bluuebunny/crossref_metadata_2025 huggingface dataset:
#358 The efficacy and safety of ripertamab (SCT400) in the treatment of primary membranous nephropathy: a single center retrospective study
Authors: Yang Xiao , Tang Bihui
Published: May 2024

Background and Aims

Anti-CD20 monoclonal antibody is gaining increasing clinical acceptance in the treatment of primary membranous nephropathy (PMN). Ripertamab, a novel anti-CD20 monoclonal antibody developed in China, has been shown to be non-inferior to rituximab in efficacy and safety in patients with B-cell non Hodgkin's lymphoma. We aimed to identify the efficacy and safety of ripertamab in PMN retrospectively.

Method

The PMN patients who were diagnosed by renal biopsy and received ripertamab-based therapy between November 1 2022 and June 30 2023 were included. The inclusion criteria were: aged ≥ 18 years, and total B-lymphocyte ratio < 1% after using ripertamab. The exclusion criteria were: follow-up < 6 months, incomplete clinical data, secondary membranous nephropathy due to malignant tumor, systemic lupus erythematosus, hepatitis, etc. The primary outcome was clinical efficacy at 6 months after initial of treatment and secondary outcomes were clinical efficacy at 3 months, safety and the occurrence of adverse events. Complete remission (CR) was defined as urine protein/creatinine ratio (UPCR) < 300 mg/g or 24-hour urinary protein (UP) < 0.3 g, serum albumin >35 g, and stable renal function (eGFR with ≤50% reduction compared with baseline). Partial remission (PR) was defined as UPCR or UP with ≥ 50% reduction compared with baseline, serum albumin >30 g, and stable renal function. No response (NR) was defined as UPCR or UP with < 50% reduction compared with baseline.

Results

A total of 31 patients were included in this retrospective study. The baseline characteristics of the study population and ripertamab treatment responses were described in Table 1. At 6 months, 20 of 31 (64.6%) patients achieved CR (n = 10, 32.3%) or PR (n = 10, 32.3%) after ripertamab treatment (Table 2). Furthermore, 21 of 31 (67.7%) patients who were not given any immunosuppressive therapy before receiving ripertamab achieved CR or PR. Non-responders showed a higher level of proteinuria and a worse renal function at baseline than those of responders. All patients achieved complete B-cell depletion. No adverse events were observed in patients in this study.

Conclusion

Ripertamab can effectively induce remission of PMN and have a favorable safety profile.
#2582 For an efficient CKD healthcare delivery, knock on a door of the orthopaedist!
Authors: Tanaka Hiroshi
Published: May 2024

Background and Aims

CKD patients are usually free from symptoms. Some of them do not wish to visit a physician until the very moment when they suffer from symptoms. Those CKD patients might be found more often in certain medical specialities than others. In order to improve healthcare system efficacy, it is imperative to find the best field we should dig in.

Method

A hospital-wide survey was performed including all the patient visits according to specialities over 365 days in a general hospital. All the laboratory data including eGFR and haemoglobin were retrieved during the period. In case of multiple laboratory measurements in a single patient, a median value was used for analysis. Prevalence of cases with at least one measurement of eGFR during the period was 5 559/11 582 (48.0%) in medicine, 1 195/2 405 (49.7%) in surgery, 691/3 301 (20.9%) in orthopaedics, and 2 808/12 450 (22.5%) in “other” specialities. Here, “other” specialities are highly heterogeneous, including gynecology, dermatology, ophthalmology, otorhinolaryngology, anesthesiology and urology.

Results

A total of 29 738 patients were analyzed. The prevalence of eGFR less than 60 mL/min/1.73 m2 was highest in orthopaedics (353/691, 51.1% among patients with eGFR measurement), much more than those in medicine (2,341/5,559, 42.1%), in surgery (364/1 195, 30.5%) or in others (1 052/2 808, 37.4%). The prevalence of eGFR less than 45 mL/min/1.73 m2 was highest again in orthopaedics (133/691, 19.2%), much more than those in medicine (794/5 559, 14.3%), in surgery (80/1,195, 6.7%) or in others (339/2,808, 12.0%).

The prevalence of renal anemia, defined as eGFR <60 mL/min/1.73 m2 and haemoglobin <11 g/dL, was highest in orthopaedics (74/691, 10.7%), compared with those in medicine (302/5 559, 5.4%), in surgery (35/1 195, 2.9%) or in others (123/2 808, 4.5%).

Conclusion

For an efficient CKD healthcare delivery, the exceedingly high prevalence of CKD among patients visiting orthopaedics should not be missed.
#474 Features of the functional state of the kidney in patients with chronic heart failure with metabolic syndrome
Authors: Atahodjayeva Gulchehra , Aripova Djamilya
Published: May 2024

Background and Aims

to study the features of the functional state of the kidneys in patients with chronic heart failure with intermediate ejection fraction, depending on the representation of components of metabolic syndrome

Method

To achieve the objectives, 197 male patients with chronic heart failure (CHF) of ischemic origin II - III functional class (FC) according to NYHA, aged 40-60 years with a history of myocardial infarction of 6 months, were examined. up to 5 years. Depending on the presence of MS components, 3 groups of patients were identified: group I (n = 70), patients without MS (CHF FC II -38, CHF FC III - 32 patients); Group II (n = 67) patients with various combinations of dyslipidemia (HDL-C <1.03 mmol/l; LDL-C >3.0 mmol/l) with AO, hypertension and HTG (CHF FC II -35, CHF FC III - 32 patients); Group III (n = 60) patients with various combinations of dyslipoproteinemia (DLP) and type 2 diabetes mellitus (DM2) with AO, hypertension and HTG (CHF FC II -26, CHF FC III - 34 patients). When diagnosing MS, the International Diabetes Federation diagnostic criteria for MS were used (IDF, 2009). The study of the functional state of the kidneys included determination of the level of serum creatinine, urinary albumin excretion (determination of microalbuminuria (MAU ≥300 mg/l), glomerular filtration rate (GFR), calculated using the GFR EPI formula.

