bluuebunny/crossref_metadata_2025 huggingface dataset:
MO459: Characterization of Adrenal Gland Derived Mediators of Vascular Calcification
Authors: Bhargava Shruti , Orth-Alampour Setareh , Gayrard Nathalie , Argiles Ciscart Angel , Jankowski Joachim
Published: May 2022

BACKGROUND AND AIMS

Adrenal glands participate in cardiovascular physiology and pathophysiology via the synthesis and secretion of various well-known compounds like mineralocorticoids, amine peptides and glucocorticoids. In this study, a previously unknown systemic function of adrenal glands, that is the regulation of vascular calcification processes was investigated.

METHOD

The homogenate of the bovine adrenal gland was separated using chromatographic fractionation. The fractions were analysed in aortic smooth muscle cells, aortic rings and vitamin D3 plus nicotine elastocalcinosis rat model for effects on vascular calcification processes. Potential mediators were distinguished by mass spectrometry and comparison with pertinent databases. For ease of therapeutic application, smaller fragments of the identified mediators were analysed to identify the active sites.

RESULTS

We identified a new 19aa peptide, named ‘calcification blocking factor’ (CBF), which shows a promising protective effect against vascular calcification. CBF is released from the parent protein Chromogranin A, which is released from adrenal glands via enzymatic cleavage by calpain 1 and kallikrein. CBF reduced the calcium content of cells and aortic rings in calcifying cultures. CBF downregulates vascular smooth muscle cell (VSMC) trans-differentiation into osteoblast-like cells within the vascular wall via the sodium-dependent phosphate transporter PIT-1 and by inhibiting the NF-κB activation and the subsequent BMP2/p-SMAD pathway. VDN animals treated with CBF show a significantly decreased pulse pressure as a marker of arterial stiffness. An 8aa peptide was found to have a better effect on reducing vascular calcification when compared to the original peptide.

CONCLUSION

The adrenal glands participate in cardiovascular (CV) physiology and the pathophysiology of CV diseases through their effects on sodium and water metabolism, vascular tone and cardiac function. In the present study, we identified a previously uncharacterized peptide secreted from the adrenal gland that modulates cardiovascular calcification by regulating osteoblastic differentiation in the context of vascular calcification. We show that CBF reduces calcification via PIT-1/NF-κB/BMP2/p-SMAD pathway. Further, we identified the active site of this peptide (8aa long) which can be used as a therapeutic agent. These findings suggest a novel function of adrenal glands in cardiovascular calcification.
MO470: Outcomes of Patients in Advanced Chronic Kidney Disease (ACKD) Consultation With Covid-19 Infection
Authors: Carlos Herrero Berron Juan , Suso Andrea , Mon Carmen , Ortiz Milagros , Sanchez Maria , Camacho Rosa , Lentisco Carolina , Oñate Irene , Oliet Aniana
Published: May 2022

BACKGROUND AND AIMS

The coronavirus disease 2019 (COVID-19) has affected our patients not only in renal replacement therapy (RRT), but also in advanced chronic kidney disease (ACKD) consultation. Our aim is to assess the impact of COVID-19 in a group of patients of our ACKD consultation.

METHOD

Retrospective observational study in our centre of patients from ACKD consultation with hospitalization due to COVID-19 infection in the period from March to December 2020. We have studied demographic parameters, characteristics during hospitalization, analytics values (3 months before and 1, 3, 6 and 12 months after infection) and final status at the end of follow-up on 31 December 2021. A value comparison is made with the Wilcoxon test for paired data.

RESULTS

In an ACKD consultation with 90 patients, 12 (13%) required hospitalization due to COVID-19. 75% were male, with a mean age of 77.6 years (SD 7) (range 59–89 years) and 25% due to Diabetic Kidney Disease. Mean time in consultation 28 months (SD 14) (range 12–58). Mean Comorbidity Charlson Index 8.2 (SD 1.2) (range 7–11), all hypertensive, 42% treatment with insulin, 25% ischemic heart disease and 42% chronic obstructive pulmonary disease. In COVID-19 hospitalizations, 83% they had pneumonia, 50% steroid treatment, 75% hydroxychloroquine, 92% several antibiotics, 33% low molecular weight heparin, only two required tocilizumab, and none required admission to the intensive care unit. During hospitalization, 3 (25%) patients died, and one died during follow-up, all were males. The consequences after infection: 42% pneumology (cough, varying degrees of shortness of breath), 8% neurological (headaches, varying degrees of memory loss) and 8% loss of smell (from 1 to 6 moths). At the follow-up, only one patient needs RRT with haemodialysis (at 19 months after COVID-19).

Table 1 shows analytics comparison before and after COVID. From 6 months after COVID, the results are like 3 months after the disease.

CONCLUSION

With the important limitation of few patients and without a control group, ACKD patients with hospitalization to COVID-19 show similar patterns to those with RRT: more frequent in males, advanced age, lung comorbidity and diabetics, elevation of inflammatory parameters, anemia and increase in creatinine during hospitalization. Recovery to values prior to admission occurs from the first month after infection.
MO475: Dapa-CKD Patient Profile: Transposability Assessment in Real-Life Through the CKD-Rein French Cohort
Authors: Alencar de Pinho Natalia , Lambert Oriane , Thomas-Delecourt Florence , Bineau Sebastien , Jacquelinet Christian , Massy Ziad , Stengel Benedicte , Fouque Denis
Published: May 2022

BACKGROUND AND AIMS

The objective of this observational study was to describe the `DAPA-CKD-like’ population and to assess the burden of illness (comorbidities, cardiovascular (CV) and renal events) and prognosis in patients with CKD in France, compared with those randomized in the DAPA-CKD RCT [1].

