bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO505IMPACT OF THE COVID-19 PANDEMIC ON SYMPTOMS OF ANXIETY AND DEPRESSION AND HEALTH-RELATED QUALITY OF LIFE IN OLDER PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Voorend Carlijn , Van Oevelen Mathijs , Nieberg Margot , Meuleman Yvette , Franssen Casper , Joosten Hanneke , Berkhout-Byrne Noeleen , Abrahams Alferso C , Bos Willem Jan W , Van Buren Marjolijn 
Published: May 2021

Abstract

Background and Aims
Older patients with advanced chronic kidney disease (CKD) are at increased risk for a severe course of the coronavirus disease-2019 (COVID-19) and vulnerable to mental health problems. We aimed to investigate prevalence and associated patient (demographic and clinical) characteristics of mental wellbeing (health-related quality of life [HRQoL] and symptoms of depression and anxiety) before and during the COVID-19 pandemic in older patients with advanced CKD.

Method
An ongoing Dutch multicentre prospective cohort study enrols patients of ≥70 years with an eGFR &lt;20 mL/min/1.73m2 from October 2018 onward. With additional questionnaires during the pandemic (May-June 2020), disease-related concerns about COVID-19 and general anxiety symptoms were assessed cross-sectionally, and depressive symptoms, HRQoL, and emotional symptoms longitudinally.

Results
The 82 included patients had a median age of 77.5 years (inter-quartile range 73.9-82.1), 77% was male and none had tested positive for COVID-19. Cross-sectionally, 67% of the patients reported to be more anxious for COVID-19 because of their kidney disease, and 43% of the patients stated that their quality of life was reduced due to the COVID-19 pandemic (Figure 1). Higher COVID-19-related stress was associated with a lower education level (p=0.036), and patients who reported to feel more down due to COVID-19 were more often female (p=0.020). Anxiety scores were higher among females compared to males (median 4.0 [IQR 3.0-9.0] versus 2.0 [0.0-6.0], p=0.020), and weakly associated to a decline in eGFR (correlation coefficient 0.197, p=0.023).
Compared to pre-COVID-19, presence of depressive symptoms had increased (11% to 22%; p=0.022) and physical HRQoL declined (40.4±10.1 to 36.1±10.4, p&lt;0.001). Mental HRQoL (50.3±9.6 to 50.4±9.9; p=0.913) and emotional symptoms remained similar. Males showed a greater decline in physical HRQoL (mean -5.3, SD 8.5) compared to females (mean -0.9, SD 5.7; p=0.039).

Conclusion
Our findings show that older patients with advanced CKD suffered from disease-related anxiety for COVID-19, increased depressive symptoms, and reduced physical HRQOL during the COVID-19 pandemic. The impact of the pandemic on this vulnerable patient group extends beyond increased mortality risk, and awareness of mental health problems during the pandemic is essential. More in-depth investigation on disease-related COVID-19 concerns and its implications for the CKD population is needed.
MO506RELATIONSHIP BETWEEN SODIUM CONSUMPTION, PRO-INFLAMMATORY PARAMETERS AND KIDNEY DISEASE IN THE JACKSON HEART STUDY
Authors: Wenstedt Eliane , Vogt Liffert 
Published: May 2021

Abstract

Background and Aims
Kidney disease is thought to be linked to inflammation. Pro-inflammatory parameters like C-reactive protein (CRP), endothelin-1, and TNF-a inversely associate with kidney function cross-sectionally and some have predictive value for longer-term kidney outcomes. Given the recently argued pro-inflammatory effect of sodium, we questioned whether sodium consumption has a role in the relationship between pro-inflammatory parameters and renal outcomes.

Method
Our research question was investigated using the Jackson Heart Study, which is a large prospective cohort study involving n=5301 Afro-Americans residing in Jackson, Mississippi, US. Spot urine sodium was used to estimate 24-hour sodium excretion with the Kawasaki formula, serving as a proxy for sodium consumption, and was available for n=1831 participants (depicting a random sample of the total population) that had a median follow-up of 8 years. Multiple linear regression was used to assess the relationship between sodium consumption and pro-inflammatory parameters. The parameters available for this cohort involved endothelin-1, high-sensitivity CRP, and leukocyte subsets (monocytes, neutrophils, and lymphocytes). Models were adjusted for potential confounders, involving sex, age, body mass index, estimated potassium intake, smoking status, and presence of diabetes. Subsequently, linear regression analyses between pro-inflammatory parameters and baseline estimated glomerular filtration rate (eGFR CKD-EPI) and change during follow-up were carried out with and without adjustment for sodium consumption as a confounder, to explore the possibility of a causal mediating pathway.

