bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO1041AWARENESS, KNOWLEDGE AND PERCEPTION OF CHRONIC KIDNEY DISEASE PATIENTS AT RENAL MEDICINE OUTPATIENTS' CLINIC, SINGLE CENTRE EXPERIENCE
Authors: AlRahbi Fatma , Alsalmi Issa 
Published: May 2021

Abstract

Background and Aims
Chronic kidney disease (CKD) is a major cause of morbidity and mortality in the Sultanate. Many preventive measures have focused on early detection and education. Hence, awareness and education of kidney disease influence positively its medical management and diminish significantly the economic burden on public health. Knowledge of CKD and risk factors increases the perception of being at high risk and increasing health seeking behaviour.
We conducted a longitudinal survey at Renal Medicine Department among our patients to assess the level of awareness, knowledge of CKD and the treatment options.

Method
We used a pretested structured questionnaire to collect information on socio-demographic and knowledge of patients attending Renal Medicine Department. The questionnaire was distributed to all CKD patients of at least one-year duration after their diagnosis.

Results
A total of 200 patients completed this study, mainly from the capital region. The mean age was 50 (SD 17.1) years for male participants and 42.3 (SD 16) years for female participants. The majority (74.3%) knew the reason for their referral to nephrologist. 31% of the patients with CKD reported their shock when informed about their kidney status by the nephrologist at the first time. Two third (64%) of patients reported having no knowledge of their kidney function and 50% of them were not aware about renal replacement therapy options. 52.1% of participants refused for early access creation. 22% of them expressed their refusal for the early access creation as they have no uremic signs. Finally, 60% of the study participants had no family member attending with them during their clinic visit.

Conclusion
Patients and their family should receive enough information and education regarding the nature of renal disease and the options for the treatment to allow them to make an informed decision about the management of their CKD. Awareness of the factors associated with a well-informed-decision making in the treatment of CKD can provide health professionals with evidence on how best to deliver education programs for patients and their families. It may also enhance communication and improve the capacity for patient and family involvement in shared decision making.
MO1042SCREENING FOR CHRONIC KIDNEY DISEASE IN PATIENTS WITH HIGH BLOOD PRESSURE: A SURVEY OF TRAINEES’ ATTITUDES AND PRACTICES IN MOROCCO
Authors: Naouaoui Salma , Chettati Meriem , Fadili Wafaa , Laouad Inass 
Published: May 2021

Abstract

Background and Aims
High blood pressure is a leading cause of end stage renal disease (ESRD). However; early detection of chronic kidney disease (CKD) delays progression of kidney failure and reduces the risk of cardiovascular complications. Therefore, the aim of our study was to assess the attitudes and practices of interns and residents regarding screening for chronic kidney disease in patients with high blood pressure at a Moroccan University hospital.

Methods
A cross-sectional survey was conducted among 100 medical interns and residents at Mohammed VI university hospital of Marrakesh.

Results
Overall, 82% of the trainees who responded (response rate 89%) stated that they were sensitized to screening for chronic kidney disease in patients with high blood pressure, mainly during their medical studies. However, trainees who systematically monitor renal function in their hypertensive patients did not exceed 13%. While 34% of respondents preferred to refer them to a cardiologist or a nephrologist, and 35% looked for renal impairment only in special situations, dominated by the presence of diabetes or severe hypertension. The main tests used by the participants for monitoring kidney function were represented by blood renal function (100%) and 24h urine protein (61%). Microalbuminuria was mentioned by only 23% of the trainees. The major limits reported by the surveyed physicians were the lack of experience and the non- compliance of patients.

Conclusion
Our findings revealed inappropriate practices among our training doctors concerning the screening of CKD in hypertensive patients. Therefore, more educational workshops and courses are recommended, especially in low-income countries where access to dialysis is not always affordable.
MO933EFFECT OF PHYSICAL ACTIVITY AND LIFESTYLE CHANGES ON INSULIN RESISTANCE IN PATIENTS AFTER KIDNEY TRANSPLANTATION
Authors: Graňák Karol , Matej Vnucak , Skálová Petra , Pytliaková Margaréta , Laca Ľudovít , Mokáň Marián , Dedinska Ivana 
Published: May 2021

Abstract

Background and Aims
The incidence of post-transplant diabetes mellitus (PTDM) after kidney transplantation (KT) is high and ranges from 15-30%. Insulin resistance (IR) at the time of KT is the most significant risk factor for the development of PTDM in patients after KT, as demonstrated by several analyzes. It is possible to reduce the high incidence of PTDM by influencing just modifiable risk factors, including obesity and the associated IR. The aim of this work is to determine the effect of precisely determined physical activity and lifestyle changes on IR and other risk factors for PTDM in patients after KT.

