bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0792FAT ATTENUATION INDEX OF CORONARY ARTERY IN COMPUTED TOMOGRAPHY ANGIOGRAPHY PREDICTS LONG-TERM OUTCOME IN CHRONIC KIDNEY DISEASE
Authors: Cho Nam-Jun , Kwon Soon hyo , Nam Bo Da , Choi Kyoungin 
Published: June 2020

Abstract

Background and Aims
Perivascular fat attenuation index (FAI) of coronary artery represents the degree of coronary inflammation. High coronary artery FAI in computed tomography angiography (CTA) is associated with increased all-cause and cardiac mortality in general population. However, the ability of the perivascular FAI using coronary CTA to predict long term outcome in chronic kidney disease (CKD) patients is unknown.

Method
This is a single center retrospective study. We analyzed coronary FAIs on CTA for CKD including patients with end stage renal disease (ESRD). The patients with percutaneous coronary intervention or coronary artery bypass graft were excluded. Mapping and analysis of perivascular FAI were performed around proximal three major coronary arteries. We assessed the prognostic value of FAI of CTA for long-term mortality (data from the Korean National Statistical Office) with Cox regression models, adjusted for age, sex, dialysis vintage, and clinical parameters.

Results
Between January 2012 and June 2018, 268 CKD patients were included. Mean age of this cohort was 64.5 ± 12.0 years, and 132 (49.3%) participants were men. 109 (44.7%) participants has diabetic kidney disease, and 179 (66.4%) participants were on hemodialysis. Median follow-up after coronary CTA was 29.2 (15.1 − 46.3) months. During follow-up, there were 43 (20.6%) deaths. The optimum cut-off value of FAI around the left anterior descending artery (LAD) was ascertained as -65.5 Hounsfield unit. The high perivascular FAI around the LAD was significantly associated with higher adjusted risk of all-cause mortality (hazard ratio, 2.15; 95% CI, 1.07–4.32). In ESRD subgroup, the high perivascular FAI group also has higher adjusted risk of all-cause mortality compared to low perivascular FAI group (hazard ratio, 2.43; 95% CI, 1.16–5.09).

Conclusion
The perivascular FAI around LAD predicts the long-term mortality in patients with CKD. This could provide the chance of early primary intervention in CKD patients.
P0800PROFILING HYPOKALAEMIC AND HYPERKALAEMIC STATES IN THE IRISH HEALTH SYSTEM: TESTING RATES, INCIDENCE AND DETERMINANTS
Authors: Browne Leonard , Austin Stack 
Published: June 2020

Abstract

Background and Aims
Hypo- and hyperkalaemia are potentially life-threatening electrolyte abnormalities often associated with severe adverse clinical outcomes. Real-world incidence and determinants of hypo- and hyperkalaemia in clinical settings are poorly characterised. We studied incidence and determinants of these abnormalities in the Irish healthcare system

Method
Data from the Irish National Kidney Disease Surveillance and Quality Assurance Programme were used to construct a retrospective observational study. We identified all adult individuals (age &gt; 18 years) who accessed health care from 2006 and 2010 in a regional health system (n = 205,334). Cumulative incidence of hypokalaemia (K+ &lt; 3.5 mmol/L), hyperkalaemia (K+&gt; 5 mmol/L), and moderate/severe hyperkalaemia (K+&gt; 5.5 mmol/L) was estimated over a 3-year period. Kidney function was assessed by estimated glomerular filtration rate (eGFR). Multinomial logistic regression explored associations of baseline patient characteristics with dyskalaemia states.

Results
Of 205,334 participants, 85.2% had 1–2 potassium tests, 5.8% had 2–3 tests, 2.7% had 3-4 tests and the remaining 6.4% had &gt; 4 potassium tests/year. Hypokalaemia occurred in 17,145 (8.35%) individuals, of these 43.8% had recurrent hypokalaemia (&gt;1 event). Hyperkalaemia occurred in 44,283 (21.6%) individuals, with 29.7% recurrence. Moderate/severe hyperkalaemia occurred in 9,672 (4.71%) with 18.0% recurrence. The frequency of potassium testing was an important determinant of dyskalaemia risk. In adjusted analyses, advancing age profile, women, inpatients, outpatients and emergency department patients (vs general practice), and frequency of tests had significantly higher risks of hypokalaemia. Additionally, advancing age, men, poorer kidney function, and frequency of potassium testing, and general practice were associated with significantly higher risk of hyperkalaemia.