METHOD

The CKD-REIN cohort study enrolled 3033 patients with moderate or advanced CKD from 40 nationally representative nephrology clinics in France [median age of 68 (IQR: 60–76), min-max: 19–94, 65% men, CKD stage 3 (60%) or 4 (40%)]. Inclusions started in July 2013 and ended in July 2016. The analysis describes baseline characteristics of patients with DAPA-CKD inclusion criteria (75 ≥ eGFR ≥ 25 mL/min/1.73 m2 and 5000 ≥ UACR ≥ 200 mg/g) and CV and renal outcomes >3-year follow-up.

RESULTS

Among the 3033 adult patients included in CKD-REIN cohort, 503 met the inclusion and exclusion criteria of the DAPA-CKD RCT. The characteristics of these 503 French `DAPA-CKD-like’ patients and those of the DAPA-CKD RCT were similar in terms of age (63.9 ± 13.6 versus 61.8 ± 12.1), gender (74% men versus 67%), eGFR (36.5 ± 9.1 mL/min/1.73 m2 versus 43.1 ± 12.4 mL/min/1.73 m2) and SBP (145 ± 21 mmHg versus 137 ± 17 mmHg). The CV and renal event rates/100 patient-year (PY) were similar between the two populations, both for the main composite outcome (eGFR decline ≥50% or end-stage kidney disease (defined as eGFR <15 mL/min/1.73 m2 long-term dialysis or kidney transplantation) or CV or renal deaths), 7.9/100 PY versus 7.5/100 PY, but also for each outcome of the main endpoint and secondary endpoints.

CONCLUSION

In conclusion, the DAPA-CKD RCT patient profile appears to be similar to a real-life French CKD patient profile based on the French CKD-REIN cohort meeting the inclusion and exclusion criteria of the DAPA-CKD RCT.
MO526: Renal Function in Patients With Non-Dialysis Kidney Disease Treated With Ferric Carboxymaltose
Authors: Roldão Marisa , Duarte Rui , Escoli Rachele , Gonçalves Hernâni , Vila Lobos Ana
Published: May 2022

BACKGROUND AND AIMS

Iron deficiency anemia occurs in most patients with non-dialysis chronic kidney disease (ND-CKD). Several studies have suggested the efficacy and safety of ferric carboxymaltose (FCM) in this group of patients, but none have shown a positive impact on renal function. The aim our study was to investigate the impact of FCM on renal function in ND-CKD patients.

METHOD

Prospective observational study of ND-CKD stages 3 to 5 patients, with anemia and iron deficiency [ferritin level <100 µg/L or <200 µg/L with transferrin saturation (TSAT) <20%],  treated with FCM from 01 January 2019 to 31 June 2021. FCM was administrated as a single IV infusion. Patients were categorized into two cohorts according to the dose of FCM received: 500 mg or 1000 mg. Clinical and analytical data were compared among groups at baseline and 24 weeks after infusion. Renal function was assessed using estimated glomerular filtration rate (eGFR), calculated using the CKD-EPI formula. Statistical analysis was executed using SPSS (Version 23 for Mac OSX).

RESULTS

The mean age of 140 patients was 77.31 ± 9.68 years, 62 (44.3%) were male, 86 (61.4%) were diabetic, 84 (60%) had congestive heart failure and 121 (86.4%) had hypertension. Thirty-five (25%) patients had CKD stage 3, 74 (52.9%) had stage 4 and 31 (22.1%) had stage 5. Seventy-eight (55.7%) patients were treated with 1000 mg of FCM. There were no gender, comorbidity, CKD etiology or stage differences among groups. Patients treated with 1000 mg were younger (74.36 ± 13.59 versus 78.44 ± 9.28 years, P = .046).

At baseline, mean Hb was 10.4 ± 1.35, 10.27 ± 1.47 and 10.54 ± 1.2 g/dL and mean eGFR was 26.18 ± 17.167, 23.55 ± 4.17 and 28.71 ± 19.43 mL/min/1.73 m2 for the whole group, 1000 mg and 500 mg cohorts. At 24 weeks, Hb showed an increase of 1.24 ± 1.78 (P = .001), 1.54 ± 1.99 (P = .001) and 0.86 ± 1.4 g/dL (P = .001), and eGFR an increase of 1.13 ± 6.49 (P = .041) and 1.55 ± 6.87 mL/min/1.73 m2 (P = .049) for the whole group and 1000 mg cohort, but not 500 mg cohort.

A Pearson correlation was performed and revealed a positive correlation between the variation of Hb and eGFR during the study follow-up period (r = .283, P = .001 and r = .310, P = .008) in the same groups.

CONCLUSION

In addition to the effectiveness in correcting iron deficiency anemia in patients with ND-CKD, our results suggest a positive impact on renal function of higher doses of FCM after 6 months of administration.
MO538: Lower Serum Levels of Magnesium are Associated With Higher Risk of Fractures in Haemodialysis Patients
Authors: Ávila Gonçalo , Matias Patricia , Laranjinha Ivo , Amaral Tiago , Gil Célia , Anibal A. Ferreira Manuel
Published: May 2022

BACKGROUND AND AIMS

Magnesium (Mg) deficiency is associated with altered bone metabolism, However, the relationship between Mg and the risk of fragility fractures haemodialysis (HD) patients is still unclear. The aim of this study was to evaluate the association between pre-dialysis Mg serum levels and the risk of incident bone fractures in a cohort of prevalent HD patients.

METHOD

We performed a prospective study of 206 prevalent HD patients followed from 2009 until 2021. Demographic, clinical and biochemical parameters were evaluated.

RESULTS

A total of 37 episodes of fragility fractures were identified with a median HD vintage of 42 months, which corresponds to an incidence rate of 29/1000 person-years. The mean age of the studied population was 68.3 ± 13.1 years, 121 (59%) were male and the median follow-up time on HD was 58 months.

