bluuebunny/crossref_metadata_2025 huggingface dataset:
MO906DIAGNOSIS OF SARCOPENIA ACCORDING TO THE EWGSOP2 STEPS IN VERY ELDERLY HEMODIALYSIS PATIENTS
Authors: Sánchez-Tocino Maria Luz , Miranda Blanca , Mas Sebastián , De Alba-Peñaranda Ana Maria , Lopez-Gonzalez Antonio , Pereira Monica , Ortiz Alberto , Gonzalez Parra Emilio , Gracia-Iguacel Carolina
Published: May 2021

Background and Aims

Sarcopenia, defined as the loss of muscle mass and strength, is common in patients with chronic kidney disease. The variability of the prevalence of sarcopenia depends in part on the diagnostic criteria applied. In 2019, the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) proposed four steps to diagnose and assess sarcopenia. The concept of sarcopenia is encompassed within the broader concept of frailty.

The aim of this study was to analyse the incidence of sarcopenia in very elderly patients on haemodialysis following the criteria recently established by the European Working Group on Sarcopenia in Older People EWGSOP2. Additionally, to assess the usefulness of the diagnostic algorithm in the very elderly haemodialysis population, and its association with functionally scales related to sarcopenia, such as dependency, frailty, and nutrition.

Method

In a prospective study of 60 patients on chronic hemodialysis aged 75- to 95-years, sarcopenia was assessed according to the 4 EWGSOP2 steps: Find-Assess-Confirm-Severity, using Strength, Assistance walking, Rise from a chair, Climb stairs, and Falls (SARC-F) to find, grip strength by dynamometry (GFD) and sit to stand to sit 5 (STS5) test to assess, appendicular skeletal muscle mass by bioimpedance to confirm and gait speed, the Timed-Up and Go (TUG) test, and the Short Physical Performance Battery (SPPB) for severity. Functionality scales of malnutrition inflammation (MIS), comorbility of Charlson, dependence of Barthel, fragility by FRAIL index2 and Physical Activity Scale for the Elderly (PASE) were conducted.

Results

Sixty patients were involved in the study. Sixty-eight percent (41) were men, with a mean age of 81.85±5.58 years and length of stay in HD 49.88±40.29 months. The sequential four steps resulted in a prevalence of confirmed sarcopenia of 20% and of severe sarcopenia of 20%. Correlation of the different variables defined by the EWGSOP2 with the scales of MIS, Barthel, Frail, Charlson and PASE was analyzed. It is observed that the SARC-F but not BIA correlates with the functionality tests. The GFD is the test that correlates with more variables, both functional and anthropometric. Of the severity measurement scales, the SPPB is the one that correlates with the greatest number of variables.

Conclusion

These findings question the four-step EWGSOP2 assessment for very elderly hemodialysis patients and suggest that 20% had confirmed severe sarcopenia. Functionality scales correlated better with GFD and SPPB.
MO908UNCORRECT NUTRITIONAL MANAGEMENT AND LOW QUALITY OF LIFE IN HEMODIALIZED PATIENTS: MULTICENTRIC STUDY
Authors: Satta Ersilia , Romano Carmine , Della Corte Tersa , Alfarone Carmelo , Gembillo Guido , Gentile Sandro
Published: May 2021

Background and Aims

In patients with kidney impairment, the progression to end-stage renal diseases (ESRD) can lead to a gradual loss of independence with worsening quality of life. Proper nutritional management and daily exercise can help patients live with their condition in a more propositive way.

Method

We performed a multicentric study on the habits of 222 hemodialyzed patients, belonging to 4 different dialysis centers. Through self-administered questionnaires, we collected information about patients attitudes and behavior that affect their daily activities and self-care.

Results

Through the use of the Council for Nutritional Appetite Questionnaire, we assessed that 60,81% of patients had a risk of weight loss of 5% in the next six months (Table 1 Baseline Characteristics). The Malnutrition Inflammation Score indicated that 39,63% had a mild malnutrition and 12,16% a severe malnutrition; the serum albumin was between 3-5 and 3,9 g/dL in 42,79% of patients, 3,0 – 3,4 g/dL in 18,01% of patients, <3 g/dL in 3,15% of the whole cohort. For the bioimpedance analysis (BIA) the Body Cells Mass Index (BCMI) values were indicative in 60% of patients of a normal nutritional status (Figure 1), parameters that remained superimposable in the pre and post-dialysis BIA. The ECM/BCM ratio indicated in pre-dialysis that 27% of patients present a state of dehydration and, on the contrary, 73% an edematous state, vice-versa in the post-dialysis the dehydration status rises to 48% and the edematous state falls to 52% (Figure 2). For the BIA a phase angle of less than 4 ° was found in 18% of patients, a critical value linked to a higher mortality risk. 56% of patients showed a value between 4 ° -5 ° while 26% values between 6 ° and 10 °.

Conclusion

In conclusion, the data from this study show that inappetence and single alterations indicative of risk of malnutrition are frequent in Hemodialysis patients, but a clear diagnosis of malnutrition is relatively rare. A large percentage of patients are overweight, with increased abdominal adiposity but with reduced cell mass and with a protein intake lower than recommended levels. The results underline that malnutrition risk leading to a lower quality of life are still major problems in Hemodialysis patients. Bioimpedance analysis and PhA analysis represents a useful tool in the clinical management of hemodialized patients.
MO778ASSOCIATION OF ADVANCED GLYCATION END PRODUCTS (AGE) AND INDOXYL SULPHATE WITH ARTERIO-VENOUS FISTULA NON-MATURATION
Authors: Singh Mansi , Mahapatra Himansu , Sharma Lokesh , Pursnani Lalit , B Muthukumar , Inamdar Neeraj , Kaur Navjot , Singh Anamika , Krishnan Chandra
Published: May 2021

Background and Aims

The main hindrance in adequate utilization of Arteriovenous fistula (AVF) is its high rates of primary failure. Its etiology is multi factorial and several uremic toxins are under investigation. Here we explore the potential influence of Advanced Glycation End Products (AGE) and Human Indoxyl Sulphate (HIS) on AVF non maturation.

