bluuebunny/crossref_metadata_2025 huggingface dataset:
#3285 EXTRACORPOREAL BLOOD PURIFICATION DURING OPEN HEART SURGERY WITH PROLONGED CPB: CYTOSORB 300 VS JAFRON HA330
Authors: Jabayeva Nilufar , Bekishev Bolat , Lesbekov Timur , Kaliyev Rymbay , Nurmykhametova Zhuldyz , LI Tatyana , Kuanyshbek Aidyn
Published: June 2023

Background and Aims

Cardiac surgery is maintained by various complications. Major contribution associated with cardiopulmonary bypass (CBP). Cardiac surgery with CPB provokes activation of the cascade mechanism of inflammation with releasing of cytokines and a systemic inflammatory response syndrome (SIRS). Activation of the contact system due to exposure of artificial surface of the bypass circuit to blood cells, endotoxemia, ischemia and reperfusion injury and surgical trauma are all potential triggers of inflammation following CPB. This inflammatory reaction may leads to the development of postoperative complications, including vasoplegia, cytokine storm, myocardial dysfunction, respiratory failure, acute kidney injury, coagulopathy bleeding, and multiple organ dysfunction syndrome (MODS).

 A number of different strategies, including new pharmacologic agents, CPB circuits and components, and surgical techniques, have been employed during the last few years in attempts to minimize the impact of SIRS on the outcome of cardiac surgical patients. However, the complex pathophysiology of this problem has not allowed, until now, the use of a single strategy.

 The aim of our study is assessment of early application of extracorporeal cytokine adsorbers to the inflammation system during open-heart surgery with prolonged cardiopulmonary bypass.

Method

This prospective randomized single-center controlled trial observed patients, who were assigned a planned open cardiac surgery with a duration of cardiopulmonary bypass (CPB) more than 120 minutes between January 2021 to January 2023. Patients were randomized into three groups: CytoSorb -300 group, HA 330 group and the control group. A simple 1:1:1 randomization method was applied. Cytokine hemadsorption was conducted intraoperatively. Two types of cytokine cartridges were applied CytoSorb 300 (Cytosorbents Europe GmbH). НА330 (Jafron Biomedical Co., Ltd. China). The inclusion criteria: age ≥18 years, informed consent to participate in the study, CPB more than 120 min. The exclusion criteria: Age less than 18 years; refusal to participate in the study.

Results

The data of the HA 330 (n = 22) and CytoSorb300 (n = 22) groups were compared with the data of the control group (n = 22). The primary results and details of the work are given in Tables 1-3.

Conclusion

Intraoperative hemadsorption may be beneficial for patients who underwent open-heart surgery with prolonged CPB. The early hemadsorption has positive impact to postoperative period after cardiac surgery and may reduce requirement of renal replacement therapy.
#3318 PHASE II DOSE-SELECTION, RANDOMISED DOUBLE-BLIND TRIAL OF THE ASI, BI 690517, ALONE AND IN COMBINATION WITH EMPA IN PEOPLE WITH CKD
Authors: Tuttle Katherine , Rossing Peter , Cronin Lisa , Hauske Sibylle , Hussain Joanna , de Zeeuw Dick , Heerspink Hiddo Lambers
Published: June 2023

Background and Aims

Elevated aldosterone levels are associated with chronic kidney disease (CKD) progression and adverse kidney and cardiovascular disease outcomes. Therapy with an angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) improves clinical outcomes, yet elevated aldosterone levels often persist. BI 690517 is a first-in-class, selective aldosterone synthase inhibitor (ASi) that may reduce deleterious mineralocorticoid receptor-dependent and -independent actions of aldosterone. Coadministration of BI 690517 with a sodium–glucose cotransporter-2 inhibitor could mitigate the risk of hyperkalaemia. This study is investigating the efficacy and safety of three doses of BI 690517, alone and in combination with empagliflozin (EMPA), on top of an ACEi or ARB, for treatment of CKD with or without type 2 diabetes.

Method

A randomised, double-blind, placebo-controlled, parallel-dose Phase II trial (NCT05182840) in adults with or without type 2 diabetes who had an estimated glomerular filtration rate (eGFR) ≥30 and <90 mL/min/1.73 m2, urine albumin:creatinine ratio (UACR) ≥200 and <5000 mg/g, and serum potassium ≤4.8 mmol/L on stable background therapy with an ACEi or ARB. After an 8-week run-in period to assigned background therapy (EMPA 10 mg or matched placebo randomised 1:1), participants were randomised 1:1:1:1 to BI 690517 (low, medium or high dose) or matched placebo for 14 weeks. Primary outcome was the change in UACR measured in a first morning void (UACRFMV) from baseline to Week 14. Secondary outcomes were the proportion of participants with ≥15 and 30% decreases in UACRFMV. Safety outcomes and changes in eGFR and serum potassium were also evaluated.

Results

Recruitment is complete, with 1719 participants from 168 sites in 29 countries screened. In total, 714 were randomised and entered the run-in period (last randomisation on 30 December 2022). The trial is currently ongoing; data on baseline characteristics will become available and shared.

Conclusion

This study will provide key data on the potential synergistic kidney-protective effects and safety of combination therapy with BI 690517 plus EMPA, as well as data on monotherapy, for CKD with or without type 2 diabetes. Findings will inform BI 690517 dose selection for further clinical trial development.
#3337 ACCURACY OF ESTIMATED GLOMERULAR FILTRATION RATE EQUATIONS IN PATIENTS WITH DISCORDANCES BETWEEN CREATININE AND CYSTATIN C-BASED ESTIMATIONS
Authors: Fu Edouard , Levey Andrew , Coresh Josef , Elinder Carl-Gustaf , Rotmans Joris , Dekker Friedo W , Paik Julie , Barany Franz Peter , Grams Morgan , Inker Lesley , Carrero Juan Jesus
Published: June 2023

Background and Aims

Cystatin C is recommended for use along with creatinine in estimating glomerular filtration rate (eGFR) when precise estimates are needed for clinical decision-making. Although eGFR based on both creatinine and cystatin (eGFRcr-cys) is the most accurate in research studies, it is uncertain as to whether this remains true in real-world settings, particularly when there are large discordances between eGFR based on creatinine (eGFRcr) and that based on cystatin C (eGFRcys).

