bluuebunny/crossref_metadata_2025_split huggingface dataset:
#2826 The Charlson Comorbidity Index in Registry-Based Research for Survival of Vascular Access
Authors: Franco Antonio José Marín , Sánchez Christian Israel Alfaro , Useche Gustavo , Sorribes Mª Paz , Martínez-Vaquera Shaira 
Published: May 2024

Abstract

Background and Aims
Several studies have reported higher haemodialysis survival in women; however, the influence of gender on arteriovenous fistula survival has not been extensively studied. For this reason, our aim is to estimate the prevalence of arteriovenous fistulae according to gender, adjusted by the Charlson comorbidity index.

Method
Retrospective study in patients on haemodialysis programme, by consulting electronic records over a period of 35 months. Demographic variables, primary and secondary patency events were included. The population was categorised on the basis of the Charlson Index and gender. Statistical analysis was performed using Kaplan Meyer survival curves to contrast the impact of comorbidities on the different patency events.

Results
52 patients were evaluated, with a mean age of 70.7 ± 1.57 years, 69.2% men, 30.8% women, 42.3% diabetic, Charlson with a median of 7 (6.5 - 7.73), 98.1% had a native fistula, being more frequent the location in the humeral head (63.5%) and predominantly in the left upper limb (65.4% ). 21.2% of patients required some intervention on their AVF. The time required to achieve an event in both primary patency and secondary patency was longer in patients with a Charlson Index less than or equal to 7, and this was statistically significant (Log Rank Test (Mantel-Cox): primary patency p=0.003 and secondary patency p=0.002). In the group of women with a Charlson comorbidity index less than or equal to 7, mean survival for primary and secondary patency was even higher than in all patients, with statistical significance (Log Rank Test (Mantel-Cox ): primary patency p=0.005 and secondary patency p=0.008), a situation not repeated in men where no significant differences in survival were found when analysed according to the Charlson index.

Conclusion
The Charlson index in our population is a significant factor in the survival of AVFs in women.
#460 Digital twin in hemodialysis model, with machine learning algorithms. Data from the Andalusian Hemodialysis Registry. SICATA
Authors: Marcos Sergio Garcia , Sánchez Manuel Benítez , Bayo Magdalena Palomares , Dominguez Clara María Moriana , de Mota Elvira Maria Esquivias , Ojeda Raquel , Morales Ana , Novillo Carolina Lancho , Sacaluga Luis Gil 
Published: May 2024

Abstract

Background and Aims
Orthodoxly, a digital twin is a computer simulation of an individual, “in silico”, and in real time. A digital twin can also be created with BIG DATA. The Objective It is the development of a survival digital twin model using Machine Learning algorithms using data from the Andalusian SICATA registry.

Method
The database was composed of 29,189 records at the time of analysis and contains variables in the areas of comorbidity, anemia, efficacy of renal replacement therapy (RRT), and renal bone disease.
The algorithms used were: - XG Boost, AdaBoost, Cat boost. KNN, Random Forest, Decision Trees, Logistic Regression. A survival model was developed with each Machine Learning (ML) algorithm . The metrics of the models were taken into account: precision, calibration, accuracy. The software used was Orange based on Python and Rattle based on R. An explanation of the “black box” type models was carried out using SHAP (Shapley values) based on game theory.

Results
The characteristics that the digital twin that we have modeled with the greatest survival would have are: 1. Age equal to or less than 45 years, 2. Being included in the kidney transplant waiting list. 3. Longer duration of the hemodialysis session. 4. Low doses of Erythropoietin. 5. Normal or high serum albumin levels. 6. BMI &gt; 21.The sample was stratified according to the Ultrafiltration (UF) ratio during the Hemodialysis session in ml/kg/hour. Group1: UF &lt;4 ml/kg/hour. Group2: UF 5-9 ml/kg/hour. Group3: UF&gt;9 ml/kg/hour. And a mortality study was carried out using multivariate Logistic Regression. We found that the OR for mortality in groups 2 and 3 was 17% and 24% in relation to group 1, which had the lowest mortality.

Conclusion
ML has revealed that the UF ratio (ml/kg/hour) is an important predictor variable of mortality. In our studio a UF ratio&lt;4 ml/kg/hour is safe ML has found an answer to a question that we had not asked ourselves when beginning the study: What is the optimal UF rate in the hemodialysis session?
#616 Effectiveness of regdanvimab on clinical outcomes in COVID-19 infected patients on hemodialysis
Authors: Lee Young-Ki , Kee Youn Kyung , Park Hayne Cho , Cho Ajin , Kim Do Hyoung , Yoon Jong-Woo 
Published: May 2024

Abstract

Background and Aims
Although several therapeutic agents have been evaluated for the treatment of coronavirus disease 2019 (COVID-19), there are lack of effective and proven treatments for the COVID-19 patients with end-stage kidney disease (ESKD). The present study aims to evaluate the effectiveness of regdanvimab on clinical outcomes in COVID-19-infected patients on hemodialysis (HD).

