bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0688GREATER MUSCLE STRENGTH IS ASSOCIATED WITH LOWER RISK OF CHRONIC KIDNEY DISEASE
Authors: Jhee Jong Hyun , Lee Gang Yoon , Yoon Songuk , Choi Hoon Young , Park Hyeong Cheon 
Published: June 2020

Abstract

Background and Aims
Frailty is a known risk factor for chronic disease and mortality. However, the association between frailty assessed by hand grip strength (HGS) and chronic kidney disease (CKD) among adults has not been elucidated. This study evaluated the association between muscle strength and the risk of CKD.

Method
Data were retrieved from a nationwide cohort study (Korean National Health and Nutrition Examination Surveys VI-VII, 2014-2017) and participants aged 40 to 80 years were included in the study analysis (male=6,660, female=8,195). HGS was measured using digital hand dynamometer and normalized to body mass index (BMI). The association between the risk of CKD (estimated glomerular filtration rate [eGFR] &lt;60 mL/min/1.73 m2 or the presence of proteinuria) and quartile of HGS per BMI was evaluated among male and female subjects.

Results
The mean age was 58.8 ± 11.6 years and mean eGFR level was 88.2 ± 18.7 mL/min/1.73 m2. The mean levels of HGS per BMI were 1.5 ± 0.3 and 0.9 ± 0.2 in male and female subjects, respectively. Those in higher quartile of HGS per BMI showed lower prevalences of advanced CKD stages than lowest quartile among both male and female subjects. When univariable logistic regression analysis for the risk of CKD was performed, higher quartile of HGS per BMI was significantly associated with lower risk of CKD in both male and female subjects. After adjustment for confounding factors including age, systolic blood pressure, smoking and alcohol intake, education and income levels, history of hypertension, diabetes, or arthritis, physical activity, baseline eGFR, total cholesterol, hemoglobin, and daily protein intake, the higher quartile of HGS per BMI were associated with lower risk of CKD in both male and female subjects (odds ratio [OR], 0.66; 95% confidence interval [CI], 0.49-0.88 in Q4; OR, 0.64; 95% CI 0.49-0.83 in Q3 in male; OR, 0.59; 95% CI, 0.43-0.81 in Q4; OR, 0.61; 95% CI, 0.47-0.80 in Q3; OR, 0.70;95% CI, 0.55-0.90 in Q2 in female, Q1 as reference group). These associations were consistent when the HGS per BMI was treated as continuous variable that 34% and 54% of risk was reduced as 1 m2 increase in male and female subjects.

Conclusion
Greater muscle strength normalized to BMI is associated with lower risk of CKD in adults. These findings suggest that frailty in adults is an important risk factor for CKD development.
P0692NON-PROTEINURIC DIABETIC NEPHROPATHY AND THE RISK OF MORTALITY IN PATIENTS WITH CHRONIC KIDNEY DISEASE (CKD)
Authors: Santoro Antonio , Gibertoni Dino , Mandreoli Marcora 
Published: June 2020

Abstract

Background and Aims
Diabetes (DM) is considered one of the major causes of progressive CKD even when it does not induce proteinuria. However, the condition of diabetes without proteinuria is not universally considered to be accompanied by a reduced survival of the patient.
The aim of the study was to verify whether non-proteinuric diabetic CKD patients presented a different risk of mortality compared to non-diabetic and non-proteinuric CKD patients.

Method
Two matched cohorts of CKD patients were obtained from the PIRP database, that contains clinical and laboratory data from about 30,000 patients who have been followed since 2005 in the Emilia-Romagna Region (Italy). In the period 2005-2017, 2651 subjects with DM2 in CKD-EPI stages 3a to 5 and without evidence of proteinuria that entered the PIRP register surveillance were matched with as many non-diabetics patients without proteinuria by gender, age class, CKD stage. To assess the presence of a differential mortality risk in diabetic patients, a multivariable Cox regression model was fit, adjusted for several potential clinical confounders, using multiple imputation to estimate missing data and taking into account patients’ clusterization into nephrology units to correct standard error estimates.

