bluuebunny/crossref_metadata_2025 huggingface dataset:
#2454 Meeting guideline goals at hemodialysis patients impact their survival?
Authors: Kantartzi Konstantia , Lampropoulou Vasiliki , Mourvati Efthimia , Kriki Pelagia , Theodoridis Marios , Margaritis Nikos , Panagoutsos Stylianos
Published: May 2024

Background and Aims

The Institute of Medicine (IOM) defines clinical practice guidelines as "statements that include recommendations, intended to optimize patient care, that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options". First publication of Clinical Guidelines by the National Kidney Foundation (NKF), addressing good clinical practice in hemodialysis, was published in 1998. The aim of the present study was to investigate the influence of adherence to current guidelines of Mineral and Bone Disorders, Anemia and Adequacy of Dialysis, on their survival in patients undergoing hemodialysis.

Method

This is a single center retrospective study of 113 chronic hemodialysis patients (79 males and 34 females), with median age 70 years (56, 78), median duration on hemodialysis 52 months (21, 95). Based on whether or not they met the KDIGO guidelines’ targets for anemia, bone disease, dialysis adequacy, and the targets of all three guidelines during the last three years, patients were divided in two groups: group A with the patients who met the goals of the guidelines and group B with the patients who did not meet the goals. Clinical and biochemical parameters were compared among the groups of patients as well as hemodialysis adequacy (Kt/V). The survival analysis of the patients was calculated by Kaplan-Meier, while the possible effect of any parameter on survival was also evaluated with Cox-Regression.

Results

There was significant difference between the two groups in age, phosphorous (P), PTH, Kt/V, URR and Alb. There was no significant difference between the two groups in sex, duration of HD, Hemoglobin (Hg), Calcium (Ca++), Hypertension and Diabetes (Table). In Cox analyses, patient survival was associated with delivered dialysis dose (single pool Kt/V, p=0.044). There was no significant difference between the two groups when we compare the adherence to guidelines for MBD (p=0.507) and anemia (p=0.394). There was no statistical difference when we compare the achievement of targets of all three guidelines (p=0.796). We identified as an independent risk factor for patient survival the serum albumin (p<0.001). Patient survival was better with higher dialysis dose and adequate serum albumin level.

Conclusion

Clinical guidelines are useful tools for good clinical practice for hemodialysis patients. Adherence to clinical guidelines regarding dialysis adequacy is an independent risk factor for better survival of patients undergoing hemodialysis.
#2532 Identifying risk factors and protective strategies for pulmonary hypertension in chronic hemodialysis patients
Authors: Hsu Liping , Hsieh Chin Wen
Published: May 2024

Background and Aims

Pulmonary hypertension (PH) is commonly observed and is a predictor of mortality among individuals with end-stage renal disease (ESRD). However, the risk factors associated with PH and its treatment methods have not been thoroughly researched in patients undergoing chronic hemodialysis. Our objective is to investigate the risk factors and explore potential protective measures for PH in patients undergoing chronic hemodialysis.

Method

From January 1st to December 31st of 2015, 116 patients at a hemodialysis (HD) center met the inclusion criterion of receiving maintenance HD for a minimum of three months. None of the patients met any of the exclusion criteria, which included conditions like chronic obstructive pulmonary disease, interstitial lung disease, or liver cirrhosis. Each of these patients underwent echocardiography and bioimpedance spectroscopy (BIS) the day following their HD session. PH was identified in cases where the pulmonary artery systolic pressure exceeded 35 mmHg.

Results

Out of the cohort, 17 patients (14.7%) were diagnosed with PH, as shown in Table 1. These patients had fewer prescriptions of calcium channel blockers (CCBs; 5.9% vs. 40.4%, P=0.006) and a higher cardiac–thoracic ratio (CTR; 55% vs. 50%, P=0.04) compared to those without PH. Anthropometric measurements were comparable between the patients with and without PH. BIS revealed a higher extracellular water ratio (13.4% vs. 9.1%, P=0.05) and extracellular-to-intracellular (E/I) body water ratio (1.02 vs. 0.96, P=0.049) in patients with PH. In univariate logistic regression analysis, several factors were associated with PH: CCB prescription [odds ratio (OR) 0.092, 95% confidence interval (CI): 0.011–0.723, P=0.023], interventricular septum thickness (IVS, cm; OR 1.19, 95% CI: 1.046–1.355, P=0.008), ejection fraction (%; OR 0.951, 95% CI: 0.916–0.987, P=0.009), and a higher E/I ratio (>1.03; OR 5.333, 95% CI: 1.055–26.95, P=0.043). In the multivariate regression analysis, CCB prescription (OR 0.027, 95% CI: 0.001–0.478, P=0.014) and IVS (OR 1.333, 95% CI: 1.108–1.605, P=0.002) emerged as the strongest predictors of PH, as detailed in Table 2.

