bluuebunny/crossref_metadata_2025_split huggingface dataset:
#2914 Impact of COVID-19 on the mortality of hemodialysis patients
Authors: Pešić Snežana , Đurić Živka , Bajcetic Sanja , Davidovic Zeljko , Filipović Danijela , Simovic Nikola , Sakic Verica Todorov , Markovic Dragana , Đuđić Sanja , Ačimović Jovana , Todorović Sara , Naumovic Radomir 
Published: May 2024

Abstract

Background and Aims
Hemodialysis patients belong to the category of immunocompromised patients with numerous comorbidities. Infection with the SARS˗CoV˗2 virus (COVID-19) in this group of patients had a significantly higher mortality compared to the general population. During the COVID-19 pandemic, approximately 30%–35% of dialysis patients infected with SARS-CoV-2 had a fatal outcome.

Method
The study included chronic hemodialysis patients at the Zvezdara University Clinical Center, in order to determine the impact of COVID-19 on mortality. Mortality in patients during two years before the COVID-19 pandemic (2018/2019) and two years during the pandemic (2020/2021) was compared. The existence of differences during these two periods was also examined, in relation to age, the presence of comorbidities and the length of dialysis treatment of these patients.

Results
The study included 127 (61.1%) men and 81 (38.9%) women, average age 68.4 ± 11.4 years. The average dialysis experience of the examined patients was 76.6 months (1 to 418). The main cause of terminal renal failure was hypertensive nephroangiosclerosis and diabetic nephropathy 66.5% (41.9%, 24.6%). During the two years before the pandemic, a total of 73 patients died, while during the first two years of the pandemic, almost twice as many patients died, 135. Mortality is statistically significantly higher in the years of the pandemic. During the pandemic, mortality was significantly higher in patients who were on HD longer (p&lt;0.05). The most common cause of death in years was SARS-CoV-2 infection (43.7%).

Conclusion
SARS-CoV-2 infection had a significant impact on the mortality of hemodialysis patients. The mortality of hemodialysis patients who were diagnosed with Covid 19 was extremely high. In the years of the COVID-19 pandemic, the number of deaths was almost twice as high as in previous years. Hemodialysis patients can be considered a high-risk population for illness and increased mortality from respiratory infections in pandemic conditions, both due to the impossibility of isolation during dialysis procedures and the specific organization of transportation to the dialysis center.
#510 Evaluating tolvaptan as a protective agent for cardiac insufficiency in peritoneal dialysis patients
Authors: Oikonomaki Theodora 
Published: May 2024

Abstract

Introduction
Peritoneal dialysis serves as a highly effective renal replacement therapy, offering prolonged preservation of residual renal function, improved blood pressure regulation, and enhanced quality of life. While diuretics are generally considered safe and beneficial in this context, their efficacy may be limited in certain cases.

Background and Aims
The rationale behind investigating the potential benefits of tolvaptan in peritoneal dialysis stems from existing studies in Asia, where the use of tolvaptan has been approved in this population. These studies, conducted on patients undergoing peritoneal dialysis, indicate notable improvements in urine output and key heart failure indicators such as Left Ventricular Mass Index (LVMI) and Brain Natriuretic Peptide (BNP).

Materials & Methods
Recognizing the significance of these findings, a recent meta-analysis was conducted to comprehensively assess the collective data. The meta-analysis encompassed data from five pertinent studies involving a total of 70 peritoneal dialysis patients, with an average age of 66.1 ± 15 years. Participants received tolvaptan in doses of up to 15 mg, and the mean follow-up period was 8.2 ± 3.9 months.

Results
Results from the meta-analysis revealed a significant increase in urine volume in two out of four instances (Mean Difference [MD]= +554.5 cc [379,730], I²=61.5). While most studies did not indicate substantial changes in body weight or renal kt/V, a notable reduction in Left Ventricular Mass Index was evident in two studies (MD= -43.28 [-84.9,-1.6], I²=80.6%). Additionally, a substantial reduction in BNP was reported in one study, with no documented adverse events across the studies.