Results
In the 13 years examined, deaths were more frequent in patients with DM2 (38.7% vs 30.7%, p&lt;0.001) as well as CV events before and after PIRP enrolment (52.2% vs. 42.9%, p&lt;0.001), while dialysis initiation rate was lower (Fig.1). Furthermore, in diabetics there was a higher percentage of overweight or obese patients (38.9% vs 19.7%, p&lt;0.001), lower levels of hemoglobin (12.3 g/dl vs 12.7 g/dl, p&lt;0.001) and higher values of triglycerides 163 mg/dl vs 132 mg/dl, p&lt;0.001). 10-year survival was significantly lower in diabetics (22.9% vs 36.4%, log-rank test: p &lt;0.001, Fig.1). Multiple Cox regression identified a higher mortality risk for diabetics (HR = 1.326, p&lt;0.001) after adjusting for sex, age, baseline eGFR, hemoglobin level, BMI, smoking status, presence of tumors or cardio-vascular comorbidities and cohort effect (5-years period indicator).

Conclusion
In patients with CKD and non-proteinuric nephropathy, concurrent diabetes was associated to a higher frequency of CV events and represented an independent risk factor for overall mortality. Thus, in diabetic patients, even in absence of proteinuria, we have to intensify therapeutic strategies to control the so-called CV intermediate risk factors (tobacco use, low-density lipoprotein cholesterol, hypertension, hypercoagulable states, obesity, etc.)
P0698STRESS RELATED DISORDERS AND THE RISK OF KIDNEY DISEASE: A MATCHED COHORT STUDY BASED ON THE STOCKHOLM CREATININE MEASUREMENTS (SCREAM) PROJECT
Authors: Su Guobin , Song Huan , Lanka Vivekananda , Liu Xusheng , Fang Fang , Valdimarsdóttir Unnur A , Carrero Juan Jesus 
Published: June 2020

Abstract

Background and Aims
Psychiatric reactions to life stressors are common in the general population and may increase the risk of acute (AKI) and chronic kidney disease (CKD). The aim of this study is to evaluate the association between stress related disorders and subsequent risk of AKI or CKD progression.

Method
Population-matched retrospective cohort study conducted in the Stockholm CREAtinine Measurement project (SCREAM), Sweden from 2006 to 2012. The cohort included 31,137 exposed patients with stress related disorders (ie, posttraumatic stress disorder, acute stress reaction, adjustment disorder, and other stress reactions, defined by 10th international Classification of diseases, ICD-10: F43) and known kidney function (estimated glomerular filtration rate, eGFR), and 117,144 unexposed matched by age, sex and eGFR category. The primary outcome was CKD progression, defined as a sustained relative decline in eGFR of more than 40% or commencement of kidney replacement therapy. The secondary outcome was acute kidney injury (AKI), defined by death or hospitalization attributed to AKI or detected transient plasma creatinine elevations (KDIGO classification). Conditional Cox models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs).

Results
During a medium follow-up of 3.3 years and compared with the unexposed population, patients with stress related disorders were at increased risk of CKD progression (HR 1.16, 95% CI 1.04-1.30) and AKI (HR 1.17, 95% CI 1.01-1.37). While the relative risk of CKD progression remained constant over follow-up, the association with AKI was most evident during the first year after stress diagnosis (HR: 1.31, 95% CI 1.04-1.66), disappearing thereafter. Among 9 prespecified subgroups, there was suggestion of heterogeneity with possible lack of association in patients with psychiatric comorbidity.

Conclusion
Exposure to a stress related disorder was associated with the long-term risk of CKD progression and the short-term risk of AKI. Studies are needed to better understand underlying mechanisms.
P0701LONG-TERM RETROSPECTIVE OBSERVATION STUDY TO EVALUATE EFFECTS OF ADIPONECTIN ON SKELETAL MUSCLE IN KIDNEY TRANSPLANT RECIPIENTS
Authors: Adachi Hiroki , Fujimoto Keiji , Kagaya Yu , Kumano Syo , Fujii Ai , Matsuura Kazutoshi , Okada Keiichiro , Okino Kazuaki , Kengo Furuichi , Yokoyama Hitoshi 
Published: June 2020

Abstract

Background and Aims
Although it is reported that chronic kidney disease participates some roles in progression of sarcopenia, mechanisms of the progression of sarcopenia are unclear so far. In this observational study, we focused on serum adiponectin levels, that is a marker of metabolic syndrome, cardiovascular disease, and skeletal muscle mass in patients with kidney transplantation.

Method
Fifty-one patients who underwent renal transplantation at our hospital in and after 1998 (31 males and 20 females; aged 29-52 years at the time of transplantation) were retrospectively examined the relationships between the psoas muscle index (PMI), intramuscular adipose tissue content (IMAC), serum adiponectin fractions (high-/low-molecular-weight), and new-onset diabetes after transplantation (NODAT).

