bluuebunny/crossref_metadata_2025 huggingface dataset:
MO623EFFECT OF PLANTAR ELECTRICAL NERVE STIMULATION DURING ROUTINE HEMODIALYSIS PROCESS ON THE DAILY PHYSICAL ACTIVITY IN ADULTS WITH DIABETES AND END-STAGE RENAL DISEASE - A RANDOMIZED DOUBLE-BLINDED CONTROLLED TRIAL
Authors: Mishra Ram kinker , Al-Ali Fadwa , Hamad Abdullah , Ibrahim Rania , Mathew Mincy , Najafi Bijan
Published: May 2021

Background

Physical inactivity among patients undergoing hemodialysis (HD) is a long-standing clinical problem. While exercise could be beneficial, post-dialysis fatigue, limited time availability, and severe frailty to travel often lead to poor adherence to conventional exercise programs. To address this gap, we proposed testing an alternative therapy using intradialytic plantar electrical nerve stimulation (IPENS) provided during the routine hemodialysis process.

Methods

Participants were randomized into either an intervention group (IG: n=16, age=57.6±3.6 years, BMI=29.7±1.5 kg/m2, female=31%) or a control group (CG: n=15, age=63.5±1.6 years, BMI=29.9±1.6 kg/m2, female=41%). The IG received 1-hour IPENS during routine hemodialysis process (3 sessions/week) for 12 weeks. The CG was provided with an identical but non-functional device for the same period. Participants and therapy-providers were blinded to the group allocation. Daily life physical activity (e.g., cumulative postures including sitting, standing, lying, and walking; walking characteristics including step count, number of unbroken walking bout, and postural transitions including sit to stand and stand to sit) was monitored remotely at baseline and 12-week for a period of 48h using a validated pendant sensor. To determine the effect of intervention, we estimated Cohen’s effect size d. In addition, time effect, group effect, and time×group effect were estimated using general linear model.

Results

All participants in the IG tolerated the IPENS and completed all therapy sessions, indicating the feasibility. In the IG, we observed significant increase in time spent in standing (Cohen's d=0.8, p=0.039) and walking (Cohen's d=0.82, p=0.034), number of walking episodes (d=0.88, p=0.024), and number of postural transitions (d=0.93, p=0.018) with a decrease in the average duration for sit to stand transition (d=0.87, p=0.032) compared to the CG.

Conclusions

This is an ongoing study and our target sample is 100 eligible participants. This study provides earlier results on IPENS therapy's feasibility and effectiveness as an alternative to exercise programs to improve daily life physical activity among people undergoing routine hemodialysis process. If the results were held at a larger sample, we could recommend routine
MO625INHIBITION OF SGLT-2 CANNOT RESCUE NEPHRIN EXPRESSION IN DIABETIC NEPHROPATHY
Authors: Kotb Ahmed , Klanke Bernd , Kroll Jens , Schiffer Mario
Published: May 2021

Background and Aims

Early glomerular damage in diabetes is induced by high blood glucose level (hyperglycemia) which affects the glomerular filtration barrier and leads to proteinuria. Podocyte-specific proteins like the transmembrane protein nephrin form the slit diaphragm that is important for proper function of the glomerular filtration barrier. Sodium-glucose co-transporter 2 (SGLT2) specific proteins are involved in glucose reabsorption in the kidney and maintain the normal glucose level in the blood. Recent studies showed remarkable success of SGLT2-inhibition in patients with diabetic nephropathy. Therefore we wanted to study if hyperglycemia induced reduction of nephrin expression is affected bySGLT-2 inhibition. Therefore we induced hyperglycemia in zebrafish larvae by knockdown of Pancreatic duodenal homeobox 1 (Pdx1) transcription factor and treated zebrafish larvae with Empagliflozin. In parallel we treated Bl/6 mice with streptozotozin and treated them with Empagliflozin. We then analyzed nephrin expression in both model systems.

Method

Zebrafish is an ideal model to study glomerular diseases, because the zebrafish larvae develops a pronephros with high homology to the human glomerulus. In order to inhibit SLGT-2 after Pdx1-knockdown, we treated both control and diabetic zebrafish larvae with 10µM Empagliflozin from 1dpf to 5dpf. We used a zebrafish line that expresses a fluorescent Vitamin D binding plasma protein Tg(l-fabp:DBP:eGFP) to measure proteinuria by measuring the GFP signal in both retinal and glomerular vessels of 120 hpf larvae. Immunohistochemistry against nephrin was performed using a specific zebrafish antibody.

Results

Conclusion

Despite the promising effects of SLGT-2 inhibitor treatment in patients with diabetic nephropathy the early effects on nephrin expression are not addressed and remain an unchanged problem by this novel treatment option.
MO628IMPACT OF INDUCTION OF AUTOPHAGY BY RAPAMYCIN AND METFORMIN ON NATURAL HISTORY OF DIABETIC NEPHROPATHY IN RATS
Authors: Ahmed Samar , Samaan Emad , Abdallah Ibrahim Dina , Sayed-Ahmed Nagy , Sheashaa Hussein
Published: May 2021

Background and Aims

Impaired autophagy in the kidney resulted in podocyte loss and massive proteinuria in diabetic nephropathy. Improvement of autophagy by activation of mTORC1 and reduction of AMPK and Sirt1 may be a novel therapeutic option for the suppression of diabetic nephropathy.

Method

This experimental work was carried out on 48 adult male Sprague dawely rats. The total duration of the study was 10 weeks. All investigation and intervention were carried out at 3 time points, 3 weeks, 6 weeks, 10 weeks. The rats were randomly divided into healthy control group (n = 12) and 3 induced diabetic groups (n = 12 each), the three groups were the non-treated, treated with rapamycin and treated with rapamycin and metformin. To study autophagy, we use electron microscopy and immunohistochemical staining of kidney tissue with LC3 antibody

Results

Diabetic rats treated with rapamycin alone or rapamycin and metformin showed lower level of proteinuria and almost normal serum creatinine through all intervals of the study. Also, their Kidney tissue showed increased autophagosomes and high expression of LC3 compared to diabetic rats. There are no significant differences between both treated groups in terms of induction of autophagy during the experiment period.

