bluuebunny/crossref_metadata_2025_split huggingface dataset:
#5044 FLUID BALANCE AND GLOMERULAR FILTRATION RATE AS PREDICTORS OF OUTCOME AMONG COVID-19 PATIENTS IN THE ICU
Authors: Jogunčić Anes , Djuric Petar , Gradaščević Anisa , Torka Christina , Rosenberg Mark , Gajic Ognjen , Büttner Stefan 
Published: June 2023

Abstract

Background and Aims
Acute kidney injury (AKI) is associated with an increased risk of progression to a severe form in every disease and, moreover, is associated with an increased mortality, and so it is also with coronavirus disease 2019 (COVID-19). AKI is a frequent complication in COVID-19 patients admitted to ICU for severe respiratory failure. ICU treatment itself indirectly could cause or exacerbate renal damage, through suboptimal fluid management, drug toxicity, or low human resources. The aims of this study were to assess AKI prevalence, fluid balance and glomerular filtration rate as a predictor of outcome in COVID-19 patients treated in the intensive care unit.

Method
We retrospectively analysed all adult patients admitted to the ICU at a regional hospital in northern Bavaria, from 1st March to 31st December 2020. Clinical data and laboratory results were retrospectively retrieved from the hospital information system and electronic case files. According to the severity of AKI based on the KDIGO criteria, and laboratory values were followed on the first 7 days on the ICU. In total 320 patients patients were included in the study. Level of significance was set to p&lt;0.05.

Results
The mean age was 65 ± 19 years, 135 (42%) patients were females, 185 (58%) were males. Median length of ICU stay was 7 (2-13 days) in females, and 8 days (4- to 21 days) in males. At the ICU, 177 patients needed some form of ventilation, from which 109 (needed Invasive mechanical ventilation). During ICU stay, 81 patients have died, with fatality rate of 25%. Patients with AKI (n=48, 15%) at the admission to the ICU, had 2.1 times higher risk of death at the ICU than patients without AKI. There was a statistically significant difference in ICU survival based on a glomerular filtration rate, fluid balance, CRP and leukocyte values, F=1.957, p=0.026; Wilk's Λ=0.724, partial η2 = 0.276

Conclusion
Acute kidney injury is common in coronavirus disease 2019, and it is associated with poor clinical outcomes. Even first couple of days at the ICU could point to the outcome, with markers of inflammation, glomerular filtration rate, and fluid balance being most valuable variables.
#5093 DIALYSIS PATIENTS AND BNT162B2MRNA VACCINE TYPE ARE RISK FACTORS FOR IMMUNITY FADING 9 MONTHS AFTER SARS-COV-2MRNA VACCINATION (DIA-VACC STUDY)
Authors: Stumpf Julian , Anders Leona , Siepmann Torsten , Schwöbel Jörg , Karger Claudia , Lindner Tom H , Faulhaber-Walter Robert , Pietzonka Annegret , Langer Torsten , Escher Katja , Anding-Rost Kirsten , Seidel Harald , Hüther Jan , Pistrosch Frank , Martin Heike , Schewe Jens , Stehr Thomas , Meistring Frank , Paliege Alexander , Schneider Daniel , Bast Ingolf , Steglich Anne , Gembardt Florian , Kessel Friederike , Kröger Hannah , Arndt Patrick , Sradnick Jan , Frank Kerstin , Skrzypczyk Sarah , Anft Moritz , Klimova Anna , Mauer René , Röder Ingo , Tonn Torsten , Babel Nina , Hugo Christian 
Published: June 2023

Abstract

Background and Aims
SARS-CoV-2mRNA vaccination related seroconversion rates are reduced in dialysis (DP) and kidney transplant patients (KTR). Recently, we demonstrated that established vaccination related immunity (via positive seroconversion) fades faster in DP and at a lesser extent in KTR compared to medical personnel (MP).[1] We hypothesized that a longer follow up period might be able to profoundly show immunity fading differences specific to different patient groups and identify strong fading risk factors that are relevant for patient management especially in vulnerable groups.

Method
We evaluated nine months follow up data in our observational Dia-Vacc study exploring specific cellular (interferon-γ release assay) or/and humoral immune responses after 2x SARS-CoV-2mRNA vaccination in 880 participants including healthy MP (125), DP (595), KTR (111), and apheresis patients (49-AP) with positive seroconversion (de novo IgA or IgG antibody positivity by ELISA) after eight weeks.

