bluuebunny/crossref_metadata_2025_split huggingface dataset:
#4979 MORTALITY AND BIOIMPEDANCE SPECTROSCOPY–BASED DRY WEIGHT MEASUREMENT ERROR IN ELDERLY PATIENTS UNDERGOING HEMODIALYSIS
Authors: Kim Hae Ri , Kim Moo Jun , Jeon Jae Wan , Choi Dae Eun , Na Ki Ryang , Lee Kang Wook 
Published: June 2023

Abstract

Background and Aims
Dry weight (DW) estimation is important for patients undergoing hemodialysis. Although bioimpedance spectroscopy (BIS) is often employed to evaluate DW, BIS-based DW frequently differs from clinical DW. In this study, the characteristics of elderly patients were evaluated by separating them into groups based on the degree of disparity between the BIS-based DW and the clinically appropriate (DWGAP), and the mortality of each group was compared.

Method
This retrospective study included patients who underwent hemodialysis at Chungnam National University Hospital from January 1, 2016, to June 2020. All patients were aged ≥60 years. Patients with cancer, recipients of kidney transplant, and patients who dropped out of the study within 3 years were excluded. Body composition was assessed using a portable BIS device (Fresenius Medical Care, Bad Homburg, Germany). The BIS dataset includes extracellular water (ECW), intracellular water (ICW), and total body water level (TBW) as well as the lean tissue index (LTI), fat mass index (FTI), ECW/ICW ratio (E/I), lean tissue mass, fat mass (FAT), adipose tissue mass (ATM), and body cell mass (BCM). The absolute value of the gap between the BIS-based DW and the actual clinically appropriate dry weight was determined (DWGAP). To assess differences in blood chemistry and survival rate, four groups were classified based on the absolute value of DWGAP; Group 1: DWGAP &lt; 0.5 kg, Group 2: 0.5 kg ≤ DWGAP &lt; 1 kg, Group 3: 1 kg ≤ DWGAP &lt; 2 kg, and Group 4: 2 kg &lt; DWGAP. The mortality data of patients up to 3 years after BIS measurement were collected.

Results
There were 1024 patients in all. The study excluded 29 individuals with cancer, 31 patients with KT, and 249 participants with a loss of follow-up before 36 months. A total of 715 patients were analyzed: Group 1 (n = 236), Group 2 (n = 171), Group 3 (n = 137), and Group 4 (n = 171). The mean age for each group was 71.97, 70.73, 71.58, and 70.4 years, respectively. Groups 1 and 2 had the same survival rates (78%); however, Group 3 had a lower rate (73%) and Group 4 showed a significant decline (59%). In the laboratory test, Group 4 had lower hemoglobin, total protein, albumin, creatinine, and chloride levels than Groups 1, 2, and 3. In the BIS data, ECW and E/I were higher in Group 4 than in Groups 1, 2, and 3.

Conclusion
In the elderly patient group, mortality increased in the group where the DWGAP was &gt;2 kg. Lower blood albumin levels, total protein levels, and E/I ratios of ≥1 were detected in the group with a gap of ≥2 kg, and these parameters are likely to adversely affect the survival of elderly patients requiring dialysis.
#5029 PERCUTANEOUS ARTERIOVENOUS FISTULA CREATION: A DUBAI HOSPITAL EXPERIENCE
Authors: Eleraky Tarek , Saleh Ayman , Kovilazhikam Dileep , Alhadari Amna 
Published: June 2023

Abstract

Background and Aims
Targeting to improve the quality of care for chronic kidney disease patients (CKD) a non -surgical creation of native arteriovenous fistulae (AVF) with potentially cosmetic advantages, was offered for CKD patients in Dubai. The procedure started in January 2021 and the follow up continued till January 2023. The goal of this report is to share the original first experience in Dubai for this technique using 4F WavelinQ EndoAVF System.

Method
Fourteen patients underwent sonographic vascular mapping for endovascular AVF creation using 4F WavelinQ EndoAVF System. Nine patients were deemed suitable for Endovascular AVF creation and underwent the procedure under regional anaesthesia. Concomitant ulnar artery and ulnar vein or the concomitant radial artery and radial vein was used for the procedure.