Conclusion

we concluded that using a small dose of rapamycin for short duration in early diabetic rats is beneficial in halting the course of diabetic nephropathy, adding metformin to rapamycin aiming to potentiate its effect on autophagy seems to be less beneficial.
MO633GLYCAEMIC MARKERS IN PATIENTS WITH TYPE 2 DIABETES UNDERGOING HAEMODIALYSIS EVALUATED BY LONG-TERM CONTINUOUS GLUCOSE MONITORING*
Authors: Bomholt Tobias , Rix Marianne , Almdal Thomas Peter , Knop Filip K , Rosthøj Susanne , Heinrich Niels Søndergaard , Jørgensen Morten , Larsson Anders , Hilsted Linda , Feldt-Rasmussen Bo , Hornum Mads
Published: May 2021

Background and Aims

The reliability of haemoglobin A1c (HbA1c) as a glycaemic marker in patients receiving haemodialysis (HD) remains unknown. To assess accuracy, we compared HbA1c and fructosamine levels with interstitial glucose levels measured by continuous glucose monitoring (CGM) in patients with type 2 diabetes receiving HD.

Method

The HD group (maintenance HD and type 2 diabetes) comprised 30 patients who completed the study period of 17 weeks; the control group (type 2 diabetes and an estimated glomerular filtration rate >60 mL/min/1.73 m2) comprised 36 individuals. CGM (Ipro2®, Medtronic) for periods up to seven days was performed five times (with four weeks intervals) during a 16-week period. HbA1c and fructosamine were measured at week 17. The mean sensor glucose from CGM was compared with the measured HbA1c, its estimated mean blood glucose (eMBGA1c) and fructosamine levels.

Results

In the HD group, the mean sensor glucose from CGM was 1.4 (95% confidence interval [CI]: 1.0–1.8) mmol/L higher than the eMBGA1c, whereas the difference was 0.1 mmol/L (95% CI: -0.1–[0.4]; P<0.001) in the control group. Adjusted for the mean sensor glucose, HbA1c was -7.3 (95% CI: -10.0–[-4.7]) mmol/mol lower in the HD group than in controls (P<0.001), whereas no difference was detected for fructosamine (P=0.64).

Conclusion

HbA1c evaluated by CGM underestimates mean blood glucose levels in patients receiving maintenance HD; fructosamine appears to be more accurate. CGM-assessed blood glucose could complement or replace HbA1c in patients where HbA1c underestimates blood glucose levels.
MO642DAPAGLIFLOZIN HAS NO IMPACT ON SHORT-TERM BLOOD PRESSURE VARIABILITY IN PATIENTS WITH TYPE-2 DIABETES MELLITUS
Authors: Papadopoulou Eirini , Theodorakopoulou Marieta , Loutradis Charalampos , Tzanis Georgios , Tzatzagou Glyceria , Kotsa Kalliopi , Zografou Ioanna , Tsapas Apostolos , Karagiannis Asterios , Sarafidis Pantelis
Published: May 2021

Background and Aims

Increased blood-pressure-variability (BPV) is associated with increased cardiovascular and all-cause mortality in patients with type 2 diabetes mellitus (T2DM). Sodium-glucose co-transporter-2 (SGLT-2) inhibitors decrease the incidence of cardiovascular events, renal events, and death in this population. This study aimed to evaluate the effect of dapagliflozin on short-term BPV in patients with T2DM.

Method

This is a secondary analysis of a double-blind, randomized, placebo-controlled trial in 85 patients with T2DM (NCT02887677). Subjects were randomized to oral dapagliflozin 10mg once daily or placebo for 12 weeks. All participants underwent 24-h ambulatory blood pressure (BP) monitoring with the Mobil-O-Graph NG device at baseline and study-end. Standard deviation (SD), weighted SD (wSD), coefficient of variation (CV), average real variability (ARV) and variation independent of mean (VIM) were calculated with validated formulae for the 24-h and the daytime and nighttime periods.

Results

Dapagliflozin reduced 24-h brachial BP compared to placebo. From baseline to study-end 24-h brachial BPV indexes did not change with dapagliflozin (SBP-ARV: 11.51±3.45 vs 11.05±3.35; p=0.326, SBP-wSD: 13.59±3.60 vs 13.48±3.33; p=0.811) or placebo (SBP-ARV: 11.47±3.63 vs 11.05±3.00; p=0.388, SBP-wSD: 13.85±4.38 vs 13.97±3.87; p=0.308). Similarly, no significant changes in BPV indexes for daytime and nighttime were observed in any group. At study-end, no differences between the groups were observed for any BPV index. Deltas (Δ) of all indexes during follow-up were minimal and not different between-groups (SBP-wSD: dapagliflozin: -0.11±3.05 vs placebo: 0.12±4.20; p=0.227).

Conclusion

This study is the first to evaluate the effects of an SGLT-2 inhibitor on short-term BPV in patients with T2DM, showing no effect on dapagliflozin on all BPV indexes studied.
MO644:DIABETES AND DIALYSIS:PROPOSAL FOR A CONTAGION PREVENTION PROTOCOL IN COVID-19 PANDEMIA
Authors: Satta Ersilia , Romano Carmine , Della Corte Tersa , Raiola Ilaria , Alfarone Carmelo , Gembillo Guido , Latte Gianluca , Polverino Mario , Gentile Sandro
Published: May 2021

Background and Aims

After the official coronavirus (SARS-CoV-2) pandemic declaration by the WHO, Italy had the second-largest number of confirmed cases, after China. The Italian government introduced progressive infection-mitigation measurements, thus dramatically reducing social interactions and preventing virus spread. During the summer, infection containment measures progressively loosened until, due to an unjustified interpretation of some permissions and the excessive utilization of public transportation at school reopening, the contagion rate progressively increased until causing a severe challenge for our NHS again. Aim of the study: to assess the efficiency of our previously described protocol in 18 Campania region-located Nefrocenter Consortium DCs as further adapted to new knowledge under the new ubiquitous contagion conditions and to identify SARS-CoV-2-infection mortality rate and risk factors.