Conclusion

PH is linked to a lower frequency of CCB prescriptions and structural heart disease. Additionally, fluid overload in the trunk and limbs, as indicated by a higher CTR and E/I water ratio, is also associated with PH. Our study suggests that CCBs could protect against PH in ESRD patients. Additionally, previous research indicating that a subset of PH patients responds well to CCBs [1] suggests that ESRD patients might share similar pathophysiological mechanisms with this subset, further supporting the potential use of CCBs in treating PH among ESRD patients.
#867 Calciprotein particles and phosphorus in conventional and extended-hours hemodialysis
Authors: Nishibori Nobuhiro , Okazaki Masaki , Imaizumi Takahiro , Miura Yutaka , Kuro-O Makoto , Kasuga Hirotake , Kaneda Fumika , Maruyama Shoichi
Published: May 2024

Background and Aims

Extended-hours hemodialysis (HD) has better clinical outcomes than conventional HD. Previous studies have shown that a prolonged dialysis treatment time is associated with lower serum phosphorus levels, but the impact of extended-hours HD on calciprotein particles (CPP) is unknown. We investigated whether extended-hour HD and conventional HD have varying effects on blood levels of CPP and phosphorus, which have been identified as the main pathogenic molecules for vascular calcification.

Method

We performed a cross-sectional study of patients with extended-hours HD or conventional HD between January and March 2020. Blood CPP levels were measured in plasma and serum predialysis samples using a previously reported "gel filtration method". Linear and nonlinear associations between CPP and serum phosphorus levels were examined across dialysis modalities.

Results

A total of 382 participants (185 with extended-hours HD and 197 with conventional HD) were included in the analysis. The median age of participants was 71 years, 65% of the patients were men, and the mean phosphorus level was 5.4 mg/dL. Extended-hours HD was associated with lower plasma CPP levels (Extended-hours HD vs Conventional HD; 40,018 AU vs 75,728 AU) and serum CPP levels (Extended-hours HD vs Conventional HD; 66,524 AU vs 100,812 AU), regardless of similar serum phosphorus levels. Multivariable linear regression analysis showed that extended-hours HD was associated with lower natural logarithmic plasma CPP levels: -0.64 (95% CI: -0.74 to -0.55). Restricted cubic spline function indicated that extended-hours HD was associated with lower plasma CPP levels across levels of serum phosphorus, with significant differences observed between groups, especially in hyperphosphatemic conditions (P for interaction <0.01).

Conclusion

The patients with extended-hours HD had lower CPP levels than those with the conventional HD group despite no significant differences in serum phosphorus levels, which may contribute to better clinical outcomes in patients on extended-hours HD.
#495 Effect of Vit D supplementation on bone mineral density in haemodialysis patients. A comparative study
Authors: Tsikliras Nikolaos , Anagnostara Aggelina , Tsantekidou Florina , Kyrgialanis Apostolos
Published: May 2024

Background and Aims

Low serum 25(OH) vit D levels are usually observed in haemodialysis patients. In this population, vit D deficiency is associated with secondary hyperparathyroidism (SHPT) and low bone mineral density (BMD). Although, vit D supplements are routinely prescribed in haemodialysis patients, their exact role in preventing bone loss hasn't been studied thoroughly. The primary aim of this study was to estimate the effect of cholecalciferol (vit D3) use on BMD changes of haemodialysis patients. Secondary aim was to evaluate how parathyroid hormone (PTH), phosphorus and calcium levels are affected by vit D3 supplementation.

Method

Twelve (12) haemodialysis patients with low levels of serum vit D were included. All of them had their bone density measured with Dual - Energy X-Ray Absorptionmetry (DXA). The study population was then divided in two groups. Half of them (6 patients) received oral cholecarciferol (study group) and the rest continued with their standard treatment (control group). Initial dose of cholecalciferol was 25000 iu weekly and titrated upwards until 25 (OH) vit D levels were reaching 20 ng/ml. Then, cholecarciferol was continued in maintenance dose to keep vit D levels between 20 and 40 ng/ml. Thirty (30) months later, DXA was repeated in all patients. BMD in total hip region was evaluated. During the study period, phosphorus, calcium and PTH levels were measured monthly while 25 (OH) vit D levels were measured every three months.

Results

Patients’ mean age was 61.9 (±8.8) years. There were no differences in age, initial BMD, PTH or vit D levels between the two groups. Overall, initial mean vit D value was 8.5 ng/ml. At the end of the study, vit D levels had increased to 23.6 ng/ml in the study group while remaining unchanged in the control group. At the beginning of the study, mean BMD in the whole population was 0.742 gr/cm3 and it decreased by 0.042 gr/cm3 after 30 months. No differences in BMD change were observed between the two groups (ΔBMD was −0.057 versus -0.029 gr/cm3 in the study and control group respectively, p = 0.12). PTH levels were reduced in the study group and increased in the control group but the observed difference was not significant (p = 0.11). Phosphorus and calcium levels were not affected by vit D supplementation. Of note, three fractures were observed in the study group and one in the control group during the study period.

Conclusion

Vit D3 supplementation didn't seem to affect the rate of bone loss in haemodialysis patients, at least in the doses received and levels of 25 (OH) achieved above. Its exact effect in PTH levels as well as in the rate of bone fractures needs to be verified by larger studies.
#3075 Itch and ache on dialysis: the impact on the quality of life in Tunisian hemodialysis patients
Authors: Ayed Amel , Jaballah Lazhar , Brahim Mayssa Hadj , Elhadhri Asma , Elati Zohra
Published: May 2024

Background and Aims

Pruritus associated with chronic kidney disease (CKD-aP) is a common condition. However, although pruritus seriously affects the physical and mental health of patients, clinicians tend to underestimate this condition.

The aim of this study is to determine the prevalence of Pa-MRC and its impact on the quality of life (QOL) in the Tunisian hemodialysis population.

