bluuebunny/crossref_metadata_2025_split huggingface dataset:
#4322 MEDIATION ANALYSIS OF THE RELATIONSHIP BETWEEN INFLAMMATION AND CONTRAST INDUCED ACUTE KIDNEY INJURY IN PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Jung Ji Yong , Chang Jae Hyun , Oh Yun Jung , Lee Chung Sik 
Published: June 2023

Abstract

Background and Aims
Decreased kidney function is a risk factor for the development of contrast-associated acute kidney injury (CA-AKI) in chronic kidney disease (CKD). Although the relationship between CKD and CA-AKI is well established, the mechanistic link between the two, particularly the extent to which this interaction is mediated by inflammation, remains poorly understood. We examined the association between CKD and CA-AKI, as well as potential mediators, including serum albumin and high-sensitivity C-reactive protein (hs-CRP) levels.

Method
A total of 3,738 patients were enrolled for analysis from 5,299 patients and fulfilled the inclusion criteria among 12,742 patients who underwent coronary angiography (CAG) between 1 January 2007, and 31 December 2016. Multivariable logistic regression and mediation analyses were performed. In addition to the effect as risk factors, direct and indirect effects were also estimated.

Results
Among 3,738 subjects, 414 developed AKI (11.1%). Pre-procedural albumin and Lnhs-CRP (log-transformed) were independently associated with CA-AKI (odds ratio [OR], 95% confidence interval [CI]): 0.320 (0.272–0.3787), P &lt;0.001 and 1.211 (1.132-1.296), P&lt;0.001, respectively. Direct, and indirect effects were also estimated. Patients with CKD were found to be more likely to exhibit lower serum albumin and higher serum hs-CRP levels. Simple mediation analyses showed that 33.8% and 52.3% of the relationship between CKD and CA-AKI was mediated by the serum albumin and hs-CRP levels, respectively with co-mediation being 13.9%.

Conclusion
These results represent that, in addition to reduced kidney function, inflammatory parameters are also risk factors and mediators of CA-AKI in patients with CKD.
#4331 UPREGULATION OF ADIPOSE TISSUE FATTY ACID-BINDING PROTEIN 4 IN PATIENTS WITH CHRONIC KIDNEY DISEASE: IMPLICATIONS FOR DYSFUNCTIONAL VASCULAR CELLS
Authors: Noh Hyunjin , Kim Hyoungnae , Hong Moonju , Yu MI Ra , Lee Haekyung , Kwon Soon Hyo , Jeon Jin Seok , Song Dan , Yun Sangchul , Yu Byung Chul , Cho Nam-Jun , Park Samel , Park Mooyong , Choi Soo Jeong , Kim Jin Kuk , Gil Hyo-Wook , Lee Eun Young , Lee Jongsoon 
Published: June 2023

Abstract

Background and Aims
FABP4, a fatty acid-binding protein, is predominantly expressed in adipose tissue (AT) and has been shown to be elevated in patients with chronic kidney disease (CKD). Although elevated levels of FABP4 have been linked to cardiovascular disease in end-stage renal disease (ESRD) patients, the cause of this increase is unclear. The aim of this study was to evaluate the expression of AT FABP4 under uremic conditions and its impact on the function of macrophages and vascular smooth muscle cells (VSMC).

Method
We measured the levels of FABP4 in the blood and urine of CKD patients. The expression of AT FABP4 under uremic conditions was analyzed using omental AT obtained from healthy kidney donors and patients with ESRD who received peritoneal catheter insertion. The effect of FABP4 on the function of macrophages and VSMC was also assessed.

Results
The levels of FABP4 in the blood and urine of CKD patients were inversely correlated with their estimated glomerular filtration rate (eGFR). An increase in FABP4 in the blood was detected before its increase in the urine. FABP4 expression was found to be higher in mature adipocytes in visceral AT compared to the stromal vascular fraction (SVF). Adipocytes treated with p-cresol and adipocytes isolated from CKD patients showed higher levels of FABP4 expression compared to healthy individuals. Single-cell RNA sequencing of SVF showed increased FABP4 expression in progenitor cells and macrophages from CKD patients. In THP-1 cells, FABP4 induced more foam cells and increased levels of inflammatory mediators in the presence of palmitic acid. VSMC treated with p-cresol or VSMC isolated from CKD mice induced by an adenine diet showed a pro-calcific phenotype, as indicated by increased calcium content and bone-related gene expression, which was further enhanced by FABP4.

