bluuebunny/crossref_metadata_2025 huggingface dataset:
#3815 A DEEP LEARNING APPROACH TO PERSONALISED ANTI-HYPERTENSIVE MEDICATION TITRATION
Authors: Judge Conor , Roshanov Pavel , O'donnell Martin , Tripp Bryan
Published: June 2023

Background and Aims

Hypertension is the number one risk factor for premature death worldwide. Artificial Intelligence (AI) Clinical Decision Support Systems are an important next step for hypertension management but require rigorous evaluation before assimilation into routine clinical practice. Our aim is to develop and evaluate an AI clinical decision support tool for hypertension management trained on randomised clinical trial data.

Method

The Systolic Blood Pressure Intervention Trial (SPRINT) trial showed that intensive BP control to SBP <120 mm Hg results in significant cardiovascular benefit in high-risk patients with hypertension compared with routine BP control to <140 mm Hg. We trained a feed-forward neural network using Keras and Tensorflow for R and data from 9361 persons in the SPRINT randomized clinical trial to predict the probability of increase, reduce or no-change in total number of anti-hypertensive medications at each visit. The network is designed to model SPRINT investigator deviations from the protocol. Six baseline patient variables (age, sex, race, aspirin use, eGFR, group assignment (intensive or standard)), two visit patient variables (Systolic and Diastolic Blood Pressure), and two previous visit variables (Systolic and Diastolic Blood Pressure) were inputted into the model after data normalisation and centering. Hyperparameters were tuned using a grid search method. We conducted internal validation using a 20% validation set. Clinical validation was performed using an unseen test set of typical hypertension scenarios (n = 50). An R Shiny app was developed to enter new patient information and display a sensitivity analysis of probabilities calculated after changing each baseline variable by plus and minus 10 (Figure 1). To avoid poor performance on new out of distribution cases we tested five methods for Out of Distribution (OOD) detector, 1. Autoencoders, 2. Normalizing flow, 3. Local Outlier Factor (LOF), 4. Probabilistic Principal Component Analysis (PPCA) and Kernel Density Estimation (KDE).

Results

The accuracy was 76.7% on the validation dataset after 1000 Epochs. Clinical validation revealed suboptimal performance for unseen Out of Distribution data (e.g. recommending reduction of medication when SBP >160 and number of medications was zero). This poor performance on OOD samples prompted the creation of an OOD detector to use in series with the AI Decision Support System for Hypertension. The AUROCs were 0.77 for AE, 0.96 for Normalizing Flow, 0.82 for LOF, 0.88 for PPCA and 0.96 for the Kernel Density Estimation.

Conclusion

Artificial Intelligence (AI) Clinical Decision Support Systems for Hypertension are feasible and an important next step for hypertension management but generalisability and safety require rigorous evaluation before assimilation into routine clinical practice.
#3816 HYPERBARIC OXYGEN TREATMENT IN CALCIFIC UREMIC ARTERIOLOPATHY PATIENTS IN ADDITION TO CONVENTIONAL MULTIDISCIPLINARY CARE
Authors: Nordheim Espen , Røed Ine , Brekke Fredrik Barth , Gudmundsdottir Helga , Braathen Martin Rygh , der Lippe Nanna Von
Published: June 2023

Background and Aims

Calcific uremic arteriolopathy (CUA), also referred to as calciphylaxis, is a rare and serious complication in patients with advanced kidney disease. CUA has limited treatment options and poor prognosis, with one- year survival often reported to be below 50% after diagnosis [1,2]. Hyperbaric oxygen therapy (HBOT) may improve wound healing by increasing tissue oxygenation, and has been suggested as adjuvant treatment for CUA patients [3]. We added HBOT to our conventional multidisciplinary care of CUA patients in 2012 and this study aims to evaluate long- term outcomes of CUA patients after this.

Method

Data from all CUA patients treated at our institution from 2012 to 2022 were retrospectively retrieved from hospital records. This is a single-centre study, but patients from different Norwegian hospitals were referred for treatment at our centre. Conventional multidisciplinary care of CUA in our centre included sodium-thiosulphate, dialysis if indicated medical optimization of calcium- phosphate homeostasis, substitution of vitamin K2, withdrawal of warfarin and iron and vitamin D if used, minimization of systemic steroids, in addition to optimization of weight- and nutritional status. Our centre is restrictive with surgical revisions to CUA patients.

Results

25 CUA patients received a total number of 1493 HBOT treatments in addition to conventional CUA multidisciplinary care in the study period. Median HBOT per patient was 45 (range 1–267). One year after CUA diagnosis, 20 out of 25 patients were alive (80%). Fifteen out of the 20 patients, who were alive at one year after CUA diagnosis, had completely resolved CUA lesions (75%). Five patients died within the first year after CUA diagnosis, due to acute cardiovascular disease (n = 3) and infection (n = 2). Our impression is that HBOT is well- tolerated and associated with less wound- associated pain.

Conclusion

Our results suggest that HBOT is well- tolerated in CUA patients. After we included HBOT in our multidisciplinary care of CUA patients, 80% of the patients were alive one- year after CUA diagnosis.
#3865 TELEMEDICINE IN NEPHROLOGY: A CROSS-SECTIONAL STUDY
Authors: Leitão e Sousa Sofia , Santos Sofia , Cunha Ana Cristina Santos , Braga Beatriz Gil , de Bessa e Silva João Pedro Peixoto , Pereira Sandra , Lascasas Josefina Santos , Beirão Idalina
Published: June 2023

Background and Aims

Chronic kidney disease (CKD) prevalence has been increasing and estimates show it will be the fifth leading cause of lost life years worldwide by 2040. CKD patients should be evaluated by Nephrology even in early stages of disease, but patients substantially outnumber nephrologists. Telemedicine consists of delivery of health-care services and information from distant locations and its utility has been largely demonstrated in CKD patients. In our centre, teleconsultation began being used to support requests from family doctors regarding CKD patients that are at that point stable and in an early stage of their disease.

