bluuebunny/crossref_metadata_2025 huggingface dataset:
#2309 Understanding the caregiver experience: a comparison between patients undergoing hemodialysis and conservative care management
Authors: Trigo Filipa , Ramos Ana Rita , Figueiredo Cátia , Barreto Patricia , Sofia Flora , Lopes Karina , Santos Paulo
Published: May 2024

Background and Aims

Elderly patients with Advanced Chronic Kidney Disease (ACKD) experience a high rate of physical and emotional burden, whether they choose dialysis or not. However, little is known about the challenges faced by family and throughout the disease. This study aimed to evaluate how caregivers of ACKD patients over 75 years-old (yo) perceive and cope with the disease.

Method

We performed telephone interviews with family members (FM) or caregivers of ACKD patients over 75 yo, undergoing Conservative Kidney Management (CKM) or hemodialysis (HD). The interviews were recorded and analyzed by two independent investigators. The interview guide was based on literature review and the authors’ clinical experience. It comprised 12 questions focused on the medical team support and communication, the caregivers’ perception of their relatives’ quality of life (QoL), the caregivers’ burden, and the perception of advance care planning.

Results

A total of 22 FM were interviewed, 11 from patients undergoing HD and 11 undergoing CKM. All caregivers were family members: 90.9% sons/daughters and 9.1% spouses. 54.5% of patients on CKM were females, with a mean age of 88.9 ± 5.0 yo; 36.4% of patients on dialysis were female, with a mean age of 82.1 ± 4.8 yo.

Regarding team communication, FM of patients on CKM were more aware of the prognosis of kidney disease and felt more involved in the decision-making process (Table 1). All FM of both groups reported medical team support for their relatives. Concerning QoL, all FM of CKM patients mentioned symptom control, compared to 81.8% in the HD group. Additionally, 27.3% FM of CKM felt ACKD deprived their relatives of their liberty, versus 72.7% in the HD group. No caregiver recognized a high burden of the disease. Regarding advance care planning, a majority of FM of HD patients (81.8%) desired open discussions, versus 45.4% of the CKM.

Some supportive/illustrative quotes of the FM answers are shown in Table 1.

Conclusion

Caregivers are vital in the support and care of any patient with a chronic illness, especially ACKD, and their burden and awareness about the disease must always be considered. The approach to patients in CKM is essentially palliative, prioritizing QoL and symptom control. These patients are regularly evaluated by multidisciplinary teams with training in palliative care, which promotes shared decision-making and more efficient communication skills about disease and prognosis to the patient and family. Unfortunately, palliative care is not yet well established in patients undergoing HD, which may explain the results and answers given by FM. It is crucial to improve support for caregivers of all ACKD patients, preferably with a multidisciplinary team.
#60 Implementation of chronic kidney disease guidelines for sodium-glucose co-transporter-2 inhibitor use in primary care: a cross-sectional study
Authors: Forbes Anna , Hinton William , Feher Michael , Elson Willim , Joy Mark , Ordonez-Mena Jose , Fan Xuejuan , Cole Nicholas , Banerjee Debasish , Suckling Rebecca , de Lusignan Simon , Swift Pauline
Published: May 2024

Background and Aims

The cardiovascular and kidney benefits of sodium-glucose co-transporter-2 (SGLT2) inhibitors in people with chronic kidney disease (CKD) are well established. The implementation of updated SGLT2 inhibitor guidelines and prescribing in the real-world CKD population remains largely unknown.

Method

We performed a cross-sectional study of adults with CKD registered with primary care practices in the Oxford-Royal College of General Practitioners Research and Surveillance Centre network on the 31st December 2022. We examined the extent to which SGLT2 inhibitor guidelines apply to and are then implemented in adults with CKD. We used a logistic regression model to identify independent factors associated with SGLT2 inhibitor prescribing.

Results

Of 6,670,829 adults we identified 516,491 (7·7%) with CKD, including 32·8% (n = 169,443) who had co-existing type 2 diabetes (T2D). 26·8% (n = 138,183) of the overall CKD population had a guideline directed indication for SGLT2 inhibitor treatment. A higher proportion of CKD patients with co-existing T2D were indicated for treatment, compared to those without T2D (62·8% [n = 106,468] vs. 9·1% [n = 31,715]). SGLT2 inhibitors were prescribed to 17·0% (n = 23,466) of those with an indication for treatment, and prescriptions were predominantly in those with co-existing T2D; 22·0% (n = 23,464) in those with T2D, and <0·1% (n = 2) in those without T2D. In adjusted multivariable analysis of people with CKD and T2D, females (OR 0·70, 95% CI 0·67-0·72, p < 0·001), individuals of Black ethnicity (OR 0·87, 95% CI 0·79-0·95, p < 0·001) and those of lower socio-economic status (OR 0·71, 95% CI 0·68-0·75, p < 0.001) were less likely to be prescribed an SGLT2 inhibitor. Those with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 had a lower likelihood of receiving an SGLT2 inhibitor compared to those with an eGFR ≥60 mL/min/1.73 m2 (eGFR 45-60 mL/min/1·73 m2 OR 0·65, 95% CI 0·62-0·68, p < 0·001, eGFR 30-45 mL/min/1·73 m2 OR 0·73, 95% CI 0·69-0·78, p < 0·001, eGFR 15-30 mL/min/1·73 m2 OR 0·52, 95% CI 0·46-0·60, p < 0·001, eGFR <15 mL/min/1·73 m2 OR 0·03, 95% CI 0·00-0·23, p = 0·004, respectively). Those with albuminuria (urine albumin-to-creatinine ratio 3-30 mg/mmol) were less likely to be prescribed an SGLT2 inhibitor, compared to those without albuminuria (OR 0·78, 95% CI 0·75-0·82, p < 0·001).

