bluuebunny/crossref_metadata_2025_split huggingface dataset:
#178 Patient survey reveals insights into patient perceptions and understanding of polycystic kidney disease
Authors: Larkin Amy 
Published: May 2024

Abstract

Background and Aims
This patient survey examines patient knowledge of polycystic kidney disease (PKD) and provides insights into their preferences, and communication received from healthcare teams.

Method
A 20-question, online, patient-facing survey was deployed on WebMD.com. Respondent confidentiality was maintained, and responses were de-identified and aggregated prior to analyses. No personally identifiable information was collected for the respondents in this study. The activity launched in April 2023 and data were collected through August 2023.

Results
In total, 331 people participated in the survey. Key clinical takeaways include:

Conclusion
Patient experiences across several aspects of PKD were assessed in this survey to provide clinical insights into education for patients and clinicians. This educational research study uncovered valuable insights into the patient/caregiver experience as it relates to PKD. The findings and trends in healthcare utilization identified in the survey help to provide insight for future education for both clinicians and patients/care partners.
#876 Albuminuria and the risk of dementia and different dementia subtypes: the Stockholm Creatinine Measurements (SCREAM) project
Authors: Luo L I , Gansevoort Ronald , Kieneker Lyanne , Yang Yuanhang , Bosi Alessandro , de Boer Rudolf , Franssen Casper F M , Eriksdotter Maria , Carrero Juan-Jesus , Xu Hong 
Published: May 2024

Abstract

Background and Aims
Studies investigating the association of chronic kidney disease and dementia predominantly focused on estimated glomerular filtration rate (eGFR) rather than albuminuria. The few studies focusing on albuminuria reported conflicting results, probably due to a lack of power, not taking into account the different dementia subtypes, not adjusting for eGFR, and the use of different albuminuria measurement techniques. This study therefore investigated the eGFR-independent risk of all-cause and type-specific dementia associated with albuminuria, quantified as urine albumin-creatinine ratio (ACR) and by dipstick, in a large population.

Method
We included subjects from the Stockholm Creatinine Measurements (SCREAM) project without a history of dementia and with age ≥65 years. The main analyses involved 138 688 subjects with at least one ACR test, and for sensitivity analyses, we involved 170 572 subjects with at least one dipstick proteinuria test. Albuminuria was quantified as KDIGO albuminuria A1-A3 stages. The primary outcome was incidence of all-cause dementia, and the key secondary outcomes were incidence of type-specific dementia. Dementia incidence was ascertained by record linkage with the national dementia registry (SveDem). ICD-10 coding was also used to classify subtypes only when there were no available dementia records in SveDem. Multivariable Cox regression models were used to calculate hazard ratios (HRs, 95% CIs) crude, and adjusted for confounders including baseline eGFR.

Results
During a median follow-up of 3.9 (IQR, 1.8-7.2) years, 9 970 subjects developed de novo dementia. After multivariable adjustment including baseline eGFR, subjects with an ACR of 30-299 mg/g or ≥300 mg/g had a 26% (HR, 1.26; 95% CI, 1.20-1.32) and 36% (HR, 1.36; 95% CI, 1.24-1.50) higher risk of developing all-cause dementia, respectively, when compared to subjects with an ACR &lt;30 mg/g. Subjects with an ACR of 30-299 mg/g also presented a higher risk of developing several type-specific dementia, including Alzheimer's dementia (HR, 1.09, 95% CI, 1.01-1.17), vascular dementia (HR, 1.35, 95% CI, 1.22-1.48), and unspecified dementia (HR, 1.54, 95% CI, 1.41-1.69). No significant associations between albuminuria and the incidence of Lewy body dementia and Parkinson's Disease with dementia, frontotemporal dementia, as well as other types of dementia were observed. These results were generally robust in several sensitivity analyses, including replicating our main analyses in subjects with a dipstick proteinuria test instead of an ACR.

