bluuebunny/crossref_metadata_2025_split huggingface dataset:
#3144 Improving care for patients on maintenance haemodialysis effectiveness: a novel multidisciplinary approach
Authors: Althaf Mohammed Mahdi , White Carla 
Published: May 2024

Abstract

Background and Aims
Care for patients receiving maintenance haemodialysis (MH) is critically dependent on multi-professional coordination of care for multimorbidity and complex care needs. Design and coordination of care models is an important clinical concern (Kharbanda et al., 2020). We developed the Biannual Comprehensive Haemodialysis Multidisciplinary Team meeting (BCHMDT), a weekly meeting in which patients receiving MH are reviewed biannually. This study aimed to assess the efficacy of the BCHMDT in improving the provision of care for patients receiving MH.

Method
This single-centre retrospective study collected data from documentation from 146 patient encounters with the BCHMDT during from two separate time periods: August-December 2020, when the meeting had just been introduced (63 patient encounters) and February to July 2022 (83 patient encounters). Meetings involved a renal physician, haemodialysis specialist nurse, renal dietician, dialysis access nurse specialist, renal transplant coordinator, renal counsellor, and palliative care physician. Meetings were structured around a specially designed proforma Fig. 1.

Results
Actions generated by the MDT included investigations planned (41%), referrals made to other specialists (33%), changes to dialysis prescriptions (37%), medication changes (39%), dialysis access issues picked up (26%) and new RESPECT discussions (25%).The breakdown of data by time period (2020 group and 2022 group) is shown in Fig. 2 (option 1) OR “the data collected is summarized inFigure 2”(option 2). The proportion of patients achieving their prescribed Kt/V was 63% (2020 group) and 77% (2022 group). The proportion of patients who were eligible for transplant referral but had not yet been referred was 13% (2020 group) and 10% (2022 group).

Conclusion
The BCH MDT is an worthwhile method to improve coordination of dialysis care, and multi-professional staff in our centre use it as an opportunity to review and improve care. The meeting results in high numbers of actions and adjustments to patient care. Furthermore, in this uncontrolled observational study, there was improvement over time in the proportions of patients achieving adequate Kt/V, and in referral rates for transplant assessment, suggesting a positive impact on MH care.
#586 Effects of nursing facility residency on mortality in incident HD patients
Authors: Kim Hyunsuk , Yoon Jong-Woo 
Published: May 2024

Abstract

Background and Aims
As the elderly population increases and nuclear families are formed, the number of elderly people who are managed in nursing facility is increasing. We investigated whether dialysis performed while residing in a nursing facility before dialysis affects the mortality rate of dialysis patients.

Method
We enrolled 2,597 patients who visited the hemodialysis clinics of 17 teaching hospitals and surveyed the characteristics of underlying diseases, laboratory findings, and medication between patients who started dialysis while admitted to a nursing facility and those who did not. Then, multivariate survival analysis was performed to see if starting dialysis after entering a nursing facility increased mortality.

Results
9.1% (n=237) of the subjects underwent dialysis while admitted to a nursing facility. This group was predominantly female and older. Also the prevalence of diabetes, dementia, heart failure and atrial fibrillation was higher. There were many users of anti-platelet agents, warfarin, dementia drugs, and antidepressants. Additionally this group showed lower weight, lymphocyte, iPTH, albumin, phosphorus, and total cholesterol and higher duration of diabetes, and alkaline phosphatase. In multivariate analysis controlling for age, sex, access type, dementia, malignancy, ischemic heart disease, cerebrovascular accident, heart failure, atrial fibrillation, liver cirrhosis, fracture, coronary artery disease, ejection fraction, lymphocyte, platelet, BUN, Cr, albumin, phosphorus, total cholesterol, RAS blockade, B-blocker, calcium channel blocker, warfarin, hyperlipidemia drugs, Calcium-based phosphate binder, sevelamer, anti-depressant, and dementia medication, the HR of group receiving dialysis after being admitted to a nursing facility was 1.658 [1.309, 2.100].

