bluuebunny/crossref_metadata_2025_split huggingface dataset:
#2566 THE EFFECT OF ULTRASOUND-GUIDED COMPRESSION IMMEDIATELY AFTER RENAL GRAFT BIOPSY ON POST BIOPSY BLEEDING
Authors: Abdelnaeem Moataz Fatthy 
Published: June 2023

Abstract

Background and Aims
Renal biopsy is the gold standard for pathological diagnosis of graft dysfunction. Minor complications occur as haematuria, arteriovenous fistula (AVF) and/or small hematomas in 17% of cases. Major complications that require additional treatment as blood transfusion, surgical or interventional procedure. Bleeding may be excessive that may deteriorate ending in graft nephrectomy.

Method
For 6 months period, 213 renal biopsy procedure in clinically indicated patients, performed at interventional nephrology unit 144 men and 59 women, mean age 42 years old, were included. Adequate biopsies were considered showing at least ten glomeruli and 2 blood vessels. Immediate after core withdrawal, operator started ultrasound guided compression using 3-5 MHZ convex probe for 5 minutes at site of needle entrance compressing biopsy track against the graft. Post biopsy bleeding examined (peri-nephric, sub-capsular, haematuria and urinary bladder hematomas.

Results
Percentage of bleeding complications was compared with bleeding complications of previous 200 biopsies performed at the same centre with same operator using ordinary hand compression technique. Bleeding complications reduction by more than 60% especially percentage of perinephric hematomas.

Conclusion
Ultrasound guided compression technique post renal graft biopsy may reduce incidence of bleeding complications post biopsy.
#2601 THE MOLECULAR EFFECT OF SGLT2I ON THE AUTOPHAGY PATHWAY IN TYPE II DIABETES MELLITUS AND ITS VASCULAR COMPLICATIONS
Authors: Ertracht Offir , Saad Raneen , Tadmor Hagar , Nakhoul Farid , Nakhoul Nakhoul 
Published: June 2023

Abstract

Background and Aims
Type II Diabetes mellitus (T2DM) is a severe metabolic disorder characterized by chronic hyperglycemia and its subsequent glucose toxicity that lead to irreversible damages in several organs such as Diabetic Nephropathy (DN) [1]. Autophagy is involved in catabolic processes and plays a key role in the degradation of damaged intracellular proteins in order to maintain intracellular homeostasis and cell integrity. Studies showed that autophagy-related protein 5 (ATG5) and Light chain 3-II (LC3-II) play a critical role in a variety of disease processes, like DN [3]. Empagliflozin (EMPA)
is sodium glucose transporter inhibitor (SGLT2i) which represents a new class of glucose lowering drugs and is recommended in T2DM [4]. We hypothesized that EMPA effects renal integrity and function via the autophagy mechanism. The proposed research aim to investigate the molecular effect of SGLT2i on the expression of ATG5 and its downstream collaborator LC3-II in diabetic mice model [5].

Methods
8-week-old male mice: C57BL/6 Wild Type (Con), BTBR ob/ob (DM) and BTBR ob/ob treated with EMPA (1mg/kg/day P.O.) (DM+EMPA) were followed for 12 consecutive weeks for their weight, blood glucose and renal function. After sacrifice lysate from renal cortex were analyzed by Western blot and immunohistochemistry for ATG5, LC3B and fibronectin expression.

Results
Blood glucose level in DM mice was higher than Con, and lower in DM+EMPA. DM+EMPA mice drunk, urinated more and exerted more glucose than DM mice, yet had less protein in their urine. WB and IHC analyses revealed that renal ATG5 and LC3-II levels were reduced in DM mice compared with Con and DM+EMPA mice. Fibronectin expression was increased in DM compared to Con mice, and DM+EMPA mice.

