bluuebunny/crossref_metadata_2025_split huggingface dataset:
#553 Renal tubular damage is an independent risk factor for all-cause and cardiovascular mortality in a community-based population: the Takahata Study
Authors: Suzuki Takaya , Ichikawa Kazunobu , Watanabe Masafumi , Konta Tsuneo 
Published: May 2024

Abstract

Background and Aims
Renal tubulointerstitial damage is a risk for renal failure. However, the association between renal tubulointerstitial damage and all-cause and cardiovascular mortality in the general population remains unclear. In this prospective cohort study, we examined this point using urinary β2-microglobulin/creatinine ratio (UBCR) as a marker of renal tubulointerstitial damage in the general Japanese population.

Methods
We examined the association between UBCR values at entry and all-cause and cardiovascular mortality during the follow-up period (median 9.2 years) in 3 427 residents (mean age 62.5 years, 45.1% male, mean eGFR 81.6 ml/min/1.73 m², ≥1+ protein 4.4%) of Takahata Town in Japan.

Results
Study participants were divided into two groups (low &lt; 300 μg/gCre, high ≥300 μg/gCre) based on UBCR at entry. Kaplan-Meier analysis showed a significantly higher incidence of all-cause and cardiovascular mortality in the high UBCR group (Log-rank P &lt; 0.01). A multivariate Cox proportional hazards analysis adjusted for age, sex, eGFR, urinary protein level, comorbidities, smoking status, and other background factors showed a hazard ratio of 1.47 (95% CI 1.09-2.00, P = 0.01) for all-cause mortality and a hazard ratio of 1.82 (95% CI 1.06-3.12, P = 0.03) for cardiovascular death in the high-UBCR group. The addition of high UBCR to conventional risk factors, including eGFR and urinary protein level, significantly improved the net reclassification improvement (NRI) for all-cause and cardiovascular mortality (P &lt; 0.01).

Conclusions
UBCR, a marker of tubulointerstitial damage, was identified as a risk factor for all-cause and cardiovascular mortality in the general population independent of eGFR and urinary protein levels.
#939 Association between alcohol consumption and the risk of incident chronic kidney disease in community-dwelling older adults
Authors: Sun In O , Bae Eunjin , Hyun Young Youl , Chung Sungjin , Kwon Soon Hyo , Yoo Kyung Don , Yu Byung Chul , Ko Gang-Jee , Yang Jae Won , Hwang Won Min , Shin Sung Joon , Hong Yu Ah 
Published: May 2024

Abstract

Background and Aims
The relationship between alcohol consumption and kidney function decline is not well established, especially in older adults. This study aimed to investigate the effects of alcohol consumption on the risk of incident chronic kidney disease (CKD) in community-dwelling older adults.

Method
Adults aged ≥ 65 years with an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 and without proteinuria between 2009 and 2010 were recruited and followed through December 2018 from a Korean national population-based cohort. Alcohol consumption was categorised into non-, mild, moderate, and heavy drinking groups based on self-administered questionnaires. New-onset CKD was defined as an eGFR &lt;60 mL/min/1.73 m2.

Results
Of the total 122,319 subjects, the non-, mild, moderate, and heavy drinking groups were 99,091 (81.0%), 14,842 (12.1%), 4,257 (3.5%), and 4,139 (3.4%), respectively. During follow-up, 19,796 (20.0%), 4,636 (31.2%), 1,696 (39.8%), and 1,695 (41.0%) developed CKD in the non-, mild, moderate, and heavy drinking groups. Univariate Cox regression analyses showed a significantly increased risk of incident CKD in older adults in all drinking groups compared to non-drinkers (all P &lt; 0.001). However, hazard ratios (HR) for developing CKD were 0.90 (95% confidence interval [CI] 0.87–0.94, P &lt; 0.001) for mild, 0.89 (95% CI 0.84–0.95, P &lt; 0.001) for moderate, and 0.93 (95% CI 0.88–0.99, P = 0.027) for heavy drinkers after fully adjusting for confounding variables. This inverse relationship between alcohol consumption and CKD risk was observed in males in all drinking groups, whereas in females it was found only in mild drinkers.

