bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO880EFFECTIVENESS OF MEDIUM CUT-OFF VS HIGH FLUX DIALYZERS: A PROPENSITY SCORE MATCHING COHORT STUDY
Authors: Molano-Triviño Alejandra , Sanabria Mauricio , Vesga Jasmin , Buitrago Giancarlo , Sánchez Ricardo , Rivera Angela 
Published: May 2021

Abstract

Background and Aims
According to emerging evidence, medium cut-off membrane improves clearance of molecules larger than 25 kDa, including larger uremic toxins. There is growing evidence on clinical effectiveness outcomes associated with the use of these membranes.
Our aim was to evaluate clinical effectiveness of medium cut-off (HDx) versus high flux (HF-HD) dialyzers in terms of hospitalization rate and duration, cardiovascular event rate and survival in a HD prevalent cohort in Colombia through an observational, multicenter retrospective cohort analysis.

Method
Adult Prevalent HD patients (&gt; 90 days in HD) at Baxter Renal Care Services Colombia were included between September 1st, 2017 to November 30th, 2017 (follow-up until 2 years). Socio-demographic and clinical characteristics of all patients were summarized descriptively. Inverse probability of treatment weighting on the propensity score was used to balance comparison groups on indicators of baseline socio-demographic and clinical characteristics. Weighted incidence rate ratios (IRRs) and rates and duration of hospitalization and cardiovascular events according to dialyzer type were obtained using binomial negative regression with the weighting sample.

Results
We evaluated 1098 patients (37.7% women): 534 in HF-HD vs 564 in HDx (Table 1), median age was 60.6 years. Mean time on HD was 5.6 years (SD 5.51) for HF-HD and 5.88 for HDX (SD 5.48)
We observed lower hospitalization rates in HDx group, (IRR HDx/HF-HD: 0.82 95% CI 0.69 to 0.98; p=0.03); and cardiovascular events rate, (IRR HDx/HF-HD: 0.65 95% CI 0.47 to 0.91; p=0.01) see Table 2. Main cause of hospitalization was cardio-cerebrovascular (Table 3). We observed no differences in hospitalization duration or survival.

Conclusion
We evaluated 1098 patients (37.7% women): 534 in HF-HD vs 564 in HDx (Table 1), median age was 60.6 years. Mean time on HD was 5.6 years (SD 5.51) for HF-HD and 5.88 for HDX (SD 5.48)
We observed lower hospitalization rates in HDx group, (IRR HDx/HF-HD: 0.82 95% CI 0.69 to 0.98; p=0.03); and cardiovascular events rate, (IRR HDx/HF-HD: 0.65 95% CI 0.47 to 0.91; p=0.01) see Table 2. Main cause of hospitalization was cardio-cerebrovascular (Table 3). We observed no differences in hospitalization duration or survival.
MO881LUNG ULTRASONOGRAPHY AND BIOIMPEDANCE IN ASSESSMENT OF VOLUME STATUS OF HEMODIALYSIS PATIENTS: A COMPARISON BETWEEN BOTH METHODS
Authors: Figueiredo Cátia , Roldão Marisa , Valerio Alves Ana Rita , Gonçalves Hernâni , Sofia Flora , Lopes Karina 
Published: May 2021

Abstract

Background and Aims
Assessment of volume status is an important prognostic factor in hemodialysis (HD) patients. Several methods have been suggested to estimate it: bioimpedance analysis, brain natriuretic peptide levels (BNP) and lung and inferior vena cava (IVC) ultrasonography (US), which are emerging as a valuable technique in this field. Our aim was to evaluate effectiveness of lung US in assessment of volume status in chronic HD patients and compare it with the gold standard bioimpedance technique.

