bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0822ESTIMATED GFR DECLINE OF PKD PATIENTS IN CKD G3B-5 WAS AS FAST AS THAT OF DKD PATIENTS: A RESULT FROM A JAPANESE COHORT STUDY FOR PATIENTS WITH ADVANCED CKD, THE REACH-J STUDY
Authors: Hoshino Junichi , Saito Chie , Tsunoda Ryoya , Nagai Kei , Kai Hirayasu , Okubo Reiko , Kondo Masahide , Okada Hirokazu , Narita Ichiei , Wada Takashi , Kashihara Naoki , Robinson Bruce , Yamagata Kunihiro 
Published: June 2020

Abstract

Background and Aims
CKD progression in Japanese patients with advanced chronic kidney disease (CKD)—an estimated glomerular filtration rate (eGFR) &lt;45 ml/min/1.73m2—has remained largely unexamined.

Method
We conducted a nationwide cohort study of Japanese patients with advanced CKD. We recruited 2,249 advanced CKD patients (eGFR&lt;45/ml/min/1.73m2) receiving nephrologist care from a national sample of 31 facilities throughout Japan, randomly selected with stratification by region and facility size, aligned with the international CKD Outcomes and Practice Patterns Study (CKDopps). From baseline data, we calculated annual eGFR decline by CKD stage and causes of CKD over 4 years before enrollment. Variability of eGFR decline was calculated from standard error of the regression.

Results
The reported causes of CKD were 552(25%) had diabetic kidney diseases (DKD), 131(6%) had PKD, 591(26%) had nephrosclerosis, 299(13%) had glomerulonephritis, and 676(30%) had other renal diseases. Of 1939 eligible patients with eGFR data more than two years, median (IQR) annual eGFR declines (ml/min/1.73m2/year) in PKD and DKD patients were 2.30 (1.16, 3.38) and 1.18 (0.23, 3.69) in G3b, 2.60 (1.81, 3.40) and 1.97 (0.20, 4.75) in G4, and 4.00 (2.00, 5.60) and 3.94 (2.05, 7.05) in G5, respectively. These eGFR declines were significantly faster than those of other kidney diseases. On the other hand, the variability of the decline in PKD patients was significantly smaller than that of DKD patients (0.43 vs 0.71, p&lt;0.001). This trend was consistent in all CKD stages.

Conclusion
Our study clarified that, similar to DKD patients, annual eGFR decline of PKD patients was significantly faster than those of other kidney diseases throughout all stages. Furthermore, the variability of the decline in PKD patients was smaller than those of others. These data suggest that comprehensive nephrology care should be needed especially for these patients.
P0829THE ASSOCIATION BETWEEN URINARY NGAL AND EGFR SLOPE IN PATIENTS WITH CKD
Authors: Fukuda Shungo , Fujii Naohiko , Matsushita Taisuke , Yonemoto Sayoko , Hayashi Daisuke , Okuno Ayako , Saeki Mizuho 
Published: June 2020

Abstract

Background and Aims
Urinary neutrophil gelatinase-associated lipocalin (uNGAL) is a new biomarker for renal tubular damage. The association between uNGAL and renal prognosis have been reported in many papers; however, it may often be affected by urinary tract infection (UTI), and its clinical value with consideration of UTI has not been well investigated in patients with chronic kidney disease (CKD). The aims of our study were to investigate the association between uNGAL and eGFR decline in CKD incorporating the effect of UTI.

Method
This was a retrospective observational cohort study at a single hospital in Japan. We included adult patients with the estimated glomerular filtration rate (eGFR) of 10 to 70 mL/min/1.73m2 from Jan 2017, who had at least one measurement of uNGAL. We used baseline uNGAL adjusted for urinary creatinine (Cr) as an exposure variable and divided the patients into quartiles. UTI was determined by a single evaluation of urinalysis at baseline. The repeated measured eGFRs were obtained from the electrical health record until dialysis initiation, loss to follow-up, or the end of the observation period whichever occurred first. We performed longitudinal analyses for eGFR decline using the mixed effects model and evaluated the longitudinal effect of uNGAL taking into account of UTI. All statistical analyses were done using STATA 13.1.

