bluuebunny/crossref_metadata_2025 huggingface dataset:
P0825ASSOCIATION OF BODY MASS INDEX CHANGES WITH CHRONIC KIDNEY DISEASE IN A JAPANESE GENERAL POPULATION
Authors: Toda Akiko , Hara Shigeko , Tsuji Hiroshi , Arase Yasuji
Published: June 2020

Background and Aims

Obesity is a risk factor for chronic kidney disease (CKD), but the effect of reducing body mass index (BMI) on the prevention of CKD is controversial. One of reasons for this disagreement is that part of patients with a BMI decrease may have an unfavourable health status. In such cases, the BMI decrease could be a risk factor for the development of CKD. Therefore, by analysing the data of annual health check-ups, we examined an association between BMI change and CKD development to determine whether BMI reduction helps prevent CKD development.

Method

We analysed the data of 6,959 subjects who underwent annual health check-ups in both 2013 and 2018. By a multivariate logistic regression analysis, we investigated a relationship between BMI change and CKD development within the 5 years between 2013 and 2018. The percent change in the BMI (ΔBMI) was calculated using the following equation: {(BMI in 2018 − BMI in 2013)/BMI in 2013} ×100. For analyses, we classified the subjects into five groups based on their ΔBMI value: (i) severe BMI decrease (ΔBMI <−2.5%); (ii) moderate BMI decrease (ΔBMI ≥−2.5% but <0%); (iii) maintained BMI (ΔBMI ≥0% but <2.5%); (iv) moderate BMI increase (ΔBMI ≥2.5% but <5%); (v) severe BMI increase (ΔBMI ≥5%). For further analysis, we divided the subjects into non-obesity category (basal BMI <25 Kg/m2) and obesity category (basal BMI ≥25 Kg/m2). Subjects with an estimated glomerular filtration rate <60 mL/min./1.73 m2 were defined as having a CKD.

Results

After adjusting several covariates, compared with the maintained BMI group, the severe BMI decrease group showed a significantly low risk of CKD development (odds ratio (OR) 0.70, 95% confidence intervals (CI) 0.54-0.91, p <0.01) and the severe BMI increase group had a significantly high risk (OR 1.40, CI 1.08-1.81, p = 0.01). A farther analysis revealed that the OR of CKD development for the severe BMI increase group in the obesity category was higher than that in the non-obesity category (OR 1.75 vs. 1.29).

Conclusion

In subjects who underwent annual health check-ups, BMI reduction had a significant effect on the prevention of CKD development, whereas an increase in the BMI was a risk factor for CKD development. Moreover, by severe increase in the BMI, obesity subjects showed higher risk of CKD development than non-obesity subjects.
P0832FINAL OUTCOME OF CKD STAGE 5 PATIENTS WHO CHOSE PALLIATIVE TREATMENT-EXPERIENCE FROM ONE MEDICAL CENTER IN TAIWAN
Authors: Kuo Mei-Chuan , Kung Lan-Fang , Wang Shu-Li , Hwang Shang-Jyh , Wu Chien-Yi , Chiu Yi wen , Chen Hung-Chun
Published: June 2020

Background and Aims

Taiwan has a high incidence and prevalence of ESRD (end stage renal disease) in the world and all the medical expenses are covered by national insurance. Therefore, many old ESRD(end stage renal disease) patients received dialysis even had multiple co- morbidity. However, still some old late CKD patients withhold dialysis and chose palliative treatment. This study elucidate the experience of final outcome for those late CKD patients who chose palliative treatment in Taiwan.

Method

We enrolled 137 CKD stage 5 patients (age: 80.2±8.8 y/o, male/female:85/52) who were interested about palliative treatment since Oct, 2010 till July 2019. We reviewed their co-morbidity to calculate Modified Charlson comorbidity index by medical record and record their laboratory data at enrollment. The differences between two groups were calculated using a Chi-square test for categorical variables and a Mann-Whitney test for continuous variables. All statistical tests were two-tailed and a P value of less than .05 was considered a significant difference.

Results

After fully discussion, 82(59.9%) patients can accept palliative treatment, 46(33.6%) refuse palliative treatment, 9(6.6%) patients cannot decided palliative treatment or not at first. 79 patient died during study period, median survival time is 163 days. 22 death patients(27.8%) received dialysis before end of life. 10 patients (12.2%) who asked palliative treatment at first and changed their mind to received dialysis. 80% of these patients receive dialysis by double lumen catheter. For those refuse palliative treatment, 43 patient received dialysis and 24(55.8%) patients received dialysis by temporary catheter. These percentage is much higher(55.8%) than other CKD stage 5 patients (26.6%) following at our hospital. Only 13 patient(16.5%) died at home, 24 patients(30.4%) diet at hospice ward and 39(49.4%) patients diet at ordinary ward or intensive care unit. Older age, lower albumin and higher Charlson comorbidity index are found in mortality patients. The median survival time for those patients received dialysis is 467 days.

Conclusion

After fully explanation, only 59.9% patients can accept withhold dialysis and 12.2% regret later. Those who had interested in palliative treatment had higher percentage to use double lumen catheter for first dialysis. The median survival time for those patients who ever think about withhold dialysis is only 467 days even receiving dialysis. To minimize suffering before end of life and decrease medical expense burden, we still need to do more effort to popularize the concept of withhold dialysis in older and multiple comorbidity patients.
P0834IMPACT OF CKD ON MORTALITY IN HEART FAILURE
Authors: Sarnowski Alexander , Jenkins Rebeka , Anderson Lisa , Banerjee Debasish
Published: June 2020

Background and Aims

The presence of CKD impacts short term survival of heart failure patients however impact on long term survival is not well known. The aim of this study was to investigate the impact of CKD on long term survival.

