bluuebunny/crossref_metadata_2025 huggingface dataset:
#2356 Renal function in pediatric general population from a hot-spot of chronic kidney disease of unknown etiology: a cross-sectional study in Guatemala
Authors: González Aguilar , Catalina Álvarez Ana , Lou-Meda Randall
Published: May 2024

Background and Aims

Chronic kidney disease of unknown etiology incidence has been exponentially increasing in Central America. Subclinical kidney injury begins early in life and leads to a higher-than-expected prevalence of chronic kidney disease in adolescents and children. The pediatric population has not had a specific approach to the community with this type of kidney disease and very little data is known in Guatemala. We aim to estimate the glomerular filtration rate (eGFR) using two serum biomarkers (creatinine and cystatin C) and applying the Under 25 equation. Inflammatory and urine biomarkers (Urinary Neutrophil Gelatinase-Associated Lipocalin, albumin/creatinine ratio, and urine dipstick) were determined.

Method

During 2019, we performed a Cross-Sectional, population-based screening study in children and adolescents between 7-17 years of age, from local schools in a highly CKDu incident rural community in the Pacific Coast of Guatemala. Children with a diagnosis of kidney disease, hepatic and cardiac failure were excluded in the study. Subjects were chosen randomly from 10 different schools and renal function markers were analyzed by sex and age.

Results

Out of 97 participants of La Democracia, the median age was 11 years and 57% were male. Eighty-seven percent (81/97) of participants had an eGFR between 60 and 90 mL/min/1.73 m2 (Table 1). When comparing eGFR by sex, 63% (51/81) of males and 37% of females had an eGFR between 60 and 90 mL/min/1.73 m2. The difference was statistically significant (p 0.05). When comparing eGFR by age group, the scholar group had an eGFR of 82.7 mL/min/1.73 m2 (SD 7.9), pre-scholars eGFR of 82.2 mL/min/1.73 m2 (SD 6.3), and adolescents of 81.5 (SD 8.1) with no statistically significant difference (p 0.83). Among the twenty-four percent of participants who presented urine dipstick abnormalities, leukocyturia represented 23% (22/97). Twenty-two percent (21/97) of participants had albuminuria more than 0.2 mg/mg and the urinary NGAL/creatinine ratio was higher in females.

Conclusion
#1053 The exposure of phthalates and alternative plasticizers among chronic kidney disease patients during COVID-19 pandemic
Authors: Lim Chun Soo , Lee Jeonghwan , Lee Jung Pyo
Published: May 2024

Background and Aims

Phthalates are widely used in many consumer products as plasticizer and well known to be detrimental to human health. Phthalates mainly disrupt the endocrine system. Recently, phthalate exposures are revealed to be associated with decreased kidney function and increased albuminuria. Risk perception levels and behavioral patterns of CKD patients have been changing with COVID-19 pandemic. However, the effect of these changes on the environmental chemical exposures has not been investigated. We aimed to investigate the environmental chemical phthalates and alternative plasticizer exposure levels during COVID-19 pandemic among CKD patients.

Method

We analyzed the data from a study with a prospective cohort of CKD patient, namely the Study on Kidney disease and EnviromenTal CHemicals (SKETCH, Clinical Trial No. NCT04679168). This cohort included patients with CKD who visited the participating hospitals for the first time between June and October 2020 and followed up to December 2022. Demographic data, behavioral characteristics including hygienic behavior and social distancing, and laboratory data were collected prospectively. Thirty-seven metabolites from 9 light phthalates, 12 heavy phthalates, and 16 alternative plasticizers were measured in urine samples.

Results

The level of light phthalates and alternative plasticizers during the COVID-19 pandemic significantly increased, and heavy phthalates concentrations decreased compared to the pre-pandemic levels. During the 1-year follow-up period, the level of risk perception for infectious disease including COVID-19 significantly decreased. During the 1-yr pandemic period, light phthalate levels decreased for the first 6-month period, and significantly increased for the second 6-month. Heavy phthalates levels were decreased steadily. However, alternative plasticizer levels were maintained during the 1-yr follow-up period. Heavy phthalates levels were significantly higher in the higher risk perception group. However, heavy phthalates levels were not different according to the behavioral patterns. In contrast, the levels of light phthalates and alternative plasticizers were not different according to either behavioral strengthening or risk perception.

Conclusion

COVID-19 pandemic was associated with decreased exposure of heavy phthalates and increased exposure of light phthalates and alternative plasticizers. During the COVID-19 pandemic, levels of light phthalate exposures initially decreased at first 6-month period and gradually increased. This trend of environmental chemicals exposure might be associated with the change of risk perception levels.
#2415 Estimated glomerular filtration rate thresholds associated with poor long-term outcomes in older patients with diabetes
Authors: Lee Kyungho , Jeong Seoin , Kim Jeongyun , Jang Minyoung , Jeon Junseok , Jang Hye Ryoun , Huh Wooseong , Lee Jung Eun
Published: May 2024

Background and Aims

Considering the natural decline of GFR with renal senescence, an age-adjusted estimated glomerular filtration rate (eGFR)-based chronic kidney disease (CKD) definition was recently proposed, which has been supported by that mortality risks start to increase at GFR <45 mL/min/1.73 m2 in older adults (≥65 years). However, the eGFR threshold for mortality and kidney outcomes in older patients with diabetes was less understood. We aimed to evaluate eGFR levels that raise the risk of mortality or end-stage kidney disease (ESKD) in older patients with diabetes.

Method

Older adult patients (≥65 years) with type 2 diabetes who visited our outpatient diabetes center during 2009 were retrospectively identified and followed up until 2017. Patients were categorized into four groups per their CKD-EPI equation-based eGFR: ≥60, 45–59, 30–44, and 15–29 mL/min/1.73 m2. Cox proportional hazard analysis for all-cause mortality and competing-risk analysis for ESKD (with a competing event of pre-ESKD death) were performed.

