bluuebunny/crossref_metadata_2025_split huggingface dataset:
#2141 Lipoprotein a levels and atherosclerotic cardiovascular disease in hemodialysis patients
Authors: García de la Vega Cristina , Blanco Miguel A , Aguilar José C , Hernández Teresa , Grande Carmen , Quintanilla Nuria , Sánchez José M , Cives Alejandro , García-Bernalt Vanesa , Davín María E , Rocha André , Deira Javier 
Published: May 2024

Abstract

Background and Aims
Lipoprotein a (Lp(a)) is an LDL cholesterol-like particle to which two apolipoprotein(a) molecules are attached. Epidemiological and genetic studies strongly support a causal and continuous association between Lp(a) concentration and atherosclerotic cardiovascular (CV) disease, including aortic valve stenosis, even with low levels of low-density lipoprotein cholesterol. On the other hand, it is well known that patients on hemodialysis (HD) have high comorbidity due to cardiovascular pathology.

Method
We conducted a cross-sectional, observational, retrospective study in a cohort of patients on HD, with the aim of evaluating whether there was any correlation between Lp(a) concentration and atherosclerotic cardiovascular disease (ASCVD).
For this purpose, in December 2023 we measured Lp(a) levels (in nmol/L) in all prevalent HD patients in the province of Cáceres (Spain) and collected their major adverse coronary events (MACE): acute myocardial infarction (AMI) and angina, as well as major adverse non-coronary cardiovascular events (MANCE): cerebrovascular disease and peripheral artery disease. Aortic valve stenosis/calcification was also assessed by echocardiography. SPSS version 21 software was used for statistical analysis.

Results
A total of 214 patients were included, 68.7% male, with a mean age of 70.5 years. The mean Lp(a) value was 76.9 nmol/L, without differences in both sexes. A total of 66.4% had Lp(a) &lt; 75 nmol/L and 23.8% had levels ≥ 125 nmol/L. The main cardiovascular event was peripheral artery disease (14.9%), followed by AMI (14.1%), aortic valve stenosis (10.7%), stroke (8.4%), angina (2.8%) and transient ischemic attack (1.4%).
Some 23.4% (50 patients) had a CV event and, among them, almost half (42%) had Lp(a) levels &gt;75 nmol/L.
A statistically significant linear correlation was found between Lp(a) concentration and AMI (p 0.03) and aortic valve stenosis (p 0.001). No correlation was observed between Lp(a) and the other CV events analyzed (peripheral artery disease, stroke, angina, transient ischemic attack), nor between Lp(a) and sex.

Conclusion
There is a linear and positive correlation between Lp(a) levels and coronary pathology, and with aortic valve stenosis in HD patients in the cohort studied. Studies are needed to assess whether reducing their levels reduces cardiovascular disease in these patients.
#1857 Difelikefalin experience in a large dialysis organization in the US: one year follow-up on patients after completion of 12 weeks
Authors: Ficociello Linda , Lasky Rachel , Arens Hans-Juergen , Budden Jeffery , Ruessmann Despina , Anger Michael 
Published: May 2024

Abstract

Background and Aims
Chronic kidney disease associated pruritis (CKD-aP) is a common disorder that negatively impacts a patient's quality of life. Itch can be self-reported using the Worst Itching Intensity Numerical Rating Scale (WI-NRS) where higher numbers indicate more severe itch. Difelikefalin (DFK) has been shown to reduce itch in hemodialysis (HD) patients with moderate to severe CKD-aP in clinical trials. Previously, we reported the real-world results of patients who completed 12 weeks of DFK treatment as part of routine clinical care. This current analysis describes the long-term treatment of these 295 patients.

Method
Fresenius Kidney Care (FKC) in-center HD patients aged 18-89 who received at least 1 dose of DFK before 15 Nov 2022 and were administered a WI-NRS before first DFK administration were assessed. Patients who received 30+ DFK administrations within 74-84 days were classified as complete and are the focus of this analysis. The current analysis focuses on the 3- to 12-month follow-up after first DFK administration to monitor for DFK discontinuation and severity of itch when DKF therapy is discontinued.

Results
Eighty-one percent of patients (238/295) were administered DFK doses beyond 90 days. These patients treated included 167 patients who received DFK continuously (doses between days 91-101) and 71 who restarted DFK after day 101. Most patients (62%, 148/238) were treated with DKF between days 354 and 365 and 90 (38%, 90/238) stopped before 354 days. Out of those not treated with DFK beyond 90 days (19%, 57/295), 26 patients died or were transferred outside of FKC and 1 received a kidney transplant.
Out of the 84 patients previously reported with WI-NRS measured before DFK and during DFK WI-NRS, 29 had follow up WI-NRS scores during times without DFK doses. We observed a decrease in mean itch severity from 8.0 before DFK to 3.2 during DFK and then a return to higher itch severity after DFK was discontinued (7.3).

