bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0779THE POPULATION ATTRIBUTABLE FRACTION OF HYPERURICEMIA FOR ALL-CAUSE AND CARDIOVASCULAR MORTALITY: A NATIONWIDE COMMUNITY-BASED STUDY
Authors: Tanaka Tomomi , Tanaka Tomomi , Miyata Masahiro , Ichikawa Kazunobu , Konta Tsuneo , Fujimoto Shouichi , Iseki Kunitoshi , Moriyama Toshiki , Yamagata Kunihiro , Tsuruya Kazuhiko , Narita Ichiei , Kondo Masahide , Yugo Shibagaki , Kasahara Masato , Asahi Koichi , Watanabe Tsuyoshi 
Published: June 2020

Abstract

Background and Aims
Hyperuricemia is often observed in subjects with chronic kidney disease and is associated with all-cause and cardiovascular mortality. In this study, we evaluated the effect size of hyperuricemia for all-cause and cardiovascular mortality in a community-based population, using the index of population attributable fraction (PAF).

Method
This large-scale cohort study used the nationwide database of 500,511 health check-up participants (215,728 men, 284,783 women, average age 62 years) and calculated the PAF of hyperuricemia (serum uric acid &gt;7 mg/dL) for all-cause and cardiovascular deaths during the 7-year follow-up period.

Results
The frequency of hyperuricemia at baseline was 9.7% in total subjects (men: 22.0%; women: 2.6%). During the follow-up period, 5,578 deaths (1.1%) were noted (men: 3,749 [1.7%], women: 1,829 [0.6%]), including 1,104 cardiovascular deaths (0.2%) (men: 762 [0.4%], women: 342 [0.1%]). In the Cox proportional hazard analysis adjusted for confounding factors including age, gender, body mass index, smoking, alcohol consumption, hypertension, diabetes, dyslipidemia and eGFR, hyperuricemia was an independent risk factor for all-cause and cardiovascular mortality, (adjusted hazard ratios [95% confidence interval]; 1.39 [1.27-1.53] for all-cause mortality, and 1.76 [1.47-2.11] for cardiovascular mortality). The adjusted PAF of hyperuricemia for all-cause and cardiovascular deaths were 3.1% and 4.7% (approximately 1 in 32 all-cause deaths, and 1 in 21 cardiovascular deaths), respectively. In subgroup analyses, the association between hyperuricemia and death was stronger in men and smokers. The adjusted PAF for all-cause and cardiovascular deaths was 5.5% and 8.6% (approximately 1 in 18 all-cause deaths, 1 in 12 cardiovascular deaths) in men, and 6.2% and 8.2% (approximately 1 in 16 all-cause deaths, 1 in 12 cardiovascular deaths) in smokers, respectively.

Conclusion
This study showed that a substantial number of all-cause and cardiovascular deaths, was statistically attributed to hyperuricemia in the community-based population, especially men and smokers.
P0784RAPID WEIGHT CHANGE OVER TIME IS A RISK FACTOR FOR ADVERSE OUTCOMES IN PREDIALYSIS CHRONIC KIDNEY DISEASE: RESULTS FORM KNOW-CKD STUDY
Authors: Ryu Hyunjin , Hong Yeji , Kang Eunjeong , Kang Minjung , Kim Jayoun , Oh Yun Kyu , Yang Soo Jin , Ahn Curie , Oh Kook-Hwan 
Published: June 2020

Abstract

Background and Aims
Both obesity and underweight are related to the adverse outcomes in the chronic kidney disease (CKD). However, the effects of longitudinal weight changes on predialysis CKD population has not been studies so far. In this study, we analysed the effects of longitudinal body weight changes on the adverse outcomes in the predialysis CKD population, using the multicentre prospective cohort study in Korean pre-dialysis CKD cohort, so called KNOW-CKD.

Method
In this longitudinal analysis, total 2,022 patients were included. Longitudinal weight changes of study population were calculated into the percent change per year using regression analysis and classified into five groups: group 1; ≤ -5%/year (74 subjects), group 2; -5&lt; to ≤-2.5 %/year (122 subjects), group 3; -2.5&lt; to &lt;2.5%/year (1642 subjects), group 4; 2.5≤ &lt;5 %/year (123 subjects), and group 5; ≥ 5 %/year (61 subjects). The risk of end-stage renal disease (ESRD) development and composite outcome of cardiovascular disease (CVD) and all-cause death were compared according to the longitudinal weight changes.

