bluuebunny/crossref_metadata_2025_split huggingface dataset:
#2025 Associations of obesity, sarcopenia, and sarcopenic obesity with chronic kidney disease development in the elderly population
Authors: Park Jung Tak , Joo Young Su , Han Seung Hyeok , Yoo Tae-Hyun , Kang Shin-Wook 
Published: May 2024

Abstract

Background and Aims
Previous studies indicate that sarcopenia and obesity increase the risk of chronic kidney disease (CKD) in middle-aged populations. Despite noting reverse epidemiology for cardiovascular disease in the elderly, the relationship between sarcopenic obesity and CKD incidence in older populations is insufficiently explored. This study aims to assess whether obesity modifies the association between sarcopenia and CKD development in elderly adults with preserved kidney function.

Method
Elderly individuals aged over 65 with preserved kidney function among UK Biobank participants were examined. Participants with an estimated glomerular filtration rate (eGFR) &lt;60 ml/min/1.73 m² or albuminuria were excluded. The individuals were categorized based on the presence of sarcopenia and obesity, with sarcopenia defined as hand grip strength &lt;27 kg in males and &lt;16 kg in females. Obesity was defined as having a BMI of 30 kg/m² or higher, and sarcopenic obesity was identified in those with concomitant obesity and sarcopenia. The development of CKD was determined using ICD-10 codes in claim and death register records.

Results
A total of 62,735 individuals were assessed, with a mean age of 66.9 ± 1.5 years and 44.3% being male. Sarcopenia was identified in 8,648 individuals (13.8%), while obesity was present in 13,075 individuals (20.8%), resulting in a 3.29% prevalence of sarcopenic obesity. Over a median follow-up of 13.3 years (770,179 person-years), 5,567 participants (8.9%) developed CKD. A significant interaction between sarcopenia and obesity was observed for CKD development (P &lt; 0.001). Incident CKD rates were 7.8% in non-obese without sarcopenia, 9.5% in obese without sarcopenia, 11.7% in non-obese with sarcopenia, and 14.7% in obese with sarcopenia. Compared to the non-obese without sarcopenia group, hazard ratios (HRs) and 95% confidence intervals (CIs) were 1.26 (1.16-1.37) in the obese without sarcopenia group, 1.55 (1.45-1.65) in the non-obese with sarcopenia group, and 2.02 (1.80-2.27) in the obese with sarcopenia group. After adjusting for confounding factors, the risk of CKD development in the obese without sarcopenia group was comparable to the non-obese without sarcopenia group (HR, 1.07, 95% CI, 0.99-1.15). However, elevated risk persisted in participants with sarcopenia and was most accentuated in those with sarcopenic obesity (non-obese with sarcopenia; HR, 95% CI, 1.22 [1.11-1.34]; obese with sarcopenia, 1.32 [1.15-1.50]).

Conclusion
Sarcopenia, not obesity, was significantly associated with an increased risk of chronic kidney disease (CKD) development in elderly individuals, with sarcopenic obesity showing the highest risk elevation for incident CKD in this group.
#1913 Long-term trends of blood pressure and blood glucose in patients with chronic kidney disease in South Korea, 1998-2021
Authors: Kim Dae Kyu , Kim Hyun Kyu , Lee Jeong-Yeun , Yoon Soo-Young , Kim Jin Sug , Jeong Kyung Hwan , Hwang Hyeon Seok 
Published: May 2024

Abstract

Background and Aims
Uncontrolled hypertension and elevated blood glucose are established risk factors for the progression of chronic kidney disease (CKD) and its complications. The long-term trends in these CKD risk factors, including the coronavirus 2019 (COVID-19) pandemic, have not been thoroughly studied in South Korea.

Method
We used data from Korea National Health and Nutrition Examination Survey, which nationally representative survey in South Korea. Data from Korean adults from 1998 to 2021 were obtained. We defined CKD as the participant's estimated glomerular filtration rate being &lt;60 mL/min/1.73 m², one-time spot proteinuria of ≥1+. The evaluated risk factors for CKD included uncontrolled blood pressure and blood glucose, defined as a mean systolic blood pressure ≥120 mmHg and a glycated hemoglobin (HbA1c) level ≥6.5%. We examined the trend in the prevalence of uncontrolled hypertension and blood glucose, conducting subgroup analysis based on socioeconomic and behavioral factors.

