bluuebunny/crossref_metadata_2025_split huggingface dataset:
#5556 QUALITY OF LIFE IN FAMILY CAREGIVERS OF END STAGE KIDNEY DISEASE PATIENTS: A PROSPECTIVE STUDY
Authors: Vovlianou Stavroula , Koutlas Vasileios , Papoulidou Fani , Tsigaras George , Milionis Haralampos , Skapinakis Petros , Ntounousi Evangelia 
Published: June 2023

Abstract

Background and Aims
Family caregivers of patients with end stage kidney disease (ESKD) face the challenge of demanding patients’ care, in addition to their own daily tasks, which affect their well-being and quality of life (QoL). The aim of this prospective study was to assess and describe the QoL of family caregivers of ESKD patients at the beginning of kidney replacement therapy (KRT) and one year later.

Method
Sixty - two ESKD patients and their caregivers were recruited. Caregivers’ QoL was assessed with the Short Form-36 questionnaire and EuroQol-5Dimension-3Level. QoL of caregivers and patients was measured twice, three months after initiation of KTR (T0) (53 patients started hemodialysis and 9 peritoneal dialysis) and after the first 12 months of KTR(T1), in order to investigate the possible changes of QoL during this crucial period.

Results
The mean value (Table 1) of caregivers’ physical component summary (PCS) subscale was found to change significantly during study period (T0: M = 54.21, SD = 8.06 vs T1: M = 51.58, SD = 10.46, (t(61) = 2.02, p = .048). Caregivers presented a statistically significant decrease (p &lt;.05) in physical health after one year of KRT. Likewise, the EQ-5D Index and the EQ-5D visual analogue scale (VAS) showed a statistically significant decline (p = .046 and p&lt;.001 respectively). Finally, correlation of means of QoL dimensions between ESKD patients and their caregivers did not yield statistical significance in the particular longitudinal study.

Conclusion
The results provide evidence that the overall caregivers’ QoL scores deteriorated over the one-year period of KTR. Further studies of larger sizes and with a longer duration will probably better define the QoL variations of ESKD patients’ caregivers. Both groups may be benefit from an educational program before patients initiate KTR.
#5577 PERITONEAL DIALYSIS COMPLICATIONS IN PEDIATRICS: A TUNISION EXPERIENCE
Authors: Abdellatif Abir , Jellouli Manel , Bousetta Abir , Sayari Taha , Gargah Tahar 
Published: June 2023

Abstract

Background and Aims
Peritoneal dialysis (PD) is the preferred chronic dialysis modality for children suffring from chronic end-stage renal failure (CKD). But, it presents different infectious and non-infectious complications, causes of important morbidity and mortality. In this study, we aimed to describe the deferent infectious and mecanical complications observed in children on PD and to investigate the risk factors for the occurrence of different infectious and mechanical complications.

Method
In this study, we retrospectively collected the records of 99 patients who were treated with PD within the last eleven years (2010-2020) in the department of pediatrics of the University Hospital Charles Nicolle of Tunis. Analysis examining possible risque factors were performed using parametric and non-parametric tests and multivariate logistic regression in multivariate analysis.

Results
Ninety-nine children were on PD. All our patients were on automated PD. The sex ratio was 1.02. The overall duration of the PD was 290 years with an average of 2.93 years± 1.92 years. The average age at the beginning of PD was 9.75± 4.67 years. Sixty-nine patients had infectious complications, of which 65 patients had 120 episodes of peritonitis (IP) with a rate of 0.41 episodes per patient-year, 10 patients had exit-site infection and 3 patients had a tunnel infection. Mechanical complications were noted in 63 patients with a catheter revision rate of 1 per 38 patient-months. We noted an hernia in six patients, hemoperitoneum in seven patients, pancreatitis in three patients and no cases of hydrothorax. Analysis of PD complications risk revealed the following factors : poor adherence to treatment (p = 0.018 and p = 0.011) and weight less than 15 Kg (p = 0.041, p = 0.02) for infectious complications and IP respectively, comorbidity (p = 0.005) for mechanical complications, comorbidity (p = 0.008) and history of PI (p = 0.46) for catheter revision.

