bluuebunny/crossref_metadata_2025 huggingface dataset:
P0723CHRONIC KIDNEY DISEASE AS AND INDICATION FOR MINIMIZATION OF IMMUNOSUPPRESSION IN LIVER TRANSPLANT RECIPIENTS
Authors: Mucha Krzysztof , Knioła Emilia , Foroncewicz Bartosz , Moszczuk Barbara , Zieniewicz Krzysztof , Pac Michaå‚ , Pączek Leszek
Published: June 2020

Background and Aims

Liver transplantation (LT) requires patients to take immunosuppression (IS). Long term IS leads to hypertension and chronic kidney disease (CKD). Calcineurin inhibitors (CNi) are known to have nephrotoxic effects. Thus, liver transplant recipients (LTRs) that are taking either long-term or high cumulative doses of CNi are at a significantly higher risk of developing CKD. This study aimed to find predictive factors for development of CKD post-LT. Furthermore, it introduced IS minimization protocol in LTRs with clinical or laboratory indications with the aim to prevent the CKD progression and decrease the burden of other comorbidities.

Method

212 out of all 870 LTRs from our center were screened for eligibility and 93 were recruited in 2018 for IS minimization after obtaining informed consent. They were deemed eligible if the primary cause of LT was a non-autoimmune disease and the graft function was stable. At the time of screening, patients were on IS either triple-, dual- or monotherapy (Table 1). The IS were reduced in 3 months intervals and was minimized until monotherapy with subtherapeutic serum levels (tacrolimus <5mg/ml or cyclosporine <50mg/ml).

Results

The indications for IS minimization were hypertension (73.87%), CKD (35.87%), cardiovascular diseases (32%), diabetes mellitus (23.91%) or malignancies (6.52%). It was found that LTRs with CKD were older (61.8 CKD vs. 49.6 non-CKD) and predominantly male (84.85% male; 15.15% female) when compared to non-CKD patients (33.9% male; 66.1% female). Another risk factor for post-LT CKD development was higher BMI (27.57 vs. 25.35). Time from transplantation of LTR with CKD was 129.12 months while for non-CKD was 150.19 months, suggesting that longer time since transplantation is not a predictive factor for development of CKD after LT. LTRs with CKD concomitantly had hypertension (84.85% vs. 67.80%) and DM (48.48% vs. 27.12%) more often than non-CKD LTRs. It was found that CKD-LTRs at the beginning of the IS minimization were more commonly taking IS polytherapies (triple 6.06% and dual 45.45% vs. triple 0% and dual 33.9%) than monotherapy (48.48% vs. 67.80%). In the first 12 months of the study, 22 out of the 33 patients with CKD safely reached monotherapy, 11 of those reached subtherapeutic levels of CNi (50,0%). Moreover, when kidney function was compared before and after IS reduction any progression of CKD was observed. Liver function tests were elevated in 4 patients with CKD, but return to the previous dose of IS resulted in normalization of liver function.

Conclusion

Minimization of IS should be considered in patients after LT who suffer from IS related comorbidities, particulary CKD. Its incidence post-LT was found to be associated with male gender, BMI and IS polytherapy. Our protocol of IS minimization seems to be safe in respect to graft rejection.
P0724ASSOCIATIONS OF URINARY POLYMERIC IMMUNOGLOBULIN RECEPTOR PEPTIDES IN THE CONTEXT OF CARDIO-RENAL SYNDROM
Authors: He Tianlin , Siwy Justyna , Metzger Jochen , Mullen William , Mischak Harald , Schanstra Joost , Zürbig Petra , Jankowski Vera
Published: June 2020

Background and Aims

The polymeric immunoglobulin receptor (pIgR) which transports immunoglobulins from the basolateral to the apical surface of epithelial cells was recently shown to be associated with kidney dysfunction. The immune defense is initiated at the apical surface where the N-terminal domain of pIgR, termed secretory component (SC), is proteolytically cleaved and released either unbound (free SC) or bound to immunoglobulins. The aim of our study was to show the association of pIgR peptides with the cardio-renal syndrome in a large cohort and to get information on how the SC will be released.

Method

We investigated urinary peptides of 2707 individuals available in the Human Urine Proteome Database using capillary electrophoresis coupled to mass spectrometry.

Results

The mean abundance of 23 different pIgR peptides correlates negatively with the estimated glomerular filtration rate (eGFR, r=-0.314, p<0.0001). Furthermore, pIgR peptides are significantly increased in coronary artery disease after adjustment for eGFR. We further predicted the proteases involved in urinary peptide generation using the Proteasix tool. Peptide cleavage site analysis suggests that several, and not one, proteases are involved in the generation of the SC.

Conclusion

In this large cohort, we could demonstrate that pIgR is associated with the cardio-renal syndrome and provide more detailed insights on how pIgR can be potentially cleaved to release the SC.
P0730ALTERATION OF BRAIN CONNECTIVITY IN NEUROLOGICALLY ASYMPTOMATIC PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Kim Yang Wook , Lee YOO JIN , Park Bong Soo , Park Sihyung , Heo Chang min , Lee Yoojin
Published: June 2020

Background and Aims

Our previous study demonstrated that patients in End stage renal disease had decreased structural and functional brain connectivity, and there was significant association between brain connectivity and cognitive function. The aim of this study was to evaluate the alterations of structural and functional connectivity using graph theoretical analysis in the neurologically asymptomatic patients with relatively early stage chronic kidney disease (CKD).

Method

We prospectively enrolled neurologically asymptomatic 20 patients with CKD stage 3 and 20 healthy controls, and all of the subjects underwent diffusion tensor imaging (DTI) and resting state functional MRI (rs-fMRI). Using data from the structural and functional connectivity matrix based on DTI and rs-fMRI, we calculated network measures, including global efficiency, local efficiency, mean clustering coefficient, characteristic path length, and small-worldness index, and investigated the differences between the patients with CKD and healthy controls.

