bluuebunny/crossref_metadata_2025 huggingface dataset:
#1146 Role of renal dysfunction in the use of anticoagulants in COPD patients with atrial fibrillation
Authors: Karimdjanova Guzal , Egamberdieva Dano , Ruzmetova Iroda
Published: May 2024

Background and Aims

The renal dysfunction is known to be the most important predictor of outcome in patients with atrial fibrillation (AF). At the same time, assessment of the functional state of the kidneys is an integral part of the protocol when selecting the dose of oral anticoagulants. The prognostic role of the functional state of the kidneys during treatment with oral anticoagulants on a possible worsening of the cardiac prognosis during the treatment of AF in patients with concomitant comorbid background, in particular with COPD, has not been sufficiently studied.

The aim of the study was to evaluate the prognostic role of renal dysfunction in terms of possible cardiovascular events and bleeding in patients with COPD and AF treated with oral anticoagulants.

Method

56 COPD patients with CHF and AF who received oral anticoagulants were examined. Renal function (creatinine level and estimated glomerular filtration rate - eGFR) was assessed at baseline and follow-up. The functional state of the kidneys was calculated using the CKD-EPI-2011 formula. At baseline, the risk of bleeding was assessed using the HAS-BLED scale. Worsening of the functional state of the kidneys was detected when the level of creatinine increased or eGFR decreased by at least 20%.

Results

In addition to standard treatment for COPD in the presence of AF, patients received oral anticoagulants during six months of observation. Worsening of the functional state of the kidneys was observed in 18.3% of patients. In patients with renal dysfunction, the frequency of episodes of CHF decompensation and non-major bleeding (MB) was significantly higher. With a reduced glomerular filtration rate, there was no effect on the incidence of bleeding and stroke. The oral anticoagulants used did not have a significant effect on the observed renal dysfunction and did not affect the occurrence of new cardiovascular events in patients with COPD. It turned out that predictors of renal dysfunction in patients with COPD are age, female gender, and lower hemoglobin levels. In multivariate analysis, renal dysfunction was identified as an independent predictor of non-major bleeding (OR 2.04, 95%, p < 0.05).

Conclusion

In patients with COPD and atrial fibrillation, the presence of renal dysfunction was an additional exacerbating factor associated with a poor mid-term cardiovascular prognosis and the risk of bleeding. However, oral anticoagulants did not affect the degree of deterioration of renal function or the incidence of cardiovascular events.
#610 Alterations in frequency and function exhausted memory B cells in lupus nephritis and systemic lupus erythematosus
Authors: Yap Desmond , Zhu Litong
Published: May 2024

Background and Aims

Various B cell abnormalities have been implicated in the pathogenesis of LN, and our previous studies have demonstrated that memory B cells assume pathogenic relevance in disease relapse. Memory B cell exhaustion is a B lymphocyte aberration initially reported in chronic human immunodeficiency virus (HIV) infection, and was later also observed in chronic graft versus host disease (cGVHD) and autoimmune disorders. The pathogenic roles of exhausted memory B cells in LN and disease relapse remains unclear. We will validate the significance role of exhausted B cell in the pathogenesis of LN.

Method

Classical memory (CD19 + CD21 + CD27+) and exhausted B cells (CD19 + CD21 – CD27–) were measured in LN patients with multiple relapses (MR) (n=15) or no relapse (NR) (n=15) during disease remission. B cell-related cytokines, homing and inhibitory receptors, proliferation and calcium mobilization in classical and exhausted memory B cells were also assessed. Using single-cell RNA sequencing data from NIH and GEO, we also performed bioinformatics analysis to identify genes and pathways relevant to memory and exhausted B cells in SLE, LN and healthy controls.

Results

The MR group exhibited higher proportion of circulating exhausted memory B cells compared to NR. Blood levels of IL-6, BAFF and IL-21 in MR patients were higher than the NR group. The MR had higher blood levels of Siglec-6, CXCR3 and CD62L than the NR group. Expression of inhibitory receptors CD22, CD85j, CD183 and FCRL4 in exhausted B cells were increased in the MR group compared to the NR group. Exhausted B cells from MR patients also showed decreased proliferation compared to NR patients and impaired calcium mobilization in response to B-cell receptor triggering. STAT1, XAF1, MX1, IFI44L, EPSTI1, LCP1, OAS1, NEAT1, IFI16, IFI44 in exhausted B cells and XAF1, MX1, IFI44L in memory B cells play a pathogenic role in LN patients (Figs. 1 and 2). SLE patients also show increased proportion of exhausted B cells compared to healthy control and the expression of STAT1, XAF1, MX1, IFI44L correlate positively with the proportion of exhausted B cells.

Conclusion

Our results suggested that altered numbers and function of exhausted B cells may have pathogenic significance in SLE and LN.
#1128 Accuracy of shorter iohexol glomerular filtration rate measurement protocols in individuals with preserved kidney function
Authors: White Christine A , Gaynor-Sodeifi Kavey , Norman Patrick , Furman Michele , Sochett Etienne
Published: May 2024

Background and Aims

Measuring glomerular filtration rate (mGFR) using exogenous tracers is recommended in a number of settings with plasma one-compartment multi-sample protocols (MSP) being the most commonly used and iohexol being the dominant tracer. The accuracy of MSP protocols has mostly been evaluated in the setting of reduced GFR where delayed initial and final samples are recommended. Much less is known about MSPs when GFR is not decreased and the default protocol tends to include initial sampling at 120 minutes and final sampling at 240 minutes post iohexol injection. The objective of this study was to assess the performance of shorter MSPs with earlier initial (60 and 90 minutes) and final (150, 180, and 210 minutes) sampling times in individuals with preserved GFR.