Results

Among 3,065 patients, 19%, 8%, and 2% of patients had eGFR 45–59, 30–44, and 15–29 mL/min/1.73 m2 at baseline, respectively. After adjusting various clinical covariates, including blood pressure, diabetes duration, urine albumin/creatinine ratio, HbA1c, serum cholesterol levels, and major comorbidities, patients with eGFR 30–44 and 15–29 mL/min/1.73 m2 had 1.51-fold (95% confidence interval [CI] 1.17–1.95, P < 0.001) and 2.66-fold (95% CI 1.87–3.79, P < 0.001) higher risks of mortality, respectively, whereas patients with eGFR 45–59 mL/min/1.73 m2 had a comparable risk (1.18, 95% CI 0.96–1.45, P = 0.127) to those with eGFR ≥60 mL/min/1.73 m2. Substitution hazard ratios for ESKD were 2.29 (95% CI 1.41–3.71, P = 0.001), 5.25 (95% CI 3.27–8.41, P < 0.001), and 16.74 (95% CI 9.73–28.80, P < 0.001) in patients with eGFR 45–59, 30–44, 15–29 mL/min/1.73 m2, respectively. In a subgroup of patients 75 or older (n = 800), patients with eGFR 45–59 mL/min/1.73 m2 exhibited comparable risks for both ESKD and mortality.

Conclusion

Reduced eGFR < 60 mL/min/1.73 m2 predicted an increased risk of ESKD in older patients with diabetes, suggesting that the current traditional eGFR threshold appears feasible. Thus, some high-risk individuals may be missed if age-adapted eGFR criteria with a lower eGFR threshold than 60 mL/min/1.73 m2 are universally applied for older adults ≥65 years.
#1111 The impact of the Covid-19 pandemic on mortality: a study based on the National Health Data System (SNDS)
Authors: Piveteau Juliette , Bayat Sahar , Vigneau Cécile , Couchoud Cécile , Raffray Maxime
Published: May 2024

Background and Aims

The Covid-19 pandemic had a major impact on healthcare systems, challenging the continuity of chronic disease management. Patients with Chronic Kidney Disease (CKD) were identified as particularly at risk. The aim of this study was to measure the impact of the Covid-19 pandemic on their mortality using the French National Health Data System (SNDS).

Method

The SNDS contains the outpatient and inpatient care of all the French population. We applied an algorithm to identify individuals with CKD based on the healthcare consumption available in the SNDS. We identified two cohorts: individuals identified with CKD in 2016 and in 2019. These two cohorts were followed for one year after the year of identification. Patients’ characteristics were extracted from the SNDS and compared between the two cohorts. The event of interest was death documented in the SNDS with death certificates. The follow-up year was divided into periods according to the chronology of the epidemic: pre-epidemic, first lockdown, post-lockdown and second lockdown.

Results

The 2016 and 2019 cohorts included 570,701 and 674,008 individuals respectively. The two cohorts didn't differ in terms of age and sex or comorbidities (median age = 76 years old, 51% female). At 31/12 of the year following identification, 10.90% (n = 62,234) of the 2016 cohort had died, compared with 10.94% (n = 76,756) of the 2019 cohort. Among the 60-year-old and less, mortality in the 2019 cohort was lower than the mortality in the 2016 cohort in all periods of the follow-up year. This remained true among those aged ≥60 years old during the pre-epidemic period (Week 1-Week 10). During the first week of the first lockdown, the instantaneous risk of death for the 2019 cohort reached 5.42 individuals per 1000 in the ≥75-year-old group, compared with 3.12 in the equivalent period for the 2016 cohort (+68%).

Conclusion

All results suggest overall lower mortality in the 2019 cohort of CKD. However, an increase in mortality was observed during strong epidemic periods in the age group of those over 75. These results will be completed with the analyses of the healthcare consumption in the two cohorts describe above.
#1141 Chronic kidney disease in inflammatory bowel disease: systematic review and meta-analysis
Authors: Zadora Ward , Innocenti Tommaso , Verstockt Bram , Meijers Björn
Published: May 2024

Background and Aims

Chronic kidney disease (CKD) is defined by a reduction in kidney function (estimated glomerular filtration rate < 60 mL/min/1.73 m2) and/or damage markers that are present for at least three months, regardless of the underlying aetiology. Case reports and cohort studies suggest that inflammatory bowel disease (IBD is associated with CKD. The extent and magnitude of a potential association between IBD and CKD is currently unknown.

Method

A comprehensive search was conducted in EMBASE, MEDLINE, Web of Science, the Cochrane database, and SCOPUS. Two separate reviewers were involved in the process of article selection and evaluation. In studies where a comparison between an IBD population and a non-IBD control population was available, odds ratios were calculated to quantify the association. To derive an overall estimate of the effect, the Mantel–Haenszel test was employed, utilising a random effect model. This systematic was registered with Prospero.

Results

Fifty-four articles were included in the review (Table 1). Eight articles compared an IBD population with a healthy control population and were included in the meta-analysis, although with high heterogeneity (I2 88%). An increased risk of CKD in the IBD population was observed, with an overall odds ratio of 1.59 (95% CI 1.31-1.93) (Fig. 1). Importantly, this effect was independent of 5-aminosalicylic acid use. Data on other therapies was sparse, except for known nephrotoxic medication like tacrolimus and cyclosporine. Interestingly, several studies reported a decreasing relative risk with increasing age, potentially reflecting an increased baseline risk in this ageing population.