Patients with incident fractures showed significantly lower Mg levels compared with those without fractures (2.3 ± 0.3 versus 2.8 ± 0.4 mg/dL, P < 0.001). In a multivariable analysis, lower Mg levels (P = 0.02) were independently associated with increased risk of fracture, in a model adjusted to age, female gender, albumin and dialysis vintage.

Patients with a Mg serum level < 2.2 mg/dL (lowest quartile) had a 1.32-fold higher risk for fragility fractures than those in the highest quartile [95% confidence interval (95% CI), 1.15–1.48; P < 0.001].

CONCLUSION

This study shows that the incidence of bone fragility fractures in HD patients is high and significantly associated with lower pre-dialysis Mg levels. Management of fracture risk in HD patients and assessment of its risk factors requires further study.
MO557: Lanthanum Dioxycarbonate is Safe in Rats
Authors: Khare and Gupta Pramod Atul
Published: May 2022

BACKGROUND AND AIMS

Over 7 million patients suffer from end-stage kidney disease (ESKD) worldwide.[1] Due to low kidney function, patients often become hyperphosphatemic, which leads to negative outcomes[2] including increased risk of death.[3] Patients usually rely on dietary restriction and phosphate(P) binders to address hyperphosphatemia. However, current P binders often do not achieve desired P levels[4] and have a high pill burden due to high quantity of large pills.[5,6] Having a therapeutic option using the same quantity of elemental lanthanum as existing therapies (and therefore similar efficacy) but with a potentially smaller and easy-to-administer pills would enhance patient quality of life (QoL). Lanthanum dioxycarbonate, RENAZORB(LDC), is a novel nanotechnology product that combines lanthanum, which has the highest binding capacity versus other P binders,[7] with a potentially smaller pill size that is swallowed rather than chewed to treat hyperphosphatemia in ESRD patients. However, its safety results have not yet been published. We present the results from a toxicity study evaluating safety of lanthanum dioxycarbonate in rats.

METHOD

A repeat-dose toxicology study was conducted to evaluate the potential toxicological profile of LDC. Rats were administered oral doses of LDC at 200, 600 or 2000 mg/kg/day by gavage for approximately 6 weeks. Blood samples for TK analysis were obtained from cohorts of 3 rats/sex/group/time pre-dose and at 1, 2, 4, 8, 12, 24 and 48 h after Day 1 and 38 dosing.

RESULTS

LDC was well tolerated at all test doses. The only test article-related effects noted at the high dose of 2000 mg/kg in both sexes were decreased mean cell hemoglobin (MCH) and mean cell hemoglobin concentration (MCHC), and increased urine pH, and at 600 mg/kg increased urine pH in female rats. The increased urinary pH was considered not of toxicologic relevance, and the decreases in MCH and MCHC were considered to be small enough to not adversely affect the animals’ health. The no-observed-adverse-effect level was 2000 mg/kg.

CONCLUSION

All doses of lanthanum dioxycarbonate were well tolerated and found safe in rats. These results suggest lanthanum dioxycarbonate may be a suitable candidate for further development. Potential benefits of LDC may include reduced pill burden and ease of dose administration (smaller easy-to-swallow versus chewable), which collectively has potential to enhance patient adherence, improve treatment outcomes and enhance QoL.
MO560: Adherence to Nutritional Recommendations as Expressed by Patients on Hemodialysis, Their Informal Carers and Healthcare Professionals—the Goodrenal Project
Authors: Avesani Carla , Garcia-Testal Alicia , Van Craenenbroeck Amaryllis , Kouidi Evangelia , Clyne Naomi , Lauer Andreas , Cana-Poyatos Alicia , Elena Marin Alexandra , Lindholm Bengt , Antonio Lozano-Quilis José , Yang Kevin , Moura Reboredo Maycon , Kougioumtzidou Ourania , Mesa-Gresa Patricia , Moscoso Paula , Segura Eva
Published: May 2022

BACKGROUND AND AIMS

Low adherence to nutritional recommendations is common in patients on hemodialysis (HD), but the reasons are not well known. We explored the main needs, barriers and facilitators affecting nutritional adherence as experienced by patients on HD, their informal carers and their healthcare professionals (HCPs) at the dialysis centre.  

METHOD

This study is part of the GoodRENal project—funded by the European Community, Erasmus + program that comprises four countries: Spain, Sweden, Belgium and Greece. As part of this project, exploratory questionnaires were constructed and answered by the patients, their carers and their HCPs. The questionnaire comprised three sections consisting of statements exploring the needs, barriers and facilitators affecting adherence to nutritional recommendations for patients on HD. Each statement could be rated from 1 (strongly disagree), 2 (disagree), 3 (neither agree or disagree), 4 (agree) to 5 (strongly agree). In addition, there was a section for free text. To avoid bias in patient selection, 10 patients were randomized from the first dialysis shift of the week in the four participating countries. 

RESULTS

In total, 40 patients, 40 informal carers and 40 HCPs HealthCP accepted to participate, out of whom 38 patients (68% male, 62 ± 15 years), 33 informal carers (21% male, age 54 ± 12 years, of whom 68% were spouses) and 37 HCPs (22% male, age 42 ± 10 years, 60% were nurses) answered the questionnaires. Two of the four centres had a dedicated dietitian at the dialysis unit, who worked there on average 18 ± 8 hours per week. At the dialysis units without a dietitian, the nurses and doctors were responsible for nutritional care. To simplify the analysis, answers rated as 4 and 5 were grouped as agree. The main findings are presented below:

CONCLUSION

These descriptive findings show that patients, informal carers and HCPs identified different needs, barriers, and facilitators to increase adherence to nutritional recommendations. These results can be used to build and tailor strategies aimed at patients, informal carers and HCPs.
MO563: Effect of Probiotics on Uremic Toxins Production and Inflammation in Patients Suffering from CKD Stage 3 and 4
Authors: Sharma Manjuri , Kharbuli Indakiewlin , Kumar Doley Prodip , Dange Shruti , Gope Manas , Pegu Gayatri , Brijesh Singh K.
Published: May 2022

BACKGROUND AND AIMS

Probiotics are being coprescribed in the management of chronic kidney disease (CKD). Few studies have reported that probiotics could slow down the progression of CKD by regulating the intestinal flora and by reducing the uremic toxins. [1,2] Objective of our study is to assess the effect of probiotics on uremic toxins production and inflammation in patient suffering from CKD stage 3 and 4.

