bluuebunny/crossref_metadata_2025 huggingface dataset:
#6962 INCIDENCE AND PROGNOSIS OF HYPONATREMIA IN HOSPITALIZED PATIENTS WITH ALCOHOLIC LIVER DISEASE
Authors: Lee Tae Won , Lee Seolje , Ryu Jun Ha , Bae Eunjin , Park Dong Jun
Published: June 2023

Background and Aims

Hyponatremia is a common electrolyte disorder in hospitalized patients and has a poor prognosis leading to an increased risk of poor quality of life, morbidity, and mortality. Although the prevalence and prognosis of hyponatremia in advanced liver disease such as liver cirrhosis are well known, no previous studies have been conducted on the prevalence of hyponatremia in early liver disease or alcoholic liver disease (ALD). Therefore, the purpose of this study was to investigate the prevalence and prognosis of hyponatremia in ALD group.

Method

We performed a retrospective, single centre study of patients admitted to the hepatology department from March 2016 to December 2022. Adults aged 18 years or older were included, and patients with liver cirrhosis, one of the common causes of hyponatremia, were excluded from the study. Based on the electronic medical records, the study was conducted by dividing the ALD group including alcoholic hepatitis and heavy alcoholics into a control group.

Results

A total of 830 patients were included, hyponatremia (under 135 mmol/L) occurred in 32.2%, and the ALD group showed a significantly higher prevalence than the control group (53.8% vs. 28.6, p<0.001). In addition, the ALD group was statistically significantly higher than the control group in mortality at hospitalization (8.4% vs. 3.9%, p = 0.031) and all-cause mortality (22.7% vs. 12.1%, p = 0.002). The length of hospital stay was significantly longer (13.5±10.9 vs. 10.5±9.1, p = 0.006), and the readmission rate was also higher in the ALD group (39.5% vs. 22.5%, p < 0.001). Kaplan-Meier analysis revealed significantly higher overall survival in the control group than the ALD group (87.9% vs. 77.3% p = 0.002).

Conclusion

Our study shows that ALD has a higher incidence rate of hyponatremia, which is followed by a poor prognosis, such as an increase in readmission rates, length of hospitalization, and mortality. Therefore, clinicians should realize the importance of electrolyte imbalance in ALD patients and strive to improve prognosis through early and appropriate treatment.
#2537 EPIDEMIOLOGY OF CHRONIC KIDNEY DISEASE IN THE REPUBLIC OF UZBEKISTAN
Authors: Rasulev Yorkin , Daminov Botir , Tursunbayev Aziz
Published: June 2023

Background and Aims

Chronic kidney disease (CKD) is an emerging global health problem, currently affecting up to 15% of the global adult population, and is independently associated with an increased risk of cardiovascular disease (CVD) similar to that of diabetes mellitus or coronary artery disease. heart [Reddy K.S., Shah B., Varghese S., Ramados A. 2005; 366: 1744-1749]. To assess the epidemiological characteristics of the development of CKD in the Republic of Uzbekistan (RUz) for 2020.

Method

The object of the study is the database of the Republican Specialized Scientific and Practical Medical Center for Nephrology and Kidney Transplantation of the Republic of Uzbekistan.

Results

According to the Institute of Health and Medical Statistics of the Ministry of Health of the Republic of Uzbekistan, the number of patients with end-stage renal disease (ESRD) decreased between 2011 and 2015. However, according to the data for 2020, the number of patients with stage 5 CKD reached 23,773 thousand and its increase is expected. The proportion of patients with chronic renal failure older than 18 years was registered 21,003 thousand in 2011 and 19,149 thousand in 2015, in those years there was a decrease. However, according to the national registry for 2020, CKD cases in the Republic of Uzbekistan, identified in all regions, amounted to 118026, there were 23773 patients with chronic renal failure receiving hemodialysis - 5149. The number of registered patients with CKD in the Autonomous Republic of Karakalpakstan was 9013, with CRF - 912, in need of hemodialysis - 115, receiving hemodialysis - 98, in need of transplantation - 21. In Andijan region, 416 persons were registered, with CRF - 201, in need of replacement therapy 137, receiving dialysis - 137, needing in transplantation - 11. In the Bukhara region, 4500 such patients were registered, CKD - 501, in need of substitution therapy - 172, receiving dialysis - 164 and in need of transplantation - 36.

Conclusion

With a general increase in the prevalence of CKD in the Republic of Uzbekistan in the dynamics of 2020, there is an improvement in the quality of diagnosing complications at earlier stages, at a later age and with a longer duration of CKD. Advances in the management of patients with CKD in recent years do not reduce the risk of end-stage chronic renal failure, but delay its development. Pronounced interregional differences in the frequency of registration of CKD in the database indicate problems in diagnosing CKD in a number of regions where the standard for examining patients with CKD with a mandatory assessment of glomerular filtration rate (GFR) and albuminuria at least once a year is not met.
#2598 KLOTHO DEFICIENCY INDUCES REGULATORY T CELLS IN MURINE LUPUS NEPHRITIS
Authors: Takenaka Tsuneo , Kurosaki Yoshifumi , Ishii Naohito , Inoue Tsutomu , Nishiyama Akira , Hayashi Matsuhiko
Published: June 2023

Background and Aims

Recent studies demonstrate that klotho deficiency participate in various chronic kidney disease. However, it has not been fully assessed the influence of klotho in autoimmune kidney diseases. On the one hand, klotho is known to binds transforming growth factor β (TGFβ) receptor to antagonize its pathophysiological actions including renal fibrosis. On the other hand, TGFβ is required to generate and maintain regulatory T cells with inducing FOXP3, an important cell population for immunological tolerance.

