bluuebunny/crossref_metadata_2025 huggingface dataset:
#3022 Rationale and design of the CORDIAL first-in-human clinical trial: a system for sorbent-assisted continuous flow peritoneal dialysis
Authors: de Vries Joost , van Gelder Maaike , Simonis Frank , Bolhuis Dian , Rubio María Auxiliadora Bajo , del Peso Gilsanz Gloria , Selgas Rafael , Donati Gabriele , Cappelli Gianni , Ligabue Giulia , Verhaar Marianne , Gerritsen Karin
Published: May 2024

Background and Aims

Peritoneal dialysis has important disadvantages, including low plasma clearance and a limited technique survival. A new device for sorbent-assisted continuous flow peritoneal dialysis has been designed (Wearable Artificial KIDney, WEAKID) that is based on continuous recirculation (rapid cycling) of peritoneal dialysate via a single-lumen peritoneal catheter with regeneration of dialysate using sorbents. Anticipated benefits are a better plasma clearance a higher mass transfer area coefficient with continuous flow of dialysate and enhanced diffusion due to a higher time-averaged plasma-dialysate concentration gradient with sorbent-based dialysate regeneration, and a prolonged technique survival thanks to lower peritonitis risk (less (dis)connections) and a lower glucose exposure.

Method

This is a first-in-human, prospective, open-label, non-randomized, single-arm, multicenter study, that will be performed at the University Medical Center Utrecht (Utrecht, The Netherlands), Università degli studi di Modena e Reggio Emilia (Italy), and Instituto de Investigación Hospital Universitario La Paz, Servicio Madrileño de Salud (Spain). We aim to include 12 stable, adult PD patients. In the first week, blood, urine, and dialysate samples will be collected over three separate days to assess the efficacy of the patient's standard PD schedule. The WEAKID system will then be tested in a clinical setting on 6 days over a period of 2 weeks (three consecutive days per week). During the first week, participants will be treated with WEAKID without sorbents for 4h (first day) or 8h (second and third day). The second week, treatment will consist of WEAKID with sorbents for 4h (first day) or 8h (second and third day). This way, exposure to new components of the system is incremental and the effectiveness of continuous recirculation of dialysate and that the added effect of sorbent-based dialysate regeneration can be analyzed separately.

Outcomes

The primary aim of this first-in-human clinical trial is to evaluate the (short term) clinical safety and performance of WEAKID treatment in a clinical setting. The primary safety objective will be assessed by describing and examining the incidence of:

Key secondary objectives include an evaluation of efficacy in terms of plasma clearance, ultrafiltration, net base release, and patient tolerance.

Planning

Inclusion of the first patient is expected in January 2024, the final inclusion is expected to take place in November 2024.
#2040 Effect of donor–recipient size mismatch on long-term graft survival in pediatric kidney transplantation: a multicenter cohort study
Authors: Park Min Ji , Cho Min Hyun
Published: May 2024

Background and Aims

Kidney transplantation (KT) is the main treatment option for patients with end-stage kidney disease (ESKD). However, it is limited by the low number of donor organs. Moreover, donor–recipient size mismatching is a common problem in KT given the various types of donors. Donor–recipient size mismatching is commonly occurs in pediatric kidney transplantation (KT). However, its effect on graft survival remains unknown. This study aimed to determine the effect of donor–recipient size mismatch on the long-term survival rate of transplant kidneys in pediatric KT.

Method

A total of 241 pediatric patients who received KT were enrolled. The medical records of all patients were retrospectively reviewed, and the correlation between donor–recipient size mismatch and graft function and long-term graft outcome was analyzed according to donor–recipient size mismatch.

Results

Recipients and donors’ mean body weight at the time of KT were 34.31 ± 16.85 and 56.53 ± 16.73 kg, respectively. The mean follow-up duration was 96.49 ± 52.98 months. The mean age of donors was 34.74 ± 14.91 years, and the ratio of males and females was 105:136. Approximately 81.7%, 1.2%, and 17.0% of all transplant donors were identified as living-related, living-unrelated, and deceased donors, respectively. A significant positive correlation was observed between donor–recipient body weight ratio (DRBWR) or donor–recipient body surface area ratio (DRBSR) and graft function until 1 year after KT. However, this correlation could not be confirmed at the last follow-up. The results of long-term survival analysis using Fine and Gray's subdistribution hazard model showed no significant difference of the survival rate of the transplant kidney according to DRBWR or DRBSR.

Conclusion

Donor–recipient size mismatch in pediatric KT is not an important factor in determining the long-term prognosis of transplant kidneys.
#2132 Recipient outcomes after laparoscopic versus open living donor nephrectomy: a propensity score-matched cohort study
Authors: Skalioti Chrysanthi , Bellos Ioannis , Soukouli Ioanna , Mantios Evangelos , Kofotolios Ioannis , Vernadakis Spyros , Boletis Ioannis , Marinaki Smaragdi
Published: May 2024

Background and Aims

Kidney transplantation is the optimal treatment for end-stage renal disease. To meet the growing demand for kidney allografts and to ensure the well-being of donors, laparoscopic nephrectomy has been adopted leading to superior donor outcomes. However, data on recipient outcomes of laparoscopically retrieved grafts are underreported.

The aim of the study is to estimate the impact of laparoscopic compared to open living donor nephrectomy (LDN, ODN) on recipient outcomes in the first-year post-transplant.

