bluuebunny/crossref_metadata_2025_split huggingface dataset:
#3786 CORONARY ARTERY CALCIFICATION IN AN SLE PATIENT WITH RENAL:
IS IT PATIENT OR DISEASE RELATED?
Authors: Mohamed Nourelsabah , Refaie Ayman , Zayed Kareem , Sobh Mohamed 
Published: June 2023

Abstract

Background and Aims
Cardiovascular disease is one of the leading causes of death in SLE patients (Fors Nieves CE, et al. 2016). Coronary artery calcium scores can be used as a predictor CVD events, independent of traditional risk factors. CAC scores quantify the presence and extent of calcified plaque in the coronary arteries. A CAC&gt;0 in the general population is an independent predictor of CVD mortality (PatKiani AN, et al. 2015) patients with SLE, especially those aged &gt;45 years, have an increased prevalence of CAC and the presence of renal affection obviously increases this risk. Patients with SLE aged ≤45 years have an increased prevalence of detectable CAC compared with the general population (Yevgeniya Gartshteyn, et al. 2019). We evaluated CAC in SLE with predominantly renal affection.

Method
in this observational study We identified 86 patients with SLE and documented lupus nephritis by renal biopsy ISN/RPS classification 2004, without known coronary artery disease and who had a non-contrast chest CT performed as part of their clinical care, with images retrievable for calculation of CAC scores. Demographics, disease characteristics and comorbidities were ascertained and adjusted for.

Results
15.1% of patients with SLE, LN (mean age 43±11 years, 84%female,) had CAC&gt;0, 53.8% for age ≤45 years and 46.2% for age &gt;45. Patients with SLE with CAC&gt;0 were older and had longer disease duration and higher disease activity than patients with normal CAC (p.value 0.004, 0.004 and 0.02 respectively) Furthermore, DM was at higher incidence in normal CAC patient and all patients with CAC&gt;0 were hypertensive.

Conclusion
Patients with SLE and LN have an increased prevalence of detectable CAC Our data suggest that subclinical atherosclerosis in SLE may develop early and it is directly related to disease factors as its duration and pathological activity. although, patient age is an important risk factor for developing coronary artery calcification. and this need a close monitoring and even some cardioprotective interventions.
#3815 A DEEP LEARNING APPROACH TO PERSONALISED ANTI-HYPERTENSIVE MEDICATION TITRATION
Authors: Judge Conor , Roshanov Pavel , O'donnell Martin , Tripp Bryan 
Published: June 2023

Abstract

Background and Aims
Hypertension is the number one risk factor for premature death worldwide. Artificial Intelligence (AI) Clinical Decision Support Systems are an important next step for hypertension management but require rigorous evaluation before assimilation into routine clinical practice. Our aim is to develop and evaluate an AI clinical decision support tool for hypertension management trained on randomised clinical trial data.

Method
The Systolic Blood Pressure Intervention Trial (SPRINT) trial showed that intensive BP control to SBP &lt;120 mm Hg results in significant cardiovascular benefit in high-risk patients with hypertension compared with routine BP control to &lt;140 mm Hg. We trained a feed-forward neural network using Keras and Tensorflow for R and data from 9361 persons in the SPRINT randomized clinical trial to predict the probability of increase, reduce or no-change in total number of anti-hypertensive medications at each visit. The network is designed to model SPRINT investigator deviations from the protocol. Six baseline patient variables (age, sex, race, aspirin use, eGFR, group assignment (intensive or standard)), two visit patient variables (Systolic and Diastolic Blood Pressure), and two previous visit variables (Systolic and Diastolic Blood Pressure) were inputted into the model after data normalisation and centering. Hyperparameters were tuned using a grid search method. We conducted internal validation using a 20% validation set. Clinical validation was performed using an unseen test set of typical hypertension scenarios (n = 50). An R Shiny app was developed to enter new patient information and display a sensitivity analysis of probabilities calculated after changing each baseline variable by plus and minus 10 (Figure 1). To avoid poor performance on new out of distribution cases we tested five methods for Out of Distribution (OOD) detector, 1. Autoencoders, 2. Normalizing flow, 3. Local Outlier Factor (LOF), 4. Probabilistic Principal Component Analysis (PPCA) and Kernel Density Estimation (KDE).

