bluuebunny/crossref_metadata_2025_split huggingface dataset:
#5737 THE ASSOCIATION OF SERUM IRISIN WITH EARLY PATENCY LOSS OF ARTERIOVENOUS FISTULA
Authors: Li Xiejia , Wu Hong , Li Zheng , Yang Lingzhi , Liu Hong 
Published: June 2023

Abstract

Background and Aims
In patients receiving hemodialysis (HD), arteriovenous fistula (AVF) is the preferred form of vascular access owing to its long-term patency and low risk of infection. Early patency loss of AVF (≤1 year) is associated with higher risk of mortality and morbidity. Irisin is thought to play a protective role in the regulation of endothelial function and vascular calcification. However, the relationship between serum irisin level and early patency loss of AVF is unclear.

Method
In 73 end-stage kidney disease (ESKD) patients, including pre-dialysis patients who receive AVF placement for the first time (n = 10), HD patients with early patency loss of AVF (n = 24), HD patients that lose AVF function more than 1 year (n = 39), fasting (&gt;8 hours) serum irisin levels and other biochemical parameters (hemoglobin, serum albumin, calcium, phosphate, intact parathyroid hormone, triglyceride, total cholesterol, D-Dimer, fibrinogen, FGF23, C-reactive protein) were measured before receiving access placement or after AVF thrombosis. All patients had radial-cephalic fistula.

Results
Among 73 patients (median age 58 years, 60.3% male, 31.5% diabetes mellitus (DM)), patients with early patency loss of AVF had significantly higher serum irisin levels, and lower fibrinogen, compared with other two groups. Other characteristics had no significant difference among these three groups (shown in Table 1).

Conclusion
HD patients with early patency loss of AVF had higher serum irisin levels compared with pre-dialysis patients and HD patients whose AVF patency maintained more than 1 year. The increase of irisin may be related to its putative role in compensatory mechanisms against vascular injury, which is then lost with longer dialysis duration and aggravated vascular damage.
#5764 STUDY OF THE INFLUENCE OF PHYSICAL ACTIVITY ON THE FUNCTION OF EXTERNAL RESPIRATION IN PATIENTS WITH CKD IN THE PROCESS OF REHABILITATION
Authors: Saipova Durdona , Ruzmetova Iroda , Egamberdieva Dano 
Published: June 2023

Abstract

Background and Aims
Chronic kidney disease is a global health problem in which patients performance decreases as renal dysfunction progresses. The aim was to study of the function of external respiration in patients with CKD in the dynamics of a 12-week rehabilitation program.

Method
The study included 130 patients with CKD stages 2-3, aged 45 to 65 years, whose average age was 58.7 ± 0.73 years, and the proportion of women in the sample was 47.7%. All patients were examined of urea, serum creatinine, hemoglobin level. To determine exercise tolerance, a cardiorespiratory exercise test and spirogram were performed. Patients of the main group, depending on the initial CRET parameters, were divided into 2 subgroups: 1 subgroup - 67 patients who performed light intensity exercises; 2 subgroups - 33 patients who performed medium-intensity exercises for 12 weeks 3 times a week. The choice of training intensity was made according to the level of individual or subjective perception of the load and was calculated using the approximate heart rate. The control group consisted of patients with CKD stages 2-3 who did not perform physical training.

Results
An analysis of the spinographic parameters of patients with CKD revealed that the FEV1 and FVC indicators are of great importance in assessing the results of rehabilitation measures. There were positive results of 12 weeks of physical training with a more pronounced increase in FEV1. Patients in the light intensity training group achieved 35-45% of maximum heart rate or 40% of peakO2 consumption, and in the moderate intensity training group, 45-55% of maximum heart rate and 50-60% of peakO2 were achieved. The index (FEV1/FVC, in %) showed significant differences both in the initial indicators and in the dynamics.

Conclusion
In patients with pre-dialysis stages of CKD, a significant effect was revealed with the combined use of standard therapy and physical activity of light and moderate intensity, which ensures the preservation of positive dynamics in terms of the degree of increase in diastolic blood pressure at the time of exercise and respiratory parameters (FEV-1 and FVC, p&lt;0.05).
#5768 ASSOCIATION OF HIGH SERUM PHOSPHORUS WITH INCREASED MORTALITY RISK IN PATIENTS ON PERITONEAL DIALYSIS: RESULTS FROM COLOMBIA
Authors: Gomez Rafael , Qureshi Abdul Rashid Tony , LI Xiejia , Stachowska-Pietka Joanna , Debowska Malgorzata , Waniewski Jacek , Lindholm Bengt 
Published: June 2023

Abstract

Background and Aims
Elevated levels of serum phosphorus (PO4) in patients with kidney failure are associated with complications such as cardiovascular (CV) disease, bone disease and impaired wound healing, and increased mortality in hemodialysis patients. A recent PDOPPS study (Lopes et al NDT 2023) showed that high PO4 is associated with increased mortality also in patients undergoing peritoneal dialysis (PD). We explored PO4 levels in a large cohort of patients undergoing chronic PD in Colombia to determine the association of PO4 levels with mortality.

