bluuebunny/crossref_metadata_2025_split huggingface dataset:
#2495 Renal and peritoneal protective effects of SGLT2 Inhibitors in incident peritoneal dialysis (PD) patients
Authors: Ishioka Kunihiro , Mitomo Ayaka , Maruyama Haruka , Hagiwara Takayuki , Yamano Mizuki , Mochida Yasuhiro , Oka Machiko , Maesato Kyoko , Moriya Hidekazu , Ohtake Takayasu , Hidaka Sumi , Kobayashi Shuzo 
Published: May 2024

Abstract

Background and Aims
The renoprotective effect of SGLT2 inhibitors has been evaluated in several large studies, but renal function of the subject is defined as eGFR≥20-30 mL/min/1.73 m2 or higher in most studies. On the other hand, SGLT2 is expressed in the peritoneum, and there have been reports of decreased glucose absorption and improvement of ultrafiltration injury with SGLT2 inhibitors in animal studies. However, there are very few reports on the protective effects of SGLT2 inhibitors on renal and peritoneal function in PD patients. In the present study, we retrospectively evaluated the renal and peritoneal protective effects of SGLT2 inhibitors in patients undergoing PD.

Method
Among the patients who received PD at our hospital, 8 patients who continued SGLT2 inhibitors and underwent peritoneal equilibrium testing (PET) at the time of induction and 1 year after induction were assigned to the SG group, and 32 patients who received PD without SGLT2 inhibitors were assigned to the control group. PET data, PD drainage volume, urine output, renal • peritoneal • total Kt/V, and renal • peritoneal • total weekly CCr at the time of PD induction and 1 year after PD induction were compared retrospectively.

Results
Among the 40 patients, the median age was 64 years (interquartile range 52-71), with 33% males, and the median eGFR at PD induction was 5.25 ml/min/1.73 m2. The most common cause of end-stage renal failure was diabetic nephropathy (37.5%), followed by chronic glomerulonephritis (15.0%) and nephrosclerosis (12.5%). At the time of induction of peritoneal dialysis, there were no significant differences between the SG group and the control group in PET data, PD drainage volume, urine output, renal • peritoneal • total Kt/V and weekly CCr. However, at one year after PD induction, urine volume, renal • total Kt/V, and renal weekly CCr were higher in the SG group. Total weekly CCr at 1 year of PD induction was significantly higher in the SG group (p = 0.03). Multivariate linear regression analysis showed that SGLT2 inhibitors were independently associated with total weekly CCr at 1 year after PD induction (p = 0.04).

Conclusion
Our results suggest that SGLT2 inhibitors may have renal and peritoneal protective effects in patients undergoing PD induction. For CKD stage G4 and 5 patients scheduled for PD induction in the future, proactive continuation of SGLT2 inhibitors may be effective in preserving renal and peritoneal function.
#1821 Baroflex sensitivity and hemodynamic responses during physical and mental tests: a comparative study between HD and PD patients
Authors: Faitatzidou Danai , Theodorakopoulou Marieta P , Dipla Konstantina , Koutlas Aggelos , Karagiannidis Artemios , Georgiou Areti , Dimitriadis Chrysostomos , Pateinakis Panagiotis , Papagianni Aikaterini , Zafeiridis Andreas , Sarafidis Pantelis 
Published: May 2024

Abstract

Background and Aims
Cardiac arrhythmias and sudden death are the leading causes of mortality in end-stage kidney disease (ESKD) and autonomic dysfunction is considered to play a predominant role. This is the first study to compare baroreflex sensitivity (BRS) and hemodynamic responses after mental- and physical-stimulation maneuvers between hemodialysis (HD) and peritoneal (PD) patients.

Method
68 ESKD patients (34 HD and 34 PD patients matched for age, sex, and dialysis-vintage) were included. Continuous recordings from Finometer-PRO at rest and during mental-arithmetic, orthostatic, and handgrip-exercise tests were used for calculation of BRS and hemodynamic responses in each individual.

