bluuebunny/crossref_metadata_2025 huggingface dataset:
P0728ASSOCIATIONS BETWEEN LUNG WATER NON-TRADITIONAL PARAMETERS AND FUNCTIONAL TEST IN CKD G4-5 WITH PRESERVED EJECTION FRACTION
Authors: Szymczak Anna , Mariusz Kusztal , Krzysztof Letachowicz , Gołębiowski Tomasz , Goździk Anna , Magdalena Krajewska
Published: June 2020

Background and Aims

Patients with chronic kidney disease (CKD) are characterized by higher cardiovascular risk resulting amongst others from fluid expansion. Lung water measured by ultrasound (US) technique is increasingly recognised as an effective, quick and objective technique of even subclinical congestion/fluid overload. We aim to search correlates between the amount of artifact b-lines in lungs ultrasound (US-B lines; a metric of lung water), intra- and extracellular water (ICW, ECW), arterial stiffness by pulse wave velocity, result of functional six minute walk tests (6MWT) and global longitudinal strain score (GLS) assessed during heart ultrasound in patients with preserved ejection fraction.

Method

ICW/ ECW was assessed by bioimpedance (BIA 101 Akern), pulse wave velocity (PWV) by oscillometric method (mobilograph, IEM Germany). GLS was calculated using 2-dimensional speckle tracking. Traditional biochemical cardiac and renal markers and inflammatory markers were also assessed.

Results

The study included 51 consecutive patients (34 male) with CKD stage 4 and 5 (median eGFR MDRD4 11 ml/min IQR 9; 17) with oligosymptomatic congestion. The median (IQR) EF was 60 (60; 65)%, GLS was -18,7 (-21; -14)%, US-B lines was 10,5 (6; 17). Factors that were associated with US-B lines include BNP (r 0,5), ECW (r 0,4), distance in 6MWT (r –0,48) and hemoglobin (r -0,37).

In comparison between groups (below vs above median) with more lung water (>11 US-B lines) and less lung water amount (<11) assessed after 5 min in a supine position we found markedly higher concentration of BNP and more extracellular water (ECW) in the first mentioned group (table). Patients with more B-lines have had lower hemoglobin level and shorter distance walked in 6MWT.

Conclusion

Lung water assessed by US is an quick and objective measure of congestion in advanced CKD with normal EF showing correlation with BNP concentration, distance walked in 6MWT and with extracellular water in bioimpedance. Its application into daily practice can be recommended.
P0735ELAVATED INTRACELLULAR COPPER CONTRIBUTES A UNIQUE ROLE TO KIDNEY FIBROSIS BY LYSYL OXIDASE MEDIATED MATRIX CROSSLINGKING
Authors: Niu Yangyang , Yu Chen
Published: June 2020

Background and Aims

Copper is an essential trace element required for many biological processes. Some studies have demonstrated that copper accumulating was related to liver fibrosis and lung fibrosis, but the underlying mechanism is not very clear. Copper is the essential unit of lysyl oxidase (LOXs), which are the key enzymes of crosslinking of extracellular matrix.

Method

Sprague-Dawley rats were divided into the sham group, unilateral ureteral obstruction (UUO) operated group and UUO treated with copper chelating agents tetrathiomolybdate (TM). Rat kidney fibroblast cells (NRK-49F) were used in vitro. The concentration of copper, the LOXs activity and the degree of cross-linking of extracellular collagen were detected in vivo and vitro.

Results

(1) The copper concentration in serum, urine and kidney of rats increased significantly at 7 days after UUO surgery; After treatment of TGF-β1, the intracellular copper concentration was increased significantly in cells; The concentration of copper in patients` serum is on the rise with the progression of chronic kidney disease (CKD). (2) The expression of CTR1 was upregulated in the kidneys of UUO rats; The level of CTR1 was increased significantly by TGF-β1 in vitro; (3) Blockage of Smad2/3 suppresses TGF-β1-induced expression of CTR1; (4) Downregulation of CTR1 significantly inhibited the intracellular copper concentration; (5) The activity of LOXs was increased significantly after TGF-β1 treatment; (6) Downregulation of CTR1 significantly inhibited the activity of LOXs and the cross-linking of extracellular collagen induced by TGF-β1 in vitro; (7) The concentration of copper, the degree of collagen cross-linking and the deposition of collagen were decreased in the kidney tissue of UUO rats after treatment with TM. The concentration of intracellular copper, the activity of LOXs and the degree of collagen cross-linking were attenuated with treatment of TM in vitro.

Conclusion

We firstly found that the intracellular copper accumulating was closely to renal fibrosis. The underlying mechanism was related with the increasing expression of CTR1 and activity of LOXs. Treatment with TM ameliorated the renal fibrosis. This study presented a novel treatment target for renal fibrosis.
P0750ASSOCIATION OF SERUM POTASSIUM LEVELS WITH RAPID KIDNEY FUNCTION DECLINE IN PATIENTS WITH CONGENITAL SINGLE KIDNEY
Authors: GADALEAN FLORICA , Parv Florina , Petrica Ligia , VELCIOV SILVIA , Gluhovschi Cristina Anca , Bob Flaviu , OANA MILAS , Mihaescu Adelina , GOLEA-SECARA ALINA , SIMULESCU ANCA , Grosu Iulia Dana , Chisavu Lazar , Floroiu Madalina , Schiller Adalbert
Published: June 2020

Background and Aims

Hypokalemia is associated with progression of chronic kidney disease (CKD), although the possible underlying mechanisms are not well established. Several observational studies showed that low or even low to normal serum potassium levels predict the decline of kidney function in the general population. However, this hypothesis has not been yet investigated in patients with reduced nephron number as are congenital single kidney (cSK) patients.

Our aim was to prospectively examine the association of plasma potassium with risk of rapid kidney function decline in a cSK patients’ cohort.

