bluuebunny/crossref_metadata_2025_split huggingface dataset:
#1737 Kidney function, kidney function decline, and the risk of abdominal aortic aneurysm: the Stockholm CREAtinine Measurements (SCREAM) project
Authors: Tanaka Shigeru , Bosi Alessandro , Fu Edouard L , Faucon Anne-Laure , Carrero Juan-Jesus 
Published: May 2024

Abstract

Background and Aims
Small, cross-sectional, cohort studies suggest a relationship between low estimated glomerular filtration rate (eGFR) and risk of developing abdominal aortic aneurysm (AAA). We here explored the possible association between eGFR and annual eGFR decline with future risk of AAA in a large community-based sample.

Method
Observational study from the SCREAM project, including participants free from AAA history. We used Cox regression to explore associations between eGFR and the rate of incident AAA and fatal-AAA (followed by death within 30 days). Among those with repeated eGFR tests within a year, we used linear mixed models to explore associations between the annual slope in eGFR and AAA rates.

Results
We included 1 586,543 eligible participants (mean age 47 years, 53% female, median eGFR 97 ml/min/1.73 m2). During median 7.6 years, 5,248 (0.34%) participants experienced AAA, of which 317 were fatal. In multivariable analyses, compared with individuals with eGFR 90 mL/min/1.73 m2, the rates of AAA and fatal-AAA were higher across lower eGFR: for eGFR 30 mL/min/1.73 m2, the HR of AAA was 1.23 (95% CI 1.09-1.39), and for fatal-AAA was 2.59 (1.71-3.90); for eGFR 15 mL/min/1.73 m2, the HR of AAA was 1.58 (1.31-1.90) and for fatal-AAA was 3.92 (2.28-6.70). Total 639 607 participants had repeated eGFR measures within a year, and experienced 3,416 AAA events during median 8.8 years of follow-up. Compared with participants showing a stable eGFR slope (−1 to 1 mL/min/y), the rate of AAA was 10% higher (HR 1.10 [1.00-1.21]) in those with an eGFR decline of 1-3 mL/min/y, and 30% higher (HR 1.30 [1.03-1.65]) in those with an eGFR decline &gt;3 mL/min/y.

Conclusion
Both a single point eGFR and the annual slope of eGFR decline were associated with future risks of AAA. The incidence rate of AAA, and particularly fatal AAA, was higher with greater severity of chronic kidney disease or speed of eGFR decline.
#208 Obesity is associated with incident chronic kidney disease in individuals with normal renal function
Authors: Bae Eun Hui , Kim Minah , Kim Jin , Song Su Hyun , Oh Tae Ryom , Suh Sang Heon , Choi Hong Sang , Kim Chang Seong , MA Seong Kwon , Kim Soo Wan 
Published: May 2024

Abstract

Background and Aims
Obesity is a representative modifiable risk factor for chronic kidney disease (CKD). This study aimed to investigate whether both body mass index (BMI), waist-to-hip ratio (WHR) and changes of WHR during follow-up are risk factors for development of incident CKD.

Method
A total of 2 711 participants from a community-based cohort with normal renal function were prospectively analyzed. Among participants with obesity, we analyzed the change in WHR to evaluate the association of obesity reduction with CKD development.

Results
During a mean follow-up of 11.03 ± 4.22 years, incident CKD occurred in 190 (7.0%) participants. In the fully adjusted multivariable Cox proportional hazard models, the risk of incident CKD increased with higher BMI (hazard ratio, 1.06; 95% confidence interval, 1.00–1.11; p = 0.033) and higher WHR (hazard ratio, 1.33; 95% confidence interval, 1.07–1.66; p = 0.009). In the Kaplan–Meier analysis, cumulative adverse renal events were significantly more common in the maintained obesity group than in the reduced obesity group (p = 0.001).

