bluuebunny/crossref_metadata_2025_split huggingface dataset:
#911 A mice model of SHPT with bone abnormalities in CKD and potential functional role of sphingolipid in renal osteodystrophy
Authors: Wang Yujia , Tang Rining 
Published: May 2024

Abstract

Background and Aims
Renal osteodystrophy (ROD) is the skeletal disease of chronic kidney disease associated mineral and bone disorder (CKD-MBD). ROD is characterized by abnormal bone mineralization and impaired bone remodeling, leading to increased risk of fractures and mortality in patients with CKD. To date, the pathology of ROD remains poorly understood due to the lack of a suitable animal model. Hence, we successfully established a stable mouse model of ROD using an optimized adenine diet and explored the possible signaling based on RNA-seq expression analyses.

Method
Blood biochemical analysis, micro-computed tomography (micro-CT) and bone histomorphometry were performed to analyze the skeletal characteristics. RNA sequencing (RNA-seq) was used to investigate the mechanisms involved in ROD. The functions of differentially expressed genes (DEGs) were evaluated by Gene Ontology (GO) analyses, Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses and Gene Set Enrichment Analyses (GSEA). DEGs were validated by quantitative real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR).

Results
The mice with ROD induced by optimized adenine diet showed severe abnormalities in serum creatinine (Scr) and blood urea nitrogen (BUN) along with marked hyperparathyroidism and hyperphosphatemia. The bone mineral density (BMD) of femurs was significantly lower in the ROD mice than that in the control (CTL) mice. The trabecular and cortical bone parameters of femurs significantly showed bone loss and severe cortical porosity. ROD mice showed high bone turnover with increased osteoid, eroded, osteoblast, and osteoclast perimeters as well as increased bone formation rate and mineral apposition rate. Transcriptomic profiling identified 1286 genes were upregulated in the femurs of ROD mice compared to the CTL mice and 333 genes that were downregulated. GO, KEGG and GSEA pathway analyses indicated that these genes were highly enriched in functions related to lipid metabolism pathway, sphingolipid signaling pathway, among others. The differential expression of alkaline ceramidase 1(Acer1), ceramide synthase 4 (Cers4) sphingomyelin phosphodiesterase 3 (Smpd3), sphingosine-1-phosphate phosphatase 2 (Sgpp2) in skeletal tissue and serum of CKD patients were validated by qRT-PCR. Since sphingolipid pathways have been recently implicated in bone metabolism, these genes are potential target genes in the settings of ROD.

Conclusion
In conclusion, our findings demonstrated that the CKD mice with bone abnormalities induced by optimized adenine diet may serve as a useful model for skeletal analysis in ROD. Based on the RNA-seq, we identified that sphingolipid might play a crucial role in the pathogenesis of ROD and provided new therapeutic targets for future study.
#814 Inflammatory biomarkers and progression of diabetic kidney disease
Authors: Vasilkova Volha , Mokhort Tatsiana , Borovets Yana 
Published: May 2024

Abstract

Background and Aims
Diabetic kidney disease (DKD) is one of the fastest growing causes of chronic kidney disease and associated morbidity and mortality. Previous studies have demonstrated the involvement of inflammation in the progression of kidney damage.
The aim of our study was to evaluate potential therapeutic approaches using inflammatory biomarkers to assess DKD progression.

Method
A total of 499 patients with DT1 and DT2, aged 34 to 84 years (60 [60;72]), were examined. All patients underwent standard clinical and laboratory examination, with an assessment of the levels of the inflammatory biomarkers (FGF-23, TNF-α, VEGF-A, hsCRP, Il-6) in baseline plasma samples. Renal function was assessed based on the levels of serum creatinine, eGFR and albumin/creatinine ratio. Control group included 65 people the same age without diabetes.

Results
We divided all patients into two groups according to the presence DKD. The levels of FGF-23 (p &lt; 0.001), TNF-α (p = 0.014), VEGF-A (p = 0.006), hsCRP (p &lt; 0.001), Il-6 (p &lt; 0.001) were significantly higher in patients with DKD than in control group.
A predictive model was developed to estimate the probability of DKD depending on VEGF-A, FGF-23, TNF-α, Il-6, hsCRP, age, duration of diabetes, systolic blood pressure, HbA1c, LDL-C, using binary logistic regression. The resulting regression model was statistically significant (p &lt; 0.001). Based on the value of Nagelkerke R², the model explained 79.5% of the observed DKD variance.
1 pmol/l increase of FGF-23 was associated with 1.921 times increase in DKD odds. 1 pg/ml increase of TNF-α was associated with 1.092 times decrease in DKD odds. 1 mg/ml increase of Il-6 was associated with 1.612 times increase in DKD odds. 1 mg/l increase of hsCRP was associated with 1.496 times increase in DKD odds.

