bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO130GLOMERULAR FILTRATION RATE IS THE MAIN PREDICTOR OF URINE OUTPUT IN AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE (ADPKD) PATIENTS TREATED WITH TOLVAPTAN
Authors: Borrego-Utiel Francisco-Jose , Merino Garcia Enoc , Garnica Alvarez Maria Luisa , Moriana Dominguez Clara 
Published: May 2021

Abstract

Background and Aims
Tolvaptan was approved to treat autosomal dominant polycystic kidney disease (ADPKD) to slow the rate of kidney growth and renal function decline. Tolvaptan blocks the V2 vasopressin receptor in renal collecting ducts and distal nephron causing intense polyuria. Few authors have analyzed what factors influence the volume of diuresis in patients taking tolvaptan.

Method
We have analyzed the influence of solute excretion and glomerular filtration rate, besides age and gender as predictors of urine output, using multivariable analysis. In concret, we have searched the importance of osmolar excretion as predictor of volume of diuresis.

Results
We studied 24 h-urine samples from 18 ADPKD patients on treatment with tolvaptan, who had received the three doses: 45/15, 60/30 and 90/30 mg. Each patient was represented once per dose, for a total of 54 urine samples (Table 1). Tolvaptan increased urine volume, which was roughly doubled, and roughly halved urine solute concentrations expressed by volume and calculated osmolality. By contrast, solute concentrations expressed as ratios with creatinine remained constant as did osmolality corrected with urinary creatinine, indicating that there was no change in solute excretion after tolvaptan.
Urine volume was correlated with serum creatinine (Rho= -0.36, p= 0.008), urinary creatinine (Rho = -0.29, p = 0.034) and GFR-MDRD4 (Rho = 0.44, p= 0.001). Urine volume was correlated with calculated daily osmolar excretion in Osm/day (Rho = 0.76, p &lt;0.001). Urine volume was not correlated with calculated urinary osmolality in mOsm/Kg (Rho= -0.04, p= 0.77) or as urinary osmolality/creatinine ratio (Rho= 0.23, p= 0.1). Correlation of urine volume with osmolar excretion was lost when urine volume was removed from the predictor variable. Urine volume was additionally not correlated with urinary urea o sodium concentrations nor their solute/creatinine ratios, and although it was correlated with urinary potassium concentration (Rho = -0.33, p=0.014), it was not correlated with potassium/creatinine ratio.
We also performed a linear regression analysis searching predictors of urine volume. Only GFR and the osmolality/creatinine ratio were significant predictors of urine volume (urine volume= 55.35 x GFR + 4.74 x Osmolality/Cr; r2= 0.41, p&lt;0.001) but individual solute assessments or tolvaptan dose did not predict urine volume.

Conclusions
Therefore, urine volume after initiating tolvaptan in patients with ADPKD is influenced mainly by the degree of renal function. There might also be a contribution of urinary solute load but it can not be studied using total solute excretion due to collinearity. We propose that the urinary solute/creatinine ratio and osmolality/creatinine ratio should be used to search for predictors of urine output in patients on tolvaptan.
MO203ALTERATIONS IN T REGULATORY CELLS IN CHRONIC KIDNEY DISEASE PATIENTS UNDERGOING HEMODIALYSIS
Authors: Sampani Erasmia , Fylaktou Asimina , Stangou Maria , Vagiotas Xaralampos , Kasimatis Efstratios , Nikolaidou Vasiliki , Daikidou Dimitra Vasileia , Antoniadis Nikolaos , Papagianni Aikaterini 
Published: May 2021

Abstract

Background and Aims
Disturbances in T cell immunity are frequently seen in patients with end stage renal disease (ESRD), and the effect of long term hemodialysis (HD) is still obscure, though extremely important, especially regarding T regulatory cells (Tregs, CD4+CD25+FoxP3+) which seem to have a central role in immune response and tolerance after renal transplantation. In the present study, we assessed the possible effect of HD vintage on Treg population.

Method
Cytometric analysis was performed in 66 patients with ESRD on HD, in order to estimate CD4+ and CD4+CD25+FoxP3+ subtypes. According to HD vintage, patients were classified into two groups, group A: recently commenced on HD, and group B: on long term HD (≤12months and &gt;12months, respectively).