METHOD

Patients of either sex, aged 18–75 years, suffering from CKD stage 3 and 4 were enrolled. Study was conducted at Department of Nephrology, Guwahati Medical College and Hospital (GMCH), Guwahati, Assam. Patients received 1 capsule containing 45 billion of colony forming units of probiotics twice a day for 180 days. Patients were evaluated at day 0, 90 and 180. Parameters such as serum creatinine, blood urea, uric acid, C-reactive protein (CRP), hemoglobin and albumin were recorded at each visit.

RESULTS

During period of May 2019 to May 2020, 102 patients were enrolled and followed for 180 days. Significantly higher number of males 67 (66%) than 35 (34%) females is reported (P = 0.024). CKD stage 3 and 4 is reported in 41 (40% ) and 61 (60%), respectively. Insignificant drop of serum creatinine of -0.17 (on day 90, P = 0.146) and -0.23 (on day 180, P = 0.135) compared with baseline Sr. creatinine 2.53 ± 0.56 (mean ± SD) is reported. Significant drop in blood urea is reported on day 90 (-2.97, P = 0.014) and on day 180 (-3.60, P < 0.001) compared with baseline 52.11 ± 26.90 (mean ± SD). The reduction in CRP on day 90 and day 180 from baseline was found to be statistically significant (P = 0.037, 0.011). However, reduction in uric acid and increase in hemoglobin and albumin did not reach significance on day 90 and day 180.

CONCLUSION

Probiotics supplementation lead to decrease in blood urea and CRP. However, its effect on serum creatinine, hemoglobin, uric acid and albumin did not reach statistical significance. More randomized controlled trials are required to prove the efficacy of probiotics to retard CKD progression.
MO621: Effectiveness of Adjuvant Astragalus for Diabetic Kidney Disease: Interim Analysis of A Pragmatic Randomised Controlled Trial
Authors: Wa Chan Kam , Siu Kei Kwong Alfred , Nang Tsui Pun , Fai Choi Wing , Han Yiu Wai , Beng Kathryn Tan Choon , Tang Sydney
Published: May 2022

BACKGROUND AND AIMS

More regimens targeting different mechanisms are needed for the residual risk of renal progression among diabetic kidney disease (DKD) patients. Although in vivo and in vitro studies suggested that add-on astragalus, a commonly used Chinese medicine, could retard renal progression in chronic kidney diseases, its effect on DKD is unclear.

METHOD

This assessor-blind, add-on, randomized, controlled, parallel, pragmatic trial evaluates the effect of 48 weeks of oral astragalus granules on 118 patients with estimated glomerular filtration rate (eGFR) of 30–90 mL/min/1.73 m2 and urinary albumin-to-creatinine ratio (UACR) of 34–565 mg/mmol. Primary endpoints are the changes in eGFR and UACR between baseline and treatment endpoint. Outcomes are analyzed as intention-to-treat by mixed-effect regression models, adjusting the baseline values of quantitative outcomes, allocation, visit and the interaction between allocation and visit.

RESULTS

Recruitment started in July 2018. Baseline demographics are comparable between groups. The mean age is 67.9 years and 35.6% are female. Baseline eGFR is 58.1 mL/min/1.73 m2 and the geometric mean of the baseline UACR is 124.5 mg/mmol. From the first 60 patients who have completed the 48-week study period, the endpoint eGFR is 56.2 and 52.7 mL/min/1.73 m2 {intergroup difference: 3.4 mL/min/1.73 m2 [95% confidence interval (CI) −0.3–7.1], P = 0.071} after receiving add-on astragalus and standard care alone, respectively. The endpoint UACR is 138.4 and 116.8 mg/mmol [proportional difference: 1.19 (95% CI 0.91–1.54)] after receiving add-on astragalus and standard care alone, respectively. Four patients developed serious adverse events in each arm. The most common adverse events are edema, syncope and hyperkalemia.

CONCLUSION

Our interim analysis suggests that add-on astragalus treatment has a trend of stabilizing eGFR among DKD patients with macroalbuminuria.
MO627: Effectiveness of Integrative Chinese–Western Medicine for Chronic Kidney Disease and Diabetes: A Retrospective Cohort Study
Authors: Wa Chan Kam , Yee Chow Tak , Yan Yu Kam , Wong Taam Vivian , Tang Sydney
Published: May 2022

BACKGROUND AND AIMS

Chronic kidney disease (CKD) and diabetes are key contributors of disability-adjusted life years globally awaiting more therapeutic options. This registry-based retrospective cohort study aimed to evaluate the effectiveness, safety profile and prescription pattern of a pilot integrative Chinese–Western medicine service program in Hong Kong.

METHOD

Data from 38 patients with diabetes and CKD received 48 weeks of individualized add-on Chinese medicine (CM) were retrieved from electronic hospital database. Patients from the same source were matched by propensity score to generate a 1:1 cohort. Primary outcomes were the change of estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) analyzed by analysis of covariance (ANCOVA) and mixed-effect regression model adjusted for baseline eGFR, age, gender, duration of diabetes history, history of hypertension, diabetic retinopathy, and the use of insulin and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. Rate of adverse events and the change of key biochemical parameters were also analyzed.