Method

Data were collected on long term survival of 845 patients (1029 admissions) admitted with diagnosis with acute heart failure. Data on mortality was collected by electronic patient records. Data were analysed using IBM SPSS 25.

Results

The baseline characteristics were: age 76 (13) mean (SD); Haemoglobin 11.8 (2), urea 37.2 (26.8), eGFR 63.3 (30.4), potassium 4.34 (0.70) and 36% diabetics, 567 patients (67%) died during follow up of median 916 days (IQR 188-1936 days).

Patients who died were older, with higher urea, creatinine, potassium and NT proBNP. In a survival analysis adjusted for diabetes and haemoglobin; age, urea, NT-proBNP baseline eGFR and potassium predicted mortality (see table).

CKD patients with eGFR <60 ml/min/1.73m2 had poorer survival compared to patients with eGFR>60 (log rank p=0.000) (see figure 1)

Conclusion

Long term mortality in patients with CKD was higher which was an independent predictor of survival
P0839EVALUATION OF ECHOCARDIOGRAPHIC INDICES OF DIASTOLIC DYSFUNCTION IN PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Kourtinos Alexandros , Pappas Kostas , Belbasis Lazaros , DUNI ANILA , Rapsomanikis Karolos Pavlos , Kitsos Athanasios , Katsouras Christos , Tsiara Stavroula , Ntounousi Evangelia
Published: June 2020

Background and Aims

The structure and function of the left ventricle (LV) are affected since the early stages of chronic kidney disease (CKD). Our cross-sectional study aimed to estimate the echocardiographic indices of the LV diastolic function and the evaluation of their potential correlation with indices of kidney injury in patients with CKD, before initiation of renal replacement therapy.

Method

99 patients with CKD (stage 2 CKD: 31 patients (27%), stage 3 CKD: 47 patients (40.9%) and stage 4 CKD: 37 patients (32.1%)) were enrolled in the study. Anthropometric data, indices of renal function (eGFR-CKD-EPI, urinary protein excretion in mg/24h), biochemical laboratory parameters, comorbidities [hypertension (HT), diabetes mellitus (DM), coronary heart disease (CAD)] and echocardiographic indices of LV diastolic function were recorded. In specific, left atrial (LA) dimensions were measured in M-Mode and were expressed both as absolute values in mm as well as indexed to body surface area ((BSA) and expressed as the LA index in mm/m2. The study sample, after taking into account patient gender, was further divided into separate groups according to the presence or not of LA dilation.

Results

The average patient age was 62 +/- 13 years and average eGFR (CKD-EPI) was 44.1+/-21.4 ml/min/1.73m2. With regard to comorbidities, 59.3% of the sample population had arterial hypertension, 24.3% had diabetes mellitus and 10.4% had known coronary artery disease. Regarding anti-hypertensive and hypolipidemic treatment, 22.6% of the patients were on ARB and 24% on ACEi, 51.3% on CCB, 29.6% on β-blockers, 37.4% on diuretics and 28.7% of the patients were receiving statin treatment. 28.2% of the patients had dilated LA in terms of absolute value and 13.8% had dilated LA following indexing to BSA (LA index). A positive correlation was observed between the LA size and age (p=0.001), BMI (p=0.041), uric acid levels (p=0.022), PTH (p=0.029), fibrinogen (p=0.035), LV mass (p=0.006) and LV mass/BSA (p=0.005), whereas a negative correlation was observed with serum LDL (p=0.027). Additionally, there was observed a negative correlation of LA index with eGFR (p=0.05), as well as an inverse relationship between LA index and PTH (p=0.012), age (p=0.004), BMI (p=0.037) and LV mass/BSA (p=0.005). No significant correlations between LA size and LA index with proteinuria or with co-morbidities (DM, HT, CAD) were observed.

Conclusion

In a population of patients with stage 2-4 CKD, LA size correlated to indices of CKD. Larger studies are required in order to further confirm these correlations.
P0843EFFECT OF GROUP PSYCHO SOCIAL SUPPORT ON QUALITY OF LIFE AND MORTALITY WITH END STAGE KIDNEY DISEASE
Authors: Nisar Zara , Sajjad Hassan , Anwar Nisar
Published: June 2020

Background and Aims

The patients of end stage renal disease suffer a lot of psychological trauma as well as feel a lot of social burden. They mostly show psychological distress in different forms, be it impaired quality of life, depression or anxiety. The aim of our study was to find out the effect of supportive-expressive group therapy in end stage kidney disease patients in the outcome of better health related quality of life and survival.

Method

181 patients were recruited in the study after consent between June 2012-June 2017. They were then assigned randomly to Group A supportive-expressive group therapy or to a Group B control group (no intervention). It was a double blinded randomized control trial. 115 patients were assigned to Group A and 66 were assigned to group B. The primary outcome was the effect on health related quality of life. Secondly, if it had any impact on survival. Significant predictors of survival were not analysed. Analysis was done by intention to treat.

Results

The patients of group A showed decrease in physical pain(p=0.002), mood elevation (p=0.04), compliance with treatment (p=0.001), reduced hopelessness (p=0.004), newly diagnosed depressive disorders (p=0.01) and better social life (p=0.003). Group A had 97% survival rate as compared to group B with 77%.

