bluuebunny/crossref_metadata_2025 huggingface dataset:
#4590 A PROSPECTIVE STUDY OF EPLERENONE IN THE TREATMENT OF PATIENTS WITH GLOMERULONEPHRITIS
Authors: Papasotiriou Marios , Georgopoulou Georgia Andriana , Bratsiakou Adamantia , Ntrinias Theodoros , Goumenos Dimitrios , Papachristou Evangelos
Published: June 2023

Background and Aims

Clinical evidence suggests that high aldosterone plasma levels contributes to progressive kidney disease. Although administration of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin type 1 receptor blockers (ARB) can delay kidney disease progression, plasma aldosterone levels may increase to a significant extent even after the initiation of such treatment. Thus, administration of mineralocorticoid receptor antagonists such as spironolactone, on top of treatment with ACEi or ARBs has been shown to reduce albuminuria and slow down kidney function deterioration. Nevertheless, there is scanty evidence on the effect of eplerenone in patients with kidney disease due to glomerulonephritis.

Method

In this prospective open-label study, we evaluated the effects of eplerenone in patients with biopsy proven glomerulonephritis already treated with ACEi or ARBs. Patients were divided in the active treatment arm, who received 25 mg of eplerenone daily besides ACEi or ARBs, and a control group that received only standard treatment. Protein excretion in 24 h urine, eGFR, blood pressure and serum K+ levels were measured at 3, 6 and 12 months after study initiation.

Results

Out of 83 patients who were screened, 62 patients were included in the final analysis. Twenty-six received eplerenone and 36 were treated with ACEi (25) or ARBs (9) alone (controls). After 1 year of treatment with eplerenone, proteinuria decreased from 1597 to 1145 mg/24 h while it did not alter in controls. Eplerenone reduced proteinuria especially in those with baseline proteinuria of >1000 mg/24 h. Kidney function remained stable in patients treated with eplerenone (from eGFR: 82.51±22.6 to 84.68±31.7 ml/min/1.73 m2, p = 0.8) and showed a non significant deterioration in controls (from eGFR: 68.39±26.2 to 66.63±29.8 ml/min/1.73 m2, p = 0.08). Systolic blood pressure was significantly reduced in the active treatment arm (from 128.1±17.5 to 126.3±10.93 mmHg, p = 0.03), whereas eplerenone did not increase serum K+ levels or had any other significant adverse effect.

Conclusion

Administration of eplerenone at a dose of 25 mg/day, on top of treatment with ACEi or ARBs, can further reduce proteinuria and systolic blood pressure in patients with chronic glomerulonephritis.
#4621 TREATMENT PREFERENCES TO SERIOUS ILLNESS IN PATIENTS RECEIVING PERITONEAL DIALYSIS
Authors: Cheng Ching-I , Chuang Pei-Ni , Peng Jen-Kuei , Chueh Shu-Neng , Lai Chun-Fu , Tasi Hung-Bin , Chiang Chih-Kang , Tsai Jaw-Shiun
Published: June 2023

Background and Aims

People with end-stage kidney disease receiving maintenance dialysis are more likely to receive intensive pattern of end-of-life care than those with other severe illness. It's important to understand the preferences to cardiopulmonary resuscitation (CPR) and other end-of-life care. However, no prior studies have investigated patients receiving peritoneal dialysis. This study aimed to explore the preference to CPR and patterns of end-of-life care in patient receiving peritoneal dialysis (PD), which had not been specifically investigated in the literature.

Method

This cross-sectional study of patients receiving PD was conducted in the National Taiwan University Hospital between Dec. 2021, and Mar. 2022. Patients were enrolled if they were 20 years or older, sufficiently fluent to complete surveys and cognitively able to provide written informed consent and had received maintenance peritoneal dialysis for at least 3 months. Enrollee were asked to the Chinese version of Physician Orders for Life-Sustaining Treatment questionnaire.

Results

Among 400 eligible patients, 364 (91%) responded to the questionnaire. The average age was 55.5 years; 50.3% were men. Among the 364 responders, 73.6% selected do not attempt resuscitation (DNR) and 26.4% preferred CPR. Multivariate logistic analysis revealed that age (OR = 0.96, 95% CI 0.94-0.98), male (OR = 2.44, 95% CI 1.45-4.1) and residual kidney Kt/V (OR = 2.45 95% CI 1.24-4.82) were associated with CPR. If they are facing on serious illness, 47.5% of participants prefer to “Focus on comfort”, 28.6% choose “try treatments, but do not suffer” and 23.9% request “live as long as possible”. Furthermore, 51.4% of participants selected “No artificial nutrient support” in the end of life and 87.1% select “comfort care” as their first priority. Paradoxically, only 13.5% of the patients who preferred CPR took “staying alive” as their first priority, while 71.9% focused on “comfort care”.

Conclusion

Around 75% of PD patients selected DNR when cardiopulmonary arrest. Age, gender, residual Kt/V were important factors associated with CPR preference. Most patients preferred supportive pattern of end-of-life care. Integrating patients' treatment preference to serious illness and values and goals of end-of-life care in shared decision making is important for patients receiving dialysis.
#4659 PREVALENCE OF LIVER STEATOSIS MEASURED BY MULTIFREQUENCY BIOIMPEDANCE IN PATIENTS WITH CKD
Authors: Barril Guillermina , Nogueira Ángel , Josa Esmeralda , Alvarez Graciela , Cortinas Alejandra , Núñez Almudena , Giorgi Avión , Sanchez Carmen , Ruperto Mar
Published: June 2023

Background and Aims

The increase in visceral fat is one of the factors that contribute to the increased cardiovascular risk associated with CKD. There are few data on the prevalence of hepatic steatosis in patients with CKD. The Maltron multifrequency BIA offers us the possibility of evaluating it. The purpose of this study was to determine the prevalence of hepatic steatosis by means of multifrequency bioimpedance and to correlate it with its presence by ultrasound or CT in patients with CKD on Advanced CKD(ACKD) and HD.

