bluuebunny/crossref_metadata_2025_split huggingface dataset:
#1439 Risk factors and significance of a reduction of serum albumin after start of PD
Authors: Finne Patrik , Vartiainen Heini , Bitar Wisam , Haapio Mikko , Helve Jaako 
Published: May 2024

Abstract

Background and Aims
A reduction in the serum level of albumin following the initiation of peritoneal dialysis (PD) has been reported to associate with impaired survival. Our aim was to identify pre-PD risk factors of drop of serum albumin, and to estimate how a decrease in albumin level affects PD patients’ survival prognosis.

Method
We included all adult patients who had been on PD for at least half a year in the Helsinki area in Finland during the years 2004 to 2019. Patients who had a dialysis history longer than 1 year before transferal to PD were excluded. We analysed the serum albumin level at start of PD and the last available albumin level before 6 months after start of PD. A 20% reduction of serum albumin was considered significant. Logistic regression was used to assess the association between risk factors (age, sex, primary kidney disease, comorbidities, laboratory variables) and a 20% drop of serum albumin. Cox regression was employed to study the effect of albumin drop on survival with adjustment for confounders.

Results
Of 379 patients, 80 (21%) showed a reduction of serum albumin of at least 20% after start of PD. High age, high albumin level at start of PD, high level of HDL cholesterol and low level of ionized calcium all associated independently with the risk of an albumin drop in the logistic regression analysis. The albumin level at start (hazard ratio 0.94 per one g/l increment, 95% CI 0.89-0.98) and a 20% or larger drop of albumin level (HR 2.3, 95% CI 1.4-3.9) were connected to impaired survival irrespective of each other. Other independent predictors of worse survival were high age, peripheral vascular disease, a history of stroke, and diabetes.

Conclusion
A drop of serum albumin after start of PD is frequent and associates with impaired survival. Drop of albumin is more common among elderly patients and those with high values HDL cholesterol or low levels of ionized calcium.
#1270 Exploring the shift in gut microbiota due to renal ischemia/reperfusion injury in rats
Authors: Hiroyoshi Toshiya , Hitaka Yukihiro , Isoyama Naohito , Shiraishi Koji 
Published: May 2024

Abstract

Background and Aims
Acute kidney injury (AKI) due to renal ischemia/reperfusion (I/R) is a major clinical problem in renal transplantation and partial nephrectomy, which is associated with morbidity and mortality and substantial healthcare expenditures, but there is no effective and specific treatment. Recently, the clinical impact of the interaction between gut bacteria and the kidney function has become increasingly clear. Experimental evidence has highlighted a bidirectional relationship between gut microbiota and kidney disease. Therefore, we investigated the possibility that I/R can ameliorate AKI by studying gut-renal interactions and gut microbiota in AKI.

Method
We induced varying degrees of renal I/R injury in adult male Wistar rats by clamping the left renal pelvis for 30 and 45 minutes, simulating mild and severe conditions, respectively. These samples were subjected to extensive histologic examination using standard techniques such as hematoxylin and eosin (HE), Sirius Red, and F4/80 staining. In addition, we performed a quantitative analysis of the mRNA expression levels of fibrotic and inflammatory markers in both kidney and colon tissues using real-time PCR. Gut microbiota genomic DNA was extracted from rat feces and microbial 16S ribosomal RNA (rRNA) gene sequencing was performed.

Results
Renal function deteriorated with increasing ischemia time and fibrosis progressed, as confirmed by Sirius Red staining and qPCR of fibrosis genes such as TGFB. The expression of inflammatory genes such as IL-1B and IL-6 was also increased. The expression of inflammatory genes such as Toll-like receptor, C3, and IL-1B in the intestine also increased with ischemia time. In the fecal microbiota, the total read percentage of Bacteroides acidifaciens at the species level increased with increasing ischemia time.

