bluuebunny/crossref_metadata_2025_split huggingface dataset:
#2192 Aging dialysis population and late referral: two factors influencing the choice of vascular access
Authors: Lomeo Elettra , Maria D'ascenzo Francesca , Sturniolo Antonio , Mangiacapra Roberto , Aureli Fabio , Pesce Francesco , Grandaliano Giuseppe 
Published: May 2024

Abstract

Background and Aims
The decision on the type of vascular access for hemodialysis is based on several factors including the timing of renal replacement therapy initiation and certain patients’ clinical and demographic features. We hypothesized that the increasing age of patients on hemodialysis and the issue of "late referral" can be relevant in this context and favor the use of central venous catheter (CVC) over arteriovenous fistula (AVF), with a surge in catheter-related complications.

Method
We carried out a retrospective observational study of vascular access procedures (AVF creation and long-term CVCs placement) performed at the Nephrology Unit of the “Fondazione Policlinico Universitario Agostino Gemelli” between January 2020 and December 2023.

Results
A total of 415 procedures for AVF creation (median age 63.5, IQR 55.5 - 71.5 years), of which 59 (14,2%) in “late referral” patients (median age 61, IQR 47.5 - 72.5 years), were performed.
During the same period, 343 CVCs were placed, of which 151 (44%) in patients with planned admission as previously evaluated by a nephrologist (median age 69, IQR 60 - 79 years). The remaining 192 CVC placements (56%) involved patients after an emergency admission (median age 69, IQR 57 - 80 years).
In 56 (29%) of these patients an AVF was created concurrently or within 60 days from the emergency procedure. Such patients were significantly younger (median age 66, IQR 57 - 73 years) than those who underwent a CVC placement after a planned admission (p=0.01) or others with emergency admission (p=0.03).
In a multivariate analysis (logistic regression) the use of CVC over AVF was significantly and independently correlated with both late referral and age.

Conclusion
These data suggest that the increasing use of CVCs in hemodialysis may be due to the age of incident patients and remark the importance of early evaluation in order to choose the most appropriate vascular access.
#2833 Charlson comorbidity index predicts early failure and overall survival of vascular access among diabetic dialysis patients.
Authors: Sánchez Christian Israel Alfaro , Franco Antonio José Marín , Sorribes Mª Paz , Martínez-Vaquera Shaira 
Published: May 2024

Abstract

Background and Aims
Vascular access (VA) survival is a determinant factor in the morbidity and mortality of haemodialysis patients, directly influencing their quality of life. Some studies have described the influence of diabetes on the reduced survival of arteriovenous fistulas as an independent factor; however, the correlation between other comorbidities in diabetic patients with vascular access survival has been less well documented. Therefore, our aim is to describe the relationship between comorbidities in diabetic haemodialysis patients and arteriovenous fistula (AVF) patency.

Method
Descriptive, observational and retrospective study in prevalent patients included in a haemodialysis programme by consulting electronic records over a period of 35 months. Demographic variables; related to vascular access and primary and secondary patency of all accesses were included. The Charlson Comorbidity Index was used to categorise diabetic patients according to comorbidities. Kaplan Meyer survival curves were used to contrast the impact of comorbidities on the different patency.

Results
22 patients, mean age 68.36 ± 10.9 years, 68.18% male, 31.82% female, Charlson index with a median of 6.5 (5 - 8), 95.45% had a native fistula, with humero-cephalic location being more frequent (72.72%) and predominance of the left upper arm (68.18%). The time required to reach an event in both primary patency and secondary patency in diabetic patients was longer in patients with a Charlson index less than or equal to 7, this being statistically significant (Log Rank Test (Mantel-Cox): primary patency p=0.022 and secondary patency p=0.032).

