bluuebunny/crossref_metadata_2025 huggingface dataset:
#2697 Association between neutrophil-lymphocyte ratio and morbidity among patients on maintenance hemodialysis with ESRD from diabetic nephropathy
Authors: Olores Lovenia Anne , Darunday Grecia , Polito Eratosthenes , Maguad Ruben
Published: May 2024

Background and Aims

The prevalence of end-stage renal disease (ESRD) is on the rise in the Philippines, and the prognosis for ESRD worsens with the presence of diabetes mellitus. Although the neutrophil-to-lymphocyte ratio (NLR) is a dependable prognostic marker for mortality, its applicability as a prognostic biomarker in patients with diabetes and chronic kidney disease remains uncertain. This study seeks to establish the correlation between NLR and morbidity among Filipino patients with ESRD due to diabetic nephropathy undergoing maintenance hemodialysis. To determine the association between NLR and morbidity among Filipino patients on maintenance hemodialysis due to ESRD secondary to diabetic nephropathy.

Method

Among the 191 screened ESRD patients on maintenance hemodialysis, 71 were attributed to diabetic nephropathy, and only 63 met the inclusion criteria for the study. Clinicodemographic information, encompassing age, sex, height, weight, body mass index (BMI), medications, and comorbidities, was extracted from the medical records of these 63 eligible patients. Subsequently, the patients were categorized into two groups based on their baseline neutrophil-to-lymphocyte ratio (NLR) values, with a cutoff set at 3.5—forming the high NLR group (≥3.5) and the low NLR group (<3.5). This threshold was established considering data indicating that an NLR of ≥3.5 is associated with heightened inflammatory states, leading to increased morbidity. After a 6-month follow-up, data on the primary outcome measure, i.e., the occurrence of the disease, were collected.

Results

Out of the 63 patients assessed, the majority (n=39, 61.9%) had a baseline NLR value of <3.5, and only 2 individuals in this group developed a disease. The high NLR group comprised 24 (38.1%) patients, with 15 of them developing diseases. Among these cases, 4 (0.16%) had diabetic foot, 3 (0.125%) had pneumonia, 3 (0.125%) developed catheter-related bloodstream infections, and 2 (0.08%) had pulmonary edema. Additionally, 1 case each of coronary artery disease (0.04%), hypertensive emergency (0.04%), and calciphylaxis (0.04%) were observed. NLR demonstrated a significant association with clinical outcomes (p < 0.05).

Conclusion

In conclusion, there is a significant correlation between the neutrophil-to-lymphocyte ratio (NLR) and disease development in Filipino patients undergoing maintenance hemodialysis for ESRD attributed to diabetic nephropathy. Patients with a high baseline NLR exhibit an elevated inflammatory state and a greater susceptibility to developing disease conditions compared to those with an NLR<3.5. Therefore, a high baseline NLR can serve as a predictive indicator for prognosis within this specific population.
#2224 Higher serum level of indoxyl sulfate is not associated with increased abdominal aorta calcification in patients on maintenance hemodialysis
Authors: Pyatchenkov Mikhail , Shсherbakov Evgeniy
Published: May 2024

Background and Aims

Vascular calcification is strongly associated with an increase in all-cause and cardiovascular mortality, especially in patients with and stage renal disease. Results of numerous experimental studies have shown direct toxic effect of microbial-derived uremic toxins on vascular endothelial and smooth muscle cells which may contribute vascular calcification. Meanwhile, the effects of these metabolites on vascular remodeling in patients receiving dialysis treatment remains largely unclear. Here we aimed to investigate the relationship between serum level of the uremic toxin indoxyl sulfate and severity of abdominal aorta calcification (AAC) in patients on maintenance hemodialysis.

Method

This single-center, cross-sectional study included eighty (40 men, average age – 59,7±11,8 years) clinically stable patients receiving hemodialysis treatment for 52(21,3-120) months. 13(16,3%) participants had history of smoking, 27(33,8%) were diabetic, 63(78,8%) had high blood pressure, 17(21,3%) – previous history of ischemic heart disease, including 5(6,3%) suffered a myocardial infarction. Severity of AAC was determined by lateral lumbar radiography with Kauppila scoring. The total AAC score ranged from 0 to 24 points, and a higher AAC score indicated a more pronounced degree of calcification. Routine laboratory data were collected before hemodialysis session after fasting for 12 hours. Serum concentration of indoxyl sulfate was assessed by ELISA using commercially available kit (Cloud-Clone Corp., USA). Statistical analysis was performed with IBM SPSS Statistics 26 program. Non-parametric Spearman's rank correlation method was used to evaluate the associations between the studied parameters. Value of p <0.05 was considered statistically significant in all tests.

Results

Median serum indoxyl sulfate was 2,1(1,4-3,0) μmol/l (the same parameter in relatively healthy individuals without impaired renal function is 0,1(0-0,3) μmol/l, р˂0,001). Serum levels of calcium (Ca) was 2,27(2,1-2,5) mmol/l, ionized calcium (Ca++) – 1,15(1,1-1,3) mmol/l, phosphate (P) – 1,6(1,3-2,0) mmol/l, intact parathyroid hormone (iPTH) – 303(162,2-492,8) pg/ml, total cholesterol (TH) – 4,5(3,5-5,4) mmol/l, low-density lipoprotein (LDL) – 2,6(2,0-3,3) mmol/l. AAC score in hemodialysis participants was 4,5(0,0-9,0) and significantly correlated with age (r=0,693; р˂0,001), Ca (r=0,208; р=0,04) and iPTH (r=0,418; р=0,021) but not with other indicators, including indoxyl sulfate concentration (r=0,164; р=0,147).

