bluuebunny/crossref_metadata_2025_split huggingface dataset:
#5497 PREVALENCE, TREATMENT AND RECURRENCE OF STAPHYLOCOCCUS AUREUS NASAL CARRIAGE IN PATIENTS ON RENAL REPLACEMENT THERAPY
Authors: Tsikliras Nikolaos , Anagnostara Aggelina , Tsantekidou Florina , Kyrgialanis Apostolos 
Published: June 2023

Abstract

Background and Aims
Searching for and treating nasal carriage of staphylococcus aureus in patients undergoing renal replacement therapy (RRT) has been debated. Indeed, previous meta-analyses showed that dialysis patients who were treated with intranasal mupirocin had lower rates of staphylococcus aureus infection but significantly more infections by other microorganisms. However, given the severity of staphylococcus aureus infections, it seems reasonable to detect and treat nasal carriers among patients on RRT. The aim of our study was to estimate the prevalence of staphylococcus aureus nasal carriage in patients on RRT, to evaluate the effectiveness of intranasal mupirocin in eradication of staphylococcus aureus and to detect the recolonization rate with the above microorganism after successful treatment.

Method
It was a single center prospective observational study. In 63 patients undergoing RRT (48 on hemodialysis and 15 on peritoneal dialysis) we performed cultures of the anterior nares to identify the carriage of staphylococcus aureus. Carriers then received intranasal mupirocin twice daily for seven days (in every nostril). Thirty days later, nasal cultures were repeated in those treated with mupirocin. In patients that were decolonized, new cultures were obtained three months after initial eradication of staphylococcus aureus had been detected.

Results
Nasal carriage of staphylococcus aureus was identified in 14 out of 63 patients (rate = 22%). Female sex was related with higher rate of nasal carriage (p = 0.014). All but one patient that received mupirocin were found decolonized after thirty days (cure rate = 92.8%). Recurrence of staphylococcus aureus nasal carriage was observed in 6 out of 13 patients that had successfully been treated (recurrence rate = 46%). Sex, age, renal replacement method, primary disease or previous immunosuppression treatment didn’t seem to significantly affect the possibility of recurrence.

Conclusion
Our study found a remarkable prevalence of staphylococcus aureus nasal carriage in patients on RRT. Intranasal mupirocin was highly effective in the eradication of the above microorganism, but nearly half of the successfully treated patients experienced a recurrence of nasal carriage. Further studies are needed to detect the effect of repeated mupirocin treatment to the nasal carriage status as well as to the rate of infection in the above population.
#5525 NEPHROTOXICITY OF CHIMERIC ANTIGEN RECEPTOR T CELL (CAR-T) THERAPY: ACUTE KIDNEY INJURY AND ELECTROLYTE DISORDERS
Authors: Francés Francesc Moncho , Morales Rafael Hernani , Solis Miguel Angel , Vallejos Ana Benzaquén , Garcia Isabel Juan- , Boluda Juan Carlos Hernández , Sanchez Jose Luis Piñana , Pérez Ariadna , Teruel Jose Luis Gorriz , Maicas Isidro Antonio Torregrosa 
Published: June 2023

Abstract

Background and Aims
Chimeric antigen receptor T cell therapy (CAR-T) has improved the prognosis of patients with refractory hematologic malignancies. The most important toxicities are the cytokine release syndrome (CRS), where interleukin 6 (IL-6) plays a major role, and the immune effector cell-associated neurotoxicity syndrome (ICANS). A low incidence of acute kidney injury (AKI) with a high frequency of electrolyte imbalance has been described with CAR-T therapy. The aim of our study is to describe the nephrotoxicity of CAR-T therapy and to focus on AKI and the physiopathology of hypophosphatemia.

Method
A prospective single-center case series was performed which included all patients undergoing CAR-T therapy between 2020 and 2022. Clinical data included medical history, previous chemotherapy treatments, concomitant treatments, and clinical evolution. Daily monitoring of renal function, electrolytes and IL-6 was obtained after infusion of CAR-T. A urine sample was obtained on days 0, +7 and +14 with parathyroid hormone (PTH) and 25-OH vitamin D. AKI was classified according to the KDIGO criteria.

