bluuebunny/crossref_metadata_2025 huggingface dataset:
#5172 ASSESSMENT OF THE RELATIONSHIP BETWEEN RENAL VOLUME, PAIN, DEPRESSION, AND ANXIETY IN PATIENTS WITH AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE
Authors: Demir Fatma Banu , Yildiz Abdulmecit
Published: June 2023

Background and Aims

The most prevalent hereditary kidney disease is autosomal dominant polycystic kidney disease (ADPKD). Multiple cysts developing in the kidneys are a defining feature of this systemic, progressive disease. The quality of life, psychosocial load, and discomfort associated with renal volume in people with ADPKD have not been well studied. This study aimed to examine the relationship between renal volume, psychological issues brought on by pain and the burden of the disease, and deteriorating sleep quality in ADPKD patients.

Method

The study included sixty patients who were being treated in the nephrology clinic at the Bursa Uludag University Faculty of Medicine Hospital. The ADPKD Pain and Discomfort Scale (ADPKD-PDS), Beck Depression Inventory Questionnaire, Beck Anxiety Scale, Pittsburgh Sleep Quality Scale (PSQI), and Insomnia Severity Index (ISI) were assessed. The computed tomography ellipsoid formula was used to determine the total kidney volume, and kidney volume adjusted for body size was obtained for each patient. The eGFR values computed using the CKD-EPI algorithm and the patients' baseline biochemical parameters were recorded.

Results

The mean age at diagnosis was 31±13, and the mean total kidney volume (TKV) was 1526.35±1595.90. Eight (13.3%) individuals were determined to have mild mood disorders, whereas seven (11.7%) patients had borderline clinical depression. Four individuals (6.7%) were found to have severe anxiety. It was shown that 25% of the patients had poor sleep quality. There was no statistically significant difference in kidney volume between the depression groups or between the pain and discomfort scale sub-dimensions. (Table-1)

Conclusion

It was shown that, in accordance with the literature, the severity of depression increased as the patients' sleep quality declined in ADPKD patients. However, there was no significant relationship between kidney volume and the degree of anxiety, depression, pain or discomfort.
#5179 LESS MICROBUBBLES ENTERED THE PATIENTS USING THE VENOUS CHAMBER EMBOLESS DURING HAEMODIALYSIS
Authors: Forsberg Ulf , Stegmayr Bernd , Jonsson Per
Published: June 2023

Background and Aims

The extracorporeal circuit (ECC) enables haemodialysis (HD) of patients. Air contamination of the blood appears when it passes the ECC and consequently microbubbles (MBs) enter to the patient [1]. MBs were verified at autopsy of HD patients and covered by clots as microemboli deposited within tissue from lungs, heart and brain [2]. A venous chamber is inserted in the ECC to reduce contamination of MBs. However, chambers in clinical use have limited capacity to eliminate MBs from entering the return bloodline. In an in vitro preclinical study the Emboless chamber showed best results compared to common models in clinical use; the best of those was for Fresenius 5008 [3]. We compared if the venous chamber Emboless differs in capacity to limit MB exposure from the original venous chamber of Fresenius 5008 (F5008).

Method

Thirty-eight HDs were performed as 19 paired HD sessions. Eleven patients were included. Venous chambers used were either F5008 or Emboless, in a randomised order. Dialyzers, blood-pump speed, HD or HDF and ultrafiltration was kept similar between the pairs. Microbubbles were measured at the ‘Inlet’ and ‘Outlet’ of the venous chamber with an ultrasound device adjusted for HD (hil mode, BCC200, GAMPT). Measurements were made for MBs between all sizes 20µm-500µm diameter. If HDF was performed the first 30min measured were by HD and the subsequent 30min by HDF (extended time if less than 1000 detected inlet MBs). The percentage of change in ‘Outlet’ versus ‘Inlet’ counts were compared (paired Wilcoxon test). Total reduction was -100% while increase of MBs (worsened) caused unlimited (+) percentage. If a diameter was without counts it was not included in the analysis.

Results

The median overall change of MBs were for F5008 −33% (mean −20 ±76%, N = 8544) and for Emboless -69% (mean -56 ±54%, N = 8402; and pairwise N = 8093, p<0.001). The Table 1 shows more results.

Conclusion

Less MBs and subsequently less microemboli entered to the patient using the EmbolessTM compared to using the Fresenius 5008 venous chamber during haemodialysis. Considering our previous autopsy studies2 this supports less tissue damage of the patients using EmbolessTM.
#5184 THE RELATIONSHIP OF BONE MINERAL DENSITY AND VITAMIN K IN RENAL TRANSPLANT PATIENTS
Authors: Şentürk Merve , Çatal Sıla , Menteşe İlay Berke , Kaya Burcu , Atas Dilek Barutcu , Tugcu Murat , Asicioglu Ebru , Arikan Izzet Hakki , Tuglular Z Serhan , Velioglu Arzu
Published: June 2023

Background and Aims

Kidney transplantation is the best treatment for end-stage renal disease (ESRD). Osteoporosis is a common health problem in kidney transplant recipients. It is known that the risk of bone fracture increases by 30% in the first 3 years after transplantation in kidney transplant recipients. Vitamin K is a cofactor involved in the activation of osteocalcin. This protein plays a role in bone mineralization. Currently, vitamin K cannot be measured directly from blood samples, and markers such as proteins induced in the absence of vitamin K (PIVKA-II) and undecarboxylated osteocalcin (ucOC) are used for indirect measurement of vitamin K. In our study, we aimed to investigate the relationship between vitamin K and osteoporosis by measuring serum PIVKA-II, ucOC and BMD in kidney transplant recipients.

