bluuebunny/crossref_metadata_2025 huggingface dataset:
MO509DOSE-RESPONSE RELATIONSHIP BETWEEN ALCOHOL CONSUMPTION AND THE RISK OF DEVELOPING CKD: RETROSPECTIVE COHORT STUDY
Authors: Hashimoto Yusaku , Imaizumi Takahiro , Hori Akihiro , Kato Sawako , Yasuda Yoshinari , Maruyama Shoichi
Published: May 2021

Background and Aims

Drinking habits are one of the most important modifiable lifestyle factors to prevent the development of chronic kidney disease (CKD). Previous studies showed that it was inversely associated with the risk of developing CKD, but the dose-response relationship between alcohol consumption and the development of CKD is still controversial. In the present study, we aimed to examine whether the amount of alcohol consumed at one time is associated with new onset of CKD in general population.

Method

Study subjects were 11,162 Japanese aged 45 to 74 years, with an estimated glomerular filtration rate ≥60 mL/min/1.73m2, no proteinuria, no past history of cardiovascular disease, COPD or liver disease. The drinking status was obtained by self-administered questionnaires. We categorized the study subjects into four groups based on the amount of alcohol consumption: <20g/time of ethanol equivalent (lowest); 20-40g/time (low intermediate); 40-60g/time (high intermediate); >60g/time (highest). We set non-drinkers as a reference category. The primary outcome was the incidence of CKD, defined as 25% reduction of eGFR and to less than 60 mL/min/1.73 m2 and/or a dipstick urinalysis score of 1+ or greater (equivalent to ≥30 mg/dL) during the follow up period. We employed Cox proportional hazards regression models to examine the dose-response relationship between baseline alcohol consumption and the risk of CKD. Trend tests were performed using Cox proportional hazards regression models that treated alcohol consumption as a continuous linear term.

Results

Lowest and low intermediate groups were significantly associated with a decreased risk of CKD (hazard ratio [HR] 0.84; 95% confidence interval [CI], and 0.71–0.99; HR 0.79; 95% CI, 0.66–0.96, respectively) compared to non-drinkers. High intermediate group was associated with a decreased risk of CKD (HR 0.92; 95% CI, 0.70–1.21), and highest group was associated with an increased risk of CKD (HR 1.28; 95% CI, 0.84–1.95), but these associations did not reach statistical significance. There was no dose-response relationship between baseline alcohol consumption and risk of CKD (P-trend = 0.30).

Conclusion

A J-shape association was observed between self-reported alcohol intake and the incidence of CKD. Moderate alcohol consumption at one time may help reduce the risk of CKD.
MO510OLFACTORY AND GUSTATORY DYSFUNCTION AMONG PATIENTS WITH KIDNEY IMPAIRMENT
Authors: Chewcharat Api , Phipps Elizabeth , Bhatai Khushboo , Nigwekar Sagar
Published: May 2021

Background and Aims

Poor appetite and food aversion are common in chronic kidney disease patients. Olfactory and gustatory function changes might be attributed to poor appetite among this population. Nevertheless, the associations between impaired kidney function and olfactory and gustatory dysfunction are less clear. Moreover, the prevalences of olfactory and gustatory dysfunction among patients with impaired kidney function have not been reported.

Method

We conducted a cross-sectional study among 3,529 US adults aged ≥ 40 years old in the National Health and Nutrition Examination Survey (NHANES) 2013-2014. We calculated the prevalences of olfactory and gustatory dysfunction among patients with impaired kidney function aged ≥ 40 years old by using analytic survey weights and design factors. We also examined the association between impaired kidney function and olfactory and gustatory dysfunction as well as the association between olfactory and gustatory dysfunction and nutritional markers among patients with impaired kidney function using weighted multivariable linear regression and logistic regression.

Results

The prevalences of olfactory impairment and gustatory dysfunction among impaired kidney function participants were 25% and 14%, respectively. After adjusting for confounders, impaired kidney function was significantly associated with higher odds of olfactory dysfunction (OR = 1.29, 95% CI [1.03, 1.60]; p=0.04) but not gustatory dysfunction (OR = 1.41, 95%CI [0.96, 2.09]; p=0.08). Among impaired kidney function population, olfactory dysfunction was significantly associated with lower serum albumin and grip strength but not serum total cholesterol, LDL-cholesterol or protein-energy malnutrition. However, gustatory dysfunction was not significantly associated with any nutritional markers among the impaired kidney function population. (Figure 1)

Conclusion

Impaired kidney function was associated with higher odds of olfactory but not gustatory dysfunction. Among those with impaired kidney function, only olfactory but not gustatory dysfunction was associated with lower serum albumin and grip strength.
MO512THE RENAL CONSEQUENCES OF LUNG TRANSPLANTATION IN ADULT CYSTIC FIBROSIS PATIENTS
Authors: Novel Etienne , Pelletier Solenne , Koppe Laetitia , Nove Josserand Raphaele , Reynaud Quitterie , Fouque Denis , Durieu Isabelle
Published: May 2021

Background and Aims

Cystic fibrosis patients are at high risk for chronic kidney disease (CKD), because of chronic aminoglycoside exposure, high protein and dietary salt intake, and Cystic Fibrosis Related Diabetes. Lung transplantation also entails a high renal burden in the long run because of calcineurin inhibitors exposure. We aimed at studying kidney function by gold standard glomerular filtration rate (mGFR) before and 1 year after lung transplantation, as well as identify risk factors for kidney function impairment.

Method

Patients from the Cystic Fibrosis reference center in Lyon, France were systematically referred to the nephrology department before lung transplantation. mGFR (iohexol or inulin clearance) was performed before and 12-18 months after lung transplantation. Risk factors for a worse nephrological outcome (i.e. post transplantation mGFR < 60mL/min/1.73m²) were searched for.

