bluuebunny/crossref_metadata_2025_split huggingface dataset:
#376 Self-efficacy, social support and hemodiafiltration are independently associated with better Self-Reported Health Status over time
Authors: Cromm Krister , Pham Ngoc , Jaha Hanna , Schappert Anna , Liegl Gregor , Fischer Kathrin I , Fischer Felix , Rose Matthias 
Published: May 2024

Abstract

Background and Aims
Patients with kidney disease receiving dialysis are a highly vulnerable population. Psychosocial determinants of Self-Efficacy (SE) and Social Support (SS) have been suggested as potentially important outcomes for people with end stage kidney disease. We investigated whether these variables could explain differences in Health-Related Quality of Life (HRQL) outcome domains over time independently or in interaction with treatment modality of high-flux hemodialysis (HD) versus high-dose hemodiafiltration (HDF).

Method
HRQL in 1264 participants from the international multi-centre, prospective, randomized, open label, controlled CONVINCE trial were assessed, using screening and quarterly follow-up data up to 24 months. Measures included the MOS Social Support Scale, General Self-Efficacy Scale, and PROMIS short forms for fatigue, physical function, pain interference and intensity, sleep disturbance, anxiety, cognitive function, depression, ability to participate in social roles. SE, SS and interactions with modality were included as independent variables and HRQL domains as dependent variables in a linear mixed effects model with random intercept and slope for SE and SS.

Results
Participants were 20-92 (M=62.33, SD=13.50) years old, 62.9% were male. Linear mixed effect regression models showed significant main effects for self-efficacy (β = −0.15-1.09, all p &lt; .0001) on all HRQL domains. Significant SE × time interactions were found for all variables (β = −0.02-0.04, all p &lt; .01) but pain intensity. Main effects for SS were found for cognition (β = 0.31, p = .00) and sleep disturbance (β = −0.21, p = .00). A significant SS × time interaction was found for anxiety (β = 0.01, p = .02) and sleep disturbance (β = 0.02, p = .00).
Plots for these associations can be found in Figs 1 and 2. Marginal means were plotted and 25%, 50% and 75% quantiles were used to separate the different levels of SE and SS.
There were no significant interactions between treatment modality (HDF vs. HD) and SE/SS.

Conclusion
Our results indicate that higher SE and better SS are independently associated with higher HRQL of dialysis patients over time, showing no significant interactions with HDF. SE had the largest effects on HRQL. This bears the chance to develop targeted psychosocial interventions to improve health outcomes when introducing new therapy options for patients. However, patients achieving higher HRQL over the course of the treatment may also experience higher SE and SS over time. Future research should include longitudinal assessments on these psychosocial determinants to evaluate their effect further.
#2575 GFR in onco-nephrology: the innovative use of measured GFR in the management of oncological solitary kidney
Authors: Trevisani Francesco , Floris Matteo , Trevisani Francesco , Angioi Andrea , Cinque Alessandra , Bettiga Arianna , Capitanio Umberto , Salonia Andrea , Locatelli Massimo , Pizzagalli Giorgio , Simeoni Mariadelina , Montorsi Francesco 
Published: May 2024

Abstract

Background and Aims
A reliable assessment of renal function in onco-nephrology and especially in oncological solitary kidney (SK) is of paramount importance. Nowadays, the use of estimated GFR is predominant in clinical practice because it is fast, easy and cost-effective. However, eGFR harbours a significant error in comparison to gold standards methods using exogenous molecules such as iohexol or iothalamate (mGFR). Aim of this study was to determine the extent of the error of eGFR compared to the mGFR in onco-nephrological patients with a solitary kidney (SK) after nephrectomy (RN).

Method
A total consecutive cohort of 200 SK who previous underwent RN for renal cancer was enrolled in a single tertiary institution from 2017 to 2023 to compare the most used eGFR formulas (MDRD, CKD-EPI crea 2012, CKD-EPI 2021 crea, CKD-EPI cyst 2012, CKD-EPI Cyst 2021, CKD-EPI cyst/creat, Cockroft-Gault) with a mGFR method using Iohexol Plasma Clearance. Clinical and laboratory data were reported for each patient. True positives (TP) and False positives, (FP) were classified in CKD stages based on eGFR and mGFR. Comparisons between groups were performed using Wilcoxon ranks sum test for numerical variables and Pearson's Chi square test for categorical ones.