Conclusion

Our preliminary results do not allow to consider the elevated level of indoxyl sulfate as a factor contributing to increased AAC in patients on maintenance hemodialysis. Further prospective studies in larger populations should clarify the true role of indoxyl sulfate in vascular remodeling in individuals with chronic kidney disease.
#784 Peritoneal dialysis-related infections by Kocuria kristinae: cases from a Mexican hospital
Authors: Ovando-Morga Daniel , Moreno-Hernández Carmen , Morelos-González Daniel , Hidalgo-Alquicira Francisco
Published: May 2024

Background and Aims

Kocuria species, gram-positive actinobacteria, are typically found in the environment, on human skin and as oral flora. These microorganisms are considered saprophytes and non-pathogenic. They rarely cause infections. Patients generally have some compromise due to underlying conditions, including solid tumors, hematologic malignancies, or metabolic disorders. There are few cases in the literature of peritoneal dialysis-associated peritonitis due to these germs. Reports of exit site infections or tunnel infections are even rarer or doesn't exist.

Method

Retrospective description of 4 cases of exit site and/or tunnel infections due to Kocuria kristinae over a 3-year period in a single center.

Results

Four cases of exit site infection were evaluated, with an average age of 63.2 ± 8.8 years. Half of the patients were diabetic. No patient had a history of peritoneal dialysis-related infection. The dialysis modality for all patients was CAPD (Continuous Ambulatory Peritoneal Dialysis). All patients presented symptoms of exit site infection, such as erythema and purulent discharge, but none of them had peritonitis. Three cases were treated with quinolones, and one received linezolid. One case received two antibiotic treatment regimens without an adequate response, and tunnel infection developed, required the removal of the dialysis catheter and a change in modality to HD (hemodialysis).

Conclusion

Exit site infections due to Kocuria are extremely rare. Despite the absence of specific management guidelines, the response to treatment is usually adequate. Due to the theoretical ability to produce biofilm, Kocuria infections should be considered a potential risk for recurrence and refractory disease. To our knowledge, there are no reports of exit site infections due to Kocuria.
#2361 The influence of glucose biocompatible solutions to the clinical outcomes of patients treated with continuous ambulatory peritoneal dialysis
Authors: Bulatovic Ana , Bjedov Jelena , Damjanovic Tatjana , Jankovic Aleksandar , Sakic Verica Todorov , Djuric Petar , Naumovic Radomir
Published: May 2024

Background and Aims

The use of biocompatible glucose solutions is associated with longer preservation of residual renal function and less frequent occurrence of complications in patients on peritoneal dialysis. The aim of this study was to examine the influence of conventional and biocompatible glucose solutions to laboratory parameters and clinical outcomes of PD patients during a four-year period at Zvezdara University Medical Center.

Method

This retrospective study included 25 incident patients treated with continuous ambulatory peritoneal dialysis (CAPD) during the follow up period from 2018 to 2022. During 2018/2019 these patients used conventional solutions (Dianeal PD4) containing lactate as a buffer, while due to the change in solution production technology in 2020/2021, all patients were transferred to a biocompatible solution (Physioneal 40) with lactate and bicarbonate as a buffer. Clinical outcomes were compared in relation to the administered solution: pain during infusion (measured by a Visual Analogue Scale—VAS), correction of anaemia and bicarbonate, average annual 24h diuresis and 24h ultrafiltration, occurrence of CAPD peritonitis. The statistical significance of the differences between the two periods was checked using the SPSS.

Results

The average age of 25 patients was 61 ± 14 years, of which 59.1% were male and 40.9% female. The average BMI was 28.5 ± 5.30 kg/m2, and the most common comorbidities were HTA and DM. No statistically significant difference was found for the values of Le, albumin, Hb, PTH, bicarbonate, and K (p ˃ 0.05). During the use of biocompatible solutions, patients had statistically significantly lower Na values (138.84 ± 2.63 vs 137.17 ± 2.41 mmol/l, p = 0.0116, 95% CI 137.15– 138.84) and lower CRP values (15.3 ± 3.3 mg/l vs 7.7 ± 3.2, p = 0.0003, 95% CI 18.60-4.50). Although the dialysis exposure was longer, the rate of peritonitis was lower during the use of biocompatible solutions, but without a statistically significant difference (0.40 episodes per patient-year, vs 0.31 episodes per patient-year, p ˃ 0.05). No statistical significance was found in 24h diuresis value (900 ml vs 750 ml, p = 0.167.95% CI 686.90–1203.31) but the value is expected to be lower due to dialysis duration.

Conclusion

Our study showed that patients treated with the CAPD method while using a biocompatible solution have statistically significantly higher values of 24h ultrafiltration, lower Na and CRP values and less occurrence of pain during infusion, which significantly affects the quality of life. Although this may indicate better preservation of the peritoneal membrane, a prospective and randomized study is needed to clarify these potential differences.
#2603 Focus on a crucial moment in decision making: evaluate peritoneal dialysis as incident renal replacement therapy
Authors: Najera Esther , Espinoza Karla Jackeline López , Ruiz Aránzazu Pardo , Bengoa Guillermo Pereda , Ovalles Altagracia Elisa Bello , Vargas Hermann Hernández , Sierra Milagros , Larrañaga Marta Artamendi , Pacheco Celia Garijo , Loza Emma Huarte
Published: May 2024

Background and Aims

Chronic kidney disease affects 10% of the world population (15.1% in Spain, ENRICA 2019 study), being a health problem with important physical, emotional, and socio-occupational repercussions.