Conclusion
As an adjunct therapy, tolvaptan exhibits potential benefits in volume control, potentially contributing to improved cardiac function in peritoneal dialysis patients. The findings of this study align with existing research, highlighting the positive impact of tolvaptan on heart failure markers. Nevertheless, further high-quality studies are imperative to consolidate and validate these observed benefits in the peritoneal dialysis population.
#2650 A novel approach for exit site care reduces peritoneal dialysis catheter related infections
Authors: Ben-Bassat Orit Kliuk , Soetendorp Hila 
Published: May 2024

Abstract

Background and Aims
Peritoneal dialysis (PD) related infections, including peritonitis and catheter related infections, are associated with significant morbidity and technique failure. Various exit site care protocols are available, most allow to shower in running water after the exit site is well healed. Following an increase in exit site infections (ESI) in our dialysis unit, partially resulting from water derived organisms, we implemented a novel exit site care protocol. The protocol included complete avoidance of water exposure using stoma bag during shower; and change in antibiotic treatment from gentamycin to mupirocin. We aimed to evaluate its efficacy to decrease ESI episodes.

Method
A prospective single center trial. Study group included PD patients between June 2018 - May 2021 who implemented the new exit-site care protocol. They were compared to a historical control group that included all PD patients between January 2016 to May 2018. In the control group, exit-site care included a daily shower with a bactericidal cleanser containing chlorhexidine 4%, thereafter local gentamycin 0.1% was applied with sterile gauze dressing. In the study group, water exposure during daily wash was avoided using a stoma bag sealed around the catheter exit-site and the tubing. Thereafter, the exit-site was cleaned with a chlorhexidine 0.5%- alcohol 70% solution and local mupirocin 2% was applied with a sterile gauze cover. Primary outcome was catheter related infections, including ESI and tunnel infection. Secondary outcomes were peritonitis and technique loss.

Results
A total of 113 patients were included, 58 patients in control and 55 in study group. Mean follow up time was 13.28 ± 9.5 months in control and 16.4 12.7 months in study group. ESI rate was significantly lower in study group (0.11/patient year) compared to control group (0.71/ patient year), p&lt;0.001. Time to first ESI was significantly longer in study group, χ² (1) = 25.104, p &lt; 0.001 (Fig. 1). On multivariate logistic regression analysis confirmed the protective effect of the intervention on ESI risk (p &lt;0.001). Longer PD vintage and active cancer predicted ESI (p = 0.01 and 0.02, respectively).
There were no tunnel infections during study period compared to 3 episodes during control.
Peritonitis rate was significantly lower in study group (0.19/patient years) compared to control group (0.40/patient years), p=0.011. There was no difference in time to first peritonitis episode between groups χ² (1)=2.32, p=0.128.
Nine patients were lost to PD due to PD related infection in control group, compared to 5 in study group. Peritonitis related mortality occurred in one patient in control group.

Conclusion
Protection of exit site from water exposure in conjunction with local Mupirocin cream reduced significantly ESI and peritonitis episodes in peritoneal dialysis patients. This protocol may be more beneficial in areas of poor water quality.
#3022 Rationale and design of the CORDIAL first-in-human clinical trial: a system for sorbent-assisted continuous flow peritoneal dialysis
Authors: de Vries Joost , van Gelder Maaike , Simonis Frank , Bolhuis Dian , Rubio María Auxiliadora Bajo , del Peso Gilsanz Gloria , Selgas Rafael , Donati Gabriele , Cappelli Gianni , Ligabue Giulia , Verhaar Marianne , Gerritsen Karin 
Published: May 2024

Abstract

Background and Aims
Peritoneal dialysis has important disadvantages, including low plasma clearance and a limited technique survival. A new device for sorbent-assisted continuous flow peritoneal dialysis has been designed (Wearable Artificial KIDney, WEAKID) that is based on continuous recirculation (rapid cycling) of peritoneal dialysate via a single-lumen peritoneal catheter with regeneration of dialysate using sorbents. Anticipated benefits are a better plasma clearance a higher mass transfer area coefficient with continuous flow of dialysate and enhanced diffusion due to a higher time-averaged plasma-dialysate concentration gradient with sorbent-based dialysate regeneration, and a prolonged technique survival thanks to lower peritonitis risk (less (dis)connections) and a lower glucose exposure.

