bluuebunny/crossref_metadata_2025 huggingface dataset:
#3525 TRANSITION BETWEEN NUTRITION CATEGORIES IN HEMODIALYSIS PATIENTS
Authors: Blumberg-Benyamini Sara , Burbea Zvi Hai Barnea , Cernes Relu , Katkov Anna , Biro Alexander , Levi Anat , Katzir Zeev , Feldman Leonid
Published: June 2023

Background and Aims

We have previously characterized four nutritional categories in hemodialysis (HD) patients, evaluated by the method of ICNDS (Integrative Clinical Nutrition Dialysis Score) and slope of three subsequent monthly scores. Category 1 appeared to have the best and category 4 the worst nutritional status [1]. The aim of this study was to explore the association between nutritional category at dialysis initiation, survival, Length of Stay in hospital (LOS), and transition between nutrition categories up to 12 months following dialysis initiation.

Methods

Two hundred twenty-six patients who started dialysis between March 2009 and March 2019 were enrolled in the study. Scoring method of the ICNDS is based on the following 7 parameters: albumin, percentage post dialysis weight change, creatinine, urea, cholesterol, CRP, and Kt/V. We calculated the slope of first three subsequent monthly scores of each patient at HD commencement and 12 months later. Cox proportional hazard model was used to present differences in mortality hazard ratio (HR) during the first year in dialysis between four categories of patients. We used the analysis of variance and post hoc Bonferroni test to analyze differences in hospitalization frequency and LOS between the four categories during first year in dialysis. We used the Pearson chi-square test to analyze transition between categories between dialysis initiation and one year after.

Results

Baseline nutritional category is associated to all-cause mortality HR (χ2 = 16.402, df = 3, P = 0.051). Patients enrolled to category 2,3 and 4 at dialysis initiation were significantly associated with increased mortality HR compared to patients in category 1 (category 4: HR = 3.951, 95% CI 1.218-12.812, P = 0.022; category 3: HR = 2.705, 95% CI 1.126-6.497, P = 0.026; category 2: HR = 1.778, 95% CI 0.631-5.064, P = 0.027). LOS during first year in dialysis is significantly affected by patient nutritional category at dialysis initiation, (F = 4.671, df = 3, P = 0.003). LOS is lower in patients of category 1 and 2 compared with category 3 and 4 (between categories 1 and 4, P = 0.006; between categories 1 and 3, P = 0.03). Hospitalization frequency is not affected by patient nutritional category (F = 1.705, df = 3, P = 0.167). Pearson chi-square showed no differences in transition between the four categories between dialysis initiation and one year after (χ2 = 6.763, df = 3, P = 0.149).

Conclusion

Nutrition status at dialysis commencement is a main prognostic factor, transition between nutrition categories during first year in dialysis exists and may prove in future to be associated with patients’ survival.
#3538 SURVIVAL OUTCOMES FOLLOWING CARDIOPULMONARY RESUSCITATION IN ADULTS RECEIVING KIDNEY REPLACEMENT THERAPY: A SYSTEMATIC REVIEW AND NARRATIVE SYNTHESIS
Authors: Tuharska Zofia , Brown Alastair , Hole Barnaby , Caskey Fergus , Pippias Maria
Published: June 2023

Background and Aims

Individuals receiving kidney replacement therapy (KRT) are at higher risk of cardiac arrest than the general population. The aim of this systematic review was to evaluate survival outcomes in individuals on different forms of KRT (haemodialysis, peritoneal dialysis or kidney transplantation) following cardiopulmonary resuscitation (CPR) within healthcare settings (hospital or outpatient clinics).

Method

A comprehensive literature search of EMBASE, MEDLINE, CINAHL, Web of Science and Central was carried using a pre-defined search strategy with no date or language restrictions. Retrospective and prospective observational studies reporting outcomes following CPR in adults on kidney replacement therapy were included. The study protocol was prospectively registered on PROSPERO: CRD42022336363.

Results

Thirteen eligible studies were identified. Due to the heterogeneity of study populations, lack of a standardised outcome set and inconsistent use of control groups, a narrative review was conducted, and a meta-analysis was not performed. Crude unadjusted survival rate to discharge from hospital was reported in 11 studies and ranged from 0%—75%. Only two studies reported neurological outcome at discharge, with rates of a favourable cerebral performance category score (CPC 1 or 2) on discharge between 17–20%.

Conclusion

The current evidence is insufficient to guide clinical decision-making regarding resuscitation due to a lack of up-to-date data, uncertainty about outcomes and inconsistent reporting of neurological status after CPR. Additionally, there is a lack of data comparing survival outcomes for people on different types of KRT. There remain unanswered questions regarding the likelihood of favourable outcomes for the KRT population and whether these can be accurately predicted using clinical and demographic features.
#3546 “SURPRISE QUESTION”: IS IT A USEFUL TOOL IN CKD STAGES 4 TO 5?
Authors: Pepe Bruno , Prazeres Teresa , Carnevale Andreia , Calça Rita , Matias Patricia , Branco Patricia , Azeredo-Lopes Sofia , Pereira Sofia Azeredo , Martins Ana Rita
Published: June 2023

Background and Aims

The “Surprise Question” (SQ) (“would you be surprised if this patient died in 6 months/one year?”) has proven to be an interesting prognostication tool in a range of settings. However, its reliability in non-dialysis-dependent CKD is still unclear. Our aim was to study the applicability of the SQ to an outpatient CKD-EPI stages 4 to 5 and correlate it with mortality.

Method

Observational, prospective and single center study. Baseline comorbid conditions, cause of CKD, degree of autonomy, literacy, social support and baseline laboratory values (i.e., serum creatinine/ estimated glomerular filtration rate, serum albumin and hemoglobin) were collected.

