bluuebunny/crossref_metadata_2025 huggingface dataset:
#4313 AN ANTI-FIBROTIC GENE ATTENUATES DIABETIC KIDNEY INJURY IN DB/DB MICE BY INHIBITING FIBROSIS VIA EPITHELIAL-MESENCHYMAL TRANSITION PATHWAY
Authors: Lee Seunghye , Kim Jin Hyun , Cho Hyun Seop , Jang Ha Nee , Jung Sehyun , Jung Jung Hwa , Chang Se-Ho , Kim Hyun-Jung
Published: June 2023

Background and Aims

Diabetic nephropathy (DN) is a major cause of mortality in patients with diabetes and chronic kidney disease, but there is a lack of effective therapeutic drugs for this disease. The development and progression of DN is influenced by fibrosis. transforming growth factor (TGF)-β1 is a key cytokine involved in fibrosis in many different organ systems. Anti-fibrotic gene (Anti-F) is a TGF-β/Smad signaling. Here we examined the therapeutic effect of Anti-F in a model of DN using db/db mice with streptozotocin (STZ) treatment.

Method

The db/db mice were divided into five groups; db/m+ (wild type), db/db+saline, db/db+STZ, db/db+STZ+CMV-Anti-F, and db/db+STZ+TGF-β-Anti-F. STZ was peritoneally injected for five consecutive days (50mg/kg) and Anti-F (40μg/head) was peritoneally administered once every two weeks. Mice were sacrificed four months after STZ injection.

Results

The Anti-F with CMV and TGF-β promoter administration markedly alleviated metabolic syndrome assessed by obesity and hyperglycemia, and renal dysfunction assessed by renal overweight and albuminuria in db/db+STZ mice. The administration obviously mitigated glomerular damage in diabetic mice, as reflected by the reduction of increased mesangial expansion and the expression of nephrin and podocin in db/db+STZ mice. Additionally, renal interstitial fibrosis was also significantly inhibited by Anti-F through suppressing epithelial-mesenchymal transition (EMT) signaling including α-SMA, Twist, and Snail, as well as inflammation reflected by IL-1β, MMP-2, and MMP-9 in diabetic mice.

Conclusion

Anti-F attenuated the development of DN in db/db mice with type 2 diabetes. The protective effect was associated with decreased inflammation and subsequent attenuation of EMT-mediated renal fibrosis. Thus, this study suggests that targeting the Anti-F could be considered as a novel therapeutic approach for preventing the progression of DN.
#4376 THE ASSOCIATION AMONG CAROTID IMT, PWV AND VASCULAR ACCESS FAILURE IN HEMODIALYSIS PATIENTS
Authors: Yoon Jong-Woo , Kim Hyunsuk , Kim Seokhyung , Choi Gwangho , Kim Jin-Up , Lee Younh-Ki
Published: June 2023

Background and Aims

Patients with chronic kidney disease (CKD) or end stage renal disease (ESRD) have an increased risk of cardiovascular mortality and morbidity. We aimed to compare the value of IMT with tests such as coronary CT and Pulse wave velocity(PWV) as predictors of cardiovascular risk in ESRD patients undergoing maintenance dialysis and examine their association with cardiovascular disease.

Method

We reviewed the participants’ medical records, including height, body weight, smoking status, alcohol intake, medication history, etiology of ESRD, HD vintage, and blood pressure which were measured during hemodialysis. Carotid dopplerwas performed by an skilledsonographer who are unaware of the aims of the study and blinded to the laboratory findings. For PWV measurement, Patients lie down, rest for at least 5 minutes, and prohibit smoking and coffee for 3 hours before the measurement. BaPWV is measured by recording pulse waves of both arm and both ankles from the pressure signal obtained by measuring 4-extremitiy blood pressure.

Results

One hundred patients were included, of whom 51 (50.5%) were men. The median age was 66years (interquartile range 58-76 years). The median vintage of hemodialysis was 47.5 months (range 31.3-89.1 months). There were no significant differences between high IMT groupand low IMT group in sex, hemodialysis vintage, end-stage renal disease etiology, and type of vascular access. However, age was significantly older in the high IMT group. IMT was significantly associated with PWV. (hazard ratio [HR] 2.109; 95% CI 1.037-4.291, P = 0.039). After adjusting for age, sex and presence of diabetes, IMT was independently associated with PWV (HR 2.110, 95% CI 1.036-4.298, P = 0.040). The risk of recurrent vascular access failure was higher in the high IMT group (HR 1.615, 95% CI 1.460-5.669, P = 0.034).

Conclusion

IMT was associated with PWV and recurrent access failure. Thus IMT may be suggested as a potential predictor of vascular access failure.
#4379 SURVIVAL RATES AND ANALYSIS OF PREDICTORS OF MORTALITY AMONG INCIDENT HEMODIALYSIS PATIENTS: A SINGLE CENTER FIVE-YEAR COHORT STUDY
Authors: Leano Danice Romagne , Chua Eric , Ninalga-Rodriguez Hazel Daphne , Danguilan Romina
Published: June 2023

Background and Aims

Studies on improving survival rate among maintenance hemodialysis patients have been extensive. However, only a handful of studies have focused on the factors that determine mortality risk among incident hemodialysis patients, considering that the first few months of hemodialysis initiation are the most critical. Survival rates and factors predicting mortality may vary from one geographic area to another. Local data on these factors, however, are quite lacking. Identification of factors that can be optimized during this crucial period can greatly impact survival of Filipino hemodialysis patients. This study was designed primarily to determine 1-year, 3-year and 5-year survival rates of incident hemodialysis patients enrolled at the National Kidney and Transplant Institute (NKTI). Demographic and clinical factors that may influence mortality risk were identified and analyzed.

