bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO184ANTICOAGULANT THERAPY IN PATIENTS WITH CHRONIC KIDNEY DISEASE AND ATRIAL FIBRILLATION
Authors: Abdullaev Sherzod , Igamberdieva Rano , Sharapov Olimkhon 
Published: May 2021

Abstract

Background and Aims
Chronic kidney disease (CKD) significantly alters the pharmacokinetics of drugs, which in practice complicates the selection of adequate anticoagulant therapy (ACT) in patients with atrial fibrillation (AF) and CKD. At the same time, in the vast majority of patients with AF and CKD, ACT is required to prevent life-threatening thromboembolic complications. In such an environment, maintaining a balance between the effectiveness and safety of ACTs is extremely important.
Aim is evaluation of the efficacy and safety of the use of direct oral anticoagulants (OAC) in CKD stages 1-3 in combination with AF.

Method
The study included 93 patients (38 men and 55 women) aged 41 to 86 years with CKD stages 1-3 and AF receiving therapy with OAC (rivaroxaban) and vitamin K antagonists (warfarin). The observation period was 12 months.

Results
An analysis of 75 patients with CKD of various stages and AF receiving rivaroxaban was performed, the control group consisted of 18 patients taking warfarin. The average CHA2 DS2-VASc score in the OAC group was 4.1±1.8 points, in the warfarin group - 4.2±1.3 points. There were also no significant differences between the groups in terms of the average score on the HAS-BLED scale (risk of developing hemorrhagic complications): 2.3±0.94 points in the OAC group, 2.5±0.6 points in the warfarin group. Among the comorbidities in the OAC group, 93.2% of patients had arterial hypertension (AH), 24.5% had type 2 diabetes mellitus (DM); in the warfarin group, 94.3% of patients had hypertension and 16.8% had type 2 diabetes. In 23.9% of patients in the OAC group, minor bleeding was recorded. The largest number of hemorrhagic complications occurred in patients with stage 3 CKD: 18.9% of bleeding, which significantly (p&lt;0.05) exceeds the number of bleeding in patients with a more pronounced decrease in renal function. In 33.3% of patients with diabetes, hemorrhagic complications were recorded, which is significantly (p&lt;0.05) more than in the group of patients without diabetes - 21.4%. The greater number of hemorrhagic complications is most likely due to a more pronounced progression of the decline in renal function compared with patients without diabetes: 71.4% of patients with diabetes showed a decrease in GFR by an average of 16.6 ml/min/1.73 m2 for 12 months, which is significantly more (p&lt;0.05) than in patients without diabetes (an average of 5.7 ml/min/1.73 m2).

Conclusion
In patients with CKD stages 1-3 with non-valvular AF, the use of OAC is most effective and safe in preventing thromboembolic complications. At the same time, the progression of CKD against the background of diabetes when taking anticoagulants occurs faster than in its absence, regardless of the specific anticoagulant. Patients with AF, DM and CKD are more likely to have hemorrhagic complications, which requires more frequent monitoring and monitoring of the functional state of the kidneys.
MO187NON-STEROIDAL ANTI-INFLAMMATORY DRUG PRESCRIPTION IN THE YOUNG-OLD AND VERY- OLD: TYPE, ROUTE AND BURDEN OF CARDIOVASCULAR RISK FACTORS
Authors: Lim Cynthia , Choo Jason , Kwek Jia Liang , Abdul Kadir Hanis , Tan Ngiap Chuan 
Published: May 2021

Abstract

Background and Aims
Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with cardiovascular and kidney adverse effects, especially in older adults. However, NSAIDs are still frequently prescribed to some at-risk groups. We aimed to evaluate the burden of traditional cardiovascular risk factors and pattern of NSAID prescription in the very-old and young-old.

Method
Cross-sectional study of older adults who received prescriptions over 3 years from a large healthcare cluster in Singapore. Individuals aged 65-79 years were the “young-old” and those ≥80 years were the “very-old”. Prescriptions and traditional cardiovascular risk factors were retrieved from electronic records.

