRD) patients. Osteopontin (OPN) is a glycol-phosphoprotein that stimulates osteoclast adhesion to bone. OPN may play a significant role in the pathways involved in bone turnover disorders. The objective of this study was: (1) to identify plasma levels of OPN in ESRD and normal populations, and (2) to elucidate if relationships exist between OPN and iPTH, and OPN and alkaline phosphatase.

Method
Plasma levels of OPN were measured via commercially available enzyme linked immunosorbent assays (ELISAs) in ESRD patients (n=92). A chart review was conducted on these patients to identify levels of intact parathyroid hormone (iPTH) and alkaline phosphatase at time of plasma draw. Additionally, levels of total calcium, albumin, calcium corrected for albumin, phosphorus, ferritin, white blood cell count (WBC), and platelet count (PLT CT) were identified at time of plasma draw via the chart review. OPN levels were also measured in normal control patient plasma (n = 49) purchased from George King Bio-Medical, Inc., Overland Park, KS.

Results
The ESRD cohort showed a statistically significant elevation of OPN plasma levels (p &lt; 0.0001, Mann-Whitney t-test) compared to the normal group. Spearman correlation tests revealed a significant positive correlation of OPN with iPTH (p &lt; 0.0001; r = 0.5606, 95% confidence interval = 0.3968 to 0.6898) and OPN with alkaline phosphatase (p &lt; 0.0001; r = 0.4381, 95% confidence interval = 0.2494 to 0.5948) in the ESRD cohort. No statistically significant correlations were identified between OPN and total calcium, calcium corrected for albumin, albumin, phosphorus, ferritin, WBC, and PLT CT (p &gt; 0.05).

Conclusion
OPN levels are significantly elevated in ESRD patients. Furthermore, OPN levels were also found to be positively correlated with the bone turnover biomarkers iPTH and alkaline phosphatase. These studies suggest that hyperparathyroidism secondary to ESRD increases circulating iPTH, stimulating osteoblast and osteoclast activation and differentiation that increases alkaline phosphatase and OPN production, ultimately resulting in increased bone turnover.
P1406A CASE-CONTROL STUDY ON RISK FACTORS OF CALCIPHYLAXIS: DATA FROM CHINESE HEMODIALYSIS PATIENTS
Authors: Liu Yuqiu , Xie Xiaotong , Yang Canlin , Yang Xin , Zhang Xiao liang 
Published: June 2020

Abstract

Background and Aims
Calciphylaxis (CUA) is a rare but potentially fatal disease that is commonly occurred in dialysis patients. Since there is no data based on Chinese population, the study is aimed to investigate risk factors of CUA in Chinese hemodialysis patients.

Method
We retrospectively evaluated medical records of 20 hemodialysis patients who were newly diagnosed with CUA by skin biopsy admitted to Zhongda Hospital Southeast University from Oct.2017 to Dec.2018. Non-CUA dialysis patients with the same age and duration of dialysis were randomly selected as controls (Ratio=1:2).

Results
Most of CUA patients were male (80%) and elderly (55%), while 50% had a body mass index higher than 24. The mean time interval since start of dialysis to CUA diagnosis was 114.65±81.32 months, and the median time from appearance of skin lesion to diagnosis was 6 (2, 15) months. The incidence of hyperparathyroidism was higher in patients with CUA (80% vs 62.5%), but the differences of duration of elevated serum intact parathyroid hormone (iPTH) and its highest value were not significant compared with the controls. Warfarin therapy had no significant difference between two groups (15% vs 5%). Univariate logistic regression analysis indicated that male (OR 3.619, 95%CI 1.027-12.748), each 1 point increase in score of use of vitamin D and its analogues (OR 1.505, 1.029-2.201), each 1 mmol/L increase in corrected serum calcium level (OR 24.486, 1.570-381.873), each 1 mmol/L increase in serum phosphate level (OR 5.382, 1.767-16.389), each 1 pg/mL increase in iPTH level (OR 1.002, 1.000-1.003), each 1 g/L decline in serum albumin level (OR 1.181, 1.041-1.340), each 1 IU/L increase in serum alkaline phosphatase (ALP) level (OR 1.005, 1.000-1.009) and each 1 mg/L increase in hypersensitive c-reactive protein level (OR 1.029, 1.000-1.059) were significantly associated with CUA. Serum phosphate, albumin and ALP were still significant risk factors after multivariate analysis.

