bluuebunny/crossref_metadata_2025_split huggingface dataset:
#2630 Current perceptions and interests of Spanish Nephrology Fellows
Authors: Lozano Claudia Yuste , Cabrera Maria Sagrario Soriano , Sanchez-Alvarez Jose Emilio 
Published: May 2024

Abstract

Background and Aims
The Spanish Peritoneal Dialysis Support Group (GADDPE) aim to enhance peritoneal dialysis (PD) education among young nephrologists to increase the incidence and prevalence of PD in Spain.

Method
Aiming to develop initiatives to make PD a more attractive and suitable for nephrologist, we conducted a 22-item survey targeting Spanish nephrology fellows (NF) sought to explore their areas of interest, experiences, and perceptions across their training in various nephrology subspecialties.

Results
51 survey answers where received, mainly from women (69%) during their last two years of training in tertiary hospitals (76%). Clinical nephrology was the preferred subespeciality of nephrology among NF (61.5%), and so the most frequently chosed as their free rotation (36.5%). As expected, interventional nephrology held the second place in NF preferences (25%) and the second-one selected as their free rotation (30.8%), since the 36.5% of NF consider interventional nephology as their least well-trained subespeciality. Sadly, most of the NF believe they will end up working in hemodialysis (63.5%), even though is favorite area of just the 11.5%. Regarding PD, is favorite area of just one fellow (1.9%), none believe they will end up working in it, and 28.8% thinks it is the area where they are least well-trained. On the other hand, 41.2% of residents perceive that clinical nephrology is the most renowned subespecility in their training hospital, while 31.4% believe that transplant is the least renowned area, followed by PD in the 21.6%. Finally, the 66% of the residents have participated in some research mainly related to Clinical nephrology (75.7%), followed by far from hemodialysis (16.2%).

Conclusion
Clinical nephrology is the preferred nephrology subespeciality for nephrology fellows, likely due to their greater involvement in research and the feeling that is the most renowned subespeciality on their hospital. To enhance the appeal of Peritoneal Dialysis for residents it is essential to promote innovation and research.
#748 Association between systemic inflammation biomarkers and mortality in patients with SA-AKI receiving CKRT
Authors: Jung Chan-Young , Jung Jiyun , Lim Jeong-Hoon , Paek Jin Hyuk , Kim Kipyo , Ban Tae Hyun , Park Jae Yoon , Kim Hyosang , Kim Yong Chul , Back Chung Hee 
Published: May 2024

Abstract

Background and Aims
Identifying risk factors and improving prognostication for mortality among patients with sepsis-associated acute kidney injury (AKI) undergoing continuous kidney replacement therapy (CKRT) is important in improving the adverse prognosis of this patient population. This study aimed to compare the prognostic value of existing systemic inflammation biomarkers and determine the optimal systemic inflammation biomarker in patients with sepsis-associated AKI receiving CKRT.

Method
This multi-centre, retrospective, observational cohort study included 1,500 patients with sepsis-associated AKI treated with intensive care and CKRT. The main predictor was a panel of 13 different systemic inflammation biomarkers. The primary outcome was 28-day mortality after CKRT initiation. Secondary outcomes included 90-day mortality after CKRT initiation, CKRT duration, KRT dependence at discharge, and lengths of ICU and hospital stays.

Results
When added to the widely accepted Acute Physiology and Chronic Health Evaluation-II score, platelet-albumin ratio (PAR) and neutrophil-platelet score (NPS) had the highest improvements in prognostication of 28-day mortality, where the corresponding increases in C-statistic were 0.01 (95% CI, 0.00-0.02) and 0.02 (95% CI, 0.01-0.03). Similar findings were observed for 90-day mortality. The 28- and 90-day mortality rates were significantly lower for the higher PAR and NPS quartiles. These associations remained significant even after adjustment for potential confounding variables in multivariable Cox proportional hazards models.

Conclusion
Of the available systemic inflammation biomarkers, the addition of PAR or NPS to conventional ICU prediction models improved the prognostication of patients with sepsis-associated AKI receiving intensive care and CKRT.
#1301 Orellanine intoxication—a case report
Authors: Ahmad Irma , Sundstedt Amanda , Tenerz Linnea , Mörtberg Lina Josefin Gisela , Haraldsson Boerje 
Published: May 2024

Abstract

Background and Aims
This is a case report presenting a patient with orellanine-caused acute kidney failure. Cortinarius rubellus is a mushroom containing orellanine which is a selective nephrotoxin that destroys the proximal tubule cells of the kidney. Intake of just a few mushrooms is enough to cause irreversible damage and furthermore lead to severe kidney failure. Symptoms as gastrointestinal irritation usually occur 3-7 days after intake. Anti-oxidative medication and steroids have been evaluated but have not shown any effect on the kidney damage.
The aim of this case report was to raise awareness about the clinical manifestations of orellanine poisoning, diagnostic challenges, and potentially severe consequences.

