bluuebunny/crossref_metadata_2025_split huggingface dataset:
#926 Qatar's Assisted Home Hemodialysis Program (AHHD): a new challenge to reach better outcomes for elderly patients
Authors: Elshirbeny Mostafa Fottoh , Mohamed Mohamed Yahya Abdelhai , Hamad Abdulla , Filali Mossab , Almohanadi Teha , Tolba Hoda , Joseph Shajahan , Chembolu Sandhya , Alkadi Mohamad , Almalki Hassan 
Published: May 2024

Abstract

Background and Aims
There are a growing number of patients supported by dialysis in older age. In Qatar, 58% of haemodialysis patients are above 60 years. The dialysis care of these patients can be challenging due to frailty, chronic health conditions, diminished QOL, and function. One important reason to favor Assisted Home Haemodialysis (AHHD), especially in the older population is the greater flexibility in conducting dialysis sessions. Our aim is to assess the efficacy of AHHD program in comparison to in-center dialysis.

Method
This is retrospective study to evaluate AHHD program in Qatar between July 2021 to December 2023 and compare to in-center haemodialysis in complications, compliance, infectivity and cost.

Results
The AHHD population increased gradually to 122 patients in December 2023. Patients and families reported great satisfaction 98.9% with the AHHD experience as they reported less fatigue post dialysis, eliminated the burden of transportation, and improved quality of life by having HD provided in a home environment. AHHD patients had a significantly lower infection rate (5%) during the COVID-19 outbreak than those receiving in-center dialysis. AHHD freed up crucial slots in hemodialysis centers, increasing the availability of dialysis slots by 10%. Mortality rate was 20.6% while 5 % of patient returned back to in-center dialysis. No major clinical or technical complications had been reported during follow up. The program had resulted in 25% reduction in total cost mainly due to reduction in ambulance use.

Conclusion
AHHD service increases access to hemodialysis care for elderly patients. The AHHD in Qatar showed great success over 30 months and there was a remarkable increase in the number of patients who started the AHHD with better outcomes regard to QOL and infectivity. It was cost-effective and showed an obvious outcome of reducing ambulance transport utilization and improving patients’ QOL and satisfaction.
#494 Analysis of technique failure and reasons for the end of follow-up in a peritoneal dialysis unit
Authors: Fernández Antonio Faúndez , del Pino Estrada Carmen , Quirós María Teresa Fernandez , Mateos María Isabel Rebollo , Pérez Elisa Pereira , Giron Ana María García , Huete María José Espigares 
Published: May 2024

Abstract

Background and Aims
Currently, there are various definitions for peritoneal dialysis technique failure, and several related factors are described. There is controversy regarding whether mortality should be considered a form of technique failure or not, as it involves an event of a different nature. Besides, the exit form peritoneal dialysis (PD) technique can occur due to the transition to hemodialysis (HD), kidney transplantation or the patient's death in general. The aim of this study was to investigate which factors are associated with survival in peritoneal dialysis technique.

Method
A retrospective study was conducted with 111 incident PD patients in the dialysis unit of Hospital Universitario Virgen de las Nieves, in Granada, Spain, between 2015 and 2020. A survival curve was obtained, evaluating the association of different variables with technique failure and the end of follow-up. By identifying mortality as a competitive risk for technique failure, a Fine and Gray competitive risks model was applied.

Results
A total of 111 patients were analyzed, with an annual technique survival of 90%, being it 83% at two years, and 74% at three years. Table 1 reflects the demographic and clinical characteristics of the patients.
The main causes of technique failure were psychosocial causes (19%), peritoneal catheter mechanical issues (12%), ultrafiltration failure (9.52%), and peritonitis (9.52%). The main reasons for the end of follow-up were kidney transplantation (55%), transfer to HD (26%), and death (12.6%).
Among the deceased, 64% were of cardiovascular origin, and 21% were infectious.
Technique failure was more observed in patients over 65 years old, in those with a Charlson index higher than 4 points, with diabetes, a history of cardiovascular disease (CVD) and heart failure (HF), in former smokers, and in diabetic kidney disease.

