bluuebunny/crossref_metadata_2025_split huggingface dataset:
#2499 ALBUMINURIA AND THE RISK OF CANCER: THE STOCKHOLM CREATININE MEASUREMENTS (SCREAM) PROJECT
Authors: Luo Li , Yang Yuanhang , Kieneker Lyanne M , Janse Roemer J , Bosi Alessandro , Mazhar Faizan , de Boer Rudolf A , de Bock Geertruida H , Gansevoort Ron T , Carrero Juan-Jesus 
Published: June 2023

Abstract

Background and Aims
Studies investigating the association of chronic kidney disease and cancer have focused on estimated glomerular filtration (eGFR) rather than on albuminuria. The few studies focusing on albuminuria provide results that vary considerably, probably due to a lack of consideration of eGFR, their limited sample sizes, and that different albuminuria measurement techniques were used. This study therefore aimed to investigate the eGFR independent risk of cancer incidence associated with albuminuria measured as ACR as well as by dipstick in a large Swedish population.

Method
We included subjects of the Stockholm Creatinine Measurements (SCREAM) project without a history of cancer, 250,768 subjects with at least 1 urine albumin-creatinine ratio (ACR) test (primary cohort), and 433,850 subjects with at least 1 dipstick albuminuria test (secondary cohort). Albuminuria was quantified as KDIGO albuminuria stages. The primary outcome was overall cancer incidence. Secondary outcomes were site-specific cancer incidence rates. Multivariable Cox proportional hazards regression models were used to calculate hazard ratios (HRs, 95% CIs) crude, and additionally adjusted for confounders including baseline eGFR.

Results
During a median follow-up of 4.3 (IQR, 2.0-8.2) years, 21,901 subjects of the ACR cohort developed de novo cancer. In multivariable analyses, adjusting among others for eGFR, subjects with an ACR of 30–299 mg/g or ≥300 mg/g had a 23% (HR, 1.23; 95% CI, 1.19-1.28) and 40% (HR, 1.40; 95% CI, 1.31-1.50) higher risk of developing cancer, respectively, when compared to subjects with an ACR ≪30 mg/g. This graded, independent association was also observed for urinary tract, gastrointestinal tract, lung, and hematological cancer incidence (all P≪0.05). No significant associations of albuminuria with the incidence of melanoma, breast, and prostate cancers were found. Results were similar in the dipstick albuminuria cohort, and were robust in several sensitivity analyses.

Conclusion
Albuminuria was associated with the risk of cancer independent of eGFR. This association was primarily driven by a higher risk of urinary tract, gastrointestinal tract, lung, and hematological cancers.
#2528 APOL1 GENOTYPING AND PROTEINURIC KIDNEY DISEASE IN EUROPE
Authors: Knebelmann Bertrand , Bramham Kate , Mccafferty Kieran , Zaidan Mohamad , Torres Pablo Antonio Urena , Audard Vincent , Boffa Jean Jacques , Powell Thomas , Shahid Nauman , Echeverri Diego , Provenzano Christopher , Bauman John , Zamauskaite Aurelia , Delestre-Levai Irisz , Yang Yuan , Krause Silva , Ferreira Anna Carolina , Egbuna Ogo , Chertow Glenn 
Published: June 2023

Abstract

Background and Aims
Apolipoprotein L1 (APOL1) toxic gain-of-function variants (G1 or G2) are genetic factors driving a broad spectrum of progressive, proteinuric nephropathies referred to as APOL1-mediated kidney disease (AMKD). APOL1 genotyping is not routinely performed in kidney disease care, and prevalence of APOL1 variants among persons with chronic kidney disease (CKD) in Europe is not well known. These variants are common in persons of recent African ancestry. We report interim data of a global study estimating the prevalence of APOL1 genotypes in participants of recent African ancestry and proteinuric CKD, with a focus on data from Europe.

Method
Enrollment in this ongoing study will include up to 2,500 participants across different geographies who are of recent African ancestry and have focal segmental glomerulosclerosis (FSGS) or other proteinuric nondiabetic kidney disease (NDKD). The study includes a single visit during which blood samples are collected from participants to determine their APOL1 genotype using a validated polymerase chain reaction (PCR)-based assay. The percent of participants with two APOL1 variants and percent of participants in each genotype category (e.g., G1/G1, G1/G2, G2/G2) are assessed; genetic counseling services are available to participants, if desired.

