bluuebunny/crossref_metadata_2025_split huggingface dataset:
#525 SGLT2 inhibition in non-diabetic CKD: results in experimental lupus nephritis
Authors: Cachá Conxita Jacobs , Martos Nerea , Cebrià Carmen Llorens , Motto Enam , Martínez-Díaz Irene , Anders Hans Joachim , Romeo Maria José Soler 
Published: May 2024

Abstract

Background and Aims
Sodium glucose cotransporter type 2 inhibitors (SGLT2i) potently attenuate cardiovascular morbidity and progression of CKD in patients with type 2 diabetes. It has been proposed that SGLT2 inhibition may also elicit renoprotective effects in non-diabetic CKD. The aim of this work is to evaluate whether the treatment with an SGLT2i improves kidney disease progression in a mouse model of lupus nephritis (LN).

Method
We performed a single center randomized controlled preclinical trial using female MRLlpr/lpr mice. The animals were randomly assigned to (1) vehicle or (2) empagliflozin (EMP, 10 mg/kg/day) treatment once signs of active systemic lupus erythematosus (SLE) appeared: proteinuria &gt;100 mg/dL (++ in reactive strips) or lymphadenopathy in minimum 2 bilateral sites with proteinuria &gt;30 mg/dL (+ in reactive strips). We included 13 mice per group that were treated during 4 weeks. Empagliflozin was given as an admix into standard chow diet. Reduction of urinary albumin to creatine ratio (UACR) was considered the primary endpoint whereas glomerular filtration rate (GFR), renal histology (LN activity/chronicity index, glomerulosclerosis, interstitial fibrosis) and SLE markers (total serum IgG, anti-dsDNA IgG, glomerular IgG deposits, lymph node weight, spleen weight) were considered secondary endpoints.

Results
After 4 weeks of treatment, no significant differences in fasting blood glucose levels were found between the experimental groups. As expected, empagliflozin administration notably inhibited SGLT2 in the tubular cells demonstrated by a significant increase of urinary glucose (p &lt; 0.0001). This is consistent with the increased water intake observed in MRLlpr/lpr mice treated with empagliflozin (p &lt; 0.0001). At the end of the experiment, vehicle treated MRLlpr/lpr mice showed a significant increase in UACR (p = 0.0012) consistent with LN progression that was not attenuated by empagliflozin. In line, empagliflozin did not modify GFR and LN activity/chronicity indexes, glomerulosclerosis or interstitial fibrosis in kidney. Finally, regarding SLE markers, 4-weeks empagliflozin treatment was not able to decrease total serum IgG, anti-dsDNA IgG, glomerular IgG deposits or lymph node weight. Only spleen weight was significantly decreased in empagliflozin treated MRLlpr/lpr mice (p = 0.003).

Conclusion
In our experimental setting, empagliflozin treatment reduced spleen weight suggesting a protective role in SLE in MRLlpr/lpr mice. However, empagliflozin did not modify LN progression in MRLlpr/lpr mice probably because the acute LN phase. It is expected that the positive effect in terms of reducing proteinuria will be observed in patients with LN and residual proteinuria
#598 Successful application of allo-hemodialysis in a porcine model of embolization-induced acute kidney injury
Authors: Wang Xin , Soni Pinakin , Patel Amrish , Nikolic Dejan , Heide Alexander , Dong Jiaming , Maheshwari Vaibhav , Grobe Nadja , Nayak Shivanand , Kotanko Peter 
Published: May 2024

Abstract

Background and Aims
Annually, millions of kidney patients, primarily in low- and low-middle income nations, die prematurely due to the lack of affordable kidney replacement therapy. We propose a novel, low-cost alternative dialysis modality called allo-hemodialysis (alloHD), where blood of a patient with kidney failure flows counter-current to the blood of a healthy subject (“buddy”) through the dialyzer [1]. Uremic solutes and excess fluid are then excreted by the buddy's healthy kidneys. We have already demonstrated the technical feasibility of alloHD in pigs with acute kidney injury (AKI) induced by renal artery ligation [2]. In this study, we explored alloHD in a less invasive porcine model of AKI induced by renal artery embolization.