Method

This was an observational cohort study of primary data on 396 recipients who had undergone living kidney transplantation from January 2011 to December 2021 at the Clinic of Nephrology and Renal Transplantation of ‘Laiko’ hospital. Since October 2018 laparoscopic surgery has supplanted ODN in the reporting center. Graft function, the risk of adverse events, patient and graft survival within the first-year post-transplantation, were evaluated. A propensity score analysis was applied (2:1 nearest-neighbor matching, with a caliper width of 0.05). As a robustness check, the analysis was rerun on the sub-groups of low and high immunological risk patients.

Results

After propensity score matching, 389 patients were analyzed. One-year post-transplantation, renal function (−0.074 mg/dl, p: 0.063) patient (99.44% vs 100%, p: 0.27) and graft (99.43% vs 100%, p: 0.13) survival were statistically equal among LDN and ODN recipients. Laparoscopically retrieved grafts demonstrated statistically higher risk of delayed graft function (10.1%, p: 0.032) and higher risk for transfusion (12.9%, p:0.022). The risk for acute rejection, surgical complications and infections (Fig. 1), as well as the length of hospital stay did not differ between the two groups. Kidney function at one year was similar in LDN and ODN patients, regardless of the immunological risk. Low immunological risk patients demonstrated comparable risk of adverse events in the first post-transplant year. High-immunological risk patients after LDN after LDN exhibited greater risk for reoperation (16%, p: 0.0078) urologic complications (19.6%, p: 0.042) and bacterial infections (7.1%, p: 0.027) compared to ODN recipients during the first year after transplantation.

Conclusion

The results indicate that one-year post-transplantation, renal function, patient and graft survival are equivalent among recipients of allografts procured either laparoscopically or by open surgery, with similar risk of adverse events.
#1436 Donor plasma cystatin C, but not creatinine, is associated with measured GFR at one year after kidney transplantation
Authors: Kremer Daan , Dielwart Belle , Knobbe Tim J , Groothof Dion , Leuvenink Henri , Kootstra-Ros Jenny E , de Borst Martin H , van Londen Marco , Pol Robert , Bakker Stephan J L
Published: May 2024

Background and Aims

Although widely used during deceased kidney donor selection, donor plasma creatinine has limited capacity to predict future recipient kidney graft function. Cystatin C is a muscle-mass independent kidney function marker that could serve as alternative for this purpose. However, the association between donor cystatin C and subsequent recipient graft function remains unclear. We aim to assess the association of pre-donation cystatin C concentrations with recipient iothalamate-measured GFR (mGFR) one year after kidney transplantation and compare it to the association of donor creatinine concentrations.

Method

All deceased kidney donors, within the affiliated donation region of the University Medical Center Groningen (UMCG), who donated at least one kidney to a kidney transplant recipient (KTR) affiliated to the same hospital during a period of 15 years (2004-2019) were included. We excluded all subjects with missing data on donor plasma cystatin C or recipient mGFR at 1 year. Donor plasma creatinine concentrations were measured using an enzymatic assay, while donor cystatin C concentrations were measured using a validated particle-enhanced turbidimetric immunoassay (Roche). Associations of donor plasma creatinine and cystatin C concentrations with recipients’ mGFR one year after transplant were assessed using linear regression.

Results

A total of 53 deceased kidney donors (55% male, age 47 ± 18 years, 47% donation after circulatory death) donated a kidney to 53 kidney transplant recipients (55% male, age 57 ± 12 years). Median pre-donation plasma creatinine and cystatin C concentrations were 64 [55 to 82] μmol/L and 0.64 [0.51 to 0.82] mg/L respectively. Mean recipient mGFR one year after transplantation was 52.7 ± 17.1 ml/min. In univariable linear regression, higher donor cystatin C was significantly associated with lower mGFR (β −0.42, 95% CI: −0.67 to −0.16, p = 0.002), while donor creatinine was not associated (β −0.03 95% CI: −0.32 to 0.25, p = 0.81). The association between donor cystatin C and recipients’ mGFR remained independent of adjustment for potential confounders, including donor sex and age, t (p = 0.008).

Conclusion

Higher donor cystatin C, but not creatinine, is associated with lower measured GFR one year after kidney transplant. Consequently, donor cystatin C could be valuable for inclusion in the pre-transplant evaluation of deceased kidney donors.
#2968 Preemptive kidney transplantation: the best option for retransplantation?
Authors: Alonso Marta , Villanego Florentino , Serrano Blanca , Lopez Juan Manuel Cazorla , Roncero Francisco Manuel González , Rodríguez-Benot Alberto , Ruiz-Fuentes Maria Carmen , López Verónica , Castro Pablo , Mazuecos Auxiliadora
Published: May 2024

Background and Aims

Kidney re-transplantation (Re-KT) is associated with worse outcomes. Better results have been described when the KT is performed preemptive, before the patient returns to dialysis. However, the experience is limited so far.

Method

We performed a retrospective analysis of KT patients who received a preemptive KT (pRe-KT) in Andalusia between 1978-2023. A case-control study was carried out, choosing 2 controls for each case, adjusted for donor and recipient demographic characteristics (1 patient receiving a second non-preemptive KT [npRe-KT] and 1 patient receiving a first KT). We compared clinical characteristics and evolution between the 3 groups.

Results

During this period, 12217 KT recipients were registered in Andalusia. Of these, 1380 (11.3%) received at least a second KT. Eighty-two (0.059%) patients were pRe-KT recipients, all of them with a second KT.

In the npRe-KT patients, there was a lower proportion of living donors than in the other groups (pRe-KT 30.4%, npRe-KT 6.3%, first KT 28.4%; p < 0.001). There were no differences nor in age neither in gender of donors and recipients. Graft survival in pRe-KT and first KT patients was similar and significantly better than in npRe-KT. Adjusting for donor type (living/deceased), npRe-KT remained as a risk factor. However, we observed no differences in patient survival between groups.