Results
In all 66 patients there was a negative correlation between time on HD and lymphocyte count, both percentage (r=-0.34 p=0.005) and absolute lymphocyte number (r=-0.42 p&lt;0.001) as well as CD4+ cells frequencies (r=-0.25 p=0.042) and total numbers (r=-0.41 p=0.001).
Twenty eight patients (42%) were included in group A (HD vintage 9±3 months) and 38 (58%) in group B, (HD vintage 99±41 months). Compared to group A, patients in group B, showed a significant reduction in percentage of Tregs on total lymphocytes (2.6±1.3% vs 1.9±0.9%, respectively, p&lt;0.019) as well as absolute number of Tregs (34±14 μ/L vs. 21±11 μ/L, respectively, p&lt;0.001).

Conclusion
Long term HD may act as an additional factor reducing lymphocyte count, especially Tregs in ESRD patients. This result, apart from direct affecting immunity of patients, is mostly important for those preparing for renal transplantation, or being on the waiting list.
MO207END-OF-LIFE CARE IN NEPHROLOGY INPATIENTS - ARE WE GETTING IT RIGHT?
Authors: Mateus Catarina , Martins Ana Rita , Cacheira Eunice , Gaspar Maria Augusta 
Published: May 2021

Abstract

Background and Aims
Average life expectancy have been continuously increasing within the general population and, equally so, within Nephrology patients. End-of-life (EOL) care is part of non-oncologic palliative care provided by Nephrology. The aim of our study is to evaluate the quality of EOL care provided in Nephrology, and to determine potential areas of improvement.

Method
Retrospective single-centre analysis of all nephrology and kidney transplant inpatients dying between January 2019 and June 2020. Clinical records were reviewed for evidence of recognition of end of life, resuscitation plans, acute interventions in the 48 hours previous to death, comfort care plans and symptoms evaluation.

Results
A total of 83 patients were included. 19.6% of patients had chronic kidney disease, 60.2% were in haemodialysis, 14.5% were kidney transplanted patients and 3.6% had acute kidney injury. 89.2% of the admissions were for acute events, 5% for symptom control and 4.8% for diagnosis.
In 72.3% of admissions, EOL was recognised. Most patients were unable to discuss EOL plans (67.5%), and the family was informed of the prognosis in only 61.4% of the cases.
At the time of dead: only 62.7% of patients had a clear resuscitation plan, 44.6% were on antibiotics and 26.5% died with nasogastric tube. Within 48h of death: invasive interventions were still being given in 42.2%, blood samples were taken in 69.9%; imaging was performed in 36.1% and 48.2% had a haemodialysis session. Comfort measure were provided to 53% and only 60.2% had evidence of symptom evaluation. 44.6% stopped invasive measures in the last 48h.
Recognition of EOL was associated with having a clear resuscitation plan (p&lt;0.001), comfort measures (p&lt;0.001), evidence of symptom evaluation (p=0.004), stopping invasive measures (p&lt;0.001), having less imaging (p=0.270) and discussing prognosis with the family (p&lt;0.001). Despite recognition of EOL, there was no difference in dying with nasogastric tube (p=0.404) or dying on antibiotics (p=0.134).
In a multivariable analysis (binary logistic regression), EOL recognition was associated with a clear resuscitation plan (Exp(B) 0.088, (CI 95%: 0.018-0.419) p=0.002), with discussion of prognosis with family ( Exp(B) 0.061 (CI 95%: 0.011-0.337) p=0.001), and with reduced body mass index (Exp(B) 0.870, (CI 95%: 0.763-0.991), p=0.037,); in a model adjusted to the age.

Conclusion
In our cohort, patient for whom EOL was recognized had better EOL care. In conclusion, there are still areas in which EOL care can be improved. Palliative care should be an investment area for training within the Nephrology core curriculum and awareness for EOL care is needed.
MO210SERUM LEVELS OF PLASMINOGEN ACTIVATOR UROKINASE RECEPTOR AND CARDIOTROPHIN-LIKE CYTOKINE FACTOR 1IN PATIENTS WITH NEPHROTIC SYNDROME
Authors: Chebotareva Natalia , Vinogradov Anatoliy , Cao Wenjing , Gindis Alla , Alentov Igor , Sergeeva Natalia 
Published: May 2021

Abstract

Background and Aims
The pathogenesis of primary focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD) remains unknown to date. Some circulating permeability factors are discussed. This work assessed molecule candidates for permeability in serum samples of patients with nephrotic syndrome (NS).

