bluuebunny/crossref_metadata_2025_split huggingface dataset:
#2801 Which patients may benefit most from hemodiafiltration compared with hemodialysis: prediction of the individualized treatment effect
Authors: Vernooij Robin Wm , van Kruijsdijk Rob , Blankestijn Peter J , Bots Michiel L 
Published: May 2024

Abstract

Background and Aims
Haemodiafiltration (HDF) with an appropriate dosing reduces death from any cause based on an individual participant data meta-analysis and aggregated data meta-analyses of available randomized trials. No differences in treatment effect are reported for specific patient populations when defined on a single characteristic in subgroup analyses. Yet, it is unclear to what extent individual patients, characterized by a combination of clinical characteristics, may benefit from HDF. This study aimed to develop and internally validate a treatment effect prediction model to determine which individual patients would benefit most from well dosed HDF, compared with haemodialysis (HD), in terms of survival.

Method
Individual participant data from five randomized controlled trials (CONTRAST, ESHOL, Turkish HDF study, French HDF study, CONVINCE) comparing HDF with HD on all-cause mortality were used to derive a Royston-Parmar model for exploring the prediction of absolute treatment effect of HDF based on pre-specified patient and disease characteristics, notably age, sex, body mass index, diabetes mellitus, history of cardiovascular disease, creatinine levels, and c-reactive protein levels. Internal validation of the model was performed using internal-external cross validation.

Results
Among 4153 participants, with a median follow-up of 30 months (Q1-Q3: 24-36), death from any cause occurred in 558 patients (27.2%). The median predicted survival benefit of HDF compared with HD was 6.9 (Q1–Q3: 5.6–9.0) months, with a range of 2 to 42 months. Patients who were predicted to benefit most from HDF were younger, less likely to have diabetes or a cardiovascular history and had higher serum creatinine levels. Internal-external cross validation showed adequate discrimination and calibration.

Conclusion
All-cause mortality is reduced by HDF compared with HD in ESKD patients. Yet, the absolute survival benefit seems to considerably differ between individual patients. Our results suggest that the effects of HDF on absolute survival can be predicted accurately using a combination of readily available patient and disease characteristics. This prediction model approach exemplifies the potential of prediction algorithms in supporting clinical decision-making for the choice of treatment options. Validation and potential updates to the presented algorithm are necessary, along with a preferable randomized evaluation of its clinical impact before widespread implementation.
#3099 Time dependent evolution of patient perception of care in a large dialysis population
Authors: Santos Carla , Pearce Suzanne , Lucas Carlos , Silva Eliana , Silva Israel , Haarhaus Mathias , Macário Fernando 
Published: May 2024

Abstract

Background and Aims
Patient perspectives about the level of attention provided in chronic hemodialysis (HD) are increasingly considered cornerstones in individualization of true patient-centred and high-value care. The objective of our work was to evaluate the time dependent evolution of the level of patient perception of care (PPC) in a large dialysis provider.

Method
A multicenter retrospective observational study in HD patients was conducted in 19 countries. Responses to an anonymous PPC survey were collected, in all eligible patients, in 2021, 2022 and 2023 and analyzed using Kruskal-Wallis method. PPC survey is composed of several questions covering 12 areas, considered fundamental in hemodialysis care: “Access”, “Communication”, “Fluid intake and diet”, “Information”, “Needling”, “Privacy and dignity”, “Scheduling and planning of your appointments”, “Sharing decisions about your care”, “Support”, “Tests and investigations”, “The environment” and “Transport”. The level of satisfaction about medical staff interactions and level of care before, during and after dialysis, are individually graded from 0 and 7 obtaining a final average PPC score, with a higher score representing a better perception of the level of care provided. Additionally, a Net Promoter Score (NPS) is calculated with a single-question survey and valued between −100 to +100. Results were presented as means and a p-value below 0.05 was considered statistically significant.

Results
All HD patients from 19 countries, with valid responses in the PPC surveys performed in 3 years were included. The response rate increased throughout the period of evaluation: 89.2% in 2021, 86.8% in 2022 and 93.8% in 2023. Generally, an improvement in mean PPC score was observed: 6.30 in 2021, 6.36 in 2022 and 6.43 in 2023 and NPS score also increased over time: 62% in 2021, 66% in 2022 and 68% in 2023. Along the time, the three areas with higher and lower scores were fairly stable: “Fluid intake”, “Information” and “Privacy and dignity” in the top three, and “Needling”, “Transport” and “Sharing decisions about your care” in the bottom three valued parameters. With the exception of “The environment” and “Transport”, all the scores presented an average equal or higher than 6.

