bluuebunny/crossref_metadata_2025 huggingface dataset:
P1781CONVERSION TO SIROLIMUS IN ADVANCED STAGES OF CHRONIC ALLOGRAFT NEPHROPATHY. A RANDOMIZED CLINICAL TRIAL
Authors: Ghafari Ali , Ghafari Negar
Published: June 2020

Background and Aims

Some studies have shown that proteinuria more than 800 mg per day and glomerular filtration rate (GFR) less than 40 ml/min are the most important relative contraindications for mTOR inhibitors prescription. There is no pathophysiologic reason to put aside mTOR inhibitors in more advanced stages of chronic allograft nephropathy(CAN). To clarify the safety of conversion to mTOR inhibitors in more advanced stages of CAN we conduct a randomized clinical trial

Method

Among 1911 renal transplant recipients which was performed from May 1989 to May 2016, patients (pts) with CAN included to the study. CAN was defined by pathology results and rule out of other causes of renal dysfunction and GFR less than 60 ml/min. pts with recent acute rejection, chronic Ab mediated rejection, active viral infection, malignancy, advanced cardiac, liver and respiratory diseases, obstructive uropathy and non-adherence were excluded from the study. After exclusion there were 211 pts with CAN. Among CAN pts 112 pts have GFR less than 40 ml/min. These patients were assigned in two group randomly. Group 1 continued their immunosuppression which consists of mycophenolate mofetil/myfortic, Cyclosporin A /Tacrolimus and prednisolone. Group B which received Sirolimus 2 mg daily instead of CyclosporinA / tacrolimus. All pts followed for 18 months. allograft function and pts morbidity and mortality were monitored every two months. results were recorded in clinic sheets and were analyzed using SPss version 22

Results

G1 consist of 53 and G2 59 pts. There were no differences in two group in respect to sex (M/F was 0.89 and 0.84 in G1 and G2 respectively), and age (mean age was 41 6 9.5 and 43 6 8.23 in G1 and G2 respectively). there were no differences in admission rate for medical reasons (0.43 and 0.39 admission per pts per year in G1 and G2 respectively p=0.23). There was no difference between two group in respect to cardiovascular events (0.23 and 0.27 events per pts per year in G1 and G2 respectively p=0.31). The average trough level of SRL was 8.38± 3.12 ng/mL at 18 months. At 18 months, the incidence of acute rejection was not higher in G2 (21% vs. 18.8 %, p = 0.21) and renal function was superior in patients converted to SRL (eGFR 32.3 vs. 23.4 mL/min/ 1.73 m2, p = 0.019) compared to those maintained on CsA/TAC. There were no significant differences in pts survival (one death in each group) Graft loss was higher in G1( 5 versus 2 at 18 months p= 0.014). there were no significant differences in respect to liver, respiratory, GI, hematologic and infectious complications. pts in G2 group had lower BP and uric acid levels.

Conclusion

Conversion to mTOR inhibitors in more advanced stages of CAN is safe and has beneficial effect on renal allograft function with no more side effect.
P1786THE HIGHWAY TO KIDNEY TRANSPLANTATION
Authors: Scheuter-van Oers Daènne , Kooij van Ton , Schelfhout Renske , Dorpel van den René
Published: June 2020

Background and Aims

Close cooperation between nephrologist, nurse coördinator and social workers in a large non academic hospital.

By timely starting the process of education and examinations we have increased the possibilities of pre-emptive transplantation

Method

When a patiënt needs to be informed about renal replacement therapy, the digital program is used by the nephrologist to inform all necessary disciplines involved. They each will make an appointment within the given time slot with te patient. At first the social worker start the education process, preferably, in the home situation. General information about the procedures and actions to be taken in the coming period, is given to the patient and his family/friends. They support patients in making difficult dicisions. Secondly, the nurse coordinator in the process, gives information about all options in renal transplantation and gives an explanation about the test procedures which are necessary to decide if patients are able te receive a kidney and donors are appropriate candidates. In case of availability of a potential donor, information is directly given about living donation and the procedure can directly be started. The nurse coordinator ensures that the patient and potential donor complete all required tests in the shortest time possible in their own hospital.

The close cooperation consists of daily deliberation between all disciplines and quickly changing the process of a patient or donor when needed. The progress is reported in the digital file and everyone involved will be informed.

Results

From 2013 until 2020

516 patients entered the program. 575 donors ( for 348 recipients) entered the program. 191 couples have been approved ans presented for transplantation of which 87 couples have been transplanted, 61 couples have been put on hold because of a stabilised kidney function. 40 couples are still in the work up program.

44 recipients were not transplantable due to medical/psychological reasons.

The median work up time of the procedure of the recipients was 260 days from start of the process to transfer tot he transplant centre. (2017) Various patient/medical retarding factors are discribed.

The median work up time fort he donors was 191 days (2017) days from start of the process to transfer tot the transplant centre. Various donor/medical retarding factors are discribed.

Conclusion

Patients and family are well informed about the treatment options, with a special attention for kidney transplantation. The efficient work up program in the patients treating hospital, results in a significant improvement of the possibility of pre-emptive renal transplantation, or otherwise, patients are earlier registered on the waiting list.
P1787DESENSITIZATION IN LIVE KIDNEY DONOR RECIPIENTS PROVIDES GOOD OUTCOME AT MID-TERM FOLLOW-UP
Authors: APAYDIN SUHEYLA , KASAPOGLU UMUT , AKBAY FATIH GOKHAN , Ozdemir Kayalar Arzu , KUDU AYSEGUL , Dikec Mehmet , DEGER GUNDEN , TOPRAK ZEKI , CARIN MAHMUT
Published: June 2020

Background and Aims

The recipients who have antibodies againts to donors’ HLA (Anti HLA- DSA) carrie a huge risk for allograf (AG) losing. In current study, it was retrospectively evaluated whether the live donor kidney recipients (LDKRs) under desensitization (DS) were exposed to more AG loss, lower AG survival and more complications.