Method
Forty-one patients with chronic glomerulonephritis (CGN) were included in our study. Seventeen patients had FSGS, 7 patients had MCD, 5 patients had membranoproliferative glomerulonephritis (MPGN), 6 patients had IgA nephropathy, and 6 patients had membranous nephropathy (MN). The laboratory data were compared with the clinical and histological features of nephritis. Serum levels of uPAR and CLCF-1 were measured by ELISA.

Results
The serum levels of plasminogen activator urokinase receptor (uPAR) were higher in FSGS patients before treatment than in patients with other morphological forms (MCD, IgA nephropathy, MN and MPGN). The levels of uPAR in serum did not correlate with daily proteinuria, serum creatinine/eGFR, arterial hypertension, the number of sclerosed glomeruli or tubulointerstitial fibrosis. No correlations were found between the levels of cardiotrophin-like cytokine factor 1 (CLCF-1) in serum and creatinine levels/glomerular filtration rate, the percentage of sclerosed glomeruli or the severity of tubulointerstitial fibrosis. There were no significant differences between the histological variants of nephritis. However, we found correlations between CLCF-1 levels and proteinuria (Rs = 0. 397, p = 0.015) and triglycerides levels (Rs = 0. 475, p = 0.003).

Conclusion
The data indicate an increase in the serum uPAR levels of FSGS before treatment. CLCF-1 levels in serum do not depend on histological forms of CGN, kidney function or immunosuppressive treatment, but they correlate with proteinuria and serum lipids in patients with NS.
MO213GOOD PRACTICES FOR DIALYSIS EDUCATION, TREATMENT AND EHEALTH: A SCOPING REVIEW
Authors: Van Eck van der Sluijs Anita , Vonk Sanne , Bonenkamp Anna , Van Jaarsveld Brigit , Abrahams Alferso C 
Published: May 2021

Abstract

Background and Aims
Recommendations regarding dialysis education and treatment are provided in various (inter)national guidelines, which should ensure that these are applied uniformly in nephrology and dialysis centers. However, there is much practice variation which could be explained by good practices: practices developed by local health care professionals, which are not evidence-based. Because an overview of good practices is lacking, we performed a scoping review to identify and summarize the available good practices for dialysis education, treatment and eHealth.

Method
Embase, Pubmed, and the Cochrane Library databases were searched for relevant articles using all synonyms for the words ‘kidney failure’, ‘dialysis’ and ‘good practice’. Relevant articles were structured according to the categories dialysis education, dialysis treatment or eHealth, and assessed for content and results.

Results
Nineteen articles (12 for dialysis education, 3 for dialysis treatment, 4 for eHealth) are identified. The good practices for education endorse the importance of providing complete and unbiased predialysis education, assisting PD patients in adequately performing PD, educating HD patients on self-management, and talking with dialysis patients about their prognosis. The good practices for dialysis treatment focus mainly on dialysis access devices and general quality improvement of dialysis care. Finally, eHealth is useful for HD and PD and affects both quality of care and health-related quality of life.

Conclusion
The results of our scoping review can inspire nephrological health care professionals to change their practices and these good practices could be used in addition to guidelines. It is important to increase the attention for local good practices, because they can truly support health care professionals and can improve outcomes and quality of life for patients, even if they are not evidence-based.
MO215DEPRESSIVE DISORDER IN LUPIC PATIENTS WITH LUPUS NEPHRITIS: DATA FROM A POPULATION OF 67 PATIENTS WITH BIOPSY PROVEN LUPUS NEPHRITIS
Authors: Stroie Anna Mirela , Paul Balanescu , Penescu Mircea , Geanina Eugenia Beldea 
Published: May 2021

Abstract

Background and Aims
Systemic lupus erythematosus is a multi-organ, multi-systemic autoimmune disease with significant burden on generally young patients. Renal involvement is relatively frequent, recent studies cite a prevalence of 15-60% of patients, and 25% develop end-stage renal disease after 10 years of disease onset. We studied the incidence of depressive disorders in a population of 67 patients with biopsy proven lupus nephritis. Data about depression in patients with renal involvement of lupus is still scarce. We identified variables associated with the development of depressive disorders in lupus patients.

Method
We concluded a single center transversal study to assess the incidence of depressive disorder in patients with biopsy proven lupus nephritis. We used the self-report Beck Depression/ Anxiety Inventory (BDI/ BAI), 1961/ 1990, translated in Romanian and validated in the Romanian population to diagnose depression. We also wanted to identify risk factors associated with depression in such patients. We used EpiInfo for the statistical analysis and data was extracted from medical records.