Method

This one year prospective observational study included single stage AVF in consecutive CKD 4 and 5 patients. At baseline, demographic, biochemical (including AGE and HIS levels) and doppler ultrasound of upper limb were done followed by AVF construction. At 12 weeks, AVF was assessed for clinical maturation (usage of fistula with 2 needles for 75% of dialysis sessions during 15 day period); accordingly divided in to matured or non-matured groups. Demographic and biochemical parameters between both groups were compared; ROC and correlation of AGE and HIS were analyzed.

Results

Of 129 AVF, 67.4% were matured and 32.5% non-matured. Overall mean age was 40.9 year, male predominance (77.5%) and more non-matured AVF among diabetes. The mean value of AGE and IS was 0.18 µg/ml and 0.18µg/ml respectively; but difference was non significant between two group. AGE levels were further showing positive correlation with CRP (p 0.01, r 0.21) and venous diameter (p 0.02, r -0.22). There were significant positive correlation between AGE and HIS (p<0.00, r 0.5) but not with other parameters. AUC of AGE and HIS were 0.48 and 0.5 respectively and association could not be demonstrated between all studied parameters and AVF outcome.

Conclusion

Study cohort showed high incidence of primary failure without any association of AGE and HIS with clinical AVF non maturation.
MO782VASCULAR ACCESS IN ELDERLY PATIENTS
Authors: Burgos García Elena , Villegas Andres , Graterol Fredzzia , Soler Majoral Jordi , Cacho Judit , Martinez Lucia , Lleida Manuela , Bonal Jordi
Published: May 2021

Background and Aims

The arteriovenous fistula (AVF) continues to be the first-line vascular access (AV) in the hemodialysis population. However, it is disputed whether the profitability and survival in the elderly patient are the same as in the younger patient. Thus, there are authors who propose the tunnelled catheter as the best option in this group of patients. The objective of this study was to analyze the characteristics of vascular access in incident patients over 80 years of age at our center.

Method

A retrospective analysis was performed included incident hemodialysis patients >80 years between 2017-2020. Epidemiological and vascular access complications related, as well as first permanent vascular access survival were analysed. A Pearson's correlation coefficients were employed to determine the correlation between the exitus and other variables and Regression models of mixed effects of covariance (ANCOVAs) were created to determine the effect of these with the exitus.

Results

Demographic characteristics of forty-four patients included are shown in Table 1. Significant differences in sex and comorbidities (diabetes, ischemic heart disease, peripheral vascular disease and hypertension) were found. A total of 26 patients (62%) had a fistula at the time of beginning hemodialysis, all of them with pre-surgical mapping and monitoring, only 15 (34%) of them being working. The most prevalent type of vascular access (VA) was the left humerus-cephalic (21%). 12 (27%) patients were exitus during the 36 months after the beginning of hemodialysis, with significant differences between groups. The variables catheter, male, and type of VA showed a significant correlation with the exitus (-0.345, -0.347, -0.347 and -0.309 respectively). The multivariate analysis showed a significant association between gender and catheter as vascular access at the beginning of hemodialysis with the exitus (p<0.05) even after being adjusted for age and AVF.

Conclusion

In our population, male sex and catheter at the beginning of hemodialysis have a significant association with exitus. AVF should be considered as the first choice vascular access even in the subgroup of patients over 80 years old
MO783CENTRAL VEIN STENOSIS IN HEMODIALYSIS PATIENTS WITH PAST CENTRAL VEIN MANIPULATION
Authors: Reis Pereira Pedro , Sousa Círia , Silva Natalia , Francisco Jose , Fructuoso Mónica , Morgado Teresa
Published: May 2021

Background and Aims

Central vein stenosis (CVS) is frequently observed in hemodialysis patients. Risk factors for CVS include prior ipsilateral central venous catheterization (CVC) and cardiac rhythm device (CRD) insertions. Though it may have clinical manifestations, CVS is often asymptomatic and, therefore, not diagnosed. The aim of this work was to evaluate the prevalence of CVS in a population of hemodialysis patients, as well as underlying risk factors, clinical manifestations and impact in patients’ vascular access.

Method

We retrospectively evaluated all venous angiographies of prevalent patients in our hemodialysis units from 2013 to 2018. In patients with proved CVS, we evaluated history of prior short term and long term upper ipsilateral CVC and CRD insertions. We also analyzed symptoms associated CVS as well as the rate of loss of vascular access for hemodialysis related to the presence of CVS.

Results

The prevalence of CVS in prevalent patients in hemodialysis during the period of our study (n=209) was 14%. We identified 31 upper CVS in 29 patients undergoing venous angiography. Left brachiocephalic vein was the most commonly affected site (45.1% of cases), followed by the right brachiocephalic vein (19.3%), left subclavian vein (16.1%), right subclavian vein (12.9%) and superior vena cava (6.4%). The majority of patients with CVS (95%) had previous history of ipsilateral CVC (previous short-term CVC in 40%, pervious short term and long-term CVC in 27% and previous long-term CVC in 33%). Loss of vascular access for hemodialysis due do CVS was observed in 26% of patients with CVS.