Results

The patients with CKD had altered global structural connectivity and preserved functional connectivity compared to healthy controls. The all of the measures of global structural connectivity were significantly different between the patients with CKD and healthy controls. However, all of the measures of global functional connectivity in the CKD patients were not different from those in healthy participants. In the CKD patients, the functional betweenness centrality of the right insular cortex, right occipital pole, and right thalamus was significantly different from that in healthy subjects. The structural betweenness centrality of the left calcarine, right posterior cingulum was significantly different from that in healthy subjects.

Conclusion

There were significant alterations of global structural connectivity between patients with CKD and control. However, functional connectivity of brain network was preserved in contrast to ESRD patients.
P0742ASSOCIATION BETWEEN EOSINOPHILIA AND RENAL PROGNOSIS IN PATIENTS WITH CHOLESTEROL CRYSTAL EMBOLISM
Authors: Mochida Yasuhiro , Ohtake Takayasu , Morota Marie , Ishioka Kunihiro , Moriya Hidekazu , Hidaka Sumi , Kobayashi Shuzo
Published: June 2020

Background and Aims

Approximately, 20%-70% of patients with cholesterol crystal embolism (CCE) have eosinophilia. However, it remains unknown how eosinophilia influences on renal prognosis in patients with CCE. In this study, we investigated an association between eosinophil count (Eo) and renal prognosis in CCE patients on steroid therapy.

Method

The present study is a single-center retrospective cohort study in patients with pathological proven CCE and Chronic kidney disease from April 2007 to May 2018. This study included the patients who are not treated with maintenance dialysis nor steroid, and moreover followed until November 2019. We analyzed the validity of eosinophil counts using receiver operating characteristic (ROC) curve analysis. In the statistical analysis, renal survival was calculated with the Kaplan– Meier method, and comparisons between higher and low Eo groups were made with the log-rank test.

Results

Thirty-two patients with pathological diagnosed CCE were enrolled and followed-up for 11.0 (4.7-43.6) months. There were significant differences in the white blood cell (p=0.03), hemoglobin (p=0.007), serum creatinine levels (p=0.03), phosphate (p=0.045), Calcium×Phosphate (p=0.03), and Eo (p=0.016) between the renal survival and renal death groups. Using the receiver operating characteristic curve analysis with Youden index, Eo of 810/µL showed the sensitivity and specificity 71% and 88% for detecting renal death, respectively (area under the carve; 0.789). Comparing the outcomes in patients having Eo ≥ and <810/µL by using the log-rank test, there are significantly higher renal death rate in CCE patients with Eo ≥810/µL (p=0.004).

Conclusion

Higher eosinophilia was a prognostic risk factor for renal death in the patients with CCE.
P0747STRESS ERGOMETRY PERFORMANCE AND ABDOMINAL AORTIC CALCIFICATION PREDICT PATIENT OUTCOMES IN CKD STAGE 4-5
Authors: Lankinen Roosa , Hakamäki Markus , Metsarinne Kaj Peter , Pärkkä Jussi , Hellman Tapio , Kartiosuo Noora , Raitakari Olli , Järvisalo Mikko
Published: June 2020

Background and Aims

Patients with chronic kidney disease (CKD) stage 4-5 have an increased risk of cardiovascular morbidity and mortality.

Method

We recruited 174 consecutive patients with CKD stage 4-5 between 2013 and 2017 into a prospective follow-up study assessing arterial disease, quality of life, mortality and their predictors. Together with baseline medical data, standard maximal bicycle ergometry stress testing, abdominal aortic calcification score (AAC) and echocardiography was collected. Patients were followed up for mean 42 months.

Results

Mean age at recruitment was 61 years, 54 (31%) were women and estimated glomerular filtration rate (eGFR) was 12.9 ml/min. Altogether, 36 (21%) patients died during follow-up with a mean time to death of 835 days. At baseline, all but one patient were hypertensive, 75 patients had diabetes and 21 patients had coronary artery disease. Mean AAC was 6.27±5.68 and work load of the last 4 minutes of maximal stress (WMAX) was 83.7±36.5W, respectively. In the multivariate proportional hazard models pro-BNP [1.98 (95% CI 1.36 – 2.90), p=0.0004], WMAX [HR 0.45 (95% CI 0.27 – 0.77), p=0.0033], AAC [HR 2.51 (95% CI 1.37 – 4.61), p=0.0030], E/e’ –ratio [HR 1.66 (95% CI 1.08 – 2.56), p=0.0221] and albumin [HR 0.59 (95% CI 0.39 – 0.90), p=0.0134] were significant predictors for mortality when adjusted with age, sex, diabetes and previous coronary artery disease. Patients who perished, especially those who died in less than 2 years, within follow-up had significantly higher AAC and lower WMAX compared to those surviving to the end of the study (Figure 1).

Conclusion

Maximal stress ergometry test work load and AAC are associated with patient survival in severe CKD.
P0748CLINICAL OUTCOMES OF JAPANESE ANTI-MYELOPEROXIDASE ANTI-NEUTROPHIL CYTOPLASMIC ANTIBODY-RELATED RAPIDLY PROGRESSIVE GLOMERULAR NEPHRITIS
Authors: Nishida Yoshihiro , Ito Kenji , Yasui Yuki , Takahashi Koji , Yasuno Tetsuhiko , Himuro Naoko , Miyake Katsuhisa , Masutani Kosuke
Published: June 2020

Background and Aims

Anti-myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA)-related nephritis constitutes 60% of rapidly progressive glomerular nephritis (RPGN). In 2014, Japanese Society of Nephrology (JSN) created RPGN clinical guidelines for Japanese MPO-ANCA-related RPGN patients, and proposed the clinical grading system for predicting their prognosis, which took into consideration factors such as age, renal function, lung involvement, and serum CRP (Yoshihiro Arimura et al. Clin Exp Nephrol. 2016). However, evidence regarding clinical outcomes is still limited. In the study reported here, we conducted a single-center retrospective study to evaluate the outcomes of MPO-ANCA-related RPGN patients and to establish an efficacy of RPGN guidelines of JSN.