Method
This is a prospective controlled analysis, which included 44 patients after primary KT in the Martin Transplant Center. Half consisted of a study group (n = 22) whose patients were assigned to perform regular physical activity. The primary goal was to complete at least 150 minutes of moderate intensity physical exertion per week. They performed an aerobic or combined (aerobic + anaerobic) type of sports activity. Monitoring was provided by a sports tracker (Xiaomi Mi Band 3 compatible with Mi Fit mobile application). The other half was made up of a control group. The exclusion criterion at that time was already diagnosed with diabetes mellitus or a pre-diabetic condition. IR was assessed using the HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) index from fasting blood glucose and insulinemia values. Each patient underwent an oral glucose tolerance test (oGTT) at the end of follow-up. Patients in both groups have the same immunosuppressive protocol. The duration of follow-up was 6 months.

Results
In the observed group we univariately found in the 3rd and 6th month of monitoring significantly lower waist circumference (P = 0.0437, P = 0.0372), better graft function (P = 0.0036, P = 0.0137), lower value glycemia (P = 0.0016, P = 0.0003), C-peptide (P = 0.0447, P = 0014) and lower low-density lipoprotein (LDL) at 6 months (P = 0.0444) compared to the control group. We confirmed a statistically significantly lower IR at 6 months (P = 0.0202) and fasting blood glucose at 3 and 6 months (P = 0.0227) by multivariate analysis in the observed group. After the end of the follow-up, we identified statistically significantly fewer patients with a negative oGTT result in the control group (P &lt; 0.0001), significantly more patients with impaired glucose tolerance, fasting hyperglycemia (P = 0.0078) and diagnosed with PTDM (P = 0.0212). In the control group, we found a statistically significant increase in glycemia at 30 (P = 0.0034) as well as at 120 minutes (P = 0.0011) during oGTT compared to the observed group.

Conclusion
In our study, we confirmed a significant effect of regular physical activity in preventing the development of IR and associated pre-diabetic conditions and PTDM.
MO937ASSOCIATION OF RENAL ELASTOGRAPHY WITH BANFF MICROVASCULAR INFLAMMATION IN PROTOCOL BIOPSIES FOR SUBCLINICAL RENAL GRAFT REJECTION DIAGNOSIS
Authors: Bahena Carrera Lucino , Bastida Alquicira Javier 
Published: May 2021

Abstract

Background and Aims
The most common cause of renal graft failure is chronic dysfunction in 24.7% and the most common etiology of this is clinical or subclinical rejection. The incidence of subclinical rejection varies from 15 to 50% (25% in protocol biopsies in the first year after transplantation and 35% after two years).
Melek E et al have shown that doppler ultrasound is a non-invasive study that, through the resistance index (RI), has traditionally been used for the early diagnosis of acute graft rejection (AR); however, it is influenced by extrarenal systemic factors. Naesens et al published that in 321 kidney transplant recipients, RI wasn´t associated with histological findings of AR in protocol biopsies.
Elastography is another ultrasonographic modality for the evaluation of the kidney graft, which measures the stiffness/elasticity of the tissue expressed in Kpa (kilopascals).
Stock in 2011 and Kim BJ in 2018 published studies where they showed that increased stiffness was correlated with the diagnosis of kidney graft rejection.
The aim of this study was to describe the association between elastography with microvascular inflammation determined by Banff for diagnosis of renal allograft subclinical rejection.

Method
Observational, analytical and cross-sectional study that included kidney transplant patients who underwent protocol biopsy and renal elastography at the Central Military Hospital in Mexico City between January 2018 and December 2020. The demographic and biochemical characteristics, degree elastography stiffness and Banff 2017 lesions were determined. The sample calculation, determination of correlation degree and ROC curve elaboration were performed.

Results
We included 146 patients. 56.8% were men; the most common causes of CKD were undetermined and chronic glomerulonephritis with 52.7% and 17.1% respectively. 47.3% were hypertensive at biopsy time and 1.4% had chronic heart failure. The most common immunosuppression schemes were FK/MPA/steroid and FK/mTOR-i/steroid with 60.3% and 13%, respectively. The mean GFR was 65.31 ml/min which shows graft good function. The mean stiffness in the elastography was 15.73 Kpa. The rest of baseline data are shown in Table 1.
Had rejection 36.3% of the biopsies, the most frequent chronic AMR C4d- with 15.1% and active AMR C4d- 8.9%. When analyzing the ROC curves, the Banff 2017 lesions AUC values that correlated better with graft stiffness were: v=0.607, i=0.594, g=0.578, C4d deposit=0.519, ptc=0.498. Figure 1.

