bluuebunny/crossref_metadata_2025 huggingface dataset:
MO682: Serum Total Indoxyl Sulfate is Associated with Intraperitoneal Inflammation and High Peritonitis Episodes in Peritoneal Dialysis Patients
Authors: Stepanova Natalia , Korol Lesya , Driianska Victoria , Snisar Lyudmyla , Lebid Larysa , Kompaniets Olga
Published: May 2022

BACKGROUND AND AIMS

The accumulating evidence presented thus far supports the idea that indoxyl sulfate (IS) is a trigger of chronic inflammation in end-stage kidney disease patients. However, although serum IS is one of the most extensively studied uremic toxins, no single study exists which has investigated the association between serum IS and intraperitoneal inflammation in peritoneal dialysis (PD) patients.

The present study was undertaken to evaluate the association between serum total IS (tIS) concentration and the pro-inflammatory markers in peritoneal dialysis effluent (PDE) and peritonitis episodes in PD patients.

METHOD

In this observational cross-sectional study, we analysed serum tIS concentration and 24-h PDE levels of interleukin 6 (IL-6), tumor necrosis factor-α (TNF-α) and monocyte chemoattractant protein -1 (MCP-1) in 74 PD patients with an average age of 55 (38–64) years and dialysis vintage of 36 (30–58) months. All patients had been undergoing continuous ambulatory PD and had no PD-associated infectious complications for more than 3 months.

Serum concentrations of tIS were determined using the spectrophotometry method. The concentrations of IL-6, TNF-α and MCP-1 in PDE were analysed using ELISA.

For the statistical analysis, we stratified this PD patient cohort into two groups depending on experienced peritonitis: the peritonitis group (n = 48) and the peritonitis-free group (n = 26). The data were presented as the median and the interquartile ranges [Me (Q25–Q75)] and compared using the Kruskal–Wallis test. The Spearmen correlation test was performed to assess the association between IS and the pro-inflammatory markers.

RESULTS

Significant differences were found in serum concentrations of tIS and PDE levels of IL-6 between the peritonitis and the peritonitis-free PD patients (Table 1).

In addition, serum tIS was significantly associated with number of experienced peritonitis episodes (r = 0.26, P = 0.022).

Although PDE levels of TNF-a and MCP-1 did not differ between the peritonitis and the peritonitis-free groups in our cohort, they had a direct association with serum tIS similar to those of IL-6 (Fig. 1, 2).

Moreover, serum tIS was statistically higher in the anuric PD patients compared with the non-anuric patients [33.6 (13.9–74) versus 20.2 (9.3–46) μg/mL, P = 0.043], had a negative association with residual renal function (r = −0.39, P = 0.0017) and, accordingly, total weekly Kt/V (r = −0.27, P = 0.026).

CONCLUSION

Serum tIS concentration has a significant direct association with PDE levels of the pro-inflammatory markers, high peritonitis episodes and their outcomes in PD patients. Further well-designed studies are required to establish the effect of serum tIS concentration on intraperitoneal inflammation and clinical outcomes in PD patients.
MO683: Peritoneal Transport Characteristics, Sodium Sieving and Dialysate Electrolyte Clearance in Peritoneal Dialysis Patients: 4.25% Peritoneal Equilibration Test Analysis
Authors: Liao Ruoxi , MA Dengyan , Zhou Xueli , Zhong Hui
Published: May 2022

BACKGROUND AND AIMS

Peritoneal dialysis (PD) is a well-established renal replacement therapy for patients with end-stage renal disease. The peritoneal equilibration test (PET) is widely used for assessing peritoneal solute transport. Recently, the International Society for PD committee recommended performing PET with 4.25% dextrose solution instead of traditional 2.5% dextrose solution to provide better information on ultrafiltration capacity. This study aims to explore the peritoneal transport characteristics, sodium sieving and electrolyte clearance with PET-4.25%.

METHOD

We conducted a cross-sectional study in PD patients treated in West China Hospital between June 2021 and December 2021. All patients underwent PET-4.25%. Peritoneal transport characteristics, sodium sieving and dialysate electrolyte clearance were analysed.

RESULTS

A total of 108 patients (61 males, 56%; mean age 48 ± 4 years old, median PD duration 17 months) were included. Dialysate to plasma (D/P) creatinine values at 4 h were distributed similarly in PET-2.5% and PET-4.25% (Fig. 1). The dialysate sodium decreased at the beginning of PET-4.25% and gradually increased, while other dialysate electrolyte levels continued to increase or decrease during the 4 h (Fig. 2). Most patients had their maximal sodium dip at 2 h (N = 80, 74%). The mean sodium dip at 1 h was 7.28 ± 2.93 mmol/L (sodium sieving ratio 0.057 ± 0.023), and the mean maximal sodium dip was 8.81 ± 4.18 mmol/L. In both univariate and multivariate analyses, sodium sieving was negatively correlated with 4-h D/P creatinine and glomerular filtration rate (GFR) and positively correlated with PET-4.25% ultrafiltration volume (Fig. 3). The total clearances of sodium, potassium, chloride, calcium, magnesium and phosphate with 2 L of 4.25% dextrose were 66.9 ± 22.4 mmol, 6.64 ± 1.25 mmol, 62.7 ± 27.7 mmol, 0.07 ± 0.27 mmol, 0.63 ± 0.19 mmol and 1.98 ± 0.63 mmol, respectively. The amount of electrolyte clearance was not related to peritoneal transport characteristics. Nine patients were diagnosed with ultrafiltration failure (UFF). Patients with UFF had significantly lower sodium and chloride clearance than non-UFF patients.