Method
In an observational study of 8113 prevalent PD patients treated with APD (n = 2692) or CAPD (n = 5421), PO4 levels together with demographic and clinical data, including dialysate to plasma ratio of creatinine at 240 min (D/PCr240min at peritoneal equilibration test) and body mass index (BMI), were recorded. During follow-up for a median of 1.99 years, 3169 patients died, and 988 patients underwent kidney transplantation (KT). We divided patients into 5 groups (P1 to P5) according to their baseline PO4 levels (first available measurement) with the following cut-off values for groups: up to 3.5, 4.5, 5.5, 6.5, and over 6.5 mg/dL, respectively. The association of baseline PO4 levels with all-cause and CV mortality risk was analyzed with a competing-risk regression model and KT as a competing risk.

Results
Characteristics of patients classified into groups P1 (16%), P2 (33%), P3 (27%), P4 (13%), and P5 (9%) are presented in Table. P5-patients were in general younger, more often men, less often diabetic (DM), and had lower hemoglobin (Hb) and serum albumin compared to P1-patients. All-cause mortality risk (after adjusting for age, sex, BMI, albumin, Hb, D/PCr240min, residual renal function, DM, and hypertension) was increased in P4- and P5-patients compared with P2-patients, sub-hazard ratio (sHR) of 1.14 (95% Cl: 1.01-1.27) and sHR of 1.27 (95% Cl: 1.10-1.46), respectively. Higher PO4 levels were not associated with significantly increased CV mortality risk for P4-patients, sHR of 1.10 (95% Cl: 0.93-1.31), or for P5-patients, sHR = 1.14 (95% Cl: 0.93-1.39) compared to P2-patients.

Conclusion
Among 8113 PD patients in Colombia, 49% had baseline PO4 &gt;4.5 mg/dL and 22% PO4 &gt; 5.5 mg/dL. Baseline PO4 levels &gt; 5.5 mg/dL (P4 and P5 groups) were associated with increased all-cause mortality. These results are in agreement with the results of the PDOPPS study and suggest that effective management of hyperphosphatemia is important to improve clinical outcomes in PD patients.
#5782 AN EXCEPTIONAL CASE OF A PATIENT WITH TWO RARE GENETIC VARIANTS OF AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE AND ALPORT SYNDROME
Authors: Venda João , Henriques Andreia Dos Santos , Leal Rita , Alves Rui 
Published: June 2023

Abstract

Background
Alport syndrome and autosomal dominant polycystic kidney disease (ADPKD) belong to the most prevalent monogenic causes of chronic kidney disease (CKD) and both progress to end stage renal disease (ESRD). Alport syndrome, is caused by mutations in genes encoding collagen IV protein family. Inheritance might be X-linked, autosomal recessive, autosomal dominant or digenic and several pathogenic variants have been identified. ADPKD is mostly caused by mutations in PKD1and PKD2 genes but recently, the GANAB gene, that encodes the glucosidase IIa subunit, has been identified has a cause of a milder form of ADPKD. We present a case report of a patients with CKD-4, bilateral sensorineural hearing loss and multiple renal cysts where two unrelated and distinct genetic variants of both diseases were concomitantly found.

Case report
A 63-year-old caucasian male with medical history of arterial hypertension, hematuria and bilateral sensorineural hearing loss since his 40 years-old, with cochlear implant surgery 13 years ago was referred to the Nephrology unit due to progressive CKD, currently stage 4. His mother had ESRD of unknown etiology, in peritoneal dialysis since the age of 78 years and he has two healthy sons (aged 16 and 20 years old). Physical examination was irremarkable. Laboratorial workout showed serum creatinine of 2.7 mg/dL, ratio albumin/creatinine of 105mg/g with 11 erythrocytes in urinary sediment. Renal ultrasound showed normal sized kidneys with more than 10 cysts in each kidney, the biggest with 44mm. Genetic testing via next generation sequencing was performed revealing heterozygous mutations in COL4A3 (c.4421T&gt;C p.(Leu1474Pro)), reported in ClinVar, and described in literature as an autosomal dominant variant present in Alport families. A mutation in the GANAB (c.2281A&gt;G p.(Thr761Ala)) gene, classified as variants of unknown significance in was also detected, but this mutations is not reported in gnomAD or ClinVar. The patient was referred for genetic counseling.

