bluuebunny/crossref_metadata_2025_split huggingface dataset:
#2049 Prognosis of decreased renal function in patients with arterial hypertension
Authors: Boiko Olha , Rodionova Viktoriia 
Published: May 2024

Abstract

Background and Aims
Chronic kidney disease and hypertension are closely related in cause and effect. As the glomerular filtration rate decreases, the frequency and severity of arterial hypertension increases. In addition, the risk of morbidity and mortality from cardiovascular diseases increases significantly with comorbidity of arterial hypertension and chronic kidney disease. The purpose of this study was to identify predictors of a decrease in GFR below 60 ml/min in patients with arterial hypertension.

Method
The cross-sectional study included 43 patients with arterial hypertension (average age 56.7 (10.6) years). Exclusion criteria were age over 80 years, primary kidney disease, diabetes mellitus, cancer, heart failure, stage III arterial hypertension. All patients underwent determination of cystatin C in the blood, the composition of the body was studied using the bioimpedance method and 24-hour blood pressure monitoring. To identify predictors of kidney damage, we used regression analysis with ROC curve estimation using MedCalc software.

Results
The optimal value (cut-off point) of the content of total adipose tissue, which allows the most accurate prediction of a decrease in GFR &lt; 60 ml/min in patients with hypertension, was 26.1% (sensitivity −100%, specificity—77.8%), and the content of total muscle tissue—35.9% (sensitivity −100%, specificity—44.4%). The optimal value (cut-off point) of cystatin C was 1.13 (sensitivity −100%, specificity—53.9%), AUC—0.73 (0.46; 0.92). At the same time, when this predictor was included once in multiple logistic regression, the statistical significance decreased (p = 0.5). Among individual predictors of decreased renal function, indicators of 24-hour blood pressure monitoring were studied. The optimal value (cut-off point) of the ambulatory arterial stiffness index, which allows the most accurate prediction of a decrease in GFR &lt; 60 ml/min in patients with arterial hypertension, was 0.36 (sensitivity −100%, specificity—71.4%), an indicator of an increase in the rate of increase in diastolic blood pressure. blood pressure—0.27%, AUC 0.74 (0.48; 0.91)) and the rate of increase in nighttime decrease in systolic blood pressure—8.1%, AUC 0.71 (0.47; 0.89).

Conclusion
Increase in total adipose tissue &gt; 26.1%, decrease in total lean tissue &lt;35.9%, increase in ambulatory arterial stiffness index &gt;0.36, increase in rate of increase in diastolic blood pressure &gt;0.27%, and increased nocturnal decrease in systolic blood pressure &gt; 8.1% were identified as significant predictors of a decrease in GFR below 60 ml/min in hypertension.
#723 The impact of kidney function on arterial stiffness in COVID-19 survivors: an analysis from CARTESIAN Study
Authors: Moriconi Diego , Mayer Christopher , Boutouyrie Pierre , Bruno Rosa Maria 
Published: May 2024

Abstract

Background and Aims
SARS-CoV-2 pandemic has been linked to an increased incidence of cardiovascular events, potentially due to accelerated vascular aging [1]. Conversely, impaired kidney function is known to contribute to the pathogenesis of heightened arterial stiffness, independent of traditional cardiovascular risk factors [2]. This study aimed to assess the impact of COVID-19 on arterial stiffness among a cohort of survivors of the first pandemic wave, with varying degrees of infection severity. The assessment was conducted at 6 ± 3 (T1) and 12 ± 3 months (T2) post-infection, with the population stratified based on kidney function.

Method
the CARTESIAN study, a large international multicenter cohort study, was designed to assess the long-term effects of COVID-19 on vascular aging.
A total of 938 subjects were stratified into three groups based on their estimated glomerular filtration rate (eGFR) percentiles using the CKD-EPI_2021 equation: 1) &gt;75th percentile, 2) 75th-25th percentile, and 3) &lt;25th percentile, respectively. The same population was further categorized based on the severity of COVID-19 into three groups: 1) patients who were not hospitalized (No-Hosp), 2) subjects requiring hospitalization in a medical unit (Hosp), or 3) those in an intensive care unit (ICU). Arterial stiffness was evaluated using carotid-femoral pulse wave velocity (cf-PWV). A hierarchical repeated measures mixed model analysis was conducted to compare cf-PWV across these groups (&gt;75th, 75th-25th, and &lt;25th groups, respectively).