Results

28 patients (10 males), mean age 32 yr, underwent pre transplantation mGFR. Three died following lung transplantation and two progressed to end stage renal disease rapidly thereafter. 23 patients benefited from both pre and post transplantation mGFR.

Mean mGFR was 105±21mL/min/1.73m² and 67±19 mL/min/1.73m² before and after transplant respectively. Factors associated with a worse renal outcome in both univariate and multivariate analysis were age at transplantation (p=0.03) and the occurrence of acute kidney injury in the post-operative period (p=0.005). Cumulated aminoglycoside exposure and time spent under cardiopulmonary bypass were not associated with renal outcome.

Conclusion

Lung transplantation is associated with a high renal burden in adult Cystic Fibrosis patients. We advise a clinical referral to a nephrologist as part of the systematic evaluation in lung transplantation candidates even if GFR is in the normal range.
MO517EFFECT MODIFIERS OF SERUM POTASSIUM AND MORTALITY IN THE IRISH HEALTH SYSTEM: THE NATIONAL KIDNEY DISEASE SURVEILLANCE SYSTEM (NKDSS)
Authors: Browne Leonard , Stack Austin
Published: May 2021

Background and Aims

Serum potassium (K+) exhibits a u-shaped association with mortality but uncertainty exists regarding optimal thresholds for survival and influencing factors. We examined the impact of serum K* on mortality in the Irish Health System with particular focus on kidney function and location of medical supervision.

Method

We utilised data from the Irish Kidney Disease Surveillance System (NKSS) to explore the association of serum K+ and mortality in a longitudinal cohort study.

We identified all adult individuals (age > 18 years) who accessed health care from 2007 and 2012 in a regional health system with complete data on serum K+, associated laboratory indicators and vital status up to 31st December 2013 (n = 32,643). We randomly selected a single K+ measurement per patient with date of measurement as index date. Chronic kidney disease was defined as eGFR <60ml/min/1.73m² vs greater recorded at index date. Location of medical supervision was recorded as emergency room, inpatient location; outpatient clinic, and general practice location. The association of serum K+ was explored in categories and as a continuous variable in restricted cubic splines with mortality. Multivariable Cox regression determined hazard ratios and 95% confidence intervals with adjustment for baseline health indicators.

Results

Mean age was 57.1 years, 5,056 died (15.4%) with a median follow-up of 5.1 years.

With adjustment, for age, sex, baseline health status, and location of medical supervision, the pattern of mortality was non-linear and u-shaped with greatest risks for patients with extreme values. Modelled as a continuous variable, the serum K +thresholds for optimal survival were from 4.1 to 5.2 mmol/L. Compared to patients without baseline CKD, the risks were attenuated for patients with CKD (p-value interaction 0.012). The associated risk thresholds were wider for CKD patients with significant increased risk above 5.8 mmol/L whereas, for those without CKD, serum K +thresholds for optimal survival were between 4.2-5.4 mmol/L. Similarly, mortality patterns were greatly attenuated for patients who were managed in the outpatient and general practice locations (p-value interaction <0.001) than the emergency room or inpatient settings (Figure 1).

Conclusion

Risk thresholds for optimal survival for serum K+ vary according to CKD and location of medical supervision in real-world clinical cohorts. Better understanding of these thresholds and effect modifiers are essential for inform decision making and therapeutic interventions.

Funding Source

Health Research Board (HRB-SDAP-2019-036), Midwest Research and Education Foundation (MKid), Vifor Pharma.
MO519THE COST OF CHRONIC KIDNEY DISEASE BEFORE RENAL REPLACEMENT THERAPY IN MOROCCO: A COST OF ILLNESS STUDY
Authors: Chrifi Alaoui Amina , Omari Mohammed , Qarmiche Noura , Kouiri Omar , Chouhani Basmat Amal , Sqalli Houssaini Tarik , El Fakir Samira , Tachfouti Nabil
Published: May 2021

Background and Aims

Chronic kidney disease (CKD) is a leading public health problem in Morocco, its consequences and costs have implications for public health policy. The present study aimed to estimate the social cost of CKD before the start of renal replacement therapy in a Moroccan region.

Method

A cross-sectional cost of illness study, using bottom-up approach was performed at the department of nephrology in university hospital of Fez during 2020, among stages 3 to 5 CKD patients, followed up for at least one-year. The analyzed costs include the following annual expenditures: hospitalizations, outpatient visits, day care hospital, drugs, laboratory tests, imaging, and medical specialized acts. Non-medical costs such as transportation and indirect costs like loss of productivity were also assessed. Determinants of CKD cost were identified by univariate analysis using t test, ANOVA or non-parametric tests, p < 0.05 is the level of statistical significance.

Results

Eighty-eight patients were included (63.6% women, mean age: 61.8±14.0 years), 76.1% were on CKD stage 4 or 5. The estimated annual social cost of CKD was 2231,12 US$ (95% CI, 1676,09-2793,93 US$). The direct cost accounted for 99,5% (direct medical cost: 91,2%, direct non-medical cost: 8,3%), and the indirect cost accounted for 0,5 % of the social cost. Hospitalizations, diagnosis and treatments represented the main expenses of the direct medical cost (32,2%, 29,7%, 32,2% respectively). The social cost components were not significantly different between CKD stages.