Conclusion
In summary, the current study suggests a correlation between starting dialysis in a nursing facility and a higher mortality rate among dialysis patients.
#477 Risk factors for the mortality among hemodialysis patients with COVID-19 infection in 28 hemodialysis centers, South Korea
Authors: Seo Moon Jeong , Kim Hwa Jeong , Ko Sung Min , Yoon Jeong Min , Lee Shin Yeong , Chung Shi Jung , Lee Eun Ah , Kim Ki-Hyun 
Published: May 2024

Abstract

Background and Aims
Understanding mortality risk factors in hemodialysis patients with COVID-19 is critical for effective management. This study aimed to identify the factors influencing mortality risk and to evaluate the efficacy of COVID-19 vaccines in this specific population.

Method
This retrospective study analyzed clinical data from patients with COVID-19 who underwent hemodialysis at 28 affiliated centers of the Yeolin Medical Foundation between January 2020 and December 2022. Risk factors contributing to mortality were assessed through comparative analysis between survivors and deceased patients using R statistics.

Results
Of the 1,983 (ive study analyzed clinical data from patients with COVID-19 who underwent hemodialysis at 28 affiliated centers of the Yeolin analysis comparing survivors and deceased individuals revealed significant associations between mortality risk and several factors such as the omicron dominance period, age om patients with COVID-19 who underwent hemodialysis at 28 affiliated centers of tation, except for one dose, showed a decreasing trend in mortality risk with increasing doses. In the multivariable analysis, age ≥65 years(OR 1.04;95% CI[1.00 - 1.09],p=0.028), dyspnea(OR1.13;95% CI [1.07 - 1.19],p&lt;0.001), and multiple doses of COVID-19 vaccination{2 doses(OR 0.91;CI[0.86 - 0.96],p=0.001), 3 doses(OR 0.88;CI[0.84- 0.92],p&lt;0.001), 4 doses(OR 0.88;CI [0.84 - 0.93],p&lt;0.001), 5 doses(OR 0.87;CI[0.81 - 0.93],p&lt;0.001)} retained significance. Mortality did not appear to be significantly affected by sex, duration of ESRD, BMI, pneumococcal vaccination status, type and total number of comorbidities, or use of immunosuppressants.

Conclusion
Hemodialysis patients with COVID-19 infection have a high mortality rate per se, and comorbidity had no effect on mortality. Age(&gt;65) and dyspnea were associated with higher mortality rates, and the lower ORs with increasing number of vaccines suggest that vaccination is a crucial protective factor in dialysis patients.
#1561 A tool for the “screening” of the dialysis facilities environmental impact
Authors: Perrotta Adolfo Marco , Mazzaferro Sandro , Rotondi Silverio 
Published: May 2024

Abstract

Background and Aims
The great number of resources needed for hemodialysis treatment can be a limiting factor in the perspective of access to care, especially in developing Countries, and may have a negative impact on the environment.
The aim of the study was to develop a questionnaire that is easy and informative of the ecologic impact (energy costs and waste production) of a single dialysis center. The questionnaire's goal is to highlight potentially modifiable factors that are responsible of the ecologic footprint of dialysis.

Method
A team of 8 people, 3 nephrologists, 3 representatives of dialytic equipment companies and 2 of water treatment systems, developed the questionnaire.
The items have been decided after two meetings in person. The completed questionnaire included 49 items divided into three sections, exploring the organization techniques of the dialysis center, its consumption and its water treatment system's characteristics. The questionnaire was then submitted to 11 dialysis centers and made available from 30 September 2022 to 1 February 2023, and included data collected in May 2022. An investigator assisted within filling in the form and collecting feedback on the comprehension of the questions and on any problems that may have surfaced during the compilation of the questionnaire.

Results
The questionnaires were completed by the center's managers who, unanimously, thought that the form was easily understandable and without significant problems during the compilation. The data collected evidenced that there is almost no real knowledge of the center's consumptions and that also many data about power and water consumption and of waste production are ignored and are therefore missing. No center is fueled by renewable energies.
Data refers to a total of 10337 dialysis treatments, with an average 940 treatments per center. Electrical consumption and waste production are in line with the literature, with an average of 13 KwH and 1,9 kg consumption per treatment, respectively. The average water consumption in our sample (550 L per treatment) seems to be higher than expected. Standard dialysate flow was greater than or equal to 500 ml/min in both HD and HDF, except in two centers. Five centers had a water treatment system which is more than eight years old. Average values of each center are reported in the Table 1.

