bluuebunny/crossref_metadata_2025 huggingface dataset:
#6829 DIFFERENTIAL LIPIDIC PROFILE WITH THE USE OF CITRATE OR ACETATE DIALYSATES
Authors: Monzo Jose Jesus Broseta , Rodríguez Diana , Cuadrado Elena , Romero Luis Carlos López , Granell Sergio Bea , Jaras Julio Hernandez
Published: June 2023

Background and Aims

Unlike other high-cardiovascular-risk populations, the efficacy obtained from lipid-lowering therapy remains uncertain in dialysis-dependent chronic kidney disease (DD-CKD) patients. This is probably given to the exclusion in clinical trials of patients with very high LDL levels, their population's heterogeneity, accompanying cardiovascular morbidities, and the higher mortality risk explained partly by chronic inflammation. The latter has been associated with the accumulation of uremic toxins, membrane biocompatibility, and acetate-based dialysates, which promote inflammation. Different dialysate weak acidifying agents such as lactic, pyruvic, hydrochloric, or citric acids have surged as less-inflammatory alternatives to acetate. This study aims to evaluate the effects of the metabolism of acetate and citrate in the lipidic profile of DD-CKD patients.

Method

In a unicentric, cross-over, prospective study, we compared the lipidic profile by assessing the plasma levels of total cholesterol (TC), low-density lipoprotein (LDL), triglycerides (TG), high-density (HDL) and very low-density (VLDL) lipoprotein cholesterol, and lipoprotein (a) [Lp(a)] comparing the use of citrate (CD) vs. acetate (AD) as dialysate buffers, after twelve sessions with each one. Prealbumin was also measured to rule out malnutrition as a potential confounding factor. Prevalent (i.e., dialysis vintage ≥3 months) adult patients on maintenance hemodialysis were included. The dialysis prescription parameters and additional medical treatments remained unchanged during their sessions with both dialysates. Quantitative variables are reported with mean and standard deviation. Normal distribution was assessed with the Shapiro-Wilk test, and the comparisons were made with the Student's paired T-test or Wilcoxon's signed-rank test, accordingly. A two-sided p-value ≤0,05 was considered statistically significant.

Results

After twelve dialysis sessions with CD, compared to AD, there was a statistically significant decline in TG and HDL and an increase in LDL. There was also a notable but non-significant reduction in VLDL (Table 1).

Conclusion

There were noteworthy differences in the lipid profile that can only be attributed to the change of dialysis fluid, as we avoided inter-individual (with a cross-over design) and intra-individual (different inflammatory or nutritional profiles would not be expected with this short-term setting) variabilities. Further studies must elucidate if the short-term changes induced in the lipidic profile of DD-CKD patients by the dialysate's weak acid translate into clinical implications.
#6837 ASSOCIATION BETWEEN SELF-REPORTED FATIGUE AND THE NEED FOR RECOVERY TIME AFTER THE MAINTENANCE HEMODIALYSIS SESSION: PROHEMO
Authors: Peredo Gabriel Brayan Gutierrez , Martins Márcia Tereza Silva , Da Silva Fernanda Albuquerque , Lopes Marcelo , Lopes Gildete Barreto , Lopes Antonio Alberto
Published: June 2023

Background and Aims

Fatigue and the need for recovery time after a hemodialysis session are frequent complaints in patients with chronic kidney disease treated with maintenance hemodialysis (MHD). In the present study, we investigated whether there is an association between self-reported fatigue and the need for recovery time after HDM sessions.

Method

This is a cross-sectional study with data from 239 adult patients participating in the prospective cohort study “Prognostic Study of Patients on Chronic Hemodialysis” (PROHEMO), developed in Salvador, BA, Brazil. We used “The Chalder Fatigue” questionnaire (CFQ-11) to calculate fatigue scores. CFQ-11 scores can range from 0 to 33; Higher scores mean more intense fatigue. Fatigue was categorized as: absent or mild if the score was <4 and moderate to severe if the score was ≥4. To assess the need for recovery time from hemodialysis, participants answered a question: After finishing dialysis, do you usually need some time to recover? with two answer options (yes or no). We used logistic regression to estimate the odds ratio (OR) of the association between fatigue and need for recovery after hemodialysis, with adjustments for age, sex, diabetes, and heart failure.

Results

The mean age was 52.5 ± 12.5 years, 57.7% were men, 94.5% were non-white. Self-reported fatigue as absent or mild was 28.4% (68/233) and moderate to severe fatigue was 71.5% (171/233). The prevalence of need for recovery time after hemodialysis was 2.5 times higher in patients with moderate to severe fatigue (prevalence: 51.5%) than in patients with no or mild fatigue (prevalence: 20.6%); prevalence ratio: 2.50 (95% confidence interval: 1.53; 4.08). In logistic regression, an association between moderate to severe fatigue and need for recovery was observed even after adjusting for the effects of age, sex, diabetes, and heart failure (OR = 4.36; 95% CI: 2.21; 8.59).

Conclusion

The results suggest that patients who report a more intense degree of fatigue, more often have a greater need for time to recover after the end of the hemodialysis session. It is interesting to investigate whether interventions that reduce fatigue in patients undergoing MHD treatment result in a reduction in the need for recovery time after the hemodialysis session.
#6861 FABRY DISEASE: A DESCRIPTIVE STUDY OF A COHORT OF PATIENTS
Authors: Pablos Nuria García , Garofano Remedios , Gomez Carlos , Gonzalez Francisco
Published: June 2023

Background and Aims

Fabry disease is a rare X-linked disease, caused by deficient activity of the lysosomal enzyme α-galactosidase A. Accumulation of globotriaosylceramide leads to organ failure and premature death. The aim of this study is to describe the population of patients with Fabry disease in our healthcare area.

