bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO885: Anxiety Burden in Haemodialysis and Peritoneal Dialysis Patients
Authors: Trbojevic-Stankovic Jasna , Milošević Saša , Nikic Petar , Andrić Branislav 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The growing number of people undergoing dialysis therapy on a global scale is becoming a universal concern. Their mental health is substantially associated with quality of life and outcomes. The prevalence of anxiety for people on dialysis is not well known, but appears much higher than in the general population. Nevertheless, it remains under-recognised and under-managed. We aimed to assess the prevalence of anxiety in adult patients on chronic haemodialysis (HD) and continuous automated peritoneal dialysis (CAPD).

METHOD
This single-centre cross-sectional study enrolled 123 patients (61 on HD and 62 on CAPD) in stable clinical condition and able to understand and fill-in the self-administered Beck Anxiety Inventory questionnaire (BAI). The patients’ self-rated health was assessed by an EQ Visual Analogue Scale (EQ-VAS). Standard laboratory parameters and Kt/V were measured in all patients. Other relevant demographic and clinical data were obtained from patients’ medical records. The results were analyzed with independent sample T-test and χ2 statistic.

RESULTS
The HD and CAPD groups did not differ significantly with regard to sex (59% versus 48% men; P = 0.237), age (60.83 ± 12.98 versus 60.37 ± 13.10 years; P = 0.845), level of education (44% versus 52% with only primary school; P = 0.593) and dialysis vintage (35.14 ± 26.77 versus 30.31 ± 26.11 months; P = 0.312). The average BAI was 19.40 ± 15.64 in HD and 11.52 ± 9.69 in CAPD patients (P &lt; 0.01). Among HD patients 17% had mild (BAI = 8–15) and 53% severe (BAI &gt;15) anxiety, while among CAPD patients 37% had mild and 26% severe anxiety (P = 0.013). No statistically significant difference was noted within the HD and CAPD groups related to the presence of anxiety and sex, age, level of education, dialysis vintage, dialysis adequacy and laboratory measurements. HD patients with BAI ≥ 8 had significantly lower EQ-VAS than those with BAI &lt; 8 (48.89 ± 21.98 versus 66.92 ± 26.70; P = 0.032). However, no such observation was obtained in the CAPD group.

CONCLUSION
Anxiety is a common symptom among patients undergoing dialysis. In HD patients, it appears to be related to an overall worse health status. Early detection and treatment of anxiety may have a positive impact on patient outcomes. Thus, the high prevalence of anxiety in the current study supports the need to adopt effective strategies to adopt and improve screening strategies.
MO890: Modifiable and Non-Modifiable Factors Associated With Increased COVID-19 Related Mortality Among Dialysis Patients
Authors: Carioni Paola , Kooman Jeroen , Stuard Stefano , Kotanko Peter , Usvyat Len A , Kovarova Vratislava , Arkossy Otto , Bellocchio Francesco , Tupputi Antonio , Winter Anke , Zhang Yan , Zhang Hanjie , Larkin John , Neri Luca 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Patients with end-stage kidney disease (ESKD) face higher risk for severe outcomes from COVID-19 infection. Moreover, it is not well known to which extent potentially modifiable risk factors contribute to mortality risk. In this study, we investigated the incidence and risk factors for 30-day case-fatality of COVID-19 in haemodialysis patients treated in the European Fresenius Medical Care (FMC) Nephrocare network.

METHOD
In this historical cohort study, we included unvaccinated adult dialysis patients with a first documented SARS-CoV-2 infection between 1 February 2020 and 31 March 2021 (study period) registered in the European Clinical Database (EuCliD®). The first SARS-CoV-2 suspicion date for all documented infections was considered the index date for the analysis. Patients were followed for up to 30 days. Follow-up time was defined from the index date until the date of death, end of follow-up period or lost to follow-up, whichever occurred first. We ascertained patients’ characteristics in the 6-month period prior to index date. We used logistic regression and XGBoost to assess risk factors for 30-day mortality.