Conclusion

In pRe-KT patients, outcomes are significantly better than npRe-KT outcomes and similar to that of the first KT. These patients, when their clinical situation allows it, should be evaluated for inclusion on the waiting list before the definitive graft loss. Living donor KT should be actively encouraged in patients who are losing the functionality of their renal graft.
#2572 Sodium-glucose transport protein 2 (SGLT-2) inhibitors in diabetic and non-diabetic kidney transplant recipients
Authors: Chalvatzis Antonios , Ntrinias Theodoros , Trivyza Maria Styliani , Papasotiriou Marios , Tsiotsios Konstantinos , Karkania Aglaia , Bratsiakou Adamantia , Georgopoulou Georgia Andriana , Perdiki Panagiota , Goumenos Dimitrios , Papachristou Evangelos
Published: May 2024

Background and Aims

The beneficial effects of administering sodium-glucose transport protein 2 (SGLT2i) inhibitors in patients with Chronic Kidney Disease, with or without Type 2 Diabetes (T2D), has been proven in large randomized controlled trials. Nevertheless, there is limited data considering Kidney Transplant Recipients (KTRs) with or without albuminuria. The purpose of this study was to evaluate the safety and efficacy of administering SGLT2i to KTRs in association to their kidney function and albuminuria.

Method

In this retrospective study we examined the effects of treatment with SGLT2i on kidney function (eGFR calculated with CKD-EPI formula), albuminuria (24h urine collection) and fasting serum glucose levels of KTRs. We included KTRs with T2D or without T2D and confirmed albuminuria (ACR >30 mg/gCr) in two consecutive ACR measurements. Kidney function and albuminuria monitoring was performed one month post-treatment initiation and in three month intervals thereafter. Moreover, immunosuppression trough levels were measured in each visit and active surveillance for adverse events was performed.

Results

Twenty-four KTRs (20 males) with a mean eGFR of 51.1 ± 14.2 ml/min/1.73 m2 were included in this study. Nine patients had T2D. Treatment was initiated 10 ± 5.4 years post transplant and all KTRs received dapagliflozin. Mean follow-up was 9 ± 2 months. Kidney function was non-significantly decreased directly after SGLT2i initiation and remained stable until the end of follow up (51.1 ± 14.2 vs. 51.4 ± 13.8 ml/min/1.73 m2). Overall, we found a significant reduction of albuminuria (371 ± 460 vs 235 ± 294 mg/24 h, p = 0.015). When KTRs were examined separately based on their diabetes status (KTRs with T2D vs. no T2D) we found that only those with T2D showed a significant decrease in albuminuria (450.4 ± 548 vs. 259.8 ± 332.5 mg/24 h, p = 0.008) at the end of follow up. Furthermore, a significant reduction of morning fasting glucose (106.4 ± 19.6 vs 99.9 ± 16.6 mg/dl, p = 0.0006) was noted. Trough levels of immunosuppression agents (tacrolimus, everolimus or cyclosporine) did not show any significant change after the initiation of SGLT2i and two patients had to discontinue the treatment, due to one episode of pyelonephritis and detection of funguria.

Conclusion

Prescription of SGTL2i in KTRs with T2D and albuminuria, seems to be a reliable option with significant efficacy on the decrease of albuminuria with minimal adverse effects.
#1714 The treatment of antibody-mediated rejection in kidney transplantation with recent drugs: a network meta-analysis
Authors: Song Joon Ho , Lee Seoung Woo , Kim Kipyo , Cha Joonhyuk , Hwang Seun Deuk
Published: May 2024

Background and Aims

The recent treatments for antibody-mediated rejection (AMR) have been carried out in a small number of controlled clinical trials and are based on limited data. In recent research on AMR treatment, new drugs targeting B cells, plasma cells, the complement system, and IL-6 have been gaining attention.

Method

Studies on antibody mediated rejection (AMR) treatment were divided into four groups:, 1) rituximab, 2 bortezomib, 3 eculizumab, and 4) tocilizumab. We searched the CENTRAL, MEDLINE, EMBASE, and Science Citation Index Expanded databases from 1970 to February 2023.5. We performed direct and indirect network meta-analyses using Bayesian models and ranked different AMR treatment method using a generation mixed treatment comparison (GeMTC) and Stata version 13. The outcomes included patient survival, graft failure, and bacterial and viral infections

Results

This analysis included 21 clinical trials with a total of 1217 participants. We focused on graft failure events based on the use of four groups of medications when patients received induction therapy for AMR treatment. There was a lower tendency in graft failure rates in the bortezomib and tocilizumab groups (odds ratio [OR] 0.31, 95% CrI: 0.058-1.4 and OR 0.42, 95% CrI 0.012-7.4), while the eculizumab group showed a higher graft failure rate (OR 2.3, 95% CrI 0.26-31.0) compared to the rituximab using group. However, these study results were not statistically significant.