Method

Dialysis patients did so too during that period according to the expected shifting prevalence over time (mean ± SD: 853 ± 30 per month; range 825 to 873) ± (11.8% in April, and 14.8% in November vs. a pre-COVID-19 12.0% rate in January).

Results

More patients got infected in November (10.19%) than in April (0,24%), and 22 patients of the 89 from the SARS-CoV-2 November positive subjects required hospitalization for moderate-severe symptoms (24.72%), with death unavoidably coming in 19 (86.36% of hospitalized and 21.35% of infected patients) compared to the only one recorded in April (0.12%). The pandemic's two periods showed a strong association between mortality rate and often co-existing comorbidities, primarily represented by arterial hypertension, type 2 diabetes mellitus (T2DM), and chronic kidney disease (CKD).

Conclusion

The prevously efficient contagion containment measures adopted by our DCs were not enough in November to fight the global infection risk pending on the whole Italian social community around. The Authors discuss possible reasons and put forward further suggestions for the best handling of any future infection waves
MO650EMPHYSEMATOUS PYELONEPHRITIS IN TYPE 2 DIABETES – CLINICAL PROFILE AND MANAGEMENT
Authors: Bhat Dr Sanjay , Kaul Anupma , Rai Priyanka , Srivastav Rohit
Published: May 2021

Background and Aims

Emphysematous pyelonephritis (EPN) is a rare but life-threatening acute suppurative infection of the kidney among diabetics. There is no current consensus on management of EPN.

Method

A prospective observational study was conducted at Department of General Surgery at RML institute of Medical sciences , Lucknow as well as at Eras Lucknow medical college, Lucknow from 2015-2018 to look for clinical, microbial profile and treatment outcome of diabetic patients with emphysematous pyelonephritis.

Results

A total of 76 Diabetic patients diagnosed with pyelonephritis were identified, of which 15 patients were diagnosed with EPN (26.3%). The mean age of the patients was 58.4±6.5 years. Mean duration of diabetes was 5.3 ± 3.3 years. 12 (82%) of the 15 patients with DM had a glycosylated hemoglobin A1C level higher than 7.5. Renal dysfunction at presentation was seen in 11 (73.3%) patients. Among the unilateral involvement, left kidney was more affected. Escherichia coli in 11 (73.3%), Klebsiella sp. in 1 (6.6%), Pseudomonas in 1 (6.6%), and 1 each with polymicrobial and fungal UTI respectively. Of 15 EPN patients, 13 (86.6 %) survived and 1 (6.6 %) expired. 2 of them underwent nephrectomy both survived. All patients with Stage I, II and IIIa EPN (n = 12) were managed with antibiotics with or without PCD. In EPN Stage IIIb/IV (n = 3), all the 3 (20 %) patients were managed with antibiotics and PCD and later 2 (13.3%) needed nephrectomy. Only time to diagnosis, altered sensorium, shock at presentation and thrombocytopenia were associated with poor outcome in EPN patients (P < 0.05) Multiple logistic regression tests showed shock (P = .04) and and disturbance of consciousness (P = .05) on hospital admission as being the independent factors for poor outcome.

Conclusion

EPN in diabetics needs high index of suspicion, timely diagnosis and good multidisciplinary approach with adequate antibiotics and surgical management for better patient outcomes.
MO634SEMAGLUTIDE IN REAL LIFE PRACTICE DECREASES ALBUMINURIA IN HIGH RISK PROGRESSION CHRONIC KIDNEY DIABETIC PATIENTS
Authors: Aviles Beatriz , García de Lucas Maria Dolores , Perez Belmonte Luis , Jiménez Millán Anabel , Rivas Ruiz Francisco
Published: May 2021

Background and Aims

Semaglutide has shown safety and efficacy in type 2 diabetic patients (DM2) in extensive clinical studies including patients until eGFR>15ml/min/1.73m2. Our aims are to analyse the changes in metabolic and renal parameters in chronic diabetic patients after 12 months of treatment in real life practice with semaglutide.

Method

Retrospective observational study. Inclusion criteria: Patients over 18 years old with DM2 and eGFR(CKD-EPI)>15 ml/min/1.73m2. We selected cases with eGFR<60 ml/min/1,73m2 and/or albuminuria/Creatinineu (albu/creatu)>30 mg/g treated with semaglutide in real life practice for 12 months. Our main objectives were to assess the changes in HbA1c and weight. Secondary objetives to analyse evolution of albuminuria (albu/creatu), eGFR(CKD-EPI), blood pressure (BP), lipidic profile and adverse events. Statistics anlysis: we used descriptive, student's t, McNemar (paired data), method by steps forward; SPSS v 19.0.

Results

We included 122 patients, 62% males, mean age 51,43 ± 33 years, time of DM2 12.3 ± 3.4 years, body mass index (BMI) 35.8 ± 4.79, 25% had retinopathy, 93.4% hypercholesterolemia and 97% were hypertensive, 18% were active smokers. Mean Albu/Creatu: 349.49 ± 863.16 mg/g and mean eGFR (CKD-EPI): 50.32 ± 31.47 ml/min/1.73m2. Previous cardiovascular events: 36.5% myocardial infarction, 41% congestive hearth failure, 10% peripheric arteriopathy and 6% strokes. 42.6% were already on iSGT2 who were kept and 64.8% were switched from other GLP-1ar. After 12 months of treatment with semaglitude HbA1c reduced -0.74 ± 0.41% obtaining a mean objective <7% (from 7.57±1.36 to 6.83±0.85, p<0.0001). Patients decreased weight in -6.95 ± 6.0 Kg (from 98.48±16.6 to 91.53±16.42 p<00001) more than -5% of total body weight in 69% of cases. Albuminuria reduced in -162,21 mg/g ± 365,77 (from 349.49±863.16 to 187.287±897.39 p<0.0001, 53% reduction). eGFR(CKD-EPI) remained with a low increased of 2,2 ml/min/1.73m2. Systolic and Diastolic BP decreased -9.85 ± 13.34 mmHg (from 129.95±11,27 to 120.09±09 p < 0.0001) and -5.92 ± 7.43 mmHg (from 77.05±8.95 to 71.12±7.83 p< 0.0001) respectively. LDL-cholesterol and triglyceridemia decreased in -10.79 ± 28.21.09 mg/dl (p <0.0001) and -29,15 mg/dl ± 91,47 (p <0.0001) respectively. 5 % of patients on insulin had mild hipoglycemic episodes. Our patients needed 25% less units of rapid insulin (p<0.01). Semaglutide was stopped in 5% of cases (65% because digestive intolerance).

