bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO816PULSE PRESSURE IS AN INDEPENDENT PREDICTOR OF THE RISK OF RECURRENT ALL-CAUSE HOSPITALIZATION IN CHRONIC HEMODIALYSIS PATIENTS
Authors: Mermelstein Ariella , Cherif Alhaji , Zhang Hanjie , Ye Xiaoling (Janice) , Kotanko Peter , Raimann Jochen 
Published: May 2021

Abstract

Background and Aims
Pre - and peri-dialytic systolic blood pressures (SBP) have been linked to heightened cardiovascular morbidity and mortality in hemodialysis (HD) patients. High pulse pressure (PP) is clinically associated with increased arterial stiffness and atrial fibrillation, while low PP is associated with cardiac insufficiency. We studied the relationship between PP and all-cause hospitalization in patients undergoing maintenance HD.

Method
This retrospective cohort study was performed in HD patients from January 2015 to May 2020. To be included in the study, patients were required to be 18 or older, dialysis vintage of at least a year, and must have received treatment within the first 30 days after dialysis initiation. We developed Cox proportional hazards models with spline corrected terms for recurrent all-cause hospitalizations. 95% confidence interval (CI) were also computed. Further, we stratified the patient population into 4 SBP categories, namely: SBP &lt; 120, 120 ≤ SBP &lt; 150, 150 ≤ SBP &lt; 180, and SBP ≥ 180 mmHg, and investigated the mediating effects of SBP on hospitalization risk.

Results
We studied 2453 HD patients (age 58.9±16.1 years, 58% male) dialyzed between January 2014 and October 2018 in Renal Research Institute facilities. We observe that PPs between 45 and 70 mmHg were associated with lower risk of recurrent hospitalization (Figure 1a), possibly driven by the behavior of SBPs between 120 to 180 mmHg (Figure 1c-e). No statistically significant association was seen between PP and hospitalization for patients with SPB &lt;120mmHg and &gt;180mm (Figures 1b-d). A decreasing trend with PP greater than 90mmHg is noted but rendered negligible, and a statistical artifact caused by a case mix at these unusually high levels. The lack of significant associations between inflammatory (NLR) and nutritional (Albumin and phosphorus) factors renders PP a significant and independent predictor of recurrent hospitalization adding to the current knowledge in the field.

Conclusion
Our analysis found associations between PP (with and without SBP stratification) and the risk of recurrent hospitalization and all-cause mortality. Even after adjustment for hospitalization risk and other clinical, inflammatory, and nutritional parameters at baseline PP remained an independent predictor of recurrent hospitalizations. Further investigations into the relationship are needed to better understand the mediating effects of PP as a driver of hospitalization and mortality risk.
MO817ALDOSTERONE ANTAGONISTS FOR PATIENTS WITH CHRONIC KIDNEY DISEASE REQUIRING DIALYSIS
Authors: Hasegawa Takeshi , Nihiwaki Hiroki , Ota Erika , Levack William , Noma Hisashi 
Published: May 2021

Abstract

Background and Aims
Patients with chronic kidney disease (CKD) undergoing dialysis are at a particularly high risk of cardiovascular mortality and morbidity. This systematic review and meta-analysis aimed to evaluate the benefits and harms of aldosterone antagonists, both non-selective (spironolactone) and selective (eplerenone), in comparison to control (placebo or standard care) in patients with CKD requiring haemodialysis or peritoneal dialysis.

Method
We searched the Cochrane Kidney and Transplant Register of Studies up to 29 July 2019 using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register Search Portal and ClinicalTrials.gov. We included individual and cluster randomised controlled trials (RCTs), cross-over trials, and quasi-RCTs that compared aldosterone antagonists with placebo or standard care in patients with CKD requiring dialysis. We used a random-effects model meta-analysis to perform a quantitative synthesis of the data. We used the I2 statistic to measure heterogeneity among the trials in each analysis. We indicated summary estimates as a risk ratio (RR) for dichotomous outcomes with their 95% confidence interval (CI). We assessed the certainty of the evidence for each of the main outcomes using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) approach.