Method
Cross-sectional study of 58 prevalent HD patients. Several analytical data were analyzed, including BNP, albumin and sodium levels. Lung and IVC US were performed to assess the presence and distribution of B-lines and the diameter and respiratory collapsibility of IVC, respectively. Fresenius® body composition monitor (BCM) was the bioimpedance technique used. It defines hyperhydration as relative fluid overload (RFO) &gt;15%. Both US and BCM were performed at the same day, immediately before the middle week HD session. Categorical variables are presented as frequencies and percentages, continuous variables as means and standard deviations, or medians and interquartile ranges (IQR) for variables with skewed distributions. Statistical analysis was performed using SPSS® version 25 for Windows.

Results
The average age was 75.3±1.6 years and 56.9% were male. The average time in HD was 36.6±4.1 months. Half of the patients (n=29) presented B-lines in lung US. The diameter of IVC was significantly higher in this group of patients, both inhaling (1.3±0.4 vs 0.9±0.4; p=0.001) and exhaling (2.0±0.4 vs 1.6±0.5; p&lt;0.001). Similarly, most patients with B-lines at lung US presented collapsibility of IVC &lt; 50% (n=25; 89.3%).
Although not statistically significant, the RFO was higher in patients with presence of B-lines compared to those who did not present it (10.2±10.6% vs 5.4±6.9%; p=0.061). Considering the mean RFO value in patients with B-lines, we observed that its presence was significantly higher in patients with RFO &gt; 10% compared to those with RFO &lt; 10% (58.6% vs 31%; p=0.035). Besides, patients with RFO &gt; 10% also presented higher BNP (9878±34646 pg/mL vs 3945±8634 pg/mL; p=0.009) and lower albumin levels (3.4±0.5 vs 3.7±0.4; p= 0.039) than other group.

Conclusion
Lung US seems to be a valuable tool to diagnose overhydration earlier than BCM, which currently defines hyperhydration as RFO &gt;15%. In this study we verified that patients with lower levels of RFO (&gt;10%) already presented signals of fluid overload, such as presence of B-lines at lung US, higher BNP and lower albumin levels. These findings support the benefit of lung US in guiding fluid removal and may change the practice in our HD unit to probe the ideal dry weight for chronic dialysis patients.
MO883FATIGUE IS THE PREDOMINANT PATIENT-REPORTED OUTCOME MEASURE IN HEMODIALYSIS PATIENTS: RESULTS OF A MULTICENTER CROSS-SECTIONAL EPROMS STUDY
Authors: Guerraoui Abdallah , Kolko-Labadens Anne , Prezelin-Reydit Mathilde , Chauveau Philippe , Lasseur Catherine , Lino-Daniel Marie , Haesebaert Julie , Cailette-beaudoin Agnes 
Published: May 2021

Abstract

Background and Aims
End Stage renal disease (ESRD) and hemodialysis are associated with a decrease in quality of life (QOL). Self-reported QOL symptoms are not always prioritized by the medical team, potentially leading to conflicting priorities with patients. Electronic patient-reported outcome measures (ePROMs) allow physicians to better describe these symptoms. The objective was to describe the prevalence of symptoms self-reported by HD patients.

Method
A multicenter cross-sectional study was conducted in three HD centers. Patients were included if they were 18 years old or over and treated with HD for at least three months in a center. Data were collected by the patient via a self-administered ePROMs questionnaire. Data included patient characteristics, post-dialysis fatigue and intensity, recovery time after a session, perceived stress, impaired sleep the day before the dialysis session, current state of health, and the one-year change.