Conclusion
PPC scores in our dialysis population showed a good level of perception of the level of care provided and improved throughout the 3 years of the study evaluation. Despite this, the survey consistently identified three main areas of improvement and motivated the creation and implementation of oriented programs in our population. Re-evaluation of the effect of these interventions in the next survey will be fundamental to guide further actions.
#1751 Validation of the ReDO Death Score in a Portuguese cohort
Authors: Pais Telma , Teixeira Beatriz , Carrilho Miguel , Costa Cláudia S , Branco Carolina , Da Silva Bernardo Marques , Fonseca José Agapito , Jorge Sofia , Outerelo Cristina , Resina Cristina , Lopes José António , Gameiro Joana 
Published: May 2024

Abstract

Background and Aims
Mortality within the first year after dialysis start is estimated to be 20-30%, and it is mostly due to cardiovascular disease. Prognostic assessment after starting hemodialysis is challenging. Clark et al. developed the Recovery and Death Outcome risk score, which accurately predicted the likelihood of renal recovery to dialysis independence and of death within 1 year after discharge from in-hospital dialysis initiation. These models can be used at discharge or soon after patients start outpatient dialysis. We aimed to validate the Death Outcome risk score to predict one-year mortality after dialysis start in our population.

Method
.Retrospective analysis of hospitalized patients who initiated hemodialysis in a tertiary care hospital (Unidade Local de Saúde Santa Maria), from January 1st of 2016 to December 31st of 2019, and were discharged to outpatient dialysis. The risk of death within one year of discharge was calculated according to the ReDO score. We evaluated all-cause mortality within one year of hospital discharge. We classified patients into death outcome risk groups (labeled D1 to D4) according to the ReDO predictive score. Cox regression method was used to determine if the risk score was predictive of mortality within the first year after discharge. The discriminatory ability for the ReDO score to predict mortality was determined using the receiver operating characteristic (ROC) curve.

Results
369 patients were included, with a mean age of 71.1 ± 14.3 years. The majority were male (59.9%, n = 221) and 87% were Caucasian (n = 321). The median Charlson score was 7 ± 3. The mortality rate within one year after discharge was 22.2% (n = 82). The one-year survival was significantly lower in patients with the highest probability of death (D4 = 61.3% vs. D3 = 67.6% vs. D2 = 81.3% vs. D4 = 97.3%, p &lt; 0.001). The ReDO Death score accurately predicted the one-year risk of mortality, with an area under the ROC curve of 0.741, [95% CI (0.687–0.794), p &lt; 0.001] (Fig. 1). The optimal REDO Death risk cut-off was &gt;30%, with a hazard ratio of 6.57 [95% CI (3.48–12.2), p &lt; 0.001] for one year risk of death, with a sensitivity of 78.0% and specificity of 60.6%.

Conclusion
We validated the ReDO score for 1-year mortality prediction after starting hemodialysis during hospitalization in a Portuguese population. This score can be used as a tool to inform goals of care discussion at the time of transition to out-of-hospital care, involving the in-hospital nephrology care team, the patient, and, if applicable, the future care team, as it can enlighten clinical decisions and, in some cases, lead to better end-of-life planning.
#3078 The utility and cost-effectiveness of embedding geriatric expertise in a tertiary referral renal clinic
Authors: Mooney Andrew , Relton Sam , Winterbottom Anna , Howdon Dan , Aylett Virginia 
Published: May 2024

Abstract

Background and Aims
The demographic of people receiving dialysis is changing with an increasing prevalence of frailty, co-morbidity and geriatric syndromes. To address this, we initiated routine, embedded, consultant geriatric review of a selected group of patients (frail/living with frailty syndromes, age&gt;80 preparing for dialysis, undecided between treatment options, patient/family judged by MDT to have unrealistic perception of treatment benefit) in our renal low clearance (pre-dialysis) clinic alongside our already-established palliative care service to support decision-making about treatment options for end stage kidney disease

Method
Starting in 2018, 77 patients were reviewed before suspension enforced by the Covid-19 pandemic in March 2020 and a further 56 since resumption between July 2021 and January 2023. We present the short-term results of all 133 patients immediately following geriatric review, plus long-term outcome data for the first 77 patients for whom we have 3 years’ follow up, including health economic analysis and ANOVA of frailty and treatment choice.

