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3. Cardiovascular and All-Cause Mortality Is Affected by Serum Magnesium and Diet Pattern in a Cohort of Dialysis Patients.

Author

Petrakis, Ioannis, Bacharaki, Dimitra, Kyriazis, Periklis, Balafa, Olga, Dounousi, Evangelia, Tsirpanlis, George, Theodoridis, Marios, Tsotsorou, Ourania, Markaki, Anastasia, Georgoulidou, Anastasia, Triantafyllis, George, Giannikouris, Ioannis, Kokkalis, Apostolos, Stavroulopoulos, Aristeides, and Stylianou, Kostas

Subjects
MEDITERRANEAN diet, DIETARY patterns, PERIPHERAL vascular diseases, PERITONEAL dialysis, CHRONIC kidney failure
Abstract

Background: Hypomagnesaemia is associated with an increased overall mortality in patients with chronic kidney disease on dialysis (CKD-5D). Mediterranean-style diet (MD), having a high magnesium content, can serve as a form of dietary magnesium supplementation. We examined whether there is a potential link between increased Mediterranean Diet score (MDS) and elevated serum magnesium (sMg) to assess its impact on reducing mortality risk in CKD-5D patients. Methods: In this multi-center prospective observational study, 117 CKD-5D patients (66 on hemodialysis and 51 on peritoneal dialysis) with a mean age of 62 ± 15 years were studied for a median follow-up period of 68 months. After baseline assessment, including measurement of sMg and MDS, all patients were followed up for cardiovascular (CV) and all-cause mortality. Results: Forty deaths occurred, 58% of which were cardiovascular. Patients who were above the median value of sMg (2.2 mg/dL) had a 66% reduction in CV (crude HR, 0.34; 95% CI, 0.11–0.70), and 49% reduction in all-cause (crude HR, 0.51; 95% CI, 0.27–0.96) mortality, even after adjustment for age, malnutrition inflammation score, left ventricular mass index, peripheral vascular disease and diabetes. Similar results were obtained when sMg was analyzed as a continuous variable. sMg was associated directly with MDS (r = 0.230; p = 0.012). Conclusions: Higher sMg levels are strongly and independently associated with reduced CV and all-cause mortality in CKD-5D patients. A strong correlation exists between MDS and sMg. Elevated sMg levels, achieved through MD adherence, can significantly reduce CV mortality, implicating MD as a mediator of the association between sMg and CV mortality. [ABSTRACT FROM AUTHOR]

Published
2024
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5. Novel and Founder Pathogenic Variants in X-Linked Alport Syndrome Families in Greece

Author

Hadjipanagi, Despina, primary, Papagregoriou, Gregory, additional, Koutsofti, Constantina, additional, Polydorou, Christiana, additional, Alivanis, Polichronis, additional, Andrikos, Aimilios, additional, Christodoulidou, Stalo, additional, Dardamanis, Manthos, additional, Diamantopoulos, Athanasios A., additional, Fountoglou, Anastasios, additional, Frangou, Eleni, additional, Georgaki, Eleni, additional, Giannikouris, Ioannis, additional, Gkinis, Velissarios, additional, Goudas, Pavlos C., additional, Kalaitzidis, Rigas G., additional, Kaperonis, Nikolaos, additional, Koutroumpas, Georgios, additional, Makrydimas, George, additional, Myserlis, Grigorios, additional, Mitsioni, Andromachi, additional, Paliouras, Christos, additional, Papachristou, Fotios, additional, Papadopoulou, Dorothea, additional, Papagalanis, Nikolaos, additional, Papagianni, Aikaterini, additional, Perysinaki, Garyfalia, additional, Siomou, Ekaterini, additional, Sombolos, Konstantinos, additional, Tzanakis, Ioannis, additional, Vergoulas, Georgios V., additional, Printza, Nicoletta, additional, and Deltas, Constantinos, additional

