bluuebunny/crossref_metadata_2025 huggingface dataset:
#6193 MULTICENTER RETROSPECTIVE STUDY EVALUATING THE CLINICAL PICTURE AND OUTCOME OF THE SARS-COV2 INFECTION AMONG PATIENTS WITH GLOMERULAR DISEASES
Authors: Lionaki Sophia , Marinaki Smaragdi , Katartzi Kostantia , Galitsiou Dimitra , Moustakas George , Dounousi Eva , Flouda Sophia , Boumpas Dimitrios , Liakopoulos Vassilios , Vaios Vasileios , Karagiannis Minas , Kalogeropoulos Petros , Mpintas Christos , Pantzopoulou Evaggelia , Giannakopoulos Panagiotis , Gkika-Zervou Louiza , Papasotiriou Marios , Goumenos Dimitrios , Venetsanopoulou Aliki , Voulgari Paraskevi , Grapsa Eirini , Andronikidi E , Stylianou Konstantinos , Panagoutsos Stylianos , Boletis Ioannis
Published: June 2023

Background and Aims

This is a retrospective study aiming to describe the clinical picture and outcome of sars-cov2 infection in patients with glomerular diseases (GD) and its impact in the probability of relapse of the primary disease.

Methods

Patients with biopsy-broven GD, who had been infected by sars-cov2 were studied. Patients who ended up in end-stage kidney disease prior to infection were excluded. We recorded demographics, histopathological diagnosis, past medical history, immunosuppressive regimens which were given for the GD, status of GD at the time of infection, clinical picture and outcome of the infection including specific symptoms, requirement for hospitalization, duration of hospitalization and outcome of Covid-19. The probability of relapse following Covid-19 was also estimated in patients who were infected and those who did not.

Results

To date 312 patients have been included in the study, of whom 214 (68,5%) were diagnosed with Covid-19, while the remaining 98 did not. Infected patients were younger compared with those not infected [44 (28-59.75) vs. 53 (38-64) years, p<0.001]. The mean time from the diagnostic biopsy to Covid-19 was 67,6(±59,3) months. 82,5% of the infected patients were vaccinated against sars-cov2 and 49,1% were treated with immunosuppressive therapy at vaccination. 28(13%) of the infected patients required admission to hospital, with a mean duration of 8,3(±5,1) days. 84,2% of the infected patients experienced complete recovery of the infection, 4 (1,9%) died due to Covid-19 and 24 (11%) had Covid-19 related symptoms for more than 3 months. Among patients who had achieved remission of the GD prior to the infection, the frequency of relapse of the primary disease was higher in patients with Covid-19 versus not infected patients (11.9% vs. 2.1%, p = 0.007).

Conclusions

According to our findings, the sars-cov2 infection appears to have a significant impact in patients with GD not only due to the increased morbidity but also by increasing the probability for relapse of the primary disease.
#6235 ELEVATED PLASMA ANGIOPOETIN-2 PREDICT THE NEED FOR DIALYSIS INITIATION IN PATIENTS WITH CKD 4 AND 5 WITHIN TWO YEARS
Authors: Szymczak Anna , Kusztal Mariusz , Krzysztof Letachowicz , Gołębiowski Tomasz , Gozdzik Anna , Koscielska-Kasprzak Katarzyna , Tukiendorf Andrzej , Krajewska Magdalena
Published: June 2023

Background and Aims

Volume status, congestion and endothelial activation/injury were found to play a role in GFR decline and CKD progression. This pilot study aimed to determine whether the plasma markers of endothelial injury and activation as well as markers of fluid overload could serve as independent predictors for dialysis initiation in stable patients with CKD 4 and 5 and preserved EF.

Method

This prospective study was conducted from March 2019 to March 2022 and enrolled consecutive patients with GFR <30ml/min/1.72 m2 and preserved LVEF. Plasma levels of angiopoietin (Ang)-2, Vascular Endothelial Growth Factor-C (VEGF-C), Vascular Cell Adhesion Molecule-1 (VCAM-1), Copeptin (CPP), beta-trace protein (BTP), brain natriuretic peptide (BNP), cardiac troponin I (cTnI) were measured (Quantikine ELISA;R&D Systems Inc, Minneapolis, MN). Clinical markers of congestion were also recorded: lung US (B-lines), bioimpedance (ECV/ICV), echocardiography with global longitudinal strain (GLS), pulse wave velocity (PWV). Study outcome was need to initiate dialysis during 24-months follow-up.

Results

We analyzed a total of 105 patients with mean eGFR 21,3 ml/min/1.73m. The median age at enrollment was 52 (+/-14.8) years and 65% of the patients were male; 79% were hypertensive and 24% were diabetic. A positive correlation between concentration of Ang-2 and VCAM-1 and BTP was observed. Ang-2 concentration correlated positively with BNP, TnT, sCr, e/e’, ECV/ICV. Over a follow-up period of 24 months, the deterioration of renal function was observed in 47 patients (58%), 31 (38%) presented stable or ameliorated renal function and 24 on maintenance dialysis formed a control group. In Kaplan-Meier analysis significant impact of Ang-2 on renal survival (Figure) was found. Namely, 72% of patients with Ang-2 concentrations below the median (3.15 ng/ml) survived without dialysis for two years, compared to 42% of those with Ang-2 concentrations above the median. Such impact was not observed for GFR, VCAM, CCP, VEGF-C, BTP.

Conclusion

Endothelial activation, quantified by plasma levels of Ang-2 may play an important role in GFR decline and need for dialysis initiation in patients with CKD 4 and 5.
#6297 LAPAROSCOPIC VERSUS OPEN-SURGERY CATHETER PLACEMENT IN PERITONEAL DIALYSIS PATIENTS: A META-ANALYSIS OF OUTCOMES
Authors: Abdijalil Guled
Published: June 2023

Background and Aims

The peritoneal dialysis catheter (PDC) can be placed either through the laparoscopic technique, percutaneous technique or surgical procedures. The utilization of these PDC placement procedures is based on successful placement and reduced risk of development of complications. The main objective of this study was to compare the complications associated with laparoscopic vs. open-surgery PDC placement procedure.