Method

A cohort of 67 consecutive patients with cSK (mean age = 44.4+/-15.7 years; males 29p (43.28%)), with a mean estimated glomerular filtration rate (eGFR) = 65.2+/-28 ml/min/1.73m2, were enrolled in this longitudinal observational study. We evaluated the associations of plasma potassium levels with longitudinal kidney function decline by estimated glomerular filtration rate (eGFR). The eGFR was assessed with CKD-EPI formula. The rapid kidney function decline was defined as a fall in eGFR of more than 5 ml/min/1.73 m2/year, according to the KDIGO guidelines.

Results

During a mean follow-up time of 20.16+/-9.3 months, 31.34% (21p) of patients presented decline of eGFR, with a fall of mean – 11.6+/-5.43 ml/min/1.73m2/year. In univariable regression analysis, the decline of eGFR was associated with baseline eGFR (R2=0.09, p=0.013), age (R2=0.31, p<0.001), male gender (R2=0.14, p=0.001), arterial hypertension (R2=0.17, p=0.001), diabetes mellitus (R2=0.13, p=0.003), coronary artery disease (R2=0.12, p=0.005), uric acid (R2=0.23, p<0.001), C-reactive protein (R2=0.09, p=0.011), proteinuria/24h (R2=0.14, p=0.002) and serum potassium (R2=0.29, p<0.001). The serum potassium levels were significantly lower in the group with rapid decline of eGFR, with a mean of 3.62+/-0.41 mmol/L vs. 4.51+/-0.74 mmol/L, p<0.001. In multivariable regression analysis, the association between lower serum potassium levels and risk of rapid eGFR decline remained significant (HR=1.65; 95%CI, 1.105-2.49; p=0.015).

Conclusion

These results suggest that lower serum potassium levels may play a role in rapid kidney function decline in the cSK population. Further research is required to assess whether the higher risk of kidney function decline in cSK individuals could be diminished when optimised serum potassium levels strictly.
P0751METFORMIN, A CLASSIC TREATMENT FOR TYPE 2 DIABETES WITH POSSIBLE RENOPROTECTIVE EFFECTS
Authors: Acosta Barrios Adriana , Goicoechea Marian , Verde Eduardo , González-Rojas Ángela , Delgado Andres , Muñoz de Morales Alejandra , Carbayo Javier , Verdalles Ursula , Ana Pérez de José , Luno Fernandez Jose
Published: June 2020

Background and Aims

Metformin is the antidiabetic of choice in patients with type 2 diabetes mellitus. Experimental studies and clinical observations have shown that metformin could have a beneficial effect on the progression of kidney disease through the activation of cAMP due to its anti-inflammatory, antifibrotic, and anti-oxidative action. The objective was to compare the progression of CKD in diabetic patients with or without metformin as antidiabetic in their treatment and the prevalence of cardiovascular events in both groups.

Method

Unicentric retrospective observational analysis. Inclusion criteria: outpatients seen in nephrology consultation during the year of 2012 with diabetes mellitus and stage 3 CKD. Renal, cardiovascular outcomes and mortality were analyzed between patients treated with / without metformin. Median follow-up of 76.5 months (41-84). Renal end-point: estimated glomerular filtration rate drop (MDRD-4) by 50% and / or start of dialysis program. Cardiovascular end-point: ischemic heart disease, stroke, arterial revascularization and / or amputation. Cardiovascular or any cause mortality.

Results

148 patients (96M, 52W) with a mean age of 75±9 years and an eGFR of 40±9 ml / min / 1.73 m2 were included. In relation to hypoglycemic therapy: 45 received metformin, 61 insulin and 31 DPP4i. 80% received treatment with RAAS blockers. After the follow-up, the progression of the renal disease was greater in patients who did not receive metformin: eGFR fall of -7.0±16 vs -0.15±16 ml / min in those treated with metformin (p = 0.019). 25 patients in the group without metformin suffered a renal event vs. 5 in the metformin group (logRank: 4.186, p = 0.045). In the Cox analysis, metformin treatment decreases the progression of kidney disease in a model adjusted for baseline renal function and treatment with RAASB (HR 0.368, p = 0.043), losing its predictive power in a proteinuria-adjusted model. During the follow-up, 45 patients died (20 metformin, 25 non-metformin) and 45 patients suffered a cardiovascular event (15 metformin, 30 non-metformin), with no differences between the two groups.

Conclusion

Metformin treatment in patients with stage 3 CKD could slow the progression of CKD, this effect should be demonstrated in randomized studies with larger sample size.
P0762THE SERUM URIC ACID HAS A INDEPENDENT ASSOCIATION WITH 1-YEAR RENAL OUTCOMES IN CHRONIC KIDNEY DISEASE PATIENT WITH HYPERTENSION
Authors: RYU JIWON , Lee Chung Sik , Kim Sejoong , Cha Ran-Hui , Lee, Hajeong , Lee Jung Pyo , Song Young Rim , Kim Yon su , Kim Sung Gyun
Published: June 2020

Background and Aims

Serum uric acid (UA) is associated with renal disease. Hyperuricemia can be a risk of hypertension, intrarenal vascular disease and renal injury. We investigate the serum UA has an association with renal disease progression in patients with chronic kidney disease (CKD) with hypertension.

Method

We recruited 270 CKD patients with hypertension from 4 centers in Korea through the APrODiTe study and followed for 1 year. Serum UA was evaluated as a continuous value and groups divided by quartiles. The renal outcomes were an increase in random urine protein/creatinine ratio (PCR) than baseline value or estimated glomerular filtration rate (eGFR) deterioration which means a decrease in eGFR ≥ 5 (ml/min/1.73m2).

