bluuebunny/crossref_metadata_2025 huggingface dataset:
#5992 PERITONEAL DIALYSIS-RELATED PERITONITIS: A SINGLE CENTER EXPERIENCE
Authors: Bulatovic Ana , Bjedov Jelena , Damjanovic Tatjana , Jankovic Aleksandar , Sakic Verica Todorov , Djuric Petar , Dimkovic Nada , Naumovic Radomir
Published: June 2023

Background and Aims

Peritonitis is a common and severe complication in Continuous ambulatory peritoneal dialysis (CAPD). A high peritonitis rate affects PD patients’ technique survival and mortality. The aim of this retrospective study is to assess epidemiological aspects, microbiology presentation with antibiotic resistance and clinical outcomes for patients with acute CAPD peritonitis during 5-year period.

Method

The study included all patients treated by CAPD between the 1st of January 2017 and 1st of January 2022 in the Clinical Hospital Center Zvezdara. We included prevalent patients on CAPD, and analyzed demographic, clinical and microbiological data, and patient's outcomes during 5 year period. The data was collected from patient records, medical history and processed in SPSS.

Results

This study included 119 patients treated by PD of which 24 (8.13%) had one or more acute episodes of CAPD peritonitis in the designated period. The mean age of the population was 69±9 year, 54% were male, 20% had diabetes mellitus and 60% arterial hypertension as cause of end stage renal disease. During follow up it was diagnosed 41 episodes of CAPD peritonitis. The main characteristics of patients with peritonitis were turbid liquid (100 %), abdominal pain (73 %) and fever (43 %). Gram staining revealed that 53 % were gram-positive, and 10 % were gram-negative. The most frequent bacterial specimen was Staphylococcus epidermidis (11) followed by Streptococcus viridans (6), sterile culture (9), Staphylococcus aureus (3) and other organisms less than 2 episodes. The peritonitis rate was 1 episode per 27.36 patient-months, or 0.44 episodes per patient year. Resistance to Ampicillin and Penicillin occurred most often. In 2 patients, PD peritonitis was present once each, with multi-resistant bacteria: Klebsiella pneumoniae which was treated with parenteral administration of Tigacycline and Methicillin-resistant Staphylococcus aureus (MRSA) which was treated with parenteral administration of Moxifloxacin and Clindamycin. Out of 24 patients, 2 (8.33%) had 4 episodes of peritonitis, 3 (12.5%) had 3 episodes of peritonitis, 6 (25%) had 2 episodes of peritonitis, and the rest (54.16%) were had only one each. Only one patient had an episode of relapsing peritonitis. During 5-year period, 1 (4%) patient died of acute CAPD peritonitis caused by Proteus mirabilis, 7 (29%) died of other causes, 11 (46%) were transferred to hemodialysis and 5 (21%) are still receiving treatment by CAPD modality. CAPD peritonitis was the reason for technical failure in 20% patients.

Conclusion

PD-associated peritonitis is serious infective complication which could influence the outcome of PD patients, including technique survival. The rate and outcomes of peritonitis in our patients were slightly above of current recommendations.
#6031 ASSOCIATION BETWEEN THE MINI-BESTEST AND POSTUROGRAPHY IN PATIENTS ON HEMODIALYSIS
Authors: Lucinda Leda , de Jesus Luciana , Bainha Ana Clara , de Oliveira Gabriela , Haddad Maria Fernanda , Vidigal Ana Beatriz , Maciel Júlia , Watanabe Lucca , Oliveira Cristino , Reboredo Maycon Moura
Published: June 2023

Background and Aims

Patients on hemodialysis present complications due chronic kidney disease and hemodialysis treatment that compromise postural balance. Posturography is the gold standard device for measuring postural balance; however, its cost limits the use of this method for routine patient evaluation. Alternatively, the Mini Balance Evaluation Systems Test (Mini-BESTest) have been used to evaluate postural balance, as it is inexpensive and has high test-retest reliability. Therefore, the aim of this study was to evaluate the association between the Mini-BESTest and posturography in patients on hemodialysis.

Method

A cross-sectional study was conducted with patients aged ≥18 years who were undergoing hemodialysis treatment for at least three months. Patients were excluded if presented physical or cognitive incapable to perform the proposed tests, assisted gait, uncorrected visual impairments, severe and unstable comorbidities, and hospitalization in the past three months. Postural balance was evaluated by the Mini-BESTest and posturography [a force plate recorded the center of pressure (COP) path length in a static position with eyes opened (EO) and eyes closed (EC) on a firm surface]. The normality of the data was analyzed using the Shapiro‒Wilk test. The associations between Mini-BESTest score and COP path length in the EO and EC were tested using Spearman´s correlation coefficients. Then, two multiple linear regression models were constructed with COP path length in the EO and EC as the dependent variable and Mini-BESTest score and potential confounders (age, gender, diabetes mellitus, body index mass, hemodialysis efficiency index, and hemoglobin) as independent variables. A p value <0.05 was considered as statistically significant.

Results

This study included 109 patients (58.4 ± 12.9 years, 57.8% male). The Mini-BESTest was correlated with COP path length in the EO (ρ = -0.365, p < 0.001) and EC (ρ = -0.279, p = 0.003). The multiple linear regression models showed an association of the Mini-BESTest with COP path length in the EO (R2 = 0.28; adjusted R2 = 0.23; p < 0.001) and EC (R2 = 0.26; adjusted R2 = 0.20; p < 0.001).