Method

Descriptive observational study of patients with Fabry disease (n = 23). Demographic, clinical and treatment variables were analysed.

Results

The mean age of the patients was 47.5 years; 70% female. Symptom onset was at 18 years, being diagnosed 25 years later, similar to that described in the literature. Enzyme deficiency was observed in 61% of patients. Four types of pathogenic variants of the GLA gene were detected. The most prevalent was P205S,followed by W262X,V199G,G80D. The phenotype was classical (V199G, W262X) or late (P205S, G80D).48% of the patients had left ventricular hypertrophy (55% women). 48% had right bundle branch block, atrial fibrillation and sinus bradycardia.47% (64% women) had renal involvement, defined by proteinuria. Other manifestations: hypoacusis (17%), acroparaesthesia and neuropathic pain (13%), ophthalmological (13%) and dermatological (4%).22% were treated with ACE inhibitors/ARA II.1 patient received iSGLT2.Other complementary treatments: statins (22%), antiaggregants (13%), anticoagulants ACOD (1 patient). Regarding specific treatment, 43% were treated, the majority (39%) received enzyme replacement therapy with agalsidase beta (only 1 patient with agalsidase alpha), one patient received migalastat.

Conclusion

The characteristics of our patients are similar to those described in the literature. We observed a predominant general involvement in women, in contrast to other series. Cardiac involvement predominates with left ventricular hypertrophy, and renal involvement with proteinuria.The diagnostic delay is similar to that described, emphasizing the need for early diagnosis and treatment to avoid severe complications and death.
#6863 MANAGEMENT AND OUTCOMES OF SEPSIS ASSOCIATED ACUTE KIDNEY INJURY IN CRITICALLY ILL PATIENTS
Authors: Naouaoui Salma , Chettati Mariam , Fadili Wafaa , Laouad Inass
Published: June 2023

Background and Aims

Sepsis-associated acute kidney injury (AKI) remains a major cause of mortality in patients with critical illness and has an especially high health-related burden in developing countries. However, only a few clinical studies have focused on the clinical characteristics and prognosis of septic AKI, especially in low-income settings. Therefore, the aim of our study was to describe the clinical profile, management and outcome of critically ill patients with sepsis associated AKI.

Methods

A retrospective observational study of critically ill patients with septic AKI was performed from March 2020 to June 2021 at our university hospital. Sepsis was diagnosed clinically by the presence of acute infection and new organ dysfunction. The presence of AKI was evaluated using the Acute Kidney Injury Network (AKIN) criteria. Patients with preexisting ESRD and those who did not fulfill at least one predefined criterion for AKI were excluded.

Results

A total of 105 patients with a median age of 58.9 years (31-78) were enrolled, including 69 and 36 patients with persistent and transient AKI, respectively. The mean SAPS II score was 51.8 (38-77). The primary source of sepsis was mainly abdominal (42.8%). AKI was defined by oliguria in 18 patients (17.1%), by creatinine elevation in 65 patients (61.9%), and by both criteria in 22 patients (21%). Septic AKI was associated with great aberrations in hemodynamics, with 71 patients (67.6%) requiring vasoactive therapy and 65 patients (61.9%) requiring mechanical ventilation. AKI severity according to the AKIN classification scheme was determined to be stage 1 in 32 patients (30.5%), stage 2 in 22 patients (20.9%), and stage 3 in 51 patients (48.6%). Overall, 75.2% of the cohort required renal replacement therapy (RRT). Hospital survival was 63.8% (n = 23) in patients with transient AKI and 43.5% (n = 30) in patients with persistent AKI.

Conclusion

Sepsis is the main cause of AKI in intensive care units, accounting for up to 50% of cases. Our results suggest that septic AKI is associated with higher disease severity scores at admission, requirement of vasoactive drugs, need for mechanical ventilation and increased hospital mortality. Further studies are required, especially in developping countries, to implement more preventive measures and therapeutic interventions to decrease CKD progression and mortality in these patients.
#6866 FRENCH EXPERIENCE OF HOME HEMODIALYSIS PATIENTS TREATED WITH NXSTAGE HAEMODIALYSIS CYCLER WITH THE PURE FLOW SL SYSTEM
Authors: Hebibi Hadia , Berthy Fabien , Attaf David , Ridel Christophe , Stephane Edet
Published: June 2023

Background and Aims

NxStage haemodialysis cycler with the Pure Flow SL system was introduced for the first time in France in June 2022. This system is designed to produce an ultrapure dialysis fluid and mixing a concentrate to the source water to prepare 60 L batch of dialysate. It can be used for a maximum of 3 home treatments. No major plumbing modifications are required to install this system at home. Here, we report to our knowledge the first French clinical evaluation of the use of the Pure Flow system in haemodialysis patients using this device and trained in NephroCare Villejuif haemodialysis center and Rouen Hospital.