Method

This is a retrospective cohort study which evaluated the data of all incident adult patients enrolled at NKTI Outpatient Dialysis Unit, over a period of 5 years (January 2016 to December 2020). Patients were followed, retrospectively, from initiation until censorship (end of study, loss to follow up, transfer, conversion to peritoneal dialysis or kidney transplant) and the following factors were compared between those who remained alive and those who expired: etiology of kidney disease, age, sex, mode and frequency of dialysis, access, socioeconomic class and biochemical parameters. Descriptive statistics was used to describe and summarize the baseline data. Frequency and proportion were used for categorical variables, and median and inter-quartile range (IQR) for non-normally distributed interval/ratio variables. Survival probabilities were estimated using the Kaplan-Meier method. Cox regression was done to determine factors of overall survival. All valid data were included in the analysis. Null hypothesis was rejected at 0.05α-level of significance. Stata 15.0 was used for data analysis.

Results

A total of 562 incident hemodialysis patients were enrolled, 94 of whom expired. Among those who expired, there were more patients who were aged above 60 years (56.38% vs 29.91%, p <.001) and with low serum phosphorus level (29.21% vs 16.78%, p=.029) in comparison to those who were alive. Computed 1-year, 3-year, and 5-year survival rate among patients were 89.51% (95% CI 86.10% - 92.12%), 73.03 (95% CI 66.46 – 78.52%) and 42.06% (95% CI 29.52% - 54.99%), respectively. Patients who are older than 60 years (HR 2.75, p= 0.013), hepatitis C positive (HR 3.92, p= 0.021) and those with low phosphorus (HR 1.86, p= 0.015) were noted to have increased risk of mortality.

Conclusion

Survival rate of incident hemodialysis patients at NKTI is at par with survival estimates abroad. Risk factor identification and optimization of modifiable ones are key in improving patient survival.
#4431 PREPARATION OF IMIDAZOLE QUATERNARY AMMONIUM SALT MICROSPHERES WITH HIGH BILIRUBIN ADSORPTION PERFORMANCE AND SELF-ANTICOAGULATION ABILITY
Authors: Deng Ningyue , Jin Lunqiang , Su Baihai
Published: June 2023

Background and Aims

Bilirubin is a crucial toxin in liver metabolism. Increase of bilirubin is one of common manifestations in patients with abnormal liver function, and large accumulation of bilirubin in the blood can lead to more severe hepatic dysfunction and even death. Due to the poor therapy effect and the shortage of available donor organs, the artificial liver support system has been introduced to maintain the liver function and bridge patients to transplantation. Previous studies have found that imidazole quaternary ammonium salts have great potential to adsorb bilirubin. This work is to develop a novel bilirubin adsorption column by simple and general method, and evaluate the removal efficiency, anticoagulant property and biocompatibility of the bilirubin adsorption column.

Method

Multifunctional microspheres were fabricated by in situ co-polymerization of 1-vinylimidazole and divinylbenzene. Nuclear magnetic resonance (NMR), thermo-gravimetric analysis and X-ray photoelectron spectroscopy (XPS) etc. were performed to characterize the chemical compositions of the microspheres. Meanwhile, hemolysis test, blood routine test and clotting time test etc. were leveraged to evaluate the biocompatibility of the microspheres. Both static adsorption test and dynamic adsorption test were performed in vitro to evaluate adsorption performance.

Results

A variety of methods had proved successful synthesis of the adsorption performance. The hemolysis ratios of microspheres were less than 5%. Compared with BS330 microspheres and PES microspheres, the activated partial thromboplastin time (APTT) and thrombin time (TT) were longer in this work. Moreover, the microspheres showed a high adsorption clearance. In PBS solution of bilirubin, the adsorbent could decrease bilirubin from 200 mg/L to 45-55 mg/L.

Conclusion

The results suggested that the multifunctional microspheres can significantly reduce bilirubin concentration without obvious adverse interactions and could exhibit anticoagulation activity.
#4437 ASSESSMENT OF THE PSYCHOLOGICAL EXPERIENCE OF KIDNEY TRANSPLANT PATIENTS DURING THE COVID-19 PANDEMIC
Authors: Mazighi Sara , Naouaoui Salma , Chettati Mariam , Fadili Wafaa , Laouad Inass
Published: June 2023

Background and Aims

The coronavirus (COVID 19) pandemic has caused a major health crisis, and quarantined half of the world's population, therefore it contributed to the appearance or aggravation of mental distress such as anxiety, depressive disorders and deterioration of the quality of sleep especially in the immunocompromised population and especially in the kidney transplant patients. Among the causes of these disorders are the risk of infection and the relatively high mortality rate associated with this virus. The aim of our study is to investigate anxiety and depression scores in renal transplant patients during the COVID 19 pandemic and compare them to those of the general population to highlight the impact that the pandemic has had on this vulnerable population.

Method

This is a descriptive and analytical case-control study of a group of 113 patients divided into 2 groups: group of kidney transplant patients and that of the general population. A questionnaire collecting sociodemographic data was used. Anxiety symptoms were assessed by the GAD anxiety scale. Depressive symptoms were assessed using the Beck's scale abbreviated.

Results

In our study, the rates of anxiety and depression in the general population group were around 33.3% and 18.3% respectively. This rate was significantly higher in subjects with previous psychiatric history. These rates were higher in women with an anxiety rate of 18.3% versus 15% in men and a depression rate of 11% in women versus 7% in men and were significantly higher in subjects with previous psychiatric history. In the group of kidney transplant patients the rates of anxiety and depression were high compared to the general population, with a rate of anxiety at 66% and depression at 26.4% (p<0.001).

