bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO641IMPACT OF MAGNESIUM AND L-CARNITINE ADMINISTRATION ON 3-YEAR SURVIVAL IN DIABETIC PATIENTS WITH END-STAGE RENAL DISEASE
Authors: Susla Oleksandr , Litovkina Zoriana , Bushtynska Olha 
Published: May 2021

Abstract

Background and Aims
According to population registries, the survival of diabetic patients with end-stage-renal disease (ESRD) remains low today. In this context, it is reasonable to develop new therapeutic strategies based on advances in science of the important role of magnesium (Mg) and L-carnitine deficiency (via inflammation and endothelial dysfunction) in mechanisms of cardiovascular remodeling, high morbidity and mortality rates. Thus, the purpose of the present study was to evaluate the effect of Mg and L-carnitine supplementation on 3-year survival and development of the cardiovascular complications in diabetic hemodialysis (HD) patients.

Method
48 type 2 diabetic ESRD patients were included in this prospective cohort study (male/female, 29/19; age, 59.9±0.6 years; HD duration, 34.8±4.8 month; diabetes mellitus duration, 174.7±7.1 month). The study was performed in accordance with the provisions of the Declaration of Helsinki last revision. Depending on the treatment programme, patients were divided into two groups: the 1st (main) group (n=24) in addition to basic treatment (hypoglycemic, antihypertensive therapy, according to indications - correction of anemia, hyperparathyroidism, hyperphosphatemia) was treated by combination of magnesium aspartate (0.5 g/day orally) and L-carnitine (1 g/day parenterally after each HD session (three times weekly); the 2nd (comparison) group (n=24) was only on the basic therapy. Complex treatment lasted 12-months; administration of L-carnitine was performed continuously throughout the year, while magnesium aspartate – by three 2-months’ courses/year. The follow up period in both groups was 36 months. Quantitative data are expressed as means±SEM, qualitative ones – as %. Kaplan-Meier method and Log-rank test were used to estimate survival of HD patients, χ2-test – to compare the frequency values.

Results
The cumulative proportion of survivors at the end of follow-up was 60.4%; however, after 36 months, the survival rate of diabetic HD patients who received a combination of magnesium aspartate and L-carnitine as part of their modified treatment was significantly higher (75 vs. 45.8%; Log-rank=2.07, p=0.038) compared to patients who were on basic therapy (Figure). Survival time in main and comparison groups was 31.9±1.7 and 26.4±2.2 months respectively. It is noteworthy, that throughout the year (from 10 to 22 months), no completed events were recorded in subjects who underwent Mg and L-carnitine supplementation.

Conclusion
(1) The combined use of magnesium aspartate and L-carnitine in addition to the basic 12-month treatment provides an effective reduction of cardiovascular complications and promotes 3-year survival of diabetic HD patients. (2) The results obtained substantiate the advisability of using repeated courses of Mg and L-carnitine administration 1 years after the end of the primary modified treatment to improve the prognosis in these ESRD patients.
MO788ERYPTOSIS AND PARATHORMONE IN PATIENTS WITH END STAGE RENAL DISEASE TREATED BY HEMODIALYSIS
Authors: Hefny Aya , El-Tahir Fatima , Fikry Abeer , Shendi Ali M 
Published: May 2021

Abstract

Background and Aims
Eryptosis (Red cell apoptosis) has been recognized as one of the mechanisms that mediate anaemia in patients with chronic kidney disease whether pre or on dialysis. Phosphorus (Ph) and parathormone (PTH) can be considered as uremic toxins which are associated with renal anaemia, and both were suggested to be associated with shortened red blood cell (RBC) life span. We aimed to assess the relation between each of PTH and phosphorus levels and eryptosis in a cohort of patients with end stage renal disease (ESRD) treated by haemodialysis.

Method
We studied a cohort of 85 patients with ESRD on conventional hemodialysis for at least 3 months. Blood was drawn prior to the mid-week dialysis session. Patients are dialysed on Fresenius 4008s machines. The percent of Annexin V-binding RBCs was assessed by flow cytometry in fresh blood samples and was used to indicate the percent of Eryptotic RBCs. Data were represented as median (interquartile range).