Conclusion
This is the first report of risk factors of CUA based on Chinese population. The results show that high levels of serum phosphate and ALP, low level of serum albumin are independent risk factors of CUA in Chinese hemodialysis patients. Unlike previous research from western countries, warfarin therapy didn’t show an increased risk in this study, propably because of the low exposure rate of it in China.
P1409HIP FRACTURE TRENDS IN SWEDISH GENERAL POPULATION AND DIALYSIS PATIENTS
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
Hip fracture incidence rate is higher in dialysis patients than in general population. We investigated and compared temporal changes in age-standardized hip fracture incidence rate (ASRhip fracture) 2007-2016 in men and women in the dialysis population and in the general population.

Method
We used the population-based Swedish national database of fractures and the Swedish Renal Registry of ESRD patients to retrieve data on ASRhip fracture in the general population and among dialysis patients. The average annual percent change of the hip fracture incidence trend was evaluated by join-point regression analysis according to gender in the two databases.

Results
ASRhip fracture was about three times higher in Swedish dialysis patients as compared to the Swedish general population. In dialysis patients, rates have steadily declined during the recent decade when assessed in both sexes combined, and when analysed in women and men separately. A similar trend was also seen in the general population; however, the rate of decline was steeper in dialysis patients than in the general population. The most recent data on ASRhip fracture (for 2016) show that ASRhip fracture was similar among female and male dialysis patients whereas ASRhip fracture in the general population was higher in women than in men.

Conclusion
Hip fracture incidence is declining in the general population and even more so in dialysis patients. In contrast to the general population where hip fracture incidence in 2016 is higher among women than in men, there was no such difference between the two sexes among dialysis patients.
P1410IMPACT OF VITAMIN D SUPPLEMENTATION ON CKD-MBD HEMODIALYSIS PATIENTS - A PROSPECTIVE STUDY
Authors: Figueiredo Cátia Raquel , Valerio Alves Ana Rita , Gonçalves Hernâni , Lopes Karina , Sofia Flora , Vila Lobos Ana 
Published: June 2020

Abstract

Background and Aims
There are evidences suggesting that 50-90% of hemodialysis (HD) patients are vitamin D deficient [25(OH) D level &lt;20 ng/mL] or insufficient (between 21 to 29 ng/mL). Recent guidelines recommend evaluation and supplementation low serum vitamin D levels in HD patients. However the effects of supplementation remains uncertain. Our aim was to evaluate the effect of supplementation on phosphocalcic metabolism and secondary hyperparathyroidism in HD patients of a hospital unit.

Method
Prospective study with an 18 months follow-up period. HD patients were supplemented with 12000 IU cholecalciferol 3 times a week if vitamin D level under 30ng/mL and 4000 IU if above. Every 6 months (3 time points) vitamin D, bone alkaline phosphatase (AF), calcium (Ca2+), phosphorus (P+) and intact parathyroid hormone (iPTH) blood levels were measured. Demographic, analytical and clinical data, including diabetic status, were analyzed. Categorical variables are presented as frequencies and percentages, continuous variables as means and standard deviations, or medians and interquartile ranges (IQR) for variables with skewed distributions. Statistical analysis was performed using SPSS version 21 for Windows.

Results
Sixty patients completed the follow-up period. The average was 74.70±1.43 years, 65% (n=39) were male and 41.7% (n=25) were diabetic. The average HD time at point 3 (18 months) was 3.15±3.62 years.
A repeated measures ANOVA with a Greenhouse-Geisser correction showed that cholecalciferol supplementation significantly changed vitamin D blood levels along time (F(2.492;144.54)=26.832; p&lt;0.001), with a statistically significant increase in vitamin D blood levels from time point 0 to point 3 (+8.27 ng/mL, p&lt;0.001). There was also a significant reduction of phosphorus (-0.53mg/dL, p=0.017) and iPTH blood levels (-144.09 pg/nL p&lt;0.001) in the same period. Seric calcium had a statistically significant increase from point 0 to 2 (+0.22 mg/dL, p=0.038). Using Pearson’s correlation, from point 0 to 3, we found a negative correlation between vitamin D and iPTH blood levels variation (Rs= -0.303, p=0.018) and a positive correlation between vitamin D and AF blood levels variation (Rs= 0.043, p=0.002).

