bluuebunny/crossref_metadata_2025_split huggingface dataset:
#4769 EFFECT OF EXTREMELY LONG DIALYSIS VINTAGE ON RENAL ALLOGRAFT SURVIVAL: A SINGLE-CENTER EXPERIENCE
Authors: Kumru Gizem , Eyupoglu Sahin , Şengül Şule , Keven Kenan 
Published: June 2023

Abstract

Background and Aims
Dialysis vintage is long in kidney transplant recipients (KTRs) due to the donor shortage in Turkey. We assessed the effect of pre-transplant dialysis duration (more than 10 years) on the outcomes of renal allografts.

Method
We retrospectively evaluated 480 KTRs who were grafted between January 2009 and October 2020 at Ankara University School of Medicine, Ibni Sina Hospital. KTRs were divided into two groups according to the duration of pre-transplant dialysis treatment: Group A, ≥10 years and Group B, &lt;10 years. Data on demographics, comorbidities, immunologic properties and graft survivals were compared between the two groups.

Results
Group A included 60 patients and dialysis vintage was 288±60 months (Table 1). 420 patients in Group B had an average of 19 months period of dialysis treatment. While cadaveric transplantation was 78.3% in Group A, it was much lower in Group B (11.2%, p&lt;0.001). Most of the patients were on hemodialysis treatment (95.0% vs. 58.3%, respectively, P = .001). Recipients’ age (P = .001), HLA mismatch number (P = .008) and PRA positivity (P = .001) were significantly higher in Group A. Although anti-human T-thymocyte globulin had been mostly chosen for induction therapy in Group A (p&lt;0.001); almost all patients were under standard triple maintenance immunosuppression therapy. First year and late acute rejection rates were similar between two groups (p=1.000 and P = .407, respectively). Clinically important difference was demonstrated in graft loss, which was mostly seen in the ≥10 years dialysis group (Group A, 18.3% vs. Group B, 8.3%, P = .014). The 1-, and 5- years graft survival rates were 91.4%, and 81.3%, respectively, in Group A and 97.4%, and 93.4%, respectively, in Group B (P = .034 and P = .029, respectively). Patient loss was significantly higher in Group A (Group A, 28.3% vs. Group B, 14.3%, P = .018).

Conclusion
We demonstrated that pre-transplant dialysis duration for more than 10 years has adverse effects on post-transplant graft and patient outcomes, accompanied by high immunological risk. Updates of organ allocation system considering sensitized candidates and strategies to expand donor pool and donation rates are needed to reduce waiting times on dialysis.
#4837 CLINICAL OUTCOMES OF HEMOPERFUSION WITH MG350 AMONG RT-PCR-CONFIRMED SEVERE AND CRITICAL COVID-19 PATIENTS IN A TERTIARY HOSPITAL IN LA UNION
Authors: Echave Mayene Alyssa , Octaviano Chrysanta 
Published: June 2023

Abstract

Background and Aims
Hemoperfusion (HP) refers to the circulation of anticoagulated blood through an extracorporeal circuit with a disposable, adsorbent-containing cartridge. Earlier studies showed that HP stabilizes the plasma levels of cytokines in sepsis and septic shock. Case reports demonstrated the benefit of HP among COVID-19 patients with severe and critical illness but local data on the outcome of HP in COVID is still lacking. This study aimed to determine the clinical outcomes of HP with MG 350 cartridge among RT-PCR confirmed severe and critical COVID-19 patients admitted in a tertiary hospital in La Union in terms of the trend of clinical parameters before and after HP, mean duration of ventilatory support, mean duration of hospital stay and patient's disposition.

Method
This is a descriptive, correlational, retrospective cohort single-center study that reviewed the in-patient medical records of 89 RT-PCR confirmed severe and critical COVID-19 patients who underwent at least two HP treatments. We determined their clinical profile and described the trend of clinical parameters before and after HP. Outcome of HP in terms of mean duration of ventilatory support, mean duration of hospital stay and patient's disposition were determined. The possible significant influence of HP to the clinical profile and outcomes as well as clinical parameters to outcomes were also correlated.

