bluuebunny/crossref_metadata_2025 huggingface dataset:
P1505COMORBIDITY AND AGE OF DIALYSIS PATIENTS OUTPERFORMS FRAILTY BURDEN AS A PREDICTOR FOR MORTALITY
Authors: Milenkova Mimoza , Spasovska Vasilova Adrijana , Canevska Aleksandra , Pushevski Vladimir , SELIM GJULSEN , Sikole Aleksandar , Rambabova Bushljetikj Irena , Trajcheska Lada , Spasovski Goce
Published: June 2020

Background and Aims

The life expectancy in dialysis patients depends on patients’ age and comorbidities. Frailty in elderly patients is a state of impaired homeostasis with loss of physiologic reserve and a consequent impaired responses to dialysis burden. In this study we assessed the impact of age, comorbidities and frailty on dialysis patients’ survival.

Method

The study enrolled 162 prevalent patients on chronic hemodialysis with mean dialysis vintage of 100 months, 55% were women and 21 % had diabetes. Patients were divided into three groups by the Khan Comorbidity index score, highest score was considered worse. Frailty was assessed by presence of 3 or more symptoms (unintentional weight loss, feeling exhausted, weak grip strength, slow walking speed and low physical activity) and expressed as absolute number. Estimates of five years life expectancy were assessed by Kaplan Meier survival log-rank test and Cox regression hazard model.

Results

There were 26 (16%) with lowest score, 85 (52%) with medium score and worst highest score in 51 (31%). During the 5 years of follow up 69(43%) patients died of all-cause mortality. There were no deaths in the group with lowest score and mortality rates in the intermediate and worse score group increased by double (0; 30%; 69%, respectively). Significantly higher mean life expectancy was found in lower Khan Score groups: 60mo; 48.40 ± 18.51; 32.44 ± 22.06, log-rank: p < 0.012. Patients that scored worse had four folds higher risk for death HR 4.2 (95% CI: 2.72 – 6.36), p=0.0001. In the multivariate model Khan Score was a more powerful predictor of mortality than frailty in elderly, with HR 3.2 (95% CI: 2.88 – 5.41), p=0.0001.

Conclusion

Comorbidities and age outperforms frailty burden as a predictor of mortality in dialysis patients.
P1535ANXIETY AND DEPRESSIVE DISORDERS IN HEMODIALYSIS PATIENTS
Authors: Chaabouni Emna , Jbali Hela , Ikram Mami , Mohamed Chermiti , Hanene El Kateb , Lamia Rais , Karim Zouaghi
Published: June 2020

Background and Aims

Dialysis impacts the patients' quality of life drastically, increasing the risk of mortality. Depression and anxiety are commonly reported among dialysis patients.

But little is known about their prevalence.

The aim of this study is to examine the prevalence of anxiety and depression and associated factors among patients receiving hemodialysis

Method

A cross-sectional study was carried out among 94 hemodialysis patients treated at four hemodialysis center in a mediterranean country during a period of two months . The patients were interviewed while undergoing their dialysis session using the Hospital Anxiety and Depression Scale (HAD). The score of HAD was correlated with demographic and clinical variables.

Results

Based on Hospital Anxiety and Depression Scale, 49 patients (52%) had symptoms of depression, 41 patients (43%) had mild symptoms of anxiety, whereas moderate or severe symptoms of anxiety were present in 30 patients (32%).

In univariate analysis, HAD score for symptoms of depression correlated significantly with age (p=0,012) and past medical history of hypertension (p=0,024). Anxiety correlated significantly with female gender (p=0,039), smoking (p=0,017) and coffee addiction (p=0,024).

Conclusion

These results underline the important prevalence of anxiety and depression in hemodialysis patients .

Strategic options are necessary to improve the diagnosis of anxiety and depressive disorders, potentially enhancing quality of life and medical outcome in hemodialysis patients.
P1541HEMODIALYSIS IN END-STAGE RENAL DISEASE PATIENTS OVER 75 YEARS OLD
Authors: Mesbahi Tasnim , Samia Barbouch , Safa Fattoum , Mariem Najjar , Hela Jebali , Wided Smaoui , Lamia Rais , Fethi Ben Hamida , Mohamed Karim Zouaghi , Taieb Ben Abdallah
Published: June 2020

Background and Aims

Over the last decade, the age of dialysis patients has been increasing steadily worldwide. The benefits of dialysis in older people with end stage renal disease (ESRD) are not clear. We will try to evaluate whether dialysis in older has survival advantage compared to younger people.

Method

It is a prospective descriptive and analytic study including 229 patients who initiated chronic hemodialysis during the period between January and June 2017. Patients were classified into two groups by age at dialysis initiation. Patients above 75 years of age were considered old (old group OG). Patients aged less then 75 years old were considered young (young group YG). Primary outcome was old patient’s survival during the first 3 and 12 months from the dialysis initiation.

Results

Among a total of 229 new patients who began dialysis treatment, 41 (17,9%) ESRD were above 75 years of age.The sex ratio was 0,95 and 1,54 in respectively in OG and YG (p = 0,167). Diabetes was present in 56% of the elderly and in 59% of the younger group (p = 0,72) and was more frequently the cause of ESRD in the two groups. The average of modified Charlson Comorbidity Index was 6,7 ± 2,3 and 3,9 ± 2,6 respectively in OG and YG(p = 10-3). Younger patients had been referred earlier to nephrologists than the older ones. In fact, glomerular filtration rate at the beginning of the follow up was 18,7 ± 8,9 ml/min/1,73 in OG and 25,4 ± 16,2 in YG (p = 0,004). There was no statically significant difference between the two groups in the frequency of the use of temporary catheters at dialysis initiation (p = 0,778) and the urgent or planned initiation of dialysis (p = 0,298). Younger patients required hospitalization to organize dialysis initiation more than older patients (51,6% VS 26,8%; p = 0,005). Compared with the group of younger patients, Cox model showed an incremental increase in mortality associated with older patients’ group during the first year of HD (p = 0,036). However, there was no difference between OG and YG in the mortality rate during the first 3 months of HD (p = 0,102).

