bluuebunny/crossref_metadata_2025_split huggingface dataset:
#443 LEVIL evaluates the impact of HDx on HR-QoL and symptoms, including durability-of-effect and variability
Authors: Penny Jarrin , Mcintyre Christopher 
Published: May 2024

Abstract

Background and Aims
Current hemodialysis (HD), utilizing conventional high-flux dialyzers, is handicapped by clearance limitations (larger-sized uremic toxins), which contribute to poor health-related quality-of-life (HR-QoL) and symptom-burden. Recent international consensus and guideline-setting efforts have explicitly prioritized identification and management of symptoms and subjective experience, whilst also acknowledging the lack of tools available to fully appreciate and continuously monitor these challenges. This study aimed to utilize dynamic patient-reported-outcome-measurement tool (PROM), London Evaluation of Illness (LEVIL-developed in-house), to iteratively interrogate patient-experience and to confirm previously reported HR-QoL benefits of the use of expanded hemodialysis (HDx) using medium cut-off dialyzer (extending the spectrum of uremic toxins being addressed). Furthermore, this study aimed to extend appreciation of effects on patient subjective experience to include durability-of-effects, variability of symptom-measures and impact of HDx withdrawal.

Methods
We conducted a multi-centre interventional study in 47 patients established on conventional thrice weekly centre-based HD in Ontario, Canada. Study protocol was 15-months in length with five phases 1) one-month observation (high-flux-HD), 2) three-months HDx 3) two-month wash-out (high-flux-HD), 4) six-months HDx, 5) three-month wash-out (high-flux-HD). HR-QoL and symptom-burden were evaluated using LEVIL throughout study.

Results
HDx-therapy improved HR-QoL [p 0.0006 (19% from baseline)] and a variety of symptoms including general wellbeing [p 0.005 (23%)], energy [p 0.004 (33%)], sleep-quality [p 0.001 (33%)], pruritus [0.003 (30%)], pain [p 0.01 (19%)], restless leg syndrome [p 0.0006 (15%)], mood [p 0.02 (12%)], appetite [ p 0.03 (9%)], breathlessness [p 0.001 (9%)], and HD-recovery [p 0.004 (26%)]. Response was more pronounced in those with poorer HR-QoL and higher symptom-burden. Improvements were durable over time with continued use with less symptom-variability (range 10-35% improvement). Improvements diminished gradually with return to high-flux-HD. The drivers of poor HR-QoL were largely general-wellbeing, energy, sleep-quality, pruritus, and bodily pain.

Conclusion
Use of a dynamic PROM effectively allowed appreciation of HR-QoL burden in HD-patients. Use of HDx-therapy results in improved patient subjective outcomes that are durable and associated with significantly lower variation in important symptom-domains than patients experience with receiving conventional high-flux-HD.
#2589 Predictive value of serum lactate in ICU dialysis-dependent AKI patients
Authors: Jerman Alexander , Šturm Hana , Suligoj Brina , Persic Vanja 
Published: May 2024

Abstract

Background and Aims
Hyperlactatemia is frequently observed in critically ill patients. It is often associated with unfavorable outcomes and serves as a strong predictor of mortality. Renal replacement therapy aims to mitigate lactate accumulation in this particular subgroup of patients, but the effectiveness of this therapy in reducing morbidity and mortality in acute kidney injury (AKI) associated lactic acidosis remains inconclusive. The aim of this retrospective study was to evaluate the predictive role of serum lactate in dialysis-dependent AKI patients stratified on three different underlying etiologies (septic shock, concomitant liver failure and metformin-associated lactic acidosis).

Method
A retrospective, single-center cohort analysis was conducted to examine patients with AKI who underwent hemodialysis in our ICU between 2022 and 2023 and had a serum lactate &gt; 4 mmol/L. Patients were stratified according to underlying etiology: isolated septic shock with AKI, shock with concomitant AKI and fulminant liver failure (serum ammonia &gt; 100 µmol/L), and AKI with metformin-associated lactic acidosis (MALA). We compared patients according to age and 3-day, 30-day, and 90-day mortality. Finally, we performed receiver-operating-curve (ROC) analysis to potential predictive power of serum lactate for 30-day mortality.