Method

It was a cross-sectional observational study. Patients were selected from kidney transplant patients over 18 years old. A control group was formed from dialysis patients over the age of 18. For vitamin K levels, PIVKA-II and ucOC levels were measured in serum samples taken from patients. The relationship between vitamin K markers, bone mineral densitometry and the risk of major osteoporotic fracture calculated by FRAX in kidney transplant patients was evaluated.

Results

68 kidney transplant patients and 20 dialysis patients followed in our clinic were included in this study. As results, it was observed the increased risk of osteoporosis in postmenopausal women patients related with decreased serum vitamin K level (r = −0.520, p = 0.047). Of the transplant group, PIVKA-II and Lumbar I-IV BMD values were statistically significant (p = 0.034, r = -0.258). PIVKA-II was found to be a risk factor for low BMD by multiple linear regression analysis in the transplant group (beta coefficient = −0.195, p = 0.037).

Conclusion

In our study, it has been proven that as the vitamin K level decreases in kidney transplant patients, the vertebral bone mineral density decreases while the risk of osteoporosis increases. This result shows that vitamin K replacement may have positive effects on bone metabolism.
#5200 IMPACT OF MINERAL BONE PARAMETERS IN COGNITIVE IMPAIRMENT IN DIALYSIS PATIENTS
Authors: Rroji (Molla) Merita , Shehaj Larisa , Zeneli Nereida , Seferi Saimir
Published: June 2023

Background and Aims

Mineral bone disease and cognitive impairment are related diseases in the CKD population. Vascular calcification, a marker of MBD, may play a role in the early detection of cognitive decline. This study aims to identify a relationship between MBD biomarkers and cognitive function and to identify dialysis patients with a high risk of dementia.

Method

A total of 98 patients participated in this cross-sectional study, with 63 on hemodialysis and 35 on peritoneal dialysis. They underwent the Montreal Cognitive Assessment (MoCA) questionnaire, which categorized mild, moderate, severe, and severe based on scoring. PTH, P, Ca, ALP, and Mg serum concentrations and vascular calcification were measured as MBD biomarkers. The Adragaos score was applied to graphs of the hands and pelvis to evaluate vascular calcification.

Results

The mean MoCA score was 20,28±5.8. Based on the responses, it was concluded that 70% of HD patients had mild cognitive impairment, compared to 63% of PD patients. According to the descriptive data, patients whose underlying CKD was caused by nephroangisclerosis had the lowest MOCA test results compared to other groups (p<0.001). The degree of calcification was observed to have an adverse effect on cognitive performance in both groups (p<0.012); the high Adragaos score contributed to the decline in the MoCA test score. In multivariate logistic regression analysis, hypercalcemia and hypomagnesemia were independent variables for cognitive function impairment (p = 0.006 and p = 0.04, respectively). The serum concentration of PTH (p = 0.008) and ALP (p = 0.001) were found to be risk factors for HD patients during the evaluation of the MoCA test in each of the groups.

Conclusion

Vascular calcifications are considered a risk factor for cognitive impairment. In our study, vascular calcification risk is positively impacted by indicators such as hyperparathyroidism, hypercalcemia, high levels of ALP, and hypomagnesemia. Recently research has demonstrated the effectiveness of magnesium as a vascular calcification inhibitor. So, nephrologists should be more careful in monitoring levels of MBD biomarkers.
#5201 KIDNEY BIOPSY IN PATIENTS WITH TYPE 2 DIABETES: A SINGLE CENTER OBSERVATIONAL STUDY
Authors: Alexandre Inês , Curto Andreia , Henriques Fábio , Ramos Mariana , Brás Catarina , Santos Afonso , Campos Pedro , Domingos Fernando , Pires Ana
Published: June 2023

Background and Aims

Patients with type 2 diabetes mellitus (T2DM), may have various underlying causes contributing to kidney disease beyond diabetic nephropathy (DN). In such cases, a kidney biopsy (KB) can provide a definite diagnosis and allow for tailored treatment options. The aim of this study is to evaluate non diabetic kidney disease (NDKD) in T2DM patients and identify data to support KB indications.

Method

This is a retrospective observational study that included patients with T2DM who were submitted to a native KB between 2011 and 2022. We collected demographic, clinical and laboratory data at the date of biopsy. KB indication was considered in order to include the patients in the first encountered criteria defined sequentially as the presence of (1) nephrotic syndrome, (2) low or rapidly declining estimated glomerular filtration rate (eGFR), (3) nephrotic proteinuria and (4) hematuria.

Results

We analysed 72 patients with T2DM that were submitted to KB (Table 1). All except one patient had hypertension and 38 patients were screened for diabetic retinopathy (DR), which was present in 23 patients (60%). The criteria for KB was in most of the patients (59.7%) a low or rapidly declining eGFR, followed by nephrotic proteinuria (19.4%), nephrotic syndrome (16.7%) and hematuria (4.2%). KB showed 50% (n = 36) of patients with NDKD, 12.5% (n = 9) with NDKD and DKD and 37.5% (n = 27) with isolated NDKD. Among these patients, hypertensive nephrosclerosis (19.4%), focal segmental glomerulosclerosis (13.8%), acute interstitial nephritis (13.8%), membranous nephropathy (11.2%) and IgA nephropathy (5.6%), were the most prevalent diagnosis. Patients with DR had a higher prevalence of DKD with a positive predictive value (PPV) of 87%. On the other hand, in the absence of DR, DKD was only absent in 66.7%. Patients submitted to KB for the criteria of low or rapid declining eGFR had significantly more NDKD (p = 0.016). DKD with or without NDKD was found in patients with higher levels of albumin to creatinine ratio (p = 0.001) and HbA1c (p = 0.05).

