bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO657: Low Incidence of Intradialytic Hypotension During Online Post-Dilution High-Volume Haemodiafiltration: A Randomized Cross-Over Trial between Four Intermittent Dialysis Modalities
Authors: Rootjes Paul A , Charaa Sabrine , de Roij van Zuijdewijn Camiel , Nubé Menso J , Wijngaarden Gertrude , Grooteman Muriel 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Compared with standard haemodialysis (S-HD), online post-dilution haemodiafiltration (HDF) is associated with improved survival, especially when high convection volumes [high-volume (HV)-HDF] are achieved [1]. A superior intradialytic haemodynamic stability may play an important role in this respect. Therefore, we assessed whether the intradialytic haemodynamic profile differs between four dialysis modalities, including S-HD and HV-HDF.

METHOD
In the current randomized cross-over trial (NCT03249532, ClinicalTrials.gov), 40 prevalent dialysis patients were subjected to S-HD [dialysate temperature (Td) 36.5°C], HD with cool dialysate (C-HD; Td 35.5°C), low-volume (LV)-HDF [convection volume (CV) 15 L/1.73 m2/session) and HV-HDF (CV ≥23 L/1.73 m2/session) (both Td 36.5°C). Blood pressure (BP) was measured 4x/hour. The primary endpoint was the total number of intradialytic hypotensive (IDH) episodes. IDH was defined as a nadir in systolic BP (SBP) &lt;90 mmHg for a pre-dialysis SBP &lt;160 mmHg and &lt;100 mmHg for a pre-dialysis SBP ≥160 mmHg, independent of symptoms and interventions. In addition, an explorative analysis was performed on the incidence of early-onset IDH, which has recently been related to mortality [2]. Secondary endpoints included the intradialytic courses of SBP, diastolic BP (DBP) and mean arterial pressure (MAP).

RESULTS
IDH occurred significantly less frequent during C-HD (0.21 episodes/session) and HV-HDF (0.27/session) compared with S-HD (0.68/session, both P &lt; .0005) (Figure 1). Furthermore, early-onset of IDH was also observed more frequently during S-HD (0.32/session) than during C-HD (0.07/session, P&lt;.0005) or HV-HDF (0.10/session, P = .001) (Figure 1). After correction for multiple testing, the intradialytic courses of SBP, DBP and MAP declined only significantly during S-HD (−6.8, −5.2, −5.2 mmHg/session; P = .004, &lt;.0005, .002 resp.) whereas these remained stable in the other modalities (Table 1).

CONCLUSION
In conclusion, during both C-HD and HV-HDF, IDH occurred least frequent and the intradialytic haemodynamic stability was best preserved. In contrast, intradialytic haemodynamic stability is most dysregulated during S-HD. Therefore, it is conceivable that the survival benefit of HV-HDF over S-HD is (at least partly) due to a more stable intradialytic haemodynamic profile and consequently less repetitive tissue injury.
MO681: Association of Framingham Risk Score with Mortality in Kidney Failure Patients from China and Sweden
Authors: LI Xiejia , Chen Zhimin , Rashid Tony Qureshi Abdul , Mukai Hideyuki , Suliman Mohamed , Heimbürger Olof , Peter Barany Franz , Chen Jianghua , Stenvinkel Peter , Lindholm Bengt 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The Framingham risk score (FRS) was developed to estimate an individual`s risk of coronary heart disease over the next 10 years in the general population by using traditional cardiovascular disease (CVD) risk factors age, sex, systolic blood pressure, treatment of hypertension, total cholesterol, high-density lipoprotein cholesterol and smoking status. However, the utility of FRS in predicting CVD mortality in kidney failure patients is not clear. We examined the association between FRS and all-cause and CVD mortality in two cohorts of kidney failure patients from China and Sweden, respectively.

METHOD
In 1276 Chinese incident peritoneal dialysis [median age 50 years, 56% males, BMI 21 (19–23); incident peritoneal dialysis] and 559 Swedish incident or prevalent dialysis patients [median age 58 years, 62% males, BMI 24 (22–28)], FRS and baseline biochemical and metabolic biomarkers were analysed in relation to mortality during follow-up period of up to 5 years. All-cause and CVD mortality risk of were analysed with competing-risk regression models with transplantation as competing risk adjusting for BMI, serum albumin, hemoglobulin and calendar year.

