bluuebunny/crossref_metadata_2025 huggingface dataset:
#3276 LUPUS NEPHRITIS: THE INTERPLAY BETWEEN SENESCENT B AND NAÏVE T LYMPHOCYTES
Authors: Moysidou Eleni , Lioulios Georgios , Christodoulou Michalis , Xochelli Aliki , Nikolaidou Vasiliki , Stai Stamatia , Fylaktou Asimina , Papagianni Aikaterini , Stangou Maria
Published: June 2023

Background and Aims

Systemic Lupus Erythematosus (SLE) is characterized by a shift to senescent B cells, namely, switched memory (SM) (CD19+IgD-CD27+) and exhausted-double negative (DN) (CD19+IgD-CD27-) subtypes. The aim of this study was to evaluate the impact of T cell immunity in the distinct B cell - senescent pattern of SLE.

Method

A wide range of senescent and exhaustion related lymphocyte surface molecules, including CD45RA, CCR7, CD31, CD28, CD57, on T cells and CD27 and IgD on B cells, was analyzed by flowcytometry and distinct naïve, active and senescent B and T lymphocyte subtypes were determined in 31 patients with inactive Lupus Nephritis (LP).

Results

Comparison of SM and DN B cells with T cell subpopulations revealed significant correlation of naïve and “unexperienced” CD4 and CD8 compartment with SM and DN B cells. Indeed, the correlation appeared even stronger regarding SM B cells and Recent thymic emigrants (RTE) CD4CD31+ (r=0.575), CD4+ Central Memory (CM) (CD45RA-CCR7+) (r=0.546), CD4CD45RA+CD28+(r=0.556), CD4CD28+CD57- (r=0.621), CD4CD45+CD57- (r=0.544), CD4CD45-CD57- (r=0.65), CD8CD28+CD57- (r=0.596), CD8CD45-CD57- (r=0.556) while weak yet significant was their correlation with CD4 Naïve (CD45RA+CCR7+) (r=0.432), CD8CM(CD45RA-CCR7+) (r=0.474), RTE CD8CD31+ (r=0.461), CD8CD28+CD57+ (r=0.442). Less apparent was this phenomenon between DN B cells and CD4 CM (CD45RA-CCR7+) (r=0.381), CD4CD45RA+CD28+ (r=0.504), RTE CD4CD31+ (r=0.587), CD4CD28+CD57- (r=0.487), CD4CD28+CD57+ (r=0.491), CD4CD45+CD57- (r=0.419), CD4CD45-CD57- (r=0.397), CD8 Naive(CD45RA+CCR7+) (r=0.432), RTE CD8CD31+ (r=0.366), CD8CD28+CD57- (r=0.363), CD8CD28+CD57+ (r=0.483), CD8CD45-CD57- (r=0.444), CD8CD45-CD57+ (r=0.384).

Conclusion

The predominant shift to senescent/exhausted B lymphocytes in SLE and LN may have a direct impact on naïve CD4 and CD8 T lymphocyte subpopulations.
#3429 HIGHER INPATIENT COSTS FOR HEMODIALYSIS PATIENTS HOSPITALIZED FOR CEREBROVASCULAR DISEASE
Authors: Kuroki Aki , Shimura Satoru
Published: June 2023

Background and Aims

Dialysis patients often have comorbidities that result in frequent hospitalizations. Several studies showed that inpatient costs contributed largely to the medical costs of dialysis patients. In this study, to assess the impact of comorbidities on inpatient costs in dialysis patients, we examined the association between reasons for admission and the inpatient costs using electronic medical records.

Method

This was a single-center, retrospective, observational study of dialysis patients admitted to Yokohama General Hospital (300 beds) between April 2020 and March 2022. Information on patient demographics, cause of end-stage kidney disease (ESKD), dialysis duration, number of complications, and reasons for admission were collected from electronic medical records. Inpatient costs were calculated from claims data and analyzed based on patient characteristics and reasons for admission. Inpatient costs for dialysis patients were compared with those for all hospitalized patients. Data were analyzed using the Kruskal-Wallis test.

Results

During the observation period, 172160 patients were admitted to the hospital, of which 169 were maintenance dialysis patients. One hundred and twenty-three of them were male, with a mean age of 73.0 years. Diabetic kidney disease was the most common cause of ESKD (n=128), followed by chronic glomerulonephritis (n=21), nephrosclerosis (n=19), and autosomal polycystic kidney disease (n=1). The median time on dialysis was 5 years. Seventy-three patients were admitted for peripheral vascular disease, 24 for cardiovascular disease, 24 for fractures, 16 for gastrointestinal disease, 13 for cerebrovascular disease, and remainder for other conditions. Inpatient costs ranged from €764 to €79743, with a mean of €14884, and a median of €9002. Inpatient costs did not differ significantly by age, sex, time on dialysis, number of complications, or cause of ESKD. There were significant differences in inpatient costs according to the reason for admission. Patients hospitalized for cerebrovascular disease had significantly higher inpatient costs with a mean of €17733 and a median of €14623 (P = .049). During the study period, dialysis patients accounted for 0.098% of all inpatient admissions, and their medical costs were 3% of the hospital's total inpatient medical costs.