Method

We retrospectively investigated 54 patients (female, n=32; average age ± 13.0 years) with MPO-ANCA-related nephritis. The patients were admitted to Fukuoka University Hospital between 2009 and 2018. Their clinical grade determined by JSN guideline and method of treatment were retrospectively evaluated for prediction of survival, as well as laboratory data and clinical features.

Results

12 patients (22.2 %) has deceased during a median observation period of 17.1 months. 7 patients are died of infectious disease (Bacterial pneumonia 4, Sepsis 2, pulmonary aspergillosis 1), and 10 patients died within 1 year. Median estimated glomerular filtration rate (eGFR) was 15.5 mL/min/1.73m2 at admission. 14 patients (25.9%) presented with end-stage renal disease (ESRD) during the observation period, 8 of them were died. The distribution of clinical grade of JSN guideline was grade I for 10, II for 27, III for 10 and IV for 7. (grade IV is the most severe) Patients with high clinical grade showed significantly high mortality (Log Rank test, p<0.05; figure 1). Multivariate Cox proportional hazards model analysis revealed that high clinical grade was a significant risk factor for all-cause death (Hazard ratio (HR), 7.09; 95% confidence interval (CI), 2.01-15.69, p<0.05) and for infectious disease death (HR, 16.9; 95% CI, 2.56-121.5, p<0.05). On the other hands, the preventive administration of Trimethoprim-Sulfamethoxazole (TS) decreased the risk of infectious disease death (figure 2).

Conclusion

The MPO-ANCA-related RPGN clinical grading system created by JSN was a useful tool for prediction of prognosis. Furthermore, TS should be administrated for all immune-suppressive patients to prevent variable infections not only Pneumocystis.
P0753HOW FREQUENTLY PATIENTS WITH RISK FACTORS FOR CHRONIC KIDNEY DISEASE ACHIEVE RECOMMENDATIONS OF FOOD CONSUMPTION FREQUENCY
Authors: Corona Rodríguez Elizabeth , Márquez Herrera Roxana Michel , Cortés Sanabria Laura , Nuñez Murillo Gabriela Karen , Gomez Garcia Erika Fabiola , Rojas Campos Enrique , Martinez Ramirez Hector Ramon , López Leal Jorge , Cueto Manzano Alfonso Martín
Published: June 2020

Background and Aims

Risk factors for chronic kidney disease (CKD) such as type 2 diabetes mellitus (DM2), high blood pressure (HBP) and obesity are strongly related to negative lifestyle and nutritional habits. The aim of this study was to estimate the proportion of patients with and without risk factors for CKD who meet recommendations for food consumption.

Method

Cross-sectional study. A qualitative food frequency questionnaire (FFQ) was applied. Consumption of each food group was classified as adequate or inadequate based on dietary guidelines (DASH and ENSANUT Mexican Guidelines). Sociodemographic, biochemical and clinical variables were measured. DM2, HBP and obesity were defined as risk factors.

Results

744 adults were evaluated, age 51±16 y, 68% women, 59% without risk factors, 7% DM2, 17% HBP, 8% DM2+HBP, and 18% obesity. Glomerular filtration rate was 99 (89-100) mL/min/1.73m2. Differences in FFQ between groups were found in relation to consumption of legumes, fast food, sugar, sweets and desserts (p<0.05). Figure A shows the frequency of consumption of healthy and B, unhealthy foods.

Conclusion

In general, subjects in this sample had negative dietary habits, with <50% consuming healthy food and >50% consuming unhealthy food. Subjects without risk factors for CKD displayed a similar pattern of food consumption than those with risk factors, with only a significantly lower legumes intake than patients with HBP, and higher intake of sweets and desserts, sugar, and fast food compared to patients with DM2+HBP. It is necessary to implement strategies to prevent the long-term development of CKD in groups with poor adherence to healthy food consumption recommendations.
P0759ORTHOSTATIC SYSTOLIC BLOOD PRESSURE CHANGE AND THE RISK OF CHRONIC KIDNEY DISEASE: A COMMUNITY-BASED PROSPECTIVE STUDY IN KOREA
Authors: Min Hyang Ki , Lee Sung Woo
Published: June 2020

Background and Aims

There have been no studies which explored the relationship between orthostatic blood pressure (BP) change and incident chronic kidney disease (CKD) in Asian population.

Method

We reviewed the data of 7,461 non-CKD adults aged 40-69 years who participated in Ansung_Ansan Cohort, a prospective community-based cohort study. BP was measured on supine position and 2 minute–upright position, and the difference was defined as orthostatic BP change. Incident CKD was defined as the first event to be estimated glomerular filtration rate < 60 ml/min/1.73 m2, which was confirmed at least 2 or more times thereafter.

Results

Of 7,461, orthostatic diastolic BP change was not associated with incident CKD in multivariate Cox proportional-hazard regression model. However, per 1 mmHg increase of orthostatic systolic BP was associated with decreased hazard of incident CKD: hazard ratio 0.988 and 95% confidence interval (0.982-0.994, P <0.001). In penalized spline curve analysis, we identified L-shaped relationship between orthostatic systolic BP change and incident CKD, with the threshold of - 2.4 mmHg. In subgroup analysis, the relationship between orthostatic systolic BP change and incident CKD was evident, particularly in participants without central obesity and reduced high density lipoprotein cholesterol and those with increased white blood cells.

