bluuebunny/crossref_metadata_2025_split huggingface dataset:
#5446 A COHORT OF DIALYSIS PATIENTS WITH LOW PREVALENCE OF UPPER ARM FISTULAS
Authors: Cuna Simona , Fonto Giulia , Lefons Luisa , Ria Paolo , Protopapa Paolo , Napoli Marcello , Barbarini Silvia 
Published: June 2023

Abstract

Background and Aims
International guidelines encourage the use of distal native fistula (AVF) which is the best first-line vascular access (VA). But, despite these indications, all over the world, except for Japan, the prevalence of upper arm fistula (UAF) is dramatically increasing. Previous surveys in our department included about 50% of Haemodialysis patients (HP) and showed prevalence of UAFs less then 5%–very low, if compared with those of our country, reported by DOPPS 5 study. We decided to analyse 100% of HP in our department, in order to confirm or exclude the low prevalence of UAF.

Method
Puglia, southern east of Italy, has 1.4 millions inhabitants, of which 1365 need dialysis; 1295 on haemodialysis in 17 different centers and 70 on peritoneal dialysis. The department is organized on a Hub and Spoke model for VA management (Fig. 1). Hub performs simple and complex AVFs, Graft, PTA of non matured or stenotic fistulas, PTA of central stenosis, and surgical rescue of thrombosed or stenotic fistulas. Our four spokes perform mainly simple distal forearm fistula (DFF). In December 2021 we collected datas of VA prevalence of all 1295 HP. The AVFs were classified, according to their anatomical site, in DFF, mean-proximal forearm fistula (MPFF) and UAF.

Results
The average age of 1295 HP was 69 ± 14,65% yo (65% males and 21% diabetics) and 458 of them (35%) where more than 75 yo. The prevalence of DFF, MPFF, UAF, GRAFT and CVC was 63.5%, 10.1%, 3%, 0.7%, 22.5% respectively (fig. 2). Patients aged ≥75 years, women and diabetics showed a higher prevalence of CVC and a lower prevalence of DFF.

Conclusion
Data collected on all patients confirm the low prevalence of UAF detected in the previous surveys -which involved only a part of haemodialysis patients. Zero upper arm fistulas is an utopian goal, but it seems possible to reduce the prevalence of proximal fistulas to 5% or less as the Japanese experience has showed.
#5524 THE ROLE OF C5AR VERSUS C3 IN THROMBOTIC MICROANGIOPATHY, ISCHEMIC KIDNEY NECROSIS, AND ACUTE KIDNEY INJURY INDUCED BY CHOLESTEROL CRYSTAL EMBOLISM
Authors: Zhao Danyang , Mammadova-Bach Elmina , Anders Hans-Joachim 
Published: June 2023

Abstract

Background and Aims
Certain thrombotic microangiopathies (TMA) respond to inhibition of complement factor C5, which abrogates formation of the membrane attack complex and hence impairs host defense. Inhibition of C5a receptor (C5aR) avoids this safety problem and still controls autoimmune systemic vasculitis. We speculated that targeting C5aR could be sufficient also in TMA, e.g., related to cholesterol crystal embolism (CCE).

Method
We induced experimental TMA in C3-/-, C5aR-/- or wildtype mice by injecting CC into the left kidney artery of mice and analyzed thrombotic angiopathy, drop in measured glomerular filtration rate (GFR), and ischemic necrosis 24 hours after CCE.

Results
In wildtype mice, CC injection caused diffuse TMA followed by a consistent drop of GFR compared to baseline and ischemic kidney necrosis. Genetic deficiency in C3 convertase profoundly attenuated TMA and hence GFR drop and ischemic kidney necrosis indicating a key role of the complement system in CCE-related TMA. Genetic deficiency of C5aR attenuated TMA, GFR drop and ischemic necrosis to the same extent indicating that C5aR provides the main contribution of the complement system to the pathogenesis of TMA.

