bluuebunny/crossref_metadata_2025 huggingface dataset:
MO320: Risk Factors and Outcomes Related to Acute Kidney Injury Among Enhanced Recovery After Surgery (ERAS) Colorectal Surgery
Authors: Fernandes Adriana , Ribeiro Daniel , Carvalho Sofia , Raimundo Mário , Almeida Edgar
Published: May 2022

BACKGROUND AND AIMS

Enhanced recovery after surgery (ERAS) protocol is an evidence-based programme that englobe more restrictive fluid therapy to maintain euvolemia and the use of multimodal analgesia, which includes non-steroidal anti-inflammatory drugs (NSAIDs). Consequently, it's pertinent to assess the risk and potential consequences of acute kidney injury (AKI) in the short and medium term.

METHOD

A descriptive and single-center retrospective study, which included 428 patients that were submitted to colon-rectal surgery according to ERAS protocol between November 2016 and May 2020. AKI was defined according to KDIGO criteria.

RESULTS

Data were collected from 428 patients. AKI occurred in 25.2% of patients (108), mostly KDIGO 1 (63.9%) and 6.5% required haemodialysis. The median time of follow-up was 25.6 months (IQ 15.6–38.8). Patient-related variables that positively influenced AKI were ASA Class III/IV [F (1, 426) = 23.2; P < .001], diabetes [F (1, 426) = 9.96; P = .002], severe heart disease [F (1, 426) = 7.12; P = .008], CKD [F (1, 425) = 11.58; P < .001], obesity [F (1, 423) = 14.21; P < .001] and use of ACE inhibitors/ARBs [F (1, 425) = 17.4; P < .001]. Preoperative and surgery-related variables that influenced AKI were preoperative haemoglobin [F (85, 338) = 1.36; P = .030], open approach [F (1, 424) = 21.5; P < .001], NSAIDs [F (1–426) = 5.77; P = .017], iodinated intravenous contrast exposure [F (1, 424) = 26.8; P < .001), postoperative support aminergic [F (1, 424) = 18.9; P < .001], surgery complications [F (1, 426) = 36.5; P < .001] and blood transfusion [F (1, 426) = 10.15; P = 0.002].

AKI group had a superior length of stay (9 versus 6 days; P < .001), ICU admission (31.5% versus 8.8%; P <.001), readmission at 30 days (12% versus 5.6%; P = .027) and mortality (23.1% versus 6.6%; P < .001). Kaplan–Meier analysis showed that the AKI group was associated with lower survival (log-rank test = 26.601; P < .001). We also found that the AKI group was associated with a greater reduction in GFR after 2 years (3.3 mL/min/1.73 m2 versus 1.8 mL/min/1.73 m2; P = .009).

CONCLUSION

AKI was frequent among ERAS patients and was associated with worst outcomes—higher costs (since it was associated to longer hospitalization, higher readmission at 30 days and ICU admission), higher risk of reduction in GFR in the first 2 years and higher mortality.
MO321: The Critical Role of Cytokine Dysregulation in Acute Kidney Injury Development in Patients With COVID-19
Authors: Moreno-Amaral Andrea N , Soares Tozoni Sara , de Castro Deus Marina , Carolina Gadotti Ana , Clara Flórido Ana , Bohnen Gabriela , Bacarin Monte Alegre Julia , Sousa Dias Erika , Proença de Moraes Thyago
Published: May 2022

BACKGROUND AND AIMS

One of the complications described in critically ill patients in intensive care units with severe COVID-19 was acute kidney injury (AKI). The pathophysiology of AKI in patients with COVID-19 is multifactorial. In addition to the direct virulence of SARS-CoV-2 in renal cells, the tissue inflammation and local immune cell infiltration, cytokine storm, secondary infections and nephrotoxicity associated drugs may contribute to AKI [1]. Mounting evidence throughout the pandemic suggests that patients with severe COVID-19 may have a cytokine storm syndrome, one of the possible causes of AKI in these patients [2]. The present prospective cohort study analysed the correlation between circulating cytokine profile and estimated glomerular filtration rate (eGFR) in patients with COVID-19.

METHOD

After signing the informed consent, patients positive for SARS-CoV-2 infection (n = 74) had blood samples (n = 139) collected at hospital admission until the day of the outcome. ELISA measured the cytokines IL-10, IL-4, L-6, TNF-α and IFN-γ, and the eGFR was calculated by the CKD-EPI Cystatin C equation. Statistics description: Continuous variables were checked for normality and presented as mean ± standard deviation or median and interquartile range. The association between continuous variables is shown in scatterplots, and a predicted response with 95% confidence interval (95% CI) is plotted using fractional polynomials. For linear correlations, we obtained P-values using Pearson's correlation coefficient.

RESULTS

There is a more significant distribution of eGFR below 90 mL/min in the population studied, associated with older patients. Glomerular filtration rates were negatively correlated with age as expected (–0.60; P < 0.0001). Lower eGFR was correlated with levels of proinflammatory cytokines such as IL-6 (–0.33; P < .0007) and TNF- α (–0.21; P < .03); but without positive correlation with IL-10 (0.04; P < 0.68) or IFN-γ (–0.14; P < .16), even though higher IFN-γ levels have been linked to a worse prognosis in patients with severe COVID-19 [3]. Curiously, a positive correlation was observed between lower eGFR and IL-4 levels.

