bluuebunny/crossref_metadata_2025 huggingface dataset:
MO453: Post-Translational Guanidinylation of Apolipoprotein C3 (APOC3) is Associated With Kidney and Vascular Injury
Authors: Schunk Stefan , Jankowski Joachim , Fliser Danilo , Speer Thimoteus , Jankowski Vera
Published: May 2022

BACKGROUND AND AIMS

Cardiovascular diseases (CVD) and chronic kidney diseases (CKD) are highly prevalent in Western populations and account for a substantial proportion of mortality. We recently found that apolipoprotein C-3 (ApoC3), a constituent of triglyceride-rich lipoproteins, induces alternative NLRP3 inflammasome activation leading to sterile inflammation. In the present study, we aimed to assess post-translational modifications (PTMs) of ApoC3 in patients with CKD, to determine the effects of post-translationally modified ApoC3 in vitro and in vivo, and to test the relevance in a prospective clinical trial.

METHOD

Using mass-spectrometry, we screened ApoC3 for PTMs We determined the effects of modified ApoC3 on monocyte inflammatory response in vitro and assessed its effects in humanized mice subjected to a vascular injury model and unilateral ureter ligation. Finally, we assessed the association of post-translationally modified ApoC3 and cardiovascular and renal events in a prospective clinical trial of 543 CKD patients.

RESULTS

We identified post-translational guanidinylation of ApoC3 (gApoC3) in patients with CKD, which augments the proinflammatory effects of ApoC3. Mechanistically, guanidine and urea induced guanidinylation of ApoC3. gApoC3 accumulates in kidneys and plasma of mice subjected to a CKD model as determined by 2D-proteomic analyses. In humanized mice, gApoC3 promotes kidney fibrosis and impedes vascular regeneration. In the clinical trial, higher gApoC3 blood levels as determined by mass spectrometry were associated with increased mortality as well as cardiovascular and renal events.

CONCLUSION

Guanidinylation of ApoC3 represents a novel pathogenic mechanism in CKD and CKD-associated vascular injury, rendering gApoC3 a potential therapeutic target.
MO456: Renal and Major Clinical Outcomes After Nephrectomy in Patients With Pre-Existing Chronic Kidney Disease (ON-CKD Study)
Authors: Schleef Maxime , Roy Pascal , Paparel Philippe , Colombel Marc , Badet Lionel , Guebre-Egziabher Fitsum
Published: May 2022

BACKGROUND AND AIMS

Partial nephrectomy (PN) has progressively replaced radical nephrectomy (RN) whenever feasible for renal tumors. However, its effects on renal outcomes are less known in patients with pre-existing chronic kidney disease (CKD) or with solitary kidney (SK). We aimed to assess renal and major clinical outcomes after PN or RN in patients with moderate to severe CKD or SK.

METHOD

We included all surgical procedures conducted between 2013 and 2018 in the Hospices Civils de Lyon, in patients with last pre-operative estimated glomerular filtration rate (eGFR) <60mL/min/1.73m², or with SK. Exclusion criteria were eGFR < 15mL/min/1.73m² or dialysis, RN on SK, ablative therapy. Demographic, tumors and surgeries characteristics were collected, as well as eGFR 1 month and 1 year after surgery. Main outcome was a composite criterion including CKD progression or major cardio-vascular events or death, assessed 1 year after surgery. Predictors of the main outcome were determined using multivariate analyses.

RESULTS

We included 173 procedures (67 RN and 79 PN on CKD patients, 27 PN on SK patients). Patients undergoing RN were older, had bigger tumors and higher T stages on TNM classification. Preoperative estimated glomerular filtration rate (eGFR) and CKD stages were not different between the groups. One year after surgery, PN was associated with less occurrence of the main composite outcome compared to RN (42.9% versus 70.7%, P < 0.01). On multivariate analysis, independent risk factors for the main outcome were postoperative AKI (no AKI as reference; AKI stage 1 odds ratio (OR) = 8.68, 95% confidence interval (CI) 3.23–23.33; AKI stage 2 OR = 23.50, 95% CI 2.33–236.51; AKI stage 3 OR = 28.87, 95% CI 4.77–167.61) and bigger tumor size (OR = 1.21/cm, 95% CI 1.02–1.45), while preoperative eGFR was not (Table 1). Compared to pre-operative values, eGFR significantly decreased both after RN or PN 1 month after surgery (eGFR loss -12mL/min 1.73m² after RN P < 0.001, −3mL/min/1.73m² after PN, P < 0.05) and this decrease remained stable 1 year after surgery (eGFR loss -11mL/min/1.73m² after RN, P < 0.001, −3mL/min/1.73m² after PN, P < 0.05), but renal function was better preserved after PN than after RN at 1 month (P < 0.05) or 1 year (P < 0.01) (Figure 1).

CONCLUSION

In moderate to severe CKD patients, PN was associated with less risk of CKD progression or major cardio-vascular event or death 1 year after surgery, compared to RN. Postoperative AKI was the major determinant of clinical and renal outcomes.
MO457: Diffusion-MRI Predicts Decline of Renal Function in Chronic Kidney Diseases and Kidney Allograft Patients
Authors: Berchtold Lena , Crowe Lindsey , Combescure Christophe , Kassai Miklos , Aslam Ibtisam , Legouis David , Moll Solange , Martin Pierre-Yves , de Seigneux Sophie , Vallée Jean-Paul
Published: May 2022

BACKGROUND AND AIMS

Kidney cortical interstitial fibrosis is highly predictive of renal prognosis and is currently assessed by the evaluation of a biopsy. Diffusion-weighted magnetic resonance imaging is a promising non-invasive tool to evaluate kidney fibrosis. We recently adapted a diffusion-weighted imaging sequence, allowing for the discrimination between the kidney cortex and medulla. The cortico-medullary difference in apparent diffusion coefficient (ΔADC) correlated to histological interstitial fibrosis. The aim of this study was to assess whether ΔADC as measured with diffusion-weighted magnetic resonance imaging is predictive of renal function decline and dialysis in chronic kidney diseases (CKD) and kidney allograft patients.