Method

NZBWF1 mice were used as a model of lupus nephritis. NZBWF1 mice were housed separately in metabolic cage, and divided into two groups (n=10 for each): one group was treated with daily subcutaneous injection of klotho protein (20 µg/kg/day), and the other received vehicle alone. Systolic blood pressure was measured by tail-cuff method. Glomerular filtration rate was assessed using FITC-inulin. Four weeks later, the animals were killed to harvest the spleen and kidneys for analyses.

Results

Klotho supplementation suppressed blood pressure, 8-epi-prostaglandin F2a excretion and renal angiotensin II levels (p<0.05 for all) without changes in albuminuria and glomerular filtration rate in NZBWF1 mice. Exogenous klotho protein supplementation increased serum klotho levels, urine klotho excretion, and endogenous renal expression of klotho in NZBWF1 mice (p<0.05 for all). Surprisingly, anti-double strand DNA antibody was slightly elevated in klotho-treated NZBWF1 mice (p<0.05). Glomerular pathology and interstitial cell infiltration were similar between 2 groups. The spleen tended to be greater in klotho-treated group, but statistical significance was not attained. In consistent, CD8+FOXP3+ T cells were unaltered between 2 groups. However, klotho supplementation reduced CD4+FOXP3+ T cells in spleen of NZBWF1 mice (p<0.05).

Conclusion

The present data indicated that klotho protein supplementation suppressed renal renin-angiotensin system, ameliorating blood pressure and oxidative stress. Our results suggest that klotho supplementation worsened auto-antibody, possibly by inhibiting TGFβ with resultant deterioration in regulatory T cells. The present findings implicate that although klotho may not suite for the management of autoimmune kidney diseases, such as lupus and ANCA-related nephritis, klotho supplementation for dialysis patients could mitigate against the defect in cellular immunity and susceptibility to infections including tuberculosis and COVID-19.
#2627 IGA-DOMINANT POSTINFECTIOUS GLOMERULONEPHRITIS, “THE OTHER SIDE OF THE COIN”: A CASE REPORT
Authors: Moreno Rodolfo , Blackaller Guillermo Navarro , Chávez-Iñiguez Jonathan S , De Leon Werner
Published: June 2023

Background and Aims

Postinfectious glomerulonephritis (PIGN) is a disease presented as nephritic syndrome with hypocomplementemia usually secondary to a skin or throat infection by beta hemolytic Streptococcus and with histopathological findings of endocapillary proliferation, C3 deposits along the capillary wall and mesangium, subepithelial immune complex deposits and IF positive for IgG. There are other unusual presentations of PIGN with IgA dominance or C3-IgA codominance.

Method

A 58-year-old Guatemalan male, with history of one-week duration pain in the right upper quadrant associated with jaundice, diagnosed with cholangitis and intravenous antibiotics use. History of consumption of 10 beers a month for 40 years. No other medical history. During hospitalization, presented a lower-limb cellulitis, for which clindamycin was started. Blood cultures were taken and were positive for S. epidermidis and AKI (Cr 2.84 mg/dl) was observed, associated with de novo appearance of hematuria (80% acanthocytes), proteinuria (580mg/day) and hypertension. Diagnostic approach for nephritic syndrome was performed obtaining: C3 0.592 (low) ANA, ANCAs, HIV-HCV-HBV negative, total cholesterol 184 mg/dl, albumin 2.78 g/dl.

Results

Renal biopsy was performed and reported: PIGN with IgA dominance with extra capillary proliferation. Reason why pulses of methylprednisolone were given for 3 days and then oral prednisone (1 mg/kg/day), progressively decreasing it until it was discontinued. Resolved the soft tissue infection and was discharged. At 1-month follow-up as outpatient, was evidence of a 50% decrease in proteinuria compared to baseline, disappearance of hematuria but with persistent of high Cr (2.09 mg/dl).

Conclusion

IgA-dominant PIGN is characterized by usually presenting in patients >60 years with DM, alcohol consumption and staphylococcal skin infections. It can present hypocomplementemia and histopathological findings are characterized by IgA dominance over C3 and no IgG in IF. Elevated serum IgA levels may be involved in the pathogenesis. Treatment is based on eradication of the infection with antibiotics and in some cases the use of steroids is suggested depending on the aggressiveness of the lesion and the presence of crescents in the renal biopsy. It has worse prognosis than the traditional PIGN.
#2702 ANALYSIS OF IMMUNOSUPPRESSANT ADHERENCE, TREATMENT PREFERENCES AND NEEDS, AND MENTAL HEALTH DISORDERS IN THE POST-TRANSPLANTATION PERIOD
Authors: Santacruz Juan , Garcia-Llana Helena , Santana María , Selgas Rafael , Jimenez Carlos , Gonzalez Elena
Published: June 2023

Background and Aims

Medical treatment after kidney transplantation is not enough to assure optimal outcomes due to emotional factors that contribute on graft survival. To incorporate patient´s treatment preferences in clinical practice improves health outcomes. Few is known about treatment preferences and needs of kidney transplant population. The aims of the study were to quantify mental health disorders prevalence, immunosuppressive adherence, treatment preferences and needs of Spanish kidney transplant patients in post-transplantation period.

Method

Transversal-observational study in stable kidney transplant patients from one center in Madrid-Spain. Demographics, social-clinical variables, validated questionaries for anxiety, depression, stress, resilience, life satisfaction and quality of life related with health, and an ad-hoc survey of treatment preferences and needs were applied.

Results

A total of 116 patients were included, 25% had mental health pathology before transplant. Mental health disorders prevalence for depression, anxiety and stress were 26%, 27% and 23.3% respectively. Life satisfaction screening revealed only 29% of patients very satisfied with life. Patients with lower scores in mental health tests were significatively related with poor immunosuppressive adherence (P = .004). Treatment preferences and needs identified were how to improve physical condition (47%), information for anxiety and/or depression management (37%), and to receive psychological therapy from Nephrology Service (95%). See Table 1 and 2 for results.

