bluuebunny/crossref_metadata_2025_split huggingface dataset:
#2587 Survival and access to renal transplantation of patients with type 1 diabetes: a study from the REIN registry
Authors: Elsa Vabret , Bayat Sahar , Lassalle Mathilde , Raffray Maxime , Foucher Yohann , Vigneau Cécile 
Published: May 2024

Abstract

Background and Aims
One of the most severe complication of type 1 diabetes (D1) is renal injury which can lead to end stage renal disease. Even though improvement have been made to slow the progression of the renal disease, some of D1 patients still reach dialysis. Those patients seem to have more comorbidities and poor prognosis compare to patients without diabetes (D0) starting dialysis or patients with type 2 (D2) diabetes.

Method
The French Renal Epidemiology and Information Network (REIN) registry collects information on all patients starting dialysis in France. We used this cohort to explore survival and access to renal transplantation of D1 on dialysis patients compare to D0 and D2 patients, using Cox proportional hazard models and graphical representation of the variables to explore the pathway from type 1 diabetes to the outcomes of interest. We performed sensitivity analysis on the imputed base obtain by MICE (in order to reduce the influence of missing data) to compare HR.

Results
From January 1, 2010 to December 31,2016, 1596 D1 patients were compared to 39540 D0 patients and 28170 D2 patients. Excess in all-cause mortality rate were 1.26 [1.14-1.40] (p &lt; 0.001) for D1 versus D0 and rises to 1.45 [1.32-1.59] (p &lt; 0.001) when considering diabetes-related comorbidities on the pathway from diabetes to death. D1 had a poorer access to kidney transplantation (0.74 [0.66-0.82] p &lt; 0.001) adjusting for non-diabetes-related comorbidities. Using the survival model to compare D1 and D2 on the imputed bases, we obtained an HR: 1.11; 95% CI: 1.01-1.21 p = 0.027, in favor of a worse survival of D1 patients in dialysis compare to D2 patients

Conclusion
These results confirm that D1 patients starting dialysis are severely ill and particular care need to be given to detect and so reduce diabetes-related comorbidities and increase access to kidney transplantation.
#69 Validation of the Visayan Translation of the End Stage Renal Disease—Adherence Questionnaire (VESRD-AQ)
Authors: Canoy Julienne Marie , Torres Hariett 
Published: May 2024

Abstract

Background and aims
End-stage renal disease (ESRD) is one of the chronic diseases that rely heavily on patient's adherence to treatment. Measuring the factors related to adherence have been done but are difficult to compare due to non-uniformity of the tools used. The 46-item End-Stage Renal Disease—Adherence Questionnaire (ESRD-AQ) by Kim, et.al (2010) is a validated tool used to measure treatment adherence to the whole of ESRD management: hemodialysis, medications, fluid restrictions, and diet prescription. About 2000 ESRD patients have been registered in the Central Visayas, Philippines in 2022. The availability of a standardized and validated tool in the Visayan native language will help in assessing adherence and its related factors which can lead to interventions that could improve outcomes in ESRD patients. This study was done to translate the End-stage renal disease (ESRD-AQ) into the Visayan dialect (Visayan ESRD-AQ) and test its validity.

Method
The ESRD-AQ underwent forward translation into a Visayan version. This translation was evaluated for content validity using the Content Validity Index (CVI) rated by 5 experts, and face validity with a group of 5 ESRD patients. Blind backward translation was done and compared to the original ESRD-AQ. Construct validity was tested via a Known-Group Analysis. Test-retest reliability was done using the Intraclass Correlation Coefficient (ICC) to establish the questionnaire's stability overtime.

Results
The Visayan ESRD-AQ had adequate Content Validity Index of 1.0 which shows that each item on the questionnaire was relevant to its aim. Construct validity showed that the known adherers had higher scores than the known non-adherers. This means that the questionnaire was able to differentiate between the two groups. The responses of two patients were evaluated through the Intraclass Correlation Coefficient (ICC) and had the scores of 0.52 and 0.69, meaning that the questionnaire can be reliably used over time.