Method

This is a prospective observational study conducted at the hemodialysis unit at Taher Sfar University Hospital (February - May 2022). The presence and severity of Pa-MRC were documented based on a 5-D pruritus questionnaire, demographic and clinico-biological data were extracted from the dialysis unit register.

Results

A total of 63 chronic hemodialysis patients (CHD) were recruited in this study, 68.3% of whom presented pruritus, most often generalized (2/3 cases). More than half of the patients reported pruritus throughout the day. Thirty patients reported moderate to severe Pa-CKD. Patients were not treated for pruritus in 72% of cases, but 92% of those treated were satisfied with their treatment. Patients reporting a more severe Pa-CKD had a shorter duration of dialysis, higher phosphate and parathormone levels and more frequent diabetes (p = 0.03). The QOL deteriorated when the severity of pruritus increased (p = 0.01). Patients reported having difficulty falling asleep (52%), irritability (61.4%), concentration disorders (31.8%). In addition, pruritus limits the daily life of patients in 59.1% of cases with an impact on nutritional status in 13.6%.

Conclusion

This study reveals that Pa-CKD is a distressing condition with a huge impact on the QOL of CHD patients. However, there is an unmet need for treatment, hence the need for new therapeutic approaches.
#1806 Cycling is safe – effect of intradialytic cycle ergometry on cerebral oxygenation and cognitive function – a pilot study
Authors: Kächele Martin , Hugo Lukas , Mentz Lennart , Kirsten Johannes , Treff Gunnar , Schroeppel Bernd , Schulte-Kemna Lena Sophia , Steinacker Jürgen
Published: May 2024

Background and Aims

Patients on chronic hemodialysis benefit from intradialytic exercise with improvements in endurance, muscle strength and health-related quality of life. It is not known whether the increased oxygen demand during intradialytic exercise negatively affects cerebral oxygenation and cerebral function. The aim of the study was to assess the risk of cerebral undersupply by measuring cerebral oxygenation, perfusion and cognitive function during and after intradialytic ergometer training.

Method

Twelve patience on maintenance hemodialysis (HD) trice weekly were included in the study. In an initial ramp test, using bed cycle ergometer, we first determined the maximum physical strength (Pmax) at the level of exhaustion (HD A). Then, one hour after start of a second HD (HD B), patients performed 40%, 50% and 60% of Pmax for 6 min. Pulmonary function tests, blood volume (BVM), cardiac output (by electrical cardiometry), regional cerebral oxygen saturation (rSO2) (by near-infrared spectroscopy) and cerebral blood flow (CBF, by Doppler sonography) were measured. The relative changes in rSO2, CBF and hematocrit were used to calculate cerebral oxygen supply (DO2). Cognitive tests (Stroop, Trail Making and Mini Addenbrookes Cognitive Examination Test) were performed before and after HD sessions with and, as controls, without ergometry (HD-C).

Results

Median age was 68 (42-85) years, 9/12 were male, complete data set was obtained in 10 patients. During step test exercise (HD B), at the highest exercise level (according to Borg (1-10) 6.75 ± 2.9), rSO2 increased (+6 ± 9%, p=0.034) without a significant change in CBF. In the meantime, relative blood volume decreased during ergometry (-5.8 ± 2.73%; p=0.002), causing a temporary increase of hematocrit. Despite a small decrease in CBF in 3 patients, the mean change of rSO2, CBF and hematocrit always had a positive trend in all patients, as a surrogate of stable cerebral oxygen supply (Table 1). In comparative cognitive tests (B vs. C), we observed no significant changes in cognitive functions.

Conclusion

In this pilot study, intradialytic bed-cycle ergometry during the first hour of HD for <20 min at 40-60% of patients’ individual maximum intensity had no negative effects on cerebral oxygenation and function. Specific studies testing the safety intradialytic exercise with different conditions, such as increasing intensity or duration, are needed.
#2131 Difelikefalin in the management of pruritus associated with chronic kidney disease (Pa-CKD) in hemodialysis: Results from Andalusia
Authors: Mejía Carlos Narváez , Puerto Ana Maria , Ureña Ana Delgado , Rodriguez Francisca Lopez
Published: May 2024

Background and Aims

Pruritus associated with chronic kidney disease (CKD-aP) is a debilitating and common symptom in patients with chronic kidney disease on hemodialysis, with a prevalence of moderate to severe pruritus around 40–45%. The pathogenesis is not yet fully understood. It has been formally attributed mainly to abnormal levels of uremic toxins. The most recent data indicate a significant role for the dysregulation of the kappa opioid receptor (KOR) along with an imbalance in the mu-opioid receptor (MOR). Difelikefalin (DFK) is a KOR agonist approved for the treatment of moderate to severe CKD-aP in patients on hemodialysis in the USA, European Union (EU), Switzerland, Canada, Singapore, and Australia. It has shown rapid and sustained improvement in pruritus and is generally very well tolerated.

Method

We present the real-world experience of DFK in an early access program for patients in a hemodialysis (HD) program three times a week, diagnosed with CKD-aP, receiving the administration of DFK at 0.5 mcg/kg per HD session.

A total of 14 HD patients with severe to very severe CKD-aP (WI-NRS >7) and (moderate-severe SADS) were treated with DFK.

The severity of itching was assessed using the numerical rating scale (WI-NRS). Quality of life was assessed using the Self-Assessed Disease Severity Score (SADS).

Results

The results are shown in Table 1.