Results
Among 197,932 older adults (including 41,079 very-old), 49.9% received at least 1 NSAID prescription. Topical NSAIDs were more frequently prescribed among the 19,979 very-old with NSAID prescriptions (91.5% versus 82.9% of the young-old), while oral non-selective (22.1% versus 38.5%) and selective NSAID (15.1% versus 24.9%) were less frequently prescribed compared to the young-old (all p&lt;0.001). The very-old with NSAID prescriptions were more likely to have diabetes (38.2% vs. 32.8%), hypertension (19.3% vs. 14.0%), chronic kidney disease (51.4% vs. 23.6%) and cardiovascular disease (7.0% vs. 3.8%) than the young-old with NSAID prescriptions (all p&lt;0.001).
Table 1 shows that among the very-old, the odds of receiving oral non-selective NSAIDs was significantly lower in those with cardiovascular disease, while the odds of receiving oral COX II inhibitors was significantly higher in female and hypertension. Among the young-old, the odds of receiving oral non-selective NSAID was lower in those with cardiovascular disease, diabetes and chronic kidney disease, while the odds of receiving oral COX II inhibitors was higher in female, hypertension, cardiovascular disease and lower in diabetes and chronic kidney disease.

Conclusion
This study highlights that NSAIDs were frequently prescribed among older adults with comorbidities that may predispose to NSAID-associated adverse events. Physician education and policies are required to avoid potentially inappropriate prescriptions.
MO188RECONSIDERING THE EDELMAN EQUATION: IMPACT OF INDIVIDUAL TOTAL BODY CATION CONTENT AND BODY WEIGHT
Authors: Oppelaar Marjet , Vuurboom Mart , Wenstedt Eliane , Vogt Liffert , Olde Engberink Rik 
Published: May 2021

Abstract

Background and Aims
Treatment of dysnatremias is guided by formulas that are based on the Edelman equation, including Adrogue-Madias’ and others. Edelman’s equation is the result of a unique study in which serum sodium concentration ([Na+]), total body exchangeable sodium (Nae+) and potassium (Ke+) and total body water (TBW) were measured in a highly heterogeneous population. Because these observations resulted from steady state observations, the equation might not account for the recently uncovered highly dynamic Na+ body compartment where Na+ is temporarily stored and released without affecting TBW. Various factors that influence this Na+ body compartment have been identified and we questioned as to what extent these factors affect associations between serum [Na+] and [Nae+Ke]/TBW.

Method
We performed a post-hoc analysis of original data published by Edelman. In the linear regression model, effects of sex, edema (y/n), age and body weight (&gt;/&lt; median split) were examined. Serum [Na+] was calculated by multiplying serum water [Na+] of the original data set by 0.93. Using piecewise regression, we analyzed differences in slope and y-intercept for the regression between serum [Na+] and increasing values of (Nae+Ke)/TBW, in which the clinical characteristics from the subgroups were included as interaction factors .

Results
Data was available for 85 measurements in 82 patients; 57 males and 25 females. The median age (range) age was 58 (27-90) years and median weight (range) was 59.6 (36.4 – 168.2) kilograms. Median serum [Na+] (range) was 131.4 (103.4 – 150.2) mmol/L. The association between serum [Na+] and (Nae+Ke)/TBW was different for high and low weight categories (figure 1A). Sex, age or presence of edema did not alter the relationship. Piecewise regression showed a significant decrease in slope in the regression between serum [Na+] and (Nae+Ke)/TBW above 149 mmol/L (Nae+Ke)/TBW (figure 1B).

Conclusion
Edelman equation’s coefficients are significantly affected by weight and total body cation content. In subjects with a low weight and low total body cation content, the Edelman equation seems to adequately predict the course of serum [Na+]. However, the clinical use of the Edelman-based formulas may be hampered in subjects with higher weight and higher total body cation content, which may reflect increased tissue Na+ storage. Our analysis underlines the importance of further research into the role of osmotically inactive Na+ storage in osmoregulation.
MO189OUTCOMES OF AN ACCELERATED CITRATE ANTIGOAGULATED MEMBRANE SEPARATION PLASMA EXCHANGE ALGORITHM
Authors: Halpin Michael , Chen Bonny , Singer Richard 
Published: May 2021

Abstract

Background and Aims
Plasma exchange is a standard therapy for some anti glomerular basement membrane disease and some types of renal transplant rejection. As with other extracorporeal therapies, anticoagulation is usually required. This study assessed the safety, efficacy and Calcium flux of an accelerated algorithm for regional citrate anticoagulation in membrane-based plasma exchange.

Method
This was an observational study in patients receiving citrate anticoagulated, membrane-based, plasma exchange at the Canberra Hospital between July 2017 and May 2020. Data was collected prospectively using an electronic medical record and compared to data from our previously published algorithm which had used a slower blood pump speed.

