bluuebunny/crossref_metadata_2025 huggingface dataset:
#4383 WHEN SHOULD WE TRY TREATMENT FOR PERITONEAL SCLEROSIS?
Authors: Martika Antigoni , Lampropoulou Ioanna , Ntemka Alexandra , Tsamelasvili Maria , Pozoukidou Kalliopi , Georgilas Nikolaos , Spaia Sofia
Published: June 2023

Background and Aims

Although it is very important to detect patients at increased risk of developing encapsulating peritonitis (EPS), there are not established predictors which would promote early diagnosis and treatment of EPS ensuring sustainability of peritoneal dialysis (PD). D-Dimers are considered a significant test in evaluation of peritoneal fibrinolysis activity and Ca 125 is used as an alternative marker for the integrity of peritoneal membrane.[1] We examined prospectively a combination of these surrogate markers both in serum and effluent to discern early peritoneal sclerosis.

Method

In a cohort of 39 PD patients D-Dimers, Ca 125, CRP along with a complete biochemical profile were tested both in serum and overnight effluent dialysate at the beginning of the study. In 9 patients, who presented with recurrent gastrointestinal symptoms, such as mild nausea, incidence of gastric discomfort or sense of bloating, CT imaging was performed for evaluation of potent EPS and thickening of the bowel wall was measured. The latter group of nine patients received tamoxifene for a period of approximately one year and both serum/effluent biomarkers and CT imaging were repeated at the end of this period.

Results

In Table 1 characteristics of patients are shown. At the beginning of the study CRP was the only biomarker that was different between the group with or without gastrointestinal symptoms (4±6mg/dl vs 0.8±1.1mg/dl, p = 0.04). In patients, who received tamoxifene gastrointestinal symptoms improved. In these patients follow up with CT imaging demonstrated amelioration of bowel wall thickening compared to the beginning (3±1.2mm vs 2.1±0.4mm), which was not statistically significant. Moreover, Ca 125 in dialysate decreased (60.4±74 U/ml vs 27±27 U/ml, p = 0.04). No side effects were recorded. Five patients are still on PD, 3 patients died from unrelated causes and 1 was transferred to hemodialysis.

Conclusion

In this study neither D-Dimers, a test for the assessment of the peritoneal fibrinolysis activity, nor Ca 125 an alternative marker for assessing the integrity of peritoneal membrane helped us to distinguish patients at risk for EPS. In fact Ca 125 levels in the effluent were higher in the treated group just before initiation of treatment, although in some references it is proposed that it is minimized.[1,2] Clinical evaluation along with radiologic findings led us to the decision to treat patients with tamoxifene, which exerts a protective effect on the peritoneal membrane during both early and late stages of fibrotic disorders.[3] Despite the small number of patients in this study, bowel wall thickening showed a tendency to decrease and symptoms improved.
#4387 LIQUID BIOPSY IN PATIENTS TREATED WITH BIOCOMPATIBLE PERITONEAL DIALYSIS FLUIDS – ITS RELATIONSHIP WITH CYTOLOGICAL AND HISTOLOGICAL FINDINGS
Authors: Gilsanz Gloria del Peso , Albar Patricia , Heffernan Jose Jiménez- , Osorio Marta , Machado Lina Maria Leon , Perdomo Yanieli Hernandez , Botella Mario , López-Cabrera Manuel , Rubio María Auxiliadora Bajo
Published: June 2023

Background and Aims

Peritoneal fibrosis can limit long term peritoneal membrane function in peritoneal dialysis (PD) patients. It has been related to bioincompatible PD fluids and peritoneal infections. There are no prospective studies regarding correlation between effluent biomarkers and peritoneal biopsy findings. Our aim was to study the possible relation of peritoneal effluent biomarkers and peritoneal morphology alterations.

Method

Multicenter prospective study in a cohort of stable PD patients treated with biocompatible PD fluids who received a kidney transplant. We collected in each patient peritoneal biopsy samples and peritoneal effluent fluid. We analyzed the relation between effluent biomarkers, phenotype of mesothelial cells (MC) cultured ex vivo, and peritoneal biopsy parameters (mesothelial integrity, fibrosis and hyalinizing vasculopathy). We compared them with patient characteristics, including peritoneal transport parameters. The biomarkers tested were Collagen-1 (COL-1), Fibronectin (FN), Collagen-13 (COL-13), Interleukin-6 (IL-6), Trombospondin-1, Cadherin 13 (CDH-13), CA-125, Gremlin-1 (GREM-1), Matrix metalloproteinase 2 (MMP-2), CC chemokine ligand 18 (CCL18), Plasminogen activator inhibitor 1 (PAI-1) and Vascular endothelial growth factor A (VEGF-A).

Results

Forty patients were included (mean age 54.5±15 years, 64% male, 24.1% diabetics). Mean time on PD was 25.5±27 months, 62.1% were on automated PD (APD) and 17.2% had prior peritonitis episodes. A normal MC culture phenotype was observed in 78% of patients. In peritoneal biopsies samples we found partial or total mesothelium preservation in 39%, submesothelial thickness in 42% and vasculopathy in 14% of cases. Effluent PAI-1 levels were significantly lower in patients with mesothelial cell loss than in those with mesothelial preservation (21.62 vs. 38.59 pg/ml respectively; p = 0.031). Patients with peritoneal fibrosis showed significantly higher effluent CDH-13 levels (3.51 vs. 2.32 pg/ml; p = 0.048) and supernatant PAI-1 levels (1183 vs. 72.73; p = 0.000) than those without fibrosis. No other statistical differences were found in other biomarkers analysed.