Results
During the median 4.4 years of follow-up, total 414 and 188 events of ESRD and composite outcome of CVD and death occurred. When cause-specific regression analysis was conducted before and after adjusting age, sex, body mass index, mean blood pressure, estimated glomerular filtration rate, urine albumin-to-creatinine ratio, diabetics, cardiovascular disease, and modified Charlson Comorbidity Index score, all groups showed significant increased HR compared to group 3 for the ESRD. There was U-shape correlation between the degree of longitudinal body weight changes and the renal outcome (HR 3.89, 2.00, 1.89 and 3.34, P &lt;0.001, &lt;0.001, =0.001 and &lt;0.001 for group 1, 2, 4 and 5, respectively). Also similar U-shape relationship was seen with composite outcome, (HR 3.14, 2.05, 1.65 and 2.68, P &lt;0.001, 0.007, 0.123 and 0.007 for group 1, 2, 4 and 5, respectively) when compared to the reference group 3 When spline curve was drawn between the longitudinal body weight changes and adjusted HR for ESRD and composite of CVD and death, clear U-shape relationship was observed (Figure). The U-shape correlation was highlighted in the subgroup of estimated glomerular filtration rate &lt;45 mL/min/1.73m2.

Conclusion
Both rapid weight reduction and gain are independent risk factor for the ESRD development and composite outcome of CVD and death in predialysis CKD patients, especially in advanced CKD stages. Therefore, monitoring bodyweight changes are important and more studies are needed to give safe guideline to the predialysis CKD for maintaining optimal nutritional status.
P0786CLINICAL SIGNIFICANCE AND RELATED FACTORS OF GFR SLOPE IN A LARGE MULTICENTER OBSERVATIONAL STUDY IN JAPAN
Authors: Kamijo Yuji , Hashimoto Koji , Yamada Yosuke , Harada Makoto , Aida Masatsugu , Yamauchi Shitotomo 
Published: June 2020

Abstract

Background and Aims
Recently, glomerular filtration rate (GFR) slope has attracted attention as an important surrogate marker for the prognosis of chronic kidney disease (CKD), with a reduction in slope of eGFR decline by 0.75 mL/min/1.73 m2 per year reportedly having clinical significance. As few large clinical studies on Japanese CKD patients exist, this investigation addresses the clinical significance of GFR slope and its related factors.

Method
To evaluate the clinical impact of GFR slope, we conducted a prognostic investigation of CKD patients in Japan by means of a large, multicenter, retrospective, observational study. Patients with CKD who were seen at among 15 general hospitals between January and March 2014 were surveyed using medical records. The selection criteria were age ≥20 years, estimated GFR (eGFR) &lt;60 mL/min/1.73 m2, and receiving medical treatment for CKD. Baseline patient characteristics, eGFR changes, and hard endpoints (death or end-stage kidney disease requiring renal replacement therapy) during observation were analysed. We calculated GFR slope using GFR data of 2 years following the observation start point by 2 calculation methods, the linear mixed model and least squares linear regression, and examined the relationship of GFR slope with the hazard ratio of the composite hard endpoints. The factors related to GFR slope were also assessed by multiple regression analysis.

Results
Among a total of 11233 collected patients, we analyzed the data of 7490 CKD G3 and G4 patients whose GFR data during 2 years could be obtained (60% male, mean age: 71 years, CKD G3a: 55%, G3b: 30%, G4: 15%, mean eGFR: 44.1 mL/min/1.73 m2, urine protein positive: 51%, diabetes mellitus: 49%, use of RAS inhibitors: 57%). The mean observation period was 1040 days. Hard endpoints after the GFR slope measurement period occurred in 301 subjects. The GFR slope of the cohort was -0.948 mL/min/1.73 m2 per year (95% confidence interval [CI] -1.016, -0.880) in the linear mixed model and -0.982 mL/min/1.73 m2 per year (95% CI -1.075, -0.889) according to least squares linear regression. Both calculated GFR slopes were significantly related to the hazard ratio of the composite hard endpoints. Hazard ratio decreased by 0.85 (linear mixed model) and 0.9 (least squares linear regression) times in case of a reduction in slope of eGFR decline by 0.75 mL/min/1.73 m2 per year. Multiple regression analysis revealed strongly significant associations for GFR slope with urine protein and CKD stage and undetectable relationships for GFR slope with diabetes and age.

Conclusion
This study demonstrated the clinical significance of GFR slope as a surrogate marker for renal prognosis in Japanese CKD patients. In order to reduce slope of eGFR decline, active intervention for proteinuria before the progression to an advanced CKD stage appears to be effective.
P0789SERUM URIC ACID IS ASSOCIATED WITH CHRONIC KIDNEY DISEASE PROGRESSION AND MORTALITY: INSIGHTS FROM THE CKD-REIN COHORT
Authors: Prezelin-Reydit Mathilde , Combe Christian , Harambat Jerome , Massy Ziad , Metzger Marie , Lange Céline , Lambert Oriane , Stengel Benedicte , Leffondré Karen 
Published: June 2020

Abstract

Background and Aims
The association between hyperuricemia and CKD progression is not well established in Europe and, to our knowledge, has not yet been investigated using longitudinal measurements.

