bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO743: The Influence of Ambulatory Blood Pressure on the Associations of Intradialytic Hypertension with Future Cardiovascular Events and Mortality in Haemodialysis Patients
Authors: Theodorakopoulou Marieta , Iatridi Foteini , Eleni Alexandrou Maria , Karpetas Antonios , Bikos Athanasios , Raptis Vasileios , Tsouchnikas Ioannis , Giamalis Panagiotis , Papagianni Aikaterini , Sarafidis Pantelis 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Patients with intradialytic hypertension (IDH) have higher mean 44-h ambulatory blood pressure (BP) levels than patients without the phenomenon. IDH is associated with an increased risk of cardiovascular and all-cause mortality. Whether the excess risk for mortality in patients with IDH depends on the BP rise during dialysis per se or on elevated 44-h ambulatory BP is not known. This is the first study evaluating the association of IDH with cardiovascular events and all-cause mortality before and after adjustment for ambulatory BP and other cardiovascular risk factors.

METHOD
A total of 242 haemodialysis patients underwent 48-h ABPM with Mobil-O-Graph-NG and were followed for a median of 45.7 months. IDH was defined as: SBP rise ≥ 10 mmHg from pre- to post-dialysis and post-dialysis SBP ≥ 150 mmHg. The primary end-point was all-cause mortality; the secondary endpoint was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, resuscitation after cardiac arrest, hospitalization for heart failure, coronary or peripheral revascularization procedures.

RESULTS
During follow-up, a total of 122 patients died; 69 due to cardiovascular causes. Cumulative freedom from both the primary and secondary endpoints was significantly lower for patients with IDH (log rank-P = 0.048/0.022, respectively). The risk for all-cause mortality was significantly higher for patients with IDH [HR = 1.566, 95% confidence interval (95% CI) (1.001, 2.450)]; similarly, the risk for the combined cardiovascular endpoint was higher for these individuals [HR = 1.675, 95% CI (1.071, 2.620)]. The observed associations attenuated after adjustment for 44-h SBP [all-cause mortality: HR = 1.529, 95% CI (0.952, 2.457)] and combined cardiovascular endpoint: HR = 1.388 95% CI (0.866, 2.225). After additional adjustment for age, interdialytic weight gain, dialysis vintage, 44-h pulse wave velocity, history of coronary artery disease, diabetes mellitus and heart failure the respective HRs were 1.409 [95% CI (0.851, 2.332)] and 1.435 [95% CI (0.879, 2.343)].

CONCLUSION
Patients with IDH presented higher risk for death and cardiovascular outcomes. Sustained high BP levels during the 44-h interdialytic period and not only intradialytic BP rise per se may be participating in the excess risk of this condition.
MO753: Marinobufagenin Predicts Intradialytic Hypotension Episodes in Prevalent Haemodialysis Patients
Authors: Carullo Nazareno , Greco Marta , Presta Pierangela , De Rosa Salvatore , Crugliano Giuseppina , Sabatino Jolanda , Arena Roberta , Andreucci Michele , Indolfi Ciro , Foti Daniela , Coppolino Giuseppe , Bolignano Davide 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Intradialytic hypotension (IDH) is a sudden and often dangerous complication of chronic haemodialysis (HD) treatment that may occur in ∼20%–30% of HD sessions. The pathogenesis of IDH is acknowledged to be multifactorial, as it might depend from an impaired vascular refilling capacity, excessive absolute fluid removal, an impaired sympathetic nerve response to volume loss or inadequate peripheral arterial vasoconstriction. This makes the prediction of IDH extremely challenging in the majority of cases.

METHOD
In this pilot, prospective study, we aimed at evaluating the clinical predictors of IDH in a small cohort of prevalent HD patients, with a particular focus on marinobufagenin (MBG), an endogenous cardiotonic steroid whose blood levels have previously been found notably altered in various cardiovascular disorders and body fluid status alterations.