Conclusion

Orthostatic SBP change was independently associated with incident CKD development. Future studies need to be followed to confirm the results.
P0761STUDY ON THE MECHANISM OF MICROINFLAMMATION WITH UREMIA CAUSED BY LACTOBACILLUS ACTIVATION OF INTESTINAL MACROPHAGES BY MINCLE
Authors: Sun Lingshuang
Published: June 2020

Background and Aims

My previous studies have found that Intestinal macrophages in the uremic rats are polarized towards a proinflammatory phenotype and had dysfunction of phagocytosis leading to aggravate microinflammation and assist bacterial translocation in uremia resulting in microinflammation. However, it is still unclear what kind of mechanism of action of intestinal bacteria activates intestinal macrophages and thus participates in the occurrence and development of microinflammation in uremia.

Method

Male Sprague-Dawley rats were randomly divided into two groups: sham, uremia. The macrophage ultrastructure was examined by transmission electron microscopy. Immunochemistry was used to analyze the expression of macrophage-inducible C-type lectin (Mincle). RT-PCR and western blot were employed to assess the mRNA and protein expression of toll-like receptor 4 (TLR4).

Results

Our RCT study found that the number of Lactobacilli in the intestines of patients with end-stage diabetic nephropathy was significantly higher than that in non-diabetic patients(Figure 1). The plasma levels of endotoxin, CRP, IL-6, and TNF-a in the uremia group were greater than those in the sham group (p>0.05)(Table 1).Compared with the sham group, the uremic macrophages showed fewer cytoplasmic protrusions and pseudopodia(Figure 2) and the uremia group exhibited macrophages with higher staining intensities for Mincle and higher mRNA and protein expression of TLR4(Figure 3-5).

Conclusion

Studies have shown that Lactobacillus planta can directly activate Mincle. The relationship between Mincle and the activation of intestinal macrophages was verified. The solution to this scientific problem will not only clarify the molecular mechanism of intestinal bacteria in controlling the activation of intestinal macrophages, but also link the immune regulation of intestinal macrophages with the micro-inflammation of uremia so as to clarify the micro-inflammation state of uremia.
P0763A COMPARATIVE STUDY OF ARTERIAL STIFFNESS AND WAVE REFLECTIONS IN DIABETIC AND NON-DIABETIC PATIENTS WITH CKD
Authors: Schoina Maria , Loutradis Charalampos , Memmos Evangelos , Papadopoulos Rafael , Intzevidou Eleni , Doumas Michael , Karagiannis Asterios , Papagianni Aikaterini , Sarafidis Panteleimon
Published: June 2020

Background and Aims

Arterial stiffness is associated with increased risk for target-organ damage, cardiovascular events and overall mortality in the general population, patients with diabetes mellitus and patients with chronic kidney disease (CKD) of all stages. This is the first study to evaluate in comparison arterial stiffness and arterial wave reflections in diabetic and non-diabetic patients with CKD.

Method

This study included 48 diabetic and 48 non-diabetic adult patients (>18 years) with CKD (eGFR: <90 και ≥15mL/min/1.73m2), matched in a 1:1 ratio for age, sex and eGFR within each CKD stage (2, 3a, 3b and 4). All patients underwent carotid-femoral pulse wave velocity (PWV), central blood pressure (BP), and wave reflections measurement with applanation tonometry (Sphygmocor, Atcor Medical, Australia).

Results

Office systolic and diastolic blood pressure was similar between diabetic and non-diabetic subjects with CKD in total and across CKD stages. Office brachial pulse pressure (PP) was significantly lower in non-diabetics (49.00±8.0 vs 52.67±8.7 mmHg, p= 0.034). Office PWV was marginally higher in diabetics compared with non-diabetics (10.89±2.0 vs 10.06±2.2 m/sec, p=0.056). In CKD stages 2 and 4, no significant difference in PWV between the two groups was noted, but PWV was higher for diabetics in CKD stages 3a (11.28±1.4 vs 9.83±1.5 m/sec, p=0.023) and 3b (11.13±1.9 vs 9.46±1.2 m/sec, p=0.016). Heart-rate-adjusted augmentation index [AIx(HR75)] was higher in diabetic compared with non-diabetic subjects only in CKD stage 4 (32.08±4.2 vs 25.92±6.6%, p=0.013).

Conclusion

Diabetic CKD patients present higher arterial stiffness than non-diabetic counterparts. The additional contribution of diabetes towards increased arterial stiffness is more prominent in patients with moderately impaired renal function (CKD stage 3a and 3b), whereas at stage 4, PWV was increased independent of diabetes presence.
P0764STUDY OF 15 CASES OF CHOLESTEROL CRYSTAL EMBOLISM WITH LOW-DENSITY LIPOPROTEIN APHERESIS
Authors: Shimizu Taisuke , Sano Tatsuro , Takayanagi Kaori , Ogawa Kouki , Iwashita Takatsugu , Ogawa Tomonari , Hasegawa Hajime
Published: June 2020

Background and Aims

Cholesterol crystal embolism (CCE) causes renal damage, and there is a high risk of end-stage renal disease. Corticosteroids, statins and low-density lipoprotein apheresis (LDL-A) have been used to treat CCE, but the prognosis remains poor and treatment not yet established. This study evaluated the efficacy of LDL-A in patients with CCE.

