bluuebunny/crossref_metadata_2025_split huggingface dataset:
#976 Empagliflozin limits AKI incidence and severity following cardiac surgery: an open-label phase IV randomized pilot study
Authors: Snel Lars , Oosterom-Eijmael Marjella , Rampanelli Elena , Lankadeva Yugeesh , Plummer Mark , Preckel Benedikt , Hermanides Jeroen , van Raalte Daniël , Hulst Bram 
Published: May 2024

Abstract

Background and Aims
Cardiac surgery-associated acute kidney injury (CSA-AKI) is a frequent complication of cardiac surgery assisted by cardiopulmonary bypass (CPB). Currently, no effective preventative strategies exist to reduce the incidence of acute kidney injury (AKI). Sodium-glucose transport protein 2 (SGLT2) inhibitors are effective in reducing the incidence of AKI in studies conducted in patients with chronic kidney disease. Therefore, we hypothesized that perioperative SGLT2 inhibition could reduce the incidence of CSA-AKI.

Method
In this open-label phase IV, randomized, parallel-group, balanced (1:1), pilot study, adult patients undergoing elective cardiac surgery with CPB were randomized to receive 10 mg empagliflozin per os once daily three days before surgery until two days after surgery, or standard care. The primary outcome was AKI incidence according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Other outcomes included hypoxia-inducible factor 1 alpha (HIF1A) and urinary Kidney Injury Molecule (KIM-1), urinary neutrophil gelatinase associated lipocalin (NGAL) and metabolic parameters such as plasma ketone and glucose concentrations.

Results
Between March 2022 and April 2023, 60 patients were randomized to empagliflozin (n = 29) or control (n = 31). All patients who underwent cardiac surgery with CPB were included in the intention-to-treat analysis (n = 25; empagliflozin group, n = 30; control group). SGLT2 inhibition significantly reduced the incidence of all stages of AKI (20% vs 66.7%; absolute difference 46%, 95% CI .13 to .63, P &lt; .001). This decline in AKI incidence was reflected in the kidney biomarkers. SGLT2 inhibition also significantly reduced the number of patients with postoperative hyperglycemia (28% vs 60%; absolute difference 32%, 95% CI −56.8 to −7.2, P = .029). We observed no differences in the incidence of neither ketoacidosis nor hypoglycemic events.

Conclusion
Perioperative SGLT2 inhibition, compared with standard of care, demonstrated a significant reduction in AKI incidence rates. These findings merit validation in a larger placebo-controlled trial which is currently ongoing.
Supplementary figures:
#259 Predictive capacity and comparison of new biomarkers for AKI in patients undergoing non-cardiac surgery
Authors: de Cal Massimo , Virzì Grazia Maria , Ronco Claudio , Zanella Monica 
Published: May 2024

Abstract

Background and Aims
The diagnosis of AKI, according to the KDIGO guidelines, is still based on a tangible increase in serum creatinine which, however, cannot be detected until 24-48 hours after renal damage. Unfortunately, it has not been possible to identify among the various new biomarkers the one that is potentially able to detect AKI early, to intervene promptly to preserve renal function.
The aim of this study was to analyze, in a population of patients undergoing major non-cardiac surgery, the most recent urinary biomarkers to evaluate their predictive potential for AKI and compare them with creatinine levels.

Method
22 patients (18 males, 4 females) with an average age of 76 (67-85) years were enrolled for the study.
22 urine samples were analyzed by:

Results
Carrying out a correlation between the new biomarkers for AKI (Nephrocheck, NGALds and SEPP1) with creatinine levels at different times (pre-operative, post-operative and 24 h post-operative) shows a significant correlation only with NGALds (respectively p = 0.017, p = 0.035 and p = 0.012) (Table).
Subdividing patients based on the increase in creatinine levels from pre-operation to 24 hours post-operation, the only biomarker that showed an increase in values ​​was NGALds, while the others showed levels discordant with creatinine.

