bluuebunny/crossref_metadata_2025 huggingface dataset:
#6009 MUSCLE OXYGENATION AND MICROVASCULAR REACTIVITY ACROSS DIFFERENT STAGES OF CHRONIC KIDNEY DISEASE: A NEAR-INFRARED SPECTROSCOPY STUDY
Authors: Theodorakopoulou Marieta , Zafeiridis Andreas , Dipla Konstantina , Faitatzidou Danai , Koutlas Aggelos , Doumas Michael , Papagianni Aikaterini , Sarafidis Pantelis
Published: June 2023

Background and Aims

Previous studies in chronic kidney disease (CKD) showed that vascular dysfunction in different circulatory beds is progressively deteriorating with CKD severity. This study evaluated muscle oxygenation and microvascular reactivity at rest, during an occlusion-reperfusion maneuver, and during exercise in patients with pre-dialysis CKD versus controls, as well as between different CKD stages

Method

Continuous measurement of muscle oxygenation [tissue saturation index (TSI%)] via near-infrared-spectroscopy at rest, during occlusion-reperfusion, and during a 3-min handgrip exercise(at 35% of maximal-voluntary-contraction). Aortic pulse wave velocity (PWV) and carotid intima-media thickness (cIMT) were also recorded.

Results

Resting muscle oxygenation did not differ among the study groups (controls: 64.3±2.9 stage-2: 63.8±4.2stage-3a: 64.1±4.1 stage-3b: 62.3±3.3 stage-4: 62.7±4.3%; p = 0.6). During occlusion, no significant differences among groups were detected in TSIocl magnitude- and occlusion-slope. However, during reperfusion, theTSImax and the hyperemic response were significantly lower in groups of patients with more advanced CKD stages (controls: 11.2±3.7 stage-2: 8.3±4.6 stage-3: 7.8±5.5 stage-3b: 7.3±4.4 stage-4: 7.2±3.3; p = 0.04). During handgrip exercise, muscle oxygenation (TSIaverage-decline) was marginally lower in CKD patients than controls, but no significant differences were detected between CKD stages.

Conclusion

Although no differences were observed in muscle oxygenation at rest and during occlusion, the microvascular hyperemic response during reperfusion was significantly impaired in CKD and deteriorated in more advanced CKD stages. This impaired ability of microvasculature to respond to stimuli may be a crucial component of the adverse vascular profile of CKD patients and may contribute to exercise intolerance
#6032 LONG-TERM OUTCOMES IN A COHORT OF PATIENTS WITH SYSTEMIC VASULITIDES (SV) AND KIDNEY INVOLVEMENT
Authors: Petrakis Ioannis , Dermitzaki Kleio , Palamaris Kostas , Drosataki Eleni , Maragkou Sevasti Alexandra , Pleros Christos , Kroustalakis Nikos , Stayrakaki Ioanna , Gakiopoulou Harikleia , Stylianou Kostas
Published: June 2023

Background and Aims

Many randomized trials address the issue of SV therapy. Nevertheless, individualized treatment in patients with SV and renal involvement requires long term data and is often center specific. We present the experience of our center, a tertiary University hospital in Crete, Greece.

Method

Medical records were reviewed for clinical signs and symptoms. Statistical analysis was performed using SPSS 20 (IBM). Data were tested for normality, statistical significance was set at <0,05. Chi-Square test, Student's T-Test, Multiple-Regression analysis were utilized for statistical analysis.

Results

We examined 58 patients (37 females) with a mean follow-up of 5 years (Range 1-31) and a mean age of 66 years (Range 12-102). Serology revealed 46 pANCA+ve (79%), 8 cANCA+ve (14%) and 4 p/c ANCA negative patients (7%). Nine patients lost renal function and 16 patients died during follow-up. All patients received immunosuppressive induction therapy (Cyclophosphamide N = 42, Rituximab N = 7, Steroid monotherapy N = 9). All patients with pulmonary hemorrhage underwent plasmapheresis. The severity of clinical manifestation was associated with need for plasmapheresis and rapid renal function deterioration. Plasmapheresis resulted in the remission of pulmonary hemorrhage in all patients. Renal death was associated with renal function decline in months 1 and 6 post diagnosis. Treatment with cyclophosphamide or rituximab did not affect outcome (death or renal death). Number of relapses (14 patients), surprisingly, was not associated with renal function deterioration. Death was not associated with renal function deterioration in months 1 and 6 post diagnosis. Loss of Follow up was associated with increased mortality.

Conclusion

In this cohort either cyclophosphamide or Rituximab does not seem to affect prognosis. plasmapheresis efficiently contains pulmonary hemorrhage and, as expected, loss of follow-up is associated with poor outcomes.
#6070 PREDICTIVE MODEL OF OBSTETRIC ACUTE RENAL FAILURE IN THE INTENSIVE CARE UNIT
Authors: Hafiani Yassine , Erragh Anas , Nabih Ibtissam , Khalayla Mohammad , Moussaid Ihsane , Elyoussoufi Smael , Salmi Said
Published: June 2023

Background and Aims

Obstetric acute renal failure (OARF) remains a frequent and serious complication that engages the maternal and fetal prognosis. The objective of our work is to develop a predictive model of obstetric acute renal failure in the intensive care setting.

Method

To meet our objective we conducted a retrospective comparative and analytical study spread over a period of 7 years, from January 2014 to September 2021 within the obstetric resuscitation department of ABDERRAHIM HAROUCHI hospital of CHU Ibn Rochd of Casablanca. We have thus distinguished two groups of parturients:

 • Group 1 “ OARF + ” : parturients with ARF (n = 863)

 • Group 2 “ OARF -” : parturients without ARF (n = 1856

Results

During this period 2719 obstetric admissions in intensive care were collected including 863 cases of ARF that we classified according to the KDIGO classification with a percentage of stages I, II and III respectively of 45.2%, 28.5% and 25.3% of cases. The average age of our OARF+ sample was 28.6±5.4 years. 40% of the parturients in this group were primiparous and 60% were multiparous, with the majority of cases occurring between 20 and 28 weeks' gestation (32%). OARF was associated with pre-eclampsia in 57% of cases, hemorrhagic shock in 37.19% of cases and severe sepsis in 31.74% of cases. Extra renal purification was necessary in 148 parturients (17.2%) and the mortality rate in the OARF+ group was 26.18%.