Conclusion
Increased albuminuria is associated with a higher risk of all-cause, Alzheimer's, and vascular dementia, independent of baseline eGFR and different albuminuria measurement techniques.
#1024 Lung ultrasound in 28 versus 8 places and volume status in chronic hemodialysis patients
Authors: Varda Luka , Petreski Tadej , Jensen Sophie Fromholt , Chamkar Ikram , Bilici Bilge Nur , Ekart Robert 
Published: May 2024

Abstract

Background and Aims
Overhydration is considered a significant risk factor for cardiovascular and all-cause mortality in end-stage kidney disease patients. Measurement of total and extracellular water with bioelectrical impedance analysis (BIA), inferior vena cava diameter (IVCd) measurement, and circulating pro-B-type natriuretic peptide (proBNP) levels have previously been tested as possible indicators of volume status in hemodialysis (HD) patients, with BIA showing the most potential. Recently, it has been shown that lung ultrasound (LUS)-guided volume depletion is an effective strategy for relieving lung congestion in chronic HD patients. The aim of our study was to determine whether performing LUS on only 8 places was comparable to the regular 28 places.

Method
LUS was performed on 29 randomly selected patients before their regular HD procedure in 28 regular places and correlated with 8 places (4 on each side). In addition, BIA with a body composition monitor (BCM) was performed, IVCd was measured using ultrasound and serum NT-proBNP value was determined. Statistical analysis was performed using a commercially available SPSS® for Windows® (version 29.0; Chicago, IL, USA). Spearman's non-parametric test was used to determine a correlation between variables. P-values less than 0.05 were considered statistically significant.

Results
We included 29 chronic HD patients, 15 male (51.7 %), with a mean age of 66.3 ± 12.5 years and a median dialysis vintage of 53.0 (95% CI (40.9, 100.6)) months. Most patients (96.6 %) had a functional arteriovenous fistula, whereas only one patient (3.4 %) was dialysed using a Hickman catheter. A very strong, directly proportional correlation was found between performing LUS in 28 and 8 places (ρ=0.909; p&lt;0.001). A significant moderate correlation was also found between both LUS in 28 and 8 places and systolic blood pressure (ρ=0.503; p=0.005 and ρ=0.467; p=0.011, respectively) (Table 1). Neither of the LUS methods statistically correlated with other tested volume markers – overhydration, intracellular and extracellular volume measured with BIA, IVCd in inspiration and expiration and IVC index, or serum NT-proBNP levels.

Conclusion
In our study, we found a very strong, positive, and significant correlation between performing LUS in 28 regular places and 8 places. Both also moderately correlated with systolic blood pressure. However, we did not find a statistically significant correlation between LUS and other tested volume markers.
#2778 The Charlson Index can be used prospectively to identify patients who will need a close follow up of surveillance for the vascular access
Authors: Franco Antonio José Marín , Sánchez Christian Israel Alfaro , Pizarro Jose Luis , Sorribes Mª Paz , Martínez-Vaquera Shaira 
Published: May 2024

Abstract

Background and Aims
The primary screening methods for monitoring vascular access in haemodialysis involve measuring access blood flow and dialysis venous pressure. However, challenges are present in both aspects, potentially hindering the attainment of desired results. Research in this field is crucial to identify the optimal combination of intensive clinical monitoring and supplementary surveillance for effective outcomes.
For this reason, we aim to describe the impact of comorbidities and patency of native arteriovenous fistulae (nAVF).

Method
Descriptive study of prevalent patients on haemodialysis, carried out by consulting electronic medical records over a period of 35 months. Demographic and vascular access-related variables were included. Primary and secondary patency was calculated for all accesses. Patients with upper limb AVF were classified according to distal and proximal access location; and the Charlson Index was used to categorise patients according to comorbidities. Kaplan Meyer survival curves were used to contrast the impact of comorbidities on the different patency.

Results
52 patients, age 70.7 ± 1.57 years, 69.2% male, 42.3% diabetic, Charlson index with a median of 7 (6.5 - 7.73), 98.1% with a native fistula, the most frequent nAVF location in our population was humerocephalic (63.5%) and a predominance of the left upper extremity (65.4%). According to the location of the access, adjusted by the Charlson index, it is evident that in proximal accesses (humerocephalic and basilic humerus nAVF), with a Charlson Index less than or equal to 7, the time required to reach an event was statistically significantly longer (Log Rank Test (Mantel-Cox): primary patency p=0.057 and secondary patency p=0.069). This comparison was not significant in distal fistulas.

