bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1002EFFECT OF VITAMIN D ON URINARY ANGIOTENSIOGEN LEVEL IN EARLY DIABETIC NEPHROPATHY
Authors: Mahapatra Himansu , Kumar Adarsh , Kulshreshtha Bindu , Chirkara Anubhuti 
Published: June 2020

Abstract

Background and Aims
UrinaryAngiotensinogen (UAGT) is supposed to be a marker of activation of intrarenalreninangiotensin system (RAS) system in early Diabetic Nephropathy (DN). Vitamin D has been studied as a negative regulator of the circulating and tissue RAS activity; so its supplementation may prevent progression of DN. This study was planned to assess the RAS activation and effect of vitamin D supplementation in early diabetic nephropathy progression by estimatingUAGT level.

Method
A total of 730 Diabetic subjects were screened for early DN based on Inclusion criteria(eGFR ≥ 120ml/min/1.73m2 with unrestricted ACR value eGFR of 60- 120 mL/min/1.73m2 and ACR 30-300mg) and Exclusion criteria(on ACE I or ARB, eGFR&lt;60ml/min/1.73m2, Hypercalcemia (&gt;11.5mg%), UTI, Pregnancy, Hypertension, HbA1c (&gt;8.0 %), vitamin D supplementation during the last 6 month).Of them 103 included subjects were underwent randomization to receive either Cholecalciferol(54) or matching Placebo(49) in a double blind method. All were subjected to routine investigations, urinary albumin: creatinine (UACR), UAGT, serum 25(OH)vitamin D, and intact parathyroid hormone (iPTH) at the zero and six months. A total 40 healthy controls without any comorbidity were also includedfor assessment of same investigations at zero month. Comparative results at zero months of all three groups were analyzed.

Results
The change in levels of UACR (mg/g), UAGT (ng/ml), vitamin D (ng/ml) and iPTH(pg/ml)in Cholecalciferol group from zero to six month were [Median (IQR)] : 12.50 (-24.82 to -5.95); p&lt;0.001, -6.60 (-20.91 to -2.63);p&lt;0.001, 5.75 (2.07-9.70); p&lt;0.001, -5.35 (-11.55 to -3.67) ;p&lt;0.001, respectively. After six months, median (IQR) of UAGT and UACR levels were significantly lower in the Cholecalciferol group as compared to Placebo group (p&lt;0.001 and p= 0.04 respectively).Significant reduction of UACR (mg/g) and UAGT (ng/ml) level corroborating with increase in 25(OH) vitamin D(ng/ml) levelfrom zero to six months (all three p&lt;0.001). There was significant correlation of vitamin D3 level with UAGT (r value: -0.255 & p value: 0.009) and UACR level (r value: -0.28& p value: &lt;0.01). The median UAGT level was significantly higher in patients with early DN (Cholecalciferol&Placebo Group) than Control Group at zero month (p =0.001).

Conclusion
Significantly higher UAGT levels in early DN supports role of intrarenal RAS activation. Significant decrease in UAGT level in cholecalciferol group supports beneficial role of vitamin D supplementation in progression of early DN.
P1005LONG NONCODING RNAS MAY INTERVENE IN PODOCYTE INJURY AND PROXIMAL TUBULE DYSFUNCTION THROUGH MODULATING MIRNAS EXPRESSION IN EARLY DIABETIC KIDNEY DISEASE OF TYPE 2 DIABETES MELLITUS PATIENTS
Authors: Petrica Ligia , GADALEAN FLORICA , VLAD ADRIAN , Vlad Mihaela , DUMITRASCU VICTOR , VELCIOV SILVIA , Gluhovschi Cristina Anca , Bob Flaviu , URSONIU SORIN , JIANU CATALIN , MATUSZ PETRU , Pusztai Agneta , CRETU OCTAVIAN , OANA MILAS , GOLEA-SECARA ALINA , SIMULESCU ANCA , MOGOS-STEFAN MARIA , PATRUICA MIHAELA , POPESCU ROXANA , Vlad Daliborca 
Published: June 2020

Abstract

Background and Aims
Interactions among multiple molecules and signalling pathways contribute to the pathogenesis and progression of diabetic kidney disease (DKD). Long noncoding RNAs (lncRNAs) play key roles in the pathophysiology of DKD involving actions of microRNAs (miRNAs). The aim of the study was to establish the involvement of selected lncRNAs in the epigenetic mechanisms of podocyte damage and tubular injury in DKD of type 2 diabetes mellitus (DM) patients. The molecular mechanisms of lncRNAs intervention were evaluated in relation to a particular miRNA profile.

