bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO672: Covid-19 in Patients on Peritoneal Dialysis: A Case-Series
Authors: Alfano Gaetano , Fontana Francesco , Morisi Niccolò , Cappelli Gianni , Magistroni Riccardo , Donati Gabriele 
Published: May 2022

Abstract

BACKGROUND AND AIMS
A great amount of information has been divulged on the epidemiology and outcome of coronavirus disease 2019 (COVID-19) in patients with ESRD. The majority of the studies have been conducted in patients on maintenance hemodialysis (HD) and kidney transplant recipients. Unfortunately, few studies focused on the outcome of peritoneal dialysis (PD) patients. Information regarding this subset of the population has been extrapolated from aggregated data including a higher percentage of HD patients. As a result, the impact of COVID-19 is indefinite in patients receiving PD. We conducted a study to better understand how patients on PD have been affected by COVID-19.

METHOD
We conducted a single-center retrospective analysis of 141 PD patients followed at the University Hospital of Modena, Italy from 1 March 2020 to 31 December 2021. The diagnosis of COVID-19 was performed through nasopharyngeal swab RT–PCR testing. Duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shedding measured the time elapsed from diagnosis of COVID-19 to one or two (if available) negative nasopharyngeal PCR tests. Median and interquartile range or mean and standard deviation were used for continuous variables and percentage for categorical variables. A P-value &lt;0.05 was considered statistically significant.

RESULTS
During the pandemic, 18 out of 141 (12.7%) patients receiving PD dialysis contracted COVID-19. Median age was 60 (50.2–66.5) years with a predominance of males (72.2%)
The percentage of patients on APD accounted for 33.3%.
The infection was symptomatic in out of 18 (94.4%) patients. Fever (94.4%) and cough (55.6%) were the most common symptoms. Viral shedding, traced with nasopharyngeal swabs lasted 26 (14.5–3.5) days. Two patients were inactive on the waiting list for kidney transplantation for a mean of 43 ± 1.4 days.
COVID-19 caused hospital admission of seven (38.9%) patients. During hospitalization two (11.1%) patients switched from PD to HD for ultrafiltration failure and inadequate solute clearance and two (11.1%) died for septic shock with multiorgan failure. In our cohort of patients, excess death due to COVID-19 was 22.2%.
Half of the patients contracted the infection before the availability of SARS-CoV-2 vaccine. There were no statistically significant differences between vaccinated and unvaccinated patients in terms of symptoms, viral shedding and hospital admission or (Table 1). We underline that COVID-19 was fatal only in two unvaccinated patients.

CONCLUSION
This study reports the monocentric experience of a large PD center during the COVID-19 pandemic. COVID-19 was symptomatic in the majority of patients and led to hospitalization of about 40% of the patients. The rate of symptoms, viral shedding and hospital admission was similar between vaccinated and unvaccinated patients. Two unvaccinated patients died for the severe consequence of COVID-19.
MO678: Telemonitoring in Peritoneal Dialysis. Benefits in Clinical Events and Quality of Life. A Retrospective Multicenter Study
Authors: Javier Centellas Pérez Francisco , Devesa Such Ramon , García Isabel , Vera Manel , Flores Carmen , Muñoz de Bustillo Eduardo , Manzano Diana , Alonso Valente Rafael , Prats Mercedes , Pedro Morais Jose , Díez Ojea Beatriz , Luis Quirós Ganga Pedro , Ortega Cerrato Agustin , Pérez Martínez Juan 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Telemonitoring (RM), applied in automated peritoneal dialysis (APD), has shown both clinical and quality of life (QoL) benefits, although current evidence is limited.
The aim of this study is to analyse the number of significant interventions in a 3-month period (unscheduled consultations and teleconsultations, ) as well as clinical consequences (hospitalizations) and QoL, measured by the EuroQol-5D questionnaire in cohort of RMAPD patients.

METHOD
Retrospective multicenter exploratory cohort study analysed three cohorts of patients in RMAPD: incident (3 months in technique) versus prevalent with 6 months to 1 year in technique versus prevalent with more than 1 year in technique.
Both the baseline characteristics of the patients and the number of significant interventions in a 3-month period were analysed: (unscheduled consultations and teleconsultations,) as well as clinical consequences (hospitalizations) and QoL, measured by the EuroQol-5D questionnaire. The variables have been expressed as mean and standard deviation, as well as an ANOVA test to make comparisons between variables, as well as non-parametric for non-normal variables.

