bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO764: Type of Vascular Access in Incident Hemodialysis Patients in Morocco: Predialysis Nephrology Care Should be Improved
Authors: Naouaoui Salma , Chettati Mariam , Fadili Wafaa , Laouad Inass 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Current guidelines recommend early placement of an autogenous arteriovenous fistula (AVF) before initiation of chronic hemodialysis therapy. Also, several studies showed that optimal pre-dialysis care is crucial to prepare a functioning permanent dialysis access. However, despite these recommendations, incident patients in Morocco usually initiate dialysis therapy using temporary catheters. Therefore, the purpose of our study was to identify the types of vascular access used by incident hemodialysis patients in Morocco and to determine the effect of pre-dialysis renal care on native AVF utilization.

METHOD
We conducted a cross-sectional study at the nephrology department of Mohammed VI university hospital from January 2019 to January 2021 among adult incident hemodialysis patients. Clinical and demographic characteristics, as well as data on vascular access type and nephrology care prior to dialysis initiation, were recorded.

RESULTS
A total of 210 patients were enrolled in our study. The mean age of the participants was 51.6 ± 12.3 years (19–78) with a male predominance (71.4%). The leading cause of the end-stage renal disease (ESRD) was diabetic nephropathy in 41.4% of the patients. At hemodialysis therapy initiation, 173 patients (82.4%) were dialyzed using a temporary central venous catheter (CVC), 20 (9.5%) with a tunneled hemodialysis catheter (TDC) and 17 (8.1%) with an AVF. Out of all participants, only 81 (38.5%) received prior nephrology care. Patients who reported being seen by a nephrologist at least 1 month before starting hemodialysis therapy (75%) were more likely than those referred later to use an AV access at initiation (22.2% versus 1.5%; P &lt; 0.001). This association remained significant after adjustment for age, sex, geographical origin, education, insurance coverage, comorbidity status and underlying renal diagnosis.

CONCLUSION
Our findings showed a high incidence of CVC use among incident hemodialysis patients which is contrary to all recommendations. Also, we found that patients who received pre-dialysis nephrology care were significantly more likely to start their HD through AVF. Therefore, further efforts to improve both referral patterns and preparation for dialysis after referral are needed.
MO768: The Association among Carotid IMT, Pulse Wave Velocity and Vascular Access Failure in Haemodialysis Patients
Authors: Yoon Jong-Woo , Kim Hyunsuk , Kim Seokhyung , Choi Gwangho , Lee Younh-Ki 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD) have an increased risk of cardiovascular mortality and morbidity. We aimed to compare the value of IMT with tests such as coronary CT and pulse wave velocity (PWV) as predictors of cardiovascular risk in ESRD patients undergoing maintenance dialysis and examine their association with cardiovascular disease.

METHOD
We reviewed the participants’ medical records, including height, body weight, smoking status, alcohol intake, medication history, aetiology of ESRD, HD vintage and blood pressure which were measured during haemodialysis. Carotid doppler was performed by a skilled sonographer who was unaware of the aims of the study and blinded to the laboratory findings. For PWV measurement, patients lie down, rest for at least 5 minutes and stop smoking and coffee for 3 h before the measurement. BaPWV is measured by recording pulse waves of both arms and ankles from the pressure signal obtained by measuring 4-extremity blood pressure.

RESULTS
A total of 100 patients were included, of whom 51 (50.5%) were men. The median age was 66 years (interquartile range 58–76 years). The median vintage of haemodialysis was 47.5 months (range 31.3–89.1 months). There were no significant differences between the high IMT group and the low IMT group in sex, haemodialysis vintage, ESRD aetiology and type of vascular access. However, age was significantly older in the high IMT group. IMT was significantly associated with PWV [hazard ratio (HR) 2.109; 95% confidence interval (95% CI) 1.037–4.291, P = 0.039). After adjusting for age, sex and presence of diabetes, IMT was independently associated with PWV (HR 2.110, 95% CI 1.036–4.298, P = 0.040). The risk of recurrent vascular access failure was higher in the high IMT group (HR 1.615, 95% CI 1.460–5.669, P = 0.034).

