bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO821OXYGEN EXTRACTION RATIO AND MORTALITY RISK IN HAEMODIALYSIS PATIENT: A MULTICENTRE STUDY
Authors: Rotondi Silverio , Tartaglione Lida , Muci Maria Luisa , Panocchia Nicola , Gesuete Antonio , Papalia Teresa , Solmi Luigi , Mazzaferro Sandro 
Published: May 2021

Abstract

Background and Aims
Patients on haemodialysis (HD) suffer a very high rate of cardiovascular mortality with some evidence suggesting a possible association with decreasing blood oxygen saturation (SO2) during sessions. The ratio between arterial SO2 (SaO2) and central venous SO2 (ScvO2) or Oxygen Extraction Ratio (OER), which represents an estimate of the amount of oxygen claimed by peripheral tissues and of the haemodialysis related hypoxic stress, might represent a new prognostic factor.

Method
We evaluate the relationship between OER values and mortality risks in HD patients in a prospective multicentre observational study. We enrolled chronic HD patients with permanent central venous catheter (CVC) and no fistula, in whom ScvO2 measurement is at hand and SaO2 is available with a peripheral oxymeter. OER ([(SaO2−ScvO2)/SaO2]×100) was measured before and after HD at enrolment (HD OER sessions) in each patients, and a one-year follow-up was planned to record the number of deaths.

Results
In 101 patients (age 71.5 ± 14 years on dialysis for 47 ± 38 months), during 9 ± 6 months of follow up, we recorded 35 deaths. Patients were then divided into two groups, above or below the median value of pre-HD OER, which was 30%. In these groups, the average incidence of deaths was 12% (24 deaths) and 5,5% (11 deaths) respectively (p&lt;0.05), with significantly different survival curves (Kaplan-Meier log rank test = 0.04, fig). No difference in mortality was evident if we divided patients according to the median intradialytic change in OER value.

Conclusion
Patients with pre-HD OER &gt; 30% have a higher mortality risk, most probably secondary to reduced capability to respond to HD related oxygen requirements. OER is novel biomarker to identify patients at greatest clinical risk.
MO828INTENSIFIED TREATMENT FOR PREGNANCY IN HEMODIALYSIS PATIENTS, ANALYSIS OF 13 CASES: IS THERE A GENDER ADVANTAGE?
Authors: Marcelli Daniele , Rybakova Olga , Shilo Valery , Wohn Luisa , Barth Claudia 
Published: May 2021

Abstract

Background and Aims
Pregnancy in dialysis patients is rare but challenging for nephrologists and obstetricians, because pregnancy has a significant maternal and fetal risk in these patients. Although intensified hemodialysis is effective to achieve favorable clinical outcomes, the evidence concerning reliable parameters for the optimal dialysis prescription is scarce. Herein, we report the management on hemodialysis and outcome of pregnancies occurring in the B. Braun dialysis network in Russia.

Method
We performed retrospective analysis of all pregnancy cases in B. Braun dialysis chain in Russia from 2013 to 2020. Cases were reported by the involved Renal Care Centers by a common questionnaire. All patients were treated with B. Braun Dialog+, AV set Dialog +, SolCart bicarbonate cartridge and Xevonta dialyzers.

Results
13 pregnancies were reported, all achieved without infertility treatment: 1 was interrupted by voluntary termination of pregnancy, 9 resulted with living birth (6 females and 3 males) after a mean of 24 gestational weeks (7 cesarean and 2 vaginal deliveries), 2 with stillbirth and 1 with spontaneous abortion after 8 gestational weeks. Mothers with positive pregnancy outcome were significantly younger (27.9±5.1 vs. 36.3±5.6 years), without differences in dialysis vintage, previous successful or unsuccessful pregnancies and during follow-up blood pressure was well controlled. Females newborns had borderline significant greater body weight (1.9±0.6 vs. 1.1±0.1 kg, p=0.076). 5 newborns had respiratory distress syndrome, 1 jaundice.

Conclusion

Prompt increase of treatment frequency and time on high-flux/HDF dialysis were associated with successful pregnancy outcome. Considering that cardiovascular system and endogenous metabolism dynamically alter during pregnancy, various clinical parameters, i.e. body weight and blood pressure, should be closely monitored to modify dialysis settings accordingly. Female gender of the newborn seems to be associated with a better outcome. This study shows the safety of high-flux hemodialysis and hemodiafiltration treatments in pregnancy and the benefit of enhanced prescription in dialysis time and frequency.

