bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO813ANALYSING TRANSITIONS IN THE INTEGRATED MODEL OF RENAL REPLACEMENT THERAPY IN A REGIONAL HEALTH SYSTEM
Authors: Gil-Casares Casanova Beatriz , Portoles Jose , López Paula , Tornero Molina Fernando , Marques Vidas Maria , Rojo Alvarez Jose Luis 
Published: May 2021

Abstract

Background and Aims
Every year 83,000 Europeans and 6,500 Spanish CKD patients require dialysis or transplantation. The choice of renal replacement therapy (RRT) is an important decision that determines the quality of life and survival. A single therapy option might not be adequate across a patient’s entire lifespan and a majority of patients change from one RRT modality to another to adapt RRT to clinical and psychosocial needs. Transitions should be considered as an expected progression in the patient’s treatment options.
In these circumstances, there are new questions about the best sequence of techniques.

Method
This observational study examined a cohort of all incident patients from the Madrid Registry of Renal Patients (REMER), who initiated RRT between January 2008 and December of 2018. This study used the proportional hazards models and competitive risk models to examine the impact of transitions between RRT modalities on survival.
We performed an intention-to-treat (ITT) analysis, according to the initial RRT chosen and an as treated (AT) analysis, by RRT received (Only HD, Only PD, PD then HD or HD then PD).

Results
A total of 8,971 patients started RRT during this period in Madrid (6.6 Million population): 7,207 on hemodialysis (HD), 1,401 on peritoneal dialysis (PD) and 363 received a pre-emptive kidney transplantation (KTX). Incident HD-patients were older and had more comorbidities. They presented higher mortality (HD group 40.9% vs PD group 22.8% vs 8.3% KTX group, p &lt;0.001) and less access to a transplant (HD group 30.4% vs DP group 51.6%; p &lt;0.001). Transitions between dialysis techniques define different groups of patients with different clinical outcomes. Those who change from HD to PD do it earlier (66% in less than 6 months), are younger and behave like those treated only with PD. Those who change from PD to HD do so later (1.5 years on average), are older (61.6 vs 53.5 years) and present higher mortality and less access to kidney transplantation than the group who initiates in HD and transfer to PD. Survival analysis by competitive risks is essential for integrated RRT models, especially in groups such as PD patients, where 58.6% of the patients were considered as lost follow-up (received a KTX after during the first 2.5 years on PD). This analysis reflects how patients who change dialysis modality share more characteristics with the second technique than the original one.

Conclusion
Our data suggest that transitions between RRT-techniques describes different patients, who associate different risks, and should be analyzed in an integrated manner to define improvement actions. This approach should be incorporated into the analysis and repports of renal registries.
MO858BIOCHEMICAL CHARACTERIZATION AND SURVIVAL OF PATIENTS URGENT-START HEMODIALYSIS DURING COVID-19 PANDEMIC: EXPERIENCE IN A GUATEMALAN CENTER
Authors: Mazariegos Celso , Sánchez Polo José Vicente 
Published: May 2021

Abstract

Background and Aims
The Coronavirus Disease 2019 (COVID-19) pandemic has greatly impacted the world health system, affecting almost 20 million people with a high fatality rate, mainly patients with comorbidities including patients with chronic kidney disease (CKD) in all its stages and renal replacement therapy. The aim of the present study was to evaluate the biochemical characteristics of the patients who urgent-start hemodialysis during the pandemic and additionally to evaluate their survival.

Method
Patients urgent-start hemodialysis were taken during the months of August to November 2020, the admission laboratory data was recorded, including the test to determine SarsCov-2, and Kaplan-Meier survival analysis was applied taking in it counts variables such as sex, professional who placed the vascular access, COVID-19 test result and evaluation by nephrology in the pre-dialysis clinic.