Results
There was a significant decrease in the levels of inflammatory markers such as C-Reactive Protein (CRP), D-dimer, ferritin and Lactate dehydrogenase (LDH) as well as improved respiratory and perfusion parameters such as oxygen saturation and Partial pressure of Oxygen (PaO2) after HP. Patients with higher oxygen saturation, PaO2 and lower fraction of inspired oxygen (FiO2) had shorter duration of ventilatory support. Increased FiO2, CRP, D-dimer, ferritin, white blood cell (WBC) count and Neutrophil Lymphocyte Ratio (NLR) are highly correlated with increased mortality. Early hemoperfusion correlated with shorter duration of ventilatory support, shorter hospital stay and decreased mortality. Interestingly, those with higher oxygen saturation, Pao2, ferritin and procalcitonin correlated with longer duration of hospital stay after HP. Patients with critical illness and late HP had longer duration of ventilatory support. Patients with bilateral infiltrates on chest X-ray and those on mechanical ventilator had longer duration of hospital stay. Increased COVID severity and decreased mean arterial pressure (MAP) had higher likelihood of death even after HP.

Conclusion
Hemoperfusion significantly decreased the level of inflammatory markers thereby lowering the risk for cytokine storm for COVID-19 patients. Early HP is recommended as it is correlated with shorter duration of ventilatory support, shorter hospital stay and decreased mortality.
#4916 A PILOT STUDY ON THE BENEFICIAL EFFECT OF RASBURICASE IN THE PREVENTION OF ACUTE RENAL FAILURE IN PATIENTS WITH CARDIORENAL SYNDROME
Authors: Melero Maria Rosa , Garcia-Prieto Ana , Torroba Beatriz , Patrocinio Rodriguez Benitez , Goicoechea Marian 
Published: June 2023

Abstract

Background and Aims
Uricase metabolizes uric acid into allantoin, a soluble compound that is easily excreted in the urine. Acute hyperuricemia is associated with endothelial injury and vasoconstriction, favoring acute renal failure. Preliminary studies show the protective role of lowering uric acid in cardiac patients.

Method
Pilot study conducted in patients with cardiorenal syndrome and hyperuricemia (&gt;9 mg/dl). All received a single dose of rasburicase (0.20 mg/kg/day in the first 9 patients or a fixed dose of 6 mg in 14 patients) evaluating its effect on renal function and the need for renal replacement therapy.

Results
Twenty-three patients aged 68 ± 14 years were included, 14 men and 9 women, 87% hypertensive, 35% diabetic, 17% with liver disease, and 26% with cancer. Baseline: mean LVEF 40±14.1% (13-63), pro-BNP 19880±14000ng/l, basal Cr 1.55±0.58 mg/dl, uric acid 14.1±2.26, phosphorus 5 .3±1.6 mg/dl and CRP 7±8 mg/l. The evolution of renal function after treatment is shown in Table 1. In all patients, uric acid after rasburicase decreased to 0.5 mg/dl. There were no differences in renal function, RRT, and hospitalization between patients who received a dose of 0.20 mg/kg/day or 6 mg iv. Only 3 patients required RRT for 21±23 hours, with recovery from acute renal failure. Comparing the patients who required RRT versus those who did not, these presented higher baseline uric acid levels: 16.5±2.5 vs 13.7±1.1 mg/dl, P = .049, and there were no differences in LVEF. pro-BNP and previous renal function. One patient died during the hospital stay due to terminal CHF and sepsis, but having recovered kidney function.