Conclusion

Our data showed that NDKD is prevalent in T2DM patients, and given its potentially treatable nature, KB should be considered in T2DM patients, especially in those with low or rapid declining eGFR. DR supports the diagnosis of DKD (PPV of 87%), but alone is insufficient to exclude other causes. Patients with DKD had higher levels of albuminuria and HbA1c. Overall, more than half of the patients had hematuria, without any correlation with any group.
#5221 PULMONARY HYPERTENSION: AN IMPORTANT RISK FACTOR IN CARDIOVASCULAR MORTALITY IN DIALYSIS PATIENTS
Authors: Rroji (Molla) Merita , Zeneli Nereida , Cafka Majlinda , Seferi Saimir , Barbullushi Myftar
Published: June 2023

Background and Aims

It is widely known that chronic dialysis patients experience significantly higher cardiovascular (CV) death rates than the overall population. Among other CV risk factors, recent research has shown pulmonary hypertension (PH) as a consequence of chronic kidney disease and end-stage renal failure. The present study aimed to determine the risk factors that impact survival in chronic haemodialysis and peritoneal dialysis patients and to analyse the correlation of these factors with pulmonary hypertension.

Method

We studied 125 stable haemodialysis and peritoneal patients (females 40%, mean age 52.42 ±11.88 years) on RRT for more than three months with a two-year follow-up. Demographic information, clinical characteristics, blood tests, and a thorough echocardiographic evaluation were collected at the optimal dry weight. After conventional echocardiographic examination, a tissue Doppler echocardiographic (TDE) examination was performed to evaluate the global and regional myocardial systolic and diastolic functions and pulmonary hypertension. Systolic pulmonary artery pressure (sPAP) of 35 mmHg was used to define PH.

Results

The cardiovascular mortality rate was 15.5%. In ROC analysis for CV mortality, the area under the curve (AUC) for PH and CRP was found 0.8; for LVM-I, E/E', and PP, the AUC was 0.76, 0.75, 0.72, respectively, while the inverse relationship was found with MASa and TASa with AUC = 0.66 and 0.95 respectively. According to the echocardiographic findings, PH was found in 28% (35 patients) of all patients. The mean PH was 33.46±5.38 mmHg. The higher level of higher parathormone (PTH), C-reactive protein (CRP), and E/E’ average, the lower left ventricular ejection fraction (EF), the peak systolic velocity at the lateral mitral annulus (MASa), and the peak systolic velocity at the lateral tricuspid annulus (TASa) were found to be predictors of PH. Patients evaluated with PH have a significantly lower cardiovascular survival rate [Long Rank (Mantel-Cox) p = 0.0001.

Conclusion

Our research demonstrates that cardiovascular morbidity and death in dialysis patients are mainly attributed to pulmonary hypertension, inflammation, vascular stiffness, and left ventricular hypertrophy. PH is common among dialysis patients. Inflammation, CKD-MBD biomarkers linked to systolic and diastolic left and right ventricular dysfunction, and inflammation all influence it. These conditions are all connected. Cardiovascular imaging is simple to use, offers a favourable viewpoint in the early identification of cardiac abnormalities and quick treatment of this disease, and is thus strongly advised in the dialysis population.
#5256 REACTIVATION OF HEPATITIS B VIRUS IN KIDNEY TRANSPLANT RECIPIENTS WITH RESOLVED INFECTION: A SINGLE-CENTER EXPERIENCE
Authors: Pimenta Gonçalo , Weigert André , Conde Sara Querido
Published: June 2023

Background and Aims

Patients with end-stage renal disease (ESRD) frequently present serologic evidence of previous contact with hepatitis B virus (HBV). Although uncommon, HBV reactivation after kidney transplantation (KT) may cause serious complications and adverse outcomes in these patients. However, data regarding risk factors for reactivation are still scarce. This study aims to describe a cohort of patients with resolved HBV infection who showed reactivation of the virus after KT.

Method

Retrospective cohort study including patients with resolved HBV infection who underwent KT between August 2007 and December 2021. Resolved HBV infection was defined as being seronegative to HB surface antigen (HBsAg) and seropositive to HB core antibody (HBcAb), regardless of HB surface antibody (HBsAb) status. HBV reactivation after KT was defined as seropositivity to HBsAg or presence of HBV-DNA in the serum (viraemia). Preemptive prophylactic entecavir was not used. Demographic and clinical data were collected from the electronic records.

Results

A total of 104 patients (70.2% male) were included with a mean age of 52±10 years. Prior to KT, 93.3% were seropositive to HBsAb. Seropositivity to other viruses was present in 18 patients: human immunodeficiency virus (HIV) alone in 5 patients, hepatitis C virus (HCV) alone in 11 patients and coinfection in 2 patients. Deceased-donor KT was performed in 94.2% and only 9 patients had had a previous KT. Rituximab was used as induction immunosuppressive therapy in 13 patients. Median follow-up time after KT was 75 months (IQR 37-115). HBV reactivation occurred in 6 patients with a median time after KT of 5 months (IQR 3-11.5). At reactivation diagnosis, median HBsAg titer was 83.2 (IQR 34-784.5; reference range < 1) and median viral load was 6.7 × 106 copies/mL (IQR 0.4 × 106-378 × 106). Only one patient presented seropositivity to HBsAg without viraemia. Half of these patients were seropositive to HBsAb prior to KT and became seronegative at reactivation diagnosis. No liver enzyme elevation was registered at reactivation diagnosis. Donor HBcAb status, coinfection with HIV or HCV, Rituximab use and recipient HBsAb status were not associated to HBV reactivation after KT. Two patients with HBV reactivation lost kidney graft function and 2 died during follow-up.

