bluuebunny/crossref_metadata_2025_split huggingface dataset:
#4483 THE 2021 KDIGO BLOOD PRESSURE TARGET AND THE PROGRESSION OF CHRONIC KIDNEY DISEASE: FINDINGS FROM THE KNOW-CKD
Authors: Lee Hyun Jung , Park Cheol Ho , Kim Hyung Woo , Park Jung Tak , Chang Tae Ik , Yoo Tae-Hyun , Kang Shin-Wook , Han Seung Hyeok 
Published: June 2023

Abstract

Background and Aims
The 2021 Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline for management of blood pressure (BP) in chronic kidney disease (CKD) recommends a target systolic BP of &lt;120 mmHg because this lower target can provide cardiovascular benefits. However, whether implementing the new BP target could improve kidney outcome remains unknown.

Method
We examined the association of the 2021 KDIGO BP target with CKD progression compared with the 2012 KDIGO BP target among 1724 participants from the Korean Cohort Study for Outcomes in Patients With CKD. The main exposure was BP status categorized according to the 2012 or 2021 KDIGO guideline: 1) controlled within 2021 target; 2) controlled within 2012 target only; and 3) above both targets. The primary outcome was a composite kidney outcome of ≥50% decline in estimated glomerular filtration rate from baseline measurement or the initiation of kidney replacement therapy during the follow-up.

Results
During 8,078 person-years of follow-up (median, 4.9 years), the composite kidney outcome occurred in 650 (37.7%) participants. The incidence rates of this outcome were 55, 66.5, and 116.4 per 1,000 person-years in BP controlled within the 2021 and 2012 KDIGO targets, and BP above both targets, respectively. In the multivariable cause-specific hazard model, hazard ratios for the composite outcome were 0.76 (95% confidence interval, 0.60-0.95) for BP controlled within the 2021 target and 1.36 (95% confidence interval, 1.13-1.64) for BP above both targets, compared with BP controlled within 2012 target only.

Conclusion
The newly lowered BP target by the 2021 KDIGO guideline was associated with improved kidney outcome compared with BP target by the 2012 KDIGO guideline.
#4506 ACCURACY OF NOVEL GFR ESTIMATING EQUATIONS BASED ON CREATININE, CYSTATIN C OR BOTH IN ROUTINE CARE
Authors: Fu Edouard , Levey Andrew , Faucon Anne-Laure , Delanaye Pierre , Inker Lesley , Carrero Juan Jesus 
Published: June 2023

Abstract

Background and Aims
New equations to estimate GFR (eGFR) based on creatinine, cystatin C or both have been developed in the last two years. A comprehensive comparison of their accuracy is currently lacking, particularly in cohorts not involved in their development or validation and among people with comorbid conditions.

Method
We included 6174 adults from the Stockholm Creatinine Measurements (SCREAM) project referred for plasma clearance of iohexol during 2011-2021, in whom we observed 9579 concurrent measurements of creatinine, cystatin C and iohexol clearance. We assessed the performance against measured GFR (mGFR) of eGFR equations proposed by the CKD-EPI collaboration (CKD-EPI 2009, 2012 and 2021), European Kidney Function Consortium (EKFC 2021 and 2023), and the revised Lund-Malmö (2011) and CAPA (2014) equations, which are used in Sweden. Bias was expressed as the median difference in eGFR minus mGFR, with negative biases indicating underestimation of mGFR. P30 described the percentage of individuals with eGFR within 30% of mGFR. Correct classification was defined as agreement of eGFR and mGFR categories using the KDIGO GFR categories. Subgroup analyses were conducted according to age, sex, BMI, eGFR, cancer, cardiovascular disease, diabetes, heart failure and liver disease.

Results
Mean age was 57 years, 46% of participants were female, mean mGFR was 62 mL/min/1.73 m2 and mean BMI was 26 kg/m2. Cardiovascular disease was the most common comorbid condition (30%), followed by liver disease (28%), diabetes (26%) and cancer (26%). Equations that used both creatinine and cystatin C had better performance than eGFR using each marker alone, regardless of the equation used; all such equations had small bias and P30 close to 90%. Among creatinine-based equations, CKD-EPI 2009 and CKD-EPI 2021 showed larger overestimates of mGFR than EKFC 2021 and revised Lund-Malmö, with median biases of 5.6, 9.1, 2.7 and 0.2 mL/min/1.73 m2, respectively (Table 1). There were no meaningful differences in performance across eGFR equations based on cystatin C. Findings were consistent across subgroup analyses stratifying for comorbid conditions (Figure 1).