METHOD

We performed a prospective study including 197 patients. We measured ΔADC in 43 CKD patients [estimated glomerular filtration rate (eGFR) 55 mL/min/1.73m2] and 154 kidney allograft patients (eGFR 53 ml/min/1.73m2). Patients underwent a renal biopsy and diffusion-weighted magnetic resonance imaging, within 1 week of biopsy. Follow-up was 2.2 years in median. During follow-up, laboratory parameters were measured. Primary outcome was defined as rapid decline of renal function (eGFR decline > 30% or dialysis initiation) during follow-up.

RESULTS

Patients with low ΔADC (<0 x10-6mm2/s) had 5.4 times more risk of rapid decline of renal function or dialysis [95% confidence interval (CI): 2.29–12.58; P < 0.001]. After correction for renal function at baseline and proteinuria, low ADC still predict renal function loss with a hazard ratio (HR) of 4.62 (P < 0.001, 95% CI 1.56–13.67).

CONCLUSION

We demonstrate in this study that low ΔADC is a predictor of renal function decline and dialysis initiation in CKD and kidney allograft patients, independent of baseline renal function and proteinuria.
MO458: Superb Micro-Vascular Imaging: An Innovative Ultrasound Technique for Early Detecting of Renal Damage
Authors: Armaly Zaher , Abu-Rahme Munai , Kinaneh Safa , Hijazi Basem , Habasshe Nayef , Abassi Zaid , Artul Suheil
Published: May 2022

BACKGROUND AND AIMS

Novel ultrasound (US) methods are required to assess qualitative alterations in renal tissue. Superb microvascular imaging (SMI) is an innovative US technique designed for imaging and better visualization of micro-vascularization unseen with color Doppler US. We assume that SMI will provide sufficient information regarding the severity of chronic kidney disease (CKD) and reflect renal histological alterations. To assess the early detection of kidney dysfunction and renal fibrosis capabilities of SMI imaging in comparison to the reference standard renal biopsy, in order to determine the usefulness of this approach in the early diagnosis of kidney dysfunction and renal fibrosis.

METHOD

The SMI was performed in patients (n = 52) with CKD stage 2–5, where some of them underwent biopsy-proven chronic renal dysfunction and fibrosis as part of the diagnosis and therapeutic judgment as needed. In addition, biochemical tests were performed in order to determine kidney function (BUN, Serum Creatinine), a urine collection test for the assessment of proteinuria and estimation of GFR by MDRD formula in patients with CKD of various severity and healthy controls (n = 17). In addition, all subjects underwent SMI US imaging, where vascularity is expressed as SMI index (low index reflects low vascularity/fibrosis and vice versa).

RESULTS

As expected, SMI vascular index was significantly lower in CKD patients as compared with healthy control (72.2 ± 12.9 versus 49.9 ± 16.7 %, P < 0.01). Interestingly, significant correlation between the SMI index and eGFR was found among the CKD patients (r = 0.56, P < 0.001). Similarly, a keen correlation was found between the SCr and SMI index of the diseased subjects (r = −0.54, P < 0.001). Among those who underwent renal biopsy, SMI index corresponds with the histological alterations such as fibrosis and CKD staging.

CONCLUSION

These findings show that SMI technique could be used due to its diagnostic capacity as a simple and practical method for evaluation of chronic renal histological changes and for the differentiation between CKD grades.
MO461: A Novel Chronic Kidney Disease to HFpEF Connection: Inflammatory Signaling, Micro-RNAs, and NF-KB
Authors: Chade Alejandro , Mohamed Tamer , Miller Jessica , Aboulesia Riham , Ouand Qinghui , Tang Hui , Saadiq Ishran , Eirin Alfonso
Published: May 2022

BACKGROUND AND AIMS

Chronic kidney disease (CKD) is an independent risk factor for heart failure with preserved ejection fraction (HFpEF), a progressive condition that affects ˃50% of patients in dialysis. We developed a swine model of CKD-HFpEF and showed that renal inflammatory signaling plays a key role in HFpEF pathophysiology via cardiac activation of nuclear factor-kappa B (NF-kB). However, the mechanisms of CKD-induced cardiac NF-κB activation remain unclear. We hypothesized that micro-RNA (miRNA)-mediated processes contribute to cardiac NF-kB activation in CKD-HFpEF.

METHOD

Using an in-silico approach (miRWalk3.0 and TargetScan 7.2), we identified all miRNAs capable of targeting the NFKB Inhibitor Alpha (NFKBIA) gene. We then identified those expressed in swine myocardium and measured their levels in normal and CKD pigs by qPCR. In a biomimetic heart culture system that mimics the cardiac CKD-HFpEF microenvironment, pig heart slices were exposed to plasma from normal or CKD pigs, and cardiac kinetics, NF-kB signaling, and miRNA expression levels were investigated in vitro.

RESULTS

We identified 5 miRNAs expressed in swine hearts capable of targeting NFKBIA, of which only miR-1271–3p showed higher expression in the myocardium of CKD-HFpEF pigs compared to normal pigs. miR-1271–3p upregulation was mirrored in pig heart slices exposed to plasma from CKD pigs, associated with blunted cardiac contraction/relaxation kinetics, downregulation of NFKBIA, and increased protein expression of NF-κB (Figure).