Conclusion

When looking at the study results, although not statistically significant, it was observed that bortezomib and tocilizumab, compared to rituximab, showed a tendency to reduce the incidence of graft failure after AMR occurrence. Although this study did not demonstrate statistical significance, it is believed that future research with increased enrollment and additional studies may help identify effective drugs for AMR treatment.
#2504 Histopathological findings and cardiovascular events in kidney transplantation
Authors: Espinosa Diana Rodríguez , Hermida Evelyn , Cúpich Agustín Leal , Cuadrado Elena , Escudero Victor Joaquin , Morantes Laura , García-Herrera Adriana , Diekmann Fritz , Monzo Jose Jesus Broseta , Prats José Vicente Torregrosa
Published: May 2024

Background and Aims

Despite offering superior outcomes for patients with end-stage kidney disease, kidney transplantation poses significant cardiovascular risks. Recently, histopathological findings in chronic kidney disease patients have been associated with all-cause mortality and cardiovascular events, but there is scant data on this subject in kidney transplant recipients. This study assesses the relationship between histopathological findings in protocol biopsies of kidney grafts and cardiovascular events, graft loss, and mortality in renal transplant recipients.

Method

A prospective observational study included 530 renal transplant recipients at the Hospital Clínic de Barcelona from March 2015 to 2019, with follow-up until March 2023. Data included demographics, comorbidities, laboratory tests, and protocol allograft biopsies at 3 and 12 months post-transplant. Associations between histopathological findings and outcomes (cardiovascular events, graft loss, mortality) were analyzed.

Results

Chronic vascular lesions (CV) were significantly correlated with cardiovascular death and major adverse cardiovascular events (MACE) (OR 10.4 (1.6–66.4); p 0.002). Arteriolar hyalinosis and interstitial fibrosis were independently associated with all-cause mortality (OR 4.9 (1.1-21.4); p 0.02, and 1.2 (1.03-1.3), p 0.005; respectively) regardless of the estimated glomerular filtration rate (eGFR). Associations were also found between pre-transplant factors (diabetes, hypertension, hyperphosphatemia), active smoking, and deceased donors. Notably, post-transplant hypophosphatemia was related to MACE, suggesting a potential association with malnutrition though, this subject requires further investigation.

Conclusion

Histopathological findings in early protocol biopsies of kidney grafts, especially chronic vascular lesions, arteriolar hyalinosis, and interstitial fibrosis, have a potential predictive value for cardiovascular events, mortality, and graft outcomes in transplant recipients, irrespective of eGFR. These insights emphasize the importance of timely post-transplant histological assessments for risk stratification and personalized interventions. Prospective studies are imperative to validate these findings and improve customized care strategies in this population.
#132 Electrocauterization versus ligation of lymphatic vessels to prevent lymphocele development after kidney transplantation—a meta-analysis
Authors: Matrisch Ludwig , Nitschke Martin , Lapshyn Hryhoriy , Rau Yannick
Published: May 2024

Background and Aims

Lymphoceles are amongst the most common complications following kidney transplantation. They can cause pain, discomfort, and even transplant malfunction or graft loss through the application of pressure on the graft as well as its surrounding structures. Therefore, effective strategies to prevent their development are needed. The ligation of lymphatic vessels has proven to be a successful concept for that purpose. However, whether electrocauterization or suture ligation is more effective is unclear.

Method

We conducted a meta-analysis using a random effects model with the log risk ratio as primary outcome measure. Additionally, an analysis using a random effects model with the raw mean difference in lymphatic sealing time between suture ligation and electrocauterization was performed. Adequate studies were found in a literature research conducted on PubMed and Web of Science as well as from independent sources.

Results

A total of 7 studies including 511 patients were included in the analysis. 16/244 (6.5%) lymphoceles were observed in the electrocauterization group and 28/267 (10.5%) in the suture ligation group, resulting in an overall incidence of 44 (8.6%) in the total population. The estimated average log risk ratio based on the random-effects model was µ=−0.349 (95% CI: −0.934 to 0.235), not significantly different from zero (z=−1,17, p=0.241). Lymphatic sealing time was 7.28 (95% CI: 1.25-13.3, p=0.018) minutes shorter in the electrocauterization group.

Conclusion

We conclude that neither technique is superior for the purpose of lymphocele prevention post kidney transplantation and secondary criteria like time saving, cost and surgeons’ preference should be considered in the decision for optimal outcome. However, it is unclear whether these results can be generalized for all patients.
#2608 Trends over time in the causes of death with a functioning graft among kidney transplant recipients
Authors: Sab Marc , de Terwangne Christophe , Goffin Eric Jean , Darius Tom , Buémi Antoine , Mourad Michel , Devresse Arnaud , Kanaan Nada
Published: May 2024

Background and Aims

Cardiovascular diseases are traditionally considered as the leading cause of death in kidney transplant recipients. Significant improvements in immunosuppressive strategies but also in the prevention and management of cardiovascular diseases have been made over the last decades. Therefore, we aimed to explore the evolution over time of the causes of death with a functioning graft in kidney transplant recipients.

Method

We performed a retrospective study including all patients transplanted with a kidney between January 1995 and December 2009 at Cliniques Universitaires Saint-Luc in Brussels who died with a functioning graft. Patients younger than 18 years old and those who received bone marrow or other solid organ transplant were excluded. Clinical data were collected by electronic medical chart review. Differences in causes of death were assessed between two eras of transplantation (first era [1995-2001] vs second era [2002-2009]).

Results

A total of 256 patients (aged 56 ± 11.18 years, 164 (64.9%) man) were included. Among those patients, 65 (25.39%) died from infectious causes, 64 (25%) from neoplastic causes, 62 (24.22%) from cardiovascular causes and 24 (9.38%) from other causes. The cause of death was unknown for 42 (16.41%) patients. Patients who received a kidney graft during the first era mostly died from cardiovascular causes (33%), while those who received a graft during the second era mostly died from infectious causes (31%). Death from neoplastic causes remained similar across eras (32 (26%) versus 32 (24%), p-value > 0.1). Patients grafted in the more recent era have threefold higher odds of dying from infectious than cardiovascular causes compared to those grafted in the former graft era (OR 3.1, p=0.002). Infectious causes of death were the most prevalent early cause of death in both eras i.e. 3 patients (60%) in the first era and 6 patients (50%) in the second era.

