bluuebunny/crossref_metadata_2025_split huggingface dataset:
#2972 Comparison cTPE & DFPP in PIDC patients for procedure time, clinical, biological tolerance and microcosting estimation: lymphapheresis study
Authors: Moranne Olivier , Chkair Sihame , Pambrun Emilie , Ahmadpoor Pedram , Messikh Ziyad 
Published: May 2024

Abstract

Background and Aims
Therapeutic plasmapheresis (TP) is an established therapy in different pathology according to international guidelines. There is different method of TP such as single plasma exchange (SPE) and Double plasmafiltration (DFPP) defined as non selective or semi selective method. Centrifugal (cSPE) and Filtration-membrane based (mSPE) are two different methods of SPE. These methods were already compared but few data exist about comparison of cSPE and DFPP. Objective of this ancillary study is to compare procedure time, biological variation and microcosting of patients treated with cSPE vs DFPP in a prospective single case study (Moranne O BMC neurology 2022).

Method
Lymphapheresis study included 5 patients with idiopathic CIPD treated with chronic TP with regular interval time and clinically stable. Vascular access was central venous catheter (CVC) for 2 patients and peripheral venous access (PVA) for 3 others. cSPE or DFPP was randomized at inclusion then patient was alternatively treated for 6 consecutive session by SPEc (Comtec, FMC KABI) or DFPP (HF 440 Infomed) sessions for a total of 30 session. The target plasma TPV) volume to be processed was 1.5 of total plasma volume and was not modified during the study. Anticoagulation was non fractionated heparin for DFPP with CVC and regional citrate for others. For each session replacement fluid was 100% human serum albumin (HSA) 4% for cSPE and 500 mls HSA for DFPP. We compare cSPE and DFPP considering each patient for (i) time session (including time preparation, time device and time before living) (ii) clinical tolerance (iii) biological tolerance (variation before and after session of Hb, Platelet, Fibrinogen) and (iv) microcosting. Quantitative values were described with median interquartile and compared with mixed model regression analysis.

Results
Patients have median age of 62 [56-68] years with 100% male and a BMI of 27 [23-31]. Patients were treated alternatively with 15 session of cSPE and 15 session of DFPP without difference of TPV between session (4500 mls) but significant higher blood volume process because of lower plasma fraction filtration with DFPP. Time session was not different between TP method but depend on vascular access. No difference was observed for clinical tolerance and Hemoglobin variation between methods. However a significant higher decreased of platelet and fibrinogen was observed during session with cSPE vs DFPP. The quantity of SHA infused during session was significantly higher with cSPE vs DFPP (180 g vs 20 g). Finally according to hospital's perspectives the cost is not very different between cSPE and DFPP but depends on specific material resources and pharmaceutical products of methods.

Conclusion
We show some differences between methods.
#1465 Enhancing vascular access planning in CKD: validating the 40% KFRE threshold in a French retrospective cohort study
Authors: Ingwiller Maxime , Keller Nicolas , Krummel Thierry , Prinz Eric , Steinmetz Lydie , Hannedouche Thierry , Florens Nans 
Published: May 2024

Abstract

Background and Aims
The optimal timing for dialysis vascular access creation remains a complex clinical decision, balancing the risk of early intervention against the prospect of starting dialysis with a central venous catheter. This study sought to compare the predictive capabilities of the Kidney Failure Risk Equation (KFRE) and estimated Glomerular Filtration Rate (eGFR) in determining the appropriate timing for arteriovenous fistula (AVF) creation in patients with advanced chronic kidney disease (CKD).

Method
A retrospective cohort of 238 patients referred for ultrasound vascular mapping from April 2013 to June 2023 was analyzed. Data on patient characteristics, laboratory results, and clinical outcomes were collected. The 4-variable and 8-variable KFRE and eGFR were assessed for their ability to predict end-stage kidney disease (ESKD) within a 2-year period. Discrimination was evaluated using receiver operating characteristic (ROC) curves, and calibration was assessed graphically. Net benefit decision curves were utilized to compare the net benefit of the KFRE models at various threshold probabilities.