Methods

We carried out a study of body composition with BIA in 315 patients, analyzing with the Maltron monitor Bioscan i-touch8 the determination of hepatic steatosis and its classification into 4 stages of involvement (normal, mild, moderate, moderately-severe and severe steatosis. We also correlated with ultrasound studies that had In order to see coincidence, we also obtained data from 9 patients without CKD.We established global steatosis prevalence and in CKD and HD and correlated with GOT,GPT,GGT,MIS, waist/height ratio, mass-fat and BMI.

Results

315 patients evaluated for CKD 151 (48%) and HD 163 (52%), 67.9% men aged 70.79 ± 12.87 years (sig difference between CKD and HD (72.4 ± 2.7) vs 69.2 ±14.3) p0.023. Globally we found healthy liver in 37.9% and steatosis in 61.3% appearing mild-13.4%, moderate 11.8%, light-high 11.4% and high 24.5%. We observed healthy liver in 35.1% in ACKD vs 40.5% in HD. We did not find significant differences between liver enzyme values between healthy liver and steatosis at a global level. We established correlation/coincidence between ultrasound/CT and BIA in 72 patients. We found a healthy liver BIA-ECHO correlation in 43 cases (93.4%), steatosis by BIA coincides with ECHO in 41.6%. If we combine healthy liver + mild steatosis by BIA, the BIA-Echo healthy liver coincides in 92.7% and steatosis in 50%. Establishing cut-off points for BMI, % fat mass and waist/height index using COR curves, we obtain areas-under-the-curve 0.828, 0.738 and 0.853 respectively, being Waist-height index (WC 0.6) with better sensitivity 80% and specificity 71, 3%. If we determine the area of fat mass with another tool, we see AUC 0.838 with 72.3% specificity and 91.3% sensitivity to detect normal liver.

Conclusion

1) A high prevalence of hepatic steatosis due to IAB appears in patients with CKD greater in CKD than in HD. 2) There is a good correlation with ECO for a healthy liver and there are parameters that correlate well in a healthy liver diagnosis. 3) Specific studies of Ultrasound-BIA are needed to validate the diagnosis of steatosis.
#4661 KIDNEY TRANSPLANTATION IN PATIENTS WITH ANCA-ASSOCIATED VASCULITIS IS ASSOCIATED WITH A HIGH INCIDENCE OF POST-TRANSPLANT CANCER
Authors: Perna Alessandro , Campise Maria Rosaria , Alfieri Carlo Maria , Regalia Anna , Cresseri Donata , Verdesca Simona , Castellano Giuseppe
Published: June 2023

Background and Aims

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) are challenging systemic diseases. Kidney transplantation is the treatment of choice for patients with AAV and end stage kidney disease.[1] AAV relapses after transplantation are rare and data regarding AAV recurrences in this setting are lacking.[2]

Method

In this single-centre retrospective cohort study, we analyzed the data from medical records of adult patients transplanted at our transplant Center between February 2006 and January 2022 and followed at the Nephrology Unit of the same Hospital: Fondazione IRCCS Cà Granda Ospedale Policlinico in Milan.

Results

We identified 9 patients on 1026 with a pre-transplant diagnosis of AAV; all patients had received previous treatment with cyclophosphamide. Maintenance immunosuppression after transplant was tacrolimus-based in 89% of the patients. At the end of a median follow-up of 132 ± 61.1 months after transplantation, only one case of extra-renal vasculitis relapse was observed (Table 1). The relapse rate was 0.01 per patient per year comparable to what reported in the literature. However, seven patients were diagnosed with cancer after a median follow-up of 81.4 ± 35.8 months after transplantation; six had skin cancer and three a renal cell carcinoma of the native kidneys (cumulative incidence of 78%). One patient died from metastatic spinous cell carcinoma. We therefore decided to make a narrative comparison between this cohort and a previous series published by our group including 19 patients transplanted between December 1987 and January 2006.[3] In the older cohort we reported 7 relapses and a relapse-rate of 0.076 per patient per year (Table 2).

Conclusion

In conclusion, compared with previous data from our group (December 1987-January 2006), we found a consistent decrease in disease relapse (7 relapse in 19 patients previous cohort vs 1 relapse in current cohort) in kidney transplant patients with AAV, followed by the appearance of post-transplant cancer. This result could be attributable to the use of more powerful immunosuppression a deserved particular attention in the follow up of AAV patients after kidney transplantation.
#4688 ATP6V0A4 GENE MUTATION-ASSOCIATED NEPHROPATHY
Authors: Peng Siqi , Wang Bin , Zhang Xiao Liang
Published: June 2023

Background and Aims

The ATP6V0A4 gene is localized to chromosome 7q33∼34 and encodes for vacuolar H+-ATPase (V-ATPase) α4 subunit. Decreased V-ATPase function due to mutations in the ATP6V0A4 genes could cause H+ excretion defect of α-intercalated cells in the renal collecting duct, resulting in hereditary distal renal tubular acidosis (dRTA). However, crucially, no gain-of-function mutations in the ATP6V0A4 gene have been reported previously. This study reports a gain-of-function mutation of ATP6V0A4 gene occurred in a 32-year-old male with metabolic alkalosis, hypokalemia and hearing loss, and further explore potential pathogenic mechanisms of this mutation.

Method

Clinical information was collected from the proband and his family members. Kidney tissue samples were collected for morphological observation and immunohistochemical staining. High-throughput sequencing analyses were done for the proband and his parents. ATP6V0A4 wild-type and mutant plasmids were constructed and used to transfect the 293T cells. After 48 hours of transfection, the expression of ATP6V0A4 was verified using WB analyses and V-ATPase activity was measured by ultraviolet spectrophotometry.

