bluuebunny/crossref_metadata_2025 huggingface dataset:
In vivo and ex vivo study on cell wall components as part of the network in tomato fruit during the ripening process
Authors: Kutyrieva-Nowak Nataliia , Leszczuk Agata , Denic Dusan , Bellaidi Samia , Blazakis Konstantinos , Gemeliari Petroula , Lis Magdalena , Kalaitzis Panagiotis , Zdunek Artur
Published: May 2024

Ripening is a process involving various morphological, physiological, and biochemical changes in fruits. This process is affected by modifications in the cell wall structure, particularly in the composition of polysaccharides and proteins. The cell wall assembly is a network of polysaccharides and proteoglycans named the arabinoxylan pectin arabinogalactan protein1 (APAP1). The complex consists of the arabinogalactan protein (AGP) core with the pectin domain including arabinogalactan (AG) type II, homogalacturonan (HG), and rhamnogalacturonan I (RG-I). The present paper aims to determine the impact of a disturbance in the synthesis of one constituent on the integrity of the cell wall. Therefore, in the current work, we have tested the impact of modified expression of the SlP4H3 gene connected with proline hydroxylase (P4H) activity on AGP presence in the fruit matrix. Using an immunolabelling technique (CLSM), an immunogold method (TEM), molecular tools, and calcium mapping (SEM-EDS), we have demonstrated that disturbances in AGP synthesis affect the entire cell wall structure. Changes in the spatio-temporal AGP distribution may be related to the formation of a network between AGPs with other cell wall components. Moreover, the modified structure of the cell wall assembly induces morphological changes visible at the cellular level during the progression of the ripening process. These results support the hypothesis that AGPs and pectins are required for the proper progression of the physiological processes occurring in fruits.
Resident pharmacist participation in shared medical appointments in palliative care in São Paulo, Brazil: experience and contributions
Authors: da Silva Charles Henrique Carvalho , França Gustavo Galvão , Tenório Ingrid Alckmin Beltrão , Rotta Inajara , Gomes Ligia Ferreira , Visacri Marília Berlofa
Published: May 2024

Objective

To describe the resident pharmacist’s participation in Shared Medical Appointments (SMA) in palliative care.

Methods

The resident pharmacist participated in face-to-face SMA with the attending physician, medical and gerontology students, and a nurse.

Key findings

The resident pharmacist supported interdisciplinary discussions and performed pharmaceutical interventions. He helped raise awareness about the effective, safe, and convenient use of medicines, helping improve the quality of life of patients and caregivers.

Conclusions

Providing pharmaceutical care to patients in palliative care helped to improve the quality of clinical services offered to these patients, as well as adding value to resident pharmacists’ interprofessional practice.
Education and non-communicable diseases in India: an exploration of gendered heterogeneous relationships
Authors: Kundu Jhumki , Goli Srinivas , James K S
Published: May 2024

Background

While the association between education and non-communicable diseases (NCDs) is well established, it remains unclear whether this association varies by gender. The aim of this study was to examine two critical research questions: whether the association of education and NCDs is conditioned by gender and, if so, what are the factors contributing to this?

Methods

Data from the Longitudinal Aging Study in India Wave 1 (2017–2018) was used for the empirical analysis. The study employs bivariate, binary logistic regression and Oaxaca decomposition analyses.

Results

The results reveal that the net likelihood of having at least one chronic NCD increases with an increase in education level for men (<5 y of schooling: odds ratio [OR] 1.18 [95% confidence interval {CI} 1.09 to 1.28]; ≥10 y of schooling: OR 1.43 [95% CI 1.33 to 1.53]). However, for women, the result showed a contrasting pattern. The decomposition analysis revealed that the distinctive roles of marital status and working status in the diagnosis of morbidity for men and women are the key factors behind the gendered heterogeneous relationship of education and NCDs in India.

Conclusions

The study found that it is important to acknowledge the potential impact of self-reporting bias in morbidity data while examining the relationship between education and NCDs.
Monocyte Anisocytosis Changes in Patients After Major Burn Injuries
Authors: Nazemidashtarjandi Saeed , Muldur Sinan , Supple Matthew D , Ryan Colleen M , Yonker Lael M , Karabacak Murat N , Goverman Jeremy , Yarmush Martin L , Irimia Daniel
Published: May 2024

The recovery of patients after severe burns is a long and complex process. Genomic analysis of white blood cells from burn and trauma patients revealed excessive and prolonged innate immune activation in patients with complicated outcomes. However, translating this knowledge into practical biomarkers has not been possible yet. Although several biomarkers for monitoring burn patients have been proposed, their ability to accurately distinguish between inflammation stemming from initial tissue destruction, infections, and organ failure complications is limited. Here, we focused on monocytes, critical innate immune cells in the response to burn injured tissues. We measured the monocyte anisocytosis (quantified as monocyte distribution width (MDW), a recently emerged marker of sepsis) throughout the recovery of patients from the time of burn injury until the end of the hospital stay. We observed that MDW increases in patients during the first week after major burns. Among the patients with major burns who survive, MDW starts decreasing in the second week and normalizes by the end of the hospital stay. The duration of hospital stay appears to be proportional to how fast MDW decreases during the second week after the injury. We also found that MDW decreases significantly in most patients after excision and debridement surgeries but not after allo- and auto-graft surgeries. Moreover, high MDW values correlated with a higher rate of positive microbiology blood culture samples and respiratory infections. These findings underscore the importance of monitoring MDW as a potential biomarker for the risk of complications during burn patient recovery.
#2837 Novel therapeutic for crescentic glomerulonephritis through targeting CLDN1 in parietal epithelial cells
Authors: Delbet Jean-Daniel , Anquetil Vincent , Saitoski Kevin , Toso Alberto , Baumert Thomas , Toovey Stephen , Manenti Luigi , Iacone Roberto , Ulinski Tim , Lenoir Olivia , Teixeira Geoffrey , Tharaux Pierre-Louis
Published: May 2024

