bluuebunny/crossref_metadata_2025 huggingface dataset:
#3144 KIDNEY TRANSPLANT-RELATED KNOWLEDGE AMONG SOUTH ASIAN COMPARED TO WHITE CANADIAN PATIENTS
Authors: Jolly Simran , Balaji Shilpa , Hamid Marzan , Patel Tasneem , Lodge Denzel , Waterman Amy , Mucsi Istvan
Published: June 2023

Background and Aims

Kidney transplant (KT) is the best treatment for many patients with kidney failure. However, patients from racialized communities are less likely to receive KT. Gaps in transplant-related knowledge may be one of the potential reasons for the observed inequities in accessing KT. Here we compare patient characteristics and KT-related knowledge between South Asian (SA) versus white Canadians with kidney failure using the “Knowledge Assessment of Renal Transplantation” (KART) questionnaire.

Method

Secondary analysis of data from a cross-sectional convenience sample of white and SA adults with kidney failure. Sociodemographic data, self-reported information about racialized status and KART score were collected through electronic data capture. The association between racialized status and participant demographics were assessed using ANOVA, Kruskal–Wallis test or chi squared test, as appropriate. The independent association between racialized status and KART scores was assessed by multivariable adjusted linear or multinomial logistic regression, with adjustment for immigration status, age, marital status, education, gender, Ontario Marginalization Index material deprivation quintile, Charlson Comorbidity Index and ethnicity.

Results

Among 578 participants (mean [SD] age: 57 [14] years, 64% male), 43% were white and 16% were SA. 84% vs 27% of SA vs white participants were immigrants. The Charlson Comorbidity Index score was >=4 for of 31[40%] SA vs 105[51%] white participants (p<0.001). The median (interquartile range) KART score of white vs SA participants was 17[6] vs 14[7] (p<0.001). In a univariable linear regression model the KART score was significantly associated with SA status (B: -3.27 ([95% CI]: -4.76, -1.77, p<0.001). This association remained significant after adjustment for potential confounding (B: -3.36 ([95% CI]: -5.05, -1.67, p<0.001) (Table 1). 26% of SA vs. 41% of white participants scored in the highest tertile for KART score (p<0.001) (Fig. 1). The relative risk ratio to be in the lowest KART tertile was 3.09 [95% CI: 1.49, 6.43] for SA compared to white participants in our final, adjusted multinomial model.

Conclusion

SA participants with kidney failure are commonly immigrants who have poorer KT-related knowledge compared to white participants. Our findings indicate the need to develop culturally relevant KT related patient education for South Asian Canadian communities.
#3186 INVESTIGATING TREM2 MACROPHAGES IN CHRONIC KIDNEY DISEASE
Authors: Trivioli Giorgio , Richoz Nathan , Subramanian Ayshwarya , Vernon Katherine , Trotter Patrick , Zhou Yiming , Shaw Jillian , Greka Anna , Clatworthy Menna
Published: June 2023

Background and Aims

Kidney macrophages have been implicated in interstitial fibrosis and inflammation in various forms of chronic kidney disease (CKD), but subsets with different markers and putative functions have been identified through the application of single cell technologies. A recent study from the Greka Lab revealed distinct macrophage populations in the human kidney bearing lymphatic endothelium hyaluronan receptor-1 (LYVE1) and triggering receptor expressed on myeloid cells-2 (TREM2). Notably, TREM2+ macrophages, which have been implicated in limiting metabolic toxicity in chronic diseases, were enriched in diabetic mouse kidneys and human kidneys from obese individuals (Subramanian et al. BioRvix 2021). To support these findings, we aimed at characterizing LYVE1+ and TREM2+ macrophages in kidney samples taken from subjects with CKD-associated co-morbidities, including hypertension, diabetes mellitus and obesity.

Method

We performed immunofluorescence microscopy of samples collected from the cortex of kidneys donated for transplantation but deemed unsuitable for implantation. Each sample was stained with anti-CD163, -LYVE1, and -TREM2 antibodies, plus Hoechst to stain nuclei. Two identically sized fields of view were imaged in each sample. Macrophages were identified based on CD163 expression and the expression of the LYVE1 and TREM2 in macrophages delineated. Macrophage subsets were compared according to age, BMI, eGFR and the presence of hypertension, obesity and diabetes.

Results

of 49 donors assessed, 19 (39%) were “healthy”, six (12%) “hypertensive” without obesity or diabetes, 16 (33%) “obese” with no evidence of diabetes, and 8 (16%) “diabetic” (all had type 2 diabetes and 6/8 were also obese) The median eGFR at donation was 95 mL/min/1.73 m2 and none of the donors had a history of CKD. Gender, median age and cause of death were not significantly different as well (Table 1). “Healthy”, “hypertensive” and “obese” donors had similar numbers of total macrophages, LYVE1+ and TREM2+ macrophages per region of interest. In contrast, “diabetic” subjects had a tendency towards a higher macrophage count (P = .10) and significantly higher numbers of LYVE1+ (P = .02) and TREM2+ macrophages (P = .002), compared to “healthy” ones (see Figure 1). The median LYVE1+/CD163+ ratio was 0.69 and did not differ substantially between the groups (P = .18), while the TREM2+/CD163+ ratio was higher among “diabetic” compared to “healthy” donors (0.43 vs 0.34, P = .06).

Conclusion

Diabetes is associated with an increase in kidney macrophages, particularly in those expressing TREM2. Further investigation is required to determine the role these cells may play in CKD progression.
#3194 THE IMPACT OF COVID-19 PANDEMIC ON PSYCHOLOGICAL AND SOCIOECONOMIC WELL-BEING OF HEMODIALYSIS PATIENTS: AN ANALYTICAL CROSS-SECTIONAL STUDY
Authors: Pasamante Jane Angele
Published: June 2023

Background and Aims

This study aimed to determine and assess the prevalence of depression, anxiety, and stress of the COVID-19 pandemic among outpatient hemodialysis patients and the relationship to sociodemographic and clinical factors, and to assess the economic impact of the COVID-19 pandemic.