 In univariate analysis, the clinico-biological risk factors for the occurrence of obstetric ARF were haemostasis disorders (p < 0.001), hypertension (p < 0.001), oligo-anuria (p = 0.002), severe anaemia (p < 0.001) and thrombocytopenia (p < 0.001). As for the etiological factors, our analysis allowed us to retain pre-eclampsia (p < 0.001), hemorrhagic shock (p < 0.001), sepsis (p < 0.001), Hellp Syndrome (p = 0.002) and DIC (p = 0.002).

Conclusion

Pre-eclampsia, pre- and postpartum hemorrhage, and sepsis represent the main etiologies of obstetric ARF, which is a frequent obstetric complication in the ICU setting and responsible for significant maternal morbidity and mortality. The determination of the risk factors for the occurrence of such a complication allowed us to detect and prevent the patients at risk.
#6075 GENDER DISPARITIES IN HEMODIALYSIS PATIENTS: WORKING LIFE, MENTAL STATUS AND PHYSICAL CAPACITY
Authors: Yıldırım Saliha , Albayrak Haluk Cihad , Helvacı Özant , Erten Yasemin , Derici Ulver , Ayli Deniz , Duranay Murat , Guz Galip
Published: June 2023

Background and Aims

Globally, there are more women with chronic kidney disease (CKD) then man, but there are disparities in even receiving dialysis treatment. Gender disparity is a common problem in many fields. In this study, we aimed to determine the gender disparities in a sample of Turkish hemodialysis patients in the terms of working life, symptoms, depression, dementia and physical activity.

Method

219 patients (ages 18–65 years) were included in this study. Demographic characteristics, laboratory parameters and social status were recorded. All participants completed the Beck depression scale, standardized mini-mental test, physical activity score and a questionnaire consisting of symptoms related to hemodialysis.

Results

132 male and 87 female patients were included in this study. Male patients and female patients were statistically similar in the terms of age (p = 0.604), CKD vintage (p = 0.226), RRT vintage (0.559) and laboratory parameters (p > 0.05). Weakness (p < 0.001), palpitation (p < 0.001), chest pain (p = 0.015), hypotension (p < 0.001), myalgia (p < 0.001) and forgetfulness (p = 0.002) were more common in female patients. Serious depression was similar in the two groups (p = 0.525) while physical inactivity (p = 0.022) and dementia (p = 0.024) were more often in female patients. Unemployment was more in the female group (p < 0.001) although willingness to work is similar in both groups and female patients had a low salary than male patients (p = 0.033).

Conclusion

Women with CKD face many challenges in daily life but the major disparities are in the social and economic fields. Not only laboratory parameters but also gender disparities in the social field must be improved to achieve equal care for all people with CKD.
#6120 MIRNA PROFILING OF URINARY EXTRACELLULAR VESICLES (EVS) IN TBMN AND CFHR5 NEPHROPATHY FOR THE IDENTIFICATION OF NOVEL DISEASE BIOMARKERS
Authors: Louka Stavroula , Kakouri Andrea , Papagregoriou Gregory , Deltas Constantinos
Published: June 2023

Background and Aims

Thin basement membrane nephropathy (TBMN) and complement factor-H related protein 5 (CFHR5) nephropathy are two of the most common renal monogenic diseases with high phenotypic heterogeneity that is only partly accounted for by locus and allelic factors. Intra-familial variability in the age of ESKD onset for some patients particularly exemplifies such highly variable phenotypes, suggesting a potential modifying role of additional factors such as non-coding regulatory RNAs. Given that miRNAs are key regulators of gene expression, miRNAs from urine-derived extracellular vesicles (EVs) were investigated for their potential use as biomarkers in TBMN and CFHR5 diagnosis and prognosis.

Method

MiRNA profiling of human urinary EVs was carried out by small RNA-sequencing in an initial discovery cohort of 54 patients with TBMN and 44 patients with CFHR5 nephropathy, each classified further into three subgroups based on disease severity (Grey-zone: eGFR >60 ml/min/1.73m2 and age <50 y/o; Mild: eGFR >60 ml/min/1.73m2 and age <50 y/o; Severe: eGFR <60 ml/min/1.73m2 independently of age). Differential expression of miRNAs from urine-derived EVs was compared with 30 age and sex matched healthy controls, whilst bioinformatic analysis was performed to delineate their associated mechanisms.

Results

Kidney-enriched candidate miRNA families were identified in urine-derived EVs for both TBMN and CFHR5 patients and further verified by RT-qPCR in the respective validation cohorts. Distinct miRNAs with significantly differentiated expression levels, compared to that of healthy control cohort, showed significant correlations with some of the evaluated clinical characteristics for both TBMN and CFHR5 patients suggesting a possible diagnostic and prognostic value on long follow-up. Finally, inverse correlations of miRNA expression with their predicted targeted genes identified dysregulated pathways and transcriptional networks for further investigation.

