bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO587PREVALENCE OF MINERAL AND BONE DISORDERS MAKERS AMONG RECIPIENTS OF KIDNEY TRANSPLANT: SINGLE-CENTER EXPERIENCE
Authors: Vatazin Andrey , Parshina Ekaterina , Kantaria Rusudana , Stepanov Vadim , Zulkarnaev Aleksei 
Published: May 2021

Abstract

Background and Aims
Mineral and bone disorders (MBD) are common after successful kidney transplantation in patients with chronic kidney disease (CKD). We aimed to evaluate the prevalence of biochemical abnormalities among recipients of kidney transplant.

Method
We performed a cross-sectional study of 236 patients underwent successful kidney transplantation in our clinic between 2007 and 2019. 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. We evaluated serum intact parathyroid hormone (iPTH), total calcium (Ca), phosphorus (P) and alkaline phosphatase (AP) levels. Target ranges were defined according to National guidelines on CKD-MBD as follows: 2,1 - 2,5 mmol/l for total Ca, 0,87 – 1,49 mmol/l for P; normal AP level is defined considering a gender (53-128 Е/l for men, 42-98 Е/l for women). Target iPTH level for optimal and slightly decreased transplant function (corresponding chronic kidney diasease (CKD) stage 3T) was defined as 35-70 pg/ml, for eGFR corresponding CKD 4T – as 70-110 pg/ml, for CKD 5T – as 70-150 pg/ml.

Results
In our cohort normal iPTH level was observed only in 13% cases, whereas 84% of the patients had hyperparathyroidism. iPTH inversely correlated with eGFR (ρ= -0,454 [95%CI: -0,55; -0,34], р&lt;0,0001 – fig.1) and its level differed significantly between groups with different CKD stage (р&lt;0,0001, Kruskall-Wallis test) – fig.2. However, fraction of patients with target iPTH did not differ in recipient groups with normal and decreased eGFR (p=0,118). Hypercalcaemia was observed in 29% cases; there was a weak correlation of serum total Ca level with iPTH (ρ= 0,282 [95%CI: 0,15; 0,4], р&lt;0,0001) and AP (ρ=0,181 [95%CI: 0,05; 0,31], р=0,006) – fig.3. Hypophosphatemia was seen much more frequently during the first year after transplantation than in long-term period (30,3% vs 6,4% respectively, р=0,0002). Serum P level varied significantly in groups with different eGFR (p&lt;0,0001, Kruskall-Wallis test), increasing in parallel with declining of transplant function – fig.4. The percentage of patients within a target range of AP amounted to 54%, above the target range – 40,7%. In total, only 6,8% of our cohort had all laboratory parameters within the target range.

Conclusion
We observed a high prevalence of biochemical abnormalities in kidney transplant patients confirming that transplantation itself does not cure mineral and bone disorders in CKD patients.
MO565M2 MACROPHAGES REGULATE MOUSE AORTIC SMOOTH MUSCLE CELL CALCIFICATION BY TRANSMITTING SENESCENCE INFORMATION
Authors: Fang Yaping , Zhu Xiaodong , Zhao Yu , Zhang Xiao liang 
Published: May 2021

Abstract

Background and Aims
Vascular calcification is highly prevalent in chronic kidney disease (CKD)with high morbidity and mortality. Complex pathological mechanisms are involved in the development of vascular calcification, including aging. Previous work have indicated that M2-macrophage promote mouse aortic smooth muscle cells (MAoSMCs) calcification. The present study aimed to understand the contribution of M2-macrophage to MAoSMCs calcification by focusing on the mechanisms underlying the transmitting senescence information

Method
The expression of IFITM3 and P16, marker of aging, in aging macrophages were confimed by RT-qPCR, western blotting and immunofluorescence staining. Then, the MAoSMCs were co-cultured with the supernatant of M2 macrophages. The expression of IFITM3 and P16 in MAoSMCs also were detected. Alizarin red staining and calcium content assay were used to analyse MAoSMCs calcification. We modulated the expression of IFITM3 using siRNAs to study M2-macrophages function in regulating MAoSMCs calcification.We detected the expression of IFITM3 and P16 in co-cultivate MAoSMCs and validate intracellular calcium contents by calcium test kit.

