bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO775CONTROL OF BONE DISEASE ASSOCIATED WITH CHRONIC KIDNEY DISEASE AS A PREDICTOR OF PRIMARY PERMEABILITY AFTER THE CREATION OF THE VASCULAR ACCESS
Authors: Piccone Saponara Luis Guillermo , Castro Fernández Maria Paz , Uribe Heredia Nancy Giovanna , Carreno Agustin , Anaya Fernandez Sara , Olazo Gutierrez Eliana , Ferrer García Guillermo , Sanchez Escudero Patricia , García Conejo Gloria , Romero Barragán Maria del Pilar , Vozmediano Poyatos Maria del Carmen 
Published: May 2021

Abstract

Background and Aims
Clinical practice guidelines recommend an arteriovenous fistula (AVF) as the preferred vascular access for hemodialysis. Patency of the arteriovenous access is important for effective hemodialysis. However, maintaining the patency of the AVF remains a challenge. We determined those independent prognostic factors for the patency of the AVF at the time of its creation.

Method
Cross-sectional study; We include all AVFs performed at the HGUCR in the last 2 decades. Demographic variables (age, sex), etiology of CKD and associated comorbidity were collected. We determine the factors involved in the primary patency of AVFs. Statistical analysis with SPSS 25.0. Categorical variables are expressed as percentages and are compared using the Chi2 test. Quantitative variables are expressed as mean ± standard deviation and the Mann Whitney Student-T/U was used to compare them. Statistical significance for a value of p &lt;0.05.

Results
622 AVFs performed in 482 patients were reviewed. 86.8% were autologous. The mean age was 65.4±14 years; 66.6% were male. The most frequent etiologies of CKD were diabetic nephropathy (30.2%), unknown (18%), and glomerulonephritis (16.6%). 91.2% had arterial hypertension (HBP) and diabetes mellitus (DM) 47.9%. 48.7% received antiplatelet therapy and 15.6% anticoagulation prior to the creation of the AVF. 27% presented primary failure. The univariate analysis showed statistical significance for the qualitative variables HTA (p=0.002), treatment with statins (p&lt;0.01) and antiplatelet (p&lt;0.01), and for the quantitative variables fibrinogen (p=0.048), serum phosphorus (p=0.001), CRP (p=0.004), triglycerides (p=0.05), ferritin (p=0.006) and age (p=0.05). When performing a multivariate analysis using logistic regression, HTA (OR: 0.46 95% CI 0.22-0.95 p = 0.036), high phosphorus levels (OR: 1.22 95% CI 1.08-1, 49 p = 0.004) and statin treatment (OR: 0.58 95% CI 0.36-0.96 p = 0.004) are predictors of primary VA failure.

Conclusion
In our study, HTA and antiplatelet therapy prior to the creation of the VA behave as protective factors for primary failure, with high phosphorus levels being an independent factor for primary failure of AVFs.
MO776THE USE OF HAND GRIP DEVICE IN ELDERLY PATIENTS ON ARTERIOVENOUS FISTULA MATURATION PROCESS
Authors: Tapia González Irati , Esteve Vicent , Ibañez Sara , Rubio Sandra , Moreno Guzman Fatima , Fulquet Nicolás Miquel , Duarte Gallego Verónica , Pou Potau Mónica , Saurina Solé Anna , Ramírez de Arellano Serna Manel 
Published: May 2021

Abstract

Introduction
The indication of creation arteriovenous fistula(AVF) may be controversial in elderly population with advanced chronic kidney disease (CKD). Postoperative exercises improve maturation. However, sometimes these exercises could be difficult to perform in the elderly CKD patients. The hand grip device is easy to use, inexpensive and able to increase the muscles of the hand and foream. Nevertheless, scarce scientific evidence has been reported about the role of hand grip device on AVF maturation process in elderly population.

Objectives
To evaluate the efficacy of a hand grip training program on AVF maturation in our patients older than 75 years old with stages 5-5D CKD.

Methodology
A 15 months prospective study. After surgery, all patients were randomized to hand grip group (HG) or control group (CG). HG performed a training program using a hand grip device. CO received usual care. Demographics data, upper limb muscle strength (ULMS), Doppler ultrasound (DUS), measurements (outflow vein (OV) diameter and humeral artery blood flow rate (BFR), DUS and clinical AVF maturation as well as VA related complications (hematoma, stenosis, thrombosis, pseudoaneurysm, aneurysm) were assessed at 4 and 8 weeks postoperatively.