Conclusion

A significant proportion of patients in hemodialysis presents CVS. The majority of patients with CVS had a previous history of ipsilateral central venous catherization. A significant proportion of patients with CVS had a previous history central venous catherization uniquely with short term CVC, highlighting the importance of the risk of vascular lesion, even during short periods of catherization. The presence of CVS is associated with a significant rate of loss hemodialysis vascular access.
MO784ABDOMINAL AORTIC CALCIFICATIONS AND ARTERIOVENOUS FISTULA CLINICAL OUTCOMES ON HAEMODIALYSIS PATIENTS
Authors: Saii Amira , Salma Toumi , Fendri Beya , Abid Hanen , Lahouimel Rania , Agerbi Ikram , Dammak Najla , Chaker Hanen , Kamoun Khaoula , Yaich Soumaya , Ben hmida Mohamed
Published: May 2021

Background and Aims

Vascular calcification has now been recognized as a major problem in dialysis patients because of its strong influence on the prognosis of this population. Several reports have shown the strong relationship between vascular calcification and clinical outcomes including cardiovascular events and arteriovenous fistula (AVF)survival.

The aim of this study is to evaluate the severity of vascular calcifications in our hemodialysis patients and to determine its impact on the AVF survival.

Method

It is a transversal descriptive and analytical study including chronic haemodialysis patients in our unit of the nephrology department.

A lateral lumbar spine radiograph was taken: the aortic arch calcification(ACC) score (VCS) was calculated according to the score validated by Kauppila and Schousboe. The overall VCS ranged from 0 to 24.

Results

Our study included 55 patients divided into 31 men and 24 women with a sex ratio of 1.29. The mean age was 49.54 ± 12.66 years. The mean duration in HD was 96.16± 73 months. 76.8% of the patients have hypertension, 26.8% are diabetic and 14.3% are smokers. AVF failure was noted in 34 patients (60.7%).

We divided our population in 3 groups: G1:23 patients with a low VCS (41.1%), G2: 15 patients with a moderate VCS (26.8%) and G3: 17 patients with a severe VCS (30.4%).

Patients in G2 and G3 were more frequently diabetics (p=0.05): over 50% of patients in G3 were diabetic and the mean duration in HD was longer: 133 months in G3, 102 months in G2 and 74 months in G1 with a significant difference p=0.03.

We noted that AVF failure was more frequent in patients in G2 and G3 (65.7%) patients) versus patients in G1 (39.13%) with a significant difference (p=0.01)

Conclusion

vascular access dysfunction is one of the leading causes of morbidity and mortality in haemodialysis patients We have demonstrated throw this study the relation between the presence of higher AAC grade and the poor survival of AVF in our patients.

So, an identification of these ACC by a simple lateral lumbar spine radiograph would allow the clinician to implement more rigorous and planned monitoring for such AVFs.
MO786HEPARIN VERSUS SODIUM BICARBONATE CATHETER LOCK SOLUTION: AN ALTERNATIVE LOCK HEMODIALYSIS CATHETER?
Authors: Partipilo Francesca , Detomaso Francesco , Pietanza Stefania , Gernone Giuseppe
Published: May 2021

Background and Aims

Infections and thrombosis of central venous catheter (CVC) in hemodialysis patients are the major causes of catheter loss resulting in hospitalization and increased costs. Interdyalitic catheter lock solutions, usually heparin, avoid these complications. Among the many, sodium bicarbonate has been proved as effective and safe catheter lock solution due to its antimicrobial and antithrombotic properties. The aim of this study was to compare the efficacy of two different CVC lock solution: sodium heparin versus sodium bicarbonate, to prevent catheter–related thrombosis and infection in hemodialysis patients

Method

They were enrolled, in a 12 months case-control study, 17 hemodialysis patients with tunneled hig-flux CVC (femoral or internal jugular). Each patient was evaluated in its common treatment for CVC dysfunction (Qb, CVC that works in reverse branches during the hemodialysis session, use of urokinase or extra lock with sodium heparin or 4% citrate) and infection (WBC count, C reactive protein -CRP, bloodstream culture, exit-site infection -ESI) during standard sodium heparin CVC lock solution (hep-lock), for the first 6 months, and then, during sodium bicarbonate lock solution (10 mEq/10 ml, bic-lock) for following 6 months. aPTT, PLT, Hct and albumin are also montly evaluated. Type and anticoagulant dose during hemodialysis sessions were unchanged over the study as well as any antiplatelet/anticogulant home therapy.

Results

Fifteen patients on 17 completed the study and the main results are reported in table 1. There were no significant differences between patients on demographics and number of catheter days treatments for both study periods. The blood flow was similar in either study phases and stable during the hemodialysis sessions (Qb 225±13 ml/m’ at 2-hours vs 225±15 ml/min at start of dialysis), even the use of reverse branches was similar. Hep-lock showed a lower usage of extra lock drug in comparison with Bic-lock (0,4% vs 3,1%, p<0,05), data confirmed also for Urokinase (1,9% vs 3,4%, p=0,274). None bloodstream are registred while ESI and WBC count show no significant differences between two study periods. No HD catheter was loss during the study due to thrombosis or infection. Finally, Hct, CRP and Albumin was found slightly lower on Bic-lock phase.

Conclusion

There is no CVC ideal lock solution and although sodium bicarbonate is inexpensive and readily avalaible our data shows better CVC performances with sodium heparin.
MO767CENTRAL VEIN STENOSIS: FROM DIAGNOSTICS TO TREATMENT STRATEGY
Authors: Zulkarnaev Aleksei , Stepanov Vadim , Parshina Ekaterina , Novoseltseva Mariya , Fomin Aleksandr , Chursinova Julia , Vatazin Andrey
Published: May 2021

Background and Aims

To analyze the screening and prognostic value of various diagnostic signs of central vein stenosis (CVS).

Method

The retrospective study included 549 patients with AVF/AVG dysfunction. 211 patients were diagnosed with CVS, other patients had lesions of peripheral venous segments. In case of vascular access dysfunction, patients were examined according to the local protocol: ultrasound examination of peripheral (to exclude damage of the peripheral AVF segments) and central veins (at an accessible length) was performed, followed by CT angiography or percutaneous angiography, if necessary.