Conclusion
eGFR equations that combined information on creatinine and cystatin C performed better than equations based on creatinine or cystatin C alone in this Swedish cohort of routine referrals for plasma clearance of iohexol. There was larger variation in the performance of equations based on creatinine than cystatin C.
#4520 THE USE OF FAR INFRARED LIGHT DURING HEMODIALYSIS SEEMS TO MAINTAIN ARTERIOVENOUS FISTULA BLOOD FLOW BETTER THAN USING A HEAT PAD - A PILOT STUDY
Authors: Wãrme Anna Vb , Peters Björn , Nasic Salmir , Stegmayr Bernd 
Published: June 2023

Abstract

Background and Aims
The use of the native arteriovenous fistula (AVF) in chronic hemodialysis (HD) patients yields great challenges to keep a patent AVF, especially among those with diabetes mellitus and cardiovascular disease. Often repeated radiological interventions or surgery of the AVF is necessary. Accumulation of advanced glycation end products (AGE) in tissue is shown to contribute to the complications of diabetes mellitus and uremia [1]. Far infrared light (FIR) irradiation of the AVF have shown protective effects in maintaining AVF blood flow [2,3]. Using a heat pad (HP) to stimulate vascular flow is another alternative. Primary aim of the study was to compare if the use of a HP is as good as FIR to maintain AVF blood flow. Secondary aim: Evaluate change in AGE accumulation in tissue after FIR and HP treatment.

Method
This pilot study included HD patients with a native lower arm AVF. Eighteen patients were randomly assigned to treatment during HD; Ten patients to FIR and another group of eight patients to use HP (Two of the HP-patients refused to fulfill the study). Before and after a period of 15 HD treatments each, blood tests, AVF blood-flow measured with a Transsonic® and skin autofluorescence (SAF, measuring AGE) were analyzed. The distance of the FIR emitter to the AVF puncture area was 25 cm. The HP-group was exposed to a waterfilled rubber HP that kept a temperature of 40-41°C and was positioned to the backside of the AVF arm to avoid dislodgement of or compressing needles. The patient was her/his own control and non-parametric Mann-Whitney U- and Wilcoxon sign ranked tests were used.

Results
The blood flow of the AVF was similar at start in the FIR group versus the HP-group median 921 ml/min IQR (714-1210) vs. 610 ml/min, IQR (538-861), p = 0.118, while after 15 treatments the blood flow was maintained in the FIR group but was lower in the HP-group; median 902 ml/min IQR (718-1241) vs. 635 ml/min IQR (531-772), p = 0.022. The FIR exposure did not alter the SAF content (in arbitrary units -AU) after treatment and was similar in the FIR group (median 3.2 AU, IQR 2.2-3.6) and in the HP group (median 3.2, IQR 2.4-3.3), p-value = 0.864.During the follow-up period after 3 and 6 months, PTA was performed due stenosis with decreased blood flow of the AVF in 3/10 patients in the FIR group and 1/6 patients in the HP group. Data are given as median and interquartile range (IQR). A two-sided p-value of &lt;0.05 was defined as significant.

Conclusion
This pilot study showed that the access flow after FIR versus HP exposure during 15 HD treatments was better maintained among patients treated with FIR than with HP. SAF as a predictor for atherosclerosis was not changed. Long-term exposure to FIR may be necessary.
#4583 NEUROLOGICAL DISEASES TREATED WITH PLASMAPHERESIS PERFORMED BY NEPHROLOGISTS
Authors: Valdivia Verónica Ruth Mercado , Carrillo Rocío Echarri , Villalobos Ángel Gallegos , Sánchez Gabriel Ledesma , Orjuela Yesika María Amezquita , Mancebo Raquel Diaz , Ruisánchez Sílvia Caldés , Hernández Yolanda Hernández , Ojanguren María Covadonga Hevia , García Antonio Cirugeda 
Published: June 2023

Abstract

Background and Aims
Apheresis is an extracorporeal technique whose objective is to eliminate pathological elements considered to be responsible for a disease or its clinical manifestations. Plasmapheresis is part of the nephrology activity that will precise to be promoted within clinical practice. It is a therapeutic alternative for a large number of diseases, with certain neurological pathologies being the most benefited of its use. The purpose of this study is to describe the experience with plasmapheresis performed by nephrologists on patients with neurological diseases.

