bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO738CLINICAL IMPACT OF ORAL ANTICOAGULATION THERAPY ON MORTALITY, EMBOLIC AND HEMORRHAGIC EVENTS IN CHRONIC HEMODIALYSIS PATIENTS WITH ATRIAL FIBRILLATION
Authors: Dimitrijevic Zorica , Salinger Sonja , Tasic Danijela , Stojanovic Miomir , Paunovic Karolina , Mitic Branka 
Published: May 2021

Abstract

Background and Aims
A balance between embolic and bleeding risk is challenging in patients on chronic hemodialysis (HD). Embolic prevention with oral anticoagulation is the cornerstone for managing patients with atrial fibrillation (AF). However, there is a lack of specific recommendations for the use of antithrombotic therapy in HD patients with AF, and data about the efficacy and safety of oral anticoagulation in those patients are limited. Anticoagulation may exacerbate the hemorrhagic tendency; therefore, its potential benefits must be carefully weighed against hemorrhagic complications. We aimed to analyze the impact of oral anticoagulation on mortality, embolic and hemorrhagic events in chronic hemodialysis patients with AF.

Method
We used data from 106 hemodialysis patients [median age of 72 years (IQR 59–79) and 74.8% of the male gender] diagnosed with AF between 2016 and 2019. An analysis was performed to match the baseline characteristics of patients treated or not with oral vitamin K antagonists (OAK). The impact of oral anticoagulation in the embolic and hemorrhagic risk was assessed by a competitive risk analysis, with death being the competitive event. For embolic risk, we have considered a stroke, pulmonary or peripheral embolism, including arteriovenous fistula thrombosis. For bleeding risk, we have considered major bleeding according to the ISTH definition.

Results
More than half of HD patients with AF were anticoagulated (65.1%; n=69). During a median follow-up of 27.6 months (IQR 11.8-42.9 months), 33 patients died (31.1%), 21 presented embolic events (19.8%), and 19 had a major bleeding event (17.9%). In total, we recorded eight cerebral bleedings, ten gastrointestinal bleedings, and one urogenital bleeding. Of those, eleven (57.9%) were observed in orally anticoagulated patients (p=0.066). Patients with bleeding events had a higher prevalence of arterial hypertension (p=0.012), diabetes mellitus (p=0.002), advanced age (p=0.03) lower platelets count (p&lt;0.001) and lower hemoglobin (p=0.04). After propensity-score matching, anticoagulation therapy was associated with lower mortality rate (HR 0.86, 95% CI 0.71-0.92; p=0.004) and embolic events (HR 0.78, 95% CI 0.69-0.88; p=0.003), but more bleeding events (HR 1.83, 95% CI 1.34-2.91; p=0.002).

Conclusion
Among HD patients with AF, oral anticoagulation was associated with lower all-cause mortality. Although survival free of embolic events was significantly higher in patients with anticoagulation, the risk of major bleeding was almost twice than in non-anticoagulated patients. Patients who experienced bleeding events did not show worse outcomes. This study strengthens the role of low hemoglobin and platelet counts as well as comorbidities on increased bleeding risk.
MO739EX VIVO THROMBOCYTE FUNCTION IN HEMODIALYSIS PATIENTS
Authors: Bonell Vera , Lorenz Georg , Kessler Thorsten , Heemann Uwe , Schmaderer Christoph , Kemmner Stephan 
Published: May 2021

Abstract

Background and Aims
Coagulation disorders with both risk for bleeding and thrombotic events are common in hemodialysis (HD) patients. Altered thrombocyte counts and function may account for that. Here, we sought to better characterize thrombocyte function in hemodialysis patients.

Method
Platelet function was investigated using the Multiplate analyzer (Roche) based on impedance aggregometry. Adenosine diphosphate (ADP) was used to induce platelet aggregation and area under the curve (AUC) was used as primary endpoint. Platelet counts and C-reactive protein (CRP) levels were measured. Hospitalization was the primary clinical outcome. Pearson regression was used to test for associations of thrombocyte function and the primary endpoint.

