bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0915PROTEIN ENERGY WASTING IS ASSOCIATED WITH A DECLINE IN MUSCLE PROTEIN SYNTHESIS IN CKD PATIENTS
Authors: Saio Michela , Sofia Antonella , Russo Rodolfo , Cipriani Leda , Garibotto Giacomo , Verzola Daniela 
Published: June 2020

Abstract

Background and Aims
Skeletal muscle is a highly adaptive tissue, however even small imbalances between protein synthesis and degradation can lead to substantial protein loss. Althought proteolysis plays a major role in the development of cachexia in CKD (chronic kidney disease), the responses of muscle protein metabolism to malnutrition had not been completely elucidated.
We evaluated retrospectively the results of kinetic studies of protein turnover estimated by the forearm perfusion method associated with H2phenylalanine kinetic, obtained in CKD patients and controls in the last 25 years.

Method
We analyzed 59 forearm H2phenylalanine kinetic studies obtained in 14 controls (C) (M 11, F 3) and 45 patients with CKD, of whom 15 (M 10, F 5) were on conservative treatment (CKD stage IV-V), 16 (M 14, F 2) under maintenance hemodialysis (HD), 14 (M 12, F 2) in peritoneal dialysis (DP); all subjects were on non-restricted protein/calorie (0.8-1.1 g/kg and 28-32 kcal/kg, respectively) diets. Ten (M 9, F 1) HD patients had Protein Energy Wasting. Acidosis was corrected in all patients (HCO3 24.2±1.9 mmol/L) and studies were performed in the post-absorptive overnight fasted state at rest.

Results
Overall, Muscle protein synthesis and degradation were similar (p=NS) in patients and controls. Protein net balance was reduced in patients with PD and those with CKD Stage IV-V (p &lt;0.003 - p &lt;0.014) indicating a reduced catabolic state and nitrogen conservation. However PEW HD patients showed reduced rates of protein synthesis and degradation (p &lt;0.048 and p &lt;0.04 respectively). In addition the efficiency of muscle protein turnover, a parameter expressing muscle's ability to reuse amino acids derived from degradation into protein synthesis, was significantly reduced in HD PEW patients vs. controls (55.5 vs. 61.2 %, p &lt;0.018, respectively) and vs. not malnourished patients in conservative treatment (70.1 % p &lt;0.0025) or in PD (74.6 % p &lt;0.005).

Conclusion
In CKD patients, in absence of acidosis, muscle is able to increase the efficiency of protein metabolism for the maintenance of nitrogen balance. However, in PEW patients, combined alterations of protein synthesis and degradation proceed together to a reduced efficiency of amino acids recycled into protein synthesis and contribute to maintaining wasting. These data also suggest that calorie/protein requirements of CKD patients with PEW may be higher than currently theorized.
P0920THE METHIONINE RESTRICTION DIET ATTENUATES CHRONIC KIDNEY PROGRESSION IN MICE
Authors: Yang Jihyun , Min Hyeon-jin , Sun Bong Gyun , Son Young-Bin , Choi Eunho , Oh Se Won , Kim Myung-gyu , Jo Sang-Kyung , Cho Won-Yong 
Published: June 2020

Abstract

Background and Aims
The clinical usefulness of protein-restricted diets is known to slow the progression of obesity, fatty liver, aging and cancer. Protein-restricted diet in chronic kidney disease is known to alleviate the deterioration of the renal function. The purpose of this study is to confirm whether the reduction in new function can be improved when methionine restricted (MR) diet is supplied in the chronic kidney disease (CKD) animal model and to study the its renoprotection mechanism.

Method
We used four-week-old C57L/B6 to make a CKD model by administration 0.025% adenine chow mixed with R3 diet for four weeks for the control group. For the MR diet group, we supplied the mixture of 0.025% adenine with methionine/Choline Deficient Diet. We measured serum blood urea nitrogen (BUN), serum creatinine, gut permeability, stool short chain fatty acid (SCFA), kidney α-SMA and renal pathology. This study was approved by Korea University Institutional Animal Care and Use Committee (KOREA-2019-0047).

