bluuebunny/crossref_metadata_2025_split huggingface dataset:
#782 Latent profiles of patients undergoing maintenance hemodialysis based on hemodynamic indicators
Authors: Baroz Frederic , Suri Rita , Sharma Abhinav , Tom Alexander , Beaubien-Souligny William , Brophy James , Takano Tomoko , Mavrakanas Thomas 
Published: May 2024

Abstract

Background and Aims
Both intradialytic hypotension and intradialytic hypertension are conditions occurring frequently during hemodialysis and are associated with unfavorable clinical outcomes. However, they remain incompletely understood and poorly defined in the literature. Since intradialytic parameters are now captured automatically in electronic medical records in many institutions, machine learning could emerge as an innovative tool for hemodialysis clinical research. Latent Profile Analysis is a model-based clustering method. It allows to identify hidden subpopulations derived from a set of observed indicator variables, maximizing between-group differences and within-group similarities.

Method
The objectives of this study were to identify latent profiles using a set of hand-crafted indicators and to interpret these subgroups of patients in a clinically meaningful manner. We conducted a retrospective single-center cohort study of adult patients receiving hemodialysis between January 2017 and December 2022 in Montreal. Given the highly heterogeneous nature of this population, we only enrolled incidental patients. The data were extracted from the NephroCare database, which is the clinical information system used by dialysis teams in our center. Sixteen indicators were derived from time series of blood pressure and heart rate measurements, capturing various patient-centric aspects of intradialytic hemodynamics, including trends, zeniths, nadirs, and time-related features. Latent Profile Analysis involved fitting a series of models, and the best model was selected based on fit indices, evaluation metrics, and clinical interpretation of the distribution of indicator within identified profiles. The primary analysis used complete-case data, and a sensitivity analysis assessed the impact of missing data through multiple imputation. Internal model validation was conducted using k-fold cross-validation.

Results
The selected model consisted of four profiles with varying variance and null covariance across indicators. Fig. 1 presents radar plots summarizing the identified profiles. Profile 1 included patients with prolonged early nadirs and a nadir-to-zenith transition pattern at the session level. Profile 2 was characterized by frequent nadirs and zeniths without a specific timing preference. Profile 3 comprised patients with infrequent blood pressure variations altogether. Profile 4 included patients with frequent early nadirs but no zeniths. The model demonstrated good generalization to unseen cases and exhibited relative robustness to missing data.

Conclusion
In this preliminary study, we demonstrated that Latent Profile Analysis can identify clinically meaningful subpopulations of hemodialysis patients based on hemodynamic indicators. The association between the identified profiles and hard clinical endpoints remains to be established.
#2470 Isolated diastolic hypertension in hemodialysis patients
Authors: Torino Claudia , Mallamaci Francesca , Sarafidis Pantelis , Ekart Robert , Balafa Olga , Del Giudice Antonio , Aucella Filippo , Morosetti Massimo , Tripepi Rocco , Marino Carmela , Tripepi Giovanni Luigi , Zoccali Carmine 
Published: May 2024

Abstract

Background and Aims
Isolated diastolic hypertension (IDH) is relatively rare in the general population (prevalence about 6.5%, Front Cardiovasc Med. 2021;8:810105) and of uncertain etiologic implications. The prevalence of this alteration in the hemodialysis (HD) population and the etiologic implications of IDH have not been studied.

Method
We investigated the prevalence and the risk for all-cause death and cardiovascular events of isolated diastolic hypertension in a population of 534 HD patients enrolled in 7 centres in 3 European countries (the EURECA-m working group). BP was measured by a golden standard method in this population (48 h ABPM) using well-validated instruments (AAMI/ESH/ISO). Along with recommendations by the European Society of Hypertension guidelines, recordings were made at 15-minute intervals during the day and 30 minutes at night. According to a consensus document by the EURECAm working group (Nephrol Dial Transplant. 2019;34:1542-1548), isolated diastolic hypertension was defined as 48 h diastolic BP &gt; 80 mmHg with a systolic BP &lt;130.

Results
Among 534 HD patients, thirty-one (5.8%) had isolated diastolic HTN, which is very close to the prevalence estimated in the general population (6.5%). During a mean follow-up of 2.6 years, 138 patients died, 188 had at least one CV event, and 249 experienced the combined event. In univariate analyses, diastolic hypertension was associated with death (HR 0.21; 95% CI: 0.05-0.86, P = 0.03) and the combined outcome of death and CV events (HR 0.42, 95% CI: 0.20-0.88, P = 0.02). However, these associations were no longer significant after adjustment for age and sex (all P &gt; 0.45). Additional sensitivity analyses substantially confirmed these findings. No effect modification by age or gender was observed in these associations.