Results
We included 16 trials (14 parallel RCTs and two cross-over trials) involving a total of 1,446 patients. Among included studies, 13 trials compared spironolactone to placebo or standard care and one trial compared eplerenone to a placebo. Most studies had an unclear or high risk of bias. Compared to control, aldosterone antagonists reduced the risk of all-cause death for patients with CKD requiring dialysis (9 trials, 1,119 patients: RR 0.45, 95% CI 0.30 to 0.67; moderate certainty of evidence). Aldosterone antagonist also decreased the risk of death due to cardiovascular disease (6 trials, 908 patients: RR 0.37, 95% CI 0.22 to 0.64; moderate certainty of evidence) and cardiovascular and cerebrovascular morbidity (3 trials, 328 patients: RR 0.38, 95% CI 0.18 to 0.76; moderate certainty of evidence). While aldosterone antagonists had an apparent increased risk of gynaecomastia compared with control (4 trials, 768 patients: RR 5.95, 95% CI 1.93 to 18.3; moderate certainty of evidence), the elevated risk of hyperkalaemia due to aldosterone antagonists was uncertain (9 trials, 981 patients: RR 1.41, 95% CI 0.72 to 2.78; low certainty of evidence).

Conclusion
Based on moderate certainty of the evidence, aldosterone antagonists could reduce the risk of all-cause and cardiovascular death and morbidity due to cardiovascular and cerebrovascular disease but increase the risk of gynaecomastia in patients with CKD requiring dialysis.
MO656CORRELATION BETWEEN CHANGES IN THE BODY FLUID VOLUME CALCULATED BY THE URIC ACID KINETIC MODEL AND CHANGES IN THE BODY WEIGHT*
Authors: Nakai Shigeru , Ozawa Kiyoshi , Shibata Kazuhiko , Shinzato Takahiro 
Published: May 2021

Abstract

Background and Aims
Uric acid (UA) is a solute unable to cross the cell membranes in general tissues by any of simple diffusion, facilitated diffusion or active transport. These facts imply that UA distribution volume (UDiV) equals to the extracellular fluid volume (ECFV). We have developed a method for calculating UDiV from serum uric acid levels before and after hemodialysis based on a uric acid kinetic model (Shinzato T, Int J Artif Organs 2020). Urea is evenly distributed throughout the body fluids. Therefore, the total body fluid volume (TBFV) can be calculated by using the same method as the calculation of UDiV for the serum urea level. The remaining body fluid volume, which is TBFV minus UDiV, is considered to reflect the intracellular fluid volume (ICFV). In this study, we clarified the relationship between the amount of change over time in UDiV and ICFV calculated by the uric acid kinetic model and the amount of change over time in the actual body weight of hemodialysis patients.

Method
Subjects were 1,101 patients with chronic maintenance hemodialysis. UDiV and ICFV before and after dialysis were calculated for two time points, December 2019 and June 2020.

Results
The amount of change in UDiV per body during the dialysis session showed a very good correlation with the amount of body weight change during the same dialysis (UDiV change = 0.950 x body weight change - 0.158, R-square 0.90, p &lt; 0.0001). The amount of change in ICFV during the 6 months from December 2019 to June 2020 showed a good correlation with the amount of change in post-dialysis body weight during the same period (ICFV change = 0.270 x post-dialysis body weight change + 0. 240, R-square 0.21, p &lt;0.0001).