Conclusion
The elevated levels of FABP4 in CKD patients are not solely a result of decreased renal clearance but also due to increased production in AT. These higher levels of circulating FABP4 may be associated with dysfunction in vascular cells.
#4339 CARDIORENAL SYNDROME TYPE 1 IN CHILDREN AFTER SURGICAL TREATMENT OF CONGENITAL HEART DISEASE USING CARDIOPULMONARY BYPASS
Authors: Amanzholova Ainamkoz , Ivanova-Razumova Tatyana , Bekishev Bolat , Morenko Marina , Jabayeva Nilufar 
Published: June 2023

Abstract

Background and Aims
According to recent data, acute kidney injury (AKI) after pediatric cardiac surgery is a significant postoperative complication that occurs in 35-64% of children (1,2) and is associated with increased hospital mortality and unfavorable short-term outcomes. The problem of acute kidney injury in children after cardiac surgery remains relevant, despite the development of modern technologies and methods. Complications after pediatric cardiac surgery have serious negative consequences, prolonging the days of stay in the pediatric intensive care unit (PICU) and increasing mortality (3). The aim of the study is to analyze the frequency of AKI in children after open-heart surgery for congenital heart defects (CHD) using cardiopulmonary bypass (CBP).

Method
We conducted a retrospective analysis of 402 medical records of patients hospitalized in the ICU of JSC NRCSC Astana, Kazakhstan, from January 2018 to December 2022. Inclusion criteria: Children under 18 with CHD who underwent open-heart surgery with the following diagnosis - transposition of the great vessels, total anomalous pulmonary venous connection, interrupted aortic arch, coarctation of the aorta, ventricular septal defect. Exclusion criteria: The presence of AKI and terminal chronic kidney failure.

Results
The analysis included the total number of patients - 402 patients. The frequency of AKI was 15.6% (63 out of 402). Among the patients who developed AKI: boys - 45 (71.4%), girls - 18 (28.5%). The age distribution is as follows: children under 1 month among AKI - 50 (79.3%), under 6 months among AKI – 13 (20.6%), under 1 year among AKI – 5 (7.9%). According to the statistical analysis results, the complication depends on the type of operation, as there is a statistical significance of the differences in the groups (p = 0.046). However, the type of operation (p = 0.35) does not matter for the outcome. Also, the children's weight (p = 0.082) has no statistical significance on the number of complications and the outcome. The sex of children has a statistical significance for complications; in boys, it is significantly higher (p = 0.05). In addition, the lethal outcome in male children is higher than in girls (p = 0.000). The total number of patients with peritoneal dialysis is 63 (15.6%). The total mortality was 80 patients (19.9%). Mortality in the intensive care unit in patients with AKI after open-heart surgery for CHD was 43 (68.2%).

Conclusion
According to our data, the frequency of AKI developed in 15.6% of patients after surgical treatment of CHD using CBP. The overall mortality rate is 19.9%, with boys having a higher risk. Thus, the frequency of AKI is influenced by many factors before, during and after surgery. Therefore, developing preventive measures is a priority for improving the cardiac surgery results in children.
#4355 THE INFLUENCE OF ANTIRETROVIRAL DRUGS AND HIV RESISTANCE MUTATIONS ON THE SHEDDING OF HIV-1 INTO PERITONEAL DIALYSIS EFFLUENT
Authors: Mooko Teboho , Bisiwe Busiswa , Chikobvu Perpetual , Morobadi Daniel , Nyaga Martin , Bester Phillip , Kemp Gabre , Goedhals Dominique , Mofokeng Thabiso , Ndlovu Kwazi 
Published: June 2023

Abstract

Background and Aims
Antiretroviral therapy (ART) is effective HIV management even in HIV-positive patients with end-stage kidney failure (ESKF). However, drug resistance mutations are important determinants of therapeutic effects. The study aimed to determine the prevalence of HIV resistance mutations and ART drug penetration in the peritoneal compartment and their effect on the shedding of HIV-1 into continuous ambulatory peritoneal dialysis (CAPD) effluents.

Method
This prospective cross-sectional study of HIV-positive ESKF patients managed with ART and CAPD at Universitas Academic Hospital collected enrolled patients' background information and clinical and laboratory data. HIV-1 was detected using quantitative polymerase chain reaction (qPCR) and sequenced by the Sanger method, while ART levels were quantified using LC-MS/MS.