Conclusion
Technique survival in our center was 90% at one year and 83% at two years, similar to previous Spanish records. The reasons for technique exit were: 55% due to kidney transplantation, 26% due to transfer to hemodialysis, and 19% due to for psychosocial causes. Risk factors related to technique failure were advanced age, Charlson index, diabetes, and a history of cardiovascular disease (CVD) and heart failure (HF).
#3017 Renal-friendly lamivudine dosages are unlikely to contribute to HIV-1 shedding into PD effluents—an open label non-randomized pharmacokinetics study
Authors: Mooko Teboho , Bisiwe Busiswa , Mondleki Enkosi , Morobadi Daniel , Chikobvu Perpetual , Nyaga Martin , Goedhals Dominique , Mofokeng Thabiso , Kemp Gabre , Ndlovu Kwazi 
Published: May 2024

Abstract

Background and Aims
Renally adjusted lamivudine dosages are effective. However, some of the kidney failure patients managed with lamivudine-containing regimens are failing to suppress HIV in peritoneal dialysis (CAPD) effluent. The steady-state lamivudine pharmacokinetics among these patients was evaluated.

Method
This overnight open-label pharmacokinetic study enrolled participants living with HIV and managed with CAPD. Lamivudine levels in blood serum and CAPD effluent samples were quantified using liquid chromatography coupled with a mass spectrometry. Pharmacokinetic measures were obtained through non-compartmental analysis.

Results
Twenty-eight participants were recruited with a median ARV duration of 8 (IQR, 4.5-10.5) years and a CAPD duration of 13.3 (IQR, 3.3-31.9) months. The majority, 78.6% (22/20) of participants received a 50 mg dose and 25% (1/4) had a detectable HIV viral load (HIV-VL) in CAPD, while 10.7% (3/28), and another 10.7% (3/28) received 75 mg and 300 mg dosages, respectively. Among those treated with 75 and 300 mg, 50% (2/4) and 25% (1/4) had detectable HIV-VL in CAPD, respectively. The peritoneal membrane characteristics and CAPD system strengths were variable across the entire study population. Lamivudine exposure was increased in blood serum (50 mg-AUC0-24 hours, 651.3 ng/mL; 75 mg-AUC0-24 hours, 677.84 ng/mL; 300 mg-AUC0-24 hours, 3135.89 ng/mL) compared to CAPD effluents (50 mg-AUC0-24 hours, 384.91 ng/mL; 75 mg-AUC0-24 hours, 383.24 ng/mL; 300 mg-AUC0-24 hours, 2001.60 ng/mL) among the entire study population. The Cmax (50 mg, 41.5 ng/mL; 75 mg, 53.2 ng/mL; 300 mg, 199.1 ng/mL) and Cmin (50 mg, 17.8 ng/mL; 75 mg, 16.4 ng/mL; 300 mg, 76.4 ng/mL) measured in serum were within the therapeutic levels.

Conclusion
Steady-state lamivudine pharmacokinetic measures were variable among the entire study population; however, the total lamivudine exposure was within the therapeutic levels.
#189 Aortic stenosis is an independent risk factor for mortality in end-stage kidney disease patients on the transplant waitlist
Authors: Chen Haoyang , Ho Quan Yao , Lye Yan Nerng , Koh Choong Hou , Keh Yann Shah , Tien Shan-Yeu Carolyn , Liew Ian Tatt , Thangaraju Sobhana , Yeo Khung Keong , Kee Terence 
Published: May 2024

Abstract

Background and Aims
Valvular heart disease (VHD) is a risk factor for adverse outcomes in end-stage kidney disease (ESKD) patients. However, the impact of individual valvular heart lesions on outcomes in patients on the kidney transplant waitlist is unclear. This study aims to analyse the relationship between different VHD and all-cause mortality, and to determine the characteristics of patients on the transplant waitlist stratified by the different types of VHD.

Method
This was a single-center retrospective cohort study of ESKD patients who were referred for kidney transplant waitlist placement from May 2008 to February 2021 and had undergone baseline transthoracic echocardiogram (TTE). Significant VHD was defined as VHD of at least moderate severity based on TTE findings. Patients were followed up until death or kidney transplantation.