Conclusion

The existing evidence on CKD in IBD was systematically reviewed, including all human epidemiological studies. An increased CKD prevalence in IBD was found; independent of medication. Hence, we suggest regular measurements of kidney function for all patients with IBD, irrespective of the therapeutic regimen. Measurements should include determination of the baseline creatinine, albumin/creatinine ratio and urinary sediment. For patients having a normal baseline function, we would recommend annual follow-up. A more systematic research approach regarding CKD and IBD is warranted
#2478 Multiparametric magnetic resonance imaging predicts decline of kidney function but does not perform better than diffusion-weighted MRI alone
Authors: Huber Aurélie , de Seigneux Sophie , Aslam Ibtisam , De Perrot Thomas , Vallée Jean-Paul , Pruijm Menno , Berchtold Lena
Published: May 2024

Background and Aims

Renal cortical interstitial fibrosis, typically measured by biopsy, is a critical factor for kidney function prognosis. Diffusion-weighted magnetic resonance imaging (DW-MRI) has emerged as a novel promising non-invasive method to assess the degree of fibrosis. We have previously shown that there is a strong correlation between the cortico-medullary apparent diffusion coefficient difference (ΔADC) and histologically assessed fibrosis. We also developed a model based on ΔADC, eGFR and proteinuria that calculates a risk score for future renal function decline. Multiparametric MRI combines DW-MRI with other sequences and can provide synchronized insights into perfusion, diffusion, oxygenation, and tissue characterization (T1 and T2 mappings). Our current research evaluates whether additional multiparametric MRI sequences increase the power of the DW-MRI based model to predict renal function decline.

Method

We used data from 197 patients with either chronic kidney disease (42) or allograft kidneys (155). Each participant underwent a biopsy followed by a multiparametric MRI within the following week. The median follow-up period was 2.2 years, during which laboratory parameters were recorded. The primary endpoint was defined as a rapid decline in kidney function, characterized by a reduction in eGFR of over 30%, or the initiation of dialysis. Prognostic factors for the primary outcome were analyzed using both univariable and multivariable Cox regression models, incorporating MRI parameters (ΔADC, cortical and ΔT1, cortical and ΔT2), eGFR, and proteinuria.

Results

At baseline, mean eGFR was 54.5 ml/min/1.73 m2 (SD 23.8) and mean proteinuria was 0.90 g/24 h (SD 2.4). Rapid decline of renal function occurred in 54 patients after a median time of 1.1 years (interquartile range, 0.9–2.1 years). In univariable survival analysis, cortical T1 measure and cortico-medullar difference ΔT2 have showed the best association to rapid kidney function decline. Compared to our previously established model incorporating ΔADC, eGFR, and proteinuria, adding cortical T1 did not significantly improve the hazard ratio (from 4.62 (95% CI: 1.56–13.67) to 4.36 (95% CI: 1.46–13.02) with cortical T1 inclusion). Harrell's C-index marginally increased with cortical T1, suggesting no significative improvement in prognostic capacity (0.77 versus 0.79 with cortical T1). Additionally, adjusting the regression model for ΔT2 yielded no enhancement in predictive power.

Conclusion

Our results did not demonstrate an enhancement of the prognostic power of the composite score with the inclusion of additional MRI sequences. Consequently, no clear benefit of multiparametric MRI on top of DW-MRI was observed. Additional research is required to investigate this issue more thoroughly.
#2435 Calciphylaxis: patient demographics, risk factors and outcomes in a single regional centre in New Zealand
Authors: Gupta Ankur , Mcclintick Jess , James Rhiannon , Rashed Ahmed
Published: May 2024

Background and Aims

Calciphylaxis, a condition associated with microvascular calcification and subsequent formation of non-healing tender skin lesions, has previously been estimated to affect only approximately 1% of patients with ESRD each year. However, clinicians practicing in a regional renal unit in the North Island of New Zealand have noted an increase in the frequency of clinical diagnoses of this condition over recent years. The aim of this review was to analyze patient demographics and risk factors and attempt to identify any correlation with subsequent outcomes.

Method

A cross sectional retrospective review of dialysis patients from Palmerston North Hospital's Renal Unit who were found to have diagnoses of calciphylaxis, was performed. The following factors were assessed: gender, ethnicity, smoking status, diabetes, obesity, hypertension, dialysis modality, prescription of phosphate binders, vitamin D analogues, and sodium thiosulphate (STS). We included patients with both histologically proven calciphylaxis and clinical diagnosis only. Levels of serum PTH, calcium and phosphate at the time of diagnosis were reviewed, though only PTH levels were included in the final analysis.

Results

A total of nineteen patients were identified having calciphylaxis as a diagnosis in the period studied. Findings were limited due to the small patient cohort size, but of those identified and reviewed some commonalities were found.

Included were 9 NZ European people and 8 NZ Māori people. There were 8 females. One patient was a current smoker at time of diagnosis and five were documented as ex-smokers. Fourteen patients (74%) had type 2 diabetes mellitus and hypertension. Twelve patients (63%) were obese. Eighteen patients (95%) had hyperparathyroidism. Warfarin use was seen in 10 of the patients studied (52%) and twelve (63%) had used phosphate binders. Nine patients (47%) were diagnosed in the period between 2011 and 2021, with the remaining ten (53%) diagnoses occurring in 2022 or 2023. The majority (90%) were treated with STS, however 84% died.

Dialysis modality at time of diagnosis and throughout disease span was also reviewed. Eight patients (42%) used only haemodialysis (HD), six patients (32%) used both modalities and five patients (26%) used only peritoneal dialysis. The majority (63%) of patients were on haemodialysis at time of diagnosis.

