bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0205SYMPTOM BURDEN IN AUSTRALIAN PATIENTS WITH ADVANCED CHRONIC KIDNEY DISEASE AND END-STAGE KIDNEY DISEASE RECEIVING RENAL SUPPORTIVE CARE: A SINGLE CENTRE COHORT STUDY
Authors: Chen Jenny , Ilic Narelle , Mitchell Holly 
Published: June 2020

Abstract

Background and Aims
Renal supportive care (RSC) is a novel multidisciplinary patient-centred model of care that focuses on symptom management and quality of life improvement in patients with advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD), including conservative care. Despite an increased interest in embedding RSC into routine nephrology practice, there is limited literature on the effects of symptom improvement in patients attending RSC services. We aimed to examine symptom improvement and symptom progression in patients receiving renal supportive care.

Method
Using Integrated Palliative care Outcome Scale Renal (IPOS-renal) scores collected during routine RSC clinics, we analysed the changes in individual IPOS-renal items and summative scores for symptoms associated with chronic kidney disease, stratified by time from the initial clinic visit (0-6 months, 6-12 months, and &gt;12 months), in all patients attending our RSC service in a tertiary hospital between November 2015 and July 2019.

Results
Of 245 patients referred to our RSC service, 61 patients completed two or more IPOS-renal surveys. At initial visit, majority of the patients were reviewed at hospital outpatient clinic (n=42, 71%), followed by dialysis (n=8, 13%), home visit (n=6, 10%), and inpatient ward (n=4, 7%). The median (IQR) eGFR was 13 (7-16) ml/min/1.73m2 and median Karnofsky score was 70 (60-80). Weakness (n=59, 97%) and poor mobility (n=52, 85%) were the most common initial complaints. For all reported symptoms, dyspnea improved the most for all three time periods (summative IPOS score changes of 28, 17, and 8 points for 0-6, 6-12, &gt;12 months, respectively). Poor mobility was the only symptom that continued to deteriorate between 0-6 months despite attending renal supportive care (without a physiotherapist). For asymptomatic patients, more than half of the symptoms remained quiescent after attending RSC service for more than 12 months. Among newly developed symptoms, nausea, dyspnea, and drowsiness were most common between 0-6 months. In contrast, pruritus, dry mouth, and constipation were the most common complaints after 12 months.

Conclusion
RSC interventions provided symptom improvement in patients with advanced CKD and ESKD, but poor mobility remained a concern in this population. Incorporating physiotherapy to RSC may further improve symptom management.
P0208DIFFERENTIAL ADAPTATION OF RENAL FUNCTION IN TWO TYPES OF INTENSE PHYSICAL EXERCISE
Authors: Coca Armando , Gonzalez Pablo , Rollan Maria Jesus , Toribio Beatriz , Marcos Hortensia , Fidalgo Veronica , Lorenzo Arturo , Andres Melchor , Acosta-Ochoa Isabel , Mendiluce Alicia 
Published: June 2020

Abstract

Background and Aims
Marathon running induces AKI even in adequately prepared and healthy athletes. Heat stress, maintained during more than 2h, has been proposed as one of the leading causes of AKI in marathons runners. Other possible explanations of AKI in this setting could be associated with a reduction of blood supply to the kidneys during the exercise, inadequate hydration or actual structural damage due to microtraumatisms. However, the effect of vigorous exercise of shorter duration on renal function has not been previously described although most risk factors described could also affect kidney function in this type of physical activity.

Method
40 volunteer healthy athletes were enrolled in this study. Subjects participated in two physical tests (10km running, 1.5km swimming) which were separated by at least two weeks from each other. These tests were chosen because of their similar oxygen consumption rate and metabolic load. Vitals, blood and urine samples were collected immediately before and after each test. Informed consent was obtained from all participants. The project was funded by Consejería de Sanidad, Junta de Castilla y León (GRS1732/A/18).

