bluuebunny/crossref_metadata_2025_split huggingface dataset:
#2022 Clinical outcomes in US patients initiating finerenone – a report from the FOUNTAIN platform
Authors: Oberprieler Nikolaus G , Kovesdy Csaba P , Layton J Bradley , Thapa Bishnu , Curhan Gary , Farjat Alfredo E , Liu Fangfang , Johannes Catherine , Vizcaya David 
Published: May 2024

Abstract

Background and Aims
Evidence from clinical trials demonstrates that finerenone reduces the risk of cardiovascular and renal complications among patients with chronic kidney disease (CKD) and type 2 diabetes (T2D). What is lacking is the evidence on finerenone use in real-world clinical practice.

Method
The present analysis is based on a longitudinal single-arm cohort study of patients initiating finerenone between July 2021 and August of 2023 and with prior diagnoses of CKD and T2D. Data were obtained from US electronic health records and insurance claims (OM1 Real-World Data CloudTM). CKD was defined as either having 1 diagnostic code for CKD stage 2-4 or unspecified stage, two estimated glomerular filtration rate (eGFR) measurements between 15 and 60 ml/min/1.73 m2, or two urine albumin to creatinine ratio (UACR) measurements over 30 mg/g; T2D was defined as having a diagnostic code for T2D. We described patient demographics, comorbidities, and comedications at baseline (365 days prior and including index date), and incidence rates of cardiovascular and renal outcomes, including eGFR and UACR changes over time. The presented analysis (NCT05703880) is part of the multi-national, multi-database observational research platform FOUNTAIN.

Results
We identified 28,056 new users of finerenone with prior CKD and T2D. The users had a mean (SD) age of 68.8 (10.8) years and 44.8% were female. Comorbidities of interest at baseline were hypertension (89.8%), cardiovascular disease (21.2%), neuropathy (13.4%), retinopathy (8.1%), heart failure (7.9%), and cerebrovascular disease (4.2%). Assessment of comedication use at baseline indicates that patients who initiate finerenone had exposure to renin–angiotensin system inhibitors (52.5%), sodium-glucose cotransporter-2 inhibitors (39.2%), or glucagon-like peptide-1 receptor agonists (27.4%) within 180 days prior to initiating finerenone. Overall, 82.5% of patients initiated finerenone at 10 mg/d, while 17.5% of patients started with 20 mg/d. Complete results including incidence rates of cardiovascular and renal outcomes, hyperkalemia events, and changes in kidney function measures (eGFR, UACR) during follow-up will be presented as part of the conference presentation.

Conclusion
Data from patients receiving finerenone as part of clinical practice in the USA suggest that finerenone is used concurrently with other renal and cardiovascular protective medication-classes recommended for patients with CKD and T2D.
#1593 ARGDRR, a novel disintegrin, attenuates AKI to CKD-related renal fibrosis
Authors: Chiang Chih-Kang , Yang Shao-Yu , Chen Jia-Huang , Chiang Tsai-Chen , Huang Jenq-Wen , Huang Tur-Fu , Chuang Woei-Jer 
Published: May 2024

Abstract

Background and Aims
Acute kidney injury (AKI) can lead to progress renal fibrosis, resulting in chronic kidney disease (CKD) and end stage renal disease (ESRD). Nevertheless, the underlying pathological mechanisms remain unclear. Platelet activation has been demonstrated as one of the important factors involved in the pathophysiology of AKI, and studies show the therapeutic potential for using platelet inhibitors or antagonists in ischemia-reperfusion (IR)-induced AKI models. However, drug-induced side effects, including thrombotic microangiopathies (TMA)-related kidney damage, thrombocytopenia and bleeding, hinder clinical application in AKI or CKD treatment. Our newly developed dual effect disintegrin, ARGDRR, is derived from snake venom exert a high affinity to αIIbβ3 and αvβ3 binding affinity without causing bleeding and other thrombosis-related side effects.

Method
We performed a unilateral ischemia-reperfusion injury (UIRI) model to investigate integrin αIIb(Itga2b) and β3(Itgb3) mRNA levels in the injured kidney for 15 days. For exploring the therapeutic efficiency of ARGDRR in AKI, we administered ARGDRR post-ischemic injury and measured platelet activation after 24 hours using quantitative polymerase chain reaction (qPCR) and immunohistochemistry (IHC) for Itgb3, Lcn2, and CD42b. For exploring the therapeutic efficiency of ARGDRR in CKD progression, we administrated ARGDRR daily for 15 days after IRI with nephrectomy, and examined the difference of renal dysfunction, renal fibrosis, and cell death compared to sham group.