Conclusion
In a large cohort of HD patients studied by state-of-the-art 48-hour BP monitoring, the prevalence of isolated diastolic hypertension in HD patients (5.8%) is close to that registered in the general population (6.5%). This alteration predicts the risk for clinical outcomes in unadjusted analyses but not after adjustment for age and sex. Isolated diastolic hypertension is as rare as it is in the general population and unlikely to contribute to the high risk of adverse clinical outcomes in the dialysis population.
#608 Effects of shared decision-making on the prognosis of peritoneal dialysis patients
Authors: Shin Ho Sik , Kil Song Yi , Park Byung Hwa , Kim Ye Na , Jung Yeonsoon , Rim Hark 
Published: May 2024

Abstract

Background and Aims
Patients with chronic kidney disease (CKD) require shared decision-making (SDM) processes when choosing a dialysis method. Peritoneal dialysis (PD) guarantees patient autonomy; thus, SDM is even more important. Based on these findings, we aim to highlight the benefits of PD and increase the rate in which patients choose PD. In order to increase the rate of PD implementation, patients must actively participate in dialysis decisions, and SDM process is necessary between doctors and patients. So, we investigated the effect of SDM on the prognosis of patients with CKD. We focused on the effects of SDM on patient death, survival rates, hemodialysis conversion, emergency room visits, hospitalization days, and outpatient visits. The results of this study suggest that SDM has a positive impact on increasing the number of patients who choose PD and reduce unnecessary medical cost.

Method
Among patients with chronic kidney failure from eight hospitals in Korea who started dialysis, 256 who participated in a pilot project for home management of PD were included in the present study. A mixed-methods study was conducted using questionnaires and semi-structured interviews. Our study focused on the effects of SDM on patient death, survival rate, hemodialysis conversion, emergency room visits, hospitalization days, and outpatient visits.

Results
A significant difference was observed in the number of days of hospitalization per admission (p = 0.0044) between the SDM and non-SDM groups. However, no significant differences were observed in survival rate, rate of conversion to hemodialysis (HD), survival rate after conversion to HD, emergency room visit rate, number of hospitalizations per patient, outpatient visit rate, medical cost, hospitalization cost, outpatient cost, and phosphate-binding agent prescription rate.

Conclusion
The number of hospitalization days per admission decreased throughout the SDM process. Continued communication between patients and medical staff on how to manage PD in the long term after making the decision to undergo dialysis will be beneficial in promoting the home management of PD patients.
#2967 C-reactive protein/serum chloride ratio: a novel marker of all-cause mortality in prevalent chronic haemodialysis patients
Authors: Amado Ernesto Francisco Valga , Monzon Tania , Santana Angelo , Santana Ana Yurena Sánchez , Anton-Perez Gloria , Vega Nicanor , Ruiz-Santana Sergio , Rodriguez-Perez Jose Carlos , Perez Patricia 
Published: May 2024

Abstract

Background and Aims
Serum chloride (Cl-) is an emerging marker of mortality in hypertension, sepsis, heart failure and chronic kidney disease. The pathophysiological mechanism is unclear, but haemodynamic and inflammatory factors have been suggested. As C-reactive protein (CRP) is an established marker of inflammation and prognosis in haemodialysis patients, we sought to determine whether there is an association between the CRP/Cl- ratio and prognosis in these patients.

Method
Retrospective cohort study. We included n = 281 prevalent patients in our chronic haemodialysis programme between 19 January 2022 and 11 August 2022. The mean follow-up was 10 months. The sample was divided into quartiles according to CPR/Cl— ratio values. Baseline demographic, analytical and bioimpedance data were collected (Table 1). Survival time was recorded in all patients and analysed using the Kaplan-Meier method.

Results
The median CPR/Cl— ratio was 0.04 mg/mEq (0.02; 0.12). Women accounted for 31.8%. 28.9% had underlying diabetic nephropathy. Overall survival at 10 months was 87.9%. Patients who died had a higher CPR/Cl— value [0.12 (0.04; 0.19)] vs [0.04 (0.02; 0.10)] (p = 0.0005). In addition, those in the fourth quartile had a lower probability of survival compared to the other quartiles (p = 0.0011, log-rank test) (Fig. 1).