Conclusion
Using the Charlson comorbidity index information, we transformed it into an accessible and valuable tool for maintaining vascular access patency. Close follow-up in patients with proximal nAVF and high Charlson comorbidity index could be beneficial.
#2885 Thrombosis complicating the first native arteriovenous fistula: what are the risk factors?
Authors: Smii Amani , Ikram Mami , Hiba Ghabi , Syrine Tlili , Lamia Rais , Fatma Lilia Ben , Zouaghi Karim 
Published: May 2024

Abstract

Background and Aims
The native arteriovenous fistula is considered the best vascular access for hemodialysis, whose ultimate complication is thrombosis. The risk factors for this complication are multiple. The aim of our work is to determine the risk factors for thrombosis of the first created native AVF.

Method
This is a retrospective descriptive study of 65 patients over 18 years of age and hemodialyzed in our department who benefited of the confection of a native arteriovenous fistula at the same hospital.

Results
Arteriovenous fistula thrombosis occurred in 41.53% of patients with an average age of 49.4 years and a sex ratio M/F=3.5.
59.2% of arteriovenous fistulae were distal versus 40.7% proximal, divided into humerocephalic (29.6%) and humerobasilic (11.1%).
AVF thrombosis occurred after a mean duration of 3.19 years after its confection [01 months, 13 years].
25.9% of arteriovenous fistulae had not yet been punctured.
63% of patients were smokers, 55.6% were diabetics, 74.1% were hypertensive and 66.7% were cardiac with predomination of ischemic etiology in 29.6%.
44.4% of patients had obliterative arteriopathy of the lower limbs, 25.9% of whom were amputees.
Patients had been on dialysis for an average of 4.4 years [01 months, 13 years], with diabetic nephropathy predominating at 51.9%.
All patients were on antiplatelet therapy and 7.4% on anticoagulation.
11.1% had perdialytic hypotension.
Multivariate statistical analysis revealed a significant correlation between anemia, diabetes and the occurrence of thrombosis (respectively p = 0.03; p = 0.024).

Conclusion
Patients with arteriovenous fistula thrombosis have multiple cardiovascular risk factors. Diabetes and anemia remain the main predictive factors for thrombosis.
#865 Autologous cephalic vein transposition in the placement of forearm arteriovenous fistulas
Authors: Lomonte Carlo , Corciulo Simone , Libutti Pasquale , Bagagli Francesca , Robles Sara , Montinaro Vincenzo 
Published: May 2024

Abstract

Background and Aims
The autologous vein transposition was commonly used for hemodialysis vascular access (VA) in selected patient. The saphenous vein was used as a vascular graft; while, the contralateral cephalic vein was used as a bridge. We describe a new technique of autologous cephalic vein transposition to create a native AVF in hemodialysis patients.

Method
Patients referred to our hospital for a vascular access placement. US vascular mapping of upper extremities revealed small arteries, but adequate forearm veins in all patients. Specifically, the radial artery luminal diameter was &lt; 1.4 mm and &lt; 1.6 mm, respectively at wrist and at middle-arm. While, at bend of the elbow, the ulnar artery diameter (&gt;2.5 mm) in one case, and the brachial artery diameter (&gt;3.5 mm) in two cases, were deemed adequate as feeding arteries of a possible AVFs. Furthermore, the diameter of the forearm cephalic vein ranged from 2.0 to 2.4 mm; in the upper arm the veins were obstructed or stenotic in one of the two arms. The basilic vein was patent in both arms of the patients; the internal diameter varied from 2.5 to 2.7 mm. Due to difficulty to create a traditional fistula, and higher risk of primary failure, it was decided to transpose the cephalic vein, from the forearm not suitable for the AVF, to the contralateral arm chosen for the AVF placement.

