bluuebunny/crossref_metadata_2025_split huggingface dataset:
#192 Intradialytic cognitive and physical training to enhance functional capacity: a randomized controlled trial
Authors: Bogataj Špela , Pajek Maja , Kren Aljaž , Mesarič Katja Kurnik , Pajek Jernej 
Published: May 2024

Abstract

Background and Aims
Haemodialysis (HD) patients frequently experience cognitive and physical impairments due to various factors, including age, comorbidities, and the demanding nature of the treatment. This study explores the impact of a 12-week integrated cognitive and physical training program on the functional capacity of HD patients.

Method
A single-blind, randomized controlled trial was conducted with 44 HD patients. Participants were divided into an experimental (EXP) group (n = 22) and a control (CON) group (n = 22). The EXP group underwent 12 weeks of intradialytic cycling and tablet-based cognitive training three times a week, while the CON group received standard care (Fig. 1). Outcome measures were assessed pre- and post the 12-week intervention. Cognitive performance was evaluated using the Trail Making Tests A and B (TMTA and TMTB), while motor performance was assessed with the Timed Up and Go (TUG) test. Additionally, cognitive-motor interactions were examined using the TUG dual task test (TUG-dual).

Results
Results showed a significant effect of group*time interaction for TMTA test results (F(1,41) = 16.218, p &lt; 0.001), TMTB test results (F(1,41) = 19.944, p &lt; 0.001) favouring the EXP group. Additionally, a significant interaction was found for TUG test (F(1,40) = 8.854, p = 0.005) and for TUG-dual test (F(1,40) = 8.457, p = 0.006). Within the EXP group we observed significant improvements in cognitive function, as evidenced by decreased TMT completion times (TMTA: −3.6s, p = 0.006; TMTB: −14.0s, p &lt; 0.001; TMTB–TMTA: −10.4s, p = 0.004). In contrast, the CON group experienced a significant decline in TMTA and TMTB (p &lt; 0.009 and p &lt; 0.026). Additionally, the EXP group exhibited enhanced mobility, with reduced TUG completion times (−0.8s, p &lt; 0.001) and improved cognitive-motor performance in the TUG-dual (−1.0s, p &lt; 0.001), while the CON group showed no significant changes (p &gt; 0.05).

Conclusion
This study demonstrates that a 12-week combined cognitive and physical training program during HD sessions significantly enhances cognitive function and mobility in HD patients. These findings suggest that integrated non-pharmacological interventions can mitigate functional declines in this population and consequently improve their overall quality of life. Further research with larger samples and active control groups is warranted to confirm and expand upon these promising results.
#1309 Case-based online medical education improves physicians’ knowledge and competence in the healthcare of patients with type 2 diabetes and CKD
Authors: Trier Joachim , Pecoits-Filho Roberto , Da Silva Rita Moreira 
Published: May 2024

Abstract

Background and Aims
Kidney disease, including chronic kidney disease (CKD), affects more than 850 million people globally. At least 40% of people with diabetes develop CKD, and many progress to end-stage kidney disease (ESKD) and kidney failure. Globally, diabetes is the leading cause of kidney failure requiring transplantation or dialysis.
The risk of both progression to kidney failure and cardiovascular (CV) events is significantly elevated in patients with type 2 diabetes (T2D) and CKD. Both T2D and CKD are CV disease (CVD) risk multipliers. Patients at early stages of CKD are more likely to die of CVD than they are to progress to ESKD.
The goal of this online medical education activity was for learners to better acknowledge serious health risks associated with CKD in patients with T2D and have greater awareness of the availability of novel treatment options shown to reduce the risk of associated complications.

