bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO795: Management of Anemia in Hemodialysis Patients With Thalassaemia Minor
Authors: Nabil Hamouche , Mazighi Sara , Chettati Mariam , Fadili Wafaa , Lisri Mohamed , Laouad Inass 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Thalassemia is a group of hemoglobinopathies characterized by the decrease or lack of β or α globin chain production (Hb) [1]. Minor thalassemia has little to no symptoms since the other gene is capable of compensating for the anomaly; however, it represents a rare cause of resistance to erythropoietin (EPO) in chronic hemodialysis patients (CHP) in multiple regions, particularly the Mediterranean region [2]. As a matter of fact, CHP suffering from minor thalassemia often take higher EPO doses to correct the anemia [3], even if all causes of EPO resistance are resolved; a recent Italian investigation indicated that EPO need in this population is almost double in comparison with other groups [4]. EPO résistance can be secondary to the quantitative anomalies of the hemoglobin chain, notably Hb A2 and Hb F, Biagio Di Lorio et al. reported a positive correlation between the percentage of Hb A2 and EPO doses [5], actually patients that had an Hb A2 &gt;6% needed higher EPO doses and vice versa. The aims of this study were to evaluate the efficiency of different therapeutic means [Erythropoiesis-stimulating agents (ESA), blood transfusion (TS)] aiming to correct the anemia in CHP with minor thalassemia. To detect the correlation between quantitative anomalies in hemoglobin chains and EPO resistance.

METHOD
It's a descriptive multi-centric study, involves eight CHP suffering from minor thalassemia. The statistical analysis of the data was done through Excel using the correlation coefficient and SPSS using the P-value. A value &lt;.05 was considered as significant.

RESULTS
The average value of hemoglobin was 7.35 g/dL, Ferritin (M: 964 ± 971 ng/L) and PTH levels (M: 433 ± 126 pg/mL). These results are detailed in Table 1. Electrophoresis was done for all our patients with an average of HbA à 96.2 ± 1.7%; HbA2 à 3.43 ± 1.41%; HbF à 0.35 ± 0.45%. We have noticed that a decreased percentage up to nul of Hb F fraction is correlated with the lowest Hb levels (Fig. 1). The main therapeutic mean in anemia patients is epoietin beta, the average dose given to patients is 300 UI/kg/week, 326UI/kg/s at 2 months, 233 UI/kg/s at 6 months and 326 UI/kg/s at 12 months. Figure 2 illustrates the response to the EPO during the maintenance phase. The Darbepoetin alpha (μg/Kg/s) is administered (depending on availability) to two patients out of the eight. One of the two was receiving a dose of 0.57 μg/kg/s for 8 weeks, the other one was receiving a dose 0.7 μg/kg/s for 8 weeks as well, with a different response in the two patients. CONCLUSION: The presence of minor thalassemia in chronic hemodialysis patients entails erythropoietin resistance and a serious case of anemia. In our study, the maximum EPO dose used was 500 UI/kg/s reaching a value of 9.7 g/dL of Hb.
MO808: Indoxyl-Sulphate and Cresyl Sulphate are Respectively Linked to Calcium-Phosphate Metabolism Variables and to Cardiovascular Morbidity in Hemodialysed Patients
Authors: Bologna Arianna , Edvige Foligno Nadia , Avino Monica , Del Mastro Teresa , Conte Ferruccio , Palmieri Nicola , Bisegna Sergio , Slaviero Giorgio , Arcidiacono Teresa , Vezzoli Giuseppe 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Indoxyl sulphate (IS) and Cresyl sulphate (CS) are uremic toxins generated by the intestinal amino acid catabolism. Blood levels of these toxins increase in patients with CKD and are linked to cardiovascular events. Therefore, we studied the relationship between serum levels of free IS and CS and divalent ion metabolism variables and cardiovascular morbidity (stroke, heart failure, angor and myocardial infarction) in 139 haemodialysis patients (age 68 + 13 years, weight 65 + 13 kg, dialysis vintage 69 + 71 months).

METHOD
We divided patients according to tertiles of free serum IS and CS.

RESULTS
Patients in the highest tertile of serum free IS showed shorter dialysis vintage and higher body weight gain between dialysis sessions than patients in the other two tertiles. Patients in the highest tertile of IS showed lower body weight and serum concentrations of alkaline phosphatase, 1,25(OH)2D and PTH compared with the lowest tertile. Serum PTH was also measured during 2 years after the baseline; it was higher in patients in the lowest than those in the highest tertile of serum free IS. No relationships of serum free CS concentrations with phosphate and calcium metabolism variables were observed.
Kaplan–Meier survival analysis shows an increased cardiovascular morbidity in patients in the CS highest tertile (blue line in the figure) compared with those in the lowest and middle tertiles taken together (red line; P = 0.01). This association was not found considering IS tertiles.