CONCLUSION

PET-4.25% could assess peritoneal transport characteristics with similar results to PET-2.5%, while it could provide more information on ultrafiltration capacity. Four-hour D/P creatinine, GFR and ultrafiltration volume are independent predictors for sodium sieving. Dialysate electrolyte clearance is not related to peritoneal transport characteristics, while sodium clearance is decreased in UFF patients.
MO687: Positive Association of Serum Galectin-3 Level with the Peripheral Arterial Disease in Patients with Peritoneal Dialysis
Authors: Mitra Sari Santi , Teng Yi-Yen , Wang Chih-Hsien , Kuo Ch , Hsu Bang-Gee
Published: May 2022

BACKGROUND AND AIMS

Galectin-3 expressed by epithelial cells, endothelial cells and macrophages, with multiple biological abilities, including cell proliferation, differentiation, growth and inflammation; it also participates in cardiovascular development. Peritoneal dialysis (PD) was an independent predictor for further mortality in uremic patients with subclinical peripheral arterial disease (PAD). The aim of this study was to evaluate the relationship between serum values of galectin-3 levels and ankle–brachial index (ABI) values in PD patients.

METHOD

Fasting blood samples were obtained from 92 PD patients. ABI values were measured using an ABI-form device. Serum galectin-3 concentrations were determined by commercially available enzyme-linked immunosorbent assays. Left or right ABI values <0.9 were included in the low ABI group.

RESULTS

A total of 19 PD patients (20.7%) were in the low ABI group. Compared with patients in the control group, patients in the low ABI group had higher prevalence of diabetes (P = 0.010), older age (P = 0.009), higher serum fasting glucose (P = 0.001), triglyceride (P = 0.021), C-reactive protein (P < 0.001), galectin-3 level (P < 0.001), while lower total clearance of creatinine (P = 0.028). Multivariable logistic regression analysis of the factors significantly associated with PAD revealed that serum galectin-3 level [odds ratio: 1.148, 95% confidence interval (CI): 1.032–1.227, P = 0.011] and C-reactive protein level (increase 0.1 mg/dL, odds ratio: 1.324, 95% CI: 1.101–1.592, P = 0.003) were the independent predictor of PAD in PD patients. The area under the curve plotted to estimate the optimal level of galectin-3 predicting PAD in PD patients by the receiver-operating characteristic curve analysis was 0.844 (95% CI: 0.753–0.911, P < 0.001).

CONCLUSION

High serum level of C-reactive protein and galectin-3 were found to be independent risk factors for predicting PAD in PD patients.
MO750: Dialysate Magnesium Impact on Progression of Coronary Artery Calcification
Authors: Kusic Milicevic Jovana , Vidakovic Radosav , Andjelkovic Apostolovic Marija , Apostolovic Branislav , Ostojic Ana , Markovic Rodoljub , Djurkovic Veselinka , Trbojevic Stankovic Jasna , Jemcov Tamara , Dragovic Gordana
Published: May 2022

BACKGROUND AND AIMS

The development of vascular calcifications is accelerated in dialysis patients and is associated with an increased risk of cardiovascular morbidity and mortality. Studies have shown that magnesium (Mg) reduces mineral deposit formation, thus potentially abating the process of vascular calcification. Therefore, the use of higher dialysate-Mg might present a promising tool to reduce vascular calcification. Many in vitro studies have investigated effects of Mg on vascular calcification, but prospective clinical trials are lacking. This study evaluated the difference in coronary artery calcification progression over 12 months based on different concentrations of routinely used dialysate-Mg.

METHOD

This prospective randomized, multicentre study included 60 angina-free chronic haemodialysis (HD) patients distributed into two equal groups based on dialysate-Mg level (0.5 versus 1.0 mmol/L) used routinely before and throughout the study period. Laboratory measurements, including total serum Mg level and coronary artery calcium score (CACS) determined by cardiac computed tomography, were performed in all patients at baseline and after 12 months of follow-up.

RESULTS

Total serum Mg was significantly higher in patients on higher dialysate-Mg, both at baseline and after 12 months of follow-up (P < 0.001). Nevertheless, in both study groups, total serum Mg decreased after 12 months of follow-up; from 1.13 ± 0.15 mmol/L to 0.99 ± 0.14 mmol/L (P < 0.001) in the lower dialysate-Mg group and from 1.39 ± 0.22 mmol/L to 1.29 ± 0.21 mmol/L (P < 0.001) in the higher dialysate-Mg group. CACS increased significantly in both study groups after 12 months: from 361.90 ± 725.67 to 480.00 ± 783.53 (P <0.001) in the lower dialysate-Mg group and from 437.71 ± 573.77 to 589.07 ± 682.82 (P < 0.001) in the higher dialysate-Mg. Still, the mean change in CACS (ΔCACS) did not differ significantly between the study groups (109.29 ± 181.99 versus 151.86 ± 211.22;  P = 0.321). In patients with CACS = 0 at the beginning of the study (4 in the lower and 5 in the higher dialysate-Mg group), the mean ΔCACS was 21.25 ± 3.96 and 0 (P = 0.180), respectively.

CONCLUSION

Routine use of higher dialysate-Mg (1.0 mmol/L) increases total serum Mg level compared with standard dialysate-Mg solutions (0.5 mmol/L). However, this was not associated with lower CACS progression over 12 months of follow-up. Further research is needed to assess if patients with CACS = 0 may benefit from higher dialysate-Mg in terms of reduced calcification progression compared with standard dialysate-Mg solutions.
MO751: Calciphylaxis is Characterized by Pyrophosphate Deficiency in Dialysis Patients: A Pilot Study
Authors: Nigwekar Sagar , St Hillien Shelsea , Seethapathy Rituvanthikaa , Krinsky Scott , Torcatti Jeanfranco , Howe Jennifer , Kalim Sahir , Portales-Castillo Ignacio , Mengesha Beza , Wen Wen , Cizman Borut , Sabbagh Yves
Published: May 2022

BACKGROUND AND AIMS

Calciphylaxis is a rare but devastating disorder predominantly affecting patients with end-stage kidney disease [1]. Patients with calciphylaxis present with painful ischemic skin lesions caused by microvascular occlusion secondary to calcification, intimal hyperplasia, and thrombosis. In experimental models and in genetic disorders of mineralization, deficiency of pyrophosphate (PPi) results in vascular calcification and neointimal formation [2–4]. We investigated the role of PPi deficiency in the development of calciphylaxis and explored whether PPi levels predict outcomes among patients with calciphylaxis.

