bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1066OBJECTIVIZATION OF “DRY WEIGHT” CLINICAL ASSESSMENT IN HEMODIALYSIS PATIENTS BY MULTI-FREQUENCY BIOIMPEDANCE SPECTROSCOPY WITH VECTOR ANALYSIS
Authors: Vishnevskii Konstantin , Dudash Ekaterina , Domashenko Olga , Volkova Olga , Turbasova Elena , Frolova Ekaterina 
Published: June 2020

Abstract

Background and Aims
Hydration status is an important prognostic factor in patients receiving hemodialysis (HD). An accurate hydration status assessment and determination of the euvolemia (“dry weight”, DW) target value is a difficult task and need to be objectified by instrumental methods. One of these methods is the vector analysis of multi-frequency bio-impedance spectroscopy (MBIS). The aim of the study was to assess the effect of DW correction according to the results of a vector analysis of MBIS on the blood pressure dynamics and the frequency of intra-dialysis complications.

Method
Total 104 patients were included in the study. The mean age was 63±11 years, mean duration of renal replacement therapy was 91±68 months. Patients were randomly (block randomization) divided into the study (SG, N=52) or control (CG, N=52) groups. In the SG, the correction of DW performed according to the results of the MBIS vector analysis using the Bodystat MultiScan 5000 analyzer (Bodystat Ltd) with specially developed correction algorithm (figure). In the CG the correction of DW was carried out only according to clinical indicators. Within 3 months before and 3 months after the initial assessment of DW the blood pressure during HD and the number of intradialytic complications were recorded in all patients.

Results
In the SG, DW was increased in 13 patients by an average of 1.0±0.9 kg, decreased in 26 patients (-1.1±0.7 kg) and did not change in 13 patients. In the CG, DW increased on average by 1.3±0.9 kg in 19 patients, in 27 decreased (-1.2±0.8 kg) and in 2 did not change. In patients who had a history of increased blood pressure during dialysis, in SG the frequency of hypertension episodes decreased from 3.8 to 1.1 episodes per month (p=0.02), in contrast to CG (from 2.4 up to 2.3 episodes per month, p=0.87). Also, among patients initially prone to hypertension in SG, in contrast to CG, a decrease in systolic blood pressure was observed both before the HD (from 163±16 to 143±10 mm Hg, p=0.004) and after the HD (from 151±23 to 130±15 mmHg, p=0.02). No changes in the frequency of episodes of hypotension and diastolic blood pressure during HD were observed either in the study or in the control group

Conclusion
Objectification of the dry weight clinical assessment of in HD patients using multifrequency bioimpedance spectroscopy with vector analysis can help to reduce the complications rate and arterial hypertension severity.
P1069COMPARISON OF BIOCOMPATIBILITY OF REGULAR AND INCREASED DOSE OF CITRATE IN CHRONIC HEMODIALYSIS - PRELIMINARY RESULTS OF A RANDOMIZED TRIAL
Authors: Orsag Alesa , Bozic-Mijovski Mojca , Simcic Sasa , Gubensek Jakob 
Published: June 2020

Abstract

Background and Aims
The dose of citrate that is needed in regional citrate anticoagulation (RCA) to achieve optimal biocompatibility of the extracorporeal circuit is not known. Insufficient biocompatibility is related with increased inflammation and oxidative stress and therefore higher risk for cardiovascular events, as well as decreased dialysis dose. Biocompatibility is multifaceted and includes activation of coagulation and complement cascades, as well as degranulation of leukocyte and platelets. We performed a randomized control trial (ACTRN12613001340729) to compare regular and increased dose of citrate in RCA.

Method
30 chronic hemodialysis patients were randomly assigned to a single hemodialysis session with RCA using either regular (2.7 mmol/l) or increased dose of citrate (4.0 mmol/l). Markers of activation of complement system (C5a), activation of hemostasis (thrombin – antitrombin complex (TAT)), activation of platelets (platelet factor 4 (PF4)) and activation of leukocyte (myeloperoxidase (MPO)) were taken at the beginning (time 0), after 30 minutes (arterial line) and after 4 hours (arterial and venous line) of dialysis. Results were corrected for changes in hematocrit, and compared between groups using T test.