Conclusion

The Mini-BESTest was associated with posturography in patients on hemodialysis. Therefore, the Mini-BESTest is a feasible test to evaluate postural balance in clinical routine practice during the physical function evaluation of these patients.
#6156 TUBULAR CHANGES IN PATIENTS WITH AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE
Authors: Salomone Luca , Lai Silvia , Zippo Francesca , Tinti Francesca , Perrotta Adolfo Marco , Rotondi Silverio , Tartaglione Lida , Pasquali Marzia , Rocca Rachele , Mazzei Mario , Mazzaferro Sandro
Published: June 2023

Background and Aims

Autosomal dominant polycystic kidney disease (ADPKD) is characterized by the presence of multiple cysts, leading to progressive reduction in renal function and systemic involvement. The possible presence of tubular alterations has been suggested, but the mechanisms involved have not yet been fully identified. The study aims to highlight possible tubular alterations in ADPKD patients compared to patients with chronic kidney disease (CKD).

Method

A total of 145 patients were enrolled, including 37 with ADPKD and CKD, while 108 had CKD with the same clinical characteristics, and a comparative analysis of urinary and serum parameters were performed. A venous blood gas analysis was performed on each patient to assess serum pH, lactate concentration, and base excess, and a spot urine test was performed to evaluate urinary pH using a pH meter and specific gravity (SG).

Results

The comparative analysis of serum parameters showed a significant reduction in serum pH (spH) in ADPKD patients (p <0.001), with a significant increase in lactates (1.3 vs 0.9 mmol/L, p <0.001) and a significant reduction in base excess (BE) (p <0.001). The evaluation of urinary parameters in ADPKD patients showed a urinary pH (upH) that was on average more acidic compared to patients with CKD (p < 0.001) with a reduction in the capacity to concentrate urine (p < 0.001). No statistically significant differences were found in terms of glomerular filtration rate between the two groups.

Conclusion

The collected data showed some alterations in the serum and urinary metabolic profile of ADPKD patients compared to the CKD group. The alterations in upH are consistent with those of recent studies in the literature, where it is hypothesized that a urinary concentration defect, already present in early stages, may cause a reduction in upH due to a reduced medullary trapping of ammonium and a reduced presence of bicarbonates. The hypothesis of a preferentially anaerobic metabolism in ADPKD patients is also in line with the increased levels of serum lactates.
#6369 RESULTS OF KIDNEY TRANSPLANTATION IN PATIENTS WITH LOW MFI PREFORMED DONOR SPECIFIC ANTIBODIES
Authors: Salerno Maria Paola , Silvestri Patrizia , Zanoni Natalia Romina , Citterio Franco
Published: June 2023

Background and Aims

Preformed DSA at transplantation, significantly increase risk of antibody-mediated rejection (ABMR). While pre-existing positive DSA with concomitant positive cross-match is a general contra-indication to kidney transplantation, DSA presence with negative crossmatch is still a controversial topic. The presence of DSA with Mean Fluorescence Index (MFI) up to 3.000 and a negative cross-match is not valued as a contraindication to transplantation and is widely accepted. In some transplant centers the chance of transplantation is also offered to DSA positive patients, with MFI up to 5.000. Aim of this study was to analyze graft and patient survival, acute cellular rejection, humoral rejection, renal function and side effects in kidney transplant recipients (KTR) with positive DSA (MFI up to 3.000) and negative cross-match.

Method

Nineteen pts (age 53+/-11) with chronic renal failure on chronic hemodialysis treatment (8+/-6 years) received a kidney transplant between May 2017 and December 2020. Median PRA was 66%; 100% pts had DSA with average MFI 2122 (min 1039, max 3779). As immunosuppressive therapies all pts received induction with Thymoglobuline plus Rituximab, followed by maintenance immunosuppression with Tacrolimus, MofetilMycoFenolate and Steroids. All patients were on periodic follow up in our Transplant Clinic. Mean follow up was 26.5+/-14.4 months. Results were compared to a concomitant KTR group DSA and crossmatch negative.

Results

After 2y follow-up, 17/19 pts are alive (89.5%), one patient died (1/19, 5.2%) after treatment for ABMR. Three patients returned to dialysis treatment (15.8%) during the first year post-tx, because of: PNF 1pt; irreversible ABMR rejection 2 pts. One other patient had reversible ABMR. Cumulative one year graft survival was 79% and the cumulative incidence of ABMR was 15.8%. Average 2 years follow-up creatinine was 1.46+/-0.88 mg/dl, median 2 year GFR was 51+/-25 ml/min. Comparing the matched control group (19 pts DSA and cross-match negative) 2 years patient survival, graft survival, GFR, acute rejection were not significantly different. Incidence of acute rejection was higher in the DSA positive group (16% vs 0%), as well as graft loss (21% vs 12%).

Conclusion

Our data suggest that low dose Thymoglobuline plus Rituximab induction allow kidney transplantation in recipient with high PRA (69%) and positive DSA with low MFI (< 3.000), with higher risk of acute rejection, and graft loss.
#6442 HOW CAN IT BE NEPHROANGIOSCLEROSIS? HE´S BEING TREATED ONLY WITH ONE ANTIHYPERTENSIVE DRUG
Authors: Garcia Carolina González , Marquez Eva , Farrera-Núñez Júlia , Barrios-Barrera Clara , Ribas Andres , Sans Laia , Gimeno Javier , Crespo Marta , García Eva Rodríguez
Published: June 2023

Background and Aims

Nephroangiosclerosis is a frequent renal disease due to chronic arterial hypertension and it is one of the main causes leading to renal replacement therapy. A minority of these patients have nephroangiosclerosis although they apparently have hypertension under control with minimal treatment.