Background and Aims

Crescentic glomerulonephritis (CrGN) is the final mode of kidney injury common to several immune-mediated kidney diseases. CrGN is characterized by extensive glomerular parietal epithelial cells (PECs) proliferation forming crescents. The destructive crescent is then progressively replaced by fibrosis. Currents therapies for CrGN do not directly target the deleterious response of resident kidney cells. In a pathological context, claudin-1 (CLDN1), a transmembrane protein involved in epithelial tight junctions, can be exposed outside the tight junctions and mediate pro-fibrotic pathways and extracellular matrix (ECM) remodelling. Lixudebart (formerly ALE.F02) is a first-in-class monoclonal antibody that specifically targets and blocks exposed CLDN1 in injured epithelial cells. A phase II clinical trial is under way for patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV) with rapidly progressive glomerulonephritis which induces kidney fibrosis (RENAL-F02, NCT06047171). CLDN1 is highly expressed by glomerular PECs. This study investigated the functional role of CLDN1 in CrGN and the potential benefit to target CLDN1 in CrGN.

Method

CLDN1 expression in renal tissues of CrGN patients was analyzed using kidney multicolor immunofluorescence staining and spatial transcriptomics. Correlation between CLDN1 expression and clinical endpoints (eGFR, proteinuria), disease biomarkers and crescent evolution were studied. A spatially resolved molecular roadmap from CLDN1+ crescentic glomeruli was conducted. Proof-of-concept studies using anti-CLDN1 mAb were performed in preclinical models of CrGN.

Results

In tissues (n = 150) of patients with AAV and IgAN, multicolor immunofluorescence revealed up-regulated CLDN1 expression by cellular and fibrocellular crescents. At the time of diagnostic kidney biopsy, glomerular CLDN-1 expression was correlated with podocyte loss (as measured with P57 staining) and fibronectin area.

The extent of dual expression of CLDN1 and CD44 at the surface of active PECs was associated with poor renal outcome (eGFR < 30 ml/min) in AAV and IgAN patients with a median follow-up of 2.5 and 3.7 years respectively. Spatial transcriptomics analysis highlighted the association between CLDN1+ crescentic glomeruli and ECM genes.

Treatment with anti-CLDN1 mAb reduced albuminuria, improved kidney function and decreased fibrosis biomarkers in nephrotoxic serum-induced CrGN in mice.

Conclusion

Our results suggest a functional role of CLDN1 in the pathogenesis of CrGN, providing preclinical proof-of-concept for anti-CLDN1 antibodies as a novel therapeutic approach in patients with CrGN.
#1526 Effects of dietary intervention on diabetic nephropathy: an umbrella review of systematic review and meta-analysis of randomized controlled trials
Authors: Cai Linli
Published: May 2024

Background and Aims

To evaluate the quality of evidence, potential biases, and validity of all available studies on dietary intervention and diabetic nephropathy (DN).

Method

We conducted an umbrella review of existing meta-analyses of randomized controlled trials (RCTs) that focused on the effects of dietary intervention on DN. Literature searching was performed via PubMed, Embase, Web of Science, Cochrane Database of Systematic Reviews, and hand searching of the reference lists. Systematic reviews and meta-analyses of RCTs that evaluated the effects of any dietary intervention on clinical outcomes of DN were included. Two reviewers evaluated the methodological quality of the included articles through AMSTAR score. In addition, according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE), evidence of each outcome was evaluated and graded as “high”, “moderate”, “low” or “very low” quality to draw conclusions. Additionally, we classified evidence of outcomes into 4 categories (class I to IV and non-significant (NS)).

Results

We identified 36 meta-analyses of RCTs and 55 clinical outcomes of DN from 395 unique articles (Fig. 1). Moderate quality evidence suggested that probiotics supplementation could significantly improve blood urea nitrogen (BUN), total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) in DN patients. Low quality evidence indicated that probiotics supplementation significantly improved serum creatinine, urinary albumin creatinine ratio (UACR), fasting blood glucose (FBG), HbA1c and high-density lipoprotein cholesterol (HDL-C) in DN patients. In addition, low quality evidence suggested that a salt restriction diet could significantly improve creatinine clearance rate (CrCl) in patients with DN. Low quality evidence suggested that vitamin D supplementation could significantly improve UACR in patients with DN. Besides, low quality evidence indicated that soy isoflavone supplementation could significantly improve BUN, FBG, TC, triglycerides (TG) and LDL-C in patients with DN. Furthermore, low quality evidence suggested that coenzyme Q10 supplementation could significantly improve HbA1c, TC and HDL-C in patients with DN, and dietary polyphenols also significantly improved HbA1c in patients with DN. Finally, low quality evidence suggested supplementation of antioxidant vitamins could significantly improve serum creatinine, systolic blood pressure, and HbA1c in patients with DN. The remaining outcomes were rated as very low quality due to significant risk of bias, significant heterogeneity, imprecision, and publication bias. Given the small sample size, all significantly associated outcomes were evaluated as class IV evidence (Fig. 2).