CONCLUSION

Our data support a novel pathophysiological mechanism for cardiac activation of NF-κB in CKD via post-transcriptional modulation of NFKBIA partly through miR-1271–3p. This miRNA might represent a novel therapeutic target to ameliorate the deleterious effects that renal inflammatory signaling in CKD imposes on the heart and may lead to HFpEF.
MO467: Time to Improvement of Itch Intensity in Patients With Chronic Kidney Disease-Associated Pruritus Treated With Difelikefalin
Authors: Csiky Botond , Walpen Sebastian , Schaufler Thilo , Morin Isabelle , Wen Warren , Menzaghi Frederique
Published: May 2022

BACKGROUND AND AIMS

Chronic kidney disease-associated pruritus (CKD-aP) is frequently reported by patients with CKD undergoing haemodialysis (HD), impacting sleep quality, quality of life and depression. Difelikefalin is a selective kappa-opioid receptor agonist approved in the United States for the treatment of moderate-to-severe pruritus in adults undergoing HD. In the Phase 3 KALM-1 and KALM-2 multicentre, placebo-controlled trials, difelikefalin significantly reduced itch intensity in HD patients with CKD-aP. The KALM trials used the Worst-Itching Numerical Rating Scale (WI-NRS) to assess itch intensity [range from 0 (no itching) to 10 (worst itching imaginable)], for which a ≥ 3-point improvement has been validated as a clinically relevant reduction in itch in this patient population. The aim of this post hoc analysis was to determine the time to clinically relevant improvement in WI-NRS score in patients with CKD-aP treated with difelikefalin.

METHOD

The KALM-1 and KALM-2 studies enrolled maintenance HD patients with moderate-to-severe CKD-aP [mean baseline 24-h WI-NRS score > 4 (KALM-1) or ≥ 5 (KALM-2)]. Patients were randomized 1:1 to intravenous difelikefalin 0.5 mcg/kg or placebo 3 times/week for 12 weeks. Patients completed the WI-NRS questionnaire daily. A post hoc analysis was performed to assess the cumulative proportion of patients achieving a ≥ 3-point improvement in WI-NRS score each week.

RESULTS

Two-thirds of patients treated with difelikefalin who reported a response did so within 4 weeks. A further 4 weeks of treatment resulted in over 90% of difelikefalin responders reporting a clinically relevant improvement (Figure 1). Fewer patients receiving placebo reported a reduction in itch at any time during treatment (44% versus 57% of difelikefalin-treated patients) and any improvements in pruritus were reported later than for difelikefalin-treated patients.

CONCLUSION

A clinically relevant response to difelikefalin is likely to be reported by most patients within 4 weeks and almost all patients benefit from improvement after a further 4 weeks of treatment. Compared with patients receiving a placebo, those treated with difelikefalin are more likely to experience clinically-relevant reductions in itch, as well as an earlier improvement in pruritus.
MO479: CKD Coding Across Hertfordshire and West Essex. Are We Missing the Chance for Early Intervention?
Authors: Findlay Andrew , Sivaramakrishnan Ramanarayanan , Hanna Antonious
Published: May 2022

BACKGROUND AND AIMS

Coding of chronic kidney disease (CKD) is associated with better outcomes through addressing the risk factors, and CKD-coded cases were found to have fewer unplanned hospital admission rates.

We aim to compare the CKD coding across Hertfordshire and West Essex to the published CKD prevalence by Quality and Outcomes Framework (QOF) and New Opportunities for Early Renal Intervention by Computerised Assessment (NEOERICA), and to demonstrate variation in coding across primary care practices within the region.

METHOD

In August 2020, we reviewed data for Clinical Commissioning Groups (CCG), Primary Care Networks (PCN), practice code and practice name. Data were obtained from 136/144 practices, including the numbers of adult patients, number of CKD-coded patients, and percentage as a total of the adult population by practice, PCN and CCG were derived. Then we compared the actual obtained data with predicted numbers and percentages of CKD patients estimated from practice-registered adult populations using QOF (2009–10) that demonstrated a 4.3% prevalence [1] and NEOERICA (2003) that demonstrated an 8.5% prevalence [2].

RESULTS

Across the adult population of 1.2 million, 38 645 patients had a CKD code, giving a 3.2% CKD prevalence. Assuming a QOF of 4.3% prevalence, then 13 316 CKD patients are uncoded. While considering a NEOERICA 8.5% prevalence, this would yield the assumption of 64 160 CKD uncoded patients. East & North Hertfordshire NHS Trust had the lowest coded CKD percentage at 2.7% of the served adult population. All three CCG areas had considerable percentage variations in CKD coding across the 135 practices.

CONCLUSION

Across Hertfordshire and West Essex, CKD coding is below the published CKD prevalence from QOF and NEOERICA, suggesting significant numbers of patients are uncoded. There are variations in coding percentage between primary care practices within the PCN and CCG groups. Suboptimal coding may decrease the ability to offer early intervention to decrease CKD progression and would be associated with poor outcomes, including cardiovascular disease. This demonstrates the current unmet need for improved coding through community nephrology surveillance between primary and secondary care.
MO481: Novel Predictors of CKD in Metabolic Fatty Liver Disease Patients: Steatosis Vs Fibrosis. A Prospective Study Using Transient Elastography With Controlled Attenuation Parameter
Authors: Marc Luciana , Mihaescu Adelina , Lupusoru Raluca , Bob Flaviu , Chisavu Lazar , Timar Bogdan , Timar Romulus , Schiller Adalbert
Published: May 2022

BACKGROUND AND AIMS

Recent data have proven that NAFLD (nonalcoholic fatty liver disease) and NASH (nonalcoholic steatohepatitis) increase the risk of CKD. Changing the concept of NAFLD to MAFLD (metabolic dysfunction associated fatty liver disease) changes the data of inclusion of patients in the new category and also the relationship with CKD. Our study aimed to explore this relation using liver steatosis and liver fibrosis assessments by transient elastography (TE) with controlled attenuation parameter (CAP).

METHOD

We prospectively evaluated 402 diabetic patients with MAFLD and high CKD risk using TE with CAP (FibroScan®). CKD was defined according to Kidney Disease Improving Global Outcomes (KDIGO) 2012 guidelines. Inclusion criteria: patients >18 years old and the presence of MALFD. Exclusion criteria: pregnancy, ascites, outliers, known chronic liver disease, decompensated liver disease, cardiac pacemaker, end-stage renal disease, heart failure, unreliable or invalid TE and CAP measurements, AST and ALT levels >5 times the upper limit of normal. Transient elastography was performed with the FibroScan® device. To discriminate between fibrosis and steatosis stages, we used the TE and CAP cut-off values from a published multicentric trial compared with biopsy. Logistic regression and stepwise multiple logistic regression were used to evaluate the factors associated with CKD. In addition, ROC analysis was used to assess the performance of CAP and TE in predicting CKD. The study was conducted >1 year period.