Results
29 patients. 16 HG, 13 CO. 69% men. Mean age 80,5±2,9 years. 41,4% Radiocephalic AVF. Demographic data, ULMS and DUS measurement at baseline were similar. A significant increase was observed in ULMS only in HG at the end of study (18,8±6,5 vs 21,3±7,1Kg, p=0,005). DUS measurements statistically increased for both groups (OV diameter: CG 2,9 ± 0,6 vs. 5,8 ± 1,4mm; HG 2,9 ± 0,8 vs. 7,2 ± 2,2 mm; humeral artery BFR: CG 132,9± 30,3 vs. 1310,2 ± 691,8ml/min; HG 128,1± 28,9 vs. 1530,7 ± 708,9 ml/min) at the end of study. HG group obtained highest clinical (CG 21,4% vs HG 78,6%;p=0,018) and DUS maturation (CG 27,8% vs HG 72,2%; p=0,011) at 4 weeks and highest clinical (CG 20% vs HG 80%;p=0,007) and DUS maturation (CG 25% vs HG 75%; p=0,002) at 8 weeks, significantly. Despite no significant differences, the number of complications was lower in the HG, mainly significant stenosis (CG 60% vs HG 40%; p=0,428).

Conclusions
The hand grip device is a useful, safety and easy to use training device to improve the AVF maturation in elderly patients. This device results a novel therapeutic option for the AVF maturation in elderly patients. Further studies are required to support these outcomes in this population.
MO779DETECTION OF INTRADIALYTIC SLEEP APNEA IN HEMODIALYSIS PATIENTS
Authors: Paneque Galuzio Paulo , Cherif Alhaji , Tao Xia , Thwin Ohnmar , Preciado Rojas Priscila , Cato Matthew , Thijssen Stephan , Kotanko Peter 
Published: May 2021

Abstract

Background and Aims
Sleep apnea syndrome (SAS) has emerged as an important cardiovascular risk factor in hemodialysis (HD) patients. In patients with SAS, high-frequency oscillations of arterial oxygen saturation (SaO2) and arousal can be used to characterize repetitive respiratory cessation. Although these repetitive patterns have been observed in SAS patients, it has not been studied during HD treatment. In this study, we aim to detect intradialytic SAS in HD patients to provide novel prognosticators of adverse events related to SAS.

Method
We use the Crit-Line® monitor to record SaO2 at 1 Hz frequency, and video recording to capture periods of wakefulness for the entire treatment session (3.5±0.5hr). We developed a recurrent-based time-series analysis to characterize the desaturation and arousal in SaO2. For each patient, we compute four metrics, namely: (i) the probability of recurrence for any given state (recurrent rate, RR), (ii) systemic predictability (determinism, DET), (iii) occurrence of laminar state (LAM), and (iv) permutation entropy to quantify complexity. These four quantities were used to detect episodes of SAS in patients while undergoing HD treatments.

Results
We study 16 HD patients with arterio-venous vascular access. Their age was 54±11 years, 63% were males and 69% were African Americans. SaO2 was measured during two HD sessions per patient. The mean SaO2 was 94.3±2.1%. We observe distinguishable patterns in which periods of awake and asleep are differentiated. Figure 1 shows a typical SaO2 annotated with the period of awake and asleep (shaded area in Fig. 1A), during which the four metrics decrease during the corresponding period where the patient is asleep (Fig. 1B-C). Figure 1D-E shows the consistency of the metrics in all 16 patients, in which DET and entropy are analyzed around the onset of sleep. We observe monotonically decreasing trends around the episode of sleep, suggesting that these results are sensitive to the sleep states, and potentially to an episode of intradialytic SAS.

