bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO554THE EFFECT OF HEMOGLOBIN CHANGES AND THE SEVERITY OF CHRONIC KIDNEY DISEASE IN PHYSICAL FUNCTION IN ELDERLY PATIENTS WITH HEART FAILURE
Authors: Noda Takumi , Kamiya Kentaro , Hamazaki Nobuaki , Nozaki Kohei , Ichikawa Takafumi , Yamashita Masashi , Uchida Shota , Yoshikoshi Shun , Maekawa Emi , Yamaoka-Tojo Minako , Matsunaga Atsuhiko , Ako Junya 
Published: May 2021

Abstract

Background and Aims
Anemia is frequently observed in patients with heart failure (HF) and causes increased hospitalization and mortality rates. Anemia is also associated with and is a major risk factor of impaired physical function and frailty. On the other hand, a high percentage of elderly patients with HF have chronic kidney disease (CKD), which is an aggravating factor for anemia, and the combination of anemia and CKD has been reported to increase physical dysfunction and mortality. However, the relationship between hemoglobin (Hb) changes and physical function during hospitalization in elderly patients with HF is unclear, and the impact of CKD severity on these relationships is also unclear. This study aimed to examine the relationship between Hb changes and physical function during hospitalization in elderly patients with HF. We further examined the relationship when stratified by CKD severity.

Method
Seven hundred and thirty-seven elderly patients with HF, who underwent changes in Hb and physical function test (leg strength, gait speed, and 6-min walking distance [6MWD]), were included in this study. Using a multiple linear regression model, associations between Hb changes and physical function were assessed. In addition, using a generalized linear mixed model, we divided the HF patients into three groups with eGFR ≥60, 30–60, and &lt;30, and examined whether the severity of CKD was related to the Hb change and physical function.

Results
The median age of the subjects in this study was 77 years (interquartile range 72–82). Changes in Hb during hospitalization were independent determinants of physical function (leg strength, β: 0.158, P &lt; 0.001; gait speed, β: 0.023, P &lt; 0.001; 6MWD, β: 13.039, P &lt; 0.001), even after accounting for factors related to severity of HF. Moreover, the group with more severe CKD showed significantly lower physical function, although Hb improved (P &lt; 0.001) with respect to leg strength and 6MWD compared with the group with lower CKD stage.

Conclusion
Hb change during hospitalization was an independent determinant of physical function in patients with HF. Patients with a more severe CKD showed lower leg strength values and 6MWD even if Hb improved.
MO572BONE BIOPSY AND MINERAL METABOLISM, CARDIOVASCULAR DISEASE AND PATIENT SURVIVAL IN END-STAGE RENAL PATIENTS
Authors: Ferreira Ana Carina , Cotovio Patrícia , Aires Inês , Mendes Marco , Navarro David , Silva Cecília , Caeiro Fernando , Salvador Rute , Correia Bruna , Cabral Guadalupe , Nolasco Fernando , Ferreira Manuel Anibal A 
Published: May 2021

Abstract

Background and Aims
Chronic kidney disease-mineral and bone disorder (CKD-MBD) is frequent in end-stage renal disease (ESRD) patients, increasing morbid-mortality. The aim of this study was to determine the prevalence and phenotype of bone disease before transplantation; and to correlate FGF23, klotho and sclerostin serum levels with bone histomorphometric parameters and CV disease. The secondary aim was to correlate bone biopsies data with other bone related parameters, as PTH, bone alkaline phosphatase, 25-hidroxivitamin D3, calcitonin, calcium, phosphorus, and magnesium.

Method
We performed a prospective cohort study of a sample of ESRD patients listed for renal transplant. All patients were submitted to renal transplant and were followed for 12 months. Patient and graft survival were recorded. At inclusion, demographic and clinical data were collected, laboratorial evaluation; bone biopsy and X-ray of the pelvis and hands (Adragão score) were performed. Continuous variables are presented as medians and categorical variables as frequencies. Associations between variables were performed using Wilcoxon rank sum test, Fisher and Kruskal Wallis test. Multivariate analysis was performed using logistic regression. STATA software was used and p &lt; 0.05 was considered statistically significant.