Conclusion

Most patients treated with biocompatible peritoneal dialysis fluids showed normal mesothelial cell phenotype in peritoneal effluent culture. Lower PAI-1 effluent levels were associated with mesothelial cell loss and higher effluent CDH-13 levels were related to peritoneal fibrosis.
#4412 URINARY SODIUM-TO-POTASSIUM RATIO DOES NOT ACCURATELY REFLECT DIETARY SODIUM-TO-POTASSIUM RATIO
Authors: van Vliet Anne Myrthe , Zwager Charlotte , Rauh Manfred , Titze Jens , Engberink Rik Olde
Published: June 2023

Background and Aims

Low sodium intake is associated with a lower blood pressure and less proteinuria, which are important therapeutic targets in chronic kidney disease. In contrast, a low potassium intake has been associated with higher blood pressure and a higher incidence of chronic kidney disease and cardiovascular events. Counselling of patients regarding their sodium and potassium intake requires accurate estimation of their intake, but 24-hour urinary sodium and potassium excretion can deviate substantially from actual intake. Urinary sodium-to-potassium (Na/K) ratio is a promising alternative as it is less affected by incomplete urine collections and additionally captures both the effect of sodium and potassium. Our study aimed to assess whether the Na/K ratio in 24-hour urine reflects dietary intake more accurately than separate measurement of sodium or potassium in 24-hour urine.

Method

We performed a post-hoc analysis on data from the long-term sodium balance studies Mars105 and Mars520. Ten healthy participants consumed a diet with a known sodium and potassium content and collected 24-hour urine samples for 105 or 205 days. We calculated the log fold difference between dietary intake and urinary excretion of sodium, potassium and Na/K ratio. A mixed-effects model with a random intercept per subject was used to compare these estimates of accuracy. Subsequently, we performed a subgroup analysis per salt intake level (i.e. 6, 9 or 12 grams per day) and assessed the effect of increasing the number of 24-hour urine collections.

Results

Overall, the urinary Na/K ratio underestimated dietary Na/K ratio with a median difference of -0.21 (IQR -0.47 to 0.09). Estimation of dietary Na/K ratio intake using the urinary Na/K ratio was significantly less accurate compared to using urinary sodium or potassium measurement for estimation of sodium or potassium intake (Figure 1A). Only during a salt intake of 6 grams per day, the urinary Na/K ratio did not perform significantly worse than sodium measurements. Although increasing the number of 24-hour urine measurements to three or seven improved the accuracy of the urinary Na/K ratio, it remained inferior to separate assessment of urinary sodium and potassium excretion (Figure 1B).

Conclusion

The 24-hour urinary Na/K ratio is less accurate than 24-hour urinary sodium or potassium excretion for estimation of dietary intake in a controlled setting in healthy volunteers.
#4414 GLOMERULONEPHRITIS DIAGNOSIS AND MANAGEMENT: IMPROVING KNOWLEDGE AND COMPETENCE AMONGST NEPHROLOGISTS THROUGH ONLINE CME CASE CHALLENGES
Authors: Bahra Sukhbir , Stan Adriana , Schoonheim Peter , Da Silva Rita Moreira , Kavanagh David
Published: June 2023

Background and Aims

Continuing medical education (CME) aims at modeling best practice in promoting positive behavior. We hypothesized that participation in the case-based medical education “Challenging Cases of Glomerulonephritis: How Would You Diagnose and Manage These Patients?” would lead to improved knowledge and competence of nephrologists in the diagnosis and management of glomerulonephritis.

Method

The online CME activity consisted of 2 patient case scenarios, and it was delivered as an interactive, text-based format. Using a “test and teach” methodology to elicit cognitive dissonance, clinicians completed multiple-choice questions to test their application of evidence-based recommendations. Each response was followed by detailed, referenced, feedback to improve learners’ knowledge, competence, and confidence on the diagnosis and management of glomerulonephritis. The educational effect was assessed using a repeated-pairs design with pre-/post-assessment, where 3 multiple choice questions assessed knowledge/competence and 1 question assessed confidence. Significance was assessed using paired samples t-test for overall average number of correct responses and for confidence rating, and the McNemar's test for individual questions (5% significance level, P <0.05). Cohen's d estimated the effect size impact on number of correct responses (<.20 modest, .20-.49 small, .59-.79 moderate, ≥.80 large). Data were collected between July 15 2022 and September 27 2022.

Results

Comparison of responses to questions before and after education demonstrated a large educational effect for nephrologists (n = 119; d = 1.36; P <.001). Overall 84% nephrologists improved their knowledge/competence related to the diagnosis and management of glomerulonephritis (P< .001), showing a 76% relative increase in correct responses from pre- to post-CME (51% pre, 90% post). Significant increases in knowledge/competence on rare complement-mediated kidney diseases were reported (P <.001 for all comparisons) for:

- Clinical manifestations (64% pre; 97% post)

- Diagnosis (18% pre; 84% post)

- Management (71% pre; 90% post)

Around 55% of nephrologists showed a measureable confidence increase (P<.001) in their ability to recognize clinical information suggestive of rare complement-mediated kidney diseases.