Conclusion
The observed shifts in gut microbiota composition may serve as a critical indicator of chronic kidney disease (CKD)-induced gut dysbiosis secondary to AKI. This finding highlights the need for further research into the identification and migration patterns of the gut microbiota, which represents a promising avenue for early detection, prevention, and therapeutic intervention in AKI. Future investigations elucidating the mechanisms by which the microbiota influence IRI-induced AKI and the development of practical therapeutic strategies have the potential to significantly improve clinical outcomes in patients suffering from IRI-induced AKI.
#426 “Predict-PD”: a machine learning tool to predict patient survival in peritoneal dialysis patients
Authors: Ali Hatem Kaies Ibrahim Elsayed , Baharani Jyoti , Hamer Rizwan 
Published: May 2024

Abstract

Background and Aims
With the rising prevalence of chronic kidney disease (CKD), particularly among the elderly, the need for effective renal replacement therapy has become increasingly crucial. Peritoneal dialysis (PD), recognized as a gentler alternative to haemodialysis, offers advantages in cognitive preservation and overall quality of life. Patient survival on PD, a tangible outcome measure, gains particular importance, especially in an aging demographic confronting end-stage kidney disease. Predicting survival thus becomes vital in facilitating individualized treatment planning and has implications on resource allocation and patient counseling.

Method
Our study analysed data from the UK Renal Registry and included 22 711 incident dialysis patients choosing PD between 2007 and 2022. Our objective was to employ Artificial Intelligence (AI) algorithms in developing an advanced risk stratification indicator with high predictive capabilities, specifically tailored for use in the United Kingdom's transplant selection procedure. We conducted experiments using three distinct machine learning models and evaluated their performance in terms of calibration and discrimination, utilizing metrics such as the integrated Brier score (IBS) and Harrell's concordance index. We assessed the potential clinical utility using decision curve analysis.

Results
The XGBoost model demonstrated excellent predictive efficacy for patient survival, with a concordance of 0.78. Further scrutiny revealed AUC values at 1 year (0.81), 3 years (0.78), and 5 years (0.77). The integrated Brier score, a comprehensive measure of predictive accuracy, was 0.09. There was no statistical difference between the actual and predicted survival probabilities (P = 0.72). Decision curve analysis accentuated the model's clinical applicability.

Conclusion
This study illustrates the potential of machine learning in prognosticating patient survival in PD, offering a pathway towards individualized patient-centric management in nephrology. The findings advocate for the integration of data-driven methodologies in clinical decision-making, paving the way for enhanced personalized care in CKD management and can serve as a guide for future research.
#1349 Importance of malnutrition and frailty in kidney transplant waiting list
Authors: Demirag Alp , Demirag Hayriye Nilgun Guvener , Vandergrift Julia , Mercimek Mehmet , Kline Vanesa 
Published: May 2024

Abstract

Background and Aims
Malnutrition and frailty predict postoperative complications. Recently, in an effort to assess nutritional status modified quantitative subjective global assessment (QSGA) systems have been devised in which scores are assigned for items or components of the SGA. This prospective study evaluated relationship QSGA and frailty assessment methods in patients waiting for kidney transplantation.

Method
We operated a fully quantitative scoring system consisting of 7 variables: weight changes, dietary intake, gastrointestinal symptoms, functional capacity, comorbidity, subcutaneous fat, and sign of muscle wasting. Each component was assigned a score from 1 (normal) to 5 (very severe). The sum of all seven components in this malnutrition score lies between 7 (normal) and 35 (severely malnourished). To evaluate frailty status, Short Physical Performance Battery (SPPB), Revised Risk Analysis Index (RAI), Karnofsky Frailty Score, Hand Grip Strength (HGS) methods were used. Three hundred and sixty patients (143 women and 217 men) were randomly selected from kidney transplant waiting list. Patients were aged between 21 and 82 years (56 ± 12.8) and had undergone hemodialysis for between 0 and 240 months (33.3 ± 34.6).

Results
The malnutrition score of each patient was assessed by a dietitian within 5-10 min. Pearson correlation coefficients showed positive correlation between the QSGA score and duration of hemodialysis (r = +0.52), age (r = +0.21), EPTS (+0.29) and RAI ((+0.25). QSGA showed negative correlation with Karnofsky score (r = −.30), SPPB (r = −.40), HGS (r = −.20). Multiple regression analysis showed a significant correlation between QSGA score and the combination of duration of hemodialysis, severity of RAI index, BMI and SPPB (R2 = 0.32, p = 0.00).

