bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO905EFFECTS OF DIFFERENT DIALYSIS TECHNIQUES ON INFLAMMATION IN MAINTENANCE HEMODIALYSIS PATIENTS WITH COVID-19: A RANDOMIZED STUDY
Authors: Esposito Pasquale , Cipriani Leda , Verzola Daniela , Grignano Maria Antonietta , Grosjean Fabrizio , Russo Elisa , Rampino Teresa , Viazzi Francesca 
Published: May 2021

Abstract

Background and Aims
Uncontrolled inflammation plays a relevant role in the pathogenesis of Coronavirus Disease-19 (COVID-19) and has been related to disease severity and unfavorable outcomes. Here, we studied the time trend of pro-and anti-inflammatory markers in a population of patients undergoing hemodialysis (HD) affected by COVID-19, evaluating the potential modulating effects of two different dialysis approaches.

Method
For this prospective randomized study, we recruited maintenance hemodialysis patients with confirmed COVID-19 infection. After diagnosis, the patients were randomized to two different dialysis modalities, expanded HD (HDx), performed by use of a medium cut-off membrane, and standard treatment based on the use of a protein-leaking dialyzer (PLD). Clinical and laboratory data were collected, including circulating pre and post-dialysis levels of interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), soluble TLR4 (sTLR4), and interferon-gamma (IFN-g). Samples were collected at diagnosis (T0), one and two weeks after the diagnosis (T7 and T14, respectively).

Results
Twenty-seven HD patients with COVID-19 (69.7 ±16.6 years, 14 males) were compared with 14 non-infected HD patients, as the control group. COVID-19 patients presented a significantly reduced number of lymphocytes, including CD4 andCD8 subpopulations, and higher levels of ferritin and lactate dehydrogenase. Moreover, COVID-19 patients had higher levels of IL-6 [35.5 (59.4) vs 12 (43) pg/ml, p=0.048] and IL-10 [9.3 (20.8) vs 1.2 (1.4) pg/ml, p=0.02], while the levels of IL-8 and sTLR4 were comparable. Then, twenty-five patients were randomized to undergo HDx (n.15) or PLD (n.10).
Basal characteristics and cytokine levels were not significantly different between the two groups. All over the study, no significant modifications of circulating cytokine levels were observed. Similarly, no significant differences were found between patients on HDx or PLD evaluated at different time points. After a single HD treatment, IL-8 showed a significant reduction compared to pre-dialysis levels in both groups. IL-8 reduction rate resulted significantly correlated with IL-8 pre-dialysis levels. Finally, there were no correlations between cytokine levels and clinical characteristics and outcomes.

Conclusion
In maintenance HD patients, COVID-19 is not related to a sustained inflammatory response. Modulation of the inflammation is not a suitable therapeutic target in this specific population. Other mechanisms could be involved in the pathogenesis of COVID-19 in HD patients.
MO906DIAGNOSIS OF SARCOPENIA ACCORDING TO THE EWGSOP2 STEPS IN VERY ELDERLY HEMODIALYSIS PATIENTS
Authors: Sánchez-Tocino Maria Luz , Miranda Blanca , Mas Sebastián , De Alba-Peñaranda Ana Maria , Lopez-Gonzalez Antonio , Pereira Monica , Ortiz Alberto , Gonzalez Parra Emilio , Gracia-Iguacel Carolina 
Published: May 2021

Abstract

Background and Aims
Sarcopenia, defined as the loss of muscle mass and strength, is common in patients with chronic kidney disease. The variability of the prevalence of sarcopenia depends in part on the diagnostic criteria applied. In 2019, the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) proposed four steps to diagnose and assess sarcopenia. The concept of sarcopenia is encompassed within the broader concept of frailty.
The aim of this study was to analyse the incidence of sarcopenia in very elderly patients on haemodialysis following the criteria recently established by the European Working Group on Sarcopenia in Older People EWGSOP2. Additionally, to assess the usefulness of the diagnostic algorithm in the very elderly haemodialysis population, and its association with functionally scales related to sarcopenia, such as dependency, frailty, and nutrition.

Method
In a prospective study of 60 patients on chronic hemodialysis aged 75- to 95-years, sarcopenia was assessed according to the 4 EWGSOP2 steps: Find-Assess-Confirm-Severity, using Strength, Assistance walking, Rise from a chair, Climb stairs, and Falls (SARC-F) to find, grip strength by dynamometry (GFD) and sit to stand to sit 5 (STS5) test to assess, appendicular skeletal muscle mass by bioimpedance to confirm and gait speed, the Timed-Up and Go (TUG) test, and the Short Physical Performance Battery (SPPB) for severity. Functionality scales of malnutrition inflammation (MIS), comorbility of Charlson, dependence of Barthel, fragility by FRAIL index2 and Physical Activity Scale for the Elderly (PASE) were conducted.

