bluuebunny/crossref_metadata_2025_split huggingface dataset:
#1604 LACE index as predictors of 30 day rehospitalisation among patients on maintenance hemodialysis, cohort study
Authors: Alhomrany Mohammed , Fadlallah Ayman , Samson Jennifer , Boudalia Mohamed , Alharbi Ali 
Published: May 2024

Abstract

Background and Aims
Over 35% of patients on maintenance dialysis are readmitted to the hospital within 30 days of hospital discharge. Validated risk assessment tools such as the LACE index (Length of stay, Acuity of admission, Co-morbidities, and Emergency department visits) have been developed to identify patients at high risk of hospital readmission in non-dialysis patients but have not been tested in dialysis patients.

Method
Data was collected from electronic medical records of patients on maintenance hemodialysis in Diaverum outpatient clinics hospitalized during 2023. Data included Age, gender, duration of hospital stay, Charlson comorbidity index (CCS), urgent or planned, and cause of Hospitalization. Multivariable logistic regression models with 30-day readmission for the same reason as the dependent outcome were used to identify readmission risk factors and whether the LACE score validly predicts 30-day rehospitalization among our cohort.

Results
Among (4829) patients received dialysis in Diaverum Saudi Arabia during 2023. (1487) episodes of hospitalization were reported due to various reasons rate of hospitalization was 0.54 Episodes per patient-years at risk, and 372(25%) of hospitalized patients were re-hospitalized for the same reason within 30 days.
The proportion of patients with 30 days of rehospitalization for the same reason was higher in patients with post-initial discharge LACE index ≥10 in comparison to patients with LACE index&lt;10, 348(32.6%) & 24(5.7) respectively P-VALUE&lt;0.001. also significantly higher in patients ≥65years old than those younger 163(27.7%) &209(23.3%) respectively P-VALUE&lt;0.05, those in high risk group (defined as those with higher comorbidity index ≥6 and/or lower Individual Patient Performance Score&lt;75) than those who are not in high risk group 215(35%) & 157(17.9%) respectively P-VALUE&lt;0.001.
Multivariate logistic regression including covariates significantly associated with higher 30-day rehospitalization to avoid confounder effect with model including ( age, gender, dialysis duration, body mass index, comorbidity index, diabetes, vascular access, cause of hospitalization and inclusion in high-risk group ) showed significantly higher rehospitalization in patients with post-initial discharge LACE index ≥10 in comparison to patients with LACE index&lt;10 ODDS RATIO (95%CI) 7.95(5.1-12.5) P-VALUE&lt;0.001. independent of other covariates in the model

Conclusion
LACE index at discharge is an independent predictor of (30) days re-hospitalization in patients on maintenance Hemodialysis. Further analysis needed for a specific model for HD patients taking into consideration the unique characteristics of this cohort of patients.
#658 Analysis of cerebral blood volume and flow changes in ESRD patients undergoing hemodialysis using functional near-infrared spectroscopy
Authors: Park Bong Soo , Kim Yang Wook , Park Sihyung , Lee Yoo Jin , Heo Chang Min , Yi Jiyae , Son Sung Hyun , Bae Hoyoon 
Published: May 2024

Abstract

Background and Aims
End stage renal disease (ESRD) patients undergoing hemodialysis experience diverse neurological complications. However, studies regarding how hemodialysis is related to these neurological problems are limited. This study investigated cerebral blood volume (CBV) and cerebral blood flow (CBF) during hemodialysis using functional near-infrared spectroscopy (fNIRS) to analyze cerebral hemodynamic changes.

Method
ESRD patients undergoing maintenance hemodialysis without a history of neurological disorders were enrolled prospectively. The fNIRS data were collected using a NIRSIT Lite device. The fNIRS values were recorded three times for each patient: before the start of hemodialysis (pre-HD), 1 h after the start of hemodialysis (mid-HD), and after the end of hemodialysis (post-HD). The average changes in oxy-hemoglobin (HbO2), deoxy-hemoglobin (HbR), total hemoglobin (HbT, calculated as HbO2 + HbR) concentrations, and in hemoglobin concentration difference (HbD, calculated as HbO2 – HbR) were analyzed. We then compared the differences in changes in HbO2, HbR, HbT, and HbD according to the hemodialysis period.

