bluuebunny/crossref_metadata_2025_split huggingface dataset:
#1073 Changes in endothelial function in patients with impaired central and renal hemodynamics respiratory pathology
Authors: Korakulova Zilola , Atahodjayeva Gulchehra , Alimovna Dilorom , Alyavi Anis 
Published: May 2024

Abstract

Background and Aims
To determine the degree of influence of endothelial dysfunction on the hemodynamics of renal and central vessels in respiratory pathology, as well as to determine the effectiveness of complex therapy regimens with carvedilol.

Method
Studies were conducted in 26 patients with chronic obstructive pulmonary disease (COPD) of II- III severity (group 1, in whom the level of glomerular filtration rate of the kidneys eGFR CKD-EPI ≥6 ml/min/1.73 m2 was determined) and 32 patients with COPD of IV severity (group 2, they were determined e GFR CKD-EPI ≥60 ml/min/1.73 m2). Patients received one course of ten-day standard therapy (GOLD, 2020) in combination with a beta–blocker drug, T. carvedilol 5 mg (Vertex).
Doppler echocardiographic examination of peripheral vessels, heart and renal vessels of patients was performed. Stable metabolites of nitric oxide (Cm NO) in blood plasma, ventilation and perfusion state of the lungs were determined.

Results
A significant decrease in the functional state of the respiratory system was parallel with a decrease in Cm NO synthesis, which was clearly reflected in the second group (by 11%) compared with the first group (by 7%). Pronounced structural changes with remodeling of the right parts of the heart, as well as a pronounced degree of pancreatic hypertrophy in the second group were accompanied by a sharp change in renal filtration function (eGFR ≤60 ml/min/1.73 m2). When measuring the state of diastolic dysfunction of the right parts of the heart, a decrease in E/As well as an increase in the circulatory vascular resistance index and mean blood pressure were significantly higher in the first group of patients (where еGFR ≥6 ml/min/1.73 m2).
After a course of treatment with t. carvedilol, based on basic treatment, normalization of endothelial function was determined, reflected in an increase in the concentration of stable metabolites of nitric oxide by 1.05 and 1.5 times (p&lt;0.05) in the biological fluid, respectively, in the first and second groups. In the dynamics of the course of therapy in groups of patients with 75% and 35% decrease in lung ventilation capacity, mean pulmonary arterial pressure decreased by 18.1 and 14.3%, respectively, and the hemodynamic resistance index decreased by 7.9% and 5.7% in parallel (p&lt;0.05).

Conclusion
When monitoring the functional state of central and renal hemodynamics and ventilation-perfusion function of the bronchopulmonary system after complex treatment with carvedilol, a long-term hypotensive effect, a decrease in endothelial dysfunction, respectively, and an improvement in central and renal hemodynamics were determined.
#1190 Expression of metabolic disorders in patients with hypertension and chronic kidney disease
Authors: Duysenbaeva Aziza , Srojidinova Nigora 
Published: May 2024

Abstract

Background and Aims
To study the frequency of metabolic disorders in patients with hypertension depending on the stage of chronic kidney disease (CKD).

Method
The study analyzed 594 case histories of patients with AH of I-III degree (ESC/ESH 2018). CKD stages were determined according to eGFR (EPI-2021), according to the modern KDIGO 2013 classification. All patients were tested for uric acid, glucose, creatinine, and blood lipids using a Daytona autoanalyzer from RANDOX (UK). The study was conducted against the background of antihypertensive therapy (AHT). Statistical analysis was carried out using the SPSS 24.0 software package.