Method

Participants were recruited from a 4-year prospective, observational study evaluating the cardiovascular, renal, and bone health profile of young adults with Type 1 Diabetes. The reference mGFR was calculated using a plasma iohexol clearance one compartment slope intercept method with 5 samples collected between 120-240 minutes post iohexol injection. Four different combinations of shorter sampling strategies were investigated: 60-150 min, 60-180 min, 90-180 min and 90-210 min. Performance was evaluated using measurements of bias, precision, and accuracy (P2, P5, and mean absolute error).

Results

Mean age of the 43 participants was 23.9 ± 1.9 yrs with a mean eGFRCKiD-1 of 95.5 ± 15.9 ml/min/1.73 m2 and mean reference mGFR (120-240 min) of 102.3 ± 13.7 ml/min/1.73 m2. All exploratory shorter mGFRs performed well, with median biases less than 1 ml/min/1.73 m2 and mean absolute error less than 1.6 ml/min/1.73 m2. All shorter mGFRs were within 5% of the reference mGFR and the majority were within 2%.

Conclusion

These results demonstrate that shortening the mGFR procedure in individuals with preserved GFR provided very similar results to the current standard while significantly decreasing procedure time. The cost savings and improved feasibility of these shortened protocols should reduce some of the barriers to more widespread adoption of GFR measurement.
#1921 Resveratrol improves the indoxyl sulfate-induced intestinal damage by promoting mitophagy and inhibiting apoptosis pathways
Authors: Zheng Cai-Mei , Liao Min-Tser , Lu Kuo-Cheng
Published: May 2024

Background and Aims

Chronic Kidney Disease (CKD) represents a systemic condition marked by progressive impairment stemming from the pathological effects of uremic toxins. There are noted interactions between these toxins and the intestinal microbiota, leading to disruption of metabolic and immune pathways central to the gut-renal axis in patients with CKD. The present study examines the protective properties of Resveratrol (RSV), which functions as an antagonist to the aryl hydrocarbon receptor (AhR), against the adverse effects of the uremic toxin, indoxyl sulfate (IS), in relation to intestinal harm within the context of CKD.

Method

Our research utilized 5/6 nephrectomized mice and isolated primary mouse intestinal cells to assess the influence of IS on the development of tight junction barriers within the intestinal epithelium and overall cellular health within the intestine. Serum biochemistry assessments, hematoxylin & eosin (H&E) and immunohistochemistry staining (IHC), Western blot tests, q-PCR, and si-RNA targeted against AhR were used in the study.

Results

Experiments carried out on 5/6 nephrectomized mice and IEC-6 cell lines disclosed that IS compromises the integrity of the intestinal barrier, affecting the tight junction proteins (TJPs), along with perturbing mitophagy through the upregulation of IRF1 and inhibition of DRP1. RSV mitigates intestinal barrier dysfunction by promoting the expression of TJPs including zona occludens 1 (ZO-1), occludin, claudin-1, and claudin-2 proteins in uremic conditions. It also reverses the IS-related negative impacts on mitophagy. Additionally, RSV exerts antioxidant defenses by enhancing the PI3K/Akt/Nrf2 signaling pathway and decreasing cellular apoptosis via modulation of Bcl-2/Bax/cleaved caspase 3/cytochrome C/PARP-1 pathways.

Conclusion

Our findings highlight the promise of RSV as an agent capable of mitigating intestinal barrier dysfunction in CKD. This contributes substantial findings with implications for the modulation of the gut-renal axis.
#1852 When ‘pebbles’ affect the kidney: nephrolithiasis and chronic renal failure in Crohn's disease. The experience of a 3rd level centre
Authors: Lopez Antonia , Cignesi Denise , Perivolioti Dimitra , de Sanctis Lucia Barbara , Patregnani Laura , Romani Francesca , Cannarile Daniela Cecilia , Zucchelli Annalisa , Rizzello Fernando
Published: May 2024

Background and Aims

Nephrolithiasis is the most common expression of kidney involvement in chronic inflammatory bowel disease (IBD), especially in Crohn's disease (CD). Stone formation favoring factors are hyperoxaluria, dehydration, acidosis, common conditions in CD patient, who present a little higher incidence of renal stones, made of calcium oxalate, than the normal population.

Only few studies focused on the relationship between CD activity (defined by CDAI score) and the development of nephrolithiasis and possible subsequent development of chronic renal failure (CRF).

Materials and Method

We conducted a retrospective study on a cohort of 1236 patients affected by CD referring to our Centre of IBD- Sant'Orsola between 2014 and 2021. We identified two cohorts from this population: 118 patients with nephrolithiasis and 118 patients without nephrolithiasis. Among these two groups, we identified variable clinical manifestations of CD and their relation with CRF and lithiasis.

Results

The prevalence of nephrolithiasis in all CD patients was 10.3%, a little higher than in the general population.

The results of the analysis of patient and disease variables in the two groups are shown in Table 1. The mean age at diagnosis of CD was higher in the group without nephrolithiasis, so the treatment was started later. The presence of perianal disease, extraintestinal manifestations (MEI), like ankylosing spondylitis (APS), biliary tract involvement, or previous surgery, and presence of ileostomy correlate with the formation of stones in univariate regression analysis (Table 2). Perianal disease and MEI also maintained significance in multivariate analysis.