Method
The junior doctors (IA, LT, AS) and the senior doctor (JM) took care of the patient at the ED, the internal medicine ward and the dialysis clinic. All data was extracted from the medical record. Informed consent was obtained from the patient. An attempt to analyze orellanine in the kidney biopsy was made.

Results
A 40-year-old male entered the emergency department with abdominal pain, fever, nausea and vomiting. The creatinine concentration was 278 µmol/L (3.14 mg/dl) where acute kidney failure due to prerenal cause was suspected. The patient was recommended to stay but declined due to personal reasons, and instead a follow-up next day was planned.
The following day, the creatinine concentration was increased to 477 µmol/L (5.39 mg/dl). The junior doctor specifically asked for mushroom intake. The patient confirmed that three days before, he had been in the forest picking mushrooms, of which he consumed two raw and the rest in a stew. Acute renal failure from mushroom poisoning was now suspected. The patient was admitted, and serum creatinine increased to 817 µmol/L (9.24 mg/dl) the following day. The urine production decreased, and the patient was anuric 7 days after intake. Hemodialysis was initiated due to uremic symptoms and volume overload. After showing the patient different photos of mushrooms it was suspected that he had consumed Cortinarius Rubellus. A renal biopsy was performed 12 days after the mushroom intake, which showed a fulminant acute tubular necrosis, no sign of glomerulonephritis, vasculitis, or interstitial nephritis. The attempt to analyze orellanine in the kidney biopsy material was not successful. Orellanine would not be detected in the urine or blood samples because they were collected 72 hours after intake. The half-life of orellanine in otherwise healthy humans is considered to be around 2-4 hours.
The patient stayed at the hospital for a total of 14 days. He was on hemodialysis for 14 months and was then successfully kidney transplanted.

Conclusion
Orellanine is a very potent toxin leading to severe damage of the kidney tubules. Due to the diagnostic challenges, it is important to keep this in mind when managing a patient with acute renal failure.
#2921 The SOFA score: predictive factor of nephrotoxicity post injection of iodized PDC in the emergency room
Authors: Othmani Safia , Jouini Sarra , Hedhli Hana , Bouarada Ghada , Jendoubi Asma , Hosni Dhekra , Jemai Mouna 
Published: May 2024

Abstract

Background and Aims
Nephrotoxicity following injection of iodinated contrast media is the leading cause of iatrogenic acute renal failure. Its incidence is variable taking into account the study population as well as associated factors.
The aim: To study the contribution of the SOFA score in the prediction of nephrotoxicity post injection of iodized PDCs in septic patients.

Method
This was a prospective, single-center study over a six-month period. Patients aged over 14 years and having undergone an injection of iodinated contrast products were included. Nephropathy in this context is defined by an elevation in plasma creatinine of more than 25% within 48 to 72 hours following injection and in the absence of other etiologies.

Results
During the study period, 135 patients were collected with a mean age of 46 ± 18 years and range of 16 to 97 years. The gender ratio was 3.2 with a male predominance. Hypertension and diabetes were the most noted comorbidities (20.7%, 20%).
Clinical examination revealed polypnea in 26% of cases, desaturation in 11.8%, tachycardia (27%) and oliguria (5.2%). Fourteen patients had an altered state of consciousness with coma in 10.4% of cases. Twenty-one patients (15.6%) were febrile on admission.
The incidence of nephropathy post injection of iodized PDCs was 15.6%. 111 patients (82.8%) benefited from per-procedure hydration. Emergency mortality was 4.4% (n=6).
The SOFA score was calculated in 24 patients with a median score of three. Nineteen patients (14.1%) had a score ranging from two to six, which predicts an intra-hospital mortality risk of 10%. Four patients (2.9%) had a score between 7 and 9, which reflects a risk of death of 15 to 20%. In univariate analysis, the SOFA score was calculated in six patients with nephrotoxicity and in 18 patients who did not develop nephrotoxicity. A score between seven and nine was significantly associated with the risk of developing nephrotoxicity (14.3% vs 0.9%) with p=0.012 and ORb=19.2, 95% CI [1.8-196.8].