Results
Thirty hemodialysis patients were analyzed. Between the Pre-HD and Post-HD periods, there were significant differences in changes in HbO2 (0.005 ± 0.001 µM vs. 0.015 ± 0.004 µM, p=0.046) and HbT (0.006 ± 0.001 µM vs. 0.016 ± 0.008 µM, p=0.029). Additionally, between Pre-HD and Post-HD periods, HbD tended to increase; however, this was not statistically significant (0.005 ± 0.001 µM vs. 0.014 ± 0.004 µM, p=0.094).

Conclusion
We demonstrated that during one hemodialysis session, the relative change in CBV increased post-HD compared with pre-HD. These results are expected to help understand the mechanisms underlying the effects of hemodialysis on brain function.
#1371 Cutaneous manifestations in hemodialysis patients and assessment of the changes in quality of life after 12 weeks of treatment by dermatologist
Authors: Park Ji In , Jeong Jin Seon , Kwon Jung , Kim Hee Jeong , Her Young , Lee Young , Lee Sunhwa , Baek Hyunjeong 
Published: May 2024

Abstract

Background and Aims
Cutaneous manifestations are frequently found in end-stage kidney disease (ESKD) and disturbing quality of life of patients under maintenance hemodialysis. Even dialysis patients frequently visit the hospital, they do not receive active dermatologic care. The aim of this study is to assess the cutaneous manifestations of hemodialysis patients and to investigate changes in quality of life before and after active treatment by dermatologists.

Method
A 12-weeks, prospective study was conducted with two centers of hemodialysis. Patients in one center received dermatologic intervention and patients in another center received supportive management by nephrologist. Patients scored their quality of life using questionnaires, Dermatology Life Quality index (DLQI) and Skindex-29, on start of study and 12 weeks later. Patients were matched between two groups according to propensity score. Simple and multiple linear regression were used to identify associations of dermatologic treatment and improvement of quality of life.

Results
A total of 120 patients from two dialysis centers were included in this study, of whom 65 as intervention group and 55 of control group. About 93.8% of patients had dermatologic manifestations, and pallor and xerosis accounted for the most proportion. Improvement in quality of life as assessed by the DLQI were confirmed after 12 weeks in overall population. However, the active intervention by a dermatologist did not affect the improvement of quality of life significantly.

Conclusion
Patients treated with dermatologic intervention by dermatologist had not improved in quality of life compared with control group. It is important for a nephrologist to carefully assess skin issues of patients with ESKD and provide the best possible treatment.
#2594 Patient-reported inter- and intradialytic symptoms in HD & HDF patients
Authors: Pham Ngoc , Cromm Krister , Zhang Yan , Schappert Anna , Liegl Gregor , Fischer Kathrin I , Fischer Felix , Rose Matthias 
Published: May 2024

Abstract

Background and Aims
Patients on hemodialysis (HD) experience a wide range of symptoms during and between dialysis that negatively affect their well-being. Addressing these symptoms, particularly from the patient's perspective, is a crucial component in the treatment. Our findings suggest a beneficial effect of hemodiafiltration (HDF) over hemodialysis (HD) on mortality and quality of life. This study aimed to investigate the differences in symptom severity between patients on HD and HDF.

Method
Patient-reported outcomes data of 1264 hemodialysis patients were extracted from CONVINCE, an international randomized controlled trial comparing high-dose hemodiafiltration with high-flux hemodialysis, including baseline and quarterly follow-up data up to 24 months. Symptoms were assessed using the CONVINCE peridialytic symptoms questionnaire covering inter- as well as intradialytic symptoms (see Table 1) with items scored between 0-100, higher scores indicating fewer symptoms. Prevalence and scores of all inter- and intradialytic symptom items at baseline and during follow-up visits were assessed and compared between HD and HDF groups. The association of changes of symptom scores over time with dialysis modality (HD vs. HDF) was assessed by Mixed Models for Repeated Measures (MMRM).

