bluuebunny/crossref_metadata_2025 huggingface dataset:
#6660 HERPES ZOSTER IN LUPUS NEPHRITIS: AN UNDERESTIMATED COMPLICATION
Authors: Reggiani Francesco , Cardi Silvia , Tumminello Fabio , Calatroni Marta , Moroni Gabriella Luisa
Published: June 2023

Background and Aims

Herpes zoster (HZ) is a known complication of lupus nephritis (LN) because of the drug-related immunosuppression. In fact, high dose corticosteroids (CS) and immunosuppressive (IS) therapy are almost always used in this setting. Our aim is to evaluate the predisposing factors for the development of HZ in patients with LN.

Method

Retrospective cohort study on 292 LN patients. Demographic and clinical data are expressed as numbers or percentages in case of discrete variables, whereas, in case of continuous variables, they are expressed as median and interquartile range (IQR). The demographic characteristics have been analyzed with Mann-Whitney U test and Fisher's test where appropriated. A univariate and multivariate logistic regression has been performed to identify potential risk factors.

Results

The incidence of HZ in our cohort is 22.6% (66/226). The patients’ characteristics are shown in Table 1. HZ patients are older (54 vs 45 yo, p<0.001). No differences were found in the clinical characteristics at LN diagnosis, except for higher chronicity index in HZ patients (2 vs 1, p = 0.03). No difference was found in the initial IS therapy. Higher cumulative dose of CS was used in patients with HZ (48.9 vs 21.5 grams, p<0.0001). At univariate and multivariate logistic regression (Table 2) age, female sex, the presence of a proliferative form at renal biopsy (class III or IV) and cumulative CS dose greater than 100 grams are linked to a higher risk for HZ.

Conclusion

Incidence of HZ in our LN cohort is high (22.6%). HZ patients are older, while non-significative differences in clinical presentation or initial IS therapy are present. Age, female sex, the presence of a proliferative form at biopsy and greater cumulative CS dose seems to be a risk factor for HZ development in LN patients. According to these data and to the possible evolution of HZ infection in disseminated forms, HZ vaccination should be strongly recommended in LN patients.
#6677 RELATIONSHIP BETWEEN CARDIAC TROPONIN LEVELS AND ECHOCARDIOGRAPHIC PARAMETERS IN DIABETICS WITH ADVANCED CHRONIC RENAL DISEASE (ACKD)
Authors: Ordoñez Katherine Peña , Romero Pablo Pérez , Naranjo Paola Gabriela Donoso , Collado Natalia Santos , Blandino Maria Luisa Vidal , Prieto Francisco Javier Toro
Published: June 2023

Background and Aims

Cardiovascular disease is the leading cause of chronic kidney disease (CKD) death. On the other hand, elevated cardiac Troponin T (cTnT) levels are associated with cardiovascular events and mortality. Several studies have established an inverse association between CKD and cTnT, and knowledge of this association in diabetic patients would benefit their management. The objective of this study was to analyze the relationship between cTnT levels, renal function and echocardiographic parameters in diabetic patients with advanced chronic kidney disease (ACKD).

Method

A prospective study was carried out during one year of 180 patients attending for the first time for ACKD consultations, with an estimated glomerular filtration rate (eGFR) <30 ml/min/1.72 m2. The following data were analyzed: age, sex, diabetes, HBP, BMI, smoking, peripheral artery disease, coronary artery disease, non-age-adjusted Charlson index (non-age-CCI), eGFR by CKD EPI, ultrasensitive cTnT, Creatinine albumin ratio (ACR), C-reactive protein (CRP), ferritin, hemoglobin (Hb), ejection fraction (EF) and left ventricular hypertrophy (LVH), interventricular septum thickness (IVST) and left ventricular wall thickness (LVWT). Statistical tests were used according to the distribution of the variables.

Results

Baseline characteristics are summarized in Table 1. In the group of patients, when analyzing the presence or absence of diabetes, diabetic patients were significantly older, had higher troponin levels, a higher percentage of smoking, coronary artery disease, peripheral artery disease, non-age-CCI, IVST and LVH than non-diabetic patients. In diabetic patients, troponin levels correlated significantly with eGFR (0.03) and ACR (0.09), with ACR remaining as a predictive variable (0.003). It did not correlate with echocardiographic data. In non-diabetics, the correlation was significant with age and IVST and LVH (Table 2, Figure 1). In the multivariate analysis in diabetic patients, only the association remained with ACR (0.026) and in non-diabetics with eGFR (0.038) and IVST (0.004).

Conclusion

The cTnT levels are found to be higher in diabetic patients and with higher ACR, considering it as a therapeutic target to reduce cardiovascular risk since echocardiographic data would not discriminate this risk in this profile of patients.
#6693 INCREASED INFILTRATION OF LRG1+VCAN+LY6CHIGH MACROPHAGES ARE ESSENTIAL CONTRIBUTORS TO KIDNEY INJURY IN ADR MICE
Authors: Chen Qilin , Jiang Yaru , Zhong Jinjie , Feng Xiaoqian , Jiang Huimin , Wan Junli , Peng Liping , Wang Mo , Yang Haiping , LI Qiu
Published: June 2023

Background and Aims

The ADR mouse model is a well-established rodent model of FSGS that can manifest with albuminuria. Resident macrophages are present in the tubulointerstitium of the kidney, and circulating macrophages can be recruited to the kidney in disease states. However, the presence of macrophages in glomeruli and the role of macrophages in podocyte injury in ADR mouse models remain unknown.

Method

Single-cell RNA sequencing comprehensively characterized the expression of macrophages in mice glomeruli. Eight-week-old male BALB/c mice were used to induce ADR model. Immunofluorescence was used to detect the changes of renal macrophages after injected with ADR at different time points. Transwell co-culture system were used to detect the effect of Lrg1+Vcan+Ly6Chigh macrophages on MPCs. HCH6-1,the FPR1 inhibitor were used to restrain ANXA1-FPR1 pathway.

