bluuebunny/crossref_metadata_2025_split huggingface dataset:
#2708 Impact of dialysis modality on bone phenotype
Authors: Lloret Maria Jesus , Jørgensen Hanne Skou , Verhulst Anja , Bammens Bert , Claes Kathleen , Devusser Katrien , Meijers Björn , Van Craenenbroeck Amaryllis , De Loor Jetty , Cavalier Etienne , Evenepoel Pieter 
Published: May 2024

Abstract

Background and Aims
Literature data suggest that low bone turnover is the prevailing bone phenotype in patients treated with peritoneal dialysis (PD) and point to high sclerostin as the central culprit. Lack of adequate controls, diagnostic heterogeneity, and a changing mineral metabolism landscape and armamentarium call for a cautious interpretation and confirmation in contemporary patients.

Method
Laboratory parameters of mineral metabolism (biointact parathyroid hormone (PTH), fibroblast growth factor 23 [FGF23] and sclerostin), bone turnover markers (bone alkaline phosphatase [BALP], intact procollagen type I N-terminal propeptide [PINP], tartrate-resistant acid phosphatase 5b [TRAP5b]) and bone mineral density (BMD) were assessed in 636 non-diabetic kidney transplant candidates of whom 447 were treated with hemodialysis (HD) and 189 with PD. A bone biopsy was performed in 204 patients (n = 134 HD; n = 70 PD), with bone sclerostin expression assessed in a subset (n = 52).

Results
Patients treated with PD had lower levels of PINP (79.6 vs 99.5 ug/L; p &lt; 0.01) and BALP (20.2 vs 23.7 ug/L; p = 0.04) compared to those treated with HD. Histomorphometric parameters of bone formation were numerically lower in patients treated with PD, but significance was not reached. Bone mineralization was impaired in HD patients (osteoid width: 7.90 vs 6.75 µM; p = 0.01; osteoid maturation: 9 vs 6 days; p = 0.03), while frank osteomalacia was rare in both modalities (6.0%, both groups). BMD was higher in patients treated with PD compared to HD at skeletal sites rich in cortical bone (Z-score midshaft radius −0.4 ± 1.3 vs −0.9 ± 1.7; p = 0.04). PTH levels were comparable (150 vs 144 pg/mL, PD vs HD), while patients treated with PD showed higher serum phosphate (4.9 ± 1.3 vs 4.5 ± 1.6 mg/dl; p &lt; 0.01) and FGF23 levels (3852 pg/ml vs 2361 pg/ml; p = 0.01). Circulating (1.82 ng/mL, both groups) and bone tissue expression (205 ± 126 vs 206 ± 112 positive osteocytes per mm2) of sclerostin did not differ between groups.

Conclusion
Patients treated with PD present a lower bone turnover, better mineralization, and higher cortical BMD than counterparts treated HD. Overall, differences are marginal and most probably clinically irrelevant. We speculate that inferior phosphate control may be in the causal pathway.
#1736 Correlation between chronic kidney disease-mineral and bone disorder parameters and clinical events in hemodialysis patients
Authors: Rotondi Silverio , Palladino Gaia , Tartaglione Lida , Pasquali Marzia , Lai Silvia , Perrotta Adolfo Marco , Mazzaferro Sandro 
Published: May 2024

Abstract

Background and Aims
Patients with chronic kidney disease experience mineral and bone metabolism alterations, collectively known as Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD), linked to elevated cardiovascular mortality. A significant biochemical change is the development of secondary hyperparathyroidism—an adaptive response to uremic conditions that, when surpassing critical thresholds, becomes maladaptive, heightening clinical risk. Presently, optimal parathyroid hormone (PTH) values for hemodialysis (HD) patients lack a clear definition, with recent evidence challenging international guideline limits. This study aimed to evaluate the impact of PTH values on mortality in a population of patients in HD.

Method
A prospective observational study involving chronic hemodialysis patients commenced in January 2020, with a 40-month follow-up for mortality recording. Exclusion criteria comprised parathyroidectomy, primary hyperparathyroidism evidence, prior kidney transplant, or transplant plans within three months. Clinical and biochemical data, aligned with the 2017 KDIGO guidelines for PTH, calcium (Ca), and phosphorus (Ps) target values, were recorded. Our laboratory PTH values ranged from 25 to 88 pg/ml, and stable PTH values within 180 to 700 pg/ml were deemed adequate in HD patients. Patients were categorized based on the average of three values over 12 months for PTH, Ca, and Ps parameters.