Results
The cohort comprised 238 patients with an average age of 65.2 years and a mean eGFR of 13.3 mL/min/m²73. During the median 10.7-month follow-up, 178 patients (74.8%) progressed to ESKD, and 21 (9.2%) died prior to reaching ESKD. At the 1-year mark, the probability of progressing to ESKD was 77.6% (95% CI, 69.9-85.3%) when a 40% threshold for the 4-variable KFRE was applied, compared to 65.8% (95% CI, 58.3-73.3%) with an eGFR threshold of 15 mL/min/m²73. Discrimination analysis demonstrated a superior predictive performance for the 8-variable KFRE at 6 months, with a C-statistic of 0.82 (95% CI: 0.76-0.88). At 1 year, both KFRE models showed strong predictive abilities, with C-statistics of 0.835 (95% CI: 0.78-0.89) for the 4-variable KFRE and 0.82 (95% CI: 0.76-0.875) for the 8-variable KFRE. Sensitivity and specificity analyses underscored the benefits of utilizing the 40% KFRE threshold for predicting ESKD over the eGFR threshold.

Conclusion
The study demonstrates that both the 4-variable and 8-variable KFRE are valuable tools for predicting the need for vascular access in pre-dialysis patients, outperforming eGFR alone. The 8-variable KFRE, in particular, provides a significant improvement in 6-months ESKD prediction, with potential implications for clinical decision-making and patient management in advanced CKD. These findings advocate for the incorporation of KFRE in the clinical evaluation process for timely and appropriate vascular access planning.
#540 Investigation of vascular sound visualization system using electronic stethoscope
Authors: Naganuma Toshihide , Shin Kentaro , Takemoto Yoshiaki , Uchida Junji 
Published: May 2024

Abstract

Background and Aims
The routine evaluation of VA involves visual, palpatory, and auscultatory examinations, as well as monitoring of venous pressure and other parameters. Surveillance indices include Flow Volume (FV) and Resistance Index (RI) obtained by Doppler ultrasound (DU) and Access Blood Flow (Qa) obtained by the Ultrasound Dilution Method (UDM) are well known. On the other hand, the MSS-U11C electronic stethoscope (Fig. 1) and dedicated application (Fig. 2) developed by Pioneer Inc. converts vascular sound into digital data and calculates the INDEX value obtained from the sound intensity (dB) analyzed by the vascular sound visualization system. In this study, we examined the correlation between INDEX values and conventional surveillance indices.

Method
1. Eighty-three cases in which INDEX, FV, RI, and Qa were simultaneously measured in hemodialysis patients with AVF at the Artificial Kidney Department of Osaka Metropolitan University Hospital were included. 2. The measurement site for INDEX was just above the anastomosis of the AVF. 3. FV and RI were measured using a KONICA MINOLTA SONIMAGE HS2 diagnostic ultrasound system with the brachial artery as the measurement site. 4. Measurements were expressed in Median [IQR], and for statistical examination, Pearson's correlation coefficient was used for the correlation of each measurement, transformed to the natural logarithm to satisfy the assumption of normality of the residuals. The significance level for all hypothesis tests was 5%. For statistical analysis, R version 4.2.1 (https://www.r-project.org/foundation/) with the “rms” and “RcmdrPlugin.EZR ” packages were used. 5. This study protocol was conducted in accordance with the Principles of the Declaration of Helsinki. The ethics review boards of Osaka Metropolitan University approved the study (No. 2021-243). Opt-out consent was obtained instead of written informed consent.

Results
INDEX showed a significant positive correlation with Qa and FV (R = 0.449, P = 0.002 / R = 0.484, P &lt; 0.001, respectively), INDEX showed a significant negative correlation with RI (R = −0.336, P = 0.002).

Conclusion
INDEX measurement using an electronic stethoscope is a monitoring index and showed a positive correlation with FV and Qa, which are established surveillance indices, and a weak negative correlation with RI. In Japan, FV and RI are commonly used as surveillance indices, but it has been reported that these indices can be underestimated or overestimated depending on the skill of the examiner, and that Qa requires specialized equipment and cannot be measured depending on the puncture site. We believe that monitoring by stethoscope is influenced by subjective factors of staff members, which may lead to differences in evaluation, but INDEX could become a more quantitative and standardized indicator. In addition, the electronic stethoscope could be used without any difference compared to the stethoscope currently in clinical use.
#1228 MOTS-c improves CV and mortality risk prediction in chronic hemodialysis patients: a prospective, multicenter cohort study
Authors: Musolino Michela , Presta Pierangela , Duni Anila , Zicarelli Mariateresa , Arena Roberta , Pappas Efthymios , Andreucci Michele , Coppolino Giuseppe , Ntounousi Evangelia , Bolignano Davide 
Published: May 2024