Conclusion

Chronic kidney diabetic patients with grade 3 albuminuria after 12 months of treatment in real life practice with semaglutide improved their glycemic control (mean final HbA1c <7%), with 25% less needs of rapid insulin. 69% of them decreased their total body weight in > 5%. We observed 53% reduction of albuminuria and better control of blood pressure.
MO652EFFECT OF ESTIMATED GLOMERULAR FILTRATION RATE (EGFR) ON HEMOGLOBIN CHANGE INDUCED BY SODIUM-GLUCOSE COTRANSPORTER 2 INHIBITORS (SGLT2I)
Authors: Maroto Alba , Domenech Ester , Marques Vidas Maria , López Paula , Portoles Jose' M
Published: May 2021

Background and Aims

The use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) is associated with increase of hemoglobin (Hb) levels and this effect has been related to improvement of tubulointerstitial hypoxia and increase on EPO production. Chronic kidney disease (CKD) associated anemia is mainly due to decreased EPO synthesis. The aim of this study was to assess if the degree of Hb increase induced by SGLT2i is higher on T2DM patients with decreased estimated glomerular filtration rate (eGFR).

Method

We analyzed the changes on Hb after 12 months of SGLT2i treatment in T2DM patients with different degrees of eGFR. All patients were on maximum tolerated RAA system blockade, and none was on erythropoiesis or iron therapy.

Results

62 patients were include, age 67,6 ± 12,3 years, 72.6% males, eGFR CKD EPI 62,9 ± 21 (21-108) ml/min/1.73m2. Type of SGLT2i was dapagliflozin (46.8%), canagliflozin (30,5%) and empagliflozin (22,6%). 7 patients discontinued SGLT2i therapy and 62 were finally include in the analysis. Treatment with SGLT2i induced increase of Hb levels ( ΛHb 0,57 mg/dl SE 0,17 95% CI 0,25-0,93, p 0,001) independently of eGFR (aR2 0.02 p ns) In the multivariate analysis, initial eGFR, and basal Hb were the main determinants of the Hb increase induced by SGLT2i treatment (aR2 0,29). eGFR (≤60 vs >60 ml/min/173) or type of SGLT2i did not modified ΛHb

Conclusion

We conclude that SGLT2 inhibitors induce increase on Hb level independently of eGFR, in patients with preserved renal function, by mechanisms that are yet to be determined.
MO636THE ROLE OF DIFFUSION-WEIGHTED MRI AND APPARENT DIFFUSION COEFFICIENT IN ASSESSMENT OF DIABETIC KIDNEY DISEASE: PRELIMINARY EXPERIENCE STUDY
Authors: Taha Mohamed
Published: May 2021

Background and Aims

Diabetic kidney disease is the most common cause of ESRD. There is poor correlation between the degree of renal fibrosis and current screening markers. A noninvasive imaging technique is needed to assess the degree of structural changes in the kidney.

Method

Forty adult diabetic patients with chronic kidney disease as well as 20 age- and sex-matched adult healthy controls were recruited from Nephrology Department of our University Hospital. All patients underwent renal MR-DWI and ADC mapping on a 1.5-T scanner (Philips Achieva) using phased array body coil.

Results

Among the studied 40 diabetic patients, five groups of patients were resulted 8 patients for each and the ADC values were inversely correlated with advancement in renal parenchymal affection, ie, in late stages of the disease the ADC values were lower than in early stages. The mean ADC values of renal parenchyma in patients with diabetic kidney disease were considerably lower than that of healthy controls with normal renal function (2.1± 0.3x10− 3 mm2/s vs 2.4± 0.1x10− 3 mm2/s with p< 0.001).

Conclusion

ADC value is a possible noninvasive technique in evaluating the stage of renal dysfunction with assessment of disease progression.
MO637THE HIDDEN PREVALENCE OF DIABETIC KIDNEY DISEASE IN A HOSPITAL-BASED REAL-WORLD DATA ANALYSIS
Authors: Marques Vidas Maria , Maroto Alba , Domenech Ester , López Paula , Tornero Molina Fernando , Portoles Jose' M
Published: May 2021

Background and Aims

Correct identification of diabetic kidney disease (DKD) in type 2 diabetes mellitus (T2DM) patients is crucial to implement therapeutic interventions to prevent disease progression and premature death.

Method

We have analyzed the prevalence of DKD according to lab criteria and the rate of identification of DKD and/or chronic kidney disease (CKD) on 516,578 hospital care electronic medical records (EMR) in a tertiary hospital-based population using Savana Manager®.

Results

Out of 24,129 T2DM patients, 15,304 met inclusion criteria. DKD was defined as eGFR<60 ml/min/1.73m2 or urinary albumin to creatinine ratio (UACR) >30 mg/g or urinary protein to creatinine ratio (UPCR) >0.3 g/g after excluding acute kidney injury (AKI). A total of 4,526 (29.6%) T2DM patients had DKD according to lab criteria. However, the terms “CKD” or “DKD” were only present in 33.1% and 7.5% of the 4,526 EMR, with a hidden prevalence of CKD and DKD of 66.9% and 92.5%, respectively. Less severe kidney disease (lower UACR or UPCR, higher eGFR values), female sex, and lack of insulin prescription were associated with the absence of “DKD” or “CKD” terms in EMR (p<0.001) in the patients fulfilling laboratory criteria for DKD. However, while younger age (<70 years) was associated with a missing CKD diagnosis, older age (≥70 years) was associated with a missing DKD diagnosis in EMR.

