bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO464TWO-YEARS CHANGES IN ABPM, CARDIAC AND RENAL PARAMETERS PREDICT CARDIOVASCULAR OUTCOME OF PATIENTS WITH CKD AND HYPERTENSION
Authors: Bussalino Elisabetta , Ravera Maura , Mallia Laura , Minutolo Roberto , Vettoretti Simone , Paoletti Ernesto 
Published: May 2021

Abstract

Background and Aims
Changes over time in eGFR and albuminuria provide better accuracy than baseline values for end-stage risk prediction in CKD patients, whereas no studies have evaluated the impact of changes in renal, cardiac, and BP parameters on cardiovascular (CV) outcome.

Methods
We prospectively evaluated 249 hypertensive CKD patients with available baseline and 2-year echocardiography and ambulatory blood pressure monitoring (ABPM). Outcome was a composite of death or any non fatal CV event. Predictors of outcome were tested by multivariable regression analysis. The accuracy of prediction models that included baseline and 2-year changes (Δ) in cardiac, renal and BP parameters was assessed by ROC analysis.

Results
During a follow-up period of 71 months, 69 CKD patients (28%) experienced a major CV event or died. By multivariable Cox regression analysis baseline nighttime pulse pressure (PP) (HR 1.01, 95% CI 1.00 to 1.04), left ventricular mass (LVMi) (HR 1.03, 95% CI 1.02 to 1.04), ejection fraction (EF) (HR 0.96, 95% CI 0.90 to 0.97), Δ nighttime PP (HR 1.04, 95% CI 1.01 to 1.07), Δ LVMi (HR 1.02, 95% CI 1.00 to 1.04), and ΔEF (0.93, 95% CI 0.89-0.97) were associated with outcome. A model that includes 2-year changes in LVMi, EF, proteinuria, and nighttime PP was more accurate than a model that only evaluated baseline values (Δc-statistic 0.08, 95% CI 0.02 to 0.13, P=0.006; net reclassification improvement -NRI- 0.24, P= &lt; 0.0001).

Conclusion
Estimation of 2-year changes in renal, cardiac, and BP parameters improve the predictive accuracy of adverse CV outcome in CKD patients followed in tertiary care.
MO465PROGNOSTIC IMPLICATION OF URINARY POTASSIUM EXCRETION IN PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Mori Daisuke , Tamai Shinjiro , Tokuchi Maho , Inoue Natsumi , Kawai Hideaki , Shimada Naoyuki , Nomi Hiroki , Haga Ryota , Nagatoya Katsuyuki , Yamauchi Atsushi 
Published: May 2021

Abstract

Background and Aims
Plasma potassium levels are impacted by decreased kidney function and are known to be associated with increased mortality, adverse cardiovascular events and adverse kidney events. However, the prognostic implication of urinary potassium is unclear.

Method
We conducted an observational study of 1102 patients with chronic kidney disease (CKD) who were hospitalized between 2010 and 2018. The expected primary outcomes were all-cause mortality, adverse cardiovascular events and CKD progression. CKD progression was defined as a 30% increase in serum creatinine, the initiation of maintenance dialysis or the need for kidney transplantation. The Cox proportional hazards model was used to analyse the association between urinary potassium excretion and adverse clinical outcomes after adjustment for potential confounders.

Results
At baseline, 66% of the patients were men, with a median age of 72 years (interquartile range or IQR, 64–79 years); 61% of the patients were diabetic, and 54% of them were hypertensive. The median values for estimated glomerular filtration rate (eGFR) was 12 mL/min/1.73m2 (IQR, 8–18), serum potassium 4.5 mmol/L (IQR, 4.1–5.1) and urinary potassium/creatinine ratio (UK/Cr) 27 mmol/gCr (IQR, 20–38). Over a median follow-up period of 2.6 years (IQR 0.2–4.5), the number of all-cause deaths was 87. There were 171 cases of cardiovascular events and 860 cases of CKD progression. After adjusting for the eGFR, serum potassium level, proteinuria, renin–angiotensin system inhibitors, diuretics and other potential confounders, UK/Cr was found to be neither significantly associated with all-cause mortality nor with adverse cardiovascular events. However, a low UK/Cr was associated with an increased risk of CKD progression (adjusted hazard ratio [95% confidence interval] for the first, second and third quartiles, compared with the fourth quartile, were as follows: 2.09 [1.43-3.06], 1.33 [0.96-1.86] and 1.05 [0.75-1.46])