Method

We included 6185 adults from the Stockholm Creatinine Measurements (SCREAM) project referred for plasma clearance of iohexol in Stockholm, Sweden, who had 9404 concurrent measurements of creatinine, cystatin C and iohexol clearance. The performance of eGFRcr, eGFRcys and eGFRcr-cys was assessed against mGFR with bias, P30 and correct classification of GFR strata. We stratified analyses within three categories: eGFRcys at least 20% lower than eGFRcr (eGFRcys < eGFRcr), eGFRcys within 20% of eGFRcr (eGFRcys ≈ eGFRcr) and eGFRcys at least 20% higher than eGFRcr (eGFRcys > eGFRcr). Bias was expressed as the median difference in estimated GFR minus mGFR, with negative biases indicating underestimation of mGFR. P30 described the percentage of individuals with eGFR within 30% of mGFR. Correct classification of GFR categories was defined as agreement of eGFR and mGFR categories using the KDIGO GFR categories (<15, 15-29, 30-44, 45-59, 60-89 and ≥90 ml/min/1.73 m2).

Results

eGFRcr and eGFRcys were similar in 4226 (45%) of samples, and there all three estimating equations displayed similar performance (Table 1). In contrast, eGFRcr-cys was much more accurate in cases of discordance. For example, when eGFRcys < eGFRcr (47% of samples), median biases were 15.0 (overestimation), −8.5 (underestimation) and 0.8 ml/min/1.73 m2 for eGFRcr, eGFRcys and eGFRcr-cys, respectively; P30 was 50%/73%/84%, respectively; and correct classification was 38%/45%/62%, respectively. When eGFRcys > eGFRcr (8% of samples), median biases were −4.5, 8.4, and 1.4 ml/min/1.73 m2. Findings were consistent among individuals with cardiovascular disease, heart failure, diabetes mellitus, liver disease and cancer (Figure 1).

Conclusion

When large discordances between eGFRcr and eGFRcys are found in clinical practice, eGFRcr-cys is more accurate than either eGFRcr or eGFRcys.
#3368 DIAGNOSTIC YIELD AND CLINICAL SIGNIFICANCE OF SYSTEMATIC CARDIAC SCREENING OF KIDNEY TRANSPLANT CANDIDATES USING CARDIAC COMPUTED TOMOGRAPHY
Authors: Nielsen Marie Bodilsen , Iversen Malene , Derai Amal , Dahl Jonathan , Jespersen Bente , Ivarsen Per , Winther Simon , Birn Henrik
Published: June 2023

Background and Aims

Cardiovascular screening of kidney transplant candidates is currently recommended, although the patient value is presently questioned. The prognostic ability is known, whereas systematic screening may have less recognized effects such as incidental findings, triggering of additional investigations, procedural complications, delay of transplantation and deselection of patients for kidney transplantation. To address this, we characterized the diagnostic yield and clinical implications of systematic screening for cardiovascular disease using cardiac computed tomography (CT) in asymptomatic kidney transplant candidates.

Method

In a single-centre, observational study, we included all potential kidney transplant candidates ≥ 40 years or with diabetes or on dialysis treatment ≥ 5 years, who were systematically referred to cardiac CT (a non-contrast enhanced CT scan and a coronary CT angiography) prior to kidney transplantation between March 2014 and September 2019 in North and Central Denmark Regions. Patient records were examined to obtain data on baseline characteristics, additional investigations, incidental findings, conference decisions.

Results

In total, 473 patients underwent cardiac CT. The screening programme led to additional cardiac investigations in 155 patients (33%) and 7% were revascularised. Thirty patients (6%) had significant incidental non-vascular findings on cardiac CT, but only 4 patients were changed in medical management based on these findings. Furthermore, no patients were rejected for transplantation based on the cardiac CT. In patients not yet on dialysis, the slope in eGFR decline did not change significantly after coronary CT angiography.

Conclusion

The clinical significance of the screening by cardiac CT was limited, and one third of patients had to go through additional investigations. Few patients were revascularised and no patients rejected for transplantation. No evidence of contrast-induced acceleration of kidney function decline was observed.
#3466 RISK FACTORS AND TRANSITIONAL PROBABILITY OF CLINICAL EVENTS IN KOREAN CKD PATIENTS USING THE MULTI-STATE MODEL: RESULTS FROM THE KNOW-CKD STUDY
Authors: Kim Ji Hye , Kim Jayoun , Kim Jinheum , Oh Kook-Hwan
Published: June 2023

Background and Aims

Compared to western countries, Korean CKD patients show distinctive differences in clinical outcomes including lower cardiovascular disease (CVD) and higher end-stage kidney disease (ESKD) events. This study analysed the risk factors, transition probability and cumulative hazards associated with clinical events using the multi-state model.

Method

This study included 1423 patients at CKD stages 1-4 from KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease. Multivariate multi-state model analysis was performed to investigate the risk factors, 10-year transition rate and cumulative hazard estimates for five clinical event status including ESKD, CVD, death, death after ESKD and death after CVD events.

Results

Among 1423 patients (age 54 [44-63] years), the overall prevalence of clinical events were the following: ESKD (22.6%), CVD (7.5%), death (3.3%), death after ESKD (3.6%) and death after CVD (1.2%). Different risk factors were associated with different clinical outcomes and in particular the risk factors associated with higher ESKD event were underlying CVD, diabetes, polycystic kidney disease, fibroblast growth factor-23 while hypertension, increased age and estimated glomerular filtration rates were associated with lower risks. The 10-year progression probability for each event status include the following: 0.23 for ESKD, 0.08 for CVD, 0.04 for death, 0.09 for death after ESKD and 0.01 for death after CVD (Figure 1). The 10-year cumulative hazard estimates for each event status were the following: ESKD [0.43, 95% CI (0.37-0.49)], CVD [0.12, (0.10-0.15)], death [0.05, (0.03-0.06)], death after ESKD [0.52, (0.20-0.84)] and death after CVD [0.27, (0.15-0.40)] (Figure 2).