Conclusion

In conclusion, the prevalence of DKD among T2DM patients according to laboratory data is higher than prevalence based on specific diagnosis written in EMR. This could imply underdiagnosis of DKD, especially in patients with less severe disease who may benefit the most from optimized therapy
MO789SERUM SOLUBLE TRANSFERRIN RECEPTOR IS A PROMISING MARKER OF IRON DEFICIENCY ANEMIA IN PREVALENT HEMODIALYSIS PATIENTS
Authors: Abouseif Khaled , Abdallah Hussein , Abdulhady Marwa , Zaki abdelmegied Shaimaa
Published: May 2021

Background and Aims

End stage renal disease (ESRD) is chronic inflammatory condition which affects iron parameters. Serum soluble transferrin receptor (sTfR) is a reliable indicator for assessing iron status in inflammatory conditions. This study evaluates the usefulness of serum sTfR in iron deficiency anemia detection in prevalent hemodialysis patients.

Method

This case-control study included 40 ESRD patients on conventional hemodialysis with CRP>10, 40 ESRD patients with CRP<10 and 8 apparently healthy controls. Serum sTfR was measured for all patients and controls.

Results

STFRs predicts iron deficiency anemia in prevalent hemodialysis patients at cut off value 12.5 mg/l with area under curve 0.949, sensitivity 88.75, specificity 100, PPV 100% and NPV 47.1%. The prevalence of STFRs in patients with CRP<10 was 85%, while in patients with CRP>10 was 92.5% (P-value 0.288). Patients who have elevated STFRs have risk 1.22 times to have iron deficiency anemia if CRP <10 (odds ratio: 1.22) and 3.14 times if CRP>10 (odds ratio: 3.14). There was significant difference on comparing patients with CRP<10, CRP>10 and control as regard haemoglobin and STFR with P-value 0.0001 and 0.0001 respectively. Post Hoc analysis showed significant difference between the patients with CRP<10 and control also in patients with CRP>10 and control as regard haemoglobin and STFR (p value <0.0001). on comparing patients with CRP<10 with patients with CRP>10 there was significant difference in STFRs p value 0.0001 despite no significant difference in haemoglobin (p value 0.642) and classic iron markers (s.iron, TIBC, TSAT) with p value 0.701, 0.192, 0.382 respectively. Serum STFRs was negatively correlated with s.iron and Kt\v in patients with CRP <10 (r -0.372, P-value 0.018) and (r-0.416, p value 0.008) respectively.

Conclusion

Serum soluble transferrin receptor is a highly sensitive and specific marker of iron deficiency anemia in hemodialysis patients especially with high CRP level.
MO792CONTEMPORARY MINERAL AND BONE DISORDER MARKERS AND TREATMENT AMONG HEMODIALYSIS PATIENTS IN THE EUROPEAN DIALYSIS OUTCOMES AND PRACTICE PATTERNS STUDY (DOPPS)*
Authors: Bieber Brian , Dasgupta Indranil , Evenepoel Pieter , Jacobson Stefan H , Messa Piergiorgio , Vega Almudena , Weinreich Thomas , Karaboyas Angelo , Robinson Bruce , Pisoni Ronald
Published: May 2021

Background and Aims

Chronic kidney disease mineral and bone disorder (CKD-MBD) is characterized by abnormalities in serum calcium, phosphorus, and parathyroid hormone (PTH) and associated with morbidity and mortality. Previous publications from the Dialysis Outcomes and Practice Patterns Study (DOPPS) have demonstrated country differences in the prevalence and treatment of CKD-MBD among hemodialysis patients in participating European countries. We aim to compare the distribution of CKD-MBD related labs and treatments across countries in a contemporary population of European hemodialysis patients.

Method

DOPPS is an international prospective cohort study of hemodialysis patients ≥18 years of age. Patients are enrolled randomly from a representative sample of dialysis facilities within each nation at the start of each study phase. The current analysis includes n=1,701 patients from 91 facilities in the initial prevalent cross section of Europe DOPPS phase 7 (2019-present; Belgium, Germany, Italy, Spain, Sweden, UK). Results from Belgium should be considered preliminary as initial questionnaire completion is ongoing.

Results

The % of patients with a high PTH (>600 pg/mL) ranged from 6% in Italy to 24% in the UK, with 12-17% having high PTH in all other countries. Mean serum total calcium ranged from 8.7 in Germany to 9.1 mg/dL in the UK (Table). Mean serum phosphorus varied from 4.5 in Belgium to 5.3 mg/dL in Germany. Dialysate calcium of 2.5 mEq/L was predominant in Germany, Sweden, and the UK while 3.0 mEq/L was the most common prescription in Belgium, Italy, and Spain. Calcimimetic prescription ranged from 13% in the UK to 32% in Spain. Etelcalcetide prescription ranged from 1% in the UK to 12% in Spain and 14% in Italy. Active vitamin D prescription ranged from 27% in Belgium to 75% in Sweden. Nearly all vitamin D prescriptions were administered intravenously in Spain versus about half in Italy; in all other countries, the route of active vitamin D administration was primarily oral. Patient age and dialysis vintage varied by country, potentially contributing to some of the observed country differences in MBD marker levels and treatment practices.

Conclusion

CKD-MBD related abnormalities in PTH, serum phosphorus and calcium remain common in European dialysis patients, with prevalence varying considerably by country. Substantial international variation in CKD-MBD treatments was also observed in prescription of vitamin D and calcimimetics. Uptake of the relatively new calcimimetic, etelcalcetide, varied considerably by country. A detailed understanding of the effect of treatment variation on CKD-MBD marker levels and patient outcomes is needed to provide important insights for the European HD community in optimizing management of secondary hyperparathyroidism.
MO801SAFETY AND EFFICACY OF DENOSUMAB IN HEMODYALISED PATIENTS UP TO 48 MONTHS TREATMENT FOLLOW-UP
Authors: Ierace Rita Chiara , Moioli Alessandra , Festuccia Francescaromana , Fofi Claudia , Barberi Simona , Mene' Paolo
Published: May 2021

Background and Aims

Osteoporosis in hemodialysed (HD) patients with Chronic Kidney Disease - Mineral Bone Disorder (CKD-MBD) is a debilitating clinical condition with complex therapeutic management. In fact, most of the drugs commonly used to counteract osteoporosis are generally contraindicated when Glomerular Filtration Rate (GFR) is lower than 30 ml/min. Denosumab (DMab) is a monoclonal antibody approved for the treatment of osteoporosis and does not require dose adjustment in case of impaired renal function. For this reason, since 2014 this drug has been used by nephrologists for the treatment of osteoporotic patients also in hemodialysis. Although the interest and diffusion in this specialized clinical field are growing, only few data are still available in literature.