Results
Sixty patients were involved in the study. Sixty-eight percent (41) were men, with a mean age of 81.85±5.58 years and length of stay in HD 49.88±40.29 months. The sequential four steps resulted in a prevalence of confirmed sarcopenia of 20% and of severe sarcopenia of 20%. Correlation of the different variables defined by the EWGSOP2 with the scales of MIS, Barthel, Frail, Charlson and PASE was analyzed. It is observed that the SARC-F but not BIA correlates with the functionality tests. The GFD is the test that correlates with more variables, both functional and anthropometric. Of the severity measurement scales, the SPPB is the one that correlates with the greatest number of variables.

Conclusion
These findings question the four-step EWGSOP2 assessment for very elderly hemodialysis patients and suggest that 20% had confirmed severe sarcopenia. Functionality scales correlated better with GFD and SPPB.
MO908UNCORRECT NUTRITIONAL MANAGEMENT AND LOW QUALITY OF LIFE IN HEMODIALIZED PATIENTS: MULTICENTRIC STUDY
Authors: Satta Ersilia , Romano Carmine , Della Corte Tersa , Alfarone Carmelo , Gembillo Guido , Gentile Sandro 
Published: May 2021

Abstract

Background and Aims
In patients with kidney impairment, the progression to end-stage renal diseases (ESRD) can lead to a gradual loss of independence with worsening quality of life. Proper nutritional management and daily exercise can help patients live with their condition in a more propositive way.

Method
We performed a multicentric study on the habits of 222 hemodialyzed patients, belonging to 4 different dialysis centers. Through self-administered questionnaires, we collected information about patients attitudes and behavior that affect their daily activities and self-care.

Results
Through the use of the Council for Nutritional Appetite Questionnaire, we assessed that 60,81% of patients had a risk of weight loss of 5% in the next six months (Table 1 Baseline Characteristics). The Malnutrition Inflammation Score indicated that 39,63% had a mild malnutrition and 12,16% a severe malnutrition; the serum albumin was between 3-5 and 3,9 g/dL in 42,79% of patients, 3,0 – 3,4 g/dL in 18,01% of patients, &lt;3 g/dL in 3,15% of the whole cohort. For the bioimpedance analysis (BIA) the Body Cells Mass Index (BCMI) values were indicative in 60% of patients of a normal nutritional status (Figure 1), parameters that remained superimposable in the pre and post-dialysis BIA. The ECM/BCM ratio indicated in pre-dialysis that 27% of patients present a state of dehydration and, on the contrary, 73% an edematous state, vice-versa in the post-dialysis the dehydration status rises to 48% and the edematous state falls to 52% (Figure 2). For the BIA a phase angle of less than 4 ° was found in 18% of patients, a critical value linked to a higher mortality risk. 56% of patients showed a value between 4 ° -5 ° while 26% values between 6 ° and 10 °.

Conclusion
In conclusion, the data from this study show that inappetence and single alterations indicative of risk of malnutrition are frequent in Hemodialysis patients, but a clear diagnosis of malnutrition is relatively rare. A large percentage of patients are overweight, with increased abdominal adiposity but with reduced cell mass and with a protein intake lower than recommended levels. The results underline that malnutrition risk leading to a lower quality of life are still major problems in Hemodialysis patients. Bioimpedance analysis and PhA analysis represents a useful tool in the clinical management of hemodialized patients.
MO778ASSOCIATION OF ADVANCED GLYCATION END PRODUCTS (AGE) AND INDOXYL SULPHATE WITH ARTERIO-VENOUS FISTULA NON-MATURATION
Authors: Singh Mansi , Mahapatra Himansu , Sharma Lokesh , Pursnani Lalit , B Muthukumar , Inamdar Neeraj , Kaur Navjot , Singh Anamika , Krishnan Chandra 
Published: May 2021

Abstract

Background and Aims
The main hindrance in adequate utilization of Arteriovenous fistula (AVF) is its high rates of primary failure. Its etiology is multi factorial and several uremic toxins are under investigation. Here we explore the potential influence of Advanced Glycation End Products (AGE) and Human Indoxyl Sulphate (HIS) on AVF non maturation.