Method
This is a first-in-human, prospective, open-label, non-randomized, single-arm, multicenter study, that will be performed at the University Medical Center Utrecht (Utrecht, The Netherlands), Università degli studi di Modena e Reggio Emilia (Italy), and Instituto de Investigación Hospital Universitario La Paz, Servicio Madrileño de Salud (Spain). We aim to include 12 stable, adult PD patients. In the first week, blood, urine, and dialysate samples will be collected over three separate days to assess the efficacy of the patient's standard PD schedule. The WEAKID system will then be tested in a clinical setting on 6 days over a period of 2 weeks (three consecutive days per week). During the first week, participants will be treated with WEAKID without sorbents for 4h (first day) or 8h (second and third day). The second week, treatment will consist of WEAKID with sorbents for 4h (first day) or 8h (second and third day). This way, exposure to new components of the system is incremental and the effectiveness of continuous recirculation of dialysate and that the added effect of sorbent-based dialysate regeneration can be analyzed separately.

Outcomes
The primary aim of this first-in-human clinical trial is to evaluate the (short term) clinical safety and performance of WEAKID treatment in a clinical setting. The primary safety objective will be assessed by describing and examining the incidence of:
Key secondary objectives include an evaluation of efficacy in terms of plasma clearance, ultrafiltration, net base release, and patient tolerance.

Planning
Inclusion of the first patient is expected in January 2024, the final inclusion is expected to take place in November 2024.
#2040 Effect of donor–recipient size mismatch on long-term graft survival in pediatric kidney transplantation: a multicenter cohort study
Authors: Park Min Ji , Cho Min Hyun 
Published: May 2024

Abstract

Background and Aims
Kidney transplantation (KT) is the main treatment option for patients with end-stage kidney disease (ESKD). However, it is limited by the low number of donor organs. Moreover, donor–recipient size mismatching is a common problem in KT given the various types of donors. Donor–recipient size mismatching is commonly occurs in pediatric kidney transplantation (KT). However, its effect on graft survival remains unknown. This study aimed to determine the effect of donor–recipient size mismatch on the long-term survival rate of transplant kidneys in pediatric KT.

Method
A total of 241 pediatric patients who received KT were enrolled. The medical records of all patients were retrospectively reviewed, and the correlation between donor–recipient size mismatch and graft function and long-term graft outcome was analyzed according to donor–recipient size mismatch.

Results
Recipients and donors’ mean body weight at the time of KT were 34.31 ± 16.85 and 56.53 ± 16.73 kg, respectively. The mean follow-up duration was 96.49 ± 52.98 months. The mean age of donors was 34.74 ± 14.91 years, and the ratio of males and females was 105:136. Approximately 81.7%, 1.2%, and 17.0% of all transplant donors were identified as living-related, living-unrelated, and deceased donors, respectively. A significant positive correlation was observed between donor–recipient body weight ratio (DRBWR) or donor–recipient body surface area ratio (DRBSR) and graft function until 1 year after KT. However, this correlation could not be confirmed at the last follow-up. The results of long-term survival analysis using Fine and Gray's subdistribution hazard model showed no significant difference of the survival rate of the transplant kidney according to DRBWR or DRBSR.

Conclusion
Donor–recipient size mismatch in pediatric KT is not an important factor in determining the long-term prognosis of transplant kidneys.
#2132 Recipient outcomes after laparoscopic versus open living donor nephrectomy: a propensity score-matched cohort study
Authors: Skalioti Chrysanthi , Bellos Ioannis , Soukouli Ioanna , Mantios Evangelos , Kofotolios Ioannis , Vernadakis Spyros , Boletis Ioannis , Marinaki Smaragdi 
Published: May 2024

Abstract

Background and Aims
Kidney transplantation is the optimal treatment for end-stage renal disease. To meet the growing demand for kidney allografts and to ensure the well-being of donors, laparoscopic nephrectomy has been adopted leading to superior donor outcomes. However, data on recipient outcomes of laparoscopically retrieved grafts are underreported.
The aim of the study is to estimate the impact of laparoscopic compared to open living donor nephrectomy (LDN, ODN) on recipient outcomes in the first-year post-transplant.

Method
This was an observational cohort study of primary data on 396 recipients who had undergone living kidney transplantation from January 2011 to December 2021 at the Clinic of Nephrology and Renal Transplantation of ‘Laiko’ hospital. Since October 2018 laparoscopic surgery has supplanted ODN in the reporting center. Graft function, the risk of adverse events, patient and graft survival within the first-year post-transplantation, were evaluated. A propensity score analysis was applied (2:1 nearest-neighbor matching, with a caliper width of 0.05). As a robustness check, the analysis was rerun on the sub-groups of low and high immunological risk patients.