The aim of the study was to evaluate the efficacy and safety of denosumab in long-term therapies in hemodialysed patients.

Method

Since November 2013, a total of 19 hemodialysed patients have been treated with denosumab annually (4) or semi-annually (15) for up to 48 consecutive months. During the course of therapy, the laboratory parameters of osteo-mineral metabolism were monitored, and Qualitative UltraSonography (QUS) or Computerized Bone Mineralometry (CBM) were used alternatively, every 30 months and every 2 years, respectively (depending on guidelines recommendation for both radiological methods and timing).

Results

7/19 patients completed at least 30 months of follow-up, observing a substantial stability of blood calcium and phosphorus values, against a reduction in the mean values of B-CrossLaps and ostase (respectively from 2975.32 to 1852.25 pg/ml and from 28.13 to 11.93 mcg/L). Comparison of QUS exams demonstrated improved T-score (-4.71 to -4.17) and reduced fracture risk (13% to 8%). The results of the CBMs confirmed the stability of the bone disease at the spine and the improvement of the Tscore at the femoral level (from -3.5 to -3).

It should be noted that in our samples two patients achieved the longest observation period (48-month follow-up in continuous therapy), in which the stability of bone damage was observed at CBM compared to the start of treatment.

Only one fracture has been recorded.

Conclusion

We underline that close biochemistry monitoring and careful evaluation of the therapeutic procedures before and after DMab administration helped us to minimise and promptly correct adverse effects due to hypocalcemia. In addition we are particularly satisfied to report in most patients a significant reduction of pain and an improvement of mobility.

The results collected are consistent with acceptable safety and demonstrated efficacy of denosumab in hemodialysis patients.
MO805CAUSAL PATHWAY-BASED PHYSIOLOGICAL MODELING OF VASCULAR CALCIFICATION IN HEMODIALYSIS PATIENTS
Authors: Cherif Alhaji , Voelkl Jakob , Kotanko Peter
Published: May 2021

Background and Aims

Vascular calcification (VC) is common sequelae in chronic and end-stage kidney diseases (CKD/ESKD), and is associated with multiple risk factors, including disturbed bone metabolism and mineral disorders (CKD-BMD), uremia, leading to increased morbidity and mortality. The mechanism involves multiple physiological processes and is not well understood. The study aims to develop a causal pathway-based physiological model describing patient-specific drivers of vascular calcification.

Method

We develop a causal pathway-based physiological modeling that utilizes clinical data to identify patients with high risks of progression of VC and cardiometabolic diseases to provide multifactorial intervention strategies targeting the risk factors. We investigate the response of pulse pressure (PP, a proxy for pulse wave velocity) to parathyroid hormones (PTH), calcium (Ca), phosphate (PO4), calcium-phosphate product (CaPO4), neutrophil-lymphocyte ratio (NLR), and albumin (Alb). Pulse pressure may account for both cardiac and vascular conditions (e.g., atrial fibrillation, aortic insufficiency, arterial stiffness or arteriovenous malformation, aortic valve stenosis, cardiac insufficiency or cardiac tamponade).

Results

We demonstrate the causal pathway of PTH, Ca, PO4, NLR, and Alb on PP, and find that there are likely paths from PTH, Ca, PO4, CaPO4, NLR to PP, where the strength of the relationships vary from patient to patient. Figure 1 shows a representative patient. Figure 1(a) shows the longitudinal data for the aforementioned clinical parameters. Using a subset of the data (1 year was used), we extracted causal relationships between the clinical (Fig. 1(b)). As shown in Fig. 1(c), some of the relationships are physiologically consistent with current knowledge of the PTH, Ca, and PO4 disturbances on CKD-BMD, vascular calcification being one of the axes. Also, NLR is a measure of inflammation, which is also known to promote vascular calcification. Further, potential pathways were also detected, namely the direct or mediated effects of Alb and PTH on PP (as shown in Figs. 1(b)-(c)). Using these pathways, a dynamic model describing these interactions can be used to prescriptive investigate the impact of the dynamics on the progression of calcification.

Conclusion

From the clinical variables, the method was able to extract both known and potential drivers for changes on PP for the representative patients. Additional study is needed to confirm these relationships both prospectively, clinical investigation of potential pathways, and to further observe the long-term clinical manifestation of vascular calcification.
MO808THE IMPACT OF PARICALCITOL FOR PARATHYROID GLAND SIZE OF SHPT PATIENTS WITH LONG-TERM MAINTENANCE HEMODIALYSIS: AN OBSERVATIONAL STUDY
Authors: Tao Chenghui
Published: May 2021

Background and Aims

This is an observational study to assess effectiveness of paricalcitol for treating secondary hyperparathyroidism (SHPT) patients with long-term maintenance hemodialysis, via changes in biochemical indexes, such as Calcium (Ca), Phosphate (P) and Parathyroid Hormone (PTH), and size of parathyroid gland (PG).

Method

This single-centre and small sample study included 11 Long-term maintenance hemodialysis patients with SHPT, who were undergoing SHPT treatment with paricalcitol in the Blood Purification Centre of Fengdu people’s hospital, Chongqing, China, from December 2018 to October 2019. We collected biochemical indexes including Ca, P and iPTH, and imaging parameters of PG via ultrasonography (volume and number), evaluating variations between baseline and Month 11 of post-treatment.

