bluuebunny/crossref_metadata_2025 huggingface dataset:
#4735 USEFULNESS OF CYSTATIN C IN MEASURING RENAL FUNCTION AND PREDICTING METHOTREXATE ASSOCIATED TOXICITIES IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: Kim So MI , Lee Eun Kyoung , Jeon Ji Hyun , Cho Jong Tae , Lee Hwa Young
Published: June 2023

Background and Aims

Rheumatoid arthritis (RA) is a representative chronic disease accompanied by muscle loss, and cystatin C may be more useful than traditional creatinine (Cr) when measuring renal function. RA is affected not only by drug dose but also by side effects of treatment according to renal function. Therefore, we tried to compare the estimated glomerular filtrate rate (eGFR) using cystatin C and Cr and analyze the methotrexate (MTX) associated toxicities after treatment.

Method

A total of 436 RA patients was enrolled in this study. The eGFR was calculated using the Chronic kidney Disease Epidemiology Collaboration (CKD-EPI) equation based on cystatin C and serum Cr. According to eGFR, CKD stages and drug dosing stages were classified and MTX associated toxicities were evaluated.

Results

Mean eGFR using the CKD-EPI cr and CKD-EPI cystatin C equations were 95.36 and 89.44 mL/min. In the CKD-EPIcr group, there were 11 patients with eGFR less than 50 mL/min that required dosing reduction, and 38 patients in the CKD-EPI cystatin C group, showing a statistically significant difference (Table 1A). In addition, CKD stage 3B and 4 patients were also higher in the CKD-EPI cystatin C group compared to those in CKD-EPI cr group (Table 1B), and anemia and nephrotoxicity were high in the MTX related toxicity stage upgraded group.

Conclusion

Our study showed that eGFR by CKD-EPI Cr can be overestimated than that by CKD-EPI cystatin C, and also demonstrated higher MTX associated toxicities in the group, which the stage was changed upward. Therefore, this study suggests that cystatin C is useful predictor in measuring renal function and predicting MTX associated toxicities in RA patients
#4738 EVALUATION OF BONE MINERAL STATUS WITH DUAL-ENERGY X-RAY ABSORPTIOMETRY AND QUANTITATIVE COMPUTED TOMOGRAPHY IN CHRONIC RENAL DISEASE
Authors: Alan Aydan Mütiş , Sezer Zehra , Dincer Mevlut Tamer , Oz Ahmet , Karaca Cebrail , Alagoz Selma , Guzel Elif , Gonen Mustafa Sait , Seyahi Nurhan
Published: June 2023

Background and Aims

Mineral and bone disease (BMD) is one of the common complications of advanced chronic kidney disease (CKD). Fracture risk could be predicted by bone densitometry using dual-energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT). This study aims to evaluate the effectiveness of imaging techniques in diagnosing BMD in CKD patients and healthy subjects.

Method

We performed control cross-sectional study in single center in Turkey between 2019, and 2022. We evaluated two groups aged 18-50 years. Patients groups; consisted of patients with stage 4 -5 chronic kidney disease, and control healty groups; consisted of healty participants. The bone status of thirty-three participants was evaluated using both cQCT and DXA. Diagnostic discordance was assessed between the lumbar spine and femoral neck from DXA and cQCT.

Results

Thirty-eight participants were included in the study and BMD of 33 was evaluated with DXA and cQCT. The median age was 44 years (range 22-50) in the patient's group (33% female), and 42 years (range 27-48) in controls (55% female). Baseline variables were outlined in Table 1. Using the DXA T score and cQCT; the incidence of osteopenia or osteoporosis was not statistically different in the patient and control groups (for DXA; spine and femoral neck, p: 0,62 and 0,61 respectively, for cQCT; spine and femoral neck, p:0,8 and 0,73 respectively). Regarding the lumbar spine, DXA diagnosed osteopenia or osteoporosis more frequently compared to QCT in the patient's group [6 (40%) vs 3 (20%), p = 0,01]. Three of 6 patients (50%) diagnosed with osteopenia or osteoporosis by DXA were evaluated as having normal bone status by QCT. There was no statistical difference between the two methods in the control group. The results of bone status in lumbar spine and femoral neck in the whole cohort were summarized in Table 2.

Conclusion

According to our result, in young or middle-aged patients with stage 4-5 CKD, DEXA might overdiagnosis osteopenia or osteoporosis compared to QCT.
#4742 SURVIVAL AND PREDICTORS OF MORTALITY IN HEMODIALYSIS PATIENTS
Authors: Tourountzis Theodoros , Stasini Foteini , Skarlatou Zoi , Bikos Athanasios , Kagiadaki Chrysoula , Sombolos Konstantinos , Ginikopoulou Evdoxia
Published: June 2023

Background and Aims

Mortality in hemodialysis patients significantly exceeds the one observed in general population. Identifying and early management of risk factors is essential for improving survival of these patients. Aim of the study is to assess survival and evaluate factors related to mortality in hemodialysis population.

Method

We retrospectively studied 237 patients [99 ♀, median age 76 (69-84) years] undergoing hemodialysis in a single Dialysis Center for a 10-years period of time (from 1/2/2010 to 31/1/2021). Demographics, comorbidities and laboratory parameters were recorded and analyzed. Median survival, mortality rate and factors that may affect them were evaluated.

Results

The mortality rate was 9.28% in the first year and 36.29% in five years after starting dialysis, respectively (Figure 1. Kaplan-Meier survival curves for the study population). Elderly patients (>65 years) had a lower median survival compared to younger ones (63 versus 103 months, p = 0.031). Survival of diabetics undergoing on-line hemodiafiltration was twice versus those undergoing hemodialysis (87 versus 42 months, p<0.001). Most common causes of death were cardiovascular diseases (32.38%), infections (20.95%) and cancer (18.1%) (p<0.001). Multivariate analysis identified as important predictors of mortality, the existence of: diabetes mellitus [hazard ratio (HR) = 2.387, 95% confidence interval (CI) 1.278-4.46, p = 0.006], peripheral arterial disease (HR = 1.875, 95% CI 1.12-3.139, p = 0.017) and central venous catheter (HR = 2.421, 95% CI 1.297-4.518, p = 0.005). In contrast, absence of vascular access thrombotic episode (HR = 0.289, 95% CI 0.158-0.527, p<0.001) and body mass index >20 kg/m2 (HR = 0.517, 95% CI 0.294-0.909, p = 0.022) had a favorable effect on survival.