Results

The proband and his father both suffered from severe hypertension and hearing loss. Blood tests showed hypokalemia, metabolic alkalosis and renal insufficiency. Urinalysis indicated acidic urine. Laboratory tests on admission are shown in Table 1. Renal biopsy suggested malignant hypertensive kidney injury. Whole-exome sequencing demonstrated that the proband carried the heterozygous mutation c.1534G>T; p.V512L in exon 15 of the ATP6V0A4 gene. Sanger sequencing confirmed that the variant was inherited from his father. The immunohistochemical results implied the expression of V-ATPase α4 was significantly higher in renal tissues from proband than that of the control who was diagnosed with minimal change disease (Figure 1B).WB analysis showed 293T cells transfected with ATP6V0A4 mutant plasmids with darker protein bands, suggesting higher expression of V-ATPase α4 (Figure 1D). The cells transfected with mutant ATP6V0A4 plasmids showed significantly higher V-ATPase activity compared with wild-type ATP6V0A4 plasmids transfected cells (Figure 1E).

Conclusion

The ATP6V0A4 c.1534G>T; p.V512L mutation is a gain-of-function mutation and this result indicates the possibility that this mutation might enhance the normal physiological function of the V-ATPase, and likely contributes to the increased hydrogen ions excretion and thereby to the development of metabolic alkalosis (Figure 1F).
#4846 ROXADUSTAT-INDUCED HYPOTHYROIDISM: THE EFFECT OF ROXADUSTAT ON SUPPRESSION OF THYROID FUNCTION
Authors: Ohsawa Masato , Kuji Tadashi , Nishihara Masahiro , Ohsawa Rento , Oshikawa Jin
Published: June 2023

Background and Aims

There have been only two case reports of hypothyroidism in patients treated with roxadustat, a HIF-PH inhibitor as new renal anemia drug. However, there has yet been no studies to examine the effect of roxadustat on thyroid function.

Method

In this study, we retrospectively examined the effects of roxadustat on thyroid-stimulating hormone (TSH) in hemodialysis patients by two blood examinations, before and during treatment with roxadustat. We included patients who had TSH levels measured after at least two consecutive weeks of roxadustat treatment and before. We excluded patients with a history of taking other HIF-PH inhibitors before roxadustat. The period was from September 2021 to November 2022 in this interim analysis. A p value of<0.05 was considered statistically significant. Analyses were performed using SPSS.

Results

93 patients were included in this analysis. TSH levels significantly decreased after treatment with roxadustat. A total of 58.1% of patients had decreased TSH levels (2.23 ± 1.18 v.s. 1.81 ± 1.35, μIU/mL, p value = 0.040, Wilcoxon signed-rank test), and 18.3% of patients had a significant decrease below the normal range. Additionally, patients treated with thyroid hormone replacement therapy in primary hypothyroidism had a higher frequency (81.0%) of TSH decrease compared to patients without (p value = 0.013, Pearson's chi-square test).

Conclusion

This is the first study to examine that roxadustat has a suppressive effect on TSH secretion in hemodialysis patients. We also found that roxadustat-induced hypothyroidism is prevalent in the high frequency of TSH suppression, especially in primary hypothyroidism patients treated with thyroid hormone replacement therapy. Thyroid hormone receptor beta (THRβ), which is expressed in the hypothalamus and pituitary gland, plays an important role in regulating thyroid hormone through feedback mechanisms. Yao et al. have reported that roxadustat has a similar structure to T3 and acts as a THRβ-selective ligand, particularly activating THRβ. Therefore, it is possible that roxadustat suppresses TSH secretion through negative feedback via THRβ. It is important to monitor thyroid function in patients receiving roxadustat. Roxadustat should be avoided in patients with primary hypothyroidism, since it is inferred that roxadustat-induced hypothyroidism cannot be improved by enhancement of thyroid hormone replacement therapy.
#4880 SUCCESSFUL LIMB SALVAGE IN A CHALLENGING PATIENT ON DIALYSIS BY IMPLANTATION OF AUTOLOGOUS PERIPHERAL BLOOD MONONUCLEAR CELLS: A CASE REPORT
Authors: Capone Martina , Liberato Lorenzo Di , Ndrecka Olsi , Monaco Maria Pia , Sirolli Vittorio , Vezzani Valeria , Orfeo Chiara Alessia , Giudice Bianca Lo , Bonomini Mario
Published: June 2023

Background and Aims

Peripheral arterial disease (PAD) is an extremely common condition in patients with End-Stage Renal Disease (ESRD) on dialysis. Concomitant comorbidity such as diabetes may be associated with complex vascular dysfunction, and ESRD itself is a recognized risk factor for PAD leading to non healing ulcers and lower limb amputation, which occurs in a high rate of patients [1]. Despite improvement in endovascular techniques for lower extremity revascularization, the incidence of limb salvage among dialysis patients remains poor. Furthermore, lower extremity amputation in these patients is associated with higher mortality rates [2], in addition to important social and economic implications. In this Case Report, an emergent therapy approach was applied aiming to limb salvage in a 74 years old female patient on hemodialysis suffering from lower extremity critical ischemia in diabetic foot infection, otherwise candidate for major amputation, after ineffective angioplasty and Negative Pressure Wound Therapy (NPWT).

Method

After surgical debridement of the ischemic lesion, an innovative therapeutic approach [3] was performed. It consisted in implantation, in the perilesional area of the affected lower limb, of a concentrate of autologous peripheral blood mononuclear cells (PBMNC) taken from 120 ml of peripheral blood of the patient, by using a selective filtration separation system. This procedure was managed in the operating room and was repeated three times at intervals of 15 days from each other. Since concomitant osteomyelitis occurs in the ischemical diabetic foot under treatment, it was managed with a 2-dose regimen of weekly Dalbavancin, reaching infection control. The patient was followed twice a week for 7 months for regular medications.

Results

After the treatment approach, the granulation tissue improved gradually, obtaining complete surgical wound healing. Since toes gangrene occurs, amputation of the toes was necessary, but limb rescue was successfully reached.