Conclusion

SGLT2 inhibitor guidelines in CKD have not yet been successfully implemented into clinical practice, most notably in those without co-existing T2D. Enhanced efforts to embed SGLT2 inhibitors equitably into routine care for people with CKD are urgently needed, particularly in those at highest risk of adverse outcomes and in the absence of T2D.
#377 Assessment of kidney function by creatinine and cystatin C and cardiovascular outcomes in patients with atrial fibrillation
Authors: Abdullaev Sherzod , Igamberdieva Ranokhon
Published: May 2024

Background and Aims

Atrial fibrillation (AF) in patients with chronic kidney disease are at an increased risk for ischemic and bleeding events and all-cause mortality. Accurate kidney function estimation is key for risk assessment. Creatinine is commonly used to calculate the Glomerular Filtration Rate (GFR). However, cystatin C has been described to be more sensitive than creatinine independent of muscle mass, autoimmune disease, inflammation or consuming diseases. Our aim was to evaluate the associations between kidney function, assessed by creatinine and cystatin C, and cardiovascular events (CVE), its individual components, and major bleedings.

Method

We enrolled 326 AF patients into two prospective, multicenter cohort studies. Creatinine and cystatin C were measured at baseline and clinical outcome events were assessed yearly. We calculated GFR using the Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] formula based on either creatinine (GFRcr), cystatin C (GFRcy) or both (GFRc2). Primary outcome was major CVE, defined as a composite of stroke or systemic embolism, myocardial infarction and cardiovascular death. Secondary outcomes were the individual components of major CVE and major bleeding. Multivariable adjusted Cox regression analyses were built to evaluate the associations between kidney function and outcome events.

Results

Mean age was 56 ± 9 years and 37% were female. Mean creatinine and cystatin С levels were 112 ± 21 μmol/l and 1.6 ± 0.3 mg/l, respectively, translating to a GFRc2 of 58.2 ± 16.8 ml/min/1.73 m2. Over a median follow-up of 2 years, the incidence rates for major CVE (per 100 person-years) across quartiles (Q1-Q4) of GFRc2 were 23.1, 20.3, 17.6 and 14.7, respectively. When using multivariable adjusted Cox regression analysis, major CVE was significantly associated with GFRcr (per 1 standard deviation: HR 0.89 (95% CI 0.79; 0.98) p = 0.01), GFRcy (HR 0.65 (CI 0.53; 0.72), p < 0.001) and GFRc2 (HR 0.74 (CI 0.63; 0.82), p < 0.001). This association was mainly driven by cardiovascular death. Major bleeding was associated with GFRcy (HR 0.78 (0.64-0.93) p = 0.001) and GFRc2 (HR 0.82 (0.69-0.97), p = 0.01), but not with GFRcr (HR 0.93 (95% CI 0.83-1.1) p = 0.33).

Conclusion

Among AF patients, GFR equations including cystatin C were associated both with major CVE and bleeding events, while creatinine based GFR equations were only associated with major CVE. Therefore, Cystatin C based GFR equations might offer more comprehensive risk stratification in patients with AF.
#2551 Treatment and prognosis for myocardial infarction in patients with chronic kidney disease 2010-2022: a nationwide cohort study
Authors: Ballegaard Ellen Linnea Freese , Grove Erik Lerkevang , Kamper Anne Lise , Feldt-Rasmussen Bo , Torp Christian , Gislason Gunnar , Carlson Nicholas
Published: May 2024

Background and Aims

Chronic kidney disease (CKD) is present in >30% of patients with acute coronary syndrome. Although prognosis following myocardial infarction (MI) has improved throughout the last decades, patients with CKD remain at considerably increased risk of recurrent cardiovascular events. We investigate use of guideline-directed cardiovascular interventions and cardioprotective medical therapy and associated cardiovascular outcomes in patients with and without CKD.

Method

From 2010 to 2022, all adult patients hospitalized with first-time MI (ICD10: DI21) were identified in nationwide Danish health care registers. CKD was defined by an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2. Study outcomes were evaluated in multiple logistic and cause-specific Cox regression models with computation of standardized risks/probabilities of outcomes. The probability of referral for interventional work-up was evaluated based on 30-days probability of cardiovascular interventions, i.e. coronary angiography (CAG) and/or revascularization. Guideline-directed cardioprotective medical therapy, i.e. lipid-lowering treatment, dual antiplatelet therapy, renin-angiotensin-system inhibitors, aldosterone antagonists, beta blockers, calcium channel blockers, and nitrates, was evaluated as 90-days probability of treatment in 90-days survivors. Lastly, one-year standardized risk of mortality was evaluated. All models were adjusted for age, sex, kidney transplant, congestive heart failure, hypertension, diabetes, cancer, thromboembolism, and any arrhythmia.