CONCLUSION
IMT was associated with PWV and recurrent access failure. Thus, IMT may be suggested as a potential predictor of vascular access failure.
MO774: Clean Buttonhole Puncture Prevents Infection
Authors: Shibata Kazuhiko , Shinzato Takahiro , Nakai Shigeru , Toma Shigeki , Kobayashi Yusuke , Hashimoto Tatsuo 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The buttonhole (BH) puncture has been criticized for the problem of infection. We considered that at least one of the causes for the higher infection rate in the BH technique might be insufficient removal of scabs. The scab pushed into the BH by a dull needle provides optimal temperature, moisture and nutrition for the germs, and protects them from immune system attack. We considered that the infection would be established if enough bacteria were inside when the scab was dissolved. Usually, scabs covering the BH entry site are removed with needles or forceps, and this procedure tends to injure the entry site so that scabs stick more firmly to the site after that. We reported the effect of the moist wound healing procedure on the BH entry site to solve this problem from the 49th ERA-EDTA congress. Since that time, we have continued this method to the BH entry site in Yokohama Minami Clinic. After transferring to the Toshin Clinic in 2019, we faced the problem of difficulty in performing the BH method because nurses were not familiar with removing the scab. For this reason, we had to ask patients who wanted the BH procedure to soak the scabs in the bathtub and wash it with a nylon towel until the scab was gone.

METHOD
This study was conducted at Toshin Clinic from April 2021 to November 2021. In most patients, fistula vessels were punctured by either the BH or the rope-ladder method. But, in some patients, however, fistula vessels were punctured by both methods. For the BH method, supercath clump cath P painless needles were used. After hemostasis was achieved, we put a small amount of white petroleum jelly. We instructed patients to wash the puncture site at home, especially when they took a bath, using a nylon towel until the blistered scabs were gone. Patients were also instructed to apply the white petrolatum on the site after washing the site. Thanks to this method, in many patients, scabs could be wiped off easily.

RESULTS
At the end of November 2021 119 patients were punctured by the rope ladder method (79 males/40 females, 70.2 years old, 107 months on dialysis) and 35 patients by the BH method (29/6, 68.9 years old, 93.3 months). We have punctured 66 925 times by the rope-ladder method and 8011 by the BH method. One local infection requiring hospitalization debridement occurred in the rope-ladder group and one local infection occurred in the BH group. There was no significant difference between the two groups (P = 1.0, Pearson's chi-squared test).

CONCLUSION
Infection can be prevented by continued moist treatment of the BH and vigorous self-cleaning. I would like to call this method the "clean buttonhole method" because it keeps the BH clean in appearance, unlike the conventional dirty BH method where the scabs are dried and have to be plucked off.
MO780: Effect of Acupressure Applied to Li4 Point on Fistula Needle Pain Intensity in Haemodialysis Patients
Authors: Turgay Gülay , Çevik Banu , İnanoğlu Işılay , Kaya Semiha , Burak Sayın Cihat 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Arteriovenous fistula (AVF) is the most reliable method for vascular access, which is vital for haemodialysis patients. To perform haemodialysis therapy, AVF cannulation is by puncture with thick needles three to four times a week. Patients usually feel pain while a needle is inserted into the fistula [1]. This acute pain can be relieved by acupressure, which is a non-pharmacological application method. It is stated in the literature that acupressure is especially effective in acute pain management. This study was designed to evaluate the effect of acupressure application to the LI4 point on the severity of acute pain caused by fistula needle insertion in patients with antecubital arteriovenous fistula [2–3].

METHOD
This study was conducted as a randomized controlled experimental study in a total of 64 patients who received haemodialysis treatment between 15 November 2021 and 5 January 2022 in the Dialysis Centre of a foundation university in Turkey. Inclusion criteria for the study; have an antecubital fistula; ≥18 years; can speak Turkish, not using analgesics in the last 6 h; no extremity pain; no bleeding or coagulation problems and volunteering to participate in the study. In the study, data were collected using the patient identification form and the Visual Analogue Scale (VAS) for measuring the pain intensity of the individual. In the experimental group, in the first dialysis session of the week, a needle was inserted into the patient's arteriovenous fistula by the nurse, and the pain intensity was measured with VAS. In the second and third sessions of the same week, finger acupressure was applied for 3 min before the fistula needle insertion and the patient's pain intensity was evaluated with VAS after needle insertion. Fistula needle insertion was performed by the same nurse in all patients. Descriptive statistics, including mean, standard deviation, frequency distribution; Wilcoxon, Mann–Whitney U and Friedman test were used. P &lt; 0.05 was considered as significant level.

RESULTS
In this study, data were found to be similar in terms of age, gender, education level, duration of dialysis treatment and VAS mean score. While there was no decrease in the severity of acute pain during fistula needle insertion of the patients in the control group, there was a significant decrease in the mean acute pain severity scores experienced by the patients in the experimental group, whose LI4 point acupressure was applied during fistula needle insertion (P &lt; 0.05) (Table).