Method
The protocol was approved by the Committee for the Purpose of Control and Supervision of Experiments on Animals (CPCSEA), New Delhi, India. We studied two female Yorkshire pigs (weight 80-90 kg) with central venous catheter as vascular access. AKI was induced by embolization of both kidneys by transcatheter deployment of Contour™ Poly Vinyl Alcohol particles (Boston Scientific, Marlborough, MA, USA). The AKI pig and the buddy pig were connected to the dialysate and blood compartments, respectively, of a Nipro Cellentia 17H dialyzer. The AKI pig was then dialyzed for 4 hours against the healthy buddy pig. During alloHD, both pigs were anticoagulated with heparin (5,000 IU/h) and the buddy pig was sedated with 1-2% isoflurane gas. Blood samples were collected before, during, and after alloHD for measurements of blood urea nitrogen (BUN) and creatinine.

Results
We performed nine alternate day alloHD sessions with the same pair of pigs. During alloHD, BUN and Creatinine levels declined in the AKI pig (Fig. 1) and increased—as expected—transiently above baseline in the buddy pig and then trended towards baseline post-dialysis (Fig. 1). We found no indication of hemolysis or coagulation of the extracorporeal circuit in any of the nine alloHD sessions. The animals were sacrificed after the 9th session.

Conclusion
We demonstrated the feasibility of alloHD in a porcine embolization AKI model. This study corroborates and complements our previous experience with alloHD in a porcine model of AKI induced by renal artery ligation. Given these promising results, we are investigating the potential for advancing to a clinical trial.
#2499 Multicenter observational study on the impact of continuous monitoring of vascular access on the survival and quality of life of patients on dialysis
Authors: Russo Domenico , Satta Ersilia , Romano Carmine , Erbaggio Gioacchino , Santoro Gianluca , Scarpati Luisa , Maio Monica D I , Iacono Fabrizio Lo 
Published: May 2024

Abstract

Background and Aims
AVE is a multicenter observational study aimed at evaluating the improvements in dialysis efficiency, AVF longevity and mortality that can be achieved by implementing both monitoring by a multidisciplinary team. The universal goal of AV monitoring is to identify early events such as stenosis and intervene before thrombosis, thus maximizing the longevity of access and minimizing morbidity.

Method
This study takes advantage of the opportunity to use data from 19 hemodialysis centers and approximately 1000 patients and to correlate and examine variables that are commonly reported with each treatment, trends in AV use, trends in patient characteristics, and the practice associated with VA. The data were collected by nurses in a specific section of the management database at each treatment for 5 years.

Results
Trends at the beginning and at the end of the study were evaluated, and Kaplan Maier curves were performed regarding the survival of the VA and the survival of the patients. The average age of 1000 patients enrolled was 73.5 years. Native AVF was used by 79%, AVG by 2% and CVC by 19%. With increasing age, the use of CVC goes from 6% (15-39 years) to 50.5% in patients over 85 years old. The most frequent complications were: Thrombosis 16.5%, Infections 5.5%. VA-related hospitalization days are 28.7% of total days. The average dialysis goals achieved were: QB 290 ml/Min; purified blood 69.7 L; KT/V:1.35. The AVE study, the survival curves evaluated in aggregate were not different between men and women during the observation period (year 2018: p = 0.327; year 2019: p = 0.174; year 2020: p = 0.343).
This finding was also confirmed when the survival data were analyzed according to gender and chronological age. No difference was observed between genders while the significant difference (p = 0.000) between chronological age levels was confirmed as shown in the Figure

Conclusion
By interpreting data collection for specific performance measures using accurate reports, healthcare professionals can highlight AV performance/inefficiencies and provide correct information to clinical staff to support them in their daily clinical practice and decision making.
#2838 Dialysis regret is associated with level of information about health status but not with frailty
Authors: Schulte-Kemna Lena Sophia , Jazah Mohamed Nooreddin , Künzig Miriam , Bettac Lucas , Kächele Martin , Schroeppel Bernd 
Published: May 2024

