bluuebunny/crossref_metadata_2025_split huggingface dataset:
#4566 PREDICTIVE ADMISSION RISK FACTORS, CLINICAL FEATURES AND KIDNEY OUTCOMES IN COVID-19 HOSPITALISED PATIENTS WITH ACUTE KIDNEY INJURY
Authors: Taneska Aleksandra Canevska , Bushljetik Irena Rambabova- , Markovska Zhaklina Shterjova- , Milenkova Mimoza , Vasilova Adrijana Spasovska , Pushevski Vladimir , Trajcheska Lada , Spasovski Goce 
Published: June 2023

Abstract

Background and Aims
Kidneys in COVID-19 patients demonstrate high vulnerability and acute kidney injury (AKI) is recognized as a cause of poor outcome and high mortality, in those requiring hospitalisation. The aim of our study was to assess the predictors and rate of AKI involvement among COVID-19 hospitalised patients at the day of admission, and to see the impact of AKI on patient's prognosis and life expectancy.

Method
We analysed admission data of COVID-19 patients, hospitalized in a tertiary nephrology hospital, during the first pandemic wave. Outcome data were recorded, including the need for renal replacement therapy (RRT) and inpatient mortality at 30 days.

Results
Out of 115 admitted patients included into the final analysis, 62(53.9%) presented with AKI, 21(33.9%) met KDIGO criteria for stage 1, 7(11.3%) for stage 2 and 34(54.8%) for stage 3 of AKI. RRT was required in 26 patients (22.6% of total, 41.9% of all AKI). From the discharged patients, AKI has been resolved in 76% and no need of RRT following hospital discharge was noted. Pre-existing CKD was associated with a 13-fold risk of AKI (OR 13.04; 95% CI:3.85–44.06, p &lt; 0.0001) adjusted for demographics and comorbidities, low albumin (OR 0.895; 95% CI: 0.797–0.970, p  =  0.017), thrombocytopenia (OR 0.994; 95% CI:0.988–0.999, p  =  0.022) and increase of CK over 350UI (OR 3.60; 95% CI:1.184–10.95, p  =  0.024) were all independently associated with a higher risk for AKI. Mortality rates were significantly higher among patients who developed AKI compared to those without (59.6% vs 30.2%, p &lt; 0.003). The low oxygen blood saturation at admission and albumin were presented as powerful independent predictors of mortality (OR 0.937; 95%CI: 0.917 – 0.958, p  =  0.000; OR 0.987; 95%CI: 0.885–0.991, p &lt; 0.024, respectively). The Kaplan-Meier curve illustrated longer survival in patients without AKI compared to patients with AKI (22.01± 1.703 vs 16.69 ± 1.54, log rank p = 0.009).

Conclusion
Renal impairment in COVID-19 patients occurs in significant percentage, and it is a factor of poor prognosis. The severity of the disease itself is emphasized as main contributing mechanism in the occurrence of AKI, and the lower blood saturation at admission is the strongest mortality predictor, outreaching the significance of the AKI itself.
#4577 RENAL SAFETY OF FLOT REGIMEN FOR GASTROESOPHAGEAL CANCER
Authors: Trevisani Francesco , Floris Matteo , Angioi Andrea , Liscia Nicole , Cinque Alessandra , Pani Antonello , Puzzoni Marco , Scartozzi Mario , Dettori Manuela , Mazza Elena , Cascinu Stefano 
Published: June 2023

Abstract

Background and Aims
Currently, peri-operative docetaxel, oxaliplatin, leucovorin, and 5-fluorouracil (FLOT) chemotherapy is the gold standard treatment for patients with locally advanced gastric cancer (LAGC), who undergo peri-operative chemotherapy and surgery. The known nephrotoxicity of both docetaxel and oxaliplatin compounds may limit the its application in CKD population. Nevertheless, limited evidence is available regarding the effects of FLOT regimen on renal function. In our analysis we evaluated the renal safety of FLOT regimen in LAGC population.