Results

Among various clinical signs only limb edema and dilated veins on the chest demonstrated high sensitivity. Aneurysmal dilatation of an AVF was more common in peripheral lesions (CVS RR<1). It should be considered that the clinical signs itself are more likely to be associated with the peripheral lesion than CVS (high NPV value) – table 1. “Indirect dialysis signs” also have very low screening efficacy (Se and Sp) and prognostic values – table 2.

Ultrasound signs have low screening accuracy, but high prognostic values. In other words, in the presence of ultrasound signs, patient is likely to have CVS with high probability – table 3.

When comparing the frequency of correct and incorrect classifications for different types of lesion, ultrasound accuracy exceeds the clinical picture for types of lesion 1C and 1D (according to the types of lesion in Society of Interventional Radiology Reporting Standards for Thoracic Central Vein Obstruction, doi: 10.1016/j.jvir.2017.12.013): RR= 3,433 [95% CI 2,074; 6,132], p<0.0001 and RR= 2,538 [95% CI 1,592; 4,265], p<0.0001, respectively, but not for lesion types 2B and 3: RR=1.583 [95% CI 0.935; 2.779], p=0.0883 and RR=1 [95% CI 0.231; 4.325], p >0.9999, respectively. In total, incorrect CVS type classifications is noted in 30.7% of cases when using ultrasound imaging.

CT angiography and percutaneous angiography are almost 100% effective in the diagnosis of CVS. However, CT angiography is not always informative when AVF is functioning and the volume blood flow is high. In turn, percutaneous angiography does not always allow to assess the condition of the veins of the contralateral side. At the same time, correct detection of lesion type is pivotal to determine the future strategy of providing the patient with permanent vascular access. For example, the patient has very little chance to get functional AVF in case of with two-sided subclavian vein stenosis.

Conclusion

The CVS diagnostics should be comprehensive, using different methods for screening, confirming CVS and determining of it type.
MO771A DEDICATED INTERVENTIONAL NEPHROLOGY SERVICE LEADS TO BETTER RENAL SERVICE PROVISION
Authors: Clark Rauri , Ahmed Saeed , Andrews James , Srivastava Shalabh
Published: May 2021

Background and Aims

Interventional Nephrology is a renal procedural sub-speciality that provides procedures the following procedures necessary for the maintenance of dialysis access and renal diagnostics:

In most centres regionally and nationally, these procedures are performed by a mix of nephrologists, radiologists and surgeons. In many centres haemodialysis catheter procedures are performed by nephrologists but without fluoroscopic guidance, with only those procedures which fail to be completed being escalated to interventional radiology. Access to real time imaging improves safety and quality of patient experience by reducing the rate of procedural failure and can the rate of serious complications.

The Sunderland Diagnostic and Interventional Nephrology (SDIN) service was launched in 2018. Briefly, this is a ‘one stop shop’ for all of the above procedures with pre-procedural assessment and post-procedural recovery provided in a dedicated renal day-case area. Procedure lists run Monday to Friday, 52 weeks per year, and are provided by four interventional nephrologists.

Method

Data was collected retrospectively on all activity under the Sunderland Diagnostic and Interventional Nephrology service.

Results

The service has delivered the following benefits:

Conclusion

A dedicated interventional Nephrology service leads to significant benefits for the providing unit and leads to efficiency savings. Most importantly, patients receive safe and efficient care leading to improved experience and in the long term improved clinical outcomes.
MO253A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED DOSE-RANGING STUDY (LUMINA-1 STUDY) TO EVALUATE THE SAFETY AND EFFICACY OF CCX140 IN SUBJECTS WITH FOCAL SEGMENTAL GLOMERULOSCLEROISS (FSGS)*
Authors: Cortazar Frank , Niles John L , Schall Thomas J , Staehr Peter
Published: May 2021

Background and Aims

Primary Focal Segmental Glomerulosclerosis (FSGS) is the most common primary glomerular disease in patients with end stage renal disease in the United States. Current treatment regimens target reduction in proteinuria, but may have limited response or exhibit disease recurrence. CCX140 is an orally-administered selective small molecule inhibitor of the C-C chemokine receptor 2 (CCR2) under investigation for the treatment reduction of proteinuria in patients with FSGS.

The primary objectives of this study were to evaluate the safety and efficacy of CCX140 in patients with FSGS and a urine protein to creatinine ratio (UPCR) of ≥1 g/g. Efficacy was assessed by the change in UPCR.

Method

Forty-six adult patients with primary or genetic FSGS were randomized into a double-blind, placebo-controlled Phase 2 dose-ranging study designed to evaluate the safety and efficacy of CCX140. Changes of urinary protein excretion estimation (UPCR) from baseline to Week 12 were measured in four blinded treatment groups (three active CCX140 doses of 5 mg once daily, 10 mg and 15 mg twice-daily (BID) vs placebo). Starting at Week 12, all subjects including those in the placebo group received the CCX140, 15 mg BID for an additional 12 weeks, and UPCR changes from Week 12 to Week 24 were assessed. There was a 4-week follow-up period from Week 24 to Week 28 where no CCX140 was administered.

Results

In the intent to treat (ITT) analysis of UPCR changes at Week 12 relative to baseline, the 15 mg BID CCX140 group exhibited the greatest reduction of UPCR (median reduction from baseline 0.9 g/g or approximately 30%, and approximately 25% reduction from baseline for the geometric mean), but that did not differ significantly from the placebo group (median reduction from baseline 0.45 g/g; or approximately 22%, and approximately 23% reduction from baseline for the geometric mean). Also, after crossover of the blinded portion of the trial to 15 mg BID active dosing, the previous placebo group did not appear to exhibit an additional reduction of UPCR. CCX140 at all doses was well-tolerated, with no serious adverse events (SAEs) during the blinded trial and a numerically lower rate of treatment-emergent adverse events in the CCX140 treatment groups.