Results

Totally 506 macrophages were sequenced and Lrg1+Vcan+Ly6Chigh macrophages were significantly increased in ADR induced nephrotic mice glomeruli (P<0.01). The ligand receptor relationship between podocytes and macrophages were changed(P<0.01, means>1). Immunofluorescence demonstrated that macrophages are present in ADR glomeruli(P<0.05). However, the temporal and spatial changes of macrophages in ADR glomeruli still need to be proved by further experiments. After co-culture of Lrg1+Vcan+Ly6Chighmacrophages and MPCs, the expression of nephrin in MPCs decreased(P<0.05), which proved that macrophages can cause podocyte injury. In ADR group, the ANXA1-FPR1 signaling pathway was activated, and renal Lrg1+Vcan+Ly6Chighmacrophage infiltration, albuminuria and renal injury were reduced in ADR+HCH6-1gruop (all P<0.05).

Conclusion

Lrg1+Vcan+Ly6Chighmacrophages are recruited into mice glomeruli by activation of ANXA1-FPR1 signaling pathway and cause the damage of podocyte.
#6695 THE ROLE OF A DEEP LEARING MODEL FOR EVALUATING HISTOPATHOLOGY OF ACUTE RENAL TUBULAR INJURY
Authors: Kim Hyeongwan , Yeom Ji-Hyun , Park Woong , Jung Yujin , Nguyen Thi Thuy Uyen , Shin Yujin , Lee Soojin , Kim Won
Published: June 2023

Background and Aims

Acute tubular injury is the most common intrinsic cause in acute kidney injury. Histopathological diagnosis may help distinguish between different types of acute kidney injury and aid in treatment. Currently, there have not been any studies that uses deep learning model for assisting histopathological diagnosis in acute kidney injury. The aim of our study is histopathological classification and segmentation identified four structures of acute renal tubular injury based on deep learning models.

Method

We used injury classification model to evaluate the degree of renal injury (grade 0, grade 1 and grade 2) and segmentation model (glomerulus, healthy tubules, tubules with cast, and necrotic tubules) specifically to classify the tubular specific injury after cisplatin treatment. We trained a classification model using ResNet-18 to classify the grade of acute tubular injury and a segmentation model using DeepLabV3 with ResNet-50 backbone for four structures of the mouse PAS-stained histopathology of acute renal tubular injury.

Results

The classification algorithm achieved area under the receiver operating characteristics curve of 0.98, 0.77, and 0.80 for grade 0, grade 1, and grade 2, respectively. In segmentation model for four structures, the highest Intersection over Union and the Dice coefficient were obtained for the segmentation of “glomerulus” class, followed by the “healthy tubules”, “tubules with cast”, and “necrotic tubules” classes. The overall performance of the segmentation algorithm for all classes in the test set is Intersection over Union 0.7256, Dice coefficient 0.8185.

Conclusion

The predictive model by deep learning could identify the histopathological structures and classify the grade of renal tubular injury, and may contribute to a more effective evaluation of renal pathology.
#6727 INFLAMMATORY INTERSTITIAL FIBROSIS AND TUBULAR ATROPHY ARE ASSOCIATED WITH HIGHER EXPRESSION OF INTRAGRAFT GRANZYME-B+ AND PHOSPHOSMAD-3+ PROTEIN
Authors: Yadav Brijesh , Prasad Narayan , Agrawal Vinita , Agarwal Vikas , Jain Manoj
Published: June 2023

Background and Aims

Inflammatory Interstitial fibrosis and tubular atrophy (i-IF/TA) is a prominent histological lesion reported in late biopsy and poorly associated with graft survival. Cytotoxic T cell secrets Granzyme-B, which cleaves cytoskeleton protein, and activates pro-IL-1β, and TGF-β into their active form, leading to inflammation, fibrosis, and the apoptosis in target cell. The association of Granzyme-B+ cytotoxic T cell and phospho-SMAD-3 expression has been not explored in i-IF/TA in depth. Therefore, in this study, we aimed to determine the circulating and intragraft profiles of Granzyme-B+ cytotoxic T cell together with fibrosis pathway mediator p-SMAD-3 expression in renal transplant recipients (RTRs) patients with biopsy proven i-IFTA.

Method

The circulating frequency of CD3+CD8+Granzyme-B+ cytotoxic T (CTLc) was measured by the flowcytometry; serum and PBMCs culture supernatants Granzyme-B and proinflammatory cytokines TGF-β, IL-1β level by the ELISA, Intragraft Granzyme-B mRNA transcript expression by the RT-PCR and Granzyme-B+, pSMAD-3+ Cell was analyzed by the immunohistochemistry techniques. Independent T-test for continuous variables and Pearson correlation was applied for the different variables.

Results

The circulating frequency of cytotoxic-T cell (CD3+CD8+Granzyme-B+) in SGF vs i-IF/TA was (27.96±4.86 vs 23.19±3.85%, p = 0.011), CD3+T cell was (66.08±6.8 vs 65.18±9.35%; p = 0.68), CD3+CD8+T cell was (37.29±4.11 vs 34.68±5.43%; p = 0.28). Serum Granzyme-B level was in SGF vs IF/TA was (100.82±22.41 vs 130.32±46.60, p = 0.038 pg/ml), serum TGF-β level was (367.50±31.50 vs 318.81±48.39, p = 0.005), IL-1β level was (49.14±17.03 vs 63.69±23.13, p = 0.076). Intragraft Granzyme-B mRNA transcript expression in SGF vs i-IF/TA was (1.01±0.048 vs 2.10±1.02-fold, p<0.001). Granzyme-B+ cell/mm2 count was (0.40±0.69 vs 2.20±1.27; p = 0.001). The intragraft phosphorylated SMAD-3+ cell was (3.70±1.82 vs 6.73±3.21; p = 0.008). Fig. 1. The intragraft Granzyme-B+ cell count was positively correlated with pSMAD-3+ cell (r = 0.315, p = 0.047). The frequency of circulating CTLc was negatively correlated with urine proteinuria (r = -0.51, p<0.001), serum creatinine (r = -0.28, P = 0.007) and eGFR (r = -0.28, p = 0.037). While urine proteinuria was positively correlated with serum Granzyme-B level (r = 0.343, p = 0.001), intragraft Granzyme-B mRNA transcript expression (r = 0.38, p<0.001).