Results

Baseline serum UA was 6.58 ± 1.73 mg/dl and 6.52 ± 3.59 mg/dl after 1 year. For proteinuria progression, a 1 mg/dl higher serum UA has independent correlation in multivariate regression (odds ratio (OR): 1.272; 95% confidence interval (CI): 1.031-1.568; P = 0.024). The higher quartile of serum UA showed a correlation with the odd ratio than lower quartile (OR: 2.243; 95% CI: 0.862-5.837; P = 0.098, OR:3.417; 95% CI: 1.275-9.152; P= 0.015, OR: 2.754; 95% CI: 1.013-7.488; P < 0.047). In subgroup analysis, the patients with late CKD stage (3-5) showed serum UA has a positive correlation with proteinuria progression (OR: 1.311; 95% CI: 1.022-1.682; P= 0.033) and the top quartile group was correlated with the increased odds ratio compared to lower quartile (OR: 3.811; 95% CI: 1.153-12.59; P = 0.028). For eGFR deterioration, the higher quartile of UA was positively correlated with the odd ratio in only univariate analysis.

Conclusion

Serum UA level has an independent correlation with proteinuria progression in especially late CKD patient with hypertension. Whereas for eGFR deterioration, serum UA did not show a significant correlation.
P0815ASSOCIATIONS BETWEEN ALCOHOL CONSUMPTION AND CHRONIC KIDNEY DISEASE: A POPULATION-BASED SURVEY
Authors: Wu Hon-Yen , Tsai Wan-Chuan , Hsu Le-Yin , Peng Yu-Sen
Published: June 2020

Background and Aims

Observational studies suggest an association between moderate alcohol consumption and cardioprotective effects. However, the role of alcohol consumption on chronic kidney disease (CKD) remains inconclusive, and little is known about whether age influences the effects alcohol consumtion. This study aimed to evaluate the associations between alcohol consumption and chronic kidney disease in a population-based survey.

Method

We used data from the Taiwanese Survey on Prevalences of Hypertension, Hyperglycemia, and Hyperlipidemia. This is a population-based survey which applied a multistage, stratified, and random sampling from population throughout Taiwan in 2007. The survey assessed the prevalence, awareness, and treatment of metabolic syndrome by body measurements, structured questionnaires, and examinations of blood and urine. We obtained data of adult participants, including demographic characteristics, anthropometric measurements, lifestyle habits, and results of blood and urine exams. According to the frequency of alcohol consumption, we categorized participants into frequent drinkers (at least 1 time per week), occasional drinkers (less than 1 time per week), and nondrinkers. The study outcome was CKD, which was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 or a dipstick proteinuria ≥ 1+. The eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. We used univariate and multivariate logistic regression analyses to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for study outcome comparing different levels of alcohol consumption. To evaluate the influence of age, we stratified participants into younger (age < 45 years) and older (age ≥ 45 years) subgroups.

Results

The mean age of the participants were 48 years, with a female prevalence of 53% and CKD prevalence of 12%. There were 2,197 older participants and 1,770 younger participants. There were 548 frequent drinkers, 915 occasional drinkers, and 2,504 nondrinkers. Compared with nondrinkers, occasional drinkers (OR 0.59, 95% CI 0.43-0.81) and frequent drinkers (OR 0.61, 95% CI 0.44-0.87) showed a lower hazard risk of CKD (Table). Among those with an age ≥ 45 years, occasional drinkers (OR 0.56, 95% CI 0.30-0.81) showed a lower risk of CKD but frequent drinkers (OR 0.70, 95% CI 0.49-1.01) showed a borderline lower risk of of CKD compared with nondrinkers (Table). Among those with an age < 45 years, only frequent drinkers (OR 0.36, 95% CI 0.13-1.00) showed a lower risk of CKD compared with nondrinkers (Table).

Conclusion

Our study showed that alcohol consumption was associated with a lower risk of CKD, and this effect seemed to be more prominent among frequent drinkers and those with an age ≥ 45 years. Whether alcohol consumption provides renoprotective effects, as well as the influence of age, requires longitudinal studies.
P0830PREVALENCE OF ANXIETY IN CHRONIC KIDNEY DISEASE PATIENTS - A SYSTEMATIC REVIEW AND META-ANALYSIS OF LITERATURE
Authors: Huang Weihao Caleb , Wee Poh Hui , Low Lian Leng , Koong Ying Leng Agnes , Htay Htay , Foo Marjorie , Fan Qiao , Seng Jun Jie Benjamin
Published: June 2020

Background and Aims

Anxiety is a common psychopathology that affects patients with chronic kidney disease (CKD) and has been associated with poor quality of life and clinical outcomes. This review aimed to summarize the prevalence of anxiety symptoms and disorders among CKD patients.

Method

A literature search for observational studies, which reported the prevalence of anxiety in CKD patients, was performed in Medline®, Embase®, PsychINFO® and CINAHL® (through January 2019), in accordance with the PRISMA checklist. Peer reviewed, full text articles in English language were included. Studies involving kidney transplant patients were excluded. Anxiety disorders and symptoms were diagnosed and assessed using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) or DSM-V criteria in clinical interviews, or self-administered anxiety rating scale questionnaires. To estimate the prevalence of anxiety, random effects meta-analyses were used due to the expected heterogeneity across studies.

Results

Of the 4130 reports screened, 53 studies were included. Majority of studies were conducted in Asia (n=26, 49.1%) followed by Europe (n=14, 26.4%) and North America (n=7, 13.2%). The Hospital Anxiety and Depression Scale (HADS) was the most used instrument (n=28, 52.8%) followed by the Beck’s Anxiety Inventory (BAI) (n=11, 20.7%). The pooled point prevalence of anxiety across the studies involving 9,355 patients was 40.0% (95% confidence interval (CI): 33.3 – 46.7). Across continents, the prevalence of anxiety was highest in Asia (42.9%) (95% CI: 32.3 – 53.5) followed by North America (42.3%) (95% CI: 28.6 – 56.0). The prevalence of anxiety in studies that included only dialysis (n=45) or non-dialysis (n=4) patients were similar at 38.9% (95% CI: 31.8 – 46.1) and 30.5% (95% CI: 14.6 – 46.3) respectively. The prevalence of anxiety in studies that had both dialysis and non-dialysis patients (n=4) was 62.6% (95% CI: 47.1 – 78.2).