Method

Since January 2020 and December 2022, 456 patients were evaluated using teleconsultation. Their demographical characteristics and the savings on dislocation cost, based on the price per kilometre, were analysed. In addition, a questionnaire about the use and utility of telenephrology was shared through general practice centres.

Results

From 456 patients, 43% male and 57% female, with an average age of 78 years. One out of five patients were dependent for daily life activities. On average, the patients lived within 22kms of the hospital, the maximal distance was 540kms. Based on this data we estimate 6660 euros savings on dislocation costs alone. A total of 47 general medicine doctors answered the survey, out of which 21% were male, with an average age of 40 years, 23% had under 5 years of experience, 26% had between 5 and 10 years of experience, 26% between 11 and 15 and the remaining over 16 years of experience. Around 70% had never used the teleconsultation, the majority of which due to lack of knowledge of this possibility. In the group that had used it, 77% were satisfied with the patient's orientation and 85% would consider using it again. Most of the general practitioners (62%) had referenced patients between 2 and 5 times. A fast answer to the request was the most frequently pointed advantage and the time between request and patient orientation was considered appropriate.

Conclusion

From this data, we conclude that telenephrology is not well known among family doctors in Portugal, yet it has the potential to reduce the distance between patients and nephrologists and build bridges between different areas of specialisation. It will also allow for cost reduction, a matter more pressing each day, and to increase patients comfort by reducing unnecessary hospital visits.
#3873 UTILITY OF BLOOD KETONE MONITORING IN HAEMODIALYSIS PATIENTS UNDER INPATIENT NEPHROLOGY CARE
Authors: Doak Ailsa , Coleman Sophie , Hills James , Hutton Rona , Geddes Colin C , Stevens Kate
Published: June 2023

Background and Aims

There is a lack of evidence regarding the relationship between capillary blood glucose (CBG) >15 mmol/L and blood ketones in maintenance haemodialysis dialysis patients meaning the utility of ketone measurement in this group is uncertain. Despite this, guidance published by the Joint British Diabetes Society for Inpatient Care (JBDS-IP) in 2022 states that blood ketones should be measured in patients on maintenance haemodialysis with diabetes mellitus (DM) who have pre- or post-dialysis CBG >15mmol/L and symptoms consistent with diabetic ketoacidosis (DKA), acknowledging that these can be non-specific [1]. We sought to identify if there is a relationship between elevated CBG and blood ketone levels in haemodialysis patients, and if haemodialysis affects blood ketone levels.

Method

Maintenance haemodialysis patients with DM admitted to a single ward over 2 separate 2 month periods were included. Nursing staff recorded CBG and blood ketone levels pre- and post-dialysis using a FreeStyle PrecisionPro ketone meter. For each patient, further demographic data were collected from the electronic patient record.

Results

79 measures were collected from 30 patients, with between 1 and 7 measures for each patient. 57% patients (n = 17) were male, 37% (n = 11) had T1DM, and 80% (n = 24) were on insulin therapy. The median pre-HD CBG for all measures was 10.5mmol/L (IQR 8.15-15.05), median post-HD CBG was 9.1mmol/L (IQR 6.8-12.95), median pre-HD ketones were 0.1mmol/L (IQR 0.1-0.2) and median post-HD ketones were 0.1mmol/L (IQR 0.1-0.3). There was no significant difference in blood ketones pre-and post-HD for all measures (p = 0.09) (Figure 1). For measures where pre-HD CBG was >15mmol/L (n = 21) median pre-HD and post-HD ketones were 0.1 (IQR 0.1-0.2) and 0.2mmol/L (IQR 0.1-0.2) respectively (p = 0.45). For measures where pre-HD CBG was >20mmol/L (n = 6) median pre-HD and post-HD ketones were 0.1 mmol/L (IQR 0.1-0.13) and 0.2 mmol/L (IQR 0.1-0.2) respectively (p = 0.13). For measures where pre-HD CBG was <15mmol/L, median pre-HD ketones were 0.1 (IQR 0.1-0.2). There was no significant difference in blood ketones pre-HD between those with a pre-HD CBG >15mmol/L and those with a pre-HD CBG <15mmol/L (p = 0.69).

Conclusion

These results demonstrate no significant relationship between elevated CBG measures (>15mmol/L) and blood ketone levels in haemodialysis patients, nor do they demonstrate a significant change in blood ketone levels post haemodialysis. Unwell haemodialysis patients with elevated CBG clearly warrant medical assessment, but there is a lack of evidence that blood ketones are useful to aid assessment and guide management of these patients.
#3911 DIETARY OXALIC ACID INTAKE AND PLASMA OXALIC ACID CONCENTRATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Visser Wesley , Hospers Gideon Post , van Egmond Anneke , Laging Mirjam , Verhoeven Jeroen , Baart Sara , Ramakers Chris , Hesselink Dennis , Wetering van de Jacqueline , Reinders Marlies , Hoorn Ewout , Severs David , Roodnat Joke
Published: June 2023

Background and Aims

High oxalic acid concentration may be caused by genetic disorders, enteric diseases, but also by kidney insufficiency per se. It may result in kidney oxalic acid stones, kidney function decline, and failure. This study aimed to investigate whether dietary oxalic acid intake influences plasma oxalic acid concentration in a population undergoing kidney transplantation.

Method

Dietary oxalic acid intake was assessed using a Food Frequency Questionnaire. Based on frequency and portion size, average daily oxalic acid intake in the past year and in the last 24 hours was calculated. A blood sample for determination of plasma oxalic acid concentration was drawn on the operation ward before transplantation. For multivariable analysis seventeen recipient related variables were gathered.