Results
The two groups were similar in terms of age, sex, dialysis vintage and major comorbidities. BRS during mental (HD 3.59 ± 2.62 vs PD 5.50 ± 9.40 ms/mmHg, p = 0.280) and physical stress tests (orthostatic: HD 3.23 ± 2.42 vs PD 2.07 ± 2.69 ms/mmHg, p = 0.777) was similar between HD and PD patients. During mental test, both groups presented increases in SBP/DBP levels compared to rest (SBP HD: 156.3 ± 27.7 vs 142.7 ± 20.0 mmHg, p &lt; 0.05; PD: 158.0 ± 25.6 vs 143.1 ± 23.6 mmHg, p &lt; 0.05, respectively), but without significant between-group differences (p = 0.853/p = 0.611 respectively for SBP/DBP). Similarly, no significant between-group differences were noted in stroke volume, cardiac output, and total peripheral resistance during the same testing period. The mean SBP levels during the orthostatic test were significantly decreased compared to rest in both groups (HD: 135.4 ± 26.8 vs 142.2 ± 20.1 mmHg; p &lt; 0.05; PD 135.3 ± 21.9 vs 143.1 ± 23.6 mmHg; p &lt; 0.05), but the overall response was not different between-groups (p = 0.937). Similarly, the responses to the other hemodynamic parameters were similar between HD and PD. Finally, the hemodynamic responses during handgrip exercise and recovery were not differed between HD and PD.

Conclusion
BRS and hemodynamic responses to mental and physical stress tests were similar between HD and PD patients, suggesting that ANS function in ESKD is not affected by dialysis modality.
#1156 Outcomes after kidney transplantation in ANCA-associated vasculitis
Authors: Brilland Benoit , Dekervel Marine , Traversat Priscille , Piccoli Giorgina , Henry Nicolas , Gatault Philippe , Thierry Antoine , Bertrand Dominique , Golbin Leonard , Anglicheau Dany , Duveau Agnès , François Augusto Jean 
Published: May 2024

Abstract

Background and Aims
ANCA-associated vasculitis with glomerulonephritis (AAV-GN) can lead to end-stage kidney disease (ESKD), requiring replacement therapy with dialysis or kidney transplant (KT). Few large studies evaluated the outcome of these patients after KT. Our aim was to describe, in comparison with a control group, the occurrence of the following events: delayed graft function recovery, graft survival, relapse, acute rejection, overall survival; and to study the risk factors associated with these events.

Method
This was a retrospective, multicenter (6 French centers), observational study including patients who received a KT between 2005 and 2023 for ESKD secondary to AAV-GN. Each vasculitis case receiving a KT was matched with 2 controls, matched on gender, center, recipient age (±5 years) and transplant period (±1 year). Event-free survival and the associated risk factors were analyzed.

Results
369 patients were included, including 123 with AAV-GN and 246 control patients. The median post-KT follow-up for all patients was 58 months. There was no difference in the occurrence of DGF between the groups (18 vs 17%, p = 0.9). In univariable analysis, graft survival was lower in the AAV-GN group compared to the controls (76% vs 81% at 10 years, p = 0.017) (Fig 1A). 10 patients experienced a relapse after KT. ANCA positivity at the time of transplantation appeared to be correlated with relapse. There was no difference in the incidence of acute rejection between the groups (p = 0.44). In univariable analysis, overall survival tended to be lower in AAV-GN patients compared to controls (62% vs 73% at 10 years, p = 0.084) (Fig. 1B).