Abstract

Background and Aims
Cardiovascular disease (CVD) is the leading cause of death in patients with end stage kidney disease (ESKD), especially in those undergoing chronic hemodialysis (HD), but correct risk prediction in this setting is often complicated.
The mitochondrial open reading frame of 12S rRNA type-C (MOTS-s) is a peptide encoded by mitochondrial DNA, mainly expressed by cardiac and skeletal muscle tissues, which may prevent CVD thanks to its remarkable anti-oxidant capacities. From a clinical point of view, altered circulating MOTS-c levels predict worsen CV outcomes, particularly among diabetic individuals or post-AMI patients. Mitochondrial dysfunction is highly pervasive in HD patients. Starting from this background, we aimed at evaluating the clinical significance and predictive usefulness of measuring circulating MOTS-c in a multicenter cohort of chronic HD patients, beyond common cohort-related risk factors.

Method
We conducted a prospective, observational study on 94 chronic HD patients. The study endpoint was a composite of all-cause/CV mortality and non-fatal CV events. We identified the cohort-related predictors of the endpoint by logistic and Cox-regression analyses and built prognostic models based on such variables. Performance of such models was tested before and after the inclusion of MOTS-c.
31 healthy patients were employed as controls. MOTS-c was measured in serum using a commercially available ELISA kit.

Results
MOTS-c levels were more elevated in HD patients than in controls (36.7 [24.9-49.9] vs. 13.8 [10.4-28.7] ng/mL; p &lt; 0.001; Fig. 1) and independently correlated with a history of ischemic heart disease (β = 0.213; p = 0.03), LVMi (β = 0.185; p = 0.05) and phosphate plasma concentration (β = −0.201; p = 0.05). Of note, MOTS-c levels were even more increased in the 53 individuals experiencing the endpoint during a median 26.5. months follow-up (p = 0.01; Fig. 2).
MOTS-c predicted the endpoint at either multivariate logistic (OR 1.020; 95% CI 1.011-1.109; p = 0.03) or Cox-regression analyses (HR 1.004; 95% CI 1.000-1.025; p = 0.05) and the addition of this peptide to multivariate models including the other, cohort-related risk factors (age, LVMi, E/e’, diabetes, pulse pressure) remarkably improved the calibration, risk variability explanation (+3%), discrimination (ROC-AUC from 0.727 to 0.743; C-index from 0.658 to 0.700) and, particularly, the overall reclassification capacity (NRI 15.87%; p = 0.01).

Conclusion
Circulating MOTS-c balance is altered in chronic HD patients. In these individuals, MOTS-c may add significant information to improve CV and mortality risk prediction, on top of traditional and uremia-specific, cohort-related risk variables. Future investigations are needed to extend this preliminary observation in wider HD cohorts.
#1105 Prognosis of dialysis patients with obstructive sleep apnea syndrome diagnosed by polysomnography
Authors: Nakamura Kei , Iseki Kunitoshi , Iseki Chiho , Moromizato Takuhiro , Takara Chikashi , Nakamura Hiroshi 
Published: May 2024

Abstract

Background and Aims
Obstructive Sleep Apnea Syndrome (OSA) is common among CKD, in particular dialysis patients. However, it is not yet studied in a large polysomnography (PSG) database. Randomized controlled trials (RCTs) proved the effectiveness of continuous positive airway pressure (CPAP) for the SAS-related symptoms, but not for lowering the mortality risk of all-cause and cardiovascular disease. However, the effect of CPAP on mortality risk is not examined among dialysis patents.

Method
We identified dialysis patients by reviewing medical records in the Okinawa Nakamura Clinic (ONSLEEP). (J Clin Sleep Med 2021). In the ONSLEEP, a total of 10,856 Japanese patients received PSG from September 1990 to December 2010. We defined patients who were on CPAP more than one month as CPAP user. Patients qualified and eligible for CPAP but refused it were assigned as CPAP non-users. Median observation was 6.6 years. We studied 9,841 PSG patients after excluding those with insufficient data, age&lt;20 years, and central SAS. Among them, we found 195 dialysis patients: 16 (1.0%) dialysis patients with AHI&lt;5/hour in 1,665 subjects and 164 (2.5%) in 8,176 OSA patients. Mortality rate was compared between CPAP users and nonusers by multivariate logistic analysis adjusted for age, gender, body mass index (BMI), and apnea hypopnea index (AHI).