Results

A total of 269 patients completed the study, mean age 65 years old; 256 patients (85.3%) had hypertension and 124 (41.3%) had diabetes. The main causes of renal disease were diabetic kidney disease (n = 53; 17.7%), hypertension (n = 15; 5%) and IgA nephropathy (n = 11; 3.7%). The etiology of kidney disease was undetermined for 24 patients (8.0%). Average CKD-EPI was15.5±7.4 mL/min/1.73 m2. A total of 188 patients (63%) were independent for daily living activities and 68 (23%) were professionally active and 45 (48%) were accompanied by family members or caregivers in outpatient consultation to discuss and define the care of plan regarding end stage renal disease. Mean follow up time of the study was 365±254 days, and 27 (9%) patients died during this time period. Using the SQ, providers responded Yes and No for 162 (54%) and 92 (31%) patients, respectively. There were no differences in CKD-EPI stage, arterial hypertension, cerebrovascular disease and dyslipidemia. The No group was older (73±16 vs. 63±16, p<0.001) and had more diabetes (n = 46, 55%, p = 0.015). About 8 (30%) and 18 (67%) of Yes and No patients died, respectively (P<0.001). In the Cox-proportional hazard model adjusted to diabetes, the risk of all-cause mortality was significantly increased by around 5.700 times in patients with a No answer by the providers to the SQ (95%CI, 2.340-13.900; p<0.001) and around 1.045 times with increasing age (95%IC, 1.012-1.080; p = 0.007). The model of the SQ to have predictive capacity for occurrence of death had an area under the ROC curve of 0.684 (95%CI, 0.580-0.790; p = 0.002).

Conclusion

SQ proved to be a support tool in order to identify patients at high risk of death, who might not have a full benefit of starting dialysis. The choice around kidney replacement therapy is a shared decision-making process, in which competing risks and benefits must be considered. It is essential and urgent to identify means of support for patients, caregivers and health providers to provide and discuss personalized prognostic information.
#3553 TUBULE CELL-DERIVED ANGIOPOIETIN-2 EXACERBATES INFLAMMATION AND IS DETRIMENTAL TO RENAL FIBROSIS
Authors: Luo AN Jie , Chang Fan-Chi , Lin Shuei-Liong
Published: June 2023

Background and Aims

Our previous studies have shown that angiogenic growth factors are dysregulated in fibrotic kidneys. In murine models of progressive renal disease, angiopoietin-2 (Angpt2) was upregulated in injured tubule epithelial cells. We hypothesize that overexpression of Angpt2 in tubule epithelial cells would exacerbate renal fibrosis and inflammation.

Method

The unilateral ureteral obstruction (UUO) and unilateral ischemia-reperfusion injury (UIRI) are used as the murine model of chronic kidney disease. We use the tetracycline/doxycycline-controlled Tet-on system to induce tubule cell-specific overexpression of Angpt2 before the induction of renal fibrosis. Transgenic mice carrying both Pax8-rtTA and pTetos-hAngpt2 genes (double transgenic mice) are used for Angpt2 overexpression. Littermates that inherit single or no transgene serve as experimental controls. Doxycycline is administered to adult (8 weeks) mice to overexpress Angpt2 in tubule epithelial cells.

Results

Doxycycline administration induce overexpression of human Anpgt2 in the tubule epithelial cells of both sham and fibrotic kidneys. Compared to littermate controls after the UUO and UIRI surgery, the expression of fibrosis-related genes, Col1a1, Col3a1, and Acta2 are higher in the kidneys of double transgenic mice. Deposition of picrosirius red-stained collagen fibrils is significantly higher in double transgenic mice. Inflammatory cell infiltration is also significantly higher in double transgenic mice.

Conclusion

Overall, these findings suggest that increased Angpt2 in tubule epithelial cells deteriorate renal fibrosis through detrimental inflammation. Further studies are necessary to explore the participating cellular components and pathogenic mechanisms.
#3556 ASSOCIATION OF SERUM 25-HYDROXYVITAMIN D WITH ALL-CAUSE MORTALITY AND KIDNEY OUTCOME IN PATIENTS WITH EARLY STAGES OF CKD
Authors: Yuxin Lin , Zhang Yuping , Nie Sheng , Xin Xu
Published: June 2023

Background and Aims

Although serum 25-hydroxyvitamin D (25(OH)D) deficiency is prevalent in all stages of chronic kidney disease (CKD), the effects of 25(OH)D deficiency on all-cause mortality and kidney outcomes in patients with early-stage CKD remain incompletely understood.

Method

This nationwide retrospective cohort study included 9840 adults with stages 1–3 CKD from 19 medical centers across China. The study outcomes included all-cause mortality, cardiovascular mortality, and kidney disease progression. The associations between serum 25(OH)D concentrations and the risks of mortality and CKD progression were evaluated using a Cox proportional hazard model. A mixed-effects model was used to estimate the slopes of estimated glomerular filtration rate (eGFR).

Results

Of 9840 adults with stages 1–3 CKD, 26.9% had severe (<10 ng/ml) and 38.7% had moderate (10–20 ng/ml) serum 25(OH)D deficiency. Compared with patients having 25(OH)D >20 ng/ml, patients with serum 25(OH)D <10 ng/ml were at significantly higher risks of all-cause mortality (hazard ratio [HR] 1.87, 95% confidence interval [CI] 1.53–2.28), cardiovascular mortality (HR 1.80, 95% CI 1.33–2.44), and CKD progression (HR 2.28, 95% CI 1.74–2.99), and had a steeper decline in eGFR slope (estimate -0.07; 95% CI -0.10 to -0.05 mL/min/1.73 m2 per year). Similar results were obtained in subgroups and by sensitivity analyses.