Results
Among the examined patients, intact renal function of CKD C1 (eGFR&gt;90 ml/min/1.73 m2) was observed in 19.5% (n = 116); CKD C2 (eGFR 60-89 ml/min/1.73 m2) – in 50.5% (n = 300); CKD C3A (eGFR 45-59 ml/min/1.73 m2) – in 20.4% (n = 121); CKD C3B (eGFR 30-44 ml/min/1.73 m2) – in 6.4% (n = 38); CKD C4 (eGFR 29-15 ml/min/1.73 m2) - in 3.2% (n = 19) p &lt; 0.0001. The terminal stage of CKD was not revealed. The mean creatinine in the groups was 66.20 ± 11.74 vs 83.44 ± 11.30 vs 105.84 ± 17.36 vs 139.78 ± 24.40 vs 212.00 ± 19.73 µmol/l, respectively (p &lt; 0.00001) . Mean eGFR 97.99 ± 6.98 vs 75.44 ± 7.15 vs 53.46 ± 4.30 vs 37.82 ± 3.63 vs 23.11 ± 5.63 ml/min/1.73 m2, respectively, (p &lt; 0.00001). The groups did not differ significantly in body mass index (BMI), but patients with high stage of CKD have pronounced abdominal obesity. BMI was 30.71 ± 4.4 vs 32.25 ± 5.8 vs 31.45 ± 4 vs 31.6 ± 5.6 vs 30.36 ± 10.2 kg/m2, respectively, p = 0.11. Waist measurement (WT): 98.68 ± 10 vs 104.36 ± 13.6 vs 103.62 ± 10.7 vs 104.51 ± 12.4 vs 106.94 ± 27.3 cm, respectively (p = 0.001) . It should be noted that the high stages of CKD are characterized by significantly pronounced asymptomatic hyperuremia. At the same time, the level of uric acid was 5.07 ± 1.4 vs 6.1 ± 4.7 vs 6.6 ± 1.7 vs 7.87 ± 1.7 vs 7.52 ± 1.01 µmol/l, respectively (p &lt; 0.00001). When analyzing lipid spectrum data, total blood cholesterol (TC) and triglycerides (TG) in the blood did not differ significantly among the studied groups. However, it was found that increasing of CKD leads to significantly rising of low-density lipoproteins: 107.04 ± 42.57 vs 103.53 ± 38.04 vs 112.44 ± 44.27 vs 120.64 ± 39.27 vs 133.94 ± 29.83 mmol/l, respectively, р = 0.03, while the amount of high density lipoproteins significantly decrease: 42.64 ± 13.79 vs 41.86 ± 11.03 vs 41.51 ± 10.64 vs 39.62 ± 11.08 vs 36.72 ± 7.72 mmol/l, respectively, p = 0.0001.

Conclusion
In patients with hypertension and CKD, metabolic disorders are more pronounced, which increases the risk of developing complications of arterial hypertension.
#2982 Shifts in SGLT2 inhibitor initiation in CKD non-dialysis patients
Authors: Mcclatchy Ellie , Snyder Justin , Weiss Meghan 
Published: May 2024

Abstract

Background and Aims
KDIGO guidelines have changed since 2020 with the introduction of SGLT2 inhibitors to CKD care. As the agents have become more standard of care in CKD, this research assesses how the treatment of more than 2000 CKD non-dialysis patients in the EU5 aligns with the KDIGO guidelines.

Method
Data from 1062 patient charts were collected in partnership with 265 EU5 (Germany, United Kingdom, Italy, France, and Spain) nephrologists via an online survey from December 2022-February 2023. Additionally, data from 1282 patient charts were collected from 263 EU5 nephrologists from December 2021-February 2022 via an online survey.

Results
Nephrologists often report that they strongly rely on the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines when making treatment decisions for their patients. Globally recognized, the KDIGO guidelines are created and periodically updated based on a rigorous scientific process to create an all-encompassing set of clinical practice recommendations.
Over the past several years, SGLT2 inhibitors have become a fundamental part of CKD treatment and eGFR management. While the agents are primarily used in CKD patients with diabetic kidney disease (DKD), treatment rates among non-diabetic CKD patients have increased year-over-year. According to 2023 audited patient chart data, approximately one-half of DKD patients in the EU5 are on an SGLT2 inhibitor, while there has been a notable increase in treatment rates among non-diabetic CKD patients, from 11% in 2022 to 23% in 2023.
Despite the recent change in the KDIGO guideline, which lowered the recommended eGFR level for SGLT2 inhibitor initiation to 20 mL/min/1.73 m2, 71% of patients who are treated with an SGLT2 inhibitor were initiated on therapy in CKD Stage 3 (eGFR 30-50), indicating that EU5 nephrologists have not yet conformed to the revised guidelines.
Notably, participating EU5 nephrologists elicit increased comfort prescribing SGLT2 inhibitors to both their DKD and non-diabetic CKD patients year-over-year. In 2023, nearly all physicians reported that they expect to increase their use of SGLT2 inhibitors in their CKD patients, regardless of their diabetes status, indicating that there is potential for further adoption of the revised KDIGO guidelines into clinical practice.

