bluuebunny/crossref_metadata_2025 huggingface dataset:
#267 “Surprise question”, malnutrition, frailty, and health-related quality of life in predicting mortality in a cohort of haemodialysis patients
Authors: Shoji Tetsuo , Mori Katsuhito , Nakatani Shinya , Morioka Tomoaki , Fujii Hisaka , Kimura Seiichi , Kabata Daijiro , Emoto Masanori
Published: May 2024

Background and Aims

“Would I be surprised if this patient died in the next year (or six months)?” This question by a medical staff is called “surprise question” (SQ) and the answer “no” (SQ-No) was shown to predict a higher risk of mortality. However, it is unknown what is intuitively assessed by this question. We examined whether SQ is assessing the patient's malnutrition, frailty, or self-perceived health-related quality of life in haemodialysis patients.

Method

We analysed data from 994 patients on maintenance haemodialysis who participated in the Osaka Dialysis Complication Study (ODCS). Attending nurses answered to SQ. Malnutrition was evaluated by Geriatric Nutritional Risk Index (GNRI). Frailty was assessed by a modified CHS criteria. Patient-perceived health-related quality of life was examined by SF36 physical component summary (PCS). The associations of these exposures with 5-year all-cause mortality (ACM) were analysed by Cox proportional hazards model.

Results

Median of age and dialysis vintage was 66 and 5.9 years, 35.8% were female, and 39.6% had diabetic kidney disease. The prevalence of SQ-No and frailty was 19.7% and 46.2%. Medians of GNRI and SF36 PCS were 96.3 and 46.2, respectively. During follow-up, 250 patients died. Each of SQ-No, a low GNRI, being frail, and a low SF36 PCS was a significant predictor of a higher risk for ACM independent of potential confounders. SQ-No remained a significant predictor after further adjustment for GNRI or frailty, but SQ-No was no longer significant when adjusted for SF36 PCS.

Conclusion

Predictive ability of SQ was closely related to SF36 PCS in haemodialysis patients. SQ by nurses appears to assess patient-perceived health-related quality of life rather than objectively assessed malnutrition or frailty.
#1587 Decreased NK cell-mediated cytotoxicity is associated with hypoalbuminemia in hemodialysis patients
Authors: Chiu Yen-Ling , Chuang Bing-Rong
Published: May 2024

Background and Aims

The significance of Natural Killer (NK) cells in cancer immunity and immunotherapy has garnered substantial attention. Impaired NK cell function can severely compromise the host’s immune system. End-stage kidney disease (ESKD) and hemodialysis (HD) are known among various factors contributing to NK dysfunction. Nonetheless, the precise mechanisms underpinning this phenomenon remain insufficiently elucidated.

Method

We conducted a comprehensive multivariate and comparative analysis of NK cell subtypes and surface receptors across different age and gender categories in healthy donors (HC). Furthermore, we compared these parameters in HD patients to healthy controls. Additionally, NK cell cytotoxicity between HD patients and HC is assessed. The study also examines the biochemical data in HD patients with varying levels of NK cell cytotoxicity.

Results

The analysis of NK cells in 44 HC reveals age-related increases in the proportions of total NK cells, CD56dim cells, and CD56dimCD16bright cells, accompanied by reductions in CD56bright cells and CD56dimCD16dim cells. Gender differences were not observed. Among 30 age-matched HD patients and 30 HC individuals, CD56bright cells increased, while CD56dim cells decreased in HD patients. As a result, premature aging-related NK cell phenotypes were not observed in HD patients. Nevertheless, HD patients exhibit reduced NK cell cytotoxicity across all four effectors: target ratios. Furthermore, a comparison within the HD patient group, distinguishing those with high and low cytotoxicity (7 in the former, 11 in the latter), reveals higher albumin levels in the high cytotoxicity group.

Conclusion

This study uncovers significant functional impairment in NK cell cytotoxicity between HD patients and healthy individuals. Impaired cytotoxicity among HD patients is attributable to malnutrition, possibly mediated by hypoalbuminemia. This research is the first to elucidate the connection between serum albumin levels and NK cell dysfunction in ESKD.
#1325 Patients reporting not “sleeping normally” are more likely to transition to in-center hemodialysis within 90 days of peritoneal dialysis start
Authors: Ficociello Linda , Lasky Rachel , Kraus Michael , Chatoth Dinesh
Published: May 2024

Background and Aims

Although there are many advantages to home dialysis therapies such as peritoneal dialysis (PD), many patients drop out of PD and transition to in-center hemodialysis (ICHD). Reasons for this transition are varied and may be multifactorial. The current analysis aims to assess whether self-reported abnormal sleep is associated with transition to ICHD within 90 days of starting automated peritoneal dialysis (APD).

Method

Patients initiating APD at any Fresenius Kidney Care dialysis clinic between 2017-2019 were eligible for inclusion in this retrospective database analysis (n = 11 668). Monthly, various health-related questions are asked to patients as part of routine care through a home therapy nursing assessment (HTNA). One question asks if the patient is “sleeping normally”. After removing patients without completed HTNA questions on sleep, there were 11 449 patients included. We assessed patients for the first 90 days of PD for transition to ICHD through survival analysis with other reasons for discontinuing PD treated as competing events.

