bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1819PEDIATRIC KIDNEY TRANSPLANTATION IN INDIA :IMPROVING OUTCOMES
Authors: Gulati Sanjeev , Sinha Rajiv , Saxena Vishal , Jain Alok , Sharma Amit , Kalra Deepak , Gill Harinder Singh 
Published: June 2020

Abstract

Background and Aims
Renal transplantation is the modality of the choice for the management of children with end stage renal disease. It offers better quality of life, though associated with risk of rejection and infection. This study was conducted

Method
This is a retrospective review of patients &lt;= 18 years of age who underwent renal transplant at Fortis hospitals, India from 2006 to 2019.The choice of induction agent was based on the discretion of the treating team and the socioeconomic tests of the patient, All these children were treated with Tacrolimus, MMF and prednisone, At each visit they were subjected to standard haematological and biochemical tests Data on age, sex, use of immunosuppression, incidence of infection and rejection was collected. Percentage, range and median were used to represent the data.

Results
The study group comprised of a total 120 pediatric patients underwent renal transplant between 2006-2018 at Fortis hospitals. Median age was 14 years (3-18 years) and 85 were boys and 35 were girls. The immunosuppression protocol consisted of induction by either basiliximab or ATG, followed by maintenance immunosuppression with tacrolimus, mycophenolate and steroids. 17 patients received no induction. Median creatinine at the time of discharge was 0.74 mg/dl (0.3-1.6 mg/dl). The median duration of follow up was 60 months (1-156 months). In our cohort, patient survival rate was 97.9 % and graft survival rate was 94.6 %. 18 patients had infections - UTI (8), CMV infections (7), BK virus infection (2), tuberculosis (1), varicella (1), cryptosporidium diarrhea (1) and fungal infection (1). Rate of rejection was 13.3%. Two patients had graft loss in the early post operative period, one secondary to renal vein thrombosis and other due to BK virus infection/acute tubular necrosis. Five patients lost the graft over the next 12 years due to non compliance with medications (4) and recurrence of FSGS (1). 2 patients died with functioning graft, one due to severe pancreatitis and other due to severe sepsis. One died after return to dialysis.

Conclusion
With advances in immunosuppression, rejection rate and graft survival have improved dramatically over the last decade. Compliance with medications and regular follow up are the major contributors for satisfactory long-term outcome.
P1829CARDIOVASCULAR DISORDERS IN CHILDREN WITH CHRONIC KIDNEY DISEASE
Authors: Nugmanova Aigul , Meriken Nuriya , Dikanbayeva Saule , Zhumagulova Zeinep , Baidauletova Zhuldyz , Eshankulov Khursanbek , Kuandykova Aigerim , Auyezkhanov Bakyt 
Published: June 2020

Abstract

Background and Aims
Pathology of the cardiovascular system is the leading cause of death in patients with CKD, while determining the causes of the formation of cardiac events is often difficult.

Method
We conducted an analysis of echocardiography data performed by 50 children with CKD. On the echoCG, the final systolic and diastolic sizes of the left ventricle (FSS and FDS), the final systolic and diastolic volumes of the left ventricle (FSV and FDV) were determined; measured the thickness of the interventricular septum (IVS) and the posterior wall of the left ventricle (PWLV). Left ventricular myocardial mass (LVMM) was determined by the formula proposed by R. Devereux and N. Reichek: LVMM = 1.04x (/ IVS+PWLV+FDS/3-FDS3) - 13.6where, IVS - thickness of IVS in diastole,PWLV-thickness of PWLV in diastole, FDS-final diastolic size of the left ventricle.

Results
We conducted an analysis of echocardiography data performed by 50 children with CKD. On the echoCG, the final systolic and diastolic sizes of the left ventricle (FSS and FDS), the final systolic and diastolic volumes of the left ventricle (FSV and FDV) were determined; measured the thickness of the interventricular septum (IVS) and the posterior wall of the left ventricle (PWLV). Left ventricular myocardial mass (LVMM) was determined by the formula proposed by R. Devereux and N. Reichek: LVMM = 1.04x (/ IVS+PWLV+FDS/3-FDS3) - 13.6where, IVS - thickness of IVS in diastole,PWLV-thickness of PWLV in diastole, FDS-final diastolic size of the left ventricle.