Conclusion

Different risk factors were associated with varying clinical outcomes in Korean CKD patients. The 10-year progression probability was the highest in ESKD followed by death after ESKD events. Also, the 10-year cumulative hazard estimate was the highest for death after ESKD followed by ESKD events. These findings correlate with the distinctive clinical outcome features of Korean CKD patients.
#3479 RISK FACTORS OF DEATH OR CHRONIC RENAL REPLACEMENT THERAPY REQUIREMENTS IN PATIENTS WITH THROMBOTIC MICROANGIOPATHIES WITHOUT ADAMTS-13 DEFICIENCY
Authors: Rivera Miguel Giovanni Uriol , Mendoza Sonia Cleofe Jimenez , Mulet Aina Obrador , Mas Antonio , Parraga Leonor Periañez , Ojeda Felipe Ignacio , Rodenas Estela de Los Angeles Mas , Ballester Maria Carmen
Published: June 2023

Background and Aims

Thrombotic microangiopathy without severe ADAMTS-13 deficiency activity levels (TMA-13n) has a high mortality rate. Early recognition of patients at higher risk of dying or needing chronic renal replacement therapy (composite outcome: CO) has become of paramount importance since treatments such as eculizumab could ameliorate the prognosis of this group of patients. Plasmic score have been shown to predict severe ADAMTS-13 deficiency; however, its role as a prognostic factor of CO in TMA-13n is unknown.

Method

We retrospectively evaluate the potential factors associated with the risk of CO. Patients diagnosed with TMA-13n (defined by microangiopathic anaemia, thrombocytopenia, organ damage and ADAMTS-13 activity ≥ 10%) from January 2008 to May 2018 in our centre were included in the study.

Results

Forty-two consecutive patients were included. Mean (SD) age: 41(20) years. Twenty-five (60% were females. Mean (SD) ADAMTS-13 activity: 69 (24%). Twenty-six (62%) patients required dialysis at admission. Nineteen (45%) met CO (10 patients died). Higher age, lower lactate dehydrogenase, PLASMIC score values ≤ 4, neuroradiological damage and early eculizumab use [median (IQR): 4 (0-16) days from hospital admission: 5] were factors associated with the risk for developing CO. Only three factors were independently associated with CO mortality by logistic regression: early use of eculizumab (OR: 0.14; 95% CI: 0.02-0.94) and neuroradiological damage (OR: 6.67; 95% CI: 1.12-39.80) and PLASMIC score ≤ 4 (OR: 7.39; 95% CI: 1.18-46.11).

Conclusion

In TMA-13n patients, neuroradiological damage, low PLASMIC score and early use of eculizumab were independent prognostic factors of death and chronic renal replacement therapy requirements.
#3517 BRAIN MAGNETIC RESONANCE IMAGING AND COGNITIVE FUNCTION IN PATIENTS RECEIVING HEMODIALYSIS
Authors: Kuo Mei-Chuan , Wu Ping-Hsun , Lin Hsiu-Fen , Wu Tsai-Shan , Lin Yi-Ting
Published: June 2023

Background and Aims

Chronic kidney disease is high risk to adverse events including stroke, cardiovascular diseases and cognitive decline. Cognitive function was known to be linked to chronic kidney disease. The Fazefa's scale, which was used for assessing white matter hyperdensities(WMH), has been reported to associate with poor cognitive performance. We aim to investigate the associations between mini-mental status examination (MMSE), Montreal cognitive assessment (MoCA), cognitive abilities screening instrument (CASI) and Fazefa's scale in patients under hemodialysis (HD).

Method

The periventricular (PV) and deep white matter (DWM) lesions in brain MR images of 59 patients under dialysis for at least 90 days were graded by Fazefa's scale. Cognition function tests including MMSE, MoCA, and CASI were performed. Multivariable ordinal regression and logistic regression were used for identifying the associations between cognitive performance and Fazekas scale.

Results

Inverse associations were found between three cognitive function tests across the Fazekas scale of PV lesions (p = 0.037, 0.006 and 0.008 for MMSE, MoCA, and CASI, respectively), and higher scales were associated with lower cognitive function scores in trend; however, the association attenuated in the DWM group. In subdomains of CASI, significant differences were identified in five subdomains, including short-term memory, mental manipulation, abstract thinking, spatial construction, and name fluency; nevertheless, in DWM hyperdensities, only abstract thinking and short-term memory showed obvious correspondence.

Conclusion

Inverse correlation between the Fazefa's scale, predominantly in PV lesions, and cognition was detected in HD patients. The Fazefa's scale of PV lesions were associated with cognitive performance assessed by MMSE, MoCA and CASI, as well as with subdomains of CASI such as memory, language, and name fluency in HD patients.
#3537 RAPID DECLINE IN KIDNEY FUNCTION IS ASSOCIATED WITH HIGHER HEMOGLOBIN VARIABILITY IN CHRONIC KIDNEY DISEASE
Authors: Kim Hyo Jin , Kim Da Woon , Rhee Harin , Song Sang Heon , Seong Eun Young
Published: June 2023

Background and Aims

Hemoglobin decrease and anemia are common in chronic kidney disease (CKD). This study aimed to evaluate hemoglobin variability in patients with CKD according to decline in kidney function.

Method

We analyzed patients from the KoreaN cohort study for Outcome in patients With CKD (KNOW-CKD). The rates of renal function decline per year were determined using the slope of estimated glomerular filtration rate (eGFR) analyzed using a generalized linear mixed model. Rapid decline in kidney function was defined as a decline in the eGFR of >3 mL/min/1.73 m2/year. Hemoglobin value was measured at 0, 6, and 12 month and annually for up to 8 years. Hemoglobin variability was calculated by standard deviation. Higher hemoglobin variability was defined as a hemoglobin variability value greater than the median.