Results
In total, we included 173 patients with a mean age of 66.2 years, a mean ± SD hemodialysis duration of 48.9 ± 58.02 months, mainly treated in self-dialysis unit (67%) and having at least one comorbidity (72.5%). The prevalence of fatigue was 72.1% [IC 95% 64.7% to 78.7%] with a mean severity score of 5.84± 2.12. 66.4% had a high level of stress (level B or C). Recovery time was more than 6 hours for 24.9% of patients and 78 % declared they had a better or unchanged health status than the previous year. The self-perceived health status of patients was 6.2± 2.12 and 77.5% [IC 95% 70.5% to 83.5%] of patients stated that they had not a worsened health status than the year before. No statistical differences were observed between centers for the PROMS. Despite significant differences in patient characteristics from the three centers including age, comorbidities or type of dialysis, no differences were found on the prevalence of the various PROMs, in favor of internally

Conclusion
Fatigue and stress were the main symptoms reported by HD patients. There was no association between symptoms reported and comorbidities clinical results of patients. The patient’s care teams should better consider these symptoms.
MO704THE PROGNOSTIC IMPACT OF WEIGHT GAIN AFTER PERITONEAL DIALYSIS
Authors: Than Win Hlaing , Ng Jack K C , Chan Gordon C K , Fung Winston , Szeto Cheuk Chun 
Published: May 2021

Abstract

Background and Aims
The prevalence of obesity has increased over the past decade in patients with End Stage Kidney Disease (ESKD). Obesity at the initiation of peritoneal dialysis (PD) was reported to adversely affect clinical outcomes. However, there are few studies on the prognostic relevance of weight gain after PD.

Method
We reviewed the change in body weight of 954 consecutive PD patients from the initiation of dialysis to 2 years after they remained on PD. Clinical outcomes including patient survival, technique survival, and peritonitis rate in the subsequent two years were reviewed.

Results
The mean age was 60.3 ± 12.2 years; 535 patients (56.1%) were men and 504 (52.8%) had diabetes. After the first 2 years on PD, the average change in body weight was 1.2± 5.1 kg; their body weight was 63.0 ± 13.3 kg; body mass index (BMI) 24.4 ± 4.4 kg/m2. The patient survival rates in the subsequent two years were 64.9%, 75.0%, and 78.9% (log rank test, p = 0.008) for patients with weight loss ≥3 kg during the first 2 years of PD weight change between -3 and +3 kg, and weight gain ≥3 kg, respectively. The corresponding technique survival rates in the subsequent two years were 93.1%, 90.1%, 91.3%, respectively (p = 0.110), and the peritonitis rates were 0.7±1.5, 0.6±1.7, and 0.6±1.1 episodes per patient-year, respectively (p = 0.3). When the actual BMI after the first 2 years of PD was categorized into underweight, normal weight, marginal overweight, overweight, and obesity groups, the patient survival rates in the subsequent two years were 77.3%, 75.2%, 73.3%, 74.3%, and 75.9%, respectively (p= 0.005), and technique survival 98.0%, 91.9%, 88.0%, 92.8%, and 81.0%, respectively (p= 0.001). After adjusting for confounding clinical factors by multivariate Cox regression models, weight gain ≥ 3kg during the first 2 years of PD was an independent protective factor for technique failure (adjusted hazard ratio [AHR] 0.049; 95% confidence interval [CI] 0.004-0.554, p = 0.015), but was an adverse predictor of patient survival (AHR 2.338, 95%CI 1.149-4.757, p = 0.019). In contrast, weight loss ≥ 3kg during the first 2 years of PD did not predict subsequent patient or technique survival.

Conclusion
Weight gain during the first 2 years of PD confers a significant risk of subsequent mortality but appears to be associated with a lower risk of technique failure. The mechanism of this discordant risk prediction deserves further study.
MO705SLEEP DISTRUBANCES IN PATIENTS ON PERITONEAL DIALYSIS
Authors: Rihem Dahmane , Hanen Chaker , Salma Toumi , Olfa Zini , Fatma Mseddi , Khawla Kammoun , Soumaya Yaich , Mohamed Ben Hmida 
Published: May 2021

Abstract

Background and Aims
Sleep disturbances are more common in patients with chronic renal failure and on dialysis than in the general population. They affect their mental health and quality of life. The objective of this study was to evaluate the sleep disorders of patients on peritoneal dialysis (PD).