Conclusion

Our data suggest that a higher degree of disease activity, defined by the presence of perianal disease (a variable on CDAI score) and the presence of MEI, correlates with higher risk of lithiasis. It is advisable to start early the study of nephrolithiasis in these patients to adopt preventive strategies against formation and progression of renal stones. Future studies are required for a better definition of this deep relationship.
#1066 Unobvious long-term effects of COVID-19 for kidneys
Authors: Fedulkina Veronika , Artamonova Aleksandra , Vatazin Andrey , Zulkarnaev Aleksei , Fomin Aleksandr
Published: May 2024

Background and Aims

The impact of COVID-19 on the chronic kidney disease (CKD) has already been confirmed by researchers around the world. However, there is still no description of this infection influence on kidney function without signs of CKD before it.

Method

The study included 359 patients from the Moscow region who applied to the nephrologist of the first level regional center in 2022, 154 men and 205 women, mean age 59±16 years. Among the patients who applied for the past year, there were 70 patients with a previously confirmed diagnosis of CKD and 289 who first applied to a nephrologist and had no nephrology complaints, clinical or laboratory signs of CKD before.

Results

A total of 95 patients from both groups had COVID-19 in 2020-2022 before a visit to a nephrologist, 45 people from the group with CKD (47.4%) and 50 people (52.6%) who were not diagnosed with CKD before COVID-19. 20.4% had COVID-19 earlier than 2 months ago, 6.4% - from 2 to 6 months ago, 45.3% - from 6 to 12 months ago, 27.9% from 12 to 24 months ago.

A mild degree of COVID-19 was in 49.4% of patients, moderate - 43, 3%, heavy - 7.3%.

It is important to note that 48 patients (96%) who first contacted a nephrologist after COVID-19 were diagnosed with CKD (CKD stages 1-2 - 14 patients (29.17%), 3A and 3B stages - 24 patients (50%), 4 and 5 stages - 10 patients (20.83%)).

Relative risk of stage 3+ CKD after COVID-19: RR= 1.036 [95% CI 0.8961 to 1.170], p=0.6742, relative risk of stage 5 CKD: RR= 0.7164 [95% CI 0.3259 to 1.534], p= 0.5403. Thus, the development of advanced (3+) stages of CKD cannot be directly related to past COVID-19. However, if we consider the risk of developing advanced stages of CKD for patients who have experienced moderate to severe COVID-19, then the relative risk of stage 3+ CKD: RR= 1.082 [95% CI 0.8936 to 1.236], p= 0.4607, and relative risk of stage 5 CKD RR = 1.013 [95% CI 0.4134 to 2.341], p>0.9999.

Conclusion

Unfortunately, it is not possible to link the risk of developing CKD in patients after COVID-19 with the timing after COVID-19 at this stage of the study. In addition, the relationship between COVID-19 and CKD stage cannot be assessed without taking about the structure of CKD causes in both groups. Obviously, a larger and deeper study of this issue is needed, possibly with more patients and long-term monitoring of the dynamics of renal function in patients of both groups.
#3106 The prevalence and degree of hyperkalaemia in adult patients with chronic kidney disease, in Durban, South Africa
Authors: Bux Tasmeen , Assounga Alain
Published: May 2024

Background and Aims

Hyperkalaemia is a known risk factor for the development of cardiac rhythm disturbances and sudden cardiac death. The presence of chronic kidney disease (CKD) is also an independent risk factor for cardiovascular complications. The prevalence of hyperkalaemia in patients with CKD has previously varied widely between studies. The prevalence of hyperkalaemia in the patients attending the renal clinic at Inkosi Albert Luthuli Central Hospital (IALCH) has not been previously determined. This study aimed to discover the prevalence of hyperkalaemia in patients attending the renal clinic at IALCH, as well as the degree of severity amongst the patients in whom hyperkalaemia was present. Demographic and other variables were also assessed for an association with hyperkalaemia.

Method

A retrospective review of outpatients attending the renal clinic at IALCH from 1 October 2016 until 30 September 2017. Demographic and clinical characteristics were retrieved and descriptive statistical methods and logistic regression analysis were performed.

Results

The study consisted of 200 patients, of whom the majority were female (n=120, 60%). The prevalence of hyperkalaemia amongst these patients was found to be 16%. In those with stage 3 CKD, the prevalence of hyperkalaemia was 7.69%. In those with stage 4 CKD, the prevalence of hyperkalaemia was 20.5% and in those with stage 5 CKD the prevalence was 17.3%. There were no statistically significant associations between hyperkalaemia and demographic variables, nor with dietician intervention. There was a significant association with the use of sodium polystyrene sulfonate.

Conclusion

CKD is a growing burden in the developing world. With CKD comes metabolic and other derangements, including electrolyte abnormalities as well as increased cardiovascular risk. Hyperkalaemia is associated with worsening CKD. In addition, hyperkalaemia puts patients at risk of cardiac dysrhythmias and sudden cardiac death. Pharmacological measures to manage CVD risk should be weighed up against the risk of hyperkalaemia related complications. Potassium lowering agents should be considered to allow for optimal CVD management in the setting of hyperkalaemia in CKD.
#2767 Micro(nano)plastics are exposed and bioaccumulated in human fetus—the first evidence from neonatal umbilical cord blood and urine
Authors: Feng Xiaoqian , Song Xuan , Du Lixia , Tan Zhongyou , Qiu Xihong , Chen Zongwen , Mo Yunbo
Published: May 2024

Background and Aims

At present, the world population problem is increasingly serious, and the impact of environmental pollution on the health of pregnant women and fetuses is a global research focus. Among them, micro(nano)plastics (MNPs), as an emerging pollutant, has been confirmed by several animal experiments and in vitro human cell experiments to have biotoxic effects. Recent studies have shown that MNPs are found in human placenta, amniotic fluid, meconium, and other samples, but there is still a lack of direct evidence that MNPs can enter and bioaccumulate in the fetus.

