bluuebunny/crossref_metadata_2025_split huggingface dataset:
#1983 In vitro iohexol adsorption in cartridges with mesoporous styrene-divinylbenzene sorbent
Authors: Lorenzin Anna , de Cal Massimo , Ramírez-Guerrero Gonzalo , Corradi Valentina , Reis Thiago , Marcello Matteo , Ronco Claudio , Zanella Monica 
Published: May 2024

Abstract

Background and Aims
Patients with pre-existing chronic kidney disease (CKD) present the highest risk of developing contrast-associated acute kidney injury (CA-AKI). Iodinated contrast agents such as iohexol (molecular weight 821 Da) don't bind to proteins and are easily removed by hemodialysis filters. However, the session time necessary to remove approximately 75% of the injected iohexol load is around six hours. Due to lack of evidence, current guidelines do not recommend to start hemodialysis in CKD patients in conservative management after the administration of iodinated contrast media to prevent or mitigate CA-AKI. Still, a strong rationale supports the removal of iodinated contrast media because of its nephrotoxicity. In this study, we aimed to investigate the capability of a mesoporous styrene-divinylbenzene sorbent to bind iohexol in vitro.

Method
We used 1,000 mL of saline solution spiked with 40 mL of iohexol 350 mg/mL in a closed-loop configuration. Iohexol concentration was 14 mg/mL. The amount of the iodinated radiocontrast was proportional to the amount used in complex percutaneous coronary interventions (worst-case scenario), around 200 mL, in a 70 kg person with an estimated blood volume of 5,000 mL. The solution circulated through a HA380 mini-module cartridge filled with 75g of mesoporous styrene-divinylbenzene sorbent beads at 250 ml/min.
The experiment was carried out twice with the same setup.
Samples were collected at eight-time points (0, 5, 10, 15, 20, 30, 40, and 60 minutes) from the reservoir to measure iohexol concentration. The analysis of the samples was carried out in duplicate. The removal ratio (RR) was calculated considering the initial concentration (C(0)) and the variation of the concentration during the experiment (C(t), where t is the time point), as follows:
$RR( \% ) = \frac{{C( 0 ) - C( t )}}{{C( 0 )}}100$

Results
In the first experiment, the removal ratios after 5, 30, and 60 minutes were 23.4%, 45.8%, and 52.9%, respectively on average. In the second experiment, the reduction ratios after 5, 30, and 60 minutes were 23.4%, 45.5%, and 53.1%, respectively on average. After 30 minutes, the adsorption curved plateaued, indicating cartridge saturation (Fig. 2).

Conclusion
This in vitro model demonstrated that HA380 sorbent cartridge was effective in removing iohexol. The use of hemoadsorption as a strategy to remove iodinated contrast media warrants further investigation because of its clinical potential to reduce the exposure to nephrotoxic contrast agents and CA-AKI.
#1449 Maturation of tertiary lymphoid structures in progressive kidney damage due to chronic phosphate load
Authors: Weingärtner Nina , Richter Beatrice , Walles Franziska , Kapanadze Tamar , Schmitz Jessica , Bräsen Jan Hinrich , Limbourg Florian , Haffner Dieter , Leifheit-Nestler Maren 
Published: May 2024

Abstract

Background and Aims
We have recently shown that a high phosphate diet (HPD) in mice leads to an increase in FGF23 levels and causes progressive tubular damage and interstitial fibrosis with increased accumulation of macrophages and concomitant perivascular immune cell aggregates in the corticomedullary zone. Such tertiary lymphoid structures (TLS) can develop as a result of chronic inflammation and have already been described in lupus nephritis and IgA nephropathy, among others. In our model, the question arose to what extent damage to the proximal tubule is temporally associated with the development and maturation of TLS and which factors favor TLS development.

Method
Wild-type mice were fed HPD for 1, 2, 3, 4 and 6 months and the kidneys of each were compared with those of mice on a normal phosphate diet (NPD). To evaluate the effect of high FGF23 ± phosphate, Fgf23 was overexpressed in mice on NPD and HPD using an adeno-associated virus (AAV-Fgf23), and hypophosphatemic Hyp mice were used.