Results
We found that platelet activation with progressively increased mRNA level of platelet glycoprotein IIb-GPIIIa (Itga2b and Itgb3) in the UIRI kidney over time. After 24 hr of ischemic AKI, ARGDRR administration reduced Lcn2 and Itgb3 mRNA level and CD42b positive area in the kidney, indicating its efficacy in protecting the kidneys by inhibiting platelet activation and aggregation. In AKI to CKD transition, serum creatine and blood urea nitrogen (BUN) were significantly lower both in efficacious and high dose of ARGDRR administration group. ARGDRR significantly reduced CD42b expression and increased LTL positive area. Also, ARGDRR administration alleviated renal fibrosis, cell apoptosis and senescence-related molecules p21 and Ctgf expression in the AKI to CKD transition.

Conclusion
Our results have successfully proved our hypothesis that disintegrin-ARGDRR has the potential for renal protection in the transition of AKI to CKD through inhibition of platelet activation and aggregation during acute injury.
#884 Do parenteral iron therapies preserve or deteriorate kidney functions
Authors: Emre Turker , Gökmen Yalçın 
Published: May 2024

Abstract

Background and Aims
Treatment of Chronic Kidney Disease (CKD) is based on preserving renal functions. Since renal anemia is frequently detected, We use par enteral iron treatments in patients with Chronic Kidney Disease (CKD). However, there are no clear and sufficient studies on the effect of these treatments on the rate of decrease in Glomerular Filtration Rate (GFR). Therefore, we conducted a study comparing the rates of change in renal function in patients who had used parenteral iron for a five years at least.

Method
Our study is a retrospective cohort study, and 180 patients with CKD (86 women, 94 men, mean age 63.5±11.4 years) who had been followed and treated in Nephrology Outpatient Clinics for at least 5 years and met the study criteria were included into the study. Patients divided into three groups for receiving iron therapy: not received iron therapy, receiving iron carboxy maltose (ICM) and receiving iron sucrose (IS) par enterally . Each group consists of 60 people. The first and last creatinine, GFR values were compared for a 5-year follow-up in each group.

Results
There was no significant difference between the two groups, those using and not using iron, in terms of creatinine increase and GFR decrease rate. Additionally, no significant difference was detected in the GFR decline rates of patients using ICM and IS.

Conclusion
We concluded that anemia treatment with iron carboxy maltose and iron sucrose are renally safe in predialysis CKD patients.
This study reduces concerns that correction of anemia through parenteral iron therapy in patients with CKD may harm renal function.
#854 Developing a free renal recipe resource, Kidney Kitchen, in collaboration with Kidney Care UK and the Renal Nutrition Group
Authors: Taylor Angeline 
Published: May 2024

Abstract

Background and Aims
In 2018 Kidney Kitchen (KK), a free resource that can turn renal dietary restrictions into enjoyable and nutritionally adequate meals was launched. Together with the British Dietetic Association's Renal Nutrition Specialist Group (RNG), trained chefs, food photographer, a videographer and Kidney Care UK, KK became a reality. Today, KK offers &gt;200 online recipes and have produced four free patient recipes books/magazines. Recipes aim to be tasty, culturally diverse, and family-friendly and are for all stages of kidney disease.

Method
Each recipe goes through a rigorous four stages of development before patients can access:

Results
Since its launch in 2018, KK have &gt;200 RNG approved recipes, available online, with downloadable recipe cards, and 50 with accompanying videos (https://kidneycareuk.org/get-support/healthy-diet-support/kidney-kitchen/).
Analytics during 2021 indicated the following:

Results recipe books
KK is about to release its forth free recipe book/magazine. In 2021 KK produced a printed recipe book containing 40 recipes, making this free resource available to all UK renal dietitians and patients (Fig. 2). A total of 12,000 copies have been provided.
In 2022, and in response to the cost of living crisis, KK developed a 21-budget friendly recipe magazine (Fig. 3), along with a guide for Foodbanks (Fig. 4). A total of 15,000 copies have been made available at no cost to patients.
In 2023 KK launched a weight loss recipe magazine (Fig. 5), with a range of healthy recipes and healthy eating advice. A total of 10,000 copies were printed at the time.
January 2024 will see the launch of a South Asian recipe magazine containing 20 recipes and dietary tips to manage salt and potassium within the South Asian diet.
During 2024 and into 2025 we will continue adding recipes to the recently updated website. In addition, we will review the initial recipe book produced in 2021, create a recipe magazine for African and Caribbean diets, and develop a children friendly section of the KK website.