Results

In total, 21 009 patients were included; median age 72 years (IQR 63; 81), 60.8% males, median eGFR 82 ml/min/1.73 m2, 20.9% CKD. Patients with CKD were older, less likely to be male, had a longer admission time, had more comorbidities, and received more medical treatment compared with patients without CKD. The 30-days probability of CAG was 77.8% (95% CI 77.2%-78.5%) and 65.8% (95% CI 64.1%-67.3%), p < 0.001, and of revascularization 58.2% (95% CI 57.3%-59.0%) and 48.8% (95% CI46.9%-50.5%), p < 0.001, in patients without and with CKD, respectively. Development in probability of cardiovascular interventions and risk of 1-year mortality during the study period is depicted in Fig. 1. Probability of cardioprotective medical therapy in 90-days survivors is presented in Fig. 2. The 1-year risk of mortality was 16.4% (95% CI 15.7%-17.0%) and 20.9% (95% CI 19.9%-22.0%) in patients without and with CKD.

Conclusion

Although prognosis following first-time myocardial infarction has been improved for all patients, CKD continues to be associated with lower rates of guideline-directed cardiovascular interventions and cardioprotective medical therapy and increased 1-year mortality compared with patients without CKD.
#3069 The effects of characteristics associated with dialysis on cognitive functions in patients with chronic kidney disease
Authors: Yıldırım Saliha , Altinok Murat , Erdut Arda , Yildirim Tolga , Helvacı Özant , Derİcİ Ülver , Altok Kadriye , Erten Yasemin , Erdem Yunus , Cankaya Edem , Guz Galip
Published: May 2024

Background and Aims

Cognitive functions are affected in all stages of chronic kidney disease (CKD), regardless of age.

This study aims to determine the effects of characteristics associated with dialysis (peritoneal dialysis (PD) or hemodialysis (HD)) on cognitive functions in patients with CKD.

Method

CKD patients who were followed up with PD or HD at least for six months from 3 different centers from Turkey were included in this study. For dementia screening, the AD8 dementia scoring system was used. The patients’ sociodemographic characteristics, dialysis types, dialysis access routes, weekly dialysis session numbers, dialysis adequacies, dry weights, and laboratory parameters were recorded.

Results

A total of 261 CKD patients, 142 of whom were male (54.4%), were included in the study (mean age: 54.46 SD: 15.297, 29.1% over 65 years of age). 151 (57.8%) of the patients were HD patients.HT (70.1%) and DM (28.7%) were the most common comorbidities. While 50% of peritoneal dialysis patients were monitored with APD, 34.4% of HD patients had a central venous catheter (CVC) for vascular access.

In the study population there was no statistically significant difference in the prevalence of cognitive impairment between those over and under 65 years of age (<65 years of age 61%, >65 years of age 68%, p = 0.300). The prevalence of cognitive impairment was significantly higher in HD patients than in PD patients (p < 0.001). PD type was not related with cognitive impairment (p = 0.446). In HD patients under 65 years of age cognitive impairment was observed more frequently in the patients with CVC as vascular access (63% in patients <65 years of age with CVC, 32% in patients with AVF/AVG, p = 0.014).

Conclusion

Chronic kidney disease is one of the age-independent risk factors for cognitive impairment. In our study group cognitive impairment was similar in different age groups. Compared to HD patients, in PD patients less cognitive impairment was observed. In HD patients under 65 years of age using a CVC as vascular access was associated with more frequent cognitive impairment.
#1801 Gut dysbiosis contributes to TMAO accumulation in CKD
Authors: Gerritzmann Frederick , Holle Johannes Benjamin , Mcparland Victoria , Anandakumar Harithaa , Behrens Felix , Schumacher Fabian , Kleuser Burkhard , Bartolomaeus Hendrik , Wilck Nicola
Published: May 2024

Background and Aims

Chronic kidney disease (CKD) patients face a substantial morbidity risk, especially related to cardiovascular complications. The imbalance of circulating metabolites influences inter-organ crosstalk and disease pathophysiology. In this regard, metabolites of microbial origin have gained increasing attention. Trimethylamine N-oxide (TMAO) originates from microbial Trimethylamine (TMA) metabolism and is found at high concentrations in the blood of CKD patients. A high TMAO concentration is known to be an independent risk factor for cardiovascular disease. This study aims to investigate the extent to which high concentrations of TMAO in the blood are due to increased bacterial production or are mainly a consequence of impaired renal clearance.

Methods

We used existing biomaterials and clinical data of a pediatric CKD cohort, consisting of patients enrolled at CKD stage G3-5, including G5 patients treated with hemodialysis (HD), as well as patients after kidney transplantation (KT) and individuals with normal kidney function. We analyzed TMAO in plasma and urine samples using LC-MS/MS and developed a novel gene targeting assay (GTA) that quantifies the abundance of the bacterial target genes (CutC, CntA) encoding for the key enzymes of microbial TMA synthesis in each fecal sample.

Results

Plasma TMAO levels were stage-dependently elevated in CKD, with HD patients showing the highest levels (75 ± 46 µmol/l). While urinary TMAO levels were lower in the CKD groups, TMAO/creatinine ratios and fractional excretion were not significantly different in CKD compared to controls. Fecal microbial gene abundance of both CutC and CntA genes was elevated across CKD stages and correlated with both plasma TMAO levels and eGFR. Although KT patients exhibited an eGFR range comparable to controls, they still showed higher plasma TMAO levels and elevated TMAO-associated gene abundances. In a regression analysis, this gene abundance was associated with plasma TMAO independent of eGFR in a model adjusted for age, sex, and BMI. Using a likelihood ratio test, we showed that adding fecal microbial gene abundance to the model provided a significantly better fit compared to only eGFR, age, sex, and BMI.

