bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0753HOW FREQUENTLY PATIENTS WITH RISK FACTORS FOR CHRONIC KIDNEY DISEASE ACHIEVE RECOMMENDATIONS OF FOOD CONSUMPTION FREQUENCY
Authors: Corona Rodríguez Elizabeth , Márquez Herrera Roxana Michel , Cortés Sanabria Laura , Nuñez Murillo Gabriela Karen , Gomez Garcia Erika Fabiola , Rojas Campos Enrique , Martinez Ramirez Hector Ramon , López Leal Jorge , Cueto Manzano Alfonso Martín 
Published: June 2020

Abstract

Background and Aims
Risk factors for chronic kidney disease (CKD) such as type 2 diabetes mellitus (DM2), high blood pressure (HBP) and obesity are strongly related to negative lifestyle and nutritional habits. The aim of this study was to estimate the proportion of patients with and without risk factors for CKD who meet recommendations for food consumption.

Method
Cross-sectional study. A qualitative food frequency questionnaire (FFQ) was applied. Consumption of each food group was classified as adequate or inadequate based on dietary guidelines (DASH and ENSANUT Mexican Guidelines). Sociodemographic, biochemical and clinical variables were measured. DM2, HBP and obesity were defined as risk factors.

Results
744 adults were evaluated, age 51±16 y, 68% women, 59% without risk factors, 7% DM2, 17% HBP, 8% DM2+HBP, and 18% obesity. Glomerular filtration rate was 99 (89-100) mL/min/1.73m2. Differences in FFQ between groups were found in relation to consumption of legumes, fast food, sugar, sweets and desserts (p&lt;0.05). Figure A shows the frequency of consumption of healthy and B, unhealthy foods.

Conclusion
In general, subjects in this sample had negative dietary habits, with &lt;50% consuming healthy food and &gt;50% consuming unhealthy food. Subjects without risk factors for CKD displayed a similar pattern of food consumption than those with risk factors, with only a significantly lower legumes intake than patients with HBP, and higher intake of sweets and desserts, sugar, and fast food compared to patients with DM2+HBP. It is necessary to implement strategies to prevent the long-term development of CKD in groups with poor adherence to healthy food consumption recommendations.
P0759ORTHOSTATIC SYSTOLIC BLOOD PRESSURE CHANGE AND THE RISK OF CHRONIC KIDNEY DISEASE: A COMMUNITY-BASED PROSPECTIVE STUDY IN KOREA
Authors: Min Hyang Ki , Lee Sung Woo 
Published: June 2020

Abstract

Background and Aims
There have been no studies which explored the relationship between orthostatic blood pressure (BP) change and incident chronic kidney disease (CKD) in Asian population.

Method
We reviewed the data of 7,461 non-CKD adults aged 40-69 years who participated in Ansung_Ansan Cohort, a prospective community-based cohort study. BP was measured on supine position and 2 minute–upright position, and the difference was defined as orthostatic BP change. Incident CKD was defined as the first event to be estimated glomerular filtration rate &lt; 60 ml/min/1.73 m2, which was confirmed at least 2 or more times thereafter.

Results
Of 7,461, orthostatic diastolic BP change was not associated with incident CKD in multivariate Cox proportional-hazard regression model. However, per 1 mmHg increase of orthostatic systolic BP was associated with decreased hazard of incident CKD: hazard ratio 0.988 and 95% confidence interval (0.982-0.994, P &lt;0.001). In penalized spline curve analysis, we identified L-shaped relationship between orthostatic systolic BP change and incident CKD, with the threshold of - 2.4 mmHg. In subgroup analysis, the relationship between orthostatic systolic BP change and incident CKD was evident, particularly in participants without central obesity and reduced high density lipoprotein cholesterol and those with increased white blood cells.

Conclusion
Orthostatic SBP change was independently associated with incident CKD development. Future studies need to be followed to confirm the results.
P0761STUDY ON THE MECHANISM OF MICROINFLAMMATION WITH UREMIA CAUSED BY LACTOBACILLUS ACTIVATION OF INTESTINAL MACROPHAGES BY MINCLE
Authors: Sun Lingshuang 
Published: June 2020

Abstract

Background and Aims
My previous studies have found that Intestinal macrophages in the uremic rats are polarized towards a proinflammatory phenotype and had dysfunction of phagocytosis leading to aggravate microinflammation and assist bacterial translocation in uremia resulting in microinflammation. However, it is still unclear what kind of mechanism of action of intestinal bacteria activates intestinal macrophages and thus participates in the occurrence and development of microinflammation in uremia.

