bluuebunny/crossref_metadata_2025 huggingface dataset:
#4642 DO WOMEN HAVE LESS ACCESS TO THE KIDNEY TRANSPLANTATION WAITING LIST THAN MEN IN FRANCE?
Authors: Adoli Latame Komla , Pouliquen Valérie Chatelet , Daugas Eric , Lobbedez Thierry , Vabret Elsa , Jais Jean-Philippe , Bayer Florian , Vigneau Cécile , Couchoud Cécile , Bayat Sahar
Published: June 2023

Background and Aims

Studies performed in several countries and in some French regions showed that women have less access to kidney transplantation waiting list (KTWL) than men. The aim of this study is to analyse women's access to the kidney transplantation waiting list at the national level and in all French regions.

Method

This is a retrospective cohort study using the French National Renal Epidemiology registry (REIN). All incident patients initiated dialysis from 2017 to 2019 and aged between 18 and 85 were included. Patients were followed three years from the dialysis start. Our outcome of interest was the registration on the KTWL 1 and 3 years following dialysis initiation. We performed Cox proportional hazard models, adjusted on age, comorbidities and neighbourhood deprivation level using European Deprivation Index (EDI), at national level and in all French regions. The sex/age and sex/EDI interactions were studied.

Results

29 395 patients started dialysis in 2017-2019. 35% were women. 40% of female and 34% of male patients lived in most deprived areas. Men were more comorbid than women were at dialysis start. At the national level, women had less access to the KTWL compared to men one (adjHR: 0.91; IC95: [0.87 – 0.96]) and three years (adjHR: 0.87 [0.84 – 0.91]) after dialysis start. There was no significant sex/EDI interaction but a significant sex/age interaction. Therefore, the analyses were stratified by age (<60 and ≥ 60 years old). Only women aged more than 60 had less access to the KTWL at one year (adjHR: 0.76 [0.71 – 0.82]) and three years (adjHR: 0.75 [0.71 – 0.81]). At regional level, the same trends were found in Nouvelle Aquitaine and Pays de Loire one-year after dialysis start and two more regions (Bourgogne-Franche-Comté and Île-de-France) 3 years after dialysis start.

Conclusion

This study shows that women have less access to KT WL one and three years after dialysis start on the national level and in some regions. This disparity is found to be present especially among patients aged beyond 60 years. A qualitative study is planned to better understand this sex based disparity.
#4657 COMPARISON OF TWO BIOIMPEDANCE SPECTROSCOPY DEVICES: A PRACTICAL STEP FORWARD ON THE WAY TO DAILY BIOIMPEDANCE MEASUREMENTS FOR DIALYSIS PATIENTS
Authors: Mussnig Sebastian , Krenn Simon , Wabel Peter , Hecking Manfred
Published: June 2023

Background and Aims

Bioimpedance spectroscopy (BIS) is a non-invasive diagnostic tool to assess volume status and body composition through the measurement of voltage drops in alternating currents and subsequent extrapolation of extracellular (R0), intracellular (Ri), and total body (RInf) resistances. Currently available devices mostly rely on disposable electrodes and require supine body position. Here we tested whether a new, more versatile BIS device with reusable electrodes matches an established system in various setups, aiming to enable daily BIS-measurements in the near future.

Method

Two BIS devices (“Cella” and the “Body Composition Monitor” [BCM]) were compared both with four resistance testboxes (circuit boards with resistors and capacitors simulating different body conditions) and in 40 healthy volunteers. In-vivo comparisons included supine hand-to-foot (HF) reference measurements with adhesive disposable electrodes and hand-to-hand (HH) measurements with adhesive disposable and prototype reusable electrode sets (Figure 1).

Results

Analyses of testboxes were reproducible in both devices (intra-device coefficients of variation <1%). Mean differences from testbox components were similar and small for R0 (2-3 Ohm) but not for Ri, where Cella was off by 101 Ohm compared to the BCM's 29 Ohm in a testbox designed with a deliberately low R0/Ri ratio. In-vivo, HF measurements with disposable electrodes differed significantly between both devices (p < 0.001). Prototype reusable HH electrodes exhibited a bias towards larger resistances than HF measurements (R0: 738.36 Ohm vs. 643.09 Ohm; Ri: 1508.18 Ohm vs. 1257.17 Ohm; RInf 500.03 vs. 423.81 Ohm, respectively) and the HH/HF ratio varied between 1.0-1.4 (R0 and RInf) and 0.9-1.6 (Ri).

Conclusion

While the Cella BIS device was shown to produce results with comparable consistency to the BCM in-vivo, the latter measured more accurately under testbox conditions. Accuracy of in-vivo measurements could not be determined for lack of gold-standard measurements. Implementation of HH reusable electrodes will require per-patient calibration against HF measurements due to the large inter-patient fluctuations in the HH/HF ratio. We recommend further longitudinal analyses of intra-patient HH/HF ratios to investigate long-term variabilities.
#4670 HYPERPARATHYROIDISM DURING 1ST YEAR OF RENAL TRANSPLANT IS ASSOCIATED WITH LONG TERM GRAFT LOSS
Authors: Alfieri Carlo Maria , Molinari Paolo , Cicero Elisa , Cresseri Donata , Regalia Anna , Campise Maria Rosaria , Verdesca Simona , Favi Evaldo , Castellano Giuseppe
Published: June 2023

Background and Aims

Persistent hyperparathyroidism (HPT) is a frequent problem, especially during the first year after Renal transplant (RTx). We aimed to evaluate the possible association between parathormone (PTH) levels during 1st year of RTx and long-term graft loss (GL) in RTx patients (RTx-p).

Method

We retrospectively evaluated 871 RTx-p, transplanted in our unit from 2004 to 2020. We measured main renal function and mineral metabolism parameters at 1 month (T1), 6 months (T6) and 12 months (T12) after RTx. Renal outcome was intended as GL during the global follow-up (FU) of 103±60 mths.