Deciding on the most appropriate renal replacement therapy (RRT) for each patient, according to their lifestyle and family environment, represents a considerable challenge.

Peritoneal dialysis (PD) offers several benefits, including greater independence, preserved kidney function, less restrictive diet, and better adaptation to the patient's lifestyle. It also improves the capacity for self-training and learning.

Although kidney transplantation is the best RRT option, PD has demonstrated better quality of life, patient autonomy, and higher survival rates. Despite these advantages, PD as a technique for starting RRT represents 16.4% among incident patients in Spain, reaching 25% in our community, similar data to that of other northern European countries (ERA EDTA Report 2021).

Method

We carried out a retrospective descriptive study of patients followed in Advanced Chronic Kidney Disease (ACKD) over a period of five years (2017-2021). The inclusion criteria considered the acceptance of the technique in optimal candidates, with integrity of the peritoneal membrane and/or functional abdominal cavity, as well as the ability to learn the technique and family support.

The study aimed to assess the percentage of patients who, meeting optimal criteria for PD candidacy, successfully initiated the technique.

Results

The analyzed population consisted of 113 patients, 73.4% males, with a mean age of 77 years. 59% of ACKD patients were considered candidates, and of these, 73% (n 38) chose PD as the modality, successfully initiating the technique.

The main causes of abandonment or failure of the technique were:

Out of the 38 patients successfully initiating PD as RRT, 34% continued with this modality.

Conclusion

PD provides quality of life and autonomy to patients who choose this technique. Individualized and ongoing training through updated information is essential during this process, as it helps reduce most complications and reinforces patient autonomy.
#1820 Use of MiDiálisis App in peritoneal dialysis patients
Authors: Frías-González Aida , González-Bermudez Ana , Caro Jara , Bergesio Luca , Ruiz Enrique Morales , Bernardos Ana María , Yuste Claudia
Published: May 2024

Background and Aims

Technological innovation has revolutionized medical assistance. Peritoneal dialysis (PD) patients, who prioritize their autonomy and freedom choosing to undergo dialysis at home, are the paradigm of patients willing to use telemedicine. Remote monitoring allows real-time therapy supervision, ensures proper adherence and empowers the patients by promoting self-care and self-awareness The aim of this study is to assess the feasibility and acceptance of MiDiálisis App.

Method

MiDiálisis App, developed independently, integrates essential self-care data (such as blood pressure, ultrafiltration and weight), presenting it in real-time graphs and tables for both patients and nephrologists. It also allows asynchronous communication between them.

This is a prospective observational pilot study in which MiDiálisis App was offered to PD patients at a tertiary hospital.

Results

Out of the 10 patients offered the use of the MiDiálisis App, 3 did not use it (NU) due to technical issues. Seven patients used (U) MiDiálisis for a median of 9 [4-11] months. The majority were male (n = 6) and on automated PD (n = 6) for a period of 30 (15-38) months. We registered 6.3 (5.6-6.7) days with interaction/week.

NU patients were older (U 61 [54-69] years vs NU 68 [34-75] years, p = 0.5), with higher comorbidity Charlson index (U 5 [4-7] points vs NU 7 [3-9] points, p = 0.5), and greater Frail index (U 2 [1-2] points vs NU 3 [2-4] points, p = 0.067).

Six patients completed a survey after using MiDiálisis. 100% perceived a better communication with their nephrologist and greater accuracy of data compared to their previous method (paper-based recording). All of them entered the data by themselves and found both learning and using MiDiálisis to be easy; 83% considered the app beneficial for their health, and 100% felt secure using it. Furthermore, 67% reported significant changes in their self-care habits, and 83% mentioned an increased awareness of their health status. All participants would recommend it to other patients.

Conclusion

MiDiálisis App is applicable and has good acceptance among people undergoing PD. It might be a useful tool that can improve self-care, adherence, and communication with these patients.
#1439 Risk factors and significance of a reduction of serum albumin after start of PD
Authors: Finne Patrik , Vartiainen Heini , Bitar Wisam , Haapio Mikko , Helve Jaako
Published: May 2024

Background and Aims

A reduction in the serum level of albumin following the initiation of peritoneal dialysis (PD) has been reported to associate with impaired survival. Our aim was to identify pre-PD risk factors of drop of serum albumin, and to estimate how a decrease in albumin level affects PD patients’ survival prognosis.

Method

We included all adult patients who had been on PD for at least half a year in the Helsinki area in Finland during the years 2004 to 2019. Patients who had a dialysis history longer than 1 year before transferal to PD were excluded. We analysed the serum albumin level at start of PD and the last available albumin level before 6 months after start of PD. A 20% reduction of serum albumin was considered significant. Logistic regression was used to assess the association between risk factors (age, sex, primary kidney disease, comorbidities, laboratory variables) and a 20% drop of serum albumin. Cox regression was employed to study the effect of albumin drop on survival with adjustment for confounders.

Results

Of 379 patients, 80 (21%) showed a reduction of serum albumin of at least 20% after start of PD. High age, high albumin level at start of PD, high level of HDL cholesterol and low level of ionized calcium all associated independently with the risk of an albumin drop in the logistic regression analysis. The albumin level at start (hazard ratio 0.94 per one g/l increment, 95% CI 0.89-0.98) and a 20% or larger drop of albumin level (HR 2.3, 95% CI 1.4-3.9) were connected to impaired survival irrespective of each other. Other independent predictors of worse survival were high age, peripheral vascular disease, a history of stroke, and diabetes.