Results

Among 1895 patients, 736 patients (38.8%) were in the rapid kidney function decline group. In 1472 patients who were 1:1 propensity score-matched, the baseline eGFR was not significantly different between the non-rapid and rapid kidney function decline groups (48.2 ± 26.9 vs 46.9 ± 26.2 ml/min/1.73m2, P = 0.345). The use of iron supplements (P = 0.536) or erythropoiesis stimulating agents (P = 0.699) was similar in both groups. In multivariable logistic regression analysis, rapid decline in kidney function was significantly associated with higher hemoglobin variability (odds ratio [OR]: 1.81; 95% confidence interval [CI]: 1.43–2.28; P < 0.001). This association was prominent in the group without anemia at baseline (OR: 2.82; 95% CI: 1.99–4.01; P < 0.001).

Conclusion

Rapid decline in kidney function is associated with higher hemoglobin variability in patients with CKD. Attention should be paid to hemoglobin variability in patients with a rapid decline in kidney function.
#3597 MONOCLONAL GAMMOPATHY AS A RISK FACTOR FOR ARTERIOVENOUS FISTULA PRIMARY FAILURE
Authors: Almeida Catarina , Peixoto João , Martins Vítor , Nogueira Clara , Pereira Susana , Ventura Ana , Almeida Maria Clara
Published: June 2023

Background and Aims

Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis (HD) in most patients. However, postoperative complications such as primary failure (PF) with a reported incidence between 20-60% remain a major problem. Patients diagnosed with monoclonal gammopathy (MG) are at increased risk of thrombotic events, either due to the disease itself or the chemotherapy used for its treatment. The aim of this study was to evaluate whether the presence of MG was associated with primary AVF failure.

Method

We performed a retrospective single-center case-control study including 103 patients observed in our vascular access consultation for planning their first HD access. Demographic and clinical data were collected, such as the presence of diabetes, hypertension, cardiovascular disease and MG. Distal AVF was the access of choice when possible. Primary failure was defined as incapacity to use AVF for HD because of failure to mature or thrombosis. Univariate analysis was performed, and a logistic regression was applied to access predictors of PF. A p-value inferior to 0,05 indicated statistical significance.

Results

In total 14 (13.6%) patients had MG (11 multiple myeloma, 1 light-chain deposition disease, 1 proliferative glomerulonephritis with monoclonal immunoglobulin deposits and 1 amyloid light-chain amyloidosis). Regarding the AVF location, 13 patients constructed a constructed a distal AVF and 1 patient a proximal AVF. When compared to the group of 89 patients who did not have MG, there were no significance differences in sex, age, prevalence of diabetes and cardiovascular disease neither in AVF construction site. Arterial hypertension was more frequent in the group of patients without MG (93.2% versus 64.3%, p = 0.007). PF occurred in 57.1% (8/14) of patients with MG and in 27% (24/89) of those without MG (p = 0.032). In logistic regression, the presence of MG was the only predictor of primary AVF failure (OR 4.39 95% CI: 1.23-15.75).

Conclusion

In our study, we found that a patient with monoclonal gammopathy has a 4-fold increased risk for primary AVF failure comparing to the general chronic kidney disease patients. Therefore, a careful evaluation must be made when planning for AVF placement in these patients, balancing individual life's expectancies and monoclonal gammopathy prognosis.
#3610 EPIDEMIOLOGY AND CLINICAL CORRELATES OF POST-AKI PROTEINURIA IN CHINESE HOSPITALIZED ADULTS
Authors: Su Licong , LI Yanqin , Xu Ruqi , Gao Qi , Chen Ruixuan , Zhang Xiaodong , Luo Fan , Nie Sheng , Xin Xu
Published: June 2023

Background and Aims

Acute kidney injury (AKI) has been associated with increased risks of new-onset and worsening proteinuria. However, the epidemiologic data of post-AKI proteinuria was still lacking. This study aimed to determine the incidence, risk factors and clinical correlations of post-AKI proteinuria among hospitalized patients.

Method

This study conducted a multicenter cohort from Chinese Renal disease Data System (CRDS), including patients aged 18–100 years with hospital-acquired AKI (HA-AKI) hospitalized at 19 medical centers throughout China. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) creatine criteria. The results of both quantitative and qualitative urinary protein tests were used to determine post-AKI proteinuria. The primary outcome was the incidence of post-AKI proteinuria. Secondary outcomes included AKI recovery and kidney disease progression. Cox proportional hazard model with stepwise regression was used to determine the risk factors for post-AKI proteinuria. The associations of post-AKI proteinuria with kidney disease progression were analyzed by logistic regression models.

Results

Of 6,206 HA-AKI patients without proteinuria at baseline, 2,102 (33.9%) had new-onset proteinuria, whereas, of 5,137 HA-AKI with baseline proteinuria, 894 (17.4%) had worsening proteinuria after AKI (Table 1). Higher AKI stage and preexisting CKD diagnosis were risk factors for new-onset proteinuria and worsening proteinuria, whereas treatment with RAS inhibitors was associated with an 11% lower risk of incident proteinuria. About 60% and 75% of patients with post-AKI new-onset and worsening proteinuria, respectively, recovered within 3 months. Worsening proteinuria was associated with a lower incidence of AKI recovery and a higher risk of kidney disease progression (Table 2).

Conclusion

Post-AKI proteinuria is common and usually transient among hospitalized patients. The risk profiles for new-onset and worsening post-AKI proteinuria differed markedly. Worsening proteinuria after AKI was associated with adverse kidney outcomes, which emphasized the need for close monitoring of proteinuria after AKI.
#3629 EFFECTS OF METFORMIN IN KIDNEY TRANSPLANT RECIPIENTS TAKING TACROLIMUS WITH POST-TRANSPLANTATION DIABETES MELLITUS
Authors: Jung Jiyun , Lee Jaeyun , Park Jae Yoon , Kim Hyosang
Published: June 2023

Background and Aims

Tacrolimus is a pivotal maintenance immunosuppressive drug in kidney transplantation (KT). Although diabetogenic property of tacrolimus is still an inevitable concern, it can reduce the risk of acute rejection and improve graft survival compared to cyclosporine. Metformin, despite limited randomized controlled trial, has been found to be safe and effective in patients with post-transplantation diabetes mellitus (PTDM). We aimed to investigate the effect of metformin on acute rejection and graft survival in kidney transplant recipients taking tacrolimus.