Conclusion
The Charlson Comorbidity Index in our population is a significant factor in arteriovenous fistula survival.
#1703 Role of early AV fistula creation among elderly and its impact on estimated decline in GFR among pre dialysis patients
Authors: Bhat Dr Sanjay , Chandra Abhilash , Rai Priyanka , Srivastava Rohit , Srivastava Alok 
Published: May 2024

Abstract

Background and Aims
Recent evidence suggests that AVF creation may slow estimated glomerular filtration rate (eGFR) decline. The aim of the present study was to assess the impact of the pre dialysis AVF creation on eGFR decline and the need for dialysis, after controlling for key confounding factors among elderly population with advanced renal failure .

Method
A retrospective cohort study among patients attending Nephrology, Urology and General Surgery OPD between Jan 2019-Jan 2022 in Tertiary care hospital, Lucknow for AV fistula creation and assessed their stage of CKD and trajectory of fall in eGFR within a year's time and the time to initiation of dialysis from AV fistula creation was assessed.

Results
34 men and 23 females (&gt; 65 years ) of age who at time of AV fistula creation had an median eGFR at time of AVF creation of 15.5 (10.3–16.9) mL/min/1.73m2. The factors like frailty, diabetes, psychosocial issues were matched between the two genders . Males were more in age with better BMI .Baseline eGFRs were 14.4± 2.0 mL/min/1.73m2 in men and 13.8.0 ± 1.2 mL/min/1.73m2 in women. The crude annual eGFR decline rates were − 3.20 ± 2.50 mL/min/1.73 m2 pre- and − 2.45 ± 2.16 mL/min/1.73 m2 post-AVF.
In a mixed effect linear regression model, monthly eGFR decline was − 0.43 mL/min/1.73m2/month.. The period after AVF creation was associated with a relatively higher eGFR . There was a significant association between follow-up time and the period pre/post AVF such that eGFR decline was more attenuated each month after AVF creation. There was better preservation of GFR from the pre AV fistula creation .

Conclusion
In this cohort, AVF creation was associated with a significant reduction of eGFR decline among elderly population . Further prospective studies are needed to confirm this association
#1899 Transitional care clinic for incident hemodialysis patients : the Singapore experience
Authors: Baikunje Shashidhar , Chawla Mayank , Ekanayaka Mahesh , Guo Ww 
Published: May 2024

Abstract

Background and Aims
The period of transition from chronic kidney disease (CKD) to End stage kidney disease (ESKD) presents significant morbidity and mortality risk to the patients. This higher mortality risk is largely contributed by cardiovascular factors and infection.
The last 2 decades have seen a remarkable succession of programs to improve outcome in incident dialysis patients. One such initiative is the use of ‘fistula first’ policy. In Singapore, pre-emptive access creation among ESKD patients continues to be low, with up to 80% of incident dialysis patients being commenced on hemodialysis (HD) via a dialysis catheter. Ensuring that incident dialysis patients have definitive vascular access, early referral to transplantation and adequate psychosocial support, amongst other factors, is an important consideration in their journey towards improved health outcomes. In order to achieve this, meticulous care coordination and a multifaceted approach is required. This realization is what led to the inception of our transition care clinic (TCC) in 2019.
Conducted bi-monthly by a multidisciplinary team of nephrologists and renal coordinators, with inputs from pharmacists and medical social workers as needed, the TCC engages patients within 4-6 weeks post-hospital discharge. Its focus includes vascular access, dietary and fluid compliance, blood pressure control, HD adherence, transplantation referral, and medication reconciliation.

Method
A retrospective analysis of 314 ESKD patients who initiated HD between September 2019 and September 2022 compared outcomes between TCC attendees (n=164) and non-attendees

Results
TCC attendees exhibited a lower 1- year mortality rate (p=0.002) and higher rates for vascular access creation within first 6 months (p=0.001) as compared to non-attendees. However, no statistical differences were observed in hospitalization rates in the first year (p=0.760) and kidney transplantation referrals (p=0.20) between the two groups.

