bluuebunny/crossref_metadata_2025_split huggingface dataset:
#6744 SELF-ASSEMBLED FISETIN NANOPARTICLES WITH ENHANCED BIOACTIVITIES FOR EFFECTIVE HYPERURICEMIC NEPHROPATHY THERAPY
Authors: Ren Qian , Liang MA , Fu Ping 
Published: June 2023

Abstract

Background and Aims
The prevalence of hyperuricemia is rising rapidly around the world, and increasing evidence demonstrates that hyperuricemia is the independent risk factor for chronic kidney diseases (CKD) development and progression. Hyperuricemia-induced renal injury, namely hyperuricemic nephropathy (HN), is characterized by urate crystal formation, tubulointerstitial fibrosis and glomerulosclerosis, which would eventually progress into end-stage renal disease (ESRD). Up to now, the mechanism of HN remains unclear and the treatment still needs further exploration. Fisetin is a natural flavanol with potent antioxidative and anti-inflammatory properties and showed therapeutic effects in mice with HN. However, the poor water solubility, rapid metabolism, and low bioavailability of fisetin largely hampered its clinical application. Herein, we reported the simple and efficient preparation of fisetin-EGCG nanoparticles (EG/FIS NPs) based on a solvent-mediated disassembly/reassembly strategy.

Method
The fisetin nano-formulation (FIS/EG NPs) was prepared based on a general solvent-mediated disassembly/reassembly strategy. The physicochemical properties of FIS/EG NPs including morphology, specific surface area and pore size distribution, drug encapsulation rate and loading rate, intracellular distribution were characterized. The potential toxic effects of FIS/EG NPs on RAW264.7 and TCMK-1 cells were investigated by CCK-8. Meanwhile, the anti-oxidative and anti-inflammatory effects of FIS/EG NPs were detected in vivo and in vitro. In vivo small animal imaging was employed to assess the kidney accumulation of FIS/EG NPs. And finally, HN was induced to measure the effect of FIS/EG NPs in mice and PAS staining, Masson staining, RT-qPCR were used to explore underlying mechanisms.

Results
EG/FIS NPs with stable water dispersion was prepared by using a general solvent-mediated disassembly/reassembly strategy. EG/FIS NPs contains both features of fisetin and EG NPs, and displayed more potent free radical scavenging ability than fisetin and EG NPs. Meanwhile, it was found that both RAW264.7 and TCMK-1 cells were able to uptake EG/FIS NPs and no proliferation toxicity was observed in these two cell types after incubation with various concentrations of EG/FIS NPs. By in vivo and in vitro experiments, fisetin and EG NPs were shown to have synergistic effects in inhibiting LPS-stimulated NO production after encapsulation. Moreover, fluorescence imaging revealed that EG/FIS NPs preferentially accumulated in the injured kidneys of HN mice. Finally, it was observed that EG/FIS NPs exhibited enhanced therapeutic efficiency against HN due to the combined antioxidative, anti-inflammatory, and antifibrotic activities of fisetin and EG NPs

Conclusion
Collectively, these results suggested that EGCG-based nanocarriers might be a novel strategy for the development of therapeutic drugs for HN.
#6825 ECOLOGICAL APPROACH FOR KIDNEY REPLACEMENT THERAPY IN CRITICAL CARE: SLED MAY BE A STRATEGY
Authors: Sala Inês , Vida Ana Carlota , Lopes Liliana , Fernandes João , Madureira Anselmo , Castro Ana , Ferreira Cristina , Lobato Luísa 
Published: June 2023

Abstract

Background and Aims
Dialysis has an enormous environmental impact, not only for disposable consumables, but also for the water and energy consumption. Despite increasingly evidence regarding comparable outcomes between continuous kidney replacement therapy (CKRT) and slow low efficiency dialysis (SLED), ecological-based endpoints are not frequently evaluated. Literature in critical care concerning the environmental impact of these techniques is scarce. We aimed to determine the waste production, water and energy consumption in SLED and CKRT and identify the technique with higher environmental impact.

