bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO752EVALUATION AND ANALYSIS OF CHRONIC PAIN IN HEMODIALYSIS PATIENTS
Authors: Ezzaki Sanae , Failal Imane , Elafifi Rania , Elkhayat Salma siham , Medkouri Ghizlane , Ramdani Benyounes 
Published: May 2021

Abstract

Background and Aims
Despite progress these recent years in support the hemodialysis, chronic pain remains a problem concern that ultimately affect the quality of life and psycho-emotional state, even among dialysis patients already psychologically fragile. However, it is often overlooked and its characteristics in chronic hemodialysis (HDC) are poorly understood. The purpose of this study was to evaluate the prevalence, features, impact and treatment of pain in our population of chronic hemodialysis patients and to determine the factors associated with it.

Method
cross-sectional study conducted in January 2020 including 71 chronic hemodialysis patients from the nephrology department of the CHU ibn rochd CASABLANCA. They were subjected to a questionnaire on socio-demographic characteristics, the characteristics of the pain, its impact on daily life, the various treatments performed. The pain is chronic if it persists for more than 3 months. The intensity was assessed using a visual analog scale.

Results
Of the 71 patients, 64.4% report chronic pain, the average age of our patients was 46.5 years, ranging from 16 to 93 years, with a sex ratio M/F 1.1, seniority hemodialysis was 17.3 years.
The pain is continuous, frequent, intermittent and rare in respectively 55.5%, 27.5%, 13.7%, 3.44% of cases, it is a weak, moderate, severe, very severe in respectively: 13.7%, 58.6%, 17.24%, 10.3%, causing musculoskeletal was predominant in 75.8% of cases, the most common sites are: shoulders (47,23%), knees (34.5%), the head (41.2%) and the back (19.65%). It resounded on the patient's daily activity in 55.17%, and sleep in 41.3%, the treatment was essentially based analgesics in 58.6% of cases, these analgesics were level 1 in 47.1% cases and level 2 in 52.9% of cases. This is taken daily in 28.5% of patients, common in 42.8% and 28.5% rare among of them, the disappearance of pain was achieved in 65.51% of cases. In perdialyse, the intensity of the pain does not change in 79.4% of patients.
Pain was favored by advanced age and age dialysis (advanced age (p = 0.043) and age dialysis (p = 0.01).)

Conclusion
Chronic pain is a major problem in hemodialysis by its high prevalence, its significant intensity and its impact on life daily patient. However its management remains inadequate. Regular assessment of pain using a well-codified questionnaire is necessary to improve the care of dialysis patients.
MO754THE INTERRELATIONSHIP BETWEEN FLUID OVERLOAD AND VASCULAR STIFFNESS IN HEMODIALYSIS PATIENTS: A SCOPING REVIEW
Authors: Lafta Aya , Bello Aminu , Davison Sara , Thompson Stephanie , Braam Branko 
Published: May 2021

Abstract

Background and Aims
Fluid overload and vascular stiffness are two independent predictors of cardiovascular events in hemodialysis (HD) patients. To date, observational and interventional studies that investigated the effect of inter- and intradialytic fluid overload changes on vascular stiffness in HD patients are very limited. We performed a scoping review to explore existing reports about effects of fluid overload on vascular stiffness in adults receiving HD treatment and to identify knowledge gaps for future research.

Method
We followed the framework originally developed by Arksey and O’Malley. We searched Medline, Embase, CINAHL, and Cochrane Database of systematic reviews from inception to October 29, 2019. References of review papers were screened for relevant studies not identified from the initial search until saturation is achieved.

Results
Of 666 eligible studies, nineteen studies met the inclusion criteria. These included clinical observational studies (n=16) and randomized controlled trials (n=3). In general, most of the identified studies had small sample size and short term of follow up. Studies use different definitions of fluid overload and vascular stiffness. Measures of relative fluid overload like the ratio of extracellular fluid/intracellular fluid, fluid overload/extracellular fluid, and/or extracellular fluid/total body fluid were used as a representative of fluid status. Pulse wave velocity and augmentation index were used interchangeably as vascular stiffness measures. The accumulated findings were inconsistent and inconclusive. There was no consensus whether intradialytic fluid volume changes affected vascular stiffness. In the majority of the observational studies, a decrease in pulse wave velocity or augmentation index correlated with a decrease in blood pressure after fluid correction by HD treatment. The randomized clinical trials used different methods and technologies for the correction of fluid overload, thereby, results were conflicting.