Conclusion

Mortality rate in our cohort was measured 9.28% in first year and 36.29% in five years after starting hemodialysis. Survival was lower at elderly and diabetic patients undergoing hemodialysis. Our study identified some mortality factors potentially modifiable, such as body weight, type of vascular access and method of dialysis treatment.
#4750 PREVALENCE OF ELECTROCARDIOGRAPHIC ABNORMALITIES IN PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Pedersen Louis Nygaard , Carlson Nicholas , Nelveg-Kristensen Karl-Emil , Rantanen Jesper Moesgaard , Madsen Bo , Graff Claus , Nielsen Jonas , Pietersen Adrian , Torp Christian , Riahi Sam , Svensson My , Gregersen Jon Waarst , Polcwiartek Christoffer
Published: June 2023

Background and Aims

The presence of electrocardiogram (ECG) abnormalities is high in patients with end-stage kidney disease, but no studies have examined the prevalence of ECG abnormalities according to different strata of estimated glomerular filtration rate (eGFR) in a population-based setting.

Method

This was a retrospective cross-sectional study including 310,060 individuals from the Copenhagen General Practitioners' Laboratory who had an available digital ECG recorded between 2001 and 2015 and a creatinine measurement within 7 days of the ECG. eGFR was calculated using the The Chronic Kidney Disease Epidemiology Collaboration equation. ECG abnormalities were categorized as no, minor or major, as done previously [1]. Patients with both minor and major ECG abnormalities were assigned as major ECG abnormalities. The prevalence of ECG abnormalities was examined according to different strata of renal function [eGFR (ml/min/1.73 m2) >90, 61–90, 46–60, 31–45, 30-16 and ≤15]. Ordinal logistic regression was used to illustrate the probability of ECG abnormalities as a function of eGFR.

Results

The median age was 55 [IQR, 41-69] years and 46% were male. A total of 47,249 (17.9%) of the included patients had an eGFR <60. The prevalence of major ECG abnormalities increased with declining eGFR: >90 (16.5%), 61–90 (21.6%), 46–60 (36.5%) 31–45 (52.1%), 30-16 (57.9%) and ≤15 (60.1%). In ordinal logistic regression, the risk of having major ECG abnormalities compared to minor/no abnormalities significantly decreased pr. 5 ml/min increase in eGFR, OR 0.90 (95% CI, 0.85-0.90), Fig. 1. The most common major ECG abnormalities were left ventricular hypertrophy and ST-T deviations. The prevalence of all ECG abnormalities is shown in Table 1.

Conclusion

ECG abnormalities are common in patients with chronic kidney disease, and the probability of major ECG abnormalities increases with declining eGFR.
#4771 PROGNOSTIC RELEVANCE OF ELECTROCARDIOGRAPHIC ABNORMALITIES ACCORDING TO EGFR CATEGORIES
Authors: Pedersen Louis Nygaard , Carlson Nicholas , Nelveg-Kristensen Karl-Emil , Rantanen Jesper Moesgaard , Madsen Bo , Graff Claus , Nielsen Jonas , Pietersen Adrian , Torp Christian , Riahi Sam , Svensson My , Gregersen Jon Waarst , Polcwiartek Christoffer
Published: June 2023

Background and Aims

Electrocardiogram (ECG) abnormalities are associated with adverse cardiovascular outcomes in patients with chronic kidney disease (CKD), but their prognostic relevance according to estimated glomerular filtration rate (eGFR) categories remains unexplored. This study investigated the associations between no, minor, and major ECG abnormalities and fatal cardiovascular disease (CVD) according to different strata of renal function.

Method

This was a retrospective cohort study including 310.060 individuals aged ≥16 years from the Copenhagen General Practitioners' Laboratory that had an available digital ECG and creatinine measurement within 7 days from 2001–2015. eGFR was calculated using The Chronic Kidney Disease Epidemiology Collaboration equation, and data were cross-linked with Danish nation-wide healthcare registries to gain information on medication, comorbidity, and fatal CVD. ECG abnormalities were categorized as either no abnormalities, minor (first-degree atrioventricular block, incomplete bundle branch block or corrected QT prolongation) or major (left ventricular hypertrophy, atrial fibrillation/flutter, bundle branch block, Q waves, or ST-T deviations), as done previously [1]. Patients with both minor and major ECG abnormalities were assigned as major ECG abnormalities. ECG abnormalities and their association with fatal CVD were compared across strata of renal function [eGFR (ml/min/1.73m2) >90, 61–90, 46–60, 31–45, 16–30 and ≤15] based on multivariable Cox-regression analysis adjusted for age, sex, and comorbidities. Counterfactual G-estimation of Hazard Ratios (HRs) standardized to age and sex was performed to estimate 5-year absolute risk of fatal CVD.

Results

The median age was 55 [IQR, 41-69] years and 46% were male. Median study follow-up time was 10.3 [IQR, 6.7-14.4] years. A total of 47,249 (17.9%) of the included patients had an eGFR <60. The rate of fatal CVD according to ECG abnormalities and their adjusted HRs is shown in Fig. 1, while 5-year standardized risk of fatal CVD is depicted in Fig. 2. Generally, having minor or major ECG abnormalities, conferred a worse prognosis across all eGFR strata, with the highest 5-year absolute risk of fatal CVD being observed among patients with major ECG abnormalities and an eGFR between 31–45 [19% (95% CI, 18–20%)], eGFR 16–30 [25% (95% CI, 24–26%)] or an eGFR ≤15 [27.5% (95% CI, 24–31%)], Fig. 1–2.

