bluuebunny/crossref_metadata_2025 huggingface dataset:
#2518 EFFECT OF VACCINATION ON OXIDANT/ANTIOXIDANT STATUS IN HEMODIALYSIS PATIENTS WITH POST-COVID CONDITIONS
Authors: Korol Lesya , Stepanova Natalia , Ostapenko Tetyana , Rysyev Andriy , Marchenko Valeriya , Belousova Olga
Published: June 2023

Background and Aims

Hemodialysis (HD) patients are at high risk for post-COVID conditions and a high mortality rate over a 1-year period after diagnosis of COVID-19, especially in the first 3 months. Evidence shows that vaccinated individuals who experience breakthrough infection are less likely to report post-COVID conditions compared with unvaccinated individuals. Although oxidative stress has been shown to be an important cause of post-COVID conditions, there is a general lack of data on oxidant/antioxidant status in HD patients with post-COVID conditions. The present study aimed to evaluate the oxidant/antioxidant markers in HD patients with post-COVID conditions according to vaccination status.

Method

A total of 106 HD patients, aged 52.4 ± 10.2 years, and dialysis vintage of 68 (29-134) months, were enrolled in this cross-sectional observational cohort study. Patients were divided into 3 groups according to their vaccination status and the presence of post-COVID conditions. Group 1 consisted of 36 HD patients who had been fully vaccinated against COVID-19 with either Pfizer-BNT-162b2 or Moderna-mRNA-1273 vaccine and had experienced a post-vaccination SARS-CoV-2 infection and had at least 1 post-COVID symptom. Group 2 consisted of 35 fully vaccinated HD patients who had never been infected with COVID-19 (vaccinated control group), and Group 3 included 35 unvaccinated HD patients who had experienced COVID-19 and had post-COVID conditions (unvaccinated control group). Concentrations of malondialdehyde in serum (MDAs) and erythrocytes (MDAe), sulfhydryl groups (SH-groups), serum catalase activity (CTs), serum transferrin and ceruloplasmin levels were determined 3 months after COVID -19 recovery. Data were expressed as a median and interquartile range [Me (Q25-Q75)] and compared with the Kruskal-Wallis test.

Results

The vaccinated HD patients with post-COVID conditions had the highest concentrations of MDAs and ceruloplasmin, and lower serum levels of CTs and transferrin compared with the vaccinated and unvaccinated control groups (Table 1).

Conclusion

Our findings suggest a significant oxidative imbalance in HD patients with post-COVID syndrome most likely due to the synergistic effects of the virus and the vaccine. The use of antioxidant supplements might be a possible strategy to treat post-COVID conditions in HD patients.
#2530 “HOME-MADE” REMOTE MANAGEMENT IN CAPD
Authors: Di Stante Silvio , Lionte Laurentia , Lucarelli Lucia , Magi Loredana , Mambelli Sabrina , Manfredi Elena , Mazzoli Elisa , Ranocchi Alessandra , D’onofrio Giovanni , Rinaldi Angela Pia , Sebastianelli Antonella , Silvestrini Stefania , Di Luca Marina
Published: June 2023

Background and Aims

Remote control of dialysis parameters has become an essential routine in the Centers that perform Peritoneal Dialysis. For patients in APD there are Cloud-based platforms or with VPN connection that allow daily monitoring and which have proved to be very useful for reducing hospital visits and treatment complications, especially during the recent pandemic. The same cannot be said of CAPD patients for whom the procedures are carried out manually, without electromedical devices, with a paper report of the parameters. Furthermore, to date, there are no dedicated applications able to communicate these important measurements to the Centres.

Method

In March 2021 we created a calculation table file, with limited data entry, divided by days, daily exchanges and monthly sheets. Patients and/or caregivers can insert loading and drainage volumes, type of bags used, blood pressure values, weight and diuresis at an agreed time. The system automatically calculates and graphically displays the total daily and monthly average ultrafiltration for each exchange, the daily balance as well as the average of all the aforementioned parameters for the entered period (Figure 1). There is also a graphic sheet with an annual summary of the average values (Figure 2). The file is uploaded online, subject to the patient's consent, via a free file hosting service that allows modification and reading shared and protected by password between patients and Center operators.

Results

To date, 9 CAPD patients in our Center have been included in the program with good acceptance by patients and caregivers, who enter data based on their availability of time and regularly in anticipation of the monthly outpatient visit. The staff of the Centre, both Doctors and Nursing, access the file periodically, in case of need and in preparation for the visit. In this way, regular checks and evaluations of prescription compliance, ultrafiltration efficacy, maintenance within the expected ranges of weight, blood pressure and fluid balance of patients in CAPD are obtained, as is the case for patients in APD.

Conclusion

The creation of a shared file for monitoring the dialysis parameters of CAPD patients could be able to reduce the existing gap with those in APD, at least as regards the vital and dialysis parameters, since the functioning of the catheter in individual exchanges cannot be evaluated. A more extensive experience is needed, and is being studied, to confirm the usefulness of this approach which currently already guarantees a reduction in hospital admissions and integrates and structures the clinical information that can be obtained in the traditional way.
#2547 THE EFFECTS OF HEMODIALYSIS ON THE FUNCTIONAL BRAIN CONNECTIVITY IN PATIENTS WITH END-STAGE RENAL DISEASE
Authors: Heo Chang Min , Son Sung Hyun , Park Sihyung , Park Bong Soo , Lee Yoojin , Kim Yang Wook
Published: June 2023

Background and Aims

The aim of this study was to investigate functional brain connectivity in patients with end-stage renal disease (ESRD) undergoing hemodialysis using functional near-infrared spectroscopy (fNIRS), and analyzed the effect of hemodialysis on the functional brain connectivity.