Conclusion
In the subgroup analysis, the beneficial effect of alcohol consumption on incident CKD was prominent among moderate drinkers aged 65–75 years, male mild drinkers aged ≥ 75 years, and female mild drinkers aged &lt; 85 years. This study shows that alcohol consumption is inversely associated with the risk of incident CKD in older adults. Further studies are required to elucidate the effects of alcohol on kidney damage in older adults.
#284 Risk of dose-dependent methotrexate therapy on renal functions in patients with rheumatoid arthritis
Authors: Elsharabasy Reem , Gamal Dalia , Khedr Lamis , Farid Sara , Mohsen Ghada 
Published: May 2024

Abstract

Background and Aims
Methotrexate is often used as first-line therapy for RA because of its proven efficacy, good safety profile, and low cost. The importance of MTX also comes from the fact that in combinatory treatments, the efficacy of bDMARDs or tsDMARDs is always higher when these drugs are combined to MTX, suggesting making MTX at the base of any conventional treatment of RA. Although renal impairment is a major concern in patients taking high-dose MTX for the treatment of malignancy, it has not been fully examined in RA patients treated with low-dose MTX, so we aimed at studying the dose- dependent effects of MTX on renal function and creatinine clearance.

Method
Three hundred and sixty adult RA patients, regularly attending rheumatology OPC for regular follow up participated in this retrospective cohort study. Young children, patients with any degree of renal impairment and other rhematic diseases were excluded. Serum creatinine and creatinine clearance were followed up at 1 year and 3 years of different doses of MTX therapy, and results were compared to baseline levels.

Results
Patients’ ages had a mean of 44.60 years, with most being females (80.6%). Range of disease duration was 2-34 years with the mean of 9.93 years. Most of the patients had significant disease activity, where 36.4% had moderate activity and 26.1% of them had high disease activity according to DAS 28 score. We noticed a significant decline of the creatinine clearance at 1 & 3 years follow up regardless the MTX dose used (P-value: ≤0.001 for both).

Conclusion
We may conclude that MTX therapy has a potential nephrotoxic effect regardless the dose or the duration of therapy, mandating a close monitoring of renal functions for patients maintained on the drug.
#1948 Transcriptome analysis of the effect of roxadustat on osteoclasts
Authors: Li Afang , Zuo Li 
Published: May 2024

Abstract

Background and Aims
In recent years, hypoxia-inducing factor prolyl hydroxylase inhibitors (HIF-PHIs) have been widely used in the treatment of renal anemia, bringing a revolutionary breakthrough in the treatment of anemia in CKD patients. However, HIF-PHIs acts on a variety of cells and regulates the expression of multiple target genes. Some studies have reported that HIF-PHIs plays an important role in regulating bone metabolism and promoting the differentiation and calcification of osteoblasts, but its influence on osteoclasts remains controversial. This study intends to explore the effect of roxadustat, a representative drug of HIF-PHIs, on osteoclasts.

Method
Bone marrow mononuclear cells (BMMCs) from 6-8 weeks old male C57BL/6 wild mice were extracted and induced to differentiate into osteoclasts using macrophage colony-stimulating factor (M-CSF) and receptor activator of nuclear factor-κB ligand (RANKL). Meanwhile, lipopolysaccharide (LPS) was used to simulate the inflammatory environment in CKD patients. According to the experimental group, different concentrations of roxadustat (0 μM, 2.5 μM, 5 μM, 10μM) were added simultaneously. When osteoclast induction reached day 6, mRNA was extracted for transcriptome sequencing and bioinformatics analysis.

Results
As shown in Table 1, different concentrations of roxadustat were given to primary bone marrow monocytes under both conditions, and there were 3 biological replicates for each sample. The reproducibility scatter plot showed that the data in each group had good repeatability (Fig. 1), and the heat map for basic difference analysis of each sample was shown in Fig. 2. The trend analysis results of the two groups were shown in Fig. 3. BMMCs group and LPS stimulated group showed two upward trends, respectively. KEGG enrichment analysis of these two upward trends showed that HIF-1, MAPK, PI3K-Akt, NF-κB and osteoclast differentiation pathways were significantly enriched in both groups. It is suggested that roxadustat can promote osteoclast differentiation and increase inflammatory response with the increase of roxadustat concentration. The enrichment analysis of the two groups showed that there was no significant enrichment pathway.