Results
In total, 281 patients with CKD were included. Mean age and eGFR at baseline were 70.2 years and 33.9 mL/min/1.73m2, respectively. The median [interquartile range (IQR)] of baseline uNGAL and urinary protein to Cr ratio (uPCR) were 49.6 [19.4 - 171.4] ug/gCr and 0.82 [0.18 - 3.26] g/gCr, respectively. Patients with UTI (15%) showed significantly higher uNGAL at baseline than those without (219 [89 - 425] vs. 39 [16 - 131]). During the mean follow up of 229 days, nine patients developed eGFR &lt; 5 mL/min/1.73m2. Although a higher uNGAL level was significantly associated with lower eGFR levels at baseline (-3.3 [95% confidence interval (CI): -7.6, 0.93], -9.6 [-14.2, -4.9], and -16.3 [-21.4, -11.1] mL/min/1.73m2 in quartiles Q2-4 as compared to Q1); the eGFR trajectory did not differ with or without baseline UTI in the analytic model, while baseline proteinuria was significantly associated with a steeper slope of eGFR.

Conclusion
A higher uNGAL was significantly associated with lower eGFR levels at baseline; however, it was not associated with a steeper slope of eGFR in the longitudinal analysis, even with the consideration of the effect of UTI.
P0836ROLE OF THE NEPHROLOGIST AS A CONSULTANT FOR VASCULAR SURGERY SERVICE IN A UNIVERSITY HOSPITAL
Authors: Siverio Morales Orlando , Martin Edduin , Dominguez Virginia , Marin Carlos , Aragao Ana , Luis Rodríguez Desirée , Jarque Ana , Garcia Patricia , Reguera Maria Jose , Macia Manuel 
Published: June 2020

Abstract

Background and Aims
The clinical profile and complexity of hospitalised patients from Vascular Surgery are similar to those from Nephrology. Also, the majority of patients with peripheral vascular disease has some degree of chronic kidney disease. Therefore, the collaboration of nephrologist as consultants could have a significant impact on the adequate attention of these patients.
Our aim was to analyze the epidemiological and clinical characteristics of the vascular surgery patients admitted in a public university hospital of 1000 beds that were attended by a nephrologist during their hospitalization.

Method
Observational study of a retrospective cohort of 138 patients in a 1 year period (January 1st to December 31st 2018). The following data were considered: nature of the consultation (“Urgent” LESS THAN 24 H TO BE ATTENDER OR “Standar”), reason for consultation/nephrological diagnosis, cause of admission, follow-up period, age, sex, presence of : Diabetes Mellitus (DM), Hypertension (HT) and/or Chronic Kidney Disease (CKD) presence.

Results
138 patients, Mean age was 67,8 y (range 35-92 y). 76,81% were men and 23,19% were women. Most frequent cause for consultations were: 1. Patients on Hemodialysis treatment (66 = 47,83%); 2. Exhacerbations of CKD (29 = 21,01%); 3. Acute Kidney Failure (18 = 13,04%); 4. Kidney transplantation (11 = 7,97%); 5. Ionic alterations (7 = 5,07%); 6. Advanced CKD (6=4,35%).
Cause of admission: 1. Chronic lower limb ischemia (68=49,27%); 2. Problems related to arteriovenous fistula (Creation of vascular access: 10=7,25% and complications of vascular access: 16=11,59%); 3. Aneurysmatic complications (14=10,14%); 4. Diabetic foot (11=7,97%); 5. Infections (7=5,07%); 6. Deep venous thrombosis (6=4,35%).
About 75.35% had DM, 91.30% were hypertensive and 62.32% had both clinical conditions.
The average follow-up time was 72 days (range 1-223 days) and 92,03 % need to be follow-up more than 24 hours.
About 49,27% of the consultation were urgent.

Conclusion
The number of patients admitted to vascular surgery department requiring nephrology attention are high and represents an important percentage of the clinical activities and resources demanding to the nephrology service.
Exhacerbations of CKD, Diabetes Mellitus and Hypertension are constant clinical conditions in patients admitted to vascular surgery requiring nephrology assessment.
Based on these data is important to improve the coordination between both departments and to stablish a specific training program for nephrologist and vascular surgeons in order to optimize the management of this patients.
P0841SPECTRUM OF RENAL DISORDERS AT A TERTIARY CARE HOSPITAL IN KARACHI, PAKISTAN: RESULTS FROM AN OUTPATIENTS DATABASE IN A DEVELOPING COUNTRY
Authors: Yaqub Sonia , Awan Safia 
Published: June 2020

Abstract

Background and Aims
The burden of renal diseases in developing countries is rising. However, little is known about the epidemiology and clinical pattern of various disorders in our part of the world. The objective of this study was to understand the burden of disease faced by nephrologists in a tertiary care setting.