Conclusion
Rasburicase administration may prevent established renal failure in patients with cardiorenal syndrome and hyperuricemia. Early treatment, avoiding very high levels of hyperuricemia, could be more effective in reducing the need for renal replacement therapy.
#4945 NEPHROPROTECTIVE EFFECTS OF DIPEPTIDYL PEPTIDASE–IV INHIBITORS FROM PHENOLIC RICH FRACTION OF TRIGONELLA FOENUM IN DIABETIC NEPHROPATHY RATS
Authors: Singh Anand Krishna , Tripathi Purnima 
Published: June 2023

Abstract

Background and Aims
The most common effect of renal disease in the world is diabetic nephropathy (DN). Dipeptidyl peptidase–IV (DPP-IV) enzyme is most abundant present in kidney, which is increased in diabetic nephropathy. A novel approach to treat type 2 diabetes mellitus (T2DM) along with DN, based on incretin hormones: glucagon-like peptide-1 (GLP-1) which regulated by DPP-IV. We hypothesized that DPP-IV inhibitors isolated from phenolic rich fraction of Trigonella foenum (TF) will regulate DPP-IV activity as well as DN: in-vivo; in-silico and kidney histology.

Method
DPP-IV inhibitors from phenolic rich fraction of TF in high sucrose diet along with dexamethasone induced T2DM was explored in-vivo in rat. Apart from serum glucose, DPP-IV, and inhibition activity, HbA1c, Insulin was estimated. We also examined GLP-1, albuminuria, and antioxidant properties in kidney tissue along with histology. Molecular docking of phenolic rich fraction (Gallic acid) of TF with DPP-IV

Results
High sucrose diet with Dexamethasone administration (1 mg /kg BW 45 days) increased concentration of serum glucose, DPP-IV and albuminuria, cholesterol and renal LPO with increase in tissue antioxidant to scavenging free radicals generated by oxidative stress, but after some time antioxidants such as SOD, CAT, GSH was decreased. However, after administration of phenolic rich fraction of TF, DPP-IV inhibition activity increase in TF (71.1%), as compared to Sitagliptin (89.5%) with significant reduction in levels of glucose, albuminuria, TC, TG and with increased Insulin and GLP-1. Kidney histology showed some significant change as compared to diabetes control. Isolated Gallic acid depicts the conformer and affinity energy was – 5.3 and distance from RMSD i.b was 38.669. Sitagliptin depicted the conformer and affinity energy was – 8.9 and distance from RMSD i.b was 3.826.

Conclusion
DPP-IV inhibitors isolated from TF are nephroprotective, antioxidant with novel antidiabetic properties. DPP-IV inhibition lower blood glucose by decreasing DPP-IV activity, albuminuria and increasing levels of GLP-1
#5153 CHARACTERISTICS AND MORTALITY OF PATIENTS STARTING HAEMODIALYSIS IN A PORTUGUESE TERTIARY HOSPITAL: A DESCRIPTIVE ANALYSIS
Authors: Branco Carolina , Costa Claudia , Silva Bernardo Marques Da , Peres Nadiesda , Sant'ana Mariana , Fonseca José Agapito , Outerelo Cristina , Resina Cristina , Lopes José António , Gameiro Joana 
Published: June 2023

Abstract

Background and Aims
Portugal has one of the highest incidences and prevalence of end-stage kidney disease in Europe, with haemodialysis (HD) being the most common modality of renal replacement therapy. The aim of our study was to analyse a cohort of patients who started HD in a large tertiary care hospital in Lisbon and describe the evolution of the patient characteristics throughout the studied years.

Method
This study was a retrospective analysis of all adult individuals who started HD between January of 2014 and December of 2019 in tertiary care hospital in Lisbon. Data was attained from individual electronic clinical records. The primary outcome was mortality. Statistical significance was defined as a P-value lower than 0.05.

