bluuebunny/crossref_metadata_2025_split huggingface dataset:
#1961 Cardiovascular-kidney-metabolic syndrome components and cardio-vascular disease mortality based on half-a-million Asian adults
Authors: Wu Mei-Yi , Tsai Min Kuang , Chien Kuo-Liong , Wen Chi Pang 
Published: May 2024

Abstract

Background and Aims
The American Heart Association (AHA) has recently issued guidelines addressing the “Cardiovascular-Kidney-Metabolic (CKM) Syndrome” to mitigate cardiovascular diseases. In parallel, European healthcare entities have established the CaReMe (CArdioRenal and MEtabolic) Partnership, emphasizing interdisciplinary health concepts. This study aims to evaluate CKM prevalence and its associated components in a substantial Asian cohort, along with the risk of cardiovascular mortality.

Method
The investigation focused on a cohort of 565 940 participants aged 20 years and above enrolled in a health screening program in Taiwan spanning from 1994 to 2017. The study assessed cardiovascular disease (CVD) and cause-specific mortality related to CKM stages and its components—hypertension, diabetes, chronic kidney disease, metabolic syndrome, and hyperlipidemia. Multivariable Cox proportional hazards models were employed to calculate hazard ratios (HRs).

Results
In this cohort with more than half-a-million Asian adults, approximately 74.3% exhibit CKM syndrome, distributed as 28.1% in Stage 1, 38.9% in Stage 2, 4.9% in Stage 3, and 2.4% in Stage 4. Among individuals aged 50 and above, almost 90% had CKM. The CKM components—hypertension (20.5%), chronic kidney disease (CKD) (11.1%), hyperlipidemia (28.4%), metabolic syndrome (13.1%), and diabetes (5.5%)—display diverse prevalence rates. We identified 13,449 participants who had CVD mortality, and the median follow-up was 15 years. CKM predicts CVD mortality with a dose-response relationship: Hazard Ratios (HRs) for Stage 2 is 2.34 (95% confidence interval (CI): 2.06, 2.65); HR for Stage 3 is 2.69 (95% CI: 2.36, 3.07), and HR for Stage 4 is 4.70 (95% CI: 4.11, 5.39). Within CKM, 43.3% have two or more components, 20.4% have three or more, and 7.3% have four or more. In those aged 65 and above, 66.6% have two or more components, 37.9% have three or more, and 17.8% have four or more. Participants with two or more components exhibit a higher CVD mortality risk than those with a single CKM component.

Conclusion
The prevalence rates of CKM and its components vary, contributing to distinct risks of cardiovascular disease mortality. A clustering phenomenon exists among different components, where an increased number of clustered factors corresponds to a higher risk of cardiovascular disease mortality.
#2756 Metabolomic prediction of end stage renal disease in large national biobanks
Authors: Barrett Jeffrey 
Published: May 2024

Abstract

Background and Aims
Identifying at-risk individuals likely to progress to end-stage renal disease as early as possible is important to effectively concentrate preventative interventions. Existing predictive tools, like the kidney failure risk score, are effective for individuals who already have moderate to severe kidney disease. Here we examine whether comprehensive metabolomics can improve performance in individuals with mildly impaired kidney function.

Method
Using an NMR metabolomics platform we measured &gt;200 biomarkers including creatinine, albumin, lipids, fatty acids, amino acids, glycolysis metabolites and inflammation markers in blood samples from all 500,000 participants of the UK Biobank, who have &gt;10 years of linked prospective follow-up data. We used machine learning to develop a score to predict kidney disease progression based on biomarkers, age and sex. We compared its performance to eGFR in a held out set of individuals in UK Biobank, and replicated in 200,000 participants of the Estonian Biobank.

Results
Among individuals with prevalent diabetes, hypertension or eGFR &lt; 90 the biomarker score performs as well as or better than eGFR for all individuals. In particular it outperforms among individuals with only moderate (eGFR 60-75) or mild (eGFR 75-90) impairment of kidney function with an AUC increase from 0.63 to 0.72 and 0.48 to 0.70, respectively (Figure). This improvement is driven by contributions from numerous biomarkers, including lipids and inflammation markers. Furthermore, because these biomarkers capture diverse metabolic risk, the biomarker score also strongly predicts major adverse cardiovascular outcomes.