Conclusion

This study raised the major negative impact of the covid 19 pandemic on the increase of psychiatric disorders in this at-risk population compared to the general population. This requires a multidisciplinary and adapted management of these vulnerable patients, associating a joint nephrological and psychiatric follow-up in order to preserve their quality of life and their mental health.
#4568 C-REACTIVE PROTEIN / SERUM ALBUMIN RATIO IN PATIENTS WITH COVID-19 AND ADVANCED CHRONIC KIDNEY DISEASE DUE TO TYPE 2 DIABETES MELLITUS
Authors: Klochkova Nataliya , Lysenko Mariana , Zeltyn-Abramove Eugene , Belavina Natalya
Published: June 2023

Background and Aims

The patients with advanced kidney disease (DKD) due to type 2 diabetes mellitus (T2DM) are at a high risk of adverse outcomes of COVID-19. The causes of high mortality among these patients are the subject of debate. C-reactive protein (CRP)/serum albumin (SA) ratio is one of the probable prognostic laboratory indicator of adverse outcome.

Aims

The evaluation of diagnostic value of CPR/SA in patients with COVID-19 and advanced DKD.

Method

The patients with laboratory confirmed COVID-19 and advanced DKD were included in the retrospective observation study. The observation period 04.01-10.31.2020. The study endpoints were the outcomes of hospitalization−discharge or lethal outcome. Data were collected from electronic medical database. The observation group was divided in two subgroups: (1) patients with advanced DKD 4-5stage (according to eGFR) not requiring maintenance hemodialysis (MHD), (2) patients on MHD. CPR, SA, CPR/SA were analyzed at hospital admission.

Results

A total of 120 patients were included. 55 patients with advanced chronic kidney disease not requiring MHD (1) and 65 patients on MHD (2). Mediana age 69 y (IQR 63.5; 79.5), females 53%. The study subgroups did not significantly differ on gender, age, comorbidity, duration of DKD and onset of COVID-19. The mortality in both subgroups was rather high (38.2% vs 38.5% resp). The median of CRP in (1) was 96 (IQR 27; 144) mg/l (survivors) vs 158 (IQR 43; 193) mg/l (nonsurvivors), P = .025. The median of SA in (1) was 37.0 (IQR 32.0; 38.5) g/l (survivors) vs 30.0 (IQR 29.6; 33.0) g/l (nonsurvivors), p<0.001. The median of CPR (2) was 69 (IQR 39; 133) mg/l (survivors) vs 90 (IQR 33; 156) mg/l (nonsurvivors), P = .246. The median of SA in (1) was 34.8 (IQR 32.0; 37.0) g/l (survivors) vs 33.0 (IQR 28.0; 35.0) g/l (nonsurvivors), P = .084. CPR/SA in (1) subgroup was 2.7 (IQR 0.8; 4.0) (survivors) and 4.9 (IQR 2.6; 5.9) (nonsurvivors), P = .012. CPR/SA in (2) subgroup was 2.4 (IQR 1.3; 4.3) (survivors) and 2.6 (IQR 1.0; 5.9) (nonsurvivors), P = .457. Determination of the cut-off point for CPR/SA ratio was based on the receiver operating characteristic (ROC) analysis. Cut off point CPR/SA ratio for (1) subgroup is 3.6 and cut off point for CPR/SA ratio for subgroup (2) is 2.4. 55-days cumulative proportion surviving (Kaplan-Meier method) are presented on the Fig. 1 and Fig. 2 In subgroup (1), a threshold value of the CRP/SA ratio was revealed, which significantly affects the survival of patients. In subgroup (2), it was not possible to identify the threshold value of the CPR/SA ratio, which significantly affects the cumulative survival rate of patients.

Conclusion

CRP/SA ratio ≥3.6 in patients with advanced DKD not requiring MHD is a laboratory indicator of adverse outcome of COVID-19. The studied parameter did not differ in patients on MHD regardless of the COVID-19 outcomes.
#4654 THROMBOEMBOLIC EVENTS AND THEIR RELATIONSHIP WITH COVID-19 IN HEMODIALYSIS PATIENTS: MYTH OR TRUE ?
Authors: Cidraque Ignacio , Román Vicente García , Pérez Alicia Sobrino , Bello Abraham Rincon , Shkolenko Kateryna , Ortego Sofia , Blanco Ana , Samaniego Diana , Salvador Maria Eva Baró
Published: June 2023

Background and Aims

Since the beginning of COVID-19 pandemic, there has been more than 668 million of diagnosis and more than 6 million deaths worldwide. This pandemic also has had a dramatic impact on chronic patients, such as those with end stage renal disease (ESRD) on hemodialysis (HD).

Many studies have hypothesized that COVID-19 could induce a hypercoagulability state, activating coagulation cascade. Post-mortem studies revealed vascular injuries in more than 60% of lung tissues and many patients diagnosed with COVID-19 have suffered neurological pathologies, as ischemic stroke. Patients with ESRD are also at higher risk of thromboembolic events than healthy subjects.

In this study, we analyze thromboembolic events in HD patients with or without COVID-19 diagnosis.

Method

We performed a retrospective observational study between March 2020 and December 2022 with 4679 HD patients (2635 COVID-19 positive patients (Group 1) and 2044 COVID-19 negative (Group 2)) from 50 Spanish clinics. The baseline dates of the non COVID-19 patients were randomly chosen. Follow-up time was 1 year since COVID-19 diagnosis (Group 1) or since selection (Group 2).

We identified patients who has suffered any thromboembolic event during follow-up time. We compared usual clinical parameters between groups using Chi2 and Mann-Whitney U tests. Survival analysis was performed by Kaplan-Meier and Cox regression. Continuous variables were categorized to perform the Cox analysis.

Results

Small differences between Group 1 and 2 were found in age (70.45 (62-81) vs 68.94 (61-80); p<0.001), proportion of men (63% vs 67.2%; p<0.05), HD vintage (34 (14-71) vs 30 (11-65); p<0.05), preHD systolic blood pressure (SBP) (140.73 (126-155) vs 142.65 (128-157); p<0.05), plasma hemoglobin (Hb) (11.19 (10.40-11.90) vs 11.31 (10.5-12); p<0.05) and proportion of patients with antithrombic medication (604 (22.9%) vs 401 (19.6%); p<0.05).