Conclusions
EMPA treatment preserved DM mice renal dysfunction. Our data suggest that there is a link between DM and ATG5/LC3-II dysregulation and subsequent DN. EMPA preserves ATG5/LC3-II in DM mice. Our findings may be translated into clinical practice approach and may lead to further studies to address DM and vascular complications by selective modulation of ATG5/LC3-II expression with SGLT2i treatment.
#2608 IV IRON IN CKD AND HF: IMPROVING CLINICAL OUTCOMES WITH HIGH-DOSE IV IRON IN PATIENTS WITH IRON DEFICIENCY, HEART FAILURE AND CKD
Authors: Kalra Philip A , Ahmed Fozia 
Published: June 2023

Abstract

Background and Aims
The emerging role of IV iron to reduce cardiovascular risk, particularly risk of hospitalisation for heart failure. Cardiovascular diseases are a common comorbidity in patients with chronic kidney disease. There is emerging evidence that treating with IV iron may not only correct for iron deficiency and anaemia but also have positive effect on hard clinical endpoints.

Method
The most recent RCT trial published is the IRONMAN trial, which was a prospective, randomised, open-label, blinded-endpoint trial done at 70 hospitals in the UK. 1137 patients with heart failure, a reduced left ventricular ejection fraction and iron deficiency were randomised to receive either ferric derisomaltose (FDI) on top of usual care or usual care alone. A large proportion of the patients (64%) had an eGFR &lt; 60 mL/min/1.73 m2.

Results
Compared to usual care, FDI was associated with a 18% lower risk of recurrent heart failure hospitalisations and CV death, which approached statistical significance (p = 0.07). In the prespecified COVID-19 sensitivity analysis, the primary endpoint was nominally statistically significant with a relative risk reduction of 24% (p = 0.047). Between Aug 25, 2016, and Oct 15, 2021, 1869 patients were screened for eligibility, of whom 1137 were randomly assigned to receive intravenous ferric derisomaltose (n = 569) or usual care (n = 568). Median follow-up was 2·7 years (IQR 1·8–3·6). 336 primary endpoints (22·4 per 100 patient-years) occurred in the ferric derisomaltose group and 411 (27·5 per 100 patient-years) occurred in the usual care group (rate ratio [RR] 0·82 [95% CI 0·66 to 1·02]; p = 0·070). In the COVID-19 analysis, 210 primary endpoints (22·3 per 100 patient-years) occurred in the ferric derisomaltose group compared with 280 (29·3 per 100 patient-years) in the usual care group (RR 0·76 [95% CI 0·58 to 1·00]; p = 0·047). No between-group differences in deaths or hospitalisations due to infections were observed. Fewer patients in the ferric derisomaltose group had cardiac serious adverse events (200 [36%]) than in the usual care group (243 [43%]; difference –7·00% [95% CI –12·69 to –1·32]; p = 0·016).

Conclusion
For a broad range of patients with heart failure, reduced left ventricular ejection fraction and iron deficiency, intravenous ferric derisomaltose administration was associated with a lower risk of hospital admissions for heart failure and cardiovascular death, further supporting the benefit of iron repletion in this population.
#2610 NURSE-LED OPTIMIZATION OF VOLUME AND BLOOD PRESSURE IN KIDNEY DISEASE – ENABLING AT MULTI-LEVELS USING A TECHNOLOGY (NOVELTY) PROGRAM
Authors: Huang Zhihua , Mok Irene , Ng LI Choo , Tan Hui Zhuan , Choo Jason , Tan Chieh Suai , Lim Cynthia 
Published: June 2023

Abstract

Background and Aims
Fluid overload and hypertension are common in chronic kidney disease (CKD). They increase healthcare utilization due to frequent ambulatory consults and/or hospitalizations but can be avoided with self-management. We evaluated the feasibility of a nurse-led, team-based program that incorporated (1) objective fluid volume assessment using body impedance analysis (BIA) to enable diuretic and antihypertensive titration, and (2) structured patient education and action plan coaching for ambulatory patients with CKD and fluid overload and/or uncontrolled blood pressure.