Conclusion
Intimal arteritis, inflammation, and glomerulitis are the Banff lesions best associated with elastography graft stiffness in protocol biopsies. Prospective studies are recommended in patients with acute graft dysfunction to find an adequate elastography cut-off value that allows another tool for fast and non-invasive diagnosis of renal graft rejection.
MO940ACUTE REJECTION IN KIDNEY RETRANSPLANTATION: RISK FACTORS AND IMPACT IN GRAFT SURVIVAL
Authors: Leal Rita , Pardinhas Clara , Rodrigues Luís , Guedes Marques Maria , Santos Lidia , Romãozinho Catarina , Caramelo Francisco , Sá Helena , Figueiredo Arnaldo , Alves Rui 
Published: May 2021

Abstract

Background and Aims
Kidney retransplantation confers a robust survival benefit over dialysis in selected patients and recent data has shown second graft outcomes similar to those of a first graft. However, the management of these patients is challenging, particularly due to allosensitization and an increased risk of acute rejection, which are related with poorer graft survival. The recognition of risk factors to acute rejection, dependent on the first and second graft, might help us to personalize standard care and achieve similar graft survival rates to patients with a first transplant. Our aim was to identify risk factors to second graft acute rejection, and the impact of acute rejection in graft failure.

Method
We performed a retrospective, longitudinal study including all patients submitted to a second kidney transplant between January 2008 and December 2019, excluding patients with more than 2 grafts or multi-organ transplant. Demographic, clinical and histocompatibility data from the donor and receptor were collected from our unit database. Delayed graft function was defined as the need of dialysis in the first week post-transplant. All acute rejection episodes were biopsy proven, according to Banff 2017 criteria. Follow-up was defined at 1st June 2020 for functioning grafts or at graft failure, with a mean time of 94±42 months.

Results
We included 109 patients of which 70 males (64%), mostly Caucasian (97%), with a mean age of 43±12 years at second kidney transplant. The main causes of end stage renal disease were glomerular disease (37%), undetermined cause (34%), and urological pathology (15%). First kidney transplant was performed before the year 2010 in 95 patients (87%). The median time of first graft survival was 75 months (IQR 58.5-91.4) and the main causes of first graft loss were chronic allograft nephropathy (N=62, 70.5%) and 11 patients (12.5%) presented primary disfunction due to surgical/vascular complications. During follow-up, 20 patients (18%) presented biopsy proven acute rejection: 3 patients borderline changes, 10 patients T cell mediated and 7 patients antibody mediated, the majority during the first-year post-transplant (N=17, 85%). The risk factors for second graft rejection are summarized in table 1. First year graft survival of the second transplant was 90% and survival at follow up was 72.5% (N=79). Acute rejection was an important risk factor for graft loss (OR 6.548 (95%CI[2.292 - 18.703]), p&lt;0.01).

Conclusion
Worst outcomes in first kidney transplant, such as acute rejection, primary dysfunction and lower graft survival were related with an increased risk of acute rejection in second graft outcomes, and consequently a higher risk of graft failure.
MO942PREDICTORS OF DELAYED GRAFT FUNCTION IN KIDNEY TRANSPLANT RECIPIENTS THROUGHOUT 3 DECADES: A SINGLE-CENTER EXPERIENCE
Authors: Figueiredo Carolina , Fernandes Mariana , Mira Filipe , Pardinhas Clara , Leal Rita , Rodrigues Luís , Guedes Marques Maria , Santos Lidia , Romãozinho Catarina , Bastos Carlos Alberto , Sá Helena , Figueiredo Arnaldo , Alves Rui 
Published: May 2021

Abstract

Background and Aims
Delayed graft function (DGF), defined as the need for dialysis within one week post-transplantation, is associated with poorer kidney graft survival. We aimed to identify risk factors for DGF throughout 3 decades and evaluate their effect on graft survival.

Method
Retrospective study including 3081 kidney transplants performed at our transplantation unit between January 1st, 1989 and December 31st, 2018, split in 3 decades (1: 1989-1998; 2: 1999-2008; 3: 2009-2018). Data regarding donor and recipient demographics, time on dialysis, immunization, cold ischemia time, hemodynamic parameters and immunosuppression were collected from our prospectively maintained data base.