Method

We performed a retorospective study of 15 Japanese patients in clinical and histological diagnosis of CCE was made April 2015 to December 2017. 10(67%) patients were diagnosed pathologically on skin biopsy and others were diagnosed clinically. All patients had shown CKD with eGFR <60 mL/min/1.73m2 before being diagnosed with CCE. All patients received LDL-A; of these, 13 (87%) also received corticosteroids. The median estimated GFR diagnosis (at baseline) were 13.4 mL/min/1.73m2, and were analyzed stratified into High eGFR group(H) and Low eGFR group(L). Differences in eGFR, 1 month, 3 months and 1 year after LDL-A, were compared in these groups.

Results

High eGFR group was significantly higher than Low eGFR group over all observation periods (at 1 month; H:21.3 ± 8.9 vs L:15.9 ± 5.6, P=0.023, at 3 months; H:25.9 ± 10.3 vs L:15.4 ± 5.4, P=0.035, at 1 year; H:21.7 ± 8.9 vs L:13.2 ± 5.7, P=0.01). In high eGFR group, eGFR was no change during the observation period and no decrease significantly. In Low eGFR group, eGFR increased significantly at 1 month and 3 months compared to baseline (10.5 ± 2.1 at baseline, 15.9 ± 5.6 at 1month, P=0.007, 15.4 ± 5.4 at 3month, P=0.01), but was comparable to baseline at 1 year.

Conclusion

In this study, introduction of LDL-A may have the effect of maintaining renal function over the long term at 1year regardless of eGFR at diagnosed as CCE.
P0771STOPPING MINERALOCORTICOID RECEPTOR ANTAGONISTS AFTER HYPERKALEMIA AND RISK OF ADVERSE OUTCOMES IN PATIENTS WITH HEART FAILURE
Authors: Trevisan Marco , Xu Yang , Qiao Yao , Savarese Gianluigi , Lund Lars , Grams Morgan , Sjolander Arvid , Carrero Juan Jesus
Published: June 2020

Background and Aims

Stopping mineralocorticoid receptor antagonists (MRAs) after an episode of hyperkalemia is common, particularly among patients with chronic kidney disease (CKD). This may involve therapeutic compromises, in that the cessation of MRAs deprives patients of their beneficial cardiovascular effects. The aim of this study is to determine the risks of adverse health outcomes in heart failure patients after an episode of hyperkalemia, comparing users of MRA who stop treatment to those who continue the drugs.

Method

Observational study from the Stockholm Creatinine Measurements (SCREAM) project. We identified patients with heart failure patients initiating MRAs and surviving a first-detected episode of hyperkalemia (plasma potassium >5.0 mmol/L). We used Cox regression, adjusting for multiple confounders, to estimate hazard ratios (HR) for adverse events following hyperkalemia. The primary outcome was the composite of hospital admission with heart failure, stroke, myocardial infarction or death. The secondary outcome was a new hyperkalemia event. We compared risks between people who stopped MRA treatment and those who continued MRA within 4 months from the hyperkalemia event (landmark analysis at month 4 after event).

Results

We identified 1,330 patients with heart failure that developed hyperkalemia after initiating MRA therapy. Their median age was 80 years, 46% were women and their median eGFR was 43 ml/min/1.73m2. Of those, 595 (45%) had discontinued MRA by 4 months after hyperkalemia. Patients who stopped MRA were more likely to have eGFR <60 ml/min/1.73m2 (81% vs 71%), had a more severe index hyperkalemia (potassium>5.5 mmol/L, 35% vs 21%), and had hyperkalemia occur earlier in the course of MRA therapy (within 3 months from MRA initiation, 66% vs 51%).

During median 1.5 years of follow-up, a total of 846 patients (64%) experienced the primary composite outcome. Compared to patients who discontinued MRA, those who continued had a similar risk of the primary composite outcome (HR 0.95, 95% CI 0.82-1.10). A total of 569 patients (43%) developed a subsequent hyperkalemia event. Compared to patients who discontinued MRA, those who continued with the therapy were at higher risk of another hyperkalemia (HR 1.46, 95% CI 1.21-1.75). Results were consistent across age strata, sex and presence of CKD.

Conclusion

Continuing treatment with MRA after an episode of hyperkalemia was not associated with different medium-term cardiovascular risk compared to those who stopped the drugs.
P0780TRENDS IN EMERGENCY DEPARTMENT USE IN PATIENTS DIAGNOSED WITH HYPERKALAEMIA: AN ANALYSIS OF A U.S. NATIONAL EMERGENCY DEPARTMENT DATABASE
Authors: Rafique Zubaid , Aggarwal Saurabh , Topaloglu Ozlem , Cornea Georgiana , Conrad Ansgar , Peacock Frank
Published: June 2020

Background and Aims

Hyperkalaemia (HK) refers to increased serum potassium concentration, with possible severe effects on health outcomes and resource utilisation. HK is prevalent in patients suffering from heart failure, chronic kidney disease (CKD) and diabetes mellitus and its risk is increased by medications, e.g. inhibitors of the renin-angiotensin-aldosterone system (RAAS). The objective of this study was to examine trends in emergency department (ED) use in patients diagnosed with HK.

Method

The latest available 2016 Nationwide Emergency Department Sample (NEDS) data set from the Healthcare Cost and Utilization Project was analysed to estimate the burden of ED visits in patients with HK. Patients with an ICD-10 diagnosis code E87.5 (Hyperkalaemia) or E87.8 (Other disorders of electrolyte and fluid balance, not elsewhere classified; included due to the incidence of miscoding HK) were included. The rate of comorbidities (diabetes, CKD, heart failure and hypertension) were assessed using previously validated ICD-10 codes.