Conclusions

Higher intragraft Granzyme-B+ Cytotoxic T-cell and phosphoSMAD-3 positive cells are associated with i-IF/TA in RTRs.
#6744 SELF-ASSEMBLED FISETIN NANOPARTICLES WITH ENHANCED BIOACTIVITIES FOR EFFECTIVE HYPERURICEMIC NEPHROPATHY THERAPY
Authors: Ren Qian , Liang MA , Fu Ping
Published: June 2023

Background and Aims

The prevalence of hyperuricemia is rising rapidly around the world, and increasing evidence demonstrates that hyperuricemia is the independent risk factor for chronic kidney diseases (CKD) development and progression. Hyperuricemia-induced renal injury, namely hyperuricemic nephropathy (HN), is characterized by urate crystal formation, tubulointerstitial fibrosis and glomerulosclerosis, which would eventually progress into end-stage renal disease (ESRD). Up to now, the mechanism of HN remains unclear and the treatment still needs further exploration. Fisetin is a natural flavanol with potent antioxidative and anti-inflammatory properties and showed therapeutic effects in mice with HN. However, the poor water solubility, rapid metabolism, and low bioavailability of fisetin largely hampered its clinical application. Herein, we reported the simple and efficient preparation of fisetin-EGCG nanoparticles (EG/FIS NPs) based on a solvent-mediated disassembly/reassembly strategy.

Method

The fisetin nano-formulation (FIS/EG NPs) was prepared based on a general solvent-mediated disassembly/reassembly strategy. The physicochemical properties of FIS/EG NPs including morphology, specific surface area and pore size distribution, drug encapsulation rate and loading rate, intracellular distribution were characterized. The potential toxic effects of FIS/EG NPs on RAW264.7 and TCMK-1 cells were investigated by CCK-8. Meanwhile, the anti-oxidative and anti-inflammatory effects of FIS/EG NPs were detected in vivo and in vitro. In vivo small animal imaging was employed to assess the kidney accumulation of FIS/EG NPs. And finally, HN was induced to measure the effect of FIS/EG NPs in mice and PAS staining, Masson staining, RT-qPCR were used to explore underlying mechanisms.

Results

EG/FIS NPs with stable water dispersion was prepared by using a general solvent-mediated disassembly/reassembly strategy. EG/FIS NPs contains both features of fisetin and EG NPs, and displayed more potent free radical scavenging ability than fisetin and EG NPs. Meanwhile, it was found that both RAW264.7 and TCMK-1 cells were able to uptake EG/FIS NPs and no proliferation toxicity was observed in these two cell types after incubation with various concentrations of EG/FIS NPs. By in vivo and in vitro experiments, fisetin and EG NPs were shown to have synergistic effects in inhibiting LPS-stimulated NO production after encapsulation. Moreover, fluorescence imaging revealed that EG/FIS NPs preferentially accumulated in the injured kidneys of HN mice. Finally, it was observed that EG/FIS NPs exhibited enhanced therapeutic efficiency against HN due to the combined antioxidative, anti-inflammatory, and antifibrotic activities of fisetin and EG NPs

Conclusion

Collectively, these results suggested that EGCG-based nanocarriers might be a novel strategy for the development of therapeutic drugs for HN.
#6825 ECOLOGICAL APPROACH FOR KIDNEY REPLACEMENT THERAPY IN CRITICAL CARE: SLED MAY BE A STRATEGY
Authors: Sala Inês , Vida Ana Carlota , Lopes Liliana , Fernandes João , Madureira Anselmo , Castro Ana , Ferreira Cristina , Lobato Luísa
Published: June 2023

Background and Aims

Dialysis has an enormous environmental impact, not only for disposable consumables, but also for the water and energy consumption. Despite increasingly evidence regarding comparable outcomes between continuous kidney replacement therapy (CKRT) and slow low efficiency dialysis (SLED), ecological-based endpoints are not frequently evaluated. Literature in critical care concerning the environmental impact of these techniques is scarce. We aimed to determine the waste production, water and energy consumption in SLED and CKRT and identify the technique with higher environmental impact.

Method

We conducted a cross-sectional, observational, single-center study in patients with acute kidney injury requiring kidney replacement therapy admitted to an intensive care unit (ICU). We analyzed the waste weight of each dialysis technique (Fresenius Medical Care 5008 for SLED and Baxter Prismaflex for CKRT) before and after the treatment. We estimated the water consumption of a SLED session with a Qd of 300 ml/min for 8 hours and 12 hours sessions, considering a Reverse Osmosis (RO) system with a 50% rate water rejection and a CKRT session for an 80Kg patient, with a Qd of 1300 mL/h and a reposition solution flow of 500 mL/h. Both techniques included a disinfection volume of 14 L.

Results

A SLED session produced 1600 g of waste (1200 g was hazardous and 400 g was non-hazardous waste). A CKRT session produced 2700 g of waste, not considering the substitution solution volume, which can vary up to a maximum of 15000 g/treatment. Waste consumables for each technique are discriminated in Table 1. The unpurified water consume of 8-hours and 12-hours SLED treatment was 237 L and 345 L, respectively. For CKRT, we estimated a consume of 43.2 L a day and 129.6 L for a 72-hour treatment. SLED had an energy consumption of 5.71 kW and 8.43 kW, for 8-hours and 12 hours treatment, respectively. The CKRT consumed about 12 to 14.4 kW per day.

