bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1793MICROBIAL URETERAL STENT COLONIZATION IN KIDNEY TRANSPLANTATION: INCIDENCE AND IMPACT IN URINARY TRACT INFECTION AND RENAL FUNCTION
Authors: Rau Melissa , Carrera Salinas Anna , Marti Sara , Fiol Maria , Etcheverry Begoña , Riera Luis , Ardanuy Tisaire Carmen , Melilli Edoardo 
Published: June 2020

Abstract

Background and Aims
Ureteral stent insertion is nowadays a common practice in kidney transplantation, leading to a dramatic reduction of surgical issues. On the other hands, urinary tract infections are the most common complication in the first months after transplant.
Main scope of our study was to analyze the incidence of stent colonization and its impact on the development of urinary tract infection (UTI) in the first six months after transplantation

Method
Prospective observational study including 23 consecutively recruited patients at one single center. Patients with a previous history of surgical intervention on urinary tract before transplant were excluded. Pigtail stents were removed as for local protocol between 3 and 4 weeks after transplantation in aseptic condition and were cut in a half (proximal and distal) and analyzed separately. Stent colonization were detected by sonication method. Urine culture timing are depicted in Figure 1. In case of clinical symptoms, extra urine cultive were performed as for clinical practice. Patient were followed for 6 months, and results of stent colonization were blinded to clinicians.

Results
Table 1 shows main characteristic of our cohort.

Conclusion
P1794CHANGES IN PHARMACOKINETIC PROFILE OF MYCOPHENOLATE MOFETIL AND TACROLIMUS IN THE TRANSPLANTED PATIENT AFTER BOWEL SURGERY: A PROSPECTIVE COHORT STUDY
Authors: Montero Nuria , Favà Alexandre , Manonelles Anna , González Costello José , Melilli Edoardo , Coloma Lopez Ana , Salvador Gil-Vernet Cebrian , Rigo Raul , Fontova Pere , Torras Joan , Cruzado Josep , Bestard Oriol , Lloberas Núria 
Published: June 2020

Abstract

Background and Aims
Considering the particular pharmacokinetic (PK) profile of mycophenolate (MMF/MPS) with the important contribution of enterohepatic recirculation (EHC) and the potential alteration in tacrolimus (TAC) exposure, a PK study in solid-organ transplant patients who had undergone intestinal resection was carried out.

Method
This is a prospective single-center study of MMF/MPS and TAC exposure changes after bowel resection and after reconstruction. Whole blood samples were collected at the following time points: 0, 0.5, 1, 1.5, 2, 4, 6, 8 and 12 hours post-dose. Areas under the curves (AUCs) were determined in both conditions: with ileostomy and after bowel reconstruction.

Results
Six renal and two cardiac transplant recipients were included. Four subjects completed both pre- and post-reconstruction surgery procedures. Different intestinal anatomic resections were performed (Table 1). Patients with terminal ileostomy showed an under exposure to MMF/MPS. In three patients, initial MPA levels were on target, but they decreased &gt;80% after 4 hours post-drug administration. After bowel reconstruction, the AUC increased maintaining MMF/MPA levels during 12h (Table 2). Before bowel reconstruction, TAC trough levels were within therapeutic target but, after reconstruction, AUCs normalized by dose were much higher than the expected.

Conclusion
Transplant recipients with ileostomy showed infra-exposure to mycophenolate. After 4 hours post-dose, MMF/MPA was undetectable because of the absence of EHC, which was recovered after anatomical correction. TAC exposure was higher after bowel reconstruction suggesting changes in the absorption. The use of mTORi in such clinical situations would be an alternative.
P1802EVALUATION OF THE GENETICAL FEATURES AFFECTING THE RENAL OUTCOMES IN CHILDREN WITH STEROID RESISTANT NEPHROTIC SYNDROME
Authors: Comak Elif , Toylu Aslı , Bilge Ugur , Kaya Aksoy Gülsah , Koyun Mustafa , Akman Sema 
Published: June 2020

Abstract

Background and Aims
Nephrotic syndrome in childhood is characterized by proteinuria, hypoalbuminemia, edema, and hyperlipidemia. Although most children respond to glucocorticoid therapy, approximately 10% of patients turn out to be steroid resistant (steroid-resistant nephrotic syndrome [SRNS]). Although several studies in children with SRNS have shown that mutations in genes encoding proteins in the podocyte skeleton may be responsible for the etiology in only one-third of cases, the genetic features related with renal prognosis and response to immunosuppressive agents are not fully recognized.
The aim of this study was to investigate the genomic alterations associated with renal prognosis and resistance to immunosuppression in children with SRNS.