Conclusion

Collectively, distinct profiles of miRNAs from urine-derived EVs were identified in TBMN and CFHR5 nephropathy suggesting that a subset of differentially expressed miRNAs could serve as novel non-invasive biomarkers of disease progression and/or targets for the development of novel therapeutic approaches.
#6128 IMPACT OF MANNOSE-BINDING LECTIN DEFICIENCY ON GRAFT SURVIVAL IN TRANSPLANT RECIPIENTS WITH IGAN
Authors: Stea Emma , Pesce Francesco , Franzin Rossana , Sturdà Elisabetta , Bari Ighli Di , Pontrelli Paola , Gesualdo Loreto
Published: June 2023

Background and Aims

The progression of IgA nephropathy (IgAN) has been associated with Mannose -Binding Lectin levels (both excess or deficiency). The MBL deficiency, is associated with the rs5030737, the rs1800450 and the rs1800451, who represent the “O” allele. Since lectin pathway deregulation may impact on IgA progression on native kidney we hypothesized that the presence of the “O” allele and therefore MBL deficiency, could influence also the graft survival in recipients with a biopsy-proven diagnosis of IgAN on native kidneys. Therefore we investigated the role of MBL “O” allele in kidney transplant recipients with IgAN.

Method

We enrolled 32 kidney transplant recipients with biopsy-proven IgAN on the native kidney. The region in MBL encompassing the SNPs rs5030737, rs1800450 and rs1800451were amplified using PCR and analyzed by Sanger sequencing.Clinical data at baseline and during the follow-up were collected from patients’ records. An eGFR <60mL/min/1.73m2 (MDRD equation) was considered as main outcome at univariate and multivariate analyses.

Results

The 38% of patients carry the“O” allele and 62% of patients the “A” allele which is associated with the wild genotype. No difference between the two groups as for demographic features, donor and transplant-related variables has been found. Interestingly we found that patients with the “O” allele had a worse graft outcome (P = 0.01) during a mean follow-up of 151 months (Figure 1). The “O” allele was an independent predictor for the graft survival in a Cox survival analysis model adjusted for donor's and recipient's age, acute rejection, and disease recurrence (HR 0.046; 95% I.C. 0.005-0.423; P = 0.01). Moreover we found a link between the genetic background and the MBL serum level (Figure 2).

Conclusion

Our study suggest a potential role of the MBL deficiency in the long term graft dysfunction in kidney transplant recipient with IgAN.
#6146 EARLY REFERRAL TO PRE-DIALYSIS NEPHROLOGICAL CARE ASSOCIATES WITH LOWER COVID-19 INCIDENCE IN PREVALENT DIALYSIS PATIENTS
Authors: Haarhaus Mathias , Bratescu Lavinia , Pana Nicholae , Marta Gemene Emanuela , Stojceva-Taneva Olivera , Silva Eliana , Santos Carla , Macário Fernando
Published: June 2023

Background and Aims

Early referral to nephrological care associates with improved long-term survival and lower hospitalization rates after dialysis initiation. Despite the strong evidence for this beneficial effect of early referral to pre-dialysis nephrological care in dialysis patients, the effect on COVID-19 incidence and outcome has not yet been investigated.

Method

Patients in the current study were recruited from a cohort of 349 consecutive patients who initiated dialysis between 2015 and 2018 at a dialysis network in Romania. All patients alive at the start of the pandemic (March 2020 = baseline) were included in this retrospective cohort study. Follow-up ended July 2021. At each visit, patients were screened for 2019 Coronavirus Disease (COVID-19) symptoms and symptomatic patients underwent PCR testing. We studied the effect of pre-dialysis nephrological care on COVID-19 incidence. Independent predictors of COVID-19 incidence were identified by multivariable logistic regression analysis.

Results

In total, 224 patients were included. Of these, 89 were early referral patients. At dialysis initiation, they had higher hemoglobin (median (25-75%), 10.0 (9.4-10.8) g/dL vs. 8.5 (7.6-9.4) g/dL, p<0.001), transferrin saturation (21.5 (16.8-25.3)% vs. 18.1 (13.4-23.5)%, p = 0.01), calcium (8.8 (8.3-9.1) mg/dL vs. 8.3 (7.8-8.8) mg/dL, p<0.001), phosphate (5.9 (5.0-6.8) mg/dL vs. 4.8 (3.9-5.8) mg/dL, p<0.001), and albumin (3.5 (3.2-4.2) g/dL vs. 3.5 (3.2-3.8) g/dL, p = 0.04), lower PTH (220 (136-357) pg/mL vs. 289 (148-510) pg/mL, p = 0.03), and initiated dialysis less often via a central dialysis catheter (40 (44.9%) vs. 132 (97.8%), p<0.001). Age, sex, diabetes, and Charlson Comorbidity Index did not differ between groups. During the 16 months of follow-up, 82 patients (36.6%) developed COVID-19. Incidence of COVID-19 was higher in patients with diabetes (32 (46.4%) vs. 50 (32.4%), p = 0.04), while early referral was weakly associated with a lower COVID-19 incidence (26 (29.2%) vs. 56 (41.5%), p = 0.06). Logistic regression, correcting for differences between early and late referral and differences between patients with and without COVID-19, identified a lower risk for COVID-19 among early referral patients (Table 1). No difference in mortality was detected between patients with and without COVID-19 during follow-up (19 (23.2%) vs. 36 (25.4%), p = 0.7).

Conclusion

Among prevalent dialysis patients, early referral to nephrological care before dialysis initiation was an independent predictor of lower COVID-19 incidence during a follow-up period of 16 month from the beginning of the pandemic.
#6157 PREDICTORS OF 24 PULSE WAVE VELIOCITY IN HYPERTENSIVE CHRONIC KIDNEY DISEASE PATIENTS: A CASE CONTROL STUDY
Authors: Radic Josipa , Vučković Marijana , Đogaš Hana , Gelemanović Andrea , Kolak Ela , Nenadić Dora Bučan , Radić Mislav
Published: June 2023

Background and Aims

Pulse wave velocity (PWV) is a significant predictor of chronic kidney disease (CKD) progression and death in people with impaired kidney function. It is known that patients with type 2 diabetes mellitus have higher values of PWV. Our study assessed the difference in arterial stiffness parameters (value of peripheral and central blood pressure parameters and PWV) according diabetic status and to evaluate predictors of PWV in hypertensive CKD patients.