RESULTS
MBG levels in HD patients were significantly higher than in controls (0.75 ± 0.29 versus 0.59 ± 0.19 nnmol/L; P = 0.03), remained unchanged throughout a single HD session and were not correlated with the absolute or partial fluid loss achieved. During a 30-day follow-up, 19 patients (65.5%) experienced at least one IDH (73 total episodes). An inverse correlation was found between baseline MBG and the number of IDH (R = –0.55; P = 0.001). HD patients experiencing IDH presented remarkably lower baseline MBG as compared with others (0.65 ± 0.28 versus 0.94 ± 0.21 nmol/L; P = 0.008) In these individuals, there was an apparent increase in MBG levels after the first hour of dialysis [0.72 (0.56–1.00) versus 0.65 ± 0.28 nmol/L; P = 0.04], while such levels progressively decreased throughout the rest of the session, being even more reduced at HD end as compared with baseline [0.45 (0.24–0.95) versus 0.65 ± 0.28 nmol/L; P = 0.04]. At Kaplan–Meier analyses, HD patients with lower MBG manifested a 4-fold to6-fold increased risk of IDH during follow-up (crude HR ranging from 4.37 to 6.68), depending on the time-point measurement of MBG. At Cox regression analyses, MBG measured at different time points resulted the strongest time-dependent predictor of IDH among all the variables considered (HR ranging from 0.068 to 0.155; P=0.002 to &lt;0.0001).

CONCLUSION
Findings obtained suggest that altered MBG in prevalent HD patients may reflect a diverse vascular and haemodynamic tolerance to HD stress, eventually leading to recurrent IDH episodes. Further studies are needed to confirm the prognostic capacity of MBG for identifying HD patients at high risk of IDH, particularly those with apparently optimal fluid status.
MO756: Roxadustat Versus Erythropoietin: Comparison of Efficacy in Reversing Ventricular Remodeling in Dialysis Patients with Anemia
Authors: Wang Mengying , MA Kunling 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Renal anemia is one of the main complications of dialysis patients, which has been identified as an important independent risk factor for left ventricular hypertrophy and progression of heart failure, as well as adverse cardiovascular outcomes. Recent studies suggest that hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) Roxadustat represents a novel pharmacological treatment for renal anemia. This study aimed to compare the role of the Roxadustat and erythropoietin in reversing ventricular remodeling in dialysis patients with anemia.

METHOD
This was a retrospective cohort study that compared the treatment of Roxadustat and recombinant human erythropoietin (rhEPO) in dialysis patients for at least 24 weeks from January 2016 to October 2021. A total of 182 participants underwent echocardiography at least twice every 6 months. Baseline and follow-up examinations focused on the change of cardiac structure and function (doppler echocardiography), clinical and biochemical parameters and blood pressure. Participants were treated with oral iron supplements and controlled blood pressure (target value ≤ 130/80 mmHg).

RESULTS
Compared with baseline, left ventricular mass index (LVMI) decreased from 139.8 ± 36.0 to 126.5 ± 35.0 g/m2 (P&lt;0.001) in the Roxadustat hemodialysis subgroup after 6-month treatment. Left ventricular end-diastolic diameters (LVEDd) and left ventricular wall thickness (LVPWT) were both significantly improved (from 5.13 ± 0.66 to 4.92 ± 0.65 cm; P= 0.002, and from 1.12 ± 0.17 to 1.07 ± 0.13 cm; P = 0.033, respectively). There was significant difference in LVMI before and after treatment in rhEPO group (from baseline 134.3 ± 36.8 to 131.8 ± 37.5 g/m2). There was greater reduction in LVMI from baseline to 6 months in Roxadustat group (–13.3 ± 22.4 g/m2 versus –5.02 ± 21.3 g/m2 for Roxadustat versus rhEPO; P= 0.028). In the peritoneal dialysis subgroups, Roxadustat also caused a significant improvement in LVMI and LVEDd (from baseline 133.9 ± 28.0 to 118.5 ± 28.2 g/m2; P= 0.001; from baseline 5.12 ± 0.55 to 4.86 ± 0.58 cm; P = 0.002). In addition, Roxadustat increased hemoglobin, serum albumin level and TIBC, and reduced the level of blood pressure, low density lipoprotein, TC and SF in Roxadustat hemodialysis subgroup. However, there were significant differences in the changes of systolic blood pressure, diastolic blood pressure and TIBC between the two hemodialysis groups.

CONCLUSION
In addition to the efficacy in the treatment of renal anemia, Roxadustat was found to be closely associated with improvement of LV diastolic function in dialysis patients. Our findings may provide new insights into anemia management in dialysis patients. Prospective clinical trials are necessary to further evaluate the role of Roxadustat or other HIF-PHIs in reversing ventricular remodeling.
MO761: Real-Time Prediction of Intradialytic Hypotension using Machine Learning and Cloud Computing Infrastructure
Authors: Zhang Hanjie , Chaudhuri Sheetal , Pickering Aaron , Usvyat Len A , Larkin John , Waguespack Peter , Kuang Zuwen , Kooman Jeroen , Maddux Frank , Kotanko Peter 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Intradialytic hypotension (IDH) is a frequent complication of chronic hemodialysis that could lead to serious clinical outcomes and can be difficult to predict. We used machine learning (ML) and cloud computing infrastructure to develop and evaluate a model that enables real-time IDH prediction.

