bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO749CATHETER ABLATION FOR ATRIAL FIBRILLATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE AND ON DIALYSIS - A META-ANALYSIS
Authors: Chung Isaac , Khan Yasir , Kondapally Rao , Sohal Manav , Banerjee Debasish 
Published: May 2021

Abstract

Background and Aims
Atrial fibrillation (AF) is common in chronic kidney disease (CKD) patients and is difficult to treat with antiarrhythmics and anticoagulants due to abnormal metabolism and increased side effects. Catheter ablation if successful may be a safer alternative. This review evaluates the efficacy of catheter ablation therapy in CKD and haemodialysis (HD) patients.

Method
MEDLINE and Embase databases were searched with the following search terms: “(atrial fibrillation AND (chronic kidney disease OR renal failure OR renal function OR dialysis) AND ablation)” for journal articles of any language until December 2020. Two authors abstracted the data independently. Risk ratios were derived using random-effects meta-analysis.

Results
Of the initially identified 520 studies, 5 and 3 observational studies on CKD and HD patients respectively were found reporting AF recurrence rates. During a mean (SD) follow-up of 25.5 (9.8) months, CKD patients had a higher risk of AF recurrence compared to patients without CKD (RR 2.34, 95% CI 1.36-4.02, p&lt;0.01). The heterogenicity test showed there were significant differences between individual studies (I2 = 91%, 95% CI 82.2%-95.6%, p&lt;0.01). In a mean (SD) follow-up of 40.3 (20.8) months, HD patients may be at a higher risk of AF recurrence compared to healthy non-dialysis AF patients (RR 1.21, 95% CI 0.64-2.30, p=0.55). Heterogeneity analysis showed the studies were heterogeneous (I2 92.3%, 95% CI 80.8%-96.9%, p &lt;0.01).

Conclusion
Our meta-analysis suggests patients with CKD and patients on HD are more likely to have AF recurrences after catheter ablation compared to AF patients who are otherwise healthy. However, more robust evidence from randomized controlled trials comparing catheter ablation and pharmaceutical rhythm therapy are urgently needed to guide therapy in this difficult to treat population.
MO723EFFICACY AND SAFTY OF DAPAGLIFLOZIN FOR HEART FAILURE: A SYSTEMIC REVIEW
Authors: Wang Zhe 
Published: May 2021

Abstract

Background and Aims
Dapagliflozin is an inhibitor of sodium-dependent glucose transporters 2, which is a new drug for diabetes mellitus. Recent researches indicated that among patients with heart failure, the risk of worsening heart failure or death from cardiovascular causes was lower among those who received dapagliflozin than those who received placebo, regardless of the presence or absence of diabetes. This systematic review aimed to evaluate efficacy and safety of dapagliflozin for heart failure.

Method
According to the collaborative search strategy, MEDLINE(1966-2020.9), Embase(1974-2020.9), Chinese Wanfang database(1996-2020.9),CNKI(1979-2020.9), the clinical control test database of Cochrane Library and were searched. Only randomized controlled trials (RCT) were included in this research. Quality assessment and data extraction were conducted by two independent investigators. Meta-analysis was conducted by Stata 11.0.

Results
A total of 5 RCTs were identified which met the inclusion criteria, including 5998 patients. Compared with control group, dapagliflozin was associated with a lower risk of cardiovascular mortality/hospitalization for heart failure composite events (HR=0.73, 95%CI 0.64∼0.83, P&lt;0.001), cardiovascular mortality (RR=0.80, 95%CI 0.68∼0.93, P=0.005), hospitalization for heart failure (HR=0.68, 95%CI 0.58∼0.80, P&lt;0.001), and all-cause mortality (RR=0.80, 95%CI 0.70∼0.92, P=0.002). Dapagliflozin also increased the Kansas city cardiomyopathy questionnaire (KCCQ), without increasing the risk of major hypoglycemia, volume depletion, renal adverse event and amputation.

Conclusion
Dapagliflozin could effectively lower the risk of mortality and hospitalization for heart failure, as well as improve the quality of life among patients with heart failure.
MO724IS INDIVIDUALIZED DIALYSATE SODIUM REASON FOR BETTER SURVIVAL IN HEMODIALYSIS PATIENTS?
Authors: Eftimovska-Otovikj Natasha , Petkovikj Natasha , Stojceva-Taneva Olivera 
Published: May 2021

Abstract

Background and Aims
We are uncertain about whether dialysate sodium improves overall health and well-being for people on haemodialysis, since there are a mixture of probably good and bad effects. Dialysate sodium is one of the most easy changeable parameter which can inﬂuence hemodynamic stability, echocardiography and laboratory parameters. The aim of the study was to investigate whether dialysis patients will have some beneﬁcial effects of dialysate sodium set up according to serum sodium.