Conclusion

Our study highlights the quantity of waste produced, water and power consumption of dialysis techniques in the critical patient. CKRT produces more hazardous waste, that generates a larger carbon footprint. Hazardous waste cannot be recyclable and implies specific management and disposal, which is more expensive and laborious than non-hazardous. CKRT has also a higher power consumption due to treatment duration and technology used to generate electricity. SLED has higher water consumption, nevertheless, current strategies used in hemodialysis units could also be implemented in UCI to minimize this effect. For example, the rejected water can be reused to agriculture and toilet flushing; more efficient water purification system with a lower proportion of rejected water can also reduce water consumption. SLED has unequivocal clinical benefits in the critical patient and, from an ecological perspective, seems to be a more sustainable option.
#6827 DI(2-ETHYLHEXYL) PHTHALATE INDUCES RENAL PROXIMAL TUBULAR CELLS TO UNDERGO EPITHELIAL-MESENCHYMAL TRANSITION VIA AHR SIGNALING
Authors: Lee Wen-Chin , Tsai Kai-Fan , Lee Chien-Te , Kung Chia-Te
Published: June 2023

Background and Aims

Environmental factors account for the majority of identified risks associated with CKD of uncertain etiology (CKDu). Among the various environmental factors, plasticizer di(2-ethylhexyl) phthalate (DEHP) is widely used in modern life. The exposure to DEHP is extensive but mostly underestimated in the general population. The link between DEHP exposure and renal injuries has been scarcely reported but the underlying mechanisms are largely unknown. This study aimed to examine the mechanisms by which DEHP causes renal tubular injuries.

Method

Human proximal tubular cells (PTC), HK2 cells, were used as a cellular model to test the central hypothesis of this study. Cells were treated with various concentrations of DEHP at different time points. WST-1 assay was used to examine the impacts of DEHP on cell viability. Bright field microscopy and immunofluorescence were used to analyze the morphological evidence of epithelial-mesenchymal transition (EMT). Western blots were used to investigate the changes in the expression of EMT-related proteins and arylhydrocarbon receptor (AhR) signaling. Inhibitors of AhR signaling were employed to investigate the crucial roles of AhR signaling in DEHP-induced EMT in HK2 cells.

Results

By using WST-1 assay, we found that DEHP did not affect cell viability when the examined concentration was below 50 μM, which resembled the low-level environmental exposures. However, when the concentration was higher than 100 μM, DEHP reduced the cell viability in a dose-dependent manner. In response to DEHP, HK-2 cells changed from cuboid to spindle shape when cultured with DEHP (25 μM). This morphological evidence became evident when the treatment time was longer than 48 hours. At the protein levels, DEHP resulted in down-regulation of e-cadherin and upregulation of vimentin and α-SMA. DEHP also lead to upregulation of AhR. The inhibitor of AhR signaling, CQDP (chloroquine diphosphate) reversed the DEHP-induced EMT, which were evidenced by morphology and by the expression patterns of EMT-related proteins.

Conclusion

At cellular level, our results suggested that low-level environmental exposures of DEHP led to EMT in renal PTC via AhR signaling.
#6847 HEALTH-RELATED QUALITY OF LIFE AND SYMPTOM BURDEN IN YOUNGER AND OLDER HAEMODIALYSIS PATIENTS: A PROSPECTIVE COHORT STUDY
Authors: Van Oevelen Mathijs , Bonenkamp Anna , van der Sluijs Anita van Eck , Bos Willem Jan W , Douma Caroline , van Buren Marjolijn , Meuleman Yvette , Dekker Friedo W , Van Jaarsveld Brigit , Abrahams Alferso C
Published: June 2023

Background and Aims

Patients on haemodialysis generally report poor health-related quality of life (HRQoL) and a broad range of physical and emotional symptoms, but it is unknown if this differs between younger and older patients. We aimed to describe the trajectories of HRQoL and symptom burden of patients < 70 and ≥ 70 years old after dialysis initiation and to assess the impact of symptom burden on HRQoL.

Method

Incident Dutch haemodialysis patients were included between December 1st, 2017, and January 19th, 2019. HRQoL and symptom were measured with the 12-item Short Form Health Survey (range 0-100, higher scores indicate better HRQoL) and the Dialysis Symptom Index (range 0-150, higher scores indicate more symptoms and/or higher severity). Questionnaires were taken at the start of dialysis and after 3, 6 and 12 months. We used (multilevel) linear regression to examine the trajectories of HRQOL and symptom burden, and the impact of symptom burden on HRQoL.

Results

In 774 patients, the trajectories of physical HRQoL, mental HRQoL and symptom burden were stable. Compared with patients aged < 70 years, patients ≥ 70 years reported similar physical HRQoL (crude mean difference -0.61, 95% CI -1.86; 0.63, p = .33) but slightly better mental HRQoL (1.77, 95% CI 0.54; 3.01, p = .005) and lower symptom burden (-2.38, 95% CI -5.08; 0.32, p = .08) during the first year of dialysis. With increasing symptom burden, physical HRQoL declined more in older than in younger patients (β -.287 versus β -.189, respectively, p-value for interaction = .007). For mental HRQoL, this decrease was similar (β -.295 versus -.288, p-value for interaction = .847).

Conclusion

Older haemodialysis patients generally experience better mental HRQoL and a (non-statistically significant) lower symptom burden in the first year after dialysis initiation, compared to younger patients. However, their physical HRQoL declines more rapidly with increasing symptom burden, compared to younger patients.
#6857 MATHEMATICAL MODEL FOR ADVERSE CARDIOVASCULAR EVENTS RISK ASSESSMENT IN KIDNEY TRANSPLANT RECIPIENTS
Authors: Smaliakova Maria
Published: June 2023

Background and Aims

Kidney transplantation is the most cardioprotective method of renal replacement therapy. Nevertheless, cardiovascular diseases are one of the main reason of mortality of with functioning kidney graft. The aim is creation of a mathematical model for adverse cardiovascular events risk assessment in kidney transplant recipients (KTR).