Results
There was no significant difference in any of the measured biocompatibility parameters between the two citrate dose groups at any of the time points. We have observed a significant, but transient increase in PF4 after 30 minutes (28 +/- 17 to 47 +/-29 IU/mL vs. 30 +/-17 to 54 +/- 33 IU/mL, p&lt;0.05 for both groups), which was parallel in both groups (p=0.76 for between group comparison). No significant changes in TAT, MPO or C5a were observed during dialysis. There were no clotting problems or significant hypocalcemia observed in either group.

Conclusion
Given the absence of significant increase in the majority of biocompatibility parameters at the standard dose of citrate and absence of blunting of PF4 increase by the higher dose of citrate, the standard dose of citrate (2.7 mmol/l) seems sufficient in RCA for chronic hemodialysis.
P1070ONLINE HIGH-VOLUME HEMODIAFILTRATION REDUCES PRE-DIALYSIS LEVELS OF INDOXYL SULFATE COMPARED TO HIGH-FLUX HEMODIALYSIS: RESULTS FROM HDFIT MULTICENTRIC RANDOMIZED CONTROLLED TRIAL
Authors: Lima Jordana , Guedes Murilo , Rodrigues Silvia , Flórido Ana Clara , Barra Ana Beatriz , Canziani Maria Eugênia , Cuvello Américo , Poli De Figueiredo Carlos Eduardo , Pecoits-Filho Roberto , Nakao Lia 
Published: June 2020

Abstract

Background and Aims
Online High-Volume Hemodiafiltration (OL-HDF) combines convective and diffusive clearances and is associated with better outcomes compared to standard hemodialysis (HD). Although HDF has been shown to improve the clearance and pre-dialysis concentration of middle size uremic toxins, little is known about its effect on concentration of protein-bound uremic toxins (PBUT), particularly in comparison to high-flux HD. Here, we investigated whether high-volume post-dilution OL-HDF impacts pre-dialysis plasma levels of PBUT indoxyl sulfate (IxS), p-cresyl sulfate (pCS) and indole 3-acetic acid (IAA) compared to high-flux HD over time, since accumulation of these PBUT has been associated with increased overall mortality of CKD patients.

Method
This is post hoc analysis of the multicentric randomized controlled trial (RCT) studying the impact of post-dilution high-volume OL-HDF versus high-flux HD on measured physical activity (HDFit - clinicalTrials.gov: NCT02787161), which included clinically stable HD patients with a vintage &gt;3 to &lt;24 months. Total plasma levels of IxS, pCS and IAA were determined by high performance liquid chromatography (HPLC) with fluorescence detection at baseline, 3 and 6 months. The difference between HDF and HD in respect to changes in the PBUT concentrations during the follow up, analyzed using linear mixed effect models, was compared. Results are presented as mean differences between groups in the change from baseline along with 95% confidence intervals (CI).

Results
193 patients (mean age 53 years old, 70% males and 60% white – no differences between groups) were analyzed. There were no differences between HD and OL-HDF groups regarding clinical and biochemical characteristics at the baseline. In the OL-HDF group, 99% of patients achieved a convective volume higher than 22 L and both groups had similar dialysis session duration and blood flows throughout the follow up. The mean differences (95% CI) in concentrations over time for PBUTs among HDF and HD groups are shown in Figure 1. HDF group presented a significantly lower trajectory of IxS levels and a lower trajectory of pCS levels than HD group. Trajectories of IAA levels were not different between groups.

Conclusion
OL-HDF reduced the pre-dialysis concentration of IxS and pCS through 6 months-period compared to high-flux HD.
P1074SIMPLIED REGIONAL CITRATE ANTICOULATION USING A CALCIUM-CONTAINING REPLACEMENT SOLUTION FOR RENAL REPLACEMENT THERAPY: A RANDOMIZED CONTROLLED CLINICAL TRIAL
Authors: Wei Tiantian , Fu Ping , Zhang Ling 
Published: June 2020

Abstract

Background and Aims
A simplified protocol for Regional citrate anticoagulation (RCA) using a commercial calcium-containing replacement solution, without a continuous calcium infusion, is more efficient to be used in continuous renal replacement therapy (CRRT). We aim to design a randomized prospective pilot trial to compare the safety and efficacy between calcium-free and calcium-containing replacement solution in CRRT with RCA.