Conclusion

In a population-based setting, having minor or major ECG abnormalities were associated with an increased risk of fatal CVD across all strata of renal function. Patients with an eGFR ≤45 and major ECG abnormalities represent a high-risk population, that might benefit from careful monitoring and cardiovascular risk management.
#4772 DOUBLE FILTRATION PLASMAPHERESIS DURING HETEROLOGOUS FERTILIZATION PREGNANCY FOR THE TREATMENT OF HETEROZYGOUS FAMILIAL HYPERCHOLESTEROLEMIA
Authors: Spasiano Andrea , Palazzetti Daniela , Ambrogio Martina , Rosati Erica , Moffa Simona , Naticchia Alessandro , Giaccari Andrea , Ferraro Pietro Manuel , Grandaliano Giuseppe , Panocchia Nicola
Published: June 2023

Background and Aims

Pregnancy in women affected by familial hypercholesterolemia is rare. Estrogen and progesterone fluctuations, featuring pregnancy, adversely influence lipid metabolism, causing considerable increase of LDL-C, triglyceride and lipoprotein A levels. These changes in fatty metabolism, essential for embryonic development, might be critical for placental circulation and for mother's health. Indeed, high lipoprotein amount can raise uteroplacental vascular resistance and it is associated with intrauterine growth restriction because of oxidative stress, whereas hypertriglyceridemia and hypercholesterolemia might cause an increased risk of cardiovascular accidents and pancreatitis. Lipid-lowering drugs, such as statins, ezetimibe or PCSK9 inhibitors are discontinued due to possible teratogen effects. Thus, LDL apheresis is the only available therapy for severe hypercholesterolemia during pregnancy.

Method

A 46 years old woman affected by heterozygous familial hypercholesterolemia in treatment with PCSK9 inhibitors and statins, decided to undergo an heterologous in vitro fertilization with oocyte donation. Hence, pharmacological therapy was stopped to avoid teratogen effects. We started a 10-months apheresis program with double filtration plasmapheresis (DFPP). The treatment was performed by a temporary double lumen central venous catheter. Initially, she underwent apheresis twice a month with an average exchange volume of 1.2, low blood flow (≤ 90 ml/min) and incremental plasma flow (from 5 to 30 ml/min every 10 minutes of treatment), to ensure a physiological procedure. We gradually modulated the exchange volume monitoring blood levels of LDL-C, Lp(a) and triglycerides before and after each procedure. We aimed to keep mean LDL-C level < 200 mg/dl. We did not use anti-coagulation during the procedure, monitoring TMP values and arterial-venous pressure.

Results

LDL-C levels remained about 227.2 ± SD 91 mg/dl, with a median of 186.8 mg/dl, complying with the target range (Figure 1). Mean triglycerides and Lp(a) values were, respectively, 180.3±94 mg/dl (median 146 mg/dl) and 77.3±36.3 mg/dl (median 55.7 mg/dl) (Figure 1). Our patient did not face any complications related to pregnancy or to the procedure, and gave birth at 38th gestational week to an healthy full-term male baby of 52 centimeters and 3.34 kilograms.

Conclusion

Although there is a widespread hesitation in performing extracorporeal blood purification treatment in pregnancy, this case underlines the essential role of LDL apheresis in in this setting, giving spark to standardize the procedure and to encourage its use also in pregnancy.
#4774 THE USE OF REGDANVIMAB FOR THE PREVENTION OF SEVERE COVID-19 IN PATIENTS ON HEMODIALYSIS
Authors: Shutov Evgeny , Bolshakov Stepan , Kotlyarova Galina , Dolidze David , Sorokoletov Sergey
Published: June 2023

Background and Aims

A new coronavirus infection has become a serious threat leading to increased mortality worldwide. COVID-19 is an acute airborne disease caused by severe acute respiratory syndrome virus (SARS-Cov-2). Evolution of the virus, emergence of new mutant strains, changes in virulence dictate the need to search for new tools both in treatment and prevention of severe disease. The aim of our study was evaluation of the efficacy of Regdanvimab (Regkirona, Samsung BioLogics) to prevent severe COVID-19 in patients receiving ambulatory hemodialysis in the period of increasing morbidity.

Method

The study included 20 patients on program hemodialysis, mean age 54.9±17.6 years, vaccinated or who underwent COVID-19 more than six months ago. All subjects of the study received Regkirona at a standard dose of 40 mg/kg of body weight intravenously once at the end of the hemodialysis procedure after the physician assessed the feasibility of prophylaxis. All subjects were assessed for humoral immunity before Regkirona administration and after Regkirona administration according to the level of total SARS-CoV-2 IgG and IgG antibodies to the subunit of the S1 receptor-binding domain of the SARS-CoV-2 protein.

Results

Total SARS-CoV-2 IgG level and IgG level of antibodies to SARS-CoV-2 receptor-binding subunit S1 was 83.9±69.5 U/ml and 260.7±199.5 BAU/ml respectively before drug administration. During the 6-month follow-up period from July to November 2022, which paralleled the next round of increased morbidity, four patients with SARS-CoV-2 PCR test positive reported mild to moderate symptoms of SARS (marked weakness, fever, loss of smell, catarrhal symptoms, cough, shortness of breath, and chest pain unassociated with other causes). None of the subjects required hospitalization. We evaluated IgG antibody titers to the receptor-binding domain of the SARS-CoV-2 protein subunit S1 after 1, 3 and 6 months and demonstrated a nonlinear decline titers from 5104±2257.1 BAU/ml, 1988.7±1440.4 BAU/ml to 407,0±350,2 BAU/ml respectively, which may indirectly reflect short half-life of Regkirona.