Objetives

To describe the characteristics of this group of patients when compared to the rest of patients with histological diagnosis of nephroangiosclerosis.

Method

Observational, retrospective and descriptive study. Review of 67 patients with nephroangiosclerosis as the sole diagnosis in the renal biopsy (consecutive biopsies from 2010 to 2020). We divided the population in two different groups according to the number of prescribed antihypertensive drugs: Group 1 (0-1 antihypertensive drugs) vs Group 2 (≥2 antihypertensive drugs).

Results

Both groups had similar demographics and renal function/proteinuria. Both groups had the same adequate/inadequate blood pressure control, but group 1 had significantly less time of hypertension'evolution. The histological differences (although not statistically significant) are noteworthy: Group 1 had a higher percentage of global glomerulosclerosis, interstitial fibrosis and tubular atrophy than Group 2. In addition, after 3-years of follow-up, in Group 1 there were more patients requiring renal replacement therapy. We hypothesize that a factor that could explain these results could be the lower use of RASi (33.3% vs 73.9%, P = .003*) and a higher percentage of history of dyslipidemia in Group 1 (62.,5% vs 22.,2%, p=0,017*).

Conclusion

Patients with hypertension requiring a maximum of one drug for its control, presented histological results of more marked nephroangiosclerosis, than the group of patients with more than one drug, despite similar time of evolution and degree of blood pressure control. These findings could be related to a lower rate of RASi use. Our study reinforces the indication for RASi as a first-line hypertension treatment in this population.
#6467 DETERMINANTS OF NON-DIABETIC KIDNEY DISEASES IN DIABETIC PATIENTS
Authors: Kir Yusuf , Murt Ahmet , Dincer Mevlut Tamer , Trabulus Sinan , Seyahi Nurhan , Altiparmak Mehmet Riza
Published: June 2023

Background and Aims

While diabetic nephropathy is the main kidney disease in patients with type 2 diabetes mellitus, a variety of non-diabetic kidney diseases (NDKD) may also occur. The decision to order a biopsy in diabetic patients is not an easy one as diabetic kidney disease is itself a proteinuric condition. The main objective of this study is to define factors that may differentiate isolated diabetic nephropathy and non-diabetic kidney disease in diabetic patients. In addition, we also aimed to analyze the effects of treatment choices on renal and overall survival.

Method

The study was conducted at a university hospital, which served as a tertiary healthcare center. One hundred and three diabetic patients who underwent kidney biopsy were involved in the study. Demographic characteristics, physical examination findings, laboratory tests and kidney biopsy findings were retrospectively evaluated.

Results

According to kidney biopsy findings 30 patients (29,1%) had isolated diabetic nephropathy. NDKDs were present in 73 (70,9%) of the patients. 78,1% of the patients with NDKDs had non-diabetic glomerular diseases. Among glomerular diseases, focal segmental glomerulosclerosis (36,9%), IgA nephropathy (17,8%) and membranous nephropathy (13,7%) were the leading three diseases. The duration of diabetes (p=0,00), HBA1C level (p=0,00) and the amount of proteinuria (p=0,02) were higher in patients who had isolated diabetic nephropathy. Presence of diabetic retinopathy (p=0,00), concomitant vascular diseases (p=0,02) and the use of insulin treatment were also more often in patients with isolated diabetic nephropathy. Multivariate analysis revealed that patients with higher HBA1C levels and longer diabetes duration had more tendencies to have isolated diabetic nephropathy. Immunosuppressive treatments for glomerular diseases were administered in around 50% of the patients. However, renal and overall survivals were not different between patients who received immunosuppressive treatments and those who didn't.

Conclusion

A renal biopsy in diabetic patients might be preserved for those with shorter diabetes duration and lower HBA1C levels. As poor glycemic control and susceptibility to infections pose additional risks, immunosuppressive treatments might not always be beneficial.
#6579 ANALYSIS OF RISK FACTORS FOR CUTANEOUS CALCIPHYLAXIS IN HEMODIALYSIS PATIENTS
Authors: Ren Zhimin , Zhou LI , Xiang Ting
Published: June 2023

Background and Aims

Risk factors with cutaneous calciphylaxis were analyzed in hemodialysis patients.

Method

Clinical data of hemodialysis patients who were diagnosed with cutaneous calciphylaxis and admitted to Sichuan University West China Hospital and hospitals in West China Nephrology Union were retrospectively collected. Noncalciphylaxis patients in hemodialysis center of West China Hospital Sichuan University were randomly selected as the controls. Group 1: The 1:1 matched cases and controls by age (year, within ±3) and duration of hemodialysis (month, within ±20%) as matching factors. Group 2: The controls were matched to cases in a 1:1 ratio by gender and duration of hemodialysis (month, within ±20%) as matching factors. Univariate and multivariate binary Logistic were used regression analysis model, screening for statistically significant variable factors.

Results

Most of cutaneous calciphylaxis patients were male and elderly. Group 1: The univariate regression analysis showed that gender, diabetes mellitus, coronary heart disease are significantly associated with calciphylaxis. Laboratory examination results showed that parathyriod hormone (PTH), serum albumin, serum phosphate, C reactive protein (CRP) were significantly with calciphylaxis. Diabetes mellitus, lower albumin, higher serum phosphate and higher CRP were independent risk factors after multivariate analysis. Group 2: The univariate logistic regression analysis showed that age, BMI, coronary heart disease, diabetes were significantly associated with calciphylaxis. Laboratory examination showed that alkaline phosphatase (ALP), PTH, serum albumin and CRP were all significantly associated with calciphylaxis. Diabetes mellitus, lower albumin, higher PTH, and higher CRP were independent risk factors after binary Logistic analysis.