Method

We prospectively enrolled the patients with ESRD undergoing hemodialysis for more than six months without any previous history of neurological or psychiatric disorders. The fNIRS data acquisition was made with a NIRSIT Lite device. Measurements were made three times in the resting state for each patient; before the start of hemodialysis (Pre-HD), one hour after the start of hemodialysis (Mid-HD), and after the end of hemodialysis (Post-HD). We processed and exported the entire data, and made a weighted connectivity matrix using a Pearson correlation analysis. From the connectivity matrix, we obtained the functional connectivity measures by applying a graph theoretical analysis (Fig. 1). We compared the differences of the functional connectivity measures according to hemodialysis in patients with ESRD.

Results

We included 34 patients with ESRD. Table 1 and Fig. 2 show the differences in functional brain connectivity according to hemodialysis. There were significant changes in the functional connectivity measures of the mean clustering coefficient, transitivity, and assortative coefficient in the comparisons between Pre-HD and Post-HD periods (0.353 vs. 0.399, p = 0.047; 0.523 vs. 0.600, p = 0.042; 0.043 vs. -0.012, p = 0.044; respectively). However, there were no changes in the connectivity measures of the mean clustering coefficient, transitivity, and assortative coefficient in the comparisons between Pre-HD and Mid-HD periods, and between Mid-HD and Post-HD periods. In addition, there were no significant differences in the connectivity measures of the average strength, global efficiency, and local efficiency in the comparisons among Pre-HD, Mid-HD, and Post-HD periods.

Conclusion

We demonstrate the significant effect of hemodialysis on the functional brain connectivity in patients with ESRD. The functional brain connectivity would change in a more efficient direction through hemodialysis.
#2559 THE EFFECT OF INTRADIALYTIC EXERCISE ON CARDIAC OUTCOMES IN HEMODIALYSIS PATIENTS
Authors: Huang Mei , LV Aili , LV Honghong , Yang Feng , LI Yan , Hua Yan , Ni Chunping
Published: June 2023

Background and Aims

Cardiovascular disease is the main cause of death of hemodialysis patients, accounting for 42% of all deaths. Because exercise can reduce many risk factors of cardiovascular disease in these patients, we observed the effect of intradialytic exercise on left ventricular structure and function.

Method

A randomized controlled trial was used. Participants were randomly divided into control group and exercise group. Among them, the exercise group carried out intradialytic aerobic and resistance exercise for 3 months, 5-6 times every two weeks, according to their dialysis frequency. The left ventricular end-diastolic volume, mass and ejection fraction were measured by echocardiography before and 12 weeks after the intervention. (ClinicalTrial registration number: NCT05718765).

Results

At first, 60 people were recruited and completed the baseline assessment (30 people in each group). The average age of patients in the intervention group was 47.81-11.76 years old, and the average hemodialysis vintage was 17.23-3.09 months. There were 18 men in total. The average age of patients in the control group was 48.56-16.83 years old, and the average hemodialysis period was 17.67-2.83 months. There were 25 men in total. Before the intervention, the two groups of patient indicators were balanced, and the difference was not statistically significant (P>0.05). Finally, 53 patients completed the trial protocol (27 control group and 26 exercise group). After 3 months of intervention, there were significant differences in left ventricular mass, left ventricular end diastolic volume and left ventricular ejection fraction between the two groups (P<0.05). Moreover, the cardiac outcomes of the intervention group were lower than those of the control group, as shown in Table 1.

Conclusion

The exercise for 3 months can effectively reduce the left ventricular mass and significantly improve the left ventricular function and structure of hemodialysis patients. This will help to improve the research and development of exercise on cardiac in hemodialysis patients.
#2566 THE EFFECT OF ULTRASOUND-GUIDED COMPRESSION IMMEDIATELY AFTER RENAL GRAFT BIOPSY ON POST BIOPSY BLEEDING
Authors: Abdelnaeem Moataz Fatthy
Published: June 2023

Background and Aims

Renal biopsy is the gold standard for pathological diagnosis of graft dysfunction. Minor complications occur as haematuria, arteriovenous fistula (AVF) and/or small hematomas in 17% of cases. Major complications that require additional treatment as blood transfusion, surgical or interventional procedure. Bleeding may be excessive that may deteriorate ending in graft nephrectomy.

Method

For 6 months period, 213 renal biopsy procedure in clinically indicated patients, performed at interventional nephrology unit 144 men and 59 women, mean age 42 years old, were included. Adequate biopsies were considered showing at least ten glomeruli and 2 blood vessels. Immediate after core withdrawal, operator started ultrasound guided compression using 3-5 MHZ convex probe for 5 minutes at site of needle entrance compressing biopsy track against the graft. Post biopsy bleeding examined (peri-nephric, sub-capsular, haematuria and urinary bladder hematomas.

Results

Percentage of bleeding complications was compared with bleeding complications of previous 200 biopsies performed at the same centre with same operator using ordinary hand compression technique. Bleeding complications reduction by more than 60% especially percentage of perinephric hematomas.

Conclusion

Ultrasound guided compression technique post renal graft biopsy may reduce incidence of bleeding complications post biopsy.
#2601 THE MOLECULAR EFFECT OF SGLT2I ON THE AUTOPHAGY PATHWAY IN TYPE II DIABETES MELLITUS AND ITS VASCULAR COMPLICATIONS
Authors: Ertracht Offir , Saad Raneen , Tadmor Hagar , Nakhoul Farid , Nakhoul Nakhoul
Published: June 2023

Background and Aims

Type II Diabetes mellitus (T2DM) is a severe metabolic disorder characterized by chronic hyperglycemia and its subsequent glucose toxicity that lead to irreversible damages in several organs such as Diabetic Nephropathy (DN) [1]. Autophagy is involved in catabolic processes and plays a key role in the degradation of damaged intracellular proteins in order to maintain intracellular homeostasis and cell integrity. Studies showed that autophagy-related protein 5 (ATG5) and Light chain 3-II (LC3-II) play a critical role in a variety of disease processes, like DN [3]. Empagliflozin (EMPA)

is sodium glucose transporter inhibitor (SGLT2i) which represents a new class of glucose lowering drugs and is recommended in T2DM [4]. We hypothesized that EMPA effects renal integrity and function via the autophagy mechanism. The proposed research aim to investigate the molecular effect of SGLT2i on the expression of ATG5 and its downstream collaborator LC3-II in diabetic mice model [5].