Method
An interactive text-based educational program including two detailed patient cases challenges clinicians to apply most recent evidence-based guideline recommendations. Detailed scenarios prompt learners to determine the correct treatment and follow-up for the patient with expert commentaries providing in-depth advice at each stage and a conclusion at the end of the program.
Educational effect was assessed using a repeated-pair design with pre-/post-assessment. 3 multiple choice questions assessed knowledge/competence, 1 question rated on a Likert-type scale assessed confidence. A paired samples t-test was conducted on overall average number of correct responses and for confidence rating, a McNemar's test was conducted at the question level (5% significance level). Cohen's d with correction for paired samples estimated the effect size of the education on number of correct responses.
Data collection from 24 February 2023 to 20 April 2023.

Results

Conclusion
Participation of PCP and NEPH in an interactive case-based online medical educational program improved their knowledge, competence and confidence in the management of patients with T2D and CKD.
#2330 Fisetin supplement ameliorates aging related changes in the kidney
Authors: Fu Ping , Ren Qian , Li Hui , Ma Liang 
Published: May 2024

Abstract

Background and Aims
As the ageing population continues to grow worldwide, aging-related diseases are becoming an excessive burden on the global healthcare system. The kidney is one of the organs most affected by aging, which undergoes changes of decreased glomerular filtration rate (GFR), alterated renal blood flow, increased inflammation and fibrosis that increase the susceptibility to developing acute kidney injury (AKI) and chronic kidney disease (CKD). To date, the mechanisms underlying the changes of aged kidneys has not been fully elucidated and therapeutic strategies are still under exploration. Fisetin is a natural flavonol that has been shown to be beneficial to many age-related disorders, as well as increase lifespan in preclinical animal models. However, whether and how fisetin protects against kidney aging remains unclear. In the present study, we assessed the efficacy of fisetin as a senolytic to reduce cell senescence and SASP factors and improve renal function in old mice.

Method
18 month-old C57BL/6 mice were randomly divided into the model group (n = 6), the fisetin low-dose group (100 mg/kg/d B.W., n = 6), fisetin high-dose group (100 mg/kg/d B.W., n = 6) and the rapamycin group (14 ppm, positive control, n = 6). The control group (n = 6) was composed of wild-type C57BL/6 mice of 4 month age. The fisetin and rapamycin were given in the diet for 4 months. Mice of model and treatment group were sacrificed at the age of 22 month and the blood and kidney samples were collected. The GFR of mice in each group was detected and the pathological morphology, lipid accumulation, collagen deposition of the kidneys were assessed. Additionally, the expressions of senescence markers including p53, p21,p16, and SASPs within the kidneys were analyzed.

Results
Fisetin treatment effectively restored the decline in GFR of old mice. Moreover, administration with fisetin significantly reduced age-related pathology including lipid accumulation and collagen fiber deposition in mice kidneys. The expression of aging markers of p53, p21,p16 and SASPs was remarkably upregulated in the kidneys of model mice, which was suppressed by fisetin treatment. Moreover, the kidney inflammation and oxidative stress as observed in aged kidneys was alleviated in mice of fisetin treatment group.

Conclusion
The natural product fisetin has senotherapeutic activity in mice kidneys. Intervention with fisetin is a promising therapy for clinical translation to target excess cell senescence to treat age-related kidney dysfunction.
#2418 Effects of correction of acidosis on body composition and biochemical parameters in CKD patients on maintenance hemodialysis
Authors: Singh Gaurav , Phadke Chetan , Dighe Tushar Anil , Sajgure Atul , Bale Charan , Shinde Nilesh , Wakhare Pavan , Godbole Shreeharsh , Borle Abhishek 
Published: May 2024

Abstract

Background and Aims
Metabolic acidosis is a common problem in patients of chronic kidney disease and patients on maintenance hemodialysis. In resource poor countries, due to financial constraints frequency of dialysis and compliance to medication is adversely affected. This leads to worsening of clinical condition of patient and requirement of in hospital care, many times intensive care, further increasing cost of treatment. Metabolic acidosis has implications on bone and muscle health.
Aim of our study was to assess the changes in body composition (fat percentage and lean body mass), changes in third space fluid, biochemical parameters, number of admissions and requirement of blood transfusions before and after correction of metabolic acidosis.