Method

Literature for this review was obtained from all databases. to studies published in the period between 1998 and 2019 using Stata Version 12.

Results

The results showed significant difference in catheter malfunction between the laparoscopic and open-surgery group (relative risk [RR] = 0.58; 95% CI: 0.42–0.8; P = 0.031). Furthermore, there was no significant statistical difference in dialysate leakage (RR = 0.77; 95% CI: 0.51–1.17, P = 0.116) peritonitis (RR = 0.8; 95% CI: 0.6–1.06, P = 0.349) and exit-site infection (RR = 0.84; 95% CI: 0.65–1.09, P = 0.834) between the laparoscopic and open-surgery PDC placement groups.

Conclusion

The laparoscopic PDC placement procedure was superior to open surgery in regards to catheter malfunction. Additionally, the choice of treatment procedure should put in consideration factors such as cost and comfortability of the patient.
#6332 INFLUENCE OF NUTRITIONAL STATUS ON THE INCREASE IN CARDIOVASCULAR RISK AND THE RISK OF KIDNEY DAMAGE IN COMORBIDITY OF HYPERTENSION AND COPD
Authors: Boiko Olha , Rodionova Viktoriia
Published: June 2023

Background and Aims

It is widely known that obesity is a modulated additional factor in increasing cardiovascular risk in patients with hypertension. Since the number of patients with comorbidity of arterial hypertension and COPD is increasing, the question of the relationship between nutritional status and cardiovascular risk remains relevant. Purpose of the study: to determine the role of nutritional status indicators in the formation of cardiovascular risk in patients with comorbidity of hypertension and COPD.

Method

101 patients were included in a cross-sectional study: 32 patients with comorbidity of hypertension and COPD (Gr I), 43 patients with hypertension (Gr II), and 26 patients with chronic obstructive pulmonary disease (Gr III). Exclusion criteria: informed consent of the patient to processing of personal data, Hypertension stage II, 1-3 degree, COPD A - C clinical groups(stable phase), age≥40 years. Exclusion criteria: age≥80 years, myocardial infarction and cerebral circulatory disorders, kidney diseases (polycystosis, developmental abnormalities, glomerulonephritis, pyelonephritis), diabetes mellitus, cancer, GFR < 30 ml/min. Patients underwent general clinical examination, determined nutritional status by anthropometric study and bioimpedancemetry, assessed the renal function by laboratory examination of blood. Methods of parametric and nonparametric statistics were used.

Results

A high cardiovascular risk in Gr I was in 22 (68,8%) patients, in Gr II - in 27 (62,9%) patients and in Gr III - in 10 (38,5%) patients. GFR in Gr I was 67,5 (57,0;77,0) ml/min, in Gr II -70.6 (57.0; 83.0) ml/min, and in Gr III - 82.5 (70.0;89.0) ml/min (p = 0.02). BMI in Gr I was 30.2 (26.5;35.0) kg/m2, in GrII - 29.7 (26.3;33.9) kg/m2, in GrIII - 26.8 (24.6;29.6) kg/m2. Percentage of adipose tissue in Gr I was 35.1 (30.0;41.7), in Gr II-38.2 (32.4;42.1) and in Gr III - 27.7 (21.0;34.1) (p = 0.01). The total muscle tissue in Gr I was 28,6 (24,6;30,6)%, in Gr II - 28,5 (25,0;31,2)%, in Gr III - 32,1 (27,8;35,3)%(p = 0.1), visceral fat in Gr I was 11,0 (8,0;14,0)%, in Gr II- 11,0 (9,0;15,0) %, in Gr III- 9,0 (6,0;13,0) %(p = 0.1); sarcopenia index in Gr I was 77,8(61,6;86,2), in Gr II- 77,8(66,1;101,8), in Gr III- 90,6(86,0;98,6)(p = 0,1). In Gr I, correlations were found: negative between GFR and high cardiovascular risk (R = -0.6), positive - between sarcopenia index, visceral fat and high cardiovascular risk (R = 0.5; 0.6), negative - between the amount of muscle tissue and high cardiovascular risk in patients (R = -0.5) (p<0,05).

Conclusion

In patients with a comorbidity of hypertension and COPD, along with an increase in the amount of adipose tissue and visceral fat, the amount of muscle tissue decreases, which leads to sarcopenic obesity. Sarcopenic obesity is associated with high cardiovascular risk and worsening of renal function, which also leads to an increased risk of cardiovascular complications.
#6346 CANCER RELATIVE SURVIVAL IN DIALYSIS AND KIDNEY TRANSPLANT RECIPIENTS: A POPULATION-BASED STUDY IN AUSTRALIA AND NEW ZEALAND 1980-2019
Authors: Oliveras Laia , Rosales Brenda , Montero Nuria , Melilli Edoardo , Cruzado Josep , Webster Angela , Mata Nicole De La
Published: June 2023

Background and Aims

Cancer survival in the general population has improved over time. Kidney failure population have a higher incidence of cancer with increased mortality. Relative survival following cancer diagnosis can provide more insight into the excess mortality directly or indirectly attributed to cancer in the kidney failure population.

Method

We estimated and compared the relative survival for dialysis patients, kidney transplant recipients and general population with cancer in Australia and New Zealand from 1980 to 2019. The general population was reference group for background mortality, matching on sex, age, calendar year and country. We used Poisson regression to quantify the excess mortality between these three groups with cancer.