Conclusion

In the study, CCX140 did not demonstrate a therapeutically meaningful reduction in proteinuria relative to the control group after 12 weeks of blinded treatment. The study provides insights into the natural disease progression of patients with primary or genetic FSGS as part of a clinical trial setting.
MO255LONG-TERM MAINTENANCE TREATMENT WITH RITUXIMAB IN ANCA-ASSOCIATED VASCULITIS: A RETROSPECTIVE COHORT STUDY
Authors: Chalkia Aglaia , Thomas Konstantinos , Kourniotis Dimitrios , Panagiotopoulos Alexandros , Alexakou Zoe , Mpora Margarita , Aggelis George , Vasilopoulos Dimitrios , Petras Dimitrios
Published: May 2021

Background and Aims

There is limited guidance and evidence for the ideal duration of maintenance treatment in ANCA-associated vasculitis (AAV) with rituximab (RTX). This study aimed to describe the efficacy and safety of long-term maintenance treatment with RTX, in a cohort of patients with AAV.

Method

Retrospective, descriptive study of 62 patients with AAV. We included 42 patients, who received RTX maintenance treatment in a newly diagnosed or a relapsed disease. We recorded the duration, dosage, and adverse events (infections, infusion-related events, relapses, late onset leukopenia, malignancy and hypogammaglobulinemia).

Results

43 patients (average age 60.33 years, 49% women) received fixed interval dosing with RTX maintenance 1000 mg every 6 months. The most frequent organ involvement (74%) was lung and/or kidney. 33% (14/43) of the patients received RTX maintenance in a relapsed disease. The RTX regimen was followed after induction treatment with rituximab (47%), cyclophosphamide (33%), combination cyclophosphamide and rituximab (14%) or methotrexate/MMF (6%). Median total duration of maintenance treatment was 24 months (range 6-72 months). The most frequent adverse event was serious infections in 23% of the patients, including SARS-CoV-2 in two patients, while four of these patients died. We also recorded: hypogammaglobulinemia in 14%, malignancy in 5% and infusion-related events in 2%. The rate of the major relapses in our cohort during RTX maintenance was quite low at 7% (3/43), the time between 24-60 months, and the rate of the major relapses dependent on the induction treatment was quite the same: cyclophosphamide group vs rituximab group (7 vs 10%, p=0.786).

Conclusion

In our cohort long-term maintenance treatment in AAV with rituximab maintains remission for longer time, with a quiet safety profile. This could suggest that in selected patients, extended periods of rituximab treatment might be safe.
MO261LUPUS NEPHRITIS AND COVID-19 INFECTION
Authors: Valentinova Monova Daniela , Monov Simeon
Published: May 2021

Background and Aims

Covid-19 infection poses a serious challenge for immune-compromised patients with autoimmune systemic diseases. This is likely due to a combination of immune dysfunction, immunosuppressive therapy and excess co-morbidities.

The aim of this study is to describe clinical characteristics of patients with lupus nephritis (LN) and Coronavirus disease 2019 (COVID-19), and to identify baseline variables associated with a severe infection requiring hospitalization.

Method

A telephone survey investigating the impact of COVID-19 on patients with biopsy - proven LN was administered. Data extraction included diagnosis, disease activity status, demographics, occupational exposure, adherence to social distancing advise, therapy, comorbidities, and laboratory tests. Covid-19 was classified as definite diagnosis of Covid-19 disease (presence of symptomatic Covid-19 infection, confirmed by a nasopharyngeal SARS-CoV-2 polymerase chain reaction test). Comparisons between patients with or without hospitalization were performed.

Results

114 patients (median age 34,9 ± 12,4 years) with LN were included in the study. All were on different doses glucocorticoids, 82 were taking hydroxychloroquine and 30 took immunosuppressants. 31 patients (26 women, 5 men) developed symptomatic COVID-19 infection - they have at least one symptom (chest pain, fever, asthenia, chills, cough, sore throat, dyspnea, headache, arthralgia, myalgia, odynophagia, diarrhea, conjunctivitis, hypo-, ageusia, hypo-, anosmia) of COVID-19 and were PCR test positive. These 31 patients prior to their COVID-19 illness were treated with methylprednisolone, 16 - with cyclophosphamide, 8 - with azathioprine, 3 – with hydroxychloroquine. Six patients (4 men, 2 women) required hospitalization - these were more frequently older and with comorbidities (cardio-respiratory illness, hypertension and other) and active LN (3 –class IV LN, 2-class V LN, 1 class III LN and 1 Class II LN, according the 2003 ISN/RPS classification). Adherence to therapy and to social distancing advise was high. The median time from onset of symptoms to hospital admission was 6 (3-11) days. The median length of stay was 12 days (8-20) days. No deaths occurred.

Conclusion

Covid-19 is more frequent in the subgroup of LN patients without therapy with hydroxychloroquine, which might play some protective role against the most harmful manifestations of Covid-19. Male sex, previous lung disease, serum creatinine level, proteinuria, glucocorticoids use > 5 mg/day, were associated to hospitalization of patients with LN.
MO263KLOTHO IS PROTECTIVE IN THE CONTEXT OF ACUTE GLOMERULAR INJURY BUT IS NOT EXPRESSED IN PODOCYTES
Authors: Charrin Emmanuelle , Dabaghie Dina , Mencke Rik , Sen Ilke , Möller-Hackbarth Katja , Zambrano Sonia , Olauson Hannes , Patrakka Jaakko
Published: May 2021

Background and Aims

Podocyte integrity is crucial for the maintenance of glomerular function in health and disease. Numerous studies have reported that Klotho overexpression, or treatment with recombinant Klotho, reduces glomerular and tubular damage in mouse models of renal disease. However, the mechanism(s) of action are not fully understood. Several recent studies have also reported that Klotho is expressed in podocytes, where it protects against various types of injury. These findings conflict with previous studies, which have shown that renal Klotho expression is exclusively confined to proximal and distal tubular cells.