Acknowledgement
The authors express their gratitude to the entire medical multidisciplinary team from B. Braun Russia Renal Care Centers and other local medical institutions directly and indirectly involved in the treatment of each case described.
MO829INSTITUTIONAL TRANSPORT AS RISK FACTOR FOR COVID-19 IN HEMODIALYSIS PATIENTS
Authors: Heylen Line , Van Kerrebroeck Margaretha , Oris Els , Hendrickx Liesbet , Macken Eline , Metalidis Christoph , Peeters Jacques , Van Mieghem Ann , Steensels Deborah 
Published: May 2021

Abstract

Background and Aims
Hemodialysis patients face an exceptional risk in the current COVID19 pandemic, both for infection/transmission as well as for mortality. All efforts to reduce potential risk factors are needed to protect this vulnerable group. We aimed to evaluate risk factors for SARS-CoV-2 infection and transmission during the first COVID19 wave, in order to tackle these factors in the second.

Method
We included all hemodialysis patients who were dialyzed at our central institution on March 19, 2020 (date of first COVID19 diagnosis). External low care and home hemodialysis patients were excluded. Our central hemodialysis center has 5 dialysis shifts in 6 units located next to each other, with a separate seventh dialysis unit dedicated for COVID19 isolation. COVID19 infections were diagnosed with nasopharyngeal swab PCR at the discretion of the treating nephrologist. On May 18 and 19, after the first wave, all hemodialysis patients were evaluated for presence of SARS-CoV-2 antibodies using ELISA to screen for previous asymptomatic infections. Chi square and logistic regression were used for statistical analyses.

Results
216 hemodialysis patients were included in this study, with a mean age of 72 years old (IQR 65-83). COVID19 was diagnosed in 17 patients during the first wave: in 15 symptomatic cases through nasopharyngeal swab PCR and in two additional asymptomatic cases through SARS-CoV-2 IgG positivity. Interestingly, we observed that 58.8% of COVID19 patients were transported by the same transport company, while this company transports only 20.4% of hemodialysis patients (p=0.005) (Figure A). As such, 22.7% of patients transported by this company became infected (OR 6.93, 95% CI 2.49-20.34, p=0.0002).

Conclusion
Institutional transport was the most significant risk factor for SARS-CoV-2 infection among hemodialysis patients at our center. After stringent prevention measures we were able to prevent transmission during transport in the second wave of the COVID19 pandemic.
MO830COVID-19 INFECTION IN HEMODIALYSIS POPULATION
Authors: AlSahow Ali , AlQallaf Ahmed , Bahbahani Hamad , Alyousef Anas , Bahbahani Yousif , Alhelal Bassam , AlRajab Heba , Almuhaiteeb Abdullah , Shalaby Heba , Elabbadi Mohamed , Elsebaei Mohammad , Abdallah Emad , Ayoub Medhat , Abou Trabeh Aissar , AlSarraji Mariam , AlAwadhi Abdullah 
Published: May 2021

Abstract

Background and Aims
A third novel coronavirus leading to severe respiratory infection (coronavirus disease 2019, COVID-19) was first identified in Wuhan, China in December 2019; 1 as of January 2021, more than 90 million person infected and more than 2,000,000 died worldwide. 2 Hemodialysis (HD) patients are at risk of COVID-19 infection but reported infection rates are variable. 1 We report results of prospectively collected data on HD patients who contracted COVID-19 infection in Kuwait.

Method
Demographics, comorbidities, and mortality data for HD patients who got infected with COVID-19 in Kuwait from 1/March/2020 to 31/July/2020 were collected and analyzed.

Results
Kuwait population during that same period was 4,600,000 (63% Males and 37%Females). 3 Total number of HD patients was 2000 (representing only 0.04% of the total population with 52% Males and 48% Females). Total number of COVID-19 cases confirmed by PCR from nasopharyngeal swab was 66,957. Total number of infected HD patients was 141 (representing 7% of the total HD population and 0.2% of the total number of people infected with COVID-19 in Kuwait). All COVID-19 positive cases were treated for free in ministry of health hospitals
Mean age for HD patients with COVID-19 was 57 (54 for males and 62 for males). DM was present in 70%, HTN in 95%, CV disease in 61%, respiratory illness in 20.5%, and ICU admission was required for 31 patients (22%), with 80% requiring intubation and assisted ventilation. Conventional HD was switched to CRRT in 61 patients (43%). Steroids were used for 23%, convalescent plasma in 1 patient, lopinavir/ritonavir in 7 patients, tocilizumab in 3 patients.
Total number of mortality due to covid-19 infection in Kuwait was 447 (0.7% of the total cases). 4 Total mortality in HD population during that period for any reason was 100 (5% of the total HD population), however, total mortality due to COVID-19 infection was 30% of the total mortality in the HD population (and 7% of the total COVID-19 related mortality in the country). Patients who died were older with mean age of 63 vs 56 for survivors and had respiratory illness more frequently (27% vs 18%) and 60% were males. Of those who were switched to CRRT, 21 of 61 (34%) died. Of the 31 HD patients admitted to ICU, 19 (61%) died.

