bluuebunny/crossref_metadata_2025_split huggingface dataset:
#4093 OSTEOSARCOPENIA AMONG PATIENTS UNDERGOING HEMODIALYSIS IS RELATED WITH MORTALITY
Authors: Xiang Ting , Zhou Li , Fu Ping 
Published: June 2023

Abstract

Background and Aims
Sarcopenia and osteoporosis are closely interconnected and associated with adverse health outcomes. Osteosarcopenia means the concurrent presence of the two conditions and has rarely been reported in hemodialysis patients. Whether hemodialysis patients with osteosarcopenia are at greater risk of mortality than those with either condition alone remains unknown. The aim of this study was to explore the prevalence of sarcopenia and its association with osteoporosis and to determine its impact on survival risk in hemodialysis patients.

Method
A total of 209 adults undergoing hemodialysis were enrolled from the dialysis center in the West China Hospital of Sichuan University. Muscle mass, handgrip strength, bone mineral density (BMD), and biochemical parameters were assessed. All deaths were recorded during a follow-up of 34.8 ± 13.8 months.

Results
Seventy-eight patients were diagnosed with sarcopenia with a prevalence of 37.3%. After adjustment for potential confounders, age (OR = 1.094, P &lt;0.001), female (OR = 3.44, P = 0.005), diabetes (OR = 3.756, P = 0.008), CRP (OR = 1.09, P = 0.015), serum magnesium (OR = 0.06, p = 0.042) and BMI (OR = 0.701, P &lt;0.001) were independently associated with sarcopenia (Table 1). Among the 209 patients, 103 patients completed the BMD assessment. The prevalence of osteosarcopenia was 22.3%, while 20.4% of participants had sarcopenia alone and 12.6% had osteoporosis alone. The respective proportions of patients who died were 10.9% for nonsarcopenia/nonosteoporosis, 15.4% for osteoporosis alone, 47.6% for sarcopenia alone, and 47.8% for osteosarcopenia. Cox regression analysis showed that osteosarcopenia was independently associated with all-cause mortality (HR = 3.541, 95% CI: 1.035-12.117), while osteoporosis alone and sarcopenia alone were not (Table 2).

Conclusion
Patients undergoing hemodialysis had a high incidence of sarcopenia and osteosarcopenia, muscle mass and strength showed a significant association with BMD, and osteosarcopenia might have a powerful impact on mortality in those patients.
#4109 THE IMPACT OF IMPLEMENTING AN INNOVATIVE OBSTETRIC NEPHROLOGY SERVICE ON MATERNAL AND FETAL OUTCOMES IN WOMEN AT RISK OF PR-AKI
Authors: Shemies Rasha Samir , Nagaty Kareem , Younis Dalia , Elnaggar Sherouk , Khreba Nora , Mosbah Alaa , Taman Mohamed , El-Kannishy Ghada , Sayed-Ahmed Nagy , Sobh Mohamed 
Published: June 2023

Abstract

Background and Aims
Pregnancy Related Acute kidney injury (PR-AKI) is a global health problem with substantial maternal and fetal morbidity and mortality. Late referral, and late diagnosis of women with risks of PR-AKI represent the major barriers for curtailment of this ugly trend, particularly in the developing world. Our past experience per se revealed striking maternal and fetal mortality of women with PR-AKI. Great strides are strongly needed to save maternal and fetal lives. This study assessed the impact of implementing an innovative obstetric nephrology service (ONS) and healthcare program on maternal and fetal outcomes in women at risk of PR-AKI.

Method
An innovative interdisciplinary obstetric nephrology clinic was established in 2020 to improve the quality of care for pregnant women at risk of PR-AKI. The service was staffed by both nephrologists and obstetricians. Women who presented to the clinic were stratified into low, moderate, and high-risk groups. A risk stratification-based care program was adopted. Very high-risk women were admitted to the maternal care unit. The study compared the outcomes of ONS-treated women who completed their follow up (n = 43) versus two groups of conventionally treated women (n = 40) and women presented before service (n = 40).