Conclusion
Our questionnaire appears to be an easily fillable option to carry out consumption “screenings” of each dialysis center. The form could also prove itself useful for a large-scale investigation, to collect an adequate amount of data and to conduct a thorough research to highlight critical issues that could affect the center's consumption. A wider spread of this questionnaire could improve the awareness of nephrologists about their dialysis structure's consumption, taking part in the cultural revolution which is needed to develop a “greener” nephrology.
#620 Remaining life expectancy of Korean hemodialysis patients: how much longer can they live?
Authors: Lee Young-Ki , Park Hayne Cho , Kim Do Hyoung , Cho Ajin , Yoon Jong-Woo 
Published: May 2024

Abstract

Background and Aims
Hemodialysis (HD) patients have a higher mortality rate compared to general population. However, no study has investigated life expectancy in Korean HD patients so far. Therefore, this study aimed to calculate the remaining life expectancy among Korean maintenance HD patients and compare it to those of general population as well as HD patients from other countries.

Method
Baseline data were retrieved from HD quality assessment data from October to December 2015. Among the total number of patients who were alive at the beginning of 2016 (20,537 men and 14,404 women), a total of 22,439 (12,848 men and 9,591 women) were still alive at the end of 2021 while 12,502 (7,689 men and 4,813 women) were deceased during 6 years of follow-up. We used the life table method to calculate the expected remaining years of life in two-year increments.

Results
The mean age of the patients was 60.5 ± 12.4 years, and 58.7% were male. The average duration of HD was 5.63 ± 5.11 years. The most common cause of end-stage kidney disease was diabetes mellitus (42.0%), followed by hypertension (27.1%) and glomerulonephritis (10.9%). The remaining life expectancy for 60-year-old patients were 11.64 years for men and 14.64 years for women. The average remaining lifetimes of the HD population were only about a half of the general population (Fig.). Diabetic patients demonstrated shorter life expectancy compared to the patients with hypertension or glomerulonephritis. The remaining life expectancy of Korean HD patients was similar to that of Japanese and was almost double that of HD patients in Western countries such as Europe and United States.

Conclusion
HD population showed shorter life expectancy compared to the general population. Asian HD population seemed to demonstrate better patient survival compared to other countries. Longitudinal analysis should be warranted to analyze the effect of advanced dialysis technology upon improved survival rate among HD population.
#1625 Influence of polymorphisms in genes for interleukin-6 and interleukin-10 on dialysis patients survival
Authors: Pavlovic Svetlana Jovicic , Simic-Ogrizovic Sanja , Pavlovic Natalija , Bukumiric Zoran , Novakovic Ivana 
Published: May 2024

Abstract

Background and Aims
Chronic inflammation is an important non-traditional risk factor for morbidity and mortality in patients with terminal kidney disease. Associated occurrence of malnutrition, inflammation and atherosclerosis was observed in patients on dialyses and marked as MIA syndrome, a vicious circle in which pro inflammatory cytokines play a key role. It is known that there were individual differences in creation of cytokines, and it is assumed that polymorphisms in the promoter regions of cytokine genes can have a key role in the predisposition to chronic inflammation and its consequences.
We investigated association between interleukin-6 -174 G&gt;C, interleukin-10 -1082 G&gt;A, inteleukin-10 -819 T&gt;C genotypes with the survival of patients with terminal renal failure.

Method
In this study, a total of 128 patients were examined, 77 on the regular hemodialysis (HD) and 51 on the peritoneal dialysis (PD) program of the UKCS Nephrology Clinic in Belgrade. Age, gender, BMI, duration of HD/PD, C-reactive protein (CRP), albumin and IL-6 and IL-10 concentration in serum were analyzed. Analysis of IL6 -174G&gt;C and IL10 -819T&gt;C polymorphisms was performed by the allele-specific PCR method, and analysis of the IL10 -1082G&gt;A polymorphism by the PCR/RFLPs method.
The patients were followed for 36 months and during that time 37 patients died.