Method
This one year prospective observational study included single stage AVF in consecutive CKD 4 and 5 patients. At baseline, demographic, biochemical (including AGE and HIS levels) and doppler ultrasound of upper limb were done followed by AVF construction. At 12 weeks, AVF was assessed for clinical maturation (usage of fistula with 2 needles for 75% of dialysis sessions during 15 day period); accordingly divided in to matured or non-matured groups. Demographic and biochemical parameters between both groups were compared; ROC and correlation of AGE and HIS were analyzed.

Results
Of 129 AVF, 67.4% were matured and 32.5% non-matured. Overall mean age was 40.9 year, male predominance (77.5%) and more non-matured AVF among diabetes. The mean value of AGE and IS was 0.18 µg/ml and 0.18µg/ml respectively; but difference was non significant between two group. AGE levels were further showing positive correlation with CRP (p 0.01, r 0.21) and venous diameter (p 0.02, r -0.22). There were significant positive correlation between AGE and HIS (p&lt;0.00, r 0.5) but not with other parameters. AUC of AGE and HIS were 0.48 and 0.5 respectively and association could not be demonstrated between all studied parameters and AVF outcome.

Conclusion
Study cohort showed high incidence of primary failure without any association of AGE and HIS with clinical AVF non maturation.
MO782VASCULAR ACCESS IN ELDERLY PATIENTS
Authors: Burgos García Elena , Villegas Andres , Graterol Fredzzia , Soler Majoral Jordi , Cacho Judit , Martinez Lucia , Lleida Manuela , Bonal Jordi 
Published: May 2021

Abstract

Background and Aims
The arteriovenous fistula (AVF) continues to be the first-line vascular access (AV) in the hemodialysis population. However, it is disputed whether the profitability and survival in the elderly patient are the same as in the younger patient. Thus, there are authors who propose the tunnelled catheter as the best option in this group of patients. The objective of this study was to analyze the characteristics of vascular access in incident patients over 80 years of age at our center.

Method
A retrospective analysis was performed included incident hemodialysis patients &gt;80 years between 2017-2020. Epidemiological and vascular access complications related, as well as first permanent vascular access survival were analysed. A Pearson's correlation coefficients were employed to determine the correlation between the exitus and other variables and Regression models of mixed effects of covariance (ANCOVAs) were created to determine the effect of these with the exitus.

Results
Demographic characteristics of forty-four patients included are shown in Table 1. Significant differences in sex and comorbidities (diabetes, ischemic heart disease, peripheral vascular disease and hypertension) were found. A total of 26 patients (62%) had a fistula at the time of beginning hemodialysis, all of them with pre-surgical mapping and monitoring, only 15 (34%) of them being working. The most prevalent type of vascular access (VA) was the left humerus-cephalic (21%). 12 (27%) patients were exitus during the 36 months after the beginning of hemodialysis, with significant differences between groups. The variables catheter, male, and type of VA showed a significant correlation with the exitus (-0.345, -0.347, -0.347 and -0.309 respectively). The multivariate analysis showed a significant association between gender and catheter as vascular access at the beginning of hemodialysis with the exitus (p&lt;0.05) even after being adjusted for age and AVF.

Conclusion
In our population, male sex and catheter at the beginning of hemodialysis have a significant association with exitus. AVF should be considered as the first choice vascular access even in the subgroup of patients over 80 years old
MO783CENTRAL VEIN STENOSIS IN HEMODIALYSIS PATIENTS WITH PAST CENTRAL VEIN MANIPULATION
Authors: Reis Pereira Pedro , Sousa Círia , Silva Natalia , Francisco Jose , Fructuoso Mónica , Morgado Teresa 
Published: May 2021

Abstract

Background and Aims
Central vein stenosis (CVS) is frequently observed in hemodialysis patients. Risk factors for CVS include prior ipsilateral central venous catheterization (CVC) and cardiac rhythm device (CRD) insertions. Though it may have clinical manifestations, CVS is often asymptomatic and, therefore, not diagnosed. The aim of this work was to evaluate the prevalence of CVS in a population of hemodialysis patients, as well as underlying risk factors, clinical manifestations and impact in patients’ vascular access.

Method
We retrospectively evaluated all venous angiographies of prevalent patients in our hemodialysis units from 2013 to 2018. In patients with proved CVS, we evaluated history of prior short term and long term upper ipsilateral CVC and CRD insertions. We also analyzed symptoms associated CVS as well as the rate of loss of vascular access for hemodialysis related to the presence of CVS.