Results
In the present study, we observed a significant increase in the expression of IFITM3 and P16 expression in M2 macrophages.Compared with M0 and M1 macrophages, the expression of IFITM3 and P16 at lowlevel. Alizarin red staining and calcium content assay revealed that M2 macrophage-mediated IFITM3 and P16 overexpression led to an apparent VSMC calcification in the presence of M2 macrophages medium.By contrast, inhibition of IFITM3 by siRNAs significantly blocked calcification of VSMCs in vitro. Moreover, we found that aging macrophages that overexpressed of IFITM3 and P16 increased in rats with CKD. Furthermore, pharmacological inhibition of aging signal was shown to block IFITM3-induced VSMC calcification. These findings demonstrate for the first time that M2 macrophage-mediated IFITM3 contributes to vascular calcification through a mechanism involving transmitting Senescence signalling.

Conclusion
Collectively, our present study demonstrated that the functional importance of M2 macrophage-IFITM3 dependent vascular calcification and provided a novel mechanistic insight to the macrophage senescence in CKD.
MO570PULSE PRESSURE: A PREDICTOR OF CARDIOVASCULAR CALCIFICATION AND CARDIOVASCULAR MORTALITY IN HEMODIALYSIS PATIENTS
Authors: Rroji (Molla) Merita , Seferi Saimir , Cafka Majlinda , Likaj Erjola , Cadri Vilma , Barbullushi Myftar 
Published: May 2021

Abstract

Background and Aims
The mortality rate is extremely high in chronic kidney disease (CKD), primarily due to the high prevalence of cardiovascular disease (CVD). Increased pulse pressure (PP), defined as the difference between inappropriately elevated systolic blood pressure (SBP) and reduced diastolic blood pressure (DBP) at any value of mean arterial pressure (MAP), is a surrogate measure of increased arterial stiffness of central elastic arteries (aorta and its major branches). CKD-MBD anomalies leading to calcification contribute to increased arterial stiffness and pulse pressure. This study aimed to evaluate the relationship of pulse pressure parameter with valve calcification and abdominal aortic calcification in hemodialysis patients and its impact on cardiovascular mortality.

Method
We performed a prospective case series study with 3 years follow- up. Plain X-ray images of the lateral lumbar spine from all subjects were studied to obtain images of the lower abdominal aorta using semiquantitative scores as described by Kauppila et al. Cardiac valve calcifications were evaluated by two-dimensional echocardiography with an HDI 5000 Sono CT echocardiographic machine with a 3.3-MHz multiphase array probe in subjects lying in the left decubitus position an according to the recommendations of the European Association of Echocardiography. The patient was evaluated as having vascular calcification if he had the presence of calcification in at least one of the site examined: a mitral valve, aortic valve or abdominal aorta.

Results
We studied 85 chronic stable hemodialysis patients. Mean age and meantime is therapy was 49.9±12.4 years and 51.5±28.7 months, respectively. Mean pulse pressure was 55.72±14.2 mmHg. Fifty-nine patients (69.4%) were identified with aortic abdominal calcification, and the mean Kauppila score was 4.91 ± 4.05. Sixty patients (70.5%) had at least one valve calcified, while thirty-three patients (38.8%) had both valves calcified. Univariate analysis revealed that every 1 mmHg increase in pulse pressure was associated with increased cardiovascular calcification risk p=0.020. In multivariate analysis, after adjustment for age, gender, diabetes mellitus, cholesterol, and triglyceride serum levels, the association also remained strong, where every increase of 1 mm Hg in pulse pressure was associated with increased risk for cardiovascular calcification (HR 1.02, 95% CI (1.00-1.03), p= 0.038). Besides, pulse pressure was an independent predictor for cardiovascular mortality (HR 1.03, 95% CI (1.02-1.05), p=0.002).

Conclusion
Pulse pressure may identify hemodialysis patients with subclinical cardiovascular calcification who need further evaluation. Wide pulse pressure is associated with increased cardiovascular mortality.
MO490SYMPTOM BURDEN AND ITS IMPACT ON QUALITY OF LIFE IN PATIENTS WITH MODERATE TO ADVANCED CKD
Authors: Speyer Elodie , Tu Charlotte , Zee Jarcy , Sesso Ricardo , Lopes Antonio , Hoshino Junichi , Ayav Carole , Pisoni Ronald , Pecoits-Filho Roberto , Stengel Benedicte 
Published: May 2021

Abstract

Background and Aims
It is generally considered that the early stages of CKD are asymptomatic, and that CKD becomes apparent once kidney function is significantly impaired, but large-scale studies in real-world non-dialysis CKD patients under nephrology care are still scarce. We evaluated symptom burden and its impact on quality of life in patients with moderate to advanced CKD.