Results

In 2016, there were an estimated 1,322,071 ED visits with a diagnosis of HK, out of which 6.7% were recorded as the primary diagnosis. The vast majority of these ED visits resulted in same hospital admission (1,075,492 hospital stays). The rate of ED visits and hospital admission were 409.1 and 332.8 per 100,000 persons respectively. The mean (SE) age was 61.8 (0.21) years and 52% were male. Patients had high rate of comorbidities: diabetes 43.1%, hypertension 62.0%, CKD 44.4%, heart failure 23.1%, non-dialysis CKD 12.1% and CKD requiring dialysis 12.1%. In patients with primary diagnosis of HK, the mean (SD) hospital length of stay was 3.3 (4.2) days and total mean (SD) hospital charges were $34,923 ($100,435).

Conclusion

Patients with HK represent an expensive health care burden, as well as suffering with high rates of comorbidities and ED visits. There is an urgent need for new treatment options in the acute setting to improve outcomes for patients with HK.
P0781ESTIMATION OF NEPHRON NUMBER IN CKD PATIENTS
Authors: Kawaguchi Takehiko , Nakazato Takashi , Yahata Kensei , Kitamura Hiroshi , Imasawa Toshiyuki
Published: June 2020

Background and Aims

The nephron number is thought to be associated with clinical outcomes of chronic kidney disease (CKD). If the nephron number can be estimated in a clinical setting, it could become a strong tool to predict the outcomes. This preliminary study estimated nephron number in CKD patients, and examined the relationship between the nephron number and patient characteristics.

Method

Data from a multicenter study of the National Hospital Organization of Japan were analyzed, including 565 CKD patients aged over 14 years who underwent a kidney biopsy. The nephron number was estimated by the glomerular density in biopsy specimens and the renal cortex volume. The renal cortex volume was calculated by the previously established equation using ultrasound measurement of the kidney. Linear regression models were used to investigate the associations of the nephron number separately with age, sex, and estimated glomerular filtration rate (eGFR).

Results

A total of 50% of the patients were women, and the mean (±SD) age of the patients was 51±19 years. The mean eGFR was 63±32 ml/min/1.73m2, and the mean estimated number of non-sclerotic nephrons was 660,000±320,000 per kidney. A larger number of estimated nephron number was associated with younger age, male sex, and higher eGFR.

Conclusion

To the best of our knowledge, this was the first study to estimate the renal cortex volume and nephron number of CKD patients in the general clinical setting. The results from this study should provide powerful tools for nephrologists in routine clinical practice. Further investigations will be needed to verify the associations between the nephron number and clinical outcomes of CKD patients.
P0783PREVALENCE AND PROGNOSIS OF HYPERKALAEMIA IN PEOPLE HOSPITALISED WITH AND WITHOUT AKI
Authors: McLean Andrew , Black Corri , Marks Angharad , Sawhney Simon
Published: June 2020

Background and Aims

Hyperkalemia is a clinical emergency associated with kidney diseases and hospital mortality. It may be apparent on initial hospital presentation, or develop during the course of admission, and can occur in the context of AKI. The prevalence of hyperkalemia across these different presentations and contexts is not well described. No work has previously described whether the prognosis of hyperkalemia varies depending on timing of presentation, or on AKI status defined by KDIGO creatinine change biochemical criteria.

Method

We constructed a cohort of all adult residents in Grampian (North Scotland) admitted to hospital in 2012 (n=28462). We used a validated and replicated KDIGO based definition of AKI to identify AKI using serial serum creatinine values. We determined the presence of hyperkalemia (serum potassium >= 6 mEq/L) both on first blood test on presentation to hospital, and also during the course of hospital admission. We explored the outcome of 30 day mortality within subgroups of AKI status and timing of hyperkalemia. Covariates of interest included age, CKD, medications prescribed in the preceding 90 days and comorbidities (ICD-10 hospital episode codes). The relationship between hyperkalemia and 30 day mortality was determined using multivariable logistic regression.

Results

Of 28462 hospital admissions, 247 (0.9%) presented with hyperkalemia, whereas 560 (2.0%) had hyperkalemia during the course of hospital admission. Hyperkalemia was common in the presence of AKI (4.2% at hospital presentation, 9.3% during hospital admission and rising to 24.5% during AKI stage 3). Hyperkalemia was uncommon in the absence of AKI (0.3% and 0.7% respectively) (OR AKI vs no AKI 13.9, 11.6-16.6). Other factors associated with hyperkalemia were male gender (OR 1.5, 1.3-1.8), age >70 years (OR 2.4, 2.0-2.9), CKD based on eGFR or proteinuria (5.5, 4.6-6.5), diabetes (OR 3.4, 2.8-4.0), heart failure (OR 3.0, 2.4-3.7), RAAS blockers (OR 2.4, 2.0-2.9), trimethoprim containing antibiotics (OR 2.2, 1.7-2.8)), non-RAAS antihypertensives (OR 1.7, 1.4-2.0), but not NSAIDs (OR 0.9, 0.7-1.1). Hyperkalemia mortality (AKI vs no AKI) was 31% vs 29% when presenting at admission, or 34.3% vs 27.8% when occurring during hospital admission. Although absolute risks were similar irrespective of AKI, the excess relative mortality risk associated with hyperkalemia was lower for those with AKI (OR 2.7, 2.1-3.4) than those without AKI (OR 9.5, 6.8-13.2), which may be explained by a higher mortality for those with AKI even without hyperkalemia.

Conclusion

Hyperkalemia is associated with a high mortality even in the absence of AKI and irrespective of the timing of presentation. Management protocols should draw attention to this poor prognosis across all clinical contexts. As hyperkalemia usually occurs within the context of AKI, it should prompt clinicians to consider ongoing close observation for emerging AKI even when AKI is not yet evident on blood tests.
P0787THE IMPORTANCE AND BENEFITS OF THE REGISTRY OF PREDIALYSIS PATIENTS - ROMANIAN EXPERIENCE
Authors: PERIDE Ileana , NICULAE Andrei , CHECHERITA Ionel Alexandru
Published: June 2020

Background and Aims

Registries provide an organized and standardized method to systematically collect observational data about specific groups of patients managed in routine clinical practice for a predetermined objective. Data collected by patient registries may help researchers develop hypotheses about disease mechanisms or treatment approaches and inform health care policy thereby potentially improving quality. It is known that chronic kidney disease (CKD) represents the 6th cause of mortality worldwide and it has an increased prevalence. Therefore, the aim of our Registry is to collect epidemiological and medical data regarding the CKD patients from our country in order to drive improvements in health care quality.