Conclusion
By analyzing the new biomarkers and comparing them with the creatinine data, it emerged that NGALds alone significantly correlated with the latter at different times. The other urinary biomarkers (Nephrocheck and SEPP1) showed no correlation with creatinine levels.
Based on this outcome, it could be assumed that NGALds is the biomarker which, due to its characteristics already stated in numerous studies and its correlation with creatinine, could be used and replace the latter as an early biomarker of AKI.
#2698 Regression of amyloid deposits after treatment with tocilizumab
Authors: Tortosa-Cabañas Marina , Acosta-Battle Jose , Perna Cristian , Andreu-Suárez África , Corral-Bote Ana , Bachiller-Corral Javier 
Published: May 2024

Abstract

Background and Aims
AA amyloidosis is a multisystem disease characterized by the deposition of serum amyloid A protein, which is secondary to chronic inflammation. Tocilizumab (an interleukin-6 inhibitor monoclonal antibody) is effective in suppressing inflammation, normalizing serum amyloid A protein levels and inducing remission in patients with amyloidosis. Recently, tocilizumab treatment has been associated with the disappearance of amyloid deposits.

Results
We report a case of AA amyloidosis secondary to chronic arthritis in a 61-year-old woman referred to our hospital in 2011 due to oligoarthritis of the knees and elevation of acute-phase reactants. Corticosteroids and methotrexate were prescribed, without clinical response. Two years later, the patient presented with foamy urine, nocturia, sweating and dizziness. An elevated C-reactive protein (CRP), erythrocyte sedimentation rate and nephrotic-range proteinuria were found. Rectal and oral mucosa biopsies were performed and amyloid AA deposits were detected in both (Fig. 1A, B). Magnetic resonance imaging (MRI) of the right knee showed arthropathy due to amyloid deposition (Fig. 2). Intravenous monthly tocilizumab was prescribed with rapid improvement of CRP, proteinuria (Fig. 3) and nephrotic syndrome symptoms. Arthritis also improved significantly. Two years later, a new biopsy of the rectal mucosa did not show amyloid deposits (Fig. 1C, D) and right knee MRI was normal, without evidence of amyloid synovitis (Fig. 4). Eight years later, the patient continues treatment with tocilizumab and remains clinically stable, with no evidence of recurrence.
Literature review: The efficacy of tocilizumab has been described mainly in patients with rheumatoid arthritis, but also in AA amyloidosis secondary to systemic juvenile idiopathic arthritis, familial Mediterranean fever, psoriatic arthritis, ankylosing spondylitis, Still's disease, Muckle-Wells syndrome, Behçet syndrome, polyarteritis nodosa and Takayasu arteritis. Some of the studies report long-term effectiveness of up to 9 years. In 11 case reports of patients with AA amyloidosis treated with tocilizumab, a follow-up biopsy was performed and a reduction or disappearance of the deposits was also observed. Lane et al. analyzed pre- and on-treatment serial scintigraphy scans in 20 patients with AA amyloidosis, showing that AA amyloid deposits either regressed or did not increase whilst on tocilizumab. We have not identified any study demonstrating the disappearance of amyloid arthropathy in MR images.

Conclusion
Tocilizumab treatment controls chronic inflammatory disease and improves symptoms of AA amyloidosis. Long-term treatment with tocilizumab may remove amyloid deposits from tissues, leading to a definitive cure of this disease.
#2358 Impact of COVID-19 on the clinical course of nephrotic syndrome in children: a single-center study
Authors: Park Min Ji , Cho Min Hyun 
Published: May 2024

Abstract

Background and Aims
Children with nephrotic syndrome may experience disease relapse or aggravation triggered by various viral infections. Limited studies on the clinical implications of the coronavirus disease 2019 (COVID-19) pandemic in children with nephrotic syndrome have been published worldwide. Therefore, this study aimed to investigate the effects of COVID-19 on the clinical course of nephrotic syndrome in children.

Method
The medical records of pediatric patients with idiopathic nephrotic syndrome who visited our hospital between February and June 2022 were retrospectively analyzed. Patients aged &lt;1 year and &gt;19 years and those with inadequate medical records were excluded. Finally, total 59 patients (20 pediatric patients diagnosed with COVID-19 and 39 pediatric patients who did not have COVID-19) were included in the study.