Conclusion

Calciphylaxis appears to be increasing dramatically in the single center studied in this review. Positive correlations were identified between high levels of PTH, obesity, hypertension, type 2 diabetes, and use of warfarin. Unfortunately, due to small case numbers, and poor historical documentation, further conclusions could not be drawn easily. A further RCT would be required to investigate the efficacy of STS as a treatment for calciphylaxis.
#2125 Endotypes of kidney injury in patients with acute decompensation of heart failure and their impact on long-term mortality
Authors: Kontareva Natalia , Khruleva Yulia , Andriamanohery Robinson Tsimine , Efremovtseva Marina , Karapetyan Lala , Montoya Flora Elisa Cabello , Galochkin Svyatoslav , Kobalava Zhanna
Published: May 2024

Background and Aims

Renal dysfunction with and without albuminuria is common in patients with heart failure and associated with poorer outcomes. However, the prevalence and long-term influence of increased urine albumin creatinine ratio (uACR) and/or isolated decreased glomerular filtration rate (GFR < 60 ml/min/1,73 m2) have not been well studied in patients with acute decompensation of heart failure (ADHF). The aim was to investigate the prevalence of different variants of kidney injury and their impact on the mortality in patients with ADHF within 1 year of follow-up.

Method

This prospective, observational study included 140 patients who were discharged after ADHF. We excluded patients with terminal stage of chronic kidney disease, end-stage heart failure, malignancy. Patients were divided according to the kidney function (the maximum level of GFR) and albuminuria level taken at hospitalization into four groups: normal renal function (GFR>60 ml/min/1,73 m2, uACR<30 mg/gCr), isolated decreased GFR (GFR<60 ml/min/1,73 m2, uACR<30 mg/gCr), isolated albuminuria (GFR>60 ml/min/1,73 m2, uACR>30 mg/gCr), combined changes (GFR<60 ml/min/1,73 m2, uACR>30 mg/gCr). The observation period was 365 days.

Results

During hospitalization 25% (n = 35) patients had GFR>60 ml/min/1,73 m2, uACR<30 mg/gCr, 19.3% (n = 27) patients had isolated decreased GFR, 22.8% (n = 32) patients had isolated uACR>30 mg/gCr, and 32.9% (n = 46) patients had both. The baseline and admission characteristics are presented in the table (Fig. 1).

34 (24,3%) patients died during follow-up. Mortality was remarkably higher in groups with registered albuminuria during hospitalization regardless of GFR level (25% (n = 8) patients with isolated increased uACR, 39.1% (n = 18) patients with combined changes; with non-albuminuria: (11.4% (n = 4) patients with GFR>60 ml/min/1,73 m2, uACR<30 mg/gCr, 14.8% (n = 4) patients with isolated decreased GFR, p = 0.019 for trend). Kaplan-Meier plots revealed worse outcomes for these groups after adjusting for ejection fraction (EF) (Log-Rank p = 0.0057) (Fig. 2). In the multivariate Cox regression, in which age, gender, reduced EF and three categories of kidney damage were included, only combination of decreased GFR and albuminuria was an independent predictor of long-term mortality (hazard ratio: 3.71 95% confidential interval 1.59 to 8.67, p = 0.002).

Conclusion

Albuminuria is frequently observed in patients with ADHF and, especially with combination with decreased GFR, associated with higher mortality rate during 1 year of follow-up. Albuminuria with decreased GFR during hospitalization with ADHF was an independent risk factor for mortality during one year.
#2294 Muscle ultrasound as a tool for morphofunctional assessment in patients with chronic kidney disease
Authors: Barril Guillermina , Cabrera Alicia , Ochoa Patricia , Alvarez Graciela , Nogueira Ángel
Published: May 2024

Background and Aims

The measurement of the rectus femoris of the quadriceps by ultrasound is used as a measure correlated with muscle mass, strength and functionality, being able to determine diameters and muscle area.

Aims

To assess the usefulness of ultrasound parameters of muscle mass and correlate it with age, gender, dynamometry, exercise, biochemistry and body composition by BIVA

Method

We evaluated 78 patients with ACKD stages 3,4,5(87.2%) and peritoneal dialysis (22.8%) with ultrasound with an echography device (Echographe Sonosite) measuring: transverse(A) and longitudinal(B) axes, ratio B/A and circumference and muscle area of the rectus femoris of the quadriceps according the usual technique. Likewise, we evaluate Hand-grip strength (HOGS), calf circumference and body-composition by BIA.

Results

We evaluated 78 patients with CKD: age 71.54 ± 11.76 years, 59% men and 48.7% DM. Dynapenia/presarcopenia =20.8% with lower muscle-ultrasound parameters, with significant direct correlation p0.01 with A, B, C and muscle mass area transverse diameter (A) = 0.99 ± 0.43, B (longitudinal diameter) = 2.63 ± 0.77, muscle circumference (C) = 6.33 ± 1.83, muscular area = 2.23 ± 1,23.(healthy-population A = 1.31 ± 1.2 cm, B = 3.21 ± 3.4 cm), ratio B/A = 2.97 ± 0.94. Right HGS = 27.22 ± 8.26 kg. Having exercised shows better sig parameters: A1.08 ± 0.45 vs 0.84 ± 0.35 p < 0.01, area 2.50 ± 1.27 vs 1.80 ± 1.02 p0.01 (B and C not sig) as well as age ≤75 vs >75 sig. better in all eco-muscular parameters. We found significant differences between men and women in all parameters as well as dynamometry, perimeter-calf and muscle mass by BIA, not in albumin, Hb or CRP. Overall normal vs low hand-grip-strength (HGS) showed better not significant echo-muscle values. CKD vs PD showed higher values in CKD but not significant. Global significant direct correlations of muscle area p < 0.01) with: HGS r0.324, calf-perimeter r0.30, MM r0.40, Phase-Angle r0.35, Cell mass (BCM) r0.39, and intracellular water (AIC) r0.38. Inverse sig p < 0.01 with B/A ratio.

