bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO644:DIABETES AND DIALYSIS:PROPOSAL FOR A CONTAGION PREVENTION PROTOCOL IN COVID-19 PANDEMIA
Authors: Satta Ersilia , Romano Carmine , Della Corte Tersa , Raiola Ilaria , Alfarone Carmelo , Gembillo Guido , Latte Gianluca , Polverino Mario , Gentile Sandro 
Published: May 2021

Abstract

Background and Aims
After the official coronavirus (SARS-CoV-2) pandemic declaration by the WHO, Italy had the second-largest number of confirmed cases, after China. The Italian government introduced progressive infection-mitigation measurements, thus dramatically reducing social interactions and preventing virus spread. During the summer, infection containment measures progressively loosened until, due to an unjustified interpretation of some permissions and the excessive utilization of public transportation at school reopening, the contagion rate progressively increased until causing a severe challenge for our NHS again. Aim of the study: to assess the efficiency of our previously described protocol in 18 Campania region-located Nefrocenter Consortium DCs as further adapted to new knowledge under the new ubiquitous contagion conditions and to identify SARS-CoV-2-infection mortality rate and risk factors.

Method
Dialysis patients did so too during that period according to the expected shifting prevalence over time (mean ± SD: 853 ± 30 per month; range 825 to 873) ± (11.8% in April, and 14.8% in November vs. a pre-COVID-19 12.0% rate in January).

Results
More patients got infected in November (10.19%) than in April (0,24%), and 22 patients of the 89 from the SARS-CoV-2 November positive subjects required hospitalization for moderate-severe symptoms (24.72%), with death unavoidably coming in 19 (86.36% of hospitalized and 21.35% of infected patients) compared to the only one recorded in April (0.12%). The pandemic's two periods showed a strong association between mortality rate and often co-existing comorbidities, primarily represented by arterial hypertension, type 2 diabetes mellitus (T2DM), and chronic kidney disease (CKD).

Conclusion
The prevously efficient contagion containment measures adopted by our DCs were not enough in November to fight the global infection risk pending on the whole Italian social community around. The Authors discuss possible reasons and put forward further suggestions for the best handling of any future infection waves
MO650EMPHYSEMATOUS PYELONEPHRITIS IN TYPE 2 DIABETES – CLINICAL PROFILE AND MANAGEMENT
Authors: Bhat Dr Sanjay , Kaul Anupma , Rai Priyanka , Srivastav Rohit 
Published: May 2021

Abstract

Background and Aims
Emphysematous pyelonephritis (EPN) is a rare but life-threatening acute suppurative infection of the kidney among diabetics. There is no current consensus on management of EPN.

Method
A prospective observational study was conducted at Department of General Surgery at RML institute of Medical sciences , Lucknow as well as at Eras Lucknow medical college, Lucknow from 2015-2018 to look for clinical, microbial profile and treatment outcome of diabetic patients with emphysematous pyelonephritis.

Results
A total of 76 Diabetic patients diagnosed with pyelonephritis were identified, of which 15 patients were diagnosed with EPN (26.3%). The mean age of the patients was 58.4±6.5 years. Mean duration of diabetes was 5.3 ± 3.3 years. 12 (82%) of the 15 patients with DM had a glycosylated hemoglobin A1C level higher than 7.5. Renal dysfunction at presentation was seen in 11 (73.3%) patients. Among the unilateral involvement, left kidney was more affected. Escherichia coli in 11 (73.3%), Klebsiella sp. in 1 (6.6%), Pseudomonas in 1 (6.6%), and 1 each with polymicrobial and fungal UTI respectively. Of 15 EPN patients, 13 (86.6 %) survived and 1 (6.6 %) expired. 2 of them underwent nephrectomy both survived. All patients with Stage I, II and IIIa EPN (n = 12) were managed with antibiotics with or without PCD. In EPN Stage IIIb/IV (n = 3), all the 3 (20 %) patients were managed with antibiotics and PCD and later 2 (13.3%) needed nephrectomy. Only time to diagnosis, altered sensorium, shock at presentation and thrombocytopenia were associated with poor outcome in EPN patients (P &lt; 0.05) Multiple logistic regression tests showed shock (P = .04) and and disturbance of consciousness (P = .05) on hospital admission as being the independent factors for poor outcome.