Results
in the cross-section analysis (T1) &lt;25th group exhibited higher age, increased cardiovascular risk factors, and higher prevalence of severe COVID-19 compared to the &gt;75th group. Using hierarchical linear modeling, the &lt;25th exhibited higher cf-PWV than the &gt;75th group, even after adjusting for both all the random and fixed variables, included the three COVID-19 group (+0.51 m/s, p = 0.013).
In longitudinal analysis, globally, no substantial changes were found in the cf-PWV between T1 and T2, remained significantly higher in the &lt;25th group compared to the &gt;75th group (p = 0.003), in a linear mixed model adjusted for all the random and fixed variables. Interestingly, a significant interaction between eGFR groups* COVID-19 groups was found in repeated measures analysis (p = 0.039). In particular, within ICU group, we found a significant increase of cf-PWV between 6- and 12-months in &lt;25th group, from 8.64 [7.59-9.31] to 9.41 [8.89-10.41] m/s, p = 0.021) (Fig. 1).

Conclusion
the findings suggest that individuals with both lower eGFR and a history of severe COVID-19 may be at a heightened risk of accelerated arterial aging. Understanding these dynamics is crucial for targeted interventions to mitigate long-term cardiovascular consequences in COVID-19 survivors with kidney disease.
#780 “In vivo” difference in ultrafiltration coefficient between two same membrane dialyzers: bigger surface area accounts for better dialysis outcomes?
Authors: Villa-Valdés Miguel , Nava-Chávez Coraima Claudia , Vega Almudena , Verde Eduardo , Vaca Marco , Bascuñana Arturo , Macías Nicolás , Goicoechea Marian 
Published: May 2024

Abstract

Background and Aims
Ultrafiltration coefficient (KUF) is a measure of dialyzer permeability to water, given by manufacturers, and expressed in milliliters/hour/mmHg of pressure gradient. Most dialyzers used at this moment are classified as high-flow as having a KUF &gt;20 mL/h/mmHg. KUF value of a dialyzer is an “in vitro” measure which does not correlate with “in vivo” measure, stated to be 5-30% less than theoretical KUF. According to this statement, we wanted to study differences between theoretical and real KUF of two dialyzers with the same membrane composition and different surface area. For this task, we chose 2 dialyzers of usual use in our dialysis unit: FX CorDiax 1000 and FX CorDiax 80 (®FMC). These dialyzers have a main difference in Surface area: 2.3 and 1.8 m2, respectively, and have a theoretical KUF of 76 and 64 mL/h/mmHg. Also, both dialyzers differ in intern diameter (210 vs 185 µm).

Method
A prospective, not randomized trial was conducted. Inclusion criteria were patients in chronic dialysis at our center, in postdilutional online hemodiafiltration with a FX1000 dialyzer. All patients were informed and accepted freely signing an informed consentment. On 2 consecutive weeks, the intermediate dialysis session of the week was performed in a DBB-EXA dialysis monitor (®Nikkiso), first with a FX CorDiax 1000 and next week with a FX CorDiax 80, with habitual patient dialysis parameters (240 minutes). Blood tests were taken previous and after the session to evaluate clearance differences between both filters. During the session, pressure and flow data was recorded, with an “in vivo” KUF measurement given by the monitor.

Results
Dialysis sessions were performed in 12 patients who met inclusion criteria. Data results are shown in Table 1. Significant differences between FX CorDiax 1000 and FX CorDiax 80 were observed in prefilter pressure (p 0.008), convective volume (p 0.034), prolactin reduction ratio (p 0.012), “in vivo” KUF/ “in vitro” KUF ratio (p 0.002). “In vivo” KUF graphic given by the monitor showed a logarithmic function curve, with a stabilization between the 2nd and 3rd hour of the session.