Conclusion

Moderate to low evidence suggests that supplementation with probiotics, vitamin D, soy isoflavones, coenzyme Q10, dietary polyphenols, antioxidant vitamins, and salt-restricted diets may significantly improve clinical outcomes in patients with DN.
#1308 Role of uremic compound, indoxyl sulfate, in the cardiac alterations lead by the acute kidney injury
Authors: Fogaça-Ruiz Fernanda , Carneiro-Ramos Marcela , Da Silva Jéssica Verônica , Falconi Carlos Alexandre
Published: May 2024

Background and Aims

Uremic toxins (UTs) have been largely discussed in the late years due to its deleterious effects in different tissues in the human body. In healthy people, UTs are excreted by the kidneys, however, if they are not filtered because of any imbalance of the organism, the state of uremia starts damaging not only the kidneys but also the heart and other organs. Indoxyl Sulfate (IS) is a protein-bound UT, that is not removed by the dialysis membrane, and has its mechanisms still unknown. The cross-talk between the heart and the kidneys is called cardiorenal syndrome (CRS) and is usually divided in 5 different types. The CRS 3 is described as an acute kidney injury (AKI) leading to posterior cardiac alterations. Therefore, the present work aims to investigate the effects of IS in a model of CRS 3 induced by AKI.

Method

All surgical procedures and protocols were approved by the Ethics Committee on Animal Use of the Federal University of ABC (no. 5250040123) in accordance with the National Council for Control of Animal Experimentation (CONCEA). Mice C57BL/6 (between 6 and 8 weeks of age) were submitted to the left kidney ischemia and reperfusion protocol as previously described by our group [1] for 60 minutes. After, they were divided in two groups: 1) Injected with IS (100 mg/kg/day) during 15 days intraperitoneally; 2) Control: treated with saline 0.9% for the same period. The Sham group went through the same procedures but didn't have the renal pedicle clipped. The animals were submitted to euthanasia and the blood, heart, kidneys and tibia were harvested to posterior analysis. Data are expressed as mean ± SEM. One-way ANOVA was used to statistically analyze all groups followed by Tukey's post hoc test; p < 0.05 was considered statistically significant.

Results

The morphometric analysis demonstrated that there was no difference in the heart weight/body weight and heart weight/tibia length ratios in the different experimental groups. IR+IS promoted a significant increase in the right kidney weight/tibia length ratio (80.54 ± 2.919 sham vs 94.34 ± 2.698 IR+IS). Regarding the left kidney, IR promoted a decrease in the kidney weight/tibia length ratio, when compared to the sham group (35.88%), indicating success in the AKI induction protocol. The urea dosage was reduced in the group treated with IS in relation to IR (52.88 ± 1.767 Sham+IS vs 70.75 ± 3.004 IR), but it did not present statistical significance among the other groups. Creatinine levels remained unchanged regardless of the group.

Conclusion

Treatment with IS does not lead to morphometric changes in the heart, and in the kidneys, it does not intensify the effect of ischemia.
#2711 Cardiomyocytes exposed to medium conditioned by kidney cells treated with the uremic toxin p-cresyl sulfate undergo changes in cell viability
Authors: Bedin Beatriz Favero , de Souza Laura Francisca Leite Do Prado , Rodrigues Tiago , Ramos Marcela Sorelli Carneiro
Published: May 2024

Background and Aims

Cardiorenal Syndrome (CRS) is a condition involving the heart and the kidneys, where a disturbance in one of these organs can lead to alterations in the other. High levels of uremic toxins (UTs) such as p-Cresyl Sulfate (PCS) can induce renal injury. Furthermore, UTs play a crucial role in inflammatory status and cardiac function. Therefore, it is crucial that studies regarding the influence of uremic toxins in the context of cardiorenal syndrome be conducted. Nevertheless, few studies have been conducted in the context of Acute Kidney Injury (AKI) causing acute damage to the heart, and few mechanisms are still known. The objective of the study was to evaluate the role of PCS in cell viability and inflammatory genes in renal and cardiac cells, to simulate cardiorenal syndrome due to excessive PCS.

Method

The HEK293 (human epithelial renal cells) and H9c2 (murine cardiomyocyte cells) cell lines were used. HEK293 was treated with concentrations of 0.25 mM, 0.5 mM, 1 mM, and 1.5 mM PCS for 6, 24, and 48 hours. H9c2 was treated with PCS (1.5 mM) and conditioned media from PCS-treated renal cells (1.5 mM) for 6 and 24 hours. MTT assays, growth curve analysis, and Hoechst-PI staining were performed. Gene expression was evaluated by RT-qPCR. ANOVA followed by Bonferroni post-test was conducted, considering P < 0.05 as significant.

Results

PCS treatment led to a time and dose-dependent decrease in cell viability. The cell growth curve indicated a negative impact across time on renal cell proliferation at all different PCS concentrations. Hoechst-PI assay revealed increased cell death in the treatment with PCS (1.5 mM) for 24 hours. There was no change in the gene expression of IL-6, IL-1β, Bax, and Bcl-2 in renal cells. Cardiac cell viability decreased both after direct PCS treatment (85.3%) and exposure to PCS-conditioned media from renal cells for 24 hours (87.3%).

Conclusion

PCS reduces renal cell viability and inhibits cell proliferation without affecting the inflammatory status and apoptosis signaling within the evaluated time frames. Cardiac cell viability decreased after PCS treatment, either directly or indirectly, suggesting a cardiotoxic effect of PCS, independent of changes in renal cells.
#2374 Long-term clinical outcomes in pediatric patients with primary nephrogenic insipidus
Authors: Ahn Yo Han , Lim Seon Hee , Kim Ji Hyun , Lee Seung Jae , Song Ji Yeon , Park Eujin , Park Se Jin , Park Min Ji , Cho Min Hyun , Kang Hee Gyung , Suh Jin Soon
Published: May 2024

Background and Aims

Nephrogenic diabetes insipidus (NDI) is a rare inherited disorder, and there is a paucity of studies assessing long-term clinical outcomes in affected individuals. This study aims to evaluate the long-term clinical outcomes, encompassing growth and kidney function, in pediatric patients with NDI.