Results
Although they had greater pre-existing risks, ONS-treated women had no reported maternal or fetal mortality compared to women in the conventionally treated group (11.8% and 51.5% respectively), and to women presented before service (22.5% and 45% respectively). Progression to end-stage renal disease was significantly less in ONS-treated women compared to both conventionally treated and those treated before service (3% versus 13.2% and 37.5% respectively).

Conclusion
Easily feasible Obstetric nephrology service implementation and adoption of early referral program and diagnosis policies were associated with better maternal and fetal survival as well as better renal outcomes. Provision of parallel services is strongly recommended to decrease the magnitude of PR-AKI.
#4125 CHANGES OF MEDICAL COSTS AND NUMBER OF USES OF CONTINUOUS RENAL REPLACEMENT THERAPY UNTIL RECENT SIX YEARS IN SOUTH KOREA
Authors: Kim Hyung-Jong , Chang Jae Hyun , Jung Sang Hyun , Park Keun Hyung 
Published: June 2023

Abstract

Background and Aims
Continuous renal replacement therapy (CRRT) is a necessary dialysis treatment method applied to patients with acute renal injury at intensive care unit. In South Korea, the use of such CRRT is increasing, and the cost of health insurance used for CRRT is also increasing. In this study, the pattern and medical costs increase of CRRT usage until recent 6 years were investigated.

Method
From 2016 to 2021, the number of CRRT claims was investigated using data from the National Health Insurance Review and Assessment Service. CRRT costs is applied by a resource-based relative value score in Korea. CRRT can be charged as continuous venovenous hemodialysis, continous venovenous hemofiltration, and continuous venovenous hemodiafiltration depending on the treatment mode. The CRRT cost differs from the very day and the next day's cost, and the cost of the very day includes the femoral hemodialysis catheter insertion cost, which is higher than the next day's cost.

Results
CRRT medical practice is gradually increasing. The number of CRRT the very day increased from 15,640 cases in 2016 to 20,883 cases in 2021, and it continues to increase from 81,649 cases CRRT the next day in 2016 to 121,376 cases CRRT the next day in 2021. The CRRT relative value score is higher than the conventional hemodialysis(HD) and the CRRT relative value score is 9715 points higher than the conventional HD 1065 points. The total cost of CRRT increased by about KRW 52.5 billion (approximately 38,363,171 dollars) in 2021 from about KRW 17.3 billion (approximately 12,641,578 dollars) in 2016. In addition to CRRT medical practice costs, dialysis fluid, anticoagulant costs, and material costs are added, and so actual CRRT-related costs are more expensive.

Conclusion
CRRT is essential and it seems necessary to consider medical practices or medical costs that are important for essential medical care. CRRT is a high-cost treatment method that requires definitive guidelines or consensus on the initiation and discontinuation of CRRT.
#4161 DELETION OF PROTEIN TYROSINE KINASES 4A1 AMELIORATE RENAL FIBROSIS INDUCED BY UUO IN MICE
Authors: Choi Dae Eun , Park Heyrim , Shin Jin Ah , Chang Yoon-Kyung , Lee Eu Jin , Ham Young Rok , Na Ki Ryang , Lee Kang Wook , Kim Hae Ri , Jeon Jae Wan 
Published: June 2023

Abstract

Background and Aims
Inhibitors of protein tyrosine kinases has been investigated as potential anti-fibrotic agents. protein tyrosine kinases 4A1 belongs to a sub-class of three prenylated protein tyrosine kinases. protein tyrosine kinases 4A1 has known as promoting growth and migration of tumor cells. The role protein tyrosine kinases 4A1 has little known in kidney. We evaluated whether the protein tyrosine kinases 4A1 could be target of renal fibrosis.

Method
10 weeks old male background protein tyrosine kinases 4A1 KO mice and wild type mice were divided into 4 groups; wild, protein tyrosine kinases 4A1 KO, wild with unilateral ureteral obstruction, and protein tyrosine kinases 4A1 KO with unilateral ureteral obstruction. Mice were sacrificed at 7 days after surgery and kidney tissue were collected. Molecular study and Histologic examination were performed.