METHOD

As part of the ongoing national-level calciphylaxis registry work (ClinicalTrials.gov Identifier: NCT03032835) [5], we prospectively enrolled 14 dialysis-dependent patients with calciphylaxis (cases) and 7 dialysis-dependent patients without calciphylaxis (controls) matched for age, sex and race. Clinical data and blood samples were collected at enrolment. PPi levels were measured using an ATP Sulfurylase/Luminescence-Based Method for the quantification of inorganic PPi in human plasma and were compared between cases and controls using the Kruskal–Wallis test. Associations between PPi levels and clinical outcomes (ulcer formation, number of skin lesions and 1-year mortality) were explored.

RESULTS

The average age of calciphylaxis cases and controls was 62 and 61 years, respectively; 53% were women and 53% were Caucasian. The prevalence of diabetes mellitus, obesity, coronary artery disease and peripheral arterial disease were 71%, 23%, 29% and 53%, respectively and comparable between cases and controls. Warfarin exposure was present in 19% of cases. Most patients with calciphylaxis had ulcerated skin lesions involving abdominal wall and/or thighs. Median number of calciphylaxis skin lesions was 2 [interquartile range (IQR) 1–4]. Serum levels of calcium, phosphate, intact parathyroid hormone, 25-OH vitamin D and alkaline phosphatase were similar between cases and controls. Compared with controls, however, patients with calciphylaxis had lower plasma PPi levels [0.32 μM (IQR 0.19–0.70) versus 0.64 μM (IQR 0.46–1.08);  P = 0.03]. Plasma PPi levels demonstrated a modest correlation with skin lesion count (r = –0.35) but were similar between patients with and without ulcer formation. Lower plasma PPi levels predicted 1-year mortality (Fig. 1).

CONCLUSION

In this pilot study, dialysis-dependent patients with calciphylaxis had lower levels of plasma PPi compared with controls. Plasma PPi levels predicted 1-year mortality among patients with calciphylaxis. Additional data from a larger study and longitudinal assessments of PPi levels are needed to support future clinical intervention trials targeting the PPi pathway in calciphylaxis.
MO757: Prevention of Vascular Calcification by the Endogenous Chromogranin a-Derived Mediator that Inhibits Osteogenic Transdifferentiation
Authors: Jankowski Joachim , Orth-Alampour Setareh , Jankowski Vera , Argiles Ciscart Angel , Gayrard Nathalie
Published: May 2022

BACKGROUND AND AIMS

The adrenal glands participate in cardiovascular (CV) physiology and the pathophysiology of CV diseases through their effects on sodium and water metabolism, vascular tone and cardiac function.

METHOD

In this study, we identified a new adrenal compound controlling mesenchymal cell differentiation that regulates osteoblastic differentiation in the context of vascular calcification.

RESULTS

This peptide was named the ‘calcification blocking factor’ (CBF) due to its protective effect against vascular calcification and is released from chromogranin A via enzymatic cleavage by calpain 1 and kallikrein. CBF reduced the calcium content of cells and thoracic aortic rings under calcifying culture conditions, as well as in aortas from animals treated with vitamin D and nicotine (VDN animals). Furthermore, CBF prevented vascular smooth muscle cell (VSMC) transdifferentiation into osteoblast-like cells within the vascular wall via the sodium-dependent phosphate transporter PIT-1 and by inhibition of NF-κB activation and the subsequent BMP2/p-SMAD pathway. Pulse pressure, a marker of arterial stiffness, was significantly decreased in VDN animals treated with CBF. In line with our preclinical data, CBF concentration is significantly reduced in diseases characterized by increased calcification, as shown in patients with chronic kidney disease. In preparation for clinical translation, the active site of the native 19-AS long native CBF was identified as EGQEEEED.

CONCLUSION

In conclusion, we have identified the new peptide CBF, which is secreted from the adrenal glands and might prevent vascular calcification by inhibition of osteogenic transdifferentiation. The anti-calcific effects of CBF and short-active sites may therefore promote the development of new tools for the prevention and/or treatment of vascular calcification.
MO798: Impact of Body Composition on Erythropoietin Resistance Index in Patients Receiving Chronic Hemodialysis
Authors: Yun Lee Hyang , Cho Heejin , Shin Jungho , Ho Hwang Jin , Hyun Kim Su , Bin Park Sung
Published: May 2022

BACKGROUND AND AIMS

Erythropoietin resistance index (ERI) seems to be a predictor for adverse outcomes in patients receiving chronic hemodialysis. Despite the role of erythropoietin in non-hematopoietic tissues such as skeletal muscle or fat, clinical studies investigating the association between body composition and ERI are still lacking. The aim of this study was to examine the longitudinal impact of body composition on ERI in patients on chronic hemodialysis.

METHOD

This study included outpatients on chronic hemodialysis who received body composition analysis, which was performed every 6 months. The ERI was calculated by dividing the weekly body weight-adjusted erythropoietin dose by the hemoglobin concentration, and the values were averaged every 3 months period. The relationship between body composition and baseline ERI was evaluated in the multiple linear regression analysis, and the trend of ERI over time according to the changes in body composition was analyzed using a linear mixed effect model.