Results

On average, patients were aged 57 (15) years with BMI of 31 (14.5) and 42% were female. Approximately 5% of patients described their sleep as not normal (553/11449) in their first HTNA. Patients who reported abnormal sleep had 4.4 times the rate of switching to ICHD when compared to patients who reported normal sleep (Hazard Ratio (HR): 4.4; 95% CI: 3.5-5.5, p < 0.0001). After controlling for case mix variables, the HR was 3.7 (95% CI: 2.9-4.7, p < 0.0001). Case mix variables included gender, dialysis vintage, age, race, ethnicity, body size, residual renal function, Charlson Co-morbidity Index, diabetes status, geographic region, size of PD program, insurance primary payor, relationship status, and primary language spoken.

Conclusion

Among patients dialyzing at home with APD, abnormal sleep may be a risk factor for transitioning from home therapy to ICHD. Identifying root causes of sleep disturbances may help to prevent modality change.
#2253 The gender influence on peritoneal membrane transport
Authors: Espada Paula Jara Caro , Fernandez-Vidal María , Capón Irene Martín , Gayo Lucia Rodriguez , Pérez Justo César Sandino , González-García Celia , Navarro Begoña Aguado , Herreo Inmaculada Tapia , Fernandez Julia García , Hermida Tamara Calleja , Ruiz Enrique Morales , Lozano Claudia Yuste
Published: May 2024

Background and Aims

The classification of peritoneal dialysis (PD) patients based on their peritoneal transport was introduced by Twardowski in 1987, analysing a cohort of 86 PD patients, where gender was not specified.

Method

Aiming to analyze gender differences in the interpretation of peritoneal transport outcomes, we completed a single-center cross-sectional study of 143 incident patients in PD between 2015 and 2022. We also, assessed differences in their follow-up outcomes until PD cessation (21.2 ± 17 months).

Results

We analyzed 143 patients (55.3 ± 15.5 years, 92% hypertension, 25.5% diabetic, Charlson index 5.9 ± 2.4 points), corresponding to 85 men (M) and 58 women (W). M were older (M 56.4 ± 15.4 years vs. W 53.7 ± 15.7 years, NS) and associated higher comorbidity (hypertension M 95.8% vs. W 86.4%, p = 0.04 and diabetes M 33.7% vs. W 13.6%, P = 0.007, NS on Charlson index) compared to W.

Creatinine transport in W is slower than in M (D/P Cr M 0.73 ± 0.1 vs W 0.69 ± 0.1, p = 0.017), but no differences in glucose transport were observed. Although most patients were classified as medium-high transporters, the percentage of M was significantly higher than W (H 71.1% vs M 52.6%). In our cohort, initial adequacy tests using incremental PD reveal that W have a higher total Kt/v (M 2.2 ± 0.5 vs W 2.8 ± 1.9, p = 0.021) attributed to a higher peritoneal Kt/v (M 0. 95 ± 0.41 vs. W 1.3 ± 1.1, p = 0.035) and renal Kt/v (NS). Despite W presented lower residual renal function (NS) and lower residual diuresis (H 1.5 ± 0.7 L vs. M 1.3 ± 0.6 L) compared with M.

There was no gender difference in average duration of PD (M 22.4 vs. W 21.5 months). However, most W ended PD to receive a kidney transplant (46.8%), while most M transitioned to haemodialysis (41.3%). Nineteen patients died during follow-up, with 68.4% being M (NS).

Conclusion

Differences in D/P Cr and normal distribution curves between M and W suggest significant differences in peritoneal membrane transport. Classical methods of assess PD quality and adequacy may need to be corrected by gender, further studies are needed to determine these differences.
#2490 Analyzing the morphology of mesothelial cells when exposed to peritoneal dialysis solutions
Authors: Masola Valentina , D'apolito Luciano , D'alessandro Angelo , Franchi Marco , Bonomini Mario , Capasso Giovambattista , Trepiccione Francesco , Onisto Maurizio , Prosdocimi Tommaso , Divino-Filho Jose Carolino , Arduini Arduino
Published: May 2024

Background and Aims

Glucose remains the predominant osmotic agent in peritoneal dialysis (PD), yet its prolonged use is associated with an inevitable decline in peritoneal filtration capacity. Persistent contact with glucose during dialysis can induce significant morphological and functional changes in the peritoneum. In this study, we explore the morphological alterations in mesothelial cells exposed to both conventional glucose-based PD solutions and an innovative biocompatible PD solution (XyloCore) containing L-carnitine and Xylitol.

Method

Met5A mesothelial cells were seeded and cultured on a polyester filter (with a pore size of 0.4 micrometers, Transwell, 12 well type, Millipore) utilizing a full medium. The impact of PD solutions, differentiating between glucose-based and XyloCore, was assessed on cells cultivated on transwells. These cells were exposed to PD solutions on the apical side and to culture medium on the basal side. The cells were then employed for proteomic and metabolomic assessments and were also fixed and scrutinized through scanning electron microscopy (SEM).

Results

Through unsupervised hierarchical clustering analysis, discernable proteomic distinctions emerged between wild-type (WT) cells (control) and cells exposed to either glucose-based PD solution or XyloCore. In SEM analysis, control cells exhibited a distinct flat epithelial appearance. Contrastingly, subjecting WT cells to treatment with a glucose-based PD solution induced significant alterations in cellular morphology. Notably, cells displayed elongated shapes, loosening of cell-cell contacts, and a consistent denuding of the culture surface. In contrast, XyloCore maintained a better cellular morphology and mitigated cell detachment.

