bluuebunny/crossref_metadata_2025 huggingface dataset:
MO107CLINICAL CHARACTERISTICS OF A PATIENT POPULATION WITH ATYPICAL HAEMOLYTIC URAEMIC SYNDROME AND MALIGNANT HYPERTENSION: THE GLOBAL AHUS REGISTRY ANALYSIS
Authors: Halimi Jean-Michel , Al-Dakkak Imad , Anokhina Katerina , Ardissino Gianluigi , Licht Christoph , Lim Wai , Massart Annick , Schaefer Franz , Van de Walle Johan , Rondeau Eric
Published: May 2021

Background and Aims

Atypical haemolytic uraemic syndrome (aHUS) is a rare disease that manifests as complement-mediated thrombotic microangiopathy (TMA), which can lead to severe organ damage. Some patients with aHUS may present with malignant hypertension (MHT); both conditions can result in TMA. The objective of this analysis was to characterise patients with aHUS and MHT.

Method

In this analysis, patients from the Global aHUS Registry (NCT01522183) were included if they were diagnosed with MHT and were followed ≥90 days after initial aHUS symptom presentation or diagnosis date; patients were excluded if they withdrew from the registry or discontinued treatment with eculizumab due to a diagnosis other than aHUS. Demographics and clinical characteristics were evaluated.

Results

Seventy-one of 1903 registry patients were included in the analysis. Clinical characteristics are presented in the table. Seventeen patients (24%) had a paediatric (<18 years) onset of disease, and 54 (76%) were adults at aHUS diagnosis; female patients were slightly overrepresented (61%). Sixty-nine percent of patients were reported to have MHT at around the same time as aHUS diagnosis (+/-2 months), while 11% and 13% experienced MHT before and after aHUS diagnosis, respectively. aHUS triggering conditions were reported in 6/71 patients (8%) (Table). Cardiovascular (27%) and gastrointestinal (21%) symptoms were the most commonly reported extra-renal manifestations. Eight patients (11%) had a reported family history of aHUS and 40 patients (56%) had a complement pathogenic variant or an anti-CFH-antibody. Thirty-three patients (46%) had a kidney transplant; of these, 20 were prescribed eculizumab in the peri- or post-transplant period.

Conclusion

In this analysis of patients with aHUS and MHT, the observed high prevalence of pathogenic variants in complement genes or anti-CFH antibodies, alongside the high proportion of patients with extrarenal manifestations and/or requiring kidney transplant, indicate a high severity of presentation and poor prognosis of aHUS associated with MHT.
MO108ACCURACY OF PERIDIALYTIC, INTRADIALYTIC AND SCHEDULED INTERDIALYTIC RECORDINGS FOR DIAGNOSING HIGH AMBULATORY BLOOD PRESSURE IN HEMODIALYSIS
Authors: Theodorakopoulou Marieta , Iatridi Foteini , Loutradis Charalampos , Alexandrou Maria Eleni , Karpetas Antonios , Koutroumpas Georgios , Raptis Vasileios , Ferro Charles , Papagianni Aikaterini , Sarafidis Pantelis
Published: May 2021

Background and Aims

Hypertension is highly prevalent in hemodialysis patients. Current recommendations suggest the use of ambulatory-BP-monitoring (ABPM) as the gold-standard for hypertension diagnosis and management in these subjects. This study assessed the accuracy of peridialytic, intradialytic and scheduled interdialytic recordings in diagnosing high 44-h interdialytic BP.

Method

A total of 242 hemodialysis patients that underwent valid 48-h ABPM were included in the analysis. We used ambulatory BP as reference standard and tested the accuracy of the following BP metrics: Pre- and post-dialysis, Intradialytic, Intradialytic plus pre/post-dialysis readings and Scheduled interdialytic BP (out-of-dialysis day: readings at 8:00 am, 8:00 pm or their average).

Results

44-h SBP/DBP levels had significant differences with and pre- or post-dialysis BP, but no or minor differences with any of the other BP metrics. 44-h SBP and DBP correlated strongly with Intradialytic (r=0.713/0.753, p<0.001), Intradialytic plus pre/post-dialysis (r=0.725/0.758, p<0.001) and averaged Scheduled interdialytic BP (r=0.874/0.823, p<0.001). Bland-Altman plots showed absence of systemic bias for all index metrics, but large between-method difference and wider 95% limits of agreement for pre- and post-dialysis BP compared to Intradialytic, Intradialytic plus pre/post-dialysis and averaged Scheduled interdialytic BP. In ROC-analysis for diagnosing 44-h SBP≥130mmHg, the Area-Under-the-Curve of pre-dialysis (0.723) and post-dialysis SBP (0.746) were significantly lower than that of Intradialytic (0.850), Intradialytic plus pre/post-dialysis (0.850) and Scheduled interdialytic SBP (0.917) (z-test, p<0.001 for all pairwise comparisons). The corresponding sensitivity/specificity values were 76.6%/54.5%, 78.7%/59.4%, 73.0%/81.2%, 68.1%/88.1% and 82.3%/89.1%, respectively. Similar observations were made for DBP.