Method
This was a prospective, observational study. 25 patients on maintenance hemodialysis at our center were included in the study. Bio-impedance analysis (BIA), biochemical parameters (Complete blood counts, renal function tests, serum calcium and phosphorous, liver function tests, Blood gas analysis) were done at baseline before starting bicarbonate supplementation. Number of admissions and blood transfusions in 3 months prior to initiation of bicarbonate supplementation were noted. The oral bicarbonate supplementation was increased from baseline, based on the baseline blood gas analysis. The same parameters were assessed after 3 months and analyzed.

Results
At the end of 3 months we observed that there was significant reduction (p &lt; 0.05) in total leucocyte counts (mean 8100/cumm to 6800/cumm), urea (mean 113.7 mg/dL to 83.72 ng/dL), creatinine (mean 7.87 mg/dL to 6.68 mg/dL), phosphorous (mean 5.18 mg/dL to 4.43 mg/dL), SGOT (mean 56.52 IU to 25.2 IU) and SGPT (mean 46.48 IU to 22.88 IU) with a trend of decrease (p ≤ 0.1) in percentage of extra cellular water (27.31% to 25.03%), lean body mass (44.27 kg to 43.0 kg) and trend of increase (p ≤ 0.1) in body fat composition (15.62 kg to 18.82 kg) and body fat percentage (26.924% to 31.90). There was a reduction in third space fluid (0.88 lit to 0.43 lit). The number of hospitalizations reduced (15 three months prior to initiation of therapy to 7 after initiation of therapy) and number of blood transfusions required also reduced (21 before initiation to 10 after initiation of therapy).

Conclusion
We concluded that correction of acidosis probably reduces the inflammation in patients of CKD on maintenance hemodialysis. This could be seen from the reduced total leucocyte counts, liver enzymes, urea and creatinine values. Changes in body composition with increased total fat mass, fat percentage and decreased lean mass was also noted. There was also a significant reduction in hospitalizations and number of blood transfusions.
#2737 “The right choice for you.” How descriptions of treatment options in information resources may influence patient understanding and decision-making
Authors: Sowden Ryann , Robb James , Shaw Chloe , Winterbottom Anna , Bristowe Katherine , Bekker Hilary , Tulsky James , Murtagh Fliss , Barnes Rebecca , Caskey Fergus , Selman Lucy E 
Published: May 2024

Abstract

Background and Aims
For people over the age of 65 with comorbidities and/or poor performance status, and for patients over the age of 80, the choice between receiving conservative kidney management (CKM) or receiving dialysis can be complex, and involves weighing possible benefits, risks and effects on quality and length of life. Patients often rely on information resources from renal units, to support their decision-making. We describe how information resources present living with and dying of kidney disease in relation to CKM, haemodialysis and peritoneal dialysis, and consider implications for patients’ treatment decision making.

Method
Information resources were collected between June 2021 and January 2023 from four UK renal units with varying CKM treatment rates, as part of the OSCAR study (Optimising Staff-Patient Communication in Advanced Renal Disease). Physical and digital copies of information resources were collected from outpatient waiting areas, consultation rooms, and group patient education sessions.
We included resources which focused on the treatment options of CKM, haemodialysis, peritoneal dialysis and transplant. Documents were categorised as: Direct Treatment Option Information Resources, focusing specifically on treatment options, either individually or in comparison (category A); Indirect Information Resources, focusing on broader contextual information related to treatment options, such as lifestyle, holiday and diet guidance, and the logistics of receiving treatment, e.g. transport (category B).
Document analysis of the information resources was conducted, informed by critical discourse analysis. We examined how documents describe and explain living and dying with kidney failure in relation to treatment options, and how treatment options were placed in context, identifying themes, ‘frames’ and discourse.