Conclusion
Kidney transplantation is an interesting option for patients with AAV-GN: the relapse rate is low, and the occurrence of acute rejection is comparable to a population of control patients. However, in AAV-GN, graft survival and overall survival appear to be poorer than in control patients. Comparison with a matched AAV-GN population remaining on dialysis would be of interest to go further.
#1462 Muscle mass, muscle strength, and health-related quality of life in kidney transplant recipients results of the TransplantLines Biobank & cohort study
Authors: Knobbe Tim J , Lenis Gijs M M , van der Vossen Dirk A J , Wentink Jory , Kremer Daan , Quint Evelien E , Gomes-Neto António W , Pol Robert , Berger Stefan P , Franssen Casper F M , Bakker Stephan J L , Post Adrian 
Published: May 2024

Abstract

Background and Aims
Muscles play a vital role in nearly every aspect of daily living, and kidney transplant recipients (KTR) often experience reduced muscle mass and strength, potentially contributing to their diminished health-related quality of life (HRQoL). We aimed to investigate the potential relationship of muscle mass and muscle strength with physical HRQoL in KTR.

Method
Data of stable KTR (≥1 year after transplantation) enrolled in the TransplantLines Biobank and Cohort Studies were used. Muscle mass was assessed using both appendicular skeletal muscle mass (via bioimpedance analysis) indexed to height squared (ASMI) and 24-hour urinary creatinine excretion rate indexed to height squared (CERI). Muscle strength was assessed using handgrip strength indexed to height squared (HGSI). HRQoL was assessed using the physical component score derived from the Short Form 36 questionnaire.

Results
A total of 751 KTR (61% male, mean age 56 ± 13 years) at a median of 3 years after transplantation were included. Mean ASMI was 7.5 ± 1.2 kg/m2, mean CERI was 4.1 ± 1.1 mmol/24 h/m2 and mean HGSI was 12.4 ± 3.4 kg/m2. The mean physical HRQoL score was 70 ± 21. Lower ASMI, CERI and HGSI were all associated with lower physical HRQoL, independent of potential confounders. Both associations were best characterized by a significant non-linear relationship (see Figure). Below median values, ASMI, CERI and HGSI were each associated with physical HRQoL, whereas above median values, associations were far less pronounced. When associations of ASMI, CERI and HSGI were adjusted for each other, associations of below median values of ASMI and CERI with physical HRQoL materially weakened, while those of HGSI remained strongly associated. Compared to the 50th percentile, a decrease to the 10th percentile was associated with a decrease in physical HRQoL of 6.0% for ASMI (P = 0.006), of 5.1% for CERI (P = 0.006) and 13.2% for HGSI (P &lt; 0.001), whereas an increase to the 90th percentile was associated with an increase in physical HRQoL of only 1.3% for ASMI (P = 0.22), of 3.6% for CERI (P = 0.05) and −0.4% for HGSI (P = 0.73).

Conclusion
Our findings suggest that low muscle mass and muscle strength are potentially modifiable risk factors for impaired physical HRQoL. Both muscle mass and muscle strength were complementarily associated with HRQoL. However, muscle strength was most strongly associated with physical HRQoL. The non-linear nature of the associations implies that KTR with low muscle mass or strength may particularly benefit from (p)rehabilitation interventions to improve HRQoL.
#1742 Hybrid-immunity protection against SARS-CoV-2 reinfection on kidney transplant recipients
Authors: Couceiro Carlos , Favà Alexandre , Semper Laura Calatayud , Montero Nuria , Coloma Ana , Manonelles Anna , Codina Sergi , Oliveras Laia , Lino Luis , Melilli Edoardo , Luzón Maria Angeles Dominguez , Garrit Josep Maria Cruzado 
Published: May 2024

Abstract

Background and Aims
Scarce data is available about the impact of hybrid immunity (vaccination plus infection) in immunocompromised patients. Several studies report a greater immunological response in hybrid individuals compared to those who are vaccinated-only, but no study has evaluated its clinical implication. We aimed to investigate the protection of hybrid immunity against SARS-CoV-2 infection, relative to the vaccine-only acquired immunity in a population of kidney transplant recipients over a omicron SARS-CoV-2 wave.