Method
We report the results of a descriptive cross-sectional study in 27 patients on PD in order to assess the quality of sleep in these patients and its relation with mental health and quality of life. Sleep quality was performed using the Pittsburgh Sleep Quality Index (PSQI) to assess origin and extent of sleep disorders. Anxiety-depressive disorders were assessed using the HAD (Hospital anxiety and depression) scale. The quality of life (QOL) measurement was performed by the SF36 and KDQoL.

Results
We included 15 men and 12 women with an average age of 45.74 years (21–77). Eleven patients were on automated peritoneal dialysis (APD) and 16 patients on continuous ambulatory peritoneal dialysis (CAPD). The mean duration of dialysis was 45.77 ± 25 months. Poor quality of sleep was reported in 14 patients. The mean PSQI was 7.22 ± 4.87. The most affected components were sleep duration and usual sleep efficiency. Depression was objectified in 22.22% of patients and 26% of patients had anxiety.
Impaired quality of sleep was associated with decreased quality of life. The components of the physical dimension of quality of life: limitation due to physical condition, physical pain were significantly lower in dialysis patients with good quality of sleep (p=0.014, p= 0.033 respectively)
The mental dimension component of QOL of SF36: relationship to others, limitation due to mental condition was also lower in patients with sleep disturbances (p=0.039, p= 0.036 respectively).
Symptoms and problems, as well as the effects and the burden of kidney disease were not associated with poor quality of sleep. Impaired sleep quality was also not significantly associated with depression or anxiety in our series.

Conclusion
Sleep disturbances are common in PD patients and are associated with decreased quality of life. Therefore, they must be taken into account in the therapeutic measures recommended in order to improve the quality of life of these patients and reduce morbidity and mortality.
MO708INCREASE IN PERITONEAL DIALYSIS-RELATED HOSPITALIZATION RATES DURING COVID-19 PANDEMIC
Authors: Calice-Siva Viviane , Ferreira Helen , Sevignani Gabriela , Vieira Marcos , Vodianitskaia Raíssa , Nerbass Fabiana 
Published: May 2021

Abstract

Background and Aims
In March 2020 to reduce the coronavirus spread in Brazil professional regulatory agencies allowed the telemedicine for distance patients’ monitoring. All peritoneal dialysis (PD) patients from our center previously followed monthly in face-to-face visits were monitored by telephone call appointments since then. In this study, we aimed to investigate and compare the hospitalization rates before and during the telehealth assistance.

Method
Patients aged 18 years and older in March 2020 were included. We analysed total hospitalization rate and PD-related hospitalization rate (infectious, mechanical dysfunction and hypervolemia) 6-month before (first phase) and 6-month after (second phase) telehealth implementation.

Results
A total of 117 patients were included (male: 45%; age: 56.9 ± 16.2 years old; PD vintage: 15 (7–26) months; automated PD: 97%; diabetes: 45%). There were 15 hospital admissions in 13 patients (2 patients were admitted twice) during the first phase, resulting in an incident rate (IR)=23 per 1000 patients-month. In the second phase, the numbers increased to 34 admissions (3 due to covid-19) in 30 patients (1 patient admitted twice and another four times), IR=56 per 1000 patients-month. The total hospitalization incident rate ratio (IRR) was 2.43 (CI 95% 1.32 – 4.48). The total PD-related hospitalization increased from 4 (3 hypervolemia, 1 mechanical) to 20 (12 infectious, 3 mechanical; 5 hypervolemia) episodes during telehealth assistance, representing 26% to 59% of total hospitalizations. IRR for PD-related hospitalization was 5.5 (CI 95% 1.8 – 16.4).