Results
The principal coordinates analysis of the microbiome showed the two groups have distinctive component features. The stool SCFA, especially butyrate was increased in the MR diet group. However, gut permeability using FITC-dextran showed no significant change. The kidney α-SMA and MT stain area showed that the MR diet could improve renal fibrosis. The kidney inflammation including neutrophil and macrophage infiltration was also improved in histology analysis. The macrophage phenotype was more favorable to M2 type. Serum BUN and creatinine were significantly attenuated in the MR diet group.

Conclusion
In conclusion, the MR diet has a reno-protective effect in adenine induced CKD. The MR diet increased butyrate production and decreased renal inflammation and fibrosis. These results shed light on the role of protein restriction diet for CKD management in the real world.
P0926ASSOCIATION OF HIGH-SENSITIVE C-REACTIVE PROTEIN WITH CARDIOVASCULAR EVENTS, MORTALITY, AND ADVERSE KIDNEY OUTCOMES IN KOREAN PATIENTS WITH CHRONIC KIDNEY DISEASE: RESULTS FROM KNOW-CKD
Authors: Lee Changhyun , Park Keun Hyung , Joo Young Su , Nam Ki Heon , Chang Tae-Ik , Kang Ea Wha , Lee Joongyub , Oh Yun Kyu , Jung Ji Yong , Ahn Curie , Lee Kyu-Beck , Park Jung Tak , Yoo Tae-Hyun , Kang Shin-Wook , Han Seung Hyeok 
Published: June 2020

Abstract

Background and Aims
High-sensitivity C-reactive protein (hs-CRP) level is lower in East Asians than in the Western people and its clinical significance needs to be further explored. We aimed to investigate whether hs-CRP could function as a biomarker in Korean CKD patients.

Method
We studied the association of hs-CRP with adverse clinical outcomes in 2,018 patients from the KoreaN cohort study for Outcome in patients With Chronic Kidney Disease (KNOW-CKD). The primary outcome was a composite of extended major cardiovascular events (MACE) or all-cause mortality. Extended MACE (eMACE) included non-fatal cardiovascular events, symptomatic arrhythmia, and cardiac death. The secondary endpoints were separate outcome of eMACE, all-cause death, and adverse kidney outcome. We also evaluated predictive ability of hs-CRP for the primary outcome.

Results
The median hs-CRP level was 0.60 mg/L (IQR 0.2-1.7), and the mean eGFR was 53.6 ml/min/1.73 m2. During the mean follow-up of 3.9 years, there were 125 (6.2%) eMACEs and 80 (4.0%) deaths. The primary composite outcome occurred more frequently in patients with higher hs-CRP level than in those with lower hs-CRP level. In multivariable Cox analysis after adjustment of confounders, there was a graded association of hs-CRP with the primary outcome. The HRs (95% CI) for hs-CRP of 1.0 to 2.99, and ≥ 3.0 mg/L were 1.37 (0.89-2.12) and 2.20 (1.36-3.56), compared with
hs-CRP of &lt;1.0 mg/L. In analyses of secondary outcomes, this association was consistent for eMACE and all-cause death; however, hs-CRP was not associated with adverse kidney outcomes. Finally, prediction models failed to show improvement of predictive performance of hs-CRP compared to conventional factors.