Method

In this analytical, cross-sectional study, purposive sampling was used and a total of 69 subjects were enrolled. Sociodemographic data were collected using researcher-administered questionnaires and recent laboratory parameters were collected by reviewing medical records. Patients completed 4 sets of questionnaires including Patient Health Questionnaire 9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7), Perceived Stress Scale 4 (PSS-4), and CoRonavIruS Health Impact Survey (CRISIS). Quantitative variables were presented using mean and standard deviation, median, and Interquartile Range (IQR). Qualitative variables were presented using frequency and percentages. Pearson's correlation was used to determine the relationship of laboratory parameters with anxiety, depression, and stress scores. The Chi-Square test was used to determine the relationship of sociodemographic profile with anxiety, depression, and stress scores. P values <0.05 were considered statistically significant.

Results

Our study showed that the prevalence of anxiety, depression, and stress were 39%, 16%, and 51% respectively. There was an association between age and stress level, with older subjects reporting higher stress scores. Hemoglobin levels had a weak negative correlation with anxiety, depression and stress. The distribution of anxiety scores was significantly different between patients with normal phosphorus levels and elevated phosphorus levels. Financial worries were less of a concern since almost two-thirds of our subjects were retired and unemployed.

Conclusion

Hemodialysis patients belong to high-risk populations with a high prevalence of psychological distress hence they are subjected to more severe psychological stress, depression, and anxiety. Our findings suggest that psychological intervention may be necessary for some patients during this pandemic.
#3314 DIURETIC AND RENOPROTECTIVE EFFECTS OF GOREISAN IN A RAT MODEL OF NEPHROTIC SYNDROME
Authors: Yamatani Satoshi , Fujii Hideki , Kono Keiji , Shimizu Mao , Hirabayashi Ken , Sakamoto Kazuo , Watanabe Kentaro , Goto Shunsuke , Nishi Shinichi
Published: June 2023

Background and Aims

Goreisan, a traditional Chinese medicine composed of five herbs, is commonly used for the purpose of control of edema and gastrointestinal symptoms. However, the detailed mechanisms have not been fully elucidated. In clinical settings, nephrotic syndrome often causes edema, mainly due to hypoalbuminemia and sodium retention. Thus, we investigated the effects of Goreisan on the kidney using a rat model of nephrotic syndrome.

Method

A model of nephrotic syndrome was created by a right nephrectomy and subsequent administration of adriamycin using Sprague Dawley rats. Nephrotic rats were randomly divided into three groups at 10 weeks of age as follows; vehicle (control), Goreisan 0.5 g/kg (GL), and Goreisan 1.0 g/kg (GH) groups. Goreisan was administered once a day for 4 weeks. At 14 weeks of age, the rats were sacrificed for the evaluation of blood, urine, mRNA expressions, and kidney histopathology.

Results

Urine volume was significantly increased in the GL and GH groups than in the control group (Δurine volume: control; −1.25±2.48 mL, GL group; 9.83±4.16 mL, GH group; 10.00±2.62 mL). The GH group showed significantly lower urine osmotic pressure compared to the control group. There were no significant differences in urinary sodium excretion and serum arginine-vasopressin levels among the three groups. Subsequently, we assessed the expression of aquaporin (AQP) in kidney tissue using real-time PCR and immunohistochemical staining. The mRNA expression of AQP1, AQP2, AQP3, and AQP4 did not differ among the three groups. However, immunohistochemical staining showed that the localization of AQP2 at the apical plasma membrane of the collecting ducts was decreased by treatment with Goreisan. Furthermore, deterioration of kidney function was prevented by treatment with Goreisan. Histological analysis revealed that glomerular and tubulointerstitial damages were ameliorated in the GL and GH groups compared to the control group (glomerular damage score: control; 2.19±0.05, GL group; 1.71±0.05, GH group; 1.10±0.05, tubulointerstitial damage score: control; 2.55±0.09, GL group; 2.28±0.10, GH group; 2.12±0.10). In addition, urinary 8-OHdG, which is an oxidative stress marker, was significantly lower in the GL and GH groups than in the control group.

Conclusion

Our results suggested that Goreisan may have diuretic and renoprotective effects by suppressing the trafficking of AQP2 to the apical plasma membrane of the collecting ducts and possibly reducing systemic oxidative stress.
#3419 LINARIN PROTECTS THE KIDNEY FROM ISCHEMIA-REPERFUSION INJURY AND SUPPRESSES ETS2 INDUCED ACUTE KIDNEY INJURY
Authors: Yang Chengyu
Published: June 2023

Background and Aims

Ischemia/reperfusion injury (IRI), a participant in acute kidney injury (AKI), can occur as a series of pathological processes such as inflammation. Linarin (LIN) has been widely used for different diseases. To confirm the anti-inflammatory value and relevant mechanism of LIN during IRI, in vivo and vitro model were established.

Method

LIN or isovolumetric DMSO was given, and histologic analysis, quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR), serum creatinine (SCr) testing and blood urea nitrogen (BUN) were used to evaluate kidney injury. Microarray analysis, protein-protein interaction (PPI) analysis and molecular docking were used to identify target protein of LIN.

Results

At first, we find that LIN could inhabit the kidney injury in vivo IRI model and decrease the expression of IL-12 p40 in vitro IRI model. To explore the mechanism of LIN, we collected raw data from public microarray database and identified E26 oncogene homolog 2 (ETS2) as a target protein of LIN according to microarray analysis, PPI and molecular docking. The contact area is highly conserved and located on a protein-protein interaction domain of ETS2 which indicated that LIN may alter the interaction with synergistical protein in the regulation of IL-12 p40 expression.

