bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO808THE IMPACT OF PARICALCITOL FOR PARATHYROID GLAND SIZE OF SHPT PATIENTS WITH LONG-TERM MAINTENANCE HEMODIALYSIS: AN OBSERVATIONAL STUDY
Authors: Tao Chenghui 
Published: May 2021

Abstract

Background and Aims
This is an observational study to assess effectiveness of paricalcitol for treating secondary hyperparathyroidism (SHPT) patients with long-term maintenance hemodialysis, via changes in biochemical indexes, such as Calcium (Ca), Phosphate (P) and Parathyroid Hormone (PTH), and size of parathyroid gland (PG).

Method
This single-centre and small sample study included 11 Long-term maintenance hemodialysis patients with SHPT, who were undergoing SHPT treatment with paricalcitol in the Blood Purification Centre of Fengdu people’s hospital, Chongqing, China, from December 2018 to October 2019. We collected biochemical indexes including Ca, P and iPTH, and imaging parameters of PG via ultrasonography (volume and number), evaluating variations between baseline and Month 11 of post-treatment.

Results
Compared to baseline, the maximum diameter lines (Fig 1) of PG decreased significantly (mean 15.727 mm vs 10.936 mm, P=0.005) after 11 months’ treatment, though the minimum diameter lines (Fig 2) decreased without statistical difference (mean 6.727 mm vs 5.255 mm, P=0.089). The number of glands was less in Month 11 than that of baseline (mean 2.455 vs 2.182, P=0.277) and iPTH declined significantly (mean 1045.109 pg/ml vs 610.934 pg/ml, P=0.001). The overall effective rate of paricalcitol was 90.9% after 11 months’ treatment. Moreover, there were no significant changes in serum calcium and phosphorus levels during the whole treatment.

Conclusion
Intravenous paricalcitol can decrease the size and number of parathyroid gland, and reduce iPTH concentrations in SHPT patients with Long-term maintenance hemodialysis, without significant influence for serum Ca and P levels.
MO799IS COMBINATION OF MAINTENANCE HEMODIALYSIS WITH HEMOPERFUSION AN EFFECTIVE METHOD IN MANAGEMENT OF RENAL OSTEODYSTROPHY AND INFLAMMATION IN HEMODIALYSIS PATIENTS?
Authors: Beciragic Amela , Mutevelic-Turkovic Alma , Dervisevic Amela , Äœengiä† Roljiä† Badema , Masnic Fahrudin , Coric Aida , Ajanovic Selma , Prohic Nejra 
Published: May 2021

Abstract

Background and Aims
Some of the conditions which occur in maintenance hemodialysis (MHD) patients with a high incidence resulting in a decline in their quality of life, include malnutrition, renal osteodystrophy, refractory hypertension and chronic systemic inflammation. In developing countries, due to the low level of economic development, low-flux dialysis is the main means of extracorporeal blood purification therapy. But it can hardly remove the middle and large molecule uremic toxins and protein-bound toxins; as a result, the patients suffer from long-term complications and poor quality of life. In this study, we attempted to investigate whether the combination of maintenance hemodialysis (MHD) with hemoperfusion (HP) could improve the clearance rate of middle and large molecule uremic toxins so as to improve their uremic complications.

Method
A total of 54 patients, who underwent routine hemodialysis, were assessed in this study. Those patients were randomly divided into two groups: Group 1 (27 patients) received combined treatment of HD with hemoperfusion (HP) in this regimen: HD 2 times a week with HD+HP once a week two times in a row, then after two weeks, and afterwards once a month as a maintenance treatment. Group 2 (27 patients) was only undergoing maintenance HD 3 times a week. The clinical and laboratory properties of both groups were followed up for 18 months, whereas the primary outcomes included normal clinical data, high sensitive C-reactive protein (hsCRP), immunoreactive parathyroid hormone (iPTH), phosphorus (P04), calcium (Ca), albumin, iron (Fe), total iron binding capacity (TIBC), hemoglobin, Epo doses and types of hypertensive drugs.