Conclusion
In Korean CKD patients, serum hs-CRP level was low and significantly associated with higher risk of eMACEs and mortality. However, a low serum hs-CRP level was not predictive of adverse kidney outcome, and the predictive performance of hs-CRP was not strong.
P0929LOW PROTEIN DIET, BLOOD PRESSURE CONTROL AND NATRIURESIS IN PATIENTS WITH ADVANCED DIABETIC KIDNEY DISEASE AND HEAVY PROTEINURIA
Authors: Mihalache Andreea , Garneata Liliana , Mocanu Carmen-Antonia , Simionescu Tudor Petrisor , Mircescu Gabriel 
Published: June 2020

Abstract

Background and Aims
Recent data suggest the possibility to optimize blood pressure control by low protein diet (LPD) in patients with diabetic kidney disease (DKD). We aimed to assess the effects of a low protein diet (LPD) supplemented with keto-analogues on urinary sodium excretion and blood pressure control.

Method
Prospective, uni-center study with a total duration of 15 months.The study was conducted in a tertiary Nephrology Clinic and included a total of 92 diabetic patients with advanced CKD (eGFR &lt; 30 mL/min) and heavy proteinuria (&gt; 3 g/g creatininuria). Intervention consisted in a LPD (0.6 g/kg-day) supplemented with keto-analogues of essential amino acids with nutritional counselling and adjustment of antihypertensive therapy.
The primary efficacy parameter was proteinuria during intervention as compared to pre-enrolment. Blood pressure (BP), urinary sodium excretion, eGFR and blood glucose control were secondary end-points.

Results
Mean arterial pressure (MAP) decreased from baseline (Bs) to end of study (EOS) with -11 (-17 to -7) mmHg despite a reduction with 22% of patients needing antihypertensive medication. Independent predictors of a lower than median MAP (90mmHg) were a lower protein intake (HR 0.00 (0.00; 0.04; p=0.002), treatment with furosemide (HR 1.06 [1.06; 3.85]; p=0.03) but not with angiotensin-aldosterone system inhibitors (RAASi) [HR 0.17 (0.17; 0.90); p=0.03)] and was not influenced by natriuresis.
Natriuresis decreased from 130 (121-135) to 80 (71-86) mmol/day (p&lt;0.0001). A lower than median natriuresis (100mmol/day) was directly related to proteinuria [HR 0.0003 (0.00; 0.004); p=&lt;0.0001], eGFR [HR 0.0001 (0.00; 0.14); p=0.01] and to diuretic therapy [0.21 (0.05; 0.83); p=0.03] but not to protein intake.
Cardiovascular events were observed in 20% of patients and their occurrence was related to a lower MAP [0.97 (0.95; 0.99}; p=0.001]. No renal adverse were noted and the diet was nutritionally safe.

Conclusion
A low protein diet supplemented with ketoanalogues of essential amino acids on top of anti-hypertensive therapy (mostly loop diuretics) allows for a good control of blood pressure, unrelated to natriuresis in heavy proteinuric patients with advanced DKD.
P0930SERUM LEVELS OF OSTEOPROTEGERIN ARE ASSOCIATED WITH OBESITY IN CHRONIC KIDNEY DISEASE
Authors: Nam Yooju , Lee Seonyeong , Kim Hyung Woo , Chang Jae Hyun , Yoo Tae-Hyun 
Published: June 2020

Abstract

Background and Aims
Osteoprotegerin (OPG), which is an osteoclastic inhibitory factor, is associated with type 2 diabetes mellitus, severity of vascular calcification, coronary artery disease, and chronic kidney disease. Obesity is a risk factor for diabetes, and cardiovascular disease, however there are few studies about the relationship between OPG and obesity, especially in patients with CKD. This study aimed to investigate association between OPG level and obesity in a large-scale prospective cohort.

Method
Among 2,238 patients with non-dialysis CKD enrolled in the KoreaN cohort study for Outcome in patients With Chronic Kidney Disease (KNOW-CKD), 1,970 patients who measured body mass index (BMI), waist circumference (WC) and OPG level were included in the analysis. Obesity were defined as having a BMI &gt;25 kg/m2 and WC &gt; 90 cm in male, &gt; 85 cm in female.