Results
There were 134 plasma exchange sessions performed during the observational period. Circuit clotting occurred in 4 sessions and 1 session was affected by symptomatic hypocalcaemia. A systemic ionised calcium &lt;0.96 mmol/L was seen in 19.4% of sessions, which was a similar frequency to that seen in our previous algorithm. A systemic ionised Ca &lt;0.81 mmol/L occurred in 4 sessions (all asymptomatic). This hypocalcaemia occurred towards the end of the sessions, after switching from albumin to fresh frozen plasma replacement fluid. Median treatment time was 135 minutes, compared to 219 minutes in our previously published algorithm. Mean net Ca gain/session was 7.7 ± 2.3 mmol.

Conclusion
An accelerated algorithm for regional citrate anticoagulation achieves substantial time savings while maintaining efficacy and safety. The 4 episodes of systemic ionised calcium &lt;0.81 mmol/L may have been due to recirculation of infused citrate but, probably more likely, are due to the additional citrate load imposed by use of fresh frozen plasma in these sessions. Future algorithms need to better account for the citrate load present in fresh frozen plasma.
MO190NORMATIVE DATA FOR GLOMERULAR FILTRATION RATE IN HEALTHY KIDNEY DONOR POPULATION
Authors: Bhoyar Ashish , Bhargava Vinant , Gupta Ashwani , Gupta Anurag , Tiwari Vaibhav , Bhalla A K , Malik Manish , Rana Devinder Singh 
Published: May 2021

Abstract

Background and Aims
Glomerular filtration rate (GFR) is estimated traditionally from 24-hour urinary creatinine clearance. Creatinine is mainly filtered by glomerulus. The collection of 24-hour urinary sample is a difficult task with many patients fail to collect all the urine samples. As measuring GFR is cumbersome, expensive, and not easily available in all centers, various equations are developed for estimating GFR from creatinine like MDRD, CKD EPI creatinine. GFR obtained from serum creatinine shows wide variation as muscle mass and dietary protein intake are important determinants of serum creatinine concentration. Literature shows very few studies with GFR estimation with reference to age in Indian population. Hence, this study is planned to develop age specific nomogram for GFR in healthy kidney donor population as well as to study agreement between GFR obtained by 99m Tc DTPA three sample method and GFR estimated by 24-hour urinary creatinine. The aim of this stidy was to develop age-specific nomogram GFR in healthy kidney donor population and to study the agreement between the GFR measured by Technetium-99m diethylene triamine pentaacetic acid (99m Tc DTPA) and 24-hour urinary creatinine method.

Method
This study was conducted at Sir Ganga Ram hospital, New Delhi. All healthy individuals aged more than 20 years and less than 65 years, undergoing evaluation as prospective kidney donor at our hospital were the part of this study. GFR was measured by 99m Tc DTPA clearance using 3 sample method. GFR measured by DTPA method was used to develop nomogram. Creatinine Clearance was calculated from 24-hour urinary creatinine by formula U x V/P where, U is urinary creatinine level, P is plasma creatinine level and V is total volume of urine. Nomogram was developed with respect to these 3 Age groups; namely, 20 to 40 years, 40 to 50 years and 50 to 65 years

Results
Total 100 kidney donors were included in this study. Enrolled subjects were divided into 3 age groups; 20 to 40 years (n=28), 40 to 50 years (n=46) and 50 to 65 years (n=26). Majority of the donors were females (n=80). The agreement between GFR obtained by 99m Tc DTPA and 24-hour urinary creatinine clearance methods was 92.6 vs. 94 ml/min, 80.4 vs. 76 ml/min and 76.3 vs. 70 ml/min in respective age groups.

Conclusion
In the younger age group (20 to 40 years), there is better agreement in GFR measured by 99m Tc DTPA method and 24-hour urinary creatinine clearance methods.
MO192ASYMPTOMATIC HYPERURICEMIA AS A RISK FACTOR OF OUTCOME IN CARDIORENAL PATIENTS
Authors: Mumajesi Suela , Idrizi Alma , Imeraj Matilda , Cadri Vilma , Pasko Nevi , Strakosha Ariana , Thereska Nestor , Barbullushi Myftar 
Published: May 2021

Abstract

Objective
The purpose of the study was to evaluate the impact of asymptomatic hyperuricemia on long-term outcome including death, rehospitalization in cardiorenal patients.

Introduction
Hyperuricemia is associated with progression of kidney failure, cardiovascular diseases and cardiorenal syndrome, which represents a significant health burden. There is a growing interes on evaluation of serum acid levels(SUA) as a risk factor in cardiorenal syndrome, because of the evidences that xanthine oxidase inhibitors are satisfactorily useful on cardio and renal protection.

