bluuebunny/crossref_metadata_2025 huggingface dataset:
#1810 The association between circulating fibroblast growth factor 23 (FGF23) and serum aldosterone level in chronic kidney disease patients
Authors: Khalifa Amr , Dohuim Amira
Published: May 2024

Background and Aims

Chronic kidney disease (CKD) remains a major health problem, till now, diagnosis of CKD depends on radiology and estimated glomerular filtration rate (eGFR). Therefore, there is an ultimate need for new sensitive prognostic and diagnostic biomarkers for diagnosis and progression of CKD. CKD is accompanied by increased levels of circulating fibroblast growth factor 23 (FGF23) and aldosterone levels. In the current study, we aim to evaluate the association between circulating FGF23 and serum aldosterone levels in CKD patients and to test the hypothesis that aldosterone may be a direct driving factor of increased FGF23 secretion in CKD patients.

Method

This cross section observational study was carried out at Kafr El Sheikh University Hospital's internal medicine department which enrolled 140 subjects that were divided into two groups: group I: 70 patients with various stages of newly diagnosed chronic kidney disease who did not receive renin-angiotensin-aldosterone system (RAAS) blocker yet (CKD stage 1 –5) & group II: 70 apparently healthy subjects (of corresponding age and sex as a control group). We detected serum FGF-23 and Serum aldosterone using enzyme-linked immunosorbent assay (ELISA).

Results

A strong correlation was identified between FGF-23 and serum aldosterone in group I (p =  < 0.001), there was remarkably stage dependent strong associations in CKD patients. High FGF-23 and serum aldosterone significantly independently increase risk of CKD by 1.15 and 1.043 folds respectively. The best cutoff of FGF-23 in prediction of kidney injury is ≥59.735 with area under curve 0.977, sensitivity 91.4%, specificity 90%, positive predictive value 90.1%, negative predictive value 91.3% and overall accuracy 90.7% (p < 0.001). The best cutoff of aldosterone in prediction of kidney injury is ≥117.59 with area under curve 0.978, sensitivity 92.9%, specificity 88.6%, positive predictive value 89%, negative predictive value 92.5% and overall accuracy 90.7% (p < 0.001).

Conclusion

FGF23 and aldosterone may be used as markers in CKD progression. aldosterone may be a direct driving factor of increased FGF23 secretion in CKD patients.
#1908 Characterization of the gut mycobiome composition in patients with end-stage renal disease
Authors: Wang Mengxiao , Wang Ting , Xia Chenyan , Zhi Yingxin , Zhao Zhanzheng , Shang Jin
Published: May 2024

Background and Aims

The serum uremic toxins of end-stage renal disease (ESRD) patients is intricately linked to the metabolism of gut microbiota. Despite the pivotal role played by gut mycobiome in the pathogenesis of several renal diseases, limited investigations have been conducted on its involvement in ESRD patients, including dialysis and pre-dialysis individuals. Therefore, the objective of this study is to gain further insights into the alterations occurring in the gut mycobiome of ESRD patients, aiming to provide novel strategies for improving the prognosis of these patients.

Method

This is an observational retrospective study. A total of 200 fecal samples were collected from each participant, including 51 healthy controls (HC), 51 pre-dialysis (ND) patients, 42 hemodialysis (HD) patients, and 56 peritoneal dialysis (PD) patients. Gut mycobiome was analyzed using the internal transcribed spacer region (ITS) ribosomal RNA gene sequencing. Additionally, we conducted spearman correlation analysis to identify associations between differential fungi and clinical parameters in ESRD patients, including both dialysis and pre-dialysis individuals.

Results

In comparison with healthy controls, ESRD patients exhibited a significant reduction in alpha diversity of the gut mycobiome. At the phylum level, ESRD patients had a significantly decreased relative abundance of Ascomycota and Basidiomycota, and an increased relative abundance of Fungi_phy_Incertae_sedis. Although there was no significant difference in mycobiome diversity between pre-dialysis and dialysis patients, differential fungi were observed at the taxonomic level between the two groups. Similarly, differential fungi were also found when comparing hemodialysis and peritoneal dialysis patients. Importantly, we observed a linear correlation between the abundance of differential fungi and kidney function, suggesting a potential interaction between these fungi with kidney function.

Conclusion

This study demonstrated the diversity and composition of the gut mycobiome are significantly altered in ESRD patients. Dialysis therapy affects the relative abundance of fungi at the taxonomic level. These findings suggest potential implications of specific fungal species on kidney function.
#2186 Lower psoas muscle volume is associated with CKD progression
Authors: Fujii Naohiko , Yokoyama Yuki , Ozaki Shingo , Harada Wakako , Kani Nao , Endo Yuna , Yonemoto Sayoko , Okuno Ayako , Saeki Mizuho
Published: May 2024

Background and Aims

Renal rehabilitation is important for keeping quality of life and kidney function of patients with CKD. Psoas muscle is representative of total body muscle and its cross-sectional area divided by squared height (PMI) is known to be associated with CKD prognosis. However, the selection of the slice of computer tomography (CT) used for calculation of PMI is arbitrary and may be a source of bias. Recently, AI technology using raw helical CT data has facilitated the measurement of total volume of the psoas major muscle (PMV), which is theoretically less biased by measurer. The aim of this study is to investigate the association between PMV and the progression of CKD.

Method

This is a pilot retrospective observational study using electrical health records (EHR) in Hyogo Prefectural Nishinomiya Hospital, Japan. We extracted patients with CKD who had taken abdominal CT in 2021 by nephrologists for evaluation of urological anatomy or clinical reasons. PMV was automatically extracted and measured by SYNAPSE VICENT (Fuji Film Medical), a commercially available software. Baseline laboratory data and patient characteristics were collected through EHR with a margin of 90 days from CT scan. The outcome of CKD progression was defined as a 40% decrease in eGFR from baseline. Survival analysis was performed by using the Cox proportional hazards model.