Conclusion

Considering the number of dialysis patients as a percentage of all inpatients during the study period, it was clear that dialysis patients had a high cost burden. Among dialysis patients, hospitalization for cerebrovascular disease was associated with significantly higher costs.
#3493 INCIDENCE, PREVALENCE, DEMOGRAPHIC PROFILE, AND CLINICAL OUTCOMES OF PERITONEAL DIALYSIS IN A TERTIARY MEDICAL CENTER IN THE PHILIPPINES
Authors: Cruz Keth Ivory Dela , Arsolon Clarissa
Published: June 2023

Background and Aims

Chronic Kidney Disease (CKD) has emerged as a global public health burden. As one of the treatment options for CKD-5, peritoneal dialysis is underutilized, accounting for only 11% of the global distribution of renal replacement therapy (RRT). In the Philippines, PD accounts for only 4.2% [1] of all dialysis. This is perplexing because PD has several advantages over hemodialysis including better survival in the first few years of RRT, better survival of PD to HD than HD to PD [2], more cost-effective [3], can be done at home without sophisticated equipment, and feasible in remote areas. This study aims to characterize the incidence, prevalence, demographic profile, and clinical outcomes of the PD patients in our center to uncover strengths, weaknesses, and roadblocks for a stronger “PD First” program in the Philippines.

Method

Descriptive retrospective chart review of 146 PD patients of the Southern Philippines Medical Center from January 2018 to September 2022.

Results

There were a total of 146 adult patients enrolled to the PhilHealth PD Z-package from January 2018 to September 2022. Majority of the patients were aged 50-59 years old (20%), followed by 40-49 years old (19%), and 60-69 years old (19%), mostly male (57%). Predominant etiology of CKD-5 was Chronic Glomerulonephritis (41%), followed by Diabetic Nephropathy (30%), and Hypertensive Nephrosclerosis (19%). Incidence rate of PD was 44%, 22%, and 41% for 2019, 2020, and 2021 respectively. The prevalence rate of PD was 64%, 56%, and 59% for 2019, 2020, and 2021 respectively. The PD peritonitis rate was 1.25, 0.4, 0.24, and 0.3 episodes per patient year in 2018, 2019, 2020, and 2021 respectively. Out of the 146 PD patients, 41 (28%) are still on active PD, 1 (0.07%) underwent Kidney Transplantation, 38 (26%) had PD Technique Failure from peritonitis and catheter malfunction, and 66 (46%) expired due to death at home, sepsis, and acute coronary syndrome. Among those who expired, 22 (33%) were PD First and 44 (67%) were shifted from HD. There was a significant difference in the primary outcomes between those who were PD First and shifted from HD, with a p-value of 0.048.

Conclusion

PD First is infrequently practiced in our center. There is a significant difference in the number of those who were PD First, and those who were shifted from HD. There is a higher rate of mortality among those who were shifted from HD to PD compared to those who were PD First. PD-peritonitis is the number one cause of PD Technique Failure followed by issues with the PD Catheter. To improve the mortality rate of our CKD-5 patients, it is recommended to do PD First, rather than HD to PD, while awaiting transplant.
#3642 SERUM APELIN AND RENAL PROGNOSIS IN PATIENTS WITH NON-DIALYSIS DEPENDENT CHRONIC KIDNEY DISEASE
Authors: Kani Nao , Hirata Michinori , Makino Shuzo , Naka Tomoya , Okamoto Kazuhiro , Miyakawa Hiromitsu , Uwatoko Ryuta , Bessho Saki , Hashimoto Nobuhiro , Iio Rei , Ueda Yoshiyasu , Hayashi Terumasa
Published: June 2023

Background and Aims

The apelin/APJ system is a novel pleiotropic system with an essential role in renal and cardiovascular physiology and disease. A role for the apelin/APJ system in diverse pathological states, including disorders of sodium and water balance, hypertension, heart failure, pre-eclampsia, acute kidney injury, sepsis and diabetic nephropathy, has recently been reported. Especially, the impact of apelin/APJ system on cardiovascular system has been attracting attention, but scarce data is available in chronic kidney disease (CKD).

Method

We measured serum apelin-36 by ELISA in 411 outpatients with non-dialysis dependent (NDD) CKD and analyzed factors associated with serum apelin. Furthermore, we examined the association of serum apelin with renal outcome (renal replacement therapy, RRT) using multivariate Cox proportional hazards model.

Results

Median age and eGFR were 71 years and 21.7 ml/min/1.73 m2, respectively and the prevalence of male gender and diabetes was 26.8% and 50.8%, respectively. Median serum apelin was 0.81pg/ml. There was no significant difference in serum apelin level between male and female patients, or those with and without diabetes. Moreover, serum apelin level had no significant association with age and eGFR; however, there was a significant relationship between serum apelin and brain natriutetic peptide. During the follow-up period of 38 months, 126 patients started RRT. eGFR and age were associated with the time to RRT induction. Serum apelin was not associated with renal outcome (HR, 1.05; 95%CI, 0.64-1.71; P,0.86); however, this association was interacted by diabetes and gender (P for interaction, 0.073 and 0.070, respectively).

Conclusion

Serum apelin could be a predictive marker of renal prognosis in male and non-diabetic CKD patients.
#3736 SACUBITRIL/VALSARTAN IMPROVES THE VASCULAR ACCESS FLOW OF HEMODIALYSIS PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION
Authors: Lin Chih-Ching
Published: June 2023

Background and Aims

Sacubitril/valsartan improved left ventricular systolic and diastolic function in patients with heart failure with reduced ejection fraction<40% (HFrEF) and end-stage kidney disease. However, there was no report concerning the effect of sacubitril/valsartan on access flow (Qa) of vascular access in maintenance hemodialysis (HD) patients with HFrEF. We aimed to investigate the effect of sacubitril/valsartan on Qa of vascular access in HD patients with HFrEF.

Method

We retrospectively screened the HD patients who received echocardiogram and Qa measurement in Taipei Veterans General Hospital and Cheng Hsin General Hospital from Jan. 2019 to Dec. 2021. Patients with HFrEF received twice of both echocardiography and Qa at 1 year apart were enrolled and divided into two groups, including those with or without the treatment of sacubitril/valsartan. The difference of Qa at baseline and 1 year later was compared by Wilcoxon signed-rank test, with a statistical significance of P<0.05.