Results
In this case series, the patients have a mean age of 53 ± 17 years, majority of the cases were men (77.8%). All cases were hypertensives (100%) with 2 cases(22.2%) have biopsy proven Glomerulonephritis and 5 cases (55.5%) were diabetics. The technique succeeded (defined by blood flow from used artery to concomitant deep vein and through perforator vein to superficial vein) in all patients (100%). Maturation success (defined as estimated fistula flow rates exceeded 500 mL/min and access vessel diameter was more than 4 mm) with multiple venous outflows was achieved in 8 cases (88.1%). One case (11.1%) showed primary maturation failure. Five cases (55.5%) achieved successful cannulation with excellent blood flow and reliable arterial and venous pressure during dialysis. Time to maturation was 35 ± 17 days and time to successful cannulation averaged 63 ± 45 days. Among patients achieving maturation success, one patient requested AVF closure (using coil embolization) due to mild to moderate upper limb oedema that required reintervention, one case underwent pre-emptive kidney transplantation and did not require to use the AVF and one patient refused using the AVF. In our study 3 cases (33.3%) required reintervention to facilitate maturation. It worth mention that among the 3 cases underwent reintervention, one case requested closure of the fistula and one case refused to use the fistula and only one case of the successful cannulation group underwent single reintervention.

Conclusion
In our limited experience, AVF creation using Endovascular technique resulted in dependable haemodialysis access with reliable maturation time, achieving excellent patency in the successful cannulation group with high blood flow rate and accepted arterial and venous pressure during dialysis. It also showed that the procedure was safe with better cosmetic shape and no scars. However more studies with bigger sample size are needed for better evaluation of the technique and to confirm the endovascular AVF creation proper position in the guidelines for vascular access creation in haemodialysis.
#5069 THE EFFECT OF DIFFERENT DIALYSATE SODIUM CONCENTRATIONS ON AMBULATORY BLOOD PRESSURE AND PULSE WAVE VELOCITY ON HEMODIALYSIS PATIENTS
Authors: Bratsiakou Adamantia , Papasotiriou Marios , Alexandrou Maria Eleni , Mpimpis Theodoros , Georgopoulou Georgia Andriana , Tsiotsios Konstantinos , Goumenos Dimitrios , Sarafidis Pantelis , Papachristou Evangelos 
Published: June 2023

Abstract

Background and Aims
Hypertension and arterial stiffness are associated with increased morbidity and mortality in dialysis patients. The purpose of the present study is to investigate the effect of sodium concentration in the dialysate on 72h ambulatory blood pressure and arterial stiffness, as well as its effect on body weight.

Method
The study involved adult patients on thrice weekly maintenance hemodialysis program. All patients initially underwent six sessions with dialysate sodium concentration of 137 meq/l, subsequently another six sessions with dialysate sodium concentration of 139 meq/l and finally six sessions with dialysate sodium concentration of 141 meq/l. At the start of the sixth hemodialysis session at each different sodium dialysate concentration, the Mobil-o-graph device was placed for 72h in order to cover the 3-day interdialytic interval. The parameters evaluated by the Mobil-o-graph device were peripheral and central systolic (pSBP and cSBP) and diastolic (pDBP and cDBP) blood pressure and pulse wave velocity (PWV). All patients were screened for hydration status with lung ultrasound before entering the study and body weight was actively monitored before each session.

Results
Overall, 29 patients with a mean age of 57.9±14.9 years were included in this prospective interventional study. Body weight did not change significantly between the 3 dialysate concentrations. There was a significant increase of 6 mmHg in the mean pSBP with the change in sodium concentration from 137 to 139 and to 141 meq/l (from 122.7 to 125,6 and to 128.3 mmHg respectively, p = 0.032). Mean cSBP was also significantly increased by 5 mmHg (from 110.3 to 112.6 and to 115.1 mmHg respectively, p = 0.02). Peripheral and central DBP did not change significantly (from 71.4 to 73.2 and to 74.1 mmHg, p = ns and from 73.9 to 74.8 and to 75.3 mmHg, p = ns, respectively), as well as PWV (from 8.4 to 8.2 cm/sec, p = ns).