CONCLUSION
Our findings suggest that serum free IS may be associated with PTH and 1,25(OH)2D secretion, whereas free PCS may predict cardiovascular risk in haemodialysis patients. A point for future investigation could be the relationship between IS and adynamic bone disease.
MO809: Sucroferric Oxyhydroxide for the Management of Hyperphosphataemia in Peritoneal Dialysis Patients
Authors: Emilio Sanchez-Alvarez J , Astudillo Cortés Elena , Paraíso Vicente , Auxiliadora Bajo Rubio María , Millán Beatriz , Janet Chang Macchiu Pamela , Carlos Quevedo Reina Juan , Rama Inés , González Tabares Lourdes , González Peña Olga , Burguera Victor , Barbosa Francesc 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Bone and mineral metabolism disorders are very common in chronic kidney disease (CKD) patients. The increase in phosphorus levels leads to bone disease, risk of calcification and higher mortality, so any strategy aimed at reducing it should be welcomed. The latest drug added to the therapeutic arsenal to treat hyperphosphataemia in CKD is sucroferric oxyhydroxide (SO).
Our objective was to analyse the efficacy and safety of SO in patients with CKD on peritoneal dialysis (PD), followed for 6 months.

METHOD
Observational, multicentre, prospective, clinical practice study. Patients who had been on PD for &gt;6 months and who had been prescribed SO as a treatment for hyperphosphataemia were included; they should also meet any of the following conditions: serum phosphate &gt;4.5 mg/dL, serum phosphate ≤4.5 mg/dL but receiving a high number of tablets or using another phosphate binder with adverse effects or intolerance. Clinical and epidemiological variables were analysed; also parameters related to bone and mineral metabolism disorders and anaemia. Variations in stool consistency and the need for laxatives were also taken into account.

RESULTS
A total of 92 patients (62 ± 14 years, 66% male, 23% diabetic), from 11 centres, were included in the study. In 66 patients (72%), SO was the first phosphate binder; in the other 26, a previous binder was replaced by SO due to lack of tolerance or efficacy. The initial dose of SO was 942 ± 516 mg/day. Globally, serum phosphate levels decrease at 3 (10.7%, P &lt; .001) and at 6 months of treatment (18.3%, P &lt; .001). After 6 months of treatment, 63% of the patients achieved a phosphataemia of &lt;5 mg/dL and 41% &lt;4.5 mg/dL. The decrease in serum phosphate levels correlated with baseline phosphate level (r = 0.367; P = .039), age (r = .338; P = .033) and time on dialysis (r = 0.578; P = 0.001). There were no differences in the efficacy of the drug when comparing the different populations analysed. Serum levels of calcium, iPTH, ferritin, transferrin saturation index and haemoglobin did not change throughout the study. Stool consistency was reduced, and the need for laxatives decreased by 18%. The mean dose of SO increased over time to 1167 ± 381 mg/day. The drug was well tolerated.

CONCLUSION
SO is an effective option for the treatment of hyperphosphataemia in PD patients. Age, basal phosphate levels and time in the technique are factors associated with a greater decrease in serum phosphate levels. Stool consistency became softer (which may improve dialysis efficiency) with less need for laxatives.
MO813: The Validity of Combined Urea and Phosphate Kinetic Modelling in Estimation of Daily Protein and Phosphate Intake in Haemodialysis Patients
Authors: Nagah Mohamed , Elsaid Ghada , Samaan Emad 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The interpretation of patient dietary records, laboratory results in haemodialysis units to manage their phosphate and nutritional status is time and effort consuming and needs strictly compliant patients. This justifies the need of estimates of these parameters with accepted validity and applicability.

METHOD
In 100 haemodialysis patients [50 with residual kidney function (RKF) and 50 anuric patients], Daugirdas [1, 2] supposed urea and phosphate kinetic models’ estimates were extracted and correlated with the actual dietary records, phosphate binder dosage and dialysis prescription parameters. The estimates of interest were, daily ingested phosphorus (DIP), estimated phosphorus removed, intradialytic time averaged phosphate level, normalized protein catabolic ratio (nPCR) and dialysis estimated kt/v.

