bluuebunny/crossref_metadata_2025_split huggingface dataset:
#2916 Interdialytic weight gain and low-salt diet in patients on chronic hemodialysis: a systematic review and meta-analysis
Authors: Mariani Ilaria , Bossola Maurizio , DI Stasio Enrico 
Published: May 2024

Abstract

Background and Aims
Interdialytic weight gain (IDWG) is one of the most important indicators of the patient status in chronic hemodialysis: it is correlated with fluid and/or food intake and it is assessed at the beginning of the dialysis session being an easily measurable parameter. High IDWG is associated with risk of all-causes mortality and hospitalization; furthermore, high IDWG leads to supplementary dialysis sessions with consequent reduction of the quality of life and increase of the costs. Numerous barriers have been shown to determine failure to adherence to diet and fluid restrictions such as lack of self-assessment. The present systematic review and meta-analysis tries to determine the differences in the IDGW between low salt diet and normal/high salt diet, and between nutritional counseling aimed at reducing salt intake and no nutritional counseling in patients on chronic hemodialysis.

Method
Medline, PubMed, Web of Science, and the Cochrane Library were searched for studies comparing subjects who experienced educational or psychological interventions to untreated control patients. Outcome of interest was IDWG.

Results
Eight articles (783 patients) were fully assessed for eligibility and included in the investigation. The meta-analysis showed patients that after dialysis increased their weight more than 2.5 Kg over total enrolled subjects for each group (control and experimental). As no significant heterogeneity was observed (I2 =8%; p=0.36), the pooled analysis was performed using a fixed-effect model. Funnel plot was generated and no obvious asymmetry was observed, which indicates no clear evidence of publication bias. The Overall Odds Ratio to get an event in the experimental group, in respect to controls, is 0.57 (0.33-0.97) (p=0.04] with single studies OR ranging between 0.11 to 1.08, the last derived by a peculiar result reported in the Sevick's manuscript referring an identical IDGW of 1.1 Kg for both groups and an extremely narrow IQ range (1.0-1.2); therefore, in this case, the estimated number of events (patients with IDGW &gt; 2.5 Kg) was rounded up to 1.

Conclusion
The present systematic review and meta-analysis suggest that the use of a low salt diet and/or a nutritional counseling aimed at reducing salt intake are associated with a statistically significant reduction of the IDWG in patients on chronic hemodialysis.
#705 Survival of expanded hemodialysis and high-flux hemodialysis patients in Colombia: a cohort's study
Authors: Castillo Juan Carlos Mario , Sanabria Mauricio , Vesga Jasmin , Aldana Andrea , Sánchez Ricardo , Buitrago Giancarlo , Oliveros Henry , Rivera Angela , Rutherford Peter 
Published: May 2024

Abstract

Background and Aims
Survival is a core outcome of hemodialysis (HD) therapy. Progressive improvement in the permeability and biocompatibility of membranes for HD, dialysis techniques and clinical processes around these therapies have been developed. Recently, expanded hemodialysis (HDx) enabled by the medium cut-off membrane Theranova® has demonstrated encouraging efficacy outcomes in terms of better clearance of medium molecules and better outcomes reported by patients when compared to high-flux hemodialysis membranes (HF HD). The objective of the present study is to compare survival in an HDx cohort versus an HF HD cohort at a 48-month follow-up.

Method
Cohort study, one group with expanded haemodialysis (HDx) enabled by Theranova® and the other with HF HD, adult prevalent HD patients (&gt; 90 days) at Baxter Renal Care Services Colombia starting between September 1, 2017, and November 30, 2017, with follow-up for up to 48 months. The sociodemographic and clinical characteristics of all patients were summarized descriptively. A Fine-Gray regression model was performed to evaluate the factors associated with time to death from causes other than COVID-19, death attributable to COVID-19 cause is a competing risk. A sensitivity analysis was performed using different statistical methods, such as extended Cox regression and Cox regression, after adjusting for imbalance between the cohorts with the inverse probability of treatment weighting (IPTW) method.