Conclusion

25(OH)D deficiency is associated with increased risks of all-cause mortality and CKD progression in patients with early-stage CKD. Studies are needed to determine whether early intervention for 25(OH)D deficiency could improve the prognosis of patients with early-stage CKD.
#3568 THE ERROR OF ESTIMATED GFR IN PREDIALYSIS CARE: IMPACT ON CLINICAL DECISION MAKING
Authors: Cabrera Beatriz Escamilla , Lima Sergio Luis , Valcarce Eduardo Gallego , Rinne Federico González , Dorta Nuria Victoria Sánchez , Negrã­n Mena Natalia , Perera Coriolano Cruz , Martin Laura Díaz , Ramírez Armando Torres , Porrini Esteban
Published: June 2023

Background and Aims

The error of estimated glomerular filtration rate (eGFR) and its consequences in predialysis are unknown.

Method

We analysed 315 predialysis patients who underwent measured GFR (mGFR) by the clearance of iohexol and eGFR by 52 formulas. We evaluated the agreement between eGFR and mGFR by the concordance correlation coefficient (CCC), total deviation index (TDI) and coverage probability (CP). In a sub-analysis we investigated the impact of the error of eGFR in decisions like (i) starting dialysis, (ii) preparation for renal replacement therapy (RRT) and (iii) continuing with clinical follow-up. For this sub-analysis patients who started dialysis due to uremia or fluid overload were excluded (n = 18).

Results

Patients: 315 patients were included, 70% male and mean age was 66±13 years. 38% had diabetic nephropathy. Mean mGFRwas 22 ± 8 ml/min. Mean eGFR was 22 ± 8 ml/min (CKD-EPI), 22 ± 8 ml/min (MDRD) or 26 ±10 ml/min (24-h creatinine clearance). Cystatin C measurement was available in 266 patients (84%) and averaged 2.8 ± 1.08 mg/L. Over 70% of the patients had proteinuria 1588±2204 mg/24 h. Agreement between eGFR and mGFR eGFR had very low precision and accuracy in reflecting mGFR as reflected by average CCC, TDI and cp of 0.60, 70% and 22%, respectively. The error was comparable between creatinine- and cystatin-based formulas. Extreme variations -larger than 10 ml/min- between mGFR and eGFR were frequent. Differences in clinical decision making: Concerning clinical decisions, the error of formulas (mainly GFR overestimation) would have suggested (a) early unnecessary preparation for RTT in 14% of clinically stable patients evaluated by mGFR; (b) to continue with clinical follow-up in 59% of the subjects in whom RTT was indicated by low mGF and (c) to delay the starting of dialysis in all patients (n = 6) in whom RRT was indicated based on very low mGFR without uremic symptoms or fluid overload.

Conclusion

The error of formulas in predialysis care was frequent and large and may have consequences in clinical care.
#3600 ACUTE KIDNEY INJURY IN THE ELDERLY: DIFFERENCES OVER TIME
Authors: Pešić Snezana , Čučković Čedomir , Stopić Bojan , Dimkovic Nada , Naumovic Radomir
Published: June 2023

Background and Aims

The incidence of acute kidney injury (AKI) in people older than 60 years constantly increasing and it is higher than in the rest of the population. Increased risk of AKI in the elderly is due to decreased functional reserves of the kidneys, aggressive surgical and diagnostic interventions, and frequent use of nephrotoxic drugs. The aim of this study was to analyze the incidence and causes of AKI in a patient older than 60 years during three different periods: the first period between 1974-1994 year, the second between 1997-2001 year, and the third period between 2014-2018 year. At the same time, we examined the most common causes of AKI over time.

Method

The retrospective study included 927 patients with AKI treated in our clinic, 572 patients during the first period, 75 patients during the second period, and 280 patients in the third period. The diagnosis was made based on an absolute increase in serum creatinine by>26.5 umol/l, or an increase of 50% relative to basal values, or a decrease in urine output <0.5 ml/kg/h within 6 h. We analyzed causes and type of AKI, method of treatment, and mortality.

Results

Incidence of AKI in patients older than 60 years in the period 1974-1994 is 19%, only three years later this percentage has risen to 64%, while in the last period this percentage was 82%. Conservative method of treatment was more often used in the last examined period 83.6% compared to 33% and 56.2% in previous periods. In the last examined period, HD was used in 16.4% of patients (in two previous periods 4% and 8.3% respectively).

While PD was used by 50.5% in the period 1997-2001 and 31.3% in the period 1974-1994, in the last period PD was not used. Mortality has declined slightly over time but remains high (27.1%, then 29.6%, and recently 22%). Regarding the type of AKI during all three examined periods, statistically the most common is the prerenal type over 50%, and the renal type during the last five-year period increased by 26.4% compared to the previous 17.5% and 20.8% respectively.

Conclusion

The incidence of AKI in people over the age of 60 is on the rise. Mortality, although still high, is noticeably declining compared to the previous periods, which may be a consequence of better treatment of both conservative and active dialysis treatment.
#3617 APPLICATION OF CKD EPI 2021 EQUATION FOR ESTIMATION OF GLOMERULAR FILTRATION RATE (EGFR) TO AN ELDERLY KOREAN COHORT TO PREDICT MORTALITY
Authors: You Julee , Chin Ho Jun
Published: June 2023

Background and Aims

A new eGFR equation using serum creatinine (CKD-EPI 2021) without race were developed by Chronic Kidney Disease Epidemiology Collaboration in 2021. We projected the changes of eGFR and CKD prevalence in a prospective cohort of elderly Koreans, using current (MDRD equation and CKD-EPI 2009) and new equation (CKD-EPI 2021)

Method

This study was a part of the Korean Longitudinal Study on Health and Aging, which included a randomly selected, community-based, elderly population aged 65 years or more in a city of Korea, Seong-nam. The base line study was conducted from Sep. 2005 to Sep. 2006; the follow-up study, from May 2010 to March 2012, and the final survey about mortality and renal function, at Jan. 2023. Among 1,000 subjects originally included in the study, 984 subjects with baseline serum creatinine were included in this analysis. We compared the difference of eGFR and predictability of mortality and renal survival between values calculated by MDRD, CKD-EPI 2009, and CKD-EPI 2021. Serum creatinine was expressed as the IDMS-traceable creatinine.