Conclusion
Ongoing educational programs for doctors, nurses and caregivers are needed to limit infectious complications. A collaboration between the pediatric nephrologist and the pediatric surgeon is recommended to improve catheter insertion techniques and prevent mechanical complications.
#5590 PRE-DIALYSIS TRAJECTORIES OF ESTIMATED GFR AND CONCURRENT TRENDS OF CKD-RELEVANT BIOMARKERS
Authors: Tsao Hsiao-Mei , Lai Tai-Shuan , Lin Shuei-Liong , Chou Yu-Hsiang , Chen Yung-Ming 
Published: June 2023

Abstract

Background and Aims
The glomerular filtration rate (GFR) decline varies in patients with advanced chronic kidney disease (CKD), and the concurrent changes in CKD-related biomarkers are unclear.

Method
We adopted a group-based trajectory model to categorize CKD patients by their pre-dialysis eGFR trajectory and then analyzed the concurrent changing trends of CKD-relevant biomarkers, including urine protein-creatinine ratio (UPCR), albumin, and uric acid.

Results
Using longitudinal data from two years before dialysis initiation, 1,758 CKD patients were included. We identified three distinct eGFR trajectories: persistently low eGFR levels, progressive loss of eGFR, and accelerated loss of eGFR. Eight of the 15 biomarkers showed distinct patterns among the trajectory groups. Compared to the group with persistently low eGFR values, the other two groups were associated with a more rapid increase in the serum urea level and UPCR, especially in the year before dialysis initiation, and a more rapid decline in hemoglobin and platelet counts. Rapid eGFR decline was associated with lower levels of albumin and potassium, and higher levels of MCHC and WBC. The albumin level in the group with an accelerated loss of eGFR was below the normal range. Overall, there was a total of 691 (39.3%) deaths observed during the follow-up period. In the 2-year and 5-year follow-up, 302 (17.2%) and 549 (31.2%) deaths were observed, respectively. The corresponding median follow-up times were 2 years (IQR:1.6 – 2.0) and 3.3 years (IQR:1.6 –5.0). Kaplan–Meier survival plots showed that the eGFR trajectory was significantly associated with the risk of mortality two years and five years after dialysis, with the log-rank test P = .0057 and P = .0001, respectively

Conclusion
The changes in CKD biomarkers were delineated with disease progression. The results provide information to clinicians and clues to elucidate the mechanism of CKD progression.
#5591 CIRCULATING ACTIVIN A REFLECTS THE SEVERITY OF RENAL FIBROSIS IN BIOPSY-PROVEN KIDNEY DISEASES—THE TAIPEI RENAL BIOPSY COHORT STUDY
Authors: Tsai Ming-Tsun , Ou Shuo-Ming , LI Szu-Yuan 
Published: June 2023

Abstract

Background and Aims
Despite considerable evidence indicating circulating activin A as a novel renal biomarker, its performance for predicting the severity of renal fibrosis and major adverse renal events (MARE) has not yet been extensively studied.

Method
We sought to assess the relationship between plasma activin A, renal fibrosis severity, and incidence of MARE in 339 patients undergoing clinically indicated native renal biopsies. To determine the primary source of circulating activin A, RNA-sequencing and histological analyses were performed on kidney biopsy specimens from patients with chronic kidney disease (CKD). We also conducted in vitro experiments to investigate whether inhibiting endogenous activin A could attenuate TGF-β-mediated activation of cultured fibroblasts.