Results
The accuracy was 76.7% on the validation dataset after 1000 Epochs. Clinical validation revealed suboptimal performance for unseen Out of Distribution data (e.g. recommending reduction of medication when SBP &gt;160 and number of medications was zero). This poor performance on OOD samples prompted the creation of an OOD detector to use in series with the AI Decision Support System for Hypertension. The AUROCs were 0.77 for AE, 0.96 for Normalizing Flow, 0.82 for LOF, 0.88 for PPCA and 0.96 for the Kernel Density Estimation.

Conclusion
Artificial Intelligence (AI) Clinical Decision Support Systems for Hypertension are feasible and an important next step for hypertension management but generalisability and safety require rigorous evaluation before assimilation into routine clinical practice.
#3816 HYPERBARIC OXYGEN TREATMENT IN CALCIFIC UREMIC ARTERIOLOPATHY PATIENTS IN ADDITION TO CONVENTIONAL MULTIDISCIPLINARY CARE
Authors: Nordheim Espen , Røed Ine , Brekke Fredrik Barth , Gudmundsdottir Helga , Braathen Martin Rygh , der Lippe Nanna Von 
Published: June 2023

Abstract

Background and Aims
Calcific uremic arteriolopathy (CUA), also referred to as calciphylaxis, is a rare and serious complication in patients with advanced kidney disease. CUA has limited treatment options and poor prognosis, with one- year survival often reported to be below 50% after diagnosis [1,2]. Hyperbaric oxygen therapy (HBOT) may improve wound healing by increasing tissue oxygenation, and has been suggested as adjuvant treatment for CUA patients [3]. We added HBOT to our conventional multidisciplinary care of CUA patients in 2012 and this study aims to evaluate long- term outcomes of CUA patients after this.

Method
Data from all CUA patients treated at our institution from 2012 to 2022 were retrospectively retrieved from hospital records. This is a single-centre study, but patients from different Norwegian hospitals were referred for treatment at our centre. Conventional multidisciplinary care of CUA in our centre included sodium-thiosulphate, dialysis if indicated medical optimization of calcium- phosphate homeostasis, substitution of vitamin K2, withdrawal of warfarin and iron and vitamin D if used, minimization of systemic steroids, in addition to optimization of weight- and nutritional status. Our centre is restrictive with surgical revisions to CUA patients.

Results
25 CUA patients received a total number of 1493 HBOT treatments in addition to conventional CUA multidisciplinary care in the study period. Median HBOT per patient was 45 (range 1–267). One year after CUA diagnosis, 20 out of 25 patients were alive (80%). Fifteen out of the 20 patients, who were alive at one year after CUA diagnosis, had completely resolved CUA lesions (75%). Five patients died within the first year after CUA diagnosis, due to acute cardiovascular disease (n = 3) and infection (n = 2). Our impression is that HBOT is well- tolerated and associated with less wound- associated pain.

Conclusion
Our results suggest that HBOT is well- tolerated in CUA patients. After we included HBOT in our multidisciplinary care of CUA patients, 80% of the patients were alive one- year after CUA diagnosis.
#3865 TELEMEDICINE IN NEPHROLOGY: A CROSS-SECTIONAL STUDY
Authors: Leitão e Sousa Sofia , Santos Sofia , Cunha Ana Cristina Santos , Braga Beatriz Gil , de Bessa e Silva João Pedro Peixoto , Pereira Sandra , Lascasas Josefina Santos , Beirão Idalina 
Published: June 2023

Abstract

Background and Aims
Chronic kidney disease (CKD) prevalence has been increasing and estimates show it will be the fifth leading cause of lost life years worldwide by 2040. CKD patients should be evaluated by Nephrology even in early stages of disease, but patients substantially outnumber nephrologists. Telemedicine consists of delivery of health-care services and information from distant locations and its utility has been largely demonstrated in CKD patients. In our centre, teleconsultation began being used to support requests from family doctors regarding CKD patients that are at that point stable and in an early stage of their disease.

Method
Since January 2020 and December 2022, 456 patients were evaluated using teleconsultation. Their demographical characteristics and the savings on dislocation cost, based on the price per kilometre, were analysed. In addition, a questionnaire about the use and utility of telenephrology was shared through general practice centres.