Conclusion
These results suggest that the body fluid volume calculated by the uric acid kinetic model has high accuracy.
MO668EXTRACORPOREAL REMOVAL OF MYOGLOBIN IN PATIENTS WITH RHABDOMYOLYSIS AND SEVERE ACUTE KIDNEY INJURY: COMPARISON OF HIGH AND MEDIUM CUT-OFF MEMBRANE AND AN ADSORBER CARTRIDGE
Authors: Jerman Alexander , Andonova Milena , Peršič Vanja , Gubensek Jakob 
Published: May 2021

Abstract

Background and Aims
Severe rhabdomyolysis often causes acute kidney injury (AKI). If severe, AKI significantly reduces myoglobin removal through the kidneys. Given molecular size of myoglobin, extracorporeal removal using newer hemodialysis membranes and adsorption techniques is possible, although its role on clinically significant outcomes is not yet fully established. We aimed to compare the efficacy of high cut-off (HCO) membrane, medium cut-off (MCO) membrane and Cytosorb® adsorber on myoglobin removal.

Method
In this retrospective study we included 15 patients with AKI and concomitant rhabdomyolysis with severely increased myoglobin (&gt;20.000 µg/L), who underwent at least one extracorporeal procedure with the intention of extracorporeal myoglobin removal. There were 28 procedures performed: 13 HCO (Theralite®, Gambro) dialysis, 9 MCO (Theranova®, Gambro) dialysis and 6 adsorber (Cytosorb®, Cytosorbents) procedures. Serum myoglobin and albumin levels were recorded from the time frame of up to 12 hours prior to and up to 12 hours after the index procedure and reduction rates (RR) for myoglobin were calculated. Albumin levels were compared before and after procedure as a safety parameter.

Results
Treatment duration differed significantly and was the longest for Cytosorb® adsorber (median 11 h) and the shortest for MCO membrane (median 5 h). Pre-treatment serum myoglobin levels were comparable across the groups. Reduction in myoglobin during procedure was significant for HCO and MCO and borderline significant in adsorber group, with respective median RR of 0.64, 0.54 and 0.50 (p = 0.83). Routine albumin substitution was implemented only in HCO group, but serum albumin levels were stable in all subgroups.

Conclusion
In this preliminary observational study we found comparable effectiveness of a novel MCO and ‘standard’ HCO dialysis membrane for serum myoglobin removal in patients with severe AKI. Cytokine adsorber showed borderline effectiveness, but the number of procedures in this group was small. MCO dialysis is associated with lower costs and no need for albumin supplementation and therefore might be the optimal mode of treatment of severe rhabdomyolysis-associated AKI. For patients with multiorgan failure requiring cytokine removal and severe myoglobinemia, hemoadsorption can reduce cytokine and myoglobin levels simultaneously.
MO672HIGH FLUX VERSUS LOW FLUX HEMODIALYSIS: A PRE-POST STUDY
Authors: Zaidan Nadim , Nourie Nicole , Finianos Serge , Nehme Chelala Dania , Azar Hiba 
Published: May 2021

Abstract

Background and Aims
High flux hemodialysis has largely replaced low flux hemodialysis in developed countries. Clinical trials, in particular the Hemo and the MPO studies, conducted many years ago, showed that the survival benefit was mainly for patients on long term hemodialysis for the first one and for high risk patients with low albumin level (less than 40g/dl) for the latter. Moreover, the effect on hematopoiesis or mineral balance is not unequivocally established in the literature. In Lebanon, following the recommendations of the ministry of health, we switched patients undergoing hemodialysis at our center from low to high flux starting April 2019. We aimed in this study to assess the effect of this switch on hemoglobin level, dose of ESA used, mineral metabolism parameters and nutritional parameters.

Method
This is an observational pre-post study where each patient is his own control. Subjects included are adults on chronic hemodialysis for more than 6 months at Hotel Dieu de France University Hospital. Patients who needed transfusion for bleeding, admission to the hospital or parathyroidectomy during the study period were excluded from the study. Demographic parameters, medical history and laboratory values were extracted from the patients’ files.
Paired t- test was used to compare values obtained in the 6 months on low flux compared to the 6 months on high flux hemodialysis.