Results
Main donor, recipient and perioperative characteristics are summarized in table 1. There were clear differences in these characteristics between the decades, standing out more adverse features from both recipients and donors.
Overall incidence rate of DGF was 16% (n=493): 14% in decade 1; 19.3% in decade 2 and 15% in decade 3.
On univariate analysis, most studied variables included in table 1 were statistically significant as predictors of DGF. However, on multivariate analysis, we found that in the first decade the predominant risk factors for DGF were pre-transplant dialysis time and cold-ischemia time, whilst in the following decades donor characteristics, as well as recipient’s weight became more relevant (table 2).

Conclusion
The observed shift from donor-unrelated variables in the first decade into donor-related variables in the second and third decades as the main determinants of DGF highlights the impact of expanding donor’s acceptance criteria. Nevertheless, the increase in expanded criteria donors did not translate into poorer overall results, probable contributors being shorter cold-ischemia times and stronger immunosuppression.
MO954DONOR TYPE INFLUENCE IN EARLY POST KIDNEY TRASPLANTATION HYPERTRANSAMINASEMIA
Authors: Solà-Porta Eulàlia , Redondo Pachon Dolores , Núñez-Delgado Sara , Arias-Cabrales Carlos , Mir Marisa , Buxeda Anna , Burballa Carla , Crespo Marta , Pascual Julio , Pérez-Sáez María José 
Published: May 2021

Abstract

Background and Aims
The early increase in transaminases after kidney transplant (KT) is a frequent finding. It has been associated with the cross-talk produced between liver and kidney in ischemia-reperfusion situations. However, the influence of the donor type has not been evaluated. We analyze the incidence, relevance and possible correlations of postKT hypertransaminasemia.

Method
Retrospective study (2004-2018) to analyze the increase in serum AST/ALT during the first 3 months after KT in 119 KT recipients of deceased donors, either brain death (DBD n=59), controlled after cardiac death (cDCD n=21) or uncontrolled after cardiac death (uDCD n=39). All recipients received induction with thymoglobulin and maintenance immunosuppression with tacrolimus and mycophenolate.

Results
Recipients of uDCD group were younger, with a higher proportion of men and lower percentage of diabetics and retransplants. Delayed graft function duration was longer, although serum creatinine was similar at 3 months between groups. There were no differences between recipients in terms of past medical liver disease, postKT transfusion requirement or vasoactive drug use. There were also no differences in cumulative thymoglobulin dose, and uDCD recipients presented, as expected, lower levels of tacrolimus at one week postKT (Table).
From all KT recipients, 37.3/45.3% presented with an increase in AST/ALT at 72 hours postKT. Regarding donor type, the percentage of recipients who experienced 72 hours postKT hypertransaminasemia was higher (69.2/82.1% in uDCD group vs 22/29.3% in DBD and 21.1/21.1% in cDCD, p&lt;0.001). This liver function alteration resolved early, and one month after transplant, AST/ALT values in all groups returned to baseline (Figure).
The multivariate analysis showed that uDCD recipients had x10 higher risk of developing early post-KT hypertransaminasemia than the other groups (for AST, OR 10.85 [2.463-47.826] and for ALT OR 11.15 [2.627-47.294]). However, when we tried to correlate this hypertransaminasemia with a prolonged delayed graft function (creatinine decrease&gt; 14 days postKT) we did not find any association.

Conclusion
Early postKT hypertransaminasemia is a frequent and transient event that is related to the kidney donor type, being more frequent in recipients of donors in uncontrolled cardiac death.
MO957LONG TERM OUTCOME OF POST-TRANSPLANT INFECTIONS IN ADULT RENAL TRANSPLANT RECIPIENTS
Authors: Prasad Narayan , Gala Ruju , Kaul Anupama , Bhadauria Dharmendra , Patel Manas Ranjan 
Published: May 2021

Abstract

Background and Aims
Infections are a significant cause of morbidity in the form of graft loss and mortality in RTR. Several factors in the pre and peri transplant period increase the susceptibility to PTI, affecting the overall graft and patient survival.

Method
An observational study of 644 adult RTR (=&gt;18yrs) between Jan 2010 and Dec 2015, followed till Jun 2019. The primary objective was to study the epidemiology of risk factors of PTI. The secondary objective was to evaluate transplant outcomes.