Results
With local anesthesia, an approximately 10-cm stretch of cephalic vein was harvested from the arm contralateral to the site chosen for AVF. Then, the transposed veins, reversed in their cranio-caudal position, were tunneled subcutaneously and anastomosed, in an end-to-end fashion, with cephalic vein at wrist region, and subsequently in a side-artery to end-vein at the elbow crease. The transposed AVFs were created in three patients with ESKD (2M/1F), mean age 47± 3.6 years, (two in the non-dominant arm), without complications. After 4 weeks, all the AVF were patent and the access flow was 660±120 ml/min. All the three AVF was deemed mature and usable for hemodialysis.

Conclusion
In selected cases, autologous transposition of the cephalic vein can be used to create an AVF, providing a long segment for cannulation. This type of AVF can be an alternative to prosthetic fistula, sparing the central venous catheter.
#831 Associations of quality of life with hospitalization for infection and subsequent death in hemodialysis patients: Osaka Dialysis Complication Study
Authors: Nagata Yuki , Shoji Tetsuo , Nakatani Shinya , Mori Katsuhito , Morioka Tomoaki , Emoto Masanori 
Published: May 2024

Abstract

Background and Aims
Health-related quality of life (HRQOL) as self-reported health status is known to predict mortality in hemodialysis (HD) patients. Infection is one of the major causes for death in those patients, although limited studies have examined possible associations of HRQOL with infection-related outcomes. In the present study, we examined the associations of HRQOL scores with all-cause mortality, hospitalization for infection, and subsequent death in HD patients.

Method
Patients for this study were selected from the Osaka Dialysis Complication Study (ODCS) which is a prospective cohort study from 2012 to 2017 including a total of 1696 HD patients. HRQOL was assessed by Medical Outcomes Study short form 36 (SF-36) questionnaire to determine scores of the physical component summary (PCS) and the mental component summary (MCS) at baseline, and patients were divided into tertiles of them. The key outcomes were all-cause mortality, hospitalization for infection, and subsequent death after infection. Association was analyzed with Cox proportional hazards models or Fine-Gray models to estimate hazard ratios (HRs) with the highest tertile of PCS or MCS (T3) as referent. Models were unadjusted and adjusted for potential confounders including major demographic factors, traditional cardiovascular risk factors, and the factors related to chronic kidney disease-mineral and bone disorder (CKD-MBD), protein energy wasting and inflammation, and renal anemia.

Results
We analyzed data from 1464 patients, and we identified 384 all-cause deaths, 321 hospitalizations for infections, and 143 subsequent deaths following infection. Risk of all-cause death was the highest in the lowest PCS tertile in unadjusted model, and this association remained significant in multivariable-adjusted models. In addition, a lower PCS was significantly predictive of a higher risk of both hospitalization for infection in models unadjusted and adjusted for demographic variables, but not significant in a model adjusted for all confounders. However, risk of death after hospitalization for infection was significantly higher in the lowest PCS tertile in unadjusted and in multivariable-adjusted models, compared with the highest PCS tertile. In contrast, MCS was not associated with all-cause mortality, hospitalization for infection, or death following hospitalization for infection.

Conclusion
A low PCS was associated with both hospitalization for infection and subsequent death after infection in HD patients, but it was more closely associated with the latter. This study revealed that HRQOL, particularly its physical component, is an independent predictor of infection-related outcomes in this population.
#2377 Association of uremic toxins with morbidity and mortality in patients on hemodialysis
Authors: Tourountzis Theodoros , Lioulios Georgios , Van Laecke Steven , Stai Stamatia , Christodoulou Michalis , Moysidou Eleni , Fylaktou Asimina , Glorieux Griet , Stangou Maria 
Published: May 2024

Abstract

Background and Aims
Morbidity and mortality are increased in patients on hemodialysis (HD), and the possible impact of protein bound uremic toxins (PBUT) is of great interest. We assessed the association between PBUT serum levels and clinical events including cardiovascular (CVE), severe infections (hospitalization due to infection, respiratory infection) and all-cause mortality.