Conclusion
As the treatment of CKD patients continues to evolve with SGLT2 inhibitors and newer therapies, KDIGO guidelines will adjust to accommodate evolution. Increased awareness of guideline changes will be paramount in ensuring that patients are receiving top quality care based on treatment recommendations.
#2019 Comparing survival outcomes between hemodialysis and hemodiafiltration using real-world data from Brazil
Authors: Da Rocha Erica Pires , Wagner Carolina S , Kojima Christiane Akemi , Costa Daniel Monte , Magalhães Andrea Olivares , Rocha Whelington Figueiredo , de Vasconcelos Júnior Leonardo Nunes , Rosa Maria Gabriela , de Andrade Luis Gustavo Modelli 
Published: May 2024

Abstract

Background and Aims
The CONVINCE trial and others studies, demonstrates that high-dose hemodiafiltration offers a survival advantage and benefits in reducing cardiovascular complications for patients in high-flux hemodiafiltration group compared to hemodialysis.

Method
We compared the outcomes of hemodialysis and hemodiafiltration using real-world data. We conducted an analysis on a cohort of patients who underwent hemodiafiltration therapy (HDF) at a single center, NefroStar Clinics from 28/06/2021 to 30/05/2023. The results obtained were then compared with data from patients receiving hemodialysis (HD) therapy within the Brazilian Public Health System (SUS). Baseline data, type of access for dialysis and adequacy tests obtained through the average of monthly tests were collected. The HDF data were obtained through automatic extraction of electronic medical records and the HD data were obtained by Datasus. The primary outcome was mortality from any cause.

Results
85 patients undergoing hemodiafiltration were compared with 149,372 patients receiving hemodialysis through the Brazilian Public Health System (SUS). Using a 2:1 propensity score, we compared the 170 best-match HD patients along with 85 HDF patients. The percentage of vascular access and male sex were similar in both groups. The mean age of HDF and HD patients was 54 [41-67] and 58 [46-68] years, p=0.054, respectively. The adequacy tests show higher hemoglobin values and mores PTH values in the HDF group. In the Cox analysis, HDF therapy showed a reduced risk of mortality with an HR of 0.29 [0.11 – 0.77]. The propensity score analysis showed a HR of 0.32 [95% CI: 0.11 – 0.91]. This analysis was adjusted for age, type of access, KT/v, hemoglobin, and phosphorus. The Kaplan-Meier analysis showed respective survival rates for HDF and HD at the end of one year, 92.1% and 79.9%, p&lt;0.001.

Conclusion
These results suggest high flux hemodiafiltration had survival advantages over hemodialysis in real word scenario.
#704 Albumin, inflammation and nutrition in hemodialisis patients in Colombia: a cohort study
Authors: Castillo Juan Carlos Mario , Sanabria Mauricio , Vesga Jasmin , Aldana Andrea , Sánchez Ricardo , Buitrago Giancarlo , Oliveros Henry , Rivera Angela , Rutherford Peter 
Published: May 2024

Abstract

Background and Aims
Hypoalbuminemia is a well-identified risk factor for mortality in chronic hemodialysis patients. As a negative acute phase reactant, albumin levels could be associated with several factors that affect the patient on hemodialysis (HD), such as alterations in the rate of hepatic synthesis, an increase in the rate of catabolism, or an increase in losses due to the dialysis process.
The objective of the present study is to analyze serum albumin values in repeated measurements over time in two cohorts, one with expanded HD (HDx) enabled by the medium cut-off membrane (MCO) Theranova and the other with high flux (HF) HD and estimate the relationship with other relevant variables.

Method
Cohort study, one with HDx enabled by Theranova® and the other with HF HD, adult prevalent HD patients (&gt; 90 days) at Baxter Renal Care Services Colombia starting between September 1, 2017, and November 30, 2017, with follow-up for up to 48 months. Sociodemographic and clinical characteristics were summarized descriptively, and a mixed linear model with repeated measures was performed to evaluate the association between dialysis membrane and albumin levels, controlling for confounding variables.

Results
We evaluated 1092 patients (62% male): 533 in HF-HD vs. 559 in HDx (Table 1); the median age was 61 years, 42% had a history of diabetes, and 19% had cardiovascular disease. We found no differences in albumin levels over time when comparing Theranova versus HF HD patients, p-value = 0.789 (see Fig. 1). No association between serum albumin levels and the Theranova dialyzer was found with the linear mixed model with repeated measures when controlling for confounding variables, p-value= 0.198. On the other hand, we found that serum albumin was associated with inflammatory and nutritional variables such as C reactive protein, Ratio platelets/lymphocytes, and Protein Energy Wasting (PEW) (Table 2).