Conclusion

A drop of serum albumin after start of PD is frequent and associates with impaired survival. Drop of albumin is more common among elderly patients and those with high values HDL cholesterol or low levels of ionized calcium.
#1270 Exploring the shift in gut microbiota due to renal ischemia/reperfusion injury in rats
Authors: Hiroyoshi Toshiya , Hitaka Yukihiro , Isoyama Naohito , Shiraishi Koji
Published: May 2024

Background and Aims

Acute kidney injury (AKI) due to renal ischemia/reperfusion (I/R) is a major clinical problem in renal transplantation and partial nephrectomy, which is associated with morbidity and mortality and substantial healthcare expenditures, but there is no effective and specific treatment. Recently, the clinical impact of the interaction between gut bacteria and the kidney function has become increasingly clear. Experimental evidence has highlighted a bidirectional relationship between gut microbiota and kidney disease. Therefore, we investigated the possibility that I/R can ameliorate AKI by studying gut-renal interactions and gut microbiota in AKI.

Method

We induced varying degrees of renal I/R injury in adult male Wistar rats by clamping the left renal pelvis for 30 and 45 minutes, simulating mild and severe conditions, respectively. These samples were subjected to extensive histologic examination using standard techniques such as hematoxylin and eosin (HE), Sirius Red, and F4/80 staining. In addition, we performed a quantitative analysis of the mRNA expression levels of fibrotic and inflammatory markers in both kidney and colon tissues using real-time PCR. Gut microbiota genomic DNA was extracted from rat feces and microbial 16S ribosomal RNA (rRNA) gene sequencing was performed.

Results

Renal function deteriorated with increasing ischemia time and fibrosis progressed, as confirmed by Sirius Red staining and qPCR of fibrosis genes such as TGFB. The expression of inflammatory genes such as IL-1B and IL-6 was also increased. The expression of inflammatory genes such as Toll-like receptor, C3, and IL-1B in the intestine also increased with ischemia time. In the fecal microbiota, the total read percentage of Bacteroides acidifaciens at the species level increased with increasing ischemia time.

Conclusion

The observed shifts in gut microbiota composition may serve as a critical indicator of chronic kidney disease (CKD)-induced gut dysbiosis secondary to AKI. This finding highlights the need for further research into the identification and migration patterns of the gut microbiota, which represents a promising avenue for early detection, prevention, and therapeutic intervention in AKI. Future investigations elucidating the mechanisms by which the microbiota influence IRI-induced AKI and the development of practical therapeutic strategies have the potential to significantly improve clinical outcomes in patients suffering from IRI-induced AKI.
#426 “Predict-PD”: a machine learning tool to predict patient survival in peritoneal dialysis patients
Authors: Ali Hatem Kaies Ibrahim Elsayed , Baharani Jyoti , Hamer Rizwan
Published: May 2024

Background and Aims

With the rising prevalence of chronic kidney disease (CKD), particularly among the elderly, the need for effective renal replacement therapy has become increasingly crucial. Peritoneal dialysis (PD), recognized as a gentler alternative to haemodialysis, offers advantages in cognitive preservation and overall quality of life. Patient survival on PD, a tangible outcome measure, gains particular importance, especially in an aging demographic confronting end-stage kidney disease. Predicting survival thus becomes vital in facilitating individualized treatment planning and has implications on resource allocation and patient counseling.

Method

Our study analysed data from the UK Renal Registry and included 22 711 incident dialysis patients choosing PD between 2007 and 2022. Our objective was to employ Artificial Intelligence (AI) algorithms in developing an advanced risk stratification indicator with high predictive capabilities, specifically tailored for use in the United Kingdom's transplant selection procedure. We conducted experiments using three distinct machine learning models and evaluated their performance in terms of calibration and discrimination, utilizing metrics such as the integrated Brier score (IBS) and Harrell's concordance index. We assessed the potential clinical utility using decision curve analysis.

Results

The XGBoost model demonstrated excellent predictive efficacy for patient survival, with a concordance of 0.78. Further scrutiny revealed AUC values at 1 year (0.81), 3 years (0.78), and 5 years (0.77). The integrated Brier score, a comprehensive measure of predictive accuracy, was 0.09. There was no statistical difference between the actual and predicted survival probabilities (P = 0.72). Decision curve analysis accentuated the model's clinical applicability.

Conclusion

This study illustrates the potential of machine learning in prognosticating patient survival in PD, offering a pathway towards individualized patient-centric management in nephrology. The findings advocate for the integration of data-driven methodologies in clinical decision-making, paving the way for enhanced personalized care in CKD management and can serve as a guide for future research.
#1349 Importance of malnutrition and frailty in kidney transplant waiting list
Authors: Demirag Alp , Demirag Hayriye Nilgun Guvener , Vandergrift Julia , Mercimek Mehmet , Kline Vanesa
Published: May 2024

Background and Aims

Malnutrition and frailty predict postoperative complications. Recently, in an effort to assess nutritional status modified quantitative subjective global assessment (QSGA) systems have been devised in which scores are assigned for items or components of the SGA. This prospective study evaluated relationship QSGA and frailty assessment methods in patients waiting for kidney transplantation.

Method

We operated a fully quantitative scoring system consisting of 7 variables: weight changes, dietary intake, gastrointestinal symptoms, functional capacity, comorbidity, subcutaneous fat, and sign of muscle wasting. Each component was assigned a score from 1 (normal) to 5 (very severe). The sum of all seven components in this malnutrition score lies between 7 (normal) and 35 (severely malnourished). To evaluate frailty status, Short Physical Performance Battery (SPPB), Revised Risk Analysis Index (RAI), Karnofsky Frailty Score, Hand Grip Strength (HGS) methods were used. Three hundred and sixty patients (143 women and 217 men) were randomly selected from kidney transplant waiting list. Patients were aged between 21 and 82 years (56 ± 12.8) and had undergone hemodialysis for between 0 and 240 months (33.3 ± 34.6).