Conclusion

This online, interactive, case-based CME activity significantly improved the ability of nephrologists to diagnose and manage patients with glomerulonephritis. Additional gaps were identified for future education.
#4445 ANAEMIA MANAGEMENT IN PERITONEAL DIALYSIS: FROM GUIDELINES TO ROUTINE CLINICAL PRACTICE
Authors: Portoles Jose , Quiroga Borja , Salazar Maria Luisa Serrano , Peña Olga González , Domínguez María Sandra Gallego , Vera Manel , Espada Paula Jara Caro , Garcia Maria Alba Herreros , Vila Maria Antonia Munar , Amenos Aleix Cases
Published: June 2023

Background and Aims

The evidence on the management of renal anemia in peritoneal dialysis (PD) is much weaker than in hemodialysis (HD). Current guidelines establish the same haemoglobin (Hb) target for patients under eritropoietin stimulating agents (ESAs) in both dialysis techniques (PD, HD), although patients in PD are usually younger, more active and lesss comorbid. Unfortunately, there is not randomized controlled trials evaluating the efficacy and safety the effect of different Hb target on clinical outcomes. The aim is to describe the current situation of anaemia prevalence, treatments, and achievement of clinical guidelines recommendations in this population.

Method

Retrospective nationwide multicenter study including patients from 19 PD units. All prevalent PD patients that were active in the technique in November 2019 for at least 3 months was included (to avoid COVID pandemic interferences). Exclusion criteria were a previous kidney transplant failure and being on PD due to a cardiorenal syndrome with a residual renal function over 20 ml/min/1.73 m2. The nephrologists collected baseline data, demographics, comorbidities, and data related to anemia management (ie, laboratory values, previously prescribed treatments, and subsequent adjustments) from electronic medical records. The European adaptation of KDIGO guidelines was the reference for iron and Hb limits, prescriptions and targets.

Results

A total of 343 patients (mean age 62.9 years, 61.2% male) were included. Regarding anaemia-treatment prescription, 72.9% were receiving ESAs and 33.2% iron therapy (20.7% intravenously-IV and 12.5% orally). Eighty-two (32.8%) patients were receiving ESA without iron therapy, despite to have an indication to do it according ERBP guidelines in 53 out of them. After knowing lab results, iron therapy was only started in 8 (15%) patients. Among ESA-treated patients, 58.8% had an optimal control (Hb 10–12 g/dl). Seventeen patients had haemoglobin over 13 g/dl, and 12 of them continued receiving ESA after knowing lab results. Only three patients had persistent haemoglobin <10 g/dl. Seven patients (2%) met criteria for ESA resistance (epoetin dose >300 IU/kg/week). Patients in the highest tertile of erythropoietin resistance index (ERI) (>6.3 UI/kg/week/g/dl) were more inflamed, had lower albumin levels and lower residual renal function.

Conclusion

Anaemia prevalence is high in this population and its management in PD Units could be improved according to the ERBP guidelines. The lack of iron therapy in patients who should have received it and the excessive tolerance to high Hb levels are the most relevant opportunities to improve compliance with clinical guidelines.
#4447 EFFECT OF RENAL IMPAIRMENT ON IPTACOPAN PHARMACOKINETICS
Authors: Schmouder Robert , Lestini Giulia , Bartels Christian , Baltcheva Irina , Junge Guido , Kulmatycki Kenneth
Published: June 2023

Background and Aims

Iptacopan (LNP023) is a first-in-class, oral, proximal complement inhibitor that specifically binds to Factor B and inhibits the alternative complement pathway (AP). Current Phase III studies of iptacopan focus on diseases associated with AP activation, such as paroxysmal nocturnal hemoglobinuria (PNH), C3 glomerulonephritis (C3G), IgA nephropathy (IgAN), and atypical hemolytic uremic syndrome. The liver is the primary route of iptacopan elimination. Based on a previous healthy volunteer pharmacokinetic (PK) study, the contribution of the renal route of iptacopan elimination was measured to be low, approximately 14%. A population PK (PopPK) analysis was done to further quantify the effect of renal impairment on iptacopan PK.

Method

A PopPK dataset pool was created by pooling across 6 Phase II/III studies in PNH, C3G, and IgAN indications. The pool comprised patient data on the two highest dose levels (100 and 200 mg bid) and included 2439 datapoints in 234 unique patients. Factors (baseline characteristics) that could possibly affect exposure, body weight, age, gender, ethnicity, and eGFR (mL/min/1.73 m2) at baseline were investigated. The range of eGFR was 27.4 to 142.8 mL/min/1.73 m2. Age, ethnicity, and body weight were included as the significant covariates in the final model.

Results

The median eGFR was 87.5 mL/min/1.73 m2. As shown in the table below, the PopPK model detected a significant (p = 4.3 × 10−11) but modest effect of eGFR on simulated mean AUC0-24. At an eGFR of 34.3, AUC0-24 is expected to increase by only 38%, compared with median eGFR. Changes of eGFR of ≤15% with respect to median eGFR were observed with eGFR range between 59.7 and 132.0 mL/min /1.73 m2.

Conclusion

Consistent with previously observed primarily hepatic clearance of iptacopan in preclinical and clinical studies, renal impairment down to an eGFR of 34.3 did not have a clinically meaningful effect on iptacopan PK. Currently, iptacopan PK in patients with eGFR <30 mL/min/1.73 m2 is being explored. These results support the use of iptacopan in patients with mild and moderate renal impairment.
#4451 MONOCYTE MIGRATION AND ACTIVATION IN ANCA-ASSOCIATED GLOMERULONEPHRITIS
Authors: Vegting Yosta , Hanford Katie , Jongejan Aldo , Moerland Perry , Gajadin Gayle , van der Bom-Baylon Nelly , Dekker Tamara , Vogt Liffert , Bemelman Frederike , Kroon Jeffrey , Hilhorst Marc
Published: June 2023

Background and Aims

Glomerular injury in Anti-Neutrophil Cytoplasmic Antibodies (ANCA)-associated glomerulonephritis (AGN) is associated with macrophage infiltration. To date, their role and origin remain to be fully elucidated. Activated blood monocytes likely transmigrate and differentiate into kidney macrophages depending on the local microenvironment. Even in remission, some studies indicate sustained monocyte activation and upregulation of adhesion markers. The aim of this study was to research the intrinsic migration capacity of monocytes in AGN. Targeting monocyte migration might open new therapeutic avenues in the treatment of AGN.