Results
MMRM analyses showed no significant main effects of dialysis modality on symptoms at the p &lt;.05 level. However, descriptive statistics and plots indicated higher scores for most symptoms in the HDF group. The highest score differences between HDF and HD group over all timepoints were found for itchy skin (2.09 [95% CI −0.09-4.26]), numbness in hands or feet (2.03 [95% CI −0.22-4.28]), being washed out or drained (1.88 [95% CI −0.23-3.99]) and lack of appetite (1.73 [95% CI −0.03-3.50]). Plots for these symptoms can be found in Fig. 1. Furthermore, no significant interactions were found between dialysis modality and time, indicating that the rate of change in symptom scores did not differ significantly between the HDF and HD group.

Conclusion
No statistically significant differences in patient-reported symptoms between HDF and HD patients were found. We may not have the granularity of data to fully explore factors which may have contributed to the positive effects of HDF that have been reported previously. This might be due to the method of symptom assessment used or specific issues with perception of symptom burden. Our results highlight the complexity of symptom management in dialysis patients and underscore the need for future symptom assessments to allow for personalized treatment strategies that further optimize patient care.
#1114 Rate and reasons for peritoneal dialysis dropout following haemodialysis to peritoneal dialysis switch: a systematic review and meta-analysis
Authors: O'neill Stephen , Sun Xingge , Mckeaveney Clare , Shields Joanne , Chan Chi Peng , Henderson Matthew , Fitzell Fiona , Noble Helen 
Published: May 2024

Abstract

Background and Aims
Patient outcomes can be influenced by dialysis initiation and subsequent modality choices. This systematic review and meta-analysis aimed to explore the rate and reasons for peritoneal dialysis (PD) dropout following a haemodialysis (HD) to PD switch.

Method
This systematic review conducted searches in four databases, including Medline, PubMed, EMBASE, and Cochrane. The protocol was registered on PROSPERO (study ID: CRD42023405718). Outcomes included the rate and reasons for PD dropout and the mortality difference in two groups (PD first group versus HD to PD group). The Critical Appraisal Skills Programme (CASP) checklist and the GRADE tool were used to assess the quality of evidence.

Results
4971 papers were detected, and 13 studies were included. On meta-analysis, there was no statistically significant difference in PD dropout in the PD first group (OR: 0.81; 95%CI: 0.61, 1.09; I2=83%; P=0.16), however, there was a statistically significant reduction in the rate of mortality (OR: 0.48; 95%CI: 0.25, 0.92; I2=73%; P=0.03) compared to the HD to PD group. Causes for PD dropout differed between the two groups, with psychosocial reasons more common in the HD to PD group. However, inadequate dialysis and peritonitis were the main reasons for PD dropout across both groups.

Conclusion
Compared to the PD first group, a previous HD history may not impact PD dropout rates for patients, but it could increase mortality in the HD to PD group. Reasons for PD dropout differed between the two groups, but there were no statistically significant differences. Exploring psychosocial reasons for PD dropout is a valuable area for future research.
#3109 Sarcopenia in peritoneal dialysis patients
Authors: Carnevale Andreia , Domingos Diogo , Matias Patrícia , Calça Rita , Branco Patrícia , Gaspar Maria Augusta 
Published: May 2024

Abstract

Background and Aims
Sarcopenia is considered a frequent cause of morbidity and mortality among patients with chronic kidney disease (CKD). In clinical practice, tools such as handgrip strength and bioelectrical impedance analysis (BIA) can help us diagnose sarcopenia and possibly predict clinical outcomes. However, the outcomes associated with this diagnosis in the population of patients under peritoneal dialysis (PD) and the consequent importance of the implementation of these tools is not clear.

Method
Single-centre retrospective study with patients who started peritoneal dialysis (PD) between January 1st 2017 and December 31st 2023, with a follow-up of 18 months or until technique dropout. Demographic, clinical data and outcomes were collected. Muscle strength (measured by handgrip strength with a dynamometer) and muscle mass (estimated through BIA-derived lean tissue index (LTI)) were also evaluated. Sarcopenia was considered when low strength (handgrip strength values &lt;27 kg and &lt;16 kg for men and women, respectively) and loss of muscle mass (LTI &lt;10th percentile, relative to an age and gender-matched healthy population) were present.