Results

when studying the parameters of the functional state of the kidneys in patients with CHF HFmrEF group 1, MAU was identified in 10 patients (35.7%) out of 28. Serum creatinine clearance in this group was 89.0 ± 8.49 μmol /l, and the GFR level was 88.58 ± 8.36 ml/min. With the development of MS in group II patients, 16 out of 28 patients had MAU (53.6%). A decrease in GFR was also found by 11.3% ( P < 0.05) with an increase in serum creatinine levels by 12.7% (P < 0.01), in contrast to the data from group I of the study. Further analysis of the parameters of renal function in group III of CHF HFmrEF revealed a significant decrease in GFR (by 23.0%; P < 0.01) with a significant increase in blood creatinine levels (by 21.8%; P < 0.01) in relation to the data Group I. Also in group III of patients with CHF and MS (+DM2 ), microalbuminuria was detected in 24 patients (85.7%) out of 32 . When comparing indicators of renal function between study groups II and III, there was a significant difference in the level of blood creatinine clearance and glomerular filtration rate by 11.3% and 10.1% (P < 0.05), respectively.

Conclusion

MS in patients with CHF HFmrEF aggravates renal dysfunction, which developed as one of the main pathogenetic links of CHF. Evidence of the importance of MS in the nature of the clinical manifestations of CHF HFmrEF is the established dependence of the identified disorders on the severity of MS.
#1230 Comparative analysis of vitamin D status between patients with advanced chronic kidney disease and those on dialysis
Authors: Delgado Carlos Marín , Rodríguez Desirée Luis , Navarro-González Juan F , Henriquez Fernando , del Peso Gilsanz Gloria , Prieto Francisco Javier Toro , Jesús Lloret María , Morales Orlando Siverio , Macia Manuel
Published: May 2024

Background and Aims

Decreased plasma concentration of 1,25-dihydroxy-vitamin D3 or calcitriol, the most active biological form of vitamin D3, in patients with advanced chronic kidney disease (ACKD) and on dialysis, is almost universal. In addition, 25-50% of these patients also have decreased levels of 25-hydroxy-vitamin D3 (calcidiol or calcifediol). The main cause of calcitriol deficiency is decreased hydroxylation in the kidney, both due to intrinsic renal damage and hyperphosphataemia. Calcifediol deficiency is directly related to decreased intake and sun exposure. We already know that this calcifediol deficiency is associated with ACKD, but we do not know if there are differences between ACKD patients and dialysis patients. The aim of this study is to analyse whether there are differences in calcifediol levels between ACKD and dialysis patients.

Method

An observational, analytical, ambispective, multicentre, analytical study was carried out with the participation of five Centres in Spain, under conditions of routine clinical practice. As study subjects, we included patients with ACKD and on haemodialysis from the University Hospitals of Virgen del Rocío, La Paz and Nuestra Señora de Candelaria, and the dialysis centres: Avericum, Quironsalud Tenerife. We selected demographic variables and also included serum levels of calcifediol, calcium, phosphorus and PTH; treatment with: phosphorus binders, erythropoietin synthesis analogues (ESA), ferrotherapy, calcimimetics, active vitamin D, native vitamin D. Data are organised and analysed with SPSS Statistics v22. In all analyses, the significance level is set for a P value < 0.05. Multivariate logistic regression analysis was also performed.

Results

A total of 161 patients were included. Both groups were homogeneous in the presence of diabetes, calcium levels and treatment with iron, native vitamin D, active vitamin D and calcimimetics. There were significant differences in sex, age, phosphorus levels, PTH, phosphate binders, ESA treatment. There are no significant differences in calcifediol levels or vitamin D status between the two comparison groups.

Conclusion

In our study, within a general context of hypovitaminosis D, patients with ACKD have a vitamin D status similar to dialysis patients.
#2545 Hemodialysis for salbutamol intoxication: patient case report
Authors: Jerman Alexander , Bezeljak Neva
Published: May 2024

Background and Aims

Salbutamol/albuterol is a moderately selective beta-2-adrenergic receptor agonist that acts as an airway smooth muscle relaxant. It is used to prevent and treat acute bronchospasm in various respiratory conditions. Due to its large volume of distribution, it is not considered dialysable.

Method

This is a clinical case report of inadvertent parenteral administration of salbutamol resulting in acute intoxication. Salvage renal replacement therapy was implemented due to the severity of the patient's clinical condition and the large amount of salbutamol administered. Multiple plasma measurements of salbutamol were taken during hemodialysis, allowing for a correlation to be made with the patient's clinical presentation.

