bluuebunny/crossref_metadata_2025_split huggingface dataset:
#1999 Retrospective observational study of uremic pruritus prevalence on dialysis
Authors: Santos-Alonso Carlos , Jiménez Miguel Ángel Navas , Botella Mario , Garrote Pablo Luis Sánchez , Gomez Astrid Rodriguez , Garcia Leonardo Calle , Varas Carmen Martin , Luis Maria Jose Fernandez-Reyes , Garcia Laura Alvarez , del Peso Gilsanz Gloria , Rubio María Auxiliadora Bajo 
Published: May 2024

Abstract

Background and Aims
In Spain, the prevalence of moderate-severe Uremic Pruritus (UP) was 46% and 40% in the DOPPS I and DOPPS. This symptom is usually underdiagnosed and could worsen the quality of life, as some recent studies have revealed. The last reports regarding UP prevalence date back to 2004, hence we decided to assess its current frequency of this while exploring the degree of recognition along with other UP-associated factors.

Method
This study includes 192 patients in renal replacement therapy (RRT), retrospectively recruited from our centre. Data were collected from revisit medical records in 2021. UP was evaluated using a visual analogic scale (VAS). In addition, age, time on dialysis, UP treatment, haemoglobin, eosinophils, plasma levels of calcium, phosphorus, urea, parathyroid hormone, c-reactive protein (CRP), and clearance (measured by KT/V) were also recorded.

Results
Average patient age was 61.3 years old, with an average time in dialysis of 37.4 months. The most common group of chronic kidney disease was glomerular diseases (25.5%). The patient distribution by RRT was: 51.9% in haemodialysis (HD), 36.5% in peritoneal dialysis (PD), and 11.6% in home haemodialysis (HHD). UP average prevalence was 56.7% (50% in HHD, 55.2% in HD and 60.9% in PD), of which 69.8% had a VAS ≥ 5. UP was statistically associated with older age (p = 0.017) and higher plasmatic phosphorus (p = 0.015). Notably, only 51.9% UP patients had been prescribed specific drugs for itching. Among UP treated patients, 70.9% improved 3 or more VAS points (with no differences among drugs). Interestingly, this improvement was associated with lower calcium levels (p &lt; 0.0001), the absence of peripheral artery disease (PAD) (p = 0.035), and the shortest time on dialysis (p = 0.001).

Conclusion
Despite the advances made in HD techniques and the recent incorporation of biocompatible solutions in PD, UP remains a frequent symptom among dialysis patients, without relevant prevalence improvements over the last 20 years.
UP was misdiagnosed and mistreated in our unit, since just 51.9% of patients with UP were under treatment. In addition, clinical response to treatment was appropriate in 70.9% of patients, and our results suggest that calcium, PAD, and time on dialysis could predict the response to the treatment. Therefore, our study supports previous data, highlighting UP as a frequent underdiagnosed symptom among dialysis patients; and opens the path for new research in the identification of novel prognosis markers.
#2879 Residual kidney function is more than urinary output alone in PD patients: insights derived from tubular functional Na MRI of the kidney
Authors: Lemoine Sandrine , Akbari Alireza , Dorie Justin , Tamasi Tanya , Jain Arsh , Mcintyre Christopher 
Published: May 2024

Abstract

Background and Aims
Maintenance of a cortico-medullary concentration gradient (CMG) is required for urine concentration and is one of most important tubular functions. We have previously demonstrated that the CMG can be quantified in both healthy controls and patients receiving HD, using 23NaMRI of the kidney. Peritoneal dialysis (PD) patients, in general, are considered to have better preservation of residual renal function (RKF), than comparative haemodialysis (HD) patients. We aimed to investigate if this was evident with respect to functional imaging of the CMG, to explore the concept that glomerular and tubular function may be dichotomized in patients with chronic kidney disease (CKD) requiring maintenance dialysis.

Method
We conducted an exploratory pilot study for 8 PD patients and 21 HD patients. Patients were instructed to fast from midnight before scanning. Urines samples were collected to measure osmolarity after fasting and a first MRI scan- performed to acquire baseline anatomical and sodium images. All MR imaging was carried out on a GE MR750 3T (GE Healthcare, WI) instrument. A custom-built two-loop (18cm in diameter) butterfly radiofrequency surface coil tuned for 23Na frequency (33.786 MHz) was used to acquire renal 23Na images.