Results
The median baseline eGFR and proteinuria were 36 mL/min/1.73 m2 and 2.9 mg/mg creatinine, respectively. After multivariable adjustment, elevated plasma activin A was associated with the extent of renal fibrosis. Histological analysis showed increased activin A expression in kidney tissues from patients with CKD, mainly in interstitial myofibroblasts. RNA-sequencing of tubulointerstitial tissue from human biopsy samples also revealed a direct correlation between tissue activin A mRNA expression and plasma activin A levels. During a median follow-up of 22 months, 113 participants suffered MARE. Cox proportional hazards analysis revealed that plasma activin A was associated with higher risk of renal events; however, the association became insignificant after correcting for confounders. Results from in vitro studies demonstrated that knocking down activin A expression could prevent TGF-β-induced activation of NRK49F fibroblasts.

Conclusion
The findings of this study support activin A as a potential diagnostic and therapeutic target in fibrotic kidney disease.
#5608 THE INFLUENCE OF AMBULATORY BP ON THE ASSOCIATIONS OF SEX WITH CARDIOVASCULAR EVENTS AND MORTALITY IN DIALYSIS PATIENTS: A PROSPECTIVE COHORT STUDY
Authors: Sarafidis Pantelis , Theodorakopoulou Marieta , Iatridi Foteini , Georgiou Areti , Karagiannidis Artemios , Karkamani Eleni , Tsitouridis Alexandros , Faitatzidou Danai , Papagianni Aikaterini 
Published: June 2023

Abstract

Background and Aims
Male patients with pre-dialysis CKD have worse ambulatory BP control than females and this is associated with higher mortality risk. Male hemodialysis patients have higher ambulatory BP levels compared to females. The aim of this study was to investigate the influence of ambulatory BP on the associations of sex with cardiovascular events and mortality in hemodialysis individuals.

Method
129 male and 91 female hemodialysis patients with valid 48-hour ABPM were followed prospectively for 53.4±31.1 months. The primary endpoint was cardiovascular mortality; the secondary endpoint was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, resuscitation after cardiac arrest, hospitalization for heart failure, coronary or peripheral revascularization procedure.

Results
Cumulative-freedom from the primary endpoint was significantly lower for women (logrank-p = 0.032), while cumulative-freedom from the secondary endpoint did not differ significantly between the two groups (logrank-p = 0.644). The crude risk for cardiovascular mortality was significantly higher for women (HR = 1.613, 95% CI [1.037, 2.509]). The crude risk for the combined cardiovascular endpoint was not different between the two genders (HR = 0.918, 95% CI [0.638, 1.320]). After adjusting for other risk factors (age, diabetes, dialysis vintage, coronary disease) no significant differences in the risk for both the primary and the secondary endpoint were observed between women and men (primary: HR = 1.464 (95% CI [0.929, 2.307]), secondary: 0.866 (95% CI [0.596, 1.260])). After additional adjustment for 44-hour ambulatory BP the above relationships did not alter (primary: HR = 1.498, 95% CI [0.947, 2.368]), secondary: (HR = 0.911, 95%CI [0.625, 1.327])).

Conclusion
In contrast to patients with pre-dialysis CKD, ambulatory BP does not appear to significantly influence the relationship between gender and adverse cardiovascular outcomes in hemodialysis patients.
#5619 THE ASSOCIATION BETWEEN THE LEVELS OF URIC ACID AND RENAL OUTCOMES IN EARLY CKD PATIENTS: A MULTI-CENTER REAL-WORLD DATA ANALYSIS
Authors: Luo Yuxin , Song Qirong , Fu Sha , Liu Qin , Chen Xiaohong , Nie Sheng , Chen Junzhe , Tang Ying 
Published: June 2023

Abstract

Background and Aims
It is well known that serum uric acid (SUA) plays an important role both in patients with and without chronic kidney disease (CKD). However, the effect of SUA on renal outcomes of CKD patients, especially with asymptomatic hyperuricemia, remains controversial. Therefore, our study explores the relationship between SUA and adverse events in early CKD (stage 1-3) patients in a real-world setting.