Results

This case report presents an elderly patient with sepsis, Down syndrome, and liver cirrhosis. The patient required non-invasive ventilation due to worsening respiratory failure and was prescribed intravenous methylprednisolone. However, the patient inadvertently received 5mg of parenteral salbutamol (albuterol), which resulted in immediate severe arrhythmic tachycardia followed by hemodynamic collapse. After unsuccessful cardioversion and treatment with landiolol infusion, salvage hemodialysis was initiated to reduce the suspected highly elevated serum salbutamol levels. After 30 minutes, sinus rhythm with normocardia was observed. No rebound tachycardia was noted after the hemodialysis termination. However, due to severe septic shock, hypotension persisted, and vasoactive medications were adjusted. However, the measured levels of plasma salbutamol do not support the view that hemodialysis was the cause of the described improvement. The total amount of the drug cleared was exceedingly small, only 2.8% of the total dose. Data from the literature support our findings, even in the case of the life-threatening intoxication described.

Conclusion

The results confirm a large volume of distribution for salbutamol. The measured half-life time during hemodialysis (3.1 hours) is comparable to observed half-life times in therapeutic settings. The observed clinical benefit associated with dialysis appears to be fortuitous. This case report highlights the potential bias towards positive clinical outcomes and unproven therapies.
#1608 Use of intraperitoneal hydration by peritoneal dialysis fluid as a complementary palliative therapy in peritoneal dialysis patients
Authors: Zeiler Matthias , Fioravanti Gilda , Angelini Andrea , Silvestri Simona , Fioravanti Giuseppe , Santarelli Stefano
Published: May 2024

Background and Aims

End life care should manage pain, other distressing symptoms and guarantee sufficient hydration. It should also involve psychological, social and spiritual support. Palliative care in peritoneal dialysis is a new and growing clinical question. There are several open questions: Should we stop peritoneal dialysis totally? Should we go on with peritoneal dialysis in a reduced fashion? Hereby we report a new application of CAPD exchanges, intraperitoneal hydration, in end life care of peritoneal dialysis patients.

Method

In seven peritoneal dialysis patients (2 female, 3 male, age 82 to 90 years) affected by severe heart failure (3 patients), dementia (2 patients) and malnutrition-inflammation syndrome (2 patients) we applied the concept of intraperitoneal hydration as a complementary palliative care. Peritoneal dialysis was switched into a single CAPD bag therapy utilizing a glucose concentration of 1.36% or 1.5%. Depending on the clinical hydration status 1000 ml of dialysis fluid was loaded daily or each other day without prior drainage. None of the patients was on intravenous therapy.

Results

The duration of the intraperitoneal hydration therapy varied between 5 and 16 days. In two cases, therapy was performed initially at the hospital ward and hereafter at a nursing home, whereas in the latter 5 cases at the patient's home by family members. No case of hypervolemia occurred. The intraperitoneal hydration therapy was well accepted by the family members.

Conclusion

The transformation of peritoneal dialysis from ultrafiltration and depuration into hydration without depuration seems to be a feasible approach. This approach should be kept in mind in special conditions such as end life palliative care and hypohydration.
#1350 Finerenone in real-life clinical practice: first results from a pilot study
Authors: Piko Nejc , Petreski Tadej , Kukovič Aleksandra , Tramšek Nika Aleksandra Kravos , Hojs Radovan , Ekart Robert , Bevc Sebastjan
Published: May 2024

Background and Aims

Finerenone is a new drug for the treatment of patients with albuminuric diabetic kidney disease (DKD) that has protective cardiorenal effects, with hyperkalemia being a possible side effect. Our pilot study aimed to obtain real-life clinical data in patients with DKD treated with finerenone.

Method

So far, we have included 16 patients receiving finerenone due to albuminuric DKD (urine albumin/creatinine ratio - UACR > 3 g/mol in two random urine samples taken at least one week apart) (Fig. 1). Nine patients (56.3%) were prescribed 20 mg. Seven patients (43.7%) received 10 mg daily. The dose was then adjusted at follow-up visits according to guidelines. Arterial stiffness measurements were performed non-invasively (Sphygmocor Atcor Medical®, Australia). A 28-zone lung ultrasound (LUS) was performed, and the sum of B-lines was recorded (VscanTM GE HealthCare Technologies Inc.®). Bioimpedance was measured with BCM®, Fresenius Medical Care. SPSS version 29 was used for statistical analysis.

Results

10 patients (62.5%) were male. The most common comorbidities were arterial hypertension (n=15, 93.8%), hyperlipidemia (n=15, 93.8%) and ischemic heart disease (n=4, 25%). Baseline data are shown in Table 1. Paired samples T-test showed a slight increase in serum potassium after introducing finerenone, without clinically significant hyperkalemia or renal damage. UACR decreased, but the difference was insignificant (Table 2). Patients had no change in prescribed medications during this time, and no side effects of finerenone were noted.

Conclusion

Finerenone has the potential to lower UACR with little risk of hyperkalemia or acute kidney injury. The effects of the drug on lung extracellular water, body composition and arterial stiffness will be prospectively investigated in our research.
#1828 Venous thromboembolic events in ANCA associated vasculitis patients—data from Croatian referral center
Authors: Crnogorac Matija , Strizić Ana , Durlen Ivan , Djerek Lovorka , Galesic Kresimir , Horvatic Ivica
Published: May 2024

Background and Aims

Our aim was to investigate the prevalence of venous thromboembolic events (VTE) in a cohort of patients with ANCA-associated vasculitis (AAV) and define factors associated with the frequency of VTE considering there is data on high incidence of VTE in AAV patients. In these cohorts VTE occurred mostly early in the course of disease.