Method
A total of 136 patients with type 2 DM and 25 healthy subjects were enrolled in a cross-sectional case series study and assessed concerning urinary albumin: creatinine ratio (UACR), eGFR, biomarkers of podocyte damage (synaptopodin, podocalyxin) and proximal tubule (PT) dysfunction (Kidney injury molecule-1-KIM-1, N-acetyl-D-glucosaminidase-NAG), urinary lncRNA metastasis-associated lung adenocarcinoma transcript 1 (MALAT1), nuclear-enriched abundant transcript 1 (NEAT1), myocardial infarction-associated transcript (MIAT), taurine-upregulated gene 1 (TUG1), and urinary miRNA21, 124, 93, 29a (quantified by a real-time PCR System).

Results
Multivariable regression analysis yielded models in which urinary lncRNA MALAT1 correlated directly with urinary synaptopodin, podocalyxin, KIM-1, NAG, miRNA21, 124, UACR, and negatively with eGFR, miRNA93 and 29a (p&lt;0.0001; R2=0.727); urinary lncRNA NEAT1 correlated directly with synaptopodin, KIM-1, NAG, miRNA21, 124, and negatively with eGFR, miRNA93, and 29a (p&lt;0.0001; R2=0.702); urinary lncRNA MIAT correlated directly with miRNA93 and 29a, and eGFR (p&lt;0.0001; R2=0.671) and negatively with synaptopodin, KIM-1, NAG, UACR, miRNA21, and 124 (p&lt;0.0001; R2=0.654); urinary lncRNA TUG1 correlated directly with eGFR, miRNA93 and 29a, and negatively with synaptopodin, podocalyxin, NAG, miRNA21, and 124 (p&lt;0.0001; R2=0.748). The results provided document upregulated lncRNA MALAT1 and NEAT1, as well as miRNA21 and 124. By contrast, lncRNA MIAT and TUG1, and miRNA93 and 29a were downregulated.

Conclusion
In patients with type 2 DM lncRNAs exert distinct functions in different cell types, either deleterious or protective, at both glomerular and tubular level. LncRNAs may contribute to DKD through modulating miRNAs expression and activities. This observation holds true independently of albuminuria and DKD stage.
P1009RENAL OUTCOMES IN DIABETIC KIDNEY PATIENTS TREATED WITH GLP1 AGONIST RECEPTORS VS SGLT2 INHIBITORS
Authors: Maroto Alba , Marques Vidas Maria , Sanz Ignacio , López Paula , Portoles Jose' M 
Published: June 2020

Abstract

Background and Aims
End stage renal disease of diabetic cause is an increasing issue worldwide. Both GLP1 antagonist receptors (GLP1ar) and the sodium-glucose co-transporter 2 inhibitors (SGLT2i) have shown promising results in preventing or ameliorating the progression of renal disease, however there is no data comparing the effect of both drugs on renal outcomes.

Method
Here we present the result of a retrospective study analyzing the main renal outcomes of 98 T2DM patients treated with GLP1ar (25% dulaglutide, 25% liraglutide, 50% semaglutide) or SLGT2 (46.9% dapagliflozin, 21% empagliflozin, 32.1% canagliflozin). All participants were on ACEi/ARB on maximally tolerated dose and patients that have been on both treatments at any time during observation period were excluded. Mean follow-up was 1,9 years, (SD 1,1).