METHOD
Data were analyzed from six dialysis clinics (Fresenius Kidney Care, Waltham, MA, United States) between January 2020 and November 2020. Data included demographic, clinical, treatment and laboratory were obtained from the electronic health record. The intradialytic data such as systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate and blood flow rate were transferred in real time to Amazon Web Services (AWS, Amazon Web Services, Inc., Seattle, WA, United States) using secure Internet of Things software. Data were randomly divided into model training (80%) and testing (20%) sets. IDH was defined as SBP less than 90 mmHg. A ML tool known as an extreme gradient boosting algorithm (XGBoost) was used. Each time when an intradialytic SBP was measured, the model, which was hosted in AWS, would enable real-time prediction (in less than a minute) of patients who were at risk of IDH within the next 15–75 min. Area under the receiver operating characteristic curve (AUROC) was used to measure the model's performance. Shapley values were calculated to derive variables that were considered highly predictive of IDH.

RESULTS
We obtained data from 42 546 hemodialysis sessions involving 693 patients and 355 693 intradialytic observations. IDH occurred in 17% of the treatments. Our model reasonably predicted IDH, achieving an AUROC of 0.89. Top three predictors of IDH within the next 15–75 min were last intradialytic SBP, IDH rate of the last 10 treatments and mean nadir SBP of the last 10 treatments (Fig. 1).

CONCLUSION
Our study clearly shows the possibility of predicting IDH within the next 15–75 min using ML and cloud computing infrastructure, it suggests that the tool has the potential to assist clinicians to intervene proactively in patients at risk for IDH in real time.
MO776: Central Tunnelled Catheter Implantation by a Multidisciplinary Nephrology and Radiology Team: 10-Year Experience
Authors: Rodríguez Farré Neus , Núñez Delgado Sara , Calaf Forn Francesc , Pelegrí Martínez Laura , Rap Copindean Oana , Sánchez Escuredo Anna , Cabrera López Cristina , Giménez Torrecilla Isabel , Ibernon Vilaro Meritxell , Pilar Ruiz Valverde Maria 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Insertion of tunnelled central venous catheters (TCVC) in patients with chronic kidney disease requiring haemodialysis is a technique of increasing interest in interventional nephrology. Ambulatory placement by a multidisciplinary team of nephrologists and radiologists reduces immediate complications among these patients.

METHOD
Retrospective study of TCVC implantation from 2011 to 2021. The ultrasound-guided technique was used for localization and venipuncture. Correct catheter location and venous anatomy were subsequently checked by fluoroscopy. Early adverse events (30 days post-placement) were recorded.

RESULTS
A total of 427 TCVC were placed in 344 patients during this period. Out of these 248 (58.07%) were primary placements (PP) and 179 (41.92%) guidewire exchanges over previous catheter (GE). A total of 406 (95.08%) TCVC were placed in the internal jugular and 374 (87.59%) TCVC with right laterality. During the follow-up period, early minor complications were recorded in 23 procedures (5.39%), 15 of which (3.51%) required catheter replacement. Patients with GE developed more complications (P 0.039), being venous stenosis, the main complication described (Figure).
A total of 61 patients required successive catheter placements: 48 (78.69%) underwent two procedures and 13 (21.31%) more than three procedures, for a total of 83 TCVC. There were no differences in the number of early complications between the first (10) and successive (14) placements (P 0.94). Catheter durability was similar in subsequent procedures (355 ± 62.3 days at first placement versus 459 ± 60.3 days in successive placements, P 0.24).

CONCLUSION
Multidisciplinary TCVC implantation guarantees good effectiveness of the technique. The performance of subsequent procedures is safe and durable in patients with CKD.
MO782: Evaluation of Acceleromet Reuse for Method of Measurement for Turbulent Blood Flow in Arteriovenous Fistulas in Haemodialysis Patients
Authors: Damsgaard Oliver , Hagstrup Christensen Jeppe , Schmidt Samuel 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Haemodialysis (HD) is the primary treatment for end-stage renal disease. HD therapy requires access to the vascular system. This can be achieved through surgically constructing an arteriovenous fistula (AVF). Post-surgery up to 30% of patients experience dysfunction of the AVF, which may lead to a chronically damaged AVF and render the patient without HD treatment [1]. At present no satisfactory post-surgery monitoring of the AVF exist and, therefore, malfunction of the AVF is recognized too late at a time where no rescue is possible. The functionality of the AVF is normally assessed by auscultation of the murmurs produced by the blood flow. Narrowing of the AVF caused by thrombosis or stenosis causes changes in the blood flow, thus causing changes in the murmurs [2]. The changes in murmurs have not been widely studied but may be of importance to gain knowledge on AVF malfunction. This could be used in developing a method for monitoring the AVF post-surgery.