Results
Nine months after first vaccination, receptor binding domain (RBD) antibodies were still positive in 90 % of MP, 86 % of AP, but only 55 %/48 % of DP/KTR, respectively. Seroconversion remained positive in 100 % of AP and 99·2 % of MP, but 86 %/81 % of DP/KTR, respectively. Compared to MP, DP but not KTR or AP were at risk for a strong RBD decline, while KTR kept lowest RBD values over time (see Fig. 1 and Table 1). By multivariate analysis, BNT162b2mRNA versus 1273-mRNA vaccine type was an independent risk factor for a strong decline of RBD antibodies. Within the DP group, only time on dialysis was another (inverse) risk factor for the DP group. Compared to humoral immunity, T-cell immunity decline was less prominent.

Conclusion
While seroconverted KTR reach lowest RBD values over time, DP are at specific risk for a strong decline of RBD antibodies after successful SARS-CoV-2mRNA vaccination, which also depends on the vaccine type being used. Therefore, booster vaccinations for DP should be considered earlier compared to normal population.
#5094 PREGNANCY OUTCOME AFTER KIDNEY TRANSPLANTATION AND IMPACT ON GRAFT FUNCTION
Authors: Alkot Ahmed , Sally Samir , Sakr Mohamed , Zahran Mahmoud , Wasif Salwa El 
Published: June 2023

Abstract

Background and Aims
Within 2 to 3 weeks of a successful renal transplantation, the fertility of women in childbearing age improves; however, pregnancy after kidney transplantation is challenging and may be associated with serious maternal and fetal complications. To study the prevalence of pregnancy and pregnancy related complication after kidney transplantation.

Method
Retrospective cohort study conducted on 236 patients out of 3000 kidney transplant recipient who underwent renal transplantation (RT) at Mansoura Urology and Nephrology Centre between March 1976 and December 2019, divided into two groups, group I; 118 kidney transplant recipient who experienced pregnancy at any time after kidney transplantation and Group II; 118 kidney transplant recipients who didn`t experience pregnancy after renal transplantation, they were matched according to age, duration of renal transplantation and they are comparable in primary immunosuppressant drugs. All kidney recipients were reviewed for preoperative, operative, and post-operative details also we record maternal and fetal complication.

Results
Prevalence of pregnancy in our centre is 191 pregnancies in 118 women who had underwent kidney transplantation between 1976 and 2019. We have found that the mean age of pregnancy between (26.27±4.37 - 29.89±4.6), the mean gestational age between (33.69±6.4 - 33±7.5) weeks, the live birth rate is 126 (66%). Preterm delivery rate in our study is 85 (44.5%), neonatal death 8 (4.1%), miscarriage 59 (30.9%), intrauterine foetal death 6 (3.1%) and birth defect 4 (2%). The prevalence rates of gestational hypertension is 87 (45.5%), preeclampsia 48 (25.1%), gestational diabetes 19 (9.9%), urinary tract infection 36 (18.8%), and graft rejection 8 (4.1%) during pregnancy. caesarean section is the most common method of delivery in our study 133 (69.6%).

Conclusion
The risk of maternal and fetal complications is still high in RT patients and requires multidisciplinary care. All should be considered in patient counselling and clinical decision making. So we recommend educating the transplanted patients to allow for outcome optimization and minimization of complications.
#5120 CARBON FOOTPRINT OF IN-CENTER HEMODIALYSIS: RESULTS OF A FRENCH PILOT STUDY
Authors: Hachad Hafsah , Rey Jocelyne , Dupré Dylan , Marrauld Maurie , Mariat Christophe , Legallais Cecile , Hourmant Maryvonne , Jullien Perrine 
Published: June 2023

Abstract

Background and Aims
Since the beginning of the industrial era, human activities have led to a significant increase in the concentration of greenhouse gases (GHGs) in the atmosphere and are the cause of climate change, the negative effects of which on human health are already visible (1). Paradoxically, the health sector also exerts a major pressure on the environment through carbon-based care activities that emit GHGs (2). In this context, a few studies have highlighted the significant carbon footprint associated with hemodialysis (3). However, to date, no similar study has been conducted in France.

Method
The objective of this work was to evaluate the carbon footprint of a hemodialysis unit in France using the Bilan Carbone ® approach developed by The French Agency for Ecological Transition and the Bilan Carbone Association. Activity data associated with hemodialysis provision at the Charles De Gaulle facility in 2021 was collected and converted to a common measurement unit of tonnes of CO2 equivalents (t CO2-eq) via established emissions factors. This facility, that belongs to the ARTIC 42 association, is located in the town of Saint-Priest en Jarez and provides hemodialysis through a total of 56 hemodialysis generators.