RESULTS

The prevalence of CKD in our group was 60.8%. Patients with CKD had higher mean LSM and CAP values than those without CKD (LSM 8.64 ± 4.30 versus 8.03 ± 6.57; P = .04 and CAP 320.09 ± 57.12 versus 306.29 ± 61.21; P = .04). We found that hepatic steatosis was a better predictor of CKD than fibrosis. Univariate regression showed that CAP values > 353 dB/m were predictive of CKD, and multivariate regression analysis (after adjustment according to sex, BMI, LDLc, HDLc and fasting glucose) showed that CAP values >353 dB/m were more strongly associated with the presence of CKD compared with LSM (fibrosis) values.

CONCLUSION

In patients with MAFLD, CAP-assessed steatosis appears to be a better predictor of CKD compared with LSM-assessed hepatic fibrosis.
MO490: Fast and High Phosphate Reduction With Lanthanum Dioxycarbonate Versus Selevamer In In-Vivo Study
Authors: Khare Atul , Pramod Gupta
Published: May 2022

BACKGROUND AND AIMS

Over 7 million patients suffer from end-stage kidney disease (ESKD) worldwide [1]. Due to low kidney function, patients often become hyperphosphatemic, which leads to an increased risk of death [2]. Patients usually rely on dietary restrictions and phosphate (P) binders to address hyperphosphatemia. Current P binders often do not achieve desired levels of P3 and have a high pill burden due to the high quantity of large pills [4, 5]. A therapeutic option with a potentially smaller dose volume (i.e. fewer pills and smaller pill size) and efficacy similar to or possibly better than current products would enhance patient quality of life (QoL). Lanthanum dioxycarbonate, RENAZORB(LDC), is a novel nanotechnology product that combines lanthanum, which has the highest binding capacity versus other P binders [6], with a potentially smaller pill size that is swallowed rather than chewed. We present the results of an in-vivo study evaluating the reduction of urine P levels by LDC and sevelamer (SVH).

METHOD

An in-vivo study evaluated the reduction of urine P levels by LDC and SVH in healthy mice. For 7 days, 1 group of 6 mice received 0.394 g LDC/day, and another group of 6 mice received 0.412 g SVH/day, which represent comparable doses.

RESULTS

On day 1, LDC decreased urine phosphate excretion by 93% versus 42% with SVH. LDC decreased urine phosphate excretion throughout the treatment. However, SVH decreased urine phosphate excretion only in the first 3 days. The health of surviving animals did not appear to be affected. The incidence of animals that did not survive the study duration was similar across groups.

CONCLUSION

LDC effectively decreased urinary phosphate excretion on day 1 and maintained effectiveness throughout the treatment period. LDC appeared to have at least similar if not improved efficacy compared with SVH in this animal model. LDC may be a welcome choice for patients as it is effective and is targeted to be available in a small, easy-to-swallow pill.
MO507: Prediction of CKD Progression and Cardiovascular Events Using Pulse Wave Velocity and Albuminuria
Authors: Carlsen Rasmus , Sherzad Khatir Dinah , Jensen Danny , Birn Henrik , Henrik Buus Niels
Published: May 2022

BACKGROUND AND AIMS

Chronic kidney disease (CKD) is associated with an increased risk of cardiovascular disease (CVD) and death. Albuminuria has been identified as a risk factor, however, additional biomarkers predicting CKD progression and CVD are needed. Arterial stiffness is an easily measurable candidate that has been associated with CVD and mortality. We compared the ability of carotid-femoral pulse wave velocity (PWV) and urine albumin-creatinine (UAC) ratios to predict CKD progression, cardiovascular events (myocardial infarction or stroke) and mortality in a cohort of CKD patients.

METHOD

In stage, CKD stage 3–4 patients PWV and UAC were measured at baseline. The endpoint of CKD progression was defined as a 50% decline in estimated glomerular filtration rate (eGFR), the initiation of dialysis or renal transplantation. The composite endpoint was defined as the CKD progression endpoint, myocardial infarction, stroke or death. Endpoints were analyzed in a Cox regression analysis adjusted for age, gender, blood pressure, baseline eGFR, BMI and including both PWV and UAC. Data were collected from individual patient biochemistry files, the Danish National Nephrology Registry and the Danish Health Data Registry.

RESULTS

We included 182 patients [median age 69 (interquartile range 60–75) years, 68% males] with a mean eGFR 37 ± 12 mL/min/1.73 m2 and a UAC of 52 (5–453) mg/g. The mean PWV was 10.6 m/s. The median follow-up until the first event was 4 (3–6) years, with 44 and 89 patients reaching the CKD progression and the composite endpoints, respectively. UAC (mg/g) significantly predicted both the CKD endpoint [HR: 1.0005 (1.0002–1.0008)] and the composite endpoint [HR 1.0004 (1.0001–1.0007)] in adjusted cox regression. In contrast, PWV (m/s) was not associated with the CKD endpoint [HR: 0.99 (0.84–1.18)] nor the composite endpoint (HR: 1.03 (0.92–1.15)].