Method

This multicenter retrospective study included forty-nine children diagnosed with NDI. The medical records of these patients were retrospectively reviewed, and a linear mixed model was employed to analyze variations in growth and kidney function with increasing age.

Results

Mutations in the AVPR2 and AQP2 genes were identified in 40 (81.6%) and 4 (8.2%) patients, retrospectively, while pathogenic variants were either not found or not tested in 5 (10.2%) patients. The median ages at diagnosis and the last follow-up were 0.41 (interquartile ranges (IQR) 0.12−0.64) years and 9.97 (IQR 2.42−18.66) years, respectively. Thiazide treatment was administered to all patients, with 43 (87.8%) and 14 (28.6%) patients also receiving amiloride and indomethacin, respectively, in conjunction with thiazide. Our analysis using linear mixed models revealed significant changes in growth including height, weight, and body mass index (BMI) with increasing age. The estimated marginal means (EMM) for height Z score decreased from −0.114 (95% confidence interval (CI) −0.507 to 0.279) at diagnosis to −1.464 (95% CI −1.880 to −1.048) at 2 years of age, subsequently increasing to −0.706 (95% CI −1.186 to −0.225) at 14 years of age (P < 0.001). The height Z score at 19 year of age is −0.899 (95% CI −1.434 to −0.365), significantly lower than those at diagnosis (P = 0.038). The EMM for weight Z score increased from −1.580 (95% CI −2.009 to −1.149) at one year of age to 0.760 (95% CI 0.170 to 1.350) at 19 years of age, exhibiting a steady increase (P < 0.001). The EMM for BMI Z score demonstrated a consistent increase after age of 2 years (P < 0.001), which were −0.326 (95% CI −0.835 to 0.182) at 2 years of age and 1.210 (95% CI 0.602 to 1.817) at 19 years of age. The proportion of obesity increased from 3.2% at 3 years of age to 33.3% at 19 years of age. The EMM for estimated glomerular filtration rate (eGFR) consistently increased from 82.8 (95% CI 75.2 to 90.3) mL/min/m2 to 100.8 (95% CI 88.9 to 112.7) mL/min/m2. Although eGFR less than 60 mL/min/m2 is not present, the eGFR less than 90 mL/min/m2 is 47.5% at last follow up.

Conclusion

At the end of growth, the height Z score is low, and the proportion of obesity is high. To improve the growth pattern, clinicians need to monitor nutritional status and establish nutritional support during follow-up in patients with NDI. Since mild decreased kidney function developed in half, patients with NDI need long-term follow-up evaluation for kidney function.
#3127 Bedside cycling modulated the bone-resorption markers in patients with end-stage renal disease
Authors: Lu Kuo-Cheng , Hou Yi-Chou
Published: May 2024

Background and Aims

Exercise provided multifactorial benefits in improving the health of the CKD patients. The exercise itself improved the bone remodeling. For CKD patients, chronic kidney disease mineral bone disorder (CKD-MBD) is an important complication and the treatment for renal osteodystrophy is unsatisfactory. The aim of study is to validate the role of bedside cycling in bone remodeling markers for patients with end-stage renal disease (ESRD).

Method

Participants were grouped into 4 groups: health control, chronic kidney disease (GFR 15∼60 ml/min) and ESRD (GFR<15 ml/min with maintenance dialysis). For ESRD patients, 12-week bedside cycling ((30 minutes per session; 3 times per week) were given for subjects. The pre-and post-exercise bone remodeling markers and clinical outcome were compared in ESRD with and without exercise in ESRD subjects.

Results

Bone formation markers (Bone specific alkaline phosphatase (15.57 ± 1.59 pg/dL) and Procollagen type 1 amino-terminal propeptide (1269.12 ± 116.34 pg/dL) were higher in ESRD patients with correlation with indoxyl sulfate and intact parathyroid hormone concentration(p < 0.05) respectively. In ESRD patients, the post-exercise concentration of Tartrate-resistant acid phosphatase 5b (3.64 ± 0.25 pg/dL to 4.23 ± 0.31 pg/mL, p = 0.003) and N-terminal telopeptide-1 (113.67 ± 20.53 pg/mL to 260.61 ± 30.9 pg/mL, p = 0.001)increased after 12 weeks of bed-side cycling. The hospitalization and mortality were similar between ESRD with or without exercise.

Conclusion

The bone formation marker concentration increased along with the severity of CKD. Bedside cycling increased the concentration of the bone resorption markers in ESRD patients.
#1351 Assessment of safety and efficacy of expanded hemodialysis in comparison to HDF
Authors: Marcello Matteo , Simonini Marco , Virzì Grazia Maria , Lorenzin Anna , Brendolan Alessandra , Ronco Claudio , Zanella Monica
Published: May 2024

Background and Aims

In end-stage kidney disease, solutes with a wide spectrum of molecular weight, called uremic toxins, are retained due to impaired kidney cleansing capacity. Particularly, the retention of toxins in the middle molecular weight range 15–45 kDa might negatively affects multiple organ systems and metabolic pathways. The removal of such large uraemic toxins is still a challenge. HDF has produced some results although large convective volume, optimal vascular access to increase the blood flow rate and strict water quality management are required. Medium Cut-Off, high Retention Onset membrane have been recently developed introducing the concept therapy called “expanded haemodialysis” (HDx). Furthermore, vitamin E-coated membrane has potential beneficial effects on inflammation and oxidative stress.