Conclusion

Supportive-expressive group therapy to patients with end stage kidney disease improves health related quality of life. It also has an effect on survival maybe because of compliance with treatment. We would like to further explore the role of Supportive-expressive group therapy in survival. Support groups should be provided to patients in developing countries like the setup of ours because it has a great impact on the betterment of the patient.
P0845INCREASING TOTAL RENAL VOLUME AFTER NEPHRECTOMY FOR RENAL CELL CARCINOMA IS ASSOCIATED WITH RENAL FUNCTION EVOLUTION
Authors: PAMPA-SAICO SAUL , Pizarro-Sánchez M Soledad , Alexandru Simona , García Puente-Suárez Laura , López-Picasso María , Barba Martín Raquel
Published: June 2020

Background and Aims

Renal cell carcinoma is the most common form of kidney cancer. Reduction of renal mass after radical nephrectomy (RN) in these patients, results in compensatory hypertrophy of the contralateral kidney. The capacity of compensation will determine the renal function (RF) evolution. Measuring of total renal volume (TRV) of the remaining kidney pre and post RN can help assess the RF evolution.

Aims

To determine the correlation between TRV pre and post nephrectomy (a year of follow-up) with RF and the factors that modify.

Method

A retrospective cohort study was carried out in our institution, in 62 patients who had underwent RN from 2014 to 2018, due to renal cell carcinoma (confirmed by histopathology). The demographic data included age, gender, body mass index (BMI), associated comorbidities, smoking habits were collected.

Serum creatinine, estimated glomerular filtration rate (eGFR) and proteinuria were collected in the preoperative period and in the follow-up.

The TRV was calculated pre and post (a year of follow-up) RN, using ellipsoid formula equation (computed tomography scan or magnetic resonance imaging).

Renal function evolution was assessed by eGFR using the modification of diet in Renal Disease formula. Multivariate linear regression analysis was used to determine the predictor of TRV at 1 year of follow-up.

Results

The median age at the time of RN was 71 years old (range, 43-86 years). Most of them were men, 69% (43/19). The estimated glomerular filtration rate (FGe) pre and post nephrectomy was 74 (41-102) and 52.1 ml/min/ m2 (22-89) respectively (P=0.013). The TRV pre and post-nephrectomy was 165.3 (102.3-259.7) and 188.3 ml (115.3-271.2) respectively (P=0.001).

On multivariate linear regression analysis, controlling for age and sex; the pre-nephrectomy FGe (β = 0.42; P = 0.023) and the pre TRV (β = 1.23; P <0.0001) were positively correlated with the post-nephrectomy TRV, while the FGe at year of follow-up was correlated negatively (β = -1.11; P = 0.024)

Conclusion

The post nephrectomy TRV was positively correlated with TRV and FGe pre nephrectomy. While with the FGe at one year post nephrectomy was negatively correlated. The increasing TRV pre and post nephrectomy can help to predict renal function at a year of follow-up in this group of patients.
P0849LOWER TRANSFERRIN SATURATION INDEX (TSAT) IS ASSOCIATED WITH WORSE HEALTH-RELATED QUALITY OF LIFE (HRQOL) IN NON-DIALYSIS DEPENDENT CHRONIC KIDNEY DISEASE (NDD-CKD) PATIENTS AT BOTH HIGHER AND LOWER HEMOGLOBIN LEVELS
Authors: Guedes Murilo , Muenz Daniel , Zee Jarcy , Lopes Marcelo , Waechter Sandra , Stengel Benedicte , Massy Ziad , Speyer Elodie , Finkelstein Fredric , Sesso Ricardo , Pisoni Ronald , Robinson Bruce , Pecoits-Filho Roberto
Published: June 2020

Background and Aims

Iron Deficiency (ID) is a common condition in NDD-CKD patients that is associated with poorer clinical outcomes. In different populations, such as congestive heart failure patients, treatment of ID leads to better clinical outcomes and HRQOL. However, the impact of ID on HRQOL is previously unknown among NDD-CKD individuals. We analyzed real world data from a multinational cohort of NDD-CKD stage 3 to 5 patients under nephrology care to evaluate the association between TSAT and HRQOL measures from the KDQOL-36.

Method

Patients from Brazil (N=205), France (N=2015), and the US (N=293) enrolled in the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps, 2013 to 2019) with available TSAT, ferritin, and HRQOL data were included in the analysis. We grouped patients according to their TSAT levels as ≤15%, >15-20%, >20-30% (reference group), >30-50%, and >50%. We considered the TSAT value that preceded the HRQOL measurement closest in time as the predictor. Linear mixed regression was used to estimate the mean differences (95% CI) in physical composite summary (PCS), mental composite summary (MCS), and KDQOL-36 subdomains across TSAT categories. Models were adjusted for potential confounders.

Results

2513 patients (62% male, 44% with diabetes, mean (SD) age 67 (13) years; 48%, 44% and 8% having stage 3, 4 and 5 NDD-CKD, respectively) were included in the analysis. Mean TSAT was 25 % (10). Distribution across TSAT categories was 14%, 19%, 42%, 23, and 2%, respectively. The median [IQR] number of days between TSAT measurement and PRO collection was 24 [13, 49] days. Mean PCS was 41 (10) and MCS was 45 (11). In the multivariate analysis, TSAT ≤15% was associated with lower HRQOL scores, in particular PCS, and with less favorable effects and symptoms of kidney disease (Figure). Similarly, less favorable HRQOL scores captured in the SF-12 subdomains indicative of physical HRQOL were observed in patients with lower TSAT. The adjustment for Hb only slightly attenuated the effects, and the results were not different for subgroup of patients with hemoglobin <11.5 vs ≥ 11.5 g/dL.

Conclusion

Lower TSAT levels, indicative of iron deficiency, are associated with poorer HRQOL in NDD-CKD patients, particularly for physical domains and effects of kidney disease, even after adjustment for potential confounders and stratification for normal and low hemoglobin levels. Randomized controlled trials of iron replacement therapy aiming to evaluate its impact on HRQOL among NDD-CKD individuals are needed to confirm and integrate these findings into clinical practice.
P0851THE DIFFERENTIAL IMPACT OF INTRAVENOUS IRON IN A MODEL OF EXPERIMENTAL URAEMIA ON TISSUE MARKERS OF OXIDATIVE STRESS
Authors: Bhandari Sunil , Nuhu Faisal , Seymour Anne Marie
Published: June 2020

Background and Aims

Uraemia leads to changes in cardiac structure, metabolic remodelling and anaemia, key factors in the development of heart failure in patients with chronic kidney disease (CKD). Previous studies have identified abnormalities in mitochondrial function in experimental uraemia, potentially impairing energy provision and enhancing oxidative stress. The aim of this study was to characterise oxidant status and changes in mitochondrial function in uraemia and the impact of iron therapy.