Conclusion
Our preliminary analysis suggests that DET, LAM, RR, and entropy may contain characteristic properties that could be used to detect the onset of intradialytic SAS, which are characterized by the high-frequency oscillatory patterns in SaO2. Further studies are needed to identify SAS-related desaturation and arousal detected in the SaO2 measurement. The predictive power of these features and their relationships to clinical outcomes warrants further investigation.
MO780SURVIVAL STUDY OF ARTERIOVENOUS FISTULAS CREATED IN A HIGH RESOLUTION HOSPITAL
Authors: Piccone Saponara Luis Guillermo , Castro Fernández Maria Paz , Uribe Heredia Nancy Giovanna , Carreño Parrilla Agustín , Anaya Fernandez Sara , Ferrer García Guillermo , García Conejo Gloria , Ugarte Cámara Marina , Valle Dominguez Casimiro , Romero Barragán Maria del Pilar , Vozmediano Poyatos Maria del Carmen 
Published: May 2021

Abstract

Background and Aims
Clinical practice guidelines recommend an arteriovenous fistula (AVF) as the ideal vascular access for hemodialysis. Autologous AVFs have higher primary, assisted primary and overall survival, associated with lower morbidity and mortality compared to prosthetic AVFs. However, primary failure of AVFs function is not uncommon, above all due to the vascular pathology of patients on hemodialysis (HD). We determined the survival rates in a series of vascular accesses created in a high-resolution hospital.

Method
Cross-sectional study; We include all AVFs performed during the last 20 years. Demographic variables (age, sex), etiology of CKD and associated comorbidity were collected. We determine the primary, assisted and global survival times. Statistical analysis with SPSS 25.0. Categorical variables are expressed as percentages and are compared using the Chi2 test. Quantitative variables are expressed as mean ± standard deviation and the Mann Whitney Student-T/U was used to compare them. We performed a kaplan-Meier analysis determining primary, assisted and overall survival. Statistical significance for a value of p &lt;0.05.

Results
622 AVFs performed in 482 patients were reviewed. 86.8% were autologous. The mean age was 65.4±14 years; 66.6% were male. The most frequent etiologies of CKD were diabetic nephropathy (30.2%), unknown (18%), and glomerulonephritis (16.6%). 91.2% had arterial hypertension (HBP) and diabetes mellitus (DM) 47.9%. 48.7% received antiplatelet therapy and 15.6% anticoagulation prior to the creation of the AVF. 27% presented primary failure. In the survival analysis using the Kaplan Meier test, the mean time to perform angioplasty in dysfunctional AVFs was 14.6±1.37 months and to perform a thrombectomy 17.6±1.31 months. The overall survival of AVFs was 41.9±2 months. When assessing the type of AVF, we observed a longer survival for autologous (31.5±1.8) vs prosthetic (21.8±3.6) (p = 0.03 log Rank 4.73).

Conclusion
In our study, autologous AVFs have better survival compared to prosthetic ones. Of the AVFs created, primary survival at one year (requiring angioplasty) was 64%, assisted primary survival (requiring thrombectomy) was 42%, and overall survival 24%.
MO764AVF VOLUME BLOOD FLOW REDUCTION AS THE FIRST STAGE OF TREATMENT OF CENTRAL VEIN STENOSIS IN HD PATIENTS
Authors: Zulkarnaev Aleksei , Stepanov Vadim , Vatazin Andrey , Parshina Ekaterina , Novoseltseva Mariya , Chursinova Julia 
Published: May 2021

Abstract

Background and Aims
It is well-known that central vein stenosis (CVS) significantly reduces the time of AVF functioning. At the same time, according to current guidelines (KDIGO, European Vascular Surgery Society, European Best Clinical Practice), only clinically significant CVS should be treated. Often, CVS becomes clinically manifest due to a significant increase of AVF volume blood flow (Qa) through the matured dialysis access. Aim: to assess the effect of Qa reduction on the CVS clinical course.

Method
We performed a retrospective study included 56 patients who underwent Qa reduction as the first step of treatment, and 62 patients who received endovascular interventions without Qa reduction (balloon angioplasty supplemented with stenting if necessary).
Blood flow reduction was performed using banding under intraoperative ultrasound control.