Conclusions
#2815 Single center, single arm, prospective, observational study of desidustat in chronic kidney disease-induced anemia
Authors: Datta Jayanta , Sarkar Piyali
Published: May 2024

Background and Aims

Anemia in chronic kidney disease (CKD) is multifactorial. Relative deficiency of erythropoietin is one of the key reasons for decreased RBC production. This anemia is associated with poor quality of life and increases morbidity in CKD patients. Injectable erythropoietin is the standard of care for CKD-anemia, which has safety concerns. Desidustat, an oral hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), stimulates endogenous erythropoiesis and is approved for CKD anemia treatment. Hence, the present study identifies the real-world clinical efficacy and safety of the desidustat treatment for a short duration in CKD anemia.

Method

This is an open-label, single-center, prospective study. We analyzed the data of 130 patients who are currently in follow-up and received Desidustat as treatment for CKD-anemia. The study is for the duration of 24 weeks. We followed up on patent at 1 month, 3 months, and the end of the study (6 months). Patients were given a 100-mg Desidustat tablet orally three times in a week. The primary outcome is to assess the change in Hb from baseline, and the secondary outcome is the safety of the therapy.

Results

In this study, we enrolled 130 patients. Of these 130 patients, 58.4% (n = 76) were male and 41.5% (n = 54) were female. The mean age of the study population was 53.6 ± 12.3 years. The majority of the study population was in the pre-dialysis category; 80% (n = 104) and 20% (n = 26) were on dialysis. All the dialysis patients were on three times per week on Dialysis. Diabetes (68%) and hypertension (75%) are the most common co-morbid conditions in patients with CKD anemia. All the patients received desidustat at a 100 mg, three-weekly dose. During each follow-up visit, a significant rise in hemoglobin was observed (p<0.001), as shown in the figure. With desidustat therapy, adverse drug reactions were seen in 5.3% (n = 7) cases: three cases of abdominal pain, two cases of vomiting, and two cases of diarrhea.

Conclusion

Oral HIF-PHIs and Desidustat showed significant improvement in hemoglobin in CKD anemia patients. More studies require for safety and efficacy in Dialysis dependent CKD - Anemia patients.
#1585 Ten years’ practice with calcimimetics and paricalcitol for the treatment of secondary hyperparathyroidism. Experience of one dialysis center
Authors: Shutov Evgeny , Kotlyarova Galina , Bolshakov Stepan , Keroglyan Seda , Dolodze David
Published: May 2024

Background and Aims

Secondary hyperparathyroidism (SHPT) remains one of the main problems in patients with chronic kidney disease (CKD), associated with deterioration in quality of life, progression of cardiovascular complications and mortality.

Method

Patients on HD (n = 2517) were treated from 2012 to 2023 years in our dialysis center with secondary SHPT were included in this study. All patients were divided into 2 groups: 1 gr. included −1536 (61%) patients whose PTH levels remained in the target range from 300 to 600 pg/ml, without therapy or with low doses of alfacalcidol (0.75-5 μg/week ); 2 gr. included - 981 (39%) patients with PTH levels >600 pg/ml were treated with calcimimetics (doses of cinacalcet used from 30 mg to 90 mg/day, doses of etelcalcetide used from 5 to 15 mg/week) as monotherapy or in combination with paricalcitol (5–15 μg/week). Phosphorus levels were controlled by an adequate dose of dialysis and administration of phosphate binders (sevelamer and sucrose iron oxyhydroxide).

Results

The average PTH level in 2 gr. of patients at the time of treatment initiation was 916.7 ± 879.9 pg/ml (601-2500 pg/ml). During the treatment the level of PTH decreased to target values and amounted 523.4 ± 216.7 pg/ml (63-594 pg/ml) in 73% of patients. Monotherapy with calcimimetics was effective in 41%; the remaining of patients (59%) were required the addition of paricalcitol to therapy to achieve target PTH values. Therapy of SHPT was also carried out in 15 (0.6%) patients with identified parathyroid adenomas (volume more than 1 cm3) and PTH levels >1000 pg/ml; the effect was achieved in 9 patients (60%), 6 patients underwent parathyroidectomy. During the previous years of observation, parathyroidectomy was required in all patients with SHPT with similar changes in the parathyroid glands.

Conclusion

In the overwhelming majority of patients with CKD5D and SHPT, the administration of calcimimetics as monotherapy or in combination with paricalcitol during the progression of SHPT allowed us to achieve target PTH values and maintain it for a long time (from 1 to 10 years), as well as reduce the number of surgical interventions for parathyroid glands, compared to the previous period.
#2085 Testosterone and markers of nutritional status correlate with leptin in chronic kidney disease
Authors: Rusu Crina Claudia , Kacso Ina , Moldovan Diana , Potra Alina Ramona , Tirinescu Dacian Călin , Maria Ticala , Orasan Remus , Budurea Cristian , Bondor Cosmina Ioana
Published: May 2024

Background and Aims

Leptin, the anorexic hormone, also appears to have a proatherogenic effect, contributing to the development of cardiovascular morbidity and mortality. Current data on factors related to serum leptin levels in different stages of chronic kidney disease (CKD) are inconsistent.

The aim of this study was to evaluate the determinants of leptin level in pre-dialysis stage of CKD.

Method

We performed a cross-sectional study, including 73 patients, mean age 67 (60-78) years, 38% diabetic, with GFR 31 ± 20.85 ml/min per 1.73 m(2). We followed the correlations of leptin with inflammatory, nutritional, lipid markers, testosterone and others by univariate analysis and subsequently determined the strongest predictor for leptin level by multivariate analysis.

Results

Table. Correlation between the parameters and leptin in CKD pre-dialysis group.

In the CKD pre-dialysis patients the best predictors for leptin level were body mass index, adipose tissue mass, lean tissue mass (for each p < 0.001) and testosterone (p < 0.001). Blood glucose (p = 0.013) was also a significant determinant of leptin level in pre-dialysis CKD patients.