Results
An increased tubular damage score was seen after only two months of HPD. In parallel, perivascular immune cell clusters developed in the corticomedullary zone and in the renal cortex, which were characterized by aggregates of CD45R+ B cells and CD3+ T cells, as well as LYVE1+ lymphatic vessels after three months of HPD and were accompanied by increased expression of venous markers (Plvap, Aplnr, EphB4) and cell adhesion molecules (Sell, Vcam1, Madcam1). Further analyses showed a time-dependent induction of the immunofibroblast-derived chemokines Cxcl13 and Ccl19, as well as the lymphotoxins Lta and Ltb, which are important for the differentiation of immunofibroblasts into follicular dendritic cells (FDC) and follicular reticular cells (FRC). Already after four months of HPD, proliferating B-cell clusters with FDCs, FRCs located in T-cell clusters, podoplanin+ networks, high endothelial venules, plasma cells and increased IgD synthesis indicated fully mature TLS, while tubular damage and fibrosis continued to increase until six months of HPD. Compared to AAV-Fgf23 mice on NPD, only AAV-Fgf23 animals on HPD developed tubular damage with fibrosis and fully mature TLS. Hypophosphatemic Hyp mice with high FGF23 showed neither signs of tubular damage nor the development of TLS.

Conclusion
The development of renal TLS due to chronic high phosphate load coincides with the development of tubular damage, with earlier maturation of TLS and progression of tubular damage.
#299 The association between body fat distribution, albuminuria, and mortality in relatively healthy adults
Authors: Claudel Sophie , Verma Ashish 
Published: May 2024

Abstract

Background and Aims
Albuminuria is a risk factor for kidney disease progression and cardiovascular disease (CVD). Metabolic syndrome has been associated with incident albuminuria. We aimed to understand which measures of adiposity are associated with albuminuria and mortality in relatively healthy adults.

Method
We included 8,215 adults in the National Health and Nutrition Examination Survey (years 2003-6 and 2011-2016) without prior CVD, estimated glomerular filtration rate &lt;60 ml/min/1.73 m2 (eGFR), diabetes, hypertension, or prior dialysis. We used multivariable adjusted linear regression modelling to evaluate sex-stratified relationships between urine albumin excretion and multiple measures of adiposity, controlling for urine creatinine. We then performed sex-stratified multivariable adjusted Cox regression models of the association between adiposity and all-cause mortality. Measures of adiposity included android fat mass index (FMI), gynoid FMI, android-to-gynoid ratio, subcutaneous FMI, abdominal FMI, visceral FMI, body mass index (BMI), and waist circumference. Models were adjusted for age, race or ethnicity, education, food insecurity, health insurance, survey year, physical activity, eGFR, total cholesterol, systolic blood pressure, hemoglobin A1c, and urine albumin:creatinine ratio (UACR), and menopausal status (among women). Models were subsequently adjusted for BMI and waist circumference.

Results
The sample was 52.3% women, the mean (standard deviation, SD) BMI was 27.1 kg/m2 (SD 6.7), and the median UACR was 5.4 mg/g [3.8, 8.6]. Over a median follow up of 7.8 years [IQR 5.3-14.3], there were 128 deaths among men and 89 deaths among women. Among men, a 1-SD increase in android fat mass index (FMI) was associated with 13.1% (95% CI 4.5, 22.5) higher albuminuria. Similarly, a 1-SD increase in visceral FMI was associated with 8.3% (95% CI 1.3, 15.7) higher albuminuria. BMI was non-linearly associated with albuminuria among men. Among women, a 1-unit increase in android to gynoid ratio was associated with 47.7% lower albuminuria (% change = −47.7 (95% CI −61.4, −29.3). A 5 kg/m2 increase in BMI was associated with 11.0% lower albuminuria (% change = −11.0 (95% CI −15.0, −6.7) and a 3 cm increase in waist circumference was associated with 1.6% (95% CI 0.03, 3.0) higher albuminuria. Among men, a 1-SD increase in abdominal FMI was associated with 2.09-fold higher risk of all-cause mortality (HR 2.09 [95% CI 1.16-3.74]), independent of BMI and waist circumference. Among women, a 1-SD increase in gynoid FMI was associated with 56% decreased risk of all-cause mortality (HR 0.44 [95% CI 0.20-0.88]), independent of BMI and waist circumference.

Conclusion
Adiposity is differently associated with albuminuria and mortality in relatively healthy men and women. Sex-specific patterns of adipose deposition may inform CVD risk stratification.
#444 Novel MRI filtration fraction method to assess glomerular hemodynamics in diabetic kidney disease
Authors: Hockings Paul , Makvandi Kianoush , Unwin Robert John , Hulthe Johannes , Baid-Agrawal Seema 
Published: May 2024

Abstract

Background and Aims
Filtration fraction (FF) is the ratio of the glomerular filtration rate (GFR) to renal plasma flow (RPF) and is therefore an important measure of glomerular hemodynamics. The gold standard method to assess effective RPF is renal clearance of para-aminohippuric acid (PAH) but technical and labour-intensive difficulties limit its application [1]. Quicker and simpler assays of FF are needed, particularly to assess the renal hemodynamic dysfunction (hyper- or hypofiltration) and effects/mode of action of therapeutic interventions in chronic kidney disease (CKD). We assessed a novel magnetic resonance imaging (MRI) technique to measure FF in patients with diabetic kidney disease (DKD) and healthy controls (HC) [2].