Method
Of the 59 patients who requiring CRRT and being treated with RCA-based continuous venovenous hemodiafiltration (CVVHDF) enrolled, 31 patients were randomized to calcium-containing group and 28 to calcium-free replacement solution group. Primary endpoints were filters lifespan. Secondary endpoints were mortality, kidney function recovery and severe complications rates. Time spent on fluids preparation before CRRT and the amount of 4% trisodium citrate solution pumped during CRRT were recorded. Serum and effluent citrate and calcium concentration during CVVHDF were measured during CRRT.

Results
Filters lifespan were superior for calcium-containing group (mean 58.06 versus 47.12 hours, P=0.05). Mortality and renal outcome were comparable between groups during hospitalization: 10/31 (33.26%) of calcium-containing group patients died versus 13/28 (46.43%) of calcium-free group patients, and 16/31 (51.61%) of calcium-containing group patients had kidney function recovery versus 15/28 (53.57%) of calcium-containing group (P = 0.265). Only 5 patients showed the symptoms and signs of hypocalcemia or citrate toxicity in this study. The mean CRRT preparation time in calcium-containing group: 25.5 minutes, was significantly shorter than calcium-free group: 43.7 minutes (p&lt;0.001). The serum and effluent calcium concentration was slightly lower in calcium-containing group during CRRT. While, the mean 4% trisodium citrate solution infusion rate was similar between groups (161.5 mL/h versus 157.4 mL/h, P=0.376).

Conclusion
Patients treated with calcium-containing or calcium-free replacement solution have similar clinical outcomes. Since the calcium-containing replacement solution based RCA has longer filter lifespan and obviates the need for a separate venous catheter and intravenous calcium preparation for continuous intravenous calcium infusion, it is more efficient to be used in clinical practice and superior to the calcium-free replacement solution.
P1075CONTROL AND MONITORING OF DIAGNOSTIC AND TREATMENT PROCESS IN HEMODIALYSIS CLINIC USING TELEMEDICINE TOOLS
Authors: Zinovev Dmitriy , Novitskiy Vladimir , Malkoch Andrey 
Published: June 2020

Abstract

Background and Aims
Quality of life of hemodialysis patients and adequacy of hemodialysis therapy in general, is defined by the number and duration of incidents during hemodialysis procedures. In this study we examined the effect of telemedical system for control and monitoring of hemodialysis procedures on patients’ condition and their quality of life.

Method
The system described in this work included: doctor/patient video call functionality initiated from both ends; functionality of hemodialysis procedure parameters and patient’s condition parameters monitoring and registration; functionality of alerting medical staff about registered incidents, functionality of visual control of hemodialysis procedure. The effect of control and monitoring system usage was studied on population of 2300 hemodialysis patients (at the start of the study) with median follow-up of 2 years. The primary end-point was doctor’s reaction time on patient’s complaint, medical staff reaction time on intradialysis hypertension incidents. Secondary end-points were: number of patients who left the clinic due to reasons besides lethality, patients’ satisfaction by hemodialysis therapy (according to survey), number of incidents of intradialysis and interdialysis hypertension.

Results
During the study we observed that as a result of system deployment average doctor’s reaction time on patient’s complaint (defined as the time from emergence of the complaint to start of patient/doctor communication) reduced from 8 to 1.5 minutes, average staff reaction time on intradialysis hypertension incidents (defined as time from registration of hypertension incident to start of blood pressure normalization actions) reduced from 5 to 2 minutes. Number of patients who left the clinic due to reasons besides lethality reduced from 2.5 per 100 patients before system deployment to 1.7 per 100 patients at the end of the study. Average value of patient’s satisfaction by dialysis therapy increased from 7.2 to 9.1 points on 10-point scale (according to survey conducted at the beginning and at the end of the study). By the end of the study, average number (across population) of hypertension incidents per month reduced from 8.3 to 6.2 and from 20.7 to 16.5 episodes for intradialysis and interdialysis hypertension correspondingly.