Published
2022
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6. Lower serum magnesium is a predictor of left ventricular hypertrophy in patients on dialysis

Author

Balafa, Olga, primary, Dounousi, Evangelia, additional, Giannikouris, Ioannis, additional, Petrakis, Ioannis, additional, Georgoulidou, Anastasia, additional, Karassavidou, Despina, additional, Kokalis, Apostolos, additional, Stauroulopoulos, Aristeidis, additional, Theodoridis, Marios, additional, Oikonomidis, Ignatios, additional, Triantafyllis, Georgios, additional, Tsotsorou, Ourania, additional, Tzannis, Kimon, additional, and Bacharaki, Dimitra, additional

Published
2022
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7. VOLume flow assistance for optimizing outcomes of dysfunctional autologous arteriovenous fistula Angioplasty: the VOLA Pilot Study

Author

Spiliopoulos, Stavros Giannikouris, Ioannis E. Katsanos, Konstantinos Filippou, Panagiotis Efthymiou, Evgenia Reppas, Lazaros Kitrou, Panagiotis Palialexis, Konstantinos and Filippiadis, Dimitrios Brountzos, Elias and Spiliopoulos, Stavros Giannikouris, Ioannis E. Katsanos, Konstantinos Filippou, Panagiotis Efthymiou, Evgenia Reppas, Lazaros Kitrou, Panagiotis Palialexis, Konstantinos and Filippiadis, Dimitrios Brountzos, Elias

Abstract

Objectives To investigate the feasibility of VF-assisted angioplasty (VFA) in dysfunctional AVF using sequential intraprocedural duplex ultrasound (DUS), to utilize intraprocedural VF as a quantifiable, functional endpoint in endovascular treatment. Methods This prospective study included 20 consecutive patients (23 lesions; 16 men; mean age 67 +/- 16 years) with dysfunctional AVF undergoing fluoroscopically guided balloon angioplasty between June 2019 and May 2020. Primary endpoints were quantification of outcome using sequential DUS VF analysis following each dilation, 6-month target lesion re-intervention (TLR)-free rate, standard technical success, procedural success (achievement of a postprocedural VF value equal (or 10% less) or superior to the baseline steady-state access), and correlation between procedural success and TLR-free rate. Secondary endpoints included 6-month lesion late lumen loss (LLL), correlation between balloon diameter used and intraprocedural VF values, and correlation between VF and LLL at 6 months follow-up. Results Mean VF increase was 168.5% +/- 102.5% (range: 24.24-493.33%). Procedural success was 80% (16/20 cases). VFA improved procedural success by 20% (4/20 cases) compared to standard assessment (< 30% residual stenosis and palpable thrill). TLR-free rate was 78.3% and 67.3% at 6 and 12 months. Significantly less TLR was noted in cases of procedural success (82.4% vs. 66.7% 6 months; p = 0.041). Unweighted linear regression showed a significant positive relationship between diameter of balloon and VF (146.9 +/- 42.3 mL/min VF gain per mm of balloon diameter; p = 0.001, R2 = 0.23) and a significant negative relationship between LLL and VF decline at follow-up (102.0 +/- 34.6 mL/min loss per mm of LLL; p = 0.01, R2 = 0.35). Optimal VF cutoff value and percentile increase to predict access failure were 720 mL/min (sensitivity 58.3%, specificity 71.4%) and 153% (sensitivity 66.7%, specificity 85.7%), respectively. Conclusion Intrapro

Published
2022

8. VOLume flow assistance for optimizing outcomes of dysfunctional autologous arteriovenous fistula Angioplasty: the VOLA Pilot Study

Author

Spiliopoulos, Stavros, primary, Giannikouris, Ioannis E., additional, Katsanos, Konstantinos, additional, Filippou, Panagiotis, additional, Efthymiou, Evgenia, additional, Reppas, Lazaros, additional, Kitrou, Panagiotis, additional, Palialexis, Konstantinos, additional, Filippiadis, Dimitrios, additional, and Brountzos, Elias, additional