Conclusion
Current literature is insufficient to justify whether fluid overload changes have a direct effect on vascular stiffness in HD patients. The findings were conflicting which limits the comparisons of studies and generalization of findings. These knowledge gaps urge the need for further clinical studies to enhance the understanding and to improve the quality of research in this topic. This includes standardized definitions and methodologies as well as longer term of follow up.
MO755SPONTANEOUS SOFT TISSUE HEMATOMAS IN ESRD PATIENTS WITH SYMPTOMATIC SARS-CO-V2 INFECTION – THE EXPERIENCE OF AN EMERGENCY NEPHROLOGY AND DIALYSIS DEPARTMENT
Authors: Ileana Adela Vacaroiu , David Cristiana , Razvan Ion Florin Dragomirescu , Turcu Flavia Liliana , Cristina Dumitraciuc , Cristina Calinoiu , Daniela Radulescu 
Published: May 2021

Abstract

Background and Aims
While actual proofs plead for an increased thrombotic risk in SARS-Co-V2 infection and need for anticoagulant therapy in severe cases, we report suspicious occurrence of hemorrhagic events in a series of ESRD patients.

Method
59 patients with stage 5 CKD were hospitalized in a two months interval, since our hospital was designated for the admission of mild-severe SARS-Co-V2 patients exclusive. 8 patients were admitted for RRT initiation and 51 were maintenance dialysis patients admitted with SARS-Co-V2-associated complications. Beside hemodialysis and treatment of chronic complications of ESRD, all patients were treated, according to the stage and gravity of SARS-Co-V2 infection and under continuous supervision of an infectious disease physician, with antivirals, antibiotics, anticoagulants and IL-antagonists. Daily or at 2 days laboratory monitoring was performed and consisted in evaluation of inflammatory markers, clotting tests, complete hemogram, D-dimer testing, IL-1 and IL-6 serum levels, serum urea, creatinine and albumin.

Results
In 6 cases spontaneous soft tissue hematomas were noted, totalizing a number of 9 hematomas documented through ultrasound and CT-scan. In order of frequency, the locations were: 4 rectus abdominalis hematoma, 2 in the external oblique, 2 in gluteus maximus muscle, and one in the right psoas muscle. The source of the bleeding could not be identified in any patient. The occurrence of spontaneous hematomas was correlated with the D-dimer values (p=0.02), prolonged anticoagulation (over 7 days), albumin levels (p=0.01), platelets count (p=0.05). We found no correlation with the serum urea, creatinine, hemoglobin, INR, or with the dialysis age. In all these cases cough was severe. A conservative approach was instituted, with daily US monitoring, withdrawal of anticoagulants and antiplatelet medication, and blood transfusions. 2 patients necessitated surgical procedures and two deaths were recorded.

Conclusion
In this brief report, we observed that in chronic hemodialysis patients infected with SARS-Co-V2, risk of hemorrhagic manifestations may overcome the benefits of anticoagulant routine therapy. There is a need to explore further this risk in the future; until then, a careful individualized assessment of the safety and indications for anticoagulant therapy regimens is mandatory for ESRD patients with symptomatic new Coronavirus infection.
MO756MANAGEMENT OF CHRONIC HIPERKALAEMIA IN CLINICAL PRACTICE IN HAEMODIALYSIS
Authors: Esteve Simó Vicent , Tapia González Irati , Vadillo Ursula , Guzman Claudia , Fulquet Nicolás Miquel , Moreno Guzmán Fátima , Duarte Gallego Verónica , Pou Potau Mónica , Saurina Solé Anna , Oleas Diana , Ramírez de Arellano Serna Manel 
Published: May 2021

Abstract

Background and Aims
Patients with chronic kidney disease (CKD) on haemodialysis (HD) have an increased risk of hyperkalaemia, a serious and potentially fatal electrolyte disorder. New effective strategies for managing hyperkalaemia have recently become available. However, as yet, there is insufficient experience in routine clinical practice in HD.
The aim of our study was to report the prevalence of chronic hyperkalaemia and analyse the effects of different treatment strategies on potassium management, ratio of adherence and gastrointestinal symptoms in our HD population.

Method
A 12-week, prospective, single-centre study in HD patients with chronic hyperkalaemia (&gt;5.5 mmol/l). Three study phases were established: Phase 1 — dietary advice (DA); Phase 2 — calcium polystyrene sulfonate resins (CPSRs); and Phase 3 — patiromer. In each phase, we analysed sociodemographic data, related biochemical data, treatment adherence and compliance (Simplified Medication Adherence Questionnaire [SMAQ]), gastrointestinal symptoms (Gastrointestinal Symptom Rating Scale [GSRS]), HD characteristics and usual medical treatment.