Conclusion
Oral cholecalciferol supplementation increases significantly vitamin D blood levels and can be a good option in the management of secondary hyperparathyroidism and hypocalcemia. However, one of the limitations of our study was not to evaluate the use of medication such as P+ chelating agents and the small sample size. Therefore, large randomized clinical trials with clinically meaningful endpoints (fracture, hospitalization, parathyroidectomy, death) are still required to assess the usefulness of different vitamin D compounds for CKD and dialysis patients.
P1418BONE-DERIVED HORMONES, MINERAL METABOLISM, CARDIOVASCULAR DISEASE AND PATIENT OUTCOME IN END-STAGE RENAL PATIENTS
Authors: Ferreira Ana Carina , Mendes Marco , Silva Cecília , Cotovio Patrícia , Aires Inês , Navarro David , Correia Caeiro Pereira Fernando , Salvador Rute , Correia Bruna , Cabral Guadalupe , Nolasco Fernando , Ferreira Manuel Anibal A 
Published: June 2020

Abstract

Background and Aims
Chronic kidney disease-mineral and bone disorder (CKD-MBD) is frequent in end-stage renal disease ESRD (ESRD) patients, increasing morbid-mortality. The aim of this study was to analyse the associations between the new CKD-MBD players [alpha-klotho, fibroblast grow factor (FGF) 23, sclerostin] and the usual markers of the disease [parathyroid hormone (PTH), bone alkaline phosphatase (bAP), vitamin D (vitD), phosphorus (Pi), Calcium (Ca) and Magnesium (Mg)], as well echocardiographic findings [left ventricular mass index (LVMI) measured by Devereux formula, valvular calcifications], vascular calcifications and patients outcomes.

Method
We performed a prospective cohort study of a sample of ESRD patients listed for renal transplant. All patients were submitted to renal transplant and were followed for 12 months. Patient and graft survival were recorded. At inclusion, demographic and clinical data were collected, laboratorial evaluation, bone biopsy and X-ray of the pelvis and hands (Adragão score) were performed. Continuous variables are presented as medians and categorical variables as frequencies. Associations between variables were performed using Wilcoxon rank sum test and Spearman correlation test. STATA software was used and p &lt; 0.05 was considered statistically significant.

Results
We included 85 patients. Mean age 50.1±12.7 years, 59 men (69.4%), 66 caucasian (77.6%). The median LVMI was 108.5 (92 – 129) g/m2, with 32 patients presenting LVH and 19 valvular calcifications. Median Adragão score was 1 (0 – 2). At the end of 12 months, 4 patients died and 5 had graft failure (non-primary function).
Alpha-klotho correlated with bAP (p=0.0006) and marginally with PTH and absence of valvular calcifications (p=0.05). FGF23 correlated with Pi (p&lt;0.001), Ca (p=0.004), PTH (p=0.003), Mg (p=0.002), and inversely with bAP (p=0.003). There was a marginal association with Adragão score (p=0.06). We didn’t found correlations between FGF23 and alpha-klotho or dialysis vintage or echocardiographic characteristics.
Sclerostin correlated negatively with bAP (p=0.007) and PTH (p=0.04). The 3rd sclerostin tertile was associated with high scores of vascular calcifications (p=0.02). Lower levels of sclerostin were associated with patient survival at the end of 12 months (p=0.02).

Conclusion
From these 3 new bone-derived hormones, sclerostin, a bone formation inhibitor, seems to act as a risk factor for vascular calcifications and worse outcomes.
P1423INCREASED BLOOD FLOW RATE IN HIGH-FLUX HAEMODIALYSIS - IS IT RELEVANT FOR PHOSPHORUS REMOVAL IN HAEMODIALYSIS PATIENTS?
Authors: Smokovska Nikolina , Stojceva-Taneva Olivera , Nedelkoska Mence , Misovska Nadica , Josimovski Nikola , Vangelova Aleksandra 
Published: June 2020

Abstract

Background and Aims
High-flux haemodialysis (HD), beside other uremic solutes harmful for patients, controls the level of phosphorus, major factor for HD-related morbidity and mortality. First line in phosphorus control in HD patients is dietary phosphorus intake reduction, whereas its’ removal is undervalued by hemodialysis. The primary objective was to analyse whether change in the rate of blood flow is relevant in phosphorus removal in HD patients. Second objective was to evaluate other variables impacted by higher blood flow rates.

Method
Retrospective study was conducted enrolling 80 patients from a single center in a period of 12 months. In the first six months, all patients were on lower blood flow rate (LBFR group) than the same patient group was switched to a higher blood flow rate in the following six months (HBFR group). Demographic, clinical and laboratory variables were collected and intra/inter-patient group analysis was performed.