Conclusion
Both hypo- and hyperkalaemic states are common in the Irish healthcare system with high rates of recurrence. Surveillance strategies should be put in place to allow timely detection and treatment of potassium disturbances in these high-risk groups.
P0806RESIDUAL RENAL FUNCTION IS COMPLEMENTARY TO GERIATRIC ASSESSMENT SCORE IN ASSESSING CLINICAL RISK OF ELDERLY PATIENTS
Authors: Castagna Alberto , Bolignano Davide , Figlia Irma , Cerra Rosa Paola , Ruberto Carmen , Ruotolo Giovanni , Coppolino Giuseppe 
Published: June 2020

Abstract

Background and Aims
Renal function impairment is highly pervasive in the elderly and triggers increased morbidity and mortality. Comprehensive geriatric assessment (CGA) is a validated multidisciplinary instrument to assess medical, psychosocial and functional limitations of old patients with diagnostic and risk-stratification purposes.
In a focused cohort of frail individuals, we aimed at evaluating possible relationships between single CGA items and renal function.

Method
254 consecutive elderly subjects (mean age 79.9±6.6 years, female 65.8%) from the geriatric division of a large Italian community hospital were studied. We collected clinical data including CGA and renal function (CKD-EPI formula). CGA single items included the Cumulative Illness Rating Scale (CIRS), the Exton Smith Scale (ESS), the Mini Nutritional Assessment Short Form (MNA-SF), the Katz‘s Activities of Daily Living (ADL), the Lawton’s Instrumental Activities of Daily Living (IADL), the Short Portable Mental Status Questionnaire (SPMSQ) and the amount of drugs administered (AD).

Results
Mean eGFR was 66.37±30.94 mL/min/1.73 m2. Overall, the reported CIRS, ESS, MNA, ADL and AD scores were low (7.6±3.3) while IADL and SPMQ were on a mild range, denoting a potential alarm signal for poor prognosis and the risk for adverse outcomes.
At univariate analyses, eGFR was significantly associated with CIRS (R=-0.389, p&lt;0.0001), ESS (R=0.355, p&lt;0.0001), MNA (R=0.394, p&lt;0.0001), ADL (R=0.394, p&lt;0.0001), AD (R=-0.374, p&lt;0.0001. while a weak, although significant correlation was found with IADL (R=0.131, p=0.038) and SPMSQ (R=-0.141, p=0.038). In a fully adjusted multivariate analyses only SPMSQ (ß=-0.174, p=0.04), ADL (ß=0.182, p=0.012), IADL (ß =0.209, p=0.003) and AD (ß=-0.354, p&lt;0.0001) remained significant predictors of residual renal function.

Conclusion
In elderly frail subjects, residual renal function may influence daily life and cognitive activities, the perceived quality of living and the entity of drug assumption. Inclusion of renal function within a comprehensive geriatric assessment could help improving risk stratification in the elderly
P0821OBESITY, FAT TISSUE, CELL MEMBRANE INTEGRITY PARAMETERS AND ARTERIAL STIFFNESS IN RENAL TRANSPLANT RECIPIENTS
Authors: Heleniak Zbigniew , Illersperger Sarah , Brakemeier Susanne , Debska-Slizien Alicja , Budde Klemens , Halleck Fabian 
Published: June 2020

Abstract

Background and Aims
Arterial stiffness, altered body composition (increased body fat mass and decreased soft lean mass) and cell membrane integrity (Phase Angle) are acknowledged risk factors for adverse outcomes after kidney transplantation related to cardiovascular diseases. Phase angle is a linear method of measuring the relationship between electric resistance and reactance. Taking the arc tangent value of the ratio of reactance versus electric resistance provides us with the phase angle value. Lower phase angles appear to be consistent with low reactance and equals either cell death or a breakdown in the selective permeability of the cell membrane. The aim of the study was the assessment of the relationship between arterial stiffness and fat tissue parameters, cell membrane integrity marker in renal transplants recipients (RTRs).