Conclusion

The cost of CKD in its early stages still lower than the cost of renal replacement therapy, which brings the light on the necessity of secondary prevention of CKD to postpone or prevent the progression toward ESRD.
MO521OUTCOME OF CHRONIC KIDNEY DISEASE PATIENTS WITH SARS COV-2 INFECTION- A SINGLE CENTRE EXPERIENCE
Authors: Bjedov Jelena , Bulatovic Ana , Maslarevic Radovic Vesna , Dimkovic Nada , Naumovic Radomir
Published: May 2021

Background and Aims

Since the outbreak of COVID 19 there have been 88.1 million confirmed cases and 1,9 million deaths in 218 countries, while in Serbia we have had 39.867 cases of COVID 19 and 3479 deaths with approximate death rate of 1%. Fatality rate worldwide vary widely, from 0% in Singapore to 8,8% in Mexico with the average value of 3%. Although there are many published studies about COVID 19, influence of chronic kidney disease and chronic dialysis on outcome of patients with the coronavirus infection is still not clear. The aim of this study was to explore whether the presence of CKD including ESRD and chronic dialysis treatment increases COVID 19 patients’ risk for adverse clinical outcome.

Method

This retrospective study included 88 patients who were hospitalized at the Nephrology department in Zvezdara University Clinical Center which was transformed into a COVID hospital at the time. These patients were treated from 01.04.2020. to 01.06.2020. and 37 (42%) of them had CKD, while 51 (58%) had no signs of kidney disease. We analysed data collection from the patients’ history, including age, sex, comorbidities, symptoms, blood and radiology findings, therapy and outcome. We compared outcome (fatal and need for mechanical ventilation) between CKD and non CKD group and also analized dialysis as a risk factor for adverse outcome. Statistical analysis has been performed using SPSS software version 20 and OR was calculated using Logistic Regression.

Results

We analysed 88 patients, a mean age of 62+15 years, 59.1% males. Out of 88 patients, 37 had CKD, while 27 of them were on hemodialysis and 2 on peritoneal dialysis (CAPD). At the end of follow-up, 46 patients (52.3%) was discharged home, 27 (30.7%) was transferred to another hospital and 14 (15.9%) died. Regarding influence of CKD on COVID-19 patients’ outcome it was shown that patients with CKD had 3-fold higher chances for discharge than for the fatal outcome (p=0.05) and 4-fold less risk for use of the mechanical ventilation (ns) as compared to non CKD patients. We also found that ESRD and chronic dialysis affect outcome with statistical significance (p=0.01) in a way that it doubles the risk for the adverse outcome.

Conclusion

Patients with CKD, especially those with ESRD had significantly higher risk for the lethal outcome and higher chances to require the mechanical ventilation.
MO523PATIENTS FROM COVID-19 MOSTLY RECOVER FROM TUBULAR PROTEINURIA AND ACUTE KIDNEY INJURY AFTER HOSPITAL DISCHARGE
Authors: Bouquegneau Antoine , Huart Justine , Lutteri Laurence , Erpicum Pauline , Grosch Stéphanie , Résimont Guillaume , Wiesen Patricia , Thys Marie , Rousseau Anne-Françoise , Bovy Christophe , Krzesinski Jean-Marie , Lambermont Bernard , Misset Benoit , Pottel Hans , Darcis Gilles , Cavalier Etienne , Jouret François , Delanaye Pierre
Published: May 2021

Background and Aims

Proteinuria, hematuria and acute kidney injury (AKI) are frequently observed in hospitalized patients with COVID-19. However, few data are available on these parameters after hospital discharge.

Method

This retrospective, observational and monocentric study included 153 hospitalized patients, in whom urine total proteinuria and α1-microglobulin (a marker of tubular injury) were measured. Thirty patients died. Among the 123 survivors, follow-up urine and creatinine analyses were available for 72 patients (after a median of 51 [19;93] days following hospital discharge).

Results

The median proteinuria at hospitalization and follow-up (n=72) was 419 [239; 748] and 79 [47; 129] mg/g, respectively (p<0.0001). The median concentrations of urinary α1-microglobulin (n=66) were 50 [25; 81] and 8 [0; 19] mg/g, respectively (p<0.0001). Estimating glomerular filtration rate (eGFR) was lower during the hospitalization compared to the follow-up: 81 [62; 92] versus 87 [66; 98] mL/min/1.73m² (p=0.0222). At follow-up, a decreased renal function was observed in 10/72 (14%) of patients, with 50% of them presenting decreased renal function before COVID-19 hospitalization and others developing severe AKI and/or proteinuria during hospitalization.

Conclusion

In most hospitalized patients with COVID-19, proteinuria and eGFR significantly improved after hospital discharge. Only patients who developed severe AKI and/or heavy proteinuria will require a specific follow-up by nephrologists.
MO529PREVALENCE AND DETERMINANT FACTORS OF DEPRESSION AND ANXIETY IN PEOPLE WITH CHRONIC KIDNEY DISEASE : A MOROCCAN CROSS-SECTIONAL STUDY
Authors: Chrifi Alaoui Amina , Omari Mohammed , Qarmiche Noura , Kouiri Omar , Chouhani Basmat Amal , Sqalli Houssaini Tarik , Tachfouti Nabil , Ei Fakir Samira
Published: May 2021

Background and Aims

The Chronic kidney disease (CKD), like many chronic illnesses, is invariably associated with various psychiatric conditions and poorer quality of life. This study aims to assess the prevalence of depression and anxiety among CKD patient and their determinant factors.

Method

this is a cross sectional single center study in a Moroccan university hospital. Patients aged ≥ 18 years old and followed for more than one year were included. The data was collected using a questionnaire for sociodemographic and clinical information and the Hospital anxiety and depression scale (HADS) to assess depression and anxiety prevalence. After the description of the population’s characteristics, the statistical analysis aimed to assess the association between depression and anxiety disorders and the estimated glomerular filtration rate before and after adjustment on several confounding factors.