Conclusion
Our study identifies FGF-23, TNF-α, Il-6, hsCRP as promising targets of novel therapeutic interventions in patients with diabetes, which should be investigated in future clinical trials.
#3065 Factors associated with recurrence or persistently high parathormone levels after parathyroidectomy in patients with CKD
Authors: Yıldırım Saliha , Helvacı Özant , Yavuz Aydın , Erten Yasemin , Derİcİ Ülver , Guz Galip 
Published: May 2024

Abstract

Factors associated with recurrence or persistently high parathormone levels after parathyroidectomy in patients with secondary hyperparathyroidism receiving renal replacement therapy

Background and Aims
Resistant hyperparathyroidism that indicates surgery usually occurs in patients with CKD who receive renal replacement therapy (RRT). This study aims to evaluate the factors associated with persistent or recurrent high levels of PTH after parathyroidectomy due to SHPT in patients receiving RRT.

Method
In this retrospective study, we included 66 adult patients (mean age: 46.86 ± 13.79) with parathyroidectomy for SHPT receiving renal replacement therapy. Clinicopathological features, laboratory parameters (preoperatively, at the first hour of surgery, at least every three months for at least two years after surgery), type of surgery and pathologic diagnosis were recorded from the medical records. Persistence was defined as failure to achieve a decrease in PTH level of more than fifty percent of preoperative PTH level. Recurrence was defined as elevated PTH levels after six months post-operation (&gt;600 pg/mL).

Results
The demographics and clinical characteristics of the study population are described in Table 1. High PTH levels were observed in nineteen patients, while recurrence was observed in nine. Persistence was associated with lower preoperative ALP levels (455.27 ± 296.23, 619.72 ± 593.18, p = 0.017). Recurrence was associated with higher preoperative CRP levels (22.89 ± 6.82, 6.82 ± 5.35, p:0,046) and postoperative high phosphorus levels (4.93 ± 0.99, 4.16 ± 1.09, p = .049).

Conclusion
In our study persistence of high parathormone levels were more common in patients with lower preoperative ALP levels and recurrence was associated with higher preoperative CRP levels and postoperative inadequate phosphorus control. In conclusion, patients with lower ALP and higher CRP levels can be suitable for total parathyroidectomy, which is associated with a lower recurrence rate in SHPT. Also, postoperative phosphorus control can be a key point for preventing the patients' recurrence of high PTH level.
#2380 A multicenter and randomized study of a VLPD supplemented with ketoanalogues in patients with advanced CKD in Spain. Adherence study
Authors: Montesa María , Guillen Marta Arias , Barril Guillermina , Loza Emma Huarte , Durbà Alba , Romano Barbara , Nogueira Ángel , Oliva Juan Carlos Gonzalez , Carrero Juan-Jesus , Molina Pablo 
Published: May 2024

Abstract

Background and Aims
Clinical guidelines recommend a very low-protein diet (VLPD) supplemented with ketoanalogues (KAs) for patients with advanced chronic kidney disease (CKD) to reduce progression (evidence 1A) and improve the quality of life (evidence 1C). However, there is no prior experience with this nutritional intervention in Spain.

Method
A multicenter, randomized, and controlled study that evaluated adherence to a VLPD supplemented with KAs (Ernamin®) in non-dialysis dependent CKD patients, estimated using the Morisky scale. Secondary objectives included assessing the effect of VLPD + KAs on kidney function, urine protein, albumin levels and other metabolic and nutritional parameters, including changes in body composition stores, at months 0, 1, 3, 6, and 9.