Conclusion
In addition to frailty assessment, the QSGA system may be additional method for evaluation of patients on the kidney transplant waiting list. More comparative studies are required to confirm the validity of this scoring system in nutritional evaluation of renal transplant candidates.
#2566 Clinicopathological and molecular characteristics of plasma cell rich rejection in renal transplant biopsies
Authors: du Long Romy , Florquin Marie Chevalier , Bemelman Frederike , Claessen Nike , Peters-Sengers Hessel , Florquin Sandrine , Kers Jesper 
Published: May 2024

Abstract

Background and Aims
Plasma cell rich rejection (PCRR) is an uncommon, ill-defined type of renal allograft rejection in the literature considered as a subtype of T cell-mediated rejection (TCMR). PCRR has poorer clinical outcome and is often refractory to classic immunosuppressive therapy. Our study analyzed In this study, we analyzed PCRR in a large cohort of patients who underwent renal transplantation at the Amsterdam UMC. Our objective was to study clinical, histological and molecular signatures of PCRR in comparison to other types of rejection, especially late presentations of TCMR and ABMR. We hypothesized PCRR could be a specific subtype of allograft rejection with different molecular and cellular characteristics compared to (late) TCMR and ABMR with differences in clinical outcome.

Method
We retrospectively scored and reclassified the last known biopsy of 263 renal transplant recipients, morphologically classified as rejection according to the 2019 Banff classification. mRNA expression analysis was performed using the Nanostring B-HOT panel on a subset of cases. PCRR was compared to (late) TCMR, ABMR and mixed rejection for renal function follow-up and graft survival.

Results
mRNA analysis revealed uniquely expressed genes in PCRR including LOX, CPA3, IL4, IL17F, and MMP12. PCRR is enriched for genes related to mast cells, memory B- and T-cells and transcripts involved in NK cells and allograft fibrosis with heterogeneity in gene expression in biopsies with PCRR. PCRR might be a late event compared to late TCMR and ABMR, with a higher degree of total inflammation and fibrosis. Graft survival and kidney function was similar to late TCMR and ABMR during a 5-year follow-up period after renal biopsy

Conclusion
PCRR represents a distinct late-onset stage of inflammation displaying diverse gene expression patterns, with presence of mainly mast cells, NK cells and transcripts involved in renal allograft fibrosis. Such insights could enable a better and more tailored treatment for these patients and ultimately enhance long-term graft survival for patients affected by PCRR. Clinical outcomes in patients with PCRR appeared similar to late TCMR and ABMR.
#3105 Tocilizumab for treatment of antibody mediated rejection in kidney transplant patients
Authors: Szabó Eszter , Marton Adrienn , Remport Adam , Török Szilárd , Patonai Attila , Piros László , Fintha Attila , Szijártó Attila , Wagner Laszlo , Cseprekal Orsolya 
Published: May 2024

Abstract

Background and Aims
Chronic active antibody-mediated rejection (caABMR) causes 40% of long-term graft failure after kidney transplantation (KT). Early treatment is of great importance, however, hard clinical evidence is still lacking. Currently the combination of plasmapheresis (PF), rituximab and intravenous immunoglobulin is used as standard treatment. Tocilizumab (TCZ) is a monoclonal antibody, IL-6 receptor antagonist, and it inhibits the production of donor-specific antibodies (DSA). We hypothesized that tocilizumab administration has an additional effect on graft survival and non-inferior to standard therapy in KT patients with ABMR.

Method
Retrospective single-center noninferiority case-control study was performed by involving 73 KT patients (43.5 ± 14.3 years, females 31, eGFR 19.5 ± 13.4) with biopsy proven ABMR diagnosed between June 2017 and May 2022. 19 patients received 8 mg/kg intravenous TCZ therapy for 6 months (12 aABMR, 7 caABMR, 38.6 ± 12.8 years, females 6). In the control group (C, n=54, 10 aABMR, 44 caABMR, 45.2 ± 14.5 years, females 25), 20 patients received plasmapheresis treatment, the rest stayed on optimized maintenance therapy (tacrolimus, mycophenolic acid, prednisolone). Baseline demographic data, standard laboratory data, proteinuria and DSA level were also monitored and analyzed.