Conclusion
While notable improvements were observed in mortality rates and vascular access creation, there was no significant difference in hospitalization rates or kidney transplantation referrals between the two groups. In spite of the limitations due to its retrospective nature, this study clearly demonstrates the effectiveness of TCC in enhancing patient outcomes during the critical initial phase of hemodialysis. The study highlights the importance of setting up, refinement and expansion of such services in improving the outcome of this vulnerable patient group.
#1904 Prevalence of osteoporosis in dialysis dependent CKD patients: a cross sectional study from India
Authors: Sharma Jay Kumar , Bunger Deepak , Chaturvedi Alok 
Published: May 2024

Abstract

Background and Aims
Chronic kidney disease (CKD) is associated with the development of mineral bone disorder (MBD), osteoporosis, and fragility fractures. However, the data on prevalence of Osteopenia and osteoporosis in Chronic kidney disease in India is scarce
This multicentric, cross sectional study was done to assess the prevalence of osteoporosis in dialysis dependent chronic kidney disease patients.

Method
This study was conducted in CKD patients on maintenance hemodialysis. Osteoporosis and osteopenia were confirmed on the basis of T-scores using portable- Heel Ultrasound Bone Densitometer.

Results
A total of 1033 Dialysis patients were screened during August 2022 to December 2022. More than half (56%) of the patients were male. The prevalence of osteoporosis and osteopenia was observed to be 17% and 66%, respectively. Mean T- Score observed in overall population was -1.71 + .0.85, while it was -1.66 + 0.86 and -1.77 + 0.83 in males and females respectively. The maximum T- score observed in males was 2.0 and in females it was 4.0. In females, the minimum T-score was -4.3 while in males it was -2.51. Overall, 16.5% of males and 18% of females were osteoporotic. Among geriatric males (&gt;60 years), average T-score was -1.55 + 0.42 while in geriatric female it was 1.78 + 0.80

Conclusion
This data of Osteopenia and osteoporosis should be alarming as osteopenia itself is considered a very serious risk factor for the development of osteoporosis. Early intervention for diagnosis and timely initiation of treatment of osteoporosis is recommended for the CKD population to prevent complications like fractures and falls.
#2473 Renal failure in the emergency department: indications for emergency hemodialysis
Authors: Hedhli Hana , Hajji Roua , Jemai Mouna , Jouini Sarra , Mahrsia Chaima , Othmani Safia 
Published: May 2024

Abstract

Background and Aims
kidney failure is a frequent reason for emergency department (ED) visits. Patients may require emergency hemodialysis and this situation may increases mortality risk.
We set out to study the clinical relevance and biological characteristics of patients with renal failure presenting to the emergency department with an indication for emergency hemodialysis.

Method
A prospective observational study conducted in ED conducted over a 6-month period. Patients were included if they were 18 years or older and suffering from acute or chronic renal insufficiency defined by creatinine clearance (CrCL) calculated by MDRD&lt;60 ml/min. Information is recorded on demographics, clinical profile, clinical presentation, laboratory, causes of for emergency hemodialysis and in-hospital complications.

Results
Eighty one patients were enrolled, among them 61.7% patients had an indication for emergency hemodialysis. Mean age was 61± 12, sex-ratio=1,7. Sixty seven patients (82.7%) were known to have a chronic kidney failure and 17.3 % were discovered at the emergency department at the same hospitalisation period. Clinical profile (%): Anuric patients (11.1), preserved diuresis (40.7). Clinical presentation (%): deterioration of general condition (35.8), dyspnea and chest pain (21) and fever (17.3). Clinical examination showed a peripheral oxygen saturation between 70 and 100% with a mean of 94.81, a respiratory rhythm mean of 20 cycles/min, a systolic blood pressure mean of 134.61 mmHg and a diastolic blood pressure mean of 70 mmHg. biological exams showed that kalemia was between 2.4 and 8.6 and 45 of those patients had kalemia more or equal to 5.5. Twelve per cent of these patients had hyperkalemia signs on the electrocardiogram. The average were 28 mmol/l with a maximum of 83.3 mmol/l. Creatinine values were between 185 et 2620 μmol/l with a median of 81. The value of Ph was between 7.04 and 7.53 with a median of 7.29 mm Hg. The value of HCO3- value was between 4.6 and 28.4 with a median of 14.2.
Causes of emergency hemodialysis were acidosis in 12 cases, severe anemia with blood transfusion in 4 cases, hyperkalemia in 10 cases, acute pulmonary oedema in 5 cases and acute renal failure in 6 cases .the evolution of the patients was marked by improvement of 61.7% of the patients, only 3 of the 81 patients died during the hospitalization.