Results
In total 60 chronic HD patients undergoing dialysis 3 times per week, and 67 healthy controls were included. In general, HD patients presented with significantly lower thrombocyte numbers compared to healthy controls (Median: 221 vs. 245 G/l, p=0.029). Further, thrombocyte function as determined by AUC was significantly altered in HD patients versus healthy controls (Median: 455 vs. 677 AU*min, p&lt;0.001; figure 1) with a significant correlation for platelet count and platelet function (r=0.42, p=0.001).
Platelet function also correlated with the inflammatory state as seen by systemic CRP levels (r=0.28, p=0.033). Regarding the clinical outcome, platelet function correlated with hospitalization rates for infectious disease (r=0.27; p=0.040) and cardiovascular events (r=0.30; p=0.022). In case of hospitalization rates for infectious disease this correlation remained stable irrespective of adjustment for thrombocyte counts (r=0.27, p=0.036).

Conclusion
Lower platelet counts and altered function in HD patients was associated with risk of hospitalization and markers of inflammation in this cohort. The Multiplate analyzer appeared to be a valid and easily accessible method to assess thrombocyte function. Further studies are needed to determine whether assessment of thrombocyte function in clinical routine should be used to stratify risk in the vulnerable population of HD patients.
MO722PHOSPHATE-BINDER THERAPY WITH SUCROFERRIC OXYHYDROXIDE REDUCES ENDOGENOUS CALCIPROTEIN PARTICLE FORMATION AND CRYSTALLIZATION IN A POST-HOC ANALYSIS OF A RANDOMIZED CONTROLLED TRIAL IN DIALYSIS PATIENTS
Authors: Thiem Ursula , Hewitson Tim D , Toussaint Nigel D , Haller Maria C , Pasch Andreas , Cejka Daniel , Smith Edward 
Published: May 2021

Abstract

Background and Aims
Calcification propensity of serum can be measured with the so-called T50-test, which integrates the complex biological interplay of promoters and inhibitors of calciprotein particle formation in blood into a single readout. Calcification propensity is associated with the risk for cardiovascular events and death in dialysis patients. As we have recently demonstrated in a randomized, controlled, cross-over study in 39 chronic hemodialysis patients with hyperphosphatemia, lowering serum phosphate with high-dose phosphate-binder therapy with 2000 mg/d of sucroferric oxyhydroxide (SO) over two weeks reduces calcification propensity as determined by the T50-test compared to a two-week wash-out phase. Based on these results, we hypothesized that SO would influence endogenous calciprotein particle (CPP) formation and crystallization, i.e. conversion from primary to secondary CPP.

Method
To test this hypothesis, we conducted post-hoc analyses of the previously reported RCT (74% men, mean age 63±27 years, median dialysis vintage 24, IQR 16-36 months). Native serum CPP levels were measured by a fluorescent probe-based flow cytometric assay. Moreover, hydrodynamic radii (Rh) of secondary CPP formed after enrichment with exogenous calcium and phosphate was assessed by three-dimensional cross-correlation dynamic light scattering.

Results
Phosphate-binder therapy with SO lead to a reduction in serum phosphate levels from 2.28±0.5 mmol/l to 1.63±0.43 mmol/l (p&lt;0.0001), accompanied by a significant reduction of endogenous calciprotein particle load and crystallization. Median (IQR) number of primary CPP decreased from 9.2x105 (7.7x105 - 12x105) particles/ml to 3.8 x105 (2.7x105 - 4.4x105) particles/ml (p&lt;0.0001) and secondary CPP decreased from 5.4x104 (3.6x104 - 7.5x104) particles/ml to 3.2x104 (2.4x104 - 4.2x104) particles/ml (p&lt;0.01, both by Wilcoxon matched-pairs test). Upon SO therapy we also observed a significant reduction of secondary calciprotein particle size as determined by Rh compared to phosphate-binder wash-out (214±55 nm vs. 231±52 nm, p&lt;0.01 by paired t-test).