Method
We conducted a cross-sectional, observational, single-center study in patients with acute kidney injury requiring kidney replacement therapy admitted to an intensive care unit (ICU). We analyzed the waste weight of each dialysis technique (Fresenius Medical Care 5008 for SLED and Baxter Prismaflex for CKRT) before and after the treatment. We estimated the water consumption of a SLED session with a Qd of 300 ml/min for 8 hours and 12 hours sessions, considering a Reverse Osmosis (RO) system with a 50% rate water rejection and a CKRT session for an 80Kg patient, with a Qd of 1300 mL/h and a reposition solution flow of 500 mL/h. Both techniques included a disinfection volume of 14 L.

Results
A SLED session produced 1600 g of waste (1200 g was hazardous and 400 g was non-hazardous waste). A CKRT session produced 2700 g of waste, not considering the substitution solution volume, which can vary up to a maximum of 15000 g/treatment. Waste consumables for each technique are discriminated in Table 1. The unpurified water consume of 8-hours and 12-hours SLED treatment was 237 L and 345 L, respectively. For CKRT, we estimated a consume of 43.2 L a day and 129.6 L for a 72-hour treatment. SLED had an energy consumption of 5.71 kW and 8.43 kW, for 8-hours and 12 hours treatment, respectively. The CKRT consumed about 12 to 14.4 kW per day.

Conclusion
Our study highlights the quantity of waste produced, water and power consumption of dialysis techniques in the critical patient. CKRT produces more hazardous waste, that generates a larger carbon footprint. Hazardous waste cannot be recyclable and implies specific management and disposal, which is more expensive and laborious than non-hazardous. CKRT has also a higher power consumption due to treatment duration and technology used to generate electricity. SLED has higher water consumption, nevertheless, current strategies used in hemodialysis units could also be implemented in UCI to minimize this effect. For example, the rejected water can be reused to agriculture and toilet flushing; more efficient water purification system with a lower proportion of rejected water can also reduce water consumption. SLED has unequivocal clinical benefits in the critical patient and, from an ecological perspective, seems to be a more sustainable option.
#6827 DI(2-ETHYLHEXYL) PHTHALATE INDUCES RENAL PROXIMAL TUBULAR CELLS TO UNDERGO EPITHELIAL-MESENCHYMAL TRANSITION VIA AHR SIGNALING
Authors: Lee Wen-Chin , Tsai Kai-Fan , Lee Chien-Te , Kung Chia-Te 
Published: June 2023

Abstract

Background and Aims
Environmental factors account for the majority of identified risks associated with CKD of uncertain etiology (CKDu). Among the various environmental factors, plasticizer di(2-ethylhexyl) phthalate (DEHP) is widely used in modern life. The exposure to DEHP is extensive but mostly underestimated in the general population. The link between DEHP exposure and renal injuries has been scarcely reported but the underlying mechanisms are largely unknown. This study aimed to examine the mechanisms by which DEHP causes renal tubular injuries.

Method
Human proximal tubular cells (PTC), HK2 cells, were used as a cellular model to test the central hypothesis of this study. Cells were treated with various concentrations of DEHP at different time points. WST-1 assay was used to examine the impacts of DEHP on cell viability. Bright field microscopy and immunofluorescence were used to analyze the morphological evidence of epithelial-mesenchymal transition (EMT). Western blots were used to investigate the changes in the expression of EMT-related proteins and arylhydrocarbon receptor (AhR) signaling. Inhibitors of AhR signaling were employed to investigate the crucial roles of AhR signaling in DEHP-induced EMT in HK2 cells.