Method

442 PTDM patients who were prescribed tacrolimus between 2000 and 2018 were collected. We conducted propensity score matching between the metformin and non-metformin group and evaluated the effects of metformin on the occurrence of T-cell mediated rejection (TCMR) and antibody-mediated rejection (ABMR), and graft survival with Cox proportional hazard model.

Results

During the average follow up of 8.7 years, 90 patients were diagnosed as PTDM within one year after KT. Among 442 patients taking tacrolimus, 297 patients were treated with metformin for the average of 4.4 years. After 1:1 matching, cumulative incidences of TCMR (p = 0.008) and graft failure (p = 0.005) in the metformin group was lower than the non-metformin group, while no significant difference was observed in ABMR. Metformin use was associated with a reduced risk of TCMR (HR 0.43, 95% CI 0.21-0.88, p = 0.021) and graft failure (HR 0.39, 95% CI 0.19-0.79, p = 0.009). There was no significant difference in t (tubulitis), i (interstitial inflammation), and v (endarteritis) scores of TCMR between the metformin and the non-metformin group.

Conclusion

Our study demonstrates that combination therapy with metformin and tacrolimus in kidney transplant recipients with PTDM is associated with a lower risk of acute rejection and graft failure.
#3718 WHAT ARE THE MOST COMMON HEADACHE PROBLEMS IN PATIENTS RECEIVING DIALYSIS?
Authors: Khalmukhamedov Javokhir
Published: June 2023

Background and Aims

Analysis of the clinical features of headache in patients on the program dialysis.

Method

The study included 40 males and 40 females with CKD on program dialysis for more than 12 months in 2022, each session lasting 4 hours. The exclusion criteria were patients receiving drugs that can cause headache and with any type of primary headache not associated with the HD procedure, diabetes mellitus, and others. Patients with DH were further compared with patients without DH in terms of BP and blood values such as urea, creatinine, Na+, K+.

Results

45% (n = 36) reported DH, which was common in women 60%. Differences between pre- and post-dialysis urea values in patients with DH were statistically significant (p<0.05). Patients with DH showed significantly higher mean SBP and DBP values before dialysis compared with patients without DH (systolic, P<0.001; diastolic, P<0.01). 80% of patients (n = 64) reported the quality of their headaches as being throbbing, whereas (20%, n = 6) had headaches with dull character. Headache intensity was moderate in 73% (n = 58) and severe in 27% (n = 22). The headache duration was reported to last less than 4 hours in 63% (n = 50) and 4 to 36 hours in 37% (n = 30), Table 2.

Conclusion

We determined that DH is a common type of headache among HD patients, female predominance, begins after several hours of therapy, with progressive intensity and throbbing character, which is not associated with a coexisting primary headache, but may be related to differences in urea levels and BP before and after treatment.
#3754 GLUCAGON-LIKE PEPTIDE TYPE 1 (AGLP1) AGONISTS AND THEIR INITIATION IN KIDNEY TRANSPLANTATION
Authors: López Rómulo Katsu Loayza , Morales Nancy Daniela Valencia , Rincón María Muñiz , Meneses Arianne Aiffil , Cubillo Beatriz Rodríguez , Díaz María Ángeles Moreno de la Higuera , Romero Natividad Calvo , Pérez-Flores Isabel , Fructuoso Ana Sanchez
Published: June 2023

Background and Aims

Glucagon-like peptide type 1 agonists (aGLP1) is an important therapy to consider for patients with type 2 diabetes (DM2), especially those with chronic disease with glomerular filtration rates (GFR) up to 15ml/min. They stimulate the production and secretion of insulin from pancreatic β cells, delay gastric emptying, promote weight loss, reduce appetite by acting on the central nervous system, and decrease glucagon secretion from pancreatic α cells.

OUTCOMES

To assess the serum, urinary and clinical effects of treatment with aGLP1 in kidney transplant (KT) patients.

Method

This is a retrospective observational study of 32 KT patients from our center who met criteria for treatment with aGLP1. In the sample, serum and urinary data are compared, six months before, after and at the time of intervention. The management of DM was evaluated with glycosylated hemoglobin (HbA1C) and basal glycemia levels, before and after the start of treatment. Changes in cardiovascular risk are studied with the number of heart failure episodes, hospital admissions, and changes in the left ventricular ejection fraction. In addition, other parameters such as: hemoglobin (Hb), iron, ferritin, calcium, phosphorus, magnesium, potassium, uric acid, proteinuria and clinical data such as body weight were assessed.

Results

The sample presented a mean GFR by CKD EPI of 43.2ml/min. A significant drop in body weight was observed, from 93.3kg to 89.2kg (p = 0.001). Regarding the control of DM, no statistically significant results were obtained, a decrease in glycemia figures from 136 to 133 g/dl and HbA1C was obtained, with a reduction of 2.7%, p = 0.404 and p = 0.105, respectively. Regarding the progression of kidney disease, a decrease in proteinuria from 0.33g/day to 0.25 g/day was obtained, as well as a 9.5% protein/creatinine ratio, p = 0.480 and p = 0.721, respectively. Serum creatinine levels unchanged, with a mean of 1.6 mg/dl.