Results
There were 38 patients recruited with a median age of 41.8 (IQR, 36.15–48.0) years and were predominantly on abacavir (89.5%), lamivudine (100%) and efavirenz (76.3%) for a median duration of 8 (IQR, 6–11) years. Among participants with detectable HIV in CAPD effluents, the prevalence of ARV-drug resistance mutations was 71.4% (5/7) compared to 12.9% (4/31) among those with undetectable HIV-1 (p = 0.004) with NNRTI resistance mutations predominating. Participants with detectable HIV-1 had lower abacavir (0.00182 vs 5.68 ng/µl; p = 0.021), lamivudine (0.0152 vs 1.09 ng/µl; p = 0.001) and efavirenz (3,605 vs. 57,8 ng/µl; p = 0.004) plasma levels compared to those with undetectable HIV-1. Measured lamivudine (0.455 vs 0.342 ng/µl; p = 0.007) and efavirenz (46.5 vs 2.34 ng/µl; p&lt;0.001) drug levels are significantly higher in plasma than CAPD effluents.

Conclusion
ART resistance mutations, lower drug levels and poor compartment penetration are suggested significant factors for HIV-1 shedding into CAPD effluents.
#4356 DYNAMIC EFFECT OF PROTEINURIA ON ADVERSE KIDNEY OUTCOMES WITH TARGETED MAXIMUM LIKELIHOOD ESTIMATION METHOD: RESULT FROM THE KNOW-CKD STUDY
Authors: Oh Yun Jung , Oh Kook-Hwan , Chung Wookyung , Jung Ji Yong 
Published: June 2023

Abstract

Background and Aims
Proteinuria is a risk factor for the progression of chronic kidney disease (CKD), but its causal inference may be challenging due to time varying exposure and confounding, the changing its degree, and loss to follow up.

Method
A total of 1,223 patients enrolled as part of The Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD) were analyzed at 3 observational points (baseline, 3-year; early, and 7-year; late) at which spot urine protein creatinine ratio (UPCR) was measured. We used longitudinal targeted minimum loss-based estimation (TMLE) and marginal structural models (MSM) to estimate the cumulative incidence of adverse kidney outcomes (eGFR halving and kidney failure requiring replacement therapy) of dynamic exposure to high proteinuria (UPCR≥1g/g) comparing counterfactuals (UPCR&lt;1g/g) adjusted for time varying confounding (systolic blood pressure, estimated glomerular filtration rate, and renin-angiotensin-aldosterone blockers) and baseline covariates (age, sex, diabetes, cardiovascular disease, and smoking).

Results
Patients with sustained high proteinuria throughout 7-year follow-up had significant higher risk of renal events than those with counterfactuals (relative risk [RR], 3.120; 95% confidence interval, 2.150-4.528; P &lt; 0.001). The RR were 0.168 (0.055-0.517; P = 0.002) and 0.613 (0.337-1.114; P = 0.108) for early and late proteinuria reduction comparing sustained high proteinuria, respectively. In MSM, hazard ratio (HR) of accumulative high proteinuria frequency were 1.612 (1.463-1.844; P &lt;0.001) up to 3 years and 1.102 (0.877-1.387; P = 0.404) up to 7 years, respectively.

Conclusion
In CKD patients, sustained higher proteinuria is the main risk factor during the entire observation period. However, considering dynamic exposure, proteinuria reduction from the beginning has a protective effect on renal progression, but the effect weakens as the observation period becomes longer.
#4358 INCREASED RV PRESSURE AS A PREDICTOR OF ACUTE DECOMPENSATED HF IN ESRD PATIENTS ON MAINTENANCE HD
Authors: Kim Ye Na , Park Byung Hwa , Shin Ho Sik , Jung Yeonsoon , Rim Hark 
Published: June 2023

Abstract

Background and Aims
Many patients with end-stage renal disease (ESRD) on hemodialysis (HD) have reduced vascular compliance and are likely to develop heart failure (HF). This study aimed to determine the factors associated with acute decompensation events among ESRD patients undergoing HD.

Methods
We retrospectively investigated ESRD patients on HD using a medical record review. We divided the patients into those admitted to hospital due to acute decompensated heart failure (ADHF) and those who were not. We compared the medical histories, electrocardiograms, and echocardiographic and laboratory data between the two groups. The cut-off value of the TR jet velocity for predicting an ADHF with corresponding sensitivity and specificity was estimated using a receiving operator characteristic (ROC) curve analysis. A p value &lt; 0.05 was considered to indicate statistical significance.