Results
Fifty-three patients were included, with 66% male and a mean age of 58 ± 15 years. Comorbidities included hypertension in 88.7%, diabetes mellitus (DM) in 26.4% and coronary artery disease (CAD) in 17.0%. PD vintage was 23 months (IQR 21) and most were on continuous ambulatory peritoneal dialysis (75.5%). Median Clinical Frailty Score (CFS) was 2 (IQR 1). Mean LTI was 13.2 ± 2.7 kg/m2 and average handgrip strength was 28.4 ± 8.8 kg in the right arm and 26 kg (IQR 13) in the left. Reported outcomes of number of peritonitis, outer peritoneal catheter infection, hospitalizations and MACE (Major Adverse Cardiovascular Events) episodes were low. There were 3 reported deaths during follow-up.
Six patients were considered sarcopenic, with 66% male and a mean age of 58.1 ± 14.9 years, with DM in 50%, hypertension in 100% and CAD in 33.3%. Median LTI was 9.4 (IQR 1.2), with left and right median hand grip of 24 (IQR 10) and 26 (13), respectfully. Outcomes were also low, with no statistically significant difference between sarcopenic and non-sarcopenic patients.

Conclusion
Despite being considered an indication of higher morbidity and mortality, the diagnosis of sarcopenia was not associated with worse outcomes in patients under peritoneal dialysis.
#2189 Percutaneous peritoneal dialysis catheter implantation
Authors: Soler Laura Boix I , Suárez Gabriel Manuel González , Devia Claudia Marcela Castillo , Álvarez Saltos Jehimy Jean , Cantalejo Leyre Garcia , Alemany Nadia Martín , Martínez Jordi Calabia 
Published: May 2024

Abstract

Background and Aims
There are three main techniques to implant a peritoneal dialysis catheter (PDC): percutaneously, laparoscopically or through open surgery; and current guidelines recommend individualising according to previous abdominal surgeries and anaesthetic risk. Recent metanalysis show the percutaneous technique to be safe, non-inferior in catheter survival, and with an equal incidence in mechanic complications (within &lt;3 months after implantation) and infectious complications (within &lt;1 month after implantation) to laparoscopic technique.
On the other side, as the percutaneous PDC implantation is a minimal intervention that requires neither surgery room nor over 24h hospitalisation, it allows for a lower waiting time to PDC implantation, a shorter period until usage, and it's economically efficient. Considering these benefits and its non-inferiority described in the literature, our centre started using this technique since 2018. In this study we analyse our results.

Method
This is an observational retrospective unicentric study, which included the first PDC implantation in adult patients between January 2019 and August 2023, were we analysed the mechanical and infectious complications associated with the implantation technique. All PDC were double-cuff straight Tenckhoff, placed using Seldinger technique with radioscopy. A single dose of prophylactic antibiotic was used. We considered as mechanic complication all those non-infectious incidences that required repositioning or replacement of the PDC within 3 months of implantation (excluding those patients whose catheter was removed because of kidney transplantation, death by other reasons non related to the procedure, or trespass to haemodialysis); and we considered as infectious complications all those peritonitis diagnosed the first month after implantation.

Results
We analysed a total of 147 patients, 71.4% were male, mean age was 61 years old, and mean kidney function at implantation time was 11.5 ml/min/1.73 m2. We found a total of 8.1% of mechanical complications (33% required repositioning and 66% required replacement) and 5.4% infectious complications. There were no deaths related to percutaneous PDC technique.

Conclusion
In this study we observe that mechanic or infectious complications associated with percutaneous PDC technique are similar to those published in the literature: ISPD guidelines recommend the incidence of peritonitis associated to catheter implantation to be less than 5%. And though there is no clear percentage of mechanical complications that are considered acceptable or unavoidable, many studies report a survival of 76-86% PDC at 90 days of implantation in percutaneous and laparoscopic procedures, without significant differences between them.
#2241 Validation of a new formula for total body water in peritoneal dialysis patients
Authors: Ramos Ana Rita , Duarte Rui , Alves Rita Valerio , Gonçalves Hernâni , Santos Paulo 
Published: May 2024

Abstract

Background and Aims
Peritoneal dialysis (PD) adequacy, assessed primarily by Kt/V, is crucial in routine clinical practice for detecting issues with PD treatment. This metric relies on urea levels and its volume (V) distribution, classically equivalent to total body water (TBW). TBW estimation, commonly achieved through the Watson and Watson (WW) formula, lacks dialysis patients in its original study, it also excluded patients with water metabolism disturbances, raising concerns about its generalizability to this population. Responding to this need, a new formula (NF) for calculating TBW in PD patients was developed in our center, with the aim of improving the correlation between administered Kt/V and clinical outcomes. Consequently, this study seeks to validate the proposed formula by applying it to a population.