Method
4423 patients with CKD Stage 3 to 5 from Brazil (N=548), France (N=2691), and the US (N=1184) enrolled in the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps) from 2013-2019 completed the Kidney Disease Quality of Life (KDQOL) questionnaire at baseline to assess how much they were bothered by 13 symptoms. Response options ranged from “not at all” to “extremely” bothered. From these Symptoms/Problems of Kidney Disease items, a score was calculated, ranged from 0 to 100, and analyzed in 3 categories: low (≥90), intermediate (66-90), or high symptom burden (&lt;66). Poisson regressions were used to estimate prevalence ratios for each symptom and to study associations between CKD stage and a high symptom burden before and after adjusting for demographics and major comorbidities. Multiple linear regression accounting for clustering at the clinic level was used to examine associations between high symptom burden and physical and mental component summary (PCS and MCS, respectively) scores, with lower scores indicating poorer quality of life.

Results
Patients (mean age 68±13 years, 40% women, mean eGFR at baseline 30.4±12.2 mL/min/1.73m²) were very much to extremely bothered by a number of symptoms, the prevalence of three of which - washed out or drained, nausea or upset stomach, and lack of appetite – significantly increased in more advanced CKD stages before and after adjusting for confounders (Figure). Nearly one in four patients reported a high symptom burden, which was more prevalent in women, those with obesity, anemia, or albumin&lt;3.5 g/dL; it was also more common in France than in the US and Brazil. In adjusted models, as compared to patients with low symptom burden, those with high symptom burden had a worse quality of life with PCS and MCS scores 14.6 (95% confidence interval [95% CI], 15.7 to 13.5) and 7.2 (95% CI, 8.3 to 6.1) points lower, respectively.

Conclusion
Our findings demonstrate a high symptom burden even in nondialysis CKD stages 3-5 with a substantial impact on physical and mental health-related quality of life. Several symptoms, particularly fatigue, and gastrointestinal symptoms, appeared to worsen with increasing CKD stage, independent of patient comorbidities.
MO499CKD-MBD BIOMARKERS AND CKD PROGRESSION: AN ANALYSIS BY JOINT MODELS
Authors: D'Arrigo Graziella , Mallamaci Francesca , Pizzini Patrizia , Versace Maria Carmela , Tripepi Giovanni Luigi , Zoccali Carmine , Mauro Working Group Of behalf of 
Published: May 2021

Abstract

Background and Aims
Biomarkers of the Chronic Kidney Disease – Bone Mineral Disorder (CKD-BMD)-including serum phosphate, calcium, PTH, 1,25 vitamin D, alkaline phosphatase and FGF23- have been implicated in CKD progression in follow up studies focusing on single measurements made at baseline only. The relationship between the time trend of these biomarkers over the course of CKD and renal outcomes has never been tested.

Method
In this study we applied the joint model, an approach combining the mixed linear model (MLM) and Cox’s regression analysis, to investigate the longitudinal relationship between repeated measurements (median 3, interquartile range 2-5) of serum phosphate, calcium, PTH and alkaline phosphatase and a composite renal outcome measure (eGFR reduction &gt;30%, dialysis or transplantation) cohort of 729 stage 2-5 CKD patients (average eGFR = 36±13 ml/min/1.73 m2) over a 2.4 year follow up. Data were adjusted for traditional and CKD specific risk factors in models including also baseline serum 1,25 vitamin D and FGF23.

Results
On univariate MLM analyses, serum PTH was the sole CKD-BMD biomarker which significantly changed over time [b=0.030 (95% CI from 0.018 to 0.041), p&lt;0.001]. In the multivariate mixed linear sub-model of the Joint Model, repeated measurements of PTH were related directly with male gender (P=0.033), alkaline phosphatase (P&lt;0.01) and systolic BP (P=0.004) and inversely with calcium (P&lt;0.001), baseline eGFR (P&lt;0.001), and CRP (P&lt;0.045). In the survival analysis sub-model of the joint model, the longitudinal series of PTH valuesover time were directly related to the incidence rate of renal events [HR (1 ln increase in PTH)=3.358 (95% CI from 2.628 to 4.293), p&lt;0.001] and this was also true after data adjustment for a series of potential confounders [HR (1 ln increase in PTH)=2.25 (95% CI from 1.524 to 3.321), p&lt;0.001]. In this analysis, also serum phosphate, baseline FGF23, proteinuria, baseline 1.25 vit D, calcium, and haemoglobin were significantly related to the incidence rate of renal events and these relationships were all independent of the baseline eGFR.