Results
Among the OSA dialysis patients (men 127, women 37), there were 116 (2.6%) in the CPAP users and 48 (2.2%) in the CPAP non-users, respectively. Number of deaths was 65 (39 CPAP users, 26 CPAP non-users) during the follow-up. The death rate was 33.6% in the CPAP users and 54.2% in the CPAP non-users, respectively. CPAP users showed better survival after starting dialysis; hazard ratio (HR) 0.52 and 95% confidence interval (CI) of 0.31 to 0.88 (P = 0.015). Age was also a significant predictor of death; HR (95% CI) 1.04 (1.02-1.06, P &lt; 0.0001).

Conclusion
Dialysis patients with OSA showed better survival by use of CPAP. In dialysis patients, screening of OSA is recommended if they complained sleep problems such as insomnia, daytime sleepiness, headache, and fatigue. Also, we need further study for those CPAP nonusers.
#1252 Non-standardized definition of chronic dialysis within German health claims data results in varying estimates for incidence and mortality
Authors: Ebert Natalie , Bothe Tim , Fietz Anne-Katrin , Mielke Nina , Freitag Julia , Schaeffner Elke 
Published: May 2024

Abstract

Background and Aims
Chronic dependency on dialysis in patients with chronic kidney failure (CKF) demands invasive, high-risk, and costly treatments. At present, there is no standardized definition for dialysis-dependent CKF within German health claims data from statutory health insurance (SHI) funds.

Method
Random samples from four year tranches (2012, 2014, 2016, 2018), each with 62,200 individuals aged ≥70 years, of German health claims data of the SHI AOK Nordost were analysed. Four literature-based definitions of dialysis-dependent CKF (1–4) and a newly developed definition, based on a billing logic with criteria required for monetary reimbursement for chronic dialysis treatments in patients with CKF by SHIs, were selected. The definitions were compared with regard to sociodemographic and clinical characteristics, dialysis-dependent CKF prevalence and incidence (standardized by year-, age group-, and sex-specific weights for Northeast-Germany), overall mortality, and direct health care costs.

Results
All definitions of dialysis-dependent CKF resulted in varying estimates of 12-month prevalence (0.33–0.61%) and six-month incidence (0.058–0.100%). Depending on the definition, 27.6% to 61.8% of incident individuals had a preceding acute kidney injury (AKI). Survival probabilities of individuals with dialysis-dependent CKF ranged from 70.2% to 88.1% and 60.5 to 81.3% after three and six months, respectively (Fig. 1). After stratification, survival probabilities differed less between the definitions in individuals without a preceding AKI. Monthly health care cost ranged from 6,010 to 9,606 EUR and varied strongly in out- and inpatient treatment costs depending on the definition. Cost was highest in inpatients with preceding AKI.

Conclusion
Due to a non-standardized definition of dialysis-dependent CKF in claims data we found varying case numbers, mortality, and health care costs, most probably in large part explained by the discrepant inclusion of individuals with short-term dialysis treatment due to AKI.
#82 Serum zinc level is associated with aortic arch calcification in patients with incident dialysis
Authors: Saka Yosuke , Naruse Tomohiko 
Published: May 2024

Abstract

Background and Aims
Aortic calcification is one of predictors of cardiovascular (CVD) events. Several studies show association between zinc deficiency and aortic calcification in patients with chronic kidney disease (CKD). However, there are few studies in patients with advanced CKD. Therefore, we investigated associations between serum zinc (s-Zn) levels and aortic arch calcification (AAC) in patients with incident dialysis.

Method
We analyzed data from 776 consecutive patients with CKD who started dialysis at our hospital between January 2013 and December 2022. We excluded 71 patients who were supplemented with zinc or who were not measured laboratory data including serum zinc at the time of dialysis initiation. AAC is graded from 0 (no calcification) to 3 on chest X-ray, as follows: grade 0, no visible calcification; grade 1, &lt; 50% calcification in the arch; grade 2, &gt; 50% calcification; grade 3, circumferential calcification. We defined grade 2 or 3 as severe calcification.