Conclusion
A low UK/Cr might be an independent risk factor for poor renal outcome.
MO466A NOVEL PREDICTION MARKER OF 10-YEAR RISK AND LIFETIME RISK OF RECURRENT CARDIOVASCULAR EVENTS IN PATIENTS WITH CKD AND DIABETES MELLITUS
Authors: Gembillo Guido , Cernaro Valeria , Siligato Rossella , Giuffrida Alfio Edoardo , Labbozzetta Vincenzo , Satta Ersilia , Santoro Domenico 
Published: May 2021

Abstract

Background and Aims
Chronic kidney disease (CKD) is one of the most prevalent complication of Diabetes Mellitus and patients with both diseases are more exposed to atherosclerosis injury and premature death from cardiovascular disease (CVD).
CVD is worsened by inflammation, oxidative stress, lipid accumulation and high-density lipoprotein cholesterol (HDL) reduction: patients with altered lipid metabolism more often present monocyte profile changes, with an altered pro-inflammatory phenotype leading to a significant risk of plaque formation and atherosclerosis. The alteration of the balance between monocyte and HDL, represented by the Monocyte/HDL ratio (MHR), is an easy way to evaluate the inflammatory status and to study appropriate strategies to treat high-risk patients.

Method
We evaluated 150 consecutive diabetic patients with CKD hospitalized in the Unit of Nephrology and Dialysis of the Policlinic G. Martino of Messina, Italy, with a history of CVD. We used the SMART-REACH SCORE, a model created to estimate life expectancy without recurrent cardiovascular events for individuals with a history of CVD. We performed a retrospective analysis of the MHR status of our patients to study its correlations with the 10-year risk and lifetime risk for myocardial infarction, stroke or vascular death, recurrent CVD events and free life-expectancy if standard care is provided.

Results
In the entire cohort of patients, MHR appeared to be positively correlated with ten-year risk (ρ=0.469; P &lt;0.0001) (Figure 1) and lifetime risk of myocardial infarction, stroke, or CV death (ρ=0.428; P &lt;0.0001) (Figure 2). Furthermore, patients with higher MHR levels had a significantly smaller number of years of CVD-free life expectancy (ρ=-0.364; P &lt;0.0001) (Figure 3).

Conclusion
MHR can represent a valid tool to predict the recurrence of CVD in CKD patients with diabetes. This easy-to-perform marker of oxidative stress and CVD risk can be used alone or in a multiple biomarker panel, improving the stratification and management of patients with comorbidities and risk of life- threatening conditions.
MO467SINGLE NEPHRON GFR AND GLOMERULAR HYDROSTATIC PRESSURE IN JAPANESE HEALTHY SUBJECTS
Authors: Nobayashi Hiroki , Kanzaki Go , Sasaki Takaya , Oba Rina , Okabayashi Yusuke , Haruhara Kotaro , Koike Kentaro , Kobayashi Akimitsu , Yamamoto Izumi , Nobuo Tsuboi , Yokoo Takashi 
Published: May 2021

Abstract

Background and Aims
Hemodynamic abnormalities such as intraglomerular hypertension and glomerular hyperfiltration associated with the nephron loss are deeply involved in renal damage progression. Recent studies in humans have described a new method to calculate single nephron GFR (SNGFR), which is defined as GFR divided by the estimated total number of non-sclerosed glomeruli. We have previously shown that a higher SNGFR, which indicates glomerular hyperfiltration, is associated with CKD risk factors. However, it is still unknown that the hemodynamic changes in humans within the glomerulus in response to SNGFR. In the present study, we analysed the renal microcirculatory dynamics with SNGFR in healthy individuals without CKD.

Method
We retrospectively identified 51 living kidney donors who underwent enhanced computed tomography and kidney biopsy at the time of donation from January 2007 till December 2020. Nglom was calculated as the cortical volume of both kidneys assessed on computed tomography times the 1-hour posttransplant renal biopsy-determined glomerular density. SNGFR was calculated by dividing GFR (calculated from the corrected creatinine clearance) by the non-sclerosed Nglom. Glomerular hydrostatic pressure (Pglom) and afferent / efferent arteriolar pressure were calculated from the Gomez / Ohm's formula.

Results
Age was 57.0 ± 10.4 years, mean blood pressure was 88.7 ± 13.2 mmHg, GFR was 73.3 ± 16.7 mL/min, and Nglom was 807,774 ± 401,0352 / kidney. SNGFR was significantly associated with renal blood flow and Pglom (p for trend = 0.02, and 0.02, respectively), but not with age, mean blood pressure, renal plasma flow, filtration fraction, afferent / efferent arteriolar pressure (Table1).