Conclusion

The results of our study showed the efficacy of Regdanvimab to prevent the severe disease of COVID-19 in high-risk patients during the period of rising morbidity.
#4777 BLOOD PRESSURE RESPONSE TO A LOW SODIUM DIET IN NORMOTENSIVE SUBJECTS
Authors: Margulis Fernando , Sabbatiello Roberto , Golglid Veronica , Cuevas Carlos , Castro Claudia , Aguirrezabala Veronica , Martinez Miriam , Schiavelli Ruben
Published: June 2023

Background and Aims

The term salt sensitivity (SS) has been used to show an increase in BP in response to saline overload in both normotensive and hypertensive patients. Age, sex, and obesity have been proposed as predisposing factors. The objective of our work was to evaluate the response of office BP (OBP) and ambulatory BP (ABP) to changes in salt intake in healthy normotensive subjects.

Method

We analyzed 193 subjects who participated in the evaluation as potential kidney donors; none had a history of hypertension, diabetes, renal or cardiovascular disease. They received two consecutive standardized diets, one with 300 mEq and the other with 30 mEq of Na+/day. On the last day of each diet, a 24-h urine collection was obtained and an ambulatory BP monitor was placed for 24 h in the non-dominant arm, following recording of OBP. Data were expressed as mean and standard deviation (SD). Student's test and one-way ANOVA were used to compare means, values of p<0.05 were considered statistically significant differences.

Results

In the study group there were 120 females (62%) and 71 were salt sensitive (SS) (37%). The mean age was 46.9 ± 10 years (20 – 72) without significant gender differences (F = 46.7 ± 10 vs M = 47.3 ± 9 p = 0.704). The age of the salt sensitive (Ss) group was significantly higher than the salt resistant (Sr) (49.8 ± 9 vs 45.3 ± 10 p = 0.002). BMI was found to be increased (27.7 ± 4) without significant gender or incidence of SS differences. We found no association between gender and SS (p = 0.509). After the high sodium and before low sodium diets, the mean difference in urinary Na+ excretion was 165.2 ± 83 mEq/24h, significantly higher among men than women (201.6 ± 84 vs 142.3 ± 75 p = 0.0001). There were no differences based on SS. We did not find significant gender differences in the variation of OBP or ABP, with the changes in the diet. The mean reduction of systolic pressure OBP for the group was 6.13 ± 10 and of diastolic pressure OBP 0.35 ± 5 mmHg. In separate analysis, systolic and diastolic OBP drops were significantly higher in the Ss than in the Sr (9.69 ± 12 vs 2.57 ± 8 and 2.24 ± 7 vs – 0.95 ± 5 mmHg respectively, p = 0.001). The average reduction in systolic ABP was 7.13 ± 8 and in diastolic ABP 3.33 ± 5 mmHg. In separate group analysis we also observed a significantly greater reduction in Ss than in Sr (12.83 ± 7 vs 1.8 ± 5 and 6.56 ± 5 vs. 0.12 ± 3 mmHg respectively, p = 0.001).

Conclusion

In our study group, the reduction of both OBP and ABP following a low sodium diet in normotensive subjects depends on salt sensitivity and is independent of gender and body weight.
#4779 CARDIAC BIOMARKERS FOR THE PREDICTION OF INCIDENT MAJOR ADVERSE CARDIAC EVENTS IN PATIENTS STARTING HAEMODIALYSIS: A REAL-WORLD ANALYSIS
Authors: Mcdowell Garry , Moore Louise , Buckley Benjamin , Austin Philip , Lip Gregory , Rao Anirudh
Published: June 2023

Background and Aims

Despite its advantages, haemodialysis (HD) is associated with increased cardiovascular mortality and morbidity, with some studies reporting 48% higher mortality within 2 years of starting HD. Currently, there are no established prognostic models to stratify cardiovascular risk in incident HD. Cardiac biomarkers provide insight into cardiac structure and function, including myocyte injury, stress, inflammation and fibrosis. We aimed to investigate the prognostic significance of routine cardiac biomarkers (troponin and natriuretic peptides) in the prediction of incident Major Adverse Cardiovascular Events (MACE) within 5 years of commencing HD.

Method

A retrospective cohort study was performed using electronic medical records from a global federated research network from the US (TriNetX). The TriNetX network was searched on 31st January 2023. The cohorts commenced HD post-diagnosis of End-Stage Kidney Disease. Data censoring for MACE was invoked prior to the index event of HD. Cardiac biomarkers were the first reported result within 3 months of starting HD. Cohorts were grouped according to biomarker-specific thresholds and 1:1 propensity-score matched for age, gender, and co-morbidities (hypertension, diabetes mellitus and smoking status). Logistical regression produced odds ratios with 95%CI for 5-year incident MACE. MACE was defined, a priori, as a composite of ischaemic heart disease, angina pectoris, acute myocardial infarction, heart failure, AF, stroke, and all-cause mortality. All statistical analysis was performed on the TriNetX online platform.

Results

The results are shown in Table 1. Results that reached statistical significance (p<0.05) are shown.

Conclusion

Routinely available cardiac biomarkers can predict incident MACE and outcomes in incident HD, although results differ between markers of myocyte injury (troponin) and stress (NTproBNP). The results suggest the clinical need for CV mortality and morbidity risk profiling in incident dialysis using a combination of clinical and laboratory variables.
#4789 ROUTINE CARDIAC BIOMARKERS FOR THE PREDICTION OF INCIDENT MAJOR ADVERSE CARDIAC EVENTS IN PATIENTS WITH GLOMERULONEPHRITIS: A REAL-WORLD ANALYSIS
Authors: Davies Elin , Mcdowell Garry , Buckley Benjamin , Austin Philip , Lip Gregory , Rao Anirudh
Published: June 2023

Background and Aims

Patients with glomerulonephritis (GN) frequently have both proteinuria and decreased kidney function, and together with immunosuppressive therapies used to treat it could lend these patients to a high risk for cardiovascular disease (CVD). We aimed to investigate the prognostic significance of routine cardiac biomarkers (troponin) in predicting incident Major Adverse Cardiovascular Events (MACE) within 5 years of diagnosis of GN.