Results
Main descriptive data are shown on the table: in summary, patients on SGLT2i had higher eGFR (64,7 SD 22,7 vs 43,7 SD 13,5) ml/min/1,73m2 (p&lt;0.001), lower BMI (30,2 SD 4,8 vs 35,0 SD 4,0 p&lt;0,001) and were more frequently free from previous cardiovascular events (60% vs 29,4%, p 0,02)Incident kidney disease defined as drop of eGFR below 60 ml/min/1,73m2 and/or new onset albuminuria occurred on 18 (39,1%) and 7 (87,5%) of patients on SGLT2i and GLP1ar respectively (p 0,01), however, nor SGLT2i or GLP1ar treated patients suffered significant decrease on eGFR along the study period (2.5% change in eGFR-SGLT2i and 5% in GLP1ar). We found no significant differences on arterial blood pressure or glycemic control along the study period and BMI decrease was only significative on GLP1ar patients (-7,7%, p&lt;0.001)6,7% and 15,8% of patients treated with GLP1ar and SGLT2i respectively suffered one CV event along the follow-up period (p ns) with 6,7% deaths on both groups (0.03 death/patient-year). Adverse events were similar on both groups though discontinuation rate was higher on SGLT2i (16,7% gastrointestinal intolerance, 58% “others”)

Conclusion
We conclude that both GLP1ar and SGLT2i prevent progression of kidney disease in T2DM patients. Though GLP1ar patients showed higher rates of incident kidney disease, when initiated on already decreased GFR this treatment achieved similar results to SGLT2i in preventing progression of kidney disease even in high cardiovascular risk patients.
P1012NAIL CAPILLARY DENSITY DURING POSTOCCLUSIVE REACTIVE HYPEREMIA AND VENOUS CONGESTION IS MORE IMPAIRED IN DIABETIC COMPARED TO NON-DIABETIC CKD PATIENTS
Authors: Schoina Maria , Loutradis Charalampos , Memmos Evangelos , Triantafillidou Eva , Pagkopoulou Eleni , Dimitroulas Theodoros , Garyfallos Alexandros , Papagianni Aikaterini , Sarafidis Panteleimon 
Published: June 2020

Abstract

Background and Aims
Αlterations in endothelial function and capillary circulation have been associated with increased cardiovascular events and overall mortality. Both diabetes mellitus (DM) and chronic kidney disease (CKD) have been associated with microcirculatory damage. Nailfold video-capillaroscory can provide a thorough assessment of capillary density and microcirculation changes. This is the first study examining in comparison microcirculatory function parameters in diabetic and non-diabetic patients with CKD.

Method
We included 48 diabetic and 48 non-diabetic adult patients (&gt;18 years) with CKD (eGFR: &lt;90 and ≥15mL/min/1.73m2), matched in a 1:1 ratio for age, sex and eGFR within each CKD stage (2, 3a, 3b and 4). All participants underwent nailfold video-capillaroscopy, during which capillary density was measured at normal conditions (baseline), after a 4-minute arterial occlusion (postocclusive reactive hyperemia) and at the end of a 2-minute venous occlusion (congestion phase).

Results
Baseline demographic, anthropometric and laboratory characteristics were similar between patients with and without diabetes in total and in CKD stages. Overall, no significant differences at baseline capillary density were observed between groups; however diabetic patients presented significantly lower capillary density during reactive hyperemia (36.3±3.8 vs 38.3±4.3 capillaries/mm2, p=0.022) and at venous congestion (37.8±4.0 vs 39.8±4.2 capillaries/mm2, p=0.015). When stratified according to CKD stages, the between-group differences in parameters of interest were not significant in stages 2, 3a and 4. In stage 3b, capillary density was significantly lower in diabetic compared to non-diabetic subjects at baseline (31.1±2.8 vs 33.4±3.4 capillaries/mm2, p=0.044), during postocclusive hyperemia (36.8±2.7 vs 40.0±4.3 capillaries/mm2, p=0.037) and venous congestion (38.3±2.8 vs 41.5±3.5 capillaries/mm2, p=0.022).