Method

To address this discrepancy and enhance our understanding of the putative glomeruloprotective effects mediated by Klotho, we examined the expression pattern of Klotho in human and mouse kidney by several different methods, and explored its protective effects by overexpressing full-length human Klotho directly in podocytes or in a distant organ (i.e. liver).

Results

Data at the mRNA and protein levels all converged towards an absence or very low expression of Klotho in podocytes. The generation of a podocyte-specific Klotho knockout mouse further demonstrated that its deletion did not affect glomerular structure or function. Moreover, Klotho deficiency did not worsen glomerular injury in an experimental model of glomerulonephritis (anti-GBM). However, when Klotho was overexpressed in hepatocytes (Alb-cre;hKlothofl/+ - Alb-hKL), serum Klotho increased drastically with no changes in Fgf23 or phosphate metabolism. In mice challenged with anti-GBM, renal histology and ultrastructure of the filtration barrier was less severely affected in Alb-hKL compared to WT mice. There were also significantly less albuminuria, podocyte loss and interstitial fibrosis in Alb-hKL mice compared to their WT littermates. In contrast, mice which overexpressed Klotho in podocytes (Pod-hKL) were not protected from renal injury.

Conclusion

Taken together, these results strongly suggest that Klotho is not expressed in any substantial amounts in human or mouse podocytes, and that membrane-bound Klotho does not play a role in podocyte biology. Importantly, our results confirm a beneficial role for soluble Klotho in protecting podocytes against injury, and in maintaining glomerular integrity and function.
MO264COMPLEMENT PATHWAY MIGHT HAVE A ROLE IN FOCAL SEGMENTAL GLOMERULOSCLEROSIS: A RETROSPECTIVE SINGLE CENTER STUDY OF 15 YEARS
Authors: Eren Sadioğlu Rezzan , Kiremitçi Saba , Aktar Merve , Şengül Şule , Gokmen Derya , Akturk Serkan , Keven Kenan , Nergizoglu Gökhan , Ertürk Şehsuvar , Ateş Kenan , Ensari Arzu , Kutlay Sim
Published: May 2021

Background and Aims

The role of complement in focal segmental glomerulosclerosis (FSGS) is an area of interest and C4d staining could indicate complement related renal damage. We investigated detailed C4d staining properties in native kidney biopsies and possible relation to clinical features.

Method

We retrospectively evaluated the renal biopsies of 114 patients diagnosed with FSGS within last 15 years. C4d expressions examined in glomeruli (mesangial and/or capillary wall, vascular pole, sclerotic areas), tubular region (basement membrane, adsorbtion droplet) and vascular areas (arteriols and arteries) via immunohistochemistry. A novel glomerular C4d score (G-C4d-S) was achieved on the basis of the localization, pattern, extent and intensity of the C4d expression (min-max, 0-13).

Results

Of the patients (56 females, mean age 43±14 years) with a median follow-up time of 35±3 months, mean proteinuria, eGFR, and albumin level were 4984 mg/day, 72.2 ml/min/1.73m2, 3.56 g/dL, respectively. Median G-C4d-S was 6 (IQR, 4-7) and it was negatively correlated with serum creatinine at diagnosis (r=-0.21, p=0.02). Glomerular staining (both focal and diffuse, higher than moderate in intensity) was positive in 78 (68.4%) of the patients. C4d on glomerular sclerotic area was positive in 43 (37%) patients and it was associated with lower eGFR at diagnosis.

Forty five patients achieved remission during the follow-up. Among the pathological features only glomerular C4d staining was associated to remission (p=0.02). There were 20 (18.7%) patients who need renal replacement theraphy (RRT) and 7 deaths (6.1%) at the end of the cohort. Lower rate of C4d staining on tubular adsorption droplets and arteriols/arteries were found to be associated need for RRT (p=0.013, p=0.012, respectively). There were no significant relationship between mortality and C4d staining features.

Conclusion

In conclusion, we noted that significant number of patients had positivie C4d on glomeruli, arteiroles and tubular area. We indicated that C4d staining at diagnosis could help to distinguish active glomerulonephritis. Additionally, it seems to be essential to examine non-glomerular area of native kidney biopsies, as well.
MO266URINARY TRANSFERRIN AND IGG EXCRETIONS PREDICT TUBULOINTERSTITIAL LESIONS IN PATIENTS WITH IGA NEPHROPATHY
Authors: Elena Saganova , Galkina Olga , Sipovskii Vasiliy , Smirnov Alexei
Published: May 2021

Background and Aims

IgA nephropathy (IgAN) is the most common form of primary glomerulonephritis worldwide and is a frequent cause of end-stage renal disease. The best predictors of progression are histologic parameters. Nevertheless, there is a pressing need to identify suitable noninvasive biomarkers in IgAN, to aid with diagnosis, treatment decisions, and prediction of the disease progression.

Our aim was to assess diagnostic value of urinary excretions of transferrin and IgG in prediction of morphological lesions in patients with IgAN.

Method

37 patients [19 female, age Me 33 (25; 48) years] with biopsy proven IgAN and without acute kidney injury, infectious diseases, severe heart failure, respiratory insufficiency, cancer were included in the study. 24-hour urinary excretions of transferrin (uTr), IgG (uIgG) were measured by immunoturbidimetric method (Furuno CA-90, Furuno Electric Co., Ltd., Japan). Tubulointerstitial fibrosis (TIF) and tubular atrophy (TA) were assessed semi-quantitatively (0-lesions absent; 1-mild focal tubular and interstitial lesions; 2-moderate tubular and interstitial lesions; 3-diffuse tubular and interstitial lesions). All patients consistently were separated into two groups according to the degree of each morphological lesion (TIF or TA): “mild” (TIF or TA grade 0 or 1) and “severe” (TIF/TA grade 2-3).