Method
Prospective pilot study of adults who participated in the 4-week program (Figure 1) between August and October 2022. Patients were eligible if they had CKD not requiring dialysis and had fluid overload and/or systolic blood pressure (BP) &gt;160 mmHg or diastolic BP &gt;100 mmHg at the ambulatory renal clinic. We evaluated fluid overload symptoms and signs, standardized clinic BP, BIA over-hydration volume and patient reported outcomes on (1) chronic disease self-management using the Partner in Health (PIH) questionnaire (2) perceived autonomy support from the healthcare team using the modified Health Care Climate Questionnaire (HCCQ), and (3) health-related quality of life (HrQOL) using the EuroQOL-5 Dimension (EQ5D5L) questionnaire, before and after the program.

Results
Fifteen patients were referred by their nephrologists, but 1 was uncontactable and 1 did not want to adhere to the recommended treatment. Among 13 patients in the pilot, 64.3% was male, median age was 68 (range 40 – 85) years and 35.7% had ≥4 visits to healthcare institutions in the past six months. Causes of kidney disease were diabetes (64.3%), hypertension (21.4%) and glomerulonephritis (14.3%), with a median eGFR of 30 (14 – 106) ml/min/1.73 m2. At enrolment, fluid overload was present in 57.1% and BIA over-hydration value was 1.7L (0 – 6.4L). Eleven patients (84.6%) completed the 4-week follow-up; 1 stopped after the first consult due to lack of time, while 1 stopped after 2 weeks (already confident of self-management). At 4 weeks, systolic BP [141 (109-179) mmHg versus 162 (120-198) mmHg at enrolment, p = 0.046] and PIH score [84 (72-96) versus 57 (10-94), p = 0.04] had improved significantly compared to enrolment, while HrQOL was not different (Table 1). Patients generally perceived a high level of autonomy support from the healthcare team. Serum creatinine did not change significantly after antihypertensive and diuretic titration.

Conclusion
A nurse-led program incorporating objective fluid volume assessment, structured patient education and action plan coaching was well-received, with improved BP and self-management in patients with kidney disease.
#2613 DIETARY FIBER INTAKE, THEIR SOURCES AND MORTALITY IN ADULTS ON HEMODIALYSIS: THE DIET-HD STUDY
Authors: Su Guobin , Saglimbene Valeria , Carrero Juan Jesus , Natale Patrizia , Ruospo Marinella , Strippoli Giovanni 
Published: June 2023

Abstract

Background and Aims
Higher fiber intake is associated with lower cardiovascular and all-cause mortality in the general population, but their benefits and which sources of fiber are healthier in patients on hemodialysis are uncertain.

Method
Daily fiber intake (DFI) and their sources (vegetable and fruit, staple food and other sources) were ascertained by the Global Allergy and Asthma European Network food frequency questionnaire within the DIET-HD study, a multinational cohort study of adults on hemodialysis. Adjusted Cox regression analyses were conducted to evaluate the association of DFI and fiber sources (vegetable and fruit, staple foods, others[including dressing sauce etc.]) (both as tertiles and continuous) with all-cause and cardiovascular mortality. Estimates were calculated as hazard ratio (HR) with 95% confidence interval (CI).