Conclusion

We may conclude that life expectancy of patients who began dialysis above 75 years is significantly shorter than younger patients in the first year of HD. In the other hand, the difference between the 2 groups wasn’t significant regarding the conditions of dialysis initiation.
P1554TYPES OF INCIDENTS MANAGED AT TWO DIFFERENT MEDICAL LEVELS IN A LARGE MULTINATIONAL RENAL SERVICES PROVIDER NETWORK
Authors: Marrón Belén , Silva Israel , Lucas Carlos , Torok Marietta , Wollheim Charlotta , Akdeniz Filiz , Pearce Suzanne , Westesson Ulf , Macário Fernando
Published: June 2020

Background and Aims

Patient safety programs need a well-structured organization to facilitate proactive and fair reporting, prompt evaluation analysis and timely feedback followed by measure implementation and auditing.

To analyze all types of incidents in our network from Jan.1st to Sept. 30th, 2019 by two different levels (Corporate and Country) of medical management alert.

Method

Our institution has tracked all incidents under a structured process program for the last 10 years, according to 4 incident types (Patient related, Staff-visitors, Products and Equipment) and 54 subcodes. Incidents are considered as serious when they may be life-threatening or result in death, impaired body function/structure and/or are deemed serious based on appropriate medical judgment. Communication to Health Authorities applies in accordance with local country regulations. “Serious incidents” are immediately notified to the Corporate Office and to each Country Medical lead, whilst different codes may generate alerts into Corporate or Country.

Results

A total of 68.399 incidents (2.7 incident/patient/year) were reported during Q1-Q3 2019. Total incidents/1000 treatments were 17.1 (12.1 were patients related incidents). Causes for alerts at corporate level (n=65) were: cardiorespiratory arrest (28%); unexpected death (15%); seroconversion (9%); hemolysis (8%), severe hypotension (6%) and air embolism (3%). Reported incidents at country level (n=655) were almost half ascribed to equipment [water supply, power failure and flooding (41%)], medication errors (36%), venous needle dislodgment (19%) and Injuries (3%).

Conclusion

Despite continuous efforts to get better results, there is room for improvement on better staff compliance with our standard operating procedures especially regarding medications and venous needle dislodgment risk assessment.
P1555REVERSIBLE AKI AND HEART INVOLVEMENT RESULTING FROM AMANITA PROXIMA POISONING TREATED WITH HAEMODIALYSIS: A SINGLE-CENTER CASE SERIES
Authors: Leonardi Giuseppe , Di Renzo Brigida , Covella Patrizia , Spinelli Alessandra , Flores Antonio , Montanaro Alessio , De Giorgi Annarita , Balestra Cosima , Mariotti Amalia , Schiavone Palmira , Marangio Massimo , Coppolino Giuseppe , Vernaglione Luigi
Published: June 2020

Background and Aims

Worldwide, amatoxin-containing mushrooms account for >95% of mushroom poisoning-related death. Recently, Amanita species not containing amatoxin, such as Amanita Proxima, have been implicated in poisonings resulting in acute kidney injury. Allenic norleucine has been isolated from these fungi and accounts for their nephrotoxicity. AKI is characterized by interstitial nephritis on renal biopsy and resolves over weeks. Here we report several case of AKI associated with cardiac involvement. We aimed to describe improvement of cardiac output and resolution of AKI after replacement dialysis treatment.

Method

From January 2013 to January 2020, eight consecutive patients with AKI from Amanita Proxima poisoning were enrolled in a large Italian community hospital. We collected clinical data including hepatic, cardiac and renal function parameters. In all the cases studied, in addition to renal failure, there were a worsening of cardiac function.

Results

We identified 8 patients suffering from Amanita Proxima intoxication, with a mean age of 57.8±24.5 years (62.5% were female). All patients presented preliminary gastrointestinal symptoms occurred within 24 hours from the mushroom intake and suddenly developed kidney injury and underwent replacement dialysis treatment using standard bicarbonate dialysis. At baseline, patients' mean eGFR was 7±2.3 mL/min/1.73m, with a mean BUN of 124±41 mg/dl, AST 52,6±42,5 IU/L, ALT 115,5±105,7 IU/L,. Cardiac involvement was also found in all cases, evidenced by ECG alteration (62,5%), an increase in myocardial necrosis enzymes (87,5%) and a reduction in the ejection fraction (50%) of about 15 percent. In 25% of cases, typical chest pain was also found. Mean troponin was 3,82±7,31 ng/ml, myoglobin 243,55±275,18 ng/ml CPK 187,6±42 IU/L and CK-MB of 13,72±14,96 IU/L. Kidney failure and cardiac impairment was successfully resolved in 87.5% of poisonings. At the end of treatment all renal and cardiac parameters significantly decreased (P<0.001): mean eGFR was 57±24 mL/min/1.73m, mean BUN was 69±12.7 mg/dl, AST 23,57±9,77 IU/l, ALT 25±10,64 IU/L. Mean troponin was 0,04±0,03 ng/ml, myoglobin 111,8±93,39 ng/ml, CPK 68,33± IU/L and CK-MB 0,66± 0,61 IU/L.

Only one patient died for intoxication-related complication. The mean number of dialysis treatments to achieve the resolution of renal failure was eight.

