bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0803SYNERGISTIC INTERACTION OF ACUTE HYPERGLYCEMIC STRESS AND NON-ALCOHOLIC FATTY LIVER DISEASE ON THE DEVELOPMENT OF ALBUMINURIA IN GENERAL POPULATION
Authors: Lee Chang Hwa , Yu Mi-yeon , Choi Jong Wook , Yi Joo-Hark , Han Sang-Woong , Park Joon-Sung 
Published: June 2020

Abstract

Background and Aims
Both increased glycemic exposure and non-alcoholic fatty liver disease (NFALD) are independent risks of vascular endothelial dysfunction. To find interactive effects of acute hyperglycemia and hepatic necro-inflammation on initiation of albuminuria, we conducted this nation-wide, population-based interaction analysis using acute-to-chronic glycemic ratio (ACGR) as a candidate indicator of acute increased glycemic exposure and ZJU index as an indicator of NFALD.

Method
Eligible as cases were all native Koreans aged 20 years or older without significant medical illness. A total of 9494 participants were divided into quintiles according to their ACGR results and stratified by sex.
Results: Participants in the highest ACGR quintile were more obese and they were more likely to have elevated BP and increased glycemic exposure as compared with other quintiles. Restricted cubic regression analyses revealed that there was non-linear relationship of ACGR and ZJU index with albuminuria. Multiple logistic regression, adjusted for various conventional risk factor of kidney disease, demonstrated that both ACGR (adjusted OR = 5.388, 95% CI = 1.119-25.95) and ZJU index (adjusted OR = 1.057, 95% CI = 1.002-1.114) were independent predictor of albuminuria. Interestingly, our interaction analysis revealed that ACGR had bigger effect on the risk of albuminuria in participant with elevated ZJU index than those without (adjusted RERI = 2.296, 95% CI = 2.277-2.313; adjusted AP = 0.643, 95% CI = 0.472-0.814; adjusted SI = 8.135, 95% CI = 7.267-9.003).

Conclusion
Our findings suggest that the interaction of acute hyperglycemia and abnormal hepatic fat metabolism may exert synergistic biologic effect on the development of albuminuria.
P0804TRENDS IN BODY MASS INDEX IN PATIENTS WITH INCIDENT CHRONIC AND END STAGE KIDNEY DISEASE FROM 2004 - 2019
Authors: Gamio-Izasmendi Diana , Gillis Keith , Mark Patrick , McManus Siobhan , Traynor Jamie 
Published: June 2020

Abstract

Background and Aims
Obesity is increasingly prevalent in the general population. Body mass index (BMI) has a U-shaped relationship with mortality in chronic kidney disease (CKD), but also has implications for service delivery. We analysed the BMI trends in incident patients referred to CKD clinic (CKD), starting haemodialysis (HD), peritoneal dialysis (PD) and receiving a kidney transplant (Tx). Our aim was to establish the trend in BMI across these specified patient groups over the last 15 years.

Method
A single centre retrospective analysis was carried out including adults referred to secondary care nephrology services between 2004 and 2019. Patients were categorised into CKD, HD, PD, or Tx. Those reaching ESKD were grouped according to first method of renal replacement therapy (RRT). Patients with acute kidney injury and with missing BMI data were excluded. As per the World Health Organisation’s definition, BMI was categorised into classes I, II and III (&gt;30, 35, and 40kg/m2 respectively).

Results
Of 10,057 patients, 6,936 patients were included. Of these, 59.96% (n=4,249) were CKD, 7.39% (n=524) were Tx, 4.85% (n=344) were PD, and 27.43% (n=1,944) were HD. BMI was 27.3±7.2kg/m2 in 2004 and 27.8±7.72kg/m2 in 2019 with no significant change in BMI as a whole throughout that time period (p=0.07). In subgroup analysis, there was no change in BMI in the CKD (p=0.52) or PD (0.76) groups. However, there was a significant increase in BMI seen in both the HD (p&lt;0.001) and Tx (p=0.006) groups. An increase in the proportion of patients with class III obesity was also observed in the HD group (p=0.009) but not the CKD, Tx or PD groups.