Method

This case control, cross-sectional study included 252 hypertensive CKD patients 143 (56.7%) men and 109 (43.3%) women, aged 67 years (IQR = 15). For each participant data about sex, age, height, presence of CKD, AH and other comorbidities were collected. Laboratory parameters (urea, creatinine, estimated glomerular filtration rate (eGFR), glycated hemoglobin (HbA1c)) were obtained from peripheral blood and 24-hour urine samples were collected to analyze albuminuria. Each participant underwent 24-hour ambulatory blood pressure measurement using the IEM Mobil-O-Graph based on the oscillometry. Tanita MC780 Multi Frequency segmental body composition analyzer was used to measure body weight and level of visceral fat. Body mass index (BMI) was calculated.

Results

Out of 252 participants with AH and CKD, 107 (42.5%) also had DM. Participants with DM were older (p<0001), had higher pulse pressure (p<0.001) and PWV (p<0.001) while the levels of peripheral and central diastolic pressure (p<0.001) were lower. Regarding body composition parameters, DM participants had higher BMI (p = 0.001) and visceral fat level (p<0.001). Positive predictors of PWV adjusted for age, sex, presence of DM and eGFR were HbA1c (β = 0.216, p = 0.007), albuminuria (β = 0.000, p = 0.002), central and peripheral systolic and diastolic blood pressure (β = 0.035, p<0.001; β = 0.035, p<0.001; β = 0.033, p<0.001; β = 0.035, p<0.001), pulse pressure (β = 0.047, p<0.001) and mean arterial pressure (β = 0.042, p<0.001). Body composition parameters were not found to be significant predictors of PWV.

Conclusion

We found significant differences in 24-hour blood pressure parameters and body composition in relation to the presence of DM. One possible explanation for the lower peripheral and central diastolic blood pressure in diabetic participants is the older age of these participants. Accordingly, PWV as a parameter of arterial stiffness, which is higher in DM participants, could also be due to the age difference. As for the predictors of PWV, the expected predictors were parameters of blood pressure. HbA1c and albuminuria were also associated with PWV as parameter of arterial stiffness in CKD participants with AH.
#6211 THE OPPORTUNITY COSTS EXPERIENCED BY PATIENTS WHO INJECT DRUGS UNDERGOING HAEMODIALYSIS: A CASE SERIES
Authors: Hartemink John , Mcdonnell Thomas , Burns Katy , Hanumapura Prasana , Kanigicherla Durga , Hamilton Patrick
Published: June 2023

Background and Aims

Patients who inject drugs (PWIDs) represent a uniquely difficult population to manage with haemodialysis, often with reliance on tunneled venous access. This population is historically difficult to reach, and their care is usually associated with higher per capita healthcare costs [1], unsurprisingly poor outcomes are reported [2] with a multitude of likely causes. Here we show the time associated opportunity costs these patients experience including the significant complication of tunnelled dialysis line infection in a person who actively injects drugs.

Method

This study follows on from the work by Burns [3]. In this retrospective observational study, the electronic health records of patients who were known to be ongoing users of recreational drugs were reviewed from January 2015 – August 2021. Patients were reviewed from their first tunneled line placement until either their death or until the end of the study time period. Stata 14 was used to generate descriptive statistics.

Results

6 Patients were identified, 5 had a primary diagnosis of AA Amyloidosis with the other being IgA. This cohort of patients did poorly, 5 out of 6 of the cohort had died with a mean survival of 27 months. Patients were followed for an average of 769 days (range 485 - 1052). The majority of this time alive was spent as an inpatient with the mean percentage of time as an inpatient being 55% (Range 35–81%) with a mean of 411 total inpatient days. The first confirmed bacteraemia occurred within the first 100 days in 4 out of 6 of the patients.

Conclusion

With this case series we demonstrate the opportunity cost PWIDs experience in the form of time spent as an inpatient. This cost is further added to by the burden of outpatient maintenance haemodialysis. Consideration should also be given to the excess burden their care places on over-stretched healthcare systems. Infections and dialysis compliance are key components in the care of PWIDs and while moving away from tunneled access should be sought whenever possible a multidisciplinary approach should also be considered; these patients commonly lead chaotic lifestyles and in-center dialysis is usually the only option. Including addiction, social and psychiatric services alongside dialysis may be a way to engage with this historically difficult to reach population. The hope is that this study provides the incentive for further studies focusing on the opportunity costs and the quality of life this population can expect when embarking on haemodialysis. This would provide patients with realistic expectations while also aiding clinicians in navigating this difficult ethical situation.
#6246 PIVKA II IS A BIOMARKER FOR PREDICTING CORONARY CALCIFICATION IN HEMODIALYSIS PATIENTS WITH DIABETES
Authors: Park Mooyong , Yu Byung Chul , Choi Soo Jeong
Published: June 2023

Background and Aims

Vascular calcification (VC) is a commonly occurring and serious complication in end-stage renal disease (ESRD) patients that increases mortality. Vitamin K deficiency is well known to cause the occurrence of VC through the inactivation of Vitamin K dependent proteins (VKDP). Therefore, a marker that can easily predict the risk of VC due to vitamin K deficiency is needed in clinical practice. In this study, we aim to investigate whether the easily measurable vitamin K absence II (PIVKA-II) can serve as a surrogate marker for predicting coronary artery calcification (CAC) in ESRD patients receiving hemodialysis and what factors influence the prediction of CAC.

Method

This study is an observational study conducted on end-stage renal disease patients receiving hemodialysis treatment. Patients with liver cirrhosis, HCC, or a history of coronary artery disease with stent placement were excluded, as well as patients with active infectious diseases. CAC score was measured by Non-enhanced computed tomography, and before starting hemodialysis, blood samples were collected to measure PIVKA-II, osteocalcin (OC), and bone-specific alkaline phosphatase (BAP) among other bone markers. PIVKA-II was measured two times with 3 months interval, and the average value was calculated. Additionally, ankle-brachial index (ABI) and DEXA bone densitometry were also performed.

