bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO789: The Effect of Oral Vitamin K2 Versus K1 on Vascular Calcification in Hemodialysis Patients: A Randomized Controlled Trial
Authors: El Shinnawy Howayda , Elsaid Tamer , Farid Sarah , Shamseldin Ahmed , Ibrahim Sherin , Elsharabasy Reem 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Vascular calcification is a common complication of end-stage renal disease and an important cause of cardiovascular diseases and mortality. Vitamin K is essential for the activation of matrix Gla protein (MGP), a powerful inhibitor of tissue calcification. However, there are limited data on the efficacy and safety of different vitamin K forms on vascular calcification in hemodialysis patients, most of whom are essentially vitamin K deficient.

METHOD
A prospective, randomized, placebo-controlled clinical trial, that included 120 eligible hemodialysis patients who were randomly assigned to one of three equal study groups: vitamin K1 (10 mg phytomenadione thrice-weekly), vitamin K2 (90 ug daily), or placebo for 3 months. Serum MGP, calcium, phosphorus, their product and intact parathyroid hormone (iPTH) levels were all assessed at baseline and at the end of the study.

RESULTS
MGP levels showed a significant increase in the vitamin K2 group (700%) compared with (78%) and (40%) in vitamin K1 and placebo groups respectively. No change was found in bone profile at 3 months compared with baseline at both of the treatment groups. No correlations between calcium, phosphorous and PTH and MGP levels at baseline or after treatment. None of the treatment group patients experienced any adverse effects.

CONCLUSION
Vitamin K supplementation was tolerable and effective in improving levels of a potent calcification inhibitor as MGP, with K2 form showing superiority over K1 in their impact on MGP levels among hemodialysis patients.
MO803: Cost-Effectiveness of Paricalcitol versus Calcitriol for Management of Secondary Hyperparathyroidism in Maintain Haemodialysis Patients in Beijing
Authors: Zhou Jiannan , Chen Gang 
Published: May 2022

Abstract

BACKGROUND AND AIMS
To compare the cost efficacy analysis and the effect on calcium and phosphorus variability of paricalcitol and calcitriol in the treatment of haemodialysis CKD-MBD patients in Beijing from the payer's perspective.

METHOD
Patients were divided into the paricalcitol group and the calcitriol group, and both groups could be treated with a combination of cinacalcet. The treatment duration was 6 months, and the attainment endpoint was a mean iPTH ≤ 300 pg/mL in the 4th–6th month of treatment. Efficacy was the attainment rate of patients in both groups. The cost is the sum of medications and laboratory tests over a 6-month period. We evaluated incremental cost-efficacy analysis (ICER) and plotted to scatter plots of incremental cost-effects using nonparametric Bootstrap repeated sampling 1000 times. A one-way sensitivity analysis of factors affecting ICER was also performed, and a probabilistic sensitivity analysis of parametric random sampling was performed using Monte Carlo simulation. The calcium and phosphorus smoothing index (SI) was applied to assess the effect of treatment on calcium and phosphorus variability.

RESULTS
The effective rates in the two groups were 88.7% (paricalcitol group) and 56.5% (calcitriol group), respectively. The cost-effect basis analysis showed that the ICER of paricalcitol and calcitriol and was CNY 41 554.702. The single-factor sensitivity analysis showed that the price of paricalcitol is the most sensitive factor, and the probabilistic sensitivity analysis showed that paricalcitol was a more economical solution when the willingness to pay (WTP) was above CNY 32 500. There are no differences of the calcium and phosphorus SI between two groups.

CONCLUSION
Paricalcitol has an economic advantage when the 6-month WTP is CNY 32 500 or more per effective patient treated.
MO820: Comparison of All-Cause-Mortality Before and After COVID-19 Vaccination in a Hemodialysis Center
Authors: Yavari Vahideh 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Control of COVID-19 outbreaks in hemodialysis wards has been a great challenge for dialysis ward managers during the pandemic. Besides, frequent patient education and provision of sanitation and prevention protocols, COVID-19 vaccination brought light to systematic control of COVID mortality. The aim of this study was to assess the effect of the COVID-19 vaccination on all-cause mortality in our hemodialysis ward.