Conclusion
The incidence of post-iodized PDC injection nephropathy was high in emergency rooms. Among the independent factors associated with nephrotoxicity, the SOFA score was found to be.
#1378 A single-center retrospective study on clinical characteristics and outcomes of extended-spectrum beta-lactamases positive acute pyelonephritis
Authors: Bae Eunjin , Lee Tae Won , Park Dong Jun 
Published: May 2024

Abstract

Background and Aims
The increase of extended-spectrum beta-lactamases (ESBL) releasing bacteria in acute pyelonephritis (APN) is a growing problem world-wide. Recently, little is known about the incidence, clinical features and outcomes of ESBL positive APN. This study intends to describe the epidemiology and clinical outcomes of ESBL positive APN.

Method
A retrospective study of 1631 culture positive patients with APN admitted from Jan, 2011 to Dec, 2019 in a single-center was performed. Adults over 18 years of age were included, and outpatient treatment, pregnant women, and transplant patients were excluded.

Result
A total of 2818 patients were diagnosed as APN during this period and causative bacteria was confirmed in1631 patients among them (57.9%). ESBL positive bacteria were found in 553 patients (33.9%). There were no differences in baseline characteristics between ESBL positive and negative groups. Most common strain was Escherichia coli, followed by Klebsiella and Pseudomonas species. The proportion of ESBL positive APN increased when evaluated at one-year intervals for 8 years (from 4.9% in 2011 to 20.9% in 2019). The rate of positive blood culture was higher in ESBL positive patients (39.2% vs 21.1%, p&lt;0.001). Hospital stay was longer in ESBL positive patients (12.3 ± 2.2 vs. 5.4 ± 5.2, p&lt;0.001) and the number of re-admission is higher (1.7 ± 1.3 vs. 1.2 ± 0.6, p&lt;0.001). The incidence of acute kidney injury according to KDIGO was higher in ESBL positive groups (25.4% vs 12.3%, p&lt;0.001). There was no hospital mortality between two groups.

Conclusion
We should attempt to detect ESBL positive bacteria through timely performing blood and urine culture and administer appropriate antibiotics if APN is clinically suspected because of poor clinical courses.
#2561 Association of acute kidney injury stage with in-hospital mortality in elderly patients with hip fractures
Authors: Kwon Soon Hyo , Lee Haekyung , Kim Hyoungnae , Noh Hyunjin , Jeon Jin Seok 
Published: May 2024

Abstract

Background and Aims
Elderly individuals often experience hip fractures and acute kidney injury (AKI), both of which are associated with higher rates of morbidity and mortality. This study aimed to evaluate whether the severity of AKI is associated with higher mortality rates in elderly patients with hip fractures.

Method
Patients aged 65 years and older, who underwent surgery for hip fracture between October 2015 and October 2020, were retrospectively evaluated. Those with known chronic kidney disease stages 4, 5, or end-stage kidney disease were excluded. AKI was defined and categorized into stages 1, 2, and 3 according to the Kidney Disease Improving Global Outcomes (KDIGO) guidelines.

Results
In the study, 780 elderly patients with hip fractures were included, with a median age of 82.0 years (interquartile range 77.0–87.0) and 22.4% of them being men. Of these, 172 patients (22.1%) experienced AKI, with 125 (72.7%), 26 (15.1%), and 21 (12.2%) of these patients categorized as having stage 1, 2, and 3 AKI, respectively. Higher AKI stages were independently associated with increased in-hospital mortality compared to patients without AKI (odds ratio [OR] 1.07, 95% confidence interval [CI] 0.18–6.55, P=0.940 for AKI stage 1; OR 14.09, 95% CI 1.47–135.52, P=0.022 for AKI stage 2; and OR 413.79, 95% CI 45.84–3735.28, P&lt;0.001 for AKI stage 3). Furthermore, compared to patients without AKI, those with AKI stage 3 had a significantly increased risk of mortality (hazard ratio 15.30, 95% CI 2.65–88.48, P=0.002).

Conclusion
A higher stage of AKI is independently associated with increased in-hospital mortality in elderly patients with hip fractures. Prevention and prompt treatment of AKI, especially higher AKI stages, is important in elderly patients with hip fractures.
#927 Assessment of kidney function recovery post discharge in patients with acute kidney injury requiring dialysis during hospitalization
Authors: Elshirbeny Mostafa Fottoh , Elesnawi Mohamed , Abdellatif Tarek , Abdulrahman Rasha , Khater Iman , Hamad Abdulla , Alkadi Mohamad , Al-Ali Fadwa , Almalki Hassan 
Published: May 2024

Abstract

Background and Aims
Acute kidney injury requiring dialysis (AKI-D) is a serious medical condition that becomes increasingly common and associated with high rate of mortality. Identifying modifiable predictors of AKI-D patients’ outcomes will lead to better care and improve kidney and patient survival. This study aimed to assess long-term outcomes (ESRD, HD-independence, or death) of AKI-D patients after hospital discharge as well as to identify the clinical predictors of their outcomes.