Method

The study included 237 kidney transplant recipients whose age was 47.1±10.8 years. For three years of observation 79 (33.3%) patients had adverse cardiovascular events (CVE) (acute coronary syndrome, life-threatening rhythm disturbance, complicated hypertensive crisis). The comparison group was 158 (66.7%) recipients without cardiovascular events. The study groups were comparable by gender, age and traditional cardiovascular risk factors.

Results

The proportion of patients with obesity and the graft glomerular filtration rate less than 30 ml/min/1.73 m2 were higher in KTR with CVE than in KTR without CVE –– 27.8% (n = 22) versus 12.7% (n = 20) and 12.7% (n = 10) versus 3.2% (n = 5), p<0.01. p<0.01. The erythrocytosis and an increased NT-proBNP blood level was more common in KTR with CVE than in KTR without CVE – 29.1% (n = 23) versus 16.5% (n = 26), p<0.05 and 27.8% (n = 22) versus 11.4% (n = 18), p<0.01. KTR with CVE had a longer duration of chronic kidney disease than KTR without CVE – 21.1±12.2 years versus 16.6±9.6 years, p<0.01. Triglycerides and low density lipoproteins blood levels of KTR with CVE were higher than those of KTR without CVE – 1.70 (1.30-2.50) mmol/L versus 1.45 (1.08-1.80) and 2.97±0.88 mmol/L versus 2.61±0.69 mmol/L, p<0.01, respectively. was more common in KTR with CVE than in KTR without CVE. The above factors were included in the mathematical model.

$Y\; = \;\frac{1}{{\;1 + {e^{( {4,156 - 1,033X1 - 0,037X2 - 1,003X3 - 0,384X4 - 0,470X5 - 1,712X6 - 1,119X7} )}}}},$

X1 - body mass index > 30 kg/m2 (0 - no, 1 - yes),

X2 - duration of chronic kidney disease (years);

X3 - erythrocytosis (0 - no, 1 - yes),

X4 - triglycerides blood level (mmol/l);

X5 - low density lipoproteins blood level (mmol/l);

X6 - glomerular filtration less than 30 ml/min/1.73 m2 (0 - no, 1 - yes),

X7 - increased NT-proBNP blood level (0 - no, 1 - yes)

The formula predicts low risk of CVE in kidney transplant recipients with an estimated value of Y<0.35, with Y≥0.35 - high risk.

Conclusion

Obesity, graft dysfunction erythrocytosis, an elevated NT-proBNP blood level, longer duration of chronic kidney disease, higher triglycerides and low density lipoproteins blood levels can be used to assess cardiovascular risk in kidney transplant recipients.
#6868 MACHINE LEARNING-BASED HYPERTENSION DISEASE RISK CLASSIFICATION USING LEARNING VECTOR QUANTIZATION ALGORITHM
Authors: Fajar Rifaldy , Putri Sahnaz , Syafruddin Elfiany
Published: June 2023

Background and Aims

According to the World Health Organization, the disease dubbed as the silent killer of death is the number one cause of death in the world. Hypertension is a disease that does not show certain symptoms. There are about 95% of hypertension cases have no known cause, while the rest are caused by other diseases. Therefore, an early detection system for hypertension is needed. In this research, the Learning Vector Quantization (LVQ) algorithm is used to perform the classification process.

Method

In this research, the LVQ machine learning algorithm is used. LVQ is an algorithm that is a type of artificial neural network and uses neural computation. The data in this study is hypertension patient data from Sultan Daeng Radja Hospital which is divided into four classes. In the system design stage using the LVQ algorithm, the process in this system is by entering input data in the form of medical records consisting of 12 attributes based on their weights which will then be carried out by the LVQ process to produce classification results. If the classification results have been obtained, the system will stop. After the classification testing process is carried out, the accuracy calculation process is carried out.

Results

Based on six test scenarios that have been carried out, the system produces recommendations for a value of 0.1 for the learning rate, a value of 0.2 for the learning rate multiplier, the amount of training data of as much as 50%, the maximum epoch value of six, the minimum value of alpha 0.001. From these values, the average accuracy result obtained is 94%.

Conclusion

Based on the value of accuracy results obtained exceeding 90%, the system can be done quite successfully in detecting hypertension. However, further research is needed to further develop the system.
#6880 PREDICTION OF GRAFT SURVIVAL PRIOR TO ACCEPTING AN OFFER FOR LIVING DONOR KIDNEY TRANSPLANT: AN ARTIFICIAL INTELLIGENCE APPROACH
Authors: Ali Hatem Kaies Ibrahim Elsayed , Burke Bernard , Mohamed Mahmoud , Briggs David , Krishnan Nithya
Published: June 2023

Background and Aims

The current available models for evaluation of outcomes of living donor kidney transplant before accepting an offer are poorly developed, reported, validated and have small sample sizes. We aim to use Artificial Intelligence to build a model that can accurately predict death censored graft survival for living donor kidney transplant prior to accepting an offer.

Method

All living kidney transplant patients who were: registered in the UNOS database between 1/1/2007 and 1/6/2021, maintained on TAC/MMF immunotherapy were included in our analysis. We excluded patients with age<18 years old and ABO incompatible transplant. We divided the data randomly into training and testing dataset with ratio 80:20. We performed recursive feature elimination to select the important ones for prediction. Features were selected based on their Gini impurity scores. We performed Artificial Neural Network analysis (ANN). We evaluated the model using Harrell Concordance-time-dependent score (for discrimination), and Integrated Brier score (for calibration). We also assessed dynamic AUC for model performance.