Conclusion
The use of telemedical tools of hemodialysis procedures control and monitoring has positive impact on patients’ satisfaction level by the dialysis procedure and on duration/frequency of incidents registered by these tools, which, in return may improve the quality of patient’s life.
P1078IMPACT OF A MEDIUM CUT-OFF DIALYZER ON SKIN AUTOFLUORESCENCE IN HAEMODIALYSIS PATIENTS
Authors: Viramontes Horner Daniela , Kolhe Nitin , Leung Janson , Fluck Richard , Selby Nicholas , Taal Maarten 
Published: June 2020

Abstract

Background and Aims
Advanced glycation end-products (AGEs) are middle-sized uraemic toxins that accumulate in haemodialysis (HD) patients due to increased production, impaired excretion and insufficient removal. Previous studies have reported that the use of a medium cut-off (MCO) dialyzer promotes a greater removal of larger middle molecules (such as AGEs) than conventional high-flux HD and haemodiafiltration. However, to our knowledge, there is no published evidence regarding the effect of an MCO dialyzer on skin autofluorescence (SAF), a measure of long-term tissue AGE accumulation and independent risk factor for mortality in the HD population. We aimed to investigate the impact of using an MCO dialyzer on change in SAF over time in HD patients.

Method
HD patients were enrolled in a prospective observational study. SAF was measured using a validated Autofluorescence Reader at baseline, 12 and 24 months. During the initial 12 months patients dialysed using high-flux polysulphone, polyarylethersulfone or polyvinylpyrrolidone dialyzers. At a variable time after 12 months patients were switched to an MCO dialyzer (Theranova; Baxter®). Forty patients who had been using the MCO dialyzer for at least 3 months were included in this analysis.

Results
Mean age, baseline SAF levels and time on MCO dialyzer were 63±13 years, 3.5±0.9 arbitrary units (AU) and 124±49 days, respectively. SAF increased significantly from baseline to 12 months (3.5±0.9 vs. 3.9±1.1 AU; p&lt;0.0001) but tended to decrease between 12 and 24 months, after conversion to an MCO dialyzer (3.9±1.1 vs. 3.7±0.7 AU; p=0.06). Additionally, mean ΔSAF from baseline to 12 months was positive (0.41±0.68 AU) whereas ΔSAF from 12 to 24 months was negative (-0.18±0.76 AU; p=0.002 for comparison). Furthermore, SAF at 24 months correlated negatively and significantly with time on MCO dialyzer (r= -0.384; p=0.01) though second year ΔSAF (delta from 12 to 24 months) did not (r= 0.061; p=0.7).

Conclusion
We found in this observational study that SAF levels decreased/stabilised in HD patients after switching to an MCO dialyzer compared to the time when patients were using conventional high-flux HD and haemodiafiltration, during which SAF levels increased. Future prospective and interventional studies with larger sample sizes and longer follow-up are needed to confirm these findings and to evaluate the impact of using an MCO dialyzer on long-term outcomes, including survival.
P1088BRAND NEW METHOD TO CALCULATE THE VOLUME OF EXTRA CELLULAR FLUID IN HEMODIALYSIS PATIENT ONLY FROM REGULAR BLOOD TEST
Authors: Shibata Kazuhiko , Nakai Shigeru , Masakane Ikuto , Ito Takahito , Ozawa Kiyoshi , Maeda Kanenori , Matusuoka Teppei , Shinzato Takahiro 
Published: June 2020

Abstract

Background and Aims
Uric acid is a small molecule with molecular weight 168, but has an electrical pole which enables pass through the phospholipid bilayers of cell membranes by simple diffusion. Urate transport proteins of cell membranes (URAT1, GLUT9, OAT, MRP4, MCT9, NPT4, ABCG2) are expressed only in uric acid-excreting tissues. These findings suggest that uric acid does not pass through the cell membrane, either by diffusion or active transport. Since uric acid does not pass through cell membranes, the uric acid distribution volume (UDiV) would reflect the extracellular volume (ECV). At ASN 2018, we reported that UDiV significantly correlated with ECV predicted by the bio-impedance method measured by InBody, S 20 (Biospace Co., Ltd, Korea). However, both data were correlated, there was a large fixed error. This time, we examined the correlation with the UDiV again using the Fresenius BCM (Fresenius Medical Care, Bad Homberg, Germany), which is trusted worldwide.