Results
PD participants were 60 ± 10 years old, 50% male, mean body mass index (BMI) was 26.7 ± 4.6 kg/m2 and dialysis vintage was 20 ± 13 months, mean creatinine and urea clearance was 12 ± 7 mL/min/1.73 m2; HD participants were well matched, 60 ±18 years old, 52% men, BMI 27 ± 6 kg/m2 and dialysis vintage was 33 ± 25 months respectively. Urinary osmolarity was 284 ± 66 mosm/L and 239 ± 72, p = 0.1; mean medulla to cortex ratio was 1.2 ± 0.2 and 1.2 ± 0.1, p = 0.2 between PD and HD participants respectively.
7/8 PD participants were able to perform 24 hrs urine collection. Mean urine volume was substantial at 1525 ± 594 mL. We found no correlation between urine volume and corticomedullary gradient (Fig. 1A). Fig. 2C illustrates a 75 year old male, with medulla to cortex ratio at 1, urine volume 2100 mL, CLcrUr 18 mL/min/1.73 m2 and Fig. 1C showed a 55 years old patients, male, medulla to cortex ratio at 1.4, urine volume 2100 mL, CLcrUr 18 mL/min/1.73 m2.

Conclusion
These results underscore residual kidney function currently estimated by urine volume provides an incomplete assessment. Despite PD patients retaining higher degrees of RKF than HD patients, as assessed by urinary volume and small solute clearance, both patient groups have very similar degrees of directly imaged tubular function. The clinical importance of a focus on functional tubular mass to outcomes in dialysis patients is currently under further investigation.
#1832 Unraveling enteric peritonitis risk factors: the role of nutrition
Authors: Mompó-Ramos Mar , Viejo-Boyano Iris , Soldevila-Orient Amparo , Peris-Fernandez Maria , Such Ramon Devesa , Sánchez-Pérez Pilar , Jaras Julio Hernandez 
Published: May 2024

Abstract

Background and Aims
Malnutrition estimated to have a prevalence of 30-50% among peritoneal dialysis (PD) patients. It independently correlates with increased patient morbidity and a lower technique survival, and it is exacerbated by protein loss through peritoneal fluid. Enteric-origin peritonitis in PD patients represents a severe complication also linked to elevated morbidity, hospitalizations, and inferior technique survival.
However, the association between both is not well established. This study aims to analyze malnutrition-related as well as general risk factors and their association with peritonitis type (enteric/cutaneous).

Method
A longitudinal and retrospective observational analysis was conducted on PD patients with peritonitis at Hospital La Fe from 2012 to 2023. Demographic data (age, gender, obesity, diabetes, immunosuppression, polycystic kidney disease), analytical parameters (albumin, total proteins, potassium, phosphorus), number of exchanges, adequacy, surgical interventions, and/or catheter placement 6 months prior were analyzed for their association with peritonitis type (Cutaneous/Enteric/Mixed). Recurrences and peritonitis without microbial isolation were excluded.

Results
We collected data about 109 peritonitis cases; 59.6% cutaneous, 38.5% enteric, and 1.8% mixed, from 61 predominantly male patients (68.9%) with a mean age of 61.35 years. Common germs were S. epidermidis in cutaneous peritonitis and E. coli in enteric peritonitis.
Obesity (27.9% of the sample), immunosuppression (16.4%), and hypoalbuminemia (56%) were statistically significantly associated with enteric peritonitis development (p 0.08, p 0.039, and p 0.036, respectively).
No statistically significant differences were found for peritonitis type and gender, diabetes, residual renal function, hypokalemia, hypophosphatemia, and underdialysis.
85.3% of peritonitis cases involved manual exchanges, and 14.7% automated PD. While no statistically significant association was found between modality and peritonitis type, more manual exchanges correlated with increased peritonitis cases.
Peritoneal catheter insertion and other surgical interventions in the previous 6 months were not significantly related to peritonitis type.