RESULTS
Chinese patients were significantly younger (P &lt; 0.01) and had lower BMI (P &lt; 0.01) and FRS (P &lt; 0.01) than Swedish patients but their sex distribution was similar. ‘In the Chinese patients,’ during median 3.6 years of follow-up, all-cause mortality rate was 16%, and 91 (46%) of the 199 deaths were caused by CVD. Both middle and high tertiles of FRS were associated with higher all-cause (Fig. 1A) and CVD mortality (Fig 1B) risk after adjusting for confounders. ‘In the Swedish patients,’ after median 2.1 years of follow-up, all-cause mortality rate was 36%, and 89 (44%) of the 204 deaths were caused by CVD. Both middle and high tertiles were associated with higher all-cause (Fig. 2A) and CVD mortality (Fig. 2B) risk after adjusting for confounders.

CONCLUSION
Higher FRS (both middle and high tertiles of FRS) was independently associated with significantly higher all-cause and CVD mortality risk in Chinese as well as in Swedish patients with kidney failure. These results underline the importance of traditional CVD risk factors in kidney failure patients and suggest that FRS may be a useful risk-assessment tool for predicting clinical outcomes in these patients.
MO682: Serum Total Indoxyl Sulfate is Associated with Intraperitoneal Inflammation and High Peritonitis Episodes in Peritoneal Dialysis Patients
Authors: Stepanova Natalia , Korol Lesya , Driianska Victoria , Snisar Lyudmyla , Lebid Larysa , Kompaniets Olga 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The accumulating evidence presented thus far supports the idea that indoxyl sulfate (IS) is a trigger of chronic inflammation in end-stage kidney disease patients. However, although serum IS is one of the most extensively studied uremic toxins, no single study exists which has investigated the association between serum IS and intraperitoneal inflammation in peritoneal dialysis (PD) patients.
The present study was undertaken to evaluate the association between serum total IS (tIS) concentration and the pro-inflammatory markers in peritoneal dialysis effluent (PDE) and peritonitis episodes in PD patients.

METHOD
In this observational cross-sectional study, we analysed serum tIS concentration and 24-h PDE levels of interleukin 6 (IL-6), tumor necrosis factor-α (TNF-α) and monocyte chemoattractant protein -1 (MCP-1) in 74 PD patients with an average age of 55 (38–64) years and dialysis vintage of 36 (30–58) months. All patients had been undergoing continuous ambulatory PD and had no PD-associated infectious complications for more than 3 months.
Serum concentrations of tIS were determined using the spectrophotometry method. The concentrations of IL-6, TNF-α and MCP-1 in PDE were analysed using ELISA.
For the statistical analysis, we stratified this PD patient cohort into two groups depending on experienced peritonitis: the peritonitis group (n = 48) and the peritonitis-free group (n = 26). The data were presented as the median and the interquartile ranges [Me (Q25–Q75)] and compared using the Kruskal–Wallis test. The Spearmen correlation test was performed to assess the association between IS and the pro-inflammatory markers.

RESULTS
Significant differences were found in serum concentrations of tIS and PDE levels of IL-6 between the peritonitis and the peritonitis-free PD patients (Table 1).
In addition, serum tIS was significantly associated with number of experienced peritonitis episodes (r = 0.26, P = 0.022).
Although PDE levels of TNF-a and MCP-1 did not differ between the peritonitis and the peritonitis-free groups in our cohort, they had a direct association with serum tIS similar to those of IL-6 (Fig. 1, 2).
Moreover, serum tIS was statistically higher in the anuric PD patients compared with the non-anuric patients [33.6 (13.9–74) versus 20.2 (9.3–46) μg/mL, P = 0.043], had a negative association with residual renal function (r = −0.39, P = 0.0017) and, accordingly, total weekly Kt/V (r = −0.27, P = 0.026).