Results
40 patients received CAR-T therapy during the follow-up period. The median age was 62 years. The same number of men as women were included. The most frequent comorbidities were hypertension (27.5%), followed by diabetes (12.5%) and chronic kidney disease (12.5%). 12 patients presented AKI. Baseline serum creatinine (SCr) in patients with AKI was 0.9 mg/dL (0.68-1.04) with a SCr peak of 1.27 mg/dL (1.1-1.7). The time from CAR-T therapy infusion to SCr peak was 6.5 days (4-10). Of these 12 patients, 8 presented stage 1, 3 stage 2, and 1 stage 3 AKI. There were no differences between the AKI and non-AKI group in baseline characteristics, inflammatory markers, CRS, ICANS or hospital length stay. Hypophosphatemia was the most frequent electrolyte imbalance, occurring in 36 patients (90 %), 22 (61 %) patients experienced moderate hypophosphatemia (phosphorus &lt; 2 mg/dL) while 14 (39 %) patients experienced mild hypophosphatemia. 29 patients (72 %) presented hypokalemia and 25 patients (62.5 %) hyponatremia. Patients with moderate hypophosphatemia had a significantly higher elevation of IL-6 but there were no differences in PTH or vitamin D (Table 1). Although there were no significant differences in fractional excretion of filtered phosphate (FEPO4), patients with moderate hypophosphatemia trend to have higher FEPO4 values.

Conclusion
Electrolyte disturbances are common in CAR-T therapy, with hypophosphatemia being the most frequent. There is probably a mechanism for renal phosphorus loss related to systemic inflammation. AKI is less frequent and has mild characteristics in these patients.
#5541 EVALUATION OF PROTEIN MALNUTRITION IN CKD PATIENTS ON LOW-PROTEIN DIET
Authors: Bologna Arianna , Pisoni Matteo Brambilla , Avino Monica , Giambo Federica , Arcidiacono Teresa , Vezzoli Giuseppe 
Published: June 2023

Abstract

Background and Aims
Low-protein diet is considered crucial in patients with chronic kidney disease to slow down kidney function deterioration and control metabolic variables such as serum phosphate, urea and bicarbonate. However, low-protein diet may result in malnutrition if patients do not respect nutritional prescription. Thus, the present study examined the risk of protein malnutrition in CKD patients who started a low-protein diet.

Method
We analysed anthropometric variables, nutrient intake and body composition in 27 patients with CKD stage 4-5 (M/F 15/12; 69±15 years; 72±18 kg; BMI 27.3±7 kg/m2; serum creatinine 4.9±1.9 mg/dl; GFR 11±4 ml/min; 10 diabetic patients) before and after 3-months of low-protein diet (0.6 g/kg). We estimated nutrient intake with a food frequency questionnaire composed of 37 items and administered by a nutritionist who also prescribed the low-protein diet. We also measured body fat mass (FM) and free-fat mass (FFM) and appendicular skeletal muscle mass using bioimpedentiometry analysis (Akern, Florence). Patients having a protein intake lower than 0.6 g/kg at the nutritional survey was defined as malnourished.

Results
In the whole sample, after a 3-month diet protein intake decreased from 0.87±0.23 to 0.69±0.18 g/kg (p&lt;0.001; Wilcoxon test). Protein intake was positively correlated with 24-h urine excretion of phosphate at baseline (r = 0.69, p = 0.012) and after 3-monts of diet (r = 0.62, p = 0.02). The diet induced a decrease in body weight (72±18 to 70±17 kg; p = 0.001), BMI (27.3±7 to 26.7±6.8 kg/m2; p = 0.001), FM (24±11 to 21±11 kg; p = 0.006), serum phosphate (1.68±0.33 to 1.52±0.32 mmol/l; p = 0.033) and urea (166±53 to 133±42 mg/dl; p&lt;0.001), whereas FFM, expressed as percentage of body weight, significantly increased (69±9 to 73±8%; p = 0.011). Six patients (22%; 3 diabetic patients) had a protein intake lower than 0.6 g/kg after 3-months of diet. Their protein intake was significantly lower than that in the other 21 patients with protein intake above 0.6 g/kg (0.43±0.1 vs 0.77±0.12 g/kg; p&lt;0.001). These patients had lower FM (14±2 vs 26±11 kg; p = 0.03) and protein intake before starting the low-protein diet than the other 21 patients (0.64±0.06 vs 0.94±21 g/kg; p = 0.003). Patients with protein intake lower than 0.6 g/kg slightly decreased FFM after 3 months of diet compared to the value at baseline (52±7 to 50±7 kg; p = 0.07); conversely the other 21 patients did not change FFM (51±10 to 53±11 kg; p = 0.17), but significantly decreased FM (26±11 to 23±12 kg; p&lt;0.001).