Conclusion
Variables including nutritional status and inflammation, age, and hospitalization events are associated with serum albumin levels varying over time. Variation in serum albumin levels over time are not associated with type of dialyzer (Theranova® vs HF).
#857 How low can we go with dialysate flow? Does that mean we can make nephrology green?
Authors: Glowinska Irena , Kakareko Katarzyna , Rydzewska-Rosołowska Alicja , Pietruczuk Adam , Hryszko Tomasz 
Published: May 2024

Abstract

Background and Aims
Green nephrology encompasses all initiatives in kidney care that have a positive impact on the climate and environment. We know that environmental impact of dialysis is particularly high, considering water consumption and disposable waste production during each session. All that suggests a great opportunity where many improvements should be made.
To prepare the dialysate 240 liters of water are needed for one four-hour session with a dialysate flow (Qd) set at 500 ml/min. Including additional water needed to rinse and sterilize the system, this gives approximately 500 liters of water used for one hemodialysis. Lower dialysate flow rate is associated with a significant reduction in the amount of water used for the hemodialysis procedure.
An increase in Qd from 500 ml/min to 800 ml/min has been recommended to increase dialysis efficiency. It's benefit was not confirmed in in vivo studies which suggested that increasing the dialysate flow rate offers no benefit in terms of delivered Kt/V. Similarly, studies with a Qd of 400 ml/min showed comparable efficiency. If hemodialysis could be performed equally effectively with less dialysate consumption, water could be significantly saved.
The aim of this study was to check whether change of dialysate flow from 500 ml/min to 300 ml/min has a significant impact on dialysis adequacy (measured by Kt/V).

Method
The study was a retrospective analysis. During the COVID19 surge in January 2022 due to administrative issues in a satellite dialysis center the dialysate flow was reduced to 300 ml/min. The center again increased Qd to 500 ml/min in February 2022. We analyzed laboratory data from 3 months before dialysate flow reduction, in the month with reduced Qd to 300 ml/min, and from 3 months thereafter with Qd set at 500 ml/min.

Results
26 patients (10 men and 16 women – all dialysis patients from a satellite dialysis center) were enrolled in the study. Two of them died during observation, therefore 24 people were included in final analysis. Their median age was 72 (66-78) years. ANOVA with repeated measures showed lack of differences between three time points in terms of Kt/V (Qd 500 ml/min - 1.285±0.202, Qd 300 ml/min - 1.275±0.192 and Qd 500 ml/min - 1.337±0.199; p=0.093). Change in serum potassium during hemodialysis did not depend on dialysate flow (ΔK Qd 500ml/min - 1.5±0.5 mmol/l, Qd 300 ml//min - 1.7±0.5 mmol/l, Qd 500 ml/min - 1.6±0.4 mmol/l; p=0.197). Serum phosphorus was comparable between three time points (Qd 500 ml/min - 5.99±1.68 mg/l, Qd 300 ml/min - 5.65±1.4mg/l, Qd 500 ml/min - 6.01±1.67 mg/l; p=0.066).

Conclusion
Reduction in dialysate flow rate to 300 ml/min is safe for the patients and probably does not cause any short-term negative effects. Thus we can achieve the same therapeutic effect saving water consumption. Larger, long-term studies are needed to confirm the efficacy of this approach.
#1340 Validation of artificial intelligence algorithm classifying arteriovenous access aneurysms in hemodialysis: a blinded multicenter prospective study
Authors: Dong Zijun , Zhang Hanjie , Wang Lin-Chun , Ren Sarah , Tisdale Lela , Han Maggie , Bittencourt Valeria G , Rosales Merlo Laura , Prakash-Polet Sindhuri , Douglas Denzil , Starakiewicz Piotr , Shtaynberg Norbert , Fuca Nicholas , Kozyra Andrzej , Thijssen Stephan , Preddie Dean C , Kotanko Peter 
Published: May 2024

Abstract

Background and Aims
In hemodialysis (HD) patients, arteriovenous (AV) access aneurysms may lead to severe and potentially life-threatening consequences, such as rupture. To address this issue, we developed an artificial intelligence-based application that utilizes images of the AV access to classify AV aneurysms [1].
We conducted a blinded, multicenter, prospective pilot study to assess the correlation between the classification results generated by the aneurysm classification application and the independent clinical examination conducted by physicians specializing in vascular access care.