Conclusions

The cases reported suggest that Amanita proxima have a potential severe cardiac toxicity that request a precise cardiac evaluation. Early identification of intoxication and rapid start of dialysis therapy are crucial for the resolution of heart damage.
P1565THE COMBINATION OF MALNUTRITION-INFLAMMATION AND LIMITATIONS IN FUNCTIONAL STATUS IS ASSOCIATED WITH A HIGH RISK OF MORTALITY IN HEMODIALYSIS PATIENTS: RESULTS FROM THE DIALYSIS OUTCOMES AND PRACTICE PATTERNS STUDY
Authors: Kanda Eiichiro , Lopes Marcelo , Karaboyas Angelo , Bieber Brian , Tsuruya Kazuhiko , Hirakata Hideki , Iseki Kunitoshi , Jacobson Stefan , Dasgupta Indranil , Robinson Bruce
Published: June 2020

Background and Aims

The malnutrition-inflammation-complex (MIC) is a risk factor for mortality and lower quality of life in haemodialysis (HD) patients. The identification of MIC and its risk factors, which include the limited ability to perform functional status (FS), is key to improve the patient experience on HD. Our study investigates the association of MIC and FS combinations with mortality in HD patients.

Method

We analysed data from a cohort of 5465 HD patients from Australia, France, Germany, Italy, Japan, New Zealand, Spain, Sweden, and United Kingdom, enrolled in the Dialysis Outcomes and Practice Patterns Study phases 4 (2009-2011) and 5 (2012-2015). MIC syndrome was defined as low serum albumin (<3.8 g/dL) and high serum C-reactive protein (>3mg/L in Japan; >10 mg/L elsewhere). Poor functional status was defined as the sum of scores from the self-reported limitations in the Katz Index of Independence in Activities of Daily Living (score ranges from 0 to 5) and the Lawton-Brody Instrumental Activities of Daily Living Scale (score ranges from 0 to 8) less than 11. We investigated the association between combinations of MIC (+/-) and FS (low/high) with death, using Cox proportional hazards models adjusted for possible confounders including patient demographics, comorbidity history, catheter use, serum creatinine, phosphorus levels, WBC count, haemoglobin level, and time on dialysis therapy.

Results

The prevalence of different combinations were: MIC-/High FS 57%, MIC-/Low FS 24%, MIC+/High FS 9%, and MIC+/Low FS 10%. Patients with MIC-/high FS were younger, better nourished, and had lower prevalence of comorbidities. Compared to this reference group, the adjusted hazard ratios [HR (95% CI)] for all-cause mortality were 1.56 (1.24-1.98) for MIC-/ low FS, 1.75 (1.32-2.32) for MIC+/ high FS, and 2.97 (2.31-3.82) for MIC+/ low FS groups. The adjusted HRs for infection-related mortality were 1.57 (0.91, 2.71) for MIC-/low FS, 1.67 (0.84, 3.31) for MIC+/High FS, and 5.45 (3.15, 9.45) for MIC+/low FS groups.

Conclusion

The combination of MIC and low FS is a strong predictor of mortality, and infectious mortality in particular, in HD patients. Identification of patients with MIC and FS status may plausibly help to direct interventions to improve patients’ experiences and lessen adverse clinical outcomes in the HD setting.
P1578LOW ANKLE BRACHIAL INDEX, AND HIGH SERUM ALBUMIN WAS INDEPENDENTLY ASSOCIATE WITH HIGHER OF ISCHAEMIC MODIFIED ALBUMIN IN CHRONIC HAEMODIALYSIS PATIENTS
Authors: Nongnuch Arkom , Sappadungsuk Supawadee , Davies Nathan , Davenport Andrew
Published: June 2020

Background and Aims

Haemodialysis (HD) is one of the life-saving procedures which prolonged life of chronic kidney disease stage 5, however, the long-termed complications such as cardiovascular disease (CVD), immune and endothelial dysfunction are commonly occurred. The high incidence of CVD in haemodialysis patient associated with traditional and non-traditional risk factors. The novel non-traditional risk factors such as p-cresol, Advance Glycosylation End Products (AGEs), Ankle-Brachial Index (ABI), Cardio-Ankle Vascular Index (CAVI). The ischemic modified albumin (IMA) is the new marker for cardiovascular disease in various populations including haemodialysis. We aimed to explored the factors associate with higher IMA in chronic haemodialysis patients.

Method

Cross sectional study 196 chronic haemodialysis patients were collected blood sample for Ischemic modified albumin (IMA), measured Ankle-Brachial Index (ABI), Cardio-Ankle Vascular Index (CAVI), and skin autofluorescence advanced glycosylation end products (SAF).

Results

53% were female, 21% were smoker, 57% were diabetes, 93% were hypertension, 33% were coronary artery disease, 12% on HDF. Mean Age were 69.2±13.2 year, ABI 1.1±0.15, CAVI 9.3±1.5, SAF 3.1±0.8 arbitrary unit, IMA 37.5±15.2 U/ml, and serum albumin 3.7±0.4 g/dl. In multivariate adjustment showed factors associate with higher IMA were low ABI (B co-efficiency -13.4, P=0.049) and high serum albumin (B co-efficiency 1.68, P=0.000002).

Conclusion

Lower ABI and high serum albumin associate with higher IMA. The finding underlines the association between the atherosclerosis, vascular endothelial function and cardiac injury in haemodialysis. These results should be confirmed and explored in larger and longer clinical trials.