Method
We used data from CKD-REIN, a prospective cohort study conducted in 40 representative French nephrology clinics, which included 3033 patients with CKD stages 3 to 5 between 2013 and 2016. Patients who had no serum uric acid or no creatinine measure at within 6 months of their inclusion date in the CKD-REIN study were excluded. All uric acid measures were taken into account, from inclusion to the occurrence of renal replacement therapy (RRT), death, or end of follow-up, whichever came first. We used a shared random-effect model for the joint analysis of individual trajectories of uric acid and the hazard of the composite outcome (RRT or death before RRT) and each specific event separately. Hazard ratio were adjusted (aHR) for age, sex, primary kidney disease, metabolic syndrome, cardiovascular disease, proteinuria (&lt; 30, 30-300, &gt; 300 mg/day), and the CKD-EPI estimated glomerular filtration rate (eGFR) at baseline. In a sensitivity analysis, we further adjusted for individual eGFR trajectory.

Results
A total of 2781 patients (65.5% men, median age 69 years) were included. At baseline, the median eGFR was 31.8 mL/min/1.73m2 and the median uric acid value was 425 µmol/L. During a median follow-up of 3.2 years, 434 patients received RRT and 264 died before RRT. At any time of follow-up, an increase of 100 µmol/l of the current value of uric acid was associated with a 16% increased hazard of RRT or death before RRT (aHR 1.16, 95% CI 1.07-1.26). The estimated effect of uric acid was similar with RRT (aHR 1.18, 95% CI 1.04-1.34) and death before RRT (aHR 1.16, 95% CI 1.05-1.28). When further adjusted for eGFR trajectory, the estimated effect of uric acid on the composite outcome was much weaker (aHR 1.06, 95% CI 0.98-1.16).

Conclusion
A higher current level of uric acid is associated with a strong increase in the hazard of RRT or death before RRT in European patients with CKD stage 3 to 5. However, the association is much weaker after adjustment for eGFR trajectory. Further analyses are necessary to better understand the dynamic of the association between uric acid and GFR.
P0790RISK OF CARDIOVASCULAR DISEASE AND CHRONIC KIDNEY DISEASE ACCORDING TO BLOOD PRESSURE CATEGORIES IN DIABETIC PATIENTS : A POPULATION-BASED STUDY
Authors: Lee Jun Young , Choi Seung Ok , Kim You Jin , Shin Hanwul , Kim Miryung , Yang Jae Won , Kim Jae Seok , Han Byoung Geun 
Published: June 2020

Abstract

Background and Aims
American College of Cardiology/American Heart Association (ACC/AHA) guidelines and cardiovascular disease (CVD) and chronic kidney disease (CKD) in diabetes patients remain unclear. We aimed to examine the effects of BP categories defined by the 2017 ACC/AHA guidelines in diabetes patients on the risk of CVD and CKD.

Method
In this population-based cohort study we analyzed data from the National Health Information Database in Korea during 2009-2017. The BP categories were defined as per the 2017 ACC/AHA guidelines: level 1 (systolic &lt;120 mmHg and diastolic &lt;80 mmHg), level 2 (systolic 120-129 mmHg and diastolic &lt;80 mmHg), level 3 (systolic 130-139 mmHg or diastolic 80-89 mmHg), and level 4 (systolic ≥140 mmHg or diastolic ≥90 mmHg). We obtained the risk of CVD, CKD, cerebrovascular disease and CVD mortality.

Results
Overall, 490,352 diabetes patients (men 313,752 [64·0%], women 176,599 [36·0%]) were included in the analysis. Over a mean follow-up of 5 years, 6,508 CVD events occurred. Compared to people with BP levels 1, the adjusted hazard ratios (HRs) for CVD in people with BP levels 2, 3, and 4 were 1·07 (95% confidence interval [CI], 0·98-1·16), 1·12 (95% CI, 1·04-1·20) and 1·17 (95% CI, 1·08-1·26), respectively.
There were also increased risks of CKD [1·18 (95% CI, 1·12-1·24) and 1·22 (95% CI, 1·15-1·29)], cerebrovascular disease [1·21 (95% CI, 1·14-1·29) and 1·52 (95% CI, 1·42-1·63)], and CVD mortality [1·31 (95% CI, 1·09-1·56) and 1·91 (95% CI, 1·58-2·32)] among subjects with BP levels 3 and 4 compared with those with BP level 1. Moreover, among people not taking antihypertensive medications, there were higher risks of CVD, CKD, cerebrovascular disease, and CVD mortality in those with BP levels 3 and 4 than in those with BP level 1. The risks of CVD, CKD, cerebrovascular disease, and CVD mortality significantly increased in patients with a systolic BP of 130 mmHg and diastolic BP of 80 mmHg. These findings provide evidence supporting the 2017 ACC/AHA guidelines for BP targets in diabetes patients.