Conclusion
Despite the fact the HD population represents only a small fraction of the total population, they represent a sizable proportion of the total COVID-19 positive cases and a significant percentage of the total COVID-19 related mortality. This study highlights the increased susceptibility of HD population to COVID-19 infection, which is associated with high rate of mortality, although lower than mortality rates reported in Europe and the united states. 5,6
MO831PROGNOSIS OF HEPATOCELLULAR CARCINOMA IN HEMODIALYSIS PATIENTS
Authors: Ogura Yoshiyasu , Ohki Takamasa , Sato Kenta , Aihara Hideaki , Yabushita Sayaka , Tsukada Hiroyuki , Furuse Satoshi , Toda Nobuo , Mise Naobumi 
Published: May 2021

Abstract

Background and Aims
The aim of this study was to compare the prognosis of hepatocellular carcinoma (HCC) between dialysis and non-dialysis patients.

Method
In this retrospective observational study, we examined consecutive patients with naïve localized HCC, who were treated with radiofrequency ablation (RFA) between February 2000 and December 2017. The patients were categorized into two subgroups based on whether they were on maintenance dialysis (Dialysis Group, n=458) or not (Non-dialysis Group, n=13), and were followed until December 2019. The primary endpoint was overall survival using Kaplan-Meier analysis. As for propensity score matching, we matched 13 pairs of cases by using age, sex, Child-Pugh score, tumor size, number of tumors and HCV positivity. We also compared causes of death between the 2 groups.

Results
The study cohort were aged 69.9±9.1 years and included 328 male patients (70%). Hepatitis B was positive in 37 patients (7.9%), C in 322 (68.4%) and co-infection of HBV and HCV was detected in 3 (0.6%). Ninety-five (20.2%) were heavy alcohol drinkers. In Dialysis Group, patients were younger (p=0.004), total bilirubin, AST, ALT levels were significantly lower and PT level was significantly higher. In the entire cohort, overall survival was comparable between Dialysis Group and Non-dialysis Group (5-year survival rate 55.2% vs 52.7%, respectively; p =0.144). In the propensity score matching analysis, however, Dialysis Group showed significantly worse overall survival than Non-dialysis Group (5-year survival rate 52.7% vs 92.3%, respectively; p =0.018). During the observational period, 255 (54%) patients died. As for causes of death, liver-related death occurred in 44% in Dialysis Group and 67% in Non-dialysis Group, whereas cardiovascular death was 22% in Dialysis Group and 5% in Non-dialysis Group. Procedure-related major complication in the first RFA session of each patient was 0% in Dialysis Group.

Conclusion
Prognosis of hepatocellular carcinoma was poorer in dialysis patients compared to non-dialysis ones, which may be explained by a higher rate of non-liver-related death in dialysis population. Since RFA, per se, has been safely preformed in dialysis patients, prognostic improvement may be expected by treating HCC in dialysis patients as aggressively as in non-dialysis cases.
MO834LOWER POST DIALYSIS POTASSIUM AND HIGHER ULTRAFILTRATION RATE ARE INDEPENDENT PREDICTORS OF ALL-CAUSE MORTALITY IN DIALYSIS PATIENTS
Authors: Rista Elvana , Cadri Vilma , Akshija Ilir , Harja Endri 
Published: May 2021

Abstract

Background and Aims
Dialysis is a life-saving procedure for the end-stage kidney disease, but mortality in this category of patients is still high. The survival of these patients is much lower compared to the general population. Factors affecting this survival has been studied for years and still continue to be an important part of current studies. While ultrafiltration rate is known to be associated with mortality in prevalent dialysis patients an important predictor of survival is the control of potassium profile.
The aim of our study was to assess the hemodynamic and biochemical data, and to identify any significant association between post-dialysis potassium and all-cause mortality.

Method
This is a prospective study of 308 patients on maintenance dialysis, followed for seven years, ending 2019. All patients are dialysis dependent for ESKD and getting treatment in a single-center.
Hypokalemia was defined as a serum potassium level &lt; 3.5 mEq/L and high ultrafiltration rate (UFR) &gt; 13 ml/kg/h. Other hemodynamic and metabolic data were also evaluated
The survival rate was analysed by Kaplan-Meier curves and Cox regression analysis.