Results
The mean age was 53.6 ± 12.2 years and 1,196 (60.7%) patients were males. At baseline, obesity by BMI, WC, and composite of BMI and WC were found in 814 (41.3%), 208 (26.9%) and 1,137 (57.7%) patients. A multivariate logistic regression model showed that log transformed OPG level was independently associated with the prevalence of obesity by BMI, WC, composite of BMI and WC (odds ratio [OR], 0.33; 95% confidence interval [CI], 0.16-0.65, P&lt;0.001 and OR, 0.37; 95% CI, 0.18-0.75, P=0.006, and OR, 0.33, 95% CI, 0.16-0.69, P=0.003, respectively). Among patients without baseline obesity, 207 (19.3%) patients developed obesity by BMI, 202 (21.7%) by WC, and 194 (23.3%) by composite of BMI and WC. In the fully adjusted multivariable Cox models, risks of developing obesity by BMI, WC and composite of BMI and WC were significantly higher with increased level of OPG (hazard ratio [HR], 0.59; 95% CI, 0.38-0.92; P=0.019, HR, 0.63; 95% CI, 0.41-0.98; P=0.001).

Conclusion
We showed that serum OPG levels are associated with obesity in patients with non-dialysis CKD.
P0936INJURY OF NEUTROPHILS DURING HAEMODIALYSIS AND ITS INVOLVEMENT FOR DEVELOPMENT OF CHRONIC MICROINFLAMMATION
Authors: Nakayama Masaaki , Miyazaki Mariko , Yamamoto Tae , Fukushi Taro 
Published: June 2020

Abstract

Background and Aims
Owing to the quality developments of membrane material and dislysis water, it is believed that the biocompatibility of haemodialysis (HD) system has been considerably improved. However, mortality and morbidities of dialysis patients have remained unacceptably high, which raises a question as to the biocompatibility improvement of current HD systems.

Method
Seventy-one patients on regular HD (male/female: 52/19, mean age: 63 years old, median HD duration: 19 months, HD session 3 times a week for 3 to 4 hours each by using high performance synthetic membrane) at Tohoku University Hospital were examined. Blood samples were obtained from all patients before and after the HD session, to measure followings; number of white blood cell fraction, and apotosis cells, plasma levels of following molecules; myeloperoxidase (MPO), pentraxin 3, angiogenin, lactoferrin, complement (C3a, C5a, C5b-9), and 17 cytokines. Apoptosis (positive for Annexin-V-FITC and negative for propidium iodide) was measured in 100,000 cells by flow cytometer, and plasma molecules were measured by ELISA kit.

Results
The main findings of this study were as follows (changes in the values after HD as compared to the pre HD); the significant decrease of leukocytes counts (neutrophil and lymphocyte), significant increases of apoptosis positive cells of leukocytes (neutrophiles and monocytes), significant increases of plasma MPO and pentraxin3 levels, significant decrease of angiogenin, and, no or only marginal changes in plasma pro-inflammatory cytokine levels and complement products. There was a significant positive correlation between the change in MPO and apoptosis before and after HD.

Conclusion
Bio-incompatibility of HD has remained a crucial issue even in the current systems. Among the several pathologies, process of neutrophile apoptosis accompanying MPO degranulation, may plays a central role for developing microinflammation. In this regard, change of plasma MPO could be a clinical marker for the biocompatibility of HD system. And in order to achieve better patients’ outcomes, innovative HD systems which fully improve biocompatibility are needed.
P0940CLINICAL ASSOCIATION BETWEEN SEVERE INFECTION AND HYPOZINCEMIA IN INCIDENT PATIENTS ON HEMODIALYSIS
Authors: Saka Yosuke , Kato Akihisa , Naruse Tomohiko 
Published: June 2020

Abstract

Background and Aims
Hypozincemia can arise in patients with advanced chronic kidney disease (CKD) due to low protein intake and urinary or dialytic loss. Several studies have confirmed an association between hypozincemia and infection. Because infections comprise a major complication in patients with advanced CKD, we investigated whether hypozincemia is associated with infection risk in incident patients on dialysis.