Conclusion
In a real-world analysis of patients who completed 12 weeks of DFK therapy, 81% of patients received further DKF administrations. Most patients were treated with DFK between days 354 and 365, although not all patients received continuous DFK therapy. In a subset 29 patients with WI-NRS scores before DFK, during DFK, and after discontinuation, improvements in itch were noted during DFK treatment and a return to severe itch after DFK discontinuation.
#267 “Surprise question”, malnutrition, frailty, and health-related quality of life in predicting mortality in a cohort of haemodialysis patients
Authors: Shoji Tetsuo , Mori Katsuhito , Nakatani Shinya , Morioka Tomoaki , Fujii Hisaka , Kimura Seiichi , Kabata Daijiro , Emoto Masanori 
Published: May 2024

Abstract

Background and Aims
“Would I be surprised if this patient died in the next year (or six months)?” This question by a medical staff is called “surprise question” (SQ) and the answer “no” (SQ-No) was shown to predict a higher risk of mortality. However, it is unknown what is intuitively assessed by this question. We examined whether SQ is assessing the patient's malnutrition, frailty, or self-perceived health-related quality of life in haemodialysis patients.

Method
We analysed data from 994 patients on maintenance haemodialysis who participated in the Osaka Dialysis Complication Study (ODCS). Attending nurses answered to SQ. Malnutrition was evaluated by Geriatric Nutritional Risk Index (GNRI). Frailty was assessed by a modified CHS criteria. Patient-perceived health-related quality of life was examined by SF36 physical component summary (PCS). The associations of these exposures with 5-year all-cause mortality (ACM) were analysed by Cox proportional hazards model.

Results
Median of age and dialysis vintage was 66 and 5.9 years, 35.8% were female, and 39.6% had diabetic kidney disease. The prevalence of SQ-No and frailty was 19.7% and 46.2%. Medians of GNRI and SF36 PCS were 96.3 and 46.2, respectively. During follow-up, 250 patients died. Each of SQ-No, a low GNRI, being frail, and a low SF36 PCS was a significant predictor of a higher risk for ACM independent of potential confounders. SQ-No remained a significant predictor after further adjustment for GNRI or frailty, but SQ-No was no longer significant when adjusted for SF36 PCS.

Conclusion
Predictive ability of SQ was closely related to SF36 PCS in haemodialysis patients. SQ by nurses appears to assess patient-perceived health-related quality of life rather than objectively assessed malnutrition or frailty.
#1587 Decreased NK cell-mediated cytotoxicity is associated with hypoalbuminemia in hemodialysis patients
Authors: Chiu Yen-Ling , Chuang Bing-Rong 
Published: May 2024

Abstract

Background and Aims
The significance of Natural Killer (NK) cells in cancer immunity and immunotherapy has garnered substantial attention. Impaired NK cell function can severely compromise the host’s immune system. End-stage kidney disease (ESKD) and hemodialysis (HD) are known among various factors contributing to NK dysfunction. Nonetheless, the precise mechanisms underpinning this phenomenon remain insufficiently elucidated.

Method
We conducted a comprehensive multivariate and comparative analysis of NK cell subtypes and surface receptors across different age and gender categories in healthy donors (HC). Furthermore, we compared these parameters in HD patients to healthy controls. Additionally, NK cell cytotoxicity between HD patients and HC is assessed. The study also examines the biochemical data in HD patients with varying levels of NK cell cytotoxicity.

Results
The analysis of NK cells in 44 HC reveals age-related increases in the proportions of total NK cells, CD56dim cells, and CD56dimCD16bright cells, accompanied by reductions in CD56bright cells and CD56dimCD16dim cells. Gender differences were not observed. Among 30 age-matched HD patients and 30 HC individuals, CD56bright cells increased, while CD56dim cells decreased in HD patients. As a result, premature aging-related NK cell phenotypes were not observed in HD patients. Nevertheless, HD patients exhibit reduced NK cell cytotoxicity across all four effectors: target ratios. Furthermore, a comparison within the HD patient group, distinguishing those with high and low cytotoxicity (7 in the former, 11 in the latter), reveals higher albumin levels in the high cytotoxicity group.