Conclusion
We conclude that targeting the C5a/C5aR axis could be sufficient to attenuate also TMA for which a better safety profile would be expected as compared to C5 inhibition.
#5661 EARLY COMPENSATORY INCREASE IN SINGLE-KIDNEY EGFR AFTER UNILATERAL NEPHRECTOMY IS ASSOCIATED WITH A LOWER LONG-TERM RISK OF EGFR DECLINE
Authors: Van Der Weijden Jessica , Mazhar Faizan , Fu Edouard , Van Londen Marco , Evans Marie , Berger Stefan P , de Borst Martin , Carrero Juan Jesus 
Published: June 2023

Abstract

Background and Aims
The healthy kidney has reserve capacity, allowing for an increase in single-kidney GFR (ΔskGFR) in the remaining kidney after nephrectomy. We evaluated whether higher ΔskGFR, as a reflection of renal resilience, is associated with a lower long-term risk of eGFR decline in individuals undergoing unilateral nephrectomy.

Method
We included 1777 participants from the observational SCREAM project who underwent radical unilateral nephrectomy in Stockholm during 2006–2021. We calculated the ΔskGFR using the eGFR (CKD-EPI 2009) at 3 months post-nephrectomy eGFR minus 50% of the pre-nephrectomy eGFR and evaluated its pre-nephrectomy determinants (age, sex, eGFR, comorbidities) with multivariable linear regression. Follow-up started at 3-months post-nephrectomy, and Cox regression was used to explore the association between Δsk-GFR and the subsequent risk of CKD progression (defined as composite of a decline &gt;30% relative to three months post-nephrectomy eGFR or initiation of kidney replacement therapy), adjusting for age, sex and pre-nephrectomy eGFR.

Results
Mean (SD) age was 68 ± 11 years, 40% of patients were female, 92% had a kidney cancer diagnosis and mean (SD) pre-nephrectomy eGFR was 75 ± 19 mL/min/1.73m2. Median (IQR) Δsk-GFR was 11 (7–20) mL/min/1.73m2. Pre-nephrectomy determinants of Δsk-GFR were age (St.Β = −0.20, P≪0.001) and pre-nephrectomy eGFR (St.Β = 0.14, P&lt;0.001). During a median follow-up of 4 years (maximum 15 years), 178 participants developed CKD progression. The group with a Δsk-GFR above the median value (11 mL/min/1.73m2) had a 42% lower risk of CKD progression (adjusted HR: 0.58, 95% CI: 0.42 – 0.80), compared to those with a lower Δsk-GFR (Figure).

Conclusion
A larger compensatory increase in single-kidney eGFR early after unilateral nephrectomy, suggesting better renal resilience, was associated with a lower risk of CKD progression during long-term follow-up. Evaluation of Δsk-GFR could help identify patients at higher risk of progressive kidney function decline.
#6300 CHANGES IN ECHOCARDIOGRAPHIC INDICES FOLLOWING KIDNEY TRANSPLANTATION: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Betsikos Achilleas , Theodorakopoulou Marieta , Korogiannou Maria , Marinaki Smaragdi , Papagianni Aikaterini , Boletis John , Tsioufis Costas , Sarafidis Pantelis 
Published: June 2023

Abstract

Background and Aims
Cardiovascular disease is the leading cause of death in ESKD and uremic cardiomyopathy contributes significantly to the increased cardiovascular risk in these patients. Kidney transplantation is associated with improved survival compared to dialysis. This systematic review and meta-analysis (CRD42022371202) aims to assess the changes in echocardiographic indices in patients before and following kidney transplantation

Method
We included studies in adult subjects with echocardiographic assessments before (baseline) and following kidney transplantation (&gt;1 month follow-up). The primary outcome measure was left-ventricular mass index (LVMI). Literature search involved PubMed, Web-of-Science and Scopus databases, manual search of article references and grey literature.