RESULTS
Modeled DIP is significantly correlated to calculated phosphate intake from average 3-day dietary records in both anuric and RKF patients (r = 0.89 and r = 91, respectively; P &lt; .001). Also, the nPCR is significantly correlated with daily protein intake/kg in both study groups (r = 0.85 in anuric, r = 0.78 in RKF; P &lt; .001). Estimated phosphorus removed is positively correlated to dialysis kt/v in both study groups (r = 0.51 in anuric, r = 0.52 in RKF; P &lt; .001). Patients with RKF had significantly lower pre-dialysis serum phosphate (5.78 ± 1.05 versus 4.39 ± 0.78; P &lt; .001), calcium-based phosphate binders’ dosage (2616.28 ± 390.93 mg/day versus 1937.5 ± 395.29 mg/day; P &lt; .001), estimated phosphate removed in haemodialysis (1271.86 ± 274.5 mg/day versus 1016.82 ± 198.42 mg/day; P &lt; .001) and intradialytic average phosphate levels (4.052 ± 0.87 mg/dL versus 3.26 ± 0.61 mg/dL; P &lt; 0.001) than the anuric group.

CONCLUSION
Modeled DIP and nPCR can be used as estimates for phosphate and protein intake in haemodialysis patients with or without RKF. RKF has a positive impact on the phosphate measures and decreases the need for phosphate binders.
For each patient is shown the mean result after CC treatment and after SO treatment. The red bold line represents mean values. (A) Bone turnover estimated from whole-body 18F-NaF PET/CT as Ki at lumbar vertebrae 1–5 in 20 participants. (B) Bone volume estimated as CT-derived HU at lumbar vertebrae 1–5 in 21 participants. * Significance level &lt; 0.05.
MO814: Sucroferric Oxyhydroxide versus Calcium Carbonate in the Treatment Bone Metabolism in Patients with Ckd3–5 Evaluated by 18F-NA Fluoride PET/CT and Biomarkers: A Randomized Crossover Study
Authors: Vrist Marie , Mai Hindkjær Østergaard Ann , Mose Frank , Lauridsen Thomas G , Theil Jørn , Fynbo Claire , Langdahl Bente L , Nørgaard Bech Jesper 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Non-invasive methods for assessing bone metabolism have been lacking in chronic kidney disease (CKD), and the effects of different treatments on bone metabolism are mostly unknown. However, fluorine-18 labeled sodium fluoride (18F-NaF) PET/CT scanning can assess bone turnover as skeletal plasma clearance of tracer (Ki) and bone volume/tissue volume (BV/TV) in CKD. In a randomized crossover study, we aimed to compare the 8-week treatment effects of a non-calcium-based phosphate binder, sucroferric oxyhydroxide (SO), with 8 weeks of treatment with a calcium-based phosphate binder, calcium carbonate (CC), on bone turnover and BV/TV.

METHOD
Whole body 18F-NaF PET/CT scans were performed at the end of the CC and SO treatment periods in each participant. Ki was determined by the single-point Patlak method with semi-population input functions. A recently established CKD-MDB population residual curve was applied. Estimation of BV/TV was made by CT-derived Hounsfield units (HU) in specified volumes of interest. Paired t-tests were used or non-parametric tests (Wilcoxon signed-ranks test) when data were not normally distributed. Statistical analyses were performed using SPSS 20.

RESULTS
Ki assessed by the 18F-NaF scan was not significantly different at the lumbar spine (CC: 0.030 ± 0.014 mL min–1 mL–1; SO: 0.031 ± 0.014 mL min–1 mL–1; P = .75) or any other site after short-term treatment with SO or CC. However, HU was significantly higher after CC treatment.

CONCLUSION
18F-NaF PET/CT is a practical tool with which to evaluate bone metabolism in CKD. Short-term SO treatment did not affect Ki (turnover) differently than CC treatment, but BV/TV (volume) was significantly lower after SO treatment than after CC treatment.
MO817: New Scenarios in Use of Calcimimetics: Could Etelcalcetide Improve Anaemia?
Authors: Leonardi Giuseppe , Spinelli Alessandra , Covella Patrizia , Montanaro Alessio , De Giorgi Annarita , Schiavone Palmira , Flores Antonio , Balestra Cosima , DI Renzo Brigida , Mariotti Amalia , Figlia Irma , Patella Gemma , Grazia Arcidiacono Maria , Coppolino Giuseppe , Vernaglione Luigi 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Alterations of mineral metabolism in patients with chronic renal failure (MBD-CKD) are frequently found and appear in the earliest stages of the disease. If not accurately diagnosed and treated, they could lead to serious clinical complications. With the same safety and better tolerability compared with cinacalcet, etelcalcetide demonstrated greater efficacy in the control of parathyroid hormone (iPTH) with an improvement in patients' compliance.
Several reports in the literature document the effect of elevated levels of iPTH on anaemia. In vitro experiments showed that elevated concentrations of PTH (comparable to those found in the blood of uraemic patients with secondary hyperparathyroidism) exert a significant inhibition on erythroid progenitors, decreasing the number of erythropoietin receptors on erythroid progenitors and making these cells insensitive to erythropoietin.
High levels of iPTH could have, furthermore, a haemolytic effect on the peripheral RBCs causing disturbed calcium metabolism, increased cytosolic calcium and enhanced osmotic fragility of the cells.
Aim of this study was to verify in a dialysis cohort if etelcalcetide could not only improve iPTH levels but also haemoglobin levels with a reduction in weekly doses of erythropoiesis-stimulating agents (ESA).