Results
The prevalence of CVS in prevalent patients in hemodialysis during the period of our study (n=209) was 14%. We identified 31 upper CVS in 29 patients undergoing venous angiography. Left brachiocephalic vein was the most commonly affected site (45.1% of cases), followed by the right brachiocephalic vein (19.3%), left subclavian vein (16.1%), right subclavian vein (12.9%) and superior vena cava (6.4%). The majority of patients with CVS (95%) had previous history of ipsilateral CVC (previous short-term CVC in 40%, pervious short term and long-term CVC in 27% and previous long-term CVC in 33%). Loss of vascular access for hemodialysis due do CVS was observed in 26% of patients with CVS.

Conclusion
A significant proportion of patients in hemodialysis presents CVS. The majority of patients with CVS had a previous history of ipsilateral central venous catherization. A significant proportion of patients with CVS had a previous history central venous catherization uniquely with short term CVC, highlighting the importance of the risk of vascular lesion, even during short periods of catherization. The presence of CVS is associated with a significant rate of loss hemodialysis vascular access.
MO784ABDOMINAL AORTIC CALCIFICATIONS AND ARTERIOVENOUS FISTULA CLINICAL OUTCOMES ON HAEMODIALYSIS PATIENTS
Authors: Saii Amira , Salma Toumi , Fendri Beya , Abid Hanen , Lahouimel Rania , Agerbi Ikram , Dammak Najla , Chaker Hanen , Kamoun Khaoula , Yaich Soumaya , Ben hmida Mohamed 
Published: May 2021

Abstract

Background and Aims
Vascular calcification has now been recognized as a major problem in dialysis patients because of its strong influence on the prognosis of this population. Several reports have shown the strong relationship between vascular calcification and clinical outcomes including cardiovascular events and arteriovenous fistula (AVF)survival.
The aim of this study is to evaluate the severity of vascular calcifications in our hemodialysis patients and to determine its impact on the AVF survival.

Method
It is a transversal descriptive and analytical study including chronic haemodialysis patients in our unit of the nephrology department.
A lateral lumbar spine radiograph was taken: the aortic arch calcification(ACC) score (VCS) was calculated according to the score validated by Kauppila and Schousboe. The overall VCS ranged from 0 to 24.

Results
Our study included 55 patients divided into 31 men and 24 women with a sex ratio of 1.29. The mean age was 49.54 ± 12.66 years. The mean duration in HD was 96.16± 73 months. 76.8% of the patients have hypertension, 26.8% are diabetic and 14.3% are smokers. AVF failure was noted in 34 patients (60.7%).
We divided our population in 3 groups: G1:23 patients with a low VCS (41.1%), G2: 15 patients with a moderate VCS (26.8%) and G3: 17 patients with a severe VCS (30.4%).
Patients in G2 and G3 were more frequently diabetics (p=0.05): over 50% of patients in G3 were diabetic and the mean duration in HD was longer: 133 months in G3, 102 months in G2 and 74 months in G1 with a significant difference p=0.03.
We noted that AVF failure was more frequent in patients in G2 and G3 (65.7%) patients) versus patients in G1 (39.13%) with a significant difference (p=0.01)

Conclusion
vascular access dysfunction is one of the leading causes of morbidity and mortality in haemodialysis patients We have demonstrated throw this study the relation between the presence of higher AAC grade and the poor survival of AVF in our patients.
So, an identification of these ACC by a simple lateral lumbar spine radiograph would allow the clinician to implement more rigorous and planned monitoring for such AVFs.
MO786HEPARIN VERSUS SODIUM BICARBONATE CATHETER LOCK SOLUTION: AN ALTERNATIVE LOCK HEMODIALYSIS CATHETER?
Authors: Partipilo Francesca , Detomaso Francesco , Pietanza Stefania , Gernone Giuseppe 
Published: May 2021

Abstract

Background and Aims
Infections and thrombosis of central venous catheter (CVC) in hemodialysis patients are the major causes of catheter loss resulting in hospitalization and increased costs. Interdyalitic catheter lock solutions, usually heparin, avoid these complications. Among the many, sodium bicarbonate has been proved as effective and safe catheter lock solution due to its antimicrobial and antithrombotic properties. The aim of this study was to compare the efficacy of two different CVC lock solution: sodium heparin versus sodium bicarbonate, to prevent catheter–related thrombosis and infection in hemodialysis patients