Conclusion
In this longitudinal study in stage 2-5 CKD patients investigating the links of CKD-MBD biomarkers with a composite renal outcome, PTH was the sole variable to show a linear increase overtime and to be directly related with the same outcome. Even though stable over-time, also the longitudinal series of serum phosphate (in a direct fashion) and calcium (in an inverse fashion) values were related to the same outcome as it were baseline FGF23 and 1.25 vit D. Findings in this longitudinal study further underscore the potential relevance of CKD-MBD biomarkers as risk factors for CKD progression.
MO501INCREASED ALBUMINURIA RISK IN CHRONIC KIDNEY DISEASE PATIENTS WHOSE WHITE COAT-, MASKED-, AND SUSTAINED HYPERTENSION: SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Putra Boby Pratama , Putra Felix Nugraha 
Published: May 2021

Abstract

Background and Aims
Latest classification of hypertension based on ambulatory blood pressure measurement was normotension (NT), white coat hypertension (WCHT), masked hypertension (MHT), and sustained hypertension (SHT). Recent studies suggest that WCHT, MHT, and SHT increase risk of target organ damage, particularly albuminuria, although the results were still inconsistent. Albuminuria is not only the sign of early glomerular damage in CKD patients, but also the signs of hypertension progression and predictors for cardiovascular events mortality. This study aims to compare the albuminuria risk among NT and WCHT, MHT, also SHT in CKD patients.

Method
We searched the literature comprehensively in online databases of Pubmed, EMBASE, ScienceDirect, and Cochrane Library to include all relevant studies using predefined terms until December 2020. We included studies that analyzed the albuminuria risk and compared the log2 urinary albumin-to-creatinine ratio (ACR) among NT and WCHT, MHT, or SHT in CKD patients. We used the Newcastle-Ottawa Scale for Observational Study checklist for evaluating bias risks. Analysis of the studies was conducted to provide pooled Odds Ratio (OR) for albuminuria risk and standard mean difference (SMD) for log2 ACR comparison with 95% Confidence Interval (CI) with random-effect heterogeneity test.

Results
We included 7 observational studies met our inclusion criteria. WCHT increases albuminuria risk although not statistically significant (pooled OR = 1.72, 95%CI 0.97 to 3.07, p = 0.06, I2 = 75%), while MHT and SHT significantly increase albuminuria risk with pooled OR respectively 1.62 (95%CI 1.03 to 2.53, p = 0.04, I2 = 82%) and 3.17 (95%CI 1.66 to 6.05, p = 0.0005, I2 = 94%). Controlled hypertension significantly protects CKD patients against albuminuria risk based on log2 ACR comparison with WCHT (SMD = 0.52, 95%CI 0.38 to 0.67, p&lt;0.00001, I2 = 0%), MHT (SMD = 0.34, 95%CI 0.19 to 0.49, p&lt;0.0001, I2 = 39%), and SHT (SMD = 0.63, 95%CI 0.31 to 0.95, p=0.0001, I2 = 76%).

Conclusion
White coat hypertension, masked hypertension, and sustained hypertension increase albuminuria risks in CKD patients. However, further studies are needed to determine the causality.
MO503SAFETY AND EFFICACY OF ANTICOAGULATION IN PATIENTS WITH EGFR&lt;30 ML/MIN/1.73 M2 AND ATRIAL FIBRILLATION
Authors: Freese Ballegaard Ellen Linnea , Bjerring Olesen Jonas , Kamper Anne Lise , Feldt-Rasmussen Bo , Gislason Gunnar , Torp-Pedersen Christian , Carlson Nicholas 
Published: May 2021

Abstract

Background and Aims
Net benefit of anticoagulation in patients with eGFR &lt;30 ml/min/1.73 m2 and atrial fibrillation remains uncertain. The aim of this study was to evaluate the use, efficacy and safety of anticoagulation therapy in patients with eGFR&lt;30 ml/min/1.73m2 (including dialysis treated patients) and atrial fibrillation.

