bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1037EFFECT OF VITAMIN D SUPPLEMENTATION ON PROTEINURIA, LIPID STATUS, GLICOREGULATION, C-REACTIVE PROTEIN, VEGF-A, TGF-BETA1 AND NEPHRIN IN PATIENTS WITH TYPE 2 DIABETES MELLITUS
Authors: Petroviä‡ Marijana , Petrovic Stanko , Obrencevic Katarina , Dragovic Tamara , Rancic Nemanja , Vavic Neven , Vojvodic Danilo , Petrovic Dejan , Rabrenovic Violeta , Tadic Jelena , Mijuskovic Mirjana , Terzic Brankica , Pilcevic Dejan 
Published: June 2020

Abstract
Background and Aims: Vitamin D insufficiency/deficiency is often present in patients with Type-2 diabetes mellitus and could present a risk factor for rapid progression of diabetic nephropathy and higher incidence of cardiovascular events. The aim of this study was to examine the influence of vitamin D supplementation on glucoregulation, inflammation, cholesterol, triglycerides, albuminuria and biomarkers of renal injury – nephrin, VEGF-A and TGF- β1 in patients with Type-2 diabetes mellitus and vitamin D insufficiency/deficiency. Method: We included 90 patients with Type-2 diabetes mellitus and vitamin D insufficiency/deficiency in this prospective, cohort study. Patients are divided in 3 equal groups: 30 patients with normal albuminuria, 30 with microalbuminuria and 30 with macroalbuminuria. Therapy included 6 months of supplementation with cholecalciferol drops: first 2 months with 20000 IU twice weekly, than if vitamin D level remained below normal range, we procedeed with same dose next 4 months. If the level of vitamin D normalized, we proceeded with 5000 IU twice weekly. At the beginning and at the end of the study we measured levels of albumin, hemoglobin, serum iron, urea, creatinine, fasting blood glucose, hemoglobin A1c, calcium, phosphorus, total cholesterol, triglycerides, C-reactive protein, intact parathyroid hormone, and urine analysis: 24-hour urine protein, albumin/creatinine ratio and creatinine clearance. Biomarkers are measured in serum and urine. Levels of calcium, phosphorus and vitamin D are also checked 2 months after beginning of therapy due to possible correction of cholecalciferol dose. Results are analysed according to the vitamin D level at the beginning and at the end of the study. Results: The lowest level of vitamin D, before therapy, is found in patients with macroalbuminuria, while at the end of the study we found significantly higher level of vitamin D in all three groups. After 6 months of therapy we found significant decrease of 24-hour urine protein, total cholesterol, triglycerides, hemoglobin A1c and VEGF-A in urine, in all three groups, and C-reactive protein in patients with normal albuminuria and microalbuminuria, nephrin in urine in patients with microalbuminuria and TGF- β1 in urine in patients with macroalbuminuria. Conclusion: vitamin D supplementation with high-dose cholecalciferol in patients with Type-2 diabetes mellitus (with or without albuminuria) decreases C-reactive protein, hemoglobin A1c, total cholesterol, triglycerides in serum, and albumin/creatinine ratio, 24-hour urine protein, VEGF-A, TGF- β1 and nephrin in urine.
P1040PREGNANCY IN WOMEN WITH DIABETIC NEPHROPATHY: COMPLICATIONS AND OUTCOMES
Authors: Prokopenko Elena , Vatazin Andrey , Gurieva Vera , Nikol`skaya Irina , Burumkulova Fatima , Zulkarnaev Aleksei 
Published: June 2020

Abstract

Background and Aims
Pregnancy in patients with diabetic nephropathy (DN) is characterized by an increased incidence of complications and adverse outcomes. The aim of the study was to determine the nature and incidence of pregnancy complications and maternal and fetal outcomes in women with DN.