Results
The median age of our cohort of 63 patients was 67 (range 52 - 74) years, with a median lactate level of 12.9 (7.6 – 18.0) mmol/L. The 3-day, 30-day and 90-day mortality rate was 57%, 78%, and 83%, respectively. We observed that patients with concomitant liver failure were significantly younger (p = 0.004). Interestingly, while all groups have comparable 90-day mortality, patients with septic shock exhibit extremely high 3-day mortality (74%), compared to 35% and 25% for acute liver failure and metformin-associated shock. ROC curve analysis showed that serum lactate was highly predictive of 30-day mortality in group of AKI with concomitant fulminant liver dysfunction. On the contrary, in metformin-associated hyperlactatemia the level of serum lactate showed no such prediction.

Conclusion
Our retrospective analysis underscores the crucial importance of differentiating between various groups of patients (septic shock, concomitant liver failure and metformin-associated lactic acidosis) in patients with hyperlactatemia. In metformin-induced kidney failure, the level of lactate does not predict mortality, while in the cases of AKI with concurrent acute liver dysfunction our results are highly suggestive that dialysis may not be effective for severe lactacidosis. The findings contribute valuable insights for designing future prospective studies in this complex patient population.
#2799 Myoglobin removal by hemadsorption: ex-vivo adsorption kinetics
Authors: Marcello Matteo , Lorenzin Anna , de Cal Massimo , Ramirez-Guerrero Gonzalo , Zanella Monica , Ronco Claudio 
Published: May 2024

Abstract

Background and Aims
Myoglobin, due to its molecular weight of 17 kDa and a Einstein-Stoke radius greater than expected, is classed as a middle molecular weight uremic toxin and presents a two-compartment model of distribution in the body. Rhabdomyolysis is a condition in which muscle cell content including myoglobin, are released into blood circulation due to severe injury to the muscle. Circulating myoglobin induces renal injury with several mechanisms: reduced concentration of nitric oxide in medullary renal arterioles, production of free radicals with oxidative stress, tubular necrosis as a consequence of tubular obstruction by myoglobin and cellular debris. A possible therapeutic option is the use of High Cut-off membranes but with the risk of significant loss of albumin and other proteins. The use of adsorption can overcome these limitations. The aim of our study is to assess the adsorption of myoglobin with neutral microporous styrene-divinylbenzene copolymer sorbent (e.g., HA330/380, Jafron Biomedical CO, Lts, Zhuhai City, China).

Method
Using a downscaled module of HA380 Cartridge, we set up an ex-vivo circulation experiment in which 1 liter of plasma containing 0.1 mg of myoglobin was pumped through the cartridge. We collected samples (3 mL) at different timepoints to measure Myoglobin concentration. We calculated the removal ratio (RR) and mass adsorbed at a given timepoints.

Results
Initial myoglobin concentration was 99.3 ng/ml. Final myoglobin concentration after 4 hours of experiment was 30.6 ng/ml. Removal Ratio at 4 hour was 69 % and mass adsorption of 0.068 mg of myoglobin.

Conclusion
To our knowledge, this is the first experiment that assessed the adsorption capacity of polystyrene-divinylbenzene sorbent. Our study, demonstrated high adsorption capacity in the first 4 hours of treatment therefore, confirming the possibility to use adsorption as an effective treatment option in rhabdomyolysis and avoiding complications associated to current dialytic treatment.
#1328 Haemodynamic effects of low versus high dialysate bicarbonate concentration in haemodialysis patients
Authors: Jensen Jonas Schandorph Kaalund , Peters Christian Daugaard , Jørgensen Ina Ejsing Hunnerup , Jensen Jens Dam , Buus Niels Henrik 
Published: May 2024

Abstract

Background and Aims
Haemodialysis (HD) treatment using standard dialysate bicarbonate concentrations cause transient metabolic alkalosis possibly associated with haemodynamic instability. We performed a detailed comparison of blood pressure (BP), haemodynamic parameters, electrolytes and orthostatic BP response with low (LDB) versus high dialysate bicarbonate concentration (HDB).

Method
Fifteen HD patients were examined in a single-blind, randomised, controlled, crossover study. Participants underwent a 4-hour HD session with dialysate bicarbonate concentration of 30 mmol/l (LDB) or 38 mmol/l (HDB) with one week between interventions. During HD, cardiac output (CO), total peripheral resistance (TPR), stroke volume (SV) and central blood volume were measured with ultrasound dilution technique (Transonic). Throughout dialysis, blood samples were obtained from the arterial cannula. Orthostatic BP was measured pre and post HD.