Results
We included 84 patients. Median age 53.5 (IQ range: 40.5 – 61.5) years, 59 men (70.2%), 65 caucasian (77.4%). The median left ventricular mass index was 108.5 (92 – 129) g/m2, with 32 patients presenting left ventricular hypertrophy and 19 valve calcifications. Median Adragão score was 1 (0 – 2). We diagnosed adynamic bone disease in 15 patients; hyperparathyroid bone disease in 19 patients; osteomalacia in 1 patient and mixed renal osteodystrophy in 3 patients. At the end of 12 months, 4 patients died, 5 had graft failure (non-primary function) and 4 had a cardiovascular event. Sclerostin was found to be a risk factor for low bone volume; whereas low phosphorus, low FGF23 and high bAP risk factors for abnormal mineralization. High turnover was mainly present in patients with high bAP and phosphorus and low sclerostin levels. The presence of valve calcifications was associated with low volume and with low or high turnover disorder. FGF23 appears as an important independent factor for vascular calcifications [as well age (p=0.009), BMI (p=0.02), presence of diabetes (p=0.01)], and for cardiovascular events. Sclerostin emerged as a risk factor for vascular calcifications and lower levels of sclerostin were associated with patient survival at the end of 12 months.

Conclusion
From the bone-derived hormones, sclerostin and FGF23 seem to act as risk factors for vascular calcifications and worse outcomes.
MO573CNI AND MTORI-BASED REGIMENS ON FIVE-YEAR COURSE OF BONE MINERAL DENSITY SCORES AFTER RENAL TRANSPLANTATION
Authors: Korucu Berfu , Yeter Hasan Haci , GÜZ Galip 
Published: May 2021

Abstract

Background and Aims
Since glucocorticoids are used in low maintenance doses today, the relationship between calcineurin inhibitors (CNI) and osteoporosis after solid organ transplantation has gained clinical significance. In contrast, (mammalian target of rapamycin inhibitors) mTORi agents are shown to have an antiresorptive effect on bone by reducing osteoclastic activity in vitro and in vivo. We investigated the bone mineral density (BMD) changes on an extremely selective group of incident renal transplant recipients under CNI or mTORi-based maintenance treatment regimens during the first five-year posttransplant course.

Method
This study consists of renal allograft recipients with a dialysis history of less than one year. Patients older than 50 years old, using CNI - mTORi combinations, patients with a history of a prior renal transplant, acute rejection, CNI – mTORi switch after posttransplantation first three months, bisphosphonate treatment, parathyroidectomy, diuretic use, and malignancy excluded to eliminate all confounding factors for bone mineral loss. First and fifth-year BMD scores and simultaneous laboratory parameters were evaluated.

Results
CNI (n=21) and mTORi (n=17) groups had similar demographics, dialysis vintages, cumulative steroid doses, first and fifth-year parathormone, calcium, phosphate, magnesium, alkaline phosphatase, and 25-OH-vitamin D levels. The femur neck scores of the CNI group decreased from -0.82(±0.96) to -1.52(±0.92) (p=0.020). We observed a significant decrease in the CNI group compared to the mTORi group [-0.70(±0.68) and 0.30(±0.36), respectively; p&lt;0.01] when BMD score changes evaluated among years. The mean femur neck score of the mTORi group insignificantly increased from -1.13(±0.65) to -0.82(±0.56) at the fifth-year DXA scan (p=0.230). Although statistically insignificant, similar trends were also observed in L1-4 scores.