Results
One hundred patients (average age: 71 ± 13.59) were enrolled. Seventy-seven percent achieved PTH targets (180-700 pg/ml), 73% for Ca, and 19% for phosphorus (Table 1). During follow-up, 36 deaths (36%) occurred. While percentages of target achievement were similar between survivor and non-survivor groups, non-survivor patients exhibited higher PTH values (423.08 ± 277 vs. 360.44 ± 214.92; p = 0.05) without differences in Ca and Ps levels between the two groups (Table 2). Stratifying based on the median PTH value (330 pg/ml) revealed higher mortality in patients with PTH &gt; 330 pg/ml (Log-rank test p = 0.05) (Fig. 1).

Conclusion
Despite comparable target achievements for PTH, Ca, and Ps, deceased patients had elevated average PTH values, especially those exceeding 330 pg/ml, indicating a higher risk of death during our follow-up.
In line with recent literature, these findings underscore PTH's role as a uremic toxin, suggesting a revaluation of current PTH targets for hemodialysis patients
#2786 Effect of intradialytic virtual reality exercise program on lower limb muscle strength in patients on hemodialysis
Authors: Reboredo Maycon Moura , Pinton Marcelly Oliveira , Barros Fabrício , Silva Daniele Thomé , Gravina Emanuele Poliana Lawall , de Lima Souza Dias Ana Paula , de Lima Assis Maria Clara , Lucinda Leda Marília Fonseca , Segura-Orti Eva 
Published: May 2024

Abstract

Background and Aims
In patients on hemodialysis, muscle weakness is highly prevalent and may lead to frailty, limitation of mobility and functional impairment. Moreover, low muscle strength was associated with an increase in mortality risk in these patients. Despite the fact that some studies showed that resistance training improves muscle strength in patients on hemodialysis, the effects of virtual reality (VR) exercise should be confirmed. Therefore, the aim of this study was to evaluate the effects of an intradialytic non-immersive VR exercise program, performed at different times during the hemodialysis session, on lower limb muscle strength in patients on hemodialysis.

Method
A randomized clinical trial was conducted with patients aged ≥18 years who were undergoing hemodialysis treatment for at least 3 months. Patients were randomized into 2 protocols of exercise at different times during the hemodialysis session (first 2 hours and last two hours) for 3 months. The intradialytic exercise program in both groups consisted of a non-immersive VR game (Treasure Hunting) in which the patients try to catch treasures and avoid bombs by moving their lower limbs (hip flexion, abduction and adduction, and knee flexion and extension), with a progressive duration of 6 to 36 minutes. The difficulty level of the game was graduated according to the characteristics of each patient. The muscle strength of the hip flexion (HF), hip abduction (HA) and ankle extension (AE) was evaluated using a portable handheld dynamometer during hemodialysis session. Patients were advised to perform a 5 s maximum isometric contraction, and the peak values were recorded for 3 repetitions in both lower limbs. The mean muscle strength of 3 trials was recorded. Data were expressed as the median (interquartile range). The Mann‒Whitney U test was used for between-group comparisons. The Friedman test was conducted to evaluate the differences in medians among the muscle strength data at baseline, after 1, 2 and 3 months of exercise program.

Results
This study included 11 patients in the exercise within the first 2 hours group [50 (55-75) years, 55% male] and 11 patients in the exercise within the last 2 hours group [64 (58-72) years, 64% male]. Table 1 shows that muscle strength of the HA and AE increased significantly in the exercise within the first 2 hours group. Muscle strength of HF, HA and AE improved significantly in the exercise within the last 2 hours group. There were no significant differences between two groups.

Conclusion
This study suggests that an intradialytic non-immersive VR exercise program can improve lower limb muscle strength in patients on hemodialysis.
#941 Pentraxin-3 as a marker of coronary artery disease in hemodialysis patients
Authors: Milicevic Jovana Kusic , Vidakovic Radosav , Markovic Rodoljub , Apostolovic Marija Andjelkovic , Coric Vesna , Stankovic Jasna Trbojevic , Ercegovac Marija Pljesa , Jemcov Tamara , Dragovic Gordana 
Published: May 2024

Abstract

Background and Aims
Pentraxin-3 (PTX3), a novel inflammatory biomarker, has been recognized as a predictor of cardiovascular events in the general population, including coronary artery disease (CAD). Although PTX3 is elevated in dialysis patients, its potential diagnostic value for the estimation of CAD severity is still insufficiently studied. The aim of this study was to evaluate the association between PTX3 and CAD in hemodialysis patients.