CONCLUSION
The results of this study support the effectiveness of LI 4 acupressure point can be conducted as an effective and low-cost way to reduce the acute pain of needle insertion in fistulas in dialysis patients. In addition, the results provide a practical reference to acute pain management for dialysis nurses.
MO794: Central Venous Catheter-Related Complications in Older Haemodialysis Patients: A Multicentre Observational Cohort Study
Authors: Van Oevelen Mathijs , Heggen Boudewijn , Abrahams Alferso C , Rotmans Joris , Snoeijs Maarten , Vernooij Robin , van Buren Marjolijn , Meijvis Sabine 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Central venous catheters (CVC) remain a commonly used vascular access option in haemodialysis, despite guidelines advising to preferably use arteriovenous fistulae. Compared to younger patients, the risk-benefit ratio of CVC in older patients might be more beneficial, but previous studies mainly focussed on catheter-related bacteraemia and/or assessed tunnelled CVC (TCVC) only. This study's aim was to compare all catheter-related infections and malfunctions in older patients with younger patients using all CVC subtypes.

METHOD
We used data from DUCATHO, a multicentre observational cohort study in the Netherlands. All adult patients in whom a CVC was placed for haemodialysis between 2012–2016 were included. The primary endpoint was the occurrence of catheter-related infections, comparing patients aged ≥ 70 years with patients aged &lt;70 years (reference). As secondary endpoints, catheter malfunctions and catheter removal due to either infection or malfunction were assessed. Using Cox proportional hazards and recurrent events modelling, hazard ratios (HR) with 95% confidence intervals (CI) were calculated with adjustment of prespecified confounders. Additionally, endpoints were assessed for non-tunnelled CVC (NTCVC) and TCVC separately.

RESULTS
A total of 1595 patients with 2731 CVC (66.5% NTCVC, 33.1% TCVC) were included. Of these patients, 1001 (62.8%) were aged &lt;70 years and 594 (37.2%) ≥70 years. No statistically significant difference was found for the occurrence of catheter-related infections (adjusted HR 0.80, 95% CI 0.62–1.02), catheter malfunction (adjusted HR 0.94, 95% CI 0.75–1.17) and catheter removal due to infection or malfunction (adjusted HR 0.94, 95% CI 0.80–1.11). Results were comparable when assessing NTCVC and TCVC separately.

CONCLUSION
Patients aged ≥ 70 years and &lt;70 years have a comparable risk for the occurrence of catheter-related infections and catheter malfunction. These findings may help when discussing treatment options with older patients starting haemodialysis and may inform the current debate on the best vascular access for these patients.
MO805: Combination of Conventional Haemodialysis with Haemoperfusion: Does it Provide any Benefits to Haemodialysis Patients?
Authors: Sonikian Makrouhi , Velentza Aikaterinh , Chiras Theodoros , Skarakis Jacob , Biblaki Dimitra , Dagkounaki Paraskevi , Karakou Eugenia , Trakas Nikolaos , Barbatsi Aggeliki , Martsoukou Maria 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Conventional haemodialysis (HD) with low-flux membranes does not provide adequate middle molecular weight (MMW) clearance of uremic toxins [1]. The potential for better removal of parathyroid hormone (PTH) and β2-microglobulin (β2M) was investigated using a combination of low-flux HD and haemoperfusion (HP) (HD + HP).

METHOD
A total of 16 stable HD male patients, free of infections, malignancies or haematological disorders, under usual medications for anaemia and hyperparathyroidism, treated with low-flux polysulfone membranes, were randomized into two groups: group A (GA) included eight patients under HD + HP and group B (GΒ) included eight patients under HD only. In GA patients, a type HA130 HP cartridge was connected in parallel to the dialyzer, once a week for the first month, once every 2 weeks for the second month and once a month for the next 4 months. A third group C (GC) was also studied, consisting of eight males undergoing online haemodiafiltration (OL-HDF). In all three groups, serum β2M and iPTH levels were determined at months 0 and 6, before (preD) and after (postD) the mid-week session.