Method

To initially explore the actual situation of neonatal exposure to MNPs, this study collected umbilical cord blood samples and postnatal urine samples from 6 healthy fetuses in Chengdu, Sichuan, China, and used pyrolysis-gas chromatography/mass spectrometry (Py-GC/MS) and laser direct infrared spectroscopy (LDIR) to detect and analyze MNPs in samples.

Results

With an average abundance of 81.15 (40.71) μg/g, MNPs were found in 6 umbilical cord blood samples by Py-GC/MS. Polyethylene (PE), polyvinyl chloride (PVC), polystyrene (PS) and polyamide 66 (PA66), 4 different types of MNPs were found, with PE content being the highest among them. By using LDIR, MNPs were found in 5 umbilical cord blood samples, with an average abundance of 17.39 (18.91) particles/g. Three different types of MNPs were found, they are acrylates (ACR), polyethylene terephthalate (PET) and polypropylene (PP). MNPs particles were detected in 6 urine samples by PY-GC/MS, and the average abundance was 8.42 (4.70) μg/g. Two kinds of MNPs, PE and PVC, were detected, and the content of PE was higher.

Conclusion

The findings demonstrated that the contents and types of MNPs in umbilical cord blood samples were higher than those in urine samples. The levels of MNPs were correlated with the living habits of pregnant mothers, such as the frequency of ordering take-out food. In this study, through the detection of MNPs in umbilical cord blood and neonatal urine samples, we found the direct evidence of MNPs in the fetus for the first time, further confirmed that MNPs can enter the urine through renal metabolism, preliminarily explored the exposure and bioaccumulation effect of MNPs in the fetus, and analyzed the possible risks and related factors of exposure of MNPs during pregnancy, which provided a theoretical basis for in-depth study of the health impact of MNPs on pregnant women and fetuses.
#676 Correlation between dietary live microbe intake and all-cause mortality based on baseline characteristics: results from NHANES 2011-2018
Authors: Nicikowski Jan , Łopińska Joanna , Habura Ireneusz
Published: May 2024

Background and Aims

The gut microbiome plays a beneficial role in human health, including kidney function and chronic kidney disease progression. Potential therapeutic strategies for CKD and hypertension that target the gut microbiota include dietary interventions, mainly probiotic, prebiotic, synbiotic modulation. In addition to probiotic foods, live micro-organisms are also found in other food products, such as raw vegetables and fruits. In this study, we evaluated the potential impact of dietary live microbiome intake on all-cause mortality in different baseline characteristics, including kidney function status.

Method

A total of 20 627 subjects were included in the study. We used data from the US National Health and Nutrition Examination Survey 2011-2018. Based on a 2-day 24-hour dietary recall, the dietary intake of the live microbiome was adjusted and the participants were categorized into three groups: low (<104 CFU/g), medium (104–107 CFU/g), or high (>107 CFU/g) dietary intake of live microbes, according to the classification system for the dietary intake of live microbes and participants’ 24-hour dietary recall data. Low intake was used as a reference. Baseline characteristics included kidney function by estimated glomerular filtration rate (GFR-EPI <60 mL/min/1.73 m2) and urinary albumin-to-creatinine ratio (uACR >30 mg/g). We used a multivariate Cox proportional hazards model to identify the impact of dietary live microbiome intake on all-cause mortality. In subgroups, we adjusted the Hazard Ratio (aHR) of the additional factors in the models.

Results

The risk for all-cause mortality was significantly decreased in subjects included in the medium dietary live microbiome intake (HR: 0.82, 95% Cl: 0.73-0.93, p < 0.004). In subgroup analysis (N = 3302), medium dietary intake of the live microbiome decreased mortality in subjects with eGFR <60 mL/min/1.73 m2 or uACR >30 mg/g and BMI >25 (aHR: 0.86, 95% CI: 0.75-0.99, p<0.05) as compared to low dietary intake of the live microbiome group after adjustment for hypertension, diabetes, BMI, total calorie intake, laboratory results (hemoglobin, creatinine, total cholesterol, estimated glomerular filtration rate). However, there was no significance to the risk for all-cause mortality in the subgroup with CKD between the high and low dietary live microbiome intake groups.

Conclusion

In this study, low dietary live microbial intake significantly increased all-cause mortality in the population. The medium dietary intake of live microbiome significantly decreased all-cause mortality in overweight or obese patients with CKD or microalbuminuria.
#210 Effects of serum magnesium level on kidney disease progression and major cardiovascular outcome in patients with chronic kidney disease
Authors: Kwon Seong , Park Hyejin , Cho Da Hae , Suh Sang Heon , Bae Eun Hui , Kim Soo Wan
Published: May 2024

Background and Aims

Magnesium is known for its anti-inflammatory, anti-apoptotic, and anti-oxidative effects, potentially inhibiting renal fibrosis. Additionally, it is believed that magnesium can inhibit vascular calcification, potentially improving cardiovascular outcomes. However, this remains a topic of controversy. This study aims to investigate the association between serum magnesium levels and CKD progression as well as cardiovascular outcomes.