Method

Starting from January 2019, all Romanian nephrologist have been collecting demographic and medical data CKD-related from patients diagnosed with CKD stages 1-5. These data are introduced in a special designed software program – ReNal – that is easy to be accessed. The demographic and medical information include: ID, gender, age, region, body mass index, CKD etiology, comorbidities, chronic treatment, CKD stage, laboratory test, such as serum creatinine, urea, uric acid, calcium, phosphates, iPTH, albuminuria, proteinuria, glomerular filtration rate, hemoglobin etc. (results collected from each medical assessment).

Results

During almost 1-year, over 10000 patients with CKD stages 1-5 were introduced in our Registry, with mean age of 69.2 ± 3.5, 51.22% female patients, 48.78% male patients. From our preliminary results, hypertension and diabetes mellitus represent the main cause of CKD in Romania, according with the international data. In addition, CKD stages 3b and 4 were highly represented. These are part of the preliminary results, future data will be available.

Conclusion

Analyzing the assessed data from our Registry, in future several key points could be achieved: the importance of a correct financial appraisal sustained by health system, adequate and active assessment of CKD patients including the complications, highlighting the disease progression rate depending on the recommended treatment, designing an efficient prevention program.
P0792FAT ATTENUATION INDEX OF CORONARY ARTERY IN COMPUTED TOMOGRAPHY ANGIOGRAPHY PREDICTS LONG-TERM OUTCOME IN CHRONIC KIDNEY DISEASE
Authors: Cho Nam-Jun , Kwon Soon hyo , Nam Bo Da , Choi Kyoungin
Published: June 2020

Background and Aims

Perivascular fat attenuation index (FAI) of coronary artery represents the degree of coronary inflammation. High coronary artery FAI in computed tomography angiography (CTA) is associated with increased all-cause and cardiac mortality in general population. However, the ability of the perivascular FAI using coronary CTA to predict long term outcome in chronic kidney disease (CKD) patients is unknown.

Method

This is a single center retrospective study. We analyzed coronary FAIs on CTA for CKD including patients with end stage renal disease (ESRD). The patients with percutaneous coronary intervention or coronary artery bypass graft were excluded. Mapping and analysis of perivascular FAI were performed around proximal three major coronary arteries. We assessed the prognostic value of FAI of CTA for long-term mortality (data from the Korean National Statistical Office) with Cox regression models, adjusted for age, sex, dialysis vintage, and clinical parameters.

Results

Between January 2012 and June 2018, 268 CKD patients were included. Mean age of this cohort was 64.5 ± 12.0 years, and 132 (49.3%) participants were men. 109 (44.7%) participants has diabetic kidney disease, and 179 (66.4%) participants were on hemodialysis. Median follow-up after coronary CTA was 29.2 (15.1 − 46.3) months. During follow-up, there were 43 (20.6%) deaths. The optimum cut-off value of FAI around the left anterior descending artery (LAD) was ascertained as -65.5 Hounsfield unit. The high perivascular FAI around the LAD was significantly associated with higher adjusted risk of all-cause mortality (hazard ratio, 2.15; 95% CI, 1.07–4.32). In ESRD subgroup, the high perivascular FAI group also has higher adjusted risk of all-cause mortality compared to low perivascular FAI group (hazard ratio, 2.43; 95% CI, 1.16–5.09).

Conclusion

The perivascular FAI around LAD predicts the long-term mortality in patients with CKD. This could provide the chance of early primary intervention in CKD patients.
P0800PROFILING HYPOKALAEMIC AND HYPERKALAEMIC STATES IN THE IRISH HEALTH SYSTEM: TESTING RATES, INCIDENCE AND DETERMINANTS
Authors: Browne Leonard , Austin Stack
Published: June 2020

Background and Aims

Hypo- and hyperkalaemia are potentially life-threatening electrolyte abnormalities often associated with severe adverse clinical outcomes. Real-world incidence and determinants of hypo- and hyperkalaemia in clinical settings are poorly characterised. We studied incidence and determinants of these abnormalities in the Irish healthcare system

Method

Data from the Irish National Kidney Disease Surveillance and Quality Assurance Programme were used to construct a retrospective observational study. We identified all adult individuals (age > 18 years) who accessed health care from 2006 and 2010 in a regional health system (n = 205,334). Cumulative incidence of hypokalaemia (K+ < 3.5 mmol/L), hyperkalaemia (K+> 5 mmol/L), and moderate/severe hyperkalaemia (K+> 5.5 mmol/L) was estimated over a 3-year period. Kidney function was assessed by estimated glomerular filtration rate (eGFR). Multinomial logistic regression explored associations of baseline patient characteristics with dyskalaemia states.

Results

Of 205,334 participants, 85.2% had 1–2 potassium tests, 5.8% had 2–3 tests, 2.7% had 3-4 tests and the remaining 6.4% had > 4 potassium tests/year. Hypokalaemia occurred in 17,145 (8.35%) individuals, of these 43.8% had recurrent hypokalaemia (>1 event). Hyperkalaemia occurred in 44,283 (21.6%) individuals, with 29.7% recurrence. Moderate/severe hyperkalaemia occurred in 9,672 (4.71%) with 18.0% recurrence. The frequency of potassium testing was an important determinant of dyskalaemia risk. In adjusted analyses, advancing age profile, women, inpatients, outpatients and emergency department patients (vs general practice), and frequency of tests had significantly higher risks of hypokalaemia. Additionally, advancing age, men, poorer kidney function, and frequency of potassium testing, and general practice were associated with significantly higher risk of hyperkalaemia.