Conclusion

The autologous implantation of PBMNC resulted in limb salvage in this patient on dialysis affected by critical peripheral arterial disease in diabetic foot. This approach has not been described in literature among patients on dialysis, despite the higher mortality rate associated with lower limb amputation in these patients. It seems to be a very promising therapy, with the potential to modify the natural history of no-options critical limb with diabetes complications, in terms of major amputation and overall survival rates. After thorough validation, the reported management could be considered for similar cases.
#4960 TIXAGEVIMAB AND CILGAVIMAB (EVUSHELD) FOR PRE-EXPOSURE PROPHYLAXIS OF COVID-19: A MONOCENTRIC STUDY IN KIDNEY TRANSPLANT RECIPIENTS
Authors: Stefanelli Lucia Federica , Alessi Marianna , Ungaro Claudia , Ciotti Chiara , Calò Lorenzo
Published: June 2023

Background and Aims

Patients, who underwent kidney transplantation, may be at particularly high risk of mortality due to immunosuppressive therapy and underlying comorbidity such as hypertension, cardiovascular disease and diabetes mellitus finally increasing the risk of a severe form of SARS-CoV-2 infection. According to the ERA-EDTA DESCARTES expert opinion, management of immunosuppression in SARS-CoV-2 infection suggests withdrawal of antimetabolite (mycophenolate or azathioprine) in patients with mild upper respiratory and/or gastrointestinal symptoms and discontinuation of all immunosuppressive drugs with maintenance of steroid for severe bilateral pneumonia. Despite SARS-CoV-2 vaccination, kidney transplant patients remain at increased risk for severe COVID-19 infection and mortality and at high priority for additional strategies for preexposure prophylaxis.Tixagevimab and cilgavimab are long-acting monoclonal antibodies against the spike protein of SARS-CoV-2, which block the virus’ attachment and entry into human cells. This combined monoclonal antibody (Evusheld®) has been granted emergency use authorization (EUA) by the U. S food and drug administration (FDA) for individuals 12 years and older who have a moderate to severe immunocompromising condition and may not mount an adequate vaccination response.This single cohort observational study reports the incidence and outcomes of COVID-19 among kidney transplant recipients receiving Evusheld® as preexposure prophylaxis.

Method

Observational monocentric cohort study of 119 kidney transplant patients receiving Evusheld® 150/150 mg intramuscularly as preexposure prophylaxis between July 1, 2022 and December 31, 2022. Inclusion criteria: kidney or combined kidney-pancreas transplantation within 1 year; recent acute allograft rejection; time since COVID-19 infection of 120 days and time since last vaccine dose of 2 weeks.

Results

After a median (range) follow-up of 150 days, COVID-19 was confirmed in 48/119 patients (40.3%), who had only a light form of COVID-19 infection. No one complained side.

Conclusion

Our study reported a low rate of infections with only light symptoms among kidney transplant patients treated with Evusheld®. A long-term study with a larger cohort might better evaluate the efficacy, outcomes and safety of this preexposure prophylaxis.
#4979 MORTALITY AND BIOIMPEDANCE SPECTROSCOPY–BASED DRY WEIGHT MEASUREMENT ERROR IN ELDERLY PATIENTS UNDERGOING HEMODIALYSIS
Authors: Kim Hae Ri , Kim Moo Jun , Jeon Jae Wan , Choi Dae Eun , Na Ki Ryang , Lee Kang Wook
Published: June 2023

Background and Aims

Dry weight (DW) estimation is important for patients undergoing hemodialysis. Although bioimpedance spectroscopy (BIS) is often employed to evaluate DW, BIS-based DW frequently differs from clinical DW. In this study, the characteristics of elderly patients were evaluated by separating them into groups based on the degree of disparity between the BIS-based DW and the clinically appropriate (DWGAP), and the mortality of each group was compared.

Method

This retrospective study included patients who underwent hemodialysis at Chungnam National University Hospital from January 1, 2016, to June 2020. All patients were aged ≥60 years. Patients with cancer, recipients of kidney transplant, and patients who dropped out of the study within 3 years were excluded. Body composition was assessed using a portable BIS device (Fresenius Medical Care, Bad Homburg, Germany). The BIS dataset includes extracellular water (ECW), intracellular water (ICW), and total body water level (TBW) as well as the lean tissue index (LTI), fat mass index (FTI), ECW/ICW ratio (E/I), lean tissue mass, fat mass (FAT), adipose tissue mass (ATM), and body cell mass (BCM). The absolute value of the gap between the BIS-based DW and the actual clinically appropriate dry weight was determined (DWGAP). To assess differences in blood chemistry and survival rate, four groups were classified based on the absolute value of DWGAP; Group 1: DWGAP < 0.5 kg, Group 2: 0.5 kg ≤ DWGAP < 1 kg, Group 3: 1 kg ≤ DWGAP < 2 kg, and Group 4: 2 kg < DWGAP. The mortality data of patients up to 3 years after BIS measurement were collected.

Results

There were 1024 patients in all. The study excluded 29 individuals with cancer, 31 patients with KT, and 249 participants with a loss of follow-up before 36 months. A total of 715 patients were analyzed: Group 1 (n = 236), Group 2 (n = 171), Group 3 (n = 137), and Group 4 (n = 171). The mean age for each group was 71.97, 70.73, 71.58, and 70.4 years, respectively. Groups 1 and 2 had the same survival rates (78%); however, Group 3 had a lower rate (73%) and Group 4 showed a significant decline (59%). In the laboratory test, Group 4 had lower hemoglobin, total protein, albumin, creatinine, and chloride levels than Groups 1, 2, and 3. In the BIS data, ECW and E/I were higher in Group 4 than in Groups 1, 2, and 3.