Results

54,110 living donor kidney transplant patients were included in the study. Harrell C-Statistic scores were 0.70 at 5 years post-transplant, 0.68 at 10 years post-transplant and 0.68 at 13 years post-transplant, indicating very high discrimination power. Integrated Brier Score was 0.08, indicating very high calibration score for our model. Dynamic AUC scores were 0.71 at 5 years post-transplant and 0.68 at 10- and 13-years post-transplant, indicating adequate performance for our model. The key players in our model were recipient age (variable importance = 0.26), donor age (variable importance = 0.17), donor ethnicity (variable importance = 0.90), followed by dialysis vintage pre-transplantation.

Conclusion

The ANN model had high discrimination, calibration, and performance indices for predicting death censored graft survival prior to transplant. It can aid the clinical decision for management of the transplant patients. We are currently developing a user-friendly web application that can be used to apply the ANN model for prediction. Our model can help ranking potential living kidney donors based on graft outcomes. Therefore, our model can help improve current outcomes of kidney paired exchange schemes.
#6905 PREVALENCE OF ANTIPLA2R ANTIBODIES IN EGYPTIAN PATIENTS WITH NEPHROTIC SYNDROME
Authors: Elsharkawy Magdy , Elsharabasy Reem , Megahed Mohamed , Emara Ahmed
Published: June 2023

Background and Aims

Primary membranous nephropathy (PMN), a common form of the nephrotic syndrome, is an antibody-mediated autoimmune glomerular disease. Autoimmunity is driven by circulating autoantibodies that bind to one or more antigens on the surface of glomerular podocytes. PLA2R antigen is the most common and prevalent one among these antigens. Anti-PLA2R antibodies are measured in serum and detected within biopsies of primary membranous nephropathy patients. Up to the moment, no clear data about the prevalence of AntiPLA2R antibodies associated PMN in Egyptian patients. The aim of this work was to study the prevalence of antiPLA2R antibodies in Egyptian patients with nephrotic syndrome underwent renal biopsy.

Method

In this cross-sectional study we recruited 70 adult patients presented with nephrotic range proteinuria to Ain-shams university hospital and a private nephrology center in Cairo during a period of 20 months (from March 2020 to October 2021). All patients first presentation for whom laboratory investigations including serum anti-PLA2R antibodies titer by indirect immunofluorescence and kidney biopsy were done. Anti-PLA2R antibodies were measured in serum, checked in biopsies and correlated with biopsy findings.

Results

Membranous nephropathy (primary and secondary) was found by biopsy finding in 25 of 70 patients (35.7%) presenting with nephrotic range proteinuria. 21 patients (84%) of the cases of membranous nephropathy had been diagnosed with primary membranous nephropathy and 4 (16%) had been diagnosed with secondary membranous nephropathy. Circulating anti-PLA2R antibodies were detected within serum in 9 (42.85%) of primary MN cases while detection of anti-PLA2R antibodies within the glomerular extracts of primary MN cases was much higher; 17 patients (80.95%). There was positive correlation between serum AntiPLA2R Antibodies titer and U PCR (r = 0.839, P = 0.005) (Fig. 1).

Conclusion

A we may conclude that, most patients with primary membranous nephropathy have anti-PLA2R antibodies. Detection of anti-PLA2R antibodies within the biopsy has higher sensitivity than serum (80.95% versus 42.85%). Specificity of PLA2R to primary membranous nephropathy is 100%. Patients with high anti-PLA2R titer had higher baseline proteinuria than patients with lower anti-PLA2R titer.
#2617 CHANGES IN PSYCHOSOCIAL HEALTH IN YOUNG ADULTS WITH KIDNEY FAILURE: A 5-YEAR FOLLOW-UP OF THE SPEAK STUDY
Authors: Al-Talib Mohammed , Caskey Fergus , Ben-Shlomo Yoav , Inward Carol , Hamilton Alexander
Published: June 2023

Background and Aims

Young adulthood is a sensitive developmental period, and the psychosocial impact of kidney failure in this group is implicated in the observed high risk for transplant loss and death. In the Surveying People Experiencing young Adult Kidney failure (SPEAK) study we described differences in life-course outcomes, worse mental wellbeing and twice the likelihood of psychological disturbance among UK young adults with kidney failure (transplant or dialysis) compared to the general population. There have been no longitudinal studies investigating the natural history of these outcomes as young adults mature and get older. We undertook SPEAK-2 as a five-year follow-up study to address this.

Method

In this prospective observational study, respondents to SPEAK were invited to complete a revised online survey. PPI guided components of the original survey to amend. We analysed how psychosocial health had changed among respondents between studies using the paired t-test, Wilcoxon signed-rank test and McNemar's test for continues parametric and non-parametric data, and binary data respectively. We compared responses to age-matched respondents of the Health Survey for England 2012 using regression. Responses were weighted to increase generalisability.

Results

We had 158 survey responses. The analysis of psychological health change over time is presented in Table 1. A greater proportion of participants had evidence of psychological morbidity (45% versus 24% in the original SPEAK study; p<0.001). They had inferior mental wellbeing (Warwick-Edinburgh Mental Wellbeing Scale [WEMWBS] β, -1.76; 95% CI, -3.27 to -0.25; P = .02). No differences were identified in domains including quality of life (EQ5D).

Key outcomes of the comparison to the age-matched general population are presented in Table 2. Respondents were less likely to be married or have children and were more likely to be living with their parents. They were almost 15 times more likely to report being unable to work due to health. Respondents had poorer quality of life and poorer mental wellbeing compared to the general population. They also five times greater odds of having psychological problems or mental ill health.