Figure

Regression analysis of factors associate with IMA accumulation.
P1581IMPACT OF ACHIEVING LDL CHOLESTEROL LOWER THAN 100 MG/DL WITH STATINS, ON LIPID PROFILE AND INFLAMMATION IN END-STAGE RENAL DISEASE PATIENTS
Authors: Coimbra Susana , Reis Flávio , Nunes Sara , D. Viana Sofia , Valente Maria João , Rocha Susana , Catarino Cristina , Rocha-Pereira Petronila , Bronze-da-Rocha Elsa , Oliveira José Gerardo , Madureira José , Fernandes João Carlos , Faria Maria do Sameiro , Miranda Vasco M P , Belo Luís , Santos-Silva Alice
Published: June 2020

Background and Aims

Dyslipidemia is common in chronic kidney disease (CKD) and cardiovascular disease (CVD)-related events are the main causes of death in end-stage renal disease (ESRD) patients on dialysis. Concerning lipid management, clinical practice emphasized treatment escalation to achieve specific low-density lipoprotein cholesterol (LDLc) targets, which implies repeated LDLc evaluations, and enhancement of statin doses or combination of lipid-lowering therapies. However, the LDLc target is not consensual, with some entities suggesting 100 mg/dl and others a more conservative level. It has been hypothesized that lipoprotein’s quality (size, composition and functionality) may be more important than their total circulating levels, as CVD risk factor. Our aim was to evaluate and compare, in ESRD patients on dialysis and under statins treatment, the levels of lipoprotein fractions and subfractions and inflammatory markers, between patients who achieved LDLc levels < 100 mg/dl and those who did not achieve that target.

Method

We studied 110 ESRD patients on dialysis (high-flux hemodialysis or hemodiafiltration) and under statin therapy; 87 presented a LDLc < 100 mg/dl (group 1) and 23 a value > 100 mg/dl (group 2); levels of high-sensitivity C-reactive protein (hsCRP), interleukin(IL)-6, lipid profile including lipoprotein fractions/subfractions, and oxidized LDL (oxLDL) were evaluated.

Results

Group 1, as compared to group 2, presented lower values of total cholesterol (TC), triglycerides, oxLDL, TC/high-density lipoprotein cholesterol (HDLc) and LDLc/HDLc ratios. Concerning lipoprotein fractions/subfractions, group 1 presented significantly higher larger and intermediate LDL, and a trend towards lower small LDL (P=0.063), higher large HDL (P=0.069) and lower small HDL (P=0.080); no significant alterations were found for very-low-density lipoprotein and intermediate-density lipoprotein. Regarding inflammatory markers, no significant differences were observed between the 2 groups.

Conclusion

Patients who achieved the LDLc < 100 mg/dl target presented a better non-conventional lipid profile, including lower oxLDL levels and an increase in larger (less atherogenic) LDL subfractions. According to our data, a lower LDLc level associates with a better lipid profile; the benefits of this improvement on HDL fractions and CVD-related events in ESRD patients on dialysis needs to be better clarified.
P1585FACTORS ASSOCIATED WITH PSOAS MUSCLE INDEX IN PATIENTS WITH MAINTENANCE DIALYSIS: FOR EARLY DETECTION OF SARCOPENIA
Authors: Mori Yoshiko , Sawada Tomohiro , Sunohara Keisuke , Owaki Akiko , Nagaya Hiroshi , Inaba Shinichiro
Published: June 2020

Background and Aims

Frailty was known to be associated with higher rates of hospitalization and mortality in dialysis patients, and sarcopenia was documented as the biological substrate of physical frailty. Therefore, early-detecting sarcopenia in dialysis patients is important for improving prognosis. The aim of our study was to investigate the factors associated with low skeletal muscle mass in dialysis patients.

Method

We recruited 134 Japanese patients (male 94, female 40; 117 maintenance hemodialysis, 11 chronic peritoneal dialysis and 6 both HD and PD) who underwent maintenance dialysis at our hospital during April 2019. Computed tomography (CT) imaging at the third lumbar vertebrae level was used to measure the psoas muscle mass index (PMI, psoas muscle area (cm2)/ height (m2) ), and low skeletal muscle mass was defined as under 6.36 cm2/m2 in male and 3.92 cm2/m2 in female.

Results

The prevalence of low skeletal muscle mass was 19.4% in dialysis patients (26/134). The median values of PMI were 5.13 and 7.42 cm2/m2 in low skeletal muscle mass group and normal group, respectively. Univariate analysis identified variables associated with low skeletal muscle mass as follows: gender, age, body mass index, waist circumference, presence of coronary artery disease, total protein, albumin, asparate aminotransferase, γ-glutamyl transpeptidase, phosphorus, visceral fat area and subcutaneous fat area. Multiple logistic regression analysis using above significant factors identified independent variables associated with low skeletal muscle mass as follows: gender (male) (odds ratio [OR], 12.91; 95%confidence interval [CI], 2.50-66.57; p<0.01), age (per 1 year aging) (OR, 1.07; 95%CI, 1.00-1.14; p<0.05), waist circumference (per 1cm decrease) (OR, 1.11; 95%CI, 1.04-1.19; p<0.01), and albumin (per 1g/dL decrease) (OR, 5.55; 95%CI, 1.49-19.9; p<0.05). In sub-analysis targeting only male patients, age (per 1 year aging) (OR, 1.09; 95%CI, 1.01-1.17; p<0.05), waist circumference (per 1cm decrease) (OR, 1.13; 95%CI, 1.05-1.21; p<0.01) and albumin (per 1g/dL decrease) (OR, 5.88; 95%CI, 1.39-25.9; p<0.05) were independent factors associated with low skeletal muscle mass.

Conclusion

In patients who underwent maintenance dialysis, age, waist circumference and albumin could be predictive factors of low skeletal muscle mass. Dialysis patients with such factors are recommended to evaluate nutritional status and physical performance to identify sarcopenia earlier and prevent progressive course of sarcopenia and frailty.
P1607CD 137 SIGNALING IN REGULATORY DENDRITIC CELLS IS REQUIRED FOR SUPPRESSING A SYSTEMIC INFLAMMATION IN THE BM12-INDUCIBLE MODEL OF SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: Lee Jong Soo , Cho Hong Rae , Park Jongha , Yoo Kyung Don , Kwon Byungsuk , Park Hojong , Park Sang Jun , Park Kyungsun
Published: June 2020

Background and Aims

Although CD137 is well known as a costimulatory receptor in T cells, limited information is available for its immunoregulatory function. Here, we report that CD137 signaling maintains CD11b+ regulatory dendritic cells (DCs) that can suppress activation of donor TH1 and TH17 CD4+ T cells in chronic graft-versus-host disease (GVHD).