Conclusion

In the elderly patient group, mortality increased in the group where the DWGAP was >2 kg. Lower blood albumin levels, total protein levels, and E/I ratios of ≥1 were detected in the group with a gap of ≥2 kg, and these parameters are likely to adversely affect the survival of elderly patients requiring dialysis.
#5029 PERCUTANEOUS ARTERIOVENOUS FISTULA CREATION: A DUBAI HOSPITAL EXPERIENCE
Authors: Eleraky Tarek , Saleh Ayman , Kovilazhikam Dileep , Alhadari Amna
Published: June 2023

Background and Aims

Targeting to improve the quality of care for chronic kidney disease patients (CKD) a non -surgical creation of native arteriovenous fistulae (AVF) with potentially cosmetic advantages, was offered for CKD patients in Dubai. The procedure started in January 2021 and the follow up continued till January 2023. The goal of this report is to share the original first experience in Dubai for this technique using 4F WavelinQ EndoAVF System.

Method

Fourteen patients underwent sonographic vascular mapping for endovascular AVF creation using 4F WavelinQ EndoAVF System. Nine patients were deemed suitable for Endovascular AVF creation and underwent the procedure under regional anaesthesia. Concomitant ulnar artery and ulnar vein or the concomitant radial artery and radial vein was used for the procedure.

Results

In this case series, the patients have a mean age of 53 ± 17 years, majority of the cases were men (77.8%). All cases were hypertensives (100%) with 2 cases(22.2%) have biopsy proven Glomerulonephritis and 5 cases (55.5%) were diabetics. The technique succeeded (defined by blood flow from used artery to concomitant deep vein and through perforator vein to superficial vein) in all patients (100%). Maturation success (defined as estimated fistula flow rates exceeded 500 mL/min and access vessel diameter was more than 4 mm) with multiple venous outflows was achieved in 8 cases (88.1%). One case (11.1%) showed primary maturation failure. Five cases (55.5%) achieved successful cannulation with excellent blood flow and reliable arterial and venous pressure during dialysis. Time to maturation was 35 ± 17 days and time to successful cannulation averaged 63 ± 45 days. Among patients achieving maturation success, one patient requested AVF closure (using coil embolization) due to mild to moderate upper limb oedema that required reintervention, one case underwent pre-emptive kidney transplantation and did not require to use the AVF and one patient refused using the AVF. In our study 3 cases (33.3%) required reintervention to facilitate maturation. It worth mention that among the 3 cases underwent reintervention, one case requested closure of the fistula and one case refused to use the fistula and only one case of the successful cannulation group underwent single reintervention.

Conclusion

In our limited experience, AVF creation using Endovascular technique resulted in dependable haemodialysis access with reliable maturation time, achieving excellent patency in the successful cannulation group with high blood flow rate and accepted arterial and venous pressure during dialysis. It also showed that the procedure was safe with better cosmetic shape and no scars. However more studies with bigger sample size are needed for better evaluation of the technique and to confirm the endovascular AVF creation proper position in the guidelines for vascular access creation in haemodialysis.
#5069 THE EFFECT OF DIFFERENT DIALYSATE SODIUM CONCENTRATIONS ON AMBULATORY BLOOD PRESSURE AND PULSE WAVE VELOCITY ON HEMODIALYSIS PATIENTS
Authors: Bratsiakou Adamantia , Papasotiriou Marios , Alexandrou Maria Eleni , Mpimpis Theodoros , Georgopoulou Georgia Andriana , Tsiotsios Konstantinos , Goumenos Dimitrios , Sarafidis Pantelis , Papachristou Evangelos
Published: June 2023

Background and Aims

Hypertension and arterial stiffness are associated with increased morbidity and mortality in dialysis patients. The purpose of the present study is to investigate the effect of sodium concentration in the dialysate on 72h ambulatory blood pressure and arterial stiffness, as well as its effect on body weight.

Method

The study involved adult patients on thrice weekly maintenance hemodialysis program. All patients initially underwent six sessions with dialysate sodium concentration of 137 meq/l, subsequently another six sessions with dialysate sodium concentration of 139 meq/l and finally six sessions with dialysate sodium concentration of 141 meq/l. At the start of the sixth hemodialysis session at each different sodium dialysate concentration, the Mobil-o-graph device was placed for 72h in order to cover the 3-day interdialytic interval. The parameters evaluated by the Mobil-o-graph device were peripheral and central systolic (pSBP and cSBP) and diastolic (pDBP and cDBP) blood pressure and pulse wave velocity (PWV). All patients were screened for hydration status with lung ultrasound before entering the study and body weight was actively monitored before each session.

Results

Overall, 29 patients with a mean age of 57.9±14.9 years were included in this prospective interventional study. Body weight did not change significantly between the 3 dialysate concentrations. There was a significant increase of 6 mmHg in the mean pSBP with the change in sodium concentration from 137 to 139 and to 141 meq/l (from 122.7 to 125,6 and to 128.3 mmHg respectively, p = 0.032). Mean cSBP was also significantly increased by 5 mmHg (from 110.3 to 112.6 and to 115.1 mmHg respectively, p = 0.02). Peripheral and central DBP did not change significantly (from 71.4 to 73.2 and to 74.1 mmHg, p = ns and from 73.9 to 74.8 and to 75.3 mmHg, p = ns, respectively), as well as PWV (from 8.4 to 8.2 cm/sec, p = ns).

Conclusion

The increasing sodium concentration in the dialysate causes a significant increase in systolic blood pressure and body weight, without a change in PWV.
#5088 ARTIFICIAL INTELLIGENCE APPLIED TO VASCULAR DOPPLER ULTRASOUND MODELS FOR PREDICTING UNDERDEVELOPMENT OF VASCULAR ACCESS IN NEPHROLOGY
Authors: Ruiz Alfonso Lara , Franco María Jesús Moyano , Moreno Fernando Bertomeu , Martin Javier Burgos , Cintra Melissa , Lazo Mercedes Salguiera
Published: June 2023

Background and Aims

The vascular access of choice for hemodialysis patients is the arteriovenous fistula (AVF). There is a high rate of early primary failure and loss of primary AVF patency. Monitoring of vascular access is essential for early diagnosis of complications and prolonging survival. Models based on Artificial Intelligence (AI) and Machine Learning (ML) can be used for this.