Results
The trend among a total of 4,648 CKD patients with uncontrolled hypertension gradually decreased or remained steady from 1998 to 2019, however, there was an increase observed in COVID-19 pandemic period from 2019 to 2021 (1998-2005, 75.5% [95% confidence interval (CI) 71.5–79.5]; 2016–2019, 63.6% [95% CI 60.5–66.7]; 2021, 69.4% [95% CI 63.6–75.1]; and β diff, 0.65; 95% CI 0.30 to 1.00). Moreover, in the subgroup analysis of the prevalence of uncontrolled hypertension in CKD, almost all subgroups increased during the pandemic, except for older patients (age ≥ 65)
However, the overall trend difference in the prevalence of uncontrolled blood glucose among a total of 1,848 CKD patients with diabetes did not show significant changes (β diff, 2.80; 95% CI −0.11-5.71) between the periods before and during the COVID-19 pandemic.

Conclusion
During the COVID-19 pandemic, uncontrolled hypertension had a more significant impact on CKD patients than uncontrolled blood glucose, with an increase in the prevalence of uncontrolled hypertension. It is estimated that additional attention and policies for uncontrolled hypertension with CKD patients may be needed during periods of medical vulnerability, such as the COVID-19 pandemic.
#986 Sarcopenia and chronic kidney disease among adults over 45 years old: findings from CHARLS
Authors: Liu Fang , Jiamin Yuan 
Published: May 2024

Abstract

Background and Aims
Little is known about the association between sarcopenia and chronic kidney disease (CKD) among Chinese adults older than 45. The present study sought to investigate the relationship between sarcopenia and CKD based on a large, nationally representative survey.

Method
The China Health and Retirement Longitudinal Study (CHARLS) provided data for the study in four waves in 2011, 2013, 2015, and 2018. Based on the Asia Working Group for Sarcopenia 2019 (AWGS 2019) criteria, sarcopenia and possible sarcopenia were defined. CKD was defined as eGFR less than 60 mL/min/1.73 m2, calculated according to the CKD Epidemiology Collaboration (CKD-EPI) equation, or self-reported CKD. Logistic regression models were conducted to analyze the cross-sectional relationship between sarcopenia and CKD. Cox proportional hazards regression models were used to examine the effect of sarcopenia on CKD. Stratified analyses were used to assess the association between sarcopenia status and CKD in various subgroups.

Results
Totally, 12323 participants over 45 years old (48.2% males; mean age 59.3 ± 9.5 years) were enrolled in a cross-sectional study in 2011, and further 10445 individuals were followed up in 2013, 2015 and 2018. The prevalence of CKD was 8.4% (1040/12323) in general populations, 7.2% (556/7703) in individuals without sarcopenia, 10.1% (380/3760) in adults with possible sarcopenia, and 12.1% (104/860) in individuals with sarcopenia, respectively. In cross-sectional study, possible sarcopenia [OR (95% CI): 1.236 (1.069-1.430)] was significantly associated with CKD (P &lt; 0.01). While sarcopenia was not significantly associated with CKD. 783 cases (7.5%) with incident CKD events were identified during the 7 years of follow-up. In subgroup analyses, the incidence of CKD was 1.855 (95% CI 1.176-2.928) in the sarcopenia group compared with non-sarcopenia group among the female participants. The sarcopenia group (HR: 1.639, 95% CI 1.099-2.443) was independently associated with a higher incidence of CKD among non-smokers. Low muscle mass alone was not significantly associated with an increased risk of incident CKD (P &gt; 0.05).

Conclusion
In our cross-sectional analysis, possible sarcopenia determined by AWGS2019 criteria was associated with a higher prevalence of CKD. In our longitudinal study, sarcopenia assessed using AWGS2019 criteria was associated with a higher risk of CKD in Chinese women over 45 years old or non-smokers.
#2514 Clinical impact of the CKD-EPI 2021 versus the CKD-EPI 2012 formula on GFR estimation and CKD prevalence: results from a Dutch routine-care cohort
Authors: Veltkamp Denise Mj , Rookmaaker Maarten B , Verhaar Marianne , van Solinge Wouter W , Haitjema Saskia , Vernooij Robin Wm 
Published: May 2024

Abstract

Background and Aims
Quantifying the kidney function is crucial for diagnosing and monitoring kidney disorders in clinical practice. Recently, the CKD-EPI 2021 formula was developed for estimating glomerular filtration rate (eGFR), excluding the ethnicity variable. In this study, we aimed to analyze the impact in a Dutch routine-care cohort of introducing the new serum creatinine-based CKD-EPI 2021 formula on glomerular kidney function estimation and the prevalence of chronic kidney disease (CKD), compared to the now used CKD-EPI 2012 formula.

Method
All patients of 18 years and older of whom serum creatinine was measured between January 2013 and December 2023 at the University Medical Center Utrecht in the Netherlands, were included. Differences in the eGFR measured with the CKD-EPI 2012 formula and the new CKD-EPI 2021 formula were defined as median difference, stratified by gender, age categories, and CKD stages.