Results

The malnutrition score of each patient was assessed by a dietitian within 5-10 min. Pearson correlation coefficients showed positive correlation between the QSGA score and duration of hemodialysis (r = +0.52), age (r = +0.21), EPTS (+0.29) and RAI ((+0.25). QSGA showed negative correlation with Karnofsky score (r = −.30), SPPB (r = −.40), HGS (r = −.20). Multiple regression analysis showed a significant correlation between QSGA score and the combination of duration of hemodialysis, severity of RAI index, BMI and SPPB (R2 = 0.32, p = 0.00).

Conclusion

In addition to frailty assessment, the QSGA system may be additional method for evaluation of patients on the kidney transplant waiting list. More comparative studies are required to confirm the validity of this scoring system in nutritional evaluation of renal transplant candidates.
#2566 Clinicopathological and molecular characteristics of plasma cell rich rejection in renal transplant biopsies
Authors: du Long Romy , Florquin Marie Chevalier , Bemelman Frederike , Claessen Nike , Peters-Sengers Hessel , Florquin Sandrine , Kers Jesper
Published: May 2024

Background and Aims

Plasma cell rich rejection (PCRR) is an uncommon, ill-defined type of renal allograft rejection in the literature considered as a subtype of T cell-mediated rejection (TCMR). PCRR has poorer clinical outcome and is often refractory to classic immunosuppressive therapy. Our study analyzed In this study, we analyzed PCRR in a large cohort of patients who underwent renal transplantation at the Amsterdam UMC. Our objective was to study clinical, histological and molecular signatures of PCRR in comparison to other types of rejection, especially late presentations of TCMR and ABMR. We hypothesized PCRR could be a specific subtype of allograft rejection with different molecular and cellular characteristics compared to (late) TCMR and ABMR with differences in clinical outcome.

Method

We retrospectively scored and reclassified the last known biopsy of 263 renal transplant recipients, morphologically classified as rejection according to the 2019 Banff classification. mRNA expression analysis was performed using the Nanostring B-HOT panel on a subset of cases. PCRR was compared to (late) TCMR, ABMR and mixed rejection for renal function follow-up and graft survival.

Results

mRNA analysis revealed uniquely expressed genes in PCRR including LOX, CPA3, IL4, IL17F, and MMP12. PCRR is enriched for genes related to mast cells, memory B- and T-cells and transcripts involved in NK cells and allograft fibrosis with heterogeneity in gene expression in biopsies with PCRR. PCRR might be a late event compared to late TCMR and ABMR, with a higher degree of total inflammation and fibrosis. Graft survival and kidney function was similar to late TCMR and ABMR during a 5-year follow-up period after renal biopsy

Conclusion

PCRR represents a distinct late-onset stage of inflammation displaying diverse gene expression patterns, with presence of mainly mast cells, NK cells and transcripts involved in renal allograft fibrosis. Such insights could enable a better and more tailored treatment for these patients and ultimately enhance long-term graft survival for patients affected by PCRR. Clinical outcomes in patients with PCRR appeared similar to late TCMR and ABMR.
#3105 Tocilizumab for treatment of antibody mediated rejection in kidney transplant patients
Authors: Szabó Eszter , Marton Adrienn , Remport Adam , Török Szilárd , Patonai Attila , Piros László , Fintha Attila , Szijártó Attila , Wagner Laszlo , Cseprekal Orsolya
Published: May 2024

Background and Aims

Chronic active antibody-mediated rejection (caABMR) causes 40% of long-term graft failure after kidney transplantation (KT). Early treatment is of great importance, however, hard clinical evidence is still lacking. Currently the combination of plasmapheresis (PF), rituximab and intravenous immunoglobulin is used as standard treatment. Tocilizumab (TCZ) is a monoclonal antibody, IL-6 receptor antagonist, and it inhibits the production of donor-specific antibodies (DSA). We hypothesized that tocilizumab administration has an additional effect on graft survival and non-inferior to standard therapy in KT patients with ABMR.

Method

Retrospective single-center noninferiority case-control study was performed by involving 73 KT patients (43.5 ± 14.3 years, females 31, eGFR 19.5 ± 13.4) with biopsy proven ABMR diagnosed between June 2017 and May 2022. 19 patients received 8 mg/kg intravenous TCZ therapy for 6 months (12 aABMR, 7 caABMR, 38.6 ± 12.8 years, females 6). In the control group (C, n=54, 10 aABMR, 44 caABMR, 45.2 ± 14.5 years, females 25), 20 patients received plasmapheresis treatment, the rest stayed on optimized maintenance therapy (tacrolimus, mycophenolic acid, prednisolone). Baseline demographic data, standard laboratory data, proteinuria and DSA level were also monitored and analyzed.

Results

Graft loss occurred in 13 cases (6 aABMR, 7 caABMR) in KT on TCZ therapy and 43 (6 aABMR, 37 caABMR) in C group, meaning significantly lower risk of graft loss in the TCZ group (RR 0.69, p=0.036) during the median follow-up of 11.3 (IQR 2.5-23.1) months. In TCZ group, all caABMR patients lost their graft during the observation. In TCZ group, 1 year after the TCZ treatment, DSA (pooled) was lower (7028 (575-17782) versus 1605 (551-16903), p<0.05).

