bluuebunny/crossref_metadata_2025_split huggingface dataset:
#1550 Incident hypertension: immune biomarkers and vascular phenotypes
Authors: Murray Eleanor , Delles Christian , Virlan Aysin Tulunay , Nosalski Ryszard , Guzik Tomasz 
Published: May 2024

Abstract

Background and Aims
Blood pressure (BP) regulation is mediated by cardiac, vascular, endocrine, renal, and immune system interactions. Hence, hypertension may exist as different phenotypic variants, with different clinical features and susceptibility to target organ damage. We aimed to analyse the circulating protein biomarker ‘signature’ of: 1) untreated hypertension; 2) hypertensive phenotypes identified by arterial and blood pressure parameters.

Method
61 patients with hypertension, and 61 controls were assessed using 24hr ambulatory BP monitoring; endothelial function, arterial stiffness, carotid intima-media thickness (CIMT), and cardiovascular variability [1]. Circulating protein biomarkers analysed using Olink® Inflammation plasma biomarker panel, reported as NPX (Normalized Protein eXpression), in Log2 scale.

Results
34 biomarkers dominated by cytokines and chemokines differed between normotensive and hypertensive subjects (Fig. 1), though failed to meet Bonferroni-adjusted threshold. Inflammatory biomarkers correlated with BP and arterial stiffness, BP variability, and CIMT, but not endothelial function. Associations were concordant across systolic and diastolic BP; TPP1, CCL7, CCL11, and CCL21 positively correlating; IL18R1, and KYNU negatively. These relationships were more pronounced in hypertensive subgroup, 85 biomarkers correlating including CD molecules (CD200R1, CD22, CD58, CD6, CD70) and cytokines (IL-5, IL-11, IL-15, IL-18, IL-32, IL-1RL2, IL-22RA1, IL-5RA). HGF, AGE, and CCL21 showed greatest between group differences and correlated with multiple BP or vascular parameters. Systolic nocturnal dipping demonstrated negative correlation with biomarkers relating to immune cell interactions and cellular adhesion (CTRC, EPHA1, LGALS4, SIT1, SMOC, IL-18 and TNFSF11).
Machine learning techniques identified three phenotypes of hypertension, ‘arterially stiffened’, ‘vaso-protected’, and ‘non-dipper’ [1]. Sixteen of the 85 correlating biomarkers also differed between these phenotypic groups:

Conclusion
Hypertension is linked to alterations in circulating immune biomarkers. Multiple biomarkers correlated with both arterial stiffness and BP parameters. Some biomarkers are only correlated in the hypertensive group. Many also relate to nocturnal dipping, and differed across the hypertension endotypes. HGF is a promising biomarker for BP and arterial function; warranting further validation.
#209 Relation between exercise pattern changes and renal outcome in new-onset diabetes: a nationwide population-based study
Authors: Lim Sang Yup , Han Kyungdo , Suh Sang Heon , Choi Hong Sang , Kim Chang Seong , MA Seong Kwon , Kim Soo Wan , Bae Eun Hui 
Published: May 2024

Abstract

Background and Aims
Exercise reduced risk of diabetes and obesity. However, it remains unclear whether the pattern changes of exercise are increased risk of end-stage renal disease in new-onset diabetes mellitus (DM) patients.

Method
We assessed diabetes development in 2015 in 21,122,422 non-diabetic Koreans enrolled in Korean National Health Screening (KNHS) from 2009 to 2012 using International Classification of Diseases 10th (ICD-10) code and anti-diabetic medication prescription. Renal outcome (End-stage renal disease) was defined using V-code. The risk of ESRD evaluated in never exercise (none), after new-onset DM (post only), before new-onset DM and no exercise after new-onset DM (pre-only) and persistent exercise group (persistent group).

Results
During median 4.8-year follow-up, 275 (0.21%) of ESRD was occurred. After fully adjusted, the hazard ratio (HR) for ESRD was lowest in persistent exercise group 0.521 [0.302 to 0.899]. Post only exercise 0.674 [0.461 to 0.985] group showed better renal outcome compared to pre only exercise group 0.791 [0.535 to 1.169] or never exercise group [reference, 1.0]. Subgroup analysis for age, sex, history of chronic kidney disease, hypertension showed similar results. Even light exercise such as walking tended to reduce the risk of renal outcome 0.817 [0.634 to 1.037]. The higher 0.627 [0.441 to 0.892] or moderate 0.7 [0.514 to 0.953] strength of exercise type showed the lower risk of renal outcome in new-onset DM patients.