CONCLUSION

These results demonstrate that a shift in the immune response profile, cytokines with a Th2 profile such as IL-4, and cytokines with systemic functions such as IL-6 and TNF-α can be related to renal failure. The elucidation of the potential pathophysiological mechanisms of AKI associated with COVID-19 as well as monitoring of cytokine levels can (a) help to identify patients with severe COVID-19 at risk of loss of renal function, (b) provide information on specific therapeutic strategies.
MO330: AKI and Renal Parenchyma Attenuation in Hospitalized Patients With COVID-19
Authors: Russo Elisa , Tagliafico Alberto , Signori Alessio , Brigati Francesca , Cappadona Francesca , Derchi Lorenzo , Martinoli Carlo , Viazzi Francesca
Published: May 2022

BACKGROUND AND AIMS

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had a worldwide spread since early 2020 and a lot of studies concerning the diagnostic and prognostic role of chest computed tomography (CT) on coronavirus disease (COVID-19) has been published. Renal involvement might be present in up to 75% of cases, significantly impacting on the prognosis.

The aim of this study is to clarify the role of opportunistic kidney assessment on non-enhanced chest CT and to evaluate if radiological findings could be associated with relevant clinical information regarding kidney function and patient's prognosis in hospitalized patients with COVID-19.

METHOD

We collected data on patient demographics, comorbidities, chronic medications, vital signs, baseline laboratory test results and in-hospital treatment in patients with COVID-19 consecutively admitted to our Institution who underwent chest CT. The standard chest CT-scan acquired in full inspiration include large part of both kidneys as per protocol. Three regions of interest (ROI) of 0.5–0.7 cm2 were positioned in every kidney, right and left to include both the cortex and the medulla. The mean values of attenuation of kidney regions were analysed. The primary and secondary outcomes were the occurrence of acute kidney injury (AKI), in-hospital and 9 months of death for all causes.

RESULTS

A total of 86 patients with COVID-19 and unenhanced chest CT were analyzed splitting the cohort into CT renal parenchyma attenuation (RPA) quartiles. Patients with a CT RPA below 24 Hounsfield unit (HU) were more likely to develop AKI when compared with other patients (×2 = 2.77, P = .014). An AKI-specific cut-off point of RPA was identified by performing a survival receiver operating characteristic (ROC) curve. At multivariate logistic regression analysis, being in the first quartile of CT RPA was associated with a four-times higher risk of AKI (Table 1) after adjustment for age, gender, hypertension, kidney function at admission and other comorbidities. During a mean 22 ± 15 days of admission, 32 patients died (37.2%). Patients with lower values of RPA at CT (first quartile, <24 HU) were not at a higher risk of death compared with patients with RPA ≥ 24 HU, as shown by Kaplan Maier curve (Fig. 1) and by multivariate Cox regression analysis [HR 1.84 (95% CI 0.82–4.13); P = .14].

CONCLUSION

The association between AKI and RPA < 24 HU was independent of age, gender, creatinine and comorbidities. RPA values seemed to be predictive of AKI development in COVID-19 patients who underwent chest CT, suggesting RPA values could significantly improve patients’ care. The opportunistic measure of RPA could help physicians identifying patients with a higher risk of AKI, and this increased awareness could guide choices for diagnostic and therapeutic procedures.
MO333: Prevalence of COVID-Associated Renal Injury in ICU and Prognosis of Proximal Tubular Dysfunction in Acute Respiratory Distress Syndrome
Authors: Bobot Mickaël , Heim Xavier , Max Howard , Simeone Pierre , Velly Lionel , Bruder Nicolas , Forel Jean-Marie , Carvelli Julien , Stein Claire , Hraiech Sami , Boucraut José , Gainnier Marc , Mege Jean-Louis , Guervilly Christophe , Jourde-Chiche Noemie , Papazian Laurent , Burtey Stephane
Published: May 2022

BACKGROUND AND AIMS

During COVID-19, the renal impairment is the most frequent after lung impairment and is associated of poor prognosis particularly in the intensive care unit (ICU). In this work, we aim to assess the incidence of acute kidney injury (AKI) in COVID-19-related acute respiratory distress syndrome (ARDS) patients, the existence of an early renal dysfunction and its prognosis, and its specificity compared with patients with non-COVID ARDS.

METHOD

This a prospective and multicentric study led in four ICUs. Patients of 18 years and older in ICU with invasive mechanical ventilation for ARDS were enrolled. Precise evaluation of renal dysfunction markers, including urinary protein electrophoresis, was performed within 24 h after the onset of mechanical ventilation.

RESULTS

From March 2020 to September 2021, 131 patients in ICU for ARDS were enrolled, 98 COVID-19 ARDS and 33 ARDS from other causes. There was more tubular profile in COVID-19 patients (68% versus 24%; P = .001) and a more mixed, tubular and glomerular profile in non-COVID-19 patients (29% versus 14%; P = .001). COVID-19 patients displayed an important tubular proteinuria, tended to display more AKI (49% versus 31%; P = .07), and had a longer duration of mechanical ventilation (18 versus 10 days; P = .002) and longer ICU length of stay (23 versus 15 days; P = .013). In COVID-19 patients, tubular proteinuria was associated with poor renal prognosis with a significant association with the onset of KDIGO ≥ 2 AKI.

CONCLUSION

COVID-19 ARDS patients had a specific renal impairment with tubular dysfunction, which appeared to be of poor prognosis on kidney and disease evolution.
MO335: Reaching SCR 4.0 mg/dL, the Magical Number for KDIGO-2012 AKI Stage 3. Is it Adequate for Stratifying Severity of Acute on Chronic Kidney Disease?
Authors: Acosta-Ochoa Isabel , Lorenzo Arturo , Coca Armando , Martínez Manrique María , Ardura Paula , Lucía Valencia Ana , Mendiluce Alicia
Published: May 2022

BACKGROUND AND AIMS

Reaching a SCr ≥ 4 is one criterion of classification for stage 3 in the KDIGO-2012 AKI guidelines. No previous study has challenged this arbitrary cut point by comparing its performance on how patients with pure AKI (pAKI) versus acute on chronic kidney disease (AoCKD) reach that ‘magical number’, and how it affects the prognosis.