Method

In 17 of 269 LDKRs had high anti-HLA DSA were found prior to kidney transplantation (KTX). DS was performed with plasmapheresis (PF) and rituximab (RTX) before KTX. In order to determine the risks of DS, LDKRs who had not PF for any reason, were admitted immediately before and after those with LDKRs under DS were used as controls (n: 31). Immucor™ luminex method was used for detecting the anti HLA DSA. DS was performed to the Rs who had more than 5000 MFI DSA against to at least one donor HLA locus with double check. Non-parametric Fisher’s exact test was used for statistical analysis because of distribution of our patients was heterogeneous.

Results

In 15 Rs had DSA more than 2 HLA loci (MFI range: 5880-21712), remaining 2 Rs had one HLA locus DSA (9959-7762). Mean PF number was of 7 before TX, while 3 after TX. RTX was used in 9 Rs (53%) before TX. KTX performed when anti DSA MFI below 2000 under triple immunosuppression plus anti-thymocitic globulin (ATG) induction therapy. In 4 Rs (13%) had DSA below 5000 MFI among controls (Cs). More female Rs (88% vs. 19%, p<001) were in Rs under DS. ATG was used in 65 % of Cs. Comparison of the complications between Rs under DS and Cs, rate of rejection (35% vs. 19%, respectively, p>0.05), rate of indication biopsy (24 % vs 16 %, p>0.05), rate of CNI toxicity (5.5% vs. 6.5%, p>0.05) were indifferent. During whole follow-up period, creatinine levels and eGFR were compatible at both groups. Urinary infections were more frequent in Rs under DS (53% vs 6.5%, p<0.001) while the rate of viral infections were same. Also, late AG rejection were found in only 2 Rs under DS. Loss of AG and mortality were not seen in Rs under DS. Allograft survival for 3 years were found same (100% vs 91.2%, respectively) in groups.

Conclusion

Although our results belong to a single center and also a small group, desensitization before kidney transplantation for high risk kidney recipients are seem to be useful, effective and successful procedure.
P1792SUCCESSFUL TRANSPLANTATION OF STEM CELLS AND KIDNEY IN REFRACTORY LUPUS NEPHRITIS: REMOTE OUTCOMES
Authors: Demin Aleksandr , Demina Larisa
Published: June 2020

Background and Aims

Lupus nephritis is a common part of systemic lupus erythematosus (SLE), severe autoimmune disease that affects multiple organ systems and associated with pure prognosis. Patients with lupus nephritis who experience persisted disease activity despite conventional immunosuppression are at high risk of early death. Re-setting of the immune system and self-tolerance by high-dose immunosuppressive therapy with autologous stem cell transplantation (ASCT) is a new approach in the treatment of refractory SLE. Remote outcomes of this method and effectiveness relapse treatment are still unclear and were the aims of this study.

Method

We report a sick woman 39 years old, with refractory severe lupus nephritis. Standard therapy was ineffective, SLEDAI score remains 22 so patient was underwent high dose immunosuppressive therapy with ASCT and included in European Group for Blood and Marrow Transplantation European League against Rheumatism (EBMT/EULAR) registry on 53 pts who received ASCT for SLE between 1996 and 2005. Ethical approval was obtained for this study from Cambridge University Hospital Ethics Committee.

Results

The ASCT induced complete clinical and serological remission (SLEDAI score was 0) for 3 years. Than relapse with nephritic syndrome and anti-dsDNA positivity occurred and caused renal failure, creatinine clearance decreased to 21. Despite therapy including prednisolone, 45 mg daily, and mycophenolate mofetil, 2000 mg daily, disease activity persisted, creatinine clearance remained decreasing and 3 years later became 15 ml/min. During 1 year patient was on regular hemodialysis, then renal transplantation performed. Now, follow up is 15 years after ASCT and 8 years after kidney transplantation. Patient received a standard post-transplant immunosuppression with prednisolone, 5 mg daily, tacrolimus, 2.5 mg daily, and azathioprine, 100 mg daily, and her conditions remains stable, she has functioning renal allograft, SLEDAI score is 2 (anti-dsDNA positivity in low titer).

Conclusion

We present the successful remote outcomes of first case of immunoablation and double transplantation of autologous stem cells and allogeneic kidney in severe refractory to conventional immunosuppression SLE with lupus nephritis.
P1801RISK FACTORS FOR URINARY TRACT INFECTION CAUSED BY EXTENDED-SPECTRUM BETA-LACTAMASE GRAM NEGATIVE BACTERIA IN INFANT
Authors: Lee Juyoung , Kim Dong Hyun , Park Ji Young , Lee Hyunju , Ahn Yo Han
Published: June 2020

Background and Aims

Community-acquired extended-spectrum beta-lactamase (ESBL) producing bacterial infections are an evolving public health problem. Urinary tract infections (UTIs) due to ESBL-producing bacteria are increasing even in infants rarely exposed to antibiotic. We aimed to identify risk factors for UTI caused by ESBL-positive bacteria in infants.

Method

We retrospectively analyzed the medical records of hospitalized infants with first episode of UTI from March 2018 to August 2019. Data includes demographic characteristics, birth history, previous use of antibiotic, febrile event, urinalysis results, and urine isolated organisms and their ESBL status. Multivariate regression analysis was used to quantify independent risks associated with ESBL-positive UTI.