METHOD
We analysed data from 130 haemodialysis adult patients over 2 years from three different centres. A total of 24 patients treated with etelcalcetide (Image 1) were enrolled and followed at different time points (1–3–6–12–24 months). Patients were on stable doses of ferric carboxymaltose, active vitamin D analogues, phosphorus binders, supplement of oral calcium and calcium concentration in dialysate (1.25–1.50 mmol/L).

RESULTS
Data analysed after 24 months of treatment with etelcalcetide (Image 2) demonstrated not only a drastic improvement in iPTH values (772.53 ± 452.6 pg/mL versus 308.7 ± 207 pg/mL–60.05%) but also a statistically significant improvement of haemoglobin values ( 10.35 ± 1.45 g/dL versus 11.57 ± 0.97 g/dL; P &lt; .05) in addition to a reduction in the weekly ESAs units required (193.39 ± 148 UI/kg/week versus 142.71 ± 118 UI/kg/week; P &lt; .05). This effect was achieved by maintaining constant ferritin and TSAT levels and without substantial changes in iron carboxymaltose therapy. No side effects were recorded for the entire duration of the treatment.

CONCLUSIONS
Considering the well-known direct and indirect inhibition of parathyroid hormone on erythropoiesis, reduction of iPTH levels achieved with etelcalcetide could improve haemoglobin levels and reduce required weekly ESA units, with obvious clinical and economic advantages. Further studies, on large populations and over longer periods of time, are required.
MO818: PTH Levels and Mortality in Incident Haemodialysis Patients
Authors: Roldão Marisa , Figueiredo Cátia , Escoli Rachele , Sofia Flora , Lopes Karina , Vila Lobos Ana 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Serum intact parathyroid hormone (iPTH) is associated with the prognosis of haemodialysis (HD) patients; however, its optimal range for reducing mortality remains unknown. The aim of this study was to assess the association between different serum iPTH levels and mortality in incident HD patients.

METHOD
We conducted a retrospective single-centre study of incident HD patients between January 2013 and 2020. According to the iPTH level measured at baseline, patients were categorized into four groups: &lt;150 pg/mL, 150–300 pg/mL, 301–600 pg/mL and &gt;600 pg/mL. Clinical, analytical and demographic data were compared among groups. All-cause mortality over a mean follow-up of 3.2 years was assessed using standard survival methods. Statistical analysis was performed using SPSS (Version 23 for Mac OSX).

RESULTS
The mean age of 149 patients was 74.14 ± 14.17 years, 95 (63.8%) were male, 75 (50.3%) were diabetic, 85 (57%) had congestive heart failure (CHF) and 110 (73.9%) had hypertension. A total of 46 patients (30.9%) were treated with vitamin D analogues, 2 (1.3%) with calcimimetics and 25 (16.8%) with oral phosphate binders. A total of 57 (38.3%) patients had iPTH &lt; 150 pg/mL, 44 (29.5%) 150–300 pg/mL, 35 (23.5%) 301–600 pg/mL and 13 (8.7%) &gt; 600 pg/mL. There were no age, gender, comorbidity or HD modality differences among groups. Patients with iPTH &lt; 150 pg/mL had higher c-reactive protein (CRP) (P = .042), higher serum bicarbonate (P = .020), lower albumin (P = .001), lower serum phosphate (P = .009) and lower bone-specific alkaline phosphatase (BAP) (P = .008). During the study follow-up period, 82 patients (55%) died. Multivariate Cox regression showed that patients with iPTH &lt; 150 pg/mL had an increased risk of all-cause mortality when compared with those with iPTH 301–600 pg/mL {HR: 0.59, [95% confidence interval (95% CI) 0.36–0.96]; P = .035} and iPTH &gt; 600 pg/mL [HR: 0.36, 95% CI 0.19–0.70; P = .02] in both unadjusted and adjusted models for age, albumin, diabetes, CHF and hypertension. No significant difference was found between iPTH &lt; 150 pg/mL and iPTH 150–300 pg/mL groups. When the reference was changed to iPTH &gt; 600 pg/mL, patients in this group had a decreased mortality risk when compared with those with iPTH &lt; 150 pg/mL (HR: 2.75, 95% CI 1.43–5.29; P = .02) and iPTH 150–300 pg/mL (HR: 2.23, 95% CI 1.14–4.36; P = .02), but not iPTH 300–600 pg/mL.