Results

Compared to baseline, the maximum diameter lines (Fig 1) of PG decreased significantly (mean 15.727 mm vs 10.936 mm, P=0.005) after 11 months’ treatment, though the minimum diameter lines (Fig 2) decreased without statistical difference (mean 6.727 mm vs 5.255 mm, P=0.089). The number of glands was less in Month 11 than that of baseline (mean 2.455 vs 2.182, P=0.277) and iPTH declined significantly (mean 1045.109 pg/ml vs 610.934 pg/ml, P=0.001). The overall effective rate of paricalcitol was 90.9% after 11 months’ treatment. Moreover, there were no significant changes in serum calcium and phosphorus levels during the whole treatment.

Conclusion

Intravenous paricalcitol can decrease the size and number of parathyroid gland, and reduce iPTH concentrations in SHPT patients with Long-term maintenance hemodialysis, without significant influence for serum Ca and P levels.
MO799IS COMBINATION OF MAINTENANCE HEMODIALYSIS WITH HEMOPERFUSION AN EFFECTIVE METHOD IN MANAGEMENT OF RENAL OSTEODYSTROPHY AND INFLAMMATION IN HEMODIALYSIS PATIENTS?
Authors: Beciragic Amela , Mutevelic-Turkovic Alma , Dervisevic Amela , Äœengiä† Roljiä† Badema , Masnic Fahrudin , Coric Aida , Ajanovic Selma , Prohic Nejra
Published: May 2021

Background and Aims

Some of the conditions which occur in maintenance hemodialysis (MHD) patients with a high incidence resulting in a decline in their quality of life, include malnutrition, renal osteodystrophy, refractory hypertension and chronic systemic inflammation. In developing countries, due to the low level of economic development, low-flux dialysis is the main means of extracorporeal blood purification therapy. But it can hardly remove the middle and large molecule uremic toxins and protein-bound toxins; as a result, the patients suffer from long-term complications and poor quality of life. In this study, we attempted to investigate whether the combination of maintenance hemodialysis (MHD) with hemoperfusion (HP) could improve the clearance rate of middle and large molecule uremic toxins so as to improve their uremic complications.

Method

A total of 54 patients, who underwent routine hemodialysis, were assessed in this study. Those patients were randomly divided into two groups: Group 1 (27 patients) received combined treatment of HD with hemoperfusion (HP) in this regimen: HD 2 times a week with HD+HP once a week two times in a row, then after two weeks, and afterwards once a month as a maintenance treatment. Group 2 (27 patients) was only undergoing maintenance HD 3 times a week. The clinical and laboratory properties of both groups were followed up for 18 months, whereas the primary outcomes included normal clinical data, high sensitive C-reactive protein (hsCRP), immunoreactive parathyroid hormone (iPTH), phosphorus (P04), calcium (Ca), albumin, iron (Fe), total iron binding capacity (TIBC), hemoglobin, Epo doses and types of hypertensive drugs.

Results

At the end of the 18-month observation, the serum concentration of albumin, P04, hsCRP, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were lower with Group 1 than with Group 2 (p<0.05). Whereas, higher levels of iPTH were noticed in group 1, but when the laboratory and clinical data are analysed of the group 1 alone a statistically significant lower values after the observational period are noticed especially in the serum values of iPTH (p<0.05), P04 (p<0.001), CRP (p<0.011), SBP and DBP (p<0.05).

Conclusion

HD+HP was superior to HD in regularly eliminating middle and large molecule uremic toxins accumulated in the body which is mostly shown through reducing the values of iPTH and hsCRP. These findings suggest a potential role for HD+HP in the treatment of inflammation and renal osteodystrophy as well, because lowering these values of iPTH leads to a normalization of other minerals which is expected and therefore leads to a stabilization of this long-term uremic complications, which can improve the overall general condition of the MHD patient.
MO721THROMBOTIC EVENTS AFTER COVID-19 INFECTION IN HEMODIALYSIS PATIENTS*
Authors: Shabaka Amir , Gruss Enrique , Landaluce-Triska Eugenia , Gallego-Valcarce Eduardo , Cases Corona Clara Maria , Ocaña Javier , Tato Ribera Ana , López Katia , Furaz-Czerpak Karina R , Fernandez Juarez Gema Maria
Published: May 2021

Background and Aims

There is an increased risk of thrombotic complications in patients with COVID-19. Hemodialysis patients are already at an increased risk for thromboembolic events such as stroke and pulmonary embolism. The aim of our study was to determine the incidence of late thrombotic complications (deep vein thrombosis, pulmonary embolism, stroke, new-onset vascular access thrombosis) in maintenance hemodialysis patients after recovery from COVID-19.

Method

We performed a retrospective cohort study of 200 prevalent hemodialysis patients in our center at the start of the pandemic. We excluded incident patients after the cohort entry date and those who required hemodialysis for acute kidney injury, and excluded patients with less than 1 month follow-up due to kidney transplantation or death from non-thrombotic causes.

Results

185 prevalent hemodialysis patients finally met the inclusion criteria; 37 patients (17.6%) had SARS-CoV-2 infection, out of which 10 (27%) died during the acute phase of disease without evidence of thrombotic events. There was an increased risk of thrombotic events in COVID-19 survivors compared to the non-infected cohort (18.5% vs 1.9%, p=0.002) after a median follow-up of 7 months. Stroke incidence was 38.9 episodes/1000 patient-years in patients infected with SARS-CoV-2, compared to an incidence of 2.8 episodes/1000 patient-years in non-infected patients during the follow-up period. The median time from diagnosis of SARS-CoV-2 to the first thrombotic event was 62 days (interquartile range 5-118 days). Survival analysis with Kaplan-Meier curves revealed an increase in the rate of thrombotic events after SARS-CoV-2 compared to non-infected patients (see Figure 1). Mean survival from thrombotic event was 6.1±0.4 months in the COVID-infected group, compared to 6.97±0.04 months in the non-infected group (p<0.001). Multivariate regression analysis showed that COVID-19 infection increased risk for late thrombotic events adjusted for age, sex, hypertension, diabetes, antithrombotic treatment and previous thrombotic events (OR 26.4, 95% CI 2.5-280.6, p=0.01). Clinical and laboratory markers did not predict thrombotic events.