Method

Retrospective descriptive study of the Vascular Doppler Ultrasound (VDU) in adults carried out since January 2019 to January 2022 in our AVF follow-up nephrology clinic. We analyze the results and create AI-based AVF underdevelopment prediction models. We included clinical, demographic and ultrasound variables. Patients were undergoing AVF post-surgery follow-up (VDU by protocol at 3-4 weeks after AVF surgery) or were referred to the clinic with signs of AVF dysfunction. The insufficient development of the vascular access is established as an objective variable. SPSS 20 Statistical Package. Automated Learning Analysis (ML) with Orange ML and BigML.

Results

243 VDU were performed. Of the total, 139 (57%) were follow-up post-surgical VDU per protocol and 104 (43%) were AVF dysfunction VDU. Using supervised ML Analysis techniques with random sampling of 80% of the instances for Training and 20% for Test, we obtain prediction models for the underdevelopment (UD) attribute of FAV: Decision tree algorithm, Area under the curve (AUC) 89%, Classification accuracy (CA) 90%, Precision 90%. Random Forest Algorithm (RF) (AUC) 95%, (CA) 86%, Accuracy 81%. Near Neighbor Algorithm (K-NN) (AUC) 88%, CA 82%, Accuracy 78%. Convolutional Neural Networks (NNC) (AUC) 82%, CA 74%, Accuracy 60%. Algorithm with unsupervised technique of clustering in k-Means 3 clusters are obtained. The variables that best correlate with the objective variable are access flow, vein diameter, resistance index (RI) proximal, (RI) distal, and diameter of the anastomosis.

Conclusion

The vascular ultrasound systematized by the nephrologist facilitates the early diagnosis of complications that lead to early intervention. Analysis of the data with techniques (ML) can facilitate early diagnosis AVF poor development requiring close monitoring or intervention. The development of a nephrology clinic for monitoring vascular access could avoid invasive and unnecessary procedures for the patient.
#5243 ASSESSING HEALTH-RELATED QUALITY OF LIFE IN HEMODIALYSIS PATIENTS IN A PUBLIC HOSPITAL IN TUNIS: A CROSS-SECTIONAL STUDY
Authors: Mejri Borhene , Mariem Najjar , Helaoui Fadwa , Triqui Chifaa , Hmida Fethi Ben , Abderrahim Ezzeddine
Published: June 2023

Background and Aims

There are not many studies evaluating the quality of life of patients with chronic and advanced kidney disease in North Africa. We assessed the health-related quality of life (HRQOL) of patients receiving hemodialysis in a public hospital in Tunis using the KDQOLTM-36 (Kidney Disease Quality of Life) survey, and we investigated its sociodemographic, clinical and biological correlation.

Method

A cross-sectional study design was used, and patients were recruited from a single hemodialysis center in the Charles Nicolle Hospital in Tunis. The KDQOLTM-36 questionnaire was given to patients aged 18 or above receiving in-center hemodialysis maintenance for at least three months to assess their physical and mental health, as well as the effect, burden, and symptoms of kidney disease. Patients with hepatitis, HIV, mental illnesses, and physical disabilities were not eligible for the study. Socio-demographic and clinical data were collected for all eligible patients. We then employed linear regression models to explore the factors associated with overall KDQOL and its various domains.

Results

Sixty-five patients were included. The mean age was 50.9 years old (23-79). The sex ratio was 1.16. The median quality of life score was 52.5 for overall HRQOL, 35,6 for the Physical Component Summary (PCS) score and 44.2 for the Mental Component Summary (MSC) score. Symptoms/problems, effect, and burden of kidney disease (KD) were scored 62.5, 59.38 and 37.5, respectively. There was a significant correlation between diabetic and non-diabetic patients in Symptoms (50.19 vs 65.04 p = 0.006), Effect (45.4 vs 57.87 p = 0.038), Burden of KD (7.38 vs 39.46 p = 0,001) and MCS (p<0,0001). Cardiovascular disease was associated with a higher burden of KD (p = 0.025). Higher age was associated with lower score in Symptoms (p = 0.032) and Burden (p = 0.035). Other correlations were between weight gain between sessions and MCS (p = 0.012), Hyponatremia with both symptoms (p = 0.016), effect (p = 0.029) and MCS (p = 0.017), Hypoalbuminemia with symptoms (p = 0.018), dilated left cavity in the transthoracic ultrasound with both effect(p = 0.047) and burden of KD (p = 0.023). There was no correlation found between gender, work status and hemoglobin level and quality of life.

Conclusion

The results of this study indicate that patients receiving hemodialysis have a low quality of life. The factors associated with overall quality of life were diabetes, cardiovascular disease, age, weight gain between dialysis sessions, hyponatremia, hypoalbuminemia, and dilated left cavity in transthoracic ultrasound. Those findings should be studied using a larger sample.
#5254 COMPARISON OF EFFICACY OF DIFFERENT VANCOMYCIN ADMINISTRATION REGIMENS IN ACUTE KIDNEY INJURY ON HEMODIALYSIS PATIENTS: A RANDOMIZED CLINICAL TRIAL
Authors: Zamoner Welder , Cavalcante Ricardo , Balbi Andre , Ponce Daniela
Published: June 2023

Background and Aims

Sepsis is the main cause of Acute Kidney Injury (AKI), requiring dialysis in critically ill patients, with vancomycin being widely used. Its pharmacokinetics and pharmacodynamics (PK/PD) change during hemodialysis (HD), increasing the risk of subtherapeutic concentrations. Objective: To compare different vancomycin administration protocols to assess serum concentrations and area under the curve/minimum inhibitory concentration (AUC/MIC) ratio from PK/PD.