Conclusion
Our results showed that the increase in SNGFR is associated with elevated Pglom, indicating that glomerular hyperfiltration may lead to intraglomerular hypertension.
MO474PCSK9 LEVELS AND MARKERS OF INFLAMMATION, OXIDATIVE STRESS AND ENDOTHELIAL DYSFUNCTION IN A POPULATION OF NON-DIALYSIS CHRONIC KIDNEY DISEASE PATIENTS: IS THERE AN ASSOCIATION?
Authors: Ntounousi Evangelia , Tellis Konstantinos , Pavlakou Paraskevi , Duni Anila , Liakopoulos Vassilios , Papagianni Aikaterini , Tselepis Alexandros 
Published: May 2021

Abstract

Background and Aims
Proprotein convertase subtilisin / kexin 9 (PCSK9) plays an important role in lipid metabolism while available literature regarding its involvement in the pathogenesis of atherosclerosis and in the expression of genes associated with apoptosis and inflammation is constantly increasing. Patients with chronic kidney disease (CKD) experience disproportionately increased cardiovascular morbidity and mortality due to dyslipidemia, accelerated atherosclerosis, inflammation, oxidative stress and other risk factors. In the present cross-sectional study, we investigated the possible association of serum PCSK9 levels with markers of inflammation, oxidative stress and endothelial damage in patients with CKD.

Method
Ninety-two patients with CKD stage II-ΙV (eGRF CKD-EPI 47.3 ±25.7ml/min/1,73m2, mean age 66 years, 51 men) were included. Plasma PCSK9 levels were correlated with comorbidities (arterial hypertension; diabetes mellitus, history of cardiovascular disease), renal function indices (eGFR, proteinuria – UPR/24h), lipid parameters (LDL-cholesterol, HDL-cholesterol, triglycerides, Lp (a), APO-A1, APO-B), as well as soluble biomarkers of inflammation, oxidative stress and endothelial damage (hs-CRP, fibrinogen, 8-epiPGF2a, ox-LDL, IL-6, TNF-α, sICAM-1, sVCAM-1).

Results
The mean plasma value of PCSK9 was 278.1ng/ml. PCSK9 levels showed direct correlation with serum triglycerides (p = 0.03), Lp(a) (p = 0.01), and sICAM-1 levels (p = 0.03). There was no significant correlation between PCSK9 levels and indices of renal function, other lipid profile parameters, inflammatory markers or co-morbidities. Multiple regression analysis showed a significant effect of the Lp(a) on PCSK9 levels, for each unit of higher Lp(a), an increase by 3.082 is expected (95% CI: 0.935 - 5.228, p=0.006). At the same time, patients receiving statins are expected to have on average 63.8ng/ml higher PCSK9 values compared to patients not receiving statins (95% CI: 14.6 - 113.5 p=0.012).

Conclusion
Plasma levels of PCSK9 in non-dialysis CKD patients are correlated with endothelial dysfunction and lipid metabolism parameters. Statin intake increases PCSK9 levels significantly in this patient population. PCSK9 levels are not correlated with the severity of kidney disease. Major prospective studies are necessary to investigate the role of PCSK9 in the atherosclerotic cardiovascular outcome in CKD
MO475PREDICTION OF CARDIORENAL SYNDROME BY ARTIFITIAL INTELLIGENCE
Authors: Tasic Danijela , Djordjevic Katarina , Galovic Slobodanka , Milovancevic Milos , Kocic Gordana , Radenkovic Sonja , Dimitrijevic Zorica , Jancic Nina , Vrecic Tamara , Jovanovic Andriana 
Published: May 2021

Abstract

Background and Aims
Potassium excretion is a secretory phenomenon and levels are often abnormal in patients with heart failure. An abnormal sodium serum level is the most common electrolyte disorder and independent predictor of readmission for heart failure and post discharge death. Since different factors could affect balance of Potassium in Cardiorenal syndrome, in this study soft computing was used to predict most important factors for the detection of the severity of systolic heart failure by ejection fraction (EF), and a subclinical phase of the cardiorenal disease by EPI creatinine-cystatin C formula (Chronic Kidney Disease Epidemiology Collaboration).

Method
The balance of potassium in Cardiorenal syndrome is analyzed by soft computing approach namely adaptive neuro fuzzy inference system or ANFIS.