Results
Seventy four patients received sequentially both techniques (45 males and 29 females). Mean age was 66 years, mean dialysis vintage 65 months, diabetic and vascular diseases were the most frequent causes of ESRD found in 27 and 15% of the cases. Hemoglobin level significantly increased from 11 +/- 0.82 to 11.26 +/- 0.67 mg/dl (p=0.04) with a non-significant trend towards a lower ESA dose: 11620 UI/week (+/-2275 UI) in the first period versus 10860 UI/week (+/-2609 UI) during the second period (p=0.15). Ferritin levels were higher in the second part of the study (416 v/s 476 ng/ml) which may have contributed to the increase in hemoglobin. Phosphorus level decreased from 1.55 to 1.48 mmol/l (p=0.008) at the same doses of binders and practically stable levels of calcium and PTH. Most interestingly, albumin level increased from 38 to 40.3 g/dl (p&lt;0.001). Finally urea reduction ratio increased from 73.1% to 74.5% with a p value of 0.001.

Conclusion
Assuring quality ultrapure water is still a challenge in many developing countries. Lack of firm evidence on beneficial effect in terms of mortality may delay sanitary authorities from imposing high flux hemodialysis. In our study, switching from low to high flux hemodialysis showed positive impact on phosphorus levels but most interestingly increased albumin levels a major predictor of mortality in hemodialysis patients.
MO673THE ASSOCIATION BETWEEN UREA KINETIC MODELING WITH ANXIETY AND DEPRESSION AMONG PATIENTS ON MAINTENANCE HEMODIALYSIS AT UST HOSPITAL: A CROSS- SECTIONAL STUDY
Authors: Balmes - Garcia Maureen , Pe Dexter Clifton , Catindig Joseree Ann , Baroque Gabriel Alejandro 
Published: May 2021

Abstract

Background and Aims
Depression and anxiety are common psychiatric disorders that affect patients with chronic kidney disease on maintenance hemodialysis. Possible explanation for the development of this mental disorders includes physical and emotional stress, time restrictions, functional limitations, co-morbidities, adverse effects of medications and lack of adherence to dialysis treatment and its efficacy. Studies have shown that by improving hemodialysis adequacy, as measured by the urea kinetic remodelling (Kt/V), the clinical symptoms of the patient improve as well as their psychological condition. This study aimed to evaluate the relationship between psychological symptoms and hemodialysis adequacy.

Method
This cross-sectional study was conducted on 87 hemodialysis patients at the University of Santo Tomas Hospital. Anxiety and depression was assessed using the validated Filipino version of Hospital Anxiety and Depression scale (HADS-P). Anxiety and depression was defined as score of 8. Descriptive statistics were used to summarize the general and clinical characteristics of the participants. Frequency counts and proportions were used as descriptors for nominal variables, median and range for ordinal variables, and mean and standard deviation for interval/ratio variables. Chi square test was used to assess the association between age, sex, marital status, duration of dialysis and Kt/V.

Results
The prevalence of anxiety and depression were 34.8% and 21.7%, respectively (n=87). This study identified that younger patients, those belonging to age 20-35 y/o were more depressed (33.3%) and anxious (66.7%). Similarly, females also tend to be more anxious (42.5%) and depressed (22.5%). On the other hand, single patients tend to be more anxious (41.7%) while married are more depressed (22.8%). As to educational status, post graduate patients were more anxious (66.7%) and those with low educational attainment were more depressed (50%). Newly initiated patients (&lt;1 year) were more anxious (57.1%) and those with longer years on hemodialysis (4-6 years) being more depressed (30.4%). As to laboratory parameters, anemic patients are both anxious and depressed. Hypoalbuminemic patients were also anxious and depressed. Patients with adequate hemodialysis were more anxious and depressed.