Results
Initially the cohort included 10 patients who had already chosen conservative management (CM) of their renal failure, but after one PDSA cycle only patients choosing dialysis or undecided about treatment choices underwent review in the service (mean age 78 [range 62-92]; 70% male).
Following geriatric review, the number of patients uncertain about their future renal treatment plan changed from 43 to 3; the number choosing to have dialysis reduced from 80 to 44 and the number choosing CM increased from 10 to 74. The number of advance care plans made among the group reviewed by the geriatrician increased from 0 to 77, and the number of DNACPR records increased from 6 to 43; there were increased referrals to falls, memory and continence clinics. Overall, 57% of patients left clinic with a different management plan.
36 months after geriatric review, the survival rate in the group choosing dialysis was 46% and in the CM group was 33%; the majority of deaths were unrelated to renal failure.
ANOVA indicated that clinical frailty scores impacted outcome more than treatment choice; health economic analysis showed the costs of providing this review (average 193 GBP per patient) were highly likely to be more than off-set by reductions in unnecessary fistula formation alone (average 288 GBP per patient)

Conclusion
Routine, protocol-supported geriatric review in a tertiary referral renal service is cost effective and associated with increased dialysis decision-making, reduced dialysis uptake, increased advance care-planning, increased CPR decision-making plus recognition and appropriate referral of geriatric syndromes. Outcomes in the group suggest little difference in survival among those choosing dialysis vs CM, and that frailty is more indicative of prognosis than treatment choice.
#1008 Prognostic impact of low skeletal muscle quality on 3-year mortality in initial-dialysis patients
Authors: Wang Yao , Yuan Li 
Published: May 2024

Abstract

Background and Aims
Myosteatosis represents the infiltration of fat into the skeletal muscle in the early stages of sarcopenia, and has been suggested to be associated with adverse outcomes in patients undergoing dialysis. Skeletal muscle density (SMD) determined by computed tomography (CT) is commonly used to assess myosteatosis, but SMD is affected by contrast resulting in inaccurate measurements. Recently, indices for muscle quality measurements determined by muscle area have been developed. Thus, We aimed to investigate the relationship between a novel muscle area index and mortality in initial-dialysis patients and analyse variables related to myosteatosis using the cutoff values.

Method
This 3-year multicentric retrospective study enrolled a total of 782 initial-dialysis patients from four centres between 2014 and 2019 in China. SMD skeletal muscular area (SMA) normal attenuation muscle area (NAMA) intermuscular adipose tissue area (IMAT) was measured and skeletal muscle index (SMI) total attenuation muscle area (TAMA) NAMA/TAMA index was calculated on CT images at the level of the first lumbar vertebra. The relationship between NAMA/TAMA index and all-cause and cardiac death outcomes was analyzed. And the sex-specific optimal cut-off values of L1-NAMA/TAMA index were determined in relation to all-cause mortality. Univariate and multivariate Cox regression models were applied to evaluate potential risk factors for death.

Results
A total of 782 patients were enrolled. The optimal cut-off values of NAMA/TAMA index were 48.76 for males and 58.02 for females. Pearson's correlation coefficient between L1-NAMA/TAMA index and L1 SMD was 0.589 (P &lt; 0.001), no significant association between L1-NAMA/TAMA index and L1 SMI was observed (P &gt; 0.05), similarly, no significant association between L1 SMD and L1 SMI (P &gt; 0.05). Multivariate regression analysis revealed that the low L1-NAMA/TAMA index group had lower risks of all-cause death (hazard ratio 0.988; 95% confidence interval 0.977–0.999, P = 0.041) and cardiac death (hazard ratio 3.74; 95% confidence interval 1.43–9.79, P = 0.007).

Conclusion
Our findings demonstrate that L1-NAMA/TAMA index acquired via CT scan is of great prognostic value on all-cause and cardiac death in patients undergoing initial-dialysis.
#659 Analysis of functional brain connectivity in patient with end-stage kidney disease undergoing peritoneal dialysis
Authors: Kim Yang Wook , Park Bong Soo , Yi Jiyae , Heo Chang Min , Park Sihyung , Lee Yoo Jin , Bae Hoyoon , Son Sung Hyun 
Published: May 2024

Abstract

Background and Aims
Neurological complications are common in patients with end-stage kidney disease (ESKD). However, the mechanisms underlying neurological complications of ESKD are poorly understood. Research on brain connectivity in patients undergoing peritoneal dialysis (PD) is limited. In this study, we aimed to examine alterations in functional brain connectivity in patients with ESKD undergoing PD compared to the control group using functional near infrared spectroscopy (fNIRS).