Results
Of the 188 ESRD patients on HD, 87 were excluded, and 101 were enrolled (mean age: 63.7 years; 52.1% male). Thirty patients (29.7%) were admitted due to ADHF. These patients exhibited similar left ventricular ejection fraction (LVEF), left ventricular (LV) mass index, and E/E′ values compared to the non-ADHF group. However, the ADHF group exhibited significantly higher tricuspid regurgitation (TR) jet velocity (2.9±0.6 vs. 2.5±0.4 m/s; p = 0.004) and right ventricular systolic pressure (RVSP) (43.5±17.2 vs. 34.2±9.9 mmHg; p = 0.009) than the non-ADHF group, respectively. A multivariate logistic regression analysis demonstrated that the TR jet velocity (odds ratio, 8.356; 95% confidence interval, 1.806–38.658; p = 0.007) was an independent predictor of ADHF after adjusting for age and sex, while the LVEF and E/E′ were not.

Conclusions
Our data showed that an increased TR jet velocity was an independent predictor of ADHF events in ESRD patients on HD, but the LVEF and E/E′ were not.
#4360 FACTORS ASSOCIATED TO RENAL REMISSION IN CRESCENTIC GLOMERULONEPHRITIS
Authors: Sánchez Loreto Mariscal de Gante , Morales Cristina , Giraldo Yohana Gil , Aranzábal María Alejandra Cortiñas , Ruano Pablo , Quiroga Borja 
Published: June 2023

Abstract

Background and Aims
Impaired renal function is one of the most relevant factors associated to crescentic glomerulonephritis (CGN) prognosis. However, renal remission has not yet been defined and clinicians are required to use systemic scores (such as BVAS) to predict severity. In this retrospective study, we aim to describe the associated factors to long-term chronic dialysis incidence and survival in CGN.

Method
We included all biopsy-proven CGN of our center between 2004 and 2022. At baseline, demographics, treatments and comorbidities were collected. Renal function was assessed by glomerular filtration rate (GFR) using CKD-EPI equation, quantification of proteinuria and demonstration of hematuria. During follow-up (median 1486, interquartile range [25-3082] days) renal and vital status was evaluated. Factors associated to dialysis requirement were assessed using Cox regression models. A combined endpoint of death and dialysis was established. Factors associated to the combined endpoint were assessed.

Results
We included 47 CGN (77% female, 67±15 years). Of them, 35 (75%) presented positive ANCA antibodies, 3 (6%) positive glomerular basement membrane (GBM) antibodies, 8 (17%) ANCA and GBM antibodies and one (2%) presented negative autoimmunity. Induction treatment was based on prednisone and cyclophosphamide in 43 patients (91%), prednisone and rituximab in 3 (6%) and prednisone alone in one (2%). At admission, median CKD-EPI was 11 (11-21) ml/min/1.73 m2, proteinuria was 1030 (552-1872) mg/g and 43 (91%) patients presented hematuria. Nineteen patients (40%) required dialysis at admission. Following the definition of KDIGO guidelines for renal remission, 28 (64%) patients achieve it at 6 months. During follow-up, fifteen patients (36%) started chronic dialysis. Factors associated to chronic dialysis were the type on CGN (dual ANCA and GBM and GBM (+) vs ANCA (+), p = 0.003), CKD-EPI at admission (p = 0.001), AKIN (p = 0.050), requirement of dialysis at admission (p&lt;0.001), percentage of crescents (p = 0.037), proteinuria at admission (p = 0.046) and remission after induction treatment (p&lt;0.001). Twenty-four patients (53%) died or needed dialysis during follow-up. Factors associated to this combined endpoint were CKD-EPI at admission (p = 0.017), type on CGN (dual ANCA and GBM vs others, p = 0.003) (Figure 1), debut in dialysis (p&lt;0.001), remission after induction treatment (p&lt;0.001). An adjusted Cox regression model demonstrated that the need for dialysis or death during follow-up was independently associated to not achieving remission after induction (i.e. 6 months) (HR 8.78, 95%CI (2.88-26.7), p&lt;0.001) and requirement of dialysis at debut (HR 3.96, 95%CI [1.15-13.6], p = 0.029).