Abstract

Background and Aims
Elderly patients (&gt;75 years of age) are the fastest growing group on dialysis with a high burden of multi-morbidity, functional dependence and frailty. Treatment decisions about End-Stage Renal Disease (ESRD) in this group are complex and quality of life, development of functional status and independence are often given higher priority than prolongation of life. Studies from the U.S., Canada and the Netherlands have shown varying degrees of dialysis regret (7–61%) [1–3]. As frailty is common among patients on dialysis and associated with poor clinical outcomes, the aim of this study was to determine the prevalence of regret in having started dialysis and associated risk factors.

Method
This cross-sectional, multicenter, prospective study in southern Germany included 123 adult patients on maintenance dialysis. Dialysis regret was assessed by a single question as part of a 6-item questionnaire. Frailty status was assessed based on modified Fried criteria and by self-assessment using a 5-point visual analogue scale (VAS). Statistical analysis was performed using Fisher's exact test and Chi-square test.

Results
The median age was 68 years, 71% were male, 40% of the participants were considered frail using the Fried criteria. Only 7/123 (5.7%) patients reported regretting the decision to have started dialysis (Table 1). 85% of patients reported sufficient information about their own health status. We found a significant correlation between the level of information regarding own health status and dialysis regret. There was no correlation of dialysis regret with age, sex, frailty or dialysis vintage. Even though frailty status was not correlated with dialysis regret, frail patients were significantly less informed about their own health status. Of note, 82% of patients reported that the decision to initiate dialysis was driven mainly by the health care team or their family (Fig. 1). The main reasons for starting dialysis were prolongation of life and the feeling of having no other choice (Fig. 2).

Conclusion
Dialysis regret was uncommon in our cohort of elderly dialysis patients and was associated with the level of information about health status but not with age, sex, frailty status, comorbid conditions or dialysis vintage. This underscores the importance of patient-education and the process of shared-decision making.
#2225 Educational level and gender are associated with emotional well-being in a cohort of Dutch dialysis patients
Authors: Bakker Wisanne , Theunissen Maurice , Ozturk Elife , Litjens Elisabeth , Courtens Annemarie , van den Beuken Marieke , Hemmelder Marc 
Published: May 2024

Abstract

Background and Aims
Patients undergoing dialysis have an impaired health-related quality of life (HRQOL). There are conflicting data from small series whether patient-related factors such as educational level have an impact on experienced HRQOL. The aim of this study was to investigate the association between educational level and HRQOL in dialysis patients.

Method
In a single-center retrospective cross-sectional study HRQOL was measured using the Kidney Disease Quality of Life Short Form-36 (KDQOL-SF36) in prevalent chronic dialysis patients. Educational level was categorized into low, intermediate and high subgroups. Univariate and multivariate regression analyses were performed to assess the effects of age, gender, ethnicity, and dialysis vintage on the association between HRQOL and educational level.

Results
129 chronic dialysis patients were included. The median age of the patients was 65.0 years and 58% of the patients were male. The median age did not differ between men and women (67.0 vs. 63.0 years, p = 0.673). Median dialysis vintage was 15.0 months. Patients with an intermediate educational level (OR: 4.37 [1.89-10.13]) and a high educational level (OR 4.13 [1.04-16.42]) had significantly higher odds of higher emotional well-being than patients with a low educational level. The odds for women compared to men were 2.83 [1.32-6.06] for better general health and 2.59 [1.15-5.84] for emotional well-being. There was no interaction between gender and educational level for both subdomains. Each year of increasing age was associated with decreased physical functioning (OR 0.94 [0.91–0.97]).