Results
Increased sodium consumption significantly associates with increased serum endothelin-1 levels in both unadjusted and adjusted models (Table 1). There was no association between sodium consumption and leukocyte subsets. There was a negative association between sodium consumption and CRP (Table 2). CRP was not associated with eGFR at baseline (p=0.20) or eGFR change from baseline (p=0.20). Endothelin-1 was inversely associated with eGFR at baseline (beta -0.06, p&lt;0.001) and with eGFR change from baseline (beta 2.3 p=0.03). However, when these models were corrected for sodium consumption, endothelin-1 was no longer a significant predictor (beta -0.01 p=0.4 for eGFR at baseline) or was inversed (beta -0.1; p=0.001 eGFR during follow-up).

Conclusion
In this prospective cohort of Afro-Americans, increased sodium consumption is associated with increased circulating endothelin-1 levels. If this relationship proves to be causal (as suggested by animal sodium loading studies), this implies that sodium consumption may (at least partly) be underlying the relationship between endothelin-1 and worse renal outcomes.
MO509DOSE-RESPONSE RELATIONSHIP BETWEEN ALCOHOL CONSUMPTION AND THE RISK OF DEVELOPING CKD: RETROSPECTIVE COHORT STUDY
Authors: Hashimoto Yusaku , Imaizumi Takahiro , Hori Akihiro , Kato Sawako , Yasuda Yoshinari , Maruyama Shoichi 
Published: May 2021

Abstract

Background and Aims
Drinking habits are one of the most important modifiable lifestyle factors to prevent the development of chronic kidney disease (CKD). Previous studies showed that it was inversely associated with the risk of developing CKD, but the dose-response relationship between alcohol consumption and the development of CKD is still controversial. In the present study, we aimed to examine whether the amount of alcohol consumed at one time is associated with new onset of CKD in general population.

Method
Study subjects were 11,162 Japanese aged 45 to 74 years, with an estimated glomerular filtration rate ≥60 mL/min/1.73m2, no proteinuria, no past history of cardiovascular disease, COPD or liver disease. The drinking status was obtained by self-administered questionnaires. We categorized the study subjects into four groups based on the amount of alcohol consumption: &lt;20g/time of ethanol equivalent (lowest); 20-40g/time (low intermediate); 40-60g/time (high intermediate); &gt;60g/time (highest). We set non-drinkers as a reference category. The primary outcome was the incidence of CKD, defined as 25% reduction of eGFR and to less than 60 mL/min/1.73 m2 and/or a dipstick urinalysis score of 1+ or greater (equivalent to ≥30 mg/dL) during the follow up period. We employed Cox proportional hazards regression models to examine the dose-response relationship between baseline alcohol consumption and the risk of CKD. Trend tests were performed using Cox proportional hazards regression models that treated alcohol consumption as a continuous linear term.

Results
Lowest and low intermediate groups were significantly associated with a decreased risk of CKD (hazard ratio [HR] 0.84; 95% confidence interval [CI], and 0.71–0.99; HR 0.79; 95% CI, 0.66–0.96, respectively) compared to non-drinkers. High intermediate group was associated with a decreased risk of CKD (HR 0.92; 95% CI, 0.70–1.21), and highest group was associated with an increased risk of CKD (HR 1.28; 95% CI, 0.84–1.95), but these associations did not reach statistical significance. There was no dose-response relationship between baseline alcohol consumption and risk of CKD (P-trend = 0.30).

Conclusion
A J-shape association was observed between self-reported alcohol intake and the incidence of CKD. Moderate alcohol consumption at one time may help reduce the risk of CKD.
MO510OLFACTORY AND GUSTATORY DYSFUNCTION AMONG PATIENTS WITH KIDNEY IMPAIRMENT
Authors: Chewcharat Api , Phipps Elizabeth , Bhatai Khushboo , Nigwekar Sagar 
Published: May 2021

Abstract

Background and Aims
Poor appetite and food aversion are common in chronic kidney disease patients. Olfactory and gustatory function changes might be attributed to poor appetite among this population. Nevertheless, the associations between impaired kidney function and olfactory and gustatory dysfunction are less clear. Moreover, the prevalences of olfactory and gustatory dysfunction among patients with impaired kidney function have not been reported.