Results

88 patients were included (63.6% of them were women, the mean age was 61.8±14.0 years), 21 were on stage 3, 46 were on stage 4, and 21 were on stage 5 of the CKD. The median of depression sub-score was 5.00[2.00; 10.0], the median of anxiety sub-score was 6.00[4.00; 9.00], and the median of the global score was 11.0[7.00; 20.0], 22.0% of included patients had depression and 22.0% had anxiety. Both depression and anxiety scores were associated to eGFR before and after adjustment (p= 0.001, p<0.001and p=0.04, p=0.03 respectively).

Conclusion

This study showed that depression and anxiety are strongly related to the CKD progression, which should motivate both doctors and nurses to improve their psychological care toward CKD patients.
MO531IMPACT OF INFLAMMATORY MARKERS IN COGNITIVE IMPAIRMENT IN CHRONIC KIDNEY DISEASE PATIENTS
Authors: Rroji (Molla) Merita , Shehaj Larisa , Barbullushi Myftar
Published: May 2021

Background and Aims

Cognitive impairment is an increasingly identified major cause of chronic disability and is commonly found in patients with chronic kidney disease (CKD). Knowledge of the link between kidney dysfunction and impaired cognition may enhance our understanding of risk factors impacting cognitive dysfunction. Our study aimed to evaluate the relation between serum inflammatory markers and the risk of cognitive decline among adults with CKD.

Method

Forty-six patients predialysis patients CKD stage 5 (mean age 55.6±11.5 years old) accepted to participate in the study. The Montreal Cognitive Assessment (MoCA) scale was administered to patients. Patients with a MoCA global score of 24/30 were considered cognitively impaired. Descriptive analysis was done for the socio-demographic and clinical variables. We measured high-sensitivity C-reactive protein (hs-CRP), ferritin level, albuminemia, and fibrinogen in baseline plasma samples.

Results

The mean total MoCA score for all the patients was 22.9 ±3.8 points. Thirty-seven patients, 57.7%, were evaluated with CI, where 74.6 % with Mild CI (MCI) and 25.4% with severe CI (SCI) under 20 points). MoCA subscale analysis revealed that the mean score for visuospatial/executive domain and attention were the lowest with 5.41±1.1 /8max and 2.93±1.75/6 max, and scores for orientation were the highest 5.92±0.57/6 max. At baseline, higher levels of each inflammatory marker were associated with poorer age-adjusted performance. In analyses adjusted for baseline cognition, demographics, comorbid conditions, and kidney function, participants in the highest tertile of hs-CRP, the highest tertile of fibrinogen, and the highest tertile of ferritin had an increased risk of impairment in attention compared to participants in the lowest tertile of each marker (p=0.043, p=0.047, p=0.029, respectively. The high level of ferritin was evaluated as a risk of impairment visuospatial/executive ability, and no relationship of inflammatory markers was observed with impairment of orientation p=0.01. hs-CRP and ferritin and low albumin level were independently associated with longitudinal global cognitive function (p=0.04, p=0.02, p=0.49 respectively).

Conclusion

In CKD patients, we have a relatively high risk for cognitive impairment. Our results extend the findings from prior studies by showing that inflammatory markers used in routine practice contribute and are independently associated with longitudinal changes in some domains of cognitive function in patients with CKD going in parallel with the inflammatory mechanisms that have been implicated in the pathogenesis of vascular and Alzheimer’s dementia.
MO534VITAMIN D DEFICIENCY IN PATIENTS WITH CHRONIC KIDNEY DISEASE OF UNCERTAIN ETIOLOGY IN WILGAMUWA, SRI LANKA
Authors: Godawita Rivindi , Nayanamali Ayesha , Silva Renuka , Nanayakkara Nishantha
Published: May 2021

Background and Aims

Vitamin D deficiency (VDD) is a common, well known association in Chronic Kidney Disease (CKD). However, there are no published studies on the prevalence of VDD among CKDu (Chronic Kidney Disease of uncertain etiology) patients. This study aims to study on Vitamin D status of CKDu patients.

Method

This was a cross sectional survey conducted in Wilgamuwa area, in Mathale located in Central province of Sri Lanka. Among the 39 GN (Grama Niladahri) divisions at Wilgamuwa, GN divisions where the CKD prevalence was high areas were taken for the study. Data were collected by using clinical examination and interviewer administered questionnaire and analyzed using SPSS statistical software

Results

A total of 150 patients living in a CKDu endemic area in Sri Lanka was studied during the study period. Majority (n=118, 78.7%) of the CKDu patients were males. Mean age (years) was 56.75±7.89 and 54.34±7.87 for females and males respectively. More than half of the patients were middle aged outdoor workers. According to the BMI (Body mass index) results, majority (n= 87, 58%) of the CKDu patients were in the healthy weight category. More than one third of the patients were in the underweight category. VDD (<20ng/mL) was reported in 22.88% (n=27) of the total males and 68.75% (n=22) of the total females. Vitamin D insufficiency (20-30ng/mL) was identified among 45.76% (n=54) males and 25% (n=8) females. Rest of the males (31.35, n=37) and females (6.25%, n=2) had normal vitamin D level (>30 ng/mL). As a summary the mean Vitamin D level was 24.85 ±7.93 ng/mL. There was a signiﬁcant different in the prevalence of VDD between gender groups (p = 0.004). VDD is more common (82%) during the early stages of CKDu while less common during the late stage. However, there is no any significant association between the prevalence of VDD and CKDu stage (p=0.183).

Conclusion

VDD is more commonly encountered complication in during the early stages of CKDu and it was significantly high in male CKDu patients compared to females.
MO535PREVALENCE OF CHRONIC KIDNEY DISEASE AND ASSOCIATED RISK FACTORS ON THE ISLAND OF MONTSERRAT
Authors: Chrysostom Keniel , Fisher Lori-Ann , Barton Everard , Soyibo Adedamola , West Grethlyn , Skerritt Georgette , Hoe Kyaw
Published: May 2021

Background and Aims

Chronic Kidney Disease (CKD) is a global health problem with disproportionate burden in low- and middle-income countries in Latin America and the Caribbean. Despite these disparities, little is known of the prevalence and risk factors of CKD in the Caribbean. We sought to determine prevalence of CKD among patients attending ambulatory centres in Montserrat, an island that to date, has no facilities for renal replacement therapy.