Method
This observational retrospective cohort study was done on kidney transplant recipients vaccinated with three or four doses against SARS-CoV-2, at Bellvitge University Hospital, Spain. All participants were interviewed to ascertain if they have suffered a natural infection. Data was also obtained from clinical records database of our institution and the Catalan Transplant Organisation. Incidence of SARS-CoV-2 infection and COVID-related hospitalisation and death in the hybrid cohort was compared with the incidence in the vaccine cohort, using Cox proportional hazard regressions models.

Results
1338 kidney transplant recipients participated in the study, 544 (40.7%) out of them were hybrid at the start of the study. 341 infections, 46 hospitalisations and 14 deaths were recorded during follow-up. The overall adjusted hazard ratio for SARS-CoV-2 infection was 0.30 (95% CI 0.23-0.40) and 0.11 (95% CI 0.03-0.35) for hospitalization in the hybrid cohort versus the vaccine cohort. No death occurred in the hybrid cohort during the follow-up.

Conclusion
Hybrid immunity was associated with a lower incidence of SARS-CoV-2 infection and COVID-19 related hospitalisation. Hybrid immunity should be considered when stratifying the risk of SARS-CoV-2 infection and progression to severe COVID-19 in immunocompromised individuals, in order to better adjust immunosuppression, guide booster policies and prioritize outpatient treatments.
#1016 Kidney transplantation in highly sensitized patients with preformed donor-specific antibodies through personalized delisting strategies
Authors: Trujillo Hernando , Mancebo Esther , Monte Esther González , Polanco Natalia , García Sandra Sandra , Paz-Artal Estela , Andrés Amado 
Published: May 2024

Abstract

Background and Aims
This study explores a personalized delisting strategy enabling kidney transplantation in highly sensitized patients with preformed donor-specific anti-HLA antibodies (DSA) trying to minimize the risk of antibody-mediated rejection (ABMR).

Method
Retrospective single-centre analysis of 50 kidney transplant recipients with preformed DSA (preDSA) after employing a delisting strategy to enhance their access to transplantation, and without received a pre-transplant or immediate post-transplant desensitization protocol. The delisting approach focused on allowing less deleterious antibodies according to their mean fluorescence intensity (MFI), anti-HLA class and C1q study results. The strategy consisted on eliminating as prohibited HLA antigens those recognized by antibodies with the lowest MFI in the following order: 1st- MFI &lt; 5000; 2nd- MFI &lt; 10000; 3rd-Any MFI. Additionally, delisting prioritized a single locus in the following order: 1st- one of the HLA class I loci (A, B, or Cw); 2nd- the rest of the class I loci; 3rd- HLA-DP, followed by DR. C1q studies were performed before delisting and transplantation was contraindicated in the presence of DSA detected in the C1q assay. Two comparative cohorts included 50 sensitized recipients without pre-transplant DSA (SwoDSA) and 50 non-sensitized recipients (NS).

Results
The delisting strategy allowed transplantation with preformed DSA and demonstrated comparable rejection rates to SwoDSA and NS groups (16%, 14% and 8%, respectively; log-rank = 0.28). However, the occurrence of acute ABMR was 12% in the preDSA group, significantly higher than in SwoDSA (1%) and NS (0%) (log-rank = 0.0093). The immunological risk assumed in delisting correlated with ABMR incidence (patients with ABMR had significantly higher sum MFI [mean ± SD: 9301 ± 6340 vs 4492 ± 5641; p = 0.049]), emphasizing the importance of tailored strategies. DSA persistence after transplantation correlated with higher MFI and increased ABMR risk. Of note, 16% of preDSA patients developed de novo DSA versus only the 4% of SwoDSA and 0% of NS patients (p = 0.004). After a mean follow-up of 3.1 ± 2.1 years, the 1-, 3- and 5-year death-censored allograft survival rates were 100%, 90% and 78%, respectively, in the preDSA group; 98%, 84% and 84% in the SwoDSA group and 100% in NS group (log-rank = 0.02).