Conclusion
In contrast to the general population, the prevalence of obesity has not changed in incident patients with kidney disease over the last 15 years. In subgroup analysis however, there is a trend towards rising BMI in the incident haemodialysis patient group. Limitations of the study include retrospective design, lack of ethnicity data, and inclusion of only a single measure of adiposity.
Although the relationship between BMI and mortality in patients receiving maintenance haemodialysis is non-linear, the increase in the very obese in this patient group will have significant implications for healthcare providers.
P0805SURPRISE QUESTION IN ADVANCED CHRONIC KIDNEY DISEASE
Authors: Cardoso Fernandes Sara , Moreira Fonseca Nuno , Magriço Rita , Mesquita Isabel , Fernandes Vasco , Ferreira Ana Carina , Nolasco Fernando 
Published: June 2020

Abstract

Background and Aims
Nowadays, patients with end-stage chronic renal disease (ESRD) are initiating dialysis at more advanced ages and having multiple comorbidities. Since the initiation of dialysis in the elderly may not result in increased survival or quality of life, it would be useful to define prognostic criteria for those patients. We aim to evaluate the utility of the surprise question (“Would I be surprised if this patient died in the next 12 months?”) as a predictor of survival in elderly patients in advanced stages of chronic kidney disease (CKD).

Method
Retrospective cohort study of patients elder than 70 years with CKD stages 4 to 5 according to the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) who attended the CKD information consultation between March 2017 and November 2018. The answer to the surprise question was registered during that office visit. Demographic, clinical and laboratory data (including serum albumin) were analyzed and Charlson Comorbidity Index (CCI) was calculated. Continuous variables are presented as means (±SD) or medians (IQ range), according to normality, and categorical variables as frequencies. Comparisons between groups were made using Student’s T-test and Pearson Chi-squared test. Survival analysis was conducted using Kaplan-Meier test and Cox proportional hazard model. STATA software was used and a p&lt;0.05 was considered significant.

Results
Of the 60 patients selected, 22 (36.7%) were female, 59 (98%) were white and the median age was 78.6±6.3 years. Half of these patients had diabetes mellitus with end-organ damage and 57% suffered from congestive heart failure. The response to the surprise question was “yes” in 31 (51.7%) patients and “no” in 29 (48.3%) patients. We did not find clinical or demographic differences among these groups. The patients were followed for 26 (20-31) months, during which 19 deaths occurred, 4 (21%) in the SQ-yes group and 15 (79%) in the SQ-no group. The response to the surprise question was associated with patients’ survival (KM – p=0.0009), with a positive and negative predictive values of 79% and 66%, respectively. The multivariate analysis (age, sex, race, serum albumin and CCI) showed that the answer to the SQ is an independent predictor of mortality (HR 0.27 [IC 0.08-0.86]).

Conclusion
The SQ seems to be a good predictor of survival in elderly patients in advanced stages of CKD and can be used to assess their prognosis in order to help deciding whether the patient is a good candidate to initiate dialysis or not.
P0810DOSAGE REDUCTION OF LOW MOLECULAR WEIGHT HEPARIN IN PATIENTS WITH RENAL DYSFUNCTION: EFFECTS ON ANTI-XA LEVELS AND CLINICAL OUTCOMES
Authors: Hornung Paul , Khairoun Meriem , Dekker Friedo W , Kaasjager Karin A H , Huisman Albert , Jakulj Lily , Bos Willem Jan , Rosendaal Frits , Verhaar Marianne , Ocak Gurbey 
Published: June 2020

Abstract

Background and Aims
To prevent bio-accumulation of low molecular weight heparins (LMWHs) in patients with an impaired kidney function, guidelines recommend dosage reduction and anti-Xa monitoring. The aim of this study was to investigate the effect of pre-emptive dosage reduction of LMWH on anti-Xa levels. Furthermore, we investigated the association between anti-Xa levels and bleeding, thrombotic events and mortality.

Method
In this single center study, we followed 499 patients with an estimated glomerular filtration rate (eGFR) below 60 ml/min/1.73m2 in whom anti-Xa levels were measured. We observed how many patients had anti-Xa levels that fell within the target range (between 1.0 U/ml and 2.0 U/ml with once daily LMWH and between 0.6 U/ml and 1.0 U/ml with twice daily LMWH), with a standard protocol of a pre-emptive dosage reduction of LMWH (25% reduction in patients with an eGFR between 30 and 60 ml/min/1.73m2 and a reduction of 50% in in patients with an eGFR below the 30 ml/min/1.73m2).
Furthermore, Cox proportional hazard analyses were used to estimate hazard ratios with 95% confidence intervals (CIs) to investigate the association between anti-Xa levels and major bleeding, thrombotic events (ischemic stroke or venous thrombosis) and mortality within three months of follow-up. Hazard ratios were adjusted for age, sex, body mass index, type of LMWH, once or twice daily dosing, antiplatelet drug use, indication for anticoagulation, comorbidities, hemoglobin concentration and eGFR.