Results

We enrolled 145 consecutive CKD patients and excluded 37 whose observation period was less than 90 days. PMV was significantly greater in male than in female, positively associated with younger age and higher body mass index (BMI). PMV adjusted for age, sex, and BMI (adjPMV) decreased in a stepwise manner as baseline CKD stage advanced from G2 (N = 23) to G3b (N = 18) but was comparable in G4 (N = 37) and G5 (N = 6). The subjects were then divided into two groups (High-PMV and Low-PMV) according to whether their adjPMV were greater or less than the median value in each CKD stage. The High- and Low-PMV groups were comparable in age (71 ± 13 vs. 72 ± 13), female sex (42% vs. 45%), eGFR (41 ± 21 vs. 42 ± 22), urinary albumin-to-creatinine ratio (UACR), CRP, the prevalence of diabetes at baseline, respectively. PMI and PMV were significantly greater in High-PMV than in Low-PMV group (7.7 ± 1.8 vs. 5.8 ± 1.6 and 307 ± 110 vs. 205 ± 64, respectively). During the median follow up of 1.6 years, 40 events occurred. Hazards ratio for CKD progression was significantly lower in High-PMV group (0.48 [95% confidence interval: 0.25-0.95]) than Low-PMV group after adjusting for known risk factors (age, sex, eGFR, and UACR).

Conclusion

Preserved psoas muscle volume measured by a theoretically less biased method may be associated with better prognosis in CKD. A larger study in a different cohort, longitudinal observation, and interventional studies are warranted for future investigation.
#1117 Skipping breakfast and progression of chronic kidney disease in a general Japanese population
Authors: Takahashi Koji , Inoue Yori , Tada Kazuhiro , Hiyamuta Hiroto , Ito Kenji , Yasuno Tetsuhiko , Arima Hisatomi , Masutani Kosuke
Published: May 2024

Background and Aims

Unhealthy eating habits such as skipping breakfast are associated with adverse health outcomes including coronary heart disease, metabolic syndrome and diabetes mellitus. However, it remains uncertain whether skipping breakfast affects chronic kidney disease (CKD) risk. The aim of this study was to investigate the association between skipping breakfast and progression of CKD.

Method

Between 2008 and 2019, we conducted a retrospective cohort study using annual health check data in Iki City, Nagasaki, Japan. A total of 922 participants aged 30 years or older who had CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2 and/or proteinuria) at baseline were included in the present analysis. The breakfast-skipping group was defined as participants who skipped breakfast more than 3 times per week. The outcome was CKD progression defined as a decline of at least 30% in the eGFR from the baseline status. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for CKD progression, adjusted for other CKD risk factors.

Results

During a follow-up period with a mean of 5.5 years, CKD progression occurred in 60 (6.5%) participants. The incidence rate (per 1,000 person-years) of CKD progression was 21.5 in the breakfast-skipping group and 10.7 in the breakfast-eating group (p = 0.029), respectively. The multivariable-adjusted HR (95% CI) for CKD progression was 2.60 (95% CI 1.29‒5.26) for the breakfast-skipping group (p = 0.028) compared with the group eating breakfast. There were no clear differences in the association of skipping breakfast with CKD progression in subgroup analyses by sex, age, obesity, hypertension, diabetes mellitus, baseline eGFR and baseline proteinuria.

Conclusion

Skipping breakfast was significantly associated with higher risk of CKD progression in a general Japanese population.
#2022 Clinical outcomes in US patients initiating finerenone – a report from the FOUNTAIN platform
Authors: Oberprieler Nikolaus G , Kovesdy Csaba P , Layton J Bradley , Thapa Bishnu , Curhan Gary , Farjat Alfredo E , Liu Fangfang , Johannes Catherine , Vizcaya David
Published: May 2024

Background and Aims

Evidence from clinical trials demonstrates that finerenone reduces the risk of cardiovascular and renal complications among patients with chronic kidney disease (CKD) and type 2 diabetes (T2D). What is lacking is the evidence on finerenone use in real-world clinical practice.

Method

The present analysis is based on a longitudinal single-arm cohort study of patients initiating finerenone between July 2021 and August of 2023 and with prior diagnoses of CKD and T2D. Data were obtained from US electronic health records and insurance claims (OM1 Real-World Data CloudTM). CKD was defined as either having 1 diagnostic code for CKD stage 2-4 or unspecified stage, two estimated glomerular filtration rate (eGFR) measurements between 15 and 60 ml/min/1.73 m2, or two urine albumin to creatinine ratio (UACR) measurements over 30 mg/g; T2D was defined as having a diagnostic code for T2D. We described patient demographics, comorbidities, and comedications at baseline (365 days prior and including index date), and incidence rates of cardiovascular and renal outcomes, including eGFR and UACR changes over time. The presented analysis (NCT05703880) is part of the multi-national, multi-database observational research platform FOUNTAIN.