Conclusion
The mechanisms of damage to the heart and blood vessels in patients with CKD begin to function already in the initial stage of renal failure and increase as it progresses. The need to know the data of clinical, laboratory and instrumental examination methods at the terminal stage of CKD is dictated, first of all, by the possibility of exposure to them. An important stimulus for conducting an echocardiographic examination is the early detection and correction of cardiovascular disorders, in connection with the prospect of increasing the survival of patients after kidney transplantation.
P1834MONITORING ANTICOAGULATION IN PEDIATRIC PATIENTS ON REGULAR HEMODIALYSIS: CAN A DREAM COME TRUE?
Authors: Elhakim Ihab , Ragia M Said , Baranek Ahmed 
Published: June 2020

Abstract

Background and Aims
Anticoagulation in hemodialysis aims at preventing the activation of coagulation cascade during the procedure. Appropriate anticoagulation for hemodialysis (HD) requires a precise balance between under- and over-heparinization to prevent extracorporeal circuit (ECC) clotting and bleeding, respectively. This type of balance is practiced in hemodialysis centers, on daily basis, depending on each center’s experience and tailored to every patient, rather than in accordance to a clear guideline. Our aim was to objectively evaluate the adequacy of heparin therapy used for anticoagulation in pediatric patients on regular hemodialysis.

Method
A follow up observational study for 12 months including 44 pediatric end stage renal disease patients on regular hemodialysis through an A-V fistula or an A-V graft. We excluded patients with a known bleeding disorder, chronic liver disease, thrombophilia, vasculitis or receiving anticoagulation for any condition. All patients were subjected to thorough history taking including dialysis history, assessment of dialysis adequacy by calculating Kt/V and blood pressure monitoring before, during and after session. Clinical evaluation of anticoagulation was done through visual inspection of extra-corporeal circuit, observing transmembrane pressure and recording the duration of compression over the puncture site at the end of the hemodialysis session. Biological monitoring was done by Bedside Activated clotting time (ACT) test.

Results
On initial evaluation of patients, 11 cases had either clotting or bleeding clinically (only 4 had abnormal ACT values), being on either hemodialysis (HD) or hemodiafilteration (HDF) and receiving unfractionated heparin (UFH) either as a bolus or through a pump. They were further evaluated after being put; on HDF and a heparin pump and showed neither clotting nor bleeding though 2 cases had prolonged predialysis ACT values. On HDF and heparin bolus, no bleeding or clotting were detected though 3 cases had abnormal predialysis ACT values. On HD and heparin pump no bleeding or clotting were detected, 2 cases had low kt/V, a case had abnormal ACT values (5 minutes, 1 hour and at the end ACT values).

Conclusion
Hemodialysis mode, rather than method of heparin delivery, had a bigger impact on correcting clinical defects of anticoagulation in our patients. ACT as a bedside test of anticoagulation adequacy during HD sessions did not offer extra benefit over clinical evaluation, which is still considered a more accurate method.
P1835PREDICTION OF CHRONIC OF KIDNEY FAILURE BASED ON ARTIFICIAL INTELLIGENCE SYSTEM USING THE FUZZY DECISION TREE ALGORITHM
Authors: Fajar Rifaldy , Jupri Prihantini 
Published: June 2020

Abstract

Background and Aims
Chronic kidney disease is one type of disease that can cause death. Until now, chronic kidney failure has no antidote, so this disease cannot be cured but can be slowed down or stopped its development. Early diagnosis of this disease will help to prevent these fatal consequences. To diagnose this disease, several laboratory tests are needed in which the results of these tests will be calculated and concluded the results by a doctor or medical practitioner. The development of science and technology, especially in the field of computers will help the work of doctors to analyze the results of laboratory tests become easier and faster. In this study, a prediction attempt is made using the Fuzzy Decision Tree classification algorithm, which is expected to obtain high accuracy results.

Method
This study uses the Chronic Kidney Disease (CKD) dataset taken from the UCI Machine Learning Repository. Data was collected from the hospital for approximately two months. This dataset covers a total of 400 samples with numerical attributes totaling 11 columns and nominal totaling 14 columns. Data samples were provided as many as 400 rows with 250 samples being the ckd group (positive for chronic kidney failure) and 150 samples for the notckd group (chronic kidney failure). But after going through the preprocessing stage, data that can be used amounted to 158 rows with 43 samples are the ckd group (positive chronic kidney failure) and 115 samples of the notckd group (negative chronic kidney failure).

Results
The trial was conducted using several predetermined thresholds and the most optimal accuracy was 98.3%, which showed a fairly high degree of accuracy.