Results
The study included 85 patients on prevalent hemodialysis for a median of 8 (3-12) years, 52.9% females. Hypertension was the most common cause of ESRD (49.4%). The median hemoglobin was 10.9 (9.3 - 13) gm/dl and most patients received erythropoietin therapy (83/85) at a median dose of 8000 (4000 – 8000 units/weak). The median percent of Annexin V- binding RBCs was 2.3 (1.4 – 4.7%). On multilinear regression analysis, only PTH was independently associated with the percent of Annexin V- binding RBCs (standardized β= 0.630; 95.0% CI: 0.001 – 0.003; p&lt;0.001). Patients were then stratified according to the PTH level into: low PTH (&lt; 150 ng/dl; 25/85, 29.4%), target PTH (150 – 600 ng/dl; 33/85, 38.8%) and high PTH (&gt; 600 ng/dl; 27/85, 31.8%) groups. The 3 groups differed significantly in the percent of Annexin V- binding RBCs (1.2 (0.7-1.7); 2.5 (1.8-3.6) and 4.8 (3.2-5.6) % respectively; p&lt;0.001) (Figure). The percent of Annexin V- binding RBCs was similar in patients with high (&gt;5.5) and target (&lt;5.5 mg/dl) Ph levels (p=0.318). It was higher in patients with above-target CaXPh product (&gt;55) than those with target CaXPh product (&lt;55 mg2/dl2) (5 (2-5.4) % vs 2.3 (4.1 – 1.2) %), yet this was not statistically significant (p=0.068).

Conclusion
Patients with ESRD treated by hemodialysis express high rates of eryptosis. Parathormone excess in those patients may result in further eryptosis enhancement, and this represents a potential pathogenic mechanism linking hyperparathyroidism with the anemia of CKD. Larger interventional studies are thus warranted to further explore the association between parathormone and eryptosis.
MO791HIGH-SENSITIVITY CARDIAC TROPONIN I CORRELATES WITH THE CARDIAC DYSFUNCTION AND WITH THE SEVERITY OF ANEMIA IN DIALYSIS PATIENTS
Authors: Vita Caterina , Bolignano Davide , Presta Pierangela , Zicarelli Mariateresa , Figlia Irma , Cianfrone Paola , Arcidiacono Valentina , Comi Alessandro , Coppolino Giuseppe , Fuiano Giorgio , Andreucci Michele 
Published: May 2021

Abstract

Background and Aims
Several evidences demonstrate that chronic dialysis treatment alters troponin levels, even in the absence of an acute myocardial event, although the underlying causes remain largely unclear. In this small pilot study, we aimed at analyzing high sensitivity troponin T (HsTnT) in a cohort of dialysis patients to identify the potential clinical predictors.

Method
HsTnT levels were measured together with common laboratory and clinical parameters in 39 chronic dialysis patients (middle age: 65±12 aa; 82% M; 30 in hemodialysis and 9 in peritoneal dialysis). The patients underwent also a complete echocardiography assessment.

Results
HsTnT levels were higher than normal reference values (median 46.1 ng/L IQR 33.5-84.3),but showing no differences between hemodialysis and peritoneal dialysis patients (p=0.19). At correlation analyses, HsTnT were strongly associated with beta2-MCG (R=0.43; p=0.008), Hemoglobin (r=-0.47; p=0.002) and, in particular, with some echocardiography parameters such as ejection fraction (R=-0.29; p=0.05), E/E’ratio (R=0.56; p=0.006) and LAVI (R=0.41; p=0.05) Figure 1.

Conclusion
In a small cohort of dialysis patients, high HsTnt levels were at the crossroad between the severity of functional heart dysfunction and anemia. Larger studies are advocated to further clarify the role of HsTnT as a potential biomarker reflecting the anemic cardiorenal syndrome which characterizes uremic subjects.
MO806SAFETY OF INTRAVENOUS PARICALCITOL TREATMENT IN CHINESE HEMODIALYSIS PATIENTS: A REAL-WORLD DATABASE ANALYSIS
Authors: Wang Niansong , Jiang Gengru 
Published: May 2021

Abstract

Background and Aims
The aim of this analysis based on the real-world database was to observe the effect of paricalcitol on the safety profile in Chinese hemodialysis (HD) patients with secondary hyperparathyroidism (SHPT) under routine clinical practice.

Method
From the Better Life for Future database, a total of 668 Chinese hemodialysis patients from 104 dialysis centers between January 2015 and May 2019 were included in the analysis set. Intact parathyroid hormone (iPTH), total serum calcium (Ca), phosphate (P), dosage of intravenous (IV) paricalcitol (Zemplar®) were analyzed and discussed via retrospective analysis of the database during the treatment.

Results
Patients were divided into five groups according to the duration of follow-up. Median iPTH levels decreased from 1183 pg/ml at baseline to 676 pg/ml at the final visit, or 30.88% (p &lt; 0.0001). Serum Ca levels shown significantly increased just in the group of Month 12–24 (P=0.0479) (Table 2). The incidence of hypercalcemia for three consecutive blood draws was significantly lower than the incidence of hypercalcemia for at least once or two draws in all groups (Table 3). Subgroup analyses of patients with hyperphosphatemia showed a rapid phosphate reduction, within the first few weeks, along with the reduction in the iPTH level (Figure 1).