Method
61 pregnant women with diabetes mellitus (DM) type 1 and CKD 1-4 stages: 1 st. –29 patients, 2 st. - 19, 3-4 st. – 13 (age 29.7±4.9 years, DM duration 18.6 ± 5,3 years) and 72 pregnant patients with pre-existing (type 1) DM without CKD (age 28.2±4.8 years, DM duration 11.4 ±3.7 years) observed in 2010-2017 were included. The incidence of chronic arterial hypertension (AH), preeclampsia (PE), fetal macrosomia, fetal growth restriction, preterm delivery, cesarean section, stillbirth and the effect of pregnancy on kidney function were evaluated.

Results
Chronic AH was detected in 19.4% of women w/o CKD, in 10.3% – CKD 1 st, 17.6% – CKD2, 61.3% – CKD 3-4 (p &lt 0.05 CKD3-4 vs CKD1). The incidence of PE in patients w/o CKD was 12.5% (2-3% for general population), with CKD 1 – 24.1%, CKD 2 – 41.2%, CKD 3-4 – 38.5% (p &lt 0.001 when comparing all groups). Macrosomia was common in pregnant diabetic women w/o CKD (30.6%), patients with CKD 1 (41.4%) and CKD 2 (52.9%), but was not observed in CKD 3-4 (0%). In contrast, the incidence of fetal growth restriction was highest with CKD 3-4 (61.5%) compared women w/o CKD (5.6%) and with CKD1(13.8%) and CKD2 (11.8%), p &lt 0.05.Preterm delivery was more common in women with CKD, and its frequency increased with increasing severity of CKD: w/o CKD – 18.1%, CKD 1 – 48.3%, CKD2 – 61.3%, CKD 3-4 –84.6% (p &lt 0.05). Incidence of cesarean section was high and did not differ significantly between groups: w/o CKD – 62.5.1%, CKD 1 – 55.2%, CKD2 – 82.4%, CKD 3-4 –92.3% (p &gt 0.05). Stillbirth was observed only with CKD stage 3-4 in 15.4% of cases.Four out of 13 (30.8%) patients with pre-existing CKD 3-4 and none of the patients with CKD1-2 reached stage 5 CKD and started regular hemodialysis with a median follow-up period of 43.3 months (min 29.7 - max. 81.5).

Conclusion
DN has a negative effect on pregnancy outcomes, increasing the frequency of preeclampsia, fetal growth restriction, preterm birth and stillbirth, however, fetal macrosomia practically does not occur with CKD 3-4. The rapid achievement of CKD 5D after delivery is typical for diabetic women with advanced stages of CKD.
P1047URICOSURIA AND URINARY GLUCOSE EXCRETION ON DIABETIC KIDNEY DISEASE (DKD) PATIENTES TREATED WITH SGLT2 INHIBITORS
Authors: Marques Vidas Maria , Maroto Alba , Sanz Ignacio , López Paula , Portoles Jose' M 
Published: June 2020

Abstract

Background and Aims
The use of sodium glucose co-transporter 2 inhibitors (SGLT2i) is consistently associated with decrease of serum uric acid levels due to increase uricosuria coupled to glucosuria by mechanisms that are still incompletely understood. In diabetic kidney disease these drugs had shown only modest effects on HbA1c control allegedly due insufficient glucosuric effect. However, renal patients also benefit from hypouricemic effect of SGLT2 inhibitors. The aim of this study was to evaluate glucosuria and uricosuria in DKD patients treated with SGLT2i

Method
We prospectively analyzed glucose and urate fractional excretions of patients that were to initiate treatment with an SGLT2i, using fractional excretion classical formulas. Patients on GLP1ar or any uricosuric agent including losartan were excluded. All participants gave written consent.