Conclusion
EPN in diabetics needs high index of suspicion, timely diagnosis and good multidisciplinary approach with adequate antibiotics and surgical management for better patient outcomes.
MO634SEMAGLUTIDE IN REAL LIFE PRACTICE DECREASES ALBUMINURIA IN HIGH RISK PROGRESSION CHRONIC KIDNEY DIABETIC PATIENTS
Authors: Aviles Beatriz , García de Lucas Maria Dolores , Perez Belmonte Luis , Jiménez Millán Anabel , Rivas Ruiz Francisco 
Published: May 2021

Abstract

Background and Aims
Semaglutide has shown safety and efficacy in type 2 diabetic patients (DM2) in extensive clinical studies including patients until eGFR&gt;15ml/min/1.73m2. Our aims are to analyse the changes in metabolic and renal parameters in chronic diabetic patients after 12 months of treatment in real life practice with semaglutide.

Method
Retrospective observational study. Inclusion criteria: Patients over 18 years old with DM2 and eGFR(CKD-EPI)&gt;15 ml/min/1.73m2. We selected cases with eGFR&lt;60 ml/min/1,73m2 and/or albuminuria/Creatinineu (albu/creatu)&gt;30 mg/g treated with semaglutide in real life practice for 12 months. Our main objectives were to assess the changes in HbA1c and weight. Secondary objetives to analyse evolution of albuminuria (albu/creatu), eGFR(CKD-EPI), blood pressure (BP), lipidic profile and adverse events. Statistics anlysis: we used descriptive, student's t, McNemar (paired data), method by steps forward; SPSS v 19.0.

Results
We included 122 patients, 62% males, mean age 51,43 ± 33 years, time of DM2 12.3 ± 3.4 years, body mass index (BMI) 35.8 ± 4.79, 25% had retinopathy, 93.4% hypercholesterolemia and 97% were hypertensive, 18% were active smokers. Mean Albu/Creatu: 349.49 ± 863.16 mg/g and mean eGFR (CKD-EPI): 50.32 ± 31.47 ml/min/1.73m2. Previous cardiovascular events: 36.5% myocardial infarction, 41% congestive hearth failure, 10% peripheric arteriopathy and 6% strokes. 42.6% were already on iSGT2 who were kept and 64.8% were switched from other GLP-1ar. After 12 months of treatment with semaglitude HbA1c reduced -0.74 ± 0.41% obtaining a mean objective &lt;7% (from 7.57±1.36 to 6.83±0.85, p&lt;0.0001). Patients decreased weight in -6.95 ± 6.0 Kg (from 98.48±16.6 to 91.53±16.42 p&lt;00001) more than -5% of total body weight in 69% of cases. Albuminuria reduced in -162,21 mg/g ± 365,77 (from 349.49±863.16 to 187.287±897.39 p&lt;0.0001, 53% reduction). eGFR(CKD-EPI) remained with a low increased of 2,2 ml/min/1.73m2. Systolic and Diastolic BP decreased -9.85 ± 13.34 mmHg (from 129.95±11,27 to 120.09±09 p &lt; 0.0001) and -5.92 ± 7.43 mmHg (from 77.05±8.95 to 71.12±7.83 p&lt; 0.0001) respectively. LDL-cholesterol and triglyceridemia decreased in -10.79 ± 28.21.09 mg/dl (p &lt;0.0001) and -29,15 mg/dl ± 91,47 (p &lt;0.0001) respectively. 5 % of patients on insulin had mild hipoglycemic episodes. Our patients needed 25% less units of rapid insulin (p&lt;0.01). Semaglutide was stopped in 5% of cases (65% because digestive intolerance).