Conclusion

Hepatitis B virus reactivation is possible after kidney transplantation and may pose major adjustments to the treatment, namely the immunosuppressive therapy. Careful monitoring of hepatitis B virus serology and viraemia could be particularly useful in early diagnosis and prompt approach to its reactivation. Larger and multi-center studies are warranted to identify specific risk factors in this population and prevent reactivation.
#5280 PREVALENCE OF POLYPHARMACY AND ASSOCIATED ADVERSE OUTCOMES IN KIDNEY TRANSPLANT RECIPIENTS
Authors: Kim Sungyeon , Kim Myung-Gyu , Koo Tai Yeon
Published: June 2023

Background and Aims

Polypharmacy (PP) continues to increase, and is associated with numerous adverse clinical outcomes and mortality. Although the burden of medication in kidney transplant recipients (KTRs) is well-known, PP has not been characterized in detail in the KTRs. The aim of this study was to assess the prevalence of PP among KTRs and the association between PP and clinical outcomes in the KTRs.

Method

A total of 1,080 KTRs from multicenter observational cohort study in Korea between 2012 and 2016 (KNOW-KT) were included in the study. PP was defined as the use of more than 10 medications per day.

Results

The PP prevalence at 1, 2, 3, 5, and 8 years after transplantation was 37.9%, 37.3%, 36.5%, 37.1% and 25.4%, respectively. The prevalence of diabetes, dyslipidemia and history of cardiovascular disease was significantly higher in PP group than in non-PP group (the use of fewer than 10 medications). The mean follow-up period was 6.9 years, and there were 69 graft failures, 63 new-onset cardiovascular diseases, and 36 deaths. When the effect of PP prescribed at 1-year post-transplant on clinical outcomes was analyzed, there was no difference in glomerular filtration rate between the non-PP and PP groups, and the hazard ratio of graft failure and death in the PP group was 1.07 (0.718 to 1.59) and 1.37 (0.71 to 2.64), respectively, compared to the non-PP group. However, multivariate analysis adjusted for classical risk factors showed that PP independently increased the risk of new cardiovascular disease (adjusted HR 1.78 (1.07-2.96)) after KT.

Conclusion

These results showed that PP is common in KTRs, and considering the adverse effects of PP on KT outcomes, physician's attention and efforts are needed to systematically manage and prevent inappropriate PP after KT. Long-term and large-scale research is needed to establish management guidelines for PP in the future.
#5293 THE IMPACT OF SEVERE DEPRESSION ON THE SURVIVAL OF OLDER PATIENTS WITH END-STAGE KIDNEY DISEASE
Authors: Kim Yoon-Ju , Jeon You-Hyun , Chung Yu-Kyung , Lim Jeong-Hoon , Jung hee-Yeon , Choi Ji-Young , Park Sun-Hee , Kim Chan Duck , Kim Yong-Lim , Cho Jang-Hee
Published: June 2023

Background and Aims

Incidence of depression increases in patients with end-stage kidney disease (ESKD). We evaluated the association between depression and mortality among older patients with ESKD, which has not been studied previously.

Method

This nationwide prospective cohort study included 487 patients with ESKD aged > 65 years, who were categorized into minimal, mild-to-moderate, and severe depression groups based on their Beck Depression Inventory-II (BDI-II) scores. BDI-II scores were separated into three symptom domains: affective, cognitive, and somatic depressive symptoms. The association between the depression groups and survival were analyzed using multivariate Cox proportional hazard regression models. Predisposing factors for high BDI-II scores were evaluated using logistic regression analysis. The associations among the three depressive-symptom domains and survival were also analyzed.

Results

The severe depression group showed a higher modified Charlson comorbidity index value and lower serum albumin, phosphate, and uric acid levels than the other depression groups. The Kaplan–Meier curve revealed a significantly lower survival in the severe depression group than in the minimal and mild-to-moderate depression groups (P = 0.011). Multivariate Cox regression analysis confirmed that severe depression was an independent risk factor for mortality in the study cohort [hazard ratio (HR), 1.39; 95% confidence interval (CI), 1.01–1.91; P = 0.041). BDI-II scores were associated with modified Charlson comorbidity index (P = 0.009) and serum albumin level (P = 0.004) in multivariate linear regression. Among the three depressive symptoms, higher somatic symptom scores were associated with increased mortality (HR, 2.45; 95% CI, 1.25–4.79; P = 0.009).

Conclusion

Among older patients with ESKD, severe depression increases mortality compared with minimal or mild-to-moderate depression. And patients with concomitant somatic symptoms require careful management of their comorbidities and nutritional status.
#5339 TRANSTHYRETIN AMYLOIDOSIS WITH BIOPSY PROVEN RENAL INVOLVEMENT
Authors: Careddu Andrea , Lalloni Stefania , Marchisio Martina , Morrone Marco , Rabajoli Gianluca , Ceruti Cecilia , Fenoglio Roberta , Sciascia Savino , Roccatello Dario
Published: June 2023

Background and Aims

Systemic amyloidosis is a cluster of disorders characterized by tissue deposition of amyloid (highly ordered fibrils composed of low molecular weight subunits of a variety of proteins). Transthyretin (TTR) amyloidosis (ATTR) is either an autosomal dominant inherited condition (ATTRv, where v stands for “variant”) or a non hereditary disease due to misfolding of wild-type TTR (ATTRwt). ATTR is likely underdiagnosed due to its clinical variability and lack of specific symptoms or biomarkers. The first aim of the study is to emphasise the importance of suspecting ATTR when facing certain clinical manifestations in association with renal impairment and urinary abnormalities. Furthermore, renal biopsy provides crucial information for a correct diagnosis and treatment approach.

Method

We report 5 cases of biopsy-proven renal ATTR deposition in patients presenting with mild to moderate renal impairment and mild urinary abnormalities. The TTR precursor has been confirmed in kidney specimens by immunohistochemistry. Genotyping was carried out in every patient.