Method
Retrospective data on patient with resectable gastric cancer in four tertiary referral hospital between jan/2018 to jan/2022 have been analyzed. Patient have been treated with docetaxel (60 mg/m2), oxaliplatin (85 mg/m2), leucovorin (200 mg/m2), and 5-fluorouracil (2,600 mg/m2 as a 24 hr infusion), all given on day 1 and administered every 2 weeks in 4 administrations before surgery. Serum creatinine, hemoglobin, lymphocytes and CKD-EPI eGFR were detected at baseline and before each cycle. AKI and CKD onset/prevalence were determined according to K-DIGO criteria.

Results
A consecutive cohort of 90 patients was enrolled. At baseline CKD was present in 16 pts (21.9%). Median eGFR was 84,9 ml/min. In terms of eGFR decay and CKD onset during the treatment cycle, the result of ANOVA indicated no significant differences or relationship with FLOT; Wilks’ Lambda = 0.94, p = 0.354 (Table 1 and Figure 1). AKI incidence was very low with one episode of stage 2 AKI (0,7%) between the 2nd and the 4th treatment cycle. New onset anemia between the 1st and the 2nd cycle was the only significant adverse event observed (p = 0.003).

Conclusion
According to our results, the pre-operative FLOT regimen seems to have a negligible impact on renal function with very low rate of renal toxicity suggesting the possibility to extend its use even in patient with advanced CKD.
#4597 REDUCED VO2PEAK IN PATIENTS WITH END-STAGE RENAL DISEASE: UNVEILING THE HIDDEN IMPLICATION OF CEREBRAL AND MUSCULAR HEMODYNAMICS
Authors: Machfer Amal , Tagougui Semah , Hassen Hayfa Hadj , Fekih Nadia , Amor Hassen Ibn Hadj , Bouzid Mohamed Amine , Chtourou Hamdi 
Published: June 2023

Abstract

Background and Aims
Aerobic fitness, as reflected by maximal oxygen (O2) uptake (VO2peak), is impaired in chronic kidney disease (CKD) patients. The mechanisms underlying this impairment remain to be explored. This study aimed to investigate whether CKD influence O2 supply including O2 delivery and release to the brain and active muscles during maximal physical exercise.

Method
Twenty three male undergoing dialysis therapy (HD group) and twenty three healthy males (CTR group) performed exhaustive incremental exercise to determine VO2peak. Throughout the exercise, near-infrared spectroscopy allowed investigation of changes oxyhemoglobin (∆O2Hb), deoxyhemoglobin (∆HHb), and total hemoglobin (∆THb) in the prefrontal cortex and in the vastus lateralis muscle.

Results
VO2peak was significantly lower in HD group compared to CTR. Muscular ∆HHb changes was impaired in HD patients (Figure 1). Increase in ∆THb (i.e., muscle blood volume) was significantly blunted in HD in both muscular and cerebral side (Figure 1 and 2). Also, HD patients had impaired changes in ∆O2Hb during the exercise compared to CTR group (Figure 1 and 2). A positive correlation has been observed between VO2peak and muscular blood colume (∆THb) for both groups.

Conclusion
HD patients displayed lower VO2peak that could be linked, in part, to impaired muscular hemodynamics responses during the exercise. Furthermore, reduced exercise muscle and brain blood volume may warm clinicians of brain endothelial or microcirculation dysfunction in HD population occurring even before overt microangiopathy.
#4609 ASSOCIATION BETWEEN THE SERUM CREATININE-TO-CYSTATIN-C RATIO AND RAPID PROGRESSION OF CHRONIC KIDNEY DISEASE
Authors: Lee Jiwon , Jeong Saeyoung , Han Sang-Woong , Yu MI-Yeon 
Published: June 2023

Abstract

Background and Aims
Chronic Kidney Disease (CKD) is a common and progressive condition that affects a significant portion of the global population. It is a leading cause of death and requires timely evaluation and monitoring to ensure proper management. Cystatin C has been shown to be an effective marker of kidney function and a predictive marker of CKD progression. However, there is limited research evaluating the relationship between the serum creatinine-to-cystatin-C (Cr/cysC) ratio and the rapid progression of CKD. This study aims to investigate the effectiveness of the Cr/cysC ratio in predicting rapid progression of CKD.