Methods

8-week-old male mice: C57BL/6 Wild Type (Con), BTBR ob/ob (DM) and BTBR ob/ob treated with EMPA (1mg/kg/day P.O.) (DM+EMPA) were followed for 12 consecutive weeks for their weight, blood glucose and renal function. After sacrifice lysate from renal cortex were analyzed by Western blot and immunohistochemistry for ATG5, LC3B and fibronectin expression.

Results

Blood glucose level in DM mice was higher than Con, and lower in DM+EMPA. DM+EMPA mice drunk, urinated more and exerted more glucose than DM mice, yet had less protein in their urine. WB and IHC analyses revealed that renal ATG5 and LC3-II levels were reduced in DM mice compared with Con and DM+EMPA mice. Fibronectin expression was increased in DM compared to Con mice, and DM+EMPA mice.

Conclusions

EMPA treatment preserved DM mice renal dysfunction. Our data suggest that there is a link between DM and ATG5/LC3-II dysregulation and subsequent DN. EMPA preserves ATG5/LC3-II in DM mice. Our findings may be translated into clinical practice approach and may lead to further studies to address DM and vascular complications by selective modulation of ATG5/LC3-II expression with SGLT2i treatment.
#2608 IV IRON IN CKD AND HF: IMPROVING CLINICAL OUTCOMES WITH HIGH-DOSE IV IRON IN PATIENTS WITH IRON DEFICIENCY, HEART FAILURE AND CKD
Authors: Kalra Philip A , Ahmed Fozia
Published: June 2023

Background and Aims

The emerging role of IV iron to reduce cardiovascular risk, particularly risk of hospitalisation for heart failure. Cardiovascular diseases are a common comorbidity in patients with chronic kidney disease. There is emerging evidence that treating with IV iron may not only correct for iron deficiency and anaemia but also have positive effect on hard clinical endpoints.

Method

The most recent RCT trial published is the IRONMAN trial, which was a prospective, randomised, open-label, blinded-endpoint trial done at 70 hospitals in the UK. 1137 patients with heart failure, a reduced left ventricular ejection fraction and iron deficiency were randomised to receive either ferric derisomaltose (FDI) on top of usual care or usual care alone. A large proportion of the patients (64%) had an eGFR < 60 mL/min/1.73 m2.

Results

Compared to usual care, FDI was associated with a 18% lower risk of recurrent heart failure hospitalisations and CV death, which approached statistical significance (p = 0.07). In the prespecified COVID-19 sensitivity analysis, the primary endpoint was nominally statistically significant with a relative risk reduction of 24% (p = 0.047). Between Aug 25, 2016, and Oct 15, 2021, 1869 patients were screened for eligibility, of whom 1137 were randomly assigned to receive intravenous ferric derisomaltose (n = 569) or usual care (n = 568). Median follow-up was 2·7 years (IQR 1·8–3·6). 336 primary endpoints (22·4 per 100 patient-years) occurred in the ferric derisomaltose group and 411 (27·5 per 100 patient-years) occurred in the usual care group (rate ratio [RR] 0·82 [95% CI 0·66 to 1·02]; p = 0·070). In the COVID-19 analysis, 210 primary endpoints (22·3 per 100 patient-years) occurred in the ferric derisomaltose group compared with 280 (29·3 per 100 patient-years) in the usual care group (RR 0·76 [95% CI 0·58 to 1·00]; p = 0·047). No between-group differences in deaths or hospitalisations due to infections were observed. Fewer patients in the ferric derisomaltose group had cardiac serious adverse events (200 [36%]) than in the usual care group (243 [43%]; difference –7·00% [95% CI –12·69 to –1·32]; p = 0·016).

Conclusion

For a broad range of patients with heart failure, reduced left ventricular ejection fraction and iron deficiency, intravenous ferric derisomaltose administration was associated with a lower risk of hospital admissions for heart failure and cardiovascular death, further supporting the benefit of iron repletion in this population.
#2610 NURSE-LED OPTIMIZATION OF VOLUME AND BLOOD PRESSURE IN KIDNEY DISEASE – ENABLING AT MULTI-LEVELS USING A TECHNOLOGY (NOVELTY) PROGRAM
Authors: Huang Zhihua , Mok Irene , Ng LI Choo , Tan Hui Zhuan , Choo Jason , Tan Chieh Suai , Lim Cynthia
Published: June 2023

Background and Aims

Fluid overload and hypertension are common in chronic kidney disease (CKD). They increase healthcare utilization due to frequent ambulatory consults and/or hospitalizations but can be avoided with self-management. We evaluated the feasibility of a nurse-led, team-based program that incorporated (1) objective fluid volume assessment using body impedance analysis (BIA) to enable diuretic and antihypertensive titration, and (2) structured patient education and action plan coaching for ambulatory patients with CKD and fluid overload and/or uncontrolled blood pressure.

Method

Prospective pilot study of adults who participated in the 4-week program (Figure 1) between August and October 2022. Patients were eligible if they had CKD not requiring dialysis and had fluid overload and/or systolic blood pressure (BP) >160 mmHg or diastolic BP >100 mmHg at the ambulatory renal clinic. We evaluated fluid overload symptoms and signs, standardized clinic BP, BIA over-hydration volume and patient reported outcomes on (1) chronic disease self-management using the Partner in Health (PIH) questionnaire (2) perceived autonomy support from the healthcare team using the modified Health Care Climate Questionnaire (HCCQ), and (3) health-related quality of life (HrQOL) using the EuroQOL-5 Dimension (EQ5D5L) questionnaire, before and after the program.