Results
Preliminary data from 33 patients (67% men; mean age 68 ± 10; GFR 16.7 ± 3.9 ml/min/1.73 m2), randomized into 2 groups, are presented.
The VLPD group showed good acceptance and tolerance of the diet and supplement, with medium or high adherence in 80% of patients from the first month, maintained throughout the study (Figure).
The use of VLPD was associated with a decrease in phosphorus levels (−0.4 mg/dl VLPD vs. 0.09 mg/dl LPD, P = 0.027) and C-reactive protein (CRP) levels (−2 mg/dl VLPD vs. 0.33 mg/dl LPD), an increase in calcium levels (0.3 mg/dl VLPD vs. −0.2 mg/dl LPD, P = 0.015), and an increase in muscle mass (LTM) measured by bioimpedance (3.7 kg VLPD vs. −0.6 kg LPD, P = 0.03). Stability in weight, fat mass, extracellular volume, albumin levels, and MIS scale was observed during the follow-up. Estimated glomerular filtration rate, and urine protein remained unchanged in both groups.

Conclusion
Protein restriction associated with KAs shows good short-term tolerance and acceptance. This study confirms several effects associated with VLPD supplemented with KAs, including an anti-inflammatory effect, the preservation of nutritional status, and a better control of phosphate levels. These data suggest safe protein intake restriction with stabilization of protein stores.
#1868 Dapagliflozin reduces urinary kidney injury biomarkers in chronic kidney disease irrespective of albuminuria level
Authors: Park Kootae , Kwon Soon Hyo 
Published: May 2024

Abstract

Background and Aims
The beneficial effects of Sodium-Glucose Cotransporter 2(SGLT2) inhibitor in patients with chronic kidney disease (CKD) with low albuminuria levels have not been established. In this study, we aimed to compare the effects of dapagliflozin on kidney injury biomarkers in patients with CKD stratified by albuminuria level.

Method
We prospectively enrolled healthy volunteers (HVs) (n = 20) and patients with CKD (n = 54) with and without diabetes mellitus (DM). Patients with CKD were divided into two subgroups by age- and sex-matched according to urinary albumin-creatinine ratio (uACR) levels (&lt;300 mg/g and ≥300 mg/g). The CKD group received dapagliflozin 10 mg per day. Urine samples were collected before treatment and after 3 months and 6 months of dapagliflozin. Urinary kidney injury molecule-1 (KIM-1), interleukin-1β (IL-1β), and mitochondrial DNA nicotinamide adenine dinucleotide dehydrogenase subunit-1 (mtND1) copy number were measured.

Results
The estimated glomerular filtration rate (eGFR) of patients with CKD was lower than that of HVs (p &lt; 0.001). During the study period, eGFR decreased and uACR did not change in the CKD group. Kidney injury markers were significantly elevated in patients with CKD compared with those in HVs. Dapagliflozin reduced urinary KIM-1, IL-1β and mtDNA copy number in patients with CKD after 6 months of treatment. In further, the levels of urinary KIM-1 and IL-1β, patients with CKD decreased after 6 months of dapagliflozin treatment regardless of albuminuria level.

Conclusion
In this study, dapagliflozin reduced urinary kidney injury biomarkers in patients with CKD, regardless of albuminuria level. These findings suggest that SGLT2i may also attenuate the progression of low albuminuric CKD.
#1036 Studying the quality of life in patients with CKD during the short physical rehabilitation program
Authors: Saipova Durdona , Egamberdieva Dano , Ruzmetova Iroda 
Published: May 2024

Abstract

Background and Aims
The purpose of the study was to study the quality of life in patients with stages 2-3 CKD during a short physical rehabilitation program.

Method
The study included 130 patients with stage 2-3 CKD at the age of 45 - 65 years (average age - 58.7 ± 0.73 years).
Patients included in the study were divided into 2 groups – main group and control group, depending on adherence to non-drug treatment: 1st - CG group (control) – patients receiving standard therapy (n = 30); 2nd - MG group (main) - patients who, in addition to medication treatment, received a course of physical training for 12 weeks 2-3 times a week (n = 100). Laboratory data were analyzed in patients urea, creatinine, electrolytes, albumin, total protein, blood hemoglobin.

Results
During the study of patients with CKD at pre-dialysis stages, patients in the main group rated their quality of life more positively. The total quality of life indicator in the main group during 12 weeks of regular physical training increased by 15.5% (p &lt; 0.05). In the control group, after 12 weeks of physical training quality of life parameters remained at the same level, but there was a tendency to decrease. Patients in the study group reported significant improvements in physical quality of life measures compared with control group measures, including role limitations (physical) (mean change = −8.9 in the control group compared with mean change + 19.0 in study group P &lt; 0.001), physical functioning (mean change = −0.7 in the control group compared with a mean change of +11.1 in the study group; P ˂ 0.005), Patients in the study group also reported a significant improvement in pain scores.