Results

418 patients were included. The median age of the participants was 62 year, 60% were male, all had an eGFR <20 ml/min/1.73 m2, and 66% were on dialysis with a median dialysis vintage of 13 months. The median plasma oxalic acid concentration was 32.2 µmol/L (range 4.6-243.2). In 98.3% of patients oxalic acid concentration was above the upper limit of normal. The average oxalic acid intake was 199 mg/day (range 4-1599), while it was 138 mg/day in the last 24 hours before transplantation (range 0-3906). Multivariable linear regression analysis showed that plasma oxalic acid concentrations were significantly higher in recipients with higher average (p<0.001) and last 24 hours oxalic acid intake (p = 0.002), lower age (p<0.001), lower residual diuresis (p<0.001), higher body mass index (p<0.001), longer dialysis vintage (p = 0.032), hemodialysis (p<0.001), and peritoneal dialysis (p<0.001) versus preemptive status.

Conclusion

In pre-kidney transplant patients, plasma oxalic acid concentration is above upper normal limit in 98.3% of patients and is multifactorially determined. As all other factors are not modifiable, the only way to decrease plasma oxalic acid concentration is dietary restriction.
#3913 GENETIC SUSCEPTIBILITY AS AN EFFECT MODIFIER FOR THE ASSOCIATION BETWEEN CHRONIC KIDNEY DISEASE AND RISK OF VENOUS THROMBOEMBOLISM
Authors: Zhang Jingwen , Shan Ying , Liu Beini , Dai Liang , Song Congying , Carrero Juan Jesus , Xiong Zuying , Huang Xiaoyan
Published: June 2023

Background and Aims

The association between chronic kidney disease (CKD) and the risk of developing venous thromboembolism (VTE) is still controversial. Further, it is unknown if genetic predisposition modifies this relationship. This study was conducted to investigate plausible effect modification of genetic factors on the association between CKD and incident VTE.

Method

Population-based cohort study of the UK Biobank, including 397,658 participants of European ancestry that were free of VTE at recruitment. We used cystatin C combining creatinine estimated glomerular filtration rate (eGFR) and albuminuria to classify participants with CKD stages 1-5 according to the low, intermediate, and high/very high-risk groups suggested by KDIGO (Kidney Disease: Improving Global Outcomes). Cox proportional hazards model was applied to evaluate the associations of CKD with incident VTE. In addition, we used externally validated polygenic risk score (PRS) for VTE to evaluate whether the genetic predisposition modified the associations of interest.

Results

During median follow-up of 12.7 years, 11,372 participants developed VTE. As compared with low KDIGO risk category, covariate-adjusted hazard ratios (HR) and 95% confidence intervals (CI) for future VTE risk with intermediate and high/very high KDIGO risk categories at baseline were 1.278 (1.191-1.372) and 1.892 (1.658-2.159), respectively. Participants at high/very high risk of CKD prognosis and in the highest tertile of PRS had the highest risk of developing VTE (HR, 4.397; 95% CI, 3.639-5.313), and this group had shown the most conspicuous additive interactions between CKD and the genetic predisposition, which responsible for 1.389-fold relative excess risk and accounted for 31.6% of incident VTE. Also, when either eGFR or urine albumin-creatinine ratio (ACR) was treated as the exposure, similar associations and supra-additive interactions were yielded.

Conclusion

CKD is associated with future VTE, especially in those with high genetic risk.
#3927 AN ANOREXIGENIC HORMONE IN PEDITARIC CKD PATIENTS
Authors: Sallam Dina E
Published: June 2023

Background and Aims

Chronic kidney disease (CKD) is a major health problem associated with faltering growth, which is a complex process, where anorexia, inadequate oral intake in addition to disturbed body metabolism play a significant role. Leptin, the anorexigenic hormone that's secreted by fat tissue, and affect appetite, & hence, aids to weigh loss & faltering growth. The present study evaluated serum leptin level, & its relation to growth parameters in pediatric patients with different stages of CKD.

Method

A cross-sectional study that was conducted on 87 subjects, who were divided equally into groups; CKD stage 5 on regular hemodialysis (CKD5d), & CKD stage 2–4, & age & gender matched controls. Patient with diabetes, infected with hepatitis C virus, & on growth hormone therapies were excluded. Full history taking, assessment of growth parameters using gender & age specific Z-scores of heights, weight & body mass index were done. Fasting serum leptin, calcium, phosphorus, PTH, albumin, total proteins, iron & hemoglobin were measured.

Results

Our patients had significantly lower growth parameters compared to controls. Hypocalcemia, high PTH, iron deficiency anemia & hypoalbuminemia were significant in CKD2-4 groups compared to other groups. Serum leptin was abnormally high in 12.6% of CKD patients. The median leptin level was comparable between the groups (p = 0.20). Serum leptin hadn’t changed significantly as regards gender, BMI Z-scores, diagnoses, or CKD stage (p = 1.00, 0.379, 0.542, 0.171 respectively). A negative correlation was found between leptin level & CKD duration (r = -0.276, P = 0.036), otherwise, no correlations were found with clinical & laboratory variables.

Conclusion

Leptin level was not affected by CKD stage & not a useful marker for growth in pediatric CKD patients. Large studies on relationship between leptin & growth is needed.
#3957 SUSTAINED RECOVERY OF KIDNEY FUNCTION IN PATIENTS WITH ESKD UNDER CHRONIC DIALYSIS TREATMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Garofalo Carlo , De Nicola Luca , Minutolo Roberto , Conte Giuseppe , Andriella Simona , Marzano Federica , Ambrosino Tino Paolo , Borrelli Silvio
Published: June 2023

Background and Aims

The prevalence of recovery of kidney function (RKF) in patients under maintenance dialysis is poorly defined mainly because of different definitions of RKF. The accurate assessment of sustained RKF is critical because the survival and quality of life of patients treated by maintenance dialysis are dramatically poor as compared to patients under conservative treatment. The sustained withdrawal of chronic dialysis has moreover a significant social and economic impact, considering the high burden of dialysis on health resources.

