bluuebunny/crossref_metadata_2025_split huggingface dataset:
#4162 COMPARISON OF EGFR CYSTATIN C AND EGFR CREATININE IN RECENTLY HOSPITALISED INDIVIDUALS
Authors: Horne Kerry , Viramontes-Horner Daniela , Packington Rebecca , Shaw Sue , Akani Aleli , Monaghan John , Reilly Tim , Taal Maarten , Selby Nick 
Published: June 2023

Abstract

Background and Aims
Creatinine and cystatin C are endogenous biomarkers that can be used to estimate glomerular filtration rate (GFR). Cystatin C may be less dependent on age, gender and muscle mass. The comparative performance of these markers in patients recently hospitalised patients with acute kidney injury (AKI), who may have experienced changes in body composition, is unclear.

Method
Two matched cohorts of hospitalised individuals who had survived to 90 days after admission were recruited. The cohorts consisted of people who had sustained AKI during hospital admission and those who had not, and were matched 1:1 for age, baseline eGFR stage and diabetes. Serum creatine and serum cystatin C were measured at 3 months after hospitalisation and eGFR calculated using CKD EPI creatinine (eGFRcr) and CKD EPI cystatin C (eGFRcys) equations. Difference between the measures (eGFRdiff) was calculated as eGFRcys-eGFRcr and percentage difference (eGFR%diff) was relative to the mean of both eGFR measures. Primary outcome was mortality after 5 years of prospective follow up. Univariable survival analyses were conducted with the Kaplan Meier method and comparisons were performed with the log rank test, and a fully adjusted multivariable analysis performed with Cox proportional hazards model.

Results
854 individuals were recruited, matched, and had paired creatinine and cystatin C measurements. 427 (50%) had sustained AKI. Median eGFRcys was lower than eGFRcr (53.5ml/min/1.73 m2 [34.4-85.4] vs 68.4ml/min/1.73 m2 [52.6-84.7], p&lt;0.001). eGFRcys and eGFRcr were correlated (r = 0.486, p&lt;0.001) but Bland Altman analysis showed variable bias across the eGFR range. More individuals had an eGFR &lt;60ml/min using eGFRcys (57%) compared with eGFRcr (35.6%). There was a graded relationship between eGFR%diff and outcome, with a shorter survival time (Figure 1) and higher proportion of deaths at 5 years (Q1 64 (30.0%), Q2 54 (25.4%), Q3 41 (19.2%), Q4 (31 (14.6%), p&lt;0.001) in the first quartile. Cox proportional hazards analysis showed that eGFR%diff was an independent predictor of 5-year mortality after adjustment for age, Charlson index score and albuminuria (adjusted OR 0.995 [0.992-0.998], p = 0.002).

Conclusion
Cystatin C eGFR measures were lower than creatinine eGFR measures in recently hospitalised individuals. Lower eGFRcys relative to eGFRcr was independently associated with increased mortality. A larger difference between eGFRcys and eGFRcr may reflect loss of muscle mass (resulting in relatively lower serum creatinine) in somebody who has recently had an acute illness. Further, these results confirm how eGFRcr may over-estimate kidney function and potentially miss patients with failed renal recovery at 3-months after AKI. The difference between eGFRcys and eGFRcr may be helpful in identifying people at greater risk of early mortality after an acute illness.
#4178 HYPERCHLOREMIC METABOLIC ACIDOSIS AFTER PLASMAPHERESIS IN A PATIENT WITH RENAL TRANSPLANT REJECTION: A CASE REPORT
Authors: Simon Sanédy , van Sandwijk Marit , Engberink Rik Olde 
Published: June 2023

Abstract

Background and Aims
Plasmapheresis is an effective therapeutic intervention for several renal disorders, including renal transplant rejection. However, repeated plasmapheresis can cause various side effects and complications.

Method
We present a 61-year-old male with a medical history of type 2 diabetes, hypertension, successfully treated multiple myeloma and a post-mortem kidney transplantation 7 months ago. The patient was hospitalized because of rapid deterioration of his renal function (eGFR CKD-EPI 15 ml/min/1.73m2). Renal biopsy of the transplanted kidney confirmed the diagnosis of antibody-mediated transplant rejection. Treatment with methylprednisolone, plasmapheresis with a 40 g/L albumin solution as a replacement fluid and intravenous immunoglobulins was initiated. After 4 plasmapheresis treatments, the patient developed gastrointestinal complaints and muscle weakness. Despite the patient's use of 3 grams of oral sodium bicarbonate supplements a day, laboratory tests revealed a hyperchloremic metabolic acidosis: bicarbonate 11.7 mmol/L, chloride 111 mmol/L, sodium 138 mmol/L. Metabolic acidosis due to citrate accumulation was ruled out with a normal total-to-ionized calcium ratio. After treatment with intravenous bicarbonate supplementation, the symptoms disappeared. Analysis of the albumin plasmapheresis solution showed a chloride concentration of 132 mmol/L.