Results
By using WST-1 assay, we found that DEHP did not affect cell viability when the examined concentration was below 50 μM, which resembled the low-level environmental exposures. However, when the concentration was higher than 100 μM, DEHP reduced the cell viability in a dose-dependent manner. In response to DEHP, HK-2 cells changed from cuboid to spindle shape when cultured with DEHP (25 μM). This morphological evidence became evident when the treatment time was longer than 48 hours. At the protein levels, DEHP resulted in down-regulation of e-cadherin and upregulation of vimentin and α-SMA. DEHP also lead to upregulation of AhR. The inhibitor of AhR signaling, CQDP (chloroquine diphosphate) reversed the DEHP-induced EMT, which were evidenced by morphology and by the expression patterns of EMT-related proteins.

Conclusion
At cellular level, our results suggested that low-level environmental exposures of DEHP led to EMT in renal PTC via AhR signaling.
#6847 HEALTH-RELATED QUALITY OF LIFE AND SYMPTOM BURDEN IN YOUNGER AND OLDER HAEMODIALYSIS PATIENTS: A PROSPECTIVE COHORT STUDY
Authors: Van Oevelen Mathijs , Bonenkamp Anna , van der Sluijs Anita van Eck , Bos Willem Jan W , Douma Caroline , van Buren Marjolijn , Meuleman Yvette , Dekker Friedo W , Van Jaarsveld Brigit , Abrahams Alferso C 
Published: June 2023

Abstract

Background and Aims
Patients on haemodialysis generally report poor health-related quality of life (HRQoL) and a broad range of physical and emotional symptoms, but it is unknown if this differs between younger and older patients. We aimed to describe the trajectories of HRQoL and symptom burden of patients &lt; 70 and ≥ 70 years old after dialysis initiation and to assess the impact of symptom burden on HRQoL.

Method
Incident Dutch haemodialysis patients were included between December 1st, 2017, and January 19th, 2019. HRQoL and symptom were measured with the 12-item Short Form Health Survey (range 0-100, higher scores indicate better HRQoL) and the Dialysis Symptom Index (range 0-150, higher scores indicate more symptoms and/or higher severity). Questionnaires were taken at the start of dialysis and after 3, 6 and 12 months. We used (multilevel) linear regression to examine the trajectories of HRQOL and symptom burden, and the impact of symptom burden on HRQoL.

Results
In 774 patients, the trajectories of physical HRQoL, mental HRQoL and symptom burden were stable. Compared with patients aged &lt; 70 years, patients ≥ 70 years reported similar physical HRQoL (crude mean difference -0.61, 95% CI -1.86; 0.63, p = .33) but slightly better mental HRQoL (1.77, 95% CI 0.54; 3.01, p = .005) and lower symptom burden (-2.38, 95% CI -5.08; 0.32, p = .08) during the first year of dialysis. With increasing symptom burden, physical HRQoL declined more in older than in younger patients (β -.287 versus β -.189, respectively, p-value for interaction = .007). For mental HRQoL, this decrease was similar (β -.295 versus -.288, p-value for interaction = .847).

Conclusion
Older haemodialysis patients generally experience better mental HRQoL and a (non-statistically significant) lower symptom burden in the first year after dialysis initiation, compared to younger patients. However, their physical HRQoL declines more rapidly with increasing symptom burden, compared to younger patients.
#6857 MATHEMATICAL MODEL FOR ADVERSE CARDIOVASCULAR EVENTS RISK ASSESSMENT IN KIDNEY TRANSPLANT RECIPIENTS
Authors: Smaliakova Maria 
Published: June 2023

Abstract

Background and Aims
Kidney transplantation is the most cardioprotective method of renal replacement therapy. Nevertheless, cardiovascular diseases are one of the main reason of mortality of with functioning kidney graft. The aim is creation of a mathematical model for adverse cardiovascular events risk assessment in kidney transplant recipients (KTR).