RESULTS

After a median follow-up of 51 weeks, patients who received add-on CM had stabilized eGFR [0.74 mL/min/1.73 m2 (95% CI −1.01–2.50)] and UACR [0.95 (95% CI 0.67–1.34)]. Add-on CM was associated with significantly preserved eGFR [inter-group difference: 3.19 mL/min/1.73 m2 (95% CI 0.32–6.06), P = 0.030] compared with standard care. The intergroup ratio of UACR were comparable [0.70 (95% CI 0.45–1.08), P = 0.104] between groups. The result is robust in sensitivity analysis with different statistical methods. The rate of serious adverse events (8.1% versus 18.9%, P = 0.174), moderate-to-severe hyperkalemia (8.1% versus 2.7%, P = 0.304) and hypoglycemia (13.5% versus 5.4%, P = 0.223), and the levels of key biochemical parameters were comparable between groups. Top 7 most used CMs contained two classical formulations namely Liu-wei-di-huang-wan and Si-jun-zi-tang.

CONCLUSION

Add-on individualized CM was associated with kidney function preservation. Further randomized controlled trial using CM prescriptions based on Liu-wei-di-huang-wan and Si-jun-zi-tang is warranted.
MO631: Diabetic Retinopathy and/or Diabetic Nephropathy Confers A Worse Renal Prognosis
Authors: Bermejo Garcia Sheila , Agraz Irene , Vergara Ander , Bestard Oriol , Jose Soler Romeo Maria
Published: May 2022

BACKGROUND AND AIMS

Around 50%–60% lesions of non-diabetic nephropathy (NDN) have been identified in patients with diabetes and renal biopsy. NDN patients have a better renal prognosis and survival. Diabetic retinopathy (DR) is a microvascular complication of diabetes frequently associated with diabetic nephropathy (DN). The objective of the work is to study the renal prognosis and survival of patients with DN with or without DR.

METHOD

Retrospective, observational, multicenter study of the pathological results of diabetic patients with renal biopsy was undertaken. A total of 18 Spanish centers have participated.

RESULTS

Cohort of 832 patients: 621 men (74.6%), median age 61.7 ± 12.8 years, median creatinine 2.8 ± 2.2 mg/dL and proteinuria 2.7 (1.2–5.4) g/24 h. Of them, 26.6% (n = 221) presented DR, 18.8% (n = 156) peripheral vasculopathy and 17.7% (n = 147) ischemic heart disease.

On biopsy, 39.5% (n = 329) of patients had DN, 413 (49.6%) NDN and 90 (10.8%) mixed forms. We evidenced more DR in the DN group compared with the other two groups (44.1% versus 11.1% in NDN and 33.3% in mixed forms). Regarding renal prognosis, 58.9% (n = 109) of patients with DR and DN and mixed forms required RRT versus 40.7% (n = 88) of patients without DR. A total of 39.1% (n = 18) of patients with DR and NDN required renal replacement therapy (RRT) versus 23.9% (n = 79) of patients without DR. Regarding mortality, 28.6% (n = 50) of patients with DR and DN or mixed forms died during the follow-up versus 22.7% (n = 49) of patients without DR. A total of 15.2% (n = 7) of patients with DR and NDN died and 15.4% (n = 51) of patients without DR.

In survival analysis (Kaplan—Meier curves), patients with DR had worse renal prognosis (P < 0.001), patients with DN (P < 0.001) and patients with DR and/or DN and mixed forms (P = 0.02). Cox regression analysis identified as independent risk factors of RRT: age (OR 1.014;1.025–1.004, P = 0.006), creatinine (OR 1.262; 1.217–1.309; P < 0.001), proteinuria (OR 1.057; 1.03–1.085; P < 0.001), DR (OR 1.359; 1.007–1.833; P = 0.045), DR and/or DN (OR 1.59; 2.42–1.04; P = 0.033) and DN (OR1.489; 1.05–2.11; P = 0.026).

CONCLUSION

The presence of DR and/or DN confers a worse renal prognosis. The diagnosis of diabetic microangiopathy in terms of retinopathy and/or diabetic nephropathy is crucial since it confers a worse renal prognosis indicating patients at risk of progression to end-stage renal disease.
MO634: Effects of Dapagliflozin in Patients with Heart Failure
Authors: Abdullaev Sherzod , Sharapov Olimkhon
Published: May 2022

BACKGROUND AND AIMS

In patients with type 2 diabetes, inhibitors of sodium–glucose cotransporter 2 (SGLT2) reduce the risk of a first hospitalization for heart failure, possibly through glucose-independent mechanisms. More data are needed regarding the effects of SGLT2 inhibitors in patients with established heart failure and a reduced ejection fraction, regardless of the presence or absence of type 2 diabetes.

METHOD

A multicenter prospective cohort study, where 225 patients with heart failure (III and IV by NYHA) and an ejection fraction of 45% or less to receive either dapagliflozin (10 mg once daily) or placebo, in addition to basic therapy. The primary outcome was a composite of worsening heart failure (hospitalization or an urgent visit resulting in intravenous therapy for heart failure) or cardiovascular death.

RESULTS

After 12 months, the primary outcome occurred in 17 of 111 patients (15.31%) in the dapagliflozin group and in 24 of 114 patients (21.05%) in the placebo group {HR 0.74 [95% confidence interval (CI), 0.65–0.85]; P < 0.001}. A first worsening heart failure event occurred in 10 patients (9.0%) in the dapagliflozin group and in 16 patients (14.0%) in the placebo group [HR 0.70 (95% CI 0.59–0.85)]. Death from cardiovascular reasons occurred in six patients (5.4%) in the dapagliflozin group and in 11 patients (9.6%) in the placebo group [HR 0.80 (95% CI 0.69–0.95)]; 12 patients (10.8%) and 15 patients (13.1%), respectively, died from other causes [HR 0.83 (95% CI 0.71–0.96)]. Findings in patients with diabetes were not significantly pronounced than in patients without diabetes. The frequency of adverse events related to volume depletion, renal dysfunction and hypo/hyperglycemia did not differ between treatment groups.