RESULTS
Serum preD-β2M levels were similar in groups A and B at month 0 (44.1 ± 8.6 versus 34.6 ± 16.2 mg/L; P = NS) and at month 6 (46.1 ± 7.6 versus 41.1 ± 18.9 mg/L; P = NS). In GC, preD–β2M values were lower compared with GA at month 0 (31.1 ± 4.2 mg/L; P = .008) and at month 6 (33.8 ± 6.82 mg/L; P = .02), and postD–β2M values decreased significantly at month 0 (7.4 ± 1.9 mg/L; P &lt; .001) and at month 6 (9.9 ± 3.8 mg/L; P &lt; 0.001). The reduction was maintained, with no difference between month 0 and month 6. An improvement/decrease in β2M values was observed between month 0 and month 6 only in GA (–5.8 ± 7. 2 versus 1.8 ± 5 mg/L; P = .03) but not in GB. PreD–iPTH values did not differ between groups A, B and C at month 0 (623 ± 432 versus 434 ± 350 versus 710 ± 286 pg/mL, respectively; P = NS) and at month 6 (758 ± 550 versus 383 ± 186 versus 559 ± 296 pg/mL, respectively; P = NS). PostD–iPTH values showed a decrease at month 6 in GA (from 758 ± 550 to 514 ± 474 pg/mL; P = .04) but not in GB and a mild decrease in GC (from 559 ± 296 to 363 ± 295 pg/mL; P = .05), with a marginal reduction improvement between month 0 and month 6 in GC (41 ± 55 versus 196 ± 87 pg/mL; P = .046).

CONCLUSION
OL-HDF is obviously the most effective method for the elimination of MMW uremic toxins [2]. Interestingly, the combination HD + HP seems to be more effective than low-flux HD alone [3], and it could be useful for specific patient cases in daily clinical practice.
MO816: Bone Turnover Markers as Risk Factors of Severe Hypocalcemia After Parathyroidectomy for Secondary Hyperparathyroidism
Authors: Parshina Ekaterina , Kislyy Pavel , Zulkarnaev Aleksei , Tolkach Alexey 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Hungry bone syndrome is a common postoperative complication after parathyroidectomy (PTx) for severe secondary hyperparathyroidism (SHPT). We aimed to evaluate whether preoperative levels of serum alkaline phosphatase (AP) and β-crosslaps (CTX) are associated with the development of severe hypocalcemia after PTx for SHPT in dialysis-dependent patients.

METHOD
The retrospective study included 127 severe SHPT dialysis-dependent patients who underwent subtotal (SPTx) or total parathyroidectomy with autotransplantation of parathyroid tissue (PTx + AT) in a single high-volume centre of endocrine surgery between 2011 and 2014. Severe postoperative hypocalcemia was defined as an ionized serum calcium level &lt;0.9 mmol/L on a day 3 after surgery.

RESULTS
Severe hypocalcemia was observed in 83 (65.4%) patients after PTx. Comparing to those with mild hypocalcemia, hypoCa patients were significantly younger (mean age 44.2 ± 11.3 years versus 49.7 ± 10.4 years in a non-hypoCa group; P = .0089). Patients in two groups did not differ in terms of gender (P = .198), dialysis vintage (P = .24) and type of surgery (TPTx + AT or SPTx; P = .127). Preoperative PTH level was significantly higher in hypoCa group comparing to non-hypo Ca group [134 (Q1–Q3: 103–190) pmol/L versus 93.9 (Q1–Q3: 74.6–124.3) pmol/L, respectively; P &lt; .0001]. In univariate analysis preoperative AP level was associated with the risk of postoperative severe hypocalcemia [363.2 (Q1–Q3: 180.9–726.3) IU in hypoCa group versus 142.1 (Q1–Q3: 97.2–223.7) IU in non-hypoCa group; P &lt; 0.0001) (Figure 1). AP level above the cut-off value of 238.5 IU/L caused a 5-fold increase risk of severe hypocalcemia. We observed a moderate negative correlation between preoperative AP level and serum ionized calcium level on the third postoperative day after PTx {ρ = –0.637 [95% confidence interval (95% CI) –0.51 to –0.74]; P &lt; .0001}. In contrast, preoperative CTX level was not associated with postoperative severe hypocalcemia [5.34 (Q1–Q3: 4.06–6.03) µg/L in hypoCa group versus 4.6 (Q1–Q3: 3.42–5.69) µg/L in non-hypoCa group; P = .191] (Figure 2). Moreover, the correlation between preoperative AP and CTX levels was weak, even though it was statistically significant [ρ = 0.27 (95% CI 0.08–0.44); P = .006]; and we observed no statistically significant correlation between preoperative CTX and PTH levels (P = .07).
The multivariate logistic regression revealed AP level as the only independent risk factor of severe hypocalcemia development after PTx [ОR 1.006 (95% CI 1.002–1.009) per each IU; P = .005].