No statistically significant differences were found in time to first thromboembolic event between the two groups (Figure 1). In univariate Cox regression (Table 1) thromboembolic events showed significant relation with gender, Charlson Index above 8, preHD relative overhydration (relOH) above 13.4% and preHD SBP above 155 mmHg. In multivariate analysis (Table 1), Charlson Index and preHD SBP showed hazard ratio above 1.5 for thromboembolic event (p<0.05). COVID-19 diagnosis did not show relationship with thromboembolic events.

Conclusion

Publications on thromboembolic events in HD patients who have suffered from COVID-19 are scarce and with small size samples. In our large HD sample, thromboembolic events were not related to COVID-19. Only Charlson Index and preHD SBP showed a significant relationship in the multivariate analysis.
#4695 LOSS OF NLRP6 INCREASES THE SEVERITY OF KIDNEY FIBROSIS
Authors: Valiño Lara , Favero Chiara , Pintor-Chocano Aranzazu , Carriazo Sol , Ortiz Alberto , Sanchez-Nino Maria Dolores
Published: June 2023

Background and Aims

The burden of chronic kidney disease (CKD) is growing worldwide, illustrating the need for better prevention and therapeutic approaches. Kidney fibrosis is a hallmark of CKD that is not specifically addressed by current therapeutic options. The nucleotide-binding oligomerization domain-like receptor (NLR) family has 22 members. The NLRP3 inflammasome has been most extensively studied in the context of kidney disease where it plays a pathogenic role. However, the role of NRLP6 during CKD and kidney fibrosis remains unexplored. The aim of the study was to explore the role for endogenous Nlrp6 in protecting from kidney fibrosis.

Method

A hypothesis-driven analysis of non-biased human kidney disease transcriptomics databases was performed to identify NLRs other than NLRP3 of potential therapeutic interest, based on differential gene expression during CKD and the relationship of gene expression to severity of CKD. We explored Nlrp6 expression in preclinical accelerated CKD and kidney fibrosis (UUO) and characterized the function of endogenous Nlrp6 by inducing UUO in Nlrp6-deficient mice and validated the results in a second model of kidney fibrosis. Once tubular cells were identified as the key cells expressing NLRP6 and regulating NLRP6 expression during UUO, we explored the drivers of Nlrp6 downregulation in tubular cells, as well as the consequences of Nlrp6 downregulation in these same cells.

Results

The role of Nlrp6 in experimental CKD was explored in wild-type and Nlrp6-deficient mice with unilateral ureteral obstruction (UUO). Whole kidney Nlrp6 mRNA and tubular cell Nlrp6 protein decreased following UUO. Low kidney Nlrp6 immunostaining was also observed in human CKD. Genetic Nlrp6 deficiency resulted in increased kidney p38 MAP kinase activation and more severe kidney inflammation and fibrosis, as assessed by kidney inflammatory gene expression, interstitial macrophage infiltration, expression of profibrotic cytokines and extracellular matrix encoding genes, Smad3 phosphorylation, Sirius red staining, collagen, and fibronectin deposition and myofibroblast numbers. Similar results were obtained in adenine-induced kidney fibrosis. Cytokines involved in the pathogenesis of kidney fibrosis, such as the profibrotic cytokine TGF-β1 and the proinflammatory cytokine TWEAK, decreased Nlrp6 expression in cultured tubular cells, while siRNA targeting Nlrp6 resulted in increased TGF-β1 and CTGF expression, which was limited by inhibiting p38 MAPK.

Conclusion

In conclusion, endogenous constitutive Nlrp6 dampens sterile kidney inflammation and fibrosis likely by dampening tubular cell responses. Loss of Nlrp6 expression may contribute to CKD progression.
#4769 EFFECT OF EXTREMELY LONG DIALYSIS VINTAGE ON RENAL ALLOGRAFT SURVIVAL: A SINGLE-CENTER EXPERIENCE
Authors: Kumru Gizem , Eyupoglu Sahin , Şengül Şule , Keven Kenan
Published: June 2023

Background and Aims

Dialysis vintage is long in kidney transplant recipients (KTRs) due to the donor shortage in Turkey. We assessed the effect of pre-transplant dialysis duration (more than 10 years) on the outcomes of renal allografts.

Method

We retrospectively evaluated 480 KTRs who were grafted between January 2009 and October 2020 at Ankara University School of Medicine, Ibni Sina Hospital. KTRs were divided into two groups according to the duration of pre-transplant dialysis treatment: Group A, ≥10 years and Group B, <10 years. Data on demographics, comorbidities, immunologic properties and graft survivals were compared between the two groups.

Results

Group A included 60 patients and dialysis vintage was 288±60 months (Table 1). 420 patients in Group B had an average of 19 months period of dialysis treatment. While cadaveric transplantation was 78.3% in Group A, it was much lower in Group B (11.2%, p<0.001). Most of the patients were on hemodialysis treatment (95.0% vs. 58.3%, respectively, P = .001). Recipients’ age (P = .001), HLA mismatch number (P = .008) and PRA positivity (P = .001) were significantly higher in Group A. Although anti-human T-thymocyte globulin had been mostly chosen for induction therapy in Group A (p<0.001); almost all patients were under standard triple maintenance immunosuppression therapy. First year and late acute rejection rates were similar between two groups (p=1.000 and P = .407, respectively). Clinically important difference was demonstrated in graft loss, which was mostly seen in the ≥10 years dialysis group (Group A, 18.3% vs. Group B, 8.3%, P = .014). The 1-, and 5- years graft survival rates were 91.4%, and 81.3%, respectively, in Group A and 97.4%, and 93.4%, respectively, in Group B (P = .034 and P = .029, respectively). Patient loss was significantly higher in Group A (Group A, 28.3% vs. Group B, 14.3%, P = .018).