Results
Surgical banding leads to a clinically obvious and statistically significant decrease in Qa in all patients – fig. 1. In contrast, after endovascular intervention most of the patients show a modest but statistically significant increase in Qa - fig. 2. All surgeries were performed to reduce the severity of clinical manifestations of CVS. AVF was better available for immediate cannulation after endovascular interventions than after banding: RR=4,537 [95%CI 1,416; 14,84], p=0,0116. However, the probability of successful cannulation at the third postoperative HD session did not differ between groups: RR=3.024 [95%CI 0.674; 13.67], p=0.2126. Taking in consideration these findings, we can conclude that the short-term results of Qa reduction are satisfactory.
After Qa reduction in case of recurrence of CVS symptoms or absence of their complete resolving, we supplemented the treatment with endovascular interventions. Both primary and secondary patency were significantly better than in the case of endovascular interventions without Qa reduction – fig. 3.
Moreover, in patients who underwent endovascular interventions without Qa reduction, higher Qa values were associated with decrease of the primary and secondary patency – fig. 4. So, increasing or maintaining large Qa values after endovascular intervention may be an important risk factor for CVS relapse and AVF function loss.

Conclusion
Qa is an important factor of CVS clinical manifestation. When determining treatment strategy, it is necessary to evaluate Qa first and reduce it, if necessary. Manage of Qa allows to transfer manifest CVS into its subclinical course, which itself leads to improved treatment results.
Endovascular interventions are the preferred treatment of CVS with clinical manifestations in a case of underlying normal or suboptimal Qa.
MO785CAUSES OF THE DELAY IN CREATING PERMANENT VASCULAR ACCESS IN HEMODIALYSIS PATIENTS
Authors: Al-Sayyari Abdulla 
Published: May 2021

Abstract

Background and Aims
Many patients start HD with central venous catheter (CVC) which has multiple complications This study aims at identifying the physicians’ perspectives regarding the reasons of delayed AVF creation

Method
This is a cross-sectional questionnaires-based survey designed at discovering the physicians' opinions and perception about the reasons for the delay in the creation of permanent vascular access and patient’s factors, physicians factors, and hospital factors leading to this delay,

Results
There was a total of 212 participants, of whom 131 (61.8%) were of consultant level.
The three most important factors associated with delay in AVF creation were “denial of kidney disease or the need of AVF” (76.4%), “dialysis fears and practical concern” (75.9%) and “the patient refusing to undergo AVF surgery” (73.1%). Significantly fewer consultants (42.7%) than below consultants (45.7%) pointed out that “patient noncompliance with nephrology appointments” was a significant factor (p=0.046).
The most important physicians & hospital factors was “insufficient conduction of pre-dialysis care and education about AVF initiation to the patient (63.7%)
The respondents were asked to choose one of four possible factors that they felt was the main factor in delaying AVF creation. Over two thirds (68.4%) chose the patient factor as the main factor There was no significant difference in this response whether the respondents were consultants or below consultants (p=0.8))

Conclusion
The most agreed on factors associated with AVF creation delay are the denial of the need for dialysis, fear of dialysis and practical concern, insufficient conduction of pre-dialysis care and education about AVF initiation to the patient, and late referral to a nephrologist. a validated approach to patients' selection and referral to vascular access creation that could be applied on different types of patient in different regions is required .
MO787USE OF THE PREVENTIVE HAEMOSTASIS IN SURGICAL COMPLICATIONS OF VASCULAR ACCESS
Authors: Corciulo Simone , Covella Bianca , Rossi Luigi , Lomonte Carlo 
Published: May 2021

Abstract

Background and Aims
Arteriovenous fistula (AVF) is currently the recommended vascular access type and its preservation is required to ensure a safe treatment for HD patients. Nevertheless, reinterventions are often needed to treat life threatening complications such as eschars, aneurysms, high flow.These surgical procedures are at high risk of bleeding, time-consuming and technically demanding. Here we describe our approach by using preventive hemostasis to treat different types of AVF complications, such as aneurysmectomy, high flow fistula correction, ulcerectomy.

Method
The technique consists of a few steps. First, regional anesthesia is performed by brachial plexus nerve block and intravenous antibiotic prophylactic therapy is administered. Then, an inflatable tourniquet is placed on the arm, proximally to the elbow joint, after wrapping the site with a soft gauze to prevent postoperative discomfort and bruising due to accidental pinch of the skin. The arm is then elevated to allow passive exsanguination and a 5” Esmarch bandage is applied from the hand to the tourniquet cuff. The methodical application of the Esmarch bandage requires an assistant to hold the arm properly in the upright position. Once the bandage is applied, the tourniquet is inflated to complete the exsanguination of the extremity. The inflation pressure has to be adapted to patient systolic pressure, generally a 'suitable' pressure for an upper limb tourniquet is 250-300 mmHg. Lastly, the Esmarch bandage is unwrapped and, after sterile surgical draping, it is possible to proceed to skin incision.