Results
From 6463 records initially retrieved, 35 studies with a total of 2692 participants were included in the final quantitative meta-analysis. From 30 studies (2211 patients) reporting the primary outcome, LVMI was significantly decreased after kidney transplantation compared to pre-transplantation values [WMD -21.16 g/m2, 95%CI(-27.21, -15.12), I2 = 88%, P&lt;0.001]. In subgroup analysis, higher differences were evident among 6 studies (N = 163) evaluating LVMI&lt;6 months after kidney transplantation [WMD -41.54 g/m2, 95%CI (-51.31, -31.78), I2 = 13%, P&lt;0.001] and lower differences among 24 studies (N = 2048) evaluating LVMI &gt;6 months after kidney transplantation [WMD -16.64 g/m2, 95%CI(-22.79, -10.49), I2 = 88%, P&lt;0.001]. In sensitivity analyses, patients receiving kidney from living kidney donors (WMD; -76.90 g/m2, 95%CI (-122.13, -31.67), I2 = 88%, P&lt;0.001) and those on hemodialysis before KTx [WMD;-33.76 g/m2, 95%CI (-51.51, -16.00), I2 = 92% P&lt;0.001] presented higher LVMI reductions following transplantation.

Conclusion
Kidney transplantation is associated with significant reductions in LVMI compared to the pre-transplantation levels. This could be another factor contributing to the lower cardiovascular risk observed in KTRs compared to dialysis patients.
#6485 UNI-494 LOWERS URINARY B2-MICROGLOBULIN LEVELS IN RATS
Authors: Reddy Guru , Gupta Pramod , Khare Atul , Gupta Shalabh 
Published: June 2023

Abstract

Background and Aims
Mitochondrial dysfunction in renal cells play a critical role in the pathophysiology of acute kidney injury (AKI) and chronic kidney disease (CKD). The proximal tubule is the primary sensor and effector in CKD progression and AKI. The measurement of urine Β2-microglobulin (Β2M) is a sensitive assay for proximal tubule injury. Nicorandil, a selective mitochondrial ATP-sensitive potassium channel activator, may be a promising AKI treatment, but its clinical use is limited by serious gastrointestinal side effects and rapid absorption and elimination. UNI-494, a novel nicorandil prodrug designed to improve its pharmacologic properties, may increase the short half-life and improve the safety profile of nicorandil. This study presents the efficacy data on the effects of UNI-494 in a rat ischemia-reperfusion (I/R) model, evaluating biomarkers of renal injury.

Method
49 male Sprague-Dawley rats were randomly assigned to 4 groups to evaluate the in vivo efficacy of UNI-494 in a bilateral renal (I/R) model. Group 1, the Sham group, consisted of 10 subjects while groups 2–4 each had 13. Group 1 received no treatment, Group 2 a vehicle, Group 3 10mg/kg of UNI-494, and Group 4 20mg/kg of UNI-494. Treatments were administered as a single dose on Day 0, 1 hour prior to modeling. Body weights were measured on Days -1, 0, and 1. Urine Β2M levels and urinary albumin-to-creatinine ratio (UACR) samples were collected within 24 hours after the surgery using the metabolic cages. Serum blood urea nitrogen (BUN) and creatinine samples were collected on Day -1 (pre-modeling) and 24 hours after modeling. T-tests were used to evaluate statistical differences between groups.

Results
Β2M levels were significantly lower for the 20 mg/kg UNI-494 dose group compared to the vehicle group, and Β2M content in both UNI-494 dose groups (10 and 20 mg/kg) was significantly lower compared to the vehicle group (Fig. 1). Β2M levels and content were lower for the 20 mg/kg UNI-494 dose group than for the 10 mg/kg dose group (Fig. 1). There was no difference in body weight changes between the UNI-494 dose groups and the vehicle group. There were no statistically significant differences among all groups for serum creatinine and BUN pre-modeling and in UACR.