Results
This interim analysis included 1,256 participants of whom 174 (13.9%) were from Europe. As shown in the table, among the 88 participants with FSGS and 86 participants with proteinuric NDKD, 54 (61.4%) and 32 (37.2%) have two APOL1 variants, respectively.

Conclusion
Our study will generate one of the largest global APOL1 genotyping data sets in participants with proteinuric kidney disease. These data begin to address a critical knowledge gap and highlight the importance of APOL1 genotyping in kidney disease care to identify AMKD, potentially optimize disease management, and enable referral for interventional clinical trials evaluating targeted therapies for AMKD.
#2775 USING A DEEP LEARNING MODEL TO EVALUATE PATHOLOGICAL INJURY OF DIABETIC KIDNEY DISEASE
Authors: Jin Feng Yong , Huang Yang , Huang Yu Lin , Zhao Qing , Wu Qin Yi , Ma Kun Ling 
Published: June 2023

Abstract

Background and Aims
Early diagnosis and evaluation play an important role in preventing the progression of diabetic kidney disease (DKD). Renal biopsy is the gold standard of DKD diagnosis. In 2010, the Renal Pathology Society (RPS) developed a consensus classification for DKD, which classifies DKD glomerular lesions and scores for tubulointerstitial lesion. However, as the pathologic heterogeneity of DKD patients and unparallel relationship between pathology features and clinical symptoms, it remains controversial whether is reliable to use RPS classification for renal outcomes prediction. Besides, the inconsistence between pathologists might magnify the gap between prediction and outcome. More reliable methods for DKD pathology assessment are needed. The development of machine learning (ML) algorithms especially convolutional neural networks (CNNs) enables it possible, which can provide automatic and precise analysis for complicated images. Thus, this study aimed to construct a ML-based model to assist and provide automatic decision supports to clinical doctors.

Method
We examined 204 DKD renal biopsied whole-slide images (WSIs) of Periodic Acid Schiff staining from Southeast University Institute of Nephrology whose database came from more than 30 hospital centers. All the WSIs were randomly annotated by three pathologists. We established a consecutive CNNs framework: DKD pathology evaluation system (DPES). It consists of three parts: 1. Based on classic UNet architecture, we developed a segmentation model whose backbone is replaced by ResNet 50 architecture for detecting glomeruli. 2. According to RPS classification, a CNN added with channel attention mechanism is built to discriminate sclerotic glomeruli, glomeruli with K-W node, and glomeruli with mesangial expansion. Through this method, the entire WSIs were divided into RPS grades I-IV. 3. For the analysis of tubulointerstitial lesion, we constructed a segmentation model as previous description to calculate the area of the atrophic tubule and its percentage of the total tubules.

Results
For glomerular assessment, compared with other ML networks, DPES achieved better performance in segmentation for glomeruli (Intersection over Union (IOU): 0.82, Precision: 0.89, Accuracy: 0.91) and tubulointerstitial (atrophy (TA): IOU: 0.9;Precision: 0.94; Accuracy: 0.95; non-tubular atrophy (NT): IOU: 0.84; Precision: 0.90; Accuracy: 0.93). Interstitial fibrosis and tubular atrophy (IFTA) from network compared with three pathologists didn’t show statistically difference.

Conclusion
Our findings demonstrated that the DPES achieved similar performance with three pathologists. It suggests that machine learning algorithms can generate reliable results and provide more supports for clinical decision.
#2819 BIOELECTRICAL IMPEDANCE PARAMETERS AS EARLIER PREDICTORS OF FRAILTY AND FUNCTIONAL IMPAIRMENT IN ECUADORIAN HEMODIALYSIS PATIENTS
Authors: Juan Santacruz , Armijo Kevin , Arévalo Vanessa , Santacruz Angel , Vásquez Ana , Gavilanes Verónica 
Published: June 2023

Abstract

Background and Aims
Functional impairment (FI) and frailty are highly prevalent in hemodialysis (HD) population and are associated with morbidity/mortality. Bioelectrical impedance analysis (BIA) is a non-invasive test to assess body composition and water distribution. Few is known about BIA parameters as predictors of frailty and FI. The aim of the study was to study BIA parameters associated with frailty and FI and to determine their prevalence among Ecuadorian adult patients on HD.