Conclusion

We report the first longitudinal study of the psychosocial health of a cohort of young adults with kidney failure as they age and mature. Over five years, we observed worse psychosocial health in terms of mental wellbeing and psychological morbidity. Respondents also lagged behind their peers in terms of life-course and psychosocial outcomes. Dedicated long-term follow-up is needed to clarify the extent and duration to which kidney failure in young adulthood impacts life participation and psychosocial health in the long term. Regardless, the degree of psychosocial ill health we have described warrants urgent increased support for this group.
#2665 EFFECT OF RENAL DENERVATION ON THE PLASMA LEPTIN CONCENTRATION IN PATIENTS WITH RESISTANT HYPERTENSION
Authors: Adamczak Marcin , Czerwienska Beata , Lelek Michal , Gojowy Damian , Mizia-Stec Katarzyna , Wiecek Andrzej Jan
Published: June 2023

Background and Aims

Leptin is mainly produced by adipose tissue and has hypertensinogenic properties. In patients with arterial hypertension, plasma concentration of leptin is higher than in healthy subjects. Percutaneous ablation of the sympathetic nervous system fibers located in the wall of the renal arteries by radio frequency waves (renal denervation - RDN), was introduced as a method of invasive treatment of resistant arterial hypertension. The aim of this single center, interventional, clinical study was to assess the effect of RDN on the plasma leptin concentration in patients with resistant arterial hypertension.

Method

Eighteen patients (9 women, 9 men) aged 53.2±6.5 years with resistant hypertension who underwent RDN using Simplicity catheters (Medtronic, Inc., Northridge, CA) were enrolled in the study. Plasma leptin concentration was determined using the Human Leptin RIA HL-81K (Linco Research, Inc., Missouri, USA) before RDN denervation and 6 months after RDN. Additionally, patients were divided into two subgroups: responders (systolic and diastolic blood pressure - BP reduction 6 months after RDN >25 mmHg and >12 mmHg, respectively; n=9) and low responders (systolic and diastolic BP reduction 6 months after RDN ≤25 mmHg and ≤12 mmHg, respectively; n=9).

Results

Systolic and diastolic BP was significantly reduced after RDN (196.6±28.2 and 162.9±15.6; p<0.001 and 117.9±26.4 and 90.7±8.6 mmHg; p<0.001, respectively). Body mass index (BMI) before RDN and 6 months after RDN was similar (31.0±4.4 and 31.3±4.4 kg/m2; P = .8, respectively). Mean plasma leptin concentration before RDN and 6 months after RDN did not change significantly in the entire studied group (27.2±14.3 and 24.6±13.1 [ng/mL], NS), as well as both in responders (29.9±14.4 and 28.2±12.9 [ng/mL, NS) and low-responders subgroups (24.4±14.7 and 21.0±12.9 [ng/mL], NS), respectively.

Conclusion

Renal denervation is effective in the treatment of patients with resistant hypertension, however this effect is not mediated by the influence on plasma leptin concentration.
#2708 THE EFFECT OF PERCEIVED TEMPERATURE ON THE MORTALITY IN CHRONIC KIDNEY DISEASE PATIENTS
Authors: Lim Chun Soo , Lee Jeonghwan , Lee Jung Pyo
Published: June 2023

Background and Aims

With the global warming, the interest in health risks from the high temperature exposure is growing. The perceived temperature is an equivalent temperature based on a complete heat budget model of the human body. We aimed to analyse the effect of perceived temperature on the overall mortality among patients with chronic kidney disease.

Method

A total of 32,870 patients with chronic kidney disease living in Seoul metropolitan region were recruited in a retrospective cohort (2001-2018). The perceived temperature during summer season (from July to September, at each year) was calculated using various climate factors including air temperature nearby automated weather station, dew point temperature, wind velocity, height of anemometer above ground, and total cloud amount. We assessed the association of perceived temperature using inverse distance weighting on mortality in patients with chronic kidney disease in the Cox proportional hazard model that was adjusted for sex, age, body mass index, estimated glomerular filtration rate, hypertension, and diabetes mellitus status.

Results

During the 6.14±3.96 years, 3,863 deaths (13%) were observed. We confirmed the significant effects of perceived temperature (average perceived temperature: hazard ratio [HR] 1.21, 95% confidence interval [CI] 1.18-1.23; minimum perceived temperature: HR 1.02, 95% CI 1.00-1.05; maximum perceived temperature: 1.20, 95% CI 1.18-1.22) on mortality among patients with chronic kidney disease in univariable analysis. In multivariable analysis, average perceived temperature (HR 1.22, 95% CI 1.19-1.25) and maximum perceived temperature (HR 1.20, 95% CI 1.17-1.23) showed increased risk for overall mortality among patients with chronic kidney disease.

Conclusion

Long-term exposure to high perceived temperature during summer season increased the risk of mortality among patients with chronic kidney disease.
#2947 COMPARISON OF TRACE ELEMENT CONCENTRATIONS IN PREDIALYSIS, HEMODIALYSIS AND PERITONEAL DIALYSIS PATIENTS
Authors: Koz Suleyman , Oguz Esin , Sayın Cagla
Published: June 2023

Background and Aims

Regulation of many trace elements (TE) is critically dependent on kidney functions. Dialysis modality, duration of dialysis, equipment, purity of water and nutrition also impacts TE balance. There are inadequate data on comparison of TE in patients with different stages of kidney disease.

We aimed to compare TE levels in a restricted geographical area across a wide range of glomerular filtration rate (GFR) including end stage kidney disease. We assumed that this kind of design might be beneficial for understanding TE balance and impact of dialysis.

Method

Hemodialysis (HD), peritoneal dialysis (PD) and chronic kidney disease (CKD) patients with reduced GFR were included in this cross-sectional study. A sample of plasma was analyzed by inductively coupled plasma mass spectrometry (ICP-MS) (Thermo Scientific™ iCAP Q ICP-MS, USA). Sensitivity was on the order of ppb (µg/L). A control group (CG) with glomerular filtration rate ≥ 90 ml/min were used for comparison of plasma levels of TE.