Conclusion
We explored the differentiation of osteoclasts under normal conditions and osteoclast differentiation under simulated inflammation in CKD patients respectively. Transcriptomic analysis results showed that HIF-1, MAPK, PI3K-Akt, NF-κB and osteoclast differentiation pathways were significantly enriched with the increase of roxadustat concentration. It is suggested that the use of roxadustat may promote bone destruction and increase the risk of inflammatory response.
#1815 The neutrophil/lymphocyte, neutrophil/HDL-cholesterol, and monocyte/HDL-cholesterol ratios as simple markers of low-grade inflammation in CKD patients
Authors: Lajdová Ingrid , Spustová Viera , Wsolová Ladislava , Okša Adrián 
Published: May 2024

Abstract

Background and Aims
Chronic kidney disease (CKD) has been associated with inflammation and oxidative stress, as well as with high cardiovascular (CV) morbidity and mortality. The neutrophil/lymphocyte (NLR), neutrophil/HDL-cholesterol (NHR), and monocyte/HDL-cholesterol (MHR) ratios have been linked both to inflammation and increased CV risk in a variety of diseases. The aim of this study was to investigate changes in these ratios in CKD patients of stage 2-5 without any clinical and laboratory signs of inflammation, and to compare these indicators with those in healthy volunteers.

Method
A retrospective cross-sectional study was conducted in 88 healthy volunteers and 187 CKD patients (50 of stage 2, 44 of stage 3a, 45 of stage 3b and 48 of stage 4-5). Patients with acute renal impairment, nephrotic proteinuria, infections, systemic inflammation, malignancies and hematologic diseases were excluded, as were those receiving hypolipidemic, corticosteroid, immunosuppressive or immunostimulant drugs. The whole blood samples were collected and the absolute numbers of neutrophils, lymphocytes, and monocytes were used for calculation of NLR, NHR and MHR, respectively. Serum creatinine, HDL-cholesterol, C-reactive protein (CRP) and albumin were measured and eGFR calculated according to the CKD EPI equation. Statistical analysis was performed with the Mann-Whitney, Shapiro–Wilk, Kruskal-Wallis, and Spearman's correlation tests using the SPSS software.

Results
The NLR, NHR and MHR were higher in CKD patients when compared to healthy volunteers (P &lt; 0,001), but only NLR and NHR increased significantly across CKD stages (P &lt; 0,01). The ratio differences between CKD stages were more evident for NHR which was also in best correlation with eGFR (ρ = −0,406, P &lt; 0,001). The CRP values increased across CKD stages as well (P &lt; 0,01) although remaining within the reference range. The NLR, NHR and MHR were significantly related to CRP with NHR providing the best correlation (ρ = 0,289, P &lt; 0,001).

Conclusion
This study showed that NLR and NHR increased across CKD stages 2-5 and could be used to identify low-grade inflammation in this population even within normal CRP values.
#331 Vascular and lipid profile interplays in pediatric CKD patients
Authors: Sallam Dina E 
Published: May 2024

Abstract

Background and Aims
Chronic kidney disease (CKD) is characterized by irreversible kidney damage and/or progressive loss of function. Children with CKD often have additional CVD risk factors, including hypertension and dyslipidemia. They may have myocardial abnormalities and early atherosclerosis evidence, such as coronary artery calcification, abnormal flow-mediated dilation, increased carotid intima-medial thickness (CIMT), and increased aortic stiffness. These abnormalities seem to be, in part, related to the degree of uremia.
This study aimed at assessing the interrelationship between vascular status and lipid profile abnormalities in different stages of CKD in pediatric patients.

Method
This cross-sectional study was done on 99 patients: 33 with stage 5 CKD on regular hemodialysis & 33 pre-dialysis CKD stage 2-4 on conservative management & 33 age and sex matched controls. Anthropometric measures, blood pressure readings, and a lipid profile were done to all groups. Intima media thickness was measured using B-mode ultrasound doppler in both the common and internal carotid arteries (CCA, ICA).
Which is a non-invasive way to measure the artery walls and track the early impacts of the atherosclerotic process.