Conclusion

In contrast to pre- and post-dialysis BP, the average of intradialytic, intradialytic plus pre/post-dialysis or scheduled interdialytic BP recordings show reasonable agreement with ambulatory BP and may be used for hypertension diagnosis and management in hemodialysis.
MO097BETA BLOCKER PREVENTS CARDIAC MOLECULAR AND MORPHOLOGICAL REMODELLING IN EXPERIMENTAL URAEMIA
Authors: Chinnappa Shanmugakumar , Maqbool Azhar , Denby Laura , Mooney Andrew , Drinkhill Mark
Published: May 2021

Background and Aims

Fifty years of heart failure research has shown that pathological cardiac remodelling forms a vicious cycle with myocardial dysfunction leading to progressive heart failure (HF) [Circulation, 102

IV14-23, 2000]. Fetal gene induction is associated with this process and beta blocker therapy has been shown to prevent it. Although chronic kidney disease (CKD) and HF share similar mediators of cardiac remodelling, the benefits of beta blocker therapy in CKD has not been studied. We, therefore, tested the hypothesis that beta blocker therapy prevents fetal gene induction and pathological cardiac remodelling in experimental uraemia.

Method

Wistar rats (n=32) had subtotal nephrectomy (STNx) [Frontiers in physiology, 10

1365, 2019] or sham surgery and were followed up for 10 weeks. The animals were randomly allocated to metoprolol (10mg/kg/day) or vehicle. In vivo and in vitro cardiac assessments were performed, and changes in myocardial fetal gene expression were also studied.

Results

Heart rate was significantly lower in metoprolol groups compared to untreated groups demonstrating effective beta blockade (Fig 1A). Echocardiographic LV mass was significantly higher in untreated STNx group compared to the metoprolol group (896.4 vs 632.2g, P=0.0004). Similar changes were seen with heart weight to tibia ratio (Fig 1B). There was no significant difference in blood pressure (BP) between treated and untreated STNx animals (123 vs 119 mmHg, P=0.359) (Fig 1A). STNx increased mRNA expression of fetal genes and there was a trend towards attenuation of this increase with beta blocker therapy (Fig 1C).

Conclusion

Beta blocker therapy ameliorates uraemic pathological cardiac remodelling irrespective of changes to BP. This benefit appears be associated with a reduction of induced fetal gene expression. Further translational research on the benefits of beta blockade in the treatment of uraemic cardiomyopathy is required.
MO119COMPUTER-DERIVED SOFTWARE IN CLINICAL PRACTICE: RESULTS FROM A SHORT-TERM FOLLOW-UP ACCORDING TO KIDNEY STONE COMPOSITION IN KIDNEY STONE FORMERS
Authors: Cunha Tamara , Rodriguez Adrian , Ferraro Pietro Manuel
Published: May 2021

Background and Aims

Urinary supersaturation (SS) contributes to stone formation, and its assessment in stone formers may be helpful in clinical practice. Several computer programs are available for SS calculation, including EQUIL2, JESS and Lithorisk1. The aim of this study was to evaluate changes in SS in 24-hour urine in patients with known stone composition before and after about three months of regular treatment.

Method

Patients who submitted their stone/s for composition analysis and had provided an adequate 24-hour urine collection (creatinine 15-20 mg/kg/24-hour) before and around 90 days under regular treatment were included. Stone composition was defined using morphoconstitutional and infrared spectroscopy. The treatment was initiated in accordance with specific guidelines, and included dietary advices and medications2. SS for calcium oxalate (CaOx), calcium phosphate (CaP) and uric acid (UA) using EQUIL2, JESS and Lithorisk were calculated at baseline and after about 90 days on treatment. Continuous variables were reported as means (SD) while categorical variables were reported as frequencies and percentages. Baseline and follow-up SS urine values were compared using the Wilcoxon signed-rank test. 3D graphs were plotted using mean SS values of CaOx, CaP and UA obtained from each program before and after treatment, dividing the stones into 4 groups1: calcium oxalate monohydrate (COM), calcium oxalate dihydrate (COD), calcium phosphate (CaP), and uric acid (UA). Ethical Committee approval was obtained.

Results

105 patients (61 men, 58%) were followed and provided 24h urine collection. Of these, 101 (96%) were recurrent patients. The mean (SD) follow-up was 94 (14) days. 48 (46%) of all calculi were made of CaOx, either COM or COD, 36 (34%) of UA, and 21 (20%) of CaP. A significant reduction in SS values during treatment was observed in patients with COM (p<0.05) , COD (p<0.001), and UA stones (p<0.001) with all programs. The reduction in SS values over time in patients with CaP stones was not significant (Table 1). Figure 1 shows 3D plots with SS before and after treatment into 4 groups of stone formers.

Conclusion

EQUIL2, JESS and Lithorisk are suitable software currently used for clinical and research purposes. SS values calculated by EQUIL2, JESS and Lithorisk during follow-up showed a significant reduction among COM, COD and UA stone formers. CaP stone formers did not show significant changes in SS over time.
MO120STONE COMPOSITION AND CARDIOVASCULAR DISEASE IN PATIENTS WIITH NEPHROLITHIASIS
Authors: Valencia Ana Lucía , Coca Armando , Lorenzo Arturo , Fidalgo Veronica , Perez Vicente , Fernandez Lucila , Aller Carmen , Sanz Sandra , Mendiluce Alicia
Published: May 2021

Background and Aims

Kidney stone disease is widely prevalent in the general population and has been associated with multiple comorbidities including hypertension, diabetes, chronic kidney disease and cardiovascular disease. We aimed to describe the possible link between stone composition and cardiovascular disease and its differential effect among women and men.

Method

Retrospective review of patients with known stone composition seen in a nephrolithiasis unit in the last five years. Anthropometric and clinical data were gathered from the hospital records. Stone composition was defined as such if ≥50% of the stone was made from a single component. Cardiovascular disease included coronary artery disease, stroke and peripheral vascular disease. Unadjusted and adjusted logistic regression analysis were applied to describe the potential relationship between stone composition and cardiovascular disease.