Conclusion
Lower levels of urine Β2M levels in the higher UNI-494 dose group compared to the other groups indicate that UNI-494 may have a renoprotective effect. Additionally, the lower levels of Β2M in the higher dose group compared to the lower dose group indicate a dose-response trend. Our study results are consistent with previously published data with nicorandil in a similar rat model of I/R. This potential renoprotective effect should be further investigated.
#2513 EFFECT OF HEMODIALYSIS WITH MEDIUM CUT-OFF VERSUS HIGH-FLUX MEMBRANES ON ENDOTHELIAL FUNCTION OF CHRONIC KIDNEY DISEASE PATIENTS
Authors: Armani Rachel , Carvalho Aluizio , Vercia Monique , Bortolotto Luiz Aparecido , Canziani Maria Eugênia 
Published: June 2023

Abstract

Background and Aims
Endothelial dysfunction (ED) is considered a marker of vascular complications, especially in patients with chronic kidney disease (CKD). Inflammation and the uremic state contribute to ED in hemodialysis (HD) patients. Recently, the medium cut-off (MCO) HD membrane has been proposed to efficiently remove inflammatory cytokines and higher molecular weight uremic toxins. This study aimed to compare the effect of dialysis with medium cut-off (MCO) or high-flow (HF) membranes on the endothelial function of patients on chronic HD.

Method
A prospective, randomized, crossover study in which 32 patients with CKD were dialyzed for 12 weeks with each membrane, including a 4-week washout period between treatments. Endothelial function was assessed by flow-mediated dilation (FMD) using brachial artery ultrasound at weeks 1, 12, 16, and 28.

Results
The population consisted of 59% men, 52.7±13.4 years, 16% non-black, on HD for 8.8(4.1-15.1) years, 72% with arteriovenous fistula). Hypertension was the most common etiology of CKD and 34% of patients had previous cardiovascular disease. Table 1 shows clinical and demographic characteristics of all subjects. The Patients were grouped, regardless of treatment sequence, into MCO or high flow groups, since no drag (p = 0.634) or sequence (p = 0.998) effects were observed in the FMD assessment. The ANOVA model with repeated measures showed no effects of treatment (p = 0.426), time (p = 0.972) or interaction (p = 0.413) in the comparison of FMD, between the MCO and high flow groups.

Conclusion
Dialysis performed with MCO, or HF membranes did not influence endothelial function in patients undergoing chronic HD.
#2518 EFFECT OF VACCINATION ON OXIDANT/ANTIOXIDANT STATUS IN HEMODIALYSIS PATIENTS WITH POST-COVID CONDITIONS
Authors: Korol Lesya , Stepanova Natalia , Ostapenko Tetyana , Rysyev Andriy , Marchenko Valeriya , Belousova Olga 
Published: June 2023

Abstract

Background and Aims
Hemodialysis (HD) patients are at high risk for post-COVID conditions and a high mortality rate over a 1-year period after diagnosis of COVID-19, especially in the first 3 months. Evidence shows that vaccinated individuals who experience breakthrough infection are less likely to report post-COVID conditions compared with unvaccinated individuals. Although oxidative stress has been shown to be an important cause of post-COVID conditions, there is a general lack of data on oxidant/antioxidant status in HD patients with post-COVID conditions. The present study aimed to evaluate the oxidant/antioxidant markers in HD patients with post-COVID conditions according to vaccination status.

Method
A total of 106 HD patients, aged 52.4 ± 10.2 years, and dialysis vintage of 68 (29-134) months, were enrolled in this cross-sectional observational cohort study. Patients were divided into 3 groups according to their vaccination status and the presence of post-COVID conditions. Group 1 consisted of 36 HD patients who had been fully vaccinated against COVID-19 with either Pfizer-BNT-162b2 or Moderna-mRNA-1273 vaccine and had experienced a post-vaccination SARS-CoV-2 infection and had at least 1 post-COVID symptom. Group 2 consisted of 35 fully vaccinated HD patients who had never been infected with COVID-19 (vaccinated control group), and Group 3 included 35 unvaccinated HD patients who had experienced COVID-19 and had post-COVID conditions (unvaccinated control group). Concentrations of malondialdehyde in serum (MDAs) and erythrocytes (MDAe), sulfhydryl groups (SH-groups), serum catalase activity (CTs), serum transferrin and ceruloplasmin levels were determined 3 months after COVID -19 recovery. Data were expressed as a median and interquartile range [Me (Q25-Q75)] and compared with the Kruskal-Wallis test.