Results
92 patients were including in the analysis, 65% male, the nephrologist placed the vascular access in 54% of the patients, 71% had a negative result in the COVID-19 test and 55% had no evaluation in the pre-dialysis clinic. Among the biochemical results was found BUN 95.3mg/dl (SD 38.1), sCr 10.3mg/dl (SD 6.3), Na 130.6mg/dl (SD 7.5), K 5mmol/L (SD 1.1), Ca 7.8mg/dl (SD 1), P 6.5mg/dl (SD 3.3), uric acid 8.3mg/dl (SD 10) and PTH 279pg/ml (SD 267). As prognostic markers of infection by COVID-19, the following results were found WC 12.3k/UL (SD 9.3), hemoglobin 9.35g/dl (SD 2.5), hematocrit 28.7% (SD 9.4), platelets 291mcL (SD 137), sedimentation 75mm/hr. (SD 37), CRP 81.8mg/L (SD 113.8), interleukin-6 232-6pg/ml (SD 838.8), ferritin 1074.3mg/ml (SD 825.3), D dimer 4.3mcg/dl (SD 11.2), lactate dehydrogenase 322U/L (SD 255) and procalcitonin 6.5ng/ml (SD 16.8). When evaluating survival with the Kaplan-Meier analysis, no statistically significant difference was found when analyzing the variable presence of COVID-19 infection (Figure 2 - p: 0.89), sex (Figure 3 - p: 0.54), professional who placed vascular access (Figure 4 - p: 0.1), and the pre-dialysis evaluation (Figure 5 - p: 0.33), having a survival in general of 77% at 3 months (Figure 1).

Conclusion
The present study found a 77% survival rate in patients with urgent-start hemodialysis. There are no other documented data in Guatemala, which is why it provides guidelines for future studies in the country. Among the variables taken, no one was found that would determine a better survival, including SarsCov-2 infection. It will be necessary to carry out more studies with greater follow-up, more patients and more centers to carry out a better analysis.
MO862COVID-19 INFECTION IN HEMODIALYSIS PATIENTS:FINDINGS-EXPERIENCE-OUTCOME
Authors: Griveas Ioannis , Schinas Antonis , Balitsari Anthoula , Asimakopoulos Gerasimos , Pratilas Evangelos 
Published: May 2021

Abstract

Background and Aims
Our Nephrology Department during spring period on the first wave of COVID-19 was the referral Dialysis Unit for Covid-19 positive HD patients in the district area of Athens, Greece. The aims of this study are to report characteristics, rates and outcomes of all patients affected by infection with SARS-CoV-2 undergoing HD and treated under our care

Method
This is an observational study. Our Dialysis Unit has been assigned as a referral unit for Covid-19 positive HD patients. We registered all the data regarding the clinical course of our patients population. Age, primary cause of end stage renal disease, weight, clinical presentation, HD history, outcome, days of hospitalization.

Results
22 Covid-19 positive HD patients were treated under the care of our facility during the period 8 April 2020-17 June 2020. 16 patients were symptomatic at admission and 13 patients admitted with or developed during their stay pleural effusions. 12 patients (8 male) of our group died during their hospitalization. 3 out of 12 were admitted to Intensive Care Unit (ICU). 6 patients were septic, 4 had respiratory failure and 2 developed cardiovascular events. 14.5 days were the mean hospitalization days (range: 1-38 days) for the diceased ones.
2 out of 3 patients that admitted to ICU had quick deterioration, incubated and stayed in ICU for 48 hours. The third one with severe cormobidities (multiple myeloma, cancer of bladder) developed respiratory failure after 8 days of hospitalization, incubated, became septic and died after 20 days in ICU.
Mean age of our patients was 74.5 years. It has to be pointed out that 13 patients were over 75 years old. Mean age was higher in those who died compared with those who were discharged with double negative Covid-19 tests (79 vs 74,5 years old respectively). Median dialysis vintage for our patients was 63 months and for the diceased ones was 89 months. Average weight of our patients was 69 kgrs. Weight of diceased patients was 63 kgrs. 11 out of 22 patients and 5 out of 12 diceased patients were diabetic. 14 patients were hypertensive and 16 had official cardiovascular backround. 10 out of total 22 patients under our care discharged after 43 days of hospitalization (range:35-56 days).