CONCLUSION
In our study, the baseline iPTH level was associated with all-cause mortality in incident HD patients. Our results suggest that the optimal serum iPTH level conferring the lowest mortality risk is &gt; 300 pg/mL in this group of patients.
MO821: Quality of Life and Depression in Hemodialysis Patients
Authors: Denden Ghada , Ben Mahmoud Nouha , Letaief Ahmed , Hammouda Mouna , Ben Salah Manel , Ben Salem Meriem , Sabra Aloui , Skhiri Habib 
Published: May 2022

Abstract

BACKGROUND AND AIMS
End-stage renal disease (ESRD) has certainly an impact on patients’ health-related quality of life (HRQoL). Depression is, also, highly prevalent in hemodialysis patients. This study aimed to evaluate HRQoL, the prevalence of depression, its associated factors, and its impact on quality of life in our population.

METHOD
This was a cross-sectional study including 70 hemodialysis patients in Monastir, Tunisia. Depression was evaluated using the Beck Depression Inventory (BDI). Quality of life was assessed with the Short-Form 36. Data were also collected on sociodemographic, laboratory (albumin, parathormone, hemoglobin and phosphorus) and dialysis (dialysis vintage, vascular access and hemodialysis adequacy) characteristics. The analysis was performed with descriptive and analytical statistics.

RESULTS
Among 70 patients, 64.3% were men. The mean age was 49 ± 15.7 years old. High blood pressure, diabetes and dyslipidemia were the most common comorbidities. Low drug adherence was frequent. The global average score according to the SF-36 was 38.2. The QOL was impaired in 64.2% of the cases. We have identified five variables correlated with impaired QOL: lack of autonomy, a dialysis rhythm of 3 times a week, an age &gt;60 years, low social economic level and living in rural areas. Depression was present in 14.2% of the sample. Depressed patients presented poor quality of life, lower serum albumin and higher parathormone levels.

CONCLUSION
Our study highlights the high frequency of QOL impairment in patients on hemodialysis. Actions aimed at changing some factors associated with reduced QOL can promote well-being.
MO828: The Humoral Response of SARS-COV-2 Vaccine in Haemodialysis
Authors: Chalkia Aglaia , Alexakou Zoi , Kourniotis Dimitrios , Mpora Margarita , Aggelis George , Petras Dimitrios 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Although vaccination against COVID-19 infection in dialysis patients is an urgent issue of worldwide concern, literature data regarding the antibody level and their kinetics over time and the efficacy towards complete COVID-19 vaccination and booster dose in these patients is inconclusive.

METHOD
We retrospectively assessed the response to COVID-19 vaccination, after the completion of vaccine series and after a booster dose in haemodialysis (HD) patients. IgG antibodies to the spike protein S1 subunit of SARS-CoV-2 were measured using ELISA at least 15 days after completion of a vaccination series, 1 month and finally 15–30 days after the booster dose.

RESULTS
Among the 28 vaccinated HD patients (mean age = 59.8 years, 100% male) with two doses of mRNA vaccine, a seroconversion was documented in all the patients (100%) with a median antibody titre of 3270.6 U/mL (IQR: 94–40.000). We recorded 9 out of 28 early responders (peak level at 2 weeks) and 19/28 late responders (peak level at 1 month). The early responders were younger (56.25 years versus 61.63; P = 0.07), without cardiovascular history (88% versus 44%; P = 0.042) or diabetes (100% versus 63%; P = 0.042), compared with late responders. On multivariate analysis, combined haemoperfusion and haemodialysis (HR = 0.167, 95% confidence interval: 0.034–0.826; P = 0.028) was an independent prognostic factor for early responders. After 6 months, all the patients received a booster mRNA dose. The patients presented median antibody levels of 33.939 U/mL (IQR: 1112–181.223), much higher titre than the first peak. Finally, four patients, all from the late responders group, presented COVID-19 infection during the vaccination period (two patients in the early period &lt;1 month and two patients in the late period &gt;5 months).

CONCLUSION
HD patients develop a substantial humoral response against SARS-CoV2 and the booster dose much higher response. The early responders presented more rapidly and more efficacious antibody levels, while the combined haemoperfusion and haemodialysis emerged as a positive predictor factor.