CONCLUSION
We identified serum AP level, but not CTX, as an independent risk factor of severe hypocalcemia development after surgical treatment of SHPT. The correlation between CTX and other bone turnover markers (PTH, AP) is weak in dialysis-dependent patients with severe SHPT.
MO831: Hepatitis Virus Infection in End-Stage Kidney Disease Patients Treated by Haemodialysis in Romania After 5 Years of Active Antiviral Therapy, Revisited
Authors: Marc Luciana , Lupusoru Raluca , Schiller Oana-Marina , Mihaescu Adelina , Bob Flaviu , Chisavu Lazar , Schiller Adalbert 
Published: May 2022

Abstract

BACKGROUND AND AIMS
After 5 years from the previous national prospective observational study and a modern antiviral program, we aimed to re-evaluate the prevalence of hepatitis virus infection and its impact in end-stage kidney disease (ESKD) patients treated with haemodialysis (HD) in Romania.

METHOD
A total of 1516 ESKD patients (909 men and 608 women, median age 60.1 ± 12.9 years) treated with chronic HD in twelve centres from all the historical regions of Romania have been assigned to this study. Data regarding their HBs Ag and anti-HCV antibodies were recorded.

RESULTS
HBsAg was positive now in 5% (n = 76) patients and it was significantly lower than in 2015 (9.5%, n = 57), P = 0.0001, anti-HCV antibodies were detected in 11.5% (175) versus 27.3% (n = 164), P &lt; 0.0001; and 1.5% (n = 24) versus 5% (n = 30) were positive for both HBV and HCV infection, P &lt; 0.0001. When we split the cohort between the historical regions of Romania (Moldavia 426 patients, Muntenia 321 patients, Transylvania 769 patients), in Moldavia (Eastern Romania), the prevalence of both HBV and HCV infection was significantly lower than 2015 (4.2% versus 16.8%; P &lt; 0.001, respectively for HCV 20% versus 42.9%; P &lt; 0.0001). The prevalence of HBV infection in Muntenia region was 3.1% versus 9.9% in 2015 (P = 0.003), but Muntenia recorded a significant decrease in the prevalence of HCV infection in haemodialysis patients from 2015 until now (9.6% versus 36.4%, P &lt; 0.001). Data from Transylvania are similar, there are no significant differences in terms of HBV infection (3.7% versus 4.7% in 2015; P = 0.455) but the prevalence of HCV infection is significantly &lt;2015 (7.6% versus 13.9%; P = 0.001).

CONCLUSION
This study shows that the systematically nationwide applied measures for significant reduction of infection risk and antiviral therapy significantly decreased HV infection prevalence in HD patients in Romania.
MO836: Patients Receiving Haemodialysis Maintain Sars-Cov-2 Immunity Comparable With Healthy Individuals: A Prospective Cohort Study
Authors: Parshina Ekaterina , Tolkach Alexey , Ivanov Andrey , Kislyy Pavel 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Patients with end-stage kidney disease receiving maintenance haemodialysis (HD) are at increased risk for mortality after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) compared with the general population. However, it is currently unknown whether the long-term SARS-CoV-2 humoral and cellular immune responses in patients receiving HD are comparable to individuals with normal kidney function. We aimed to investigate the 6-month kinetics of SARS-CoV-2 IgG antibody and specific T-cell levels in patients receiving HD compared with those in healthy individuals.

METHOD
The prospective cohort study included 24 patients treated with maintenance HD and 27 healthy controls with confirmed history of coronavirus disease (COVID-19). Nobody of them received vaccination before and during the study period. In all participants, the levels of specific IgG were quantified at three timepoints: 10, 18 and 26 weeks from disease onset. In a subgroup of patients, specific CD4+ and CD8+ T-lymphocyte responses were evaluated using IGRA test.

RESULTS
The incidence of COVID-19-related symptoms did not differ between the groups, except for the loss of smell, which occurred much more frequently among healthy subjects (70% versus 30.4% in HD group, P = 0.01). The seropositivity rate declined in healthy subjects over time and was 85% and 70.4% at weeks 18 and 26, respectively. All HD patients remained seropositive over the study period. Seropositivity rate at week 26 was greater among patients receiving HD: RR = 1.4 [95% confidence interval (95% CI): 1.17–1.94] (reciprocal of RR = 0.7, 95% CI: 0.52–0.86), P = 0.0064. In both groups, IgG levels decreased from week 10 to week 26, but antibodies vanished more rapidly in controls than in HD group (ANOVA P = 0.0012)—Figure 1. The magnitude of T-cell response was significantly lower in controls than in HD patients at weeks 10 (P = 0.019) and 26 (P = 0.0098) after COVID-19 diagnosis, but not at week 18—Figure 2.

CONCLUSION
Compared with healthy adults, patients receiving HD maintain significant long-term humoral and cellular immune responses following natural COVID-19. SARS-CoV-2 IgG antibodies did not decline more rapidly in patients receiving HD than in healthy controls over 6-months period.