Conclusion
Thus, when studying the quality of life, a group of patients who received physical training with standard therapy noted an improvement in both physical and mental functioning.
#1530 Studying parenteral nutrition in patients with dialysis stage chronic kidney disease
Authors: Raimkulova Narina , Rasulev Yorkin , Ruzmetova Iroda , Khudoiberdieva Gulnoza 
Published: May 2024

Abstract

Background and Aims
Hemodialysis is associated with high rates of morbidity and mortality, as well as poor quality of life. Changes in nutritional status and loss of protein and energy are important indicators of these risks. Maintaining optimal nutritional status in hemodialysis patients is an important but sometimes overlooked aspect of treatment. In some cases, intradialytic parenteral nutrition is possible, but lack of knowledge about the practical aspects of administration is rarely discussed.
The purpose of our study was to study the age-related characteristics of the nutritional status in patients with CKD of the dialysis stages who are on parenteral nutrition.

Method
The study included 40 patients with stage C5 CKD. Glomerular filtration rate (eGFR) was estimated using the CKD-EPI formula (2011) [11]. Anthropometric data were studied: height, weight, body mass index (BMI), mid-thigh circumference and mid-upper arm circumference, as well as laboratory data: urea, creatinine, electrolytes, albumin, total protein, hemoglobin. All patients underwent instrumental research methods: ECG, EchoCG.
The patients were divided into 2 groups – with and without PEM. Statistical data processing was carried out according to standard methods using a computer program package.

Results
Total body water (TBW) (P = 0.026) and triceps skinfold thickness (P &lt; 0.05) were higher in the hemodialysis group. BMI and other anthropometric parameters showed no significant differences between the two groups. Total caloric intake (P &lt; 0.05) and total cholesterol (P &lt; 0.05) were higher in patients with PEM. Intake of other nutrients, including proteins, lipids, microelements and vitamins, did not show significant differences between the two groups. Only 24% of patients were malnourished. Triglyceride levels were higher in non-malnourished patients, but HDL levels were higher in malnourished patients. Some anthropometric indicators were significantly higher in patients not suffering from PEM. It is worth noting that malnourished patients consumed more calories and nutrients, including proteins, plant lipids, animal lipids and carbohydrates.

Conclusion
Compared with malnutrition patients and non-malnutrition patients, several anthropometric parameters, including subiliac skinfold thickness and MAC, were significantly lower in the malnutrition group. These values can be measured using simple methods and are used as a useful method for assessing malnutrition. Interestingly, patients with malnutrition and lower BMI albumin actually consumed more calories and nutrients from food. This means that malnutrition in dialysis patients is not simply caused by low food intake.
#1048 Why are felids at such a high risk of chronic kidney disease?
Authors: Painer-Gigler Johanna , Rauch-Schmücking Hanna , Bohner Julia , Kalogeropoulu Szilvia , Stalder Gabrielle , Shiels Paul , Johnson Richard J , Stenvinkel Peter 
Published: May 2024

Abstract

Background and Aims
Felids are obligatory hyper-carnivorous mammals, representing the utmost manifestation of a carnivorous dietary adaptation. Chronic kidney disease (CKD) could be characterized as an epidemic amongst domestic and captive wild felids, affecting up to 87%. However, its aetiology remains yet unknown. The aim of the study was to assess how various diets influence the development of CKD in felids.

Method
Ninety adult, captive non-domestic felids (tigers, leopards, cheetahs, and lions) from zoological parks were examined under anaesthesia. Their examination and sampling were part of planned annual health evaluations, not related to experiments. Husbandry and dietary information, as well as medical history were collected through a questionnaire. Blood serum and urine were taken. For the staging of CKD, symmetric dimethylarginine (SDMA), the level of azotaemia (serum creatinine) and the level of proteinuria with the urinary protein creatinine ratio were evaluated and correlated to dietary, biological and management factors.

Results
Sixty percent of the felids were diagnosed with CKD. The risk for developing CKD was much higher in animals fed primarily with skeletal muscle meat only compared to animals being fed with meat containing bones or whole pray carcasses. Furthermore, the incorporation of fasting days was significantly linked to a lower CKD prevalence. In addition, feeding a combination of white and red meat showed a lesser association with CKD presence compared to exclusively feeding red meat.