Results
Graft loss occurred in 13 cases (6 aABMR, 7 caABMR) in KT on TCZ therapy and 43 (6 aABMR, 37 caABMR) in C group, meaning significantly lower risk of graft loss in the TCZ group (RR 0.69, p=0.036) during the median follow-up of 11.3 (IQR 2.5-23.1) months. In TCZ group, all caABMR patients lost their graft during the observation. In TCZ group, 1 year after the TCZ treatment, DSA (pooled) was lower (7028 (575-17782) versus 1605 (551-16903), p&lt;0.05).

Conclusion
Early administration of TCZ seems to be noninferior to standard therapy and effective to prevent early graft loss as part of standard therapy in aABMR. Further clinical studies are needed to clarify clinical indications of TCZ and its long-term effects on the course of chronic active ABMR.
#1688 Association of baseline serum activin levels with left atrial diameter at 5 years post-kidney transplantation: results from the KNOW-KT
Authors: Kang Woo Jin , Koo Tai Yeon , Kim Beom Seok , Yang Jaeseok 
Published: May 2024

Abstract

Background and Aims
Serum activin A inhibits muscle growth, promotes apoptosis, and impairs heart function. However, the role of serum activin remains unclear in kidney transplant patients, where cardiovascular complications are a significant cause of morbidity and mortality. In this multicenter, observational cohort study, we investigated a potential association of pre-transplant serum activin levels with the left atrial (LA) diameter, an indicator of diastolic burden and a predictor of cardiovascular complications, to indirectly assess the impact of pre-transplant activin levels on heart function in kidney transplant patients.

Method
Overall, 602 kidney transplant patients from KNOW-KT (Korean cohort study for outcome in patients with kidney transplantation) were analyzed. Activin levels were measured at baseline immediately before kidney transplantation (KT). The primary outcome was the LA diameter that was measured by transthoracic echocardiography at 5 years after KT.

Results
The mean age of study population was 45.4 years and 221 (46.7%) patients were men. Pre-transplant serum activin levels were 718.4 ± 363.2 (mean ± standard deviation). When activin levels were divided into categorical variables according to the median value, the ejection fraction of LV showed a lower tendency in the high-activin group (64.3 ± 7.0) compared to the low-activin group (65.3 ± 6.2); however, there was no statistical significance (P=0.069). LV diastolic dimension was significantly higher in the high-activin group (47.3 ± 5.3) compared to the low-activin group (46.3 ± 5.5) (P=0.021). Notably, the post-transplant LA diameter was 37.0 ± 7.0 mm in the low-activin group and 39.1 ± 6.5 mm in the high-activin group, showing a significant difference (P&lt;0.001). The multivariate linear regression coefficient for association between activin groups and LA diameter was 1.08 (95% confidence interval [CI], 0.67-2.10, P=0.037). In an additional logistic regression analysis of LA diameter groups, the high activin group was significantly associated with the high LA diameters compared to the low-activin group in multivariate analysis (adjusted odds ratio [OR], 2.04; 95% CI, 1.34-3.09, P=0.001). When activin levels were used as a continuous variable, adjusted ORs of activin for high LA diameters were 1.29 (95% CI, 1.04-1.60, P=0.018).

Conclusion
Pre-transplant serum activin levels were independently associated with a higher post-transplant LA diameter, suggesting that activin may negatively affect heart functions in kidney transplant patients. Therefore, activin may be a potential prognostic and therapeutic target in kidney transplant patients.
#3077 Activity and chronicity index as graft lost predictors in kidney transplant with antibody mediated rejection or isolated microvascular inflammation
Authors: Tarrega Carla Burballa , Morcillo Sofia , Buxeda Anna , Huacon Betty Odette Chamoun , Alari-Pahissa Elisenda , Sanz-Ureña Sara , Federico Judit , Redondo-Pachón Dolores , Pérez-Saéz María José , Crespo Marta 
Published: May 2024

Abstract

Background and Aims
Antibody mediated rejection (ABMR) is the major cause of graft lost in kidney transplant (KT) recipients. Banff classification considers active ABMR (aABMR) and chronic active ABMR (caAMBR) but does not consider isolated microvascular inflammation (iMVI). Considering histologic lesions in kidney biopsies (KB), activity (AI) and chronicity index (CI) have been developed. Only CI ≥4 has been associated to worse graft survival in ABMR, yet the prognostic value of AI and CI in iMVI is still unknown. Our aim was to evaluate chronicity and activity index as prognostic tools in ABMR and iMVI.