Results

A total of 33 HD patients with HFrEF were analyzed with a mean HD vintage of 4.7 years. Sixteen patients received sacubitril/valsartan and the other 17 patients received conventional treatment. The mean Qa increased significantly from 633.8 to 948.8 mL/min (P<0.001) and the Qa change correlated with LVEF change [Fig. 1. correlation coefficient (r) =0.70, P=0.006] after 1-year treatment of sacubitril/valsartan; however, there was neither significant change of Qa (from 637.7 to 621.8 mL/min, P=0.44) nor correlation with LVEF change (Fig. 2, r=0.41, P=0.13) for controls after one year.

Conclusion

Sacubitril/Valsartan improves Qa in HD patients with HFrEF possibly related to the increase of LVEF.
#3945 ACUTE KIDNEY INJURY (AKI) AMONG COVID-19 POSITIVE PATIENTS INCREASES THE RISK OF MORTALITY: A SINGLE CENTER EXPERIENCE
Authors: Alotaibi Torki , Nagib Ayman Maher , Alserwy Nabil , Abbas Ahmad , Sobhy Islam , Nair Prasad , Khalid Mahmoud , Abdulhamed Mohamed , Fayad Zohair , Atta Ahmed , Mostafa Mohamed , Yahya Ahmed , Sami Ahmed , Abdelmonem Mohamed , Gheith Osama Ashry Ahmed
Published: June 2023

Background and Aims

Renal complications of COVID-19 are not yet well studied. We aimed to evaluate the prevalence of acute kidney injury (AKI) among positive COVID-19 hospitalize cases and explore its impact on patient outcomes.

Method

586 hospitalized patients with COVID-19 were retrospectively evaluated. of them, 267 (45.5%) developed AKI- classified according to the Kidney Disease Improving Global Outcomes (KDIGO) guidelines- compared with 319 (54.5%) patients without AKI.

Results

Most cases were males (72.7% vs. 69.7%), and their ages ranged (60.8± 14 vs. 51.7± 16 years). Comorbid conditions significantly predominant among the AKI group were diabetes mellitus (64 vs. 42.9%), hypertension (72.6% vs. 43.5%), and ischemic heart disease (25% vs. 14.7%). Fever, cough, shortness of breath, and dehydration were the main presentations among the AKI group, and they had significant radiological findings concordant with COVID-19 (86.8% vs. 59.8%). Sepsis, volume depletion, shock, arrhythmias, and ARDS were significantly higher in the AKI group. Anticoagulation (85% vs. 59.2%), vasopressors, plasma infusions, antimicrobials, and steroids were more frequently used in the AKI group. Acute respiratory failure requiring mechanical ventilation and the overall mortality rate were significantly higher in the AKI group (62.3% vs. 32.9% and 63.2%. vs. 31.1%, respectively).

Conclusion

AKI associated with severe COVID-19 was more frequent than reports from Chinese, European, and North American cohorts. AKI risk factors included COVID-19 comorbidities like hypertension, diabetes, mechanical ventilation, male gender, and older age. Mortality was high in this population, especially elderly patients, and in those who develop KDIGO stage 3 AKI.
#4419 THE IMPACT OF TRANSGLUTAMINASE 2 INHIBITION ON HYPERTENSION-INDUCED FIBROSIS IN HYPERTENSIVE NEPHROPATHY
Authors: Lee Jiwon , Han Sang-Woong , Yang Seung Hee , Yu MI-Yeon
Published: June 2023

Background and Aims

Hypertensive nephropathy is a chronic disease that requires the novel treatment. Transglutaminase 2 (TG2), linked to various diseases including cardiovascular and kidney diseases, has been suggested to play a role in the development of hypertensive nephropathy through its contribution to fibrous tissue formation, oxidative stress regulation, and inflammation. This study aimed to explore the role of TG2 in the development of hypertensive nephropathy and evaluate its potential as a therapeutic target.

Method

An in vitro hypertensive model was established using a device that mimics hypertension by applying rotational force. An in vivo hypertensive model was established in rats through subtotal 5/6 nephrectomy to induce fibrosis. The relationship between TG2 expression and the progression of hypertension-induced fibrosis was analyzed, and the impact of TG2 inhibition on fibrosis was evaluated using the TG2 inhibitor, cysteamine.

Results

In the in vitro study, rotational force was applied to induce hypertension using a hypertensive mimic device, which resulted in fibrosis in primary human glomerular endothelial cells and tubular epithelial cells and increased expression of TG2. The administration of cysteamine at concentrations of 0.5 mM, 1 mM, and 2 mM decreased fibrosis and phosphorylated P65 in a dose-dependent manner. The in vivo hypertensive model demonstrated a significant increase in blood pressure (P<0.001) and kidney fibrosis (P<0.001) over time at 4 and 8 weeks after surgery. A significant increase in TG2 expression was observed as hypertension and fibrosis progressed (P<0.001).

Conclusion

The progression of hypertension-induced fibrosis was accompanied by an increase in TG2 expression. Inhibition of TG2 showed improvement in fibrosis, suggesting further study of its mechanism may provide new therapeutic options for hypertensive nephropathy.
#4430 PREVALENCE OF AMPUTATION IN HD PATIENTS: A DIALYSIS PROGRAM WITHOUT SOCKS
Authors: Hernández Rosa Sánzhez , González-Mariño Rocío Zamora , Jiménez Laura Rodríguez-Osorio , Gúrpide Beatríz Durá
Published: June 2023

Background and Aims

Peripheral arterial disease affects very commonly CKD patients on dialysis. Frequently such injuries precede severe complications that lead to hospitalizations, amputations and even death.

Objectives: Study the prevalence of ulcers and amputation on dialysis, analyze related risk factors, post-surgical results and establish a prevention program.

Method

Descriptive, observational, retrospective (7 years), single-center study in patients with CKD on dialysis.