Results
Over the year 2021, the Charles de Gaulle facility provided a total of 25270 hemodialysis treatments ensuring the care of approximately 162 patients (at a rate of 3 sessions per week). The associated annual carbon footprint for the facility was 1436 t CO2-eq. Annual carbon footprint amounted to 8.9 t CO2-eq/patient/year corresponding to 57 kg CO2-eq /treatment. Emissions were essentially indirect, with more than 90% coming from scope 3. The main sources of emissions were: products and services purchase (30% of total emissions, that is 437 t CO2-eq), patients and staff travels (25% of total emissions, that is 361 t CO2-eq), and fixed assets (21% of total emissions, that is 299 t CO2-eq). Energy consumption (particularly electricity) and waste treatment accounted for a small proportion of GHG emissions (respectively 8% et 6%).

Conclusion
Our results confirm the high carbon footprint associated with in-center hemodialysis, showing that it is mainly attributable to indirect emissions. These empirical data will serve as a basis for reflection in the development of a strategy to reduce GHG emissions associated with hemodialysis. This work will hopefully be paving the way for the necessary ecological transition of medical practices, focused on the patient and the ecosystems on which he/she depends.
#5123 EFFICACY AND SAFETY OF PATIROMER IN THE TREATMENT OF CHRONIC HYPERKALEMIA IN ASTURIAS: THE K-ASTUR STUDY
Authors: Sanchez-Alvarez Jose Emilio , Bueno María del Carmen Merino , Pérez Anna Gallardo , Sango Cristina , Zorrilla Carlos Ruiz , Ulloa Catalina 
Published: June 2023

Abstract

Background and Aims
Hyperkalemia is a frequent problem in patients with chronic kidney disease (CKD), especially in those on hemodialysis (HD) and confers increased morbidity and mortality. It is common to carry out urgent HD sessions or increase the number of weekly sessions due to toxic hyperkalemia. Hyperkalemia also prevents the administration or adequate titration of drugs such as renin-angiotensin-aldosterone system (RAAS) inhibitors despite the evidence of their cardiovascular benefits and on the progression of CKD. New drugs have recently entered the market that can help treat chronic hyperkalemia. The aim of the present study was to analyse the efficacy and safety of Patiromer in patients with CKD

Method
Multicenter, prospective, clinical practice study in patients with CKD stages 3-5. Patiromer was administered with the indication of chronic hyperkalemia. Epidemiological and clinical data were analyzed; the evolution of serum potassium and elements involved in bone and mineral metabolism were taken into account.

Results
Finally, 52 patients (71±12 years old, 75% male, 63% diabetic, 54% with heart failure, and 42% receiving RAAS inhibitors) were included in the study. Regarding CKD, 17% were in stage 3b, 31% in stage 4, 38% in stage 5 (not on dialysis) and 13% were on HD. Of the 52 patients included, 46 reached 6 months of follow-up, 2 died, 2 underwent a kidney transplant and 2 were transferred to another center. The initial dose of Patiromer was in all cases 8.4 g administered orally in a single dose. Only one patient required doubling the dose because the therapeutic objectives were not achieved. Taking Patiromer was associated with a decrease in the levels of serum potassium of 27% (5.9 vs 4.6 mEq/L; P&lt;0.001), a decrease that was more pronounced in the first month of treatment. There were no changes in the concentration of serum calcium and magnesium. We did find a decrease of 18% in serum phosphorus (5.1 vs 4.2 mg/dl; P 0.022), with no changes in dieto r phosphate binders. Patiromer was well tolerated and only 2 patients reported mild constipation; none discontinued the medication due to adverse effects.

Conclusion
Patiromer is effective and safe in reducing serum potassium concentrations. Due to its calcium content, it is possible that it favors the reduction in phosphoremia due to a decrease in the intestinal absorption of phosphorus. The use of this drug can help us control potassium levels in patients with CKD, properly titrate the use of ISRAAs, and even reduce the number of HD sessions or dialysis emergencies in some patients.
#5128 PREDICTIVE FACTORS OF RENAL RECOVERY AND END-STAGE KIDNEY DISEASE IN PATIENTS WITH SEVERE ANCA-ASSOCIATED VASCULITIS WITH GLOMERULONEPHRITIS
Authors: Moura Marta Casal , Zubidat Dalia , Patricio Marc , Romeo Maria José Soler , Santos Fernanda Dos , Nardelli Luca , Román Juan León , Sousa Círia , Zand Ladan , Warrington Kenneth , Sethi Sanjeev , Specks Ulrich , Fervenza Fernando Custodio 
Published: June 2023

Abstract

Background and Aims
A significant number of patients with anti-neutrophil cytoplasmic antibodies (ANCA) associated vasculitis (AAV) with glomerulonephritis (AAV-GN) still progress to end-stage kidney disease (ESKD, eGFR&lt;15mL/min/1.73m2) despite advances in remission-induction treatment.