Conclusion
The present study demonstrates the feasibility and acceptable outcomes of kidney transplantation in highly sensitized patients with preformed DSA through a personalized delisting strategy without using desensitization protocols.
#2677 A propensity score-matched analysis of kidney replacement therapy outcomes for older adults stratified by frailty severity
Authors: Pontula Arya , Moore Louise R , Nixon Andrew C 
Published: May 2024

Abstract

Background and Aims
Older people living with frailty who receive kidney replacement therapy (KRT) experience higher mortality and hospital readmission compared to their non-frail counterparts [1–3]. Shared decision making with older people regarding the optimal KRT modality (haemodialysis [HD], peritoneal dialysis [PD], or kidney transplant [TX]) can present challenges due to the lack of research comparing KRT modalities stratified by frailty severity. The Hospital Frailty Risk Score (HFRS), which uses routinely collected clinical data to categorise frailty severity, has been shown to predict outcomes in advanced chronic kidney disease (CKD) [4]. However, the HFRS has not been used to compare outcomes across KRT modalities. This single-centre project aims to explore outcomes between KRT modalities for older people stratified by HFRS frailty severity.

Method
Adults aged 60 years or older starting KRT at our institution between December 2012 and January 2022 were included. HFRS was calculated at first estimated glomerular filtration rate (eGFR) result below 15 mL/min/1.73 m2 and at start of KRT. Patients were stratified by KRT modality and their frailty severity (categorized as low, intermediate, or high according to their HFRS score). TX patients were then matched to 1:2 to HD patients and 1:1 to PD patients, based on patient age, HFRS category, and Charlson Comorbidity Index (CCI) at KRT start. Outcomes of interest were hospital readmission and mortality, both overall and within 1 year of KRT initiation. Descriptive statistics compared HD, PD, and TX groups.

Results
Twenty TX, 20 PD, and 40 HD matched patients were included. Age (HD vs PD vs TX: 68.5 vs 67.6 vs 68.3 years, p = 0.50), proportion of males (57.5% vs 70.0% vs 55.0%, p = 0.66), and CCI (15.0 vs 13.0 vs 13.0, p = 0.95) were similar between cohorts. Frailty, as assessed by the HFRS, worsened or remained the same for most patients in all 3 cohorts between first eGFR &lt; 15 and KRT start (81.0% vs 93.0% vs 83.0%, p = 0.61). All patients were either of low (85.0% vs 80.0% vs 85.0%) or intermediate (15.0% vs 20.0% vs 15.0%) frailty status at time of KRT start and the proportion of patients in each category did not vary with modality (p = 0.92).
Re-hospitalization within 1 year of starting KRT was similar between groups (32.5% vs 25.0% vs 10.0%, p = 0.12). Kaplan-Meier survival analyses also demonstrated similar survival among groups at 1 year (75.0% vs 95.0% vs 90.0%, log-rank p = 0.09), but better survival among TX patients overall (0.0% vs 66.1% vs 79.4%, log-rank p = 0.02). Overall and 1 year Kaplan-Meier survival for patients stratified by KRT modality and HFRS are shown in Fig. 1.

Conclusion
TX may optimize longer term survival for older people with low and intermediate frailty status and kidney failure. Furthermore, the HFRS appears to be a useful prognostic tool that could inform shared decision making with older patients regarding KRT modality choice.
#2300 Validation study of the 4-variable kidney failure risk equation for prediction of allograft loss in a group of pediatric kidney transplant recipients
Authors: Machado Sara Nogueira , Freitas Joana C , Vieira Beatriz , Monteiro Sara , Moreira Célia , Teixeira Ana , Costa Teresa , Faria Maria Do Sameiro , Mota Conceição 
Published: May 2024

Abstract

Background and Aims
Emerging evidence suggests that the 4-variable Kidney Failure Risk Equation (KFRE) can be used to predict the risk of graft failure in adult transplant recipients. However, research studies in pediatric patients are lacking. This study aimed to validate the 4-variable KFRE (age, sex, estimated glomerular filtration rate [eGFR], and urine albumin-to-creatinine ratio [uACR]) for prediction of the 2- and 5-year risk of graft failure in a group of pediatric transplant patients.