Published
2021
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12. SP587DIAGNOSTIC NEPHROLOGY IN DAILY PRACTISE: ANNUAL AUDITS OF VASCULAR ACCESS FUNCTION IN HEMODIALYSIS PATIENTS WITH THE USE OF COLOR DOPPLER ULTRASOUND

Author

Fragkidis, Stylianos, primary, Giannikouris, Ioannis Emmanouil, additional, Spanos, George, additional, Bantis, Christos, additional, Livia, Karmen Armentzoiou, additional, Ellada, Tsantekidou, additional, Styliani, Paschou, additional, Christos, Dontsios, additional, and BAMICHAS, GERASIMOS, additional

Published
2019
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14. SP386MEDITERRANEAN DIET AND MORTALITY ΙΝ CHRONIC KIDNEY DISEASE (CKD) STAGE 5D (DIALYSIS) PATIENTS

Author

Giannikouris, Ioannis Emmanouil, primary, Georgoulidou, Anastasia, additional, Dermitzaki, Elefteria, additional, Korovesi, Anastasia, additional, Kokkalis, Apostolos, additional, Stavroulopoulos, Aristeidis, additional, Perakis, Kostas, additional, Theodoridis, Marios, additional, Passadakis, Ploumis, additional, Dounousi, Evangelia, additional, Markaki, Anastasia, additional, Kyriazis, Periklis, additional, Tsotsorou, Ourania, additional, Katsoudas, Spyros, additional, Bacharaki, Dimitra, additional, and Vlahakos, Demetrios, additional

Published
2019
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17. SP542LOWER SERUM MAGNESIUM (SMG) IS A STRONG PREDICTOR OF LEFT VENTRICULAR HYPERTROPHY (LVH) AND PATTERNS OF LV REMODELING IN PATIENTS WITH STAGE 5 CHRONIC KIDNEY DISEASE (CKD)

Author

Dermitzaki, Eleftheria-Kleio, primary, Giannikouris, Ioannis, additional, Stavroulopoulos, Aristeidis, additional, Hatzidimitriou, Despina, additional, Makridis, Dimitris, additional, Tsotsorou, Ourania, additional, Balafa, Olga, additional, Dounousi, Evangelia, additional, Stylianou, Kostas, additional, Triantafyllis, Georgios, additional, Christos, Katsinas, additional, Passadakis, Ploumis, additional, Kyriazis, Periklis, additional, Katsoudas, Spyros, additional, Dimitra, Bacharaki, additional, and Demetrios, Vlahakos, additional

Published
2018
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19. FP574A MODERN CHALLENGE FOR NEPHROLOGISTS VASCULAR ACCESS SURVEILLANCE IN THE HEMODIALYSIS UNIT. IMPACT OF AN INTENSIVE ULTRASOUND SURVEILLANCE PROTOCOL PERFORMED BY NEPHROLOGISTS IN ARTERIOVENOUS FISTULAE AND ARTERIOVENOUS GRAFT PATENCY RATES

Author

Giannikouris, Ioannis, primary, Konstantos, Chrysostomos, additional, Gkinis, Velissarios, additional, Alevizaki, Fotini, additional, Karabogia, Rania, additional, Petrichou, Christiana, additional, Chaviaras, Emmanuel, additional, and Triantafyllis, Georgios, additional

Published
2018
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20. FP578EVALUATION OF HEMODYNAMIC MATURATION OF NATIVE ARTERIOVENOUS FISTULA FOR HEMODIALYSIS. THE HEMODYNAMIC MATURATION (HEMA) TRIAL. A NOVEL PROSPECTIVE FROM A SINGLE CENTER EXPERIENCE