Results

The presence of amyloid was found in all patients, with different distribution (#1-3 pericapsular and vascular; #2 vascular; #4 mesangial, vascular, in tubular basement membrane and in the interstitium of cortex and medulla; #5 pericapsular, vascular and interstitial). On genetic analysis three patients were wild-type (#1-2-5), one carried the c.424G>A (p.(Val142Ile)) mutation (#3) and the last one the Val30Met mutation (#4).

Conclusion

Suspicion of ATTR should be considered in patients with increase in serum creatinine, mild proteinuria and cardiac and peripheral nerve symptoms. This can be of utmost importance in elderly patients in whom a monoclonal gammopathy of undetermined significance can co-exist and drive a wrong diagnosis of primary light chain amyloidosis (AL), that could lead the clinician to undertake inappropriate treatments. Renal biopsy and genetic sequencing are both critical in diagnosing ATTR. Finally, we suggest distinguishing in the context of the ATTR deposition disease an ATTR nephropathy characterized by mesangial accumulation of amyloid, that impacts functional and urinary assessment, from isolated deposition in small vessels without specific clinical consequences, albeit critical for ATTR diagnosis.
#5340 ASSOCIATION BETWEEN PARABEN EXPOSURE AND INDEX OF CHRONIC KIDNEY DISEASE (CKD) AMONG THE GENERAL TAIWANESE POPULATION
Authors: Chang Jung-Wei , Chen Hsin-Chang , Chang Wan-Ting , Huang Po-Chin
Published: June 2023

Background and Aims

Exposure to consumer chemicals has been associated with chronic kidney disease (CKD) among humans, but their associations with estimated glomerular filtration rate (eGFR) are inconsistent. We aimed to assess the relationship between paraben exposure and renal function including the serum level of blood urea nitrogen (BUN), and the urinary levels of microalbumin, albumin, protein, and creatinine from a population-based study.

Method

We enrolled 310 participants (≥18 y, N = 240; <18 y, N = 70) who provided questionnaire information as well as blood and urine samples from a nationally representative study. Urinary parabens including methylparaben (MeP), ethylparaben (EtP), propylparaben (PrP), and butylparaben (BuP) are measured by liquid chromatography/ tandem mass spectrometry. From the renal function index, we measured the serum level of blood urea nitrogen (BUN), and the urinary levels of microalbumin, albumin, protein, and creatinine. We used multiple logistic regressions to evaluate the relationship between paraben exposure and renal function in our participants.

Results

Median levels of urinary MeP, EtP, PrP and BuP in adults were 399 [interquartile range (IQR) = 257–611], 38.3 (IQR = 25.9–62.2), 115 (IQR = 74.6–160) and 6.60 (IQR = 4.42–9.42) ng/mL, respectively, which were significantly lower than those in children/adolescents [MeP: 186 (IQR = 6.92–453); EtP: 13.0 (IQR = 0.05–38.1); 60.3 (IQR = 0.62–101); 2.65 (IQR = 0.73–7.84) ng/mL] (all P<0.001). Multivariate regression models adjusted for the same confounding factors confirmed the association of BUN and eGFR with urinary EtP (β: 0.137; 95% confidence interval [CI] = 0.003 to 0.272; β: -0.101; 95% CI = -0.202 to -0.001), which means BUN increased by 0.137 × 10−2 mg/dL, and eGFR decreased by 0.101 × 10−2 mL/min/1.73 m2 with a 1% increase in urinary EtP level, respectively. The multiple logistic regression showed that the adjusted odds ratio of the higher EtP and PrP level (median) in participants ≥18 y for lower eGFR (eGFR <90 mL/min/1.73 m2) was 1.86 and 1.87 times (95% CI = 1.03–3.34 and 1.04–3.37) than the lower group, respectively.

Conclusion

Our findings suggested that daily exposure to EtP were significantly positively associated with an increased risk of higher BUN and lower eGFR in Taiwanese ≥18 y. Comprehensive or mechanistic studies are required to elucidate these associations.
#5390 INTENSIFIED B CELL DEPLETION THERAPY IN ANCA-VASCULITIS WITH SEVERE RENAL IMPAIRMENT AS COMPARED TO CONVENTIONAL IMMUNOSUPPRESSION
Authors: Amore Giorgio , Marchisio Martina , Lalloni Stefania , Longo Roberta , Geraci Giovanni , Careddu Andrea , Fenoglio Roberta , Sciascia Savino , Roccatello Dario
Published: June 2023

Background and Aims

Rituximab (RTX) has shown to be an effective induction treatment for small-vessel vasculitides associated with antineutrophil cytoplasm antibodies (AAV) in both newly diagnosed and relapsing patients. However, the role of RTX in the management of the most severe cases of AAV remains to be fully elucidated. The aim of this study was to assess both safety and efficacy of an intensified B-cell depletion therapy (IBCDT) protocol, including RTX, cyclophosphamide (CYC), and methylprednisolone pulses without additional maintenance immunosuppressive therapy in a cohort of 15 AAV patients with the most severe features of AVV renal involvement (as <15 ml/min GFR and histological findings of paucimmune necrotizing glomerulonephritis with more than 50% crescents of non-sclerotic glomeruli at the renal biopsy).

Method

Results of the IBCDT regimen have been compared to those obtained in a control cohort of 10 patients with AAV treated with a conventional therapy regimen based on oral CYC and steroids followed by a prolonged maintenance therapy with azathioprine (AZA). Plasma exchange was equally employed in the study and the control group.