Method

A retrospective cohort study was performed using electronic medical records from a global federated research network from the US (TriNetX). The TriNetX network was searched on 31st January 2023. Data censoring for MACE was invoked prior to the index event of GN. Cardiac biomarkers were the first reported result within 3 months of diagnosis of GN. Cohorts were grouped according to biomarker-specific thresholds and 1:1 propensity-score matched for age, gender, and co-morbidities (hypertension, diabetes mellitus and smoking status). Logistical regression produced odds ratios with 95%CI for 5-year incident MACE. MACE was defined, a priori, as a composite of ischaemic heart disease, angina pectoris, acute myocardial infarction, heart failure, AF, stroke, and all-cause mortality. The analysis was carried conducted by all-cause GN and individual primary GNs: IgA nephropathy (IgAN), membranous nephropathy (MN), focal segmental glomerulosclerosis (FSGS), and minimal change disease (MCD). All statistical analysis was performed on the TriNetX online platform.

Results

The results are shown below for all-cause GN. Results that reached statistical significance (p<0.05) are shown. The risk of MACE and its components was consistent across the individual GN sub-types IgAN (N = 1802), MN (N = 1674), FSGS (N = 1844) and MCD (N = 2014).

Conclusion

Routinely available cardiac biomarkers can predict incident MACE and outcomes in patients with glomerulonephritis. The results suggest the clinical need for CV mortality and morbidity risk profiling in patients with glomerular disease using a combination of clinical and laboratory variables.
#4795 PEAK SYSTOLIC VELOCITY IN THE KIDNEY INTERLOBAR ARTERIES AS A POSSIBLE SCREENING MARKER OF CKD IN PREGNANT WOMEN
Authors: Maryanova Tatyana , Chechneva Marina , Prokopenko Elena , Chumarnaya Tatyana , Zulkarnaev Aleksei
Published: June 2023

Background and Aims

Currently, pregnancy is increasingly occurring in patients with CKD including patients with chronic renal failure (CRF) - CKD grade 3-5. Physiological renal hyperperfusion and glomerular hyperfiltration in pregnant women leads to a temporary decrease in serum creatinine values even in patients with CRF. Consequently, the CKD diagnosis during pregnancy may be difficult in women without a history of kidney disease, and the degree of kidney damage may be underestimated [1]. The aim of our study was to estimate Doppler sonography of the renal arteries as a possible CKD screening method in pregnant women.

Method

The study included 283 pregnant women (Table 1). Doppler sonography was performed in the main renal, segmental, interlobar and interlobular arteries in left and right kidney at the first, second and third trimesters of pregnancy. Peak systolic velocity (PSV), end-diastolic velocity, pulse index, resistive index and systolic-diastolic ratio were analyzed.

Results

PSV in the renal arteries was significantly lower in pregnant women with CKD 3-5 compared with healthy control group since 22 weeks of pregnancy. However, PSV in the interlobar arteries had a higher diagnostic value. The values of this parameter were significantly lower in pregnant women with all stages CKD compared with healthy control group. We found cut-off points of left and right interlobar arteries PSV for the diagnosis of CKD and CRF at the first, second and third trimesters of pregnancy and cut-off points of right and left interlobar arteries PSV linear combination at the second and third trimesters (Table 2).

Conclusion

In pregnant women, interlobar renal arteries PSV can be used as screening marker of CKD. Additionally, it allows to identify pregnant women with advanced stages of CKD. The linear combination of right and left interlobar arteries PSV has the greatest diagnostic value.
#4803 ANCA RENAL RISK SCORE 2023: THE UPDATED AND REVISED ARRS
Authors: Bate Sebastian , Mcgovern Dominic , Costigliolo Francesca , Mysliveček Marek , Scott Jennifer , Chapman Gavin , Brown Nina , Floyd Lauren , Brilland Benoit , Aydin Mehmet Fethullah , Ilyas Duha , Dhaygude Ajay , Mejia Juan-Manuel , Lees Jennifer , Kollar Marek , Hinojosa Andrea , Yildiz Abdulmecit , François Augusto Jean , Roberts Stephen , Wiech Thorsten , Pusey Charles Dickson , Jones Rachel , Jayne David , Bajema Ingeborg , Jennette Charles , Rosenberg Avi , Stevens Kate , Dhaun Neeraj , Mcadoo Stephen , Tesar Vladimir , Little Mark , Geetha Duvuru , Brix Silke
Published: June 2023

Background and Aims

Reliable prediction tools are needed to improve prognostication and personalisation of treatment in anti-neutrophil cytoplasmic antibody (ANCA) glomerulonephritides (GN). We aimed to validate and update the ANCA Renal Risk Score (ARRS) prediction model.

Method

The ARRS working group collated a retrospective multicentre international longitudinal cohort from referral centres and registries across the globe to revise the ARRS in a validation and recalibration study. The primary endpoint was end stage kidney disease (ESKD) and patients were censored at last follow-up. Cox proportional hazards models were used to reweight risk factors and develop a modified scoring system. Kaplan-Meier estimates, Harrell's C statistics and calibration plots were used to assess model performance.

Results

Of a total of 1591 patients, 1439 were included in the final analyses (959 in the development cohort, 52% male, median age 64 years). The ARRS demonstrated a discrimination of C = 0.800, comparable to the original cohort. Updating the model found an additional useful cut-off for kidney function (K), and serum creatinine replaced glomerular filtration rate which provided higher reliability (K0: <250 μmol/l = 0 points, K1: 250-450 μmol/l = 4 points, K2: >450 μmol/l = 11 points). The risk points for the percentage of normal glomeruli (N) and interstitial fibrosis and tubular atrophy (T) were also reweighted (N0: >25% = 0 points, N1: 10-25% = 4, N2: < 10% = 7, T0: none, mild or < 25% = 0 points, T1: ≥ mild-moderate or ≥ 25% = 3 points). We created four risk groups based on the sum of points: low (0 – 4 points), moderate (5 – 11), high (12 – 18) and an additional very high-risk (21). The model discrimination was C = 0.831 and a supplemental continuous model was developed to supply a patient-specific annual risk. Three-year kidney survival was 96%, 79%, 54%, and 19%, respectively. The ARRS23 performed similarly well in the validation cohort with excellent calibration.