Method

We analyzed 1,893 patients from The KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD), which is a prospective cohort study. These patients were categorized into three groups based on their baseline magnesium levels: Mg1 (hypomagnesemia, <1.8 mg/dL), Mg2 (normomagnesemia, 1.8-2.4 mg/dL), and Mg3 (hypermagnesemia, >2.4 mg/dL). The primary outcome was defined as meeting one or more of the following criteria during the follow-up period: initiation of dialysis or transplantation, a two-fold increase in baseline serum creatinine levels, or a 50% decline in the estimated glomerular filtration rate. The secondary outcome was a composite of major adverse cardiovascular events (MACEs). We used Cox proportional hazard regression model.

Results

A total of 673 patients (35.6%) experienced the composite renal outcome. The Mg1 group showed significantly increased adverse renal outcomes compared to the Mg2 group (HR, 1.885; 95% CI, 1.137-3.124; p = 0.013), however, Mg3 group did not show a significant difference (HR, 0.927; 95% CI, 0.783-1.097; p = 0.379). The composite cardiovascular outcome occurred in 138 patients (7.3%). The risk of composite cardiovascular outcomes significantly increased in the Mg1 group compared to the Mg2 group (HR 3.472; 95% CI, 1.492-8.076; p = 0.003). However, we observed no statistically significant differences in the Mg3 group (HR 1.021; 95% CI, 0.689; p = 0.913). The cubic spline curves demonstrated a U-shaped association between serum magnesium levels and both renal and cardiovascular outcomes.

Conclusion

Hypomagnesemia is associated with the progression of renal disease and a significant increase in MACEs. Beyond a certain level, hypermagnesemia may also be associated with worsening renal and cardiovascular outcomes.
#691 Validation of a prognostic model for adverse events in advanced chronic kidney disease in the Chinese population
Authors: Xingchen Yao , Yang Chao , Wang Jinwei , Li Chenglong , Zhang Luxia
Published: May 2024

Background and Aims

Currently, the Grams model has been developed to estimate risks of adverse events among advanced chronic kidney disease (CKD) patients in western populations. Its utility is noteworthy as it predicts multiple adverse events within a single model while taking competing risks into account. While no external validation has been conducted among Asian, especially Chinese population, restricting further practical application and clinical benefits evaluation. Hence, we aimed to validate the performance of Grams model for estimating risks of major adverse events among Chinese CKD population.

Method

The Grams model was validated in the Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE) study, a multicenter prospective cohort study which involved 39 renal departments of 39 hospitals from 28 cities of 22 provinces in China. Participants with estimated glomerular filtration rate (eGFR) <30 ml/min/1.73 m2 during baseline and follow-up were enrolled. The same predictors as those selected in the Gram model were considered, including age, sex, race, history of cardiovascular disease(CVD), smoking status, systolic blood pressure, diabetes mellitus, eGFR, and urine albumin-to-creatinine ratio (uACR). The outcomes included kidney replacement therapy(KRT), CVD and death within 2- and 4- year follow-up periods. The discrimination and calibration of the model were evaluated using the concordance index (C index), the ratio of observed and expected outcomes (O/E ratio), and the calibration curve. The clinical utility of the model was assessed through decision curve analysis. Intercept recalibration was used to update the model.

Results

Among 1333 included participants (54 (IQR, 43-64) years, 699(52.4%) male), 386(29.0%) developed KRT, 118(8.9%) developed CVD, 88(6.6%) died during the follow-up period. The Grams model showed a moderate to good discrimination for three outcomes, with the C index ranging from 0.656 to 0.720. According to the O/E ratios and calibration curves, the calibration for KRT was relatively accurate, but the model overestimated the predicted probability of CVD and death. Intercept recalibration led to closer alignment of observed and predicted risks. Decision curve analyses revealed the superior net benefit of the Grams model in guiding KRT preparation.

Conclusion

In summary, the Grams model exhibited moderate discrimination for predicting outcomes, with relatively accurate calibration for KRT but an overestimation of predicted probabilities for CVD and death, intercept recalibration improved the calibration of the model. Despite its limitations, the model offered a superior net benefit in guiding KRT preparation, suggesting its potential use in clinical decision-making process. Further investigations are warranted to improve the performance of the Grams model in Chinese population.
#3012 Great impact of the results of PREMs and PROMs in all stages of chronic kidney disease. Analysis of 281 patients
Authors: Teruel Jose Luis Górriz , Giménez-Civera Elena , Francés Francesc Moncho , Herranz Athenea , Daza Carla , Gonzalez Nayara Panizo , Perez-Baylach Carmen Maria , Calabuig Maria Asuncion Sancho , Candia Boris Marcelo Gonzales , Velásquez Caterina Rodriguez , Velasquez Maria Fernanda Alvarado
Published: May 2024

Background and Aims

In recent years, there has been a growing interest in the use and relevance of Patient-Reported Outcomes Measures (PROMs) and Patient-Reported Experience Measures (PREMs). The main objective of the study is to analyze scores in quality of life, anxiety, depression, and functional capacity using tests that assess PREMs and PROMs in patients at different stages of chronic kidney disease (CKD).

Method

Multicenter, cross-sectional, observational, non-interventional study with 281 patients (84 on hemodialysis, 48 on peritoneal dialysis, 50 with kidney transplant, 50 with advanced CKD, and 49 patients with CKD stages 1-2). Two professionals conducted interviews for data collection from all patients. Collected data: For PROMs: PFS (Piper Fatigue Scale), HADS (Hospital Anxiety and Depression Scale), FACIT-F (Functional Assessment of Chronic Illness Therapy-Fatigue Scale), SF-36, VAS (Visual Analogue Scale). For PREMs - PACIC test (Patients' Assessment of Chronic Illness Care), in addition to other comorbidity indices and laboratory analyses. ANOVA statistical analysis was used for group comparison.