Method

Chronic GVHD can be induced by mouse BMT models in which donor and recipient strain combination is MHC class I identical but MHC II mismatched. This chronic GVHD model recapitulates human SLE.

Results

: The deletion of CD137 in recipient mice shifted the disease phenotype toward acute GVHD, which was caused by the activation of donor T cells. CD137-/- recipients had had characteristic changes associated with acute GVHD: 1) there were defects in differentiation of T follicular helper (TFH) cells, germinal-center B cells, and plasma cells, and production of anti-DNA IgG1 autoantibody; 2) their splenic DCs showed dysregulated expression of DC-specific transcription factors and pro-inflammatory genes, and 3) there were strong activation of donor T cells but decreased Treg cells in the CD137-/- recipient spleen. CD11b+ splenic DCs stimulated with agnostic anti-CD137 antibody and CpG markedly increased expression of immunomodulatory genes, and such regulatory DCs inhibited acute GVHD in CD137-/- recipients. Their suppressive action was mediated through IL-10 that is indispensable for the induction and expansion of peripheral Treg cells.

Conclusion

Our study identifies CD137 signaling in DCs as an important braking point to prevent systemic inflammation, and this control system may be considered as a therapeutic strategy for a variety of inflammatory and autoimmune diseases.
P1639DEVELOPMENT OF SELF-LIMITED LOW-LEVEL BK VIREMIA/VIRURIA SUGGESTS IDEAL IMMUNOSUPPRESSION TO SUPPRESS T-CELL AND ANTIBODY-MEDIATED REJECTION AND PRESERVE KIDNEY ALLOGRAFT FUNCTION
Authors: Näf Bettina , Müller Thomas , Wuthrich Rudolf Peter , Schachtner Thomas
Published: June 2020

Background and Aims

Polyomavirus BK (BKV) viremia has been suggested as a surrogate marker of overimmunosuppression. Due to recent advances in monitoring strategies and pre-emptive therapy, progression to BKV-associated nephropathy (BKVN) has been reduced. Reduction of maintenance immunosuppression during BKVN, however, has been associated with both T-cell mediated rejection (TCMR), antibody-mediated rejection (ABMR), and inferior kidney allograft outcomes. Although the administration of intravenous immunoglobulins (IVIG) failed to treat BKVN, IVIG may have properties to reduce allosensitization.

Method

We studied 860 kidney transplant recipients (KTRs) predominantly under tacrolimus-based triple-drug maintenance immunosuppression from 2009 to 2018. We identified 130 KTRs (15.1%) with high-level BK viremia >10,000 copies/mL (presumptive BKVN), 180 KTRs (20.9%) with low-level BK viremia <10,000 copies/mL, 85 KTRs (9.9%) with isolated BK viruria, and 465 KTRs (54.1%) with no BK viruria/viremia. Kidney allograft outcomes with respect to TCMR, ABMR, development of de novo donor-specific antibodies (DSA), kidney allograft survival, and estimated glomerular filtration rate (eGFR) slope were analysed. Due to the increased incidence of TCMR and ABMR among KTRs with presumptive BKVN, 48 of 130 KTRs (36.9%) with high-level BK viremia starting from 2015 received IVIG (0.5 g/kg of body weight) on a biweekly basis during BKV replication.

Results

Very interestingly, KTRs with low-level BK viremia/viruria showed a significantly lower incidence of TCMR compared to KTRs with no BK viremia/viruria and KTRs with high-level BK viremia (p<0.05). In addition, KTRs with low-level BK viremia/viruria showed a significantly lower incidence of ABMR compared to KTRs with high-level BK viremia (p<0.05). No differences were observed with respect to the development of de novo DSA (MFI>5000) between KTRs with low-level BK viremia/viruria, KTRs with no BK viremia/viruria, and KTRs with high-level BK viremia (p>0.05). KTRs with low-level BK viremia/viruria showed superior kidney allograft survival and lower eGFR slope compared to KTRs with no BK viremia/viruria and KTRs with high-level BK viremia (p<0.05). The administration of IVIG during high-level BK viremia didn’t impact the development of TCMR, ABMR, development of de novo DSA, eGFR slope, and kidney allograft survival (p<0.05).

Conclusion

Our results show that low-level BK viremia/viruria is associated with suppression of TCMR and ABMR in the early period posttransplantation, and preservation of kidney allograft function in the long-term. The administration of IVIG didn’t prove beneficial to reduce allosensitization among KTRs with high-level BK viremia.
P1648CLINICAL OUTCOMES OF LIVING DONOR KIDNEY TRANSPLANTATION FROM MARGINAL DONORS
Authors: Kinoshita Yoshitaka , Yagisawa Takashi , Sugihara Toru , Takeshima Saki , Kubo Taro , Shinzato Takahiro , Shimizu Toshihiro , Kamei Jun , Akira Fujisaki , Ando Satoshi , Suzuki Motofumi , Kume Haruki , Fujimura Tetsuya
Published: June 2020

Background and Aims

Evidence demonstrating the outcomes of living donor kidney transplantation (LDKT) from marginal donors (MDs) is limited. We retrospectively investigated the clinical outcomes of LDKT from MDs in both recipients and donors.

