bluuebunny/crossref_metadata_2025_split huggingface dataset:
#2824 Use of proton pump inhibitors is not associated with post-dialysis fatigue and time of recovery after dialysis in patients on chronic hemodialysis
Authors: Mariani Ilaria , Bossola Maurizio , DI Stasio Enrico 
Published: May 2024

Abstract

Background and Aims
Chronic hemodialysis is often associated with post-dialysis fatigue (PDF), a condition characterized by extreme tiredness and lack of energy. PDF is a debilitating symptom that significantly impairs quality of life of hemodialysis patients. Furthermore, PDF is independently associated with the time to recover after dialysis (TIRD), which can be used as an indirect measure of PDF. Recent studies have shown that the use of proton pump inhibitors (PPI) is independently associated with the prevalence and severity of fatigue in kidney transplant recipients. The aim of this study is to determine whether the use of PPIs in patients undergoing chronic hemodialysis is associated with PDF prevalence and characteristics, as well as the TIRD.

Method
For this retrospective study, we recruited patients undergoing chronic hemodialysis and asked open-ended questions about their post-dialysis fatigue and time of recovery. Each patient was asked to rate the intensity, duration and frequency of their PDF on a scale of 1 to 5. We defined whether patients used a PPI (no PPI use or PPI use), the type of PPI used, the dose of PPI used, and the duration of the PPI use (&lt;1 year or ≥1year).

Results
The study analysed 346 patients, of whom 259 used PPIs (55 used omeprazole, 63 esomeprazole, 54 pantoprazole, 87 lansoprazole, and 7 rabeprazole) and 87 did not. Among the patients, 232 reported suffering from PDF, while 114 did not. The median [min-max] TIRD was 210 minutes [0-1440]. The prevalence of PDF in PPI users and non-users was 67% and 68%, respectively (p= 0.878). There was no significant difference in the median [min-max] TIRD between PPI users and non-users (180 [0-1440] and 240 [0-1440], respectively; p=0.871). Additionally, there was no significant difference in the median PDF intensity, duration, frequency, and severity PPI users and non-users. The prevalence of PDF was similar among the different types of PPI used and did not differ with respect to PPI non-users. Duration of PPI exposure was &lt;1 year in 42 patients and ≥1 year in 224 patients. There was no difference in prevalence of PDF between the two exposures. The correlation matrix showed no statistical significance between PPI equivalent dose, treatment duration, PDF frequency, PDF characteristics, and TIRD.

Conclusion
There is no association between the use of PPIs and PDF or time of recovery after dialysis in patients on chronic hemodialysis.
#1624 The association between serum beclin 1 level and the presence of aortic valve calcification among individuals on hemodialysis
Authors: Ahmed Fatma Abdelrahman , Hebah Hayam Ahmed , Kamel Hadeer , Bastawy Islam 
Published: May 2024

Abstract

Background and Aims
The autophagy pathway, a crucial regulator of cellular health and metabolism, plays a fundamental role in maintaining healthy blood vessel function. Studies have established its critical involvement in endothelial cell stability, vascular smooth muscle cell (VSMC) phenotype control, and VSMC calcium balance. Recent evidence, further, underlines autophagy's direct protective role against vascular calcification. It has been shown that autophagy can modulate different cardiovascular pathologies, including valvular calcification. We aimed to explore the potential link between the protein beclin 1 and heart valve calcification in dialysis patients.

Method
We compared two groups of 51 haemodialysis patients each, defined by the presence (Group 1) or absence of valve calcification (Group 2) on echocardiograms. Both groups underwent beclin 1 level measurements and other assessments (lipid profile). Cardiac valve calcification was diagnosed through echocardiography by identifying dense echoes exceeding 1 millimeter in thickness on one or more aortic valve cusps. The severity of calcification was then classified into three stages:
Mild: Calcification thickness ranged from 1 to 3 millimeters and involved less than 50% of the valve leaflet.
Moderate: Calcification thickness exceeded 3 millimeters but still affected less than half of the valve leaflet.
Severe: Calcification thickness surpassed 3 millimeters and encompassed more than 50% of the valve leaflet.