Results

In this study, 69 dialysis patients participated. Among them, 34 patients had diabetes mellitus (DM). The study compared two groups based on the presence of DM. The results showed that patients with DM had higher Body Mass Index (BMI) (p = 0.01) and a higher frequency of vascular diseases such as coronary artery disease or cerebrovascular disease (p = 0.004). The DM group also had higher LDL cholesterol levels (p = 0.03), but there was no significant difference between the two groups in terms of PIVKA-II, BAP, and Osteocalcin levels (Table 1). When analyzing the factors that had a correlation with the CAC score in all 69 patients, LDL cholesterol (r = -0.37, p = 0.002) and CRP (r = 0.28, p = 0.03) were found to have a significant correlation, but PIVKA-II (p = 0.065, Figure 1A), BAP (p = 0.57), and OC (p = 0.45) did not. In the DM group, there was a statistically significant correlation between CAC score and PIVKA-II (r = 0.283, p = 0.001), but there was no correlation between CAC score (Figure 1B) and CaxP, LDL cholesterol, CRP, BAP, and OC (p = 0.7, p = 0.4, p = 0.3, p = 0.7 and p = 0.4 respectively).

Conclusion

The results suggest that in patients with diabetes who undergo dialysis, PIVKA-II can be clinically useful as a surrogate marker for predicting CAC associated with vitamin K deficiency. This is because diabetic patients may have more pronounced VKDP inactivation and VC due to vitamin K deficiency, but additional research is needed to fully understand this relationship.
#6286 NEPHROCALCINOSIS IN 3 GENERATIONS OF FEMALE PATIENTS DUE TO A PATHOGENIC MEN1 MUTATION
Authors: Petrakis Ioannis , Dermitzaki Kleio , Pleros Christos , Konidaki Myrto , Ligerou Dimitra , Mitrakos Marinos , Antonakis Andreas , Kroustalakis Nikos , Maragkou Sevasti Alexandra , Stylianou Kostas
Published: June 2023

Background and Aims

Multiple Endocrince Neoplasia type 1 (MEN1) syndrome, has an autosomal dominant transmission pattern, characterized by hyperparathyroidism, benign or malignant tumors in pancreas islets, pituitary tumors, thymic carcinomas, adrenal cortex adenomas and angio-fibromas of the skin. We are describing 2 cases of MEN1 with first and cardinal manifestations within the kidney.

Method

Medical records review, whole exome sequencing (WES), bioinformatics analysis by Ingenuity Pathway Analysis, QIAGEN

Results

Patient 1. A 28 year old female presented with horseshoe kidney, multiple pyelonephritis episodes, primary hyperparathyroidism, hypercalcemia, magnesiuria, reduced bone mass, and nephrocalcinosis. Her mother and grandmother suffered from hyperparathyroidism. WES analysis demonstrated a 12-base deletion between intron 9 and exon 10 in MEN1 gene (c.1351-3_1359delCAGGTGCGGCAG) with an apparent pathogenicity [1]. An accompanying alteration of CLDN16 gene (c.324+13C>G, rs369250510) was also detected. Till now this alteration is considered benign. Patient 2. A 48 year old female, with primary hyperparathyroidism in the last 15 years (the mother of Patient 1), with nephrocalcinosis since 1997 (calcium oxalate stones), preserved renal function, hypercalcemia, magnesiuria, reduced bone mass, hypertelorism with concurrent diplopia. In 2013, parathyroeidectomy resulted in stabilization of nephrocalcinosis. WES revealed the same pathogenic deletion as in her daughter. A research for epigastric pain revealed a cystic pancreatic mass, with accompanying increase in serum gastrin and chromogranin. A pituitary adenoma is manifested with a marginally increased serum prolactin. Her mother suffers from primary hyperparathyroidism with nephrocalcinosis.

Conclusion

In familial nephrocalcinosis/lithiasis/hyperparathyroidism genetic counselling and screening defines individualized treatment and may prevent extra renal disease manifestations.
#6292 PSYCHOLOGICAL CHALLENGES OF THE PATIENT STARTING PERITONEAL DIALYSIS
Authors: Mulè Marica , Terlizzi Vincenzo , Bertoni Diana , Bussi Carla , Bertoni Anna , Scolari Francesco , Vizzardi Valerio , Alberici Federico
Published: June 2023

Background and Aims

The start of peritoneal dialysis (PD) in patients affected by end stage renal disease (ESRD) may have a significant psychological impact. Aim of this study was to assess the most frequent reasons triggering the request of psychological referral in patients starting PD.

Method

A thematic analysis of the clinical diaries of the psychological support sessions of 15 consecutive patients requesting a psychological referral during the first 3 months of PD was performed from 2018 to 2021.

Results

Fifteen patients were enrolled, 6 women and 9 men. The median age was 59 (range 27–73) and the cause of the ESRD were glomerulonephritis (5/15), diabetic kidney disease (2/15), tubulo-interstitial (2/15), vascular nephropathy (1/15), other (5/15). The most frequent symptoms triggering the request for a psychological referral were insomnia and anxiety respectively in 12 and 15 cases. From the psychological assessments the most frequent causes of the patients’ symptoms have been identified as per follow: - Difficulties in elaborating and accepting the chronic disease (why me?) in 15 Patients.- Difficulties in accepting the esthetical impact of the peritoneal catheter (in the summer how will I do it?) in 15 patients.- The difficulties related to managing fluid restrictions in 15 patients- The limitations to traveling (what if something happens to me?) in 13 patients.- The difficulties to comply to the dietetic restriction (things taste like cardboard; I always eat the same things) in 7 patients.- Difficulties in accepting the dependency to the dialysis (I feel tied to the machine; you can’t do anything) in 6 patients.- The concerns related to the risks of developing peritonitis (fear of not doing the procedure correctly) in 5 patients.- The anxiety of not being able to fulfil the tasks requested by the treatment (I can’t; I lack air when I have to start dialysis) in 6 patients.