Conclusion
We describe a rare case of possible overlap of ADPKD and Alport syndrome. The COL4A3 mutation is described has having a risk ≥ 20% of developing ESRD, but the association of a mild variant of ADPKD might increase exponentially this risk.
#5788 MONOCLONAL GAMMOPATHY OF RENAL SIGNIFICANCE: A SINGLE CENTER EXPERIENCE
Authors: A Kishan , Muske Sravani , Harindranath Haritha , Vankalakunti Mahesha , C G Sreedhara 
Published: June 2023

Abstract

Background and Aims
Monoclonal gammopathy of renal significance is an organ-threatening manifestation of paraproteinemia. It can be secondary to the clonal proliferation of either plasma cells or mature B-lymphocytes. The underlying clonal disorder does not meet the current hematologic criteria for immediate myeloma-specific therapy. With the advent of routine use of light chain detection by immunofluroscence technique in tissue biopsy, more cases of monoclonal gammopathy of renal significance are being diagnosed but there remains a therapeutic uncertainty. Data regarding the prognosis and outcomes of the various clinical manifestations of monoclonal gammopathy of renal significance is limited due to its rarity and under diagnosis. MGRS if left untreated can lead to end-stage renal disease and premature death.

Method
This is a retrospective study conducted at the Institute of Nephro-urology, Bangalore by retrieving the data from the digital medical records of our institute. Demographic and clinical details of the patients diagnosed with monoclonal gammopathy of renal significance from 1 st January 2018 to 31 st October 2022 were collected. Myeloma related light chain cast nephropathy was excluded from the study. Follow-up data were collected usingout patient data base, through telephone, and from the records at the cancer institute where the patient was referred post-diagnosis at our institute. The data collected was entered in excel and analyzed using SPSS software version 27.0.

Results
Fifty eight patients (n = 52) were diagnosed with the disease during the study period. MGRS contributed to 1.27% of all the renal biopsies conducted at our institute during the study period. The mean age of the study population was 52.1 with 95% CI [48.5 to 55.6] with a male: female ratio of 1.36:1 and 36.5% (n = 19) ofstudy cohort aged above 60 years. Among clinical presentations CKD (n = 23) was the main clinical presentation followed by AKI, Nephrotic syndrome, Nephritic syndrome and RPGN as the other presentations. Dialysis requirement was noted in 35% at initial presentation. Most common histiopathological presentation was Amyloidosis (n = 15) followed by Light chain deposition disease LCDD (n = 14), monoclonal non-amyloid deposition disease NADD (n = 6), Light chain proximal tubulopathy LCPT (n = 5), Proliferative glomerulonephritis with monoclonal immunoglobulin deposition disease PGNMIDD (n = 9) and others (n = 3). The patient survival at the time of analysis was 22.7% and death censored renal survival was 80%.

Conclusion
MGRS contributed to 1.27% of all the renal biopsies conducted at our institute during the study period. Because of its variable clincal presentation,one needs high degree of clinical suspicion for early diagnosis. MGRS unlike MGUS carries significant morbidity and mortality.
#5801 EXTENDED LOW DOSE RITUXIMAB REGIMEN FOR THE TREATMENT OF ADULT PATIENTS WITH STEROID-DEPENDENT AND FREQUENTLY RELAPSING MINIMAL CHANGE DISEASE
Authors: Toral Irene Mínguez , Pérez Javier Villacorta , Vallejo Maria García , Iglesias Jorge Sánchez , Fernández Guillermo , Piris Marcos , Cebrián Fernando Caballero , Casillas Esther , Lopes Vanessa , Lucas Milagros Fernandez 
Published: June 2023

Abstract

Background and Aims
Patients with frequently relapsing and steroid-dependent minimal change disease (MCD) imply a therapeutic challenge for nephrologists. The use of steroid sparing agents such as cyclosporine, rituximab and mycophenolate, allows minimization of steroids exposure among these patients. In children and adults, Rituximab has demonstrated safety and efficacy in some studies although there is no established treatment regimen. This study aims to demonstrate that a low dose extended regimen of rituximab is an effective alternative for preventing relapses among these patients.