Results
The clinical group consisted of 79 patients, 40 of whom were men (50.63%) and 39 of whom were women (49.37%), in the average age of 70.72 ± 9.26 years. After comparing serum electrolytes (Na+, K+) did not differ significantly in the clinical group from those of the control group. The tested biomarkers showed significantly higher values in the clinical group than in the control group: BNP (p&lt;0.001), cystatin C (p&lt;0.001). Figures 1 and 2 shows flowcharts of the used inputs and outputs and how they are implemented in the ANFIS networks. There are two ANFIS networks since there are two outputs. ANFIS networks shold determine which input has the strongest influence on the given outputs nased on root mean squre errors or prediciton accuracy.Based on the training error (trn) one can determine the inputs influence on the given output. Checking error (chk) is used to track the results validity. In other words the checking errors could track training error. It was found that BNP (pg/mL) has the most influence on the - EPI creatinine-cystatin C formula. Serum sodium (Na) has the most influence on the ejection fraction (EF).

Conclusion
Serum sodium-potassium disturbances are associated with advanced heart failure and reduced prognosis. ANFIS is suitable for nonlinear systems with highly redundant data. Although there are encouraging advances around this unsolved clinical problem, further investigation should consider the progressive inclusion of patients with advanced renal impairment to allow a better understanding of cardiorenal syndrome. The result of our research shows that if the values of BNP and Na significantly deviate from normal values, it is expected that EPI creatinine-cystatin C formula and EF indicate impaired organ function and that such patients are candidates for hospital treatment.
MO442ACUTE ADVERSE EFFECTS OF LOW POTASSIUM ON HEART AND KIDNEY*
Authors: Saritas Turgay , Chen Lu , Babler Anne , Rix Anne , Reimer Katharina C , Jansen Jitske , Su Xiao-Tong , Kerker Andrew S , Cuevas Catherina A , Menzel Sylvie , Kuppe Christoph , Boor Peter , Falke Lucas , Bleilevens Christian , McCormick James , Floege Jürgen , Ellison David H , Kramann Rafael 
Published: May 2021

Abstract

Background and Aims
Chronic hypokalemia causes kidney fibrosis with cystic lesions and arterial hypertension. In contrast, potassium-rich diet lowers blood pressure. The acute effects of hypo- and hyperkalemia on heart and kidney are not well understood.

Method
Wild-type mice were fed with low (LK), normal (NK) and high (HK) potassium diet for 4 and 20 days. Kidneys were examined for site of acute injury, inflammation and fibrosis. Blood analysis of electrolytes and kidney parameters were analyzed. Echocardiography and ECG were used to assess heart function. Further, KCNJ10 knockout mice were used to investigate kidney damage in a genetically induced hypokalemia model.

Results
Proximal tubule injury as detected by KIM-1+ staining and yH2AX+ DNA-damage was observed after 4 and 20 days of LK diet. Injury was associated with strong Ki-67+ proliferation of proximal tubule cells. No injury was detected in mice on NK and HK diet. After 20 days of LK diet, F4/80+ inflammation and aSMA+ extracellular matrix accumulation, typical for fibrosis, were observed. LK mice developed polyurie, volume depletion, loss of body weight and high BUN. Lower cardiac output and signs of myocardial stress was seen in echocardiography and ECG. Consistent with WT mice on LK diet, KCNJ10 knockout mice developed same pattern of kidney injury. Nine months after deletion of KCNJ10, cysts were observed in the proximal tubule in outer medzulla.

Conclusion
Acute hypokalemia causes kidney injury and myocardial stress. Cystic lesions originate from late proximal tubule. Hypokalemia should be corrected rapidly to stop progression into kidney fibrosis.
MO480FGF-23 AND LOW BIRTH WEIGHT: IS THERE ANY ASSOCIATION?
Authors: Balmukhanova Altynay , Kabulbayev Kairat , Batyrbayeva Dinara , Shepetov Abay 
Published: May 2021

Abstract

Background and Aims
According to Barker’s theory and Brenner’s hypothesis, persons were born with low birth weight (LBW) have a higher risk of CKD due to low nephron number. Also, it is well known that mineral-bone disorder (MBD) is one of the most serious complications of CKD. Views on the pathogenesis of CKD-MBD have changed considerably since Fibroblast growth factor 23 (FGF-23) was discovered. It is thought that FGF-23 increases as the nephron mass reduces. Therefore, we aimed to determine if there is an association between LBW and FGF-23.