Method
344 stable RTRs with the mean age 52.7 years, (62.5% M) transplanted between 1994 and 2018 were randomly enrolled to the study. The following parameters of arterial stiffness were measured: brachial-ankle and carotid-femoral pulse wave velocities (baPWV left and right, cfPWV). The obesity and fat tissue (body mass index (BMI), waist to hip ratio (WHR), body fat mass (BFM), fat free mass (FFM), percent fat of the body (PBF), trunk segmental fat analysis (TSFA) and visceral fat area (VFA)) parameters and cell membrane integrity phase angle (PhA) were assessed with InBody 170.

Results
The median time of dialysis and after kidney transplantation was 58.5 and 78 months respectively. The obesity according to BMI, WHR and VFA was diagnosed in 49.7%, 45% and 44.5% of patients, respectively. The median value of BFM, FFM, VFA, TSFA, PhA and the mean value of PBF were 19.3kg, 55kg, 93.2cm2, 24.9 kg, 4.9 and 27.3%, respectively. We found significant positive correlations between WHR, VFA and baPWV right, baPWV left and cfPWV. PhA correlated with arterial stiffness in univariate (r=-0.34) and multivariate analysis (R=-0.23), negatively (p&lt;0.05).

Conclusion
1. Obesity, visceral fat tissue, cell membrane integrity marker influence on arterial stiffness.
2. The analysis of magnitude of obesity, body fat tissue and cell membrane integrity parameters can be used as an additional cardiovascular risk factor in RTRs.
3. The cell membrane integrity impairment correlated with arterial stiffness.
P0825ASSOCIATION OF BODY MASS INDEX CHANGES WITH CHRONIC KIDNEY DISEASE IN A JAPANESE GENERAL POPULATION
Authors: Toda Akiko , Hara Shigeko , Tsuji Hiroshi , Arase Yasuji 
Published: June 2020

Abstract

Background and Aims
Obesity is a risk factor for chronic kidney disease (CKD), but the effect of reducing body mass index (BMI) on the prevention of CKD is controversial. One of reasons for this disagreement is that part of patients with a BMI decrease may have an unfavourable health status. In such cases, the BMI decrease could be a risk factor for the development of CKD. Therefore, by analysing the data of annual health check-ups, we examined an association between BMI change and CKD development to determine whether BMI reduction helps prevent CKD development.

Method
We analysed the data of 6,959 subjects who underwent annual health check-ups in both 2013 and 2018. By a multivariate logistic regression analysis, we investigated a relationship between BMI change and CKD development within the 5 years between 2013 and 2018. The percent change in the BMI (ΔBMI) was calculated using the following equation: {(BMI in 2018 − BMI in 2013)/BMI in 2013} ×100. For analyses, we classified the subjects into five groups based on their ΔBMI value: (i) severe BMI decrease (ΔBMI &lt;−2.5%); (ii) moderate BMI decrease (ΔBMI ≥−2.5% but &lt;0%); (iii) maintained BMI (ΔBMI ≥0% but &lt;2.5%); (iv) moderate BMI increase (ΔBMI ≥2.5% but &lt;5%); (v) severe BMI increase (ΔBMI ≥5%). For further analysis, we divided the subjects into non-obesity category (basal BMI &lt;25 Kg/m2) and obesity category (basal BMI ≥25 Kg/m2). Subjects with an estimated glomerular filtration rate &lt;60 mL/min./1.73 m2 were defined as having a CKD.