CONCLUSION

Among patients with heart failure and a reduced ejection fraction, the risk of worsening heart failure or death from cardiovascular events was lower among those who received dapagliflozin than among those who received placebo, regardless of the presence or absence of diabetes.
MO653: High-Flux Haemodialysis and Haemodiafiltration: A Comparative Study Based on 1-H NMR Serum Metabolic Profile
Authors: Flores Santos Andressa , Manfron Schiefer Elberth , Sassaki Guilherme , Menezes Leociley , Fonseca Renato , Cunha Regiane , Souza Wesley , Pecoits-Filho Roberto , Stinghen Andréa E M
Published: May 2022

BACKGROUND AND AIMS

Patients with chronic kidney disease (CKD) accumulate uraemic toxins (UTs). When compared to other conventional dialysis modalities, high volume haemodiafiltration (HDF) improves the removal of medium and low molecular weight UTs. The present study is a post-hoc analysis comparing the metabolomic profile in serum from patients under high flux HD (hf-HD) and HDF in HDFIT, a multicentric randomized controlled trial (RCT).

METHOD

Random (pre- and post-dialysis) samples from nine patients in a study arm were selected at baseline and at the end of the follow-up. To compare the samples, 26 possibly matching metabolites were identified by a t-test among the four groups using 1-H nuclear magnetic resonance (NMR).

To evaluate the comparison between the modalities in a single treatment session, the clearance rates (CRs) of each metabolite were calculated based on pre- and post-dialysis samples. In addition, to evaluate the effect of UTs removal during the trial follow-up period, the pre-dialysis metabolite concentrations both at the baseline and 6 months were compared with the two arms of the study.

RESULTS

Evaluating the concentrations of the metabolites during the follow-up period for each study arm, it was possible to assess the effects of UTs removal during the study for each modality. The comparison of the intensity of the peaks identified 26 possible metabolites that differentiated hf-HD and HDF in this timeframe. The correlation (see Figure 1a) then suggested that the peak integrals of 16 of these metabolites increased from baseline to 6 months in the hf-HD, but not in the HDF arm. Amongst the metabolites, several are involved in important metabolic pathways, such as the metabolisms of phenylalanine and the biosynthesis of phenylalanine, tyrosine and tryptophan, which both relate to UTs and the development of cardiovascular diseases. The peak integration relative to glycolic acid was significantly higher (P<.05) at 6 months than at baseline (see Figure 1b) in the hf-HD than in the HDF arm, which has been related to an increased number of renal failure and of renal insufficiency cases [1,2], as well as it related to liver damage [3].

CONCLUSION

The concentrations of metabolites related both to CKD and associated pathologies were stable in the HDF arm only during the follow-up period, suggesting enhancement of the long-term stability by this method. In the hf-HD long-term follow-up, the relative increase in the glycolic acid peak integration area, which is related to the metabolite concentration, has also previously been linked to an increased number of renal failures and renal insufficiency cases and to liver damages.
MO680: Association of Systemic Inflammation with Changing Peritoneal Membrane Characteristics
Authors: Korucu Berfu , Haci Yeter Hasan , Faruk Akcay Omer , Güz Galip
Published: May 2022

BACKGROUND AND AIMS

Increasing transport status with ultrafiltration (UF) and solute-removal inadequacy is among the most challenging issues in peritoneal dialysis (PD) continuity. Decreased transport status is less frequent but also results in solute clearance. Although the current incidence of peritonitis has reduced considerably, defined membrane disruptions are still frequently observed. Our study examines the relationship between different types of membrane disruptions and the course of systemic inflammation in incident PD patients.

METHOD

This is a retrospective, single-site, cohort study of incident adult PD patients (n = 202) sampled between January 2000 and January 2020. An increase or decrease in transport status is defined as two or more categories of a rise or decline in peritoneal equilibration test (PET) from their baseline during follow-up. The 4-h dialysate/plasma creatinine ratio was used to classify PET categories. C-reactive protein (CRP) values were obtained from the annual tests in the routine controls of the patients.

RESULTS

Baseline demographics, diabetes frequency, residual renal function, baseline laboratory, frequency of renin–angiotensin–aldosterone system blockers, high glucose–containing dialysate and icodextrin use were similar among the groups. Total episodes of peritonitis and peritonitis rates within the first 5 years of follow-up was higher in patients with stable transport status with a median rate of 0 (min:0 to max:5) than patients with increased transport status [median rate of 0 (min:0 to max:3)] and decreased transport status [median rate of 0 (min:0 to max:1)] (P = 0.009). The main time-dependent effect of CRP was statistically significant [Wilks’ λ = 0.76, F (5, 127) = 7.75, P < 0.001]. The joint effect of the mean CRP value depending on time and group was also significant [Wilks’ λ = 0.91, F (10, 254) = 1.10, P = 0.36]. The effect of CRP and time was significantly different between the groups [F (2, 131) = 3.49, P = 0.03; partial η2 = 0.05]. While there was a significant difference between stable and increased transporters in the post-hoc analysis, no similar significance was found between stable and decreased transporters (P = 0.03 and P = 0.99, respectively).