Results
Overall median age was 67 years (IQR: 56.75), median BMI 24.8 (IQR: 22.8; 27.7), Male: 74.9%,F: 25.1% Diabetes: 10.9% Hypertension: 53.8%, CKD stage I: 3.7%, II: 25.5%, IIIA:28,IIIB: 27.5%, IV: 13.4%, V: 1.74%, mean Creatinine:1,46 mg/dl (1.16-1,84), cystatin: 1.23 (0.95-1.56). Surprisingly, SK cohort harboured a non-negligible errors in each CKD class with a huge discrepancy between the eGFR formulas and the gold standard method (Figs 1 and 2), suggesting the great relevance of mGFR in the clinical decision making algorithm.

Conclusion
The use of mGFR in nephrectomized patients for RC remains fundamental to avoid misleading evaluations and to perform correct personalized pharmacological therapies.
#2243 The experience from the use of citric acid blood purification solution (CD) with l-ascorbic acid (Vitamin-C) in patients under HD
Authors: Griveas Ioannis 
Published: May 2024

Abstract

Background and Aims
The use of CD offers anticoagulation with a reduced dose of heparin while the use of L-Ascorbic acid offers better management of the patients' anemia. The purpose of the study is to record the experience of using CD solution with Vitamin-C in patients with ESRD under HD

Method
45 patients with ESRD under HD (40 new recruits) with an average weight of 75 kgrs received CD solution with vitamin-C (2 g/lt) for a period of 12 months. All changes in heparin dose as well as patients' anemia profile (Hb, Hct, ferritin, TSAT, rhEPO dose) were recorded.

Results
The initial cumulative heparin dose of 1818 ± 659.28 iu (24 iu/kgrBW) was progressively increased to 2677.41 ± 1053.15 iu (36 iu/kgrBW) at 6 months and to 3323.52 ± 1467.79 iu (44 iu /kgr/GB) at 12 months. With no observed thrombotic events or bleeding tendency, the dose of heparin used was significantly lower than the recommended doses with the classical solution (loading dose 30-50 IU/kgBW and then 10 IU/kgBW/hour). Patients' Hb and Hct progressively increased significantly (10.63 ± 1.55 start-11.79 ± 0.91 end, p &lt; 0.05, 32.25 ± 4.45 start-36.5 ± 2, 92 end, p &lt; 0.05) with constant weekly erythropoietin dose (14000 ± 9500 iu start-14000 ± 10000 iu end, p = NS) and stable ferritin levels (526.73 ± 498.72 iu start-690.44 ± 470.32 iu end, p = NS). The above observation was combined with a significant reduction in monthly iron administration (from 700 mg monthly initially to 200 mg monthly after one year).

Conclusion
Our findings suggest that the use of CD solution and vitamin C compared to the classic one offers anticoagulation with a significant reduction in the dose of heparin used, while simultaneously increasing hemoglobin with a fixed dose of erythropoietin and reduced iron administration.
#806 Predicting arteriovenous fistula success using ferumoxytol-enhanced MRI (Fe-MRI) and computational flow dynamics (CFD)
Authors: Ker Robert , Hyde-Linaker George , Barrientos Pauline Hall , Kingsmore David , Kazakidi Asimina , Stoumpos Sokratis 
Published: May 2024

Abstract

Background and Aims
Arteriovenous fistula (AVF) failure is common and is invariably associated with preexisting anatomic problems of the inflow and outflow circuit. Ferumoxytol, an iron oxide nanoparticle, provides a safe alternative to gadolinium contrast material for MR angiography in chronic kidney disease (CKD). Computational fluid dynamics (CFD) has been utilised to virtually demonstrate the haemodynamics within AVFs using high-quality vascular mapping obtained with ferumoxytol-enhanced MRI (Fe-MRI). Using Fe-MRI and CFD we aimed to assess AVF haemodynamics and identify flow patterns and geometries associated with AVF success.

Method
In this pilot study we used Fe-MRI datasets of CKD patients who had vascular mapping 6 weeks after AVF creation. Using CFD methods we performed vessel segmentation to construct three-dimensional (3D) patient-specific geometries from images obtained with Fe-MRI (Fig. 1). We then completed a detailed CFD analysis for each AVF geometry to establish the associations of haemodynamic (mean wall shear stress (WSS), oscillatory shear index (OSI), blood flow velocity, and areas of abnormal flow) and anatomical parameters (anastomosis angle, feeding artery diameter, feeding artery curvature, draining vein diameter, and draining vein curvature) with AVF outcomes. The primary outcome was AVF success defined as AVF use (assisted or unassisted) for dialysis for a minimum of 3 months. ROC analysis was used to assess anatomical predictors of AVF flows of ≥1000 ml/min.