Conclusion
Chronic kidney diabetic patients with grade 3 albuminuria after 12 months of treatment in real life practice with semaglutide improved their glycemic control (mean final HbA1c &lt;7%), with 25% less needs of rapid insulin. 69% of them decreased their total body weight in &gt; 5%. We observed 53% reduction of albuminuria and better control of blood pressure.
MO652EFFECT OF ESTIMATED GLOMERULAR FILTRATION RATE (EGFR) ON HEMOGLOBIN CHANGE INDUCED BY SODIUM-GLUCOSE COTRANSPORTER 2 INHIBITORS (SGLT2I)
Authors: Maroto Alba , Domenech Ester , Marques Vidas Maria , López Paula , Portoles Jose' M 
Published: May 2021

Abstract

Background and Aims
The use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) is associated with increase of hemoglobin (Hb) levels and this effect has been related to improvement of tubulointerstitial hypoxia and increase on EPO production. Chronic kidney disease (CKD) associated anemia is mainly due to decreased EPO synthesis. The aim of this study was to assess if the degree of Hb increase induced by SGLT2i is higher on T2DM patients with decreased estimated glomerular filtration rate (eGFR).

Method
We analyzed the changes on Hb after 12 months of SGLT2i treatment in T2DM patients with different degrees of eGFR. All patients were on maximum tolerated RAA system blockade, and none was on erythropoiesis or iron therapy.

Results
62 patients were include, age 67,6 ± 12,3 years, 72.6% males, eGFR CKD EPI 62,9 ± 21 (21-108) ml/min/1.73m2. Type of SGLT2i was dapagliflozin (46.8%), canagliflozin (30,5%) and empagliflozin (22,6%). 7 patients discontinued SGLT2i therapy and 62 were finally include in the analysis. Treatment with SGLT2i induced increase of Hb levels ( ΛHb 0,57 mg/dl SE 0,17 95% CI 0,25-0,93, p 0,001) independently of eGFR (aR2 0.02 p ns) In the multivariate analysis, initial eGFR, and basal Hb were the main determinants of the Hb increase induced by SGLT2i treatment (aR2 0,29). eGFR (≤60 vs &gt;60 ml/min/173) or type of SGLT2i did not modified ΛHb

Conclusion
We conclude that SGLT2 inhibitors induce increase on Hb level independently of eGFR, in patients with preserved renal function, by mechanisms that are yet to be determined.
MO636THE ROLE OF DIFFUSION-WEIGHTED MRI AND APPARENT DIFFUSION COEFFICIENT IN ASSESSMENT OF DIABETIC KIDNEY DISEASE: PRELIMINARY EXPERIENCE STUDY
Authors: Taha Mohamed 
Published: May 2021

Abstract

Background and Aims
Diabetic kidney disease is the most common cause of ESRD. There is poor correlation between the degree of renal fibrosis and current screening markers. A noninvasive imaging technique is needed to assess the degree of structural changes in the kidney.

Method
Forty adult diabetic patients with chronic kidney disease as well as 20 age- and sex-matched adult healthy controls were recruited from Nephrology Department of our University Hospital. All patients underwent renal MR-DWI and ADC mapping on a 1.5-T scanner (Philips Achieva) using phased array body coil.

Results
Among the studied 40 diabetic patients, five groups of patients were resulted 8 patients for each and the ADC values were inversely correlated with advancement in renal parenchymal affection, ie, in late stages of the disease the ADC values were lower than in early stages. The mean ADC values of renal parenchyma in patients with diabetic kidney disease were considerably lower than that of healthy controls with normal renal function (2.1± 0.3x10− 3 mm2/s vs 2.4± 0.1x10− 3 mm2/s with p&lt; 0.001).

Conclusion
ADC value is a possible noninvasive technique in evaluating the stage of renal dysfunction with assessment of disease progression.
MO637THE HIDDEN PREVALENCE OF DIABETIC KIDNEY DISEASE IN A HOSPITAL-BASED REAL-WORLD DATA ANALYSIS
Authors: Marques Vidas Maria , Maroto Alba , Domenech Ester , López Paula , Tornero Molina Fernando , Portoles Jose' M 
Published: May 2021

Abstract

Background and Aims
Correct identification of diabetic kidney disease (DKD) in type 2 diabetes mellitus (T2DM) patients is crucial to implement therapeutic interventions to prevent disease progression and premature death.