METHOD

Retrospective study of patients with AKI, classified according to the KDIGO-2012 guidelines. We analysed a sub-group of patients that reached a maximum SCr ≥ 4 and divided them in pAKI (basal eGFR ≥ 60) and AoCKD (≥15–≤59). We evaluated epidemiological and clinical variables, and compared the clinical outcomes needed for HD, in-hospital mortality and HD dependence at discharge. As 21 (6%) of AoCKD individuals already had a basal SCr ≥ 4.0, they were excluded in the analysis.

RESULTS

A total of 492 individuals met the inclusion criteria: 341 (69%) in the AoCKD group. Individuals in this group were older and had a higher Charlson's index. Table 1A summarizes the comparison of clinical characteristics, all patients in the pAKI group reached a four SCr with a rate of SCr increments ≥ 3×. We found no statistically significant difference in in-hospital mortality and the need for HD. The AoCKD group was more dependent on HD at discharge (Table 1B). Figure 1 shows the rate of SCr increments by which individuals reached > 4.0 mg/dL.

CONCLUSION

We found that individuals in the AoCKD group differ in their basal characteristics from the pAKI group and need lesser increments in SCr to reach the magical number of 4.0 mg/dL to be classified in stage 3. May be, one size does not fit all, and individuals with prior CKD may benefit from a lower rate of SCr increase to stratify AKI severity. We consider that a pitfall in this staging criterion consists in the small portion of patients in the AoCKD group that have a basal SCr ≥ 4.0, with a skew to AKI-KDIGO stage 3.
MO382: Validation of a Handheld Point-Of-Care Creatinine/EGFR Meter for Evaluating Renal Function
Authors: Begos Dennis , Milojkovic Bogdan
Published: May 2022

BACKGROUND AND AIMS

Measurement of glomerular filtration rate (GFR) is a cumbersome, time consuming, and expensive process, thus estimated GFR (eGFR) has become a commonly accepted surrogate or screening tool for individuals suspected to have kidney disease. Until recently this required testing through phlebotomy and a large laboratory analyzer. Nova Biomedical (Waltham, MA, USA) has developed a point-of-care (POC) handheld device, the NovaMax Cr/eGFR System that is able to measure creatinine (Cr) and calculate an eGFR using a fingerstick (1.2 µL) of whole blood.

METHOD

A group of 517 subjects (48% male) were recruited for study at three different Clinical Research Organizations (CRO's). The patient population was from both healthy cohorts and those known to have CKD. Creatinine and eGFR was tested on all subjects using a finger stick sample with the NovaMax System and compared with venous blood on a Siemens RXL (Siemens Medical Solutions, Malvern, PA, USA). The CKD-EPI formula was used to calculate eGFR.

RESULTS

The average age was 61.1 years (range 18–91). The range of Cr in the groups were as follows: NovaMax 0.57—>7 mg/dL (7 is the maximum reading), and for the Siemens 0.36–16.79 mg/dL. The range of eGFR was <7–127 mL/min/1.73 m2 on the NovaMax, and 4.3–137 mL/min/1.73 m2 on the Siemens.

See Table 1 for sensitivity and specificity results.

CONCLUSION

The NovaMax Cr/eGFR System is an acceptable alternative for eGFR measurement in patients with a wide range of renal function. Its ability to measure renal function in a variety of settings make it a very useful device for several patient populations: screening patients at risk for CKD or AKI, telenephrology, population screening in low- and middle-income countries, following patients post kidney transplant, and evaluating patients prior to and after contrast imaging studies, among other indications.
MO394: Health Related Quality of Life in Patients With End-Stage Renal Disease Before and After Starting Dialysis During Pandemic Covid-19
Authors: Pana Camelia , Tuta Liliana-Ana
Published: May 2022

BACKGROUND AND AIMS

Patients with end-stage renal disease (ESRD) have complex functional and social changes that affect their quality of life (QoL), leading to an increased cardiovascular risk, mortality and overall morbidity. Several studies showed that general QoL worsened after dialysis initiation but improved by 12 weeks. The influence of coronavirus (COVID-19) among pre-dialysis CKD patients starting dialysis during pandemic COVID-19 is challenging and still largely unexplored.

To evaluate the quality of life in patients with ESRD before and after initiating dialysis during pandemic COVID-19, in Constanta County, a south-eastern Romanian region.

METHOD

We assessed 59 patients (mean age = 61.65year ± 11.36, Male : Female = 3:1, 13.79% employee) with ESRD before and after dialysis started (T1–12 weeks and T2–24 weeks), using KDQOL–36™, in the interval of time of 1 year (May 2020–May 2021).

RESULTS

QoL was severely affected in patients with diabetes and hypertension, especially because of diet restrictions (58.6%, P < 0.01), fatigue (67.5%, P < 0.01), concerns about the kidney disease (72.4%, P < 0.05) and permanent need for medical services (48.6%, P = NS).

Most of the patients required acute initiation of haemodialysis on CVC (66.1%) due to uraemic manifestations and late referral, 34.4% started planned haemodialysis on AV fistula and 8.47% started planned peritoneal dialysis. An overall improvement of QoL was seen both in patients with urgent and planned dialysis initiation, in women group less than in males (P < 0.05). Among dialysis patients at T2, we have found significantly lower levels for mean Mental Component Summary (MCS), calculated as 45.9 ± 14.1, about 3.1 points less than the majority of other studies. The following mental health-related symptoms were claimed during the COVID-19 pandemic ‘second and third waves’: feeling sad, worrying, feeling nervous and trouble falling asleep, even though dialysis patients seemed less impacted by social distancing measures.