Results
Univariate analysis showed that significant predictors of mortality were age (OR= 1.16,95%CI 1.061-1.269, p=0.001), albumin concentration (OR= 0.81, 95%CI 0.656-0.999, p=0.049), CRP (OR= 1.06, 95%CI 1003-1.124, p=0.039) and IL-6 (OR= 1.12, 95%CI 1.038-1.216, p=0.004), as well as IL-6176G&gt;C gene polymorphism (OR= 0.82, 95%CI 0.097-0.805, p=0.018), while in multivariate logistic model separated only the concentration of IL-6 and the polymorphism in the gene for IL-6 -174 G&gt;C. Estimated arithmetic mean of survival in subjects with the IL-6 -174GG genotype was 33.1 months (95%CI 30.8-35.3), GC 34.6 months (95% CI 33.6-35.7) and CC 26.1 (95% CI 20.0-32.2). There is statistically significant difference in survival time in relation to IL-6 -174 G&gt;C genotype (chi-square=11.398; p=0.003). Estimated arithmetic mean survival in patients with the IL-10 -1082 GG genotype was 32.6 months (95% CI 30.5-35.2), in GA 31.5 (95% CI 29.2-33.8) and in AA 36.0 (95% CI 35.9-36.1). Exists statistically significant difference in survival time in relation to 1082G&gt;A genotype (chi-square=9.669; p=0.008).

Conclusion
Monitoring of survival in 128 patients during 36 months showed that significant worse survival was experienced in patients with IL -6 -174 CC genotype, while polymorphisms in IL 10 gene-1082 G&gt;A and -819T&gt;C did not significantly affect survival. In this group of patients, beside IL-6-174 CC genotype, concentrations of IL-6, C reactive protein and albumin were significant predictors of mortality as well as Kt/V.
#843 Methylation of HMGCR gene promoter in patients on hemodialysis
Authors: Mokrejsova Magdalena 
Published: May 2024

Abstract

Background and Aims
Patients with chronic kidney disease (CKD) exhibit a pronounced risk for cardiovascular mortality; the most vulnerable group enrolls patients on hemodialysis. Unfortunately no meaningful decrease of cardiovascular risk after cholesterol lowering medication – inhibitors of HMGCR - was demonstrated in hemodialysed patients. The incidence of complications in CKD patients correlates with changed epigenetic mechanisms, the most studied epigenetic phenomenon is DNA methylation.
The aim of this study was to elucidate the methylation status of HMGCR gene and evaluate its impact on cardiovascular morbidity and mortality in patients receiving hemodialysis.

Method
We analyzed DNA in plasma of 21 hemodialyzed patients before and after dialysis. Then bisulfite conversion was carried out to distinguish methylated and unmethylated form of DNA. The primers of HMGCR genes promoters were designed, after that methylation specific PCR and sequential analysis of PCR products were performed.

Results
Although the methylation rate of HMGCR gene dropped 9 patients during the hemodialysis session, no statistical significance of this demethylation was confirmed. No correlation of methylation status of HMGCR gene and cholesterol or phosphorus was confirmed. Hypomethylated promoter of HMGCR gene was found in 6 patients, who either underwent amputation of lower extremity due to arterial ischemia or has deceased due to cardiovascular event during next 6 month of follow-up period.

Conclusion
This study suggests that both DNA demethylation and consecutive increased expression of HMGCR gene could be predictors of high risk of cardiovascular morbidity and mortality in hemodialyzed diabetic patients.
#3007 Association between sarcopenia and clinical outcomes in patients on maintenance hemodialysis
Authors: Dimitrijevic Zorica , Randjelovic Jelena , Paunovic Karolina , Kostic Emina , Tasic Danijela , Cvetkovic Tatjana , Mitic Branka 
Published: May 2024

Abstract

Background and Aims
Sarcopenia is a generalized skeletal muscle disorder characterized by the progressive loss of skeletal muscle mass, strength, and function, resulting in worse quality of life and increased mortality. Chronic kidney disease and hemodialysis (HD) favor the development of sarcopenia; however, factors associated with sarcopenia in HD patients have not been well-studied. This study aimed to determine the prevalence and risk factors for sarcopenia in HD patients and to analyze the relationship between sarcopenia and overall morbidity and mortality.

Method
We conducted short-term follow-up prospective cohort study among maintenance HD patients. Hand Grip Strength was measured by a resisted hand-held dynamometer to identify muscle strength and Bioimpedance Spectroscopy to calculate appendicular skeletal muscle mass (ASM). Finally, appendicular skeletal muscle index (ASMI) was calculated as ASM (kg) divided by weight squared (m2). Patients were categorized as sarcopenic or non-sarcopenic using Revised European Working Group criteria (EWGSOP2). Low muscle mass was defined as an ASMI value of&lt;7.00 kg/m2 for men and&lt;5.40 kg/m2 for women; low muscle strength was defined as a hand grip strength of&lt;28 kg for men and&lt;18 kg for women.