Results
Forty-seven patients were male, and 41.3% were female. Mean age of the study population was 61.2±13.47 years (males 60.3±13.38, females 62.4±13.68). Mean dialysis vintage was 63.31±66.57 months. The average real blood flow rate in LBFR group was 290.75±19.65 ml/min (median 285.34 ml/min), 344.87±9.12 ml/min in HBFR group (median 339 ml/min), p=0.0002. The level of phosphorus in LBFR group was 1.52±0.03 mmol/L, and 1.45±0.04 in HBFR group, p=0.007. Other variables that significantly showed improvement following the increase of blood flow rate were eKT/V (p=0.0006), urea clearance (p=0.02) and transferrin saturation (p=0.04). The level of post-HD urea (p=0.02) and body surface area (p=0.04) were decreased. Weekly EPO dosage decrease in HBFR group (p=0.02) was not correlated with increased iron sucrose administration (LBFR group 59.99±36.18 mg/wk, HBFR group 65.8±28.7, p=0.45). There were no significant changes related to cardiac function; systolic (p=0.44) and diastolic pressure (p=0.36), mean arterial (p=0.43) and pulse pressure (p=0.26) remained in reference range. Also, the average dose of calcium-based phosphate binders did not change significantly (p=0.34).

Conclusion
This study showed that increased blood flow rate in HD patients reduces phosphorus and EPO consumption, improves urea clearance without significant impact on cardiac function and calcium overload with calcium-based phosphate binders.
P1426EFFECTIVENESS AND SAFETY OF ETELCALCETIDE IN THE LONG TERM IN CLINICAL PRACTICE IN HEMODIALYSIS PATIENTS WITH SECONDARY HYPERPARATHYROIDISM
Authors: Diaz Campillejo Rosa , Ruiz Calero Cendrero Rosa María , Olivera Azevedo Lilia , Rodriguez Sabillon Jorge Alberto , Ruiz Jimenez Belen , Fernandez Solis Maria Antonia , Galan Gonzalez Maria Josefa , Cancho Castellano Barbara , Martín Hidalgo Barquero Maria Victoria , Barroso-Hernandez Sergio 
Published: June 2020

Abstract

Background and Aims
: Secondary hyperparathyroidism (HPT) is a frequent complication in hemodialysis (HD) patients. Until now we had oral Vit / D analogues and oral Cinacalcet for treatment. The appearance of Etelcalcetide brings new treatment possibilities. Apart from clinical trials there are few long-term results in usual practice. Our goal is to evaluate results with the use of Etelcalcetide after more than a year of treatment in clinical practice of HD.

Method
We carry out a prospective descriptive study for 15 months with patients with HPT-HD, the ones who were with Cinacalcet and had not responded or had intolerance were changed to Etelcalcetide. Patients without prior treatment with calcimimetics were also included. Treatment with Vit D analogues and phosphate binders is treated according to usual clinical practice.

Results
We studied 25 HD patients, 12 men and 13 women with a mean age of 59.5 ± 13.6 years, 11 began de novo calcimimetic treatment and in 14 Cinacalcet was modified to Etelcalcetide due to lack of response or poor oral tolerance. Starting dose 2.5 mg post-dialysis, mean final dose 7.5 mg. We observed a reduction of PTH ≥30% in 80% of patients and a decrease ≥50% in 52%, Figure 1 shows the decrease over 15 months. The calcium corrected to albumine (Cac) decreased 4.8% ± 8 compared to baseline. The majority of patients present mild hypocalcemia (Cac between 7.5 and 8.3 mg / dl) and asymptomatic. There are no differences with P. Patients with PTH in range according to KDIGO went from 8% to 63%. No serious clinical manifestations of hypocalcemia or symptoms of digestive intolerance or other side effects appeared.

Conclusion
Etelcalcetide in the long term significantly improves the control of HPT in HD with a high safety profile. IV administration facilitates compliance without having followed serious side effects in 15 months of follow-up.
P1445ESPECIALLY HYPOKALEMIA IS A RISK FACTOR FOR ALL-CAUSE MORTALITY IN INCIDENT HEMODIALYSIS PATIENTS
Authors: De Rooij Esther , Dekker Friedo W , Le Cessie Saskia , De Fijter Johan W , Hoogeveen Ellen K 
Published: June 2020

Abstract

Background and Aims
Both hypo- and hyperkalemia can potentially induce fatal cardiac arrhythmias in the general population. However, little is known about the effect of potassium as a modifiable risk factor in hemodialysis (HD) patients. Therefore, we investigated the relation between serum potassium level and all-cause mortality in incident HD patients and whether there is an optimum serum potassium level to pursue.