Method

Transendothelial migration of monocytes was tested in AGN patients with active disease (n = 2), in remission (n = 8) and healthy controls (n = 6). To assess their adhesive and migratory capacity, freshly isolated CD14 positive monocytes were added to confluent TNF-α or IL1β overnight-stimulated Human Aortic Endothelial Cell (HAEC) for 30 minutes and subsequently fixed. Monocyte adhesion and transmigration was visualized by phase-contrast microscopy and quantified using ImageJ. To unravel the potential mechanisms driving these differences in monocyte migration, we performed bulk RNA-sequencing of monocytes from AGN patients with active (n = 4) and stable (n = 10) disease, and healthy controls (HC) (n = 6).

Results

Monocyte adhesion, but not migration, was significantly increased during active disease, independently of the stimuli used to mimic the pro-inflammatory phenotype of endothelial cells (EC) (Figure 1). During remission, decreased adhesion was found on the IL1β-stimulated ECs. While CD11b mRNA expression was upregulated, CD11a expression was downregulated in monocytes from active AGN patients compared to HC. Two genes involved in paracellular monocyte transmigration (JAML, PECAM-1) were significantly decreased. Most AGN patients were treated with corticosteroids at time of experiments.

Conclusion

These results suggest a remarkable increase in monocyte adhesion, but lower intrinsic migration capacity, in a 30 minute time-frame during active AGN. Our findings on migration are surprising in the light of theorized enhanced monocyte extravasation towards diseased AGN kidneys. Therefore, it could be speculated that after a longer period of time, a subset of the adherent monocytes would ultimately migrate and differentiate into kidney macrophages. In remission, long-term immunosuppressive treatment or chronic inflammation might decrease monocyte adhesion. This was the first ex-vivo study to research monocyte migration in AGN, further research is required to validate findings and to develop new therapies targeting monocyte migration.
#4472 POLYMORPHISMS OF THE GENE FOR GALECTIN-3 IN PATIENTS IN THE TERMINAL PHASE OF RENAL INSUFFICIENCY
Authors: Kovacevic Zoran , Lazarevic Tatjana , Ljujic Biljana , Canovic Petar , Kovacevic Marina Miletic , Maksimovic Nela , Jankovic Marina Gazdic , Djukic Svetlana , Glisic Milos
Published: June 2023

Background and Aims

Chronic kidney disease (CKD) is a major health problem worldwide. The last stage of CKD is end-stage renal disease (ESRD), which is characterized by a progressive decrease in glomerular filtration rate (GFR). End-stage renal failure is often complicated by anemia, uremic cardiomyopathy, and renal osteodystrophy, which can be fatal. Therefore, it is necessary to identify the risk factors that can lead to ESRD or death. In addition to well-defined early markers such as diabetes, hypertension, and obesity, it is necessary to identify other markers that would help in the prediction of the disease. It has been shown that genetic factors also have an influence on renal function, pathogenesis, and disease progression, which is confirmed by the results of genome-wide association studies (GWASs). The results of GWASs show that glomerular filtration rate and renal function are affected by several gene loci. Galectin 3 (Gal-3) is the only representative chimera type of the galectin family, which forms a pentameric structure on the cell surface after binding to glycoproteins or glycolipids. The results of numerous studies have shown that Gal-3 plays a significant role in fibrosis, inflammation, and proliferation. Increased circulating levels of Gal-3 have been associated with various diseases, including cancer, immunological disorders, and cardiovascular disease.

Method

A total of 108 ESRD patients and 38 healthy controls were enrolled in the study. Genotyping of LGALS3 geners 4644, rs4652, and rs11125 polymorphisms was performed by polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP).

Results

By multivariate logistic regression analysis, we found that LGALS3 rs4644 CC and rs4652 AA genotypes were significantly associated with a higher risk for lower hemoglobin, higher level of parathyroid hormone, and also occurrence of diabetes mellitus and arterial hypertension. The CAA haplotype was significantly more common in patients with diabetes, low hemoglobin level, and normal PTH level. It has been observed as well that the ACT haplotype was more common in patients with low glomerular filtration, lowPTH, and normal hemoglobin level.

Conclusion

We found that the LGALS3 rs4644 and rs4652 gene polymorphism may be involved in the pathogenesis and appearance of complications in ESRD patients and thus could be considered a new genetic risk factor in this population.
#4483 THE 2021 KDIGO BLOOD PRESSURE TARGET AND THE PROGRESSION OF CHRONIC KIDNEY DISEASE: FINDINGS FROM THE KNOW-CKD
Authors: Lee Hyun Jung , Park Cheol Ho , Kim Hyung Woo , Park Jung Tak , Chang Tae Ik , Yoo Tae-Hyun , Kang Shin-Wook , Han Seung Hyeok
Published: June 2023

Background and Aims

The 2021 Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline for management of blood pressure (BP) in chronic kidney disease (CKD) recommends a target systolic BP of <120 mmHg because this lower target can provide cardiovascular benefits. However, whether implementing the new BP target could improve kidney outcome remains unknown.