METHOD
Crude and age-adjusted mortality rates of 2-time frames, i.e. 6 July–6 December 2020 and the same period in 2021 (before and four weeks after full vaccination against COVID-19 with Sinopharm (Beijing): BBIBP-CorV) were compared. The data were processed with SPSS software version 26.

RESULTS
From 6 July to 6 December 2020, the crude all-cause-morality rate of our hemodialysis center was 9.12% (23 out of 252 patients). Between 6 July 2021 and 5 December 2021, the crude all-cause-morality rate was 6.74% (17 out of 252 patients). The same result was found after age adjustment of the morality rates.

CONCLUSION
COVID-19 vaccination reduced the all-cause mortality in our hemodialysis ward, as reported in the general population. Further multi-center studies are encouraged to study the effect of vaccination on the number of severe cases and the rate of hospitalization in this group of patients.
MO824: Utility of Novel Wireless Mobile Ultrasound Technology Via Nephrologists in Egyptian Hemodialyis Patients
Authors: Fatthy Abdelnaeem Moataz , Abdelaziz Tarek , Eldewi Sameh , Abdelghany Reham 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Ultrasound and ultrasound-guided procedures are being widely applied in the field of clinical and interventional nephrology [1]. Many nephrology training programs still lack structured ultrasound training. Handheld mobile ultrasound provides affordability and ease of usage of the techniques [2]. To test the feasibility of hand-held mobile ultrasound in detecting incidental asymptomatic arterio-venous (AV) access or parathyroid gland as well as assessing volume status and detection of pericardial effusion [3].

METHOD
We recruited 344 patients with end-stage renal disease undergoing regular hospital haemodialysis. Informed consents for the procedure were obtained from all patients. All patients have undergone post-session chest ultrasound, bedside cardiac ultrasound to detect pericardial effusion, neck ultrasound to detect parathyroid adenoma and arterio-venous access ultrasound scanning. All ultrasound scanning was done by the same operator using: high frequency head (curvilinear head) to examine parathyroid glands, AV access and lung ultrasound. Low frequency (linear head) to examine the abdomen and pelvis and to detect pericardial effusion.

RESULTS
Lung ultrasound scanning detected pleural effusion in 3 patients and an increase in the B line in 12 patients. Pericardial effusion was detected in one patient. Parathyroid adenoma in one patient. Native AVF access stenosis in three patients and pseudo-aneurysm of AVG in one patient.

CONCLUSION
The use of handheld mobile ultrasound via mobile application enabled an easy and fast way to scan a large number of haemodialysis patients and detect asymptomatic pleural effusion, pericardial effusion, AV access malfunction and parathyroid adenomas. The integration of mobile ultrasound techniques into the care of end-stage renal disease on haemodialysis may be of significant added on value.
MO844: Immune Response to SARS-COV-2 Vaccines Among Haemodialysis Patients
Authors: Perysinaki Garyfalia , Papadaki Panagiota , Passam Andreas-Michahl , Ntaountaki Irini 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Haemodialysis patients (HD) exhibit a poor immune response to vaccines. The aim of this study was to identify anti–SARS-CoV-2 spike protein antibody production following SARS-CoV-2 vaccination [1], determine variables affecting the response and compare with HBV vaccination response.

METHOD
Single centre prospective observational study. A total of 56 HD patients fully vaccinated for SARS- coronavirus (two doses) were followed until the day of anti–SARS-CoV-2 spike protein antibody assessment. The significance of difference was tested using either the t-test or Mann–Whitney rank-sum for continuous variables and the Chi-squared test for categorical variables. The SPSS version 22 (IBM, Armonk, NY) was used.