Results
37 patients (75.7% male) diagnosed from DKD were included, median age 69.6 years IQR [65.6-73.4], median CKD-EPI eGFR 54,10 ml/min/1,72 m2 [ 41,12- 69,68 IQR] and UACR 137 [49-443] mg/g. SGLT2i used was 53.3% dapagliflozin, 24.4% empagliflozin or 22.2% canagliflozin and mean follow- up was 1.5 years.Serum uric acid levels didn’t show any significative difference along time in this group of patients (6.8 vs 6.3; p 0.4) and %HbA1C was only slightly decreased by month 12 (7.1 vs 6.7; p0.03). Urinary uric acid fractional excretion increased by month 3 and was stabilized till month 12 when this effect seemed to decrease (figure and table) Glucosuria exhibit a similar effect: Urinary glucose fractional excretion increased immediately after the addition of the drug and stabilized over time decreasing at the end of the observation period. Spearman rank correlation test indicated dependency glucosuria and uricosuria (Spearman´s rho 0,24, p 0,03). GFR estimated by CKD-EPI kept stable along the study indicating that loss of uricosuric and glucosuric effect are independent of GFR

Conclusion
We conclude that uric acid renal excretion is significantly increased in patients treated with SGLT2i even in the presence of DKD but tends to diminish over time, feature that was also observed on urinary glucose excretion and that showed no correlation with GFR. Over-expression of SGLT1 after SGLT2 inhibition has been described in animal models of DKD. Whether this extends to human tubule and explains these results need to be further investigated
P1048EMPHYSEMATOUS PYELONEPHRITIS IN TYPE 2 DIABETES -CLINICAL PROFILE AND MANAGEMENT
Authors: Bhat Dr Sanjay , Srivastava Alok , Ahmad Nisar , Rai Priyanka , Singh R P , Srivastava Rohit , ROY A K , Fatima Jalees 
Published: June 2020

Abstract

Background and Aims
Emphysematous pyelonephritis (EPN) is a rare but life-threatening acute suppurative infection of the kidney.60-70% are associated with uncontrolled diabetes mellitus (DM) with or without obstructive uropathy and superimposed with infection caused by gas-forming organisms. Conventional treatment of EPN is parenteral antibiotics with percutaneous or open surgical drainage and/or nephrectomy. There is no current consensus on management of EPN as to whether present day antibiotics alone good enough or is surgical intervention necessary and if surgical intervention required when should one go for nephrectomy.

Method
A prospective observational study was conducted at Tertiary care hospital, Lucknow from 2015-2018 to look for clinical, microbial profile and treatment outcome of diabetic patients with emphysematous pyelonephritis.The clinical features and laboratory data at the initial presentation, management and outcomes were analyzed .Contrast enhanced computerized tomography (CECT) was performed in case of suspected renal abscess and nonrecovering pyelonephritis

Results
A total of 76 Diabetic patients diagnosed with pyelonephritis were identified, of which 15 patients were diagnosed with EPN (26.3%) Renal papillary necrosis and renal abscess was seen in 1 and 3 patients, respectively. The mean age of the patients was 58.4 ± 6.5 years (age range 22-79 years). Pyelonephritis was more common among males. Duration of symptoms prior to hospitalization ranged from 16.34 ± 7.32 (range 8-32) days. Renal dysfunction at presentation was seen in 15 (100%) patients. Bilateral involvement was seen in 5 (33.3%) patients. Fever was the most common presenting symptom followed by dysuria. Urine and blood cultures were positive in 13 (88.3%) and 3 (20 %) patients respectively. Gram-negative bacilli were the most frequent organisms isolated, Escherichia coli in 11 (73.3%), Klebsiella sp. in 1 (6.6%), Pseudomonas in 1 (6.6%), and 1 each with polymicrobial and fungal UTI respectively. The fungus included Candida albicans managed with fluconazole. Good, moderate, and poor glycemic control was seen in 13 (12.3%), 16 (15.2%) and 76 (72.3%), respectively.Of 15 EPN patients, 13 (86.6 %) survived and 2 (13.3%) expired. 2 of them underwent Nephrectomy both survived.All patients with Stage I, II and IIIa EPN (n = 12) were managed with antibiotics with or without PCD. In EPN Stage IIIb/IV (n = 3), all the 3 (20 %) patients were managed with antibiotics and PCD and later 2 (13.3%) needed nephrectomy.Of different variable only altered sensorium and shock at presentation were associated with poor outcome in EPN patients (P &lt; 0.05)