Results

Mean age at RTx was of 49+13 yrs and 58% of RTx-p were male. Most of the RTx-p were on hemodialysis (HD) before RTx (77%) with a mean dialysis vintage of 53+52 months. Most of our cohort (84%) received a kidney from a deceased donor. HPT was highly prevalent during the 1st year of FU; at T1 79% of RTx-p were HPT, of which 63% had secondary HPT (SHPT) and 16% had tertiary HPT (THPT). Comparable prevalence was observed at T6 (HPT 80%; SHPT 64%; THPT 16%) and at T12 (HPT 77%; SHPT 62%; THPT 15%). A strong significant correlation was found between HPT type and GL at every time point [T1 GL: no HPT 6%, SHPT 11% THPT 24%, p<0.0001 - T6 GL: no HPT 9%, SHPT 9% THPT 22%, p<0.0001 - T12 GL: no HPT 8%, SHPT 9% THPT 21%, p = .008]. Moreover, PTH levels at T1 (GL+: 90.3 [50.6-165.6] vs. GL-: 61.7 [37.4-98.8] p<0.0001), at T6 (GL+: 83.6 [47.1-152.4] vs. GL-: 56.1 [38.3-89.7] p<0.0001) and at T12 (GL+: 69.8 [44-121.9] vs. GL-: 54.6 [36.4-84.1] p = 0.008) were significantly correlated to GL. PTH levels at T1 and T6 were associated with long-term GL [T1, OR: 3.3 (1.3-8.1), p = 0.01 - T6, OR: 3.9 (1.7-9.2), p = 0.001]. Then we considered PTH levels as mean exposure during the first year. Mean PTH exposure alone was strongly associated with GL [OR: 5.7 (2.7- 11.9), p<0.0001]. A multivariate logistic regression analysis was also performed. In the model, we considered 1st year mean PTH exposure and the main factors associated with GL (pre-RTx dialysis vintage, 1st year rejection, T12 uric acid, T12-Proteinuria and T12-MDRD). Mean PTH exposure remained strongly and independently associated with long-term GL (OR 3.1 [1.4-7.1], p = 0.008). We finally performed a ROC curve to calculate the best 1st-year mean PTH cut-off to predict long-term GL. AUC was 0.658, with a p<0.0001. Using Youden index we identified the best mean PTH cut off to be 88.6 pg/ml.

Conclusion

In our cohort of 871 RTx-p, the prevalence of HPT during the first year of RTx is quite high. High PTH levels during 1st year of RTx were independently associated with long-term GL. HPT might be considered a therapeutic target to prevent long-term graft failure.
#4682 DOES RENAL ASYMMETRY WITH HYPERTENSION EQUAL RENAL ARTERY STENOSIS?
Authors: Barrios R Haridian Sosa , Bustamante Adriana Maria Cavada , Quilis Aina , Díez Pablo , Clara Sanz , Vion Víctor Burguera , Lucas Milagros Fernandez , Rivera Maite
Published: June 2023

Background and Aims

Renal ultrasound (US) is a basic imaging study in renal disease with hypertension (HTN) work up. Asymmetry is a frequent finding but it does not equal renal artery stenosis (RAS). Our aim was to describe the incidence of asymmetry findings in our Diagnostic and Interventional Nephrology Unit (DINU) and study its correlation with HTN and RAS.

Method

Results

Conclusion

Renal asymmetry is infrequent (2%) and in up to a quarter of those this finding is related to RAS. In our experience, asymmetry associates with hypertension even if no RAS is present: renal asymmetry associates with higher hypertension prevalence and higher medication requirements to reach acceptable blood pressure control.
#4690 INFLUENCE OF CHRONIC KIDNEY DISEASE AND GLOMERULAR FILTRATION RATE ON THE COURSE OF ACUTE SARS-COV-2 INFECTION AND POST-COVID PERIOD
Authors: Arutyunov Alexander , Trubnikova Marina , Arutyunov Gregory , Tarlovskaya Ekaterina , Batyushin Mikhail , Bashkinov Roman , Melnikov Evgenii , Batluk Tatiana , Gordeychuk Elizaveta
Published: June 2023

Background and Aims

According to international data available in the literature, chronic kidney disease (CKD) may have a significant impact on the course and outcome of COVID-19. Moreover, kidney pathology have been suggested to aggravate the course of the post-COVID period. The aim of the study was to investigate the effect of CKD and glomerular filtration rate (GFR) on the course of acute infection and post-COVID period.

Method

An international register “Dynamics analysis of comorbidities in SAES-CoV-2 survivors” (ACTIV) (NCT04492384) was established to assess the characteristics of the course of NCI in the Eurasian region. Specialists from 7 countries participated in the register. ACTIV is a multicenter, non-interventional, real-world clinical practice registry that included men and women over 18 years of age with a confirmed diagnosis of COVID-19. The analysis presented is based on data from 8496 patients with an estimated GFR of ≥90 ml/min/1.73 m2 - 3591 (42.3%) patients, 89-60 ml/min/1.73 m2 3105 (36.5%) patients, 59-45 ml/min/1.73 m2 - 1132 (13.3%) patients, 44-30 ml/min/1.73 m2 - 433 (5.10%) patients, 29 -15 ml/min/1.73 m2 - 141 (1.7%) patients, <15 ml/min/1.73 m2 - 94 (1.1%) patients. GFR was calculated using the 2021 CKD-EPI formula. The post-COVID period was analyzed using data from telephone interviews that included 3099 patients at 3 months, 2493 patients at 6 months, and 1782 patients at 12 months after recovery from COVID-19.

Results

During the acute infection, patients with a GFR of 59-15 ml/min/1.73 m2, had more severe lung tissue damage (stage 3-4 according to computed tomography (CT), p < 0.001) and worse oxygenation (SpO2 75-94% and less than 75%, p < 0.001); increased respiratory rate (over 22 per minute, p < 0.001); and higher body temperature (more than 38.6°C, p < 0.001) compared with patients with GFR over 60 ml/min/1.73 m2. In addition, CKD increased the odds of death in hospitalized patients by 3.94-fold compared with patients without CKD (95% confidence interval (CI) 3.15-4.89, p < 0.001). The data of the deceased patients showed that most of them had a GFR of 89–60 ml/min/1.73 m2, which corresponds to stage 2 CKD (Table 1). CKD was a risk factor for increased odds of death in the post-COVID period: 4.88-fold (95% CI 2.42-9.13; p < 0.001) within 3 months; 4.24-fold (95% CI 0.60-16.3; p = 0.126) within 6 months and 8.36 -fold (95% CI 1.73-29.3; p = 0.112) within 12 months after recovery from SARS-CoV-2.