Results

We included 4,089 dialysis patients and 3,253 kidney transplant recipients with an incident cancer. Dialysis patients were older, had a higher proportion of indigenous people and had more comorbidities than kidney transplant recipients. The kidney failure population had lower 5-year relative survival: 0.25 (95%CI: 0.23-0.26) for dialysis, 0.55 (95%CI: 0.53-0.57) for kidney transplant and 0.670 (95%CI: 0.669-0.670) in the general population with cancer (Figure 1). At any given time, dialysis patients had a 2.10 times higher adjusted excess mortality compared to the general population with cancer (2.10, 95%CI: 2.02-2.18), whereas kidney transplant recipients had no excess mortality (1.02, 95%CI: 0.97-1.08). Relative survival and excess mortality varied by cancer site: lung had the lowest relative survival rates, while kidney failure population with melanoma, breast and prostate cancers had the highest excess mortality. There were also sex differences: women had greater relative survival.

Conclusion

Relative survival was lower among the kidney failure population with incident cancer compared to the general population with cancer, for all-site and particularly for melanoma, breast and prostate cancer. Decreased survival may be due to poorer access to, more harm or less efficacy of treatments.
#6355 EFFECTS OF SODIUM-GLUCOSE CO-TRANSPORTER 2 INHIBITORS ON HEART FAILURE IN CHRONIC KIDNEYDISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Alexandrou Maria Eleni , Tsitouridis Alexandros , Theodorakopoulou Marieta , Kamperidis Vasileios , Pella Eva , Sampani Erasmia , Xanthopoulos Andrew , Papagianni Aikaterini , Sarafidis Pantelis
Published: June 2023

Background and Aims

Sodium-glucose co-transporter 2 (SGLT-2) inhibitors significantly reduce the risk for hospitalizations for heart failure (HF) in patients with diabetes, and HF; findings in patients with chronic kidney disease (CKD) are not uniform. Objectives: We aimed to perform a meta-analysis exploring the effect of SGLT-2 inhibitors on HF events in patients with CKD and across subgroups defined by baseline kidney function.

Method

A systematic search in major electronic databases was performed. Randomized controlled trials providing data on the effect of SGLT-2 inhibitors on the primary outcome, time to hospitalization or urgent visit for worsening HF in patients with prevalent CKD at baseline or across subgroups stratified by baseline estimated glomerular-filtration-rate (eGFR) were included.

Results

Twelve studies (n = 89,191 participants) were included in the meta-analysis. In patients with CKD, treatment with SGLT-2 inhibitors reduced the risk for HF events by 32% compared to placebo (hazard ratio [HR] 0.68;95%CI 0.63-0.73). Reduction in HF events with SGLT-2 inhibitors was more prominent in patients with eGFR<60 ml/min/1.73m2 (HR 0.68; 95%CI 0.62-0.74) than in those with eGFR> = 60 ml/min/1.73m2 (HR 0.76;95%CI 0.69-0.83). Subgroup analysis according to type of SGLT-2 inhibitor showed a consistent treatment effect across all studied agents (p subgroup-analysis = 0.44). Sensitivity analysis including data from studies including only diabetic patients showed an even more pronounced effect in eGFR subgroup<60ml/min/1.73m2 (HR 0.62; 95%CI 0.54-0.70).

Conclusion

Treatment with SGLT-2 inhibitors led to a significant reduction in HF events in patients with CKD. These findings may change the landscape of HF treatment in patients with advanced CKD.
#6447 ASSOCIATION BETWEEN PHYSICAL ACTIVITY LEVEL AND A HISTORY OF FALLS IN PATIENTS ON HEMODIALYSIS
Authors: Lucinda Leda , de Jesus Luciana , Alvarenga Bárbara , de Castro Abner , Ávila Kéller , Garcia Rodrigo , Oliveira Cristino , Pinheiro Bruno , Reboredo Maycon Moura
Published: June 2023

Background and Aims

Patients with end-stage renal disease on hemodialysis have a lower physical activity level in daily life and a higher prevalence of sedentary lifestyle. Moreover, these patients have clinical, musculoskeletal, and physical function complications that contribute to a higher risk of falling. Therefore, the aim of this study was to evaluate the association between physical activity level and a history of falls in a retrospective 12-month interval in patients on hemodialysis.

Method

A retrospective study was conducted with patients aged ≥18 years who were undergoing regular hemodialysis treatment for at least three months. Patients were excluded if presented severe and unstable comorbidities, psychiatric or cognitive disorders, uncorrected visual impairments, and hospitalization in the past three months. The retrospective history of falls was assessed for the last 12 months, and a fall was defined as an “unexpected event in which the individual comes to rest on the ground, floor or lower level”. The daily step counts were recorded in the ActiGraph accelerometer (wGT3X-BT) during seven days, and analyzed by excluding the first and last day of recording and calculating the mean among the valid days (≥ 8 hours of wear time). Normality of data was analyzed using the Shapiro-Wilk test. The Student's t-test and the Mann-Whitney U test were used for between-group comparisons (patients with and without a history of falls). The univariate and multivariate linear regression models investigated the association between daily step counts and a history of falls. A p value <0.05 was considered as statistically significant.

Results

This study included 103 patients (59.2 ± 12.6 years, 59.2% male). Of these patients, 49.5% had a history of falls. Patients with a history of falls showed lower prevalence of workers (9.8% vs. 26.9%, p = 0.025) and daily step counts [2989 (2595) vs. 4550 (2966) steps, p = 0.018], and higher educational level [9 (7) vs. 5 (5) years, p = 0.033] compared to patients without a history of falls. The univariate linear regression model showed that daily step counts was significantly associated with a history of falls (p = 0.017). After adjusting for age, gender, educational level, work status, hemoglobin, and diabetes mellitus, this association remained significant in multiple linear regression model with a coefficient of determination of 0.21 and an adjusted coefficient of determination of 0.16 (p = 0.001).