Conclusion

Preserving the integrity of the mesothelial barrier is crucial for maintaining peritoneal ultrafiltration capacity. The findings suggest that glucose-based PD solutions trigger early morphological changes in cell shape and cell-cell contacts, likely stemming from alterations in cytoskeleton or adhesion molecules. The exploration of new osmotic agents in clinical practice holds paramount significance for the future of peritoneal dialysis.
#605 Shared decision-making intervention regarding dialysis modality in patients with CKD stage 5
Authors: Shin Ho Sik , Park Byung Hwa , Kil Song Yi , Kim Ye Na , Jung Yeonsoon , Rim Hark
Published: May 2024

Background and Aims

Patients with kidney failure must make complicated decisions about the dialysis modalities used either at home or in-hospital. Different options have varying levels of impact on patients’ physical and psychological conditions and their social life. The purpose of this study was to evaluate the implementation of an intervention designed to achieve shared decision making (SDM) in patients’ options for dialysis.

Method

SDM was performed after consent was written for stage 5 chronic kidney disease patients before dialysis, and 435 cases were performed in 408 patients from December 16, 2019 to June 30, 2021. Among these, 101 patients were compared by SDM measurement scale, patient satisfaction, disease recognition scale survey, and dialysis method.

Results

The average age of participants was 56 years, with a gender composition of 55 males (54.5%) and 46 females (45.5%). Following SDM, the final dialysis methods decided upon by patients and clinicians were peritoneal dialysis (67 patients, 66.3%), hemodialysis (22 patients, 21.8%), and kidney transplantation (1 patient, 1.0%). Looking at the items, “My doctor and I chose treatment together” (94% in the PD group, 87.5% in the HD group, P = .012) and “My doctor and I agreed on a course of treatment” (97% in the PD group, 81.3% in the HD group, P = .058), the group of patients that selected treatment with PD had a significantly higher percentage of positive answers of 4 points or higher in comparison to the group of patients that selected HD

Conclusion

Among participating patients, SDM was effective when used to decide on dialysis treatment, and patients were satisfied with the dialysis method decision process. On the disease awareness scale, those who participated in this project had relatively high positive and low negative perceptions, so it can be concluded that SDM was relatively effective. The implementation of SDM was helpful in selecting patients’ best dialysis methods, and SDM scale results were higher in the peritoneal dialysis group than in the hemodialysis group.
#2805 The effect of the COVID-19 pandemic on personal hygiene behaviours and the frequency of peritonitis in patients with peritoneal dialysis
Authors: Simsek Ezgi , Atas Dilek Barutcu , Tugcu Murat , Velioglu Arzu , Arikan Izzet Hakki , Asicioglu Ebru
Published: May 2024

Background and Aims

Peritonitis is the most important complication encountered in patients with Peritoneal Dialysis (PD). It is very important to follow the rules of personal hygiene to prevent peritonitis. The COVID-19 (Coronavirus Disease 2019) epidemic has led to the improvement of personal hygiene behaviours. In this study, we aimed to show the awareness created by the COVID-19 pandemic on personal hygiene behaviours in PD patients and to investigate the effect on the incidence of peritonitis.

Method

Fifty-two PD patients were included in our study. The personal hygiene behaviours of the patients were evaluated with a questionnaire consisting of 15 questions. The medical history, chronic diseases, height, weight and educational status of each patient were questioned. In addition, the averages of complete blood count and biochemical values of the patients before and after COVID-19 were noted and compared. The culture results of the patients who had peritonitis and the microorganisms grown were noted.

Results

Demographic characteristics of patients are summarized in Table 1. A significant difference was found in 11 personal hygiene behaviours, especially in the frequency of hand washing after the COVID-19 pandemic (p < 0.05). After the pandemic, there was a decrease in the rates of peritonitis, but no significant difference could be reached (22 (42.9%) vs. 7 (13.5%) peritonitis rates, p < 0.05). A decrease was also observed in gram (+) peritonitis case rates (Table 2). After the pandemic, the frequency of hand washing before attaching the transfer set (p = 0.014) and the frequency of daily/every other day dressing of the exit site (p = 0.026) were found to be higher in those who did not have peritonitis.

Conclusion

Due to a significant improvement in personal hygiene behaviours after the COVID-19 pandemic, a decrease in the rates of peritonitis and infection with gram (+) microorganisms was observed. In our study, it has been shown that the frequency of hand washing before attaching the transfer set and daily/every other day dressing of the exit site reduce the risk of peritonitis. Trainings for improving personal hygiene behaviours in PD patients should be expanded.
#2567 Protein-bound uremic toxins are better removed with short-daily Home Haemodialysis using low dialysate flow rate: randomized clinical trial results
Authors: Moya Mercedes González , Molina Mariola D , Castillo Belén Vizcaino , Beltrán Sandra , Quilis Aina , Peiró Julio , Pérez-Sánchez Laura , Martínez-Gómez María Amparo , Ureña Paula Gandía , Parra Manuel , Calabuig Maria Asuncion Sancho , Molina Pablo
Published: May 2024

Background and Aims

Short daily home hemodialysis (HDD) with low dialysate flow rate has been shown in recent years as an attractive alternative for portable dialysis home use. Although the effectiveness of the technique for volume control and elimination of small solutes and middle molecules has been demonstrated, data are scarce for the elimination of protein-bound uremic toxins. The aim of this study was to compare the reduction ratios (RRs) of p-cresol sulfate (pCS) and indoxyl sulfate (IS) in the Physidia HHD system with high-volume online-hemodiafiltration (OL-HDF) treatment.