Conclusion
In chronic hemodialysis patients, lowering serum phosphate with SO is associated with a reduction in the load of primary and secondary CPP and a smaller size of secondary CPP.
MO740EFFECT OF DIPHOSPHONATES FOR VASCULAR CALCIFICATION IN CHRONIC KIDNEY DISEASE: A META-ANALYSIS
Authors: Yang Canlin , Xie Xiaotong , Xing Jie , Yang Xin , Zhang Xiao liang 
Published: May 2021

Abstract

Background and Aims
Vascular calcification is an independent predict factor of cardiovascular mortality and all-cause mortality in chronic kidney disease (CKD) patients. Animals experiments and clinical studies showed the inhibition effect of diphosphonates in vascular calcification, but the results of the studies remains controversial. This meta-analysis aims to evaluate the effects of diphosphonates on vascular calcification in patients with CKD.

Method
Randomized controlled trials (RCT) and non-RCTs of diphosphonates for the treatment of vascular calcification in CKD patients until September 2020 were searched in the database of PubMed, Embase, Cochrane library, CNKI and Wanfang. Literatures were screened according to the inclusion and exclusion criteria and quality was evaluated by two investigators independently. The standard deviation from mean (SMD) and 95% confidence interval (CI) were used to representthe counting data. Data extracted from the literatures were analyzed with Stata software (version 15.0).

Results
A total of 6 RCTs and 1 non-RCT with 272 patients were included, characteristics of the studies included are shown in Table 1. Meta-analysis indicated that diphosphonates inhibit vascular calcification in CKD [SMD =-0.297, 95% CI = (-0.591, -0.002), P = 0.049] (Figure 1). Etidronate is the most effective one in treating with vascular calcification (P = 0.020) (Figure 2). But there isn’t significant difference in aortic artery calcification and coronary artery calcification compared with the control group (P&gt;0.05). There was no statistically significant difference in the change of blood calcium, blood phosphate, and serum parathyroid hormone between two groups (all P&gt;0.05).

Conclusion
Diphosphonates can inhibit the progression of vascular calcification in CKD patients, and it hasn’t obvious effect on blood calcium, blood phosphate, and serum parathyroid hormone. Etidronate is the most promising therapeutic agent.
MO745CARDIOVASCULAR EFFECTS OF HIGH FLOW ARTERIO-VENOUSE FISTULA CLOSURE IN POST-KIDNEY TRANSPLANTATION PATIENTS
Authors: Iskhakov Rustam , Belavina Natalya , Ivanova Ekaterina , Klochkova Nataliya , Zeltyn-Abramov Eugene 
Published: May 2021

Abstract

Background and Aims
Presently, the dilemma of what to do with a functioning arterio-venous fistula (AVF) in post-kidney transplantation patients is a subject of debate. One of the arguments in favor of AVF closure is symptomatic congestive heart failure (CHF) due to AVF-induced cardiomyopathy. The subject of the study was the evaluation of the dynamics of some morpho-functional cardiac parameters in post-kidney transplantation patients with AVF-induced CHF before and after AVF closure.

Method
The results of prospective single center study are presented. 13 post transplantation patients with severe AVF-induced CHF (III-IV f.c. NYHA) were enrolled. Echocardiography (Echo), Doppler evaluation of AVF flow (Qa) and calculation of cardiopulmonary recirculation (Qa/CO) were performed simultaneously (split-protocol) at baseline together with estimation of creatinine plasma level. All patients underwent surgical closure of AVF. In 8 weeks after the closure, an assessment of CHF, Echo and creatinine plasma level were carried out in all enrolled patients. Statistical analysis was performed using the STATISTICA 13 software (T-test).