Method
We conducted a cross-sectional study among 3,529 US adults aged ≥ 40 years old in the National Health and Nutrition Examination Survey (NHANES) 2013-2014. We calculated the prevalences of olfactory and gustatory dysfunction among patients with impaired kidney function aged ≥ 40 years old by using analytic survey weights and design factors. We also examined the association between impaired kidney function and olfactory and gustatory dysfunction as well as the association between olfactory and gustatory dysfunction and nutritional markers among patients with impaired kidney function using weighted multivariable linear regression and logistic regression.

Results
The prevalences of olfactory impairment and gustatory dysfunction among impaired kidney function participants were 25% and 14%, respectively. After adjusting for confounders, impaired kidney function was significantly associated with higher odds of olfactory dysfunction (OR = 1.29, 95% CI [1.03, 1.60]; p=0.04) but not gustatory dysfunction (OR = 1.41, 95%CI [0.96, 2.09]; p=0.08). Among impaired kidney function population, olfactory dysfunction was significantly associated with lower serum albumin and grip strength but not serum total cholesterol, LDL-cholesterol or protein-energy malnutrition. However, gustatory dysfunction was not significantly associated with any nutritional markers among the impaired kidney function population. (Figure 1)

Conclusion
Impaired kidney function was associated with higher odds of olfactory but not gustatory dysfunction. Among those with impaired kidney function, only olfactory but not gustatory dysfunction was associated with lower serum albumin and grip strength.
MO512THE RENAL CONSEQUENCES OF LUNG TRANSPLANTATION IN ADULT CYSTIC FIBROSIS PATIENTS
Authors: Novel Etienne , Pelletier Solenne , Koppe Laetitia , Nove Josserand Raphaele , Reynaud Quitterie , Fouque Denis , Durieu Isabelle 
Published: May 2021

Abstract

Background and Aims
Cystic fibrosis patients are at high risk for chronic kidney disease (CKD), because of chronic aminoglycoside exposure, high protein and dietary salt intake, and Cystic Fibrosis Related Diabetes. Lung transplantation also entails a high renal burden in the long run because of calcineurin inhibitors exposure. We aimed at studying kidney function by gold standard glomerular filtration rate (mGFR) before and 1 year after lung transplantation, as well as identify risk factors for kidney function impairment.

Method
Patients from the Cystic Fibrosis reference center in Lyon, France were systematically referred to the nephrology department before lung transplantation. mGFR (iohexol or inulin clearance) was performed before and 12-18 months after lung transplantation. Risk factors for a worse nephrological outcome (i.e. post transplantation mGFR &lt; 60mL/min/1.73m²) were searched for.

Results
28 patients (10 males), mean age 32 yr, underwent pre transplantation mGFR. Three died following lung transplantation and two progressed to end stage renal disease rapidly thereafter. 23 patients benefited from both pre and post transplantation mGFR.
Mean mGFR was 105±21mL/min/1.73m² and 67±19 mL/min/1.73m² before and after transplant respectively. Factors associated with a worse renal outcome in both univariate and multivariate analysis were age at transplantation (p=0.03) and the occurrence of acute kidney injury in the post-operative period (p=0.005). Cumulated aminoglycoside exposure and time spent under cardiopulmonary bypass were not associated with renal outcome.

Conclusion
Lung transplantation is associated with a high renal burden in adult Cystic Fibrosis patients. We advise a clinical referral to a nephrologist as part of the systematic evaluation in lung transplantation candidates even if GFR is in the normal range.
MO517EFFECT MODIFIERS OF SERUM POTASSIUM AND MORTALITY IN THE IRISH HEALTH SYSTEM: THE NATIONAL KIDNEY DISEASE SURVEILLANCE SYSTEM (NKDSS)
Authors: Browne Leonard , Stack Austin 
Published: May 2021

Abstract

Background and Aims
Serum potassium (K+) exhibits a u-shaped association with mortality but uncertainty exists regarding optimal thresholds for survival and influencing factors. We examined the impact of serum K* on mortality in the Irish Health System with particular focus on kidney function and location of medical supervision.