Conclusion
This study showed that the causes of emergency dialysis can be avoided by improving care and educating patients to improve the prognosis.
#1839 Evaluating the severity of restless legs syndrome in chronic kidney disease patients across different renal replacement therapies
Authors: Rroji (Molla) Merita , Shehaj Larisa 
Published: May 2024

Abstract

Background and Aims
Restless Legs Syndrome (RLS) is increasingly recognized as a significant comorbidity in chronic kidney disease (CKD) patients. This cross-sectional study evaluates the risk and severity of RLS in CKD patients across various renal replacement therapies (RRT).

Method
A total of 167 CKD patients were assessed, including those on hemodialysis (HD) (39%), peritoneal dialysis (PD) (22%), with kidney transplants (19%), and those with non-dialyzed CKD stages IV-V (20%)—the International Restless Legs Syndrome Study Group (IRLS) questionnaire measured RLS severity. Severity scales were categorized into mild (0-10), moderate (11-20), severe (21-30), and very severe (31-40). PTH, P, Ca, ALP, and Mg serum concentrations, as well as vascular calcification, were measured as MBD biomarkers. The Adragaos score was applied to graphs of the hands and pelvis to evaluate vascular calcification. Statistical analyses focused on differences in RLS severity across RRT modalities and associated risk factors.

Results
The cohort comprised 82 males and 85 females, averaging 58 years. Primary disease etiologies included nephroangiosclerosis (24%), diabetic nephropathy (12%), chronic pyelonephritis (24%), chronic glomerulonephritis (24%), and ADPKD (7%). RLS prevalence was 53.8%, with significant differences in IRLS scores across groups (p ≤ 0.001). HD patients showed a mean IRLS score of 21.8 ± 12.3, with 55% reporting severe or severe symptoms. PD patients scored 16.06 ± 13.02; non-dialyzed CKD patients scored 6.41 ± 6.04; and transplant recipients scored 3.1 ± 4.7. No correlation was found between RLS severity and age or time on RRT. However, significant correlations were observed between RLS severity with HD modality, and the high Adragaos score. Multivariate analysis showed high serum phosphorus p=0.018 and markers of inflammation as a risk factor for RLS severity (CRP levels p=0.034; ferritin (p=0.048).

Conclusion
This study underscores the disproportionately higher severity of RLS in HD patients, necessitating tailored management strategies for this subgroup. The significant association between RLS severity and calcification and inflammation markers in CKD patients, particularly those on HD, suggests that RLS severity should be a key consideration in the clinical management of CKD. Addressing RLS in these patients may improve their quality of life and influence the outcomes of their renal replacement therapy.
#1397 Predictive factors for bioprosthetic valve stenosis and prognostic factors for survival following TAVR in hemodialysis patients with severe AS
Authors: Masuyama Satoshi , Mizui Masayuki , Maeda Koichi , Shimamura Kazuo , Sakaguchi Yusuke , Sakata Yasushi , Miyagawa Shigeru , Isaka Yoshitaka 
Published: May 2024

Abstract

Background and Aims
Transcatheter aortic valve replacement (TAVR) is a promising option for the treatment of severe aortic valve stenosis (AS) in patients undergoing hemodialysis. Although the incidence of bioprosthetic valve deterioration (SVD) after TAVR has been reported to be lower than after surgical aortic valve replacement (SAVR), hemodialysis itself is still associated with a high risk of SVD. Until now, the factors that determine the prognosis of TAVR in hemodialysis patients were unknown. We previously reported that preoperative hypomagnesemia was correlated with an increase in postoperative mean aortic valve pressure gradient (MPG), an index of bioprosthetic valve stenosis as one of the indicators of SVD, in hemodialysis patients (Ren Fail. 2022 Dec;44(1):1083-1089). However, the study had a limited sample size of 24 cases, which raised concerns about statistical power. Therefore, we re-evaluate predictors of SVD and life expectancy in a larger number of post-TAVR hemodialysis patients.