Results
The average age – 44 ±13 y, males 54%. All patients bore an upper arm proximal AVF. The average flow of AVF (Qa) – 3.4 ±1.4 L/min, average Qa/CO – 49 ±15%, Qa/CO was more than 30% in 92% of patients. The median of AVF vintage was 5 y (IR 3;10). In 8 weeks after AVF closure, complete clinical resolution of CHF, reduction of volumetric heart parameters, decrease of sPAP, improvement of diastolic function were observed. There was no significant difference in the serum creatinine value (1.85 ±0.66 mg/dL vs 1.97 ±0.95 mg/dL, p &gt;0.05). The results of Echo data before and after AVF closure are presented in Table 1.

Conclusion
The surgical closure oh high flow AVF in post-kidney transplantation patients with AVF-induced CHF was resulted in significant improvement of morpho-functional cardiac parameters. The CHF due to AVF-induced cardiomyopathy should be considered as one of the indications to AVF closure in post-kidney transplantation patients.
CO, cardiac output; CI, cardiac index; LV EDVi, left ventricular end-diastolic volume index; LV ESVi, left ventricular end-systolic volume index; LAVi, left atrial volume index; RAVi, right atrial volume index; TAPSE, tricuspid annular plane systolic excursion LVMi, left ventricular mass index; sPAP, systolic pulmonary arterial pressure; LVEF, left ventricular ejection fraction; Е/A ratio, E - peak early mitral inflow wave velocity, A - peak late mitral inflow wave velocity.
MO746CARDIAC REMODELING AND PULMONARY HYPERTENSION IN HEMODIALYSIS PATIENTS
Authors: Borodulina Ekaterina , Shutov Alexander M 
Published: May 2021

Abstract

Background and Aims
An important predictor of cardiovascular mortality and morbidity in hemodialysis patients is left ventricular hypertrophy. Also, pulmonary hypertension is a risk factor for mortality and cardiovascular events in hemodialysis patients. The aim of this study was to investigate cardiac remodeling and the dynamics of pulmonary arterial pressure during a year-long hemodialysis treatment and to evaluate relationship between pulmonary arterial pressure and blood flow in arteriovenous fistula.

Method
Hemodialysis patients (n=88; 42 males, 46 females, mean age was 51.7±13.0 years) were studied. Echocardiography and Doppler echocardiography were performed in the beginning of hemodialysis treatment and after a year. Echocardiographic evaluation was carried out on the day after dialysis. Left ventricular mass index (LVMI) was calculated. Left ventricular ejection fraction (LVEF) was measured by the echocardiographic Simpson method. Arteriovenous fistula flow was determined by Doppler echocardiography. Pulmonary hypertension was diagnosed according to criteria of Guidelines for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology.

Results
Pulmonary hypertension was diagnosed in 47 (53.4%) patients. Left ventricular hypertrophy was revealed in 71 (80.7%) patients. Only 2 (2.3%) patients had LVEF&lt;50%. At the beginning of hemodialysis correlation was detected between systolic pulmonary arterial pressure and LVMI (r=0.52; P&lt;0.001). Systolic pulmonary arterial pressure negatively correlated with left ventricular ejection fraction (r=-0.20; P=0.04). After a year of hemodialysis treatment LVMI decreased from 140.49±42.95 to 123.25±39.27 g/m2 (р=0.006) mainly due to a decrease in left ventricular end-diastolic dimension (from 50.23±6.48 to 45.13±5.24 mm, p=0.04) and systolic pulmonary arterial pressure decreased from 44.83±14.53 to 39.14±10.29 mmHg (р=0.002). Correlation wasn’t found between systolic pulmonary arterial pressure and arteriovenous fistula flow (r=0.17; p=0.4).