78.5% of the patients showed a reduction in WI-NRS of at least 3 points within the first 2 weeks and 92% showed a reduction of ≥ 5 points at 4 weeks, with positive effects on the patients' quality of life, describing a change from SADS C (severe deterioration of quality of life) to SADS A (mild deterioration).

Conclusion

Currently, 11 out of the 14 patients continue with Difelikefalin and maintain a sustained response in both itch intensity and quality of life.

The availability of this new treatment, along with a new understanding of the impact of pruritus on our patients, has the potential to significantly improve the lives of patients living with CKD-aP. Sharing the clinical experience of DFK in series like this is important to raise awareness, not only of DFK but also of CKD-aP, particularly in the absence of specific treatments.
#2402 Reproducibility of memory B-cell and HLA antibody detection in patients on kidney transplant waiting list
Authors: Sanz-Ureña Sara , Alari-Pahissa Elisenda , Pérez-Saéz María José , Barbosa Francesc , Collado-Nieto Silvia , Huacon Betty Odette Chamoun , Federico-Vega Judith , Medina-Jaramillo Andrea , Redondo-Pachón Dolores , Crespo Marta
Published: May 2024

Background and Aims

Detection of HLA antibodies (HLA-Abs) impacts on the access and outcomes of kidney transplantation (KT). Currently, evaluation of HLA-Abs in serum is performed using single antigen bead assays (SAB). The analysis of circulating HLA-specific memory B cells (mBc), capable of differentiating to HLA-Abs secreting cells, was conceived with the aim of complementing the study of the HLA-Abs found in serum, but there is debate regarding the representativeness and reproducibility of the test. Thus, we studied HLA-Abs generated by mBc from patients on the waiting list (WL) at two different time points without sensitizing events in between and compared them with HLA-Abs detected in serum.

Method

We selected 7 patients on the WL for a first KT with a cPRA of 3%-100%: 4 had pregnancies and 2 had blood transfusions as known sensitizing events. We collected blood and serum samples at 2 time points separated by an average of 3.5 months (T1, T2). We cultured polyclonally activated PBMCs and isolated and concentrated IgG from the supernatant (SN) to study HLA-Abs. We tested SN and sera with SAB assays. Beads with MFI >750 were considered positive.

Results

SAB serum study (Fig. 1a). Eighty-two percent of the specificities found at T1 were also detected at T2, and 97% of those identified at T2 were also observed at T1. Thus, there was good concordance between T1 and T2 samples (κ = 0.869, Cohen) and the MFI the specificities correlated (p < 0.0001, Spearman).

SAB SN study (Fig. 1b). Forty-one percent of the positive specificities detected at T1 were also identified at T2, and 59% of the positive specificities found at T2 had been seen at T1. Thus, there was a moderate concordance between T1 and T2 samples (κ = 0.454, Cohen) and the MFI of the specificities still correlated (p < 0.0001, Spearman). Only 42% and 35% of the positivities found in serum were also detected in the SN at T1 and T2, respectively. However, we found 9 positivities unique to the SN T1 (100% HLA-ABC) in 2 patients with cPRA>80% and we also identified a total of 20 positivities unique to the SN at T2 (45% HLA-ABC, 55% HLA-DPDQDR) in 3 patients with cPRA>80%.

Conclusion

The study of the degree of sensitization with SAB serum analysis remains stable between samples along time, while the mBc analysis shows less reproducibility. We identified a higher number of HLA-Ab in the study of serum compared with the study of the SN of mBc; however, we found some HLA-Abs unique to the SN. We suggest that, probably due to the small number of circulating mBC, increasing the number of samples tested for mBc improves the representativeness of the test.
#621 The effect of intra-operative mean arterial pressure on early graft function in deceased donor kidney transplantation
Authors: Oh Chang-Kwon , Bang Jun Bae
Published: May 2024

Background and Aims

The adequate perfusion pressure to the graft is essential for proper graft function in kidney transplantation, especially in deceased donor kidney transplantation. In particular, Mean arterial pressure (MAP) during operation can affect early graft function because MAP is associated with renal blood flow and glomerular filtration rate. Therefore, the analysis of intra-operative parameters are necessary to evaluate adequate graft perfusion. The aim of this study is to investigate the relationship between intra-operative parameters including MAP and early graft function in deceased donor kidney transplantation.

Method

We retrospectively analyzed 363 recipients who underwent deceased donor kidney transplantation from March 2010 to December 2020. Anesthetic monitoring data during intraoperative period was analyzed and basic clinical parameters were evaluated.

Results

In total 363 recipients, the mean recipient age was 48.9 ± 10.3 and mean donor age was 48.2 ± 15.2. Anesthetic time was mean 285.9 ± 63.8 (min) and operation time was 226.4 ± 48.7 (min). Median value of baseline MAP and MAP at reperfusion were 124 mmHg and 88 mmHg. After initial analysis, the recipients were divided into two groups, high MAP group (n = 185) and low MAP group (n = 178), according to median value of baseline MAP (124 mmHg) and these two groups were analyzed. High MAP group showed higher estimated glomerular filtration rate (eGFR) and urine output compared to low MAP group during immediate postoperative 1 week. At postoperative day 5, eGFRs were 43.4 ± 26.7 and 37.3 ± 24.2 mL/min/1.73 m2 respectively (p = 0.022) and urine outputs were 2942.6 ± 1368.6 and 2474.3 ± 1199.1 mL respectively (p = 0.001). The incidences of delayed graft function showed no significant difference between two groups (2.2% vs 6.2%, p = 0.066). We additionally analyzed the effect of MAP at reperfusion, and the result showed that there was no significant relationship between MAP at reperfusion and early graft function.