Conclusion

The aGLP-1 are a valuable treatment option for initiation in KT patients with DM2, having significant efficacy in weight loss. More studies with large samples are required to assess its safety in this population highly affected by DM2 and with borderline GFR.
#3756 HISTOLOGICAL SUBTYPING OF INTERSTITIAL INFILTRATES AND CORRELATION WITH RENAL PROGNOSIS IN ANCA-ASSOCIATED GLOMERULONEPHRITIS
Authors: Chalkia Aglaia , Koutsianas Christos , Gakiopoulou Harikleia , Giannou Panagiota , Panagiotopoulos Alexandros , Kapota Athanasia , Thomas Konstantinos , Vasilopoulos Dimitrios , Petras Dimitrios
Published: June 2023

Background and Aims

Interstitial inflammatory infiltrates in ANCA associated glomerulonephritis (AAGN) are frequently observed but their correlation to clinicopathological parameters remains elusive.

Method

Retrospective study of 40 patients with newly diagnosed AAGN. Histological assessments using the presence of interstitial inflammatory cells were performed. Biopsy tissues were investigated by CD3, CD20, CD4, CD8, CD68+ (PG-M1), CD138 immunohistochemical staining. We assessed the presence of inflammatory cells in terms of clinical, histopathological parameters as well as the renal prognosis in a large follow-up period [47.87 months (12-216)].

Results

The interstitial infiltrates were consisted of lymphocytes (CD3 T cell> CD 20 B cell) at 83%, followed by plasma cells at 43%, neutrophils at 43%, macrophages at 40% and eosinophils at 20% of the biopsies. CD8 T cells dominated the interstitial area in focal and sclerotic class, while CD8 and CD4 tended to have different expression patterns in the interstitial area (figures 1,2). Interestingly, we reported that the presence of macrophages was correlated with higher chronicity index [interstitial fibrosis (39% vs 24%, p = 0.015) and creatinine at diagnosis (4.4 vs 2.6 mg/dL, p = 0.01)], while the presence of neutrophils, lymphocytes and eosinophils was correlated with higher activity index [cellular crescents (37% vs 6%, p<0.001, 26% vs 9%, p = 0.021, 49% vs 24%, p = 0.021, respectively)]. In terms of short-term renal prognosis, only the macrophages were correlated with worst renal function at the 1st year (Cre 3.2 vs 1.8 mg/dL, p = 0.042). Regarding the long-term renal prognosis, we validated as the most reliably predictive score, amongst Berden classification and Mayo Clinic chronicity score, the ANCA renal risk score (AUC 0.694, p = 0.05) and we found that the low-risk group tended to present less severe inflammation (p = 0.029), while the presence of macrophages and eosinophils was less often present (p = 0.03 and 0.05, respectively) compared to the higher risk groups.

Conclusion

Identifying the differences in histopathological subtypes, in yet underestimated active tubulointerstitial lesions, could be the first step toward improving our understanding of distinct pathophysiological mechanisms and anticipating to specific treatment regimens.
#3792 COVID-19 INFECTION AMONG HAEMODIALYSIS PATIENTS - EXPERIENCE FROM A HONG KONG COHORT
Authors: Chan Zi , Chan Ka Lok , Lam Chi Kwan , Law Way Ping , Pak Wai Lun Will , Wong Yick Hei , Wong Sunny Sze-Ho
Published: June 2023

Background and Aims

Many haemodialysis patients were infected by COVID-19 during a severe wave of outbreak due to the Omicron variant in Hong Kong in 2022, which had a great impact on the hospital haemodialysis service. To better prepare for future outbreaks, the patient characteristics and outcomes were examined in this study.

Method

This was a retrospective cohort study of all haemodialysis patients infected with COVID-19 from February to April 2022 in our hospital. The infection rates of in-centre and home haemodialysis were analysed. The mortality rate and the rate of moderate to severe disease (as defined by requiring 2L of oxygen or above) were recorded. Factors affecting mortality and disease severity were analysed using Fisher's exact test and independent t test.

Results

There were ninety-nine haemodialysis patients infected with COVID-19 during the study period (Table 1). The infection rate of in-centre haemodialysis patients was 98/232 (42.2%) compared with 1/19 (5.3%) of home haemodialysis patients. The mortality rate was 7.1%, and the rate of moderate to severe disease was 10.1%. A higher Charlson Comorbidity Index was identified as the only significant factor associated with mortality (6.7 ± 3.4 vs. 4.9 ± 2.0) and disease severity (6.5 ± 3.0 vs. 4.9 ± 2.0). Age, gender, presence of diabetes mellitus and vaccination status did not correlate with the outcome in this cohort.

Conclusion

Home haemodialysis had the benefit of a lower infection rate during the COVID-19 outbreak. A higher burden of comorbidities increased the risk of mortality and the severity of COVID-19. Close monitoring is warranted in these group of haemodialysis patients.
#3866 PREOPERATIVE ASSESSMENT FOR VASCULAR ACCESS: VASCULAR MAPPING AND HANDGRIP STRENGTH
Authors: Oliveira João , Da Silva Bernardo Marques , Fernandes João , Silva Hugo , Fortes Alice , Lopes José António , Gameiro Joana
Published: June 2023

Background and Aims

A reliable vascular access (VA) is required for patients receiving chronic hemodialysis (HD) treatment. VA choice is complex and must consider patient characteristics, predicted patency and risk of primary failure. Vascular mapping (VM) by duplex doppler ultrasonography (DUS) can aid in the planning of which VA to place. Peripheral artery disease (PAD) is associated with higher AVF failure and can be assessed by calculating the ankle-brachial index (ABI). Muscle strength is independently associated with mortality risk and can be evaluated with handgrip strength (HGS). This study aims to describe and analyze clinical anthropometric and laboratory characteristics of patients referred for vascular mapping prior to VA creation and to correlate VM data, HGS, and ABI.

Method

Prospective analysis of all adult patients with CKD who were referred for VM, at a tertiary center, between March 2021 and August 2021. No patients were excluded. Preoperative DUS by a single experienced nephrologist was carried out. HGS was measured using a Hand Dynamometer and PAD was defined as ABI<0.9. According to distal vasculature size (<2mm) sub-groups were analyzed.