Results
251.960 patients with 2.312.313 serum creatinine measurements were included in our analysis. Our findings indicate that the CKD-EPI 2021 formula results in a higher eGFR compared to the CKD-EPI 2012 formula (median +3.6 (Inter quartile range (IQR) 2.4 to 4.5) ml/min/1.73 m2 in men, and median +3.1 (IQR 2.0 to 4.0) ml/min/1.73 m2 in women). In total, 21.1% of the patients with CKD stage 2-5 according to the CKD-EPI 2012 formula were classified as having a better CKD stage using the new CKD-EPI 2021 formula; 26.1%, 20.5%, and 15.1% of the patients classified as having CKD stage 3A, 3B, and 4 were classified as having CKD stage 2, 3A, and 3B, respectively (Table 1).

Conclusion
The introduction of the CKD-EPI 2021 formula would have significant implications for kidney function estimation in the Dutch clinical setting. It is crucial to consider these differences when interpreting kidney function data and making clinical decisions, especially given the potential impact on diagnosing CKD and dosing medication.
#1433 Geographical variation in chronic kidney disease: a nationwide cohort study in Denmark
Authors: Slot Matilde , Kristiansen Nina Sahlertz , Bertelsen Michael , Jensen Simon Kok , Nørgaard Mette , Thomsen Reimar , Birn Henrik , Heide-Jørgensen Uffe , Christiansen Christian Fynbo 
Published: May 2024

Abstract

Background and Aims
Chronic kidney disease (CKD) represents a significant and growing global health challenge, especially among aging populations. Despite declines in mortality from other non-communicable diseases, CKD-related mortality has remained stable, underscoring the need for enhanced management strategies. Primary care physicians play a crucial role in early detection and appropriate intervention. Understanding geographical variation in CKD prevalence and incidence is essential for clinicians and policy makers, informing the development of targeted interventions and resource allocation strategies. This study investigates CKD in Denmark, assessing variations in prevalence and incidence across rural and urban areas.

Method
This nationwide cohort study included all Danish residents aged ≥18 years as of January 1, 2019. Patients with CKD were identified using measurements of eGFR from the Register of Laboratory results for Research. CKD was defined according to KDIGO as at least two reported outpatient eGFR &lt;60 ml/min/1.73 m2 at least 90 days apart. Population characteristics, CKD prevalence and CKD incidence were analyzed by urbanicity of residence municipality (capital, large city, provincial, sub-rural and rural municipalities). Two different models were used to estimate incidence rates; a crude model and a model using propensity score weighting for standardization, accounting for age and sex.

Results
The study included 4,466,041 Danish residents. There was variation in population characteristics and CKD incidence between urban and rural areas such as CKD prevalence, hypertension, diabetes, and Charlson Comorbidity Index. The crude model showed geographical differences in CKD incidence rates varying between 7.4 and 12.8 per 1,000 person-years in large city municipalities and rural municipalities, respectively. The standardized model showed less variation, with incidence rates ranging from 9.2 to 10.5 cases of CKD per 1,000 person years.

Conclusion
The study illuminates geographical variations in CKD prevalence and incidence across Danish rural and urban municipalities. After standardization for age and sex, there was only minor variation in incidence rates of CKD, suggesting that variation could largely be explained by differences in demographic, highlighting the need for targeted interventions accounting for diverse population characteristics in different geographic regions.
#2175 Sodium-glucose cotransporter 2 (SGLT2) inhibitors-induced erythropoiesis and cardiovascular events in chronic kidney patients
Authors: Vidas Maria De San Miguel Marques , López Paula , Briales Paula Sanchez , Sanchez Ana , Illazquez María Victoria López , Portolés Jose Maria 
Published: May 2024

Abstract

Background and Aims
Prior research has established that in chronic kidney disease (CKD), elevating hemoglobin (Hb) levels above 11.5 g/dl correlates with heightened thromboembolic event risks and increased mortality. Similar findings are seen in heart failure patients with Hb levels exceeding 13 g/dl, following treatment with erythropoiesis-stimulating agents. Sodium-glucose cotransporter 2 (SGLT2) inhibitors consistently raise Hb levels in CKD patients, both anemic and non-anemic.
This study aims to evaluate the consequences of Hb level elevation due to SGLT2 inhibitors beyond the safe threshold in CKD patients and to investigate its association with cardiovascular (CV) events.