Results
There was an obvious increase in blood pressure the percentiles in all CKD patients in relation to controls. The waist-to-hip ratio in CKD 2-4 patients was significantly higher than in CKD 5 patients, and both were higher than the controls, with means (±SD) of 1.01 (0.19), 0.88 (0.10), and 0.86 (0.05), respectively. Except for high-density lipoproteins (HDL), the lipid profile, including triglycerides, cholesterol, and low-density lipoproteins (LDL), were all significantly increased when comparing CKD 2-4 to CKD 5, and both higher than the controls: 170.45 (42.04), 166.00 (45.57), and 100.88 (26.19) for triglycerides (p 0.001). The right and left ICA and CCA showed a significant increase in the intimal thickness being higher in the CKD 5 group than the CKD 2-4 and both higher than the controls. On studying the correlation between the duration of CKD in years and other variables, we found a positive correlation with triglycerides (r = 0.409 & p = 0.001) and right CCA IMT (r = 0.271 & p = 0.028); however, the HDL (r = −0.326 & p = 0.007) revealed a negative correlation in all CKD patients. The HDL level showed an inverse correlation with right CCA and ICA.

Conclusion
Patients with CKD have an increased waist-to-hip ratio, dyslipidemia, and increased carotid IMT, which are factors that lead to the early development of atherosclerosis. Special care should be directed to CKD patients, especially those in stages 2-4, to control their lipid profile and postpone the development of atherosclerosis as much as possible.
#1740 Survival of native arteriovenous fistulas in elderly patients
Authors: León-Póo Mariana , Abreu Ángel Méndez , Baz Miguel Gutiérrez , Gómez Beatriz Patiño , Cordon Alfredo , Corona Clara Cases , Jiménez Sandra Vicente , Fernández Elia Pérez , Gruss Enrique 
Published: May 2024

Abstract

Background and Aims
Current guidelines recommend native arteriovenous fistulas (nAVF) as the first-choice vascular access for hemodialysis. However, the patient's age may make its indication doubtful. The aim of our study was to know the association between primary survival (PS), defined as the time to the first reparation, and secondary survival (SS), defined as the end of the working life of a nAVF, with the patient's age.

Method
We conducted a prospective observational study based on a historical database including 795 nAVF from incident patients, both treated in an in-hospital dialysis unit (HDU) and an out-of-hospital dialysis center (DC), made between 1998 and 2022 and followed-up until June 2023. We performed Kaplan Meier survival curves to estimate PS and SS of the nAVF for each age group (≤ 50, 50-70 and ≥ 70 years) and a multivariate logistic regression analysis of PS and SS adjusted by comorbidity (Charlson's Comorbidity Index without age (CCI)), sex, nAVF indication at end stage kidney disease (ESKD) clinics, location of the nAVF, in-hospital dialysis unit or out-of-hospital dialysis center treated patient and initial laboratory parameters (albumin, hemoglobin and phosphorus).

Results
The medium age of the patients included was 63.4 years; 68% were males, 34% had diabetes and 63.3% had a CCI ≥ 3 at the time de nAVF was made. 53.5% of all the nAVF were indicated at the ESKD clinics; 57.9% of them were radiocephalics, 33.4% brachiocephalics and 8.8% brachiobasilics. Almost 40% of the fistulas had an in-hospital use. In the survival study we didn't find statistically significant differences for age or sex, but both PS and SS were lower for patients with a CCI ≥ 3, and SS was significantly better for the first nAVF of the patient and for radio-cephalic nAVF, as shown in Fig. 1. These results were concordant to the univariant analysis, in which we didn't find differences for age group or sex, but both PS and SS were worse in patients with a CCI ≥ 3 (HR 1.32, p 0.037). Patients with lower albumin levels at the time the nAVF was made had a lower PS (HR 0.62, p &lt; 0.001); and SS also had a statistically significant association with being treated at an out-of-hospital dialysis center (HR 0.69, p 0.024) and the indication of the nAVF at the ESKD clinics (HR 0.71, p 0.036). Nevertheless, in the multivariate logistic regression analysis we only found significant differences, both for PS and SS, regarding the albumin levels at the time the nAVF was made (HR 0.62, p 0.001).

Conclusion
The survival of a native arteriovenous fistula, both primary and secondary, does not correlate to the patient's age, sex, comorbidity, indication at the ESKD clinics or the location of the fistula.
#2338 Potassium-competitive acid blocker use is associated with a lower risk of renal function deterioration compared to proton pump inhibitor use
Authors: Jang Minyoung , Jeong Seoin , Kim Jeongyun , Gu Juyeon , Kim Minji , Jeon Junseok , Jang Hye Ryoun , Lee Jung Eun , Huh Wooseong , Lee Kyungho 
Published: May 2024

Abstract

Background and Aims
Proton pump inhibitors (PPI) are commonly used drugs worldwide and have been linked to worsening renal function and incident chronic kidney disease. Recently, potassium-competitive acid blockers (P-CAB) have emerged as alternative gastric acid-reducing agents with a comparable effect as PPIs. However, little is known about the renal safety of P-CAB. We aimed to compare the renal outcomes of patients treated with P-CAB and those treated with PPI.