Method
We prospectively analyzed 380 consecutive patients aged 20 years old or more who started hemodialysis between January 2013 and December 2018. Six patients who were receiving zinc supplementation at the time of the study were excluded. Serum zinc values were obtained at the time of dialysis initiation. We followed up the remaining patients after enrollment. The endpoint was severe infection defined as infection-related death or bacteremia confirmed by the detection of microorganisms in two sets of culture bottles. The patients were equally divided into groups with low, middle or high serum zinc concentrations. Data were analyzed using Kaplan-Meier curves and Cox hazards models. The local ethics committee approved this research. Informed consent was obtained from each individual participant included in the study.

Results
The rate of severe infection events over a follow-up of one year was the highest in the group with low zinc (p = 0.030). Cox hazards models adjusted for age, sex, diabetes mellitus, serum albumin and serum zinc, selected hypozincemia as an independent risk factor for severe infection events (HR, 10.76; 95% CI, 1.28–90.41; p = 0.029).

Conclusion
Hypozincemia is associated with risk of subsequent severe infection in incident patients on dialysis.
P0942HYPOXEMIA AND UREMIA INDUCE OXIDATIVE IMBALANCE IN ENDOTHELIAL CELLS
Authors: Moreno-Amaral Andrea N , Carvalho Silva Caroline , Andrade Gabriela Bohnen , Monteiro Julia , Grobe Nadja , Silva Pecoits Filho Roberto Flavio , Stinghen Andréa E M , Kotanko Peter 
Published: June 2020

Abstract

Background and Aims
Intradialytic hypoxemia is associated with oxidative stress, endothelial dysfunction, inflammation, higher erythropoietin requirements, and higher all-cause hospitalization and mortality in hemodialysis (HD) patients (Meyring-Wosten, et al., 2016). The aim of the present study was to further expand our insights into the hypoxia-uremia axis by investigating the oxidative balance in endothelial cells (EC) under hypoxic and uremic conditions.

Method
Human umbilical EC were incubated with DMEM medium supplemented with 10% of fetal bovine serum (FBS; control) or with sera obtained from healthy subjects (S-CON) or HD patients (S-HD, 1:10), respectively, for 40 minutes, 4 hours, and 24 hours under normoxic (21% O2) or hypoxic (5% O2) conditions (Culture Chamber ProOx, Biospherix). EC were analyzed by flow cytometer (BD Accuri™ C6 Plus) to assess a) intracellular production of reactive oxygen species (ROS, DCFH-DA probe, Abcam); b) reduced glutathione (GSH) content (ThiolTracker Violet probe, Thermo Fisher Scientific).

Results
S-HD increased intracellular ROS production at all time points compared to S-CON. Moreover, ROS production was higher under hypoxic conditions. ROS production declined after 24 hours. S-HD induced slightly higher GSH content when compared to S-CON in normoxia (Table 1).

Conclusion
In our in vitro experiments, hypoxia and uremia jointly favor EC oxidative imbalance. This effect is particularly pronounced after 4 hours. Translational studies are warranted to explore the clinical relevance of our findings.
P0943FAT MASS/FAT FREE MASS RATIO AS A CARDIOVASCULAR RISK FACTOR. SURVIVAL STUDY
Authors: Barril Guillermina , Nogueira Angel , Garcia Nuria , Sanz Paloma , Alvarez Graciela , Gil Giraldo Leydy Yohana , Muñoz Patricia , Giorgi Martin , Nuñez Almudena , Sanchez Tomero Jose Antonio 
Published: June 2020

Abstract

Background and Aims
Excess fat mass correlates with cardiovascular risk and if the increase in BMI is at the expense of fat mass it can increase mortality.
Aims- To evaluate the Fat Mass/Fat Free Mass ratio (FM/FFM)in 195 CKD patients and establish a correlation with nutrition-inflammation parameters, body composition and hand grip strenght

Method
We have studied 195 patients aged 67.01 ± 14.52 years, 126 (64.6%) men and 69 (35.4%) women. 41% in HD and 59% with advanced CKD. We have determined FM/FFM ratio using BIA monofrequency Bodigram Plus (Akhern) and hand grip stengh ( baseline).We determine biochemical nutrition-inflammation parameters also.