Results
We included in the study patients diagnosed with systemic lupus erythematosus, and had renal biopsy between January 2008 – December 2018. Patients were followe-up until May 2020. Beck Depression/Anxiety Inventory was administered a single time during the follow-up visit between (March 2019 – May 2020). In our study group, 58 patients were female (86.5%). Median age at diagnosis of lupus disease was 29 years (min 10 years, max 62 years). Median duration of the disease until the self-assessment inventory was 10 years (min 1.5 years, max 30 years). Median duration of corticosteroid treatment was 10.1 years (min 1.58 years, max 29). 1 patient had class I, 2 had class II, 12 had class III, 32 had class IV, 12 had class V, 1 had class VI, 1 had classes III+V, 1 had classes IV+V of lupus nephritis (ISN classification of lupus nephritis). 13 patients had normal scores of the Beck Inventory (0-9 points), 7 had mild depression (10 - 15 points), 37 had moderate depression (16- 23 points), 10 had severe depression (24-63 points). We identified female gender (p=0.009), duration of corticosteroid therapy (p=0.036), duration of the lupic disease (p=0.036) to be independently associated with depression development. Other variables, such as creatinine levels at the moment of the assessment, duration of maintenance therapy with mycofenolate mofetil or azathioprine, proteinuria, inflammatory markers were not associated significantly with depression.

Conclusion
We identified clinical variables associated with depression development in patients with lupus nephritis. The study brings data useful for the clinician, helping doctors focus on the variables that predict depression in lupus patients and making screening for depressive disorders more focused on the patients with risk factors.
MO217ASSOCIATION BETWEEN SERUM VITAMIN-D LEVEL WITH LUNG INVOLVEMENT AND OUTCOME IN COVID-19 PNEUMONIA
Authors: Abrishami Alireza , Dalili Nooshin 
Published: May 2021

Abstract

Background and Aims
Vitamin D deficiency has been reported as a key factor in the development of infectious diseases such as respiratory tract infections and inflammatory processes like acute respiratory distress syndrome. However, the impact of vitamin D on the severity and outcome of COVID-19 is still not fully known. Herein, we aimed to evaluate the prognostic role of serum vitamin D concentration on the extent of lung involvement and final outcome in patients with COVID-19.

Method
Seventy-three subjects with confirmed diagnosis of COVID-19 were investigated in this study. The patients had been admitted to our academic hospital from February 28, 2020 to April 19, 2020. Demographic and clinical data, serum 25(OH)D levels, and findings of initial chest computed tomography were recorded. Linear and binary logistic regression, cox regression and ROC curve tests were used for statistical analysis.

Results
The mean age of patients was 55.18 Å} 14.98 years old; 46.4% were male. Mean serum 25(OH)D concentration was significantly lower in the deceased (13.83 Å} 12.53 ng/ mL compared with discharged patients (38.41 Å} 18.51 ng/mL) (P &lt; 0.001). Higher levels of 25(OH)D were associated with significantly less extent of total lung involvement (β = − 0.10, P = 0.004). In addition, vitamin D deficiency [25(OH) D &lt; 25 ng/mL] was associated with a significant increase in the risk of mortality (hazard ratio = 4.15, P = 0.04).

Conclusion
This study suggests that serum vitamin D status might provide useful information regarding the clinical course, extent of lung involvement and outcome of patients with COVID-19. However, further studies with larger sample size are needed to confirm these findings.
MO220MID TERM E GFR AND ITS IMPACT ON ADVERSE PREGNANCY OUTCOMES- IMPORTANCE OF GESTATIONAL HYPERFILTERATION
Authors: Kaul Anupma , Pandey Amita 
Published: May 2021

Abstract

Background and Aims
The hemodynamic adaptation plays a crucial role in maintaining gestation, the clinical significance of midterm renal hyperfiltration on pregnancy outcomes is unknown. The present study was retrospective study among all pregnant ladies whose midterm eGFR wascompared with their baseline and its change from baseline was considered as a surrogatemarker for Mid term hyperfilteration among women without underlying evidence of CKD tofurther evaluate its value as a prognostic factor of the eGFR during gestation

Method
All pregnant females aged 18-50 years whose pre gestational baseline serum creatinine was available and had a singleton pregnancy were included in the study .The study was conducted from January 2015 till December 2018 in a tertiary care Institute in Northern India . MRH was represented by the highest eGFR, which was calculated using the Chronic Kidney Disease Epidemiology Collaboration method. An adverse pregnancy event was defined by the composition of preterm birth (gestational age &lt;37 weeks), low birth weight (&lt;2.5 kg), and preeclampsia.