Results

Complete clinical remission (BVAS 0) was observed at 6 months in 14 of 15 patients treated with IBCDT (93%). All cases who achieved a complete clinical remission experienced a depletion of peripheral blood B cells at the end of therapy. Of the 10 dialysis dependent patients at onset, 6 subjects (60%) experienced a functional recovery allowing the suspension of dialysis treatment. When compared to the control group, no statistically significant difference was observed in patients treated with IBCDT in terms of overall survival, 6-month therapeutic response rate, and 6-, and 12-month functional renal recovery. The cumulative total dose of CYC in the case group was on average 1 g/patient while in the control group on average 8.5 g/patient (p = 0.00008).

Conclusion

Despite the retrospective design and relative limited sample size, IBCDT appeared to be safe and had the same efficacy profile when compared to the conventional therapy with CYC plus AZA in the management of the most severe patients with AAV. Additionally, this avoided the need of prolonged maintenance therapy for long, and limited the exposure to CYC with consequent reduced toxicity and drug-related side effect rates.
#5401 REAL-WORLD STUDY BETWEEN NEPHROTIC SYNDROME AND VENOUS THROMBOEMBOLISM
Authors: Shen Jie , Nie Sheng
Published: June 2023

Background and Aims

Nephrotic syndrome (NS) is a recognized risk factor of venous thromboembolism (VTE), however, there have been limited comprehensive epidemiologic data on VTE among NS patients. Therefore, we designed our study to assess the epidemiology and clinical correlates of VTE among hospitalized adults with NS in China.

Method

In this nationwide real-world study of 78,797 hospitalized patients with NS from 18 medical centers across China, VTE was identified by International Classification of Diseases, 10th revision (ICD-10) codes or imagological examinations during hospitalization. Multivariable logistic regression analysis was used to investigate the association between clinical variables and VTE through the R Programming software.

Results

A total of 1227 VTE cases were identified in the hospitalized NS population and the detection rate was 1.56%. Detection rate of VTE varied significantly in patients with different pathologic types of NS. Patients with membranous nephropathy (MN) had a significantly increased risk of VTE {Odds ratio [OR] 2.11 [95% confidence interval (CI) 1.12–4.36]}. While patients with focal segmental glomerulosclerosis (FSGS) did not show a significant high risk [OR 0.93 (95% CI 0.29–2.60)] compared with minimal change disease. We also found that male [OR 1.44 (95% CI 1.15–1.80)], age [OR 1.09 (95% CI 1.02–1.17)], anemia [OR 1.50 (95% CI 1.15–1.95)], cerebral bleeding [OR 3.23 (95% CI 1.69–6.16)], respiratory tract infection [OR 2.05 (95% CI 1.60–2.63)], respiratory failure [OR 2.24 (95% CI 1.42–3.53)], use of proton pump inhibitors (PPIs) [OR 2.19 (95% CI 1.54–3.12)], use of glucocorticoids [OR 1.46 (95% CI 1.03–2.09)] and immunosuppressants [OR 1.48 (95% CI 1.14–1.93), orthopedic operations [OR 1.97 (95% CI 1.22–3.18)], high-level D-dimer (>0.55 mg/L) [OR 2.62 (95% CI 1.87–3.65)] were associated with increased risk of VTE detection. While 24-hour urine protein quantification >10 g/d [OR 1.24 (95% CI 0.90–1.70)] showed little significant correlation with VTE. Hypertension [OR 0.74 (95% CI 0.58–0.95)] and the use of diuretics [OR 0.72 (95% CI 0.53–0.97)] were found to have a negative correlation with VTE detection.

Conclusion

The detection rate of VTE among patients with NS during hospitalization was 1.56%. Male, age, MN, anemia, cerebral bleeding, respiratory tract infection, respiratory failure, and use of PPIs, glucocorticoids and immunosuppressants, high D-dimer concentration were associated with VTE detection in NS. While 24-hour proteinuria did not show a significant association with VTE identification.
#5418 ASSOCIATION BETWEEN TRANSIENT AKI AND ALL-CAUSE MORTALITY IN PATIENTS WITH CRITICAL ILLNESS: AN INTERNATIONAL MULTICENTRE RETROSPECTIVE COHORT STUDY
Authors: Mingzhen Pang , Nie Sheng , Hou Fan Fan
Published: June 2023

Background and Aims

Transient acute kidney injury (AKI) is common in critically ill patients. However, the effect of transient AKI on prognosis of patients remains controversial. We aimed to investigate the association of transit AKI with all-cause mortality and kidney outcomes in critically ill patients.

Method

We conducted a multicentre retrospective cohort study involving 40168 critically ill patients from CRDS and 8657 patients from MIMIC-IV databases. Among them, 10147 patients were diagnosed as AKI according to KDIGO criteria and classified into transient (duration ≤48 h) and persistent (duration >48 h). The study outcomes included mortality in hospital, by day 30 and up to 1 year, and risk of progress to CKD. We determined the effect of transit AKI on mortality by Cox regression model adjusting for confounding variables and analyzed CKD incidence by Fine-Gray model adjusted for difference in biologically plausible confounders.

Results

AKI occurred in 20.8% of 48825 critically ill patients, of which 36.4% was classified into transient and 63.6% persistent. Compared with those without AKI, Patients with transit AKI were older, more often received diuretic therapy and sedative therapy, and higher Charlson comorbidity index. After adjusting confounders including AKI severity, transient AKI was independently associated with increased risk of in hospital death (HR 1.97, 95% CI 1.68 to 2.31), 30-day mortality (HR 1.73, 95% CI 1.51 to 1.98) and 1- year mortality (HR 1.31, 95% CI 1.19 to 1.44). Meanwhile, the risk of all-cause mortality increased with the duration of AKI in those with persistent patients (P<0.05). Among survivors without history of CKD, compared with patients without AKI, transient AKI was also associated with increased risk of incident CKD after discharge (HR 1.61, 95% CI 1.33 to 1.96).