Conclusion
EPN in diabetics needs good multidisciplinary approach with adequate antibiotics and surgical management as and well required for better patient outcomes.
P1049LOWER ACCEPTANCE RATE FOR PANCREAS OR ISLET TRANSPLANTATION AFTER INTRODUCTION OF A MULTIDISCIPLINARY APPROACH FOR TRANSPLANT ELIGIBILITY
Authors: Nordheim Espen , Lindal Jørn Petter , Nordheim Espen , Åsberg Anders , Birkeland Kåre , Horneland Rune , Boye Turid Birgitte , Jenssen Trond Geir 
Published: June 2020

Abstract

Background and Aims
β-cell replacement therapy, with either pancreas or islet transplantation, is a treatment option for selected patients with brittle type 1 diabetes. All patients referred to the national transplant centre for assessment of this treatment, are evaluated in the outpatient clinic before any work-up for transplantation is initiated. Before 2015, this assessment was performed by a nephrologist alone, while from 2015 the assessment has also included an endocrinologist, a transplant surgeon and a psychiatrist in a multidisciplinary team.

Method
The proportion of patients accepted for transplantation before and after the multidisciplinary approach were compared. A chi square test was used for comparing the groups in the two periods; 2010-2014 versus 2015-2019 vs. P-values are reported according to two- tailed analysis, and p- values &lt; 0.05 were considered statistically significant.

Results
From 2010 to December 2019, 144 patients were assessed for β-cell replacement therapy eligibility. Out of all patients referred, 64 out of 79 (81%) and 22 out of 65 (34%) were listed for transplantation before and after the multidisciplinary assessment was introduced (p-value &lt; 0.005). The main reasons for not being listed after the introduction of a multidisciplinary team were suboptimal diabetes treatment and that the patients withdrew their interest after the outpatient clinic visit with thorough information about advantages and risks.

Conclusion
The rate of patients who were accepted for islet or single pancreas transplantation declined after a multidisciplinary approach was introduced for transplant candidate eligibility. We suggest that a broader, multi-disciplinary approach revealed previously undetected medical issues and improved patient information that subsequently resulted in fewer patients listed for transplantation.
P1050THE EFFICACY AND RENAL SAFETY OF SWITCHING FROM DAPAGLIFLOZIN TO EMPAGLIFLOZIN IN PATIENTS WITH TYPE 2 DIABETES
Authors: YANG AI-YU , Chen Hung-Chun 
Published: June 2020

Abstract

Background and Aims
Both dapagliflozin (DPG) and empagliflozin (EPG) are highly selective sodium-glucose cotransporter-2 (SGLT-2) inhibitors that inhibit glucose reabsorption and increase its excretion in urine. Previously, DPG was limited to patients with an estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2, while EPG can be used for those with an eGFR ≥ 45 mL/min/1.73 m2. Therefore DPG was switched to EPG in many patients when eGFR decreased. However, the clinical efficacy and safety of these switches are not clear. In this study, we compared the efficacy and renal safety between patients switching from DPG to EPG and those continuing DPG in patients with type 2 diabetes mellitus (T2DM).

Method
This retrospective observational study included patients with T2DM who were treated with DPG for more than 6 months. This study included patients who switched to EPG and those who continued using DPG. All other hypoglycemic drugs were maintained at the same dosage before and after the study period. The primary outcome measure was the change in hemoglobin A1c (HbA1c) level after 6 months. The EPG group was evaluated for whether the hypoglycemic effect remain effective after drug switching. Patients with HbA1c levels at or lower than the baseline value after 6 months were defined as effective and patients with levels higher than the baseline were defined as invalid. Safety was evaluated by comparing the difference of eGFR between the baseline value and six months after treatment.

Results
This study included 169 patients. Among them, 72 patients continued DPG and 97 patients switched to EPG. HbA1c level decreased significantly only in EPG group. In EPG group, 59 patients belong to the effective group (60.8%) and 38 patients were invalid (39.2%). There was no significant change in eGFR after treatment in both groups. Ten patients in DPG group develop adverse reactions (three patients felt uncomfortable and seven patients had urinary tract symptoms), but all continued treatment. In EPG group, five patients lacked follow-up records during the study period and it was difficult to determine whether the patient’s willingness to continue treatment was affected by adverse reactions.