Method

This retrospective study was performed in a cohort of 8 hemodialysis patients From June 2022 to January 2023. We describe the clinical benefits of Pure Flow including data on demographic, dialysis vintage, and short-term biological parameters. Patient related outcomes based on a specific questionary, at 3 and 6 months are also analyzed

Results

8 patients were included with 5 women. The mean age was 48 years. The dialysis vintage was 24 months. The median follow-up was 4 months. 2 Patients were treated by pre-mixed 5L dialysate bags 6 months prior the implementation of Pure Flow, and 6 patients started the hemodialysis program directly with Pure Flow after a period of 10 days of training. We show that PF provide adequate dialysis dose. The mean stdkt/v was 2.3. The mean of weekly dialysate volume was 146L.We note optimal ultrafiltration rate, improvement of biological markers of adequacy. Moreover, good results technique survival was recorded. We also show Reduced handling, and setup

Conclusion

The NxStage with Pure Flow system is a major advantage against the premixed bags with a simple installation and a low water consumption. Its use is associated with great clinical outcomes in patients. The Pure Flow should reduce shipments and storage of dialysis treatments and facilitate the development of home hemodialysis in France. Prolonged follow-up on a cohort with a larger number of patients is necessary and will allow an appropriate evaluation of the clinical benefice of the use of the Pure Flow.
#6871 RISK FACTORS FOR SHORT-TERM CHRONIC KIDNEY DISEASE AFTER ACUTE KIDNEY INJURY WITH RECOVERY OF NORMAL RENAL FUNCTION
Authors: Mahmoud Nouha Ben , Lahouimel Rania , Hammouda Mouna , Salem Meriem Ben , Salah Manel Ben , Letaief Ahmed , Sabra Aloui , Skhiri Habib
Published: June 2023

Background and Aims

Acute kidney injury (AKI) is a clinico-biological syndrome encompassing the entire spectrum of acute renal failure that is responsible for a higher short-term risk of developing chronic kidney disease (CKD) even after recovery of normal renal function. The risk of developing new CKD has been estimated at 4 times that of the population without an episode of AKI in several studies. Our objective was to identify its risk factors

Method

We conducted a retrospective descriptive study that included patients hospitalized for AKI with recovery of normal renal function between January 2002 and December 2015 who were followed up to one year after discharge. In order to achieve our objective, we collected data related to the patients' age, history, multitargeted or not, mechanism of AKI, KDIGO stage, glomerular filtration rate (GFR) at hospital discharge, using a pre-designed form.

Results

In the short term, 176 patients were followed up, among whom 18 patients (10.2%) had developed CKD with a mean delay of 9.07±0.4 months. Patients reaching CKD stage were older, half were over 70 years old, 61% were diabetics; 13 of them were multitargeted and 15 had a GFR < 60 ml/min at discharge. All these parameters were statistically different from patients who did not progress to CKD. However, regardless of the mechanism of AKI or the KDIGO stage selected, these two parameters were not retained as risk factors for the development of CKD. In multivariate analysis by logistic regression, only being an elderly subject remains a significant risk factor (p = 0.034) of developing short-term CKD with an OR of 3.3; 95% CI (1.09 - 10.01)

Conclusion

Our results suggest that the development of CKD occurred most often in the first year following an episode of AKI, hence the interest in following these patients.
#6879 ASSOCIATION OF THE BERDEN CLASSIFICATION AND THE PROGNOSIS OF ANCA VASCULITIS
Authors: Mahmoud Nouha Ben , Ghabi Faten , Salem Meriem Ben , Salah Manel Ben , Letaief Ahmed , Hammouda Mouna , Sabra Aloui , Skhiri Habib
Published: June 2023

Background and Aims

ANCA-associated vasculitides (AAVs) are systemic diseases characterized by inflammatory involvement of the small vessel wall, and renal involvement is frequent and severe. The new Berden histo-pathological classification established in 2010 has made it possible to classify ANCA-associated glomerulonephritis (GAA) into focal, mixed, cellular, and sclerotic forms in order to better guide the therapeutic management and to assess the prognosis. The aim of this work was to evaluate the prognostic value of this anatomopathological classification.

Method

We conducted a single-center retrospective descriptive and analytical study of patients diagnosed with histologically confirmed GAA in our Nephrology Department during the period from 2016 to 2022.

Results

We collected 20 patients, median age 52 years [21-77 years]. The sex ratio (M/F) was 0.8. Histological confirmation of GAA was based on renal biopsies in 100% of cases. Rapidly progressive glomerulonephritis was the nephrological presentation in 15 patients. One patient had no hematuria and one had no proteinuria and renal failure was present in all cases. Good Pasture syndrome was present in 7 cases. The Berden classification was applied to the 20 renal biopsies: the focal form (2 cases), the cellular form (7 cases), the mixed form (7 cases) and the sclerotic form (4 cases). The evolution was marked by a partial remission for 11 patients. After an evolution of 1 year, end-stage renal failure (ESRD) was retained in 13 patients. The sclerotic form was not associated with a poor prognosis in our population (p = 0.642).

Conclusion

Of course, our sample size was small and in our population we found a predominance of the mixed and cellular forms compared to the sclerotic form, contrasting with poor therapy with a rapid evolution towards CKD.
#6881 ELEVATED LEVELS OF THE C5B9 TERMINAL COMPLEMENT COMPLEX IN PATIENTS RECEIVING RENAL REPLACEMENT THERAPY
Authors: Nordbø Ole Petter , Tam Ga Kei , Osman Tarig Al-Hadi , Marti Hans-Peter , Mollness Tom Eirik , Leh Sabine
Published: June 2023

Background and Aims

The complement cascade and its inhibitors play an important role in health and disease. Complement activation represents a key pathogenic mechanism underlying inflammatory diseases affecting the kidney. The study aimed to investigate the C5b9 system in renal biopsies, where we stained all obtained kidney biopsies from the year 2017 (n = 256).

Method

Antibody staining against terminal C5b9 was performed, and a C5b9 score for each glomerulus (n = 1942) was generated based on automated image analysis. Mean scores for the interstitium, tubules and blood vessels, and whole biopsy sections were also calculated.