RESULTS
We included 9211 patients meeting the inclusion criteria for the study (Table 1). Age was 65.4 ± 13.7 years, dialysis vintage was 4.2 ± 3.7 years. In the follow up period, 1912 patients died within 30 days (20.8%, 95% confidence interval: 19.9%–21.6%). Correlates of COVID-19 related mortality are summarized in Table 2. Several potentially modifiable factors were associated with increased risk of death: patients on HD compared with online haemodiafiltration had shorter survival after presentation with COVID-19 as well as those who did not achieve the therapeutic targets for serum albumin, erythropoietin resistance index, protein catabolic rate, haemodynamic status, C-reactive protein, single-pool Kt/V, hydration status and serum sodium in the months before infection. The discrimination accuracy of prediction models developed with XGBoost was similar to that observed for main-effect logistic regression (AUC 0.69 and 0.71, respectively) suggesting that no major cross-interaction and non-linear effect could improve prediction accuracy.

CONCLUSION
We observed high 30-day COVID-19 related mortality among unvaccinated dialysis patients. Older patients, men and those with greater comorbidities had higher risk of death after COVID-19 infection. Derangement in potentially modifiable factors in the 6 months prior to COVID-19 infection was independently associated with increased mortality. Whether achievement of clinical therapeutic targets is associated with improved survival after COVID-19 infection is a matter of further research.
MO897: Diabetic Retinopathy and Risk of Macrovascular Complications in Patients Undergoing Hemodialysis: A National Population-Based Cohort Study
Authors: Lin Ting-Yun , Hung Szu-Chun 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The association of diabetic retinopathy (DR) with macrovascular complications in patients with end-stage kidney disease undergoing hemodialysis is unclear.

METHOD
We conducted a nationwide cohort study of 44 514 incident hemodialysis patients who were enrolled in Taiwan's national health insurance research database between 1 January 2010 and 31 December 2014 and had follow-up data until 31 December 2015. Patients with and without DR were matched by propensity score in a 1:1 ratio. The primary outcomes were acute coronary syndrome (ACS), acute ischemic stroke and hospitalizations for peripheral artery disease (PAD).

RESULTS
Of the 27 286 patients with type 2 diabetes, 10 537 (38.1%) had DR at baseline. We matched 9164 patients without DR (mean age, 63.7 years; 44.0% women) by propensity score to 9164 patients with DR (mean age, 63.5 years; 43.8% women). Over a median follow-up of 2.8 years, 2781 patients (15.2%) experienced ACS. Stroke occurred in 1613 patients (8.8%), and 1938 patients (10.6%) were hospitalized for PAD. In a multivariable Cox model accounting for the competing risk of death, the presence of DR was associated with an increased risk of stroke {subdistribution hazard ratio (sHR) 1.30 [95% confidence interval (95% CI) 1.17–1.44]; P &lt; 0.0001} and PAD (sHR 1.17, 95% CI 1.08–1.29; P = 0.0006) but not ACS (sHR 0.99, 95% CI 0.91–1.07; P = 0.9168). The observations were consistent across patient subgroups.

CONCLUSION
Our findings support early identification and close monitoring and management of hemodialysis patients with DR to prevent the development of stroke and PAD.
MO898: Comparison of Quality of Life and Bio-Psychosocial Burden in Family Caregivers Between Dialysis Patients and Kidney Transplant Recipients
Authors: Vovlianou Stavroula , Koutlas Vasileios , Papoulidou Fani , Tatsis Vasileios , Milionis Haralampos , Skapinakis Petros , Ntounousi Evangelia 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Chronic kidney disease (CKD) is considered as a high-stress disease for patients, because of severe morbidity, chronicity and its life-long treatment often requiring dedicated family care. Caregivers’ burden is considered a multidimensional bio-psychosocial reaction of great importance both for caregivers’ and CKD patients’ Quality of Life (QoL). Kidney transplantation (KT) has been shown to improve patient's QoL, however the effect of KT on family's burden in comparison with dialysis has not been sufficiently studied. Aim of this cross-sectional, multicentre, observational study was to estimate and compare the QoL and burden between family caregivers of dialysis patients versus KT recipients (KTRs).

METHOD
We included 138 caregivers of dialysis patients and 33 of KTRs. We assessed caregivers’ QoL with SF-36 questionnaire and bio-psychosocial burden with Zarit Burden Interview scale (ZBI).

RESULTS
Mean age of caregivers did not differ between the two groups (56y dialysis versus 58y KTRs). The majority of KTRs (57.6%) and dialysis patients’ caregivers (68.1%) were women of whom 73% and 52% were spouses, respectively. Educational level and financial status did not differ between the two groups of caregivers. The results of the SF-36 and ZBI are comparatively presented in the Table 1.
Dialysis patients’ caregivers had worse QoL compared with KTRs caregivers. There was a statistically significant difference in general health, bodily pain and social functioning role among KTRs versus dialysis caregivers. Dialysis caregivers showed a significantly higher burden in 3 sub-dimensions of ZBI (personal strain, role strain, relational deprivation) compared with KTRs caregivers. Moreover, the burden of KTRs caregivers found to be inverse correlated with educational level (P = 0.01), while in dialysis caregivers, older age, female gender and low income were directly associated with burden (P &lt; 0.001, P = 0.019 and P = 0.005, respectively).