Conclusion

This qualitative study performed in PD patients during the first 3 months of dialysis identified the most frequent causes triggering the request of a psychological referral. These findings may be of help for the physicians in order to identify which aspects need to be better discuss during the pre-dialysis counselling and stresses the importance of the availability of a psychological support in a PD unit.
#6306 SUSTAINED LOW-EFFICIENCY DIALYSIS VERSUS CONTINUOUS VENO-VENOUS HEMODIAFILTRATION OUTCOME IN CRITICALLY ILL PATIENTS
Authors: Elaziz Abdelrahman Marzouk Abd , Soliman Mohamed , Abdelrahman Ahmed , Abdelaziz Tarek , Battah Ahmed , Sheriff Hossam , Elsherif Ahmed , Abdelhamid Yasser
Published: June 2023

Background and Aims

Acute kidney injury due to sepsis is the most common cause of AKI in critical care settings. Different modalities of renal replacement therapies (RRT) have been used to manage this condition including Continuous Renal Replacement Therapy (CRRT) and sustained low efficiency dialysis (SLED). The aim of this work was to compare the outcome of SLED and CRRT in the form of continuous veno-venous hemodiafiltration (CVVDHF) as methods of dialysis in sepsis induced AKI.

Method

We retrospectively analysed data from 120 patients; 20 patients received CVVHDF to manage AKI in the context of sepsis, 47 patients received SLED to manage AKI in the context of sepsis and the third group included 53 patients who have been treated with SLED to manage AKI not due to sepsis. Age was found to be significantly higher in sepsis induced AKI patients treated with SLED than patients treated with CVVHDF (65±10.1# 59.5±9.3 y, p = 0.03). Sex distribution or incidences of hypertension, diabetes mellitus, malignancy or liver disease were not statistically different between groups.

Results

Unadjusted 30 day mortality was 44.7% (21pt) in the SLED group Vs 50% (10pt) in the CVVHDF group, p = 0.07. Adjusted mortality was not statically significant between SLED and CVVHDF (OR 0.97, CI = 0.95-1.06). Hypotension occurred more frequently in patients treated with SLED (24 pt = 51.1% #5 pt = 25%, p < 0.001).Clotting occurred more frequently in the CVVHDF group as compared to SLED group (7 pt = 35% Vs 4pt = 8.5% p < 0.001).

Conclusion

Sustained low efficiency dialysis (SLED) and CVVHDF had comparable 30 day mortality as modalities of RRT in critically ill Patients with sepsis induced AKI. SLED still an attractive alternative to CRRT modalities due to lower cost and lower incidence of complications. Further larger studies are recommended.
#6315 CHARACTERIZATION OF BRAIN DAMAGE AFTER ACUTE KIDNEY INJURY
Authors: Bobot Mickaël , Placier Sandrine , Samson Chloé , Prignon Aurélie , Louedec Liliane , Verpont Marie-Christine , Hadchouel Juliette , Galichon Pierre
Published: June 2023

Background and Aims

Acute kidney injury (AKI) is a very common condition in inpatients. Severe AKI is frequently associated with by neurological disorders such as confusion, the mechanisms of which are poorly understood. We have shown in several animal models that chronic kidney disease is associated with impaired cognitive performance such as memory and increased permeability of the blood-brain barrier (BBB), related to the accumulation of uremic toxin indoxyl sulfate. The goal of these experiments was to highlight the influence of AKI on cerebral impairment in mice, particularly the BBB permeability, and to describe the mechanisms involved.

Method

We performed an AKI in C57/Bl6 WT mice, by unilateral nephrectomy and transient ischemia-reperfusion of the remaining kidney for 20 minutes (RIRI20 group) and compared them to two other groups: control mice and mice with unilateral ischemia-reperfusion without nephrectomy (IR20). Modified neurological severity score (mNSS) was performed daily. BBB permeability was assessed by quantification of the Evans Blue leakage in the brain and by cerebral 68Ga-DTPA TEP/CT imaging. Cerebral immuno-histochemistry was performed to evaluate the neuro-inflammatory processes.

Results

Glomerular filtration rate at Day 1 was lower in AKI group compared to the control group 0.21 ± 0.26 vs. 0.94 ± 0.13 mL/min/100g b.w (p<0.0001) and IR group: 0.75 ± 0.17 mL/min/100g b.w (p = 0.0007). Mice with AKI displayed a neurological impairment at day 1 and day 2 post-AKI, compared to control mice and IR20 mice, with mainly an impairment of the balance. Mean mNSS score at Day 1 was 2.6 ± 4.5 in AKI group, and 0.0 ±-0.0 in both the control and IR groups (p = 0.002). BBB permeability at Day 2 was higher in the AKI group than in the control group (p = 0.10) and the IR group (p = 0.0006) by Evans blue staining. Cerebral TEP imaging found similar results with increased BBB permeability in AKI mice to compared to control mice at D1 and D2 (p = 0.004 and p = 0.009, respectively). On immunohistochemistry, brains of mice after AKI displayed more astrocytosis and microglial activation compared to brains of control mice.