Method
It was a prospective observational study of all presentations to nephrology clinics at Aga Khan University Hospital Karachi over a period of one year.

Results
A total of 1589 out-patients with renal diseases were seen during the study period. The mean age of the study participants were 49.9 years and 629 (53%) were male. 88.6% of patients belonged to Karachi and Hyderabad areas of Sind province. CKD was the most common diagnosis (93.5%). Diabetic kidney disease and hypertension and related disorders were causes of CKD in 29.5% and 29.1% cases respectively. In 13.1% patients, the etiology of CKD could not be determined. Among glomerulonephritis (6.67%), membranous nephropathy was the commonest disorder (32.1%) followed by FSGS (29.2%), Minimal change disease (15.1%) and IgA nephropathy (10.4%). SLE and lupus nephritis was seen in 48 patients (4.0%). Around 10% patients were suffering from various tubulointerstitial diseases (renal stones, UTIs, Acute and chronic tubulointerstitial nephritis).

Conclusion
It’s a first study of its kind reporting frequency of various renal disorders from an outpatient registry at a tertiary care hospital in Pakistan. Diabetes and hypertension account for almost 60% of cases with CKD. Membranous nephropathy is the commonest glomerular disease in an urban population cohort. We need more studies on spectrum of renal diseases for better planning and available resource management.
P0842MANAGEMENT OF RENAL RISK PATIENTS AND THERAPEUTIC CHANGES AFTER DIAGNOSIS OF KIDNEY DISEASE IN PRIMARY CARE
Authors: Zitt Emanuel , Sprenger-Mähr Hannelore , Lhotta Karl 
Published: June 2020

Abstract

Background and Aims
Screening for chronic kidney disease (CKD) is proposed in high risk groups. Whether a new CKD diagnosis in general practice leads to improved patient management, is largely unknown.

Method
To answer this question and evaluate the kidney disease specific pharmacological care in renal risk patients, a screening study in patients at high risk for kidney disease was performed in the primary care setting in ten general practices in the state of Vorarlberg, Austria. General practitioners were provided with guidelines for the management of CKD with a focus on blood pressure control, RAS inhibition and use of statins.

Results
In total, 434 patients between age 35 and 77 were included (61% males, mean age 56±7 years, eGFR 86±15 ml/min, body mass index 31±6 kg/m, blood pressure 135±16/83±10 mmHg), of whom 80% had hypertension, 43% had diabetes and 42% were obese. RAS-blockers were already taken by 64% of patients, statins by 39%. A diagnosis of CKD (stage ≥G3 and/or ≥A2) was established in 73 patients (17%), 60% of them had diabetes. Compared to patients without CKD, CKD patients were already treated more often with RAS-blockers (78% vs 61%, p=0.005), whereas statin usage was comparable (44% vs 38%, p=0.3347). After CKD diagnosis, medical therapy was changed in 13 patients (18%). A RAS-blocker was initiated in two out of the 16 patients without a preexisting RAS-blocker (12.5%), the dosage was increased in one patient. Antihypertensive therapy was intensified adding amlodipine in seven patients (10%), and a statin was begun in six (15%) out of 41 statin-naive patients. In those without CKD after the screening, therapy was changed in 40 patients (11%). Compared to patients with CKD, fewer patients started a statin therapy (5% vs 15%, p=0.012) and were additionally treated with amlodipine (3% vs 10%, p=0.021) to optimize blood pressure control.

Conclusion
This study shows that in the primary care setting a great proportion of CKD patients are already on RAS-blockers, whereas the prescription rate for statins is low. A diagnosis of CKD led to a moderate increase in statin therapy, which leaves further opportunity for improvement. The reasons for this rather low use of statins in CKD patients need to be determined.
P0852PERICYTE-SPECIFIC MANIPULATION OF HYPOXIA-INDUCIBLE FACTORS REGULATES ERYTHROPOIESIS WITHOUT AGGRAVATING RENAL FIBROSIS
Authors: Cai Pei-Zhen , PAN SZU-YU , LIN SHUEI-LIONG 
Published: June 2020

Abstract

Background and Aims
Stabilizers of hypoxia-inducible factor (HIF) have been shown to be effective on treatment of anemia in patients with chronic kidney disease (CKD). Increased erythropoietin (EPO) production and enhanced erythropoiesis are known to be the major mechanisms responsible for the treatment effects. However, the effect of HIF stabilization on renal fibrosis is controversial. We created animal models characterized by CKD and pericyte-specific stabilization of HIF to examine the effects of HIF on renal fibrosis and erythropoiesis.