Method

Experimental uraemia was induced in male Sprague-Dawley rats via a subtotal nephrectomy and parenteral iron administration at 6 weeks post-surgery (10mg/Kg body weight). Pro-oxidant activities and antioxidant capacities (oxidised glutathione (GSSG) relative to reduced (GSH)) in both sham and uraemic animals and lipid peroxidation (thiobarbituric acid-reactive substances (TBARS) was measured. Mitochondrial function was assessed using the SEAHORSE analyser.

Results

Oxidative stress was increased in cardiac tissue (69% increase in GSSG/GSH ratio, 38% rise in TBARS and significantly (79%) upregulated NADPH oxidase activity. Glutathione peroxidase (GPx) and glutathione reductase (GR) activities were significantly increased by 30%. Iron reduced GSSG/GSH ratio and TBARS by 62% and 51% respectively. Iron therapy was also associated with significantly increased aconitase activity. Parenteral iron improved respiratory reserve in cardiac mitochondria and skeletal mitochondria suggests IV iron restores mitochondrial function.

Conclusion

Uraemia leads or oxidative stress and mitochondrial dysfunction in cardiac tissue. Iron therapy reduces oxidative stress and improves cardiac mitochondrial function. This might lead to reduced adverse cardiovascular outcomes in CKD.
P0879EARLY STEROID WITHDRAWAL HAS A POSITIVE EFFECT ON BONE KIDNEY TRANSPLANT RECIPIENTS: A PROPENSITY SCORE STUDY WITH INVERSE PROBABILITY-OF-TREATMENT WEIGHTING
Authors: Batteux Benjamin , Gras-Champel Valérie , Lando Mathilde , Brazier François , Desailly-Henry Isabelle , Rey Amayelle , Benis Youssef , Masmoudi Kamel , Choukroun Gabriel , Liabeuf Sophie
Published: June 2020

Background and Aims

Long-term corticosteroid use after kidney transplantation is associated with a decrease in bone mineral density and a high fracture risk. We hypothesized that patients with early steroid withdrawal (ESW) would display a gain in bone mineral density in the year following kidney transplantation, when compared with patients on long-term corticosteroid therapy (LTCT).

Method

In a cohort of kidney transplant recipients, 317 patients were included between 2012 and 2018. Dual-energy X-ray absorptiometry was performed 1 and 12 months after transplantation. The data were analyzed using linear regression with inverse probability-of-treatment weighting based on a propensity score.

Results

One year after transplantation, the gain in bone mineral density was significantly greater in recipients with ESW than in recipients on LTCT for the lumbar spine (+0.027 g/cm, P < 0.001) and the femoral neck (+0.021 g/cm, P = 0.035). Among patients with ESW, (i) none had osteoporosis, (ii) the percentage with normal bone mineral density increased from 35.0% at month 1 to 56.4% at month 12, and (ii) the percentage with osteopenia fell from 52.5% to 43.6%. In patients undergoing LTCT, the fracture incidence was 14.5 per 1000 person-years. None of the patients in the ESW group experienced a fracture. Cardiovascular risk factors were more prominent in the LTCT group relative to the ESW group: patients in LTCT group (i) were more likely to have high blood pressure (p<0.001), (ii) gained more weight gain (p=0.032) and (iii) displayed a greater increase in serum triglyceride levels (p=0.004).The acute rejection rate was similar in the two groups.

Conclusion

Early steroid withdrawal is associated with a spontaneous increase in bone mineral density at 12 months post-transplantation (relative to patients on long-term steroid therapy), with a reduction in several cardiovascular risk factors and does not appear to harm the graft.
P0886EFFICACY AND SAFETY OF EVOCALCET IN PERITONEAL DIALYSIS PATIENTS: A SINGLE CENTER LONGITUDINAL STUDY IN JAPAN
Authors: Uchida Hiroki , Kurahashi Motoyasu , Harada Kenji , Kanai Hidetoshi
Published: June 2020

Background and Aims

Calcimimetic agent is used for secondaryhyperparathyroidism (SHPT), but it might cause gastrointestinal side-effects. These side effects are severe problem for PD patients with gastrointestinal symptoms due to dialysis fluid storage. Evocalcet is a new calcimimetic agent for SHPT, and expected to reduce gastrointestinal related symptoms. There have been some reports about switching from cinacalcet to evocalcet or administered for HD patients. However, there have been few reports on PD patients. Here, we reported the efficiency and safety of evocalcet in PD patients.

Method

PD patients who had newly started to treat for SHPT with evocalcet, between August 2018 to August 2019 were selected. Patients who died or transferred to HD within 6 months after administered evocalcet were excluded. We compared the changes in whole PTH level, serum phosphorus level and serum corrected calcium level with baseline and after administration. Moreover, we investigated adverse events of gastrointestinal related symptoms.