Conclusion

We observed a significant shift from cardiovascular deaths to infectious deaths between the former and the more recent transplantation era. Neoplastic causes of death remained stable over time.
#980 Lipid spectrum in patients with coronary artery disease with contrast-induced nephropathy during X-ray endovascular procedures
Authors: Muminova Sitora , Kadirovich Muminov Davron
Published: May 2024

Background and Aims

Study of the main indicators of the lipid spectrum in patients with coronary artery disease with contrast-induced nephropathy (CIN), which developed during X-ray endovascular procedures (ERP).

Method

The study included 303 patients with stable forms of coronary artery disease who underwent X-ray endovascular procedures (REP). The average age of the patients was 53.79 ± 1.27 years. Based on the results, all patients were divided into 2 groups - patients with an uncomplicated postoperative period of REP (CIN− group, 206 patients, 67.99%) and patients who developed contrast-induced nephropathy (CIN+ group, 97 patients, 32.01%). Kidney filtration function was assessed by the clearance of endogenous cystatin C with calculation of the glomerular filtration rate (eGFRcys=90.63 × cystatin C – 1.192). Three fractions of lipoproteins were selected as indicators of the lipid spectrum: cholesterol containing LDL and HDL, as an anti-atherogenic factor, and VLDL, the main triglyceride-containing fraction.

Results

It was found that in patients in the CIN+ group, the LDL level was significantly higher than that characteristic of the CIN− group (p<0.001) and CG (p<0.001). At the same time, in the CIN− and CG groups, the LDL concentration was comparable, despite the use of statins in the groups of patients with coronary artery disease. The concentration of the second studied atherogenic fraction, VLDL, was also increased in patients with IHD compared with the CG (p<0.001 compared with both groups of patients with IHD) with a maximum increase in patients of the CIN+ group (p<0.01 significance of the difference between the CIN+ and KIN−). The concentration of the antiatherogenic fraction of the lipid spectrum—HDL—was significantly and comparable reduced in both groups of patients with coronary artery disease (p<0.001 when comparing both groups of patients with CG).

Conclusion

In the course of this study, it was found that one of the risk factors for the development of CIN in patients with coronary artery disease after REP is an increased concentration of atherogenic lipoproteins in the peripheral blood. A decrease in the level of anti-atherogenic HDL in the present study was not associated with the risk of developing CIN, but serves as a marker of impaired glomerular function kidney.
#347 Long-term effectiveness of a village doctor-led multifaceted strategy on blood pressure control: a cluster randomized trial
Authors: Chen Jing , He Jiang
Published: May 2024

Background and Aims

We tested the effectiveness of a village doctor-led multifaceted strategy on blood pressure (BP) control over 36 months among patients with hypertension in rural China. Village doctors are community health workers who provide basic primary health care in rural China.

Method

326 villages were randomly assigned to the village doctor-led intervention or usual care. Individuals aged ≥40 years with an untreated mean BP ≥140/90 mmHg (≥130/80 mmHg in individuals with clinical cardiovascular disease) or treated BP ≥130/80 mmHg were recruited. The trained village doctors initiated and titrated antihypertensive medications according to a simple stepped-care protocol with supervision from primary care physicians. They also delivered discounted and free medications to patients and conducted health coaching on lifestyle change, medication adherence, and home BP monitoring. Intention to treat analysis was conducted.

Results

At baseline, mean age (62.8 vs. 63.2 years), percentage of women (60.9% vs. 61.6%), mean systolic BP (157.0 vs. 155.5 mmHg), and diastolic BP (88.1 vs. 87.3 mmHg) were comparable between intervention and control groups. At 36 months, 72.5% patients in the intervention group and 11.7% patients in the control group had a BP of less than 130/80 mmHg, with a group difference of 60.8% (95% CI 59.4 to 62.2%; p<0.0001). Mean systolic BP decreased by –30.8 mmHg (95% CI –31.7 to –29.9) from baseline to 36 months in the intervention group and by –7.6 mmHg (–8.5 to –6.8) in the control group, with a group difference of –23.1 mmHg (95% CI –24.4 to –21.9 mmHg; p<0.0001). Mean diastolic BP decreased by –14.8 mmHg (–15.3 to –14.3) from baseline to 36 months in the intervention group and by –4.9 mmHg (–5.3 to –4.4) in the control group, with a group difference of –9.9 mmHg (–10.6 to –9.3 mmHg; p<0.0001). No treatment-related serious adverse events were reported in either group.

Conclusion

In rural China, the village doctor-led multifaceted strategy significantly reduced BP over 36 months in patients with hypertension. This proven-effective and sustainable implementation strategy could be scaled up throughout rural China and in other low- and middle-income countries for hypertension control.
#1059 Value of urine transcription factor 21 as a diagnostic tool for preeclampsia
Authors: Keryakos Hesham Kamal Habeeb , Mahdy Nour Mohamed , Elsayed Ayman Moheb Youssef , Abu-Ella Moustafa , El-Fattah Mohammed Emad Abd
Published: May 2024

Background and Aims

Prediction of pre-eclampsia early in pregnancy can reduce its incidence and subsequent maternal and fetal morbidity and mortality. The sensitivity of current biomarkers is fair despite being used in clinical settings. Podocyturia was found to be a useful biomarker of preeclampsia with high sensitivity and specificity. UTF21 is highly expressed on podocytes. We investigated the relationship between urine transcription factor 21 as a new biomarker and preeclampsia.