Conclusion
Capillary density during postocclusive reactive hyperemia and after venous congestion is lower in diabetic compared to non-diabetic CKD patients, a finding indicative that diabetes is an additional factor contributing to microcirculatory functional impairment in CKD. These differences are more prominent in CKD stage 3b, and less prominent in earlier and later stages.
P1020ROLE OF CHRONIC KIDNEY DISEASE AND ASSOCIATED BIOCHEMICAL ALTERATION ON ARTERIAL STIFFNESS IN T2 DIABETIC PATIENTS WITHOUT CARDIOVASCULAR DISEASE
Authors: Rotondi Silverio , Tartaglione Lida , Pasquali Marzia , Muci Maria Luisa , Mazzaferro Sandro , D'onofrio Luca , Carbone Angela , Leto Gaetano , Mignogna Carmen 
Published: June 2020

Abstract

Background and Aims
DMT2 and its complications such as chronic kidney disease (CKD) lead to increase vascular stiffness, measurable with CAVI, and biochemical alterations in substances implicated in vascular damage like Klotho, FGF23, and Sclerostin. The aim of the study was to evaluate the role of CKD stage 1-2 and possible alterations of 25 (OH)Vitamin-D, FGF23, Klotho, and Sclerostin on early vascular damage in DMT2 patients

Method
Patients included: DMT2 from &lt;10 years, age &lt;60 years, no insulin therapy, eGFR≥60 ml/min/1.73m2, absence of vascular complications. We have evaluated CAVI, albumin-excretion-rate (ACR), 25(OH)Vitamin-D, Klotho, FGF23, and Sclerostin. 30 healthy subjects were the control for CAVI, Klotho, FGF23 and Sclerostin.

Results
We enrolled 40 women and 60 men, average age 56 years (IQR: 52-59), 5-year DMT2 (IQR: 2.7-7), HbA1c 6.3% (5.8-6.7), eGFR of 95 ml/min/1.73m2. FGF23 (42±10 vs controls 29.8±11 pmol/l, p&lt;.05) and Sclerostin (36.2±7 vs 26.6±1 pmol/l, p&lt;.05) were increased and Klotho reduced (673±300 vs 845±330 pg/ml, p&lt;.05). CKD (ACR≥30mg/gr; eGFR between 60-90 ml/min /1.73m2) was present in 12.6%. The mean CAVI value was normal. Patients with borderline (≥8, 33%) and pathological (≥9, 13%) CAVI were older (p.001), with longer duration of DMT2 (p.022) and lower 25(OH)Vitamin-D (p.041). CAVI correlated positively with age (p.001), Hb1Ac (p.036), systolic blood pressure (SBP) (p.012) and diastolic blood pressure (DBP) (p.001) and correlated negatively with 25(OH)Vitamin-D (p.046). The multivariate analysis showed positive predictors of CAVI age (p.001), DBP (p.0001), ACR (p.008) and Klotho (p.017).

Conclusion
In our DMT2 population, borderline and pathological CAVI is associated with increased ACR, elevated DBP and reduced 25(OH)Vitamin-D. Furthermore the alterations of FGF23, Sclerostin and Klotho, secondary to CKD, are an early sign of possible vascular damage. ACR, 25(OH)Vitamin-D and DBP can be modifiable risk factors for early vascular damage in DMT2
P1023DEPRESSION IS A MAJOR DETERMINANT OF HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH DIABETIC KIDNEY DISEASE
Authors: Kim Suhyun , Boo Hyo jin , Jeon Jeunseok , Jang Hye Ryoun , Huh Wooseong , Kim Yoon-Goo , Kim Dae Joong , Lee Jung Eun 
Published: June 2020

Abstract

Background and Aims
Poor health-related quality of life (HRQOL) is associated with increased cardiovascular risk and mortality in patients with kidney disease. Therefore, it is critical to identify and modify clinical contributors of poor HRQOL. This study examined modifiable factors associated with poor HRQOL in patients with diabetic kidney disease (DKD) focusing on depression, anxiety, sleep quality, and physical activity.

Method
Between April 2017 and March 2018, 141 adults (aged ≥18 years) with DKD were recruited in single tertiary hospital. HRQOL was assessed at baseline with the Short Form 36 of life Health Survey Question (SF-36) questionnaire. Poor HRQOL was defined as a score below the median value at baseline. Depression and anxiety were assessed with the Hospital Anxiety and Depression Scale. Sleep quality and physical activity were measured using Korean version of the Pittsburgh Sleep Quality Index and International Physical Activity Questionnaire respectively.