Method

A prospective longitudinal single-center study was conducted for 3 months among 18 chronic haemodialysis patients. Patients were randomly assigned into either HDF with high flux membrane or HDx with Theranova or ViE-X membrane. The primary goal was to assess albumin loss among the three types of dialyzers. Secondary goals included assessment of depurative efficacy for uraemic toxins and clinical outcomes. Throughout the treatment, a proportional part of the dialysis fluid was collected to quantify albumin loss. Blood samples were taken before and after dialysis session in order to calculate the Removal Ratio and at two different intradialytic timepoints from arterial and venous line of the circuit in order to calculate instantaneous clearance.

Results

Mean albumin loss was significantly higher in patients undergoing HDx with Theranova membrane (ANOVA, p<0.001) without any difference in serum albumin concentration among the three groups. Instantaneous clearance of small and middle molecules was significantly higher in patients undergoing HDF, but we didn't find differences in removal ratio. Reduction of Erythropoietin resistance index was observed in patients treated with ViE-X membrane but it was related to their lower dialysis vintage.

Conclusion

HDx with Theranova membrane was associated with higher albumin loss without any effect on pre-dialysis serum albumin. Moreover, patients treated Theranova membrane, in the presence lower Qb, lower convective dose and lower instantaneous clearance reached same dialysis efficacy compared to HDF.
#2158 Circulating kidney injury molecule-1 a valuable marker of mortality in hemodialysis patients?
Authors: Sircuta Alexandru , Bob Flaviu , Grosu Iulia Dana , Schiller Adalbert , Petrica Ligia , Schiller Oana-Marina , Ivan Viviana , Madalina Bodea Alexandra , Golet Ionut
Published: May 2024

Background and Aims

The importance of finding reliable biomarkers of mortality in CKD, and especially in patients treated with hemodialysis has become evident. Plasma KIM-1 has been mentioned as a marker of cardiovascular morbidity.. The aim of this study is to assess the level of plasma Kidney Injury Molecule- 1 (KIM-1) as a marker of mortality in patients treated with hemodialysis.

Method

We conducted a single-center study that included 63 CKD G5D patients (hemodialysis for 1-5 years) followed up for 48 months and a control group consisting of 52 patients diagnosed with CKD stages G1-G5, without HfrEF. All patients have been assessed at baseline, regarding cardiovascular disease (medical history, echocardiography and ECG). Circulating plasma KIM-1 levels were determined with single molecule counting immunoassay technology using the Enzyme-linked immunosorbent assay, we performed using standard methods blood biochemistry, and markers of inflammation (CRP, IL-6) and markers of anemia (complete blood count, serum ferritin, transferrin saturation- TSAT).

Results

Mean plasma KIM1 levels were 403.8 +/-546.8pg/ml) in the group of patients treated with hemodialysis, and was statistically significantly higher compared to the level in the control group (217.48 +/-267.10 pg/ml). In the group of patients treated with hemodialysis plasma KIM-1 levels showed a statistically significant correlation with inflammation (mean CRP- R=0.28, p=0.02 and IL6- R=0.36, p=0.005) and with anemia (hematocrit- R= -0.5, p=-0,0316; hemoglobin - R= -0.5, p=0.02 We found out using ANOVA that patients which presented left ventricular hypertrophy on echocardiography (37 out of 62) had significantly lower mean levels of plasma KIM-1 (155,51 vs 432,12 pg/ml; p=0,026). The group of patients with vascular calcifications on echocardiography (48 out of 62) had lower levels of serum KIM1 (210.01 vs 462.58 pg/ml, p=0.04).

After 24 months of follow up we found a mortality rate of 22.23%, while after 48 months the mortality rate was of 50.73%. Using a Cox proportion-hazards regression analysis of predicting factors of mortality we found that regarding the relationship between plasma levels of KIM-1 and mortality there is a significantly decreased survival in patients with low KIM-1<81.98 pg/ml (p<0.001), with a cut-off point for plasma KIM-1 levels= 81.98 pg/ml.

Conclusion

Plasma KIM-1 levels were significantly higher in patients treated with hemodialysis compared to the control group (ND CKD patients). However, surprisingly, low levels of plasma KIM1 were associated with some cardiovascular changes and also to an increased risk of mortality (at 4 years, not after few months).
#703 Usability of a mobile health app for peritoneal dialysis patients: a pilot study
Authors: Cely Javier , Sanabria Mauricio , Doria Cesar Mauricio , Dazzarola Maria Paz , del Castillo Alvaro , Martinez Anthony , Camargo David , Vesga Jasmin , Aldana Andrea , Sánchez Ricardo , Rivera Angela , Rutherford Peter
Published: May 2024

Background and Aims

Technology has changed how people interact with the world, so health apps may be useful for patients with long term conditions, facilitating adherence and enabling remote monitoring. Usability is a critical factor when evaluating the quality of a mobile health app, as it indicates the ease with which a user can use it to achieve specific clinically orientated goals with effectiveness, efficiency, and satisfaction.

Method

The mHealth App Usability Questionnaire (MAUQ), a reliable and validated tool, was used to evaluate the MyPD® mobile health app's usability for adult peritoneal dialysis (PD) patients. The arm using the My PD app in a pilot randomized clinical study in six renal clinics in Colombia from September 2022 to August 2023 was evaluated. The MAUQ questionnaire includes 18 items assessing 3 domains related to ease of use (5 items), interface and satisfaction (7 items) and usefulness (6 items). Patients rated each item on a seven-point Likert scale, with one (1) strongly disagreeing and seven (7) strongly agreeing. The overall rating is the mean of eighteen items (standalone version); closer to seven (7), higher usability. The socio-demographic and clinical characteristics of all patients were summarized descriptively.