Method
This cross-sectional study included 60 angina-free chronic hemodialysis patients (60% men, mean age 60 ± 11 years, mean dialysis vintage 26 ± 14 months). Coronary artery calcium score (CACS) and coronary computed tomography angiography (CCTA) were performed to evaluate CAD burden and stenosis severity, which was defined as significant if obstructing more than 50% of the vessel lumen. PTX3 was quantified using an enzyme-linked immunosorbent assay kit.

Results
Significant coronary artery stenosis was detected in 24 (40%) patients, of which the majority (17; 70.83%) had one-vessel disease. PTX3 was 194.82 ± 68.58 ng/mL in patients with significant CAD, whereas 83.55 ± 11.89 ng/mL in those without significant coronary artery stenosis (p = 0.028). PTX3 levels tend to increase in patients with CACS higher than 200 Agatston units, however statistically significant difference was not reached (p = 0.504). PTX3 levels correlated with age (p &lt; 0.05) and c-reactive protein (p = 0.007), while negatively correlated with body mass index (p &lt; 0.05).

Conclusion
PTX3 is significantly increased in hemodialysis patients with coronary artery disease. Further studies should elucidate if including PTX3 as a marker for detecting CAD prior to invasive imaging could improve cardiovascular risk stratification even in angina-free hemodialysis patients.
#2895 Erythropoietin Resistance Index (ERI) between mortality and metabolic changes in a cohort of hemodialysis patients. What acts below the surface?
Authors: Abinti Matteo , Alfieri Carlo Maria , Caldiroli Lara , Mattinzoli Deborah , Castellano Giuseppe , Vettoretti Simone 
Published: May 2024

Abstract

Background and Aims
The management of anemia in hemodialysis patients (HD-ps) is influenced by many factors, including inflammation, martial balance (MB) and mineral metabolism (MM). Recent data would identify the Erythropoietin Resistance Index (ERI) as an indicator of mortality risk in HD-ps. The objective of the present study was to evaluate the relationship of ERI with inflammation, MB and MM, as well as all-cause mortality in a cohort of HD-ps.

Method
An observational-retrospective study was performed on 100 HD-ps, excluding those with acute or chronic infections (3 months), neoplasia, or immunosuppressive therapy. Mortality was considered primary outcome along a 2-year follow-up (FU).

Results
HD-ps, predominantly males, had advanced mean age, good Hb values and fair biochemical control. ERI showed significant correlations with some elements of inflammation, MM and BM (Table 1), including c-terminal fragment of Fibroblast Growth Factor 23 (cFGF23). At multivariate, ERI remained influenced by cFGF23 (p = 0.009), iron (p = 0.002) and transferrin (p = 0.007). Furthermore, after 2 years of FU, 42% of HD-ps died. As shown in Table 2, HD-ps that faced the primary outcome (death) were older, had lower levels of albumin, hemoglobin and transferrin, and higher levels of IL6, parathormone (PTH), reactive C protein (PCR), and ERI (p &lt; 0.035). In multivariate, ERI (p = 0.011), age (p = 0.001) and albumin (p = 0.010) remained significant for the outcome studied.

Conclusion
Our data, albeit on few HD-ps, show a possible association between ERI and mortality. ERI was found to be related to several factors, including cFGF23, itself a factor implicated in maintaining a baseline inflammatory state. The results suggest the possible presence of some pathological mechanisms that can act silently with a negative impact on survival. Certainly, increased numbers and a prospective design could better clarify the explored relationships in the future.
#372 Cross-sectional association between serum magnesium with cognition in patients undergoing hemodialysis: the Osaka Dialysis Complication Study
Authors: Shoji Tetsuo , Mori Katsuhito , Nakatani Shinya , Morioka Tomoaki , Fujii Hisaka , Emoto Masanori 
Published: May 2024

Abstract

Background and Aims
Impaired cognitive performance is common in patients with chronic kidney disease including those undergoing haemodialysis, although the mechanisms are not well understood by which chronic kidney disease affects cognitive function. Phosphate plays an important role in the development of aging phenotypes particularly in patients with chronic kidney disease. Phosphate toxicity is thought to be mediated by calciprotein particles, and a shorter T50 reflects a higher propensity of transformation of primary to secondary calciprotein particles. T50 is known to be affected by phosphate, fetuin-A, magnesium, and others. We examined possible relationship between cognitive function and CKD-MBD-related factors in patients undergoing haemodialysis.