Results
The vaccinated HD patients with post-COVID conditions had the highest concentrations of MDAs and ceruloplasmin, and lower serum levels of CTs and transferrin compared with the vaccinated and unvaccinated control groups (Table 1).

Conclusion
Our findings suggest a significant oxidative imbalance in HD patients with post-COVID syndrome most likely due to the synergistic effects of the virus and the vaccine. The use of antioxidant supplements might be a possible strategy to treat post-COVID conditions in HD patients.
#2530 “HOME-MADE” REMOTE MANAGEMENT IN CAPD
Authors: Di Stante Silvio , Lionte Laurentia , Lucarelli Lucia , Magi Loredana , Mambelli Sabrina , Manfredi Elena , Mazzoli Elisa , Ranocchi Alessandra , D’onofrio Giovanni , Rinaldi Angela Pia , Sebastianelli Antonella , Silvestrini Stefania , Di Luca Marina 
Published: June 2023

Abstract

Background and Aims
Remote control of dialysis parameters has become an essential routine in the Centers that perform Peritoneal Dialysis. For patients in APD there are Cloud-based platforms or with VPN connection that allow daily monitoring and which have proved to be very useful for reducing hospital visits and treatment complications, especially during the recent pandemic. The same cannot be said of CAPD patients for whom the procedures are carried out manually, without electromedical devices, with a paper report of the parameters. Furthermore, to date, there are no dedicated applications able to communicate these important measurements to the Centres.

Method
In March 2021 we created a calculation table file, with limited data entry, divided by days, daily exchanges and monthly sheets. Patients and/or caregivers can insert loading and drainage volumes, type of bags used, blood pressure values, weight and diuresis at an agreed time. The system automatically calculates and graphically displays the total daily and monthly average ultrafiltration for each exchange, the daily balance as well as the average of all the aforementioned parameters for the entered period (Figure 1). There is also a graphic sheet with an annual summary of the average values (Figure 2). The file is uploaded online, subject to the patient's consent, via a free file hosting service that allows modification and reading shared and protected by password between patients and Center operators.

Results
To date, 9 CAPD patients in our Center have been included in the program with good acceptance by patients and caregivers, who enter data based on their availability of time and regularly in anticipation of the monthly outpatient visit. The staff of the Centre, both Doctors and Nursing, access the file periodically, in case of need and in preparation for the visit. In this way, regular checks and evaluations of prescription compliance, ultrafiltration efficacy, maintenance within the expected ranges of weight, blood pressure and fluid balance of patients in CAPD are obtained, as is the case for patients in APD.

Conclusion
The creation of a shared file for monitoring the dialysis parameters of CAPD patients could be able to reduce the existing gap with those in APD, at least as regards the vital and dialysis parameters, since the functioning of the catheter in individual exchanges cannot be evaluated. A more extensive experience is needed, and is being studied, to confirm the usefulness of this approach which currently already guarantees a reduction in hospital admissions and integrates and structures the clinical information that can be obtained in the traditional way.
#2547 THE EFFECTS OF HEMODIALYSIS ON THE FUNCTIONAL BRAIN CONNECTIVITY IN PATIENTS WITH END-STAGE RENAL DISEASE
Authors: Heo Chang Min , Son Sung Hyun , Park Sihyung , Park Bong Soo , Lee Yoojin , Kim Yang Wook 
Published: June 2023

Abstract

Background and Aims
The aim of this study was to investigate functional brain connectivity in patients with end-stage renal disease (ESRD) undergoing hemodialysis using functional near-infrared spectroscopy (fNIRS), and analyzed the effect of hemodialysis on the functional brain connectivity.