Method
This cross-sectional sub-study included 32 DKD subjects with measured GFR (mGFR) ≤ 60 ml/ min/1.73 m2 and stratified into the following GFR stages as per the Kidney Disease Improving Global Outcomes (KDIGO) classification: stage G3a (mGFR 45-59 ml/ min/1.73 m2, n = 3), G3b (mGFR 30-44 ml/ min/1.73 m2, n = 8), G4 (mGFR 15-29 ml/ min/1.73 m2, n = 15), G5 (&lt;15 ml/ min/1.73 m2, n = 6), and 18 age-, gender-matched HC with mGFR ≥ 60 ml/min/1.73 m2. All subjects were 18-79 years old. mGFR was assessed using iohexol clearance. Renal blood flow (RBF) (ml/min) was measured by a 5-minute add-on phase contrast MRI of the renal artery of each kidney and then summed together. RBF was corrected for Body Surface Area. RPF and FF were calculated as below:
${\rm{RPF }} = {\rm{ RBF}} \times \ ( {1\ -{\rm{ Hematocrit}}} )$
${\rm{FF}} = {\rm{mGFR}}/{\rm{RPF}}$

Results
RBF and mGFR were highly correlated (R2 = 0.70, Fig. 1). FF was 17.1% for HC and decreased with increasing degrees of renal impairment (Fig. 2). While the difference between HC and G3a DKD group was not significant, there was highly significant difference between HC and all other DKD groups (p &lt; 0.001). The standard deviation in the G3a group was relatively large with only 3 subjects in this group.

Conclusion
The phase contrast MRI scan can provide a quick and simple measurement of glomerular hemodynamics and therewith further insights into the pathophysiology of DKD and its progression. Given the limitations of the existing method for assessing renal plasma flow, this MRI method can facilitate the inclusion of filtration fraction in DKD clinical trials. Further, the described method could be used to identify hyperfiltration, a compensatory mechanism that can influence results in clinical trials of DKD.
#1415 The association between social isolation and all-cause mortality in patients with chronic kidney disease: a prospective cohort study
Authors: Zeng Xiaoxi , Chunyang Li , Fu Ping 
Published: May 2024

Abstract

Background and Aims
Social isolation has been linked to several diseases and adverse outcomes, such as type 2 diabetes and cardiovascular events. The current study aimed to evaluate the association between social isolation and all-cause mortality in patients with chronic kidney disease (CKD).

Method
From the UK Biobank, a population-based cohort study, we included 16,250 participants that were diagnosed with CKD and with decreased estimated glomerular filtration rate (eGFR &lt;60 ml/min/1.73 m2) at baseline. Participants were classified as socially isolated if they met at least two of the following criteria: (1) living alone; (2) having close contact with others less than once per month; or (3) lacking leisure or social activities involving interpersonal interaction. The outcome was all-cause mortality obtained from death registries. We performed Cox proportional hazards model to estimate the hazard ratio of social isolation for all-cause death in CKD patients.

Results
Over a median follow-up of 13.5 years (interquartile range (IQR): 12.6-14.4 years), 3,498 deaths were recorded. The all-cause mortality was 21.5% in the whole cohort, and 20.2%, 55.3% and 62.4% in CKD stage 3, stage 4 and stage 5 respectively. A total of 11.1% of participants were considered to be socially isolated. The results showed that social isolation was independently associated with increased risk for all-cause mortality when compared with no isolation (HR 1.22, 95% CI 1.11 to 1.34) (Fig. 1), after adjusting for age, sex, Townsend deprivation index, education levels, income levels, BMI, smoking status, diet habit, status of physical activity, consumption of alcohol, hypertension, diabetes, Charlson comorbidity index and CKD stages. Subgroup analyses showed that the significant association was only observed in men (HR 1.28, 95% CI 1.14 to 1.45) and in patients with CKD stage 3 (HR 1.23, 95% CI 1.11 to 1.36), but not in women or in those with more advanced renal failure (Fig. 1).