Results
A total of 308 patients were enrolled in this study. Mean age was 52 ± 15.6 years; 62.3% of pts were male; BMI 24.7±4.2. Of these, 55 patients (17.9%) died during the follow-up period. Our data showed the presence left ventricular hypertrophy (p=0.010), peripheral artery disease (p&lt;0.0001), diastolic disfunction (p&lt;0.01) and ultrafiltration rate during dialysis &gt;13ml/kg/h (p=0.002) were the most important predictors of mortality. Metabolic abnormalities, low albumin (p&lt;0.0005), hyperphosphatemia (p=0.011), post-dialysis potassium (p=0.037) were significantly associated with higher mortality.
Logistic regression analysis of the metabolic data identified post-dialysis potassium (OR 0.242, 95% CI 0.074 – 0.793, p=0.019), and logistic regression analysis of the hemodynamic data identified ultrafiltration ratio (OR 0.149, CI 0.033 – 0.673, p=0.013) as independent predictors of all-cause mortality.

Conclusion
Lower post dialysis potassium levels and higher ultrafiltration rate are independently associated with higher all-cause and CV mortality in prevalent hemodialysis patients. Therefore the potassium profile and the UFR of the dialysis patients needs close monitoring and optimal control. The individualization of the dialysis prescription is recommended for each patient and it has an important role in preventing the occurrence of complication with immediate and long term effects. Management of dialysis patients should focus especially on reducing the risk of hypokalemia, not only that of hyperkalemia.
MO837IMPACT OF DOWNTIME ON CLINICAL OUTCOMES IN CRITICALLY ILL PATIENTS WITH ACUTE KIDNEY INJURY RECEIVING CONTINUOUS RENAL REPLACEMENT THERAPY: A RETROSPECTIVE STUDY USING PROPENSITY SCORE-MATCHED ANALYSIS
Authors: Shin Jungho , Song Hyun Chul , Hwang Jin Ho , Kim Su Hyun 
Published: May 2021

Abstract

Background and Aims
Continuous renal replacement therapy (CRRT) is essential in treating critically ill patients with acute kidney injury, and circuit downtime is considered a quality indicator. However, it remains uncertain whether CRRT downtime affects outcomes such as mortality and renal recovery. This study investigated the impact of downtime on various clinical outcomes in critically ill patients undergoing CRRT.

Method
A total of 216 patients who underwent CRRT were retrospectively recruited. Downtime was calculated over 4 days from CRRT initiation, and patients were classified as downtime &lt;20% or ≥20% of potential operative time. Patients with ≥20% downtime were matched to those with &lt;20% downtime using 1:2 propensity score matching, adjusting for age, sex, comorbidity index, and severity score.

Results
There were 88 patients with &lt;20% downtime and 44 patients with ≥20% downtime. The cumulative volume and median flow rate of effluent in patients with ≥20% downtime were lower than those in patients with &lt;20% downtime (P&lt;0.001 and 0.062, respectively). Daily fluid balance differed on days 2 and 3 (P=0.046 and 0.031, respectively), and the difference in levels of urea and creatinine widened over time (P=0.004 and &lt;0.001, day 4). The levels of total carbon dioxide were lower in those with ≥20% downtime (P=0.038 and 0.020 at days 2 and 3). Based on our results, ≥20% downtime was not associated with increased 28-day mortality (P=0.944). On the other hand, a subgroup analysis showed the interaction between downtime and daily fluid balance on mortality (P=0.004). In this study, downtime was not related to renal recovery.

Conclusion
Increased downtime could impair fluid and uremic control and acidosis management in patients undergoing CRRT. Moreover, the adverse effect of downtime on fluid control may increase mortality rate. Further studies are needed to verify the value of downtime as a quality indicator and its impact on outcomes in critically ill patients requiring CRRT.
MO811HEALTHY LIFESTYLE SCORE AND MORTALITY IN PATIENTS ON HEMODIALYSIS: AN ANALYSIS OF THE DIET-HD STUDY
Authors: Su Guobin , Saglimbene Valeria , Wong Germaine , Ruospo Marinella , Natale Patrizia , Craig Jonathan , Hegbrant Jörgen , Carrero Juan Jesus , Strippoli Giovanni 
Published: May 2021

Abstract

Background and Aims
A healthy lifestyle promotes cardiovascular health and reduces cardiac-related mortality in the general population, but its benefits in patients treated with hemodialysis are uncertain. The aim of this study was to evaluate the association of a modified American Heart Association (AHA) healthy lifestyle score, and its individual components, with all-cause and cardiovascular mortality in a large multinational cohort of patients treated with long-term hemodialysis.