Results

Although patients showed significant differences in age and comorbidities, our analysis shows that the most PROMs do not discriminate between different stages of CKD. The PROMs that most discriminate between different stages of CKD are those related to the Piper Fatigue Scale test. PREMs, analyzed using the PACIC scale, do achieve said discrimination (Table 1).

Conclusion

The analysis of PROMs and PREMs show the significant impact that CKD has on health-related quality of life. Some PROMs can discriminate between different stages of CKD, but the most effective ones are PREMs, which are an indirect indicator of the quality of care received, contributing to patient involvement in decision-making and empowerment.
#1677 Initiation of Vericiguat and short-term cardiovascular function improvement in heart failure patients with worsened renal function
Authors: She Jianqing , Lou Bowen , Liu Hui
Published: May 2024

Background and Aims

Vericiguat, a novel soluble guanylate cyclase (sGC) stimulator, is approved for treating heart failure (HF) with reduced ejection fraction (HFrEF). This study aims to assess the short-term improvement in cardio-function resulting from in-hospital initiation of Vericiguat among patients with chronic kidney dysfunction (CKD), utilizing real-world data from a single-center experience in western China.

Method

Data were obtained from the Biobank of the First Affiliated Hospital of Xi'an Jiaotong University, spanning from January 2023 to December 2023. A total of 213 HF patients with Vericiguat initiation were screened for eligibility. Echocardiography was employed to evaluate cardio-function after 1- and 3-month short-term follow-up in each patient. Statistical analyses were conducted using one-way ANOVA (followed by Geisser-Greenhouse correction and Tukey's multiple comparison) to assess significance between different timepoints.

Results

Among the 213 patients randomized in this study, baseline characteristics were compared based on estimated glomerular filtration rate (eGFR) ≤ 30 (worsened renal function group, WRF, n = 20) and >30 mL/min/1.73 m2 (n = 193). No significant differences were observed in age, gender, and other biochemical parameters expect hemoglobin and creatine between the two groups (Table 1). Analysis of cardiac function after 1- and 3-month follow-up revealed a promising increase in left ventricular ejection fraction (EF) (37.2% vs. 43.9%, Mean diff −6.7, 95% CI −12.78 to −0.62, p = 0.03), fractional shortening (FS) (20.9% vs. 25.3%, Mean diff −4.42, 95% CI −8.57 to −0.27, p = 0.04), and a significant decrease in left ventricular end-diastolic dimension (LVEDD) (65.0 mm vs. 60.6 mm, Mean diff 4.35, 95% CI 0.33 to 8.38, p = 0.03) after 3-month follow-up compared to Vericiguat initiation in WRF patients. However, no significant changes were observed between the beginning and 1-month follow-up in echocardiographic measurements (Fig. 1).

Conclusion

In this real-world single-center study, Vericiguat demonstrated effectiveness in short-term improvement of cardiac function among HF patients with worsened renal function. The long-term efficacy in reducing major cardiovascular events in this subgroup, based on real-world experience, warrants further exploration.
#373 Risk factors for progressive cardiorenal syndrome in patients with chronic kidney disease: the CRIC study
Authors: Chen Jing , He Jiang
Published: May 2024

Background and Aims

Cardiorenal syndrome (CRS) is associated with poor outcomes. However, risk factors for progressive CRS are not well studied in patients with chronic kidney disease (CKD). We studied the incidence and risk factors for progressive CRS in a cohort of CKD patients.

Method

3 557 participants with CKD in the Chronic Renal Insufficiency Cohort (CRIC) Study were included in this analysis after excluding those with heart failure (HF) at baseline visits. The mean follow-up time was 10.5 years. Progressive CRS was defined as development of both HF and renal failure (RF) (dialysis or transplant) within 12 months of each other. Cox proportional hazards models were used to examine the association of risk factors with progressive CRS. In a sensitivity analysis, risk factors for CRS type 2 (HF preceded RF during entire follow up) and CRS type 4 (RF preceded HF) were analyzed.

Results

The average baseline age was 59 years for those with progressive CRS and 57 years for those without. The age-adjusted incidence of progressive CRS was 4.5/1000 person-years and was 5.0/1000 person-years in Men and 5.9 in Black. The multivariable-adjusted hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) for traditional risk factors are as follow: less than high school education (1.82, 1.2-2.73), history of cardiovascular disease (CVD) (1.48, 1.03-2.12), lower educational attainment (per 1 standard deviation [SD]) in eGFR (1.83, 1.40-2.39), and higher (per 1 SD) albumin-to-creatinine ratio (ACR) (2.26, 1.78-2.86). The multivariable-adjusted HRs with corresponding 95% CIs for a one-standard deviation increase in novel risk factors are as follows: hemoglobin (0.82, 0.68-0.99), hemoglobin A1C (1.31, 1.14-1.52), log alkaline phosphatase (1.18, 1.00-1.38), and log brain natriuretic peptide (1.32, 1.10-1.57), adjusting for age, sex, race, clinic sites, and all significant traditional risk factors (education, CVD, eGFR, and ACR). In sensitivity analysis, the risk factor associated with both CRS type 2 and 4 were kidney dysfunction, albuminuria, and mineral bone disorder (higher alkaline phosphatase and FGF23), inflammation (TNF-α), and fibrotic factor (GDF-15), while diabetes, CVD, systolic blood pressure, waist circumference, anemia, HbA1c, and volume overload were more strongly associated with CRS type 2 compared to CRS type 4.