Method
This multi-center real-world study analyzed the data from Chinese Renal Data System (CRDS). Eligible CKD patients (eGFR) (estimated glomerular filtration rate≥30 mL/min/1.73 m2) were enrolled. The primary endpoint is the decline of renal function defined as at least 40% decrease in eGFR. The secondary endpoints include onset of composite cardiovascular events and all-cause mortality. A multivariable cox regression model were used and the associations between levels of mean SUA and all endpoints were evaluated on a continuous scale with restricted cubic spline (RCS) curves based on Cox proportional hazards models. Kaplan-Meier survival curves were used to illustrate the ability of SUA to predict the end points.

Results
25,202 adults (mean [SD] age, 52.59 [17.90] years, 8,212 male [46.1%], 9,604 female [53.9%]) were included in this study. During a median follow-up period of 2.61 years, 3,451 (15.9%) at least 40% decreased in eGFR. After adjustment for confounders, higher uric acid concentrations were independently associated with the higher risk for the decline of renal function [Per SD increment adjusted hazard ratio [aHR]: 1.41, 95%CI 1.36-1.47]; composite cardiovascular events [Per SD increment [aHR]: 1.04, 95%CI 1.01-1.07], all-cause mortality [Per SD increment [aHR]:1.32, 95%CI 1.14-1.54]. RCS curves showed that HRs for renal function progression, all-cause mortality and composite cardiovascular events increased significantly with the increase of SUA concentration in CKD patients. Results were consistent in stratified analyses. The KM curves suggested that patients with asymptomatic hyperuricemia had a substantially worse survival rate for renal function.

Conclusion
SUA is an independent risk factor for the decline of renal function, cardiovascular events and all-cause mortality in early CKD patients (stage 1-3). Treatment of asymptomatic hyperuricemia may be a potential avenue to improve outcomes in CKD patients.
#5624 REMDESIVIR IN COVID-19 PATIENTS WITH KIDNEY DISEASE: A STUDY ON THE RENAL FUNCTION AND OUTCOMES
Authors: Lagura Crystal Faye 
Published: June 2023

Abstract

Background and Aims
The COVID-19 pandemic has created a global catastrophe with mortality rates higher in older adults and people with chronic comorbid conditions In which patients with chronic kidney disease were the most vulnerable population. Remdisivir, an antiviral nucleotide, showed promising results in individuals with COVID-19 infection. However, despite its shortened time to recovery in adults hospitalized with COVID 19, individuals with ESRD and high stage AKI were not included in clinical trials, thus when granted an emergency use authorization it was recommended to avoid use in patients with eGFR &lt;30mL/min “unless benefit outweighs the risk”. In this study, in the absence of Molnupiravir, the current drug of choice, we wished to study its safety by determining its effects on renal status of individuals with known kidney dysfunction. The study aims to determine the effect of Remdesivir on renal function and outcomes among COVID19 patients with kidney disease.

Method
The study utilized a retrospective research design. The study included patients who were 19 years old and above, with RT-PCR confirmed COVID19 infection treated with Remdesivir and who were confirmed to have kidney disease.

Results
106 patients were included; the mean age was 62.25±13.96 years old, more than half of the population were males. The majority of the population had AKI while the rest had CKD and 25% underwent renal replacement therapy. Most of them were classified with severe and critical COVID infection (Table 1). To determine effects on renal function laboratory parameters were determined at baseline and after completion of treatment. There was an overall significant improvement in egfr (&lt;0.01), albuminuria (0.013) and in acid-base balance (0.003) and odds ratio showed that none of the demographic, clinical and laboratory profile significantly in-creased the chance of death in terms of overall clinical outcome (Table 2). To determine risk factors of patients that may contribute to patients outcome, odds ratio showed that none of the demographic, clinical and laboratory profile significantly increased the chance of death among patients who took Remdesivir. (Table 3). In terms of overall clinical outcome, this study had a mortality rate of 4.9% (Table 4).