Conclusion

CKD could be a predictor of a more severe acute period of COVID-19 and also significantly impact mortality within 12 months after recovery from SARS-CoV-2.
#4703 IMPACT OF THE EARLY STAGES OF CKD WITH AND WITHOUT PROTEINURIA ON CARDIOVASCULAR OUTCOMES IN THE UK BIOBANK COHORT
Authors: Yaqoob Khadija , Naderi Hafiz , Thomson Ross , Aksentijevic Dunja , Petersen Steffen , Aung Nay , Yaqoob Muhammad
Published: June 2023

Background and Aims

Chronic kidney disease (CKD) is an established predictor of cardiovascular disease. However, the relationship between cardiovascular disease and the early stages of CKD defined as stage 1 (eGFR > 90 mL/min per 1.73 m2 + albuminuria) and stage 2 (eGFR 60–89 mL/min per 1.73 m2) with and without proteinuria, is lacking. In this study, we explored the incidence of major adverse cardiovascular events (MACE), heart failure (HF) and all-cause mortality of participants with early stages of CKD in the UK Biobank population.

Method

456,015 participants from the UK Biobank were categorised into CKD stages. We calculated eGFR using the CKD-EPI 2021 equation and proteinuria was ascertained by the urinary protein creatinine ratio (defined as > 30mg/ mmol). We demonstrated the survival probability of adverse outcomes using unadjusted Kaplan-Meier curves and performed an adjusted Cox proportional hazard analysis to include MACE, HF, MACE and HF and all-cause mortality across CKD stages.

Results

Among the participants (mean age ± standard deviation, 56.5 ± 8.1 years) 282,121 (61.9%) had normal kidney function, 33,582 (7.4%) stage 1 CKD, 121,358 (26.6%) stage 2 CKD without proteinuria, 10,788 (2.4%) stage 2 CKD with proteinuria, 4,654 (1.0%) CKD stage 3A (eGFR 59-45mL/min per 1.73 m2) without proteinuria, 1034 (0.2%) stage 3A with proteinuria and 1,478 (0.3%) with more advanced CKD defined as stages 3B and above. Using Cox regression setting normal kidney function as the reference group, with the exception of stage 2 CKD without proteinuria; there was a progressive increase in the hazard ratio (HR) in all other stages of CKD with respect to MACE, HF, MACE and HF (Figure 1). Significantly, stage 2 CKD without proteinuria was associated with a lower incidence of adverse events than stage 1 CKD and had a comparable prognosis to normal renal function. There was a statistically significant association between stage 2 with proteinuria and MACE (HR 1.33, CI: 1.26 – 1.41), which was comparable to stage 3A without proteinuria (HR 1.32, CI: 1.22 – 1.42). Preliminary analysis of the ongoing cardiac magnetic resonance imaging (cMRI) data from this cohort shows similar progressive changes, apart from stage 2 CKD without proteinuria.

Conclusion

The presence of proteinuria in patients with mild CKD is a significant risk factor for MACE, HF, cMRI changes and all-cause mortality independent of age, sex, ethnicity, height, BMI, hypertension, diabetes, smoking status, and hyperlipidaemia. We recommend that in order to better risk stratify patients for prognostication and early treatment, stage 2 CKD should be considered as a significant cardiovascular risk only in the presence of proteinuria.
#4743 OMNIGRAF (COMBINED GENE EXPRESSION AND DD-CF DNA) USE IN MONITORING RENAL ALLOGRAFT REJECTION IN MULTIORGAN TRANSPLANT RECIPIENTS
Authors: Zaky Ziad , Fleming James , Weems Juston
Published: June 2023

Background and Aims

To date there is no clinically available non-invasive biomarker to monitor for renal allograft rejection in multiorgan transplant recipients. TruGraf (Gene expression profile) and TRAC (dd-cf DNA), as part of the biomarker panel OmniGraf, have shown to be reliable “rule out” tests for subclinical rejection in stable kidney transplant recipients. However, the validity and utility of these tests in monitoring for renal allograft rejections in the setting of multiorgan transplants has yet to be assessed. The aim of this study is to assess the feasibility of using the biomarkers individually, as well as together in the OmniGraf biomarker panel, to assist in making the decision to perform a renal allograft biopsy in multiorgan transplant recipients.

Method

This is an ongoing prospective, observational sample collection study in any multiorgan (kidney + non-renal organ) undergoing a renal allograft biopsy. Biopsies were considered positive if they showed rejection in the kidney based on Banff 2019 and included borderline changes as positive results. Copper-Pearson 95% CI were used for sensitivity, specificity, and accuracy; standard logit CIs were used for NPV and PPV. For TruGraf, (TX = negative result) and (not-TX = positive test). For TRAC, 0.7% was used as the threshold for all organs except for those that had a liver transplant, where a threshold of 15% was used to determine positive vs. negative.

Results

Paired renal allograft surveillance biopsies and biomarker samples were available for 20 patients. Of the 20, 9 (45%) were liver-kidney transplants, 6 (30%) were heart-kidney transplants, and 5 (25%) were kidney-pancreas transplants. Nine (45%) of the patients were male, 14 (70%) were White, 5 (25%) were Black, and 1 patient was Hispanic. The mean age was 50 ± 13 years. Average SrCr was 1.3 ± 0.5 mg/dL. Of the 20 paired biopsies and samples, 2 (10%) had only TruGraf results, while the other 18 (90%) had OmniGraf (TruGraf and TRAC). There were 2 rejections (borderline changes). Diagnostic performance is presented in tables 1–4. Both TruGraf and TRAC individually had NPV of 89% and 85%, respectively, and PPV of 65% and 73%, respectively. When analyzing the performance of the OmniGraf biomarker panel, OmniGraf +/+ showed a 100% PPV and OmniGraf -/- showed a 100% NPV.