Results
With similar ultrafiltration volume (2.6 litres), systolic BP tended to decrease more during HDB compared to LDB (Fig. 1 and Table 1); the mean (95% confidence interval) between treatment differences in systolic BP were: 8 (-4;20) mmHg (end of HD) and 7 (0;15) mmHg (post HD). SV decreased (Fig. 2) whereas TPR increased significantly more during HDB compared to LDB with mean between treatment differences: SV: 12 (1;23) ml; TPR: -2.9 (-5.3;-0.5) mmHg/(L/min). CO tended to decrease more with HDB compared to LDB with mean between treatment difference 0.7 (0.0;1.4) L/min. HDB caused alkalosis, hypocalcaemia and lower plasma potassium, whereas patients remained normocalcaemic with normal pH during LDB (Table 1). Orthostatic BP response after dialysis did not differ significantly.

Conclusion
HDB compared to LDB was associated with hypocalcaemia and alkalosis and a more pronounced hypokalaemia which may impair preservation of BP, SV and CO during HD.
#2454 Meeting guideline goals at hemodialysis patients impact their survival?
Authors: Kantartzi Konstantia , Lampropoulou Vasiliki , Mourvati Efthimia , Kriki Pelagia , Theodoridis Marios , Margaritis Nikos , Panagoutsos Stylianos 
Published: May 2024

Abstract

Background and Aims
The Institute of Medicine (IOM) defines clinical practice guidelines as "statements that include recommendations, intended to optimize patient care, that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options". First publication of Clinical Guidelines by the National Kidney Foundation (NKF), addressing good clinical practice in hemodialysis, was published in 1998. The aim of the present study was to investigate the influence of adherence to current guidelines of Mineral and Bone Disorders, Anemia and Adequacy of Dialysis, on their survival in patients undergoing hemodialysis.

Method
This is a single center retrospective study of 113 chronic hemodialysis patients (79 males and 34 females), with median age 70 years (56, 78), median duration on hemodialysis 52 months (21, 95). Based on whether or not they met the KDIGO guidelines’ targets for anemia, bone disease, dialysis adequacy, and the targets of all three guidelines during the last three years, patients were divided in two groups: group A with the patients who met the goals of the guidelines and group B with the patients who did not meet the goals. Clinical and biochemical parameters were compared among the groups of patients as well as hemodialysis adequacy (Kt/V). The survival analysis of the patients was calculated by Kaplan-Meier, while the possible effect of any parameter on survival was also evaluated with Cox-Regression.

Results
There was significant difference between the two groups in age, phosphorous (P), PTH, Kt/V, URR and Alb. There was no significant difference between the two groups in sex, duration of HD, Hemoglobin (Hg), Calcium (Ca++), Hypertension and Diabetes (Table). In Cox analyses, patient survival was associated with delivered dialysis dose (single pool Kt/V, p=0.044). There was no significant difference between the two groups when we compare the adherence to guidelines for MBD (p=0.507) and anemia (p=0.394). There was no statistical difference when we compare the achievement of targets of all three guidelines (p=0.796). We identified as an independent risk factor for patient survival the serum albumin (p&lt;0.001). Patient survival was better with higher dialysis dose and adequate serum albumin level.

Conclusion
Clinical guidelines are useful tools for good clinical practice for hemodialysis patients. Adherence to clinical guidelines regarding dialysis adequacy is an independent risk factor for better survival of patients undergoing hemodialysis.
#2532 Identifying risk factors and protective strategies for pulmonary hypertension in chronic hemodialysis patients
Authors: Hsu Liping , Hsieh Chin Wen 
Published: May 2024

Abstract

Background and Aims
Pulmonary hypertension (PH) is commonly observed and is a predictor of mortality among individuals with end-stage renal disease (ESRD). However, the risk factors associated with PH and its treatment methods have not been thoroughly researched in patients undergoing chronic hemodialysis. Our objective is to investigate the risk factors and explore potential protective measures for PH in patients undergoing chronic hemodialysis.

Method
From January 1st to December 31st of 2015, 116 patients at a hemodialysis (HD) center met the inclusion criterion of receiving maintenance HD for a minimum of three months. None of the patients met any of the exclusion criteria, which included conditions like chronic obstructive pulmonary disease, interstitial lung disease, or liver cirrhosis. Each of these patients underwent echocardiography and bioimpedance spectroscopy (BIS) the day following their HD session. PH was identified in cases where the pulmonary artery systolic pressure exceeded 35 mmHg.