Conclusion

Early administration of TCZ seems to be noninferior to standard therapy and effective to prevent early graft loss as part of standard therapy in aABMR. Further clinical studies are needed to clarify clinical indications of TCZ and its long-term effects on the course of chronic active ABMR.
#1688 Association of baseline serum activin levels with left atrial diameter at 5 years post-kidney transplantation: results from the KNOW-KT
Authors: Kang Woo Jin , Koo Tai Yeon , Kim Beom Seok , Yang Jaeseok
Published: May 2024

Background and Aims

Serum activin A inhibits muscle growth, promotes apoptosis, and impairs heart function. However, the role of serum activin remains unclear in kidney transplant patients, where cardiovascular complications are a significant cause of morbidity and mortality. In this multicenter, observational cohort study, we investigated a potential association of pre-transplant serum activin levels with the left atrial (LA) diameter, an indicator of diastolic burden and a predictor of cardiovascular complications, to indirectly assess the impact of pre-transplant activin levels on heart function in kidney transplant patients.

Method

Overall, 602 kidney transplant patients from KNOW-KT (Korean cohort study for outcome in patients with kidney transplantation) were analyzed. Activin levels were measured at baseline immediately before kidney transplantation (KT). The primary outcome was the LA diameter that was measured by transthoracic echocardiography at 5 years after KT.

Results

The mean age of study population was 45.4 years and 221 (46.7%) patients were men. Pre-transplant serum activin levels were 718.4 ± 363.2 (mean ± standard deviation). When activin levels were divided into categorical variables according to the median value, the ejection fraction of LV showed a lower tendency in the high-activin group (64.3 ± 7.0) compared to the low-activin group (65.3 ± 6.2); however, there was no statistical significance (P=0.069). LV diastolic dimension was significantly higher in the high-activin group (47.3 ± 5.3) compared to the low-activin group (46.3 ± 5.5) (P=0.021). Notably, the post-transplant LA diameter was 37.0 ± 7.0 mm in the low-activin group and 39.1 ± 6.5 mm in the high-activin group, showing a significant difference (P<0.001). The multivariate linear regression coefficient for association between activin groups and LA diameter was 1.08 (95% confidence interval [CI], 0.67-2.10, P=0.037). In an additional logistic regression analysis of LA diameter groups, the high activin group was significantly associated with the high LA diameters compared to the low-activin group in multivariate analysis (adjusted odds ratio [OR], 2.04; 95% CI, 1.34-3.09, P=0.001). When activin levels were used as a continuous variable, adjusted ORs of activin for high LA diameters were 1.29 (95% CI, 1.04-1.60, P=0.018).

Conclusion

Pre-transplant serum activin levels were independently associated with a higher post-transplant LA diameter, suggesting that activin may negatively affect heart functions in kidney transplant patients. Therefore, activin may be a potential prognostic and therapeutic target in kidney transplant patients.
#3077 Activity and chronicity index as graft lost predictors in kidney transplant with antibody mediated rejection or isolated microvascular inflammation
Authors: Tarrega Carla Burballa , Morcillo Sofia , Buxeda Anna , Huacon Betty Odette Chamoun , Alari-Pahissa Elisenda , Sanz-Ureña Sara , Federico Judit , Redondo-Pachón Dolores , Pérez-Saéz María José , Crespo Marta
Published: May 2024

Background and Aims

Antibody mediated rejection (ABMR) is the major cause of graft lost in kidney transplant (KT) recipients. Banff classification considers active ABMR (aABMR) and chronic active ABMR (caAMBR) but does not consider isolated microvascular inflammation (iMVI). Considering histologic lesions in kidney biopsies (KB), activity (AI) and chronicity index (CI) have been developed. Only CI ≥4 has been associated to worse graft survival in ABMR, yet the prognostic value of AI and CI in iMVI is still unknown. Our aim was to evaluate chronicity and activity index as prognostic tools in ABMR and iMVI.

Method

Retrospective study of KT recipients (1987-2022) with KB (2013-2022) with ABMR (category 3, Banff’2019) [group 1] and iMVI [group 2]. We evaluated AI ([glomerulitis (g) + peritubular capillaritis (ptc), arteritis (v) + C4dscore] e CI ([interstitial fibrosis (ci), tubular atrophy (ct), chronic vasculopathy (cv), and 2xchronic glomerulopathy (2cg) scores)]). Our aim was to evaluate chronicity and activity index as prognostic tools in ABMR and iMVI.

Results

One hundred thirty-nine KT with aABMR (n=48) and caABMR (n=46) (group 1) and MVIi (n=45) (group 2). Graft loss along time of follow-up (35 [15-69] months) was higher in group 1 (41.5% vs 22.2%; p=0.02). AI was higher in group 1 (4 [3-4.5] vs. 2 [2-4]; p<0.001) and CI similar in both groups (4 [3-7] vs. 4 [4-6]; p=0.7). In the multivariate analysis CI (per unit increase) with HR 1.24 [1.09-1.42; p=0.001] and IA ≥4 in ABMR with HR 2.23 [1.08-4.58; p=0.029]. Death-censored graft survival was worse in IA. IA≥ 4 e IC ≥4 La supervivencia del injerto muerte-censurada fue peor en el grupo RH con IA≥ 4 e IC ≥4 (Fig. 1).

Conclusion

Our findings suggest that the activity index in ABMR and the chronicity index both in ABMR and iMVI are valuable prognostic tools.
#3080 Response to mRNA SARS-CoV-2 vaccination in kidney transplant recipients with HIV
Authors: Cacho Judit , Nomah Daniel Kwakye , Egri Natalia , González Ángela , Rodríguez Diana , Cuadrado Elena , Montagud-Marrahi Enrique , Diekmann Fritz , Miro Jose María , Cucchiari David
Published: May 2024

Background and Aims

No data exists on humoral or cellular responses to mRNA vaccines in kidney transplant recipients (KTR) with HIV. We compared these responses in HIV-positive and negative KTR, as well as in people living with HIV (PLWH) without kidney transplantation.