Method

Therefore, to gain more insights into the epidemiology of RKF, we performed a systematic review and meta-analysis of studies addressing the prevalence of sustained (at least for 30 days) RKF in patients under maintenance dialysis. Acute kidney injury (AKI) and RKF in the first 90 days of dialysis were the main exclusion criteria.

Results

Overall, 7 studies (10 cohorts) including 2,444,943 chronic dialysis patients (range: 430-1,900,595 patients) were meta-analyzed. The period of observation ranged from 4 to 43 years. The prevalence of RKF was 1.49% (95% C.I.:1.05-2.11; p<0.001] with high heterogeneity I2: 99.8%, P<0.001 (Figure 1). The weighted mean dialysis vintage before RKF was 294±165 days; RKF persisted for a weighted mean of 27.5 months. The percentage of RKF was higher in studies from the U.S. (1.96% [95% C.I.: 1.24-3.07]) as compared to other countries (1.04% [95%C.I.: 0.66-1.62]; P = 0.049).

Conclusion

In conclusion, sustained RKF unrelated to AKI occurs in about 1.5% of patients under maintenance dialysis. On average, RKF patients discontinue chronic dialysis about ten months after starting treatment and live free of dialysis for more than two years. The higher prevalence of RKF reported in the U.S. versus other countries suggests a major role of country-specific policies for dialysis start.
#3961 A COMPARATIVE ANALYSIS OF EMOTIONAL RECOGNITION AND DIFFERENTIATION TWO YEARS FOLLOWING KIDNEY TRANSPLANTATION VERSUS HEMODIALYSIS.
Authors: Samaan Emad , Elrefaey Rabab , Sobh Mahmoud , Abulatta Youssef , Ibrahim Ibtihal , Sobh Mohamed , Nagy Eman
Published: June 2023

Background and Aims

Cognitive impairment is common in patients with End Stage Kidney Disease. There are conflicting reports regarding the degree and interval of improvement of cognitive functions with the different modalities of renal replacement therapy. Most of the published reports relied on screening tests not covering the emotional aspects of cognition. Also, the timings of assessment are different being at most during the first year of establishing the modality.

Method

Ninety age, gender, and educational level-matched participants were enrolled in the study. The participants were divided into three equal groups, thirty kidney transplant (KT) patients, thirty hemodialysis patients (HD) for more than two years, and thirty control non-diseased participants. The participants included were below 60 years of age and with no previous history of a neurological defect. All patients were subjected to three Computerized Neurocognitive Battery tests (Age differentiation test, emotional recognition, and differentiation). All the tests were judged for accuracy and the time consumed to answer.

Results

The median value of transplant duration was 59 months (24- 168), and 66 months (27- 180) of HD duration. Both groups were comparable in age, gender, educational level, socioeconomic, and marital status. KT patients were comparable to controls at all parameters of testing. KT patients' answers were significant of higher accuracy than HD patients (P = 0.04 for age differentiation and emotion recognition, and 0.005 for emotion differentiation). KT and HD had comparable response times. Total correct responses of emotional differentiation tests were negatively correlated with KT duration (rho = −0.348, P = 0.02), and (rho = −0.345, P = 0.01) for HD duration. The cumulative steroid dose was not correlated with any of the tested parameters in the KT group.

Conclusion

KT offers a much better emotional and social cognitive improvement, an effect that is expected to positively impact the quality of life and involvement in society.
#3962 BALANCING THE RISK OF ALLOIMMUNITY WHILE MINIMIZING IMMUNOSUPPRESSIVE THERAPY: A RETROSPECTIVE STUDY OF PAEDIATRIC KIDNEY TRANSPLANT RECIPIENTS
Authors: Gramkow Ann-Maria , Baatrup Johanne , Neland Mette , Koefoed-Nielsen Pernille , Thiesson Helle Charlotte
Published: June 2023

Background and Aims

Kidney transplantation is the best treatment for end-stage kidney disease, but life with a kidney allograft comes with significant challenges. Many paediatric kidney transplant recipients (KTRs) experience side effects from immunosuppressive medication. Reducing the medication is often necessary, but the reduction comes with a risk of inducing alloimmunity. We aimed to describe the alteration in immunosuppressive medication after kidney transplantation, the reasons for the reductions, and the possible impact on alloimmunity.

Method

49 paediatric KTRs aged 1-16 years, receiving a kidney allograft from 2009 to 2020 in a Danish single centre were retrospectively studied. The standard protocol for immunologically low risk KTRs was steroid-free immunosuppression with basiliximab as induction, tacrolimus and mycophenolate mofetil (MMF) as maintenance therapy. KTRs were screened for anti-HLA antibodies with mixed and single bead antigen kits. We defined reduced immunosuppression as a KTR receiving one; OR two immunosuppressive medications AND MMF below 600 mg/m2.

Results

49 KTRs received a kidney allograft, two were ABO incompatible transplantations and six KTRs had pretransplant donor specific antibodies. The median age of the KTRs was 11 years (IQR 8), with a median follow-up time of 5 years (IQR 5). In total, 78% KTRs received standard immunosuppressive therapy (steroid free). 5-year death censored (one KTR died) graft survival was 88%, and the cumulative incidence of rejection was 4% (95% CI: -1.5; 5.5) within the first year. None of the six graft losses were related to alloimmunity. 11.4% developed de novo donor specific antibodies (dnDSA) within a median of 3.91 years (IQR 2.28; range: 2.22-9.20) from transplantation. At transplantation, 6% received reduced immunosuppressive medication increasing to 74% at year one. Immunosuppression (primarily MMF) remained reduced in most of the KTRs during follow-up (Figure 1). Side effects predominantly to MMF led to the reduction. Leukopenia caused a reduction in 77%, gastrointestinal side effects in 34%, EBV in 19% (two KTRs developed PTLD), CMV in 15%, and BK polyomavirus in 15%. The reduction was significantly more pronounced in KTRs under 11 years (87% vs. 61%, p-0.044). Tacrolimus seemed well tolerated and was sufficiently regulated according to a target through of five microg/L two months after transplantation (Figure 2).