Method
Male Sprague-Dawley rats were randomly divided into two groups: sham, uremia. The macrophage ultrastructure was examined by transmission electron microscopy. Immunochemistry was used to analyze the expression of macrophage-inducible C-type lectin (Mincle). RT-PCR and western blot were employed to assess the mRNA and protein expression of toll-like receptor 4 (TLR4).

Results
Our RCT study found that the number of Lactobacilli in the intestines of patients with end-stage diabetic nephropathy was significantly higher than that in non-diabetic patients(Figure 1). The plasma levels of endotoxin, CRP, IL-6, and TNF-a in the uremia group were greater than those in the sham group (p&gt;0.05)(Table 1).Compared with the sham group, the uremic macrophages showed fewer cytoplasmic protrusions and pseudopodia(Figure 2) and the uremia group exhibited macrophages with higher staining intensities for Mincle and higher mRNA and protein expression of TLR4(Figure 3-5).

Conclusion
Studies have shown that Lactobacillus planta can directly activate Mincle. The relationship between Mincle and the activation of intestinal macrophages was verified. The solution to this scientific problem will not only clarify the molecular mechanism of intestinal bacteria in controlling the activation of intestinal macrophages, but also link the immune regulation of intestinal macrophages with the micro-inflammation of uremia so as to clarify the micro-inflammation state of uremia.
P0763A COMPARATIVE STUDY OF ARTERIAL STIFFNESS AND WAVE REFLECTIONS IN DIABETIC AND NON-DIABETIC PATIENTS WITH CKD
Authors: Schoina Maria , Loutradis Charalampos , Memmos Evangelos , Papadopoulos Rafael , Intzevidou Eleni , Doumas Michael , Karagiannis Asterios , Papagianni Aikaterini , Sarafidis Panteleimon 
Published: June 2020

Abstract

Background and Aims
Arterial stiffness is associated with increased risk for target-organ damage, cardiovascular events and overall mortality in the general population, patients with diabetes mellitus and patients with chronic kidney disease (CKD) of all stages. This is the first study to evaluate in comparison arterial stiffness and arterial wave reflections in diabetic and non-diabetic patients with CKD.

Method
This study included 48 diabetic and 48 non-diabetic adult patients (&gt;18 years) with CKD (eGFR: &lt;90 και ≥15mL/min/1.73m2), matched in a 1:1 ratio for age, sex and eGFR within each CKD stage (2, 3a, 3b and 4). All patients underwent carotid-femoral pulse wave velocity (PWV), central blood pressure (BP), and wave reflections measurement with applanation tonometry (Sphygmocor, Atcor Medical, Australia).

Results
Office systolic and diastolic blood pressure was similar between diabetic and non-diabetic subjects with CKD in total and across CKD stages. Office brachial pulse pressure (PP) was significantly lower in non-diabetics (49.00±8.0 vs 52.67±8.7 mmHg, p= 0.034). Office PWV was marginally higher in diabetics compared with non-diabetics (10.89±2.0 vs 10.06±2.2 m/sec, p=0.056). In CKD stages 2 and 4, no significant difference in PWV between the two groups was noted, but PWV was higher for diabetics in CKD stages 3a (11.28±1.4 vs 9.83±1.5 m/sec, p=0.023) and 3b (11.13±1.9 vs 9.46±1.2 m/sec, p=0.016). Heart-rate-adjusted augmentation index [AIx(HR75)] was higher in diabetic compared with non-diabetic subjects only in CKD stage 4 (32.08±4.2 vs 25.92±6.6%, p=0.013).

Conclusion
Diabetic CKD patients present higher arterial stiffness than non-diabetic counterparts. The additional contribution of diabetes towards increased arterial stiffness is more prominent in patients with moderately impaired renal function (CKD stage 3a and 3b), whereas at stage 4, PWV was increased independent of diabetes presence.
P0764STUDY OF 15 CASES OF CHOLESTEROL CRYSTAL EMBOLISM WITH LOW-DENSITY LIPOPROTEIN APHERESIS
Authors: Shimizu Taisuke , Sano Tatsuro , Takayanagi Kaori , Ogawa Kouki , Iwashita Takatsugu , Ogawa Tomonari , Hasegawa Hajime 
Published: June 2020

Abstract

Background and Aims
Cholesterol crystal embolism (CCE) causes renal damage, and there is a high risk of end-stage renal disease. Corticosteroids, statins and low-density lipoprotein apheresis (LDL-A) have been used to treat CCE, but the prognosis remains poor and treatment not yet established. This study evaluated the efficacy of LDL-A in patients with CCE.