Conclusion
Low educational level and male sex were associated with worse emotional well-being compared to intermediate and high educational level and female sex in dialysis patients. Physical functioning decreased with increasing age.
#2628 A haemodialysis patient-centred model of care with a multidisciplinary programme: what is its clinical and health efficiency impact?
Authors: Martínez-Vaquera Shaira , Sorribes MaPaz , Martínez-Sánchez Teresa , de León Ignacio Ponce , Martínez-Pérez Oscar , Díaz-Cuervo Helena , Cuervo Jesús , Macário Fernando 
Published: May 2024

Abstract

Background and Aims
Chronic kidney disease (CKD) constitutes a public health concern due to its notable morbidity & mortality and associated costs. The Patient Care Coordination program (PCC) provides comprehensive and personalized care to haemodialysis (HD) patients. This study evaluated the cost-effectiveness of PCC compared to standard of care (SoC).

Method
The study included patients in 9 HD clinics (5 PCC, 4 SoC) in Catalonia, Spain, in 2020-2021. A comparative effectiveness evaluation was conducted to compare change in Individual Patient Performance Score (IPPS, score 0-100, evaluates parameters such as vascular access, adequacy of HD, anaemia, mineral bone disease, arterial hypertension, nutrition/hydration status) and number of hospitalisations of PCC patients vs SoC during the first year in the program. Instrumental variables (IV) regression analysis was performed to address potential confounding; number of interactions with program specialists was a valid IV to estimate degree of PCC use. An incremental cost-effectiveness analysis (iCEA) through microsimulation was performed using the effectiveness data from the previous step, population data from the renal patient registry of Catalonia, and the cost of hospitalisations obtained from the Public Health System.

Results
127 patients in PCC and 363 patients in SoC were included. The degree of PCC use had a positive impact on IPPS variation during the first year of the program (p = 0.012). In the iCEA the PCC program resulted in a mean gain of 3.4 additional IPPS points, a reduction of 0.2 hospitalisations per patient, and reduced mean costs of €1,265 per patient in the first year compared to SoC, resulting to be a dominant alternative (Fig. 1).

Conclusion
The holistic and interdisciplinary approach to the patient has further highlighted the relevance of programme use and not only belonging to the programme in achieving clinical goals. The PCC program represents thus a dominant alternative, with greater effectiveness and total cost savings that could sum up to €5.5 million per year in the region due to reduced hospitalizations. This approach may be an alternative to address the challenges of CKD and optimise the allocation of healthcare resources.
#2057 Sex differences in bioimpedance-spectroscopy-derived fluid status and body composition of maintenance hemodialysis patients
Authors: Mussnig Sebastian , Niknam Janosch , Gülmez Dilara , Krenn Simon , Hecking Manfred 
Published: May 2024

Abstract

Background and Aims
Bioimpedance-spectroscopy-(BIS)-derived estimates of fluid status and body composition are associated with mortality in patients undergoing maintenance hemodialysis (HD). Previously, thresholds for improved survival were identified for volume overload (VO, &lt;2.5 L), VO relative to extracellular water (VO/ECW, &lt;15%), lean tissue index (LTI, 15-20 kg/m2) and fat tissue index (4-15 kg/m2). However, these thresholds did not distinguish between sexes. Considering current efforts to untangle differences between male and female kidney disease patients, we aimed to analyze BIS data stratified by sex.

Method
We retrospectively evaluated pre-HD BIS measurements using the whole-body “Body Composition Monitor” device (Fresenius Medical Care). Measurements were conducted at the “Vienna Dialysis-Center”, a large tertiary dialysis center in Vienna, Austria. Continuous variables were described as medians and interquartile ranges and compared between sexes using Wilcoxon tests. Differences in proportions of males and females within the above-mentioned target ranges of body composition parameters were tested using Chi-Square tests and Fisher's exact tests.