Method
They were enrolled, in a 12 months case-control study, 17 hemodialysis patients with tunneled hig-flux CVC (femoral or internal jugular). Each patient was evaluated in its common treatment for CVC dysfunction (Qb, CVC that works in reverse branches during the hemodialysis session, use of urokinase or extra lock with sodium heparin or 4% citrate) and infection (WBC count, C reactive protein -CRP, bloodstream culture, exit-site infection -ESI) during standard sodium heparin CVC lock solution (hep-lock), for the first 6 months, and then, during sodium bicarbonate lock solution (10 mEq/10 ml, bic-lock) for following 6 months. aPTT, PLT, Hct and albumin are also montly evaluated. Type and anticoagulant dose during hemodialysis sessions were unchanged over the study as well as any antiplatelet/anticogulant home therapy.

Results
Fifteen patients on 17 completed the study and the main results are reported in table 1. There were no significant differences between patients on demographics and number of catheter days treatments for both study periods. The blood flow was similar in either study phases and stable during the hemodialysis sessions (Qb 225±13 ml/m’ at 2-hours vs 225±15 ml/min at start of dialysis), even the use of reverse branches was similar. Hep-lock showed a lower usage of extra lock drug in comparison with Bic-lock (0,4% vs 3,1%, p&lt;0,05), data confirmed also for Urokinase (1,9% vs 3,4%, p=0,274). None bloodstream are registred while ESI and WBC count show no significant differences between two study periods. No HD catheter was loss during the study due to thrombosis or infection. Finally, Hct, CRP and Albumin was found slightly lower on Bic-lock phase.

Conclusion
There is no CVC ideal lock solution and although sodium bicarbonate is inexpensive and readily avalaible our data shows better CVC performances with sodium heparin.
MO767CENTRAL VEIN STENOSIS: FROM DIAGNOSTICS TO TREATMENT STRATEGY
Authors: Zulkarnaev Aleksei , Stepanov Vadim , Parshina Ekaterina , Novoseltseva Mariya , Fomin Aleksandr , Chursinova Julia , Vatazin Andrey 
Published: May 2021

Abstract

Background and Aims
To analyze the screening and prognostic value of various diagnostic signs of central vein stenosis (CVS).

Method
The retrospective study included 549 patients with AVF/AVG dysfunction. 211 patients were diagnosed with CVS, other patients had lesions of peripheral venous segments. In case of vascular access dysfunction, patients were examined according to the local protocol: ultrasound examination of peripheral (to exclude damage of the peripheral AVF segments) and central veins (at an accessible length) was performed, followed by CT angiography or percutaneous angiography, if necessary.

Results
Among various clinical signs only limb edema and dilated veins on the chest demonstrated high sensitivity. Aneurysmal dilatation of an AVF was more common in peripheral lesions (CVS RR&lt;1). It should be considered that the clinical signs itself are more likely to be associated with the peripheral lesion than CVS (high NPV value) – table 1. “Indirect dialysis signs” also have very low screening efficacy (Se and Sp) and prognostic values – table 2.
Ultrasound signs have low screening accuracy, but high prognostic values. In other words, in the presence of ultrasound signs, patient is likely to have CVS with high probability – table 3.
When comparing the frequency of correct and incorrect classifications for different types of lesion, ultrasound accuracy exceeds the clinical picture for types of lesion 1C and 1D (according to the types of lesion in Society of Interventional Radiology Reporting Standards for Thoracic Central Vein Obstruction, doi: 10.1016/j.jvir.2017.12.013): RR= 3,433 [95% CI 2,074; 6,132], p&lt;0.0001 and RR= 2,538 [95% CI 1,592; 4,265], p&lt;0.0001, respectively, but not for lesion types 2B and 3: RR=1.583 [95% CI 0.935; 2.779], p=0.0883 and RR=1 [95% CI 0.231; 4.325], p &gt;0.9999, respectively. In total, incorrect CVS type classifications is noted in 30.7% of cases when using ultrasound imaging.
CT angiography and percutaneous angiography are almost 100% effective in the diagnosis of CVS. However, CT angiography is not always informative when AVF is functioning and the volume blood flow is high. In turn, percutaneous angiography does not always allow to assess the condition of the veins of the contralateral side. At the same time, correct detection of lesion type is pivotal to determine the future strategy of providing the patient with permanent vascular access. For example, the patient has very little chance to get functional AVF in case of with two-sided subclavian vein stenosis.

Conclusion
The CVS diagnostics should be comprehensive, using different methods for screening, confirming CVS and determining of it type.