Results

UTIs were diagnosed in 266 patients at median age of 3.6 (interquartile range (IQR) 2.3-5.4) months. Sixty-two (30.4%) patients were diagnosed with UTI caused by ESBL-producing bacteria. When we divided patients according to ESBL status, there was no difference in gender, age, birth history, milk type, and use of postpartum care center. Maternal use of antibiotic during pregnancy and previous antibiotic exposure to patients were higher in ESBL-positive group than in ESBL-negative group (32.3% vs. 10.3%, P <0.001 and 22.6% vs. 12.3%, P =0.044, respectively). Klebsiella species was more frequently identified in ESBL-positive group than in ESBL-negative group (19.4% vs. 4.9%, P =0.002). In multivariate analysis, maternal use of antibiotic during pregnancy (odds ratio (OR), 3.817; 95% confidence interval (CI) 1.812-8.040, P <0.001), previous antibiotic exposure to patients (OR 2.418; 95% CI 1.071-5.461, P =0.034), and Klebsiella species as a causative organism (OR 6.222; 95% CI 2.396-16.158, P <0.001) were associated with ESBL positivity. In comparison of clinical courses of patients, ESBL-positive group showed severe leukocytosis (WBC 16,795 (IQR 12,210-20,270)/μL vs. WBC 14,620 (IQR 12,000-18,330)/μL, P =0.04), and stayed longer in hospital than ESBL-negative group (7.0 (IQR 5.5-8.5) days vs. 4.5 (IQR 3.7-5.1) days, P <0.001).

Conclusion

In this study, high rate of ESBL positivity was detected in infantile UTI. Antibiotics exposure on both patients and mothers was associated with UTI caused by ESBL producing bacteria. Identification of underlying risk factors could improve treatment and preventive strategies.
P1812DOES THE TOTAL KIDNEY VOLUME REFLECT ALPORT SYNDROME PROGRESSION?
Authors: AKSENOVA MARINA , Konkova Natalia , Lepaeva Tatjana , Nikishina Tatjana , Piruzeeva Oxana , Dobrynina Marina , Chumak Olga
Published: June 2020

Background and Aims

The kidney volume can reflect kidney function and predict renal disease progression. The aim of the study was to define the clinical significance of kidney volume in children with Alport syndrome (AS).

Method

The medical records were obtained from 86 children (age Me 8(5;11) years; 50M/36F) with genetically (n=78) and morphologically (n=8) confirmed AS; follow-up Me 4(2;6) years. Albuminuria (Alb), proteinuria (Pr), nephrotic proteinuria (nPr) and decreased eGFR were defined as urine Alb>30 mg/gr Cr, Pr≥100 mg/m2/day, Pr≥960 mg/m2/day and eGFR<90 ml/min/1,73m2, respectively. The Body Superficial Area Related Total Kidney Volume (BSARTKV) was calculated as relation of US kidney volume to BSA: BSARTKV[ml/m2]=(L*W*D*π/6)/BSA and compared with normal volume range (Th.Scholbach, D.Weitzel, 2012).

Results

The renal volume ≥95‰ was revealed in ½ and ¾ of children at initial and last evaluation, respectively (0.51 vs 0.76, p>0.05); two boys (q=0.02) with CKD stage 4 had a BSARTKV ≤10‰ at the last presentation. BSARTKV correlated with age (r=0.3, p<0.05), mean blood pressure percentile (r=-0,22, p<0,05), Alb (r=0.25, p<0.05), Pr (r=0.4, p<0,001) and eGFR (r=0.23, p<0.05). No correlation was found between BSARTKV and birth weight and gender. Each 1SD (23.5 ml/m2) increase in BSARTKV was related with higher eGFR: OR=6.7 (95%CI 3.51;8.69, p<0,001). The children with nPr and eGFR>35 ml/min/1,73m2 had enlarged kidneys: OR=30.75(95%CI 2.56;369, p<0,001); the patients with eGFR≤35 ml/min/1,73m2 had small BSARTKV: OR=167 (95%CI 10.4;2681.3, p<0,0001).

Conclusion

The kidney volume reflects the progression of nephropathy in AS. Probably, an increased renal mass compensates decreased glomerular function, whereas small kidney volume represents the loss of function of most nephrons.
P1815LONG-TERM OUTCOME OF BLADDER DYSFUNCTION IN CHILDREN
Authors: Kari Jameela , Banakhar, Mai , Khashoggi Khalid , El-Desoky Sherif
Published: June 2020

Background and Aims

Bladder dysfunction is an important cause of chronic kidney disease (CKD) due to neurogenic causes such as a spinal lesion (SL), Hinman's syndrome, or non-neurogenic neurogenic bladder (NNNB), and valve bladder syndrome (VBS). In this study, we evaluated the outcomes of neurogenic bladder caused by different etiologies.

Method

Single-center retrospective study of children with neurogenic bladder (NB) over 13 years (2005-2017).