Method
This is a single-centre retrospective descriptive study of a case series of adult MCD patients from Ramón y Cajal’ Hospital in Madrid, Spain. Since 2019, patients with steroids-dependent or frequently relapsing MCD were treated with a low dose extended protocol of Rituximab as follows; 500 mg of rituximab once remission is achieved with steroid therapy, and four additional doses at month +6, +18 and +30 during the follow-up. Relapse free survival was analyzed after rituximab therapy.

Results
Eight patients with a median age of 42 years (22–70 years) who received at least one dose of intravenous rituximab were included. Four of the patients (50%) had previously received additional immunosuppressive regimens (including cyclophosphamide, chlorambucil cyclosporine, mycophenolate or ACTH). Two of them (25%) had frequent relapses and the remaining six (75%) had steroid-dependent behaviour. After a median of 2 years (IQR, 1,4-3,3) of follow-up, 6 out of 8 (75%) patients stayed under remission, experiencing the remaining two one relapse at one month and at one year, respectively, after the first rituximab dose. Comparing relapses during the two years-period before and after rituximab use, the median relapse rate per patient dropped from 2.8 (IQR, 2-4) to 0.5 (IQR, 0-1; P = 0.001) (Fig. 1). No patient experienced rituximab related side effects nor infections during the study period.

Conclusion
In MCD patients, the administration of rituximab in an extended low-dose regimen as corticosteroid-sparing therapy appears to be safe and effective in most of the patients for preventing relapses. This regimen allows minimization exposure to rituximab as well as disease remission during a longer period of time.
#5805 ACCURACY OF FIXED 24-H AMBULATORY BLOOD PRESSURE RECORDINGS FOR DIAGNOSING HIGH 48-H AMBULATORY BLOOD PRESSURE IN HEMODIALYSIS PATIENTS
Authors: Theodorakopoulou Marieta , Iatridi Foteini , Pella Eva , Karpetas Antonios , Georgiou Areti , Sampani Erasmia , Karkamani Eleni , Tsitouridis Alexandros , Papagianni Aikaterini , Sarafidis Pantelis 
Published: June 2023

Abstract

Background and Aims
Hypertension is highly prevalent in hemodialysis patients. Ambulatory-BP-monitoring (ABPM) during the 44-h interdialytic interval is recommended for hypertension diagnosis and management in these subjects. This study assessed the diagnostic accuracy of fixed 24-h ABPM recordings with 44-h BP in hemodialysis patients.

Method
242 Greek hemodialysis patients that underwent valid 48-h ABPM (Mobil-O-Graph NG device) were included in the analysis. We used 44-h BP used as reference method and tested the accuracy of the following BP metrics: 1st 24-h without HD period (20h-1st), 1st 24-h including HD period (24h-1st) and 2nd 24-h (24h-2nd).

Results
All studied metrics showed strong correlations with 44-h SBP/DBP (20h-1st: r = 0.973/0.978, 24h-1st: r = 0.964/0.972 and 24h-2nd: r = 0.978/0.977, respectively). In Bland-Altman analysis, small between-method differences (−1.70, −1.19 and +1.45 mmHg) with good 95% limits-of-agreement ([−10.83 to 7.43], [−11.12 to 8.74] and [−6.33 to 9.23] mmHg, respectively) for 20h-1st, 24h-1st and 24h-2nd SBP were observed. The sensitivity/specificity and κ-statistic for diagnosing 44-h SBP≥130 mmHg were high for 20h-1st SBP (87.2%/96.0%, κ-statistic = 0.817), 24h-1st SBP (88.7%/96.0%, κ-statistic = 0.833) and 24h-2nd SBP (95.0%/88.1%, κ-statistic = 0.837). Similar observations were made for DBP. In ROC-analyses, all studied BP metrics showed excellent performance with high Area-Under-the-Curve values (20h-1st: 0.983/0.992; 24h-1st: 0.984/0.987 and 24h-2nd: 0.982/0.989 for SBP/DBP respectively).

Conclusion
Fixed 24-h ABPM recordings during either the first or the second day of interdialytic interval have high accuracy and strong agreement with 44-h BP in hemodialysis patients. Thus, ABPM recordings of either the first or the second interdialytic day could be used for hypertension diagnosis and management in these subjects.
#5807 FACTORS ASSOCIATED WITH KALEMIA IN RENAL DISEASE
Authors: Maelys Granal , Fouque Denis , Michel Ducher , Fauvel Jean Pierre 
Published: June 2023

Abstract

Background and Aims
International recommendations promote a strict potassium diet in order to avoid hyperkalemia in chronic kidney disease patients. However, efficiency of such a dietary counseling has never been demonstrated. The objectives of this study were to define the relationship between kalemia, dietary potassium intake estimated by kaliuresis and renal function and to define the factors associated with kalemia in patients using artificial intelligence.