Methods

Randomized, non-blind clinical trial, including critically ill adults diagnosed with septic AKI on conventional (4 hours) and prolonged HD (6 and 10 hours) and using vancomycin for at least 72 hours from May/2019 to May /2021. Sessions of patients were analyzed and randomized into three groups (G): G control (C, dose of 15 mg/kg after HD session), G intervention (I) 2 hours (dose of 7.5 mg/kg in the second hour of HD and 7.5 mg/kg after the session) and IG continuous infusion (dose of 30 mg/kg in continuous infusion pump, in 24 hours). Patients on chronic dialysis, pregnant women, and those whose session was interrupted for clinical or technical reasons were excluded.

Results

Of the 316 patients recruited, 87 were randomized, and 174 HD sessions were monitored. There was a predominance of males (69.5%), age 61±11 years, APACHE II 31±6, ATN-ISS 0.79±0.14. For the analysis, 28 sessions belonged to the CG, 47 sessions to the 2-hour IG, and 31 to the continuous infusion IG. The groups were similar in age, weight, comorbidities, severity scores, use of diuretics and nephrotoxic drugs, urine output, albumin, CRP, hematocrit, HD modality, recovery of renal function, and death. When HD sessions were analyzed, there was no difference between the groups regarding Kt/V, ultrafiltration, system coagulation, or hypotension. The CG had a higher frequency of subtherapeutic serum levels at the end of HD compared to the 2-hour IG and continuous infusion (86.7% vs. 42.2% vs. 3.2%, p<.0001), higher clearance dialysis (p = .04) and lower AUC/MIC (p<.0001). The IG continuous infusion had a higher frequency of supratherapeutic concentrations (71%). Logistic regression identified the initial concentration variable as a risk factor (OR 1.16, p = .001) for a non-therapeutic concentration (AUC/MIC less than 400 mg·h/L or greater than 600 mg·h/L) of vancomycin. In contrast, the 2-hour intervention group was identified as a protective factor (OR 0.24, p = .04).

Conclusion

Our results suggest that administering vancomycin during dialysis resulted in a lower proportion of supratherapeutic or subtherapeutic concentrations compared to administration in continuous infusion or after the end of the session, respectively. New studies are needed to suggest more appropriate doses and assess these findings' impact on clinical outcomes.
#5372 THE ASSOCIATION BETWEEN POTASSIUM INTAKE AND RISK OF CHRONIC KIDNEY DISEASE
Authors: Han Seung Hyeok , Yun Hae-Ryong , Kim Hyo Jeong
Published: June 2023

Background and Aims

High potassium intake is closely related to lower risk of cardiovascular disease. However, the association between potassium intake and chronic kidney disease (CKD) development in the general population is uncertain.

Method

From UK biobank cohort, we included 317,162 participants without CKD between 2006 and 2010. The main predictor was spot urine potassium-to-creatinine ratio (KCR) as a surrogate of potassium intake. The primary outcome was incident CKD, defined based on ICD-10 and OPCS-4 codes. For secondary analysis, we included 141,180 participants who completed 24-h dietary recall questionnaire and dietary potassium intake was an additional predictor.

Results

At baseline, individuals with higher KCR had lower levels of blood pressure, BMI, and inflammation, and were less likely to have diabetes and hypertension than those with lower KCR. During a median follow-up of 11.9 years, the primary outcome events occurred in 15,255 (4.8%) participants. In competing risk model, adjusted hazard ratio (aHR) per 1-SD increase in KCR for incident CKD was 0.90 (95% confidence interval [CI], 0.89-0.92). In addition, compared with quartile 1 of KCR, the aHRs (95% CIs) for second, third, and fourth quartile were 0.98 (0.94–1.02), 0.90 (0.86–0.95), and 0.80 (0.76–0.84), respectively. In secondary analysis, higher potassium consumption was also inversely associated with risk of CKD. Compared with quartile 1 of dietary potassium intake, the corresponding aHRs (95% CIs) for each quartile were 0.85 (0.78–0.92), 0.73 (0.67–0.81), and 0.67 (0.60–0.75), respectively.

Conclusion

Higher urinary potassium excretion and potassium intake were associated with lower risk of incident CKD.
#5397 FRAILTY ASSESSMENT TOOLS, SURVIVAL TIME AND TIME TO INITIATE DIALYSIS IN OLDER PATIENTS WITH ADVANCED CHRONIC KIDNEY DISEASE
Authors: Hussien Hani , Onofriescu Mihai , Nastasa Andra , Popa Cristina , Teodor Iuliana , Apascaritei Irina , Covic Andreea , Cusai Silvia Corina , Covic Adrian
Published: June 2023

Background and Aims

Chronic Kidney Disease (CKD) patients with frailty have been shown to have a shorter survival time compared to non-frail individuals. Additionally, frailty has been linked to earlier initiation of dialysis among CKD patients. Despite the availability of over 50 frailty assessment tools in the literature, few have been applied in studies of older adults with CKD. There is a need for a comprehensive analysis of different frailty tools to identify the most accurate tools that could predict survival time and time to start dialysis in older adults with CKD. The present study compares four commonly used assessment tools of frailty from different categories (self-reporting tools, clinical judgment tools and complex instruments) regarding their association with survival time and time to start dialysis.

Method

Two hundred forty patients with biochemical evidence of CKD Stages 4–5 were included in this prospective cohort study. The inclusion criteria included patients 65 years old or more with two consecutive measurements of estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 separated by more than three months, while exclusion criteria included dialysis dependence, history of kidney transplantation, recent acute kidney injury, initial visit with the provider, amputation, or cerebrovascular accident. The four frailty assessment tools used in the study were Prisma-7 and FRAIL Scale, Clinical Frailty Scale (CFS), and Frailty Phenotype (FP). Patients were followed-up for 36 months for death events or dialysis initiation.