Conclusion

AKI in mice is specifically associated with early neurological damage, unlike renal ischemia-reperfusion alone, related to a BBB disruption in the first two days after AKI. AKI appears to induce astrocytosis and altered microglial phenotype, potentially due to increased neuroinflammatory processes following BBB disruption.
#6323 RENAL CONTRAST-ENHANCED ULTRASOUND AND GLOMERULONEPHRITIS: A GOOD MARKER OF DISEASE ACTIVITY
Authors: Urciuolo Federica , Ambrogio Martina , De Luca Gianmarco , Pizzolante Fabrizio , Baccaro Rocco , Grandaliano Giuseppe , Costanzi Stefano
Published: June 2023

Background

Contrast-enhanced ultrasound (CEUS) could provide a lot of information of renal blood flow. Renal blood flow is an excellent marker of inflammatory and fibrotic processes in the kidney such as glomerulonephritis. Therefore, in patients with these diseases, renal CEUS can be both a prognostic marker and an index of response to therapy. Currently in the literature there are preliminary studies showing the role of CEUS in terms of histology and outcome in the evaluation of patients with glomerulonephritis. In this pilot study we used perfusion CEUS parameters (WiR and WoR; WiAUC and WoAUC) as possible markers of renal microvascular damage. We compared the perfusion parameters with the clinical and histological findings of our patients.

Method

Eighteen patients with clinical and laboratory signs of glomerulonephritis were enrolled. All patients underwent ultrasound-assisted renal biopsy and B-mode ultrasound examination, color Doppler ultrasound and contrast-enhanced ultrasound. Time Intensity (TI) curves were obtained from renal CEUS. TI curves and several quantitative perfusion parameters were defined using VueBox® Quantitation Software.

Results

From April to October 2022, 18 patients (12 men and 6 women) with clinical and laboratory suspicion of glomerular disease were enrolled. Median age was 48.05 years, all patients underwent renal biopsy and contrast-enhanced ultrasound at basal condition. Table 1 shows patients characteristics. CKD patients were stratified into two groups according to their eGFR: group I (eGFR < 60 ml/min/1.73 m2, n. = 4) and group II (eGFR ≥ 60 ml/min/1.73 m2, n. = 3). Moreover, we divided patients into two groups based on the presence of nephrotic-range proteinuria (≥ 3.5 g/24h). At this time, seven patient data are suitable for analysis. The small sample size at present does not allow for statistical significance. However, in our study, the persistence of contrast agent signal during the wash-out phase was differed markedly in correlation with the degree of CKD. In particular, we observed a slower wash-in phase in the presence of vascular hyalinosis (Fig. 1).

Conclusion

Our experience seems to confirm that CEUS parameters can be excellent indicators both in terms of patient disease outcomes and histological data. CEUS can effectively and quantitatively demonstrate renal microvascular perfusion in patients with glomerulonephritis. Future goal is that CEUS could also be a prognostic and follow-up marker after renal biopsy in patients with glomerulonephritis.
#6348 HFR USING A HIGH-FLUX DIALYZER (SUPRA-H) AS NEW EFFECTIVE ALTERNATIVE TO ON-LINE HEMODIAFILTRATION: A SINGLE SESSION ANALYSIS
Authors: Antón Alejandro Valero , Martínez-Gómez María Amparo , Pérez-Sánchez Laura , Peiró Julio , Moya Mercedes González , Vizcaíno Belén , Rodrigo María , Quilis Aina , Ureña Paula Gandía , Parra Manuel , Calabuig Maria Asuncion Sancho , Climente Mónica , Estañ Nuria , Molina Mariola D , Molina Pablo
Published: June 2023

Background and Aims

Hemodiafiltration with regeneration of the ultrafiltrate (HFR) is a highly biocompatible dialysis technique that combines convection, diffusion, and adsorption. SUPRA-H is a new HFR system which uses a high-flux dialyzer in the diffusive stage to improve large uremic toxin removal. The aim of our study was to compare the toxin removal of the SUPRA-H system with high-volume online-hemodiafiltration (OL-HDF).

Method

In an open, randomized, cross-over, single-center, controlled study, 16 adult chronic hemodialysis patients were treated with SUPRA-H or OL-HDF. Hemodialysis sessions were delivered with Flexya dialysis monitor (Medtronic) in the middle-week session, lasting four hours. OL-HDF session was performed in post-dilution mode with the same high-flux dialyzer (Phylter HF17G, Medtronic) as that used in the diffusive stage of the SUPRA-H system. All other dialysis parameters were kept constant in both study arms. The reduction rate (RR) of urea, creatinine, phosphate, β2-microglobulin (β2mglob), kappa (κFLC) and lambda (λFLC) free light chains, interleukin-6 (IL-6) p-Cresyl sulfate, indoxyl sulfate and albumin, was intraindividually compared for the two dialysis types with linear mixed models.

Results

Whereas urea RR was significantly lower, SUPRA-H had significantly higher RR for κFLC (Median: 58.63%, IQR: 49.91-70.24) than those obtained with OL-HDF (Median: 51.97%, IQR: 37.12-62.71); p = 0.03). The RRs for the other large and protein-bound uremic toxins tended to be higher with the SUPRA-H system (Figure 1). There were no significant differences in the RRs for creatinine, phosphate, IL-6, and albumin.

Conclusion

The new HFR system SUPRA-H, appears to be a potential technologic step ahead in terms of improved large molecule removal for dialysis patients, and might contribute to a more adequate dialysis therapy.
#6352 CLINICAL AND MOLECULAR SPECTRUM OF V-LESION
Authors: Buxeda Anna , Pérez-Saéz María José , Huacon Betty Odette Chamoun , Gimeno Javier , Rodriguez Irina Torres , Pascual Julio , Mengel Michael , Adam Benjamin , Crespo Marta
Published: June 2023

Background and Aims

Isolated v-lesion is an increasingly recognized but clinically challenging entity. Some studies suggest that isolated v+ early post-transplant may be caused by non-alloimmune etiologies such as ischemic injury. We aimed to characterize the allograft outcomes of isolated v-lesions according to post-transplant time (early: ≤1 month vs. late: >1 month) and further understand the significance of this lesion by characterizing its molecular phenotype in comparison with other forms of rejection v+.