Results

Overall, 34 PD patients were included, (mean age: 67.5 years old, male/female: 23/11, average PD vintage: 39.6 months, serum phosphorus level: 5.1 ± 1.0 mg/dl). There was a significant reduction in whole PTH at week 16 from baseline (346 ± 187 pg/ml vs 258 ± 196 pg/ml, p <0.001), and this relation was continued at week 32. There was no significant change in serum phosphorus level during this study. Serum corrected calcium level was the lowest at week 12 from baseline (9.4±0.7 mg/dl vs 9.0±0.1 mg/dl: p=0.004), thereafter, serum calcium level was not decline with adjustment of vitamin D receptor activators and calcium preparation. Adverse events were observed in 6 patients (18.2 %), nausea occurred in 3 patients, decreased appetite occurred in 2 patients, and diarrhea occurred in 2 patients. Although some adverse events had occurred, all patients continued study.

Conclusion

These results suggested that evocalcet might be efficient and safety in PD patients with SHPT.
P0887MAJOR OSTEOPOROTIC FRACTURES AFTER KIDNEY TRANSPLANTATION: INCIDENCE, PREDICTORS AND ASSOCIATION WITH MORTALITY
Authors: Iseri Ken , Carrero Juan Jesus , Evans Marie , Felländer-Tsai Li , Berg Hans , Runesson Björn , Stenvinkel Peter , Lindholm Bengt , Qureshi Abdul Rashid Tony
Published: June 2020

Background and Aims

Major osteoporotic fractures (MOF) are associated with increased morbidity and mortality in ESRD patients. We investigated incidence, predictors and clinical outcomes associated with first MOF (MOFfirst) following kidney transplantation (KT).

Method

In Swedish Renal Registry of 3992 first KT recipients (2005 -2016) (age 53 years, 65% men), we identified all MOFfirst in hip, spine, humerus and forearm following KT. We estimated incidence rates and predictors of MOFfirst using flexible parametric hazard models and Fine-Gray analysis accounting for competing risk of death, and risk of all-cause mortality following MOFfirst using Cox proportional hazards models with fracture as time-varying exposure.

Results

During median follow-up of 4.8 years (IQR 2.2-7.9 years), there were 279 fractures of which 139 were forearm fractures. The crude incidence rate of MOFfirst (n=279) was 14/1000 patient-years and that of hip fractures (n=69) 3/1000 patient-years. The multivariate-adjusted fracture incidence rates were highest during the first 6 months following KT, and two-fold increased among women. High age, female sex, previous history of MOF, diabetes nephropathy, pretransplant dialysis therapy and acute rejection were associated with increased risk for MOFfirst, whereas pre-emptive KT was associated with lower risk of MOFfirst. Spline curves showed that impact of age in women on MOFfirst was markedly higher than in men. MOFfirst (including all cases) independently predicted increased all-cause mortality (hazard ratio, HR, 1.78(95%CI 1.35-2.36)). Among MOFfirst, hip fracture (HR, 4.68(95%CI 1.56-14.06)) and spine fracture (HR, 4.02(95%CI 1.19-13.54)) were significantly associated with increased all-cause mortality.

Conclusion

The initial six months following kidney transplantation is a high-risk period for major osteoporotic fractures, especially forearm fractures. MOFs, especially hip and spine fracture, are associated with increased mortality.
P0894AEFFECTS OF DENOSUMAB ON BONE MINERAL DENSITY AND LOW ENERGY FRACTURES IN KIDNEY TRANSPLANT PATIENTS: SAFE AND EFFECTIVE
Authors: Rolla Davide , Ardini Michela , Trezzi Matteo , Bizzoni Paola , Lauria Francesca , Casabella Andrea
Published: June 2020

Background and Aims

Fractures are a disabling clinical outcome after kidney transplantation (KTx), with incidence 5 to 34 times higher expected in males and females, respectively. Denosumab, a fully human monoclonal antibody that binds to RANKL with high affinity and specificity, blocking the interaction of RANKL with RANK, mimicking the endogenous effects of osteoprotegerina, increase bone mineral density; however, its effects to reduce the risk of vertebral fractures and ameliorate BMD remain undefinite in the KTx.

Method

Thirteen kidney recipients (aged from 50 to 79 yy, 6.2 + 5.5 (SD) yy after KTx), 6 M and 7 F (all postmenopausal) with nearly normal renal function (creat. 1.1+-0.31 mg/dl), affected by low energy vertebral fractures (21 dorsal and 1 lumbar vertebrae), evaluated by morphometric X-ray absorptiometry (Hologic DQR-4500A), were treated with denosumab (four 60-mg doses of denosumab Q6M) over 24 months. Data for vertebral heights and height ratios (P-A), covering 9 vertebral bodies were obtained, besides the data of vertebral, femural and radius BMD.The immunosuppressive regimen consisted of CNI (TAC or CsA), MMF and 8 out of 13 patients were still taking prednisone. Bone mineral metabolism parameters (whole-PTH, 25OHD3 and alcaline phosphatase) were also evaluated.

Results

No sides effects were observed, and all Patients concluded the study.After two years of denosumab treatment, we observed a significative reduction of vertebral T-score (from -2.12 +- 0.35 (SE) to -1.67+-0.35; p< .02), while T score of femural and radius did not show significative variation (-1.86+-0.21 versus -1.84+- 0.23 and -3.04+-0.42 versus -3.19+-0.45, respectively). The number of low energy vertebral fractures, basal versus two years control, had increased for only two dorsal vertebral fractures. However, to one of two subjects, with new dorsal vertebral fractures, was administered high dose of methylprednison for a severe kidney reject. No variations were observed in whole-PTH (89.31+-19.9 versus 68.38+-9.8 pg/ml), 25OHD3 (24.02+-2.75 versus 26.67+-2.29 ug/dl) and alcaline phosphatase (78.46+-12.73 versus 56.77+-7.14 UI).