Results
This is the first case that describes metabolic acidosis after albumin plasmapheresis in a patient with impaired renal function. The observed hyperchloremic metabolic acidosis is most likely the result of the administration of large volumes (3.5 litres per session) of a 4% albumin solution with high chloride concentrations. We hypothesize that patients with renal impairment are more prone to develop metabolic acidosis after plasmapheresis with albumin-saline replacement fluids due to their reduced renal capacity to excrete excess acid and chloride.

Conclusion
Special attention should be paid to the acid-base balance during plasmapheresis in patients with impaired renal function. Future research should investigate the incidence of hyperchloremic metabolic acidosis during albumin plasmapheresis in different eGFR categories.
#4186 FEASIBILITY OF NEPHROLOGY-TAILORED GERIATRIC ASSESSMENT: AN IMPLEMENTATION STUDY
Authors: Voorend Carlijn , Berkhout-Byrne Noeleen , van Bodegom-Vos Leti , Diepenbroek Adry , Franssen Casper , Joosten Hanneke , Mooijaart Simon , Bos Willem Jan W , van Buren Marjolijn 
Published: June 2023

Abstract

Background and Aims
Geriatric evaluation of older patients with progressive chronic kidney disease is recommended in guidelines to enhance decision-making for kidney replacement choices. Although frailty, physical and cognitive impairments, and depression are prevalent, routine identification of geriatric impairments is lacking. Therefore, we aimed to study feasibility and determinants of successful implementation of a novel approach: nephrology-tailored geriatric assessment.

Method
In a mixed-methods implementation study, we investigated the feasibility of implementation of a consensus-based geriatric assessment [1] in Dutch nephrology centers. Feasibility was assessed through hospital participation and patient inclusion (among patients aged 70+ years with eGFR≤20mL/min/1.73 m2). We also evaluated determinants of successful implementation with a post-implementation survey among healthcare professionals covering (i) perceived enablers and barriers of implementation, (ii) perceived integration in work routines (Normalization MeAsure Development tool), and (iii) perceived relevance of the instruments. In addition, patients were asked if the geriatric assessment provided them with new insights for their future treatment decision for kidney failure.

Results
Feasibility was substantiated in implementation of geriatric assessment in 10 hospitals among 191 patients, i.e. 100% and 96% of our aimed goals. According to participating healthcare professionals (n = 71), determinants that facilitated implementation were: collaboration with the geriatric department, multidisciplinary meetings and reports, and execution of assessments by nurses. Most frequently mentioned barriers to implementation were: patient illiteracy or language barrier, lack of time, and burden for patients. Professionals considered geriatric assessment sufficiently integrated into work routines (mean 6.7 of 10, SD 2.0), but also subject to improvement (Figure 1). Implementation of geriatric assessment was considered sufficiently relevant for routine care (mean score 7.8 of 10, SD 1.2). Half of the patients (n = 42/82) stated that the geriatric assessment provided them with new insights, whereas 27% (n = 22) responded not to have gained new insights from the tests.

Conclusion
Multicenter implementation of nephrology-tailored geriatric assessment seems feasible and relevant. For future implementation we recommend involving the geriatric department, using multidisciplinary teams and -meetings, acknowledging the pivotal role of nurse practitioners, and using a flexible approach matching local resources.
#4200 INTERACTIONS BETWEEN INTRADIALYTIC CENTRAL VENOUS OXYGEN SATURATION, RELATIVE BLOOD VOLUME, AND ALL-CAUSE MORTALITY IN HEMODIALYSIS PATIENTS
Authors: Zhang Hanjie , Rojas Priscila Preciado , Merlo Laura Rosales , Kooman Jeroen , Van Der Sande Frank , Kotanko Peter 
Published: June 2023

Abstract

Background and Aims
In maintenance hemodialysis patients, low central venous oxygen saturation (ScvO2) and small decline in relative blood volume (RBV) have been associated with adverse outcomes [1,2]. Here we explore the interactions between ScvO2 and RBV change in relation to all-cause mortality.