Conclusion
The requirement of dialysis at debut and not achieving remission after induction are independent predictors of death or need for chronic dialysis in CGN.
#4367 THE IMPACT OF QUALITY OF LIFE ON THE SURVIVAL IN THE ELDERLY END-STAGE RENAL DISEASE PATIENTS : A PROSPECTIVE MULTICENTER COHORT STUDY IN KOREA
Authors: Chung Yu-Kyung , Cho Jang-Hee , Lim Jeong-Hoon , Jeon You-Hyun , Kim Yong-Lim , Kim Chan Duck , Park Sun-Hee , Choi Ji-Young , Jung hee-Yeon , Lee Seong-Wook , Kim Yoon-Ju , Lee Young-Hwan 
Published: June 2023

Abstract

Background and Aims
Quality of life (QOL) are associated with mortality in dialysis patients. However, the impact of QOL index or score on elderly patients with end-stage renal disease (ESRD) is controversial. We analyzed the relationship between QOL items and survival in elderly ESRD patients.

Method
A total of 492 patients with ESKD aged &gt; 65 who assessed for QOL items were included from a Korean nationwide prospective cohort study. QOL was evaluated using the Kidney Disease Quality of Life (KDQOL) instrument, and the effect of each QOL item on mortality was analyzed. Multivariable Cox regression analysis was performed to identify independent risk factors for death after adjusting for compounding factors.

Results
The low physical component scale (PCS) and short form-36 score were significantly associated with low survival rate (PCS: p&lt;0.001 and short form-36: p = 0.017, respectively), while the mental component scale (MCS) and ESRD-targeted item score had no correlation with survival rate. Multivariable Cox regression analysis confirmed that only a high PCS score is associated with better survival (hazard ratio 0.71, 95% confidence intervals 0.52-0.97, P = 0.031). Linear regression analysis identified that age, sex, modified Charlson Comorbidity Index, albumin, and intact parathyroid hormone were factors to PCS. Among the four PCS components, only physical function score was significantly associated with mortality (p&lt;0.001).

Conclusion
Among the KDQOL items, PCS was an independent risk factor for death in elderly ESRD patients. The higher physical function score of PCS components was associated with a better outcome, suggesting the importance of physical conditions in elderly dialysis patients.
#4389 CONSENSUS STATEMENTS FROM THE DIABETOLOGISTS AND ENDOCRINOLOGISTS ALLIANCE FOR THE MANAGEMENT OF PEOPLE WITH HYPERTENSION AND TYPE 2 DIABETES MELLITUS
Authors: Tong Peter , Chan Susanna , Chan Wb , Ho Kai Leung , Leung Godwin , Lo Hok King Stanley , Mak Gary , Tse Ts 
Published: June 2023

Abstract

Background and Aims
Hypertension and type 2 diabetes mellitus (T2DM) are important, intertwined issues in public health. People with both conditions face significantly elevated risks of complications, particularly albuminuria, which is an independent risk factor for cardiovascular (CV) events, kidney failure and all-cause mortality, and thus deserves more attention among physicians and patients. The purpose of this study is to describe the development of recommendations for the management of hypertension and T2DM by a multidisciplinary expert panel.

Method
The panel included eight specialists (three cardiologists, three endocrinologists and two nephrologists) experienced treating patients with hypertension or T2DM. The panel reviewed clinical trials, meta-analyses, observational studies and clinical guidelines that were obtained by searching PubMed for the publication period from January 2015 to June 2021, to address five discussion areas: (i) blood pressure (BP) targets based on CV/renal benefits; (ii) management of isolated systolic or diastolic hypertension; (iii) roles of angiotensin II receptor blockers (ARBs); (iv) implications of albuminuria for CV/renal events and treatment choices; and (v) roles and tools of screening for microalbuminuria. The panel held three virtual meetings using a modified Delphi method to discuss the literature and their experience regarding the discussion areas. After each meeting, consensus statements were derived and anonymously voted on by every panelist. A consensus statement was accepted only if ≥ 80% of the panelists selected ‘accept completely’ or ‘accept with some reservation’.

Results
A total of 17 consensus statements were formulated.

Conclusion
The key messages include: (i) home BP is considered as important as office BP in treatment decision-making; (ii) in patients with T2DM and hypertension on antihypertensive drug treatment, the targets should be &lt; 130/80 mmHg for office BP and &lt; 125/75 mmHg for home BP; (iii) albuminuria is an important therapeutic goal and should be screened for regularly in people with T2DM or hypertension; and (iv) an ARB with proven cardioprotective and renoprotective effects is the preferred drug treatment for patients with T2DM and hypertension.