Conclusion
Higher values of the CPR/Cl index were associated with higher all-cause mortality in our sample of prevalent haemodialysis patients.
#653 Changes in iron markers and D-dimer levels during enarodustat treatment depends on different iron prescription patterns in hemodialysis patients
Authors: Hamano Takayuki , Teruya Keita , Maruyama Aya , Mitobe B S Yuko 
Published: May 2024

Abstract

Background and Aims
Iron preparations are commonly administered with erythropoiesis-stimulating agents or hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PH inhibitors) in hemodialysis patients to promote hematopoiesis and prevent iron deficiency. A recent study highlighted the causal relationship between thrombosis and upregulated serum transferrin levels due to iron deficiency. Additionally, rapid increase of hemoglobin (Hb) during HIF-PH inhibitor use is also considered a risk factor for the development of thromboembolism. Therefore, monitoring iron parameters and Hb is essential for managing anemia and thrombosis risk. We investigated the impact of practice patterns of iron supplementation on iron metabolism in patients receiving a HIF-PH inhibitor enarodustat. Changes in D-dimer levels, a thrombosis-related factor, were also assessed.

Method
We performed a post-hoc analysis using pooled data from two phase 3 clinical studies of enarodustat in Japanese maintenance hemodialysis patients, SYMPHONY HD and SYMPHONY HD-Long studies. We divided the subjects into three groups according to practice patterns of iron administration: subjects who did not receive iron at all during the enarodustat administration period (Non-Iron Group), subjects who received intravenous iron at least once (IV Iron Group), and subjects who continuously received oral iron-containing preparations including ferric citrate (Oral Iron Group). The time courses of transferrin saturation (TSAT), serum ferritin, and D-dimer levels were compared across these three groups using mixed effects models for repeated measures (MMRM) (with an unstructured covariance structure for the dependent variables).

Results
The Non-Iron Group, IV Iron Group, and Oral Iron Group consisted of 60, 69, and 73 cases, respectively. Figures show the time courses of TSAT, serum ferritin levels, and changes in D-dimer levels for each practice pattern. MMRM analysis revealed that TSAT levels in the Non-Iron Group and IV Iron Group during the enarodustat administration period were significantly lower than those in the Oral Iron Group (p &lt; 0.01 and p &lt; 0.01, respectively). Similar results were observed for serum ferritin levels (p &lt; 0.01 and p &lt; 0.01, respectively). Moreover, the rate of D-dimer increase in the Non-Iron Group was significantly higher than in the Oral Iron Group (p = 0.029). There was a trend toward a higher rate of D-dimer increase in IV Iron Groups compared to the Oral Iron Group (p = 0.11).

Conclusion
These findings suggest the superiority of continuous oral iron supplementation over intermittent IV iron supplementation or no iron supplementation during HIF-PH inhibitor administration in terms of preventing thrombosis through maintaining TSAT levels. The association between iron-related parameters and the occurrence of thrombosis needs to be analyzed.
#1426 Association of intradialytic hypertension and mortality in a cohort of Spanish population
Authors: Mora-Macià Josep , Bello Abraham Rincon , Toro Diana Jc Samaniego , García Macarena Navarro , Ortego Sofia , Pérez Alicia Sobrino , Esquivel Jorge Camilo Morente , García Ramón Polanco , Alvarado Jose Berlanga , Such Ramon Devesa , Salvador Maria Eva Baró 
Published: May 2024

Abstract

Background and Aims
Intradialytic hypertension (IH) has been identified as an independent mortality risk factor in hemodialysis (HD) patients. The are a lack of a standardized definition of (IH).
Recently, a definition of IH ≥30% of baseline sessions with an increase in pre-to post-HD systolic blood pressure (SBP) of ≥10 mmHg had the highest adjusted risk of mortality, compared with other threshold-based definitions (Singh AT, et al. Hypertension 2022;79:855–62) in American population.
The aim of these study is to evaluate this definition of IH in our Spanish population.

Method
We conduct a retrospective multicenter non-interventional study in a Spanish cohort of patients receiving HD (3 sessions PER week) between 1-July 2021 and 30-June 2023 in Fresenius Medical Care Spain. Pre-post-HD SBP, HD parameters and blood test data were averaged over the 90-day exposure period from 1-April-2021 to 30-Jun- 2021. Cox models were fit to examine the association of ID ≥10 mmHg with all-cause mortality in the univariate and multivariate model adjusted for potential confounding variables.