Results

Globally and segmentally, sclerosed areas in glomeruli stained much stronger than their non-sclerosed glomerular counterparts. The results were linked with Renal Replacement Therapy (RRT) status and clinical data from the Norwegian Kidney Biopsy Registry. The study's main findings were that elevated levels of C5b9 were present in patients on RRT in glomeruli, blood vessels and whole section staining. Fibrillar glomerulopathy and Membranous Glomerulonephritis had the highest C5b9 scores, while glomeruli from Hypertensive Nephrosclerosis were represented with a low score. C5b9 scores correlated weakly or non-significantly with clinical variables like age, blood pressure and eGFR. The degree of fibrosis showed an associated positive correlation to C5b-9 staining intensities. Additionally, patients with an elevated C5b9 score (from the 50th percentile and above) showed a significantly elevated risk of receiving RRT within 60 months of biopsy.

Conclusion

C5b9 levels were significantly elevated in sclerotic glomeruli as well as in patients receiving RRT. A weak correlation between C5b9 scores and clinical variables for renal function suggest that the C5b9 complement system may be an independent effector in CKD.
#6891 MACHINE LEARNING NEPHROPATHOLOGY DIAGNOSTICS OF THROMBOTIC MICROANGIOPATHIES
Authors: Cicalese Pietro Antonio , Rizvi Syed , Seshan Surya V , Sciascia Savino , Roccatello Dario , Barreca Antonella , Schroeppel Bernd , Kar Nicole Van De , Roelofs Joris , Kers Jesper , Mohan Chandra , Nguyen Hien , Becker Jan Ulrich
Published: June 2023

Background and Aims

Thrombotic microangiopathies, comprising atypical hemolytic uremic syndrome (aHUS) and other diseases, can present with a broad clinical and histopathological spectrum. On our way to an evidence-base for the nephropathological work-up of TMAs, we have chosen a machine-learning approach, thus eliminating suboptimal reproducibility of descriptors for individual lesions in the three decisive compartments artery, arteriole and glomerulus with human experts. Here, we present our results for an end-to-end diagnostic system.

Method

We collected 50 random biopsies with TMAs of various etiologies (including aHUS, hypertension-associated, systemic sclerosis, anti-phospholipid antibody syndrome and others) and 50 biopsies with Mimickers (differential diagnoses of TMA), including severe hypertensive nephropathy, necrotising arteritis/arteriolitis, cryoglobulinemic vasculitis from the three participating centers Cologne, Weill-Cornell Medical Center, and Turin. Whole slide images (WSIs) from all four nephropathology stainings HE, PAS, trichrome and Jones were included in this study. We developed an instance segmentation Mask-RCNN model with a Swin Transformer (t) backbone on tissue crops detected using a lightweight variant of the U-Net segmentation architecture. For the classification model we used our own MorphSet++ set transformer architecture to process batches of EfficientNetv2s-encoded tissue crops entered in three separate compartment channels. Batches were chosen with Monte Carlo sampling or using our own soft Markov Chain Monte Carlo (MCMC) approach. Results of the classification model are reported with 5-fold internal cross-validation.

Results

Segmentation performance measured as mIOU, mAP, mAR, mF1, mAS for artery reached 0.565, 0.739, 0.679, 0.704, 0.995, for arteriole 0.342, 0.531, 0.488, 0.490, 0.996, for glomeruli 0.818, 0.880, 0.919, 0.896, 0.993. Classification accuracy reached 90% with no false positives for TMA. Missed cases of TMA could be salvaged by an experienced nephropathologist on the display of decisive compartment crops, which were selected using model confidence averaged across each sampling iteration.

Conclusion

We have designed and trained architectures capable of segmenting decisive compartments and diagnosing TMAs on renal biopsy sections. This will enable automatic analysis of clinicopathological datasets with TMA in large cohorts. Our ultimate goal is to use large cohorts from collaborating institutions for weakly supervised, case-level-annotated training of diagnostic, prognostic and theranostic classifiers.
#6899 MICROVASCULAR LESIONS IN LUPUS NEPHRITIS
Authors: Knezevic Tamara , Padjen Ivan , Ivkovic Vanja , Laganovic Mario , Bulimbasic Stela , Lukač Ana , Ćorić Marijana , Anić Branimir
Published: June 2023

Background and Aims

Microvascular lesions (MVL) can be found in the kidneys of lupus nephritis (LN) patients and might be associated with worse outcomes. There are very few studies which evaluated MVLs in these patients and we aimed to provide a comprehensive evaluation of all MVLs, their frequency, characteristics and association with renal outcomes one year after kidney biopsy.

Method

We have conducted a retrospective cohort study to evaluate the characteristics and prognostic significance of MVLs in the kidney of subjects with LN. We have collected data on demographics, clinical and laboratory parameters and histopathology (light, immunofluorescent and electron microsopy). MVLs were characterized according to previous classifications. SLE was diagnosed using the American College of Rheumatology criteria.

Results

A total of 56 patients with biopsy-proven LN were followed up for at least one year after kidney biopsy (79% women, mean age at biopsy 38±13 years). Forty patients (71%) had MVLs in the kidney. The most common MVLs were arteriolar endotheliocyte swelling (54%), arteriolar hyalinosis (25%) and endothelialitis (8%) and the frequency distribution of all microvascular lesions is shown in Figure. Median number of lesions in the MVL group was 1 (interquartile range 1 to 2) and subjects had up to 6 MVLs. There was no difference in the median number of MVLs across LN classes (p>0.05). Proteinuria was highest in class V (5.5 g/day, p = 0.06 vs. all other classes). Subjects with MVLs had lower baseline proteinuria compared with those with no lesions (3.6 vs. 5.4 g/day, p = 0.037), but there was no difference in serum creatinine (92 vs. 119 umol/L, p = 0.25). There were no differences in the occurrence or number of MVLs across LN classes (p = 0.63). The number of MVLs was not correlated with proteinuria (p>0.05). There was no difference in the frequency of proliferative lupus between MVL and no MVL groups (79% vs. 60%, p = 0.15). A total of 48% of subjects achieved complete response (CR), 27% achieved partial response (PR) and 25% had no response (NR). MVLs were not associated with response (defined as CR or PR) in a multivariate regression model (OR 3.5 [0.5, 24.6]).