Conclusion

In this retrospective study, MAP at reperfusion was not significantly related to early graft function and incidence of delayed graft function. In baseline MAP analysis, high baseline MAP group showed early recovery of eGFR and more urine output than low baseline MAP group. As a result, the recipients with high baseline MAP were related to early recovery of graft function in deceased donor kidney transplantation.
#2932 Our experience in combined and simultaneous liver-kidney transplantation: recipient and kidney graft survival
Authors: Etxarri Neike Murua , de Hilla Nerea Ormaetxe Ruiz , De Juan Oihane Abaunza , Davis Mónica Paola Rodríguez , Noguer Raquel Vila I , Castaño Isabel Benito , Almáraz Sergio Fernández , Quispe Erick David Mamani , Martinez Ander Portugal , Antuñano Patricia Jimenez , Salvador del Valle Ainhoa Inza San , Larrondo Sofia Zarraga
Published: May 2024

Background and Aims

Simultaneous combined liver-kidney transplantation is a definitive treatment in patients with terminal failure of both organs, but sometimes, assessing the indication for said combined transplantation can be difficult. The liver from the same donor as the kidney graft protects the kidney immunologically and this provides long-term follow-up with a lower risk of rejection. No such protection is observed when both organs come from different cadaveric donors. There are no differences in graft survival in simultaneous or isolated transplants (liver or kidney), being prolonged in both cases. However, patient survival is lower, due to the complexity of this procedure and the clinical characteristics of the patients.

The main aim is to analyze the evolution of patients with combined and simultaneous liver-kidney transplantation in our center in terms of graft survival and overall survival of the recipient.

Method

It is a retrospective observational study. The computerized clinical history of 50 patients with combined liver-kidney transplantation was reviewed from August 1998 to November 2023. The data were recorded in an Excell-type database. Descriptive and inferential statistics were performed for the analysis.

Results

50 combined liver-kidney transplants have been performed, of which 28 (56%) died, and 23 of them (82%) with the kidney graft functioning. The main causes of death were neoplasms (11 patients) and infections (7 patients). The survival of the patients at 5 years was approximately 70%.

There were 5 cases of kidney graft loss, excluding death. Chronic rejection was the main cause (70-80%) of kidney graft loss. 60% received a kidney transplant again and died with the graft functioning; 20% died while on hemodialysis; and the remaining 20% are awaiting hemodialysis and are being studied for another kidney transplant.

Conclusion

Simultaneous liver and kidney transplantation is a good therapeutic option for patients with terminal disease of both organs. However, it is a complex procedure in patients with multiple comorbidities, which affects overall survival. In contrast, kidney graft survival is prolonged and many recipients die with functioning grafts. It seems to be related to the immunological protective function of the liver. Consequently, there are few rejections and, the vast majority are chronic rejection.
#2252 Outcome of pregnancy after kidney transplantation
Authors: Gad Donia
Published: May 2024

Background and Aims

Background 

The possibility of a term pregnancy is one of the benefits of solid organ transplantation for women. The gonadal dysfunction, caused by the failure of the kidney or another organ, is reverted within a few months after normal graft function. Unplanned pregnancies in transplant recipients, however, may compromise graft function and survival, and may also risk unnecessary fetal exposure to immunosuppressive medications.

Aims

To study the prevalence of pregnancy and pregnancy related complication after kidney transplantation (KT).

Method

Retrospective cohort study conducted on 236 patients out of 3000 kidney transplant recipient who underwent renal transplantation (RT) at Mansoura Urology and Nephrology Centre between March 1976 and December 2019. divided into group I; 118 kidney transplant female's recipient experienced pregnancy at any time after kidney transplant and group II; 118 kidney transplant female's recipients who didn't experience pregnancy after renal transplantation, they were matched according to age and duration of renal transplantation and comparable in primary immunosuppressant drugs. all kidney recipients were reviewed for preoperative & operative and post-operative details also we record maternal and fetal complication.

Results

Prevalence of pregnancy in our center is 191 pregnancies in 118 women who had underwent kidney transplantation between 1976 and 2019. We have found that the mean age of pregnancy between (26.27 ± 4.37 - 29.89 ± 4.6), the mean gestational age between (33.69 ± 6.4 - 33 ± 7.5) weeks, the live birth rate is 126 (66%). Preterm delivery rate in our study is 85 (44.5%), neonatal death 8 (4.1%), miscarriage 59 (30.9%), intrauterine fetal death 6 (3.1%) and birth defect 4 (2%). The prevalence rates of gestational hypertension is 87 (45.5%), pre-eclampsia 48 (25.1%), gestational diabetes 19 (9.9%), urinary tract infection 36 (18.8%), and graft rejection 8 (4.1%) during pregnancy. caesarean section is the most common method of delivery in our study 133 (69.6%). Kidney transplant recipients who aged more than or equal to 30 years at time of pregnancy are at higher risk for having non live-birth outcome (OR: 3.2, p value: 0.05). Proteinuria more than or equal to 0.5 g/day before pregnancy is a significant risk factor for having non live-birth outcome (OR: 4.7, p value: 0.009). Also, proteinuria ≥0.5 g/day during pregnancy is associated with increases risk for non-live-birth (OR: 10.2, p value: 0.013). Gestational hypertension is associated with increases risk for non-live-birth (OR: 8.3, p value: 0.010).Preeclampsia is associated with increases risk for non-live-birth ( OR: 4.6, p value: 0.005).