Results
Athletes ranged from 23 to 53 years old. 35% were female. A comparison of hemodynamic and analytical parameters is summarized in Table 1. Running induced a significantly higher rise of serum creatinine and inflammatory markers compared to swimming. Additionally, running caused an increment of serum phosphorus and uric acid levels. Both types of exercise caused a mild increase of urinary albumin/creatinine ratio.

Conclusion
Compared to swimming, running was associated with a greater rise of serum creatinine, possibly linked to a higher degree of acute inflammation and blood flow redistribution to the muscles. The rise of serum uric acid levels may be associated with increased metabolism and reduced elimination of this molecule while running.
P0210ASSOCIATIONS BETWEEN CHANGES IN RENIN ACTIVITY AND ALDOSTERONE LEVELS AND CHANGES IN KIDNEY FUNCTION AFTER TREATMENT FOR PRIMARY ALDOSTERONISM: A LARGE MULTICENTER COHORT STUDY IN JAPAN
Authors: Kobayashi Yusuke , Yano Yuichiro , Haze Tatsuya , Hatano Yu , Tamura Kouichi , Naruse Mitsuhide , JRAS study group JPAS/ 
Published: June 2020

Abstract

Background and Aims
Greater reduction in estimated glomerular filtration rate (eGFR) after treatment for primary aldosteronism (PA) reflects improvement of glomerular hyperfiltration associated with PA and leads to better patient outcomes. However, little is known regarding the mechanisms underlying eGFR reduction after treatment for PA.

Method
We analyzed data from the nationwide PA registry in Japan. Patients were assigned to adrenalectomy (n=419) and mineralocorticoid receptor (MR) antagonist (n=674) groups. We assessed associations between changes in BP, plasma renin activity and aldosterone levels, and eGFR after treatment for both groups.

Results
Reduction in eGFR after treatment was greater in the surgical compared to MR antagonist treatment group (median -11.0; 95% CI, -12.2 to -9.8 ml/min/1.73 m2 vs. -3.5; 95% CI, -4.3 to -2.7 ml/min/1.73 m2; p &lt;0.001). In a multivariable linear regression, the adjusted betas (95% confidence interval) for change in eGFR after treatment for each standard deviation higher level of plasma renin activity and aldosterone were -2.12 (-4.10, -0.14) and 2.41 (1.20, 3.62) ml/min/1.73 m2, respectively, in the adrenalectomy group, and -0.65 (-1.28, -0.02) and –0.64 (-2.04, 0.76) ml/min/1.73 m2, respectively, in the MR antagonist group. Plasma renin activity Change in mean arterial pressure after treatment was not associated with change in eGFR in either group.

Conclusion
Changes in plasma renin activity and aldosterone levels but not BP, after treatment for PA were associated with greater reductions in eGFR. Post-treatment improvements in glomerular hyperfiltration may be attributable to suppressed MR activity within the kidneys, not to reductions in systemic blood pressure. It is important for clinicains not only to treat PA, but also to confirm adequate suppressed MR activity after treatment for correction of glomerular hyperfiltration.
P0211GLOMERULAR HYPERFILTRATION AND CANCER: A NATIONWIDE POPULATION-BASED STUDY
Authors: Kim Yaerim , Yoon Jeongsoo , Paek Jin Hyuk , Park Woo Yeong , Jin Kyubok , Han Seungyeup , Joo Kwon Wook , Kim Dong Ki 
Published: June 2020

Abstract

Background and Aims
Glomerular hyperfiltration is associated with all-cause mortality. Herein, we evaluated the association between glomerular hyperfiltration and the development of malignant disease, the most common cause of death, in an Asian population.

Method
We retrospectively reviewed the National Health Insurance Service database of Korea for people who received national health screenings from 2012 to 2013. Glomerular hyperfiltration was defined as the 95th percentile and greater after adjusting for age and sex. We performed a multivariate Cox regression analysis using glomerular hyperfiltration at the first health screening as the exposure variable and cancer development as the outcome variable to evaluate the impact of glomerular hyperfiltration on the development of malignant disease.