Conclusion

Our study demonstrated the anti-inflammatory effect of LIN during IRI-triggered AKI, broadening the medicinal value of LIN and the therapeutic options for IRI-triggered AKI.
#3647 RELATIONSHIP BETWEEN MONOCYTE-LYMPHOCYTE RATIO AND RENAL OUTCOMES IN PATIENTS WITH TYPE 2 DIABETES
Authors: Gu Yue , Ren Yingying , Zhou Jing
Published: June 2023

Background and Aims

Acute kidney injury (AKI) is a common complication of hospitalized adults with increased risk of chronic kidney disease and end-stage kidney disease. Sepsis is the most common reason of AKI in patients admitted in intensive care unit(ICU) with the incidence over 50%. Soluble urokinase-type plasminogen activator receptor (suPAR) is an important immune mediator involved in kidney injury. Numerous studies have shown that the suPAR is associated with a variety of kidney diseases.However, it remains unknown on the diagnosis and prognosis value of suPAR in sepsis-associated acute kidney injury (S-AKI). Hence,this study aimed to explore the diagnostic value for the prediction of S-AKI courses and 28-day death.

Method

In this prospective study, adult patients with sepsis admitted to the ICU of Henan people's Hospital from December 2020 to February 2022 were enrolled. Plasma suPAR levels at 0, 12,24 and 48 hours after admission to ICU were measured by enzyme-linked immunosorbent assay. We assessed the development of S-AKI as the primary outcome and the occurrence of death within 28 days in patients who had S-AKI as a secondary outcome. The prediction of the suPAR level on S-AKI and death was tested using receiver operating characteristic curve (ROC) analysis, by calculating the area under the curve (AUC), and 95% confidence interval (CI).

Results

Of the 182 sepsis patients, 66 (36.3%) developed AKI during hospitalization, of whom 31 (46.9%) died. At 12,24 and 48 hours after admission to ICU, the plasma suPAR level was significantly higher in patients with S-AKI than in patients without AKI (P<0.05). (Fig. 1) In sepsis patients dead with 28 days after admission in ICU, the plasma suPAR level was significantly higher at 0 and 48 hours after admission in ICU compared to the survival patients(P<0.05). (Fig. 1) Diagnostic performance of plasma suPAR level improved over time with the highest area under the receiver operating characteristic curve of 0.701 (95% CI, 0.623∼0.779) 24 hours after study inclusion. Additionally, plasma suPAR levels at 0h have the highest area under the receiver operating characteristic curve of 0.647 (95% CI, 0.512∼0.782) in predicting 28-day death. The best discrimination ability for the S-AKI was achieved for suPAR 24 hours after inclusion by applying a cutoff value of greater than or equal to 6.31 ng/ml (sensitivity 62.1, specificity 71.6). The suPAR at 0h after inclusion performed best in discriminating 28-day death by using a cutoff value of greater than or equal to 4.57 ng/mL (sensitivity 87.1, specificity 51.4).(Table 1)

Conclusion

Plasma suPAR level can be a potential biomarker for early diagnosis of S-AKI and has a certain clinical value in predicting the short-term death of S-AKI. However, further clinical studies with larger sample size is needed.
#3713 NEPHROLOGISTS’ AND PRIMARY CARE PHYSICIANS’ KNOWLEDGE ABOUT NOVEL TREATMENT OPTIONS FOR TYPE 2 DIABETES AND CKD AUGMENTED BY ONLINE MEDICAL EDUCATION
Authors: Trier Joachim , Malyszko Jolanta , Silva Rita Moreira Da
Published: June 2023

Background and Aims

Diabetes is the number one cause of kidney failure and chronic kidney disease (CKD) associated with type 2 diabetes (T2D) increases the risk for cardiovascular events 2 to 3- fold thus highlighting the crucial need for early detection of CKD and comprehensive vascular risk control. Recently, novel treatment options with clear benefits for the prognosis of patients with T2D and CKD have emerged. The goal of this activity for primary care physicians (PCP) and nephrologists (NEPH) was to improve their understanding of the clinical benefits as well as safety considerations of selective non-steroidal mineralocorticoid antagonists (nsMRA) in the management of their patients with T2D and CKD.

Method

Two nephrology experts joined a 20-minute online video discussion with synchronized slides. Educational effect was assessed using a repeated-pair design with pre-/post-assessment. 3 multiple choice questions assessed knowledge, 1 question rated on a Likert-type scale assessed confidence. A paired samples t-test was conducted on overall average number of correct responses and for confidence rating, a McNemar's test was conducted at the question level (5% significance level). Cohen's d with correction for paired samples estimated the effect size of the education on number of correct responses. Data collection from 8/2/22 to 10/17/22.

Results

Conclusion

Participation of PCP and NEPH in an online video expert discussion improved their understanding of the clinical benefits and safety aspects of selective nsMRA as well as their confidence in using such novel therapies for their patients with T2D and CKD in clinical practice.
#3788 PROGNOSTIC ROLE OF THE NEUTROPHIL-TO-LYMPHOCYTE RATIO IN PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Bae Eun Hui , Kim Jin , Kim Su In , Cho Da Hae , Lim Sang Yoeb , MA Seong Kwon , Kim Soo Wan , Choi Hong Sang
Published: June 2023

Background and Aims

The neutrophil-to-lymphocyte ratio (NLR) has been demonstrated to have prognostic value in cardiovascular disease, infection, inflammatory disease, and several types of cancer. Therefore, it is expected that NLR has predictive value in patients with chronic kidney disease (CKD) but it has not been validated. Here, I aimed to investigate the possibility of NLR as a predictor of progression of CKD.