Results

MyPD app allows patients to collect and view their clinical information and dialysis treatment. Figure 1 shows a general overview of the different navigation windows. A total of 65 patients were included in this analysis; the mean age was 52.2 years, 44.6% were in CAPD, and 21.5 % achieved elementary school education or were illiterate (Table 1).

The overall usability was 6.5 (SD 0.7), the maximum possible score is 7. The items related to satisfaction and interface have a mean of 6.8 (SD 0.5). Regarding ease of use, the mean was 6.6 (SD 0.8), a very high figure given the socio-cultural context of a middle-income country. In relation to usefulness, the mean was 6.1 (SD 1.5). Patients rated the overall satisfaction item with the app as 6.8 (SD 0.6). See details in Table 2. These results are better than those reported by other authors (Table 3).

Conclusion

The usability of the health app MyPD® was rated very high by patients, which will allow this application to be used widely as a tool that supports the outpatient care of PD patients.
#3131 Catheter placement by the nephrologist: a safe and effective method for improving access to peritoneal dialysis
Authors: Lafrid Maria , Bahadi Abdelaali , Labioui Narjiss
Published: May 2024

Background and Aims

Peritoneal dialysis (PD) is as effective as hemodialysis and provides a better quality of life. However, it remains underused, particularly in our country, for several reasons, especially the unavailability of surgeons with the necessary skills to insert catheters. The aim of our study was to evaluate the impact of catheter placement by the nephrologist on the incidence of peritoneal dialysis patients, compare the success rates and assess the short- and long-term complications between surgical and nephrologist placements. The ultimate goal was to identify and promote the most effective method with the fewest complications.

Methods

Retrospective study of 69 patients with PD from January 2008 to December 2022.

Results

28 received PD catheter placement by nephrologists (group A), while 41 underwent the procedure performed by urologists (group B).The incidence of patients placed on PD has shown a significant increase since the initiation of catheter placement by nephrologists, with a growth rate of over 100% every two years. No significant difference was observed in the incidence of short-term mechanical and infectious complications between the two groups. However, the group B experienced a higher occurrence of long-term mechanical and infectious complications compared to the group A. The waiting time before catheter placement was significantly shorter in group A (5 days vs. 20 days; p < 0.001). The success rate of peritoneal dialysis catheter placement in group A was 92.85%, while it was 97.56% in group B. There was no significant difference in catheter survival at 1 year between the two groups. However, the mean catheter survival was significantly longer in group B (17 months vs. 11 months, p = 0.026).

Conclusion

The placement of the PD catheter by nephrologists has demonstrated effectiveness and safety. However, it is crucial to investigate and address the factors contributing to the shorter mean catheter survival. By identifying and correcting these factors, we can improve the longevity of catheters and enhance the overall success of PD procedures.
#1615 Working without peritoneal dialysate and urine collections during the COVID-19 pandemic: how to assure sufficient small solute removal
Authors: Zeiler Matthias , Fioravanti Gilda , Angelini Andrea , Silvestri Simona , Fioravanti Giuseppe , Santarelli Stefano
Published: May 2024

Background and Aims

The guidelines of the International Society of Peritoneal Dialysis suggest regular control of small solute removal. During the COVID-19 pandemic we did not perform additional controls of dialysis adequacy in our peritoneal dialysis patients. We judged patients according symptoms and serum urea levels. In this retrospective study, we aimed to evaluate whether the measurement of serum urea alone might indicate sufficient small solute removal in peritoneal dialysis patients.

Method

In 216 adult PD patients (139 males, 77 females, median age 64 years, median BMI 26.7) Kt/V urea (renal and peritoneal) was registered together with anthropometric and laboratory data during the first two years of PD therapy. Patients presenting urea values between 100 and 250 mg/dl were included in the statistical analysis, thus resulting in the evaluation of 410 measurements (265 in male, 145 in female patients). Urea distribution volume was calculated using the formula of Watson and Watson. The measurement of urea in blood and urine was performed by a standard kinetic test with urease.

Results

Serum urea correlated significantly to Kt/V urea (r = −0.28, p < 0.01), whereas significance was not reached in female patients (male patients: r = −0.35, p < 0.01; female patients; r = −0.14, p = 0.13). Kt/V urea of at least 1.7 is achieved in male patients presenting serum urea values lower than 160 mg/dl (95% confidence interval), whereas in female patients apparently presenting serum urea values lower than 200 mg/dl (95% confidence interval). This difference is due to the distinct sex specific urea distribution volume (median value: male patients 40.8 liters, female patients 31.8 liters) and to the absence of a significant correlation between serum urea and Kt/V urea in female patients.

Conclusion

Serum urea values below 160 mg/dl in male peritoneal dialysis patients are roughly indicating sufficient small solute removal, whereas a clear relation between serum urea and Kt/V urea was not present in female patients in our study population.
#1970 Mortality prediction of plasma presepsin in sepsis-associated acute kidney injury patients requiring continuous kidney replacement therapy
Authors: Hwang Won Min , Park Yohan , Yoon Se-Hee , Yun Sung-Ro , Lim Dong Mee
Published: May 2024

Background and Aims

Presepsin has recently introduced as a more specific biomarker for sepsis. Presepsin is greatly affected by kidney function, so its reliability may be reduced in acute kidney injury (AKI) patient, especially requiring continuous kidney replacement therapy (CKRT). For this reason, there has been no study to date analyzing presepsin in AKI patients requiring CKRT. This study analyzed the usefulness of plasma presepsin for predicting mortality in AKI patients requiring CKRT, especially in sepsis-associated AKI (SA-AKI).