Results

Totally, 199 children (134 boys, 67.3%) were included and divided into three groups: Group 1 (75, NNNB), Group 2 (64, SL), and Group 3 (60, VBS). Urodynamic examination revealed impaired bladder capacity in 49 children (57.6%), atonic bladder in 1 child (1.1%), and normal bladder compliance in 35 children (41.1%). Additionally, 113 children (56.8%) experienced clean intermittent catheterization (CIC). A significant improvement in the mean estimated glomerular filtration rate and CKD stages was observed among the three studied groups, but the NNNB group showed the least improvement. Children diagnosed and treated during their first year of life had better outcomes than those who presented at a later age. CIC without the need for surgical intervention was associated with improved renal function. Pyelonephritis and hydronephrosis had significant negative impacts on kidney function

Conclusion

Early diagnosis and management of NB in infancy are associated with better outcome and preservation of renal function. CIC is associated with better preservation of kidney function, while vesicostomy is associated with a worse outcome. Children with NB caused by SL experienced the best kidney function preservation, while those with VBS experienced the worst.
P1819PEDIATRIC KIDNEY TRANSPLANTATION IN INDIA :IMPROVING OUTCOMES
Authors: Gulati Sanjeev , Sinha Rajiv , Saxena Vishal , Jain Alok , Sharma Amit , Kalra Deepak , Gill Harinder Singh
Published: June 2020

Background and Aims

Renal transplantation is the modality of the choice for the management of children with end stage renal disease. It offers better quality of life, though associated with risk of rejection and infection. This study was conducted

Method

This is a retrospective review of patients <= 18 years of age who underwent renal transplant at Fortis hospitals, India from 2006 to 2019.The choice of induction agent was based on the discretion of the treating team and the socioeconomic tests of the patient, All these children were treated with Tacrolimus, MMF and prednisone, At each visit they were subjected to standard haematological and biochemical tests Data on age, sex, use of immunosuppression, incidence of infection and rejection was collected. Percentage, range and median were used to represent the data.

Results

The study group comprised of a total 120 pediatric patients underwent renal transplant between 2006-2018 at Fortis hospitals. Median age was 14 years (3-18 years) and 85 were boys and 35 were girls. The immunosuppression protocol consisted of induction by either basiliximab or ATG, followed by maintenance immunosuppression with tacrolimus, mycophenolate and steroids. 17 patients received no induction. Median creatinine at the time of discharge was 0.74 mg/dl (0.3-1.6 mg/dl). The median duration of follow up was 60 months (1-156 months). In our cohort, patient survival rate was 97.9 % and graft survival rate was 94.6 %. 18 patients had infections - UTI (8), CMV infections (7), BK virus infection (2), tuberculosis (1), varicella (1), cryptosporidium diarrhea (1) and fungal infection (1). Rate of rejection was 13.3%. Two patients had graft loss in the early post operative period, one secondary to renal vein thrombosis and other due to BK virus infection/acute tubular necrosis. Five patients lost the graft over the next 12 years due to non compliance with medications (4) and recurrence of FSGS (1). 2 patients died with functioning graft, one due to severe pancreatitis and other due to severe sepsis. One died after return to dialysis.

Conclusion

With advances in immunosuppression, rejection rate and graft survival have improved dramatically over the last decade. Compliance with medications and regular follow up are the major contributors for satisfactory long-term outcome.
P1829CARDIOVASCULAR DISORDERS IN CHILDREN WITH CHRONIC KIDNEY DISEASE
Authors: Nugmanova Aigul , Meriken Nuriya , Dikanbayeva Saule , Zhumagulova Zeinep , Baidauletova Zhuldyz , Eshankulov Khursanbek , Kuandykova Aigerim , Auyezkhanov Bakyt
Published: June 2020

Background and Aims

Pathology of the cardiovascular system is the leading cause of death in patients with CKD, while determining the causes of the formation of cardiac events is often difficult.

Method

We conducted an analysis of echocardiography data performed by 50 children with CKD. On the echoCG, the final systolic and diastolic sizes of the left ventricle (FSS and FDS), the final systolic and diastolic volumes of the left ventricle (FSV and FDV) were determined; measured the thickness of the interventricular septum (IVS) and the posterior wall of the left ventricle (PWLV). Left ventricular myocardial mass (LVMM) was determined by the formula proposed by R. Devereux and N. Reichek: LVMM = 1.04x (/ IVS+PWLV+FDS/3-FDS3) - 13.6where, IVS - thickness of IVS in diastole,PWLV-thickness of PWLV in diastole, FDS-final diastolic size of the left ventricle.

Results

We conducted an analysis of echocardiography data performed by 50 children with CKD. On the echoCG, the final systolic and diastolic sizes of the left ventricle (FSS and FDS), the final systolic and diastolic volumes of the left ventricle (FSV and FDV) were determined; measured the thickness of the interventricular septum (IVS) and the posterior wall of the left ventricle (PWLV). Left ventricular myocardial mass (LVMM) was determined by the formula proposed by R. Devereux and N. Reichek: LVMM = 1.04x (/ IVS+PWLV+FDS/3-FDS3) - 13.6where, IVS - thickness of IVS in diastole,PWLV-thickness of PWLV in diastole, FDS-final diastolic size of the left ventricle.

Conclusion

The mechanisms of damage to the heart and blood vessels in patients with CKD begin to function already in the initial stage of renal failure and increase as it progresses. The need to know the data of clinical, laboratory and instrumental examination methods at the terminal stage of CKD is dictated, first of all, by the possibility of exposure to them. An important stimulus for conducting an echocardiographic examination is the early detection and correction of cardiovascular disorders, in connection with the prospect of increasing the survival of patients after kidney transplantation.
P1834MONITORING ANTICOAGULATION IN PEDIATRIC PATIENTS ON REGULAR HEMODIALYSIS: CAN A DREAM COME TRUE?
Authors: Elhakim Ihab , Ragia M Said , Baranek Ahmed
Published: June 2020

Background and Aims

Anticoagulation in hemodialysis aims at preventing the activation of coagulation cascade during the procedure. Appropriate anticoagulation for hemodialysis (HD) requires a precise balance between under- and over-heparinization to prevent extracorporeal circuit (ECC) clotting and bleeding, respectively. This type of balance is practiced in hemodialysis centers, on daily basis, depending on each center’s experience and tailored to every patient, rather than in accordance to a clear guideline. Our aim was to objectively evaluate the adequacy of heparin therapy used for anticoagulation in pediatric patients on regular hemodialysis.