Method

We examined the association of the 2021 KDIGO BP target with CKD progression compared with the 2012 KDIGO BP target among 1724 participants from the Korean Cohort Study for Outcomes in Patients With CKD. The main exposure was BP status categorized according to the 2012 or 2021 KDIGO guideline: 1) controlled within 2021 target; 2) controlled within 2012 target only; and 3) above both targets. The primary outcome was a composite kidney outcome of ≥50% decline in estimated glomerular filtration rate from baseline measurement or the initiation of kidney replacement therapy during the follow-up.

Results

During 8,078 person-years of follow-up (median, 4.9 years), the composite kidney outcome occurred in 650 (37.7%) participants. The incidence rates of this outcome were 55, 66.5, and 116.4 per 1,000 person-years in BP controlled within the 2021 and 2012 KDIGO targets, and BP above both targets, respectively. In the multivariable cause-specific hazard model, hazard ratios for the composite outcome were 0.76 (95% confidence interval, 0.60-0.95) for BP controlled within the 2021 target and 1.36 (95% confidence interval, 1.13-1.64) for BP above both targets, compared with BP controlled within 2012 target only.

Conclusion

The newly lowered BP target by the 2021 KDIGO guideline was associated with improved kidney outcome compared with BP target by the 2012 KDIGO guideline.
#4506 ACCURACY OF NOVEL GFR ESTIMATING EQUATIONS BASED ON CREATININE, CYSTATIN C OR BOTH IN ROUTINE CARE
Authors: Fu Edouard , Levey Andrew , Faucon Anne-Laure , Delanaye Pierre , Inker Lesley , Carrero Juan Jesus
Published: June 2023

Background and Aims

New equations to estimate GFR (eGFR) based on creatinine, cystatin C or both have been developed in the last two years. A comprehensive comparison of their accuracy is currently lacking, particularly in cohorts not involved in their development or validation and among people with comorbid conditions.

Method

We included 6174 adults from the Stockholm Creatinine Measurements (SCREAM) project referred for plasma clearance of iohexol during 2011-2021, in whom we observed 9579 concurrent measurements of creatinine, cystatin C and iohexol clearance. We assessed the performance against measured GFR (mGFR) of eGFR equations proposed by the CKD-EPI collaboration (CKD-EPI 2009, 2012 and 2021), European Kidney Function Consortium (EKFC 2021 and 2023), and the revised Lund-Malmö (2011) and CAPA (2014) equations, which are used in Sweden. Bias was expressed as the median difference in eGFR minus mGFR, with negative biases indicating underestimation of mGFR. P30 described the percentage of individuals with eGFR within 30% of mGFR. Correct classification was defined as agreement of eGFR and mGFR categories using the KDIGO GFR categories. Subgroup analyses were conducted according to age, sex, BMI, eGFR, cancer, cardiovascular disease, diabetes, heart failure and liver disease.

Results

Mean age was 57 years, 46% of participants were female, mean mGFR was 62 mL/min/1.73 m2 and mean BMI was 26 kg/m2. Cardiovascular disease was the most common comorbid condition (30%), followed by liver disease (28%), diabetes (26%) and cancer (26%). Equations that used both creatinine and cystatin C had better performance than eGFR using each marker alone, regardless of the equation used; all such equations had small bias and P30 close to 90%. Among creatinine-based equations, CKD-EPI 2009 and CKD-EPI 2021 showed larger overestimates of mGFR than EKFC 2021 and revised Lund-Malmö, with median biases of 5.6, 9.1, 2.7 and 0.2 mL/min/1.73 m2, respectively (Table 1). There were no meaningful differences in performance across eGFR equations based on cystatin C. Findings were consistent across subgroup analyses stratifying for comorbid conditions (Figure 1).

Conclusion

eGFR equations that combined information on creatinine and cystatin C performed better than equations based on creatinine or cystatin C alone in this Swedish cohort of routine referrals for plasma clearance of iohexol. There was larger variation in the performance of equations based on creatinine than cystatin C.
#4520 THE USE OF FAR INFRARED LIGHT DURING HEMODIALYSIS SEEMS TO MAINTAIN ARTERIOVENOUS FISTULA BLOOD FLOW BETTER THAN USING A HEAT PAD - A PILOT STUDY
Authors: Wãrme Anna Vb , Peters Björn , Nasic Salmir , Stegmayr Bernd
Published: June 2023

Background and Aims

The use of the native arteriovenous fistula (AVF) in chronic hemodialysis (HD) patients yields great challenges to keep a patent AVF, especially among those with diabetes mellitus and cardiovascular disease. Often repeated radiological interventions or surgery of the AVF is necessary. Accumulation of advanced glycation end products (AGE) in tissue is shown to contribute to the complications of diabetes mellitus and uremia [1]. Far infrared light (FIR) irradiation of the AVF have shown protective effects in maintaining AVF blood flow [2,3]. Using a heat pad (HP) to stimulate vascular flow is another alternative. Primary aim of the study was to compare if the use of a HP is as good as FIR to maintain AVF blood flow. Secondary aim: Evaluate change in AGE accumulation in tissue after FIR and HP treatment.

Method

This pilot study included HD patients with a native lower arm AVF. Eighteen patients were randomly assigned to treatment during HD; Ten patients to FIR and another group of eight patients to use HP (Two of the HP-patients refused to fulfill the study). Before and after a period of 15 HD treatments each, blood tests, AVF blood-flow measured with a Transsonic® and skin autofluorescence (SAF, measuring AGE) were analyzed. The distance of the FIR emitter to the AVF puncture area was 25 cm. The HP-group was exposed to a waterfilled rubber HP that kept a temperature of 40-41°C and was positioned to the backside of the AVF arm to avoid dislodgement of or compressing needles. The patient was her/his own control and non-parametric Mann-Whitney U- and Wilcoxon sign ranked tests were used.