Method
A retrospective cohort study on MPO- or PR3-ANCA positive patients with AAV (MPA or GPA) and ESKD at presentation. Renal recovery, dialysis discontinuation and maintenance in ESKD after standard remission-induction, with or without the use of PLEX were compared.

Results
We analyzed 166 patients with biopsy proven active kidney involvement and eGFR &lt;15mL/min/1.73m2 at the time of AAV-GN diagnosis. Patients received glucocorticoids with CYC (n = 84) or with RTX (n = 72) for remission-induction, and 49 also received PLEX. The predictors for renal recovery were erythrocyte sedimentation rate, SCr at diagnosis and minimal or mild chronicity changes. We analyzed 71 patients who started dialysis with or without PLEX within 4 weeks from AAV-GN diagnosis. The predictors for dialysis discontinuation were minimal chronicity changes in kidney biopsy at the time of diagnosis (OR 6.138, [95%CI 1.389-27.118],p = 0.017) and focal glomerular involvement (OR 5.017,[95%CI 1.287-19.567],p = 0.020). Predictors for maintenance in ESKD at 12 months included higher serum creatinine (SCr) at the time of diagnosis (IRR 1.086, [95%CI 1.005-1.173],p = 0.037), moderate (IRR 3.797,[95%CI 1.090-13.225],p = 0.036), or severe chronicity changes in kidney biopsy (IRR 5.883,[95%CI 1.542–22.439],p = 0.009).

Conclusion
In our cohort, kidney recovery, dialysis discontinuation, and maintenance of ESKD in patients with AAV-GN and eGFR&lt;15mL/min/1.73m2 depended on SCr and histologic findings on kidney biopsies at the time of diagnosis and was not affected by the addition of PLEX.
#5134 THE REDS/MEWS SCALE USED FOR ASSESSMENT OF ESKD PATIENTS DIALYSED WITH CENTRAL CATHETER MAY REDUCE A NUMBER OF INFECTIVE ACCESS-RELATED COMPLICATIONS
Authors: Lachowski Michal , Ostrowska Aleksandra , Benc Krzysztof , Porazko Tomasz 
Published: June 2023

Abstract

Background and Aims
Central tunnelled catheter (CVC)-related infections are a leading cause of catheter lost and being the source of significant morbidity and mortality of end stage kidneys disease (ESKD) patients. The study aimed to evaluate the impact of the implementation of the own REDS/MEWS scale for combined assessment of ESKD patients dialysed with the CTC on the frequency of infective complication.

Method
A group of 52 ESKD patients dialysed through a CTC were evaluated, pre dialysis on every session, using the REDS/MEWS scale for 24 months years and results as well as follow up of participants were compared with a two years period of time before the tool was introduced.

Results
Two-years cumulative incidence of CTC exit site infection (ESI) has dropped significantly (log-rank p &lt; 0.001) from 0.87 episode per 1000 catheter days (52.3%, CI95 [34.2%; 67.3%]) in time before REDS/MEWS was used to 0.28 episode per 1000 catheter days (19.3%, CI95 [7.3%; 30.1%]) in REDS/MEWS time. There were also significantly less episodes of ESI complicated with catheter related blood stream infection (CRBSI) requiring CTC removal (0.8 episode per 1000 catheter days; 20.6%, CI95 [8.4%; 33.2%] vs. 0.4 episode per 1000 catheter days; 5.4%, CI95 [1.1; 8.7%]; log-rank p = 0.05, in pre – REDS and REDS time respectively). There was no serious complications as infective endocarditis, vertebral discs abscess among patients due to early detection and treatment of possible CTC related infection.