Results
72 resources were identified across the four renal units, with 46 documents included after deduplication and screening (Fig. 1). Analysis identified three global themes (see Table 1 for illustrative data extracts):

Conclusion
UK information resources typically present unbalanced explanations of dialysis and CKM, and equate CKM with death and dying. Despite the focus on patients’ “right” to choose a treatment option, it may therefore be challenging for a patient to choose CKM, even when this treatment choice is the best fit for their goals and values. Furthermore, for patients who choose dialysis, information resources often exclude important end-of-life information, limiting their opportunity to consider and participate in advance care planning.
#2926 The impact of GLP-1 receptor agonists on metabolic control and diabetic kidney disease progression
Authors: Venda João , Henriques Andreia Dos Santos , Monsanto Alice , Pompermayer Micael , Leal Rita , Alves Rui 
Published: May 2024

Abstract

Background and Aims
Diabetic kidney disease is the leading cause of end-stage kidney disease in developed world. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are a class of drugs that have shown benefits beyond glycemic control, with a reduction in cardiovascular risk and renoprotective effects. The aim of this study was to assess the effect of GLP-1 RA in metabolic control and progression of CKD. Our objective was to analyze the impact and efficacy of GLP-1 RA in patients with chronic kidney disease (CKD).

Method
This was a retrospective cohort study, that included type 2 diabetic patients with CKD, followed in Nephrology outpatient clinic, who started treatment with GLP-1 RA between January 2019 and February 2022. Clinical, demographic and laboratory data were collect at the initiation of the therapy, 6 months and 1 year during follow-up.

Results
A total of 66 patients were included, of whom 63.6% (n = 42) males with a mean age of 67.8 ± 10.9 years. 95.5% (n = 63) had history of hypertension, 59.1% (n = 39) heart failure and 16.7% (n = 11) peripheral arterial disease. The median estimated glomerular filtration rate (eGFR) at beginning of the treatment was 45 [31.8-65] mL/min/1.73 m2, mean HbA1c of 9.1 ± 1.7%, and mean weight 89.4 ± 15.4 kg. The most frequently prescribed GLP-1 RA were liraglutide (34.8%, n = 23) and dulaglutide (34.8%, n = 23), followed by semaglutide (21.2%, n = 14) and exenatide (1.5%, n = 1). Regarding concomitant therapy, all of the patients were on renin-angiotensin-aldosterone system antagonists, 90.9% (n = 60) were on SGLT2 inhibitors, and 68.2% (n = 45) were on insulin. At 6 months follow-up, there was a statistically significant reduction in HbA1c (9.2 ± 1.8 VS 7.8 ± 1.7, p &lt; 0.001) and weight (89.4 ± 15.4 VS 86.8 ± 15.7, p = 0.002). There were no significant differences in eGFR, lipidic profile and albuminuria. At 1 year follow-up, there was significant reduction of HbA1c (Z = −4.6, p &lt; 0.001), weight (Z = −3.1, p = 0.002), and a statistically significant increase of eGFR (49.5 ± 25.4 VS 56.9 ± 27.0, p = 0.007), with no significant differences in lipidic profile and albuminuria. During the follow-up period, 5 patients voluntarily discontinued the treatment, and 1 patient suspended it due to gastrointestinal adverse effects.

Conclusion
Our study findings reinforce the existing evidence supporting the renoprotective effects of GLP-1 RA. We observed a notable improvement in metabolic control, as evidenced by significant reduction of HbA1c and weight, particularly at the 6th month. There were no significant differences in albuminuria during the follow up time, but an unexpected increase in eGFR.
#1536 Serum soluble LYVE1 is a promising non-invasive biomarker of renal fibrosis: a population-based retrospective cross-sectional study
Authors: Yu Chen , Liu Jing 
Published: May 2024

Abstract

Background and Aims
Diagnosis of renal fibrosis can only be verified by kidney biopsy, but biomarkers for non-invasive evaluation remain unsatisfactory. Patients with fibrosis often have abnormalities of the lymphatic vascular system and associated immune function. We describe here a lymphatic marker as a candidate biomarker for fibrosis.