Method
A retrospective study was conducted on 1,104 patients with CKD who were treated at the Nephrology Outpatient Clinic of Hanyang University Guri Hospital between December 2020 and November 2022. Eligible patients had at least two simultaneous measurements of serum creatinine and cystatin C, with a minimum interval of 6 months. The definition of rapid progression of CKD was a decrease in creatinine-based estimated glomerular filtration rate (eGFR) of more than 4 mL/min/1.73 m2 over a 1-year period or initiation of renal replacement therapy (RRT). In addition, considering the short duration of the study, initiation of RRT was considered as a secondary outcome only in CKD stages 3b, 4, and 5.

Results
The study population consisted of patients with CKD stages 1 to 5, with a mean age of 69.7 years and 57.7% of the population being male. The mean baseline body mass index was 25.8 kg/ m2, and the mean initial eGFR was 46.7 mL/min/1.73 m2. 38.4% of the total patients showed rapid progression of CKD. The analysis showed that a lower Cr/cysC ratio was significantly associated with an increased risk of rapid progression of CKD (OR: 0.812, 95% CI: 0.761-0.867, p&lt;0.001). After adjusting for age, sex, body mass index, and initial eGFR, a lower Cr/cysC ratio remained a significant risk factor for rapid progression of CKD (OR: 0.760, 95% CI: 0.685-0.844, p&lt;0.001). The initiation of RRT increased with the advancement of CKD stage, with 11 patients with CKD stage 3b, 30 patients with CKD stage 4, and 41 patients with CKD stage 5 initiating dialysis treatment. After adjusting for all variables, the OR was 0.774 (95% CI: 0.667-0.898, p = 0.001), indicating that as the Cr/cysC ratio increased, the progression of dialysis significantly decreased by 22.6%.

Conclusion
In this study, a lower Cr/cysC ratio was significantly associated with an increased risk of rapid progression of CKD and initiation of RRT. The results of this study suggest that monitoring the Cr/cysC ratio may provide valuable information for the management of CKD patients.
#4610 LACK OF EFFICACY AND SAFETY OF ECULIZUMAB FOR TREATMENT OF ANTIBODY-MEDIATED REJECTION FOLLOWING RENAL TRANSPLANTATION
Authors: Park Byung Hwa , Kim Ye Na , Shin Ho Sik , Jung Yeonsoon , Rim Hark 
Published: June 2023

Abstract

Background and Aims
We evaluated the efficacy and safety of eculizumab in comparison with plasmapheresis and intravenous immunoglobulin therapy in renal transplant recipients diagnosed with antibody-mediated rejection (AMR).

Method
This was a multicenter, open-label, prospective, randomized analysis. The patients were randomized by therapy type (eg, eculizumab infusions or standard of care [SOC]: plasmapheresis/intravenous immunoglobulin). The patients (ie, eculizumab arm: 7 patients, SOC arm: 4 patients) were evaluated for the continued presence of donor-specific antibodies (DSAs) and C4d (staining on biopsy), as well as histologic evidence, using repeat renal biopsy after treatment.

Results
The allograft biopsies revealed that eculizumab did not prevent the progression to transplant glomerulopathy. Cases of AMR were diagnosed in the early post-transplantation period in 2 patients (eculizumab arm: 1 patient, SOC arm: 1 patient) and in the late period in 9 patients. Most of the reports show that eculizumab, in combination with other therapeutic measures such as PP and/or IVIG, effectively reversed rejection. However, eculizumab alone could not treat AMR effectively. Only 2 patients in the SOC arm experienced rejection reversal, and no graft losses occurred in either group. After AMR treatment, the DSA titers generally decreased compared to titers taken at the time of AMR diagnosis. There were no serious adverse effects in the eculizumab arm.