Method
A retrospective observational study involving 59 pediatric patients who underwent kidney transplant between January 2007 and December 2017 was conducted. The KFRE risk scores were calculated with data collected at 1-year post-transplantation. The area under the receiver operating characteristic curves (AUC) and calibration plots were used to assess the discrimination and calibration properties of the 4-variable KFRE in predicting the risk of graft failure at 2 and 5 years from the point of the 1-year post-transplantation measurements.

Results
Among the 59 patients, 41 (69.5%) were male, with median age of 12.8 years (interquartile range 9.2-15.7) at the time of the kidney transplant. Eleven (18.6%) were living donor recipients. Median eFGR at 1-year post-transplantation was 62.0 mL/min/1.73 m2 (50.0-76.5); 1 (1.7%) and 3 (5.1%) patients developed graft failure within 2 and 5 years from the point of the 1-year post-transplantation measurements, respectively. The 4-variable KFRE showed excellent discrimination for the 2-year risk (AUC 0.966, 95% confidence interval [CI] 0.914-1.000) and very good discrimination for the 5-year risk (AUC 0.887, 95% CI 0.732-1.000). Calibration plots however showed imprecise calibration. A discernible trend was apparent in this sample, suggesting that living donor recipients have increased probability of experiencing graft failure in the first 5 years (p = 0.069).

Conclusion
The 4-variable KFRE may be of interest in predicting kidney failure progression in pediatric kidney transplant recipients using data at 1-year post-transplant, however to substantiate these findings and ensure the robustness of conclusions, larger-scale studies should be conducted.
#2843 Urinary extracellular vesicles in after deceased donor kidney transplantation
Authors: Maslauskiene Rima , Bumblyte Inga Arune , Svenningsen Per , Tepel Martin 
Published: May 2024

Abstract

Background and Aims
Urinary extracellular vesicles (uEV) are membrane-bound organelles which contain several molecules from their host tissue, including proteins, membrane receptors, nucleic acids, and lipids. Currently it is unknown whether uEV can be used as a liquid biopsy tool to determine injuries of the allograft after kidney transplantation. The objective of the present study was to compare uEV early posttransplant in kidney transplant recipients with allografts from deceased male and deceased female donors.

Method
We measured the principal cell specific aquaporine 2 (AQP2) abundance in uEV with an Enzyme-linked immunosorbent assay (ELISA) using novel generated specific antibodies, 19-64-1. The AQP2 abundance in uEV was detected in urine samples from incident deceased donor kidney transplant recipients during two periods posttransplant, i.e., the first period was from 6 to 11 hours and the second period was from 12 to 23 hours posttransplant, respectively. The AQP2 abundance in uEV was normalized to urinary creatinine, i.e., abundance/mmol creatinine.

Results
Complete data were obtained from 71 kidney transplant recipients with median age, 50 years (IQR, 42 to 57 years), median weight 73 kg (IQR, 64 to 86 kg), median systolic blood pressure, 144 mmHg (IQR, 130 to 160 mmHg), median diastolic blood pressure, 87 mmHg (IQR, 78 to 98 mmHg), median time on dialysis 25 months (IQR, 10 to 44 months). In 43 kidney transplant recipients with deceased male donors the AQP2 abundance in uEV significantly decreased from median 0.12 (IQR, 0.06 to 0.29) at the first postoperative period to median 0.05 (IQR, 0.03 to 0.12; P = 0.0004 by Wilcoxon matched-pairs signed rank test). On the other hand, in 31 kidney transplant recipients with deceased female donors the AQP2 abundance in uEV did no change from median 0.09 (IQR, 0.05 to 0.24) at the first postoperative period to median 0.05 (IQR, 0.03 to 0.13; P = 0.09 by Wilcoxon matched-pairs signed rank test).

Conclusion
The larger postoperative decline of the AQP2 abundance in uEV from deceased male donors compared to deceased female donors in early periods posttransplant may point to a larger principal cell mass in males.