Method

This single-center, retrospective study included the patients who underwent CKRT with plasma presepsin measurement from April 2022 to March 2023. A total of 57 patients were enrolled, of which 35 were SA-AKI. 28-day mortality predictive values of plasma presepsin, Acute Physiology and Chronic Health Evaluation-II (APACHE-II), and Sequential Organ Failure Assessment (SOFA) scores were analyzed using receiver operating characteristics (ROC) curve analysis. Multivariate Cox regression analysis was performed to identifying risk factors for 28-day mortality in the SA-AKI subgroup.

Results

In the overall cohort, plasma presepsin showed the lower area under the ROC (AuROC) value of 0.636 than those of APACHE-II (0.663) and SOFA (0.731) scores. However, in SA-AKI subgroup, AuROC value of plasma presepsin was much increased to 0.799, which was the higher than those of APACHE-II (0.651) and SOFA (0.697) scores. Moreover, in multivariate Cox regression analysis, high presepsin was observed as an independent risk factor for 28-day mortality in the SA-AKI subgroup (HR 6.868, P=0.005).

Conclusion

Presepsin can be used as a good prognostic marker in SA-AKI patients requiring CKRT. The usefulness of plasma presepsin in the patients undergoing CKRT needs to be further studied in the future.
#710 Rare manifestation of minimal change disease associated with prostate cancer
Authors: Kleinova Patricia , Vnučák Matej , Graňák Karol , Beliančinová Monika , Blichová Tímea , Dedinská Ivana
Published: May 2024

Background and Aims

Prostate cancer is the most common malignancy in men. Secondary nephrotic syndrome as part of the paraneoplastic syndrome occurs in 11% of cases and is most often associated with membranous glomerulopathy. The association of minimal change disease (MCD) and prostate cancer is extremely rare, where only one case has been described in the available literature.

Method

We present the case of a 77-year-old patient who was admitted to the Transplantation-Nephrology Department of the University Hospital Martin with 3rd degree acute kidney injury and anasarca with fully developed nephrotic syndrome.

Results

During hospitalization, there was a gradual elevation of renal parameters and oliguria with the need for hemodialysis treatment. However, as part of the oncological screening, the level of prostate specific antigen was elevated (10.69 ng/l) with subsequent biopsy confirmed adenocarcinoma of the prostate in stage IIB (pT1cN0M0). Renal biopsy was performed with the finding of MCD, in light microscopy without pathological findings, with fully vital, normocellular glomeruli, without interstitial fibrosis and tubular damage, immunofluorescence without significant findings, in the electron microscope, pedicel podocyte fusions were present. Despite the generally valid recommendations for the treatment of prostate cancer of the given stage and age of the patient (follow-up), antiandrogen therapy was started in cooperation with the urologist along with the treatment of MCD with corticosteroids at a dose of 1 mg/kg. The patient experienced a significant improvement in renal parameters with the onset of diuresis without the need for dialysis treatment.

Conclusion

In the reported case, we describe a rare form of MCD associated with prostate cancer and a rare manifestation in the form of renal failure and the need for dialysis treatment with subsequent complete restitution of renal functions after KS treatment and antiandrogen treatment of the underlying oncological disease.
#664 Childhood Takayasu arteritis: a multicentre retrospective study
Authors: Evers Katrina , Millar Lancelot , Eleftheriou Despina , Brogan Paul , Marlais Matko , Tullus Kjell
Published: May 2024

Background and Aims

Takayasu arteritis (TA) is a rare, large vessel vasculitis affecting mainly the aorta and its major branches. Data on paediatric TA (pTA) is very scarce. The aim of this study was to characterize clinical presentation, therapy and outcome of pTA in a global study population.

Method

We conducted an international multicentre retrospective observational study of children diagnosed with pTA. Inclusion criteria were an age of less than 18 years at initial presentation in the year 2000 or more recently. Clinical data were collected from patients’ charts by the treating paediatric rheumatologist or nephrologist; data were fully anonymised for analysis purposes. Follow-up data was collected up to 2 years after diagnosis.

Results

198 patients from 20 countries were included (76% female). The median age at disease onset was 12 years. Arterial hypertension (67%), a difference in pulses between limbs (65%) and fatigue (66%) were the most common symptoms at presentation. The gastrointestinal system was the second most affected organ system. The median eGFR (estimated glomerular filtration rate) at baseline was 105 ml/min/1.73 m2. Renal artery stenosis was documented in 58% of all patients and in 37% there was need for an invasive renovascular procedure. In 25 of 32 (78%) patients who had either a positron emission tomography–magnetic resonance imaging (PET-MRI) or PET-computed tomography (CT) there was evidence of active inflammation mainly of the aorta. 67% of all patients showed thickened wall abnormalities and 31% had arterial dilatations in a major vessel on any one or more anatomical imaging modality such as ultrasound, CT or MRI. Immunosuppressive treatment was primarily steroids, cyclophosphamide and methotrexate, 37% of all patients were treated with monoclonal antibodies of which 65% received an anti-tumor necrosis factor (TNF) antibody, 31% an anti-Interleukin 6 (IL-6) antibody and 4% an anti-B-cell antibody. Dialysis was necessary in 7% and one patient underwent kidney transplantation. Seven patient deaths (4%) were documented at the most recent follow-up.