Conclusion
Thus, it can be concluded that the Fuzzy Decision Tree algorithm can be said to be able to predict chronic kidney failure with a very good results.
P1845HISTORY AND FUTURE PERSPECTIVES OF PAROXYSMAL NOCTURNAL HEMOGLOBINURIA
Authors: Gembillo Guido , Bellinghieri Guido , Savica Vincenzo , Satta Ersilia , Siligato Rossella , Salvo Antonino , Santoro Domenico 
Published: June 2020

Abstract

Background and Aims
Paroxysmal nocturnal hemoglobinuria (PNH) is a rare clonal disorder that affects about 1-1,5 cases per million individuals, characterized by hemolysis, peripheral blood cytopenia, bone marrow dysfunction, thrombosis, renal impairment and arterial and pulmonary hypertension.
The first case of PNH was probably described in 1793 by a surgeon, Dr Charles Stewart, in the medical commentaries “Account of a singular periodical discharge of blood from the urethra”. In the following decades several cases have been reported by the most eminent physicians and scientists of the time.

Method
In 1882 Paul Strübing was the first to identify PNH as a new disease entity. Hijmans in 1911 considered the possibility that the complement system mediated the hemolysis of PNH erythrocytes and in the same year, Italian scientists Ettore Marchiafava and Nazari scrupulously described the pathogenesis of the affection.
In the 1925 Enneking introduced for the first time the name “paroxysmal nocturnal hemoglobinuria”, to define this pathology.

Results
Despite the increased knowledge of this syndrome, therapies for PNH were still only experimental and symptomatic, with the use of antimicrobial agents, corticosteroids and blood transfusions. The natural history of PNH changed remarkably only in the 2007, with the introduction of Eculizumab complement blockade agent. The Ravulizumab, a long-acting C5 complement inhibitor approved on December 2018 by the U.S. food and drug Administration (FDA), and on July 2019 by the European Commission, represent a new promising instrument for PNH treatment.

Conclusion
Second generation of anti-complement agents are currently under investigation, representing future promising instruments for the treatment of PNH.
P1859“HEADING AWARDS 3.0 PATIENTS” IMPACT OF AN ONLINE HEALTH WORKSHOP ON INTERNET SEARCH OF HEALTH-RELATED ISSUES BY PERITONEAL DIALYSIS UNIT´S PATIENTS, FROM THE NEPHROLOGY SERVICE
Authors: Centellas Pérez Francisco Javier , Martínez Reolid Ricardo , Sarduy Coronado Pablo Alejandro , Piqueras Sánchez Sara , Martínez Antolinos Consuelo , Aparicio Simón Aitana , Ruiz González Cristina , Masiá Mondéjar Jesús , Pérez Martínez Juan , Ortega Cerrato Agustin 
Published: June 2020

Abstract

Background and Aims
New technologies have advanced diagnostic techniques and enabled patient self-information, nonetheless, they can become a weapon of misinformation if not used appropriately.
Online health resources utilization, gamification and the appearance of new specialized Apps are becoming a challenge in the quest for correct use of new technologies in the Nephrological field and in the patient empowerment process.

Aims
1st Phase: Determine how frequent medical information is searched for online, the main topics and the different sources of information used by PD patients in our Service of Nephrology.

Method
Observational prospective study using a cohort of patients from PD Unit (pre dialysis and on dialysis). First, an online survey was used in order to obtain demographic variables and to determine the use of different sources of information and their quality. Secondly, patients were instructed in ICTs via virtual desktop as well as in two live workshops.

Results
52 patients (37 men, 15 women). Mean age: 61.7 years. Academic level (elementary school: 20). Place of residence (urban: 65.4%). 48% never uses the internet. From the rest: 68% searches in a regular manner for health-related issues, with “Google” being the main search engine (77.8%). 100% have searched for their own illnesses, 72.2% consider the information found not completely reliable. 61% looks for information before and after the clinical encounter. 72.2% have asked other patients about nephrological health related issues, while 27.8% have given counsel of said issues to others. 86.5% doesn’t use health related Apps and only 5.8% use blogs. Among the variables analysed, differences where found in being older age and less use of internet (ANOVA test p&lt;0.001) and with lower cultural level and less use of new technologies (Chi-squared test p&lt;0.001).