Conclusion

Despite 74% of the KTRs receiving reduced immunosuppressive medication according to our protocol, the rejection rate was low, the graft survival was comparable to European reports, and only 11% developed dnDSA during follow-up. Scheduled reduction of MMF shortly after transplantation could decrease the adverse side effects and improve the treatment of paediatric KTRs.
#4068 EVALUATION OF CHRONIC TOXIC EFFECT OF PROTON PUMP INHIBITORS (PPIS) ABUSE ON MAGNESIUM LEVEL IN HEMODIALYSIS PATIENTS
Authors: Shalaby Ezzeldin
Published: June 2023

Background and Aims

Proton Pump Inhibitors are widely used in haemodialysis patients for the prevention and treatment of uremic gastritis, peptic ulcer, gastritis, esophagitis and gastro oesophageal reflux. Hypomagnesaemia is reported recently in some patients who abuse intake of Proton Pump Inhibitors (PPIs) but this problem is still not well studied yet. Our study aims to evaluate the chronic toxic effect of Proton Pump Inhibitor on Magnesium level in Egyptian haemodialysis patients, especially those who suffer from abuse of intake without medical prescriptions.

Method

The study was conducted at the haemodialysis centre and clinic of Alzawya One-Day Surgery Hospital in Cairo including 60 end stage renal disease patients after their consents and approval of ethical committee in our hospital. PPIs use and duration were investigated. The patients were dialyzed using a dialysate magnesium level of 0.5 mmol/L and Calcium level 1.5 mmol/L in all groups, after at least one month of haemodialysis with the mentioned dialysate, laboratory tests were performed. The patients participating in this study after their consents were divided into 3 groups:

• Group A: - 20 patients on Proton Pump Inhibitors regularly with long term intake for more than 6 months on high dose above or equal280 mg/week [1] • Group B: -20 patients on Proton Pump Inhibitors irregularly for less than 6 months on low dose below 280 mg/week. • Group C: -20 patients not intake Proton Pump Inhibitors.

The magnesium level in haemodialysis patients was evaluated by comparison between the 3 groups, and its correlation with duration of its use, Calcium and Phosphorus level in blood. Dialysate magnesium and calcium concentration in all groups were fixed and abuse of intake of PPIs without medical prescription in the participated patients was evaluated.

Results

Show highly statistically significant higher mean value in Non-intake of PPI group, followed by PPI intake ≤6m group and the lowest value in PPI intake >6m group according to magnesium “mg/dl”, with p-value (p<0.001). There is no statistically significant difference between groups according to calcium “mg/dl”; with p-value (p>0.05).

Conclusion

Proton Pump Inhibitors regularly with long term intake for more than 6 months on high dose above or equal 280 mg/week associated with hypomagnesaemia. So we recommend stoppage of abuse intake of PPIs in haemodialysis patients.
#4100 ACUTE KIDNEY INJURY, GLOMERULONEPHRITIS AND TUBULOINTERSTITIAL NEPHRITIS FOLLOWING VACCINATION: VIGIBASE ANALYSIS
Authors: Yoon Soo-Young , Lee Hayeon , Kim Jin Sug , Jeong Kyunghwan , Yon Dong Keon , Hwang Hyeon Seok
Published: June 2023

Background and Aims

Vaccination is the long-term established measure for disease prevention and worldwide outbreak of COVID-19 necessitates mass scale vaccination. However, there is a public concern on the risk of renal adverse reactions from several types of vaccination.

Method

We analyzed VigiBase (n = 120,715,116 reports), the World Health Organization pharmacovigilance database from Dec 1967 to Jul 2022 using disproportionate Bayesian reporting. Information component (IC) compares observed and expected values to find the associations of vaccines with acute kidney injury (AKI), glomerulonephritis (GN) and tubulointerstitial nephritis (TIN).

Results

We found 5,484 AKI (13.8% fatal), 2,846 GN (29.4% fatal) and 289 TIN reports (23.2% fatal) as vaccine-associated adverse reactions. Almost reports indicated single drug suspected cases (>99.5% reports). The cumulative number of reports on vaccine-associated AKI, GN and TIN gradually increased and Americas was most prevalent regions of reporting. Examining the different vaccines separately, reporting count of COVID-19 mRNA vaccines sharply increased and it solely was associated with significantly higher reporting of AKI (IC025 1.09) and TIN (IC025 0.48). Patients aged 12-17 years had the highest IC values for COVID-19 mRNA vaccine-associated AKI and TIN. Hepatitis B (IC025 3.22), influenza (IC025 2.64) and COVID-19 mRNA vaccine (IC025 2.89) were prominently over-reported among ten types of vaccines with significant signals of GN.

Conclusion

In conclusion, AKI, GN and TIN substantially occurred following vaccination and it was most noticeable in patients exposed to COVID-19 mRNA vaccines. Clinicians should consider the increased risk of renal adverse reactions after vaccination.
#4102 THE IMPACT OF MOBILE HEALTH ON HOME BLOOD PRESSURE AND HEALTH LITERACY IN CHRONIC KIDNEY DISEASE
Authors: Wu Pei-Yu , Tsai Yi-Chun , Chiu Yi Wen
Published: June 2023

Background and Aims

Mobile health (mHealth) management is an emerging therapeutic strategy for chronic diseases. mHealth has been considered to improve self-care management and assist in detecting a worsening health status early. However, the effect of mHealth management on the blood pressure (BP) of patients with chronic kidney disease (CKD) has not been well-studied. This study aimed to access the association between mHealth management and BP control in CKD. We also investigated the association between mHealth and health literacy(HL) in CKD.

