bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO129COMPARATIVE EFFECTIVENESS OF SGLT2I VERSUS DPP4I ON CARDIOVASCULAR AND RENAL OUTCOMES IN ROUTINE-CARE SETTINGS
Authors: Fu Edouard , Trevisan Marco , Lanka Vivekananda , Clase Catherine M , Xu Yang , Dekker Friedo W , Van Diepen Merel , Carrero Juan Jesus 
Published: May 2021

Abstract

Background and Aims
While clinical trials have demonstrated the efficacy of SGLT2 inhibitors on preventing cardiovascular and renal damage, few studies have expanded this evidence to routine-care settings.

Method
We compared clinical outcomes of adults who started SGLT2i or DPP4i therapy in Stockholm, Sweden, during 2013-2019. The primary outcome was a composite of cardiovascular (CV) death and hospitalization for heart failure (HF). Secondary outcomes included major adverse cardiovascular events (MACE; composite of cardiovascular death, myocardial infarction, stroke), all-cause mortality and the rate of eGFR decline (eGFR slope). Propensity score weighted Cox regression was used to balance 55 variables and estimate intention-to-treat hazard ratios with 95% confidence intervals. Differences in eGFR slope were calculated with linear mixed models.

Results
We identified 7136 individuals starting SGLT2i and 13,618 starting DPP4i therapy. Median age was 64 years (37% women) and median eGFR 86 ml/min/1.73m2. During median follow-up of 2.1 years, 211 individuals developed the primary outcome, 269 experienced MACE and 178 died. After propensity score weighting, patients starting SGLT2i therapy were at lower risk for the composite of CV death/HF hospitalization (HR 0.71; 95% CI 0.53-0.94) compared with DPP4i, and showed a tendency towards lower MACE (0.84; 95% CI 0.67-1.04) and all-cause mortality (0.85; 95% CI 0.62-1.18). There were a median of 4 (interquartile range: 2-8) eGFR measurements during follow-up per patient to estimate their eGFR slopes. In adjusted models, new users of SGLT2i had a slower rate of kidney function decline compared with DPP4i (eGFR slope difference of 0.43 (95% CI 0.15-0.72) ml/min/1.73m2 per year). Results for the primary outcome were consistent across 7 pre-specified subgroups, including eGFR (eGFR ≥60: HR 0.79 [95% CI 0.57-1.08]; eGFR &lt;60: HR 0.62 [0.38-0.99], p-value for interaction 0.40).

Conclusion
In patients undergoing routine care, initiation of SGLT2i was associated with fewer cardiovascular outcomes and less rapid kidney function decline compared with DPP4i initiation.
MO193EFFICACY AND SAFETY OF SINGLE DOSE RITUXIMAB IN STEROID-DEPENDENT OR FREQUENTLY RELAPSING MINIMAL CHANGE DISEASE IN A CHINESE MEDICAL CENTER
Authors: Li Chao , Xia Peng , Li Hang , Qin Yan , Chen Limeng , Li Xuemei , Li Xuewang 
Published: May 2021

Abstract

Background and Aims
The purpose of our study was to evaluate efficacy and safety of single dose rituximab in steroid-dependent or frequently relapsing minimal change disease during one-year follow-up.

Method
Twenty patients with corticosteroid-dependent (n=12) or frequently relapsing (n=8) idiopathic minimal-change diseases were hospitalized between August 2018 and July 2019 in the tertiary hospital. They received a single-dose rituximab (1g) concomitantly with their corticosteroid and immunosuppressors. The side effects of RTX were also recorded.

Results
We included 20 patients (15 males and 5 females). The mean age of onset renal disease was 21±9 years old. The included patients were steroid dependent, of whom 8 patients were frequently relapse. All patients had been received steroid in the past. 14 patients had been treated with calcineurin inhibitors (n=13, 65%) or mycophenolate mofetil (n=1, 5%). The baseline serum albumin was 33±10g/L, and serum creatinine was 76±38μmol/L, and 24-hour urine protein was 0.22 (0.06, 6.07) g/d. B-cell depletion (CD19+B cell&lt;5/μL) was achieved after RTX infusion within one week. The average frequency of administered RTX was 1.47 times per person per year. We observed B cell reconstitution (CD19+B cell&gt;20/μL) in 8 cases (35%) after the first dose of RTX. During follow-up (15.5±7.0 months), 19 patients achieved complete remission, while one patient was resistant to treatment. However, five relapse episodes were recorded during tapering steroids or after stopping steroids. Compared with the year before rituximab treatment, the per-patient average number of relapses decreased from 1.4±0.6 to 0.4±0.7 during 1 year of follow-up. After rituximab, the per-patient prednisone maintenance median dose decreased from 0.28 mg/kg (0.17, 0.46) to 0mg/kg (0, 0.07) (P&lt;0.001). Furthermore, the mean estimated GFR was stable (from 117±26 to 120±17 ml/min per 1.73m2, P&gt;0.05). There were three cases of mild infusion reaction (manifested as skin itching and rash) and two cases of infection (one case each of pneumocystis pneumonia and skin infection caused by actinomycetes).