Conclusion

Diabetes mellitus and higher CRP, higher PTH, higher serum phosphate, lower albumin, are important high risk factors.
#6754 THE EFFECT OF REDUCED RENAL FUNCTION ON SEXUAL DYSFUNCTION IN PATIENTS WITH HEART FAILURE
Authors: Loutradis Charalampos , Koutsampasopoulos Konstantinos , Intzevidou Eleni , Stavropoulos Konstantinos , Sdogkos Evangelos , Imprialos Konstantinos , Vogiatzis Ioannis , Papadopoulos Christodoulos , Doumas Michael
Published: June 2023

Background and Aims

Sexual Dysfunction is a common and often undiagnosed complication in patients with Heart Failure (HF) or Chronic Kidney Disease (CKD). Sexual dysfunction presents a strong association with cardiovascular disease and death. This study aims to evaluate the possible effect of reduced renal function on sexual dysfunction in patients with heart failure.

Method

This is a prospective case-control study in patients with Hearth Failure (clinical diagnosis based on relevant symptoms and/or signs) with preserved or reduced renal function, defined as estimated glomerular filtration rate (eGFR) ≥60 and <60 ml/min/1.73 m2, matched for age (± 5 years). The eGFR was calculated with the CKD-EPI equation. Sexual dysfunction was evaluated with the validated Female Sexual Function Index Scoring (FSFI) and the International Index of Erectile Function (IIEF) questionnaires in the native language.

Results

A total of 214 (107 per group) patients were included in this study. Patients’ age 74.10±8.97 vs 75.81±8.66; P = .157), gender (males: 65.4% vs 57.9%; P = .261) and BMI (28.10±4.90 vs 28.99±4.43; P = .164) were not different between the two study groups. In total population, sexual dysfunction was lower in patients with eGFR≥60 compared to <60 ml/min/1.73 m2 (75.7% vs 88.8%; P = .012). In females, no significant differences were evidenced in sexual dysfunction based on FSFI score <26.0 (91.9% vs 95.6%; P = .490). In contrast, males with preserved renal function had lower prevalence of sexual dysfunction (IIEF<22) compared to those with reduced renal function (67.1% vs 83.9%; P = .027). In regression analysis eGFR was an independent factor associated with sexual dysfunction.

Conclusion

Renal dysfunction may be an important factor predisposing heart failure patients to more frequent sexual dysfunction.
PROTECTIVE POTENTIAL OF 17-β-ESTRADIOL ON OXIDATIVE STRESS AND RENAL METABOLISM IN AGED FEMALE RATS
Authors: Kumar Pardeep
Published: June 2023

Background and Aims

The objective of this study was to observe the changes in activity of antioxidant enzymes, hepatic glucose homeostasis, lipogenic enzymes and lipid metabolism, serum lipid profile and liver function occurring in livers of female rats of 3, 12 and 24 months age groups, and to see whether these changes are restored to 3 months control levels rats after exogenous administration of steroid hormone estrogens (17-β-estradiol, E2).

Methods

The aged rats (12 and 24 months old) (n= 8 for each group) were given subcutaneous injection of 17beta estradiol (0.1 ug/g body weight) daily for one month. After 30 days of hormone treatment, experimental animals of all the groups were sacrificed and livers were isolated for further study. A detailed study was carried on non-enzymatic glutathione (GSH) and enzymatic antioxidants [superoxide dismutase (SOD), glutathione peroxidase (GPX) and catalase (CAT)], hepatic glucose homeostasis, lipogenic enzymes, lipid metabolism, serum aspartate aminotransferase (GOT), alanine aminotransferase (GPT),alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), phosphatase alkalin (PAL) as well as bilirubin level.

Results

The results obtained in the present work revealed that normal aging was associated with significant decrease in the activities of antioxidant enzymes, serum expression and an increase in hepatic glucose homeostasis, lipogenic enzymes and lipid profile and GGT, PAL, GOT, GPT, ALP as well as bilirubin level increased significantly in livers of aging female rats. Our data showed that exogenous administration of E2 brought these changes to near normalcy in aging female rats.

Conclusions

The present study showed that E2 treatment reversed the changes to normal levels. E2 treatment may be beneficial in preventing some of the age related changes in the liver by increasing antioxidant defences and decrease oxidative stress. E2 plays important role in the progression of chronic hepatic diseases.
#6789 HYPERTENSION AND CHRONIC KIDNEY DISEASE: A CLOSE AND PROPORTIONAL RELATIONSHIP
Authors: Rebhi Feyza , Khadhar Meriam , Sarra Hadded , Jerbi Mouna , Aoudia Raja , Gaied Hanene , Goucha Rim
Published: June 2023

Background and Aims

Hypertension is a common clinical finding in patients with Chronic Kidney Disease (CKD). In fact, hypertension accelerates the progression of the renal disease and damages other target organs leading to worsening renal failure and increased incidence of cardiovascular morbidity and mortality.

Method

We conducted a retrospective, cross-sectional study at the Department of Nephrology at Mongi Slim Hospital, and we studied the relation between blood pressure levels and CKD stages. The stage of chronic kidney disease (CKD) was defined according to the KDIGO 2012 classification.