Method
The study included 237 kidney transplant recipients whose age was 47.1±10.8 years. For three years of observation 79 (33.3%) patients had adverse cardiovascular events (CVE) (acute coronary syndrome, life-threatening rhythm disturbance, complicated hypertensive crisis). The comparison group was 158 (66.7%) recipients without cardiovascular events. The study groups were comparable by gender, age and traditional cardiovascular risk factors.

Results
The proportion of patients with obesity and the graft glomerular filtration rate less than 30 ml/min/1.73 m2 were higher in KTR with CVE than in KTR without CVE –– 27.8% (n = 22) versus 12.7% (n = 20) and 12.7% (n = 10) versus 3.2% (n = 5), p&lt;0.01. p&lt;0.01. The erythrocytosis and an increased NT-proBNP blood level was more common in KTR with CVE than in KTR without CVE – 29.1% (n = 23) versus 16.5% (n = 26), p&lt;0.05 and 27.8% (n = 22) versus 11.4% (n = 18), p&lt;0.01. KTR with CVE had a longer duration of chronic kidney disease than KTR without CVE – 21.1±12.2 years versus 16.6±9.6 years, p&lt;0.01. Triglycerides and low density lipoproteins blood levels of KTR with CVE were higher than those of KTR without CVE – 1.70 (1.30-2.50) mmol/L versus 1.45 (1.08-1.80) and 2.97±0.88 mmol/L versus 2.61±0.69 mmol/L, p&lt;0.01, respectively. was more common in KTR with CVE than in KTR without CVE. The above factors were included in the mathematical model.
$Y\; = \;\frac{1}{{\;1 + {e^{( {4,156 - 1,033X1 - 0,037X2 - 1,003X3 - 0,384X4 - 0,470X5 - 1,712X6 - 1,119X7} )}}}},$
X1 - body mass index &gt; 30 kg/m2 (0 - no, 1 - yes),
X2 - duration of chronic kidney disease (years);
X3 - erythrocytosis (0 - no, 1 - yes),
X4 - triglycerides blood level (mmol/l);
X5 - low density lipoproteins blood level (mmol/l);
X6 - glomerular filtration less than 30 ml/min/1.73 m2 (0 - no, 1 - yes),
X7 - increased NT-proBNP blood level (0 - no, 1 - yes)
The formula predicts low risk of CVE in kidney transplant recipients with an estimated value of Y&lt;0.35, with Y≥0.35 - high risk.

Conclusion
Obesity, graft dysfunction erythrocytosis, an elevated NT-proBNP blood level, longer duration of chronic kidney disease, higher triglycerides and low density lipoproteins blood levels can be used to assess cardiovascular risk in kidney transplant recipients.
#6868 MACHINE LEARNING-BASED HYPERTENSION DISEASE RISK CLASSIFICATION USING LEARNING VECTOR QUANTIZATION ALGORITHM
Authors: Fajar Rifaldy , Putri Sahnaz , Syafruddin Elfiany 
Published: June 2023

Abstract

Background and Aims
According to the World Health Organization, the disease dubbed as the silent killer of death is the number one cause of death in the world. Hypertension is a disease that does not show certain symptoms. There are about 95% of hypertension cases have no known cause, while the rest are caused by other diseases. Therefore, an early detection system for hypertension is needed. In this research, the Learning Vector Quantization (LVQ) algorithm is used to perform the classification process.

Method
In this research, the LVQ machine learning algorithm is used. LVQ is an algorithm that is a type of artificial neural network and uses neural computation. The data in this study is hypertension patient data from Sultan Daeng Radja Hospital which is divided into four classes. In the system design stage using the LVQ algorithm, the process in this system is by entering input data in the form of medical records consisting of 12 attributes based on their weights which will then be carried out by the LVQ process to produce classification results. If the classification results have been obtained, the system will stop. After the classification testing process is carried out, the accuracy calculation process is carried out.

Results
Based on six test scenarios that have been carried out, the system produces recommendations for a value of 0.1 for the learning rate, a value of 0.2 for the learning rate multiplier, the amount of training data of as much as 50%, the maximum epoch value of six, the minimum value of alpha 0.001. From these values, the average accuracy result obtained is 94%.