Methods

In an open, randomized, cross-over, single-center, controlled study, 40 adult chronic HD patients were treated with a 2.5 h-length HD session with low dialysate flow rate with the Physidia HDD system, and a 4 h-length OL-HDF session in post-dilution mode during two successive weeks. During the sessions, pre-HD and post-HD plasma samples were collected and single and weekly RRs of pC and IS were intraindividually compared for the two dialysis types with linear mixed models.

Results

Whereas single-session RRs of p-CS and IS were similar in both groups, weekly RRs of both protein-bound uremic toxins were significantly higher with the short-daily HDD Physida system than those obtained with OL-HDF (Table 1).

Conclusion

The short-daily home hemodialysis using low dialysate flow rate with the Physidia system appears to be a potential technologic step ahead in terms of improved protein-bound uremic toxins removal for dialysis patients, and might contribute to a more adequate dialysis therapy than in-center high-volume online-hemodiafiltration (OL-HDF) treatment.
#1945 Comparative analysis of kidney transplantation modeled using precision-cut kidney slices and kidney transplantation in pigs
Authors: Moor Matthias , Nordström Johan , Burmakin Mikhail , Raki Melinda , Al-Saad Samer , Nowak Greg , Wennberg Lars , Patrakka Jaakko , Olauson Hannes
Published: May 2024

Background and Aims

Kidney transplants are at risk for so far unavoidable ischemia-reperfusion injury. Several experimental kidney transplantation models are available to study this injury, but all have their own limitations. Here, we describe precision-cut kidney slices (PCKS) as a novel model of kidney ischemia-reperfusion injury in comparison with pig and human kidney transplantation.

Method

Following bilateral nephrectomy in pigs, we applied warm ischemia (1 h), cold ischemia (20 h) and a reperfusion period (4 h) to one whole kidney undergoing transplantation to a recipient pig and, in parallel, established PCKS undergoing ischemia and modeled reperfusion. Tissues were analyzed using standard histopathology assessment by two blinded pathologists, and bulk RNAseq with gene set enrichment analysis with comparison to human kidney biopsy gene sets obtained from Gene Expression Omnibus.

Results

Histopathological assessment revealed the presence of some but not all morphological features of tubular injury in PCKS as seen in pig kidney transplantation. RNAseq demonstrated that the majority of changes occurred after reperfusion only, with a partial overlap between PCKS and kidney transplantation, with some differences in transcriptional response attributable to systemic inflammatory responses and immune cell migration. Comparison of PCKS and pig kidney transplantation with RNAseq data from human kidney biopsies by gene set enrichment analysis revealed that both PCKS and pig kidney transplantation reproduced the post-reperfusion pattern of human kidney transplantation. In contrast, only post-cold ischemia PCKS and pig kidney partially resembled the gene set of human acute kidney injury.

Conclusion

Overall, the present study established that a PCKS protocol can model kidney transplantation and its reperfusion-related damage on a histological and a transcriptomic level. PCKS may thus expand the toolbox for developing novel therapeutic strategies against ischemia-reperfusion injury.
#2819 The association between oral proteome and microbiome in kidney transplant recipients: 24-months prospective study
Authors: Ribas Ana Merino , Sampaio Susana , Araujo Ricardo , Azevedo Maria João , Alencastre Ines , Pestana Manuel , Ximénez-Embún Pilar , Muñoz Javier , Sampaio-Maia Benedita , Trindade Fabio
Published: May 2024

Background and Aims

Recent evidence observed changes in saliva composition and an oral dysbiosis in end-stage renal disease (ESRD) patients. Despite of that, the relationship between oral microbiome and oral peptidome in kidney transplant recipients (KTR) is still unexplored. Therefore, the aim of this study is to investigate the interplay between oral microbiome and oral peptidome in KTR from live kidney donors (LKD) and to analyze their relevance on the recovery of renal function.

Method

This prospective study enrolled 11 adult KTR/LKD pairs to whom saliva was collected before organ transplant/donation (T0) and at 6 (T6), 12 (T12), and 24 (T24) months after (dropout rate up to 45% at T24). Saliva microbiome was evaluated by throughput sequencing (16SrRNA gene) and low-molecular weight salivary proteome by LC-MS/MS analysis.

Results

The glomerular filtration rate (GFR) of KTR recover to normal levels after transplant. Oral microbiome of ESRD differ significantly from healthy donors (T0; p = 0.04), however these differences fade away progressively post-transplant, presenting only a slight difference at T6 (p = 0.046) but no differences at T12 and T24. Also, 21 proteins were found dysregulated in ESRD and after protein-protein interaction analysis were organized into two functional clusters: one mainly composed by cysteine protease inhibitors, and another mainly composed by metabolism-related enzymes (lactate dehydrogenase, catalase, and arginase-1). Almost all differences between LKD and KTR became elusive at 6 months. It was found an inverse correlation between Streptococcus and peptidyl-prolyl-cis-trans-isomerase-A, a protein with a strong chemotactic effect on leukocytes, and a positive correlation between Bergeyellaand cystatin-D (CST5), a cysteine proteases-protective protein. The remaining secreted cystatins (CST1/2/4), but not CST5 were found significantly correlated with GFR, suggesting that renal function recovery is paralleled related to an increase in oral cystatins. Also, an inverse relationship between Bergeyella and GFR suggests that the renal function recovery has implications in the composition of oral microbiota.