Results

A total of 89 patients were recruited in this study. The mean age was 69,19 years (rang 30-96) with a gender ratio M/F of 1,225. The patients who had hypertension were 41 (46,06%). We noted the presence of chronic kidney disease stage 3 or more in 64 patients (71.91%) among whom 32 patients had hypertension . Thirty-seven patients had a stage 3 CKD, 14 had a stage 4, and 13 had a stage 5. As for blood pressure levels, the mean systolic blood pressure was 137,94 mmHg, and the diastolic 79,52 mmHg. Twenty-three patients had stage 1 hypertension and 13 presented a stage 2 hypertension. Stage 3 hypertension was noted in 5 patients, who all had a stage 3 or 4 chronic kidney disease. Higher blood pressure levels were noted in patients with CKD stage 3 or more: Among the 13 patients who had a stage 5 chronic kidney disease, 7 had hypertension.

Conclusion

Hypertension is ubiquitous in the chronic kidney disease, and it can be a cause or consequence of CKD. Both hypertension and CKD contribute to each other and it has been noted that patients with CKD are at higher risk for hypertension-related adverse outcomes, including cardiovascular disease, and therefore, the management of hypertension is particularly important in patients with CKD.
#6834 PREVALENCE, ETIOLOGY AND CLINICAL CHARACTERISTICS OF BIOPSY PROVEN NON-DIABETIC RENAL DISEASE: 10 YEARS OF BIOPSES IN DIABETIC PATIENTS
Authors: Ramos Ana Rita , Trigo Ana , Alves Ana Rita Valerio , Santos Paulo
Published: June 2023

Background and Aims

Diabetic nephropathy (DN) is the major cause of kidney disease in diabetic patients. However, a significant proportion of diabetic patients may actually have nondiabetic renal disease (NDRD). Therefore, it is important to identify patients who can benefit from a renal biopsy in order to establish the correct diagnosis. Our study aims to determine the prevalence and etiology of biopsy proven NDRD and to explore the clinical differences encountered in the diabetic patient with NDRD.

Method

Retrospective study of the medical records of all diabetic patients who underwent a renal biopsy due to suspicion of NDRD from January 2012 to December 2022 at Nephrology department Collected data comprised demographic information, indication and result of renal biopsy, lab results (serum creatinine, Hb1Ac, proteinuria, albuminemia, hematuria, presence of active urinary sediment and presence of auto antibodies) and disease's characteristics (duration of diabetes, presence of diabetic retinopathy). Categorical variables are presented as frequencies and percentages, continuous variables as means and standard deviations, or medians and interquartile ranges (IQR) for variables with skewed distributions. A p-value<0.05 was considered statistically significant. Statistical analysis was performed using SPSS version 28.1 for Mac OS X.

Results

57 patients, 33.3% (n=19) were females, the medium age was 64.9 $\langle {{\rm{italic}}} \rangle \pm \langle {/{\rm{italic}}} \rangle $ 12.1. The most frequent indication for renal biopsy was acute kidney injury (26.3%), followed by rapidly progressive renal failure and nephrotic syndrome (22.8%). In our population, 22.9% had DN and 77.4% had NDRD. Pauciimune Glomerulonephritis (14%) and Membranous Nephropathy (10.5%) were the most common causes of NDRD. A chi-square test was performed to examine the relation between the two groups (ND vs NDRD) and the presence of diabetic retinopathy. There was a statistically significant association between the two variables ($\langle {{\rm{italic}}} \rangle {{\rm{X}}}^2\langle {/{\rm{italic}}} \rangle $= 11.778, p<0.01). Mann-Whitney test was performed to compare the median of duration the diabetes and Hb1Ac in two groups. That showed a statistically significant difference (U = 357, P = .018 and U=335.5 P = .013 respectively).

Conclusion

Since renal biopsy is critical to establish the correct diagnosis and provide an appropriate treatment, it should be performed in patients with high suspicion of NRDN, especially in patients with a recent diagnosis of diabetes, good metabolic control and the absence of diabetic retinopathy.
#6843 CITATION CLASSICS IN LUPUS NEPHRITIS: A BIBLIOMETRIC ANALYSIS
Authors: Subbiah Arunkumar , K Sudarshan
Published: June 2023

Background and Aims

Lupus nephritis is an important risk factor for morbidity and mortality in systemic lupus erythematosus. During the past three decades, extensive research has been done to address this important complication and devise better management strategies. In this article we aimed to perform a thorough assessment of the research productivity in lupus nephritis by identifying the 100 most-cited articles in lupus nephritis.

Methods

The top 100 most-cited English language articles on lupus nephritis from 1990 were examined by bibliometric analysis from the Google Scholar database of ‘Harzing's Publish or Perish’ software. These articles were subsequently analysed in detail and the chief characteristics are presented here.

Results

From 1990-2022, there were 111358 citations with 3480 cites/year and an average of 111 cites/paper. Thirty articles had greater than 400 citations, with 9 having more than1000 citations. Majority of the publications were from the United States of America (46%) with maximum publications from the National Institute of Health (NIH), Bethesda. Among these 100 most-cited articles, there were a median of 7 (5-12) authors per article with a mean of 9.6 authors. Twenty-six percent of the top-100 most-cited articles were randomized controlled trials while cohort and in-vivo studies addressing pathophysiology and biopsy related data accounted for one-fourth each. Among rheumatology journals, ‘Arthritis Rheum’, ‘Ann Rheum Dis’ and ‘Lupus’ were the most preferred journals for researchers working on lupus nephritis.