Conclusion

Treatment with denosumab improve BMD at vertebral site in KTx, despite continuous steroid therapy and reduce the risk of new low energy vertebral fractures
P0907STRIKING NOVEL MULTI-MISMUTATIONS ON GNAS1,FGF23,FGFR3 GENES IN CKD WITH SECONDARY HYPERPARATHYROIDISM.(SH).SAGLIKER SYNDROME(SS).SS IS A COMBINATION-COMPULSION OF BONE DYSPLASIAS-HEREDITARY OSTEODYSTROPHİES AND SH AND CKD
Authors: Sagliker Yahya , Demirhan Osman , Sagliker Hasan Sabit , Sagliker Ozkaynak Piril , Paylar Nuray , Sagliker Cemal , Emir Idris , Ozkaynak Isıl
Published: June 2020

Background and Aims

Sagliker Syndrome seems to be related to CKD and the consequent SH.SS starts and develops particularly before puberty while CKD reaches stage III level with overt SH. Since it occurs in some patients, it is plausible to think SS is genetically predisposed.GNAS1, FGF23 and FGFR3 genes' mismutations on the genesis of SS is unclear, and no data are available.

Method

We conducted clinical, radiological, laboratory studies and screening for mutations in GNAS1 gene in 23 patients, FGF23 and FGFR3 genes in 17 patients.DNA isolations were performed from blood samples and mutations regions were amplified by Polymerase Chain Reaction (PCR).

Results

In 73.9% (17/23) patients, 17 different genetic abnormalities in GNAS1 were detected.Seven (58.3% ) of the 12 nucleotide alterations comprised novel missense mutations in different manners. There were also 6 heterozygous tranversion polymorphism in exons.Six of them were introngenic mismutations found in exons (introns; 65626, 70387 and 70817).We found 10 different mismutations in FGF23 gene. 8 were novel mismutations and are defined first in our study. 3 of them were in intronic region near exon 2.In FGFR3 gene we also found 22 different mutations. 16 were novel mismutations defined first in our study.8 of them were in intronic region near exon 11,last 2 were in non-coding exonic region of exon 18. Twelve mismutations were found in exons, 8 were found in introns and 2 were found in non-coding exonic regions. One was in the exon-exon junction region between exon 11 and 12 Therefore this mutation might be preventing splicing of this intron.

Conclusion

There are plenty of mutations on those three genes in Sagliker Syndrome and are consistent with an insufficiency of those three genes playing a role in the clinical phenotype of loss of function mutations and with functional alleles having predominant roles in preventing the hormonal resistance.Since the incidence of

CKD late stage III is around 8% in the world but the incidence of Sagliker Syndrome is around 0.5% in CKD patients, these gene mismutations might be responsible for bone Displasias-- Hereditary Osteodystrophies such as Mc Cune- Albright syndrome, achondroplasias etc.., although our patients were not resembling any of them but they could be in between and Sagliker Syndrome might be a combination-compulsion of Bone displasias-Hereditary Osteodystrophies and SH and CKD.
P0908FGF-23, MBD AND INFLAMMATION IN CKD
Authors: Chaikovska Mariana , Martynyuk Liliya , Sergii Butvyn
Published: June 2020

Background and Aims

Systemic inflammation, as well as Mineral and Bone Disease, are seen to be inherent complications of CKD, tightly related to cardio-vascular disease, protein-energy wasting and general mortality. It remains an actual problem to study relation between systemic inflammation and CKD-MBD. The aim of the study was to evaluate serum concentrations of c-terminal FGF-23 as an early marker of CKD MBD, Il-1 β, Il-6, Il-8 as inflammatory markers, and to establish relationships between FGF-23 and IL-1 β, Il-6, Il-8.

Method

The study involved 106 patients with CKD stages from 1 to 4, 47 women (44%) and 59 men (56%) aged from 35 to 72, mean (49.6± 13.9) years. The C-terminal FGF-23 fragment was determined using a set of reagents for the enzyme immunoassay «Biomedica». Concentration of IL-1β, IL-6 and IL-8 was determined using an assay «Vector BEST». The glomerular filtration rate (GFR) was calculated using the CKD EPI formula (KDIGO 2012).

Results

A progressive growth in FGF-23 levels was observed simultaneously with GFR decrease in patients with CKD. IL-1 concentration increased from CKD stage 1 ((12.64±4.30) pg/ml) to 4 ((32.06±7.86) pg/ml) (p <0.05) accordingly GFR fall, as well as the level of IL-6 ((7.25±2.14) pg/ml to (46.27±10,06)pg/ml) and Il-8 ((9.39±1.62) pg/ml to (33.00±9.17)pg/ml). The existence of a strong direct association (r = 0.84, p <0.05) between the level of Il-6 and FGF-23 in CKD stages 1-4 was established. IL-1 and Il-8 were found to have a medium strength assotiation (r=0.45, p <0.05 and r=0.57, p <0.05, accordingly) with FGF-23 concentration in patients with CKD stages 2-4.

Conclusion

The increase in the concentration of inflammatory factors along with progression of chronic renal failure was revealed. The existence of a strong link between the level of IL-6 and the C-terminal fragment of FGF-23 in CKD was established. Finding out the issue of the primary stimulation factor of FGF-23 production in CKD requires further research.
P0913HYPERPHOSPHATEMIA INCREASE INFLAMMATION PROMOTING SENESCENCE AND MUSCLE DYSFUNCTION
Authors: Sosa Patricia , Alcalde-Estévez Elena , Asenjo-Bueno Ana , Plaza Patricia , Olmos Gemma , Caballero María Angeles , Rodríguez-Puyol Manuel , López-Ongil Susana , Ruiz Maria Piedad
Published: June 2020

Background and Aims

Hyperphosphatemia has been associated with aging and chronic kidney disease (CKD). Sarcopenia, which is a related condition of these pathologies, is defined by loss of force and muscular mass. During aging, chronic systemic inflammation appears, termed inflammaging, due to changes in immune system function. Inflammaging has been associated with many age-related diseases including Sarcopenia and CKD. The work aimed to evaluate the effect of hyperphosphatemia on proinflammatory profile of cultured myoblast cells and to analyze, in old mice, the effect of a dietary restriction in the phosphate intake on the aging-related sarcopenia.