Results
In a cohort of 499 patients (445 dalteparin and 54 nadroparin users), the median anti-Xa level was 0.44 U/ml (IQR 0.21-0.75) for the total group (n=499). A pre-emptive dosage reduction of LMWH led to adequate levels of anti-Xa in only 19% of the patients (12% for the dalteparin users and 50% for nadroparin users).
Of the 499 patients, 104 patients had a major bleeding, 27 had a thrombotic event and 146 died within three months. We did not find an association between anti-Xa levels and bleeding or mortality (Table 1). An anti-Xa level below the target range was associated with a non-significant increased risk estimate for thrombosis (HR 2.5, 95% CI 0.7-8.8) after adjustment (Table 1).

Conclusion
Pre-emptive dosage reduction of LMWH leads to low anti-Xa levels in a large proportion of patients and may lead to an undertreatment of patients with an impaired kidney function.
P0812LONG-TERM EFFECTS OF AIR POLLUTANTS ON MORTALITY RISK IN PATIENTS WITH END-STAGE RENAL DISEASE
Authors: Park Jae Yoon , Jung Jiyun , Lee Sung Woo , Kim Ho , Lee Jung Pyo 
Published: June 2020

Abstract

Background and Aims
Long-term exposure to air pollutants significantly increases the morbidity and mortality associated with various diseases. However, little is known about the relationship between air pollutants and end-stage renal disease (ESRD)-related mortality.

Method
A total of 5041 patients who started dialysis between 2008 and 2015 were prospectively enrolled in the Clinical Research Center for End-Stage Renal Disease (CRC-ESRD) cohort study. We assigned a daily mean concentration of air pollutants (PM10, NO2, and SO2) to each participant. Time-varying Cox models were used to investigate the relationship between air pollutants and mortality in ESRD patients.

Results
During the follow-up period (mean 4.18 years), 1475 deaths occurred among 5041 participants. We found a significant long-term relationship between mortality risk and PM10 (HR 1.33, CI 1.13–1.58), NO2 (HR 1.46, CI 1.10–1.95), and SO2 (HR 1.07, CI 1.03–1.11). Elderly patients and patients who lived in metropolitan areas had an increased risk associated with PM10. Elderly patients also had increased risks associated NO2 and SO2.

Conclusion
Long-term exposure to air pollutants had negative effects on mortality in ESRD patients. These effects were prominent in elderly patients who lived in metropolitan areas, suggesting that ambient air pollution, in addition to traditional risk factors, is important for the survival of these patients.
P0813FRAILTY MODIFIES THE ASSOCIATION BETWEEN OPIOID USE AND MORTALITY IN CHRONIC KIDNEY DISEASE PATIENTS: A POPULATION-BASED COHORT STUDY
Authors: CHAO CHIA-TER 
Published: June 2020

Abstract

Background and Aims
The prevalence of chronic pain in patients with chronic kidney disease (CKD) is high and is associated with higher frailty risk, but satisfactory pain control frequently fails to be achieved. Opioid remains instrumental regarding optimal pain management, but its influence on outcomes can be of concern in CKD patients. We examined whether opioid use affected patient outcome and whether such relationship was modified by frailty.

Method
From the longitudinal cohort of diabetic patients (n = 840,000), a well-maintained population-based cohort, we identified those with CKD who were opioid user (at least 7 days within any month; n = 26,029), followed by propensity score-matched to opioid never-users from the same cohort in a 1:1 ratio, based on demographic features, comorbidities, and other medications. We analysed the associations between opioid use and survival in these patients according to their baseline frailty status, defined by the modified FRAIL (Fatigue, Resistance, Ambulation, Illness, and Loss of weight) scale.