Results

At baseline study, there were 436 males (44.3%). Age was 76.0 ± 9.1 years. Levels of eGFR at baseline study were 74.2 ± 21.4 ml/min/1.73 m2 by MDRD, 72.2 ± 16.9 ml/min/1.73 m2 by CKD-EPI2009, and 76.6 ± 17.3 ml/min/1.73 m2 by CKD-EPI2021. Values subtracted eGFRs by MDRD or CKD-EPI2009 from eGFR by CKD-EPEI2021 were 2.5 ± 10.1 ml/min/1.73 m2 and 4.5 ± 1.0 ml/min/1.73 m2, respectively. Between eGFRs by CKD-EPI2009 and CKD-EPI2021, the difference of eGFR was higher in females compared to males (p<0.001), was not different between subjects aged less than 75 years and more than 75 years (p = 0.139), and lowest in subject with <45 ml/min/1.73 m2 of eGFR by CKD-EPI2009 compared to subjects with other eGFR values (p<0.001). CKD stage was improved in 241 (24.5%) participants and was not changed in 743 (75.5%) using eGFR calculated by CKD-EPI2021 instead of CKD-EPI2009. Similar trend of eGFR difference between eGFRs calculated by MDRD and CKD-EPI2021. During 8.3 ± 6.2 years, 255 (25.9%) subjects were dead and 7 (0.7%) subjects had end stage renal disease (ESRD) before death. Any eGFR was an independent risk factors to mortality estimated by Cox's hazard proportional model adjusted by related factors. AUC to estimate survival by eGFRs was not different between eGFRs by CKD-EPI2021 and CKD-EPI2009 [0.662 (0.625-0.699) vs 0.658(0.620-0.695), p = 0.758], however, different between eGFRs by CKD-EPI2021 and MDRD [0.662 (0.625-0.699) vs 0584 (0.543-0.626), p<0.001]. AUC to estimate renal survival by eGFRs was not different between eGFRs by CKD-EPI2021 and CKD-EPI2009, also.

Conclusion

The eGFR calculated by CKD-EPI2021 showed higher value compared to eGFR calculated by CKD-EPI2009 or MDRD. The power to estimate mortality or renal survival was not different between eGFRs by CKD-EPI2021 and CKD-EPI2009.
#3636 INHIBITION OF THE STING PATHWAY AMELIORATES EXPERIMENTAL CRESCENTIC GLOMERULONEPHRITIS
Authors: David Gina Marcela Córdoba , García-Giménez Jorge , Ortíz Pablo Javier Cannata , Ortiz Alberto , Cortassa Adrián Mario Ramos
Published: June 2023

Background and Aims

Rapidly progressive glomerulonephritis/crescentic glomerulonephritis (RPGN/cGN) may compromise renal function in the short or medium term thus evolving into acute kidney injury (AKI) or chronic kidney disease. Innate and adaptive immune responses are placed at the epicentre of cGN. However, molecular pathways involved in the activation of these responses are by far less known. Sting is an innate immune DNA-sensing involved in promoting kidney injury and fibrosis with unknown participation in RPGN/cGN.

Method

We investigated whether Sting pathway activation contributes to the development and progression of RPGN/cGN in a preclinical model of nephrotoxic nephritis (NTN) induced by an anti-glomerular basal membrane serum. Sting expression as well as humoral and cellular innate immune responses, histological injury and functional responses in the kidney were studied in wild-type and Sting-/- mice.

Results

Sting was found expressed at higher gene and protein levels and located in tubulointerstitial and intraglomerular and periglomerular areas and tubules in kidneys from NTN wild-type mice compared to non-diseased control animals. Sting deficiency significantly decreased NTN-induced cytokine/chemokine synthesis and hence the intrarenal transit of both mononuclear phagocytes and overall or specific T-cell subsets. Sting-deficient mice also displayed less extensive histological affection, namely a fewer number of glomerular crescents and associated lesions (sclerosis, endocapillary hypercellularity/sinaquiae), and tubular injury. The presence of TUNEL-positive dead cells was also significantly reduced in Sting-/- mice. Consistent with these findings, Sting absence significantly diminished NTN-increased urea and creatinine plasma levels.

Conclusion

Sting inhibition positively impacted several well-characterized cGN-associated pathogenic events thus ameliorating the outcomes of the disease. These results identified Sting antagonism as a potential therapy to help combat cGN.
#3640 IMMUNORELATED RENAL ADVERSE EFFECTS IN PATIENTS TREATED WITH CHECKPOINT INHIBITORS
Authors: Nanwani Avinash Chandu , García Jonay Manuel , Suárez Germán Pérez , Puga Ana Ramírez , Nuez Selene González , García Fátima Batista , Granados Saulo Jesús Fernández , Martín Noemí Esparza , Garcia-Canton Cesar
Published: June 2023

Background and Aims

Checkpoint Inhibitors (CPI) use has revolutionized cancer treatment. However, Immuno-Related Adverse Effects (IRAE) occur in more than 50% of patients. At renal level, the initial incidence of IRAE was considered low and later studies suggest between 1.4–4.9%. The aim of the study was to describe a case series with kidney dysfunction related to CPI treatment and report renal and patients’ outcomes after initiation of treatment.

Methods

We retrospectively studied 28 patients (72.4% male, median age 71.1 years, IR: 40.1–87.3), with metastasic neoplasms (22 advanced lung cancer, 4 melanomas, 1 renal and 1 colon) treated with CPI (Pembrolizumab 75%, 21.4% Nivolumab and 3.6% with Pembrolizumab + Ipilimumab combination) who developed AKI after CPI use, at the Complejo Hospitalario Materno Insular from January 2016 to March 2022. Demographic clinical and analytical data were collected, as well as, the evolution of kidney function.