Results

We identified 28,056 new users of finerenone with prior CKD and T2D. The users had a mean (SD) age of 68.8 (10.8) years and 44.8% were female. Comorbidities of interest at baseline were hypertension (89.8%), cardiovascular disease (21.2%), neuropathy (13.4%), retinopathy (8.1%), heart failure (7.9%), and cerebrovascular disease (4.2%). Assessment of comedication use at baseline indicates that patients who initiate finerenone had exposure to renin–angiotensin system inhibitors (52.5%), sodium-glucose cotransporter-2 inhibitors (39.2%), or glucagon-like peptide-1 receptor agonists (27.4%) within 180 days prior to initiating finerenone. Overall, 82.5% of patients initiated finerenone at 10 mg/d, while 17.5% of patients started with 20 mg/d. Complete results including incidence rates of cardiovascular and renal outcomes, hyperkalemia events, and changes in kidney function measures (eGFR, UACR) during follow-up will be presented as part of the conference presentation.

Conclusion

Data from patients receiving finerenone as part of clinical practice in the USA suggest that finerenone is used concurrently with other renal and cardiovascular protective medication-classes recommended for patients with CKD and T2D.
#1593 ARGDRR, a novel disintegrin, attenuates AKI to CKD-related renal fibrosis
Authors: Chiang Chih-Kang , Yang Shao-Yu , Chen Jia-Huang , Chiang Tsai-Chen , Huang Jenq-Wen , Huang Tur-Fu , Chuang Woei-Jer
Published: May 2024

Background and Aims

Acute kidney injury (AKI) can lead to progress renal fibrosis, resulting in chronic kidney disease (CKD) and end stage renal disease (ESRD). Nevertheless, the underlying pathological mechanisms remain unclear. Platelet activation has been demonstrated as one of the important factors involved in the pathophysiology of AKI, and studies show the therapeutic potential for using platelet inhibitors or antagonists in ischemia-reperfusion (IR)-induced AKI models. However, drug-induced side effects, including thrombotic microangiopathies (TMA)-related kidney damage, thrombocytopenia and bleeding, hinder clinical application in AKI or CKD treatment. Our newly developed dual effect disintegrin, ARGDRR, is derived from snake venom exert a high affinity to αIIbβ3 and αvβ3 binding affinity without causing bleeding and other thrombosis-related side effects.

Method

We performed a unilateral ischemia-reperfusion injury (UIRI) model to investigate integrin αIIb(Itga2b) and β3(Itgb3) mRNA levels in the injured kidney for 15 days. For exploring the therapeutic efficiency of ARGDRR in AKI, we administered ARGDRR post-ischemic injury and measured platelet activation after 24 hours using quantitative polymerase chain reaction (qPCR) and immunohistochemistry (IHC) for Itgb3, Lcn2, and CD42b. For exploring the therapeutic efficiency of ARGDRR in CKD progression, we administrated ARGDRR daily for 15 days after IRI with nephrectomy, and examined the difference of renal dysfunction, renal fibrosis, and cell death compared to sham group.

Results

We found that platelet activation with progressively increased mRNA level of platelet glycoprotein IIb-GPIIIa (Itga2b and Itgb3) in the UIRI kidney over time. After 24 hr of ischemic AKI, ARGDRR administration reduced Lcn2 and Itgb3 mRNA level and CD42b positive area in the kidney, indicating its efficacy in protecting the kidneys by inhibiting platelet activation and aggregation. In AKI to CKD transition, serum creatine and blood urea nitrogen (BUN) were significantly lower both in efficacious and high dose of ARGDRR administration group. ARGDRR significantly reduced CD42b expression and increased LTL positive area. Also, ARGDRR administration alleviated renal fibrosis, cell apoptosis and senescence-related molecules p21 and Ctgf expression in the AKI to CKD transition.

Conclusion

Our results have successfully proved our hypothesis that disintegrin-ARGDRR has the potential for renal protection in the transition of AKI to CKD through inhibition of platelet activation and aggregation during acute injury.
#884 Do parenteral iron therapies preserve or deteriorate kidney functions
Authors: Emre Turker , Gökmen Yalçın
Published: May 2024

Background and Aims

Treatment of Chronic Kidney Disease (CKD) is based on preserving renal functions. Since renal anemia is frequently detected, We use par enteral iron treatments in patients with Chronic Kidney Disease (CKD). However, there are no clear and sufficient studies on the effect of these treatments on the rate of decrease in Glomerular Filtration Rate (GFR). Therefore, we conducted a study comparing the rates of change in renal function in patients who had used parenteral iron for a five years at least.

Method

Our study is a retrospective cohort study, and 180 patients with CKD (86 women, 94 men, mean age 63.5±11.4 years) who had been followed and treated in Nephrology Outpatient Clinics for at least 5 years and met the study criteria were included into the study. Patients divided into three groups for receiving iron therapy: not received iron therapy, receiving iron carboxy maltose (ICM) and receiving iron sucrose (IS) par enterally . Each group consists of 60 people. The first and last creatinine, GFR values were compared for a 5-year follow-up in each group.

Results

There was no significant difference between the two groups, those using and not using iron, in terms of creatinine increase and GFR decrease rate. Additionally, no significant difference was detected in the GFR decline rates of patients using ICM and IS.

Conclusion

We concluded that anemia treatment with iron carboxy maltose and iron sucrose are renally safe in predialysis CKD patients.

This study reduces concerns that correction of anemia through parenteral iron therapy in patients with CKD may harm renal function.
#854 Developing a free renal recipe resource, Kidney Kitchen, in collaboration with Kidney Care UK and the Renal Nutrition Group
Authors: Taylor Angeline
Published: May 2024

Background and Aims

In 2018 Kidney Kitchen (KK), a free resource that can turn renal dietary restrictions into enjoyable and nutritionally adequate meals was launched. Together with the British Dietetic Association's Renal Nutrition Specialist Group (RNG), trained chefs, food photographer, a videographer and Kidney Care UK, KK became a reality. Today, KK offers >200 online recipes and have produced four free patient recipes books/magazines. Recipes aim to be tasty, culturally diverse, and family-friendly and are for all stages of kidney disease.