Conclusion

In this analysis of renal allograft biopsies in a multiorgan transplant cohort, TruGraf, TRAC (when using organ-dependent thresholds) had reasonable diagnostic performance as a “rule out” test. When the tests are combined into OmniGraf, the PPV and NPV were 100% when both tests agreed with each other. These outcomes justify potential use and the need for continued analysis of the utility of the OmniGraf biomarker panel in monitoring renal allograft in multiorgan transplant recipients.
#4767 ACUTE CORTICAL NECROSIS IN PREGNANCY IS STILL AN IMPORTANT CAUSE FOR END-STAGE RENAL DISEASE IN DEVELOPING COUNTRIES
Authors: Kaul Anupma , Bhaduaria Dharmendra , Prasad Narayan
Published: June 2023

Background and Aims

Renal cortical necrosis (RCN) is a serious complication of acute kidney injury (AKI) and pregnancy is a clinical state closely associated with it with poor renal outcomes. The incidence is much higher in obstetrical AKI compared to other causes of RCN. Despite better medical care facilities available, this continues to be an important cause of morbidity and mortality in developing countries.

Method

This is a retrospective analysis among all pregnant females presenting with AKI from January 2000 to December 2020 at a tertiary care center in the northern part of India. We looked for the incidence of obstetrical-related RCN in our renal biopsies performed in the last 20 years and to evaluate precipitating factors responsible for RCN.

Results

RCN constituted 8.1 % of pregnancy-related AKI cases in our institution. The overall incidence has been declining which was 9.09% from 2000 to 2008 to 8.7 % from 2009 to 2014 and 8.1% from 2014-2020. The patient's median age was 28.4 ± 4.6 years. The average time to presentation from the day of delivery was 7.8 ±3.0 days. The mortality was observed in 10.4 % of them with sepsis and multiorgan dysfunction present in all of them. The most common etiology for RCN was found to be septic abortion and puerperal sepsis accounting for - 16.2 % each. Postpartum hemorrhage was a cause in 9.67 % of patients. The most important cause of RCN was postpartum thrombotic microangiopathy which was observed in 49.5% of patients. Kidney biopsy was helpful in diagnosis in 36 patients while computed tomography scan abdomen alone helped in diagnosis in five patients. Patchy cortical necrosis in histology was seen in 36.7% of patients and morbidity in terms of prolonged hospitalization was seen in 23.4 % while dialysis dependency in 63.4% of the study population

Conclusion

Strategies need to be implemented in reducing the preventable causes for RCN which is not only catastrophic in terms of renal outcomes but also for social and psychological perspectives as well.
#4810 DIAGNOSTIC AND THERAPEUTIC IMPACTS OF AIM ON END-STAGE KIDNEY DISEASE
Authors: Miyazaki Toru , Arai Satoko
Published: June 2023

Background and Aims

End-stage kidney disease (ESKD) is life-threating, and indispensably requires dialysis which however imposes huge burdens on patients’ QOL and medical expense. No therapies to prevent CKD progression to the end-stage have reached clinic to date. Patients undergoing dialysis exhibit a high mortality mainly due to cardiovascular diseases (CVDs), but no biomarkers are available to predict the patients’ death and the incidence of cardiovascular disease (CVD), the major cause of death, before initiation of dialysis. AIM is a macrophage-derived circulating protein present in blood at relatively high levels (∼5 μg/mL). We initially identified AIM as a supporter of macrophage survival, and it is now known as a facilitator of repair in many diseases. In healthy state, AIM associates with IgM pentamer through disulfide-bond formation and charge-based interaction with IgM-Fc, using the solitary cysteine residue and the positively charged-amino acid cluster present at the carboxyl-terminus. During various diseases including acute kidney injury, hepatocellular carcinoma and peritonitis, AIM dissociates from IgM and binds to the body-derived types of inflammatory elements using the identical sites necessary for binding to IgM, thereby promoting their phagocytic removal by phagocytes.

Method

In 561 CKD patients of all stages and 310 dialysis patients, we analyzed the serum AIM and the serum solute profiles, and thereby assessed their efficacy in predicting survival and CVD risk after dialysis induction. Additionally, a therapeutic efficacy of recombinant AIM (rAIM) in preventing CKD progression to end-stage was addressed in house cats, that are highly susceptible to CKD and show a similar disease course to humans.

Results

AIM dissociated from IgM pentamer along CKD progression. Dialytic patients showing low levels of AIM dissociation before initiation of dialysis harbored less serum detrimental solutes, exhibited lower risk of CVD and had better survival than those with high grades of AIM dissociation, suggesting that the IgM-free AIM represents the state of serum toxic solutes, and predicts patients’ prognosis before initiation of dialysis. In addition, treatment of pre-uremic (late IRIS stage 3) cats, 50% of which died of severe uremia within 196 days after diagnosis, with recombinant AIM prevented aggravation of renal function and inflammation, as well as serum toxic solute profile, thereby improving the cats’ survival dramatically. Importantly, the same serum toxin/inflammatory solutes regulatable by rAIM in cats influenced dialysis patients’ prognosis.

Conclusion

There results promise the effects of AIM treatment in humans, reducing the need for dialysis. Our findings could be a platform for new CKD therapies and predictive diagnoses to improve the prognosis of patients with ESKD.
#4845 EFFECT OF OMEGA-3 FATTY ACID ON MITOCHONDRIAL MEMBRANE FATTY ACID AND COMPARISON WITH ERYTHROCYTE MEMBRANE IN ADENINE INDUCED UREMIC RATS
Authors: Yang Dong Eun , Lee Su MI , Kim Jun Chul , An Won Suk
Published: June 2023

Background and Aims

The kidney has the second highest mitochondrial content in the human body. Fatty acids (FAs) are one of the important energy sources and main constituents of cell membranes. Higher erythrocyte membrane oleic acid contents are related to acute coronary syndrome and omega-3 FA can reduce oleic acid contents. We investigated whether omega-3 FA modifies not only erythrocyte membrane FA but also mitochondrial membrane FA of kidney in adenine-induced uremic rats.