Conclusion
Social isolation was independently associated with a higher hazard of all-cause mortality in patients with CKD. The association was more significant in men and in patients with mildly decreased renal function.
#2489 The prevalence of chronic kidney disease in different altitude areas: results from the China multi-ethnic cohort study
Authors: Wang Yujiao , CI Linongbu , Zhao Xing , Zeng Xiaoxi 
Published: May 2024

Abstract

Background and Aims
Chronic Kidney Disease (CKD) poses a significant public health challenge with substantial implications for human well-being. In China, there are significant geographical differences in the prevalence of CKD, with the highest prevalence in the southwest region, which may be related to differences in geographical environment and lifestyle. This study aimed to investigate variances in the prevalence of CKD across different altitude areas in southwest China.

Method
In this cross-sectional study, we used data from the China Multi-Ethnic Cohort (CMEC). CMEC was established in five provinces of Southwest China and recruited a total of 99,556 participants between 2018 and 2019. Altitude information for each participant was extracted from the Shuttle Radar Topography Mission (SRTM) (version 4) data based on their residential address. To facilitate analysis, we categorized them into groups of low altitude (0-1499 m) and high altitude (≥1500 m). CKD was defined as an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m2, using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Crude and age-standardized prevalence of CKD was calculated by using R.

Results
A total of 92,163 participants were included in the study, and 39.7% were men. Among the current cohort, 30,904 were high-altitude residents, and 61,259 were from low altitude. Among the participants, 1636 cases of CKD were identified, corresponding to a prevalence of 1.78%. We found, the prevalence of CKD in high altitude group was higher than that in low altitude group, and the former is 2.53%, the latter is 1.40%. The age-standardized prevalence were 1.35% and 2.73% for the low and high altitude groups, respectively, and 1.38% and 2.57% for the sex-standardized groups.

Conclusion
In southwestern China, the prevalence of CKD was higher in the high altitude group than the low altitude group. And after adjusting for age and gender, the prevalence of CKD remained lower in the low-altitude group, and the gap slightly increased.
#2590 Electrolyte abnormalities in HIV patients with CKD
Authors: Lahoti Abhishek , Saha Rajdeb , Attur Ravindra Prabhu , Nagaraju Shankar Prasad , Rangaswamy Dharshan , Rao Indu Ramachandra , Shenoy Srinivas Vinayak , Bhojaraja Mohan V 
Published: May 2024

Abstract

Background and Aims
Individuals with HIV infection and CKD are prone to various water & electrolyte disorders with previous studies showing prevalence of 70%. Many of these disturbances remain clinically silent until they reach an advanced stage, emphasizing the need for a high level of clinical suspicion and awareness, as they contribute to both morbidity and mortality. The prevalence of CKD in HIV patients has been increasing, yet data on electrolyte disturbances is sparse. The study we conducted aims to determine electrolyte imbalances in this population.

Method
Prospective observational single center study for a period of 2 years including HIV seropositive patients &gt;18 years of age who were screened for CKD as per KDIGO definition (eGFR &lt; 60 ml/min/1.73 m2 or significant proteinuria &gt; 300 mg/day for more than 3 months). Demographic features, laboratory investigations for serum electrolytes including Sodium, Potassium, Phosphorous & Calcium levels were done at baseline with follow up at 3, 6 & 12 months.

Results
Out of 695 HIV patients screened, 56 who had CKD were included in our study. The average age was 53.8 ± 11.3 years, including 41 males (73.2%). Median creatinine at baseline was 1 (1.3) mg/dL, & median eGFR was 59 (24.82) ml/min/1.73 m2 (Table 1). Commonest abnormality at baseline was hyponatremia (53.6%), and only 8.9% had severe hyponatremia (&lt;125 mmol/L). Other abnormalities prevalent were hypocalcemia (35.7%) and hypophosphatemia (46.4%). Follow up details are presented in Table 2.

Conclusion
CKD was prevalent in 56 (8%) of our patients. Dyselectrolytemias were seen in 91% of study population. Hyponatremia (89.2%) was the commonest electrolyte imbalance followed by Hypophosphatemia (62.5%) & Hypocalcemia (57.1%). Notably, our study identified a significantly higher incidence of hypocalcemia, and hypophosphatemia compared to other studies.
#2661 High albuminuria in CKD: prevalence and characteristics in a real-world clinical setting
Authors: Svensson Maria K , Bodegard Johan , Thuresson Marcus , Ambery Philip 
Published: May 2024