Results
Our analysis demonstrated a statistically significant increase in beclin 1 levels in Group 2 compared to Group 1 (p&lt;0.001), a striking relationship between lower beclin 1 levels and more severe valve calcification. Interestingly, a specific beclin 1 cutoff below 35.5 ng/ml offered the highest accuracy (98% sensitivity and 92% specificity) in predicting valve calcification. Notably, significant differences were found in lipid profiles (Analysis of the lipid profile revealed a striking trend in Group I, with significant elevations in cholesterol, triglycerides, and LDL. Conversely, HDL levels were significantly higher in Group II). and prevalence of heart disease between the groups. Analysis of IHD prevalence across the two groups yielded a striking result. Group 1 displayed a significantly higher proportion of individuals with IHD (17 cases) compared to group 2 (3 cases), with a statistically significant difference (p&lt;0.001).

Conclusion
Based on these results, it appears promising to integrate serum Beclin 1 measurements into a risk assessment model for the development of heart valve calcification in dialysis patients.
#52 Pulmonary hypertension in hemodialysis patients: prevalence and risk factors: a single center study
Authors: Khedhiri Azza , Ami Drajalha , Boudawara Mohamed , Guermazi Ines 
Published: May 2024

Abstract

Background and Aims
Pulmonary hypertension (PH) is an underestimated cardiovascular trouble in patients on hemodialysis (HD). Therefore, we studied its prevalence, risk factors, association with inflammation, and cardiac changes in HD patients.

Method
This was a single-center cross-sectional observational study conducted at Sfax CNSS polyclinic hemodialysis center during October 2023. Patients on hemodialysis for at least three months were included and divided into those with and without PH; patients with secondary causes for PH were excluded. Clinical characteristics, HD-related factors, lab parameters, and echocardiography details were compared. PH was defined as a mean pulmonary artery pressure (PAP) of &gt; 25 mmHg at rest, and it was further divided as mild (26–39 mmHg), moderate (40–60mmHg), and severe (&gt; 60 mmHg). Mean levels of PAP were compared in different groups according to the main clinical parameters.

Results
Of 30 patients, 21 patients had PH (mild:15, moderate:4, and two had severe PH) with a prevalence of 70%, and a mean age of 58 years old. No difference was found in clinical characteristics, dialysis-related factors, and biochemical parameters. Inflammation seemed to be more important in the PH group but the difference was not statistically significant (mean C-reactive protein in the PH group vs. 5,69 in the non-PH group; p=0,34). Otherwise, according to echocardiography findings, PAP was significantly higher in patients with left ventricular failure(HF) (mean PAP in HF group vs. 31,12 in the non-HF group; p=0,011), in patients with right ventricular dilation(RVD)(mean PAP in RVD patients=47,83mmHg vs 28,88mmHg in the non-RVD group; p=0,05) and in patients with mitral regurgitation(MR) (mean PAP in MR group=40,18mmHg Vs 28,32mmHg in the non-MR group; p=0,04).

Conclusion
Haemodialysis patients have a high prevalence of PH, especially in patients with heart failure and ventricular dilation. PH was significantly associated with the presence of mitral regurgitation on echocardiography. Inflammation was slightly higher in PH but our study did not find significant differences in traditional risk factors, and HD-related factors between the groups with and without PH.
#2697 Association between neutrophil-lymphocyte ratio and morbidity among patients on maintenance hemodialysis with ESRD from diabetic nephropathy
Authors: Olores Lovenia Anne , Darunday Grecia , Polito Eratosthenes , Maguad Ruben 
Published: May 2024

Abstract

Background and Aims
The prevalence of end-stage renal disease (ESRD) is on the rise in the Philippines, and the prognosis for ESRD worsens with the presence of diabetes mellitus. Although the neutrophil-to-lymphocyte ratio (NLR) is a dependable prognostic marker for mortality, its applicability as a prognostic biomarker in patients with diabetes and chronic kidney disease remains uncertain. This study seeks to establish the correlation between NLR and morbidity among Filipino patients with ESRD due to diabetic nephropathy undergoing maintenance hemodialysis. To determine the association between NLR and morbidity among Filipino patients on maintenance hemodialysis due to ESRD secondary to diabetic nephropathy.

Method
Among the 191 screened ESRD patients on maintenance hemodialysis, 71 were attributed to diabetic nephropathy, and only 63 met the inclusion criteria for the study. Clinicodemographic information, encompassing age, sex, height, weight, body mass index (BMI), medications, and comorbidities, was extracted from the medical records of these 63 eligible patients. Subsequently, the patients were categorized into two groups based on their baseline neutrophil-to-lymphocyte ratio (NLR) values, with a cutoff set at 3.5—forming the high NLR group (≥3.5) and the low NLR group (&lt;3.5). This threshold was established considering data indicating that an NLR of ≥3.5 is associated with heightened inflammatory states, leading to increased morbidity. After a 6-month follow-up, data on the primary outcome measure, i.e., the occurrence of the disease, were collected.