Method

A follow up observational study for 12 months including 44 pediatric end stage renal disease patients on regular hemodialysis through an A-V fistula or an A-V graft. We excluded patients with a known bleeding disorder, chronic liver disease, thrombophilia, vasculitis or receiving anticoagulation for any condition. All patients were subjected to thorough history taking including dialysis history, assessment of dialysis adequacy by calculating Kt/V and blood pressure monitoring before, during and after session. Clinical evaluation of anticoagulation was done through visual inspection of extra-corporeal circuit, observing transmembrane pressure and recording the duration of compression over the puncture site at the end of the hemodialysis session. Biological monitoring was done by Bedside Activated clotting time (ACT) test.

Results

On initial evaluation of patients, 11 cases had either clotting or bleeding clinically (only 4 had abnormal ACT values), being on either hemodialysis (HD) or hemodiafilteration (HDF) and receiving unfractionated heparin (UFH) either as a bolus or through a pump. They were further evaluated after being put; on HDF and a heparin pump and showed neither clotting nor bleeding though 2 cases had prolonged predialysis ACT values. On HDF and heparin bolus, no bleeding or clotting were detected though 3 cases had abnormal predialysis ACT values. On HD and heparin pump no bleeding or clotting were detected, 2 cases had low kt/V, a case had abnormal ACT values (5 minutes, 1 hour and at the end ACT values).

Conclusion

Hemodialysis mode, rather than method of heparin delivery, had a bigger impact on correcting clinical defects of anticoagulation in our patients. ACT as a bedside test of anticoagulation adequacy during HD sessions did not offer extra benefit over clinical evaluation, which is still considered a more accurate method.
P1835PREDICTION OF CHRONIC OF KIDNEY FAILURE BASED ON ARTIFICIAL INTELLIGENCE SYSTEM USING THE FUZZY DECISION TREE ALGORITHM
Authors: Fajar Rifaldy , Jupri Prihantini
Published: June 2020

Background and Aims

Chronic kidney disease is one type of disease that can cause death. Until now, chronic kidney failure has no antidote, so this disease cannot be cured but can be slowed down or stopped its development. Early diagnosis of this disease will help to prevent these fatal consequences. To diagnose this disease, several laboratory tests are needed in which the results of these tests will be calculated and concluded the results by a doctor or medical practitioner. The development of science and technology, especially in the field of computers will help the work of doctors to analyze the results of laboratory tests become easier and faster. In this study, a prediction attempt is made using the Fuzzy Decision Tree classification algorithm, which is expected to obtain high accuracy results.

Method

This study uses the Chronic Kidney Disease (CKD) dataset taken from the UCI Machine Learning Repository. Data was collected from the hospital for approximately two months. This dataset covers a total of 400 samples with numerical attributes totaling 11 columns and nominal totaling 14 columns. Data samples were provided as many as 400 rows with 250 samples being the ckd group (positive for chronic kidney failure) and 150 samples for the notckd group (chronic kidney failure). But after going through the preprocessing stage, data that can be used amounted to 158 rows with 43 samples are the ckd group (positive chronic kidney failure) and 115 samples of the notckd group (negative chronic kidney failure).

Results

The trial was conducted using several predetermined thresholds and the most optimal accuracy was 98.3%, which showed a fairly high degree of accuracy.

Conclusion

Thus, it can be concluded that the Fuzzy Decision Tree algorithm can be said to be able to predict chronic kidney failure with a very good results.
P1845HISTORY AND FUTURE PERSPECTIVES OF PAROXYSMAL NOCTURNAL HEMOGLOBINURIA
Authors: Gembillo Guido , Bellinghieri Guido , Savica Vincenzo , Satta Ersilia , Siligato Rossella , Salvo Antonino , Santoro Domenico
Published: June 2020

Background and Aims

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare clonal disorder that affects about 1-1,5 cases per million individuals, characterized by hemolysis, peripheral blood cytopenia, bone marrow dysfunction, thrombosis, renal impairment and arterial and pulmonary hypertension.

The first case of PNH was probably described in 1793 by a surgeon, Dr Charles Stewart, in the medical commentaries “Account of a singular periodical discharge of blood from the urethra”. In the following decades several cases have been reported by the most eminent physicians and scientists of the time.

Method

In 1882 Paul Strübing was the first to identify PNH as a new disease entity. Hijmans in 1911 considered the possibility that the complement system mediated the hemolysis of PNH erythrocytes and in the same year, Italian scientists Ettore Marchiafava and Nazari scrupulously described the pathogenesis of the affection.

In the 1925 Enneking introduced for the first time the name “paroxysmal nocturnal hemoglobinuria”, to define this pathology.

Results

Despite the increased knowledge of this syndrome, therapies for PNH were still only experimental and symptomatic, with the use of antimicrobial agents, corticosteroids and blood transfusions. The natural history of PNH changed remarkably only in the 2007, with the introduction of Eculizumab complement blockade agent. The Ravulizumab, a long-acting C5 complement inhibitor approved on December 2018 by the U.S. food and drug Administration (FDA), and on July 2019 by the European Commission, represent a new promising instrument for PNH treatment.