Method

A cross-sectional observational study of Participants were individuals aged ≥18 years was performed. Random cluster sampling of at least 500 participants who attended clinic from January 1 to July 1, 2020 across all primary health care facilities on island was performed. Patients without lab values for creatinine were excluded. The main outcome measures was estimated CKD prevalence (as defined based on KDIGO 2012 guidelines of eGFR < 60mL/min/1.73m2 using creatinine based CKD-EPI for blacks; and estimated prevalence of CKD risk factors (Self-reported diabetes or hypertension and obesity, BMI> 30kg/m2). Multivariate Logistic regression was used to determine independent predictors of CKD.

Results

Three hundred and fifty-five participants (n = 355) were selected for participation. Participants’ mean age was 63 ± 17 years, with 60% (n=213) being female. 38% (n=135) had self-reported diabetes and 58% (n=201) had hypertension; and 44% were obese. Mean± SD estimated GFR was 81 ± 30 ml/min/1.73 m2 . One quarter of the participants (25%) had an eGFR <60 ml/min/1.73 m2, indicating CKD. Age [95% CI, OR 1.03 (1.01–1.07)], Self-reported hypertension [95% CI, OR 2.09, (1.13–3.90)] and female gender [95% CI ,OR 0.20 (0.10, 0.39)] were independent predictors of reduced eGFR.

Conclusion

CKD and its risk factors were prevalent among adults in Montserrat. Consideration must be made for infrastructural and/or policy changes to be mandated, to slow the progression of CKD. Primary prevention initiatives can be implemented to reduce the associated morbidity, mortality and cost associated with CKD. There is room for further longitudinal studies to identify etiology, as well as factors affecting CKD progression. This study will also propel creation of the Montserrat arm of the Caribbean Renal Registry, to allow for future follow up of long-term effects, as well as ascertain risk factors for CKD progression.
MO536CHINESE CHRONIC RENAL INSUFFICIENCY STUDY: BASED ON SMARTPHONE PLATFORM (C- CRISS): DESIGN AND METHOD
Authors: Fan Xiaohong , Xia Peng , Zhang Xuehan , Li Jiaying , You Ruilian , Zhu Yuanyuan , Liu He , Qiu Ling , Qin Yan , Li Xuemei , Chen Limeng
Published: May 2021

Background and Aims

Abnormal mineral bone metabolism of chronic kidney disease (CKD-MBD) is the most common CKD complication. However, fewer data concerning the relationship between bone metabolic indexes, such as high serum phosphorus and cardiovascular diseases, bone mass reduction, and fracture, is available in Chinese adult patients. The Chinese Chronic Renal Insufficiency Study: Based on Smartphone Platform (C-CRISS) is established to explore the relationship between bone metabolic markers and other non-traditional risk factors with renal function progression, cardiovascular (CVD), and cerebrovascular diseases (BVD), and bone loss in CKD patients. 

Method/design

The C-CRISS study is a multi-center prospective cohort study in China. It will recruit 3360 pre-dialysis patients aged 18 to 74 years and follow up for at least two years. The individuals with CKD G3b-5ND will account for over 70 percent of the study population. Active glomerulonephritis, rapidly progressing and advanced heart, liver, and tumor diseases will be excluded. The primary composite endpoints include the events of progression to ESRD, cardiovascular events, and death. The participants will undergo the clinical evaluation at baseline and clinic visits at six-monthly intervals in traditional consultation ways. The CVD, BVD, retinopathy, DXR, and other complications will be measured annually. Data on the questionnaire, diet, quality of life, and patients’ status during follow-up will be collected by the smartphone platform developed for this study. The sample size will enable us to have 80% power to detect a 2.0 risk ratio of CVD events in CKD G4 patients compared with CKD G3a patients.

Conclusion

The C-CRISS study would provide evidence of the potential risk of bone metabolic markers for progressive CKD and CVD/BVD. The study will also provide a new management and complication monitoring model through smartphone communication in chronic kidney disease patients.

Trial registration

ClinicalTrials.gov Identifier: NCT04229485
MO488HOSPITALISATION EVENTS IN PEOPLE WITH CHRONIC KIDNEY DISEASE AND MULTIPLE LONG-TERM CONDITIONS
Authors: Sullivan Michael , Jani Bhautesh , McConnachie Alex , Mair Frances , Mark Patrick
Published: May 2021

Background and Aims:

Chronic Kidney Disease (CKD) typically co-exists with multiple long-term conditions (LTCs). The impact of CKD combined with multiple LTCs on hospitalisation rates is not known. We hypothesised that hospitalisation rates would be high in people with multiple LTCs, particularly in those with CKD. We also hypothesised that the association between multiple LTCs and hospitalisation would be greatest in subgroups and with certain patterns of LTCs.

Method:

Two cohorts were studied in parallel: UK Biobank (2006-2019) and Secure Anonymised Information Linkage Databank (SAIL: 2011-2018, Wales, UK). UK Biobank is a prospective research cohort. SAIL is a routine care database. Participants were included if their kidney function was measured at baseline. LTCs were obtained from self-report (UK Biobank) and primary care read codes (SAIL). Participants were categorised into zero, one, two, three and four or more LTCs with and without CKD. CKD was defined as estimated glomerular filtration rate less than 60 ml/min/1.73m2 (single blood test for UK Biobank, two blood tests three months apart for SAIL). Hospitalisation events were obtained from linked hospital records.