CONCLUSION

The initiation of dialysis was an important factor in improving the QoL in our ESRD patients and the type of dialysis and planned initiation contribute substantially to the patient's perception of the disease and influence the main psycho-social parameters of QoL. COVID-19 pandemic affected the QoL of patients that started dialysis in the established interval of time, especially the mean MCS score, probably associated with the high morbidity and mortality of Romanian ESRD and dialysis patients.
MO397: Association of Serum NT-PRO-BNP Level With Cardiometabolic Risk Factors in Different Stages of Chronic Kidney Disease Patients
Authors: Alam Ripa Roksana , Chowdhury Maa , Shahnoor Alam Kazi , Alam Babrul , Talukder Ashaduzzaman , Chaudhury Sr , Iqbal Masud
Published: May 2022

BACKGROUND AND AIMS

The role of cardiac biomarker, NT-pro-BNP and its rising over time may identify chronic kidney disease (CKD) patients at increased risk of cardiovascular morbidity and mortality. Additionally, this may be correlated with altered cardio-metabolic risk factors predicting adverse outcomes. In this study, serum NT-pro-BNP level at different stages of CKD patients was measured to observe its association with different cardiac and metabolic risk factors

METHOD

This was a cross-sectional study carried out on stable CKD patients, stages 1–5, attending the outpatient department of a tertiary renal care facility. Serum creatinine, estimated glomerular filtration rate (eGFR) and urinary ACR were measured as renal function tests. While cardio-metabolic risk factors included blood pressure, body mass index (BMI), lipid profile, serum albumin, uric acid and hsCRP. Statistical analyses of the results were obtained by using window-based computer software devised with Statistical Packages for Social Sciences (SPSS-22).

RESULTS

Patients of CKD 5 (30%), stage 4 (23%), stage 3 (26%), stage 2 (18%) and in stage 1 (6.7%) included 149 subjects. In stages 1–5 respectively, they were matched for age 48 ± 12, 48 ± 12, 51 ± 14, 50 ± 12, and 50 ± 11 years, (P = NS); BMI 24 ± 0.9 24 ± 1, 24 ± 1, 24 ± 1 and 24 ± 1 kg/m2, (P = NS) and serum creatinine was variable as 1.5 ± 1.5, 1.7 ± 0.7, 2.6 ± 2.0, 3.0 ± 1.6 and 5.7 ± 2.7mg% (P < 0.001). The mean NT-proBNP had a rising pattern in stages 1–5 showing 335 ± 674, 790 ± 1717, 1221 ± 1994, 2875 ± 6139 and 15645 ± 14741 pg/mL, (P < 0.001). There were positive correlations of NT-pro-BNP with serum creatinine (P < 0.001); CKD stages (P < 0.001). TG (P < 0.003); phosphate (P < 0.008) and negative correlation with serum albumin (P < 0.001).

CONCLUSION

Higher levels of NT-pro-BNP are seen in advancing stages of CKD. The positive association of NT-pro-BNP with lipids, phosphate and negative relation with albumin indicates its possible prognostic value for cardio-metabolic risk assessment.
MO404: Autophagy and Fibrotic Response is Genetically Determined in Mouse Mesangial Cells
Authors: Manzeger Anna , Mikone Krisztina , Mozes Miklos , Kokeny Gabor
Published: May 2022

BACKGROUND AND AIMS

C57Bl6/J (B6) mouse strain is resistant to several experimental models of renal fibrosis. Mesangial cells play an important role in the pathogenesis of glomerulosclerosis. Also, autophagy dysregulation was recently related to fibrosis. However, it is unclear whether autophagy dysregulation could be genetically determined in mice. Thus, we investigated autophagy and fibrotic response in primary mesangial cells isolated from fibrosis resistant (B6) and fibrosis prone (CBA) inbred mouse strains.

METHOD

Primary mesangial cells were isolated from 6-weeks old B6 and CBA male mice via magnetic bead separation technique. Glomerular outgrowths were maintained in RPMI medium for 21 days when cells were subcultured and characterized for mesangial markers. Mesangial cells with passage numbers P5 to P8 were seeded onto 24-well plates. Gene expressions were analyzed after 48-h of PBS (CTL) or TGF-β (10 ng/mL) treatment (n = 6/group). Data (mean ± SD) were analyzed using Kruskal–Wallis test.

RESULTS

Tgfb1 and Col1a1 expressions increased by 2.5-fold and 8-fold in TGF-β treated CBA cells as compared to B6 (P < 0.01), respectively. The expression of Egr1 (early growth response factor-1) that participates in both fibrosis and autophagy increased by 2-fold in TGF-β treated CBA cells but remained unchanged in B6 cells (P < 0.05). Similarly, the expression of core autophagy molecule Lc3b did not change in TGF-β treated B6 cells, but increased by 60% in CBA cells (P < 0.05), accompanied by 1.5-fold increase of Sqstm1/p62. On the other hand, the expression of Mtmr14 that negatively regulates autophagy decreased by 30% in TGF-β treated CBA cells but remained unchanged in B6.

CONCLUSION

We conclude that genetic background of mice highly influences the TGF-β induced fibrotic and autophagy response of mesangial cells. Our results corroborate previous reports on autophagy dysregulation associated to fibrosis.

FUNDING: Hungarian Academy of Sciences BO/00 304/20/5, ÚNKP-21–5-SE-1, NTP-NFTÖ-21-B-0045
MO418: The Risk of Renal Co-Morbidities in Celiac Disease Patients Depends on the Phenotype of Celiac Disease
Authors: Nurmi Rakel , Pasternack Camilla , Salmi Teea , Hervonen Kaisa , Koskinen Inka , Järvelin Jutta , Huhtala Heini , Collin Pekka , Mustonen Jukka , Kaukinen Katri , Mäkelä Satu
Published: May 2022

BACKGROUND AND AIMS

Albeit the association between renal disorders and celiac disease is still somewhat contradictory, an elevated risk of kidney diseases in patients with celiac disease has been shown [1, 2, 3]. Only case reports have described the link between glomerulonephritis and dermatitis herpetiformis, a cutaneous manifestation of celiac disease [4]. This study aimed to evaluate whether patients with various phenotypes of celiac disease have an increased risk of renal co-morbidities compared with matched references.