Conclusion
After telehealth implementation, the risk of hospitalization raised significantly, mainly due to PD-relates causes that increased 5.5 times. Potential causes of this finding are lack of proper training for distance monitoring to patients and health care workers, life habits and routine of care modifications and social isolation. More studies are needed to assess the independent impact of telehealth on PD patients outcomes.
MO712EVALUATION OF VOLUME OVERLOAD STATUS MARKERS IN PERITONEAL DIALYSIS PATIENTS
Authors: Carvão João , Fernandes Adriana , Veríssimo Rita , Calça Rita , Martins Ana Rita , Matias Patricia , Branco Patricia 
Published: May 2021

Abstract

Background and Aims
N-terminal fragment of B-type natriuretic peptide (NT-proBNP) can reflect changes in hydration status and may help the nephrologist to estimate it. Fluid volume overload is a major concern in dialysis patients, and it is associated with increased cardiovascular risk and death. This study evaluated the relationship between serum NT-proBNP levels and left ventricular (LV) dysfunction and extra-cellular excess water in peritoneal dialysis patients.

Method
We conducted a cross-sectional study of 60 peritoneal dialysis (PD) patients. Incident and prevalent patients were included. Echocardiography was performed using HDI 5000, allowing M-mode, two-dimensional measurement. A multifrequency bioimpedance (BIA) analyzer was used. Overhydration (OH) was defined as an extra-cellular water (ECW)/total body water (TBW) over 15%. Clinical and biochemical variables were also analysed.

Results
A total of 60 patients were evaluated (male 60% (n=36), mean age was 55,8 ± 15,3 years, BMI 25.9 ± 3.9 kg/m2 and 31.7% (n=19) had diabetes mellitus (DM). Median PD vintage was 21 months, automated PD 30%, 8.3% (n=5) were anuric and 10% (n=6) were overhydrated. The median serum NT-proBNP level was 1071 pg/mL. LV mass index and LV ejection fraction were 129.0 ± 51.1 g/m2 and 62.8 ± 13.0%, respectively. The median excess volume overload was 0.9L.
Serum NT-proBNP levels correlated positively with, diabetes (r=0.27, p=0.04), isquemic cardiopathy (r=0.37, p=0.01), LV mass index (r=0.48, p=0.001) and extracellular water (r=0.31, p=0.02) and negatively with LV ejection fraction (r= -0.81, p=0.01). In a multivariable analysis, in a model adjusted to time in DP, diabetes, residual diuresis, isquemic cardiopathy and left ventricle mass index, NT-proBNP &gt; 1600 pg/mL was associated with patient overhidratation (exp (B) 1,44, 95% CI 0,15-2.73).
No statistical difference was observed considering nutritional parameters, peritoneal transport, dialysis efficacy and NT-proBNP.

Conclusion
In this population, higher levels of NT-proBNP were associated with overhydration status and left ventricular dysfunction. Therefore, BIA and NT-proBNP may be complementary to clinical evaluation of PD patients. BIA results can be affected by malnutrition with loss of cell mass according to some studies. In our population NT-proBNP is not affected by nutritional status and therefore can also be used as a congestive marker in malnourished patients. Longitudinal application of BIA could be a useful clinical tool to evaluate adequacy in PD patients.
MO713ENCAPSULATING PERITONEAL SCLEROSIS IN KIDNEY TRANSPLANT RECIPIENTS
Authors: Ouertani Imen , Awatef Azzabi , Wissal Sahtout , Narjes Ben Aicha , Sanda Mrabet , Sabri Ferdawes , Dorsaf Zellema , Yosra Guedri , Achour Abdelatif 
Published: May 2021

Abstract

Background and Aims
Encapsulating peritoneal sclerosis (EPS) is a life-threatening complication of long-term peritoneal dialysis (PD). Causative factors are the chronic exposure to bioincompatible PD and peritonitis episodes. Pro-inflammatory state and oxidative stress associated with chronic uremia may further accelerate these pathomechanisms. Clinical symptoms are, essentially, signs of intestinal obstruction. Treatments commonly used are corticosteroids, tamoxifen, immunosuppressants like azathioprine, mycophenolate mofetil (MMF), or mTOR inhibitors which has fibrinolytic properties and may help with reducing inflammation. In the last ten years, the incidence of SEP in kidney transplant recipients has increased, but few cases have been reported. Given the rare nature of this pathology, we decided to publish the cases of two EPS happening after kidney transplantation (KT).