Results
At the end of the 18-month observation, the serum concentration of albumin, P04, hsCRP, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were lower with Group 1 than with Group 2 (p&lt;0.05). Whereas, higher levels of iPTH were noticed in group 1, but when the laboratory and clinical data are analysed of the group 1 alone a statistically significant lower values after the observational period are noticed especially in the serum values of iPTH (p&lt;0.05), P04 (p&lt;0.001), CRP (p&lt;0.011), SBP and DBP (p&lt;0.05).

Conclusion
HD+HP was superior to HD in regularly eliminating middle and large molecule uremic toxins accumulated in the body which is mostly shown through reducing the values of iPTH and hsCRP. These findings suggest a potential role for HD+HP in the treatment of inflammation and renal osteodystrophy as well, because lowering these values of iPTH leads to a normalization of other minerals which is expected and therefore leads to a stabilization of this long-term uremic complications, which can improve the overall general condition of the MHD patient.
MO721THROMBOTIC EVENTS AFTER COVID-19 INFECTION IN HEMODIALYSIS PATIENTS*
Authors: Shabaka Amir , Gruss Enrique , Landaluce-Triska Eugenia , Gallego-Valcarce Eduardo , Cases Corona Clara Maria , Ocaña Javier , Tato Ribera Ana , López Katia , Furaz-Czerpak Karina R , Fernandez Juarez Gema Maria 
Published: May 2021

Abstract

Background and Aims
There is an increased risk of thrombotic complications in patients with COVID-19. Hemodialysis patients are already at an increased risk for thromboembolic events such as stroke and pulmonary embolism. The aim of our study was to determine the incidence of late thrombotic complications (deep vein thrombosis, pulmonary embolism, stroke, new-onset vascular access thrombosis) in maintenance hemodialysis patients after recovery from COVID-19.

Method
We performed a retrospective cohort study of 200 prevalent hemodialysis patients in our center at the start of the pandemic. We excluded incident patients after the cohort entry date and those who required hemodialysis for acute kidney injury, and excluded patients with less than 1 month follow-up due to kidney transplantation or death from non-thrombotic causes.

Results
185 prevalent hemodialysis patients finally met the inclusion criteria; 37 patients (17.6%) had SARS-CoV-2 infection, out of which 10 (27%) died during the acute phase of disease without evidence of thrombotic events. There was an increased risk of thrombotic events in COVID-19 survivors compared to the non-infected cohort (18.5% vs 1.9%, p=0.002) after a median follow-up of 7 months. Stroke incidence was 38.9 episodes/1000 patient-years in patients infected with SARS-CoV-2, compared to an incidence of 2.8 episodes/1000 patient-years in non-infected patients during the follow-up period. The median time from diagnosis of SARS-CoV-2 to the first thrombotic event was 62 days (interquartile range 5-118 days). Survival analysis with Kaplan-Meier curves revealed an increase in the rate of thrombotic events after SARS-CoV-2 compared to non-infected patients (see Figure 1). Mean survival from thrombotic event was 6.1±0.4 months in the COVID-infected group, compared to 6.97±0.04 months in the non-infected group (p&lt;0.001). Multivariate regression analysis showed that COVID-19 infection increased risk for late thrombotic events adjusted for age, sex, hypertension, diabetes, antithrombotic treatment and previous thrombotic events (OR 26.4, 95% CI 2.5-280.6, p=0.01). Clinical and laboratory markers did not predict thrombotic events.

Conclusion
There is an increased risk of late thrombotic complications in hemodialysis patients after infection with COVID-19. Further studies should evaluate the benefit of prolonged prophylactic anticoagulation in hemodialysis patients after recovery from COVID-19.
MO734CONTRIBUTION OF SOLUBLE ST2 TO THE EFFECT OF RIGHT VENTRICULAR DYSFUNCTION ON MORTALITY IN HEMODIALYSIS PATIENTS
Authors: Romero-González Gregorio , Ravassa Susanna , Diaz-Dorronsoro Agnes , De la Fuente Ana , Garcia-Fernandez Nuria , Rojas Miguel A , Lorenzo Ignacio , García-Trigo Isabel , Mateo-De Castro Francisco M , López Begoña , González Arantxa , Diez Javier 
Published: May 2021

Abstract

Background and Aims
Right ventricular dysfunction (RVD) has been shown to predict mortality in patients with kidney failure. It has been proposed that RVD in these patients is mediated by inflammatory and fibrotic mechanisms, which may be enhanced by hemodialysis (HD). The present study aimed to investigate the potential associations between RVD and circulating biomarkers of myocardial inflammation and fibrosis with all-cause mortality in HD patients.