Method
Observational-prospective-cohort study performed between January/2021 and October/2022 in one HD center. Clinical Frailty Scale (CFS) score ≥4 determined frailty diagnosis, and FI was labeled with Barthel Index (BI) &lt;70. ROC curves were performed to determine the best cut-off for Phase Angle (PA) and Extracellular/Intracellular water ratio (E/I ratio) to predict frailty and FI (Fig. A). Pearson's correlation coefficient between PA and E/I ratio with CFS score and FI were calculated (Fig. B), and univariate logistic regression analysis was performed.

Results
A total of 115 patients were included. Baseline characteristics, findings and variables with statistical significance are resumed in Table 1. The AUC of PA to predict non-frailty patients and non-functional impaired patients was 0.87 (p&lt;0.001) and 0. 79 (p&lt;0.001), which corresponds to PA values of ≥4.35° and ≥3.62°, respectively. The AUC for E/I ratio to predict frailty and FI was 0.83 (p&lt;0.0001) and 0.74 (p&lt;0.0001), which corresponds to E/I ratio values of ≥0.97 and ≥0.99 respectively. Moderate-to-strong-negative correlation was found between PA and CFS score (r = −0.61, p&lt;0.0001) as well as moderate-positive correlation between PA and BI (r = −0.47, p&lt;0.0001) was found. Moderate-positive correlation between E/I ratio and CFS score (r = −0.56, p&lt;0.0001) and moderate-negative correlation between E/I ratio with BI (r = −0.45, p&lt;0.0001) were found. Univariate logistic regression analysis revealed that factors independently associated with frailty were age (OR = 1.04, CI-95%:1.02-1.06) and PA (≥4.35°) (OR = 0.17, CI-95%:0.11-0.24).

Conclusion
PA and E/I ratio obtained in a single non-invasive BIA can be used as screening tool, with sensitivity &gt;80%, for earlier prediction of FI and frailty in HD patients allowing premature identification and intervention in this group of patients.
#3193 PERFORMANCE OF THE RACE-FREE CKD-EPI CREATININE-BASED EGFR EQUATION IN A DANISH COHORT WITH CHROMIUM-51-EDTA CLEARANCE MEASUREMENTS
Authors: Munch Philip Vestergaard , Heide-Jørgensen Uffe , Jensen Simon Kok , Birn Henrik , Vestergaard Søren , Frøkiær Jørgen , Sørensen Henrik Toft , Christiansen Christian Fynbo 
Published: June 2023

Abstract

Background and Aims
In 2021, an updated estimated glomerular filtration rate (eGFR) equation based on serum creatinine, age, and sex, but without a coefficient for race (CKD-EPI21) was developed and recommended for clinical use. However, the performance of the new equation has yet to be examined among specific groups such as patients with cancer.

Method
We compared the performances of the CKD-EPI21 equation and the original creatinine-based eGFR equation assuming non-Black race (CKD-EPI09-NB) in patients ≥18 years of age with measured GFR ascertained by chromium-51-EDTA plasma clearance at Aarhus University Hospital in Denmark during 2010–2018. We examined bias, accuracy, precision (defined as the interquartile range of the absolute bias), and correct classification of chronic kidney disease (CKD) stages (GFR ≥60, 30–59, and &lt;30 ml/min/1.73 m2) using the chromium-51-EDTA clearance as the reference standard. Furthermore, we assessed the performance of the equations in the total cohort while stratifying by CKD stage. We assessed the performance in the total cohort and in cohorts of cancer patients and potential living kidney donors.

Results
In this predominantly White population, the CKD-EPI21 equation performed slightly better than the CKD-EPI09-NB equation, both when examining the total cohort (N = 4,668) and when examining cohorts of cancer patients (N = 3,313) and potential living kidney donors (N = 239). In the total cohort, the CKD-EPI21 equation demonstrated lower median absolute bias (−0.2 versus −4.4 ml/min/1.73 m2), higher accuracy (72% versus 70%) as well as equal precision (25 versus 25 ml/min/1.73 m2) and correct classification of CKD stages (86% versus 85%) when compared with the CKD-EPI09-NB equation. When we stratified by CKD stage, the CKD-EPI09-NB equation performed slightly better than the CKD-EPI21 equation among patients with a GFR &lt; 60 ml/min/1.73 m2.