Conclusion
Our study suggests that CNI-based treatment is associated with decreased femur neck and L1-4 BMD scores, and mTORi-based treatment tends to be beneficial presumably due to their antiresorptive effects in the posttransplant five-year follow-up. Our findings may shed light on long-term maintenance therapy management in renal transplant patients with bone disease if supported by future studies.
MO575SEX DISPARITY IN THE ASSOCIATION BETWEEN DIETARY SODIUM INTAKE AND THE RISK OF INCIPIENT OSTEOPOROSIS
Authors: Yu Mi-yeon , Choi Jong Wook , Han Sang-Woong , Lee Chang Hwa , Park Joon-Sung 
Published: May 2021

Abstract

Background and Aims
Rationale & Objective: Dietary nutrition is closely related with bone health, but there is wide controversy on the association of dietary sodium intake with bone densitometry (BMD) and risk of incipient osteoporosis.

Method
Study Design: Community-based retrospective cohort study
Measurement: We used Tanaka method for estimating 24-h urinary sodium excretion (e24hUNaETanaka) as candidate indicator of dietary sodium intake.
Setting & Participants: Using long-term follow-up cohort data from the Korean Genome Epidemiology Study, we identified 4310 participants without osteoporosis and classified them into quartile according to their e24hUNaETanaka.
Outcome: Participants were followed up for 12 years of less for a new diagnosis of osteoporosis.
Analytical Approach: Multiple Cox-proportional hazard model was performed to estimate hazard ratio (HR) of osteoporosis and survival curve analysis was utilized to compare cumulative survivals.

Results
Decreased dietary sodium intake was deeply related with low BMD parameters. Multiple Cox-proportional hazard model, adjusted for various conventional risk factors of decreased BMD, demonstrated that e24hUNaETanaka had inverse association with the risk of osteoporosis (adjusted HR = 0.868, 95% CI = 0.768-0.981). Interestingly, our RCS analysis revealed that there was wide variation in the relation between dietary sodium intake and the risk of incipient osteoporosis according to sex and female hormone status: negative curvilinear relationship in male participants; positive linear relationship in premenopausal female participants; and negative linear relationship in postmenopausal female participants.

Conclusion
Our findings suggest that decreased sodium intake was a significant predictor of osteoporosis progression and there was some sex disparity in the relation dietary sodium intake and the risk of incipient osteoporosis.
MO579POST-TRANSPLANT HYPERCALCEMIA AND VITAMIN D SUPPLEMENTATION
Authors: Vatazin Andrey , Parshina Ekaterina , Kantaria Rusudana , Stepanov Vadim , Zulkarnaev Aleksei 
Published: May 2021

Abstract

Background and Aims
Post-transplant hypercalcemia is common after successful kidney transplantation in patients with chronic kidney disease (CKD) and can be partially explained by the side effects of concomitant therapy. We aimed to evaluate the prevalence of hypercalcemia among recipients of kidney transplant and its relationship with vitamin D supplementation.

Method
We performed a cross-sectional study of 236 patients underwent successful kidney transplantation in our clinic. Median age was 49 [Q1-Q3: 39; 58] years, mean estimated glomerular filtration rate (eGFR) was 51,1±21,8 ml/min/1,73 m2. Most of the patients received hemo- or peritoneal dialysis treatment, pre-emptive transplantation was performed in 6% cases. For those previously received dialysis, median duration of any type of dialysis was 21 [Q1-Q3: 11; 36] months. Median time after transplantation reached 42 [Q1-Q3: 19; 75] months. Target range for total serum Ca was defined according to National guidelines on CKD-MBD as 2,1 - 2,5 mmol/l.