Conclusion

This study may provide relevant clues about the oral cavity-kidney axis dynamics and pinpoint potential markers of renal function impairment and/or recovery in KTR.
#856 Performance of ex vivo confocal microscopy in the assessment of Remuzzi score in preimplantation biopsies
Authors: Andujar Alicia Molina , Larque Ana Belen , Paredes David , Cucchiari David , Barnadas Esther , Diekmann Fritz , García-Herrera Adriana
Published: May 2024

Background and Aims

Confocal microscopy (CM) is a technique that generates digital images from fresh tissue samples with resolution comparable to that obtained with conventional stains. These images are digitally stained with Hematoxylin/Eosin-like. The clear advantage of this technique with respect to conventional staining is the speed in obtaining results which is of great importance in the donation process, as well as their digitalization. The aims of the present study were two: 1) to assess reproducibility for CM between two nephropathologist in preimplantation biopsies and 2) to describe the correlation between gold standard for preimplantation biopsies in our institution performed in frozen block and CM.

Method

Donor biopsies were reviewed according to Remuzzi score (RS) by on-call pathologist for frozen block and two nephropathologist for CM, blinded to the original frozen block report. The intraclass correlation coefficient (ICC) for every variable in RS was calculated for the two nephropathologists. Later, concordance between the techniques was evaluated by the κ index.

Results

We included 50 preimplantation biopsies between January and October 2023. Median donor age was 74 years (IQR 62-77.3), 56% were male, 74% had arterial hypertension and 24% had diabetes mellitus. Number of glomeruli were 23 (IQR 14.25-30.25). ICC was excellent for glomerulosclerosis (0.755) and total RS (0.787) and good for interstitial fibrosis (0.536), while fair for tubular atrophy (0.412) and poor for vascular narrowing (0.14). There was excellent agreement between frozen block and CM for interstitial fibrosis (κ 0.898) and global RS (κ 0.898) and substantial for glomerulosclerosis (κ 0.694) while it failed to moderate for vascular narrowing (κ 0.522) and fair for tubular atrophy (κ 0.37).

Conclusion

CM proved to have reproducibility between nephropathologists and comparability to our gold standard technique in evaluating preimplantation biopsies. The ease of acquisition of CM images suggests that it may be useful for rapid evaluation of graft histology.
#1155 Outcomes after kidney transplantation in anti-glomerular basement membrane disease
Authors: Brilland Benoit , Traversat Priscille , Dekervel Marine , Piccoli Giorgina , Assia Djema , Gatault Philippe , Thierry Antoine , Bertrand Dominique , Golbin Leonard , Anglicheau Dany , Duveau Agnès , François Augusto Jean
Published: May 2024

Background and Aims

Anti-glomerular basement membrane antibody disease-associated glomerulonephritis (anti-GBM-GN) can lead to end-stage kidney disease (ESKD), requiring replacement therapy with dialysis or kidney transplant (KT). Few studies evaluated the outcome of these patients after KT. Our aim was to describe, in comparison with a control group, the occurrence of the following events: delayed graft function recovery, graft survival, relapse, acute rejection, overall survival; and to study the risk factors associated with these events.

Method

This was a retrospective, multicenter (6 French centers), observational study including patients who received a KT between 2005 and 2023 for ESKD secondary to anti-GBM-GN. Each vasculitis case receiving a KT was matched with 2 controls, matched on gender, center, recipient age (±5 years) and transplant period (±1 year). Event-free survival and the associated risk factors were analyzed.

Results

126 patients were included, including 42 with anti-GBM-GN and 84 control patients. The median post-KT follow-up for vasculitis patients was 95 months. There was no difference in the occurrence of DGF between the groups (24 vs 18%, p = 0.5). There was no difference in graft survival when comparing both groups (78% vs 82% at 10 years, p = 0.48) (Fig. 1A). Only one patient experienced a relapse after KT (being anti-GBM negative at the time of transplantation). There was no difference in the incidence of acute rejection between the groups (p = 0.82). There was no difference in overall survival when comparing both groups (83% vs 89% at 10 years, p = 0.76) (Fig. 1B).

Conclusion

Kidney transplantation is an interesting option for patients with anti-GBM-GN: outcomes are similar to those of a matched population with similar occurrence of acute rejection, graft loss or death. Moreover, relapse rate is low. Comparison with a matched anti-GBM-GN population remaining on dialysis would be of interest to go further.
#725 Incorporating molecular rejection patterns to differentiate histologic activity and chronicity features in antibody-mediated rejection
Authors: Harmacek Dusan , Lopez Kai Castrezana , Weidmann Lukas , Rho Elena , von Moos Seraina , George Britta , Gaspert Ariana , Helmchen Birgit , Schachtner Thomas
Published: May 2024

Background and Aims

Biopsy-based transcripts associated with antibody-mediated rejection (AMR) hold promise as substitutes for C4d positivity, according to the Banff Meeting Report of 2022. However, incorporating histologic and molecular features of disease activity and chronicity is crucial to potentially guide patient management.

Method

We analyzed 365 kidney allograft biopsies by histology and the Molecular Microscope Diagnostic System (MMDx) at the University Hospital Zurich from July 2021 to November 2023. Histologic findings were classified according to Banff 2022 into (1) active AMR (n = 24), (2) chronic active AMR (MVI, n = 47), and (3) chronic AMR (n = 30). The corresponding histologic subgroups with DSA negativity were used for comparison.

