bluuebunny/crossref_metadata_2025_split huggingface dataset:
#6071 RITUXIMAB FOR MAINTENANCE OF REMISSION IN ADULT MINIMAL CHANGE DISEASE
Authors: Tsiakas Stathis , Theodoridis Ioannis , Kapsia Eleni , Skalioti Chrysanthi , Boletis Ioannis , Marinaki Smaragdi 
Published: June 2023

Abstract

Background and Aims
Maintaining remission in a minority of adult patients with minimal change disease remains challenging. Prolonged corticosteroid use is associated with severe adverse effects. A limited number of observational studies suggest that rituximab may be an alternative therapeutic option for remission maintenance, allowing steroid withdrawal.

Method
We retrospectively analysed the data of all adult patients with minimal change disease, who received rituximab in our centre between 2017 and 2022.

Results
A total of 14 adults with minimal change disease were treated with rituximab, six of whom had childhood-onset nephrotic syndrome. Six patients were steroid dependent. The median number of relapses was 6.5 (IQR 4.5-15.2) prior to rituximab. Thirteen patients had received at least ≥ 2 different immunosuppressive agents during their disease. Corticosteroid-related adverse events, including osteopenia, hypertension, cataract and diabetes mellitus were observed in 10 subjects. Rituximab was administered in a median time of 10.6 years (IQR 4.5-16.3) after diagnosis. All patients received 2 doses of 1g rituximab 2 weeks apart. The median age at rituximab administration was 31 years (IQR 18.7-49.0); all patients were in remission. Besides corticosteroids, concomitant immunosuppressive therapy included calcineurin inhibitors (n = 6) and mycophenolate acid analogues (n = 1). The median follow-up time after the first dose of rituximab was 44 months (IQR 9.5-67.2). Relapses occurred in 6/14 patients in a median time of 17.5 months (IQR 10.2-26.5). The number of relapses per year decreased to 0.27 from 0.87 (p &lt; 0.001) after rituximab. Six patients received a repeat course of rituximab. One patient developed Pneumocystis Jirovecii pneumonia, that was successfully treated with cotrimoxazole. At the last follow-up visit, corticosteroids were discontinued in 8 out of 14 patients and calcineurin inhibitors in 3 out of 7 patients.

Conclusion
Rituximab is a reasonable therapeutic approach for maintaining remission and avoiding steroid toxicity in adult minimal change disease. Randomized controlled studies are needed to further evaluate the safety and efficacy of rituximab in these patients.
#6584 WEEKEND EFFECT IN ACUTE KIDNEY INJURY ADMISSIONS AND 1-YEAR RENAL OUTCOME
Authors: Da Silva Bernardo Marques , Pais Telma , Oliveira José , Marchão Natália , Pereira Marta Sofia Henriques , Fonseca José Agapito , Jorge Sofia , Nogueira Estela , Godinho Iolanda , Rodrigues Natacha , Amaral Tiago , Gameiro Joana , Lopes José António 
Published: June 2023

Abstract

Background and Aims
The “weekend effect” is the finding of worse outcomes in hospital admissions occurring over weekends. The reasons for this are still unclear but shorter staffing has been suggested to contribute. Little is known about the impact of the “weekend effect” on renal outcomes. We aim to analyze the impact of the weekend effect on patients admitted with acute kidney injury (AKI). We evaluated one-year renal outcome and mortality in patients admitted for AKI over weekends and weekdays.

Method
We conducted a retrospective analysis of all adult patients admitted in a tertiary medical center in Portugal over a period of 6 months with a diagnosis of AKI. Variables were retrieved using clinical and laboratory data. AKI was defined and severity was accessed according to Kidney Disease Improving Global Outcomes classification. Patients were categorized according to weekdays or weekend admission. Outcomes were in-hospital mortality, hemodialysis (HD) requirement and one-year mortality. Statistical significance was defined as a P-value &lt;0.05