RESULTS
Analysis of 100 patients in RMAPD from 10 different Spanish centers, classified as: incident (group 0), prevalent 6 months to 1 year (group 1), prevalent &gt;1 year (group 2), the variables analysed are presented in the form of table (Fig. 1):
From the results analysed, no significant differences were found between the variables analysed, except in the number of unscheduled teleconsultations, significantly higher in group 0 compared to group 2 (P &lt; 0.05).
Interestingly, the patients manifested a good perceived QoL in all groups (M: 0.88, EUROQol-5D).

CONCLUSION
Despite the limitations of this study, the results allow us to consider telemonitoring as a useful technique in patients in APD since:
MO706: The Peritoneal Equilibration Test at the Start of Peritoneal Dialysis and Patient Outcome. Analysis in the Presence of Competing Events
Authors: Calatayud Emma , Beltrán Sandra , Vizcaíno Belén , Molina Pablo , González Moya Mercedes , Asuncion Sancho Calabuig Maria , Valero Alejandro , Montesa Marín María , Gonzalez-Rico Miguel 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The success of peritoneal dialysis (PD) depends on the integrity of the peritoneal membrane. The most common peritoneal functional alteration is an impaired ultrafiltration caused by fast peritoneal solute transfer rate. This situation can be present at start of PD and compromise the durability of the membrane through the stay on PD. If the patient leaves PD for another reason, as in the case of a kidney transplant, it affects the probability of a membrane dysfunction appearance. It is known as a competitive event. The aim of this study was to determine whether baseline peritoneal transport status was a risk factor of mortality and technique failure in a cohort of Spanish PD patients using a statistical competing risk model.

METHOD
The multicenter retrospective cohort study included adult patients of the Levante Registry PD Work Group in Spain who started PD between February 1993 and June 2020. All patients needed to have a peritoneal equilibration test (PET) performed within the first 6 months after PD start. Patients were followed until technique failure, transplantation, renal function recovery, death, or until September 2020. Peritoneal transport status was considered both as a continuous (D/PCr4h) and as a categorical variable, according to the four groupings of D/PCr values defined by Twardoski. We analysed the effect of peritoneal transport over mortality, peritonitis and technique failure by a competing risk model. Kidney transplantation and renal function recovery were considered competing events.

RESULTS
A total of 4848 patients were enrolled. Baseline PET measurements were available in 2.307 (47.6%). The median follow-up time was 22.2 months (IQR 11.5–40.5). The main characteristics according to the peritoneal transport status are summarized in Table 1. When peritoneal membrane transport was analysed as a continuous variable, D/PCr was an independent risk factor of technique failure. The hazard ratio subdistribution for technique failure was 1.08 [(1.01; 1.16), P-value = 0.018] for every 0.1 increase in D/P Cr ratio. This effect disappeared when the use of icodextrin was included in the model. Baseline peritoneal transport was not associated with a higher mortality or peritonitis risk.

CONCLUSION
Basal peritoneal transport rate is an independent risk factor for death-censored technique failure in the Levante DP incident population. The use of icodextrin in these patients seems to mitigate this negative effect and may improve the outcomes in PD in patients with initial fast transport. Conventional methods for survival analysis ignoring the competing events may be inappropriate this cohort of patients.
MO708: Association of Atherogenic Index of Plasma (AIP) with Mortality in Chinese and Swedish End-Stage Kidney Disease Patients: Results from Two Cohorts
Authors: Ryu Kakei , Chen Zhimin , Rashid Tony Qureshi Abdul , Suliman Mohamed , Peter Barany Franz , Heimbürger Olof , Chen Jianghua , Stenvinkel Peter , Lindholm Bengt 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Atherogenic index of plasma (AIP), a logarithmically transformed ratio of triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C), is a biomarker of dyslipidemia and cardiovascular disease (CVD) risk. However, its applicability in end-stage kidney disease (ESKD) is not clear. We examined the association of AIP with all-cause and CVD mortality in two cohorts of ESKD patients, one from China and one from Sweden.