Method
We calculated UDiV from regular blood test results by uric acid kinetic modeling.
This study was performed in Yokohama Minami Clinic. One hundred nine patient under hemodialysis was consented and enrolled in this study. The HD patients were 59males and 50females. 68.0±10.9years old.
We performed UDiV calculation from blood samples obtained before and after hemodialysis. Then, after the hemodialysis session, 30minutes interval was made to measure the BIA-ECV using BCM. Then, we compared UDiV with BIA-ECV .
We used least squares regression analysis and Bland–Altman analysis to compare the UDiV method and the BIA-ECV method, and the Steel test for multiple comparisons of UDiV and symptoms. All analyses were performed using JMP 9.0.2 (SAS Institute, Inc., Cary, NC, USA).

Results
There was a significant correlation between UDiV(x) and BIA-ECFV (y): (y = 0.70x +3.02, r-square = 0.61, p &lt; 0.0001, Figure 1a). The regression line closely coincided with the line of identity. Bland–Altman analysis showed a systematic error for UDiVvs. BIA-ECV (Figure 1b). There was a significant difference between UDiVand BIA-ECV (mean difference 1.32 L, 95% CI -2.6 to 5.2 L).

Conclusion
UdiV could be a viable alternative marker of BIA-ECV for the assessment of hydration status of patients with HD.
P1089REGIONAL CITRATE ANTICOAGULATION VERSUS LOW MOLECULAR WEIGHT HEPARIN ANTICOAGULATION FOR CONTINUS VENOVENOUS HEMOFILTRATION IN PATIENTS WITH SEVERE HYPERCALCEMIA: A RETROSPECTIVE CASE-CONTROL STUDY
Authors: Sun Shiren , Bai Ming , Yu Yan , Zhang Wei , Li Yangping 
Published: June 2020

Abstract

Background and Aims
Severe hypercalcemia, poor conservative treatment effect, or combined with renal dysfunction, heart failure, intermittent hemodialysis treatment is recommended. But calcium-free hemodialysis could cause rebound of serum calcium, hypovolemia and hypotension. Continuous renal replacement therapy (CRRT) is the most commonly used treatment in critically ill patients with severe AKI. Some case reports showed that CRRT successed control calcium with stable hemodynamics, no rebound hypercalcemia, but there was only one case used continuous venovenous hemofiltration (CVVH). During CVVH treatment, clotting in the extracorporeal circuit shortens the filter and catheter lifespan, causes blood loss, and decreases solute clearance, consequently, reduces the effectiveness of CVVH and increases the treatment cost and medical stuff’s workload. So how to safely decrease calcium level and how to choose appropriate anticoagulants during CVVH in esvere hypercalcemia patients is a challenging work. We conducted a retrospective study to evaluate the efficacy and safety of regional citrate anticoagulation (RCA) versus low molecular weight heparin (LMWH) anticoagulation for CVVH in severe hypercalcemia patients.

Method
Between January 2014 and May 2019, severe hypercalcemia patients requiring CVVH were screened and divided into the RCA and LMWH-anticoagulation group according to the CVVH anticoagulation strategy they accepted. Serum calcium reduction rate (RRSeCa), filter lifespan, bleeding, totCa/ionCa ratio, citrate accumulation, and catheter occlusion were evaluated as outcomes.

Results
Of the 33 included patients, RCA and LMWH-anticoagulation were employed for CVVH in 14 and 43 filters, respectively. The serum calcium reduction rate (RRSeCa) was not significantly different between the LMWH-anticoagulation and RCA group (P = 0.320). Compared to LMWH-anticoagulation, RCA significantly prolonged the filter lifespan (&gt; 72 hours vs. 24.0 hours [IQR, 15.0-26.0], P = 0.012). The incidence of filter failure was 55.8% (24/43) in the LMWH -anticoagulation group and 21.4% (3/14) in the RCA group (P = 0.033), respectively. The adjusted results demonstrated that RCA could significantly reduce the risk of filter failure (P = 0.028, 95% CI 0.076-0.859, HR = 0.255). No citrate accumulation was observed in RCA-CVVH patients.

Conclusion
In patients with severe hypercalcemia who underwent CVVH, both RCA CVVH and LMWH-anticoagulation CVVH could effectively decrease calcium levels. RCA CVVH had better filter lifespan and no obvious adverse events, compared with the LMWH-anticoagulation CVVH. Further prospective, randomized, control studies are warranted to obtain robust evidences.