Conclusion

Second generation of anti-complement agents are currently under investigation, representing future promising instruments for the treatment of PNH.
P1859“HEADING AWARDS 3.0 PATIENTS” IMPACT OF AN ONLINE HEALTH WORKSHOP ON INTERNET SEARCH OF HEALTH-RELATED ISSUES BY PERITONEAL DIALYSIS UNIT´S PATIENTS, FROM THE NEPHROLOGY SERVICE
Authors: Centellas Pérez Francisco Javier , Martínez Reolid Ricardo , Sarduy Coronado Pablo Alejandro , Piqueras Sánchez Sara , Martínez Antolinos Consuelo , Aparicio Simón Aitana , Ruiz González Cristina , Masiá Mondéjar Jesús , Pérez Martínez Juan , Ortega Cerrato Agustin
Published: June 2020

Background and Aims

New technologies have advanced diagnostic techniques and enabled patient self-information, nonetheless, they can become a weapon of misinformation if not used appropriately.

Online health resources utilization, gamification and the appearance of new specialized Apps are becoming a challenge in the quest for correct use of new technologies in the Nephrological field and in the patient empowerment process.

Aims

1st Phase: Determine how frequent medical information is searched for online, the main topics and the different sources of information used by PD patients in our Service of Nephrology.

Method

Observational prospective study using a cohort of patients from PD Unit (pre dialysis and on dialysis). First, an online survey was used in order to obtain demographic variables and to determine the use of different sources of information and their quality. Secondly, patients were instructed in ICTs via virtual desktop as well as in two live workshops.

Results

52 patients (37 men, 15 women). Mean age: 61.7 years. Academic level (elementary school: 20). Place of residence (urban: 65.4%). 48% never uses the internet. From the rest: 68% searches in a regular manner for health-related issues, with “Google” being the main search engine (77.8%). 100% have searched for their own illnesses, 72.2% consider the information found not completely reliable. 61% looks for information before and after the clinical encounter. 72.2% have asked other patients about nephrological health related issues, while 27.8% have given counsel of said issues to others. 86.5% doesn’t use health related Apps and only 5.8% use blogs. Among the variables analysed, differences where found in being older age and less use of internet (ANOVA test p<0.001) and with lower cultural level and less use of new technologies (Chi-squared test p<0.001).

Conclusion

The analysed data show that nowadays we face two main problems in our PD unit: Generational digital divide we have patients who have not incorporated into their lives the use of new technologies, in contraposition to others who use them in regular bases.

Guarantee that those who use digital resources can access them in a simple and trustworthy manner.

Therefore, we believe that the second phase of this project, both the workshops and the virtual desktop, are tools that can help fix these problems.
P1860PERIOPERATIVE CHANGES IN PHYSICAL FUNCTION AND ACCELEROMETER-MEASURED PHYSICAL ACTIVITY IN PRE-EMPTIVE OR POST-DIALYSIS KIDNEY TRANSPLANT RECEIPIENTS
Authors: Ichikawa Takafumi , Matsuzawa Ryota , Ishii Daisuke , Noguchi Fumino , Imura Yuki , Yamamoto Shohei , Matsunaga Atsuhiko , Yoshida Kazunari
Published: June 2020

Background and Aims

Pre-emptive kidney transplant (PEKT) is known to have better graft survival, and thereby well established as the optimal treatment for end-stage renal disease patients. On the other hand, the delayed recovery of physical function and physical activity after KT reportedly occurs in approximately 20% of KT recipients, which leads to poor prognosis. However, it is less clear whether PEKT delays recovery of them after KT. We aimed to investigate any differences in perioperative changes in physical function and physical activity for PEKT versus non-PEKT.

Method

Consecutive 34 recipients who had received a living-donor KT from January 2016 to January 2019 were enrolled in this prospective cohort study. Patient characteristics including age, sex, body mass index, primary cause of kidney disease, smoking habits, and comorbidities were collected at baseline. Six-minute walk distance (6MWD), gait speed, isometric leg strength, accelerometer-measured physical activity (number of steps and moderate to vigorous activity time) and kidney function (eGFR) were assessed at before and 2 months after KT. We divided the recipients into 2 groups: PEKT (n=11) and non-PEKT (n=23), and compared outcomes between the 2 groups using ANCOVA adjusted for baseline patient characteristics. This study was approved by institute ethical committee.

Results

KT successfully improved eGFR of all the study participants from 6.1±4.6 to 35.4±15.3. PEKT group showed significant shorter dialysis duration as compared with non-PEKT group (mean duration: 0 months in PEKT vs 64.8±95.5 months in non-PEKT, P <0.001). The 6MWD significantly improved after KT in the PEKT group, but not in the non-PEKT group as compared with that of baseline (adjusted mean change [95% confidence interval]: 44.7 [8.2 to 81.2] vs. 8.80 [-32.8 to 15.2], P=0.025). We found a tendency toward improvement of gait speed (0.11 [-0.11 to 0.32] vs. -0.15 [-0.29 to -0.01], P=0.065), and moderate-to-vigorous activity time per day (7.19 [-2.84 to 17.23] vs. -5.60 [-12.97 to 1.77], P=0.057) in the PEKT group.

Conclusion

PEKT recipients showed higher perioperative changes in physical function and physical activity compared to non-PEKT. Our findings suggest that PEKT may have benefits on early recovery of physical function and physical activity after KT.
P0513NECROINFLAMMATION VERSUS CRYSTAL CLOTS AS THERAPEUTIC TARGET IN CHOLESTEROL CRYSTAL EMBOLISM-RELATED KIDNEY INFARCT
Authors: Shi Chongxu
Published: June 2020

Background and Aims

Cholesterol crystal embolism (CCE) is usually a consequence of the rupture of atheromatous plaques in patients with advanced atherosclerosis. We hypothesized that necroinflammation contributes to CCE-related kidney injury/disease (AKI/AKD).