Method
We followed 64 AKI-D patients who survived till hospital discharge and continued receiving dialysis treatment in outpatient dialysis center. Follow up continued for 6 months between January 2016 and December 2022 for patients discharged from Hamad General Hospital to receive dialysis in Fahd Ben Jassim Kidney center. All demographic data, patients’ comorbidities, hospital course, laboratory values and outpatient dialysis details were collected and analysed. Follow up of recovered patient was continued for 2 years either in nephrology or low clearance clinic.

Results
During follow up, 20 patients (31.3%) recovered enough kidney function to stop dialysis while 44 patients (68.7%) were declared as ESRD. The average time to recovery was 106 ± 81 days. No significant difference was noticed between both groups regard to patients’ age, gender or comorbidities. Recovered patients had more ICU admission rate compared to non-recovered patients (60% and 29.5% of patients respectively, p 0.028) and more use of vasopressors (p 0.002). Moreover, the recovered patients received significantly more dialysis sessions during hospital stay than non-recovered patients (p 0.009).

Conclusion
Close monitoring of AKI-D patients during ICU admission, use of vasopressors, and frequent dialysis sessions may facilitate recovery of kidney function. More research is needed to identify the modifiable predictors of AKI-D patients’ outcomes.
#75 Extracorporeal membrane oxygenation (ECMO) in patients with acute kidney injury (AKI): a prospective, observational, multi-center study
Authors: Alsahow Ali , Alkandari Omar , Alyousef Anas , Alhelal Bassam , Bahbahani Yousif , Alsharekh Monther , Alkandari Abdulrahman , Mazroue Ahmed Mohamed Eltaher Eliwa Bayoumi , Abdallah Emad , Abdelzaher Ali , Mashal Basem , Nessim Gamal 
Published: May 2024

Abstract

Background and Aims
Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy for patients with severe respiratory and/or cardiovascular failure. Acute kidney injury (AKI) is a frequent complication in ECMO, resulting in increased morbidity and mortality. We aim to evaluate impact of ECMO on AKI outcome in Kuwait.

Method
Demographics, comorbidities, management, and 30-day kidney and patient outcome data for adult inpatients with native kidneys with AKI who received ECMO in seven public hospitals in Kuwait from 1/January to 31/December 2021, were prospectively collected and analyzed.

Results
Total number of AKI cases during study period was 3744, but only 121 patients received ECMO, or only 3.2%, with mean age of 56.3 years; and mean baseline eGFR of 81.6 ml/min. Males were 62.8% of the cohort, and 91.7% of cases were hospital-acquired AKI. Only 21.5% had pre-existing CKD (mainly diabetic kidney disease), and only 26.5% were older than 65, however, 58.7% were diabetics, and 48% were hypertensive. COVID-19 infection was a cause for AKI in 69% of patients. ECMO was veno-venous in 90% of cases, and AKI developed before ECMO initiation in 62.8% of cases. Dialysis was provided for 92% with continuous kidney replacement therapy (CKRT) accounting for 97%, and 93% of patients were in ICU (all on inotropic support). At 30 days, 86.8% of the whole group died (91% of those died on dialysis), six patients remained alive on dialysis, and only four patients recovered kidney function completely.

Conclusion
Although ECMO utilization in patients with AKI is limited in our AKI cohort, and despite relatively young age and reasonable baseline eGFR for the cohort, ECMO is associated with high need for ICU admission, high incidence of AKI, high need for dialysis, and high mortality rates.
#2500 Renal perfusion and SGLT2i
Authors: Nielsen Steffen Flindt , Duus Camilla , Buus Niels Henrik , Bech Jesper Noergaard , Mose Frank 
Published: May 2024

Abstract

Background and Aims
Sodium-Glucose Cotransporter 2 inhibitors (SGLT2i) have revolutionized treatment of type 2 diabetes mellitus (DM2) and chronic kidney disease (CKD), improving cardiovascular and renal endpoints. This improvement could be due to a decrease in renal perfusion (RP), attenuating glomerular hyperfiltration thus leading to kidney protection. This has been demonstrated in patients with type 1 diabetes and in animal studies, but not in patients with DM2 and it has never before been investigated in patients with CKD. Our aim was to examine the effects of the SGLT2i empagliflozin on RP in patients with DM2, DM2 and CKD and non-diabetic CKD, respectively.