Conclusion

In pre-dialysis CKD patients, testosterone levels together with nutritional markers are the best predictive markers for leptin levels. The management of these determinants can influence the level of leptin in CKD pre-dialysis patients and future research will determine if it can influence the atherosclerotic process.
#2137 Systemic inflammation as a main factor in CKD-MBD development
Authors: Martynyuk Liliya , Chaikovska Mariana , Malska Tetyana
Published: May 2024

Background and Aims

Chronic kidney disease (CKD) is a progressive disorder that affects more than 10% of the general population worldwide. Despite great achievements in the field of treatment of CKD, patient mortality remains at a high level. Research into the pathophysiology and correction of this condition in the early stages of development is ongoing. The aim of the study was to establish relationship between systemic inflammation and mineral disorders in any stage of CKD.

Method

We investigated 5 groups of patients with different stages (I to V) of CKD 19-22 persons in each (total amount 106 patients), aged 49,6 years and 19 healthy individuals aged 41,9 years as control group. We examined the blood level of interleukin 1 beta (IL-1β), interleukin 6 (IL-6), interleukin 8 (IL-8), C-reactive protein (CRP) and c-terminal fragment of fibroblast factor 23 (FGF-23) in all patients and control group.

Results

The course of CKD is accompanied by systemic inflammation, which is characterized by an increase in IL-1β in the I stage of chronic kidney disease ((13,41 ± 3,36) pg/ml) (p < 0.01), IL-6 in the III stage of chronic kidney disease (29,31 ± 5,49) pg/ml (p < 0.01), IL-8 in the II stage of chronic kidney disease ((11,56 ± 2,72) pg/ml) (p < 0.05) and CRP in the IV stage of chronic kidney disease ((7,22 (1,81; 10,8)) mg/ml (p < 0.01), compared to the control group ((5,93 ± 3,65), (6,01 ± 1,67), (7,99 ± 1,17) pg/ml and (0,66 (0,41; 0,85)) mg/ml accordingly), and progresses with a decrease in glomerular filtration rate. Growing already at the initial stage of chronic kidney disease, the level of FGF-23 reached a statistical difference from the control group at the 2nd stage of CKD. A strong statistically significant relationship was found between FGF-23 and IL-6 (R = 0.84; p < 0.01), IL-1β at GFR > 15 ml/(min•1.73 m2) (R = 0.45; p < 0.01) and IL-8 at GFR > 15 ml/(min•1.73 m2) (R = 0.57; p < 0.01).

Conclusion

Systemic inflammation appears in the initial stages of CKD, being a trigger for further kidney dysfunction and the development of mineral and bone disorders. Systemic inflammation treatment in patients with CKD is staying a magnetic but still unattainable goal that needs further efforts to invest.
#1372 Association of plasma beta-2-microglobulin with risk of cardiovascular disease in patients with chronic kidney disease
Authors: Jamba Ariunbold , Javzan Tuvshinbayar , Boldbaatar Khaliun , Amarbold Uugan-Erdene
Published: May 2024

Background and Aims

In patients with chronic kidney disease(CKD), beta 2 microglobulin (B2MG) can be used to assess renal function, and predialysis serum B2MG levels can predict mortality risk. In addition to the kidney, B2MG regulates the expression of interleukin 1 and tumor necrosis factor, participates in the pathogenesis of vascular damage, and is a marker that can detect the formation of amyloid, therefore it is important in the diagnosis of cardiovascular disease (CVD).

To assess the correlation of serum B2MG levels with some metabolic and cardiovascular function factors in patients with chronic kidney disease.

Method

119 people with chronic kidney disease and 52 healthy control groups were selected as a case-control study and blood samples were analyzed for creatinine, urea, cholesterol, triglycerides, LDL, calcium, phosphorus, albumin, total protein, and B2MG with Cobas 6000 fully automatic analyzer and echocardiography was performed.

Renal function was evaluated by CKD EPI crea-cys combined calculation. In the group with CKD, a person with eGFR <90 ml/min/1.73 m² was not included in the study due to the study exclusion criteria.

Results

The average age of the group with CKD was 54.92, and the average age of the healthy group was 50.66. B2MG has a significantly higher (P < 0.000) statistically significant correlation in the group with CKD compared to the control group.

B2MG was significantly associated with creatinine (g = 0.516, P < 0.000), phosphorus (g = 0.342, P < 0.000), cystatin C (g = 0.700, P < 0.000), urea (g = 0.326, P < 0.000), and echocardiography with directly indicators LVMI(g = 0.113, P < 0.000), LVESD (r = 0.265, P < 0.000), thus BMI (g = −0.274, P < 0.000), tTSH (r = −0.516, P < 0.000), calcium ( g = −0.137, P < 0.000), albumin (g = −0.180, P < 0.000), total protein (r = −0.080, P < 0.000), cholesterol (g = −0.215, P < 0.000), BNLP (r = −0.163, P < 0.000), triglycerides (g = −0.142, P < 0.000), and EV of echocardiography (g = −0.292, P < 0.000) have inverse statistical significance.

Conclusion

B2MG levels have been shown to predict CVD risk and CVD-related mortality in all stages of chronic kidney disease. According to our study, B2MG is directly related to kidney function biomarkers, phosphorus, LVMI, and LVESD indicators of cardiac echocardiography, and inversely correlated with parameters of eGFR, protein, triglycerides, calcium, and cardiac echocardiogram EV indicators, which is similar to studies conducted in other countries. Therefore, B2MG can be used to detect the risk of CVD in people with severe CKD.