Conclusion

MVLs are common in LN. They were associated with lower baseline proteinuria, but not with proliferative LN or renal outcomes. The association with proteinuria warrants further research.
#6915 IMMUNOLOGIC EFFECTS OF THE DECREASE OF IMMUNOSUPPRESSION AFTER SARS-COV-2 INFECTION IN KIDNEY TRASPLANT RECIPIENTS
Authors: Urrutia Marina , Paúl Javier , Gomez Maria Molina , Riera Josep , Fugasot Carles Cañameras , Perezpaya Ines , Taco Omar , Gelpi Rosana , Casas Angela , Cañas Laura , Rodriguez Rosely , Bover Jordi , Vila Ana
Published: June 2023

Background and Aims

The decrease of immunosuppression (IS) in kidney transplant (KT) recipients with SARS-CoV-2 infection was proposed during the first years of the pandemic due to the lack of knowledge of the course of the infection and the absence of vaccines and specific treatment. The effects of this decrease are being assessed in a medium-long term.

Method

Unicentric retrospective study that included 19 patients with a kidney biopsy after a SARS-CoV-2 infection (120 days). We measured acute kidney injury (AKI) after de infection, decrease in the IS during the infection, rejection episodes and renal function evolution during 24 months after the infection.

Results

The studied group was constituted by 19 patients from which 57.9% (11/19) men, age 56 (51, 70), being the first KT in 78.9% (15/19) of them. The IS induction was in a 57.9% (11/19) Basilximab and in a 42.1% (8/19) thymoglobulin, and the usual IS of all of them was done with prednisone, tacrolimus and mycophenolic acid. There was a graft loss in 26.3% (5/19), being all of immunologic cause, and 10.5% (2/19) of patients died. The severity of the SARS-CoV-2 infection was different between patients (21.1% (4/11) asymptomatic, 47.1% (9/19) mild respiratory symptoms, 5.3% (1/19) severe pneumonia not requiring critical care unit and 26.3% (5/19) severe pneumonia requiring critical care unit, with a decrease in IS in a 42% (8/19) of patients (steroids in monotherapy in a 31.6% (6/19) and bitherapy with steroids and tacrolimus in a 10,5% (2/19), to achieve 5-7ng/mL blood levels). AKI was found after the first month after the infection in a 57.9% (11/19) of patients, being in a 42% (8/19) AKI KDIGO1 and in a 16% (3/19) AKI KDIGO3. Renal function kept worsening until the sixth month after the infection [CKDEPI before SARS-CoV-2 37mL/min (32, 45) vs CKDEPI 6months after 34mL/min (22, 48.3); p = 0.3]. There was an improvement in renal function in 12 months after the infection (38mL/min (25, 48)). Acute graft rejection was detected in renal biopsies after the infection in 31.6% (6/19) being cellular in 15.8% (3/19), humoral in 10.5% (2/19) and mixed in 5.3% (1/19), de novo DSA were found in 15.8% (3/19).

Conclusion

The decrease in IS after SARS-CoV-2 in KT recipient has an elevated immunologic price. Glomerular filtrate rate decreases after 6 months from infection with a recovery at 1 year.
#2502 THE FREQUENCY AND RISK FACTORS OF NODAT AND ELECTROLYTE DISORDERS IN KIDNEY TRANSPLANT PATIENTS
Authors: Başdoğan Elif , Başdoğan Servet , Paydas Saime , Kaya Bülent , Sertdemİr Yaşar
Published: June 2023

Background and Aims

The purpose of the study is to investigate at the incidence and risk factors for post-transplant diabetes mellitus (PTDM) in non-diabetic kidney transplant patients (KTrs).

Method

The study included 120 KTRs who did not have diabetes in the pretransplant period. The diagnosis of PTDM was made according to the 2003 ADA DM diagnostic criteria. The relationship between PTDM and clinical and laboratory data on the 0th, 1st, 3rd, 6th, 12th and 24th months was investigated.

Results

The mean age of the patients was 33.3±11.5 years, 65% (78) of them were male. PTDM was developed in 29.1% (35) and 80% of PTDM at first 3 months. The risk factors for PTDM were found to be older (4.4%), family history of diabetes mellitus (5.24 times), beta-blocker use (2.55 times). KTRs with and without PTDM; Pretransplant dialysis type (Hemodialysis (P=0.822) and Peritoneal dialysis (P = .583)), living donor (101/84.2%)/cadaveric donor (19/ 15.8%), donor age and gender were similar. Serum magnesium and potassium were different only in the first month between the groups with and without PTDM (P = .019 and 0.008 respectively). The negative effect of PTDM on GFR was not observed in the 2-year follow-up.

Conclusion

It can be predicted that diabetes mellitus may develop with a family history of diabetes, advanced age and the use of beta-blockers. The risk of developing PTDM is higher in the first 3 months and hypomagnesemia in the first month may contribute to diabetes development.
#2515 GENDER DIFFERENCES IN KIDNEY TRANSPLANTATION: A 10-YEAR RETROSPECTIVE STUDY
Authors: Dedinska Ivana , Graňák Karol , Vnučák Matej , Beliančinová Monika , Kleinova Patricia
Published: June 2023

Background and Aims

Chronic kidney disease represents a world-wide health problem, affecting approximately 195 million women around the world. Risk of development of chronic kidney disease is greater in women in comparison to men.

Method

We retrospectively analysed cohort of 1457 patients after kidney transplantation from all transplant centres in Slovakia over period of ten years from 2010 – 2020. Parameters taken into account were cause of end-stage renal disease (ESRD), outcome of transplantation in a context of differences between the genders.