Conclusion
The increasing sodium concentration in the dialysate causes a significant increase in systolic blood pressure and body weight, without a change in PWV.
#5088 ARTIFICIAL INTELLIGENCE APPLIED TO VASCULAR DOPPLER ULTRASOUND MODELS FOR PREDICTING UNDERDEVELOPMENT OF VASCULAR ACCESS IN NEPHROLOGY
Authors: Ruiz Alfonso Lara , Franco María Jesús Moyano , Moreno Fernando Bertomeu , Martin Javier Burgos , Cintra Melissa , Lazo Mercedes Salguiera 
Published: June 2023

Abstract

Background and Aims
The vascular access of choice for hemodialysis patients is the arteriovenous fistula (AVF). There is a high rate of early primary failure and loss of primary AVF patency. Monitoring of vascular access is essential for early diagnosis of complications and prolonging survival. Models based on Artificial Intelligence (AI) and Machine Learning (ML) can be used for this.

Method
Retrospective descriptive study of the Vascular Doppler Ultrasound (VDU) in adults carried out since January 2019 to January 2022 in our AVF follow-up nephrology clinic. We analyze the results and create AI-based AVF underdevelopment prediction models. We included clinical, demographic and ultrasound variables. Patients were undergoing AVF post-surgery follow-up (VDU by protocol at 3-4 weeks after AVF surgery) or were referred to the clinic with signs of AVF dysfunction. The insufficient development of the vascular access is established as an objective variable. SPSS 20 Statistical Package. Automated Learning Analysis (ML) with Orange ML and BigML.

Results
243 VDU were performed. Of the total, 139 (57%) were follow-up post-surgical VDU per protocol and 104 (43%) were AVF dysfunction VDU. Using supervised ML Analysis techniques with random sampling of 80% of the instances for Training and 20% for Test, we obtain prediction models for the underdevelopment (UD) attribute of FAV: Decision tree algorithm, Area under the curve (AUC) 89%, Classification accuracy (CA) 90%, Precision 90%. Random Forest Algorithm (RF) (AUC) 95%, (CA) 86%, Accuracy 81%. Near Neighbor Algorithm (K-NN) (AUC) 88%, CA 82%, Accuracy 78%. Convolutional Neural Networks (NNC) (AUC) 82%, CA 74%, Accuracy 60%. Algorithm with unsupervised technique of clustering in k-Means 3 clusters are obtained. The variables that best correlate with the objective variable are access flow, vein diameter, resistance index (RI) proximal, (RI) distal, and diameter of the anastomosis.

Conclusion
The vascular ultrasound systematized by the nephrologist facilitates the early diagnosis of complications that lead to early intervention. Analysis of the data with techniques (ML) can facilitate early diagnosis AVF poor development requiring close monitoring or intervention. The development of a nephrology clinic for monitoring vascular access could avoid invasive and unnecessary procedures for the patient.
#5243 ASSESSING HEALTH-RELATED QUALITY OF LIFE IN HEMODIALYSIS PATIENTS IN A PUBLIC HOSPITAL IN TUNIS: A CROSS-SECTIONAL STUDY
Authors: Mejri Borhene , Mariem Najjar , Helaoui Fadwa , Triqui Chifaa , Hmida Fethi Ben , Abderrahim Ezzeddine 
Published: June 2023

Abstract

Background and Aims
There are not many studies evaluating the quality of life of patients with chronic and advanced kidney disease in North Africa. We assessed the health-related quality of life (HRQOL) of patients receiving hemodialysis in a public hospital in Tunis using the KDQOLTM-36 (Kidney Disease Quality of Life) survey, and we investigated its sociodemographic, clinical and biological correlation.