Results
The age was 65 [57-72] years old, and 73% (n=103) of participants were men. Prevalence of anxiety and depression were 8% (n=11) and 17% (n=24) respectively. Forty-eight (34%) subjects corresponded to poor sleepers and 40 (28%) subjects showed low physical activity. SF-36 scores were decreased with advanced CKD stages (stage 3, 79 [71-82]; stage 4, 71 [56-82]; stage 5, 70 [57-82]; p = 0.029 for trend) progressively. Anxiety, depression, and poor sleep quality were negatively correlated with SF-36 scores (p &lt; 0.05). eGFR and physical activity were positively correlated with HRQOL scores (p &lt; 0.05). In multivariable logistic analysis, depression scores were associated poor HRQOL independently of age, sex, comorbidity, eGFR, anemia, sleep quality, anxiety and physical activity (odds ratio per 1-score increment, 1.51; 95% confidence interval, 1.27-1.80, p &lt; 0.001).

Conclusion
In patients with DKD, depression was a major determinant of poor HRQOL among the modifiable clinical factors such as anxiety and sleep. Active surveillance of depression and psychosocial intervention should be considered to improve the well-being of these patients.
P1025HISTOLOGICAL AND CLINICAL FINDINGS IN ADULT AUTOPSIES OF TYPE 2 DIABETES MELLITUS PATIENTS WITH OR WITHOUT DIABETIC KIDNEY DISEASE
Authors: Gimenez-Civera Elena , Puchades Montesa Maria Jesãºs , Terrádez Liria , Moscardo Anais , D'Marco Luis , Pérez Ys Aurora , Moncho Francesc , Perez-Bernat Elisa , Panizo Gonzalez Nayara , Tomas Patricia , Gonzalez-Rico Miguel , Gorriz Jose Luis 
Published: June 2020

Abstract

Background and Aims
Few studies have analyzed early lesions of diabetic nephropathy (DN) in those patients who do not have clinical signs of this involvement, since the indication of renal biopsy is usually performed in patients with significant renal manifestations.The aim of the study was to analyze renal histological lesions from autopsies of diabetic patients with or without clinical expression of DN. Thus, we analyze their correlation according to the presence or absence of proteinuria (albumin/creatinine to ratio &gt; 300). Autopsies from non-diabetic patients was used as a control group.

Method
Kidneys from autopsies of 21 patients with type 2 diabetes mellitus (T2DM) and 4 non-diabetic controls were analyzed by two pathologists. The histological lesions score of DN was performed according to the classification of Tervaert et al. (JASN. 2010; 21: 556–63), and a description of histological findings, clinical and analytical data were made.

Results
The mean glomeruli per sample was: 170 ±88. Patient demographics of autopsies: mean age 76 ± 11 years, mean duration of diabetes 6.08 ± 3.2 years (20%&gt; 10 years). Last known eGFR: 51 ± 28, HbA1c: 7.3 ± 1.9%. Albuminuria and cardiovascular disease were present in 42% and 60% of patients with T2DM. Histological and clinical data are shown in Table and Graphics.

Conclusion
A high percentage of diabetics without early clinical lesions of DN (albuminuria) already express moderate to severe histological changes, especially severe mesangial expansion and severe glomerular vascular lesions. The control group showed minimal histological lesions except for mild expansion of the mesangium and inflammation associated with IFTA. Our data suggest renal involvement in T2DM is present in earlier stages (patients without albuminuria). Therefore, early metabolic control is important, as well as other risk factors that may influence in the development of DN. Large sample size studies are pending to confirm these data.
P1032CMV INFECTION & RISK OF NEW ONSET DAIBETES AFTER TRANSPLANTATION
Authors: KHAN MUHAMMAD TASSADUQ 
Published: June 2020

Abstract

Background and Aims
NODAT is a frequent complication among kidney transplant recipients and is considerably associated with risk of allograft rejection and allograft loss. The present research study was aimed to identify whether CMV infection acts as risk factor for NODAT development in kidney transplant recipients.