METHODS: The diagnoses of glomerulonephritis, diabetic nephropathy, interstitial nephritis and end-stage renal disease were collected from the Finnish National Hospital Discharge Register from 1970 to 2015 among 1440 celiac disease patients and 4296 age- and sex-matched references. Further, patients were divided into two cohorts, dermatitis herpetiformis and any other phenotype of celiac disease. We used Cox proportional-hazards model to compare the risk of renal co-morbidities between patients and reference individuals.

RESULTS

Celiac disease was positively associated with renal disorders even after adjusting for type 1 diabetes [hazard ratio (HR) 1.81, 95% confidence interval (CI) 1.18–2.76]. A 3-fold and 12-fold risk increase were seen for glomerulonephritis and IgA nephropathy, respectively. A similar risk increase for renal co-morbidities in dermatitis herpetiformis was not shown.

CONCLUSIONS: Celiac disease was associated with an increased risk of renal co-morbidities, especially glomerulonephritis. The risk depends on the phenotype of celiac disease. The possible association between renal disorders and celiac disease should be investigated more in the future and kept in mind also in clinical practice.
MO423: Does Renal Dysfunction Improve the Predictive Value of Hatch Score for Postoperative Atrial Fibrillation?
Authors: Gjerakaroska Radovikj Marija , Severova- Andreevska Galina , Jovev Sashko
Published: May 2022

BACKGROUND AND AIMS

Postoperative atrial fibrillation (POAF) is a frequent arrhythmic complication in cardiac surgery. Studies of this potential complication have not been able to elucidate its aetiology nor to identify the predictors of its occurrence. The aim of this study was to evaluate the predictive role of a renal dysfunction for POAF in patients undergoing cardiac surgery interventions. We also aimed to determine the role of renal dysfunction in improving the diagnostic accuracy of hypertension, age, transitory attack/stroke, chronic obstructive pulmonary disease, heart failure (HATCH) score for POAF.

METHOD

This prospective monocentric observational study included 178 consecutive patients who underwent cardiac surgery interventions in the State University Clinic for Cardiac Surgery of Skopje, Republic of North Macedonia, between September 2017 and September 2018. Patients were divided into two groups, according to the absence or occurrence of POAF. HATCH score was calculated and recorded for each patient. A new R-HATCH score was derived by the addition of renal dysfunction to the existing HATCH score and its predictive value for POAF was tested and compared to HATCH.

RESULTS

POAF occurred in 90/178 patients (50.56%). The average estimated glomerular filtration rate (eGFR) in the group developing POAF was significantly lower, 78.4 ± 26.9 versus 93.0 ± 29.0 mL/min/1,73m2 (P = 0.0005). Patients with GFR < 60mL/min/1.73m2 had almost a 5 times greater risk of developing POAF. The addition of renal dysfunction to HATCH score improved its predictive accuracy in our study. The area under the receiver operating characteristic curve increased from 0.73 to 0.76 (P < 0.001).

CONCLUSION

The addition of preoperative renal dysfunction could improve the diagnostic accuracy of HATCH score for POAF.
MO426: Elucidation of Mechanism of Low-Birth-Weight-Related Fsgs in Rats by Rna-Seq Analysis of Cultured Podocytes From Low-Birth-Weight Rats
Authors: Imasawa Toshiyuki , Hirano Daishi , Unoki-Kubota Hiroyuki
Published: May 2022

BACKGROUND AND AIMS

The pathogenesis of low-birth-weight (LBW)-related nephropathy has been considered to be the result of intra-glomerular hyperfiltration during growth due to the presence of low nephron numbers. On the other hand, we hypothesized that there may be pathogenic factor(s) other than low nephron number in LBW individuals [1]. We reported the results of proteomic analysis of the renal cortex of LBW rats to show that metabolic abnormalities should exist in the kidneys of LBW individuals [2]. However, our result of the previous study was obtained by analysis using the renal cortex, which did not allow us to interpret the mechanism of focal segmental glomerulosclerosis (FSGS) formation, the most typical pathological picture of LBW-related nephropathy.

METHOD

A total of 5 LBW rats (birth weight 4.38±0.08) were obtained by 55% caloric restriction to pregnant maternal rats. The normal-birth-weight (NBW) rats (birth weight 6.48±0.18) were obtained by feeding normal diets to pregnant maternal rats. Kidneys were removed at 4 weeks of age, and after isolation of the glomeruli by sieving of kidneys, primary culture of glomerular epithelial cells (podocytes) was performed. Then, mRNAs were extracted from the cultured podocytes after 7 days and RNA-seq analysis was performed using these mRNAs from LBW podocytes and NBW podocytes.

RESULTS

Gene expression of Nphs1 (nephrin), Nphs2 (podocin) Podxl (podocalyxin) was detected in all samples of both groups, confirming that podocytes were cultured. The number of transcripts detected was 17 967 genes. In addition, by comparison of mRNA expression levels between LBW podocytes and NBW podocytes, 107 genes (102 genes decreased in the LBW group and 5 genes increased in the LBW group) showed a False Discovery Rate (FDR) P -value (q-value) < 0.05 between the two groups. Furthermore, IPA (Ingenuity® Pathway Analysis) by using these 107 genes was performed. As a result, five candidates for the upstream master regulator were identified: TNF, SIRT1, SH2B1, C5 and GDF15 as shown in the Figure. The downstream of all these pathways contain TCS2. This gene has been implicated in FSGS formation, as we recently reported [3].