Conclusion
Single-dose of RTX effectively prevented relapse and reduced the need for steroid in steroid-dependent or frequently relapsing minimal change disease.
MO195ATYPICAL HEMOLYTIC UREMIC SYNDROME IN LUNG TRANSPLANTATION: TREATMENT WITH ECULIZUMAB, OUR EXPERIENCE
Authors: Berzal Rico Raquel , Cavero Escribano Teresa , Aunon Pilar , Frías González Aida , Aubert Lucia , Sandino Pérez Justo , Cordero García-Galán Lucía , Rivero Martínez Marta , Andrés Belmonte Amado , Praga Manuel 
Published: May 2021

Abstract

Background and Aims
Atypical haemolytic uremic syndrome (aHUS) is a clinical entity characterized by acute kidney injury, thrombocytopenia and microangiopathic hemolytic anemia. There are several cases of AHUS in non-renal solid organ transplants described in the literature, included lung transplant. Kidney and patient survival are compromised by this complication because of the lack of an effective treatment. Eculizumab is C5 complement factor specific blocker already administered in another kind of secondary aHUS with encouraging results

Method
We analys six lung transplants in a retrospective single-center study between 2018-2020 who developed an aHUS and were treated with eculizumab. Clinical and analytical data were collected along the follow-up. Principal outcome was to explore haematologycal and renal response after treatment with eculizumab.

Results
We included a total of six patients (83% were female) with a median age of 57 years at the time of transplantation. Aetiologies of lung transplantation were chronic obstructive pulmonary disease in 2 patients, interstitial lung disease in another 2, and cystic fibrosis in the remaining two. Induction and maintenance immunosuppressive therapy were based on tacrolimus, mycophenolate and prednisone in all cases. Baseline serum creatinine after lung transplantation was 1.1 mg/dl (0.9-2.4). Two patients developed an aHUS in the immediate post-transplant, one of them died because of surgical complications. Another four patients developed an aHUS 59 months (33-95) after transplantation. Previously of thrombotic microangiopathy, three patients were on treatment with everolimus instead of mycophenolate and two lung transplants have cytomegalovirus reactivation. At the aHUS onset, median serum creatinine was 4mg/dl (2.4-5-7) and acute dialysis was performed in 50% of patients. Median hemoglobin was 7.2g/dl (6.9-7.7), platelet count was 32x1000/µL (17-58), and DHL was 1343 U/L (581-1597) at the start of eculizumab despite having treated the trigger. After a median of 6 doses of eculizumab, the five surviving patients had haematologycal and renal response. No patients underwent chronic dialysis. Serum creatinine was 2.2 mg/dl (1.7-2.3), hemoglobin 9.8 g/dl and platelet count 159x1000/µL at the end of follow-up.

Conclusion
AHUS is a critical complication in lung transplantation, shortly related with immunosuppressive therapy. Patients are at risk of end stage renal disease. Eculizumab treatment appears promising.
MO196KIDNEY INVOLVEMENT IN WALDENSTROM MACROGLOBULINEMIA AND IGM MONOCLONAL GAMMOPATHY
Authors: Cardoso Fernandes Sara , Gomes Ricardo , Messias Ana , Do Sacramento Marques Da Costa Bernardo , Góis Mário , Viana Helena , Ferreira Ana Carina , Nolasco Fernando 
Published: May 2021

Abstract

Background and Aims
Renal manifestations of IgM gammopathy are less common than those seen in patients with multiple myeloma. However, a wide spectrum of kidney diseases has been described in previous publications. We aim to characterize kidney involvement in patients with Waldenström Macroglobulinemia and IgM-secreting B cell lymphoproliferative disorders.