Abstract

Background and Aims
Chronic kidney disease (CKD) is estimated to affect 1 in 10 adults globally. CKD is associated with increased morbidity, mortality and decreased quality of life, and places a financial burden on the healthcare system. Furthermore, persistently high albuminuria is associated with an especially high risk of renal and cardiovascular complications in patients with CKD. With recent advances in therapeutic approaches for CKD management, both with sodium–glucose co-transporter-2 inhibitors (SGLT2i) and endothelin receptor antagonists as add-on to renin–angiotensin system blockade, it is important to highlight patients with persistent urine albumin-creatinine ratio (UACR; ≥700 mg/g). In patients with UACR &gt;700 mg/g, a novel and highly selective endothelin receptor A antagonist (zibotentan) plus the SGLT2i dapagliflozin significantly reduced albuminuria versus dapagliflozin plus placebo (ZENITH-CKD trial). Hence, it is important to understand the prevalence and characteristics of patients with CKD and high albuminuria in a real-world clinical setting.

Methods
We used a large USA claims database (Optum's de-identified Clinformatics® Data Mart Database [CDM]) to identify patients aged ≥18 years with a CKD diagnosis and a UACR measurement ≥200 mg/g. Patients were indexed on 1st January 2022 and grouped into two UACR groups: ≥700UACR group (≥700 mg/g) and &lt;700UACR group (200–699 mg/g). Continuous variables were calculated as medians with interquartile range (IQR). Baseline characteristics and comorbidities included age, sex, median UACR, median estimated glomerular filtration rate (eGFR) and a history of heart failure.

Results
Of 53,306 patients with CKD and UACR ≥200 mg/g, 22,504 (42%) were in the ≥700UACR group and 30,802 (58%) in the &lt;700UACR group (Fig. 1). Patients were more frequently men in both groups (57%). Median UACR was 1459 mg/g (IQR 977–2473) in the ≥700UACR group and 341 mg/g (IQR 256–474) in the &lt;700UACR group. Patients in the ≥700UACR group were slightly younger (72 vs 74 years), had a higher frequency of heart failure (42% vs 34%) and lower eGFR (37 mL/min/1.73 m2 [IQR 21–55] vs 49 mL/min/1.73 m2 [IQR 34–67]) compared to the &lt;700UACR group.

Conclusions
In this contemporary study of patients with albuminuric CKD, more than 4 out of 10 had UACR levels ≥700 mg/g. These patients were slightly younger, had more severe CKD, and greater prevalence of cardiorenal disease compared to those with UACR 200–699 mg/g. Patients with UACR levels ≥700 mg/g have an urgent need for improved risk management.
#3104 Adequacy of nephroprotective prescription in an elderly diabetic population in a primary care setting
Authors: Queiros Ana Rita , Figueiredo Rafael , Fonseca Clara 
Published: May 2024

Abstract

Background and Aims
The prevalence of chronic kidney disease (CKD) has been increasing and one of the main risk factors is diabetes mellitus (DM). The addition of sodium-glucose cotransporter 2 inhibitors (SGLT2i) to the renin-angiotensin inhibitors (RASi) is recommended in patients with DM and CKD due to the benefits in metabolic control, decrease in proteinuria, and in delaying glomerular filtration decline.

Method
A retrospective cohort was performed and included a sample of patients with diabetes registered and monitored in a primary care facility. A random sample was selected, calculated for an expected prevalence of 40%, error of 4%, and alpha of 0.05. The primary outcome was to assess the adequacy of nephroprotective prescription. Secondary outcomes were to determine the prevalence of CKD (and associated factors) in the sample, and to assess the percentage of patients with correct CKD diagnosis. Demographic and analytical data of patients (glomerular filtration rates and values of albuminuria) were collected from their electronic health records. Statistical analysis was performed using SPSS v28.0. A p-value &lt; 0.05 was considered statistically significant. The study protocol was approved by the Ethics Committee.

Results
338 patients were included, 58% were men, and with a mean age of 71.4 years. 22.2% [95% CI 16.2-29.7%] of patients had the pathology properly coded in the problem list. The prevalence of CKD found was 42.6% [95% CI 37.4-48.0%]. Most patients were in stages G2 (33.3%), G3a (30.6%) and G3b (14.6%). Concerning albuminuria, most were in stage A2 (68.8%). Of the patients with CKD, 77.1% [95% CI 69.6%-83.2%], 60.4% [95% CI 52.3%-68.0%] and 43.1 [95% CI 35.3–51.2%] were medicated with RASi, SGLT2i and both, respectively.

Conclusion
In this primary setting study, the majority of this elderly population was under nephroprotective therapies (RASi and/or SGLT2i). The relatively low coding suggests underdiagnosis. Further optimization of nephroprotective therapies can be made in order to avoid renal failure, as long as the pathology is properly recognized.