Method
77 nondiabetic subjects (41men; 36women) performed 12 months hemodialysis (HD) sessions with dialysate sodium concentration setup at 138 mmol/L, followed by additional 24 month ssessions wherein dialysate sodium was set up according to pre-HD serum sodium concentration. Interdialytic weight gain (IDWG), echocardiography, laboratory parameters and survival were analysed.

Results
Sodium individualization resulted in signiﬁcantly lower IDWG by using individualized sodium according to pre HD serum sodium compared to standard dialysate sodium (2.17±0.79 vs 1.93±0.64 kg, p&lt;0,001). In all patients we confirmed positive sodium gradient and univariate regression analysis showed that by increasing the sodium gradient by 1 mmol/L, IDWG increased by an average of 0.189% and 7,1% changes in IDWG can be explain by changing of the sodium gradient. Echocardiography analysis showed an increase of 2.04 mm of left ventricular diastolic diameter (LVDD) by increasing the sodium gradient for 1mmol/L and signiﬁcantly increased left ventricular mass (LVM) of 35.69 gr by 1kg increase of IDWG. Laboratory analysis showed statistical significant increase in Kt/V, URR (urea reduction rate), serum albumin and hemoglobin by using individualized dialysed sodium compared to standard dialysate sodium, respectively (1.50±0.24 vs 1.36±0.22; 70.80±5.24 vs 67.00±6.23%; 38.23±3.80 vs 34.46±2.53 g/L; 120.32±10.14 vs 114.62±10.34 g/L, p&lt;0.001). We confirmed significant decrease in serum potassium, with no change in other electrolities (5.62±0.60vs 5.15±0.94). During the study, 7 patients died and binary logistic regression univariate analysis showed that significant predictors of mortality in patients dialyzed with individualized sodium dialysis according to pre-HD plasma sodium concentrations were Kt/V, URR, and CRP (C reactive protein). Analysis showed that patients with Kt/V lower than 1,2 have 8.8 times higher risk for death compared to patients with Kt/V&gt;1,2, URR lower than 65% have 10,9 times higher risk compared to URR&gt;65% and CRP higher than 10 mg/L have 10.2 times higher risk for death compared to patients with CRP lower than 10 mg/L

Conclusion
Individualization of dialysate sodium according to pre HD serum sodium concentration result in better IDWG control, improvement of fluid overload and regression of left ventricular hypertrophy, better dialysis adequacy and higher survival compared to standard dialysate sodium.
MO761THE CONTRIBUTION OF HIGH-PHOSPHORUS IN EXTRACELLULAR MATRIX ACCUMULATION OF VALVULAR CALCIFICATION IN CHRONIC KIDNEY DISEASE
Authors: Wang Liting , Zhang Yuxia , Wang Yujia , Tang Rining 
Published: May 2021

Abstract

Background and Aims
The characteristics of valvular calcification (VC) in early stage are extracellular matrix (ECM) accumulation and muti-cells activation. In our previous work, we found high-phosphorus (HP) diet aggravated ECM accumulation in both aortic valve and mitral valve in rats with chronic kidney disease (CKD). However, the underlying mechanism of HP contribution in ECM accumulation of CKD-induced VC is still unknown.

Method
canine valvular interstitial cells (VICs), valvular endothelial cells (VECs) and human umbilical vein endothelial cells (HUVECs) were used in this study. CKD mice (C57b and Tek-EGFP-PolyA) was build by 0.2% adenine-diet for 6 weeks and HP diet/NP diet for 10 weeks.

Results
As for VICs, HP induced qVICs transfer into aVICs, not oVICs, which was characterized with upregulated level of smoothelin and viemitin. There was no calcium accumulation was observed, suggesting that VICs do not have the ability to synthesize calcium crystals under pure HP intervention. As for VECs, aVICs activated by HP induced VECs EndMT in a transwell-assay, which was characterized with decreasing protein levels of endothelial markers (CD31, vWF, VE-cadherin) and increasing protein levels of mesenchymal makers (α-SMA, FSP1, N-cadherin). Then, IL-8 was found as the main factor releasing from VICs to induce VECs EndMT. In vitro, the concentration of IL-8 in the lower chamber could reach 2-4ng/ml. Reparixin was used to inhibit IL-8 receptor of VECs, which could relive aVICs-induced EndMT. In vivo, the expression of valve CXCL-2 (the mouse IL8 functional homolog) was increased in HP-diet compared with NP-diet, though the serum level of CXCL-2 was similar between two groups. AAV9-sm22a-CXCL-2 and Reparixin could inhibit VECs EndMT by inhibiting VICs relasing CXCL-2 and inhibiting VECs IL-8 receptor in CKD mice of Tek-EGFP-PolyA respectively. Then, IL-8 was found to induced VECs EndMT by miR-214-3p/PTEN/Akt pathway. Inhibiting EndMT by blocking IL-8/miR-214-3p could alleviate ECM accumulation.