Method

This study included 114 consecutive AAV patients with biopsy proven renal involvement in the period from 2007-2017. Patients were classified according to clinical: granulomatosis with poliangitis (GPA), microscopic polingitis (MPA) and eosinophilic granulomatosis with poliangitis (EGPA) and serological phenotype: MPO-ANCA positive, PR3-ANCA positive, MPO- and PR3-ANCA positive and ANCA-negative. Ordinal variables were analysed using logistical regression test. Statistical analysis was done in MedCalc Statistical Software version 18.11.6 (MedCalc Software Bvba, Ostend, Belgium).

Results

In the cohort there were 64 (56%) females, mean age was 58 (IQR 16-84) with mean follow up time 46.9 months (IQR 1-127). Clinically there were 84 (73%) patients with MPA, 26 (22%) with GPA and 4 (5%) with EGPA. Serologically there were 20% PR3-ANCA, 54% MPO-ANCA, 8% MPO- and PR-3 ANCA positive patients and 18% ANCA-negative patients. Mean serum creatinine levels (SCr) was 380.9 μmol/l (IQR 65-1402). Mean BVAS (Brimingham vasculitis score) at the time of diagnosis of AAV was 17 (IQR 5-50) and at the time of VTE 0, 9 (0-22). Mean body weight was 71kg (IQR 48-110) and mean CRP was 84 mg/ml (IQR 0, 3-256). During the follow up 7 (6.14%) of the patients had VTE, with 4 having VTE in first month after the diagnosis and other two at month 14 and 19. Logistic regression showed the connection of weight (P = 0.0052) and CRP (0.0138) with VTE with odds ratio of 1,0829 for CRP (1.003-1.027) and 1.0150 for weight (1.0284-1.1736) respectively. There was no statistical significance for clinical or serological phenotype being associated with VTE nor for other clinical or laboratory parameters.

Conclusion

In our cohort patients with AAV were at risk of VTE, particularly within the first year following onset of disease. In this cohort the frequency of VTE did not depend of clinical or serological AAV phenotype, age or gender. Only CRP and body weight were associated significantly with VTE occurrence. Despite VTE rates in AAV patients, routine anticoagulation is not recommended in AAV patients, given the potential risk of bleeding complications. Prospective studies are needed to assess VTE risk stratification in AAV patients and to evaluate the both benefits and potential risks ratio of prophylactic anticoagulation in AAV patients.
#2899 Role of the Th17.1 cells in IgA nephropathy
Authors: Rivera Miguel Giovanni Uriol , Mulet Aina Obrador , Alvarez Angel Garcia , Lobon Ana Gomez , Daza Vanessa
Published: May 2024

Background and Aims

T helper (Th) cells play a crucial role in glomerulonephritis, including IgA nephropathy (IgAN). Recently identified Th17.1 cells, which are elevated in sarcoidosis, lupus, and Takayasu arteritis, express chemokine receptors CCR6 and CXCR3. These receptors are implicated in inflammatory cell infiltration and fibrosis in glomerulonephritis models. Notably, Th17.1 cells express MDR-1 (multidrug resistance protein) and the drug efflux protein p-glycoprotein, associated with corticosteroid resistance. However, the exact role of Th17.1 cells in IgAN remains unclear. Intriguingly, Th17.1 cells produce INF-γ and IL-17, cytokines implicated in IgAN pathogenesis.

Method

In this retrospective cross-sectional study, we examined circulating Th17.1 cells in 18 confirmed IgAN patients. Antibodies such as anti-CXCR3-FITC and anti-CCR6-PCy7 (Biolegend, U.S.A.) were used to stain Th subpopulations. We also used combinations of the following antibodies: anti-CD45-FITC, anti-CD4-PE, anti-CD8-ECD, anti-CD3-PCy5, anti-CD56-PCy5, anti-CD3-PCy7, anti-CD19-ECD, anti-CD127-FITC, anti-CD25-PCy5, and anti-CD4-PCy7 (Coulter Immunotech, France) to evaluate T, B, NK, and Treg cells. Multicolor flow cytometry was performed using a Navios cytometer, and data were analyzed using Kaluza software (Beckman Coulter, U.S.A.). Th effector subpopulations of CD4+ lymphocytes were identified based on chemokine receptor expression: Th17.1 (CXCR3+CCR6+). Th17.1 cells were quantified as a percentage of CD4+ lymphocytes. Th1, Th2, and Treg cells were also evaluated. We explored correlations between Th17.1 cell counts, estimated glomerular filtration rate (eGFR, mL/min/1.73 m²), and proteinuria (24-hour collection). Among the patients, 5 were classified as refractory (progressive eGFR decline > 5 mL/min/1.73 m² and 24-hour proteinuria > 1g despite steroid and immunosuppressant therapy).

Results

The study included 18 patients. The mean (95% CI) Th17.1 cell count was 20% (16-23), and the 24-hour proteinuria was 2.1g (1.4-2.7). A significant direct correlation was observed between Th17.1 cells and proteinuria (g/L, adjusted for 24 hours) (r = 0.50, P = 0.03). Refractory patients exhibited higher Th17.1 levels compared to others (25% [95% CI: 17-33] vs. 18% [95% CI: 14-21], P = 0.02) (Fig. 1). Patients with proteinuria < 0.5g/24 h had lower Th17.1 cell counts compared to those with higher proteinuria (16% [95% CI: 12-20] vs. 21% [95% CI: 17-25], P = 0.06. No correlation was found between eGFR, proteinuria, and Th1, Th2, Th17, or Treg cells.