Method

Injection of cholesterol crystal (CC) into C56BL/6 WT mice kidney via the left kidney artery induced vascular obstruction, kidney infarction, and GFR loss (measured by transcutaneous monitoring of sinistrin clearance in awake and unrestricted mice). GFR recovered to baseline at 2 weeks despite persistent kidney injury and scarring, probably because the non-injected right kidney developed compensatory hypertrophy. To study the role of necroinflammation in this process, we injected CC to either Mlkl-/- mice or WT mice pre-treated with PBS, the necroptosis inhibitor Nec-1s or the NLRP3 inhibitor MCC950 30 min before CC injection.

Results

At 24h, Nec-1s, MCC950 treatment had significantly reduced infarct size, kidney injury, neutrophil infiltration, and vascular injury compared to PBS control group. Reduced infarct size, e.g. with Nec-1s persistented until day 14. CC injection into Mlkl-/- mice gave the same results. However, none of these interventions had an effect on GFR loss, i.e. AKI because they did not affect crystal clot formation in the arteria afferent to glomerular perfusion. In contrast, anticoagulant treatment prevented infarcts and GFR loss.

Conclusion

In this new model of unilateral CCE-induced AKI/AKD global kidney function recovers within 14 d, presumably due to adaptive responses in the contralateral kidney as the post-infarct tissue injury persists and leads to kidney atrophy. As both the NLRP3 inflammasome as well as necroptosis are involved in kidney infarct formation, we conclude on necroinflammation as the central mechanism of CCE-induced AKI/AKD. However, what defines AKI is renal function. We found that crystal clot formation is upstream of kidney infarction but independent of necroinflammation. We conclude, despite necroinflammation is central in kidney infarct formation, crystal clots are the better therapeutic target to prevent CCE-related AKI.
P0559AKI SEASONALITY IN ENGLAND
Authors: Wong Esther , Nitsch Dorothea
Published: June 2020

Background and Aims

Incidence of Acute Kidney Injury (AKI) is known to be seasonal, peaking in winter months among hospitalised patients. Previous studies have suggested that the seasonality of AKI is likely to be influenced by the seasonality of the underlying acute illnesses that are associated with AKI. Mortality of patients with AKI has also been reported as being higher in winter, reflecting well-described excess winter mortality associations.

Here we describe the seasonal variations of AKI alerts in England and the associated mortality rate using linked national databases.

Method

Serum creatinine changes compatible with KDIGO AKI stage 1, 2 and 3 are sent by laboratories in England as AKI alerts to the treating clinicians and the UK Renal Registry (UKRR). We linked the electronic AKI alerts to the Hospital Episode Statistics (HES) data, to identify patients who were hospitalised. We carried out descriptive statistics, and investigate the seasonal effect to the 30-day patient mortality from date of getting AKI alert, using multivariable Cox regression and sequentially adjusting for age, sex, Index of multiple deprivation (IMD) and peak AKI stage

Results

Winter has the highest number of AKI episodes (N=81,276), which is 6% higher than that in summer (N=76,329) (Table 1). For patients who had an AKI episode and admitted to hospitals, the crude 30-day mortality is higher in the winter season when compared to the summer [HR 1.28 (1.25-1.31), p<0.01] (Figure 1). After adjusting season by age, peak AKI stage, IMD and sex, winter season still has significantly higher 30-day mortality than summer [HR 1.24 (1.21-1.27), p<0.01]. Winter mortality peak is confounded by age and AKI severity, which explained the drop of hazard ratio at winter peaks; whereas season is not confounded by deprivation and sex. The pattern of seasonality varies with age, in age group 18-39, there were 26.1% of AKI episodes in summer and 23.3% in winter, whereas in age group >75, there were 23.7% in summer and 27.1% in winter.

Conclusion

Analysis of England data confirms seasonal peak in AKI during winter months. Additionally it shows increased risk of mortality for patients with AKI in winter months. Future work will investigate the impact of comorbidities and case-mix on outcomes. By understanding the seasonal variation of AKI, we can potentially plan preventive care and improve clinical practice.
P0617LEISURE-TIME PHYSICAL ACTIVITY AND MORTALITY IN CHRONIC KIDNEY DISEASE: NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY (NHANES) 1999-2012
Authors: Zhang Nanhui , Luo Ran , Cheng Yichun , Chang Dan , Liu Tingting , Ge Shu-wang , Xu Gang
Published: June 2020

Background and Aims

For patients with chronic kidney disease (CKD), evidence on the optimal dose of physical activity and possible harm with excessive exercise is limited. We aimed to analyze the dose-response association between leisure-time physical activity (LTPA) and mortality among participants with CKD and explore the optimal dose or possible harm associated with increased levels of physical activity.

Method

Leisure-time physical activity was self-reported. Data from 4604 adults with chronic kidney disease and without missing data for LTPA and mortality in the National Health and Nutrition Examination Surveys 1999-2012 were analyzed in 2019. Mortality was from baseline until 31 December 2015

Results

During the median follow-up of 114 months, 1449 (31%) all-cause deaths were recorded. Comparing with inactive groups, the multi-variable adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of 10-59, 60-149, 150-299, and 300-599 minutes/week of leisure-time physical activity for all-cause mortality were 0.71 (0.55-0.92), 0.78 (0.62-0.98), 0.79 (0.63-0.98), and 0.75 (0.57-0.99), respectively. The benefit appeared to reach a threshold of a 41% (HR,0.59; 95% CI, 0.41-0.84) lower risk of all-cause mortality among individuals reporting 600-1499 min/week for LTPA. And at ≥ 1500 min/week LTPA level, the HR and 95%CI were 0.66 (0.40-1.10).