Conclusion
In our study, measurement of “in vivo” KUF by Nikkiso monitor showed a slow decrease after 2nd hour of session, probably related with protein cake of membrane pores. “In vivo” KUF measure was approximately a 40-45% of theoretical value given by manufacturer. The “in vivo” KUF/ “in vitro” KUF ratio was higher for the smaller dialyzer, which probably means a higher optimization of its surface area with usual dialysis sessions.
Convective volume and prolactin reduction ratio, as parameters of dialysis efficacy, are higher in the dialyzer with higher surface area and inner intern diameter.
#949 Factor XIIa inhibitory antibody does not provide sufficient anticoagulation in ex vivo hemodialysis
Authors: de Laval Philip , Nilsson Bo , Ekdahl Kristina Nilsson , Fellström Bengt , Soveri Inga 
Published: May 2024

Abstract

Background and Aims
Unfractionated heparin (UFH) and low molecular-weight heparin (LMWH) are the most commonly used anticoagulants in haemodialysis (HD). While effective in preventing clotting, they are also associated with complications including increased risk of bleeding and heparin induced thrombocytopenia. The contact activation system is commonly assumed to be the main trigger of coagulation during HD, through autoactivation of factor (F)XII upon contact with the dialyser. FXII deficient individuals do not have an increased risk of bleeding which makes activated FXII (FXIIa) an attractive drug target as it has the potential to inhibit clotting without disrupting haemostasis. The aim of the study was to evaluate the efficacy of CSL312, a monoclonal, humanized IgG4 antibody against activated FXII (FXIIa), in preventing intradialytic coagulation.

Method
An ex vivo haemodialysisis model was used to test the efficacy of CSL312 as an anticoagulant. CSL312 (400 µg/mL) was compared to standard doses of UFH, LMWH and citrate anticoagulation. The antibody was provided by CSL Limited. Anticoagulant-free haemodialysisis was used as control. Whole-blood was collected from 12 healthy adult donors in blood-transfer bags containing citrate to prevent clotting before dialysis. Each donor provided blood for two HD-sessions, using different anticoagulants. The blood was dialyzed for one hour through paediatric polysulfone high-flux dialysers. Right before the start of HD, calcium was added to reverse the anticoagulant effect of citrate, except in the citrate group. Blood was sampled before and at 5, 15, 30 and 60 minutes after HD start. To quantify the activity of the contact system, the concentrations of enzyme-inhibitor complexes of antithrombin (AT) or C1-inhibitor (C1INH) in conjunction with FXIIa, FXIa, kallikrein, MASP-1, MASP-2 and thrombin were measured in plasma using enzyme-linked immunosorbent assays.

Results
Using CSL312 to inhibit FXIIa protease activity (n = 5), clotting occurred in all tests (at 30, 31, 36, 49 and 50 minutes) with a mean clotting time of 39.2 minutes compared to 17 and 30 minutes using no anticoagulation (n = 2). No clotting was evident with other anticoagulants. Using CSL312, the plasma concentration of FXIIa-C1INH at 15 minutes was significantly higher than at baseline (mean 26.2 (SD 9.08) vs mean 17.6 (SD 10.6) µg/mL, p = 0.011).

Conclusion
FXIIa inhibition using a monoclonal antibody does not provide sufficient anticoagulation during HD. This suggests that the contact system may not be solely responsible for clotting during HD.
#1562 Longitudinal changes in quality of life—a comparison between institutional hemodialysis, home-hemodialysis and peritoneal dialysis
Authors: Rydell Helena , Caldinelli Aurora , Chesnaye Nicholas , Evans Marie 
Published: May 2024

Abstract

Background and Aims
Quality of life is an important factor for patients when planning for future dialysis care and for some individuals, it might be even more important than a prolonged life. Knowledge about differences between dialysis modalities is essential for patients making informed decisions. Most previous research on differences in quality of life between dialysis modalities have been cross-sectional and subjected to selection bias; few large contemporary studies have investigated the changes in quality of life between the three dialysis modalities; institutional hemodialysis (IHD), home hemodialysis (HHD) and peritoneal dialysis. The aim of the present study was to compare longitudinal changes in health-related physical and mental quality of life between patients on IHD, PD, and HHD.

Method
Patients on dialysis with at least two Research and Development 36 (RAND-36) questionnaires between 2017-2021 in the Swedish Renal Registry (SRR) were eligible for inclusion. Information on dialysis modality, patient characteristics and medication were obtained from the SRR and other national registries. Patients were followed for three years and remained in their designated dialysis modality in the analysis until end of the follow-up (intention-to-treat). Changes in physical (PCS) and mental (MCS) component summary score were analyzed in adjusted linear mixed models and joint models where informative censoring due to mortality and kidney transplantation was considered.