Method
Retrospective study of KT recipients (1987-2022) with KB (2013-2022) with ABMR (category 3, Banff’2019) [group 1] and iMVI [group 2]. We evaluated AI ([glomerulitis (g) + peritubular capillaritis (ptc), arteritis (v) + C4dscore] e CI ([interstitial fibrosis (ci), tubular atrophy (ct), chronic vasculopathy (cv), and 2xchronic glomerulopathy (2cg) scores)]). Our aim was to evaluate chronicity and activity index as prognostic tools in ABMR and iMVI.

Results
One hundred thirty-nine KT with aABMR (n=48) and caABMR (n=46) (group 1) and MVIi (n=45) (group 2). Graft loss along time of follow-up (35 [15-69] months) was higher in group 1 (41.5% vs 22.2%; p=0.02). AI was higher in group 1 (4 [3-4.5] vs. 2 [2-4]; p&lt;0.001) and CI similar in both groups (4 [3-7] vs. 4 [4-6]; p=0.7). In the multivariate analysis CI (per unit increase) with HR 1.24 [1.09-1.42; p=0.001] and IA ≥4 in ABMR with HR 2.23 [1.08-4.58; p=0.029]. Death-censored graft survival was worse in IA. IA≥ 4 e IC ≥4 La supervivencia del injerto muerte-censurada fue peor en el grupo RH con IA≥ 4 e IC ≥4 (Fig. 1).

Conclusion
Our findings suggest that the activity index in ABMR and the chronicity index both in ABMR and iMVI are valuable prognostic tools.
#3080 Response to mRNA SARS-CoV-2 vaccination in kidney transplant recipients with HIV
Authors: Cacho Judit , Nomah Daniel Kwakye , Egri Natalia , González Ángela , Rodríguez Diana , Cuadrado Elena , Montagud-Marrahi Enrique , Diekmann Fritz , Miro Jose María , Cucchiari David 
Published: May 2024

Abstract

Background and Aims
No data exists on humoral or cellular responses to mRNA vaccines in kidney transplant recipients (KTR) with HIV. We compared these responses in HIV-positive and negative KTR, as well as in people living with HIV (PLWH) without kidney transplantation.

Method
In a cross-sectional study of 33 patients receiving two (n=13) or three (n=20) doses of mRNA SARS-CoV-2 vaccination, we evaluated the humoral response to mRNA SARS-CoV-2 vaccination using a Luminex platform for IgG and IgM, and assessed cellular response with specific T cell response with S- and N- protein by ELISpot. We used logistic regression models to assess associated factors.

Results
The study comprised 11 HIV-negative KTRs (HIV-KTR+), 11 HIV-positive KTRs (HIV+KTR+), and 11 PLWH without kidney transplantation (HIV+KTR−). PLWH had suppressed viral load on ART. Seroconversion rates after two or three vaccine doses were 72.7% among KTRs, with no significant difference between HIV-KTR+ (81.8%) and HIV+KTR+ (63.6%) (P=0.338). In HIV+KTR−, seroconversion was 100%, higher than HIV+KTR+ (P=0.027). Cellular response against protein S occurred in 63.6% cases, irrespective of HIV or transplantation status or number of doses. Protein N reactivity was observed in 27.3% KTRs (HIV-KTR+ and HIV+KTR+), versus 9.1% HIV+KTR− (P=0.378). Higher age negatively influenced cellular response in PLWH (OR 0.77, 95% CI 0.60-0.99).

Conclusion
Although cellular immune response was similar across all groups, we found a reduced humoral response in HIV+KTR+. In PLWH, higher age reduced cellular response. These findings contribute to our understanding of vaccine response in immunosuppressed populations and provide valuable insights for optimizing vaccination strategies.