Conclusion
This large dataset allows detailed investigation of the value of metabolomics in identifying future risk of severe kidney disease early. In particular these biomarkers can highlight individuals who do not already have very low eGFR.
#2309 Understanding the caregiver experience: a comparison between patients undergoing hemodialysis and conservative care management
Authors: Trigo Filipa , Ramos Ana Rita , Figueiredo Cátia , Barreto Patricia , Sofia Flora , Lopes Karina , Santos Paulo 
Published: May 2024

Abstract

Background and Aims
Elderly patients with Advanced Chronic Kidney Disease (ACKD) experience a high rate of physical and emotional burden, whether they choose dialysis or not. However, little is known about the challenges faced by family and throughout the disease. This study aimed to evaluate how caregivers of ACKD patients over 75 years-old (yo) perceive and cope with the disease.

Method
We performed telephone interviews with family members (FM) or caregivers of ACKD patients over 75 yo, undergoing Conservative Kidney Management (CKM) or hemodialysis (HD). The interviews were recorded and analyzed by two independent investigators. The interview guide was based on literature review and the authors’ clinical experience. It comprised 12 questions focused on the medical team support and communication, the caregivers’ perception of their relatives’ quality of life (QoL), the caregivers’ burden, and the perception of advance care planning.

Results
A total of 22 FM were interviewed, 11 from patients undergoing HD and 11 undergoing CKM. All caregivers were family members: 90.9% sons/daughters and 9.1% spouses. 54.5% of patients on CKM were females, with a mean age of 88.9 ± 5.0 yo; 36.4% of patients on dialysis were female, with a mean age of 82.1 ± 4.8 yo.
Regarding team communication, FM of patients on CKM were more aware of the prognosis of kidney disease and felt more involved in the decision-making process (Table 1). All FM of both groups reported medical team support for their relatives. Concerning QoL, all FM of CKM patients mentioned symptom control, compared to 81.8% in the HD group. Additionally, 27.3% FM of CKM felt ACKD deprived their relatives of their liberty, versus 72.7% in the HD group. No caregiver recognized a high burden of the disease. Regarding advance care planning, a majority of FM of HD patients (81.8%) desired open discussions, versus 45.4% of the CKM.
Some supportive/illustrative quotes of the FM answers are shown in Table 1.

Conclusion
Caregivers are vital in the support and care of any patient with a chronic illness, especially ACKD, and their burden and awareness about the disease must always be considered. The approach to patients in CKM is essentially palliative, prioritizing QoL and symptom control. These patients are regularly evaluated by multidisciplinary teams with training in palliative care, which promotes shared decision-making and more efficient communication skills about disease and prognosis to the patient and family. Unfortunately, palliative care is not yet well established in patients undergoing HD, which may explain the results and answers given by FM. It is crucial to improve support for caregivers of all ACKD patients, preferably with a multidisciplinary team.
#60 Implementation of chronic kidney disease guidelines for sodium-glucose co-transporter-2 inhibitor use in primary care: a cross-sectional study
Authors: Forbes Anna , Hinton William , Feher Michael , Elson Willim , Joy Mark , Ordonez-Mena Jose , Fan Xuejuan , Cole Nicholas , Banerjee Debasish , Suckling Rebecca , de Lusignan Simon , Swift Pauline 
Published: May 2024

Abstract

Background and Aims
The cardiovascular and kidney benefits of sodium-glucose co-transporter-2 (SGLT2) inhibitors in people with chronic kidney disease (CKD) are well established. The implementation of updated SGLT2 inhibitor guidelines and prescribing in the real-world CKD population remains largely unknown.

Method
We performed a cross-sectional study of adults with CKD registered with primary care practices in the Oxford-Royal College of General Practitioners Research and Surveillance Centre network on the 31st December 2022. We examined the extent to which SGLT2 inhibitor guidelines apply to and are then implemented in adults with CKD. We used a logistic regression model to identify independent factors associated with SGLT2 inhibitor prescribing.