Results

202 patients (12 PD 190 HD), 67 active and 135 off dialysis, 127 men 75 women. Average age 69 years. Average time on dialysis 47 months. Vascular access: 56%, native fistula 37% catheter 7% prosthesis. Cause CKD 30,2% ND, 22.8% NAS. 95.54% HBP, 46.53% DM 26.73% Ischemic heart disease, 31.19% chronic ischemia, 26.24% had intermittent claudication, 12.38 % had all the comorbidities indicated. Higher comorbidity in males M:F 4:1. 53.47% ex-smokers or active habit.

Ulcers 29.7% (40 men 20 women), 76.67%, diabetics. Half of the patients with DM (48.94%) presented ulcers. The most frequent was vascular ulcer (43.67%) followed by that associated with diabetic foot (26.67%) and pressure ulcer 15%.

Amputations (11 major and 13 minor) in 24 patients (16 men 8 women) with a prevalence: overall 12%, DM 22.34%, with ulcers 40% and 46% if they are diabetics. Analytics in amputees. Average: PTH 352 ng/dl, Phosphorus 4.4 mg/dl, Vitamin D 19 mg/dl, Albumin 3.3g/dl, hypercholesterolemia in 20%. 17 patients with chronic ischemia were revascularized (76.47% ended in amputation).

Mortality: 88 patients died (43.56%), of which 41 were patients with ulcers (68.33%) and 20 were amputees (83.33%, 3 early mortality and 17 late mortality).

Conclusion

The prevalence of amputations on dialysis is high. Most are male, DM with high cardiovascular comorbidity and a previous history of ulcers.

Mortality increases in patients with CKDG5D with ulcers and amputees. There is a need for 11dialysis without socks” programs for early detection of dialysis ulcers to reduce the incidence of amputees.
#4637 IS THE NEUTROPHIL/LYMPHOCYTE RATIO USEFUL IN PREDICTING THE OCCURRENCE OF DEPRESSION IN CHRONIC HEMODIALYSIS PATIENTS?
Authors: Shabi Imane , Chettati Mariam , Fadili Wafaa , Laouad Inass
Published: June 2023

Background and Aims

Depression is one of the most described psychiatric disorders in chronic hemodialysis patients. Previous studies have shown that the chronic inflammatory state is involved in the progression of depressive symptoms. The neutrophil/lymphocyte ratio (NLR) is an inexpensive and easily measured inflammatory marker. To date, the association between NLR and depression in this population in Morocco has never been described.

Method

In this multicenter cross-sectional study, we included a population of chronic hemodialysis patients over a period of 3 months (September- December 2023). The Patient Health Questionnaire-9 (PHQ-9) translated into Arabic (validated version) was used to assess depressive symptoms. NLR was calculated as the ratio of neutrophils to lymphocytes. An N/L ratio greater than 2.5 was considered high. We also used the patients' medical records to collect data on their biological tests and medical history.

Results

A total of 69 patients with a M/F sex ratio 1.2. The mean duration of HD was 7 ± 3.5 years, with a mean age of 53 ± 13.2 years. 28% were diabetic and 32% hypertensive. Depressive symptoms were detected in 20% of the 69 patients, and 72% of our patients had an NLR >2.5. In univariate analysis, PHQ-9 scores were positively correlated with NLR and negatively correlated with albumin. There was no correlation between PHQ-9 score and sex, age, duration of dialysis, diabetes, hypertension, ferritin. NLR was a significant predictor of mild (p = 0.06) and moderate or moderately severe (p = 0.04) depressive symptoms, after adjusting for age, gender, Kt/V, duration of dialysis, history of hypertension, diabetes and Charlson Comorbidity Index score.

Conclusion

These results suggest that NLR can be used as a biomarker to predict depressive symptoms in chronic hemodialysis patients.
#4667 IMMUNOSUPPRESSION FOR FAILED ALLOGRAFT: HOW PROLONGED AND MUCH IS ADEQUATE?
Authors: Song Jehun , Park Kyungsun , Yoo Kyung Don , Park Jongha , Lee Jong Soo
Published: June 2023

Background and Aims

The development of human leukocyte antigen (HLA) antibodies towards a failed allograft is a critical factor for the feasibility and outcomes of future transplantation. Therefore, we investigated the factors contributing to sensitization in patients with failed allografts.

Method

A single-center retrospective study of patients with failed allografts between 2010 and 2020 was performed. Samples for HLA antibodies were tested at the time of graft failure and after immunosuppression withdrawal. Sensitization was defined as more than 80% of calculated Korean panel reactive antibody (PRA) I or PRA II. In addition, variables for affecting sensitization were collected.

Results

Twenty-three patients were included in the study. The mean flow-up duration after failed allograft was 43 ±33.3 months. The sensitized patients tended to have a longer follow-up period and were exposed to less total calcineurin inhibitor (CNI) than non-sensitized patients. (non-sensitized vs sensitized patients : 27.1±12.9 vs 51.7±37.8 months, p = 0.196; 4.2±4.9 vs. 5.1±2.9 months, p = 0.231 respectively). In multivariate logistic analysis, there was no significant difference regarding the total exposure to CNI and follow-up duration (sensitization group: multivariate odds ratio [OR] 1.188, 95% confidence interval [CI] 0.55–2.52, p = 0.655, OR 1.03, 95% CI 0.97–1.10, p = 0.282, respectively). In some patients, even prolonged immunosuppression after returning dialysis therapy did not prevent sensitization toward failed allograft.

