bluuebunny/crossref_metadata_2025_split huggingface dataset:
#474 Features of the functional state of the kidney in patients with chronic heart failure with metabolic syndrome
Authors: Atahodjayeva Gulchehra , Aripova Djamilya 
Published: May 2024

Abstract

Background and Aims
to study the features of the functional state of the kidneys in patients with chronic heart failure with intermediate ejection fraction, depending on the representation of components of metabolic syndrome

Method
To achieve the objectives, 197 male patients with chronic heart failure (CHF) of ischemic origin II - III functional class (FC) according to NYHA, aged 40-60 years with a history of myocardial infarction of 6 months, were examined. up to 5 years. Depending on the presence of MS components, 3 groups of patients were identified: group I (n = 70), patients without MS (CHF FC II -38, CHF FC III - 32 patients); Group II (n = 67) patients with various combinations of dyslipidemia (HDL-C &lt;1.03 mmol/l; LDL-C &gt;3.0 mmol/l) with AO, hypertension and HTG (CHF FC II -35, CHF FC III - 32 patients); Group III (n = 60) patients with various combinations of dyslipoproteinemia (DLP) and type 2 diabetes mellitus (DM2) with AO, hypertension and HTG (CHF FC II -26, CHF FC III - 34 patients). When diagnosing MS, the International Diabetes Federation diagnostic criteria for MS were used (IDF, 2009). The study of the functional state of the kidneys included determination of the level of serum creatinine, urinary albumin excretion (determination of microalbuminuria (MAU ≥300 mg/l), glomerular filtration rate (GFR), calculated using the GFR EPI formula.

Results
when studying the parameters of the functional state of the kidneys in patients with CHF HFmrEF group 1, MAU was identified in 10 patients (35.7%) out of 28. Serum creatinine clearance in this group was 89.0 ± 8.49 μmol /l, and the GFR level was 88.58 ± 8.36 ml/min. With the development of MS in group II patients, 16 out of 28 patients had MAU (53.6%). A decrease in GFR was also found by 11.3% ( P &lt; 0.05) with an increase in serum creatinine levels by 12.7% (P &lt; 0.01), in contrast to the data from group I of the study. Further analysis of the parameters of renal function in group III of CHF HFmrEF revealed a significant decrease in GFR (by 23.0%; P &lt; 0.01) with a significant increase in blood creatinine levels (by 21.8%; P &lt; 0.01) in relation to the data Group I. Also in group III of patients with CHF and MS (+DM2 ), microalbuminuria was detected in 24 patients (85.7%) out of 32 . When comparing indicators of renal function between study groups II and III, there was a significant difference in the level of blood creatinine clearance and glomerular filtration rate by 11.3% and 10.1% (P &lt; 0.05), respectively.

Conclusion
MS in patients with CHF HFmrEF aggravates renal dysfunction, which developed as one of the main pathogenetic links of CHF. Evidence of the importance of MS in the nature of the clinical manifestations of CHF HFmrEF is the established dependence of the identified disorders on the severity of MS.
#1230 Comparative analysis of vitamin D status between patients with advanced chronic kidney disease and those on dialysis
Authors: Delgado Carlos Marín , Rodríguez Desirée Luis , Navarro-González Juan F , Henriquez Fernando , del Peso Gilsanz Gloria , Prieto Francisco Javier Toro , Jesús Lloret María , Morales Orlando Siverio , Macia Manuel 
Published: May 2024

Abstract

Background and Aims
Decreased plasma concentration of 1,25-dihydroxy-vitamin D3 or calcitriol, the most active biological form of vitamin D3, in patients with advanced chronic kidney disease (ACKD) and on dialysis, is almost universal. In addition, 25-50% of these patients also have decreased levels of 25-hydroxy-vitamin D3 (calcidiol or calcifediol). The main cause of calcitriol deficiency is decreased hydroxylation in the kidney, both due to intrinsic renal damage and hyperphosphataemia. Calcifediol deficiency is directly related to decreased intake and sun exposure. We already know that this calcifediol deficiency is associated with ACKD, but we do not know if there are differences between ACKD patients and dialysis patients. The aim of this study is to analyse whether there are differences in calcifediol levels between ACKD and dialysis patients.