Conclusion
Both higher BMI and WHR were associated with development of CKD, but the magnitude of the effect of WHR was higher than that of BMI. Moreover, reducing obesity would be beneficial for renal prognosis.
#2356 Renal function in pediatric general population from a hot-spot of chronic kidney disease of unknown etiology: a cross-sectional study in Guatemala
Authors: González Aguilar , Catalina Álvarez Ana , Lou-Meda Randall 
Published: May 2024

Abstract

Background and Aims
Chronic kidney disease of unknown etiology incidence has been exponentially increasing in Central America. Subclinical kidney injury begins early in life and leads to a higher-than-expected prevalence of chronic kidney disease in adolescents and children. The pediatric population has not had a specific approach to the community with this type of kidney disease and very little data is known in Guatemala. We aim to estimate the glomerular filtration rate (eGFR) using two serum biomarkers (creatinine and cystatin C) and applying the Under 25 equation. Inflammatory and urine biomarkers (Urinary Neutrophil Gelatinase-Associated Lipocalin, albumin/creatinine ratio, and urine dipstick) were determined.

Method
During 2019, we performed a Cross-Sectional, population-based screening study in children and adolescents between 7-17 years of age, from local schools in a highly CKDu incident rural community in the Pacific Coast of Guatemala. Children with a diagnosis of kidney disease, hepatic and cardiac failure were excluded in the study. Subjects were chosen randomly from 10 different schools and renal function markers were analyzed by sex and age.

Results
Out of 97 participants of La Democracia, the median age was 11 years and 57% were male. Eighty-seven percent (81/97) of participants had an eGFR between 60 and 90 mL/min/1.73 m2 (Table 1). When comparing eGFR by sex, 63% (51/81) of males and 37% of females had an eGFR between 60 and 90 mL/min/1.73 m2. The difference was statistically significant (p 0.05). When comparing eGFR by age group, the scholar group had an eGFR of 82.7 mL/min/1.73 m2 (SD 7.9), pre-scholars eGFR of 82.2 mL/min/1.73 m2 (SD 6.3), and adolescents of 81.5 (SD 8.1) with no statistically significant difference (p 0.83). Among the twenty-four percent of participants who presented urine dipstick abnormalities, leukocyturia represented 23% (22/97). Twenty-two percent (21/97) of participants had albuminuria more than 0.2 mg/mg and the urinary NGAL/creatinine ratio was higher in females.

Conclusion
#1053 The exposure of phthalates and alternative plasticizers among chronic kidney disease patients during COVID-19 pandemic
Authors: Lim Chun Soo , Lee Jeonghwan , Lee Jung Pyo 
Published: May 2024

Abstract

Background and Aims
Phthalates are widely used in many consumer products as plasticizer and well known to be detrimental to human health. Phthalates mainly disrupt the endocrine system. Recently, phthalate exposures are revealed to be associated with decreased kidney function and increased albuminuria. Risk perception levels and behavioral patterns of CKD patients have been changing with COVID-19 pandemic. However, the effect of these changes on the environmental chemical exposures has not been investigated. We aimed to investigate the environmental chemical phthalates and alternative plasticizer exposure levels during COVID-19 pandemic among CKD patients.

Method
We analyzed the data from a study with a prospective cohort of CKD patient, namely the Study on Kidney disease and EnviromenTal CHemicals (SKETCH, Clinical Trial No. NCT04679168). This cohort included patients with CKD who visited the participating hospitals for the first time between June and October 2020 and followed up to December 2022. Demographic data, behavioral characteristics including hygienic behavior and social distancing, and laboratory data were collected prospectively. Thirty-seven metabolites from 9 light phthalates, 12 heavy phthalates, and 16 alternative plasticizers were measured in urine samples.

Results
The level of light phthalates and alternative plasticizers during the COVID-19 pandemic significantly increased, and heavy phthalates concentrations decreased compared to the pre-pandemic levels. During the 1-year follow-up period, the level of risk perception for infectious disease including COVID-19 significantly decreased. During the 1-yr pandemic period, light phthalate levels decreased for the first 6-month period, and significantly increased for the second 6-month. Heavy phthalates levels were decreased steadily. However, alternative plasticizer levels were maintained during the 1-yr follow-up period. Heavy phthalates levels were significantly higher in the higher risk perception group. However, heavy phthalates levels were not different according to the behavioral patterns. In contrast, the levels of light phthalates and alternative plasticizers were not different according to either behavioral strengthening or risk perception.