Results
Age at kidney transplantation negatively correlated with PMI before transplantation and positively correlated with IMAC before transplantation (rS=-0.427, p&lt;0.01; rS=0.501, p&lt;0.01, respectively). Both in one and five years after transplantation, PMI was higher than before transplantation (p&lt;0.01). In contrast, IMAC transiently decreased one year after kidney transplantation, but subsequently recovered five years after kidney transplantation. Multivariate analyses identified that the mean increases of high-molecular-weight adiponectin concentrations was exacerbating factor for the mean change in PMI (p=0.003). Moreover, the mean increases of PMI and IMAC were exacerbating factors for the newly development of post-transplantation diabetes mellitus.

Conclusion
PMI increased associated with high-molecular-weight adiponectin levels after renal transplantation. In addition, PMI increased suppressed the development of NODAT.
P0720CARVEDILOL AND NON-DIHYDROPYRIDINE CALCIUM CHANNELS BLOCKERS DELAY THE PROGRESSION OF CHRONIC KIDNEY DISEASE BEYOND ACE-INHIBITION IN KWAZULU-NATAL (SOUTH AFRICA)
Authors: Reddy Verushka , Assounga Alain 
Published: June 2020

Abstract

Background and Aims
Chronic kidney disease (CKD) is on the rise worldwide. It is associated with increased morbidity and mortality and places a huge burden on cost constrained health systems in developing countries such as South Africa. ACE inhibition is well established as major factor of reduction of the decline of renal function. The aim of this study to evaluate carvedilol, non-dihydropyridine calcium channel blockers (NDCCB) as potential renal protection factor beside ACE inhibition.

Method
This is a retrospective cohort study using the medical records of 300 patients attending the outpatient renal clinic department at Inkosi Albert Luthuli Central Hospital for the period January 2007 – December 2009. The average patient age was 43 years. The patients were followed up for 24 months following their first clinic visit. Socio-demographic (age sex, residence) and clinical characteristics including eGFR, blood pressure, BMI (body mass index), proteinuria, haemoglobin, cholesterolemia, were recorded. Treatments received including ACE inhibitors, carvedilol, non-dihydropyridine calcium channel blockers (NDCCB), Beta blockers were also recorded. Patients were divided into 2 outcome categories, according to changes in eGFR (estimated glomerular filtration rate): patients with eGFR decline of 1ml/min/year or less and those with accelerated eGFR decline (&gt;1ml/min/year). Data analysis using SPSS version 23 (IBM) comprised of descriptive tests and logistic regression analysis (expressed as OR (odd ratio) and confidence interval) for the study of the association of above characteristics with patients’ outcome.

Results
ACE inhibition was used by 92% of patients. The use of carvedilol and NDCCB was associated with a reduction of the decline of eGFR with OR: 0.144[0.207-0.953] p=0.037 and OR: 0.543[0.329-0.884], p=0.016 respectively. No significant association was found between eGFR change and daily proteinuria or cholesterolemia. The aetiology of the chronic kidney disease did not affect rate of progression of eGFR. In addition, the rate of progression was not dependent on eGFR.

Conclusion
These results suggest that beyond ACE inhibition, the control of BMI, and use of carvedilol and NDCCB further delay the progression of chronic kidney disease in KwaZulu-Natal.
P0722VITAMIN D-DEFICIENT RATS RECOVER RENAL ALTERATIONS AFTER VITAMIN D REPLACEMENT FOLLOWING ISCHEMIA-REPERFUSION INJURY
Authors: Seguro Antonio Carlos , Santos Michele S , Denelle Bernardo Desiree Rita , Canale Daniele , Shimizu Maria Heloisa Massola , Volpini Rildo Aparecido , De Braganca Ana Carolina 
Published: June 2020

Abstract

Background and Aims
Several studies have been linking vitamin D deficiency (VDD) as a non-traditional risk factor to acute kidney injury (AKI). It has been shown that VDD associated with AKI potentiates the injury and may accelerate the progression of kidney disease. Conversely, some lines of evidence have been describing that vitamin D sufficiency can be considered as a renal protective factor. Thus, we aimed to verify the effect of vitamin D replacement (R) on the renal disease progression post ischemia-reperfusion injury (IRI) in vitamin D deficient rats.