Method

This retrospective observational study included 141 patients with non-dialysis CKD. Subjects were divided into terciles (T1, T2, and T3) according to NLR. The primary outcome of interest was defined as a composite renal event, which included a decline in the estimated glomerular filtration rate (eGFR) of at least 50% or onset of end-stage renal disease (ESRD) during the follow-up period.

Results

The median follow-up duration was 5.45 ± 2.11 years. The median NLR for each group was 1.35 ± 0.05 in T1 (n=47), 2.16 ± 0.04 in T2 (n=47) and 4.29 ± 0.73 in T3 (n=47). The group with the highest NLR (T3) had higher baseline CKD and serum creatinine and lower eGFR levels than the group with the lowest NLR (T1). The cumulative incidence of composite renal events was significantly increased in T3, compared to T1 (p < 0.001, log-rank test). Cox regression analysis revealed that high NLR was independently associated with the risk of composite renal events (adjusted hazard ratio 2.85, 95% confidence interval 1.18-6.93).

Conclusion

A higher NLR reflects the more advanced stage of CKD and suggests that a role for NLR as a biomarker for predicting CKD progression.
#3853 THE EFFECT OF PERITONEAL CAVITY FLUSHING ON ACID BASE BALANCE OF PERITONEAL DIALYSIS PATIENTS
Authors: Theodoridis Marios , Panagoutsos Stylianos , Margaritis Nikos , Dimitrakopoulos Charalampos , Bounta Triantafyllia , Mourvati Efthimia , Charitaki Evaggelia , Kantartzi Konstantia , Thodis Elias
Published: June 2023

Background and Aims

Flushing peritoneal cavity with dialysis fluid with short time dwells it is a necessity in some cases for peritoneal dialysis patients. Such cases are overhydration with pulmonary congestion or peritonitis before the initiation of antibiotic treatment as an effort to reduce pain. The aim of this study was to investigate the effect of frequent exchanges with peritoneal dialysis (PD) fluid with bicarbonate as a buffer on acid base balance of peritoneal dialysis patients.

Method

This is a single center cohort study of 18 stable PD patients (m=10.f=8). Their median age was 57 (47, 71) years, their median PD duration was 33 (16, 89) months and they all fulfill the criteria for achieving adequacy targets [median Kt/V 2.17 (1.99, 3.3)] with good nutrition markers [ median albumin levels 3.9 (3.6, 4) gr/dl]. A sample of arterial blood gas (ABG) was taken from the patients before the procedure and after full drainage of the peritoneal cavity . The procedure included 4 times flushing of 1000 ml of dialysis fluid remaining for15 minutes In the peritoneal cavity each time . At the end of the procedure a new blood sample for ABG was taken. We used PD solution with bicarbonate as a buffer (34 mmol/Lt). We estimated the alterations of pH, of bicarbonate (HCO3-), of pCO2, of Base Excess(ΒΕ), of ionized calcium (iCa++) and lactate (Lac)

Results

Using the non parametric related samples Wilcoxon signed method we found a statistically significant increase in arterial HCO3- concentration between the values before and after the procedure [HCO3-before:25.4 (22, 28), HCO3after:26.5 (24, 29) mEq/lt-P = .023]. Likewise there was a statistically significant increase in BE with median values before the procedure 1 (-1.2,2.9) and after the flushing 2 (-0.6,3,8), P = .018. Even though there was a statistically significant increase in the bases expression of the acid base balance of the patients there wasn't any statistically significant alterations in pH levels- i.e. Alkalemia (pHbefore=7.41,pHafter=7.42 – P = .35) or pCO2 levels i.e. Compensatory Respiratory Acidosis (pCO2προ=40, pCO2μετα=40 – P = .179) nor to the levels of ionized calcium

Conclusion

Flushing of peritoneal cavity using peritoneal dialysis solution with bicarbonate as a buffer is safe and in this study was not correlated with the development of metabolic alkalosis
#3947 COMPARISON OF CT SCAN AND BIOIMPEDANCE SPECTROSCOPY FOR FAT FREE MASS MEASUREMENTS IN PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Visser Wesley , de Geus Manon , van Ruijven Isabel , van Egmond Anneke , Venrooij Lucie , Minnee Robert , Moeskops Pim , Oei Edwin , Dam Manouk , Severs David
Published: June 2023

Background and Aims

Malnutrition and sarcopenia are highly prevalent in patients with chronic kidney disease (CKD). Since body mass index and body weight do not reflect body composition, measuring fat free mass (FFM) is essential. Bio-impedance spectroscopy (BIS) is frequently used for monitoring body composition in patients with CKD. Unfortunately, BIS derived lean tissue mass (LTMBIS) is not suitable for comparison with the Global Leadership Initiative on Malnutrition (GLIM) cut-off values for the diagnosis of malnutrition, or for calculating dietary protein requirements. Hypothetically, FFM could be derived from BIS data (FFMBIS). This study aims to compare FFMBIS and LTMBIS with computed tomography (CT) scan derived FFM (FFMCT). Secondarily, we aimed to explore the impact of using different methods on calculated daily protein requirements.

Method

CT scans of 60 patients with CKD stage 4-5 were analyzed at third lumbar vertebra (L3) level for muscle cross-sectional area, which was converted to FFMCT. Spearman rank correlation coefficient and 95% limits of agreement (LoA) were calculated to compare FFMBIS and LTMBIS with FFMCT. Dietary protein requirements were determined based on FFMCT, FFMBIS, and adjusted body weight. Deviations over 10% from FFMCT were considered clinically relevant.