Method
To this extent, data from patients followed in a nephrology unit, included in the UniverSel study and whose kalemia (measured on the day of urine collection; n = 367) were analyzed. The association between kalemia and thirty-four variables concerning the patients' characteristics, their biological work-up, their medications and their answers to the UniverSel dietary self-questionnaire on kalemia were assessed using a Bayesian network.

Results
The patients included had a wide range of estimated glomerular filtration rate, but few had stage 5 chronic kidney disease (CKD). Kalemia was negatively and linearly correlated to estimated glomerular filtration rate (p&lt;0.001) but was not correlated to kaliuresis (p = 0.55). Kaliuresis was not correlated to estimated glomerular filtration rate (p = 0.08). Factors associated with kalemia were analyzed using a Bayesian network. The 5 variables most associated with kalemia were, in descending order, estimated glomerular filtration rate, original nephropathy, age, diabetes, and plasma bicarbonate level. RAS-blockers prescription was also associated to kalemia. Consumption of potassium rich food were poorly associated to kalemia.

Conclusion
Our results do not support a strict control of potassium intake in stage 1 to 4 CKD patients. Our results reinforce the interest of a multidimensional management including personalized therapy and strict correction of metabolic acidosis. Lightning dietary restrictions in potassium would improve the quality of life of patients with CKD who are often multi-pathological and already subject to multiple dietary constraints.
#5808 EFFECTIVENESS OF ORAL FOSFOMYCIN PROPHYLAXIS IN KIDNEY TRANSPLANT RECIPIENTS
Authors: Morales Nancy Daniela Valencia , Pérez-Flores Isabel , López Rómulo Katsu Loayza , de la Higuera Díaz María Ángeles Moreno , Cubillo Beatriz Rodríguez , Romero Natividad Calvo , Fructuoso Ana Sanchez 
Published: June 2023

Abstract

Background and Aims
Urinary tract infections (UTIs) are one of the most common infectious complications in kidney transplant recipients (KTR), which are of great importance due to their high morbidity and recurrent nature. Our main objective was to evaluate the effectiveness of oral fosfomycin prophylaxis in a group of high-risk patients with recurrent/relapsing urinary tract infections.

Method
Retrospective study of a cohort of 60 KTR with frequent UTIs who had been prescribed daily fosfomycin calcium or fosfomycin trometamol every 7-10 days for prophylactic purposes. Demographic, clinical, analytical and microbiological data were collected during a year before and after prophylaxis.

Results
The median age was 61.8 (55.6-71.2) years, 68.3% were men, with 7.4 (2.8-13.6) years since the transplant. The main etiologies of the underlying renal disease were: autosomal dominant polycystic kidney disease 20%, chronic glomerulonephritis 18.3%, chronic tubulointerstitial nephropathy 10%, and diabetic kidney disease 10%, In 51.7% there was chronic pathology of the urinary tract (mainly vesico-prostatic disease, 24.8% and vesico-ureteral reflux, 15%), with a history of urological surgery in 23.3%. Up to 20% of the KTR had some type of endourological device (permanent/intermittent bladder catheter, percutaneous nephrostomy, Bricker, etc). The most frequently isolated germs were: E. coli and K. pneumoniae, 35.2 and 13.6% pre-prophylaxis and 28.3 and 22.6%, post-prophylaxis, respectively. The median number of UTI pre vs post-prophylaxis was 2 (1-4.75) vs. 1 (0.5-1.6) episode/patient/year (p&lt;0.001), with a reduction in UTI episodes in 69% of patients. Admissions were also reduced, going from 35% in the pre-prophylaxis year to 10% post (p = 0.001). After prophylaxis, the percentage of resistance to fosfomycin increased from 26 to 54%. and a greater number of multi-resistant germs were isolated, 17.7 pre- vs 35% post-. The renal function remained stable during follow-up [CKD-EPI pre- 47.2(20.8) vs 47.2(21.2) ml/min post-].

Conclusion
Oral fosfomycin prophylaxis may be useful in KTR despite the underlying urological pathology, managing to reduce UTI episodes and the need for admission for this reason.