Results
Protein tyrosine kinases 4A1 KO with unilateral ureteral obstruction mice showed decrease of renal tubule-interstitial damage and fibrosis compared to wild type unilateral ureteral obstruction mice. protein tyrosine kinases 4A1 KO with unilateral ureteral obstruction reduced the renal expression of α-SMA and TGF-β in unilateral ureteral obstruction kidney, compared to wild type with unilateral ureteral obstruction mice. Wild type with unilateral ureteral obstruction kidney showed decrease of renal expression of E-cadherin, compared to sham mice. However, protein tyrosine kinases 4A1 KO unilateral ureteral obstruction showed increase of renal expression of E-cadherin, compared to Wild type unilateral ureteral obstruction mice. In vitro, silencing of protein tyrosine kinases 4A1 in TGF-β treated HK2 cell showed increase of E-cadherin and decrease of phosphorylation of AKT and GSK3ß.

Conclusion
Protein tyrosine kinases 4A1 KO ameliorate renal fibrosis in unilateral ureteral obstruction kidney.
#4168 RISK FACTORS FOR POST-CONTRAST AKI IN PATIENTS MIXEDLY ADMINISTERED BOTH IODINE- AND GADOLINIUM-BASED CONTRAST MEDIA ON VISITING EMERGENCY ROOM
Authors: Choi Dae Eun , Park Heyrim , Lee Eu Jin , Ham Young Rok , Kim Hae Ri , Na Ki Ryang , Hwang Yunkyeong , Jeon Jae Wan , Park Heewon , Shin Jin Ah , Lee Kang Wook , Jeong Jin Young 
Published: June 2023

Abstract

Background and Aims
This study aimed to investigate the incidence of post-contrast acute kidney injury (PC-AKI) and its risk factor in patients administered iodine-based contrast media alone and mixed use of iodine-based contrast media and gadolinium-based contrast media.

Method
This retrospective study analyzed the data from 2016 to 2021. Patients who had end-stage of renal disease or missing data for estimating renal function were excluded. The primary outcome was the development of PC-AKI, i.e., an increase in creatinine of ≥25% or 0.5 mg/dL over the baseline or reduction in eGFR of ≥25% within 72 h. We compared the primary outcomes between the iodine-based contrast media alone and Mixed groups using a propensity score matching (PSM) analysis, and its risk factors were assessed from multivariable logistic regression.

Results
Of the 29,635 patients administrated iodine-based contrast media, 6,318 were included. There were 139 patients who mixedly administered iodine-based contrast media and GBCA. Mixed group showed significant higher rate of development of PC-AKI compared with iodine-based contrast media alone group in total cohort (adjusted OR, 3.09 [95% CI, 2.09 – 4.58]) and PSM cohort (adjusted OR, 2.38 [95% CI, 1.25 – 4.55]). On multivariate analysis to investigate risk factors in Mixed group, osmolality (adjusted aOR, 1.05 [95% CI, 1.01–1.10]) and eGFR (adjusted OR, 0.931; 95% CI, 0.883–0.983) were associated with PC-AKI.

Conclusion
Mixed administration of iodine-based contrast media and GBCA on same day at ED visit may be a risk factor for PC-AKI compared with single administration of iodine-based contrast media alone. Osmolality and eGFR may be independently associated with PC-AKI after mixed administration of iodine-based contrast media and GBCA
#4203 PREDICTION OF BLEEDING AND THROMBOSIS IN PATIENTS ON CHRONIC HEMODIALYSIS WITH THE TOTAL THROMBUS-FORMATION ANALYSIS SYSTEM
Authors: Dimitrijevic Zorica , Ågren Anna , Mitic Branka , Tasic Danijela , Cvetkovic Tatjana , Hosokawa Kazuya , Wallen Håkan 
Published: June 2023

Abstract

Background
End-stage renal disease patients receiving hemodialysis (HD) are at increased risk of both bleeding and thrombotic complications. There are, however, few tools to help clinicians with risk stratification of the individual patient.