Conclusion
Based on the value of accuracy results obtained exceeding 90%, the system can be done quite successfully in detecting hypertension. However, further research is needed to further develop the system.
#6880 PREDICTION OF GRAFT SURVIVAL PRIOR TO ACCEPTING AN OFFER FOR LIVING DONOR KIDNEY TRANSPLANT: AN ARTIFICIAL INTELLIGENCE APPROACH
Authors: Ali Hatem Kaies Ibrahim Elsayed , Burke Bernard , Mohamed Mahmoud , Briggs David , Krishnan Nithya 
Published: June 2023

Abstract

Background and Aims
The current available models for evaluation of outcomes of living donor kidney transplant before accepting an offer are poorly developed, reported, validated and have small sample sizes. We aim to use Artificial Intelligence to build a model that can accurately predict death censored graft survival for living donor kidney transplant prior to accepting an offer.

Method
All living kidney transplant patients who were: registered in the UNOS database between 1/1/2007 and 1/6/2021, maintained on TAC/MMF immunotherapy were included in our analysis. We excluded patients with age&lt;18 years old and ABO incompatible transplant. We divided the data randomly into training and testing dataset with ratio 80:20. We performed recursive feature elimination to select the important ones for prediction. Features were selected based on their Gini impurity scores. We performed Artificial Neural Network analysis (ANN). We evaluated the model using Harrell Concordance-time-dependent score (for discrimination), and Integrated Brier score (for calibration). We also assessed dynamic AUC for model performance.

Results
54,110 living donor kidney transplant patients were included in the study. Harrell C-Statistic scores were 0.70 at 5 years post-transplant, 0.68 at 10 years post-transplant and 0.68 at 13 years post-transplant, indicating very high discrimination power. Integrated Brier Score was 0.08, indicating very high calibration score for our model. Dynamic AUC scores were 0.71 at 5 years post-transplant and 0.68 at 10- and 13-years post-transplant, indicating adequate performance for our model. The key players in our model were recipient age (variable importance = 0.26), donor age (variable importance = 0.17), donor ethnicity (variable importance = 0.90), followed by dialysis vintage pre-transplantation.

Conclusion
The ANN model had high discrimination, calibration, and performance indices for predicting death censored graft survival prior to transplant. It can aid the clinical decision for management of the transplant patients. We are currently developing a user-friendly web application that can be used to apply the ANN model for prediction. Our model can help ranking potential living kidney donors based on graft outcomes. Therefore, our model can help improve current outcomes of kidney paired exchange schemes.
#6905 PREVALENCE OF ANTIPLA2R ANTIBODIES IN EGYPTIAN PATIENTS WITH NEPHROTIC SYNDROME
Authors: Elsharkawy Magdy , Elsharabasy Reem , Megahed Mohamed , Emara Ahmed 
Published: June 2023

Abstract

Background and Aims
Primary membranous nephropathy (PMN), a common form of the nephrotic syndrome, is an antibody-mediated autoimmune glomerular disease. Autoimmunity is driven by circulating autoantibodies that bind to one or more antigens on the surface of glomerular podocytes. PLA2R antigen is the most common and prevalent one among these antigens. Anti-PLA2R antibodies are measured in serum and detected within biopsies of primary membranous nephropathy patients. Up to the moment, no clear data about the prevalence of AntiPLA2R antibodies associated PMN in Egyptian patients. The aim of this work was to study the prevalence of antiPLA2R antibodies in Egyptian patients with nephrotic syndrome underwent renal biopsy.

Method
In this cross-sectional study we recruited 70 adult patients presented with nephrotic range proteinuria to Ain-shams university hospital and a private nephrology center in Cairo during a period of 20 months (from March 2020 to October 2021). All patients first presentation for whom laboratory investigations including serum anti-PLA2R antibodies titer by indirect immunofluorescence and kidney biopsy were done. Anti-PLA2R antibodies were measured in serum, checked in biopsies and correlated with biopsy findings.