Conclusion

In this study, there was no significant difference regarding the contributing factors for sensitization in the multivariate logistic analysis. However, in sensitized patients, trends were showing longer follow-up duration and less CNI exposure. Sensitization towards a failed graft might be affected by the dose and duration of immunosuppressant. Finally, the small sample size is one of the limitations of this study, and additional prospective research analysis for patients with failed allografts is needed in the future.
#4676 RETROSPECTIVE EVALUATION OF THE PREVALENCE OF DIABETES MELLITUS IN A SINGLE CENTER RENAL TRANSPLANT COHORT
Authors: Alfieri Carlo Maria , Molinari Paolo , Cicero Elisa , Campioli Edoardo , Regalia Anna , Campise Maria Rosaria , Cresseri Donata , Verdesca Simona , Favi Evaldo , Castellano Giuseppe
Published: June 2023

Background and Aims

Post-transplant diabetes mellitus (PTDM) might impact significantly in renal transplant (RTx) and RTx patients (RTxps) outcome. In this study we evaluated: 1) the prevalence of diabetic patients who access the RTx 2) the incidence of PTDM and 3) the most related factors for the development of diabetes after RTx.

Method

We retrospectively studied 522 RTxps transplanted in our Unit between January 2004 and December 2014. Each patient underwent: 1) to a collection of remote and pathological anamnesis and complete physical examination and to routine and specific clinical and biochemical determinations at 1(T1), 6 (T6) and 12 (T12) months after RTx. At six months of RTx, the Oral Glucose Tolerance Test (OGTT) was performed.

Results

The age of RTxps was 48±12 years. Patients with glucose metabolism abnormalities were significantly older, without differences in gender. Inpatients with PTDM (12.6%), cyclosporine was used more than tacrolimus, and higher doses of steroids at T1 and T6 were prescribed. They had a worse general metabolic and glucose (HOMA index, glycaemia and HbA1c) status than normoglycemic. of note, no differences in 25-(OH)-D and in the other mineral metabolism parameters were found. In multivariate analysis, we found that age at transplant (OR 1.28 for 5 years older) (p = 0.006), BMI at T1 (OR 1.22 for 2 kg / m2 more) (p = 0.01) and the dose of steroid prescribed during the first post-RTx month (OR 2.7 per 100 mg additional drug) (p = 0.03) were independently correlated with PTDM.

Conclusion

In this study, we demonstrated that the prevalence of PTDM was relatively high in our cohort reflecting data present in the literature. Interestingly, age at RTx, BMI and cumulative dose of steroids resulted the variables that significantly and strongly influence its development. On the other hand, no relationship was observed between blood values of 25 (OH) D, PTH and the onset of PTDM. Future research, possibly involving a higher number ofRTxps could also evaluate the effects of PTDM on graft and patients on long-term outcome.
#5129 CLINICAL-FUNCTIONAL KIDNEY-LUNG LINK IN A POPULATION OF HEMODIALYZED PATIENTS
Authors: Satta Ersilia , Romano Carmine , Raiola Ilaria , Scafarto Anna , Gentile Sandro , Erbaggio Gioacchino , Gembillo Guido , Polverino Mario
Published: June 2023

Background and Aims

We know that lung and kidney are intimately related from a functional standpoint, both in physiological conditions and in diseases. The close relationship between lung and kidney (kidney-lung link) is evidence of a homeostatic connection between all organs and systems in an attempt to maintain the body system balance. In a recent review [1] we emphasized the importance to search for the clinical signs of a disease not only in the primary affected organ but also in organ functionally related.

Method

For this purpose we examined 81 hemodialyzed patients, with a mean age of 66.6 ± 13 years (28 f and 53 M), undergoing hemodialysis treatment (mean dialysis: 96 ± 34 months), with regard to smoking habits (47 non-smokers and 34 smokers with an average of 19.8 cigarettes per day: pack / years: 33.4 ± 2.9). Pulmonary function test (PFT) and clinical signs were evaluated. we excluded 6 patients (4 males and 2 females) in the smoking group with obstructive spirometric pattern (detected by a FEV1.0/FVC ratio lower than 70 absolute value), so that the final non-smoking group consisted of 47 patients and the smoking-group by 28 smokers: both groups matched for anthropomorphic data.

Results

The mean values of PFT were globally no different between smokers with normal PFT and non smokers are summarized in Table 1: Although the never-smoking group was nearly twice as large as the smokers, and PFT were similar and normal, respiratory symptoms were predominant: daily cough (49 yes; 26 no); chronic phlegm (51 yes; 24 no).

Conclusion

in dialysis patients, cough and phlegm are common symptoms, regardless of smoking and spirometric values. Probably these results are the consequence of synergistic effects between lungs and kidneys, as recently demonstrated [2]. Hence the need to evaluate dialysis patients from the clinical-functional point of view of both, kidneys and lungs, in order to evaluate the appropriate, personalized, therapeutic strategy according to the last evidences of the literature [3].
#5199 ULTRASOUND EXAMINATION OF THE SUBCUTANEOUS PERITONEAL CATHETER TUNNEL IN CASES NOT RELATED TO INFECTION
Authors: Zeiler Matthias , Fioravanti Gilda , Fioravanti Giuseppe , Granata Antonio
Published: June 2023

Background and Aims

According to the guidelines of the International Society of Peritoneal Dialysis possible indications of ultrasound (US) examination of the catheter tunnel are suspected tunnel infection, initial evaluation of exit-site infection without clinical signs of tunnel involvement, follow-up of exit-site and tunnel infection after treatment and relapsing peritonitis episodes. Other authors suggest US examination of the subcutaneous tunnel in every case of peritonitis. We analyzed the associations between US findings at the catheter tunnel and their clinical impact, exclusively in cases not related to catheter infection.