Conclusion
HP could induce qVICs transfer into aVICs, and aVICs could cause VECs EndMT via IL-8/miR-214-3p/PTEN/Akt pathway. Both take part in ECM accumulation in CKD-induced VC.
MO762RELATIONSHIP BETWEEN INFLAMMATION AND PERIPHERAL ARTERIAL DISEASE MEASURED BY ANKLE-BRACHIAL INDEX IN CHRONIC HEMODIALYSIS PATIENTS
Authors: Parodis Yanet , Monzon Tania , Valga Francisco , Anton-Perez Gloria 
Published: May 2021

Abstract

Background and Aims
Peripheral arterial disease (PAD) is very common in patients with chronic kidney disease. There are predisposing factors such as high blood pressure, diabetes mellitus, and dyslipidemia that are highly prevalent in this population. The ankle-brachial index (ABI) is a widely validated diagnostic method for the diagnosis of PAD. A value below 0.9 is suggestive of this pathology. On the other hand, inflammation is a phenomenon that favors development of atherosclerosis and therefore could be another predisposing factor for PAD. There are emerging markers of inflammation such as the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) that have an excellent correlation with classic markers such as C-reactive protein (CRP). The objective of our study was to determine whether there is a relationship between ABI values and the degree of inflammation in patients.

Method
A retrospective observational cross-sectional study was conducted in our prevalent hemodialysis population between April-May 2019. ABI was measured through the Microlife WatchBP Office ABI™ device. The sample was divided into two groups using 0.9 as a cut-off point: group 1 (ABI &lt;0.9) and group 2 (ABI&gt; 0.9). Inflammatory ratios (NLR, PLR and SII) and other parameters of bone kidney disease such as serum calcium, bicarbonate, phosphorus, parathyroid hormone (PTH), magnesium and vitamin D were determined.

Results
100 patients with chronic kidney disease on chronic hemodialysis belonging to our Avericum Negrin center were analyzed. 42% (N = 42) of the sample were women and 42% (N = 42) were diabetic. The etiology of kidney disease was: 12% (N = 12) renal nephroangiosclerosis, 35% (N = 35) diabetic nephropathy, 14% (N = 14) chronic glomerulonephritis, 8% (N = 8) polycystic kidney disease, 17% (N = 17) unknow and 14% (N = 14) others. 19% (N = 19) had a central venous catheter as vascular access. The mean values of inflammatory and renal bone disease parameters are described in Table 1. The values of PLR and SII index were significantly higher in patients with ABI &lt;0.9. (Figures 1 and 2).

Conclusion
Patients with peripheral arterial disease (ABI &lt;0.9) had higher PLR and SII values
MO726EFFICACY OF OPHTHALMIC EXAMINATIONS FOR PREDICTING VASCULAR CALCIFICATION IN MAINTENANCE HEMODIALYSIS PATIENTS
Authors: Park Woo Yeong , Kim Yaerim , Paek Jin Hyuk , Han Seungyeup , Kang Kyung Tae , Jang Ji Hye , Kim Yu Cheol , Jin Kyubok 
Published: May 2021

Abstract

Background and Aims
Vascular calcification is a risk factor for cardiovascular disease. In maintenance hemodialysis (MHD) patients, it has been reported that vascular calcification can be detected not only in coronary vessels, but also in ocular areas. Ophthalmic examinations can be used to more easily measure the degree of vascular calcification, but they are not sufficiently validated. Therefore, we aimed to investigate the association between ophthalmic findings and vascular calcification, and the prediction of the risk of cardiovascular disease in MHD patients.

Method
Thirty two MHD patients were enrolled. Conjunctival and corneal calcification (CCC) score was calculated based on the Tokuyama method, and the severity of CCC was graded between 0 and 5 by Porter and Crombie classification. The extent of invasion in the corneal limbus and center was identified using anterior ocular CT. Coronary calcium deposit was scored using CT, and cardiac function was investigated by echocardiogram. We divided the study population into three groups: mild (0-2 score), moderate (3-5 score) and severe (6-10 score) groups according to CCC scores.