Method
Descriptive-retrospective study of neurological diseases treated with plasmapheresis in our nephologist section between the years 2008-2023. We analyzed demographic data, underlying disease, procedure, complications, and clinical response of the patients.

Results
A total number of 31 plasmapheresis procedures have been performed, of which 16 procedures have been performed in neurological diseases with a total of 92 sessions. The average age was 47 years, with 69% of the female sex predominance. The most frequently disease treated was Multiple Sclerosis with 31%, followed by Acute demyelinating polyneuropathy in the form of Guillain Barré with 25%, Myasthenia Gravis and Voltage-Gated Potassium Channel Antibody Related antiLGi-1, both with 13%. Treatment prior to the technique was corticosteroids with 75%, immunoglobulins with 56% and immunosuppressants with 13%. All sessions were performed using the transmembrane filtration technique with plasmaFlux® and the Fresenius mulitiFiltrate® equipment. The median number of sessions per patient was 6. The mean exchange volume was 2.9 l/patient/session. The replacement fluid used was albumin on 100% of patients and 4 patients required albumin plus fresh frozen plasma. 75 percent of the patients had a positive response with partial remission or stability of the disease and 88 percent had no recurrences. Patients’ neurological response to the therapy was the expected, and similar to the one reported in the medical literature.

Conclusion
In our experience, plasmapheresis is a safe and effective therapy in patients with neurological diseases that should be required as a therapeutic option. We, as nephrologists must be aware of this and promote the management of this technique by publishing the joint experience in order to broaden the level of evidence in clinical practice. The importance of coordination in early referral by other different medical specialties may obtain better results.
#4606 INNOVATIVE METHOD TO EVALUATE MATURATION OF NEWLY CREATED ARTERIO-VENOUS FISTULAS: INSIGHTS FROM A QUALITY IMPROVEMENT PROJECT
Authors: Merlo Laura Rosales , Ye Xiaoling (Janice) , Zhang Hanjie , Chan Brenda , Mateo Marilou , Van Der Sande Frank , Kooman Jeroen , Kotanko Peter 
Published: June 2023

Abstract

Background and Aims
Recently, we introduced central-venous oxygen saturation (ScvO2) and estimated upper-body blood flow (eUBBF) to monitor the maturation of newly created arterio-venous fistulas (AVF) in hemodialysis (HD) patients [1]. The approach was implemented in a clinical quality improvement project (QIP).

Method
The QIP involved two Renal Research Institute dialysis centers in New York City that use the Crit-Line monitor (CLM, Fresenius Medical Care, Waltham, MA, USA) as part of the standard of care. CLM measures
automatically and non-invasively hematocrit and oxygen saturation (i.e., ScvO2 in patients with central venous catheter as vascular access). eUBBF was computed as described previously [1]. Patients with a with a newly created AVF were included, irrespective of their HD vintage. The QIP team comprised a registered nurse per clinic, two research physicians, and two data analysts. The team met weekly to assess the AVF maturation progress based on eUBBF and ScvO2 data that were displayed on a specific dashboard. Successful AVF maturation is typically accompanied by a rise in cardiac output and eUBBF that starts immediately after AVF creation. However, it is unknown what degree of eUBBF increase indicates a subsequently successful AVF maturation. To identify predictive eUBBF thresholds, we correlated eUBBF changes with the progress of AVF maturation in the six weeks following AVF creation. We defined maturation as unsuccessful when the newly created AVF required an intervention (e.g., angioplasty) or was abandoned.