Method
We conducted a retrospective study of 230 HD patients hospitalized with COVID-19 infection between December 1, 2020 and November 30, 2021. Of these, 77 (33.5%) were treated with regdanvimab alone or in combination with dexamethasone or remdesivir during hospitalization (regdanvimab group), and 153 (66.5%) did not treat with regdanvimab (non-regdanvimab group). We compared in-hospital mortality rate according to the use of regdanvimab and investigated the factors associated with mortality.

Results
The mean age of the patients was 67.9 ± 12.1 years, with 214 (93%) patients aged 50 years or older. There were no significant differences in demographics and comorbidity between the regdanvimab and non-regdanvimab groups. Fifty-nine deaths occurred during hospitalization, 49 (32%) in the non-regdanvimab group and 10 (13%) in the regdanvimab group, and mortality rate was significantly higher in the non-regdanvimab group than that in the regdanvimab group (P=0.001, Fig.). Multivariate Cox regression analysis showed that malignancy (P=0.001), low oxygen saturation&lt;95% at admission (P=0.003), and administration of antibiotics and regdanvimab (P=0.007 and P=0.002, respectively) were significantly associated factors with mortality.

Conclusion
Regdanvimab administration is beneficial in improving prognosis in hospitalized COVID-19 patients on HD. Considering the vulnerability of ESKD patients to infection, regdanvimab may be considered as a therapeutic option in COVID-19 patients on HD.
#3034 Therapeutic compliance: another challenge for patients on chronic hemodialysis
Authors: Ayed Amel , Jaballah Lazhar , Brahim Mayssa Hadj , Elhadhri Asma , Elati Zohra 
Published: May 2024

Abstract

Background and Aims
Therapeutic compliance corresponds to the degree of concordance between the patient's behavior and the recommendations of his doctor. Non-adherence to treatment predispose to high risk of mortality and increases health costs.
The objective of our study was to assess the level of compliance in chronic hemodialysis patients and to identify the predictive factors of poor compliance.

Method
A cross-sectional study was conducted in the hemodialysis center at Taher Sfar Hospital in Mahdia. Medication adherence was assessed using a “compliance assessment test” quiz comprising six questions to which the patient must answer yes or no.

Results
Sixty-one patients were enrolled. The mean age was 50 ± 13 years (26 - 79 years) with a sex ratio M/F of 1.27. The patients have diabetes mellitus and hypertension in 35% and 68% of cases. They were dialyzed for a long duration (37 ± 15 months) that reaches a maximum of 280 months. The main initial nephropathies were diabetic nephropathy (35.5%) and chronic interstitial nephropathy (23.5%). Adherence was poor in 16.9 % of patients, average in 55.9% of patients while 27.1% were good adherents. Polymedication and missing of treatment were the leading causes of non-adherence. In univariate analyses, the socio-economic level affected significantly the compliance in elderly group as well as high comorbidity score (Charlson) (p&lt;0.04) and diabetes status (p=0.04). No significant difference was found between elderly and young group in term of compliance to treatment.

Conclusion
Compliance is a dynamic behavior that is difficult to predict and requires constant monitoring. In our hemodialysis center it turned out to be good; we must insist on the therapeutic education of patients and minimize the list to the necessary.
#670 Clinical characteristics of sarcopenic obesity in hemodialysis patients
Authors: Ito Minoru 
Published: May 2024

Abstract

Background and Aims
Sarcopenia is associated with all-cause mortality in older dialysis patients. Although obesity is a risk factor for a variety of diseases in the general population, obese hemodialysis patients have a survival advantage over lean patients. Some hemodialysis patients are obese but have reduced muscle mass, a condition known as sarcopenic obesity. The characteristics and diagnostic criteria for sarcopenic obesity in dialysis patients remain unclear. This study aims to determine the prevalence and clinical characteristics of patients at risk for sarcopenia or sarcopenic obesity.