Conclusion
Anxiety and depression are common psychiatric disorder that are associated with decrease quality of life. Addressing and including these conditions will help to improve their psychological condition.
MO674SHORT DAILY HOME HEMODIALYSIS PROGRAM, IN NEPHROCARE HEMODIALYSIS CENTER: REPORT STUDY
Authors: Hebibi Hadia , Attaf David , Ciroldi Magali , Cornillac Laure , Chazot Charles , Canaud Bernard 
Published: May 2021

Abstract

Background and Aims
Several studies showed that DHHD improved survival and quality of life and allowed a lower cost for health system. The aim of this study was to describe our first experience of DHHD in our dialysis center.

Method
We included 9 dialyzed patients trained on Nx Stage® machine (Fresenius Medical Care) from February to December 2020. Data was retrospectively obtained through review of our medical electronic records (Euclid®).

Results
Among 9 patients trained, 8 were installed at home, with an average follow up of 7 months. 6 patients were dialyzed in self hemodialysis facilities. The mean age was 45 years (28-71), 6 women, BMI: 24 kg/m2 (21-30), dialysis vintage: 5 years and 7 patients are on transplant list. The Charlson score was: 5 (4-8), 5 patients had a residual diuresis&gt; 500 ml/d. The average training duration was 5 weeks (4-8). Our training program targeted the self-puncture of AVF and the self-assembly of the machine by the patient. 100% of AVF were cannulated through Buttonhole technique. 6 patients were dialyzed 6 times a week and only one patient needed anticoagulants. The blood pressure improved on the first days of DHHD (↓ 50% of drugs for 50% of patients). Hemoglobin level maintained between 10-12 g/dl with ↓ EPO. The mineral metabolism status was improved for all patients, with stopping of binders in one case. DHHD reduced symptoms like fatigue, cramping and post-dialysis recovery for all patients, and allowed for patients a better socio-professional integration. A medico-economic analysis is conducted.

Conclusion
DHHD improved blood pressure, anemia, mineral status and quality of life. Through economy in medicaltransport and better socio-professional integration DHD provides savings for the health system
MO677RRT DURING COVID 19 EPIDEMIC. EXPIRIENCE OF ONE CENTER
Authors: Strazmester Majstorovic Gordana , Knezevic Violeta , Azasevac Tijana , Markovic Mira , Veselinov Vladimir , Mitic Igor 
Published: May 2021

Abstract

Background and Aims
The incidence of Acute kidney injuri AKI during Covid 19 infection is 3 – 15%, up to 50% for patients (pts) with Acute respiratory distress syndrome ARDS.

Method
From March till December 2020. Department for hemodialysis in Novi Sad did 184 renal replacement therapy (RRT) procedures (proc) on 65 Covid 19 positive pts.

Results
There were 73,85% men and 26,15% women (p &lt; 0,01), with average (avs.) age of 65,8 years (SD 9,20). Most of them were admitted directly to the Intensive care unit, 64,62% (p &lt; 0,01). The length of stay in hospital ranged from 2 - 61 days (avs. 15,86; SD 11,19). The most common comorbidities were hypertension (86,1%), diabetes (33,8%), coronary disease (30,8%) and chronic obstructive pulmonary disease (21,5%). Most common indication for RRT was acutisation of chronic kidney disease (CKD) 43,08% (p &lt; 0,01) followed by pre-existing end stage renal disease (ESRD) 29,23% and AKI 27,69%. RRT was started 1 - 31 days after the admittance (avs. 8,51; SD 7,33). 57 intermittent hemodialysis proc (30,98%) were done on 13 pts (14,06%) who were hemodynamicly and respiratory stable. The decision to initiate CRRT was made upon the renal indications, the presence of ARDS or significant volume load. A total of 127 CRRT proc (69,02%) were done on 57 pts (87,5%). The most of them were CVVHDF (74,02%) and the rest CVVHD (25,98%). Most commonly used membrane was oXiris 47,24% (p &lt; 0,001) followed by EMIC2 25,98%, Kit 8 17,32% and ST-150 9,45%. Most CRRT proc (89,76%) were done with heparin as an anticoagulant and 10 proc (7,87%) in 5 pts using citrate. 3 proc (2,36%) in 2 pts were done without using anticoagulant. The procedurès duration had to depend on the number of devices, the number of pts requiring CRRT and the number of available trained medical workers. The average achieved length of proc was 712 min. (11 h and 52 min.) (SD 435,07). Most patients had 1 (49,12%; p&lt; 0,001) or 2 (30,69%) CRRT proc, up to 9 (avs. 2,23; SD 1,95). The average achieved ultrafiltration was 2716,41 ml (SD 1016,82). In 23 pts (40,35%) 26 CRRT proc (20,47%) had to be stopped earlier, because of circuit clotting (9,45%; p &lt; 0,001), deterioration of hemodynamic instability/respiratory insufficiency (7,09%), device malfunction (2.36%) and RRT need for another pts (1,58%). ARDS has developed 42 pts (64,61%). The need for vasoactive support had 41 pts (63,08%). 51 pts (78,46%) requiring RRT died.