Conclusion

Given that anxiety is prevalent in 40% of CKD patients, future studies should explore developing effective anxiety screening tools and interventions as part of CKD patient management to improve clinical outcomes.
P0831HIGH SERUM ALKALINE PHOSPHATASE PREDICTS THE RISK OF CKD PROGRESSION: EFFECT NODIFICATION BY THE GFR
Authors: Mallamaci Francesca , D'arrigo Graziella , Marino F , Caridi Graziella , Parlongo Giovanna , Leonardis Daniela , Pizzini Patrizia , Cutrupi Sebastiano , Pisano Anna , Tripepi Giovanni Luigi , Kalantar-Zadeh Kamyar , Zoccali Carmine
Published: June 2020

Background and Aims

In the post-hoc analyses of the SUSTAIN and ASSURE trials (Kidney Blood Press Res. 2018;43:449-457), Apabetalone, an epigenetic modulator which lowers serum alkaline phosphatase (AlkPhos), stabilized the GFR in patients with cardiovascular disease and a GFR <60/ml/min/1.73m2. Analyzing the relationship between AlkPhos and renal outcomes in patients with established CKD is useful to preliminarily explore the biological hypothesis that AlkPhos is implicated in CKD progression.

Method

We investigated the relationship between AlkPhos and the risk for a combined renal end-point (30% GFR loss or dialysis/renal transplantation) in a cohort of 609 stage 3-5 CKD patients with an average GFR of 34.8±12.1ml/min/1.73 m2.

Results

Median AlkPhos levels were 91 IU/L (Interquartile range 71-117 IU/L) and in the vast majority of patients had values below 147 IU/L (the upper limit of the normal range). Over a median follow up of 3 years, two-hundred patients had the combined renal end-point. In an unadjusted analysis 1 ln increase in AlkPhos entailed a 49% risk excess for the renal end-point (HR: 1.49, 95% CI 1.11-2.01, P=0.008). Adjusting for traditional (age, gender, smoking, diabetes, total cholesterol, BMI, systolic BP, CV comorbidities) and CKD specific risk factors (hemoglobin, albumin, phosphate, and hs-CRP) did not modify the strength of this association (HR:1.48, 95% CI 1.08-2.02, P=0.016). Furthermore, In a fully adjusted analysis testing the GFR as an effect modifier of the AlkPhos - combined renal end point relationship showed a strong GFR- AlkPhos interaction (Figure). Indeed the risk for the combined renal end-point was gradually more pronounced at progressively more severe degrees of renal dysfunction, the HR being 0.94 (CI95% 0.60-1.47) at a GFR of 40 ml/min/m2 and 2.71 (CI95% 1.49-4.93) at 10 ml/min/1.73m2.

Conclusion

In patients with stage 3-5 CKD alkaline phosphatase within the normal range is associated with the risk for progression to ESRD and the GFR is an effect modifier of this relationship. Findings in this study are compatible with the hypothesis that within the normal range of this biomarker, the risk for CKD progression by alkaline phosphatase is amplified by the severity of CKD. These data are in keeping with post-hoc analyses of the SUSTAIN and ASSURE trials and provide circumstantial support to the hypothesis that interventions lowering serum alkaline phosphatase may mitigate CKD progression.
P0833SYMPTOM BURDEN IN CHRONIC KIDNEY DISEASE : A CASE FOR STARTING KIDNEY SUPPORTIVE CARE CLINIC
Authors: Prabhu Ravindra Attur , Singhai Pankaj , Salins Naveen , Nagaraju Shankar Prasad , Rao Indu R , Rangaswamy Dharshan , Shenoy Srinivas Vinayak , Rao Seema
Published: June 2020

Background and Aims

Chronic Kidney Disease(CKD) is associated with a huge symptom burden which increases with progression and leads to depreciation in Quality of life both directly and indirectly through effects on functional status, health perception, and feelings of subjective well-being. Dialysis therapy does not completely improve symptoms. We studied supportive care needs of patients with CKD through assessment of symptoms using translated version of Integrated Palliative Care Outcome Scale (IPOS- Renal) in a single tertiary health setting.

Method

Patients with chronic Kidney disease having creatinine clearance less than 60 ml/min/m2 were surveyed using IPOS Renal modified translated to vernacular language by forward- backward method. Translated version was approved by independent translator. Symptoms were classified into domains and analyzed using descriptive statistics. Scores were compared for those on maintenance hemodialysis with predialysis CKD patients.

Results

Of 184 patients, 128(69.6%) were receiving twice weekly hemodialysis, mean age was 52 years (range 20-82 year), 140(76%) were male. Average duration of dialysis was 4 years, 87 (46.9%) reported pain of which 39/87(45%) had moderate to severe pain. Other symptoms over past one week were dyspnea in 59(33.6%), Fatigue in 117(69.4%), Nausea in 53(33.6%), Vomiting in 36(20.9%), Anorexia in 90(42.4%), Constipation in 50(35.3%), Dry mouth/soreness in 62(36.4%), increased drowsiness in 63(46.6%), poor mobility in 87(55.8%), Itching in 69(39.3%), Disturbed sleep in 83(48.6%), Restless leg in75(43.6%), Skin related problems in 47(28.6%). Five patients reported presence of other severe symptoms. In Psychosocial domain 138(79.8%) patients and 126(72.8 %) family members expressed anxiety related to their disease or treatment of which one third had persistent anxiety, 140(81.6%) felt depressed and among them 58(42%) felt it most of the time or always and 145(88.6%) felt that they were not at peace, 59(35%) felt they did not have enough information about their disease and treatment and 79(47%) reported that they had unaddressed financial or personal problems, 124(77.2 %) felt they had to spend significant amount of time in healthcare facility. Patients on dialysis had significantly higher symptoms burden and Psychosocial needs.