Results
Among the enrolled CKD participants (mean age 62.9 ± 13.5 years, 48.2% female), 20.3% did not have any FRAIL item satisfied, while 57.2%, 20.6%, and 1.9% had 1, 2, and at least 3 positive FRAIL items at baseline, respectively. After a median of 4.2 years, 16.4% participants died. Univariate analysis showed that opioid users had an elevated risk of morality compared to non-users (hazard ratio [HR] 1.124, 95% confidence interval [CI] 1.08 – 1.17) (Figure). Cox proportional hazard regression showed that opioid users exhibited an 18.3% higher risk of mortality compared to non-users (HR 1.183, 95% CI 1.13-1.24) among patients with CKD; furthermore, the mortality risk associated with opioid use was observed in CKD participants without frailty only (HR 1.18, 95% CI 1.13-1.24) but not in those with frailty (HR 1.08, 95% CI 0.83 – 1.4).

Conclusion
Opioid use might lead to a higher risk of mortality among CKD patients, but this relationship was observed among those without frailty only. Interestingly, frail CKD patients who were opioid users were not at an elevated risk of mortality compared to non-users.
P0817SMOKING WAS ASSOCIATED WITH LOWER SERUM LEVEL OF SOLUBLE ALPHA KLOTHO IN PATIENTS WITH NON-DIALYSIS CHRONIC KIDNEY DISEASE:RESULTS FROM THE KOREAN COHORT STUDY FOR OUTCOMES IN PATIENTS WITH CHRONIC KIDNEY DISEASE (KNOW-CKD)
Authors: CHAE DONG-WAN , Yi Yong Jin , Cheong Jong Chul 
Published: June 2020

Abstract

Background and Aims
Soluble αklotho (sklotho) in systemic circulation, which is mainly derived from renal tubule, has been reported to play important roles in mineral bone disorders, cardiovascular complications and renal progression in CKD. Although decreased renal parenchymal mass is thought to be a main cause of decreased serum level of sklotho in CKD, various factors causing renal tubular injury such as hypoxia, oxidative stress, proinflammatory cytokines and uremic toxins are also known to decrease the renal tubular expression of αklotho. Because smoking contributes to hypoxia and oxidative damage, we hypothesized that smoking might be related to decreased sklotho in patients with non-dialysis CKD.

Method
To test this hypothesis, we analysed data of 2,101 subjects with non-dialysis CKD from a currently on-going Korean multi-centers prospective cohort study of CKD (KNOW-CKD, NCT01630486 at www.clinicaltrials.gov) in whom serum klotho was measured using an enzyme-linked immunosorbent assay kit (Immuno-Biological Laboratories Co, Gunma, Japan). The intra-assay and inter-assay coefficients of variations were 0.57-1.78% and 3.01-6.12% respectively.

Results
Mean age was 53.6±12.2 years and 1282 (61.0%) were men. The number of current, former and never smokers were 338 (16.1%), 642 (30.6%), and 1118 (53.2%) respectively. The median pack-year was 20.0 (interquartile range: 10.0-35.0). Mean eGFR by CKD-EPICr equation was 53.0±30.7 ml/min/1.73m2 and mean UACR was 903.9±1423.8 mg/g. Median serum sklotho was 536.0 (IQR: 419.5 – 667.0) pg/ml. In multivariable linear regression with backward stepwise adjustment by all significant factors for sklotho in univariate linear regression, smoking pack-year was independent variable for sklotho. (β= -0.786, p=0.032 95% CI for β: -1.504 to -0.069). Age and serum uric acid were also negatively associated with sklotho, while eGFR, serum alkaline phosphatase, and serum hemoglobin were positively associated with sklotho in the same analysis. Median sklotho of never, former, and current smokers were 551.0 (IQR:430 – 689.3) pg/ml, 509.5 (IQR: 407.8 – 645.3) pg/ml, and 521. (IQR: 397.8 – 645.0) pg/ml respectively. Linear mixed model adjusted by sex, age, eGFR, hemoglobin, alkaline phosphatase, and uric acid demonstrated that sklotho in never smokers was significantly higher than former (p=0.004) and current smokers (p=0.001). But there was no difference in sklotho between former and current smokers.

Conclusion
Smoking was associated with lower serum sklotho in non-dialysis CKD. But no difference in sklotho between former and current smoker casted doubt on causal relationship between smoking and serum sklotho
P0818IMPROVING MORTALITY TRENDS FOR PATIENTS WITH CHRONIC KIDNEY DISEASE IN THE IRISH HEALTH SYSTEM: THE IRISH KIDNEY DISEASE SURVEILLANCE SYSTEM (IKDSS)
Authors: Laird Matthew , Alheyali Raihan , Browne Leonard , Plant Liam , Walsh Cathal , Austin Stack 
Published: June 2020

Abstract

Background and Aims
It is unclear whether targeted efforts for the treatment of chronic kidney disease (CKD) has led to a sustained reduction in mortality rates. We examined annual trends in mortality for patients with and without CKD in the Irish health system.