Method

160 pregnant women with pre-eclampsia and age and gestational age matched 64 pregnant women with normal pregnancy were recruited. Pre-eclamptic patients were subdivided into mild (92 pregnant patients) and severe (68 pregnant patients). Each group is subdivided into early-onset and late-onset preeclampsia. Urine transcription factor 21 and compared with serum PlGF and sFlts were measured. The sFlt/PlGF ratio was calculated.

Results

The mean Urine transcription factor 21 was significantly higher in pregnant patients with preeclampsia than in healthy pregnant controls (512.3 ± 281.4 vs. 300 ± 66.8; p<0.001). Urine TCF21 could not differentiate between early- and late-onset preeclampsia with the mean urine TCF21 was higher in early-onset preeclampsia than late-onset preeclampsia (532.63 ± 312.33 vs. 491.41 ± 248.1, p=0.519). Urine TCF21 was statistically significantly higher in mild preeclampsia than severe preeclampsia (572.3 ± 300.9 vs. 361.9 ± 155.8, p<0.001). The sensitivity and specificity of urine TCF21 was 60.62% and 90.62% when using 370 pg/mL as cutoff in the prediction of preeclampsia development.

Conclusion

Urine transcription factor 21 can be used as a possible and easy diagnostic marker for preeclampsia. It can differentiate between mild and severe preeclampsia but cannot be used to differentiate between early- and late-preeclampsia.
#337 Renal 3D photoacoustic imaging and contrast-enhanced ultrasound to assess oxygenation and perfusion and to predict fibrosis after ischemia-reperfusion
Authors: Schleef Maxime , Leon Christelle , Pillot Bruno , Chanon Stéphanie , Bidaux Gabriel , Juillard Laurent , Guebre-Egziabher Fitsum , Baetz Delphine , Lemoine Sandrine
Published: May 2024

Background and Aims

Renal 3D photo-acoustic imaging (3D-PAI) and contrast-enhanced ultrasound (CEUS) are promising tools in mice models to assess repeatedly and non-invasively renal ischemia-reperfusion (RIR) consequences and damages, or their improvement by nephroprotective strategies like mild therapeutic hypothermia (mTH), at the early phase of reperfusion as well as in the chronic late phase.

Method

C57Bl6 mice underwent 15 minutes of unilateral renal vascular clamping, with body temperature at 37°C (RIR-37°C, n=7) or mTH at 34°C (RIR-34°C, n=7), or a sham procedure (Sham, n=5). Renal volume and oxygen saturation (sO2-3D; corresponding to the percentage of oxyhemoglobin over the total hemoglobin content) were measured with 3D-PAI (3D reconstruction of the whole kidney through multi-plane acquisition with an automatized mobile support), and renal perfusion parameters (rBV, mTT, rBF) with CEUS (“destruction-replenishment” model of intravenous microbubbles), performed with VEVO3100 echograph (Fujifilm Visualsonic) 1 week before RIR (basal), 20 minutes after reperfusion, and 1 month after. Renal fibrosis was quantified at 1 month with Masson's trichrome coloration on histological samples. Data were compared with Mann-Whitney test or Wilcoxon test (paired data) as appropriate. Correlation was tested by Spearman test. All animal procedures were approved by the Ethics Committee.

Results

Sham showed no significant changes during follow-up. RIR-37°C led to renal hypotrophy (volume on 3D-PAI) and fibrosis at 1 month, compared to RIR-34°C (median volume 76 IQR [71-119] vs 143 IQR[108-180] mm3; p=0.03), and those parameters were correlated (R=−0.49; p=0.03). In RIR-37°C, sO2-3D tended to lower at 20 minutes compared to basal values (median sO2-3D 37 IQR [37-44] vs 49 IQR [36-57]%; p=0.08), but not in RIR-34°C (p > 0.99), and these early variations of sO2-3D were correlated with fibrosis at 1 month (R=−0.48; p=0.04). Renal perfusion was altered in RIR-37°C at 20 minutes compared to basal values (median rBV 73 IQR [46-105] vs 100 IQR [89-126] a.u.; p=0.047), and remained altered at 1 month (median rBV 71 IQR [57-83] a.u.; p=0.03), but not in RIR-34°C (p=0.47 at both 20 minutes and 1 month). Renal perfusion early alterations at 20 minutes were correlated with late alterations at 1 month (R=0.63; p=0.005), and tended to correlate with fibrosis (R=−0.41; p=0.08).

Conclusion

Renal 3D-PAI (on the whole 3D-reconstructed kidney) and CEUS can detect early alterations of renal perfusion and oxygen saturation after RIR, and predict chronic disturbances of perfusion and the onset of fibrosis, as well as the protection conferred by mTH. 3D-PAI can also be used to evaluate non-invasively renal volume as a surrogate of renal fibrosis after RIR.
#1706 LncRNA EGOT regulates hypoxia-induced mitophagy through the EGOT/PARKIN axis in renal tubular cells
Authors: Li Chi-Yuan
Published: May 2024

Background and Aims

The activation of mitophagy plays a crucial role in hypoxia signaling during acute kidney injury (AKI). The process involves coordinating the action of coding and non-coding RNA expressions to eliminate damaged mitochondria selectively. However, the specifics of how long non-coding RNAs (lncRNAs) regulate mitophagy and mitochondria biogenesis remain unclear. This study explores the impact of lncRNA called EGOT (Eosinophil granule ontogeny transcript) on mitophagy and mitochondria biogenesis in renal tubular cells under hypoxia.