Method
Gli1CreERT2/+;Egln1F/F, Gli1CreERT2/+;VhlF/F, and Gli1CreERT2/+;Hif1aF/F;Hif2aF/F mice were generated to study the effects of pericyte-specific overexpression or knockout of Hif. Unilateral ureteral obstruction (UUO) was used to induce CKD. The severity of fibrosis was determined by Picrosirius red stain and Col1a1 mRNA level in the kidney.

Results
Pericyte-specific stabilization of HIF resulted in increased serum EPO level, augmented splenic erythropoiesis, and polycythemia, while the severity of renal fibrosis was not affected. In line with these findings, pericyte-specific knockout of Hif1a or Hif2a did not result in significant change of renal fibrosis.

Conclusion
Our study endorses the neutral effects of pericyte-specific HIF stabilization on renal fibrosis.
P0853DECISION SUPPORT SYSTEM (DSS) FOR DIAGNOSTICS AND TREATMENT OF PATIENTS WITH CKD COMPLICATIONS
Authors: Kondratiev Egor , Novitskiy Vladimir , Galchenkov Aleksei 
Published: June 2020

Abstract

Background and Aims
Some of the most common complications of CKD are anemia and bone and mineral disorders (BMD). Adequacy of treatment of patients with these complications directly affects their life quality and duration.
The goal of our work is to create medical decision support system (MDSS) that will be able to generate recommendations on diagnostics and treatment of CKD patients with anemia and BMD complications, based on clinical guidelines and control the fulfillment of corresponding prescriptions.

Method
We have developed an automated medical decision support system that generates recommendations on patient’s treatment and further studies that are mandatory according to regulations, based on patient’s electronic medical record. The functionality of MDSS is based on knowledge base (KB), which consists of clinical guidelines formalized as mathematical logic operators. The system is also able to control how medical staff fulfills generated diagnostic and treatment prescriptions: deadlines, duration and order of actions, mandatory studies from regulations, drug therapy, etc.
The assessment of the system was conducted on more than 2000 CKD patients on chronic dialysis from 30 “Nefrosovet” hemodialysis clinics.

Results
MDSS was developed using process-based management principles and was successfully employed on representative sample of patients with CKD on chronic dialysis from “Nefrosovet” hemodialysis clinics. The system generated recommendations for this group of patients for the duration of 6 months. Recommendations were related to diagnostics and treatment of patients, specific diagnoses, scheduled and additional studies, drug prescriptions (where dose was set by a physician), etc.
As a result of using a system, we were able to reduce average treatment cost of patient by 14% for anemia related treatment and by 36% for BMD related treatment. At the same time the treatment quality has improved from an average of 46% to 60% of patients in target ranges of key laboratory parameters after 6 months of system usage. Treatment cost has reduced due to the timely start and gradual cancelation (by indications) of drug therapy, which also allowed us to avoid overadministration of unnecessary drugs.

Conclusion
Deployment of developed MDSS for process-based management of patients with CKD on chronic dialysis with anemia and BMD complications has shown high cost efficiency. Furthermore, automated diagnostics, therapy and prescription fullfilment control is performed without loss of quality, sometimes even with the improvement of quality of treatment process.
P0854THE ENDOGENOUS ERYTHROPOIETIN EXPRESSION IN CKD PATIENTS AT HIGH ALTITUDE: DATA FROM TIBETAN PLATEAU
Authors: Wang Yan , Dang Zonghui , Zuo Li , Zhang Lei 
Published: June 2020

Abstract

Background and Aims
Some studies have shown that higher altitude was associated with lower EPO doses and higher hematocrit levels in HD patients. Our pre-study also confirmed that the higher the altitude, the lower the EPO resistance index [weekly weight-adjusted dose of erythropoietin (IU/kg/week) divided by Hb concentration (g/dl)]. Possible explanations included that patients at higher altitude produce more endogenous EPO or they respond more efficiently to EPO than patients at lower altitude. The aim of this study was to determine whether endogenous EPO production was up-regulated in CKD patients at high altitude.

Method
Three cohorts from different altitude were compared. Among them, 58 CKD patients were from Tibet Autonomous Region People's Hospital (3650m above sea level, recruited between March 2019 and July 2019. The other two cohorts were from the literatures. [1,2]
The exclusion criteria included patients under EPO substitution or those with acute renal failure, polycystic kidney disease, renal carcinoma or polycythemia. The subjects were then stratified into groups according to the CKD stage. EPO concentrations were determined by using electrochemiluminescent immunoassay. Change of endogenous EPO levels with altitude by CKD stage was studied.