Conclusion
COVID-19 pandemic was associated with decreased exposure of heavy phthalates and increased exposure of light phthalates and alternative plasticizers. During the COVID-19 pandemic, levels of light phthalate exposures initially decreased at first 6-month period and gradually increased. This trend of environmental chemicals exposure might be associated with the change of risk perception levels.
#2415 Estimated glomerular filtration rate thresholds associated with poor long-term outcomes in older patients with diabetes
Authors: Lee Kyungho , Jeong Seoin , Kim Jeongyun , Jang Minyoung , Jeon Junseok , Jang Hye Ryoun , Huh Wooseong , Lee Jung Eun 
Published: May 2024

Abstract

Background and Aims
Considering the natural decline of GFR with renal senescence, an age-adjusted estimated glomerular filtration rate (eGFR)-based chronic kidney disease (CKD) definition was recently proposed, which has been supported by that mortality risks start to increase at GFR &lt;45 mL/min/1.73 m2 in older adults (≥65 years). However, the eGFR threshold for mortality and kidney outcomes in older patients with diabetes was less understood. We aimed to evaluate eGFR levels that raise the risk of mortality or end-stage kidney disease (ESKD) in older patients with diabetes.

Method
Older adult patients (≥65 years) with type 2 diabetes who visited our outpatient diabetes center during 2009 were retrospectively identified and followed up until 2017. Patients were categorized into four groups per their CKD-EPI equation-based eGFR: ≥60, 45–59, 30–44, and 15–29 mL/min/1.73 m2. Cox proportional hazard analysis for all-cause mortality and competing-risk analysis for ESKD (with a competing event of pre-ESKD death) were performed.

Results
Among 3,065 patients, 19%, 8%, and 2% of patients had eGFR 45–59, 30–44, and 15–29 mL/min/1.73 m2 at baseline, respectively. After adjusting various clinical covariates, including blood pressure, diabetes duration, urine albumin/creatinine ratio, HbA1c, serum cholesterol levels, and major comorbidities, patients with eGFR 30–44 and 15–29 mL/min/1.73 m2 had 1.51-fold (95% confidence interval [CI] 1.17–1.95, P &lt; 0.001) and 2.66-fold (95% CI 1.87–3.79, P &lt; 0.001) higher risks of mortality, respectively, whereas patients with eGFR 45–59 mL/min/1.73 m2 had a comparable risk (1.18, 95% CI 0.96–1.45, P = 0.127) to those with eGFR ≥60 mL/min/1.73 m2. Substitution hazard ratios for ESKD were 2.29 (95% CI 1.41–3.71, P = 0.001), 5.25 (95% CI 3.27–8.41, P &lt; 0.001), and 16.74 (95% CI 9.73–28.80, P &lt; 0.001) in patients with eGFR 45–59, 30–44, 15–29 mL/min/1.73 m2, respectively. In a subgroup of patients 75 or older (n = 800), patients with eGFR 45–59 mL/min/1.73 m2 exhibited comparable risks for both ESKD and mortality.

Conclusion
Reduced eGFR &lt; 60 mL/min/1.73 m2 predicted an increased risk of ESKD in older patients with diabetes, suggesting that the current traditional eGFR threshold appears feasible. Thus, some high-risk individuals may be missed if age-adapted eGFR criteria with a lower eGFR threshold than 60 mL/min/1.73 m2 are universally applied for older adults ≥65 years.
#1111 The impact of the Covid-19 pandemic on mortality: a study based on the National Health Data System (SNDS)
Authors: Piveteau Juliette , Bayat Sahar , Vigneau Cécile , Couchoud Cécile , Raffray Maxime 
Published: May 2024

Abstract

Background and Aims
The Covid-19 pandemic had a major impact on healthcare systems, challenging the continuity of chronic disease management. Patients with Chronic Kidney Disease (CKD) were identified as particularly at risk. The aim of this study was to measure the impact of the Covid-19 pandemic on their mortality using the French National Health Data System (SNDS).

Method
The SNDS contains the outpatient and inpatient care of all the French population. We applied an algorithm to identify individuals with CKD based on the healthcare consumption available in the SNDS. We identified two cohorts: individuals identified with CKD in 2016 and in 2019. These two cohorts were followed for one year after the year of identification. Patients’ characteristics were extracted from the SNDS and compared between the two cohorts. The event of interest was death documented in the SNDS with death certificates. The follow-up year was divided into periods according to the chronology of the epidemic: pre-epidemic, first lockdown, post-lockdown and second lockdown.