Figure: Will be uploaded on our poster if accepted.
#2070 Associations of fecal and plasma levels of SCFAs with gut microbiota and clinical characteristics in non-dialysis renal anemia patients
Authors: Dou Yanna , Liu Lifen
Published: May 2024

Background and Aims

Renal anemia is one of the most common complications of Chronic Kidney Disease (CKD). The gut-kidney axis hypothesis has led to numerous studies showing that patients with CKD have a distinct gut microbiota structure compared with controls and that changes in gut microbiota correlate with disease severity and progression. The short-chain fatty acids (SCFAs) are speculated to be pivotal in the gut-kidney crosstalk. However, the role of SCFAs in renal anemia has not been elucidated. This study aimed to explore and compare the fecal and plasma levels of SCFAs in non-dialysis renal anemia patients and healthy controls to reveal the potential interactions among SCFAs, gut microbiota, and clinical features of renal anemia, which may provide new light on further studies.

Method

A cohort of 30 non-dialysis renal anemia patients and 20 healthy controls were recruited from the First Affiliated Hospital of Zhengzhou University. Gut microbiota was analyzed using 16S rRNA gene amplification sequencing. Fecal and plasma concentrations of SCFAs were measured using GC-MS/MS platform. The clinical characteristics of patients with renal anemia and controls were evaluated.

Results

Renal anemia patients displayed altered microbiota composition compared to healthy subjects. The relative abundance of Enterobacterales, Enterobacteriaceae, Escherichia-Shigella, and Escherichia-coli were higher in patients with renal anemia, and the Lachnospiraceae family decreased in renal anemia patients. In contrast, the relative abundance of Lachnospirales, Lachnospiraceae, and Bacteroides vulgatus was higher in the control group. Patients with renal anemia had higher fecal and plasma concentrations of SCFAs compared to controls. The fecal and plasma concentrations of SCFAs were significantly different not only between the patients with renal anemia and controls but also in the different severity of renal anemia. Moreover, different types of SCFAs are intimately associated with clinical characteristics. The applications of medications may exert effects on the fecal and plasma SCFAs. A positive correlation was obtained between Lachnospirales and the plasma SCFAs. The levels of acetic acid and caproic acid in fecal and the levels of acetic acid, propionic acid, and butyric acid in plasma were all positively correlated with the abundance of Cyanobacteria.

Conclusion

The gut metabolites SCFAs are tightly linked to the alterations of gut microbiota and clinical characteristics of renal anemia. Further studies are warranted to elucidate the relationships more in-depth.
#108 Mineral and bone disorders during chronic kidney disease
Authors: Abdelkerim Charfadine Senoussi , Ibrahim Hamat , Guillaume Mahamat Abderrramane , Youssouf Djibril , Mahamat Aboubabakar Abdelkerim , Seid Haoua Youssouf , Hissein Nassima , Djibrine Dibrine Mahamat , Mahamat Hapsita
Published: May 2024

Background and Aims

The objectives of our work were to describe mineral and bone disorders in patients with chronic kidney disease (CKD) not yet at the dialysis stage and to assess the compliance of phosphocalcic balance indicators with international KDIGO recommendations

Method

It was a retrospective study conducted over a 10-month period (01 November 2018 to 31 August 2019) in the nephrology and haemodialysis department of the Renaissance University Hospital in Ndjamena. We have included all patients followed up in the unit for non-dialysis CKD, aged over 18 years and consenting to participate to this study.

Results

A total of 387 patients files were collected, 82 of which have been taken on. The average age of the patients was 52.7 (± 15.8) years, with a male predominance (67.1%). The comorbidities were arterial hypertension (71.9%) and diabetes (24.4%). CKD has predominated in stage V (55%), followed by stage III (23%). Clinical signs were mainly diffuse bone pain (37.8%), pruritus (8.5%), muscle pain (7.3%) and insomnia (8.5%). Disorders in phosphocalcic metabolism have been noticed in stage IV (11.9% and 10.7%) and stage V (40.5% and 34.5%) for hypocalcaemia and hyperphosphataemia. Secondary hyperparathyroidism and 25 OH vitamin D deficiency were respectively 28.8% and 40.5% in stage V CKD. Compliance with international KDIGO recommendations was 59.7%, 53.7% and 37% respectively for serum calcium, serum phosphorus and parathyroid hormone. Radiological fractures were observed in 4.9% of patients. The management of these disorders has focused on calcium carbonate (52.4%), native vitamin D (64.6%) and Cinacalcet (6.1%) administration. Hypocalcaemia (p = 0.005) and hyperphosphataemia (p = 0.0001) were higher in stage V patients, with a significant difference.

Conclusion

The treatment of mineral and bone disorders has way to go for the majority of patients, due to lack of resources and the exorbitant cost of treatment. Prevention of mineral and bone disorders is a fundamental pillar of CKD treatment for our patients.
#911 A mice model of SHPT with bone abnormalities in CKD and potential functional role of sphingolipid in renal osteodystrophy
Authors: Wang Yujia , Tang Rining
Published: May 2024

Background and Aims

Renal osteodystrophy (ROD) is the skeletal disease of chronic kidney disease associated mineral and bone disorder (CKD-MBD). ROD is characterized by abnormal bone mineralization and impaired bone remodeling, leading to increased risk of fractures and mortality in patients with CKD. To date, the pathology of ROD remains poorly understood due to the lack of a suitable animal model. Hence, we successfully established a stable mouse model of ROD using an optimized adenine diet and explored the possible signaling based on RNA-seq expression analyses.

Method

Blood biochemical analysis, micro-computed tomography (micro-CT) and bone histomorphometry were performed to analyze the skeletal characteristics. RNA sequencing (RNA-seq) was used to investigate the mechanisms involved in ROD. The functions of differentially expressed genes (DEGs) were evaluated by Gene Ontology (GO) analyses, Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses and Gene Set Enrichment Analyses (GSEA). DEGs were validated by quantitative real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR).