RESULTS

There were 65 (52.8%) men and 58 (47.2%) women, and they were followed up for 24 (5, 75) months. Subjects with higher mean ERI during the study period had increased risks for all-cause death, cardiovascular events and infection requiring hospitalization, compared with those with lower mean ERI (P = .009, .076 and .051). Linear regression analyses found that the ERI was negatively correlated to body mass index, % body fat, arm circumference, arm muscle circumference, and visceral fat area (P = .067, .065, .002, .021 and .040). However, the ratio of extracellular water to total body water and skeletal muscle mass index was not related to ERI. The longitudinal trend of ERI was compared according to the slope of body composition parameters over time. The increase in ERI was associated with the increase in the ratio of extracellular water to total body water (P = .007). On the other hand, the trajectory of ERI was inversely related to the longitudinal changes in arm circumference, arm muscle circumference and visceral fat area (P = .002, P < .001 and P = .026).

CONCLUSION

The ERI seems to be associated with body composition; therefore, body composition analysis can be useful to predict erythropoietin resistance in patients receiving chronic hemodialysis. Further studies are needed to investigate whether lifestyle modifications, including nutrition and exercise, can result in positive effects on body composition and responsiveness to erythropoietin.
MO806: Change in Pth Measuring Method Affects the Cost of Pth-Lowering Treatment
Authors: Kuroki Aki , Shimura Satoru , Kikuchi Rie , Yanagida Toshihiro , Tsuboi Takahiro , Inagaki Kazuyuki , Ohashi Yasushi
Published: May 2022

BACKGROUND AND AIMS

To control mineral and bone disorders in haemodialysis (HD) patients, doses of vitamin D analogues and calcimimetics are adjusted based on serum parathyroid hormone (PTH) levels. Accordingly, method-related differences in PTH results may influence the prescribed dose of those drugs and PTH-lowering treatment costs. The aim of this study was to clarify the influence of inter-method variability in PTH measurement on PTH-lowering treatment costs.

METHOD

We used data from 30 maintenance HD patients in our facility. The Intact-PTH measuring assay was changed from the Elecsys PTH to the Alinity Intact PTH Reagent Kit (Alinity PTH) in March 2021, following a 2-month transitional period when PTH levels were measured using both assays. We examined method-related differences in PTH levels, using the results obtained in the transitional period. Using prescription records from October to December 2020, when the Elecsys PTH assay was used, and those from March to May 2021, when assay system was fully changed to the Alinity PTH, we examined the influence of the PTH measuring method on medication cost by evaluating the monthly cost of vitamin D analogues and calcimimetics in our facility. We evaluated the mean levels of serum calcium, phosphorus and PTH in 30 patients in the corresponding period.

RESULTS

Inter-method variability in PTH results was evaluated using 60 specimens from 30 patients.

PTH results of 60 specimens ranged from 11 to 802 pg/mL and 8.8 to 1198 pg/mL in the Elecsys PTH and in the Alinity PTH, respectively. Compared with PTH levels obtained with the Elecsys PTH, those measured with the Alinity PTH were significantly higher (P < .001). On average, results obtained with the Alinity PTH were 1.58-fold higher than those provided by the Elecsys PTH.

When the Elecsys PTH assay was used, the average monthly cost of vitamin D analogues and calcimimetics was €44 and €1668, respectively. After the assay was changed to the Alinity PTH, the average monthly costs were €40 for vitamin D analogues and €2471 for calcimimetics (€1 = ¥130). There were no notable changes in the mean serum levels of calcium, phosphorus and PTH throughout the study period.

CONCLUSION

Inter-method variability in PTH results would have an influence on the cost-effective assessment of PTH lowering therapy. Standardization of PTH measurement is required.
MO846: Temporal Evolution of Humoral Response in Haemodialysis Patients Vaccinated With Two Doses of CHADOX1-S Vaccine
Authors: Sharma Amit , Ramachandran Raja , Jit Singh Gill Harinder , Singh Divya
Published: May 2022

BACKGROUND AND AIMS

Patients on long term haemodialysis have been found to be more vulnerable to COVID-19 infection with greater severity of infection and mortality rates. Vaccination is instrumental in preventing morbidity and mortality in this group. The study was conducted to evaluate the humoral response of vaccination in patients on long term haemodialysis and its evolution over time.

METHOD

The study was conducted between March 2021 and December 2021. It included 59 patients who received two doses of ChAdOx1-S vaccine. Demographic data was collected and antibody level against the S1 subunit of SARS-CoV-2 spike protein antigen was measured 4 weeks and 26 weeks after the administration of second dose. The patients were divided into 2 groups based on time interval between the two doses (Group I: up to 6 weeks and Group II: >6 weeks).

RESULTS

The mean age of the patients was 62.57 years. Out of 59 patients, 38 (64.40%) were males. 31 patients (52.54%) had history of diabetes mellitus (DM) and 7 (11.86%) had history of COVID-19 infection at least 3 months prior to vaccination (Table 1). Four weeks after the administration of second dose, antibodies to SARS-CoV-2 spike protein were present in 53 (89.83%) patients. 85.29% patients (29 out of 34) in group I and 96% patients (24 out of 25) in group II had detectable antibodies. There was a wide variation between the anti-spike antibody levels in the patients, ranging from 0.4 to as high as 18 933 U/mL (Figure 1) and the levels remained high even 26 weeks after the second dose of the vaccine. Antibodies to SARS-CoV-2 spike protein were present in 49 (92.45%) patients out of the total 53 patients in whom 26 weeks had elapsed after second dose of vaccination. 91.17% patients (31 out of 34) in group I and 94.7% (18 out of 19) in group II had detectable antibodies after 26 weeks of receiving second dose of the vaccine.

CONCLUSION

The study provides evidence that two doses of ChAdOx1-S vaccine generate good antibody response in majority of patients on long-term haemodialysis. It is sustained at 26 weeks post second dose of vaccine. Increasing the time interval between two doses of the vaccine lead to better humoral response. The antibody levels decrease over time necessitating the administration of booster doses.
MO847: C-Reactive Protein to Albumin Ratio and 6-Month Mortality in Incident Haemodialysis Patients
Authors: Sant'ana Mariana , Marques Da Silva Bernardo , Branco Carolina , Costa Claudia , Peres Nadiesda , Cardoso Ana , Mafalda Abrantes Ana , Agapito Fonseca José , Outerelo Cristina , Resina Cristina , António Lopes José , Gameiro Joana
Published: May 2022

BACKGROUND AND AIMS

The prevalence of chronic kidney disease (CKD) is growing worldwide and ranges from 8% to 16%. Mortality rates are higher in the first few months of haemodialysis (HD). Protein-energy malnutrition has been demonstrated to be a major risk factor for mortality in this population. The C-Reactive Protein to Albumin ratio (CAR) has been associated with increased mortality risk. We aimed to evaluate if CAR could be used to predict 6-month mortality in incident HD patients.