Conclusion

Physical activity level was associated with a history of falls in a retrospective 12-month interval in patients on hemodialysis.
#6500 MULTICENTER RETROSPECTIVE STUDY TO ASSESS THE CLINICAL PRESENTATION AND OUTCOME OF SARS-COV2 INFECTION IN PATIENTS WITH LUPUS NEPHRITIS
Authors: Petrou Dimitra , Katartzi Kostantia , Marinaki Smaragdi , Kriki Pelagia , Venetsanopoulou Aliki , Voulgari Paraskevi , Kalogeropoulos Petros , Agoranou Marilena , Sardeli Aggeliki , Panagoutsos Stylianos , Michelakis Ioannis , Boumpas Dimitrios , Boletis Ioannis , Lionaki Sophia
Published: June 2023

Background and Aims

The present study aims to describe the clinical presentation and outcome of SARS-CoV2 infection in patients with systemic lupus erythematosus (SLE) and renal involvement (LN).

Method

82 patients with biopsy-proven LN were retrospectively studied. 56 (68.3%) had a positive test for SARS-CoV2 at some point during the follow up time and were compared with 26 patients with SLE patients who had LN but were not infected with SARS-CoV2 in oedr toexplore the impact of SARS-CoV2 infection in the outcome of LN. Patients who had reached end-stage kidney disease before infection were excluded. Biopsy data, treatment, outcome of LN, clinical presentation of SARS-CoV2 infection and outcome were recorded.

Results

The mean age of the patients was 33 (±12.7) years and 85.3% were females. In the histopathological diagnosis there was proliferative LN in 43 (76.8%) cases. All patients had received immunosuppressive therapy and 89.2% had achieved remission of LN. 66.1% of patients were treated with immunosuppressive agenst at the time of diagnosis of the SARS-CoV2 infection. 94.6% of patients were tested due to symptoms while gradually all of the patients became symptomatic. 5 (9.01%) of patients required hospitalization mainly due to hypoxemia. 11 (19.6%) of patients received specific treatment for SARS-CoV2 infection, 91.6% of patients experienced complete recovery, 2 (3.57%) experienced prolonged symptomatology, and 1 (1,785%) died. 10.9% of patients with SARS-CoV2 infection, who were in remission before infection, experienced a relapse of LN in a mean time of 2.7(±2.1) months after the infection, while none of the patients without SARS-CoV2 infection relapsed in the same time period (p = 0.09).

Conclusion

SARS-CoV2 infection affects the morbidity of patients with SLE who have renal involvement and possibly the likelihood of relapse in those who have achieved remission prior to infection.
#6501 MULTICENTER STUDY ESTIMATING THE INCIDENCE OF ADVERSE EVENTS FROM SARS-CoV-2 VACCINATION AND ITS POTENTIAL EFFECT ON THE OUTCOME OF LUPUS NEPHRITIS
Authors: Lionaki Sophia , Petrou Dimitra , Flouda Sophia , Marinaki Smaragdi , Kriki Pelagia , Katartzi Kostantia , Venetsanopoulou Aliki , Voulgari Paraskevi , Agoranou Marilena , Gkiolas Konstantinos , Panagoutsos Stylianos , Fanouriakis Antonios , Boletis Ioannis
Published: June 2023

Background and Aims

The present study aimed to investigate the incidence of adverse events associated with SARS-CoV-2 vaccination in patients with a history of lupus nephritis (LN).

Method

Patients with biopsy-proven LN, who were vaccinated against SARS-CoV-2, were retrospectively studied. Patients who had reached end-stage kidney disease prior to vaccination were excluded. We recorded the histopathological diagnosis of LN, immunosuppressive regimens which were given for LN, the outcome of LN as a result of treatment, the tome interval form the diagnostic biopsy to vaccination, the number of doses each patient received, all reported adverse effects associated with the vaccine against SARS-CoV-2, including systemic and local adverse events. We also estimated the potential effect of the vaccination on the clinical course of LN among patients who were in remission.

Results

Ninety patients with systemic lupus erythematosus and renal involvement were included with a mean age of 31 (±18) years, of whom 80% were women. Proliferative LN was present in the diagnostic kidney biopsy in 68 (77.2%) cases and 91.8% of the included patients had achieved remission with treatment prior to vaccination. 86.7% of patients were vaccinated with 3 (2.75, 3) doses. The median time from diagnosis to vaccination was 59 (32-137) months and 70.5% of patients were receiving immunosuppression at the time of vaccination. 30.5% of patients reported systemic adverse reactions and 36.1% local adverse reactions at the site of administration. Among patients in remission who were vaccinated, only 1 (1.2%) patient experienced a relapse of LN within 3 weeks of the 1st dose. Three (3.4%) patients who had treatment-resistant disease experienced a worsening of SLE activity after vaccine administration.

Conclusion

In this cohort of patients with a history of LN, the SARS-CoV-2 vaccine appears safe, with no effect on the likelihood of disease recurrence among patients who have achieved remission.
#6502 ETIOLOGICAL SPECTRUM OF MEMBRANOUS NEPHROPATHY
Authors: Tiwari Vaibhav , Jain Akash , Gupta Anurag
Published: June 2023

Background and Aims

Primary MN includes forms of MN in which there is a humoral autoimmune response to a normal podocyte antigen in the absence of secondary features or etiologies of disease. Antigens implicated in primary MN include PLA2R, thrombospondin type-1 domain-containing 7A (THSD7A), neural epidermal growth factor-like 1 (NELL1), semaphorin 3B (Sema3B), the serine protease high-temperature requirement A1 (HTRA1), protocadherin 7 (PCDH7), and others. PLA2R associated MN is most common MN among primary MN. Nowadays, a significant number of newer antigens implicating MN are being discovered. Research is ongoing for a better understanding of the role of these antigens in pathophysiology, and targeted therapeutic implications in future if possible. We aim to analyze the etiological spectrum associated with different antigens in patients with Membranous Nephropathy. We assessed the renal tissue staining of autoantigens PLA2R, THSD7A, and NELL-1 in patients with biopsy-proven Membranous Nephropathy.