Results
From Jan 2019 to Dec 2020, we enrolled 9 patients with AVF complications treated with the preventive emostasis. The mean age of the patients was 62 years (range, 45-80 years). Table 1 shows types of AVFs and complications, performed revisions, outcomes, short and long term complications. The tourniquet average time of application was 29 + 7,7 min. Preventive hemostasis ensures absence of blood loss, even during high flow access revision. In one patient, a moderate subcutaneous hemorrhage occurred 8 hours after the end of the surgical procedure, requiring further revision. No vascular or soft tissue complications were reported except for temporary dysesthesias.

Conclusion
Our experience shows that preventive haemostasis offers several advantages for surgeons and patients, allowing a clear operative field and avoidance of application of clamps, prevents blood loss, and reduce the need for blood transfusion. Furthermore, reperfusion injury risk is minimized. The only complication occurred suggests the recommendation to suture skin incision after removing the tourniquet to reduce risk of postoperative bleeding. In conclusion, the technique is reliable and safely applicable to surgical treatment of vascular access complication.
MO766EARLY ARTERIOVENOUS FISTULA FAILURE PREDICTION WITH ARTIFICIAL INTELLIGENCE: A NEW APPROACH WITH CHALLENGING RESULTS
Authors: Ibeas Jose , Monill-Raya Núria , Macias Edwar , Rubiella Carolina , Vallespin Joaquim , Merino Jana , Criado Eva , Guitart Josep , Vicario Jose , Morell Antoni , Serrano Javier 
Published: May 2021

Abstract

Background and Aims
The native arteriovenous fistula is considered the vascular access of preference, since it is directly related to major survival, reduced complications, mortality, and costs. Still, its proper maintenance remains a challenge for nephrologists. A previous study from our group, which used the data of 117 arteriovenous fistulas, led to identify in the multivariable analysis age and vein diameters as predictive factors for early failure. On the other hand, Artificial Intelligence has been established as a tool to identify relationships between variables at deep levels, which might be unseen with more conservative methods like classic statistics. Therefore, through a Machine Learning technique known as Random Forest, the aim is to evaluate the same comorbidity, biological and Doppler ultrasound variables data to identify those with a major relation with the early failure of the native arteriovenous fistula.

Method
Retrospective cohort study, gathering the same data of the previous study (from 2011 to 2015): survival, ultrasound mapping (morphology and hemodynamics), comorbidities (blood pressure, severe arteriopathy, diabetes, Charlson’s Index), and laboratory (haemoglobin, calcium, phosphorus, PTH, ferritin, PCR). Different Artificial Intelligence algorithms were tested, but the most suited one for the study's aim turned out to be Random Forest. A model was trained, dividing the data in two sets, training and validation, with an 80/20 ratio. The algorithm used 100 decision trees, with a maximum individual depth of 3 levels. The training was made with the variables that represented the 100%, 95%, 90% and 85% of impact in the fistula's maturation from a theresold according to Gini’s Index.

Results
Age 65.7 (32-88) years, male 59.8%. Hypertension 86.7%, diabetes 50.7% and vascular disease 41.3%. The trained model obtained provided the following results in the evaluation: accuracy 0.82, precision 0.86, AUROC 0.85, F1 0.86 (balance between precision and predictive value). The most relevant variables by decision order were age, phosphorous, PTH, ferritin and calcium. Morphologic and hemodynamic variables such as the vessels diameter, Peak Systolic Velocity, Charlson’s Index or PCR, were also found to be relevant, but in a minor level.

Conclusion
In comparison with classic statistics, Machine Learning techniques might create a change of paradigm in predictive models for the patency of the vascular access for Haemodialysis. Even though the Artificial Intelligence-based model provided the same relevance for age in maturation failure as traditional models, other findings stand out, like the major participation of variables related with mineral metabolism or inflammation, rather than ultrasound based ones.