Method
An observational, analytical, ambispective, multicentre, analytical study was carried out with the participation of five Centres in Spain, under conditions of routine clinical practice. As study subjects, we included patients with ACKD and on haemodialysis from the University Hospitals of Virgen del Rocío, La Paz and Nuestra Señora de Candelaria, and the dialysis centres: Avericum, Quironsalud Tenerife. We selected demographic variables and also included serum levels of calcifediol, calcium, phosphorus and PTH; treatment with: phosphorus binders, erythropoietin synthesis analogues (ESA), ferrotherapy, calcimimetics, active vitamin D, native vitamin D. Data are organised and analysed with SPSS Statistics v22. In all analyses, the significance level is set for a P value &lt; 0.05. Multivariate logistic regression analysis was also performed.

Results
A total of 161 patients were included. Both groups were homogeneous in the presence of diabetes, calcium levels and treatment with iron, native vitamin D, active vitamin D and calcimimetics. There were significant differences in sex, age, phosphorus levels, PTH, phosphate binders, ESA treatment. There are no significant differences in calcifediol levels or vitamin D status between the two comparison groups.

Conclusion
In our study, within a general context of hypovitaminosis D, patients with ACKD have a vitamin D status similar to dialysis patients.
#2545 Hemodialysis for salbutamol intoxication: patient case report
Authors: Jerman Alexander , Bezeljak Neva 
Published: May 2024

Abstract

Background and Aims
Salbutamol/albuterol is a moderately selective beta-2-adrenergic receptor agonist that acts as an airway smooth muscle relaxant. It is used to prevent and treat acute bronchospasm in various respiratory conditions. Due to its large volume of distribution, it is not considered dialysable.

Method
This is a clinical case report of inadvertent parenteral administration of salbutamol resulting in acute intoxication. Salvage renal replacement therapy was implemented due to the severity of the patient's clinical condition and the large amount of salbutamol administered. Multiple plasma measurements of salbutamol were taken during hemodialysis, allowing for a correlation to be made with the patient's clinical presentation.

Results
This case report presents an elderly patient with sepsis, Down syndrome, and liver cirrhosis. The patient required non-invasive ventilation due to worsening respiratory failure and was prescribed intravenous methylprednisolone. However, the patient inadvertently received 5mg of parenteral salbutamol (albuterol), which resulted in immediate severe arrhythmic tachycardia followed by hemodynamic collapse. After unsuccessful cardioversion and treatment with landiolol infusion, salvage hemodialysis was initiated to reduce the suspected highly elevated serum salbutamol levels. After 30 minutes, sinus rhythm with normocardia was observed. No rebound tachycardia was noted after the hemodialysis termination. However, due to severe septic shock, hypotension persisted, and vasoactive medications were adjusted. However, the measured levels of plasma salbutamol do not support the view that hemodialysis was the cause of the described improvement. The total amount of the drug cleared was exceedingly small, only 2.8% of the total dose. Data from the literature support our findings, even in the case of the life-threatening intoxication described.

Conclusion
The results confirm a large volume of distribution for salbutamol. The measured half-life time during hemodialysis (3.1 hours) is comparable to observed half-life times in therapeutic settings. The observed clinical benefit associated with dialysis appears to be fortuitous. This case report highlights the potential bias towards positive clinical outcomes and unproven therapies.
#1608 Use of intraperitoneal hydration by peritoneal dialysis fluid as a complementary palliative therapy in peritoneal dialysis patients
Authors: Zeiler Matthias , Fioravanti Gilda , Angelini Andrea , Silvestri Simona , Fioravanti Giuseppe , Santarelli Stefano 
Published: May 2024

Abstract

Background and Aims
End life care should manage pain, other distressing symptoms and guarantee sufficient hydration. It should also involve psychological, social and spiritual support. Palliative care in peritoneal dialysis is a new and growing clinical question. There are several open questions: Should we stop peritoneal dialysis totally? Should we go on with peritoneal dialysis in a reduced fashion? Hereby we report a new application of CAPD exchanges, intraperitoneal hydration, in end life care of peritoneal dialysis patients.

Method
In seven peritoneal dialysis patients (2 female, 3 male, age 82 to 90 years) affected by severe heart failure (3 patients), dementia (2 patients) and malnutrition-inflammation syndrome (2 patients) we applied the concept of intraperitoneal hydration as a complementary palliative care. Peritoneal dialysis was switched into a single CAPD bag therapy utilizing a glucose concentration of 1.36% or 1.5%. Depending on the clinical hydration status 1000 ml of dialysis fluid was loaded daily or each other day without prior drainage. None of the patients was on intravenous therapy.

Results
The duration of the intraperitoneal hydration therapy varied between 5 and 16 days. In two cases, therapy was performed initially at the hospital ward and hereafter at a nursing home, whereas in the latter 5 cases at the patient's home by family members. No case of hypervolemia occurred. The intraperitoneal hydration therapy was well accepted by the family members.