Results
The study included 17 patients with CKD who had AVF creation between 2018 and 2020. From these, 13 AVFs were successfully used for dialysis and 4 failed to mature or were used for dialysis for &lt;3 months before failure. Compared to failed fistulas, successful AVFs had higher mean WSS and OSI. Failed AVFs were characterised by different haemodynamic patterns including lower flow rates with less helical flows. On ROC analysis the three metrics with the highest area under the curve (AUC) values were the feeding artery curvature (0.82), feeding artery diameter (0.76), and draining vein diameter (0.74) with a combined AUC value of 0.83 (Fig. 2).

Conclusion
Using Fe-MRI and CFD in the post-surgical juxta-anastomotic environment higher mean WSS and OSI were predictive of AVF success. In addition, the feeding artery curvature, feeing artery and draining vein diameters are strongly correlated with high venous flow rates, one of the key factors of AVF success. Although vessel diameters are routinely measured as part of pre-operative vascular mapping, a greater emphasis should be given on mean WSS, OSI and feeding artery vessel curvature when selecting vessels for AVF creation.
#1711 The impact of a multidisciplinary vascular access team on haemodialysis vascular access-related outcomes
Authors: Figueiredo Rafael , Fernandes Bernardo , Relvas Miguel , Diniz Hugo , Pinho Ana , Coentrao Luis 
Published: May 2024

Abstract

Background and Aims
Autologous arteriovenous fistulae (AVF) are considered the vascular access (VA) of choice for most haemodialysis (HD) patients. Timely AVF creation, adequate AVF maturation and assurance of long-term functional patency significantly benefit this population. International guidelines suggest the creation of multidisciplinary VA programs to improve access-related outcomes. This study aims to evaluate the results of the institution of a multidisciplinary VA team at our center.

Method
A retrospective case-control study was performed, comparing our center's incident HD patients from years 2019 and 2022. A multidisciplinary VA team was created in 2021. Patient data was collected from their electronic health record, namely demographic variables, comorbidities, prior nephrology (NA) and vascular access appointments (VAA), and access typology at the beginning of HD. The primary outcome was VA used for HD initiation. Secondary outcomes were time until multidisciplinary VAA, AVF creation and maturation, and the prevalence of AVF at six months for patients who initiated HD with a central venous catheter (CVC). Analysis of the results was performed using SPSS v28.0. A p-value &lt; 0.05 was considered statistically significant.

Results
184 and 169 incident HD patients were included from years 2019 and 2022, respectively. There were no significant differences regarding demographic variables, comorbidities and prior NA. 42.4% and 37.3% of patients had been observed in a VAA at least 6 months before HD initiation, in 2019 and 2022 respectively (p = 0.095). Significantly more patients started HD with an AVF in 2022 (37.5% vs 50.9%, p = 0.011), regardless of demographic variables, VAA and AVF creation prior to HD institution. For those who started HD with a CVC (62.5% in 2019 and 49.1% in 2022), the median time until VAA (33 vs 25.5 days, p = 0.045), AVF placement (87 vs 46 days, p &lt; 0.001) and puncturable AVF (203 vs 132 days, p &lt; 0.001) were significantly lower in 2022. At 180 days post-HD initiation with CVC, the number of puncturable AVFs was also significantly higher in 2022 (26.1% vs 38.6%, p = 0.002).

Conclusion
Multidisciplinary VA teams have a positive impact on the number of patients who start HD with AVF. For those who initiate HD using a CVC, these teams are also a major determinant in the number of functional AVFs.
#1129 Systematic reporting of extracorporeal blood losses in a large dialysis provider organization
Authors: Beige Joachim , Jüttner Katrin , Göbel Kati , Masanneck Michael 
Published: May 2024

Abstract

Background and Aims
The assessment of adverse safety events is important for the risk assessment of major blood loss from the extracorporeal blood circuit during hemodialysis (HD). Such blood loss has been proven to result in a low double-digit number of fatal events per year in the USA. The frequency in Europe is not mandatorily recorded. The mechanisms of blood loss in the venous leg of the system, undetected by the alarm system of the dialysis machines, are not generally known and further patient and structure-related risks are not yet systematically recorded, evaluated and improved.

Method
We set up a web-based intranet database (“Event Management”) to record serious adverse events affecting patients during or around dialysis treatments in all 174 kidney centers of the Kuratorium für Dialyse und Nierentranspantation in Germany (KfH). This system is accessed via intranet within the KfH organization. Nursing and medical staff are regularly trained and informed about this system. The entry of event data that have endangered or harmed patients is mandatory.