Results
The mean coronary calcium scoring was 354.6 ± 765.8 in the mild group, 768.2 ± 594.0 in the moderate group, and 4034.9 ± 2981.0 (P&lt;0.001). The mean extent of invasion in the corneal limbus and center was significantly higher in the severe group than in the mild and moderate groups (P&lt;0.001). Ejection fraction and corrected calcium*phosphate were significantly higher in the severe group than in the mild and moderate groups (P&lt;0.001 and P=0.036). The CCC score was positively associated with the coronary calcium scoring, the extent of invasion in the corneal limbus and center, and parathyroid hormone level. The extent of invasion in the corneal limbus and center was also positively associated with the coronary calcium scoring. The CCC score was only negatively associated with ejection fraction.

Conclusion
Our study showed that CCC score and the extent of invasion in the corneal limbus and center can predict the risk of cardiovascular disease in MHD patients.
MO728OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY (OCT-A) METRICS PREDICT INTRADIALYTIC HYPOTENSION EPISODES IN CHRONIC HEMODIALYSIS PATIENTS: A PILOT, PROSPECTIVE STUDY
Authors: Coppolino Giuseppe , Carnevali Adriano , Gatti Valentina , Battaglia Caterina , Randazzo Giorgio , Figlia Irma , Patella Gemma , Giannaccare Giuseppe , Scorcia Vincenzo , Andreucci Michele , Bolignano Davide 
Published: May 2021

Abstract

Background and Aims
In chronic hemodialysis (HD) patients, intradialytic hypotension (IDH) is a complication that increases mortality risk. The pathogenesis of this condition remains partly unexplained although dysfunctions of the nervous autonomous system and various factors related to the hemodialytic procedure like rapid or excessive ultrafiltration, excessive reduction in osmolality and reaction to the dialyzer membrane or machine tubing, seem to play a key role. The observation of ocular microcirculation gives us an exceptional chance to directly evaluate in vivo the reactions of human circulation to stress stimuli. Indeed, the ocular microcirculation is involved in systemic disease and early changes in vascular structures may predict the development of systemic vascular disorders. We run a pilot study to analyzing possible relationships between optical coherence tomography angiography (OCT-A) metrics and IDH and to evaluate whether OCT-A could represent a useful tool to stratify the hypotensive risk in dialysis patients.

Method
a total of 35 eyes (35 patients) being correctly analyzed. OCT-A was performed before and after a single dialysis session. Patients were then followed up to 30 days (10 HD sessions) and a total of 73 IDHs were recorded with 12 patients (60%) experiencing at least one IDH.

Results
Central choroid thickness (CCT), 6x6 mm whole vessel density (VD) of superficial capillary plexus (SPC) and 6x6 mm foveal VD of deep capillary plexus (DCP) were reduced after dialysis (Figure 1). At logistic regression analysis, IDH was positively associated with baseline foveal VD of SCP and DCP, while an inverse association was found with the choroid (Figure 2). In Kaplan-Meier analyses of patients categorized according to the ROC-derived optimal thresholds, CCT, the 3x3 foveal VD of SCP, the 3x3 mm and 6x6 mm foveal VD of DCP and the 6x6 mm foveal VD of SCP were strongly associated with a higher risk of IDH over the 30-days follow-up.

Conclusion
In our study, we demonstrated that HD patients experiencing frequent IDH episodes showed a different ocular pattern with respect to those not facing with this complication. Furthermore, a simple measurement of retinal and choroid parameters by OCT-A before a single dialysis session may help predicting the risk of following IDH in the short-term. In HD patients, a single OCT-A measurement may represent a non-invasive, rapid tool to evaluate the compliance of vascular bed to HD stress and to stratify the risk of IDH in the short term.
MO729LUNG ULTRASOUND GUIDED DRY-WEIGHT REDUCTION DECREASES CARDIAC CHAMBERS DIMENSIONS AND IMPROVES VENTRICULAR DIASTOLIC FUNCTION IN HEMODIALYSIS PATIENTS: LONG-TERM ANALYSIS OF A LUST SUB-STUDY
Authors: Loutradis Charalampos , Papadopoulos Christodoulos , Sachpekidis Vassilios , Ekart Robert , Krunic Barbara , Papadopoulou Dorothea , Papagianni Aikaterini , Mallamaci Francesca , Zoccali Carmine , Sarafidis Pantelis 
Published: May 2021

Abstract

Background and Aims
Left ventricular hypertrophy (LVH) and dysfunction are highly prevalent in hemodialysis patients and independently associated with adverse outcomes. Few interventions were shown to effectively reduce LVH in hemodialysis. This study examines the long-term effects of dry-weight reduction with a standardized lung-ultrasound-guided strategy on echocardiographic indices of left and right cardiac chambers in hemodialysis patients.