Conclusion
As a conclusion our data provide clues regarding out experience of caring HD patients with COVID-19. Mortality was high. It seems that despite the fact that immune response of this population has not been clearly clarified, age, cormobidities and above all end-stage renal disease by its self is a significant and unpredictable risk factor for clinical outcome of HD patients with COVID-19 infection.
MO863COMPARISON OF ALL-CAUSE-MORTALITY BEFORE AND AFTER COVID-19 PANDEMIC IN A HEMODIALYSIS CENTER: A SUCCESSFUL PREVENTIVE PROTOCOL
Authors: Yavari Vahideh 
Published: May 2021

Abstract

Background and Aims
COVID-19 has exerted a lot of pressure and concern on Hemodialysis ward managers. Being successful in patient education and, simultaneously, protecting the personnel and patients with in-time provision of sanitation and prevention protocols are mandatory to survive the pandemic. The aim of this study was to assess the success of our preventive measures in the dialysis center after application of our self-developed protocols.

Method
Crude and age-adjusted mortality rates of two time frames, i.e. 4th January to 5th December 2019 and the same period in 2020 (before and after the start of pandemic) were compared. The data were processed with SPSS software version 26.

Results
During 4th January to 5th December 2019, the crude all-cause-morality rate of our hemodialysis center was 20.23% (51 out of 252 patients). Likewise, between 4th January 2020 to 5th December 2020, the crude all-cause-morality rate was 18.25% (46 out of 252 patients). Same result was yielded after age adjustment of the morality rates.

Conclusion
Tailoring effective and timely preventive measures along with tireless education of patients can control all-cause-mortality and possibly COVID-19 excess mortality rates in dialysis centers.
It seems that our preventive protocols which included strict patient and personnel screening, early referral to infectious specialist, clear isolation-sanitation protocols of COVID-19 positive cases and repeated patient and personnel education have been successful in surviving the pandemic till present.
MO864PATIENT MEDICATION ADHERENCE ON HEMODIALYSIS
Authors: Omrane Marwa , Babchia Amel , Jaballah Raja , Mahersia Afef , Saidane Olfa 
Published: May 2021

Abstract

Background and Aims
Non-adherence to treatment is a major problem in patients with end stage renal disease and contributes to the significant increase in morbidity, mortality and health costs.

Method
The objective of this work was to assess adherence to treatment prescriptions
for hemodialysis patients and to identify the predictive factors of poor compliance. This is a cross-sectional study of 59 patients on chronic hemodialysis. Adherence to treatment was evaluated by the adherence assessment test.

Results
The mean age of our patients was 51.8 years, with an M/F sex ratio of 1.26.
The socio-economic level was considered low in 83% of cases. The mean duration of hemodialysis was 81.6 months [6 months-252 months]. Causal nephropathy was dominated by vascular nephropathy (13 cases). Forty-two patients had high blood pressure. A total of 23.9% of patients were good observers, 59.5% had minimal compliance problems, and 16.7% were poor observers. Statistical analysis has shown that poor adherence to treatment is associated with male gender, low socioeconomic and intellectual level, the presence of comorbidities, increased medication, number of medications taken per day, and less knowledge of the pathology and risks as side effects of drugs.

Conclusion
Treatment adherence is unsatisfactory in our population of patients on maintenance hemodialysis. Therapeutic education targeting the expected benefit of the treatments, their mode of action, their side effects as well as a simplification of the intake would improve long-term adherence in patients.
MO865SEX HORMONAL PROFILE OF PATIENTS ON MAINTENANCE HEMODIALYSIS AND CORRELATION WITH QUALITY OF LIFE AND DEPRESSION: A CROSS-SECTIONAL STUDY FROM SOUTH INDIA
Authors: Latief Muzamil , Parry Manzoor , Abbas Farhat , Yadla Manjusha 
Published: May 2021

Abstract

Background and Aims
Hormonal abnormalities in haemodialysis (HD) patients contribute to quality of life including sexual dysfunction. Whereas Short Form 36 (SF 36) questionnaire deals with the holistic assessment of the quality of life in patients, it is directly impacted by sexual dysfunction or erectile dysfunction in males. In this study we assessed the sex hormone levels in HD patients and its correlation with quality of life (QOL).