Results

Fifteen patients were referred by their nephrologists, but 1 was uncontactable and 1 did not want to adhere to the recommended treatment. Among 13 patients in the pilot, 64.3% was male, median age was 68 (range 40 – 85) years and 35.7% had ≥4 visits to healthcare institutions in the past six months. Causes of kidney disease were diabetes (64.3%), hypertension (21.4%) and glomerulonephritis (14.3%), with a median eGFR of 30 (14 – 106) ml/min/1.73 m2. At enrolment, fluid overload was present in 57.1% and BIA over-hydration value was 1.7L (0 – 6.4L). Eleven patients (84.6%) completed the 4-week follow-up; 1 stopped after the first consult due to lack of time, while 1 stopped after 2 weeks (already confident of self-management). At 4 weeks, systolic BP [141 (109-179) mmHg versus 162 (120-198) mmHg at enrolment, p = 0.046] and PIH score [84 (72-96) versus 57 (10-94), p = 0.04] had improved significantly compared to enrolment, while HrQOL was not different (Table 1). Patients generally perceived a high level of autonomy support from the healthcare team. Serum creatinine did not change significantly after antihypertensive and diuretic titration.

Conclusion

A nurse-led program incorporating objective fluid volume assessment, structured patient education and action plan coaching was well-received, with improved BP and self-management in patients with kidney disease.
#2613 DIETARY FIBER INTAKE, THEIR SOURCES AND MORTALITY IN ADULTS ON HEMODIALYSIS: THE DIET-HD STUDY
Authors: Su Guobin , Saglimbene Valeria , Carrero Juan Jesus , Natale Patrizia , Ruospo Marinella , Strippoli Giovanni
Published: June 2023

Background and Aims

Higher fiber intake is associated with lower cardiovascular and all-cause mortality in the general population, but their benefits and which sources of fiber are healthier in patients on hemodialysis are uncertain.

Method

Daily fiber intake (DFI) and their sources (vegetable and fruit, staple food and other sources) were ascertained by the Global Allergy and Asthma European Network food frequency questionnaire within the DIET-HD study, a multinational cohort study of adults on hemodialysis. Adjusted Cox regression analyses were conducted to evaluate the association of DFI and fiber sources (vegetable and fruit, staple foods, others[including dressing sauce etc.]) (both as tertiles and continuous) with all-cause and cardiovascular mortality. Estimates were calculated as hazard ratio (HR) with 95% confidence interval (CI).

Results

8,110 patients were followed for median of 3.8 years (26,074 person-years). There were 2,953 deaths, of which 1160 cardiovascular-related. The median (interquartile range) DFI was 12.0 (8.1-17.5) gram per day and vegetables and fruits (49%) were the major source. Each unit increase in total DFI was not associated with either all-cause (hazard ratio [HR], 0.99; 95%CI:0.98-1.00, p = 0.37)or cardiovascular mortality (HR,0.99;95%CI:0.98-1.00, p = 0.08). Compared with patients in the lowest DFI tertiles (<9.5mg/day), the adjusted HRs for cardiovascular mortality among those in the middle (9.5-15.3 g/day) and highest tertiles (≥15.3 g/day) were respectively 0.97 [95% CI, 0.84-1. 13] and 0.79 (95%CI, 0.65-0.96) (P value per trend = 0.02). Each unit increase in fraction of DFI from vegetable and fruit was associated with lower all-cause (HR,0.70;95%CI: 0.57-0.86, p = 0.001) but not with cardiovascular mortality (HR,0.75;95%CI: 0.54-1.04, p = 0.08). Each unit increase in the fraction of DFI from other sources (including dressing sauce etc.) was associated with higher all-cause mortality (HR, 1.66; 95%CI, 1.22-2.27, p = 0.001) but not with cardiovascular mortality (HR, 1. 63; 95%CI, 0.83-2.24, p = 0.23). No association were observed between fiber from staple food and all-cause or cardiovascular mortality.

Conclusion

Fiber intake in the hemodialysis population is low. A higher fiber intake from vegetable and fruit, and a lower fiber intake from other sources (including dressing sauce etc.) is associated with lower all-cause death.
#2616 DIAGNOSTIC VALUE OF THE HANDGRIP STRENGTH IN DETECTING PROTEIN-ENERGY WASTING AMONG HEMODIALYSIS PATIENTS AT NATIONAL KIDNEY AND TRANSPLANT INSTITUTE
Authors: Patoc Gerry , Villanueva Anthony Russell
Published: June 2023

Background and Aims

Protein energy wasting (PEW) is a syndrome of adverse nutritional and catabolic changes common among chronic kidney disease (CKD) patients. Handgrip strength (HGS) was one of the methods of screening PEW mentioned in Kidney Disease Outcomes Quality Initiative guidelines. However, only few studies determined the validity of HGS in detecting PEW among maintenance hemodialysis (MHD) patients. The study aimed to determine the diagnostic validity of HGS in detecting PEW among MHD patients in a tertiary government hospital, with the following specific objectives: to determine the prevalence of PEW among MHD patients, to compare the demographic and clinical profile by PEW status, to identify the optimal cut-off point of HGS pre- and post-HD sessions in detecting PEW by sex, and to determine the following diagnostic value parameters of HGS pre- and post-HD sessions in detecting PEW by sex in terms of discriminative ability, accuracy, sensitivity, specificity, positive predictive value and negative predictive value.

Method

Participants included in this cross-sectional study are randomly selected patients undergoing MHD in National Kidney and Transplant Institute (NKTI) from September to October, 2022. Diagnosis of PEW was based on the Malnutrition Inflammation Score (MIS) ≥5. HGS was measured using a dynamometer pre- and post-dialysis sessions.

Results

A total of 143 patients were included in the study, and 53% were diagnosed with PEW. Pre-HD and post-HD HGS have acceptable discriminative ability based on Area Under the Curve >0.70 in detecting PEW regardless of patient sex. In males, a post-hemodialysis cut-off of <17.9 showed 72% sensitivity and 71% specificity in detecting PEW. Meanwhile, a pre-hemodialysis cut-off of <18.6 in females showed 83% sensitivity and 65% specificity in detecting PEW.