Method

Overexpression and knockdown lncRNA-EGOT were evaluated. Mitophagy proteins (PINK1, p-PARKIN, BNIP3, LC3), mitochondria dynamics and biogenesis related proteins (Drp-1, MFN-1, PGC-1α, SDHA, SOD1) were determined through western blot analysis. Immunofluorescence studies of p-PARKIN mitochondrial translocation and LC3/TOMM20 localization were determined using confocal analysis.

Results

Hypoxia upregulated mitophagy proteins, mitochondria dynamics and biogenesis related proteins expressions, and mitophagosome in HK-2 cells. LncRNA EGOT expression was also significantly downregulated in renal tubular cells during hypoxia-induced mitophagy. Overexpression studies of hypoxia-regulated lncRNA- EGOT significantly downregulated p-Parkin, Parkin, LC3II expression, and LC puncta mitophagosome formation, while EGOT knockdown reversed the suppression of mitophagy. LncRNA EGOT regulates PGC-1α through parkin/paris expression.

Conclusion

Our study shows novel findings on the lncRNA-EGOT in hypoxia-induced mitophagy regulation in the renal tubular cells. Thus, downregulated lncRNA-EGOT expression with subsequent mitophagy activation is critical for hypoxia-induced mitophagy regulation through the EGOT/PARKIN axis.
#1613 Gadolinium and gadoteric acid's short-term impact on kidney function and lipid profile
Authors: Belo Luís , Coimbra Susana , Rocha Susana , Viana Sofia D , Rebelo Rute , Rocha-Pereira Petronila , Valente Maria João , Catarino Cristina , Bronze-Da-Rocha Elsa , Reis Flávio , Santos-Silva Alice
Published: May 2024

Background and Aims

Concerns regarding the safety of gadolinium-based contrast agents (GBCA), which are often employed in medical imaging, have been raised in light of reports of free gadolinium's [Gd (III)] cytotoxicity. It appears that GBCAs having macrocyclic structures, like gadoteric acid (Gd-DOTA), are more stable and less toxic.

Previous work from our group found that Gd (III) promotes inflammation and fibrosis in proximal tubular cells cultures. A disturbance of lipid metabolism was also reported, accompanied by the build-up of lipid droplets, lipid peroxidation and the overexpression of genes linked to lipogenesis and lipolysis.

The aim of this study was to evaluate the short-term effects of Gd (III) and of Gd-DOTA on renal function and lipid metabolism biomarkers, using an animal model.

Method

Male Wistar rats were exposed to a single dose of Gd (III) or Gd-DOTA (groups A and B, respectively); a control group was also included (C). Blood was collected after 48h of exposure to compounds. We evaluated circulating levels of renal function biomarkers—creatinine and cystatin—using a routine automated assay and ELISA, respectively. The lipid profile was also determined including triglycerides (TG), total cholesterol, HDL-cholesterol, LDL-cholesterol, and oxidized LDL (oxLDL) levels.

Results

Gd (III) group (A) presented significantly higher circulating cholesterol (P=0.006) and LDL-cholesterol (P<0.001) and lower TG (P<0.001) levels than the control group (C); a non-significant increment in cystatin was also observed for group A. The Gd-DOTA group (B) only presented lower TG levels (P=0.002) compared to the control group (C), being similar to those presented by group A. Both exposed groups (A and B) presented non-significantly higher oxLDL levels compared to the control group.

Conclusion

Single exposition to free Gd (III) induced prompt changes in lipid profile, with little short-term influence in traditional kidney biomarkers. The exposition to Gd-DOTA was associated with lower disturbance in lipids and lipoproteins (only lower TG levels) and imperceptible renal changes. Despite the significantly safer profile for Gd-DOTA, further studies are necessary, testing different biomarkers, to clarify the short-term, and even the long-term impacts, of these molecules.

Acknowledgements

This work was financed by FCT through the project 2022.08400.PTDC; FCT, in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of the Research Unit on Applied Molecular Biosciences—UCIBIO and the project LA/P/0140/2020 of the Associate Laboratory Institute for Health and Bioeconomy—i4HB.
#2705 Hypertension as a risk factor for mortality and the development of chronic kidney disease after an episode of acute kidney injury in the elderly
Authors: Mahmoud Nouha Ben , Hamouda Mouna , Salah Manel Ben , Salem Meriem Ben , Bchir Sirine , Letaief Ahmed , Sabra Aloui , Skhiri Habib
Published: May 2024

Background and Aims

Acute kidney injury (AKI) is a real public health problem due to its severity and its consequences in the short, medium and long term. Hypertension is a very common disease in our country. The association between hypertension and acute and chronic renal failure is not well studied in our country, and given the lack of data, we proposed to carry out this study and even more so the elderly, who are fragile subjects with multiple illnesses.

Method

We undergone a retrospective study which was carried out in the nephrology department of Fattouma Bourguiba hospital in Monastir. We included patients aged > 65 years, who had an AKI with full recovery who had been hospitalized between January 2002 and December 2015. Our study aimed to assess the impact of hypertension on mortality and the development of chronic kidney disease (CKD) after an episode of AKI.

Results

Our population was made up of 67 men and 60 women, 30.1% had multiple comorbidities. Pre renal Aki represented the predominant mechanism of AKI which was retained in our study with a rate of 40% and dehydration as the main aetiology in 70 patients.