Method
A retrospective observational study was conducted from January 2016 to December 2021, focusing on CKD patients treated with SGLT2 inhibitors. Patients receiving erythropoiesis-stimulating agents or undergoing renal replacement therapy were excluded. We assessed the impact of Hb level changes on atheroembolic events, blood pressure variations, and mortality, while considering demographic data, red blood cell parameters, and renal function indicators. Patients receiving iron treatment were excluded to ensure accurate ferrokinetic parameter assessment.

Results
The study included 79 CKD patients, predominantly male (76%) and primarily with type 2 diabetes mellitus (T2DM) as the CKD cause (67%). Average follow-up post-SGLT2 inhibitor initiation was 3.5 years (SD 1.4, 0.7-6.7 years). Hb levels increased mainly in the first six months of treatment, with an average increase of 0.7 g/dl/year from baseline (p &lt; 0.01). Ferritin levels slightly decreased (p 0.002), while the transferrin saturation index remained stable. Baseline estimated glomerular filtration rate (eGFR) did not influence Hb increase. Various responses to SGLT2 inhibitors were noted based on baseline Hb levels.
No significant association was found between elevated Hb levels (&gt;16.0 g/dl) and increased atheroembolic events, mortality, or blood pressure changes. However, patients with Hb levels &gt;13.0 g/dl experienced more CV events compared to those maintaining Hb ≤13.0 g/dl, though not statistically significant (0% vs 17.5%: p 0.30).

Conclusion
SGLT2 inhibitor treatment led to a significant Hb increase unless baseline levels were above 16.0 g/dl. Importantly, elevating Hb levels above 13.0 g/dl appears to be linked with a higher incidence of cardiovascular (CV) events, suggesting a potential risk associated with such an increase in Hb levels in this patient population. This finding underscores the necessity for further research to confirm this correlation and to delineate the safe therapeutic window for Hb levels in CKD patients treated with SGLT2 inhibitors.
#2595 Evolution of hemoglobin and serum uric acid levels after SGLT2i initiation in patients with and without diabetic nephropathy
Authors: Coca Armando , Moultamis Aya , Ardura Paula , Manrique María Martínez , Da Silva Ana Luisa Martins , Santana Henar , Cobo Kenia , Merizalde Carlos , Acosta-Ochoa Isabel , Mendiluce Alicia 
Published: May 2024

Abstract

Background and Aims
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are glucose-lowering drugs that inhibit glucose reabsorption in the proximal tubule, enhancing urinary glucose excretion. SGLT2i exhibit significant cardio- and renoprotective effects due to their capacity to increase diuresis and weight loss and reduce intraglomerular and blood pressure. Moreover, recent studies have described the potential of SGLT2i to improve additional cardiovascular risk factors, such as anemia or hyperuricemia. In this study, we aimed to describe the evolution of hemoglobin (Hb) and serum uric acid (SUA) levels in CKD patients with and without diabetic nephropathy before and after the initiation of SGLT2i therapy.

Method
CKD patients with and without diabetic nephropathy that were followed in the outpatient clinic of a tertiary referral academic hospital during January 2020 to September 2023 and that started SGLT2i therapy during that period were randomly recruited in the study. Patient characteristics, CKD staging, and levels of Hb and SUA before and after SGLT2i initiation were compared between groups. Hb and SUA levels were averaged considering all available laboratory controls during the last 12 months before treatment initiation and any available controls after treatment start.

Results
Demographic and clinical characteristics of enrolled patients are summarized in Fig. 1. Subjects with diabetic nephropathy were significantly older, more commonly hypertensive, presented worse kidney function, had received SGLT2i for a lengthier time and had lower hemoglobin values. We observed no change in hemoglobin levels after the initiation of SGLT2i in our sample, independently of diabetic nephropathy status or CKD stage (Fig. 2A, C). In contrast, SUA levels decreased significantly both in patients with and without diabetic nephropathy (Fig. 2B). This effect was observed across all the spectrum of CKD in our sample (Fig. 2D).

Conclusion
In our sample, SGLT2i initiation was associated with a significant decrease in SUA levels, both in patients with and without diabetic nephropathy and independently of CKD stage, which may help to explain its cardio- and nephroprotective effects. No change in Hb levels was observed, possibly due to a low prevalence of anaemia in our sample.
#1986 Incidence of renal anemia among patients with atrial fibrillation and chronic kidney disease stage IIIb-V
Authors: Igamberdieva Ranokhon , Abdullaev Sherzod 
Published: May 2024

Abstract

Background and Aims
According to the QICKD study, the prevalence of anemia in stage IIIb-V chronic kidney disease (CKD) is 22%. The incidence of renal anemia ranges from 8.4% in patients with stage I CKD to 83.7% in patients with stage V CKD. In patients on program hemodialysis, anemia develops in 94.5% of cases. The problem is associated with an increased risk of unfavorable outcome of CKD, therefore, the study of aspects of anemia among patients receiving anticoagulant therapy with atrial fibrillation (AF) and CKD remains the most relevant today. The purpose of the study is to study the prevalence of renal anemia among patients with AF and CKD stages IIIb-V.