Results
Of the 512 patients included, 89 (17.4%) had significant VHD. Mean follow-up duration was 6.6 ± 3.3 years. Significant VHD included 46 (9.0%) tricuspid regurgitation (TR), 44 (8.6%) mitral regurgitation (MR), 11 (2.2%) aortic regurgitation (AR), 7 (1.4%) aortic stenosis (AS) and 2 (0.4%) mitral stenosis (MS). Of the different VHD (Table 1), only AS was associated with all-cause mortality (hazard ratio (HR) 2.41, 95% CI 1.53-3.78, p &lt; 0.0001, Fig. 1) and remained significant after adjusting for age, diabetes mellitus (DM) and other cardiovascular diseases (CVD) (adjusted HR 1.71, 95% CI 1.07-2.73, p = 0.02).
Risk factors associated with AS included older age (odds ratio (OR) 1.12, 95% CI 1.03-1.23, p = 0.01), history of CVD (OR 7.31, 95% CI 1.59-33.6, p = 0.01), longer dialysis vintage (OR 1.01, 95% CI 1.00-1.02, p = 0.02), previous parathyroidectomy (OR 15.1, 95% CI 2.68-85.4, p = 0.002) and higher corrected calcium (OR 43.9, 95% CI 1.56-1240, p = 0.03). Age (adjusted OR 1.12, 95% CI 1.02-1.24, p = 0.02), history of CVD (aOR 7.70, 95% CI 1.50-39.5, p = 0.02) and previous parathyroidectomy (aOR 11.8, 95% CI 1.83-76.7, p = 0.01) remained significant in the multivariable model. No specific risk factors were identified for the other valvular lesions.

Conclusion
AS appears to be an independent risk factor for all-cause mortality in ESKD patients on the transplant waitlist. Differences in mortality and risk factors associated with different types of VHD may suggest differing underlying pathophysiological mechanisms.
#2149 Kidney transplantation outcomes in lupus nephritis
Authors: Vigara Luis Alberto , Amaro José Manuel , Alonso Marta , Singh Arshdeep , Serrano Blanca , Villanego Florentino , Orellana Cristhian , Garcia Teresa , Mazuecos Auxiliadora 
Published: May 2024

Abstract

Background and Aims
Kidney transplantation (KT) is the renal replacement therapy of choice in patients with lupus nephritis (LN) who progress to end-stage renal disease (ESRD). The latest Spanish guidelines recommend the use of hydroxychloroquine after KT in these patients. Our study aims to analyze KT outcomes in patients with LN in our center.

Method
Retrospective cohort study, which included all KT with a diagnosis of LN who underwent KT between April 1982 and November 2023 at Puerta del Mar University Hospital (Spain). Each KT recipient with LN was matched with two controls from the same institution by age, sex and type of donor during the same period. We collected clinical and demographical characteristics, as well as immunosuppressive (IS) therapy after KT. We analyzed the death-censored graft survival and patient survival and compiled the causes of death and graft loss, comparing them with the control group. We documented LN recurrences, KT rejections, and incidence of CMV and BK infection.

Results
In this period, 2055 KTs were performed in our center, of which 39 had a diagnosis of LN (1.9%). Seventy eight controls were selected. The majority of KTs were women (89.7%) with a mean age of 44 years. Induction therapy was used in 85.2% of KT with Thymoglobulin (63%) or Basiliximab (27%). Maintenance IS therapy was based on tacrolimus (93.5%), cyclosporine (6.5%), mycophenolate (100%) and prednisone (100%). Only 4 patients (10.2%), the latest ones, received hydroxychloroquine after KT. Death-censored graft survival at 1 year (87.1% SLE vs. 88.5% Non-SLE), 5 years (74.9% SLE vs. 80.8% Non-SLE), and 10 years (65.6% SLE vs. 69.5% Non-SLE) and patient survival at 1 year (97.1% SLE vs. 100% Non-SLE), 5 years (93.7% SLE vs. 95.3% Non-SLE), and 10 years (93.7% SLE vs. 91.7% Non-SLE) were similar in both groups. No graft was lost because of recurrent LN. No significant differences were found neither in the causes of death nor between the causes of graft loss. The incidence of CMV and BK infection and KT rejection rates were similar in both groups.

Conclusion
KT is an excellent therapeutic alternative in LN with ESRD. Despite the low use of hydroxychloroquine in our series, no recurrence of LN was detected and the KT outcomes were similar to the control group.
#2913 The malignancy in transplant recipients exposed to immunosuppressive therapy prior kidney transplantation
Authors: Bloudickova Silvie Rajnochova , Novotna Anna , Modos Istvan 
Published: May 2024

Abstract

Background and Aims
Post-transplant malignancy has a negative effect on morbidity and mortality of kidney transplant recipients (KTR). Pre-transplant exposure to immunosuppression (PTI) might increase the risk for post-transplant malignancy.