Results
A total of 1,953,123 examinations who followed-up for 4.9 years were included in this study. Among the 8 different site-specific malignant disease categories, digestive organs and female genital organs showed a significant associations between glomerular hyperfiltration and malignancy. The population with glomerular hyperfiltration showed an increased risk for stomach cancer (adjusted hazard ratio [aHR], 1.27), colorectal cancer (aHR, 1.23), and liver or intrahepatic malignancy (aHR, 1.40). In addition, the risk for uterine and ovarian cancer was significantly increased in the population with glomerular hyperfiltration (aHR, 1.36).

Conclusion
Glomerular hyperfiltration was associated with an increased risk for the development of malignant diseases in specific organs, such as the stomach, colorectum, uterus, and ovary. Glomerular hyperfiltration needs to be considered a significant sign of the need to evaluate the possibility of hidden adverse health conditions, including malignancies.
P0216CHECK POINT INHIBITORS AND CANCER. RENAL ADVERSE EVENTS: CASE SERIES
Authors: González Nuez Selene , Pérez Suárez Germán , Ramírez Puga Ana , Rodríguez Abreu Delvys , Fernández Granados Saulo Jesús , Esparza Martín Noemí , García Cantón César 
Published: June 2020

Abstract

Background and Aims
The treatment of cancer with check point inhibitors (CPI) has demonstrated significant benefits. CPI initiate antitumor immunity through negative regulatory components in T cells. However, these agents are associated with adverse events related to the immune system that can affect several organs. Initially, a low incidence of renal adverse events was reported, although recent data suggest an incidence between 9.9% and 29%. The objective of the study was to describe a case series that presented renal dysfunction related to CPI treatment.

Method
11 patients were studied retrospectively (67% males, mean age 69 ± 13 years), diagnosed with Neoplasms (9 advanced lung cancer, 7 of them metastatic and 2 metastatic melanomas) treated with CPI, who developed renal dysfunction. 5 patients with lung cancer were treated with Pembrolizumab, 3 with Nivolumab and 1 with Pembrolizumab + Ipilimumab combination. Patients with melanoma received Pembrolizumab. In 55% of the cases, immunotherapy was used as first line of antitumor treatment. Demographic and clinical-analytical data were collected, as well as the evolution of renal function.

Results
The median plasma creatinine prior to receiving treatment with CPI was 0.9 mg/dl [0.67-1.5]. The maximum creatinine reached after treatment with CPI was 2.5 mg/dl [1.8-7.5] with Pembrolizumab, 5.4 mg/dl [3-6.7] with Nivolumab and 4.3 mg/dl with the combination Pembrolizumab + Ipilimumab. Renal dysfunction occurred in the fifth cycle of treatment with Pembrolizumab and in the third cycle with Nivolumab and Pembrolizumab + Ipilimumab.
All patients received steroids (1mg/kg) and CPI were permanently discontinued in 3 patients with Pembrolizumab (43%), 1 with Nivolumab (33.3%) and 1 with Pembrolizumab + Ipilimumab (100%). Renal biopsy was performed in 4 patients who initially did not respond to steroids, resulting in acute tubulo-interstitial nephritis (ATIN), 1 of them with granuloma formation and worse renal evolution.
All patients recovered renal function partially or totally, except 1 treated with Pembrolizumab who remained with advanced kidney disease. Tumor progression was observed in 3 patients and 2 died.