Results
Of 6,670,829 adults we identified 516,491 (7·7%) with CKD, including 32·8% (n = 169,443) who had co-existing type 2 diabetes (T2D). 26·8% (n = 138,183) of the overall CKD population had a guideline directed indication for SGLT2 inhibitor treatment. A higher proportion of CKD patients with co-existing T2D were indicated for treatment, compared to those without T2D (62·8% [n = 106,468] vs. 9·1% [n = 31,715]). SGLT2 inhibitors were prescribed to 17·0% (n = 23,466) of those with an indication for treatment, and prescriptions were predominantly in those with co-existing T2D; 22·0% (n = 23,464) in those with T2D, and &lt;0·1% (n = 2) in those without T2D. In adjusted multivariable analysis of people with CKD and T2D, females (OR 0·70, 95% CI 0·67-0·72, p &lt; 0·001), individuals of Black ethnicity (OR 0·87, 95% CI 0·79-0·95, p &lt; 0·001) and those of lower socio-economic status (OR 0·71, 95% CI 0·68-0·75, p &lt; 0.001) were less likely to be prescribed an SGLT2 inhibitor. Those with an estimated glomerular filtration rate (eGFR) &lt;60 mL/min/1.73 m2 had a lower likelihood of receiving an SGLT2 inhibitor compared to those with an eGFR ≥60 mL/min/1.73 m2 (eGFR 45-60 mL/min/1·73 m2 OR 0·65, 95% CI 0·62-0·68, p &lt; 0·001, eGFR 30-45 mL/min/1·73 m2 OR 0·73, 95% CI 0·69-0·78, p &lt; 0·001, eGFR 15-30 mL/min/1·73 m2 OR 0·52, 95% CI 0·46-0·60, p &lt; 0·001, eGFR &lt;15 mL/min/1·73 m2 OR 0·03, 95% CI 0·00-0·23, p = 0·004, respectively). Those with albuminuria (urine albumin-to-creatinine ratio 3-30 mg/mmol) were less likely to be prescribed an SGLT2 inhibitor, compared to those without albuminuria (OR 0·78, 95% CI 0·75-0·82, p &lt; 0·001).

Conclusion
SGLT2 inhibitor guidelines in CKD have not yet been successfully implemented into clinical practice, most notably in those without co-existing T2D. Enhanced efforts to embed SGLT2 inhibitors equitably into routine care for people with CKD are urgently needed, particularly in those at highest risk of adverse outcomes and in the absence of T2D.
#377 Assessment of kidney function by creatinine and cystatin C and cardiovascular outcomes in patients with atrial fibrillation
Authors: Abdullaev Sherzod , Igamberdieva Ranokhon 
Published: May 2024

Abstract

Background and Aims
Atrial fibrillation (AF) in patients with chronic kidney disease are at an increased risk for ischemic and bleeding events and all-cause mortality. Accurate kidney function estimation is key for risk assessment. Creatinine is commonly used to calculate the Glomerular Filtration Rate (GFR). However, cystatin C has been described to be more sensitive than creatinine independent of muscle mass, autoimmune disease, inflammation or consuming diseases. Our aim was to evaluate the associations between kidney function, assessed by creatinine and cystatin C, and cardiovascular events (CVE), its individual components, and major bleedings.

Method
We enrolled 326 AF patients into two prospective, multicenter cohort studies. Creatinine and cystatin C were measured at baseline and clinical outcome events were assessed yearly. We calculated GFR using the Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] formula based on either creatinine (GFRcr), cystatin C (GFRcy) or both (GFRc2). Primary outcome was major CVE, defined as a composite of stroke or systemic embolism, myocardial infarction and cardiovascular death. Secondary outcomes were the individual components of major CVE and major bleeding. Multivariable adjusted Cox regression analyses were built to evaluate the associations between kidney function and outcome events.

Results
Mean age was 56 ± 9 years and 37% were female. Mean creatinine and cystatin С levels were 112 ± 21 μmol/l and 1.6 ± 0.3 mg/l, respectively, translating to a GFRc2 of 58.2 ± 16.8 ml/min/1.73 m2. Over a median follow-up of 2 years, the incidence rates for major CVE (per 100 person-years) across quartiles (Q1-Q4) of GFRc2 were 23.1, 20.3, 17.6 and 14.7, respectively. When using multivariable adjusted Cox regression analysis, major CVE was significantly associated with GFRcr (per 1 standard deviation: HR 0.89 (95% CI 0.79; 0.98) p = 0.01), GFRcy (HR 0.65 (CI 0.53; 0.72), p &lt; 0.001) and GFRc2 (HR 0.74 (CI 0.63; 0.82), p &lt; 0.001). This association was mainly driven by cardiovascular death. Major bleeding was associated with GFRcy (HR 0.78 (0.64-0.93) p = 0.001) and GFRc2 (HR 0.82 (0.69-0.97), p = 0.01), but not with GFRcr (HR 0.93 (95% CI 0.83-1.1) p = 0.33).

Conclusion
Among AF patients, GFR equations including cystatin C were associated both with major CVE and bleeding events, while creatinine based GFR equations were only associated with major CVE. Therefore, Cystatin C based GFR equations might offer more comprehensive risk stratification in patients with AF.
#2551 Treatment and prognosis for myocardial infarction in patients with chronic kidney disease 2010-2022: a nationwide cohort study
Authors: Ballegaard Ellen Linnea Freese , Grove Erik Lerkevang , Kamper Anne Lise , Feldt-Rasmussen Bo , Torp Christian , Gislason Gunnar , Carlson Nicholas 
Published: May 2024

Abstract

Background and Aims
Chronic kidney disease (CKD) is present in &gt;30% of patients with acute coronary syndrome. Although prognosis following myocardial infarction (MI) has improved throughout the last decades, patients with CKD remain at considerably increased risk of recurrent cardiovascular events. We investigate use of guideline-directed cardiovascular interventions and cardioprotective medical therapy and associated cardiovascular outcomes in patients with and without CKD.