Method

Kaohsiung Medical University Hospital designed and developed a new healthcare mobile application called iCKD. The application has several major features, including BP monitoring, alarms, and a warning system. We randomly assigned 122 CKD patients stages 1-5 to utilize iCKD or paper records (control group) for BP management. The primary outcome was the portion of reaching the target goal, defined as office BP less than 130/80 mmHg, during the 6-month study. Trained nurses interviewed CKD patients using structured questionnaires to evaluate HL.

Results

Baseline kidney function and BP were not significantly different between iCKD and control groups. During the study period, 11 participants had withdrawal.42.3% of the iCKD group (22/52) had the BP control reaching the target goal, while only 22.4% (11/49) in the control group(p = 0.03). Regarding HL, CKD patients with BP reaching the target goal had higher total scores than those without. The score for iCKD group, ranging from 29.29 to 32.85, were higher than the control group, ranging from 28.94 to 31.03. (p = 0.01).

Conclusion

The iCKD group had a higher proportion of reaching the BP target goal and better HL score than the control group. This study demonstrates that mHealth can improve the CKD population's health literacy and BP management.
#4117 HYPERKALIEMIA TREATMENT APPROACH BY THE NEPHROLOGIST: A REAL-WORLD ANALYSIS (K+RENAL STUDY)
Authors: Vidas Maria Marques , Molina Fernando Tornero , Rubio María Auxiliadora Bajo , Lucas Milagros Fernandez , Morales Enrique , Rodriguez-Moreno Antolina , Paraíso Vicente , Bucalo María Laura , la Flor Jose Carlos De , López Paula
Published: June 2023

Background and Aims

hyperkaliemia is highly prevalent among chronic kidney disease (CKD) patients and its management is determinant to allow the maintenance of therapies of demonstrated cardiovascular and renal benefit. Attitude towards hyperkaliemia is variable among different guidelines and also among different clinicians. The aim of this study was to analyze nephrologist response to K serum levels > 5.5 mmol/l in the out-patient setting.

Method

multicentric cross-sectional study performed in the nephrology departments of Madrid analyzing the therapeutic approach to K serum levels > 5.5 mmol/l between July 1st and December 11th, 2022. The only exclusion criteria were being on renal replacement therapy and not obtaining patient's informed consent.

Results

13 centers entered the study including 339 patients with hyperK; 331 had enough data to be included in the final analysis. 258 (78%) patients had mild hyperK (5.5-5.9), 60 (18.1%) moderate (6.0-6.4) and 13 (3.9%) severe hyperK (≥6.5). 70.7% were males, mean age 72.0 (SD 13.4) and 87.3% and 55.6% suffered hypertension or DM, respectively. 17.3% were diagnosed from heart failure (25% NYHA type I, 63.6% TII and 11.4% TIII). Most frequent CKD diagnoses were CKD+DM 36%, nephroangioesclerosis/vascular 25.4%, glomerular 7.2% and unknown 16.6%. Median eGFG was 29.9 ml/min/1.73m2 IQR [21-41] and 40.9% had UACR > 300 mg/g. Distribution according GFR stages was homogeneous (Pearson chi2 6.4 p 0.6) Percentage of use of ACEi, ARBs, MRA and NRAi was 41.5%, 37.9%, 13.7% and 1.52% and showed no association with higher K levels. 33.6% of the patients that suffer hyperK were already on any kind of low K diet, and 24.9% were on any K-binding therapy (11.2% calcium polystyrene sulfonate (CPS), 8.2% patiromer and 11.2% sodium zirconium cyclosilicate (SZC)). After hyperK episode, low-k diet was advised in 63.9% and was reinforced in 48% of patients that were already on low-k diet. Detection of hyperK was followed by initiation of k-binding therapy in 46.5% of the patients (22.8% SZC, 13.2% patiromer and 10.5% CPS). Treatment with ACEi or ARBs was stopped or decreased in 17.5% and 13% of patients respectively and in 45% of patient on MRA, with higher percentage of drug discontinuation in severe hyperK (40%, 25% and 50% respectively)

Conclusion

Most patients in nephrologist out-patient clinic suffering from hyperK are on any RAASi treatment, more than one third on low-k diets and almost 25% are on any k-binding therapy. Hyperkaliemia was followed of dietary advise in a high proportion of patients followed by initiation of k-binding drugs. There is still a high proportion of RAASi discontinuation or dose decreasing after hyperK, especially after severe episodes
#4152 CROSS-OMICS PROFILING OF PROTEOME, METABOLOME, AND TRANSCRIPTOME REVEALS MOLECULE AND CLEARANCE DYNAMICS AND ORIGIN IN PERITONEAL DIALYSIS
Authors: Herzog Rebecca , Eibensteiner Fabian , Aufricht Christoph , Kratochwill Klaus
Published: June 2023

Background and Aims

Peritoneal dialysis (PD) effluent is not only a rich source of markers for therapy monitoring and investigation of deregulated processes during PD it is also surprisingly underexplored and therefore poorly defined. Modern high performance mass spectrometry (MS) and sequencing methods allow monitoring of hundreds of analytes in parallel. For understanding PD transport dynamic and pathomechanisms and on a systems biology level, a multi-level omics approach is particularly attractive.

Method

Samples were obtained from stable patients chronically treated with PD at different time-points of standard 4h peritoneal equilibration tests (PETs). Effluent was collected after the pre-PET (overnight) dwell and at 0h, 1h and 4h dwells. Plasma samples were taken at the 2h PET time point. Effluent was separated into a cellular and cell-free component. Soluble proteins and metabolites in the cell-free compartment were processed using material-specific protocols and standardized LC-MS workflows. The cellular material was subjected to RNA sequencing. The Plasma-Proteome database was used for referencing plasma proteins and estimating plasma concentration. A bioinformatic workflow conjoined information from the datasets to reveal novel insights into the “PD-effluentome”, especially unravelling the origin of proteins and metabolites in PD effluent.