Conclusion

We demonstrated that pre-transplant dialysis duration for more than 10 years has adverse effects on post-transplant graft and patient outcomes, accompanied by high immunological risk. Updates of organ allocation system considering sensitized candidates and strategies to expand donor pool and donation rates are needed to reduce waiting times on dialysis.
#4837 CLINICAL OUTCOMES OF HEMOPERFUSION WITH MG350 AMONG RT-PCR-CONFIRMED SEVERE AND CRITICAL COVID-19 PATIENTS IN A TERTIARY HOSPITAL IN LA UNION
Authors: Echave Mayene Alyssa , Octaviano Chrysanta
Published: June 2023

Background and Aims

Hemoperfusion (HP) refers to the circulation of anticoagulated blood through an extracorporeal circuit with a disposable, adsorbent-containing cartridge. Earlier studies showed that HP stabilizes the plasma levels of cytokines in sepsis and septic shock. Case reports demonstrated the benefit of HP among COVID-19 patients with severe and critical illness but local data on the outcome of HP in COVID is still lacking. This study aimed to determine the clinical outcomes of HP with MG 350 cartridge among RT-PCR confirmed severe and critical COVID-19 patients admitted in a tertiary hospital in La Union in terms of the trend of clinical parameters before and after HP, mean duration of ventilatory support, mean duration of hospital stay and patient's disposition.

Method

This is a descriptive, correlational, retrospective cohort single-center study that reviewed the in-patient medical records of 89 RT-PCR confirmed severe and critical COVID-19 patients who underwent at least two HP treatments. We determined their clinical profile and described the trend of clinical parameters before and after HP. Outcome of HP in terms of mean duration of ventilatory support, mean duration of hospital stay and patient's disposition were determined. The possible significant influence of HP to the clinical profile and outcomes as well as clinical parameters to outcomes were also correlated.

Results

There was a significant decrease in the levels of inflammatory markers such as C-Reactive Protein (CRP), D-dimer, ferritin and Lactate dehydrogenase (LDH) as well as improved respiratory and perfusion parameters such as oxygen saturation and Partial pressure of Oxygen (PaO2) after HP. Patients with higher oxygen saturation, PaO2 and lower fraction of inspired oxygen (FiO2) had shorter duration of ventilatory support. Increased FiO2, CRP, D-dimer, ferritin, white blood cell (WBC) count and Neutrophil Lymphocyte Ratio (NLR) are highly correlated with increased mortality. Early hemoperfusion correlated with shorter duration of ventilatory support, shorter hospital stay and decreased mortality. Interestingly, those with higher oxygen saturation, Pao2, ferritin and procalcitonin correlated with longer duration of hospital stay after HP. Patients with critical illness and late HP had longer duration of ventilatory support. Patients with bilateral infiltrates on chest X-ray and those on mechanical ventilator had longer duration of hospital stay. Increased COVID severity and decreased mean arterial pressure (MAP) had higher likelihood of death even after HP.

Conclusion

Hemoperfusion significantly decreased the level of inflammatory markers thereby lowering the risk for cytokine storm for COVID-19 patients. Early HP is recommended as it is correlated with shorter duration of ventilatory support, shorter hospital stay and decreased mortality.
#4916 A PILOT STUDY ON THE BENEFICIAL EFFECT OF RASBURICASE IN THE PREVENTION OF ACUTE RENAL FAILURE IN PATIENTS WITH CARDIORENAL SYNDROME
Authors: Melero Maria Rosa , Garcia-Prieto Ana , Torroba Beatriz , Patrocinio Rodriguez Benitez , Goicoechea Marian
Published: June 2023

Background and Aims

Uricase metabolizes uric acid into allantoin, a soluble compound that is easily excreted in the urine. Acute hyperuricemia is associated with endothelial injury and vasoconstriction, favoring acute renal failure. Preliminary studies show the protective role of lowering uric acid in cardiac patients.

Method

Pilot study conducted in patients with cardiorenal syndrome and hyperuricemia (>9 mg/dl). All received a single dose of rasburicase (0.20 mg/kg/day in the first 9 patients or a fixed dose of 6 mg in 14 patients) evaluating its effect on renal function and the need for renal replacement therapy.

Results

Twenty-three patients aged 68 ± 14 years were included, 14 men and 9 women, 87% hypertensive, 35% diabetic, 17% with liver disease, and 26% with cancer. Baseline: mean LVEF 40±14.1% (13-63), pro-BNP 19880±14000ng/l, basal Cr 1.55±0.58 mg/dl, uric acid 14.1±2.26, phosphorus 5 .3±1.6 mg/dl and CRP 7±8 mg/l. The evolution of renal function after treatment is shown in Table 1. In all patients, uric acid after rasburicase decreased to 0.5 mg/dl. There were no differences in renal function, RRT, and hospitalization between patients who received a dose of 0.20 mg/kg/day or 6 mg iv. Only 3 patients required RRT for 21±23 hours, with recovery from acute renal failure. Comparing the patients who required RRT versus those who did not, these presented higher baseline uric acid levels: 16.5±2.5 vs 13.7±1.1 mg/dl, P = .049, and there were no differences in LVEF. pro-BNP and previous renal function. One patient died during the hospital stay due to terminal CHF and sepsis, but having recovered kidney function.

Conclusion

Rasburicase administration may prevent established renal failure in patients with cardiorenal syndrome and hyperuricemia. Early treatment, avoiding very high levels of hyperuricemia, could be more effective in reducing the need for renal replacement therapy.
#4945 NEPHROPROTECTIVE EFFECTS OF DIPEPTIDYL PEPTIDASE–IV INHIBITORS FROM PHENOLIC RICH FRACTION OF TRIGONELLA FOENUM IN DIABETIC NEPHROPATHY RATS
Authors: Singh Anand Krishna , Tripathi Purnima
Published: June 2023

Background and Aims

The most common effect of renal disease in the world is diabetic nephropathy (DN). Dipeptidyl peptidase–IV (DPP-IV) enzyme is most abundant present in kidney, which is increased in diabetic nephropathy. A novel approach to treat type 2 diabetes mellitus (T2DM) along with DN, based on incretin hormones: glucagon-like peptide-1 (GLP-1) which regulated by DPP-IV. We hypothesized that DPP-IV inhibitors isolated from phenolic rich fraction of Trigonella foenum (TF) will regulate DPP-IV activity as well as DN: in-vivo; in-silico and kidney histology.