Method
In this single center cross-sectional study, 100 patients (50 males and 50 females) on maintenance HD for more than 6 months were included in the study. In female patients’ sex hormones that included Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH), Prolactin, Estrogen, Progesterone was assessed in midweek early morning blood sample. In male patients LH, FSH and Testosterone were assessed in midweek early morning samples. QOL assessment was done using SF 36 questionnaire.

Results
Mean age of our study populations was 33.76+/- 7.86 years with male female ratio of 1:1 and mean body mass index of 20.52 ± 2.89 kg/m2. Presumed chronic interstitial nephritis in was the most common cause of end-stage renal disease (76%) in our study followed by Diabetic Kidney disease (21%). In males, mean serum LH, FSH and Testosterone were 8.58 ± 3.56 mIU/ml, 8.9 ± 4.05, 217.46 ± 96.44 ng/dl respectively with 70% patients having testosterone deficiency. In females, mean serum LH, FSH, Prolactin, estrogen and Progesterone levels were 8.61± 3.86 mIU/ml, 8.08 ± 3.70 mIU/ml, 12.35 ± 5.70 ng/ml, 84.56 ± 27.39 pg/ml and 0.31 ± 0.22ng/ml respectively. Mean SF 36 score in our study was 55.37+/-12.22, in males 54.82+/-12.81 and in females 55.93+/-11.70. The prevalence depression was 53% (50% in males and 56% in females) in our study. There was no significant correlation between SF 36 scores and Beck depression inventory (BDI) scores with LH, FSH in both the genders. In males there was positive correlation between SF 36 scores and testosterone level (r= 0.366), and in females positive correlation between SF 36 score and progesterone level in women HD patients (r= 0.549) was seen. There was a negative correlation between BDI score and progesterone level in women (r=0. -510) and negative correlation between BDI score and testosterone in men (r= -0.371).

Conclusion
QOL as assessed by SF 36 in patients on HD is low. There was positive correlation between SF 36 scores and testosterone level in males and between SF 36 score and progesterone in females.
MO866SOLUBLE UROKINASE PLASMINOGEN ACTIVATOR RECEPTOR AND COVID-19 INFECTION IN HEMODIALYSIS PATIENTS
Authors: Griveas Ioannis , Schinas Antonis , Balitsari Anthoula , Asimakopoulos Gerasimos , Pratilas Evangelos 
Published: May 2021

Abstract

Background and Aims
Soluble urokinase plasminogen receptor (suPAR) is a protein in the blood that has been described to reflect the severity status of systemic inflammation. At the same time an elevated level of suPAR has been independently associated with incident chronic kidney disease. We investigated the association between admission suPAR levels and severity and outcome of Hemodialysis (HD) patients with Covid-19 infection.

Method
In an observational study of adult HD patients hospitalized for Covid-19, we measured suPAR levels in plasma samples. The time table for those measurements were as follows: at the beginning of admission, after hemoperfusion (HP) session for those patients that received them, and just before discharge.

Results
Of the 17 patients (7 were male), 13 patients received HP (mean age: 74 years old). The median suPAR level was 12.94 ng/ml. For those who undertook HP median suPAR level was 10.55 ng/ml at the end of each session (p=NS). 3 patients had suPAR level below 7 ng/ml. 2 of them survived without developing pleural effusions. 7 patients discharged from the hospital with median suPAR level 12.94 ng/ml which did not differ significantly from the median suPAR level of the diceased ones (13.68 ng/ml).