Results
In our cohort median serum total Ca level was 2,41 [Q1-Q3: 2,36; 2,56] mmol/l. Hypercalcemia was encountered in 21% (7 of 33) cases during the first year after transplantation and in 30% (61 of 203) – after first year. Serum total Ca weakly correlated with iPTH (ρ= 0,282 [95%CI: 0,15; 0,4], р&lt;0,0001), alkaline phosphatase (ρ=0,181 [95%CI: 0,05; 0,31], р=0,006) and total duration of renal replacement therapy (dialysis + transplantation) - ρ=0,2 [95%CI: 0,07; 0,32], р=0,002. We did not observe statistically significant correlations between serum total Ca and eGFR (p=0,132), total Ca level and time after transplantation (p=0,06). Total Ca levels did not differ in groups with different eGFR (p=0,04 in Kruskall-Wallis test, but no statistically significant differences after correction for multiply comparisons). Data on concomitant therapy were available for 230 patients. 173 of 230 recipients received any therapy of CKD-MBD. Of them, 123 patients took only active vitamin D (alfacalcidol), 33 patients received monotherapy with inactive vitamin D (cholecalciferol). 57 patients not taking any medications were the control group. Serum total Ca level varied significantly between groups (p=0,0006, Kruskall-Wallis test), being higher in patients supplemented with cholecalciferol - fig.1. Meanwhile, iPHT (p=0,171), serum phosphorus (p=0,563) and alkaline phosphatase levels did not differ in these three groups. Fraction of patients with normocalcemia was the lowest in cholecalciferol group (χ2, р=0,0018) - fig. 2.

Conclusion
We observed a high prevalence of hypercalcemia in kidney transplant patients, that was not associated with transplant function or time after transplantation. Our data suggest usage of active vitamin D to be safer than cholecalciferol to prevent hypercalcemia development in renal allograft recipients.
MO580HYPOPROTEIC DIET SUPPLEMENTED WITH KETOANALOGUES IN PATIENTS WITH ADVANCED DIABETIC KIDNEY DISEASE – EFFECTS ON MINERAL BONE DISORDERS
Authors: Garneata Liliana , Mocanu Carmen-Antonia , Simionescu Tudor Petrisor , Mocanu Andreea Elena , Mircescu Gabriel 
Published: May 2021

Abstract

Background and Aims
Dietary protein restriction is rediscussed as mainstay approach in advanced Chronic Kidney Disease (CKD), both in diabetics and non-diabetics to defer renal replacement therapy (RRT), mainly by better metabolic control; improvements in mineral bone disorders (MBD) were also suggested, but less studied in Diabetic Kidney Disease (DKD).
An unicentric prospective interventional trial aimed to assess the effects of ketoanalogue-supplemented low protein diet (sLPD) on proteinuria and CKD progression (data already presented). The parameters of MBD were also evaluated.

Method
Adult diabetic patients (452) with stable CKD stage 4+, proteinuria&gt;3g/g creatininuria and SGA A were enrolled in a run-in phase (3 mo), with LPD (0.6g/kg dry ideal bw). Those who proved adherent (92, 64% males, median age 55.7 yrs, 65% on insulin) received sLPD (Ketosteril®, 1 tablet/10kg) for 12mo. Monitoring and treatment followed the Best Practice Guidelines.
The primary endpoint was proteinuria during intervention as compared to pre-enrolment. Serum levels of calcium, phosphates and iPTH were considered to assess MBD. Nutrition, inflammation (SGA, BMI, serum albumin, CRP) and compliance were safety parameters.

Results
In patients with advanced DKD and severe proteinuria, sLPD was associated with a 69 (63; 82) % reduction in proteinuria (data presented).
Significant amelioration in MBD was noted: serum levels of calcium and phosphates were significantly ameliorated at the end of the study as compared to enrolment - 4.3 (4.2-4.9) vs 3.2 (3.1-3.5) mg/dL and 5.4 (4.9-6.1) vs 8.2 (7.8-8.9) mg/dL, respectively. Serum iPTH significantly decreased: 185 (168-212) vs 375 (354-585) pg/mL. The need for calcium supplementation decreased: 6.5 (6.0-6.7) vs 7.0 (6.8-7.3) g/day. Vitamin D was required by only 35% vs 65% of patients.
Nutritional status was preserved and dietary compliance was very good throughout the study.