CONCLUSION

In an ageing CKD population, UAC predicted both CKD progression and a composite endpoint of CKD progression, cardiovascular events, or death, while PWV at baseline did not.
MO511: Epidemiology of Idiopathic Nephrotic Syndrome in Children Before and During Covid-19 Pandemic in Paris Area
Authors: Thenot Victoire , Parmentier Cyrielle , Boyer Olivia , Mahdi Fouad , Nathanson Sylvie , Zenkhri Ferielle , Blanc Philippe , Mendli Nasser , Galerne Aurelien , Mandelcwajg Alexis , Hogan Julien , Dossier Claire
Published: May 2022

BACKGROUND AND AIMS

The aetiology of idiopathic nephrotic syndrome (INS) remains partially unknown. Viral infections have been reported to be associated with INS onset and relapse. The COVID-19 pandemic led to several national lockdowns aimed at limiting virus transmission. In France, schools were closed during the first lockdown (15 March–11 May 2020). Circulation of other respiratory viruses was lower due to restrictive lockdown measures. We hypothesized that these lockdown measures would be associated with a decrease in the incidence of idiopathic nephrotic syndrome in children. The aim of this study was to describe the incidence of INS over the last 4 years and during the lockdown measures and to compare this incidence with the 2007–10 period (NEPHROVIR-1 cohort).

METHOD

A written questionnaire was sent to corresponding the paediatricians of all 37 hospitals in the Paris area. Children aged 1–15 years with INS onset between January 2017 and December 2020 and living in the Paris area were included. Clinical data were collected from medical charts. To estimate incidence, population-based denominators were obtained from the National Institute for Statistics and Economic Studies (INSEE). For analyses, we separated the study period into two periods: during lockdown measures (2 months) and the rest of the time (46 months).

RESULTS

A total of 95% of centres responded to the questionnaire. On the whole, 248 cases of INS were reported, 94% of whom were steroid sensitive. The median age at diagnosis was 5.6 years. Male/female ratio was 2.1: 1. Annual incidences of INS were 2.66, 2.49, 2.91 and 2.40/100 000 children under age 15 years in 2017, 2018, 2019 and 2020, respectively, with no significant difference between years. There was also no difference between annual incidence of the 2017–20 period and the NEPHROVIR-1 cohort period (2007–10) (P = .6). The incidence of INS during the lockdown measures was 0.51 versus 2.71 for the rest of the study period (P = .03). During week 15 (6–12 April 2020), with the highest number of hospital admissions for COVID-19, no case were reported.

CONCLUSION

Over the last decade, the incidence of childhood INS was stable in the Paris area. In 2020, no peak of incidence occurred concomitantly with the COVID pandemic. In addition, during lockdown measures, the incidence of INS was significantly lower. Interestingly, incidence of other respiratory viral infections was reported decreased during lockdown measures. Together, these results argue again for a link between INS onset and viral infections, while COVID-19 does not appear to be a significative trigger for nephrotic syndrome onset in children.
MO521: Paricalcitol Direct Increases Hemoglobin Levels. A Repurposing Possibility for Treating Renal Anemia
Authors: Uriol Miguel , Obrador Mulet Aina , Cleofe Jimenez Mendoza Sonia , Martinez Mateu Josefa , Lado Fuentes Mario , Periañez Parraga Leonor
Published: May 2022

BACKGROUND AND AIMS

The anti-inflammatory properties of the paricalcitol have been related to benefits in renal anemia; however, in chronic kidney disease (CKD) patients, the presence of secondary hyperparathyroidism (SHPT) represents a bias for determining the real effect of paricalcitol in hemoglobin levels. Whether the paricalcitol directly increases hemoglobin regardless of SHPT should be considered an opportunity for treating renal anemia, where the current treatments have safety concerns.

To determine the effect of the oral paricalcitol on hemoglobin levels administered in different types of patients. Group A: n = 10, CKD patients not on dialysis under erythropoietin stimulating agents (ESA), Group B: n = 37, CKD patients not receiving ESA. A sub-group of patients without SHPT (Group C, n = 20) and glomerulonephritis patients without CKD (Group D, n = 18). Seven patients had hyperparathyroidism without CKD (plasma creatinine <1,2 mg/dL) and five CKD patients without SHPT (iPTH: 24–100 pg/mL). We also evaluated the effect of the paricalcitol according to Hb at baseline (≤10, ≤11 and ≤ 12 g/dL).

METHOD

A total of 52 consecutive patients were included and followed up by 6 months. Exclusion criteria were bleeding or recent blood transfusion history. No changes in ESA doses and iron supplements were required for inclusion. The mean paricalcitol dose was 6 mcg/week (min: 2–max: 7).

RESULTS

Age: 71(14) years, female 21(40%). As a whole, hemoglobin [mean: 95% confidence interval (CI)] increased 0.8 g/dL (0.4–1.2), partial η2: 0.24, P < .001. In group A: Hb increased 0.9 (0.2–1.6) g/dL, partial η2: 0.15, P = .015; in group B: 1.0 (0.4–1.5) g/dL, partial η2: 0.32, P < .001; in group C: 0.7 (0.2–1.2) g/dL, partial η2: 0.31, P = .008 and in group D: 0.4 (−0.02–0.9) g/dL, partial η2: 0.18, P = .06. In the seven patients only with hyperparathyroidism, Hb increased 1.3 (0.4–2.1) g/dL, partial η2: 0.67, P = .012 and in the five patients only with CKD the hemoglobin change 0.5 (−0.3–1.3) g/dL, partial η2: 0.40, P = .174. Interestingly, according to the baseline hemoglobin levels: ≤10, ≤11 and ≤ 12 g/dL, it significantly increased to 2.6, 2.3 and 1.2 g/dL, respectively.

CONCLUSION

The paricalcitol significantly increased the hemoglobin levels independently of ESA therapy, the renal function and the degree of hyperparathyroidism.

A greater effect was observed in patients with lower baseline hemoglobin levels.

Our results suggest that paricalcitol is a potential repurposing drug for treating renal anemia.
MO522: The Effect of Statin on Anemia in Patients With End-Stage Kidney Disease Receiving Hemodialysis: A Systematic Review and Meta-Analysis
Authors: Lin Yen-Chung
Published: May 2022

BACKGROUND AND AIMS

Although treatment with erythropoietin-stimulating agents is effective in treating anemia in patients with end-stage kidney disease undergoing hemodialysis, some uremia patients, especially those with inflammation, continue to suffer from anemia. HMG-CoA reductase inhibitors (statins), which are lipid-lowering agents, may have a pleiotropic effect in reducing inflammation. Hence, we investigated the role of statin on hemoglobin (Hb) in patients receiving hemodialysis.