Conclusion

LTPA was associated with reduced all-cause mortality in participants with CKD. We observed the optimal dose at the moderate-intensity LTPA level of approximately 600-1499 min/week and no longevity benefit at ≥1500 min/week.
P0877ASSOCIATIONS OF DISORDERS IN BONE MINERAL PARAMETERS WITH MORTALITY IN STAGE 4 AND 5 CKD: INSIGHTS FROM THE PECERA STUDY
Authors: Molina Pablo , Molina Mariola D , Pallardó Luis M , López-Menchero Ramón , Torralba Francisco Javier , Escudero Quesada Veronica , Castro Alonso Cristina , Del Pozo Carlos , Martín-Rivas Josefa , Sánchez-Pérez Pilar , Soldevila Amparo , González-Rico Miguel , Peris Ana , Sancho Calabuig Asunción , Gorriz Jose Luis
Published: June 2020

Background and Aims

Abnormalities of bone mineral parameters are associated with increased mortality in patients on dialysis, but their effects and the optimal range of these biomarkers are less well characterized in non-dialysis chronic kidney disease (CKD).

Method

PECERA (Collaborative Study Project in Patients with Advanced Chronic Kidney Disease) is a 3-year, multicentre, open-cohort, prospective study carried out in 995 adult patients with CKD stages 4-5 not on dialysis enrolled in 2007-09 from 12 centres in Spain. Associations between levels of serum calcium (corrected for serum albumin), phosphate, and intact parathyroid hormone (iPTH) and all-cause mortality were examined using time-dependent Cox proportional hazards models and penalized splines analysis adjusted by demographics and comorbidities, treatments and biochemical collected at baseline and every 6 months for 3 years.

Results

After a median follow-up of 30 months (IQR:14-37 months) there were 180 deaths (18%). The association of calcium and phosphate with all-cause mortality was U-shaped (Figure). The serum values associated with the minimum risk of mortality were 9.35 mg/dL for calcium and 3.56 mg/dL for phosphate, being the lowest risk ranges between 7.4 to 10.7 mg/dL and between 2.3 to 4.6 mg/dL for calcium and phosphate, respectively. For iPTH levels, the association was J-shaped, with an increased risk for all-cause mortality at levels > 110 pg/mL.

Conclusion

As previously reported in dialysis patients, PECERA provided evidence on the association of serum calcium, phosphate and iPTH levels with all-cause mortality in stage 4 and 5 CKD patients, suggesting potential survival benefits of controlling bone mineral parameters in this population. Whereas the ranges of calcium and phosphate associated with the lowest mortality in the study were consistent with the current K-DIGO guidelines, our results suggested that the threshold for considering anti-parathyroid treatment might be lower than is currently recommended.
P1620PROGNOSTIC VALUE OF RENAL BIOPSY QUANTITATIVE HISTOLOGY IN LIVING KIDNEY DONORS AND RECIPIENTS OF KIDNEYS FROM LIVING DONORS
Authors: Buus Niels Henrik , Nielsen Cecilie Molgaard , Krag Soren , Ibsen Lotte , Skov Karin , Nyengaard Jens Randel
Published: June 2020

Background and Aims

Living kidney donors (LKD) have an increased risk of chronic kidney disease. Likewise, renal transplant recipients may experience early or unexplained loss of graft function. We examined the predictive value of stereology based on a CT-scan and a biopsy from the transplanted kidney in relation to renal function outcome in both LKD and recipients of kidneys from living donors.

Method

A pre-transplantation contrast-enhanced CT-scan was used to obtain cortical volume of both kidneys using the Cavalieri estimator. Glomerular number density in a baseline biopsy from the transplanted kidney (taken at the time of transplantation) was estimated by a model-based method and multiplied with cortex volume to estimate the total number of glomeruli in the donated kidney. Glomerular volume was estimated by the 2D nucleator (1). In addition, kidney fibrosis (point-counting), glomerular sclerosis, and arteriole dimensions (2D nucleator) were also calculated. Pre-donation single kidney glomerular filtration rate (GFR) was determined using 51chrome EDTA clearance together with a renography and the GFR measurement was repeated one year after transplantation in both donors and recipients. We examined the association between GFR at one-year follow-up and cortex volume and various histology parameters from the baseline biopsy after adjustment of age, sex, body mass index, smoking status, 24-hour mean blood pressure and single-kidney GFR before transplantation.

Results

CT-scans, GFR measurements and kidney histology from 49 LKD and 38 recipients of kidneys from living donors were available for analysis. Mean age of donors was 50±12 years (55% women) and of recipients 46±13 years (26% women). In donors, GFR decreased from 113±24 to 71±16 ml/min while in recipients GFR was 61±18 ml/min at one-year follow-up (all with a functioning graft).

In donors, GFR at follow-up of the remaining kidney had increased by 28% as compared to baseline. Follow-up GFR correlated to cortex volume (P<0.001), but not to any of the histological parameters (total glomerular number, glomerular volume, % sclerosed glomeruli, % kidney fibrosis or arteriolar dimensions).

In recipients, GFR at follow-up had increased by 8% as compared to single-kidney GFR before donation. Follow-up GFR correlated to % kidney fibrosis (P=0.02) and % sclerosed glomeruli (P=0.05), but not any of the other histological parameters or cortex volume.

Conclusion

When adjusted for relevant clinical confounders the estimation of cortex volume had predictive value for renal function outcome in LKD while % kidney fibrosis and % sclerosed glomeruli had predictive value in recipients of kidneys from living donors.