Method

Male Sprague-Dawley rats were fed diets containing 0.75% adenine and 2.5% protein for three weeks. Next, rats were randomly divided into six groups that were fed diets containing 2.5% protein and saline with cholecalciferol (3000 IU/kg/week) or omega-3 FAs (300 mg/kg/day) with cholecalciferol were supplemented by gastric gavage for four weeks: normal control (n = 7), adenine control scarified at 3 weeks (n = 6), adenine control scarified at 5 weeks (n = 5), adenine control scarified at 7 weeks (n = 5), omega-3 FAs group scarified at 5 weeks (n = 5), and omega-3 FAs group scarified at 7 weeks (n = 5). The mitochondrial isolation kit was used for renal mitochondria extraction. The mitochondrial and erythrocyte membrane FA contents were measured using gas chromatography.

Results

Compared to the normal control group, serum creatinine levels in adenine control group was significantly increased and improved in omega-3 FA group. Compared with adenine control, erythrocyte and mitochondrial membrane monounsaturated FA contents including oleic acid and arachidonic acid (AA) levels were significantly decreased in omega-3 FA group. FA compositions were similar between erythrocytes and mitochondrial membranes in each group. Monounsaturated FA contents including oleic acid, and eicosapentaenoic acid were higher and saturated FA was lower in the mitochondrial membrane than erythrocyte membrane in adenine control group.

Conclusion

Omega-3 FA affects not only erythrocyte membrane FA but also mitochondrial membrane FA in uremic rats. Erythrocyte membrane FA contents can reflect mitochondrial membrane FA contents of the kidney.
#4870 MORTALITY OF ELDERLY PATIENTS WITH ACUTE KIDNEY INJURY UNDERGOING CONTINUOUS RENAL REPLACEMENT THERAPY: IS AGE A RISK FACTOR?
Authors: Kim Ji Hye , Pyo MI Ryoung , Park Jin Ah , Eum Sang Hun , Min Ji Won , Koh Eun Sil , Ko Eun Jeong , Kim Hyung Duk , Chung Byung Ha , Shin Seok Joon , Yang Chul-Woo , Yoon Hye Eun
Published: June 2023

Background and Aims

The incidence of elderly patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) is increasing. However, there is little evidence on the difference of mortality rates according to age in elderly patients. This study aimed to evaluate the age effect and predictors for mortality in elderly patients with AKI requiring CRRT.

Method

A retrospective analysis was performed in elderly patients with AKI who underwent CRRT. A total of 480 patients aged ≥ 65 years were stratified into three groups according to age: youngest-old (age 65 - 74 years, n = 205), middle-old (age 75 - 84 years, n = 217), and oldest-old (age ≥ 85 years, n = 58). The 28-day and 90-day survival rates were compared between three groups and predictors for mortality were analysed.

Results

The 28-day and 90-day survival rates were not different between three age groups (P = 0.156 and P = 0.189, respectively). The oldest-old group did not show an inferior survival rate to other two groups. For 28-day mortality, prothrombin time [hazard ratio (HR) = 1.37, 95% confidence interval (CI) = 1.01 – 1.88, P = 0.046] and urine output at the start of CRRT (HR = 0.999, 95% CI = 0.998 – 1.000, P = 0.012) and CRRT duration (HR = 0.89, 95% CI = 0.83 – 0.95, P = 0.001) were predictors. For 90-day mortality, mean arterial pressure (HR = 1.02, 95% CI = 1.00 – 1.05, P = 0.019), admission duration (HR = 0.97, 95% CI = 0.95 – 0.99, P < 0.001) and CRRT duration (HR = 0.96, 95% CI = 0.91 – 0.99, P = 0.036) were predictors. The middle-old group or the oldest-old group did not exhibit higher risk compared to the youngest-old group for 28-day and 90-day mortality.

Conclusion

An older age was not a risk factor for mortality in elderly patients with AKI undergoing CRRT. This implicates the importance of active management and application of CRRT in critically ill elderly patients with AKI.
#4875 MANAGEMENT OF TUBULOINTERSTITIAL DISEASE IN PREGNANCY: TEN-YEARS EXPERIENCE OF A NEPHRO-OBSTETRIC CLINIC
Authors: Nogueira Estela , Peres Nadiesda , Godinho Iolanda , Jorge Sofia , Centeno Mónica , Pinto Luísa , Lopes José António
Published: June 2023

Background and Aims

Tubular renal acidosis and salt losing nephropathies are rare conditions but their management during pregnancy that can be challenging due to the physiological adaptation of kidney function. Herein, the authors report the management and outcomes of 7 gestations in patients with Gitelman disease (GS) and renal tubular acidosis (RTA).

Method

Retrospective analysis of maternal, obstetric and perinatal outcomes of pregnant women with tubulointerstitial diseases surveilled at our Nephro-Obstetric clinic from 2011 to 2021.

Results

We evaluated 7 pregnancies in 5 women. Mean age was 29 years [21-36]. They were all caucasian. Genetic diagnosis was performed during pregnancy in only one patient. Tubular disorder was caused by Gitelman disease in 3 patients and by renal tubular acidosis in 2 patients (ATP6VA4 and REN genes mutations). There were 4/1 patients in CKD G1/G3a, respectively, and none developed renal function deterioration. Only one patient developed transient proteinuria during both gestations and all patients had a low blood pressure profile. Management during the first trimester was especially challenging in GS patients, due to nausea, vomiting and hyperemesis gravidarum, which required hospital admission for intravenous potassium chloride therapy in all GS patients during the first trimester. Potassium levels in GS patients were generally below normal levels throughout pregnancy (mean 3 meq/L; 2,2-3,4 meq/L), even with progressive increase in therapy. Pre-pregnancy potassium chloride replacement increased from 4–10 tablets of 600 mg/day to a maximum of 9–21 tablets/day. One patient was also treated with spironolactone. The need for oral magnesium slightly increased from 2–3 ampoules of 1500mg/day to 2–4 ampoules/day. GS patients frequently complained of astenia and cramps. Regarding RTA patients, there was also a need to increase sodium bicarbonate dosage from 3–4.5g/day to a maximum of 2–8g /day. Regarding obstetric and perinatal outcomes, none of the patients developed preclampsia, mean gestational age at delivery was 40 weeks (38-41), mean birth weight was 3233g (2775-3825) and mean Apgar score was 10/10/10 at 1st, 5th and 10th minutes respectively.