Method
AV accesses were photographed using tablets. These images were then uploaded to the cloud, where they were classified as either "Advanced" or "Not Advanced" by a convolutional neural network algorithm [1] (Fig. 1A). The study compared AV aneurysm classifications generated by our application to those made by vascular access physicians blinded to the app results. The physicians’ classifications served as the ground truth for our analysis.

Results
The study was conducted at two vascular access care centers in New York, NY, USA. A total of 121 patients were included in the analysis (Table 1). The physicians’ assessment identified a 21% prevalence of advanced aneurysms.
The application accurately classified 84 out of 95 aneurysm images as “Not Advanced” and 20 out of 26 as “Advanced,” resulting in an accuracy of 86.0% (95% CI: 78.5% to 91.6%), a sensitivity of 76.9% (95% CI: 56.4% to 91.0%), a specificity of 88.4% (95% CI: 80.2% to 94.1%), and an area under the receiver operating characteristics curve (AUROC) of 0.87 (95% CI: 0.78 to 0.94) (Fig. 1B).

Conclusion
Our results demonstrate that an AI-powered application exhibits actionable accuracy in classifying AV aneurysms within a demographically diverse HD population. These findings align with Zhang et al., where a team of vascular access experts classified 1,093 out of 1,341 (81.5%) images as “Not Advanced” aneurysms and 248 (18.5%) as “Advanced,” resulting in an AUROC of 0.96 in the validation set (n = 402) [1]. The difference in AUROCs can be attributed to the fact that, in Zhang et al., vascular access experts evaluated only AV access images, whereas in the present study, they performed a physical examination of the patient.
Our tool may have the potential to support aneurysm monitoring processes, enabling timely detection, decision-making, and interventions.
#2331 Distal arteriovenous fistulas for hemodialysis – too many interventions?
Authors: de Faria Vitoria Paes , Fernandes Luis Diogo , Dias Joana Pereira , Pereira Susana , Ventura Ana , Martins Victor Pereira , Nogueira Clara , Canedo Alexandra , Almeida Clara 
Published: May 2024

Abstract

Background and Aims
Distal arteriovenous fistula (dAVF) for haemodialysis (HD) is preferred due to lesser complications, despite greater risk of maturation failure. In HD patients, age and comorbid conditions increased the risk of access failure and number of procedures necessary for fistula patency. Preferred location for AVF poses a challenging decision. Advantages of dAVF must be taken into account although these may lead an unreasonably high number of interventions. Our aim was to determine time to functioning distal AFV in our centre and number of procedures necessary to achieve such status.

Method
Single centre retrospective analysis was performed on a cohort of patients submitted to distal AFV construction from 2015-2021. Success rate was defined as AFV patency in time for dialysis.

Results
Of 528 patients submitted to AVF construction from 2015 - 2021, 110 radiocephalic fistulas were seen, 59% male patients, mean age 68.5±12,0 yrs. Comorbidities were prevalent (80.9%, n=89), DM (54.6%) and HF (41.1%).
Outcomes at 6 weeks were adequate maturation in 4.5% (n=59), 31.8% (n=35) late maturation (LM) and 14.5%(n=16) primary failure (PF). Causes of LM included inflow and outflow stenosis, 34.3% and 37.1%, respectively. LM (&gt; 6 weeks) requiring no further intervention was seen in 28.6%. PF patients had smaller artery diameters on pre-operative US, with no statistical significance (0.23±0.07; 0.30 ± 0.2; p=0,375). Assisted patency rate was 78.2%.
Number of procedures for access permeability was 1, 2 e 3 in 40%, 25.5% and 6.4%, respectively. Mean of 1,5±0,7 interventions per patient. Median time-to-adequate AFV was 2.0 (IQR 2,0 - 6,45) months. Success rate was 72,8%.

Conclusion
Outcomes at 6 weeks in our cohort were similar to those reported in literature. Timely referencing may increase access patency with resort to vascular intervention. Individualized management is essential, discussing risks and benefits taking into account the treatment burden associated with numerous procedures. Patency rates and outcomes after HD initiation and even cost analysis are essential to guide recommendations.