Method
We prospectively enrolled 20 patients with ESKD who had been receiving PD for more than 6 months and had no prior history of psychiatric or neurological diseases, along with 20 healthy controls. The fNIRS data were obtained using an NIRSIT Lite instrument. After processing all the data, we used Pearson correlation analysis to create a weighted connectivity matrix. Functional connectivity measures were derived from the connectivity matrix using graph theory. Functional connectivity measures were compared between the controls and patients with ESKD undergoing PD.

Results
The average degree, average strength, and small-worldness were significantly lower in patients with ESKD undergoing PD than in the controls (9.333 [8.000∼11.433] vs. 12.733 [9.600∼13.400], p = 0.030; 6.865 [4.768∼7.560] vs. 8.432 [6.593∼9.432], p = 0.036; 0.836 [0.724∼0.900] vs. 0.949 [0.882∼0.972], p = 0.025, respectively).

Conclusion
This study demonstrated significant alterations in functional brain connectivity in patients with ESKD undergoing PD, suggesting that functional brain connectivity is significantly reduced in patients with ESKD undergoing PD when compared with that in healthy controls.
#1298 Combination of clinical frailty score and biomarkers as mortality predictor in hemodialysis patients
Authors: Sophie Cornet , Kevin Quinonez , Xavier Warling , Jouret François , Cavalier Etienne , Delanaye Pierre 
Published: May 2024

Abstract

Background and Aims
Frailty is common among hemodialysis (HD) patients. Its assessment is usually based on clinical criteria. In the present work, we evaluated the interest of combining clinical frailty score and biomarkers to predict mortality of chronic HD patients. Three biomarkers were assessed: myostatin, insulin-like growth factor-1 (IGF-1) and dehydroepiandrosterone sulfate (DHEA-S)

Method
Prevalent HD patients were enrolled from September 2016 to October 2017 in two centers in Liège, Belgium in this observational prospective study and followed up for 5 years. Myostatin, IGF-1 and DHEA-S levels were measured at baseline. Frailty was assessed using Fried's five points frailty score (≥3 indicates frailty). The ability to predict mortality was assessed by calculating areas under the curve (AUC). AUCs were compared by Hanley & McNeil test.

Results
We included 125 HD patients with the following characteristics: median age was 67 [53; 78] years; 60% of men; 41% of diabetic and median dialysis vintage of 30 [16; 54] months. Among them, 46% were classified as “Frail” according to Fried. The median follow up was 49 [19; 60] months (Table 1). The ability (AUC) of Fried score, myostatin, IGF-1 and DHEA-S to predict mortality was significant and comparable: 0.72 (95% CI: 0.63 to 0.80), 0.72 (95% CI: 0.64 to 0.80), 0.68 (95% CI: 0.59 to 0.76) and 0.73 (95% CI: 0.64 to 0.80), respectively (Fig. 1). Combining (by logistic regression) one biomarker with Fried score improved significantly the AUC with myostatin (AUC = 0.79, 95% CI: 0.71 to 0.86, p = 0.0049), IGF-1 (AUC = 0.78, 95% CI: 0.70 to 0.85, p = 0.0099) and DHEA-S (AUC = 0.79, 95% CI: 0.71 to 0.86, p = 0.0018) compared to Fried score alone. Compared to biomarker alone, the combination also improved significantly AUC for myostatin and IGF-1 (p = 0.035 and p = 0.011 respectively) but not for DHEA-S. The combination of several biomarkers with Fried score did not significantly improve mortality prediction compared to the combination of a single biomarker with Fried score.

Conclusion
The study suggests that combining Fried frailty score with either myostatin, IGF-1 or DHEA-S concentration improves the prediction of five-year mortality in chronic HD patients.
#2701 Prevalence of chronic kidney disease associated pruritus among hemodialysis patients in Switzerland
Authors: Helou Nancy , Nobre Dina , Pruijm Menno 
Published: May 2024

Abstract

Background and Aims
Chronic Kidney Disease Associated Pruritus (CKD-aP) is a frequent symptom in patients with end-stage renal disease. The reported prevalence differs between countries and is estimated between 20-40%; data on the prevalence of CKD-aP in Switzerland are lacking. This ongoing study aims to determine the prevalence and severity of CKD-aP among patients on hemodialysis in the French-speaking part of Switzerland and to investigate its association with demographic and clinical factors.