Conclusion

These findings suggest that Th17.1 cells may contribute to the pathogenesis of IgAN and could potentially indicate the response to steroids or immunosuppressants in treatment. While the direct involvement of Th17.1 cells in kidney tissue remains unexplored, further investigation is warranted due to its therapeutic and prognostic implications.
#958 Development and Validation of a Score Estimating the Probability of obtaining a genetic diagnosis in adults with CKD of uncertain origin
Authors: Lombardi Yannis , Robert Thomas , Villie Patricia , Steichen Olivier , Mesnard Laurent
Published: May 2024

Background and Aims

We aim to derive and validate a score estimating the probability of identifying a variant explicative of the renal phenotype using Exome Sequencing (ES) in adults with CKD of uncertain origin.

Method

Participants: prospective cohort study including all consecutive index patients with a CKD from uncertain origin in three French nephrology units (metropolitan: Sorbonne University Hospitals, Paris, and Conception Hospital, Marseille; overseas: La Réunion University Hospital, Réunion island) who underwent ES between October 11th, 2017 and May 31st, 2023.

Outcome measure: identification of a causal variant using ES data, according to the American College of Medical Genetics and Genomics diagnostic criteria.

Candiate variables and feature engineering: raw data regarding patients’ phenotypes was prospectively entered in a collection form at the time of ES by the prescribing physician. Structured data (yes/no questions and lists) was mapped to Human Phenotype Ontology (HPO) terms. Unstructured data (free text) was manually translated into HPO terms by the same investigator (nephrologist), which was blinded to ES results. First, second and third-order ancestor HPO terms were included in the analysis.

Score's derivation: an optimal weighted average of multiple models (“ensemble model”) was specified, following guidelines provided in a recently published article (PMID:36905602).

Score's validation: internal validation using 10-fold cross validation, followed by internal-external validation (data from 2/3 centers was used to develop a model which was then tested using data from the remaining center; this process was repeated in each center).

Results

We included 2,490 patients, 560/2,490 (22.5%) of whom had a causal variant identified by ES. We collected 1,028 distinct HPO terms describing the patients’ phenotypes. The most common term was “Hypertension”, occurring in 2,079/2,490 (83.5%) patients.

In internal validation, the score showed accurate calibration and discrimination (area under the receiver operating characteristics curve (AUC): 0.71, 95% CI 0.68 to 0.73; index of precision accuracy (IPA): 0.11, 95% CI 0.09 to 0.13). Performances were moderately diminished in internal-external validation but remained satisfactory (Tenon: AUC 0.64, IPA 0.04; Marseille: AUC 0.67, IPA 0.04; La Réunion: 0.68, IPA 0.09).

Conclusion

We derived, internally and internally-externally validated a clinical score which accurately predicts the probability of obtaining a genetic diagnosis using Exome Sequencing. Feature engineering could further increase the score's performances. Automatic computation by clinicians using an interactive tool is achievable and could be of clinical utility, especially to guide resource allocation in case of a low pretest probability.
#745 Age and gender specific reference values for renal volume and association with risk factors for chronic kidney disease in a general population
Authors: Stracke Sylvia , Mensel Birger , Voelzke Henry , Lorbeer Roberto , Dabers Thomas
Published: May 2024

Background and Aims

Renal volume (RV) is associated with renal function and with a variety of cardiovascular risk factors (CVRF). We analyzed RV by magnetic resonance imaging (MRI) in a large population-based study (Study of Health in Pomerania; SHIP-TREND) and tested the influence of age, sex, smoking status, BSA, systolic and diastolic blood pressure, type 2 diabetes, HDL-C, LDL-C, estimated glomerular filtration rate (eGFR) and uric acid on RV.

Method

1,815 participants without kidney disease (930 women) aged 21-81 years were included in our study. Right and left RV with and without body surface area (BSA) indexation were compared among three age groups (22-39 years, 40-59 years, 60-81 years) by median and interquartile range and tested separately in women and men.

Results

eGFR, uric acid, right and left RV were higher in men compared to women (all p < 0.001). Left kidney were larger than right kidneys (both sexes). With age, RV showed a continuously decreasing trend in women and an upside down U-shape relation in men. In multivariable linear regression models, current smoking (β = 14.96, 95% CI 12.12; 17.79), BSA (β = 97.66, 95% CI 90.4; 104.93), diastolic blood pressure (β = 0.17, 95% CI 0.01; 0.32), and eGFR (β = 0.57, 95% CI 0.50; 0.65) were positively associated with both left and right renal volume whereas uric acid (β = −0.03, 95% CI −0.05; −0.01) showed an inverse association with RV. Interestingly, the same eGFR correlated with higher RV in men compared to women.

Conclusion

Reference values for RV are different for age-groups and sex. For any given age, female kidneys are smaller than male kidneys. RV associates positively with eGFR, but for any chosen eGFR, renal volume in females is lower compared to males. RV decreases with age, but in men, RV first increases in the age group 40-59 years before finally decreasing with a faster decline after 60 years. This may reflect hyperfiltration and glomerular hypertrophy associated with the presence of CVRF.
#2160 Ketosis moderates the effect on kidney volume in dietary interventions for ADPKD—more insights on the KETO ADPKD trial
Authors: Cukoski Sadrija , Kühn Adrian , Lindemann Christoph Heinrich , Arjune Sita , Meyer Franziska , Schömig Thomas , Große-Hokamp Nils , Schmidt Johannes , Antczak Philipp , Weimbs Thomas , Grundmann Franziska , Mueller Roman-Ulrich
Published: May 2024

Background and Aims

Autosomal-dominant polycystic kidney disease (ADPKD) is the most common monogenic disease leading to kidney failure. Tolvaptan, the only approved targeted treatment strategy, comes with adverse events such as hepatotoxicity and massive polyuria, limiting its use. Novel treatment strategies are urgently needed. Cyst-lining epithelial cells are glucose-dependent and metabolically inflexible. Evidence from polycystic kidney disease (PKD) animal models show that ketogenic dietary interventions (KDI) can ameliorate cyst growth and loss of kidney function. To enable clinical translation of these findings, our group set up a series of trials—from small cohorts and proof of principle studies to our most recent trial KETO-ADPKD, showing that KDIs are feasible and can work as a treatment for ADPKD [1]. This has received a lot of attention. With this post-hoc analyses, we aim to share further in-depth analyses of the factors moderating the effects we see on ADPKD.