Conclusion
This study provides compelling evidence that exercise, particularly when maintained over time, is associated with a substantial reduction in the risk of ESRD in individuals with new-onset DM. These findings underscore the importance of incorporating regular physical activity as a crucial component of comprehensive health management strategies for individuals with diabetes, offering both clinicians and patients valuable insights for optimizing renal outcomes.
#783 Individualized net benefit of intensive blood pressure lowering among older adults in SPRINT
Authors: Jamshidian Mitra , Scherzer Rebecca , Estrella Michelle , Shlipak Michael , Ascher Simon 
Published: May 2024

Abstract

Background and Aims
The optimal blood pressure (BP) target for older adults remains controversial. This study aimed to determine whether results from the Systolic Blood Pressure Intervention Trial (SPRINT) could be tailored to individual trial participants using risk estimates and simulated preferences about the relative importance of multiple outcomes related to BP lowering.

Method
This analysis included 4,850 SPRINT participants age ≥65 years. Parsimonious Cox models were internally validated to predict the absolute difference in risk between intensive versus standard BP lowering in each SPRINT participant for all-cause death, cardiovascular outcomes, cognitive outcomes, and serious adverse events. Treatment effects were combined using simulated preference weights into an individualized net benefit, which represents the weighted sum of risk differences across outcomes. Individualized net benefits among older SPRINT participants were compared across categories of age (65-74 years vs. ≥ 75 years), frailty (fit, less fit, and frail), and polypharmacy status.

Results
When simulating preferences for older adults who view death, cardiovascular events, and cognitive impairment as much more important than the harms of BP lowering, the median (IQR) individualized net benefit was 5% (3%, 7%), and 100% had a net benefit that favoured intensive BP lowering. When simulating benefits and harms to have similar importance, the median (IQR) individualized net benefit was 2% (1%, 3%), and 95.4% had a positive net benefit. In subgroup analyses, the predicted net benefit of intensive BP lowering was significantly greater among those with advanced age, frailty, and polypharmacy compared with lower risk individuals (P&lt;0.001 for all comparisons).

Conclusion
Almost all older participants in SPRINT had a predicted net benefit that favoured intensive BP control, but the degree of net benefit varied considerably. Personalizing BP targets for older adults according to each person's estimated risks and preferences may provide more refined BP target recommendations.
#1902 Remdesivir ameliorates ferroptotic renal injury in hamster after SARS-CoV-2 infection
Authors: Kim Won , Park Woong , Jung Yujin , Kim Hyeongwan , Yeom Ji-Hyun , Lee Soo Jin 
Published: May 2024

Abstract

Background and Aims
The purpose of this study was to see how remdesivir affected renal ferroptotic damage in hamsters following a human Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection. We evaluated the inhibitory effects of remdesivir on the ferroptosis of SARS-CoV-2 infection in a hamster infection model and in in vivo assays.

Method
To investigate the effect of SARS-CoV-2 on renal ferroptosis, we administered 2.5 × 104 p.f.u. SARS-CoV-2 via intranasal to hamster. In the initial study, animals were treated with remdesivir subcutaneously (s.c.) for 7 days beginning at various times in relation to virus challenge. After 5 days, kidney tissues were harvested. The effect of REMDESIVIR on SARS-CoV-2 infection and ferroptosis were evaluated by immunohistochemistry. Next, ferroptosis-related markers, glutathione peroxidase 4 (Gpx4), 4-hydroxynonenal (4-HNE), Acyl-CoA synthetase long chain family member 4 (Acsl4), nuclear factor erythroid-2-related factor 2 (Nrf2), heme oxygenase-1 (Ho-1) were evaluated by quantitative PCR.

Results
In hamsters, SARS-CoV-2 resulted in high viral protein expression in the renal tubules and decreased renal tubular luminal diameter in periodic acid-Schiff (PAS) stained kidney sections. Remdesivir treatment decreased SARS-CoV-2-induced viral spike protein, HO-1, ferritin heavy chain1 (FTH1), ferritin light chain (FTL), and 4-HNE expression in renal tubular epithelial cells of hamsters in a dose-dependent manner. GPX4 expression suppression after infection was ameliorated by remdesivir administration. Increased ferroptosis-related mRNA marker (Gpx4, 4-HNE, Acsl4, Nrf2, Ho-1) expression in hamster kidneys was suppressed by remdesivir treatment.