Conclusion

This article gives an overview of the research productivity, landmark publications and emerging trends in lupus nephritis. Increased emphasis on high-quality data from randomized controlled trials is revolutionising the management of lupus nephritis.
#6869 CARDIAC ALTERATIONS FOUND IN PATIENTS WHO START DIALYSIS
Authors: Legarra María Iraola , Monzo Jose Jesus Broseta , Caravaca Pedro , Rodríguez Diana , Cuadrado Elena , Farrero Marta , Maduell Francisco
Published: June 2023

Background and Aims

The presence of cardiac structural alterations in patients with chronic kidney disease who start renal replacement therapy is frequent. In fact, the real prevalence of heart failure is not well known due to the masking of symptoms by frequent ultrafiltration. Despite this, most deaths in these patients occur due to cardiovascular events, especially non-atheroembolic events, which are closely related to heart failure and ventricular remodeling. This study aimed to describe the echocardiographic alterations present in patients who start renal replacement therapy.

Method

Cross-sectional study to evaluate the prevalence of structural abnormalities in transthoracic echocardiography performed in patients at the time of initiating renal replacement therapy in the prevalent group of patients in kidney replacement therapy program at Hospital Clínic de Barcelona. Demographic variables and baseline drugs for heart failure were also collected.

Results

We included 170 patients of 67.84 ± 15.92 years. 115 (67.6%) were men, and 55 were women (32.4%). Of these, 124 (72.9%) were on hemodialysis, 11 (6.5%) on home hemodialysis, and 35 (20.6%) on peritoneal dialysis.

Transthoracic echocardiogram findings at the beginning of dialysis showed a left ventricular ejection fraction of 47.5 ± 10.6%. It was reduced in 21 (12.4%), slightly reduced in 9 (5.3%) and preserved in 125 (73.5%) of the patients. The estimated pulmonary artery systolic pressure was 28.5 ± 3.53 mmHg. The telediastolic diameter of the left ventricle was 5.5 ± 0.71 cm, that of the interventricular septum was 1.15 ± 0.27 cm, the diameter of the left atrium was 4.5 ± 1.27 cm, its volume was 95.05 ± 56.5 mL in the biplane section and 54.3 ± 28.28 mL in the four-chamber section. There were no significant differences between groups when analyzed by type of renal replacement therapy.

Regarding valvulopathies, 47 (21.8%) had some degree of aortic stenosis, 68 (40%) had some degree of aortic insufficiency, 104 (62.2%) had some degree of tricuspid insufficiency, 118 (69.4%) some degree of mitral insufficiency.

Regarding treatment, 50 (29.4%) of the patients had some RAASi, 60 (35.3%) had beta-blockers, and 2 (1.2%) had MRA.

Conclusion

The presence of structural alterations in the heart of patients initiating renal replacement therapy is practically universal and independent of the type of technique initiated. Nephrologists should become aware of these findings and seek ways to prevent and reverse these alterations as far as possible to achieve better clinical results in dialysis.
#6896 A SCREENING AND CLINICAL MANIFESTATIONS OF FABRY DISEASE IN PATIENTS ATTENDING DIALYSIS AND NEPHROLOGY CLINICS IN DURBAN, SOUTH AFRICA
Authors: Singh Jillian , Benjamin Sherilene , Assounga Alain
Published: June 2023

Background and Aims

Fabry disease is inherited in an X-linked manner in which the mutated gene inhibits the functioning of the alpha-Galactosidase-A enzyme causing a deficiency or absence of the enzyme, characterizing it as a progressive, lysosomal storage disorder. Subsequently, the accumulation of globotriaosylceramide (Gb3) in the lysosomes causes damage to tissues and major organs. Fabry nephropathy is one of the major organ complications caused by Fabry disease resulting in end-stage kidney disease. The aim of our study is to determine the prevalence of Fabry disease in our patients.

Method

This study was a prospective, quantitative study. A cohort of 200 male patients with chronic kidney disease (CKD stage 2-5D) was enrolled. A control group of 14 healthy males was also enrolled for this study. The ELISA technique was employed to determine the alpha Gal-A enzyme concentration levels in plasma. A questionnaire using the MSSI scoring system was presented to the participants to identify clinical manifestations. The SPSS Version 27 (IBM, New York, USA) was used to analyse the data.

Results

A cut-off value for the alpha Gal-A enzyme concentration levels of <500 pg/ml was calculated. A total of 17 participants from the patient group (n=11) and the control group (n=6) displayed alpha-Gal-A enzyme levels <500 pg/ml. Using the univariate regression analysis, statistically significant results were revealed between alpha-Gal levels <500 pg/ml and age (P = .007), heat or cold intolerance (P = .049), hypertension (p < 0.001) and eGFR (p < 0.001). MSSI scores displayed a negative association (P = .001). The multivariate regression analysis showed that age and MSSI scores retained their significance when eGFR was excluded as a variable, however, with the inclusion of eGFR as a variable, none of the variables retained their significance.

Conclusion

Fabry disease is suspected in 17 participants with alpha-Gal levels of <500 pg/ml. The cause of CKD nephropathy raises interest as conditions such as FSGS have been associated with FD. The low levels of the alpha-Gal enzyme and presentation of the clinical manifestations can be utilized as preliminary findings. Confirmatory tests such as DNA analysis or Gb3 and GL3 analysis are warranted.
#6910 PREDICTORS OF KIDNEY FUNCTION DECLINE IN LIVING KIDNEY TRANSPLANTATION DONORS
Authors: Trajcheska Lada , Bushljetik Irena Rambabova- , Nikolov Igor , Andreevska Galina Severova- , Filipovski Stefan , Markovska Zhaklina Shterjova- , Taneska Aleksandra Canevska , Milenkova Mimoza , Vasilova Adrijana Spasovska , Spasovski Goce
Published: June 2023

Background and Aims

After nephrectomy kidney transplant donors lose 50% of their renal mass. Shortage of donors and long waiting list for deceased donor transplantation expanded the living donor criteria. The aim of this study to identify pretransplant donor related factors associated with renal function decline.