Results

FFMCT correlated strongest with FFMBIS (r=0.78, p<0.001), in males (r=0.72, p<0.001), and in females (r=0.60, p<0.001). A mean difference of -0.54 kg was found between FFMBIS and FFMCT (LoA: -14.88 to 13.7 kg, p=0.544). Between LTMBIS and FFMCT a mean difference of -12.2 kg was apparent (LoA: -28.7 to 4.2 kg, p<0.001). Compared with FFMCT, the highest occurrence of accurate predicted protein requirements was found for FFMBIS. Mean difference between protein requirements according to FFMBIS and FFMCT was -0.7 ± 9.9 grams in males and -0.9 ± 10.9 grams in females.

Conclusion

FFMBIS seems a valid surrogate measure for the estimation of FFM as compared to FFMCT. As expected, large clinically relevant differences were observed in calculated protein requirements when comparing multiple methods, with FFMBIS having the best accuracy compared to FFMCT.
#4022 RETROSPECTIVE ANALYSIS OF SPECTRUM OF INFECTIONS AND ANTIBIOTIC RESISTANCE PATTERN IN HEMODIALYSIS PATIENTS IN A TERTIARY CARE CENTRE IN NORTH INDIA
Authors: Chhakchhuak Malsawmkima , Bajpai Nitin Kumar , Chaturvedy Manish , Agarwal Jony , Tak Vibhor
Published: June 2023

Background and Aims

Hemodialysis patients are at risk of infections due to various factors. Antibiotic resistance is an ever-changing issue. Initial empirical therapy depends on local epidemiology of infection, and antibiotic resistance pattern. Non-access related infections received lesser research attention worldwide. This study examines the spectrum of infections, and antibiotic resistance pattern.

Method

We retrospectively reviewed the records of 586 hemodialysis patients from May 2018 to April 2020 in a tertiary care hospital in North India.

Results

The study identified 99 episodes of confirmed infections. Urinary tract infections were the most common type of infections (55.5%), followed by Catheter-related blood stream infections (CRBSI) (definitive 21.2%). Other infections were pneumonia (8.1%), tuberculosis (6.1%), skin and soft tissue infection (4.0%), dengue fever in (3.03%) and empyema thoracis (1.0%). Overall, Escherichia coli (33.3%) was the most common organism isolated. The most frequent uropathogens recovered were Escherichia coli (54%). In confirmed CRBSI, P. aeruginosa (23.8%) and MSSA (23.8%) were the most common pathogen isolated. K. pneumonia (37.5%) was the most common pathogen in pneumonia. Uropathogens showed highest resistance to fluoroquinolones (93.3-100%). Pathogens isolated in CRBSI shown maximum resistance to ciprofloxacin (100%). In pneumonia, highest resistance was seen to third generation cephalosporins (75-100%).

Conclusion

Though bacterial spectrum remains the same over time, antibiotic resistance is changing in uropathogens. There is a trend of predominance of gram-negative bacterial infections in CRBSI. Tuberculosis incidence rate was much higher than the general population. There is a need for nationwide and worldwide continuous surveillance.
#4041 THE INTERSTITIAL TUBULAR INJURY IN THE COURSE OF LUPUS NEPHRITIS
Authors: Mariem Najjar , Dridi Rania , Braiek Hana Ben , Kaaroud Hayet , Hamida Fethi Ben , Harzallah Amel , Abderrahim Ezzeddine
Published: June 2023

Background and Aims

Tubulo-interstitial involvement in lupus nephritis (LN) refers to the presence of interstitial fibrosis and tubular atrophy (IFTA) in the renal biopsies of patients with lupus. The impact of these features on patient outcomes has not been fully established. The aim of this study was to determine the correlation between IFTA and patient outcomes in LN.

Method

A retrospective descriptive study was conducted on 160 patients with systemic lupus erythematosus who underwent renal biopsy between 2020 and 2022. Clinical and biological data, as well as histologic findings, were analyzed to determine the outcomes associated with IFTA in LN. Other causes of tubulointerstitial nephritis like drugs and toxins were excluded.

Results

The study population consisted of 148 females and 12 males, with a mean age of 37.2 years (ranging from 18 to 62 years) at the time of renal biopsy. Hematuria was observed in 62.5% of patients, nephrotic syndrome in 28.1%, hypertension in 24.3%, and renal failure in 17.5% with a mean proteinuria of 2.4±0.6 g/24 h. ANA was positive in a diffuse pattern in all cases, positive anti-ds-DNA,mean C3 was 29 (84-122 mg/dL), and mean C4 was 16.2 (20-40 mg/dl). Other serology C-ANCA and P-ANCA were all negative as well as negative HBV and HCV serology. However serology for Sjogren's syndrome was positive in 61 cases (41%). The histopathological study showed mild mononuclear and plasma cell infiltration of the interstitium, and tubular hyaline casts in 87% of cases. Examination of renal vessels was unremarkable in 94.5% of cases. IFTA was present in 72 patients (45%), with the most frequent glomerular involvement being LN class IV (55.5%) followed by LN class III (32.4%) with respectively (P = .09, P = .2)and was associated significantly with the anti-DNA antibody titer (P = .003). The severity of these lesions was found to be independently correlated with worsening of renal failure at 6 months follow-up (P = .02).

Conclusion

The findings of this study suggest that IFTA is a significant prognostic factor for the progression of renal failure in lupus nephritis, regardless of the class of the disease. The pathogenesis of tubulointerstitial lesions seems to be the result of circulating immune complexes specifically interacting with tubulointerstitial autoantigens.
#4179 DIFFERENCES IN PROTOCOLS FOR MEASURING GLOMERULAR FILTRATION RATE USING IOHEXOL
Authors: van Londen Marco , Bökenkamp Arend , Cavalier Etienne , Delanaye Pierre , Ebert Natalie
Published: June 2023

Background and Aims

When assessing kidney function, measurement of glomerular filtration rate (mGFR) using an exogenous marker such as iohexol is the gold standard. In this study, we aim to identify similarities and differences between iohexol-based mGFR protocols.