Method

Each recipe goes through a rigorous four stages of development before patients can access:

Results

Since its launch in 2018, KK have >200 RNG approved recipes, available online, with downloadable recipe cards, and 50 with accompanying videos (https://kidneycareuk.org/get-support/healthy-diet-support/kidney-kitchen/).

Analytics during 2021 indicated the following:

Results recipe books

KK is about to release its forth free recipe book/magazine. In 2021 KK produced a printed recipe book containing 40 recipes, making this free resource available to all UK renal dietitians and patients (Fig. 2). A total of 12,000 copies have been provided.

In 2022, and in response to the cost of living crisis, KK developed a 21-budget friendly recipe magazine (Fig. 3), along with a guide for Foodbanks (Fig. 4). A total of 15,000 copies have been made available at no cost to patients.

In 2023 KK launched a weight loss recipe magazine (Fig. 5), with a range of healthy recipes and healthy eating advice. A total of 10,000 copies were printed at the time.

January 2024 will see the launch of a South Asian recipe magazine containing 20 recipes and dietary tips to manage salt and potassium within the South Asian diet.

During 2024 and into 2025 we will continue adding recipes to the recently updated website. In addition, we will review the initial recipe book produced in 2021, create a recipe magazine for African and Caribbean diets, and develop a children friendly section of the KK website.

Conclusion

In summary, KK have produced a resource, valued by both patients and dietitians, that provides free, practical guidance on implementing renal dietary restrictions in a safe, enjoyable and nutritionally adequate way.
#3055 Replacement of tunneled cuffed hemodialysis catheters on coated guidewire: a strategic approach to treat CVC-related infections
Authors: Maria D'ascenzo Francesca , Lomeo Elettra , Mangiacapra Roberto , Aureli Fabio , Sturniolo Antonio , Pesce Francesco , Grandaliano Giuseppe
Published: May 2024

Background and Aims

Infections of tunneled hemodialysis central venous catheters (CVCs) are a serious problem, and the outcome of dialysis patients strongly depends on their clinical management. Several specialists are involved in choosing the appropriate technical and clinical strategy but often there is no consensus among them on the proper management. We believe that the role of nephrologists must be pivotal in this setting throughout the entire process, from the choice of vascular access to the management of complications. Here, we present our experience using an approach to replace CVCs that was conceived to minimize the rate of infections.

Method

We propose a CVC replacement technique to minimize the risk of contamination by using a guidewire coating that allow no contact between the old and new CVC. We carried out a retrospective observational study of tunneled CVCs replacement with this technique performed at the Nephrology Unit of the "A. Gemelli Polyclinic" between January 2020 and June 2023. The following parameters were analyzed: age, sex, infection-supporting pathogen, CVC age, and dialysis age.

Results

During the reporting period, we carried out a total of 87 CVC guidewire replacement procedures for HD tunneled catheters defined “access to be preserved” using our technique. Among the patients (median age 70,6) undergoing this procedure, n=5 (5.75%) presented with endocarditis (n=4 by Staphylococcus aureus, n=1 by Pseudomonas aeruginosa).

The follow-up ranged from 6 months to 3 years. During this time only one patient, with endocarditis, had a recurrent infection caused by Pseudomonas aeruginosa after 3 months from the CVC replacement whereas 12 patients presented a de novo CVC infection caused by a different pathogen (n=4 by Staphylococcus aureus, n=1 by Pseudomonas Aeruginosa.

Conclusion

Overall, our data are encouraging as the lower rate of recurrent infections in our cohort suggests that our CVC replacement technique can be potentially used even in case of dangerous pathogens.
#2464 Association of vascular access flow and volume status on fistula arm by bio-impedance analysis
Authors: Chang Jae Hyun , Kim Hyung-Jong
Published: May 2024

Background and Aims

Multi-frequency bio-impedance is a tool of body composition measure and can monitor changes in extracellular volume during dialysis. Arterio-venous fistulae (AVF) could potentially affect fluid retention in the arm. We investigated whether multi-frequency bio-impedance could defect AVF stenosis or association of AVF with fluid retention in the AVF arm.

Method

We measured the extracellular water (ECF) and total body water (TBW) in AVF arm following hemodialysis by multi-frequency bio-impedance (Inbody S10®) using an eight-electrode contact technique. We measured AVF or AVG flow by transonic ultrasonography using an ultrasound dilution technology (HD 03®) in hemodialysis.

Results

Total 82 patients (male 38 patients : female 44 patients) were enrolled. The causes of ESRD were DM : non-DM = 38 : 44. The mean age of patients was 54.89 ± 13.21 years. The ECW/TBW ration of fistula arm was a significantly higher than the ECW/TBW ration of non-fistula arm (0.389 ± 0.010 vs. 0.382 ± 0.001; p<0.05). The ECW/TBW ration of fistula arm was a significantly negative correlation with access flow level (mL/min) on fistula (p<0.05). The 5kHz reactance of fistula arm was a significantly positive correlation with access flow level (mL/min) on fistula (p<0.05). The 5kHz Phase Angle of fistula arm was a significantly positive correlation with access flow level (mL/min) on fistula (p<0.05).

Conclusion

Absolute and also relative extracellular fluid volumes are increased in the fistula arm of hemodialysis. We thought that extracellular fluid volumes in the fistula arm were associated with access flow level (mL/min) and/or relative fistula stenosis. We suggest that multi-frequency bio-impedance can be a useful assistant tool of vascular access flow measure.
#2868 Clinical outcomes of octogenarians starting haemodialysis: a single center experience
Authors: Paunic Zoran , Maslovaric Jelena , Bjelica Slobodanka , Petkovic Dobrila
Published: May 2024

Background and Aims

Simultaneously with the aging of the general population, the number of patients with ESRD is also increasing. The question of the most favorable dialysis treatment arises, but the most frequently used method is still haemodialysis (HD).