Method

KETO-ADPKD is an exploratory randomized and controlled clinical trial (NCT04680780). Sixty-six patients were randomized to 3 months dietary intervention (ketogenic diet [KD] or water fasting [WF]) or the control group. Here, we explore correlations between biochemical readout parameters of ketosis and markers of disease progression.

Results

The KD group shows a promising, yet statistically not significant decline in height-adjusted total kidney volume (htTKV). Patients reaching high biochemical thresholds of ketosis however significantly reduced their htTKV in comparison with the control group (KD −16.3 ml/m, CG + 14.8 ml/m, p-value 0.049). This becomes even clearer when higher thresholds for adherence are administered: In a smaller group requiring not only beta-hydroxybutyrate (BHB) levels ≥0.5 mmol/l but breath acetone ≥5 ppm on 75% of daily measurements, htTKV could be reduced by −17.6 ml/m (KD) vs +14.8 ml/m (CG), p-value 0.026. The significant reduction of liver volume upon KD is not influenced by the level of ketosis. Beneficial effects on estimated glomerular filtration rate (eGFR) can be equally observed in all subsets. Weight loss ≥5% was nor associated with a more significant loss of kidney nor liver volume.

Conclusion

Subgroup analyses of the KETO-ADPKD trial show stronger impact of the dietary intervention with higher ketone body levels. In particular, ketogenesis as a marker of metabolic reprogramming strongly moderates the effects we see on kidney volume. The assessment of renal cyst fractions could further enlighten the effects on cyst burden. This is in line with preclinical data showing that ketosis rather than caloric intake is responsible for the amelioration of disease progression [2].
#Discreetshipping: Selling E-cigarettes on TikTok
Authors: Dobbs Page D , Schisler Eric D , McCormick Charlotte
Published: May 2024

Introduction

Youth and young adult use of e-cigarette products continues to remain high despite regulatory approaches to reduce youth access. This study sought to examine TikTok content regarding the sale and distribution of e-cigarettes.

Aims and Methods

TikTok videos (n = 475) and metadata posted between June 2022 and August 2023 were scraped using a TikTok application programming interface and popular hashtags used to sell vaping products (ie, #discreetshipping [40.8 million], #puffbundle [14.8 million], #hiddennic [1.0 million]). After watching the 25 most viewed videos (39 600–868 800 views), a codebook was developed. All metadata were annotated using 11 unique codes: Small business, brand, cannabis, bundled, hidden, fake, international sales, no ID, order via Instagram, order via another method, and cost.

Results

Overall, 367 videos (with an average of 2017 likes) were deemed relevant. Videos advertised popular vaping brands (50.4%) that included cannabis products (45%). Products were described as bundled (28.6%), hidden (8.7%), and able to be shipped internationally (6%) without age verification (45.2%). Some videos (8.2%) evaded algorithms’ detection of illegal activity by describing the post as “Fake.” Customers were directed to other social media platforms (most often Instagram, 57.5%) and/or other websites/links (58.3%) to purchase products; 22.1% advertised discounts, free shipping, or low costs (ranging from $25–$35).

Conclusions

Social media platforms, such as TikTok and Instagram, are being used to circumvent e-cigarette regulatory policies. Regulatory agencies should expand enforcement strategies to include social media platforms where users are illegally selling and distributing e-cigarettes internationally to young audiences.

Implications

TikTok users across the globe are violating local, state, and federal laws by selling e-cigarettes concealed inside other products or bundled in packages that avoid detection. TikTok videos posted by self-proclaimed small business owners advertise discreet shipping practices that evade age verification in order to sell nicotine and cannabis bundles worldwide. Accounts used phrases describing the post to be “fake” to avoid detection by algorithms or TikTok administrators. E-cigarette regulatory agencies can partner with social media platforms to close regulatory gaps.
Demographic Characteristics, Perinatal Smoking Patterns, and Risk for Neonatal Health Complications Among Pregnant Smokers in the United States Who Begin Using Electronic Cigarettes During Pregnancy: A Descriptive Study Using Population-Based Surveillance Data
Authors: Nian Hui , Odland Rachel , Mindlin Samantha , Ammar Lin , Tindle Hilary , Miller Angela M , Ryckman Kelli K , Xie Ethan , Hartert Tina V , Snyder Brittney M , Brunwasser Steven M , Wu Pingsheng
Published: May 2024

Introduction

Health agencies have called for research evaluating e-cigarette (EC) use in supporting prenatal smoking cessation. This study aimed to describe (1) the characteristics of smokers who begin using electronic cigarettes (ECs) during pregnancy, (2) how frequently smokers reduce or eliminate pre- and post-natal combustible cigarette (CC) use, and (3) the risk for neonatal health complications among smokers who initiate ECs during pregnancy.