Conclusion
Eculizumab alone cannot treat AMR effectively and does not prevent acute AMR from progressing to chronic AMR or transplant glomerulopathy. However, it should be considered as a potential alternative therapy because it may be associated with decreased DSA levels.
#4626 EFFECTS OF HEMODYNAMIC PARAMETERS OF THE BRACHIAL ARTERY ON AVF FLOW
Authors: Gnjidic Nadezda Zec , Milicevic Jovana Kusic , Apostolovic Marija Andjelkovic , Lazic Aleksandar , Lekovski Vladan , Jemcov Tamara 
Published: June 2023

Abstract

Background and Aims
Arteriovenous fistula (AVF) remains the preferred form of vascular access for hemodialysis, although dealing with the high rate of maturation failure. Many factors are found to be influencing the AVF outcome, however the diameter of the blood vessels, both arteries and veins, is recognized as the most important predictor. Aim of this study was to evaluate hemodynamic parameters of the brachial artery (Ab) on the change of volume flow (VF) during AVF maturation.

Method
This single-centre observational study included patients in whom AVF was created between September 2021 and December 2022. All patients underwent pre-operative physical and Color Doppler Ultrasound (CDU) measurements of the radial artery (Ar), brachial artery and cephalic vein (Vc). AVF maturation was evaluated by CDU consecutively 1, 14 and 28 days after AVF creation. As the hemodynamic parameters of the arteries, peak systolic volume (PSV), end-diastolic volume (EDV) and resistance index (RI) were measured.

Results
Study included 33 patients (81.8% male, mean age 64±10). VF was 346.55±126.86, 491.26±183.51, and 608.28±275.10 at day 1, 14 and 28, respectively (p = 0,000). Univariate regression analysis showed PSV (Beta = 0,456; p = 0,008) and EDV (Beta = 0,551; p = 0,001), both measured on Ab at day 1 post-AVF creation, are statistically significant predictors of flow change during 28 days of maturation. In the linear regression model EDV measured on Ab at day 1 post-AVF creation (Beta = 0,683; p = 0,003) and diameter of Ab (Beta = 0,441; p = 0,004) remained significant (Fig. 1 and 2). The vast majority of the study population undergone the first AVF puncture between 15-30th day post-creation (48.5%), while 12 (36.4%) and 5 (15.1%) experienced AVF puncture after more than 30 days and at the 14th day, respectively

Conclusion
Hemodynamic parametres of the brachial artery, precisely peak systolic volume and end-diastolic volume at the first day post-AVF creation, play a significant role in AVF maturation. CDU measurements of those hemodynamic parameters at day 1 may be useful for an early identification of AVF maturation outcomes.
#4663 BLOOD AND URINARY CYTOKINE PROFILES AND CLINICAL OUTCOME IN PRIMARY MEMBRANOUS NEPHROPATHY AND DIABETIC KIDNEY DISEASES
Authors: Rivera Jorge Enrique Rojas , Fernandez-Fernandez Beatriz , Saruta Yuko , Hasegawa Takehiro , Juarez Gema Maria Fernandez , Ortiz Alberto 
Published: June 2023

Abstract

Background and Aims
Primary membranous nephropathy (MN) is an autoimmune, immune complex-mediated primary glomerulopathy causing podocyte injury and nephrotic syndrome. The results of therapy may be suboptimal and biomarkers are needed that predict the need for immune suppression and the response to different immunosuppression regimens. Diabetic kidney disease (DKD) is the most common cause of kidney failure. It is characterized by non-immune podocyte injury that may lead to nephrotic syndrome. We evaluated the circulating and urine cytokine pattern and pathophysiologic difference between both conditions. For MN, we further aimed at identifying the biomarkers of immunosuppressive treatment response.