Method

Retrospective data from patients aged 80 years or older treated with chronic HD treatments in our Dialysis Center and followed between 2009 and 2023. were studied.

Results

This study included 33 octogenarians (83.5 ± 5.4 years, 25M, 8F) Underlying renal diseases were hypertensive/ischaemic nephropathy (76%), diabetic nephropathy (10%), obstructive nephropathy (4%) and UN in 3 (10%). Vascular access was AV fistula in 72%, AV graft in 4%, long-term HD catheter in 17%, temporary catheter in 7%. Over half of them (i.e., 55%) were mobile, 35% mobile with assistance and 10% were immobile.

Out of thirty-three, 3 died during the first 90 days of HD therapy and they were excluded from further analysis. During the observation period, 19 of 30 have died (63%). There was no statistically significant difference between those who were still alive and who died regarding their vascular access status, though all four of our patients with temporary catheters died (21% of all died, p 0.26). Also, their age (82.8±2.5 vs. 83.5±3.3 y), Charlson score (8.4±1.7 vs. 8.4±1.2), their Kt/V (1.45±0.24 vs. 1.43±0.31), Hb (104.4±6.2 vs 106.1±7.9 g/L) or albumin level (37.8±5.3 vs. 36.9±4.6 g/L) and other of blood analysis did not differ significantly between live and died patients. The only 2 parameters that were statistically significantly different were their HD vintage (34.3±21.0 vs. 57.1±39.2 p 0.05) and the last obtained lean tissue index (LTI, assessed by “Body Composition monitor” bioimpedance apparatus). Namely, their LTI was less than 10 kg/m2 BSA (present in 6 of 19, i.e. 32% of died patients and in none of the survivors, p<0.05)

The 1-year, 2-year, 5-year survival has a favorable rate, i.e. 86%, 77%, 42% respectively (Figure:).

The main causes of death were cardiovascular disease (47%), COVID (26.3%), sepsis, gastrointestinal bleeding, disseminated malignancy, stroke (1 case each) and 1 patient decided not to continue his HD treatments.

Conclusion

With careful clinical assessment and timely created vascular access, HD is a good choice for the treatment of very old ESKD patients. The outcomes in observed population would probably be better without pandemic COVID scenario.
#811 Effect of GLP-1 receptor agonists on the weight, urea distribution volume and blood pressure of hemodialysis (HD) patients
Authors: Chaudhuri Sheetal , Han Hao , Ficociello Linda , Kotanko Peter , Usvyat Len , Maddux Franklin
Published: May 2024

Background and Aims

Glucagon-like-peptide-1 receptor agonists (GLP-1) drugs are a class of medications commonly used to treat type-2 diabetes. Diabetes is prevalent in almost 60% of the end stage kidney disease (ESKD) patients and an increasing number of dialysis patients use GLP-1 drugs. It is important to note that GLP-1 drugs may have additional benefits such as weight loss and potential cardiovascular benefits. However, little is known about the effects of these drugs in dialysis patients. We analysed the changes in body weight and blood pressure in hemodialysis (HD) patients who start using these drugs. We also analysed whether there are changes in patients’ urea distribution volume, a proxy of lean body mass, to understand whether these medications affect muscle mass.

Method

We retrospectively evaluated 236 ESKD patients who were prescribed GLP-1 drugs as part of routine clinical care in October of 2023 at clinics in a large dialysis organization. All patients received dialysis for at least 60 days before and after they started using the medication. We looked at the changes in the average post dialysis weight, urea distribution volume, and pre dialysis systolic blood pressure (pre-SBP) between the 60 days before using GLP-1 drugs (pre-GLP1 period) and 60 days after initiating the drug (post-GLP1 phase). For each metric, we performed a paired t-test to evaluate the changes between pre-GLP1 and post-GLP1.

Results

The average post dialysis weight pre-GLP1 was 103.98 kg and the average post dialysis weight post-GLP1 was 102.02 kg (difference: −1.96 kg, 95% CI :1.37 to 4.27, p-value <0.001). The average urea distribution volume was 36.0 L pre-GLP1, and 35.6 L post-GLP1 (difference: −0.47 L, 95% CI: −0.99 to 3.56, p-value=0.07). The mean pre-SBP was 147.83 mmHg pre-GLP1 and 149.67 mmHg post-GLP1 (difference: 1.85 mmHg, 95% CI: −5.49 to 24.93, p=0.29).

Conclusion

Our analysis showed a significant decrease in the average post dialysis weight of HD patients using GLP-1 drugs. While the decline in patients' urea distribution volume, which can be considered as a proxy for lean tissue mass, was not statistically significant, it may be clinically meaningful. We do not see a significant change in pre-SBP. Reductions in weight may suggest reduction in fat and muscle mass but can also be due to “regression to the mean” phenomena as patients who were on these medications tended to be larger. Further studies are necessary to evaluate this association.
#360 Short-term treatment with medium cut-off dialyzers increases muscle mass with preserved fat tissue in maintenance HD patients
Authors: Korucu Berfu , Esme Mert , Erbay Ege , Senturk Zekiye Selin , Bildaci Yelda Deligoz , Cavdar Caner , Derİcİ Ülver , Deger Serpil Muge
Published: May 2024

Background and Aims

Protein-energy wasting is a significant complication of maintenance hemodialysis (HD) patients characterized by reduced fat or muscle mass and strength. The combination of non-modifiable general and disease-related factors, such as uremic toxin accumulation and systemic inflammation, is responsible for this condition. Medium cut-off (MCO) membranes are designed to provide clearance of large-middle molecular weight uremic toxins and inflammatory cytokines without causing loss of albumin. This study aimed to investigate the short-term effect of MCO dialyzers on fat tissues and muscle mass.