Conclusion

Mental health disorders prevalence in Spanish kidney transplanted patients were high and had a negative impact in immunosuppressive adherence. This demands a biopsychosocial, interdisciplinary, focused on patient´s treatment preferences approach, individually and in groups from Nephrology Service.
#2726 DUAL DIALYSER HAEMODIAFILTRATION: A NEW EXTRACORPOREAL DIALYSIS TREATMENT MODALITY FOR PATIENTS WITH END STAGE KIDNEY DISEASE
Authors: Glancey Gerald
Published: June 2023

Background and Aims

The introduction of High Flux (HF) haemodialysers and their application in single dialyser haemodiafiltration (sdHDF) for patients on extracorporeal dialysis (ECD) therapy has improved the extraction of uraemic toxins including the low molecular weight protein (LMWP) beta 2 microglobulin (β2M, 11.6kDa). Similar increases in the extraction of protein-bound uraemic toxins (PBUT) and larger LMWP (15-50kDa) remain elusive. High concomitant losses of albumin prohibit the use of Medium Cut-Off (MCO) or protein-losing haemodialysers in sdHDF to increase the convective transfer of these molecules.

Method

A new extracorporeal dialysis treatment modality, dual dialyser haemodiafiltration (ddHDF), has been designed together with an accompanying mathematical model to compare its predicted performance to that of sdHDF in the extraction of solute. The extra process that distinguishes ddHDF from sdHDF is the secondary ultrafiltration and partial re-infusion of the effluent haemodiafiltrate from the initial or primary haemodialyser. This allows MCO and protein-losing haemodialysers to be used to increase the extraction of both LMWP and PBUT without excessive concomitant loss of albumin.

Glancey GR. Modeling the transfer of low molecular weight proteins during haemodialysis and online haemodiafiltration. Artificial Organs 2021;45(4):419-426.

Results

Data from the mathematical model show that ddHDF could increase the extraction of smaller and larger LMWP by an extra 102% and 220% respectively compared to standard HF sdHDF whilst restricting the loss of albumin to 0.83 grams per hour of treatment. In using albumin as a recyclable carrier molecule for the extraction of PBUT from plasma ddHDF has the potential to increase PBUT reduction ratios (RR's) to 49% by convection alone. Even higher RR's are possible if the dialysate volume flow rate can be increased beyond 600 ml/min.

Conclusion:

ddHDF provides an opportunity for a step change increase in the level of extraction of both larger LMWP and PBUT in patients with end stage kidney disease.
#2736 THE PHASE ANGLE AS A PREDICTOR OF SARCOPENIA IN NORMOHYDRATED PATIENTS ON HEMODIALYSIS: A MULTICENTER STUDY
Authors: López Yanet Parodis , Ortega Sebastian Hillebrand , Alman Francisco Alonso , Vega Nicanor , Anton-Perez Gloria
Published: June 2023

Background and Aims

The skeletal muscle index (SMI) is an impedance parameter that assesses muscle mass, and the phase angle (PA) is inversely related to strength and muscle mass in hemodialysis patients. Both parameters may represent useful and inexpensive tools to identify sarcopenic patients.

Method

The presence of sarcopenia was analyzed in 348 normohydrated patients in 5 hemodialysis centers by means of vector bioimpedance using the BIA101 BIVA PRO equipment. To do this, the skeletal muscle index (SMI) and the phase angle (PA) are evaluated as markers of muscle mass and strength, respectively.

Results

Mean SMI and PA were 8.64 ± 1.5 and 5.2 ± 0.9.

The mean PA was 5.6 ± 0.9 in those with SMI within normality (9.2 ± 1.9) (p<0.001).

In moderate and severe sarcopenics patients, the means of SMI (8.9 ± 1.2 vs 7.5 ± 0.9) and PA (5.3 ± 0.86 vs 4.7 ± 0.67) were significantly lower (p < 0.001) (Table 1).

In patients on standard hemodialysis, the PA (P = .02) and the SMI (P = .004) were significantly lower.

The PA (P = .014) and the SMI (p < 0.01) were significantly lower in the female gender but the number of sarcopenic patients was higher among the men (p< 0.001).

The cut-off value of PA, which predicted a higher risk of sarcopenia, was 3.5 in all patients (95% CI, 0.60-0.71; P = .0001; 100% sensitivity, 96% specificity ); 3.55 for men (95% CI, 0.57-0.78; P = .003; 100% sensitivity, 94% specificity) and 3.65 for women (95% CI, 0.60-0.73 ; P = .0001; 100% sensitivity, 96% specificity) (Fig. 1).

In the logistic regression analysis, male gender, standard hemodialysis technique, and PA were associated with a higher risk of sarcopenia (Table 2).

Conclusion

PA is a good predictor of sarcopenia in hemodialysis patients.
#2905 CLINICAL OUTCOMES OF ORAL ANTICOAGULATION AND NO ANTICOAGULATION AMONG HEMODIALYSIS PATIENTS WITH ATRIAL FIBRILLATION
Authors: Polito Eratosthenes , Darunday Grecia
Published: June 2023

Background and Aims

The delicate balance of risk versus benefit of oral anticoagulation in the general population is well established but the decision to use these agents in end-stage renal disease (ESRD) remains complex and difficult owing to the paucity of clinical trials and lack of substantial evidence in literature for its safe and effective use in the haemodialysis population. This study aims to determine the difference in clinical outcomes between oral anticoagulation and no anticoagulation therapy among ESRD patients on maintenance haemodialysis with atrial fibrillation.