Results
From 456 patients, 43% male and 57% female, with an average age of 78 years. One out of five patients were dependent for daily life activities. On average, the patients lived within 22kms of the hospital, the maximal distance was 540kms. Based on this data we estimate 6660 euros savings on dislocation costs alone. A total of 47 general medicine doctors answered the survey, out of which 21% were male, with an average age of 40 years, 23% had under 5 years of experience, 26% had between 5 and 10 years of experience, 26% between 11 and 15 and the remaining over 16 years of experience. Around 70% had never used the teleconsultation, the majority of which due to lack of knowledge of this possibility. In the group that had used it, 77% were satisfied with the patient's orientation and 85% would consider using it again. Most of the general practitioners (62%) had referenced patients between 2 and 5 times. A fast answer to the request was the most frequently pointed advantage and the time between request and patient orientation was considered appropriate.

Conclusion
From this data, we conclude that telenephrology is not well known among family doctors in Portugal, yet it has the potential to reduce the distance between patients and nephrologists and build bridges between different areas of specialisation. It will also allow for cost reduction, a matter more pressing each day, and to increase patients comfort by reducing unnecessary hospital visits.
#3873 UTILITY OF BLOOD KETONE MONITORING IN HAEMODIALYSIS PATIENTS UNDER INPATIENT NEPHROLOGY CARE
Authors: Doak Ailsa , Coleman Sophie , Hills James , Hutton Rona , Geddes Colin C , Stevens Kate 
Published: June 2023

Abstract

Background and Aims
There is a lack of evidence regarding the relationship between capillary blood glucose (CBG) &gt;15 mmol/L and blood ketones in maintenance haemodialysis dialysis patients meaning the utility of ketone measurement in this group is uncertain. Despite this, guidance published by the Joint British Diabetes Society for Inpatient Care (JBDS-IP) in 2022 states that blood ketones should be measured in patients on maintenance haemodialysis with diabetes mellitus (DM) who have pre- or post-dialysis CBG &gt;15mmol/L and symptoms consistent with diabetic ketoacidosis (DKA), acknowledging that these can be non-specific [1]. We sought to identify if there is a relationship between elevated CBG and blood ketone levels in haemodialysis patients, and if haemodialysis affects blood ketone levels.

Method
Maintenance haemodialysis patients with DM admitted to a single ward over 2 separate 2 month periods were included. Nursing staff recorded CBG and blood ketone levels pre- and post-dialysis using a FreeStyle PrecisionPro ketone meter. For each patient, further demographic data were collected from the electronic patient record.

Results
79 measures were collected from 30 patients, with between 1 and 7 measures for each patient. 57% patients (n = 17) were male, 37% (n = 11) had T1DM, and 80% (n = 24) were on insulin therapy. The median pre-HD CBG for all measures was 10.5mmol/L (IQR 8.15-15.05), median post-HD CBG was 9.1mmol/L (IQR 6.8-12.95), median pre-HD ketones were 0.1mmol/L (IQR 0.1-0.2) and median post-HD ketones were 0.1mmol/L (IQR 0.1-0.3). There was no significant difference in blood ketones pre-and post-HD for all measures (p = 0.09) (Figure 1). For measures where pre-HD CBG was &gt;15mmol/L (n = 21) median pre-HD and post-HD ketones were 0.1 (IQR 0.1-0.2) and 0.2mmol/L (IQR 0.1-0.2) respectively (p = 0.45). For measures where pre-HD CBG was &gt;20mmol/L (n = 6) median pre-HD and post-HD ketones were 0.1 mmol/L (IQR 0.1-0.13) and 0.2 mmol/L (IQR 0.1-0.2) respectively (p = 0.13). For measures where pre-HD CBG was &lt;15mmol/L, median pre-HD ketones were 0.1 (IQR 0.1-0.2). There was no significant difference in blood ketones pre-HD between those with a pre-HD CBG &gt;15mmol/L and those with a pre-HD CBG &lt;15mmol/L (p = 0.69).