Conclusion
In conclusion, protein malnutrition may occur during a low-protein diet in CKD patients with a low consumption of proteins before starting this diet. Nutritional analysis is necessary to identify CKD patients at risk of protein malnutrition and to adequately follow up CKD patients on low protein diet.
#5554 ROLE OF THE TUBULAR EPITHELIAL CELL NLRP3 INFLAMMASOME DURING HYPERGLYCEMIA AND GLUCOSURIA IN DIABETES
Authors: Honda Tamisa , Marschner Julian , Zhao Danyang , Anders Hans-Joachim 
Published: June 2023

Abstract

Background and Aims
Diabetes is a prominent risk factor for the progression of CKD because hyperglycemia and glucose filtration increase the hemodynamic and metabolic workload to the nephrons, which imposes adaptive mechanisms. Tubules adapt to diabetes by enlargement and epithelial cell hypertrophy but an exceeding metabolic workload promotes oxidative stress, cytokine signaling and tubular epithelial (TEC) cell demise leading to tubular atrophy and interstitial fibrosis. Several studies propose a role of the NLRP3 inflammasome in tubulointerstitial inflammation in diabetic and non-diabetic kidney disease. The NLRP3 inflammasome is a sensor of cellular damage responsible for regulate the IL-1β and IL-18 production, playing important role during the progression of CKD. However, the role of NLRP3 in diabetes-induced tubular adaptation is unknown.

Method
scRNAseq analysis showed previously that the TECs do not express NLRP3 or inflammasome components. However, a group of patients diagnosed with Cryopyrin-Associated Autoinflammatory Syndromes, have a mutation that overexpress NLRP3, which is associated with chronic and systemic inflammation. To investigate the role of NLRP3 on tubular cells under diabetes conditions, we generated a mouse line by crossing mice bearing LoxP-target A350V allele with Pax8-driven Cre transgenic mice. Animals carrying the A350V allele have overexpression of NLRP3 in tubular cells. The combination of unilateral nephrectomy and treatment with multiple low doses of streptozotocin (60 mg/Kg) accelerate the kidney injury caused by hyperglycaemia. Kidney function, histology and gene expression were evaluated at the end of 16 weeks of diabetes. In vitro experiments carried out using TECs isolated from Pax8-A350V, and stimulated with LPS (1µg/ml) and/or ATP (20 mM).

Results
In silico analysis showed TECs do not express NLRP3 or inflammasome components. A350V-TECs under inflammasome activation did not produce IL-1β or IL-18. However, the Nlrp3 overexpression upregulated kidney injury markers, as well IL-6 and TNF. Moreover, the increase in kidney inflammation was associated with significative upregulation of fibrosis markers (Tgfb1, Asma, and Fn1) and extracellular molecules (Ctgf, AnxaII, and Chd2). Diabetic mice carrying the A350V mutation did not have significative differences in blood glucose, albuminuria, or body weight when compared with diabetic control mice. The overexpression of NLRP3 in tubular cells was associated with significative reduction in GFR and BUN when compared with controls mice, even though no differences in tubular injury markers observed. Furthermore, Pax8-A350V diabetic mice expressed significantly more Nlrp3 and Il1b than control group. Although, no differences observed in cryopyrin staining.

Conclusion
Our data suggest the NLRP3-associated damage in tubular epithelial cells occurs in a non-canonical manner.
#5564 OUTCOMES OF PERITONEAL DIALYSIS AFTER KIDNEY TRANSPLANT FAILURE: A SINGLE-CENTER EXPERIENCE
Authors: Kumru Gizem , Eren Sayeste Akkan , Aktar Merve , Ateş Kenan , Keven Kenan 
Published: June 2023

Abstract

Background and Aims
There is a hesitation in returning peritoneal dialysis (PD) after kidney transplant (KTx) failure. Studies in larger multicentre matched cohorts are missing.

Method
We conducted a retrospective study about 19 patients who started PD after KTx failure (PDpostTx group) between January 2010 and August 2022 in Ankara University School of Medicine who were compared with 70 never-transplanted patients having started PD during the same period (PDnoTx group). Patients’ clinical data and PD technique survival as well as peritonitis episodes were analysed.

Results
Mean age was 51 years and continuous ambulatory PD was the treatment of choice (59.6%) (Table 1). Even the mean time on PD was similar between groups (45.4 months in PDpostTx vs 51.7 months in PDnoTx, p = 0.525), transfer to HD was more common in PDpostTx patients (36.8% vs 10.0%, p = 0.015). The main cause of transfer to HD was ultrafiltration failure, which was significantly higher in PDpostTx group (p = 0.002). Diuresis at baseline was similar between groups, but decreased significantly in PDpostTx group at first year and final follow-up (p &lt; 0.001, and p = 0.001, respectively). Peritonitis was more common in PDpostTx group (68.4% vs 30.0%, p = 0.002). Diabetes mellitus was a risk factor for peritonitis episode (p = 0.012), but we didn’t observe any effect of immunosuppressive therapy on peritonitis and reduction of the diuresis. In multivariate analysis, KTx failure (p = 0.014), peritonitis episodes (p = 0.011) and ultrafiltration failure (p &lt; 0.001) were associated with a higher risk of transfer to HD. Over the study period, patients’ survival was similar between groups (p = 0.766).