Results

Fourteen out of 24 cases (58%) with active AMR, 28 of 47 cases (60%) with chronic active AMR, but only 1 of 30 cases (3%) with chronic AMR showed molecular AMR. Among cases with molecular AMR the sum of the fully-developed AMR-related (R5) and late-stage AMR-related (R6) phenotype scores was significantly higher in chronic active AMR compared to active AMR cases (p = 0.0017). This finding was even more pronounced in chronic active AMR cases with double contours (cg)>1 (p = 0.00062). Similarly, in the cases without molecular AMR the sum of the fully-developed AMR-related (R5) and late-stage AMR-related (R6) phenotype scores was higher in chronic active AMR compared to active AMR cases (p = 0.039) and more pronounced in cases with cg>1 (p = 0.008). However, rejection phenotype scores (R1-R6) among chronic AMR cases did not differ from DSA-positive or DSA-negative cases without microvascular inflammation (p = 0.705 for R5+R6).

Conclusion

Incorporating molecular rejection phenotype patterns may further differentiate disease activity and chronicity in cases with active and chronic active AMR by histology. However, molecular subthreshold findings do not appear relevant in chronic AMR cases.
#2414 Hypertension resolution after kidney transplantation is associated with better kidney transplant outcomes in patients with pre-transplant hypertension
Authors: Lee Kyungho , Kim Bong-Sung , Jeong Seoin , Jang Minyoung , Jeon Junseok , Shin Dong Wook , Lee Jung Eun , Huh Wooseong , Han Kyungdo , Jang Hye Ryoun
Published: May 2024

Background and Aims

Hypertension is prevalent in patients with advanced chronic kidney disease (CKD), and kidney transplantation (KT) can potentially improve hypertension. Although hypertension is expected to be resolved after KT in many recipients with pre-transplant hypertension, little is known about the hypertension resolution rate and its prognostic role in KT outcomes.

Method

We retrospectively identified KT recipients (between 2006 and 2015) who had pre-transplant hypertension using Health Insurance Review & Assessment Service and Korea National Health Insurance System. The recipients were categorized into two groups based on their post-KT hypertension status: “persistent hypertension” and “resolved hypertension”. Cox proportional hazard analyses were performed to assess the risk of death-censored graft failure and all-cause mortality with adjusting various clinical, immunological risk factors, and socioeconomic status.

Results

Among 11,342 KT recipients with pre-transplant hypertension, 8,233 (73%) remained hypertensive, while 3,109 (27%) experienced hypertension resolution after KT. Recipients with resolved hypertension had lower rates of delayed graft function and major comorbidities, including diabetes mellitus, ischemic heart disease, and stroke compared to recipients who remained hypertensive. After adjusting for multiple covariates, the resolved hypertension group had 0.59-fold (95% confidence interval [CI] 0.49–0.73) lower risk for graft failure and 0.59-fold (95% CI 0.48–0.73) lower risk for all-cause mortality compared to the persistent hypertension group. Subgroup analyses revealed that the protective effect of resolved hypertension on graft survival was more pronounced in females (P for interaction = 0.045), and on overall survival was weaker in recipients with diabetes (P for interaction = 0.033).

Conclusion

A significant proportion of patients experienced hypertension resolution after KT, which is associated with improved graft survival and overall patient survival. The post-KT hypertension status can be used as a prognostic indicator for predicting better outcomes in KT recipients with pre-transplant hypertension.
#3009 The impact of living donor hypertension on later function of kidney graft in kidney transplantation
Authors: Jaques David , Huegli Sophie , Grouzmann Noémie , Pasquier Théodore , Hirt Patricia , de Seigneux Sophie , Ponte Belen , Haidar Fadi
Published: May 2024

Background and Aims

Living donor (LD) selection is a crucial step in kidney transplantation (KTX). The impact of hypertension (HT) of LD on later kidney graft function remains insufficiently understood.

Method

We retrospectively reviewed recipients of LD KTX at a single tertiary center (Geneva University Hospitals, Geneva, Switzerland) from January 2003 to December 2021 with a follow-up until December 2022. LD blood pressure (BP) values obtained with office measurement and 24 h ambulatory BP monitoring (ABPM) were the main predictors, while recipients estimated glomerular filtration rate (eGFR) and proportion of kidney fibrosis on biopsies were the outcomes. Multivariate analyses were adjusted for the following pre-KTX donor characteristics: Age, gender, ethnicity, body mass index and eGFR.

Results

In total, 212 LD KTX recipients were included with LD mean age 51 ± 11 and 133 women (62.7%). According to European guidelines definition, 73 (34.4%) LD were hypertensive based on office BP. On a sub-group of 112 LD with ABPM, 64 (57.1%) were hypertensive. Systolic office BP was negatively associated with eGFR at 6 months, 1 year, 5 year and 10 year follow-up (p < 0.05 for all). Systolic office BP was positively associated with kidney fibrosis at 1 year follow-up (p < 0.05). Those associations were not significant after multivariate adjustment. Age at donation remained significantly associated eGFR and kidney fibrosis after multivariate adjustment (p < 0.05 in both models).