METHOD

We searched the PubMed, Embase, Medline, and Cochrane databases by using predefined keywords and MeSH terms for randomized controlled trials or cohort studies. Studies were included if (1) participants with CKD/ESKD were included, (2) treatment arms with statins were included, (3) study type was randomized control trial/cohort study and (4) outcomes of interest were hemoglobin (Hb), erythropoietin resistance index (ERI) and ferritin. Risk of bias tool 2.0 and the Newcastle–Ottawa Scale (NOS) were utilized to assess risk of bias in randomized controlled trials and cohort studies, respectively. Egger's test was used to test publication bias. In addition, our study was reported according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 statement.

RESULTS

We eventually included 10 studies (5258 participants), comprising three randomized controlled trials and seven cohort studies. Overall, Hb increased by 0.84 g/dL [95% confidence interval (95% CI) −0.02–1.70] in all groups of using statins, including single-arm cohorts, and by 0.72 g/dL (95% CI −0.02–1.46) in studies with placebo control. Hb levels were higher in the study group than in the control group, with a mean difference of 0.18 (95% CI 0.04–0.32) at baseline and 0.86 (95% CI 0.74–0.99) at the endpoint. Ferritin increased by 9.97 mg/dL (95% CI −5.36–25.29) in the study group and decreased by 34.01 mg/dL (95% CI −148.16–80.14) in the control group; ferritin fluctuation was higher in the control group.

CONCLUSION

Statin may improve renal anemia in patients with CKD and receiving regular erythropoietin-stimulating agents. Future studies with more rigorous methodology and larger sample size study should be performed to confirm this beneficial effect.
MO543: Efficacy and Influence on the Key Indicators of Mineral-Bone Disorders of the Sucroferric Oxyhydroxide and Sevelamer Carbonate in Hemodialysis Patients
Authors: Shutov Evgeny , Kotlyarova Galina , Lysenko Ksenia , Lashutin Sergey
Published: May 2022

BACKGROUND AND AIMS

Currently, the effectiveness of phosphate-binding agents in patients with CKD should be determined not only by the level of reduction in hyperphosphatemia, but also by the effect on other key factors involved in the development of CKD-MBD. The results of the effect of phosphate binders on the parameters of CKD-MBD, excluding phosphate, are unclear. Our prospective randomized controlled trial evaluated the effect of 16-week treatment with sucroferric oxyhydroxide versus sevelamer carbonate (‘sevelamer’) on the parameters of CKD-MBD in patients with hyperphosphatemia on programmed hemodialysis.

METHOD

A total of 50 stable patients with hyperphosphatemia (P ˃ 5.5 mg/dL) after a 4-week washout period, were randomized at a 1:1 ratio to receive sucroferric oxyhydroxide (n = 25) or sevelamer (n = 25) for treatment up to 16 weeks. In all patients were monthly evaluated levels of FGF23, soluble Klotho, c-reactive protein (CRP), hemoglobin (Hb), ferritin, transferrin saturation, phosphorus (P), calcium (Ca), parathyroid hormone (PTH). The dose of both medications was adjusted according to serum phosphate.

RESULTS

The average intact fibroblast growth factor 23 (FGF23), PTH, transferrin saturation and ferritin levels did not significantly change in both groups. Meanwhile, Klotho levels increased by 25% in the sucroferric oxyhydroxide group (P < 0.05). We observed a significant decrease in serum phosphate level from 6.8 ± 1.5 to 5.27 ± 0.99 mg/dL (P < 0.01) only in the group with sucroferric oxyhydroxide. However, treatment with sevelamer did not decrease the level of P: 6.32 ± 1.5 versus 6.35 ± 1.9 mg/dL by the end of the study. The number of prescribed tablets was lower in the sucroferric oxyhydroxide group (2.0 ± 1.5 tab/day, mean ± SD) compared with sevelamer group (6.1 ± 3.2 tab/day, mean ± SD). We noted also in group sucroferric oxyhydroxide an increased Hb level from 105.6 ± 15.7 to 111.9 ± 22.3 g/L (P < 0.05) and a simultaneous decrease of CRP level by 50% (P < 0.01).

CONCLUSION

Treatment with sucroferric oxyhydroxide significantly increased Klotho and Hb levels and lowered CRP levels. Sucroferric oxyhydroxide was more effective in lowering phosphorus levels than sevelamer, which can be explained by an insufficient dose of sevelamer and a short treatment period.
MO556: Markers of Oxidative Stress and Coronary Calcifications in Chronic Hemodialysis Patients
Authors: Azouaou Leila , Arab Medina , Ballouti Wafa , Chader Henni , Mahrane Sadjia , Kezzal Kamel , Seba Atmane
Published: May 2022

BACKGROUND AND AIMS

Cardiovascular morbidity and mortality are increased in hemodialysis patients. Oxidative stress is considered to be an important factor in these cardiovascular complications in these patients. The aim of this research is to establish the link between the levels of advanced oxidation protein products (AOPP) in the serum of hemodialysis patients and coronary calcifications.

METHOD

This is a longitudinal study involving 67 hemodialysis patients, all patients underwent a Coro-CT scan to assess coronary calcifications according to the Agatston coronary calcium score (SCCA). We divided the patients into three groups according to their low (0–100), medium (101–400) and severe calcification score > 400, we measured the levels of AOPP in the three groups and we studied the correlation between the rate of AOPP at the level of the different groups.