Author

Giannikouris, Ioannis, primary, Konstantos, Chrysostomos, additional, Chaviaras, Emmanuel, additional, Gkinis, Velissarios, additional, Alevizaki, Fotini, additional, Petrichou, Christiana, additional, Karabogia, Ourania, additional, and Triantafyllis, Georgios, additional

Published
2018
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22. Results of a hemodialysis vascular access routine ultrasound surveillance protocol and frequency of surveillance guided pre-emptive access maintenance interventions

Author

Giannikouris, Ioannis E., Georgiadis, George S., Giannakopoulos, Triantafyllos, Passadakis, Ploumis, and Spiliopoulos, Stavros

Abstract

Background: To evaluate the implementation of routine surveillance using ultrasound on hemodialysis vascular access (VA) outcomes and determine the number and frequency of corrective, surveillance-guided procedures performed.Methods: Multicenter, prospective, observational study that includes consecutive hemodialysis patients receiving therapy from native arteriovenous fistulae (AVF) or grafts (AVG). Participants were assigned to a routine VA Color Doppler ultrasound surveillance (DUS) protocol from January 2019 to December 2021. Patients were referred for corrective procedures (endovascular or surgical) based on clinical or DUS findings (pre-emptive procedures; PEP). Primary endpoint was the estimation of primary unassisted (PUP) and secondary patency (SP) rates. Secondary endpoints were the determination of the number and frequency of PEP and VA survival rates.Results: In total, 223 patients with 243 VA (192 AVF and 51 AVG) were included. Access PUP and SP rates were 83% and 93% at 12 months, 75% and 88% at 24 months, and 72% and 83% at 36 months follow-up. Autologous fistulae PUP and SP were 89% and 96% at 12 months, 81% and 93% at 24 months, and 80% and 89% at 36 months, respectively. Graft PUP and SP were 56% and 80% at 12 months, 44% and 65% at 24 months, and 39% and 54% at 36 months, respectively. In total, 56 corrective procedures (38/56 PEP; 65.5%) were performed (0.13 procedures/year), of which 34 were in AVF patients (0.09 procedures/year) and 22 in AVG patients (0.40 procedures/year). Overall, 33 VA losses occurred (0.06 failures/year), 17 in AVF (0.04 failures/year), and 16 in AVG patients (0.20 failures/year).Conclusion: The use of DUS resulted in the timely diagnosis of dysfunction, satisfactory overall VA survival, and patency rates, with a low PEP frequency. Randomized controlled trials are required to establish the value of DUS surveillance on access patency and whether DUS-guided interventions could improve VA outcomes.

Published
2024
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23. Evaluation of arteriovenous fistula maturation and early prediction of clinical eligibility, using ultrasound: The Fistula Maturation Evaluation (FAME) Study

Author

Giannikouris, Ioannis E, Spiliopoulos, Stavros, Giannakopoulos, Triantafyllos, Katsanos, Konstantinos, Passadakis, Ploumis, and Georgiadis, George