Results
The median s-Zn levels were 51, 47 and 44 μg/dL in patients with grade 0, 1 and 2-3 on AAC, respectively (p &lt; 0.0001). The optimal cutoff value for s-Zn levels was 48 μg/dL in receiver operating characteristic (ROC) curves analysis. In multivariate analysis, low s-Zn level (s-Zn &lt; 48 μg/dL) was independently associated with AAC [OR 2.36 (95% CI 1.55–3.60), p &lt; 0.0001)], especially with severe AAC [OR 4.59 (95% CI 2.46–8.59), p &lt; 0.0001)]. Addition to s-Zn level in a model with established factors on AAC improved the C-index (0.812 to 0.824, p = 0.0181), net reclassification improvement (NRI) (0.397, p &lt; 0.0001) and integrated discrimination improvement (IDI) (0.020, p &lt; 0.0001). More robust findings for the C-index (0.856 to 0.878, p = 0.0077), NRI (0.591, p &lt; 0.0001) and IDI (0.045, p &lt; 0.0001) were observed on severe AAC.

Conclusion
Low s-Zn level was independently associated with severity of AAC, also in patients with incident dialysis.
#570 A study of QTc time trends and factors affecting QTc changes during dialysis
Authors: Mimura Yasuyuki , Kuma Akihiro , Tasaka Mariko , Suwabe Atsuko , Nanami Masayoshi , Nakanishi Takeshi , Kuragano Takahiro 
Published: May 2024

Abstract

Background and Aims
Several studies have revealed the relationship between an abnormal QTc interval and mortality with sudden death in patients undergoing haemodialysis (HD). The QTc interval in HD is regulated by several factors, such as electrolytes, pH, and drugs. However, few studies have investigated the changes in the QTc interval during HD sessions and the determining factors. Therefore, we investigated the relationship between changes in electrolytes and QTc interval during HD.

Method
In this cross-sectional study, 53 patients undergoing maintenance HD were enrolled. Electrocardiogram and blood samples were obtained two days after dialysis. QTc was measured every hour from the start of the HD session, and blood samples were collected at the start, 2 h after, and at the end of the HD session. At the start of the HD session, we measured the blood levels of urea nitrogen, creatinine, β2-microglobulin (β2MG), HCO3-, albumin, intact-parathyroid hormone, phosphorus, Ca, Mg, and K. Blood Ca, Mg, K, and HCO3- levels were evaluated at the start, 2 h after, and at the end of the HD session. The relationship between changes in the QTc interval and various parameters was analysed by Spearman correlation analysis and multiple regression analysis.

Results
The patients were aged 37–91 (median; 71.5) years, and the duration of dialysis was 1–402 months (median; 2 months). Of the patients, 40.4% were diagnosed as the prolonged QTc interval (≥460 ms) at the start of HD (median; 455 ms). Conversely, 15.9% of patients at 2 h after the start of HD (median; 444 ms) and 8.4% of patients at end of HD (447 ms) were normalized in QTc interval. The peak change in the QTc interval occurred 2 h after start of HD. Thus, we estimated the factors that affected the change in QTc 2 h after the start of dialysis (ΔQTc2h). The duration of HD treatment (r = 0.312, P = 0.025) and serum levels of β2MG (r = 0.324, P = 0.019) were positively correlated with ΔQTc2h. The 2-h change in corrected Ca (ΔcCa2h) (r = −0. 31, P = 0.03) and intact-PTH (r = −0.30, P = 0.035) were negatively correlated with ΔQTc2h. We found no significant correlation between ΔQTc2h and changes in K and Mg. According to the multiple regression analysis, ΔcCa2h (β = −0.293, P = 0.033) and β2MG (β = 0.271, P = 0.042) were significant predictors of ΔQTc2h.

Conclusion
We anticipated that QTc interval might be prolonged due to the decreased serum K and Mg levels via HD treatments. However, QTc levels during HD were shortened according to increased serum Ca levels. Among the electrolyte levels, the change in blood Ca was significantly correlated with the change in the QTc interval but not with the change in Mg and K. The study results suggest the importance of optimal dialysate electrolytes composition to prevent adverse events and premature death caused by abnormalities in the QTc interval.