Method

DPP-IV inhibitors from phenolic rich fraction of TF in high sucrose diet along with dexamethasone induced T2DM was explored in-vivo in rat. Apart from serum glucose, DPP-IV, and inhibition activity, HbA1c, Insulin was estimated. We also examined GLP-1, albuminuria, and antioxidant properties in kidney tissue along with histology. Molecular docking of phenolic rich fraction (Gallic acid) of TF with DPP-IV

Results

High sucrose diet with Dexamethasone administration (1 mg /kg BW 45 days) increased concentration of serum glucose, DPP-IV and albuminuria, cholesterol and renal LPO with increase in tissue antioxidant to scavenging free radicals generated by oxidative stress, but after some time antioxidants such as SOD, CAT, GSH was decreased. However, after administration of phenolic rich fraction of TF, DPP-IV inhibition activity increase in TF (71.1%), as compared to Sitagliptin (89.5%) with significant reduction in levels of glucose, albuminuria, TC, TG and with increased Insulin and GLP-1. Kidney histology showed some significant change as compared to diabetes control. Isolated Gallic acid depicts the conformer and affinity energy was – 5.3 and distance from RMSD i.b was 38.669. Sitagliptin depicted the conformer and affinity energy was – 8.9 and distance from RMSD i.b was 3.826.

Conclusion

DPP-IV inhibitors isolated from TF are nephroprotective, antioxidant with novel antidiabetic properties. DPP-IV inhibition lower blood glucose by decreasing DPP-IV activity, albuminuria and increasing levels of GLP-1
#5153 CHARACTERISTICS AND MORTALITY OF PATIENTS STARTING HAEMODIALYSIS IN A PORTUGUESE TERTIARY HOSPITAL: A DESCRIPTIVE ANALYSIS
Authors: Branco Carolina , Costa Claudia , Silva Bernardo Marques Da , Peres Nadiesda , Sant'ana Mariana , Fonseca José Agapito , Outerelo Cristina , Resina Cristina , Lopes José António , Gameiro Joana
Published: June 2023

Background and Aims

Portugal has one of the highest incidences and prevalence of end-stage kidney disease in Europe, with haemodialysis (HD) being the most common modality of renal replacement therapy. The aim of our study was to analyse a cohort of patients who started HD in a large tertiary care hospital in Lisbon and describe the evolution of the patient characteristics throughout the studied years.

Method

This study was a retrospective analysis of all adult individuals who started HD between January of 2014 and December of 2019 in tertiary care hospital in Lisbon. Data was attained from individual electronic clinical records. The primary outcome was mortality. Statistical significance was defined as a P-value lower than 0.05.

Results

We included 1122 patients (mean age 64.9 ±16.8 years, 21.2% at least 80 years old; 60.9% male and 79.7% caucasian). At HD start, mean eGFR was 8.98 ±5.66mL/min/1.73 m2 and the vascular access was a central venous catheter in 56.0%, an arteriovenous fistula in 40.6% and an arteriovenous graft in 3.4%. The number of patients that started HD per year was variable between 169-204 and the percentage of elderly patients increased throughout the years. There was a trend of initiating dialysis with progressively lower eGFR. The percentage of patients with central venous catheter increased. In total 392 patients died (7.5% within the first 90 days of starting HD). Mortality rate within the first 90 days and first year declined from 2015 to 2019. As expected mortality was higher in older patients (Fig. 1), as well as in patients that started HD with a central venous catheter (Fig. 2).

Conclusion

We describe a large cohort of Portuguese patients that started HD between 2014-2019 that correlates well with the available recent data from the national and european registries. There was a greater percentage of patients initiating HD by catheter, which was associated with higher mortality, Although, considering the increase in elderly patients starting HD, their underlying comorbidities might impair vascular access placement and also have an impact on mortality. Additionally, despite the increase in elderly patients, mortality within the first 90 days and first year declined, highlighting the quality of care provided, in addition to a better acknowledgment and referal to conservative care.
#5177 COVID-19 IN ELDERLY CHRONIC HEMODIALYSIS PATIENTS: PREDICTORS OF MORTALITY
Authors: Sellami Nada , Belhaj Wiem , Agrebi S , Khadhar M , Ayed T Ben , Lazzez R , Bouassida S , Jouini S , Ounissi M , Hamida1 F Ben , Abdallah T Ben , Abderrahim E
Published: June 2023

Background and Aims

Studies have shown that the incidence of severe COVID-19 pneumonia is higher in elderly patients and especially those with comorbidities including chronic kidney disease. The aim of our study was to determine risk factors for mortality in elderly chronic hemodialysis (HD) patients.

Method

We conducted a cross-sectional, observational, and analytical study, in the dialysis unit of the internal medicine department at Charles Nicolle Hospital over an 11-month period from September 2020 to August 2021. We studied the correlation between mortality and the different epidemiological, clinical and biological data via the SPSS software.

Results

We included 59 patients, with a mean age of 73 years [65-93] and a gender ratio of 1. All patients had confirmed COVID-19 infection, chronic kidney failure and required regular HD since at least 3 months. One on four patients had a coronary artery disease, 55% were diabetics and 72% had hypertension. From the 19 patients who underwent chest scan, 68% had severe lesions. Emergency HD had to be conducted for 25% of the patients, mainly because of hyperkalemia. At least one ongoing HD session was interrupted for neurologic, hemodynamic or respiratory instability in 26% of the patients. Mortality rate was 58%. Data that were associated with mortality in the univariate study were oxygen needs (p<10-3), COVID-19 infection severity (p=0.007), and interruption of HD session (p<10-3). Low blood pH levels and high pCo2 levels were also correlated to mortality (p=0.032 and p=0.020). Predictors of mortality in multivariate analysis were high oxygen needs (OR=1.368; 95% CI [1.081-1.732]; P = .009), interruption of HD session (OR=1.426; 95% CI [1.070-1.846]; P = .014) and severe form of COVID-19 infection (OR=1.770; 95% CI [1.062-2.980]; P = .029).