Method

We conducted a prospective, single-center cross-over study on maintenance HD patients treated with regular low-flux (LF) dialyzers. Fat tissues were measured with a skinfold caliper and mid-upper arm circumference. Muscle thickness and strength parameters from six different muscle groups were evaluated with ultrasound. The baseline (control) parameters were measured under LF dialyzers, and the measurements were repeated two weeks after switching to MCO dialyzers for the patients ordered by their clinicians according to the clinical indications.

Results

The median age was 69.5 (50.3,78.8) years, and 60% of the patients were female. Two weeks after switching to MCO, the Kt/Vs, urea reduction ratios, mean serum albumin, dry weight, and body mass index scores were similar. Mean skinfold thickness and mid-upper arm circumference were 15 mm (11,17) and 28mm (27,30) under LF and 16mm (14,19) and 28mm (27,30) under MCO dialyzers (p=0.82 and p=0.27). Rectus abdominis and external oblique muscle groups remained similar. Internal and external oblique muscle thickness were significantly increased (p=0.002 and p=0.001). Mean rectus femoris and gastrocnemius medialis (GKM) thicknesses were 1.19cm (0.99,1.33) and 1.16cm (0.9,1.4) under LF and 1.31cm (1.20, 1.40) and 1.24cm (0.95,1.40) under MCO dialyzers (p=0.002 and p=0.02). Mean GKM fibrile length and pennation angles were 2.4cm (2.2,2.8) and 20o (18,23) under LF and 2.7cm (2.4, 2.9) and 22o (19,24) under MCO dialyzers (p=0.007 and p=0.001).

Conclusion

Our study showed that MCO dialyzers increase muscle mass with preserved fat tissues in HD patients, short-term follow-up. This favorable effect might be due to the clearance of uremic toxins, which cannot be removed with conventional methods. If long-term studies support our findings, MCO dialyzers would be a milestone for the treatment of sarcopenia in HD patients.
#926 Qatar's Assisted Home Hemodialysis Program (AHHD): a new challenge to reach better outcomes for elderly patients
Authors: Elshirbeny Mostafa Fottoh , Mohamed Mohamed Yahya Abdelhai , Hamad Abdulla , Filali Mossab , Almohanadi Teha , Tolba Hoda , Joseph Shajahan , Chembolu Sandhya , Alkadi Mohamad , Almalki Hassan
Published: May 2024

Background and Aims

There are a growing number of patients supported by dialysis in older age. In Qatar, 58% of haemodialysis patients are above 60 years. The dialysis care of these patients can be challenging due to frailty, chronic health conditions, diminished QOL, and function. One important reason to favor Assisted Home Haemodialysis (AHHD), especially in the older population is the greater flexibility in conducting dialysis sessions. Our aim is to assess the efficacy of AHHD program in comparison to in-center dialysis.

Method

This is retrospective study to evaluate AHHD program in Qatar between July 2021 to December 2023 and compare to in-center haemodialysis in complications, compliance, infectivity and cost.

Results

The AHHD population increased gradually to 122 patients in December 2023. Patients and families reported great satisfaction 98.9% with the AHHD experience as they reported less fatigue post dialysis, eliminated the burden of transportation, and improved quality of life by having HD provided in a home environment. AHHD patients had a significantly lower infection rate (5%) during the COVID-19 outbreak than those receiving in-center dialysis. AHHD freed up crucial slots in hemodialysis centers, increasing the availability of dialysis slots by 10%. Mortality rate was 20.6% while 5 % of patient returned back to in-center dialysis. No major clinical or technical complications had been reported during follow up. The program had resulted in 25% reduction in total cost mainly due to reduction in ambulance use.

Conclusion

AHHD service increases access to hemodialysis care for elderly patients. The AHHD in Qatar showed great success over 30 months and there was a remarkable increase in the number of patients who started the AHHD with better outcomes regard to QOL and infectivity. It was cost-effective and showed an obvious outcome of reducing ambulance transport utilization and improving patients’ QOL and satisfaction.
#494 Analysis of technique failure and reasons for the end of follow-up in a peritoneal dialysis unit
Authors: Fernández Antonio Faúndez , del Pino Estrada Carmen , Quirós María Teresa Fernandez , Mateos María Isabel Rebollo , Pérez Elisa Pereira , Giron Ana María García , Huete María José Espigares
Published: May 2024

Background and Aims

Currently, there are various definitions for peritoneal dialysis technique failure, and several related factors are described. There is controversy regarding whether mortality should be considered a form of technique failure or not, as it involves an event of a different nature. Besides, the exit form peritoneal dialysis (PD) technique can occur due to the transition to hemodialysis (HD), kidney transplantation or the patient's death in general. The aim of this study was to investigate which factors are associated with survival in peritoneal dialysis technique.

Method

A retrospective study was conducted with 111 incident PD patients in the dialysis unit of Hospital Universitario Virgen de las Nieves, in Granada, Spain, between 2015 and 2020. A survival curve was obtained, evaluating the association of different variables with technique failure and the end of follow-up. By identifying mortality as a competitive risk for technique failure, a Fine and Gray competitive risks model was applied.