METHOD
In 1276 Chinese incident peritoneal dialysis (PD) patients (median age 50 years, 56% males) and 559 Swedish ESKD patients starting on dialysis (n = 392) or undergoing hemodialysis (n = 109) or PD 58 (median age 58 years, 62% males), baseline AIP and other 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 were analysed with competing-risk regression models with transplantation as competing risk adjusting for age, sex, smoking, diabetes, serum albumin, hemoglobulin and calendar year.

RESULTS
Chinese patients [median (IQR) BMI 21 (19–23) kg/m2 TG 1.4 (1.0–1.8) and HDL-C 1.0 (0.9–1.3) mmol/L] compared with Swedish patients [median (IQR) BMI 24 (22–28)] kg/m2 TG 1.6 (1.2–2.2) and HDL-C 1.2 (1.0–1.6) mmol/L] were significantly younger (P &lt; 0.01) and had lower BMI (P &lt; 0.01), TG (P &lt; 0.001), HDL-C (P &lt; 0.001), and Framingham risk score (P &lt; 0.01) while sex distribution was similar. ‘Chinese patients’: After median 3.6 years of follow-up, all-cause mortality rate was 16%, and 91 (46%) of the 199 deaths were caused by CVD. The highest tertile of AIP was associated with higher all-cause [sub-hazard ratio sHR (95% CI) 1.52 (1.05); Fig. 1A] and CVD mortality [sHR 1.82 (1.02–3.27); Fig. 1B] risk, after adjusting for confounders. ‘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. The highest tertile of AIP was associated with lower all-cause [sHR 0.66 (0.47–0.94); Fig. 2A] and CVD mortality [sHR 0.59 (0.35–0.97); Fig. 2B] risk after adjusting for confounders.

CONCLUSION
The highest tertile of AIP was independently associated with higher mortality risk in Chinese ESKD patients while it was associated with lower mortality risk in Swedish ESKD patients suggesting that AIP is context dependent, which limits is usefulness as a risk-assessment tool for predicting clinical outcomes in ESKD patients.
MO717: Prevalence and Management of Non-Valvular Atrial Fibrillation in Peritoneal Dialysis. Results of a Multicentric Survey
Authors: Perez-Bernat Elisa , Cases Aleix , Gonzalez-Rico Miguel , Montomoli Marco , Moncho Francesc , Fernanda Alvarado Maria , Solano Rivera Camila , Emilio Sanchez-Alvarez J. , Ortega Cerrato Agustin , Luis Gorriz Teruel Jose 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Among patients with chronic kidney disease, the incidence and prevalence of nonvalvular atrial fibrillation (NVAF) increases as renal function decreases, detecting a prevalence of up to 27% in hemodialysis patients. However, its prevalence among patients on peritoneal dialysis (PD) has been less studied.
The aim of the study is to analyse the prevalence of NVAF and characteristics related to its management in PD patients older than 18 years.

METHOD
An observational, cross-sectional, multicenter and retrospective study was carried out through a survey and request for variables sent through a Google questionnaire to PD units in our country. A total of 1403 patients from 30 PD units were included.

RESULTS
The mean prevalence of NVAF in the study was 13.2%, median 11.7% (interquartile range: 6.1–19.4). A total of 60% of the centers had a prevalence &gt;10%.
A total of 57.6% (n = 17) used the CHADS2 or CHAS2-VASC score to calculate the risk of stroke/thromboembolism in their patients with NVAF. A total of 43.3% (n = 13) do not use it. In these cases, 15.3% (n = 2) do not calculate it because they treat all patients with NVAF and the remaining 84.6% (n = 11) do not use it because the cardiologist uses it and delegates it to them.
Regarding the decision to start anticoagulant treatment in NVAF: in 60% of the centers (n = 18) the cardiologist indicates anticoagulation, in 36.7% (n = 11) the indication is made jointly (cardiologist and nephrologist) and only in 3.3% (n = 1) the indication is made by the nephrologist.
A total of 72.5% of the patients with NVAF (135/186) received anticoagulant treatment. Of these, 28 (20.7%) received direct-acting anticoagulants and 107 (79.3%) received acenocoumarol. Among direct-acting anticoagulants, the most frequent regimens were: apixaban 2.5 mg/12 h (86%), and edoxaban 30 mg/24 h (7%). A total of 5.9% (11/186) of patients with NVAF did not receive anticoagulant or antiplatelet treatment.
A total of 90% of the centers (n = 27) are familiar with the technique of percutaneous appendage closure for the treatment of NVAF, but it is not available in five of them. This technique has been performed in 17 of the patients with NVAF.