Method
This was a cross-sectional study in 1207 patients on maintenance haemodialysis selected from the participants of Osaka Dialysis Complication Study (ODCS). Cognitive function was assessed by Modified Mini-Mental State examination (3MS). Associations of serum calcium, phosphate, intact PTH, magnesium, fetuin-A, and T50 with 3MS was examined by multiple regression models adjusted for age, sex, dialysis vintage, diabetic kidney disease, prior stroke, prior non-stroke cardiovascular disease, education level, SBP, DBP, Hb, BMI, serum albumin, and CRP.

Results
Serum magnesium and phosphate levels were significantly and positively associated with 3MS level independent of the potential confounders, whereas other factors were not.

Conclusion
We found positive associations of cognitive performance with serum magnesium and phosphate levels in haemodialysis patients, suggesting the roles of CKD-MBD-related factors in impaired cognition in this population.
#2196 Impact of intradialytic exercise on blood pressure and quality of life in hemodialysis patients: a randomized controlled trial
Authors: Ramadan Shaimaa R , Tawfik Mona , Abdelsalam Adel , Elshabrawy Nehal 
Published: May 2024

Abstract

Background and Aims
Hemodialysis is essential for end-stage renal disease (ESRD) patients, but they often face complications affecting their quality of life and cardiovascular health. Exercise has emerged as a potential adjunct therapy for improving outcomes in hemodialysis patients. This study aimed to examine the effects of exercise during dialysis on laboratory parameters, intradialytic blood pressure events, and quality of life in hemodialysis patients.

Method
An Egyptian dialysis center conducted a 6-month randomized controlled trial involving 80 hemodialysis patients. Patients were randomized into two groups: an intervention group (40 patients), which engaged in 30-minute exercise)in the form of 15 minutes for cycler and 15 minutes for hand grip (three times per week during dialysis sessions, and a control group (40 patients), which did not exercise. Laboratory investigations were performed before and after the intervention, measuring hemoglobin, serum sodium, potassium, calcium, phosphorus, and intact parathyroid hormone (iPTH). Intradialytic blood pressure events were recorded, and quality of life (QOL) was assessed using the Arabic version of the kidney disease and Quality of Life-Short Form 36 (KDQOL-SF™) Questionnaire.

Results
The intervention group exhibited a statistically significant reduction in inter-dialytic hypertension episodes compared to the control group (partial η² = .142, Cohen's f = .407). Additionally, the intervention group showed a significant increase in the physical composite score (partial η² = .178, Cohen's f = .465) accompanied by a significant decrease in the mental composite score (partial η² = .232, Cohen's f = .550) Moreover, The intervention group demonstrated a significant reduction in serum calcium levels post-intervention compared to the control group (partial η² = .069, Cohen's f = .272), with a positive correlation between the change in calcium level and the change in the physical composite score.

Conclusion
These findings indicate that exercise during haemodialysis may contribute to better blood pressure control and improved physical functioning. Incorporating exercise into the dialysis routine may serve as an effective approach to optimize the health and well-being of haemodialysis patients. Further research should focus on long-term effects and optimal exercise protocols to maximize these benefits.
#442 Hyperparathyroidism, serum phosphorus and dietary intake in hemodialysis patients: is there a novel relationship?
Authors: Garagarza Cristina , Valente Ana , Queirós Cátia , Neto Inês , Sebastião Joana , Gomes Melanie , Ferreira Manuel Anibal A 
Published: May 2024

Abstract

Background and Aims
Hyperparathyroidism (HPTH), classified when intact parathyroid hormone (iPTH) serum levels are above 585 pg/mL, is a common complication in patients undergoing maintenance hemodialysis (HD). Despite there is little evidence about the relationship between iPTH levels and nutritional status, the intervention frequently focusses on appropriate management of mineral and bone markers, being the decrease of serum and dietary phosphorus some of the targets. The aim of this study was to investigate the association between iPTH, serum phosphorus levels and dietary intake.

Method
This was a cross-sectional, multicenter, observational study with 561 patients on HD treatment from 37 dialysis centers across Portugal. Clinical parameters, body composition and dietary intake (obtained from a Food Frequency Questionnaire) were assessed. For the analysis, patients were divided in 3 groups depending on their iPTH levels: a) iPTH&lt;130, b) iPTH between 130-585 and c) iPTH &gt;585 pg/mL. The association between PTH, serum phosphorus and dietary intake was analyzed with linear regression models. A p-value lower than 0.05 was considered statistically significant.