Results

Immuno-related AKI occurred after a median of 3.7 months (IR: 0.23–24.0). The median plasma creatinine prior to receiving treatment with CPI was 0.9 mg/dl [IQR: 0.67-1.65]. After initiation of steroids (1mg/kg/day), 85.7% showed recovery of kidney function. Seventeen patients (60.7%) presented complete remission, 8 (28.6%) partial remission, while 3 patients (10.7%) did not recover from kidney function. In patients who did not respond initially to steroid therapy, a renal biopsy was performed (n = 7; 25.9%) showing tubulointerstitial nephritis (TIN) in 5 patients, 1 granulomatous nephritis with poor kidney function evolution, and 1 endocapillary glomerulonephritis together with TIN. More than half of the patients who developed immuno-related ARF presented toxicity in other organs (n = 13; 56.5%); being thyroiditis the most frequent (n = 3; 10.7%).

 At the end, two patients (7,1%) presented complete remission of neoplasms, 6 (21.4%) partial remission, stability was observed in 8 patients (28,6%), the neoplasm progress in 4 (14,3%) and 8 (28,6%) patients died during the follow-up. Finally, the patient median survival was 36,7 months ((IR 5,7- 79,6) post CPI treatment.

Conclusion

Immuno-related AKI after use of CPI is low; over two-thirds of patients recovered from total or partial renal function after initiation of steroids. The presence of granulomas in renal biopsy may confer poor prognosis.
#3641 DOES IBANDRONATE OR CALCIUM AND VITAMIN D MAINTAIN OR IMPROVE BONE MICROARCHITECTURE IN THE FIRST YEAR AFTER KIDNEY TRANSPLANTATION?
Authors: Strommen Ruth , Smerud Knut , Meland Nils , Godang Kristin , Pihlstrøm Hege Kampen , Åsberg Anders , Reisater Anna Varberg , Bollerslev Jens
Published: June 2023

Background and Aims

Modern immunosuppressive protocols are associated with less loss of bone mass immediately after kidney transplantation, as compared with previous eras. Even so, bone microarchitecture may still be disturbed due to long-standing uremia, leading to bone fragility and fracture susceptibility. Trabecular bone score (TBS) is a new tool to assess trabecular bone microarchitecture based on standard dual energy X-ray absorptiometry (DXA) of lumbar spine images. TBS reflects bone quality rather than quantity. Studies on the effect of common anti-fracture strategies on TBS in kidney transplant recipients (KTR) are scarce. Our aim was to investigate different treatments on bone microarchitecture by TBS in KTR.

Method

We analyzed TBS changes and potential treatment effects in 179 de novo KTR, 118 of whom had participated in a randomized controlled trial[1] evaluating the effect of ibandronate (active/placebo) on top of calcium and vitamin D in the first year after kidney transplantation. Trial participants were compared to 61 patients transplanted in the same time-period, meeting the same study inclusion criteria, but receiving no specific bone-directed treatment. Correlations between changes in TBS and lumbar spine BMD were investigated. We used ANOVA and ANCOVA with adjustment for baseline TBS values to evaluate the potential effects of calcium and vitamin D with/without concomitant ibandronate on TBS 12 months after transplantation, as compared to no treatment.

Results

Mean TBS increased in all groups from baseline to 12 months after transplantation (2.1% for ibandronate/calcium/vitamin D, 2.7% for calcium/vitamin D, and 3.4% for no treatment). Adjusting for baseline TBS, there were no significant differences in TBS at 12 months, neither with overall comparison (p = 0.377) nor when comparing the groups pairwise. The correlation between TBS and BMD was weak (r = 0.170, p = 0.02) at baseline, and change in TBS was not significantly correlated with change in lumbar spine BMD in any of the groups.

Conclusion

In a group of de novo KTR with reasonably well-preserved bone mass, it does not appear that one year of treatment with ibandronate or calcium and vitamin D significantly affects bone quality as measured by TBS. We found surprisingly weak correlation between changes in TBS and BMD over the study period, indicating that these measurements reflect different aspects of bone integrity and metabolism. This study strengthens the view that focus should be on identifying KTR at high risk of fracture at time of transplantation, as these patients could benefit from anti-resorptive therapy.
#3651 COMPARISON OF WHOLE-BODY VERSUS THORACIC BIOIMPEDANCE IN RELATION TO ULTRAFILTRATION VOLUME AND SYSTOLIC BLOOD PRESSURE DURING HEMODIALYSIS
Authors: Schoutteten Melanie , Lindeboom Lucas , Brys Astrid , Lanssens Dorien , Smeets Christophe , De Cannière Hélène , De Moor Bart , Peeters Jacques , Heylen Line , Van Hoof Chris , Groenendaal Willemijn , Kooman Jeroen , Vandervoort Pieter
Published: June 2023

Background and Aims

In contrast to portable whole-body bioimpedance, which estimates fluid status at a single point in time, thoracic bioimpedance applied by a wearable device could enable continuous measurements. However, clinical experience with thoracic bioimpedance in patients in dialysis is still limited. The aim of this study is to test the reproducibility of whole-body and thoracic bioimpedance measurements and to compare their association with hemodynamic changes during hemodialysis.

Method

In total, 54 patients were included in this cross-sectional observational study. Whole-body resistance at 5kHz, thoracic resistance at 8kHz, systolic blood pressure and ultrafiltration volume were measured. All measurements were taken at pre- and end-dialysis during two consecutive sessions. Data were approached by mixed-modelling and Spearman correlation analysis.

Results

Intraclass correlation of pre- to end-dialysis changes in whole-body and thoracic resistance between the first and second session was .71 [.58 – .8] and .72 [.6 – .81] respectively (Fig. 1). The correlation between ultrafiltration volume and relative whole-body and thoracic resistance was respectively .94 [.91 ─ .96], p < .001 and .76 [.66 ─ .83], p < .001 in the first session and .95 [.93 ─ .97], p < .001 and .75 [.65 ─ .82], p < .001 in the second session (Table 1). Changes in systolic blood pressure negatively correlated to both bioimpedance techniques (whole-body resistance in the first session: -.37 [-.19 ─ -.53], p < .001; in the second session: -.37 [-.19 ─ -.53], p < .001; thoracic resistance in the first session -.45 [-.28 ─ -.59], p < .001; in the second session -.39 [-.22 ─ -.54], p < .001) (Table 1).