Conclusion

This study indicates that education level, history of CVD, kidney dysfunction, albuminuria, mineral bone disorder, diabetes control, anemia, volume overload, inflammation, and fibrotic factors are associated with progressive CRS. Many of these risk factors are modifiable. Further studies are warranted to assess the benefits of specific interventions to improve CRS outcomes.
#1313 Dicumarinics and the direct thrombin or factor Xa inhibitors (NOAs) their usefulness in advanced chronic renal disease
Authors: Gutiérrez Paulo García , Garrote Pablo Luis Sánchez , Morales Byron Chiliquinga , Varas Carmen Martin , Gomez Astrid Rodriguez , Garcia Leonardo Calle , Alonso Carlos Santos , Losada Maria Nieves , Luis Maria Jose Fernandez-Reyes
Published: May 2024

Background and Aims

Our population with advanced chronic kidney disease (ACKD), is more prone to thrombotic and hemorrhagic processes so the indication of anticoagulation before the appearance of atrial fibrillation (AF) is complex. Since AF is the most common cardiac arrhythmia, its main complications are thromboembolism and stroke. New treatments are being developed, such as the new oral anticoagulants (NOAs), but their safety in ACKD is still uncertain.

To see anticoagulation needs, safety and major adverse effects (major or minor bleeding) in population with ACKD and taking dicumarinics or NOAs.

Method

Retrospective study of 234 patients followed in our ACKD practice, at least two revisions, with a mean follow-up 25.5 months, in which we recorded cause of anticoagulation, type and major adverse effects.

Results

26% of patients have indication for anticoagulation (66 patients), of which 55 remain anticoagulated during follow-up (45% Dicumarinics, 44% NOAs). The indication for anticoagulation was 23% AF (56 patients) and 3% mechanical prostheses (7 patients). Table 1 shows the characteristics of the overall population and the comparison between anticoagulated patients with different types of anticoagulation and non-anticoagulated patients. Non-anticoagulated patients are younger and have less ischemic heart disease, with no differences in the non-anticoagulated population. Throughout follow-up, we found a higher incidence of bleeding with NOAs (compared to the rest) and higher mortality in patients with dicumarinics (compared to the rest). There were no differences in age, sex and ischemic heart disease between the two anticoagulant treatments.

Conclusion

Our CKD population has a high need for anticoagulation but also a high risk of bleeding. NOAs can be used in ACKD although they are associated with a higher incidence of bleeding than dicumarinics but lower mortality. More studies are needed to conclude which is the best approach for these patients.
#1533 The relationship between the severity of anemia, the level of inflammation markers and the dose of epoetin in patients in pre-dialysis stages of CKD
Authors: Egamberdieva Dano , Ruzmetova Iroda
Published: May 2024

Background and Aims

Inflammation is known to be an important factor associated with hemoglobin variability in patients with anemia of chronic disease. However, the question remains whether high levels of C-reactive protein, a widely used marker of inflammatory activity, and other inflammatory markers predict less stable anemia control in patients with CKD.

The purpose of this study was to establish the relationship between the severity of anemia with the levels of inflammatory markers (C-reactive protein, IL-6) and the dose of epoetin in patients with pre-dialysis stages of CKD.

The purpose of our study was to study the age-related characteristics of the nutritional status in patients with CKD of the dialysis stages who are on parenteral nutrition.

Method

180 patients (96 men and 84 women) with CKD as a result of nephropathies of diabetic and non-diabetic etiology were examined. Chronic pyelonephritis was diagnosed in 96 patients, chronic glomerulonephritis - in 73, polycystic kidney disease - in 11 patients. Glomerular filtration rate was calculated based on serum creatinine concentration using the CKD-EPI formula (2011). The patients were divided into 2 groups, depending on the achievement of the target hemoglobin value. Thus, group 1 included patients with CKD C3, C4, whose hemoglobin concentration was above 110 g/l (n = 101). Group 2 included patients whose hemoglobin concentration was less than 110 g/l in at least one analysis (n = 79).

Results

In the examined patients, a significant correlation was found between the range of hemoglobin concentration and the range of CRP concentration (p < 0.05), as well as between the range of hemoglobin concentration and the variation in the percentage of hypochromic erythrocytes (p < 0.05), between the range of hemoglobin concentration and the variation of ferritin ( p < 0.05). The change in the percentage of hypochromic erythrocytes also correlated with the change in IL-6 (p < 0.05) and the change in CRP ( p < 0.05). We found an association between the average weekly dose of epoetin and the levels of CRP, IL-6 and TNF-α. Patients with TNF-α levels ≥2 ng/mL and IL-6 ≥40 ng/mL required a significantly higher dose of epoetin than patients with lower levels of these markers (128 U/kg per week versus 57 U/kg at week).

Conclusion

The establishment of a relationship between inflammatory markers and hemogram and iron parameters suggests that inflammation had an indirect effect on the increase in hemoglobin through its effect on iron metabolism. The results of the study indicate the presence of diabetic and non-diabetic etiology of systemic inflammation in CKD, more so in the group of patients with type 2 diabetes mellitus.
#1073 Changes in endothelial function in patients with impaired central and renal hemodynamics respiratory pathology
Authors: Korakulova Zilola , Atahodjayeva Gulchehra , Alimovna Dilorom , Alyavi Anis
Published: May 2024

Background and Aims

To determine the degree of influence of endothelial dysfunction on the hemodynamics of renal and central vessels in respiratory pathology, as well as to determine the effectiveness of complex therapy regimens with carvedilol.