Conclusion
In summary, KK have produced a resource, valued by both patients and dietitians, that provides free, practical guidance on implementing renal dietary restrictions in a safe, enjoyable and nutritionally adequate way.
#3055 Replacement of tunneled cuffed hemodialysis catheters on coated guidewire: a strategic approach to treat CVC-related infections
Authors: Maria D'ascenzo Francesca , Lomeo Elettra , Mangiacapra Roberto , Aureli Fabio , Sturniolo Antonio , Pesce Francesco , Grandaliano Giuseppe 
Published: May 2024

Abstract

Background and Aims
Infections of tunneled hemodialysis central venous catheters (CVCs) are a serious problem, and the outcome of dialysis patients strongly depends on their clinical management. Several specialists are involved in choosing the appropriate technical and clinical strategy but often there is no consensus among them on the proper management. We believe that the role of nephrologists must be pivotal in this setting throughout the entire process, from the choice of vascular access to the management of complications. Here, we present our experience using an approach to replace CVCs that was conceived to minimize the rate of infections.

Method
We propose a CVC replacement technique to minimize the risk of contamination by using a guidewire coating that allow no contact between the old and new CVC. We carried out a retrospective observational study of tunneled CVCs replacement with this technique performed at the Nephrology Unit of the "A. Gemelli Polyclinic" between January 2020 and June 2023. The following parameters were analyzed: age, sex, infection-supporting pathogen, CVC age, and dialysis age.

Results
During the reporting period, we carried out a total of 87 CVC guidewire replacement procedures for HD tunneled catheters defined “access to be preserved” using our technique. Among the patients (median age 70,6) undergoing this procedure, n=5 (5.75%) presented with endocarditis (n=4 by Staphylococcus aureus, n=1 by Pseudomonas aeruginosa).
The follow-up ranged from 6 months to 3 years. During this time only one patient, with endocarditis, had a recurrent infection caused by Pseudomonas aeruginosa after 3 months from the CVC replacement whereas 12 patients presented a de novo CVC infection caused by a different pathogen (n=4 by Staphylococcus aureus, n=1 by Pseudomonas Aeruginosa.

Conclusion
Overall, our data are encouraging as the lower rate of recurrent infections in our cohort suggests that our CVC replacement technique can be potentially used even in case of dangerous pathogens.
#2464 Association of vascular access flow and volume status on fistula arm by bio-impedance analysis
Authors: Chang Jae Hyun , Kim Hyung-Jong 
Published: May 2024

Abstract

Background and Aims
Multi-frequency bio-impedance is a tool of body composition measure and can monitor changes in extracellular volume during dialysis. Arterio-venous fistulae (AVF) could potentially affect fluid retention in the arm. We investigated whether multi-frequency bio-impedance could defect AVF stenosis or association of AVF with fluid retention in the AVF arm.

Method
We measured the extracellular water (ECF) and total body water (TBW) in AVF arm following hemodialysis by multi-frequency bio-impedance (Inbody S10®) using an eight-electrode contact technique. We measured AVF or AVG flow by transonic ultrasonography using an ultrasound dilution technology (HD 03®) in hemodialysis.

Results
Total 82 patients (male 38 patients : female 44 patients) were enrolled. The causes of ESRD were DM : non-DM = 38 : 44. The mean age of patients was 54.89 ± 13.21 years. The ECW/TBW ration of fistula arm was a significantly higher than the ECW/TBW ration of non-fistula arm (0.389 ± 0.010 vs. 0.382 ± 0.001; p&lt;0.05). The ECW/TBW ration of fistula arm was a significantly negative correlation with access flow level (mL/min) on fistula (p&lt;0.05). The 5kHz reactance of fistula arm was a significantly positive correlation with access flow level (mL/min) on fistula (p&lt;0.05). The 5kHz Phase Angle of fistula arm was a significantly positive correlation with access flow level (mL/min) on fistula (p&lt;0.05).