Results
8,110 patients were followed for median of 3.8 years (26,074 person-years). There were 2,953 deaths, of which 1160 cardiovascular-related. The median (interquartile range) DFI was 12.0 (8.1-17.5) gram per day and vegetables and fruits (49%) were the major source. Each unit increase in total DFI was not associated with either all-cause (hazard ratio [HR], 0.99; 95%CI:0.98-1.00, p = 0.37)or cardiovascular mortality (HR,0.99;95%CI:0.98-1.00, p = 0.08). Compared with patients in the lowest DFI tertiles (&lt;9.5mg/day), the adjusted HRs for cardiovascular mortality among those in the middle (9.5-15.3 g/day) and highest tertiles (≥15.3 g/day) were respectively 0.97 [95% CI, 0.84-1. 13] and 0.79 (95%CI, 0.65-0.96) (P value per trend = 0.02). Each unit increase in fraction of DFI from vegetable and fruit was associated with lower all-cause (HR,0.70;95%CI: 0.57-0.86, p = 0.001) but not with cardiovascular mortality (HR,0.75;95%CI: 0.54-1.04, p = 0.08). Each unit increase in the fraction of DFI from other sources (including dressing sauce etc.) was associated with higher all-cause mortality (HR, 1.66; 95%CI, 1.22-2.27, p = 0.001) but not with cardiovascular mortality (HR, 1. 63; 95%CI, 0.83-2.24, p = 0.23). No association were observed between fiber from staple food and all-cause or cardiovascular mortality.

Conclusion
Fiber intake in the hemodialysis population is low. A higher fiber intake from vegetable and fruit, and a lower fiber intake from other sources (including dressing sauce etc.) is associated with lower all-cause death.
#2616 DIAGNOSTIC VALUE OF THE HANDGRIP STRENGTH IN DETECTING PROTEIN-ENERGY WASTING AMONG HEMODIALYSIS PATIENTS AT NATIONAL KIDNEY AND TRANSPLANT INSTITUTE
Authors: Patoc Gerry , Villanueva Anthony Russell 
Published: June 2023

Abstract

Background and Aims
Protein energy wasting (PEW) is a syndrome of adverse nutritional and catabolic changes common among chronic kidney disease (CKD) patients. Handgrip strength (HGS) was one of the methods of screening PEW mentioned in Kidney Disease Outcomes Quality Initiative guidelines. However, only few studies determined the validity of HGS in detecting PEW among maintenance hemodialysis (MHD) patients. The study aimed to determine the diagnostic validity of HGS in detecting PEW among MHD patients in a tertiary government hospital, with the following specific objectives: to determine the prevalence of PEW among MHD patients, to compare the demographic and clinical profile by PEW status, to identify the optimal cut-off point of HGS pre- and post-HD sessions in detecting PEW by sex, and to determine the following diagnostic value parameters of HGS pre- and post-HD sessions in detecting PEW by sex in terms of discriminative ability, accuracy, sensitivity, specificity, positive predictive value and negative predictive value.

Method
Participants included in this cross-sectional study are randomly selected patients undergoing MHD in National Kidney and Transplant Institute (NKTI) from September to October, 2022. Diagnosis of PEW was based on the Malnutrition Inflammation Score (MIS) ≥5. HGS was measured using a dynamometer pre- and post-dialysis sessions.

Results
A total of 143 patients were included in the study, and 53% were diagnosed with PEW. Pre-HD and post-HD HGS have acceptable discriminative ability based on Area Under the Curve &gt;0.70 in detecting PEW regardless of patient sex. In males, a post-hemodialysis cut-off of &lt;17.9 showed 72% sensitivity and 71% specificity in detecting PEW. Meanwhile, a pre-hemodialysis cut-off of &lt;18.6 in females showed 83% sensitivity and 65% specificity in detecting PEW.

Conclusion
PEW is common among MHD patients in NKTI. The diagnostic performance of HGS in detecting PEW was found to be acceptable in both
males and females. While both pre- and post-HD measures can be used in males, only the pre-HD measures are recommended for females. HGS can, therefore, be used as a non-expensive, accurate and objective screening assessment tool in detecting PEW for MHD patients. External validation of the proposed HGS cut-off values is still recommended.
#2620 WHY DIALYSIS PATIENTS CHOOSE OR REFUSE KIDNEY TRANSPLANTATION AS RENAL REPLACEMENT THERAPY: A QUALITATIVE STUDY
Authors: Muharremi Shkelqim , Poposki Aleksandar , Shavreska Vangjelka Kovacheska , Spasovski Goce , Selim Gjulsen 
Published: June 2023