Results

Metabolomics enabled detecting of 207 unique metabolites in cell-free PD effluent. A mixed-effect ANOVA of all metabolites demonstrated dwell time-dependent concentration changes in 173 metabolites. Post-hoc testing revealed most metabolites to be changed between 1h and overnight time points, followed by 114 and 46 differently concentrated metabolites between 4h and overnight and 1h and 4h, respectively. We quantified 9,797 transcripts in PD-effluent cells and 2,729 proteins in PD effluent. 342 proteins were filtered from plasma, while 800 proteins were attributable to local origin or production. A quantitative analysis of the interaction proteome and cellular transcripts of ∼1700 protein-transcript pairs showed clusters of proteins explained by over-expression in peritoneal cells compared to plasma concentrations.

Conclusion

Cross-omic profiling of PD effluent can be a valuable approach for revealing small molecule related changes during PD. The exploitation of PD effluent on multiple levels could improve the understanding of pathophysiological molecular processes and transport dynamics in the peritoneal cavity and their role in development of PD complications.
#4154 CIRCULATING BETA-TRACE PROTEIN VERSUS CREATININE AS MARKERS OF EARLY KIDNEY (DYS)FUNCTION IN THE NX-INDUCED RAT MODEL OF CHRONIC KIDNEY DISEASE
Authors: Lousa Irina , Belo Luís , Viana Sofia D , Vieira Pedro , Vala Helena , Santos-Silva Alice , Reis Flávio
Published: June 2023

Background and Aims

Beta trace protein (BTP) is a low molecular weight protein that has been proposed as an earlier biomarker of decreased glomerular filtration rate (GFR) and renal damage, than the traditional biomarkers, particularly in the creatinine blind range. Early biomarkers of renal (dys)function are needed to allow, in due time, the detection and treatment, to prevent worsening of the disease. To the authors’ knowledge, neither urine nor serum BTP has been assessed in animals with kidney disease. In the present study, we aimed to concomitantly evaluate BTP and creatinine circulating levels, to compare their value as early biomarkers of renal dysfunction, by performing the studies in rat models of mild and moderate chronic renal failure (CRF) induced by nephrectomy.

Method

Male Wistar rats, 12 weeks old, were randomly divided in three groups: Sham (n = 8, subjected to surgical process without kidney mass reduction), Mild CRF (n = 8, subjected to 1/2 nephrectomy), and Moderate CRF (n = 7, subjected to 5/6 nephrectomy). After five weeks, rats were sacrificed, blood and kidneys were collected. We analysed the circulating levels of BTP and creatinine and studied the association of BTP concentration with the glomerular and tubulointerstitial lesions, and with the traditional biomarkers of renal (dys)function, eGFR and creatinine.

Results

The serum levels of BTP were correlated with serum levels of creatinine (r = 0.575, p = 0.004) and also with eGFR (r = -0.453, p = 0.030); additionally, we found positive correlations with the total score of mild and advanced tubular lesions (r = 0.610, p = 0.02 and r = 0.517, p = 0.011, respectively), observed in kidney sections. The circulating levels of BTP increased with disease severity; Mild CRF showed a higher value of BTP than Sham group, although without statistical significance that was reached in Moderate CRF group, as observed for serum creatinine. The combined use of BTP and creatinine did not improve the discriminatory power in early disease detection. Though, the combination showed stronger correlations with the total score of tubular lesions (r = 0.849, p < 0.001 for mild tubular lesions and r = 0.774, p < 0.01 for advanced tubular lesions).

Conclusion

In rat models of mild and moderate CRF induced by nephrectomy, serum BTP levels increased with kidney function worsening, and correlated with disease severity, assessed by GFR and the degree of histopathological alterations. However, the earlier diagnostic value of BTP does not outperform serum creatinine in this model.
#4160 PHASE ANGLE (PA), AGE AND MIS AS MORTALITY PREDICTORS IN PATIENTS WITH ADVANCED CKD
Authors: Barril Guillermina , Alvarez Graciela , Núñez Almudena , Glez Carmen Sanchez , Nogueira Ángel
Published: June 2023

Background and Aims

Survival study in Advanced CKD patients according to age, MIS and phase angle

Method

We studied 225 patients with ACKD, 153 men (68.3%), xage 70.09±12.72 years. We analyze survival at 120 months and how the Phase angle (PA) and MIS scale influence mortality. We chose these parameters, one of body composition (BIA-vector) and the MIS malnutrition-inflammation scale, since they are described as independent predictive factors.

Results

We defined the cut-off point for PA with the ROC curve, appearing as 3.75 (sensitivity 67% and specificity 55%). With 83 (37.1%) ≤3.75 and 141 (62.9%) greater than 3.75 PA, with significance between men and women p0.001. Analyzing the % of deaths with PA with PC- 3.75 there is a significant difference between groups p0.001 with difference between men and women With a cut-off point of 5 for MIS, we established 162 (72.3%) with ≤5 and 82 (22.7%) with MIS>5. Analyzing the % of deaths according to MIS strata, there is a significant difference p 0.001, Sig difference between men and women p0.021 We define with COR cut-off point age = 70.5 years sens 85% spec 63% 79 patients (64.6%) died in 120 months, 53/152 (65.1%) men and 45/71 (63.4%) women pns. xage deceased 76.39±9.16 vs 66.63±13.14 years p0.001. The survival curves for the 3 variables by Kaplan Meier are significant with the established cut-off points (Fig. 1). In the univariate analysis we found that age (CP-70.5 years) p0.001, and PA (CP-3.75) p0.04 are significant, but not MIS(CP-5). In the Cox analysis we evaluated age, PA and MIS, with age appearing as a priority, followed by PA and finally the statistical MIS Wald 18.73, 3.77 and 2.26 respectively.