Results

337 patients were included in the study sample. Median age was 57 (IQR 47-67), 61.1% males. 58.2% suffered from recurrent stone disease and 28.5% from family history of stone formation. 32.9% of patients had hypertension, 22,4% diabetes and 13,1% chronic kidney disease. The most common kidney stone component was calcium oxalate (38.6%) followed by calcium phosphate (21.3%), uric acid (14.2%), struvite (8%) and brushite (0.9%). Only uric acid as main stone component was associated with cardiovascular disease among men but not women in our sample in univariate analysis. That relationship was lost in adjusted logistic regression analysis.

Conclusion

Calcium oxalate and phosphate were the most common components of kidney stones. No relationship was found between stone composition and cardiovascular disease in the study sample.
MO1021HYPERTENSION IN CHILDHOOD MINIMAL CHANGE DISEASE: IGNORED, MISSED OR UNDER-DIAGNOSED?
Authors: Sharma Sourabh , Sharma Neha
Published: May 2021

Background and Aims

Minimal change disease (MCD) is most common form of primary nephrotic syndrome (76.6% as per ISKDC) in children aged 1 to 10 years. As per current literature, blood pressure (BP) is usually normal in childhood MCD while in adults, 50% MCD cases are hypertensive. We hypothesized that hypertension is prevalent in childhood MCD also and most of cases are missed or under-diagnosed due to lack of BP monitoring, inappropriate BP cuff size (larger cuff will inaccurately show lower BP; cuff should cover 75% to 80% of arm circumference between antecubital fossa and axilla) or lack of knowledge about childhood hypertension criteria (systolic or diastolic BP> 95th percentile for age on ≥2 clinical visits at least 1 week apart).

Method

This cross-sectional study was performed from March 2018 to December 2020 at a tertiary care centre in India. Newly diagnosed and relapses of primary nephrotic syndrome (presumed MCD) in children aged 1 to 10 years were included in the study. All cases were subjected to careful BP monitoring and charting using appropriate BP cuff, while child is calm and relaxed, in quiet room with comfortable temperature and empty bladder. Three measurements were taken at 1 minute interals and taking average of last 2 measurements. Percentile charts for age and height were followed.

Results

fifty four cases of childhood MCD were studied. Thirty six cases (66.67%) were male. Mean age was 5.48 years (SD ±2.31). Thirty two cases (59.26%) were found to be hypertensive. Fourteen cases (43.75%) were relapses. Seven cases (21.87%) were steroid resistant nephrotic syndrome while three cases were steroid dependent. Five cases were already on calcineurin inhibitors when diagnosed of hypertension. There was family history of hypertension in 9 cases diagnosed of hypertension (p value 0.77). There was no correlation between occurrence of hypertension and degree of proteinuria, hypoalbuminemia or body mass index. All hypertensives were managed with angiotensin receptor blockers and regularly followed-up.

Conclusion

Results of our study are contrary to traditional belief that hypertension is not common in childhood MCD. Significant number of cases are hypertensive. Correct BP measurement and interpretation is necessary in each childhood MCD case. Its occurrence is not correlated with family history or degree of proteinuria, hypoalbuminemia or body mass index.
MO1026MICROALBUMIN LEVEL IN URINE DEPENDING ON ACE GENE POLYMORPHISM IN PATIENTS WITH VUR
Authors: Zaikova Natalia , Dlin Vladimir , Sinitsina Lilia , Sacara Victoria , Korsunskiy Anatolii
Published: May 2021

Background and Aims

reflux nephropathy (RN) is the most serious complication of vesicoureteral reflux (VUR). The aim of the study was to assess the urinary level of MA (microalbumin) as an expression of tubulointerstitial damage depending of ACE genotype polymorphisms in children with VUR.

Method

94 patients, with VUR at the age from 3 year to 16 years (average age of 6.72 ± 0.68 years), including 65 girls (69,1%) were enrolled. As a control population to compare the distribution of genotypes and alleles of ACE gene used a sample of 100 healthy children (82girls), indigenous ethnic groups, mean age of 11.3 ± 5.4 years. To determine the gene polymorphism of ACE we used the method of polymerase chain reaction. Renal scar in DMSA scan was performed at least six months after urine tract infection (UTI). According to DMSA scan results, children were divided into 2 groups: gr. 1 - 12p. (VUR without RN), gr. 2 – 82 p. (VUR with RN). Urinary excretion of MA was measured by ELISA method.

Results

In gr. 1 is the frequency of genotype I/I amounted to 58%, I/D is 42% and D/D – is not detected. In the scar group (gr.2) frequency of genotype I/I is 12% (p1,2<0,05), I/D is 63% and (p>0.05), and D/D is 25% (p<0.05), respectively. In the distribution of I and D allele in children with VUR (71,3% of children with RN has got D allele). In RN groups with genotype D/D, the level of MA/Cr in the urine was 1,5 times higher than in children with genotype I/D (p<0.05) and 3-3,5 times higher than in patients with genotype I/I (р=0.0001). Significant difference in urinary levels of MA/Cr in the non scar group with genotype I/I and I/D is not revealed.

Conclusion

D/D-genotype of ACE may be a genetic susceptibility factor contributing to adverse renal prognosis – reflux nephropathy and presenting as risk factor for scar formation. A high urinary level of MA/Cr and positive correlation with genotype D/D is a significant and sensible marker of tubulointerstitial damage
MO1009TWENTY-FOUR-HOUR AUGMENTATION AND CARDIAC INDEX LEVELS ARE INCREASED IN CHILDREN ON HEMODIALYSIS COMPARED TO PERITONEAL DIALYSIS PATIENTS
Authors: Stabouli Stella , Askiti Varvara , Chrysaidou Katerina , Malakasioti Georgia , Karava Vasiliki , Mila Maria , Chainoglou Athanasia , Marinaki Smaragdi , Mitsioni Andromachi
Published: May 2021

Background and Aims

Cardiovascular disease is highly prevalent in the chronic kidney disease population and associates with higher morbidity and mortality even in young ages. The aim of the present study was to assess data from 24h ambulatory blood pressure monitoring (ABPM) and 24h pulse wave analysis (PWA) in dialyzed children and investigate their association with left ventricular mass as a marker of increased cardiovascular risk.