Method
The children with SRNS were enrolled in this study. Custom gene panel was designed for next-generation sequencing analysis of more than 20 target genes (ABCB1, ABCC2, CTLA4, CYP2C8, CYP2C9, CYP2C19, CYP2D6, CYP3A4, CYP3A5, FOXP3, GSTP1, IMPDH1, IMPDH2, NOS3, NR3C1, SLCO1B1, SLCO1B3, TPMT, UGT1A9, UGT2B7) and 200 single nucleotide variants (SNVs) which were reported as implicated in renal prognosis of nephrotic syndrome. The target gene panel was enriched for drug metabolism regulating transporters and enzymes.

Results
A total of 25 children, 16 boys (64%), median age at last visit 17.5 years (13-18 years), median age at diagnosis 7.5 years (2-15), median follow-up 9.58±4.54 years, were included in the study. All patients were diagnosed focal segmental glomerulosclerosis on renal biopsy.
P1804DIALYSIS AFTERKIDNEY GRAFT LOST: DATA OF THE ITALIAN REGISTRY OF PEDIATRIC DIALYSIS
Authors: La Porta Edoardo , Conversano Ester , Zugna Daniela , Consolo Silvia , Labbadia Raffaella , Mattozzi Francesca , Parolin Mattia , Verrina Enrico Eugenio , Vidal Enrico 
Published: June 2020

Abstract

Background and Aims
An increasing number of patients are returning to dialysis after kidney allograft failure (KAF). These patients are at higher risk of complications and mortality compared with incident ESKD patients.. In the pediatric population these data are missing and outcomes have never been investigated before in a nationally representative sample. The aim of this study was to describe the characteristics and hard outcomes of children entering dialysis after KAF in a large population of pediatric dialysis patients.

Method
We retrospectively reviewed the files of patients receiving chronic dialysis at &lt;18 years, recorded from January 1990 to June 2019 by the Italian Registry of Pediatric Chronic Dialysis (IRPCD), a nationwide population-based chronic dialysis network involving all 12 Italian pediatric dialysis centers. We identified 126 patients who had returned to dialysis after KAF. All patients were followed from (re)initiation of dialysis until death, re-transplantation or loss to follow-up. Multivariable regression and survival analysis were used to evaluate factors involved in the choice of dialysis modality and patient outcomes.

Results
After KAF, 45 (35.7 %) patients were treated with PD and 81 (64,3%) with HD. Prior to kidney transplantation (Ktx), 74 (58.7%) were on PD, 45 (35.7%) on HD, and 7 on conservative care (5.5%). Compared with PD patients, those on HD were older (median age of 14.8 years [IQR 11.4-17.5] vs. 10.8 [IQR 2-6.5] vs.; p=0.002), had a longer transplant vintage ([55.2 months [13.2-100.3]) vs. 33 [5.1-82.2], and reentered dialysis in more recent calendar years (2013 [2007-2017] vs. 2004 [2001-2009]). Significant predictors for being treated with PD after KAF were a younger age at dialysis start (OR 0.83 per year increase [95%CI 0.72-0.94]) and a history of PD use before Ktx (OR 12.74 [2.2-74.6]). Patients returning to dialysis in more recent eras (OR 0.87 per year increase [0.81-0.94]) and those who were treated with more than one dialysis modality before Ktx (OR 0.15 for being treated with PD [0.04-0.63]) were more likely to be initiated on HD.
Over the observation period, 6 PD (13.6%) and 3 HD (4.2%) patients died. After adjustment for several covariates, patients on PD exhibited an increased risk for mortality compared with HD (HR 4.65 [1.12-19.30], while the difference for modality failure and access to renal transplantation did not reach statistical significance (Fig.1)

Conclusion
Patients returning to dialysis after KAF in more recent years are more likely to be initiated on HD rather than PD. According to our registry data, the use of PD is associated with a lower survival among patients initiating dialysis after KAF.
Fig.1 Cumulative incidences for the competing events, death, transplant and other techniques (solid line: PD, dash line: HD)
P1816KIDNEY DAMAGE IN NECROTIZING ENTEROCOLITIS OF PREMATURE BORN INFANTS
Authors: Kyslova Iuliia , Chornopyshchuk Nataliia , Yablon Olga , Konoplitska Anastasiia , Chornopyshchuk Roman 
Published: June 2020

Abstract

Background and Aims
Neonatal kidney damage can be the result of hypoxic-ischemic events or nephrotoxic drugs. The long-term effects of hypoxia on the kidneys are still unclear. Unlike full-term infants, premature infants of less than 36 weeks of gestational age exhibit persistent nephrogenesis According to literature database, ischemia as well as reperfusion and infection (hypoxia, acidosis, hypotension, the action of free oxygen radicals) are also major risk factors for necrotizing enterocolitis (NEC). The aim is to establish the peculiarities of kidney damage in necrotizing enterocolitis of premature infants who died from it and infants with NEC surviving.