Conclusion

CKD patients face high physical and psychosocial burden which is unaddressed in present clinical care and increases with stage. Tools such as iPOS renal are required to assess need of supportive care in CKD. Kidney supportive care clinic may be required to address this unmet need.
P0840RENAL FUNCTION AND RISK FACTORS IN LIVER TRANSPLANT PATIENTS
Authors: Kang Gun Woo , Kim Seoung Gyu , Lee In Hee , Ahn Ki Sung
Published: June 2020

Background and Aims

Advanced surgical techniques and medical managements play major roles in improving patient survival after liver transplantation (LT). At the same time, identifying the causes and risk factors for long-term survival after LT are also important. Renal dysfunction following malignancy and infection is known as an important cause of mortality after LT. Various causes such as pre/post transplantation factors are known to affect renal function. The purpose of this study is to investigate the changes of renal function in patients undergoing LT and to identify factors that can predict long-term renal dysfunction.

Method

A retrospective study was performed on 113 patients aged 15 years or older who had undergone LT at Daegu Catholic University Hospital form January 2012 to December 2013. 97 patients survived and were followed up. Changes of renal function after LT were identified using serum creatinine every year up to 4 years. And all patients were divided into groups with increased creatinine (70 patients) and non-increased creatinine (27 patients) at 4 years after LT. pre-transplantation factors were blood urea nitrogen (BUN), creatinine, protein, albumin, hemoglobin, total bilirubin, international normalized ratio. Subsequent BUN and creatinine were compared by independent t test. Statistical analysis was performed with IBM SPSS Statistics for Window, Version 19.0.

Results

58 were male (59.7%) and the mean age was 49.5 years old. 83 patients (85.6%) received liver transplantations from living donors. There were no significant differences in the donor types and recipient’s sex between the two groups with the increased and non-increased creatinine at 4 years after LT. However, the age of recipients was a significant difference between the two groups (51.3 and 45.4 years old) (p=0.018). Annual mean creatinine levels from pre-transplantation to 4 years after LT were 0.88 ± 0.39 (before transplant), 1.19 ± 0.54 (1 year after LT), 1.07 ± 0.44 (2 years), 1.12 ± 0.68 (3 years), and 1.19 ± 0.99 (4 years). Renal function decreased in 1 year after LT and improved in 2 years, then decreased again. In univariate analysis, the increased creatinine group was older than the non-increased group, and BUN and creatinine at 1 year after LT were significant differences in the two groups (p = 0.018, p = 0.031, p = 0.013). Multivariate analysis identified the creatinine at 1 year was an independent risk factor for long-term renal function after LT (OR 14.31, 95% CI: 1.5-133.3, p = 0.019).

Conclusion

This study explored that renal function was continuously decreased after LT and renal function at 1 year after LT had a significant effect on long-term renal function. Therefore, management of renal function during one year after LT is important for long-term renal function and may reduce mortality.
P0860INTRAVENOUS IRON ADMINISTRATION SUPPRESSES ENDOGENOUS ERYTHROPOIETIN SECRETION IN PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Muras-Szwedziak Katarzyna , Pawlowicz Ewa , Nowicki Michal
Published: June 2020

Background and Aims

Iron therapy may induce inflammatory response that may indirectly affect endogenous erythropoietin (EPO) production. We postulated that increased secretion of FGF-23 may provide a link between intravenous iron administration and suppression of endogenous EPO secretion.

Evaluation of a short-term effect of intravenous iron sucrose administration on the secretion of endogenous EPO in patients with chronic kidney disease (CKD).

Method

35 non-dialysed patients with G3b-5 CKD were included. All patients received 100 mg of intravenous iron infusion (iron (III)-hydroxide sucrose complex) daily for 5 days. Plasma concentration of EPO, iFGF-23, cFGF-23, PTH, bone alkaline phosphatase (BAP), phosphorus (PO4) and calcium (Ca) were measured before and two hours after the first and third iron infusion and at the end of iron therapy.

Results

EPO concentration at the end of iron treatment was significantly lower compared to 2 h after the first iron infusion (p<0.001) and before the third dose (p<0.001) (12.6 [31.2] mIU/mL, 30.9 [38.3] mIU/mL, 33.4 [41.3] mIU/mL and, respectively). Conversely, serum iFGF-23 increased significantly after the third dose (61.1 [401.5] pg/mL; p<0.05) and after the treatment (92.1 [849.7] pg/mL; p<0.01) compared to pre-treatment value (48.4 [403.8] pg/mL). cFGF-23 concentration decreased significantly after the first dose of iron (491.8 [828.6] vs. 339.2 [875.8] RU/mL; p<0.01) and after the completion of the therapy (398.7 [931.9]) vs. baseline (p<0.05). There was no linear correlation between EPO and FGF-23.

Conclusion

Intravenous iron therapy increases the secretion of FGF-23 and supresses endogenous EPO production but these two effects do not seem to be related.
P0880EFFICACY AND SAFETY OF SEVELAMER CARBONATE IN NON-DIALYSIS HYPERPHOSPHATEMIA PATIENTS: A RANDOMIZED, DOUBLE BLIND, PARALLEL GROUP STUDY FOR THE TREATMENT OF HYPERPHOSPHATEMIA IN PATIENTS WITH CHRONIC KIDNEY DISEASE NOT ON DIALYSIS IN CHINA
Authors: Yu Xueqing
Published: June 2020

Background and Aims

Hyperphosphatemia in chronic kidney disease (CKD) patients is associated with adverse outcomes, including vascular calcification, increasing risks of disease progression and even death. Sevelamer carbonate have been approved in Europe for phosphate lowering treatment in pre-dialysis CKD patient, its efficacy and safety in Chinese CKD hyperphosphatemia patients are not previously reported.