Method
All incident HD patients (&gt;18 y) from the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD), a prospective multi-center cohort study, were included. These patients were followed from the start of their first dialysis treatment until death, transplantation or a maximum of 2 years. Serum potassium levels were obtained at fixed 6-month time intervals and divided into six categories: ≤ 4.0, &gt; 4.0 - ≤ 4.5, &gt; 4.5 - ≤ 5.0, &gt; 5.0 - ≤ 5.5 (reference), &gt; 5.5 - ≤ 6.0 and &gt; 6.0 mmol/L. Using a Cox proportional-hazards model with serum potassium category as a time-dependent variable, hazard ratios (HR) for all-cause mortality were calculated, adjusted for baseline age, sex, current smoking, diabetes and residual kidney function.

Results
In total, 1278 HD patients were included. At baseline, mean (±SD) age was 64 (±14) years, 60% were men, 23% were current smokers, 21% had diabetes and the median (interquartile range) residual kidney function was 3.0 (1.5-4.8) ml/min/1.73m2. Mean (±SD) serum potassium level was 4.8 (±0.8) mmol/L. The prevalence of the six potassium categories was: 10%, 19%, 26%, 22%, 15% and 8%, respectively. A total of 298 (23%) deaths was observed during 2 years of follow-up. After multivariable adjustment the HR (95% CI) for any death according to the six potassium categories were: 2.5 (1.5-4.3), 1.9 (1.2-3.0), 1.6 (1.0-2.5), 1 (reference), 1.3 (0.8-2.2) and 1.7 (1.0-3.0).

Conclusion
We found a U-shaped relation between serum potassium and all-cause mortality in incident hemodialysis patients. Especially, low serum potassium was a 2.5-fold stronger risk factor for all-cause mortality compared to normal serum potassium. Our results indicate an optimum serum potassium level between 5.0 - 5.5 mmol/L, emphasizing that potassium lowering therapy should be used with caution in hemodialysis patients.
P1459PREVALENCE AND CONTROL OF HYPERTENSION AMONG PATIENTS ON HEMODIALYSIS USING PREDIALYSIS, POSTDIALYSIS AND HOME BP RECORDINGS
Authors: Tsikliras Nikolaos , Georgianos Panagiotis , Vaios Vasilios , Kousouls Varvara , Anagnostara Aggelina , Chatzidimitriou Christos , Mavromatidis Konstantinos , Liakopoulos Vassilios , Zebekakis Pantelis , Balaskas Elias 
Published: June 2020

Abstract

Background and Aims
Earlier studies provided considerably variable estimates on the prevalence and control rates of hypertension in hemodialysis because of their heterogeneity in definitions and blood pressure (BP) measurement techniques applied to detect hypertension.

Method
In the present study, 116 clinically stable hemodialysis patients from 3 dialysis centers of Northern Greece underwent home BP monitoring for 1 week with the validated automatic device HEM-705 (Omron, Healthcare). Routine BP recordings taken before and after dialysis over 6 consecutive sessions were also prospectively collected and averaged. Hypertension was defined as: (i) 1-week averaged home BP ≥135/85 mmHg; (ii) 2-week averaged predialysis BP ≥140/90 mmHg; (iii) 2-week averaged postdialysis BP ≥130/80 mmHg. Participants on treatment with ≥1 antihypertensives were also classified as hypertensives.

Results
The prevalence of hypertension was 88.8% by home, 86.2% by predialysis and 91.4% by postdialysis BP recordings. In all, 96 participants (82.7%) were being treated with an average of 1.7 antihypertensive medications. Among drug-treated participants, 32.6% were controlled by home, 50.5% by predialysis and 45.3% by postdialysis BP recordings. In multivariate logistic regression analysis, greater use of antihypertensive medications and postdialysis overhydration, assessed with bioimpendence spectroscopy, were both independently associated with higher odds of inadequate home BP control.

Conclusion
This study shows that epidemiology of hypertension in hemodialysis differs considerably between routine dialysis-unit and home BP recordings. Since greater antihypertensive drug use and postdialysis overhydration appeared to be the major determinants of inadequate home BP control, then management of hypertension should be initially relied on strategies targeting to control volume overload.