Results
The 2016 and 2019 cohorts included 570,701 and 674,008 individuals respectively. The two cohorts didn't differ in terms of age and sex or comorbidities (median age = 76 years old, 51% female). At 31/12 of the year following identification, 10.90% (n = 62,234) of the 2016 cohort had died, compared with 10.94% (n = 76,756) of the 2019 cohort. Among the 60-year-old and less, mortality in the 2019 cohort was lower than the mortality in the 2016 cohort in all periods of the follow-up year. This remained true among those aged ≥60 years old during the pre-epidemic period (Week 1-Week 10). During the first week of the first lockdown, the instantaneous risk of death for the 2019 cohort reached 5.42 individuals per 1000 in the ≥75-year-old group, compared with 3.12 in the equivalent period for the 2016 cohort (+68%).

Conclusion
All results suggest overall lower mortality in the 2019 cohort of CKD. However, an increase in mortality was observed during strong epidemic periods in the age group of those over 75. These results will be completed with the analyses of the healthcare consumption in the two cohorts describe above.
#1141 Chronic kidney disease in inflammatory bowel disease: systematic review and meta-analysis
Authors: Zadora Ward , Innocenti Tommaso , Verstockt Bram , Meijers Björn 
Published: May 2024

Abstract

Background and Aims
Chronic kidney disease (CKD) is defined by a reduction in kidney function (estimated glomerular filtration rate &lt; 60 mL/min/1.73 m2) and/or damage markers that are present for at least three months, regardless of the underlying aetiology. Case reports and cohort studies suggest that inflammatory bowel disease (IBD is associated with CKD. The extent and magnitude of a potential association between IBD and CKD is currently unknown.

Method
A comprehensive search was conducted in EMBASE, MEDLINE, Web of Science, the Cochrane database, and SCOPUS. Two separate reviewers were involved in the process of article selection and evaluation. In studies where a comparison between an IBD population and a non-IBD control population was available, odds ratios were calculated to quantify the association. To derive an overall estimate of the effect, the Mantel–Haenszel test was employed, utilising a random effect model. This systematic was registered with Prospero.

Results
Fifty-four articles were included in the review (Table 1). Eight articles compared an IBD population with a healthy control population and were included in the meta-analysis, although with high heterogeneity (I2 88%). An increased risk of CKD in the IBD population was observed, with an overall odds ratio of 1.59 (95% CI 1.31-1.93) (Fig. 1). Importantly, this effect was independent of 5-aminosalicylic acid use. Data on other therapies was sparse, except for known nephrotoxic medication like tacrolimus and cyclosporine. Interestingly, several studies reported a decreasing relative risk with increasing age, potentially reflecting an increased baseline risk in this ageing population.

Conclusion
The existing evidence on CKD in IBD was systematically reviewed, including all human epidemiological studies. An increased CKD prevalence in IBD was found; independent of medication. Hence, we suggest regular measurements of kidney function for all patients with IBD, irrespective of the therapeutic regimen. Measurements should include determination of the baseline creatinine, albumin/creatinine ratio and urinary sediment. For patients having a normal baseline function, we would recommend annual follow-up. A more systematic research approach regarding CKD and IBD is warranted
#2478 Multiparametric magnetic resonance imaging predicts decline of kidney function but does not perform better than diffusion-weighted MRI alone
Authors: Huber Aurélie , de Seigneux Sophie , Aslam Ibtisam , De Perrot Thomas , Vallée Jean-Paul , Pruijm Menno , Berchtold Lena 
Published: May 2024

Abstract

Background and Aims
Renal cortical interstitial fibrosis, typically measured by biopsy, is a critical factor for kidney function prognosis. Diffusion-weighted magnetic resonance imaging (DW-MRI) has emerged as a novel promising non-invasive method to assess the degree of fibrosis. We have previously shown that there is a strong correlation between the cortico-medullary apparent diffusion coefficient difference (ΔADC) and histologically assessed fibrosis. We also developed a model based on ΔADC, eGFR and proteinuria that calculates a risk score for future renal function decline. Multiparametric MRI combines DW-MRI with other sequences and can provide synchronized insights into perfusion, diffusion, oxygenation, and tissue characterization (T1 and T2 mappings). Our current research evaluates whether additional multiparametric MRI sequences increase the power of the DW-MRI based model to predict renal function decline.