Conclusion
We reported similar patient survival, but higher peritonitis rates and PD technique failure in the PDpostTx group, when compared to patients who started PD for other reasons. Considering these findings, taking precautions against peritonitis is more important for patients who started PD after KTx failure.
#5571 THERAPY WITH BUROSUMAB IN ADULT PATIENTS WITH X-LINKED HYPOPHOSPHATEMIA: A YEAR OF FOLLOW-UP
Authors: Rotondi Silverio , Tartaglione Lida , Perrotta Adolfo , Carroccia Nadia , Pasquali Marzia , Mazzaferro Sandro 
Published: June 2023

Abstract

Background and Aims
X-linked hypophosphatemic rickets (XLH) is a genetic disorder secondary to the mutation of the PHEX gene that results in increased circulating levels of FGF23. Increased FGF23 causes hypophosphatemia secondary to renal phosphate loss. Clinically, the disease is characterized by reduced growth, bone alterations, weakness, chronic pain and reduced mobility. From a biochemical point of view, patients have hypophosphatemia, increased values of alkaline phosphatase, increased fraction excretion of phosphate (FEP). Recently, therapy with Burosumab, a monoclonal antibody against FGF23, has been introduced. Burosumab by reducing the receptor availability of circulating FGF23 reduces its activity. This leads to a normalization of serum phosphate and in paediatric patients an improvement of the clinical phenotype. In adult patients, the effectiveness of therapy in improving the clinical outcome and quality of life is being investigated. The purpose of the study was to evaluate the efficacy in improving the biochemical, bone and clinical picture of adult patients with XLH in therapy with Burosumab for one year.

Method
We enrolled patients with XLH naive for Burosumab therapy. In all we evaluated the biochemical aspects (phospahatemia, alkaline phosphatase, FEP), bone Radiographic Global Impression of Change score and clinical improvements (six-minute walk test, UP and go timed test, WOMAC Index) pre therapy and after a year of therapy. Burosumab was administered monthly at a dose of 1 mg/Kg.

Results
We enrolled 5 patients (45 ± 10 year old, weight 60 ± 10 Kg, Burosumab dose 60 ±10 mg) with genetic diagnosis of XLH. The comparison between pre therapy and post-one-year therapy showed in all patients: increase in average phosphatemia (pre 1.9± 0.5 mg/dl vs post 3.4 ±0.6 mg/dl p = 0.003), reduction in FEP (pre 50 ±15% vs 20 ±10% p = 0.004), reduction of UP and go timed test (pre 20± 5 sec vs post 11 ±5 sec p = 0.005) increase of the distance in the six minutes’ walk test (pre 150 ± 30 meters vs post 250 ± 50 meters p = 0.01), improvement of the WOMAC test (pre 15± 3 vs post 5± 2; p = 0.008) and reduction of the Radiographic Global Impression of Change score (pre -2 ±0.5 and post 2± 0.4; p = 0.001). The serum value of alkaline phosphate was high and it did not change with the Burosumab therapy (pre 200±50 UI/L vs post 220±60 UI/L; p: n.s. n.v. 33–98 UI/L). No patients had significant complications during the first year of treatment.

Conclusion
The therapy with Burosumab was well tolerated by patients. It resulted in a marked improvement in the biochemical picture associated with a better quality of life identified by increased strength (improved walk test and UP and go timed test) reduction of pain (best WOMAC test) and bone damage score. In conclusion, Burosumab may be a good and safe therapy option for adults’ patients with XLH.
#5602 DEPRESSION AND ANXIETY IN FAMILY CAREGIVERS OF END STAGE KIDNEY DISEASE PATIENTS IN GREECE: A COMPARISON BETWEEN DIALYSIS AND KIDNEY TRANSPLANTATION
Authors: Vovlianou Stavroula , Koutlas Vasileios , Papoulidou Fani , Tsigaras George , Skapinakis Petros , Milionis Haralampos , Ntounousi Evangelia 
Published: June 2023

Abstract

Background and Aims
Chronic kidney disease (CKD) is considered a high-stress disease because of its chronicity, co-morbidity, and lifelong treatment. Family members are often the main caregivers of end stage kidney disease (ESKD) patients and they are involved in various roles. Caregivers of ESKD patients experience emotional stress, anxiety and depression as they support their family members throughout the disease and treatment. This cross-sectional study aimed to assess depression and anxiety in caregivers of ESKD patients and to compare these disorders between caregivers of hemodialysis (HD) patients’ and kidney transplant recipients (KTR), as well as to investigate potential social-demographic parameters associated with caregivers’ depression and anxiety.