Conclusion
The transformation of peritoneal dialysis from ultrafiltration and depuration into hydration without depuration seems to be a feasible approach. This approach should be kept in mind in special conditions such as end life palliative care and hypohydration.
#1350 Finerenone in real-life clinical practice: first results from a pilot study
Authors: Piko Nejc , Petreski Tadej , Kukovič Aleksandra , Tramšek Nika Aleksandra Kravos , Hojs Radovan , Ekart Robert , Bevc Sebastjan 
Published: May 2024

Abstract

Background and Aims
Finerenone is a new drug for the treatment of patients with albuminuric diabetic kidney disease (DKD) that has protective cardiorenal effects, with hyperkalemia being a possible side effect. Our pilot study aimed to obtain real-life clinical data in patients with DKD treated with finerenone.

Method
So far, we have included 16 patients receiving finerenone due to albuminuric DKD (urine albumin/creatinine ratio - UACR &gt; 3 g/mol in two random urine samples taken at least one week apart) (Fig. 1). Nine patients (56.3%) were prescribed 20 mg. Seven patients (43.7%) received 10 mg daily. The dose was then adjusted at follow-up visits according to guidelines. Arterial stiffness measurements were performed non-invasively (Sphygmocor Atcor Medical®, Australia). A 28-zone lung ultrasound (LUS) was performed, and the sum of B-lines was recorded (VscanTM GE HealthCare Technologies Inc.®). Bioimpedance was measured with BCM®, Fresenius Medical Care. SPSS version 29 was used for statistical analysis.

Results
10 patients (62.5%) were male. The most common comorbidities were arterial hypertension (n=15, 93.8%), hyperlipidemia (n=15, 93.8%) and ischemic heart disease (n=4, 25%). Baseline data are shown in Table 1. Paired samples T-test showed a slight increase in serum potassium after introducing finerenone, without clinically significant hyperkalemia or renal damage. UACR decreased, but the difference was insignificant (Table 2). Patients had no change in prescribed medications during this time, and no side effects of finerenone were noted.

Conclusion
Finerenone has the potential to lower UACR with little risk of hyperkalemia or acute kidney injury. The effects of the drug on lung extracellular water, body composition and arterial stiffness will be prospectively investigated in our research.
#1828 Venous thromboembolic events in ANCA associated vasculitis patients—data from Croatian referral center
Authors: Crnogorac Matija , Strizić Ana , Durlen Ivan , Djerek Lovorka , Galesic Kresimir , Horvatic Ivica 
Published: May 2024

Abstract

Background and Aims
Our aim was to investigate the prevalence of venous thromboembolic events (VTE) in a cohort of patients with ANCA-associated vasculitis (AAV) and define factors associated with the frequency of VTE considering there is data on high incidence of VTE in AAV patients. In these cohorts VTE occurred mostly early in the course of disease.

Method
This study included 114 consecutive AAV patients with biopsy proven renal involvement in the period from 2007-2017. Patients were classified according to clinical: granulomatosis with poliangitis (GPA), microscopic polingitis (MPA) and eosinophilic granulomatosis with poliangitis (EGPA) and serological phenotype: MPO-ANCA positive, PR3-ANCA positive, MPO- and PR3-ANCA positive and ANCA-negative. Ordinal variables were analysed using logistical regression test. Statistical analysis was done in MedCalc Statistical Software version 18.11.6 (MedCalc Software Bvba, Ostend, Belgium).

Results
In the cohort there were 64 (56%) females, mean age was 58 (IQR 16-84) with mean follow up time 46.9 months (IQR 1-127). Clinically there were 84 (73%) patients with MPA, 26 (22%) with GPA and 4 (5%) with EGPA. Serologically there were 20% PR3-ANCA, 54% MPO-ANCA, 8% MPO- and PR-3 ANCA positive patients and 18% ANCA-negative patients. Mean serum creatinine levels (SCr) was 380.9 μmol/l (IQR 65-1402). Mean BVAS (Brimingham vasculitis score) at the time of diagnosis of AAV was 17 (IQR 5-50) and at the time of VTE 0, 9 (0-22). Mean body weight was 71kg (IQR 48-110) and mean CRP was 84 mg/ml (IQR 0, 3-256). During the follow up 7 (6.14%) of the patients had VTE, with 4 having VTE in first month after the diagnosis and other two at month 14 and 19. Logistic regression showed the connection of weight (P = 0.0052) and CRP (0.0138) with VTE with odds ratio of 1,0829 for CRP (1.003-1.027) and 1.0150 for weight (1.0284-1.1736) respectively. There was no statistical significance for clinical or serological phenotype being associated with VTE nor for other clinical or laboratory parameters.