Conclusion

Bioimpedance signals from both devices were moderately reproducible between two dialysis sessions. Whereas the relation between changes in ultrafiltration volume and resistance was stronger for whole-body bioimpedance, the relation between changes in systolic blood pressure and resistance was at least comparable for thoracic measurements. Thoracic bioimpedance measurements by a wearable device may serve as an interesting alternative to whole-body measurements for continuous hemodynamic monitoring during hemodialysis.
#3658 PERITONEAL INFLAMMATION INDUCES SYSTEMIC ERYPTOSIS IN PERITONEAL DIALYSIS-ASSOCIATED PERITONITIS
Authors: Virzi Grazia Maria , Manani Sabrina Milan , Marturano Davide , Mattiotti Maria , Tantillo Ilaria , Ronco Claudio , Zanella Monica
Published: June 2023

Background and Aims

Eryptosis is stress-induced RBC (Red Blood Cell) death mechanism. Our preliminary data show that there is a significative increased of eryptosis during peritoneal dialysis-associated peritonitis. Furthremore, there is an elevation of local and systemic inflammatory mediators. The aim of this study was to evaluate the relationship between systemic eryptosis levels in peritonitis and specific peritonitis biomarkers in peritonitis effluent (PDE), such as Peritoneal White Blood cell count (pWBC), peritoneal NGAL (pNGAL) and peritoneal cytokines levels.

Method

We enrolled 22 PD patients with peritonitis and 17 healthy subjects. PD-related peritonitis was defined according to the Guidelines of the International Society of Peritoneal Dialysis. At the time of diagnosis, blood samples were collected for eryptosis and peritoneal effluent were taken to evaluate pWBC, pNGAL and cytokines. All eryptotic measurements were made in freshly isolated RBCs. PS avidly binds AnnexinV, which is thus employed to identify eryptotic cells. Thus, PS exposure at RBC surface was estimated from FITC-AnnexinV binding using flow cytometric analyses.

Results

13/22 patients were treated with continuous ambulatory PD (CAPD) and 9 with automated PD (APD). The median length of PD treatment was 28.1 months and the range was: minimum: 3 – maximum: 124.9 months. The percentage of AnnexinV-binding RBCs was significantly higher in PD patients with peritonitis than in CTR (PD patients with peritonitis: 7.7; IQR 4.3-14.2, versus CTR: 0.8; IQR 0.7-1.3; p<0.001) (Figure 1). WBC, NGAL and cytokines levels in PDE are reported in Table 2. We observed important correlation between eriptosis levels and peritoneal biomarkers (Figure 2).

Conclusion

In conclusion, we investigated a potential connection between systemic eryptosis and peritoneal biomarkers involved in peritonitis. The presented results revealed that upregulated inflammatory markers could be the cause of high levels of systemic eryptosis during PD-related peritonitis.
#3662 FREQUENCY OF INR TESTING IN HEMODIALYSIS PATIENTS ON VITAMIN K ANTAGONISTS: A RETROSPECTIVE STUDY
Authors: Aoun Mabel , Baleynaud Juliette , Champtiaux-Dechamps Beatrice , Gritti Marion , Mouellic Lionel Le , Duneau Gabrielle
Published: June 2023

Background and Aims

Despite the rising of direct oral anticoagulant agents’ use in the general population, vitamin K antagonists (VKA) are still used in hemodialysis (HD) French patients with atrial fibrillation. These HD patients on VKA have also poor levels of time in therapeutic range. It is recommended generally to follow patients with monthly INR, however there is lack of such evidence in HD. This study aims to analyze the frequency of INR testing needed in HD patients.

Method

This is a retrospective study of all patients treated with VKA in three French dialysis units between 1st January and 31st December 2022. Patients are followed with weekly INR. Variables collected included over twelve months the number of INR tests, their percentage within target, above target and below target, and number of VKA dose adjustment. Bleedings, transfusions, thrombotic events and antibiotic use were recorded. Linear regression analysis evaluated factors associated with number of VKA dose adjustment per year. This study was conducted in concordance with the Declaration of Helsinki 1975.

Results

Out of 160 HD patients, 45 (28.1%) were on VKA for paroxysmal or chronic atrial fibrillation. Their characteristics are summarized in Table 1. A total of 2609 INR tests were performed over a year with a mean of 57.9±18.6 per patient. The median number of VKA dose adjustment per year was 11 (8, 13). A significant correlation was found between the number of antibiotics and number of VKA dose adjustment (Spearman Rho = 0.360, p = 0.015). In univariate regression analysis, factors associated with higher numbers of dose adjustment were diabetes, sevelamer and blood flow (Table 2). Bleeding was not significantly different between those with high versus low VKA dose adjustment.

Conclusion

In this study, 22% of tests led to VKA dose adjustment. Patients with diabetes, on sevelamer, treated with antibiotics and with lower serum albumin needed frequent INR testing more than once monthly. These results could be helpful in contexts with limited resources.
#3667 REVEAL-CKD: PREVALENCE OF UNDIAGNOSED STAGE 3 CHRONIC KIDNEY DISEASE IN AUSTRALIA, BRAZIL, CANADA AND SPAIN
Authors: Pecoits-Filho Roberto , de Castro Maria Cristina Ribeiro , Cebrian Ana , Santamaria Rafael , Lim Kean-Seng , Wittbrodt Eric , Barone Salvatore , Arnold Matthew , Tangri Navdeep
Published: June 2023

Background and Aims

Chronic kidney disease (CKD) is a progressive condition that affects >850 million people globally. Global clinical guidelines from K-DIGO recommend early CKD identification and management to mitigate disease progression. The REVEAL-CKD study aims to assess the prevalence of, and factors associated with, undiagnosed stage 3 CKD across 11 countries. Here we report data from 4 countries in 4 continents.