CONCLUSION

Our study shows that the peritoneal membrane kinetics may change into different characteristics in many patients over time, despite the very low frequency of peritonitis episodes and similar baseline characteristics, and may be significantly affected by systemic inflammation. Systemic inflammation, in particular, appears to be related to increased transport status, which is most often responsible for the deterioration of UF and solute clearance over time.
MO719: Contrast Nephropathy in Peritoneal Dialysis Patients: A Single-Center Experience
Authors: Cardoso Fernandes Sara , Carina Ferreira Ana , Fernandes Vasco , Nolasco Fernando
Published: May 2022

BACKGROUND AND AIMS

Peritoneal dialysis (PD) patients are frequently exposed to contrast media through contrast-enhanced computed tomography (CT) and/or coronary angiography, which may be used as diagnostic tools or as part of pretransplant evaluation. However, the risk of contrast nephropathy frequently limits the use of these imaging techniques. The authors aim to evaluate the loss of kidney function after contrasted examination in PD patients.

METHOD

We performed an observational retrospective study in a population of patients with end-stage kidney disease on PD. All patients included had performed an ionized radiation-imaging exam (CT or coronary angiography), with or without contrast media. In patients who performed more than one of the aforementioned exams, only the first one was considered. Demographic and laboratory data including kidney function and dialysis dose before and after the imaging exams were collected. We divided the population into two groups (no contrast use versus contrast use) and compared them using Mann–Whitney test or Chi square. A survival analysis was performed (time to exam; outcome—loss of renal function; predictor—contrast use).

RESULTS

A population of 41 patients in PD, 26 in automated PD (63.4%), with a dialysis vintage of 29 (17–38) months were included in this analysis. The median time since starting PD and the exam was 15 (5–20) months, and contrast was used in 21 exams (51.2%). Five patients underwent coronary angiography and 16 were submitted to contrast-enhanced CT. Only two patients performed contrast nephropathy prophylaxis before contrast exposure.

In univariate analysis, we found no difference between renal residual function, KT/v and creatinine clearance before and after the imaging exam, irrespective of contrast use. After the diagnostic exam, 19 patients lost residual renal function [median GFR 1 (1–2) mL/min/1.73 m2], and the group of patients who did not use contrast were the most affected ones; however, there was no statistical significance difference between the two groups (P = 0.08). Since we found a significant difference in the time to imaging exam between the two studied groups, we performed a survival analysis, and the use of contrast was associated with preservation of renal function (P = 0.02). A multivariate Cox analysis with age, Charlson index, GFRe pre-exam, diabetes, use of RAASi, beta-blocker, loop diuretic and spironolactone as potential confounders showed that use of contrast was not associated with loss of renal function in PD patients.

CONCLUSION

Our study showed that contrast nephropathy is not frequent in PD patients and that we can allow contrast media (low or iso-osmolal) as it was not associated with loss of residual renal function.
MO728: Association of Interleukin-6 with Subendocardial Viability Ratio in Haemodialysis Patients
Authors: Ekart Robert , Piko Nejc , Vodošek Hojs Nina , Stropnik Galuf Tina , Hren Martin , Zorman Tadej , Hojs Radovan
Published: May 2022

BACKGROUND AND AIMS

Inflammation is an important process in the pathogenesis of atherosclerosis, and chronic kidney disease (CKD) is recognized as a proinflammatory state. Interleukin-6 (IL-6) is associated with cardiovascular events and also predicts mortality in individuals with CKD patients.

The subendocardial viability ratio (SEVR) is one of the pulse wave analysis parameters and represents a non-invasive measure of coronary perfusion. In a non-dialysis CKD population, we previously reported about the prognostic value of SEVR for cardiovascular outcome in these patients.

The aim of this study was to investigate the association between inflammatory markers IL-6, tumour necrosis factor-α (TNF-α), high-sensitive C-reactive protein (hsCRP) and SEVR in CKD patients undergoing maintenance hemodialysis (HD).

METHOD

In a cross-sectional study, we enrolled only HD patients. SEVR was assessed using a generalized transfer function applied to the radial artery pressure wave form (Sphygmocor, Atcor Medical, Sydney, Australia). Plasma IL-6, TNF-α and hsCRP were measured by an enzyme-linked immunosorbent assay.

RESULTS

A total of 40 HD patients (mean age 65.2 ± 11.8 years, 72.5% male) were included. Other descriptive parameters are presented in Table 1. A statistically significant correlation was found between SEVR and IL-6 (r = 0.379; P = 0.016), but not between SEVR and TNF-α (P = 0.195), nor between SEVR and hsCRP (P = 0.686).

In a multivariate adjusted model with SEVR as dependent variable and IL-6, TNF-α and hsCRP as independent variables we found a statistically significant association only between SEVR and IL-6 (β = 0.393; P = 0.017).

CONCLUSION

This study suggests an association between IL-6 and SEVR in HD patients.
MO748: The Effect of Warfarin-TG2-MVS Axis in Vascular Calcification
Authors: Liu Yuqiu , Liang Zhang Xiao
Published: May 2022

BACKGROUND AND AIMS

Warfarin is a common anticoagulant drug. How to effectively reduce vascular calcification induced by warfarin while ensuring its anticoagulant effect is an urgent problem to be solved. Previous studies have found that warfarin enhances the expression and activity of transglutaminase 2 (TG2) in vascular smooth muscle cells (VSMCs), which mediates communication between cells and extracellular matrix (ECM). Matrix vesicles (MVs) are the center of hydroxyapatite crystal precipitation, which is released to ECM and interacts with ECM protein to initiate mineralization and form calcification core. This study observed the role of the warfarin-TG2-MVs axis in vascular calcification by culturing VSMCs in vitro.

METHOD

VSMCs were cultured in normal or osteogenic medium (OM) and stimulated with 10 μm warfarin for 3–14 days. The expressions of SM22α, Runx2, ALP, OPN and OPG were detected by RT-PCR and western blot. Alizarin red and von Kossa staining were performed to evaluate calcification, and calcium content was determined. Meanwhile, the expression and activity of TG2 were detected. Differential centrifugation was used to extract MVs and evaluate their release. Type I collagen was coated in the culture dish to determine the calcification of MV-collagen.