Conclusion

In GS patients, management in the first trimester of pregnancy can be challenging due to nausea and vomiting, generally requiring admission for therapy with iv potassium. In spite of increasing doses in oral supplementation, ionic and acid base homeostasis during pregnancy is difficult to achieve. In our small series, maternal, obstetric and perinatal outcomes do not seem to be affected by this unbalance.
#4884 DISRUPTION OF THE INTESTINAL MUCOSAL BARRIER IN CHRONIC KIDNEY DISEASE IS RELATED TO REDUCED EXPRESSION OF THE TIGHT JUNCTIONS' COMPONENTS
Authors: Georgopoulou Georgia Andriana , Papasotiriou Marios , Bosgana Pinelopi , Delastic Anne-Lise , Papachristou Evangelos , Goumenos Dimitrios , Zolota Vasiliki , Thomopoulos Konstantinos , Assimakopoulos Stelios
Published: June 2023

Background and Aims

Patients with chronic kidney disease (CKD) present evidence of systemic inflammation without clinical infection. This is partly attributed to intestinal barrier dysfunction resulting in increased gut permeability with microbial and endotoxin translocation. However, the potential mechanism(s) implicated in increased gut permeability remain unclear. In this study, we investigated several parameters of the intestinal barrier in patients with CKD of various stages.

Methods

Thirty-three patients with CKD were prospectively enrolled. Patients were divided in stage I-IV CKD (group A, n = 17, 9 of them with IgA nephropathy) or end-stage kidney disease (ESKD) (group B, n = 16) and were compared with 11 healthy controls (group C). Duodenal biopsies from all subjects, obtained by endoscopy, were examined histologically for evaluation of the villous length and apoptotic bodies in cryptal epithelium. Intraepithelial CD3+ T-lymphocytes, expression of occludin and claudin-1 in the intestinal epithelium were evaluated by immunohistochemistry. Circulating endotoxin concentration was measured by enzyme-linked immunosorbent assay and cytokine levels [interleukin (IL)-1β, IL-6, IL-8, IL-10, TNF-a] by flow cytometry.

Results

Patients in groups A and B presented significantly higher serum endotoxin, IL-8 and IL-10 levels compared to controls (p<0.01, both groups). Patients in group B presented additionally significantly higher IL-6 levels compared to controls (p<0.01). Occludin expression was significantly decreased in groups A and B compared to group C (p<0.0001 and p<0.001, respectively). Interestingly, in CKD patients (groups A and B) a gradient of occludin expression along the length of the villi, from crypt to tip was recorded with greater loss of its expression at villous tip. Claudin-1 expression was significantly decreased in crypts in groups A and B compared to group C (p<0.0001 and p<0.01 respectively). Endotoxin concentrations were inversely correlated with intestinal occludin (p<0.0001) and claudin-1 (p<0.01) expression and positively correlated with serum IL-6 (p<0.05) and IL-8 (p<0.001) levels. Subgroup analysis for patients with IgA nephropathy showed similar histological findings for occludin and claudin-1 expression as well as for serum endotoxin levels.

Conclusion

Decreased enterocytes’ occludin and claudin-1 expression, might represent an important mechanism of intestinal barrier disruption and increased gut permeability in patients with CKD.
#4901 THE EFFECT OF CHRONIC KIDNEY DISEASE IN CONTRAST-ENHANCED ULTRASONOGRAPHY WITH ARRIVAL TIME PARAMETRIC IMAGING
Authors: Marc Luciana , Lupusoru Raluca , Mihaescu Adelina , Schiller Oana-Marina , Chisavu Lazar , Pascota Razvan Dragota , Olariu Nicu , Schiller Adalbert
Published: June 2023

Background and Aims

CEUS is a reliable method to diagnose ischemic renal pathologies such as infarction, identify renal abscesses, discriminate between renal tumors and anatomical variants, describe complex cyst lesions, and monitor non-surgical renal lesions. Few studies explore the relationship between CEUS and the diagnosis or progression of CKD. The aim of this study was to evaluate the relationship between contrast-enhanced ultrasonography with arrival time parametric imaging (CEUS-PAT) and CKD.

Method

We prospectively evaluated 64 subjects (37 liver cirrhosis patients and 27 healthy volunteers) using CEUS-PAT to detect if the presence of CKD influences the arrival time of the contrast in the kidney. CKD was defined according to KDIGO 2021 guidelines. Ultrasonography was performed using the LOGIQ E9 (GE Healthcare, Chalfont St.Giles-UK) system, probe C1-6. CEUS was performed on each subject using SonoVue (Bracco SpA, Milan, Italy) as a contrast agent (1/2 of a vial). A 2.5 mL contrast substance followed by a 5 mL normal saline solution was infused in the cubital vein. A ratio between the arrival time of the substance in the kidney and liver was calculated. Subjects were in fasting conditions for at least 12 h. Laboratory data were extracted from the patient's GP file. The study was conducted between January -December 2018. All patients provided their informed consent for the procedures.

Results

The study included 64 subjects, mean age of 58.98 ± 8.90 years, predominantly male gender (56.3%). Of the 64 patients, 13 (20.3%) had chronic kidney disease. All patients with chronic kidney disease had liver cirrhosis. When comparing the two groups, with and without CKD, there was a significant difference between the ratio of the arrival time of the contrast agent into the kidney and liver, 0.85 ± 0.09 vs 0.65 ± 0.19, p = 0.0005. The factors associated with kidney disease were liver steatosis (p<0.0001), age over 60 years (p = 0.01) and low albumin (p<0.0001).