Results
930 patients (IHD 714, HHD 88, PD 128), were followed for 1.8 years (IQR 1.0–2.1). Patients on HHD were younger, had lower Charlson comorbidity index (CCI) and higher serum albumin compared with IHD and PD (Table 1). At baseline, patients on IHD had a mean PCS 30.7 (95% CI 29.9–31.4) and MCS 45.6 (95% CI 44.7–46.5). The unadjusted PCS at baseline was higher in HHD patients (4.5 [95% CI 2.2–6.9]) and PD patients (2.5 [95% CI 0.5–4.5]) compared with patients on IHD but showed no difference in the adjusted models. Both unadjusted and adjusted MCS was similar at baseline. The PCS declined over time in all modalities; faster for patients on PD compared with IHD (−1.2 per year [95% CI −2.1 – −0.3]; Fig. 1). MCS decreased similarly for both PD and IHD over time, while patients on HHD had an improving MCS (1.5 per year [95% CI 0.1–2.8]) compared with patients on IHD (Fig. 2).

Conclusion
There are differences in the development of physical and mental quality of life over time for patients on different dialysis modalities. The dialysis modality with the overall most positive development was HHD. Offering HHD to more patients could potentially improve the quality-of-life for patients on dialysis.
#1498 Higher body mass index in patients with diabetes mellitus and hemodialysis associated with a better survival in contrast to peritoneal dialysis
Authors: Afghahi Hanri , Nasic Salmir , Wãrme Anna , Peters Björn 
Published: May 2024

Abstract

Background and Aims
The association between Body Mass Index (BMI) and the risk of mortality in patients with end stage renal diseases and dialysis treatment is debated. The aim of this study was to assess the association between BMI and the risk of all-cause mortality in patients with diabetes mellitus (DM) on maintenance hemo- (HD) versus peritoneal dialysis (PD).

Method
We used the data from Swedish Renal Registry (SRR) which included 3235 patients with diabetes mellitus on dialysis treatment (2452 on HD and 783 on PD). The follow-up period was 3.9 ± 3.5 years and patients who switched from PD to HD, or vice versa, during the study period were excluded. The patients were divided in six groups by mean value of BMI according to classification of BMI by WHO. The relationships between mean value of BMI and mortality were examined by time-dependent Cox models to estimate hazard ratios (HR) and 95% confidence intervals (CI) in univariate and multivariate analyses, with adjustment for demographics, laboratory findings and comorbidities. The group with BMI 18.5&lt;BMI≤25.0 kg/m2 was used as a reference group.

Results
During the follow-up period 1688 (53%) deaths occurred (1275 on HD, 413 on PD). The mean value of BMI was 27 ± 6 kg/m2 in HD and 26 ± 5 kg/m2 in PD. In the multivariate analyses, patients on HD with a low BMI≤18.5 kg/m2 had a higher risk for all-cause mortality (HR1.94, CI 1.47-2.54; p &lt; 0.01) compared to the reference group. However, HD-patients with a higher BMI 25.1-30.0 kg/m2 (HR 0.84, CI 0.73-0.96; p &lt; 0.01), 30.1-35 kg/m2 (HR 0.66, CI 0.55-0.78; p &lt; 0.01), and 35.1-40.0 kg/m2 (HR 0.65, CI 0.49-0.85; p &lt; 0.01) had a significantly decreased risk of all-cause mortality compared to the reference group. In multivariate analyses, patients on PD, BMI groups of 25.1-30 kg/m2 (HR 0.86, CI 0.67-1.09), 30.1-35 kg/m2 (HR0.94, CI 0.67-1.31), and 35.1-40 kg/m2 (HR 0.93, CI 0.48-1.77) were not-significantly associated with a risk of mortality.

Conclusion
In patients with diabetes mellitus on maintenance hemodialysis underweight (BMI≤18.5 kg/m2) was associated with an increased risk of all-cause mortality; however overweight (BMI 25.1-30.0 kg/m2), class 1 obesity (BMI 30.1-35.0 kg/m2) and class 2 obesity (BMI 35.1-40.0 kg/m2) were associated with better survival. In contrast, in patients with diabetes mellitus on maintenance peritoneal dialysis no association between BMI and risk of all-cause mortality was found.
#861 Intradialytic oxygen saturation in chronic hemodialysis patients—results from a large U.S. population
Authors: Ban Andrea Nandorine , Wang Lin-Chun , Ye Xiaoling (Janice) , Filardi Vincent , Soni Mitesh , Scott Shawn , Singh Kanti , Waguespack Peter , Kotanko Peter , Zhang Hanjie 
Published: May 2024

Abstract

Background and Aims
The study of intradialytic oxygen saturation (SO2) in hemodialysis (HD) patients is a significant yet under-explored area. This study's objective was to evaluate the epidemiological aspects of SO2 during HD.