Conclusion
All of our data suggest that remdesivir treatment ameliorated SARS-CoV-2 infection-induced ferroptosis in the kidney in a hamster model.
#2989 Superposition of atypical hemolytic syndrome and tubulointerstitial nephritis, a case report
Authors: Padilla Manuel Enrique Villalobos , Lopez Daniela Paola Giron , Chacón Melisa Elizalde 
Published: May 2024

Abstract

Background and Aims
Hemolytic uremic syndrome is a heterogeneous group of diseases that have in common the development of thrombotic microangiopathy with diffuse endothelial damage, resulting in the classic triad composed of microangiopathic hemolytic anemia, thrombocytopenia and acute kidney injury, on the other hand, tubulointerstitial nephritis is characterized by the presence of inflammatory infiltrates and edema and of the interstitial compartment that causes deterioration of renal function.

Method
The following is the case of a patient with acute kidney injury of etiology composed of thrombotic microangiopathy and tubulointerstitial nephritis.

Results
27-year-old female patient without significant history, began 3 weeks prior to admission with fever, chills, asthenia, nausea and vomiting of food content, approximately 5 episodes per day for 3 days, presenting intermittent episodes of jaundice of the mucous membranes and conjunctivae, with progressive increase of the symptoms to the point of preventing daily activities, she was admitted for study, detecting hemolytic anemia, thrombocytopenia and severe acute kidney injury, so she was referred to our center was decided for evaluation by Nephrology and Hematology. In our institution, urinary sediment with dysmorphic erythrocytes was documented, peripheral blood smear without the presence of schistocytes, positive Coombs 4 crosses, renal ultrasound with data compatible with acute kidney injury, and supportive management with hemodialysis was initiated. Due to suspicion of autoimmune glomerulopathy, an autoantibody panel was indicated with negative antinuclear antibodies, anti-double-stranded DNA, anti-Sm, anti-B2 glycoproteins, and lupus anticoagulant, with normal complement values, stool culture, and negative stool Shiga protein assay, angiotomography of the abdomen where the integrity of renal circulation is verified, so renal biopsy with immunohistochemical study is performed, finding data compatible with thrombotic microangiopathy and acute tubulointerstitial nephritis. The patient is maintained with supportive care, steroids and hemodialysis as required with progressive recovery of renal function until renal replacement therapy is weaned, she is discharged with a steroid regimen and clinical nephrology and hematology follow-up.

Conclusion
Acute kidney injury is a complex and multifactorial entity, which requires a comprehensive approach in order to identify the best therapeutic option and to offer a better outcome in the renal function of these patients. The case of our patient presented a sudden deterioration of renal injury composed of two entities with different pathophysiology, demonstrating that, although the approach to these two entities converge in certain etiologies, it is imperative that the clinician does not forget the wide variety of factors that contribute to the development of renal injury.
#2206 Predictors of post-operative acute kidney injury after colorectal cancer surgery
Authors: Larsen Mads Skovsgaard , Munch Philip Vestergaard , Christiansen Christian Fynbo 
Published: May 2024

Abstract

Background and Aims
Post-operative acute kidney injury (PO-AKI) is a common complication of colorectal cancer (CRC) surgery associated with increased morbidity and mortality, and higher hospital costs. Specific treatment of AKI is still limited, supporting the importance of preventing AKI. Identification of patients at high risk may allow early interventions, including closer monitoring and perioperative optimization. This study aimed to identify predictors of PO-AKI by assessing the association between preoperative factors and the occurrence of PO-AKI.

Method
We conducted a nationwide cohort study including adult CRC surgery patients in 2010–2021 using Danish health registries. We defined PO-AKI as AKI within 7 days after the CRC surgery according to the 2012 KDIGO criteria using creatinine measurements. A list of patient characteristics associated with AKI was identified using existing literature. We obtained information on variables using population-based health registries containing data on diagnosis codes, redeemed prescriptions, and laboratory data. We investigated the individual predictive factors by estimating PO-AKI risks and the odds ratios (ORs) with 95% confidence intervals (CIs) adjusting for sex and age.

Results
We identified 35,650 CRC surgery patients, of whom 24,555 had creatinine measurements during the study period, making them eligible for further analysis. Among these patients, we identified 2,694 cases of PO-AKI, corresponding to a 11% risk of PO-AKI.
The risk of PO-AKI was higher for males (13.5% vs. 8.4%, aOR=1.76 [1.62-1.91]), and patients with diabetes (15.4% vs. 10.2%, aOR=1.46 [1.32-1.61]), cardiovascular disease (15.4% vs. 9.9%, aOR=1.38 [1.26-1.52]), CKD (18.9% vs. 9.2%, aOR=1.99 [1.80-2.19]), COPD (16.6% vs. 10.3%, aOR=1.59 [1.42-1.78]), and hypertension (13.6% vs. 7.5%, aOR=1.68 [1.53-1.84]).
When examining potentially nephrotoxic medicine, the risk was higher in ACE-I/ARB users (14.5% vs. 9.6%, aOR=1.44 [1.32-1.56]) and similar in NSAID users and nonusers (10.3% vs. 11.0%, aOR=1.00 [0.84-1.19]).