CONCLUSION
The caregivers of dialysis patients showed worse QoL and significantly higher burden compared with KTRs caregivers. Further studies of larger size will probably shed light to the potential benefits of ΚΤ in patients’ caregivers and families. Currently, implementation of programs for psychological support in high burdened caregivers of kidney disease patients’ could be of help.
MO913: Exploring Factors Influencing Intradialytic Hypotension Using Deep Learning
Authors: Kawasaki Michihiro , Suzuki Satoshi 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Intradialytic hypotension (IDH) is an independent risk factor affecting the life prognosis in patients undergoing haemodialysis. Various studies using statistical methods have been conducted to identify the factors that cause IDH, but the factors and the interactions among the factors have not yet been clearly elucidated. In this study, we used a neural network model (deep learning) using factors that can be measured in real time as input parameters to identify factors strongly influencing the risk of IDH, with the ultimate goal of predicting IHD using only factors that can be measured in real time.

METHOD
A total of 25 parameters obtained during dialysis treatment in 208 patients were selected as the input parameters for deep learning; the 25 parameters included 18 items selected from the patient background and vital data (including the dialysis time, treatment mode, systolic blood pressure, diastolic blood pressure and mean blood pressure), and seven items calculated from the above data (including the difference between the actual and planned dialysis times and the difference in body weight before and after dialysis). As the evaluation indices, we used F-measure, which is calculated from precision and recall, and attention weight, which indicates the % influence of an input parameter on deep learning. We compared the F-measure and attention.

RESULTS
In the learning using all the input parameters, the correct response rate was 69.6%, the recall rate was 64.2%, the fit rate was 41.7% and the F-measure was 41.7%. The highest value of attention weight among the input parameters was 21.1% for the occurrence of IDH in the most recent treatment. Even in the pattern in which the highest F-measure was found, the attention weight of the occurrence of IDH in the most recent treatment was 21.9%. In all patterns, the top three attention-weighted items were the occurrence of IDH in the most recent treatment, the systolic blood pressure and the body weight before dialysis. The items with high values of the F-measure and high attention weight were considered essential factors for the prediction model.

CONCLUSION
By using deep learning to compare the accuracy of prediction of various input patterns, the occurrence of IDH in the most recent treatment, systolic blood pressure and body weight before dialysis were identified as the factors most strongly influencing the risk of IDH.
MO925: Psychological Wellbeing in Haemodialysis Patients: Comparing Perspectives From Patients, Caregivers and Healthcare Professionals––The Goodrenal Project
Authors: Mesa-Gresa Patricia , Elena Marin Alexandra , Avesani Carla , Clyne Naomi , Garcia-Testal Alicia , Kouidi Evangelia , Van Craenenbroeck Amaryllis , Antonio Lozano-Quilis José , Lindholm Bengt , Yang Kevin , Kougioumtzidou Ourania , Garcia-Maset Rafael , Moscoso Paula , Moura Reboredo Maycon , Lauer Andreas , Segura Eva 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The start of dialysis therapy can contribute to the development of depression, stress and anxiety, which, in turn, has an impact on the patient´s quality of life, the disease process and the associated social and health care costs. This underlines the importance of studies that analyse the psychological profiles of patients on maintenance dialysis to establish relationships between risk factors, prevention steps and intervention strategies aimed at improving their quality of life. Therefore, we explored the perceptions regarding the patient's psychological wellbeing, seen from three different perspectives: patients’ own, their caregivers’ and that of their healthcare professionals (HCPs).

METHOD
This study is part of the GoodRENAL Project, which is funded by the European Community Erasmus + and involves four countries: Belgium, Greece, Spain and Sweden. Exploratory questionnaires regarding patients’ psychological wellbeing were developed by the team, and responses were obtained from three groups of stakeholders: 38 patients, who were randomly allocated to this study from the first dialysis shift of the week (mean age 58 ± 0.51 years; 50% women); 34 caregivers (mean age 54 ± 13 years; 80% women); and 39 healthcare professionals (HCPs mean age 42 ± 10 years; 79% women).
The exploratory questionnaires comprised different parts, exploring the psychological state of patients through closed questions, open questions and questions about barriers, needs and facilitators regarding psychological wellbeing. The patients’ and caregivers’ questionnaires had 10 items scored from 1 (‘never’) to 5 (‘almost all the time’). The HCPs questionnaire included 10 items rated as 1 (‘totally disagree’) to 5 (‘totally agree’).