Method
We performed a retorospective study of 15 Japanese patients in clinical and histological diagnosis of CCE was made April 2015 to December 2017. 10(67%) patients were diagnosed pathologically on skin biopsy and others were diagnosed clinically. All patients had shown CKD with eGFR &lt;60 mL/min/1.73m2 before being diagnosed with CCE. All patients received LDL-A; of these, 13 (87%) also received corticosteroids. The median estimated GFR diagnosis (at baseline) were 13.4 mL/min/1.73m2, and were analyzed stratified into High eGFR group(H) and Low eGFR group(L). Differences in eGFR, 1 month, 3 months and 1 year after LDL-A, were compared in these groups.

Results
High eGFR group was significantly higher than Low eGFR group over all observation periods (at 1 month; H:21.3 ± 8.9 vs L:15.9 ± 5.6, P=0.023, at 3 months; H:25.9 ± 10.3 vs L:15.4 ± 5.4, P=0.035, at 1 year; H:21.7 ± 8.9 vs L:13.2 ± 5.7, P=0.01). In high eGFR group, eGFR was no change during the observation period and no decrease significantly. In Low eGFR group, eGFR increased significantly at 1 month and 3 months compared to baseline (10.5 ± 2.1 at baseline, 15.9 ± 5.6 at 1month, P=0.007, 15.4 ± 5.4 at 3month, P=0.01), but was comparable to baseline at 1 year.

Conclusion
In this study, introduction of LDL-A may have the effect of maintaining renal function over the long term at 1year regardless of eGFR at diagnosed as CCE.
P0771STOPPING MINERALOCORTICOID RECEPTOR ANTAGONISTS AFTER HYPERKALEMIA AND RISK OF ADVERSE OUTCOMES IN PATIENTS WITH HEART FAILURE
Authors: Trevisan Marco , Xu Yang , Qiao Yao , Savarese Gianluigi , Lund Lars , Grams Morgan , Sjolander Arvid , Carrero Juan Jesus 
Published: June 2020

Abstract

Background and Aims
Stopping mineralocorticoid receptor antagonists (MRAs) after an episode of hyperkalemia is common, particularly among patients with chronic kidney disease (CKD). This may involve therapeutic compromises, in that the cessation of MRAs deprives patients of their beneficial cardiovascular effects. The aim of this study is to determine the risks of adverse health outcomes in heart failure patients after an episode of hyperkalemia, comparing users of MRA who stop treatment to those who continue the drugs.

Method
Observational study from the Stockholm Creatinine Measurements (SCREAM) project. We identified patients with heart failure patients initiating MRAs and surviving a first-detected episode of hyperkalemia (plasma potassium &gt;5.0 mmol/L). We used Cox regression, adjusting for multiple confounders, to estimate hazard ratios (HR) for adverse events following hyperkalemia. The primary outcome was the composite of hospital admission with heart failure, stroke, myocardial infarction or death. The secondary outcome was a new hyperkalemia event. We compared risks between people who stopped MRA treatment and those who continued MRA within 4 months from the hyperkalemia event (landmark analysis at month 4 after event).

Results
We identified 1,330 patients with heart failure that developed hyperkalemia after initiating MRA therapy. Their median age was 80 years, 46% were women and their median eGFR was 43 ml/min/1.73m2. Of those, 595 (45%) had discontinued MRA by 4 months after hyperkalemia. Patients who stopped MRA were more likely to have eGFR &lt;60 ml/min/1.73m2 (81% vs 71%), had a more severe index hyperkalemia (potassium&gt;5.5 mmol/L, 35% vs 21%), and had hyperkalemia occur earlier in the course of MRA therapy (within 3 months from MRA initiation, 66% vs 51%).
During median 1.5 years of follow-up, a total of 846 patients (64%) experienced the primary composite outcome. Compared to patients who discontinued MRA, those who continued had a similar risk of the primary composite outcome (HR 0.95, 95% CI 0.82-1.10). A total of 569 patients (43%) developed a subsequent hyperkalemia event. Compared to patients who discontinued MRA, those who continued with the therapy were at higher risk of another hyperkalemia (HR 1.46, 95% CI 1.21-1.75). Results were consistent across age strata, sex and presence of CKD.