Method

The subcutaneous tunnel of the peritoneal catheter was examined with a linear probe of 6.5-10 MHz having covered the exit site with a transparent adhesive film-dressing. For the retrospective investigation covering the last 10 years, we selected peritoneal dialysis patients who performed an US examination without clinical signs or suspect of exit site or tunnel infection. During the US examination, the distance of the external cuff from the exit site, the presence and extend of leakage or size of a hematoma (along the catheter and at the surgical site), the proximity of the inferior epigastric artery to the catheter, the configuration of the subcutaneous tunnel (including inclination and direction of the catheter at the entrance into the peritoneal cavity) and the position of the inner catheter cuff were documented.

Results

Several US findings were found to be associated to a specific risk or need of intervention in the follow up of the patient. The following table reassumes the US findings and the respective clinical impact.

Conclusion

US findings documented during the examination of the catheter tunnel in cases not related to infection have a certain clinical impact due to their association to a specific risk or need of intervention, and therefore should not be overseen during the examination.
#5219 PEROXIREDOXINS ARE RELATED TO EGFR DECLINE IN IGA NEPHROPATHY, MEMBRANOUS NEPHROPATHY AND LUPUS NEPHRITIS: A 5-YEAR FOLLOW-UP
Authors: Krata Natalia , Moszczuk Barbara , Tanska Julia , Monticolo Marta , Paczek Leszek , Foroncewicz Bartosz , Mucha Krzysztof
Published: June 2023

Background and Aims

Oxidative stress (OS) is known as a disturbance between pro- and antioxidant factors, that may lead to DNA or protein oxidation, resulting in cellular damage. Peroxiredoxins (PRDXs) are enzymes with an antioxidant properties. They play dominant role in regulation of cellular peroxide levels, which is crucial in maintaining organisms’ oxidative balance. PRDXs types 1-5 are involved in the pathophysiology of various diseases (e.g. cancer, inflammatory, or renal). We aim to study their role as a prognostic marker of eGFR changes in IgA nephropathy (IgAN), lupus nephritis (LN) and membranous nephropathy (MN) patients.

Method

This is a retrospective 5-year-follow-up study of 108 IgAN, MN and LN patients, in whom PRDX 1-5 serum levels were assessed with ELISA in 2017. In 2022, we were able to collect the data out of 80 patients: IgAN (n=36); MN (n=22) and LN (n=22). The remaining 28 were considered as lost-to-follow-up, namely: lack of any medical results within last 2 years (n=23); on dialysis (n=2); after renal transplantation (n=2); deceased (n=1). We classified patients depending on the changes of eGFR (decline/stable/increase; Fig. 1) between baseline and after 5 year follow-up and the PRDX levels (high/medium/low; Table 1). The Mann Whitney-U, Kruskal-Wallis and Chi-Square Test were used for statistical analysis, the p-values <0.05 were considered significant.

Results

Baseline PRDX measurements indicated, that the mean concentrations of serum PRDX 1-5 differ between the glomerulonephropathies (GN). In 2022, we observed significantly different (P = .012) change of eGFR depending on the GN type. 16/80 individuals had eGFR decline and 75% of them were diagnosed with IgAN. The MN and LN groups had increase of eGFR in the last 5 years in most cases, probably as a result of the treatment. We verified if follow-up eGFR was associated with baseline PRDX levels. The 2022 eGFR differed significantly between the GNs depending on the level of serum PRDX 2, 4 and 5 at baseline (P = .002; P = .009; P = .006, respectively, Table 1).

Conclusion

Our results showed the link between serum PRDXs concentration and IgAN, MN and LN follow-up. Importantly, selected PRDXs’ might be used to predict eGFR decline, particularly in IgAN and LN.
#5364 LOW DOSE VALGANCICLOVIR AS A PRE-EMPTIVE THERAPY IS EFFECTIVE FOR CYTOMEGALOVIRUS INFECTION IN KIDNEY TRANSPLANTATION: A SINGLE-CENTER EXPERIENCE
Authors: Jeon Jin Seok , Lee Haekyung , Kim Hyoungnae , Kwon Soon Hyo , Noh Hyunjin
Published: June 2023

Background and Aims

Pre-emptive therapy, screen for and treat asymptomatic cytomegalovirus (CMV) viremia, is an important preventive strategy for CMV disease in kidney transplant (KT) recipients. Oral valganciclovir is the most commonly used as preventive strategy. However, the optimal dose and treatment duration of valganciclovir remains elusive.

Method

We retrospectively evaluated the efficacy and toxicity of low-dose of oral valganciclovir (450 mg twice daily) as pre-emptive therapy in KT recipients who underwent KT between January 2015 and December 2021. CMV viral load was measured by polymerase chain reaction. Pre-emptive therapy with valganciclovir was applied for 2 weeks.

Results

of 33 kidney transplant recipients who received pre-emptive CMV therapy with valganciclovir (55 therapy cases), 32 (97.0%) were CMV seropositive except 1 patient who had no related information. Thirty-two (97.0%) received T-cell depleting agent, thymoglobulin as an induction immunosuppressive treatment. Treatment failure, defined as a CMV DNA load more than or equal to 1000 copies/mL after 2 weeks of treatment, occurred in 3 (5.45 %) patients. No patient developed CMV disease during pre-emptive therapy. The median viral copies in patients treated successfully was 487.50 (311.24 – 826.25), whereas 4420.00 (2535.00 – 137450.00) in patients who undergone treatment failure.

Conclusion

These results suggest that pre-emptive therapy with low dose oral valganciclovir for 2 weeks can be successfully used for preventing CMV disease among KT recipients with low-level CMV viremia. Further research is needed to replicate these findings in larger samples and assess long-term outcomes.
#5941 SERUM LEPTIN AND MALNUTRITION IN PERITONEAL DIALYSIS PATIENTS: A CONNECTION YET TO BE FOUND
Authors: Trigo Ana , Ramos Ana Rita , Duarte Rui , Alves Ana Rita Valerio , Gonçalves Hernâni , Santos Paulo
Published: June 2023

Background and Aims

Leptin is a hormone responsible for the modulation of the satiety signals and that it is known for being increased in patients undergoing Peritoneal Dialysis (PD) treatment. Nevertheless, conclusions about its role in the malnutrition associated with this technique remains to be done. Our study aimed to characterize the nutritional state of a Portuguese program of PD and to establish the impact that leptin levels had on it.