Method

This is a prospective, single-center, observational study conducted in Perpetual Succour Hospital that included all ESRD patients on maintenance haemodialysis for at least 3 months with atrial fibrillation. Out of the 188 identified patients, only 69 patients were included in the study and were grouped according to how the cardiac dysrhythmia was approached either with oral anticoagulation or no use of oral anticoagulation. Basic demographic information were obtained as well as the aetiology of ESRD, CHA2DS2-VASc Score and the HAS-BLED Score. Lastly, patients were prospectively followed for a period of 12 months and were then assessed for new onset of thromboembolic events, hemorrhagic events, calciphylaxis and all-cause mortality.

Results

At enrolment, 59 (85.5%) patients were identified to have no oral anticoagulation therapy and 10 (14.5%) were already receiving oral anticoagulation. Ischemic strokes was more prevalent among patients who were on oral anticoagulant (80%, p <0.0001). Patient outcomes differ significantly in terms of intracranial hemorrhage (30%, p= 0.0004) and gastrointestinal bleeding (50%, p <0.00001) which were noted among patients on oral anticoagulation. In relation to over-all mortality, acute myocardial infarction, peripheral arterial occlusive disease and calciphylaxis, there was no significant difference between the two groups.

Conclusion

This study suggests that the use of oral anticoagulation did not prevent ischemic strokes in ESRD patients on maintenance haemodialysis with atrial fibrillation and its use was associated with increased risk for intracranial haemorrhage and gastrointestinal bleeding. There was no significant difference in relation to all-cause mortality, acute myocardial infarction, peripheral arterial occlusive disease and calciphylaxis between the two study groups.
#2970 CYTOMEGALOVIRUS INFECTION AND RISK OF NEW-ONSET DIABETES AFTER TRANSPLANTATION: A RETROSPECTIVE STUDY
Authors: Khan Muhammad Tassaduq
Published: June 2023

Background and Aims

New-onset diabetes after transplantation (NODAT) is one of the common complications reported in patients with kidney transplant and is associated with risk of infection, poor allograft and patient survival. There is conflicting research literature regarding the role of cytomegalovirus (CMV) infection in increasing the risk of NODAT development.

Aim

To assess the risk of development of NODAT in kidney transplant patients with CMV infection

Method

A total of 59 kidney transplant patients were studied from March 2017 to February 2019. NODAT was defined as two readings of fasting plasma glucose of ≥126 mg/dL at three months post-transplant. CMV viral load was also documented. The 12 months post-transplant allograft and patient survival outcomes were also measured.

Results

Mean age was 43.4 ± 6.2 years. Nearly one-fourth, 14 (23.7%), of the patients had NODAT. CMV viral load and viremia were high in NODAT group; however, the result did not reach statistical significance. CMV DNA replication was statistically high during 1-6 months post-transplant for NODAT group (P<0.001). Only 7 (11.9%) recipients advanced to symptomatic CMV infection. Also, we found that high CMV viremia load was associated with poor kidney allograft function at 12 months.

Conclusion

In summary, this study showed that infection with CMV may not be a risk factor to develop NODAT in patients transplanted with kidney. An elevated CMV viral load may decrease the post-transplant allograft function at 12 months. The prompt diagnosis and timely 2 management of CMV infection could substantially lessen the risk to develop NODAT subsequent worsening of allograft and patient survival.
#3003 IMPACT OF FULL CORRECTION OF HEMOGLOBIN AMONG POST-TRANSPLANT ANEMIC KIDNEY TRANSPLANT RECIPIENTS: A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL
Authors: Alotaibi Torki , Gheith Osama Ashry Ahmed , Nagib Ayman Maher , Abdulhalim Medhat , Aboatya Hasaneen Hasaneen Ahmed Aboatya , Mahmoud Tarek S H , Nair Prasad , Adel Hany , Mosaad Ahmed , Atta Ahmed , Abdulhamed Mohamed
Published: June 2023

Background and Aims

Several studies have shown that post-transplant anemia (PTA) might be associated with increased mortality and decreased graft survival and de-novo congestive heart failure. So we aimed from this prospective randomized controlled study to assess the impact of full correction of PTA on the cardiovascular system of renal transplant recipients receiving erythropoietin stimulating agents (ESA).

Method

We recruited 247 kidney recipients with stable graft function in this RCT with 2 groups according to their target hemoglobin (11-12 g/dl, group 1, n=183) and (13:15 g/dl, group 2, n=64). After correction of deficiencies, the target hemoglobin was achieved using ESA. All patients were followed up clinically and Laboratory and radiologically for 12 months.

Results

Diabetic nephropathy was the main cause of ESKD in group 1. The studied groups were comparable regarding pre-transplant co-morbidities. Most patients received thymoglobulin as induction then cyclosporine based maintenance immunosuppression. We did not find any significant difference between the two groups concerning post-transplant diabetes, BK viremia or malignancies and even cardiovascular events (TIA, stroke, ACS), (p>0.05). Group 1 showed higher mean blood pressure (P = .003), lower LV internal dimensions, higher LVH, LV mass, IVSD and LV mass index after one year of the study (p< 0.05). MIVSD, mean ejection fraction and FS were comparable in both groups (p>0.05). Graft outcome was comparable between both groups (P = .125), meanwhile mortality cases were significantly higher among group 1 (16 cases, 8.7%) (P = .005).

Conclusion

Full correction of PTA is associated with stabilized cardiac dimensions indices without any significant cardiovascular comorbidities.
#3078 MILD EXPERIMENTAL CKD IS ASSOCIATED WITH MYOCARDIAL FIBROSIS AND NOTCH/HEDGEHOG SIGNALING DYSREGULATION
Authors: Bogdanova Evdokia , Sadykov Airat , Beresneva Olga , Sharoyko Vladimir , Dobronravov Vladimir
Published: June 2023

Background and Aims

Chronic kidney disease (CKD) is an independent cardiovascular risk factor. The initial mechanisms of myocardial remodeling (MR) in CKD are poorly understood. The major developmental signaling pathways Notch, Hedgehog, Wnt, and Bmp seem to be involved in many crucial steps of MR (cardiomyocytes survival and regeneration, fibrotic response, angiogenesis), while their role in MR due to CKD was not previously studied. Phosphate (Pi) is essential for cellular signaling and its redistribution to the cardiovascular compartment in CKD could be a one of the mechanisms of MR. Here we investigated the involvement of Pi/PPi transport, and reactivation of developmental signaling pathways in myocardial alterations associated with mild CKD.