Results
After propensity score matching, 389 patients were analyzed. One-year post-transplantation, renal function (−0.074 mg/dl, p: 0.063) patient (99.44% vs 100%, p: 0.27) and graft (99.43% vs 100%, p: 0.13) survival were statistically equal among LDN and ODN recipients. Laparoscopically retrieved grafts demonstrated statistically higher risk of delayed graft function (10.1%, p: 0.032) and higher risk for transfusion (12.9%, p:0.022). The risk for acute rejection, surgical complications and infections (Fig. 1), as well as the length of hospital stay did not differ between the two groups. Kidney function at one year was similar in LDN and ODN patients, regardless of the immunological risk. Low immunological risk patients demonstrated comparable risk of adverse events in the first post-transplant year. High-immunological risk patients after LDN after LDN exhibited greater risk for reoperation (16%, p: 0.0078) urologic complications (19.6%, p: 0.042) and bacterial infections (7.1%, p: 0.027) compared to ODN recipients during the first year after transplantation.

Conclusion
The results indicate that one-year post-transplantation, renal function, patient and graft survival are equivalent among recipients of allografts procured either laparoscopically or by open surgery, with similar risk of adverse events.
#1436 Donor plasma cystatin C, but not creatinine, is associated with measured GFR at one year after kidney transplantation
Authors: Kremer Daan , Dielwart Belle , Knobbe Tim J , Groothof Dion , Leuvenink Henri , Kootstra-Ros Jenny E , de Borst Martin H , van Londen Marco , Pol Robert , Bakker Stephan J L 
Published: May 2024

Abstract

Background and Aims
Although widely used during deceased kidney donor selection, donor plasma creatinine has limited capacity to predict future recipient kidney graft function. Cystatin C is a muscle-mass independent kidney function marker that could serve as alternative for this purpose. However, the association between donor cystatin C and subsequent recipient graft function remains unclear. We aim to assess the association of pre-donation cystatin C concentrations with recipient iothalamate-measured GFR (mGFR) one year after kidney transplantation and compare it to the association of donor creatinine concentrations.

Method
All deceased kidney donors, within the affiliated donation region of the University Medical Center Groningen (UMCG), who donated at least one kidney to a kidney transplant recipient (KTR) affiliated to the same hospital during a period of 15 years (2004-2019) were included. We excluded all subjects with missing data on donor plasma cystatin C or recipient mGFR at 1 year. Donor plasma creatinine concentrations were measured using an enzymatic assay, while donor cystatin C concentrations were measured using a validated particle-enhanced turbidimetric immunoassay (Roche). Associations of donor plasma creatinine and cystatin C concentrations with recipients’ mGFR one year after transplant were assessed using linear regression.

Results
A total of 53 deceased kidney donors (55% male, age 47 ± 18 years, 47% donation after circulatory death) donated a kidney to 53 kidney transplant recipients (55% male, age 57 ± 12 years). Median pre-donation plasma creatinine and cystatin C concentrations were 64 [55 to 82] μmol/L and 0.64 [0.51 to 0.82] mg/L respectively. Mean recipient mGFR one year after transplantation was 52.7 ± 17.1 ml/min. In univariable linear regression, higher donor cystatin C was significantly associated with lower mGFR (β −0.42, 95% CI: −0.67 to −0.16, p = 0.002), while donor creatinine was not associated (β −0.03 95% CI: −0.32 to 0.25, p = 0.81). The association between donor cystatin C and recipients’ mGFR remained independent of adjustment for potential confounders, including donor sex and age, t (p = 0.008).

Conclusion
Higher donor cystatin C, but not creatinine, is associated with lower measured GFR one year after kidney transplant. Consequently, donor cystatin C could be valuable for inclusion in the pre-transplant evaluation of deceased kidney donors.
#2968 Preemptive kidney transplantation: the best option for retransplantation?
Authors: Alonso Marta , Villanego Florentino , Serrano Blanca , Lopez Juan Manuel Cazorla , Roncero Francisco Manuel González , Rodríguez-Benot Alberto , Ruiz-Fuentes Maria Carmen , López Verónica , Castro Pablo , Mazuecos Auxiliadora 
Published: May 2024

Abstract

Background and Aims
Kidney re-transplantation (Re-KT) is associated with worse outcomes. Better results have been described when the KT is performed preemptive, before the patient returns to dialysis. However, the experience is limited so far.