Results

Out of 1,457 patients, 557 (517 primary transplantation) were women, 900 (831) men. Primary causes leading to end-stage renal disease (ESRD) in female recipients where we observed a statistically significant difference between genders were tubulointerstitial nephritis (32.1% in females vs. 22.3% in males, p<0.0001), autosomal dominant polycystic kidney disease (17.6% vs. 11.6%, p = 0.0013), and systemic lupus erythematosus (2.3% vs. 0.2%, P = .0001). In male recipients native kidneys were more frequently affected by glomerulonephritis (38% vs. 25.7%, p<0.0001), nephropathy as a complication of type 2 diabetes mellitus (7.8% vs. 4.1%, p<0.0001), and IgA nephropathy (2.9% vs. 1.1%, P = .0232). There were no statistically significant gender differences in other causes of ESRD. However, there was no significant difference in time spent on dialysis between female and male recipients (39.4 ± 39 months vs. 35.8 ± 33.2 months, p>0.05), female recipients waited for a kidney transplant significantly longer (32.9 ± 27.4 months vs. 39.4 ± 31.5 months, p<0.0001). Overall death-censored graft survival rates in our cohort in female and male recipients were after 12 months 91.2% vs. 93.1%, p=NS, 5 years 80.7% vs. 82.6%, p=NS, and 10 years 60% vs. 66.7%, p=NS (Fig. 1). After 12 months, 5 and 10 years, the overall patient survival rates among female vs. male recipients were 96.8% vs. 97.1%, p=NS; 89.9% vs. 88.9%, p=NS; and 72.9% vs. 76%, p=NS (Fig. 2), respectively.

Conclusion

Despite comparable patient and graft survival rates in male and female recipients in our study, there are other studies showing that gender, as well as gender mismatch significantly influence outcomes of transplantation.
#2538 HEALTHY PLANT-BASED DIET IN CHRONIC KIDNEY DISEASE THROUGH USE OF SODIUM ZIRCONIUM CYCLOSILICATE (HELPFUL TRIAL): LABORATORIAL FINDINGS
Authors: Avesani Carla Maria , Heimbürger Olof , Sallstrom Torsten , Danielsson Awa , Rubin Charlotta , Irving Gerd Faxen , Lindholm Bengt , Stenvinkel Peter
Published: June 2023

Background and Aims

Patients with chronic kidney disease (CKD) and hyperkalemia (HK) are counselled to follow a diet restricted in potassium (K) which limits the intake of fruits and vegetables. This is a cause of complaints for many patients. The use of the K lowering medication sodium zirconium cyclosilicate (SZC) has the potential to treat HK and allow a healthy plant-based diet (PBD). We designed a clinical trial to explore the safety and feasibility of prescribing a healthy PBD to CKD patients with HK with the concomitant use of SZC.

Method

The HELPFUL trial is an ongoing single-arm study with patients with CKD stage 4-5 not on dialysis and with plasma K between 5.1 to 6.5 mmol/L at inclusion. Patients are followed for 6 weeks. In the first 3 weeks, SZC is prescribed to normalize plasma K (pK) while ingesting a low protein diet with low K+ content. In the subsequent 3 weeks, a healthy PBD with a target K intake of 3700 mg/day is prescribed maintaining the use of SZC. A food basked with the PBD is delivered to the participants weekly. A weekly monitoring of pK and titration of SZC to keep normokalemia is performed. Other laboratorial measurements and food intake are assessed at baseline, week 3 and week 6. Food intake is evaluated using the 24-hour food record (24HFR). Data was analyzed by repeated measures-ANOVA or by Friedman test for related samples, as appropriate. The protocol is registered at www.clinicaltrials.gov (identifier NCT04207203).

Results

22 patients were included (59±13 years; 13 men, 59%). Table 1 describes the main findings. During the study, eGFR did not change, serum urea decreased, and P-carbon dioxide increased significantly. Inflammatory markers, 24hour urinary sodium and K excretion did not change. Potassium intake from 24h-FR increased, as well as the intake of fruits, vegetables and nuts after the PBD. The mean pK normalized in week 3 and 6. After the start of PBD, 3 patients (13.6%) had pK between 5.1 and 5.3 mmol/L. Most patients needed SZC dose of 10g/day. No changes were observed in dose of RAAS.

Conclusion

The strategy of PBD food basket with concomitant use of SZC allowed an increase in dietary K intake with higher intake of fruits, vegetables and nuts. P-carbon dioxide, a surrogate of bicarbonate improved as well. The pK was kept withing normal values for most of the patients.
#2649 INFECTIOUS COMPLICATIONS AFTER KIDNEY TRANSPLANTATION IN RELATION TO INDUCTION IMMUNOSUPPRESSIVE THERAPY
Authors: Vnučák Matej , Graňák Karol , Beliančinová Monika , Kleinova Patricia , Dedinska Ivana
Published: June 2023

Background and Aims

Infections are the most common non-cardiac cause of death after kidney transplantation (KT). The main goal of immunosuppressive therapy is to find a balance between the low incidence of acute rejection and infectious complications.

Method

We conducted a retrospective, monocentric analysis of transplant patients at the Transplant Center University Hospital Martin from 2011 to 2020 with various induction immunosuppressive therapies. We monitored the incidence of infections in terms of etiology, localization and severity at different intervals after KT.