Results
After adjusting several covariates, compared with the maintained BMI group, the severe BMI decrease group showed a significantly low risk of CKD development (odds ratio (OR) 0.70, 95% confidence intervals (CI) 0.54-0.91, p &lt;0.01) and the severe BMI increase group had a significantly high risk (OR 1.40, CI 1.08-1.81, p = 0.01). A farther analysis revealed that the OR of CKD development for the severe BMI increase group in the obesity category was higher than that in the non-obesity category (OR 1.75 vs. 1.29).

Conclusion
In subjects who underwent annual health check-ups, BMI reduction had a significant effect on the prevention of CKD development, whereas an increase in the BMI was a risk factor for CKD development. Moreover, by severe increase in the BMI, obesity subjects showed higher risk of CKD development than non-obesity subjects.
P0832FINAL OUTCOME OF CKD STAGE 5 PATIENTS WHO CHOSE PALLIATIVE TREATMENT-EXPERIENCE FROM ONE MEDICAL CENTER IN TAIWAN
Authors: Kuo Mei-Chuan , Kung Lan-Fang , Wang Shu-Li , Hwang Shang-Jyh , Wu Chien-Yi , Chiu Yi wen , Chen Hung-Chun 
Published: June 2020

Abstract

Background and Aims
Taiwan has a high incidence and prevalence of ESRD (end stage renal disease) in the world and all the medical expenses are covered by national insurance. Therefore, many old ESRD(end stage renal disease) patients received dialysis even had multiple co- morbidity. However, still some old late CKD patients withhold dialysis and chose palliative treatment. This study elucidate the experience of final outcome for those late CKD patients who chose palliative treatment in Taiwan.

Method
We enrolled 137 CKD stage 5 patients (age: 80.2±8.8 y/o, male/female:85/52) who were interested about palliative treatment since Oct, 2010 till July 2019. We reviewed their co-morbidity to calculate Modified Charlson comorbidity index by medical record and record their laboratory data at enrollment. The differences between two groups were calculated using a Chi-square test for categorical variables and a Mann-Whitney test for continuous variables. All statistical tests were two-tailed and a P value of less than .05 was considered a significant difference.

Results
After fully discussion, 82(59.9%) patients can accept palliative treatment, 46(33.6%) refuse palliative treatment, 9(6.6%) patients cannot decided palliative treatment or not at first. 79 patient died during study period, median survival time is 163 days. 22 death patients(27.8%) received dialysis before end of life. 10 patients (12.2%) who asked palliative treatment at first and changed their mind to received dialysis. 80% of these patients receive dialysis by double lumen catheter. For those refuse palliative treatment, 43 patient received dialysis and 24(55.8%) patients received dialysis by temporary catheter. These percentage is much higher(55.8%) than other CKD stage 5 patients (26.6%) following at our hospital. Only 13 patient(16.5%) died at home, 24 patients(30.4%) diet at hospice ward and 39(49.4%) patients diet at ordinary ward or intensive care unit. Older age, lower albumin and higher Charlson comorbidity index are found in mortality patients. The median survival time for those patients received dialysis is 467 days.

Conclusion
After fully explanation, only 59.9% patients can accept withhold dialysis and 12.2% regret later. Those who had interested in palliative treatment had higher percentage to use double lumen catheter for first dialysis. The median survival time for those patients who ever think about withhold dialysis is only 467 days even receiving dialysis. To minimize suffering before end of life and decrease medical expense burden, we still need to do more effort to popularize the concept of withhold dialysis in older and multiple comorbidity patients.
P0834IMPACT OF CKD ON MORTALITY IN HEART FAILURE
Authors: Sarnowski Alexander , Jenkins Rebeka , Anderson Lisa , Banerjee Debasish 
Published: June 2020

Abstract

Background and Aims
The presence of CKD impacts short term survival of heart failure patients however impact on long term survival is not well known. The aim of this study was to investigate the impact of CKD on long term survival.

Method
Data were collected on long term survival of 845 patients (1029 admissions) admitted with diagnosis with acute heart failure. Data on mortality was collected by electronic patient records. Data were analysed using IBM SPSS 25.