Results
141 reports of blood loss were identified for a total of approximately 3 million hemodialysis treatments performed in 174 renal centers in between 2020 and 2022, including venous needle loss due to complications in the extracorporeal blood circuit, 15 of which required inpatient treatment. The breakdown of the causes and consequences of blood losses is shown in the Figure.

Conclusion
Venous disconnection must be reduced by earlier detection with appropriate technical and patient-adapted measures. Patients should be educated about their individual risk and about individual measures to manage risk. Identification of patient-specific and shunt-specific risk factors is necessary. Patient-related risk factors include cognitive impairment, frailty, and dialysis in special areas (ICU, isolation area, nocturnal dialysis). Monitoring systems (blood sensors) currently on the market have good technical blood detection sensitivity. Such systems should be investigated with regard to their clinical benefit according to the rules of evidence-based medicine before their broad introduction into routine care.
#470 Relationship between intraperitoneal volume and intraperitoneal pressure during peritoneal dialysis
Authors: Zhu Fansan , Merlo Laura Rosales , Tisdale Lela , Villamar Maricar , Yi Jun , Wang Xiaoling , Grobe Nadja , Fischer Karsten , Plahey Kulwinder , Chamney Paul , Schiller Brigitte , Kotanko Peter 
Published: May 2024

Abstract

Background and Aims
Monitoring intraperitoneal pressure (IPP) has been advocated to quantitate intraperitoneal volume (IPV) during peritoneal dialysis (PD). The aim of this study was to investigate the relationship between IPV and IPP during a short PD dwell.

Method
Thirteen patients (age 60.2 ± 13.8 years, 5 females, BMI 28.6 ± 7.8 kg/m2) were studied during a 2-hour dwell (2 L dialysate, 2.5% dextrose) in a sitting position. IPP was measured 4x per minute by a pressure sensor integrated in the Liberty Cycler (Fresenius Medical Care, Waltham, MA, USA). Segmental abdominal bioimpedance (Hydra 4200, Xitron Technologies, San Diego, CA, USA) was done concurrently to measure IPV. Serum and dialysate creatinine and glucose concentrations were measured before and after the dwell. Dialysate density (ρ) was measured by a handheld density meter (Mettler-Toledo, Columbus, OH USA). Ultrafiltration volume (UFV) was recorded by the Liberty Cycler. A simple physical model (IPP = ρ × h × g) was used to explore the relationship between IPP and IPV (Fig. 1). Based on the model, a change in IPP (ΔIPP) depends on the change of apparent dialysate height (Δh) and dialysate density (Δρ); g is the gravity constant. The apparent cross-sectional area (A) of the peritoneal cavity was calculated as IPV/h.

Results
Average UFV was 0.31 ± 0.25 L (range 0.03 to 1.03 L). During the dwell, IPP decreased in 12 patients (UFV 0.03 to 0.49 L; Fig. 2) and increased in one (UFV 1.03 L). The IPP decrease (−3.81 ± 2.78 cmH2O; −21.2 ± 18%, p &lt; 0.01) was accompanied by a decrease of apparent h (−0.04 ± 0.03 m; −20.9 ± 18.5%, p &lt; 0.01) and ρ (−3.41 ± 0.56 kg/m3; −0.34 ± 0.06%, p &lt; 0.0001). In patients with a decrease in IPP, the apparent dialysate h decreased from 0.19 ± 0.04 to 0.14 ± 0.04 m, and the apparent A increased from 107.8 ± 23 to 154.7 ± 34 cm2. In the patient with IPP increase, the apparent h increase from 0.14 to 0.18 m, and the apparent A from 138.4 to 164.6 cm2. ΔIPP inversely correlated with Δρ (Fig. 3) and UFV (Fig. 4). Moreover, ΔIPP correlated with D/P creatinine (Fig. 5) and with D/D0 glucose (Fig. 6).

Conclusion
In this proof-of-concept study, a simple physical model was used to explore the relationship between IPP and IPV. Contrary to our expectation, we found that IPP declines in most patients during the dwell. Decrease in IPP is related to increase in the apparent cross-sectional area of the peritoneal cavity. We hypothesize that during the dwell additional spaces of the peritoneal cavity become accessible to IPV. To what extent this opening of peritoneal space is associated with membrane characteristics warrants further studies.
#1470 Study of limitations for the implementation of an assisted peritoneal dialysis program in Spain
Authors: Escuredo Ana Sánchez , Nuñez Sara , Tango Ariel , Ramos Maria Quero , Sanchez-Alvarez Jose Emilio , Fontan Miguel Perez , Macia Manuel , Roblero Maria Fernanda Slon 
Published: May 2024

Abstract

Background and Aims
Assisted peritoneal dialysis (APD), whether partial or total, is a home-based technique for patients who have lost their independence due to age or comorbidities, requiring some assistance to manage their treatment. It is also a viable option for patients ineligible for Peritoneal Dialysis (PD) due to social, cognitive, or physical barriers or those approaching the end of life. Moreover, APD has demonstrated lower hospitalization and mortality rates, lower costs, and similar quality of life compared to in center Hemodialysis (HD).
To understand the usual clinical practice in PD and the limitations for the implementation of an APD program in Spain.