METHOD
Acoustic recordings was obtained from 21 patient post AVF-surgery at Aalborg University Hospital. Recordings were made with a Silicon Designs 1521 accelerometer encapsulated in a 3D printed box, attached to the skin using double adhesive tape 2–5 cm proximal to the AVF. A total of 11 patients were recorded twice resulting in a total of 32 recordings. Data were sampled at 5000Hz. All data processing and analysis were performed using MATLAB 2021b (MathWorks Inc.). Every recording was manually analysed and labelled with or without audible murmurs. Before processing every recording was split into segments of 3 sec length resulting in a total of 697 segments. Data was processed with a signal processing method [wavelet packet decomposition (Daubechies 4)] to analyse if the frequencies of the sounds differed between recordings with and without murmurs. Energy of the wavelet scales (Scale Energy) was calculated for each frequency band. The scale energy was then log-transformed using natural logarithm to make data normally distributed, and converted to decibel (dB).

RESULTS
A total of 654 segments contained murmurs and 43 segments did not contain murmurs. In all frequency bands, murmurs resulted in a significant change in energy level (P &lt; 0.05).

CONCLUSION
This study shows AVF murmurs results in a significant change in acoustic energy across all frequency bands. This demonstrates that accelerometers can be used to quantify murmurs from AVFs post-surgery.
MO783: Reduction of the Incidence of Dialysis Catheter-Associated Bacteraemia in Intensive Care Units after Systematic Application of Taurolock in the Sealing of the Catheter
Authors: Del Risco Zevallos Jimena , Molina-Andujar Alicia , Piñeiro Gaston , Fernando Quintana Porras Luis , Blasco Miquel , Morata Laura , Soriano Alex , Poch Esteban 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Dialysis catheter-associated bacteraemia in Intensive Care Units (ICUs) increases morbidity and mortality, prolongs hospital admission and increases admission costs. TauroLock™ is a lock solution containing (cyclo)-taurolidine (1.35%) and citrate (4%). (Cyclo)-taurolidine has broad antimicrobial activity against gram-positive and gram-negative bacteria and fungi. The objective of this study was to analyse the effect of systematic sealing of haemodialysis catheters in the ICUs of the Hospital Clínic de Barcelona on the incidence of bacteraemia associated with haemodialysis catheters (BACH).

METHOD
BACH episodes of patients who underwent intermittent haemodialysis (IHD) during ICU admission were reviewed. The period analysed as pre-Taurolock™ was from 2010 to 2014 and post-TauroLock™ from 2015 to 2018. Patients who only received renal replacement therapy with continuous techniques were excluded.

RESULTS
A total of 279 patients received IHD in the pre-TauroLock™ period and 331 in the post-TauroLock™ period. The number of BACH in the pre-TauroLock™ period was 18 (6.45%) and 9 (2.72%) in the post-TauroLock™ period. All infections were from percutaneous catheters (acute patients) except three catheters that were tunnelled. In the pre-TauroLock™ period, femoral catheters predominated (61.1%) while in the post-TauroLock they were jugular (66.7%). There was no association between the location of the catheter and the incidence of BACH. Of the 27 patients with BACH, 14 (51.8%) were men with a mean age of 63 years, with no significant differences between the two groups. The most frequent reasons for admission to the ICU in the pre-TauroLock™ period were post-cardiac surgery, cardiogenic, septic or hypovolemic shock and acute myocardial infarction (3 patients per group) and in the post-TauroLock™ period, septic shock and pancreatitis (3 and 2 patients respectively). The most frequent isolated bacteria were Gram-positive (in total 48.38%: pre-TauroLock™ 47.61% and post-TauroLock™ 50%), with a global predominance of staphylococcus epidermidis (32.25%) (Table). There were no significant differences in the median days from the start of haemodialysis to bacteraemia (23.5 pre-TauroLock™ versus 21 post-TauroLock™). There were also no significant differences between the days of ICU stay in the BACH in both groups or in mortality, being the overall mortality of 70.4%.