Method
Patients aged ≥18 years, on hemodialysis for ≥6 months, and free of cognitive impairment were recruited. Clinical, laboratory and dialysis prescription characteristics were collected by an independent research nurse, who also performed CKD-aP assessment using the Visual Analog Scale (VAS, numeric score 0-10) and the Verbal Rating Scale (VRS, 0 = no itch - 4 = extremely severe itch). Multiple linear regression analysis was carried-out to investigate associations of CKD-aP with demographic and clinical factors.

Results
Preliminary data from 401 participants (mean age 69.4 years, SD 13.6; 65% men) showed a CKD-aP prevalence of 24%. Most participants with CKD-aP (69%) reported generalized itching and 35% waking-up at night because of the itching.
Mean VAS in participants with CKD-aP was 4.78 (SD 2.02) during the last 24 hours and 6.65 (SD 2.2) for the worst intensity itching during the last 24 hours. According to the VRS, most participants with CKD-aP suffered from moderate (60%) to severe itching (23%), and 72% experienced at least one severe to extremely severe episode of itching during the last 24 hours.

Conclusion
Despite high dialysis standards and easy access to medications, CKD-aP affected around 24% of patients on hemodialysis in the French-speaking part of Switzerland, and its intensity was moderate to severe. Results may help to increase clinicians’ awareness of CKD-aP, improve its regular screening, severity reporting and treatment.
#129 Impact of Ramadan fasting on bone mineral metabolism in hemodialysis: a multi-center prospective study
Authors: Elshabrawy Nehal , Elhadedy Muhammed Ahmed , Abdalbary Mohamed , Sobh Mahmoud , Tawfik Mona , Abdelsalam Mostafa , Sabry Alaa , Refaie Ayman F , Fathi Amr M , Almenshawy Ahmed , Hendawy Shimaa R , El-Husseini Amr 
Published: May 2024

Abstract

Background and Aims
Fasting is fundamental in several major religions and cultural traditions worldwide. In Islam, Ramadan fasting is characterized by daily complete eating and drinking abstinence from the dawn to sunset for an entire lunar month. Sick patients, including patients with advanced chronic kidney disease are not required to fast, however the majority of them are still choose to fast. The Impact of Ramadan fasting on bone health has not been studied prospectively. This study aims to examine the effect of Ramadan fasting on parameters of bone mineral metabolism in patients on hemodialysis.

Method
: This is a multi-center prospective study on 138 patients with ESKD who are maintained on intermittent hemodialysis for at least six months. Ninety-three (67%) were fasting while 45 patients (33%) did not fast. All patients' demographics, clinical and laboratory parameters were compared before and after the holy month of Ramadan. Serum biochemical parameters included serum sodium, potassium, bicarbonate, chloride, albumin, calcium, phosphorus, magnesium, intact parathyroid hormone (iPTH), FGF23, klotho, sclerostin, bone-specific alkaline phosphatase (BSAP), and tartrate-resistant alkaline phosphatase 5b (TRAP5b).

Results
The two groups exhibited comparable demographics and clinical parameters at baseline, except for the mean age, which was significantly lower in the fasting group (45.5 vs. 54.4 years, p-value = 0.003) and the non-smoker habit was significantly higher in the fasting group (71% vs. 56%, p-value = 0.02). There was no change in the clinical parameters by the end of Ramadan in both groups including intra-dialytic hypotension, inter-dialytic weight gain, and hypoglycemia. The basic biochemical parameters did not change significantly at the end of Ramadan in both groups, except there was an increased serum albumin level (p-value = 0.04). The BSAP levels significantly went down by the end of Ramadan in the fasting group (p-value = 0.01). The other novel serum biomarkers (FGF23, klotho, sclerostin, and TRAP5b) did not change significantly in both groups.

Conclusion
This multi-center prospective study demonstrates that Ramadan fasting does not significantly alter the clinical and biochemical parameters in hemodialysis patients, highlighting its safety in this population. Moreover, our findings reveal a noteworthy reduction of the higher BSAP towards normal levels in fasting patients, suggesting a potential benefit of fasting in improving high bone turnover. Further research is warranted to elucidate this phenomenon's underlying mechanisms and long-term implications, which may hold promise for managing bone health in hemodialysis patients during Ramadan fasting.