CONCLUSION
The prevalence of NVAF in PD patients is high. The management of these patients is carried out mainly by cardiologists with little participation of nephrologists. Most patients receive anticoagulant treatment with coumarin drugs. The data from this analysis, as well as the limited data from the literature, indicate that an adequate format, a consensus document, as well as more data from observational studies (and especially from randomized controlled trials) are needed to adequately address this common complication in patients with DP.
MO725: The Risk of Hypertension and Atrial Fibrillation in Hemodialysis Patients
Authors: Al-Sayyari Abdulla 
Published: May 2022

Abstract

BACKGROUND AND AIMS
This study aims to evaluate the prevalence of and the association between hypertension (HTN) in and AF in hemodialysis patients.

METHOD
All patients receiving hemodialysis for at least 6 months were included in the study. Demographic, hemodynamic and laboratory data were retrieved from the BestCare system, and the main outcomes were the pre/post-dialysis blood pressure measurements and the presence of AF. The data were analyzed using the SPSS program. For determination of independent effect of laboratory variables, multiple logistic regression was used to evaluate the independent effect of the laboratory.

RESULTS
Our sample consisted of 304 HD patients; 162 (53%) were male and the mean age was 63 ± 18 years. One-fifth, 68 (20%) had AF of whom, 44 (64.7%) were male with mean age of 73 ± 12 years.
The mean age in the AF group was significantly higher in males 73(12) versus 61 (18) years (p = 0.001) The risk of AF increased by 0.4 [odd ratio 1.04, 95% confidence interval (95% CI) 1.02–1.06; P &lt; 0.001] for every year of age and there were more males than fem ales (64.7% versus 35.3%; P = 0.032).
Almost two-thirds the entire sample (66.45%, n = 202) were hypertensive, with mean age of 64 ± 17 years and almost a third had a BMI in the obese category (28.7%, n = 58).
Male patients were 33% less likely to develop hypertension (odd ratio 0.77, 95% CI 0.47–1.24; P = 0.289).
Based on logistic regression analysis, the patients who had both HTN and diabetes were more likely to develop AF (odd ratio 7.12, 95% CI 0.91–55.1; P = 0.060), compared with patients who did not.
According to the logistic regression analysis, male patients were 33% less likely to develop hypertension (odd ratio 0.77, 95% CI 0.47–1.24; P = 0.289), and age had no effect OR = 1. In addition, with every increase of the Carlson comorbidity index score by two points, there was a 40% increased risk of developing HTN (odd ratio 2.47, 95% CI 1.17–5.18; P = 0.017).
According to the univariate analysis, having HTN before dialysis increased the risk of continuing anti-hypertensive therapy by 23% (odd ratio 1.37, 95% CI 0.81–2.36; P = 0.756). However, after adjusting the analysis for other cofactors, the odd ratio became less significant, suggesting that the risk increased only by 0.9% (odd ratio 1.09, 95% CI 0.60–1.99; P = 0.756).
Being a male was associated with a 54% (odd ratio 0.54, 95% CI 0.31–0.95; P = 0.019) decrease in the risk of developing HTN on hemodialysis.
Almost two-thirds (66.1%, n = 197) were hospitalized during the previous 12 months, the majority were due to dialysis-related infections. The mortality rate was 5.9% (Table 1).

CONCLUSION
The risk factors for the development of HTN and AF in HD patients were found to be increasing age for AF and female gender for hypertension. The presence of HT and DM increases the risk of developing AF 7-fold after hemodialysis.
MO735: Increased Serum Adipocyte Fatty Acid Binding Protein Level Associated with Endothelial Dysfunction in Patients Undergoing Hemodialysis
Authors: Tang Chi-Chong , Wang Chih-Hsien , Hsu Bang-Gee 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Adipocyte fatty acid binding protein (A-FABP) is independently associated with atherosclerosis. Endothelial dysfunction is one of the causes of cardiovascular morbidity and mortality in patients with hemodialysis (HD). This study evaluated the correlation between serum A-FABP level and endothelial function measured by vascular reactivity index (VRI) in patients with HD.