RESULTS
To analyse the descriptive data, the response frequency was grouped into items based on the level of agreement or the frequency of the occurrence (almost all the time and all the time). The table below shows answers received from patients, caregivers and HCPs.

CONCLUSION
Patients consistently reported a much more positive subjective perception of their psychological state, compared with that assumed by HCPs, while the perceived perception of patients’ states reported by their caregivers was in general closer to that reported by the patients. The extent by which patients’ positive responses are related to adaptations such as social desirability, distorted subjective perception, minimization or normalization of symptomatology should be explored in further studies.
MO929: Oxidative Stress in Hemodialysis Patients
Authors: Chiodan Milena , Bob Flaviu , Sircuta Alexandru , Maralescu Felix-Mihai , Petrica Ligia , Schiller Adalbert , Schiller Oana-Marina 
Published: May 2022

Abstract

BACKGROUND AND AIMS
It is known that chronic kidney disease (CKD) is associated with complications such as anaemia, mineral bone disorders (CKD-MBD) or diselectrolytemia.Therefore, the diet of renal patients is restricted in different nutrients such as potassium or phosphorus, a fact that could potentially increase oxidative stress [1]. We investigated the relationship between an oxidative damage marker (malondialdehyde-MDA) on the one hand, and plasma antioxidant status (glutathione peroxidase-GPx) activity on the other hand with the nutritional status and with complications associated with CKD (anaemia, CKD-MBD).

METHOD
We conducted a single-centre cross-sectional study that included 58 CKD G5D patients (mean age of 60.39 ± 11.73 years; 33 males, 25 females; mean haemodialysis vintage of 6.43 ± 4.89 years). All patients have been assessed regarding dialysis status (medical history). We performed analysis before the dialysis session using standard methods blood biochemistry, complete blood count and using spectrophotometry (HPLC)-malondialdehyde and glutathione peroxidase.

RESULTS
The studied patients’ mean malondialdehyde was 1.41 ± 0.42 mcmol/L, while mean glutathione peroxidase was 58.65 ± 12.15 U/g Hg. The oxidative stress markers did not show any statistically significant correlation with age, gender, dialysis vintage or with predialysis urea and bicarbonate. Patients with a BMI &gt; 30 kg/sqm (21 versus 37 patients) showed a significantly higher level of MDA 1.57 ± 0.51 mcmol/L versus 1.31 ± 0.33 mcmol/L, P = 0.02. We have also found a negative statistically significant correlation between MDA level and serum K (r = –0.29, P = 0.02) and serum phosphorus (r = –0.29, P = 0.03). Patients with predialysis K of higher then 5.5 mEq/L had a statistically significant lower MDA (1.29 ± 0.4 mcmol/L versus 1.54 ± 0.4 mcmol/L, P = 0.025) and a non-significant higher GPx (59.0 ± 12.58 U/g Hg versus 58.2 ± 11.87 U/g Hg, P = 0.8). We found a negative statistically significant correlation of the MDA level with haemoglobin (r = –0.39, P = 0.002) and with haematocrit (r = –0.35, P = 0.006). No statistically significant correlation of the plasma antioxidant GPx with the studied parameters of anaemia and CKD-MBD has been found.

CONCLUSION
In our study, we found that increased oxidative stress (expressed through the malondialdehyde level) is associated with obesity and more severe anaemia. The indirect relationship found with serum K and phosphorus could indicate the risk of oxidative stress, and therefore it could be useful to take into account the dietary antioxidants when recommending low potassium and low phosphorus diet.
MO934: Correlation Between Sarcopenia and Oral Health in Patients on Chronic Haemodialysis
Authors: Kovačević Petra , Altabas Karmela , Klarić Iva , Altabas Velimir , Kovačević Karla 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Patients on haemodialysis have signs of chronic systemic inflammation and a higher incidence of sarcopenia. Poor oral health can also trigger systemic inflammation and thus affect sarcopenia. The aim of the study was to examine oral health and the presence of sarcopenia in patients on chronic haemodialysis and to determine whether there is a correlation between them.