Results
Out of the cohort, 17 patients (14.7%) were diagnosed with PH, as shown in Table 1. These patients had fewer prescriptions of calcium channel blockers (CCBs; 5.9% vs. 40.4%, P=0.006) and a higher cardiac–thoracic ratio (CTR; 55% vs. 50%, P=0.04) compared to those without PH. Anthropometric measurements were comparable between the patients with and without PH. BIS revealed a higher extracellular water ratio (13.4% vs. 9.1%, P=0.05) and extracellular-to-intracellular (E/I) body water ratio (1.02 vs. 0.96, P=0.049) in patients with PH. In univariate logistic regression analysis, several factors were associated with PH: CCB prescription [odds ratio (OR) 0.092, 95% confidence interval (CI): 0.011–0.723, P=0.023], interventricular septum thickness (IVS, cm; OR 1.19, 95% CI: 1.046–1.355, P=0.008), ejection fraction (%; OR 0.951, 95% CI: 0.916–0.987, P=0.009), and a higher E/I ratio (&gt;1.03; OR 5.333, 95% CI: 1.055–26.95, P=0.043). In the multivariate regression analysis, CCB prescription (OR 0.027, 95% CI: 0.001–0.478, P=0.014) and IVS (OR 1.333, 95% CI: 1.108–1.605, P=0.002) emerged as the strongest predictors of PH, as detailed in Table 2.

Conclusion
PH is linked to a lower frequency of CCB prescriptions and structural heart disease. Additionally, fluid overload in the trunk and limbs, as indicated by a higher CTR and E/I water ratio, is also associated with PH. Our study suggests that CCBs could protect against PH in ESRD patients. Additionally, previous research indicating that a subset of PH patients responds well to CCBs [1] suggests that ESRD patients might share similar pathophysiological mechanisms with this subset, further supporting the potential use of CCBs in treating PH among ESRD patients.
#867 Calciprotein particles and phosphorus in conventional and extended-hours hemodialysis
Authors: Nishibori Nobuhiro , Okazaki Masaki , Imaizumi Takahiro , Miura Yutaka , Kuro-O Makoto , Kasuga Hirotake , Kaneda Fumika , Maruyama Shoichi 
Published: May 2024

Abstract

Background and Aims
Extended-hours hemodialysis (HD) has better clinical outcomes than conventional HD. Previous studies have shown that a prolonged dialysis treatment time is associated with lower serum phosphorus levels, but the impact of extended-hours HD on calciprotein particles (CPP) is unknown. We investigated whether extended-hour HD and conventional HD have varying effects on blood levels of CPP and phosphorus, which have been identified as the main pathogenic molecules for vascular calcification.

Method
We performed a cross-sectional study of patients with extended-hours HD or conventional HD between January and March 2020. Blood CPP levels were measured in plasma and serum predialysis samples using a previously reported "gel filtration method". Linear and nonlinear associations between CPP and serum phosphorus levels were examined across dialysis modalities.

Results
A total of 382 participants (185 with extended-hours HD and 197 with conventional HD) were included in the analysis. The median age of participants was 71 years, 65% of the patients were men, and the mean phosphorus level was 5.4 mg/dL. Extended-hours HD was associated with lower plasma CPP levels (Extended-hours HD vs Conventional HD; 40,018 AU vs 75,728 AU) and serum CPP levels (Extended-hours HD vs Conventional HD; 66,524 AU vs 100,812 AU), regardless of similar serum phosphorus levels. Multivariable linear regression analysis showed that extended-hours HD was associated with lower natural logarithmic plasma CPP levels: -0.64 (95% CI: -0.74 to -0.55). Restricted cubic spline function indicated that extended-hours HD was associated with lower plasma CPP levels across levels of serum phosphorus, with significant differences observed between groups, especially in hyperphosphatemic conditions (P for interaction &lt;0.01).