Methods

Culture murine myoblast C2C12 cells were used for in vitro experiments. Cells were treated with 10 mM beta-glycerophosphate (BGP) as phosphate donor for 24, 48 or 72h. Inflammation was assessed through IL6, TNFα and MCP-1 expression by RT-qPCR. Twenty-four months old, C57BL6 mice were used for in vivo studies. Mice were fed with a normal diet containing 0.6% of phosphate until 21 months, after that, one group of mice continued with a normal diet and the other group was fed with a hypophosphatemic diet, containing a 0.2% of phosphate, for the following 3 months. Old mice were compared with 5 months old mice. Muscle force was measured by a grip strength test. Serum phosphate concentration was evaluated with a commercial kit and inflammation was assessed through IL-1β expression levels by RT-qPCR.

Results

Results showed that BGP treatment augmented pro-inflammatory cytokines levels, in myoblast, at 72h. On the other hand, old mice had a 40% increase in serum phosphate concentration regarding young mice, and, in parallel, they showed a reduction in forelimb strength. Old animals feeding with a hypophosphatemic diet showed a decreased level of phosphate serum linked to a better muscle function. Pro-inflammatory cytokines expression was higher in old mice compared to young mice; those values were reduced in 24-month-mice fed with a low phosphate diet. Furthermore, there was a positive correlation between IL-1β expression levels and serum phosphate levels, suggesting that high levels of serum phosphate were increasing inflammation in vivo and a negative correlation between IL-1β and grip strength test, which shows that high levels of inflammation decrease muscular function

Conclusion

In this work, we propose that high levels of phosphate are related to inflammation in vitro and in vivo. This increase of proinflammatory cytokines decreases muscle function whereas dietary restriction of phosphate decreases inflammation and improves muscle function. These results could point to a direct link between elevated serum phosphate levels and inflammaging presented in sarcopenic people such as CKD patients and aged people.
P0946OXIDATIVE STRESS AND HEME METABOLISM IN RED BLOOD CELLS FROM HEMODIALYSIS PATIENTS
Authors: Ferreira Dias Gabriela , Bohnen Gabriela , Grobe Nadja , Tao Xia , Pecoits-Filho Roberto , Kotanko Peter , Moreno-Amaral Andrea N
Published: June 2020

Background and Aims

We have previously described that indoxyl sulfate promotes red blood cells (RBC) ROS generation through organic anion transporter 2 as well as NADPH oxidase activity-dependent and GSH-independent mechanisms (Dias et al., 2018). However, there is little information regarding pathways of antioxidant balance to protect RBC from extensive oxidative stress that occurs during hemodialysis (HD). Intracellular free heme is degraded by Heme Oxygenase 1 (HO-1), which is regarded as the major cytoprotective enzyme (Maines, 1988; Gozzelino et al., 2010). In the current study, we assessed HO-1 activity and ROS production in RBC from healthy subjects and hemodialysis (HD) patients before and after HD.

Method

Blood was drawn from 6 healthy individuals (CON-RBC) and 6 HD patients (HD-RBC) before (pre/HD-RBC) and after high flux HD (post/HD-RBC). Isolated RBC were stained with DCFH-DA (Abcam) for ROS measurements. To quantify HO-1, RBC were incubated with anti-HO-1 antibody (Abcam) and m-IgGκ BP-CFL 488 (Santa Cruz Biotechnology) as a secondary antibody. Samples were analyzed by flow cytometry.

Results

Our results show a 4-fold increase in ROS levels in pre/HD-RBC compared to CON-RBC. ROS levels were even further increased by 1.65-fold after HD treatment in post/HD-RBC (Figure 1). Both pre/HD-RBC and post/HD-RBC showed a similarly significant increase of 3.3-fold in HO-1 compared to CON-RBC. (Figure 1).

Conclusion

High levels of HO-1 may represent a defense against oxidative stress that occurs in ESKD and particularly during the HD session. Further research is needed to evaluate whether HO-1 overexpression could accelerate heme degradation and contribute to renal anemia.
P0953NITRIC OXIDE AND LEFT VENTRICULAR HYPERTROPHY IN PATIENTS WITH CHRONIC RENAL FAILURE
Authors: Azouaou Leila , Abderrezak Khelfi , Wafa Bellouti , Arab Medina
Published: June 2020

Background and Aims

Nitric oxide, nitric oxide, nitric oxide or NO is an endogenous molecule released by endothelial cells, macrophages, liver cells and neurons. There are three forms of nitric oxide synthase in the body. : the inducible form (iNO), the neuronal form and the endothelial form (eNO). In this work we are interested in (iNO) in patients with CKD and their impact on cardiac complications.

Method

A study of 202 patients with chronic renal failure at different stages (2.3.4.5 and 5D) was performed in our department. We investigated the correlation between mean (iNO) values in patients with CKD and its relationship with left ventricular hypertrophy.