Method

This was a phase III, multi-center, randomized, double blind, placebo-controlled, balanced (1:1, sevelamer: placebo) parallel-group study to evaluate the efficacy and safety of sevelamer carbonate versus placebo over 8 weeks’ duration in hyperphosphatemic CKD patients not on dialysis in China (Registration number NCT03001011). The primary objective of this study is to demonstrate efficacy of sevelamer carbonate tablets in the reduction of serum phosphorus in hyperphosphatemia in patients with chronic kidney disease (CKD) not on dialysis.

Results

In all, 202 patients were randomized (sevelamer, n=101; placebo, n=101); mean age was 50.7 years, 53.5% were male and the mean time of CKD diagnosis was 3.4 years with mean eGFR 7.5 ml/min/1.73 m2. The baseline phosphorous were 2.13±0.35 mmol/L and 2.12±0.37 mmol/L in sevelamer and placebo group, respectively. The mean serum phosphorous decreased significantly in patients treated with sevelamer carbonate (-0.22±0.47 mmol/L) compared with placebo (0.05±0.44 mmol/L) (mean difference between sevelamer carbonate and placebo was -0.26 mmol/L, P<0.0001). When compared with placebo, sevelamer carbonate significantly reduced serum total cholesterol (-0.90±0.85 vs. -0.06±0.68 mmol/L, P<0.0001), low-density lipoprotein cholesterol (-0.94±0.72 vs. -0.04±0.58 mmol/L, P<0.0001) and calcium-phosphorous product (-0.48±0.97 vs. 0.05±0.81 mmol2/L2) from baseline to week 8. Serum iPTH was not significantly changed in sevelamer carbonate group compared with placebo group (-9.60±136.00 vs. 7.61±141.92 ng/L, P=0.83). Sevelamer carbonate was well tolerated with 83.27% compliance compared with 82.19% compliance in placebo arm. Average dose of sevelamer carbonate was 7.51 g/d at the end of study and 4.52 g/d across the study. Adverse events experienced by patients in sevelamer carbonate and placebo group were similar.

Conclusion

This study demonstrated that sevelamer carbonate has produced a significant reduction of serum phosphorous, and is safe and tolerated in Chinese pre-dialysis CKD patients with hyperphosphatemia.
P0901REAL-WORLD ASSESSMENT: CLINICAL EFFECTIVENESS AND SAFETY OF VITAMIN D THERAPIES IN ND-CKD PATIENTS
Authors: Germain Michael J , Paul Subir K , Broumand Varshasb , Fadda George , Nguyen Andy , McGarvey November , Gitlin Matthew , Ashfaq Akhtar
Published: June 2020

Background and Aims

Extended-release calcifediol (ERC), active vitamin D analogs (VDA), and nutritional vitamin D (NVD) are the predominant vitamin D therapies (VDTs) commonly used for treatment (Tx) of secondary hyperparathyroidism (SHPT) in adults with stage 3 or 4 non-dialysis chronic kidney disease (ND-CKD) and vitamin D insufficiency (VDI). Clinical trials have demonstrated varying efficacy on serum total 25-hydroxyvitamin D (25D) and intact parathyroid hormone (iPTH) across VDTs. This study aimed to descriptively assess the real-world experience of various VDTs in increasing 25D, reducing iPTH, and modifying serum calcium (Ca).

Method

Medical records of the first 376 adult patients with stage 3 or 4 CKD and a history of SHPT and VDI who met study criteria from 18 geographically representative United States nephrology clinics were reviewed from 1 year before through 1 year after initiation of VDT. Key study variables included patient demographics, medication usage, and laboratory results. The study population had a mean age of 69.5 years with gender and racial distributions representative of the US ND-CKD population. Patients were stratified into cohorts based on their index therapy at index date: ERC (n=174), VDA (n=55) and NVD (n=147).

Results

Patients treated with NVD were predominantly CKD Stage 3 (69.4%), while CKD Stage 4 were the majority of those treated with ERC (53.4%) and VDA (61.8%). The ERC Tx’ed subjects demonstrated an increase in 25D by 23.7 ± 1.6 ng/mL (p<0.001) and a decrease iPTH by 35 ± 6.2 pg/mL (p<0.001) without statistically significant impact on serum calcium (Ca) and phosphorus (P) levels. The VDA Tx’ed group demonstrated an increase in 25D by 5.5 ± 1.3 ng/mL (p<0.001) without statistically significant impact on iPTH and serum phosphorus levels. Additionally, serum Ca increased by 0.2 ± 0.1 pg/mL (p<0.001) among VDA recipients. The NVD Tx’ed group demonstrated an increase in 25D by 9.7 ± 1.6 ng/mL (p<0.001) without statistically significant impact on iPTH and serum Ca and P levels (Table 1).

Conclusion

Clinical effectiveness and safety varied across VDTs. ERC was the only VDT which significantly reduced mean iPTH in the real world setting despite highest mean levels at baseline among the three cohorts. Additionally, subjects treated with ERC demonstrated the largest mean increase in 25D and ERC was the only VDT which raised mean 25D to the normal range (>30 ng/mL). Patients treated with ERC and NVD saw no statistically significant impact on serum Ca and P levels; however, those treated with VDAs saw a small, but statistically significant increase in serum Ca levels.
P0904EFFECT OF EMPAGLIFLOZIN ON SERUM MARKERS OF OSTEOCYTE AND OSTEOBLAST FUNCTION AND ALBUMINURIA IN DIABETIC AND NON-DIABETIC PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Masajtis-Zagajewska Anna , Pä™czek Katarzyna , Holub Tomasz , Nowicki Michal
Published: June 2020

Background and Aims

Sodium-glucose co-transporter 2 (SGLT2) inhibitors are new class of oral antidiabetic drugs that show potent cardio- and nephroprotective actions. Despite having a favorable safety profile the treatment with SGLT2 inhibitors has been associated with several side-effects including increased risk of fractures. Although the pathomechanism of this complication has not been elucidated these drugs may inhibit tubular reabsorption of phosphate which may stimulate a secretion of fibroblast growth factor 23 (FGF23).