RESULTS
A total 56 patients, 62.5% males with a mean age 67.64 years and a median dialysis vintage 59 months were studied. Titers of antibodies were measured once in a median period of 138 days after the second vaccination and 76.8% of patients had a positive immune response. The same response, 76.5%, was exhibited for HBV vaccination. The age, gender, blood group, dialysis vintage, serum albumin, blood lymphocyte count, Kt/V and type of SARS-CoV-2 vaccine did not correlate with the immune response [2] (Table 1). Two females aged 81 and 50 years developed mild COVID at 140 and 118 days after the second vaccination, both with unknown antibodies at the time of infection.

CONCLUSION
Although the SARS-CoV-2 vaccination immune response is lower in HD patients than in the general population, it is the same as the response to HBV vaccination and from a clinical perspective it was protective against serious COVID in our population [3].
MO848: Platelet Thrombus Formation in Chronic Haemodialysis Patients Measured by the Total Thrombus-Formation Analysis System
Authors: Dimitrijevic Zorica , Wallen Håkan , Hosokawa Kazuya , Cvetkovic Tatjana , Mitic Branka , Tasic Danijela , Vrecic Tamara , Jovanovic Andriana , Jancic Nina , Agren Anna 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Patients with end-stage renal disease (ESRD) receiving haemodialysis (HD) often experience bleeding. However, mechanisms behind this bleeding tendency are incompletely understood but may involve platelet dysfunction. We therefore studied platelet-dependent thrombus formation in flowing whole blood inside a microchip coated with collagen, and its association with circulating von Willebrand factor (VWF).

METHOD
Blood samples were obtained in 22 patients before and after HD. The area under the 10 min flow pressure curve in a microchip (AUC10) reflecting total platelet thrombogenicity was measured, using the Total Thrombus-formation Analysis System (T-TAS01). AUC10 &lt; 260 indicates platelet dysfunction. VWF-antigen and measures of VWF-activity, i.e. VWF-RCo, VWF-CBA and latex-particle based VWF activity were also assayed.

RESULTS
VWF levels were moderately elevated and increased further after HD (P &lt; 0.01 or lower). In contrast, AUC10 before and after HD was &lt; 260 in 17/22 patients and &lt; 130 in 15/22 patients, with no statistically significant difference in pre- versus post-HD measurements (median AUC10 in all patients 10.2 versus 20.3, respectively), altogether indicating reduced platelet thrombogenicity, but with some variability (5/22 patients with normal platelet responsiveness). AUC10 before and after HD correlated fairly well (r = 0.77, P &lt; 0.001), and all VWF-related parameters (before versus after HD) were also correlated (r = 0.74 or higher; P &lt; 0.0001). In contrast, no significant correlations were found between absolute values of AUC10 and any VWF-related parameters or between changes in values (i.e delta-values for differences between pre versus post HD).

CONCLUSION
Most ESRD-patients display moderate to severe platelet dysfunction as assessed by shear-induced collagen-dependent platelet thrombus formation with T-TAS01.Platelet thrombus formation under high shear, as measured by the collagen-coated PL-chip, is not importantly influenced by a moderate HD-induced increase in VWF. T-TAS01 should be further evaluated as a tool in the assessment of bleeding risk in patients on HD.
MO868: The Impact of Cognitive Impairment in Sleep Disorders in Haemodialysis and Peritoneal Dialysis Patients
Authors: Rroji (Molla) Merita , Shehaj Larisa 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Patients undergoing dialysis have a higher cognitive impairment (CI) risk than the general population. We evaluated the association of cognitive function (CI) in haemodialysis (HD)and peritoneal dialysis patients (PD) and the relationship with restless leg syndrome (RLS) and hypersomnolence.