METHOD

Retrospective analysis of CKD patients who initiated chronic HD between January of 2014 and December of 2019 in a tertiary-care hospital in Portugal. CAR was calculated at HD start. We analyzed 6-month mortality. Variables were submitted to univariate and multivariate analysis to determine factors predictive of 6-month mortality after HD start. We assessed the logistic regression method of the CAR to predict 6-month mortality and the discriminatory ability was determined using the receiver operating characteristic (ROC) curve.

RESULTS

A total of 787 patients were analyzed (mean age 68.34 ± 15.5 years and 60.6% male). The 6-month mortality was 13.8% (n = 109). Patients who died were significantly older [76.50 ± 11.39 versus 67.29 ± 15.52 years; P < 0.001, OR: 1.055 (1.035–1.074); P < 0.001, aOR: 1.058 (1.030–1.086); P < 0.001], had more frequently cardiovascular disease [65.1% versus 46.1%; P < 0.001, OR: 2.192 (1.437–3.342); P < 0.001, aOR: 2.210 (1.210–4.037); P = 0.010], central venous catheter at HD start [83.5% versus 58.3%; P < 0.001, OR: 3.622 (2.136–6.142); P < 0.001, aOR: 3.090 (1.584–6.026); P < 0.001], lower PTH [229.44 ± 170.50 versus 365.95 ± 415.80;  P = 0.006, OR: 0.998 (0.996–0.999); P < 0.001, aOR: 0.998 (0.997–1.000); P = 0.014] and higher CAR [2.85 ± 3.85 versus 1.36 ± 2.44;  P < 0.001, OR: 1.159 (1.086–1.236); P < 0.001, aOR: 1.126 (1.023–1.239); P = 0.015]. The AUC for mortality prediction was of 0.706 [95% confidence interval (0.65–0.76); P < 0.001]. The optimal CAR cut-off was >0.5,  with an odds ratio of 5.362 (95% CI 3.208–8.963; P < 0.001).

CONCLUSION

In our study, we demonstrated that higher CAR was independently associated with a higher mortality rate in the first 6 months of starting HD, highlighting the prognostic importance of malnutrition and inflammation in patients starting chronic HD.
MO880: Clinical Characteristics Associated With Human Activity Profile Scores in Hemodialysis Patients With Thyroid Dysfunction: A Substudy of the NIH THYROID-HD Trial
Authors: Otobe Yuhei , Nguyen Danh , Guerrero Yalitzi , Narasaki Yoko , You Amy , Kalantar-Zadeh Kamyar , Rhee Connie
Published: May 2022

BACKGROUND AND AIMS

Low physical activity is common in hemodialysis (HD) patients and is associated with adverse outcomes in this population (poor health-related quality of life, cardiovascular [CV] disease, death). Prior studies show that hypothyroidism is highly prevalent in HD patients, and is associated with worse self-reported physical function.

METHOD

In a substudy of the ongoing multi-center NIH THYROID-HD Trial, we examined baseline physical activity scores determined by the Human Activity Profile (HAP), a validated 94-item instrument assessing daily activities across a wide range of energy expenditures, in HD patients with TSH levels in the high-normal (TSH >3–5 mIU/L) and subclinical hypothyroid range (TSH >5–10 mIU/L). The HAP was used to derive the Maximum Activity Score (MAS) and Adjusted Activity Score (AAS), representing greatest and mean estimated energy expenditures, respectively (range 0–94, segmented to low [<52], moderate [54–73] and high [>74] scores).

RESULTS

Among 100 HD patients who underwent baseline HAP assessment, the mean ± SD MAS and AAS scores were 48 ± 22 and 23 ± 27,  respectively; median (IQR) MAS and AAS scores were 49 (31–64) and 9 (0–39), respectively (Figure 1). In the overall cohort, 83% had low, 10% moderate and 7% high AAS scores. MAS and AAS scores were significantly lower in patients who had underlying diabetes versus those without diabetes (Table 1). There was also a trend towards lower (worse) MAS and AAS scores among older versus younger patients (≥65 versus >65 years, respectively) and patients with underlying coronary artery disease (CAD) versus those without CAD. In logistic regression analyses, older age (+∆ 1-year increments) was associated with higher likelihood of low MAS scores, and diabetes trended towards a significant association (defined as < median of observed values) (ref: MAS ≥ median): ORs [95% confidence intervals (95% CIs)]: 1.04 (1.01–1.09); P = 0.005 and 2.57 (0.96–6.86); P = 0.06, respectively. Similarly, older age (+∆ 1-year increments) and diabetes were each associated with higher likelihood of low AAS scores (defined as < 52) (ref: moderate-high AAS scores): ORs (95% CIs): 1.06 (1.02–1.11); P = 0.01 and 4.83 (14.6–16.0); P = 0.01, respectively.