Results
The characteristics of the Tibet cohort were shown in table 1, the other two can be found in references. In Tibet cohort, there was a significant correlation between serum EPO concentrations and CKD stages as well as eGFR. The equation derived from liner regression analysis was EPO (mIU/ml) =-1.941*CKD stage+17.67 (r2 = 0.093, P = 0.020) and log EPO (mIU/ml) =-0.0002311*eGFR (ml/min/1.73m2) + 1.025 (r2 = 0.097, P = 0.017). Serum EPO concentrations dropped with decreasing of eGFR, see in Figure 1.
Normally there was an exponential relation between hemoglobin and endogenous EPO in healthy people. The correlation was attenuated and even absent in CKD patients. In Tibet cohort, there was no linear relation between hemoglobin and endogenous EPO (r2 &lt; 0.001, P =0.907), see in Figure 2.
Compared with the other two cohorts at lower altitude, the average EPO concentration of Tibetan patients was higher in CKD stage one, however, it decreased quickly with increasing stages of CKD. The average EPO concentration were even lower in CKD stage two to five, see in Figure 3.

Conclusion
Endogenous EPO production was only up-regulated in patients with normal renal function at high altitude, those with impaired renal function failed to produce more EPO. Our results suggest that the possible explanation for CKD patients at high altitude had better EPO responsiveness is that they respond more efficiently to EPO other than they produce more endogenous EPO.
P0863TYPE OF PROTON PUMP INHIBITOR AND RISK OF IRON DEFICIENCY IN RENAL TRANSPLANT RECIPIENTS
Authors: M. Douwes Rianne , Vinke Joanna Sophia Jacoline , Gomes-Neto António W , Blokzijl Hans , Berger Stefan P , Bakker Stephan , De Borst Martin , Eisenga Michele Freerk 
Published: June 2020

Abstract

Background and Aims
Use of proton-pump inhibitors (PPIs) is common practice in renal transplant recipients (RTRs). Emerging data suggest several adverse effects of use of PPIs, including development of iron deficiency (ID). Although the latter has been shown with respect to PPIs, specific analyses for different types of PPIs and the associated risk of ID have not been performed.

Method
We used data from the TransplantLines Biobank and Cohort study, an ongoing prospective cohort study among all types of solid organ transplant recipients. For the current study, we used data from stable RTRs with a functional graft for more than 1 year post transplantation (n=795). We excluded RTRs who used any form of iron supplementation (n=54) and EPO-stimulating agents (n=24), resulting in 728 RTRs eligible for analyses. Use of PPIs was subdivided in different types of PPIs, i.e. omeprazole, esomeprazole, pantoprazole, and rabeprazole. ID was defined as TSAT&lt;20% and ferritin &lt;300 µg/L. Logistic regression analysis was used to assess the associations between PPIs and ID.

Results
We included 728 RTRs (age 56±13 years, 61% males), with a mean eGFR of 53±18 ml/min/1.73m2, a median [interquartile range] ferritin level of 96 (44 – 191) µg/L and mean TSAT of 24±10%. PPIs were used by 504 (69%) of the included RTRs, of which 398 (79%), 55 (11%), 49 (10%), and 2 (0.4%) respectively used omeprazole, pantoprazole, esomeprazole, and rabeprazole. Use of PPIs was strongly associated with ID (OR, 2.20; 95%CI 1.48 – 3.28; P&lt;0.001), independent of adjustment for age, sex, BMI, eGFR, hs-CRP, smoking, alcohol use, use of calcineurine inhibitors, prednisolone, antiplatelet drugs, and antihypertensives. When subdividing the PPIs into the different types, both omeprazole (OR, 1.98; 95%CI 1.39 – 2.83; P&lt;0.001) and esomeprazole (OR, 2.11; 95%CI 1.09 – 4.07; P=0.03) were independently associated with iron deficiency, whereas pantoprazole was not associated (OR, 0.89; 95%CI 0.47 – 1.70; P=0.73).

Conclusion
Omeprazole and esomeprazole, but not pantoprazole, are associated with an increased risk of ID. Our results are in line with previous reports that pantoprazole has the lowest potency with least increase in intragastric pH, thereby possibly interfering less with reduction of ferric to ferrous iron, and subsequently iron absorption. Future studies are warranted to confirm our present findings.