CONCLUSION
Serum tIS concentration has a significant direct association with PDE levels of the pro-inflammatory markers, high peritonitis episodes and their outcomes in PD patients. Further well-designed studies are required to establish the effect of serum tIS concentration on intraperitoneal inflammation and clinical outcomes in PD patients.
MO683: Peritoneal Transport Characteristics, Sodium Sieving and Dialysate Electrolyte Clearance in Peritoneal Dialysis Patients: 4.25% Peritoneal Equilibration Test Analysis
Authors: Liao Ruoxi , MA Dengyan , Zhou Xueli , Zhong Hui 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Peritoneal dialysis (PD) is a well-established renal replacement therapy for patients with end-stage renal disease. The peritoneal equilibration test (PET) is widely used for assessing peritoneal solute transport. Recently, the International Society for PD committee recommended performing PET with 4.25% dextrose solution instead of traditional 2.5% dextrose solution to provide better information on ultrafiltration capacity. This study aims to explore the peritoneal transport characteristics, sodium sieving and electrolyte clearance with PET-4.25%.

METHOD
We conducted a cross-sectional study in PD patients treated in West China Hospital between June 2021 and December 2021. All patients underwent PET-4.25%. Peritoneal transport characteristics, sodium sieving and dialysate electrolyte clearance were analysed.

RESULTS
A total of 108 patients (61 males, 56%; mean age 48 ± 4 years old, median PD duration 17 months) were included. Dialysate to plasma (D/P) creatinine values at 4 h were distributed similarly in PET-2.5% and PET-4.25% (Fig. 1). The dialysate sodium decreased at the beginning of PET-4.25% and gradually increased, while other dialysate electrolyte levels continued to increase or decrease during the 4 h (Fig. 2). Most patients had their maximal sodium dip at 2 h (N = 80, 74%). The mean sodium dip at 1 h was 7.28 ± 2.93 mmol/L (sodium sieving ratio 0.057 ± 0.023), and the mean maximal sodium dip was 8.81 ± 4.18 mmol/L. In both univariate and multivariate analyses, sodium sieving was negatively correlated with 4-h D/P creatinine and glomerular filtration rate (GFR) and positively correlated with PET-4.25% ultrafiltration volume (Fig. 3). The total clearances of sodium, potassium, chloride, calcium, magnesium and phosphate with 2 L of 4.25% dextrose were 66.9 ± 22.4 mmol, 6.64 ± 1.25 mmol, 62.7 ± 27.7 mmol, 0.07 ± 0.27 mmol, 0.63 ± 0.19 mmol and 1.98 ± 0.63 mmol, respectively. The amount of electrolyte clearance was not related to peritoneal transport characteristics. Nine patients were diagnosed with ultrafiltration failure (UFF). Patients with UFF had significantly lower sodium and chloride clearance than non-UFF patients.

CONCLUSION
PET-4.25% could assess peritoneal transport characteristics with similar results to PET-2.5%, while it could provide more information on ultrafiltration capacity. Four-hour D/P creatinine, GFR and ultrafiltration volume are independent predictors for sodium sieving. Dialysate electrolyte clearance is not related to peritoneal transport characteristics, while sodium clearance is decreased in UFF patients.
MO687: Positive Association of Serum Galectin-3 Level with the Peripheral Arterial Disease in Patients with Peritoneal Dialysis
Authors: Mitra Sari Santi , Teng Yi-Yen , Wang Chih-Hsien , Kuo Ch , Hsu Bang-Gee 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Galectin-3 expressed by epithelial cells, endothelial cells and macrophages, with multiple biological abilities, including cell proliferation, differentiation, growth and inflammation; it also participates in cardiovascular development. Peritoneal dialysis (PD) was an independent predictor for further mortality in uremic patients with subclinical peripheral arterial disease (PAD). The aim of this study was to evaluate the relationship between serum values of galectin-3 levels and ankle–brachial index (ABI) values in PD patients.

METHOD
Fasting blood samples were obtained from 92 PD patients. ABI values were measured using an ABI-form device. Serum galectin-3 concentrations were determined by commercially available enzyme-linked immunosorbent assays. Left or right ABI values &lt;0.9 were included in the low ABI group.

RESULTS
A total of 19 PD patients (20.7%) were in the low ABI group. Compared with patients in the control group, patients in the low ABI group had higher prevalence of diabetes (P = 0.010), older age (P = 0.009), higher serum fasting glucose (P = 0.001), triglyceride (P = 0.021), C-reactive protein (P &lt; 0.001), galectin-3 level (P &lt; 0.001), while lower total clearance of creatinine (P = 0.028). Multivariable logistic regression analysis of the factors significantly associated with PAD revealed that serum galectin-3 level [odds ratio: 1.148, 95% confidence interval (CI): 1.032–1.227, P = 0.011] and C-reactive protein level (increase 0.1 mg/dL, odds ratio: 1.324, 95% CI: 1.101–1.592, P = 0.003) were the independent predictor of PAD in PD patients. The area under the curve plotted to estimate the optimal level of galectin-3 predicting PAD in PD patients by the receiver-operating characteristic curve analysis was 0.844 (95% CI: 0.753–0.911, P &lt; 0.001).