Results
Twenty of the total 59 patients with nephrotic syndrome were diagnosed with COVID-19 during the study period. The mean age at the time of the diagnosis of nephrotic syndrome and COVID-19 in all 20 patients was 4.6 ± 3.5 and 8.9 ± 3.9 years, respectively. Three patients (15%) were diagnosed with nephrotic syndrome relapse during COVID-19 and the relapse rate was similar to them without COVID-19 (20.5%, 8/39 patients). At the time of the COVID-19 diagnosis, fever (85%) and cough (40%) were the most common symptoms. After the diagnosis of COVID-19, all patients showed improvement with symptomatic treatment, including antipyretic analgesics and cold medicine. None of the critical patients required hospitalization or oral antiviral medications.

Conclusion
Despite the use of immunosuppressants, the clinical manifestations of COVID-19 in children with nephrotic syndrome were not severe and are expected to be similar to that in the general population. The relapse rate of nephrotic syndrome in children with COVID-19 was also not different from them without COVID-19.
#340 Time dependent changes in the treatment of relapsing Minimal Change Disease – a multicenter cohort study
Authors: Kristensen Tilde , Maas Rutger , Birn Henrik , Ivarsen Per 
Published: May 2024

Abstract

Background and Aims
Prednisolone monotherapy is the most used initial immunosuppressive treatment for nephrotic syndrome in adults with Minimal Change Disease (MCD) but choice of treatment in relapsing MCD is not as well described. With the introduction of new drugs and increased concern relating to the adverse events of prednisolone, treatment might have changed over time. The aim of this study is to describe changes in daily clinical practice of relapsing MCD within the last 35 years.

Method
A multicenter, retrospective analysis of adult patients with biopsy proven MCD from 13 hospitals from 1987-2022 in Denmark and the Netherlands. Patients were identified from the pathology registers. Information on treatment and clinical outcomes was retrieved from health records. Relapse is defined when the nephrologist found indication to restart an immunosuppressive treatment or increase the ongoing immunosuppression in patients in partial or complete remission.

Results
We included 167 Dutch and 72 Danish patients (n = 239) with MCD. Most patients (n = 205, 86%) were initially treated with prednisolone monotherapy. Overall, 93% (n = 220) gained remission and 56% (n = 123) of those who went into remission had one or more relapse with 68% of these occurring in the first year after remission. At the time of relapse, 89% were in complete remission and 11% were in partial remission. At first relapse, prednisolone monotherapy was the most prescribed treatment both before and after 2010 (69% and 45%, respectively), while the use of CNI tripled after 2010 (p = 0.002) (10% to 32%). At second relapse, prescription of CNI after 2010 showed a five-fold increase compared with before 2010 (49% vs 10%, respectively) while the use of prednisolone monotherapy was halved (50% to 24%). The use of cyclophosphamide decreased by two-thirds (32% to 10%) after 2010.
Before 2010, 54% of patients received prednisolone monotherapy for their third to 14th relapse, but after 2010 this decreased to 26%. The use of rituximab and CNI both increased and after 2010 these were both prescribed to about one third of patients at third to 14th relapse. The use of cyclophosphamide decreased from 30% to 2% comparing before and after 2010.
Rituximab was only used after 2010, and more frequently with the number of relapses (6% at first relapse and 36% at third to 14th relapse). Regardless of the choice of treatment the rates of remission were high.

Conclusion
The treatment of relapses has changed over time with a reduced use of prednisolone monotherapy and cyclophosphamide and increased use of CNI and rituximab.
#1810 The association between circulating fibroblast growth factor 23 (FGF23) and serum aldosterone level in chronic kidney disease patients
Authors: Khalifa Amr , Dohuim Amira 
Published: May 2024

Abstract

Background and Aims
Chronic kidney disease (CKD) remains a major health problem, till now, diagnosis of CKD depends on radiology and estimated glomerular filtration rate (eGFR). Therefore, there is an ultimate need for new sensitive prognostic and diagnostic biomarkers for diagnosis and progression of CKD. CKD is accompanied by increased levels of circulating fibroblast growth factor 23 (FGF23) and aldosterone levels. In the current study, we aim to evaluate the association between circulating FGF23 and serum aldosterone levels in CKD patients and to test the hypothesis that aldosterone may be a direct driving factor of increased FGF23 secretion in CKD patients.