Method

We retrospectively studied LDKT donors from one transplant center in the period 2013 -2022. Data was retrieved from medical history charts and national electronic database system. Demographic characteristics as age, gender and relation to the recipient, patients preference to donate the kidney with higher measured split GFR, the presence of diabetes, hypertension, hyperlipidemia and BMI >30kg/m2 were analysed. Estimated GFR by CKD EPI was notified prior donation, one and two years afterwards. In a multivariate regression analysis the reduction ratio of CKD EPI was explored as dependent variable.

Results

We studied 121 donors. The average age at time of transplant was 59.18 ± 10.99 years. Donors’ average eGFR was 91.53 ± 18.62 mL/min. Donor's age and eGFR were significantly correlated (p < 0.0001, r=r−0.529). Male donors were 37 (30%), 11 (9%) were unrelated to recipients, 9(7%) had BMI>30, 17 (14%) diabetes, 53 (44%) hypertension 5 (4% hyperlipidemia), and 65 (52%) had more then one comorbidity combined. Eight of donors (7%) decided to donate the better kidney. CKD EPI declined to 68.17±18.62 ml/min at first and 66.01±21.29 ml/min at the second year. The RR of 24.53 ± 20.60 % and 27.62±18.76% raised on yearly bases, respectively. In the univariate analysis of the GFR declination at the first year BMI>30 kg/m2 was associated with higher reduction of GFR (β=0.318, P = .003). At the second year the presence of diabetes emerged as worsening factor of GFR (β=0.227, P = .034) and BMI>30 kg/m2 kept its significance (β=0.426, P = .000). All the other parameters showed no significant associations to the GFR decline. In the multivariate analysis BMI>30 kg/m2 remained as most powerful predictor at 12 months reduction of eGFR.

Conclusion

Patients with diabetes and especially with obesity are at higher risk of rapid decline in kidney function after kidney donation. Careful assessment prior kidney donation should weight the risks.
#6930 TOO ELDERLY FOR A KIDNEY BIOPSY?
Authors: Medeiros Joana , Carvalho Renata , Bastos José Mário , Viana Johanna Rodrigues , Marques Sofia Homem Melo , Vaz Raquel , Costa Rui
Published: June 2023

Background and Aims

As we age, we lose kidney function and accumulate risk factors and comorbidities that predispose to kidney damage. However, kidney disease can develop at any time. Life expectancy continues to improve worldwide. For that reason, more elderly patients are undergoing diagnostic kidney biopsies (KB). There is a general reluctance in performing KB in those patients. It is important to know if a diagnosis KB in elderly patients can have a positive therapeutic impact.

Method

In this retrospective cohort study, we analyzed the medical charts of all patients aged ≥ 80years who underwent a native kidney biopsy (KB) between January and December 2021, in a central hospital in Portugal.

Results

Between January and December 2021, 59 patients underwent a native KB, 6 of them over 80 years of age (10% of all patients). Between those elderly patients, the median age was 82 years. The indications for KB were chronic kidney disease with a nephrotic range proteinuria in 3 patients, nephrotic syndrome, acute glomerulonephritis and acute kidney injury in 1 patient each. Median serum creatinine was 2.27 mg/dL (minimum 0.8 and maximum 5.4 mg/dL) and median protein-to-creatinine ratio was 5.7g/g (minimum 3.3 and maximum 13g/g). The pathological diagnoses found were focal and segmental glomerulosclerosis (FSGS) (n=2), pauci-immune crescentic glomerulonephritis (n=1), membranous nephropathy in a patient with a follicular lymphoma (n=1), acute interstitial nephritis (AIN) (n=1), and diabetic glomerulosclerosis in a patient with a monoclonal gammopathy of undetermined significance (n=1). 3 patients have received a kidney-specific treatment – the patient with AIN started corticosteroids, one patient with FSGS was submitted to corticosteroids plus tacrolimus, and the patient with pauci-imune crescentic glomerulonephritis to corticosteroids plus rituximab. The patient with membranous nephropathy and follicular lymphoma received a specific chemotherapy regimen according with lymphoproliferative disease. An improvement in kidney function occurred only in one patient and the other three developed adverse effects (particularly corticosteroids induced diabetes and infections). One year later, one of patients who received treatment was dead, another one was on hemodialysis, and the other two patients had a glomerular filtration rate lower than 15mL/min/1.73 m2.

Conclusion

Elderly patients have a higher risk of adverse effects from the kidney-specific treatment. It is important to assess the therapeutic risk/benefit when considering performing a renal biopsy in these patients.
#6931 TWO CASES OF PREGNANCY IN PATIENTS WITH TUBEROUS SCLEROSIS COMPLEX
Authors: Knezevic Tamara , Ivkovic Vanja , Prlic Margareta Fistrek , Ivandic Ema , Brinar Ivana Vukovic
Published: June 2023

Background and Aims

Tuberous sclerosis complex (TSC) is a rare autosomal dominant genetic disorder that is characterized by formation of benign tumors of the brain, kidney, eyes, heart, lung, liver and skin. The disease is frequently associated with adverse pregnancy outcomes. Our aim is to present two cases of Tuberous sclerosis complex in pregnancy which might be illustrative in the management of these patients.