Conclusion
The Visayan ESRD-AQ is a valid and reliable tool for measuring adherence behaviors in a sample of Visayan-speaking dialysis patients as supported by the results of the Content Validity Index and known-group analysis. The can also be used reliably over time as it showed moderate test- retest reliability score. The validated VESRD-AQ may be valuable to researchers in studies of advanced chronic kidney disease. It could be used for studying adherence behaviors of ESRD patients across the Visayan region of the Philippines and the factors that contribute to adherence or non-adherence. Results of these studies can be used to improve services in dialysis units and can even be a tool in policy making with regards to hemodialysis in the Philippines. Further translations into other dialects or languages can also be done to be able to reach a broader population.
#1370 Frailty prevalence and short-term outcomes among younger end-stage renal disease patients on maintenance hemodialysis
Authors: Adelee Magboo Edna Jane , Polito Eratosthenes 
Published: May 2024

Abstract

Background and Aims
Frailty is a medical condition of reduced function and health, or a state of heightened risk for catastrophic decline in vitality and function which is evident among end-stage renal disease (ESRD) patients. There has been only limited data regarding its occurrence in the younger age group since most of the published frailty studies involved the elderly as their study population. It is important to identify who among the younger hemodialysis patients are frail, since frailty is related to a higher risk of hospitalization and mortality. This study aims to estimate the prevalence of frailty among younger ESRD patients on maintenance hemodialysis using the Edmonton Frail Scale (EFS) and its association with short-term outcomes: hospital consultations, use of emergency room services, hospitalizations, and mortality.

Method
A prospective single-center cohort study was conducted. All ESRD patients aged 18-64 years old on maintenance hemodialysis on an outpatient basis were included. Data collection included the patients’ demographic data, underlying diseases, comorbid conditions, body mass index, and recent laboratory results. The EFS was administered during the first month of the study, and patients were then monitored for consultations, use of emergency room services, hospitalizations, and mortality in the succeeding months until the end of the study period.

Results
Out of 166 ESRD patients, 94 belong to the younger age group and 87 patients were included: 33 (37.9%) were frail, 21 (24.1%) were vulnerable, and 33 (37.9%) were fit. Chronic Glomerulonephritis was the leading cause of ESRD in the younger population, and Diabetic Nephropathy was the primary cause among those categorized as frail. Hypertension was the predominant comorbid condition across all categories. Frail patients had the greatest number of hospital consultations (54%) and had frequent utilization of emergency room services. They also exhibited the highest number of hospitalizations consisting 69% of the total admissions across all categories. All deaths in this study came from the patients categorized as frail.

Conclusion
Frailty is prevalent among younger ESRD patients on maintenance hemodialysis and is associated with increased risk for hospital consultation, use of emergency room services, hospitalization, and mortality.
#2080 Prevalence and development of sarcopenia in chronic hemodialysis patients, a single center, prospective, observational study
Authors: Lys Zdenek , Balner Tomas , Kollarova Stanislava , Kupcova Monika , Valkovsky Ivo 
Published: May 2024

Abstract

Background and Aims
Sarcopenia is a progressive muscle disease (muscle failure) associated with age and various factors including chronic kidney disease that increases the risk of falls, fractures, and mortality. We aimed to analyze the prevalence of sarcopenia and other related problems, such as nutrition or physical fitness, in a group of patients in a chronic dialysis program.

Method
In our dialysis center, we conducted a prospective observational study to monitor the prevalence and development of sarcopenia. We performed repeated SARC-F (simple five-item questionnaire), grip strength, bioimpedance analysis of body composition, short physical performance battery (SPPB), muscle sonography and MNA (Mini Nutritional Assessment) in chronic hemodialysis patients. Here we report the cross-sectional results of the prevalence of probable sarcopenia (according to the recommendations, enough to trigger assessment of causes and start intervention) defined by EWGSOP2 (the European Working Group on Sarcopenia in Older People), risk of malnutrition, physical fitness, and its development in 1 year follow up.