Method
Based on the AHA’s recommendations for cardiovascular prevention, a modified healthy lifestyle score was derived from non-smoking, being physically active, higher body mass index (BMI, obesity paradox of higher BMI being protective of death in dialysis patients), healthy diet, and well-controlled systolic blood pressure for participants in the DIET-HD study, a multinational cohort study of adults on hemodialysis. Hazard ratios (aHR) were estimated to evaluate the association between the healthy lifestyle score [low (0 -3 points) as the referent, medium (4-6), and high (7-10)] and cardiovascular and all-cause mortality by using cox model.

Results
5483 out of 9757 (56%) patients with complete lifestyle data were followed for a median of 3.8 years (17450.9 person-years). There were 2,163 deaths, of which 826 cardiovascular-related. Compared with patients with a low lifestyle score (963, 18%), the aHRs (95%CI) for all-cause mortality among those with medium (3,621, 66%) and high (899, 16%) were 0.70 (0.63-0.78) and 0.57 (0.49-0.66), respectively. Cardiovascular death was 17% [aHR, 0.83 (0.68-0.99] and 30% (0.70, 0.55-0.90) lower in patients with medium and high lifestyle score, respectively. Results were consistent in stratified or complete-case analyses, and after excluding early deaths. Risk reductions were largely driven by being a non-smoker, physically active and having a higher BMI. 20% of deaths were attributed to a medium/low lifestyle score (population attributable fraction; 95% CI 12-28%).

Conclusion
A healthier lifestyle, especially non-smoking, regular physical activity, and a higher BMI, is dose-dependently associated with lower all-cause and cardiovascular mortality in hemodialysis patients.
MO842SARS-COV-2 INFECTION AMONG PATIENTS RECEIVING MAINTENANCE HAEMODIALYSIS: SINGLE HAEMODIALYSIS CENTER EXPERIENCE FROM BANGLADESH
Authors: E Khoda Mohammad Mehfuz , Rahim Muhammad Abdur , Shimu Ishrat Jahan , Hossain Md Golzar , Mansur Md Abul 
Published: May 2021

Abstract

Background and Aims
Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) infections emerged in Wuhan, China in December 2019 and rapidly became pandemic. Unfortunately, there is lack of evidence about the optimal management of corona virus disease-2019 (COVID-19) and even less is available in patients on maintenance haemodialysis. Patient receiving maintenance haemodialysis are at increased risk for infection by SARS-CoV-2 with poor outcome. So, the purpose of this study was to identify the incidence of SARS-CoV-2 infection among end-stage kidney disease (ESKD) patients on maintenance haemodialysis.

Method
A cross-sectional study was conducted at a haemodialysis unit of tertiary care hospital of Bangladesh from April to August 2020. All patients, who were on maintenance haemodialysis, twice or thrice weekly, were screened by reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV-2, irrespective of symptoms. All data were collected in case record forms and patients were followed-up over phone.

Results
During the study period, a total of 133 patients (males 70, 52.6%) were on regular maintenance haemodialysis in the study centre. Most patients were in 5th and 6th decades of life. Twenty-one (15.8%) patients tested positive for SARS-CoV-2 by RT-PCR with female (16, 76.2%) predominance. Eighteen (18/21, 85.7%) patients had symptoms suggestive of SARS-CoV-2 infection and rest three (3/21, 14.3%) patients were diagnosed during routine screening. Common presentations were fever (42.9%), cough (66.7%) and respiratory distress (66.7%) and most had multiple symptoms. The incidence of SARS-CoV-2 infection in blood group A was 8(38%) and blood group O was 8(38%). There were no significant differences of mortality rate among blood groups. Most patients (16/21, 76.2%) infected by SARS-CoV-2 were referred to COVID-dedicated hospitals, five (5/21, 23.8%) were shifted to intensive care unit (ICU). Outcome was poor; 17 (17/21, 89%) patients died in hospitals and four (4/21, 19%) patients became free of SARS-CoV-2 infection. Caregivers/relative of our patients acquired COVID-19 in course of disease.

Conclusion
One-sixth of patients on maintenance haemodialysis acquired SARS-CoV-2 infection with nearly ninety percent fatality rates. Despite having risk factors for severe infection by SARS-CoV-2, patients on dialysis must visit health care facilities. So, utmost care should be taken to reduce risk of COVID-19 among such vulnerable group of patients.