Conclusion
This is the first national retrospective real-world observational study since intravenous paricalcitol is available in China since 2014. This study adds valuable information to real-world data investigating the use of paricalcitol in Chinese HD patients and demonstrated the use of paricalcitol as an effective and well-tolerated treatment for the control of PTH during its use in routine practice. The occurrence of hypercalcemia is mostly transient, followed by continuous treatment, the blood calcium level tends to be stabilized, and the blood phosphorus level will be improved with the control of PTH.
MO807CORRELATIONS BETWEEN THE INFLAMMATORY AND THE BIOCHEMICAL BONE PROFILE OF PATIENTS ON HEMODIALYSIS
Authors: Khairallah Pascale , Nickolas Thomas , Panagoutsos Stylianos , Pasadakis Ploumis , McCann Fiona , Fraser William , Vargemezis Vassilis , Pazianas Michael 
Published: May 2021

Abstract

Background and Aims
End stage kidney disease (ESKD) is associated with a malnutrition-inflammation complex that results in several endocrine, musculoskeletal, and metabolic abnormalities. Despite the known resultant derangements from this process, few studies have evaluated the associations between inflammation and skeletal status in ESKD patients. Our goal is to evaluate correlations between inflammatory and biochemical bone profile within and between dialysis patients and a healthy cohort.

Method
This analysis is a cross-sectional evaluation of a cohort of 40 dialysis patients and 20 healthy controls.

Results
Significant differences were found between the dialysis and healthy cohort in biochemical bone profile, inflammatory markers and adipokine levels. Dialysis patients with low vs. high PTH (cutoff 50 pg/mL) had differences in bone turnover markers but no differences in inflammatory or adipokine levels (Table 1). More specifically, bone-specific alkaline phosphatase (BSAP), osteocalcin (OCN) and osteoprotegerin (OPG) were positively correlated with insulin-like growth factors but this correlation was not present after adjustment for parathyroid hormone (PTH) levels. C-terminal cross-linking telopeptide (CTX) positively correlated with IGF1 (p-value 0.02, 95% CI (0.14-1.69)) and with IGFBP3 (p-value 0.007 and 95% CI (0.31- 1.84)) after multivariate adjustment for PTH, albumin and sex. Adiponectin positively correlated with IGFBP3 and this remained significant after adjustment for PTH, albumin and sex (p=0.02). IL6, IL8 and TNF did not correlate with bone turnover markers or with adipokine levels after multivariate adjustments.

Conclusion
In this cross-sectional study, significant differences were found between the dialysis and healthy cohort in biochemical bone profile, inflammatory markers and adipokine levels. In the dialysis cohort, inflammatory markers did not correlate with bone turnover markers or with adipokine levels in dialysis patients. Dialysis patients with high vs. low PTH (cutoff 50 pg/mL) had higher levels of bone formation and bone resorption markers. Inflammatory and adipokine levels did not differ between those with high vs. low PTH.
MO795CALCIUM BALANCE AND CKD-MBD PARAMETERS DIFFERENCES OF CITRATE VS. ACETATE DIALYSATE
Authors: Broseta Monzo Jose Jesus , López Romero Luis Carlos , Rodríguez Diana , Guillen Olmos Elena , Sánchez-Pérez Pilar , Hernandez Jaras Julio 
Published: May 2021

Abstract

Background and Aims
Dialysate composition is an essential feature of hemodialysis treatment. The use of acetate as the dialysate buffer and its calcium concentration are still topics of debate. Calcium transfer during dialysis sessions is related to short-term (hemodynamic tolerance and arrhythmias) and long-term effects (cardiovascular calcification and mortality). This study aims to identify the potential benefits derived from acetate-free dialysis by using citrate as a buffer in terms of calcium balance and CKD-MBD biomarkers.

Method
We performed a prospective crossover study that analyzed 24 dialysis sessions, 12 with each dialysate buffer, on every patient. Ionized calcium and CKD-MBD parameters were analyzed with each acidifier. Both dialysates had a calcium concentration of 1.5 mml/L. The remaining hemodialysis patients’ parameters were unchanged during the study period.