Conclusion

PEW is common among MHD patients in NKTI. The diagnostic performance of HGS in detecting PEW was found to be acceptable in both

males and females. While both pre- and post-HD measures can be used in males, only the pre-HD measures are recommended for females. HGS can, therefore, be used as a non-expensive, accurate and objective screening assessment tool in detecting PEW for MHD patients. External validation of the proposed HGS cut-off values is still recommended.
#2620 WHY DIALYSIS PATIENTS CHOOSE OR REFUSE KIDNEY TRANSPLANTATION AS RENAL REPLACEMENT THERAPY: A QUALITATIVE STUDY
Authors: Muharremi Shkelqim , Poposki Aleksandar , Shavreska Vangjelka Kovacheska , Spasovski Goce , Selim Gjulsen
Published: June 2023

Background and Aims

Kidney transplantation is considered the best renal replacement therapy (RRT) for patients with end-stage renal disease, nevertheless, some dialysis patients refuse to be transplanted. Many patients are concerned about their quality of life as a patient on dialysis compared to life with a new, functioning kidney. The results from many studies have shown that patients who have been living with a transplanted kidney for 10 years demonstrate a greater likelihood of still being alive than those on dialysis. For every 10 patients receiving a new kidney, eight will still have that kidney working three years after the operation. So, considering survival alone, individuals receiving a new kidney do better than those on dialysis. But not all the CKD and CKD on HD share the same opinion and a number refuse kidney transplantation. The aim of this paper is to identify the reasons for choosing or refusing kidney transplantation as renal replacement therapy among patient with Chronic Kidney Disease (CKD).

Method

We used purposeful sampling because it was more relevant to identify and to select the individuals who seemed in-keeping with the social facts we wanted to study. We wanted to retrace participants’ paths of care to identify the reasons for their choice. Patients who were treated using hemodialysis as well as those who opted for peritoneal dialysis were interviewed. We also interviewed health professionals (doctors, nurses, a psychologist) for their opinions on the nature of their relationship with patients in the decision making process regarding kidney transplantation.

Results

Data were collected through interviews with CKD patient and CKD patient treated by dialysis. Health professionals, medical doctors and nurses were also interviewed. A thematic analysis was used to analyze the data. The collected data showed that various reasons account for CKD patients’ refusal replacement therapy without positive outcome, refusal to have an allograft. There are also situations such as the lack of organ, the age factor, contraindications to kidney transplantation that not allow some CKD patients to have a kidney transplant. Among the patients who choose kidney transplantation, lots of them have lack of information about transplantation process others see kidney transplantation as a cure which will finally make them machine dependent and a small group see it as a normal process.

Conclusion

This paper shows that the choice of kidney transplantation depends on patients’ perceptions of its outcomes. Some circumstances, such as the lack of an available organ or specific medical criteria including age factor and malignancy, reduce CKD patients’ participation in the decision-making process.
#2630 NETOSIS IS A PREVALENT IMMUNE PROCESS IN LUPUS NEPHRITIS AND NEUTROPHIL ELASTASE SCORING EXPRESSES THE ACTIVITY AND SEVERITY IN DIFFERENT CLASSES
Authors: Abdelmegied Shaimaa Zaki , Salman Manal , Mahmoud Heba , Elgendy Aya
Published: June 2023

Background and Aims

The release of NETs by activated neutrophils is known as NETosis. NETs are released not only on exposure to pathogens such as bacteria but also in sterile environments in autoimmune diseases such as lupus where they generate/trap autoantigens and aggravate inflammation. This study assesses the prevalence of neutrophil elastase (NE) as a marker of Netosis in lupus in renal biopsies and its presentation in different lupus classes.

Method

A cross-sectional study included 45 patients with lupus nephritis who underwent renal biopsy and were classified according to lupus class. NE was done for the detection of Netosis by immunohistochemistry.

Results

The prevalence of (NE) was 88.8% (40/45 cases). NE combined score with cut-off (>3) expresses moderate to severe Netosis. It allowed the detection of active proliferative lupus class III-IV with a sensitivity: 80.0%, specificity: 60.0%, PPV: 85.71%, and NPV: 50.0%. In class III-IV (N = 34 cases): NE combined score >3 was 83.3% (25/30 cases) with features: glomerular deposition >25% of the glomerulus in 60% (19/30 cases), strong intensity (+2) in 63.3% (19/30 cases), diffuse (>50% of the number of the glomeruli) 67.8% (19/28 cases). In non-proliferative lupus class II-V (N = 11 cases) NE combined score >3 was 20% (2/10 cases) and score<3 was 80% (8/10 cases) with features: glomerular deposition <25%/ faint intensity (+1)/ focal. On comparing both groups as regard NE combined score, distribution, intensity, and focal/diffuse p value was 0.0002, 0.099, 0.013, and 0.94 respectively. On redistribution of biopsies according to NE combined score >3 vs <3 there was a significant difference in activity index, distribution, intensity, and focal/diffuse p-value 0.0011, 0.0001, 0.0002, 0.0006 while non-significant for chronicity index p-value 0.08914.

Conclusion

NETOSIS is a prevalent immune process in lupus nephritis and NE combined score is a sensitive marker of proliferation that increases with class severity and activity.
#2663 KIDNEY INVOLVEMENT IN MYELODYSPLASTIC SYNDROMES
Authors: Lafargue Marie-Camille , Van Huyen Jean-Paul Duong , Isnard Pierre , Rennke Helmut , Essig Marie , Bobot Mickaël , Jourde-Chiche Noemie , Sakhi Hamza , Boudhabhay Idris , Brunet Philippe , Boulay Hugoline , Grobost Vincent , Philipponnet Carole , Jeannel Juliette , Chemouny Jonathan , Boffa Jean Jacques , Selamet Umut , Riella Leonardo , Fain Olivier , Adès Lionel , Fenaux Pierre , Cohen Camille , Mekinian Arsène
Published: June 2023

Background and Aims

Myelodysplastic syndromes (MDS) are hematologic disorders characterized by ineffective and dysplastic hematopoiesis that can be associated with systemic inflammatory and autoimmune diseases. The objective of this study was to describe kidney involvement in MDS patients, their treatments, and outcomes.