Results
29.2% hyperkalaemia (46% mild); 13 patients (61.5% female); mean age 63.8 ± 14.1 years and 46.4 ± 41.6 months on HD. Serum K values decreased significantly (*p &lt;0.05) only in phase 3 (–0.75 mmol/l), with a higher percentage of patients reaching optimal K range. Compared with CPSRs, patiromer yielded significantly better overall GSRS scores: abdominal pain (3.7 versus 2.5), constipation (7.1 versus 5.3), indigestion (6.2 versus 5.6); and also better treatment compliance. No significant changes were found in any other biocbhemical data, HD characteristics or usual medication over the course of the study.

Conclusion
Chronic hyperkalaemia is a highly prevalent disorder on our HD unit. Compared to dietary advice and traditional potassium binders; patiromer was effective in managing chronic hyperkalaemia, leading to improvement in gastrointestinal symptoms and treatment adherence with no associated severe adverse effects. Thus, considering our results, we shall consider patiromer a first-line treatment for chronic hyperkalaemia in our patients with HD.
MO757COMPARISON OF ANTI-COAGULATION AND NO ANTI-COAGULATION IN DIALYSIS PATIENTS WITH ATRIAL FIBRILLATION: A SINGLE CENTER RETROSPECTIVE STUDY
Authors: Lee Jun Young , Yang Jae Won , Kim Jae Seok , Choi Seong Ok , Han Byoung Geun 
Published: May 2021

Abstract

Background and Aims
Atrial fibrillation (AF) is common arrhythmia in end stage renal disease patients. Although, the need of anticoagulation to prevent stroke and thromboembolism is increasing, the efficacy of anticoagulation is not proven in most of study. We retrospectively analyzed the risk and benefit of anticoagulation in dialysis patients with AF.

Method
By using medical record, we retrospectively analyzed all data of 99 patients who received dialysis therapy and diagnosed AF.

Results
Among 99 patients who diagnosed AF with dialysis 36 patients received anticoagulation (17 coumadin, 19 apixaban 2.5mg bid), 63 patients received no anticoagulation. There was no significant difference of baseline characteristics between anticoagulation, and no anticoagulation patients. Although no anticoagulation group experienced more all-cause (39.7% vs 32.4%, p=0.572) and cardiovascular mortality (17.6% vs 10.8%, p=0.197) than anticoagulation group it was not statistically significant. Compared to apixaban 2.5mg bid patients, coumadin anticoagulation patients experienced more frequent mfig
ajor adverse cardiovascular events (35.3% vs 15.8%, p=0.109) but it was not statistically significant in multi variate Cox regression analysis (Hazard ratio 1.143, 95% Confidence Interval 0.503-2.597).

Conclusion
Apixaban 2.5mg bid was not inferior than coumadin considering risk and benefit of anticoagulation in dialysis patients.
MO758DIAGNOSTIC ACCURACY OF ELECTROCARDIOGRAPHIC METHODS OF ESTIMATION OF LEFT VENTRICULAR HYPERTROPHY IN A HAEMODIALYSIS POPULATION
Authors: Skampardoni Sofia , Kalra Philip A , Green Darren 
Published: May 2021

Abstract

Background and Aims
Left ventricular hypertrophy is common in end stage renal disease (ESRD) and haemodialysis. Its association with cardiovascular outcomes has been demonstrated. In this study we evaluated the diagnostic accuracy of electrocardiographic methods of calculating LVH compared to Real Time 3- Dimensional Echocardiogram (RT3DE) which we used as a surrogate gold standard test.

Method
This study was performed as a post-hoc analysis of a sub-group of patients enrolled into the Salford Kidney Study (SKS). Patients included into this analysis are from the sub-group of SKS previously known as the CRISIS-HD cohort. All adult haemodialysis patients at Salford Royal NHS Foundation Trust, UK or one of its satellite units are considered for inclusion.
In this study we examined the sensitivity, specificity, positive predictive value and negative predictive value of Sokolow – Lyon and Romhilt –Estes methods in comparison to RT3DE.

Results
The final sample comprised 44 patients. The vast majority were Caucasian (39 patients). The mean age of the patients was 62 ± 13 years and mean time on dialysis 5.1 ± 2.9 years. The sensitivity of both ECG methods for diagnosis of LVH was very low. This was the case for the whole sample and also for individual groups. Romhilt – Estes was marginally better than Sokolow – Lyon and that was especially the case for male patients.