Method
A cross-sectional study design was used, and patients were recruited from a single hemodialysis center in the Charles Nicolle Hospital in Tunis. The KDQOLTM-36 questionnaire was given to patients aged 18 or above receiving in-center hemodialysis maintenance for at least three months to assess their physical and mental health, as well as the effect, burden, and symptoms of kidney disease. Patients with hepatitis, HIV, mental illnesses, and physical disabilities were not eligible for the study. Socio-demographic and clinical data were collected for all eligible patients. We then employed linear regression models to explore the factors associated with overall KDQOL and its various domains.

Results
Sixty-five patients were included. The mean age was 50.9 years old (23-79). The sex ratio was 1.16. The median quality of life score was 52.5 for overall HRQOL, 35,6 for the Physical Component Summary (PCS) score and 44.2 for the Mental Component Summary (MSC) score. Symptoms/problems, effect, and burden of kidney disease (KD) were scored 62.5, 59.38 and 37.5, respectively. There was a significant correlation between diabetic and non-diabetic patients in Symptoms (50.19 vs 65.04 p = 0.006), Effect (45.4 vs 57.87 p = 0.038), Burden of KD (7.38 vs 39.46 p = 0,001) and MCS (p&lt;0,0001). Cardiovascular disease was associated with a higher burden of KD (p = 0.025). Higher age was associated with lower score in Symptoms (p = 0.032) and Burden (p = 0.035). Other correlations were between weight gain between sessions and MCS (p = 0.012), Hyponatremia with both symptoms (p = 0.016), effect (p = 0.029) and MCS (p = 0.017), Hypoalbuminemia with symptoms (p = 0.018), dilated left cavity in the transthoracic ultrasound with both effect(p = 0.047) and burden of KD (p = 0.023). There was no correlation found between gender, work status and hemoglobin level and quality of life.

Conclusion
The results of this study indicate that patients receiving hemodialysis have a low quality of life. The factors associated with overall quality of life were diabetes, cardiovascular disease, age, weight gain between dialysis sessions, hyponatremia, hypoalbuminemia, and dilated left cavity in transthoracic ultrasound. Those findings should be studied using a larger sample.
#5254 COMPARISON OF EFFICACY OF DIFFERENT VANCOMYCIN ADMINISTRATION REGIMENS IN ACUTE KIDNEY INJURY ON HEMODIALYSIS PATIENTS: A RANDOMIZED CLINICAL TRIAL
Authors: Zamoner Welder , Cavalcante Ricardo , Balbi Andre , Ponce Daniela 
Published: June 2023

Abstract

Background and Aims
Sepsis is the main cause of Acute Kidney Injury (AKI), requiring dialysis in critically ill patients, with vancomycin being widely used. Its pharmacokinetics and pharmacodynamics (PK/PD) change during hemodialysis (HD), increasing the risk of subtherapeutic concentrations. Objective: To compare different vancomycin administration protocols to assess serum concentrations and area under the curve/minimum inhibitory concentration (AUC/MIC) ratio from PK/PD.

Methods
Randomized, non-blind clinical trial, including critically ill adults diagnosed with septic AKI on conventional (4 hours) and prolonged HD (6 and 10 hours) and using vancomycin for at least 72 hours from May/2019 to May /2021. Sessions of patients were analyzed and randomized into three groups (G): G control (C, dose of 15 mg/kg after HD session), G intervention (I) 2 hours (dose of 7.5 mg/kg in the second hour of HD and 7.5 mg/kg after the session) and IG continuous infusion (dose of 30 mg/kg in continuous infusion pump, in 24 hours). Patients on chronic dialysis, pregnant women, and those whose session was interrupted for clinical or technical reasons were excluded.