Materials and Methods
This was a descriptive cross–sectional study. A two-years follow up was conducted to determine the outcome in cardiorenal patients. Each patient went through clinical examination with a standard valuation including the determination of uric acid levels. 139 patients (pts) with chronic kidney disease stage 3 from whom 119 had cardiorenal syndrome were included in the study. Statistical analysis was performed by χ2 test, Fisher's exact test and binary logistic regression.

Results
Hyperuricemia was founded in 65.5% of pts determined by acid uric levels higher then 7.2 mg/dl and had a strong assosiation with cardiorenal syndrome,p=0.03.The average age was 56.7 ± 12.5 years. Males were 62.2%% pts, p=0.031. Bivariate analysis revealed a strong relationship between hyperurcemia and cardiovascular components: hypertension p=0.047, diabetes mellitus p=0.021, sex p=0.03, death p=0.051 and rehospitalization in 18 pts, p=0.02. Subsequently binary logistic regression showed that higher acid uric levels even there were not statistically correlated with mortality, were a significant predictor for all-cause death (Odds Ratio [OR] 4.2, 95% confidence interval [CI] 0.87–20.35, p = 0.073).

Conclusions
Asymptomatic hyperuricemia was common and had a powerfull significant association with cardiorenal syndrome.Higher SUA was unconventionally associated with long-term adverse outcomes in these patients, so our efforts should be focused in immediate identification and treatment of this old forbidden marker.

Key words
chromic kidney disease, cardiovascular disease, etc
MO194COVID-19 INFECTION IN PATIENTS RECEIVING IMMUNPSUPPRESSIVE THERAPY: EXPERIENCE OF A NORTH AFRICAN NEPHROLOGY CENTER
Authors: Houli Rawnak , Barbouch Samia , Nadia Cherni , Mariem Hajji , Sakay Amira , Ben hamida Fethi , Amel Harzallah , Ben abdallah Taieb 
Published: May 2021

Abstract

Background and Aims
Since its outbreak in December 2019,novel coronavirus disease 2019 (COVID-19) has become one of physicians top concerns worldwide. Special attention is payed to immunocompromised patients with whom the virus is feared to be more aggressive . Our aim was to assess outcomes in patients receiving immunosuppressive therapy who presented with severe acute respiratory syndrome coronavirus-2 (SARS- CoV-2) infection.

Method
we monitored patients undergoing immunosuppressive regimens who presented with SARS- CoV-2 infection during a four months period from September to December 2020 in the Nephrology department of Charles Nicolle’s Teaching Hospital. The diagnosis was made through nasopharyngygeal swabs. Kidney transplant patients were not included.

Results
we identified 9 patients who presented a confirmed SARS-CoV-2 infection (details are shown in figure 1). Age varied from 32 to 67 years. Gender ratio was 0,8. Six patients had hypertension and one patient had diabetes. Seven patients suffered from chronic kidney disease stage 4 (2 patients) and stage 5 (5 patients). Active smoking was noted in 4 patients. Indications for immunosuppressive therapy were vasculitis (5patients) , lupus nephritis (1 patient) , scleroderma (1patient), cryoglubulinemia (1 patient) and multiple myeloma (1 patient). Therapies used included corticosteroids alone (2 patients) or in association with cyclophosphamide (6 patients) and in one case bortezomib.COVID-19 symptoms included fever (6 patients), fatigue (7 patients), joint pain (3 patients), dry cough (all patients)and diarrhea ( one patient). Medium duration under immunosuppressive treatment was of 42,1 days when COVID-19 diagnosis was made Among the patients, six had a mild COVID-19 presentation and displayed favorable outcomes; whereas the remaining three had severe symptoms requiring high dose oxygen and died. As for the renal outcomes, we observed no detioration of kidney function following the COVID-19 infection in any of the patients .All of the patients were treated with antibiotics, heparin and vitamins.

Conclusion
SARS- CoV-2 infection is a serious condition that can threaten prognosis especially in patients receiving immunosuppressive drugs responsible for a weaker immune response. Further work on a larger group of patients is necessary to establish whether this group is more prone to contract the COVID-19 infection and have poorer outcomes.
MO197KIDNEY FUNCTION AT THE EARLY ON ADMISSION HAS NO CORRELATED WITH DISEASE SEVERITY AND MORTALITY IN COVID-19 PATIENTS WHO ARE TREATED IN ISOLATION ROOM OF MUHAMMADIYAH HOSPITAL PALANGKARAYA INDONESIA
Authors: Tanod Darryl Virgiawan 
Published: May 2021

Abstract

Background and Aims
Covid-19 easily to infected and spread between person to person with different mortality rates. Affected by several factors, including the comorbid factors that are different in each patients . One of the comorbid factors currently being discussed is the function of the kidneys which can affect the severity of disease and mortality in people with Covid-19. The purpose of this study was to determine whether early kidney function in Covid-19 patients who were treated in hospital isolation rooms Muhammadiyah Palangkaraya has an effect on degrees of severity and mortality.