Results

A total of 111 patients were analyzed, with an annual technique survival of 90%, being it 83% at two years, and 74% at three years. Table 1 reflects the demographic and clinical characteristics of the patients.

The main causes of technique failure were psychosocial causes (19%), peritoneal catheter mechanical issues (12%), ultrafiltration failure (9.52%), and peritonitis (9.52%). The main reasons for the end of follow-up were kidney transplantation (55%), transfer to HD (26%), and death (12.6%).

Among the deceased, 64% were of cardiovascular origin, and 21% were infectious.

Technique failure was more observed in patients over 65 years old, in those with a Charlson index higher than 4 points, with diabetes, a history of cardiovascular disease (CVD) and heart failure (HF), in former smokers, and in diabetic kidney disease.

Conclusion

Technique survival in our center was 90% at one year and 83% at two years, similar to previous Spanish records. The reasons for technique exit were: 55% due to kidney transplantation, 26% due to transfer to hemodialysis, and 19% due to for psychosocial causes. Risk factors related to technique failure were advanced age, Charlson index, diabetes, and a history of cardiovascular disease (CVD) and heart failure (HF).
#3017 Renal-friendly lamivudine dosages are unlikely to contribute to HIV-1 shedding into PD effluents—an open label non-randomized pharmacokinetics study
Authors: Mooko Teboho , Bisiwe Busiswa , Mondleki Enkosi , Morobadi Daniel , Chikobvu Perpetual , Nyaga Martin , Goedhals Dominique , Mofokeng Thabiso , Kemp Gabre , Ndlovu Kwazi
Published: May 2024

Background and Aims

Renally adjusted lamivudine dosages are effective. However, some of the kidney failure patients managed with lamivudine-containing regimens are failing to suppress HIV in peritoneal dialysis (CAPD) effluent. The steady-state lamivudine pharmacokinetics among these patients was evaluated.

Method

This overnight open-label pharmacokinetic study enrolled participants living with HIV and managed with CAPD. Lamivudine levels in blood serum and CAPD effluent samples were quantified using liquid chromatography coupled with a mass spectrometry. Pharmacokinetic measures were obtained through non-compartmental analysis.

Results

Twenty-eight participants were recruited with a median ARV duration of 8 (IQR, 4.5-10.5) years and a CAPD duration of 13.3 (IQR, 3.3-31.9) months. The majority, 78.6% (22/20) of participants received a 50 mg dose and 25% (1/4) had a detectable HIV viral load (HIV-VL) in CAPD, while 10.7% (3/28), and another 10.7% (3/28) received 75 mg and 300 mg dosages, respectively. Among those treated with 75 and 300 mg, 50% (2/4) and 25% (1/4) had detectable HIV-VL in CAPD, respectively. The peritoneal membrane characteristics and CAPD system strengths were variable across the entire study population. Lamivudine exposure was increased in blood serum (50 mg-AUC0-24 hours, 651.3 ng/mL; 75 mg-AUC0-24 hours, 677.84 ng/mL; 300 mg-AUC0-24 hours, 3135.89 ng/mL) compared to CAPD effluents (50 mg-AUC0-24 hours, 384.91 ng/mL; 75 mg-AUC0-24 hours, 383.24 ng/mL; 300 mg-AUC0-24 hours, 2001.60 ng/mL) among the entire study population. The Cmax (50 mg, 41.5 ng/mL; 75 mg, 53.2 ng/mL; 300 mg, 199.1 ng/mL) and Cmin (50 mg, 17.8 ng/mL; 75 mg, 16.4 ng/mL; 300 mg, 76.4 ng/mL) measured in serum were within the therapeutic levels.

Conclusion

Steady-state lamivudine pharmacokinetic measures were variable among the entire study population; however, the total lamivudine exposure was within the therapeutic levels.
#189 Aortic stenosis is an independent risk factor for mortality in end-stage kidney disease patients on the transplant waitlist
Authors: Chen Haoyang , Ho Quan Yao , Lye Yan Nerng , Koh Choong Hou , Keh Yann Shah , Tien Shan-Yeu Carolyn , Liew Ian Tatt , Thangaraju Sobhana , Yeo Khung Keong , Kee Terence
Published: May 2024

Background and Aims

Valvular heart disease (VHD) is a risk factor for adverse outcomes in end-stage kidney disease (ESKD) patients. However, the impact of individual valvular heart lesions on outcomes in patients on the kidney transplant waitlist is unclear. This study aims to analyse the relationship between different VHD and all-cause mortality, and to determine the characteristics of patients on the transplant waitlist stratified by the different types of VHD.

Method

This was a single-center retrospective cohort study of ESKD patients who were referred for kidney transplant waitlist placement from May 2008 to February 2021 and had undergone baseline transthoracic echocardiogram (TTE). Significant VHD was defined as VHD of at least moderate severity based on TTE findings. Patients were followed up until death or kidney transplantation.

Results

Of the 512 patients included, 89 (17.4%) had significant VHD. Mean follow-up duration was 6.6 ± 3.3 years. Significant VHD included 46 (9.0%) tricuspid regurgitation (TR), 44 (8.6%) mitral regurgitation (MR), 11 (2.2%) aortic regurgitation (AR), 7 (1.4%) aortic stenosis (AS) and 2 (0.4%) mitral stenosis (MS). Of the different VHD (Table 1), only AS was associated with all-cause mortality (hazard ratio (HR) 2.41, 95% CI 1.53-3.78, p < 0.0001, Fig. 1) and remained significant after adjusting for age, diabetes mellitus (DM) and other cardiovascular diseases (CVD) (adjusted HR 1.71, 95% CI 1.07-2.73, p = 0.02).