Method
This cross section observational study was carried out at Kafr El Sheikh University Hospital's internal medicine department which enrolled 140 subjects that were divided into two groups: group I: 70 patients with various stages of newly diagnosed chronic kidney disease who did not receive renin-angiotensin-aldosterone system (RAAS) blocker yet (CKD stage 1 –5) & group II: 70 apparently healthy subjects (of corresponding age and sex as a control group). We detected serum FGF-23 and Serum aldosterone using enzyme-linked immunosorbent assay (ELISA).

Results
A strong correlation was identified between FGF-23 and serum aldosterone in group I (p = &lt; 0.001), there was remarkably stage dependent strong associations in CKD patients. High FGF-23 and serum aldosterone significantly independently increase risk of CKD by 1.15 and 1.043 folds respectively. The best cutoff of FGF-23 in prediction of kidney injury is ≥59.735 with area under curve 0.977, sensitivity 91.4%, specificity 90%, positive predictive value 90.1%, negative predictive value 91.3% and overall accuracy 90.7% (p &lt; 0.001). The best cutoff of aldosterone in prediction of kidney injury is ≥117.59 with area under curve 0.978, sensitivity 92.9%, specificity 88.6%, positive predictive value 89%, negative predictive value 92.5% and overall accuracy 90.7% (p &lt; 0.001).

Conclusion
FGF23 and aldosterone may be used as markers in CKD progression. aldosterone may be a direct driving factor of increased FGF23 secretion in CKD patients.
#1908 Characterization of the gut mycobiome composition in patients with end-stage renal disease
Authors: Wang Mengxiao , Wang Ting , Xia Chenyan , Zhi Yingxin , Zhao Zhanzheng , Shang Jin 
Published: May 2024

Abstract

Background and Aims
The serum uremic toxins of end-stage renal disease (ESRD) patients is intricately linked to the metabolism of gut microbiota. Despite the pivotal role played by gut mycobiome in the pathogenesis of several renal diseases, limited investigations have been conducted on its involvement in ESRD patients, including dialysis and pre-dialysis individuals. Therefore, the objective of this study is to gain further insights into the alterations occurring in the gut mycobiome of ESRD patients, aiming to provide novel strategies for improving the prognosis of these patients.

Method
This is an observational retrospective study. A total of 200 fecal samples were collected from each participant, including 51 healthy controls (HC), 51 pre-dialysis (ND) patients, 42 hemodialysis (HD) patients, and 56 peritoneal dialysis (PD) patients. Gut mycobiome was analyzed using the internal transcribed spacer region (ITS) ribosomal RNA gene sequencing. Additionally, we conducted spearman correlation analysis to identify associations between differential fungi and clinical parameters in ESRD patients, including both dialysis and pre-dialysis individuals.

Results
In comparison with healthy controls, ESRD patients exhibited a significant reduction in alpha diversity of the gut mycobiome. At the phylum level, ESRD patients had a significantly decreased relative abundance of Ascomycota and Basidiomycota, and an increased relative abundance of Fungi_phy_Incertae_sedis. Although there was no significant difference in mycobiome diversity between pre-dialysis and dialysis patients, differential fungi were observed at the taxonomic level between the two groups. Similarly, differential fungi were also found when comparing hemodialysis and peritoneal dialysis patients. Importantly, we observed a linear correlation between the abundance of differential fungi and kidney function, suggesting a potential interaction between these fungi with kidney function.

Conclusion
This study demonstrated the diversity and composition of the gut mycobiome are significantly altered in ESRD patients. Dialysis therapy affects the relative abundance of fungi at the taxonomic level. These findings suggest potential implications of specific fungal species on kidney function.
#2186 Lower psoas muscle volume is associated with CKD progression
Authors: Fujii Naohiko , Yokoyama Yuki , Ozaki Shingo , Harada Wakako , Kani Nao , Endo Yuna , Yonemoto Sayoko , Okuno Ayako , Saeki Mizuho 
Published: May 2024

Abstract

Background and Aims
Renal rehabilitation is important for keeping quality of life and kidney function of patients with CKD. Psoas muscle is representative of total body muscle and its cross-sectional area divided by squared height (PMI) is known to be associated with CKD prognosis. However, the selection of the slice of computer tomography (CT) used for calculation of PMI is arbitrary and may be a source of bias. Recently, AI technology using raw helical CT data has facilitated the measurement of total volume of the psoas major muscle (PMV), which is theoretically less biased by measurer. The aim of this study is to investigate the association between PMV and the progression of CKD.