Results
The baseline characteristics were: age 76 (13) mean (SD); Haemoglobin 11.8 (2), urea 37.2 (26.8), eGFR 63.3 (30.4), potassium 4.34 (0.70) and 36% diabetics, 567 patients (67%) died during follow up of median 916 days (IQR 188-1936 days).
Patients who died were older, with higher urea, creatinine, potassium and NT proBNP. In a survival analysis adjusted for diabetes and haemoglobin; age, urea, NT-proBNP baseline eGFR and potassium predicted mortality (see table).
CKD patients with eGFR &lt;60 ml/min/1.73m2 had poorer survival compared to patients with eGFR&gt;60 (log rank p=0.000) (see figure 1)

Conclusion
Long term mortality in patients with CKD was higher which was an independent predictor of survival
P0839EVALUATION OF ECHOCARDIOGRAPHIC INDICES OF DIASTOLIC DYSFUNCTION IN PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Kourtinos Alexandros , Pappas Kostas , Belbasis Lazaros , DUNI ANILA , Rapsomanikis Karolos Pavlos , Kitsos Athanasios , Katsouras Christos , Tsiara Stavroula , Ntounousi Evangelia 
Published: June 2020

Abstract

Background and Aims
The structure and function of the left ventricle (LV) are affected since the early stages of chronic kidney disease (CKD). Our cross-sectional study aimed to estimate the echocardiographic indices of the LV diastolic function and the evaluation of their potential correlation with indices of kidney injury in patients with CKD, before initiation of renal replacement therapy.

Method
99 patients with CKD (stage 2 CKD: 31 patients (27%), stage 3 CKD: 47 patients (40.9%) and stage 4 CKD: 37 patients (32.1%)) were enrolled in the study. Anthropometric data, indices of renal function (eGFR-CKD-EPI, urinary protein excretion in mg/24h), biochemical laboratory parameters, comorbidities [hypertension (HT), diabetes mellitus (DM), coronary heart disease (CAD)] and echocardiographic indices of LV diastolic function were recorded. In specific, left atrial (LA) dimensions were measured in M-Mode and were expressed both as absolute values in mm as well as indexed to body surface area ((BSA) and expressed as the LA index in mm/m2. The study sample, after taking into account patient gender, was further divided into separate groups according to the presence or not of LA dilation.

Results
The average patient age was 62 +/- 13 years and average eGFR (CKD-EPI) was 44.1+/-21.4 ml/min/1.73m2. With regard to comorbidities, 59.3% of the sample population had arterial hypertension, 24.3% had diabetes mellitus and 10.4% had known coronary artery disease. Regarding anti-hypertensive and hypolipidemic treatment, 22.6% of the patients were on ARB and 24% on ACEi, 51.3% on CCB, 29.6% on β-blockers, 37.4% on diuretics and 28.7% of the patients were receiving statin treatment. 28.2% of the patients had dilated LA in terms of absolute value and 13.8% had dilated LA following indexing to BSA (LA index). A positive correlation was observed between the LA size and age (p=0.001), BMI (p=0.041), uric acid levels (p=0.022), PTH (p=0.029), fibrinogen (p=0.035), LV mass (p=0.006) and LV mass/BSA (p=0.005), whereas a negative correlation was observed with serum LDL (p=0.027). Additionally, there was observed a negative correlation of LA index with eGFR (p=0.05), as well as an inverse relationship between LA index and PTH (p=0.012), age (p=0.004), BMI (p=0.037) and LV mass/BSA (p=0.005). No significant correlations between LA size and LA index with proteinuria or with co-morbidities (DM, HT, CAD) were observed.

Conclusion
In a population of patients with stage 2-4 CKD, LA size correlated to indices of CKD. Larger studies are required in order to further confirm these correlations.
P0843EFFECT OF GROUP PSYCHO SOCIAL SUPPORT ON QUALITY OF LIFE AND MORTALITY WITH END STAGE KIDNEY DISEASE
Authors: Nisar Zara , Sajjad Hassan , Anwar Nisar 
Published: June 2020

Abstract

Background and Aims
The patients of end stage renal disease suffer a lot of psychological trauma as well as feel a lot of social burden. They mostly show psychological distress in different forms, be it impaired quality of life, depression or anxiety. The aim of our study was to find out the effect of supportive-expressive group therapy in end stage kidney disease patients in the outcome of better health related quality of life and survival.