Method
We utilised data from the Irish Kidney Disease Surveillance System (NKSS) to explore the association of serum K+ and mortality in a longitudinal cohort study.
We identified all adult individuals (age &gt; 18 years) who accessed health care from 2007 and 2012 in a regional health system with complete data on serum K+, associated laboratory indicators and vital status up to 31st December 2013 (n = 32,643). We randomly selected a single K+ measurement per patient with date of measurement as index date. Chronic kidney disease was defined as eGFR &lt;60ml/min/1.73m² vs greater recorded at index date. Location of medical supervision was recorded as emergency room, inpatient location; outpatient clinic, and general practice location. The association of serum K+ was explored in categories and as a continuous variable in restricted cubic splines with mortality. Multivariable Cox regression determined hazard ratios and 95% confidence intervals with adjustment for baseline health indicators.

Results
Mean age was 57.1 years, 5,056 died (15.4%) with a median follow-up of 5.1 years.
With adjustment, for age, sex, baseline health status, and location of medical supervision, the pattern of mortality was non-linear and u-shaped with greatest risks for patients with extreme values. Modelled as a continuous variable, the serum K +thresholds for optimal survival were from 4.1 to 5.2 mmol/L. Compared to patients without baseline CKD, the risks were attenuated for patients with CKD (p-value interaction 0.012). The associated risk thresholds were wider for CKD patients with significant increased risk above 5.8 mmol/L whereas, for those without CKD, serum K +thresholds for optimal survival were between 4.2-5.4 mmol/L. Similarly, mortality patterns were greatly attenuated for patients who were managed in the outpatient and general practice locations (p-value interaction &lt;0.001) than the emergency room or inpatient settings (Figure 1).

Conclusion
Risk thresholds for optimal survival for serum K+ vary according to CKD and location of medical supervision in real-world clinical cohorts. Better understanding of these thresholds and effect modifiers are essential for inform decision making and therapeutic interventions.

Funding Source
Health Research Board (HRB-SDAP-2019-036), Midwest Research and Education Foundation (MKid), Vifor Pharma.
MO519THE COST OF CHRONIC KIDNEY DISEASE BEFORE RENAL REPLACEMENT THERAPY IN MOROCCO: A COST OF ILLNESS STUDY
Authors: Chrifi Alaoui Amina , Omari Mohammed , Qarmiche Noura , Kouiri Omar , Chouhani Basmat Amal , Sqalli Houssaini Tarik , El Fakir Samira , Tachfouti Nabil 
Published: May 2021

Abstract

Background and Aims
Chronic kidney disease (CKD) is a leading public health problem in Morocco, its consequences and costs have implications for public health policy. The present study aimed to estimate the social cost of CKD before the start of renal replacement therapy in a Moroccan region.

Method
A cross-sectional cost of illness study, using bottom-up approach was performed at the department of nephrology in university hospital of Fez during 2020, among stages 3 to 5 CKD patients, followed up for at least one-year. The analyzed costs include the following annual expenditures: hospitalizations, outpatient visits, day care hospital, drugs, laboratory tests, imaging, and medical specialized acts. Non-medical costs such as transportation and indirect costs like loss of productivity were also assessed. Determinants of CKD cost were identified by univariate analysis using t test, ANOVA or non-parametric tests, p &lt; 0.05 is the level of statistical significance.

Results
Eighty-eight patients were included (63.6% women, mean age: 61.8±14.0 years), 76.1% were on CKD stage 4 or 5. The estimated annual social cost of CKD was 2231,12 US$ (95% CI, 1676,09-2793,93 US$). The direct cost accounted for 99,5% (direct medical cost: 91,2%, direct non-medical cost: 8,3%), and the indirect cost accounted for 0,5 % of the social cost. Hospitalizations, diagnosis and treatments represented the main expenses of the direct medical cost (32,2%, 29,7%, 32,2% respectively). The social cost components were not significantly different between CKD stages.