Conclusion

We demonstrated the out-of-sample validity of the ARRS and present here the modified and improved score to optimise prognostication and risk stratification for clinical practice and trials.
#4809 EFFECT OF RITUXIMAB DOSE ON INDUCTION THERAPY IN ABO-INCOMPATIBLE KIDNEY TRANSPLANTATION: A NETWORK META-ANALYSIS USING RECENT DATA
Authors: Song Joon Ho , Hwang Seun Deuk , Kim Jaeho
Published: June 2023

Background and Aims

Rituximab is an essential inducible immunosuppressive agent for ABO-incompatible kidney transplantation (ABOi KT). However, studies on the dosage by country and transplant center are lacking. Therefore, we retrospectively investigated the effects of rituximab induction doses on patient mortality, transplant failure and adverse events.

Method

We included studies mentioning at least two of the eligible induction doses (200 mg, 200–500 mg, or 500 mg) of rituximab during ABOi KT and associated outcomes such as patient survival, graft failure, and bacterial and viral infections. We performed direct and indirect network meta-analyses using a Bayesian model and ranked different rituximab doses using generational mixed treatment comparisons. Publications from 1970 to February 2020 were searched and analyzed using the CENTRAL, MEDLINE, EMBASE, and Science Citation Index Expanded databases. GRADE of network meta-analysis approaches specified four levels of certainty for a given outcome: high, moderate, low, and very low.

Results

Among 5378 patients in 25 trials, glomerular filtration rate, graft loss, antibody-mediated rejection, T-cell-mediated rejection, fungal infection, bacterial infection, and CMV infection did not differ between ABOi groups treated with different doses of rituximab. The effect on mortality was significantly higher in the rituximab 200-500 mg and rituximab 500 mg groups (odds ratio [OR] 2.4, 95% CrI: 1.5-7.4 and OR 1.8.0, 95% CrI 1.2-11.2). The incidence of BK virus was significantly lower in the rituximab 200 mg group than in the other groups.

Conclusion

In ABO-incompatible kidney transplantation, low-dose rituximab is more effective than high-dose rituximab and reduces the risk of serious infection. Due to the small sample size, further randomized controlled trials may be needed to confirm these findings.
#4811 SIZE MATTERS: EFFECT OF NUMBER OF TRANSFUSIONS ON ADVERSE RENAL AND CLINICAL EVENTS IN PATIENTS WITH AKI
Authors: Acosta-Ochoa Isabel , Ardura Paula , Aguilar Gerardo , Coca Armando , Cobo Kenia , Merizalde Carlos , Mendiluce Alicia , Martínez María
Published: June 2023

Background and Aims

AKI and anemia independently worsen the prognosis of hospitalized patients, but their association and adverse effects have been slightly studied. We aimed to investigate the effect of transfusions during hospitalization on hard renal and clinical outcomes of patients with AKI. In addition, we tested the influence of the number of transfusions on mortality between pure AKI (pAKI) and AKI-on-CKD (AoCKD) patients.

Method

Retrospective cohorts’ study, of in-patients with AKI attended by nephrology during a 12-month period. AKI severity was categorized by KDIGO-2012 criteria; we searched in a Hematology administrative data base for transfusions (and their number) during the hospitalization period. We analyzed epidemiological and clinical variables and compared the rates of the hard outcomes Length of Stay (LoS), Acute Hemodialysis (aHD), Dialysis Dependence at Discharge (DDD), and in-hospital Mortality (IHM) between individuals that didn't and received transfusions.

Results

We included 275 individuals, 134 (49%) were transfused; they were older and suffered more DM; with no differences in the ICU hospitalization and Charlson's Index. See Table 1A. We observed that transfused patients were classified more frequently in AKI Stage-3, had longer LoS, aHD, were more frequently dialysis dependent and their mortality rate was higher. See Table 1B. We compared patients with less or more than 5 transfusions; the latter group showed a higher rate of adverse events than the group of ≤4 transfusions. See table 1C. Figure 1 plots the K-M curve for survival between pAKI and AoCKD groups showing an excess mortality associated with the number of transfusions, especially in the AoCKD individuals.

Conclusion

In our study, we found that patients that received transfusions showed worst clinical and renal results including more severe AKI, longer hospital stay, higher rate of acute HD, dialysis dependence at discharge and mortality. We observed that the appearance of these adverse events was associated in a dose dependent manner with the number of transfusions; for these reasons, we consider that number of transfusions should be included in AKI risk models and calculators. Could optimizing the number of transfusions improve the rate of adverse renal and clinical events? We will need prospective and well-powered studies in order to answer this question and to deepen on the issue of AoCKD and worst clinical outcomes if transfused.
#4820 RISK FACTORS FOR INPATIENT MORTALITY IN PATIENTS WITH NON-DIALYSIS CHRONIC KIDNEY DISEASE ADMITTED FOR COVID-19 USING A US NATIONAL SAMPLE
Authors: Morita Sae , Agrawal Akshay , Guevara Nehemias , Carlos Arias , Flores Bessy
Published: June 2023

Background and Aims

Several studies reported that the COVID-19 pandemic has disproportionately affected socioeconomically vulnerable populations. No study evaluated risk factors for inpatient mortality in patients with non-dialysis chronic kidney disease (CKD) admitted with the diagnosis of Covid-19, using a US nationwide sample. This study aimed to elucidate risk factors for mortality in patients with CKD during Covid-19 admissions.