Method

REVEAL-CKD is a multi-national, observational study, using secondary data from electronic medical records (EMR) and claims data. For this analysis, data were extracted from Australian General Practices through Pen CS (Australia), University of Sao Paulo (Brazil), the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) (Canada), and BIGPAC (Spain). The study cohort included patients aged ≥18 years with two consecutive estimated glomerular filtration rate (eGFR) values ≥30 and <60 mL/min/1.73 m2 recorded 91-730 days apart. The date of the second qualifying eGFR was the index date. Patients with no CKD diagnosis code before and up to 6 months after their index date were considered undiagnosed. The prevalence of undiagnosed CKD was calculated as the ratio of undiagnosed patients to all patients meeting the study inclusion criteria.

Results

The prevalence and baseline characteristics of undiagnosed Stage 3 CKD appear in Table 1. In all 4 countries, the undiagnosed prevalence was >80% and predominantly was more commonly observed in female patients, in patients aged > 65y, and remained high in patients with baseline comorbidities, particularly for those at highest risk of CKD (DM, CVD, HTN). Underreporting of CKD diagnosis in Brazil may be due to the inability to code for >1 condition in a patient.

Conclusion

These results indicate that a large proportion of patients across four world regions and who have biochemical evidence of early CKD lack a recorded diagnosis. An opportunity exists to identify, diagnose, and implement guideline-directed management for early CKD in order to delay its complications and improve clinical outcomes.
#3685 PERICYTE AND CXCL12 PLAY CRUCIAL ROLE IN THE RECOVERY OF ACUTE KIDNEY INJURY
Authors: Shao Yu-Han , Chou Yu-Hsiang , Chen Yung-Ming , Lin Shuei-Liong
Published: June 2023

Background and Aims

Pericytes are mesenchyme-derived perivascular cells attached to the abluminal surface of capillaries as well as the major origin of myofibroblasts in the animal model of unilateral ureteral obstruction (UUO) and ischemia-reperfusion injury (IRI). Although previous studies reported that myofibroblasts may be beneficial during acute kidney injury (AKI) via growth factor secretion, reconstitution and stabilization of the collagen framework for tubular cell regeneration, lack of solid evidence and definite mechanism make the role of pericyte/myofibroblast in AKI remain controversial.

Method

To clarify this, we used platelet-derived growth factor receptor β (PDGFRβ)-specific antibody following AKI in C57BL/6 mice to inhibit pericytes. In the meantime, We used Gli1-CreERT2;Cxcl12fl/fl genetically modified mice to conditionally knockout CXCL12 specifically in pericytes before IRI.

Results

The expression of PDGFRβ on pericytes increased after IRI. In group of administration of PDGFRβ antibody, proliferation and transition to myofibroblasts of pericytes were inhibited. Inflammation became worse and renal recovery was impeded after AKI. The chemokine stromal cell-derived factor-1 (SDF-1) which is also known as the C-X-C-type chemokine CXCL12 decreased as well. Furthermore, we demonstrated that CXCL12 was secreted mainly by pericytes and its receptor CXCR4 was expressed on tubular cell during IRI by in situ hybridization. When knockout of CXCL12 was performed before IRI, the renal microvascular rarefaction was noted after AKI and the recovery of renal function was impaired. Renal tubular cell proliferation decreased and apoptosis increased as well.

Conclusion

In summary, these findings demonstrated that pericytes contribute to renal repair after IRI through CXCL12 secretion.
#3775 PHOSPHATE BINDERS FOR PATIENTS WITH CHRONIC KIDNEY DISEASE UNDERGOING DIALYSIS: A NETWORK META-ANALYSIS OF RANDOMISED CONTROLLED TRIALS
Authors: Hasegawa Takeshi , Noma Hisashi , Yamada Shunsuke , Murashima Miho , Nihiwaki Hiroki , Mizukami Aya , Nishimoto Masatoshi , Saito Hirotaka , Kimura Hiroshi , Taniguchi Masatomo
Published: June 2023

Background and Aims

Phosphate binders (PBs) are essential for proper serum phosphorus control in patients with chronic kidney disease (CKD) requiring dialysis along with adequate dialysis and phosphorus restriction. To evaluate the clinical efficacy and safety of each PBs, we conducted a systematic review (SR) using a network meta-analysis (NMA) of randomised controlled trials (RCTs).

Method

We searched published RCTs in MEDLINE, EMBASE, the Cochrane Register of Controlled Trials (CENTRAL), and Clinical trial.gov databases using the search terms and text words relevant to this SR. We included RCTs involving adults (18 years and older) with at least 8 weeks of follow-up. Interventions and controls were the following: sevelamer-, bixalomer-, tenapanor-, iron- (ferric citrate, sucroferric oxyhydroxide), calcium-, magnesium-, lanthanum-, aluminium-, nicotinic acid-, and standard treatment or placebo). The outcomes were all-cause mortality, gastrointestinal adverse events (AEs), coronary artery calcium score (CACS), and serum calcium, phosphorus, and bicarbonate concentrations. Summary estimates were expressed as relative risk (RR) for binary outcomes and mean difference (MD) or standardised mean difference (SMD) for continuous outcomes, respectively, with 95% confidence intervals (CI). The protocol of this study is registered in PROSPERO: CRD42022328388.