Method
We conducted a retrospective study in maintenance hemodialysis patients with central venous catheters as vascular access. During a 6-month baseline period, Crit-Line (Fresenius Medical Care, Waltham, MA) was used to measure continuously intradialytic ScvO2 and hematocrit-based RBV. We defined four groups per median change of RBV and median ScvO2. Patients with ScvO2 above median and RBV change below median were defined as reference. The follow up period was 3-years. We constructed a Cox proportional hazards model with adjustment for age, diabetes, and dialysis vintage to assess the association between ScvO2 and RBV and all-cause mortality during follow-up.

Results
Baseline comprised 5,231 dialysis sessions in 216 patients. The median RBV change was –5.5% and median ScvO2 was 58.8%. During follow-up, 44 patients (20.4%) died. Kaplan-Meier analysis is shown in Figure 1. In the adjusted model, all-cause mortality was highest in patients with ScvO2 below median and RBV change above median (HR 6.32; 95% confidence interval [CI] 1.37 to 29.06), followed by patients with ScvO2 below median and RBV change below median (HR 5.04; 95% CI 1.14 to 22.35) and ScvO2 above median and RBV change above median (HR 4.52; 95% CI 0.95 to 21.36).

Conclusion
Concurrent combined monitoring of intradialytic ScvO2 and RBV change may provide additional insights into a patient's circulatory status. Patients with low ScvO2 and small changes in RBV may represent a specifically vulnerable group of patients at particularly high risk for adverse outcomes, possibly related to poor cardiac reserve and fluid overload.
#4208 CRP EXACERBATES SARS-COV-2-NUCLEOCAPSID PROTEIN-INDUCED ACUTE KIDNEY INJURY
Authors: Chen Junzhe , Wang Wenbiao , Tang Ying , Lan Xiaoru , Lan Hui Yao 
Published: June 2023

Abstract

Background and Aims
COVID-19, caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2), is a progressive viral pneumonia with a broad spectrum of clinical manifestations involving multiple organs. Acute kidney injury (AKI) is common in COVID-19, especially the critically ill patients. Our previous study proved that kidney-specifically overexpressing SARS-CoV-2 N protein induces AKI, which become worsen in mice under ischemic condition. Clinically, CRP is a risk factor for AKI in COVID-19 patients. Recent clinical study showed that CRP Apheresis is able to effectively remove the plasma CRP and thus improve the clinical outcome in critically ill COVID-19 patients. We thus hypothesize that CRP may not only be a biomarker or risk factor, but also a potential mediator or novel therapeutic target for COVID-19 AKI.

Method
The role of CRP in COVID-19 AKI was investigated in a mouse model of AKI induced by ultrasound-microbubble-mediated kidney-specifically transferring SARS-CoV-2 N-expressing plasmids in CRP wide-type (WT) and Transgenic (Tg) mice. We also developed a novel therapy for SARS-CoV-2 N-induced by targeting CRP signaling with a neutralizing anti-CD32 antibody both in vivo and in vitro.

Results
In COVID-19 patients with AKI, serum levels of CRP were significantly elevated when compared with non-AKI group. In mice, kidney-specifically overexpressing SARS-CoV-2 N protein caused AKI including tubular necrosis and elevated levels of serum creatinine and BUN in CRP WT mice, which became more severe in CRP Tg mice. Importantly, targeting CRP-CD32 signaling with a neutralizing antibody to CD32 significantly inhibited SARS-CoV-2 N protein-induced AKI in CRP Tg mice. Mechanistically, we uncovered that CRP promoted SARS-CoV-2-N protein-induced AKI via the Smad3-p21-dependent G1 cell cycle arrest and NF-κB/p-p65-driven renal inflammation, which was blocked by anti-CD32 antibody in vivo and in vitro.

Conclusion
CRP is not only a biomarker or risk factor, but also a mediator in SARS-CoV-2 N protein-induced AKI. CRP signals through CD32 mediate SARS-CoV-2 N-induced AKI via mechanisms associated with the Smad3-p21-dependent G1 cell-cycle arrest and NF-κB/p-p65-driven renal inflammation. Targeting CRP-CD32 signaling may represent as a novel therapy for COVID-19-associated AKI.
#4211 PULSE WAVE VELOCITY AND ERECTILE DYSFUNCTION IN PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Bratsiakou Adamantia , Georgopoulou Georgia Andriana , Trivyza Maria , Ntrinias Theodoros , Goumenos Dimitrios , Giannitsas Konstantinos , Papachristou Evangelos , Papasotiriou Marios 
Published: June 2023

Abstract

Background and Aims
Erectile dysfunction is a frequent problem and adversely affects quality of life. In recent years, it has been shown to be an early indicator of cardiovascular disease and endothelial damage. For patients with chronic kidney disease, the incidence of cardiovascular events is increased, while erectile dysfunction is also more frequent. In this study we evaluated in patients with chronic kidney disease the incidence and the association of erectile dysfunction with pulse wave velocity (PWV) and reflection wave parameters.