Method
This is a pilot retrospective observational study using electrical health records (EHR) in Hyogo Prefectural Nishinomiya Hospital, Japan. We extracted patients with CKD who had taken abdominal CT in 2021 by nephrologists for evaluation of urological anatomy or clinical reasons. PMV was automatically extracted and measured by SYNAPSE VICENT (Fuji Film Medical), a commercially available software. Baseline laboratory data and patient characteristics were collected through EHR with a margin of 90 days from CT scan. The outcome of CKD progression was defined as a 40% decrease in eGFR from baseline. Survival analysis was performed by using the Cox proportional hazards model.

Results
We enrolled 145 consecutive CKD patients and excluded 37 whose observation period was less than 90 days. PMV was significantly greater in male than in female, positively associated with younger age and higher body mass index (BMI). PMV adjusted for age, sex, and BMI (adjPMV) decreased in a stepwise manner as baseline CKD stage advanced from G2 (N = 23) to G3b (N = 18) but was comparable in G4 (N = 37) and G5 (N = 6). The subjects were then divided into two groups (High-PMV and Low-PMV) according to whether their adjPMV were greater or less than the median value in each CKD stage. The High- and Low-PMV groups were comparable in age (71 ± 13 vs. 72 ± 13), female sex (42% vs. 45%), eGFR (41 ± 21 vs. 42 ± 22), urinary albumin-to-creatinine ratio (UACR), CRP, the prevalence of diabetes at baseline, respectively. PMI and PMV were significantly greater in High-PMV than in Low-PMV group (7.7 ± 1.8 vs. 5.8 ± 1.6 and 307 ± 110 vs. 205 ± 64, respectively). During the median follow up of 1.6 years, 40 events occurred. Hazards ratio for CKD progression was significantly lower in High-PMV group (0.48 [95% confidence interval: 0.25-0.95]) than Low-PMV group after adjusting for known risk factors (age, sex, eGFR, and UACR).

Conclusion
Preserved psoas muscle volume measured by a theoretically less biased method may be associated with better prognosis in CKD. A larger study in a different cohort, longitudinal observation, and interventional studies are warranted for future investigation.
#1117 Skipping breakfast and progression of chronic kidney disease in a general Japanese population
Authors: Takahashi Koji , Inoue Yori , Tada Kazuhiro , Hiyamuta Hiroto , Ito Kenji , Yasuno Tetsuhiko , Arima Hisatomi , Masutani Kosuke 
Published: May 2024

Abstract

Background and Aims
Unhealthy eating habits such as skipping breakfast are associated with adverse health outcomes including coronary heart disease, metabolic syndrome and diabetes mellitus. However, it remains uncertain whether skipping breakfast affects chronic kidney disease (CKD) risk. The aim of this study was to investigate the association between skipping breakfast and progression of CKD.

Method
Between 2008 and 2019, we conducted a retrospective cohort study using annual health check data in Iki City, Nagasaki, Japan. A total of 922 participants aged 30 years or older who had CKD (estimated glomerular filtration rate &lt;60 mL/min/1.73 m2 and/or proteinuria) at baseline were included in the present analysis. The breakfast-skipping group was defined as participants who skipped breakfast more than 3 times per week. The outcome was CKD progression defined as a decline of at least 30% in the eGFR from the baseline status. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for CKD progression, adjusted for other CKD risk factors.

Results
During a follow-up period with a mean of 5.5 years, CKD progression occurred in 60 (6.5%) participants. The incidence rate (per 1,000 person-years) of CKD progression was 21.5 in the breakfast-skipping group and 10.7 in the breakfast-eating group (p = 0.029), respectively. The multivariable-adjusted HR (95% CI) for CKD progression was 2.60 (95% CI 1.29‒5.26) for the breakfast-skipping group (p = 0.028) compared with the group eating breakfast. There were no clear differences in the association of skipping breakfast with CKD progression in subgroup analyses by sex, age, obesity, hypertension, diabetes mellitus, baseline eGFR and baseline proteinuria.

Conclusion
Skipping breakfast was significantly associated with higher risk of CKD progression in a general Japanese population.