Conclusion

Our data indicate that the production of TMA by intestinal bacteria contributes significantly to the accumulation of TMAO in patients with CKD and after kidney transplantation. This finding opens the possibility for new potential interventions in the management of patients with CKD.
#1916 Infective endocarditis in young female hemodialysis patient: a case report and literature review
Authors: Junita Tiroy , Syahriza Alfian , MD Yassir
Published: May 2024

Background and Aims

Infective endocarditis (IE) in hemodialysis patient is one of major infective and cardiovascular complications with high morbidity and mortality. Compared to general population, incidence of IE among hemodialysis (HD) patients is 50-60 times higher. Despite the devastating implications, there is no particular preventive measures of IE for HD patients. Previous studies revealed leading risk factors for IE in HD population including use of central venous catheters (CVCs), first 6 months period of renal replacement therapy (RRT), aortic valve disease, and previous endocarditis.

Case Summary

We report a case of IE in a 21-year-old female hemodialysis patient using AV fistula for the past 16 months with no prior history of heart valve disease, previous endocarditis, and IV drug abuse. Patient presented with fever of 38.5°C, dyspnea, and cough since three days before admission. Physical examination revealed grade 5 pansystolic murmur with punctum maximum at apex. Vegetation on the anterior mitral leaflet (AML) was first detected through trans-thoracal echocardiography. Patient was treated with ceftriaxone and vancomycin for 14 days, followed by oral antibiotics in outpatient setting after clinical resolution.

Conclusion

This case provides insight of the occurrence of IE in relatively young patient in the absence of well-known risk factors, making strict prevention, prompt diagnosis and treatment are of the utmost importance. Possible pathophysiological mechanisms for IE in HD patients are bacteremia from repeated vascular manipulation and valvular calcification that compromises valve to colonization. Therefore, besides infection prevention, managing the progression of valvular calcification among HD patients remains an issue to be addressed in future studies.
#192 Intradialytic cognitive and physical training to enhance functional capacity: a randomized controlled trial
Authors: Bogataj Špela , Pajek Maja , Kren Aljaž , Mesarič Katja Kurnik , Pajek Jernej
Published: May 2024

Background and Aims

Haemodialysis (HD) patients frequently experience cognitive and physical impairments due to various factors, including age, comorbidities, and the demanding nature of the treatment. This study explores the impact of a 12-week integrated cognitive and physical training program on the functional capacity of HD patients.

Method

A single-blind, randomized controlled trial was conducted with 44 HD patients. Participants were divided into an experimental (EXP) group (n = 22) and a control (CON) group (n = 22). The EXP group underwent 12 weeks of intradialytic cycling and tablet-based cognitive training three times a week, while the CON group received standard care (Fig. 1). Outcome measures were assessed pre- and post the 12-week intervention. Cognitive performance was evaluated using the Trail Making Tests A and B (TMTA and TMTB), while motor performance was assessed with the Timed Up and Go (TUG) test. Additionally, cognitive-motor interactions were examined using the TUG dual task test (TUG-dual).

Results

Results showed a significant effect of group*time interaction for TMTA test results (F(1,41) = 16.218, p < 0.001), TMTB test results (F(1,41) = 19.944, p < 0.001) favouring the EXP group. Additionally, a significant interaction was found for TUG test (F(1,40) = 8.854, p = 0.005) and for TUG-dual test (F(1,40) = 8.457, p = 0.006). Within the EXP group we observed significant improvements in cognitive function, as evidenced by decreased TMT completion times (TMTA: −3.6s, p = 0.006; TMTB: −14.0s, p < 0.001; TMTB–TMTA: −10.4s, p = 0.004). In contrast, the CON group experienced a significant decline in TMTA and TMTB (p < 0.009 and p < 0.026). Additionally, the EXP group exhibited enhanced mobility, with reduced TUG completion times (−0.8s, p < 0.001) and improved cognitive-motor performance in the TUG-dual (−1.0s, p < 0.001), while the CON group showed no significant changes (p > 0.05).

Conclusion

This study demonstrates that a 12-week combined cognitive and physical training program during HD sessions significantly enhances cognitive function and mobility in HD patients. These findings suggest that integrated non-pharmacological interventions can mitigate functional declines in this population and consequently improve their overall quality of life. Further research with larger samples and active control groups is warranted to confirm and expand upon these promising results.
#1309 Case-based online medical education improves physicians’ knowledge and competence in the healthcare of patients with type 2 diabetes and CKD
Authors: Trier Joachim , Pecoits-Filho Roberto , Da Silva Rita Moreira
Published: May 2024

Background and Aims

Kidney disease, including chronic kidney disease (CKD), affects more than 850 million people globally. At least 40% of people with diabetes develop CKD, and many progress to end-stage kidney disease (ESKD) and kidney failure. Globally, diabetes is the leading cause of kidney failure requiring transplantation or dialysis.

The risk of both progression to kidney failure and cardiovascular (CV) events is significantly elevated in patients with type 2 diabetes (T2D) and CKD. Both T2D and CKD are CV disease (CVD) risk multipliers. Patients at early stages of CKD are more likely to die of CVD than they are to progress to ESKD.