Conclusion

Although the outcome of live births is favourable, the risks of maternal and fetal complications are high in kidney transplant recipients including pregnancy-induced hypertension, increased rates of preeclampsia, gestational diabetes, and caesarean section rates. The risk of miscarriage, prematurity, and low birth rate is also high.
#482 Implementation of trans-esophageal echocardiography in pre-transplant recipient's basic preparation
Authors: Fatthy Moataz
Published: May 2024

Background and Aims

Kidney transplantation is the module of choice to reduce mortality in comparison with dialysis [1]. Many patients on transplant waiting list undergoing haemodialysis via central venous catheters [2]. Cardiovascular morbidity control is one of the pillars of successful transplantation outcome [3]. Tans-thoracic echocardiographic abnormalities can be used to identify renal transplant recipients at high risk of cardiovascular disease [4]. Trans-oesophageal echocardiography is superior to trans-thoracic echocardiography in detecting vegetations. Endocarditis complicating central venous catheters often involves right-sided structures, with catheter tips in or near the right atrium, frequently requires Trans-oesophageal echocardiography for diagnosis [5]. Three-dimensional trans-oesophageal echocardiography is considered the missed module for clear vegetations visualization [6].

Method

Evaluation of Transoesophageal echocardiography results in 377 haemodialysis patients with central venous dialysis access planned for kidney transplantation. All patients were examined by transthoracic echocardiography and stated absent vegetations from our registry. Candidates were re-evaluated by real time trans-oesophageal procedure to diagnose possibility of silent vegetations. Informed consent was obtained.

Results

Among 377 patients undergoing haemodialysis via central venous access and recorded in transplantation waiting list. All of them were having absent vegetations stated by transthoracic echocardiography. Our patients were subjected to transoesophageal echocardiography. Results showed 13 patients with variable sized right sided 4-6 mm vegetations (3.4%). Among our positive group of patients six patients were founded with 6 mm vegetation (1.6%), four patients with 5 mm (0.5%) and finally three patients with 4 mm vegetations (0.7%).

Conclusion

Trans-oesophageal echocardiography may be implemented in renal transplant recipient basic preparation checklist for evaluation of silent vegetations associated with central access of dialysis.
#3070 Machine learning glomerulonephritis diagnosis on single glomeruli
Authors: Pedraza Anibal , Becker Jan , Altini Nicola , Gibier Jean-Baptiste , Quoc Huy , Nguyen Hien , Turkevi-Nagy Sándor , Rosenberg Avi Z , Seshan Surya V , Bueno Gloria
Published: May 2024

Background and Aims

Diagnostic applications of machine learning in nephropathology are only beginning to emerge. We hypothesized that we could develop a machine learning classifier for 12 different classes of glomerulonephritis with CNN and self-attention-based architectures, following the nephropathology paradigm that globally sclerosed glomeruli are not useful for diagnostic purposes.

Method

The dataset contains 11,000 PAS-stained glomerular crops from 350 biopsies (four institutions). Each crop retained the diagnosis label from the 12 classes ABMGN, ANCA, C3-GN, CryoGN, DDD, Fibrillary, infection-associated GN (IAGN), IgAGN, MPGN, Membranous, PGNMID, SLEGN-IV; globally sclerotic glomerular crops were stripped from this diagnostic label and were just labeled as the 13th class Sclerotic. This dataset was divided into 75% of samples for training, 15% for validation and 10% testing, avoiding information leak within biopsies. Moreover, a hold-out validation set of another 50 biopsies with 2,000 new crops that were taken from another three centres.

A classifier was trained in a fully supervised fashion for 13 classes (12 GN classes and Sclerotic), based on an ensemble of multiple transformer-based classification networks, including Swin-Transformer and ConvNext. This allows classification of each glomerular crop by different network instances. Since each network was trained under different conditions, the whole system acquired a more global knowledge understanding rather than a relying on a single method. For the final decision, the system takes the prediction with the largest confidence threshold, which is also predicted along with the class.

Results

The Table and the Figure list the metrics for classification performance calculated as Precision, Sensitivity, Specificity, F1 Score and balanced Accuracy. Balanced accuracy was between 0.4797 for CryoGN and 0.5949 for Membranous, it was 0.6892 for Sclerotic. AUCs for ROCs were between 0.40 for PGNMID and 0.82 for Membranous, with 0.81 for Sclerotic.

Conclusion

This proof-of-concept study establishes a baseline for this challenging classification task, which usually requires immunostains, electron microscopy and even clinical data. Our classification results even on single PAS glomerular crops appear promising. Combined with our automatic glomerular segmentation models, we could rapidly expand the training cohorts sizes and even add more classes of GN.
#681 Bw4/6 mismatch or missing donor Bw6 allele is a risk of early acute rejection in panel reactive antibodies negative kidney transplant recipients
Authors: Elsharkawy Magdy , Emara Ahmed , Abdelsamea Marwa , Abdelmegied Shaimaa Zaki
Published: May 2024

Background and Aims

Epitope and antibody diversity allows Bw4+ or Bw6+ patients to produce antibodies to Bw4 or Bw6 epitopes without breaking self-tolerance. This study assessed the prevalence of mismatched Bw4/6 or missing donor Bw6 allele in kidney transplant (KT) recipients with early acute rejection and its relation to patients and graft outcomes.