Method
We performed a retrospective single-centre cohort study of prevalent patients admitted in a chronic HD program for more than 3 months. Clinical characteristics and echocardiographic parameters were assessed in all patients. Pre-dialysis blood samples for measurement of inflammatory (e.g., C reactive protein, interleukin-1, interleukin-18) and fibrotic (e.g., soluble suppression of tumorigenesis-2 [sST2], galectin-3, C-terminal pro-peptide of procollagen type I and N-terminal pro-peptide of procollagen type III) biomarkers were collected. Right ventricular dysfunction (RVD) was defined using tricuspid annular plane systolic excursion (TAPSE) &lt;1.7 cm or pulsed Doppler peak annular velocity (S´) &lt;9.5 cm/s. The ability of sST2 to discriminate between mortality was assessed using AuROC curve.

Results
We enrolled 48 patients (mean age 74 [64–79] years, 62.5% males) followed over a period of 1.4 years. Mortality was higher 45.5% (log-rank, p=0.003) in patients with RVD as diagnosed by S' than in patients without RVD. No difference in mortality was observed for RVD defined by TAPSE. There were no differences in the morphology and function parameters of the left ventricle between patients with and without RVD. From all biomarkers measured only sST2 was associated with RVD. Indeed, an age- and sex-adjusted analyses showed that doubling of sST2 was inversely associated with a decreased in S´ (estimate=-2.03, 95% CI [-3.04 to -1.00] cm/s; P=0.002). Mortality was increased in patients with sST2 ≥40.45 ng/mL compared to patients with sST2 &lt;40.45 ng/mL (66.7% vs. 18.9%, log-rank; p=0.004). Crude analysis showed that patients presenting with S’ &lt;9.5 cm/s and sST2 ≥40.45 ng/mL exhibited higher mortality (log-rank; p=0.001) than patients with S’ &gt;9.5 cm/s and sST2 &lt;40.45pg/mL.

Conclusion
Albeit preliminary these findings suggest that an excess of sST2 may be involved in RVD and on its effect on mortality in HD patients. The myocardial pro-remodeling effect of sST2 among HD patients with RVD warrants further investigation.
MO735INTERPLAY BETWEEN GDF-15 AND LEFT VENTRICULAR HYPERTROPHY IN END-STAGE RENAL DISEASE PATIENTS ON DIALYSIS
Authors: Coimbra Susana , Catarino Cristina , Faria Maria do Sameiro , Lopes Nunes José Pedro , Rocha Susana , Valente Maria João , Rocha-Pereira Petronila , Bronze-da-Rocha Elsa , Bettencourt Nuno , Beco Ana , Homem Melo Marques Sofia , Oliveira José Gerardo , Madureira José , Miranda Vasco M P , Belo Luís , Santos-Silva Alice 
Published: May 2021

Abstract

Background and Aims
Cardiovascular disease (CVD) is the major cause of mortality and morbidity in chronic kidney disease (CKD), especially in end-stage renal disease (ESRD) patients. Left ventricular hypertrophy (LVH) is a common cardiovascular complication in CKD. Growth differentiation factor (GDF)-15 increases in tissue injury and inflammatory states associated with cardiometabolic risk. GDF-15 and N-terminal pro B-type natriuretic peptide (NT-proBNP) are both synthesized by cardiomyocytes and may be associated with cardiorenal dysfunction. Our aim was to study the association of GDF-15 with LVH in ESRD patients on dialysis.

Method
This study included 196 ESRD patients on dialysis (hemodiafiltration and high-flux hemodialysis). Left ventricular mass (LVM) was evaluated through echocardiographic studies, corrected for body surface area and the values are presented as LVM index (LVMI). LVH was defined by a value of LVMI &gt; 115 g/m2 in men and &gt; 95 g/m2 in women. Patients were divided into two groups - LVH (n=131) and non-LVH (n=65). LVMI, clinical and analytical variables (age, body mass index, dialysis vintage, dialysis adequacy, GDF-15, NT-proBNP and pentraxin (PTX) 3 were evaluated.