Method
We prospectively enrolled the patients with ESRD undergoing hemodialysis for more than six months without any previous history of neurological or psychiatric disorders. The fNIRS data acquisition was made with a NIRSIT Lite device. Measurements were made three times in the resting state for each patient; before the start of hemodialysis (Pre-HD), one hour after the start of hemodialysis (Mid-HD), and after the end of hemodialysis (Post-HD). We processed and exported the entire data, and made a weighted connectivity matrix using a Pearson correlation analysis. From the connectivity matrix, we obtained the functional connectivity measures by applying a graph theoretical analysis (Fig. 1). We compared the differences of the functional connectivity measures according to hemodialysis in patients with ESRD.

Results
We included 34 patients with ESRD. Table 1 and Fig. 2 show the differences in functional brain connectivity according to hemodialysis. There were significant changes in the functional connectivity measures of the mean clustering coefficient, transitivity, and assortative coefficient in the comparisons between Pre-HD and Post-HD periods (0.353 vs. 0.399, p = 0.047; 0.523 vs. 0.600, p = 0.042; 0.043 vs. -0.012, p = 0.044; respectively). However, there were no changes in the connectivity measures of the mean clustering coefficient, transitivity, and assortative coefficient in the comparisons between Pre-HD and Mid-HD periods, and between Mid-HD and Post-HD periods. In addition, there were no significant differences in the connectivity measures of the average strength, global efficiency, and local efficiency in the comparisons among Pre-HD, Mid-HD, and Post-HD periods.

Conclusion
We demonstrate the significant effect of hemodialysis on the functional brain connectivity in patients with ESRD. The functional brain connectivity would change in a more efficient direction through hemodialysis.
#2559 THE EFFECT OF INTRADIALYTIC EXERCISE ON CARDIAC OUTCOMES IN HEMODIALYSIS PATIENTS
Authors: Huang Mei , LV Aili , LV Honghong , Yang Feng , LI Yan , Hua Yan , Ni Chunping 
Published: June 2023

Abstract

Background and Aims
Cardiovascular disease is the main cause of death of hemodialysis patients, accounting for 42% of all deaths. Because exercise can reduce many risk factors of cardiovascular disease in these patients, we observed the effect of intradialytic exercise on left ventricular structure and function.

Method
A randomized controlled trial was used. Participants were randomly divided into control group and exercise group. Among them, the exercise group carried out intradialytic aerobic and resistance exercise for 3 months, 5-6 times every two weeks, according to their dialysis frequency. The left ventricular end-diastolic volume, mass and ejection fraction were measured by echocardiography before and 12 weeks after the intervention. (ClinicalTrial registration number: NCT05718765).

Results
At first, 60 people were recruited and completed the baseline assessment (30 people in each group). The average age of patients in the intervention group was 47.81-11.76 years old, and the average hemodialysis vintage was 17.23-3.09 months. There were 18 men in total. The average age of patients in the control group was 48.56-16.83 years old, and the average hemodialysis period was 17.67-2.83 months. There were 25 men in total. Before the intervention, the two groups of patient indicators were balanced, and the difference was not statistically significant (P&gt;0.05). Finally, 53 patients completed the trial protocol (27 control group and 26 exercise group). After 3 months of intervention, there were significant differences in left ventricular mass, left ventricular end diastolic volume and left ventricular ejection fraction between the two groups (P&lt;0.05). Moreover, the cardiac outcomes of the intervention group were lower than those of the control group, as shown in Table 1.

Conclusion
The exercise for 3 months can effectively reduce the left ventricular mass and significantly improve the left ventricular function and structure of hemodialysis patients. This will help to improve the research and development of exercise on cardiac in hemodialysis patients.