Method
In a single-center, retrospective study of 3874 KTR transplanted between January 2000 and December 2019 with follow-up until 2020 the cancer incidence and outcome were compared between KTR with glomerulonephritis as primary kidney disease treated with PTI (GN group) and KTR with polycystic kidney disease as non-PTI-receiving controls (PKD group).

Results
In both groups, the average time from transplantation to cancer manifestation was similar (p=0.947) as well as from cancer diagnosis to death (p=0.856). Depending on cancer type we observed no difference between time of onset (p=0.351) but in incidence rate for death. The worst survival probability was in lung (0.041 years, 95% confidence interval (CI) [0.014-0.301]) and gastrointestinal (0.350 years, 95% CI [0.022-1.558]) cancer. The risk of cancer increased with age (hazard ratio (HR)=1.05, 95% CI [1.03, 1.07], p&lt;0.001). After adjustment, GN increased the risk for post-transplant cancer (HR=1.72, 95% CI [1.12, 2.63], p=0.013). PTI exposure had adjusted increase of risk of cancer (HR=1.76, 95% CI [1.07, 2.89], p=0.027). Posttransplant malignancy was associated with higher risk of death (HR=8.29, 95% CI [5.46, 12.59], p&lt;0.001) together with patient's age at the time of transplant surgery (HR=1.09, 95% CI [1.06, 1.11], p&lt;0.001) while neither gender (p=0.633) nor PTI (=0.0639). Patient's adjusted probability of remaining cancer-free posttransplant had decreasing tendency over time.

Conclusion
Patients with GN exposed to PTI showed higher adjusted risk of development of post-transplant malignancy.
#3045 Understanding BK polyomavirus: surveillance and clearance in kidney transplant recipients
Authors: González-Rojas Ángela , Marcos Maria Angeles , Juarez Jordi Rovira , Cacho Judit , Leal Agustin , Cucchiari David , Revuelta Ignacio , Pujol Federico Cofan , Cuadrado Elena , Rodríguez Diana , Arana Carolt , Diekmann Fritz 
Published: May 2024

Abstract

Background and Aims
BK virus allograft nephropathy (BKVN) can develop graft loss. The aim of this study was to describe BK viraemia and BKVN related factors, our experience in treatment and the impact in graft survival.

Method
We introduce a retrospective cohort of 78 kidney transplant recipients (KTRs) with BKV viraemia between January 2013 from January 2020 and with follow-up until December 31, 2022 in our center.

Results
Thirty-four (43%) were living donor KTRs, 30 (38.5%) DBD, 11 (14.1%) DCD III, and 2 (4.3%) DCD II. Twenty-seven (34.6%) of recipients were sensitized. Immunosuppressive induction was based on Anti-CD25 in 33 (42.3%), and antilymphocytes antibodies in 44 (56.4%). Basal treatment was TAC+MPA+PDN in 44 (56.4%) and TAC+iMTOR+PDN in 31 (39.7%). Median FK levels were 7.9 (ng/ml) in the first replication. Median BK load at first replication was 3636 [1030-97151]cp/ml. Median time to replication from transplant was 6 months, and from highest load 9 months.
Immunosuppression adjustment after replication was switch to imTOR+FK 25 (32.1%), low FK 17 (21.8%), imTOR 4 (5.1%). Only surveillance was chosen in 27 (35.9%). Others therapies were Leflunomide 4 (5.1%), IVIG 6 (7.7%) or both 3 (3.8%). Photopheresis was used in 2 cases.
Viraemia was cleared in 17/24 (70.8%) of the cases in which conversion to mTOR was performed as an immunosuppression adjustment strategy, versus 9 (56.3%) in which it was decided to lower FK and in 3 (75%) with low MMF. Ten cases in which surveillance was carried out became negative for viremia, possibly because they were patients with a lower replicative load.
BKN occurred in 28/78 (36%) cases, interstitial fibrosis (ci&gt;2) was found in 14/28 (48.27%). Graft rejection after BKN was developed in 11/28 (37.9%). Graft loss occurred in 26/78 (33.3%) of cohort and in 19 (65%)of patients with BKN, reaching a significant value. Viraemia clearance was reached in 41 (60.3%) in mean time of 10 months [4-27]. Mean time since BKVN until graft loss was 22.3 months [10.2-34.2].
Exitus occurred in 7/78 (9%) of replication cases and in 3/28 (10.7%)of BKN patients.
Maximum BK load Exp β; [1-1], p 0.033, first replication load &gt;10.000 (cp/ml) and deceased donor status (Exp β; 6,9 [2.43-19.57] and 2.98 [1.10-8.07] p 0.031, were related to BKVN in bivariate analysis. No significant differences were found between therapy in BKVN and graft loss, maybe due to low BKVN cases.