Conclusion
Our study showed that switching from DPG to EPG in patients with T2DM was effective for blood glucose maintenance and caused no significant changes in renal function. In addition, no severe drug-related adverse reactions were found.
P1055REMARKABLE REMOVALS OF BETA-2-MICROGLOBULIN AND PHOSPHATE WITH SHORT-DAILY HOME HEMODIALYSIS USING LOW DIALYSATE FLOW RATE
Authors: Gonzã¡lez Moya Mercedes , Molina Pablo , Vizcaíno Belén , Rodrigo María , Pascual Pilar , Beltrán Sandra , Yugueros Alejandra , Calatayud Emma , Lidón Maria Jesús , Moncho Cristela , Santaolaria Marisa , Carbonell Araceli , Sáez Guillermo , Estañ Nuria , Pallardó Luis M 
Published: June 2020

Abstract

Background and Aims
Short-daily hemodialysis (HD) with low-dialysate volume is an appealing portable dialysis approach for home use. Although this type of HD has proved being effective for the volume control and the clearance of low molecular-weight uremic toxins, limited data are available on the impact on the removal rates of other uremic toxins like β2-microglobulin (β2M) or phosphate (P), whose clearance is limited by sequestration into compartments, poor diffusion, high time-dependency, or protein binding. We evaluated the impact of short-daily HD with slow dialysate flow rate on the removal of solutes of different molecular weights and distribution volumes.

Method
Single-session and weekly balances of β2M, P, urea, and creatinine were prospectively assessed with total dialysate collection and serum measurements before and after 341 dialysis sessions (mean dialysate volume: 30963 ± 862 mL; mean length of dialysis session: 153 ± 8 min) in 31 stable patients (female; 9, 29 %; mean age: 55.6 ± 13.6 y; dry weight: 74.9 ± 13.3 kg) undergoing short-daily home HD with NxStage cycler, between July 2014 and October 2019. The mean blood flow rate was 365 ± 17 mL/min, whereas the mean dialysate flow rate was 194 ± 12 mL/min.

Results
Single-session β2M, P, urea, and creatinine removals were 0.138 ± 0.050 g, 0.610 ± 0.161 g, 18.89 ± 6.07 g and 1.07 ± 0.31 g, respectively, whereas the reduction rates (%) were 38.0 ± 13.0, 46.8 ± 8.6, 48.2 ± 7.0 and 46.6 ± 6.6, for β2M, P, urea and creatinine, respectively. The estimated weekly β2M, P, urea and creatinine removals in HDD patients dialyzing 5-6 days per week were comparable with 4-h in-center thrice-weekly on-line hemodiafiltration according to previous studies (Table 1).

Conclusion
Treating patients with short-daily HD with low-dialysate volume at a 5-6 days per week prescription may achieve an efficient weekly β2M and P removal.
P1059REMOVAL OF LOW MOLECULAR WEIGHT AND PROTEIN-BOUND UREMIC RETENTION SOLUTES WITH ALLO-HEMODIALYSIS: RESULTS FROM EX VIVO STUDY
Authors: Maheshwari Vaibhav , Grobe Nadja , Chao Joshua , Tao Xia , Thijssen Stephan , Kotanko Peter 
Published: June 2020

Abstract

Background and Aims
It is projected that in 2030, 14.5 million people will have end stage kidney disease and need kidney replacement therapy, yet only 5.4 million will receive it due to economic, social, and political factors. We have proposed allo-hemodialysis (alloHD) as a simple and low-cost HD alternative (https://www.kidneynews.org/kidney-news/features/buddy-dialysis-probed-hemodialysis-alternative). In alloHD, the patient’s blood is dialyzed against the blood of a healthy subject (‘buddy’), who receives the excess fluid and uremic solutes and excretes them via his/her healthy kidneys.