Results

The blood flow of the AVF was similar at start in the FIR group versus the HP-group median 921 ml/min IQR (714-1210) vs. 610 ml/min, IQR (538-861), p = 0.118, while after 15 treatments the blood flow was maintained in the FIR group but was lower in the HP-group; median 902 ml/min IQR (718-1241) vs. 635 ml/min IQR (531-772), p = 0.022. The FIR exposure did not alter the SAF content (in arbitrary units -AU) after treatment and was similar in the FIR group (median 3.2 AU, IQR 2.2-3.6) and in the HP group (median 3.2, IQR 2.4-3.3), p-value = 0.864.During the follow-up period after 3 and 6 months, PTA was performed due stenosis with decreased blood flow of the AVF in 3/10 patients in the FIR group and 1/6 patients in the HP group. Data are given as median and interquartile range (IQR). A two-sided p-value of <0.05 was defined as significant.

Conclusion

This pilot study showed that the access flow after FIR versus HP exposure during 15 HD treatments was better maintained among patients treated with FIR than with HP. SAF as a predictor for atherosclerosis was not changed. Long-term exposure to FIR may be necessary.
#4583 NEUROLOGICAL DISEASES TREATED WITH PLASMAPHERESIS PERFORMED BY NEPHROLOGISTS
Authors: Valdivia Verónica Ruth Mercado , Carrillo Rocío Echarri , Villalobos Ángel Gallegos , Sánchez Gabriel Ledesma , Orjuela Yesika María Amezquita , Mancebo Raquel Diaz , Ruisánchez Sílvia Caldés , Hernández Yolanda Hernández , Ojanguren María Covadonga Hevia , García Antonio Cirugeda
Published: June 2023

Background and Aims

Apheresis is an extracorporeal technique whose objective is to eliminate pathological elements considered to be responsible for a disease or its clinical manifestations. Plasmapheresis is part of the nephrology activity that will precise to be promoted within clinical practice. It is a therapeutic alternative for a large number of diseases, with certain neurological pathologies being the most benefited of its use. The purpose of this study is to describe the experience with plasmapheresis performed by nephrologists on patients with neurological diseases.

Method

Descriptive-retrospective study of neurological diseases treated with plasmapheresis in our nephologist section between the years 2008-2023. We analyzed demographic data, underlying disease, procedure, complications, and clinical response of the patients.

Results

A total number of 31 plasmapheresis procedures have been performed, of which 16 procedures have been performed in neurological diseases with a total of 92 sessions. The average age was 47 years, with 69% of the female sex predominance. The most frequently disease treated was Multiple Sclerosis with 31%, followed by Acute demyelinating polyneuropathy in the form of Guillain Barré with 25%, Myasthenia Gravis and Voltage-Gated Potassium Channel Antibody Related antiLGi-1, both with 13%. Treatment prior to the technique was corticosteroids with 75%, immunoglobulins with 56% and immunosuppressants with 13%. All sessions were performed using the transmembrane filtration technique with plasmaFlux® and the Fresenius mulitiFiltrate® equipment. The median number of sessions per patient was 6. The mean exchange volume was 2.9 l/patient/session. The replacement fluid used was albumin on 100% of patients and 4 patients required albumin plus fresh frozen plasma. 75 percent of the patients had a positive response with partial remission or stability of the disease and 88 percent had no recurrences. Patients’ neurological response to the therapy was the expected, and similar to the one reported in the medical literature.

Conclusion

In our experience, plasmapheresis is a safe and effective therapy in patients with neurological diseases that should be required as a therapeutic option. We, as nephrologists must be aware of this and promote the management of this technique by publishing the joint experience in order to broaden the level of evidence in clinical practice. The importance of coordination in early referral by other different medical specialties may obtain better results.
#4606 INNOVATIVE METHOD TO EVALUATE MATURATION OF NEWLY CREATED ARTERIO-VENOUS FISTULAS: INSIGHTS FROM A QUALITY IMPROVEMENT PROJECT
Authors: Merlo Laura Rosales , Ye Xiaoling (Janice) , Zhang Hanjie , Chan Brenda , Mateo Marilou , Van Der Sande Frank , Kooman Jeroen , Kotanko Peter
Published: June 2023

Background and Aims

Recently, we introduced central-venous oxygen saturation (ScvO2) and estimated upper-body blood flow (eUBBF) to monitor the maturation of newly created arterio-venous fistulas (AVF) in hemodialysis (HD) patients [1]. The approach was implemented in a clinical quality improvement project (QIP).

Method

The QIP involved two Renal Research Institute dialysis centers in New York City that use the Crit-Line monitor (CLM, Fresenius Medical Care, Waltham, MA, USA) as part of the standard of care. CLM measures

automatically and non-invasively hematocrit and oxygen saturation (i.e., ScvO2 in patients with central venous catheter as vascular access). eUBBF was computed as described previously [1]. Patients with a with a newly created AVF were included, irrespective of their HD vintage. The QIP team comprised a registered nurse per clinic, two research physicians, and two data analysts. The team met weekly to assess the AVF maturation progress based on eUBBF and ScvO2 data that were displayed on a specific dashboard. Successful AVF maturation is typically accompanied by a rise in cardiac output and eUBBF that starts immediately after AVF creation. However, it is unknown what degree of eUBBF increase indicates a subsequently successful AVF maturation. To identify predictive eUBBF thresholds, we correlated eUBBF changes with the progress of AVF maturation in the six weeks following AVF creation. We defined maturation as unsuccessful when the newly created AVF required an intervention (e.g., angioplasty) or was abandoned.