Conclusion
The REDS/MEWS scale appears to be a simple, cost-effective tool reducing frequency of the CTC related infective complication and the type of vascular access loss.
#5171 MODIFIED, NON-INVASIVE, TUNNELLED CATHETER REPOSITION (NTCR), SIMPLE AND SAFE TO RESTORE FUNCTION OF CENTRAL TUNNELLED CATHETER FOR HAEMODIALYSIS
Authors: Lachowski Michal , Ostrowska Aleksandra , Benc Krzysztof , Porazko Tomasz 
Published: June 2023

Abstract

Background and Aims
Still many end stage kidney disease (ESKD) patients are dialysed using central tunnelled catheters (CTC) as vascular access. Catheter thrombosis and is a dominant, non-infectious CTC complication. There are a number protocols established, to resolve the problem, all are not always effective, time as well as cost consuming.

Method
The modified maneuver of non-invasive tunnelled catheter reposition (mNTCR) was introduced and studied, to obtain an immediate haemodialysis start, in case of CTC dysfunction. The NTCR is based on gentle movements of CTC or its part, with CTC lines flushing which resulted with quick CTC's tip reposition. The study was a continuation of previously published with modification including mandatory CTC lines flushing and locking lines with antithrombotic agent after the dialysis session.

Results
A number of 205 mNTCR were performed in 110 patients with CTC. Effective blood flow CTC was obtained after 115 procedures (56%), partial function followed 73 procedures (35,6%), and 17 attempts (8%) failed. Over 90% interventions improved a CTC patency allowing start of effective haemodialysis. The procedure could be successfully repeated with similar effect after the first, and the second attempt (28 vs 22 hemodialyses performed respectively). In the group of 50 elderly patients (median age 74 years) with CTC as the only vascular access, mNTCR was successful in 31 patients allowing dialysis continuation for median period 54 months. The mNTCR is safe as minor complications were observed after 5,1% of all procedures.

Conclusion
The novel mNTCR manoeuvre was safe and effective in a majority cases of CTC dysfunction. It permitted immediate dialysis without time consuming fibrinolytic agents usage protocols before the dialysis session, saving costs and nursing staff time.
#5213 RELATIONSHIP BETWEEN CYTOKINE RELEASE SYNDROME AND ACUTE KIDNEY INJURY AFTER CHIMERIC ANTIGEN RECEPTOR T CELL THERAPY IN HEMATOLOGIC NEOPLASMS
Authors: Román Juan León , Iacoboni Gloria , Garcia Sheila Bermejo , Carpio Cecilia , Arana Ander Vergara , Matamoros Oriol Bestard , Barba Pere , Romeo Maria José Soler 
Published: June 2023

Abstract

Background and Aims
CAR-T cell therapy is a promising new immunotherapy to treat refractory hematologic malignancies (RHM). Despite the potential benefits, high rates of treatment related toxicity have been reported after CAR-T infusion. AKI occurs between 20-30% after treatment. The purpose of this study was to identify the relationship between the proinflammatory status (CRS, ICANs, and febrile neutropenia) and AKI development.

Method
Medical records of 115 patients treated with CD19-targeted CAR-T cells for refractory hematologic malignancies at HUVH between July 2018 and May 2021 were reviewed. Clinical data was reviewed within 30 days after CAR-T cells therapy. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria: grade 1, 1.5 to &lt;2-fold of baseline; grade 2, 2- to &lt;3-fold of baseline; grade 3, ≥3-fold of baseline We performed statistically analysis to identify risk factors for AKI development.

Results
A total of 24/115 patients presented AKI after CAR-T infusion. AKI Akin stage 1 was diagnosed in 17 (15%) patients, AKI Akin stage 2 was diagnosed in 4 (3.5%) patients, and AKI Akin stage 3 was diagnosed in 3 (2.6%) patients. 4/17 patients died in the AKI Akin stage 1 group while 2/3 patients in the AKI Akin stage 3 group. Renal function was recovered in 19/24 (79%) patients within the first month. Chronic kidney disease was present in 13% patients. Among types of CAR-T cell infusion, “investigational product” was infused in 27.8%, tisagenlecleucel in 49.6%, axicabtagen ciloleucelin in 20%, and brexucabtagene autoleucel in 2.6%. The most frequent complications were cytokine release syndrome (81.9%), febrile neutropenia (67%) and neurotoxicity (28.7%). Tocilizumab was given in 31 (27%) patients for CRS grade ≥2, and 5% of patients were admitted to the intensive care unit 3/36 patients died after CAR-T infusion. Male sex, CAR T-cell construct, ICANs, CRS, and death by any cause were associated with AKI. Only CRS ≥2(p=0.001) was identified as independent risk factor for AKI.

Conclusion
AKI development is mainly transient and associated with the proinflammatory status after CAR-T cell infusion.