Method
The incidence of erectile dysfunction was examined with the use of IIEF (5) Sexual Health Questionnaire in adult male patients aged less than 65 years with chronic kidney disease stage I-V or a history of kidney transplantation that were actively monitored or treated as outpatients. Peripheral blood pressure, central blood pressure, PWV and reflection wave parameters (augmentation pressure and augmentation index) were evaluated using the Mobil-o-graph device in office measurements.

Results
Overall, 69 men with a mean age of 46.5 ± 11.79 years were included in the study. Chronic kidney disease (CKD) classification according to baseline eGFR calculation was as follows: 12 patients with CKD-I, 27 with CKD-II, 12 with CKD-III, 6 with CKD-IV and 12 with CKD-V on maintenance hemodialysis. Erectile dysfunction of all degrees (mild to severe) was detected in 52% of patients. From the correlation of the various parameters assessed with the degree of erectile function, as calculated by the IIEF questionnaires, it was found that renal function as expressed by eGFR showed a positive correlation (r = 0.24, p = 0.047), while age and PWV showed a negative correlation (r = -0.384, p = 0.002 and r = -0.474, p&lt;0.001 respectively). Moreover, pulse wave velocity was the only parameter which could predict erectile dysfunction (β = -0.995, 95% CI -0.465 to -10.074, p = 0.032).

Conclusion
The results of the study showed that worsening kidney function is associated with an increase in arterial stiffness and an increase in the incidence of erectile dysfunction. Moreover, erectile dysfunction was more common in patients with increased PWV.
#4233 FIXED LOW DOSE VERSUS CONCENTRATION-CONTROLLED INITIAL TACROLIMUS DOSING: RESULTS FROM A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL (SLOW&LOW STUDY)
Authors: Stumpf Julian , Budde Klemens , Witzke Oliver , Sommerer Claudia , Thomas Vogel , Schenker Peter , Woitas Rainer , Opgenoorth Mirian , Trips Evelyn , Schrezenmeier Eva , Hugo Christian 
Published: June 2023

Abstract

Background and Aims
Optimal initial tacrolimus dosing and early exposure of tacrolimus after renal transplantation is not well studied. Based on the assumption that current treatment protocols using frequent trough level determinations in the first week after transplantation may cause overexposure related nephrotoxic side effects and frequent monitoring is costly and not supported by basic pharmacokinetic principles, we had the hypothesis that early low and fixed tacrolimus dosing may be a safe and practical alternative.

Method
In this open-label, multicenter, randomized controlled, non-inferiority study, we randomly assigned 432 renal allograft recipients to receive basiliximab induction, mycophenolate and steroids and either standard prolonged-release tacrolimus (trough levels: 7-9 ng/ml; arm A), or an initial 7-day fixed 5 mg/day dose of prolonged-release tacrolimus followed by lower tacrolimus predose levels (trough levels: 5-7 ng/ml; arm B, see Figure 1). The primary end point was the combined incidence rate of biopsy-proven acute rejections (BPAR; including borderline), graft failure or death at 6 months with a non-inferiority margin of 12.5 %.

Results
The combined primary endpoint in arm B was non-inferior compared to the control arm A (22.1 % versus 20.2 %; difference 95 % CI: 1.9- 8.8 %). While overall rate of BPAR including borderlines were similar (B: 17.4 % versus A: 16.1 % (see Figure 2), a statistically significant difference of higher than borderline graded BPAR was noted (B: 11.6 % vs. A: 5.2 %; p = 0.027). Safety parameters such as delayed graft function, kidney function, infections or post-transplantation diabetes mellitus did not differ.

Conclusion
An initial fixed low prolonged release tacrolimus dose of 5 mg/day followed by lower tacrolimus exposure is non-inferior compared to standard tacrolimus therapy and equally efficient and safe within 6 months after renal transplantation. (EudraCT-Nr: 2013-001770-19).
#4297 AN ALTERNATIVE METHOD FOR SCREENING FABRY DISEASE IN WOMEN - PARTIAL RESULTS OF A BRAZILIAN STUDY
Authors: Silva Cassiano Augusto , Ribeiro Marcia Gonçalves , Silva Artur Quintiliano , Gueiros Ana Paula Santana , Petruccelli Karla Cristina Silva , Pascotto Roberta Correa , DE Souza Boger Marta Vaz Dias , Carvalho Luiz Roberto , Lucca Leandro Júnior , Sevignani Gabriela , Neto Osvaldo Merege Vieira , Barretto Carolina Teles , Gordon Gina Moreno , Veloso Valeria Soares Pigozzi , Vieira Fernando Antônio Freitas , Ennes Gelzie Sorrentino , Da Silva Montenegro Malaguti DE Souza Eduarda Morgana , Guedes Felipe Leite , Barreto Fellype , de Andrade Luis Gustavo Modelli 
Published: June 2023