Conclusion
The presence of malnutrition-related factors such as hypoalbuminemia and obesity increases the risk of developing enteric peritonitis, likely linked to digestive bacterial translocation to peritoneal fluid facilitated by malnutrition. Ensuring preventive nutritional strategies is imperative for these patients.
#1722 Shared decision making and dialysis choice: an observational longitudinal cohort study
Authors: Finderup Jeanette , Hansen Pernille , Jensen Victoria , Bergum Maria , Mose Frank , Khatir Dinah Sherzad 
Published: May 2024

Abstract

Background and Aims
Shared decision-making is recommended for dialysis choice, whereby patients are supported in making decisions regarding dialysis modality together with healthcare professionals. The intervention ‘Shared decision making and dialysis choice’ has been a part of usual care at two hospitals in Denmark since 2018. The aim of this study was to describe the choice of dialysis modality and the outcomes for patients with kidney failure, who received a Shared decision-making intervention.

Method
An observational longitudinal cohort study was conducted. Data was collected retrospectively from 2018 to 2023 involving 484 patients with kidney failure from two Danish hospitals one regional hospital and one university hospital. Fisher's exact tests and Wilcoxon rank-sum tests were used to assess whether choice of dialysis modality differed significantly. Additionally, Aalen-Johansen estimation assessed time from the shared decision making intervention to treatment initiation, concordance between chosen and initiated treatment, and mortality before treatment initiation. Logistic regression and Cox proportional hazards evaluated the patient characteristics predicting these three outcomes.

Results
After the intervention, 68% chose home-based treatment, while 32% chose hospital-based treatment. With significant difference, more patients age ≤70 years, at university hospital and living with a partner chose home-based treatment. Half of the patients initiated treatment within 11 months, and predictors for initiating dialysis later than 11 months after the intervention were age ≥70 years (OR 2.52) and eGFR &gt;15 ml/min/1.73 m² (2.80). 83% of the patients received the treatment chosen and predictors for concordance were center-based dialysis (HR 1.54), regional hospital (HR 1.52) and very mild to mild frailty (HR 1.55). Furthermore, 12% of the patients died before treatment initiation predicted by very mild (HR 3.67) to severe frailty (HR 6.42) and BMI &lt;25 kg/m² (HR 2.84).

Conclusion
A high proportion of patient chose a home-based treatment after receiving the intervention ‘Shared decision making and dialysis choice’ and also initiated the dialysis choice chosen. Patients received the intervention timely and only few patients died before initiating dialysis. Our study has demonstrated that many factors influence patient choices and outcomes. Maybe routinely assessment of frailty and BMI prior to shared decision making intervention could improve the patient pathway.
#546 Decline of kidney function before and after start of peritoneal dialysis (PD)
Authors: Björksten Markus , Qureshi Abdul Rashid Tony , Stenvinkel Peter , Heimbürger Olof 
Published: May 2024

Abstract

Background and Aims
Residual kidney function (RKF) is a key component for PD adequacy and associated with improved volume status, nutrition and quality of life as well as with increased survival. The aim of the present study was to compare decline of kidney function before and after start of PD.

Method
We studied patients starting PD (during 2000-2019) in an ongoing prospective study of patients starting dialysis. Study inclusion in almost all PD patients coincided with PD catheter insertion. Patients were included in the present analysis if they had at least one urinary collection before, and one after PD initiation (a), PD initiation less than six months after study inclusion (b) and &gt; 6 months PD treatment (c). P-creatinine to calculate eGFR was retrospectively collected for 12 months before start of PD. During a large part of the study period, it was a clinical routine to collect 24-hour urine collections regularly in CKD5 patients, and these data were retrieved when available. After start of PD, regular 24-hour urine collections were part of the clinical routine to follow up and were retrieved for up to 12 months after PD start. eGFR was measured using the CKD-epi 2021 equation and GFR was calculated as the average of urinary creatinine and urea clearance corrected for BSA. The decline of eGFR before start of PD, the decline of GFR from 24-hour urine collections and the decline of GFR after start of PD were compared to each other.