CONCLUSION

In this substudy of the NIH THYROID-HD Trial, HAP scores in HD patients with high-normal and subclinical hypothyroid range TSH levels were lower than observed in prior historical dialysis cohorts that did not have underlying thyroid dysfunction. Additionally, older age and diabetes were each associated with worse HAP scores. Further research is needed to determine the impact of thyroid hormone replacement on improving physical activity and function in this population, particularly those of elder age and with underlying diabetes.
MO931: Serum Uric Acid—A Marker of Malnutrition and Mortality in Patients Undergoing Maintenance Haemodialysis
Authors: Petreski Tadej , Ocepek Andreja , Piko Nejc , Ekart Robert , Hojs Radovan , Bevc Sebastjan
Published: May 2022

BACKGROUND AND AIMS

Malnutrition in patients on maintenance haemodialysis (HD) develops along different pathways, and factors contributing to the development of malnutrition may be categorized as of iatrogenic and non-iatrogenic origins. Iatrogenic factors are an inadvertent consequence of dialysis for HD patients (e.g. removal of uremic solutes), whereas non-iatrogenic factors develop spontaneously from different factors accompanying the progression of kidney disease but are not related to the primary treatment (e.g. low dietary energy and protein intake). Malnutrition is prevalent in 28%–54% HD patients and is an important risk factor for mortality. The aim of our study was to investigate the impact of serum uric acid (SUA) and other non-invasive markers of malnutrition on the survival of maintenance HD patients.

METHOD

We performed a study on 77 HD patients without malignant disease who were observed from January 2016 until their death or January 2021. Their median age was 63.0 (IQR 19) years, and their dialysis vintage was 1449 (IQR 1848) days. We recorded past medical history, laboratory tests and basic demographic data and performed bioelectrical impedance analysis with BodyStat (BodyStat Ltd). Patients who were at risk for malnutrition, based on nutrition screening tools, received oral nutritional supplements (ONS). SUA was measured every 2 months and the mean value was used for analysis. Kaplan–Meier survival analysis and Cox's regression were performed.

RESULTS

Included patients (51.9% males) had diabetes mellitus (33.8%), arterial hypertension (87.0%), ischemic heart disease (24.7%), chronic obstructive lung disease (3.9%), liver disease (3.9%) and were smokers (14.3%). They received an ONS in 63.6%. During the observation period, 50.6% of them died. We created tertile groups (low, medium and high) based on mean SUA < 294 μmol/L, 294–337 μmol/L and > 337 μmol/L, respectively. The low group had significantly lower body mass index (BMI) (P = 0.044), total iron binding capacity (TIBC) (P = 0.001), phase angle (P = 0.003) and dry lean mass (DLM) (P = 0.048), however there were no significant differences in prescription of ONS (P = 0.092). Kaplan–Meier survival analysis showed significantly higher mortality for patients in the low tertile group (P = 0.004). In Cox's regression model, SUA remained significant when adjusted for age, sex, BMI and comorbidities (P = 0.026). However, when adjusting for other markers of malnutrition and receiving ONS, only phase angle, albumin, DLM, fat free mass index and TIBC remained statistically significant.

CONCLUSION

Low SUA levels in chronic HD patients are associated with lower survival and can help identify individuals who are at risk for malnutrition. Further studies should be done to guide possible interventions.
MO941: Novel Peripheral Molecular Markers Predict Premature Graft Loss: Lessons Learned from Operational Tolerance Assessment
Authors: Hruba Petra , Klema Jiri , Wu Le Anh , Girmanova Eva , Mrazova Petra , Massart Annick , Abramowitz Daniel , Abramowicz Marc , Viklicky Ondrej
Published: May 2022

BACKGROUND AND AIMS

TOMOGRAM, a European multicenter study, recently identified a new cohort of kidney transplant recipients (KTR) with operational tolerance (OT) with the aim to identify new transcriptomic signatures of OT.

METHOD

RNA sequencing of peripheral blood was evaluated in 15 OT KTR identified by TOMOGRAM, 23 stable KTR (≥15 years, STA), 14 KTR with transplant glomerulopathy (≥1 year, CR), 14 CyA-treated primary GN patients and 14 healthy controls (HC). The ability to discriminate OT from others was analyzed using three classifiers (GLMNET, voomNSC and SVM-RFE) with 10-fold cross-validation and visualized by principal component analysis (PCA) of molecular archetypes.

RESULTS

Peripheral blood transcriptome of OT patients is similar to the STA group (AUC < 0.6) and different from the CR group (AUC > 0.8). Also, in PCA of molecular archetypes, direction of correlation suggested similarity between STA and OT and their anti-correlation to CR (Figure 1). Top 10 transcripts differentiated OT from CR were assessed in prospective independent cohort (n = 396) to predict premature graft loss. Multivariable Cox regression model based on the expression of 5 of those transcripts at 3 time-points was associated with graft loss at 3 years with an AUC = 0.815.

CONCLUSION

Identification of the OT peripheral molecular signature among stable KTR is not feasible. Instead, novel peripheral molecular markers associated with premature graft loss were identified.
MO981: DE Novo Heart Failure After Kidney Transplantation: Epidemiology, Risk Factors and Outcomes
Authors: Van Rhijn Peter , Mark Patrick , Thomson Peter , Mangion Kenneth , Stoumpos Sokratis
Published: May 2022

BACKGROUND AND AIMS

Although the risk for congestive heart failure (CHF) decreases after kidney transplantation (KT) compared with dialysis, it remains a significant clinical concern associated with a higher risk of mortality, cardiovascular events and kidney graft loss. Available epidemiological data on CHF after KT are limited, outdated and have mostly focused on traditional risk factors. We aim to describe the risk, predictors and outcomes associated with de novo CHF after KT.

METHOD

We used electronic patient records from the West of Scotland renal database to retrospectively investigate de novo CHF in adult kidney transplant recipients between 1 January 2010 and 31 March 2020. Heart failure was ascertained using a combination of physician-reported diagnosis, echocardiographic criteria, radiological evidence of heart failure and elevation of NT-proBNP levels. Participants were followed up until 15 April 2021. Multivariable regression analysis was used to identify independent correlates of post-transplantation de novo CHF (odds ratio [OR] and 95% confidence interval [CI]) and examine de novo CHF as a predictor of death and graft loss after transplantation.