Conclusion
CPI have demonstrated significant clinical benefits in the regression and prolonged stabilization of many tumors. The main cause of renal dysfunction after the use of CPI in our patients was the ATIN, with a good initial response to steroids and drug suspension. The presence of granulomas in renal biopsy confers a poor prognosis. It is an increasingly frequent entity in clinical practice, and because of its complicated management, it requires a multidisciplinary approach.
P0220EFFECTIVENESS OF SODIUM ZIRCONIUM CYCLOSILICATE (SZC) IN HAEMODIALYSIS PATIENTS WITH SEVERE HYPERKALAEMIA IN THE DIALIZE STUDY
Authors: Ford Martin , Fishbane Steven , Spinowitz Bruce , Rastogi Anjay , Guzman Nicolas , McCafferty Kieran 
Published: June 2020

Abstract

Background and Aims
Patients with severe hyperkalaemia require urgent intervention to avoid serious adverse outcomes and mortality. The phase 3b DIALIZE study (NCT03303521) showed that sodium zirconium cyclosilicate (SZC) reduces predialysis serum potassium (sK+) after the long interdialytic interval and is well tolerated in haemodialysis patients with hyperkalaemia. This post-hoc analysis of the DIALIZE data assessed the efficacy of SZC in patients with severe hyperkalaemia (defined as sK+ ≥6.0 mmol/L) at baseline.

Method
The DIALIZE study randomised 196 patients 1:1 to placebo (n=99) or SZC (n=97). The study consisted of an 8-week treatment period, comprising a 4-week SZC dose titration phase followed by a 4-week evaluation phase. The starting dose of SZC was 5 g orally once daily on non-dialysis days (4 days/week) for the 4-week dose titration phase (titrated in 5 g increments to a maximum of 15 g on non-dialysis days) to achieve predialysis sK+ 4.0–5.0 mmol/L. Patients maintained a stable dose of SZC for the 4-week evaluation phase (SZC 5, 10 or 15 g). Here, treatment response was defined as achievement of predialysis sK+ of 4.0–5.5 mmol/L during ≥3 of 4 haemodialysis treatments after the long interdialytic interval during the 4-week evaluation phase and not requiring potassium-lowering rescue therapy. Rates of response were compared between those patients with and without baseline severe hyperkalaemia (sK+ ≥6 mmol/L and &lt;6 mmol/L, respectively). The sK+ measurement on Visit 1 (Day –7) was used as the baseline value.

Results
At baseline, 88 patients had sK+ ≥6 mmol/L (SZC n=46, placebo n=42) and 106 patients had sK+ &lt;6 mmol/L (SZC n=49, placebo n=57); data were missing for two SZC patients. The overall proportion of treatment responders (irrespective of treatment and dose) in patients with baseline sK+ ≥6 mmol/L and &lt;6 mmol/L was 44.3% and 43.4%, respectively. The proportion of treatment responders was greater with SZC compared with placebo in patients with baseline sK+ ≥6 mmol/L and sK+ &lt;6 mmol/L (Figure). For patients receiving SZC, the proportion of treatment responders was consistent in those with baseline sK+ ≥6 mmol/L (67.4%) compared with those with baseline sK+ &lt;6 mmol/L (71.4%; Figure).

Conclusion
Our results suggest that SZC is effective in haemodialysis patients with severe hyperkalaemia.
P0239THE EFFECT OF CHRONIC KIDNEY DISEASE AND DIALYSIS MODALITIES ON THE EXPRESSION OF T REGULATORY (CD4+CD25+FOXP3+) AND NATURAL KILLER (CD56+CD16+ ) CELLS
Authors: Sampani Erasmia , STANGOU MARIA , Daikidou Dimitra Vasileia , Asouchidou Despoina , Nikolaidou Vasiliki , Memmos Evangelos , Giamalis Panagiotis , Dimitriadis Chrysostomos , Fylaktou Asimina , Papagianni Aikaterini 
Published: June 2020

Abstract

Background and Aims
Tregs regulate immune responses and maintain self-tolerance, while Natural Killer cells (NK) are cytotoxic lymphocytes critical for both adaptive and innate immunity. The presence of chronic kidney disease (CKD) is often characterized by disturbances in immune responses, including dysregulation between tolerance and cytotoxicity. Aim of the present study was to evaluate the influence of CKD on the Tregs (CD4+CD25+FoxP3+) and NK cells, as well as the effect of hemodialysis (HD) and peritoneal dialysis (PD) on these subtypes.