Method
We performed a retrospective analysis of KT patients who received a preemptive KT (pRe-KT) in Andalusia between 1978-2023. A case-control study was carried out, choosing 2 controls for each case, adjusted for donor and recipient demographic characteristics (1 patient receiving a second non-preemptive KT [npRe-KT] and 1 patient receiving a first KT). We compared clinical characteristics and evolution between the 3 groups.

Results
During this period, 12217 KT recipients were registered in Andalusia. Of these, 1380 (11.3%) received at least a second KT. Eighty-two (0.059%) patients were pRe-KT recipients, all of them with a second KT.
In the npRe-KT patients, there was a lower proportion of living donors than in the other groups (pRe-KT 30.4%, npRe-KT 6.3%, first KT 28.4%; p &lt; 0.001). There were no differences nor in age neither in gender of donors and recipients. Graft survival in pRe-KT and first KT patients was similar and significantly better than in npRe-KT. Adjusting for donor type (living/deceased), npRe-KT remained as a risk factor. However, we observed no differences in patient survival between groups.

Conclusion
In pRe-KT patients, outcomes are significantly better than npRe-KT outcomes and similar to that of the first KT. These patients, when their clinical situation allows it, should be evaluated for inclusion on the waiting list before the definitive graft loss. Living donor KT should be actively encouraged in patients who are losing the functionality of their renal graft.
#2572 Sodium-glucose transport protein 2 (SGLT-2) inhibitors in diabetic and non-diabetic kidney transplant recipients
Authors: Chalvatzis Antonios , Ntrinias Theodoros , Trivyza Maria Styliani , Papasotiriou Marios , Tsiotsios Konstantinos , Karkania Aglaia , Bratsiakou Adamantia , Georgopoulou Georgia Andriana , Perdiki Panagiota , Goumenos Dimitrios , Papachristou Evangelos 
Published: May 2024

Abstract

Background and Aims
The beneficial effects of administering sodium-glucose transport protein 2 (SGLT2i) inhibitors in patients with Chronic Kidney Disease, with or without Type 2 Diabetes (T2D), has been proven in large randomized controlled trials. Nevertheless, there is limited data considering Kidney Transplant Recipients (KTRs) with or without albuminuria. The purpose of this study was to evaluate the safety and efficacy of administering SGLT2i to KTRs in association to their kidney function and albuminuria.

Method
In this retrospective study we examined the effects of treatment with SGLT2i on kidney function (eGFR calculated with CKD-EPI formula), albuminuria (24h urine collection) and fasting serum glucose levels of KTRs. We included KTRs with T2D or without T2D and confirmed albuminuria (ACR &gt;30 mg/gCr) in two consecutive ACR measurements. Kidney function and albuminuria monitoring was performed one month post-treatment initiation and in three month intervals thereafter. Moreover, immunosuppression trough levels were measured in each visit and active surveillance for adverse events was performed.

Results
Twenty-four KTRs (20 males) with a mean eGFR of 51.1 ± 14.2 ml/min/1.73 m2 were included in this study. Nine patients had T2D. Treatment was initiated 10 ± 5.4 years post transplant and all KTRs received dapagliflozin. Mean follow-up was 9 ± 2 months. Kidney function was non-significantly decreased directly after SGLT2i initiation and remained stable until the end of follow up (51.1 ± 14.2 vs. 51.4 ± 13.8 ml/min/1.73 m2). Overall, we found a significant reduction of albuminuria (371 ± 460 vs 235 ± 294 mg/24 h, p = 0.015). When KTRs were examined separately based on their diabetes status (KTRs with T2D vs. no T2D) we found that only those with T2D showed a significant decrease in albuminuria (450.4 ± 548 vs. 259.8 ± 332.5 mg/24 h, p = 0.008) at the end of follow up. Furthermore, a significant reduction of morning fasting glucose (106.4 ± 19.6 vs 99.9 ± 16.6 mg/dl, p = 0.0006) was noted. Trough levels of immunosuppression agents (tacrolimus, everolimus or cyclosporine) did not show any significant change after the initiation of SGLT2i and two patients had to discontinue the treatment, due to one episode of pyelonephritis and detection of funguria.

Conclusion
Prescription of SGTL2i in KTRs with T2D and albuminuria, seems to be a reliable option with significant efficacy on the decrease of albuminuria with minimal adverse effects.