METHOD
This is a cross-section study evaluating 167 patients who met the inclusion criteria in the study. Of these, 39% were on Haemodialysis, 22% on Peritoneal Dialysis, 19% on Transplant and 20% with CKD stage IV-V. Cognitive impairment (CI) in the study population was assessed based on the MoCA test. Patients with a MoCA global score of 24/30 were considered cognitively impaired. The rating is classified: light, moderate, heavy and very heavy.The International Restless Legs Syndrome study group (IRLSSG) was used for evaluation of restless leg and the Epworth Sleepiness Scale is used as a The Epworth Sleepiness Scale is widely used in the field of sleep medicine as a subjective measure of a patient's sleepiness.

RESULTS
The frequency of CI based on the test classification was 20% mild, 61% moderate, 15% severe and 3% very severe. In the studied population, it was observed that there is a significant relationship between cognitive impairment and forms of renal replacement therapy (P &lt; 0.001) and the etiology of the underlying disease, P = 0.0011). The multivariate linear regression test shows an independent relationship of CI with age, where each increase of 1 year in age leads to a decrease of 0.094 points of the MoCA test. Patients in the study were evaluated as having enough sleep (60.8% patients), mildly sleepy (10.1% patients) and sleepy (29.1% patients). In 59% of patients that responded positively for restless leg syndrome, the degree of severity was significantly correlated with dialysis treatment (P &lt; 0.001) and not with time in dialysis. The comparison between the three tests performed in the studied population showed a positive correlation of sleepiness and restless leg syndrome (r = 0.32) and a negative correlation between CG and CK(r = –0.38).

CONCLUSION
In this study, we saw the impact of RRT on CI, RLS and Sleepiness, affecting the quality of life negatively. Cognitive function disorders negatively impact the independence of realizing essential life functions, thus reducing compliance with medical care. Sleep fragmentation in sleepiness can also affect CI through dysfunction in neural networks, particularly in the frontal lobes, probably reducing the efficiency of restorative processes in the prefrontal cortex leading to cellular and biochemical stress. RLS is associated with sleepiness, and both negatively affect the quality of life and emotional states like anxiety and depression.
MO874: Incidence of Severe Infections in Home Haemodialysis and Peritoneal Dialysis Patients
Authors: Bitar Wisam , Helve Jaako , Kanerva Maria , Olavi Honkanen Eero , Rauta Virpi , Haapio Mikko , Finne Patrik 
Published: May 2022

Abstract

BACKGROUND
Dialysis patients have a more than ten-fold risk of dying from infections compared with general population. In earlier studies, the risk of infections was similar in peritoneal dialysis (PD) and haemodialysis (HD), but comparison to home HD has not been performed. Our aim was to study the incidence of severe infections after start of home HD as compared with continuous ambulatory PD (CAPD) and automated PD (APD).

METHODS
We included all 536 adult patients, who were on home dialysis at day 90 from start of kidney replacement therapy (KRT) between 2004 and 2017 in Helsinki healthcare district. Severe infections were identified from patients’ laboratory data as a plasma C-reactive protein over 100 mg/L and confirmed from the patient data system. The cumulative incidence of the first severe infection was estimated considering death as a competing risk event. Hazard ratios of first severe infection were assessed using Cox regression with propensity score adjustment. Incidence rate (IR) and ratios (IRR) of all severe infection episodes were calculated.

RESULTS
The probability of getting a severe infection during the first year of dialysis was 35% for CAPD, 25% for APD and 11% for home HD patients. During a 5-year follow-up, the hazard ratio of severe infection was 2.8 [95% confidence interval (95% CI) 1.6–4.8] for CAPD and 2.2 (95% CI 1.4–3.5) for APD in comparison to home HD with adjustment for propensity scores. IR of infections/100 patient-years was 54 for CAPD, 37 for APD and 20 for home HD patients. The IR of peritonitis was 37 for CAPD and 25 for APD patients. When infection episodes caused by peritonitis were excluded, the IR of severe infections was not higher among PD than home HD patients.