Method
The study involved 54 of premature infants: 21 infants with NEC stage II and III who died (group A), 43 infants who survived with similar stages of NEC (group B). Statistical processing of the data obtained was carried out on a personal computer using STATISTICA 6.1 and IBM SPSS.

Results
Infants in group A had significantly higher body weight - (1371.2±70.5) g than infants in group B - (1163.9±51.6) g (p&lt;0.05). Gender peculiarities were established: boys (66.7%) were significantly more prevalent in group A, i.e. there were twice more boys among the dead (χ2 = 7.679; p = 0.006). In 85.7% children with NEC stage II and III who died was diagnosed perinatal hypoxia and 90.5% infants of this group have perinatal infections, p&lt;0.01. The level of serum urea and creatinine in children with NEC who died was significantly higher (21.2±2.9 mmol/l and 175.8±23.7 μmol/l respectively) than in premature infants who survived with NEC (6.8±0.6 mmol/l and 76.0±6.9 μmol/l, respectively), (p&lt;0.01). Odds ratio (OR) of lethal outcome in premature infants with NEC and elevated levels of urea (OR = 12.364; 95% CI: 3.415–44.768) and creatinine (OR = 8.267; 95 % CI: 2.447-27.589). In premature infants who died, one of the most frequent causes of death was acute kidney damage - in 8 (38.1%) infants, among other causes one of the most common causes was endogenous intoxication in 8 (38.1%) infants, rarely other causes.

Conclusion
Hypoxia and infections during pregnancy and during the birth of premature infants played a significant role in develop of kidney damage. Elevated levels of urea and creatinine in premature infants with NEC one of the factors that associated with mortality.
P1820THE DEVELOPMENT OF TRANSITION SERVICES IN RENAL CARE IN SYNERGY WITH YOUNG PATIENTS, PARENTS AND PEDIATRIC AND ADULT HEALTH CARE PROVIDERS: A CO-CREATION APPROACH
Authors: Els Holvoet , Van Biesen Wim , Van Humbeeck Liesbeth 
Published: June 2020

Abstract

Background and Aims
Healthcare transition to adulthood is recognised as challenging for adolescents and young adults (AYA’s) diagnosed with chronic kidney disease. Therefore the implementation of a transition programme adjusted to the needs of this patient population is of great importance. However, rarely are the views of young people or their families sought about the process or relevant outcome of their transition process. The aim of this study was to co-develop a transition programme that (1) enables health care providers to facilitate improving transition outcomes from the perspective of all stakeholders, and (2) enhances self-management by young people with chronic kidney disease.

Method
The development of this programme involved (1) an extensive review of currently existing best-practices (published and unpublished), and (2) understanding the current state of transition practice at our centre by means of semi-structured interviews and focus groups with patients, parents and health care providers of both pediatric and adult side.

Results
A working group was established incorporating a reflective process designed to develop a community of practice. During the process, participants’ experiences, lessons learned from the review of current state of evidence and practice, and appreciation of the (changing) context within which participants were working were incorporated. Analysis revealed 6 core elements as the foundation of the transition program: the AYA as the main focus, involvement of the parents, holistic approach, flexibility, forward-looking approach, continuity in guidance and follow-up. We also identified the need to distinguish the difference between transitioning from child to teenager to young adult and the actual transfer between paediatric and adult care. The actual final proposed transition programme can be divided in 4 phases: (1) introduction of the transition process to parents and patients, (2) guiding the patient to become more independent and to gain insight in the disease and related themes, (3) managing the transfer to adult health care and (4) finalizing the transition care plan. Adequate on-going communication and collaboration between paediatric and adult care seems essential for achieving a successful program.