Results

All-cause mortality was identified and analysed in 29 trials involving 12,622 participants. Compared with calcium-containing PBs, sevelamer reduced the risk of all-cause mortality (RR 0.65, 95%CI 0.45 to 0.96). The risk of gastrointestinal AEs was higher for nicotinic acid (RR 3.79, 95%CI 1.29 to 11.12), sucroferric oxyhydroxide (RR 1.96, 95%CI 1.47 to 2.63), sevelamer (RR 1.47, 95%CI 1.14 to 1.88), and lanthanum (RR 1.36, 95%CI 1.14 to 1.64) than calcium-containing PBs. Lanthanum had an inhibitory effect on CACS progression compared to calcium-containing PBs (SMD -0.63, 95% CI -1.05 to -0.22). Serum calcium was lower than calcium-containing PBs in the following order: magnesium (MD -0.67, 95% CI -1.12 to -0.22), placebo (MD -0.64, 95% CI -1.22 to -0.67), nicotinic acid (MD -0.56, 95% CI -1.11 to -0.005), sevelamer (MD -0.35, 95% CI -0.47 to -0.23), and lanthanum (MD -0.24, 95% CI -0.38 to -0.095). No significant difference was observed in serum phosphorus decrease between any PBs and calcium-containing PBs. Serum bicarbonate concentration increased with ferric citrate (MD 1.16, 95% CI 0.36 to 1.96) and sucroferric oxyhydroxide (MD 1.06, 95% CI 0.29 to 1.82) but decreased with sevelamer (MD -1.24, 95% CI -1.71 to -0.77).

Conclusion

Our findings from SR based on NMA suggest that lanthanum may attenuate CACS and sevelamer may reduce the risk of all-cause mortality compared to calcium-containing PBs in patients with CKD requiring dialysis.
#3777 ACTIVATION OF HYPOXIA-INDUCIBLE FACTORS IN ERYTHROID PROGENITOR CELLS RESULTS IN DEFECTIVE ERYTHROPOIESIS
Authors: Tsai Pei-Zhen , Pan Szu-Yu , Lin Shuei-Liong
Published: June 2023

Background and Aims

Hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI) activates HIF in renal pericytes and fibroblasts to promote erythropoietin production and erythropoiesis. However, the effects of HIF stabilization in the erythroid lineage are not clear. We aim to study the effects of erythroid lineage-specific stabilization of HIF on erythropoiesis by preclinical models.

Method

EporGFP-Cre/+;VhlF/F mice were used to achieve erythroid lineage-specific stabilization of HIF. Surface expression of TER-119, CD44, and forward scatter (FSC) were used to define erythroblast, reticulocyte, and red blood cell in the bone marrow. Expression of propidium iodide and surface annexin V were used to define apoptosis. Stress erythropoiesis was induced by subcutaneous administration of phenylhydrazine.

Results

Compared with littermate VhlF/F mice, EporGFP-Cre/+;VhlF/F mice had decreased hematocrit, decreased percentage of erythroblasts in the bone marrow, and increased apoptosis of erythroblasts in the bone marrow under steady state. These phenotypes of defective erythropoiesis were normalized in mice harboring concomitant Vhl, Hif1a, and Hif2a deletion (EporGFP-Cre/+;VhlF/F;Hif1aF/F;Hif2aF/Fmice). Although macrophages in the bone marrow also express Epor, macrophage-specific Vhl deletion in either Tg(Csf1r-CreESR1);VhlF/F or Lyz2Cre/+;VhlF/F mice did not result in defective erythropoiesis. During stress erythropoiesis, compared with littermate VhlF/F mice, EporGFP-Cre/+;VhlF/F mice had similar hematocrit, lower percentage of erythroblast in the bone marrow, and increased percentage of erythroblast in the spleen.

Conclusion

Vhl deletion in erythroid progenitor cells impairs erythropoiesis in murine bone marrow in the steady state. The phenotypes of defective erythropoiesis were partially reversed during stress erythropoiesis.
#3784 DIETARY BEHAVIOR OF CKD PATIENTS BEFORE AND AFTER THE COVID-19 PANDEMIC PERIOD
Authors: Min Son Seong , Ok Kwon Sung , Lee Sunhwa , Hyunjeong Baek , Duck-Jin Hwang , Park Ji In
Published: June 2023

Background and Aims

As the COVID-19 infection went global pandemic in 2020, many governments around the world have carried out social lockdown policies. It resulted in changes in lifestyles such as diet, physical activity, and social interaction. This study aimed to investigate the changes of lifestyles focusing on diet, especially in patients with chronic kidney disease (CKD) during the COVID-19 pandemic period.

Method

We compared data from 2019 and 2020 of the Korea National Health and Nutrition Examination Survey (KNHANES) before and after COVID-19, because COVID-19 was first detected in January 2020 in South Korea. CKD was defined as albumin to creatinine ratio >30 mg/g or estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. CKD was categorized into two groups, CKD stage 1–2 and CKD 3–5; eGFR over 60 with albuminuria and eGFR below 60 mL/min/1.73 m2. We compared changes in diet behavior, nutrients, and food intake between 2019 and 2020 in normal, CKD stage 1–2, and CKD stage 3–5 groups.

Results

This analysis included a total of 5,084 and 4,338 participants from 2019 and 2020. When compared to normal group in the post-COVID-19, CKD group showed lower energy intake (p = 0.038), but the proportion of carbohydrates, proteins, and lipids did not differ. In the pre-COVID-19, CKD stage 3–5 group ate significantly lower sodium (1612.3 ± 62.1 mg/1000kcal) compared to normal (1809.1 ± 17.3 mg/1000kcal) and CKD stage 1–2 group (1856.3 ± 44.9 mg/1000kcal) (p = 0.007). However, post-COVID-19 period, sodium intake significantly increased only in CKD stage 3–5 group (1893.5 ± 109.2 mg/1000kcal, p = 0.015), and the urine Na/Cr ratio also increased (from 19.5 ± 1.4 to 26.0 ± 1.5, p = 0.001). The main source food of sodium was kimchi in every group, but the proportion changed in the post-COVID-19 period. In CKD stage 3–5 group, compared to the pre-COVID-19 period, the intake of noodles and Ramen increased 35% and 91%, respectively. Interestingly, the potassium intake increased from pre-COVID-19 to post-COVID-19 in all three groups.

Conclusion

The COVID-19 pandemic affects CKD patients' diets in terms of sodium intake. We need to pay attention to diet and nutritional education for CKD stage 3–5 patients.