Results
No differences were found between pre-dialytical ionized calcium (iCa) (1,11 ± 0,12 vs. 1,08 ± 0,12 mmol/L) in both groups. However, we identified a significant iCa increase in the sessions were acetate dialysate was used, both in immediate (1,29 ± 0,07 mmol/L) and in 30-minutes post-dialytical blood analysis (1,22 ± 0,07 mmol/L). Whereas iCa levels remained stable during the immediate (1,07 ± 0,06 mmol/L) and 30-minutes post-dialytical analysis (1,08 ± 0,11 mmol/L) when using citrate. On the other hand, pre-dialysis albumin-corrected total calcium was higher with acetate (8,9 ± 0,6 vs. 8,31 ± 0,75 mg/dL, p = 0,003) and PTH was lower with acetate (169 vs. 267 pg/mL, p &lt; 0,001).

Conclusion
Acetate-free dialysis using citrate as an acidifier stabilizes iCa levels during dialysis sessions while maintaining a neutral or negative effect in calcium balance. This analytical benefit may translate into better cardiovascular long-term outcomes.
MO798ORAL CALCITRIOL USE, VERTEBRAL FRACTURES AND VASCULAR CALCIFICATION IN HEMODIALYSIS PATIENTS: RESULTS FROM VITAMIN K ITALIAN (VIKI) STUDY
Authors: Fusaro Maria , Aghi Andrea , Politi Cristina , Nickolas Thomas , Cianciolo Giuseppe , La Manna Gaetano , Gasperoni Lorenzo , Mereu Maria Cristina , Gallieni Maurizio , Ravera Maura , Giannini Sandro , Sella Stefania , Arcidiacono Gaetano , Tripepi Giovanni Luigi 
Published: May 2021

Abstract

Background and Aims
In patients with Chronic Kidney Disease (CKD) mineral, bone, and calcific cardiovascular abnormalities are associated to adverse clinical outcomes, including fractures, cardiovascular events and mortality. Vitamin D hormonal system along with alteration levels that occur in calcium, phosphate, PTH, FGF23/Klotho are the main responsible of the bone and vascular metabolism changes, particularly in hemodialysis (HD) patients that experienced the very negative clinical consequences (decreased bone mass, increased fragility fractures and vascular calcification). In the setting of a comparative effectiveness study, we investigated the effect of oral calcitriol on fractures in HD patients taking into account a series of potential confounders.

Method
We conducted a secondary analysis of the VIKI database, a cross-sectional study involving 387 HD patients from 18 Italian dialysis centers. Routine biochemistry and bone biochemical markers such as vitamin K levels, VKDPs, vitamin 25(OH)D, ALP, PTH, Ca, P, osteocalcin (BGP), Matrix Gla Protein (MGP) were assessed. The presence of Vertebral Fractures (VF) and Vascular Calcification (VC) was determined through spine radiograph. Reduction of &gt;20% of vertebral body height was considered a VF. The severity of the vertebral fractures was estimated as mild, moderate and severe (reduction: 20-25%, 25-40% or &gt;40%, respectively). VC were quantified by measuring the length of calcific deposits along the arteries (mild 0,1-5 cm, moderate 5,1-10 cm and severe &gt;10 cm).

Results
177 out 387 patients (45.7%) were treated with oral calcitriol. Oral calcitriol-treated and untreated patients did not differ as for Ca, P, PTH, Albumin, BGP, MGP, and ALP. The prevalence of VF was significantly lower in patients receiving oral calcitriol than in those untreated (48.6% vs 61%, P=0.015), whereas the presence of aortic and iliac calcifications was similar between the two groups (aortic: 81.9% vs 79.5% respectively, P=0.552; iliac: 52.0% and 59.5%, P=0.167). No significant between-groups differences were observed in terms of calcification severity. In a multivariable logistic regression analysis, after adjustment for all potential confounders, oral calcitriol was associated with a marked reduction (-40.2%) of the odds of fractures (OR: 0.598, 95% CI: 0.363-0.985, P=0.043) (see Table).

Conclusion
A significant association was found between oral calcitriol and lower VF rate in HD patients. Such an effect remained significant also after data adjustment for a large series of potential confounders. Further prospective and interventional studies are needed to confirm these findings.
MO733RISK FACTORS FOR INFECTIVE ENDOCARDITIS IN PATIENTS RECEIVING HAEMODIALYSIS- A PROPENSITY MATCHED COHORT STUDY
Authors: Al-Chalabi Saif , Tay Tricia , Chinnadurai Rajkumar , Kalra Philip A 
Published: May 2021

Abstract

Background and Aims
Infective endocarditis (IE) is a serious infective complication that usually results in prolonged hospitalisation and is associated with high morbidity and mortality. It is sometimes difficult to promptly diagnose infective endocarditis when a patient receiving hemodialysis presents with signs and symptoms of bacteremia, a delay which can lead to worse outcomes. In this study, we aimed to identify the risk factors that can predict infective endocarditis in haemodialysis patients with bacteremia.