Results:

Among 469,344 of 502,503 UK Biobank participants, those without CKD had a median age of 58 and a median of 1 LTC. Those with CKD had a median age of 64 and a median of 2 LTCs. Among 1,620,490 of 2,768,862 SAIL participants, those without CKD had a median age of 50 and a median of 1 LTC. Those with CKD had a median age of 79 and a median of 4 LTCs. Participants with four or more LTCs had high event rates (Rate Ratios (RRs) 5.35 (95% CI 5.20-5.51)/3.77 (95% CI 3.71-3.82)) with higher rates in CKD (RRs 8.99 (95% CI 8.47-9.54)/9.92 (95% CI 9.75-10.09)).

Amongst those with CKD, the association between each increase in LTC count and hospitalisation was greatest in those under the age of 50 (RRs 1.93 (95% CI 1.73-2.16)/1.35(95% CI 1.29-1.41)). Event rates were highest in those with eGFR<30ml/min/1.73m2, but the impact of multiple LTCs was weaker in these participants compared to those with higher eGFRs.

Event rates were high in certain patterns of LTCs: cardiometabolic LTCs (RRs 4.45 (95% CI 4.02-4.92)/2.81 (95% CI 2.71-2.91)), complex patterns (RRs 3.60 (95% CI 3.26-3.96)/2.91 (95% CI 2.81-3.01)) and physical/mental LTCs (RRs 3.30 (95% CI 2.86-3.80)/3.18 (95% CI 3.06-3.30)).

Conclusion:

People with multiple LTCs have high rates of hospitalisation and the rates are augmented in those with CKD. The impact of multiple LTCs is greatest in younger patients and in those with certain patterns of LTCs. Strategies should be developed to prevent hospitalisations in these high-risk groups.

Hospitalisation Events by Chronic Kidney Disease (CKD) status and number of Long-term conditions (LTCs) in UK Biobank

Hospitalisation Events by Chronic Kidney Disease (CKD) status and number of Long-term conditions (LTCs) in SAIL
MO489GESTATIONAL DIABETES AND THE LONG-TERM RISK OF MATERNAL KIDNEY DISEASE: A SWEDISH NATIONAL COHORT STUDY
Authors: Barrett Peter , McCarthy Fergus , Evans Marie , Kublickas Marius , Perry Ivan , Stenvinkel Peter , Kublickiene Karolina , Khashan Ali
Published: May 2021

Background and Aims

Gestational diabetes (GDM) is increasingly common worldwide. GDM is associated with increased risk of type 2 diabetes (T2DM) and cardiovascular disease in women. It is uncertain whether GDM is independently associated with long-term risk of maternal kidney disease. We aimed to examine the association between GDM and maternal chronic kidney disease (CKD) and end-stage kidney disease (ESKD) and to determine whether this depends on progression to overt T2DM.

Method

A nationwide retrospective cohort study was designed using data from the Swedish national registers. Women were included if their first delivery occurred between 1 January 1987 and 31 December 2012. Previous GDM was the main exposure variable, and this was stratified according to whether women developed T2DM after pregnancy. We estimated the risk of CKD, ESKD and different CKD subtypes (tubulointerstitial, glomerular, hypertensive, diabetic, other/non-specific). Cox-proportional hazard regression models were used with time-dependent covariates. We adjusted for a wide range of confounders including maternal age, country of origin, maternal education, parity, antenatal BMI, gestational weight gain, smoking during pregnancy and preeclampsia.

Results

There were 1,121,633 women included, of whom 15,595 (1.4%) had a diagnosis of GDM. Overall, GDM-diagnosed women were at increased risk of CKD (aHR 1.81, 95% CI 1.54-2.14) and ESKD (aHR 4.52, 95% CI 2.75-7.44). Associations were strongest for diabetic CKD (aHR 8.81, 95% CI 6.36-12.19), hypertensive CKD (aHR 2.46, 95% CI 1.06-5.69), and glomerular CKD (aHR 1.86, 95% CI 1.37-2.51). However, these associations were largely explained by progression to post-pregnancy T2DM. Among women who had GDM + subsequent T2DM, strong associations were observed with CKD (aHR 21.70, 95% CI 17.17-27.42) and ESKD (aHR 112.37, 95% CI 61.22-206.38). By contrast, women who only experienced GDM (and no future T2DM) were not at significantly higher risk of CKD (aHR 1.11, 95% CI 0.89-1.38) or ESKD (aHR 1.58, 95% CI 0.70-3.60).

Conclusion

Women who experience GDM are at increased risk of CKD and ESKD if they develop T2DM. However, GDM-diagnosed women who do not develop overt T2DM in later life have a similar risk of CKD/ESKD to those with uncomplicated pregnancies.
MO42825-HYDROXYVITAMIN D AND TUBULAR DYSTROPHY IN PATIENTS WITH CKD STAGES 1-3*
Authors: Galkina Olga , Bogdanova Evdokia , Zubina Irina , Levykina Elena , Anpilova Anastasiia , Sipovski Vassili , Panina Iraida , Kovalchuk Yurii , Smirnov Alexei
Published: May 2021

Background and Aims

According to a recent data the 25-hydroxyvitamin D (25OHD) level is known to be reduced in advanced stages of CKD presumably due to i) catabolic activity of CYP24 in damaged tubules and ii) increase in renal excretion of 25OHD/Vitamin D binding protein complex. The association of the 25OHD level with different types of tubular damage in early stages (1-3) of CKD is not well investigated.