Aims and Method
To study if the Total Thrombus-formation Analysis System (T-TAS01), which measures thrombus formation in flowing whole blood inside a microchip [1], can be used to predict bleeding and thrombotic complications in patients on HD. Odds-ratios were calculated using the median split procedure. ROC curve analyses were performed to calculate the ability of T-TAS measurements performed at baseline to distinguish between patients with and without future bleeding or thrombotic complications.

Results
176 patients on chronic HD were included and followed for one year; 11.4% were on antiplatelet drugs and 8.0% on continuous anticoagulation. Venous blood samples were taken at inclusion before dialysis procedure, and platelet-thrombus formation (PL-AUC; higher value reflects increased thrombogenicity) and platelet-fibrin thrombus formation (AR-OT; higher value reflects reduced thrombogenicity) were registered. Fifty-seven patients (32%) developed a bleeding complication, whereof 12 (6.8%) were ISTH major bleedings. The Odds-Ratio (OR; 95% CI) to develop any bleeding for patients with T-TAS01 measurements below (PL-AUC) or above (AR-OT) median were 7.67 (3.59-16.36) and 8.94 (4.10-19.51), respectively. ROC analyses to predict bleeding with T-TAS01 showed AUCs of 0.85 for all bleeding and 0.83 for ISTH major bleed (PL-AUC and AR-OT data combined). Furthermore, thirty-one patients (17.6%) developed a thrombotic complication, whereof 13 (7.4%) were acute coronary syndrome (ACS) or ischemic stroke (IS). The Odds-Ratio (OR; 95% CI) to develop any thrombosis for patients with T-TAS01 measurements below (PL-AUC) or above (AR-OT) median were 0.14 (0.05-0.40) and 0.28 (0.12-0.67), respectively. ROC analyses to predict thrombosis with T-TAS01 showed AUCs of 0.78 for all thrombosis and 0.62 for ACS/IS (PL-AUC and AR-OT data combined).

Conclusion
T-TAS01 is a promising tool to aid in the prediction of bleeding and thrombosis in HD patients.
#4204 MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING BIOMARKERS OUTPERFORM LAB BIOMARKERS FOR PREDICTING PROGRESSION OF DIABETIC KIDNEY DISEASE
Authors: Hockings Paul , Makvandi Kianoush , Hulthe Johannes , Baid-Agrawal Seema 
Published: June 2023

Abstract

Background and Aims
We recently showed that comprehensive non-contrast multiparametric Magnetic Resonance Imaging (mpMRI) allowed functional and structural assessment of diabetic kidney disease (DKD) and that an imaging endpoint, R1 cortex, showed significant predictive property for progression of DKD. We further investigated the performance of other MRI and lab biomarkers for predicting disease progression.

Method
In this prospective study, 38 DKD subjects aged 18–79 years and 20 age- and gender-matched healthy volunteers (HV) were included at baseline. 31 DKD subjects (2 stage 2, 13 stage 3, 14 stage 4, and 2 stage 5) and 17 HV were re-examined at 2 years ± 6 months. Clinical and lab examination, iohexol clearance for measured glomerular filtration rate (mGFR), urine albumin:creatinine ratio (UACR) and mpMRI were performed at both visits.
A wide range of MRI biomarkers associated with kidney hemodynamics, oxygenation and macro/microstructure were included for evaluation. Disease progression was defined by at least one of the following at 2 years: decrease in mGFR slope of &gt;5 mL/year/1.73 m2; worsening UACR category; or any major adverse kidney event defined as sustained decrease in eGFR of &gt;40%; doubling of serum creatinine from baseline; development of kidney failure with mGFR &lt;15 ml/min/1.73 m2; or death from renal cause. Univariable logistic regression analyses were performed to discriminate between progressors and non-progressors using each relevant lab and imaging endpoint as a predictor variable.