Results
Patients’ mean age was 68 ± 14 years, median HD vintage was 65 (IQR: 43-106) months and 58.8% were men. From the whole sample, 13.9% presented a iPTH &lt;130 pg/mL, 59.3% between 130-585 pg/mL and 23.2% &gt;585 pg/mL. Patients with higher iPTH levels were those with longer HD vintage (p = 0.021) and lower age (p = 0.002). At the same time, showed higher serum phosphorus (p = 0.005), serum calcium (p = 0.027), Ca/P product (p &lt; 0.001), albumin (p = 0.016) and caffeine intake (p = 0.009). In addition, a lower dietary intake of phosphorus (p = 0.044), fiber (p = 0.047), riboflavin (p = 0.031) and folate (p = 0.011) were observed in patients with higher iPTH levels. In the linear regression models, higher serum phosphorus predicted higher iPTH levels, even in the adjusted model (p = 0.019). However, a lower phosphorus intake was a predictor of higher iPTH levels, also in the model adjusted to age, gender, serum phosphorus, dialysis adequacy (Kt/V) and dialysis vintage (p = 0.035). The same result was observed when considering the dietary fiber intake in the model (p = 0.048). No significant differences in body composition parameters were found.

Conclusion
Our results bring new data on the relationship between dietary intake and iPTH values. Despite higher serum phosphorus was observed in patients with HPTH, an opposite association was noted regarding dietary phosphate and fiber as lower intakes predicted higher iPTH values. Moreover, a poorer dietary intake, considering riboflavin and folate was observed in the HPTH group.
#2028 Efficacy and safety of sucroferric oxyhydroxide versus sevelamer carbonate: a systematic review and meta-analysis
Authors: Georgopoulos Christos , Duni Anila , Stamellou Eleni , Kitsos Athanasios , Gouva Charikleia , Ntounousi Evangelia 
Published: May 2024

Abstract

Background and Aims
Hyperphosphatemia is a common and clinically significant complication in severe chronic kidney disease (CKD), associated with higher cardiovascular adverse events and higher mortality rates. High serum phosphate is also associated with a heightened risk of cardiovascular issues such as hypertension, left ventricular hypertrophy, atherosclerosis, and vascular calcifications. Phosphate binders are commonly used in patients receiving renal replacement therapy (RRT), aiming to reduce and maintain serum phosphorus. This study aims to examine the efficacy and safety of sucroferric oxyhydroxide versus sevelamer carbonate in patients receiving RRT.

Method
Data sources included MEDLINE(PubMed), Scopus, and the Cochrane Central Register of Controlled Clinical Trials with the search cut-off in October 2023. We examined RCTs that comparing sucroferric oxyhydroxide versus sevelamer carbonate in the adult population receiving RRT. Data extraction followed the PICOS protocol and bias risk was assessed using the Rob-2 tool. We performed a meta-analysis combining the data from RCTs, using R-studio. The primary endpoint of this study is the change in the serum phosphorus levels from baseline to end of treatment. Secondary outcomes included changes in serum intact parathormone (i-PTH) levels from baseline to end of treatment as well as the adverse events ratio during the study period. Given the prevalence of gastrointestinal side effects for both drugs, which often leads to drug discontinuation or patient non-adherence, a separate analysis focused on gastrointestinal-related adverse events.

Results
Inclusion criteria were met by 5 RCTs. No statistically significant difference was found in serum phosphorus reduction between the two groups {MD: −0.07 mmol/l,95% CI-random effects: −0.15 to 0.02}. Similarly, serum i-PTH reduction showed no statistically significant difference between the two drugs {MD = −1.53 mg/dl, 95% CI = (−4.45, 1.4), p = 0.26, random effects model}. Adverse events were comparable between the groups (OR: 1.11, 95% CI: 0.65-1.88, random effects model). However, further analysis of gastrointestinal adverse evets indicated a 60% increase with sevelamer carbonate {OR: 1.60, 95% CI 1.31-1.97, common(fixed) effect model}. Funnel plot examination for both continuous and dichotomous outcomes revealed a high chance for small study effect and publication bias.

Conclusion
This meta-analysis found that sucroferric oxyhydroxide and sevelamer carbonate are equally effective in controlling serum phosphorus and i-PTH levels. Sucroferric oxyhydroxide, however, demonstrated a more favorable profile regarding gastrointestinal adverse events. Our findings suggest sucroferric oxyhydroxide as a valuable alternative for RRT patients who have difficulty tolerating sevelamer carbonate.