Conclusion
Admission of suPAR levels in HD patients hospitalized for Covid-19 do not seem to be predictive for their clinical course in general. Chronic Kidney Disease backround and its relation to suPAR levels independently of patients’ inflammation status may be the key component for our notice. Despite that, in patients where low levels of suPAR combined with absence of pleural effusions the prognosis was excellent.
MO870HYPOCHLOREMIA IS ASSOCIATED WITH A GREATER INCIDENCE OF PNEUMONIA IN CHRONIC HEMODIALYSIS PATIENTS WITH COVID-19: A CENTER'S EXPERIENCE
Authors: Valga Francisco , Monzon Tania , Vega-Diaz Nicanor , Ruiz-Santana Sergio , Diallo-Saavedra Rassoul , Aladro Sara , De la Flor Jose Carlos , Rodriguez-Perez Jose Carlos 
Published: May 2021

Abstract

Background and Aims
Recently, serum chloride has gained greater importance in the assessment of patients with heart failure and sepsis. Hypochloremia has been associated with higher mortality. On the other hand, COVID-19 pandemic continues to be, to date, a threat to public health. Patients with cardiovascular comorbidity or chronic kidney disease are particularly vulnerable. There are some studies that show a trend towards a lower serum chloride concentration in patients with a positive PCR test for SARS-CoV-2. Therefore, the objective of our study was to determine if there is a relationship between serum chloride levels at the time of diagnosis and a greater tendency to develop COVID-19 pneumonia in chronic hemodialysis patients.

Method
Retrospective cohort study. We analyzed the serum chloride, C-reactive protein (CRP), procalcitonin, neutrophil-lymphocyte (NLR) and platelet-lymphocyte (PLR) ratios of 11 chronic hemodialysis patients with a positive SARS-CoV-2 TMA PCR test during the second wave of the pandemic in our hospital (August-December 2020). We collected the length of hospital stay, the diagnosis of pneumonia (yes/no) and the final state of the infection (cure or death). The patients were divided into two groups taking the median serum chloride as the cut-off point (1: &lt;97 mEq / L and 2:&gt; 97mEq / L)

Results
The mean age was 57 ± 13 years and 36.36% (N = 4) were women. All patients required hospital admission and mean hospitalization time was 19 ± 13 days. 3 patients (27.3%) died. The medians of the parameters were the following: serum chloride 97 mEq / L (IQR 94-99); CRP 29.04 mg / L (IQR 8.53-76.13); NLR 4.13 (IQR 2.67-8.48) and PLR 244.06 (IQR 208.08-320). 81.8% (N = 9) had COVID-19 pneumonia. Group 1 patients (Chloride &lt;97 mEL / L) had a higher incidence of pneumonia (p = 0.049) (Figure 1) and a greater tendency to be admitted to the Intensive Care Unit (ICU) (p = 0.029). Despite not reaching statistical significance, there was also a higher mortality in patients with lower chloride levels.

Conclusion
Chronic hemodialysis patients with SARS-CoV-2 infection and lower serum chloride levels at hospital admission were more likely to develop pneumonia.
MO871HEPARIN INDUCED THROMBOCYTOPENIA AND HEMODIALYSIS - SINGLE CENTRE EXPERINCE
Authors: Bulatovic Ana , Maslarevic Radovic Vesna , Markovic Katarina , Bjedov Jelena , Djuric Petar , Jankovic Aleksandar , Paunovic Marina , Damjanovic Tatjana , Stankovic Popovic Verica , Naumovic Radomir , Dimkovic Nada 
Published: May 2021

Abstract

Background and Aims
Heparin-induced thrombocytopenia (HIT) is a potentially fatal adverse reaction after administration of unfractionated or fractionated heparin, which underlies the generation of antibodies to the heparin complex and platelet factor 4 (PF4). It occurs in 5% of patients treated with unfractionated heparin and 0.5 - 1.5% fractionated heparin. The aim of the study is to determine the incidence and outcome of hemodialysis patients with HIT over 4-years period.