Case report
We report the cases of two male patients aged 46 and 25 with a history of chronic renal failure, who benefited of continuous ambulatory peritoneal dialysis (CAPD) for three years. The first patient was switched to haemodialysis (HD) for sub-dialysis, with one episode of peritonitis and one episode of catheter infection. The second patient had three episodes of peritonitis complicated by asymptomatic EPS, hence its transfer to HD. Our two patients presented, at 30 and 40 days post KT, an episode of acute intestinal obstruction with abdominal scans fitting with a mechanical bowel obstruction on an encapsulating peritonitis without signs of complication. Both patients were on corticosteroid therapy (15 and 17.5 mg/day) combined with MMF and Calcineurin inhibitors (CNIs) (Tacrolimus). Medical measures were not effecient. Surgical treatment was then considered. During the operation, a classical picture of EPS was found characterized by a thin cocoon-like sclerotic membrane encasing the small bowel. A complete resection of the encapsulating sclerotic membrane and total adhesiolysis were performed, with an immediate improvement on the clinical level. No recurrence was noted for both patients at 5 and 24 months respectively.

Conclusion
The specificities of our patients compared to the reported cases were the short duration of the PD and the relatively young age. In fact, some studies demonstrated an increased incidence of EPS in younger patients. In addition, this complication has declared itself despite corticosteroid therapy. Some case reports have demonstrated an increase in the incidence of SEP in kidney transplant patients, suggesting the possible implication of CNIs which have a profibrotic effect and may promote peritoneal matrix accumulation.
MO714MEAN PLATELET VOLUME / PLATELET COUNT RATIO IN PERITONEAL DIALYSIS: ASSOCIATION TO PERITONEAL TRANSPORT STATUS
Authors: Zeiler Matthias , Federico Antonio , Monteburini Tania , Santarelli Stefano 
Published: May 2021

Abstract

Background and Aims
Mean platelet volume volume (MPV) is gaining scientific interest with regard to cardiovascular risk stratification. The MPV/platelet count ratio seems to be more specific than mean platelet volume alone as a surrogate parameter for platelet activation. The MPV/platelet ratio might be of interest in peritoneal dialysis (PD) as the distribution and integrity of endothelial – platelet interaction in the abdominal space determines its function. The aim of the study was to evaluate the associations between MPV/platelet ratio and peritoneal transport status.

Method
In 123 PD patients (median age 65 years) MPV and platelet count were measured together with anthropometric patient data and peritoneal function at catheter placement and after 6 months during the first peritoneal equilibration test (PET). MPV and platelet count were determined with a fully-automated hematological analyzer. Correlation analysis was performed.

Results
The MPV/platelet ratio decreased significantly from 3.99% at placement to 3.50% at the first PET (median values, Wilcoxon test p&lt;0.001). Neither anthropometric data, nor creatinine clearance, nor BUN clearance, nor Kt/V (renal, peritoneal, total), nor erythrocyte sedimentation rate, nor C reactive protein were associated to MPV/platelet ratio. Only D/P urea and D/P creatinine were significantly correlated to MPV/platelet ratio (D/P urea r=0.223, p=0.01; D/P creatinine r=0.199, p=0.03). Slow transporters presented a significantly lower MPV/platelet ratio than average transporters (median values, 3.49% versus 3.83%, Mann-Whitney test p=0.03).

Conclusion
Peritoneal dialysis is reducing significantly the MPV/platelet ratio. Differences in MPV/platelet ratio are reflected in the peritoneal transport status at 6 months after dialysis start. The reduction of the MPV/platelet ratio might respect a reduced platelet and endothelial activation even in the abdominal space.