CONCLUSION

It is possible that TCS2 is involved in the mechanism of FSGS formation in LBW-related nephropathy.
MO432: The ESRD Progression Delayed by Transplanting 3D Printed Omental Patch
Authors: Jo Hyunwoo , Choi Boyoung , Kim Boyun , Ryu Jina
Published: May 2022

BACKGROUND AND AIMS

Renal fibrosis is one of the pathological hallmarks of chronic kidney disease (CKD) that can further progress to end-stage renal diseases (ESRD). Haemodialysis and kidney transplantation are the only feasible treatments of ESRD. In this study, a new treatment with autologous omental tissue was assessed to delay the progression of renal fibrosis. The omental tissue, a fatty structure, has been widely used in surgical procedures due to its immunologic, angiogenic characteristics and anti-fibrotic factors that enhance tissue repairs, cell proliferation and regeneration in a damaged tissue. Finally, we hypothesized that 3D printed omental patch can prevent renal fibrosis and help regenerate the damaged kidney in the animal model. The 3D printing can print cells and extracellular matrix uniformly to promote cell survival and differentiation during transplantation. The printing also can adjust the patch stiffness, providing a suitable environment for kidney recovery.

METHOD

Animal models of CKD were randomly divided into four groups: (A) sham-operated, (B) sham-operated + omental patch, (C) unilateral ureteral obstruction (UUO)-operated (Control) and (D) UUO-operated + omental patch. Micronized omental tissue as bio-ink was 3D printed in the form of a regular patch deformation. Then, the 3D printed omental patch was transplanted subcapsular layer of the kidney. All of the patches used in those groups were transplanted after 3 days of modelling. Kidneys were assessed histologically [Masson's Trichrome (MT), Sirius Red], by immunohistochemistry (α-SMA), molecular work (Bulk RNA sequencing, western blot) after 2 weeks of transplantation.

RESULTS

Omental patch treated group has been shown histologically less tubulointerstitial fibrosis and tubule atrophy by MT, Sirius Red staining. Particularly, the TGF beta mRNA expression level of the 3D printed omental treated group was decreased in the kidney, whereas the HGF level was significantly increased. Also, in terms of western blotting, pro-inflammatory and renal fibrosis markers (TGF-b, α-SMA) were all decreased. Moreover, in bulk RNA sequencing, we confirmed that STAT 3 kidney repair pathway and TF-beta signalling. From all those assessments we suggest that the induction of myofibroblasts and collagen deposition are all inhibited in the omental patch treated kidney model. The autologous 3D omental patch can prevent tubular atrophy and decreased tubulointerstitial fibrosis and this further delays the progression of ESRD.

CONCLUSION

The study demonstrated that the omental patch delays fibrosis and repairs tubule structure in the damaged kidney by providing protective effects to kidney disease. These studies indicate the feasibility of the use of the autologous omental patch in chronic kidney disease therapeutic effects and new treatment of renal replacement therapy (RRT).
MO433: Nitric-Oxide Precursors and Dimethylarginines as Risk Factors for Accelerated GFR Decline in the Non-Diabetic General Population
Authors: Balteskard Rinde Nikoline , Therese Enoksen Inger , Melsom Toralf , Fuskevag Ole-Martin , Odvar Eriksen Bjørn , Viljar Norvik Jon
Published: May 2022

BACKGROUND AND AIMS

Nitric oxide (NO) deficiency is associated with endothelial dysfunction, hypertension, vasoconstriction, atherosclerosis and chronic kidney disease (CKD) [1]. Reduced NO bioavailability is hypothesized to play a vital role in kidney function impairment and CKD. The worldwide prevalence of CKD is increasing and is a major contributor to morbidity and mortality. Differences in glomerular filtration rate (GFR) are only partly explained by conventional CKD risk factors [2]. Therefore, we investigated the association of serum levels of endogenous inhibitors of NO, asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) and precursors of NO, arginine, citrulline and ornithine, with a decline in GFR and new-onset CKD.

METHOD

In a prospective cohort study of 1407 participants in the Renal Iohexol Clearance Survey (RENIS) without self-reported kidney disease, cardiovascular disease, or diabetes, GFR was measured repeatedly with iohexol clearance during a median follow-up time of 11 years [3]. GFR decline rates were analysed using a linear mixed model, new-onset CKD (GFR < 60 ml/min/1.73 m2) with interval-censored Cox regression and accelerated GFR decline (the 10% with the steepest GFR decline) with logistic regression.

RESULTS

Neither ADMA nor arginine was associated with any outcomes. Higher SDMA was associated with a slower annual GFR decline and a lower arginine/dimethylarginine ratio with a steeper GFR decline. Higher levels of citrulline and ornithine were associated with accelerated GFR decline with an odds ratio (OR) of 1.43 [95% confidential interval (CI) 1.16–1.76] per standard deviation (SD) higher citrulline and an OR of 1.23 (95% CI 1.01–1.49) per SD increase in ornithine (Table 1). Higher citrulline was associated with new-onset CKD, with a hazard ratio of 1.31 (95% CI 1.05–1.63) per SD higher citrulline.

CONCLUSION

Associations between NO precursors and the outcomes suggest that NO-metabolism plays a significant role in the pathogenesis of age-related GFR decline, and the development of CKD in middle-aged people. Our findings warrant further investigation into the pathogenesis of NO-metabolism and the possible therapeutic targets and preventive measures.
MO434: Bemcentinib Targets Macrophage and Mesangial Cells in Renal Fibrosis
Authors: Magnus Grøndal Sturla , Hodneland Nilsson Linn , Blø Magnus , Boniecka Anna , Milde Eline , Jackson Akil , Gausdal Gro , Lorens James B
Published: May 2022

BACKGROUND AND AIMS

Renal fibrosis, a progressive process of extracellular matrix accumulation leading to renal failure, lacks effective treatment. Expression of the AXL receptor tyrosine kinase has been implicated in kidney injury and mesangial proliferation [1]. Inhibition of AXL signalling with the selective AXL kinase inhibitor bemcentinib reduces fibrosis and inflammation in murine models of unilateral ureteral obstruction (UUO) and in glomerulonephritis [2, 3].