Results
Total of 1045 pregnancies were evaluated to study. Among them, 15 , 305, 680, and 45 mothers had midterm eGFR levels of 60–90, 90–120, 120–150, and ≥150 ml/min per 1.73 m2, respectively. The adjusted odds ratio and associated 95% confidence interval (95% CI) of an adverse pregnancy outcome for eGFR levels below and above the reference level of 120–150 ml/min per 1.73 m2 were 1.97 (95% CI, 1.34 to 2.89; P&lt;0.001) for ≥150 ml/min per 1.73 m2; 1.57 (95% CI, 1.23 to 2.00; P&lt;0.001) for 90–120 ml/min per 1.73 m2; and 4.93 (95% CI, 1.97 to 12.31; P&lt;0.001) for 60–90 ml/min per 1.73 m2. Moreover, among mothers without baseline CKD, women with adverse pregnancy outcomes had less prominent MRH than those without (P&lt;0.001)

Conclusion
There was an unique relationship between the midterm eGFR and adverse pregnancy outcomes, and the optimal range of midterm eGFR levels was 120–150 ml/min per 1.73 m2. In those females without evident functional renal impairment, the absence of prominent MRH could be a significant risk factor for poor pregnancy outcomes
MO632FIRST PLACE IN MORTALITY DUE TO DIABETES IN EUROPE BRINGS TO ALERT OF MULTIDISCIPLINARY TREATMENT IN ALBANIA. ROLE OF NEPHROLOGISTS
Authors: Likaj Erjola , Shehaj Larisa , Idrizi Alma , Barbullushi Myftar 
Published: May 2021

Abstract

Background and Aims
Diabetes mellitus was prevalent in nearly 0.8 % of the adult population and assent in our modest hemodialytic population in 1990. Changing of lifestyle and nutrition, increase in longevity, aging population, and stress have brought to increase of this morbid condition. Nowadays, with a galloping rise, we have a prevalence of 11,1 % of DM in the adult population and nearly 22% of hemodialysis patients whose primary diagnosis is diabetes. Despite this, data of EUROSTAT put us in the first place for mortality due to diabetes. It's time to act!

Method
We analyzed the number of diabetic patients in Albania second the IDF data and the number of diabetic nephropathy patients hospitalized during this decade in our Departement of Nephrology according the Statistical Department of UHC "Mother Theresa".

Results
In 2010 there were 4.5% diabetics in the adult population in Albania and in 2019 there were 9%, so doubling of numbers. Diabetic nephropathy is increasing too and now is our everyday clinical practice challenge, in 2010 there were 54 patients hospitalized for DN and its complications and in 2019 this number increased to 164 patients. Diabetics on hemodialysis are now more and more present with their problems and difficulties that need not only nephrologists but a multidisciplinary approach. Diabetic nephropathy in 2011 had only 11,3% of the hemodialytic pie and now is reaching 17,2% of the primary cause of ESRD in our hemodialytic population, regarding ERA EDTA registry, but our 2020 numbers rise to 22%. We are below the European and North American data but in incident patients it is becoming the second predominant cause of renal failure, after the hypertensive nephrosclerosis, reaching 25%-27%. Mortality in this population is a crucial point, we stand first in Europe with 110 deaths/ million inhabitants despite the reimbursement range is three-fold compared to 10 years ago An increasing number is translated into increased problems especially in vascular access, cardiovascular problems, diabetic foot problems, glycemic control, etc.

Conclusion
Nephrology Units and Hemodialysis Units too are being invaded by diabetics Caring about the glycemic levels, type of hypoglycemia drugs, time and dosage, eating or not during the hemodialysis session, are every session challenges. Cardiovascular problems with frequent hypotensions, coronary heart disease, and cardiac heart failure are other difficult to manage fields. But the most important and continuous care is that of vascular access, the "Achille's Heel" of our patients. Results from our studies reveal diabetes like the second cause of arteriovenous fistulas failure, after the age of patients so we are reinforcing the whole medical chain for referring patients in the fourth stage of CKD for the creation of permanent vascular access, especially diabetics.