Method

The cross-sectional study included 100 patients (37 male; age 38 (30-50) yrs.) with biopsy proven primary glomerulopathy (membranoproliferative glomerulonephritis (n=9); minimal change disease (n=10); membranous nephropathy (n=11); focal segmental glomerulosclerosis (n=20); IgA nephropathy (n=50)) and CKD stages 1-3 (median eGFR was 64 (33-90) ml/min/1.73 m2). Patients with AKI, infectious diseases, heart failure, respiratory failure and cancer pathology were excluded. The levels of proteinuria, intact parathyroid hormone (PTH) (Beckman Coulter), 25OHD (Abbott) were estimated in all patients. In all cases the following types of tubular damage were analyzed by light microscopy of kidney tissue (hematoxylin and eosin, periodic acid Schiff, Masson's trichrome, Congo red, and Jones' silver) and calculated semi-quantitatively (0 – <10%; 1 – 10-25%; 2 – 26-50% and 3 – >50% of tissue sample): granular dystrophy, hyaline-drop dystrophy, hydropic dystrophy, foamy degeneration and atrophy. The association between clinical and morphological variables was estimated by Spearman’s coefficient and multiple linear regression analysis.

Results

The patients had a lack or deficiency of 25OHD [Me (Q1-Q3): 13.1 (7.6-19.3) ng/ml]. There was no correlation between serum 25OHD and PTH (r = -0.03, p = 0.86). Proteinuria was negatively associated with level of 25OHD (r = -0.56, p = 0.012). The level of 25OHD was associated with granular (r = -0.39, p <0.05) and hyaline-drop (r = -0.39, p <0.05) tubular dystrophy. In multiple regression analysis the 25OHD level was the independent predictor of the severe hyaline-drop tubular dystrophy (β = -0.33 ± 0.11, p = 0.046) when adjusted for proteinuria (β=0.22±0.11, p=0.062).

Conclusion

In patients with CKD stages 1-3 decline in serum 25OHD is associated with the severity of tubular dystrophy. 25OHD level may be useful in laboratory diagnosis as a risk factor of tubular damage in early stages of CKD.
MO437RENAL RESISTIVE INDEX IS INDEPENDENTLY ASSOCIATED WITH THE RENAL BLOOD FLOW IN HYPERTENSIVE PATIENTS
Authors: Lubas Arkadiusz , Zegadło Arkadiusz , Grzywacz Anna , Niemczyk Stanisław
Published: May 2021

Background and Aims

The Renal Resistive Index (RRI) measured in intrarenal arteries is considered a marker of cardiovascular damage, and its value can express the amount of renal perfusion. However, some experimental investigations don’t confirm this association. Moreover, in recent works, End Diastolic Velocity (EDV) was used as a better than RRI marker of kidney damage. The study aimed to investigate relations between different ultrasound Renal Doppler parameters (RRI, acceleration (ACC), acceleration time (ACT), and EDV) with the Renal Blood Flow (RBF) estimated in contrast-enhanced computed tomography (CE-MDCT).

Method

In 25 patients (14F, 11M; age 58.9 ±19.0; eGFR 56,9 ±27.4 mL/min/1.73m2) with hypertension and suspected renal artery stenosis, ultrasound Color Doppler examination of intrarenal segmental arteries (GE Logiq P6) was performed. Then CE-MDCT (GE Discovery 750 HD) of renal arteries with RBF assessment was completed. Renal Doppler parameters (RRI, ACC, ACT, and EDV) and RBF were evaluated for each kidney separately. Finally, 31 kidneys without a narrowing of supplying arteries were considered for statistics.

Results

Mean values of intrarenal Doppler parameters were calculated: RRI = 0.699 ±0.113; ACC = 7.41 ±2.75 [m/s2]; ACT = 35.8 ±8.4 [ms]; EDV = 13.68 ±8.41 [cm/s]. CE-MDCT RBF = 218.04 ±71.92 [ml/s/100g]. Only RRI and EDV correlated significantly with RBF (r = -0.544; p=0.002 and r=0.428; p=0.018, respectively). The retrograde multivariable regression analysis included all investigated ultrasound renal Doppler parameters showed an independent association only between RRI and RBF (b = -0.544; R2 = 0.27, p < 0.002).

Conclusion

Only Renal Resistive Index measured in intrarenal segmental arteries is independently related to the Renal Blood Flow from investigated ultrasound renal Doppler parameters. Although End Diastolic Velocity is positively correlated with RBF, this association is not superior to Renal Resistive Index.
MO438STUDY OF IMMUNOLOGICAL STATUS IN PATIENT OF CKD IN PREDIALYSIS STAGES
Authors: Olimkhonova Komilakhon
Published: May 2021

Background and Aims

It is known that inflammation is an important factor associated with the variability of the clinical picture in patients with chronic diseases. However, the question remains not completely clear: are immunological changes predictors of less stable control of the course of CKD.

The aim of this study was a comprehensive assessment of the immunological status in patients with pre-dialysis stages of CKD.

Method

80 patients (46 men and 36 women) with CKD in the outcome of nephropathies of diabetic and nondiabetic etiology, admitted to the Republican Medical Scientific and Practical Center for Therapy and Medical Rehabilitation, were examined. Chronic pyelonephritis without exacerbation was diagnosed in 31 patients, chronic glomerulonephritis - in 29, diabetic nephropathy - in 25 polycystic kidney disease - in 6 patients. Glomerular filtration was calculated based on serum creatinine concentration using the CKD-EPI formula (2011). A complex of immunological studies was performed. Immunotyping of lymphocytes was performed by flow cytofluorometry with the characterization of the main markers of immunocompetent cells.

Results

In patients with CKD, violations were observed in almost all links of immunological reactivity, first of all, a significant decrease in indicators of natural resistance (CD16 +, PS, PI) (p <0.05). The results of immunological monitoring showed a predominant violation of cellular defense mechanisms (CD3 +, CD4 +, CD8 +) (p <0.05), a multiple increase in inflammatory cytokines Il-4, TNF-α, IL-6 (p <0.05), in the absence of activation of humoral link and inadequacy of elimination mechanisms (CEC, p <0.05).