Method

In a cross-sectional study of 33 patients receiving two (n=13) or three (n=20) doses of mRNA SARS-CoV-2 vaccination, we evaluated the humoral response to mRNA SARS-CoV-2 vaccination using a Luminex platform for IgG and IgM, and assessed cellular response with specific T cell response with S- and N- protein by ELISpot. We used logistic regression models to assess associated factors.

Results

The study comprised 11 HIV-negative KTRs (HIV-KTR+), 11 HIV-positive KTRs (HIV+KTR+), and 11 PLWH without kidney transplantation (HIV+KTR−). PLWH had suppressed viral load on ART. Seroconversion rates after two or three vaccine doses were 72.7% among KTRs, with no significant difference between HIV-KTR+ (81.8%) and HIV+KTR+ (63.6%) (P=0.338). In HIV+KTR−, seroconversion was 100%, higher than HIV+KTR+ (P=0.027). Cellular response against protein S occurred in 63.6% cases, irrespective of HIV or transplantation status or number of doses. Protein N reactivity was observed in 27.3% KTRs (HIV-KTR+ and HIV+KTR+), versus 9.1% HIV+KTR− (P=0.378). Higher age negatively influenced cellular response in PLWH (OR 0.77, 95% CI 0.60-0.99).

Conclusion

Although cellular immune response was similar across all groups, we found a reduced humoral response in HIV+KTR+. In PLWH, higher age reduced cellular response. These findings contribute to our understanding of vaccine response in immunosuppressed populations and provide valuable insights for optimizing vaccination strategies.
#2992 Risk and prognostic factors for post-transplantation lymphoproliferative disease in solid organ transplant recipients—a multicenter analysis
Authors: Mucha Krzysztof , Staros Rafał , Foroncewicz Bartosz , Kamińska Dorota , Raszeja-Wyszomirska Joanna , Dębska-Ślizień Alicja , Nazaruk Paulina , Załuska Wojciech , Ochman Marek , Kosieradzki Maciej , Grąt Michał , Durlik Magdalena
Published: May 2024

Background and Aims

Post-transplantation lymphoproliferative disorder (PTLD), a potentially fatal complication of transplantation, affects solid organ transplant recipients at different rates, depending on organ graft type: the risk greater in lung transplant recipients (LngTRs), lower for liver transplant recipients (LTRs) and lowest for kidney transplant recipients (KTR). In this study we aimed to investigate the factors affecting the development and treatment outcomes of PTLD and compare their effect on KTRs, LTRs and LngTRs.

Method

In this retrospective cohort study we have included all KTRs, LTRs and LngTRs diagnosed with PTLD at six transplantation centers in Poland. The data collected from medical records included: immunosuppression (IS), viral infections, PTLD type, treatment and outcomes. Chi-squared test was used to assess the differences in group composition. To determine the impact of variables upon PTLD time of onset and patient survival, univariate Cox regression was used. p-values below 0.05 were considered statistically significant.

Results

We enrolled 50 KTRs, 36 LTRs and 5 LngTRs from 6 transplantation centers in Poland. Based on the data from the most contributing centers in each group, the prevalence of PTLD was 0.82% of KTRs, 2.03% LTRs and 1.51% of LngTRs. Two thirds of the enrolled patients were male, the median age at first transplantation was 40 years for KTRs, 45 for LTRs and 25 for LngTRs (Table 1). The groups significantly differed in IS treatment: steroid (GCS) and cyclosporin (CsA) use was more frequent in KTRs (p<0.001 and p<0.001 and respectively), tacrolimus (TAC) and anti-CD25 induction in LTRs (p ≤ 0.001 and p<0.001 respectively), sirolimus (RAPA) in LngTRs (p<0.001). KTRs were the latest to develop PTLD (126 months after transplantation, p<0.001). In all groups Monomorphic B-cell PTLD was the most frequent. Initial IS treatment reduction was used in 80-86% of patients, R-CHOP chemotherapy was most common in LTRs (p=0.021), other chemotherapy regimens in KTRs (p=0.031). TAC had the opposite effect on PTLD time of onset in KTRs (HR=2.18, p=0.013) and LTRs (HR=0.18, p=0.036). The overall survival at the end of observation period was 26% for KTRs, 58% for LTRs and 80% for LngTRs. Loss to follow up was most frequent in KTRs at 26%. Patient survival was not affected by PTLD treatment.

Conclusion

KTRs develop PTLD later than LTRs and LngTRs, and time of disease onset is associated with TAC use. Lower survival in KTRs may result from the longer follow-up period compared to other solid organ transplant recipients.
#1692 Prevalence and risk factors for persistent hyperparathyroidism in long-term kidney transplant recipients
Authors: Kittiweerawong Wiphat , Chotmongkol Wijittra , Pongchaiyakul Chatlert , Kritmetapak Kittrawee
Published: May 2024

Background and Aims

Secondary hyperparathyroidism, associated with fractures and cardiovascular mortality in end-stage kidney disease, often resolves after kidney transplantation (KT). However, limited knowledge exists regarding persistent hyperparathyroidism (persist-PTH) after long-term KT. We aimed to define the prevalence and risk factors of persist-PTH in KT recipients at ≥3 years post-KT.

Method

A historical cohort study was conducted in adult KT recipients at Srinagarind Hospital, Khon Kaen University, Thailand, from 2015 to 2020. Persist-PTH is defined as serum parathyroid hormone (PTH) exceeding twice the upper limit of normal (>130 pg/mL) after ≥3 years post-KT.