Results
We included 1122 patients (mean age 64.9 ±16.8 years, 21.2% at least 80 years old; 60.9% male and 79.7% caucasian). At HD start, mean eGFR was 8.98 ±5.66mL/min/1.73 m2 and the vascular access was a central venous catheter in 56.0%, an arteriovenous fistula in 40.6% and an arteriovenous graft in 3.4%. The number of patients that started HD per year was variable between 169-204 and the percentage of elderly patients increased throughout the years. There was a trend of initiating dialysis with progressively lower eGFR. The percentage of patients with central venous catheter increased. In total 392 patients died (7.5% within the first 90 days of starting HD). Mortality rate within the first 90 days and first year declined from 2015 to 2019. As expected mortality was higher in older patients (Fig. 1), as well as in patients that started HD with a central venous catheter (Fig. 2).

Conclusion
We describe a large cohort of Portuguese patients that started HD between 2014-2019 that correlates well with the available recent data from the national and european registries. There was a greater percentage of patients initiating HD by catheter, which was associated with higher mortality, Although, considering the increase in elderly patients starting HD, their underlying comorbidities might impair vascular access placement and also have an impact on mortality. Additionally, despite the increase in elderly patients, mortality within the first 90 days and first year declined, highlighting the quality of care provided, in addition to a better acknowledgment and referal to conservative care.
#5177 COVID-19 IN ELDERLY CHRONIC HEMODIALYSIS PATIENTS: PREDICTORS OF MORTALITY
Authors: Sellami Nada , Belhaj Wiem , Agrebi S , Khadhar M , Ayed T Ben , Lazzez R , Bouassida S , Jouini S , Ounissi M , Hamida1 F Ben , Abdallah T Ben , Abderrahim E 
Published: June 2023

Abstract

Background and Aims
Studies have shown that the incidence of severe COVID-19 pneumonia is higher in elderly patients and especially those with comorbidities including chronic kidney disease. The aim of our study was to determine risk factors for mortality in elderly chronic hemodialysis (HD) patients.

Method
We conducted a cross-sectional, observational, and analytical study, in the dialysis unit of the internal medicine department at Charles Nicolle Hospital over an 11-month period from September 2020 to August 2021. We studied the correlation between mortality and the different epidemiological, clinical and biological data via the SPSS software.

Results
We included 59 patients, with a mean age of 73 years [65-93] and a gender ratio of 1. All patients had confirmed COVID-19 infection, chronic kidney failure and required regular HD since at least 3 months. One on four patients had a coronary artery disease, 55% were diabetics and 72% had hypertension. From the 19 patients who underwent chest scan, 68% had severe lesions. Emergency HD had to be conducted for 25% of the patients, mainly because of hyperkalemia. At least one ongoing HD session was interrupted for neurologic, hemodynamic or respiratory instability in 26% of the patients. Mortality rate was 58%. Data that were associated with mortality in the univariate study were oxygen needs (p&lt;10-3), COVID-19 infection severity (p=0.007), and interruption of HD session (p&lt;10-3). Low blood pH levels and high pCo2 levels were also correlated to mortality (p=0.032 and p=0.020). Predictors of mortality in multivariate analysis were high oxygen needs (OR=1.368; 95% CI [1.081-1.732]; P = .009), interruption of HD session (OR=1.426; 95% CI [1.070-1.846]; P = .014) and severe form of COVID-19 infection (OR=1.770; 95% CI [1.062-2.980]; P = .029).

Conclusion
According to these results, high oxygen needs, severity of COVID-19 infection and interruption of HD session represented risk factors of death in elderly patients undergoing chronic hemodialysis. As highlighted in previous studies, mortality rate in COVID-19 seems to be higher among elderly patients. However, diabetes and cardiovascular diseases were not identified as predictors of mortality in this sample of patients.
#5203 THE INCESSANT QUEST FOR DRY WEIGHT: SHOULD WE ADOPT NEW STRATEGIES?
Authors: Ayed Amel , Mayssa Hadj Brahim , Jaballah Lazhar , Echouk Amel , Alaya Habiba Ben , Elati Zohra 
Published: June 2023

Abstract

Background and Aims
The estimate of the hydration state in the chronic hemodialysis patient is a key point of his care. Currently, there is no Gold Standard feasable in daily routine despite the increasingly numerous tools such as impedancemetry and pulmonary cardiac ultrasound.
The objective of our study is to compare the results of the clinical estimation of dry weight with the results of impedancemetry and cardiac ultrasound results.