Results
3221 patients met the inclusion criteria, 59.6% men, median age 74 years. The mean of SBP pre HD systolic during the exposure period was 140.6 ± 21 mmHg. The mean follow-up was 22 months. 1620 (50.3%) met the definition of IH,379 (22.4%) of patients with IH died during the follow-up period, compared with 302 of 1587 (19%) individuals who did not meet criteria for IH. In the cox multivariate model, patients with IH, had a significant association with mortality HR: 1.19 [1.01-1.41]) p &lt; 0.05 in a model adjusted for age, Charlson Index, weight loss, vintage, ultrafiltration, vascular access, OL-HDF and malnutrition, among others (Table 1).

Conclusion
Patients with IH (defined as ≥30% of baseline sessions with an increase in pre-to post-HD systolic blood pressure of ≥10 mmHg) have been associated with all-cause mortality (HR 1.19 [1.01-1.41]) in Spanish HD population, similar to previous studies in the American population.
#233 Marine n-3 polyunsaturated fatty acids and cardiovascular events in patients with end-stage renal disease receiving hemodialysis
Authors: Liboriussen Caroline Hundborg , Nygaard Louis , Jensen Jens Dam , Schmidt Erik Berg , Glerup Rie , Svensson My 
Published: May 2024

Abstract

Background and Aims
Cardiovascular (CV) disease is the leading cause of death in patients with end-stage renal disease (ESRD) receiving hemodialysis (HD). The two major marine n-3 polyunsaturated fatty acids (n-3 PUFAs) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) may have cardioprotective effects. This study aimed to investigate the predictive value of plasma n-3 PUFAs on CV events and all-cause mortality in patients with ESRD receiving HD.

Method
A validated prospective multicenter cohort study of 336 patients with ESRD receiving HD with 5 years of follow-up was conducted. Blood samples were collected at baseline and analyzed for the plasma levels of EPA and DHA expressed as a weight percentage (wt%) of total plasma fatty acids. The primary outcome was CV events defined as acute myocardial infarction, unstable angina pectoris, stroke, transient ischemic attack, peripheral artery disease (PAD), or cardiovascular mortality. The secondary outcomes were all-cause mortality and each individual component of CV events. The sum of EPA and DHA (EPA+DHA) was used in all analyses and expressed as n-3 PUFAs in wt%. The population was divided into three groups according to n-3 PUFA tertiles. Kaplan-Meier curves and multivariable Cox regressions adjusted for relevant confounders were used to analyze the association between plasma n-3 PUFA levels and study outcomes.

Results
Median follow-up time was 5.05 years (IQR, 5.02-5.07). Mean age was 65 ± 15 years and plasma n-3 PUFA levels ranged from 2.1 to 16.8 wt%, with a median of 5.7 wt% (IQR, 4.72-6.96 wt%). During follow-up 60% of the cohort died, 17% died of CV disease, and 42% had a CV event. Figure 1 shows the unadjusted associations between the plasma n-3 PUFA tertiles and the risk of CV events. A n-3 PUFA level between 5.06-6.52 wt% was associated with a 36% lower risk of CV events [unadjusted HR 0.64 (95% CI 0.43-0.96)]. Additionally, a n-3 PUFA level above 6.52 wt% was associated with a 34% lower risk of CV events [unadjusted HR 0.66 (95% CI 0.44-0.98)], both in comparison to levels below 5.06 wt%. After adjusting for relevant confounders, as shown in Figure 2, n-3 PUFA levels between 5.06 to 6.52 wt% were associated with a significantly lower risk of CV events [adjusted HR 0.60 (95% CI 0.40-0.92)], PAD [adjusted HR 0.44 (95% CI 0.22-0.88)], and all-cause mortality [adjusted HR 0.61 (95% CI 0.42-0.86)], when compared to levels below 5.06 wt%.

Conclusion
In this study of patients with ESRD receiving HD, a low plasma level of n-3 PUFA was associated with a higher risk of CV events, peripheral artery disease, and all-cause mortality.
#2652 Hemoglobin excursion outside of the target range and their associations with all-cause mortality in hemodialysis patients
Authors: Mermelstein Ariella , Kovacevic Tomislav , Hymes Jeffrey , Kotanko Peter , Raimann Jochen 
Published: May 2024

Abstract

Background and Aims
Based on earlier analyses (Mermelstein et al., ASN Renal Week 2023), where we found an improved survival with hemoglobin levels above the currently targeted range of 10 to 11 g/dL quantified as an area under the excursion curve, we hypothesized an independent association between all-cause mortality hazard ratio and a) the number of excursions, and b) the number of days outside of the target range.