Conclusion
We found that male gender, diabetes, cardiovascular disease, CKD, COPD, hypertension, and the use of ACE-I/ARB medications were associated with a higher risk of PO-AKI. Interestingly, users and nonusers of NSAIDs had similar risks of AKI. The identification of high-risk groups, such as those with pre-existing comorbidities or users of specific medications, may aid clinicians in identifying patients with a particularly high risk of PO-AKI.
#2237 Preliminary results of Protection of Renal Function after Conversion of fast IR-Tac Metabolizers to Envarsus® study (The Protect RENvarsus study)
Authors: Thölking Gerold , Jehn Ulrich , Sommerer Claudia , Guthoff Martina , Avdiu Alban , Weinmann-Menke Julia , Kommer Andreas , Hesselink Dennis , Schagen Maaike , Kurschat Christine , Miglinas Marius , Reuter Stefan 
Published: May 2024

Abstract

Background and Aims
As shown in a proof-of-concept study, renal function of fast immediate-release tacrolimus (IR-Tac) metabolizers can recover after conversion to prolonged-release tacrolimus (LCP-Tac), whereas slow Tac metabolizers showed no benefit over a 3-year follow-up [1]. The aim of this study is to test this hypothesis in a multi-center trial.

Method
In a multicenter European trial, we aim to enroll 300 renal transplant (RTx) recipients who were switched from IR-Tac to LCP-Tac one month or later after RTx. Metabolizer groups will be defined by calculation of the C/D ratio at one month after RTx: fast IR-Tac metabolizers (&lt;1 ng/mL*1/mg) and slow (≥1) [2]. The development of renal function, acute rejections, infections, and the development of diabetes mellitus will be observed in a 5-year follow-up.

Results
A total of 265 patients have been included in this study to date. Preliminary data confirm that fast metabolizers who were switched to LCP-Tac at a median time of 2.0 months (range: 1.0-253.1 months) showed a recovery of renal function. In contrast, slow metabolizers showed a stable eGFR after switching to LCP-Tac at a median time of 13.2 months (range: 1.2-172.8 months) following RTx. The incidence of complications was low and comparable in both groups.

Conclusion
Preliminary data confirm that early conversion of fast IR-Tac metabolizers to LCP-Tac can improve renal function after RTx. The 5-year follow-up data will provide additional insight.
#2727 Acute kidney in patients with ANCA associated vasculitis
Authors: Dhoha Derbel , Mariem Najjar , Mekki Soumaya , Mariem Hajji , Hmida Fethi Ben , Abderrahim Ezzedine 
Published: May 2024

Abstract

Background and Aims
Renal involvement in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is considered an emergency situation. Early diagnosis and treatment significantly improve prognosis. The aim of this study was to investigate the characteristics of acute kidney injury (AKI) in ANCA-associated vasculitis and assess its developmental aspects.

Method
Our study, conducted in the Internal Medicine Department A of Charles Nicole Hospital over a four-year period (January 2018-August 2022), was retrospective and descriptive. The diagnosis of ANCA vasculitis was made based on the ACR 1990 and/or EULAR 2012 criteria. The severity of AKI was categorized according to the KDIGO AKI classification.

Results
Seventeen patients were included, with a mean age of 51 ± 17.42 years and a sex ratio of 0.42. The primary clinical presentation of AKI was rapidly progressive glomerulonephritis (n=11), followed by acute nephritic syndrome (n=4). Pneumo-renal syndrome was observed in 4 patients. Proteinuria and hematuria were present in all 17 patients, with 4 being oligoanuric on dipstick. The mean creatinine level was 584 μmol/L, ranging from 125 to 1151 μmol/L. Thirteen patients had KDIGO stage 3 AKI on admission. The predominant histological lesion was extracapillary crescentic glomerulonephritis, based on the Berden classification (n=6). Hemodialysis was initiated immediately in 12 cases, and plasma exchange was performed in 10 cases. The average follow-up time was 24 months, ranging from 3 months to 4 years. Evolution was marked by partial remission in 7 cases, with a mean creatinine of 173 μmol/L. Progression to end-stage renal disease (ESRD) occurred in 10 cases. Relapses, presenting as pneumo-renal syndrome, were observed in 4 patients. Seven patients succumbed, with vasculitis being the cause of death in 3 cases.
In univariate analysis, age &gt;70 years was associated with progression to ESRD (p=0.03). No factor studied emerged as a prognostic factor for overall survival.