The renal function after two years was median eGFR 102 ml/min/1.73 m2, with 67% showing normal function, 31% presenting with chronic kidney disease (CKD) stage 1, 1% with stage 2, 1% with stage 3 and no patients showed stages 4 and 5. A quarter of the patients (27%) were still symptomatic at the 2-year follow-up. The median systolic blood pressure was 117 (interquartile range 107–125) mmHg. 64% of all patients still had antihypertensive treatment, and 87% were still on immunosuppressive therapy.

Conclusion

Our study represents the largest paediatric cohort of children diagnosed with Takayasu arteritis. Several organ systems were involved at onset and the clinical spectrum was highly variable. We will in our further analyses in more detail describe the outcome in relation to presenting symptoms and treatment.
#2493 Podocyturia: a novel biomarker of ageing
Authors: Puzantian Houry , Nasrallah Nadim , Malik Eva , Al Mardini Michel , Njeim Rachel , Eid Assaad , Badr Kamal
Published: May 2024

Background and Aims

Urinary podocyte shedding (podocyturia) is a biomarker of glomerular injury in young and old individuals. Podocyturia is associated with diabetes and hypertension, and it is an early indicator of systemic cardiovascular disease. Importantly, podocyturia has also been noted in healthy adults and may indicate physiologic podocyte turnover. Whether age is a predictor of podocyte loss, independently of diabetes and hypertension, is still unclear. The aim of this study was to examine the association between age and urinary podocin levels.

Method

This was a secondary analysis of data from 5 studies, including 868 individuals, 18-90 years of age. Data on urinary podocin mRNA levels was present on all subjects, as measured by CFX96 Touch™ RT-PCR detection system (Biorad, USA). Descriptive statistics, Chi-square test, ANOVA, and post hoc analysis were performed. Linear regression was conducted with gender, diabetes status, and hypertension status as covariates. Significance was set at p < 0.05.

Results

The mean age of the total sample was 55.10 ± 14.84 years; 46% were female, 26.4% had diabetes, and 37.9% had hypertension. There were significant differences in mean podocin levels by age group (F = 25.27, p ≤ 0.001) as follows. Podocin levels were significantly lower in Group 1 (age 18-35 years; 0.79 ± 0.67 million copies), compared to Group 2 (36-55 years; 2.21 ± 2.15 million copies) and Group 3 (over 56 years; 2.86 ± 3.18 million copies). Moreover, mean podocin levels differed significantly between Group 2 and Group 3 (p = 0.003). Age was a predictor of podocyturia, independently of diabetes and hypertension (p < 0.001).

Conclusion

Podocyturia was present in younger adults. There was a significant rise in podocyturia in middle-aged adults (36-55 years), denoting a transitional phase. There were higher podocyturia levels in older adults compared to the youngest and middle-aged adults. These differences in podocin by age were observed while accounting for diabetes and hypertension.
#2584 Mapping Progression of DKD in ReninAAV UNx db/db mice utilizing time-series RNA sequencing
Authors: Marstrand-Jørgensen Adam Bøgh , Østergaard Mette Viberg , Kaasbøll Ole , Dalbøge Louise S , Christensen Michael
Published: May 2024

Background and Aims

The Renin adeno-associated virus (AAV) uninephrectomized (UNx) db/db mouse model of diabetic kidney disease (DKD) recapitulates hallmarks of DKD with hypertension, including albuminuria and glomerulosclerosis. Despite previous characterization of the model, gaps persist in our understanding regarding temporal patterns of gene expression and pathophysiology in the glomeruli. This longitudinal study characterizes isolated glomeruli from ReninAAV UNx db/db mice during progression of DKD with hypertension.

Method

Female db/db (BKS.Cg-Dock7m +/+ Leprdb/J) received a single i.v. dose of LacZAAV (control) or ReninAAV. Untreated db/m mice (BKS.Cg-Dock7m +/+ Leprdb/J) served as healthy controls. One week after AAV injection, ReninAAV mice underwent UNx, recovered for three weeks, and were subsequently randomized and stratified into 4 groups according to fed blood glucose and body weight. ReninAAV UNx mice were terminated at 4, 8, 12 and 16 weeks (w4-w16) after UNx. Control groups were terminated at 16 weeks. Endpoints included urine and plasma biochemistry, kidney histology (i.e. Collagen 1a1 and Glomerulosclerosis) and RNA sequencing of glomeruli isolated by laser capture microdissection.

Results

ReninAAV UNx db/db mice showed progressive kidney fibrosis (Col1a1%-area) and albuminuria (uACR) compared to LacZAAV db/db and db/m mice across all timepoints investigated. Furthermore, a significant increase in glomerulosclerosis was observed from w12 and onwards compared to LacZAAV and db/m mice. When compared to LacZAAV mice, more than 1,700 glomerular differentially regulated genes and more than 250 uniquely regulated genes were found at each timepoint, including markers of fibrosis, inflammation and glomerular injury. Several glomerular drug targets exhibited time-specific regulated in ReninAAV UNx db/db mice (e.g. Slc5a2, Egfr, Agtr1a). Regulated genes were segmented into nine clusters with distinct temporal patterns. Among these, a continuous increase in expression of genes associated with extracellular matrix (ECM), small molecule transport and temporal stimulation of metabolic pathways. Finally, a correlation analysis revealed strong associations between ECM and ECM-related pathways vs. glomerulosclerosis and albuminuria.

Conclusion

The ReninAAV UNx db/db mouse model of hypertensive DKD demonstrates a progressive increase in fibrosis and albuminuria paralleled by dynamic changes in glomerular gene expression signatures. Notably, the identification of temporal patterns of gene expression and pathway regulation provides novel insights into DKD pathophysiology and progression. This underscores the ReninAAV UNx db/db mouse as an applicable model of human DKD in preclinical target and drug discovery.