Conclusion
In patients with advanced DKD ketoanalogue supplemented low protein diet seems to be effective and safe as part of MBD management.
MO564CHRONIC EXPOSURE TO INDOXYL SULFATE CHANGES BONE PROPERTIES AND EXPRESSION OF SIRT2, SIRT3, AND SIRT7 GENES*
Authors: Karbowska Malgorzata , Sieklucka Beata , Domaniewski Tomasz , Galazyn-Sidorczuk Malgorzata , Pawlak Krystyna , Pawlak Dariusz 
Published: May 2021

Abstract

Background and Aims
Chronic kidney disease (CKD) is connected with accumulation of uremic toxins that leads to dysfunction of many systems including skeletal system. Indoxyl sulfate (IS) is one of the most potent protein-bound uremic toxin. However, its impact on bone and mineral disorders remains unclear. Sirtuins (SIRT) are members of the class III type nicotinamide adenine dinucleotide-dependent histone deacetylases. Their roles are commonly linked to aging, metabolism, and antioxidant defense. However, SIRT1, SIRT3 and SIRT7 maintain also bone formation. In turn, reduction of SIRT2 has a protective role due to reduced activation of osteoclasts-mediated bone resorption. Thus, the aim of this work was to evaluate IS impact on bone metabolism and bone properties, and SIRT genes expression.

Method
Male Wistar rats weighting 180 – 210 g were divided into 2 groups: experimental receiving IS in the dose of 200 mg/kg of b.w. for four weeks (200IS), and control receiving pure water (CON). After four weeks the femurs and tibiae were collected, and geometrical parameters (CI – cortical index, CSA – cortical sectional area, CSMI – cross sectional moment of inertia, MRWT – mean relative wall thickness) were measured. The IS bone (cortical and trabecular), plasma and urine levels were determined by high-performance liquid chromatography (HPLC). The concentrations of Ca, Mg, Zn, Fe, Mn, and Cu in bone tissue were determined by the flame atomic absorption spectrometry. Bone turnover markers (alkaline phosphatase – ALP, and tartrate-resistant acid phosphatase - TRAP) were determined in homogenates from trabecular and cortical left femurs. The expression of ALP, TRAP, SIRT1, SIRT2, SIRT3 and SIRT7 gene was assessed by QRT-PCR in right femurs.

Results
Plasma, urine, cortical and trabecular bone IS concentrations were increased in 200IS compared to CON. Geometrical properties of femur (CI, CSA, CSMI and MRWT) were significantly reduced in 200IS. There were no differences in relative femur weight and length between studied groups. The activity of ALP and TRAP in bone tissue were significantly lower in 200IS compared to CON. In turn, the expression of TRAP gene was increased in 200IS. There were no difference in concentrations of Ca, Mg, Fe, Mn, and Cu in bone tissue. Only Zn concentration in cortical bone was reduced in 200IS. The expressions of SIRT3 and SIRT7 were decreased in 200IS, whereas SIRT2 was increased in 200IS. Chronic exposure to IS did not affect expression of SIRT1.

Conclusion
Obtained results suggest that IS affects bone properties and bone metabolism, and has impact on expression of SIRT2, SIRT3, and SIRT7 genes. Our findings may help to better understand mechanisms leading to dysfunction of skeletal system during CKD.
This work was supported by Polish National Science Centre (Grant No. 2017/27/N/NZ4/00033).
MO582LONGITUDINAL STUDY TO FIND THE ASSOCIATION OF SERUM PHOSPHORUS LEVEL WITH FGF 23 IN THREE DIFFERENT HYPERPHOSPHATEMIA MANAGEMENTS GROUPS OF STAGE 3 AND 4 CHRONIC KIDNEY DISEASE (CKD) PATIENTS
Authors: Kaur Navjot , Mahapatra Himansu , Sharma Neera , Pursnani Lalit , B Muthukumar , Inamdar Neeraj , Singh Mansi , Arora Tannu 
Published: May 2021

Abstract

Background and Aims
There were paucity of clinical evidence on target serum phosphorus levelsin early CKD. Present longitudinal study finds target phosphorus level and its association with FGF 23 in three different hyperphosphatemia managements groups.