Conclusion
Absolute and also relative extracellular fluid volumes are increased in the fistula arm of hemodialysis. We thought that extracellular fluid volumes in the fistula arm were associated with access flow level (mL/min) and/or relative fistula stenosis. We suggest that multi-frequency bio-impedance can be a useful assistant tool of vascular access flow measure.
#2868 Clinical outcomes of octogenarians starting haemodialysis: a single center experience
Authors: Paunic Zoran , Maslovaric Jelena , Bjelica Slobodanka , Petkovic Dobrila 
Published: May 2024

Abstract

Background and Aims
Simultaneously with the aging of the general population, the number of patients with ESRD is also increasing. The question of the most favorable dialysis treatment arises, but the most frequently used method is still haemodialysis (HD).

Method
Retrospective data from patients aged 80 years or older treated with chronic HD treatments in our Dialysis Center and followed between 2009 and 2023. were studied.

Results
This study included 33 octogenarians (83.5 ± 5.4 years, 25M, 8F) Underlying renal diseases were hypertensive/ischaemic nephropathy (76%), diabetic nephropathy (10%), obstructive nephropathy (4%) and UN in 3 (10%). Vascular access was AV fistula in 72%, AV graft in 4%, long-term HD catheter in 17%, temporary catheter in 7%. Over half of them (i.e., 55%) were mobile, 35% mobile with assistance and 10% were immobile.
Out of thirty-three, 3 died during the first 90 days of HD therapy and they were excluded from further analysis. During the observation period, 19 of 30 have died (63%). There was no statistically significant difference between those who were still alive and who died regarding their vascular access status, though all four of our patients with temporary catheters died (21% of all died, p 0.26). Also, their age (82.8±2.5 vs. 83.5±3.3 y), Charlson score (8.4±1.7 vs. 8.4±1.2), their Kt/V (1.45±0.24 vs. 1.43±0.31), Hb (104.4±6.2 vs 106.1±7.9 g/L) or albumin level (37.8±5.3 vs. 36.9±4.6 g/L) and other of blood analysis did not differ significantly between live and died patients. The only 2 parameters that were statistically significantly different were their HD vintage (34.3±21.0 vs. 57.1±39.2 p 0.05) and the last obtained lean tissue index (LTI, assessed by “Body Composition monitor” bioimpedance apparatus). Namely, their LTI was less than 10 kg/m2 BSA (present in 6 of 19, i.e. 32% of died patients and in none of the survivors, p&lt;0.05)
The 1-year, 2-year, 5-year survival has a favorable rate, i.e. 86%, 77%, 42% respectively (Figure:).
The main causes of death were cardiovascular disease (47%), COVID (26.3%), sepsis, gastrointestinal bleeding, disseminated malignancy, stroke (1 case each) and 1 patient decided not to continue his HD treatments.

Conclusion
With careful clinical assessment and timely created vascular access, HD is a good choice for the treatment of very old ESKD patients. The outcomes in observed population would probably be better without pandemic COVID scenario.
#811 Effect of GLP-1 receptor agonists on the weight, urea distribution volume and blood pressure of hemodialysis (HD) patients
Authors: Chaudhuri Sheetal , Han Hao , Ficociello Linda , Kotanko Peter , Usvyat Len , Maddux Franklin 
Published: May 2024

Abstract

Background and Aims
Glucagon-like-peptide-1 receptor agonists (GLP-1) drugs are a class of medications commonly used to treat type-2 diabetes. Diabetes is prevalent in almost 60% of the end stage kidney disease (ESKD) patients and an increasing number of dialysis patients use GLP-1 drugs. It is important to note that GLP-1 drugs may have additional benefits such as weight loss and potential cardiovascular benefits. However, little is known about the effects of these drugs in dialysis patients. We analysed the changes in body weight and blood pressure in hemodialysis (HD) patients who start using these drugs. We also analysed whether there are changes in patients’ urea distribution volume, a proxy of lean body mass, to understand whether these medications affect muscle mass.