Methods
From April 2012 to November 2021, all 100 hemodialysis patients treated with TAVR at Osaka University Hospital were included in the analysis. Pre- and post-operative demographic and laboratory data were analyzed by linear mixed-effects model and cox proportional hazards model.

Results
During the follow-up period (maximum 7 years), 4 out of 100 patients required re-TAVR (valve-in-valve) due to valve stenosis. The MPG increased over time with the lower preoperative serum Mg concentration (linear mixed-effects mode; +1.40 mmHg/year per 1mg/dl lower in Mg, p=0.006). However, serum calcium, phosphate, and intact PTH levels had no significant effect on the increase in MPG. In addition, a higher preoperative left ventricular ejection fraction (LVEF) was associated with a lower risk of death in a multivariate Cox proportional hazards model (hazard ratio [HR] 0.97 per 1% increase in LVEF; P=0.02).

Conclusions
Consistent with our previous report, preoperative hypomagnesemia was associated with increased MPG after TAVR. In addition, preoperative low cardiac function (LVEF&lt;40%) may be a risk factor for postoperative mortality in dialysis patients.
This was a single-center observational study, and the number of patients was still small, so our data may not be necessarily applicable to every patient. Further research is needed to identify a prognostic predictor of SVD and mortality, that will lead to the prevention of adverse outcomes in hemodialysis patients.
#2524 Impact of sevelamer hydrochloride on fibroblast growth factor-23 levels in patients undergoing hemodialysis
Authors: Ahmed Fatma Abdelrahman , Khalil Amr , Elsaid Tamer 
Published: May 2024

Abstract

Background and Aims
Serum intact fibroblast growth factor 23 (FGF23) levels are progressively increased in relation to the severity of kidney dysfunction. High serum intact FGF23 concentration is associated with the increased cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD). Clinically, phosphate binders are commonly used to reduce serum intact FGF23 levels in CKD patients by lowering serum phosphate levels. Reduction of high intact FGF23 concentration is a strategy, possibly improving the consequences of CKD. We aimed to Assessing the Impact of Sevelamer Carbonate on Fibroblast Growth Factor-23 Levels.

Method
This case-control study enrolled 100 pre-existing hemodialysis patients, evenly divided into two groups of 50. Group I received a specific sevelamer hydrochloride (Renagel)® dose (2 tablets every 8 hrs), while Group II served as the control group and did not receive (Renagel)®. All patients received the same modality of dialysis with a consistent dialysate calcium concentration. Additionally, they received comprehensive dietary phosphate counseling as part of the standard dietary education provided to our dialysis patients. The levels of phosphorus, calcium, alkaline phosphatase, and FGF23 were assessed in all individuals at the beginning of the study (baseline) and again following 3 months of sevelamer therapy.

Results
While baseline FGF-23 levels were not statistically different, a highly significant divergence emerged after 3 months of treatment. The sevelamer group experienced a remarkable 38.4% decrease in FGF-23, compared to a mere 0.5% change in the control group, highlighting the pronounced effect of sevelamer on this key protein. Analysis of PO4 levels revealed a remarkable difference between the groups following treatment. While initial PO4 measurements were statistically comparable, the sevelamer group experienced a significantly larger decrease compared to the control group (p &lt; 0.001). Both baseline and follow-up FGF-23 levels displayed highly statistically significant positive correlations with PO4, PTH, alkaline phosphatase, and hsCRP.

Conclusion
This study found that non-calcium-based phosphate binders were associated with a substantial reduction in FGF-23 in hemodialysis patients. This finding suggests that utilizing such binders may offer protection against the adverse effects of high FGF-23 levels, which are prevalent in this population.