CONCLUSION
High serum level of C-reactive protein and galectin-3 were found to be independent risk factors for predicting PAD in PD patients.
MO750: Dialysate Magnesium Impact on Progression of Coronary Artery Calcification
Authors: Kusic Milicevic Jovana , Vidakovic Radosav , Andjelkovic Apostolovic Marija , Apostolovic Branislav , Ostojic Ana , Markovic Rodoljub , Djurkovic Veselinka , Trbojevic Stankovic Jasna , Jemcov Tamara , Dragovic Gordana 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The development of vascular calcifications is accelerated in dialysis patients and is associated with an increased risk of cardiovascular morbidity and mortality. Studies have shown that magnesium (Mg) reduces mineral deposit formation, thus potentially abating the process of vascular calcification. Therefore, the use of higher dialysate-Mg might present a promising tool to reduce vascular calcification. Many in vitro studies have investigated effects of Mg on vascular calcification, but prospective clinical trials are lacking. This study evaluated the difference in coronary artery calcification progression over 12 months based on different concentrations of routinely used dialysate-Mg.

METHOD
This prospective randomized, multicentre study included 60 angina-free chronic haemodialysis (HD) patients distributed into two equal groups based on dialysate-Mg level (0.5 versus 1.0 mmol/L) used routinely before and throughout the study period. Laboratory measurements, including total serum Mg level and coronary artery calcium score (CACS) determined by cardiac computed tomography, were performed in all patients at baseline and after 12 months of follow-up.

RESULTS
Total serum Mg was significantly higher in patients on higher dialysate-Mg, both at baseline and after 12 months of follow-up (P &lt; 0.001). Nevertheless, in both study groups, total serum Mg decreased after 12 months of follow-up; from 1.13 ± 0.15 mmol/L to 0.99 ± 0.14 mmol/L (P &lt; 0.001) in the lower dialysate-Mg group and from 1.39 ± 0.22 mmol/L to 1.29 ± 0.21 mmol/L (P &lt; 0.001) in the higher dialysate-Mg group. CACS increased significantly in both study groups after 12 months: from 361.90 ± 725.67 to 480.00 ± 783.53 (P &lt;0.001) in the lower dialysate-Mg group and from 437.71 ± 573.77 to 589.07 ± 682.82 (P &lt; 0.001) in the higher dialysate-Mg. Still, the mean change in CACS (ΔCACS) did not differ significantly between the study groups (109.29 ± 181.99 versus 151.86 ± 211.22; P = 0.321). In patients with CACS = 0 at the beginning of the study (4 in the lower and 5 in the higher dialysate-Mg group), the mean ΔCACS was 21.25 ± 3.96 and 0 (P = 0.180), respectively.

CONCLUSION
Routine use of higher dialysate-Mg (1.0 mmol/L) increases total serum Mg level compared with standard dialysate-Mg solutions (0.5 mmol/L). However, this was not associated with lower CACS progression over 12 months of follow-up. Further research is needed to assess if patients with CACS = 0 may benefit from higher dialysate-Mg in terms of reduced calcification progression compared with standard dialysate-Mg solutions.
MO751: Calciphylaxis is Characterized by Pyrophosphate Deficiency in Dialysis Patients: A Pilot Study
Authors: Nigwekar Sagar , St Hillien Shelsea , Seethapathy Rituvanthikaa , Krinsky Scott , Torcatti Jeanfranco , Howe Jennifer , Kalim Sahir , Portales-Castillo Ignacio , Mengesha Beza , Wen Wen , Cizman Borut , Sabbagh Yves 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Calciphylaxis is a rare but devastating disorder predominantly affecting patients with end-stage kidney disease [1]. Patients with calciphylaxis present with painful ischemic skin lesions caused by microvascular occlusion secondary to calcification, intimal hyperplasia, and thrombosis. In experimental models and in genetic disorders of mineralization, deficiency of pyrophosphate (PPi) results in vascular calcification and neointimal formation [2–4]. We investigated the role of PPi deficiency in the development of calciphylaxis and explored whether PPi levels predict outcomes among patients with calciphylaxis.