Method

We conducted a French and American multicenter retrospective observational study in nine centers, identifying MDS patients with acute kidney injury (AKI), chronic kidney disease (CKD), and urine abnormalities.

Results

Seventeen patients (males n = 11, median age 76 [70-79]) developed a kidney disease 6 months [0-31] after the diagnosis of MDS. Median urinary protein to creatinine ratio was 1.9g/g [0.8-3.3], and median serum creatinine was 3.5mg/dL [1.5-4.7]. Twelve patients (70%) had AKI at presentation, and 14 (82%) extra-renal symptoms, which consisted mostly in cutaneous and pneumological manifestations. The renal diagnoses included antineutrophilic cytoplasmic antibody (ANCA) associated vasculitis (AAV) (n = 8, 47%), ANCA negative vasculitis (n = 4, 24%), C3 glomerulonephritis (n = 2), immune complex-mediated glomerulonephritis (n = 1), polyarteritis nodosa (n = 1), and IgA vasculitis (n = 1). Kidney biopsies were performed in 10 of the cases. All patients, except one, received a treatment following the MDS-associated kidney injury (n = 16, 94% with steroids). The effect of MDS treatment on kidney injury could be assessed in 8 patients treated with azacitidine, and renal function evolution was heterogenous. After a median follow-up of 9 months [4.1-14.2], 4 patients had CKD stage 3, 4 CKD stage 4, 5 an end stage kidney disease. Three patients evolved to an acute myeloid leukemia (AML), and 3 died. Compared to 84 MDS controls, patients who had a kidney involvement were younger (p = 0.03), had a higher number of dysplasia lineages (3 lineages, p = 0.001), and were more eligible to receive hypomethylating agents (p = 0.031), but no survival difference was seen between the two groups (p = 0.5227). Compared to 265 AAV without MDS, MDS-associated AAV were older (p = 0.019), ANCA serology was more frequently negative (p = 0.014), and more cutaneous lesions were seen (p = 0.003).

Conclusion

The spectrum of kidney injuries associated with MDS is mostly represented by vasculitis, and especially AAV. A diagnosis of ANCA vasculitis in an elderly patient, or with a cutaneous manifestation, or without ANCA positivity, should lead to the search for a possible MDS.
#2664 CHRONIC MYELOMONOCYTIC LEUKEMIA (CMML) PATIENTS WITH LYSOZYME NEPHROPATHY AND CMML RENAL INFILTRATION DISPLAY MARKERS OF SEVERE DISEASE
Authors: Lafargue Marie-Camille , Van Huyen Jean-Paul Duong , Isnard Pierre , Rennke Helmut , Essig Marie , Carre Martin , Mercadal Lucile , Farhi Jonathan , Bobot Mickaël , Sakhi Hamza , Comont Thibault , Golbin Leonard , Chemouny Jonathan , Cambier Nathalie , Laribi Kamel , Selamet Umut , Riella Leonardo , Fain Olivier , Adès Lionel , Fenaux Pierre , Cohen Camille , Mekinian Arsène
Published: June 2023

Background and Aims

Chronic myelomonocytic leukemia (CMML) is a hematologic disorder which is an overlap syndrome between myelodysplastic syndromes, and myeloproliferative neoplasms, and can be associated with autoimmune and inflammatory diseases. The objective of this study was to describe kidney involvement in CMML patients, their treatments, and outcomes.

Method

We conducted a French and American multicenter retrospective observational study in fifteen centers, identifying CMML patients with acute kidney injury (AKI), chronic kidney disease (CKD), and urine abnormalities.

Results

Sixteen patients (males, n = 14, median age 76.5 [71.9-83]) developed a kidney disease 6 months [1.6-25.6] after the diagnosis of CMML. Median urinary protein to creatinine ratio was 2 g/g [1.3-3.4], and median serum creatinine was 2.26 mg/dL [1.46-2.68]. Fourteen patients (87.5%) underwent a kidney biopsy. The two main renal diagnoses were either a lysozyme nephropathy (n = 9, 56%), or a renal infiltration by the CMML (n = 6, 37.5%). Histological findings showed lesions of acute tubular injury with focal tubular epithelial necrosis (n = 4), a vacuolization of the epithelial cells of the proximal tubules (n = 7), and an inflammatory infiltrate with mostly mononuclear myeloid cells (n = 9). Ten patients received a new treatment following the CMML-associated kidney injury. The effect of CMML treatment on kidney injury could be assessed in 10 patients, and renal function evolution was heterogenous. After a median follow-up of 15 months [9.9-34.9], 4 patients had CKD stage 3, 4 CKD stage 4, 1 an end-stage kidney disease. Two patients evolved to an acute myeloid leukemia (AML), and 5 died. Compared with 116 CMML controls, patients who had a kidney involvement had a higher monocytes count (p<0.001), had more CMML-1 (p = 0.005), were more susceptible to develop an AML (p = 0.02), and were more eligible to receive a specific hematologic treatment, with hydroxyurea, or hypomethylating agents (p<0.001), but no survival difference was seen between the two groups (p = 0.6978).