Method

This was a single center ambispective observational study. The study was performed up till September 2022 for prospective data, and retrospective data from January 2018 to March 2021 was retrieved from the medical records department of the institute. The study included patients with biopsy-proven Membranous Nephropathy (Primary and secondary). The primary outcome was to study the etiological spectrum of Membranous Nephropathy.

Results

A total of 90 patients were included in the study of membranous nephropathy over the period of 4 years. 72 cases had primary MN whereas 18 cases had secondary MN. The mean age was 42.01 ± 14.6 years. Among 18 cases of Secondary MN, the majority of the cases were of lupus nephritis 14 (78%), while other etiologies of secondary MN were malignancy related (11%), rheumatoid arthritis (5.5%) and HCV (5.5%). PLA2R renal tissue positivity was found in 44 (61.1%) cases of primary MN, whereas in 4 (22.2%) cases of Secondary MN. The THSD7A was found in 4 (5.6%) cases of primary MN. One patient of MN was dual PLA2R and NELL1 positive. Two cases of MN were dual PLA2R and THSD7A positive. Renal tissue staining for NELL-1 was found in 8 (11.1%) cases of primary MN whereas it was found in 1 (5.6%) case of secondary MN. In terms of clinical presentation, proteinuria is the most common clinical finding present in nearly all the patients (80%). Most of the cases with nephrotic syndrome (60%) belonged to primary MN.

Conclusion

PLA2R is the most common etiology of Primary membranous nephropathy. None of the antigens was exclusive to primary membranous nephropathy.
#6505 POST-BURNS PERSISTENT INFLAMMATION LEADS TO KIDNEY PROGRAMMED CELL DEATH THROUGH ACTIVATION OF THE CASPASES SIGNALING PATHWAY
Authors: Yang Guang , Tan Lishan , Fengping Zheng , Xiong Zibo
Published: June 2023

Background and Aims

The underlying mechanism for the increased incidence of chronic kidney disease (CKD) in burn patients discharged from hospital remains unclear. Recent studies have shown that burn patients are discharged from the hospital with chronic inflammation despite normalization of all physiological parameters. We hypothesized that severe burns accelerate the onset and progression of CKD by activating persistent inflammation. This study aimed to investigate the long-term effects of severe burns on kidney and its possible mechanisms.

Method

The study was divided into three parts. First, to understand the effect of burns on the general population and the CKD population, 4-month-old C57BL/6 mice were divided into a blank control group (Blank) and an adenine-induced CKD group. Some mice were established by burns in a 10% total body burn surface area model at 5-month-old. Experiments were terminated at 7-month-old. The function, morphology, inflammatory response and oxidative stress of the kidney were assayed. Second, the effect of activated macrophages on podocytes was studied by in vitro experiments.

Results

In the Blank group, burns did not cause kidney function and weight alterations, but caused a small amount of organic lesions, glomerular atrophy, apoptosis, and macrophage infiltration. In the CKD group, burns not only significantly reduced kidney function, but also caused kidney atrophy, organic lesions, glomerular atrophy, apoptosis and macrophage infiltration. In addition, burns significantly increased Caspase-1 and -3 pathway expression in all mice. Electron microscopy showed that burns significantly aggravated glomerular injury in the CKD group, including podocyte injury, cell membrane blubbing and rupture. In vitro studies showed that polarized M1 macrophages increased MPC5 podocytes death.

Conclusion

Severe burns cause programmed cell death through activation of inflammation-induced Caspase-dependent pathways leading to kidney injury in mice. This phenomenon has a small effect on normal populations and a larger effect on CKD populations. This study has important implications for determining the prognosis of kidney function in burn patients and provides a promising therapeutic strategy.
#6535 SEXUAL DIMORPHISMS OF ACUTE KIDNEY INJURY: DIVERGENT PERFORMANCES OF BIOMARKERS OR DIFFERENT MOLECULAR MECHANISMS?
Authors: Piedrafita Alexis , Siwy Justyna , Sanz Ana Belen , Bousquet Paul , Klein Julie , Alves Melinda , Casemayou Audrey , Minville Vincent , Benjamin Breuil , Mischak Harald , Ortiz Alberto , Schanstra Joost , Faguer Stanislas
Published: June 2023

Background and Aims

Before implementing individualized strategies to prevent or treat acute kidney injury (AKI), identifying clusters of patients with common (or divergent) pathophysiological mechanisms, diagnosis criteria or outcome is of upmost importance.

Method

We compared the characteristics of 1170 male and female patients referred for cardiac surgery with cardiac bypass (CBP) using multivariate logistic regression and propension score-based analysis. Performances of the candidate urinary biomarkers neutrophil gelatinase-associated lipocalin (uNGAL), [IGFBP7].[TIMP-2] product (Nephrocheck), and a recently developed AKI signature of 204 urinary peptides (PeptAKI) were compared, and sex-dependent individual urinary peptide changes were studied.

Results

In these patients referred for CBP-surgery, incidence and severity (K/DIGO classification) of AKI were similar in men and women (about 25%), even after adjustment of the usual risk factors of AKI including baseline estimated glomerular filtration rate, age, diabetes mellitus, length of CBP and red blood cell transfusion. Performances of uNGAL, Nephrocheck and PeptAKI strongly diverged between males and females. In the overall cohort, as well as in sub-groups of males and females, the multi-markers PeptAKI signature outperformed uNGAL and NephroCheck. Reanalysis of peptides included in PeptAKI at the single peptide level suggested divergences of AKI mechanisms between sexes. In women, the peptide score-derived risk of AKI strongly relied on peptides indicating kidney inflammation (including SERPINs, SAA1, osteopontin, uromodulin fragments) and hemolysis (HBA1, HBB), whereas a peptide derived from a stress-responsive protective gene in kidney tubular epithelial cells (VGF nerve growth factor) was dramatically less abundant in women developing AKI.