Conclusion
Use of Remdesivir in patients with AKI, CKD and ESRD on dialysis was not associated with further renal function deterioration. Contrary to concerns there was rather an overall significant improvement in EGFR, degree of albuminuria and acid-base balance after treatment regardless of their disease severity and its use in patients on hemodialysis have not shown any detrimental impact on mortality.
#5642 ASSOCIATION BETWEEN FIBROBLAST GROWTH FACTOR 23 AND TRABECULAR BONE SCORE IN EARLY STAGES OF CKD
Authors: Kužmová Zuzana , Kužma Martin , Gazova Andrea , Killinger Zdenko , Jackuliak Peter , Kyselovič Ján , Payer Juraj 
Published: June 2023

Abstract

Background and Aims
Newer markers of kidney damage and mineral and bone changes in chronic kidney disease (CKD) are needed. The fracture risk increases with worsening of CKD with highest incidence in later stages. Thus methods for early bone status assessment and laboratory marker of kidney function is needed. Aim of the study was to evaluate bone mineral density (BMD) and trabecular bone score (TBS) – a novel surrogate of trabecular bone microstructure, in relationship with newer laboratory markers of CKD, such as fibroblast growth factor 23 (FGF23) and klotho.

Method
A cross-sectional study during July 2018-July2019 was conducted. Plasma levels of soluble klotho and FGF23 were determined by ELISA (enzyme-linked immuno -assay). All patients undergone bone mineral density (BMD) and trabecular bone scores (TBS) measurement. Patients were divided into 2 groups as follows: A - patients in stages G1 - G3; B - patients in stages G4 – 5 accoridng to KDIGO.

Results
A total of 74 CKD patients (42 males and 32 females; mean age 68.8 years) were included in the study. Greater FGF23 levels in group B(N = 15) in comparison to group A (N = 59)(p = .001) were observed. FGF23 was associated with glomerular filtration (GF)(R = -0.43; p = 0.003), with greater levels of FGF23 at GF less than 0.8 ml/s. Significant difference in TBS within first 3 CKD stages (mean TBS in G1 = 1.374 vs. G2 = 1.304 vs. G3a = 1.24; p = 0.03) and negative correlation of FGF23 and TBS (R = -0.33; p = 0.05) and a positive correlation between klotho and TBS (R = 0.419; p = 0.04) was observed.

Conclusion
This study confirmed that FGF23 is associated with TBS. However, TBS reflects kidney function decline only in first 3 stages of CKD. Thus, FGF23 together with TBS are promising markers of early trabecular bone impairment in CKD.
#5655 NEUTROPHIL TO LYMPHOCYTE RATIO, TOTAL IRON BINDING CAPACITY, SERUM ALBUMIN AND SYSTEMIC INFLAMMATION IN CHILDREN WITH CHRONIC KIDNEY DISEASE
Authors: Karava Vasiliki , Kondou Antonia , Dotis John , Taparkou Anna , Farmaki Evangelia , Kollios Konstantinos , Printza Nikoleta 
Published: June 2023

Abstract

Background and Aims
Chronic kidney disease (CKD) is widely linked to chronic inflammation, with a higher incidence in the advanced stages of the disease. Recognition of systemic inflammation may be useful for prompt diagnosis and management of various CKD related disorders and may open the door towards the development and application of anti-inflammatory strategy treatments. This case-control and cross-sectional study investigates the association of neutrophil to lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), total iron binding capacity (TIBC) and serum albumin with high serum interleukin-6 (IL-6) in children with chronic kidney disease (CKD).

Method
NLR and PLR were measured in 53 patients (median age: 12.9 years) and 25 healthy controls, stratified by age and sex. Lipid and iron profile, glucose tolerance parameters, serum albumin, uric acid and IL-6 were measured in the patient group.