Method

We extracted data from the National Inpatient Sample year 2020, the largest nationally representative inpatient-care database in the US. We created a cohort of all adults with CKD hospitalized for Covid-19 by ICD-10 codes. The outcome was inpatient mortality. We excluded patients with end stage kidney disease on maintenance dialysis and transplant patients. We compared baseline characteristics and used multiple logistic regression to determine risk factors for inpatient mortality in this cohort.

Results

Total of 201,460 admissions with a diagnosis of Covid-19 were detected in patients with non-dialysis CKD. Table 1 showed the baseline characteristics. The mean age was 72.8±0.2 years and females accounted for 43.6%. Of all, White accounted for 52.3%, followed by Black (26.1%) and Hispanic (14.6%). Inpatient mortality was 20.9%. Table 2 showed the results of the multivariable logistic model. Older patients, Males, higher Charlson Comorbidity Index scores were associated with a higher risk of inpatient mortality. White patients had a higher risk compared to Black patients and Native Americans had the highest risk, followed by other ethnic minorities, Hispanic, and Asians. Those from the lowest income households had the highest risk. Admission to a rural, publicly owned hospital and those located in the West and Northeast had higher odds of inpatient mortality.

Conclusion

Our study showed males, race, commercial payment type, lower income, and hospital settings such as regions and location were risk factors for inpatient mortality in patients with non-dialysis CKD. Further studies are needed to evaluate whether differences in clinical practice underly some of these risks.
#4825 AUTOPHAGY REGULATES TUBULAR CELL SENESCENCE IN DIABETIC KIDNEY DISEASE
Authors: Zhang Ying , Zhang Xiao Liang , Zhao Yu
Published: June 2023

Background and Aims

Cellular senescence commonly occurs in innate renal cells of diabetic kidney disease (DKD) and autophagy may be implicated. However, the characteristics of senescent cells in different pathological stages of DKD, and the driving force behind the cell senescence remain primarily unknown. This study aimed to examine kidney cellular senescence and its relationship to renal function in DKD and the effect of autophagy on high-glucose-induced cellular senescence.

Method

According to the DKD pathologic type, 46 patients diagnosed with renal biopsy were categorized into I IIa IIb III IV classes. The other four normal kidney specimens taken from patients with renal trauma were as the control group. Pathological changes in kidney tissues were detected by PAS staining, and the expressions of autophagy-related protein LC3 and senescence marker p21 were demonstrated by immunohistochemical staining. DKD rats were established by intraperitoneal injection with streptozotocin (STZ). HK-2 cells were cultured with 35mM glucose with or without autophagy inhibitor (3-methyladenine, 3-MA) and lysosomal inhibitor (chloroquine CQ). Immunohistochemistry and Western Blot were used to detect the expression of the senescence markers p53 and p21, as well as the autophagy-related proteins LC3 and p62. The electron microscopy technique was used to observe the number of autophagosomes in the DKD rats and each group of HK-2 cells.

Results

(1) In renal tissues of DKD patients, p21 infiltrated the interstitium and tubules, while LC3 was primarily expressed in the tubules. Both p21 and LC3 expression increased over time as the disease progressed (P<0.05) and were directly proportional to blood creatinine and proteinuria, respectively. Additionally, p21 and LC3 expression were positively correlated. (2) Compared with the control group, the renal tissue of DKD rats displayed higher levels of p21, p53, LC3, and p62 expression (P < 0.05), higher levels of renal tubular autophagosomes, and increased co-expression of p21 and LC3 (P< 0.05). (3) HK-2 cells treated with high glucose exhibited increased expression of p21, p53, p62 and LC3, as well as the number of autophagosomes (P<0.05). (4) 3-MA reduced p21 and p53 expression compared to the high glucose group (P< 0.05), whereas the opposite trend was observed in the CQ treatment (P<0.05).

Conclusion

Renal tubular cell senescence is closely associated with DKD progression. Autophagic flow may be involved in high glucose-induced renal tubular cell senescence.
#4835 KIDNEY FUNCTION-SPECIFIC CUT-OFF VALUES OF HIGH-SENSITIVITY CARDIAC TROPONIN T FOR THE DIAGNOSIS OF ACUTE MYOCARDIAL INFARCTION
Authors: Chen Ruixuan , Hou Fan Fan , Nie Sheng
Published: June 2023

Background and Aims

Acute myocardial infarction (AMI) is the leading cause of death worldwide. Patients with kidney dysfunction have high prevalence of AMI, thus early detection of AMI is necessary. However, in patients with decreased estimated glomerular filtration rate (eGFR), using the traditional cut-off value (14 ng/L) of high-sensitivity cardiac troponin T (hs-cTnT) resulted in lower specificity for diagnosing AMI. Our study aims to determine and validate kidney function-specific cut-off values of hs-cTnT for diagnosing AMI in patients with different degrees of kidney dysfunction.

Method

This large, multicenter, observational cohort study included 21,912 hospitalized patients who had undergone coronary angiography in 6 clinical centers from 2013 to 2021. The study outcome was the diagnosis of AMI. In the derivation cohort, kidney function-specific cut-off values of hs-cTnT for diagnosing AMI were determined to improve the specificity without the cost of sensitivity, as compared to that using 14 ng/L as the cut-off value in the normal kidney function group. The efficacy of the novel cut-off values was validated in an independent validation cohort enrolled from another clinical center.

Results

In the derivation cohort (n = 12,900), 3,247 patients (25.2%) had an eGFR <60 mL/min/1.73m2. Even in the absence of AMI, 1485 (50.2%) participants with eGFR <60 mL/min/1.73m2 had a hs-cTnT concentration ≥14 ng/L. Using 14 ng/L as the threshold of hs-cTnT for diagnosing AMI led to a significantly reduced specificity (9.1–52.7% vs. 75.0%) and positive predictive value (15.5–21.1% vs. 28.7%) in patients with kidney dysfunction, as compared with patients with normal kidney function. The kidney function-specific cut-off values (eGFR ≥60 ml/min/1.73m2: 14 ng/L, 60>eGFR≥30 mL/min/1.73m2: 18 ng/L, and eGFR <30 ml/min/1.73m2: 48 ng/L) were determined and remarkably improved the diagnostic accuracy for AMI in participants with different levels of kidney dysfunction (specificity: reach to 52.8–63.0%; positive predictive value: 18.7–33.6%), without compromising sensitivity (96.6–97.9%). The kidney function-specific cut-off values increased the diagnosis accuracy of hs-cTnT for diagnosing AMI in every eGFR subgroup in the independent validation cohort (n = 8,012).