Method
SO2 levels during HD were measured using the Crit-Line Monitor (CLM; Fresenius Medical Care North America, Waltham, MA), a device certified by the US Food and Drug Administration (FDA) for the measurement of hematocrit and SO2 in the extracorporeal circuit. CLM measurements were recorded at 10-second intervals and transmitted into Amazon Web Services (AWS) via Apache KAFKA, a real time streaming software. Apache KAFKA was rolled out in phased approach, started early 2021. We extracted CLM data between January 14, 2021, and July 30, 2023.
CLM values with the following characteristics were deemed implausible and hence, excluded: SO2 ≤ 0 or ≥99.9; hematocrit &lt; 15% or &gt;60%. We computed basic statistics of SO2 for every HD session. We then excluded the sessions with the standard deviation of SO2 &lt; 0.1%, an interquartile range of zero, and sessions with less than 360 SO2 measurements (i.e., less than 60 minutes of recording).

Results
We collected data from over 5.6 million HD sessions. After data cleaning, we retained 4.9 million HD sessions from 72,656 patients treated in 727 dialysis clinics across the US. The average duration of a session was 204.5 (±42.8) minutes. Per HD session, on average 1,227 (±257) SO2 measurements were recorded. The distribution of the number of SO2 measurements per HD session is shown in Fig. 1A. The mean of the session-level average SO2 was 88% (±15%). The distribution of session-level average SO2 is shown in Fig. 1B. The bimodal distribution of SO2 is attributed to the use of arterio-venous and central venous vascular accesses, respectively.

Conclusion
We collected and analysed a substantial dataset of intradialytic SO2 in a large US HD population. These data provide a rich source for future research into SO2 and its clinical correlates. Exploring intradialytic SO2 in depth will offer valuable insights to improve patient care and optimize treatment procedures.
#2155 Evaluating the health-related quality of life of patients undergoing haemodialysis: highlights from a multicentric nationwide study
Authors: Martínez-Vaquera Shaira , Sorribes Mª Paz , Sánchez Christian Israel Alfaro , Martínez-Sánchez Teresa , Porras Jonathan , de León Ignacio Ponce , Martínez-Pérez Oscar , Díaz-Cuervo Helena , Cuervo Jesús , Macário Fernando 
Published: May 2024

Abstract

Background and Aims
Haemodialysis (HD) represents the most common renal replacement therapy for end-stage renal disease worldwide. Despite recent advances in HD the health-related quality of life (HRQoL) should be monitored in conjunction with clinical variables to optimize a comprehensive treatment.

Method
From June to July 2022, all patients from 47 clinics were included. Among other key relevant clinical variables, HRQoL was assessed by using the Kidney Disease Quality of Life Short Form (KDQOL-SF™ 1.3).It`s generic part is summarised in the physical component summary (PCS) and mental component summary (MCS). The specific part evaluates 11 domains: symptom/problem list; effects of kidney disease on daily life; burden of kidney disease; work status; cognitive function; quality of social interactions; sexual function; sleep; social support; dialysis staff encouragement; and patient satisfaction. All scores range from 0 (worst) to 100 (best). To ensure comparability of results, mean ± SD values are outlined, even though non-parametric tests were used to test associations.

Results
A total of 3,595 patients (67.3% male) completed the KDQOL (out of 4259 HD patients treated during study period). Most of them (67.18%) were over 60yo of age, and 65.67% had a severe comorbidity index score. In addition, 50.54% had a native AV fistula and only 3.92% were incident HD. PCS scores reported were higher in over 75yo (47.68 ± 10.63) rather than normative population (40.16 ± 11.62), indicating an overall good physical function. However, MCS values (33.17 ± 9.36) were indicative of substantial impact. Gender differences were noted across almost all disease-specific and generic domains (all p &lt; 0.05). Severe comorbidity scores were associated with lower scores in certain renal specific domains and MCS. Finally, incident HD patients reported lower satisfaction and poorer perceived overall health (p-values = 0.001).

Conclusion
Although PCS scores reported were reasonable, a remarkable impact on mental health was found. Moreover, a differential impact of patient's HRQoL was captured based on gender and other variables highlighting the need of individualised evaluation and management of HD patients.