Method

We induce mild CKD by 3/4 nephrectomy in adult male SHRs (SHR-Nx, n=8) with normal phosphate intake (0.6%) and 2-month follow-up. Controls were sham-operated SHR (SHR-Sham, n=8) and Wistar Kyoto rats (WKY-Sham, n=8). We analyzed chronic kidney injury and Pi exchange parameters, serum intact parathyroid hormone (PTH), intact fibroblast growth factor 23 (FGF23), myocardial phosphorus content (ICP-AES), histomorphometry, PiT1 and PiT2 expression (IHC), and mRNA expression of Slc20a1, Slc20a2, Ankh, Mapk1, Mapk3, Bmp2, Bmp4, Ctnnb1, Fzd2, Sfrp2, Dkk1, Wif1, Numb, Notch1, Jag1, Hes1, Lgr4, Tnfrsf11b, Tnfsf11, Ptch1.

Results

Systolic blood pressure and myocardial mass index (MMI) were higher in SHRs vs WKY-Sham (Table 1). Decrease in creatinine clearance by 30% and an increase in albuminuria corresponded to mild CKD in SHR-Nx model (Table 1). In SHR-Nx, myocardial interstitial fibrosis was significantly higher (Figure 1), while MMI and cardiomyocyte diameter did not differ compared to SHR-Sham (Table 1). Myocardial alterations were accompanied by the increase in myocardium phosphorus content (Figure 1), down-regulation in PPi-exporter Ankh, and up-regulation in Hes1 and decline in Ptch1 mRNA expression (Figure 2). We found no changes in Slc20a1 and Slc20a2 mRNA levels (Figure 2). An appearance of PiT2-positive fibroblasts-like cells in myocardial interstitium was apparent in SHR-Nx rats (data not shown).

Conclusion

Myocardial alterations in mild CKD are manifested in an increase in its phosphorus content, interstitial fibrosis, and dysregulation in genes likely related to the induction of the myofibroblasts and extracellular matrix remodeling.
#3242 OUTCOMES OF THERAPEUTIC PLASMA EXCHANGE: A ONE-YEAR EXPERIENCE IN AN INTERNAL MEDICINE INTENSIVE CARE UNIT
Authors: Fayed Ahmed , Mohammed Momtaz , Hammad Hany , Fathy Moataz , Abdelhamid Yasser
Published: June 2023

Background and Aims

There is uncertainty regarding the best indication, device type, frequency, length of time, kind of replacement fluid, and criteria for ceasing therapeutic plasma exchange (TPE) for various disorders. TPE is an intrusive technique that has the potential to save lives, but it also has a risk of unfavorable outcomes and complications, necessitating close supervision by professional teams. In the intensive care unit (ICU), there are three categories of indications for TPE: (1) absolute, well-established, and evidence-based, for which TPE is recognized as first-line therapy; (2) relative; for which TPE is a recognized second-line treatment (alone or in combination) and (3) rescue therapy; for which TPE is used with a limited or theoretical evidence base. The purpose of this study is to continue our evaluation of the outcome of nephrology care in internal medicine ICU regarding bedside membrane therapeutic plasma exchange.

Method

In the continuity of our previous work in the analysis of the outcome of TPE. From August 2021 to August 2022, 425 membrane plasma exchange sessions were performed on 69 patients in the internal medicine department's ICU-Cairo University Hospitals-Egypt.

Results

Closely similar to what we found before; the most frequent diagnosis was thrombotic microangiopathies (24 (34.8%) patients) with complete recovery seen in 18/24 patients (75%); followed by systemic vasculitis with pulmonary renal involvement (14 (20.3%) patients) with partial remission was seen in 9/14 patients (64.3%); Guillain-Barré syndrome (13 (18.8%) patients) with complete recovery was seen in 8/13 patients (61.5%); Proliferative Lupus Nephritis with crescents [10 (14.5%) patients] with partial remission in 8/10 patients (80%), and myasthenia gravis [8 (11.6%) patients] with complete recovery in 6/8 patients (75%). Hypotension occurred during 69/425 (16.2%) sessions and hypocalcemia in 8/69 (11.5%) patients during treatment. Infection of vascular access occurred in 4/69 (5.8%) patients. 6/69 (8.7%) patients died during their stay in ICU none during treatment with TPE, all of them were diagnosed to have severe sepsis as a cause of death.

Conclusion

According to our experience, membrane therapeutic plasma exchange is a successful and secure treatment for a variety of illnesses including thrombotic microangiopathies, systemic vasculitis, myasthenia gravis, proliferative lupus nephritis, and Guillain-Barré syndrome. The main reason for death was sepsis.
#3249 BLOOD UREA NITROGEN TO CREATININE RATIO IS ASSOCIATED WITH HIGH MORTALITY IN ELDERLY PATIENTS STARTING HEMODIALYSIS: A KSGN RETROSPECTIVE COHORT
Authors: Huh Daseul , Kim Keonhwa , Kim Sang-Eun , Yang Jihyun , Lee Kyu-Beck , Kim Hyang , Hyun Young Youl
Published: June 2023

Background and Aims

Previous studies have shown that increased blood urea nitrogen to creatinine ratio (BCR) is a poor prognostic marker in patients with some chronic diseases or in the general population. However, the clinical implication of BCR in elderly dialysis patients is unknown. The purpose of this study was to verify the association of BCR with the risk of death in elderly patients starting hemodialysis.