Methods
We conducted three randomized, double-blind placebo controlled cross-over studies, including patients with:
Participants were randomized to four weeks' treatment with empagliflozin 10 mg or matching placebo and were, after a washout period of at least two weeks, crossed over to four weeks of the opposite treatment. At the end of each treatment period we measured RP using 82Rb-PET/CT and standardized GFR using 99mTc-DTPA-clearence. We also measured 24-hour ambulatory blood pressure (BP), urinary albumin/creatinine ratio (UACR) and Hb1Ac.

Results
A total of 49 patients completed the studies, 16 in the DM2-group, 17 in the DM2-CKD-group and 16 in the CKD-group. In the combined study-population empagliflozin reduced RP compared to placebo by 4% (geometric mean ratio: 0.96, 95% CI: 0.94; 0.99, p = 0.0171). This change was most pronounced in the DM2-CKD-group, with a reduction of 6% (geometric mean ratio: 0.94, 95% CI: 0.91; 0.97), p &lt; 0.001). There was a decrease of 4% in the DM2-group and 1% in the CKD-group, though these changes were not statistically significant (p = 0.29 and 0.72, respectively, see Fig. 1). In the 29 patients with a UACR &gt; 30 mg/g, empagliflozin treatment led to a significant decrease in UACR in the combined study-population (geometric mean ratio: 0.61, 95% CI: 0.46; 0.80, p = 0.001), again primarily driven by a decrease in the DM2-CKD-group (geometric mean ratio: 0.51, 95% CI: 0.31; 0.85, p = 0.014), with non-significant decreases in the remaining groups. Empagliflozin decreased standardized GFR and BP in the combined population as well as in all sub-groups, while we found no change in Hb1Ac. For further details, see Table 1.

Conclusion
Short-term empagliflozin treatment reduces RP, GFR, BP and albumin excretion. Relative changes in RP and UACR were most pronounced in patients with concomitant DM2 and CKD, whereas changes in BP and GFR were seen in all groups.
#2743 Impact of fatty acid-binding protein 4 on SUMOylation balance and renal tubular epithelial cell senescence in acute kidney injury
Authors: Liu Jing , Wu Qimei , LI Lingzhi , MA Liang , Fu Ping 
Published: May 2024

Abstract

Background and Aims
Dysregulated lipid metabolism and cellular senescence intricately interact in the context of acute kidney injury (AKI). Fatty acid-binding protein 4 (FABP4), a critical enzyme regulating lipid metabolism, potentially induces cell senescence through lipotoxicity in AKI. However, the specific mechanisms remain unclear.

Method
We established an ischemia-reperfusion-induced AKI (IRI-AKI) model in C57 mice and quantified and localized FABP4 expression in renal tissues using Western blotting (WB), qPCR, and immunofluorescence (IF). Oil Red O staining and beta-galactosidase staining were employed to assess lipid deposition and cellular senescence in tubular cells. The same measurements were repeated in IRI-AKI by knocking out Fabp4. Additionally, bulk mRNA sequencing and single-cell sequencing were conducted on renal tissues to analyze key molecules and related mechanisms.

Results
In vivo, we observed a significant decline in renal function, severe tubular epithelial damage, and abundant inflammation in the IRI-AKI group, which was noticeably alleviated in the Fabp4 knockout group (Fig. 1). Furthermore, we detected upregulation of FABP4 expression in the kidneys of IRI-AKI, primarily localized in the tubular epithelial cells. Fabp4 knockout effectively reduced tubular lipid accumulation and cellular senescence (Fig. 3). Through integrating mRNA and single-cell sequencing data, UBC9, an E2 enzyme involved in protein SUMOylation, emerged as a potential key regulator of cell senescence and AKI. WB and qPCR both confirmed the upregulation of UBC9 expression in IRI-AKI and its downregulation after Fabp4 knockout. Conversely, we observed that downregulated SUMOylation in IRI-AKI was upregulated in the Fabp4 knockout group (Fig. 4).

Conclusion
In conclusion, FABP4 modulates the expression of UBC9 and SUMOylation, thereby mediating cellular senescence and causing renal tubular cell damage in IRI-AKI. The mechanisms underlying FABP4’s regulation of UBC9 and the opposing trend between UBC9 and SUMOylation require further elucidation.