Conclusion
In a selected cohort of Danish patients with measured GFR, the CKD-EPI21 equation performed slightly better than the CKD-EPI21-NB equation except for patients with a GFR &lt; 60 ml/min/1.73 m2.
#3743 MULTIDIMENSIONAL RISK ASSESSMENT OF KIDNEY ALLOGRAFT REJECTION USING DONOR DERIVED CELL-FREE DNA
Authors: Ursule-Dufait Cindy , Aubert Olivier , Brousse Romain , Gueguen Juliette , Racapé Maud , Legendre Christophe , Anglicheau Dany , Lefaucheur Carmen , Loupy Alexandre 
Published: June 2023

Abstract

Background and Aims
Post-transplantation patient care requires development and validation of non-invasive biomarkers to improve allograft monitoring and prevention from unnecessary and costly biopsies. Reports have suggested the association of donor derived cell-free DNA (dd-cfDNA) with allograft rejection. However, there is no proof of its added value on standard of care in large, unselected and deep phenotyped cohorts.

Method
We enrolled 1134 kidney transplant recipients having concomitant evaluation of allograft histology, anti-HLA DSA and functional parameters between April 2013 and June 2018 in the derivation cohort, representing 1415 biopsies. Dd-cfDNA was measured in plasma at the time of the biopsy. Diagnoses were performed using Banff 2019 criteria. 171 AMR, 34 TCMR and 17 mixed rejections occurred. Parameters associated with rejection were assessed using uni- and multivariable logistic regression. We then developed a risk model using the variables that were independently associated with kidney rejection. The validation cohort comprised 1929 evaluations including 499 evaluations in one Belgian center and 1430 evaluations in nine North American centers.

Results
Higher levels of dd-cfDNA were observed for AMR and TCMR or both compared to other diagnoses (Fig. 1A). Dd-cfDNA incrementally increased with Banff acute lesions without significant increase for chronic lesions. In multivariable analysis, the variables independently associated with rejection were anti-HLA DSA (P&lt;0.0001), dd-cfDNA (P&lt;0.0001), eGFR (P&lt;0.033), proteinuria (P = 0.016), and previous history of rejection (P&lt;0.0001). Dd-cfDNA remained independently associated with kidney allograft rejection in validation cohorts from Belgium (P = 0.0006) and North America (P&lt;0.0001). Discrimination of the model without dd-cfDNA was 0.777 and 0.821 with its inclusion, showing its added value (Fig. 1B). The good discrimination performances of the model with dd-cfDNA were also confirmed in the validation cohorts from Belgium (AUC: 0.815) and North America (AUC: 0.826).

Conclusion
We here demonstrate the independent and added value of dd-cfDNA in addition to conventional features to predict rejection. This first integrative system shows improved performance for patient monitoring and could help physicians in decision-making process.
#3819 THE PROTECTIVE EFFECT OF INTERLEUKIN-1 RECEPTOR ANTAGONIST ON KIDNEY FUNCTION: A MENDELIAN RANDOMIZATION STUDY
Authors: Cho Jeong Min , Joo Kwon Wook , Kim Jung-Hyun , Kim Dong Ki , Park Sehoon 
Published: June 2023

Abstract

Background and Aims
Interleukins (ILs), key cytokine family of inflammatory response, are closely associated with kidney function. However, the causal effect of various ILs on kidney function needs further investigation.

Method
We performed two-sample summary-level mendelian randomization (MR) analysis (Fig. 1). Genetic variants with strong association with serum IL levels were obtained from a previous genome-wide association study meta-analysis. Summary-level data for eGFR were obtained from CKDGen database. A replication analysis was performed in the independent UK Biobank data. As a main MR analysis, multiplicative random-effect inverse-variance weighed method was performed. Pleiotropy-robust MR analysis, including MR-Egger with bootstrapped error and weighed-median methods, were also implemented.

Results
We tested the causal estimates from nine ILs on eGFR traits. Among ILs, we found that genetically predicted serum IL-1ra level showed consistently significant association (P &lt;0.05) with eGFR, also supported by significant (P &lt;0.05) pleiotropy-robust MR results. Using 20 SNPs (18 of pQTL and 2 of eQTL SNPs), genetically predicted higher serum IL-1ra level was significantly associated (&lt;0.05) with higher eGFR in multiplicative random effect IVW analysis (Fig. 2). In addition, the result was consistent towards eGFR decline phenotype of the outcome database. Otherwise, nonsignificant association was identified between other genetically predicted ILs and eGFR outcome (Fig. 3).