Results
ESRD patients with LVH presented significantly higher levels of NT-proBNP and GDF-15, and a trend towards higher PTX3 values. In LVH patients, GDF-15 correlated positively and significantly with NT-proBNP and PTX3; LVMI correlated positively and significantly with pro-BNP and PTX3 levels; pro-BNP correlated significantly and positively with PTX3.

Conclusion
Our data show that in ESRD patients on dialysis with LVH, GDF-15 is raised and shows a strong association with NT-proBNP, PTX3 and LVMI. Further studies are needed to clarify if the rise in GDF-15 is a cause or a consequence of LVH development.

Acknowledgments
This work was supported by Applied Molecular Biosciences Unit-UCIBIO, financed by national funds from FCT/MCTES (UIDB/04378/2020), by North Portugal Regional Coordination and Development Commission (CCDR-N)/NORTE2020/Portugal 2020 (Norte-01-0145-FEDER-000024) and by REQUIMTE-Rede de Química e Tecnologia-Associação in the form of a researcher (S. Rocha) – project Dial4Life co-financed by FCT/MCTES (PTDC/MEC-CAR/31322/2017) and FEDER/COMPETE 2020 (POCI-01-0145-FEDER-031322).
MO741TUMOR NECROSIS FACTOR ALPHA AND MAGNESIUM ARE LINKED TO CARDIAC VALVE CALCIFICATION IN DIABETIC HEMODIALYSIS PATIENTS
Authors: Susla Oleksandr , Litovkina Zoriana , Mysula Ihor , Gozhenko Anatoliy 
Published: May 2021

Abstract

Background and Aims
The processes of cardiac valve calcification (CVC) in diabetic hemodialysis (HD) patients are not fully understood. In this context, it is reasonable to complex and comprehensively research the activity of chronic inflammation and magnesium (Mg) imbalance as cardiovascular risk factors in end-stage renal disease (ESRD). The main purpose of the current study was to determine the relationship of tumor necrosis factor alpha (TNF-α) and Mg levels with the presence and severity of CVC in diabetic patients with ESRD.

Method
We enrolled 136 patients undergoing HD (male/female, 78/58;age, 53.9±1.0 years; HD duration, 47.6±4.2 month) in this observational cross-sectional study. The study was performed in accordance with the provisions of the Declaration of Helsinki last revision. Depending on the presence of type 2 diabetes mellitus (T2DM) all subjects were divided into two groups: the 1st one – non-diabetic patients (n=88); the 2nd one – diabetic patients (n=48). Presence of CVC was detected by ultrasound. The mitral (MVC) and aortic (AVC) valve calcification degree were scored as follows: 1, no calcification; 2, valve thickening without calcification; 3, valve annulus or cusps calcification. Serum content of TNF-α as one of the key proinflammatory cytokine was determined by enzyme-linked immunosorbent assay. Serum Mg concentration was estimated by biochemical method. Data are expressed as means±SEM. Used nonparametric statistics methods: Mann-Whitney U-test, χ2-test, Spearman’s rank R correlations.

Results
In diabetic HD patients TNF-α content was higher (13.86±1.34 vs. 8.73±0.60 ng/L; Z=3.04, p=0.002) whereas Mg concentration (0.87±0.02 vs. 1.00±0.02 mmol/L; Z=4.91, p&lt;0.001) – lower compared to non-diabetic ones, and in 2nd group indices of TNF-α and Mg were related (Rs=-0.68, p&lt;0.001). CVC was detected in 66.6% of T2DM patients with predominance of calcification of both valves (35.4%) over isolated MVC (20.8%) and AVC (10.4%). Combined MVC and AVC in the 2nd group was observed 2.6 times more often (χ2=8.78, p=0.003) than in the 1st one. For the first time it was established that in diabetic patients with ESRD the presence of CVC closely associated with indices of TNF-α (Rs=0.51, p&lt;0.001) and Mg (Rs=-0.57, p&lt;0.001). The MVC as well as AVC degree were related with the content of TNF-α (Rs=0.49, p&lt;0.001; Rs=0.52, p&lt;0.001) and Mg concentration (Rs=-0.47, p&lt;0.001; Rs=-0.50, p&lt;0.001) respectively.