Results
We studied 138 patients starting PD. The mean age was 55 ± SD13 years, and there were 80 males and 58 females. The mean blood pressure was 153 ± SD21/89 ± SD11 mmHg and BMI was 25 ± SD4 kg/m2. The etiologies of end stage kidney disease were nephrosclerosis 17%, diabetic nephropathy 22%, glomerulonephritis 25%, polycystic kidney disease 14% and other 22%. The GFR at PD start was 8.5 ± SD 2.3 mL/min/1,73 m² and eGFR was 5.8 ± SD 1.9 mL/min/1,73 m². The results show a significantly slower kidney function decline rate after start of PD, with an average of −0.59 mL/min/1,73 m²/month before PD initiation compared to −0.34 mL/min/1,73 m²/month after.

Conclusion
Decline of GFR was slower after start of PD suggesting that earlier initiation of dialysis may be beneficial for the preservation of RKF. Notably, there was a marked attenuation after 3 months of dialysis. Furthermore, the decline rate of GFR before PD start was similar using eGFR or GFR from 24-h urine collection, though for eGFR at somewhat lower levels. However, there were pronounced differences between those two methods in individual patients demonstrating that eGFR is unreliable with very low GFR. Further study will be performed to analyze what factors that are associated with better preservation of RKF.
#1319 “Peritoneal volume influence on bedside ultrasound or point-of-care ultrasonography (POCUS) volume assessment in peritoneal dialysis patients”
Authors: Rincón María Muñiz , Barbieri Diego , López de la Manzanara Pérez Virginia , Ortiz Cristina Riaza , López Rómulo Katsu Loayza , Fernández Carlos Fernández , Herrero José , Sánchez-Fructuoso Ana I 
Published: May 2024

Abstract

Background and Aims
To study the variations in hydrosaline overload ultrasound parameters using PoCUS in PD patients with full and drained peritoneum and their correlation with clinical parameters.

Method
PoCUS and intra-abdominal pressure (IAP) measurements were performed on included patients with a full peritoneum. After drainage, a new PoCUS and a bioimpedance analysis (BIA) were conducted.

Results
Seventeen patients were included: 70.6% male, mean age 66 ± 9.5 years. 65% had hydrosaline overload &gt;1L as assessed by BIA. The mean IAP was 15 ± 3.9 mmHg.
The maximum diameter of the IVC with full and drained peritoneum was 1.44 ± 0.35 cm and 1.53 ± 0.4 cm, respectively, with no significant difference (p = 0.179). The % collapsibility of IVC with full and drained peritoneum was 49 ± 23% and 47 ± 13%, respectively, with no significant difference (p = 0.58).
Kerley B-lines with full peritoneum were 1.3 ± 1.5, and with drained peritoneum were 0.71 ± 1.16, with this difference approaching statistical significance (p = 0.063).
The same analyses in subgroups of patients with volume overload by BIA (OH&gt;1 or OH/ECW&gt;15%) did not show significant differences.
In the correlation analysis of variables, IAP and peritoneal dialysis fluid volume per m2 of body surface did not correlate with the diameters or collapsibility of IVC with full or drained peritoneum. The degree of overhydration by OH (L) correlated with IVC collapsibility with drained peritoneum (Spearman ρ = −0.43; p = 0.08), as did the overhydration by OH/ECW (Spearman ρ = −0.61; p = 0.02). These correlations disappeared with full peritoneum (p &gt; 0.05).
The same correlation analyses were performed in subgroups of patients with volume overload by BIA (OH&gt;1L or OH/ECW&gt;15%) and were not significant with either full or drained peritoneum.

Conclusion
We did not find significant differences in the ultrasound volume overload parameters with full vs. drained peritoneum in PD patients. However, indirect data indicate a lower sensitivity of PoCUS to hydrosaline overload with a full peritoneum.
#573 Development of a model for simultaneous normothermic perfusion in porcine kidney grafts
Authors: Navez Margaux , Coelho Tiago Pinto , El Karouni Walid , Erpicum Pauline , Vandermeulen Morgan , Lagny Marc-Gilbert , Gilbo Nicholas , Thierry Gabriel , Delanaye Pierre , Cavalier Etienne , Jouret François , Detry Olivier 
Published: May 2024

Abstract

Background and Aims
In recent years, DCD or ECD deceased donors have been increasingly used in kidney transplantation as a partial response to the deceased donor shortage, leading to a suboptimal quality of kidney grafts. There is a need for developing better kidney graft preservation methods, such as hypo- or normo- thermic machine perfusion. Machine perfusion might provide the unique opportunity to directly treat the perfused kidney grafts to improve their quality and to decrease ischemia/reperfusion injury during transplantation. Our aim was to develop a pig model of simultaneous normothermic perfusion of both kidneys procured from the same donor and to compare the assessment of renal function through the injection of creatinine and iohexol.