Conclusion

In patients referred for CBP-surgery, significant clinical and biological differences between men and women, as well as sexual dimorphism of AKI biomarkers performances, were identified. Urinary peptide signatures may help to personalize prevention of AKI progression by giving both quantitative and sex-related qualitative information on molecular mechanisms underlying AKI.
#6572 FLUORINATED GRAPHENE REDUCES PLATELET ACTIVATION AND ADHESION ON HEMODIALYSIS CATHETER
Authors: Liu Chen , Liu Zhuang , Zhang Ling , Fu Ping
Published: June 2023

Background and Aims

Catheter thrombosis remains one of the major complications of hemodialysis. Superhydrophobic surfaces are suggested to be capable of creating an energy barrier that prevents cells and proteins from contacting with the catheter surface directly, making catheter less thrombotic. Fluorinated graphene (FG) is a superhydrophobic material. It has been applied to create self-cleaning surfaces. It also shows good biocompatibility. Based on these features of FG, we prepared an FG coating on hemodialysis catheter attempting to reduce clinical thrombotic events.

Method

FG suspension was made in a solution of 95 wt.% ethanol, 5 wt.% deionized water and 3 wt.% 1H,1H,2H,2H-Perfluorooctyltriethoxysilane (POTS, C14H15F17O3Si). Immediately following the plasma activation, catheter segments of 1 cm²(Gamcath, GDHK1325) were spray coated with FG suspension both inside and outside the catheter lumen. Samples were air-dried for later use. We tested the hemolysis rate, platelet activation and adhesion performances, and the partial thromboplastin time (PTT) of the FG-coated samples. Test for hemolysis was performed with FG-coated catheter and the isotonic extract of the FG coating in direct contact with fresh rabbit blood respectively. Platelet activation and adhesion was performed according to the ASTM F2888-19 standard and also assessed by scanning electron microscope. PTT assay was performed according to the ASTM F2382-18 standard.

Results

FG-coated catheter is hydrophobic and shows a water contact angle of 150° (Figure 1a). It reduced 83.5% of platelet adhesion per 100 μm² catheter surface area and avoided 35.86% of platelet loss from the blood when compared to uncoated catheter (Figure 1b, 1c). It has a hemolysis rate of less than 2% in both direct blood contact test and the extract test (Figure 1d). The PTT of FG-coated sample was 88.92±1.31s versus 83.03±9.49s of the uncoated catheter yet with no statistical significance (P>0.05) (Figure 1e).

Conclusion

FG coating has great hemocompatibility. Though no significant improvement was observed in the PTT assay, FG coating still significantly reduced the adherent and activated platelet on catheter, which seems promising to reduce thrombotic events. Yet, more tests needed to be performed, and the antithrombotic ability of FG coating in the fluid state needs to be further confirmed in the following study.
#6597 THE EFFECT OF PATHOGEN ON THE OUTCOME OF HEMODIALYSIS CATHETER-RELATED BLOODSTREAM INFECTIONS IN HOSPITALIZED PATIENTS: A SINGLE CENTER ANNUAL RECORD
Authors: Kalogeropoulos Petros , Tsotsorou Ourania , Tsoympoy Ioanna , Nikolopoulos Petros , Lionaki Sophia
Published: June 2023

Background and Aims

Tunneled double-lumen catheters are increasingly used as permanent vascular access in hemodialysis patients, particularly in those with limited vascular access options. Catheter-related bloodstream infection (CRBSI) is a major cause of hospitalization with increased mortality and cost. The purpose is to study the effect of the pathogen on the clinical course of the hemodialysis patients with CRBSI.

Method

Patients hospitalized in our department from 11/2021 to 12/2022 with established CRBSI were retrospectively studied. Their demographics, duration of hospitalization, microbiological data, central venous catheter management and hospital outcome were recorded.

Results

A total of 27 patients with median age (SD) 68,03 (16,93) years were treated, 12 (44.4%) were men. The following pathogens were isolated from the blood cultures: Staphylococcus aureus in 7 (25.9%) patients, coagulase-negative Staphylococcus in 10 (37%) patients, Gram-positive bacteria in 4 (14.8%) patients, Gram-negative bacteria in 3 (11.1%) patients, candida in one (3.7%) patient, while 2 (7.4%) patients had negative cultures. Mean (SD) duration of hospitalization was 16,85 (13,15) days for all patients. Patients in whom Staphylococcus aureus and Candida were isolated had longer hospital stay than other infections with a mean (SD) 29 (18) days and 41 days respectively (p = 0.014). Metastatic infections occurred in 4 (14,8%) patients, of whom 2 had endocarditis, one endocarditis and pulmonary abscess, and one endocarditis, lung abscess and brain abscess. All 4 patients isolated Staphylococcus aureus in blood culture out of a total of 7 (57,1%) patients with this pathogen (p = 0.02). 3 of 7 (42,8%) patients with Staphylococcus aureus, 1 of 10 (10%) with coagulase-negative Staphylococcus, and 1 of 3 (33,3%) with Gram-negative bacteria died (p = 0.385). In 26 of the 27 patients (96.3%) central venous catheter was removed.

Conclusion

The majority of patients in the present sample required central venous catheter removal. The type of pathogen seems to play an important role both in the duration of hospitalization and in the occurrence of metastatic infections.
#6598 STUNNING RENAL FUNCTION RECOVERY AFTER TREATMENT WITH DARATUMAMB IN A CASE OF C3 GLOMERULOPATHY WITH MONOCLONAL GAMMOPATHY
Authors: Costigliolo Francesca , Esposito Pasquale , Macciò Lucia , Viazzi Francesca
Published: June 2023

Background and Aims

38 years old man with C3GN linked to Monoclonal Gammopathy recovers from dialysis after treatment with Daratumamb.