The goal of this online medical education activity was for learners to better acknowledge serious health risks associated with CKD in patients with T2D and have greater awareness of the availability of novel treatment options shown to reduce the risk of associated complications.

Method

An interactive text-based educational program including two detailed patient cases challenges clinicians to apply most recent evidence-based guideline recommendations. Detailed scenarios prompt learners to determine the correct treatment and follow-up for the patient with expert commentaries providing in-depth advice at each stage and a conclusion at the end of the program.

Educational effect was assessed using a repeated-pair design with pre-/post-assessment. 3 multiple choice questions assessed knowledge/competence, 1 question rated on a Likert-type scale assessed confidence. A paired samples t-test was conducted on overall average number of correct responses and for confidence rating, a McNemar's test was conducted at the question level (5% significance level). Cohen's d with correction for paired samples estimated the effect size of the education on number of correct responses.

Data collection from 24 February 2023 to 20 April 2023.

Results

Conclusion

Participation of PCP and NEPH in an interactive case-based online medical educational program improved their knowledge, competence and confidence in the management of patients with T2D and CKD.
#2330 Fisetin supplement ameliorates aging related changes in the kidney
Authors: Fu Ping , Ren Qian , Li Hui , Ma Liang
Published: May 2024

Background and Aims

As the ageing population continues to grow worldwide, aging-related diseases are becoming an excessive burden on the global healthcare system. The kidney is one of the organs most affected by aging, which undergoes changes of decreased glomerular filtration rate (GFR), alterated renal blood flow, increased inflammation and fibrosis that increase the susceptibility to developing acute kidney injury (AKI) and chronic kidney disease (CKD). To date, the mechanisms underlying the changes of aged kidneys has not been fully elucidated and therapeutic strategies are still under exploration. Fisetin is a natural flavonol that has been shown to be beneficial to many age-related disorders, as well as increase lifespan in preclinical animal models. However, whether and how fisetin protects against kidney aging remains unclear. In the present study, we assessed the efficacy of fisetin as a senolytic to reduce cell senescence and SASP factors and improve renal function in old mice.

Method

18 month-old C57BL/6 mice were randomly divided into the model group (n = 6), the fisetin low-dose group (100 mg/kg/d B.W., n = 6), fisetin high-dose group (100 mg/kg/d B.W., n = 6) and the rapamycin group (14 ppm, positive control, n = 6). The control group (n = 6) was composed of wild-type C57BL/6 mice of 4 month age. The fisetin and rapamycin were given in the diet for 4 months. Mice of model and treatment group were sacrificed at the age of 22 month and the blood and kidney samples were collected. The GFR of mice in each group was detected and the pathological morphology, lipid accumulation, collagen deposition of the kidneys were assessed. Additionally, the expressions of senescence markers including p53, p21,p16, and SASPs within the kidneys were analyzed.

Results

Fisetin treatment effectively restored the decline in GFR of old mice. Moreover, administration with fisetin significantly reduced age-related pathology including lipid accumulation and collagen fiber deposition in mice kidneys. The expression of aging markers of p53, p21,p16 and SASPs was remarkably upregulated in the kidneys of model mice, which was suppressed by fisetin treatment. Moreover, the kidney inflammation and oxidative stress as observed in aged kidneys was alleviated in mice of fisetin treatment group.

Conclusion

The natural product fisetin has senotherapeutic activity in mice kidneys. Intervention with fisetin is a promising therapy for clinical translation to target excess cell senescence to treat age-related kidney dysfunction.
#2418 Effects of correction of acidosis on body composition and biochemical parameters in CKD patients on maintenance hemodialysis
Authors: Singh Gaurav , Phadke Chetan , Dighe Tushar Anil , Sajgure Atul , Bale Charan , Shinde Nilesh , Wakhare Pavan , Godbole Shreeharsh , Borle Abhishek
Published: May 2024

Background and Aims

Metabolic acidosis is a common problem in patients of chronic kidney disease and patients on maintenance hemodialysis. In resource poor countries, due to financial constraints frequency of dialysis and compliance to medication is adversely affected. This leads to worsening of clinical condition of patient and requirement of in hospital care, many times intensive care, further increasing cost of treatment. Metabolic acidosis has implications on bone and muscle health.

Aim of our study was to assess the changes in body composition (fat percentage and lean body mass), changes in third space fluid, biochemical parameters, number of admissions and requirement of blood transfusions before and after correction of metabolic acidosis.

Method

This was a prospective, observational study. 25 patients on maintenance hemodialysis at our center were included in the study. Bio-impedance analysis (BIA), biochemical parameters (Complete blood counts, renal function tests, serum calcium and phosphorous, liver function tests, Blood gas analysis) were done at baseline before starting bicarbonate supplementation. Number of admissions and blood transfusions in 3 months prior to initiation of bicarbonate supplementation were noted. The oral bicarbonate supplementation was increased from baseline, based on the baseline blood gas analysis. The same parameters were assessed after 3 months and analyzed.