Conclusion
In our cohort, maximum BK load, first replication load &gt;10,000 (cp/ml), and deceased donor status appear to be related to nephropathy.
No significant differences were found between induction, basal or adjuvant therapy and graft loss.
The current challenge is to stop replication before fibrosis, without increasing the risk of rejection.
#701 Occult hepatitis B infection in kidney transplant recipients and their donors
Authors: Musialik Joanna , Kolonko Aureliusz , Wiecek Andrzej Jan 
Published: May 2024

Abstract

Background and Aims
Occult hepatitis B infection (occult HBV infection—OBI) in kidney transplant recipients (KTRs) poses a potential risk of transforming into an overt process during immunosuppressive therapy. We aimed to evaluate the frequency of OBI occurrence in KTRs population and in the corresponding cohort of kidney donors.

Method
We analyzed 1222 consecutive KTRs transplanted between Jan 2012 and Jun 2023 and their 670 deceased donors. The diagnosis of seropositive OBI was based on the presence of anti-HBc antibodies without detectable HBs antigen. In eligible KTRs with pre-transplant OBI, the status of HBV infection was examined including the HBV-DNA and calculated aspartate aminotransferase to platelet ratio index (APRI) and Fibrosis-4 (FIB-4) indexes to assess the degree of liver fibrosis.

Results
Prior to transplantation, OBI was diagnosed in 178 (14.9%) KTRs [median age 49 (IQR, 38-59) years] and in 72 (10.7%) donors [median age 49 (38-58)]. OBI was significantly more frequent in KTRs than in general population (χ2=6.4, p&lt;0.05). In a long-term follow-up period [median 84 (47-117) months], 5 out of 85 pre-transplant OBI patients (5.9%) presented the negative HBc status, whereas HBV viremia and HBs antigen, as determined using the high-sensitive method, were absent in all subjects. Among 85 pre-transplant OBI subjects, anti-HBs antibodies &gt;10 mIU/ml were present in 84.7% and no liver fibrosis was found by APRI and FIB-4 indexes calculation.

Conclusion
1. OBI is still a significant clinical problem not only in KTRs, but also in the general population, despite the widespread access to preventive vaccinations against HBV. 2. A separate analysis is necessary to evaluate the influence of OBI on kidney graft and liver function in KTRs.
#833 Spectrum of tuberculosis after kidney transplantation: a case-control study in a middle-endemic area
Authors: Cherif Tehir Mohamed , Lylia Trima 
Published: May 2024

Abstract

Background and Aims
Tuberculosis (TB) is the leading cause of infectious-disease death worldwide. Post-transplant TB is a problem in successful long-term outcome of kidney transplantation recipients (KT) and is often associated with high morbidity and mortality. The aim of this study was to assess the clinical features, risk factors, and outcome of TB after kidney transplantation in a middle-prevalence area.

Method
We performed a retrospective analysis of a cohort of adult KT recipients from 2015 to 2020 at the Annaba University Hospital with follow-up until October 2022.

Results
Among 152 KT recipients evaluated, 8 developed TB, the prevalence was 5.26%. Median time to diagnosis was 28.4 months, with 25% of the cases occurring in the first Two year. Pulmonary TB represented 75% of the cases, including disseminated disease. Two patients received isoniazid prophylaxis for latent TB infection and developed active infection. Median duration of treatment was 12 months. However TB was associated with a significant reduction in patient and graft survival (74% vs. 90.2% in 5 years for patient survival, P=0.001; and 58.6% vs. 80.2% in 5 years for graft survival, P&lt;0.001). Death and graft loss occurred in the first 6 months after diagnosis in one-third of the patients, 38.8% of them with disseminated disease. Disseminated disease was significantly associated with mortality compared to local disease (41.8% vs. 9.7%, P=0.035). It should also be pointed out that Algeria is a country with an intermediate level of tuberculosis endemicity.

Conclusion
TB is the archetype of opportunistic infection in KT, with significant impact on patient and graft survival. Our results emphasize the need for systematic screening for LTBI in all patients awaiting transplant. Treatment challenges in KT recipients with TB, drug interactions, drug toxicities and therapeutical adherence must be considered.