Results
Out of the 63 patients assessed, the majority (n=39, 61.9%) had a baseline NLR value of &lt;3.5, and only 2 individuals in this group developed a disease. The high NLR group comprised 24 (38.1%) patients, with 15 of them developing diseases. Among these cases, 4 (0.16%) had diabetic foot, 3 (0.125%) had pneumonia, 3 (0.125%) developed catheter-related bloodstream infections, and 2 (0.08%) had pulmonary edema. Additionally, 1 case each of coronary artery disease (0.04%), hypertensive emergency (0.04%), and calciphylaxis (0.04%) were observed. NLR demonstrated a significant association with clinical outcomes (p &lt; 0.05).

Conclusion
In conclusion, there is a significant correlation between the neutrophil-to-lymphocyte ratio (NLR) and disease development in Filipino patients undergoing maintenance hemodialysis for ESRD attributed to diabetic nephropathy. Patients with a high baseline NLR exhibit an elevated inflammatory state and a greater susceptibility to developing disease conditions compared to those with an NLR&lt;3.5. Therefore, a high baseline NLR can serve as a predictive indicator for prognosis within this specific population.
#2224 Higher serum level of indoxyl sulfate is not associated with increased abdominal aorta calcification in patients on maintenance hemodialysis
Authors: Pyatchenkov Mikhail , Shсherbakov Evgeniy 
Published: May 2024

Abstract

Background and Aims
Vascular calcification is strongly associated with an increase in all-cause and cardiovascular mortality, especially in patients with and stage renal disease. Results of numerous experimental studies have shown direct toxic effect of microbial-derived uremic toxins on vascular endothelial and smooth muscle cells which may contribute vascular calcification. Meanwhile, the effects of these metabolites on vascular remodeling in patients receiving dialysis treatment remains largely unclear. Here we aimed to investigate the relationship between serum level of the uremic toxin indoxyl sulfate and severity of abdominal aorta calcification (AAC) in patients on maintenance hemodialysis.

Method
This single-center, cross-sectional study included eighty (40 men, average age – 59,7±11,8 years) clinically stable patients receiving hemodialysis treatment for 52(21,3-120) months. 13(16,3%) participants had history of smoking, 27(33,8%) were diabetic, 63(78,8%) had high blood pressure, 17(21,3%) – previous history of ischemic heart disease, including 5(6,3%) suffered a myocardial infarction. Severity of AAC was determined by lateral lumbar radiography with Kauppila scoring. The total AAC score ranged from 0 to 24 points, and a higher AAC score indicated a more pronounced degree of calcification. Routine laboratory data were collected before hemodialysis session after fasting for 12 hours. Serum concentration of indoxyl sulfate was assessed by ELISA using commercially available kit (Cloud-Clone Corp., USA). Statistical analysis was performed with IBM SPSS Statistics 26 program. Non-parametric Spearman's rank correlation method was used to evaluate the associations between the studied parameters. Value of p &lt;0.05 was considered statistically significant in all tests.

Results
Median serum indoxyl sulfate was 2,1(1,4-3,0) μmol/l (the same parameter in relatively healthy individuals without impaired renal function is 0,1(0-0,3) μmol/l, р˂0,001). Serum levels of calcium (Ca) was 2,27(2,1-2,5) mmol/l, ionized calcium (Ca++) – 1,15(1,1-1,3) mmol/l, phosphate (P) – 1,6(1,3-2,0) mmol/l, intact parathyroid hormone (iPTH) – 303(162,2-492,8) pg/ml, total cholesterol (TH) – 4,5(3,5-5,4) mmol/l, low-density lipoprotein (LDL) – 2,6(2,0-3,3) mmol/l. AAC score in hemodialysis participants was 4,5(0,0-9,0) and significantly correlated with age (r=0,693; р˂0,001), Ca (r=0,208; р=0,04) and iPTH (r=0,418; р=0,021) but not with other indicators, including indoxyl sulfate concentration (r=0,164; р=0,147).