Results

The mean age of the patients is 56.5 ± 17 years with a sex ratio of 1.43. The mean value of (iNO) is 65.82 ± 1.06 μmol / l. Its value increases significantly with the degradation of renal function (p <0.05) (stage 2 (61.75 ± 2.34), stage 3 (63.91 ± 2.21). ), stage 4 (64.08 ± 2.18), stage 5 (67 ± 2.7) and stage 5D (72.47 ± 2.18μmol / l). It is found that the mean value of nitric oxide NO is slightly higher in patients with HVG + ( 67.58 ± 1.48) versus HVG-patients (63.1 ± 1.39) (p <0.05).Discussion: iNOS secreted nitric oxide (NO) initiates cardiac remodeling to lead to left ventricular hypertrophy and cardiac fibrosis

Conclusion

Cardiac complications are the leading cause of death in patients with chronic renal failure. oxidative stress is a risk factor for these cardiac complications, iNOS accelerates cardiac aging.
P0955IS THERE AN ENDOCRINE CONTRIBUTION TO THE SEXUAL DYSFUNCTION SEEN IN END STAGE RENAL DISEASE PATIENTS?
Authors: Elbardisi Haitham , Majzoub Ahmad , Al-Ali Fadwa , Elesnawi Mohamed , Hamad Abdullah , Al Emadi Ibrahim , Arafa Mohamed
Published: June 2020

Background and Aims

Male sexual dysfunction is commonly prevalent in patients with end stage renal disease (ESRD) and has been partly attributed to the concurrent state of hyperprolactinemia and hypogonadism, often observed in this patient population. The aim of this study was to evaluate the hormone profile and sexual function of ESRD patient, using validated questionnaires, in attempt to explore this association.

Method

This was a prospective study which included 98 patients with ESRD who followed in the outpatient department of a tertiary medical centre over a period of 1 year. Patients receiving treatment for hyperprolactinemia or those known to have an endocrine disorder were excluded in addition to patients receiving medical or surgical treatment for erectile dysfunction (ED) or premature ejaculation (PE). After filling the international index for erectile function-5 and the Arabic index for PE questionnaire, morning serum samples were taken from patients to measure testosterone and prolactin levels. Descriptive statistics was used to report frequency or means of variables. Chi-square test was used to examine associations between categorical variables. P<0.05 was considered statistically significant.

Results

Out of the 98 ESRD patients, 72 (73.6%) were treated with hemodialysis, 13 (13.2%) with peritoneal dialysis and 13 (13.2%) with medical treatment only. Diabetes mellitus was observed in all patients (type 1, 52%; and type 2, 48%), while hypertension, coronary heart disease and dyslipidemia were detected in 97.1%, 34.3% and 25.5%, respectively. The mean age, serum testosterone and prolactin levels were 52.4 ± 12.1 years, 12.95 ± 6.5 nmol/L and 514.2 ± 592.8mIU/L. Results of the PE index questionnaire revealed that 86 (87.7) patients had PE, 9 (9.1%) probable PE and 3 (3.1%) no PE. With IIEF-5, ED was detected in 96 patients; it was severe in 23 (23.5%), moderate- severe ED in 29 (29.4%), mild-moderate ED in 30 (30.4%) and mild in 14 (14.7%). 55 patients had high prolactin while 33 had low testosterone levels. Table 1 presents the IIEF-5 and PE questionnaire results in patients with low/normal testosterone and normal/high prolactin. No significant differences were observed in IIEF or PE levels between patients with low/normal testosterone and normal/high prolactin.

Conclusion

ESRD is commonly associated with sexual dysfunction that is more likely to be attributed to organic causes rather than solely to endocrine disturbances.
P0959EFFECT ON THE DIALYSIS DOSE OF THE EXERCISE WITH VIRTUAL REALITY DURING THE FIRST VERSUS SECOND PART OF THE DIALYSIS SESSION
Authors: Garcia-Testal Alicia , Garcia-Maset Rafael , Gil-Gómez José Antonio , Martínez-Olmos Francisco José , Valtueña-Gimeno Noemi , Ortega-Perez de Villar Lucia , Ferrer-Salva Ana , Piñón-Ruiz Jocelyne , Lehtoviita Maari Elvi Amanda , KARANDYSZ KATARZYNA , Lavirgen Heras Hector , Pans Alcaina Delia , López Tercero Víctor , Rico-Salvador Inmaculada , Royo-Maicas Pilar , Segura-Ortí Eva
Published: June 2020

Background and Aims

Exercise using non-immersive virtual reality (VR) is a novel rehabilitation method for patients undergoing hemodialysis treatment. This method has shown in a pilot study improved physical function and health-related quality of life.

There is controversy about the effect of intradialysis exercise on the dialysis dose. Furthermore, theoretical models also indicate that intradialytic exercise at the end of session may be beneficial in postdialysis rebound.

Objective: to determine effect of exercise with virtual reality during the first two hours and the last two hours of dialysis session on postdialysis rebound and dialysis dose.

Method

The design was a randomized clinical trial. Patients were randomized to exercise in the first (Start group) or last two hours (End group) of dialysis session. Dialysis dose was measured through the monocompartimental Kt/V, and the potassium, urea, phosphorus and creatinine rebound was calculated after both baseline and exercise sessions at 17 weeks. Intradialysis exercise consisted of a video game adapted to dialysis: Treasure hunting. It is a non-immersive VR game in which the patient must catch some objectives avoiding obstacles by moving the lower limbs. The exercise session lasted from 20 to 40 minutes. Intensity was checked through the rate of perceived exertion. An mixed ANOVA of repeated measures was used to assess the effect of the intervention. Patients exercised for 17 weeks.

Results

43 patients participated, 11 dropouts, 17 in Start group and 15 in End group. Mean age 73 years, males 28. There were no significant differences in rebound urea, creatinine, potassium and phosphorus 30 minutes after finishing dialysis. The mean baseline Kt/V was 1.65 (SD 0.21) and with exercise 1.75 (SD 0.25). The mixed ANOVA analysis showed a significant time effect with an increase in Kt/V (mean 0.10, 95% CI 0.02-0.19, p 0.018) from exercise session vs baseline. No group per time significant interaction was found, so that there was no difference in the dialysis dose between Start and End group.

Conclusion

Intra-dialysis exercise with virtual reality can improve the dose of dialysis, no matter the timing of the exercise is performed.