Method
We performed bilateral 45 min IRI on day 30 in all animal groups. Male Wistar rats were randomized into three groups: 1- IRI (fed a standard diet for 120 days); 2- VDD+IRI (fed a vitamin D-free diet for 120 days); and 3- VDD+IRI+R (fed a vitamin D-free diet for 30 days and just after IRI, on day 31, we reintroduced the standard diet for more 90 days). We evaluated inulin clearance (Cin); mean arterial pressure (MAP); renal blood flow (RBF); plasma levels of Vitamin D2+D3 [25(OH)D] and Parathormone (PTH) by ELISA. In addition, we performed histomorphometrical studies for CD3+ cells, fibronectin and vimentin as well as the fractional interstitial area (FIA). Moreover, we run qPCR studies and immunoblotted for vitamin D receptor (VDR) and Klotho. All the results are described in table 1.

Results
Vitamin D replacement restored the plasma levels of 25(OH)D and PTH in VDD+IRI+R group. Also, VDD+IRI+R presented an improvement of renal function and hemodynamic parameters. In addition, we observed more evident alterations in tubulointerstitial compartment, featuring interstitial expansion (renal fibrosis and inflammatory cell infiltrates) and fibronectin and vimentin expression in VDD+IRI rats. These alterations were recovered by vitamin D replacement. Concerning VDR and Klotho data, our results revealed a decreased expression of these targets in VDD+IRI group. On the other hand, vitamin D replacement retrieved the expression of VDR and Klotho.

Conclusion
Our study suggests that vitamin D replacement improved the recovery of renal function, hemodynamics, inflammatory and morphological alterations. In addition, vitamin D replacement was able to reestablish the expression of VDR and Klotho in IRI-AKI associated with vitamin D deficiency. Thus, it is recommendable that vitamin D levels should be observed as well as its reposition should be taken into account in renal patients.
P0725INDICATORS OF AGING KIDNEY, MEDIATORS OF EXTRACELLULAR MATRIX REMODELING
Authors: Cha Dae , Han Jee Young , Park Jeong Hoon , Kang Young Sun , Ghee Jung Yeon , Yoo Ji Ae , Cha Jin Joo 
Published: June 2020

Abstract

Background and Aims
The main characteristics of aging kidney are age dependent glomerulosclerosis, tubular atrophy and interstitial fibrosis, therefore aging is now considered as an independent risk of chronic kidney disease. Extracellular matrix accumulation (ECM) is an early indicator of aging. Therefore in order to search for early indicator of aging kidney, we examined the expressions of regulators of ECM in the kidney in biologically aging and disease aging mice.

Method
C57BL/6 mice were studied at 2, 6, 12, 24 months of age, and leptin-deficient db/db mice were studied at 3, 6, 9 months of age. Gene and protein expressions of the kidney were examined as well as kidney injury markers in blood and urine.

Results
As expected, the biologically aging B6 mice exhibited progressive microalbuminuria during the lifespan. Systemically, the aging mice showed decreased levels of adiponectin, insulin and cholesterols. In the kidney tissue, proinflammatory and profibrotic gene expressions, in association with its regulators were significantly increased in age-dependent manners. At 24months, MCP-1, PAI-1, Collagen IV, MMP7, MMP9, angiotensin II, FGF23 and β-catenin gene expressions were significantly increased, whereas MMP2 and Snail, a direct activator of MMP-2 were significantly decreased. Protein expressions showed similar patterns. In high glucose condition, several markers showed diverse features in aging mice. As compared to db/m control, gene expressions of proinflammatory, profibrotic molecule as well as its regulators were all significantly increased in diabetic condition. Angiotensin II, FGF23, MCP-1, MMP7 and MMP9, TIMP-1 were significantly upregulated in diabetic kidney according to ages and interestingly Klotho was significantly downregulated in aged diabetic kidney. Snail and MMP2 showed no significant differences.