Results

At the end of 3 months we observed that there was significant reduction (p < 0.05) in total leucocyte counts (mean 8100/cumm to 6800/cumm), urea (mean 113.7 mg/dL to 83.72 ng/dL), creatinine (mean 7.87 mg/dL to 6.68 mg/dL), phosphorous (mean 5.18 mg/dL to 4.43 mg/dL), SGOT (mean 56.52 IU to 25.2 IU) and SGPT (mean 46.48 IU to 22.88 IU) with a trend of decrease (p ≤ 0.1) in percentage of extra cellular water (27.31% to 25.03%), lean body mass (44.27 kg to 43.0 kg) and trend of increase (p ≤ 0.1) in body fat composition (15.62 kg to 18.82 kg) and body fat percentage (26.924% to 31.90). There was a reduction in third space fluid (0.88 lit to 0.43 lit). The number of hospitalizations reduced (15 three months prior to initiation of therapy to 7 after initiation of therapy) and number of blood transfusions required also reduced (21 before initiation to 10 after initiation of therapy).

Conclusion

We concluded that correction of acidosis probably reduces the inflammation in patients of CKD on maintenance hemodialysis. This could be seen from the reduced total leucocyte counts, liver enzymes, urea and creatinine values. Changes in body composition with increased total fat mass, fat percentage and decreased lean mass was also noted. There was also a significant reduction in hospitalizations and number of blood transfusions.
#2737 “The right choice for you.” How descriptions of treatment options in information resources may influence patient understanding and decision-making
Authors: Sowden Ryann , Robb James , Shaw Chloe , Winterbottom Anna , Bristowe Katherine , Bekker Hilary , Tulsky James , Murtagh Fliss , Barnes Rebecca , Caskey Fergus , Selman Lucy E
Published: May 2024

Background and Aims

For people over the age of 65 with comorbidities and/or poor performance status, and for patients over the age of 80, the choice between receiving conservative kidney management (CKM) or receiving dialysis can be complex, and involves weighing possible benefits, risks and effects on quality and length of life. Patients often rely on information resources from renal units, to support their decision-making. We describe how information resources present living with and dying of kidney disease in relation to CKM, haemodialysis and peritoneal dialysis, and consider implications for patients’ treatment decision making.

Method

Information resources were collected between June 2021 and January 2023 from four UK renal units with varying CKM treatment rates, as part of the OSCAR study (Optimising Staff-Patient Communication in Advanced Renal Disease). Physical and digital copies of information resources were collected from outpatient waiting areas, consultation rooms, and group patient education sessions.

We included resources which focused on the treatment options of CKM, haemodialysis, peritoneal dialysis and transplant. Documents were categorised as: Direct Treatment Option Information Resources, focusing specifically on treatment options, either individually or in comparison (category A); Indirect Information Resources, focusing on broader contextual information related to treatment options, such as lifestyle, holiday and diet guidance, and the logistics of receiving treatment, e.g. transport (category B).

Document analysis of the information resources was conducted, informed by critical discourse analysis. We examined how documents describe and explain living and dying with kidney failure in relation to treatment options, and how treatment options were placed in context, identifying themes, ‘frames’ and discourse.

Results

72 resources were identified across the four renal units, with 46 documents included after deduplication and screening (Fig. 1). Analysis identified three global themes (see Table 1 for illustrative data extracts):

Conclusion

UK information resources typically present unbalanced explanations of dialysis and CKM, and equate CKM with death and dying. Despite the focus on patients’ “right” to choose a treatment option, it may therefore be challenging for a patient to choose CKM, even when this treatment choice is the best fit for their goals and values. Furthermore, for patients who choose dialysis, information resources often exclude important end-of-life information, limiting their opportunity to consider and participate in advance care planning.
#2926 The impact of GLP-1 receptor agonists on metabolic control and diabetic kidney disease progression
Authors: Venda João , Henriques Andreia Dos Santos , Monsanto Alice , Pompermayer Micael , Leal Rita , Alves Rui
Published: May 2024

Background and Aims

Diabetic kidney disease is the leading cause of end-stage kidney disease in developed world. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are a class of drugs that have shown benefits beyond glycemic control, with a reduction in cardiovascular risk and renoprotective effects. The aim of this study was to assess the effect of GLP-1 RA in metabolic control and progression of CKD. Our objective was to analyze the impact and efficacy of GLP-1 RA in patients with chronic kidney disease (CKD).

Method

This was a retrospective cohort study, that included type 2 diabetic patients with CKD, followed in Nephrology outpatient clinic, who started treatment with GLP-1 RA between January 2019 and February 2022. Clinical, demographic and laboratory data were collect at the initiation of the therapy, 6 months and 1 year during follow-up.

Results

A total of 66 patients were included, of whom 63.6% (n = 42) males with a mean age of 67.8 ± 10.9 years. 95.5% (n = 63) had history of hypertension, 59.1% (n = 39) heart failure and 16.7% (n = 11) peripheral arterial disease. The median estimated glomerular filtration rate (eGFR) at beginning of the treatment was 45 [31.8-65] mL/min/1.73 m2, mean HbA1c of 9.1 ± 1.7%, and mean weight 89.4 ± 15.4 kg. The most frequently prescribed GLP-1 RA were liraglutide (34.8%, n = 23) and dulaglutide (34.8%, n = 23), followed by semaglutide (21.2%, n = 14) and exenatide (1.5%, n = 1). Regarding concomitant therapy, all of the patients were on renin-angiotensin-aldosterone system antagonists, 90.9% (n = 60) were on SGLT2 inhibitors, and 68.2% (n = 45) were on insulin. At 6 months follow-up, there was a statistically significant reduction in HbA1c (9.2 ± 1.8 VS 7.8 ± 1.7, p < 0.001) and weight (89.4 ± 15.4 VS 86.8 ± 15.7, p = 0.002). There were no significant differences in eGFR, lipidic profile and albuminuria. At 1 year follow-up, there was significant reduction of HbA1c (Z = −4.6, p < 0.001), weight (Z = −3.1, p = 0.002), and a statistically significant increase of eGFR (49.5 ± 25.4 VS 56.9 ± 27.0, p = 0.007), with no significant differences in lipidic profile and albuminuria. During the follow-up period, 5 patients voluntarily discontinued the treatment, and 1 patient suspended it due to gastrointestinal adverse effects.