Method
192 MN data-points from the STARMEN trial and 92 DKD from the biobank of IIS-FJD-UAM were included. We analyzed the blood and urine samples by HISCL (Sysmex Inc. Kobe, Japan), a chemiluminescence immunoassay that can afford a high-throughput multiplex cytokine analysis. Sixteen biomarkers were measured and evaluated for the correlation with the clinical outcome (eGFR, uPCR, 24-hour proteinuria). Also, the biomarkers’ concentration at baseline was compared with the treatment response during 6-9 months and the disease status after treatment until 24 months. The treatments evaluated STARMEN were Tacrolimus-Rituximab (TacRt) and alternating therapy with corticosteroids-cyclophosphamide. Box plot and Mann Whitney U test were used to assess subgroup differences and Spearman's rank correlation to assess correlation between variables.

Results
Median age, baseline eGFR and proteinuria for the MN and DKD cohorts were 53 and 66 years, 74 and 52 ml/min/1.73 m2, and 8.8 and 0.2 g/24h, respectively. Five cytokine markers in blood and 5 in urine from MN and 2 in blood and 2 in urine from DKD showed a significant correlation with proteinuria (Table). Circulating TNFa had been previously related to both MN and DKD pathophysiology and we confirmed its correlation with clinical outcomes in both. CCL20 is one of blood biomarkers correlated with anti-PLA2R (rS = 0.151, p = 0.036) and proteinuria in MN but not DKD. We identified a baseline urinary Protein A whose concentration differed between responders and non-responders to TacRt.

Conclusion
MN and DKD displayed characteristic cytokine patterns. Protein A is related to the progression of chronic inflammation and B cells. Its presence in urine and the differences between TacRt responders and non-responders suggest that high inflammatory progression activities may offset the treatment response. In conclusion, protein A could be the potential prognostic marker of TacRt response. However, additional investigation is needed to confirm and evaluate the possible application to other glomerular diseases.
#4666 ASSOCIATION BETWEEN URINARY ALBUMIN CREATININE RATIO AND CARDIOVASCULAR DISEASE
Authors: Lee Jun Young , Shin Dong Hui , Choi Soo Yeon , Kim Jae Seok , Yang Jae Won , Han Byoung Geun 
Published: June 2023

Abstract

Background and Aims
The association between microalbuminuria and cardiovascular disease (CVD) is accumulating in various patient populations. However, when stratified by sex, the relationship between microalbuminuria and CVD remains unclear.

Method
We obtained data from the 2011–2014 and 2019–2020 Korea National Health and Nutrition Examination Survey (KNHANES). Microalbuminuria was measured based on spot urine albumin-creatinine ratio (UACR). The Framingham risk score (FRS) model was implemented to evaluate the CVD risk. Linear and logistic regression models were used to identify the associations of microalbuminuria status with cardiometabolic predictors and CVD status determined by the FRS score.

Results
Among 19,340 representative Korean participants, the (UACR) in Korean women and men with history of CVD was higher than in those without history of CVD. Among patients without history of CVD, multivariate regression analysis showed that a high UACR was related to older age, lower high-density lipoprotein cholesterol level, higher total cholesterol level, higher systolic blood pressure, higher prevalence of current smoking, higher prevalence of diabetes, and higher anti-hypertensive medication use in both women and men. The UACR showed a positive linear correlation with the Framingham risk score in both women and men.

Conclusion
The presence of microalbuminuria was significantly associated with the cardiometabolic risk factors and the increased risk of CVD evaluated by FRS model in both women and men in a nationally representative sample of Korea.
#4677 EARLY MARKERS OF POSTOPERATIVE ACUTE KIDNEY INJURY
Authors: Cocchini Lorenzo , Filippo Marta De , Lanzani Chiara Livia , Vezzoli Giuseppe , Citterio Lorena , Zagato Laura , Raimondo Davide , Manunta Paolo , Simonini Marco 
Published: June 2023

Abstract

Background and Aims
Acute kidney injury (AKI) is a common clinical condition among patients who undergo cardiac surgery, significantly affecting morbidity and mortality[1]. To date, preoperative biomarkers and solid predictive models for AKI are not yet currently available in clinical practice. Recent studies reported endogenous ouabain (EO), a stress hormone secreted by the adrenal glands, as associated to worse kidney outcomes after cardiac surgery[2]. The aim was to validate the use of EO as biomarker of individual susceptibility for AKI after cardiac surgery and to create a new powerful score for postoperative AKI risk.