Method
Under general anaesthesia, the donor pigs (n = 5) were euthanized by exsanguination and the blood was recovered using a cell-saving system. Both kidneys (n = 10) were submitted to 30 min of warm and a 2-hour cold ischemia period, before being perfused for 6 hrs at 37°C. Kidney perfusion started and run in parallel using 2 independents, modified extracorporeal machines. Urine production, arterial blood gas exchange, and perfusion parameters (flow, pressure, resistance) were monitored and compared. Creatinine and iohexol were added to the perfusate of both machines to assess renal function.

Results
A parallel evolution of blood parameters in both perfusions was observed. By maintaining a constant perfusion pressure of 70 mmHg, flow rates increased to 100 mL/min. Despite variations in urinary excretion, creatinine and iohexol clearances remained comparable, demonstrating a parallel kidney function.

Conclusion
In conclusion, we established a model of parallel and simultaneous normothermic perfusion of pig kidneys, and for the first time, we demonstrated the utility of iohexol measurements for improved functional assessment in an isolated perfusion model. After randomization of the grafts, this model will be used for testing innovative therapies as MSC during perfusion, both in swine kidneys and human discarded grafts, using the contralateral kidney as a paired control.
#717 Recipient/donor characteristics and immunosuppression impact eGFR creatinine and creatinine-cystatin c equations in kidney transplant recipients
Authors: Harmacek Dusan , Weidmann Lukas , Lopez Kai Castrezana , Rho Elena , George Britta , von Moos Seraina , Schachtner Thomas 
Published: May 2024

Abstract

Background and Aims
Previous studies have shown substantial heterogeneity in the performance of estimated glomerular filtration rate (eGFR) equations when applied to kidney transplant recipients (KTRs). The impact of transplantation-related characteristics on eGFR equations based on creatinine (eGFRcr) compared with creatinine and cystatin C (eGFRcr-cys), however, remains insufficiently studied.

Method
We analyzed 596 KTRs transplanted at the University Hospital Zurich. The accuracies of four eGFRcr equations (CKD-EPI 2009 and 2021, EKFC 2021, KRS-GFR 2023) were compared with three eGFRcr-cys (CKD-EPI 2012 and 2021, EKFC 2023), and evaluated across a detailed range of transplantation-related variables. Performances were assessed using bias, P30, P20 and correct classification (CC). Multivariate analysis identified transplantation-related characteristics independently associated with a smaller or greater difference between eGFRcr and eGFRcr-cys equations.

Results
Based on eGFRcr-cys CKD-EPI 2012 as the reference, CKD-EPI 2021 (P30: 77.0%, P20: 56.4%, CC: 56.4%) and KRS-GFR 2023 (P30: 80.2%, P20: 64.9%, CC: 60.1%) had lower performance, while EKFC 2021 (P30: 88.6%, P20: 75.8%, CC: 66.8%), and CKD-EPI 2009 (P30: 87.1%, P20: 70.3%, CC: 64.6%) showed higher performance. Belatacept use was associated with a smaller difference between eGFRcr CKD-EPI 2009 and eGFRcr-cys CKD-EPI 2012 (OR 3.295, 1.605-6.764, p = 0.001), while a higher donor BMI was associated with a greater difference between eGFRcr KRS-GFR 2023 and eGFRcr-cys CKD-EPI 2012 (OR 1.077, 1.001-1.158, p = 0.046).

Conclusion
More recent eGFRcr equations do not overcome the limitations of non-GFR determinants of creatinine in KTRs, however European equations seem to be equally feasible in transplanted patients. Transplantation-related characteristics of the recipient, donor, and immunosuppressive medication affect the differences between eGFRcr and eGFRcr-cys, which needs attention in clinical practice.