RESULTS

Warfarin stimulation promoted transdifferentiation of VSMCs, and the expression of osteogenic factors Runx2, ALPL and OPN were increased, while the expression of SM22α and calcification inhibitor OPG were decreased. When using OM, the above trend was more obvious. Alizarin red and von Kossa staining were performed when the cells were cultured for 14 days. The results of calcium staining in the warfarin intervention group were all positive. Warfarin promoted the expression and activity of TG2, and it gradually increased with the extension of the intervention time. The same number of cells were cultured for 7 days under different stimuli, and the medium was changed every other day. Then, the supernatant was collected for differential centrifugation. The amount of MVs produced by the warfarin and OM groups was significantly higher than that of other groups, and the ability to mineralize of MVs in type I collagen was increased.

CONCLUSION

Warfarin increased the expression and activity of TG2, promoted the release of MVs from VSMCs, and further cross-linked ECM to aggravate vascular calcification.
MO770: Are There Any Differences in Survival According to the Type of Tunnelled Central Venous Catheters?
Authors: Maria Cases Corona Clara , Gruss Enrique , Cordon Alfredo , Furaz-Czerpak Karina , Patiño Gómez Beatriz , del Mar Andrés Vázquez Maria , Díaz Enamorado Yunayka , Dominguez Torres Patricia , Gallego Valcarce Eduardo , Shabaka Amir , Maria Fernandez Juarez Gema
Published: May 2022

BACKGROUND AND AIMS

An elevated proportion of haemodialysis patients require at some point the utilization of a tunnelled central venous catheter (tCVC) as vascular access. There are several designs for tCVC that differ in the type of material used, the number of lumens, length and tip design. Currently, a scarcity of studies has compared the different types of tCVC. The aim of this study was to analyse whether there were differences in catheter survival between three types of tCVC: symmetrical-tip, step-tip and split-tip catheters.

METHOD

We conducted a prospective observational study that included all incident patients in two haemodialysis centres between 2016 and 2020, with a minimum follow-up of 6 months (until June 2021). The election of tCVC type was performed by the interventional radiologist in a random manner according to available tCVC. We collected demographic data (age, sex, dialysis site), comorbidities (diabetes mellitus, Charlson Index), laboratory values (albumin, haemoglobin, C-reactive protein), dialysis adequacy (KtV, dose of urokinase used for maintaining tCVC patency) and a number of tCVC used.

RESULTS

Table 1 shows the characteristics of the 182 tCVC included in this study, stratified in three groups according to the type of tip, without observing significant differences. We did not find significant differences in catheter survival between the three types of tCVC, neither globally nor after adjusting for other confounding variables. However, catheter survival decreased after the second tCVC independent of the type of tCVC (cumulative incidence: tCVC 1 versus >1:  180 days 7% versus 32%; 360 days 10% versus 34%; 720 days 11% versus 34%, P = 0.001) Catheter survival also decreased in patients >70 years old (cumulative incidence <70 versus >70 years: 360 days 7.6% versus 20%; 720 days 10.8% versus 21.1%, P = 0.035)

CONCLUSION

There are no differences in catheter survival between the three types of tCVC.

The patency of vascular access decreases with age and the number of previously used catheters, being both independent risk factors for catheter dysfunction.
MO807: Tenascin-C is a Promising Marker of High-Turnover Bone Disease and Vascular Calcification in Prevalent Haemodialysis Patients
Authors: El Shinnawy Howayda , Shawky Sahar , Fouad Mohammed , Zaki Abdelmegied Shaimaa
Published: May 2022

BACKGROUND AND AIMS

Tenascin-C is an extracellular matrix glycoprotein associated with high cell turnover, vascular calcification and atherosclerosis. This study determines the frequency of tenascin-C in uncontrolled intact parathyroid hormone (iPTH) and its relation to vascular calcification in prevalent haemodialysis patients.

METHOD

A cross-sectional study included 90 prevalent haemodialysis patients divided into two equal groups: uncontrolled iPTH level >300 pg/mL and controlled iPTH (150–300 pg/mL) groups. Serum tenascin-C was measured by ELISA and vascular calcification was assessed by the Adragao score, by plain X-ray on hands, pelvis and vascular access for all patients.

RESULTS

The prevalence of tenascin-C was 84.4% (38 patients), and vascular calcification was 46.7% (21 patients) in patients with uncontrolled iPTH. Serum tenascin-C can predict high-turnover bone disease (uncontrolled iPTH) at a cutoff value of 7377 ng/mL with AUC 0.794, sensitivity 84.4% and specificity 60%, while predict vascular calcification at a cutoff value of >8859 ng/mL AUC 0.745, sensitivity 72.7%, specificity 72.1%. Tenascin-C was high in patients with uncontrolled iPTH [median (IQR) 637 (4245) ng/mL] compared with patients with controlled iPTH [median (IQR) 211 (143) ng/mL; P-value < .0001]. According to Adragao calcification score, in uncontrolled iPTH, 31.1% (14 patients) had a score 1 and 15.6% (7 patients) had a score 2. All patients with controlled iPTH had a score 0. Patients with vascular calcification had high tenascin-C [median (IQR) 10 697 (53 974) ng/mL] compared with patients without vascular calcification [median (IQR) 7697 (18 000) ng/mL; P-value < .001]. Patients have elevated tenascin-C had 10.3, 3.7 risk to have high-turnover bone disease and vascular calcification [odds ratio (95% confidence interval) 10.3 (3–34.7), 3.7 (1.2–11.1), respectively]. Tenascin-C was positively correlated with iPTH level (r = 0.494; P < .001) in patients with uncontrolled iPTH.

CONCLUSION

Tenascin-C appears to be a sensitive marker for assessment of high-turnover bone disease and vascular calcification in prevalent haemodialysis patients.