Conclusion

According to these results, high oxygen needs, severity of COVID-19 infection and interruption of HD session represented risk factors of death in elderly patients undergoing chronic hemodialysis. As highlighted in previous studies, mortality rate in COVID-19 seems to be higher among elderly patients. However, diabetes and cardiovascular diseases were not identified as predictors of mortality in this sample of patients.
#5203 THE INCESSANT QUEST FOR DRY WEIGHT: SHOULD WE ADOPT NEW STRATEGIES?
Authors: Ayed Amel , Mayssa Hadj Brahim , Jaballah Lazhar , Echouk Amel , Alaya Habiba Ben , Elati Zohra
Published: June 2023

Background and Aims

The estimate of the hydration state in the chronic hemodialysis patient is a key point of his care. Currently, there is no Gold Standard feasable in daily routine despite the increasingly numerous tools such as impedancemetry and pulmonary cardiac ultrasound.

The objective of our study is to compare the results of the clinical estimation of dry weight with the results of impedancemetry and cardiac ultrasound results.

Method

This is a transverse study in the dialysis unit of Taher Sfar Mahdia hospital. The estimation of the hydration state was assessed before and after the hemodialysis session by the three above methods. The volume evaluation was carried out by a clinical score (NYHA> III dyspnea, orthopnee; jugular turgor (TJ), hepato-jugular reflux (HRJ), crackling in auscultation, peripheral edema and pre-dialysis hypertension); as well as by cardiac ultrasound (diameter of the lower vein, E/E ratio and systolic pulmonary arterial pressures).

Results

The values ​​measured by the different techniques decreased significantly after the hemodialysis session (p <0.001). At the two -stroke studied, we have objectified a significant correlation between the results of the impedancemetry, the index of the lower vein and its compliance. A significant difference between the results provided by the techniques studied and the results of the clinical evaluation was found in 64 % of patients. Only the orthopnee (p = 0.03) and the hepato-jugular reflux (p = 0.04) were significantly associated with the ultrasound overload diagnosis.

Conclusion

The existence of a difference between the subjective and objective target weight suggests the incessant need for a mixture between the different techniques evaluated. Our strategy requires to be adapted to the particularities of each patient.
#5245 SUCCESSFUL THROMBOLYSIS OF AN ATRIAL TUNNELED DIALYSIS CATHETER AS A LAST RESORT VASCULAR ACCESS
Authors: Saïed Salah , Mariem Najjar , Mbarek Meriem , Othman Ilhem Ben , Gorsane Imane , Khadhar Yassine , Ayed Tasnim Ben , Kaaroud Hayet , Hmida Fethi Ben , Ziadi Jaleleddine , Abderrahim Ezzeddine
Published: June 2023

Background and Aims

The prolonged survival of patients on dialysis has resulted in a higher frequency of complications and failure related to vascular access. As a result, the situation of depleted vasculature in hemodialysis is becoming increasingly prevalent. The use of an atrial tunneled dialysis catheter (ATDC) has been reported as an effective solution for vascular access in these patients, but limited data is available on the associated complications, particularly thrombosis.

Method

This study reports the experience of a single nephrology center in Tunis with thrombosis of an ATDC as a last resort vascular access for dialysis.

Results

A 32-year-old patient with undetermined tubulo-interstitial nephropathy receiving dialysis presented in November 2022 with depleted vasculature. An ATDC was inserted as a final solution for vascular access, with an initial complication of a catheter-related bloodstream infection, which was resolved with broad-spectrum antibiotics with favorable results. One month later, dialysis could not be initiated through the ATDC. Catheter thrombosis was diagnosed as a guidewire was unable to pass through the catheter's lumen. The patient was successfully treated with thrombolysis using 50 mg of Alteplase, allowing dialysis to be resumed with a blood flow of 300 mL/min.

Conclusion

ATDC is a lifesaving and safe option for patients with depleted vasculature, with only 51 cases reported since 1999 [1]. The treatment of catheter thrombosis is not well defined, and to the best of our knowledge, no thrombolysis protocol has been established. This successful case may contribute to filling the knowledge gap in this field.
#5246 RISK FACTORS FOR COMMUNITY-ACQUIRED ACUTE KIDNEY INJURY
Authors: Rembeci Edi , Tafaj Ermir , Seferi Sajmir , Mumajesi Suela , Idrizi Alma , Barbullushi Myftar
Published: June 2023

Background and Aims

Acute renal injury represents a heterogeneous clinical syndrome with multifactorial etiology rather than a single specific pathology, which is associated with high morbidity and mortality. The disease burden of community-acquired AKI in our country is not well understood. In fact it is known little about it. The aim of this study is to identify and evaluate the risk factors for developing AKI in our community.

Method

This is a cross-sectional study conducted with a small size sample, 76 adult patients. These patients were identified with AKI at hospital admission. AKI was defined according RIFLE Classifications. This champion was selected among patients hospitalized in the Nephrology Clinic, UHC “Mother Tereza” during 2018. The data was collected through medical files.

Results

Most of the patients with AKI were males (66%), with the average age of 64 years old. Nephrotoxic drugs were the most frequent precipitating factor (51%) followed by sepsis (47%) and hypovolemia (41%). A total of 40% of patients had acute on chronic kidney disease, 32% were with diabetes, 14% with cardiac failure and 63% with arterial hypertension. Mostly (93%) had more than one precipitating factor for developing AKI. All the patients with the longest hospital stay (16-35days) had a septic condition. Almost 89% of patients were treated in a conservative way . Patients treated with Hemodialysis had a higher number of risk factors (P<0,4).