Conclusion
Pulmonary hypertension was diagnosed in half of patients at the beginning of hemodialysis treatment. Pulmonary hypertension in hemodialysis patients was associated with left ventricular hypertrophy, systolic left ventricular dysfunction. After a year-long hemodialysis treatment, a regress in left ventricular hypertrophy and a partial decrease in pulmonary arterial pressure were observed. There wasn’t correlation between arteriovenous fistula flow and systolic pulmonary arterial pressure.
MO747AN ASSESSMENT OF COMPLEXITY OF CARDIOVASCULAR SIGNALS USING ENTROPY IN HEMODIALYSIS SESSION AND GLUCOSE INJECTION DURING HEMODIALYSIS IN END STAGE RENAL DISEASE PATIENTS WITH AND WITHOUT DIABETES MELLITUS TYPE 2
Authors: Niemczyk Longin , Schneditz Daniel , Buszko Katarzyna , Wojtecka Anna , Saracyn Marek , Niemczyk Stanisław 
Published: May 2021

Abstract

Background and Aims
Few studies have focused on the imbalance of the autonomic nervous system during hemodialysis (HD), although it seems to be an important factor for the maintenance of blood pressure.
The aim of this work was to assess the impact of hemodialysis (HD) and glucose injection upon entropy of heart rate and blood pressure during HD session in end stage renal disease (ESRD) patients with and without diabetes mellitus (DM) type 2.

Method
21 patients without DM (NDO), in age 54,95 +/-13,08 y.o., and 10 DM patients, in age 69,70 +/- 8,27 y.o., were studied during HD. 30 minutes after dialysis begins, 40% glucose solution was administered in the amount of 0.5g/kg body dry-weight (constant rate of 1 mL/s). The cardiovascular signals were extracted from the recordings using Portapres® system. The analysis was performed using Amplitude Aware Permutation Entropy (AAPE). The parameters of AAPE were set as d=7, A=0.5. All statistical analysis were performed on significance level α=0.05. The comparisons between groups were conducted with Mann-Whitney test with Holm corrections. The comparisons in time points were performed using Friedman test with post-hoc (Wilcoxon test with Holm corrections). The calculations of AAPE and all statistical analysis were performed with Matlab R2020a and R.

Results
The results are presented in table.
It was found that AAPE(HR) tends to decrease during dialysis (NS) and increases only in the DM group after glucose injection (p=0.019); without difference between groups. There were no differences in AAPE of blood pressure between the groups, but hemodialysis reduces AAPE(fiSYS) in both groups (p&lt;0.001 in both DM and NDO groups) and AAPE(fiDIA) in NDO (p&lt;0.01). AAPE(TPR) is high before dialysis, and decreases during HD in both groups (p&lt;0.0001). There is no effect of glucose injection on AAPE(HR) in both groups, but AAPE(fiSYS) and AAPE(fiDIA) increase in NDO (p&lt;0.001, p&lt;0.01, p&lt;0.05 respectively); without difference between groups. AAPE(TPR) tends to increase after glucose injection (p&lt;0.05 for NDO, NS for DM).

Conclusion
AAPE(HR)tends to decrease during HD, and glucose injections increase AAPE(HR) in DM patients. Hemodialysis reduce, and glucose injections increase AAPE of blood pressure especially in NDO. A weaker response to hemodialysis and glucose injection in diabetic patients may be caused by impairment of the autonomic system, and may have clinical impact – may leads to faint. Glucose administration does not prevent autonomic system disorders in patients with DM.
MO750THE COMBINED PROGNOSTIC SIGNIFICANCE OF ALKALINE PHOSPHATASE AND INTRA-CRANIAL ARTERIAL CALCIFICATIONS IN HEMODIALYSIS PATIENTS
Authors: Cohen Hagai Keren , Erez Daniel , Zitman-Gal Tali , Fanadka Feda , Einbinder Yael , Benchetrit Sydney 
Published: May 2021

Abstract

Background and Aims
Intra-cranial arterial calcification (ICAC) in hemodialysis (HD) patients has a prevalence of about 90%, and its severity is correlated with age, hemodialysis vintage and mineral bone disease. Elevated concentrations of calcium and phosphorus are not sufficient to induce medial calcification because of inhibition by pyrophosphate. Alkaline Phosphatase (ALP) promotes vascular calcification by hydrolyzing pyrophosphate. Epigenetic mechanisms regulation by Apabetalone downregulates pathways involved in vascular calcification.
This study assessed the combined impact of ICAC and elevated serum ALP on mortality among chronic HD patients.