Conclusion

In this largest published cohort of CMML patients with a kidney injury, the two most frequent renal complications were lysozyme-induced nephropathy, and renal infiltration by the CMML. The development of a kidney injury during CMML appears to worsen the patient prognosis.
#2667 CARDIOVASCULAR AND MORTALITY RISKS IN YOUNG HEALTH SCREENING EXAMINEES WITH MARGINAL ESTIMATED GLOMERULAR FILTRATION RATE
Authors: Kim Minsang , Kim Dong Ki , Kim Jung-Hyun , Joo Kwon Wook , Park Sehoon
Published: June 2023

Background and Aims

Additional evidence is necessary to interpret the kidney function parameters in young adults, particularly in those with marginal eGFR values. We aimed to study the clinical significance of marginal eGFR values in large-scale general health screening examinees of young age (20-39 years).

Method

We performed a nationwide retrospective cohort study using the health screening database of South Korea. We included young adults aged 20-39 years without a history of major cardiovascular events (MACE) or end-stage kidney disease who underwent a nationwide health screening in 2012. The study exposure was eGFR categorized into 15 mL/min/1.73 m2 intervals, with a reference group and a main group of interest: < 30, 30-45, 45-60, 60-75, 75-90 (reference), 90-105, 105-120, and ≥ 120 mL/min/1.73 m2. The risks of all-cause mortality and MACE were calculated using Cox regression analysis adjusted for various clinicodemographic characteristics.

Results

In total, 3,132,409 young adults were included in this study. During a median follow-up of 7.3 years, marginal eGFR (60-75 mL/min/1.73 m2) was not significantly associated with a higher risk of all-cause mortality [adjusted HR 0.92 (0.86-0.99)]. The results were similarly identified for the MACE outcome [adjusted HR 1.01 (0.94-1.07)]. On the other hand, those with presence of albuminuria, even the marginal eGFR range was significantly associated with higher risks of all-cause mortality [adjusted HR 1.52 (1.01-1.29)] and ischemic stroke [adjusted HR 1.73 (1.10-2.74)].

Conclusion

Marginal eGFR alone was not associated with higher risks of all-cause mortality and MACE in general young adults. However, in those with albuminuria, the mortality risk was higher even in eGFR of 60-75 mL/min/1.73 m2.
#2704 MANAGEMENT OF HAEMODIALYSIS PATIENTS UNDERGOING RADIOACTIVE IODINE THERAPY FOR THYROID CANCER
Authors: Lin Raymond , Malaroda Alessandra , Ryder William , Wong Veronica , Wong Nikki
Published: June 2023

Background and Aims

Radioactive iodine (RAI) 131I is used in the adjuvant treatment of thyroid carcinoma following thyroidectomy. 131I is renally excreted, with reduced clearance in patients with end-stage kidney disease (ESKD). There are no established protocols for RAI dosing, timing of dialysis and safety in this population [1]. We describe a single-centre experience with a modified protocol and setup for RAI in haemodialysis (HD) patients including serum 131I measurements to monitor for red marrow toxicity. We present the outcomes in two HD patients.

Method

A protocol was developed for performing HD post-RAI administration. HD sessions were performed at 24, 72 and 144 hours post-treatment. Custom HD plumbing was installed within existing lead-lined infrastructure. Specific considerations were made for radiation safety including emergency protocols, handling of blood samples, nursing education, patient self-cannulation and dose-reduction of thyrogen pre-treatment. In addition to standard dose-rate meter measurements of radiation, serum 131I measurements were taken pre- and post-HD as a more accurate measurement of red marrow toxicity.

Results

The two patients included in the study were aged 41 and 60 years. Special considerations for these patients included anuric state in one patient (bilateral nephrectomy) and morbid obesity in the other. Both had early-stage papillary thyroid cancer treated with thyroidectomy. Retained radioactivity measured by dose-rate meter is shown in Figure 1. The largest reduction in radioactivity occurred after the first HD session (approximately 60%). The highest risk of radiation exposure was in the 24 hours prior to the first HD session. Pre-and post-HD serum 131I measurements estimated the radiation dose to red marrow to be below 0.2Gy (maximum tolerated radiation dose for red marrow is 2.0Gy2). Radiation received by HD nurses is shown in Figure 2. Overall exposure was well within national regulatory dose limit of 0.5mSv for members of the public.

Conclusion

HD at 24, 72 and 144 hours produced a radiation clearance profile similar to controls with normal renal function. The effect of residual renal function on 131I clearance was minimal and HD was the main determinant of 131I clearance in ESKD. Non-routine serum measurements of 131I can be used to assess toxicity to red marrow and guide HD session timing during RAI therapy. Performing HD at 24 and 72hrs post- 131I resulted in a radiation burden to the red marrow well below the accepted radiotoxicity threshold of 2Gy [2]. RAI can be given safely to HD patients with thyroid cancer in centres with the appropriate protocol and setup.
#2779 THROMBOMODULIN IS A SPECIFIC MARKER OF ENDOTHELIAL DYSFUNCTION IN HEMODIALYSIS PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE
Authors: Hebah Hayam , Sabry Manal , Elnagar Mohamed , Abdelmegied Shaimaa
Published: June 2023

Background and Aims

Non-alcoholic fatty liver disease (NAFLD) is associated with endothelial dysfunction which is a common problem in hemodialysis patients and a risk for high cardiovascular mortality in hemodialysis. Thrombomodulin is a promising marker of endothelial cell injury in different pathological conditions. This study evaluates the additive effect of non-alcoholic fatty liver disease (NAFLD) in prevalent HD patients on endothelial dysfunction.

Methods

A case-control study was conducted on 60 end-stage renal disease (ESRD) patients on conventional hemodialysis: group A: 30 patients with NAFLD, group B: 30 patients without NAFLD, and control group of 30 apparently healthy subjects. Excluding elderly, diabetic patients, chronic Liver disease, advanced heart Failure, active infection, COVID-19 infection, autoimmune diseases and patients with hemodialysis catheters. Thrombomodulin was measured for all participants by ELISA technique.