Results
Our study enrolled 176 adult HD patients (60% male, 56.1 ± 14.8 years of age). Median follow-up was 15.9 (interquartile range [IQR] 8.6–21) months. Sarcopenia was present in 32.5 % of males and 28% of female patients and associated with older age (55.2 ± 13.4 vs. 64.0 ± 7.3, p&lt;0.001), lower body mass index (25.3 ± 1.3 vs. 22.8 ± 3.1 kg/m2, p&lt;0.05), longer dialysis vintage (9.2 ± 1.1 vs. 6.2 ± 1.9 years, p&lt;0.001) lower Kt/V and lower serum phosphorus and albumin levels (p = 0.037, p = 0.042 and p = 0.048, respectively). In the multivariate analysis, the sarcopenic group had a significantly higher risk for all causes hospitalization than the non-sarcopenic group after adjusting for age and gender (OR 3.92, (95%CI 1.21–12.53, p = 0.031)). Sarcopenia was significantly associated with higher mortality risk (adjusted OR 1.76 (95% CI 1.32 to 2.67)), cardiovascular (adjusted OR 3.31 (95% CI 1.55 to 9.22)) and cerebrovascular events (adjusted OR 2.67 (95% CI 1.52 to 6.03)). Kaplan–Meier survival analysis showed a twelve-month survival rate of 82.1% in sarcopenic patients, which was significantly lower than the non-sarcopenic group (p = 0.034). Finally, both ASM and low muscle strength were independently related to increased mortality risk in dialysis patients (OR 1.86; 95% CI 1.31 to 2.62 and OR 2.31 95% CI 1.49 to 3.93, respectively).

Conclusion
Our study demonstrated that sarcopenia was highly prevalent among HD patients and was shown to be a significant predictor of poor patients outcomes. Future research should address whether the early diagnosis and treatment of sarcopenia improve outcomes.
#2579 Chronic pain in chronic kidney disease: differences between stages and replacement therapies
Authors: Pedrón Miriam Garrigós , Martínez Maria Dolores Arguisuelas , Mauro Juan Carlos Julián , Costantino Flavia , Monnier Victor , Valtueña-Gimeno Noemi , Caballer Vicente Benavent , Martínez-Olmos Francisco José , Ferrer-Sargues Francisco José , Reboredo Maycon Moura , Simó Vicent Esteve , Segura-Orti Eva 
Published: May 2024

Abstract

Background and Aims
Pain is one of the most common symptoms among patients with End-Stage Renal Disease (ESRD), often going unrecognized or inadequately managed in people undertaking hemodialysis. Over 50% of people on hemodialysis experience pain, with 75% of them being ineffectively treated due to healthcare professionals' lack of awareness of this symptom. Managing pain in this population is a complex and challenging task for healthcare professionals. Variables related to chronic pain can influence the patient's response to pain.
There is a gap in the literature on this topic, as it has not been studied whether patients with ESRD undergoing hemodialysis exhibit characteristics of chronic pain that may be influencing their pain response.
The objective of this study is to evaluate the presence and characteristics of variables related to chronic pain in hemodialysis patients with ESRD to assess whether including the management of chronic pain is relevant in the holistic treatment of these patients.

Method
This is a cross-sectional observational study that is currently ongoing. Participants included subjects that were willing to participate, with chronic kidney disease (CKD) stages 3 and 4, CKD stage 5 in hemodialysis and transplanted patients. Several questionnaires were recorded to report different aspects related to chronic pain. The Kruskal-Wallis test was used to assess differences between groups.

Results
Preliminary results on 26 subjects are shown in Table 1. No significant differences were found between groups. Transplanted and hemodialysis patients (in the hospital) experience more sleep disturbances and more pain catastrophizing. Transplanted and hemodialysis patients (in the hospital) present higher belief in their abilities to handle stressful situations in daily life, but they also suffer more headaches. Hemodialysis patients (hospital and home) present higher levels of anxiety and depression. Hemodialysis patients (at home) and transplanted patients exhibit higher levels of stress conditions. Finally, patients undergoing hemodialysis (in the hospital) and CKD stages 3 and 4 present higher levels of chronic pain.

Conclusion
A bigger sample is needed. However, based on the data, it seems that patients with CKD exhibit characteristics of chronic pain that should be addressed by healthcare professionals.