Method
This one year, prospective, randomised controlled, open labelled study was conducted among three equally allocated treatment groups in 120 screened early CKD patients.Group1 Dietary phosphorus modificationn40; Group2 calcium-based phosphate bindersn40 and Group3 non calcium-based phosphate bindersn40.Three monthly dietary assessment, MDRD e-GFR, phosphorus, calcium, iPTH, Alkaline phosphatise and six monthly FGF23, 2D Echocardiography, X ray of chest and abdomen were performed. Association of three categories of phosphorus level up to 3.9 mg/dl, 4 to 5mg/dl and &gt;5mg/dl, rate of progression of all parameters and correlation with FGF 23among all three groups were studied.

Results
At baseline, all clinical and biochemical parameters were equally distributed with a controlled nutritional phosphate among all groups. There was no significant difference of FGF23 in all the three categories of phosphorus level among all groups. Association of serum phosphorus at the level of 5 mg/dl was there with iPTH and e-GFR at one year. Over one year there were significant decline in serum phosphorus levels in Group1 p 0.02, Group2 p 0.00,Group3p 0.05;FGF23 was declined significantly only in group3p 0.00.Correlation of FGF23 was positive and negative with iPTH r 0.19,p 0.03 and e-GFR r-0.30, p 0.00respectively but not with phosphorus p0.13

Conclusion
Serum phosphorus levels up to 5mg/dl has no effect on FGF 23 at early CKD stages. Although different treatment groups have significant phosphorus reduction, non-calcium phosphate binder has major impact on FGF23 reduction.
MO584TRABECULAR BONE SCORE AND BONE MICROARCHITECTURE IN HEMODIALYSIS PATIENTS. ITS POTENTIAL RELATIONSHIP WITH PTH-RESISTANCE : A PILOT STUDY
Authors: De paola Luciano , Ciaccio Chiara , Saturno Laura , Mascaro Maria antonietta , Ruotolo Giovanni , Vatrano Marco , Puntieri Paolo , De paola Federica 
Published: May 2021

Abstract

Background and Aims
To explore:i)differences in predictive variables between TrabecularBoneScore(TBS)-derived and LumbarT-score derived bone types.ii)the relationship difference of TBS and LumbarT-score with various ranges of PTH levels in order to identify the levels of PTH that overcome PTH resistance iii) to conform normal upper limit of PTHi levels in hemodialysis patients recommended by K-DIGO guidelines.

Method
In twenty-five hemodialysis patients,following variables were recorded:biochemical variables,DXA derived variables(including TBS),FRAX-tool derived HRs.The relationship of variables with TBS-derived and LumbarTscore-derived bone types was tested by univariate analysis. The association of TBS,LumbarTscore and fracture HRs with PTHi was tested by univariate analysis and regression curve fitting(maximizing R²).

Results
Using univariate analysis,the predictive variables of lumbarT-score derived and TBS-derived bone types are different.By curve fitting regression TBS vs PTHi had a sinusoidal pattern with higher values,correlating to PTHi values in the 4th quartile(462 pg/ml (341 -696)corresponding to the normal levels recommended by K-DIGO guidelines.In the same range of values,LumbarT-score vs PTHi for BMD-derived bone type has a progressively increasing trend for osteopenia and osteoporosis,with a statistically significant difference(P0.008).

Conclusion
The predictive variables of TBs-derived and LumbarT-score derived bone types are different.Bone microarchitecture(MA),measured by TBS,correlates oppositely than LumbarT-score with higher PTHi values in the normal range of PTHi levels recommended by the K-DIGO-CKD-MBD2009-2017 guidelines.Within this range,PTHi values overcome PTH-resistance and improve the bone mineral metabolism. Results must not be extended to higher or lower levels of PTHi compared to those considered in the study for which there is a clear evidence of increase in the relative risk of mortality.