Results
We evaluated 1092 patients, 533 in HF-HD vs 559 in HDx; the mean age 61 years; 42% had diabetes, and 19% had cardiovascular disease. All patients' sociodemographic and clinical characteristics are summarized descriptively by cohort arm (Table 1).
A multivariate analysis was performed to evaluate the effect of demographic, clinical, and laboratory variables on the risk of death, adjusting for the competing risk of death from COVID-19 during four years of follow-up. Our results indicate that the Theranova dialyzer has a protective effect on mortality risk when controlling for confounding variables SHR = 0.75 [95% CI: 0.58 to 0.95, p-value = 0.019] (Table 2). The different sensitivity analyses report a statistically significant beneficial effect of Theranova versus HF dialyzer. See Table 3. Fig. 1 shows a difference in the survival functions according to the type of dialyzer.

Conclusion
HDx enabled by Theranova dialyzer was associated with an approximately 25% reduction in mortality risk compared to HF HD patients followed for up to 4 years; this effect was consistently observed using different survival analysis methods.
#1906 Lung ultrasound as a valid tool for fluid assessment in dialysis patients: a systematic review
Authors: Petersen Nanna Aagaard , Falster Casper , Schultz Anders Ørsted , Kampmann Jan 
Published: May 2024

Abstract

Background and Aims
The evaluation of hydration status in dialysis patients is a crucial aspect of their care. Focused lung ultrasound has garnered attention as a cost-effective and accessible tool for assessing hydration status, particularly through the detection of B-lines. Despite its potential, there is a lack of comprehensive systematic reviews addressing the clinical utility of lung ultrasound in fluid assessment for dialysis patients.

Method
A systematic search was conducted on PubMed, MEDLINE, EMBASE, Cochrane, and Web of Science. Two independent reviewers screened titles, abstracts, and full texts, with a third reviewer consulted in cases of discrepancy. Inclusion criteria encompassed papers utilizing lung ultrasound to evaluate fluid status in dialysis patients. Exclusion criteria were: abstracts or posters and papers not investigating at least one of the following endpoints: B-type natriuretic peptide, cardiovascular events, inferior vena cava, preload, NYHA classification, ultrafiltration/weight reduction, blood pressure, total body water/bioimpedance, hospitalization, mortality, and clinical evaluations. A modified QUADAS2-score was employed for assessment of risk of bias and applicability by two independent investigators. The protocol was registered at Prospero (CRD42022334147).

Results
A total of 2543 papers were identified of which 156 underwent full-text screening. Of these, 49 papers were included in the review, comprising seven randomised controlled trials and 41 observational studies. The most common study aim was impact assessment of ultrafiltration on the quantity of B-lines. However, numerous studies investigated the correlation between lung ultrasound and various endpoints such as bioimpedance, chest x-ray, and clinical examination.
Overall, the included papers were characterized by noteworthy heterogeneity in terms of ultrasound protocol, encompassing differences in number of scanning zone (8-28), B-lines cut-off points, and definitions of endpoint. The QUADAS assessment revealed risk of bias in the included studies, most commonly related to a lack of blinding and, consequently, an impact on the interpretation of index test results. Only n=24 studies (49%) scored “low” risk of bias. Regarding patient selection, the numbers were even lower with only n=17 studies (34%) scoring “low” on risk of bias.

Conclusion
The collective evidence on clinical utility of lung ultrasound for fluid assessment of dialysis patients is characterised by notable heterogeneity and risk of bias, precluding meta-analysis. Well-designed large scale studies are still warranted to determine the optimal ultrasound protocol.
Future studies should establish guidelines for scanned zones and consensus cut-offs to enhance homogeneity.
#1573 Effects of haemodialysis coupled with hemadsorption on uremic toxins removal, oxidative stress and cellular death.
Authors: Marcello Matteo , Virzi Grazia Maria , Cantaluppi Vincenzo , Marengo Marita , Brendolan Alessandra , Ronco Claudio , Zanella Monica 
Published: May 2024

Abstract

Background and Aims
The retention of middle-molecules and Protein Bound Uraemic Toxins (PBUT) in dialysis patients are directly linked to specific clinical complications such as anaemia, inflammation and cardiovascular disease leading to increased mortality. These toxins, not adequately cleared by current dialysis techniques, could be removed by adsorption as demonstrated in numerous studies on dialysis patients. Furthermore, in dialysis patients there's an increased inflammation and oxidative stress only partially attenuated by biocompatibility of newly developed membraned. This pathologic inflammatory response lead to tissue damage and cellular death. A particular form of programmed cellular death involving red blood cells is called Eryptosis and is detectable as changes in the morphology and in the shape of human erythrocytes. The aim of this study was to assess the safety of dialysis coupled with hemadsorption (HA+HD) in terms of biocompatibility and efficacy in terms of removal of middle-molecules and PBUTs.