Method
Cross-sectional observational study conducted through a survey with closed-ended questions distributed by email to the PD working group of the Spanish Society of Nephrology. Participation was voluntary and anonymous. The survey included four questions about the center's structure, six about usual practices, and six about potential barriers to the implementation of APD.

Results
A total of 74 responses from 59 centers were analyzed. Average PD programs were 40 ± 26 [2-100]. The median number of patients undergoing APD is 5 [3-10] per program. Among the respondents, 73% believe that APD should include support in organizing and preparing materials at home, connecting and disconnecting in APD/CAPD, and documenting the treatment.
Regarding the offering of APD, 48% of respondents answered it should be provided to patients who have initiated PD and need assistance to continue the technique, 47% in cases of family surrender, 39% to all patients wishing to undergo PD despite physical or mental impairment, 38% at any time if the patient requires it, and 22% during information sessions on techniques in CKD clinic.
Regarding who should perform APD, 73% responded with a caregiver, 63% with external nursing/assistant personnel not affiliated with the PD unit, 52% with a family member, and 48% with nursing/assistant personnel from the PD unit itself.
Perceived limitations by the respondents include lack of funding (80%), lack of experience in PD units (15%), lack of motivation in PD units (11%), lack of trained personnel (5%), and none of the above (7%).
Eighty percent of the respondents believe that implementing APD would increase the number of PD patients in their program.

Conclusion
Seventy-three percent considers that APD should include support in material preparation at home, connection-disconnection, and treatment documentation. There is no consensus on who should be offered APD or who should perform the treatment at the patient's home.
The primary perceived limitations are program funding and a lack of training and motivation among the teams.
#2857 Home hemodialysis training time: associated factors and impact on technique survival
Authors: Quilis Aina , Castillo Belén Vizcaino , Moya Mercedes González , Hernandis Amanda , Pascual Pilar , Alba Amparo , Ureña Paula Gandía , Parra Manuel , Saura Laura Porcar , Barrilero Elena Galván , Sancho Asunción , Molina Pablo 
Published: May 2024

Abstract

Background and Aims
The optimal training time for Home Hemodialysis (HHD), its related factors and its impact in the technique survival are not well established.
Our objective was to analyze the risk factors associated with longer duration of HD training and to assess the impact of training time on the survival of the technique.

Method
Single-center observational study in which all patients seen in our HHD program from January 2013 to November 2023 were included. Training time was defined as the total number of dialysis treatments undertaken for instructional purposes, regardless of prior experience. Patients were divided into two groups, according to standard (≤31 days) or prolonged (&gt;31 days) training duration. Sociodemographic and clinical variables were compared between the two groups, and the factors associated with prolonged training were analyzed using binary logistic regression. HDD failure was the composite of technique failure (defined as transfer to in-center HD for ≥ 30 consecutive days) and death.

Results
We analyzed 50 patients (women: 18, 36%) with a mean age of 55.1 ± 12.6 years and a median length of time on dialysis of 33 (IQR 3-369) months. The median training time was 31 (IQR 24-45) days. 14 (28%) patients were single, 22 (44%) were actively working and the percentage of primary, middle and university education was 20%, 56% and 24%, respectively.
In the univariate analysis, a younger age, and the presence of a care partner were associated with a shorter HHD training time, whereas the type of vascular access, the educational level, the marital status, the gender, and the need for a care partner were similar in both standard and prolonged training duration groups. After a multivariate logistic regression analysis, the only factor independently associated to a longer training time was the age (OR: 1.08, 95% CI: 1.02-1.14; p = 0.01). After a median follow-up of 27 (IQR: 15-50) months, HDD failure was observed in 12 (27%) of patients. Although in the crude analysis the technique survival tended to be lower in the prolonged training duration group (Fig. 1), this finding was not confirmed after adjusting for age.

Conclusion
In our experience, the older age was the only factor independently associated with longer HDD training time, whereas a longer training time did not impact in the HDD survival. These data suggest that HHD training should be especially careful in elderly patients, whose learning may require greater use of time and resources.