Method
This retrospective study recruited 59 kidney transplant recipients (43 males and 16 females). The diagnosis of NODAT was established if two fasting plasma glucose readings were ≥126 mg/dL after the 3rd month of post-transplantation. We carefully monitored recipients for CMV viremia (CMV DNA copies/mL) in the plasma through quantitative Polymerase Chain Reaction (qPCR). The 1 year post-transplantation allograft outcomes due to CMV viremia were also measured; eGFR (CKD-EPI method), allograft and transplant patient survival.

Results
In this study, 14 (23.7%) patients were diagnosed with NODAT. The CMV load and CMV viremia was elevated in NODAT cohort in comparison with their counterparts (4000 versus 3600 and 51.1 versus 47.6, respectively); however, no statistical relationship was observed (P = 0.79 and P = 0.84, respectively). We witnessed significantly high CMV DNA replication in first (1-6 months) half of the post-transplant period in both controls and NODAT patients; however, statistically significant CMV DNA replication was only observed for NODAT cohort (P&lt;0.001). Majority of the NODAT diagnoses; 9 out of 14 (64.3%), in our cohort was made during the first six months of kidney transplantation (P&lt;0.001). Overall, 7 (11.9%) of the kidney transplant recipients recruited in our study progressed to symptomatic CMV infection. We also witnessed that a greater CMV viremia load was worsening the kidney allograft function at 12 months post-transplantation. The allograft and patient survival (censored for death) was poor in the NODAT cohort; however, without any statistical significance.

Conclusion
The present study demonstrated that CMV infection is not a risk factor for NODAT development among kidney transplant recipinets.
P1036THE SHORT-TERM EFFICACY AND SAFETY OF THE APPLICATION OF SGLT2I AS A DIURETIC MEDICATION ON THE DIURETIC RESISTANCE IN PATIENTS WITH DIABETIC NEPHROPATHY ON CKD STAGE 3-4
Authors: Liang Wei 
Published: June 2020

Abstract

Background and Aims
At stage 3-4 of chronic renal disease, patients with diabetic-induced renal dysfunction are not sensitive to the conventional diuretic therapy based on loop diuretics and thiazide diuretics, leading to the earlier renal replacement at stage CKD 3-4. The lower sodium excretion could contribute to the development of diuretic resistance. The protective effects of SGLT2 inhibitors on cardiovascular is contributed by metabolic regulation and osmotic diuretic effect of glucose due to extra excretion of Glucose. The present study aim to investigate the efficacy and safety of SGLT2 inhibitors on the diuretic resistance of diabetic nephropathy at CKD 3-4 stage.

Method
Patients with Diabetic nephropathy at CKD3-4 stage were administrated with furosemide + hydrochlorothiazide for 3 days with urine volume &lt;1000ml, urine sodium excretion &lt;90mmol followed by Dapagliflozin/Canagliflozin once a day for 7 days.

Results
3 male and 7 female patients with diabetic nephropathy were included, aged 51-80 years, with eGFR 60-4.6ml/min, and 3 patients presented with cardiac insufficiency. Urine volume was 800±300ml/24 hours before treatment and 2000±500ml/24 hours after treatment. Sodium excretion in urine was 80±20mmol/24 hours before treatment and 150±50mmol/24 hours before treatment. The average net weight change was -3.5±2.2kg. The Scr increased by 30%±5% before and after treatment, and the renal function in 2 patients increased by &gt;30% after 7 days of treatment, and returned to the level of Scr before treatment after 7 days of withdrawal of Dapagliflozin/ Canagliflozin. Electrolyte levels were comparable before and after treatment.

Conclusion
The diuretic regimen based on SGLT2i could significantly improve the resistance of diabetic nephropathy patients to loop diuretics, increase urinary sodium excretion, and slightly elevate renal function in the short term without affecting blood electrolyte level. The efficacy and safety of long-term use of SGLT2i in diabetic nephropathy patients at CKD3-4 stage need further investigate in larger sample size.