Method
This is a transverse study in the dialysis unit of Taher Sfar Mahdia hospital. The estimation of the hydration state was assessed before and after the hemodialysis session by the three above methods. The volume evaluation was carried out by a clinical score (NYHA&gt; III dyspnea, orthopnee; jugular turgor (TJ), hepato-jugular reflux (HRJ), crackling in auscultation, peripheral edema and pre-dialysis hypertension); as well as by cardiac ultrasound (diameter of the lower vein, E/E ratio and systolic pulmonary arterial pressures).

Results
The values ​​measured by the different techniques decreased significantly after the hemodialysis session (p &lt;0.001). At the two -stroke studied, we have objectified a significant correlation between the results of the impedancemetry, the index of the lower vein and its compliance. A significant difference between the results provided by the techniques studied and the results of the clinical evaluation was found in 64 % of patients. Only the orthopnee (p = 0.03) and the hepato-jugular reflux (p = 0.04) were significantly associated with the ultrasound overload diagnosis.

Conclusion
The existence of a difference between the subjective and objective target weight suggests the incessant need for a mixture between the different techniques evaluated. Our strategy requires to be adapted to the particularities of each patient.
#5245 SUCCESSFUL THROMBOLYSIS OF AN ATRIAL TUNNELED DIALYSIS CATHETER AS A LAST RESORT VASCULAR ACCESS
Authors: Saïed Salah , Mariem Najjar , Mbarek Meriem , Othman Ilhem Ben , Gorsane Imane , Khadhar Yassine , Ayed Tasnim Ben , Kaaroud Hayet , Hmida Fethi Ben , Ziadi Jaleleddine , Abderrahim Ezzeddine 
Published: June 2023

Abstract

Background and Aims
The prolonged survival of patients on dialysis has resulted in a higher frequency of complications and failure related to vascular access. As a result, the situation of depleted vasculature in hemodialysis is becoming increasingly prevalent. The use of an atrial tunneled dialysis catheter (ATDC) has been reported as an effective solution for vascular access in these patients, but limited data is available on the associated complications, particularly thrombosis.

Method
This study reports the experience of a single nephrology center in Tunis with thrombosis of an ATDC as a last resort vascular access for dialysis.

Results
A 32-year-old patient with undetermined tubulo-interstitial nephropathy receiving dialysis presented in November 2022 with depleted vasculature. An ATDC was inserted as a final solution for vascular access, with an initial complication of a catheter-related bloodstream infection, which was resolved with broad-spectrum antibiotics with favorable results. One month later, dialysis could not be initiated through the ATDC. Catheter thrombosis was diagnosed as a guidewire was unable to pass through the catheter's lumen. The patient was successfully treated with thrombolysis using 50 mg of Alteplase, allowing dialysis to be resumed with a blood flow of 300 mL/min.

Conclusion
ATDC is a lifesaving and safe option for patients with depleted vasculature, with only 51 cases reported since 1999 [1]. The treatment of catheter thrombosis is not well defined, and to the best of our knowledge, no thrombolysis protocol has been established. This successful case may contribute to filling the knowledge gap in this field.
#5246 RISK FACTORS FOR COMMUNITY-ACQUIRED ACUTE KIDNEY INJURY
Authors: Rembeci Edi , Tafaj Ermir , Seferi Sajmir , Mumajesi Suela , Idrizi Alma , Barbullushi Myftar 
Published: June 2023

Abstract

Background and Aims
Acute renal injury represents a heterogeneous clinical syndrome with multifactorial etiology rather than a single specific pathology, which is associated with high morbidity and mortality. The disease burden of community-acquired AKI in our country is not well understood. In fact it is known little about it. The aim of this study is to identify and evaluate the risk factors for developing AKI in our community.