Method
The dialysis centers involved in this study were four dialysis centers belonging to Seiei-kai Medical Corporation. Hemodialysis patients attending these facilities were included. Obesity was defined as a BMI of 25 kg/m2 or higher, and sarcopenia risk was described as a SARC-F questionnaire score of 4 or higher and a sit-to-stand test (SS-5) of 12 seconds or longer. Patients were classified as sarcopenic obese if they met both criteria. Patients classified as obese (OB) or sarcopenic obesity (SO) were compared for the following factors: age, history of dialysis, sex ratio, presence of diabetes, blood biochemical tests, Kt/V, nPCR, %CGR, number of falls in the past year, and symptoms using the Patients Reported Outcomes Measure (PROM).

Results
We analyzed the cross-sectional data of 622 patients attending our four dialysis centers. The prevalence of SO among all patients was 6% (34 patients), and OB was 26% (164 patients); Hb (10.9 ± 1.5 vs. 11.4 ± 1.2 g/dl; p=0.03), albumin (3.40 ± 0.3 vs. 3.63 ± 0.3 mg/dl; p&lt;0.01) and nPCR (0.82 ± 0.16 vs. 0.91 ± 0.13 g/kg/day; p=0.01) were significantly lower in the SO group than in the OB group. Age (72.4 ± 9.2 vs. 32.9 ± 12.7 years; p&lt;0.01) was higher in the SO group, and patients with a history of falls were significantly more likely to be in the SO group (59% vs. 29%; p&lt;0.01). Symptom severity as measured by the PROM was also higher in the SO group.

Conclusion
This study showed that patients in the SO group were more likely to fall and had inadequate protein intake. In addition, patients in the SO group are older and have more severe PROM symptoms. Interventions to increase muscle strength and improve physical function should be considered for patients with SO. Nutritional support, treatment of individual symptoms, and exercise therapy will be necessary, and these interventions may be complex and challenging. We will design an observational study on the prognostic impact of sarcopenic obesity. A limitation of this study is that we used the SARC-F questionnaire and SS-5 rather than the AWGS criteria to assess sarcopenia, which may not have captured true sarcopenia.
#743 Clinical outcomes of patients hospitalized with the diagnosis of COVID-19 infection and undergoing hemodialysis: a single center experience
Authors: Savsar Mehmet Gürdal , Oguz Ebru Gok , Kayhan Sanem , Okyay Gulay Ulusal , Sahin Hatice , Ayli Mehmet Deniz , Atilgan Kadir Gokhan , Ebinc Fatma Ayerden 
Published: May 2024

Abstract

Background and Aims
The main purpose of this study is to determine the effect of dialysis on the prognosis (admission to intensive care unit, intubation requirement, length of hospitalization, mortality) of patients with COVID-19 receiving hemodialysis treatment in our clinics. Another aim of this study is to examine the effect of the need for hemodialysis on COVID-19 prognosis in order to contribute to the data of our country.

Method
Cross-sectional study of 104 patients with hemodialysis and were diagnosed COVID-19 were conducted. In this study, patients were divided into three groups: (i) those with chronic renal failure (CRF) and receiving routine hemodialysis; (ii) those with chronic kidney disease (CKD) but needing urgent hemodialysis; and (iii) those who did not have a known kidney disease but needed urgent hemodialysis because of acute kidney injury (AKI) . The study was performed in accordance with the Declaration of Helsinki. The local ethical committee approved the study design (date: 21.03.2022; reference number: 133/13).

Results
When we evaluated the demographic, clinical and laboratory factors in our study, it was found that the factors affecting mortality were lymphopenia, emergency HD treatment under the presence of CKD, an increase in AST more than 2 times, the need for mechanical ventilation and high d-dimer (Table 1).

Conclusion
This case demonstrates that AKI associated with cytokine storm and developing multi-organ dysfunction situation is directly linked to mortality, particularly in patients with severe clinical condition. When the biochemical data of the patients were analysed, it was discovered that AST increase, lymphopenia, and d-dimer rise were directly found associated with increase mortality. In light of these observations, the above-mentioned biochemical laboratory values of the patients can be closely monitored, as can the clinical course of COVID-19 and renal-related mortality.
#1807 Use of teriparatide to prevent severe hypocalcemia after parathyroidectomy in dialysis-dependent patients: a feasibility study
Authors: Parshina Ekaterina , Novokshonov Konstantin , Chernikov Roman , Tolkach Alexey 
Published: May 2024

Abstract

Background and Aims
Hungry bone syndrome is a common postoperative complication after parathyroidectomy (PTx) for severe secondary hyperparathyroidism (SHPT). We aimed to conduct a feasibility study to assess the potential impact of teriparatide on the course of postoperative hypocalcemia after PTx in dialysis-dependent patients.