METHOD
As part of the ongoing national-level calciphylaxis registry work (ClinicalTrials.gov Identifier: NCT03032835) [5], we prospectively enrolled 14 dialysis-dependent patients with calciphylaxis (cases) and 7 dialysis-dependent patients without calciphylaxis (controls) matched for age, sex and race. Clinical data and blood samples were collected at enrolment. PPi levels were measured using an ATP Sulfurylase/Luminescence-Based Method for the quantification of inorganic PPi in human plasma and were compared between cases and controls using the Kruskal–Wallis test. Associations between PPi levels and clinical outcomes (ulcer formation, number of skin lesions and 1-year mortality) were explored.

RESULTS
The average age of calciphylaxis cases and controls was 62 and 61 years, respectively; 53% were women and 53% were Caucasian. The prevalence of diabetes mellitus, obesity, coronary artery disease and peripheral arterial disease were 71%, 23%, 29% and 53%, respectively and comparable between cases and controls. Warfarin exposure was present in 19% of cases. Most patients with calciphylaxis had ulcerated skin lesions involving abdominal wall and/or thighs. Median number of calciphylaxis skin lesions was 2 [interquartile range (IQR) 1–4]. Serum levels of calcium, phosphate, intact parathyroid hormone, 25-OH vitamin D and alkaline phosphatase were similar between cases and controls. Compared with controls, however, patients with calciphylaxis had lower plasma PPi levels [0.32 μM (IQR 0.19–0.70) versus 0.64 μM (IQR 0.46–1.08); P = 0.03]. Plasma PPi levels demonstrated a modest correlation with skin lesion count (r = –0.35) but were similar between patients with and without ulcer formation. Lower plasma PPi levels predicted 1-year mortality (Fig. 1).

CONCLUSION
In this pilot study, dialysis-dependent patients with calciphylaxis had lower levels of plasma PPi compared with controls. Plasma PPi levels predicted 1-year mortality among patients with calciphylaxis. Additional data from a larger study and longitudinal assessments of PPi levels are needed to support future clinical intervention trials targeting the PPi pathway in calciphylaxis.
MO757: Prevention of Vascular Calcification by the Endogenous Chromogranin a-Derived Mediator that Inhibits Osteogenic Transdifferentiation
Authors: Jankowski Joachim , Orth-Alampour Setareh , Jankowski Vera , Argiles Ciscart Angel , Gayrard Nathalie 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The adrenal glands participate in cardiovascular (CV) physiology and the pathophysiology of CV diseases through their effects on sodium and water metabolism, vascular tone and cardiac function.

METHOD
In this study, we identified a new adrenal compound controlling mesenchymal cell differentiation that regulates osteoblastic differentiation in the context of vascular calcification.

RESULTS
This peptide was named the ‘calcification blocking factor’ (CBF) due to its protective effect against vascular calcification and is released from chromogranin A via enzymatic cleavage by calpain 1 and kallikrein. CBF reduced the calcium content of cells and thoracic aortic rings under calcifying culture conditions, as well as in aortas from animals treated with vitamin D and nicotine (VDN animals). Furthermore, CBF prevented vascular smooth muscle cell (VSMC) transdifferentiation into osteoblast-like cells within the vascular wall via the sodium-dependent phosphate transporter PIT-1 and by inhibition of NF-κB activation and the subsequent BMP2/p-SMAD pathway. Pulse pressure, a marker of arterial stiffness, was significantly decreased in VDN animals treated with CBF. In line with our preclinical data, CBF concentration is significantly reduced in diseases characterized by increased calcification, as shown in patients with chronic kidney disease. In preparation for clinical translation, the active site of the native 19-AS long native CBF was identified as EGQEEEED.

CONCLUSION
In conclusion, we have identified the new peptide CBF, which is secreted from the adrenal glands and might prevent vascular calcification by inhibition of osteogenic transdifferentiation. The anti-calcific effects of CBF and short-active sites may therefore promote the development of new tools for the prevention and/or treatment of vascular calcification.