Method
We have analyzed the prevalence of DKD according to lab criteria and the rate of identification of DKD and/or chronic kidney disease (CKD) on 516,578 hospital care electronic medical records (EMR) in a tertiary hospital-based population using Savana Manager®.

Results
Out of 24,129 T2DM patients, 15,304 met inclusion criteria. DKD was defined as eGFR&lt;60 ml/min/1.73m2 or urinary albumin to creatinine ratio (UACR) &gt;30 mg/g or urinary protein to creatinine ratio (UPCR) &gt;0.3 g/g after excluding acute kidney injury (AKI). A total of 4,526 (29.6%) T2DM patients had DKD according to lab criteria. However, the terms “CKD” or “DKD” were only present in 33.1% and 7.5% of the 4,526 EMR, with a hidden prevalence of CKD and DKD of 66.9% and 92.5%, respectively. Less severe kidney disease (lower UACR or UPCR, higher eGFR values), female sex, and lack of insulin prescription were associated with the absence of “DKD” or “CKD” terms in EMR (p&lt;0.001) in the patients fulfilling laboratory criteria for DKD. However, while younger age (&lt;70 years) was associated with a missing CKD diagnosis, older age (≥70 years) was associated with a missing DKD diagnosis in EMR.

Conclusion
In conclusion, the prevalence of DKD among T2DM patients according to laboratory data is higher than prevalence based on specific diagnosis written in EMR. This could imply underdiagnosis of DKD, especially in patients with less severe disease who may benefit the most from optimized therapy
MO789SERUM SOLUBLE TRANSFERRIN RECEPTOR IS A PROMISING MARKER OF IRON DEFICIENCY ANEMIA IN PREVALENT HEMODIALYSIS PATIENTS
Authors: Abouseif Khaled , Abdallah Hussein , Abdulhady Marwa , Zaki abdelmegied Shaimaa 
Published: May 2021

Abstract

Background and Aims
End stage renal disease (ESRD) is chronic inflammatory condition which affects iron parameters. Serum soluble transferrin receptor (sTfR) is a reliable indicator for assessing iron status in inflammatory conditions. This study evaluates the usefulness of serum sTfR in iron deficiency anemia detection in prevalent hemodialysis patients.

Method
This case-control study included 40 ESRD patients on conventional hemodialysis with CRP&gt;10, 40 ESRD patients with CRP&lt;10 and 8 apparently healthy controls. Serum sTfR was measured for all patients and controls.

Results
STFRs predicts iron deficiency anemia in prevalent hemodialysis patients at cut off value 12.5 mg/l with area under curve 0.949, sensitivity 88.75, specificity 100, PPV 100% and NPV 47.1%. The prevalence of STFRs in patients with CRP&lt;10 was 85%, while in patients with CRP&gt;10 was 92.5% (P-value 0.288). Patients who have elevated STFRs have risk 1.22 times to have iron deficiency anemia if CRP &lt;10 (odds ratio: 1.22) and 3.14 times if CRP&gt;10 (odds ratio: 3.14). There was significant difference on comparing patients with CRP&lt;10, CRP&gt;10 and control as regard haemoglobin and STFR with P-value 0.0001 and 0.0001 respectively. Post Hoc analysis showed significant difference between the patients with CRP&lt;10 and control also in patients with CRP&gt;10 and control as regard haemoglobin and STFR (p value &lt;0.0001). on comparing patients with CRP&lt;10 with patients with CRP&gt;10 there was significant difference in STFRs p value 0.0001 despite no significant difference in haemoglobin (p value 0.642) and classic iron markers (s.iron, TIBC, TSAT) with p value 0.701, 0.192, 0.382 respectively. Serum STFRs was negatively correlated with s.iron and Kt\v in patients with CRP &lt;10 (r -0.372, P-value 0.018) and (r-0.416, p value 0.008) respectively.