Aims and Methods

Pregnant women using CCs exclusively during prepregnancy, who participated in a U.S. surveillance study, were classified by their reported late-pregnancy smoking behavior as CC-exclusive users, EC initiators, or quitters. EC initiators were further subclassified as dual users (used both ECs and CCs) or EC replacers (used ECs exclusively).

Results

Of 29 505 pregnant smokers, 1.5% reported using ECs during the last three pregnancy months. Among them, 29.7% became EC-exclusive users. EC initiators were disproportionately non-Hispanic White. Relative to quitters, EC initiators had lower income, were less likely to be married, have intended pregnancies, receive first-trimester prenatal care, and participate in a federal assistance program. Compared to CC-exclusive users, EC initiators overall, and dual users specifically, were more likely to reduce pre- and post-natal CC usage relative to prepregnancy levels. EC initiators’ risk for neonatal health complications fell between quitters and CC-exclusive users, though the differences were not statistically significant.

Conclusions

Although EC initiators reduced CC use more than CC-exclusive users, only 29.7% reported complete CC cessation, and there was insufficient evidence of reduction in neonatal health complications relative to CC-exclusive users. Currently, ECs should not be considered a viable gestational smoking cessation strategy.

Implications

Health agencies have identified a critical need for research evaluating the use of e-cigarettes in supporting prenatal smoking cessation. Using the U.S. Pregnancy Risk Assessment Monitoring System surveillance study data, we provide real-world evidence that prenatal e-cigarette initiation as a smoking cessation tool is used infrequently among pregnant CCs smokers. Most using e-cigarettes in the last 3 months of pregnancy also used CCs.
A Pilot Study to Evaluate the Use of Automated Nicotine Metabolite Ratio Reporting Within Primary Care as an Implementation Strategy to Increase the Use of Tobacco Treatments
Authors: Schnoll Robert , Leone Frank T , Bauer Anna-Marika , Wileyto E Paul , Wollack Colin , Stevens Nathaniel , Blumenthal Daniel , Foster Casey , Koita Fodie , Villasenor Julia , Jenssen Brian P
Published: May 2024

Introduction

Concerns about safety and effectiveness of tobacco treatments reduce their use. We explored integrating the nicotine metabolite ratio (NMR), and messaging about its potential for improving safety and effectiveness, as a strategy to increase the use of tobacco treatments within primary care.

Aims and Methods

Through a prospective cohort design, we explored the effects of integrating NMR testing within primary care on the provision of tobacco treatment; 65 patients completed assessments including NMR before a clinic visit. At the clinic visit, patients’ clinicians received an electronic health record (EHR) alert about the patient’s NMR and personalized treatment recommendations to improve effectiveness and safety. Being asked about smoking and advised to quit, and a referral for tobacco treatment or medication prescription, were assessed within 30 days of the appointment and were compared to a usual care cohort (N = 85).

Results

The NMR and usual care cohorts reported similar rates of being asked about smoking (92.3% vs. 92.9%, p = 1.0), being advised to quit (72.3% vs. 74.1%, p = .85), being referred for tobacco treatment (23.1% vs. 36.5%, p = .11), and receiving tobacco use medications (20% vs. 27.1%, p = .34). In the NMR cohort, fast versus slow metabolizers were more likely to receive medication (26% vs. 0%, p = .003) and all patients who received varenicline (n = 8) were fast metabolizers.

Conclusions

NMR results and treatment recommendations did not increase tobacco treatment rates in primary care, although it may increase treatment rates and the use of varenicline for fast metabolizers. Future studies could test ways to use the NMR to increase tobacco treatment rates in clinical settings.

Implications

This study generated a novel implementation strategy, namely an EHR alert about patients’ NMR and personalized treatment recommendations, in an effort to increase tobacco treatment rates in primary care. While the strategy did not increase tobacco treatment rates, it may have boosted the rate of varenicline prescription for patients who metabolize nicotine faster, aligning with evidence-based practice.
Hearing Double
Authors: Kane Brian
Published: May 2024

Hearing Double is an extended meditation on the jazz standard that brings together both musical analysis and philosophical analysis to offer a novel theory of musical works. Rather than focus on works of classical music, which has been the main focus of most Anglophone philosophy of music, Hearing Double focuses on “jazz standards” and attempts to theorize what makes them ontologically and historically specific and important. In this theory, standards are understood to emerge from networks of musical performances. Part I describes the ontology of these musical networks by considering two musical processes, “replication” and “nomination,” and their interaction. Part II discusses the historical conditions that encouraged standards to emerge. These conditions promoted an auditory culture where new songs were expected to circulate in ever-changing performances and arrangements. By weaving together ontological theory and auditory cultural history, Hearing Double challenges conventional understandings of the jazz repertoire and opens up a new perspective on the history, purpose, meaning, and aesthetics of jazz standards.
Wicked Problems for Archaeologists
Authors: Schofield John
Published: May 2024

‘Wicked problems’ were first defined in 1967, as a class of problems which are ill-formulated, where the information is confusing, where there are many clients and decision-makers with conflicting values, and where the ramifications in the whole system are thoroughly confusing. The adjective ‘wicked’ describes the mischievous and even evil quality of these problems, where proposed solutions often turn out to be worse than the symptoms. This book presents some of the novel ways that archaeology, alongside the closely related field of cultural heritage practice, can contribute to resolving some of the world’s most wicked problems through adopting a small-wins framework. With chapters covering climate change, environmental health, health and well-being, social injustice, and conflict, the book uses many and diverse examples to explain how, by studying the past in ways that are creative, bold and both inter- and transdisciplinary, significant ‘small wins’ can be achieved.
Introduction
Authors: Sterba James , Swinburne Richard
Published: May 2024