Method

A retrospective study included 40 live-related KT recipients divided into 2 equal groups. Group A: 20 KT recipients with early acute rejection in 1st 3 months post-KT and group B: 20 KT recipients with no rejection. Bw4/6 mismatches or missing donor Bw6 were examined in all patients with an assessment of the type of rejection, patients, and graft outcomes.

Results

The prevalence of Bw4/6 mismatch or missing donor Bw6 allele in patients with early acute rejection was 70% (14 patients). Bw4/6 mismatch represented 25% (5 patients) while missing donor Bw6 allele was 45% (9 patients) while the prevalence of Bw4/6 mismatch or missing donor in patients with no rejection was 10% (2 patients) with significant p-value (0.0001). The analysis of demographic data of Bw4/6 mismatch or missing donor Bw6 allele in patients with rejection (N=14) (Fig. 1); mean age was 27.92 years, 71.4% were males (10 patients), panel reactive antibodies (PRA) was positive in 7.1% (1 patient), Donor specific antibodies (DSA) and complement-dependent cytotoxicity (CDC) cross-match were negative in all patients. The most common type of rejection in these patients was acute antibody-mediated rejection (ABMR) 71.4% (10 patients). Patients and graft outcomes; mean serum creatinine after treatment of rejection was 2.16 mg/dl, mortality was 14.3% (2 patients) with graft loss, and survival with functioning graft was 85.7% (12 patients).

Conclusion

Bw4/6 mismatch or missing donor Bw6 allele is a risk of early acute rejection in PRA-negative kidney transplant recipients and is linked to negative patients and graft outcomes.
#1550 Incident hypertension: immune biomarkers and vascular phenotypes
Authors: Murray Eleanor , Delles Christian , Virlan Aysin Tulunay , Nosalski Ryszard , Guzik Tomasz
Published: May 2024

Background and Aims

Blood pressure (BP) regulation is mediated by cardiac, vascular, endocrine, renal, and immune system interactions. Hence, hypertension may exist as different phenotypic variants, with different clinical features and susceptibility to target organ damage. We aimed to analyse the circulating protein biomarker ‘signature’ of: 1) untreated hypertension; 2) hypertensive phenotypes identified by arterial and blood pressure parameters.

Method

61 patients with hypertension, and 61 controls were assessed using 24hr ambulatory BP monitoring; endothelial function, arterial stiffness, carotid intima-media thickness (CIMT), and cardiovascular variability [1]. Circulating protein biomarkers analysed using Olink® Inflammation plasma biomarker panel, reported as NPX (Normalized Protein eXpression), in Log2 scale.

Results

34 biomarkers dominated by cytokines and chemokines differed between normotensive and hypertensive subjects (Fig. 1), though failed to meet Bonferroni-adjusted threshold. Inflammatory biomarkers correlated with BP and arterial stiffness, BP variability, and CIMT, but not endothelial function. Associations were concordant across systolic and diastolic BP; TPP1, CCL7, CCL11, and CCL21 positively correlating; IL18R1, and KYNU negatively. These relationships were more pronounced in hypertensive subgroup, 85 biomarkers correlating including CD molecules (CD200R1, CD22, CD58, CD6, CD70) and cytokines (IL-5, IL-11, IL-15, IL-18, IL-32, IL-1RL2, IL-22RA1, IL-5RA). HGF, AGE, and CCL21 showed greatest between group differences and correlated with multiple BP or vascular parameters. Systolic nocturnal dipping demonstrated negative correlation with biomarkers relating to immune cell interactions and cellular adhesion (CTRC, EPHA1, LGALS4, SIT1, SMOC, IL-18 and TNFSF11).

Machine learning techniques identified three phenotypes of hypertension, ‘arterially stiffened’, ‘vaso-protected’, and ‘non-dipper’ [1]. Sixteen of the 85 correlating biomarkers also differed between these phenotypic groups:

Conclusion

Hypertension is linked to alterations in circulating immune biomarkers. Multiple biomarkers correlated with both arterial stiffness and BP parameters. Some biomarkers are only correlated in the hypertensive group. Many also relate to nocturnal dipping, and differed across the hypertension endotypes. HGF is a promising biomarker for BP and arterial function; warranting further validation.
#209 Relation between exercise pattern changes and renal outcome in new-onset diabetes: a nationwide population-based study
Authors: Lim Sang Yup , Han Kyungdo , Suh Sang Heon , Choi Hong Sang , Kim Chang Seong , MA Seong Kwon , Kim Soo Wan , Bae Eun Hui
Published: May 2024

Background and Aims

Exercise reduced risk of diabetes and obesity. However, it remains unclear whether the pattern changes of exercise are increased risk of end-stage renal disease in new-onset diabetes mellitus (DM) patients.

Method

We assessed diabetes development in 2015 in 21,122,422 non-diabetic Koreans enrolled in Korean National Health Screening (KNHS) from 2009 to 2012 using International Classification of Diseases 10th (ICD-10) code and anti-diabetic medication prescription. Renal outcome (End-stage renal disease) was defined using V-code. The risk of ESRD evaluated in never exercise (none), after new-onset DM (post only), before new-onset DM and no exercise after new-onset DM (pre-only) and persistent exercise group (persistent group).