Conclusion
These results demonstrate no significant relationship between elevated CBG measures (&gt;15mmol/L) and blood ketone levels in haemodialysis patients, nor do they demonstrate a significant change in blood ketone levels post haemodialysis. Unwell haemodialysis patients with elevated CBG clearly warrant medical assessment, but there is a lack of evidence that blood ketones are useful to aid assessment and guide management of these patients.
#3911 DIETARY OXALIC ACID INTAKE AND PLASMA OXALIC ACID CONCENTRATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Visser Wesley , Hospers Gideon Post , van Egmond Anneke , Laging Mirjam , Verhoeven Jeroen , Baart Sara , Ramakers Chris , Hesselink Dennis , Wetering van de Jacqueline , Reinders Marlies , Hoorn Ewout , Severs David , Roodnat Joke 
Published: June 2023

Abstract

Background and Aims
High oxalic acid concentration may be caused by genetic disorders, enteric diseases, but also by kidney insufficiency per se. It may result in kidney oxalic acid stones, kidney function decline, and failure. This study aimed to investigate whether dietary oxalic acid intake influences plasma oxalic acid concentration in a population undergoing kidney transplantation.

Method
Dietary oxalic acid intake was assessed using a Food Frequency Questionnaire. Based on frequency and portion size, average daily oxalic acid intake in the past year and in the last 24 hours was calculated. A blood sample for determination of plasma oxalic acid concentration was drawn on the operation ward before transplantation. For multivariable analysis seventeen recipient related variables were gathered.

Results
418 patients were included. The median age of the participants was 62 year, 60% were male, all had an eGFR &lt;20 ml/min/1.73 m2, and 66% were on dialysis with a median dialysis vintage of 13 months. The median plasma oxalic acid concentration was 32.2 µmol/L (range 4.6-243.2). In 98.3% of patients oxalic acid concentration was above the upper limit of normal. The average oxalic acid intake was 199 mg/day (range 4-1599), while it was 138 mg/day in the last 24 hours before transplantation (range 0-3906). Multivariable linear regression analysis showed that plasma oxalic acid concentrations were significantly higher in recipients with higher average (p&lt;0.001) and last 24 hours oxalic acid intake (p = 0.002), lower age (p&lt;0.001), lower residual diuresis (p&lt;0.001), higher body mass index (p&lt;0.001), longer dialysis vintage (p = 0.032), hemodialysis (p&lt;0.001), and peritoneal dialysis (p&lt;0.001) versus preemptive status.

Conclusion
In pre-kidney transplant patients, plasma oxalic acid concentration is above upper normal limit in 98.3% of patients and is multifactorially determined. As all other factors are not modifiable, the only way to decrease plasma oxalic acid concentration is dietary restriction.
#3913 GENETIC SUSCEPTIBILITY AS AN EFFECT MODIFIER FOR THE ASSOCIATION BETWEEN CHRONIC KIDNEY DISEASE AND RISK OF VENOUS THROMBOEMBOLISM
Authors: Zhang Jingwen , Shan Ying , Liu Beini , Dai Liang , Song Congying , Carrero Juan Jesus , Xiong Zuying , Huang Xiaoyan 
Published: June 2023

Abstract

Background and Aims
The association between chronic kidney disease (CKD) and the risk of developing venous thromboembolism (VTE) is still controversial. Further, it is unknown if genetic predisposition modifies this relationship. This study was conducted to investigate plausible effect modification of genetic factors on the association between CKD and incident VTE.

Method
Population-based cohort study of the UK Biobank, including 397,658 participants of European ancestry that were free of VTE at recruitment. We used cystatin C combining creatinine estimated glomerular filtration rate (eGFR) and albuminuria to classify participants with CKD stages 1-5 according to the low, intermediate, and high/very high-risk groups suggested by KDIGO (Kidney Disease: Improving Global Outcomes). Cox proportional hazards model was applied to evaluate the associations of CKD with incident VTE. In addition, we used externally validated polygenic risk score (PRS) for VTE to evaluate whether the genetic predisposition modified the associations of interest.

Results
During median follow-up of 12.7 years, 11,372 participants developed VTE. As compared with low KDIGO risk category, covariate-adjusted hazard ratios (HR) and 95% confidence intervals (CI) for future VTE risk with intermediate and high/very high KDIGO risk categories at baseline were 1.278 (1.191-1.372) and 1.892 (1.658-2.159), respectively. Participants at high/very high risk of CKD prognosis and in the highest tertile of PRS had the highest risk of developing VTE (HR, 4.397; 95% CI, 3.639-5.313), and this group had shown the most conspicuous additive interactions between CKD and the genetic predisposition, which responsible for 1.389-fold relative excess risk and accounted for 31.6% of incident VTE. Also, when either eGFR or urine albumin-creatinine ratio (ACR) was treated as the exposure, similar associations and supra-additive interactions were yielded.