Method
181 patients were recruited in the study after consent between June 2012-June 2017. They were then assigned randomly to Group A supportive-expressive group therapy or to a Group B control group (no intervention). It was a double blinded randomized control trial. 115 patients were assigned to Group A and 66 were assigned to group B. The primary outcome was the effect on health related quality of life. Secondly, if it had any impact on survival. Significant predictors of survival were not analysed. Analysis was done by intention to treat.

Results
The patients of group A showed decrease in physical pain(p=0.002), mood elevation (p=0.04), compliance with treatment (p=0.001), reduced hopelessness (p=0.004), newly diagnosed depressive disorders (p=0.01) and better social life (p=0.003). Group A had 97% survival rate as compared to group B with 77%.

Conclusion
Supportive-expressive group therapy to patients with end stage kidney disease improves health related quality of life. It also has an effect on survival maybe because of compliance with treatment. We would like to further explore the role of Supportive-expressive group therapy in survival. Support groups should be provided to patients in developing countries like the setup of ours because it has a great impact on the betterment of the patient.
P0845INCREASING TOTAL RENAL VOLUME AFTER NEPHRECTOMY FOR RENAL CELL CARCINOMA IS ASSOCIATED WITH RENAL FUNCTION EVOLUTION
Authors: PAMPA-SAICO SAUL , Pizarro-Sánchez M Soledad , Alexandru Simona , García Puente-Suárez Laura , López-Picasso María , Barba Martín Raquel 
Published: June 2020

Abstract

Background and Aims
Renal cell carcinoma is the most common form of kidney cancer. Reduction of renal mass after radical nephrectomy (RN) in these patients, results in compensatory hypertrophy of the contralateral kidney. The capacity of compensation will determine the renal function (RF) evolution. Measuring of total renal volume (TRV) of the remaining kidney pre and post RN can help assess the RF evolution.

Aims
To determine the correlation between TRV pre and post nephrectomy (a year of follow-up) with RF and the factors that modify.

Method
A retrospective cohort study was carried out in our institution, in 62 patients who had underwent RN from 2014 to 2018, due to renal cell carcinoma (confirmed by histopathology). The demographic data included age, gender, body mass index (BMI), associated comorbidities, smoking habits were collected.
Serum creatinine, estimated glomerular filtration rate (eGFR) and proteinuria were collected in the preoperative period and in the follow-up.
The TRV was calculated pre and post (a year of follow-up) RN, using ellipsoid formula equation (computed tomography scan or magnetic resonance imaging).
Renal function evolution was assessed by eGFR using the modification of diet in Renal Disease formula. Multivariate linear regression analysis was used to determine the predictor of TRV at 1 year of follow-up.

Results
The median age at the time of RN was 71 years old (range, 43-86 years). Most of them were men, 69% (43/19). The estimated glomerular filtration rate (FGe) pre and post nephrectomy was 74 (41-102) and 52.1 ml/min/ m2 (22-89) respectively (P=0.013). The TRV pre and post-nephrectomy was 165.3 (102.3-259.7) and 188.3 ml (115.3-271.2) respectively (P=0.001).
On multivariate linear regression analysis, controlling for age and sex; the pre-nephrectomy FGe (β = 0.42; P = 0.023) and the pre TRV (β = 1.23; P &lt;0.0001) were positively correlated with the post-nephrectomy TRV, while the FGe at year of follow-up was correlated negatively (β = -1.11; P = 0.024)

Conclusion
The post nephrectomy TRV was positively correlated with TRV and FGe pre nephrectomy. While with the FGe at one year post nephrectomy was negatively correlated. The increasing TRV pre and post nephrectomy can help to predict renal function at a year of follow-up in this group of patients.