Conclusion
The risks of CVD, CKD, cerebrovascular disease, and CVD mortality significantly increased in patients with a systolic BP of 130 mmHg and diastolic BP of 80 mmHg. These findings provide evidence supporting the 2017 ACC/AHA guidelines for BP targets in diabetes patients.
P0793THE PERFORMANCE OF THE RENAL FUNCTION IN THE STAGE CKD 5: A DESTINY ALREADY WRITTEN?
Authors: Cannarile Daniela Cecilia , De Liberali Matteo , Gaggi Rossella , Schiavone Giulia , Gibertoni Dino , Mancini Elena 
Published: June 2020

Abstract

Background and Aims
There is a large amount of data on the factors and progression of Chronic Kidney Disease (CKD), especially in the early stages. Stages 4 and 5, on the contrary, have always been considered hard to modify in their speed and evolution. Recent observational studies have however shown that, even in these stages, the progression is often non-linear, heterogeneous and with frequent changes of trajectory. We retrospectively evaluated our CKD stage 5 patients (pts) from 1/1/2016 to 12/31/2018, with a view to analyzing their functional evolution.

Method
We included only patients with longer than 6 months follow-up (Table 1) and at least 4 clinical-laboratory controls that included measured Creatinine Clearance (ClCr) and estimated GFR with CKD-EPI (eGFR). For each patient we analyzed: comparability between eGFR and ClCr, progression rate (Table 2); correlation between ClCr, GFR and some clinical-laboratory parameters (diabetes, blood pressure control, use of ACEi / ARB, ischemic myocardiopathy, peripheral obliterant arteriopathy (POA), proteinuria, Hb, uric acid, PTH, phosphorus).

Statistics
Linear correlation test for continuous variable analysis, chi-square test for group comparison.

Results
Average slope of eGFR: -2.98 ± 3.73 ml / min / year, of ClCr: -3.73 ± 5.8 ml / min / year. The slope of the progression rate by eGFR followed a Gaussian distribution (R 16.9%; L 55.9%; S 18.6%; M 8.4%) with a trend not statistically different from the progression assessed with ClCr (R 32.2%, L 45.7%, S 11.8%, M 10.1%) (Figure 1).
Measured CrCl and eGFR proved well correlated (r=0.565, p&lt;0.001), especially for GFR values &lt;12ml / min.
No correlation was found between eGFR and diabetes, ischemic myocardiopathy, Hb, uric acid, PTH, phosphorus, ACEi / ARB therapy, whereas a significant correlation emerged between the rate of progression and the presence of POA (70% of rapid progression POA, p = 0.035) and pressure control (80% of rapid progression patients do not have adequate pressure control, p = 0.031).

Conclusion
This analysis confirms what is transpiring from the literature: even in stage CKD5 careful monitoring and precise therapeutic strategies can still modify and slow down functional progression. Less than one third of the patients have a GFR loss&gt; 5 ml / min / year, and this rapid progression seems to correlate with the presence of AOCP and poor blood pressure control. For the remaining 70% of the patients, however, a slow evolution or even the possibility of stabilization or functional improvement is expected. These data on the slope of the renal function progression in CKD5, despite the limits of the sample size, encourage us not to consider CKD stage 5 as an inexorable short journey towards artificial replacement therapy.
P0795OUTCOME COMPARISON STUDY ACCORDING TO THE CAUSE OF CHRONIC KIDNEY DISEASE: RESULTS FROM KNOW-CKD STUDY
Authors: Ryu Hyunjin , Hong Yeji , Kim Jayoun , Ahn Curie , Oh Yun Kyu , Oh Kook-Hwan 
Published: June 2020

Abstract

Background and Aims
The cause of chronic kidney disease (CKD) is one of important factors for predicting the outcome. However, relative risks for the adverse outcomes according to the specific causes of CKD is unknown.