Results
PTI were seen in 83.1%, of which majority (64%) occurred in the first year. Of all infections, 55.5% were bacterial, 18.5% viral, 10.8% parasitic, 8% fungal, and remaining 7.1% mycobacterial. UTI (37.4%) was most common infection with E. Coli (18.9%) being the commonest cause.
Relative risk with PTI for graft dysfunction was 3 times higher (95% CI 1.70-3.57, p=0.00), 3 times higher for graft failure (95% CI 1.35-4.93, p=0.002) compared to non-PTI group and death was 3 times higher (95%CI 1.3-7.2, p=0.01) as compared to non-PTI. Overall, graft loss was 19.4% and the mortality rate was 12.1% of the study population.
The relative risk of fungal infections to cause graft loss was 2 times higher as compared to other infections (95% CI 1.23-2.18, p&lt;0.003). The relative risk of fungal infections to cause death was 2 times higher than other infections (95% CI 1.20-2.56, p &lt;0.008)
On multivariate analysis, the predictors of PTI were ATG induction (P&lt;0.01), pre transplant Tuberculosis (P=0.02) and dialysis vintage (P=0.02).
On KM survival analysis, graft and patient survival was inferior in PTI at 1,5and 9years; (graft: 94.6%; 81.8%;70.1% vs non PTI 97.2%; 92.2%; 88.1%, p = 0.006, patient: PTI 97.1 %; 88.2%; and 81.9%vs non PTI 99.1% , 95.8%; 92.9% , p=0.012)

Conclusion
PTI have a significant impact on graft survival (70% vs 88%) and patient survival (82% vs 93%) in RTR, with fungal infections having worse outcomes.
MO925VALVULAR HEART DISEASE EVOLUTION IN KIDNEY TRANSPLANT RECIPIENTS AND RELATED RISK FACTORS
Authors: Galceran Isabel , Redondo Pachón M Dolores , Pérez Sáez María José , Arias Cabrales Carlos , Burballa Tarrega Carla , Buxeda Anna , Crespo Barrio Marta , Pascual Santos Julio 
Published: May 2021

Abstract

Background and Aims
Cardiovascular diseases remains the leading cause of death in recipients of kidney transplantation (KT). Valvular heart disease (VHD) is not an exclusion criteria for KT, however it’s repercussion on KT follow-up has been less studied. Our objective was to analyse the impact of VHD in KT recipients and related risk factors of VHD progression (VHDp).

Method
Observational retrospective cohort study of all patients who underwent KT at Hospital del Mar (Barcelona, Spain) between January 1980 and December 2018. VHD was defined as presence of aortic stenosis (AS), aortic regurgitation, mitral stenosis, mitral regurgitation, tricuspid stenosis, tricuspid regurgitation or double valve injury of any degree diagnosed by echocardiography. We analysed the VHDp, defined as worsening of the initial valvular degree on heart ultrasound after KT, risk factors related with VHDp, recipients and graft survival.

Results
During the study period, 1422 patient underwent KT and 48 of them (3.4%) had VHD diagnosed prior to KT. In the median time of follow-up of 56.3 months (IQR25-75 17.7-119 month), 17 patients (35.4%) presented VHDp and 31 patients did not (64.6%). Figure 1 shows the primary outcome in the different types of VHD, AS was the valve with more VHDp after KT.
Statistical evaluation revealed that recipients with VHDp had a higher body mass index (BMI) (27.4 ± 6.3 vs 24.3 ± 3.8 kg/m2, p=0.04) and worse PTH control (427.0 ± 309.3 vs 186.2 ± 140.6 pg/ml, p=0.02) at the moment of the KT. Also, patients with VHDp reached a worse nadir glomerular filtration rate (GFR) (44.1 ± 17.5 vs 56.0 ± 13.9 ml/min/1.73m2, p=0.01) during the follow-up, needed more time to reach their nadir GFR (4 [2-13] vs 1.2 [1.0-4.7] months, p&lt;0.001) and required more furosemide dose at that time (72.7 ± 21.7 vs 15.8 ± 5.6 mg/day, p=0.02).
At the end of follow-up, 213 KT recipients had died, 16 with preKT-VHD (33.3% of all patients with VHD) and 197 without preKT-VHD (14.3% of all cases without VHD). There was a statistical significant association between preKT-VHD status and all-cause mortality after KT (log rank &lt; 0.001). However, there wasn’t statistical association between preKT-VHD status and death-censored graft survival (log rank = 0.2).

Conclusion
VHD has a significant impact on increased pos-KT mortality but it is not associated with graft survival. More than one third of recipients with preKT-VHD presented deterioration after KT. We found that increased preKT BMI and PTH, nadir GFR after KT, time to reach this nadir GFR and diuretic dose at that time are related with VHD progression.