Method

Detailed data on iohexol measurement protocols were obtained using a standardized survey sent to centres in Europe and the US. It was completed by 15 participants. Data are reported as number and percentage (n, %).

Results

In the participating centres, measurements are performed after referral by a nephrologist (n=6, 40%), other specialties (n=5, 33%) or for research purposes (n=4, 27%). Most common indications for mGFR are evaluation of kidney donors (n=5, 33%), drug dosing (n=4, 27%), abnormal body composition (n=3, 20%) and transplant evaluation (n=4, 27%). Most participants perform measurements in the morning (n=10, 67%), with patients withholding caffeine (n=5, 33%), fasting (n=4, 27%) or avoiding heavy meals (n=3, 20%). Most centres use an IV iohexol dose of 5 mL 300 mg I/mL (n=10, 67 %) or a dose based on weight (n=2, 13%). The timing of sample collection is shown in Figure 1, most often a single sample per time point (n=12, 80%). Iohexol is measured by LC-MS (n=8, 53%) or LC-UV (n=7, 47%). Within-assay variability ranges between <2% (n=3, 20%) and 6-8% (n=1, 7%) and the between-assay variability ranges between <2% (n=2, 13%) and 6-8% (n=2, 13%). When asked about assumptions and corrections, most centres make a one-compartment assumption in their PK model (n=8, 53%), others making two-compartment (n=2, 13%) or measurement-dependent (n=1, 7%) assumptions. mGFR is standardized for body surface area according to the DuBois-formula (n=6 (40%), Haycock and Schwarz formula (n=2, 13%) or not-specified (n=7, 47%). Some participants correct their measurements for eGFR (n=9, 60 %). Most centres participate in external quality control (Equalis, n=12, 80%).

Conclusion

There is a large variation in protocols for iohexol-based mGFR, which highlights the need for a standardized mGFR protocol before widespread use in clinical routine.
#4556 IMPACT OF KIDNEY DONATION ON PREGNANCY OUTCOMES: A RETROSPECTIVE ANALYSIS
Authors: Kaul Anupma , Prasad Narayan , Bhaduaria Dharmendra
Published: June 2023

Background and Aims

More than 50% of living kidney donors are females with a significant proportion being in the childbearing age group. Recent data suggests risk of gestational hypertension, proteinuria and pre-eclampsia among pregnancies after kidney donation with a lower likelihood of full-term delivery.

Method

This retrospective study was conducted among females who donated kidney between (1997 - 2017) at a tertiary renal transplant centre in Northern India to assess for consequences of pregnancy outcomes among donors in terms of maternal and foetal outcomes.. Data of participants were collected using pre-tested semi structured questionnaire.

Results

925 female kidney donors (1332 pregnancies) in the pre donation group while 45 females (48 pregnancies) in the post donation period were included . Mean age of first pregnancy, weight (kg) gain, proportion of history of pre-natal check-up and history of unrelated donation was statically significant among the post -donation group . The proportion of pre-eclampsia, gestational hypertension, gestational diabetes, post-partum hemorrhage was insignificantly higher among post donation group with higher preterm birth with low birth weight babies . In Univariate analysis, Cesarean delivery, proteinuria and low birth weight <2500g were significantly associated with post donation pregnancy. While Cesarean delivery (Adjusted odds ratio: 8.2, 95% CI: 4.7-14.3, P = .024) and low birth weight < 2500g (Adjusted odds ratio: 6.3, 95% CI: 2.3-11.8, P = .003) were identified as an independent determinant among post donation pregnancies using multivariate analysis .

Conclusion

The study demonstrated not a large risk to maternal outcomes yet an increase risk to fetal outcomes in terms of prematurity and low birth weight among the post donation pregnancy group.
#4561 VOLUNTARY EXERCISE EXACERBATES CHRONIC KIDNEY DISEASE INDUCED BY FOLIC ACID IN MALE C57BL6J MICE
Authors: Santos Raisa Brito , Estrela Gabriel , Budu Alexandre , Arruda Adriano , Araújo Ronaldo
Published: June 2023

Background and Aims

Voluntary exercise is of utmost importance to avert a plethora of diseases and to ameliorate other conditions, such as neuromuscular diseases, however in some occasions, the inflammation can be exacerbated by intense physical activity. The folic acid kidney disease model is of key interest since it is non-invasive and leads to conspicuous fibrosis. Our main objective was to determine the influence of voluntary exercise on chronic kidney disease in folic acid-treated mice.

Method

Male C57/Bl6 mice were divided into 3 groups, vehicle (V), folic acid (FA), and folic acid + voluntary exercise (FA + E). The animals were kept in cages with or without voluntary wheels (sedentary or exercised groups) for 30 days, and then received a single injection of folic (240 mg/kg i.p.) in 0.3 mol/L sodium bicarbonate. The animals were euthanized after 28 days.

Results

Chronic kidney disease in the folic acid model is exacerbated by voluntary exercise. Voluntary exercise decreases the survival level in animals treated with folic acid (V- 100%, FA- 85,71%, FA+ E- 60%). On day 28 after folic acid administration the urea levels (FA vs. FA + E P= 0,003) and creatinine (V vs. FA + E p= 0,0004; FA vs. Fa+ E p= 0,0001). Renal injury marker such as KIM-1 (FA vs. FA + Ex p= 0,0131, FA vs. Fa+ E p= 0,0213) was higher in animals that went to the wheel, but NGAL showed no significant differences. Inflammation markers as IL-6 (V vs. FA + Ex p= 0,0337 FA vs. Fa+ E p= 0,0254) and TLR4 (V vs. FA + Ex p= <0,0001 FA vs. Fa+ E p= <0,0001) were exacerbated as well as apoptosis relation BAX/BCL2 (V vs. FA + Ex p= <0,0001 FA vs. Fa+ E p= <0,0001). Picrosirius red staining was used to assess tubulointerstitial fibrosis and the kidney architecture; animals from the FA+E group showed the highest destruction of kidney architecture.