Results

80 patients were included and 67.5% were male, mean age 65.7 ± 14.7 years and 51.3% were on Renal Replacement Therapy (RRT). Twelve (15%) participants had PAD. HGS was higher in dominant arm (20.5 ± 12.0 kg vs 18.8 ± 11.2 kg). Fifty-eight (72.5%) patients had vessels smaller than 2 mm in diameter. There were no significant differences between groups concerning demographic and comorbidities (diabetes, PAD). HGS was significantly higher in patients who had vessels greater than or equal to 2 mm in diameter (26.1 ± 15.5 kg vs 18.4 ± 9.7 kg, p = 0.010).

Conclusion

Greater HGS was associated with more developed distal vessels. Low HGS might be an indirect sign of poor vascular characteristics, which might help predict the outcomes of VA creation and maturation.
#3875 ASSESSING THE 3-YEAR RISK OF 40% EGFR DECLINE OR KIDNEY FAILURE IN THE US POPULATION
Authors: Tio Maria Clarissa , Zhu Xiaoqian , Obi Yoshitsugu , Yen Timothy Edmund , Hall Michael , Dossabhoy Neville , Shafi Tariq
Published: June 2023

Background and Aims

Prognostication of CKD progression currently relies exclusively on eGFR and albuminuria and do not consider comorbid conditions. Recently, the Chronic Kidney Disease Prognosis Consortium (CKD-PC) equation was developed to predict the 3-year risk of 40% eGFR decline or kidney failure in the general population [1]. The goal of our study was to assess the distribution of this risk in the US population.

Method

We included US adults from the 1999-2020 United States National Health and Nutrition Examination Survey (NHANES; N = 51,699). We calculated eGFR using the CKD-EPI 2021 equation and the 3-year risk of 40% eGFR decline or kidney failure using the CKD-PC equation (3-year risk). We categorized the 3-year risk as <1%, 1%-<5%, 5%-<10%, ≥10% and compared this with the current KDIGO 2012 CKD staging (eGFR<60 mL/min/1.73 m2 or albuminuria≥30 mg/g).

Results

Among 199.8 million US adults, mean age was 46±15 years, 51% were female, 11% were non-Hispanic Black persons, and mean BMI was 29±6 kg/m2. 71 million (36%) had hypertension and 26 million (13%) had diabetes. Table 1 shows the distribution of 3-year risk across stages of eGFR and albuminuria. Among 26 million US adults with CKD, the 3-year risks were <1% in 4 million (15%), 1% to <5% in 15 million (56%), 5 to <10% in 4 million (17%), and ≥10% in 3 million (11%). Importantly, among persons without CKD by current criteria, 1 million persons (0.58%) had a ≥5% 3-year risk, whereas only 331,840 (6%) persons with CKD 3a A1 had a ≥5% 3-year risk of CKD progression or kidney failure.

Conclusion

Calculating the 3-year risk of a 40% decline in eGFR or kidney failure can identify at-risk persons beyond the current eGFR and albuminuria staging. Our findings highlight the importance of factors besides eGFR and albuminuria in considering the risk for CKD progression.
#3939 EFFECTIVENESS OF IMATINIB FOR MCTO NEPHROPATHY
Authors: Usui Toshiaki , Morito Naoki , Ishibashi Shun , Gogoleva Natalia , Kanai Maho , Inoue Yuri , Fuseya Sayaka , Kuno Akihiro , Mizuno Seiya , Hamada Michito , Takahashi Satoru , Yamagata Kunihiro
Published: June 2023

Background and Aims

MAFB is a podocyte-specific transcription factor. Point mutations in the MAFB transactivation domain in humans result in multicentric carpometacarpal-tarsal osteolysis (MCTO). MCTO patients show focal segmental glomerulosclerosis (FSGS) due to podocyte damage, known as MCTO nephropathy. Effective treatment for MCTO has not been found. Imatinib is a tyrosine kinase inhibitor (TKI), which inhibits PI3K-Akt pathway, and is in long-term use for the treatment of chronic myeloid leukemia.

Method

In order to develop a new treatment for MCTO, we generated disease model mice using the CRISPR-Cas9 system. These animals have the same genetic mutation as human MCTO patients. Albuminuria was evaluated at 4 weeks of age, and renal histological analysis was performed at 26 weeks of age. In addition, RNA-seq for isolated glomeruli of 10-week-old MCTO mice and wild-type animal was performed for genetic and pathway analysis.

Results

MCTO mice exhibited growth retardation, and presented albuminuria from 4 weeks of age. Foot process effacement and FSGS-like renal histological changes were shown. Nephropathy symptoms were similar to that of human MCTO patients. Interestingly, the upregulated genes in RNA-seq analysis were a group of receptor genes associated with PI3K-Akt signaling, including lpar1 and csfr1.Transesophageal administration of imatinib, a PI3K-Akt pathway inhibitor, treatment for 5 consecutive weeks decreased albuminuria and ameliorated histological renal damage. RNA-seq of isolated glomeruli of MCTO mice after imatinib treatment showed decreased expression of genes associated with TGFβ-related signaling pathways compared to the non-treated group. Recently, enhanced PI3K-Akt signaling in podocytes has been linked to several renal diseases associated with podocyte injury. In addition, lpar1 inhibition in glomeruli is known to suppress TGFβ. Imatinib suppressed PI3K-Akt signaling, which is enhanced in podocytes of MCTO mice. This may have shown a podocyte-protective effect by suppressing fibrosis-related genes such as TGFβ. Imatinib is classified as a TKI, but frequency of podocyte toxicity is lower than other TKIs.