Method
Using the longitudinal data of prospective cohort of Korean predialysis CKD, KNOW-CKD cohort, the relative risk of end-stage renal disease (ESRD), composite of ESRD development or creatinine doubling, and composite of cardiovascular disease (CVD) and all-cause mortality according to the cause of CKD were compared. The patients were subgrouped in to four categories at the study entry according to the cause of CKD: glomerulonephritis (GN), diabetic nephropathy (DN), hypertensive nephropathy (HTN), and polycystic kidney disease (PKD). Since the baseline characteristics differed according to the causes of CKD, the inverse probability of treatment weighting (IPTW) methods was used to exclude the effects of other variables on the outcomes. The estimated glomerular filtration rate (eGFR) slope during follow-up was calculated for each cause of CKD using linear mixed model

Results
During the median follow-up of 4.1 years (interquartile range 1.12-7.12 years) total 441 (21.5%) of ESRD, 556 (27.1%) of composite of ESRD or creatinine doubling and 190 (9.3%) composite of CVD and all cause death occurred. In the IPTW adjusted cohorts, DN and PKD showed significantly increased hazard ratios of 1.85 and 5.57 for ESRD development and 1.74 and 4.57 for composite of ESRD developement or creatinine doubling, respectively, compared to GN in the fully adjusted model. Regarding compsite of CVD and all-cause death, also DN and PKD showed significantly increased hazard ratios of 1.93 and 2.16 compared to GN. The adjusted eGFR slope for DN, HTN and PKD was -2.32, -0.90, and -2.41 mL/min/1.73m2 per year, respectively, and all differ statistically significantly compared to GN (eGFR slope of -1.49 mL/min/1.73m2 per year). During the follow-up, GN and DN showed linear declining pattern however, HTN and PKD showed convex linear pattern.

Conclusion
The DN and PKD showed relatively higher risks for renal progression and composite of CVD and death compared to GN.
P0801EGFR LEVEL BEFORE HOSPITALIZATION INFLUENCES OUTCOMES AFTER DISCHARGE REGARDLESS OF ADMISSION DIAGNOSIS
Authors: Ravaglia Fiammetta , Profili Francesco , Spatoliatore Giuseppe , Francesconi Paolo , Rosati Alberto 
Published: June 2020

Abstract

Background and Aims
The risk of hospitalization and death is known to be greater among patients with chronic kidney disease. Less known are the risks after hospital discharge.
Our aim is to evaluate the prognosis after hospital discharge according to the presence and the degree o CKD before the hospitalization.

Method
Target population: Tuscany population (patients on RRT excluded) aged 50+ years, discharged from medical setting in 2017, ordinary regimen (excluding long-term stay/ rehabilitation, trauma and hospitalizations of a special nature), without hospitalization episodes in the 28 days before, with at least one creatinine determination in an outpatient setting in 2017, prior to admission. Data were extracted from hospital discharge sheets.
Exposure measurement: CKD stage, based on glomerular filtration rate estimated by CKD-EPI equation. Laboratory tests were linked with hospital data with a unique anonymous identifier.
Outcome one month and one year after discharge were:
- hospitalization (medical area, ordinary regime, excluding long-term stay / rehabilitation and special hospitalizations). For all causes and by diagnosis-related group.
- Institutionalization or activation of home care, calculated only one year after discharge.
- all-cause mortality.
Statistical analysis: incidence rates (IR) and ratio of incidence rates (IRR), with 95% confidence intervals, were calculated for institutionalization / home care, hospitalization and death (rough and adjusted for covariates at discharge index: comorbidity, age, gender, discharge department, diagnosis-related group of discharge, days of hospitalization) with Poisson regression model.

Results
33,253 discharges met the eligibility criteria in 2017 (28,706 subjects). The discharges of patients with a eGFR &gt; 60 were 18,194 (54.8%), with eGFR &lt;30 were 4,268 (12.8%). The risk of hospitalization or death increases with decreasing eGFR, both at one month and at one year. One-month death IRR for a GFR &lt;30 vs GFR&gt; 60 was 1.59 (CI95%: 1.39-1.83), the hospitalization IRR was 1.61 (CI95%: 1.46-1, 77). One-year death IRR was 1.46 (CI95%: 1.35-1.58), the hospitalization IRR was 1.35 (CI95%: 1.21-1.50). One-year institutionalization IRR was 1.35 (CI95%: 1.21-1.50) As expected, the main causes of hospitalization were cardiovascular, genitourinary or gastrointestinal diseases.

Conclusion
The lower the renal function before the hospital admission, the greater the chances of hospitalization or death, in the short term and at one year, regardless of admission diagnosis. The risk of losing autonomy also increases. For this reason, the patient discharged with known kidney disease can benefit from protected discharge paths and dedicated post-hospital follow-up.