Conclusion

1-Age, phase angle and MIS are independent mortality risk factors for ACKD patients. 2-In the multivariate model Age and phase angle are predictors of mortality. 3-Independent of age, the phase angle is the best predictor of mortality.
#4162 COMPARISON OF EGFR CYSTATIN C AND EGFR CREATININE IN RECENTLY HOSPITALISED INDIVIDUALS
Authors: Horne Kerry , Viramontes-Horner Daniela , Packington Rebecca , Shaw Sue , Akani Aleli , Monaghan John , Reilly Tim , Taal Maarten , Selby Nick
Published: June 2023

Background and Aims

Creatinine and cystatin C are endogenous biomarkers that can be used to estimate glomerular filtration rate (GFR). Cystatin C may be less dependent on age, gender and muscle mass. The comparative performance of these markers in patients recently hospitalised patients with acute kidney injury (AKI), who may have experienced changes in body composition, is unclear.

Method

Two matched cohorts of hospitalised individuals who had survived to 90 days after admission were recruited. The cohorts consisted of people who had sustained AKI during hospital admission and those who had not, and were matched 1:1 for age, baseline eGFR stage and diabetes. Serum creatine and serum cystatin C were measured at 3 months after hospitalisation and eGFR calculated using CKD EPI creatinine (eGFRcr) and CKD EPI cystatin C (eGFRcys) equations. Difference between the measures (eGFRdiff) was calculated as eGFRcys-eGFRcr and percentage difference (eGFR%diff) was relative to the mean of both eGFR measures. Primary outcome was mortality after 5 years of prospective follow up. Univariable survival analyses were conducted with the Kaplan Meier method and comparisons were performed with the log rank test, and a fully adjusted multivariable analysis performed with Cox proportional hazards model.

Results

854 individuals were recruited, matched, and had paired creatinine and cystatin C measurements. 427 (50%) had sustained AKI. Median eGFRcys was lower than eGFRcr (53.5ml/min/1.73 m2 [34.4-85.4] vs 68.4ml/min/1.73 m2 [52.6-84.7], p<0.001). eGFRcys and eGFRcr were correlated (r = 0.486, p<0.001) but Bland Altman analysis showed variable bias across the eGFR range. More individuals had an eGFR <60ml/min using eGFRcys (57%) compared with eGFRcr (35.6%). There was a graded relationship between eGFR%diff and outcome, with a shorter survival time (Figure 1) and higher proportion of deaths at 5 years (Q1 64 (30.0%), Q2 54 (25.4%), Q3 41 (19.2%), Q4 (31 (14.6%), p<0.001) in the first quartile. Cox proportional hazards analysis showed that eGFR%diff was an independent predictor of 5-year mortality after adjustment for age, Charlson index score and albuminuria (adjusted OR 0.995 [0.992-0.998], p = 0.002).

Conclusion

Cystatin C eGFR measures were lower than creatinine eGFR measures in recently hospitalised individuals. Lower eGFRcys relative to eGFRcr was independently associated with increased mortality. A larger difference between eGFRcys and eGFRcr may reflect loss of muscle mass (resulting in relatively lower serum creatinine) in somebody who has recently had an acute illness. Further, these results confirm how eGFRcr may over-estimate kidney function and potentially miss patients with failed renal recovery at 3-months after AKI. The difference between eGFRcys and eGFRcr may be helpful in identifying people at greater risk of early mortality after an acute illness.
#4178 HYPERCHLOREMIC METABOLIC ACIDOSIS AFTER PLASMAPHERESIS IN A PATIENT WITH RENAL TRANSPLANT REJECTION: A CASE REPORT
Authors: Simon Sanédy , van Sandwijk Marit , Engberink Rik Olde
Published: June 2023

Background and Aims

Plasmapheresis is an effective therapeutic intervention for several renal disorders, including renal transplant rejection. However, repeated plasmapheresis can cause various side effects and complications.

Method

We present a 61-year-old male with a medical history of type 2 diabetes, hypertension, successfully treated multiple myeloma and a post-mortem kidney transplantation 7 months ago. The patient was hospitalized because of rapid deterioration of his renal function (eGFR CKD-EPI 15 ml/min/1.73m2). Renal biopsy of the transplanted kidney confirmed the diagnosis of antibody-mediated transplant rejection. Treatment with methylprednisolone, plasmapheresis with a 40 g/L albumin solution as a replacement fluid and intravenous immunoglobulins was initiated. After 4 plasmapheresis treatments, the patient developed gastrointestinal complaints and muscle weakness. Despite the patient's use of 3 grams of oral sodium bicarbonate supplements a day, laboratory tests revealed a hyperchloremic metabolic acidosis: bicarbonate 11.7 mmol/L, chloride 111 mmol/L, sodium 138 mmol/L. Metabolic acidosis due to citrate accumulation was ruled out with a normal total-to-ionized calcium ratio. After treatment with intravenous bicarbonate supplementation, the symptoms disappeared. Analysis of the albumin plasmapheresis solution showed a chloride concentration of 132 mmol/L.

Results

This is the first case that describes metabolic acidosis after albumin plasmapheresis in a patient with impaired renal function. The observed hyperchloremic metabolic acidosis is most likely the result of the administration of large volumes (3.5 litres per session) of a 4% albumin solution with high chloride concentrations. We hypothesize that patients with renal impairment are more prone to develop metabolic acidosis after plasmapheresis with albumin-saline replacement fluids due to their reduced renal capacity to excrete excess acid and chloride.

Conclusion

Special attention should be paid to the acid-base balance during plasmapheresis in patients with impaired renal function. Future research should investigate the incidence of hyperchloremic metabolic acidosis during albumin plasmapheresis in different eGFR categories.