Conclusion

Transient AKI was associated with increased risk of all-cause mortality and incident CKD in critically ill patients. Raising of awareness about transient AKI was required to urge clinician monitor such patients closer.
#5438 SERUM TUMOUR NECROSIS FACTOR RECEPTOR 1 PROTEIN ACCURATELY PREDICTS RAPID DISEASE PROGRESSION IN DIABETIC KIDNEY DISEASE
Authors: Bidin Mohammad Zulkarnain , Shah Anim MD , Stanslas Johnson , Ghani Fauzah Binti Abd , Goh Bak Leong , Lim Christopher Thiam Seong
Published: June 2023

Background and Aims

Diabetic kidney disease (DKD) has an enormous disease burden globally. In the area of personalised medicine, biomarker is set to play an important role in the management of DKD. Prior studies have reported the possible association of Tumour Necrosis Factor Receptor 1 (TNFR1), Dickkopf-3 (DKK3) and B cell lymphoma 3 (BCL-3) with the pathogenesis of DKD. However, there had been no prior studies that investigate the association of these biomarkers as prognostic markers for DKD disease progression. Hence, we aim to investigate the correlation of these biomarkers with renal progression among the diabetic population with and without kidney disease.

Method

A total of 156 subjects were recruited, which consisted of 64 control vs 92 patients with DKD. The principal outcomes of this study were rapid renal decline (doubling of serum creatinine, renal decline > 5ml/min/year and > 10 ml/min/year) and their association with serum TNFR1, BCL-3 and urine DKK3. A bivariate analysis was used to test the association of rapid renal decline, and sensitivity and specificity were used to test the validity of the level of the biomarkers with outcomes.

Results

The baseline parameters for both case and control: age 50.19±9.22 vs 60.35±13.73, serum albumin 38.97±2.07 vs 33.01±8.98g/l (p< 0.001), eGFR 117.96±31.94 vs 38.00±22.04 ml/min/ 1.73 m2 (p<0.001), serum creatinine 77.34±14.15 vs 247.45±148.09 µmol/L (p< 0.00), uPCI g/day 0.001±0.0 vs 4.268±5.29 (p< 0.001), HbA1c 7.83±1.88 vs 7.86±1.78 mmol/L (p = 0.942), sTNFR 11781.91±337.46 vs 4394.03±1960.06 pg/mL (p<0.001), uDKK3/creatinine 132.84±37.61 and 1243.63±495.27 pg/mg (p< 0.001), and sBCL3 194.60±32.81 vs 490.17±259.02 pg/mL(p<0.001). During the follow-up, there was a significant association of sTNFR1 with rapid renal decline > 5ml/min/year, > 10 ml/min/year and doubling of serum creatinine [p < 0.003 [IQR = 2891.50-4885.75], p< 0.009 [2891.50-4885.75], p< 0.001 [2891.50-4885.75] but not with uDKK3 and sBCL-3 (Table 1). Specificity and sensitivity analyses on the performance of the biomarkers versus outcomes were highly significant (Figure 1).

Conclusion

Despite TNFR1, BCL-3 and urine DKK3 were all elevated in our DKD patients, there was a strong association between incident serum TNFR1 level and the subsequent deterioration of renal function which has not been reported in the literature before. In addition, TNFR1 level had consistently picked up cases of DKD that would experience rapid renal progression, be it > 5ml/min/year, > 10 ml/min/year or doubling of serum creatinine. The correlation studies have shown TNFR1 level high sensitivity, and specificity of TNFR1 on the rapid renal function decline. Thus, we believe in our DKD population, targeting TNFR1 pathway could be a promising tool in monitoring and treating our DKD population.
#5439 HOME DIALYSIS DOES NOT HAVE THE MONOPOLY ON LOW COST
Authors: Laruelle Eric , Huré Fabrice , Dolley-Hitze Thibault , Vega Isabella Vanorio , Bayat Sahar , Couchoud Cécile
Published: June 2023

Background and Aims

End-stage kidney disease (ESKD) is a major challenge for health-care systems around the world because of its ever-rising rates and the ensuing rise in health-care costs. The objective of this study was to compare the cost of four dialysis modalities that enable patients to play a substantial role in their own care and have social and professional lives.

Method

We identified all patients in the national French ESKD REIN registry aged 18–65 years who received any dialysis treatment in 2015-2019, used stepwise indirect linkage with the national health database to analyse exhaustive hospital stays and outpatient health-care utilisation. Four treatment groups were defined: non-assisted haemodialysis in self-care units (scHD), non-assisted automated peritoneal dialysis (naAPD), daily home HD (dhHD), and non-hospital-based nocturnal extended hours HD (neHD).Total costs by categories and subcategories were aggregated monthly and by patient. Costs are expressed as their medians and interquartile ranges (Q1-Q3).

Results

Our study included 1932 patients with 39 966 patient treatment-months. The median monthly cost for one patient was €6154 (IQR €5088 – €7566) and varied from €5700 for naAPD to €7903 € for dhHD. Analysis by cost subcategories showed that the main cost came from dialysis fee payments —60% of the monthly cost. Hospitalization costs came next (11%). The costs of the different subcategories varied between dialysis modalities. During the study period, the hospitalization rate was 33 per 100 months at risk: 14 for inpatient admissions and 19 for day hospitalization. Day hospitalization was more frequent for patients with home treatment. Various compensatory allowances were paid to 49% of the patients.