Results
The median age in our cohort was 64 years (IQR 16.5). We examined 58 patients (36 men and 22 women) who signed informed consent in the period from 1 October 2020 to 31 January 2023. The prevalence of probable sarcopenia was 20.7%. A higher prevalence was observed in women than in men (27.3% vs 16.7%, P = 0.505), in patients ≥65 years than in the &lt;65 years (26.5% vs 8.3%, P = 0.102) and in the group of patients more than one year on dialysis compared to the group up to one year (27.8% vs 4.5%, P = 0.039). We observed reduced physical performance (SPPB test) in 20 subjects (34.5%) and risk of malnutrition according to MNA in 33 subjects (56.9%). Seven of 29 evaluated patients (24.1%) had a worsening of physical performance (SPPB) after one year. Ten out of 29 patients (34.5%) had worsened MNA scores; the prevalence of malnutrition risk in this group remained the same (51.7%). The development of other parameters did not lead to significant conclusions, given the heterogeneity of characteristics and the relatively small number of subjects.

Conclusion
Sarcopenia is a serious and potentially impactful problem. The prevalence of probable sarcopenia in our cohort was 20.7% and was higher, although not statistically significant, in women, in patients ≥65 years of age and in patients more than one year on dialysis.
#2647 Assessing atherosclerosis using epicardial adipose tissue in hemodialysis patients: a meta-analysis
Authors: Yadav Rukesh 
Published: May 2024

Abstract

Background and Aims
Hemodialysis (HD) patients had higher cardiovascular mortality due to accelerated atherosclerosis in such patients. Epicardial adipose tissue (EAT) thickness is a marker of atherosclerosis and independent predictor of coronary artery disease. The potential use of EAT as an imaging biomarker for cardiovascular disease risk stratification has attracted attention in the recent times. EAT's value in cases of HD hasn't been thoroughly analyzed, though. A meta-analysis of the literature assessing the mean differences in EAT value between HD patients and healthy controls was conducted.

Method
Pubmed, Google Scholar and Embase databases were searched from inception till 15 January 2024 for studies that measured EAT thickness of adult patients with HD and matched healthy controls. Outcomes included mean difference (MD) and 95% confidence interval (CI) of EAT thickness between the HD patients and the healthy controls. The results were combined using a fixed or random effect model as per heterogeneity among the included studies in Revman 5.4 software. The between-study heterogeneity of effect size was quantified using the Q statistic and I2. The results were represented in forest plots. Statistical significance was determined as P value of less than 0.05.

Results
Eight studies comprising 757 patients were included in this analysis. EAT thickness were significantly higher in HD patients as compared to healthy controls [MD: 1.88, Confidence Interval (CI): 0.74-3.02, I2 = 98%, P value = 0.001] (Fig. 1).

Conclusion
This meta-analysis concluded that HD patients are independently associated with higher EAT as compared to healthy controls. The utility of EAT as an imaging biomarker for predicting atherosclerosis in HD patients is promising. EAT represent readily available clinical markers useful in estimating risk of cardiovascular mortality in HD patients.
#452 Cardiac troponins are independent predictors of cardiovascular mortality in haemodialysis patients
Authors: Tyden Maria , Westerlund Magnus , Svensson Maria K , Eriksson Niclas , Soveri Inga , Girerd Nicolas , Rossignol Patrick , Zannad Faiez , Fellström Bengt 
Published: May 2024

Abstract

Background and Aims
Patients with end-stage kidney disease (ESKD) and haemodialysis treatment (HD) have a high risk of cardiovascular (CV) events. The underlying pathophysiology is complex and multifactorial. This study aimed to explore the role of high-sensitivity cardiac Troponin I (hs-cTnI) as a predictor of major adverse cardiac events (MACE), CV- and all-cause mortality.

Method
A retrospective analysis using data from the AURORA study (CT00240331). Association with baseline hs-cTnI and MACE, CV- and all-cause mortality were assessed using Cox-regression analyses. The analyses were adjusted for multiple background factors and available biomarkers. hs-cTnI was log2 transformed and modelled using a four knot restricted cubic spline. The hazard ratio [HR] estimates are presented for the upper quartile (32.6 pg/mL) vs the lower quartile (10.1 pg/mL) of the distribution of hs-cTnI. Variables were ordered by variable importance in the models using χ2 value minus degrees of freedom.