RESULTS

The mean age of the patients is 55 ± 12.5 years, the sex ratio is 1.3, the mean us-CRP level is 12.5 mg/L, the mean NO, AOPP, MDA level, MPO and LDLox are respectively (62.188 ± 5.598, 70.82 ± 10, 6.97 ± 0.488 µmol/L, 61.466 ± 8.82 IU/mL and 31.755 ± 3.9 µmol/l), we divided the patients into three groups according to the agtston coronary calcium score (SCCA), we found 27% of the patients had a low score (0–100), 48% had a moderate sore (101–400) and 25% had a severe score >400. We found that the rate of oxidative stress markers worsened with increasing calcification score, patients with a low score had levels of NO, AOPP, MDA, MPO and LDLox are respectively (67.2 ± 6.5, 64.9 ± 7, 3.24 ± 0.32, 57.8 ± 6.9 IU/mL and 10.17 ± 1.9 µmol/l), the mean score had respective levels of NO, AOPP, MDA, MPO and LDLox are respectively (62.5 ± 3.2, 72.7 ± 12, 7.2 ± 0.24 µmol/L, 60.34 ± 5.7 IU/mL and 27.6 ± 2.1 µmol/L) and patients with a severe calcification score had NO, AOPP, MDA, MPO and LDLox levels respectively (59.3 ± 2.4, 82.82 ± 12, 9.45 ± 0.34 µmol/L, 74.23 ± 9.7 IU/mL and 42.89 ± 5.19 µmol/L), there are positive correlations between the rate of coronary calcifications and the levels of markers oxidative stress NO, AOPP, MDA, MPO and LDLox) which are respectively (r = 0744, P = 0.0001; r = 0.777, P = 0.000; r = 0.318, P = 0.000; r = 0.620, P = 0.000; r = 0.526, P = 0.0001).

CONCLUSION

Markers of oxidative stress are higher in hemodialysis patients with vascular calcifications, they can be predictors of cardiovascular complications in hemodialysis patients.
MO559: The Dietary Intake of Chronic Kidney Disease According to Stages: Findings From the Korean National Health and Nutritional Examination Survey
Authors: Jung Oh Hyung , Kim Seon-MI
Published: May 2022

BACKGROUND AND AIMS

Appropriate dietary adjustment in patients with chronic kidney disease (CKD) is important, and nutritional guidelines recommend different dietary management depending on the CKD stage. However, there is no study, to our knowledge, of the characteristics of dietary intake according to CKD stages.

METHOD

We tried to assess the comparison of nutritional intake according to CKD stages. A cross-sectional study was conducted to reveal the characteristics of dietary intake among CKD patients based on the Korean National Health and Nutritional Examination Survey between 2011 and 2014. Based on Kidney Disease Improving Global Outcomes guidelines, we stratified CKD into five groups (I, II, IIIa, IIIb and IV–V) and investigated the characteristics of dietary intake, such as energy, water, protein, fat, carbohydrate, sodium, potassium, calcium and phosphorus, according to stage of CKD. We also explored nutritional intake according to CKD stage among patients with early CKD (stage I and II) and advanced CKD (stage IIIa, IIIb and IV–V).

RESULTS

Of 16 878 participants, 14 952 were classed as non-CKD (88.61%) and 1926 (11.39%) as CKD. Of 16 878 participants, 14 952 were classed as non-CKD (88.61%) and 1926 (11.39%) as CKD. Intake of energy, water, protein, fat, carbohydrate, sodium, potassium, calcium, and phosphorus tended to be decreased as CKD progressed. In early CKD stage, intake of energy, water, protein, fat, carbohydrate, potassium, and phosphorus seemed to be statistically significant decreased as CKD progressed. In advanced CKD stage, intake of sodium and potassium seemed to be decreased as CKD progressed, but the intake of energy was about to be lower limit.

CONCLUSION

Appropriate dietary education and CKD recognition are needed to improve nutritional intake depending on the CKD stage.
MO564: The Association Between Monocyte to High-Density Lipoprotein Cholesterol Ratio and Cardiovascular Disease in Patients with Chronic Kidney Disease
Authors: Naouaoui Salma , Chettati Mariam , Fadili Wafaa , Laouad Inass
Published: May 2022

BACKGROUND AND AIMS

Recently, monocyte count to HDL-C ratio (MHR) has emerged as a new cardiovascular prognostic marker. However, few studies have evaluated the impact of this marker on cardiovascular endpoints in moderate-to-severe chronic kidney disease (CKD). Therefore, we aimed to investigate whether baseline monocyte to high-density lipoprotein cholesterol ratio (MHR) is associated with cardiovascular diseases (CVD) in patients with CKD.

METHOD

In this retrospective study, carried out at nephrology department of Mohammed VI University hospital of Marrakesh, 110 patients with stage 3–5 CKD were recruited. MHR was calculated for all patients. The presence of heart failure, coronary artery disease or arrhythmia was defined as CVD.

RESULTS

Monocyte/HDL cholesterol ratio was negatively correlated with estimated glomerular filtration rate (eGFR) (P < 0.001). The study cohort was divided into tertiles based on MHR. Cardiovascular diseases were more common in patients in the highest tertile of MHR with a hazard ratio of 2.41 compared with the lowest tertile. The association remained significant after adjusting for established cardiovascular risk factors including age, gender, diabetes mellitus, hypertension, eGFR and smoking status.

CONCLUSION

The present study revealed that MHR is strongly associated with CVD in patients with pre-dialysis CKD. Therefore, this easily available inflammatory marker might be useful to predict CDV in patients with CKD, especially in low-income settings.
MO567: Is Sarcopenia Associated With Clinical Outcomes in Chronic Kidney Disease Patients? A Systematic Review and Meta-Analysis
Authors: S. Ribeiro, Heitor , G. R. Neri Silvia , S. Oliveira Juliana , N. Bennett Paul , L. Viana João , M. Lima Ricardo
Published: May 2022

BACKGROUND AND AIMS

Sarcopenia is a risk factor for adverse outcomes in older adults,[1], but this has yet to be confirmed in chronic kidney disease (CKD).[2] We conducted a systematic review to investigate the association between sarcopenia and its traits with mortality, hospitalization and end-stage kidney disease (ESKD) progression in CKD patients.