Case report

C3 glomerulonephritis related to monoclonal gammopathy is a challenging entity and the efficacy of treatment with Daratumumab is not clearly defined yet. We would like to describe the case of a stunning renal response to Daratumumab in a young man with MGUS and C3 glomerulonephritis. In July 2021 a 38 years old man presented to our nephrology division with full nephrotic syndrome, creatinine 1.2 mg/dl, low C3 and little IgG lambda spike of 2 g/dL on serum electrophoresis. Kidney biopsy revealed a membranoproliferative GN with bright C3 staining by immunofluorescence, no other positive immune-reactant and no masked deposits on pronase digested tissue. Electron microscopy confirmed the presence of subendothelial electron dense deposits. The diagnosis was consistent with C3 glomerulonephritis. Complement genetic test and C3 nephritic factor were negative. Assuming a form of C3GN associated to monoclonal gammopathy (MGRS), a bone marrow biopsy was performed and revealed a small clonal plasma cells population. In November 2021 he was started on velcade/dexamethasone but unfortunately stopped early due to severe side effects. Subsequently he begun cyclophosphamide and steroids without clinical or serological response. In few months renal function rapidly worsened requiring dialysis since April 2022. A repeat kidney biopsy confirmed C3GN with still moderate activity and low chronicity. In May 2022 he was started on Daratumamab/Lenalidome/Dexamethasone. After eight months of dialysis the diuresis progressively increased and the renal function improved so remarkably that dialysis was discontinued since December 2022. At present the patient renal function is stable with creatinine 3.5 mg/dl, proteinuria 3g/L, and monoclonal component decreased to 1.1 g/L from 3.5 g/L. He continues Daratumumab single agent monthly and we have scheduled a further renal biopsy in the next week. To our knowledge this is the first time a patient recovers from dialysis after treatment with Daratumamb for a C3GN linked to a monoclonal gammopathy. It definitely makes this case unique and inspiring for further studies and considerations regardinf this intriguing field of MGRS.
#6603 THE ROLE OF ANTICOAGULATION IN KIDNEY TRANSPLANTATIONS FROM UDCD WITH HIGH RESISTANCE INDEX
Authors: Gomez Maria Molina , Urrutia Marina , Romero-González Gregorio A , Paúl Javier , Torres Fredzzia Amada Graterol , Riera Josep , Fugasot Carles Cañameras , Perezpaya Ines , Taco Omar , Cañas Laura , Rodriguez Rosely , Fernandez Mario , Montes Ester Gonzalez , Sevillano Angel , Morales Enrique , Cabrera Jimena , Bover Jordi , Vila Ana , Belmonte Amado Andrés
Published: June 2023

Background

Kidney transplantations (KT) from uncontrolled donation after cardiac death (uDCD) achieve very good outcomes to short and long follow-up, but the incidence of primary non-function and venous thrombosis (VT) is very high. The resistance index (RI) after kidney transplantation increase in the VT cases and in other kidney diseases.

Aims

To describe the effect of prophylactic anticoagulation in KT from uDCD with RI ≥0.8 to avoid VT and its secondary effect.

Method

Unicentric retrospective cohorts study that included all KT from uDCD with RI ≥0.8 measured by ecodoppler in the first 72 hours post-transplantation. We compared one group, which never received anticoagulation (Group I), and a second one which received prophylactic anticoagulation (Group II). Sodic heparin was the administer anticoagulant to achieve aPTT 1.5-2 time normal range and/or low molecular weight heparin adjusted to patient's weight and renal function.

Results

We included 107 KT from uDCD with RI≥0.8, with 36 in Group I and 76 in Group II. In Group I the donors were younger (39 ± 12 vs 46 ± 8; p = 0.003) and there were more men donors (97.2% vs 81.7%; p = 0.032). The prevalence of VT was higher in Group I (19.4% vs 0%; p<0.001). Patients in Group II needed more red blood transfusions (19.4% vs 39.4%; p = 0.05) and had more macroscopic haematuria (5.6% vs 21.1%; p = 0.049). The competing risk analysis showed a higher probability to develop a VT in non-anticoagulation group (p = 0.00012) than anticoagulation group or other causes of primary non-function (Figure 1).

Conclusion

The prophylactic anticoagulation treatment in KT from uDCD with RI≥0.8 decreases the VT incidence and it is safe for a donor recipient.
#6606 MEDICATION VOLUME COMPARISON TO BIND PHOSPHATE
Authors: Sprague Stuart , Vayalakkada Suresh , Jermasek Doug , Gupta Shalabh , Gupta Pramod
Published: June 2023

Background and Aims

Elevated phosphate concentrations are associated with a significantly increased risk of cardiovascular disease and overall mortality in patients with chronic kidney disease. Current Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend lowering elevated serum phosphorus concentrations toward the normal range in patients with end-stage kidney disease on dialysis through restriction of dietary phosphorus intake, increase in clearance by dialysis, and the use of phosphate binders. However, ∼75% of dialysis patients are not achieving normal phosphate concentrations, potentially due to low adherence and/or binders’ insufficient phosphate binding capacity to match dietary intake. A phosphate binder with a higher phosphate binding capacity could improve phosphate control and potentially clinical outcomes. This study evaluated the medication volume of various phosphate binders to bind 1 gram of phosphorus.

Methods

Five phosphate binders were assessed: ferric citrate (210 mg ferric iron), calcium acetate (667 mg calcium acetate), lanthanum carbonate (500 and 1,000 mg lanthanum), sevelamer carbonate (800 mg sevelamer carbonate), and lanthanum dioxycarbonate (500 and 1,000 mg lanthanum). The mean daily dose volume to bind 1 g of phosphate was calculated as volume per tablet multiplied by the mean number of tablets taken per day. The volume to bind 1 g of phosphate was calculated by dividing the volume per tablet by its in vivo binding capacity, based on NIH DailyMed website.

Results

Binding to 1 g of phosphate required 5.6 cm3 of lanthanum dioxycarbonate compared with lanthanum carbonate (19.8 cm3), calcium acetate binders (25.0 cm3), ferric citrate (46.5 cm3), and sevelamer carbonate (73.4 cm3) (Figure 1).