Results
In November 2022, the Vienna Dialysis-Center cared for 304 patients, 159 of whom underwent BIS measurements. A total of 137 patients remained for analysis after excluding erroneous results (62% male, 38% female). The median [interquartile range] age among analyzed male and female patients was 60.0 years [48.0; 72.0] and 65.5 years [57.8; 75.3], and the median dialysis vintage was 28.9 months [12.1; 52.7] and 27.2 months [14.8; 61.9], respectively. VO (2.7 vs 1.9 L, p = 0.025), LTI (13.4 vs. 11 kg/m2, p &lt; 0.001) and FTI (11.1 vs. 14.2 kg/m2, p = 0.036) differed significantly between males and females but VO/ECW did not (14.3 vs. 12%, p = 0.4). 27.1% of males (n = 23) were within 15-20 kg/m2 LTI compared to 7.7% of females (n = 4, p = 0.007). Differences in the proportions of male and female patients within optimal ranges of VO (43.5% vs. 61.5%, p = 0.062) and FTI (67.9% vs. 50.0%, p = 0.058) were close to reaching statistical significance.

Conclusion
We discovered relevant differences in fluid status and body composition among patients undergoing maintenance HD not only in absolute numbers, but also in the proportion of patients within the optimal range of LTI. Considering sex differences in body composition but (on average) equal mortality among HD patients, optimum target ranges of BIS measurements may differ between sexes. Our findings from this relatively small cohort call for large-scale sex-specific analyses of fluid status, body composition and outcomes in maintenance HD patients.
#329 Effectiveness of dosing strategies of polymyxin B among sepsis patients with and without renal replacement therapies
Authors: Rajan Asha K , Thunga Girish , Shanbhag Vishal , Chaudhuri Souvik , Kunhikatta Vijayanarayana , Rajan Surulivel , Attur Ravindra Prabhu 
Published: May 2024

Abstract

Background and Aims
Despite numerous population pharmacokinetic studies on polymyxin B, a gap exists in establishing uniform dosing strategies among sepsis patients due to various clinical and patient related factors. The International Consensus guidelines, provide detailed dosing calculation for colistin but not for polymyxin B in renal impairment patients [1]. We aimed to compare and evaluate the effect of various dosing strategies of both polymyxin B and colistin among sepsis patients with and without renal replacement therapies (RRT) in the clinical setting.

Method
We conducted a retrospective audit on adult patients (aged≥ 18 years) diagnosed with gram negative sepsis, both with and without RRT, who were administered polymyxins. Data was collected from the medical records of patients admitted to critical care setting of a tertiary care hospital from January 2018 to December 2022. Patients who received polymyxin B doses for less than 3 days, pediatric, neonate patients or those discharged against medical advice were excluded. Data such as demographic details, RRT, polymyxin type and dosage, and therapy outcomes were collected. Polymyxin B dosing strategies were converted into low dose group (LD) [≤100 mg &gt;150 mg loading dose (ld) and &lt;150 mg maintenance dose (md)], usual dose group (UD) [150 mg ld and 150 mg md] and high dose (HD) [150 mg ld and &gt;150 mg md] to evaluate its effectiveness [2]. Linear and logistic regression were used for continuous and categorical outcomes respectively. All statistical analyses were performed using IBM SPSS vs 29.0 [3].

Results
Our study cohort included 550 patients with mean age of 59.79 ± 15.78 years, and majority of them being male patients (55.2%). A total of 243 (39.6%) patients were on RRT. Among the study population, 465 (84.5%) patients were on polymyxin and 146 (26.5%) were on colistin therapy. Regression analysis of different regimens of Polymyxin B prescribed with various doses showed UD group (p = 0.04) as well as HD group (p = 0.05) with better outcome in terms of improvement. Among the Polymyxin B cohort patients on RRT, HD group showed better outcome (p = 0.045). There was a significant mean difference between polymyxin B dosing strategies with respect to ventilator-free days (p = 0.006), while the other clinical outcomes showed non-significant results.

Conclusion
Our results suggest polymyxin B dosing strategy with a loading and maintenance dose of 150 mg in general patients. In patients with RRT, a loading dose of 150 mg and maintenance dose of &gt;150 mg is warranted. Further population pharmacokinetic studies with large sample size of RRT patients on polymyxin B is required.