Conclusion
Serum soluble transferrin receptor is a highly sensitive and specific marker of iron deficiency anemia in hemodialysis patients especially with high CRP level.
MO792CONTEMPORARY MINERAL AND BONE DISORDER MARKERS AND TREATMENT AMONG HEMODIALYSIS PATIENTS IN THE EUROPEAN DIALYSIS OUTCOMES AND PRACTICE PATTERNS STUDY (DOPPS)*
Authors: Bieber Brian , Dasgupta Indranil , Evenepoel Pieter , Jacobson Stefan H , Messa Piergiorgio , Vega Almudena , Weinreich Thomas , Karaboyas Angelo , Robinson Bruce , Pisoni Ronald 
Published: May 2021

Abstract

Background and Aims
Chronic kidney disease mineral and bone disorder (CKD-MBD) is characterized by abnormalities in serum calcium, phosphorus, and parathyroid hormone (PTH) and associated with morbidity and mortality. Previous publications from the Dialysis Outcomes and Practice Patterns Study (DOPPS) have demonstrated country differences in the prevalence and treatment of CKD-MBD among hemodialysis patients in participating European countries. We aim to compare the distribution of CKD-MBD related labs and treatments across countries in a contemporary population of European hemodialysis patients.

Method
DOPPS is an international prospective cohort study of hemodialysis patients ≥18 years of age. Patients are enrolled randomly from a representative sample of dialysis facilities within each nation at the start of each study phase. The current analysis includes n=1,701 patients from 91 facilities in the initial prevalent cross section of Europe DOPPS phase 7 (2019-present; Belgium, Germany, Italy, Spain, Sweden, UK). Results from Belgium should be considered preliminary as initial questionnaire completion is ongoing.

Results
The % of patients with a high PTH (&gt;600 pg/mL) ranged from 6% in Italy to 24% in the UK, with 12-17% having high PTH in all other countries. Mean serum total calcium ranged from 8.7 in Germany to 9.1 mg/dL in the UK (Table). Mean serum phosphorus varied from 4.5 in Belgium to 5.3 mg/dL in Germany. Dialysate calcium of 2.5 mEq/L was predominant in Germany, Sweden, and the UK while 3.0 mEq/L was the most common prescription in Belgium, Italy, and Spain. Calcimimetic prescription ranged from 13% in the UK to 32% in Spain. Etelcalcetide prescription ranged from 1% in the UK to 12% in Spain and 14% in Italy. Active vitamin D prescription ranged from 27% in Belgium to 75% in Sweden. Nearly all vitamin D prescriptions were administered intravenously in Spain versus about half in Italy; in all other countries, the route of active vitamin D administration was primarily oral. Patient age and dialysis vintage varied by country, potentially contributing to some of the observed country differences in MBD marker levels and treatment practices.

Conclusion
CKD-MBD related abnormalities in PTH, serum phosphorus and calcium remain common in European dialysis patients, with prevalence varying considerably by country. Substantial international variation in CKD-MBD treatments was also observed in prescription of vitamin D and calcimimetics. Uptake of the relatively new calcimimetic, etelcalcetide, varied considerably by country. A detailed understanding of the effect of treatment variation on CKD-MBD marker levels and patient outcomes is needed to provide important insights for the European HD community in optimizing management of secondary hyperparathyroidism.
MO801SAFETY AND EFFICACY OF DENOSUMAB IN HEMODYALISED PATIENTS UP TO 48 MONTHS TREATMENT FOLLOW-UP
Authors: Ierace Rita Chiara , Moioli Alessandra , Festuccia Francescaromana , Fofi Claudia , Barberi Simona , Mene' Paolo 
Published: May 2021

Abstract

Background and Aims
Osteoporosis in hemodialysed (HD) patients with Chronic Kidney Disease - Mineral Bone Disorder (CKD-MBD) is a debilitating clinical condition with complex therapeutic management. In fact, most of the drugs commonly used to counteract osteoporosis are generally contraindicated when Glomerular Filtration Rate (GFR) is lower than 30 ml/min. Denosumab (DMab) is a monoclonal antibody approved for the treatment of osteoporosis and does not require dose adjustment in case of impaired renal function. For this reason, since 2014 this drug has been used by nephrologists for the treatment of osteoporotic patients also in hemodialysis. Although the interest and diffusion in this specialized clinical field are growing, only few data are still available in literature.
The aim of the study was to evaluate the efficacy and safety of denosumab in long-term therapies in hemodialysed patients.