METHOD

Five electronic databases were searched, including MEDLINE and Embase. Observational cohort studies with CKD patients were included. The sarcopenia traits assessed were low muscle strength, low muscle mass and low physical performance, as well as confirmed sarcopenia (combined low muscle mass and low strength/performance).[3] Hazard ratios (HR), risk ratios (RR), odds ratios (OR) and 95% confidence intervals (CI) were pooled using random-effect meta-analyses.

RESULTS

From a total of 4922 screened studies, 50 (72 347 patients) were included in the review and 38 (59 070 patients) in the meta-analyses. Most of the included studies were in dialysis patients (n = 29, 58%). Table 1 shows that low muscle strength (15 studies; HR: 1.99; 95% CI: 1.65–2.41; I²:45%), low muscle mass (20 studies; HR: 1.51; 95% CI: 1.36–1.68; I²: 26%), low physical performance (five studies; HR: 2.09; 95% CI: 1.68–2.59; I²: 0%) and confirmed sarcopenia (eight studies in dialysis patients; HR: 1.87; 95% CI: 1.35–2.59; I²: 40%) were associated with an increased mortality risk. On the other hand, for dialysis patients it was uncertain whether low muscle mass was associated with hospitalization (two studies; RR: 1.81; 95% CI: 0.78–4.22; I²: 59%). Further, limited ESKD progression measures prevented meta-analysis for this outcome.

CONCLUSION

Low muscle strength, low muscle mass and low physical performance are associated with higher mortality in CKD patients. In dialysis patients, confirmed sarcopenia also represented higher mortality risk. Evidence to conclude associations with hospitalization and ESKD progression are currently lacking.

CI, confidence interval
MO568: The Relationship Between Oxidative Stress and Undernutrition in CKD Patients
Authors: Azouaou Leila , Arab Medina , Chader Henni , Seba Atmane
Published: May 2022

BACKGROUND AND AIMS

Undernutrition is frequent in patients with chronic renal failure. It affects 35% of patients at the start of dialysis and represents one of the causes of morbidity and mortality. The objective of this work is to determine the relationship between oxidative stress and undernutrition in patients at different stages of chronic renal failure.

METHOD

A descriptive longitudinal study of 162 patients with chronic renal failure at different stages (2, 3, 4, 5 and 5D). We have studied the biological and anthropometric nutritional parameters in CKD patients at different stages as well as markers of oxidative stress, and we have studied their correlations with undernutrition in these patients.

RESULTS

The mean age of the patients is 56.5 ± 17 years with a sex ratio of 1.43. Regarding markers of oxidative stress, MDA, MPO and AOPP were studied. The means of which are respectively (6.1 ± 0.12 μmol/L, 59 0.89 ± 1.98 IU and 61.89 ± 1.4 μmol/L). The average body mass index, albumin and pre-albumin levels are respectively: (21.98 ± 0.28), (37.84 g/L ± 0.47) and (302.93 mg/L ± 5.4). All three parameters decrease significantly (P <0.05) with degradation of renal function (from stage 2 to stage 5D) and increase in markers of oxidative stress with a negative correlation (P < 0.05). The most undernourished patients are found in stage 5 and 5D with high levels of oxidative stress markers. Undernutrition is greater in patients with severe CKD and in hemodialysis patients with high levels of oxidative stress markers.

CONCLUSION

Chronic renal failure represents a real public health problem. Undernutrition is one of the causes of morbidity and mortality in these patients, especially after extra renal treatment, hemodialysis, oxidative stress worsens undernutrition and cardiovascular morbidity.
MO569: Assessment of Inflammation Using Neutrophil-Lymphocyte Ratio Among Non-Dialyzed Chronic Kidney Disease Patients—A Prospective Observational Study
Authors: Rashid Ishfaq , Tiwari Pramil , Cruz Sanjay D , Jaswal Shivani
Published: May 2022

BACKGROUND AND AIMS

Persistent low-grade inflammation is intimately linked to the pathophysiology of chronic kidney disease and contributes grossly to poor nutritional status and mortality. There is insufficient evidence on inflammation in relation to diabetic status, stages of CKD among chronic kidney disease patients before the commencement of dialysis. This study has characterized the prevalence and factors of inflammation among pre-dialysis chronic kidney disease patients at a tertiary care public teaching hospital.

METHOD

This longitudinal observational study adopted neutrophil–lymphocyte ratio (>3.53) to evaluate the inflammatory status among pre-dialysis chronic kidney disease patients. Glomerular filtration rate (eGFR) calculated by CKD-EPI equation from National Kidney Foundation was used as a measure of renal function. Multiple/multinomial regression analysis was also performed to determine the predictors of inflammatory status.

RESULTS

A total of 450 non-dialysis chronic kidney disease patients with or with diabetes were recruited during the period of study, consisting of 265 males and 185 females. Patients were aged 53.9 ± 14.2 years. According to neutrophil–lymphocyte ratio, the prevalence of inflammation among chronic kidney disease patients was found to be 91 (20.2%). The chronic kidney disease patients with diabetes 51(11.3%) were found to have higher rates of inflammation than non-diabetic chronic kidney disease patients 40 (8.9%). The adult age group 57 (12.7%) suffered more with inflammation than the elderly 34 (7.6%). Patients with severe malnutrition 42 (9.3%) were noted to have higher prevalence of inflammation followed by well-nourished 27 (6.0%) and mild/moderately malnourished population 22 (4.9%). The extent of inflammation was found to increase {CKD stage 1–2 (0.6%), CKD stage 3a-3b 34 (7.6%), CKD stage 4–5 54 (12.0%)} with decrease in renal residual function. Serum albumin, nutritional status and serum phosphorous have shown a significant association with the inflammatory status among chronic kidney disease patients.

CONCLUSION

The current findings demonstrate that the inflammation should be regarded as a familiar comorbid condition in chronic kidney disease. The intensity of inflammation is greater in patients with poorer renal function, comorbid diabetes and higher age. Future work needs to be aligned with respect to comprehensive understanding of inflammation mechanisms among patients with chronic kidney disease.