Results
xRatio FM/FFM = 0.499 ± 0.2304, in men = 0.41 ± 0.16 and in women = 0.64 ± 0.26 (both less than published 0.57 men and 0.867 in women). Median 0.4558 and percentils (p) with cut-off points 0.3868 and 0.5574. In HD 31 in P1, 23 in P2 and 26 in P3. In advanced CKD 32 in P1, 41 in P2 and 42 in P3. Anova significant according to percentiles: SMI, age, TBW% BCMI, albumin, waist circunference, and Hand grip strenght.
Correlations

Men
FM / FFM ratio direct sig correlation with weight, AEC% and Trasferrin%, inverse with MIS, SMI, Na / K, BCM%, TBW%, IBW%, BCMI and right dynamometry. Do not continue with BMI, Phase Angle, Hb, lymphocytes, prealbumin, PCR.

Women
FM/FFM ratio direct sig correlation wih: weight, Na / k, BMI, prealbumin, CRP, MIS, inverse with: TBW. No sig: SMI, BCM%, EBW%, IBW%, MAMC, BCMI, Hb, hand grip strenght, lymphocytes or transferrin.
In the 24-month mortality study we found no significant differences in Kaplan Meier overall mortality using the 3 percentiles. They died 7/63 in P1, 1/64 in P2 and 8/68 in P3. If we make the union of 1 and 2 vs percentil3 we find significant differences in mortality between strata, especially in HD with Long Rank 0.05.

Conclusions
1.-The FM /FFM ratio is a useful tool for diagnosis of sarcopenic obesity
2.-It correlates significantly with parameters of CRP (direct) inflammation, muscle strength (inverse) and CV risk (direct waist circumference and tricipital fold)
3.- In a survival study joining P1 + P2 vs P3 we found greater survival in P1 + P2, mainly in HD.
P0950EFFECT OF THYROID HORMONE TREATMENT ON RENAL REABSORPTION OF GLUCOSE IN ALLOXAN-INDUCED DIABETIC RATS
Authors: Dayma Gireesh 
Published: June 2020

Abstract

Background and Aims
The thyroid hormone (TH) plays an important role in glucose metabolism. Recently, we showed that the TH improves glycemia control by decreasing cytokines expression in the adipose tissue and skeletal muscle of alloxan-induced diabetic rats, which were also shown to present primary hypothyroidism. In this context, this study aims to investigate whether the chronic treatment of diabetic rats with T3 could affect other tissues that are involved in the control of glucose homeostasis, as the liver and kidney.

Method
Adult male Wistar rats were divided into nondiabetic, diabetic, and diabetic treated with T3 (1.5 ?g/100 g BW for 4 weeks). Diabetes was induced by alloxan monohydrate (150 mg/kg, BW, i.p.). Animals showing fasting blood glucose levels greater than 250 mg/dL were selected for the study.

Results
After treatment, we measured the blood glucose, serum T3, T4, TSH, and insulin concentration, hepatic glucose production by liver perfusion, liver PEPCK, GAPDH, and pAKT expression, as well as urine glucose concentration and renal expression of SGLT2 and GLUT2. T3 reduced blood glucose, hepatic glucose production, liver PEPCK, GAPDH, and pAKT content and the renal expression of SGLT2 and increased glycosuria.

Conclusion
Results suggest that the decreased hepatic glucose output and increased glucose excretion induced by T3 treatment are important mechanisms that contribute to reduce serum concentration of glucose, accounting for the improvement of glucose homeostasis control in diabetic rats.