Method

The NanoString B-HOT panel (770 genes) was used to measure the expression of six literature-derived gene sets in 92 archival FFPE kidney biopsies from two centers, including transplant biopsies with isolated v-lesion (n = 23), antibody-mediated rejection (ABMR) with v+ (n = 26), pure T-cell mediated rejection (TCMR) with v+ (n = 10), mixed rejection v+ (n = 23), and normal implant biopsies (Normal, n = 10). The evaluated gene sets included transcripts previously associated with ABMR, DSA (DSAST), endothelial injury (ENDAT), TCMR, early injury, and late injury. Gene expression was compared between groups using principal component and class comparison analyses. Death-censored graft survival according to diagnosis and time after KT was assessed.

Results

Isolated v+ early conferred the worst death-censored graft survival one year after the biopsy (40%) when compared to isolated v+ late (100%) or other forms of rejection (≥82%, p = 0.034). The principal component analysis demonstrated significant molecular overlap between sample groups (PC1: 29.4%, PC2: 8.1%). However, gene set analysis showed lower expression of TCMR-related genes in isolated v+ groups compared to TCMR and mixed rejection (p<0.001). Both Isolated v+ early and late had lower ABMR-related genes than ABMR, mixed rejection, and TCMR groups (p ≤ 0.022). Moreover, isolated v+ late showed lower DSAST and ENDAT gene set expression than ABMR (p ≤ 0.046); and lower early injury gene set expression than isolated v+ early, ABMR, TCMR, and mixed rejection (p ≤ 0.026). Late injury gene set expression was highest in TCMR and mixed rejection compared to the other groups (p ≥ 0.034).

Conclusion

These results suggest that early and late isolated v+ lesions display lower expression of TCMR-related genes than TCMR and mixed rejection and lower expression of ABMR-related genes than ABMR. Isolated v+ early confers a bad prognosis and is associated with higher expression of early injury genes compared to isolated v+ late, suggesting a different ethology.
#6368 PLATELET TO LYMPHOCYTE RATIO AND SICKLE CELL NEPHROPATHY
Authors: Kabasele Dieu Merci Betukumesu , Michel Aloni , Orly Kazadi , Ehungu Gini , Mbenza Longo
Published: June 2023

Background and Aims

Platelet-to-lymphocyte ratio (PLR) was introduced as cheap and readily assessed biologic markers of subclinical inflammation in sickle cell disease. Microalbuminuria and hyperfiltration, early markers of Sickle cell nephropathy (SCN) have been reported to be associated with platelet-to-lymphocyte ratio (PLR). This association has not yet been assessed in Congolese Sickle cell disease (SCD) children. Therefore, the aim of the present study was to assess the association between PLR and early markers of kidney disease in SCD children living in the Democratic Republic of Congo (DRC).

Method

In this cross-sectional study, we have investigated 175 SCD children from four centers (Kinshasa university clinics, CMMASS, CMD Diamand, and Biamba Marie Mutumbo Dikembe) that give a comprehensive care to SCD patients. The PLR were calculated from full blood count. Elevated albuminuria and hyperfiltration, as the main outcomes of the study, were defined by urinary albumin/creatinine ratio (ACR) ≥30 mg/g and estimated glomerular filtration ratio (eGFR) >130 ml/min per 1.73 m2 for females and >140 ml/min per 1.73 m2 for males, respectively. Logistic regression analysis was used to assess the relationship between RPL and early sickle cell nephropathy.

Results

Of the 175 SCD children enrolled, 41(23.4%) and 67(38.3%) of them presented with abnormal albuminuria and hyperfiltration, respectively. RPL >130 was observed in 90 (51.4%) patients. RPL was strongly, significantly and independently associated with both abnormal albuminuria (aOR 3,381; IC95% 2, 22-1, 63; p = 0,000) and hyperfiltration (aOR 2, 19; 95%IC 2, 98 - 22, 25; p = 0,010).

Conclusion

The present study has shown that nearly fifty two out of one hundred SCD children bear a high platelet to lymphocyte ratio that is strongly and significantly associated with early markers of kidney disease.
#6419 PYTHON LANGUAGE TO APPLY DATA SCIENCE METHOD TO DAILY DIALYSIS PATIENT CARE
Authors: Donini Ugo , Donini Sara
Published: June 2023

Background and Aims

Python is a high-level programming language. It was created by Guido van Rossum in 1991 and it is known for being user-friendly thanks to a readable code and a clear syntax. Python is widely used in scientific computing and big data analysis. Dialysis monitors can collect and record a wealth of data concerning the patient during dialysis. The purpose of this study is: 1) writing a Python code that automatically processes dialysis data from a selected period and a) provides printouts with the most significant values acquired; b) prepares graphs to visualize the trend in the progression of the selected parameters over time. The printouts and graphs should help set up each dialysis session. 2) Stimulating the formation of a Python community within the nephrologists for the development of the data science style in daily practice.

Method

Hemodialysis sessions were carried out using monitors of Fresenius Medical Care (FMC) mod. 5008. FMC's Therapy Support Suite (TSS) application allows data obtained from the monitor and data entered by the nurse during the dialysis session to be saved on a dedicated server. TSS selected data are then exported to excel file. Using the open-source Python 3.9 program, with the support of Pandas, Numpy and Seaborn libraries, a code was written in order to: 1) load the excel file with the selected data, 2) isolate the data of interest, on a selected period of time, concerning patients currently on dialysis. 3) create the tables and graphs for individual patients to set up the current dialysis session.

Results

Running the Python script produces three main sheets to check body weight (W), hemoglobin (HB) values, and blood pressure (BP) values. Other parameters are also examined graphically, drawing the linear regression line of the main parameter and the superimposed plot of other parameters.

Conclusion

Data collected during individual dialysis sessions can provide valuable information about a patient's condition and help healthcare professionals make informed decisions about their treatment. Python and its libraries provide the nephrology community with an open source and easy-to-use tool to automatically process each patient's data scientifically. In daily practice this method helps better understand and evaluate the dialysis treatment.