Results
Of the 316 patients recruited, 87 were randomized, and 174 HD sessions were monitored. There was a predominance of males (69.5%), age 61±11 years, APACHE II 31±6, ATN-ISS 0.79±0.14. For the analysis, 28 sessions belonged to the CG, 47 sessions to the 2-hour IG, and 31 to the continuous infusion IG. The groups were similar in age, weight, comorbidities, severity scores, use of diuretics and nephrotoxic drugs, urine output, albumin, CRP, hematocrit, HD modality, recovery of renal function, and death. When HD sessions were analyzed, there was no difference between the groups regarding Kt/V, ultrafiltration, system coagulation, or hypotension. The CG had a higher frequency of subtherapeutic serum levels at the end of HD compared to the 2-hour IG and continuous infusion (86.7% vs. 42.2% vs. 3.2%, p&lt;.0001), higher clearance dialysis (p = .04) and lower AUC/MIC (p&lt;.0001). The IG continuous infusion had a higher frequency of supratherapeutic concentrations (71%). Logistic regression identified the initial concentration variable as a risk factor (OR 1.16, p = .001) for a non-therapeutic concentration (AUC/MIC less than 400 mg·h/L or greater than 600 mg·h/L) of vancomycin. In contrast, the 2-hour intervention group was identified as a protective factor (OR 0.24, p = .04).

Conclusion
Our results suggest that administering vancomycin during dialysis resulted in a lower proportion of supratherapeutic or subtherapeutic concentrations compared to administration in continuous infusion or after the end of the session, respectively. New studies are needed to suggest more appropriate doses and assess these findings' impact on clinical outcomes.
#5372 THE ASSOCIATION BETWEEN POTASSIUM INTAKE AND RISK OF CHRONIC KIDNEY DISEASE
Authors: Han Seung Hyeok , Yun Hae-Ryong , Kim Hyo Jeong 
Published: June 2023

Abstract

Background and Aims
High potassium intake is closely related to lower risk of cardiovascular disease. However, the association between potassium intake and chronic kidney disease (CKD) development in the general population is uncertain.

Method
From UK biobank cohort, we included 317,162 participants without CKD between 2006 and 2010. The main predictor was spot urine potassium-to-creatinine ratio (KCR) as a surrogate of potassium intake. The primary outcome was incident CKD, defined based on ICD-10 and OPCS-4 codes. For secondary analysis, we included 141,180 participants who completed 24-h dietary recall questionnaire and dietary potassium intake was an additional predictor.

Results
At baseline, individuals with higher KCR had lower levels of blood pressure, BMI, and inflammation, and were less likely to have diabetes and hypertension than those with lower KCR. During a median follow-up of 11.9 years, the primary outcome events occurred in 15,255 (4.8%) participants. In competing risk model, adjusted hazard ratio (aHR) per 1-SD increase in KCR for incident CKD was 0.90 (95% confidence interval [CI], 0.89-0.92). In addition, compared with quartile 1 of KCR, the aHRs (95% CIs) for second, third, and fourth quartile were 0.98 (0.94–1.02), 0.90 (0.86–0.95), and 0.80 (0.76–0.84), respectively. In secondary analysis, higher potassium consumption was also inversely associated with risk of CKD. Compared with quartile 1 of dietary potassium intake, the corresponding aHRs (95% CIs) for each quartile were 0.85 (0.78–0.92), 0.73 (0.67–0.81), and 0.67 (0.60–0.75), respectively.

Conclusion
Higher urinary potassium excretion and potassium intake were associated with lower risk of incident CKD.
#5397 FRAILTY ASSESSMENT TOOLS, SURVIVAL TIME AND TIME TO INITIATE DIALYSIS IN OLDER PATIENTS WITH ADVANCED CHRONIC KIDNEY DISEASE
Authors: Hussien Hani , Onofriescu Mihai , Nastasa Andra , Popa Cristina , Teodor Iuliana , Apascaritei Irina , Covic Andreea , Cusai Silvia Corina , Covic Adrian 
Published: June 2023

Abstract

Background and Aims
Chronic Kidney Disease (CKD) patients with frailty have been shown to have a shorter survival time compared to non-frail individuals. Additionally, frailty has been linked to earlier initiation of dialysis among CKD patients. Despite the availability of over 50 frailty assessment tools in the literature, few have been applied in studies of older adults with CKD. There is a need for a comprehensive analysis of different frailty tools to identify the most accurate tools that could predict survival time and time to start dialysis in older adults with CKD. The present study compares four commonly used assessment tools of frailty from different categories (self-reporting tools, clinical judgment tools and complex instruments) regarding their association with survival time and time to start dialysis.