Method
This retrospective study analyzed patients who were tested for evidence of positive anti-heparin antibody in the period from 2015 to 2020 in Zvezdara University Medical Center. The diagnosis was confirmed by the 4T clinical scoring system, a positive antiheparin-PF4 ELISA test and a positive platelet aggregation test with heparin.

Results
During observation period, total of 64 tests were performed, out of which 23 patients were positive. Out of them, 14 patients were on HD, 7 patients (geriatric, surgery and cardiology departments) received therapy due to peripheral thrombosis, AIM or arrhythmia and 2 patients during 2020 due to SARS-CoV-2 bilateral pneumonia. All patients treated at nephrology, started hemodialysis (HD) with unfractionated heparin, while others were treated with LMWH. 4T scoring showed that 64% of patients had a moderate risk of developing HIT, while high risk was assessed in 36% of patients. Thrombotic complications in the form of deep venous thrombosis had 53% of patients and pulmonary thromboembolism had 17,5 % of patients. The greatest decrease in Tr was the most commonly observed between 10th and 14th day (61% of patients) and 39% from 4th to 10th day from start of heparin administration. In addition to heparin withdrawal and treatment with alternative non-heparin anticoagulation (fondaparinoux), 7 patients needed plasma treatment. 11 patients on HD were transferred to peritoneal dialysis (PD), and 3 patients recovered renal function. Overall mortality was 52%, and it was below 30% in hemodialysis patients.

Conclusion
HIT should be considered in patients at risk. It is necessary to abolish heparin treatment and use alternative method (PD) or alternative anticoagulation. Hemodialysis patients have better prognosis than other comparable patients
MO872INFLUENCE OF SARS-COV-2 INFECTION ON MORTALITY IN PATIENTS UNDER RENAL SUBSTITUTE TREATMENT
Authors: Ferrer García Guillermo , Piccone Saponara Luis Guillermo , Sanchez Escudero Patricia , Castro Fernández Maria Paz , Uribe Heredia Nancy Giovanna , Olazo Gutierrez Eliana , Carreño Parrilla Agustín , Anaya Fernández Sara , García Conejo Gloria , Ugarte Camara Marina , Vozmediano Poyatos Carmen 
Published: May 2021

Abstract

Background and Aims
Dialysis patients constitute a risk group for coronavirus infection due to their immunosuppressed condition, with the increased risk of morbidity and mortality that this entails. We analyzed the factors associated with mortality from coronavirus infection in a cohort of patients undergoing renal replacement therapy at our center.

Method
Transversal study. We included patients in renal replacement therapy (RRT) in our center. Demographic variables (age, sex), associated comorbidity, RRT technique, clinical and laboratory parameters were collected. Statistical analysis with SPSS 25.0. Categorical variables are expressed in percentages and are compared using the Chi2 test. The quantitative variables are expressed as mean ± standard deviation and compared using Student's T-test. Statistical significance p &lt;0.05.

Results
38 patients, mean age 66 ± 18 years, 51.4% men. 92.1% had arterial hypertension, 39.5% diabetes mellitus (DM). 63.2% on hemodialysis, 2.6% peritoneal dialysis, 34.2% transplanted. 84.2% presented fever, 63.2% cough, 73.7% pneumonia, 34.2% dyspnea, 15.8% digestive symptoms. 21.1% leukopenia, 73.7% lymphopenia, money D 1509 ± 1351, CRP 12.45 ± 19.47, sodium 136 ± 5.5. 81.% were admitted to hospitalization, of which 2.6% required admission to the ICU. 44% died. Mortality was statistically significantly related to DM (56.3% vs 43.8% p = 0.05), and with the need for hospitalization (93.8 vs 6.3% p = 0.054).

Conclusion
In our experience, DM patients and those who required hospitalization had a higher risk of mortality.