In the short term, 15 patients had progressed to CKD. The mean overall survival in our study was 159 months with a high risk of mortality in elderly (patients aged >65 years), who had multiple comorbidities, hypertensive, diabetics, with vascular disease, Charlson Comorbidity index >5, who presented with hyperkalaemia >5.5 and pre renal mechanism of the AKI episode.

In the medium term and the long term, 4 and 2 patients developed CKD respectively. Hypertension was a factor in poor prognosis and mortality in elderly subjects after an episode of acute kidney injury (p=0.005).

Conclusion

Hypertension is a real public health problem impacting the short, medium and long term prognosis of patients who have had an episode of AKI with full recovery.
#2781 Renal cortical necrosis—a rare cause of acute kidney injury
Authors: Jaryal Ajay , Vikrant Sanjay , Yadav Riti
Published: May 2024

Background and Aims

Renal cortical necrosis (RCN) is a rare and catastrophic cause of acute kidney injury (AKI). It is characterized by ischemic destruction of all the elements of renal cortex due to marked reduction in renal arterial perfusion of renal cortex due to vascular spasm and microvascular injury. It can be patchy or diffuse depending upon the cause and extent of hypoperfusion. Snake bite is rare cause of RCN. Incidence of RCN following snake bite has been reported to be as high as in 25% of the bitten patients to <1%. Lack or delay in receiving anti snake venom (ASV) has been observed to be a contributing factor in development of RCN following snake bite.

Method

A 45-year-old female had an unknown bite on foot while returning to home at twilight. She had intense pain at site of bite with slight ooze of blood. Overnight she had vomiting and pain abdomen. Subsequently she developed progressive fall in urine output and dyspnoea. After about 36 hours of bite at the time of admission in hospital she had anuria, prolonged whole blood clotting time, tachypnoea, hypoxemia and required oxygen (O2) to maintain normal O2 saturation. She was given two doses of polyvalent ASV 6 hours apart which corrected her coagulation defect. Investigations showed: haemoglobin—9 gm/dl, total leucocyte count—18700/mcl, platelet—1.15 lakh/mcl, blood urea—88 mg/dl and serum creatinine—10.5 mg/dl. She was managed with haemodialysis and supportive care. Even after 3 weeks of onset of AKI, she had anuria so a kidney biopsy was done.

Results

kidney biopsy on light microscopy examination showed 9 glomeruli; 8 revealing global tuft necrosis along with necrosis of adjacent tubules and vasculature and necrotic process affected around 60% of sampled cortical area consistent with cortical necrosis (Fig. 1). She was continued with haemodialysis support and urine output and pre-dialysis serum creatinine were monitored. Her urine output after 3 months of onset of AKI is around one litre per day but her pre-dialysis serum creatinine stays in the range of 9-10 mg/dl and so she continues to receive biweekly haemodialysis.

Conclusion

In our index case, there was delay in getting ASV which may have contributed to development of RCN. So, early treatment of snake bite is important to prevent this catastrophic complication.
#2875 Experience in the use of plasmapheresis as a therapeutic tool in acute pathologies in a tertiary level hospital
Authors: Fernández Maria Paz Castro , Valverde Daniel Campos , Fernández Sara Anaya , Saponara Luis Guillermo Piccone , Conejo Gloria García , Conforme Roger Abduvar Cox , Escudero Patricia Sanchez , Del Carmen Vozmediano Poyatos Maria
Published: May 2024

Background and Aims

Apheresis is a therapeutic modality which purpose is the elimination from plasma of the pathogenic components of a disease or its clinical manifestations. Plasmapheresis is an apheresis technique used in the treatment of various diseases with varying degrees of proven clinical efficacy. The aim of our work is to describe the experience in the use of plasmapheresis in different acute pathologies in our center, and if there are factors that favor the clinical response to treatment.

Method

Retrospective cohort study. We included plasmapheresis performed in the years 2017-2022. Variables such as age, sex, etiology, type of replacement performed, number of sessions, and American Society for Apheresis (ASFA) classification, among others, were collected. We defined response to treatment as partial or total clinical remission.

Results

We included 72 patients who received plasmapheresis during 2017-2022. Mean age 54 ± 18 years. 56.9% male. Disease etiology was neurological in 56.9%, nephrological in 36.1% and hematological in 6.9%. Between 2017-2019, 39.7% of the plasmapheresis were performed, while the remaining 60.3% were between 2020-2022. The number of sessions was 5.3 ± 2. 59.6% were performed with albumin, 29.2% with fresh frozen plasma and 13.9% with albumin and fresh frozen plasma. The ASFA indication was category I in 68.1%. 23.6% presented some complication, the most frequent being febrile in 6.9%, systemic infection and allergic reaction in 5.6%. A response to treatment was observed in 75%. Antibodies were positive before starting plasmapheresis in 29.2%, decreasing to 16.7% 3 months after treatment. There was recurrence in 19.4%, 16.7% received more cycles of plasmapheresis and there was 11.1% mortality due to disease. In patients with response to treatment, a higher percentage of response was observed in those diseases of non-nephrological origin (70.4% vs. 29.6%, p 0.04), lower percentage of complications (16.7% vs. 83.3%, p 0.01) and lower mortality associated with the disease (3.7% vs. 96.3%, p 0.001).

Conclusion

Plasmapheresis is a therapeutic plasma exchange technique that is increasingly used in our hospital, with a greater increase in recent years. It is a therapeutic option that should be considered in many occasions as first line or adjuvant treatment, with a low rate of complications and clinical improvement in most patients. Despite this, studies with a larger number of patients are required to increase and consolidate the existing evidence on the use of these procedures.