The study was designed to assess the effect of SGLT2 inhibitor on markers of calcium-phosphate metabolism, bone turnover and early glomerular injury in diabetic and non-diabetic patients with stage 3 chronic kidney disease (CKD).

Method

41 patients with chronic kidney disease including 23 without diabetes (13 M, 11F, age 52.9±0.7 years, estimated glomerular filtration rate (eGFR) 38.6±10.8 ml/min/1.73 m2) and 18 with type 2 diabetes (12 M, 6F, age 58.8±1.4 years, eGFR 38.8±7.7 ml/min/1.73 m2) were recruited. Main inclusion criteria were CKD stage 3 and urine albumin secretion >100 mg/g creatinine. All subjects received oral empagliflozin 10 mg once daily for 7 days.

Serum calcium, phosphorus, parathormone (PTH), calcitriol, bone alkaline phosphatase (BAP), FGF23 and urine calcium, phosphate and albumin were measured at baseline and after 7 days of empagliflozin treatment.

Results

Plasma calcitriol, serum and urine calcium, phosphorus and BAP did not change significantly during the administration of empagliflozin. Urine phosphate/creatinine ratio was similar in both subgroups at baseline and did not change during empagliflozin administration. Plasma PTH was higher in non-diabetics than in diabetics both at baseline and after empagliflozin. The increase of PTH after empagliflozin tended to be higher in diabetic patients (p=0.07). There was only a trend towards an increase of serum FGF23 in both non-diabetic and diabetic subgroup (by 4.2±0.2 vs. 9.3±1.1 pg/mL, ns). BAP was significantly higher at baseline in diabetic patients but did not significantly change after empagliflozin in the subgroups.

Albumin/creatinine ratio decrease after empagliflozin administration was significant only in non-diabetic patients (-62±17 vs. -2±8 mg/g in diabetic patients, p=0.03 for difference).

Conclusion

Our study showed no effect of short-time administration of empagliflozin on calcium-phosphate and bone metabolism markers in patients with both diabetic and non-diabetic CKD. Empagliflozin decreased albuminuria significantly only in non-diabetic CKD that may suggest a potentially greater nephroprotective effect of this SGLT2 inhibitor in non-diabetic than in diabetic nephropathy.
P0905INFLUENCE OF TUMOR NECROSIS FACTOR ON MINERAL BONE DISEASE IN ESRD PATIENTS
Authors: Tosic Dragovic Jelena , Dimkovic Nada , Popovic Jovan , Djuric Petar , Naumovic Radomir
Published: June 2020

Background and Aims

Serum levels of parathyreoid hormone is the main cause of mineral disorders in patients on chronic hemodialysis, and it well known that this hormone acts as an uremic toxine and contributes to oxidative stress and overall mortality rate. However, there are many observations which imply that the protean manifestations of renal bone disease cannot be explained simply by abnormalities of PTH or vitamin D metabolites. For example, levels of PTH correlate relatively poorly with various parameters of bone histology. It has been shown that uremia leads to cytokijne imbalance with overbalance of proinflammatory citokines such as TNF. Also, studies showed that calcimimetic therapy decreases not only PTH levels, but also levels of TNF. The aim was to analyse tumor necrosis factor (TNF) gene polymorphisms in group of hemodialysis patients and to correlate the findings with presence of secondary hyperparathyroidism.

Method

This cross sectional study included 202 patients on regular hemodialysis for more than six months in University Medical Centar Zvezdara. Venous blood for genotyping and for PTH analysis was collected on midweek dialysis session from each patient. Genetic analysis was performed by using polymerase chain reaction. Patients are diveded in two groups regarding the level of PTH, so that first group had normal PTH levels or mild SHPT, while patients in second group had sever SHPT. We analysed influence of genetic polymorphism for TNF on apperance of SHPT.

Results

The results have shown 3 fold lower risk for developing SHPT in GG homozygots for TNF gene with statistical significance (p=0,01)- Table 1.

Conclusion

Parathyreoid gland hyperfunction is multifactorial disorder and there are emerging evidence that cytokines as endogenous modulators have an important impact on its pathogenesis.
P0918LONGITUDINAL TRAJECTORIES OF NUTRITIONAL PARAMETERS WITH ORAL NUTRITIONAL SUPPLEMENT USE AMONG NON-DIALYSIS CHRONIC KIDNEY DISEASE PATIENTS
Authors: Wong Michelle , Renouf Dani , Zheng Sophia , Sheriff Zainab , Levin Adeera
Published: June 2020

Background and Aims

Malnutrition and protein-energy wasting are complications of advanced CKD associated with increased risk of mortality and morbidity. In the province of British Columbia, Canada, a Nutritional Supplement Policy stewarded by renal dietitians guides prescription of oral nutritional supplements (ONS). To date, there have been a lack of studies assessing the effects of ONS among non-dialysis CKD patients (CKD-ND). The aim of the study was to assess longitudinal trajectories of nutrition, inflammation and associated biochemical parameters following initiation of ONS among CKD-ND patients.

Method

In this retrospective cohort study of adult CKD-ND patients who initiated follow-up at multidisciplinary Kidney Care Clinics during 2013-2015, we used radar charts to examine longitudinal trajectories of nutritional, inflammation and related parameters over 2 years, among patients who had at least one ONS prescription and who had available lab data for the following 8 parameters within any given time interval: body mass index (BMI), serum albumin, bicarbonate, phosphate, parathyroid hormone, ferritin, neutrophil-to-lymphocyte ratio (NLR) and haemoglobin. Mean values of each parameter were plotted at 6-month intervals from the first prescription of ONS, up to 29 months.