Method
vascular calcifications represented by ICAC were measured simultaneous with mineral bone disease parameters including serum ALP of chronic HD patients who underwent non-contrast brain computerized tomography (CT) from 2015 to 2018 in our institution.

Results
This retrospective study included 153 hemodialysis patients (mean age 71.3±12.1 years, 60.1% male). Of the total cohort, 12(7.8%) had no brain calcifications and 69 (45.1%) had multiple intracranial calcifications. Considering the patients with normal ALP and no calcification as the reference group yielded adjusted odds ratios for all-cause mortality of 4.6 (95%CI 1.7-12.7) among patients with brain calcifications and normal ALP, p=0.003, and odds ratios for all-cause mortality of 6.1 (95%CI 2.1-17.7) among patients with brain calcifications and increased ALP.

Conclusion
We founded an independent association between ICAC and the risk of death among hemodialysis patients. The combined effect of ICAC and increased ALP was significantly associated with higher odds-ratio for all-cause mortality in chronic HD patients and may contribute to the risk stratification of these patients.
MO751OXIDATIVE STRESS IN PATIENTS WITH CHRONIC RENAL FAILURE AND CARDIOVASCULAR COMPLICATIONS
Authors: Azouaou toualbi Leila , Toualbi Chahine , Abderrezak Khelfi , Arab Medina , Ballouti Wafa , Chader Henni , Benoui Abdelghani , Seba Atmane 
Published: May 2021

Abstract

Background and Aims
The atherosclerosis process is highly accelerated in patients with chronic kidney disease (CKD). Oxidative stress is considered as one of the pro-atherogenic factors involved in accelerating the atherosclerosis process of the carotid artery. The aim of the present study was to determine the relationship between oxidative stress markers and the progression of carotid atherosclerosis in CKD patients.

Method
The study was conducted on 220 patients with CKD and 40 controls, and the disease stage was scored between 2 and 5D. Blood samples were taken and myeloperoxidases, malondialdehyde, nitric oxide, glutathione, and oxidised low-density lipoprotein were measured. Furthermore, we studied the correlations between these biomarkers and clinical and para-clinical cardiovascular complications.

Results
The average age of patients was 60.5 years. The oxidative stress markers average ± SD levels in CKD groups compared to the control were as follows: myeloperoxidase (49.89 ±1.98 vs. 38.45 ±1.98 UI/ml), malondialdehyde (5.2 ±0.12 vs. 3.26 ±0.03 µmol/l), nitric oxide (56.82 ±1.06 vs. 42.19 ±2.1 µmol/l), glutathione (42.21 ±1.3 vs. 79.4 ±2.6 IU/ml), and oxLDL (15.57 ±1.07 vs. 1.72 ±0.82 µmol/l). While the glutathione level decreased significantly in advanced CKD stage (p &lt; 0.05), the concentrations of all the other biomarkers increased significantly in accordance with CKD score (p &lt; 0.05). Patients with high IMD (&gt; 1 mm) had higher values of the prooxidant markers (NO, oxLDL, MDA, MPO) but lower antioxidant marker values (glutathione), compared to other patients with lower IMD

Conclusion
Cardiovascular diseases, mainly atherosclerosis, can be diagnosed indirectly by measuring oxidative stress markers. Furthermore, theses markers can be used to predict the progression of CKD, for better management of the disease.