Method

A cross-sectional study was performed involving 28 patients of a PD program. To characterize the patients’ nutritional status we collected the following data: anthropometric measurements (weight, body mass index (BMI), fat tissue index and lean tissue index using Fresenius ® Body Composition Monitor), analytical values (albumin, total proteins, total cholesterol, high-density lipoprotein cholesterol, low-density cholesterol, triglycerides, leptin serum levels), protein metabolism (normalized protein catabolic rate (nPCR), normalized dialysate protein loss (nEPL), normalized urine protein loss (nUPL), normalized total protein loss (nTPL) and normalized dietary protein requirement (nDPR)) and peritoneal dialysis adequacy (total, renal and peritoneal kT/v; total, renal and peritoneal creatinine clearance). The collected data were statistically analyzed and correlations were made using Mann-Whitney U test and Spearman test, depending on the variable type.

Results

7 (25%) patients were females, and the mean age was 59.5 years old (± 14.31). The mean dialysis vintage was 27.04 months (± 20.14) and the majority (n=23, 82,1%) preformed automated peritoneal dialysis (APD). Regarding the nutritional status, the mean BMI, FTI and LTI was 26.64 kg/m2 (±4.39), 14.24 kg/m2 (±5.47) and 11.62 kg/m2 (±2.52) respectively. 57.1% (n=16) had serum albumin below 3.5 mg/dL, with a mean phosphorus of 5.01mg/dl (±0.72) and a mean leptin of 28.58ng/mL (±28.44). The serum leptin was 5.4 times higher than the adjusted value for BMI in the population without kidney disease. The adjusted serum leptin for BMI was different between sex (U=15, P = .001) and it was positively correlated with total (ρ=0.47, P = .012) and high-density lipoprotein (HDL) cholesterol (ρ=0.535, P = .003). It was not associated with the protein metabolism (nPCR, nEPL, nUPL, nTOL and nDPR), albumin or total proteins and PD adequacy.

Conclusion

Leptin values independent of BMI are significantly higher amongst patients on PD. Alike the healthy population, women on PD are also prone to have higher serum leptin values. Although studies are still controversial about the association between this hormone and cholesterol, in this population there is a positive correlation. As so, hyperleptinaemia cannot yet be associated with the malnutrition that is generally present amongst PD patients, but it must be considered as a contribute to the already known increased cardiovascular risk.
#5963 THE ASSOCIATION OF FRAILTY, DENTAL STATUS, İNFLAMMATION AND MALNUTRITION İN HEMODIALYSIS PATIENTS
Authors: Çağlar Tuğçe Topoğlu , Erten Yasemin , Yıldırım Saliha , Borazan Funda Yıldırım , Ozkula Handan
Published: June 2023

Background and Aims

Persistent low-grade inflammation and malnutrition in chronic kidney disease (CKD) are associated with so many CKD complications. Frailty, the state of increased vulnerability often associated with aging, had a higher incidence in CKD patients regardless of age. In this study, we aimed to investigate the frequency of frailty among hemodialysis patients and volunteers with normal kidney function to define its relationship with inflammatory markers, biochemical parameters and dental status.

Method

A cohort of 86 CKD patients with hemodialysis (HD) and 74 volunteers with normal kidney function (similar in terms of age and gender distribution) were included in this study. Both groups were evaluated by the Clinical Frailty Scale in three groups as non-brittle, pre-frail and frail. Demographic characteristics, biochemical parameters and dental status were recorded.

Results

21 of 86 patients (24.4%) were frail in CKD patients with HD, and 4 of 76 patients (5.4%) in the control group were frail (p<0.001). The frail individuals in the HD group were older (p<0.001), had more systemic diseases (p<0.001), had higher serum C-Reactive Protein (CRP) levels (p<0.001), lower serum albumin levels (P = .001), lower serum creatinine levels (p<0.003). When the number of teeth is evaluated; the number of patients with more than 20 teeth was significantly lower in the frail group than in the non-frail group (p<0.001).

Conclusion

In our study, the frequency of fraility in hemodialysis patients was found to be significantly higher than in the control group. The lower albumin and serum creatinine levels, the higher CRP levels and the lower number of teeth suggest the relationship between frailty with dental status, malnutrition and inflammation in hemodialysis patients. It can be concluded that improvements in oral health and/or inflammation status can contribute to the improvement of frailty in this patient group.
#6140 DEPENDENCE IN THE ELDERLY PATIENT ON HEMODIALYSIS
Authors: Pereira Monica , Manso Paula , Burgos Marina , Carneiro Damian , Mas Sebastián , González-Parra Emilio , Arenas Maria Dolores , Sánchez-Tocino Maria Luz
Published: June 2023

Background and Aims

Frailty constitutes a syndrome, characterized by loss of lean body mass (sarcopenia), weakness, and decreased resistance to physical exercise, which leads to decreased activity and a poor response to stress. Reduced activity, in turn, worsens sarcopenia and weakness, leading to a vicious cycle toward functional decline and increased risk of death. Frail patients starting HD may lose independence, as their functional capacity deteriorates, with increased frailty and sarcopenia, especially in the elderly. Aims: Observe the clinical differences in elderly patients on hemodialysis depending on whether they are dependent or not and observe if dependence has an impact on the dialysis regimen used.