Method
We performed a randomized controlled pilot study in 20 dialysis-dependent patients with severe SHPT undergoing total parathyroidectomy with autotransplantation of parathyroid tissue. Patients were randomized to receive either 20 mcg teriparatide (Forsteo) subcutaneously on day 1 after surgery in addition to standard postoperative care (n=11) or standard postoperative care alone (n=9). Severe postoperative hypocalcemia was defined as an ionized serum calcium level of less than 0.8 mmol/l during the first 3 days after surgery.

Results
Patients in the two groups did not differ in terms of pre- and postoperative laboratory data, including PTH, corrected total calcium, ionized calcium and alkaline phosphatase levels – Table 1.
Severe hypocalcemia was observed in 6 patients in the teriparatide group (55%) and in 4 patients (44%) in the control group (p=0.99). The proportion of patients with symptoms of hypocalcemia was higher in patients not receiving teriparatide (67% vs 27%, p=0.17), although these differences did not reach statistical significance.
All post-PTx patients received standard supplementation according to local protocol, including calcium carbonate 20 gr/day, active vitamin D 2 mcg/day per os, and intravenous calcium gluconate supplementation on demand for symptoms of hypocalcemia (e.g. numbness, tingling, or cramps).
Total elemental calcium requirement after surgery (which may serve as a surrogate for the severity of hungry bone syndrome) was higher in patients receiving standard treatment alone (41 [Q1-Q3: 33; 49] grams per hospitalization vs 33 [Q1-Q3: 25; 40] grams in the teriparatide group, p=0.0375) – Fig. 1.
The total length of hospital stay was 4 ± 1 days in teriparatide group and 5 ± 2 in control group, p=0.36.

Conclusion
In dialysis-dependent patients after PTx, we observed a trend towards an alleviation of postoperative hypocalcemia after single injection of teriparatide in addition to routine care. Further studies with larger sample sizes are needed to confirm these preliminary results.
#1112 A simplified lung ultrasound guided management protocol of pulmonary congestion in hemodialysis
Authors: Saleh Kaysi , Hamad Abdulla , Boulgheraif Abdullah , Bonkain Florence , Libertalis Mark , Baz Mahmoud , Farah Ibrahim , Ibrahim Rania , Ateya Heba , Mathew Mincy , Almalki Hassan , Nortier Joelle 
Published: May 2024

Abstract

Background and Aims
Pulmonary congestion PC is frequent in Hemodialysis HD and holds a negative prognostic value. Lung ultrasound LUS is accurate in detecting and quantification PC, however, there are many methods to use LUS to evaluate PC. Here we validate a simplified LUS guided pulmonary congestion management protocol in HD patients that can be easily integrated in clinical practice, while studying at the same time the impact of such method on blood pressure control.

Methods
A prospective randomized multi-centric trial including stable HD patients in 3 countries.
Patients were randomized into two groups: active and control group.
All patients had a bedside LUS at the end of their mid-week session every two weeks according to the following time-line: Day 1, 15, 30, 45, 60.
Lung ultrasound was performed according to the 8-zone method, and a B line score BLS was obtained. A global BLS of more than 6 was considered reflecting a significant PC level.
The dry weight was adapted according to the standard of care in the control group. In the active group, in addition to the standard of care, if BLS was more than 6 at day 1 then the dry weight was reduced by 500 g. The same procedure was repeated at Day 15. (The maximum global dry weight modification per patient was 1 kg) (Fig. 1).
Home blood pressure monitoring HBPM was also obtained weekly all through the study period.

Results
28 stable HD patients (21 males) were enrolled in the study up until now. Mean age was 66.4 years, 14 were diabetics, 4 with stable ischemic heart disease, 1 heart failure and 27 were suffering from hypertension. Mean dialysis vintage was 35.8 months, and mean residual urine volume was 548 ml/24H. Mean session time was 4 hours. Main study population characteristics are described in Table 1.
In the active group, mean BLS at day 1 (13.5) was significantly reduced, and reached (7.57) at day 60. (P &lt; 0.001, ES:1.55) (Fig. 2). This was in parallel with a little but significant reduction in the dry weight (P: 0.03, ES: 0.6) but without a statistically greater UF values (P: 0.23) (Table 2).
A significant reduction in home blood pressure was also observed by the HBPM readings, especially in the diastolic BP (P: 0.004).
In the control group, the mean BLS at day 1 was (12.1). This level did not change all through the study time line, as it was (12.1) at day 60. No significant difference was observed in the dry weight, or ultrafiltration rate UF or home blood pressure values (Table 3).