Conclusion

Based on our experience, a significant proportion of LD are hypertensive at kidney donation. While an adverse impact of HT on later kidney function and fibrosis could be measured, this effect seemed negligible after accounting for other more relevant clinical characteristics, with age at donation being decisive.
#2586 Time to event prediction of new-onset diabetes after transplantation in kidney transplant recipients using machine learning models
Authors: Szili-Torok Tamas , Suleja Agata M , Verbeek Max J , Guo Jiapan , Bakker Stephan J L , Tietge Uwe J F , de Borst Martin H
Published: May 2024

Background and Aims

New-onset diabetes after transplantation (NODAT) is a common and serious complication of kidney transplantation that contributes to long-term morbidity and mortality after the transplant procedure. Conventional methods may predict the risk of, but not time to developing NODAT. We aimed to develop a machine learning model that predicts the time to NODAT in kidney transplant recipients (KTR).

Method

Two large prospective cohort studies of stable KTR (inclusion >1 year after transplantation) from the University Medical Center Groningen were combined. Data collection took place between 2001 and 2003 for cohort A, and between 2008 and 2011 for cohort B, resulting in the inclusion of 750 KTR free of NODAT at baseline. To predict absolute time to NODAT, a bootstrap aggregating (bagging) approach was utilized which consisted of several extreme gradient boosting (XGBoost) models with the accelerated failure time (AFT) objective. The performance of the resulting bagging model was internally evaluated by assessing the concordance index (c-index) in 20% of the dataset not used for training.

Results

From the 750 KTR included, 76 (10.1%) developed NODAT during a median (interquartile range [IQR]) follow-up of 5.8 (4.7 to 9.2) years. The median (IQR) age was 51.2 (40.5 to 60.7) years and 342 (45.6%) of the KTR were female. During feature engineering, 18 features from 53 were selected. After hyperparameter tuning, model performance during internal validation was 0.84. Furthermore, SHapley Additive exPlanations (SHAP) values were used to estimate feature importance, which revealed that glucose, HbA1c, mean arterial pressure, cyclosporine concentrations and daily vegetable intake were the most important features.

Conclusion

The developed machine learning model shows good discriminative ability of time to NODAT prediction. Due to the methodology used, the model allows for flexible incremental learning, meaning that the bagging model can be retrained with additional data without compromising on performance.
#1860 Oral semaglutide in diabetic kidney transplant recipients: Evaluating effectiveness and safety
Authors: Singh Arshdeep Singh , Vigara Luis Alberto , Mozo Marta Alonso , Amaro José Manuel , Fernández Florentino Villanego , Alonso Myriam Eady , Márquez Maria Gabriela Sánchez , Chavez Cristhian Orellana , Garcia Teresa , Blanca María Auxiliadora Mazuecos
Published: May 2024

Background and Aims

Glucagon-like peptide 1 receptor agonists (GLP1-RA) have demonstrated cardiovascular and renal benefits in obese diabetic patients. However, the evidence for oral semaglutide in kidney transplant (KT) patients is very limited. Our study aims to analyze the effectiveness and safety of oral semaglutide in diabetic KT patients.

Method

Retrospective cohort study of KT with diabetes who started oral semaglutide in 3 Spanish hospitals (Puerta del Mar University Hospital, Jerez de la Frontera University Hospital and Puerto Real University Hospital) between December 2021 and December 2023. None of them had previously received subcutaneous GLP1-RA. Clinical and demographic variables were analyzed. Glomerular filtration rate (eGFR), proteinuria, and weight were collected at the start of the treatment and after 6 and 12 months. We analyze glycemic control, blood pressure, lipid profile and trough level, dose and C/D ratio of tacrolimus. Acute rejections (AR), de novo donor-specific antibodies (dnDSA) and adverse effects were documented. Parametric and non-parametric tests were performed according to the normality of the sample.

Results

In this period, 22 KT with DM started treatment with oral Semaglutide, of which 16 patients completed follow-up for 6 months and 11 patients for 1 year. Fourteen (63.6%) had developed post-transplant DM. The mean age was 61 years, and 77% were men. The mean baseline estimated glomerular filtration rate (eGFR) was 46.1 ml/min/1.73 m2, the baseline body mass index was 34.7 kg/m2 and the median KT vintage was 45 months. Three patients were on treatment with SGLT2i at the start of the drug. Variables compared during the follow-up are shown in Table 1. Four patients (18%) suffered gastrointestinal side effects. No dnDSA were documented during follow-up. One episode of AR was documented after drug initiation.

Conclusions

We show the longest series of oral semaglutide in KT patients. Our results support that it can be a good option for managing DM in KT, especially in obese patients.
#535 Roxadustat as a treatment of anemia after kidney transplantation
Authors: Beliančinová Monika , Blichová Tímea , Kleinova Patricia , Graňák Karol , Vnučák Matej , Dedinska Ivana
Published: May 2024

Background and Aims

Roxadustat is a recently approved hypoxia-inducible factor prolyl hydroxylase inhibitor that has demonstrated favourable safety and efficacy in the treatment of renal anaemia.

The goal of this study is to analyse the effect of roxadustat on the level of hemoglobin in a group of patient with chronic kidney disease with or without kidney transplantation.

Method

This is a monocentric study conducted on the patients of Transplant-nephrology department and/or Transplant-nephrology out-patient clinic of University Hospital Martin, Slovakia who have been treated with roxadusat since August 1st, 2022.

Results

33 patients were included in the study. The average follow up of treatment with roxadustat was 4.2 months. The following parameters were recorded at the baseline: age, gender, estimated glomerular filtration rate—eGFR (CKD-EPI), treatment with iron and level of iron in serum, level of C-reactive protein, level of hemoglobin, starting dose of Roxadustat.