Conclusion
In our cohort patients with AAV were at risk of VTE, particularly within the first year following onset of disease. In this cohort the frequency of VTE did not depend of clinical or serological AAV phenotype, age or gender. Only CRP and body weight were associated significantly with VTE occurrence. Despite VTE rates in AAV patients, routine anticoagulation is not recommended in AAV patients, given the potential risk of bleeding complications. Prospective studies are needed to assess VTE risk stratification in AAV patients and to evaluate the both benefits and potential risks ratio of prophylactic anticoagulation in AAV patients.
#2899 Role of the Th17.1 cells in IgA nephropathy
Authors: Rivera Miguel Giovanni Uriol , Mulet Aina Obrador , Alvarez Angel Garcia , Lobon Ana Gomez , Daza Vanessa 
Published: May 2024

Abstract

Background and Aims
T helper (Th) cells play a crucial role in glomerulonephritis, including IgA nephropathy (IgAN). Recently identified Th17.1 cells, which are elevated in sarcoidosis, lupus, and Takayasu arteritis, express chemokine receptors CCR6 and CXCR3. These receptors are implicated in inflammatory cell infiltration and fibrosis in glomerulonephritis models. Notably, Th17.1 cells express MDR-1 (multidrug resistance protein) and the drug efflux protein p-glycoprotein, associated with corticosteroid resistance. However, the exact role of Th17.1 cells in IgAN remains unclear. Intriguingly, Th17.1 cells produce INF-γ and IL-17, cytokines implicated in IgAN pathogenesis.

Method
In this retrospective cross-sectional study, we examined circulating Th17.1 cells in 18 confirmed IgAN patients. Antibodies such as anti-CXCR3-FITC and anti-CCR6-PCy7 (Biolegend, U.S.A.) were used to stain Th subpopulations. We also used combinations of the following antibodies: anti-CD45-FITC, anti-CD4-PE, anti-CD8-ECD, anti-CD3-PCy5, anti-CD56-PCy5, anti-CD3-PCy7, anti-CD19-ECD, anti-CD127-FITC, anti-CD25-PCy5, and anti-CD4-PCy7 (Coulter Immunotech, France) to evaluate T, B, NK, and Treg cells. Multicolor flow cytometry was performed using a Navios cytometer, and data were analyzed using Kaluza software (Beckman Coulter, U.S.A.). Th effector subpopulations of CD4+ lymphocytes were identified based on chemokine receptor expression: Th17.1 (CXCR3+CCR6+). Th17.1 cells were quantified as a percentage of CD4+ lymphocytes. Th1, Th2, and Treg cells were also evaluated. We explored correlations between Th17.1 cell counts, estimated glomerular filtration rate (eGFR, mL/min/1.73 m²), and proteinuria (24-hour collection). Among the patients, 5 were classified as refractory (progressive eGFR decline &gt; 5 mL/min/1.73 m² and 24-hour proteinuria &gt; 1g despite steroid and immunosuppressant therapy).

Results
The study included 18 patients. The mean (95% CI) Th17.1 cell count was 20% (16-23), and the 24-hour proteinuria was 2.1g (1.4-2.7). A significant direct correlation was observed between Th17.1 cells and proteinuria (g/L, adjusted for 24 hours) (r = 0.50, P = 0.03). Refractory patients exhibited higher Th17.1 levels compared to others (25% [95% CI: 17-33] vs. 18% [95% CI: 14-21], P = 0.02) (Fig. 1). Patients with proteinuria &lt; 0.5g/24 h had lower Th17.1 cell counts compared to those with higher proteinuria (16% [95% CI: 12-20] vs. 21% [95% CI: 17-25], P = 0.06. No correlation was found between eGFR, proteinuria, and Th1, Th2, Th17, or Treg cells.

Conclusion
These findings suggest that Th17.1 cells may contribute to the pathogenesis of IgAN and could potentially indicate the response to steroids or immunosuppressants in treatment. While the direct involvement of Th17.1 cells in kidney tissue remains unexplored, further investigation is warranted due to its therapeutic and prognostic implications.
#958 Development and Validation of a Score Estimating the Probability of obtaining a genetic diagnosis in adults with CKD of uncertain origin
Authors: Lombardi Yannis , Robert Thomas , Villie Patricia , Steichen Olivier , Mesnard Laurent 
Published: May 2024

Abstract

Background and Aims
We aim to derive and validate a score estimating the probability of identifying a variant explicative of the renal phenotype using Exome Sequencing (ES) in adults with CKD of uncertain origin.