Method
Since November 2013, a total of 19 hemodialysed patients have been treated with denosumab annually (4) or semi-annually (15) for up to 48 consecutive months. During the course of therapy, the laboratory parameters of osteo-mineral metabolism were monitored, and Qualitative UltraSonography (QUS) or Computerized Bone Mineralometry (CBM) were used alternatively, every 30 months and every 2 years, respectively (depending on guidelines recommendation for both radiological methods and timing).

Results
7/19 patients completed at least 30 months of follow-up, observing a substantial stability of blood calcium and phosphorus values, against a reduction in the mean values of B-CrossLaps and ostase (respectively from 2975.32 to 1852.25 pg/ml and from 28.13 to 11.93 mcg/L). Comparison of QUS exams demonstrated improved T-score (-4.71 to -4.17) and reduced fracture risk (13% to 8%). The results of the CBMs confirmed the stability of the bone disease at the spine and the improvement of the Tscore at the femoral level (from -3.5 to -3).
It should be noted that in our samples two patients achieved the longest observation period (48-month follow-up in continuous therapy), in which the stability of bone damage was observed at CBM compared to the start of treatment.
Only one fracture has been recorded.

Conclusion
We underline that close biochemistry monitoring and careful evaluation of the therapeutic procedures before and after DMab administration helped us to minimise and promptly correct adverse effects due to hypocalcemia. In addition we are particularly satisfied to report in most patients a significant reduction of pain and an improvement of mobility.
The results collected are consistent with acceptable safety and demonstrated efficacy of denosumab in hemodialysis patients.
MO805CAUSAL PATHWAY-BASED PHYSIOLOGICAL MODELING OF VASCULAR CALCIFICATION IN HEMODIALYSIS PATIENTS
Authors: Cherif Alhaji , Voelkl Jakob , Kotanko Peter 
Published: May 2021

Abstract

Background and Aims
Vascular calcification (VC) is common sequelae in chronic and end-stage kidney diseases (CKD/ESKD), and is associated with multiple risk factors, including disturbed bone metabolism and mineral disorders (CKD-BMD), uremia, leading to increased morbidity and mortality. The mechanism involves multiple physiological processes and is not well understood. The study aims to develop a causal pathway-based physiological model describing patient-specific drivers of vascular calcification.

Method
We develop a causal pathway-based physiological modeling that utilizes clinical data to identify patients with high risks of progression of VC and cardiometabolic diseases to provide multifactorial intervention strategies targeting the risk factors. We investigate the response of pulse pressure (PP, a proxy for pulse wave velocity) to parathyroid hormones (PTH), calcium (Ca), phosphate (PO4), calcium-phosphate product (CaPO4), neutrophil-lymphocyte ratio (NLR), and albumin (Alb). Pulse pressure may account for both cardiac and vascular conditions (e.g., atrial fibrillation, aortic insufficiency, arterial stiffness or arteriovenous malformation, aortic valve stenosis, cardiac insufficiency or cardiac tamponade).

Results
We demonstrate the causal pathway of PTH, Ca, PO4, NLR, and Alb on PP, and find that there are likely paths from PTH, Ca, PO4, CaPO4, NLR to PP, where the strength of the relationships vary from patient to patient. Figure 1 shows a representative patient. Figure 1(a) shows the longitudinal data for the aforementioned clinical parameters. Using a subset of the data (1 year was used), we extracted causal relationships between the clinical (Fig. 1(b)). As shown in Fig. 1(c), some of the relationships are physiologically consistent with current knowledge of the PTH, Ca, and PO4 disturbances on CKD-BMD, vascular calcification being one of the axes. Also, NLR is a measure of inflammation, which is also known to promote vascular calcification. Further, potential pathways were also detected, namely the direct or mediated effects of Alb and PTH on PP (as shown in Figs. 1(b)-(c)). Using these pathways, a dynamic model describing these interactions can be used to prescriptive investigate the impact of the dynamics on the progression of calcification.

Conclusion
From the clinical variables, the method was able to extract both known and potential drivers for changes on PP for the representative patients. Additional study is needed to confirm these relationships both prospectively, clinical investigation of potential pathways, and to further observe the long-term clinical manifestation of vascular calcification.