Results
We studied 39 patients (age 56 ±18 years; 25 males). Twenty-eight of them were incident patients. Two patients had a second AVF created. In 15 patients AVF maturation was unsuccessful. In these patients, eUBBF increased to an average of 119.2% (SD 35.2) compared to pre-AFV creation. In patients with successful AFV maturation (N = 24), eUBBF increased to an average of 153.7% (SD 31.6) (Figure 1). The difference between the groups is 34.4 percentage points (95% CI: 12.4 to 56.4; p = 0.003). Using eUBBF as a diagnostic measure to discriminate successful vs. failed AVF maturation, an area under the receiver operating characteristics curve of 0.824 (95% CI: 0.673 to 0.925; p&lt;0.0001) was obtained. An eUBBF increase of 25% had a sensitivity of 59% and a specificity of 92% to predict AVF maturation outcomes.

Conclusion
Computation of eUBBF provides a simple and non-invasive means to track AVF maturation and predict its outcomes.
#4611 THE INTEREST OF THE COMBINATION OF AN ANTIOXIDANT AND ANGIOTENSIN II RECEPTOR ANTAGONISTS IN THE REDUCTION OF RENAL FIBROSIS
Authors: Azouaou Leila 
Published: June 2023

Abstract

Background and Aims
Chronic kidney disease represents one of the frequent pathologies of non-communicable diseases where the mortality rate is high. Oxidative stress is one of the main causes of the deterioration of renal function. The aim of this work is to develop a new therapeutic molecule with an anti-fibrotic effect associated with an antioxidant to increase renal clearance.

Method
This is an experimental study using the aminonucleoside model of puromycin (PAN) on Sprague-Dawley rats weighing between 100 and 150 g. Mice are resistant to the effect of PAN Administration of PAN can be subcutaneous (SC) intravenous (IV) and intraperitoneal (IP)). The dosage for IV and IP administration of PAN is generally 150 mg/kg body weight and 120 mg/kg body weight for SC administration. Control rats receive an isotonic saline solution. The progression of glomerular lesions to glomerular fibrosis depends on the cumulative dose of PAN. The single injection of PAN induces reversible fibrosis lesions between the seventh and one month and after reinjection irreversible lesions. The mice benefited from PAN 2 injections on the 1st day and on the 40th day. the new molecular association was made on 15 days and 50 days.

Results
Two to four days after the injection of PAN, a disorganization of the ultrastructure of the pedicels is observed with a flattening of the podocyte feet, an effacement of the pedicels, a modification of the actin cytoskeleton and the disappearance of the diaphragm of cleft. The ultrastructural changes observed 10 days after PAN injection lead to podocyte detachment contemporary with proteinuria. If the aggression continues, podocyte apoptosis is associated with the histological appearance of segmental and focal hyalinosis. After the injection of the molecular combination, a regression of the lesions was observed 15 days after the first injection and 30 days after the second injection.

Discussion
The anti-fibrotic-antioxidant drug combination has a significant anti-fibrotic effect, especially during the first injection, the effect is less important during the evolution of histological fibrosis. The antioxidant gave a synergistic effect to the anti-fibrotic effect

Conclusion
The experimental study is very promising concerning the antioxidant ARII molecular association while waiting for the clinical trial that will hopefully be promising for this new association.
#4617 THE IMPACT OF DONOR NEPHRECTOMY ON THE ELDERLY LIVING KIDNEY DONORS
Authors: Hiramitsu Takahisa , Futamura Kenta , Okada Manabu , Norihiko Goto , Ichimori Toshihiro , Narumi Shunji , Watarai Yoshihiko 
Published: June 2023

Abstract

Background and Aims
Because of the serious cadaveric donor shortage, the number of living donor kidney transplantation (LDKT) is increasing. To increase the living donor (LD) source, elderly LDs are indicated for the donor nephrectomy. However, the safety of the LDs ≥ 70 years is still remained to be investigated.