Conclusion
Continuing treatment with MRA after an episode of hyperkalemia was not associated with different medium-term cardiovascular risk compared to those who stopped the drugs.
P0780TRENDS IN EMERGENCY DEPARTMENT USE IN PATIENTS DIAGNOSED WITH HYPERKALAEMIA: AN ANALYSIS OF A U.S. NATIONAL EMERGENCY DEPARTMENT DATABASE
Authors: Rafique Zubaid , Aggarwal Saurabh , Topaloglu Ozlem , Cornea Georgiana , Conrad Ansgar , Peacock Frank 
Published: June 2020

Abstract

Background and Aims
Hyperkalaemia (HK) refers to increased serum potassium concentration, with possible severe effects on health outcomes and resource utilisation. HK is prevalent in patients suffering from heart failure, chronic kidney disease (CKD) and diabetes mellitus and its risk is increased by medications, e.g. inhibitors of the renin-angiotensin-aldosterone system (RAAS). The objective of this study was to examine trends in emergency department (ED) use in patients diagnosed with HK.

Method
The latest available 2016 Nationwide Emergency Department Sample (NEDS) data set from the Healthcare Cost and Utilization Project was analysed to estimate the burden of ED visits in patients with HK. Patients with an ICD-10 diagnosis code E87.5 (Hyperkalaemia) or E87.8 (Other disorders of electrolyte and fluid balance, not elsewhere classified; included due to the incidence of miscoding HK) were included. The rate of comorbidities (diabetes, CKD, heart failure and hypertension) were assessed using previously validated ICD-10 codes.

Results
In 2016, there were an estimated 1,322,071 ED visits with a diagnosis of HK, out of which 6.7% were recorded as the primary diagnosis. The vast majority of these ED visits resulted in same hospital admission (1,075,492 hospital stays). The rate of ED visits and hospital admission were 409.1 and 332.8 per 100,000 persons respectively. The mean (SE) age was 61.8 (0.21) years and 52% were male. Patients had high rate of comorbidities: diabetes 43.1%, hypertension 62.0%, CKD 44.4%, heart failure 23.1%, non-dialysis CKD 12.1% and CKD requiring dialysis 12.1%. In patients with primary diagnosis of HK, the mean (SD) hospital length of stay was 3.3 (4.2) days and total mean (SD) hospital charges were $34,923 ($100,435).

Conclusion
Patients with HK represent an expensive health care burden, as well as suffering with high rates of comorbidities and ED visits. There is an urgent need for new treatment options in the acute setting to improve outcomes for patients with HK.
P0781ESTIMATION OF NEPHRON NUMBER IN CKD PATIENTS
Authors: Kawaguchi Takehiko , Nakazato Takashi , Yahata Kensei , Kitamura Hiroshi , Imasawa Toshiyuki 
Published: June 2020

Abstract

Background and Aims
The nephron number is thought to be associated with clinical outcomes of chronic kidney disease (CKD). If the nephron number can be estimated in a clinical setting, it could become a strong tool to predict the outcomes. This preliminary study estimated nephron number in CKD patients, and examined the relationship between the nephron number and patient characteristics.

Method
Data from a multicenter study of the National Hospital Organization of Japan were analyzed, including 565 CKD patients aged over 14 years who underwent a kidney biopsy. The nephron number was estimated by the glomerular density in biopsy specimens and the renal cortex volume. The renal cortex volume was calculated by the previously established equation using ultrasound measurement of the kidney. Linear regression models were used to investigate the associations of the nephron number separately with age, sex, and estimated glomerular filtration rate (eGFR).

Results
A total of 50% of the patients were women, and the mean (±SD) age of the patients was 51±19 years. The mean eGFR was 63±32 ml/min/1.73m2, and the mean estimated number of non-sclerotic nephrons was 660,000±320,000 per kidney. A larger number of estimated nephron number was associated with younger age, male sex, and higher eGFR.

Conclusion
To the best of our knowledge, this was the first study to estimate the renal cortex volume and nephron number of CKD patients in the general clinical setting. The results from this study should provide powerful tools for nephrologists in routine clinical practice. Further investigations will be needed to verify the associations between the nephron number and clinical outcomes of CKD patients.
P0783PREVALENCE AND PROGNOSIS OF HYPERKALAEMIA IN PEOPLE HOSPITALISED WITH AND WITHOUT AKI
Authors: McLean Andrew , Black Corri , Marks Angharad , Sawhney Simon 
Published: June 2020

Abstract

Background and Aims
Hyperkalemia is a clinical emergency associated with kidney diseases and hospital mortality. It may be apparent on initial hospital presentation, or develop during the course of admission, and can occur in the context of AKI. The prevalence of hyperkalemia across these different presentations and contexts is not well described. No work has previously described whether the prognosis of hyperkalemia varies depending on timing of presentation, or on AKI status defined by KDIGO creatinine change biochemical criteria.