Conclusion

Most of the cost difference variability related to payment methods for the different dialysis techniques. Our study shows that different care strategies could be offered to French dialysis patients. Underused techniques such as neHD might usefully be promoted as they do not involve any excess costs, at least compared with dhHD. Real cost analyses are however needed because some reimbursements are not adapted and deserve to be revised upwards.
#5456 TUBERCULOSIS IN DIALYSIS PATIENTS IN THE CENTRAL REGION OF MOROCCO: WHAT IS THE HEALTH-CARE DELAY?
Authors: Ghita Elbardai , Kabbali Nadia , Chouhani Basmat Amal , Houssaini Tarik Sqalli
Published: June 2023

Background and Aims

Due to the predominantly cellular immunosuppression, infections are frequent in chronic dialysis patients, in particular tuberculosis (TB). The main objective of our study is to evaluate tuberculosis healthcare delay in dialysis patients and to raise the diagnostic challenge in these patients.

Method

The study is retrospective and multicenter including tuberculosis cases of chronic dialysis patients either in hemodialysis (HD) or peritoneal dialysis (PD) in the central region of Morocco during a 10-year period between 2012 and 2021.

Results

We included 94 patients, five of whom were in PD, with a mean age of 50.79 ± 16.72 years, and a sex ratio of 0.67. The time between the initiation of dialysis and the onset of the clinical and biological presentation was 50.3 ± 67.12 months. The most frequent initial manifestations were an alteration of the general state (85.1%), a biological inflammatory syndrome (83%) or a prolonged fever (70.1%). Among our 94 patients, the diagnosis was confirmed with bacteriological evidence only in 18 cases (19.1%), by identification of Koch's Bacillus (BK) in 13 cases, by molecular biology test (GeneXpert; Cepheid, Inc., Sunnyvale, CA, USA) in five cases. The diagnosis of tuberculosis was presumptive in most cases (79 cases), i.e. 80.9%. Twenty-one patients underwent the interferon gamma release essay test (QuantiFERON; Qiagen, Hilden, Germany) which was positive in 14 patients. Thirty-four (36.1%) cases had a histological diagnosis. The remaining patients were offered a trial treatment. Tuberculosis localization was mostly extrapulmonary (75.5%): lymph node (23.4%), pleural (13.8%), peritoneal (13.8%), whereas it was pulmonary in 23 cases (24.5%). Most of our patients had a clear delay in management from symptom onset to initiation of anti-TB treatment 78.9% (time >21days) vs 21.1% (time ≤21days). The median time to management delay was 46.5 interquartile range (IQR) (28.5-90), the mean delay was 78.4 ± 87.9 (6-360). All patients were treated according to the RHZE/RH protocol (R: rifampicin, H: isoniazid Z: pyrazinamide and E: ethambutol), with a duration between six and 18 months. Side effects associated with anti-tuberculosis treatment were observed in half of the patients (51.1%). The evolution was favorable with remission and improvement of the general condition in 90% of cases. Two cases of resistance were noted in our series. The overall mortality was 7.7%.

Conclusion

We have confirmed a delay in the diagnosis and treatment of tuberculosis in chronic dialysis patients. This can be explained by the often atypical or incomplete clinical and paraclinical presentation and the extra-pulmonary localizations, making diagnosis difficult in this population whose prognosis remains poor. It is therefore necessary to establish a diagnostic approach that is adapted to the specificities of these high-risk patients within the framework of a national tuberculosis control program.
#5476 SEX DIFFERENCES IN INCIDENT KIDNEY FAILURE AND THE IMPACT OF RISK FACTORS IN A POPULATION STUDY
Authors: Sullivan Michael , Mata Nicole De La , Rosales Brenda , Wyld Melanie , Mark Patrick , Webster Angela , Lees Jennifer
Published: June 2023

Background and Aims

Chronic kidney disease (CKD) has different effects on women and men. Women are more likely to have CKD, but men are more likely to develop kidney failure requiring treatment (KFRT: dialysis or transplantation). Recent studies have highlighted sex differences in CKD progression and there is a need to determine if this relates to differential effects of risk factors.

Method

We used primary care data stored within the electronic health records repository Secure Anonymised Information Linkage Databank (SAIL) for adults with CKD stages G3/4 (estimated glomerular filtration rate (eGFR) 15-59 mL/min/1.73 m2) living in Wales, UK. We studied the relationship between sex and the development of kidney failure (KFRT or incident eGFR<15 mL/min/1.73 m2 for ≥3 months). Sex-specific rates of kidney failure were compared using an event plot with patients censored on the date of death. Cox proportional hazards models tested associations between sex and kidney failure, before and after adjustment for other known risk factors (age, baseline eGFR, smoking, social deprivation, diabetes mellitus and hypertension). Interactions between sex and risk factors were sought and interaction terms were retained if these were statistically significant (p-value<0.05). Models were then stratified by sex to compare the impact of risk factors in men and women.

Results

135,635 patients (median age 78 years, 57% female, median baseline eGFR 50 mL/min/1.73 m2) were followed up for a median of 6.8 years, representing a total of 782,237 patient years. 1.1% of women and 2.3% of men developed kidney failure. An unadjusted Cox model including both sexes showed a hazard ratio of 2.06 (95% confidence interval 1.89-2.24) for men. After adjustment for all risk factors and inclusion of interaction terms (between sex and baseline eGFR and sex and age), men were not more likely to develop kidney failure (aHR 0.91, 0.60-1.38) (Figure 1A). In sex-stratified models, kidney failure was most likely to develop in those with low baseline eGFR, younger age, current and ex-smokers, patients with diabetes mellitus and patients with hypertension (Figure 1B). Diabetes was a more important risk factor for kidney failure in women (aHR in women 1.73 (1.51-1.98) compared with men (aHR 1.56, 1.39-1.74). Hazard ratios for other risk factors were similar in men and women.

Conclusion

We found that sex differences in rates of kidney failure are related to a differential impact of risk factors – in particular diabetes – on CKD progression. These results warrant further investigation with a need to determine whether risk reduction strategies should be different in men and women with CKD, or whether current diagnosis, monitoring and treatment strategies are either applied differentially or have different benefit and harms by sex.