CONCLUSION
The risk of severe infection was considerably lower among home HD than PD patients. This difference was mainly explained by the peritonitis episodes among the PD patients.
MO876: B Lymphocyte Subpopulations in End-Stage Renal Disease Patients Undergoing Renal Replacement Therapy: Does the Method Affect the Phenotype?
Authors: Vasileia Daikidou Dimitra , Sampani Erasmia , Fylaktou Asimina , Nikolaidou Vasiliki , Dimitriadis Chrysostomos , Lioulios Georgios , Papagianni Aikaterini , Stangou Maria 
Published: May 2022

Abstract

BACKGROUND AND AIMS
End-stage renal disease (ESRD) patients are considered as immunocompromised, and infections contribute greatly to their morbidity and mortality. This study focuses on the changes of B lymphocyte subpopulations in pre- and post- renal replacement therapy ESRD patients and the potential differences between haemodialysis and peritoneal dialysis.

METHOD
Using flow cytometry, B cells (CD19+) and their subsets B1a (CD19 + CD5+), naive (CD19 + CD27−), memory (CD19 + CD27+), (CD19 + BAFF-R+) and (CD19 + IgM+), were quantified in the peripheral blood of 40 pre-dialysis patients. IgG, IgA and IgM serum levels and apoptotic lymphocytes and b lymphocytes were also measured, and the measurements were repeated 6 months after the initiation of renal replacement therapy. The patients were allocated to haemodialysis (22patients, M/F 10/12, age 64,1 ± 9,8) and peritoneal dialysis (18 patients, M/F 11/11, age 56,4 ± 15,6). Exclusion criteria were age &lt; 18 or &gt;75 years, active autoimmune or chronic inflammatory disease, medical history of malignancy, corticosteroids or immunosuppresive treatment for the last 12 months.

RESULTS
There were no statistically significant difference between the two groups concerning the aforementioned variants pre dialysis. Collectively, ESRD patients showed no statistically significant alterations after the initiation of dialysis concerning the B cells phenotype, lymphocyte apoptosis and Immunoglobin serum levels, with the notable exception of B1a cells, which presented a decrease (3.6 ± 4.9 μ/L versus 1.6 ± 2.5 μ/L, P = 0.022). There seem to be no particular differences between the two methods either, with the exception of WBC count (6574 ± 1519 μ/L versus 8325 ± 2541 μ/L, P = 0.014) and apoptotic B lymphocytes (2 ± 2.4 μ/L versus 4.5 ± 3.9 μ/L, P = 0.02), which were lower in the peritoneal dialysis patients. Lastly there seemed to be no differentiation between the two methods concerning the percentage change of B lymphocytes subpopulations, lymphocyte apoptosis and IgG, IgM and IgA serum levels.

CONCLUSION
The changes that the uremic milieu causes in ESRD patients concerning their humoral Immunity do not reverse with the initiation of renal replacement therapy. Furthermore, with the exception of B cells apoptosis and WBC count, there is no significant difference between haemodialysis and peritoneal dialysis.
MO889: High Flux Dialyzer 2.6 M2 is Promising for Free Light Chains Removal in High Flux Hemodialysis and Hemodiafiltration
Authors: Elsayed Hesham , Anwar Waleed , Zaki Abdelmegied Shaimaa , Emara Ahmed , Sultan Reem , Elsharkawy Magdy 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Immunoglobulin light chains are classified as middle molecule uremic toxins and its removal through effective dialyzer is needed with less albumin loss. This study assessed the free light chains removal using dialyzer surface area (SA) 2.6m2 in high flux dialysis (HD) versus hemodiafiltration (HDF) and its relation to cumulative albumin loss.

METHOD
A cross-over study included 25 patients who underwent hemodialysis using dialyzer surface area 2.6 m2 in high flux HD followed by online post-dilution hemodiafiltration with washout period 2 weeks using high flux dialyzers (max 2.0 m2 SA). All patients were subjected to single session measurement of dialysate albumin every hour and pre-post dialysis Free light chains (FLC) kappa and Lambda by ELISA.