We discovered a significant improvement in the levels of hemoglobin after one month of roxadustat treatment (P < 0.0001) and another significant improvement in follow-up (P ‚0,0373). There was no significant difference in eGFR, CRP or iron levels during follow up, so hemoglobin levels were not affected by inflammation or kidney function. In the next step the group of patients was divided based on history of kidney transplantation. Again, we confirmed significant improvement in hemoglobin levels in kidney transplantation group in first month of treatment (P < 0.0001) as well as in follow up (P < 0.0001). There was a significant improvement in hemoglobin levels in the first month of roxadustat treatment in the group of patients who did not undergo kidney transplantation (P = 0.0261). However, there was no significant difference between hemoglobin levels in month 1 and follow up in this group.

Conclusion

Roxadustat—as a new treatment option of anaemia for patients with chronic kidney diseases. Our first analysis confirmed that roxadustat is very effective not only in patients with CKD, but also in patients with anaemia after kidney transplantation.
#537 Proliferative glomerulonephritis with monoclonal immunoglobulin deposits: effects of pretreatment on posttransplant outcomes
Authors: El Ters Mireille , Daum Joshua , Barbir Elena-Bianca , Nasr Samih , Leung Nelson , Amer Hatem , Said Samar
Published: May 2024

Background and Aims

Proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) has a poor renal prognosis and a high rate of recurrence after kidney transplantation, up to 90%, typically within the first-year post-transplant. Nearly 50% of patients lose their renal allograft within 3 years of recurrence. It has been suggested that pretreatment therapy (with B cell depleting or plasma-cell directed therapy) can help prevent recurrence or modulate the course of disease post-transplant.

The aim of our study is to evaluate the effect of pretreatment therapy given within 6 months prior to kidney transplant on outcomes including PGNMID recurrence and all cause graft loss.

Method

Between 1996 and 2022, a total of 28 patients with biopsy-proven PGNMID as the cause of end stage kidney disease received a total of 31 kidney transplants. All patients had at least one year of follow-up data, for all but one patient this included surveillance kidney transplant biopsies completed at our center. Recurrence was defined histologically by immunofluorescence finding of monoclonal immunoglobulin deposits, independent of other histological or clinical parameters. The incidence of recurrence and all cause graft loss were analyzed by Kaplan-Meier plots.

Results

Median age of patients at transplant was 57 years, 87% were white, 65% were male, 74% received living donor transplant, 59% received thymoglobulin induction, 81% received maintenance with tacrolimus, mycophenolate, and prednisone. Median follow up time was 80 months. A total of 9 patients received pretreatment within 6 months of transplant, 8 received Rituximab and one received Daratumumab. The pretreatment group was generally younger at transplant (53 years vs 57 years) and had a shorter median follow up time (65 months vs 96.5 months), but neither were statistically significant. Overall recurrence rate was 78% for pretreatment and 91% for control, though difference in time to recurrence was not statistically significant (Fig. 1). The difference in all cause graft loss between groups was not statistically significant, however, none in the pretreatment group had graft loss by 60 months (Fig. 2). One patient who received daratumumab had no recurrence by 1 year post-transplant.

Conclusion

In kidney transplant recipients with PGNMID, pretreatment (primarily with rituximab) may be modulating the post-transplant course of disease. Further studies are needed to determine the extent of this effect and if plasma-cell directed vs B-cell directed therapy may be superior.
#2665 Acute kidney injury (AKI) and chronic kidney disease (CKD) in living kidney donors (LKD): time for a new “surgical” classification system?
Authors: Trevisani Francesco , Floris Matteo , Trepiccione Francesco , Capasso Giovambattista , Pani Antonello , Trevisani Francesco , Rigotti Paolo , Furian Lucrezia , Angioi Andrea
Published: May 2024

Background and Aims

Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD) represent two significant complications in patients who undergo radical (RN) nephrectomy in oncological patients. However, Living kidney donors (LKD) undergo a similar surgery, but kidney dysfunctions are rare. Our study aimed to investigate the incidence of AKI and CKD in a consecutive cohort of LKD.

Method

This multi-institutional study involved 256 kidney donors who performed RN between 2014 and 2021 in four tertiary care hospitals. Clinical and laboratory data were collected at baseline pre-surgery, six months after surgery, and then every 12 months for a five-year follow-up. eGFR was calculated with the CKD-EPI equation. Statistical analysis was performed using descriptive statistics and logistic regression.

Results

Descriptive analysis is reported in Table 1. Of note, the rate of AKI was high (85%), even though it was 100% of stage 1. At 12 months, LKD missed 27.9 ± 19.67 ml/min/1.73 m2, persisting stable at 60 months. 26% of patients developed CKD stage GIII, and 10% of patients lost about 30 ml/min/1.73 m2 from the baseline eGFR (Fig. 1 and Tables 1 and 2). The multivariate analysis (logistic regression) showed that age had a direct correlation with the risk of AKI (OR 1.057, p = 0.019), while the female sex was inversely correlated (OR 0.180, p = 0.006); on the other hand, age had a direct correlation with the risk of CKD (OR 1.15, p = 0.001), as well as eGFR before the surgery (OR 1,053, p = 0.027).

Conclusion

AKI and CKD affected a non-negligible percentage of LKD. However, it is remarkable that most LKD had a medium final eGFR >60 ml/min/1.73 m2 due to a healthy solitary kidney that worked properly, increasing its function by about 30% of its baseline capacity.