Method
We retrospectively identified all patients who were prescribed P-CAB (tegoprazan) or PPI (esomeprazole) for 30 days or more in outpatient clinics of a tertiary care center between 2019 and 2023. Longitudinal serum creatinine data and various demographic and clinical variables were collected. Renal outcomes were defined as creatinine doubling or decline in estimated glomerular filtration rate (eGFR) of 30%. Patients with baseline eGFR &lt; 15 mL/min/1.73 m2 and those who do not have sufficient creatinine measures to assess renal outcomes were excluded. Cox proportional hazard analyses were performed for renal outcomes with adjustment of multiple clinical covariates.

Results
Among 8 436 patients with a mean followup of 21 months, 2 214 and 6 222 patients were treated with P-CAB and PPI, respectively, for esophageal and gastric diseases. P-CAB group showed lower rates of creatinine doubling (Log-rank P = 0.001) and decline of eGFR (Log-rank P = 0.001) compared to PPI group. P-CAB use was associated with a 0.50-fold (95% confidence interval [CI] 0.33–0.75) lower risk for creatinine doubling and 0.58-fold (95% CI 0.42–0.81) lower risk for eGFR decline in unadjusted analysis. After adjusting multiple covariates including baseline eGFR, prescription days, major comorbidities, and concomitant use of other medications, hazard ratios for creatinine doubling and eGFR decline were 0.64 (95% CI 0.42–0.98) and 0.73 (95% CI 0.53–1.02), respectively.

Conclusion
Use of P-CAB is associated with a lower risk for renal function deterioration compared to PPI. Given the renal safety concerns of PPIs, using P-CAB could be a relatively safer strategy for preserving kidney function in patients who need long-term gastric acid suppression. Further studies with a larger cohort incorporating other P-CABs are required to validate this finding.
#2744 Analysis of bacteremia and mortality in patients with tunneled catheter for hemodialysis: a 14-years observational study
Authors: Almenara-Tejederas Marina , Moreno Fernando Bertomeu , Rodriguez-Baño Jesus , De Cueto-López Marina , Lazo Mercedes Salguiera 
Published: May 2024

Abstract

Background and Aims
Infections are a leading cause of morbidity and mortality in hemodialysis patients. Tunneled catheters (TC) have been associated with increased risk of infection and death, but mortality rates are not widely reported. Our study aimed to analyse catheter infection-free survival and mortality of patients with this vascular access.

Method
This is a retrospective study of all TC inserted during the period of 1 January 2005 to 31 December 2019. The TC were inserted by nephrologists, following a preimplantation protocol agreed with the Infectious Diseases Service. Patients were followed up from the tunneled catheter insertion until the study end date (December 31, 2020), TC related bacteremia or died.

Results
In the 14-year period under study, 406 TC were implanted in 325 patients. A total of 85 tunneled catheter related bacteremia were diagnosed, resulting in an incidence of 0.40 per 1000 catheter days (81.1% after 6 months of implantation). The predominant microorganisms isolated were Gram-positive organisms: Staphylococcus epidermidis (48.4%); Staphylococcus aureus (28.0%). During the study, a total of 145 patients had the TC removed or exchanged due different causes. The main reasons for catheter removal were the adequate development and use of the arteriovenous fistula (48, 33.1%) and discharge from hemodialysis due to recovery of renal function, transfer to peritoneal dialysis or renal transplantation (47, 32.4%). Only in 26 (17.9%) patients, the TC was removed due to bacteremia at a median of 4.8 (1.0-8.0) days from the bacteremia. The median time to catheter removal for non-infection-related reasons was 448 (185-910) days, without significant differences with the TC related bacteremia group [430 (116-695)] (p=0.83). The 30-day mortality rate from the first TC related bacteremia was 8.7%. During the study period, a total of 168 (51.7%) patients died for different causes.

Conclusion
The incidence of bacteremia in our study was low and did not seem to have a relevant impact on catheter survival. The global mortality rate was similar to that reported in European registries for patients on renal replacement therapy. An implantation and management protocol, strict in prophylactic measures, could reduce the incidence of bacteremia and reduce its morbidity and mortality.