Method
In this prospective observational study, PBUT plasma levels [hippuric acid (HA), indoxyl sulfate (IxS), p-cresyl sulfate (pCS), p-cresyl glycuronide (pCG), indole-3-acetic acid (IAA), 3-carboxy-4-methyl-5-propyl-2-furanpropionate (CMPF)] were quantified by ultra-performance liquid chromatography in 54 patients on HD (Age 51.3±16.91 years) and the association with future clinical events (CVE, hospitalization due to severe infection, respiratory infection and all-cause mortality) during 24 months follow up (FU), was assessed.

Results
In patients who died during FU (n=6), increased levels of total HA 6.42 (4.54) vs 2.75 (3.03)mg/dl (p=0.007), free HA 4.79 (3.93) vs 1.363 (1.85)mg/dl (p=0.004); free IxS 0.29 (0.29) vs 0.13 (0.17)mg/dl (p=0.045); total pCG 0.36 (0.5) vs 0.19 (0.28)mg/dl (p=0.045), free pCG 0.33 (0.43) vs 0.18 (0.26)mg/dl (p=0.042) were found. Moreover, in patients who experienced a CVE (n=11), a higher concentration of CMPF [0.39 (0.67) vs 0.15 (0.19)mg/dl (p=0.015)] was observed. No significant correlations were found between pCS and IAA levels with morbidity and mortality in this study.
A logistic regression model, describing the effect of each PBUT on death probability could explain 44% (Nagelkerke R2) of the variance in death and correctly classified 90.7% of cases. Patients with increased levels of free IxS, total and free HA were more likely to die within a 2-year FU period (p=0.047, p=0.013, p=0.003, respectively).
PBUT levels were not different among HD patients with and without severe infections.

Conclusion
Increased levels of PBUT (HA and free IxS) in patients on HD, associate with increased risk of death and CMPF with cardiovascular events.
#2973 COVID-19 increased hemodialysis patients’ mortality, relation with inflammation and telomere attrition
Authors: Kovačević Tamara , Pešić Snežana , Kotur-Stevuljevic Jelena , Naumovic Radomir 
Published: May 2024

Abstract

Background and Aims
An increased risk of mortality and hospitalization has been consistently demonstrated in patients with CKD who are additionally affected by corona virus disease 19 (COVID-19). In this study, we tried to identify predictive factors of mortality and hospitalizations, especially the ratio of neutrophils to lymphocytes (NLR), lactate dehydrogenase (LDH), c-reactive protein (CRP), disease status of COVID-19, telomere length in peripheral blood cells (TL) and 2-year risk score.

Method
A total of 130 chronic hemodialysis patients, were enrolled in the present study and followed up for 18 months. Routine laboratory parameters including LDH, were determined by standard automated methods, redox status parameters SOD and O2. - Using spectrophotometric methods.TL was determined using the modified Cawthon method and was calculated as the T/S ratio. Kaplan-Meier analysis was used to test survival predictors.

Results
Patients in deceased group (30%) were significantly older (p &lt;0.001), with higher body mass index (BMI), (p &lt; 0.01) than survived patients. Also, patients in the deceased group had higher levels of LDH, NLR index, CRP compared to survivors. Lower lymphocytes and shortened TL were characteristic of these patient groups, but the deceased group had the lowest lymphocytes (p &lt; 0.005) and telomeres (p&lt;0.002), and had the highest NLR (0.004). The difference in 2-years risk score also was significant (p &lt; 0.001), with higher scores in the deceased group. Kaplan-Meier survival analysis showed six parameters were significant predictors in the following order of significance: COVID-19 status, 2-years risk score, NLR, TL, CRP, LDH. Using binary logistic regression analysis Summary risk score, a combination of these six parameters revealed as the best predictor of patients’ survival in this group of parameters (Log rank=25.4, P &lt; 0.001).

Conclusion
Independent predictors of mortality in chronic haemodialysis patients are higher NLR, CRP, LDH, Lower lymphocytes and shortened TL, and COVID -19 made the situation even worse by significantly arising these patients’ mortality rate.