Conclusion
Comparing group of pts who survived with group of those who died, greater number of pts with ESRD was in the first group. In survivor group, RRT was started earlier with greater number and shorter duration of proc. In the group of pts who died, there were more ARDS and vasoactive support need. They had a higher levels of CRP, leukocyte count and the neutrophil to lymphocyte ratio.
MO658POLYVINYLPYRROLIDONE IN HEMODIALYSIS MEMBRANES: IMPACT ON PLATELET LOSS DURING HEMODIALYSIS
Authors: Zawada Adam , Melchior Pascal , Erlenkötter Ansgar , Delinski Dirk , Stauss-Grabo Manuela , Kennedy James 
Published: May 2021

Abstract

Background and Aims
Hydrophilic modification with polyvinylpyrrolidone (PVP) increases the biocompatibility profile of synthetic dialysis membranes. However, PVP may be eluted into patient’s blood, which has been discussed as a possible cause for adverse reactions rarely occurring with synthetic membranes. We now investigated the content of PVP and its elution from the blood-side surface from commercially available dialyzers, including the novel FX CorAL with α-tocopherol-stabilized, PVP-enriched membrane, and link the results to the level of platelet loss during dialysis as a maker of biocompatibility.

Method
Six synthetic, PVP containing, dialyzers (FX CorAL, FX CorDiax [Fresenius Medical Care]; Polyflux, THERANOVA [Baxter]; ELISIO [Nipro]; xevonta [B. Braun]) were investigated in the present study. The content of PVP on blood-side surface was determined with X-ray photoelectron spectroscopy (XPS). The amount of elutable PVP was measured photometrically after 5h recirculation. The level of platelet loss was evaluated in an ex vivo recirculation model with human blood.

Results
Highest PVP content on the blood-side surface was found for the polysulfone-based FX CorAL (26.3%), while the polyethersulfone-based THERANOVA (15.6%) had the lowest PVP content. Elution of PVP was highest for the autoclave steam sterilized THERANOVA (9.1 mg/1.6m² dialyzer) and Polyflux (9.0 mg/1.6m² dialyzer), while the lowest PVP elution was found for the INLINE steam sterilized FX CorAL and FX CorDiax (&lt; 0.5 mg/1.6m² dialyzer, for both). Highest platelet loss was found for xevonta (+164.4% compared to the reference) and the lowest for the FX CorAL (-225.2%) among the polysulfone-based dialyzers; among the polyethersulfone-based dialyzers, THERANOVA (+95.5%) had the highest and ELISIO (-52.1%) the lowest platelet loss.

Conclusion
PVP content and elution differs between commercially available dialyzers and was found to be linked to the membrane material and sterilization method. The amount of non-eluted PVP on the blood-side surface may be an important determinant for the hemocompatibility of dialyzers.