Conclusion

The podocyte injury mechanism of MCTO nephropathy is associated with enhanced PI3K-Akt signaling in podocytes. Imatinib inhibits this pathway and suppresses TGFβ. Imatinib may become a therapeutic agent for MCTO nephropathy.
#3959 ASSOCIATION BETWEEN AMORPHOUS CALCIUM-PHOSPHATE RATIOS IN CIRCULATING CALCIPROTEIN PARTICLES AND PROGNOSTIC BIOMARKERS IN HEMODIALYSIS PATIENTS
Authors: Nakamura Kimihiko , Isoyama Naohito , Shiraishi Koji , Kuro-O Makoto
Published: June 2023

Background and Aims

Calciprotein particles (CPPs) are circulating colloidal mineral-protein complexes containing crystalline and/or non-crystalline (amorphous) calcium-phosphate (CaPi). Serum CPP levels correlate with vascular stiffness and calcification in patients with chronic kidney disease (CKD). In vitro studies showed that CPPs containing crystalline CaPi were more arteriosclerogenic and inflammogenic than CPPs without containing crystalline CaPi. Thus, we hypothesized that not only the quantity but also the quality of CPPs (the phase of CaPi) might affect clinical outcomes.

Method

To test this hypothesis, we quantified amorphous CaPi ratio defined as the ratio of the amorphous CaPi amount to the total CaPi amount in serum CPPs from 183 hemodialysis patients and explored its possible correlation with serum parameters associated with prognosis of hemodialysis patients.

Results

Multivariate analysis revealed that the amorphous CaPi ratio correlated positively with hemoglobin and negatively with fibroblast growth factor-21 (FGF21), which remained significant after adjusting for the total CaPi amount. Because, low hemoglobin and high FGF21 were associated with increased mortality. Patients with low amorphous CaPi rate tended to have lower 2-year survival rates (p = 0.07).

Conclusion

This study suggests that low amorphous CaPi ratio in circulating CPPs is associated with poor prognosis in hemodialysis patients. Further investigation of the association with prognosis is warranted.
#4006 ADDING 6-MONTH PARAMETERS FOR THE PREDICTION OF RENAL PROGNOSIS IN ANCA-ASSOCIATED GLOMERULONEPHRITIS
Authors: Boud'hors Charlotte , Riou Jérémie , Fage Nicolas , Samoreau Clément , Desouche Alice , Gatault Philippe , Bridoux Frank , Martin Cécile , Wacrenier Samuel , Vinatier Emeline , Djema Assia , Henry Nicolas , Croué Anne , Piccoli Giorgina Barbara , Copin Marie-Christine , Augusto Jean-François , Brilland Benoit
Published: June 2023

Background and Aims

Antineutrophil-cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) with kidney involvement (AAV-GN) frequently evolves to end-stage kidney disease (ESKD) despite aggressive immunosuppressive treatment. Several risk scores have been used to assess renal prognosis. We aimed to determine whether kidney function and markers of AAV-GN activity after 6 months could improve the prediction of ESKD.

Method

This retrospective and observational study included adult patients with AAV-GN recruited from 6 French nephrology centers (including from the Maine-Anjou AAV registry). The primary outcome was kidney survival. Analyses were conducted in the whole population and in a sub-population that did not develop ESKD early in the course of the disease.

Results

241 patients were included in the whole cohort, with a median follow-up of 59 months. At diagnosis, Berden classification and Renal Risk Score (RRS) were not found better than kidney function (eGFR) alone, at predicting ESKD (C-index = 0.70, 0.79, 0.82, respectively). At 6 months, 20 patients reached ESKD. In the sub-population of 221 patients, 6 months eGFR outperformed Berden classification and RRS (C-index = 0.88, 0.62, 0.69, respectively) to predict ESKD. RRS performed better when it was updated with the eGFR at 6 months instead of the baseline eGFR. While 6-months proteinuria was associated with ESKD and improved ESKD prediction, hematuria and serological remission did not.

Conclusion

This work suggests the interest of the reassessment of the renal prognosis 6 months after AAV-GN diagnosis. Kidney function at this time remains the most reliable for predicting renal outcome. To improve the long-term prediction of ESKD, there may be a place for repeated kidney biopsy following induction treatment, in order to obtain a precise evaluation of disease activity, discuss the immunosuppressive treatment strategy and improve prognosis scores.
#4031 VALIDATION OF THE GRAMS MODEL AS A PROGNOSTIC TOOL IN ADVANCED CHRONIC KIDNEY DISEASE (ACKD)
Authors: Collado Alba Temprado , Blandino Marisa Vidal , Cosano Gema Montilla , Gómez Cristina Andrades , Prieto Francisco Javier Toro
Published: June 2023

Background and Aims

Elderly patients with Advanced Chronic Kidney Disease (ACKD) present high cardiovascular comorbidity and increased mortality risk. The CKD-G4+ risk calculator was developed by Grams specifically for the population with CKD G4 and analyzes the risk of requiring kidney replacement therapy (KRT), cardiovascular events and death. Ours aims was validation of the Grams score as a prognostic tool in patients with CKD G4 aged over 65 years old in our hospital area.

Method

Descriptive and retrospective non-randomized study of a cohort of patients older than 65 years with CKD G4 attending for the first time for consultation during 2016 and 2017. Follow-up for 4 years or first clinical event defined as need for KRT, eGFR < = 8 ml/min/1.72 m2 or death. Demographic and clinical data were collected for Grams model risk calculation (age, sex, CKD-EPI eGFR, urine albumin/creatinine ratio (CAC), systolic blood pressure (SBP), diabetes, smoking, cardiovascular history, non-fatal cardiovascular event (CHF, AMI, stroke) and death). SPSS statistical analysis.

Results

Of 663 patients who started follow-up in ACKD consultations in our hospital area between 2016 and 2017, 303 patients who met inclusion criteria were analyzed, 31 were excluded due to loss to follow-up. The clinical characteristics of the studied population are collected in Table 1. The results are collected in Table 2, they include predicted and observed incidences of death, KRT onset and cardiovascular events in 2 and 4 years from the first visit. Predictors used in this study included Grams calculator risk scores at 2 and 4 years (Grams-2 and Grams-4,respectively) for any KRT, cardiovascular events, and death.

Conclusion

In our cohort of patients with G4 ACKD older than 65 years old, the Grams score provides good discrimination to significantly predict the onset of KRT and cardiovascular events. The risk of death was moderately accurate and should be taken into account for care planning. Further external validation studies are required.