Method
We conducted a cross-sectional study on 56 children with CKD stages 1-4. There were approximately equal numbers of participants in each stage. The mean age was 8.9 ±4.9 years old. We measured the concentration of FGF-23 (C-terminal) in serum by a sandwich enzyme-linked immunosorbent assay (ELISA) kit (Biomedica Medizinprodukte GmbH, Austria). The exclusion criteria: tubulopathy, active inflammatory, infectious, oncological and bone diseases, renal transplant, as well as taking steroids, calcium, and vitamin D. The informed consent was obtained from the parents. The study was conducted in accordance with the Declaration of Helsinki and approved by the Local Ethical Committee. FGF-23 concentration more than 1.5 pmol/l was considered as abnormal. Statistical analysis was performed using GraphPad Prism 9.0.0 (San Diego, USA)

Results
Mineral-bone disorder was diagnosed as CKD complication in 20 (35.7%) children. LBW was revealed in 14 (25%) patients. The median (IQR) eGFR among patients with normal birth weight was 65.23 (31.23-84.73) ml/min/1.73m2, among LBW – 68.93 (24.59-98.9) ml/min/1.73m2, so there were no differences in kidney function between the two groups (p=0.64). The median (IQR) level of serum FGF-23 in patients with normal birth weight was 1.75 (0.68- 2.5) pmol/l, in LBW children was 1.85 (0.78 -3.1) pmol/l. Analysis of serum level of FGF-23 in relation to weight at birth revealed no statistical differences in patients with LBW and those with normal birth weight (p=0.719), and the Spearman rank correlation was insignificant as well (r=-0.08, p=0.560).

Conclusion
FGF-23 is an important biomarker of CKD-MBD. FGF-23 does not depend on the birth weight although LBW is considered as a risk factor for CKD. However, further investigations and studies in this area are needed to make the right conclusions regarding the association between this bone biomarker and birth weight.
MO611CARDIOPULMONARY RESERVE EXAMINED WITH CARDIOPULMONARY EXERCISE TESTING IN INDIVIDUALS WITH AND WITHOUT CHRONIC KIDNEY DISEASE; A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Pella Eva , Theodorakopoulou Marieta , Boutou Afroditi , Alexandrou Maria Eleni , Bakaloudi Dimitra , Boulmpou Aristi , Papadopoulos Christodoulos , Papagianni Aikaterini , Sarafidis Pantelis 
Published: May 2021

Abstract

Background and Aims
Patients with chronic kidney disease (CKD) often present with reduced physical activity and exercise performance due to a number of factors relevant to co-existing disturbances of the cardiac, nervous and muscular systems. Cardiopulmonary exercise testing (CPET) is widely applied in daily clinical practice used for clinical evaluation of exercise intolerance and related symptoms (i.e. dyspnea, fatigue), as well risk stratification, and other applications in several medical fields.

Method
This is a systematic review and meta-analysis of studies which used CPET technology in adult patients with CKD to examine cardiopulmonary reserve in individuals with versus individuals without CKD. The primary outcome was peak oxygen uptake (VO2peak). Literature search involved PubMed, Web of Science and Scopus databases; manual search of article references and of grey literature was also performed. Newcastle-Ottawa Scale was applied to evaluate the quality of retrieved studies.

Results
From an initial 4944 literature records, we identified 29 studies fulfilling the inclusion criteria; of these, 25 studies with complete data including 2213 participants were included in final meta-analysis. Peak oxygen uptake (VO2peak) was significantly lower in CKD patients compared to controls without CKD (standardized-mean-difference, SMD:-1.40, 95%CI[-1.68, -1.13]) (Figure). Oxygen consumption at anaerobic threshold (VO2AT) (SMD:-1.06, 95%CI[-1.34, -0.79]), maximum workload (weighted-mean-difference, WMD:-58.26, 95%CI[-74.14, -42.38]) and respiratory exchange ratio (RER) (WMD:-0.02, 95%CI[-0.05, 0.01]) were also impaired in CKD patients compared to non-CKD individuals. In 3 studies comparing patients with CKD versus patients with heart failure without CKD VO2peak was higher in the former (WMD:6.60, 95%CI[3.02, 10.18]). Sensitivity analyses confirmed the robustness of these findings.

Conclusion
VO2peak and other commonly analyzed CPET variables were lower in CKD patients compared to controls, indicating reduced functional cardiopulmonary reserve in the former. In contrast, CKD patients performed better when compared patients with heart failure.