Method

Clinical data on patients who received LDKT in Jichi Medical University Hospital between 2006 and 2019 were extracted from the medical records. Based on the Japanese guideline for preoperative conditions of donors, they were classified as standard donors (SDs) or MDs, the latter including the elderly and patients with obesity, hypertension, diabetes mellitus, and reduced renal function. Multivariate Cox proportional hazard regression analysis for graft survival was performed using explanatory variables of the donor conditions (MD vs SD) and recipient conditions, including age, gender, duration of dialysis, ABO compatibility, and presence of donor specific antibodies. The estimated glomerular filtration rates (eGFRs) of the donors were compared using an unpaired t-test.

Results

Of the 293 donors, 195 were SDs and 98 were MDs.

Demographics and baseline characteristics of recipients and donors

Recipients of kidney transplants from MDs were associated with a higher incidence of death-censored graft loss than recipients of kidney transplants from SDs.

Kaplan-Meier plots for overall and death-censored graft survival.

Multivariate Cox proportional hazard regression analyses for overall and death-censored graft survival

The eGFRs of MDs before transplantation were significantly lower than those of SDs, while no significant differences were observed between the two groups 3- and 5-years after transplantation.

Comparison of estimated glomerular filtration rates of donors

Conclusion

While the renal prognosis of recipients of kidneys from MDs is poorer than that of recipients from SDs, donating a kidney has no adverse effects on the renal health of MDs. The present study is the most comprehensive study that examined that the outcomes of LDKT from MDs according to the Japanese guideline.
P1649IS BK VIRUS CARCINOGENIC?!
Authors: Saleh Ahmed , Halawa Ahmed
Published: June 2020

Background and Aims

The role of polyomaviruses (PyV) in malignancy is controversial, this can be demonstrated in three ways; Firstly, hit and run mechanism where polyomaviruses contribute to the early phases of oncogenic progression. The second way, where PyV act as a passenger as polyomaviruses neither necessary nor contribute to the oncogenic progression. The third way, where PyV acts as (bystander) as PyV is not related to the malignancy, but PyV could be detected in the anatomically connected sites or neighbouring cells. BKV has been classified as a possible carcinogenic to humans (2b) as there is sufficient evidence that it is carcinogenic to animals, however, BKV carcinogenicity evaluation to humans was inadequate. There are inconsistent data regarding the contribution of BKV to tumors that occur in both animals and humans.

Method

Retrospective analyses of 492 consecutive renal transplant recipients in a single-center, 2010-2018. Data Source: prospectively managed electronic patient records. Malignancy data in both control and BKV infected groups were assessed.

Results

A total of 492 cases were studied, were categorized into 2 groups the BKV infected group (n:73) patients and BKV non-infected group (n: 419) patients, then an assessment of different malignancies in both groups. The BKV infected group had 15 cases out of 73 who had malignancy, while the BKV non-infected group had 28 cases out of 419 totally (Table 1). The association between malignancy in BKV was statistically significant (P-value of 0.038). Moreover, the risk factors involved in the development of malignancy in renal transplant recipients were older age, BK virus infection and maintenance immunosuppression agents (Table 2). Lastly, Logistic regression analysis was used to assess predictors of malignancy among renal transplant recipients. For every one-year increase in age among renal transplant recipients, the odds of having a malignancy increase by 4.6% (p=0.003). Meanwhile, there is a 4 times increase in the odds of having malignancy for recipients who are BK virus-positive vs. those who are BK virus negative (p=0.001). Furthermore, there is a 10 times increase in the odds of having malignancy for recipients who are on sirolimus as a maintenance immunosuppressant vs. those who are on TAC/PRED/MMF (p=0.007).

Conclusion

Our study highlights the statistically significant correlation between BK virus infection and the development of malignancy in renal transplant recipients. However, statistical correlation doesn`t mean causation which makes the potential oncogenic role of BKV is unclear. Also, there is increased reporting of malignancy in patients infected with BKV. Increased vigilance is required for early detection of malignancy in patients infected with BKV not only the patients who are heavily immunosuppressed.
P1663CLINICAL AND PATHOLOGICAL FACTORS INFLUENCING RESIDUAL RENAL FUNCTION AFTER LIVING DONOR NEPHRECTOMY
Authors: Okubo Akihiro , Yokoi Hideki , Sakai Kaoru , Matsubara Takeshi , Yanagita Motoko
Published: June 2020

Background and Aims

Renal function decreases with aging. Aging is associated with significant changes in structure and function of the kidney. On the macrostructural level, kidney cortical volume decreases, therefore total kidney volume (TKV) also decreases with aging. On the microstructural level, the number of glomerulosclerosis increases, therefore nephron number decreases with aging. Some reports show that the decline of TKV and nephron number is accompanied by a reduction in renal function.

However, in the field of living kidney transplantation, TKV and glomerulosclerosis are not fully evaluated as factors influencing the donor’s post-transplant renal function.

Living kidney transplantation is an established renal replacement therapy for end-stage renal disease patients. To predict living kidney recipient’s renal function, one-hour protocol biopsy is conducted during the operation. From one-hour protocol biopsy, donor’s pathophysiological findings such as glomerulosclerosis can be evaluated. In this study, we evaluated the correlation of potential influencing factors including TKV and glomerulosclerosis with pre- and post-transplant renal function in living kidney donors.

Method

This is a retrospective study including all 37 living related kidney donors seen at Kyoto University Hospital from January 2013 to April 2019. Estimated glomerular filtration rate (eGFR) was calculated using equation for Japanese population from serum creatinine levels at pre- and post-transplant. TKV was calculated from the 3D volume-rendered images of enhanced CT (=π/6×length×width×thickness), and adjusted to standard body surface area (BSA) by individual BSA. The ratio of number of non-glomerulosclerosis per that of whole glomeruli (non-GS) was evaluated by protocol renal biopsy at one hour after renal reperfusion. This study protocol was approved by the Ethics Committee on human research of the Graduate School of Medicine, Kyoto University.