Method

Observational descriptive study for 1 year in patients of the chronic hemodialysis program of four out-of-hospital centers and a hospital unit of the Fundación Renal Íñigo Álvarez de Toledo (Spain). Of the total number of patients receiving dialysis in the units, 107 over 75 years of age, who had been in the program for more than 3 months and who had signed the informed consent, were included in the study.

The variables considered for the study were: age, sex, height, weight, and body mass index (BMI), etiology of kidney disease, time on hemodialysis, residual diuresis > 500 mL/min, and type of vascular access. In relation to the hemodialysis regimen, the duration variables were collected in hours of the HD session at the beginning of the program and at the time of the study, weekly hours and days per week

Analytically determined: albumin, total iron binding capacity (TIBC) and creatinine. In addition, the measure of dialysis efficacy was established by eKt/V

To assess the degree of functional dependency, the Barthel index is considered the most appropriate scale to assess the basic activities of daily living (BADL), obtaining a quantitative estimate of the degree of dependency.

Results

Association between dependency and the rest of the qualitative variables. Data expressed n (%) or mean ± SD.

Conclusion

Dependent patients have lower residual renal function, greater comorbidity, less ability to walk, and therefore need transportation to go to dialysis, live in residences, and are extremely tired at the end of dialysis.
#6389 EARLY WEIGHT LOSS AFTER BARIATRIC SURGERY IN PATIENTS WITH ORGAN FAILURE OR TRANSPLANTATION
Authors: Moore Linda , Yi Stephanie , Davis Garth , Sherman Vadim , Guha Ashrith , Victor David , Huang Howard , Knight Richard , Gaber A , Ghobrial R , Tariq Nabil
Published: June 2023

Background and Aims

Obesity is an epidemic that complicates global health and economies. Surgery for obesity (OS) is one effective treatment that results in significant weight loss. Patients with chronic organ failure who are obese undergo OS but it is unknown whether they achieve similar weight loss response as patients who do not have organ failure.

Method

Patient records of OS cases between May 2016 and June 2022 from a large healthcare system were examined to review weight changes after OS by whether the patient was a transplant patient or not. The proportion of excess weight lost was determined for 1month, 3months, 6months and 1year post OS. Non-parametric analyses were performed; p <0.05 was considered significant.

Results

of 1,673 OS cases, the mean (SD) age was 47.6 (12.5) years, the majority were female (1,276, 76.3%), and 58% identified as Caucasian. Within this number, 92 patients were transplant candidates (n=50, 3%) or recipients (n=42, 2.5%). The transplant patients were older [51.5 (10.8) years vs 47.3 (12.6) years, P = .0008], had similar body weight [124.4 (22.5) kg vs 126.0 (27.2) kg, P = .8271] but a lower body mass index [42.6 (5.7) kg/m2 vs 45.1 (8.1) kg/m2, P = .0046] compared to patients who were not having a transplant. Transplant patients experienced different weight loss in the early post-operative period but similar weight loss after OS as non-transplant patients (Table 1 and Table 2).

Conclusion

Though early post-operative differences were noted in this study, patients with organ failure responded similarly to OS as patients without organ failure.
#6567 ANCA ASSOCIATED VASCULITIS AND COVID
Authors: File Ibolya , Markóth Csilla , Szabo Reka P , Balla Jozsef , Bidiga László , Mátyus János
Published: June 2023

Background and Aims

The coronavirus 2019 (COVID-19) pandemic has brought on challenges not only to acute care, but also chronic care of patients. Patients with ANCA-associated vasculitis (AAV) frequently require immunosuppression and may be at increased risk for developing COVID-19. The incidence and impact of COVID-19 on patients with AAV is currently not well known. We collected the data of patients with AAV infected with SARS-CoV-2, focused on the relationship with the employed immunosuppressants and the stage of chronic kidney disease.

Method

A retrospective study of AAV patients was conducted. Data regarding demographics, disease characteristics and therapy were confirmed by review of the electronic medical record. Information regarding current and previous therapies was collected.

Results

In our center there were 110 AAV patients who had data in the pandemic period. The majority was diagnosed with microscopic polyangiitis (MPA, n=61) or with granulomatosis with polyangiitis (GPA, n=44), there was 5 patients with eosinophilic granulomatosis with polyangiitis (EGPA). Seventy pts (77%) were receiving immunosuppression treatment, sixteen (17.6%) of these patients employing rituximab during the pandemic period. Twelve patients on immunosuppression treatment for AAV was diagnosed with COVID infection. Eight pts had kidney transplantation, no one had positive PCR test. Thirty-two pts of the 110 pts with AAV was on chronic dialyisis treatment, (29 pts on haemodialysis, 3 pts on peritoneal dialysis), eleven of them had positive PCR test for COVID-19. Among the 110 pts with AAV eighteen pts (19%) had positive PCR test for COVID-19. Seven pts had mild disease (with no or mild pneumonia), no specific therapy was applied. Five of them received immunosuppression (rituximab combinated with azathioprine or micophenolate mofetil), two pts was on haemodialysis. Severe disease (dyspnea, hypoxia, or >50 percent lung involvement on imaging within 48 hours) was reported in 7 pts. Five pts was on immunosuppression treatment (2 rituximab, 2 azathioprin, 1 leflunomide), 2 of them was on haemodialysis as well, 2 pts on HD without ISU. In the hospital four patients received favipiravir and prednisolone, no one of them died. Four pts was treated with critical disease (respiratory failure, shock, or multiorgan dysfunction). Two of them was on chronic haemodialysis, and received rituximab with azathioprine, one of them died. The other two pts was without immunosuppression, unfortunately both of them died.

Conclusion

The incidence of COVID infection is higher among pts with AAV. The pts treated with immunosuppression has higher risk for COVID infection, but the mortality was not significantly higher than in other pts groups. The highest incidence of the COVID infection was in the pts on chronic dialysis treatment, mostly due to the infection during the transfer to the HD Unit.