Results

There were 963, 692, 569, 481, 425 patients with available data during the intervals at month 0-5, 6-11, 12-17, 18-23 and 24-29 following the first ONS prescription, respectively. Mean serum albumin increased from a mean of 37 to 40 g/L over the 29-month period after ONS initiation, while mean NLR declined from 4.5 to 3.6 (Figure). Mean serum ferritin also declined slightly from 293 to 261 µg/L at 3 months and remained stable thereafter. There were small fluctuations in mean BMI (range 24.5 to 25.1 kg/m2), bicarbonate (range 24 to 25 mmol/L), PTH (range 15.5 to 18.0 pmol/L). Mean haemoglobin rose from 108 g/L in the first interval to 116 g/L in the last interval. Mean serum phosphate changed minimally from 1.4 to 1.3 mmol/L.

Conclusion

Among CKD-ND patients who had at least one ONS prescription, serum albumin increased, while there was a decrease in inflammation parameters (NLR and ferritin), and other variables had small fluctuations over the 2+ year follow-up. Future analyses will include multivariable-adjusted models to assess the associations of ONS treatment with nutritional variables and with clinical outcomes, including progression to end-stage kidney disease.
P09235-AMINOLEVULINIC ACID PREVENTS LIPID-INDUCED ER STRESS AND APOPTOSIS BY INDUCING HEME OXYGENASE-1
Authors: Mae Yukari , Kobayashi Yui , Takata Tomoaki , Hosokawa Kohshiro , Sugihara Takaaki , Kanda Tsutomu , Isomoto Hajime
Published: June 2020

Background and Aims

A growing number of evidence indicates the association with dyslipidemia and the progression of chronic kidney disease. Endoplasmic reticulum (ER) stress and apoptosis in renal tubule are suggested to be linked to the pathophysiology of toxic lipid-induced kidney injury. 5-aminolevulinic acid (ALA) is a precursor of heme oxygenase (HO)-1, which plays an important role in protecting cells from various stresses. In the present study, we aimed to investigate the therapeutic effect of ALA, on toxic lipid-induced ER stress and apoptosis in the renal tubule.

Method

Renal proximal tubular epithelial cells (RPTECs) were treated with palmitic acid to induce ER stress and apoptosis. ALA was also added with palmitic acid (PA). The gene and protein expressions of NF E2-related factor 2, HO-1, glucose-regulated protein (GRP)78, and C/EBP-homologous protein (CHOP) were quantified. Apoptotic cells were evaluated by caspase-3/7 assay. An HO-1 inhibitor, Zn-protoporphyrin IX, was added to investigate the involvement of HO-1 in ALA-mediated therapeutic effect on the ER stress and apoptosis.

Results

The expressions of GRP78 and CHOP increased in cells treated with PA. Apoptotic signals also increased with PA treatment. ALA induced a significant increase in the HO-1 expression and that led to the suppression of ER stress response. Apoptotic signals in PA-treated cells also decreased with ALA and the effect of ALA disappeared when combined with Zn-protoporphyrin IX.

Conclusion

PA-induced ER stress and apoptosis in RPTECs. ALA has a therapeutic effect by suppressing ER stress, possibly through HO-1 induction.
P0928PHYSICALLY ACTIVE PATIENTS IN HEMODIALYSIS: DO THEY HAVE A DIFFERENT EATING PATTERN AND BODY COMPOSITION?
Authors: Garagarza Cristina , Valente Ana , Caetano Cristina , Ramos Inês , Pinto Mariana , Oliveira Telma , Ferreira Manuel Anibal A , Sousa Guerreiro Catarina
Published: June 2020

Background and Aims

Body composition influences outcomes in hemodialysis (HD) patients. These patients need to follow specific nutritional recommendations and physical activity has been highly encouraged. The aim of this study was to evaluate if there are differences in body composition and in dietary patterns between physically active and no physically active HD patients.

Method

This was a multicenter observational cross-sectional study where 582 HD patients from 38 dialysis centers were enrolled. Clinical parameters were recorded and body composition analysis was performed with the Body Composition Monitor®. Dietary intake and physical activity were obtained respectively from the Food Frequency Questionnaire and from the International Physical Activity Questionnaire, both validated for the Portuguese population. For the analysis, patients were divided in 2 groups: physically active (PA), if they follow the World Health Organization recommendations, and no physically active (NPA). T-student and non-parametric tests were performed to compare means and medians respectively. A p<0.05 was considered significant.

Results

Mean age was 67.8 ±17.7 years, 41.4% were female, 31.6 % had diabetes mellitus and median HD vintage was 65 (Interquartil range:43-104) months. PA patients were younger (p<0.001) and had a higher energy intake (p= 0.017), protein (p=0.016), total fat (p=0.023) and omega 3 fatty acids (p=0.006). Regarding body composition; higher total body water (p=0.027), intracellular water (p=0.002), lean tissue index (p=0.002), % lean tissue mass (p=0.001), body cell mass (p=0.001) and lower % fat (p=0.003) was found in PA patients. Urea pre-dialysis (p=0.013), albumin (p=0.026), creatinine (p< 0.001) and 6 months weight gain (p=0.047) were higher in PA patients whereas age-adjusted Charlson comorbidity index (p<0.001) was lower in these patients. No statistically significant differences were observed among other nutrients or parameters studied nor in body mass index, HD vintage or overhydration.

Conclusion

These data shows that, after comparing PA patients with NPA, differences were observed in body composition and clinical parameters related to a better nutritional status. Moreover, the PA patients` dietary intake was more approximated to the existing recommendations for this population, namely for energy and protein daily intake.