Conclusion

Our study indicated that the presence of CKD influences the contrast agent arrival time in the kidney. Further studies are needed to establish the predictive significance of CEUS-PAT data in CKD patients.
#4913 ANALYSIS OF THE LIPID PROFILE IN THE RENAL PATIENT AND SUB-ANALYSIS OF THE POPULATION WITH POLYCYSTIC KIDNEY DISEASE
Authors: Ruiz Alfonso Lara , Heres Salia Pol , Cintra Melissa , Velilla Teresa Arrobas , Flores Rocío Molas , Lazo Mercedes Salgueira
Published: June 2023

Background and Aims

Dyslipidemia is frequent in patients with chronic kidney disease (CKD), it constitutes a factor of progression of both cardiovascular risk (CVR) and CKD itself. It has its own characteristics, which are modified with the ERC stadium. The subgroup of patients with Polycystic Kidney Disease (PKD) presents its own characteristics. The aim of the study was to analyze the lipid profile in the renal population and the differences in the PKD group.

Method

Retrospective observational study, includes population under follow-up in nephrology consultations in a health area, during 2018–2021. We analyzed lipid profile, renal function and whether they received statins. IBM SPSS Statistics V24 was used.

Results

3301 prevalent patients with kidney disease were collected, excluding those on renal replacement therapy (RRT), with glomerular filtration rate (GFR), glomerular filtration rate (GFR) <10ml/min/1.73m² and proteinuria greater than 1.5g. Of these, 112 (3.4%) patients had PKD. 51% of the total CKD patients were under treatment with statins. The average number of Total Cholesterol (TC) was 170.4+/-43mg/dl, LDL 92.3+/-37mg/dl, HDL 50.3+/-15mg/dl and triglycerides (TG) 147.3+/-92mg/dl. In 37% of CKD patients, LDL was >100mg/dl and only 35% had LDL<75mg/dl. In the CKD group with a GFR <60ml/min/1.73m² (N = 2337; 71%), there was a high prevalence of patients with LDL values >100mg/dl (N = 784; 33.5%). In the case of GFR <30ml/min/1.73m² (N = 981; 29.7%), the presence of LDL>100mg/dl 30% (N = 297) was also frequent. In the subanalysis of patients with PKD, the mean TC was 182+/-40mg/dl, LDL 101.2+/-33mg/dl, HDL 56.4+/-17mg/dl, and TG 123.7+/-59mg/dl. 76% of the PKD had GFR <60ml/min/1.73m² (N = 73), of which 43% presented LDL>100mg/dl (N = 32). In PKD patients with GFR > 60ml/min/1.73m² (N = 39), half (N = 22; 56.4%) also had LDL >100mg/dl. In addition, 51% were taking a statin, despite this they had a mean TC 183mg/dl+/-46, LDL 102.7+/-39, HDL 53+/-15, and TG 142+/-69mg/dl.

Conclusion

The presence of elevated LDL was frequent in CKD, especially in the group with GFR < 60ml/min/1.73m² without statin and in a quarter of patients with the same GFR with statin. It is notable in the PKD group, probably due to less awareness of strict CVR control.
#4996 TPPP3 REGULATES THE MICROTUBULE ACETYLATION AND PROMOTING YAP NUCLEAR RECRUITMENT IN HUMAN PODOCYTES
Authors: Chen Qilin , Jiang Yaru , Peng Liping , Jiang Huimin , Wan Junli , Feng Xiaoqian , LI Qiu
Published: June 2023

Background and Aims

Minimal change disease (MCD) is a podocytopathy more commonly seen in children, but it also accounts for 10%–25% of adult NS. Patients with MCD manifest with abundant albuminuria, which is related to the damage of the glomerular filtration barrier. Podocytes are major components of the glomerular filtration barrier and play a crucial role in maintaining the integrity of the glomerular filtration barrier. Alterations in podocyte actin critically affect podocyte function. Tubulin polymerization-promoting protein family member 3 (TPPP3) is regulator of microtubule dynamic that has microtubule bundling activity. However, the mechanism of TPPP3 involved in podocyte apoptosis is remains unknown.

Method

Single-cell RNA sequencing comprehensively characterized the expression of TPPP3 in human glomeruli. We cultured human immortalized podocyte cells (HPC) in vitro, and constructed the HPC injury model. Immunofluorescence, western blot were used to determine the expression of TPPP3, α-tubulin, acetylated tubulin, phosopho-YAP1, Podocyte apoptosis was determined by Annexin V APC Apoptosis Detection Kit.

Results

TPPP3 was specifically expressed in human glomerular podocytes, and its expression level was significantly decreased in the cases of MCD and ADR induced podocyte injury(P<0.05). Knockdown of TPPP3 leaded to decreasing expression of acetylated tubulin in podocytes(P<0.05). Phosopho-YAP1 was also observed in the TPPP3 knockdown HPCs(P<0.05). Apoptosis was increased in the TPPP3 knockdown HPCs, suggesting TPPP3 may be related to the podocytes injury and apoptosis.

Conclusion

TPPP3 is involved with the apoptosis of podocytes by regulates nuclear recruitment of YAP which was promoted by microtubule acetylation.
#5081 THE VALUE OF ANTI-C1Q ANTIBODIES IN PREDICTING THE CLINICAL-HISTOLOGICAL FEATURES OF LUPUS NEPHRITIS PATIENTS AT TIME OF KIDNEY BIOPSY
Authors: Calatroni Marta , Conte Emanuele , Reggiani Francesco , de Liso Federica , Moroni Gabriella Luisa
Published: June 2023

Background and Aims

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with renal involvement in around 50% of patients. Delayed diagnosis of lupus nephritis (LN) is associated with higher risk of end-stage kidney disease (ESKD) and mortality. Kidney biopsy remains the gold standard for diagnosis and management of LN, but in the last decades there is an interest for new serum biomarkers. Anti-C1q antibodies are autoantibodies associated with LN. Nevertheless, few studies have correlated the association of anti-C1q antibodies with active LN with focus on renal histology.

Method

We evaluated clinical and histological data of 59 patients with biopsy proven LN. Kidney biopsies were categorized following the ISN/RNP Classification. We evaluated the correlation of the main clinicopathologic features with values of antiC1q antibodies, measured by a commercial kit with a clinically validated ELISA test. Normal values of antiC1q were < 20 UA, medium values were between 20 and 80 UA and high values were > 80 UA. Demographic and clinical data were expressed as numbers or percentage for discrete variables and for continuous variables as mean and standard deviation. The correlation between antiC1q levels and clinicopathological characteristics have been analyzed with Fisher's test.