Abstract

Introduction: The study of time-related alterations of ultrasound-determined parameters during maturation, and the assessment of time to hemodynamic maturation, enabling early prediction of clinical eligibility, of hemodialysis autologous arteriovenous fistulae (AVF).Methods: This is an observational, prospective, study of only AVF-eligible patients referred for access creation, from 02/2019 to 02/2022 (ClinicalTrials.gov identifier: NCT0473687). Brachial artery diameter (dBA), access flow volume (FV), non-augmented efferent vein diameter (dEV), resistivity index (RI), and efferent vein total wall thickness (tEV), were assessed by ultrasound. Measurements were conducted daily in the first week and repeated on days 14, 21, 30, 60, and 90, postoperatively. The primary endpoint included the documentation of serial changes of flow and structural parameters related to AVF maturation in the first 90 days of the post-operative period and maturation early prediction. Secondary endpoints included the determination of factors affecting maturation.Results: One hundred one participants (mean age, 67 ± 6 years; 76 males) were enrolled. Average dBA and FV reached maximum on day 60 (5.64 ± 0.85 mm) and 90 (1.172 ± 617 mL/min), respectively. Day 7 values of dBA (5.48 ± 0.73 mm) and FV (1.039 ± 531 mL/min) did not alter significantly during the follow-up period. Parameters indicative of clinical functionality, dEV (5.82 ± 0.90 mm) and tEV (0.493 ± 0.10 mm), reached approximately 90% of maximum (6.66 ± 1.42 mm and 0.526 ± 0.11 mm), by day 14. RI reached minimum on day 30 (0.46 ± 0.09), without significant changes after day 2 (0.48 ± 0.09, p= 0.284). A significant correlation was identified, between day 7 FV and day 60 dEV (r= 0.40, p= 0.0002). A FV cut-off value ⩾657.51 mL/min, on day 7, predicted successful fistula maturation with 85% sensitivity and 100% specificity. Multivariate analysis identified female gender, age >75, diabetes, and wrist access as independent predictors of decreased values of maturation parameters.Conclusion: Hemodynamic maturation is completed by the first postoperative week, while AVF is clinically functional, by the second. FV can be used for early prediction of maturation.

Published
2024
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28. US Volume Flow Assessment to Optimize Angioplasty of Dysfunctional Dialysis Access: The VOLA-II Multicenter Study.

Author

Spiliopoulos S, Filippou P, Giannikouris IE, Katsanos K, Palialexis K, Grigoriadis S, Kitrou P, Brountzos E, and Karnabatidis D

Subjects
Humans, Male, Female, Aged, Prospective Studies, Middle Aged, Angioplasty, Balloon methods, Ultrasonography, Interventional methods, Angioplasty methods, Renal Dialysis methods, Arteriovenous Shunt, Surgical
Abstract

Background Digital subtraction angiography and thrill palpation demonstrate limitations when used to assess the outcomes of angioplasty in autologous arteriovenous fistulas (AVFs). Purpose To investigate a new functional quantifiable index of successful angioplasty for failing AVFs using intraprocedural percutaneous US volume flow (VF) measurements. Materials and Methods This prospective, multicenter, single-arm, cohort clinical trial included consecutive patients with indications for fluoroscopically guided balloon angioplasty due to AVF dysfunction between June 2020 and May 2022. Intraprocedural VF measurements were obtained before the procedure and after balloon dilation using transcutaneous duplex US. The primary end points were the quantification of VF-guided angioplasty outcomes and assessment of the association between postprocedural VF and freedom from target lesion reintervention (TLR) due to recurrence of access failure. Cox multivariate regression analysis was performed to identify predictors of TLR-free survival, which was estimated using Kaplan-Meier methods. Receiver operating characteristic curve analysis was used to determine the optimal cutoff VF value. Results In total, 100 participants (mean age, 67 years ± 12 [SD]; 84 male) were evaluated. The rate of freedom from TLR was 73% at 6 months. The mean pre- and postintervention VF values were 353 mL/min ± 199 and 1045 mL/min ± 413, respectively. Higher VF at completion of angioplasty (hazard ratio, 0.89 per 100 mL/min [95% CI: 0.82, 0.98]; P = .01) and forearm versus upper arm AVF (hazard ratio, 0.51 [95% CI: 0.27, 0.95]; P = .03) were independent predictors of increased freedom from TLR. A postprocedural VF of 720 mL/min ( P < .001) was identified as the optimal cutoff point for predicting increased fistula freedom from reintervention and freedom of restenosis for radiocephalic AVFs, compared with an optimal cutoff point of 1120 mL/min ( P = .03) for upper arm AVFs. Conclusion Intraprocedural VF measurement is a quantifiable functional index and postprocedural predictor of outcomes following angioplasty for failing dialysis AVFs. ClinicalTrials.gov identifier: NCT04694287 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Prince et al this issue.

Published
2024
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