Conclusion
Our preliminary results do not allow to consider the elevated level of indoxyl sulfate as a factor contributing to increased AAC in patients on maintenance hemodialysis. Further prospective studies in larger populations should clarify the true role of indoxyl sulfate in vascular remodeling in individuals with chronic kidney disease.
#784 Peritoneal dialysis-related infections by Kocuria kristinae: cases from a Mexican hospital
Authors: Ovando-Morga Daniel , Moreno-Hernández Carmen , Morelos-González Daniel , Hidalgo-Alquicira Francisco 
Published: May 2024

Abstract

Background and Aims
Kocuria species, gram-positive actinobacteria, are typically found in the environment, on human skin and as oral flora. These microorganisms are considered saprophytes and non-pathogenic. They rarely cause infections. Patients generally have some compromise due to underlying conditions, including solid tumors, hematologic malignancies, or metabolic disorders. There are few cases in the literature of peritoneal dialysis-associated peritonitis due to these germs. Reports of exit site infections or tunnel infections are even rarer or doesn't exist.

Method
Retrospective description of 4 cases of exit site and/or tunnel infections due to Kocuria kristinae over a 3-year period in a single center.

Results
Four cases of exit site infection were evaluated, with an average age of 63.2 ± 8.8 years. Half of the patients were diabetic. No patient had a history of peritoneal dialysis-related infection. The dialysis modality for all patients was CAPD (Continuous Ambulatory Peritoneal Dialysis). All patients presented symptoms of exit site infection, such as erythema and purulent discharge, but none of them had peritonitis. Three cases were treated with quinolones, and one received linezolid. One case received two antibiotic treatment regimens without an adequate response, and tunnel infection developed, required the removal of the dialysis catheter and a change in modality to HD (hemodialysis).

Conclusion
Exit site infections due to Kocuria are extremely rare. Despite the absence of specific management guidelines, the response to treatment is usually adequate. Due to the theoretical ability to produce biofilm, Kocuria infections should be considered a potential risk for recurrence and refractory disease. To our knowledge, there are no reports of exit site infections due to Kocuria.
#2361 The influence of glucose biocompatible solutions to the clinical outcomes of patients treated with continuous ambulatory peritoneal dialysis
Authors: Bulatovic Ana , Bjedov Jelena , Damjanovic Tatjana , Jankovic Aleksandar , Sakic Verica Todorov , Djuric Petar , Naumovic Radomir 
Published: May 2024

Abstract

Background and Aims
The use of biocompatible glucose solutions is associated with longer preservation of residual renal function and less frequent occurrence of complications in patients on peritoneal dialysis. The aim of this study was to examine the influence of conventional and biocompatible glucose solutions to laboratory parameters and clinical outcomes of PD patients during a four-year period at Zvezdara University Medical Center.

Method
This retrospective study included 25 incident patients treated with continuous ambulatory peritoneal dialysis (CAPD) during the follow up period from 2018 to 2022. During 2018/2019 these patients used conventional solutions (Dianeal PD4) containing lactate as a buffer, while due to the change in solution production technology in 2020/2021, all patients were transferred to a biocompatible solution (Physioneal 40) with lactate and bicarbonate as a buffer. Clinical outcomes were compared in relation to the administered solution: pain during infusion (measured by a Visual Analogue Scale—VAS), correction of anaemia and bicarbonate, average annual 24h diuresis and 24h ultrafiltration, occurrence of CAPD peritonitis. The statistical significance of the differences between the two periods was checked using the SPSS.

Results
The average age of 25 patients was 61 ± 14 years, of which 59.1% were male and 40.9% female. The average BMI was 28.5 ± 5.30 kg/m2, and the most common comorbidities were HTA and DM. No statistically significant difference was found for the values of Le, albumin, Hb, PTH, bicarbonate, and K (p ˃ 0.05). During the use of biocompatible solutions, patients had statistically significantly lower Na values (138.84 ± 2.63 vs 137.17 ± 2.41 mmol/l, p = 0.0116, 95% CI 137.15– 138.84) and lower CRP values (15.3 ± 3.3 mg/l vs 7.7 ± 3.2, p = 0.0003, 95% CI 18.60-4.50). Although the dialysis exposure was longer, the rate of peritonitis was lower during the use of biocompatible solutions, but without a statistically significant difference (0.40 episodes per patient-year, vs 0.31 episodes per patient-year, p ˃ 0.05). No statistical significance was found in 24h diuresis value (900 ml vs 750 ml, p = 0.167.95% CI 686.90–1203.31) but the value is expected to be lower due to dialysis duration.