Conclusion

Our study showed that the immunological parameters were characterized by insufficient activation of the first line of defense of natural resistance, as well as specific mechanisms - an imbalance of the cellular and humoral links of immunity, hyperactivation of cytokine regulation in the absence of effector functions.
MO429A NOVEL METHOD LINESCAN-DRIVEN FOR SNGFR MEASUREMENTS AS ALTERNATIVE TO HIGH FULL FRAME MULTIPHOTON MICROSCOPY ACQUISITION
Authors: Costanzo Vincenzo , D'Apolito Luciano , Sardella Donato , Iervolino Anna , Frische Sebastian , La Manna Gaetano , Capasso Giovambattista , Trepiccione Francesco
Published: May 2021

Background and Aims

Renal micropuncture, which requires the direct access to the renal tubules, has been for long time the technique of choice to measure the single nephron glomerular filtration rate (SNGFR) in animal models, but this approach is challenging by virtue of complex animal preparation and numerous careful steps. The introduction of intravital multiphoton microscopy (MPM) permitted to improve the study of renal functions exploiting the high laser penetration and the optical sectioning capacity. Previous MPM studies measuring in vivo the SNGFR relied on fast full frame acquisition during the filtration process obtainable with microscope resonant scanners, which represent optional expensive equipment able to reach very high acquisition speed. In this work we propose an innovative linescan-based MPM method to calculate SNGFR in rodents doable without using the fast acquisition rate offered by resonant scanners.

Method

An in vivo MPM approach was used to measure the SNGFR in control Munich Wistar Frömter rats (MWF) and to test the feasibility of the innovative linescan approach. In order to validate this method in conditions known for reduced and increased SNGFR, it was applied to ischemia reperfusion injury (IRI) and low-dose dopamine treated conditions, respectively.

Results

The glomeruli connected to S1 proximal tubules extending at least 100 μm from the exit of the Bowman’s space were chosen for the measurement. A linescan path starting from the urinary pole and crossing many times the tubular lumen orthogonally to the cellular wall was hand drawn. The linescan was acquired soon after a i.v. bolus of low-molecular weight fluorescent marker was injected. The tubular length, the mean diameter and the transit time of the fluorescent marker within two lines of interest (called cross1 and cross2) were measured to obtain the SNGFR. SNGFR measured in control rats was comparable with previous reported data both at MPM and micropuncture. Significantly higher values compared to control were obtained in 3 μg/kg/min dopamine-treated rats. In IRI-treated rats the SNGFR was reduced about 35% compared to the controls.

Conclusion

The results achieved with our linescan method were quite similar to those obtained with conventional micropuncture, suggesting that the two methods overlap for the normal, dopamine and IRI treatment. Our results show that linescan approach is a promising and cheap alternative to the fast full frame acquisition for the investigation of SNGFR in health and disease, offering results comparable to conventional micropuncture with unprecedent temporal resolution.
MO432COMPARATIVE ANALYSIS OF INDIRECT IMMUNOFLUORESCENCE AND ENZYME-LINKED IMMUNOSORBENT ASSAYS FOR ANTI-PLA2R ASSESMENT IN PATIENTS WITH PRIMARY MEMBRANOUS NEPHROPATHY
Authors: Galkina Olga , Bogdanova Evdokia , Zubina Irina , Levykina Elena , Smirnov Alexei
Published: May 2021

Background and Aims

Antibodies to M-type phospholipase A2 receptor (PLA2R-Ab) are considered to be a promising biomarker for laboratory diagnosis of primary membranous nephropathy (PMN) and may be useful in the evaluation of the response to therapy and CKD prognosis. The aim of the study was to compare two immunoassay methods – indirect immunofluorescence (IIF) and enzyme immunoassay (ELISA) for the determination of circulating PLA2R-Ab in patients with PMN.

Method

The study included 54 patients aged 55 (40-63) yrs. (M: F [33:21]) with PMN before treatment (n=16) and treated with immunosuppressive therapy (IST) (n=38), and apparently healthy individuals of the corresponding gender and age (n=10). Proteinuria and estimated glomerular filtration rate (eGFR) were determined in all participants. The levels of PLA2R-Ab were determined by IIF and quantitative/ semi-quantitative ELISA (EURUIMMUN AG test, Germany). In 16 PMN patients without treatment and 28 PMN patients treated with IST the level of PLA2R-Ab was measured one time and in 10 PMN patients treated IST – in dynamic, from 2 to 5 times. Statistical comparisons among groups were performed using Mann–Whitney U-test and Kruskal-Wallis H tests. The association between variables was estimated using Spearman’s coefficient. Sensitivity and specificity of the methods were calculated.

Results

The correlation coefficient between IIF and ELISA was 0.82 (p <0.005). There were more PLA2R-Ab-positive cases detected by ELISA, both before treatment (ELISA - 80%, IIF - 67%) and among patients treated with IST (ELISA - 63%, IIF - 50%). In control group, ELISA showed no positive results for PLA2R-Ab (specificity was 100%). The levels of proteinuria and eGFR were associated with autoantibodies determined by ELISA, both quantitative and semi-quantitative (proteinuria: r = 0.69, p = 0.001; eGFR: r = -0.38, p = 0.035) but not by IIF (proteinuria: r=0.33, p=0.061; eGFR: r=-0.26, p=0.082). The levels of PLA2R-Ab measured by ELISA correlated with the course of disease in patients treated with IST, while IIF did not show any dynamics is some cases.

Conclusion

Both quantitative and semi-quantitative ELISA were considered to be more preferable methods since the obtained results correlate with renal dysfunction and allow to assess the concentration of PLA2R-Ab in the course of disease more accurately, that may contribute to timely correction of treatment and improvement of outcome.