Method
We constructed a cohort of all adult residents in Grampian (North Scotland) admitted to hospital in 2012 (n=28462). We used a validated and replicated KDIGO based definition of AKI to identify AKI using serial serum creatinine values. We determined the presence of hyperkalemia (serum potassium &gt;= 6 mEq/L) both on first blood test on presentation to hospital, and also during the course of hospital admission. We explored the outcome of 30 day mortality within subgroups of AKI status and timing of hyperkalemia. Covariates of interest included age, CKD, medications prescribed in the preceding 90 days and comorbidities (ICD-10 hospital episode codes). The relationship between hyperkalemia and 30 day mortality was determined using multivariable logistic regression.

Results
Of 28462 hospital admissions, 247 (0.9%) presented with hyperkalemia, whereas 560 (2.0%) had hyperkalemia during the course of hospital admission. Hyperkalemia was common in the presence of AKI (4.2% at hospital presentation, 9.3% during hospital admission and rising to 24.5% during AKI stage 3). Hyperkalemia was uncommon in the absence of AKI (0.3% and 0.7% respectively) (OR AKI vs no AKI 13.9, 11.6-16.6). Other factors associated with hyperkalemia were male gender (OR 1.5, 1.3-1.8), age &gt;70 years (OR 2.4, 2.0-2.9), CKD based on eGFR or proteinuria (5.5, 4.6-6.5), diabetes (OR 3.4, 2.8-4.0), heart failure (OR 3.0, 2.4-3.7), RAAS blockers (OR 2.4, 2.0-2.9), trimethoprim containing antibiotics (OR 2.2, 1.7-2.8)), non-RAAS antihypertensives (OR 1.7, 1.4-2.0), but not NSAIDs (OR 0.9, 0.7-1.1). Hyperkalemia mortality (AKI vs no AKI) was 31% vs 29% when presenting at admission, or 34.3% vs 27.8% when occurring during hospital admission. Although absolute risks were similar irrespective of AKI, the excess relative mortality risk associated with hyperkalemia was lower for those with AKI (OR 2.7, 2.1-3.4) than those without AKI (OR 9.5, 6.8-13.2), which may be explained by a higher mortality for those with AKI even without hyperkalemia.

Conclusion
Hyperkalemia is associated with a high mortality even in the absence of AKI and irrespective of the timing of presentation. Management protocols should draw attention to this poor prognosis across all clinical contexts. As hyperkalemia usually occurs within the context of AKI, it should prompt clinicians to consider ongoing close observation for emerging AKI even when AKI is not yet evident on blood tests.
P0787THE IMPORTANCE AND BENEFITS OF THE REGISTRY OF PREDIALYSIS PATIENTS - ROMANIAN EXPERIENCE
Authors: PERIDE Ileana , NICULAE Andrei , CHECHERITA Ionel Alexandru 
Published: June 2020

Abstract

Background and Aims
Registries provide an organized and standardized method to systematically collect observational data about specific groups of patients managed in routine clinical practice for a predetermined objective. Data collected by patient registries may help researchers develop hypotheses about disease mechanisms or treatment approaches and inform health care policy thereby potentially improving quality. It is known that chronic kidney disease (CKD) represents the 6th cause of mortality worldwide and it has an increased prevalence. Therefore, the aim of our Registry is to collect epidemiological and medical data regarding the CKD patients from our country in order to drive improvements in health care quality.

Method
Starting from January 2019, all Romanian nephrologist have been collecting demographic and medical data CKD-related from patients diagnosed with CKD stages 1-5. These data are introduced in a special designed software program – ReNal – that is easy to be accessed. The demographic and medical information include: ID, gender, age, region, body mass index, CKD etiology, comorbidities, chronic treatment, CKD stage, laboratory test, such as serum creatinine, urea, uric acid, calcium, phosphates, iPTH, albuminuria, proteinuria, glomerular filtration rate, hemoglobin etc. (results collected from each medical assessment).

Results
During almost 1-year, over 10000 patients with CKD stages 1-5 were introduced in our Registry, with mean age of 69.2 ± 3.5, 51.22% female patients, 48.78% male patients. From our preliminary results, hypertension and diabetes mellitus represent the main cause of CKD in Romania, according with the international data. In addition, CKD stages 3b and 4 were highly represented. These are part of the preliminary results, future data will be available.

Conclusion
Analyzing the assessed data from our Registry, in future several key points could be achieved: the importance of a correct financial appraisal sustained by health system, adequate and active assessment of CKD patients including the complications, highlighting the disease progression rate depending on the recommended treatment, designing an efficient prevention program.