Results
During the follow-up, there were 1094 total deaths of which 598 were CV deaths, and 734 MACE in patients with hsTnI measurements available at baseline. Baseline hs-cTnI was associated with an increased risk for MACE (HR 1.92; 95% Confidence interval [CI] 1.57-2.35), CV mortality (HR 2.12; 95% CI 1.69-2.66), all-cause mortality (HR 1.84; 95% CI 1.55-2.17) and non-CV mortality (HR 1.59; 95% CI 1.23-2.05) after adjustments for age, ethnicity, sex, smoking status, diabetes status, history of coronary heart disease, atrial fibrillation, blood pressure, heart rate, height, weight, years on HD, hemoglobin, cholesterol, LDL-C, HDL-C, triglycerides, hs-CRP, creatinine, albumin, phosphate, erythropoietin treatment, ACE -inhibitor use, anticoagulation treatment, treatment with rosuvastatin, sevelamer use, iron supplements, ferritin, transferrin, galectin-3, pro-BNP, CICP and SCF. When ranking variables by variable importance, hs-cTnI was the strongest predictor for MACE (Fig. 1), CV- and all-cause mortality. For non-CV mortality age was the most important variable.

Conclusion
Baseline hs-cTnI, is a strong and independent risk marker for MACE and all-cause mortality in patients with haemodialysis treatment.
#1943 The association of uncarboxylated, non-phosphorylated Matrix Gla protein with arterial stiffness in hemodialysis and peritoneal dialysis patients
Authors: Roumeliotis Stefanos , Varouktsi Garyfallia , Tsinari Ariti , Neofytou Ioannis , Kourtidou Christodoula , Vaios Vasilios , Divanis Dimitrios , Schurgers Leon , Liakopoulos Vassilios 
Published: May 2024

Abstract

Background and Aims
Vitamin K deficiency has been identified as a marker of vascular calcification AND STIFNESS and an independent cardiovascular risk factor in hemodialysis (HD) and peritoneal dialysis (PD) patients, as the most powerful inhibitor of vascular calcification, Matrix Gla Protein requires vitamin K to become activated. However, until to date, it has not yet been clarified whether hepatic or extrahepatic markers of vitamin K status reflect the arterial status of dialysis patients. In this study we aimed to investigate the association of vitamin K deficiency with arterial stiffness in End-Stage Kidney Disease (ESKD) patients.

Method
In 42 ESKD patients undergoing either HD or PD, we measured plasma levels of the inactive vitamin-K dependent Matrix Gla Protein (dp-ucMGP) and serum levels of prothrombin (PIVKA-II) as markers of extrahepatic and hepatic insufficiency of vitamin K (CARIM Institute, Maastricht, Netherlands). In these patients we determined arterial stiffness parameters (pulse wave velocity-PWV) by the Mobil-O-Graph device (IEM, Stolberg, Germany).

Results
Serum PIVKA-II was associated with T2D duration (r = −0.38, p = 0.013), phosphorus levels (r = −0.41, p = 0.009) serum albumin (r = −0.33, p = 0.036) Spearman's rho test, and the type of transporter in PD patients (p = 0.039), Kruskal-Wallis test. Plasma dp-ucMGP was associated with PWV (r = 0.51, p = 0.001), peripheral (r = −0.37, p = 0.016) and central diastolic blood pressure (BP) (r = −0.34, p = 0.026) and age (r = 0.41, p = 0.007), Spearman's rho. Patients with T2DM, history of acute myocardial infarction and those receiving warfarin had significantly increased levels of circulating dp-ucMGP (p = 0.036, p = 0.039 and p &lt; 0.0001, respectively, Kruskal-Wallis). Warfarin was associated with a 2.5-fold and a 23-fold increase in dp-ucMGP and PIVKA-II levels, respectively. Stepwise multiple regression analysis showed that PWV (p = 0.001, B = 494, 95% CI: 242-746) was an independent predictor of dp-ucMGP, independent of age, T2T2, history of myocardial infraction and diastolic BP.