RESULTS

One hundred and four (8.9%) of 1172 transplant recipients had de novo CHF [mean age, 50 ± 13 years; 470 (40%) women]. The cumulative incidences of de novo CHF were 3.8% (95% CI: 2.9–5.1), 5.2% (95% CI: 4.1–6.7) and 7.1% (95% CI: 5.6–8.9) at 1, 3 and 5 years, respectively. Risk factors for de novo CHF included older recipient age (OR: 1.04; 95% CI: 1.02–1.06; P < 0.001), pre-transplantation diabetes mellitus (OR: 1.9; 95% CI: 1.1–3.2; P = 0.014), pre-transplantation vascular disease (OR: 2.2; 95% CI: 1.3–3.7; P = 0.003), pre-emptive kidney transplant (OR: 0.4; 95% CI: 0.2–0.9; P = 0.024) and the presence of a functional fistula at time of transplantation (OR: 2.3; 95% CI: 1.1–4.9; P = 0.025). In separate analyses, de novo CHF predicted death (OR: 3.3; 95% CI: 1.5–7; P = 0.002) and death-censored graft failure (OR: 5.1; 95% CI: 2.8–9.3; P < 0.001).

CONCLUSION

Congestive heart failure is a common complication after kidney transplantation associated with markedly increased risk for death and graft loss. Identification and optimization of pretransplantation risk factors for CHF and pre-emptive transplantation, suggests targets for improving outcomes.
MO983: Effect of Haptoglobin Gene Polymorphism On Covid-19 Severity in Kidney Transplant Recipients
Authors: Ural Zeynep , Helvacı Özant , Korucu Berfu , Gönen Sevim , Derİcİ Ülver , Arinsoy Turgay
Published: May 2022

BACKGROUND AND AIMS

The SARS-CoV-2 pandemic has become one of the most serious health problems globally. Covid-19 poses a serious life-threatening risk, especially for immunocompromised patients such as kidney transplant recipients. However, the reason why some transplant recipients are asymptomatic while others are severely ill is still not clear. Genetic variation might affect the outcome and mortality of Covid-19 infection. Haptoglobin (Hp) is a plasma protein with antioxidant, immunomodulatory properties and has an important biological function in the host defense responses to infection and inflammation [1]. In humans, Hp is characterized by a molecular heterogeneity with three main genotypes/phenotypes: Hp1-1, Hp2-1, and Hp2-2 [2, 3]. This polymorphism might have important biological consequences in various bacterial and viral infections [3, 4]. In the present study, we aimed to evaluate whether haptoglobin gene polymorphisms effect Covid-19’s severity in kidney transplant patients.

METHOD

About 229 renal transplant recipients were evaluated in retrospective fashion. Patients with a history of Covid-19 infection (n:62) were included in the study. We investigated the relation between Hp phenotypes (Hp 1–1, Hp 1–2, Hp 2–2) and Covid-19 disease severity.

RESULTS

Baseline characteristics, laboratory and health parameters were similar between Hp 1–1, Hp 1–2 and Hp 2–2 groups. We found that Hp2-2 phenotype was a significant predictor of disease severity in renal transplant recipients with Covid-19 (p:0013). Hp 2–2 phenotype was significantly associated with longer hospitalizations and intensive care unit admissions (p:0012 and p:0032).

CONCLUSION

Renal transplant recipients with the Hp 2–2 phenotype might have worse outcomes with Covid-19. It has been suggested that the Hp2-2 phenotype predisposes to greater oxidative stress and more pronounced viral replication [5]. Thus, the HP 1–1 protein has been described superior antioxidant and anti-inflammatory properties compared with the other two genotypes. This difference and geographic variation in haptoglobin phenotypes may be one of the factors contributing to the geographical variation in Covid-19 disease severity and mortality. Hp phenotype may be useful in the risk stratification algorithm and management of Covid-19. Studies involving more patients will be welcome to enlighten Hp genes effect on this subject.
MO1035: Adipokine Profile and Protein-Energy Wasting in Children with Chronic Kidney Disease
Authors: Karava Vasiliki , Dotis John , Kondou Antonia , Christoforidis Athanasios , Taparkou Anna , Farmaki Evangelia , Liakopoulos Vassilios , Kollios Konstantinos , Printza Nikoleta
Published: May 2022

BACKGROUND AND AIMS

This cross-sectional study investigates the association between adipokine profile, serum interleukin-6 (IL-6) levels and protein-energy wasting (PEW) in children with chronic kidney disease (CKD).

METHOD

Serum adiponectin, leptin, resistin and IL-6 were measured in 53 patients, with a median age of 12.9 years, presenting CKD stage 3–5. Body composition indices, lean tissue (LTI) and fat tissue index (FTI), were measured by bioimpedance analysis spectroscopy. PEW was defined as the presence of muscle wasting [LTI adjusted to height and age (LTI HA) Z-score < −1.65 SD] and at least two of the following criteria: poor growth [height Z-score < −1.88 SD], questionnaire-based reduced appetite, or serum albumin ≤ 3.8 g/dL.

RESULTS

PEW was present in 8 (15.1%) patients. At least 1,2,3 and 4 PEW criteria were present in 25 (47.2%), 16 (30.2%), 9 (17%), 3 (5.6%) patients respectively. Among the PEW criteria, muscle wasting was present in 18 (34%), poor growth in 14 (30.2%), reduced appetite in 8 (15%) and low serum albumin in 13 (24.5%) patients respectively. PEW was more frequent in CKD stage 5 (P = .010). Adiponectin and resistin levels were higher in CKD stage 5 (P < .001, P = .005), while leptin did not differ among CKD stages (P = .440). Adiponectin was negatively correlated to LTI HA (rs =− 0.417, P = .002), leptin was positively correlated to FTI (rs = 0.620, P < .001), while resistin was not correlated to body composition indices. IL-6 was positively correlated only to adipokine resistin (rs = 0.513, P < .001). Adiponectin and IL-6 were associated with PEW after adjustment for CKD stage [odds ratio (OR) 1.239, 95% confidence interval (95% CI) 1.040, 1.475 and OR 1.034, 95% CI 1.007–1.06), leptin was not associated with PEW, while resistin association with PEW lost significance in multivariate analysis.