Method

The Korean Society of Geriatric Nephrology Retrospective Cohort consists of patients who started maintenance hemodialysis from January 1, 2010 to December 31, 2017 at 17 nephrology centers in Korea. After excluding patients with malignancy or estimated glomerular filtration rate 30 ml/min/1.73 m2 or greater, we retrospectively analyzed 2,183 patients. The main predictor was patients BCR at the time of hemodialysis initiation and subjects were divided into four groups according to their BCR quartile. The main outcome was all-cause mortality.

Results

During 7,545 person-years of follow-up, 1,382(63.3%) patients died. Patients in the high BCR group died more (60.9%, 59.3%, 62.5% and 70.5% for the 1st to 4th BCR quartiles, respectively, P=0.001). In multivariate Cox proportional hazard model, BCR increase by one was associated with increased risk of death (HR 1.01; 95% CI, 1.01-1.02). This model was adjusted for age, sex, body mass index, cause of renal disease, hypertension, diabetes, ischemic heart disease, cerebrovascular disease, congestive heart failure, eGFR, hemoglobin, albumin, calcium and phosphorus. Compared to 3rd quartile of BCR group, 4th quartile group was associated with increased risk of death (HR, 1.30; 95% CI, 1.12-1.51).

Conclusion

High BCR is a predictor of high mortality in elderly patients starting hemodialysis. This result suggests that more attention should be paid to elderly patients starting hemodialysis with high BCR.
#3616 NON-ANESTHETIC STENTING IS AN EQUIVALENTLY EFFECTIVE METHOD COMPARED WITH PERCUTANEOUS NEPHROSTOMY IN ACHIEVING EARLY RECOVERY IN STONE INFECTED PATIENTS
Authors: Choi Bomi , Yu Hoon , Kim Sung Jin
Published: June 2023

Background and Aims

The prevalence of urinary tract stones is increasing. Although the importance of urgent decompression in managing this condition is well established, preferences for drainage methods (stenting vs. percutaneous nephrostomy [PCN]) differ depending on the treating institution. We therefore analyzed the effects of different drainage methods on early recovery.

Method

We retrospectively reviewed the medical records of patients hospitalized for infection with urinary obstruction due to urinary calculi at Gangneung Asan Hospital between January 2011 and December 2020. All patients underwent stenting or PCN. Early recovery was defined as subsided fever or discharge within 3 days after the procedure.

Results

A total of 178 patients, including 98 treated with double J stents and 80 treated with PCN were included. Univariate analysis revealed male sex, diabetes mellitus, coronary heart disease, mid ureter stone, upper ureter stone, stone size of 10-20 mm, and renal stone concomitance as significant prognostic factors for early recovery. In contrast, multivariate analysis revealed male sex (P=0.036), diabetes mellitus (P=0.031), mid ureter stone (P=0.007), upper ureter stone (P=0.026) as significant prognostic factors for early recovery (Table 2). When stenting was compared with PCN, the recovery period of fever and C-reactive protein and white blood cell levels showed similar trends.

Conclusion

Male patients and those without risk factors for stone-related complications tended to recover more easily after the procedure. The results demonstrate that non-anesthetic stenting is an effective method, compared with PCN, to achieve early recovery in infected patients due to stone obstruction.
#3625 TREATMENT OUTCOMES FOR IDIOPATHIC SUDDEN SENSORINEURAL HEARING LOSS IN DIALYSIS PATIENTS
Authors: Kim Seonju , Lee Dong Kyu , Kim Hae-Rim , Park Jung Mee , Yu Hoon
Published: June 2023

Background and Aims

Idiopathic sudden sensorineural hearing loss (ISSNHL) is one of the most challenging complications nephrologists encounter when treating dialysis patients (pts). Since no previous study has compared the treatment response of dialysis pts to that of non-dialysis pts, physicians have difficulty managing these pts. This study aimed to investigate the treatment outcome of dialysis pts with ISSNHL.

Method

In this single-center, retrospective, observational study, 700 pts diagnosed with ISSNHL between January 2005 and December 2021 at Asan Medical Center, Korea were enrolled. Among them, 47 were dialysis pts and 653 were non-dialysis pts. Non-dialysis pts were compared using a 5:1 propensity score matching (PSM) analysis to balance pre-existing clinical characteristics. High-dose systemic steroid therapy or intra-tympanic (IT) steroid injections were administered according to the standard protocol. The pure tone average (PTA) of the two groups was compared before initiating the treatment, and after 2 weeks and 2 months of treatment. The degree of improvement in the hearing was evaluated using Siegel's criteria.

Results

Without PSM, the age, prevalence of diabetes or hypertension, initial hearing threshold by each frequency level (0.5, 1, 2, and 4 kHz), and treatment strategies were statistically different between the two groups. In the PS-matched cohort, none of the measured confounding variables were statistically different between the two groups (Table 1).

Two months after steroid treatment, the average improvement in pure tone audiometry (p = 0.025) and the percentage of complete response according to Siegel's criteria were significantly higher in the non-dialysis pts group than the dialysis pts group (27.2% vs. 6.4%) (Table 2).

Conclusion

This study suggests that dialysis pts have significantly worse treatment outcomes for ISSNHL compared to non-dialysis pts.
#3626 A CASE OF PODOCYTE DISEASE WITH AZOTEMIA FOLLOWING TREATMENT WITH INTRAVENOUS IBANDRONATE
Authors: Kim Beom , Chung Yerin , Jang Woojin , Jeong Jin Seon , Lee Sanghee , Lee Dong-Young , Moon Kyoung Hyoub , Kim Huiseo
Published: June 2023

Background and Aims

Bisphosphonate use may induce several types of nephrotoxicity. There are many reports on pamidronate-associated glomerular disease, such as focal segmental glomerulosclerosis and zoledronate-associated acute tubular necrosis. However, there are limited reports on ibandronate-associated nephrotoxicity. Herein, we describe a case of podocyte disease accompanied with azotemia following intravenous administration of ibandronate.