Method
This was a preliminary analysis of a multicentre observational study that evaluated 4 dialysis session focusing on 7 chronic dialysis patients of our dialysis centre. Patients were treated with HA+HD with HA130 cartridge (Jafron) only in the early-week dialysis session and then returned to their usual prescription. Blood samples were taken before and after dialysis session in order to measure Eryptosis as a marker of biocompatibility and few uremic toxins to assess the efficacy of the treatment by using Removal Ratio. Eryptototic RBCs were identified by FS (cell volume dimension) and FITC_AnnexinV-binding (Beckman Coulter, Brea, CA, USA) using Navios Flow Cytometer (Beckman Coulter, Brea, CA, USA). A minimum 100.000 events were collected on each sample. Statistical analysis was performed using the SPSS Software package. A p-value of &lt;0.05 was considered statistically significant.

Results
This study was carried out on 7 patients (4 women) with a mean age of 65.7 ± 11.5 years and a median dialysis vintage of 33 months (IQR 28-51). All patients had AVF with Qb of 330 ml/min. Dialysis length was 210 minutes. We didn't find any differences between Eryptosis values measured before and after dialysis (Table 1), and between different timepoints. We found significant reduction of PTH (pre: 391.5 ng/L, IQR 206.5-602.8 vs post: 162.0 ng/L, IQR 95.0-363.3; p=0.005) and β2-microglobulin (pre: 23.10 mg/L, IQR 22.1-24.1 vs post: 6.72 mg/L, IQR 6.2-8.3; p&gt;0.005) throughout the dialysis session coupled with hemadsorption (Fig. 1).

Conclusion
In this preliminary analysis, we found that the association of Dialysis with Hemadsorption allows a great removal of middle molecular-weight uremic toxins without compromise biocompatibility and thus represent a better treatment option in patients with high retention of these toxins.
#885 Combination of medium cut-off dialyzer membrane and diet modification to reduce serum concentrations of p-cresyl sulfate and indoxyl sulfate
Authors: Herič Tjaša , Bogataj Špela , Pajek Jernej 
Published: May 2024

Abstract

Background and Aims
Online hemodiafiltration (ol-HDF) may be considered currently as the best choice for chronic hemodialysis (HD) treatment, but medium cut-off (MCO) membranes may provide similar efficiency for larger and protein-bound toxin removal. P-cresyl sulfate (PCS) and indoxyl-sulfate (IS) concentration depends mainly on residual renal function and diet. Increased dietary fiber intake and short-chain fatty acid (SCFA) supplementation were associated with decreased production of PCS and IS. The aim of this study was to pragmatically combine MCO use with diet modification in an attempt to reduce serum concentration of PCS and IS and compare this strategy to online HDF use.

Method
We report preliminary results from a subset of a study sample with 42 chronic prevalent HD patients in a prospective randomized controlled interventional study. Two weeks after standard bicarbonate HD (BHD), patients were randomized to hemodialysis with MCO membrane (EXP group) or ol-HDF with a standard "high-flux" (HF) dialyzer membrane (CON group). After 4 weeks, both groups were supplemented by a change in the diet with increase of the daily intake of dietary fiber to 30g and addition of a SCFA propionate in the dose of 1g daily for 8 weeks. Two main outcomes were serum concentrations of PCS and IS. Measurements were taken at baseline (after 2 week wash-in period), after 4 weeks of the first intervention phase (MCO vs. ol-HDF; T1), after 8 weeks of the second intervention phase (fiber and SCFA supplementation; T2) and finally, after 4 weeks of wash-out period with BHD (T3).