Method
From 2010 to 2022, all adult patients hospitalized with first-time MI (ICD10: DI21) were identified in nationwide Danish health care registers. CKD was defined by an estimated glomerular filtration rate (eGFR) &lt;60 ml/min/1.73 m2. Study outcomes were evaluated in multiple logistic and cause-specific Cox regression models with computation of standardized risks/probabilities of outcomes. The probability of referral for interventional work-up was evaluated based on 30-days probability of cardiovascular interventions, i.e. coronary angiography (CAG) and/or revascularization. Guideline-directed cardioprotective medical therapy, i.e. lipid-lowering treatment, dual antiplatelet therapy, renin-angiotensin-system inhibitors, aldosterone antagonists, beta blockers, calcium channel blockers, and nitrates, was evaluated as 90-days probability of treatment in 90-days survivors. Lastly, one-year standardized risk of mortality was evaluated. All models were adjusted for age, sex, kidney transplant, congestive heart failure, hypertension, diabetes, cancer, thromboembolism, and any arrhythmia.

Results
In total, 21 009 patients were included; median age 72 years (IQR 63; 81), 60.8% males, median eGFR 82 ml/min/1.73 m2, 20.9% CKD. Patients with CKD were older, less likely to be male, had a longer admission time, had more comorbidities, and received more medical treatment compared with patients without CKD. The 30-days probability of CAG was 77.8% (95% CI 77.2%-78.5%) and 65.8% (95% CI 64.1%-67.3%), p &lt; 0.001, and of revascularization 58.2% (95% CI 57.3%-59.0%) and 48.8% (95% CI46.9%-50.5%), p &lt; 0.001, in patients without and with CKD, respectively. Development in probability of cardiovascular interventions and risk of 1-year mortality during the study period is depicted in Fig. 1. Probability of cardioprotective medical therapy in 90-days survivors is presented in Fig. 2. The 1-year risk of mortality was 16.4% (95% CI 15.7%-17.0%) and 20.9% (95% CI 19.9%-22.0%) in patients without and with CKD.

Conclusion
Although prognosis following first-time myocardial infarction has been improved for all patients, CKD continues to be associated with lower rates of guideline-directed cardiovascular interventions and cardioprotective medical therapy and increased 1-year mortality compared with patients without CKD.
#3069 The effects of characteristics associated with dialysis on cognitive functions in patients with chronic kidney disease
Authors: Yıldırım Saliha , Altinok Murat , Erdut Arda , Yildirim Tolga , Helvacı Özant , Derİcİ Ülver , Altok Kadriye , Erten Yasemin , Erdem Yunus , Cankaya Edem , Guz Galip 
Published: May 2024

Abstract

Background and Aims
Cognitive functions are affected in all stages of chronic kidney disease (CKD), regardless of age.
This study aims to determine the effects of characteristics associated with dialysis (peritoneal dialysis (PD) or hemodialysis (HD)) on cognitive functions in patients with CKD.

Method
CKD patients who were followed up with PD or HD at least for six months from 3 different centers from Turkey were included in this study. For dementia screening, the AD8 dementia scoring system was used. The patients’ sociodemographic characteristics, dialysis types, dialysis access routes, weekly dialysis session numbers, dialysis adequacies, dry weights, and laboratory parameters were recorded.

Results
A total of 261 CKD patients, 142 of whom were male (54.4%), were included in the study (mean age: 54.46 SD: 15.297, 29.1% over 65 years of age). 151 (57.8%) of the patients were HD patients.HT (70.1%) and DM (28.7%) were the most common comorbidities. While 50% of peritoneal dialysis patients were monitored with APD, 34.4% of HD patients had a central venous catheter (CVC) for vascular access.
In the study population there was no statistically significant difference in the prevalence of cognitive impairment between those over and under 65 years of age (&lt;65 years of age 61%, &gt;65 years of age 68%, p = 0.300). The prevalence of cognitive impairment was significantly higher in HD patients than in PD patients (p &lt; 0.001). PD type was not related with cognitive impairment (p = 0.446). In HD patients under 65 years of age cognitive impairment was observed more frequently in the patients with CVC as vascular access (63% in patients &lt;65 years of age with CVC, 32% in patients with AVF/AVG, p = 0.014).