METHOD

Male C57Bl/6 mice were subjected to UUO for 3 or 15 days and treated twice daily with vehicle or bemcentinib (50 mg/kg) by oral gavage. Kidneys were divided into pieces that were either dissociated into single cells for mass cytometry analysis or subjected to Sirius Red staining to evaluate collagen deposition. Samples for mass cytometry were stained with a 45-plex antibody panel, acquired on Helios, then cleaned and analysed using UMAP [4] for dimensionality reduction and PARC [5] for clustering. The effect of ligation was modelled with the least absolute shrinkage and selection operator (LASSO) using centered log-ratio transformed cluster compositions to predict the number of days of ligation. LASSO is a regression method that prevents overfitting by penalizing variables and is commonly used for variable selection.

RESULTS

Sirius Red staining confirmed, as previously published, reduced fibrosis development in kidneys from bemcentinib treated animals compared to the vehicle following 15 days of UUO. No significant effect of bemcentinib was observed after 3 days of obstruction.

Mass cytometry analysis yielded 31 clusters representing immune, endothelial, pericyte, mesangial and epithelial cells from proximal tubules, loop of Henle, distal tubules and collecting duct. AXL was expressed by pericytes, endothelial cells, mesangial cells and macrophages. Modelling with LASSO suggested that the most important feature of ligation was the expansion of mesangial cells. Bemcentinib treatment did not result in any significant changes in non-ligated kidneys and kidneys ligated for 3 days. At 15 days, post-bemcentinib treatment, the number of mesangial cells and macrophages decreased, while the number of epithelial cells comprising the proximal tubules and loop of Henle increased. The LASSO model estimation corresponded to an apparent reduction in disease progression of 30% (corresponding to day 10 or 11 post-ligation).

CONCLUSION

AXL targeting macrophages and mesangial cells delays the progression of kidney fibrosis in the UUO model and represents a valid approach to treat kidney disease.
MO462: Change in KDIGO Kidney Risk Category With Semaglutide Treatment—A Post Hoc Analysis of the Sustain 6 Trial
Authors: Tuttle Katherine , Bain Stephen C , Cherney David , Lawson Jack , Rasmussen Søren , Vrhnjak Blaz , Khunti Kamlesh
Published: May 2022

BACKGROUND AND AIMS

Glucagon-like peptide-1 receptor agonists, such as semaglutide, have been associated with reductions in albuminuria, and may preserve estimated glomerular filtration rate (eGFR) in people with type 2 diabetes (T2D). However, it has not been explored whether treatment with semaglutide affects a person's chronic kidney disease (CKD) risk category. The Kidney Disease: Improving Global Outcomes (KDIGO) risk category classification is a validated approach for defining the likelihood of CKD and cardiovascular (CV) disease progression, based on eGFR and urinary albumin-to-creatinine ratio (UACR). The aim of this analysis was to determine whether treatment with once-weekly (OW) semaglutide resulted in improvements in KDIGO risk category compared with placebo.

METHOD

The proportion of subjects with T2D moving to a lower KDIGO risk category, remaining in the same category or moving to a higher risk category between baseline and 2 years on treatment with OW subcutaneous semaglutide versus placebo was assessed post hoc using SUSTAIN 6 (NCT01720446) CV outcomes trial data. The endpoints were assessed for the overall population and by baseline KDIGO risk category (low, moderate, high and very high). Sensitivity analyses were conducted to investigate the contributions of UACR and eGFR to change in risk category.

RESULTS

Data from 2804 of the 3297 subjects randomized in SUSTAIN 6 were available for this post hoc analysis. At 2 years, in the overall population, subjects receiving OW semaglutide were more likely to move to a lower risk category (n = 183; 13.0%) than subjects receiving placebo (n = 114; 8.2%); odds ratio (OR; semaglutide versus placebo) 1.69 [95% confidence interval (CI) 1.32; 2.16, P < 0.0001) (Figure). Conversely, subjects receiving OW semaglutide were less likely to move to a higher risk category (n = 254; 18.1%) than those receiving placebo (n = 330; 23.6%); OR 0.71 (95% CI 0.59;0.86, P = 0.0003) (Figure). When the data were stratified by baseline KDIGO risk categories, across all categories, greater proportions of subjects receiving semaglutide than placebo moved to a lower risk category and lower proportions of subjects receiving semaglutide than placebo moved to a higher risk category (Figure). The effects of semaglutide on UACR and eGFR both contributed to the favourable change-in-risk-category profile compared with placebo (Table).

CONCLUSION

Subjects receiving semaglutide versus placebo were more likely to move to a lower KDIGO risk category and less likely to move to a higher risk category, both in the overall population and across KDIGO risk category subgroups. The potential kidney protective effects of semaglutide and the mechanisms underlying these are being investigated in subjects with T2D and CKD in the FLOW and REMODEL trials.
MO472: Comparison of the Quality of Life and Survival in Children Undergoing Hemodialysis Versus Peritoneal Dialysis: A Comparative Cross-Sectional Study
Authors: Mazighi Sara , Nabil Hamouche , Chettati Mariam , Fadili Wafaa , Laouad Inass
Published: May 2022

BACKGROUND AND AIMS

A child with end-stage renal disease (ESRD) hopes for a kidney transplant to avoid dialysis. Despite the recent priority rules for assigning transplants to children. Most of them, due to their young age, the time required to prepare for the transplant, and especially the limited availability of grafts, will go on dialysis. The objective of this study is to compare the quality of life and survival of children with ESRD treated by hemodialysis (HD) and those treated by peritoneal dialysis (PD).

METHOD

All children with end-stage renal disease under the age of 16 who started dialysis treatment between 2018 and 2021 were included, for a total of 72 children. Data were collected from an HRQOL questionnaire (Health Related Quality of Life ESRD Module questionnaire).