Conclusion
This study addressed the development of a transition programme as a multi-actor process wherein patients, parents and health care providers significantly contribute to the transition to adulthood and transfer to adult care.
P182125 YEARS OF GROWTH HORMONE TREATMENT IN CHILDREN WITH CHRONIC KIDNEY DISEASE IN POLAND - RESULTS OF NATIONAL MULTICENTER STUDY
Authors: Leszczyńska Beata , Daniel Maria , Majcher Anna , Pyrzak Beata , Szczepanska Maria , Zagozdzon Ilona , Jander Anna , Tkaczyk Marcin , Sikora Przemysław , Wasilewska Anna , Zachwieja Katarzyna , Miklaszewska Monika , Stankiewicz Roman , Jarmuzek Wioletta , Rubik Jacek , Makulska Irena , Pańczyk-Tomaszewska Małgorzata 
Published: June 2020

Abstract

Background and Aims
Growth retardation is one of considerable problems in children with chronic kidney disease (CKD) with a great impact on life activity and quality of life. Recombinant human growth hormone (rhGH) treatment has been used for more than 30 years to improve growth velocity and final growth in children with CKD. In Poland rhGH therapy in children with CKD is available since 1994.
The aim of the study was to assess growth velocity in all children with CKD treated with rhGH in Poland since 1994.

Method
We retrospectively analyzed 321 polish children with CKD (mean age: 10.2±7.60, 210 ♂ (65%) qualified to the rhGH therapy between 1994 and 2019. Among 321 children, 180 (56.1%) were on conservative treatment (CT), 118 (36.7%) on chronic dialysis (RRT) and 23 (7.2%) after kidney transplantation (KTx). In 240 (75%) patients who were treated continuously for at least 12 months we have evaluated: growth velocity and mean annual values of selected biochemical parameters.

Results
Mean height SDS at the beginning of the treatment was -2.73±1.04 SD, among children on CT -2.22±1.20, on RRT -2.9±1.11, after KTx -3.07±1.30. Mean time of rhGH treatment was 23±10.7 months. During one-year rhGH treatment mean growth velocity in 240 children was: 8.5 ± 2.7 cm (ΔSDS 0.78±1.02) and mean height SDS increased significantly
(-2,73±1.04 vs. -1.92±1.11, p&lt;0.0001). Children on CT did not differ significantly in age vs. children on RRT (10.66±3.40 vs. 10.26±3.61 years, p =0.972), and growth velocity was slower in RRT group expressed in cm (7.52±2.59 vs. 9.2±2.30, p&lt;0.0001) and in ΔSDS (0.4±0.83 vs. 0.72±1.15, p=0.045). Growth velocity (ΔSDS) correlated negatively with age of rhGH initiation in children on CT (r=-0.40, p=0.008) and on RRT (r=-0.28, p=0.03). We found no significant relation between growth velocity and sex, cause of CKD, hemoglobin, total protein, albumin, urea, creatinine, calcium, phosphorus, Ca x P, PTH and alkaline phosphatase.

Conclusion
1. Growth hormone treatment is highly effective in children with CKD especially those who are treated consevatively. 2. Early initiation of rhGH therapy is the crucial factor determining response to the treatment in children with CKD.
P1849ANALYSIS OF ASSOCIATION BETWEEN URBANIZATION AND REDUCED RENAL FUNCTION IN INDIAN POPULATION
Authors: Kumar Rahul 
Published: June 2020

Abstract

Background and Aims
While chronic kidney disease (CKD) is a growing public health concern in low- and middle-income countries, such as India, few studies have investigated the association between urbanization and the occurrence of CKD in those countries.

METHODS
We investigated the association between urbanization and estimated glomerular filtration rate (eGFR), an important CKD risk marker. Data came from the India Health and Nutrition Survey wave 2017, in which we collected fasting serum, individual and household data along with community level urbanization data, which was used to derive a study-specific urbanization measure, in 218 communities across fifteen states. A total of 8754 men and 8566 women participants aged 18 years or older were included in the analysis. Reduced renal function was defined as eGFR of less than 60 mL/min/1.73 m2 measured using serum creatinine concentration (mg/dL).

RESULTS
After adjusting for socio-demographic (e.g., age, education and household income), a sex-stratified multilevel logistic model revealed that living in a more urbanized community was associated with higher odds of reduced eGFR (odds ratio [OR] = 1.38 per one-standard deviation [SD] increase in the CHNS specific urbanization index, 95% confidence interval [CI] = 1.11-1.73 for men; OR = 1.35, 95% CI = 1.11-1.62 for women). After adjusting for behavioral variables (i.e., alcohol consumption, smoking, physical activity and diet), as well as obesity and cardiometabolic risk factors, the association was attenuated in men (OR = 1.25, 95% CI = 0.98-1.59), but remained statistically significant in women (OR = 1.24, 95% CI = 1.01-1.52).