Conclusion

Both hypo- and hyperkalaemic states are common in the Irish healthcare system with high rates of recurrence. Surveillance strategies should be put in place to allow timely detection and treatment of potassium disturbances in these high-risk groups.
P0806RESIDUAL RENAL FUNCTION IS COMPLEMENTARY TO GERIATRIC ASSESSMENT SCORE IN ASSESSING CLINICAL RISK OF ELDERLY PATIENTS
Authors: Castagna Alberto , Bolignano Davide , Figlia Irma , Cerra Rosa Paola , Ruberto Carmen , Ruotolo Giovanni , Coppolino Giuseppe
Published: June 2020

Background and Aims

Renal function impairment is highly pervasive in the elderly and triggers increased morbidity and mortality. Comprehensive geriatric assessment (CGA) is a validated multidisciplinary instrument to assess medical, psychosocial and functional limitations of old patients with diagnostic and risk-stratification purposes.

In a focused cohort of frail individuals, we aimed at evaluating possible relationships between single CGA items and renal function.

Method

254 consecutive elderly subjects (mean age 79.9±6.6 years, female 65.8%) from the geriatric division of a large Italian community hospital were studied. We collected clinical data including CGA and renal function (CKD-EPI formula). CGA single items included the Cumulative Illness Rating Scale (CIRS), the Exton Smith Scale (ESS), the Mini Nutritional Assessment Short Form (MNA-SF), the Katz‘s Activities of Daily Living (ADL), the Lawton’s Instrumental Activities of Daily Living (IADL), the Short Portable Mental Status Questionnaire (SPMSQ) and the amount of drugs administered (AD).

Results

Mean eGFR was 66.37±30.94 mL/min/1.73 m2. Overall, the reported CIRS, ESS, MNA, ADL and AD scores were low (7.6±3.3) while IADL and SPMQ were on a mild range, denoting a potential alarm signal for poor prognosis and the risk for adverse outcomes.

At univariate analyses, eGFR was significantly associated with CIRS (R=-0.389, p<0.0001), ESS (R=0.355, p<0.0001), MNA (R=0.394, p<0.0001), ADL (R=0.394, p<0.0001), AD (R=-0.374, p<0.0001. while a weak, although significant correlation was found with IADL (R=0.131, p=0.038) and SPMSQ (R=-0.141, p=0.038). In a fully adjusted multivariate analyses only SPMSQ (ß=-0.174, p=0.04), ADL (ß=0.182, p=0.012), IADL (ß =0.209, p=0.003) and AD (ß=-0.354, p<0.0001) remained significant predictors of residual renal function.

Conclusion

In elderly frail subjects, residual renal function may influence daily life and cognitive activities, the perceived quality of living and the entity of drug assumption. Inclusion of renal function within a comprehensive geriatric assessment could help improving risk stratification in the elderly
P0821OBESITY, FAT TISSUE, CELL MEMBRANE INTEGRITY PARAMETERS AND ARTERIAL STIFFNESS IN RENAL TRANSPLANT RECIPIENTS
Authors: Heleniak Zbigniew , Illersperger Sarah , Brakemeier Susanne , Debska-Slizien Alicja , Budde Klemens , Halleck Fabian
Published: June 2020

Background and Aims

Arterial stiffness, altered body composition (increased body fat mass and decreased soft lean mass) and cell membrane integrity (Phase Angle) are acknowledged risk factors for adverse outcomes after kidney transplantation related to cardiovascular diseases. Phase angle is a linear method of measuring the relationship between electric resistance and reactance. Taking the arc tangent value of the ratio of reactance versus electric resistance provides us with the phase angle value. Lower phase angles appear to be consistent with low reactance and equals either cell death or a breakdown in the selective permeability of the cell membrane. The aim of the study was the assessment of the relationship between arterial stiffness and fat tissue parameters, cell membrane integrity marker in renal transplants recipients (RTRs).

Method

344 stable RTRs with the mean age 52.7 years, (62.5% M) transplanted between 1994 and 2018 were randomly enrolled to the study. The following parameters of arterial stiffness were measured: brachial-ankle and carotid-femoral pulse wave velocities (baPWV left and right, cfPWV). The obesity and fat tissue (body mass index (BMI), waist to hip ratio (WHR), body fat mass (BFM), fat free mass (FFM), percent fat of the body (PBF), trunk segmental fat analysis (TSFA) and visceral fat area (VFA)) parameters and cell membrane integrity phase angle (PhA) were assessed with InBody 170.

Results

The median time of dialysis and after kidney transplantation was 58.5 and 78 months respectively. The obesity according to BMI, WHR and VFA was diagnosed in 49.7%, 45% and 44.5% of patients, respectively. The median value of BFM, FFM, VFA, TSFA, PhA and the mean value of PBF were 19.3kg, 55kg, 93.2cm2, 24.9 kg, 4.9 and 27.3%, respectively. We found significant positive correlations between WHR, VFA and baPWV right, baPWV left and cfPWV. PhA correlated with arterial stiffness in univariate (r=-0.34) and multivariate analysis (R=-0.23), negatively (p<0.05).

Conclusion

1. Obesity, visceral fat tissue, cell membrane integrity marker influence on arterial stiffness.

2. The analysis of magnitude of obesity, body fat tissue and cell membrane integrity parameters can be used as an additional cardiovascular risk factor in RTRs.

3. The cell membrane integrity impairment correlated with arterial stiffness.