Conclusion

Our study findings reinforce the existing evidence supporting the renoprotective effects of GLP-1 RA. We observed a notable improvement in metabolic control, as evidenced by significant reduction of HbA1c and weight, particularly at the 6th month. There were no significant differences in albuminuria during the follow up time, but an unexpected increase in eGFR.
#1536 Serum soluble LYVE1 is a promising non-invasive biomarker of renal fibrosis: a population-based retrospective cross-sectional study
Authors: Yu Chen , Liu Jing
Published: May 2024

Background and Aims

Diagnosis of renal fibrosis can only be verified by kidney biopsy, but biomarkers for non-invasive evaluation remain unsatisfactory. Patients with fibrosis often have abnormalities of the lymphatic vascular system and associated immune function. We describe here a lymphatic marker as a candidate biomarker for fibrosis.

Method

After assessing and grading the fibrosis scores, testing serum soluble lymphatic vessel endothelial hyaluronan receptor1 (sLYVE1) level, and collecting clinical information, the association between sLYVE1 and renal fibrosis was analyzed. Logistic regression analysis was used to screen variables. Diagnosis models with or without sLYVE1 were built, and nomograms were plotted. Calibration curve, C-index, and DCA were performed to assess the models.

Results

A total of 298 patients were enrolled in the study, of which 199 were included in the training cohort and 99 patients in the validation cohort. Serum sLYVE1 levels markedly elevated with increasing fibrosis grade (p < 0.05). ROC analysis of sLYVE1 showed an AUC of 0.791 and 0.846 with optimal cut-off value of 405.25 ng/mL and 498.55 ng/mL for the prediction of moderate-to-severe renal fibrosis (MSF) and severe renal fibrosis (SF), respectively (Fig. 1). The diagnostic nomogram model without sLYVE1 (model 1) included traditional clinical determinants (C-index: 0.658 for MSF; 0.603 for SF). A combination of model 1 and sLYVE1 (model 2) improved predictive performance (C-index: 0.847 for MSF; 0.856 for SF) (Figs 2 and 3). Calibration curve and DCA demonstrated a better consistency accuracy and clinical benefit of model 2 than model 1.

Conclusion

Serum sLYVE1 may be identified as a potential biomarker of renal fibrosis. Models incorporating sLYVE1 may be beneficial for a more accurate non-invasive diagnosis of renal fibrosis.
#761 Effect of ketoanalogue-supplemented very low protein diet in the need to initiate renal replacement in chronic kidney disease patients
Authors: Larrazabal Ramon , Gujilde Jason , Serrano Julius John
Published: May 2024

Background and Aims

Chronic kidney disease (CKD) is a global concern, with increasing complications and potential end-stage renal disease. Protein intake restriction is crucial for conservative therapy. Investigators have theorized on the nephroprotective effect of either a very low-protein diet (VLPD) with ketoanalogues (KAA) or a low-protein diet (LPD); this was however not confirmed by the Modification of Diet in Renal Disease (MDRD) randomized clinical trial (RCT). This meta-analysis aims to evaluate the effect of VLPD supplemented with KAA on RRT need and disease progression among CKD patients.

Method

A systematic literature search was conducted up to January 3, 2024 for trials in the following databases: PUBMED/MEDLINE, Ovid MEDLINE, Google Scholar, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science and ClincalTrials.gov. Studies that compared VLPD supplemented with KAA to LPD in pre-dialysis CKD patients demonstrating outcomes such as the need for RRT, CKD progression, and all-cause mortality were included. A total of four studies were included in the final analysis. The number of individuals requiring and not requiring RRT on follow-up were computed and analyzed using fixed effects model; while CKD progression and mortality were analyzed using random effects models.

Results

Four studies (738 participants) investigated patients who needed RRT, CKD progression, and all-cause mortality on follow-up between those on VLPD with KAA and LPD. In Fig. 1, VLPD with KAA reduced the need of RRT by 36% (Odds Ratio 0.64, 95% CI: 0.45 to 0.93, P = 0.02), and decreased the incidence of CKD progression (Fig. 2) by 65% (Odds Ratio 0.35, 95% CI: 0.14 to 0.87, P = 0.02). Three studies (531 participants) reported on all-cause mortality (Fig. 3), and our analysis did not show a significant effect on all-cause mortality (OR 1.46, 95% CI: 0.72 to 2.96, P = 0.29). There was no significant heterogeneity among the studies.