Abstract

Background and Aims
Kidney transplantation is considered the best renal replacement therapy (RRT) for patients with end-stage renal disease, nevertheless, some dialysis patients refuse to be transplanted. Many patients are concerned about their quality of life as a patient on dialysis compared to life with a new, functioning kidney. The results from many studies have shown that patients who have been living with a transplanted kidney for 10 years demonstrate a greater likelihood of still being alive than those on dialysis. For every 10 patients receiving a new kidney, eight will still have that kidney working three years after the operation. So, considering survival alone, individuals receiving a new kidney do better than those on dialysis. But not all the CKD and CKD on HD share the same opinion and a number refuse kidney transplantation. The aim of this paper is to identify the reasons for choosing or refusing kidney transplantation as renal replacement therapy among patient with Chronic Kidney Disease (CKD).

Method
We used purposeful sampling because it was more relevant to identify and to select the individuals who seemed in-keeping with the social facts we wanted to study. We wanted to retrace participants’ paths of care to identify the reasons for their choice. Patients who were treated using hemodialysis as well as those who opted for peritoneal dialysis were interviewed. We also interviewed health professionals (doctors, nurses, a psychologist) for their opinions on the nature of their relationship with patients in the decision making process regarding kidney transplantation.

Results
Data were collected through interviews with CKD patient and CKD patient treated by dialysis. Health professionals, medical doctors and nurses were also interviewed. A thematic analysis was used to analyze the data. The collected data showed that various reasons account for CKD patients’ refusal replacement therapy without positive outcome, refusal to have an allograft. There are also situations such as the lack of organ, the age factor, contraindications to kidney transplantation that not allow some CKD patients to have a kidney transplant. Among the patients who choose kidney transplantation, lots of them have lack of information about transplantation process others see kidney transplantation as a cure which will finally make them machine dependent and a small group see it as a normal process.

Conclusion
This paper shows that the choice of kidney transplantation depends on patients’ perceptions of its outcomes. Some circumstances, such as the lack of an available organ or specific medical criteria including age factor and malignancy, reduce CKD patients’ participation in the decision-making process.
#2630 NETOSIS IS A PREVALENT IMMUNE PROCESS IN LUPUS NEPHRITIS AND NEUTROPHIL ELASTASE SCORING EXPRESSES THE ACTIVITY AND SEVERITY IN DIFFERENT CLASSES
Authors: Abdelmegied Shaimaa Zaki , Salman Manal , Mahmoud Heba , Elgendy Aya 
Published: June 2023

Abstract

Background and Aims
The release of NETs by activated neutrophils is known as NETosis. NETs are released not only on exposure to pathogens such as bacteria but also in sterile environments in autoimmune diseases such as lupus where they generate/trap autoantigens and aggravate inflammation. This study assesses the prevalence of neutrophil elastase (NE) as a marker of Netosis in lupus in renal biopsies and its presentation in different lupus classes.

Method
A cross-sectional study included 45 patients with lupus nephritis who underwent renal biopsy and were classified according to lupus class. NE was done for the detection of Netosis by immunohistochemistry.

Results
The prevalence of (NE) was 88.8% (40/45 cases). NE combined score with cut-off (&gt;3) expresses moderate to severe Netosis. It allowed the detection of active proliferative lupus class III-IV with a sensitivity: 80.0%, specificity: 60.0%, PPV: 85.71%, and NPV: 50.0%. In class III-IV (N = 34 cases): NE combined score &gt;3 was 83.3% (25/30 cases) with features: glomerular deposition &gt;25% of the glomerulus in 60% (19/30 cases), strong intensity (+2) in 63.3% (19/30 cases), diffuse (&gt;50% of the number of the glomeruli) 67.8% (19/28 cases). In non-proliferative lupus class II-V (N = 11 cases) NE combined score &gt;3 was 20% (2/10 cases) and score&lt;3 was 80% (8/10 cases) with features: glomerular deposition &lt;25%/ faint intensity (+1)/ focal. On comparing both groups as regard NE combined score, distribution, intensity, and focal/diffuse p value was 0.0002, 0.099, 0.013, and 0.94 respectively. On redistribution of biopsies according to NE combined score &gt;3 vs &lt;3 there was a significant difference in activity index, distribution, intensity, and focal/diffuse p-value 0.0011, 0.0001, 0.0002, 0.0006 while non-significant for chronicity index p-value 0.08914.