CONCLUSION

In advanced paediatric CKD, adiponectin and resistin are probably involved in muscle wasting and systemic inflammation process respectively. Serum leptin reflects adiposity status. Apart from serum inflammatory cytokines, serum adiponectin may be a useful biomarker of PEW in children with CKD.
MO1036: 24-H Central Blood Pressure is Related to Renal Lesions in Children with Tuberous Sclerosis Complex
Authors: Skrzypczyk Piotr , Maria Wabik Anna , Szyszka Michał , Jozwiak Sergiusz , Wroniewicz Tobiasz , Bujanowicz Adam , Bombinski Przemyslaw , Jakimow-Kostrzewa Aleksandra , Brzewski Michal , Panczyk-Tomaszewska Malgorzata
Published: May 2022

BACKGROUND AND AIMS

Adult data show that in people with tuberous sclerosis complex (TSC), blood pressure is related to the extent of renal involvement. Central blood pressure and 24-h ambulatory blood pressure are stronger predictors of a cardiovascular burden compared to office peripheral blood pressure. The study aimed to analyse 24-h central blood pressure and its relation with renal involvement in paediatric patients with TSC.

METHOD

In a group of 32 children with TSC (9.6 ± 4.4 years, 16 boys, 16 girls), we evaluated peripheral and central 24-h ambulatory blood pressure, office peripheral blood pressure, medications used, renal lesions in magnetic resonance and ultrasonography, including the presence of angiomyolipoma (AML), atypical AML, cysts and their maximal diameter (mm) and laboratory parameters.

RESULTS

In the studied group, 20 (62.5%) children had renal angiomyolipomas, including 5 (15.6%) with atypical angiomyolipomas, 22 (68.8%) with renal cysts and 4 children (12.5%) were treated with mTOR inhibitors (2 patients with everolimus and 2 patients with sirolimus) at the moment of evaluation, glomerular filtration rate (GFR) was 127.4 ± 36.7, one patient had GFR 80.5, 22 patients had GFR between 90 and 139 and 9 patients had hyperfiltration defined as GFR > 140 mL/min/1.73 m2. A total of 4 (12.5%) children had elevated blood pressure in ABPM. The 24-h central systolic and diastolic blood pressure correlated with maximal diameter of renal cysts (mm) (r = 0.359, P = .044; r = 0.466, P = .029) and urinary albumin loss (mg/24-h) (r = 0.511, P = .004; r = 0.478, P = .021), 24-h central systolic, mean blood pressure and pulse pressure with serum cystatin-C (ng/mL) (r = 0.523, P = .005; r = 0.464, P = .015; r = 0.419, P = .029); 24-h peripheral MAP Z-score correlated with cyst size (mm) (r = 0.571, P = .021). No significant correlations between presence and AML size and peripheral and central blood pressure were found in the study group. There were following positive correlations of arterial stiffness parameters: 24-h central augmentation index (24hcAI x 75HR) with total cholesterol (r = 0.357, P = .045) and ambulatory arterial stiffness index (AASI) with uric acid (r = 0.520, P = .003). Size of AML correlated with age (r = 0.468, P = .007), whereas there was no correlation between cyst size and age (r = 0.145, P = .416).

CONCLUSION
MO1037: Insulin Sensitivity in Children with Autosomal Dominant Polycystic Kidney Disease
Authors: Dachy Angélique , De Rechter Stéphanie , Breysem Luc , Vennekens Rudi , Mathieu Chantal , Casteels Kristina , Van Hoorenbeeck Kim , Jouret François , Mekahli Djalila
Published: May 2022

BACKGROUND AND AIMS

Autosomal Dominant Polycystic Kidney Disease (ADPKD) is the most common inherited kidney disorder. Defective glucose metabolism was identified as a key feature in ADPKD, and several ‘metabolic’ approaches are currently under evaluation in adults with ADPKD. Whether this defective glucose metabolism could be an early primary event and a potential therapeutic option in the early disease stages is still unknown. In this study, we evaluated the insulin sensitivity profile in genotyped children with ADPKD.

METHOD

We performed a cross-sectional study to evaluate the insulin sensitivity profile in a genotyped cohort of ADPKD children (<19 years) with preserved renal function [estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2]. Overweight/obese children were respectively defined as body mass index (BMI) 25–30 and > 30 kg/m2. The Homeostasis Model Assessment Index (HOMA-IR) was calculated: fasting insulin (μIU mL− 1) x fasting glucose (mmol L − 1)/22.5. The Quantitative Insulin Sensitivity Check Index (QUICKI) was calculated: 1/[log (fasting insulin μU/mL) + log (fasting glucose mg/dL)].

RESULTS

A total of 37 ADPKD patients (22 boys) were included with a mean ($ \pm $ SD) age at diagnosis was 10.3 $ \pm $ 4.2 years. A total of 36 patients had PKD1 mutation (one GANAB mutation). Median BMI was 16.8 ± 4.3 kg/m2. Median serum fasting glucose: 86.0 ± 9.3 mg/dL, median fasting insulin: 6.1 ± 7.2 μU/mL and median serum C-peptide: 0.4 ± 0.3 nmol/L. Median HOMA-IR was 1.4 ± 1.7 and median QUICKI was 0.4 ± 0.1. A total of 16 patients presented a HOMA-IR > 1.6 and 6 normal-weight children had a HOMA-IR > 2.3. No patient displayed glucosuria. An oral glucose tolerance test was performed on five overweight patients, four of them showed insulin resistance and were treated with metformin.

CONCLUSION

Even with normal BMI, ADPKD children displayed a high index of insulin resistance. Further clinical studies are needed to determine whether ADPKD could be an additional risk factor for insulin resistance.