Abstract

Background and Aims
Fabry disease (FD) is a rare X-linked lysosomal storage disease that can affect multiple organs, including the kidneys. The main objective of this study was to evaluate the effectiveness of a combination of α-GAL enzyme activity and plasma levels of lyso-GL3 for screening FD in women with chronic kidney disease (CKD).

Method
Women with CKD, stages 3 to 5, in regular nephrological follow-up were selected from renal centers in all regions of Brazil. Exclusion criteria: under 18 years old and known diagnosis of CKD. Patients underwent biochemical analysis of α-GAL enzyme activity and plasma levels of lyso-GL3. GLA gene sequencing was performed if α-GAL enzyme activity was below and/or lyso-GL3 levels were above the reference range. Sensitivity and specificity analyzes were performed to evaluate the performance of the combined biochemical approach for the diagnosis of FD.

Results
From October 2020 to December 2022 1,647 collections were carried out. Low α-GAL activity was found in 44 (2.6%) of the cases and increased lyso-GL3 was found in 101 (6.1%) of the cases. The mean age was 53 [42 – 64] years. All cases of low α-GAL and/or increased lyso-GL3 were submitted to genetic analysis, and 6 positive cases were found. As for genetic variants, four patients have R118C, one A143T and other with T430G, all considered variants of uncertain significance (VUS). The sensitivity and specificity of α-GAL reduction for the detection of FD was 83.3% and 97.6%, respectively. As for the increase in lyso-GL3, the values were 16.6% and 93.9%, respectively. There were no cases that presented a concomitant increase in lyso-GL3 and a reduction in enzymatic activity.

Conclusion
Preliminary results suggest that the combination of α-GAL enzymatic activity with lyso-GL3 measurement may be a good alternative for screening FD in women with CKD. A thorough medical evaluation is required to determine the pathogenicity of variants in these patients.
#4318 ASSOCIATION OF PLANT PROTEIN INTAKE AND RISK OF INCIDENT CHRONIC KIDNEY DISEASE: THE UK BIOBANK STUDY
Authors: Heo Ga Young , Koh Hee Byung , Kim Hyo Jeong , Kim Kyung Won , Jung Chan-Young , 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
Dietary intake from various protein sources can affect health differently. However, the association between plant protein intake and incident chronic kidney disease (CKD) is uncertain.

Method
Using the UK Biobank prospective cohort, we included 117,809 participants who completed more than one dietary questionnaire and had an estimated glomerular filtration rate (eGFR) ≥60 ml/min/1.73 m2, urinary albumin-to-creatinine ratio (UACR) &lt;30 mg/g, and no prior history of CKD. The main predictor was the daily plant protein intake, assessed with a web-based 24-hour recall questionnaire. The primary outcome was incident CKD, based on the International Classification of Diseases, 10th Revision (ICD-10) or Office of Population Censuses and Surveys Classification of Interventions and Procedures, version 4 (OPCS-4) codes. We additionally analyzed this association in 37,955 participants with primary care-linked data for eGFR and UACR. We used strictly defined CKD based on ICD-10 and OPCS-4 codes or two consecutive measures of eGFR &lt;60 ml/min/1.73 m2 or UACR &gt;30 mg/g.

Results
During the median follow-up of 9.9 years, incident CKD occurred in 3745 (3.2%) participants (incidence rate, 3.2 per 1,000 person-years). In a multivariable cause-specific model, the adjusted hazard ratios (aHRs; 95% confidence intervals [CIs]) for the second, third, and highest quartiles were 0.91 (0.83-0.99), 0.79 (0.71-0.87), and 0.75 (0.64-0.85), respectively, compared with the lowest quartile. In a continuous model, the aHR (95% CIs) per 0.1 g/kg/day increase in plant protein intake was 0.91 (0.88-0.94). This beneficial association was also consistent in the secondary analysis with strictly defined CKD and various sensitivity analyses.

Conclusion
This large prospective cohort study showed that increased dietary plant protein intake was associated with a lower risk of CKD.