Results
Mean 2-year mGFR decline (ml/min/1.73 m2) in DKD patients was -2.7± 5.4 and in HV -1.9 ± 10.7. 13/31 (42%) DKD subjects and 4/17 (24%) HV progressed. Key lab biomarkers are shown in Table 1 and MRI biomarkers in Table 2.

Conclusion
Of all analyzed biomarkers, only the imaging biomarker R1 cortex, which reflects molecular environment viscosity, fibrosis, and inflammation (interstitial oedema, cellular swelling) showed significant predictive property for progression of DKD. UACR trended towards significance but was not statistically significant. R1 cortex outperformed all other imaging and lab biomarkers, but further studies with R1 cortex as a pre-specified endpoint are required to confirm these results.
#4209 A COMPARATIVE RETROSPECTIVE STUDY OF PATIENTS WITH ADPKD: FIRST RESULTS RELATING TO THE USE OF TOLVAPTAN
Authors: Oikonomaki Theodora , Liatsos Alexandros Nikolaos , Paikopoulou Angeliki , Avgikos Dimitris , Choulitoudi Vasiliki , Christodoulidou Christallenia 
Published: June 2023

Abstract

Background and Aims
Autosomal Dominant Polycystic Disease (APKD) is the fourth leading cause of End Stage Renal Failure (ESRD). Since 2015, the administration of Tolvaptan has been approved in patients with APKD at high risk of progression to ESRD (Mayo classification system, classes 1C-D).

Method
In this study we compare the characteristics of APKD patients who received Tolvaptan (45/15 mg) in relation to those who did not receive but followed the periodic check-up. These are 33 people with an average age of 44.17± 13.6 years. Tolvaptan was administered to 9 (27.3%) patients who met the Mayo classification criteria for its administration. The mean follow-up time for all the patients was 11.41±7.4 months and for those taking tolvaptan it was 10.6±3.9 months. Values ​​of urea, creatinine, plasma sodium, specific gravity and urine osmolarity were determined at the start of follow-up and compared with those at the last visit.

Results
A significant reduction was observed in the values ​​of urea, osmolality and specific gravity of urine after one year of tolvaptan use compared to the group that did not receive the treatment and thus no titration of the drug dose was needed. In the same group, marginally higher values ​​of the plasma sodium were observed, but within normal limits. The indicators of renal function in both groups did not show any change.

Conclusion
At one year of follow-up, APKD patients who received Tolvaptan did not exhibit worsening of the kidney function. We observed changes in the values of urea, urine specific gravity and urine osmolarity associated with our instructions to drink more water, showing good compliance with the treatment.
#4251 KIDNEY TRANSPLANTATION WITH DONOR-SPECIFIC ANTIBODIES: A GROWING NEED
Authors: Aristoy Emma Calatayud , Kanter Julia , Gavela Eva , Alonso Cristina Castro , Marín María Montesa , Antón Alejandro Valero , Beltrán Sandra , Calabuig Maria Asuncion Sancho 
Published: June 2023

Abstract

Background and Aims
Preformed donor specific antibodies in kidney transplant (KT) recipients are associated with higher risk of antibody mediated rejection (ABMR) and poorer graft survival. However, remaining a long time on the waiting list is strongly related to worse patient outcomes. We aimed to analyze KT recipients with preformed DSA with mean intensity fluorescence (MFI) who received induction therapy adapted to their higher immunological risk.

Method
We conducted a cohort retrospective study. All KT with preformed DSA performed in our center since May 2010 until March 2021 were included in the analysis. The presence of DSA was evaluated through Luminex Single Antigen (SA®) technology. All KT were performed with cadaveric kidney donor and with previous negative test by CDC crossmatch. The induction therapy in the presence of DSA included steroids, thymoglobulin, rituximab, plasmapheresis and standard treatment with tacrolimus and mycophenolate.