Conclusion
The analysed data show that nowadays we face two main problems in our PD unit: Generational digital divide we have patients who have not incorporated into their lives the use of new technologies, in contraposition to others who use them in regular bases.
Guarantee that those who use digital resources can access them in a simple and trustworthy manner.
Therefore, we believe that the second phase of this project, both the workshops and the virtual desktop, are tools that can help fix these problems.
P1860PERIOPERATIVE CHANGES IN PHYSICAL FUNCTION AND ACCELEROMETER-MEASURED PHYSICAL ACTIVITY IN PRE-EMPTIVE OR POST-DIALYSIS KIDNEY TRANSPLANT RECEIPIENTS
Authors: Ichikawa Takafumi , Matsuzawa Ryota , Ishii Daisuke , Noguchi Fumino , Imura Yuki , Yamamoto Shohei , Matsunaga Atsuhiko , Yoshida Kazunari 
Published: June 2020

Abstract

Background and Aims
Pre-emptive kidney transplant (PEKT) is known to have better graft survival, and thereby well established as the optimal treatment for end-stage renal disease patients. On the other hand, the delayed recovery of physical function and physical activity after KT reportedly occurs in approximately 20% of KT recipients, which leads to poor prognosis. However, it is less clear whether PEKT delays recovery of them after KT. We aimed to investigate any differences in perioperative changes in physical function and physical activity for PEKT versus non-PEKT.

Method
Consecutive 34 recipients who had received a living-donor KT from January 2016 to January 2019 were enrolled in this prospective cohort study. Patient characteristics including age, sex, body mass index, primary cause of kidney disease, smoking habits, and comorbidities were collected at baseline. Six-minute walk distance (6MWD), gait speed, isometric leg strength, accelerometer-measured physical activity (number of steps and moderate to vigorous activity time) and kidney function (eGFR) were assessed at before and 2 months after KT. We divided the recipients into 2 groups: PEKT (n=11) and non-PEKT (n=23), and compared outcomes between the 2 groups using ANCOVA adjusted for baseline patient characteristics. This study was approved by institute ethical committee.

Results
KT successfully improved eGFR of all the study participants from 6.1±4.6 to 35.4±15.3. PEKT group showed significant shorter dialysis duration as compared with non-PEKT group (mean duration: 0 months in PEKT vs 64.8±95.5 months in non-PEKT, P &lt;0.001). The 6MWD significantly improved after KT in the PEKT group, but not in the non-PEKT group as compared with that of baseline (adjusted mean change [95% confidence interval]: 44.7 [8.2 to 81.2] vs. 8.80 [-32.8 to 15.2], P=0.025). We found a tendency toward improvement of gait speed (0.11 [-0.11 to 0.32] vs. -0.15 [-0.29 to -0.01], P=0.065), and moderate-to-vigorous activity time per day (7.19 [-2.84 to 17.23] vs. -5.60 [-12.97 to 1.77], P=0.057) in the PEKT group.

Conclusion
PEKT recipients showed higher perioperative changes in physical function and physical activity compared to non-PEKT. Our findings suggest that PEKT may have benefits on early recovery of physical function and physical activity after KT.
P0513NECROINFLAMMATION VERSUS CRYSTAL CLOTS AS THERAPEUTIC TARGET IN CHOLESTEROL CRYSTAL EMBOLISM-RELATED KIDNEY INFARCT
Authors: Shi Chongxu 
Published: June 2020

Abstract

Background and Aims
Cholesterol crystal embolism (CCE) is usually a consequence of the rupture of atheromatous plaques in patients with advanced atherosclerosis. We hypothesized that necroinflammation contributes to CCE-related kidney injury/disease (AKI/AKD).

Method
Injection of cholesterol crystal (CC) into C56BL/6 WT mice kidney via the left kidney artery induced vascular obstruction, kidney infarction, and GFR loss (measured by transcutaneous monitoring of sinistrin clearance in awake and unrestricted mice). GFR recovered to baseline at 2 weeks despite persistent kidney injury and scarring, probably because the non-injected right kidney developed compensatory hypertrophy. To study the role of necroinflammation in this process, we injected CC to either Mlkl-/- mice or WT mice pre-treated with PBS, the necroptosis inhibitor Nec-1s or the NLRP3 inhibitor MCC950 30 min before CC injection.

Results
At 24h, Nec-1s, MCC950 treatment had significantly reduced infarct size, kidney injury, neutrophil infiltration, and vascular injury compared to PBS control group. Reduced infarct size, e.g. with Nec-1s persistented until day 14. CC injection into Mlkl-/- mice gave the same results. However, none of these interventions had an effect on GFR loss, i.e. AKI because they did not affect crystal clot formation in the arteria afferent to glomerular perfusion. In contrast, anticoagulant treatment prevented infarcts and GFR loss.