The problem of evil is the problem of whether a good God would permit so much suffering in the world. Sterba, appealing to three exceptionless minimal components of the Pauline Principle never to do evil that good may come of it, will claim to show that the all-good, all-powerful God of traditional theism is logically incompatible with all the horrendous evil consequences that occur in our world. Swinburne will reject this argument, going on to present a theodicy of why a good God would permit such horrendous evils. Sterba and Swinburne agree that there are objective moral truths discoverable by rational reflection, and that the problem of evil cannot even arise without assuming an objective morality applicable to both God and ourselves. They both reject a ‘divine command’ theory which claims that all the fundamental moral truths are made true by the free choice of God.
Reimagining the Past in the Borderlands of Medieval England and Wales
Authors: Henley Georgia
Published: May 2024

This monograph challenges the assumption that English and Welsh literary cultures functioned in isolation from one another. Rather, literature from the borderlands of medieval England and Wales c.1250–1485 reveals a complex matrix of identity and power dynamics negotiated through historical memory. Baronial families in this region, particularly the Mortimers of Wigmore and the lords of Brecon, drew on their ancestral Welsh connections and refashioned the canonical histories of native Wales in order to gain political authority in the region. Their interest in the Welsh past cultivated a range of romances, genealogies, and chronicles, such as the romance of Fouke le Fitz Waryn, the Genealogy of the Lords of Brecknock, and the Epitome historiae Britanniae (an adaptation of Geoffrey of Monmouth). In reimagining the British–Welsh past, these families reshaped transmission networks that drew Welsh texts from the ‘periphery’ into England, amplifying Welsh influence on the political and literary landscape of medieval Britain.
Introduction
Authors: Henley Georgia
Published: May 2024

The book begins by discussing an exchange of letters between Llywelyn ap Gruffudd and Archbishop John Peckham late in 1282, both of whom invoke ancient British history in a fatal dispute over the independence of Gwynedd. The episode illustrates the seriousness with which the legendary history of Britain was taken in the political arenas of conquest and statecraft in the medieval period, particularly in political relations between Wales and England (c.1100–1485). This exchange shows the politically motivated manipulation of the British historical past by baronial families in the March of Wales, whose historiographical interests steered textual production in the region. The Introduction then explains the rise of marcher culture and society as a geographical region, political entity, and identity category that was uniquely positioned as an interface between England and Wales. It discusses the development of the term ‘March’ in the various languages of the region. It places the book’s argument in the context of scholarship on the subject to date. It summarizes the main arguments of the book: marcher barons’ interests in the Welsh historical past for their own political gain spurred textual transmission in the region and caused Welsh historical writing to have a greater influence on the political landscape of medieval Britain than previously appreciated.
Ancestral Memory
Authors: Henley Georgia
Published: May 2024

This chapter analyses the key role of patronage relationships in the display and preservation of family memory in the March of Wales. It focuses on a set of historical texts produced at Llanthony Priory for the lords of Brecon and short histories of the earldoms of Gloucester and Hereford, all of which delineate complicated lines of succession in families that persistently lacked male heirs. These texts, several of which are previously unedited, reveal the importance of the relationship between family and monastery, a mutually beneficial contract that allowed not only for the preservation of memory in the form of prayers for souls of the deceased, monuments, and epitaphs, but also for the writing of family histories. It thus positions family memory as a collective effort, relying on recorded events beyond an individual lifespan and therefore dependent on other people’s acts of preservation in the form of textual production.
Conclusion
Authors: Henley Georgia
Published: May 2024

The conclusion to the book points to possibilities for future analysis of canonical English and Welsh literature as marcher literature, offering a reading of Sir Gawain and the Green Knight as a preliminary example. Marcher readings of these texts draw out an interest in borders and boundaries, from the borders between reality and the otherworld of dream visions, to the political and linguistic boundaries of the marcher borderlands. In doing so, the conclusion claims canonical works of literature as marcher, destabilizing the Anglo-centric focus of medieval literary studies.
Human Rights and the Care of Older People
Authors: O’Rourke Maeve
Published: May 2024

This book argues that older people globally are experiencing widespread violations of their fundamental right to freedom from torture or cruel, inhuman, or degrading treatment or punishment through inadequate and coercive responses to their care needs. In response, the book advocates progressive interpretation and application of the anti-torture norm (which is currently enshrined in numerous international treaties and likely to be re-stated in a new United Nations Convention on the rights of older persons). The book identifies existing doctrinal rules and principles under the anti-torture norm, which are clearly relevant to older people’s experience of neglect and coercion in relation to care needs. It also highlights logical inconsistencies and ideological constraints in how norm appliers have so far interpreted the rule against torture and ill-treatment, thus hindering the norm’s effective application to older people’s care-related mistreatment. Using the concepts of dignity and vulnerability to analyse the ‘case study’ problems of inadequate continence care and deprivation of liberty for care, the book argues that the anti-torture norm should be understood to impose a positive obligation on states to ensure access to consensual care. This positive duty should be recognized to include an obligation to ensure access to decision-making support in the care context, an obligation to ensure access to self-advocacy support in the care context, and an obligation to provide consensual care services where people have insufficient resources to obtain the assistance necessary to meet their basic needs.