Results
Membranous nephropathy (primary and secondary) was found by biopsy finding in 25 of 70 patients (35.7%) presenting with nephrotic range proteinuria. 21 patients (84%) of the cases of membranous nephropathy had been diagnosed with primary membranous nephropathy and 4 (16%) had been diagnosed with secondary membranous nephropathy. Circulating anti-PLA2R antibodies were detected within serum in 9 (42.85%) of primary MN cases while detection of anti-PLA2R antibodies within the glomerular extracts of primary MN cases was much higher; 17 patients (80.95%). There was positive correlation between serum AntiPLA2R Antibodies titer and U PCR (r = 0.839, P = 0.005) (Fig. 1).

Conclusion
A we may conclude that, most patients with primary membranous nephropathy have anti-PLA2R antibodies. Detection of anti-PLA2R antibodies within the biopsy has higher sensitivity than serum (80.95% versus 42.85%). Specificity of PLA2R to primary membranous nephropathy is 100%. Patients with high anti-PLA2R titer had higher baseline proteinuria than patients with lower anti-PLA2R titer.
#2617 CHANGES IN PSYCHOSOCIAL HEALTH IN YOUNG ADULTS WITH KIDNEY FAILURE: A 5-YEAR FOLLOW-UP OF THE SPEAK STUDY
Authors: Al-Talib Mohammed , Caskey Fergus , Ben-Shlomo Yoav , Inward Carol , Hamilton Alexander 
Published: June 2023

Abstract

Background and Aims
Young adulthood is a sensitive developmental period, and the psychosocial impact of kidney failure in this group is implicated in the observed high risk for transplant loss and death. In the Surveying People Experiencing young Adult Kidney failure (SPEAK) study we described differences in life-course outcomes, worse mental wellbeing and twice the likelihood of psychological disturbance among UK young adults with kidney failure (transplant or dialysis) compared to the general population. There have been no longitudinal studies investigating the natural history of these outcomes as young adults mature and get older. We undertook SPEAK-2 as a five-year follow-up study to address this.

Method
In this prospective observational study, respondents to SPEAK were invited to complete a revised online survey. PPI guided components of the original survey to amend. We analysed how psychosocial health had changed among respondents between studies using the paired t-test, Wilcoxon signed-rank test and McNemar's test for continues parametric and non-parametric data, and binary data respectively. We compared responses to age-matched respondents of the Health Survey for England 2012 using regression. Responses were weighted to increase generalisability.

Results
We had 158 survey responses. The analysis of psychological health change over time is presented in Table 1. A greater proportion of participants had evidence of psychological morbidity (45% versus 24% in the original SPEAK study; p&lt;0.001). They had inferior mental wellbeing (Warwick-Edinburgh Mental Wellbeing Scale [WEMWBS] β, -1.76; 95% CI, -3.27 to -0.25; P = .02). No differences were identified in domains including quality of life (EQ5D).
Key outcomes of the comparison to the age-matched general population are presented in Table 2. Respondents were less likely to be married or have children and were more likely to be living with their parents. They were almost 15 times more likely to report being unable to work due to health. Respondents had poorer quality of life and poorer mental wellbeing compared to the general population. They also five times greater odds of having psychological problems or mental ill health.

Conclusion
We report the first longitudinal study of the psychosocial health of a cohort of young adults with kidney failure as they age and mature. Over five years, we observed worse psychosocial health in terms of mental wellbeing and psychological morbidity. Respondents also lagged behind their peers in terms of life-course and psychosocial outcomes. Dedicated long-term follow-up is needed to clarify the extent and duration to which kidney failure in young adulthood impacts life participation and psychosocial health in the long term. Regardless, the degree of psychosocial ill health we have described warrants urgent increased support for this group.