Method
A prospective study conducted at a single center within PD program involved the collection of data on adequacy and Body Composition Monitoring (BCM) spanning from May 2023 to January 2024.
TBW was calculated using the WW formula and the proposed new formula (TBW BI=0.36*Height+0.241*weight−9.675*BSA−26.234 for man and TBW BI=0.36*Height+0.241*weight−9.675*BSA−28.926 for woman).
Categorical variables are presented as frequencies and percentages, continuous variables as means and standard deviations, or medians and interquartile ranges for variables with skewed distributions. A p-value &lt; 0.05 was considered significant. Both formulas were subjected to correlation analysis with BCM TBW to assess mean differences using a paired-samples T test. Additionally, the resulting Kt/V values were compared, along with an examination of concordance in the detection of Kt/V values below 1.7.

Results
66 measurements were collected from 36 PD patients. 29.2% (n = 10) were female, and the mean age was 59.7 years. Both formulas exhibited strong correlations with BCM TBW (WW: ρ = 0.949 and NF: ρ = 0.953, p &lt; 0.001). BCM TBW showed a significant difference from WW TBW (34.8 vs. 38.1 liters, p &lt; 0.001), but not when compared to the new formula (34.8 vs. 33.9, p = 0.06). The resulting BCM-derived Kt/V significantly differed from both formulas, with a larger mean difference compared to the WW formula (BCM: 2.71 vs. WW: 2.42, p &lt; 0.001, and vs. the new formula: 2.77, p = 0.04). There was a perfect association between the use of NF and identification of BCM derived KtV measurements under the 1.7 target (Phi = 1, p &lt; 0.001), an association that was strong for WW (Phi = 0.69, p &lt; 0.001).

Conclusion
Errors in quantifying PD adequacy can lead to delayed detection of technical issues or inappropriate adjustments to already adequate prescriptions. We present a novel formula, specific for the PD population, reducing errors in PD quantification, particularly in settings where BCM is not available.
#2519 Technical complications assessment of the novel SILENCIA© APD cycler
Authors: Martin Ovidio Manuel Jimenez , Perplies Stefan , Busink Ellen , Boeger Sophie 
Published: May 2024

Abstract

Background and Aims
A new gravimetric peritoneal dialysis (PD) cycler, SILENCIA (Fresenius Medical Care, Bad Homburg, Germany), has been reported to achieve not only an adequate dialysis dose, but it is proposed also to be easy to use, cost-effective, and silent. In this study, we explored the alarms, cautions and number of terminated treatments due to potential errors and malfunctions of this new cycler.

Method
Over a period of 6 months, technical related device data was collected remotely, via a cloud-based infrastructure, including a Gateway and a Card Reader. The technical related data was then analyzed and visualized in a Dashboard. In special occasions, e.g., in case of device issues additional further technical data was collected on-site at patients’ home by a Service Technician.

Results
In total, 1860 technical related device data sets were collected in 3 different countries (Chile, Ecuador, and Turkey) from the treatments of 18 PD patients. 15 out of 32 patients were between 31 and 50 years old, and the mean PD duration was 2.14 years (n = 32). In total 9 alarms (5 per 1000 treatments) occurred, 5 being related to software bugs, 4 undetermined. 99.5% of the treatments were performed without alarms. In average, 5.3 cautions per 1000 treatments were observed, 94.7% due to blocked tubing system. Power failures only occurred in 4% of the treatments, with an average duration of 38.6 minutes. During power failures, the device does not wake up patients, proceeds as the power is back and treatment stays within schedule due to FlexPoint. A detailed list of alarms, cautions and power failures is presented in Table 1.

Conclusion
The results of this study demonstrate that SILENCIA supports PD treatment with a low number of alarms and cautions, which may help to achieve a smooth therapy for the patients, especially considering that the treatments are mainly performed during the night.