Conclusion
NETOSIS is a prevalent immune process in lupus nephritis and NE combined score is a sensitive marker of proliferation that increases with class severity and activity.
#2663 KIDNEY INVOLVEMENT IN MYELODYSPLASTIC SYNDROMES
Authors: Lafargue Marie-Camille , Van Huyen Jean-Paul Duong , Isnard Pierre , Rennke Helmut , Essig Marie , Bobot Mickaël , Jourde-Chiche Noemie , Sakhi Hamza , Boudhabhay Idris , Brunet Philippe , Boulay Hugoline , Grobost Vincent , Philipponnet Carole , Jeannel Juliette , Chemouny Jonathan , Boffa Jean Jacques , Selamet Umut , Riella Leonardo , Fain Olivier , Adès Lionel , Fenaux Pierre , Cohen Camille , Mekinian Arsène 
Published: June 2023

Abstract

Background and Aims
Myelodysplastic syndromes (MDS) are hematologic disorders characterized by ineffective and dysplastic hematopoiesis that can be associated with systemic inflammatory and autoimmune diseases. The objective of this study was to describe kidney involvement in MDS patients, their treatments, and outcomes.

Method
We conducted a French and American multicenter retrospective observational study in nine centers, identifying MDS patients with acute kidney injury (AKI), chronic kidney disease (CKD), and urine abnormalities.

Results
Seventeen patients (males n = 11, median age 76 [70-79]) developed a kidney disease 6 months [0-31] after the diagnosis of MDS. Median urinary protein to creatinine ratio was 1.9g/g [0.8-3.3], and median serum creatinine was 3.5mg/dL [1.5-4.7]. Twelve patients (70%) had AKI at presentation, and 14 (82%) extra-renal symptoms, which consisted mostly in cutaneous and pneumological manifestations. The renal diagnoses included antineutrophilic cytoplasmic antibody (ANCA) associated vasculitis (AAV) (n = 8, 47%), ANCA negative vasculitis (n = 4, 24%), C3 glomerulonephritis (n = 2), immune complex-mediated glomerulonephritis (n = 1), polyarteritis nodosa (n = 1), and IgA vasculitis (n = 1). Kidney biopsies were performed in 10 of the cases. All patients, except one, received a treatment following the MDS-associated kidney injury (n = 16, 94% with steroids). The effect of MDS treatment on kidney injury could be assessed in 8 patients treated with azacitidine, and renal function evolution was heterogenous. After a median follow-up of 9 months [4.1-14.2], 4 patients had CKD stage 3, 4 CKD stage 4, 5 an end stage kidney disease. Three patients evolved to an acute myeloid leukemia (AML), and 3 died. Compared to 84 MDS controls, patients who had a kidney involvement were younger (p = 0.03), had a higher number of dysplasia lineages (3 lineages, p = 0.001), and were more eligible to receive hypomethylating agents (p = 0.031), but no survival difference was seen between the two groups (p = 0.5227). Compared to 265 AAV without MDS, MDS-associated AAV were older (p = 0.019), ANCA serology was more frequently negative (p = 0.014), and more cutaneous lesions were seen (p = 0.003).

Conclusion
The spectrum of kidney injuries associated with MDS is mostly represented by vasculitis, and especially AAV. A diagnosis of ANCA vasculitis in an elderly patient, or with a cutaneous manifestation, or without ANCA positivity, should lead to the search for a possible MDS.