Results

We evaluated 37 living kidney donors (35.1% male, mean age 58.2 ± 12.0 years). Mean pre-transplant eGFR was 75.7 ± 12.1 ml/min/1.73m2, mean post-transplant eGFR; 44.9 ± 7.75 ml/min/1.73m2, adjusted TKV (aTKV); 349.3 ± 58.4 ml, and non-GS; 0.892 ± 0.086. Pre-transplant eGFR was associated with aTKV and aTKV×nonGS (r=0.525, 0.569 respectively, p<0.01). Post-transplant eGFR was associated with age (≧65 years old, p<0.01), aTKV, non-GS, and aTKV×non-GS (r=0.527, 0.344, 0.626 respectively, p<0.05). The rate of eGFR decline was associated with age (≧65 years old, p=0.044), but not with aTKV and non-GS, aTKV×non-GS.

Conclusion

These results suggest that non-GS and age are correlated with post-transplant renal function but not pre-transplant renal function in living kidney donor, and the decline rate of eGFR are correlated with age.
P1664ASSOCIATED WITH SERUM MYOSTATIN LEVEL WITH GAIT SPEED IN RENAL TRANSPLANT RECIPIENTS
Authors: Tang Chi-Chong , Hou Jia-Sian , Chang Yu-Chi , Lu Chia-Wen , Lee Ming-Che , Hsu Bang-Gee
Published: June 2020

Background and Aims

Walking speed test is a usefulness tool for cardiovascular risk stratification in older adults. The inhibition of myostatin in adult significantly increases muscle mass and confers benefits upon measures of performance and metabolism. The present study evaluated the relationship between walking speed test and serum myostatin levels in renal transplant recipients.

Method

Fasting blood samples were collected from 84 renal transplant recipients. Handgrip strength (HGS) was measured using a Jamar Plus Digital Hand Dynamometer for assessment of muscle strength. Gait speed was measured by walking 6 meters at the usual speed. Gait speed < 1 m/s was defined as low gait speed group according to the European Working Group on Sarcopenia in Older People (EWGSOP) criteria. Serum myostatin levels were measured using a commercial enzyme-linked immunosorbent assay.

Results

Thirty-one renal transplant recipients (36.9%) had low gait speed, and they included a lower percentage of use of mycophenolate mofetil (p = 0.003), higher percentage of use of steroid (p = 0.037), older age (p = 0.0090, higher body weight (p = 0.044), body mass index (p = 0.017), skeletal muscle index (p = 0.027), serum triglyceride (p = 0.029), glucose (p = 0.007), blood urea nitrogen (p = 0.041), cystatin C (p = 0.015), while lower estimated glomerular filtration rate from serum creatinine (eGFRcre, p = 0.047) and estimated glomerular filtration rate from serum cystatin C (eGFRcys, p = 0.006) compared with renal transplant recipients with normal gait speed. After adjusting for cofounders associated with low gait speed in these patients by multivariable logistic regression analysis, serum myostatin levels (Odds ratio (OR): 0.943, 95% confidence interval (CI): 0.898–0.990, p = 0.018), and mycophenolate mofetil used (OR: 0.199, 95% CI: 0.050–0.795, p = 0.022) were independently associated with low gait speed in renal transplant recipients. The area under the receiver-operating characteristic (ROC) curve indicates the diagnostic power of serum myostatin levels at predicting low gait speed of renal transplant recipients was 0.769 (95% CI: 0.664-0.854, p < 0.001). Multivariable forward stepwise linear regression analysis also showed that serum myostatin levels (β = 0.353, adjusted R2 change: 0.245, p = 0.001) was positively associated with gait speed values in renal transplant recipients.

Conclusion

In this study, serum myostatin levels is found to be positively correlated with gait speed values and is identified as serum low myostatin levels is associated with low gait speed in renal transplant patients.
P1667ANALYSIS OF RISK FACTORS FOR CMV DISEASE IN KIDNEY TRANSPLANT PATIENTS - SINGLE CENTER STUDY
Authors: Hanzal Vladimir , Slatinska Janka , Hruba Petra , Viklicky Ondrej
Published: June 2020

Background and Aims

Cytomegalovirus (CMV) disease and infection negatively influence outcome of kidney transplantation. The aim of this retrospective study was to analyze risk factors for CMV disease and its influence on kidney graft function and survival.

Method

1050 patients underwent kidney transplantation from January 2014 to December 2018 and received calcineurin inhibitor, mycophenolate mofetil and steroid-based immunosuppression. Recipients with PRA>20% received rATG while others had received basiliximab as induction. 825 out of 1050 patients (78.6%) received CMV prophylaxis (D+/R-, n=173; R+, n=652). Patients were followed up to 71 months /median 38 months/.

Results

CMV tissue invasive disease occurred in 49 out of 1050 patients (4.7%), while CMV infection in 87 patients (8.3%). CMV disease, but not CMV infection, had significant negative influence on graft survival at 5 years post transplantation (p=0.0029). Patients with CMV disease had significantly worse graft function at 4 years post transplantation (p<0.0001). CMV disease occurred in 31 out of 173 patients (17.9%) in D+/R- group vs. 18 out of 652 patients (2.8%) in R+ group. Incidence of CMV infection was 30/173 patients (17.3%) in D+/R- group vs. 57/652 patients (8.7%) with induction therapy. Shortening of CMV prophylaxis was found in 82 patients (9.9%). Leukopenia (≤ 2.0 x 109/L) was observed in 97 (11.7%) patients from those who received CMV prophylaxis, Its shortening significantly increased risk for both CMV infection (20,7% vs. 7.2%, p<0,0001) and CMV disease (8,5% vs. 4,2%, p=0,04). Among most significant risk factors for CMV disease in univariable analysis were CMV mismatch (OR 11, 95% CI: 5,9-20,4; p<0,0001), delayed graft function (OR 2,8, 95% CI: 1,6-5,1; p<0,0001, cadaveric donor (OR 6, 95% CI: 1,5-25,1; p=0,00013) and shortening of CMV prophylaxis (OR 2.1, 95% CI: 0,91-4,86; p=0,08). Multivariable analysis revealed as independent significant predictors of CMV disease DGF (OR 2,29, 95% CI: 1,2-4,3; p=0,01) and CMV mismatch (OR 10,8, 95% CI: 5,7-20,6; p<0.0001) in a model adjusted for type of donor, prophylaxis shortening and leukopenia.