Method
This retrospective observational study was conducted on all patients diagnosed with infective endocarditis (IE) and receiving maintenance hemodialysis between 2005 and 2018 in Salford Royal Hospital and its satellite dialysis units (catchment population of 1.5 million). The IE patients were propensity score matched in a 1:2 ratio with similar hemodialysis patients without IE but with bacteremia between 2011 and 2015. Propensity scores were generated by using binary logistic regression analysis incorporating age, gender, diabetes status, and dialysis vintage as variables. Logistic regression analysis was used to predict the risk factors associated with developing IE. Statistics were performed using SPSS version-24.

Results
We had a sample of 105 patients (35 IE vs 70 bacteremia). The median age of the patients was 65 years with a predominance of males (60%). 43% were diabetic, 11.5% were receiving immunosuppression and 72% had a catheter for dialysis access. IE patients had higher peak C-reactive protein (CRP) during admission compared to patients with bacteremia and no IE (253 mg/l vs 152 mg/l, p=0.001). Patients who developed IE had a longer duration of dialysis catheter use than the bacteremia group (150 vs 19 days; p&lt;0.001) (table 1). There was no significant difference between causative microorganisms in both groups. Staphylococcus aureus caused most cases (54% in IE and 47% in bacteremia). Our study showed clearly that patients who had IE had longer hospital stay (45 vs 18 days, p=0.001) with a far higher 30-day mortality rate (54.3% vs 17.1%, p&lt;0.001). Logistic regression analysis showed previous valvular heart diseases (OR: 20.1; p&lt;0.001), a higher peak CRP (OR:1.01; p=0.001), and a longer duration of catheter use (OR: 1.01; p=0.035) as significant predictors for infective endocarditis (table 2).

Conclusion
Bacteremia in patients receiving hemodialysis through a catheter as access should be actively investigated with a high index of suspicion for IE particularly those having valvular heart diseases, hypertension, higher peak CRP, and those with a longer duration of dialysis catheter usage. Work up may need to include invasive investigations such as transesophageal echocardiogram to confirm or reliably rule out this devastating condition.
MO736ELECTROCHEMICAL SKIN CONDUCTANCE BY SUDOSCAN: A NEW TOOL TO PREDICT INTRA-DIALYTIC HYPOTENSION
Authors: Reach Pauline , Touzot Maxime , Lombardi Yannis , Maheas Catherine , Sacco Emmanuelle , Fels Audrey , Beaussier Hélène , Urena Torres Pablo Antonio , Chatelier Gilles , Ridel Christophe , Zuber Mathieu 
Published: May 2021

Abstract

Background and Aims
Intradialytic hypotension (IDH) is a common complication in hemodialysis (HD) patients. It is associated with multiple risk factors including cardiac dysfunction and alterations of the peripheral autonomic nervous system. To which extent, dysautonomia may contributed to the occurrence of IHD remains elusive. We sought to investigate the clinical utility of Sudocan®, a device that quantify dysautonomia, in the prediction of IDH.

Method
We conducted a prospective monocentric study in adult HD patients from July 2019 to February 2020. Dysautonomia was assessed by the measurements of hand and foot Electrochemical Skin Conductance (ESC) by Sudocan®, before and after the end of HD. A pathological hand ESC was defined by an ESC value &lt; 40 μs in Caucasian or &lt; 30 μs in afro-American and Caribbean patients, and a pathological foot ESC by a value &lt; 50 μs in Caucasian or &lt; 30 μs in afro-American and Caribbean patients.
Arterial blood pressure (BP) was monitored before, every thirty minutes and after the end of the HD session. The primary end point was the incidence of IDH, according to the NKD/K-DOQI definition, during the 3 month-period study.

Results
A total of 176 HD patients (64 ±14 years old) were enrolled. Mean pre-dialysis hand and foot ESC were 45±20 μS and 54±22 μS, respectively. Thirty-five and 40% of patients had a pathological ESC at the hand and foot, respectively. Forty-Six IDH occurred during the study period. Logistic regression showed that a pathological hand ESC was associated with an increased risk of IDH [OR=0.39, IC95% (0.15-0.97), p= 0.04]. The cumulative risk incidence of IHD during the study was 2.17 [IC95% (1.21-3.89), p= 0.01] and 1.89 [IC95% (1.06-2.38), p= 0.03], with a pathological hand and foot ESC, respectively.

Conclusion
A pathological hand ESC, as assessed by a simple, non-invasive test, such as Sudoscan®, is associated with an increased risk of IDH.