Conclusion

We established that previous voluntary exercise has deleterious effects on nephrotoxic folic acid–Induced CKD.
#4613 PREVALENCE OF DKD RAPID PROGRESSION IN TYPE 2 DIABETES IN A DEVELOPING COUNTRY AND ITS CLINICAL PREDICTORS: A SINGLE CENTERED RETROSPECTIVE STUDY
Authors: Swaminathan Shilna Muttikal , Nagaraju Shankar Prasad , Prabhu Ravindra Attur , Nagri Shivashankara Kaniyoor , Rao Indu Ramachandra , Shenoy Srinivas Vinayak , Rangaswamy Dharshan , B Mohan V
Published: June 2023

Background and Aims

A significant proportion of diabetic kidney patients experience a rapid decline in GFR, leading to ESRD within months. Although there is a large number of studies on DKD, at present, there is a lack of well-controlled long follow-up studies to assess the burden of rapid progression, distinguishing the clinical profile of rapid progressors from non-progressors and its predictors. Identifying independent risk factors that contribute specifically to rapid progression is essential to prevent end-stage renal disease. Here we conducted a retrospective, hospital-based cohort study aimed to assess the prevalence, clinical profile, and clinical predictors for the rapid progression of DKD in type 2 DM.

Method

Type 2 DKD patients attending tertiary care hospital in South India were involved between January 2018 and 2022. CKD5 and those without minimum 6 months follow-up were excluded. Patients were followed up for 3.5 years. A sustained decline of eGFR >10 mL/1.73 m2/year was defined as rapid progressors. Patients were categorized into rapid and non-rapid progressors. Clinical profiles, micro-macrovascular complications, cardiovascular events, and other risk factors for rapid progression were studied. Data were analyzed using SPSS22

Results

In a median follow-up of 3.5 years, 220(61.3%) were rapidly progressed with median eGFR decline 12ml/1.73 m2/year(IQR 8.5-19.3), and 139(38.7%) were non-rapid progressors with median eGFR decline 1.6ml/1.73 m2(IQR-0-3.3).The baseline characteristics were given in Table 1. The presence of hypertension, proteinuria, diabetic retinopathy, and cardiovascular events (p-0.01) was higher in rapid progressors than non-progressors.On logistic regression analysis, independent predictors of rapid progression were proteinuria (OR4.7;95%CI(2.24-9.88); P = .001), diabetic retinopathy(OR 0.24; 95% CI(0.11-0.52); P = .001), and AKI episodes(OR 2.18;95% CI (1.28-3.71); P = .003) (Table 2).

Conclusion

The majority of type 2 DKD patients in our setting are rapid progressors. The higher degree of baseline proteinuria, presence of diabetic retinopathy, and AKI episodes were found independently associated with clinical predictors of progression.
#4623 A NOVEL ELECTRO-HYDRAULIC ACOUSTIC THERAPY REDUCES BLOOD PRESSURE IN HYPERTENSIVE PATIENTS WITH CHRONIC KIDNEY DISEASE: PRELIMINARY RESULTS
Authors: Wolak Talya , Lerman Amir , Glikson Michael , Sukholutsky Ivetta , Silberman Shuli , Lerman Lilach
Published: June 2023

Background and Aims

Arterial hypertension (HTN) in association with chronic kidney disease (CKD) is a global healthcare burden, yet clinically proven treatments are limited. electro-Hydraulic Acoustic Therapy (eHAT), using ∼10% of the energy used in shockwave lithotripsy, is a promising technique to ameliorate ischemia and regenerate tissues. eHAT has been demonstrated to enhance healing in tissues such as bone, muscle, and myocardium, via several mechanisms, particularly by promoting neovascularization. Furthermore, previous animal studies demonstrated that eHAT reduces blood pressure (BP) and preserves renal function after ischemic kidney injury. The present pilot study explored the clinical safety and efficacy of eHAT and tested the hypothesis that eHAT would reduce BP and preserve renal function in patients with medically-treated hypertension and CKD.

Method

So far, a total of 15 patients with HTN and Stage III a/b CKD were enrolled in this prospective, single-arm study. The patients were treated with six sessions of eHAT during a 3-week period. At each session, 2400 shockwaves were applied to each kidney with 0.09 mJ/mm2 at 2.66Hz (NephrospecTM by Curespec LTD, Yehud, Israel). Follow-up (FU) visits were performed at 1, 3, and 6 months.

Results

The treatment was well tolerated with no major adverse events or need for analgesic treatment. Average Automated Office BP (AOBP) showed a strong tendency for a decrease in diastolic BP from baseline to the Primary Efficacy Objective at FU II (3 months post last treatment), which progressively decreased further at FU III (6 months) (Table 1). Similarly, average Office BP (OBP) detected a strong trend for a progressive decrease in systolic BP from baseline to the Primary Efficacy Objective (Table 1). Levels of eGFR appeared to slightly rise throughout the study, but this change has not reached statistical significance levels (Table 1).

Conclusion

The current study demonstrates that the eHAT procedure is tolerable and safe in this cohort. Moreover, a 3-week regimen tended to reduce BP and preserve eGFR in patients with controlled HTN and CKD. Therefore, electro-Hydraulic Acoustic Therapy may emerge as a novel, safe, and non-invasive alternative therapeutic approach in the management of HTN in the context of CKD.
#4758 IMPACT OF GENDER ON CHRONIC KIDNEY DISEASE IN ELDERLY
Authors: Bhat Dr Sanjay , Kaul Anupma , Karoli Ritu , Rai Priyanka , Srivastava Rohit
Published: June 2023

Background and Aims

Men with chronic kidney disease (CKD) progress to end-stage CKD at a faster rate than women Data for the association of sex with chronic kidney disease (CKD) progression are conflicting, a relationship between the two especially among elderly population needs understanding .