Method
A total of 40 CKD Stage V patients and 15 healthy volunteer subjects were recruited into our study. Peripheral Tregs and NK cells were isolated from whole blood samples using flow cytometry, and the results were compared to those of age and gender matched controls. The immunologic profile of CKD patients was repeated 6 months after HD initiation (n=20) and PD (n=20) in order to investigate the effect of different dialysis methods.

Results
Patients with CKD had significantly reduced populations of CD4+CD25+ FoxP3+ Tregs (47.5± 28.8 vs 71.5±24.7) p=0.01, while there was no difference in NK cells between patients and controls (16.4±8.1% vs. 13.4±9.1%), p=NS, respectively. There were no differences between patients started on HD or PD in terms of clinical and laboratory parameters. Frequencies and total numbers of Tregs were significantly reduced after 6 months of HD, from 7.6±2.1% to 5.2±2.3%, p=0.009, and from 53.6±26K/μL to 36.9±19K/μL, p=0.02, respectively, while showed no differences on PD patients, from 5.3±3.3% to 5.6±2%, p=NS and 33.2±27K/μL to 45.6±28K/μL, p=NS, respectively. NK cells were increased in HD patients, not reaching statistical significance (245±156K/μL to 261±128K/μL). Frequencies of NK cells were positively correlated with CRP (r=0.56, p=0.009) and Intimal media thickness (IMT) (r=0.48, p=0.03)

Conclusion
The results of our study show that initiation of hemodialysis (HD) seems to reduce the expression of CD4+CD25+FoxP3+ T cells while peritoneal dialysis (PD) doesn’t seem affect this cell population. The immune alterations observed in hemodialysis patients may have a clinical impact on chronic inflammation and atheromatosis.
P0240ACQUIRED THROMBOTIC THROMBOCYTOPENIC PURPURA IN HIV POSITIVE PATIENTS SUCCESSFULLY TREATED WITH CAPLACIZUMAB: ABOUT TWO CASES
Authors: Baes Dulciane , Nicolazzi Paul , Moulonguet Florence , Simphal Philippine , Hazzan Marc , Maanaoui Mehdi , Provôt François 
Published: June 2020

Abstract

Background and Aims
Acquired thrombotic thrombocytopenic purpura (aTTP) is a thrombotic microangiopathy still nowadays associated with a high risk of death. Standards of care included at first the association of plasmatic exchanges, Rituximab and steroids. The emergence of Caplacizumab, a nanobody targeting the A1 receptor of Von Willebrand Factor (VWF), significantly changed the prognosis of the disease. Thrombocytopenia is frequent in HIV positive patients, and aTTP is frequently considered. Prevalence of HIV positive in aTTP patients ranges from less than 1% in western countries, up to more than 50% in African countries. The pathophysiology still remains partially understood, leading to the development of autoantibodies targeting the ADAMTS13 metalloprotease. For now, no specific recommendations are available, and standards of care consist in treating HIV positive patient the same as other aTTP patients. We present the first description of two HIV positive patients, successfully treated with caplacizumab.

Method
We report there two cases of black women, respectively aged 31 (Patient 1) and 52 years old (Patient 2), both positive for HIV for several years. The first one had stopped any antiviral treatment few months ago, and had a positive blood viral load of 110764 copies/ml. Her CD4+ rate was 30/mm3. The second one was under antiviral medication, with a negative viral load and a CD4+ rate of 295/mm3. Both were admitted in our department because of low platelet levels and hemolysis, associated with inflammatory triggers. Bacteriema for Streptococcus mitis was discovered on admission in Patient 1 and Patient 2, who had a long-term follow-up for Still disease, presented with a flare-up.