Conclusion
(1) T2DM in HD patients is characterized with an increase of serum TNF-α activity and simultaneous decreased of Mg content. (2) In diabetic patients with ESRD, both MVC and AVC are closely linked with the TNF-α accumulation and hypomagnesemia. (3) Chronic inflammation and Mg deficiency can be important factors of CVC progression and very high cardiovascular risk in diabetic HD patients.
MO742PRELOAD DEPENDENCE OF PULMONARY HAEMODYNAMICS AND RIGHT VENTRICULAR PERFORMANCE: AN ECHOCARDIOGRAPHIC STUDY IN PATIENTS ON HAEMODIALYSIS
Authors: Gual-Capllonch Francesc , Graterol Fredzzia , Soler Majoral Jordi , Bancu Ioana , Ferrer-Sistach Elena , Teis Albert , Santiago-Vacas Evelyn , Vallejo Nuria , Juncà Gladys , Bayes-Genis Antonio 
Published: May 2021

Abstract

Background and Aims
Haemodynamic cardiac changes in haemodialysis are associated with adverse cardiovascular outcomes and and they are difficult to measure. Systolic pulmonary artery pressure (SPAP) and right heart adaptation in relation to pre-existing preload are often disregarded. To determine volume-related changes in the pulmonary-right ventricle (RV) unit and the preload-dependence of its components, we analysed pulmonary haemodynamics and right ventricular performance, taking advantage of the plasma volume removal associated to haemodialysis (HD).

Methods and results
Fifty-three stable patients on chronic HD with LVEF &gt;50% and without heart failure were recruited (mean age 63.0±12.4 years; 31.2% women; hypertension in 89% and diabetes in 53%) and evaluated just before and after HD (mean ultrafiltration volume 2.4±0.7l). SPAP from both times were available in 39 patients. After HD, SPAP decreased (42.2±12.6 to 33.7±11.6 mmHg, p&lt;0.001) without modification of non-invasive pulmonary vascular resistance (1.75±0.44 to 1.75±0.40 eWU, p=0.94). Age and drop in the E/e’ ratio were the variables associated with greater reduction in PASP (p=0.022 and p=0.049, respectively). A significant reduction of right chamber sizes was observed, along with a diminution in measures of RV contractility, excluding RV longitudinal strain. Functional tricuspid regurgitation (FTR) diminution was observed in 26% of patients, occurring in every case with more than mild FTR. On multivariate analyses, left atrial size was the only predictor of pulmonary hypertension (defined as SPAP &gt;40 mmHg) (OR 1.29 (1.07–1.56), p=0.006).

Conclusion
Rapid volemic changes determined by rapid fluid removal during hemodialysis; may affect FTR grading, RV size and contractility, with RV longitudinal strain being less variable than conventional parameters. SPAP decreases after HD, and this reduction is related to age and greater diminution of the E/e′ ratio.
MO743FACTORS AFFECTING CEREBRAL OXYGENATION IN HEMODIALYSIS PATIENTS: ARTERIAL STIFFNESS, MENTAL ACTIVITIES, SMOKING
Authors: Piotr Olczyk , Kusztal Mariusz , Gołębiowski Tomasz , Krzysztof Letachowicz , Madziarska Katarzyna , Szymczak Anna , Magdalena Krajewska 
Published: May 2021

Abstract

Background and Aims
A significant deterioration of cognitive function in hemodialysis patients is observed in elderly and non-elderly patients. One of possible explantation is significant changes in the circulatory system caused by regular lower cerebral regional saturation of oxygen (rSO2) during dialysis. We aimed to identify the factors affecting the cerebral rSO2 in HD patients during session.