Method
We used data from 197 patients with either chronic kidney disease (42) or allograft kidneys (155). Each participant underwent a biopsy followed by a multiparametric MRI within the following week. The median follow-up period was 2.2 years, during which laboratory parameters were recorded. The primary endpoint was defined as a rapid decline in kidney function, characterized by a reduction in eGFR of over 30%, or the initiation of dialysis. Prognostic factors for the primary outcome were analyzed using both univariable and multivariable Cox regression models, incorporating MRI parameters (ΔADC, cortical and ΔT1, cortical and ΔT2), eGFR, and proteinuria.

Results
At baseline, mean eGFR was 54.5 ml/min/1.73 m2 (SD 23.8) and mean proteinuria was 0.90 g/24 h (SD 2.4). Rapid decline of renal function occurred in 54 patients after a median time of 1.1 years (interquartile range, 0.9–2.1 years). In univariable survival analysis, cortical T1 measure and cortico-medullar difference ΔT2 have showed the best association to rapid kidney function decline. Compared to our previously established model incorporating ΔADC, eGFR, and proteinuria, adding cortical T1 did not significantly improve the hazard ratio (from 4.62 (95% CI: 1.56–13.67) to 4.36 (95% CI: 1.46–13.02) with cortical T1 inclusion). Harrell's C-index marginally increased with cortical T1, suggesting no significative improvement in prognostic capacity (0.77 versus 0.79 with cortical T1). Additionally, adjusting the regression model for ΔT2 yielded no enhancement in predictive power.

Conclusion
Our results did not demonstrate an enhancement of the prognostic power of the composite score with the inclusion of additional MRI sequences. Consequently, no clear benefit of multiparametric MRI on top of DW-MRI was observed. Additional research is required to investigate this issue more thoroughly.
#2435 Calciphylaxis: patient demographics, risk factors and outcomes in a single regional centre in New Zealand
Authors: Gupta Ankur , Mcclintick Jess , James Rhiannon , Rashed Ahmed 
Published: May 2024

Abstract

Background and Aims
Calciphylaxis, a condition associated with microvascular calcification and subsequent formation of non-healing tender skin lesions, has previously been estimated to affect only approximately 1% of patients with ESRD each year. However, clinicians practicing in a regional renal unit in the North Island of New Zealand have noted an increase in the frequency of clinical diagnoses of this condition over recent years. The aim of this review was to analyze patient demographics and risk factors and attempt to identify any correlation with subsequent outcomes.

Method
A cross sectional retrospective review of dialysis patients from Palmerston North Hospital's Renal Unit who were found to have diagnoses of calciphylaxis, was performed. The following factors were assessed: gender, ethnicity, smoking status, diabetes, obesity, hypertension, dialysis modality, prescription of phosphate binders, vitamin D analogues, and sodium thiosulphate (STS). We included patients with both histologically proven calciphylaxis and clinical diagnosis only. Levels of serum PTH, calcium and phosphate at the time of diagnosis were reviewed, though only PTH levels were included in the final analysis.

Results
A total of nineteen patients were identified having calciphylaxis as a diagnosis in the period studied. Findings were limited due to the small patient cohort size, but of those identified and reviewed some commonalities were found.
Included were 9 NZ European people and 8 NZ Māori people. There were 8 females. One patient was a current smoker at time of diagnosis and five were documented as ex-smokers. Fourteen patients (74%) had type 2 diabetes mellitus and hypertension. Twelve patients (63%) were obese. Eighteen patients (95%) had hyperparathyroidism. Warfarin use was seen in 10 of the patients studied (52%) and twelve (63%) had used phosphate binders. Nine patients (47%) were diagnosed in the period between 2011 and 2021, with the remaining ten (53%) diagnoses occurring in 2022 or 2023. The majority (90%) were treated with STS, however 84% died.
Dialysis modality at time of diagnosis and throughout disease span was also reviewed. Eight patients (42%) used only haemodialysis (HD), six patients (32%) used both modalities and five patients (26%) used only peritoneal dialysis. The majority (63%) of patients were on haemodialysis at time of diagnosis.

Conclusion
Calciphylaxis appears to be increasing dramatically in the single center studied in this review. Positive correlations were identified between high levels of PTH, obesity, hypertension, type 2 diabetes, and use of warfarin. Unfortunately, due to small case numbers, and poor historical documentation, further conclusions could not be drawn easily. A further RCT would be required to investigate the efficacy of STS as a treatment for calciphylaxis.