Results

The mice with ROD induced by optimized adenine diet showed severe abnormalities in serum creatinine (Scr) and blood urea nitrogen (BUN) along with marked hyperparathyroidism and hyperphosphatemia. The bone mineral density (BMD) of femurs was significantly lower in the ROD mice than that in the control (CTL) mice. The trabecular and cortical bone parameters of femurs significantly showed bone loss and severe cortical porosity. ROD mice showed high bone turnover with increased osteoid, eroded, osteoblast, and osteoclast perimeters as well as increased bone formation rate and mineral apposition rate. Transcriptomic profiling identified 1286 genes were upregulated in the femurs of ROD mice compared to the CTL mice and 333 genes that were downregulated. GO, KEGG and GSEA pathway analyses indicated that these genes were highly enriched in functions related to lipid metabolism pathway, sphingolipid signaling pathway, among others. The differential expression of alkaline ceramidase 1(Acer1), ceramide synthase 4 (Cers4) sphingomyelin phosphodiesterase 3 (Smpd3), sphingosine-1-phosphate phosphatase 2 (Sgpp2) in skeletal tissue and serum of CKD patients were validated by qRT-PCR. Since sphingolipid pathways have been recently implicated in bone metabolism, these genes are potential target genes in the settings of ROD.

Conclusion

In conclusion, our findings demonstrated that the CKD mice with bone abnormalities induced by optimized adenine diet may serve as a useful model for skeletal analysis in ROD. Based on the RNA-seq, we identified that sphingolipid might play a crucial role in the pathogenesis of ROD and provided new therapeutic targets for future study.
#814 Inflammatory biomarkers and progression of diabetic kidney disease
Authors: Vasilkova Volha , Mokhort Tatsiana , Borovets Yana
Published: May 2024

Background and Aims

Diabetic kidney disease (DKD) is one of the fastest growing causes of chronic kidney disease and associated morbidity and mortality. Previous studies have demonstrated the involvement of inflammation in the progression of kidney damage.

The aim of our study was to evaluate potential therapeutic approaches using inflammatory biomarkers to assess DKD progression.

Method

A total of 499 patients with DT1 and DT2, aged 34 to 84 years (60 [60;72]), were examined. All patients underwent standard clinical and laboratory examination, with an assessment of the levels of the inflammatory biomarkers (FGF-23, TNF-α, VEGF-A, hsCRP, Il-6) in baseline plasma samples. Renal function was assessed based on the levels of serum creatinine, eGFR and albumin/creatinine ratio. Control group included 65 people the same age without diabetes.

Results

We divided all patients into two groups according to the presence DKD. The levels of FGF-23 (p < 0.001), TNF-α (p = 0.014), VEGF-A (p = 0.006), hsCRP (p < 0.001), Il-6 (p < 0.001) were significantly higher in patients with DKD than in control group.

A predictive model was developed to estimate the probability of DKD depending on VEGF-A, FGF-23, TNF-α, Il-6, hsCRP, age, duration of diabetes, systolic blood pressure, HbA1c, LDL-C, using binary logistic regression. The resulting regression model was statistically significant (p < 0.001). Based on the value of Nagelkerke R², the model explained 79.5% of the observed DKD variance.

1 pmol/l increase of FGF-23 was associated with 1.921 times increase in DKD odds. 1 pg/ml increase of TNF-α was associated with 1.092 times decrease in DKD odds. 1 mg/ml increase of Il-6 was associated with 1.612 times increase in DKD odds. 1 mg/l increase of hsCRP was associated with 1.496 times increase in DKD odds.

Conclusion

Our study identifies FGF-23, TNF-α, Il-6, hsCRP as promising targets of novel therapeutic interventions in patients with diabetes, which should be investigated in future clinical trials.
#3065 Factors associated with recurrence or persistently high parathormone levels after parathyroidectomy in patients with CKD
Authors: Yıldırım Saliha , Helvacı Özant , Yavuz Aydın , Erten Yasemin , Derİcİ Ülver , Guz Galip
Published: May 2024

Factors associated with recurrence or persistently high parathormone levels after parathyroidectomy in patients with secondary hyperparathyroidism receiving renal replacement therapy 

Background and Aims

Resistant hyperparathyroidism that indicates surgery usually occurs in patients with CKD who receive renal replacement therapy (RRT). This study aims to evaluate the factors associated with persistent or recurrent high levels of PTH after parathyroidectomy due to SHPT in patients receiving RRT.

Method

In this retrospective study, we included 66 adult patients (mean age: 46.86 ± 13.79) with parathyroidectomy for SHPT receiving renal replacement therapy. Clinicopathological features, laboratory parameters (preoperatively, at the first hour of surgery, at least every three months for at least two years after surgery), type of surgery and pathologic diagnosis were recorded from the medical records. Persistence was defined as failure to achieve a decrease in PTH level of more than fifty percent of preoperative PTH level. Recurrence was defined as elevated PTH levels after six months post-operation (>600 pg/mL).

Results

The demographics and clinical characteristics of the study population are described in Table 1. High PTH levels were observed in nineteen patients, while recurrence was observed in nine. Persistence was associated with lower preoperative ALP levels (455.27 ± 296.23, 619.72 ± 593.18, p = 0.017). Recurrence was associated with higher preoperative CRP levels (22.89 ± 6.82, 6.82 ± 5.35, p:0,046) and postoperative high phosphorus levels (4.93 ± 0.99, 4.16 ± 1.09, p = .049).

Conclusion

In our study persistence of high parathormone levels were more common in patients with lower preoperative ALP levels and recurrence was associated with higher preoperative CRP levels and postoperative inadequate phosphorus control. In conclusion, patients with lower ALP and higher CRP levels can be suitable for total parathyroidectomy, which is associated with a lower recurrence rate in SHPT. Also, postoperative phosphorus control can be a key point for preventing the patients' recurrence of high PTH level.