Method
Bewteen January 2008 and December 2020, a total 1226 LDs for LDKT was included in this retrospective cohort study. LDs were stratified into 3 groups based on age; 244 LDs aged 30-49 years, 803 LDs aged 50-69 years, 179 LDs aged 70-89 years. To investigate the safety of donor nephrectomy in the LDs ≥ 70 years, operative outcomes, the estimated glomerular filtration rate (eGFR) changes, end stage renal disease (ESRD), and mortality were investigated among 3 groups. eGFR changes were analyzed using mixed linear models. The contributing factors for the recovery in the eGFR from the nadir eGFR were analyzed using multivariate linear regression analysis adjusted for mixed linear models. Mortality rates were analyzed using Cox regression models.

Results
In the LD characteristics, significant difference was identified in sex. In the operative outcomes, significant difference was not identified in operative duration,blood loss, and complications among 3 groups. In the mixed linear models adjusted for sex, eGFRs of LDs aged 70–89 years were significantly lower at any time points after donor nephrectomy than those in 2 other groups (Figure 1). The eGFR after donor nephrectomy recovers with time in 3 groups. The recoveries in the eGFR from the nadir eGFR were similar among 3 groups. The recoveries in the eGFR were independently affected by the hypetension (P = 0.008), smoking history (P &lt; 0.001), and body mass index (P = 0.011) at donor nephrectomy. Donor age was not the independent factor. The mortality rate of LDs aged 70-89 years was significantly higher than those in 2 other groups (Figure 2). However, during the observational period, ESRD was not identified among 3 groups.

Conclusion
eGFR changes and mortality rate were significantly low in LDs aged 70-89 years. However, the recoveries in the eGFR from the nadir eGFR were similar among 3 groups. ESRD was not identified among 3 groups. These results implied that LDs aged 70–89 years might undergo donor nephrectomy safely and complete their lives without ESRD after donor nephrectomy.
#4624 VISCOELASTICITY MEASUREMENT- A NEW ULTRASOUND-BASED ELASTOGRAPHY METHOD IN THE ASSESSMENT OF THE KIDNEY
Authors: Felix-Mihai Maralescu , Bob Flaviu , Grosu Iulia Dana , Schiller Adalbert , Petrica Ligia 
Published: June 2023

Abstract

Background and Aims
Viscoelasticity is the result of the tissue's combined viscous and elastic response to stress. This characteristic can reveal details about the function of the kidney and is essential for comprehending how it responds to deformation. Hologic Aixplorer Mach 30 ultrasound system comes with new and improved software that indirectly assesses the viscosity of the renal tissue by measuring tissue shear wave dispersion.

Method
Over the course of 2022 we performed a cross-sectional study by including 50 healthy participants, 50 kidney-transplanted patients, and 40 patients with chronic glomerulonephritis (before being referred for renal biopsy). Viscosity plane-wave ultrasound (Vi PLUS) measurements were performed on each participant, and the mean value of five distinct evaluations for each kidney was correlated with their demographic, biological, and clinical parameters.

Results
The mean viscosity value for the healthy group was 2.44 ± 0.57 Pascal.second (Pa.s), correlated with age (r = -0.4251, p = 0.0021), estimated glomerular filtration rate (eGFR) (r = 0.4057, p = 0.0038) but it did not correlate with C reactive protein (CRP), the mean value for Vi PLUS in the kidney-transplanted group was 2.82± 0.59 Pa.s, correlated with eGFR (r = 0.3335, p = 0.0180), but not with age or CRP, and the mean value for the patients with chronic glomerulonephritis group was 2.39 ± 0.73 Pa.s, did not correlate with age, but correlated with eGFR (r = 0.3637, p &lt; 0.0211) and CRP (r = -0.3695, P = 0.0189) and we also found for a cut-off value of &lt;2.8 Pa.s for detecting the presence of tubulointerstitial fibrosis with an AUC of 0.792, p &lt; 0.001 with 94% sensitivity, and 60% specificity. Results of one-way ANOVA (p = 0.001), used to test the differences in the variables among the three groups, showed statistically significant higher values for the viscoelasticity in renal transplant patients compared to the other two groups, but no differences between the healthy and chronic glomerulonephritis groups.

Conclusion
Our results show that this novel ultrasound technique correlates with renal function and inflammation (in chronic glomerulonephritis patients) and it is also capable of discriminating between patients with and without tubulointerstitial fibrosis, but further research is needed for it to be implemented into routine clinical practice.