Conclusion
Our study showed that patients treated with the CAPD method while using a biocompatible solution have statistically significantly higher values of 24h ultrafiltration, lower Na and CRP values and less occurrence of pain during infusion, which significantly affects the quality of life. Although this may indicate better preservation of the peritoneal membrane, a prospective and randomized study is needed to clarify these potential differences.
#2603 Focus on a crucial moment in decision making: evaluate peritoneal dialysis as incident renal replacement therapy
Authors: Najera Esther , Espinoza Karla Jackeline López , Ruiz Aránzazu Pardo , Bengoa Guillermo Pereda , Ovalles Altagracia Elisa Bello , Vargas Hermann Hernández , Sierra Milagros , Larrañaga Marta Artamendi , Pacheco Celia Garijo , Loza Emma Huarte 
Published: May 2024

Abstract

Background and Aims
Chronic kidney disease affects 10% of the world population (15.1% in Spain, ENRICA 2019 study), being a health problem with important physical, emotional, and socio-occupational repercussions.
Deciding on the most appropriate renal replacement therapy (RRT) for each patient, according to their lifestyle and family environment, represents a considerable challenge.
Peritoneal dialysis (PD) offers several benefits, including greater independence, preserved kidney function, less restrictive diet, and better adaptation to the patient's lifestyle. It also improves the capacity for self-training and learning.
Although kidney transplantation is the best RRT option, PD has demonstrated better quality of life, patient autonomy, and higher survival rates. Despite these advantages, PD as a technique for starting RRT represents 16.4% among incident patients in Spain, reaching 25% in our community, similar data to that of other northern European countries (ERA EDTA Report 2021).

Method
We carried out a retrospective descriptive study of patients followed in Advanced Chronic Kidney Disease (ACKD) over a period of five years (2017-2021). The inclusion criteria considered the acceptance of the technique in optimal candidates, with integrity of the peritoneal membrane and/or functional abdominal cavity, as well as the ability to learn the technique and family support.
The study aimed to assess the percentage of patients who, meeting optimal criteria for PD candidacy, successfully initiated the technique.

Results
The analyzed population consisted of 113 patients, 73.4% males, with a mean age of 77 years. 59% of ACKD patients were considered candidates, and of these, 73% (n 38) chose PD as the modality, successfully initiating the technique.
The main causes of abandonment or failure of the technique were:
Out of the 38 patients successfully initiating PD as RRT, 34% continued with this modality.

Conclusion
PD provides quality of life and autonomy to patients who choose this technique. Individualized and ongoing training through updated information is essential during this process, as it helps reduce most complications and reinforces patient autonomy.
#1820 Use of MiDiálisis App in peritoneal dialysis patients
Authors: Frías-González Aida , González-Bermudez Ana , Caro Jara , Bergesio Luca , Ruiz Enrique Morales , Bernardos Ana María , Yuste Claudia 
Published: May 2024

Abstract

Background and Aims
Technological innovation has revolutionized medical assistance. Peritoneal dialysis (PD) patients, who prioritize their autonomy and freedom choosing to undergo dialysis at home, are the paradigm of patients willing to use telemedicine. Remote monitoring allows real-time therapy supervision, ensures proper adherence and empowers the patients by promoting self-care and self-awareness The aim of this study is to assess the feasibility and acceptance of MiDiálisis App.

Method
MiDiálisis App, developed independently, integrates essential self-care data (such as blood pressure, ultrafiltration and weight), presenting it in real-time graphs and tables for both patients and nephrologists. It also allows asynchronous communication between them.
This is a prospective observational pilot study in which MiDiálisis App was offered to PD patients at a tertiary hospital.

Results
Out of the 10 patients offered the use of the MiDiálisis App, 3 did not use it (NU) due to technical issues. Seven patients used (U) MiDiálisis for a median of 9 [4-11] months. The majority were male (n = 6) and on automated PD (n = 6) for a period of 30 (15-38) months. We registered 6.3 (5.6-6.7) days with interaction/week.
NU patients were older (U 61 [54-69] years vs NU 68 [34-75] years, p = 0.5), with higher comorbidity Charlson index (U 5 [4-7] points vs NU 7 [3-9] points, p = 0.5), and greater Frail index (U 2 [1-2] points vs NU 3 [2-4] points, p = 0.067).
Six patients completed a survey after using MiDiálisis. 100% perceived a better communication with their nephrologist and greater accuracy of data compared to their previous method (paper-based recording). All of them entered the data by themselves and found both learning and using MiDiálisis to be easy; 83% considered the app beneficial for their health, and 100% felt secure using it. Furthermore, 67% reported significant changes in their self-care habits, and 83% mentioned an increased awareness of their health status. All participants would recommend it to other patients.

Conclusion
MiDiálisis App is applicable and has good acceptance among people undergoing PD. It might be a useful tool that can improve self-care, adherence, and communication with these patients.