Results

uTr, uIgG positively correlated (p<0,05) with TIF (r=0,38, r=0,43) and TA (r=0,38, r=0,45), respectively. We did not find correlations between uTr, uIgG and glomerulosclerosis.

Using ROC-analysis all patients were separated in two groups using uTr or uIgG according to the degree of morphological lesions (“mild” or “severe) (Table 1,2; Figure 1).

According to the results of ROC-analysis we also found that all cut-off values of uTr, uIgG corresponded to the level of urinary protein excretion not more than 1,25 g/24hour.

Conclusion

Our results show that uTr and uIgG can be used as markers of early tubulointerstitial lesions in patients with IgA nephropathy with mild protein excretion.
MO270PROGNOSTIC ROLE OF ANTI-PHOSPHOLIPASE A2 RECEPTOR ANTIBODY NEGATIVIZATION AT THREE MONTHS IN MEMBRANOUS NEPHROPATHY
Authors: Stefan Gabriel , Stancu Simona , Popa Otilia , Zugravu Adrian Dorin , Petre Nicoleta , Mircescu Gabriel
Published: May 2021

Background and Aims

The predictive value of anti-phospholipase A2 receptor antibody (anti-PLA2R ab) levels at three-months from diagnosis in patients with membranous nephropathy (MN) is not proven.

Method

We retrospectively examined the renal outcome on 1 August 2020 of 59 adult patients (age 54 (44, 68) years, 69% male, serum creatinine 1.0 (0.9, 1.3) mg/dL) who were diagnosed with MN by kidney biopsy and had positive serum anti-PLA2R ab during 2016-2019.

The outcomes were: kidney survival defined as renal replacement therapy (RRT) initiation; partial (proteinuria 0.5 to 3.5g/24h) or complete remission (proteinuria <0.5g/24h and serum albumin ≥3.5g/dL) - whichever came first.

Variables related to renal outcome were further evaluated in univariate and multivariate Cox proportional hazard (CPH) models.

Results

Forty (69%) patients had negative anti-PLA2R ab at 3 months; there were no differences regarding age, serum creatinine, serum albumin, proteinuria and treatment when compared to the group with positive ab at 3 months.

Fifty-seven (97%) patients received immunosuppressive treatment, cyclophosphamide-based regimens were the most frequent (87%), followed by cyclosporine (10%).

Overall, 64% of the patients reached a form of remission. Cumulative remission rates were 34% after 6 months, 54% after 12 months, 68% after 18 months and 73% after 24 months. Only five patients (9%) relapsed during the study period. Median time to cumulative remission was 12.0 (95%CI 8.2, 15.7) months.

In the CPH models, negativization of the anti-PLA2R antibodies at three months was an independent predictor for remission, however lower serum albumin was also retained as a risk factor for absence of remission (Table 1).

During the follow up period 6 (10%) patients died. Cardiovascular disease and infections were the main causes of death. A total of 5 (9%) patients started RRT during the study period. The mean renal survival time was 50.3 (95%CI 46.5, 54.0) months. We found no difference in renal survival regarding anti-PLA2R Ab titer or negativization.

Conclusion

Negativization of anti-PLA2R antibodies in the first three months from diagnosis was a predictor for remission in patients with membranous nephropathy.
MO272CLINICOPATHOLOGICAL CORRELATION OF APRIL AND BAFF IN IG A NEPHROPATHY- A SINGLE CENTER LONGITUDINAL OBSERVATIONAL STUDY
Authors: Gopal Anjana , Gracious Noble
Published: May 2021

Background and Aims

Aberrantly glycosylated IgA1 molecules are important in the pathogenesis of IgA nephropathy. A proliferation-inducing ligand (APRIL) and B-cell activating factor (BAFF) are cytokines involved in immunoglobulin class switching and production of galactose deficient IgA1(Gd IgA1). We aimed to study the association of serum levels of APRIL and BAFF with the clinical severity and pathological grading of IgA nephropathy (IgAN) and to assess the strength of the association by studying the clinicopathological correlation.

Method

The research study was conducted as a single-center longitudinal observational study. The study subjects were recruited based on the pathological diagnosis of primary IgA nephropathy. The plasma levels of APRIL, BAFF and Gd IgA1 were estimated using enzyme-linked immunosorbent assay (ELISA). All the study subjects were followed up for one year to study the renal outcome.

Results

In our study group of thirty-eight patients, the median estimated glomerular filtration rate(eGFR) was 33.9(15.9,79.4) ml/minute/1.73m2. The median levels of the cytokines APRIL and BAFF were 170.81(82.45, 550.61) ng/L and 6.66(3.39,16.33) ng/ml respectively. The baseline characteristics of the study group is given in table 1. APRIL levels had significant positive correlation with Gd IgA1 levels (correlation coefficient 0.556, p=0.003) in patients with IgAN. We also observed that patients with elevated APRIL levels had elevated BAFF levels also (correlation coefficient 0.657, p <0.001). Patients who had crescents, mesangial hypercellularity and endocapillary proliferation in biopsy had elevated APRIL and BAFF levels whereas patients with segmental sclerosis and tubular atrophy had low levels of APRIL(Table 2). However, the levels of APRIL and BAFF did not show any significant correlation with eGFR and proteinuria at time of presentation. At the end of one year, 12(31.5%) patients reached end stage renal disease (ESRD) and these patients had lower levels of APRIL, BAFF, and Gd IgA1. It was also seen that eighty-three percent of those who reached ESRD had chronic changes in biopsy like tubular atrophy and interstitial fibrosis(p=0.05). Hence the severity of tubulointerstitial fibrosis in histology correlated well with progression to end stage renal disease as seen in most glomerular diseases. But we did not find any association between APRIL, BAFF, and Gd IgA1 levels and the decline in eGFR over one year.