Method
We utilised data from the Irish Kidney Disease Surveillance System (IKDSS) to explore 1-year mortality rates among patients with and without CKD in the health system. The principal data sources included; regional laboratory information systems; dialysis registers; and mortality data files from the national Central Statistics Office (CSO). We created multi-annual cohorts of patients, age &gt; 18 years with one or more serum creatinine values who received healthcare within the Irish health system from 2008 to 2012. Serum creatinine values (first test in fiscal year) were used to calculate glomerular filtration rate (eGFR) and CKD was defined as GFR &lt; 60ml/min/1.73m. Mortality data were available from the national mortality files with vital status up to December 31st 2013. Age standardised death rates were determined for the Irish population (IRE) and the European Standard Population (ESP) (standardised to the age distribution of a standard European population in 2012. Comparisons were conducted using segmented linear regression.

Results
We included 351,223 adult individuals between 2008 and 2012. Age standardised mortality rates (EU) were more than 2-fold higher for patients with CKD than without, P&lt;0.001. From 2008-2012, age-standardised mortality rates decreased significantly in patients with CKD from a peak of 47.7 to 31 per 1000 person-years, P for trend=p=0.012, and from a peak of 17.8 to 15.5 per 1000 person-years in patients without CKD, P=0.006. Mortality rates for men were significantly higher than for women in patients with and without CKD, but the pattern of improvement was similar for both sexes. These patterns were replicated when comparisons were made using Irish standard age distribution.

Conclusion
Mortality rates among CKD patients have declined in the Irish population from 2008 to 2012 in both men and women. The processes and interventions that have led to these reductions need further exploration.
Figure 1. (a) Crude and age standardised mortality rates (b-c) of those with and without CKD in the Irish Health System between 2008-2012 .
P0820EMERGENCY DEPARTMENT UTILIZATION BY PATIENTS WITH ADVANCED CHRONIC KIDNEY DISEASE AND DIALYSIS: A POPULATION BASED STUDY
Authors: Chhibba Ruchi , Leon-Mantilla Silvia , Ferguson Thomas , Komenda Paul , Tangri Navdeep , Rigatto Claudio 
Published: June 2020

Abstract

Background and Aims
Chronic Kidney Disease (CKD) is a potent risk factor for kidney failure, cardiovascular events and all cause hospitalizations. In addition to higher outpatient resource use, patients with CKD may present more frequently to the emergency department (ED) and may be more likely to be admitted for hospitalization. In Manitoba, we previously demonstrated an 8-fold increase in the frequency of ED presentations by patients on dialysis as compared to a non-dialysis population. Comparable data on ED visits remain sparse for patients with CKD G3-G5, not on dialysis. Here, we aim to describe the frequency of ED visits and highlight differences in reasons for visit in patients with CKD stages G3-G5 and Those on dialysis when compared to a non-renal population.

Method
We performed a retrospective cohort study using administrative health data from the Winnipeg Regional Health Authority, Canada. We included all adults (≥ 18 years) with CKD stages G3-G5 and patients undergoing dialysis between January 1st, 2010 and December 31, 2014. Secular trends in the in the rates of ED visits were calculated for those with CKD, those on dialysis and in the non-renal population.

Results
Over the study period, patients undergoing dialysis had the highest incidence of ED visits, followed by patients with CKD and those with normal kidney function (150 vs 106 vs 34 per 100 persons per year respectively). These rates were stable over the period studied. Among the non-renal population, the most common reasons for an ED visit were musculoskeletal complaints (25.6%), followed by gastrointestinal (11.04%) and cardiovascular complaints (10.26%). In the CKD and dialysis cohort, ED visits were more commonly secondary to cardiovascular complaints (21.54% and 18.99% respectively), followed by respiratory and gastrointestinal complaints. Admission to hospital was higher in CKD and dialysis populations than in the non-renal population (29.56%, 26.07% vs 10.61%, respectively).

Conclusion
Patients with CKD present frequently to the ED, and are often admitted after presentation. Cardiovascular and respiratory complaints are more common in the CKD population.