Conclusion
This study uncovers significant functional impairment in NK cell cytotoxicity between HD patients and healthy individuals. Impaired cytotoxicity among HD patients is attributable to malnutrition, possibly mediated by hypoalbuminemia. This research is the first to elucidate the connection between serum albumin levels and NK cell dysfunction in ESKD.
#1325 Patients reporting not “sleeping normally” are more likely to transition to in-center hemodialysis within 90 days of peritoneal dialysis start
Authors: Ficociello Linda , Lasky Rachel , Kraus Michael , Chatoth Dinesh 
Published: May 2024

Abstract

Background and Aims
Although there are many advantages to home dialysis therapies such as peritoneal dialysis (PD), many patients drop out of PD and transition to in-center hemodialysis (ICHD). Reasons for this transition are varied and may be multifactorial. The current analysis aims to assess whether self-reported abnormal sleep is associated with transition to ICHD within 90 days of starting automated peritoneal dialysis (APD).

Method
Patients initiating APD at any Fresenius Kidney Care dialysis clinic between 2017-2019 were eligible for inclusion in this retrospective database analysis (n = 11 668). Monthly, various health-related questions are asked to patients as part of routine care through a home therapy nursing assessment (HTNA). One question asks if the patient is “sleeping normally”. After removing patients without completed HTNA questions on sleep, there were 11 449 patients included. We assessed patients for the first 90 days of PD for transition to ICHD through survival analysis with other reasons for discontinuing PD treated as competing events.

Results
On average, patients were aged 57 (15) years with BMI of 31 (14.5) and 42% were female. Approximately 5% of patients described their sleep as not normal (553/11449) in their first HTNA. Patients who reported abnormal sleep had 4.4 times the rate of switching to ICHD when compared to patients who reported normal sleep (Hazard Ratio (HR): 4.4; 95% CI: 3.5-5.5, p &lt; 0.0001). After controlling for case mix variables, the HR was 3.7 (95% CI: 2.9-4.7, p &lt; 0.0001). Case mix variables included gender, dialysis vintage, age, race, ethnicity, body size, residual renal function, Charlson Co-morbidity Index, diabetes status, geographic region, size of PD program, insurance primary payor, relationship status, and primary language spoken.

Conclusion
Among patients dialyzing at home with APD, abnormal sleep may be a risk factor for transitioning from home therapy to ICHD. Identifying root causes of sleep disturbances may help to prevent modality change.
#2253 The gender influence on peritoneal membrane transport
Authors: Espada Paula Jara Caro , Fernandez-Vidal María , Capón Irene Martín , Gayo Lucia Rodriguez , Pérez Justo César Sandino , González-García Celia , Navarro Begoña Aguado , Herreo Inmaculada Tapia , Fernandez Julia García , Hermida Tamara Calleja , Ruiz Enrique Morales , Lozano Claudia Yuste 
Published: May 2024

Abstract

Background and Aims
The classification of peritoneal dialysis (PD) patients based on their peritoneal transport was introduced by Twardowski in 1987, analysing a cohort of 86 PD patients, where gender was not specified.

Method
Aiming to analyze gender differences in the interpretation of peritoneal transport outcomes, we completed a single-center cross-sectional study of 143 incident patients in PD between 2015 and 2022. We also, assessed differences in their follow-up outcomes until PD cessation (21.2 ± 17 months).

Results
We analyzed 143 patients (55.3 ± 15.5 years, 92% hypertension, 25.5% diabetic, Charlson index 5.9 ± 2.4 points), corresponding to 85 men (M) and 58 women (W). M were older (M 56.4 ± 15.4 years vs. W 53.7 ± 15.7 years, NS) and associated higher comorbidity (hypertension M 95.8% vs. W 86.4%, p = 0.04 and diabetes M 33.7% vs. W 13.6%, P = 0.007, NS on Charlson index) compared to W.
Creatinine transport in W is slower than in M (D/P Cr M 0.73 ± 0.1 vs W 0.69 ± 0.1, p = 0.017), but no differences in glucose transport were observed. Although most patients were classified as medium-high transporters, the percentage of M was significantly higher than W (H 71.1% vs M 52.6%). In our cohort, initial adequacy tests using incremental PD reveal that W have a higher total Kt/v (M 2.2 ± 0.5 vs W 2.8 ± 1.9, p = 0.021) attributed to a higher peritoneal Kt/v (M 0. 95 ± 0.41 vs. W 1.3 ± 1.1, p = 0.035) and renal Kt/v (NS). Despite W presented lower residual renal function (NS) and lower residual diuresis (H 1.5 ± 0.7 L vs. M 1.3 ± 0.6 L) compared with M.
There was no gender difference in average duration of PD (M 22.4 vs. W 21.5 months). However, most W ended PD to receive a kidney transplant (46.8%), while most M transitioned to haemodialysis (41.3%). Nineteen patients died during follow-up, with 68.4% being M (NS).