Results

Thrombomodulin could detect endothelial dysfunction in patients with NAFLD at Cut off value <0.8 ng/ml with sensitivity 53.33%, specificity 80%, PPV 72.7%, and NPV 63.2%. On comparing Thrombomodulin in patients with NAFLD (4.378±3.762 ng/ml), Non-NAFLD (1.126±0.591 ng/ml), and control (0.755±0.314 ng/ml) there was a significant difference (P-value<0.001). Post hoc analysis showed significantly high Thrombomodulin levels in patients with {NAFLD versus Non-NAFLD} and {NAFLD versus control} with p-value<0.001, 0.001 respectively while there was no significant difference between patients with Non-NAFLD and control p-value 0.792. NAFLD patients with positive thrombomodulin have a risk of 2.5 times having endothelial dysfunction. There was no significant correlation between Thrombomodulin and all variables in the study.

Conclusions

Thrombomodulin can be used as specific marker for endothelial dysfunction in hemodialysis patients with Non Alcoholic fatty liver disease.
#2794 ISOLATED GLOMERULITIS IS STRONGLY ASSOCIATED WITH THE ABSENCE OF ANTIBODY-MEDIATED REJECTION BY MOLECULAR DIAGNOSTICS
Authors: Schmid Nicolas , Weidmann Lukas , von Moos Seraina , Gaspert Ariana , Helmchen Birgit , Mueller Thomas , Schachtner Thomas
Published: June 2023

Background and Aims

According to the 2018 Banff classification, the Molecular Microscope Diagnostic System (MMDx) is indicated in cases when histology is insufficient to diagnose antibody-mediated rejection (ABMR) due to an absence of diagnostic criteria groups 2 and/or 3. The impact of isolated glomerulitis (g>0, ptc0) on the likelihood of ABMR diagnosis by the MMDx appears critical to the implementation of this new biomarker.

Method

We analyzed 251 kidney allograft biopsies by histology and molecular diagnostics at the University Hospital Zurich from October 2018 to November 2022. Histologic findings were classified concerning the absence of (1) diagnostic criteria groups 2 and 3 (n = 18), (2) diagnostic criteria group 2 only (n = 18), and (3) diagnostic criteria group 3 only (n = 28). In addition, cases with histologically proven ABMR were used for comparison (n = 65). High-resolution re-typing was performed from the kidney allograft biopsies if necessary.

Results

The MMDx diagnosed ABMR in 1 of 18 cases (6%) with absent diagnostic criteria groups 2 and 3, 4 of 18 cases (22%) with absent diagnostic criteria groups 2, and 19 of 28 cases (68%) with absent diagnostic criteria groups 3. On the contrary, MMDx confirmed the diagnosis of ABMR in 42 of 65 cases (65%) with histologically proven ABMR but did not in 23 of 65 cases (35%). Among 28 cases with absent diagnostic criteria group 3, only 2 of 19 cases (11%) with ABMR by MMDx but 6 of 9 cases (67%) with no ABMR by MMDx showed isolated glomerulitis (p = 0.0048). Among 65 cases with histologically proven ABMR, only 7 of 42 cases (17%) with ABMR by MMDx but 14 of 23 cases (61%) with no ABMR by MMDx showed isolated glomerulitis (p<0.001). Overall, 14 of 65 cases (21%) with isolated glomerulitis showed ABMR diagnosis by MMDx.

Conclusion

Isolated glomerulitis is strongly associated with the absence of ABMR by MMDx not only when diagnostic criteria group 2 is missing but also when diagnostic criteria 3 is missing or ABMR is proven by histology. Our results may help to guide the indication for MMDx in clinical practice. However, the clinical significance of these results needs further investigation.
#2795 PROSPECTIVE ASSESSMENT OF THE NEED FOR AND ADDED VALUE OF MOLECULAR DIAGNOSTICS OF KIDNEY ALLOGRAFT BIOPSIES: AN EVALUATION IN CLINICAL PRACTICE
Authors: Schmid Nicolas , Weidmann Lukas , von Moos Seraina , Helmchen Birgit , Gaspert Ariana , Mueller Thomas , Schachtner Thomas
Published: June 2023

Background and Aims

The Molecular Microscope Diagnostic System (MMDx) may resolve inconclusive histology findings, as preserved biopsy material can be examined after histology findings have been obtained. The extent to which this proposed approach can be implemented in clinical practice remains an open question.

Method

We prospectively analyzed 104 consecutive indication kidney allograft biopsies by histology and molecular diagnostics at the University Hospital Zurich from April 2022 to December 2022. Pathologists and clinicians with experience in molecular diagnostics assessed the need for MMDx by questionnaire when the histology report was available. Clinicians then assessed the added value of the molecular diagnostics by questionnaire when the MMDx report was available.

Results

29 of 104 cases (28%) showed rejection by histology, 42 of 104 cases (40%) showed no rejection by histology, and 33 of 104 cases (32%) showed histologic findings insufficient to diagnose ABMR due to an absence of diagnostic criteria groups 2 and/or 3. Pathologists considered molecular diagnostics indicated in 42 of 104 cases (40%), 9 cases to give extra confidence, and 33 cases for diagnostic clarification concerning rejection. Clinicians considered molecular diagnostics indicated in 54 of 104 (52%) cases, 5 cases to give extra confidence, and 49 for diagnostic clarification concerning rejection. In 33 cases with histologic findings insufficient to diagnose ABMR, molecular diagnostics were considered indicated by pathologists and clinicians. Molecular diagnostics allowed the diagnosis of ABMR in 8 of 33 cases (24%). In addition, 11 of 104 cases (11%) showed a discrepancy between the histologic findings and the molecular diagnosis. Clinicians considered adjustment of treatment based on the MMDx report in 3 of 11 discrepant cases. Pathologists and clinicians considered molecular diagnostics indicated in 2 of 11 and 3 of 11 discrepant cases, respectively.

Conclusion

The need for molecular diagnostics goes beyond the recommendation of the 2018 Banff classification for histologic findings insufficient to diagnose ABMR. However, the added value of molecular diagnostics appears to be largely limited to these cases.