Method

Children and adolescents aged 6 to 18 years, on dialysis for more than 12 months, [16 on peritoneal dialysis (PD) and 12 on hemodialysis (HD)], underwent 24h ABPM, 24h PWA, and echocardiography.

Results

Peripheral and central blood pressures (BPs), mean pulse wave velocity (PWV) and left ventricular mass index (LVMI) were similar between PD and HD patients (figure 1a,b). Among PWA hemodynamic parameters, augmentation index (AIx75), cardiac index (CI), and heart rate were higher in the HD group (p<0.05) (figure 1c,d). LVMI was associated with hemoglobin (Hb) (R2=0.19, p<0.05)mean arterial pressure (MAP) (R2=0.34, p<0.005), central systolic BP (cSBP) (R2=0.39, p<0.001), AIx75 (R2=0.26, p<0.005), CI (R2=0.14 p<0.05) and PWV (R2=0.26, p<0.005), but not with weight, body mass index or relative overhydration. CI and AIx75 were higher in the HD group compared to PD both in patients with normal LVMI and those with left ventricular hypertrophy (LVH). CI remained higher in HD patients after adjustment for Hb, MAP, cSBP, PWV, AIx75, and LVMI (estimated marginal means 4.17, 95%CI 3.80-4.53 versus 3.40, 95%CI 3.11-369 in PD patients, p<0.05). Similarly, AIx75 remained higher in HD patients after adjustment for Hb, MAP, cSBP, PWV, CI, and LVMI (estimated marginal means 28.89, 95%CI 24.49-33.30 versus 22.62, 95%CI 19.15-26.08 in PD patients, p=0.05).

Conclusion

HD pediatric patients demonstrate higher AIx75 and CI compared to PD patients even in the absence of LVH. These results suggest distinct patterns of vascular and cardiac functional changes in HD patients that may increase cardiovascular risk beyond LVH.
MO1010CLINICAL VARIABILITY OF ALPORT SYNDROME IN CHILDREN WITH MISSENSE COL4A5 VARIANTS
Authors: Aksenova Marina , Lepaeva Tatjana , Nikishina Tatjana , Piruzeeva Oxana , Obuhova Varvara , Konkova Natalia
Published: May 2021

Background and Aims

The phenotype-genotype relation is well established in patients (especially male) with X-linked Alport syndrome (XLAS). The aim of study was to define the spectrum of COL4A5 pathogenic variants and impact of missense mutation on disease progression.

Method

The NGS-based genetic testing of COL4A3, COL4A4, COL4A5 was performed in 186 children with suspected Alport syndrome. The comparison of clinical symptoms (frequency, age of presentation of macrohematuria, proteinuria, eGFR decrease, sensorineural deafness (SND), level of proteinuria (mg/m2/day) and eGFR (ml/min/1.73m2) at the last presentation) was carried out in male with XLAS due to different COL4A5 variants.

Results

The XLAS was diagnosed in 93 children (Ме 7,5[4;11], 51М) from 79 families. The following COL4A5 variants were revealed: missense (n=70, q=0.75), splice site (n=10 from 9 families, q=0.11), frame shift (n=6, q=0.06), nonsense (n=7, q=0.08). Missense variants were presented by COL4A5 c.1871G>A, p.(Gly624Asp) in 26% of cases (n=18). The mean age of ESRD was lower in male family member (35[24;35] years vs 48[40;55], p=0.023) with non COL4A5 p.(Gly624Asp). There was no difference in age on last presentation (13[9;14] vs 12[8;15], p=0.091) between pts with COL4A5 p.(Gly624Asp) and other missense variants. There was significant difference between the male with p.Gly624Asp and other missense variants in frequency of proteinuria (0.61 vs 0.25, p=0.043), SND (0.5 vs 0.08, p=0.03), age at onset (5[3;7] vs 14[8;16], p=0.02) and degree of proteinuria (441[78;1158] vs 66[22;160], p=0.023) and eGFR level (83[66;109] vs 96[91;104], p=0.048) at the last examination.

Conclusion

The XLAS is caused by missense variants in ¾ of cases in our cohort. We confirmed the other European studies results: the COL4A5 p.(Gly624Asp) is the most common variant of missense mutations characterized by mild phenotype of XLAS.
MO1037WOMEN REPRESENTATION IN CLINICAL PRACTICE GUIDELINES AMONG MAJOR NEPHROLOGY GUIDELINES
Authors: Mohan Arjunmohan , Chengappa Madhuri , Herrmann Sandra , Poonacha Thejaswi
Published: May 2021

Background and Aims

While the percentage of women entering nephrology has increased over the years, women representation and sex disparities in the authorship of major nephrology Clinical practice guidelines (CPG) has not been examined. Our study evaluates current sex disparities and women representation, and the nationalities of women authors in nephrology CPGs developed by the Kidney Disease: Improving Global Outcomes (KDIGO), Kidney Disease Outcomes Quality Initiative (KDOQI), and the European Renal Best Practice (ERBP), the official guideline body of the ERA-EDTA.

Method

We examined the number of female versus male guideline workgroup members (panelists) for all available CPGs in each of the three organizations as of Dec. 2020, which are available on their respective websites. We discerned the sex of the panelists based on google search and their affiliated institutional websites. We obtained the nationalities of the workgroup members from the authorship information of the respective CPG.