Results

The study population (240 patients) comprised 46% male patients with a mean age of 73.8 ± 6.6 years. Approximately 25% of patients were considered frail using the FRAIL scale, 69% using Prisma-7, and almost 40% using CFS and FP. Except for Prisma-7, “frail” patients, as determined by the FRAIL, CFS, and FP scores (Fig. 1), had significantly shorter survival times, with a mean survival of 24.9 months (Log-rank p <0.001), 27.3 months (Log-rank p = 0.041), and 26.6 months (Log-rank p = 0.004) respectively. No significant differences were observed in time to dialysis initiation when comparing frail and non-frail patients using any of the frailty assessment tools (Table 1).

Conclusion

The findings suggest that the frailty scores derived from the FRAIL, CFS, and FP tools are better predictors of survival time in frail elderly patients with CKD, while further research is required to determine the most appropriate frailty tool to predict the time to start dialysis in this population.
#5440 BONE TURNOVER MARKERS AND BONE MINERAL DENSITY 1 YEAR AFTER KIDNEY TRANSPLANTATION
Authors: Barbuto Simona , Aghi Andrea , Cianciolo Giuseppe , La Manna Gaetano , Tripepi Giovanni Luigi , Pascale Khairallah , Plebani Mario , Zaninotto Martina , Cosma Chiara , Gasperoni Lorenzo , Cortez Natalia , Nickolas Thomas , Fusaro Maria
Published: June 2023

Background and Aims

Alterations of bone metabolism are a hallmark of chronic kidney disease (CKD) patients and do not completely ameliorate after kidney transplantation. In the setting of a secondary analysis of a RCT, we evaluated changes of bone turnover biomarkers (BTM) and their associations with changes of bone mineral density (BMD) as assessed by DXA.

Method

Sixty-six Kidney Transplant (KTx) recipients were enrolled between 2014-2017. In these patients, at baseline (T0) and 12 months (T12) we measured BTM (Figure 1). The prevalence of vitamin K deficiency was assessed based on undercarboxylated-BGP (uc-BGP) cut-off: > = 4.5 ng/ml, whilst dephosphorylated-ucMGP (dp-ucMGP) we considered a cut-off >500 pmol/L levels. DXA data were assessed at lumbar spine, femoral neck, total hip, one-third and ultradistal radius both baseline and after one year, evaluating the changes in areal BMD (aBMD). Results were expressed as mean ±SD or median and inter-quartile range, as appropriate. Correlations were investigated by Spearman's analysis.

Results

The mean age of enrolled patients was 51± 13 years, 34% were female. BMI was on average 27.8 ± 5.5 kg/m2. 24 patients (39.3%) were pre-emptive and 37 (60.7%) on dialysis and 19% of patients had a history of fracture. In Figure 1 the trend of BTM 1 year after KTx. We highlighted a significant reduction of PTH, CTX, P1NP, and VKDPs. This latter while improving but was not completely restored. Table 1 shows the correlations between the percentage variation of BTM and percentage variation of BMD at several sites evaluated.

Conclusion

In the first-year post-transplant, along with the improvement of renal function, PTH values were reduced as well those of CTX and P1NP. Moreover, we observed an inverse correlation between BTM and BMD, the reduction of bone turnover expressed by the trend of BTM translates into an improvement of BMD.
#5454 DESIGN AND OPTIMIZATION OF DRUG COMBINATION THERAPIES FOR OSTEOPOROSIS VIA SIMULATIONS OF BONE TURNOVER
Authors: Joerg David , Fuertinger Doris , Kotanko Peter
Published: June 2023

Background and Aims

Many chronic kidney disease (CKD) patients suffer from mineral and bone disorders like osteoporosis, which also affects a huge part of the general population, predominantly postmenopausal women. For the treatment of osteoporosis, several drug types with different mechanisms of action are available, such as bisphosphonates, PTH analogs, RANKL inhibitors and sclerostin inhibitors (some of which are contraindicated for CKD patients beyond CKD stage 3). Different drugs can be given individually or combined in various ways, simultaneously or sequentially, resulting in a huge number of theoretically possible drug combinations that are practically impossible to study in clinical studies. We aimed to study using simulations whether there are combination therapies that would work considerably better than those tested and employed in clinical practice. If so, this could be beneficial for the treatment of a large number of osteoporosis patients by leading to a higher increase in bone strength and a higher reduction in bone fracture risk than standard therapies.

Method

We developed a physiology-based mathematical model that simulates the process of bone renewal in the human body and can predict how different osteoporosis drugs (including bisphosphonates, PTH analogs, RANKL inhibitors, and sclerostin inhibitors) affect this process, alone and in combination [1].

Results

The model was validated on over 30 clinical osteoporosis studies with about 90 study arms. It predicted the time courses of bone mineral density and bone turnover markers with a high degree of accuracy based on the knowledge of the used drugs and dosing schemes alone. We used the model to study how treatment results changed when merely reshuffling the order in which different drugs were given. For example, for 3-year drug therapies involving alendronate, denosumab and romosozumab (1 year each), our simulations showed that the order in which these drugs were given can have a considerable effect on short- and long-term therapy success [1]. This is due to different drugs favorably interacting when applied in the right sequence.

Conclusion

Our findings indicate that some osteoporosis drug administration schemes are superior to others while relying on the exact same types and amounts of drugs. Therefore, there is a large potential to improve pharmacologic therapies of osteoporosis using physiological simulations. For renal patients beyond CKD stage 3, a restricted set of drug types may be considered to account for contraindications related to impaired renal clearance. If translated into clinical practice, findings obtained using our model could give rise to novel treatments using combinations of existing drugs for osteoporosis that lead to a lower bone fracture risk than standard treatments. Moreover, our model could serve as a basis for personalizing osteoporosis therapy to individual patients.