CONCLUSION
In our cohort, the systematic application of TauroLock™ in the sealing of dialysis catheters in critically ill patients reduces the incidence of BACH in ICUs.
MO786: Monitoring of Arterio-Venous Fistula Maturation using Central-Venous Oxygen Saturation and Estimated Upper-Body Blood Flow: Impact on Catheter Residence Time
Authors: Rosales Merlo Laura , Zhang Hanjie , (Janice) Ye Xiaoling , Chan Brenda , Mateo Marilou , Jhonson Seth , Kotanko Peter 
Published: May 2022

Abstract

BACKGROUND AND AIMS
In hemodialysis patients, assessment of arterio-venous fistula (AVF) maturation is key to reduce the residence time of central venous catheters (CVC). We have introduced the use of central-venous oxygen saturation (ScvO2) and estimated upper-body blood flow (eUBBF) as means to monitor AVF maturation [1]. We now report CVC residence time in patients with and without ScvO2-based AVF maturation monitoring.

METHOD
We studied hemodialysis patients in who ScvO2-based AVF maturation monitoring was implemented within the framework of a clinical quality improvement project (QIP). ScvO2 and hematocrit were measured with Crit-Line (Fresenius Medical Care, Waltham, MA). eUBBF was computed as described previously [1]. We used time-to-event analysis to compare the CVC residence time post-AVF creation between patients who participated in the QIP (intervention group) and non-QIP patients (control group). Both groups were dialyzed in the same geography. Patients were censored at the time of death, change of dialytic modality, transplantation, lost to follow up, recovery of kidney function and end of the observation period (15 November 2021).

RESULTS
The intervention group comprised 44 patients [age 57 ± 17 years; 27 (61%) males]. In five patients, two AVF were created; in 34 (69%) CVC were removed. The control group comprised of 378 patients (age 59 ± 15 years, 61% males). CVC was removed in 199 (53%) control patients. In the intervention group, CVC were removed 125 days [95% confidence interval (95% CI): 102–171] after AVF creation. In the control group, this time was 236 days (95% CI: 173–404) (P &lt; 0.0003; log rank test; Figure).

CONCLUSION
Compared to controls, the CVC residence time post AVF-creation was shortened significantly— by about 3.6 months—in patients who participated in a QIP that used ScvO2-baseed assessment of AVF maturation. Measurement of ScvO2 and computation of eUBBF are simple, non-invasive means to track AVF maturation, trigger timely interventions and AVF cannulation and shorten CVC residence time.
MO788: Ethanol Lock Solution for Prophylaxis of CRBSI of Non-Tunnelled Catheters in Haemodialysis Patients
Authors: Sharma Manjuri , Dange Shruti , Pegu Gayatri , Kharbuli Indakiewlin , Kumar Doley Prodip , Gope Manas , Brijesh Singh K 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Prevention of catheter related blood stream infection (CRBSI) is a major challenge in hemodialysis (HD) patients. Efficacy of 70% ethanol as a catheter lock solution for the treatment of tunnelled cuff catheter's (TCC's) CRBSI is widely studied [1, 2]. Prophylactic use of ethanol lock was limited to small number of studies especially involving paediatric and home parenteral nutrition (HPN) patients [3] and studies in chronic HD patients with TCCs [4, 5]. But its role in prophylaxis of CRBSI for non-tunnelled catheter (NTC's) is less explored.

METHOD
We conducted a single centre prospective study from May 2019 to May 2020. A total of 62 patients of end-stage renal disease (ESRD) requiring NTC's for the initiation of HD in emergency or maintenance of HD while waiting for the creation or maturation of an already created arteriovenous fistula (AVF) or for TCC insertion were included. The study population was divided into two groups, Group A (n = 31) received 70% ethanol with heparin 2000 IU as a catheter lock solution. Group B (n = 31) received standard heparin 2000 IU as a catheter lock.

RESULTS
The primary endpoint of the study was the rate of CRBSI, in group A 6.5% (n = 2) it was significantly lower compared with group B 25.8% (n = 8), (P = 0.038) and when the CRBSI rate/1000 days was calculated, for group A it was 2.2/1000 catheter days and for group B it was 9.6/1000 catheter days (P = 0.04). The mean duration of catheter survival was not significantly different for group A (29.97 ± 6.7) days and group B (26.42 ± 8.04) days.

CONCLUSION
70% ethanol lock along with heparin may be safe and effective as a catheter lock for prophylaxis of CRBSI.