Results
Both patients had positive anti-ADAMTS13 autoantibodies (Patient 1: titer 42 UI/ml, Patient 2: 45 UI/ml), with undetectable ADAMTS-13 activities. They were treated with plasmatic exchanges until platelets levels reached over 150 G/L, steroids 1.5 mg/kg/j, Rituximab 375 mg/m2 at day 1, 4 and 8 and finally caplacizumab 10 mg before the 2nd plasmatic exchange and every day until the ADAMTS13 activity reached over 20%. Antiviral therapy and antibiotics were initiated in Patient 1 and antiviral therapy was maintained in Patient 2. The evolution was promptly favorable with normalization of platelets levels at Day 4 in Patient 1, and Day 15 in Patient 2. Patient 1 stopped caplacizumab at Day 12 and Patient 2 at day 17, when ADAMTS 13 reached over 20%. None of them relapsed after treatment, with a respective follow-up of 4 and 2 months.

Conclusion
Caplacizumab seems to be a safe and efficient treatment for aTTP in HIV positive patients.
P0245PERCUTANEOUS RENAL BIOPSY IN FRAIL AND HIGH RISK PATIENTS
Authors: Roccatello Dario , Fenoglio Roberta , Kamgaing Joelle , De Simone Emanuele , Del Vecchio Giulio , Ferro Michela , Quattrocchio Giacomo , Rabajoli Gianluca , Concas Maria Rosaria 
Published: June 2020

Abstract

Background and Aims:
Many patients with End Stage Kidney Disease do not undergo percutaneous kidney biopsy (KB) and do lack a definite diagnosis. Whether KB is beneficial in the extreme patients’ categories, i.e., age &gt;75 years and very late referrals with kidney disease requiring renal replacement therapy at the first evaluation, remains controversial. Aim: To analyse the benefit/risk balance in terms of therapeutic options and general outcome of KB procedure in these borderline categories.

Method
Files for all biopsies performed in our Centre between 2013 and 2019 (# 903 inpatients’ native kidney) were retrospectively analysed with special focus on histological diagnosis, biopsy complications, and post-biopsy patient’s outcome. Two groups of high risk patients were identified 1. &gt;75 years old patients, and 2. patients requiring dialysis at the first clinical evaluation. A rigorous protocol of screening of the bleeding risks was adopted.

Results
Of the 903 biopsies, 217 cases (24%) had group 1, and 92 (10%) group 2 criteria. Group 1: mean age 80 years (range 75-92), main histological diagnoses: ANCA associated vasculitis (AAV) (12,4%); membranous nephropathy (MN) (11,5%), diabetic nephropathy (10,1%), IgA glomerulonephritis (IgAGN) (9,2%), cast nephropathy (9,2%), renal amyloidosis (9.2%), focal segmental glomerulosclerosis (FSGS - 7,8 %). Group 2: mean age 60 years (range 20-92), most frequent histological diagnosis: AAV (26,1%); cast nephropathy (19,6 %), nephroangiosclerosis (9,8%), IgAGN (7,6 %), diabetic nephropathy (6,5%), renal amyloidosis (5,4%); FSGS (4,3%). Five major complications (2,3%), including AV fistula with spontaneous resolution in 4 patients and 1 case of severe bleeding requiring arterial embolization, and 14 minor complications (6,5%), including post biopsy haematomas &lt;2cm in 12 patients and haematuria in 2 patients were observed in group 1. Only 1 (1%) major complication (AV fistula) and 4 minor complications (4,3%), including post biopsy &lt;2cm haematomas in group 2 were identified in group 2. Histological diagnosis conditioned or changed treatment strategy in 71% of elderly patients (group 1), and 63% of patients in dialysis (group 2). Dialysis discontinuation was achieved in 30 out of 92 patients (36,6%) with a sparing of over 1 million euro/year.

Conclusion
Given its high diagnostic value (especially in patients who are willing to be transplanted), the prognostic significance (and the assessment of the extent of the renal sclerotic changes), and the potential impact on the treatment policy, indications to percutaneous kidney biopsy in elderly and dialysis patients should be probably revised.