Method
We retrospectively studied 7 patients with a circulating monoclonal IgM and renal histology showing evidence of monoclonal immunoglobulin deposits or lymphomatous infiltration. Demographic, clinical and laboratory data were collected.

Results
Of the 7 patients studied, four (57%) were male and the median age was 68 years old (range 41-79). Among the 7 patients, 5 met criteria for Waldenström Macroglobulinemia after bone marrow biopsy; none of them had hyperviscosity syndrome. Four patients presented with nephrotic syndrome and all had impaired renal function and hypertension. Four patients had microscopic hematuria and only one patient showed no proteinuria. Mean serum creatinine levels were 2.9mg/dL. Renal biopsy showed different patterns of renal injury, including typical intracapillary monoclonal deposits disease (5 patients), membranoproliferative glomerulonephritis with cryoglobulinemia (1 patient), AL-amyloidosis (1 patient) and interstitial lymphoplasmacytic infiltration with CD20+ lymphocytes associated with minimal change disease. Follow-up data were obtained in 4 patients: 3 underwent chemotherapy but only one achieved complete remission and 2 progressed to end-stage renal disease.

Conclusion
Although rare, Waldenström Macroglobulinemia and IgM gammopathy are responsible for diverse manifestations of renal disease. A prompt diagnosis is of utmost importance in order to ensure early start of therapy, which should be directed at the underlying hematologic disorder, to improve renal survival.
MO199DENOSUMAB: NOVEL APPROACH TO TREATMENT OF OSTEOPOROSIS IN RENAL DISEASE
Authors: Greco Rosita , Mollica Agata , Zincone Francesco , Papalia Teresa 
Published: May 2021

Abstract

Background and Aims
Denosumab is a fully human monoclonal antibody to the receptor activator of nuclear factor kappa-B ligand (RANKL), an osteoclast differentiating factor. It inhibits osteoclast formation, decrease bone resorption, increase bone mineral density (BMD), and reduce the risk of fracture. There is no restriction of its use in patients with renal disease, for whom biphosphonates are considered controindicated. The aim of our study was to evaluate the effectiveness in reducing facture risk and safety of Denosumab in patients with Osteoporosis and renal disease.

Method
This is a prospective analysis of 17 patients with Osteoporosis (average T-score below -2.5) admitted to our Nephrology Department for CKD in the last four years. in Vasculitis, Renal Allograft Recipients. Patients with severe Hyperparatiroidism were excluded. We estimated creatinine clearance (eGFR) using Cockcroft-Gault and classified levels of kidney function using the modified National Kidney Foundation classification of CKD. All patients were adequately supplemented with calcium and vitamin D before and while taking Denosumab 60 mg every 6 months. The primary endpoint is the change in bone mineral density (BMD) at one and two years. Secondary endpoints include changes in bone mineral metabolism parameters (Ca, P, PTHi, 25-OH VitD), incidence of fractures, and renal/allograft fuction at one and two years.

Results
The mean age was 52.5±4 years and 8/17 (47%) were females. N.13 patients (76.5%) were renal transplant recipients (RTR) on standard triple immunosoppression including steroids (prednisone 5 mg/day), CNI and MMF, with average eGFR 65.7±12.5 ml/min. N.2 patients (11.75%) were in hemodialysis. N.2 patients (11.75%) with Anca Vasculitis on steroid therapy and average eGFR 35.6±7.2 ml/min. All patients enrolled were with a BMD T-score of greater than -4.0 and less than -2.5. Only 2 patients had a history of fractures confirmed by a radiology report. Baseline parameters: calcium 9.8±0.32 mg/dl, phosphate 3.9±0.8 mg/dl, PTHi 137±91.0 ng/L, 25-OH VitD 18.3±8.9 ng/mL. From baseline at 1 month there were an increase in PTH and a decrease in calcemia in only 2 transplant recipients (CKD II and IV), that improved with an increased dose of Vit D. There were no significant difference in baseline bone mineral metabolism parameters to year 1 and 2 in all other patients. We found no difference in eGFR and proteinuria from baseline to 1 and 2 years in RTR and ANCA vasculitis. Significant improvement in T-score was observed at 1 year and 2 years (&lt; -1) in all patients. No one discontinued therapy for adverse events.