Method
We retrospectively evaluated 236 ESKD patients who were prescribed GLP-1 drugs as part of routine clinical care in October of 2023 at clinics in a large dialysis organization. All patients received dialysis for at least 60 days before and after they started using the medication. We looked at the changes in the average post dialysis weight, urea distribution volume, and pre dialysis systolic blood pressure (pre-SBP) between the 60 days before using GLP-1 drugs (pre-GLP1 period) and 60 days after initiating the drug (post-GLP1 phase). For each metric, we performed a paired t-test to evaluate the changes between pre-GLP1 and post-GLP1.

Results
The average post dialysis weight pre-GLP1 was 103.98 kg and the average post dialysis weight post-GLP1 was 102.02 kg (difference: −1.96 kg, 95% CI :1.37 to 4.27, p-value &lt;0.001). The average urea distribution volume was 36.0 L pre-GLP1, and 35.6 L post-GLP1 (difference: −0.47 L, 95% CI: −0.99 to 3.56, p-value=0.07). The mean pre-SBP was 147.83 mmHg pre-GLP1 and 149.67 mmHg post-GLP1 (difference: 1.85 mmHg, 95% CI: −5.49 to 24.93, p=0.29).

Conclusion
Our analysis showed a significant decrease in the average post dialysis weight of HD patients using GLP-1 drugs. While the decline in patients' urea distribution volume, which can be considered as a proxy for lean tissue mass, was not statistically significant, it may be clinically meaningful. We do not see a significant change in pre-SBP. Reductions in weight may suggest reduction in fat and muscle mass but can also be due to “regression to the mean” phenomena as patients who were on these medications tended to be larger. Further studies are necessary to evaluate this association.
#360 Short-term treatment with medium cut-off dialyzers increases muscle mass with preserved fat tissue in maintenance HD patients
Authors: Korucu Berfu , Esme Mert , Erbay Ege , Senturk Zekiye Selin , Bildaci Yelda Deligoz , Cavdar Caner , Derİcİ Ülver , Deger Serpil Muge 
Published: May 2024

Abstract

Background and Aims
Protein-energy wasting is a significant complication of maintenance hemodialysis (HD) patients characterized by reduced fat or muscle mass and strength. The combination of non-modifiable general and disease-related factors, such as uremic toxin accumulation and systemic inflammation, is responsible for this condition. Medium cut-off (MCO) membranes are designed to provide clearance of large-middle molecular weight uremic toxins and inflammatory cytokines without causing loss of albumin. This study aimed to investigate the short-term effect of MCO dialyzers on fat tissues and muscle mass.

Method
We conducted a prospective, single-center cross-over study on maintenance HD patients treated with regular low-flux (LF) dialyzers. Fat tissues were measured with a skinfold caliper and mid-upper arm circumference. Muscle thickness and strength parameters from six different muscle groups were evaluated with ultrasound. The baseline (control) parameters were measured under LF dialyzers, and the measurements were repeated two weeks after switching to MCO dialyzers for the patients ordered by their clinicians according to the clinical indications.

Results
The median age was 69.5 (50.3,78.8) years, and 60% of the patients were female. Two weeks after switching to MCO, the Kt/Vs, urea reduction ratios, mean serum albumin, dry weight, and body mass index scores were similar. Mean skinfold thickness and mid-upper arm circumference were 15 mm (11,17) and 28mm (27,30) under LF and 16mm (14,19) and 28mm (27,30) under MCO dialyzers (p=0.82 and p=0.27). Rectus abdominis and external oblique muscle groups remained similar. Internal and external oblique muscle thickness were significantly increased (p=0.002 and p=0.001). Mean rectus femoris and gastrocnemius medialis (GKM) thicknesses were 1.19cm (0.99,1.33) and 1.16cm (0.9,1.4) under LF and 1.31cm (1.20, 1.40) and 1.24cm (0.95,1.40) under MCO dialyzers (p=0.002 and p=0.02). Mean GKM fibrile length and pennation angles were 2.4cm (2.2,2.8) and 20o (18,23) under LF and 2.7cm (2.4, 2.9) and 22o (19,24) under MCO dialyzers (p=0.007 and p=0.001).

Conclusion
Our study showed that MCO dialyzers increase muscle mass with preserved fat tissues in HD patients, short-term follow-up. This favorable effect might be due to the clearance of uremic toxins, which cannot be removed with conventional methods. If long-term studies support our findings, MCO dialyzers would be a milestone for the treatment of sarcopenia in HD patients.