Conclusion
The patients with extended-hours HD had lower CPP levels than those with the conventional HD group despite no significant differences in serum phosphorus levels, which may contribute to better clinical outcomes in patients on extended-hours HD.
#495 Effect of Vit D supplementation on bone mineral density in haemodialysis patients. A comparative study
Authors: Tsikliras Nikolaos , Anagnostara Aggelina , Tsantekidou Florina , Kyrgialanis Apostolos 
Published: May 2024

Abstract

Background and Aims
Low serum 25(OH) vit D levels are usually observed in haemodialysis patients. In this population, vit D deficiency is associated with secondary hyperparathyroidism (SHPT) and low bone mineral density (BMD). Although, vit D supplements are routinely prescribed in haemodialysis patients, their exact role in preventing bone loss hasn't been studied thoroughly. The primary aim of this study was to estimate the effect of cholecalciferol (vit D3) use on BMD changes of haemodialysis patients. Secondary aim was to evaluate how parathyroid hormone (PTH), phosphorus and calcium levels are affected by vit D3 supplementation.

Method
Twelve (12) haemodialysis patients with low levels of serum vit D were included. All of them had their bone density measured with Dual - Energy X-Ray Absorptionmetry (DXA). The study population was then divided in two groups. Half of them (6 patients) received oral cholecarciferol (study group) and the rest continued with their standard treatment (control group). Initial dose of cholecalciferol was 25000 iu weekly and titrated upwards until 25 (OH) vit D levels were reaching 20 ng/ml. Then, cholecarciferol was continued in maintenance dose to keep vit D levels between 20 and 40 ng/ml. Thirty (30) months later, DXA was repeated in all patients. BMD in total hip region was evaluated. During the study period, phosphorus, calcium and PTH levels were measured monthly while 25 (OH) vit D levels were measured every three months.

Results
Patients’ mean age was 61.9 (±8.8) years. There were no differences in age, initial BMD, PTH or vit D levels between the two groups. Overall, initial mean vit D value was 8.5 ng/ml. At the end of the study, vit D levels had increased to 23.6 ng/ml in the study group while remaining unchanged in the control group. At the beginning of the study, mean BMD in the whole population was 0.742 gr/cm3 and it decreased by 0.042 gr/cm3 after 30 months. No differences in BMD change were observed between the two groups (ΔBMD was −0.057 versus -0.029 gr/cm3 in the study and control group respectively, p = 0.12). PTH levels were reduced in the study group and increased in the control group but the observed difference was not significant (p = 0.11). Phosphorus and calcium levels were not affected by vit D supplementation. Of note, three fractures were observed in the study group and one in the control group during the study period.

Conclusion
Vit D3 supplementation didn't seem to affect the rate of bone loss in haemodialysis patients, at least in the doses received and levels of 25 (OH) achieved above. Its exact effect in PTH levels as well as in the rate of bone fractures needs to be verified by larger studies.
#3075 Itch and ache on dialysis: the impact on the quality of life in Tunisian hemodialysis patients
Authors: Ayed Amel , Jaballah Lazhar , Brahim Mayssa Hadj , Elhadhri Asma , Elati Zohra 
Published: May 2024

Abstract

Background and Aims
Pruritus associated with chronic kidney disease (CKD-aP) is a common condition. However, although pruritus seriously affects the physical and mental health of patients, clinicians tend to underestimate this condition.
The aim of this study is to determine the prevalence of Pa-MRC and its impact on the quality of life (QOL) in the Tunisian hemodialysis population.

Method
This is a prospective observational study conducted at the hemodialysis unit at Taher Sfar University Hospital (February - May 2022). The presence and severity of Pa-MRC were documented based on a 5-D pruritus questionnaire, demographic and clinico-biological data were extracted from the dialysis unit register.

Results
A total of 63 chronic hemodialysis patients (CHD) were recruited in this study, 68.3% of whom presented pruritus, most often generalized (2/3 cases). More than half of the patients reported pruritus throughout the day. Thirty patients reported moderate to severe Pa-CKD. Patients were not treated for pruritus in 72% of cases, but 92% of those treated were satisfied with their treatment. Patients reporting a more severe Pa-CKD had a shorter duration of dialysis, higher phosphate and parathormone levels and more frequent diabetes (p = 0.03). The QOL deteriorated when the severity of pruritus increased (p = 0.01). Patients reported having difficulty falling asleep (52%), irritability (61.4%), concentration disorders (31.8%). In addition, pruritus limits the daily life of patients in 59.1% of cases with an impact on nutritional status in 13.6%.

Conclusion
This study reveals that Pa-CKD is a distressing condition with a huge impact on the QOL of CHD patients. However, there is an unmet need for treatment, hence the need for new therapeutic approaches.