Results

We studied 39 patients (age 56 ±18 years; 25 males). Twenty-eight of them were incident patients. Two patients had a second AVF created. In 15 patients AVF maturation was unsuccessful. In these patients, eUBBF increased to an average of 119.2% (SD 35.2) compared to pre-AFV creation. In patients with successful AFV maturation (N = 24), eUBBF increased to an average of 153.7% (SD 31.6) (Figure 1). The difference between the groups is 34.4 percentage points (95% CI: 12.4 to 56.4; p = 0.003). Using eUBBF as a diagnostic measure to discriminate successful vs. failed AVF maturation, an area under the receiver operating characteristics curve of 0.824 (95% CI: 0.673 to 0.925; p<0.0001) was obtained. An eUBBF increase of 25% had a sensitivity of 59% and a specificity of 92% to predict AVF maturation outcomes.

Conclusion

Computation of eUBBF provides a simple and non-invasive means to track AVF maturation and predict its outcomes.
#4611 THE INTEREST OF THE COMBINATION OF AN ANTIOXIDANT AND ANGIOTENSIN II RECEPTOR ANTAGONISTS IN THE REDUCTION OF RENAL FIBROSIS
Authors: Azouaou Leila
Published: June 2023

Background and Aims

Chronic kidney disease represents one of the frequent pathologies of non-communicable diseases where the mortality rate is high. Oxidative stress is one of the main causes of the deterioration of renal function. The aim of this work is to develop a new therapeutic molecule with an anti-fibrotic effect associated with an antioxidant to increase renal clearance.

Method

This is an experimental study using the aminonucleoside model of puromycin (PAN) on Sprague-Dawley rats weighing between 100 and 150 g. Mice are resistant to the effect of PAN Administration of PAN can be subcutaneous (SC) intravenous (IV) and intraperitoneal (IP)). The dosage for IV and IP administration of PAN is generally 150 mg/kg body weight and 120 mg/kg body weight for SC administration. Control rats receive an isotonic saline solution. The progression of glomerular lesions to glomerular fibrosis depends on the cumulative dose of PAN. The single injection of PAN induces reversible fibrosis lesions between the seventh and one month and after reinjection irreversible lesions. The mice benefited from PAN 2 injections on the 1st day and on the 40th day. the new molecular association was made on 15 days and 50 days.

Results

Two to four days after the injection of PAN, a disorganization of the ultrastructure of the pedicels is observed with a flattening of the podocyte feet, an effacement of the pedicels, a modification of the actin cytoskeleton and the disappearance of the diaphragm of cleft. The ultrastructural changes observed 10 days after PAN injection lead to podocyte detachment contemporary with proteinuria. If the aggression continues, podocyte apoptosis is associated with the histological appearance of segmental and focal hyalinosis. After the injection of the molecular combination, a regression of the lesions was observed 15 days after the first injection and 30 days after the second injection.

Discussion

The anti-fibrotic-antioxidant drug combination has a significant anti-fibrotic effect, especially during the first injection, the effect is less important during the evolution of histological fibrosis. The antioxidant gave a synergistic effect to the anti-fibrotic effect

Conclusion

The experimental study is very promising concerning the antioxidant ARII molecular association while waiting for the clinical trial that will hopefully be promising for this new association.
#4617 THE IMPACT OF DONOR NEPHRECTOMY ON THE ELDERLY LIVING KIDNEY DONORS
Authors: Hiramitsu Takahisa , Futamura Kenta , Okada Manabu , Norihiko Goto , Ichimori Toshihiro , Narumi Shunji , Watarai Yoshihiko
Published: June 2023

Background and Aims

Because of the serious cadaveric donor shortage, the number of living donor kidney transplantation (LDKT) is increasing. To increase the living donor (LD) source, elderly LDs are indicated for the donor nephrectomy. However, the safety of the LDs ≥ 70 years is still remained to be investigated.

Method

Bewteen January 2008 and December 2020, a total 1226 LDs for LDKT was included in this retrospective cohort study. LDs were stratified into 3 groups based on age; 244 LDs aged 30-49 years, 803 LDs aged 50-69 years, 179 LDs aged 70-89 years. To investigate the safety of donor nephrectomy in the LDs ≥ 70 years, operative outcomes, the estimated glomerular filtration rate (eGFR) changes, end stage renal disease (ESRD), and mortality were investigated among 3 groups. eGFR changes were analyzed using mixed linear models. The contributing factors for the recovery in the eGFR from the nadir eGFR were analyzed using multivariate linear regression analysis adjusted for mixed linear models. Mortality rates were analyzed using Cox regression models.

Results

In the LD characteristics, significant difference was identified in sex. In the operative outcomes, significant difference was not identified in operative duration,blood loss, and complications among 3 groups. In the mixed linear models adjusted for sex, eGFRs of LDs aged 70–89 years were significantly lower at any time points after donor nephrectomy than those in 2 other groups (Figure 1). The eGFR after donor nephrectomy recovers with time in 3 groups. The recoveries in the eGFR from the nadir eGFR were similar among 3 groups. The recoveries in the eGFR were independently affected by the hypetension (P = 0.008), smoking history (P < 0.001), and body mass index (P = 0.011) at donor nephrectomy. Donor age was not the independent factor. The mortality rate of LDs aged 70-89 years was significantly higher than those in 2 other groups (Figure 2). However, during the observational period, ESRD was not identified among 3 groups.