Method
This study was a retrospective observational study conducted at a Covid-19 referral hospital. The data were taken from the electronic health records of the hospital from July – December 2020. A 38 male and female patients, with mild and severe disease. Kidney function is known by calculating the eGFR value at the time of patients initial admission using serum creatinin through venous blood test then calculated using the formula CKD-EPI calculator. Independent Sample T-test statistical was perform to see the correlation between eGFR and the degree of severity and mortality of Covid-19 patients.

Results
In this study, a total of 38 patients consist of 15 (39.47%) men and 23 (60.52%) women who suffered from mild Covid-19 were 11 (28.94%) people, and severe 27 (71.05%) people. There were 5 patients who died (13.15%) and 33 (86.84%) who were alive. It was found that there was no correlation between the patient's baseline eGFR and the patient's mortality rate (p = 0.98), while the eGFR with the degree of severity was also not correlated (p = 0.89).

Conclusion
In this study, there was no correlation between initial kidney function in admission Covid-19 patients with the severity of Covid-19 and mortality rates. Other comorbid factors apart from renal function, early management and optimal treatment are thought to affect severity and mortality of these patients regardless of initial renal function at the time the patient was treated.
MO198IMPACT OF KIDNEY FUNCTION ON THE EVOLUTION OF MONOCLONAL GAMMOPATHIES OF UNCERTAIN SIGNIFICANCE
Authors: Gil Giraldo Yohana , Muñoz Ramos Patricia , Sanchez Ana , Cabrera Alicia , Quiroga Borja 
Published: May 2021

Abstract

Background and Aims
Monoclonal gammopathies of uncertain significance (MGUS) are very prevalent, but neoplastic transformation barely reaches 1% per year. Renal involvement in the course of a MGUS is a risk factor for complications. The objective of our study is to determine the prognosis of MGUS that present renal deterioration during their evolution.

Method
In the present retrospective cohort study, MGUS cases from our center were included. Baseline epidemiological and comorbidity data were collected (including renal function and hematological parameters). At 6 and 12 months, data on renal function and proteinuria were collected. During the follow-up, fatal events and the need for renal replacement therapy (RRT) were recorded as a combined endopoint. Associated factors to this combined endpoint were evaluated.

Results
One hundred twenty patients (47% women, age 81±9 years.) with diagnosis of MGUS were included. Of these, 61 (51%) had renal involvement at the time of diagnosis and 16 (13%) had an estimated glomerular filtration rate (eGFR) of less than 60 ml/min/1.73m2 during follow up.
Associated factors with presenting eGFR less than 60 ml/min/1.73m2 were hypertension (p=0.001), peripheral vascular disease (p=0.05), age (p=0.05), Charlson comorbidity index (p&lt;0.001), β2microglobulin (p = 0.002), baseline proteinuria (p &lt;0.001) and baseline renal function (p &lt;0.001).
During follow-up (median 41 [20-60] months), 34 patients (28%) presented the combined event (8 required RRT and 28 died). The presence of an eGFR less than 60 ml /min/1.73m2 during the first year of follow-up was associated with the combined event (p = 0.028) (Figure 1). In a multivariate model adjusted for age, sex and baseline CKD, the presence of a determination of eGFR lower than 60 ml/min/1.73m2 was an independent predictor for the combined event (HR 3.9 [95% CI 1.4-11.3], p = 0.009). In patients without chronic kidney disease at baseline, 13 (22%) combined events were reported. The incidence of a determination of eGFR lower than 60 ml/min/1.73m2 was associated with the combined event during follow-up (p = 0.012). In a multivariate model adjusted for age and Charlson index, presenting an eGFR lower than 60 ml/min/1.73m2 was an independent predictor for the combined event (HR 6.7 [95% CI 1.7-26.7], p = 0.007) (Figure 2)

Conclusion
Among patients with MGUS, the presence of eGFR lower than 60 ml/min/1.73m2 is independently associated with a higher incidence of RRT and/or mortality.