Results

A total of 281 patients were included, with a median age of 41.4 years (interquartile range (IQR), 32.7-49.1), and 117 patients (41.6%) were female. The median post-KT follow-up was 71 months (IQR, 54-89) with a glomerular filtration rate (GFR) of 61.8 mL/min/1.73 m² (IQR, 48.2-76.9). The respective median pre-KT and post-KT PTH were 403 pg/mL (IQR, 196.3-862) and 96.7 pg/mL (IQR, 67.3-166). Post-KT PTH levels correlated with pre-KT PTH levels (r²=0.18; P<0.001). Persist-PTH occurred in 100 patients, with a prevalence of 35.6% (95% confidence interval (CI), 30.2-41.4%). Multivariate analysis revealed significant associations between persist-PTH and a longer dialysis vintage (odds ratio (OR) 1.13 per 6-month increase; 95% CI, 1.06-1.20; P<0.001), lower GFR (OR, 0.76 per 10 mL/min/1.73 m² increase; 95% CI, 0.63-0.92; P=0.004), and higher pre-KT PTH (HR, 1.06 per 50 pg/mL increase; 95% CI, 1.02-1.10; P=0.001). Furthermore, persist-PTH with hypercalcemia (>10.2 mg/dL) occurred in 44 patients (15.7%; 95% CI, 11.8-20.4%), and with hypophosphatemia (<2.5 mg/dL) in 23 patients (8.2%; 95% CI, 5.5-12.0%).

Conclusion

Persist-PTH occurred in over one-third of long-term post-KT recipients, particularly in those with extended dialysis vintage, impaired graft function, and elevated pre-KT PTH levels. This underscores the need for optimal pre-KT PTH control and vigilant graft function monitoring to prevent persist-PTH.
#516 Cancer after kidney transplantation in the single transplant center
Authors: Yankovoy Andrey , Artamonova Aleksandra
Published: May 2024

Background and Aims

A retrospective analysis of peculiarities of development of malignant neoplasms in patients after kidney transplantation receiving long-term immunosuppression.

Method

In this study we evaluated incidence of malignancies observed among 718 renal transplant recipient with at least 6 months of follow-up. A total of 561 men and 257 women, mean age at transplantation 36.3 ± 8.3 years were included.

Results

Thirty-three out of 718 recipients (4.6%) developed malignant neoplasia: 45.5% of these were Kaposi's sarcomas, 12.1%—cancers of the uterine cervix, 12.1% cancer of the stomach, 12.1% - basal cell carcinomas, 6.06% - post transplant lymphoproliferative disorder. There was no significant effect of either cyclosporine A, tacrolimus doses or OKT3/ATG on the incidence of the tumors. The median time from onset of end-stage renal failure (dialysis start) and from the transplantation to the diagnosis of the tumor make up 32 (16-161) and 23 (5-158) mouths, respectively. One renal transplant recipient suffered from multiple myeloma with aggressive course. Three patients diagnosed with renal cell carcinoma of the transplant: clear cell carcinoma, papillary carcinoma, mucinous adenocarcinoma via 264, 24 and 4 months respectively.

Conclusion

The importance of strict adherence to intensive monitoring transplant patients, which can detect tumors at an early stage. Strict adherence to intensive follow-up of transplant patients is important, which makes it possible to identify neoplasms at an early stage, when organ-preserving treatment is feasible and effective. In addition, modification of immunosuppressive therapy in such patients involves reducing the dose or, if possible, completely eliminating calcineurin inhibitors and starting taking mTOR inhibitors (sirolimus or everolimus), taking into account the antitumor effect of this group of immunosuppressants.
#1294 The impact of plant-based diet on renal function and metabolic profile in kidney transplant recipients
Authors: Caletti Chiara , Stefani Lisa , De Tomi Elisa , Tassi Serena , Andreola Stefano , Ferraro Pietro Manuel , Gambaro Giovanni
Published: May 2024

Background and Aims

Controlling and reducing protein intake is the most used approach to preserve renal function in CKD patients. Compared to protein restriction alone, plant-based diets have received particular attention. However, data on the potential risks and benefits of a plant-based diet in kidney transplant patients remains sparse, and evidence in this population is indirect.

The primary purpose of this study was to evaluate if a plant-based diet affects proteinuria and eGFR in renal transplant patients. Establishing whether it influences acid load, glycolipid profile, nutritional status, and performance status were secondary objectives.

Method

26 renal transplant recipients with eGFR >20 ml/min/1.73 m², urinary protein excretion >0.5 g/day, and transplant age >1 year were considered eligible for the study. Enrolled subjects underwent dietary assessment and biochemical tests at baseline, three and six months after starting the plant-based diet. All subjects underwent performance tests: sit-to-stand and handgrip tests.

Results

Only 18 patients were included in the statistical analysis. After six months, no significant changes in levels of proteinuria, urinary anion gap, triglycerides, and grip strength were detected. However, there was a statistically significant reduction in total cholesterol (p=0.03), LDL (p=0.04), and fasting blood sugar levels (p=0.001). A statistically significant reduction in eGFR (p=0.033) was observed, likely the regression of the previous hyperfiltration caused by the animal protein diet. A significant improvement was found in sit-to-stand test performance (p=0.037). Finally, a direct relationship between azoturia and urinary anion gap was observed.

Conclusions

The work carried out has highlighted how some of the potential benefits of the plant-based diet may also be relevant among kidney transplant patients. The plant-based diet is also associated with improved performance tests.