Results
During the study period 27 KT with preformed DSA were carried out. Recipient median age was 49 (IQR 40-62) years and 70,2% were women. Dialysis vintage was 5.8 (IQR 2.3-10.2) years. 63% were blood group A and 29,5% blood group 0. 29.6% were also included in the Hypersensitized National Programme (PATHI). The main causes of sensitization were previous KT (55.6%), pregnancy (29.6%) and blood transfusions (3.7%). 63% received KT with preformed DSA class I (median MFI 2218) and 37% with preformed DSA class II (median MFI 1900). Median calculated PRA was 90.5% (IQR 80.6-98.3). Median follow up time was 32.5 (IQR 12.3-61.2) months. Seventeen kidney biopsies were carried out. The most frequent findings were acute tubular necrosis (35.3%) and active ABMR (23.5%). DSA disappeared in most of the cases in successive analysis (81%) without any differences between both DSA classes. Median serum creatinine was 1.25 (IQR 0.97-1.75) mg/dl at 12 months and 1.65 (IQR 1.1-1.81) mg/dl at 24 months. In the post-transplantation period 2 patients were diagnosed with malignant solid organ tumors, 3 developed BK nephropathy, 5 CMV asymptomatic reinfection, and 9 recurrent urinary tract infections. During the observation time, 8 grafts were lost (29.6%): 3 due to patient deaths with functioning grafts and 5 due to graft failure (3 chronic ABMR, 1 active ABMR and 1 BKV nephropathy). Graft survival was 98% and 12 months and 92% at 24 months, respectively.

Conclusion
DSA with MFI low levels must be considered as a risk factor of ABMR and not as a contraindication to perform KT. A reinforced induction immunosuppression therapy enables KT to patients with high immunological risk and avoid prolonged time on the waiting list.
#4279 ATTENTION AND EMOTIONAL COGNITIVE DEFICITS IN HEMODIALYSIS PATIENTS WITH NORMAL NEUROCOGNITIVE SCREENING TEST RESULTS: AN EGYPTIAN TRIPLE CENTER STUDY
Authors: Awad Ahmed , Abdelsalam Adel L , Ibrahim Ibtihal , Samaan Emad 
Published: June 2023

Abstract

Background and Aims
Cognitive impairment (CI) is common in hemodialysis (HD) patients. St. Louis University Mental Status (SLUMS) examination is a traditional cognitive assessment method that relies on a pen-and-paper format. SLUMS test is known to be one of the most sensitive tests to detect early CI. Its questions cover many functions, including memory, attention, orientation, and overall executive function. This study aimed to compare its results with computerized neurocognitive battery assessment for attention and emotional orientation functions.

Method
One hundred twenty HD patients from three different in-hospital HD centers in Dakhlia governorate, Egypt, were subjected to the 10-minute Arabic-validated version of the SLUMS test for early CI (11 questions- 30 points). The patients were below 60 years old with no previous functional or structural neurological disease history. According to the stated test interpretation scores, fifty patients were defined to have no CI. Those patients underwent computerized neurocognitive battery assessment for attention and emotional cognition accuracy and response times; their results were analyzed compared to another fifty age, gender, and educational level-matched healthy controls.

Results
Of the 120 SLUMS-tested patients, 50 patients (41.6%) had no CI, 43 with mild to moderate CI (36%), and 27 with severe CI (22.4%). The classified 50 HD patients with no CI results within the computerized neurocognitive battery assessment revealed significantly reduced scores than matched healthy controls in the number of true positive answers of continuous number performance test for attention (90.46±26.61 vs. 109.15±14.56, respectively, p &lt;0.001), emotion recognition correct answers (29.44±5.54 vs. 31.41±4.65, respectively, p 0.02), emotional recognition response times by m.seconds (3482.76±2907.62 vs. 2907.62±732.98, respectively, p &lt;0.001), and correct answers of emotion differentiation test (19.82±5.88 vs.23.77±3.63, respectively, p &lt;0.001). HD patients' age was the only clinical correlate to emotional recognition and differentiation accurateness (rho = 0.442, p &lt;0.001 and rho = 0.3, p 0.02, respectively).

Conclusion
Early detection of CI in HD patients is an important target to improve the patient's quality of life and functionality. The complete dependence on the known simple screening assessment may miss a significant portion of the early-affected personnel.