Results

Of the total 488 panelists in all three organizations, 115 (23.6%) were females and 373 (76.4%) males. KDIGO had 184 panelists, of which 46 (25%) were females. The CPGs with the highest and the least women representation are ‘Diabetes in Chronic Kidney Disease (CKD)’ (41.2%) and ‘Anemia in CKD’ (11.8%), respectively. The countries with the highest number of women representations are the USA (20), followed by Canada (6), and China (4). In KDOQI, 39 (31%) of 127 panelists were female. While CPGs related to ‘Evaluation and management of CKD’ and ‘Nutrition in children with CKD’ each had 50% female panelists, ‘Blood pressure management in CKD’ CPG had 10% female panelists. 28 (72%) of the total 39 women were from the USA. The ERBP had 30 (17%) females of the total 177 panelists. ‘CKD in older patients’ CPG comprised 42.1% female panelists. CPGs for ‘Glycemic control in diabetes’ and ‘Glucose lowering drugs in diabetes’ had no female panelists. Belgium and UK each had six women representatives, while France and The Netherlands 4 women representatives each.

Conclusion

The guidelines developed by the most prominent organizations – KDIGO, KDOQI, and ERA-EDTA have less than 25% women representation. While it is encouraging to note that there is more women representation in some of the CPGs developed by KDIGO in 2020, evaluating the barriers contributing to the under-representation of women in major nephrology organizations is warranted. Also notable is a lack of women representation from developing countries.
MO1038JOB BURNOUT IN RARE DISEASE RESEARCH PHYSICIANS DURING COVID-19 PANDEMIC
Authors: Zou Linfeng , Zhang Yun , Wang Ying , Zhang Lei , Xia Peng , Chen Limeng
Published: May 2021

Background and Aims

Doctors are exposed to high levels of stress in their profession and are particularly susceptible to experiencing burnout. Rare disease researches are enlightening, with more workload to clinicians, especially during the Covid-19 pandemic. We aim to explore the mental influence of participating in rare disease researches on clinicians.

Method

Doctors received electronic questionnaires regarding job-burnout in October 2020. The modified Maslach Burnout Inventory-General Survey (MBI-GS) was used to evaluate job burnout state. The MBI-GS consisting of three dimensions, emotional exhaustion (five questions), cynicism (five questions), and reduced personal accomplishment (six questions). The 7-grade Likert scale is adopted in each question, from 0 point (never) to 6 points (very frequently). Job burnout was considered if the average score of any dimension is no less than three. 

Results

Questionnaires from all 203 doctors were analysed in this study, with females (70.0%, n=140). Age ranging from 25 to 39, 40 to 54, and above 55 were 41.4%, 50.7%, 7.9%, respectively. Nearly half of the subjects (50.2%, n=102) fulfil the definition of job-burnout, which was fewer than that in the residency program (50.2% vs. 62.9%, p=0.02). An inappropriate evaluation system (36.0%) and lack of private time (35.5%) were the leading cause of job-burnout. The pressure of scientific researches (79.3%) and career promotion (58.1%) was the major source of mental pressure.

Doctors who participated in rare disease researches (46.8%, n=95) did not show significant differences in burnout rate than individuals who did not (44.2% vs 55.6%, p=0.123), nor as in three dimensions (27.3% vs 36.1%, p=0.183 for emotional exhaustion, 21.1% vs 20.4%, p=0.905 for cynicism, 21.1% vs 27.8%, p=0.267 for reduced personal accomplishment). Logistic analysis revealed that high requirement from superior (22.5% vs 6.9%, p= 0.001), pressure from family (33.3% vs 17.8%, p=0.010), inappropriate job allocation (47.1% vs 29.7%, p= 0.019) as well as delayed off-work time (p=0.013) were independent risk factors of job-burnout. Physicians who participate in rare disease research had better job allocation (75.8% vs. 49.1%, p<0.001), but not in the other three risk factors. 

Conclusion

More workload did not increase the job-burnout of physicians participating in the rare disease research, which might be contributed by the appropriate job allocation.
MO1040KNOWLEDGE, ATTITUDES AND PERCEPTION OF ORGAN DONATION BY STUDENTS IN MEDICINE
Authors: Failal Imane , Ezzaki Sanae , Elafifi Rania , Mtioui Naoufal , Elkhayat Salma , Zamd Mohamed , Ramdani Benyounes
Published: May 2021

Background and Aims

Organ transplantation is a treatment option to millions of patients worldwide. In this area, Morocco lags far behind the developed countries and even compared to some countries in the Arab world.

The objective of this study is to assess the knowledge; social attitudes and perceptions of donation and organ transplantation by medical students.

Method

This is a cross-sectional study descriptive and analytical target held in the Faculty of Medicine and Pharmacy of.

Results

320 medical students were surveyed. The mean age was 21.5 ± 2.32 years, with a female representing 78%.