Conclusion
CKD is associated with future VTE, especially in those with high genetic risk.
#3927 AN ANOREXIGENIC HORMONE IN PEDITARIC CKD PATIENTS
Authors: Sallam Dina E 
Published: June 2023

Abstract

Background and Aims
Chronic kidney disease (CKD) is a major health problem associated with faltering growth, which is a complex process, where anorexia, inadequate oral intake in addition to disturbed body metabolism play a significant role. Leptin, the anorexigenic hormone that's secreted by fat tissue, and affect appetite, & hence, aids to weigh loss & faltering growth. The present study evaluated serum leptin level, & its relation to growth parameters in pediatric patients with different stages of CKD.

Method
A cross-sectional study that was conducted on 87 subjects, who were divided equally into groups; CKD stage 5 on regular hemodialysis (CKD5d), & CKD stage 2–4, & age & gender matched controls. Patient with diabetes, infected with hepatitis C virus, & on growth hormone therapies were excluded. Full history taking, assessment of growth parameters using gender & age specific Z-scores of heights, weight & body mass index were done. Fasting serum leptin, calcium, phosphorus, PTH, albumin, total proteins, iron & hemoglobin were measured.

Results
Our patients had significantly lower growth parameters compared to controls. Hypocalcemia, high PTH, iron deficiency anemia & hypoalbuminemia were significant in CKD2-4 groups compared to other groups. Serum leptin was abnormally high in 12.6% of CKD patients. The median leptin level was comparable between the groups (p = 0.20). Serum leptin hadn’t changed significantly as regards gender, BMI Z-scores, diagnoses, or CKD stage (p = 1.00, 0.379, 0.542, 0.171 respectively). A negative correlation was found between leptin level & CKD duration (r = -0.276, P = 0.036), otherwise, no correlations were found with clinical & laboratory variables.

Conclusion
Leptin level was not affected by CKD stage & not a useful marker for growth in pediatric CKD patients. Large studies on relationship between leptin & growth is needed.
#3957 SUSTAINED RECOVERY OF KIDNEY FUNCTION IN PATIENTS WITH ESKD UNDER CHRONIC DIALYSIS TREATMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Garofalo Carlo , De Nicola Luca , Minutolo Roberto , Conte Giuseppe , Andriella Simona , Marzano Federica , Ambrosino Tino Paolo , Borrelli Silvio 
Published: June 2023

Abstract

Background and Aims
The prevalence of recovery of kidney function (RKF) in patients under maintenance dialysis is poorly defined mainly because of different definitions of RKF. The accurate assessment of sustained RKF is critical because the survival and quality of life of patients treated by maintenance dialysis are dramatically poor as compared to patients under conservative treatment. The sustained withdrawal of chronic dialysis has moreover a significant social and economic impact, considering the high burden of dialysis on health resources.

Method
Therefore, to gain more insights into the epidemiology of RKF, we performed a systematic review and meta-analysis of studies addressing the prevalence of sustained (at least for 30 days) RKF in patients under maintenance dialysis. Acute kidney injury (AKI) and RKF in the first 90 days of dialysis were the main exclusion criteria.

Results
Overall, 7 studies (10 cohorts) including 2,444,943 chronic dialysis patients (range: 430-1,900,595 patients) were meta-analyzed. The period of observation ranged from 4 to 43 years. The prevalence of RKF was 1.49% (95% C.I.:1.05-2.11; p&lt;0.001] with high heterogeneity I2: 99.8%, P&lt;0.001 (Figure 1). The weighted mean dialysis vintage before RKF was 294±165 days; RKF persisted for a weighted mean of 27.5 months. The percentage of RKF was higher in studies from the U.S. (1.96% [95% C.I.: 1.24-3.07]) as compared to other countries (1.04% [95%C.I.: 0.66-1.62]; P = 0.049).

Conclusion
In conclusion, sustained RKF unrelated to AKI occurs in about 1.5% of patients under maintenance dialysis. On average, RKF patients discontinue chronic dialysis about ten months after starting treatment and live free of dialysis for more than two years. The higher prevalence of RKF reported in the U.S. versus other countries suggests a major role of country-specific policies for dialysis start.