Method
1174 patients undergoing elective cardiac surgery were enrolled in the study. Preoperative biological samples were collected and analysed. The primary outcome was AKI development, according to KDIGO 2012 guidelines.

Results
21.6% of patients developed AKI (9% developed severe AKI, stage≥2). AKI confirmed strong correlation to postoperative death: all patients dead within 90 days for postsurgical complication developed AKI and each AKI stage was associated to a 10 times higher mortality risk (p &lt; 0.001). Different preoperative clinical variables were analyzed, identifying five independent risk factors significantly correlated to AKI and severe AKI: age, FE, NYHA class, reoperation and complex surgical intervention (p &lt; 0.001 for all of them). Preoperative EO levels turned out significantly associated to the incidence of AKI (p &lt; 0.001) and clinical complications. Specifically, patients with higher EO levels had greater incidence of AKI (p &lt; 0.001) and worse cardiac and kidney basal function (p = 0.005 and p = 0.003, respectively). Finally, a simple score was developed on the base of those preoperative clinical values significantly associated to AKI (AUC for severe AKI = 0.79, p &lt;0,001). Adding preoperative EO to the model significantly improved the predictive capability (AUC for severe AKI = 0.82, p &lt; 0.001; Δ-AUC +0.0229, p = 0.026).

Conclusion
We confirmed in a large population the role of preoperative plasma level of EO as an important early predictor for post-surgical AKI and we built a powerful clinical model for postoperative AKI risk, exclusively using few simple preoperative clinical factors and a single biohumoral marker.
#4694 AUTOMATIC SEGMENTATION OF GLOMERULAR SUBSTRUCTURES BY DEEP LEARNING
Authors: Dendooven Amélie , Styanidis Aristotelis , Raes Louis , Van Craenenbroeck Amaryllis , Maeyens Matthias , Kotras Konstantinos , De Vos Maarten 
Published: June 2023

Abstract

Background and Aims
Electron microscopy (EM) complements light microscopy (LM) evaluation of the kidney biopsy. Foot process effacement, as assessed by EM, helps in diagnosing podocytopathies. However, human interpretation of EM images is time-intensive and often subjective. In this pilot, we investigate how deep learning techniques can help in adequate segmentation of the glomerular basement membranes (GBM) and podocytes in EM images. The ultimate goal would be to design an automatic tool for reliable and fast assessment of foot process effacement.

Method
Podocytes and glomerular basement membranes (GBM) of 10 patients, 5 with podocyte disease and 5 without glomerular changes (where biopsy showed tubulointerstitial pathology on LM) were annotated with a combination of manual annotation and thresholding for providing ground truth. After data preprocessing including splitting, flipping, rotating and tiling, a modified U-net architecture was applied (‘baseline model’). This baseline model was compared to a combination of U-net and a self-supervised contrastive learning approach with pretraining on 100 additional images (SimCLR framework, ‘fine-tuned model’). Segmentation performance was measured by IoU score.

Results
Segmentation of the glomerular basement membrane was best achieved by the baseline model and resulted in an IoU score of 0.711±0.089 compared to a IoU score of 0.675 ±0.093 in the fine-tuned model Segmentation of the podocytes was most successful in the fine-tuned model, with a IoU score of 0.609±0.118 compared to a IoU score of 0.591 ±0.118 in the baseline model

Conclusion
This study pioneers in segmenting glomerular substructures on EM images by means of a modified U-net architecture. The next step is training and validation in larger datasets. Data annotation remains a challenge. Inclusion of more images is expected to greatly improve the performance of the model.
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