Conclusion
Non-domestic felids in captivity are exposed to different feeding practices. Diets closer to natural, wild diets resulted in lower risks of developing CKD. Feeding strategies such as whole-body prey, the inclusion of white meat and the implementation of fasting days were associated to significantly lower risks of developing CKD in captive wild felids. Future studies on investigating the benefits of dietary supplements, the impact of the Calcium:Phosphorus ratio, the composition of meat and the structure of fasting days is needed. In addition, the role of chronic low-grade inflammation (inflammatory biomarker analysis) as well as the impact of various dietary regimes on the microbiota composition should be explored further.
#1306 Online medical education advances physicians’ understanding of the clinical benefits of SGLT 2 inhibition in chronic kidney disease management
Authors: Trier Joachim , Da Silva Rita Moreira 
Published: May 2024

Abstract

Background and Aims
Patients with chronic kidney disease (CKD) have a substantially impaired cardio-renal health prognosis and a reduced life expectancy. Several recent cardio-renal outcomes trials have demonstrated the clinical benefits conveyed by Sodium-Glucose Cotransporter 2 (SGLT2) inhibitors with respect to improved cardiovascular (CV) risk and reduced decline in kidney function.
The goal of this online medical education activity was for learners to be better able to detect CKD early in clinical practice and integrate reno-protective therapies, such as SGLT2 inhibitors, into their management of suitable patients with CKD.

Method
Five nephrology experts participated in a 30-min online video program with synchronized slides and written transcript. 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 28 December 2022 to 1 March 2023.

Results

Conclusion
Participation of PCP in an online video expert program improved their understanding of the close association between metabolic, renal, and cardiovascular diseases, the latest results of CKD outcome trials with SGLT2 inhibition in CKD management, as well as their competence in the practical use of these reno-protective medications in suitable patients with CKD.
#346 Oxylanthanum carbonate for hyperphosphatemia in ESKD: tolerability trial in progress
Authors: Pergola Pablo , Mourya Sanjay , Hasal Steve , Reddy Guru , Gupta Shalabh 
Published: May 2024

Abstract

Background and Aims
Despite current therapies, more than 43% of patients undergoing dialysis in the USA have hyperphosphatemia, defined as serum phosphate values &gt;5.5 mg/dL and is commonly associated with an increased risk of death. Most currently available phosphate binders are known to cause gastrointestinal (GI) adverse events (AEs) that can negatively impact the patient experience. Common GI AEs include abdominal pain, nausea, and bloating. Phosphate binders are usually formulated as large tablets, and some must be chewed before ingestion. Commonly a high number of pills are needed per day to achieve goal serum phosphate levels. Oxylanthanum carbonate (OLC) is a new lanthanum-based nanotechnology product in development with a high in vitro binding capacity as compared to other phosphate binders. OLC is formulated as a small pill that is swallowed whole instead of being chewed before swallowing as is the case for lanthanum carbonate. The safety of OLC has been studied in &gt;100 healthy subjects. The most common treatment-related AE (&gt;5%) in an OLC bioequivalence (BE) study was nausea. This study aims to evaluate the tolerability of clinically effective (serum phosphate ≤5.5 mg/dL) doses of OLC in patients on hemodialysis.

Method
This open-label, single-arm, multicenter, multidose study will enroll up to 90 patients on hemodialysis who require phosphate binder therapy and have mean historical serum phosphate levels between ≥4.0 and ≤7.0 mg/dL for ≥8 weeks. The primary endpoint of the study is tolerability as assessed by the incidence of discontinuations due to treatment-related AEs. Additionally, the incidence of AEs related to OLC will be collected. Participants will undergo up to 3 weeks of phosphate binder washout until their serum phosphate levels reach &gt;5.5 and ≤10.0 mg/dL (Fig. 1). During the 6-week Titration Period, all patients will receive 1500 mg/day OLC (500 mg TID with meals/snacks) for the initial 2 weeks, with subsequent titration every 2 weeks until achieving a target serum phosphate level (≤5.5 mg/dL) or to a maximum OLC dose of 3000 mg/day. After titration, patients will enter a 4-week Maintenance Period at the effective OLC dose.

Results
We intend to present results elucidating tolerability of clinically effective doses of OLC in patients on dialysis.

Conclusion
The tolerability of OLC at doses effective in achieving a serum phosphate ≤5.5 mg/dL in patients on hemodialysis will be evaluated in this study.