Method

Studies were conducted in 26 patients with chronic obstructive pulmonary disease (COPD) of II- III severity (group 1, in whom the level of glomerular filtration rate of the kidneys eGFR CKD-EPI ≥6 ml/min/1.73 m2 was determined) and 32 patients with COPD of IV severity (group 2, they were determined e GFR CKD-EPI ≥60 ml/min/1.73 m2). Patients received one course of ten-day standard therapy (GOLD, 2020) in combination with a beta–blocker drug, T. carvedilol 5 mg (Vertex).

Doppler echocardiographic examination of peripheral vessels, heart and renal vessels of patients was performed. Stable metabolites of nitric oxide (Cm NO) in blood plasma, ventilation and perfusion state of the lungs were determined.

Results

A significant decrease in the functional state of the respiratory system was parallel with a decrease in Cm NO synthesis, which was clearly reflected in the second group (by 11%) compared with the first group (by 7%). Pronounced structural changes with remodeling of the right parts of the heart, as well as a pronounced degree of pancreatic hypertrophy in the second group were accompanied by a sharp change in renal filtration function (eGFR ≤60 ml/min/1.73 m2). When measuring the state of diastolic dysfunction of the right parts of the heart, a decrease in E/As well as an increase in the circulatory vascular resistance index and mean blood pressure were significantly higher in the first group of patients (where еGFR ≥6 ml/min/1.73 m2).

After a course of treatment with t. carvedilol, based on basic treatment, normalization of endothelial function was determined, reflected in an increase in the concentration of stable metabolites of nitric oxide by 1.05 and 1.5 times (p<0.05) in the biological fluid, respectively, in the first and second groups. In the dynamics of the course of therapy in groups of patients with 75% and 35% decrease in lung ventilation capacity, mean pulmonary arterial pressure decreased by 18.1 and 14.3%, respectively, and the hemodynamic resistance index decreased by 7.9% and 5.7% in parallel (p<0.05).

Conclusion

When monitoring the functional state of central and renal hemodynamics and ventilation-perfusion function of the bronchopulmonary system after complex treatment with carvedilol, a long-term hypotensive effect, a decrease in endothelial dysfunction, respectively, and an improvement in central and renal hemodynamics were determined.
#1190 Expression of metabolic disorders in patients with hypertension and chronic kidney disease
Authors: Duysenbaeva Aziza , Srojidinova Nigora
Published: May 2024

Background and Aims

To study the frequency of metabolic disorders in patients with hypertension depending on the stage of chronic kidney disease (CKD).

Method

The study analyzed 594 case histories of patients with AH of I-III degree (ESC/ESH 2018). CKD stages were determined according to eGFR (EPI-2021), according to the modern KDIGO 2013 classification. All patients were tested for uric acid, glucose, creatinine, and blood lipids using a Daytona autoanalyzer from RANDOX (UK). The study was conducted against the background of antihypertensive therapy (AHT). Statistical analysis was carried out using the SPSS 24.0 software package.

Results

Among the examined patients, intact renal function of CKD C1 (eGFR>90 ml/min/1.73 m2) was observed in 19.5% (n = 116); CKD C2 (eGFR 60-89 ml/min/1.73 m2) – in 50.5% (n = 300); CKD C3A (eGFR 45-59 ml/min/1.73 m2) – in 20.4% (n = 121); CKD C3B (eGFR 30-44 ml/min/1.73 m2) – in 6.4% (n = 38); CKD C4 (eGFR 29-15 ml/min/1.73 m2) - in 3.2% (n = 19) p < 0.0001. The terminal stage of CKD was not revealed. The mean creatinine in the groups was 66.20 ± 11.74 vs 83.44 ± 11.30 vs 105.84 ± 17.36 vs 139.78 ± 24.40 vs 212.00 ± 19.73 µmol/l, respectively (p < 0.00001) . Mean eGFR 97.99 ± 6.98 vs 75.44 ± 7.15 vs 53.46 ± 4.30 vs 37.82 ± 3.63 vs 23.11 ± 5.63 ml/min/1.73 m2, respectively, (p < 0.00001). The groups did not differ significantly in body mass index (BMI), but patients with high stage of CKD have pronounced abdominal obesity. BMI was 30.71 ± 4.4 vs 32.25 ± 5.8 vs 31.45 ± 4 vs 31.6 ± 5.6 vs 30.36 ± 10.2 kg/m2, respectively, p = 0.11. Waist measurement (WT): 98.68 ± 10 vs 104.36 ± 13.6 vs 103.62 ± 10.7 vs 104.51 ± 12.4 vs 106.94 ± 27.3 cm, respectively (p = 0.001) . It should be noted that the high stages of CKD are characterized by significantly pronounced asymptomatic hyperuremia. At the same time, the level of uric acid was 5.07 ± 1.4 vs 6.1 ± 4.7 vs 6.6 ± 1.7 vs 7.87 ± 1.7 vs 7.52 ± 1.01 µmol/l, respectively (p < 0.00001). When analyzing lipid spectrum data, total blood cholesterol (TC) and triglycerides (TG) in the blood did not differ significantly among the studied groups. However, it was found that increasing of CKD leads to significantly rising of low-density lipoproteins: 107.04 ± 42.57 vs 103.53 ± 38.04 vs 112.44 ± 44.27 vs 120.64 ± 39.27 vs 133.94 ± 29.83 mmol/l, respectively, р = 0.03, while the amount of high density lipoproteins significantly decrease: 42.64 ± 13.79 vs 41.86 ± 11.03 vs 41.51 ± 10.64 vs 39.62 ± 11.08 vs 36.72 ± 7.72 mmol/l, respectively, p = 0.0001.

Conclusion

In patients with hypertension and CKD, metabolic disorders are more pronounced, which increases the risk of developing complications of arterial hypertension.