METHOD
Fasting blood samples were obtained from 90 HD patients. A commercial enzyme immunoassay kit was used to measure A-FABP levels. The endothelial function and VRI were measured using a digital thermal monitoring (DTM) test (VENDYS). In this study, VRI &lt; 1.0 was used as the poor vascular reactivity, 1.0 ≤ VRI &lt; 2.0 was used as the intermediate vascular reactivity, and VRI ≥ 2.0 was used as the good vascular reactivity.

RESULTS
A total of 14 HD patients (15.6%) were categorized as poor vascular reactivity (VRI &lt; 1.0), 38 HD patients (42.2%) were categorized as intermediate vascular reactivity (1.0 ≤ VRI &lt; 2.0) and 38 HD patients had good vascular reactivity. Decreased pre-HD body weight (P = 0.016), post-HD body weight (P = 0.013), body mass index (P = 0.034), serum creatinine level (P = 0.010) and higher serum A-FABP level (P = 0.001) were associated with poor vascular reactivity. After multivariable forward stepwise linear regression analysis noted that serum creatinine level (β = 0.234, adjusted R2 change = 0.043; P = 0.019) was positively associated with, and serum A-FABP level (β = −0.347, adjusted R2 change = 0.152; P = 0.001) was negatively associated with VRI values in patients undergoing HD.

CONCLUSION
After adjusting for significant confounders, the serum A-FABP level was negatively correlated, and the serum creatinine level was positively correlated with VRI values in patients undergoing HD.
MO741: Poor Agreement between Physical Examination and Bioimpedance Spectroscopy in the Detection of Hypervolemia in Haemodialysis Patients
Authors: Tsikliras Nikolaos , Georgianos Panagiotis , Vaios Vasilios , Minasidis Elias , Karpetas Antonios , Chatzidimitriou Christos , Mavromatidis Konstantinos , Liakopoulos Vassilios , Zebekakis Pantelis , Balaskas Elias 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Assessment of dry-weight among patients on haemodialysis is challenging in the absence of reliable markers to define overhydration (OH) [1, 2]. This study aimed to explore the value of two simple clinical signs, the presence of pedal oedema and crackles at pulmonary auscultation, in diagnosing hypervolemia, using the bioimpendence spectroscopy as a more objective method.

METHOD
In a cohort of 107 asymptomatic dialysis patients, the volume status was assessed with physical examination and bioimpedance spectroscopy shortly before the mid-week dialysis session [3]. Patients were also asked to perform home blood pressure (BP) monitoring with a validated, automatic device (HEM-705, Omron, Healthcare) [4] for 1 week in order to determine their BP control status.

RESULTS
Patients within the high tertile of pre-dialysis OH had longer dialysis vintage, lower serum albumin and higher home systolic BP, despite the more aggressive treatment with a higher average number of antihypertensives daily. In receiver-operating-characteristic (ROC) curve analysis, pedal oedema [area under curve (AUC): 0.534, 95% confidence interval (95% CI) 0.416–0.651] and pulmonary crackles (AUC: 0.551; 95% CI 0.432–0.671) had limited accuracy in the diagnosis of pre-dialysis OH &gt; 2.2 L. The agreement of pedal oedema (Cohen's k-coefficient: 0.065) and pulmonary crackles (Cohen's k-coefficient: 0.122) with bioimpedance spectroscopy in the detection of hypervolemia was poor. In multivariate linear regression analysis, longer dialysis vintage (β: 0.306; P&lt;0.001) and higher home systolic BP (β: 0.287; P&lt;0.01) were the two factors that were independently associated with pre-dialysis OH.

CONCLUSION
This diagnostic-test study showed that among asymptomatic hemodialysis patients, pedal oedema and pulmonary crackles in physical examination had limited discriminatory power in the detection of hypevolemia, as assessed more objectively with the method of bioimpedance spectroscopy.