CONCLUSION
Our findings suggest that living in an urban environment is linked with higher odds of reduced renal function independently of behavioral and cardiometabolic risk factors, which have been shown to increase along with urbanization.
P1858PSYCOEDUCATIONAL TEAM IN PRE- HEMODIALYSIS FOR PATIENTS AND CAREGIVERS
Authors: Mulè Marica , Gaggia Paola , Movilli Ezio , Manenti Chiara , Appiani Miriam , Zani Orietta , Bertoni Anna , Scolari Francesco 
Published: June 2020

Abstract

Background and Aims
The aim of this work is to explain the training to create a multidisciplinary team that in the future will activate the psychoeducational groups in nephrology. These groups will be support to patients and caregivers already in the waiting period from the intervention of the fistula at the beginning hemodialysis.

Method
The training of five meetings was realized from March 2019 to May 2019. The training for a team composed by 3 nephrologist, 4 nurses, 1 dietician, 1 nursing coordinator was conducted of a psychologist to established modalities and aims of a psychoeducational pathway for patients that will begin hemodialysis and their caregivers. In the first meeting, through a focus group, the participants discussed the word “to cure”. In the second meeting participants defined patient and caregiver’s needs after the diagnosis of Chronic Kidney Disease. In the third meeting the team work defined the objectives and methods of conducting future groups psychoeducational. In the fourth meeting participants decided the duration and modalities of the psychoeducational pathway for patient and caregiver. Finally, in the fifth meeting, the team reviewed the objectives, recipients and thematic areas of the meetings for patients and caregivers. In addition, an evaluation questionnaire was administered to verify the benefit and satisfaction of the training. All the contents of the training were transcribed in a diary and analyzed with a pencil and paper mode.

Results
In the first meeting the team discussed the need to accompany and educate patients even before the onset of haemodialysis. In the second meeting team decided that the therapeutic education is not only for patients waiting to start haemodialysis but also on their caregivers often uninformed and not involved by doctors and nurses. In this focus the caregiver appears an important figure that support the patient at home and if not properly informed it can become an obstacle in patient care. In the fourth and fifth meetings have been defined a possible psychoeducational training in three total meetings so named:
The participants in the satisfaction questionnaire to the question “how much did this training respond to the needs of your job?” on nine answers collected, the outcome it was M = 4.7 on Likert scale 1(few)-5 (much).

Conclusion
The training has managed to build a multidisciplinary team ready to care patients and caregivers that will begin haemodialysis in a more informed and aware way. Currently, two psychoeducational groups have been created for patient and caregiver. As shared in the multidisciplinary team’s training these psychoeducational groups are activated to help the patient to accept dialysis at the same time help the family member to take on the role of caregiver. This project has made it possible to improve not only teamwork but overall patient and caregiver care.
P1861ARTIFICIAL PHOSPHATE- HOW DIFFICULT IS IT TO AVOID IT?
Authors: Smith Oonagh , Kiernan Sarah 
Published: June 2020

Abstract

Background and Aims
Hyperphosphataemia has been independently associated with increased morbidity and mortality across the lifecycle of chronic kidney disease. Dietary phosphate restriction is the corner stone of hyperphosphataemia management. Traditionally the focus was on limiting foods that are naturally high in phosphate such as meats, dairy, wholegrain and nut products. However, phosphate-containing additives are a growing concern. Artificial phosphates are thought to be readily absorbed by the body and are increasingly being added to processed foods, at a time when there is an increased desire and reliance on convenience foods. It has been shown that educating patients with end stage renal disease to avoid phosphate-containing food additives can result in a modest but clinically significant improvement in serum phosphorus levels. 1 The aim of this study was to evaluate how feasible it is for a patient to source convenience packaged cooked meats/poultry that are free from artificial phosphate and if such products are a suitable option for the renal patient in relation to salt and protein content.

Method
Data was manually collected in a branch of the five leading supermarket chains. The ingredient list of each product food label was checked for artificial phosphate (phos), artificial potassium (K) or the corresponding E numbers and the nutrition table examined for salt and protein content (per 100g / 25g portion or slice). The price was checked in store and manually calculated per 7g protein exchange.

Results