Conclusion
Differences in D/P Cr and normal distribution curves between M and W suggest significant differences in peritoneal membrane transport. Classical methods of assess PD quality and adequacy may need to be corrected by gender, further studies are needed to determine these differences.
#2490 Analyzing the morphology of mesothelial cells when exposed to peritoneal dialysis solutions
Authors: Masola Valentina , D'apolito Luciano , D'alessandro Angelo , Franchi Marco , Bonomini Mario , Capasso Giovambattista , Trepiccione Francesco , Onisto Maurizio , Prosdocimi Tommaso , Divino-Filho Jose Carolino , Arduini Arduino 
Published: May 2024

Abstract

Background and Aims
Glucose remains the predominant osmotic agent in peritoneal dialysis (PD), yet its prolonged use is associated with an inevitable decline in peritoneal filtration capacity. Persistent contact with glucose during dialysis can induce significant morphological and functional changes in the peritoneum. In this study, we explore the morphological alterations in mesothelial cells exposed to both conventional glucose-based PD solutions and an innovative biocompatible PD solution (XyloCore) containing L-carnitine and Xylitol.

Method
Met5A mesothelial cells were seeded and cultured on a polyester filter (with a pore size of 0.4 micrometers, Transwell, 12 well type, Millipore) utilizing a full medium. The impact of PD solutions, differentiating between glucose-based and XyloCore, was assessed on cells cultivated on transwells. These cells were exposed to PD solutions on the apical side and to culture medium on the basal side. The cells were then employed for proteomic and metabolomic assessments and were also fixed and scrutinized through scanning electron microscopy (SEM).

Results
Through unsupervised hierarchical clustering analysis, discernable proteomic distinctions emerged between wild-type (WT) cells (control) and cells exposed to either glucose-based PD solution or XyloCore. In SEM analysis, control cells exhibited a distinct flat epithelial appearance. Contrastingly, subjecting WT cells to treatment with a glucose-based PD solution induced significant alterations in cellular morphology. Notably, cells displayed elongated shapes, loosening of cell-cell contacts, and a consistent denuding of the culture surface. In contrast, XyloCore maintained a better cellular morphology and mitigated cell detachment.

Conclusion
Preserving the integrity of the mesothelial barrier is crucial for maintaining peritoneal ultrafiltration capacity. The findings suggest that glucose-based PD solutions trigger early morphological changes in cell shape and cell-cell contacts, likely stemming from alterations in cytoskeleton or adhesion molecules. The exploration of new osmotic agents in clinical practice holds paramount significance for the future of peritoneal dialysis.
#605 Shared decision-making intervention regarding dialysis modality in patients with CKD stage 5
Authors: Shin Ho Sik , Park Byung Hwa , Kil Song Yi , Kim Ye Na , Jung Yeonsoon , Rim Hark 
Published: May 2024

Abstract

Background and Aims
Patients with kidney failure must make complicated decisions about the dialysis modalities used either at home or in-hospital. Different options have varying levels of impact on patients’ physical and psychological conditions and their social life. The purpose of this study was to evaluate the implementation of an intervention designed to achieve shared decision making (SDM) in patients’ options for dialysis.

Method
SDM was performed after consent was written for stage 5 chronic kidney disease patients before dialysis, and 435 cases were performed in 408 patients from December 16, 2019 to June 30, 2021. Among these, 101 patients were compared by SDM measurement scale, patient satisfaction, disease recognition scale survey, and dialysis method.

Results
The average age of participants was 56 years, with a gender composition of 55 males (54.5%) and 46 females (45.5%). Following SDM, the final dialysis methods decided upon by patients and clinicians were peritoneal dialysis (67 patients, 66.3%), hemodialysis (22 patients, 21.8%), and kidney transplantation (1 patient, 1.0%). Looking at the items, “My doctor and I chose treatment together” (94% in the PD group, 87.5% in the HD group, P = .012) and “My doctor and I agreed on a course of treatment” (97% in the PD group, 81.3% in the HD group, P = .058), the group of patients that selected treatment with PD had a significantly higher percentage of positive answers of 4 points or higher in comparison to the group of patients that selected HD