Almost all surveyed students knew the lethal diseases requiring the use of the graft (99.8%) and 97% of them knew the transplantable organs. 92% had heard of the possibility of organ transplants in Morocco, 90% of students felt that there are many people in need of transplants

87% of students were aware of the existence of legislation governing organ donation in Morocco. Only 7% thought that acts of donation and transplantation of organs are performed in private clinics, 89% of respondents know that there is a book in which one can register to make known its agreement to give its organs after death, 81% do not know the steps to register for this registre.97% were for organ donation and causes of refusal were: religion and the attainment of bodily integrity

Conclusion

There has to be targeted actions in order to promote donation and transplant in Morocco in order to enhance knowledge and information on medical, religious and legal order that the attitudes and perceptions of the population live.
MO1041AWARENESS, KNOWLEDGE AND PERCEPTION OF CHRONIC KIDNEY DISEASE PATIENTS AT RENAL MEDICINE OUTPATIENTS' CLINIC, SINGLE CENTRE EXPERIENCE
Authors: AlRahbi Fatma , Alsalmi Issa
Published: May 2021

Background and Aims

Chronic kidney disease (CKD) is a major cause of morbidity and mortality in the Sultanate. Many preventive measures have focused on early detection and education. Hence, awareness and education of kidney disease influence positively its medical management and diminish significantly the economic burden on public health. Knowledge of CKD and risk factors increases the perception of being at high risk and increasing health seeking behaviour.

We conducted a longitudinal survey at Renal Medicine Department among our patients to assess the level of awareness, knowledge of CKD and the treatment options.

Method

We used a pretested structured questionnaire to collect information on socio-demographic and knowledge of patients attending Renal Medicine Department. The questionnaire was distributed to all CKD patients of at least one-year duration after their diagnosis.

Results

A total of 200 patients completed this study, mainly from the capital region. The mean age was 50 (SD 17.1) years for male participants and 42.3 (SD 16) years for female participants. The majority (74.3%) knew the reason for their referral to nephrologist. 31% of the patients with CKD reported their shock when informed about their kidney status by the nephrologist at the first time. Two third (64%) of patients reported having no knowledge of their kidney function and 50% of them were not aware about renal replacement therapy options. 52.1% of participants refused for early access creation. 22% of them expressed their refusal for the early access creation as they have no uremic signs. Finally, 60% of the study participants had no family member attending with them during their clinic visit.

Conclusion

Patients and their family should receive enough information and education regarding the nature of renal disease and the options for the treatment to allow them to make an informed decision about the management of their CKD. Awareness of the factors associated with a well-informed-decision making in the treatment of CKD can provide health professionals with evidence on how best to deliver education programs for patients and their families. It may also enhance communication and improve the capacity for patient and family involvement in shared decision making.
MO1042SCREENING FOR CHRONIC KIDNEY DISEASE IN PATIENTS WITH HIGH BLOOD PRESSURE: A SURVEY OF TRAINEES’ ATTITUDES AND PRACTICES IN MOROCCO
Authors: Naouaoui Salma , Chettati Meriem , Fadili Wafaa , Laouad Inass
Published: May 2021

Background and Aims

High blood pressure is a leading cause of end stage renal disease (ESRD). However; early detection of chronic kidney disease (CKD) delays progression of kidney failure and reduces the risk of cardiovascular complications. Therefore, the aim of our study was to assess the attitudes and practices of interns and residents regarding screening for chronic kidney disease in patients with high blood pressure at a Moroccan University hospital.

Methods

A cross-sectional survey was conducted among 100 medical interns and residents at Mohammed VI university hospital of Marrakesh.

Results

Overall, 82% of the trainees who responded (response rate 89%) stated that they were sensitized to screening for chronic kidney disease in patients with high blood pressure, mainly during their medical studies. However, trainees who systematically monitor renal function in their hypertensive patients did not exceed 13%. While 34% of respondents preferred to refer them to a cardiologist or a nephrologist, and 35% looked for renal impairment only in special situations, dominated by the presence of diabetes or severe hypertension. The main tests used by the participants for monitoring kidney function were represented by blood renal function (100%) and 24h urine protein (61%). Microalbuminuria was mentioned by only 23% of the trainees. The major limits reported by the surveyed physicians were the lack of experience and the non- compliance of patients.

Conclusion

Our findings revealed inappropriate practices among our training doctors concerning the screening of CKD in hypertensive patients. Therefore, more educational workshops and courses are recommended, especially in low-income countries where access to dialysis is not always affordable.
MO933EFFECT OF PHYSICAL ACTIVITY AND LIFESTYLE CHANGES ON INSULIN RESISTANCE IN PATIENTS AFTER KIDNEY TRANSPLANTATION
Authors: Graňák Karol , Matej Vnucak , Skálová Petra , Pytliaková Margaréta , Laca Ľudovít , Mokáň Marián , Dedinska Ivana
Published: May 2021

Background and Aims

The incidence of post-transplant diabetes mellitus (PTDM) after kidney transplantation (KT) is high and ranges from 15-30%. Insulin resistance (IR) at the time of KT is the most significant risk factor for the development of PTDM in patients after KT, as demonstrated by several analyzes. It is possible to reduce the high incidence of PTDM by influencing just modifiable risk factors, including obesity and the associated IR. The aim of this work is to determine the effect of precisely determined physical activity and lifestyle changes on IR and other risk factors for PTDM in patients after KT.

Method

This is a prospective controlled analysis, which included 44 patients after primary KT in the Martin Transplant Center. Half consisted of a study group (n = 22) whose patients were assigned to perform regular physical activity. The primary goal was to complete at least 150 minutes of moderate intensity physical exertion per week. They performed an aerobic or combined (aerobic + anaerobic) type of sports activity. Monitoring was provided by a sports tracker (Xiaomi Mi Band 3 compatible with Mi Fit mobile application). The other half was made up of a control group. The exclusion criterion at that time was already diagnosed with diabetes mellitus or a pre-diabetic condition. IR was assessed using the HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) index from fasting blood glucose and insulinemia values. Each patient underwent an oral glucose tolerance test (oGTT) at the end of follow-up. Patients in both groups have the same immunosuppressive protocol. The duration of follow-up was 6 months.