Results
From 42 participants, 38 completed the study (63.2% men, 66.4±10.9 years, Charlson comorbidity index 5.7±2.3). In the CON group, serum concentrations of PCS (in μg/ml) were 36.8±19.6 (baseline), 36.9±20.8 (T1), 32.4±17.4 (T2) and 38.6±22.1 (T3). Serum concentrations of IS (in μg/ml) were 31.8±13.0 (baseline), 32.9±14.7 (T1), 29.5±9.1 (T2) and 35.5±16.8 (T3). In the EXP group, serum concentrations of PCS were 33.5± 16.6 (baseline), 35.9±17.8 (T1), 34.0±16.1 (T2) and 37.4±21.5 (T3). Serum concentrations for IS were 39.6±12.6 (baseline), 37.3±12.9 (T1), 42.3±13.5 (T2) and 41.0±12.8 (T3). Repeated measures ANOVA revealed no significant time*group interaction for PCS (F(1,33)=0.479, p=0.698, ŋ2=0.014) and IS (F(1,33)=2.392, p=0.073, ŋ2=0.068). There was a significant within-group increase in serum IS concentration between T2 and T3 in CON group (p=0.042). There was a trend towards a decrease in PCS concentration between T1 and T2 and increase between T2 and T3 in CON group.

Conclusion
The results of the study suggest both hemodialysis methods are equivalent in eliminating PCS and IS. Additional fiber and SCFA propionate supplementation did not decrease serum PCS and IS concentrations significantly, although there was a trend towards lower serums concentration of PCS after diet modification in CON group.
#2266 Removal of middle size molecules: effects on the modifications of subgroups of white cell types
Authors: Viggiano Davide , Corte Michele Della , Evangelista Ciriana , Credendino Olga 
Published: May 2024

Abstract

Background and Aims
In both classical hemodialysis (HD) and its high convective version, the hemodiafiltration (HDF), the unavoidable contact of blood cells with the filters (e.g. polysulfone), may cause the formation of microaggregates and the release of Inflammatory cytokines. Reducing inflammation and thrombus formation is essential, as these may change the cardiovascular risk of patients undergoing chronic HD. To overcome this problem, removing plasma proteins with greater molecular weight, thereby modifying the protein network around blood cells, might be helpful.

Method
Synthetic dialyzers (FX 80 CorDiax [Fresenius Medical Care], medium-cutoff filter Theranova 400 [Baxter], Elisio 17-H [Nipro], and BG-U 1.6 [Toray]) have been compared regarding their effects on white blood cell types. We designed a retrospective, dual-center clinical study on patients in ESRD needing substitutive therapy. Groups comparable for age, blood pressure, and body weight have been compared. Changes in albumin, Hb, neutrophils, eosinophils, basophils, monocytes, and platelets have been analysed one month after the treatment.

Results
The Theranova treatment decreased lymphocytes but was also observed to increase neutrophils and MCV.
Platelet count was highest with Elisio-H filters, whereas they were comparable among the other groups. Correlation analysis showed a significant association between platelet counts, neutrophils, and monocytes in all groups. Conversely, the correlation between eosinophils and lymphocytes was significant for all groups except for the Theranova filters.
Furthermore, the dialyzers inulin (5.2kDa) clearance was negatively linearly correlated to the lymphocyte counts.

Conclusion
The recent introduction of MCO filters offers the clinician an adjunctive possibility to modify blood composition in terms of plasma composition and different white blood cells. Further studies may use these unique characteristics in new clinical settings.
#3132 The effect of the number of transfusions received and hemodialysis centers attended on the prevalence of hepatitis B and C in hemodialysis patients
Authors: Lafrid Maria , Aatif Taoufiq , Bahadi Abdelaali , Labioui Narjiss , Laasli Hajar 
Published: May 2024

Abstract

Background and Aims
Hepatitis B (HBV) and hepatitis C (HCV) viral infections significantly contribute to morbidity and mortality among hemodialysis patients, posing substantial challenges in the management of these individuals. These infections present a critical global public health concern. This study aims to describe the serological profile of hepatitis B and C among hemodialysis patients at the Military Hospital of Instruction Mohamed V in Rabat. Additionally, the research aims to investigate the associated risk factors, including the potential influence of blood transfusion and frequenting multiple hemodialysis centers as risk factors.