Conclusion

CMV mismatch is the main independent predictor of CMV disease after kidney transplantation in multivariable analysis.
P1669PROGNOSTIC IMPORTANCE OF BRAIN-DERIVED NEUROTROPHIC FACTOR (BDNF) IN RENAL TRANSPLANTATION
Authors: Molnar Agnes , Szkibinszkij Edgar , Lenart Lilla , Hosszu Adam , Kovacs Illes , Wagner Laszlo , Rimaszombati Fruzsina , Novozanszki Soma , Szabo Attila , Fekete Andrea
Published: June 2020

Background and Aims

The prevalence of end-stage renal disease (ESRD) has increased ten times higher in the past twenty years, where renal replacement therapy (dialysis or kidney transplantation (KTx)) is the sole life-saving treatment. KTx is the preferred option as it is associated with improved survival and quality of life as well. Delayed graft function (DGF) is one of the main problems affecting long-term kidney survival. Brain-derived neurotrophic factor (BDNF) signalling pathways play pivotal role in mitigating cerebral ischemia/reperfusion injury (IRI), however the relation of BDNF and IRI in KTx is unknown. The aim of our human clinical study was to explore the relationship between serum BDNF concentration, BDNF gene polymorphism and renal graft function after KTx.

Method

Study characteristics: We enrolled 59 ESRD patients with average age of 54.8±12 years who received KTx. Proportion of male patients was 57%. Average cold ischemic time was 927±310 min, warm ischemic time was 54.5±39 min. DGF occurred in 5 cases. Baseline triple immunosuppression therapy consisted of tacrolimus, mycophenolate or everolimus, and prednisolone. Until now, 44 patients completed the 2 years follow-up. For a comparable control group, we collected blood samples from 79 healthy volunteers with average age of 53.9±16 years and with male gender proportion of 52%. Serum BDNF, creatinine, blood urea nitrogen, haemoglobin, blood glucose level and thrombocyte numbers were measured before KTx and 1 week, 1-, 3-, 6 months, and 1-, 2 years after transplantation, as well as in controls. GFR was estimated based on the CKD-EPI formula. BDNF Val66Met polymorphism was determined by PCR-RFLP.

Results

There was no difference in genotype or allele distribution between any of the groups, and no correlation could be observed between serum BDNF and different genotypes either. Serum BDNF level was lower in ESRD patients than healthy controls (p=0.03). There was a weak correlation and marginal significance (p=0.056) between eGFR and serum BDNF level in controls, while in KTx recipients this correlation reached higher significance (p=0.01). Above median BDNF values at 1 month after KTx were predictive for better graft function during the 2 observed years.

Conclusion

Our preliminary human study proposes that BDNF could be a novel biomarker of posttransplant graft function, however further clinical studies with significantly larger population are definitely needed to confirm these results.
P1673ANEMIA AND DECREASED MUSCLE MASS AND MUSCLE STRENGTH IN KIDNEY TRANSPLANT RECIPIENTS
Authors: Vinke Joanna Sophia Jacoline , Wouters Hanneke , Post Adriaan , Stam Suzanne , M. Douwes Rianne , Gomes-Neto António W , Huls Gerwin , Berger Stefan P , Bakker Stephan , De Borst Martin , Eisenga Michele Freerk
Published: June 2020

Background and Aims

Post-transplant anemia is highly prevalent in kidney transplant recipients (KTRs). It is known that anemia impairs health-related quality of life, especially physical functioning. Although surmised, data about the latter are scarce. Hence, we aimed to investigate the association between anemia and muscle mass and muscle strength in KTRs.

Method

We used the TransplantLines Biobank and Cohort study, a prospective cohort study among all types of solid organ transplant recipients. For the current study, we used stable KTRs with a functional graft for more than 1 year post transplantation and with data available on hemoglobin levels and muscle mass (n=824). Muscle mass was assessed using 24-hour urinary creatinine excretion. Muscle strength was determined by means of hand grip strength using a dynamometer. Hand grip strength was tested three times with 30 seconds recovery time between attempts. For current analyses, the mean overall hand grip strength was calculated. Anemia was defined as hemoglobin <12 g/dL for women and <13 g/dL for men, according to WHO definitions. We used multivariable linear regression analyses to assess associations between anemia and muscle mass and strength.

Results

We included 824 KTRs (age 56±13 years, 60% males), with a mean hemoglobin of 13.5±1.8 g/dL. Anemia was present in 28% (n=277) of KTRs. Serum hemoglobin was associated with creatinine excretion, independent of age, sex, eGFR, BMI, hs-CRP, smoking status, alcohol use, and the use of RAAS-inhibitors, calcineurin inhibitors, proliferation inhibitors, or prednisolone (β=0.13, P<0.001). Similarly, the presence of anemia was independently associated with a lower creatinine excretion (β=-0.09, P=0.002). In line with creatinine excretion, hemoglobin levels (β=0.15, P<0.001) and the presence of anemia (β=-0.09, P=0.002) were also associated with handgrip strength independent of potential confounders.

Conclusion

Low hemoglobin levels and anemia are both strongly associated with lower muscle mass and muscle strength in KTRs, likely impairing physical functioning. Future research is needed to address whether correction of anemia improves physical performance in KTRs.