Conclusion
The presence and severity of AKI in ANCA-associated vasculitis are linked to a poorer prognosis, affecting both patient and renal survival.
#2391 Changes of medical costs and number of uses for continuous renal replacement therapy until recent six years in South Korea
Authors: Kim Hyung-Jong 
Published: May 2024

Abstract

Background and Aims
Continuous renal replacement therapy (CRRT) is a necessary dialysis treatment method applied to patients with acute renal injury at intensive care unit. In South Korea, the use of such CRRT is increasing, and the cost of health insurance used for CRRT is also increasing. In this study, the pattern and medical costs increase of CRRT usage until recent 6 years were investigated.

Method
From 2016 to 2021, the number of CRRT claims was investigated using data from the National Health Insurance Review and Assessment Service. CRRT costs is applied by a resource-based relative value score in Korea. CRRT can be charged as continuous venovenous hemodialysis, continuous venovenous hemofiltration, and continuous venovenous hemodiafiltration depending on the treatment mode. The CRRT cost differs from the very day and the next day's cost, and the cost of the very day includes the femoral hemodialysis catheter insertion cost, which is higher than the next day's cost.

Results
CRRT medical practice is gradually increasing. The number of CRRT the very day increased from 15,640 cases in 2016 to 20,883 cases in 2021, and it continues to increase from 81,649 cases CRRT the next day in 2016 to 121,376 cases CRRT the next day in 2021. The CRRT relative value score is higher than the conventional hemodialysis(HD) and the CRRT relative value score is 9715 points higher than the conventional HD 1065 points. The total cost of CRRT increased by about KRW 52.5 billion (approximately 38,363,171 dollars) in 2021 from about KRW 17.3 billion (approximately 12,641,578 dollars) in 2016. In addition to CRRT medical practice costs, dialysis fluid, anticoagulant costs, and material costs are added, and so actual CRRT-related costs are more expensive.

Conclusion
CRRT medical practice is gradually increasing. The number of CRRT the very day increased from 15,640 cases in 2016 to 20,883 cases in 2021, and it continues to increase from 81,649 cases CRRT the next day in 2016 to 121,376 cases CRRT the next day in 2021. The CRRT relative value score is higher than the conventional hemodialysis (HD) and the CRRT relative value score is 9715 points higher than the conventional HD 1065 points. The total cost of CRRT increased by about KRW 52.5 billion (approximately 38,363,171 dollars) in 2021 from about KRW 17.3 billion (approximately 12,641,578 dollars) in 2016. In addition to CRRT medical practice costs, dialysis fluid, anticoagulant costs, and material costs are added, and so actual CRRT-related costs are more expensive.
#2689 Risk factors for hospitalization for a major acute cardiovascular event after acute kidney injury with full recovery: a single center experience
Authors: Mahmoud Nouha Ben , Hamouda Mouna , Salah Manel Ben , Salem Meriem Ben , Bchir Sirine , Letaief Ahmed , Sabra Aloui , Skhiri Habib 
Published: May 2024

Abstract

Background and Aims
Acute kidney injury (AKI) was found to be associated with an increased risk of major adverse cardiovascular events (MACE) in the general population. We aim to evaluate the risk factors of

Method
We conducted a retrospective single center study including all patients hospitalized in the nephrology ward since 2002 to 2015, which experienced an AKI episode with full recovery. AKI was defined according to KDIGO criteria. Our primary outcome was to identify risk factors in our population exposing them to MACE after AKI.

Results
Our study included 107 men and 107 women with median age was 61 years. KDIGO stage 3 was the major stage (115 patients), 31 of whom required hemodialysis. Hypertension was found to be the major co morbidities in our population with 37.4% of patients followed by diabetes (32.2%). Median creatinine was 3.79 mg/l (1.26–34.57 mg/l). Most patients had anemia (65.4%).
Among 176 patients for whom we have followed up, in the short, medium and long term: 19, 20 and 2 patients had respectively developed a MACE. The characteristics of patients according to the occurrence of MACE or not are illustrated by Table 1. The risk factors found in our population were presence of co morbidities, vascular disease and anemia in univariate analysis and only anemia in multivariate analysis (Table 2). Patients with anemia and vascular disease had 2.4 times more the risk to develop MACE after AKI with full recovery than patients without anemia and no past history of vascular disease.

Conclusion
Patients with anemia, past history of vascular disease are at risk of MACE after AKI with full recovery and those patients should be better monitored in the short, medium and long term. Our aim is to detect the MACE earlier so we decrease the cardiovascular mortality.