Conclusion
The cost of CKD in its early stages still lower than the cost of renal replacement therapy, which brings the light on the necessity of secondary prevention of CKD to postpone or prevent the progression toward ESRD.
MO521OUTCOME OF CHRONIC KIDNEY DISEASE PATIENTS WITH SARS COV-2 INFECTION- A SINGLE CENTRE EXPERIENCE
Authors: Bjedov Jelena , Bulatovic Ana , Maslarevic Radovic Vesna , Dimkovic Nada , Naumovic Radomir 
Published: May 2021

Abstract

Background and Aims
Since the outbreak of COVID 19 there have been 88.1 million confirmed cases and 1,9 million deaths in 218 countries, while in Serbia we have had 39.867 cases of COVID 19 and 3479 deaths with approximate death rate of 1%. Fatality rate worldwide vary widely, from 0% in Singapore to 8,8% in Mexico with the average value of 3%. Although there are many published studies about COVID 19, influence of chronic kidney disease and chronic dialysis on outcome of patients with the coronavirus infection is still not clear. The aim of this study was to explore whether the presence of CKD including ESRD and chronic dialysis treatment increases COVID 19 patients’ risk for adverse clinical outcome.

Method
This retrospective study included 88 patients who were hospitalized at the Nephrology department in Zvezdara University Clinical Center which was transformed into a COVID hospital at the time. These patients were treated from 01.04.2020. to 01.06.2020. and 37 (42%) of them had CKD, while 51 (58%) had no signs of kidney disease. We analysed data collection from the patients’ history, including age, sex, comorbidities, symptoms, blood and radiology findings, therapy and outcome. We compared outcome (fatal and need for mechanical ventilation) between CKD and non CKD group and also analized dialysis as a risk factor for adverse outcome. Statistical analysis has been performed using SPSS software version 20 and OR was calculated using Logistic Regression.

Results
We analysed 88 patients, a mean age of 62+15 years, 59.1% males. Out of 88 patients, 37 had CKD, while 27 of them were on hemodialysis and 2 on peritoneal dialysis (CAPD). At the end of follow-up, 46 patients (52.3%) was discharged home, 27 (30.7%) was transferred to another hospital and 14 (15.9%) died. Regarding influence of CKD on COVID-19 patients’ outcome it was shown that patients with CKD had 3-fold higher chances for discharge than for the fatal outcome (p=0.05) and 4-fold less risk for use of the mechanical ventilation (ns) as compared to non CKD patients. We also found that ESRD and chronic dialysis affect outcome with statistical significance (p=0.01) in a way that it doubles the risk for the adverse outcome.

Conclusion
Patients with CKD, especially those with ESRD had significantly higher risk for the lethal outcome and higher chances to require the mechanical ventilation.
MO523PATIENTS FROM COVID-19 MOSTLY RECOVER FROM TUBULAR PROTEINURIA AND ACUTE KIDNEY INJURY AFTER HOSPITAL DISCHARGE
Authors: Bouquegneau Antoine , Huart Justine , Lutteri Laurence , Erpicum Pauline , Grosch Stéphanie , Résimont Guillaume , Wiesen Patricia , Thys Marie , Rousseau Anne-Françoise , Bovy Christophe , Krzesinski Jean-Marie , Lambermont Bernard , Misset Benoit , Pottel Hans , Darcis Gilles , Cavalier Etienne , Jouret François , Delanaye Pierre 
Published: May 2021

Abstract

Background and Aims
Proteinuria, hematuria and acute kidney injury (AKI) are frequently observed in hospitalized patients with COVID-19. However, few data are available on these parameters after hospital discharge.

Method
This retrospective, observational and monocentric study included 153 hospitalized patients, in whom urine total proteinuria and α1-microglobulin (a marker of tubular injury) were measured. Thirty patients died. Among the 123 survivors, follow-up urine and creatinine analyses were available for 72 patients (after a median of 51 [19;93] days following hospital discharge).

Results
The median proteinuria at hospitalization and follow-up (n=72) was 419 [239; 748] and 79 [47; 129] mg/g, respectively (p&lt;0.0001). The median concentrations of urinary α1-microglobulin (n=66) were 50 [25; 81] and 8 [0; 19] mg/g, respectively (p&lt;0.0001). Estimating glomerular filtration rate (eGFR) was lower during the hospitalization compared to the follow-up: 81 [62; 92] versus 87 [66; 98] mL/min/1.73m² (p=0.0222). At follow-up, a decreased renal function was observed in 10/72 (14%) of patients, with 50% of them presenting decreased renal function before COVID-19 hospitalization and others developing severe AKI and/or proteinuria during hospitalization.

Conclusion
In most hospitalized patients with COVID-19, proteinuria and eGFR significantly improved after hospital discharge. Only patients who developed severe AKI and/or heavy proteinuria will require a specific follow-up by nephrologists.