Conclusion

eGFR changes and mortality rate were significantly low in LDs aged 70-89 years. However, the recoveries in the eGFR from the nadir eGFR were similar among 3 groups. ESRD was not identified among 3 groups. These results implied that LDs aged 70–89 years might undergo donor nephrectomy safely and complete their lives without ESRD after donor nephrectomy.
#4624 VISCOELASTICITY MEASUREMENT- A NEW ULTRASOUND-BASED ELASTOGRAPHY METHOD IN THE ASSESSMENT OF THE KIDNEY
Authors: Felix-Mihai Maralescu , Bob Flaviu , Grosu Iulia Dana , Schiller Adalbert , Petrica Ligia
Published: June 2023

Background and Aims

Viscoelasticity is the result of the tissue's combined viscous and elastic response to stress. This characteristic can reveal details about the function of the kidney and is essential for comprehending how it responds to deformation. Hologic Aixplorer Mach 30 ultrasound system comes with new and improved software that indirectly assesses the viscosity of the renal tissue by measuring tissue shear wave dispersion.

Method

Over the course of 2022 we performed a cross-sectional study by including 50 healthy participants, 50 kidney-transplanted patients, and 40 patients with chronic glomerulonephritis (before being referred for renal biopsy). Viscosity plane-wave ultrasound (Vi PLUS) measurements were performed on each participant, and the mean value of five distinct evaluations for each kidney was correlated with their demographic, biological, and clinical parameters.

Results

The mean viscosity value for the healthy group was 2.44 ± 0.57 Pascal.second (Pa.s), correlated with age (r = -0.4251, p = 0.0021), estimated glomerular filtration rate (eGFR) (r = 0.4057, p = 0.0038) but it did not correlate with C reactive protein (CRP), the mean value for Vi PLUS in the kidney-transplanted group was 2.82± 0.59 Pa.s, correlated with eGFR (r = 0.3335, p = 0.0180), but not with age or CRP, and the mean value for the patients with chronic glomerulonephritis group was 2.39 ± 0.73 Pa.s, did not correlate with age, but correlated with eGFR (r = 0.3637, p < 0.0211) and CRP (r = -0.3695, P = 0.0189) and we also found for a cut-off value of <2.8 Pa.s for detecting the presence of tubulointerstitial fibrosis with an AUC of 0.792, p < 0.001 with 94% sensitivity, and 60% specificity. Results of one-way ANOVA (p = 0.001), used to test the differences in the variables among the three groups, showed statistically significant higher values for the viscoelasticity in renal transplant patients compared to the other two groups, but no differences between the healthy and chronic glomerulonephritis groups.

Conclusion

Our results show that this novel ultrasound technique correlates with renal function and inflammation (in chronic glomerulonephritis patients) and it is also capable of discriminating between patients with and without tubulointerstitial fibrosis, but further research is needed for it to be implemented into routine clinical practice.
#4640 PREDICTION OF CHRONIC KIDNEY DISEASE PROGRESSSION WITH ARTIFICIAL INTELLIGENCE: A CHALLENGE WITHIN OUR REACH
Authors: Galles Oscar , Rodríguez Miriam Caravaca , Suppi Remo , Macias Edwar , Morell Antoni , Comas Jordi , Martinez Elisenda , Salas Tomas , Ibeas Jose
Published: June 2023

Background and Aims

Chronic Kidney Disease (CKD) is a common and debilitating condition that affects over 850 million people worldwide. The disease is associated with high mortality rates that can reach up to 10-15% per year, multiple complications, among which cardiovascular ones stand out. These complications can contribute to the progression of CKD, and this in turn to the appearance of complications, feeding each other. Despite the availability of clinical guidelines and predictive models, accurately predicting disease progression and identifying risk factors for progression in CKD patients remains a challenge. The limitations of current methodologies, including simplifying complex relationships and relying on linear assumptions, have hindered progress in this area. The advancement of Artificial Intelligence and Machine Learning has provided a new opportunity to address these challenges. The goal of this study was to evaluate the performance of gradient boosting algorithms in predicting the progression of renal disease in a large dataset of 1327 patients with a follow up of 10 years.

Method

Design: Retrospective analysis of a historical cohort from the Register of Renal Patients of Catalonia (RMRC) and the Data analytics program for health research and innovation (PADRIS) from Health Quality and Assessment Agency of Catalonia (AQuAS). Inclusion Criteria: > 18 y.o. CKD stages from 2 to Renal Replacement Therapy (RRT) and adequate data after pre-processing the sample. N = 1.327 patients with 27.572 records. Follow up of 10 years (January 2010 - December 2020). Variables: Age, gender, BMI, Diagnoses (ICD-10) = 95, Transplant waiting list status; RRT status; Laboratory variables = 77; f) Pharmacological treatment = 100.

Method

By using Light Gradient-Boosting Machine (LGBM) testing CKD progression prediction horizon in quarterly windows for multiple periods.

Methodology: 1. Pre-processing of the sample and data. 2. Training and testing for variables exploration. 3. Dataset structuring in quarterly windows. 4. Samples randomization and data separation for a 5-fold cross-validation (20% test - 80% training). 5. Training and tuning of LGBM model for different prediction horizons.

Results

Age: 62 ± 13 years; Gender: 34% female, 66% male. Best prediction horizon was for 8 quarters (2 years), with a ROC curve of 0.967 and accuracy of 0.860. The 10 variables with major relevance in the model in order were estimated Glomerular Filtration Rate, Age, Microalbuminuria, BMI, HDL, Glucose, Urea, Platelets, Triglycerides and Sodium.

Conclusion

1. The prediction of CKD progression can benefit from the use of Machine Learning with results that outperform methods based on classical statistics. 2. It can allow the individualization of the prognosis and thus be able to carry out early interventions to improve the prognosis.