RESULTS
Dialyzer (SA) 2.6m2 showed significant reduction in post-dialysis kappa and lambda in comparison to pre-dialysis level in high flux hemodialysis and hemodiafiltration (P &lt; 0.001). HDF showed higher kappa and lambda FLC reduction ratio (45.16 ± 6.53 ng/mL), (28.68 ± 4.36 ng/mL), respectively compared with high flux HD (29.52 ± 6.38 ng/mL), (19.48 ± 1.96 ng/mL), respectively (P &lt; 0.001). HDF/HD fold change of kappa and lamda were (1.56 ± 0.23) and (1.48 ± 0.26), respectively. Patients on HDF dialysis had significant total albumin loss in dialysate [median (IQR) 2.47 (1.16) gm/dL] compared with high flux dialysis [median (IQR) 0.65 (0.64) gm/dL] with (P &lt; 0.001). Maximum albumin loss in patients on HDF was in the first hour [median (IQR) 1.22 (0.59)] gm/dL with lower albumin loss in the next hours reaching median {0.17 (0.15) gm/dL} in the fourth hour. Trans-membrane pressure was positively correlated with total albumin loss in high flux hemodialysis and hemodiafiltration (r 0.443, p 0.027, r 0.745, P = 0.001), respectively.

CONCLUSION
High flux dialyzer 2.6 m2 (SA) is effective for free light chains removal especially with online post-dilution hemodiafiltration with acceptable albumin loss.
MO893: The Prognostic Value of Dysvolemia, Cardiac Biomarkers and Echocardiographic Parameters in Chronic Haemodialysis Patients
Authors: Paunic Zoran , Dekleva-Manojlovic Milica , Markovic-Nikolic Natasa , Dimkovic Nada 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Hypervolemia is one of the important risk factors for mortality in haemodialysis (HD) patients. The aim of this study is to determine the prognostic significance of volemia determined by bioimpedance spectroscopy (BIS), as well as cardiac biomarkers and echocardiographic (ECHO) measurements.

METHOD
A prospective single-centre observational study included 73 (42 m) chronic HD patients. The BIS and cardiac biomarkers were measured before the second weekly HD procedure. In addition, to overcome the problem of possible different pre-HD and post-HD fluid volume levels (`overhydration’, OH and post-HD or `dehydration’, DH, respectively) on different HD sessions of the week, the concept of Average Weekly hypervolemia (AVOH) or hypovolemia (AVDH) was implemented—the remaining two OH and DH values were calculated from pre-HD and post-HD weights and normal weight as suggested by BIS measurement. ECHO was performed 1 day after aforementioned measurements (i.e. 1 day after HD).

RESULTS
During observation period 11 subjects died (15%): seven (64%) directly due to cardiovascular (CV), two due to infective and due to malignant causes. Three-year cumulative survival was significantly lower (by Kaplan–Meier analysis) in those who had: 1) AVOH &gt;13% extracellular fluid (ECV) (survival rate 73% versus 92% (P &lt; 0.05); 2) average AVDH&gt; -3% ECV (survival 69% versus 94%; P &lt; 0.01); 3) value of serum N-terminal prohormone of brain natriuretic peptide (NT-proBNP)&gt; 7350 pg/mL (survival 76% versus 93%; P &lt; 0.05); 4) troponin T (TnT) value &gt;0.067 ng/mL, (survival rate 68% versus 94%; P &lt; 0.01). In addition, regarding just CV mortality, left ventricular ejection fraction according to Simpson (LVEF) &lt;40% (survival rate 80% versus 93%; P &lt; 0.05) and global longitudinal strain (GLS) &lt;–8.5 (survival rate 81% versus 95%, P &lt; 0.05) were markers of pure survival.

CONCLUSION
Determination of volemia by BIS, cardiac biomarkers and echocardiography has prognostic significance in HD patients. Further studies will show how much correction of dysvolemia affects their better survival.