Results

Our study included 39 patients on induction therapy with basiliximab to whom we paired 39 patients with induction therapy with thymoglobulin based on gender and age, in total our population consisted of 78 patients (56 men, 22 women), the mean age was 45 years. In the group of patients with induction therapy with thymoglobulin, we noted a higher proportion of fungal (P=0.0409), urogenital infections (P=0.0384), sepsis (P=0.0497) and leukopenia (0.0384) from 1st to 6th month after KTx, higher incidence of skin infections (P= 0.0218) and serious infections requiring hospitalization (P = 0.0269) from 6th-12th months to TO. On the other hand, in the basiliximab patient group, we identified a higher incidence of acute humoral and cellular rejection (P=0.0218) after 6 months of TO. From the perspective of recurrent infections, in the Thymoglobulin induction group, we noted a higher incidence of infections by localization, etiology and severity. Risk factors for recurrent bacterial infections from 1st to 6th month after KT are: history of respiratory diseases (P = 0.0108), thrombocytopenia (P = 0.0104) and infections caused by multi-resistant bacteria (P = 0.0003).

Conclusion

Patients on inductive immunosuppressive therapy with thymoglobulin are at a higher risk of recurrent, multidrug-resistant and severe infections after KT compared to induction with basiliximab with identical maintenance immunosuppressive therapy. On the other hand, patients on induction therapy with basiliximab have a higher risk of developing acute rejection. Therefore, it is essential to identify risk groups of patients benefiting from milder or more intensive inductive immunosuppressive therapy without a concomitant increased risk of infectious complications or acute graft rejection
#2871 BRAIN NATRIURETIC PEPTIDE LEVEL IN CHRONIC EGYPTIAN HEMODIALYSIS PATIENTS: ITS RELATION TO VENTRICULAR FUNCTION AND VOLUME STATUS
Authors: Sabry Alaa , Elsaeed Rana , Ali Shaahat , Lotfy Zakarial
Published: June 2023

Background and Aims

Volume overload is major problem in chronic hemodialysis patient and BNP level is related to volume status of the patient .

Aims

To assess BNP level in hemodialysis patient before and after HD session and to study its role as a marker for volume overload in hemodialysis patient depending on clinical findings and echocardiography parametershemodialysis.

Method

The study was conducted on 50 patients of Nephrology and hemodialysis unit, Mansoura University Hospital. Our patients were classified according to left ventricular mass index (LVMI) into patients with left ventricular hypertrophy (LVH)(35 patients) and patients without LVH (15 patients). We classified our patients into another two groups according to predialysis BNP level to group with BNP level˃100pg/ml(33 patients) which was associated with cardiac dysfunction and group with BNP level˂100pg/ml (17 patients).

Results

In the present study, the median of pre-dialysis BNP level was 126 pg/ml and the median of post- dialysis BNP was 25 pg/ml, this demonstrate that BNP plasma level decline after the hemodialysis session.

Among The studied patients, the mean of predialysis systolic BP in patients with high BNP level ˃100 pg/ml is (155.65) higher than patients with low BNP level˂100 pg/ml .

The incidence of lower limb edema, congested neck veins and chest crepitations was high in the group with BNP level (˃100 pg/ml) when compared with BNP level (<100 pg/ml). In the present study, according to ROC curve, predialysis BNP level may be a marker for lower limb edema with cutoff point (140.8) pg/ml with (85%) sensitivity and (77%) specificity and shows that the best cutoff point of predialysis BNP level in prediction of neck veins is (40.4) pg/ml with (94%) sensitivity and(28%) specificity and shows that the best cutoff point of predialysis BNP level in prediction of chest crepitation is (42.8) with (82%) sensitivity and (30%) specificity .

Conclusion

In Egyptian hempodialysis patients, there is a negative correlation between BNP predialysis and weight pre and post dialysis.There is significant correlation between BNP postdialysis and systoilc BP predialysis, RVD and COP. There is signifcant correlation between delta BNP and systoilc BP predialysis and ultrafiltration volume.
#2954 DAPAGLIFLOZIN IN IGA NEPHROPATHY: EARLY EXPERIENCE FROM A SINGLE CENTER IN CENTRAL INDIA
Authors: Balwani Manish , Godhani Umesh , Pasari Amit , Bhawane Amol , Tolani Priyanka , Dubey Shubham
Published: June 2023

Background and Aims

IgA nephropathy (IgAN), a common glomerulopathy, may progress to end- stage kidney disease despite use of optimum treatment with immunosuppressants and renin- angiotensin aldosterone system antagonist. Recently, dapagliflozin (DAPA) has been shown to reduce the progression of kidney function decline in IgAN. The beneficial effects in kidney function could be because of reduction in the intraglomerular pressure. To assess the kidney function in terms of change in estimated glomerular filtration rate (eGFR) and urinary protein creatinine ratio (UPCR) with use of DAPA in patients with IgAN.

Method

We retrospectively collected the data of IgAN patients from our electronic database. Demographic, renal function parameters and biopsy findings were collected and compared in patients who received immunosuppression only (group I) and those who received DAPA in addition to immunosuppression (group II).

Results

We identified a total of 150 patients with IgAN from our database. Among these, 59 (39.3%) were managed conservatively whereas 91 (60.7%) were receiving immunosuppressive (steroid+/- mycophenolate mofetil) treatments. Among these, 67 (73.6%) received immunosuppression treatment alone (group I) whereas 24 (26.4%) patients received DAPA along with immunosuppression (group II). The mean age was 34.8±10.7 years and 36.7±9.4 years in groups I and II respectively. Proportion of males was 68.7% and 70.8% in two groups. At baseline, the renal function parameters such as serum creatinine, eGFR and UPCR as well as MEST-C scores were comparable in both the groups (p>0.05 for all three parameters). After a median follow-up of 4.9 months (IQR25-75: 1.6 to 13.4 months) in the group I, the improvement in eGFR (P = .065) and reduction in UPCR (P = .778) did not reach statistical significance. After a median follow-up of 3.9 months (IQR25-75: 1.1 to 12.3 months) in the groups II, there was non-significant improvement in the eGFR but the reduction in the UPCR was significant (median 2.6 [IQR25-75: 13 to 3.8] to 1.9 [IQR25-75: 0.7 to 2.6], P = .041).