Method
794 patients were admitted to the cardiology department with a diagnosis of AF and late stages of CKD—IIIb (glomerular filtration rate (GFR) 45–30 ml/min/1.73 m2), IV (GFR 29–15 ml/min/1.73 m2), V (GFR &lt;15 ml/min/1.73 m2), for the first identified sustained decrease in glomerular filtration rate (FISD in GFR) of less than 45 ml/min/1.73 m2. The classification of renal anemia was carried out according to the recommendations of the World Health Organization.

Results
Renal anemia was diagnosed in 505 (63%) patients with AF and GFR less than 45 ml/min/1.73 m2. In total, among patients with CKD stage IIIb, anemia was detected in 207 (59%) patients, with CKD stage IV—in 110 (89%), with CKD stage V—in 43 (97%), with FISD in GFR—in 145 (51%). A mild degree of anemia (hemoglobin (Hb) in men 110-129 g/l, in women 110-119 g/l) was diagnosed in 39% of patients, with CKD stage IIIb in 85 (24%) patients, with CKD stage IV in 28 (22%) patients, with CKD stage V in 9 (20%) patients, with FISD in GFR in 75 (26%) patients. A moderate degree of anemia (Hb 81-109 g/l) was detected in 47.3% of cases, with CKD stage IIIb in 86 (25%) patients, with CKD stage IV in 60 (48%) patients, with CKD stage V in 29 (66%) patients, with FISD in GFR in 64 (23%) patients. Severe anemia (Hb 81-109 g/l) was detected in 47.3% of patients, with CKD stage IIIb in 36 (10%) patients, with CKD stage IV in 22 (19%) patients, with CKD stage V in 5 (11%) patients, with FISD in GFR in 6 (2%) patients.

Conclusion
Every fourth patient in the cardiology department with AF and GFR &lt;45 ml/min/1.73 m2 was diagnosed with renal anemia, and its prevalence increases with a decrease in GFR. The above results indicate that a more careful selection of anticoagulant therapy is recommended for this patient population due to the high risk of progression of renal anemia in this cohort of patients.
#170 Vasoconstriction Inhibiting Factor: An endogenous inhibitor of vascular calcification as calcimimetic of calcium-sensing receptor
Authors: de la Puente Secades Sofia , Mikolajetz Dustin , Gayrard Nathalie , Jankowski Vera , Alghamdi Khaleda , Ciscart Angel Argiles , Schurgers Leon , Ward Donald , Jankowski Joachim , Orth-Alampour Setareh 
Published: May 2024

Abstract

Background and Aims
Patients with chronic kidney disease (CKD), have an increased risk of cardiovascular disease due to the massively accelerated calcification they develop. Vascular calcification is a highly regulated process mediated by different inducers and inhibitors. Recently, the peptide ‘vasoconstriction inhibiting factor’ (VIF) was isolated from bovine adrenal glands and has been described as an inhibitor of the angiotensin II-induced vasoconstriction. Angiotensin II inhibits calcium deposition, but VIF effect on vascular calcification is still unknown. In the present study, VIF has been characterised on vascular calcification assays.

Method
The effect of VIF was analysed in vitro in human aortic smooth muscle cells (hAoSMC) and ex vivo in rat aortic rings, both cultivated under high phosphate concentrations. VIF was also studied in vivo in rats treated with vitamin D and nicotine (calcification model).

Results
VIF inhibits calcium deposition in all the models studied. Furthermore, in hAoSMC VIF reduces the production of ROS and the initiation of diverse cascades in the cells, like activation of inflammatory cytokines and MAPK kinases, which in turn trigger the expression of various genes involved in the development of vascular calcification. Furthermore, in presence of VIF the population of apoptotic cells, directly linked to vascular calcification, is decreased. Calcium-sensing receptor (CaSR) has been found as VIF binding partner, pointing to VIF as a new calcimimetic of this receptor, that inhibits vascular calcification by increasing the production of carboxylated Matrix Gla Proteins (cMGP).

Conclusion
In conclusion, VIF is a new potent endogenous inhibitor of vascular calcification acting as a calcimimetic of CaSR, that leads to an increase cMGP production. This finding represents a basis for a new target for the prevention and therapy of patients with increased vascular calcification and shows an encouraging perspective for the future.