Results

At the presentation of 59 patients with LN, the mean age was 34 years and the time of SLE disease before the onset of LN was 73.2 months. 9 patients were male, mean serum creatinine was 1 mg/dl, glomerular filtration rate (eGFR) was 88.53 ml/min, proteinuria was 4.35 g/day and microscopic hematuria was present in 79% of pts. Kidney biopsies were classified as non-proliferative (class II and V) in 18.4% of patients and proliferative (class III and IV) in 77.6% of patients. We evaluated the correlation between all variables included in Table 1 with values of antiC1q antibodies and we found significant results for serum creatinine, active urinary sediment, C3 and C4 values, proliferative classes and the activity index at kidney biopsy (Table 2).

Conclusion

High titles of anti-C1q antibodies were significantly correlated with the main clinical and histological characteristics that identify active renal diseases in SLE. Kidney biopsy remains the gold standard for diagnosis and management of LN, but anti-c1q antibodies are strongly associated with active LN in SLE. In conclusion, anti-C1q monitoring should be helpful and might be a crucial serum biomarker for the diagnosis and follow-up of these patients.
#5142 THE NATURAL HISTORY OF FSGS IN THE GERMAN CHRONIC KIDNEY DISEASE (GCKD) COHORT
Authors: Stamellou Eleni , Nadal Jennifer , Seikrit Claudia , Hendry Bruce , Mercer Alex , Schmidt Matthias , Möller Marcus Johannes , Schiffer Mario , Eckardt Kai-Uwe , Floege Jürgen
Published: June 2023

Background and Aims

FSGS is a heterogenic glomerular disease and a common cause of kidney failure in adults. Here we describe the natural history of individuals with FSGS in the German Chronic Kidney Disease (GCKD) cohort.

Method

From 2010 to 2012, 159 patients with biopsy-proven FSGS have been enrolled into the GCKD study, a prospective observational cohort study (N = 5217). Inclusion criteria were an estimated glomerular filtration rate (eGFR) of 30–60 mL/min/1.73 m2 or overt proteinuria in the presence of an eGFR>60 mL/min/1.73 m2. Baseline date was defined as first study visit. Endpoints were the composite renal endpoint (MAKE); eGFR decline >40%, eGFR< 15ml/min/1.73 m2 or initiation of kidney replacement therapy. The associations between the incidence of MAKE and clinical parameters were analyzed using the Cox proportional hazards regression model. Data relating to baseline demographics, laboratory, comorbidity, and mortality were used.

Results

The mean age at baseline of patients with FSGS was 52.1 ± 13.6 years. Median proteinuria at baseline was 0.7 g/g (Q1 0.1; Q3 1.8), while mean eGFR was 55.8 ± 23 mL/min/1.73 m². Mean duration of the disease before enrollment was 4.7 ± 6.8 years. The majority (101;63.5%) were male; 69 (43.4%) were diagnosed as primary FSGS using clinical and pathological criteria, 55 (34.6%) as secondary FSGS and for 35 (22%) the etiology was uncertain. At baseline, 37 (23.3%) were under immunosuppressive treatment. Over a follow-up of 6.5 years, 44 reached MAKE, in detail 19 (12%) initiated kidney replacement therapy, an additional 25 (15.8%) experienced a >40% eGFR decline. Albuminuria >0.7 g/g was associated with MAKE, with a HR of 1.47 (95% CI: 1.27-1.7) compared to <0.7 g/g. Higher eGFR at baseline (per 10 ml/min) protected from MAKE with a HR of 0.8 (95% CI: 0.68-0.95).

Conclusion

The GCKD cohort represents a large study population with lengthy and adjudicated follow-up data. Lower eGFR and higher albuminuria are significant risk factors for progressive kidney disease and ESKD in patients with FSGS.
#5146 KINETIC ESTIMATION OF GFR AND URINARY CREATININE EXCRETION RATE AS PREDICTORS OF DELAYED GRAFT FUNCTION IN RENAL TRANSPLANTS FROM DECEASED DONORS
Authors: Romero Natividad Calvo , Delgado-Palacios Jesús Domínguez , Arevalo Marta Calvo , Pérez-Flores Isabel , Cubillo Beatriz Rodríguez , de la Higuera Díaz María Ángeles Moreno , Rincón María Muñiz , Meneses Arianne Aiffil , López Rómulo Katsu Loayza , Fructuoso Ana Sanchez
Published: June 2023

Background and Aims

Delayed graft function (DGF) is a common complication after renal transplant. Definitions of DGF are based on analysis of estimated glomerular filtration rate (eGFR) underlying the plasma creatinine fluctuations after renal transplant. We tried to validate an early parameter of DGF in a renal transplant population based on the kinetic estimation of glomerular filtration rate, since this formula adds a quantitative dimension to the assessment of kidney function, and consequently predicting DGF could get a better post-transplant management.

Method

This is a longitudinal study of 886 renal transplant recipients from our center during the first post-transplant month. As we are searching for functional biochemical markers in renal transplant from decesased donors, we excluded patients with primary gtaft disfunction.The final simple was composed of 574 adult kidney transplant recipients, 348 renal transplant from donors after circulatory death (DCD) and 226 from donors after brain death (DBD). The following are analyzed 5creatinine concentrations, serum Lactate dehydrogenase (LDH) and urinary creatinine excretion rate (CER).

Results

In DCD there was a significant correlation between DGF duration and all KeGFR and CER determinations during the first post-transplant week. The parameters that achieved the best correlation to predict DGF were KeGFR (r = 0.515; p<0.001) and CER on the fourth day (r = 0.584; p<0.001) (Figure 1). In the DBD, a weak correlation was observed between DGF duration and KeGFR determinations in the first days, being KeGFR at the fourth day the one that presented the highest correlation (r = 0.59 p<0.001). We observed that serum LDH on the first day in the DBD group is associated with worse renal graft function at first, third month and one year after transplantation (p<.045, p<.05 and p<.067 respectively).

Conclusion

The determination of KeGFR and CER could predict the duration of DGF, especially in DCD recipients. DCD recipients with DGF have significantly better graft survival at one year than DBD recipients with DGF. (p<.001).