Method

Case report

Results

An 88-year-old female was referred to the emergency room due to grade 4 edema that developed 1 month before. The patient was diagnosed with osteoporosis 20 months earlier, for which she received quarterly intravenous administration of ibandronate (3 mg). The last dose was administered 2 weeks ago. The patient had no history of diabetes, hypertension, or chronic kidney disease. Laboratory tests revealed heavy proteinuria with a protein/creatinine ratio (PCR) of 32 and hypoalbuminemia (1.9 g/dL) with elevated serum creatinine (sCr) (1.8 mg/dL). Values of serum complement and electrophoresis were within normal ranges. The renal ultrasonogram was unremarkable. A renal biopsy was performed and light microscopy showed mild mesangial hypercellularity and segmental amorphous collagenous deposition in the glomerulus (Fig. 1-A). The tubules revealed focal marked atrophy and interstitial fibrosis (Fig. 1-B). Immunofluorescence studies were unremarkable. Electron microscopy showed diffuse effacement of foot processes and no electron-dense deposit (Fig. 1-C), consistent with podocyte disease favoring focal segmental glomerulosclerosis. The patient was treated with tacrolimus and fimasartan. Steroid use was spared owing to severe osteoporosis. Three months later, the edema subsided and laboratory findings improved (PCR 0.64, serum albumin 4 g/dL, sCr 1.23 mg/dL).

Conclusion

Compared to pamidronate and zoledronate, ibandronate is more highly protein-bound with a significantly shorter renal tissue half life, which might explain the rarity of ibandronate-related nephrotoxicity. Contrary to the trend of other bisphosphonates nephropathies, our case showed simultaneous podocyte disease and tubule damage. We recommend close monitoring of proteinuria and renal function for prompt nephrotoxicity detection in patients treated with ibandronate.
#3727 REAL LIFE SINGLE-CENTRE EXPERIENCE IN PATIENTS WITH LONG-SURVIVAL RENAL TRANSPLANTATION
Authors: Busutti Marco , Mistretta Anna , Grandinetti Valeria , Angelini Andrea , Porcu Clara Valentina , Provenzano Michele , Comai Giorgia , Manna Gaetano La
Published: June 2023

Background and Aims

Kidney transplantation is the gold standard treatment for ESRD. Although the short-term results of kidney transplantation have improved significantly in the last 20 years, the increase in survival rates and the improvement of long-term graft outcomes represent a main challenge. Therefore, clinical data on patients with a long history of kidney transplantation are lacking and open field of research. The target of the study is to describe the outcomes in terms of renal function, immunological, infectious and neoplastic complications, and immunosuppressive therapy schemes, in a peculiar population of patients with long-lasting renal transplants.

Method

This is a retrospective, monocentric and observational cohort study. The study population consists of patients that underwent kidney transplantation in a single Kidney Transplant Unit from 1978 to 2012 and still in follow-up within the same Unit with a functioning graft. Data were extracted from the Hospital digital medical records after informed consent has been obtained. We analysed renal function at 5-year intervals from discharge to the last evaluation using eGFR calculated with the CKD-EPI formula. Data on demographic characteristics, comorbidities, immunosuppressive therapies and complication (divided as infectious, immunological and malignancy) has also been evaluated.

Results

We enrolled 332 patients with a mean follow-up of 17.9± 6.5 years, of whom 101 (30.4%) with a follow-up >20 years. Figure 1 shows the trend of renal function during the follow-up years. In Table 1 are reported the comorbidities and immunological, infectious and neoplastic complications. 46 (14.5 %) patients underwent a “for cause” kidney biopsy. The main finding, with 62% was transplant glomerulopathy/interstitial fibrosis and tubular atrophy (TG/IFTA) with a mean post-transplant onset of 12.8 years (± 6.1), 9% of rejection findings with a mean time to onset of chronic rejection of 18 years (±8) and 1.3% of biopsied patients received a diagnosis of recurrence with a mean onset of 10.8 years (±4.4). 36.1% of the patients experienced at least one neoplasm with an average post-transplant onset time of 13.4 (±7.7). Infectious complications occurred in 36.1% of the transplanted patients.

Conclusion

This study provides an exhaustive overview of the characteristics and clinical complications in a “real life” experience with long survivor kidney transplants with the aim to better understand the needs and problems of this peculiar population in order to guide clinician in a more targeted management.
#3930 EFFECT OF TWO PHOSPHATE BINDERS ON VITAMIN D LEVELS IN HEMODIALYSIS PATIENTS
Authors: Martika Antigoni , Lampropoulou Ioanna , Pozoukidou Kalliopi , Salvaridis Dimitrios , Spaia Sofia
Published: June 2023

Background and Aims

A recent meta-analysis highlighted the impact of different types of phosphate binders on vitamin D metabolism in patients with stage 3 CKD. Sevelamer was associated with lower serum 25(OH) vitamin D levels probably due to reduced intestinal absorption of D3 (cholecalciferol). Corresponding effects of different phosphate binders in hemodialysis patients have not been studied.

Method

We performed an observational prospective study in which 55 stable hemodialysis patients were followed for 28 months. Patients’ age was 42-91 years old and duration of hemodialysis was 2-312 months. Patients received as phosphate binders sevelamer, sucroferric oxyhydroxide or combination. The type of binders, the administration of D3 supplements, paricalcitol or etecalcetide as well as the biochemical control of the patients were recorded every two months. Serum 25(OH) vitamin D levels and the proportion of patients who required D3 supplementation to maintain 25(OH) vitamin D levels >20ng/mL were assessed.