Conclusion
Denosumab may have advantages in patients with kidney dysfunction, because not excreted by the kidney and there is no need for dose adjustment. This prospective study showed a significant improvement in osteoporosis (at Dexa mean T-score ≤ -1), but particular attention should be paid to ensuring that patients are calcium and Vitamin D replete.
MO202RITUXIMAB TREATMENT IN NEPHROLOGY
Authors: Malki abidi Mouna , Barbouch Samia , Mariem Hajji , Mesbahi Tasnim , Harzallah Amel , Gorsane Imen , Hafedh Hedri , Kaaroud Hayet , Goucha Rym , Ben hmida Fethi 
Published: May 2021

Abstract

Background and Aims
The B cells have a central role in the pathogenesis of several renal pathologies. Rituximab, a monoclonal antibody directed against the CD20 receptor expressed on the surface of B cells is an interesting alternative to conventional treatments of kidney pathologies.

Method
We conducted a descriptive retrospective study of the use of rituximab in nephrology patients.

Results
We collected 25 patients including 12 women and 13 men. The mean age was 33,5 [16-55] years. The rituximab was indicated for an extramembranous glomerulopathy in 6 patients, a focal segmental glomerulosclerosis in 4 patients, a minimal change disease in 4 patients, a lupus nephritis in 5 patients, and a granulomatosis with polyangiitis in 2 patients. Four kidney transplant patient received rituximab for the treatment of antibody mediated rejection in 3 cases and large cell lymphoma in 1 case.
The average time between the diagnosis of the renal disease and starting treatment with rituximab was of 76 +/- 46,5 months. And it was of 16 [ 0,7 ; 59,8] months after transplantation in kidney transplant recipients.
Side effects have been observed in 11 cases (44%). A favorable response has been obtained in 10 cases (40 %), within an average of 2,27 months, with at least one relapse in 4 cases. The follow-up time was 36,33 +/- 31,67 months.

Conclusion
Rituximab has been shown to be helpful in several cases of kidney disease. It may reduce the need for maintenance immunosuppression and help in some cases that are refractory to other therapies.
MO206MALE SEX IS ASSOCIATED WITH IN-HOSPITAL DEATH IN NON-DIALYSIS CKD PATIENTS WITH COVID-19
Authors: Coca Armando , Burballa Carla , Centellas Pérez Francisco Javier , Acosta-Ochoa Isabel , Arenas María Dolores , Pérez Martínez Juan , Fidalgo Veronica , Pascual Julio , Ortega Cerrato Agustin 
Published: May 2021

Abstract

Background and Aims
Coronavirus disease (COVID-19), caused by Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) can lead to significant organ injury. CKD has been associated with increased mortality in previous epidemics, and male sex has been correlated with worse outcomes during COVID-19 in the general population. Our aim was to describe the differential effect of sex as a risk factor for in-hospital mortality among non-dialysis CKD subjects.

Method
Multicenter, observational cohort study including 136 adult patients with CKD and 136 age- and sex-matched controls who required admission for COVID-19 in three academic hospitals in Spain. Viral infection was confirmed by real-time RT-qPCR and/or serologic testing in all cases. Disease severity on admission was classified according to the WHO—China Joint Mission Report on COVID-19. The presence of CKD was defined as sustained eGFR &lt;60 and &gt;15 ml/min/1.73m2 within the 6 months prior to COVID-19 hospitalization. Demographic and clinical data were gathered from medical records. Outcomes were recorded during the following 28 days after admission. We applied Cox proportional hazards models, adjusted for age, sex, hypertension, diabetes and severe or critical disease at presentation.

Results
Due to the matched design, no differences were found regarding age and sex between cohorts. CKD patients suffered more frequently from hypertension and diabetes and presented higher 28-day mortality after hospital admission due to COVID-19 compared with age- and sex-matched controls (40.4 vs. 24.3%; P=0.004). In adjusted Cox regression analysis among CKD patients, only age (HR: 1.087, 95% CI: 1.047-1.128) and male sex (HR: 1.883, 95% CI: 1.045-3.391) were independent predictors of 28-day mortality. Comparatively, among patients without CKD, only age acted as an independent predictor for 28-day mortality (HR: 1.082, 95% CI: 1.033-1.133). None of the variables included in adjusted regression was able to predict ICU admission in any of the cohorts.