Conclusion
Our study shows that ECG methods for assessment of LVH that rely on voltage criteria have very low sensitivity and unreliable specificity compared to RT3DE and also conventional M –Mode echocardiography. As a result, they could not be reliably used as a quick and inexpensive method of LVH estimation in clinical practice in the case of haemodialysis patients.
MO725DAPT ALLEVIATES CKD-RELATED CAC BY MODULATING PTH-INDUCED ENDOTHELIAL-TO-OSTEOBLAST TRANSITION VIA NOTCH1 PATHWAY ACTIVATION
Authors: Wang Liting , Zhang Yuxia , Tang Rining 
Published: May 2021

Abstract

Background and Aims
Coronary artery calcification (CAC)-induced myocardial infarction (MI) is an important cause of death in patients with chronic kidney disease (CKD). However, effective treatment for CAC is lacked at present. Previous studies have shown that endothelial cells (ECs) participated in vascular calcification through endothelial-to-osteoblast transition. DAPT, N-[N-(3,5-difluorophenacetyl)-l-alanyl]- S-phenylglycine t-butyl ester, could inhibit the activity of γ-secretase and block the activation of the Notch1 pathway. In this study, we investigated the function of DAPT in alleviating the CAC process by blocking endothelial-to-osteoblast transition via inhibition of the Notch1 pathway.

Method
We administered 5/6 subtotal nephrectomy and a 10-week high-phosphate diet (P, 2.0%) to construct a rat model of CKD. DAPT and AAV-129-5p was administered orally and injected abdominally to rats respectively in the treatment groups at the beginning of the high-phosphate diet. In vivo, it was performed to detect the expression levels of EndMT and Notch1 pathway markers in the coronary arteries. In vitro, the effect of high PTH levels on the endothelial-to-osteoblast transition and the role of the miR-129-5p/Notch1 signaling pathway were studied in human coronary artery endothelial cells (HCAECs).

Results
In vivo, endothelial-to-osteoblast transition accompanied with the Notch1 pathway activation was found in HCAECs upon stimulation of PTH, characteristic with up-regulated endothelial markers (CD31, CD34) and down-regulated mesenchymal markers (CD44, CD10, α-SMA, FSP1) and ostoblast markers (Runx2, Osterix). miR-129-5p was responsible for regulating Notch1; γ-secretase was time-dependently and concentration-dependently activated by PTH, which further affected the transcription of downstream regulators (HES1, HEY1). DAPT arrested HCAECs migration through decreasing γ-secretase activity, thus inhibiting endothelial-to-osteoblast transition. In vivo data showed that serum γ-secretase activity decreased in rats intraperitoneally injected with DAPT (10mg/kg) once a week after 5/6 nephrectomy. DAPT intervention or overexpression of mir-129-5p inhibited coronary endothelial-to-osteoblast transition by blocking the activation of the Notch1 pathway. Notably, DAPT retarded CAC and MI without obvious negative effects on rats heart function.

Conclusion
DAPT is a promising agent for protecting against PTH-induced endothelial-to-osteoblast transition via inhibiting the Notch1 pathway in HCAECs, thus alleviating CAC.
MO809DOES LISTENING TO LIVE MUSIC DURING HEMODIALYSIS SESIONS AFFECT THE QUALITY OF LIFE?*
Authors: Serrano Miriam , Garcia-Testal Alicia , Rico-Salvador Inmaculada , Carrrascosa López Conrado , Ortiz Ramón Rafael , Villalón Coca Javier , Royo-Maicas Pilar , Garcia-Maset Rafael 
Published: May 2021

Abstract

Background and Aims
Patients with chronic kidney disease on hemodialysis (HD) treatment have a health-related quality of life (HRQoL) lower than the reference values of the Spanish population.
Previous studies have shown through music therapy reduce levels of pain, anxiety and depression in chronic kidney disease patients on hemodialysis.
This study presents an intervention with classical music performed live during HD sessions. It is the first time to study the effect of classical music heard live on HRQL.

Method
Randomized clinical trial by groups. 90 patients agreed to participate. They were randomized into an intervention group (IG) and a control group (CG). The IG listened to 30/45 minutes of live classical music in two of the three weekly HD sessions for 1 month. The CG followed his usual treatment.
Different individual scales of the quality of life test in kidney diseases (KDQOL-SF) were analyzed, in two times, baseline (Start) and after (End) the musical intervention in both groups.
The analysis was performed using a mixed linear regression model for repeated measures with independent variables (age, sex, months in HD, Kt/v, Hemoglobin (Hb)) and dependent variables (individual KDQOL-SF scale scores).