Conclusion
Our simplified LUS guided management protocol was able to safely reduce the pulmonary congestion in HD patients in addition to better controlling their blood pressure. This protocol can be applied easily in every HD unit, and may be added to the standard of care to better estimate the dry weight in HD patients.
#492 Ten-year experience treating osteoporosis with bisphosphonate in hemodialysis patients
Authors: Sakai Kentaro , Saidou Akiharu , Hayashi Saho , Satou Yoshiki , Yada Tomotaka , Matsui Rei , Higashi Harumichi 
Published: May 2024

Abstract

Background and Aims
The treatment of osteoporosis in patients undergoing hemodialysis (HD) has not been established, as there is insufficient evidence regarding the treatment of osteoporosis. The Kidney Disease: Improving Global Outcomes (KDIGO) 2017 guidelines suggest that determining the bone marrow density (BMD) of HD patients is useful. In 2011, we began treating HD patients' osteoporosis with alendronate. Herein, we describe the effects of the treatment based on our 10-year experience.

Method
This was a single-center prospective observational study of 85 HD patients (age 67.8 ± 11.0 yrs; 47 females, 38 males) treated for osteoporosis with alendronate at our hospital during the 10 years 2011–2021. The average observational period was 3.9 ± 2.9 years. The patients' BMD values including those at the lumbar spine, femoral neck, and total hip were determined by dual-energy X-ray absorptiometry. The patients whose first T-score was ≤ −2.5 were treated with alendronate. We evaluated the patients' yearly BMD measurements and their yearly values of bone metabolism markers, i.e., parathyroid hormone (PTH), bone alkaline phosphatase (BAP), and tartrate-resistant acid phosphatase 5b (TRACP-5b).

Results
We compared the data before and after the start of alendronate treatment by dividing the patients into a responder group (the patients whose T-score had improved at 1 year after treatment started; n=44) and a non-responder group (the patients whose T-score had not improved; n=32). The mean observational period of the responder group was significantly longer than that of the non-responder group (p&lt;0.01). In a multiple regression analysis, a longer observational period was significantly associated with the improvement of T-scores (p=0.02). Only the mean T-score of the lumbar spine gradually improved during the study period; those of the femoral neck and total hip did not.

Conclusion
A long-term use of alendronate for the treatment of osteoporosis may be effective in hemodialysis patients, especially for the lumbar spine. Decisions regarding the effect of alendronate treatment for osteoporosis patients undergoing HD should not be made within only a year after the treatment initiation; rather, a longer observation period is necessary.
#665 Comparison of outcomes between kidney transplant-naïve and post-transplant graft failure peritoneal dialysis patients
Authors: Chen Yi-Ting 
Published: May 2024

Abstract

Background and Aims
Despite progress in kidney transplant medicine, there are still patients experiencing graft failure and returning to dialysis therapy. Data regarding the prognosis of these patients remain conflicting. This study was conducted to compare clinical outcomes between transplant-naïve peritoneal dialysis (PD) patients and those returning to PD after a failed allograft.

Method
In this retrospective cohort study during 2006 and 2016, we included a total of 786 patients on chronic PD. Of them 679 were transplant-naïve, 76 patients underwent a successful transplantation, and 32 patients returned to PD after a failed kidney allograft. Baseline demographics and clinical characteristics were analyzed in relation to the outcomes of all-cause mortality and peritonitis rate. We employed the Kaplan-Meier method and Cox proportional hazards model to evaluate survival, while Poisson regression was utilized to estimate rate ratios for peritonitis.

Results
During a median follow-up of 6.37 years, 56.68 % death and 146.62 episodes of peritonitis/patient-year were observed. Compared with patients who received a kidney graft, transplant-naïve patients were older, more with diabetes and having higher mortality (58.6 ± 15.8, 40.5% and 57.73%, p &lt; 0.0001). After accounting for age, gender, and comorbidities, the adjusted hazards ratios were 0.26 (95% CI 0.13-0.53) in patients with a functioning graft and 1.12 (95% CI 0.61-2.06) in patients returning to PD after graft failure, compared respectively with concurrent PD patients without kidney transplant. The adjusted relative risk of peritonitis in patients resuming PD after graft failure was comparable to those without kidney transplant (95% CI 0.22-1.14).

Conclusion
Successful kidney transplant reduced the risk of overall mortality among patients on long-term PD. Patients returning to PD after graft loss showed outcomes similar to transplant-naïve counterparts. These data support reactivation of PD as a viable option for patients with a failed kidney transplant.