Method

The first patient was a 32-year-old woman with a history of renal angiomyolipoma (AML) and pulmonic lymphangiomyomathosis (LAM) due to Tuberous sclerosis complex diagnosed at a young age. In the 35th gestational week she had an emergency Cesarean section due to acute retroperitoneal bleeding from angiomyolipoma of the right kidney and gave birth to a preterm male infant (birth mass 2077 g, Apgar 4/6). The patient did not take any medications during the course of pregnancy. Since 2015 she is being treated with everolimus (5 mg/day) due to complications for pulmonic lymphangiomyomathosis, subependymomas and epilepsy and AMLs. After eight years of treatment renal AMLs and LAM and subependymomas show no dynamic in size or number. The second patient was a 29-year-old nulliparous woman who has presented with seizures at the age of 2 and was diagnosed with TSC. At 37th gestational week of a twin pregnancy she gave birth to one male neonate (birth mass 2660 g, Apgar 8/9), while the other fetus died in utero. During the course of the pregnancy she was treated with phenobarbital, folic acid and iron supplementation. Her epilepsy is well-controlled and AMLs show no dynamic in size or number.

Results:

 

Conclusion

We have showed two cases with relatively good outcomes which have long-term stable disease. Female patients with TSC have increased risk of hemorrhagic complications of AMLs during pregnancy and it can be complicated by intrauterine growth restriction. A multidisciplinary approach is needed in the planning and monitoring pregnancies in these patients to achieve optimal outcomes.
Inequality and Stratification in East Asia
Authors: Park Hyunjoon , Ishida Hiroshi , Su Kuo-Hsien
Published: June 2023

Over the last few decades, three East Asian societies—Japan, South Korea, and Taiwan—have experienced an extraordinary degree of educational expansion, to the extent that their young adults are among the most educated population in the world. The roles of education in intergenerational social mobility in East Asia may show different patterns from those reported in Western societies, where educational expansion has been on much smaller scales. This chapter brings together various studies for each pair of the origin-education-destination stratification triangle in East Asia, along with recent studies that explicitly model the roles of education in modifying intergenerational social mobility. To contextualize empirical findings, this chapter also offers a description of structural features of educational systems, evolution of educational expansion, and changes in class structure in East Asia over time.
Modernization and Long-Term Trends in Social Mobility
Authors: Maas Ineke , van Leeuwen Marco H. D.
Published: June 2023

This chapter provides an overview of recent large-scale studies on historical trends in social mobility. The major findings are that intergenerational mobility increased and marital mobility showed a shift from ascription to achievement in the nineteenth century when industrialization and socioeconomic modernization took place. Most studies show trends in mobility, but only few analyze the association of mobility with indicators of modernization. Those that do so indicate that marital mobility was more clearly related to modernization than intergenerational mobility was. Studies are appearing that focus on women’s mobility and on non-Western countries, but these are still too few to draw general conclusions. Future research could benefit from better and more comparable measures of modernization. Alternative hypotheses on the causes of trends in intergenerational and marital mobility, related to societal inequality, political regimes, educational systems, culture, and religion, are also still awaiting testing.
PTC and DTC: a new perspective from Switzerland
Authors: Turato Filippo
Published: June 2023

This article analyses the use of private trust companies and dedicated trust companies (DTCs) in Switzerland. The Swiss trust industry has evolved steadily over the last few years, thanks to the creation of a solid regulatory framework. Professional trustees are now qualified as financial institutions, subject to licensing requirements and placed under the supervision of the Swiss Financial Market Supervisory Authority. This regulation introduced Swiss DTCs as a type of private trust company. DTCs are independent of the family, being held and supervised by a licensed trustee, and allow full flexibility in terms of governance evolving in the concept of a Swiss single-family office.
A comparison of the Newly Reformed German and the Liechtenstein Foundation Law against the background of the competition between the legal systems
Authors: Butterstein Alexandra
Published: June 2023

An European legal framework for foundation practice is still missing. Even the proposal for a regulation on the statute of the Fundatio Europaea has not yet been implemented. Meanwhile, the civil law regulations of the various foundation law systems are manifold. At the same time, competition between European legal systems not only affects civil, corporate and tax law, but has also reached foundation law. Moreover, the social and international environment of foundations is changing. In addition to a new generation of young founders, the demographic change in society and the mobility of legal forms in the European environment are also having an impact on foundations. Due to current reforms in the traditional foundation law systems of Germany and Switzerland, the question arises whether Liechtenstein should react to the competition between foundation law systems and whether the Liechtenstein legislator should become active once again. For this reason, this article deals in detail with the most important changes in German foundation law that are relevant for Liechtenstein foundation law. The article also looks at the regulations in Liechtenstein foundation law in a comparative law perspective, highlighting the competition between foundation law systems.
Strategies for Incorporating Plant-Based Nutrition Into Nursing Curricula
Authors: Benavides Heidi , Christianson-Silva Paula
Published: June 2023

A whole-food, plant-based (WFPB) eating pattern has shown benefits in preventing and reversing chronic disease, yet nursing curricula rarely include content on nutrition as a primary modality for disease management. We implemented several undergraduate and graduate nursing and interprofessional teaching strategies to increase student knowledge of a WFPB diet and help nurses improve patient outcomes through assimilation. Students requested additional emphasis on WFPB diets and chronic illness in the curriculum.