Conclusion
Elevated plasma dp-ucMGP levels (suggesting extrahepatic vitamin K deficiency) were associated with increased arterial stiffness in dialysis patients.
#2032 Heart rate-adjusted augmentation index reduces after switching low-flux dialyzers to medium cut-off dialyzers in maintenance hemodialysis patients
Authors: Korucu Berfu , Erbay Efe , Vural Akif , Caylan Saime Betul , Bildaci Yelda Deligoz , Oktan Mehmet Asi , Cavdar Caner , Deger Serpil Muge 
Published: May 2024

Abstract

Background and Aims
Arterial stiffness affects almost all maintenance hemodialysis (MHD) patients and is one of the most important predictors of cardiovascular morbidity and mortality. Medium cut-off (MCO) membrane technology provides higher clearance of large-middle uraemic toxin and cytokines compared to conventional dialyzers. In this case-control study, we investigated the change in the arterial stiffness parameters after the transition to MCO dialyzers in MHD patients receiving treatment with low-flux dialyzers.

Method
We conducted a prospective, single-center cross-over study including 19 MHD patients receiving treatment with low-flux dialyzers. Baseline and repeated parameters were measured from the brachial artery on a mid-week HD session at 0th, 120th, and 240th minutes, and the average of the three measurements were analyzed. The repeated parameters were measured two weeks after the switching to MCO dialyzers which were decided by the clinician according to clinical indication.

Results
The median age was 71 (51, 79) years, and 57.9% of the patients were female. The frequency of diabetes was 36.8%, and hypertension was 73.7%. 21.1% patients were smokers. 31.6% of the patients had a history of cardiovascular disease. Two weeks after switching to MCO dialyzers, the Kt/Vs, urea reduction ratios, laboratory parameters, systolic, diastolic, and mean arterial pressures remained similar to baseline. The mean pulse wave velocity was 10.3 m/s (8.4, 11.0) with low-flux dialyzers and 10.2 m/s (7.0, 11.5) with MCO dialyzers (p = 0.38). The mean heart rate adjusted augmentation index [AIx(75)] was 20.0% (15.0, 30.3) with low-flux dialyzers and 13.0% (11.0, 22.0) with MCO dialyzers (p = 0.04).

Conclusion
Our study showed that the rapid effect of MCO membranes is the reduction in peripheral wave reflections defined by AIx(75). Additional long-term diseases are required to determine whether MCO dialyzers might improve the cardiovascular prognosis of MHD patients.
#695 Modulation of probiotics on intestinal flora and related short-chain fatty acids in patients with peritoneal dialysis
Authors: Li Philip K T , Tian Na , Zhou Shengnan 
Published: May 2024

Abstract

Background and Aims
Probiotics may play a role in inflammation, nutritional status, kidney function and quality of life. However, few studies were performed to study the effects of probiotics on metabolites of intestinal flora in patients.

Method
We investigated the effects of Lactobacillus paracasei N1115 on intestinal flora and related short-chain fatty acids in end stage kidney disease patients on peritoneal dialysis (PD) in a single-center, prospective, randomized, double-blind, placebo-controlled study (ChiCTR-TRC2016254). Fifty one patients on peritoneal dialysis underwent an intervention with the probiotic supplement (n = 36, PR group) or placebo (n = 15, PL group) for twelve weeks. In addition to collecting fecal samples for 16S rRNA gene high-throughput sequencing and short-chain fatty acids (SCFAs) analysis, gastrointestinal symptom was also assessed at baseline and after the intervention. Moreover, PR group was divided into gastrointestinal symptom remission group (n = 30, GR group) and gastrointestinal symptom non-remission group (n = 5, GNR group).

Results
Probiotic administration caused significant changes in the composition of gut microbiota, as indicated by increased abundance of beneficial bacteria (Firmicutes), decreased Bacteroidetes, and opportunistic pathogens (Fusobacterium, Bilophila) (p &lt; 0.05). However, there was no significant difference in intestinal microbial diversity, SCFAs levels increased in PR group although the change was not statistically significant between the two groups (P &gt; 0.05). In addition, probiotic administration could effectively reduce gastrointestinal symptoms, particularly in dyspepsia and constipation (p &lt; 0.05). The contents of SCFAs was increased in GNR group (p &lt; 0.05), and there was a significant correlation between these SCFAs and the differential bacterial genera with significant changes between the GR and GNR groups (p &lt; 0.05).

Conclusion
Together, the results suggest that probiotic can promote the beneficial changes of intestinal flora in PD patients. Probiotic supplementation can improve the gastrointestinal symptoms of PD patients, possibly by affecting the composition of intestinal bacteria and their metabolites.