Method
27 patients out of 80 hemodialysed in center patients were recruited for the study (exclusion criteria: significant vision defect, fistula in the dominant hand, previous stroke, other neurological diseases impaired cognitive functions). The mean age of the patients was 51 ±18 y, BMI 25.5±5, dialysis vintage was 2.3 y; 6 with DM and 22 with HT. During the study, each patient completed battery of cognitive function tests (MOCA, Beck's Scale) including computer based assessment validated for elderly (Cognifit), arterial stiffness surrogates (PWV, Aix75 using IEM Mobil-O-Graph) and the saturation (rSO2) of frontal lobes were measured (INVOS 5100c system). Patient regular passive or active (reading, crosswords solving, electronic games) behaviour during sessions was noticed.

Results
Factors showed correlations with rSO2 are displayed in table. Lack of correlations between rSO2 and HD vintage, diabetes or BMI was observed. Patients mentally active during dialysis showed significant (p&lt;0.05) higher rSO2 (60 vs 53% left, 58 vs 49% right), Cognifit score (368 vs 233) and PWV (6,3 vs 9,3 m/s) when compared to passive patient behavior (sleeping, watching TV).

Conclusion
Significant differences in cerebral oxygenation in hemodialysis patients correlated with cognitive functions. In HD patients, cerebral rSO2 was affected by multiple factors, including non modifiable factors: arterial stiffness, age and modifiable factors – active mental activity during session and smoking. Furthermore, this is the first report describing lower levels of rSO2 in HD patients with significant central arterial stiffness (Figure).
MO748CORONARY ARTERY CALCIUM SCORE IN ASYMPTOMATIC PATIENTS RECEIVING CHRONIC HAEMODIALYSIS
Authors: Kusic Milicevic Jovana , Vidakovic Radosav , Andjelkovic Apostolovic Marija , Apostolovic Branislav , Ostojic Ana , Markovic Rodoljub , Djurkovic Veselinka , Trbojević Stanković Jasna , Jemcov Tamara , Dragovic Gordana 
Published: May 2021

Abstract

Background and Aims
Vascular calcification has been reported to be an independent predictor of all-cause mortality and cardiovascular (CV) events in patients with end-stage renal disease. Even in previously asymptomatic patients, early years of haemodialysis (HD) are associated with high CV morbidity and mortality rates. Thus, it is important to precisely and timely identify individuals at risk of coronary artery disease (CAD) who would benefit from further CV treatment. Coronary artery calcium score (CACS) is an accurate tool for noninvasive assessment of CAD. This study aimed to evaluate CACS in asymptomatic HD patients in early years of treatment.

Method
This multicentric observational study included 60 patients receiving chronic HD for less than 4 years, with neither signs nor symptoms of CV disease. All patients underwent multislice computed tomography to identify coronary artery calcifications according to the standard procedure. CACS was calculated by the Agatston method individually for the left main, left circumflex, left anterior descending, and right coronary arteries and then summed to calculate the total CACS for each patient. Patients were distributed based on CACS: group 1 with CACS = 0, group 2 with CACS ranging from 1 to 400, and group 3 with CACS &gt; 400.

Results
Nine patients (89% men) had CACS = 0, 34 (47% men) had CACS 1-400, and 17 (76.5% men) had CACS &gt; 400 (χ2 = 7.467; p = 0.024). The mean age was 51±7, 61±12 and 64±8 years in groups 1, 2 and 3, respectively (p = 0.016). Patients in group 1 were significantly younger than patients in group 2 (p = 0.046) and group 3 (p = 0.012). The highest percentage of men was observed in group 1 (x2 = 7,668; p = 0.022). Other investigated demographic characteristics (dialysis vintage, body mass index, smoking history, family CV history, systolic and diastolic blood pressure), comorbidities (hypertension, diabetes, hyperparathyroidism, hyperlipidemia) and therapy (angiotensin converting enzyme inhibitors, angiotensin receptor blockers, statins, vitamin D, CaCO3, dialysate-magnesium concentration) did not differ significantly between the investigated groups. CACS showed statistically significant negative correlation with the serum iron (σ = - 0.351; p = 0.007), while other laboratory parameters (including calcium phosphate product) did not show statistically significant correlations.

Conclusion
Older age and low serum iron are associated with higher CACS in asymptomatic patients in the early years of HD. Therefore, these patients should be closely monitored for the early signs of CV disease.