Method
Participants: prospective cohort study including all consecutive index patients with a CKD from uncertain origin in three French nephrology units (metropolitan: Sorbonne University Hospitals, Paris, and Conception Hospital, Marseille; overseas: La Réunion University Hospital, Réunion island) who underwent ES between October 11th, 2017 and May 31st, 2023.
Outcome measure: identification of a causal variant using ES data, according to the American College of Medical Genetics and Genomics diagnostic criteria.
Candiate variables and feature engineering: raw data regarding patients’ phenotypes was prospectively entered in a collection form at the time of ES by the prescribing physician. Structured data (yes/no questions and lists) was mapped to Human Phenotype Ontology (HPO) terms. Unstructured data (free text) was manually translated into HPO terms by the same investigator (nephrologist), which was blinded to ES results. First, second and third-order ancestor HPO terms were included in the analysis.
Score's derivation: an optimal weighted average of multiple models (“ensemble model”) was specified, following guidelines provided in a recently published article (PMID:36905602).
Score's validation: internal validation using 10-fold cross validation, followed by internal-external validation (data from 2/3 centers was used to develop a model which was then tested using data from the remaining center; this process was repeated in each center).

Results
We included 2,490 patients, 560/2,490 (22.5%) of whom had a causal variant identified by ES. We collected 1,028 distinct HPO terms describing the patients’ phenotypes. The most common term was “Hypertension”, occurring in 2,079/2,490 (83.5%) patients.
In internal validation, the score showed accurate calibration and discrimination (area under the receiver operating characteristics curve (AUC): 0.71, 95% CI 0.68 to 0.73; index of precision accuracy (IPA): 0.11, 95% CI 0.09 to 0.13). Performances were moderately diminished in internal-external validation but remained satisfactory (Tenon: AUC 0.64, IPA 0.04; Marseille: AUC 0.67, IPA 0.04; La Réunion: 0.68, IPA 0.09).

Conclusion
We derived, internally and internally-externally validated a clinical score which accurately predicts the probability of obtaining a genetic diagnosis using Exome Sequencing. Feature engineering could further increase the score's performances. Automatic computation by clinicians using an interactive tool is achievable and could be of clinical utility, especially to guide resource allocation in case of a low pretest probability.
#745 Age and gender specific reference values for renal volume and association with risk factors for chronic kidney disease in a general population
Authors: Stracke Sylvia , Mensel Birger , Voelzke Henry , Lorbeer Roberto , Dabers Thomas 
Published: May 2024

Abstract

Background and Aims
Renal volume (RV) is associated with renal function and with a variety of cardiovascular risk factors (CVRF). We analyzed RV by magnetic resonance imaging (MRI) in a large population-based study (Study of Health in Pomerania; SHIP-TREND) and tested the influence of age, sex, smoking status, BSA, systolic and diastolic blood pressure, type 2 diabetes, HDL-C, LDL-C, estimated glomerular filtration rate (eGFR) and uric acid on RV.

Method
1,815 participants without kidney disease (930 women) aged 21-81 years were included in our study. Right and left RV with and without body surface area (BSA) indexation were compared among three age groups (22-39 years, 40-59 years, 60-81 years) by median and interquartile range and tested separately in women and men.

Results
eGFR, uric acid, right and left RV were higher in men compared to women (all p &lt; 0.001). Left kidney were larger than right kidneys (both sexes). With age, RV showed a continuously decreasing trend in women and an upside down U-shape relation in men. In multivariable linear regression models, current smoking (β = 14.96, 95% CI 12.12; 17.79), BSA (β = 97.66, 95% CI 90.4; 104.93), diastolic blood pressure (β = 0.17, 95% CI 0.01; 0.32), and eGFR (β = 0.57, 95% CI 0.50; 0.65) were positively associated with both left and right renal volume whereas uric acid (β = −0.03, 95% CI −0.05; −0.01) showed an inverse association with RV. Interestingly, the same eGFR correlated with higher RV in men compared to women.

Conclusion
Reference values for RV are different for age-groups and sex. For any given age, female kidneys are smaller than male kidneys. RV associates positively with eGFR, but for any chosen eGFR, renal volume in females is lower compared to males. RV decreases with age, but in men, RV first increases in the age group 40-59 years before finally decreasing with a faster decline after 60 years. This may reflect hyperfiltration and glomerular hypertrophy associated with the presence of CVRF.