Conclusion

We conclude that levels of APRIL and BAFF are associated with elevated levels of Gd IgA1 in patients with IgAN and had a significant association with proliferative lesions in renal biopsy. But these cytokines levels did not have any association with the eGFR at time of presentation nor decline in eGFR over one year.
MO273A NOVEL APPROACH TO ASSESS THE DEMOGRAPHIC AND CLINICAL CHARACTERISTICS OF IMMUNOGLOBULIN A NEPHROPATHY (IGAN) PATIENTS IN A US REAL-WORLD SETTING
Authors: Przybysz Raymond , Mehta Rina , Rovira Tomas Gisela , Aldworth Carolina , Doherty Jim , Studer Rachel
Published: May 2021

Background and Aims

Immunoglobulin A nephropathy (IgAN) is a chronic glomerular disease that affects approximately 100,000-200,000 people in the US. Approximately 15-40% of IgAN patients will eventually progress to end stage kidney disease (ESKD) within 10-20 years of diagnosis, and there is currently no targeted therapy for this disease. Decreased kidney function, persistent proteinuria and hypertension are some of the clinical manifestations of IgAN, and with demographic aspects (e.g. ethnicity) are considered as predictors of disease progression. The aim of this study is to better understand the demographic and clinical characteristics of IgAN patients in the US identified via physician notes.

Method

This is a descriptive, retrospective study of adult (≥ 18 years) IgAN patients in Optum® Electronic Health Records (EHRs), between January 2007 and December 2019. Optum® EHRs contain de-identified clinical and medical administrative data from 96 million people in 50 states that come from more than 140,000 providers at 740 hospitals and over 7,000 clinics. Identification of IgAN patients is challenging because there are no specific ICD codes for this disease so we used natural language processing of physician notes and chose patients with at least two IgAN records with the first one considered to be the index date, and no negative mention, as well as a biopsy procedure. Here, we present the baseline demographic and clinical characteristics of the identified patients up to 12 months before and at the index date.

Results

A total of 1803 patients with a biopsy record (22% of all patients with at least two IgAN records in their EHRs in our study) were included in this analysis; results are presented in Table 1. The mean age was 48 years, and the majority of patients were male (60.9%) and white (75.7%). Proteinuria levels of ≥1 g/day were found in 34% of patients. The mean eGFR was 45 ml/min/1.73m2 and 21.6% of patients had severe deterioration of kidney function (eGFR <15). The mean creatinine level was 3 mg/dL. Pain, edema and fatigue/tiredness were reported in 39.6%, 18.1% and 13.4% of patients, respectively. Hypertension was reported in 73% of patients. Based on the ICD 9 (585.6) and ICD-10 (N18.6) codes for diagnosis, 17.5% of patients had ESKD in our study.

Conclusion

In our cohort, a significant proportion of patients were found to have high proteinuria levels and severe deterioration of kidney function or ESKD. Moreover, edema and fatigue were recorded for a noticeable proportion of patients. In addition to the commonly reported symptoms, our study also found that pain was reported in a high proportion of patients. These findings highlight the clinical and symptom burden to patients with IgAN, suggesting that future targeted interventions are needed to reduce the burden and delay the progression of this disease.
MO274EVALUATION OF SERUM C3 LEVELS AND C3 IMMUNOFLUORESCENCE IN PATIENTS WITH ANCA-ASSOCIATED VASCULITIS: A RETROSPECTIVE COHORT STUDY
Authors: Chalkia Aglaia , Thomas Konstantinos , Giannou Panagiota , Panagiotopoulos Alexandros , Hadziyannis Emilia , Kapota Athanasia , Gakiopoulou Harikleia , Vasilopoulos Dimitrios , Petras Dimitrios
Published: May 2021

Background and Aims

The role of complement activation, mainly alternative system, has been recently proposed to play an important role in the pathogenesis of ANCA associated vasculitis (AAV). Real life data assessing its predictive role in renal outcomes are limited. In this study, we evaluated the value of serum and kidney deposited C3 in predicting renal outcomes in patients with AAV.

Method

In this retrospective study, patients with AAV were categorized according to their baseline serum C3 levels as hypo- or normo-complementemic and to those with positive or negative kidney biopsy immunofluorescence (IF) for C3. Clinical, serologic, treatment and histopathologic characteristics, as well as prognosis between the 2 groups were compared.

Results:

Forty-seven patients (51% men) were enrolled with a mean age at diagnosis of 65 years and were followed up for a median period of 56 months. At baseline, 23% (11/47) of the patients were hypocomplementemic (C3 <75 mg/dL). These patients were older (74 vs. 65 years,p=0.013), had higher creatinine levels (4.9 vs. 2.2 mg/dL, p=0.006), were more often hemodialysis dependent (64% vs. 19%, p=0.009) and progressed more often to ESRD (55% vs .11%,p=0.01) compared to normo-complementemic patients (n=36). On multivariate analysis, serum Cr at diagnosis (HR=16.8, 95%CI: 1.354-208.62,p=0.028) and low serum C3 (HR=2.492; 95% CI: 1.537-11.567,p=0.044) were independent predictors for ESRD. Among 25 patients with kidney biopsy data, those with positive IF staining for C3 (56%, n=14) had more often a mixed histological pattern (72% vs. 27%,p=0.033), low serum C3 levels (42% vs. 18%,p<0.001) and serious infections during follow-up (57% vs. 18%,p=0.047) compared to those with negative (n=11) IF staining.

Conclusion

Low serum C3 levels at diagnosis may be an independent prognostic factor for ESRD progression in patients with AAV. This should be taken into account in therapeutic and monitoring strategies.