Conclusion

The kidney function-specific cut-off values of hs-cTnT significantly improved the diagnostic accuracy of AMI in patients with kidney dysfunction, and might be generally useful in clinical practice.
#4844 BELIMUMAB AND MULTITARGET THERAPY AS INDUCTION THERAPY OF SEVERE ACTIVE LUPUS NEPHRITIS: CASE SERIES FROM CHINA
Authors: Min Min , Zhang Jiong
Published: June 2023

Background and Aims

Belimumab (BLM) has been approved for the treatment of active systemic lupus erythematosus (SLE) and active lupus nephritis (LN). Multitarget therapy (MT) consisting of tacrolimus (FK506), mycophenolate mofetil (MMF), and steroid has been proved that can provide good curative effect as induction therapy for LN. Because of the limitations of BLM's phase III clinical trails, the exact curative effect in severe active LN of BLM is not clear yet. To assess the safety and generate preliminary efficacy data on MT followed by BLM for severe active Chinese LN patients, a case series were investigated.

Method

Six patients with severe active LN were reported. Among the 6 patients, 2 were treated with MT followed by BLM infusions, 2 were treated with MMF / (FK506) followed by BLM infusions, and 2 were treated with MT. BLM was given 10 mg/kg every 2 weeks for 3 times, then every 4 weeks till Week 24. Primary renal response index, SLEDAI, and safety data were analyzed.

Results

The patients affected by LN ISN/RNP Class III/IV±V with high disease activity are 3 de no LN and 3 refractory LN (each regimen included 1 de no LN and 1 refractory LN). At baseline, the SLEDAI score were 15,20,17,16,15,15 respectively. 4 of the 6 patients (case 1,case 2,case 3, and case 5) accepted intravenous (IV) methylprednisolone, followed by MT/MMF/FK506 after admission. The initial oral prednisone was 30-45 mg/day. Within 2 weeks of starting treatment, IV BLM was introduced. At Week 24, the SLEDAI score decreased to 2,8,8,10,8,10 respectively. 2 patients accepted BLM and MT achieved complete renal remission, and the other 4 patients achieved partial renal remission (Fig. 1). MT and BLM therapy reduced SLEDAI more rapidly than MMF/FK 506 +BLM or MT (Fig. 2). Prednisone was reduced to 10-15 mg/d. No adverse events occurred.

Conclusion

The addition of BLM to basic immunosuppressants was effective and safe for severe active LN. The BLM and MT regimen seems to lead a faster and more pronounced remission. Further prospective clinical studies with larger samples are needed to evaluate the benefits of belimumab combined with MT in severe active LN.
#4865 OBSERVATIONAL PILOT STUDY TO EVALUATE THE RELATIONSHIP BETWEEN LUNG ULTRASOUND AND BIOIMPEDANCE IN HEMODIALYSIS
Authors: Sánchez Gabriel Ledesma , Valdivia Veronica Ruth Mercado , Orjuela Yesika María Amezquita , Mancebo Raquel Diaz , Villalobos Ángel Gallegos , Hernández Yolanda Hernández , Carrillo Rocío Echarri , Ruisánchez Sílvia Caldés , Ojanguren María Covadonga Hevia , García Antonio Cirugeda
Published: June 2023

Background and Aims

There is a clear relationship between volume overload and morbidity and mortality in hemodialysis patients, which makes it essential to accurately adjust the normohydrated weight. For this, bioimpedance has become an indispensable tool in dialysis units. In recent years there has been a rapid development of lung ultrasound for the evaluation of pulmonary congestion through the quantification of B lines. Several studies have shown a correlation between the number of B lines and the volume overload estimated by bioimpedance in patients on dialysis. However, all these studies perform a 28-zone lung ultrasound protocol, which may be a limitation in clinical practice. Several studies have recently been published showing a correlation between 28-zone lung ultrasound protocol and simplified 4, 6, and 8-zone ultrasound protocols, which have been widely studied in patients treated in intensive care or emergency units. We set out to evaluate the relationship between bioimpedance and simplified 8-zone lung ultrasound protocol in hemodialysis patients.

Method

Pilot cross-sectional observation study that included 29 patients on hemodialysis at Infanta Sofía University Hospital during March 2022. Bioimpedance predialysis and postdialysis, 8-zone lung ultrasound protocol (delimited by the parasternal, anterior axillary, posterior axillary, and 4th intercostal space) and inferior vena cava ultrasound. Predialysis proBNP and Ca-125 were measured.

Results

There is a significant reduction in overhydration estimated by bioimpedance and in the number of B lines after the hemodialysis session (p<0.05). No correlation has been established between the two parameters, neither pre-dialysis nor post-dialysis. Nor with the pre-dialysis levels of proBNP or Ca125. There is a correlation of r = 0.45 (p<0.05) in the subgroup of patients from the afternoon shift (n = 9) between the number of B lines and extracellular water.

Conclusion

Lung ultrasound allows the evaluation of the degree of lung congestion, and therefore of extracellular water, becoming a useful tool for adjusting the dry weight of hemodialysis patients. In our study we found no association between the number of B lines in the simplified 8-zone lung ultrasound protocol. It is possible that this type of lung ultrasound is not sensitive enough in outpatients on hemodialysis, but it is sensitive enough in critically ill patients in whom lung overload is greater. Further studies with a larger number of patients are needed for evaluation.