Results
The CG sample included 43 patients with a mean age of 75.8 years; 22 women (51%); mean Kt/v 1.53; mean Hb 11.5 and mean time on HD 60.46 months.
The GI sample included 47 patients with a mean age of 73.53 years; 18 women (38%); mean Kt/v 1.47; mean Hb 11.3 and mean time on HD 63.34 months.
The results show that after the intervention, IG vs CG increased the mean score (pm) in all the scales significantly.
The End time and GI interaction showed a mean score increase of 15.78 (p &lt;0.001) for the Symptoms/problems scale; 14.96 (p &lt;0.001) scale Effects of kidney disease; 16.36 (p &lt;0.001) on the Kidney disease burden scale; 14.78 (p &lt;0.001) on the Sleep scale; 25.46 (p &lt;0.001) on the Vitality scale; 29.57 (p &lt;0.001) on the Emotional well-being scale; 41.92 (p &lt;0.001) on the Pain scale and 23.39 (p &lt;0.001) on the General Health scale.

Conclusion
Live classical music intervention during hemodialysis sessions improves self-perceived HRQL in patients with chronic kidney disease on HD
MO818SURVIVAL ON DIALYSIS: SWITZERLAND IN COMPARISON WITH OTHER COUNTRIES – A FOLLOW UP
Authors: Winzeler Rebecca , Ambühl Patrice Max 
Published: May 2021

Abstract

Background and Aims
Survival in dialysis patients is substantially reduced compared to the general population. The aim of the present analysis was to compare the survival of dialysis patients in Switzerland with other countries with an additional year of follow up and a higher number of patients.

Method
Incident dialysis patients (hemo- or peritoneal dialysis; N=5'406) from the Swiss dialysis registry were followed up from 2014 to December 31, 2019 (median follow up days=658). Deaths occurring during this time (N=1'353) were recorded and survival was examined using the Kaplan Meier method, censored for transplantation.

Results
Characteristics of the dialysis population stratified according to survival status are provided in Table 1.
Dialysis patients in Switzerland have an approximately 8% higher survival in the first and second year and about 10% higher 5 years after start of dialysis, compared to other European countries (Annual ERA-EDTA Report 2017).
In the first two years, the proportion in survival rates between genders is similar in Switzerland, as well as in Europe. After 5 years, however, a difference in survival rates between genders becomes apparent, with women having a 5-year survival probability of 56.6%, compared to a lower 5-year survival probability of 49.7% in men.

Conclusion
The markedly better survival in dialysis patients in Switzerland compared to other European countries could be confirmed with an additional year of follow up and more patients. Also, causes of death vary widely among European countries. 5-year survival was calculated for the first time, with Switzerland showing almost 10% better survival rates than other European countries.
MO820INTRACELLULAR WATER BEFORE HEMODIALYSIS PREDICTS ALL-CAUSE MORTALITY IN HEMODIALYSIS PATIENTS
Authors: Ekart Robert , Keber Gasper , Vodošek Hojs Nina , Jakopin Eva , Piko Nejc , Bevc Sebastjan , Hojs Radovan 
Published: May 2021

Abstract

Background and Aims
Several factors may be responsible for the increased mortality in dialysis patients, but volume overload is considered among the main mechanisms of this association. Volume status is usually estimated using clinical criteria, i.e., patien's signs and symptoms, peridialytic blood pressure measurements, and intradialytic hemodynamic instability. Bioimpedance analysis (BIA) is another way to measure volume status in dialysis patients. BIA can measure overhydration (OH), extracellular water (ECW), intracellular water (ICW) and ECW/ICW ratio.
The aim of our study was to analyze the role of BIA parameters before and after hemodialysis (HD) on all-cause mortality.

Method
Eighty-three patients (mean age 64.2 years; 51 men) on maintenance HD were included. BIA was performed and blood pressure was measured before and after the HD session. Patients were followed for assigned time, until transplantation or death. The mean follow-up time was 1181±564 days.

Results
Descriptive statistics of our patients are shown in Table 1. During the follow-up period, 6 (7.2%) patients were transplanted and 39 (47%) patients died. Univariate Cox regression analysis showed that only ICW before HD was a significant predictor of all-cause mortality (HR=1.089; 95%CI: 1.01-1.17, p=0.018). OH, ECW, ECW/ICW ratio before and after HD and ICW after HD were not associated with survival. In multivariate Cox regression analysis including ICW before dialysis, age, dialysis vintage, pulse pressure before HD, hemoglobin, CRP and serum albumin, ICW before dialysis was an independent predictor of all-cause mortality (HR=1.102; 95%CI: 1.01-1.20, p=0.029) (Table 2).

Conclusion
ICW before HD predicts all-cause mortality in HD patients.