Conclusion
These findings support the clinical importance of IL-1 associated pathway in relation to kidney function in the general individuals, particularly highlighting the importance of IL-1ra.
#3988 MARS – A NOVEL SCORE TO PREDICT THE RISK OF ACUTE KIDNEY INJURY AFTER LIVING DONOR LIVER TRANSPLANT
Authors: Rana Abhyudaysingh , Bansal Shyam , Saraf Neeraj , Choudhary Narendra , Mahapatra Amit , Sethi Sidharth , Soin Arvinder 
Published: June 2023

Abstract

Background and Aims
Acute kidney injury is common in liver transplant recipients with adverse effect on graft and patient outcomes. There are many studies on incidence, risk factors and outcomes of AKI post-LT in deceased donors, there is paucity of data about AKI in living donor liver transplant recipients (LDLT). LDLT is a difficult and prolonged surgery with inherent risk to donors, so it practised in only few centres across the world however there is little data of AKI in living donor liver transplant recipients (LDLT).

Method
This prospective observational study was undertaken to assess incidence, risk factors, patient graft outcomes and to develop a novel prediction model to identify recipients at risk for post-transplant AKI at the earliest possible time point after living donor liver transplantation in a tertiary care large volume centre in northern India.

Results
Incidence of AKI in our study was 31.7% with 13.5% requiring renal replacement therapy. Male gender, history of hepatorenal syndrome, use of intraoperative inotropes (Indicating Post reperfusion injury), MELD score &gt;14, preoperative proteinuria &gt;0.5 gram/day & estimated GFR &lt;90 ml/min/1.73 m2 were significant risk factors for AKI within 1 month post-LDLT in logistic regression model. We devised a risk prediction score (The MARS score) which had a sensitivity of 81.36%, specificity of 88.19%, positive predictive value of 76.9%, negative predictive value of 91.06% and overall accuracy of 86.02% to predict AKI. AKI was associated with longer hospital stay, higher mortality and led to higher occurrence of chronic kidney disease after a median follow up period of 724 (635 – 794) days.

Conclusion
Our risk model (MARS) with an AUC of 0.925 performed better than all previously reported scores in DDLT & LDLT .The variables in our AKI risk prediction are simple to extract and use making it favourable in resource limited settings where access to newer biomarkers of kidney injury is limited. There is a need to apply the score in other cohorts to validate its applicability.
#4216 FEASIBILITY ANALYSIS OF AN ULTRASOUND-GUIDED PLACEMENT OF TUNNELED HEMODIALYSIS CATHETERS
Authors: Kächele Martin , Bettac Lucas , Hofmann Christopher , Herrmann Hannes , Brandt Amelie , Schroeppel Bernd , Schulte-Kemna Lena 
Published: June 2023

Abstract

Background and Aims
Radiographic fluoroscopy (RAD) is the current standard for placement of tunneled central venous catheters (CVC) for hemodialysis. RAD requires structural and personnel infrastructure and exposes the patient to ionizing radiation. Here, we investigate the feasibility of solely ultrasound-guided placement of tunneled central venous dialysis catheters.

Method
We evaluated prospectively collected single center data of 134 consecutive patients who underwent CVC implantation between 2020 and 2021 regarding feasibility, safety, and catheter function. We used the inset guidewire to visualize the position of the catheter tip. In the case of inadequate visibility by ultrasound, we additionally used intracardiac ECG recording or agitated saline. A total of 1844 catheter days were assessed. As a historical control, we analyzed the position of 50 CVCs placed by RAD. Optimal CVC position was defined to be in between the cavoatrial junction (CAJ) and the right atrium (RA), according to the guidelines.

Results
The catheters were placed on the right side in 117 (87%) cases. The primary success rate for optimal position and function was 97,7% (n = 131). Placement solely by ultrasound was possible in 130 (97%) cases. There were no immediate procedure-associated complications related to the new technique. Effective blood flow averaged 292 +/- 39 ml/min. Of all ultrasound-placed catheters, 6% were in the vena cava superior (RAD 24%), 70% in the CAJ (RAD 60%), and 24% in the RA (RAD 16%), resulting in a rate of 94% with optimal position.

Conclusion
Placement of CVCs for hemodialysis solely by ultrasound is an effective and safe alternative to fluoroscopy-assisted placement.