Conclusion

The investigators conclude that the present meta-analysis of 4 RCTs demonstrates that the use of VLPD supplemented with KAA reduced the need for RRT initiation and progression of CKD among pre-dialysis CKD Stage 4-5 patients when compared to those on the conventional LPD regimen. Therefore, protein restriction diets especially VLPD with KAA should be considered and offered in eligible CKD patients as part of their supportive management.
#525 SGLT2 inhibition in non-diabetic CKD: results in experimental lupus nephritis
Authors: Cachá Conxita Jacobs , Martos Nerea , Cebrià Carmen Llorens , Motto Enam , Martínez-Díaz Irene , Anders Hans Joachim , Romeo Maria José Soler
Published: May 2024

Background and Aims

Sodium glucose cotransporter type 2 inhibitors (SGLT2i) potently attenuate cardiovascular morbidity and progression of CKD in patients with type 2 diabetes. It has been proposed that SGLT2 inhibition may also elicit renoprotective effects in non-diabetic CKD. The aim of this work is to evaluate whether the treatment with an SGLT2i improves kidney disease progression in a mouse model of lupus nephritis (LN).

Method

We performed a single center randomized controlled preclinical trial using female MRLlpr/lpr mice. The animals were randomly assigned to (1) vehicle or (2) empagliflozin (EMP, 10 mg/kg/day) treatment once signs of active systemic lupus erythematosus (SLE) appeared: proteinuria >100 mg/dL (++ in reactive strips) or lymphadenopathy in minimum 2 bilateral sites with proteinuria >30 mg/dL (+ in reactive strips). We included 13 mice per group that were treated during 4 weeks. Empagliflozin was given as an admix into standard chow diet. Reduction of urinary albumin to creatine ratio (UACR) was considered the primary endpoint whereas glomerular filtration rate (GFR), renal histology (LN activity/chronicity index, glomerulosclerosis, interstitial fibrosis) and SLE markers (total serum IgG, anti-dsDNA IgG, glomerular IgG deposits, lymph node weight, spleen weight) were considered secondary endpoints.

Results

After 4 weeks of treatment, no significant differences in fasting blood glucose levels were found between the experimental groups. As expected, empagliflozin administration notably inhibited SGLT2 in the tubular cells demonstrated by a significant increase of urinary glucose (p < 0.0001). This is consistent with the increased water intake observed in MRLlpr/lpr mice treated with empagliflozin (p < 0.0001). At the end of the experiment, vehicle treated MRLlpr/lpr mice showed a significant increase in UACR (p = 0.0012) consistent with LN progression that was not attenuated by empagliflozin. In line, empagliflozin did not modify GFR and LN activity/chronicity indexes, glomerulosclerosis or interstitial fibrosis in kidney. Finally, regarding SLE markers, 4-weeks empagliflozin treatment was not able to decrease total serum IgG, anti-dsDNA IgG, glomerular IgG deposits or lymph node weight. Only spleen weight was significantly decreased in empagliflozin treated MRLlpr/lpr mice (p = 0.003).

Conclusion

In our experimental setting, empagliflozin treatment reduced spleen weight suggesting a protective role in SLE in MRLlpr/lpr mice. However, empagliflozin did not modify LN progression in MRLlpr/lpr mice probably because the acute LN phase. It is expected that the positive effect in terms of reducing proteinuria will be observed in patients with LN and residual proteinuria
#598 Successful application of allo-hemodialysis in a porcine model of embolization-induced acute kidney injury
Authors: Wang Xin , Soni Pinakin , Patel Amrish , Nikolic Dejan , Heide Alexander , Dong Jiaming , Maheshwari Vaibhav , Grobe Nadja , Nayak Shivanand , Kotanko Peter
Published: May 2024

Background and Aims

Annually, millions of kidney patients, primarily in low- and low-middle income nations, die prematurely due to the lack of affordable kidney replacement therapy. We propose a novel, low-cost alternative dialysis modality called allo-hemodialysis (alloHD), where blood of a patient with kidney failure flows counter-current to the blood of a healthy subject (“buddy”) through the dialyzer [1]. Uremic solutes and excess fluid are then excreted by the buddy's healthy kidneys. We have already demonstrated the technical feasibility of alloHD in pigs with acute kidney injury (AKI) induced by renal artery ligation [2]. In this study, we explored alloHD in a less invasive porcine model of AKI induced by renal artery embolization.

Method

The protocol was approved by the Committee for the Purpose of Control and Supervision of Experiments on Animals (CPCSEA), New Delhi, India. We studied two female Yorkshire pigs (weight 80-90 kg) with central venous catheter as vascular access. AKI was induced by embolization of both kidneys by transcatheter deployment of Contour™ Poly Vinyl Alcohol particles (Boston Scientific, Marlborough, MA, USA). The AKI pig and the buddy pig were connected to the dialysate and blood compartments, respectively, of a Nipro Cellentia 17H dialyzer. The AKI pig was then dialyzed for 4 hours against the healthy buddy pig. During alloHD, both pigs were anticoagulated with heparin (5,000 IU/h) and the buddy pig was sedated with 1-2% isoflurane gas. Blood samples were collected before, during, and after alloHD for measurements of blood urea nitrogen (BUN) and creatinine.

Results

We performed nine alternate day alloHD sessions with the same pair of pigs. During alloHD, BUN and Creatinine levels declined in the AKI pig (Fig. 1) and increased—as expected—transiently above baseline in the buddy pig and then trended towards baseline post-dialysis (Fig. 1). We found no indication of hemolysis or coagulation of the extracorporeal circuit in any of the nine alloHD sessions. The animals were sacrificed after the 9th session.

Conclusion

We demonstrated the feasibility of alloHD in a porcine embolization AKI model. This study corroborates and complements our previous experience with alloHD in a porcine model of AKI induced by renal artery ligation. Given these promising results, we are investigating the potential for advancing to a clinical trial.