Method
After assessing and grading the fibrosis scores, testing serum soluble lymphatic vessel endothelial hyaluronan receptor1 (sLYVE1) level, and collecting clinical information, the association between sLYVE1 and renal fibrosis was analyzed. Logistic regression analysis was used to screen variables. Diagnosis models with or without sLYVE1 were built, and nomograms were plotted. Calibration curve, C-index, and DCA were performed to assess the models.

Results
A total of 298 patients were enrolled in the study, of which 199 were included in the training cohort and 99 patients in the validation cohort. Serum sLYVE1 levels markedly elevated with increasing fibrosis grade (p &lt; 0.05). ROC analysis of sLYVE1 showed an AUC of 0.791 and 0.846 with optimal cut-off value of 405.25 ng/mL and 498.55 ng/mL for the prediction of moderate-to-severe renal fibrosis (MSF) and severe renal fibrosis (SF), respectively (Fig. 1). The diagnostic nomogram model without sLYVE1 (model 1) included traditional clinical determinants (C-index: 0.658 for MSF; 0.603 for SF). A combination of model 1 and sLYVE1 (model 2) improved predictive performance (C-index: 0.847 for MSF; 0.856 for SF) (Figs 2 and 3). Calibration curve and DCA demonstrated a better consistency accuracy and clinical benefit of model 2 than model 1.

Conclusion
Serum sLYVE1 may be identified as a potential biomarker of renal fibrosis. Models incorporating sLYVE1 may be beneficial for a more accurate non-invasive diagnosis of renal fibrosis.
#761 Effect of ketoanalogue-supplemented very low protein diet in the need to initiate renal replacement in chronic kidney disease patients
Authors: Larrazabal Ramon , Gujilde Jason , Serrano Julius John 
Published: May 2024

Abstract

Background and Aims
Chronic kidney disease (CKD) is a global concern, with increasing complications and potential end-stage renal disease. Protein intake restriction is crucial for conservative therapy. Investigators have theorized on the nephroprotective effect of either a very low-protein diet (VLPD) with ketoanalogues (KAA) or a low-protein diet (LPD); this was however not confirmed by the Modification of Diet in Renal Disease (MDRD) randomized clinical trial (RCT). This meta-analysis aims to evaluate the effect of VLPD supplemented with KAA on RRT need and disease progression among CKD patients.

Method
A systematic literature search was conducted up to January 3, 2024 for trials in the following databases: PUBMED/MEDLINE, Ovid MEDLINE, Google Scholar, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science and ClincalTrials.gov. Studies that compared VLPD supplemented with KAA to LPD in pre-dialysis CKD patients demonstrating outcomes such as the need for RRT, CKD progression, and all-cause mortality were included. A total of four studies were included in the final analysis. The number of individuals requiring and not requiring RRT on follow-up were computed and analyzed using fixed effects model; while CKD progression and mortality were analyzed using random effects models.

Results
Four studies (738 participants) investigated patients who needed RRT, CKD progression, and all-cause mortality on follow-up between those on VLPD with KAA and LPD. In Fig. 1, VLPD with KAA reduced the need of RRT by 36% (Odds Ratio 0.64, 95% CI: 0.45 to 0.93, P = 0.02), and decreased the incidence of CKD progression (Fig. 2) by 65% (Odds Ratio 0.35, 95% CI: 0.14 to 0.87, P = 0.02). Three studies (531 participants) reported on all-cause mortality (Fig. 3), and our analysis did not show a significant effect on all-cause mortality (OR 1.46, 95% CI: 0.72 to 2.96, P = 0.29). There was no significant heterogeneity among the studies.

Conclusion
The investigators conclude that the present meta-analysis of 4 RCTs demonstrates that the use of VLPD supplemented with KAA reduced the need for RRT initiation and progression of CKD among pre-dialysis CKD Stage 4-5 patients when compared to those on the conventional LPD regimen. Therefore, protein restriction diets especially VLPD with KAA should be considered and offered in eligible CKD patients as part of their supportive management.