Results

In the observed group we univariately found in the 3rd and 6th month of monitoring significantly lower waist circumference (P = 0.0437, P = 0.0372), better graft function (P = 0.0036, P = 0.0137), lower value glycemia (P = 0.0016, P = 0.0003), C-peptide (P = 0.0447, P = 0014) and lower low-density lipoprotein (LDL) at 6 months (P = 0.0444) compared to the control group. We confirmed a statistically significantly lower IR at 6 months (P = 0.0202) and fasting blood glucose at 3 and 6 months (P = 0.0227) by multivariate analysis in the observed group. After the end of the follow-up, we identified statistically significantly fewer patients with a negative oGTT result in the control group (P < 0.0001), significantly more patients with impaired glucose tolerance, fasting hyperglycemia (P = 0.0078) and diagnosed with PTDM (P = 0.0212). In the control group, we found a statistically significant increase in glycemia at 30 (P = 0.0034) as well as at 120 minutes (P = 0.0011) during oGTT compared to the observed group.

Conclusion

In our study, we confirmed a significant effect of regular physical activity in preventing the development of IR and associated pre-diabetic conditions and PTDM.
MO937ASSOCIATION OF RENAL ELASTOGRAPHY WITH BANFF MICROVASCULAR INFLAMMATION IN PROTOCOL BIOPSIES FOR SUBCLINICAL RENAL GRAFT REJECTION DIAGNOSIS
Authors: Bahena Carrera Lucino , Bastida Alquicira Javier
Published: May 2021

Background and Aims

The most common cause of renal graft failure is chronic dysfunction in 24.7% and the most common etiology of this is clinical or subclinical rejection. The incidence of subclinical rejection varies from 15 to 50% (25% in protocol biopsies in the first year after transplantation and 35% after two years).

Melek E et al have shown that doppler ultrasound is a non-invasive study that, through the resistance index (RI), has traditionally been used for the early diagnosis of acute graft rejection (AR); however, it is influenced by extrarenal systemic factors. Naesens et al published that in 321 kidney transplant recipients, RI wasn´t associated with histological findings of AR in protocol biopsies.

Elastography is another ultrasonographic modality for the evaluation of the kidney graft, which measures the stiffness/elasticity of the tissue expressed in Kpa (kilopascals).

Stock in 2011 and Kim BJ in 2018 published studies where they showed that increased stiffness was correlated with the diagnosis of kidney graft rejection.

The aim of this study was to describe the association between elastography with microvascular inflammation determined by Banff for diagnosis of renal allograft subclinical rejection.

Method

Observational, analytical and cross-sectional study that included kidney transplant patients who underwent protocol biopsy and renal elastography at the Central Military Hospital in Mexico City between January 2018 and December 2020. The demographic and biochemical characteristics, degree elastography stiffness and Banff 2017 lesions were determined. The sample calculation, determination of correlation degree and ROC curve elaboration were performed.

Results

We included 146 patients. 56.8% were men; the most common causes of CKD were undetermined and chronic glomerulonephritis with 52.7% and 17.1% respectively. 47.3% were hypertensive at biopsy time and 1.4% had chronic heart failure. The most common immunosuppression schemes were FK/MPA/steroid and FK/mTOR-i/steroid with 60.3% and 13%, respectively. The mean GFR was 65.31 ml/min which shows graft good function. The mean stiffness in the elastography was 15.73 Kpa. The rest of baseline data are shown in Table 1.

Had rejection 36.3% of the biopsies, the most frequent chronic AMR C4d- with 15.1% and active AMR C4d- 8.9%. When analyzing the ROC curves, the Banff 2017 lesions AUC values that correlated better with graft stiffness were: v=0.607, i=0.594, g=0.578, C4d deposit=0.519, ptc=0.498. Figure 1.

Conclusion

Intimal arteritis, inflammation, and glomerulitis are the Banff lesions best associated with elastography graft stiffness in protocol biopsies. Prospective studies are recommended in patients with acute graft dysfunction to find an adequate elastography cut-off value that allows another tool for fast and non-invasive diagnosis of renal graft rejection.
MO940ACUTE REJECTION IN KIDNEY RETRANSPLANTATION: RISK FACTORS AND IMPACT IN GRAFT SURVIVAL
Authors: Leal Rita , Pardinhas Clara , Rodrigues Luís , Guedes Marques Maria , Santos Lidia , Romãozinho Catarina , Caramelo Francisco , Sá Helena , Figueiredo Arnaldo , Alves Rui
Published: May 2021

Background and Aims

Kidney retransplantation confers a robust survival benefit over dialysis in selected patients and recent data has shown second graft outcomes similar to those of a first graft. However, the management of these patients is challenging, particularly due to allosensitization and an increased risk of acute rejection, which are related with poorer graft survival. The recognition of risk factors to acute rejection, dependent on the first and second graft, might help us to personalize standard care and achieve similar graft survival rates to patients with a first transplant. Our aim was to identify risk factors to second graft acute rejection, and the impact of acute rejection in graft failure.

Method

We performed a retrospective, longitudinal study including all patients submitted to a second kidney transplant between January 2008 and December 2019, excluding patients with more than 2 grafts or multi-organ transplant. Demographic, clinical and histocompatibility data from the donor and receptor were collected from our unit database. Delayed graft function was defined as the need of dialysis in the first week post-transplant. All acute rejection episodes were biopsy proven, according to Banff 2017 criteria. Follow-up was defined at 1st June 2020 for functioning grafts or at graft failure, with a mean time of 94±42 months.