Method
We conducted a cross-sectional study involving 38 hemodialysis patients during the period from January 2022 to September 2022. Hepatitis B and C serological markers were analyzed using a chemiluminescent assay, while genome detection was carried out using a quantitative real-time PCR test.

Results
A total of 36 hemodialysis patients participated in the study, with 44.7% being male and 55.3% female. The age range varied from 26 to 82 years, with a median hemodialysis duration of 102 months. On average, patients attended 1.89 +/- 1.24 dialysis centers (minimum: 1, maximum: 5). Of the participants, 39.5% had a history of blood transfusion, and 13.2% were immunodeficients.
Approximately 63.2% of the patients tested positive for Hbs antibodies; however, only 42.1% demonstrated immunity to hepatitis B with antibody levels exceeding 100 UI/L. Among these patients, 31.6% had a history of vaccination, while 31.6% had previously contracted the disease. Notably, PCR results for HBV were negative in all patients. HCV antibodies were positive in 5.3% of the participants, with no viral RNA detected. Our study did not find any statistically significant risk factors.
We found no association between the prevalence of hepatitis B or C and a history of transfusion or the number of hemodialysis centers attended.

Conclusion
Our results affirm the decreasing prevalence of hepatitis B and C infections among Moroccan hemodialysis patients, attributable to the implementation of anti-HBV vaccination and other protective measures. However, the limited number of patients in our study renders the sample non-representative.
#1827 Myeloma cast nephropathy: is high cut-off hemodialysis effective?
Authors: Martín María Fernández , Gallardo José Manuel Urbizu , Garay Raquel Pérez , De Juan Oihane Abaunza , Mendia Iñigo Yañez , Arroyo Sonia Delgado , Davis Mónica Paola Rodríguez , Etxarri Neike Murua , de Hilla Nerea Ormaetxe Ruiz , Larrondo Sofia Zarraga 
Published: May 2024

Abstract

Background and Aims
Light-chain cast nephropathy is the result of intra-tubular precipitation of light-chains produced by a multiple myeloma. Treatment often includes high cut-off filters hemodialysis (HCO) with the purpose of purifying these chains until the chemotherapy response is achieved. The main goal of this study is to analyze our experience and determine if there is a correlation between the amount of chain purified and the conservation of renal function.

Method
We conducted a retrospective study that includes all patients suffering from myeloma cast nephropathy treated with hemodialysis in our hospital between 2008 and 2023. HCO filters were used in all of the cases and the diagnosis was established by clinical criteria. In the early stages of the study, only those patients who required kidney replacement therapy underwent dialysis. However, in recent years some cases which did not meet the renal replacement criteria were included.

Results
27 patients received the treatment, 59,3% were male and the average age was 68,7+/-8 years. Even though the average of glomerular filtration rate (GFR) previous to the myeloma was 72,65+/-20ml/min, it should be underlined that 8 of them suffered from 3-4 stage chronic kidney disease. The mean follow-up was 55 months, after which 16 had passed away. 59,3% were kappa gammapathy and 75% of them had bone disease. Chemotherapy schemes were variable (85% included Bortezomib).
The average of dialysis sessions was 8+/-3,8. 7 patients continued undergoing conventional hemodialysis during the hospital stay but only one of them remained in chronic dialysis. The average GFR at the beginning was 12,2+/-7ml/min. Despite the improvement of the renal function, when compared to the previous GFR, a statistically significant reduction in both hospital discharge (43,67ml/min) and after 1- and 2-year periods (51,94 and 39,91ml/min) was observed.
No differences in renal function between patients who started dialysis prematurely (GFR&gt;10ml/min) and those who did not were noticed.
The light-chain reduction ratio in each dialysis was examined; it was remarkably variable (2-87%). In order to establish a connection between the amount of chain purified and the preservation of renal function, we conducted a correlation analysis between the intra-dialysis reduction of chains and the GFR at hospital discharge and after 1-year, but not statistically interrelations were observed (p=0,376 and 0,633 respectively). Lastly, no connection between the intra-dialysis light-chain reduction and the loss of GFR was detected.

Conclusion
In patients with myeloma cast nephropathy, a higher purification of light-chains in HCO hemodialysis is not associated with a better preservation of renal function.