Method
This is the report of the 12-month trial phase of a randomized controlled trial in 71 clinically euvolemic, hemodialysis patients with hypertension. Patients were randomized (1:1 ratio) in the active group (23 male and 12 female), following dry-weight reduction guided by the total number of US-B lines prior to a mid-week dialysis session and the control group (24 male and 12 female), following standard-of-care treatment. Among several assessments, participants underwent two-dimensional and tissue-Doppler echocardiographic (TDI) at baseline and study-end.

Results
During follow-up dry-weight reduction took place in more patients in the active compared with the control group (71.4% vs 22.2%; p&lt;0.001). Left atrial (LA) surface (-1.37±4.50 vs 1.28±5.00 cm2; P=0.006) and LA volume index (-3.22±11.82 vs 4.76±12.83 ml/m2; P=0.009) decreased in the active and increased in the usual-care group. Left ventricle (LV) diastolic (-0.94±11.45 vs 6.58±13.92 ml/m2; P=0.015) and systolic (-0.89±7.11 vs 3.38±7.89 ml/m2; P=0.018) volume index decreased only in the active group. LV mass index slightly decreased in the active (134.21±44.75 vs 133.57±45.51; P=0.844) and was marginally increased in the control group (134.21±40.96 vs 143.77±50.04 g/m2; P=0.089). Right ventricular (RV) systolic pressure was stable in the active (23.74±13.76 vs 24.35±12.99; P= 0.795) and significantly increased in the usual-care group (26.24±12.95 vs 31.20±16.13 mmHg; P=0.028). Reductions in LV A wave were greater in the active compared to the usual-care group (-4.98±15.11 vs 2.23±21.71 m/s; P=0.009). Changes in LV systolic and RV diastolic function indices were not different between the two groups.

Conclusion
Over 12 months, a lung-ultrasound-guided strategy for dry-weight reduction can effectively decrease cardiac chamber dimensions, prevent LVMi increase and improve LV diastolic and RV systolic function.
MO825PERSONALIZING TREATMENT IN END-STAGE KIDNEY DISEASE: DECIDING BETWEEN HAEMODIAFILTRATION AND HEMODIALYSIS BASED ON INDIVIDUALIZED TREATMENT EFFECT PREDICTION
Authors: Van Kruijsdijk Rob , Vernooij Robin , Bots Michiel , Peters Sanne , Dorresteijn Jannick , Visseren Frank L J , Blankestijn Peter J , Debray Thomas 
Published: May 2021

Abstract

Background and Aims
An individual participant data (IPD) meta-analysis of four randomized controlled trials (RCTs) demonstrated that hemodiafiltration (HDF) reduced overall mortality compared to hemodialysis (HD) in patients with end-stage kidney disease (ESKD). It remains, however, difficult to translate these average results into clinical practice as absolute treatment effects may substantially differ between individuals. The aim of this study was to develop and validate a treatment effect prediction model to determine which patients would benefit the most from HDF or HD in terms of all-cause mortality.

Method
We used an IPD meta-analysis based on four RCTs comparing HDF with HD on mortality endpoints to derive a Royston-Parmar model for prediction of absolute treatment effect of HDF based on pre-specified patient and disease characteristics. Validation of the model with regard to model discrimination, calibration and net benefit was performed using internal-external cross validation.

Results
The median predicted gain in median survival was 44 (Q1-Q3: 44-46) days for every year of treatment with HDF compared to HD. The overall gain in median survival with HDF ranged from 2 to 48 months (Figure). Patients who benefited most from HDF were younger, less likely to have diabetes or a cardiovascular history and had higher serum creatinine and albumin levels. Internal-external cross validation showed adequate calibration and discrimination. Decision curve analysis indicated that prediction-based treatment allocation improved the net clinical benefit compared to treating all with patients HDF or treating all with HD.

Conclusion
Although overall mortality is reduced by HDF compared to HD in ESKD patients, the absolute survival gain can vary greatly between individuals. Our results indicate that the effects of HDF on survival can be predicted using a combination of readily available patient and disease characteristics, which could guide shared decision-making.