Method
We conducted ex vivo experiment with bovine whole blood, 4L in a patient and buddy bucket, respectively. In this setup, buddy blood flows through the dialyzer fiber lumen, while patient blood flows in the dialysate space (Nipro Cellentia 17H dialyzer). The patient blood was spiked with urea, creatinine, potassium chloride, indoxyl sulfate (IS), and p-cresyl sulfate (pCS); solute levels on the buddy side were not altered. The alloHD session lasted for 3 hours, the ultrafiltration (UF) volume was 750 mL. The blood flow rates were kept constant at 150 and 200 mL/min on the patient and buddy side, respectively. Heparin (5000 IU/L) was added to either bucket. The alloHD machine prototype comprises 2 pumps on the buddy side and one on patient side (Figure 1A). UF is controlled by the blood flow rate differential between the buddy-sided arterial and venous pumps, respectively.

Results
The levels of small unbound solutes (urea, creatinine, potassium) equilibrate quickly between patient and buddy buckets (Fig. 1B, top panel). Of note, the buddy-sided potassium equilibrium concentration is lower, because ongoing UF dilutes albumin in the buddy bucket and concentrates it in the patient bucket, resulting in a Gibbs-Donnan potential. The protein-bound uremic solutes IS and pCS equilibrate towards lower total concentrations on the buddy side due to the earlier mentioned UF-induced albumin dilution. Of note, the levels of free IS and pCS, respectively, converge on both sides of the dialyzer membrane (Fig 1B, bottom panel).

Conclusion
Our ex vivo data suggest that alloHD can be used to treat hyperkalemia, a major cause of death in acute and chronic kidney failure. Both unbound and protein-bound low molecular weight uremic solutes are also removed. With elimination of “classical” dialysate, we simplify the HD procedure and reduce machine size and costs significantly, making it an affordable HD alternative. Feasibility and efficacy studies in animal models are the next step.
P1063PERFORMANCE OF MEDIUM CUT-OFF DIALYZERS IN EXPANDED HEMODIALYSIS PATIENTS IN COLOMBIA
Authors: D'Achiardi Roberto , Zuñiga Eduardo , Molano Alejandra , Tran Ha , Parreno Rhea , Vesga Jasmin , Rivera Angela 
Published: June 2020

Abstract

Background and Aims
Uremic toxins which are retained in ESRD include small solutes to large middle molecules. Large middle molecules play significant roles in immune modulation and cardiovascular morbidity and mortality. Expanded hemodialysis (HDx) enabled by innovative medium cut-off (MCO) membrane more effectively removes large uremic toxins vs current dialytic therapies.
Aims: To evaluate the efficacy of MCO dialyzer in large middle molecules removal and pre-dialysis albumin levels after 24 weeks of treatment.

Method
This was an exploratory, prospective observational, multicenter cohort study. Prevalent patients on HD therapy for at least 90 days at the Renal Care Services (RCS) were included between June 6, 2018, to June 14, 2018. Uremic toxins removal was evaluated by measuring the reduction ratio (RR) of free light chains (FLC) κ, λ, Interleukin (IL) 6, IL-10, β2 Microglobulin (β2 M) and fibroblastic factor 23 (FGF-23) at 12 weeks ( w) of treatment, as well as the change in predialysis midweek serum level of β2M, FGF-23, factor XIV activity, and VII at baseline, 12 w and 24 w of treatment. A mixed-model repeated measures analysis (MMRM) was performed to identify statistical differences over time

Results
The RR of κ-FLC, λ-FLC, β2 M, and FGF-23 at week 12 showed a reduction between 46-72%; while in IL-6 RR was not significantly changed (Table 2). Predialysis serum levels decreased for β2m, FLCs and IL-6 and FGF 23 (Table 3). The decrease in albumin was within 5% from baseline.
Twenty-two adverse events (AEs) occurred during the follow-up period; No AEs during HDx were deemed related to MCO membrane use.

Conclusion
MCO dialyzers are safe and effective in removing large MMs and decrease in the uremic toxins levels.