Conclusion

Our initial experience in patients of IgA nephropathy suggests that the addition of DAPA to existing immunosuppressive treatment is useful in reducing the UPCR in short-term.
#2968 PROGNOSIS OF CRESCENTIC GLOMERULONEPHRITIS IN ADULTS
Authors: Ciurea Otilia , Marasescu Adela , Petre Nicoleta , Mircescu Gabriel , Capusa Cristina-Stela
Published: June 2023

Background and Aims

Crescentic glomerulonephritis (C-GN) is characterized by severe glomerular inflammation and injury that leads to crescent formation, rapid loss of kidney function and severe prognosis in absence of prompt immunosuppressive therapy. Depending on the histological findings, there are three main types of C-GN: anti-glomerular basement membrane antibody GN (anti-GBM GN), immune complex GN, and pauci-immune GN. This study aims to assess whether the kidney and vital outcome are different among the three histologic types of crescentic GN.

Method

This unicentric, retrospective study included seventy-six subjects [50% males, 55 (95%CI 52 to 60) years; eGFR 9.6 (95%CI 7.8-13.7) mL/min and proteinuria 1.9 (95%CI 1.5 to 2.6) g/g] that had undergone a kidney biopsy between 1st January 2008 and 31st December 2017 and had a histologic diagnosis of crescentic glomerulonephritis (crescent formation in more than 50% of the glomeruli). The subjects were followed for a mean of 47.6 (95%CI 33.5 to 61.6) months. Primary endpoints were the need of renal replacement therapy initiation (RRT) and all cause death. Kaplan-Meier method was used to evaluate kidney and patients’ survival and variables related to kidney and vital outcome were evaluated by multivariate Cox proportional hazard modelling. Patients were stratified in three groups according to the type of C-GN: pauci-immune GN (n=58 pts.), anti-GBM GN (n=9 pts.) and immune-complex GN (n=9 pts.).

Results

No demographic differences were found among the three groups. Except for a higher frequency of solid neoplasia in immune-complex GN group (2.7% vs 1.3% in pauci-immune GN vs. 0% in anti-GBM GN; P = .001), no other differences regarding the clinical or laboratory data were identified. Immunosuppressive treatment was very frequent, in more than 80% of subjects, regardless of the group, corticotherapy and cyclophosphamide being the most common immunosuppressive agents. During the follow-up period, 54% of subjects needed RRT and 19.2% died. The frequency of RRT initiation or death was not different among the three groups (P = .9 and P = .4). The univariate time-dependent analysis showed similar survival times among the analysed groups (log rank =0.9) (Figure 1). In the multivariate analysis, the only independent predictor of RRT was lower baseline eGFR (OR 0.49 (95%CI 0.31 to 0.78), P = .03). Time to death did not differ among groups (log rank P = .4) (Figure 2). The only independent predictor of death was higher Charlson comorbidity score (OR 56.8 (95%CI 6.3 to 512), p<0.001) in the Cox analysis.

Conclusion

In this cohort of subjects with crescentic glomerulonephritis, although limited by the low number of subjects, the kidney and vital prognosis seem to be similar indifferent of the histologic type of crescentic glomerulonephritis.
#3055 ASSOCIATION OF MORTALITY WITH INTRADIALYTIC EXERCISE IN HEMODIALYSIS PATIENTS
Authors: Abdullaev Sherzod , Igamberdieva Ranokhon
Published: June 2023

Background and Aims

Patients with hemodialysis (HD) have an increased risk of mortality, which can be minimized by physical activity (PA). Intradialytic exercises (IDE) are very convenient, potentially increasing adherence to PA and allowing for a sedentary lifestyle. Thus, the purpose of this study was to analyze the association of IDE with mortality in patients with HD.

Method

A single center, prospective study in adult HD patients eligible for IDE (cycling 3 times a week) was performed. After 1 year of IDE introduction, patients were followed up for up to 3 years. Three groups were created based on the impact of IDE (minutes of exercise per week): no exercise (patients who refused IDE); low load (<87 min/week); high load (≥87 min/week). Kaplan-Meier models (unadjusted analysis) and Cox proportional hazard models (adjusted for age, dialysis experience, vascular access, comorbidity index, CVD, muscle tissue, overhydration, and hospitalizations) were used with a non-exercise group as a reference. In addition, a sub-analysis was conducted, limited to IDE participants, with exposure as a continuous variable.

Results

106 patients (no exercise: 58; low exercise: 26; high exercise: 22) were followed for an average of 24.5 months. Uncorrected mortality differed between the three groups: (no exercise: 24.1%; low load: 23.0%; high load: 9.0%; p<0.01). In the adjusted analysis, the high load group had a lower risk of mortality than the no exercise group (RR = 0.42, 95% CI 0.23–0.76, p<0.05), while in the low load group this was not observed (RR). = 1.07, 95% CI 0.66–1.52, p = 0.568). In addition, mortality risk decreased for every 55 minutes of exercise per week in unadjusted (HR = 0.46, 95% CI 0.29–0.76, p = 0.01) and adjusted analyzes (HR = 0.54, 95% CI 0.32–0.91, p<0.05).

Conclusion

Our findings show that IDE is associated with a reduced risk of mortality in HD patients, but a significant amount of exercise is required. Thus, patients who achieve low load doses may require non-clinical approaches to PA in addition to IDE. These findings complement those of earlier studies and highlight the need for a tailored approach to the exercise.