Conclusion
Chronic kidney disease is one of the age-independent risk factors for cognitive impairment. In our study group cognitive impairment was similar in different age groups. Compared to HD patients, in PD patients less cognitive impairment was observed. In HD patients under 65 years of age using a CVC as vascular access was associated with more frequent cognitive impairment.
#1801 Gut dysbiosis contributes to TMAO accumulation in CKD
Authors: Gerritzmann Frederick , Holle Johannes Benjamin , Mcparland Victoria , Anandakumar Harithaa , Behrens Felix , Schumacher Fabian , Kleuser Burkhard , Bartolomaeus Hendrik , Wilck Nicola 
Published: May 2024

Abstract

Background and Aims
Chronic kidney disease (CKD) patients face a substantial morbidity risk, especially related to cardiovascular complications. The imbalance of circulating metabolites influences inter-organ crosstalk and disease pathophysiology. In this regard, metabolites of microbial origin have gained increasing attention. Trimethylamine N-oxide (TMAO) originates from microbial Trimethylamine (TMA) metabolism and is found at high concentrations in the blood of CKD patients. A high TMAO concentration is known to be an independent risk factor for cardiovascular disease. This study aims to investigate the extent to which high concentrations of TMAO in the blood are due to increased bacterial production or are mainly a consequence of impaired renal clearance.

Methods
We used existing biomaterials and clinical data of a pediatric CKD cohort, consisting of patients enrolled at CKD stage G3-5, including G5 patients treated with hemodialysis (HD), as well as patients after kidney transplantation (KT) and individuals with normal kidney function. We analyzed TMAO in plasma and urine samples using LC-MS/MS and developed a novel gene targeting assay (GTA) that quantifies the abundance of the bacterial target genes (CutC, CntA) encoding for the key enzymes of microbial TMA synthesis in each fecal sample.

Results
Plasma TMAO levels were stage-dependently elevated in CKD, with HD patients showing the highest levels (75 ± 46 µmol/l). While urinary TMAO levels were lower in the CKD groups, TMAO/creatinine ratios and fractional excretion were not significantly different in CKD compared to controls. Fecal microbial gene abundance of both CutC and CntA genes was elevated across CKD stages and correlated with both plasma TMAO levels and eGFR. Although KT patients exhibited an eGFR range comparable to controls, they still showed higher plasma TMAO levels and elevated TMAO-associated gene abundances. In a regression analysis, this gene abundance was associated with plasma TMAO independent of eGFR in a model adjusted for age, sex, and BMI. Using a likelihood ratio test, we showed that adding fecal microbial gene abundance to the model provided a significantly better fit compared to only eGFR, age, sex, and BMI.

Conclusion
Our data indicate that the production of TMA by intestinal bacteria contributes significantly to the accumulation of TMAO in patients with CKD and after kidney transplantation. This finding opens the possibility for new potential interventions in the management of patients with CKD.
#1916 Infective endocarditis in young female hemodialysis patient: a case report and literature review
Authors: Junita Tiroy , Syahriza Alfian , MD Yassir 
Published: May 2024

Abstract

Background and Aims
Infective endocarditis (IE) in hemodialysis patient is one of major infective and cardiovascular complications with high morbidity and mortality. Compared to general population, incidence of IE among hemodialysis (HD) patients is 50-60 times higher. Despite the devastating implications, there is no particular preventive measures of IE for HD patients. Previous studies revealed leading risk factors for IE in HD population including use of central venous catheters (CVCs), first 6 months period of renal replacement therapy (RRT), aortic valve disease, and previous endocarditis.

Case Summary
We report a case of IE in a 21-year-old female hemodialysis patient using AV fistula for the past 16 months with no prior history of heart valve disease, previous endocarditis, and IV drug abuse. Patient presented with fever of 38.5°C, dyspnea, and cough since three days before admission. Physical examination revealed grade 5 pansystolic murmur with punctum maximum at apex. Vegetation on the anterior mitral leaflet (AML) was first detected through trans-thoracal echocardiography. Patient was treated with ceftriaxone and vancomycin for 14 days, followed by oral antibiotics in outpatient setting after clinical resolution.

Conclusion
This case provides insight of the occurrence of IE in relatively young patient in the absence of well-known risk factors, making strict prevention, prompt diagnosis and treatment are of the utmost importance. Possible pathophysiological mechanisms for IE in HD patients are bacteremia from repeated vascular manipulation and valvular calcification that compromises valve to colonization. Therefore, besides infection prevention, managing the progression of valvular calcification among HD patients remains an issue to be addressed in future studies.