Risk factors associated with AS included older age (odds ratio (OR) 1.12, 95% CI 1.03-1.23, p = 0.01), history of CVD (OR 7.31, 95% CI 1.59-33.6, p = 0.01), longer dialysis vintage (OR 1.01, 95% CI 1.00-1.02, p = 0.02), previous parathyroidectomy (OR 15.1, 95% CI 2.68-85.4, p = 0.002) and higher corrected calcium (OR 43.9, 95% CI 1.56-1240, p = 0.03). Age (adjusted OR 1.12, 95% CI 1.02-1.24, p = 0.02), history of CVD (aOR 7.70, 95% CI 1.50-39.5, p = 0.02) and previous parathyroidectomy (aOR 11.8, 95% CI 1.83-76.7, p = 0.01) remained significant in the multivariable model. No specific risk factors were identified for the other valvular lesions.

Conclusion

AS appears to be an independent risk factor for all-cause mortality in ESKD patients on the transplant waitlist. Differences in mortality and risk factors associated with different types of VHD may suggest differing underlying pathophysiological mechanisms.
#2149 Kidney transplantation outcomes in lupus nephritis
Authors: Vigara Luis Alberto , Amaro José Manuel , Alonso Marta , Singh Arshdeep , Serrano Blanca , Villanego Florentino , Orellana Cristhian , Garcia Teresa , Mazuecos Auxiliadora
Published: May 2024

Background and Aims

Kidney transplantation (KT) is the renal replacement therapy of choice in patients with lupus nephritis (LN) who progress to end-stage renal disease (ESRD). The latest Spanish guidelines recommend the use of hydroxychloroquine after KT in these patients. Our study aims to analyze KT outcomes in patients with LN in our center.

Method

Retrospective cohort study, which included all KT with a diagnosis of LN who underwent KT between April 1982 and November 2023 at Puerta del Mar University Hospital (Spain). Each KT recipient with LN was matched with two controls from the same institution by age, sex and type of donor during the same period. We collected clinical and demographical characteristics, as well as immunosuppressive (IS) therapy after KT. We analyzed the death-censored graft survival and patient survival and compiled the causes of death and graft loss, comparing them with the control group. We documented LN recurrences, KT rejections, and incidence of CMV and BK infection.

Results

In this period, 2055 KTs were performed in our center, of which 39 had a diagnosis of LN (1.9%). Seventy eight controls were selected. The majority of KTs were women (89.7%) with a mean age of 44 years. Induction therapy was used in 85.2% of KT with Thymoglobulin (63%) or Basiliximab (27%). Maintenance IS therapy was based on tacrolimus (93.5%), cyclosporine (6.5%), mycophenolate (100%) and prednisone (100%). Only 4 patients (10.2%), the latest ones, received hydroxychloroquine after KT. Death-censored graft survival at 1 year (87.1% SLE vs. 88.5% Non-SLE), 5 years (74.9% SLE vs. 80.8% Non-SLE), and 10 years (65.6% SLE vs. 69.5% Non-SLE) and patient survival at 1 year (97.1% SLE vs. 100% Non-SLE), 5 years (93.7% SLE vs. 95.3% Non-SLE), and 10 years (93.7% SLE vs. 91.7% Non-SLE) were similar in both groups. No graft was lost because of recurrent LN. No significant differences were found neither in the causes of death nor between the causes of graft loss. The incidence of CMV and BK infection and KT rejection rates were similar in both groups.

Conclusion

KT is an excellent therapeutic alternative in LN with ESRD. Despite the low use of hydroxychloroquine in our series, no recurrence of LN was detected and the KT outcomes were similar to the control group.
#2913 The malignancy in transplant recipients exposed to immunosuppressive therapy prior kidney transplantation
Authors: Bloudickova Silvie Rajnochova , Novotna Anna , Modos Istvan
Published: May 2024

Background and Aims

Post-transplant malignancy has a negative effect on morbidity and mortality of kidney transplant recipients (KTR). Pre-transplant exposure to immunosuppression (PTI) might increase the risk for post-transplant malignancy.

Method

In a single-center, retrospective study of 3874 KTR transplanted between January 2000 and December 2019 with follow-up until 2020 the cancer incidence and outcome were compared between KTR with glomerulonephritis as primary kidney disease treated with PTI (GN group) and KTR with polycystic kidney disease as non-PTI-receiving controls (PKD group).

Results

In both groups, the average time from transplantation to cancer manifestation was similar (p=0.947) as well as from cancer diagnosis to death (p=0.856). Depending on cancer type we observed no difference between time of onset (p=0.351) but in incidence rate for death. The worst survival probability was in lung (0.041 years, 95% confidence interval (CI) [0.014-0.301]) and gastrointestinal (0.350 years, 95% CI [0.022-1.558]) cancer. The risk of cancer increased with age (hazard ratio (HR)=1.05, 95% CI [1.03, 1.07], p<0.001). After adjustment, GN increased the risk for post-transplant cancer (HR=1.72, 95% CI [1.12, 2.63], p=0.013). PTI exposure had adjusted increase of risk of cancer (HR=1.76, 95% CI [1.07, 2.89], p=0.027). Posttransplant malignancy was associated with higher risk of death (HR=8.29, 95% CI [5.46, 12.59], p<0.001) together with patient's age at the time of transplant surgery (HR=1.09, 95% CI [1.06, 1.11], p<0.001) while neither gender (p=0.633) nor PTI (=0.0639). Patient's adjusted probability of remaining cancer-free posttransplant had decreasing tendency over time.

Conclusion

Patients with GN exposed to PTI showed higher adjusted risk of development of post-transplant malignancy.