Method
Two hundred forty patients with biochemical evidence of CKD Stages 4–5 were included in this prospective cohort study. The inclusion criteria included patients 65 years old or more with two consecutive measurements of estimated glomerular filtration rate (eGFR) &lt;60 mL/min/1.73 m2 separated by more than three months, while exclusion criteria included dialysis dependence, history of kidney transplantation, recent acute kidney injury, initial visit with the provider, amputation, or cerebrovascular accident. The four frailty assessment tools used in the study were Prisma-7 and FRAIL Scale, Clinical Frailty Scale (CFS), and Frailty Phenotype (FP). Patients were followed-up for 36 months for death events or dialysis initiation.

Results
The study population (240 patients) comprised 46% male patients with a mean age of 73.8 ± 6.6 years. Approximately 25% of patients were considered frail using the FRAIL scale, 69% using Prisma-7, and almost 40% using CFS and FP. Except for Prisma-7, “frail” patients, as determined by the FRAIL, CFS, and FP scores (Fig. 1), had significantly shorter survival times, with a mean survival of 24.9 months (Log-rank p &lt;0.001), 27.3 months (Log-rank p = 0.041), and 26.6 months (Log-rank p = 0.004) respectively. No significant differences were observed in time to dialysis initiation when comparing frail and non-frail patients using any of the frailty assessment tools (Table 1).

Conclusion
The findings suggest that the frailty scores derived from the FRAIL, CFS, and FP tools are better predictors of survival time in frail elderly patients with CKD, while further research is required to determine the most appropriate frailty tool to predict the time to start dialysis in this population.
#5440 BONE TURNOVER MARKERS AND BONE MINERAL DENSITY 1 YEAR AFTER KIDNEY TRANSPLANTATION
Authors: Barbuto Simona , Aghi Andrea , Cianciolo Giuseppe , La Manna Gaetano , Tripepi Giovanni Luigi , Pascale Khairallah , Plebani Mario , Zaninotto Martina , Cosma Chiara , Gasperoni Lorenzo , Cortez Natalia , Nickolas Thomas , Fusaro Maria 
Published: June 2023

Abstract

Background and Aims
Alterations of bone metabolism are a hallmark of chronic kidney disease (CKD) patients and do not completely ameliorate after kidney transplantation. In the setting of a secondary analysis of a RCT, we evaluated changes of bone turnover biomarkers (BTM) and their associations with changes of bone mineral density (BMD) as assessed by DXA.

Method
Sixty-six Kidney Transplant (KTx) recipients were enrolled between 2014-2017. In these patients, at baseline (T0) and 12 months (T12) we measured BTM (Figure 1). The prevalence of vitamin K deficiency was assessed based on undercarboxylated-BGP (uc-BGP) cut-off: &gt; = 4.5 ng/ml, whilst dephosphorylated-ucMGP (dp-ucMGP) we considered a cut-off &gt;500 pmol/L levels. DXA data were assessed at lumbar spine, femoral neck, total hip, one-third and ultradistal radius both baseline and after one year, evaluating the changes in areal BMD (aBMD). Results were expressed as mean ±SD or median and inter-quartile range, as appropriate. Correlations were investigated by Spearman's analysis.

Results
The mean age of enrolled patients was 51± 13 years, 34% were female. BMI was on average 27.8 ± 5.5 kg/m2. 24 patients (39.3%) were pre-emptive and 37 (60.7%) on dialysis and 19% of patients had a history of fracture. In Figure 1 the trend of BTM 1 year after KTx. We highlighted a significant reduction of PTH, CTX, P1NP, and VKDPs. This latter while improving but was not completely restored. Table 1 shows the correlations between the percentage variation of BTM and percentage variation of BMD at several sites evaluated.

Conclusion
In the first-year post-transplant, along with the improvement of renal function, PTH values were reduced as well those of CTX and P1NP. Moreover, we observed an inverse correlation between BTM and BMD, the reduction of bone turnover expressed by the trend of BTM translates into an improvement of BMD.