Method
In a retrospective cohort study, all patients with atrial fibrillation and eGFR&lt;30 ml/min/1.73 m2 were identified in nationwide Danish registers between 2008 and 2018. Cumulative incidences of stroke and major bleeding stratified on anticoagulation treatment were computed using the Aalen-Johansen estimator. One-year risks of stroke and major bleeding were calculated with comparison of treatment vs. no treatment based on Cox regression models adjusted for age, sex and dialysis status with G-computation of one-year risks standardized to the distribution of risk factors in the sample. Major bleeding was defined as any diagnosis of bleeding leading to hospitalization.

Results
A total of 2,452 patients with eGFR &lt;30 ml/min/1.73 m2 and de novo atrial fibrillation were identified. Mean age was 78.8 years, 51.3% were male and 20% received dialysis therapy. Anticoagulation therapy was initiated in 877 patients (35.8%), with warfarin accounting for 58.6% of all prescriptions.
Overall, one-year standardized risk of bleeding was 10.6% (95% confidence interval (CI) 8.7%-12.7%) and 8.2% (95% CI 6.9%-9.5%) in patients with and without anticoagulation, while the risks of stroke were 3.6% (95% CI 2.6%-4.5%) and 5.1% (95% CI 4.1%-6.1%), respectively.
In subgroup analyses of patients dependent vs. non-dependent on dialysis, the standardized one-year risk of bleeding was 13.3% (95% CI 9.0%-19.8%) vs. 10.4% (95% CI 8.6%-12.4%) in patients with anticoagulation and 9.0% (95% CI 6.5%-12.0%) vs. 7.8% (95% CI 6.5%-9.2%) in patients without anticoagulation. While the risk of stroke was 3.5% (95% CI 0.8%-6.7%) vs. 3.5% (95% CI 2.5%-4.9%) in patients with anticoagulation and 5.7% (95% CI 3.5%-7.8%) vs. 4.9% (95% CI 3.7% vs. 6.3%) in patients without anticoagulation. Cumulative incidences of major bleeding and stroke are shown in the figure.

Conclusion
Use of anticoagulation was associated with increased risk of bleeding and reduced risk of stroke in patients with eGFR&lt;30 ml/min/1.73 m2 and atrial fibrillation. Randomized controlled trials are needed to establish the benefit and harm of anticoagulation in this population.
MO504LOW BIRTH WEIGHT ASSOCIATES WITH SMALLER KIDNEY SIZE IN MIDDLE-AGED WOMEN
Authors: Lillås Bjørn Steinar , Qvale Tor Hatlestad , Richter Blazej Konrad , Vikse Bjørn Egil 
Published: May 2021

Abstract

Background and Aims
Low birth weight is associated with increased risk of kidney disease due to lower nephron endowment leading to hyperfiltration and subsequent nephron loss. Nephron number is thought to associate with kidney size. We compared kidney size measured by magnetic resonance imaging (MRI) with ultrasonography and measured glomerular filtration rate (mGFR) in adults with normal versus low birth weight.

Method
Healthy individuals aged 42-52 years with Low birth weight (LBW – 1100-2300g) and normal birth weight (NBW - 3500-4000g) were invited. GFR was measured using plasma clearance of iohexol. Kidney volume was measured on MRI images using axial T2 images and coronal T1 images with fat saturation without contrast enhancement, calculations were performed according to the ellipsoid formula - π/6 x Length x Width x Depth. Ultrasonographic imaging was done using a dorsal approach. In the maximal longitudinal view the parenchymal area was calculated subtracting the area of a manual tracing around the renal pelvis from the area of a manual tracing of the whole kidney. Volume and area from the two kidneys were added and total value was used for analyses. Kidney size measurements were compared between the two groups of LBW vs NBW, and analysis using Pearson’s correlation coefficient R between kidney volume and measured GFR and parenchymal area was performed.

Results
We included 102 individuals (54 LBW, 48 NBW). Total kidney volume was 302 ± 51 ml for female NBW vs 258 ± 48 ml for female LBW (p=0.002). For men, total kidney volume was 347 ± 51 ml vs 340 ± 65 ml (p=0.7). Measured GFR was significantly associated with kidney volume with R=0.52 (p&lt;0.001) for women and R=0.39 (p=0.007) for men. Kidney parenchymal area measurements using ultrasonography showed similar results with an R=0.77 between the MRI and the ultrasonography measurement and similar differences for sex and birth weight were seen.

Conclusion
Healthy middle-aged females born with LBW have smaller kidneys than healthy middle-aged females born with NBW, no difference were seen for males. Kidney volume associate with measured GFR.