Conclusion
MMPs are involved in the crosstalk of the cells and surrounding extracellular matrix and can be considered as the marker of aging kidney. The regulators of ECM matrix seems to be different according to its’ pathological conditions. Human clinical data is needed to render the clinical significance.
P0728ASSOCIATIONS BETWEEN LUNG WATER NON-TRADITIONAL PARAMETERS AND FUNCTIONAL TEST IN CKD G4-5 WITH PRESERVED EJECTION FRACTION
Authors: Szymczak Anna , Mariusz Kusztal , Krzysztof Letachowicz , Gołębiowski Tomasz , Goździk Anna , Magdalena Krajewska 
Published: June 2020

Abstract

Background and Aims
Patients with chronic kidney disease (CKD) are characterized by higher cardiovascular risk resulting amongst others from fluid expansion. Lung water measured by ultrasound (US) technique is increasingly recognised as an effective, quick and objective technique of even subclinical congestion/fluid overload. We aim to search correlates between the amount of artifact b-lines in lungs ultrasound (US-B lines; a metric of lung water), intra- and extracellular water (ICW, ECW), arterial stiffness by pulse wave velocity, result of functional six minute walk tests (6MWT) and global longitudinal strain score (GLS) assessed during heart ultrasound in patients with preserved ejection fraction.

Method
ICW/ ECW was assessed by bioimpedance (BIA 101 Akern), pulse wave velocity (PWV) by oscillometric method (mobilograph, IEM Germany). GLS was calculated using 2-dimensional speckle tracking. Traditional biochemical cardiac and renal markers and inflammatory markers were also assessed.

Results
The study included 51 consecutive patients (34 male) with CKD stage 4 and 5 (median eGFR MDRD4 11 ml/min IQR 9; 17) with oligosymptomatic congestion. The median (IQR) EF was 60 (60; 65)%, GLS was -18,7 (-21; -14)%, US-B lines was 10,5 (6; 17). Factors that were associated with US-B lines include BNP (r 0,5), ECW (r 0,4), distance in 6MWT (r –0,48) and hemoglobin (r -0,37).
In comparison between groups (below vs above median) with more lung water (&gt;11 US-B lines) and less lung water amount (&lt;11) assessed after 5 min in a supine position we found markedly higher concentration of BNP and more extracellular water (ECW) in the first mentioned group (table). Patients with more B-lines have had lower hemoglobin level and shorter distance walked in 6MWT.

Conclusion
Lung water assessed by US is an quick and objective measure of congestion in advanced CKD with normal EF showing correlation with BNP concentration, distance walked in 6MWT and with extracellular water in bioimpedance. Its application into daily practice can be recommended.
P0735ELAVATED INTRACELLULAR COPPER CONTRIBUTES A UNIQUE ROLE TO KIDNEY FIBROSIS BY LYSYL OXIDASE MEDIATED MATRIX CROSSLINGKING
Authors: Niu Yangyang , Yu Chen 
Published: June 2020

Abstract

Background and Aims
Copper is an essential trace element required for many biological processes. Some studies have demonstrated that copper accumulating was related to liver fibrosis and lung fibrosis, but the underlying mechanism is not very clear. Copper is the essential unit of lysyl oxidase (LOXs), which are the key enzymes of crosslinking of extracellular matrix.

Method
Sprague-Dawley rats were divided into the sham group, unilateral ureteral obstruction (UUO) operated group and UUO treated with copper chelating agents tetrathiomolybdate (TM). Rat kidney fibroblast cells (NRK-49F) were used in vitro. The concentration of copper, the LOXs activity and the degree of cross-linking of extracellular collagen were detected in vivo and vitro.

Results
(1) The copper concentration in serum, urine and kidney of rats increased significantly at 7 days after UUO surgery; After treatment of TGF-β1, the intracellular copper concentration was increased significantly in cells; The concentration of copper in patients` serum is on the rise with the progression of chronic kidney disease (CKD). (2) The expression of CTR1 was upregulated in the kidneys of UUO rats; The level of CTR1 was increased significantly by TGF-β1 in vitro; (3) Blockage of Smad2/3 suppresses TGF-β1-induced expression of CTR1; (4) Downregulation of CTR1 significantly inhibited the intracellular copper concentration; (5) The activity of LOXs was increased significantly after TGF-β1 treatment; (6) Downregulation of CTR1 significantly inhibited the activity of LOXs and the cross-linking of extracellular collagen induced by TGF-β1 in vitro; (7) The concentration of copper, the degree of collagen cross-linking and the deposition of collagen were decreased in the kidney tissue of UUO rats after treatment with TM. The concentration of intracellular copper, the activity of LOXs and the degree of collagen cross-linking were attenuated with treatment of TM in vitro.

Conclusion
We firstly found that the intracellular copper accumulating was closely to renal fibrosis. The underlying mechanism was related with the increasing expression of CTR1 and activity of LOXs. Treatment with TM ameliorated the renal fibrosis. This study presented a novel treatment target for renal fibrosis.