Conclusion
In this new model of unilateral CCE-induced AKI/AKD global kidney function recovers within 14 d, presumably due to adaptive responses in the contralateral kidney as the post-infarct tissue injury persists and leads to kidney atrophy. As both the NLRP3 inflammasome as well as necroptosis are involved in kidney infarct formation, we conclude on necroinflammation as the central mechanism of CCE-induced AKI/AKD. However, what defines AKI is renal function. We found that crystal clot formation is upstream of kidney infarction but independent of necroinflammation. We conclude, despite necroinflammation is central in kidney infarct formation, crystal clots are the better therapeutic target to prevent CCE-related AKI.
P0559AKI SEASONALITY IN ENGLAND
Authors: Wong Esther , Nitsch Dorothea 
Published: June 2020

Abstract

Background and Aims
Incidence of Acute Kidney Injury (AKI) is known to be seasonal, peaking in winter months among hospitalised patients. Previous studies have suggested that the seasonality of AKI is likely to be influenced by the seasonality of the underlying acute illnesses that are associated with AKI. Mortality of patients with AKI has also been reported as being higher in winter, reflecting well-described excess winter mortality associations.
Here we describe the seasonal variations of AKI alerts in England and the associated mortality rate using linked national databases.

Method
Serum creatinine changes compatible with KDIGO AKI stage 1, 2 and 3 are sent by laboratories in England as AKI alerts to the treating clinicians and the UK Renal Registry (UKRR). We linked the electronic AKI alerts to the Hospital Episode Statistics (HES) data, to identify patients who were hospitalised. We carried out descriptive statistics, and investigate the seasonal effect to the 30-day patient mortality from date of getting AKI alert, using multivariable Cox regression and sequentially adjusting for age, sex, Index of multiple deprivation (IMD) and peak AKI stage

Results
Winter has the highest number of AKI episodes (N=81,276), which is 6% higher than that in summer (N=76,329) (Table 1). For patients who had an AKI episode and admitted to hospitals, the crude 30-day mortality is higher in the winter season when compared to the summer [HR 1.28 (1.25-1.31), p&lt;0.01] (Figure 1). After adjusting season by age, peak AKI stage, IMD and sex, winter season still has significantly higher 30-day mortality than summer [HR 1.24 (1.21-1.27), p&lt;0.01]. Winter mortality peak is confounded by age and AKI severity, which explained the drop of hazard ratio at winter peaks; whereas season is not confounded by deprivation and sex. The pattern of seasonality varies with age, in age group 18-39, there were 26.1% of AKI episodes in summer and 23.3% in winter, whereas in age group &gt;75, there were 23.7% in summer and 27.1% in winter.

Conclusion
Analysis of England data confirms seasonal peak in AKI during winter months. Additionally it shows increased risk of mortality for patients with AKI in winter months. Future work will investigate the impact of comorbidities and case-mix on outcomes. By understanding the seasonal variation of AKI, we can potentially plan preventive care and improve clinical practice.
P0617LEISURE-TIME PHYSICAL ACTIVITY AND MORTALITY IN CHRONIC KIDNEY DISEASE: NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY (NHANES) 1999-2012
Authors: Zhang Nanhui , Luo Ran , Cheng Yichun , Chang Dan , Liu Tingting , Ge Shu-wang , Xu Gang 
Published: June 2020

Abstract

Background and Aims
For patients with chronic kidney disease (CKD), evidence on the optimal dose of physical activity and possible harm with excessive exercise is limited. We aimed to analyze the dose-response association between leisure-time physical activity (LTPA) and mortality among participants with CKD and explore the optimal dose or possible harm associated with increased levels of physical activity.

Method
Leisure-time physical activity was self-reported. Data from 4604 adults with chronic kidney disease and without missing data for LTPA and mortality in the National Health and Nutrition Examination Surveys 1999-2012 were analyzed in 2019. Mortality was from baseline until 31 December 2015

Results
During the median follow-up of 114 months, 1449 (31%) all-cause deaths were recorded. Comparing with inactive groups, the multi-variable adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of 10-59, 60-149, 150-299, and 300-599 minutes/week of leisure-time physical activity for all-cause mortality were 0.71 (0.55-0.92), 0.78 (0.62-0.98), 0.79 (0.63-0.98), and 0.75 (0.57-0.99), respectively. The benefit appeared to reach a threshold of a 41% (HR,0.59; 95% CI, 0.41-0.84) lower risk of all-cause mortality among individuals reporting 600-1499 min/week for LTPA. And at ≥ 1500 min/week LTPA level, the HR and 95%CI were 0.66 (0.40-1.10).

Conclusion
LTPA was associated with reduced all-cause mortality in participants with CKD. We observed the optimal dose at the moderate-intensity LTPA level of approximately 600-1499 min/week and no longevity benefit at ≥1500 min/week.