Conclusion

There is an increased risk of late thrombotic complications in hemodialysis patients after infection with COVID-19. Further studies should evaluate the benefit of prolonged prophylactic anticoagulation in hemodialysis patients after recovery from COVID-19.
MO734CONTRIBUTION OF SOLUBLE ST2 TO THE EFFECT OF RIGHT VENTRICULAR DYSFUNCTION ON MORTALITY IN HEMODIALYSIS PATIENTS
Authors: Romero-González Gregorio , Ravassa Susanna , Diaz-Dorronsoro Agnes , De la Fuente Ana , Garcia-Fernandez Nuria , Rojas Miguel A , Lorenzo Ignacio , García-Trigo Isabel , Mateo-De Castro Francisco M , López Begoña , González Arantxa , Diez Javier
Published: May 2021

Background and Aims

Right ventricular dysfunction (RVD) has been shown to predict mortality in patients with kidney failure. It has been proposed that RVD in these patients is mediated by inflammatory and fibrotic mechanisms, which may be enhanced by hemodialysis (HD). The present study aimed to investigate the potential associations between RVD and circulating biomarkers of myocardial inflammation and fibrosis with all-cause mortality in HD patients.

Method

We performed a retrospective single-centre cohort study of prevalent patients admitted in a chronic HD program for more than 3 months. Clinical characteristics and echocardiographic parameters were assessed in all patients. Pre-dialysis blood samples for measurement of inflammatory (e.g., C reactive protein, interleukin-1, interleukin-18) and fibrotic (e.g., soluble suppression of tumorigenesis-2 [sST2], galectin-3, C-terminal pro-peptide of procollagen type I and N-terminal pro-peptide of procollagen type III) biomarkers were collected. Right ventricular dysfunction (RVD) was defined using tricuspid annular plane systolic excursion (TAPSE) <1.7 cm or pulsed Doppler peak annular velocity (S´) <9.5 cm/s. The ability of sST2 to discriminate between mortality was assessed using AuROC curve.

Results

We enrolled 48 patients (mean age 74 [64–79] years, 62.5% males) followed over a period of 1.4 years. Mortality was higher 45.5% (log-rank, p=0.003) in patients with RVD as diagnosed by S' than in patients without RVD. No difference in mortality was observed for RVD defined by TAPSE. There were no differences in the morphology and function parameters of the left ventricle between patients with and without RVD. From all biomarkers measured only sST2 was associated with RVD. Indeed, an age- and sex-adjusted analyses showed that doubling of sST2 was inversely associated with a decreased in S´ (estimate=-2.03, 95% CI [-3.04 to -1.00] cm/s; P=0.002). Mortality was increased in patients with sST2 ≥40.45 ng/mL compared to patients with sST2 <40.45 ng/mL (66.7% vs. 18.9%, log-rank; p=0.004). Crude analysis showed that patients presenting with S’ <9.5 cm/s and sST2 ≥40.45 ng/mL exhibited higher mortality (log-rank; p=0.001) than patients with S’ >9.5 cm/s and sST2 <40.45pg/mL.

Conclusion

Albeit preliminary these findings suggest that an excess of sST2 may be involved in RVD and on its effect on mortality in HD patients. The myocardial pro-remodeling effect of sST2 among HD patients with RVD warrants further investigation.
MO735INTERPLAY BETWEEN GDF-15 AND LEFT VENTRICULAR HYPERTROPHY IN END-STAGE RENAL DISEASE PATIENTS ON DIALYSIS
Authors: Coimbra Susana , Catarino Cristina , Faria Maria do Sameiro , Lopes Nunes José Pedro , Rocha Susana , Valente Maria João , Rocha-Pereira Petronila , Bronze-da-Rocha Elsa , Bettencourt Nuno , Beco Ana , Homem Melo Marques Sofia , Oliveira José Gerardo , Madureira José , Miranda Vasco M P , Belo Luís , Santos-Silva Alice
Published: May 2021

Background and Aims

Cardiovascular disease (CVD) is the major cause of mortality and morbidity in chronic kidney disease (CKD), especially in end-stage renal disease (ESRD) patients. Left ventricular hypertrophy (LVH) is a common cardiovascular complication in CKD. Growth differentiation factor (GDF)-15 increases in tissue injury and inflammatory states associated with cardiometabolic risk. GDF-15 and N-terminal pro B-type natriuretic peptide (NT-proBNP) are both synthesized by cardiomyocytes and may be associated with cardiorenal dysfunction. Our aim was to study the association of GDF-15 with LVH in ESRD patients on dialysis.

Method

This study included 196 ESRD patients on dialysis (hemodiafiltration and high-flux hemodialysis). Left ventricular mass (LVM) was evaluated through echocardiographic studies, corrected for body surface area and the values are presented as LVM index (LVMI). LVH was defined by a value of LVMI > 115 g/m2 in men and > 95 g/m2 in women. Patients were divided into two groups - LVH (n=131) and non-LVH (n=65). LVMI, clinical and analytical variables (age, body mass index, dialysis vintage, dialysis adequacy, GDF-15, NT-proBNP and pentraxin (PTX) 3 were evaluated.

Results

ESRD patients with LVH presented significantly higher levels of NT-proBNP and GDF-15, and a trend towards higher PTX3 values. In LVH patients, GDF-15 correlated positively and significantly with NT-proBNP and PTX3; LVMI correlated positively and significantly with pro-BNP and PTX3 levels; pro-BNP correlated significantly and positively with PTX3.

Conclusion

Our data show that in ESRD patients on dialysis with LVH, GDF-15 is raised and shows a strong association with NT-proBNP, PTX3 and LVMI. Further studies are needed to clarify if the rise in GDF-15 is a cause or a consequence of LVH development.

Acknowledgments

This work was supported by Applied Molecular Biosciences Unit-UCIBIO, financed by national funds from FCT/MCTES (UIDB/04378/2020), by North Portugal Regional Coordination and Development Commission (CCDR-N)/NORTE2020/Portugal 2020 (Norte-01-0145-FEDER-000024) and by REQUIMTE-Rede de Química e Tecnologia-Associação in the form of a researcher (S. Rocha) – project Dial4Life co-financed by FCT/MCTES (PTDC/MEC-CAR/31322/2017) and FEDER/COMPETE 2020 (POCI-01-0145-FEDER-031322).