Method
We explored this relationship in a retrospective cohort study of incident hemodialysis patients receiving erythropoietin stimulating agent (ESA) commencing treatment Fresenius Kidney Care clinics in the US. We included patients who were given a long-acting erythropoietin stimulating agent within 90 days of dialysis initiation, considered the first six months as baseline and the following 18 months as the follow-up period. Only patients with at least 5 hemoglobin values over the first 75 days were included. We calculated the ‘area under the curve’ (AUC) above and below the target hemoglobin range of 10-11 g/dL for each patient during the baseline period, as well as days below and above range, and number of excursions below and above range. Cox proportional hazard models additionally adjusted for age, race, sex, diabetes, serum albumin, and phosphate were developed, and the hazard ratio estimates depicted in a forest plot.

Results
We studied 62,181 patients (57% male, 39% diabetic, mean baseline hgb 10.42 ± 0.72 g/dL, baseline AUC above target 44.36 ± 49.44 g/dL * days and 78.06 ± 86.26 g/dL * days below target). Forest plot of the HR estimates showed an increased risk of death with AUC below the lower limit of the target range (i.e. 10 g/dL), which also held true both for number of excursions and days exposed to lower hgb levels). Conversely, AUC, conversions and days spent at hgb levels higher than the upper limit of the target range (i.e. 11 g/dL), associated with a significant survival advantage.

Conclusion
In an effort to validate the robustness of our previously shown association between higher hgb levels and survival advantage, and to corroborate the accuracy of the utilized AUC quantification method, we separated both components of the AUC, namely into time and magnitude and quantified the independent associations with the risk of death. This allowed to discern between the associations of both to the risk of death. Consistent with the earlier results, avoiding levels below 10 g/dL and aiming for levels above the upper limit of 11 g/dL, seems to be beneficial for the anemia management of incident hemodialysis patients treated with a long-acting ESA.
#849 Association between types of phosphate binders and fragility fractures in patients on hemodialysis
Authors: Fujii Takayuki , Yamauchi Nobuaki , Matsunaga Takahiro , Koshizaka Junya , Morimoto Mayu , Terasaki Noriko , Tanaka Hiroaki , Suzuki Satoshi 
Published: May 2024

Abstract

Background and Aims
Fractures that affect life expectancy and quality of life are an important outcome in patients undergoing hemodialysis. In older patients on dialysis, osteoporosis is particularly associated with fractures. Therefore, management of calcium, parathyroid hormone and phosphorus is essential to promote bone health. However, no effective treatment against osteoporosis has been established in patients with advanced chronic kidney disease Some reports have suggested that the use of calcium-based phosphate binder was favorable in bone metabolism; however, its effect on fragile fractures remains unclear. In this study, we aimed to investigate the relationship between the use of Ca-containing phosphate binders (CPB) or non-Ca-containing phosphate binders (NCPB) and fractures in patients on hemodialysis.

Method
A retrospective cohort study was conducted including 556 patients who started hemodialysis at our hospital between March 2004 and March 2023, and could be followed up for at least 3 months. To assess the association of the use of phosphate binders CPB or NCPB with fragile fractures, a multivariate analysis was performed using the Cox proportional hazard model with factors related to fractures as covariates.

Results
The mean age of the patients was 66 years, with women accounting for 28%. For up to 3 years from hemodialysis initiation, CPB, NCPB, vitamin D receptor activators (VDRA), and calcimimetics were prescribed in 35%, 52%, 72%, and 18% of patients, respectively. Of the 556 patients, 72 developed fragile fractures. A univariate analysis of factors associated with fractures revealed that the hazard ratio (HR) for fragile fractures was 0.39 [0.22-0.64] in CBP users and 0.81 [0.31-0.81] in NCPB users and both were statistically significant fracture suppressors. Multivariate analysis adjusted for significant factors in univariate analysis (age; history of fractures; BMI; levels of serum phosphorus, C-reactive protein, serum magnesium, and hemoglobin; and use or non-use of VDRA) as the covariates, demonstrated that the use of CPB and NCPB was not significantly associated with fractures (HR: 0.58 [0.31–1.05], HR: 0.58 [0.33–1.03]). However, the use of any phosphate binders was a significant fracture preventive factor with an HR of 0.43 [0.24-0.77].

Conclusion
Regarding fragile fractures in patients on hemodialysis, no superiority was observed among CPB and NCPB; however, the use of either phosphate binders could reduce the risk of fragility fracture occurrence.