Method
This is a cross-sectional study conducted with a small size sample, 76 adult patients. These patients were identified with AKI at hospital admission. AKI was defined according RIFLE Classifications. This champion was selected among patients hospitalized in the Nephrology Clinic, UHC “Mother Tereza” during 2018. The data was collected through medical files.

Results
Most of the patients with AKI were males (66%), with the average age of 64 years old. Nephrotoxic drugs were the most frequent precipitating factor (51%) followed by sepsis (47%) and hypovolemia (41%). A total of 40% of patients had acute on chronic kidney disease, 32% were with diabetes, 14% with cardiac failure and 63% with arterial hypertension. Mostly (93%) had more than one precipitating factor for developing AKI. All the patients with the longest hospital stay (16-35days) had a septic condition. Almost 89% of patients were treated in a conservative way . Patients treated with Hemodialysis had a higher number of risk factors (P&lt;0,4).

Conclusion
The socio-economic factor is also quite important in the development of AKI. It includes lack of access to health care, lack of health insurance, low economic level, poor quality nutrition, etc.The identification of risk factors that predispose to AKI is a crucial aspect of care. It should help primary care and hospital providers identify high risk patients. Comorbit conditions like diabetes, cardiac failure increased the risk for hemodialysis treatment.
#5276 DEVELOPMENT OF A MULTIMODAL “KIDNEY AGE” PREDICTION BASED ON AUTOMATIC SEGMENTATION CT IMAGE IN PATIENTS WITH NORMAL RENAL FUNCTION
Authors: Hou Zuoxian , Zhang Gu-Mu-Yang , MA Yixin , Xia Peng , Shi Xiaoxiao , Sun Hao , Chen Zhengguang , Chen Limeng 
Published: June 2023

Abstract

Background and Aims
Renal function, for decades, has been of interest to clinicians and researchers to describe. For example, serum creatinine (Scr) and estimated glomerulus filtration rate (eGFR) is familiar but also limited in many circumstances. Meanwhile, the physiological volumes of the kidney cortex and medulla are presumed to change with age and have been proven to change with decreasing kidney function.

Method
We recruited 182 patients with normal Scr levels and contrasted CT images between Oct. 2021 and Feb 2022 in Peking Union Medical College Hospital (PUMCH) with their demographic and clinical data. The automatic segmentation method was modified from U-NET and used for both cortex and medullary separation and their volume calculation, respectively. We combined the kidney volume and clinical data as multimodal features of the machine learning model. All the data were separated into a training dataset (PUMCH training set, 80%) and a test dataset (PUMCH test set, 20%). Besides, we included patients with the same inclusion criteria but with diabetes (PUMCH-DM test set) and diabetic nephropathy (PUMCH-DN test set) for internal comparison to verify the possible clinical value of “KIDNEY AGE” (K-AGE). Data from DongZhiMen Hospital (DZMH test set) was used as separate external validation sets to evaluate model generalizability.

Results
The PUMCH training set included 146 participants with a mean age of 47.5±7.4 years. 58.9% were female, and the mean Scr is 63.5±12.3 μmol/L. The PUMCH test set included 36 participants with a mean age of 47.1±7.9 years, 52.7% were female, and the mean Scr was 66.9±13.0 μmol/L. For segmented kidneys, volume differences between non-contrast-enhanced CT and non-contrast-enhanced CT in the left and right kidneys were not evident. The multimodal neural network predicted: K-AGE approximately close to the patient's actual physiological age, with 92% prediction within the 95% confidential interval (Figure 1). We also compared the K-AGE prediction in PUMCH, PUMCH-DM, and PUMCH-DN test sets by applying U-NET-nonCon segmentation algorithm in non-contrast CT images. The mean absolute error increases along with the disease process (control group 5.00, diabetes group 6.99, diabetic nephropathy group 9.32) (Figure 2).

Conclusion
We established a machine learning model for predicting the K-AGE of normal Scr patients.