METHOD
This study included 100 patients on chronic haemodialysis at the Clinical University Hospital `Sestre Milosrdnice’ in Zagreb, who underwent oral status, routine laboratory measurements, bioimpedance analysis of body composition and measurement of hand grip strength.

RESULTS
Of the total number of participants (N = 100), 28.0% had sarcopenia. The majority of participants were male (61.0%). Poor oral hygiene was recorded in as many as 39.0% of participants, while 46.0% had their last visit to the dentist several years ago. It is interesting to note that 64.3% of patients with confirmed sarcopenia were last examined by a dentist several years ago, while in those without sarcopenia the proportion was 38.9%. The median total number of erupted teeth in all patients was 12.0 (7.0–23.0). A positive correlation of the total number of erupted teeth and erupted premolars with sarcopenia was confirmed.
CRP was significantly elevated in patients with sarcopenia (P = 0.035), in contrast to those without sarcopenia (3.45 versus 2.70). A total of 51% of patients had increased calculus formation, 49% had oral candidiasis and 38% periodontitis, with as many as 24% of petechiae on the mucosa and 22% of dental caries. A total of 8% of patients had an ammonia breath and 4% had a metallic taste in their mouth. Of all the examined signs and symptoms of oral health, significant differences were observed only in the incidence of dental caries, which was significantly more common in the group that did not have sarcopenia (P = 0.031). However, it should be noted that in patients with sarcopenia, total edentulousness was present in 17.9% as opposed to 9.7% in patients who did not have sarcopenia, i.e. 12% of the total number of participants had total edentulousness. Moreover, in 21% of patients with sarcopenia, a complete denture was present in combination with a partial denture, while that was the case in only 9.7% of patients without sarcopenia.

CONCLUSION
This study confirmed poorer oral health in haemodialysis patients who had sarcopenia. Therefore, intervention studies are needed to improve oral health of patients on HD, which could possibly influence the incidence and severity of sarcopenia.
MO936: Oral Nutritional Supplementation Support in HAEmodialysis Patients: Impact on Nutritional Rehabilitation
Authors: Sá Martins Vitor , Adragao Teresa , Pinto Iola , Aguiar Leila , Dias Catarina , Figueiredo Rita , Lourenço Pedro , Pascoal Tania , Pereira Juliana , Pinheiro Tatiana , Ramião Inês , Velez Brígida , Luisa Papoila Ana , Borges Nuno , Calhau Conceição , Garrido Jesus , Macário Fernando 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Nutritional status management and rehabilitation are significant concern treating maintenance haemodialysis (HD) patients. Oral nutritional supplements are essential to complement insufficient dietary intake, namely of energy and protein, and to rehabilitate a patient's nutritional status. Therefore, the objective of this preliminary study was to assess the impact of oral nutritional supplementation (ONS) prescription patterns on patients’ nutritional status.

METHOD
We did a cross-sectional analysis of HD patients’ first oral nutritional supplementation with commercial formulas between October 2018 and March 2020 in 25 outpatient HD clinics. The registered nutritionist dietitian decided to initiate, choosing the type of supplement and dose as part of a routine protocol of a comprehensive nutritional intervention and assessment. We assessed albumin, normalized protein catabolic rate, potassium and phosphate at the beginning (t = 0) and end (t = 1) of the supplementation period to understand the nutritional impact. We also estimated the daily proportion of energy, and protein contribution of each oral nutritional supplementation implemented, categorizing in cut-offs of 100 kcal and 5 g of protein.

RESULTS
We analyzed 398 patients, 217 (54.5%) males, 165 (41.5%) diabetic, with a median age of 79 years. Concerning feeding support status, 24.6% were autonomous, 54.8% had family care and 20.6% were institutionalized.
Globally, the ONS impact was significant in the increment of albumin (P &lt; 0.001) and nPCR (P = 0.002), although nPCR was not significant in the categorized group providing &lt;5 g of protein/day (Table 2). The increment of K was also significant (P &lt; 0.001) but not clinically relevant in increasing the risk of hyperkalaemia. There was no significant difference in P (P = 0.086).

CONCLUSION
ONS significantly impacted nutritional rehabilitation, with an albumin and nPCR increase (except for the categorized group of &lt; 5 g protein/day). Although the increment of potassium was statistically significant, it was not clinically relevant in increasing the risk of hyperkalaemia. Further analyses are needed to understand the best targets for the energy and protein contribution of ONS.