Method
A total of 342 participants (171 couples of patients and caregivers) were recruited. Structured interviews and self-completed questionnaires were obtained from HD patients, KTR (138 HD patients and 33 KTR) and their caregivers. The Beck Depression Inventory and the Generalized Anxiety Disorder-2 scales were used as screening tools. Depression scores were classified into four levels based on the level of severity (low, mild, moderate, severe). The collected data were encoded and analyzed using ΙΒΜ SPSS version 25 and R Statistical Software.

Results
Mean age of caregivers was 58 years and the majority were females (67.2%). Total anxiety score was high (Mdn = 3) with a mildly increased score of depression (Mdn = 9.5). Caregivers’ anxiety and depressive symptoms were significantly associated with gender, duration of caregiving, educational level, financial status, and caregivers’ age (p&lt;0.01 for all). Caregivers’ depression and anxiety were also, related to the type of patients’ treatment (Table 1). HD caregivers reported significantly higher anxiety scores (Mdn = 3(2-5)) in comparison to KTR caregivers (Mdn = 2(2-4)) (p = 0.048) (Table 2). Moreover, HD caregivers revealed higher (Mdn = 11(0-46)) levels of depression than the KTR group (Mdn = 6 (0-25)) (p = 0.049) (Table 3).

Conclusion
Based on the findings of this study, the type of ESKD treatment displayed an important role in caregivers’ anxiety and depression symptoms, with KTR caregivers having the best scores. In particular, KTR caregivers appeared to have lower levels of depression and anxiety than caregivers of HD patients.
#5603 HYPERKALAEMIA MAY LIMIT POTENTIAL RENAL INTERVENTIONS IN PATIENTS WITH LOW GFR AND SIGNIFICANT PROTEINURIA
Authors: Koo Hyewon Nina , Thoren Fredrik , Greasley Peter , Chandankhede Shardul , Khayyam Afrah , Ambery Philip 
Published: June 2023

Abstract

Background and Aims
Evidence-based therapies including ACE inhibitors, ARBs and mineralocorticoid receptor antagonists (MRA) can significantly delay progression of CKD, yet their use is potentially limited by hyperkalaemia risk. In this study, we describe hyperkalaemia events among CKD patients to provide a better understanding of the current unmet need.

Method
This was a retrospective secondary data analysis from electronic medical records (EMR) in the US TriNetX analytics data CKD subset from Jan 2015-Dec 2019. Patients with ≥1 uACR measure were included, whereby the first date of the uACR measure was considered the index date. The study cohort included patients aged &gt; 18 years with a) two consecutive estimated glomerular filtration rate (eGFR) values between 20 and 90 mL/min/1.73m2 recorded 91–730 days apart prior to the index date, or, b) at least one CKD diagnosis code before the index date. Patient demographics, ACE/ARB, MRA and SGLT2i treatments on index were described. The frequency of HK (defined as serum potassium &gt;5.5 mmol/L or a diagnosis code) during a 1-year baseline period and 1-year follow-up period was described by uACR (&gt;700mg/g, 300–700mg/g, &lt;300mg/g) and eGFR (&lt;20mL/min/1.73m2, 20–45mL/min/1.73m2, 45–60mL/min/1.73m2, 60–90mL/min/1.73m2 and &gt;90mL/min/1.73m2) categories.

Results
Baseline characteristics of the included patients are described in the table below. During the 1-year follow-up period, HK events were more frequently recorded for patients with uACR&gt;700mg/g (15.3%), eGFR&lt;60ml/min/1.73m2 (9.3%) and combined uACR&gt;700mg/g and eGFR&lt;60ml/min/&lt;1.73m2 (18.3%).

Conclusion
The preliminary results of this analysis shows that HK occurs more frequently among patients with low eGFR and/or high uACR. Despite guidelines, uACR testing is not done frequently in clinical practice and likely performed more frequently among patients with high uACR. Further analyses and more conservative study definitions will be applied to more comprehensively clarify the unmet need among patients at risk of HK. Of particular interest are the patients who discontinued RAASi treatment after a hyperkalemia event during baseline and were not on renoprotective treatment, yet who had recurrent hyperkalemia. Adequate treatment options for these patients are currently limited, and there is a need for more renoprotective treatments with limited hyperkalemia risk.