Conclusion

The socio-economic factor is also quite important in the development of AKI. It includes lack of access to health care, lack of health insurance, low economic level, poor quality nutrition, etc.The identification of risk factors that predispose to AKI is a crucial aspect of care. It should help primary care and hospital providers identify high risk patients. Comorbit conditions like diabetes, cardiac failure increased the risk for hemodialysis treatment.
#5276 DEVELOPMENT OF A MULTIMODAL “KIDNEY AGE” PREDICTION BASED ON AUTOMATIC SEGMENTATION CT IMAGE IN PATIENTS WITH NORMAL RENAL FUNCTION
Authors: Hou Zuoxian , Zhang Gu-Mu-Yang , MA Yixin , Xia Peng , Shi Xiaoxiao , Sun Hao , Chen Zhengguang , Chen Limeng
Published: June 2023

Background and Aims

Renal function, for decades, has been of interest to clinicians and researchers to describe. For example, serum creatinine (Scr) and estimated glomerulus filtration rate (eGFR) is familiar but also limited in many circumstances. Meanwhile, the physiological volumes of the kidney cortex and medulla are presumed to change with age and have been proven to change with decreasing kidney function.

Method

We recruited 182 patients with normal Scr levels and contrasted CT images between Oct. 2021 and Feb 2022 in Peking Union Medical College Hospital (PUMCH) with their demographic and clinical data. The automatic segmentation method was modified from U-NET and used for both cortex and medullary separation and their volume calculation, respectively. We combined the kidney volume and clinical data as multimodal features of the machine learning model. All the data were separated into a training dataset (PUMCH training set, 80%) and a test dataset (PUMCH test set, 20%). Besides, we included patients with the same inclusion criteria but with diabetes (PUMCH-DM test set) and diabetic nephropathy (PUMCH-DN test set) for internal comparison to verify the possible clinical value of “KIDNEY AGE” (K-AGE). Data from DongZhiMen Hospital (DZMH test set) was used as separate external validation sets to evaluate model generalizability.

Results

The PUMCH training set included 146 participants with a mean age of 47.5±7.4 years. 58.9% were female, and the mean Scr is 63.5±12.3 μmol/L. The PUMCH test set included 36 participants with a mean age of 47.1±7.9 years, 52.7% were female, and the mean Scr was 66.9±13.0 μmol/L. For segmented kidneys, volume differences between non-contrast-enhanced CT and non-contrast-enhanced CT in the left and right kidneys were not evident. The multimodal neural network predicted: K-AGE approximately close to the patient's actual physiological age, with 92% prediction within the 95% confidential interval (Figure 1). We also compared the K-AGE prediction in PUMCH, PUMCH-DM, and PUMCH-DN test sets by applying U-NET-nonCon segmentation algorithm in non-contrast CT images. The mean absolute error increases along with the disease process (control group 5.00, diabetes group 6.99, diabetic nephropathy group 9.32) (Figure 2).

Conclusion

We established a machine learning model for predicting the K-AGE of normal Scr patients.
#5423 THE FUNCTIONAL STATE OF THE KIDNEYS IN PATIENTS WITH CHRONIC ISCHEMIA OF THE RENAL AND PERIPHERAL ARTERIES
Authors: Atahodjayeva Gulchehra , Daminov Botir , Asadov Nodir
Published: June 2023

Background and Aims

to study the functional state of the kidneys in patients with chronic ischemia of the renal and peripheral arteries.

Methods

We examined 120 patients with chronic lower limb ischemia (CLLI) on the background of coronary heart disease and type 2 diabetes mellitus. All examined patients were hospitalized in the department of Interventional Cardiology of the Republican Specialized Scientific and Practical Medical Center for Therapy and Medical Rehabilitation. Inclusion criteria for the study was the presence of intermittent claudication in the patient of II A-II B degree of CLLI, while the walking distance without pain in these patients was 50-1000 meters. Assessment of the functional state of the kidneys was carried out on the basis of determining the level of serum creatinine (Cr), glomerular filtration rate (GFR), calculated according to the EPI GFR formula, which takes into account race, gender, age, and serum creatinine level. To calculate GFR using the CKD-EPI formula, can be used special applications for mobile devices (QxMDCalculator) (based on the criteria of the clinical guidelines for the diagnosis, classification and treatment of CKD KDIGO - 2013).

Results

Analysis of the functional state of the kidneys depending on the severity of CKD and the level of GFR in accordance with the KDIGO classification (2013) showed that all 100% of patients with CLLI belonged to CKD categories: CKD C2 - 62 (51.7%), CKD with 3a-b - 51 (42.5%) and CKD with 4 - 7 (5.83%). In other words, there was not a single patient with CLLI with normal GFR values. We have revealed a significant increase in the concentration of blood creatinine by 2.1 times, blood urea by 77.9%, and a decrease in GFR by 64.3% (p<0.001). The mean value of the concentration of total protein in the blood serum was 58.4±3.72 mmol/l. The concentration of urea in the blood serum was 12.1±2.47 mmol/l in the CLLI group versus 6.8±0.33 mmol /l in the control group. The parameters of the functional state of the kidneys depending on the severity of CLLI showed that in the group of patients with stage IIB was an increase in serum creatinine clearance by 47.2%, amounting to 179.2 ± 15.5 μmol / l versus the data of IIA 121, 2±13.3 µmol/l (p<0.01). There was also a decrease in the level of GFR in patients with stage IIB by 29.1% (p<0.01) in relation to the data of stage IIA.

Conclusion

In all patients with CLLI, there was deterioration in the functional state of the kidneys, which was manifested by an increase in the concentration of blood creatinine, a decrease in GFR and the severity of albuminuria.