Results
Compared to controls, NLR and PLR were higher in patients (p = 0.004 and p = 0.032 respectively), and particularly in those with CKD on dialysis (CKD 5D) (17 patients) (p&lt;0.001 and p = 0.001). LnIL-6 was correlated to NLR (rs = 0.344, p = 0.014), albumin (rs = -0.350, p = 0.011) and TIBC (rs = -0.345, p = 0.012) after adjustment for CKD stage, while the correlation between lnIL-6 and PLR was not significant (rs = 0.206, p = 0.151). Patients with NLR ≥1.7, TIBC ≤300 μg/dl and albumin ≤3.8 g/dl presented a higher risk for increased IL-6 (15 patients) regardless CKD stage (OR 5.499, 95% CI 1.272-22.017, p = 0.016, OR 9.818, 95% CI 2.311-41.706, p = 0.002 and OR 7.543, 95% CI 1.891-30.083, p = 0.004). NLR ≥1.7 and TIBC≤ 300 μg/dl predicted high IL-6 with the highest sensitivity (73.3%), while NLR ≥1.7, TIBC≤ 300 μg/dl and serum albumin ≤ 3.8 g/dl with the highest specificity (97.4%).

Conclusion
Both NLR and PLR increase in pediatric CKD, especially in CKD 5D. NLR rather than PLR may serve as diagnostic marker of systemic inflammation in pediatric CKD, along with TIBC and serum albumin.
#5673 ESTIMATING AND VALIDATING MEASURES OF CKD PREVALENCE AND INCIDENCE USING OBSERVATIONAL AND CLAIMS DATA IN PERSONS AGED 70+
Authors: Bothe Tim , Fietz Anne-Katrin , Pöhlmann Anna , Schaeffner Elke , Mielke Nina , Ebert Natalie 
Published: June 2023

Abstract

Background and Aims
Estimating prevalence and incidence of chronic kidney disease (CKD) based on claims data often underlies bias and limitations due to uncertainty of diagnostic validity. We investigated CKD prevalence and incidence over time using data from a community-dwelling cohort of individuals aged 70+ linked to individual claims data. We assessed the diagnostic validity of the claims-based compared with the eGFR-based CKD definition.

Method
We assessed CKD prevalence and incidence in two data sources: 1) eGFR values of participants aged 70+ (n = 2,069) of the Berlin Initiative Study (BIS), including five biennial study visits from 2009-2019, and 2) claims data of BIS participants matched on person-level. Using eGFR, we defined CKD prevalence as eGFR &lt;60 ml/min/1.73m² calculated with the creatinine-based CKD-EPI (2009) equation. For each study visit, prevalent CKD cases were considered as incident if eGFR was ≥60 ml/min/1.73m² in the respective previous study visit. In claims data, in- and outpatient ICD-10 diagnoses (N18.3, N18.4, N18.5, N18.8, N18.9, N19) in the year preceding and/or following the study visit date were used to determine CKD prevalence. Incidence was defined as prevalent cases without a diagnosis in the year preceding the first CKD diagnosis. The denominator for incidence was defined as all persons at risk, i.e., who were not prevalent in a respective previous study visit and still under observation. We assessed the diagnostic validity of claims-based CKD prevalence and incidence using eGFR data as a reference. Analyses were stratified by sex.

Results
Between 2009 and 2019, CKD prevalence increased from 0.42 to 0.51 based on eGFR and from 0.30 to 0.43 based on claims data. Incidence varied between 0.16–0.22 using eGFR and 0.07–0.13 using BIS claims data. There was no clear time trend for incidence in any data source. Diagnostic validity of claims-based CKD prevalence and incidence detection is displayed in Table 1. Sensitivity for prevalence increased while other indicators remained stable over time. Detection of incident cases showed lower sensitivity (0.18–0.30 vs. 0.58–0.70) and PPVs (0.40–0.60 vs. 0.79–0.83) compared to prevalence, respectively. Prevalence and incidence based on claims data were slightly higher in males compared to females (Figure 1).

Conclusion
Using the eGFR-based or claims-based definition of CKD we found an increase in prevalence between 2009 and 2019. This might be due to the introduction of the KDIGO guidelines in 2012. During the same time, CKD incidence rates were stable. Comparing the claims-based with eGFR-based CKD definition, we found a sensitivity of 0.58-0.70 for prevalence and 0.18-0.30 for incidence, indicating that there is a risk of underdetection of CKD when using solely claims data, in particular for incident cases.