Results

During median 4.8-year follow-up, 275 (0.21%) of ESRD was occurred. After fully adjusted, the hazard ratio (HR) for ESRD was lowest in persistent exercise group 0.521 [0.302 to 0.899]. Post only exercise 0.674 [0.461 to 0.985] group showed better renal outcome compared to pre only exercise group 0.791 [0.535 to 1.169] or never exercise group [reference, 1.0]. Subgroup analysis for age, sex, history of chronic kidney disease, hypertension showed similar results. Even light exercise such as walking tended to reduce the risk of renal outcome 0.817 [0.634 to 1.037]. The higher 0.627 [0.441 to 0.892] or moderate 0.7 [0.514 to 0.953] strength of exercise type showed the lower risk of renal outcome in new-onset DM patients.

Conclusion

This study provides compelling evidence that exercise, particularly when maintained over time, is associated with a substantial reduction in the risk of ESRD in individuals with new-onset DM. These findings underscore the importance of incorporating regular physical activity as a crucial component of comprehensive health management strategies for individuals with diabetes, offering both clinicians and patients valuable insights for optimizing renal outcomes.
#783 Individualized net benefit of intensive blood pressure lowering among older adults in SPRINT
Authors: Jamshidian Mitra , Scherzer Rebecca , Estrella Michelle , Shlipak Michael , Ascher Simon
Published: May 2024

Background and Aims

The optimal blood pressure (BP) target for older adults remains controversial. This study aimed to determine whether results from the Systolic Blood Pressure Intervention Trial (SPRINT) could be tailored to individual trial participants using risk estimates and simulated preferences about the relative importance of multiple outcomes related to BP lowering.

Method

This analysis included 4,850 SPRINT participants age ≥65 years. Parsimonious Cox models were internally validated to predict the absolute difference in risk between intensive versus standard BP lowering in each SPRINT participant for all-cause death, cardiovascular outcomes, cognitive outcomes, and serious adverse events. Treatment effects were combined using simulated preference weights into an individualized net benefit, which represents the weighted sum of risk differences across outcomes. Individualized net benefits among older SPRINT participants were compared across categories of age (65-74 years vs. ≥ 75 years), frailty (fit, less fit, and frail), and polypharmacy status.

Results

When simulating preferences for older adults who view death, cardiovascular events, and cognitive impairment as much more important than the harms of BP lowering, the median (IQR) individualized net benefit was 5% (3%, 7%), and 100% had a net benefit that favoured intensive BP lowering. When simulating benefits and harms to have similar importance, the median (IQR) individualized net benefit was 2% (1%, 3%), and 95.4% had a positive net benefit. In subgroup analyses, the predicted net benefit of intensive BP lowering was significantly greater among those with advanced age, frailty, and polypharmacy compared with lower risk individuals (P<0.001 for all comparisons).

Conclusion

Almost all older participants in SPRINT had a predicted net benefit that favoured intensive BP control, but the degree of net benefit varied considerably. Personalizing BP targets for older adults according to each person's estimated risks and preferences may provide more refined BP target recommendations.
#1902 Remdesivir ameliorates ferroptotic renal injury in hamster after SARS-CoV-2 infection
Authors: Kim Won , Park Woong , Jung Yujin , Kim Hyeongwan , Yeom Ji-Hyun , Lee Soo Jin
Published: May 2024

Background and Aims

The purpose of this study was to see how remdesivir affected renal ferroptotic damage in hamsters following a human Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection. We evaluated the inhibitory effects of remdesivir on the ferroptosis of SARS-CoV-2 infection in a hamster infection model and in in vivo assays.

Method

To investigate the effect of SARS-CoV-2 on renal ferroptosis, we administered 2.5 × 104 p.f.u. SARS-CoV-2 via intranasal to hamster. In the initial study, animals were treated with remdesivir subcutaneously (s.c.) for 7 days beginning at various times in relation to virus challenge. After 5 days, kidney tissues were harvested. The effect of REMDESIVIR on SARS-CoV-2 infection and ferroptosis were evaluated by immunohistochemistry. Next, ferroptosis-related markers, glutathione peroxidase 4 (Gpx4), 4-hydroxynonenal (4-HNE), Acyl-CoA synthetase long chain family member 4 (Acsl4), nuclear factor erythroid-2-related factor 2 (Nrf2), heme oxygenase-1 (Ho-1) were evaluated by quantitative PCR.

Results

In hamsters, SARS-CoV-2 resulted in high viral protein expression in the renal tubules and decreased renal tubular luminal diameter in periodic acid-Schiff (PAS) stained kidney sections. Remdesivir treatment decreased SARS-CoV-2-induced viral spike protein, HO-1, ferritin heavy chain1 (FTH1), ferritin light chain (FTL), and 4-HNE expression in renal tubular epithelial cells of hamsters in a dose-dependent manner. GPX4 expression suppression after infection was ameliorated by remdesivir administration. Increased ferroptosis-related mRNA marker (Gpx4, 4-HNE, Acsl4, Nrf2, Ho-1) expression in hamster kidneys was suppressed by remdesivir treatment.

Conclusion

All of our data suggest that remdesivir treatment ameliorated SARS-CoV-2 infection-induced ferroptosis in the kidney in a hamster model.