Results

We included 109 patients of which 70 males (64%), mostly Caucasian (97%), with a mean age of 43±12 years at second kidney transplant. The main causes of end stage renal disease were glomerular disease (37%), undetermined cause (34%), and urological pathology (15%). First kidney transplant was performed before the year 2010 in 95 patients (87%). The median time of first graft survival was 75 months (IQR 58.5-91.4) and the main causes of first graft loss were chronic allograft nephropathy (N=62, 70.5%) and 11 patients (12.5%) presented primary disfunction due to surgical/vascular complications. During follow-up, 20 patients (18%) presented biopsy proven acute rejection: 3 patients borderline changes, 10 patients T cell mediated and 7 patients antibody mediated, the majority during the first-year post-transplant (N=17, 85%). The risk factors for second graft rejection are summarized in table 1. First year graft survival of the second transplant was 90% and survival at follow up was 72.5% (N=79). Acute rejection was an important risk factor for graft loss (OR 6.548 (95%CI[2.292 - 18.703]), p<0.01).

Conclusion

Worst outcomes in first kidney transplant, such as acute rejection, primary dysfunction and lower graft survival were related with an increased risk of acute rejection in second graft outcomes, and consequently a higher risk of graft failure.
MO942PREDICTORS OF DELAYED GRAFT FUNCTION IN KIDNEY TRANSPLANT RECIPIENTS THROUGHOUT 3 DECADES: A SINGLE-CENTER EXPERIENCE
Authors: Figueiredo Carolina , Fernandes Mariana , Mira Filipe , Pardinhas Clara , Leal Rita , Rodrigues Luís , Guedes Marques Maria , Santos Lidia , Romãozinho Catarina , Bastos Carlos Alberto , Sá Helena , Figueiredo Arnaldo , Alves Rui
Published: May 2021

Background and Aims

Delayed graft function (DGF), defined as the need for dialysis within one week post-transplantation, is associated with poorer kidney graft survival. We aimed to identify risk factors for DGF throughout 3 decades and evaluate their effect on graft survival.

Method

Retrospective study including 3081 kidney transplants performed at our transplantation unit between January 1st, 1989 and December 31st, 2018, split in 3 decades (1: 1989-1998; 2: 1999-2008; 3: 2009-2018). Data regarding donor and recipient demographics, time on dialysis, immunization, cold ischemia time, hemodynamic parameters and immunosuppression were collected from our prospectively maintained data base.

Results

Main donor, recipient and perioperative characteristics are summarized in table 1. There were clear differences in these characteristics between the decades, standing out more adverse features from both recipients and donors.

Overall incidence rate of DGF was 16% (n=493): 14% in decade 1; 19.3% in decade 2 and 15% in decade 3.

On univariate analysis, most studied variables included in table 1 were statistically significant as predictors of DGF. However, on multivariate analysis, we found that in the first decade the predominant risk factors for DGF were pre-transplant dialysis time and cold-ischemia time, whilst in the following decades donor characteristics, as well as recipient’s weight became more relevant (table 2).

Conclusion

The observed shift from donor-unrelated variables in the first decade into donor-related variables in the second and third decades as the main determinants of DGF highlights the impact of expanding donor’s acceptance criteria. Nevertheless, the increase in expanded criteria donors did not translate into poorer overall results, probable contributors being shorter cold-ischemia times and stronger immunosuppression.
MO954DONOR TYPE INFLUENCE IN EARLY POST KIDNEY TRASPLANTATION HYPERTRANSAMINASEMIA
Authors: Solà-Porta Eulàlia , Redondo Pachon Dolores , Núñez-Delgado Sara , Arias-Cabrales Carlos , Mir Marisa , Buxeda Anna , Burballa Carla , Crespo Marta , Pascual Julio , Pérez-Sáez María José
Published: May 2021

Background and Aims

The early increase in transaminases after kidney transplant (KT) is a frequent finding. It has been associated with the cross-talk produced between liver and kidney in ischemia-reperfusion situations. However, the influence of the donor type has not been evaluated. We analyze the incidence, relevance and possible correlations of postKT hypertransaminasemia.

Method

Retrospective study (2004-2018) to analyze the increase in serum AST/ALT during the first 3 months after KT in 119 KT recipients of deceased donors, either brain death (DBD n=59), controlled after cardiac death (cDCD n=21) or uncontrolled after cardiac death (uDCD n=39). All recipients received induction with thymoglobulin and maintenance immunosuppression with tacrolimus and mycophenolate.

Results

Recipients of uDCD group were younger, with a higher proportion of men and lower percentage of diabetics and retransplants. Delayed graft function duration was longer, although serum creatinine was similar at 3 months between groups. There were no differences between recipients in terms of past medical liver disease, postKT transfusion requirement or vasoactive drug use. There were also no differences in cumulative thymoglobulin dose, and uDCD recipients presented, as expected, lower levels of tacrolimus at one week postKT (Table).

From all KT recipients, 37.3/45.3% presented with an increase in AST/ALT at 72 hours postKT. Regarding donor type, the percentage of recipients who experienced 72 hours postKT hypertransaminasemia was higher (69.2/82.1% in uDCD group vs 22/29.3% in DBD and 21.1/21.1% in cDCD, p<0.001). This liver function alteration resolved early, and one month after transplant, AST/ALT values in all groups returned to baseline (Figure).

The multivariate analysis showed that uDCD recipients had x10 higher risk of developing early post-KT hypertransaminasemia than the other groups (for AST, OR 10.85 [2.463-47.826] and for ALT OR 11.15 [2.627-47.294]). However, when we tried to correlate this hypertransaminasemia with a prolonged delayed graft function (creatinine decrease> 14 days postKT) we did not find any association.

Conclusion

Early postKT hypertransaminasemia is a frequent and transient event that is related to the kidney donor type, being more frequent in recipients of donors in uncontrolled cardiac death.