RESULTS

A total of 72 children on ESRD started dialysis between 2018 and 2021. A total of 62 children on hemodialysis (87.5%) versus 10 children on peritoneal dialysis. The mean age in our study was 10 years ± 8 years, with a 58% female predominance. Causal nephropathy was dominated by malformative uropathy in 36% of cases, indeterminate nephropathy in 24% and lupus in 12.5% ​​of cases. Growth retardation was observed in 49 children in our population (79%) (48 in HD versus 1 in PD P < .001). Residual renal function was preserved in 48.6% of our children with a state of normal extracellular hydration (HD 40%, DP 8%). The mean HD and DP hemoglobin level was 8 mg/dL. The initial GFR was 5 with an average urea level at the start of dialysis of 3 g (3 g for HD and 2 g for children on PD). The evolution was marked by the occurrence of complications in PD (6 peritonitis and 2 infections of emergence of KTT) and HD (arteriovenous fistulae hematoma in 10 children, secondary hyperparathyroidism in 65% of children), 10 children are deceased (1 in PD and 9 in HD). Children on PD have a lower co-morbidity and dialysis initiation is more planned.

CONCLUSION

PD remains the technique of choice in our context to ensure a better quality of life for children.
MO477: Predicting 1-Year Mortality After Haemodialysis Start: The Role of the Cha₂Ds₂-VASC Score
Authors: Marques Da Silva Bernardo , Mafalda Abrantes Ana , Branco Carolina , Costa Claudia , Peres Nadiesda , Cardoso Ana , Sant'ana Mariana , Agapito Fonseca José , Outerelo Cristina , Resina Cristina , António Lopes José , Gameiro Joana
Published: May 2022

BACKGROUND AND AIMS

Chronic kidney disease (CKD) is a significant cause of morbidity, cardiovascular and all-cause mortality. CHA2DS2VASc is a score system used in patients with atrial fibrillation to predict thromboembolic risk. However, it also appears to be useful to predict mortality risk. The aim of the study was to evaluate the CHA2D2SVASc score as a tool to predict 1-year mortality after starting haemodialysis and identify factors associated with higher mortality.

METHOD

Retrospective analysis of patients who started haemodialysis between January of 2014 and December of 2019 at Centro Hospitalar Universitário Lisboa Norte. We evaluated mortality within 1 year of starting haemodialysis. The CHA2D2SVASc score was calculated at the start of haemodialysis. Variables were submitted to univariate and multivariate analysis to determine factors predictive of 1-year mortality after HD start. We assessed the logistic regression method of the CHA2DS2VASc to predict 1-year mortality and the discriminatory ability was determined using the receiver operating characteristic curve.

RESULTS

Of 856 patients analyzed, the mean age was 68.3 ± 15.5 years, the majority were male (61.1%) and Caucasian (84.5%). Mortality within 1 year after haemodialysis started was 17.8% (n = 152). The CHA2D2SVASc score was significantly higher (4.4 ± 1.7 versus 3.5 ± 1.8; P < .001) in patients who died and accurately predicted the 1-year risk of mortality {AUC: 0.646, [95% confidence interval (95% CI) 0.6–0.7]; P < .001}, with a sensitivity 71.7% and specificity of 49.1%, a positive predictive value of 23.9% and a negative predictive value of 89.2%. In the multivariate analysis, CHA2D2SVASc ≥3.5 (adjusted OR: 2.24, 95% CI 1.48–3.37; P < .001] and central venous catheter at dialysis start (adjusted HR: 3.06, 95% CI 1.93–4.85) were significant predictors of 1-year mortality.

CONCLUSION

CHA2D2SVASc score ≥ 3.5 and central venous catheter at haemodialysis start were predictors of 1-year mortality, allowing for risk stratification in haemodialysis patients.
MO482: End-Stage Renal Disease in the Elderly: Dialysis or Conservative Management?
Authors: Denden Ghada , Ben Mahmoud Nouha , Ben Salem Meriem , Ben Salah Manel , Letaief Ahmed , Hammouda Mouna , Sabra Aloui , Skhiri Habib
Published: May 2022

BACKGROUND AND AIMS

Nowadays, end-stage renal disease (ESRD) is overrepresented in elderly patients. The presence of medical comorbidities, limited life expectancy, frailty and poor functional status in these patients poses substantial challenges in clinical decision-making and provision of optimal care. The decision to start dialysis or not should always be based on shared decision-making. The objective of our study was to compare clinical outcomes for patients who had chosen either maximum conservative management (MCM) or renal replacement therapy (RRT).

METHOD

This is an observational study of a single-center cohort in Tunisia that includes 152 elderly patients (>80 years), with chronic kidney disease (CKD) who consulted our center during the period from 1 January 2015 to 31 December 2016. Demographic and comorbidity data were collected on all patients. Then, we evaluated the management of patients who had reached the end stage of CKD during the study period (dialysis or conservative treatment), and we compared the survival of the two groups.

RESULTS

Of 152 patients, 54.6% were women. The mean age was 82 ± 2.6 years. High blood pressure, diabetes and dyslipidemia were the most common comorbidities. During follow-up, 65 patients have reached stage 5 of CKD. A total of 46.1% started dialysis and the rest received conservative treatment. Patients choosing dialysis were younger compared with those opting for conservative management and were less functionally impaired. Survival was better in those receiving conservative treatment: The mean survival was 24 months for RRT patients and 30 months for maximum conservative management (MCM) patients (P < .01). A total of 1- and 2-year survival rates were 76.3% and 22% in the dialysis group (n = 30) and 75.3% and 45% in the conservative group (n = 35), respectively.

CONCLUSION

When caring for older adults with advanced CKD who are contemplating dialysis therapy vs. conservative management, efforts must focus on promoting patient values and preferences, shared decision-making, and symptom burden alleviation.