Results

At baseline, 60% of patients used sevelamer as phosphate binder, 22% sucroferric oxyhydroxide and 18% combination, while 36% were on D3 supplements. Levels of 25(OH) vitamin D showed a significant increase after the first year of follow-up. (Dstart:16±8ng/ml vs D12months:26±10ng/ml, P = .001). After one year D3 supplementation ratio increased to 48% and remained at these levels until the end of follow-up. Taking paricalcitol or etecalcetide did not affect the results. No differences in 25(OH) vitamin D and D3 supplementation rate levels were observed between those receiving the different binders or the co administration group. No differences were observed in the biochemical markers tested as well as in dialysis adequacy.

Conclusion

In context of daily clinical practice, no differences were observed in the levels of 25(OH) vitamin D in either patients receiving sevelamer, sucroferric oxyhydroxide or combination of both as phosphate binders. Half of hemodialysis patients require cholecalciferol supplementation to maintain adequate 25(OH)vitamin D levels.
#4043 FABRY DISEASE: A RARE ENTITY IN THE NEPHROLOGY SETTING
Authors: Mariem Najjar , Dridi Rania , Braiek Hana Ben , Kaaroud Hayet , Hamida Fethi Ben , Harzallah Amel , Abderrahim Ezzeddine
Published: June 2023

Background and Aims

Fabry disease is a rare genetic disorder that affects multiple organs, including the kidneys. It is characterized by the accumulation of globotriaosylceramide (Gb3) in various tissues and organs, leading to progressive interstitial fibrosis and renal dysfunction. We aim to determine the renal manifestations of Fabry disease in particular the histological aspects.

Method

This study analyzed 9 patients with Fabry disease and renal involvement in a retrospective, single-center analysis. Clinical and biological data, as well as histologic findings, were collected based on patient's observations.

Results

Data was collected from 9 patients, including 7 males and 2 females, with an average age at diagnosis of 25.2 years (ranging from 17 to 32 years). All patients showed depleted activity of alpha 1 glycosidase, confirming the diagnosis. Acrosyndrome and vascular cutaneous lesions (angiokeratomas) were the dominant signs at admission with respectively (n=7; n=4), with only 3 patients being identified through familial screening without symptoms. Uncontrolled Hypertension was noted in 2 patients. Renal manifestations included renal hyperfiltration in 2 cases, isolated proteinuria in 4 patients, and renal failure in 3 others with a mean serum creatinine levels of 240 ± 36 µmol/l. Four patients underwent renal biopsy, which showed characteristic lesions of Fabry disease with sphingolipid accumulation and tubular cell vacuolization. Thickening of the glomerular capillary walls was observed in one patient. Interstitial fibrosis and tubular atrophy were noted in 3 patients. All patients received enzyme replacement therapy. Angiotensin-converting enzyme inhibitors (ACEi) and/or angiotensin II receptors blockers (ARB) were uses in 6 patients. Five patients progressed to terminal stage of renal failure requiring dialysis after an average follow-up period of 13±2.7 years. Four patients died from cardiovascular complications.

Conclusion

Early recognition and diagnosis of Fabry disease from the onset of glomerular hyperfiltration and albuminuria are crucial for the initiation of appropriate treatment and management, which can help to delay the progression of renal and other organ damage.
#4072 HEART OF STONE: THE IMPACT OF CARDIOVASCULAR RISK ON NEPHROLITHIASIS: AN OBSERVATIONAL STUDY
Authors: Damas Juliana Francisca Da Costa e Silva Barbosa , Vidal Helena , Fonseca Nuno Moreira , Jorge Cristina
Published: June 2023

Background and Aims

The incidence of nephrolithiasis has risen in recent years, largely due to changes in diet and lifestyle. An association between nephrolithiasis and risk of cardiovascular disease has been described, including atherosclerosis. The underlying mechanisms linking the two conditions are not well understood, making it important to study the role of exercise and nutritional habits. This study aims to examine the incidence of cardiovascular comorbidities in patients with nephrolithiasis, considering demographic information and the timeline of disease diagnosis and follow-up. Conditions such as dyslipidemia, myocardial infarction, stroke, and metabolic syndrome are of particular interest in this population.

Method

We retrospectively analysed consecutive patients that were referred to our tertiary medical center nephrolithiasis clinic between 2021 and 2023. The demographic information collected included gender, age at first nephrolithiasis diagnosis, current age, and family history. The cardiovascular conditions analysed included metabolic syndrome, hypertension, diabetes, gout, smoking, stroke, and dyslipidemia. Additionally, renal function (GFR-EPI) was also taken into account. Appropriate tests for continuous and categorical variables were applied, recurring to SPSS v21.0.

Results

A total of 84 patients were included in the study. Of these, 51.2% (n=43) were women with a median age of 52 years (IQR: 13-83) and a median age of first nephrolithiasis diagnosis of 34 years (IQR: 9-75). The analysed comorbidities showed a high incidence of hypertension (n=35, 41.7%), obesity (n=33, 40.7%), dyslipidemia (n=50, 61%), and metabolic syndrome (n=20, 23.8%). Family history was identified in 37.3% (n=31) of patients, with a significant difference for men, where 64.5% (n=20) had a positive family history (p-value 0.033). The results showed a relationship between increased body mass index and younger age of first nephrolithiasis diagnosis (p-value 0.012) and lower renal function at diagnosis (p-value 0.005).

Conclusion

The diagnosis of nephrolithiasis requires a change in the patient's diet and lifestyle, not only because of the risk of recurrence, but also because these patients are at a higher risk of developing serious cardiovascular events. This study highlights the high incidence of these comorbidities and underscores the importance of both the patient and the nephrologist being diligent in addressing these issues to achieve better kidney and overall health outcomes.