Method

We conducted a prospective study among all elderly population with CKD attending Nephrology OPD between between Jan 2019-Jan 2022 in Tertiary care hospital, Lucknow and assessed for the stage of CKD and their fall in eGFR ie trajectory of fall in eGFR within a year's time.

Results

A total of 59 elder men and 34 females (>65 years) of age with estimated glomerular filtration rate (eGFR)<45mL/min/1.73 m2 followed up in renal clinics. They were looked for progression to ESRD and morbidity and mortality over time.

The age, basic disease, systolic blood pressure, underlying cardiac status and use of rennin angiotensin blockers were similar between the two groups. Baseline eGFRs were 36.4±7.0 in men and 35.0±6.2 mL/min/1.73 m2 in women (P<0.001), the degree of proteinuria among men was found to be statically significant as compared to women in this cohort. During a median follow-up of 2.9 years, (22.3% men) developed ESRD while 7.2 % died. The adjusted risks for ESKD and mortality were higher in men as compared to the women in this cohort.The decline in eGFR was evident across all stages of CKD among men as compared to women. The slop of decline in eGFR and degree of proteinuria was rapid among men compared to women (−2.9; 95% CI, −2.9 to −1.66 mL/min/1.73 m2 per year) than in women (−1.7; 95% CI, −1.92 to −1.55 mL/min/1.73 m2 per year; P<0.001). Although sex differences in eGFR decline were not different across CKD stages (P=0.3), the difference in slopes between men and women was progressively larger with proteinuria >0.5g/d (P = 0.04)

Conclusion

Elderly men have a steeper decline in eGFR along with higher proteinuria as compared to women indicating that the decline in the mean GFR in women was slower than in men, independent of health status.
#4773 INFECTIVE ENDOCARDITIS COMPLICATED BY RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS: BEYOND ANTIBIOTICS - TO TREAT OR NOT TO TREAT?
Authors: Nicolau Carla , Vieira Miguel Bigotte , Menezes Maria Do Mar , Góis Mário , Viana Helena , Sousa João , Ferreira Manuel Anibal A
Published: June 2023

Background

A significant proportion of patients with infective endocarditis, present with acute renal failure related to infective endocarditis-associated glomerulonephritis (IEAGN). However, IEAGN differs from other infection-related glomerulonephritis because it may present with clinical and serological disturbances resembling autoimmune diseases such as antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Its development introduces the dilemma of determining the best treatment approach. Immunosuppressive therapy added to antibiotic treatment may be beneficial for recovery of renal function in some cases of IEAGN with positive ANCA serology, although this approach is still controversial.

Case presentation

A 32-year-old man presented with fever, fatigue, purpura and rapidly progressive glomerulonephritis. He had a history of atrioventricular septal defect corrected at 9 years of age. Blood analysis showed anemia, acute kidney injury and positive ANCA proteinase 3 (PR3). Urine analysis revealed hematuria and proteinuria. Echocardiogram showed vegetation on the mitral valve with moderate to severe mitral regurgitation. Blood cultures showed Streptococcus mitis. After 14 days of intensive antibiotic regimen, kidney function rapidly deteriorated and ANCA titers remained high. A renal biopsy was performed and showed crescentic necrotizing glomerulonephritis with deposition of C3 and IgM – compatible with infection-related glomerulonephritis. Treatment was initiated with pulses of methylprednisolone, low dose of corticosteroids and intravenous immunoglobulin, combined with antibiotics. Renal function dramatically improved in less than a week. At three months of follow-up, kidney function remains stable and ANCA serology negative.

Conclusion

In infective endocarditis, ANCA antibodies might have an important pathogenic role rather than secondary phenomena. We suggest that patients with IEAGN, that despite adequate antibiotic regimen present, present with kidney deterioration and evidence of crescentic glomerulonephritis on kidney biopsy, might require addition of immunosuppressives.
#4850 20 YEARS' EXPERIENCE OF PERITONEAL DIALYSIS IN SARAWAK, MALAYSIA
Authors: Phui Vui Eng , Yang Zhi , Koh Alex , Hong Hui , Tan Clare
Published: June 2023

Background and Aims

Peritoneal dialysis is a modality of renal replacement therapy first introduced in the 1960s. In the event of the recent COVID 19 pandemic, peritoneal dialysis is gaining popularity due to the increased preference of home dialysis. Sarawak is the largest state in Malaysia with a population of more than 2 million. Unfortunately, 13% of households in the state are living in poverty. We present our experience with continuous ambulatory peritoneal dialysis (CAPD) for the past years in a geographically and socioeconomically challenging region.

Method

Sarawak General Hospital is the centre of referral for Tenckhoff catheter insertion from other districts in Sarawak. This is a retrospective record review of all CAPD patients who were under our clinic follow up from 2001 to 2022. Data examined included patient's demographic data, incidence of peritoneal dialysis related peritonitis and their outcome.

Results

All of the patients on CAPD were recorded by December of each year since we started our service in 2001 which shows a rising trend of patients on CAPD, with the highest in December 2022 at 399 patients. The number of patients with dialysis related peritonitis was also collected. Despite having more patients on CAPD, the number of peritonitis episodes per patient-year were in a decreasing trend. This was the result of the implementation of empirical first line intra-peritoneal antibiotics as part of the CAPD Peritonitis Management Protocol in 2015 and Decontamination Protocol in 2016.

Conclusion

Despite the headwinds of geographic and socioeconomic challenges, the number of patients on CAPD is on the rise. Over the years, peritonitis rate declined approaching to 0.2 episodes per patient-year. This was made possible with the introduction of local decontamination protocol and CAPD peritonitis management protocol, which helped improve the life expectancy and health of renal patients in the region.