Conclusion
Male sex is associated with increased mortality, but not with ICU admission, after hospitalization due to COVID-19 among non-dialysis CKD patients. That effect was not observed among hospitalized controls without CKD.
MO211FORMALIZATION AND DEVELOPMENT OF A NEPHROLOGY ELECTRONIC CONSULTATION (ECONSULT) IN COVID-19 PANDEMIC
Authors: Herrero Berron Juan Carlos , Lentisco Carolina , Oliet Aniana , Suso Andrea , Onate Alonso Irene , Sanchez Maria , Camacho Rosa , Mon Carmen , Ortiz Milagros , Ortega Olimpia 
Published: May 2021

Abstract

Background and Aims
Due to COVID-19 pandemic we must continue attending in our hospital consultations and, at the same time, avoid transfers and visit that involve risks to our patients. For this reason, we implemented new forms of care. Mainly electronic consultation (eConsult) using institutional email as way of contact between Primary Care Providers (PCPs) and nephrologist, trying to decrease in-person visit.

Objective
To analyze the results of the creation in June 2020 of a Nephrology electronic consultation in our hospital.

Method
Retrospective observational study of eConsults made to our department, which serves a population of 200.000 people, with total of 9 primary care centers. The study period was June 10, 2020 to December 31, 2020. We have studied the number of eConsults, response time, type of consult made, problem resolution and subsequent follow up.

Results
Of 141 workdays, in 61 days (43%) there was eConsult, total 80 eConsults, mean 1.3 and median 1 daily (range 1 to 3). All primary care centers used this communication way, as well as 50 PCPs. Median response time for eConsult was 1 day (range 1-4). 55% patient was male, mean age 70.8 years (SD 13.9) (range 16-95 years). 64% it was his first assessment for Nephrology. The most frequent causes of eConsult: increase of creatinine (41.3%), uncontrolled blood pressure (12.5%), sodium and potassium disturbances (11.3%), treatment adjustment (11.3%) and changes in previous appointment (8.8%). After assessment eConsult, to 55% of patients was treatment adjustment, 22.5% were converted to an in-person visit, 11% they didn´t need any action but only 1 patient was referred to the emergency room. 44% patient is subsequent follow up by PCPs, 39% by nephrologist, 15% joint assessment PCP and nephrologist and 2% by other specialists. Only 2 patients (2.5%) made second eConsult.

Conclusion
The eConsult is an important help to PCPs to solve doubts quickly, avoid unnecessary the travels to hospital the patients, treatment adjustment above all in control of hypertension an ionic disturbance, and guide in handling of chronic kidney disease. The diffusion and empowerment of this type of consultation in a next future may decrease, partly, the usual saturation of face-to-face visit and optimize the patient population being seen by nephrologist.
MO131THE SHRUNKEN PORE SYNDROME IS ASSOCIATED WITH POOR PROGNOSIS AND LOWER QUALITY OF LIFE IN HEART FAILURE PATIENTS- THE HARVEST-MALMÖ STUDY
Authors: Xhakollari Liana , Grubb Anders , Jujic Amra , Bachus Erasmus , Nilsson Peter M , Leosdottir Margret , Christensson Anders , Magnusson Martin 
Published: May 2021

Abstract

Background and Aims
The cardiorenal syndrome was studied in heart failure (HF) patients with respect to the “Shrunken pore syndrome” (SPS) that is characterized by a difference in renal filtration between cystatin C and creatinine, resulting in a low eGFRcystatin C/eGFRcreatinine-ratio.

Method
373 patients hospitalized for HF were retrieved from the HeARt and brain failure inVESTigation trial (HARVEST-Malmö). We used CKD-EPI formulas for estimated glomerular filtration rate (eGFR). Presence of SPS was defined as eGFRcystatinC ≤60% of eGFRcreatinine. In Cox regression multivariate models, associations between SPS, risk of death and risk of 30-day re-hospitalization were studied. Associations between SPS and impaired quality of life (QoL) were studied using multivariate logistic regressions.

Results
SPS was associated with all-cause mortality (124 events; hazard ratio (HR) 2.35; confidence interval (CI95%) 1.17-4.71; p=0.016 and with 30-day re-hospitalization (70 events; HR 1.82; CI95% 1.04-3.18; p=0.036). Analyses of QoL, based on a Kansas City Cardiomyopathy Questionnaire overall score &lt;50, revealed that SPS was associated with increased risk of low health-related QoL (odds ratios (OR) 2.15 (CI95% 1.03-4.49; p=0.042).

Conclusion
The results of this observational study show for the first time an association between SPS and poor prognosis in HF. Further studies are needed to confirm the results in HF cohorts and experimental settings to identify pathophysiological mechanisms.