Conclusion
Among participating patients, SDM was effective when used to decide on dialysis treatment, and patients were satisfied with the dialysis method decision process. On the disease awareness scale, those who participated in this project had relatively high positive and low negative perceptions, so it can be concluded that SDM was relatively effective. The implementation of SDM was helpful in selecting patients’ best dialysis methods, and SDM scale results were higher in the peritoneal dialysis group than in the hemodialysis group.
#2805 The effect of the COVID-19 pandemic on personal hygiene behaviours and the frequency of peritonitis in patients with peritoneal dialysis
Authors: Simsek Ezgi , Atas Dilek Barutcu , Tugcu Murat , Velioglu Arzu , Arikan Izzet Hakki , Asicioglu Ebru 
Published: May 2024

Abstract

Background and Aims
Peritonitis is the most important complication encountered in patients with Peritoneal Dialysis (PD). It is very important to follow the rules of personal hygiene to prevent peritonitis. The COVID-19 (Coronavirus Disease 2019) epidemic has led to the improvement of personal hygiene behaviours. In this study, we aimed to show the awareness created by the COVID-19 pandemic on personal hygiene behaviours in PD patients and to investigate the effect on the incidence of peritonitis.

Method
Fifty-two PD patients were included in our study. The personal hygiene behaviours of the patients were evaluated with a questionnaire consisting of 15 questions. The medical history, chronic diseases, height, weight and educational status of each patient were questioned. In addition, the averages of complete blood count and biochemical values of the patients before and after COVID-19 were noted and compared. The culture results of the patients who had peritonitis and the microorganisms grown were noted.

Results
Demographic characteristics of patients are summarized in Table 1. A significant difference was found in 11 personal hygiene behaviours, especially in the frequency of hand washing after the COVID-19 pandemic (p &lt; 0.05). After the pandemic, there was a decrease in the rates of peritonitis, but no significant difference could be reached (22 (42.9%) vs. 7 (13.5%) peritonitis rates, p &lt; 0.05). A decrease was also observed in gram (+) peritonitis case rates (Table 2). After the pandemic, the frequency of hand washing before attaching the transfer set (p = 0.014) and the frequency of daily/every other day dressing of the exit site (p = 0.026) were found to be higher in those who did not have peritonitis.

Conclusion
Due to a significant improvement in personal hygiene behaviours after the COVID-19 pandemic, a decrease in the rates of peritonitis and infection with gram (+) microorganisms was observed. In our study, it has been shown that the frequency of hand washing before attaching the transfer set and daily/every other day dressing of the exit site reduce the risk of peritonitis. Trainings for improving personal hygiene behaviours in PD patients should be expanded.
#2567 Protein-bound uremic toxins are better removed with short-daily Home Haemodialysis using low dialysate flow rate: randomized clinical trial results
Authors: Moya Mercedes González , Molina Mariola D , Castillo Belén Vizcaino , Beltrán Sandra , Quilis Aina , Peiró Julio , Pérez-Sánchez Laura , Martínez-Gómez María Amparo , Ureña Paula Gandía , Parra Manuel , Calabuig Maria Asuncion Sancho , Molina Pablo 
Published: May 2024

Abstract

Background and Aims
Short daily home hemodialysis (HDD) with low dialysate flow rate has been shown in recent years as an attractive alternative for portable dialysis home use. Although the effectiveness of the technique for volume control and elimination of small solutes and middle molecules has been demonstrated, data are scarce for the elimination of protein-bound uremic toxins. The aim of this study was to compare the reduction ratios (RRs) of p-cresol sulfate (pCS) and indoxyl sulfate (IS) in the Physidia HHD system with high-volume online-hemodiafiltration (OL-HDF) treatment.

Methods
In an open, randomized, cross-over, single-center, controlled study, 40 adult chronic HD patients were treated with a 2.5 h-length HD session with low dialysate flow rate with the Physidia HDD system, and a 4 h-length OL-HDF session in post-dilution mode during two successive weeks. During the sessions, pre-HD and post-HD plasma samples were collected and single and weekly RRs of pC and IS were intraindividually compared for the two dialysis types with linear mixed models.

Results
Whereas single-session RRs of p-CS and IS were similar in both groups, weekly RRs of both protein-bound uremic toxins were significantly higher with the short-daily HDD Physida system than those obtained with OL-HDF (Table 1).

Conclusion
The short-daily home hemodialysis using low dialysate flow rate with the Physidia system appears to be a potential technologic step ahead in terms of improved protein-bound uremic toxins removal for dialysis patients, and might contribute to a more adequate dialysis therapy than in-center high-volume online-hemodiafiltration (OL-HDF) treatment.