Conclusion

The study found that lanthanum dioxycarbonate had the lowest volume to bind the same amount of phosphate compared to other binders. With a low medication volume and high phosphate binding capacity, lanthanum dioxycarbonate, a novel investigational nanotechnology product, can be a welcoming choice for patients to manage their hyperphosphatemia. The drug's decreased pill size (making it easy to swallow) and its tolerability have the potential to increase medication adherence and improve phosphate control.
#6612 ACUTE KIDNEY INJURY ASSOCIATED WITH IMMUNE CHECKPOINT INHIBITOR THERAPY: REPORT OF 4 CASES
Authors: Sardeli Angeliki , Petrou Dimitra , Kalogeropoulos Petros , Nikolopoulos Petros , Liapis George , Lionaki Sophia
Published: June 2023

Background and Aims

Immunotherapy using immune check point inhibitors (ICIs) is the cornerstone of modern cancer therapy. Despite significant clinical benefits, ICIs are associated with remarkable adverse events of autoimmune nature involving various organs. Acute Kidney Injury (AKI) occurs more rarely, mainly with the appearance of acute interstitial nephritis. We present a series of patients with AKI after administration of immunotherapy with ICIs.

Method

Patient 1 with metastatic small cell lung cancer on immunotherapy with atezolizumab presented with purpura on the trunk and lower extremities, AKI, microscopic glomerular hematuria, and proteinuria. Patient 2 with esophageal malignancy on immunotherapy with pembrolizumab and worsening renal function. Patient 3 with endometrial malignancy on immunotherapy with pembrolizumab developed AKI, nephrotic syndrome and microscopic hematuria. Patient 4 with melanoma on immunotherapy with pembrolizumab presented with microscopic hematuria and rash.

Results

A kidney biopsy was performed in all 4 patients unreavealling the following; Patient 1: pauci-immune necrotizing glomerulonephritis with fibrinoid necrosis and inflammation in the wall of a vessel. Patient 2: acute interstitial nephritis with intense inflammation. Patient 3: findings consistent with focal segmental glomerulosclerosis (FSGS, NOS), without evidence of immune complex disease. Patient 4: focal segmental glomerulosclerosis, moderate interstitial fibrosis and interstitial nephritis in remission. The patient had already been treated with glucocorticoid. In all 4 patients immunotherapy was temporarily discontinued and they were treated with intravenous pulses of methyl-prednisolone followed by oral glucocorticoids, with significant improvement of kidney function and resolution of all extra renal manifestation i.e skin rash etc. Escalation of immunosuppressive therapy with the addition of another agent was avoided in order not to cause relapse of the malignancy.

Conclusion

AKI is a rare but potentially serious complication of ICIs. Temporal discontinuation of the implicated agent is of major importance while treatment with glucocorticoids may be critical for kindey function. Yet, constant vigilance and sustained collaboration among medical specialists are becoming essential in the increasing use of immunotherapy.
#6624 EFFICACY AND SAFETY OF GLP1 ANALOGUES IN ADVANCED CKD PATIENTS: A POTENTIAL STRATEGY FOR WEIGHT LOSS AND INCLUSION IN RENAL TRANSPLANT WAITING LIST
Authors: Alonso Marta , Sánchez Luis Alberto Vigara , Fernández Florentino Villanego , Amaro Jose Manuel , Aguilera Aurora , Singh Arshdeep , Muñoz Javier Naranjo , López Juan Manuel Cazorla , Mejía Carlos Narváez , Orellana Cristhian , Masero Julia Torrado
Published: June 2023

Background and Aims

Diabetes mellitus (DM) is one of the main causes of chronic kidney disease (CKD) and the need for renal replacement therapy. New antidiabetic drugs such as glucagon-like peptide type 1 receptor analogues (aGLP1) improve glycemic control and cardiovascular risk and promote weight loss. Our main objective was to analyze the efficacy and safety of aGLP1 agonists in patients with advanced chronic kidney disease (ACKD).

Method

Prospective cohort study of CKD (estimated glomerular filtration rate (eGFR) ≤30 ml/min) and DM2 patients who started treatment with aGLP1 between April 2018 and November 2022. We analyzed clinical and demographic variables. We collected aGLP1 type and dose, eGFR and weight at baseline and after 6 and 12 months of treatment. We analyzed glycemic and lipid control and blood pressure (BP). We documented adverse effects. Descriptive analysis was performed and we compared eGFR before and after aGLP1 initiation.

Results

During the period 36 patients with ACKD started treatment with aGLP1 in our center, 30 with a minimum follow-up of 6 months. 66.7% were male and the mean age was 67. 88.9% were hypertensive and 91.7% dyslipidemic. 33.3% had a history of ischemic heart disease, 11.1% heart failure, 41.7% peripheral arterial disease and 8.3% stroke. The mean eGFR at drug initiation was 20.7 mL/min. The most frequent cause of CKD was diabetic nephropathy (66.7%) followed by glomerulonephritis (11.1%). Mean weight was 92.7±9.7 kg and BMI 33.15±3.2 kg/m2. The most prescribed aGLP1 was Semaglutide (83.4%) followed by Liraglutide (13.9%) and Dulaglutide (2.8%). Maximum drug dose was reached in 69.4% of patients. After initiation, eGFR remained stable at 6 months and 1 year (p = .424). We observed a 12% reduction in weight at one year after treatment (94Kg vS 83Kg; p<.001). We found no differences in glycosylated hemoglobin, lipid control and BP at 6th month and first year. Two patients suffered gastrointestinal adverse effects and one discontinued the drug because of this. One patient died during follow-up of independent cause.

Conclusion

aGLP1 in patients with ACKD are safe. Adverse effects do not occur more frequently than in the non-CKD population. In addition to improving cardiovascular risk of patients, they can produce a weight loss that can independently help patients to be included in the waiting list for renal transplantation.