Results

Results of TE are presented in the Table 1. Significant number of both patients and controls lack a valid TE measurement because of the concentrations below limit of the detection (LoD). Copper, in CKD patients, is negatively correlated with hospitalization within the last six months (r= - 0,315, p= 0.005).

Conclusion

Our data suggest that TE levels except Zn and Mn deviate from that of CG in a statistically significant manner in renal patients. Existing data on TE in renal patients are inconsistent and there is some confusion. Similarly, our results are consistent with some data and conflicting with others. In future studies, this confusion could be eliminated by evaluating each trace element separately and minimizing methodological problems.

(This study is realized with support of Cumhuriyet University CUBAP)
#3008 SERENDIPITY OF SGLT2 INHIBITION – DIABETIC AND NON DIABETIC CKD
Authors: Godanci-Kelmendi Vjollca , Piraj Mimoza Ramadani , Ymeri Fatime , Konjufca Shega
Published: June 2023

Background and Aims

Ever since their therapeutic introduction, SGLT2 inhibition class of medicaments did impress physicians of related fields, nephrologists, internal medicine doctors, endocrinologists etc. Their natriuretic and glucoretic effects besides lowering the plasma glucose does produce a important effect on lowering intraglomerular pressure, this became an added value and a strong point to recommend these drugs on all CKD population irregardles the main cause of the disease.

Method

Observational retrospective study on 125 patients, three groups: G1 50 pt with diabetic nephropathy treated with empagliflozine vs control group G2 50 pt with diabetic nephropathy treated with other glucose lowering agents, and G3 25 nondiabetic pt with CKD and proteinuria treated with SGLT2i. Inclusion criteria was proteinuria and T2D for G1 and G2, and patients with proteinuria and CKD for G3. Patients with T1D and eGFR > 20 where excluded. Intervention - the SGLT2i drugs where started, median follow up 18 months. We followed on four periods creatinine levels, 24 hour proteinuria in g/24 h, HbA1c, cholesterol level, BMI.

Results

In our study the G1 showed a decrease in proteinuria average – 811 mg/24 h, serum creatinine showed increase on the first three months and it did get back to baseline afterwards, the eGFR increased + 15.44 ml/min; HbA1c decreased with -1.41%, levels, the reduction BMI – 0.9 kg/m2 and LDL cholesterol -1.11 mmol/l. G2 results decrease on 24 hour proteinuria with – 121 mg/24 hours, a drop on eGFR with - 3.3 ml/min, a drop on HbA1C – 1.45 %, - 0.3 mmol/l decrease on cholesterol level and average increase on BMI with + 0.8 kg/m2; G3 results on patients without T2D but with CKD different causes and proteinuria where: - 690 decrease proteinuria, + 14.4 increase on eGFR, HbA1C NA, we did have 2 cases that experienced hypoglycemic symptoms, both of them where improved with dose reduction, a – 0.9 decrease on cholesterol level and 0.3 kg/m2 was registered on our G3.

Conclusion

In our observation the 18 month follow up showed remarkable improve in kidney function tests, other benefits were noted such as optimal glycemic control, total body cholesterol lowering and a significant reduce of body weight expressed on BMI. Treatment with SGLT2i drugs does present a safe and efficient treatment modality for diabetic nephropathy and for all other CKD with proteinuria.
#3173 INCIDENCE AND RISK FACTORS OF SUDDEN CARDIAC DEATH IN END STAGE RENAL DISEASE PATIENTS UNDERGOING HAEMODIALYSIS: A RETROSPECTIVE STUDY
Authors: Khan Muhammad Tassaduq
Published: June 2023

Background & aims:

End Stage Renal Disease (ESRD) patients undergoing haemodialysis are prone to suffer from Sudden Cardiac Death (SCD). The present study was sought to evaluate the incidence and risk factors of SCD in ESRD patients on haemodialysis in Pakistani population.

Methods

The study recruited 202 eligible ESRD patients undergoing haemodialysis. Baseline characteristics of the study participants with and without Sudden Cardiac Arrest (SCA) were recorded using self-reported questionnaires. SCA and SCD events were identified by reviewing medical records and death certificates.

Results

Out of 202 patients, 37 (18.3%) suffered from the episode of SCA, 18 (48.6%) of which succumbed to death. ESRD patients who endured SCA were statistically older in comparison with their non-SCA counterparts (58.2 ± 11.4 vs. 52.3 ± 9.3 years, P<0.001). The HTN (67.6% versus 64.8%, P = 0.001), DM (62.2% versus 59.4%, P = 0.004), CAD (45.9% versus 41.8%, P = 0.001) and Congestive Heart Failure (CHF) (35.1% versus 34.5%, P = 0.002) were significantly prevalent in ESRD cohort with SCA in contrast to non-SCA. We also found LVH (62.2% versus 48.5%, P<0.001), ventricular tachycardia (51.4% versus 30.9%, P<0.001) and ventricular fibrillation/flutter (56.8% versus 25.5%, P<0.001) to be statistically higher in ESRD patients on haemodialysis with SCA event. Through multivariate logistic regression analysis, we evidenced hypokalemia (OR = 1.247, CI 1.214 – 1.278, P<0.001); CAD (OR 1.886, CI 1.469 – 2.342, P<0.001); LVH (OR 1.861, CI 1.392 – 1.953, P<0.001); ventricular tachycardia (OR = 1.253, CI 1.012 – 1.386, P<0.001); and ventricular fibrillation/flutter (OR = 0.547, CI 0.518 – 0.773, P<0.001) to be significantly and independently associated with SCD in ESRD patients on haemodialysis.

Conclusion

The prevalence of SCD among ESRD patients on haemodialysis with SCA episode is very high. CAD and ventricular tachyarrhythmias were statistically significant among ESRD patients on haemodialysis with SCA in comparison with non-SCA and were independently associated with the prevalence of in-patient SCD among ESRD patients with SCA on haemodialysis.