Results
We included 163 patients with mean age of 69.8±16.2 years and 52.7% were male. The majority of patients were admitted on weekdays (74.2%, n = 121). Also, the majority had AKI stage 3 (65.6%, n = 107). Forty eight patients (29.4%) required HD during hospitalization and in-hospital mortality was 24.5%. There were no significant differences in HD requirement (31.4% vs 23.8%, p = 0.434), mortality (25.6% vs 21.4%, p = 0.680) nor HD requirement at discharge (25.6% vs 26.2%, p = 0.681) between weekday or weekend admissions. Of the 123 patients discharged, during the one-year follow-up 30.1% (n = 37) died and 7.3% (n = 9) required HD. There were no differences between weekdays or weekend admissions concerning mortality (32.2% vs 24.2%, p = 0,507) and HD requirement (7.8% vs 6.1%, p = 0,746)

Conclusion
In this cohort of patients with AKI there was no “weekend effect”, which reflects the adequacy of care independently of the day of admission. The retrospective design with a limited number of patients may have influenced the results. Further studies focusing on renal outcomes are required to better understand the occurence of the weekend effect and its long-term impact.
#6858 GRAFT SURVIVAL IN MULTIPLE KIDNEY TRANSPLANT RECIPIENTS FROM CHILDHOOD TO ADULTHOOD: AN ERA STUDY FROM 1978 UNTIL 2019
Authors: Preka Evgenia , Bonthuis Marjolein , Marks Stephen , Kramer Anneke , Stel Vianda , Harambat Jerome , Jager Kitty J 
Published: June 2023

Abstract

Background and Aims
Knowledge regarding graft survival after transplantation in European children with multiple kidney transplants followed from childhood into adulthood including factors affecting these outcomes is lacking.

Method
Using ERA Registry data, we investigated all patients on kidney replacement therapy (KRT) who received their first kidney transplant (KT) before 20 years of age between 1978 and 2019. Graft survival after first, second and third KT were studied alongside their risk factors, using Kaplan-Meier survival analysis and multivariable Cox regression models.

Results
Among 10012 paediatric KT candidates, 8601, 1962 and 412 received at least one, two and three KTs. Graft survival at 5 and 10 years was 80.6% and 65.7% for first KTs, 71.3% and 53.7% for second KTs and 67.1 and 49.5% for third KTs. Factors associated with increased graft failure risk were having glomerulonephritis or a recurrent disease as cause of kidney failure for first KT recipients (aHR 1.24, 95%CI 1.12-1.37 and aHR 1.24, 95%CI 1.13-1.37, respectively). Patients whose first KT lifespan was between 0–30 days or more than 5 years presented lower graft failure risks regarding their second KT compared to patients whose KT survived between 1–5 years (aHR 0.79, 95%CI 0.64-0.98 and aHR 0.73, 95%CI 0.61-0.88, respectively). Similar results were found for third KT recipients whose second KT lived for more than 5 years (aHR 0.61, 95%CI 0.41-0.92). Patients who were transplanted for the first and second time before 2007 presented a higher graft failure risk compared to patients who received their KT between 2016–2019 (aHR 2.09, 95%CI 1.65-2.65 and aHR 1.63 95%CI 1.29-2.06 for the transplantation era before 2000 and between 2000–2007 concerning the first KT; and aHR 1.69, 95%CI 1.15-2.47 and aHR 1.51, 95%CI 1.06-2.16, respectively for the era before 2000 and between 2000–2007 concerning the second KT). Pre-emptive KTs presented less graft failure compared to patients who received dialysis &gt; 1 year for first and second KT (aHR 0.89, 95%CI 0.81-0.98 and aHR 0.63, 95%CI 0.51-0.78,respectively). Patients having received a LD KT had less chances for graft failure for first and second KT (aHR 0.77, 95%CI 0.7-0.84 and aHR 0.71 (0.6-0.85, respectively). Having a second LD KT (no matter the donor type for first KT) was advantageous compared to having a second DD.

Conclusion
Graft outcomes after pediatric kidney (re)transplantation have improved significantly over time for all recipient subgroups, especially for patients with LD KT, longer previous KT lifespan and pre-emptive KT. Patients with GN and recurrent diseases as causes of their kidney failure showed the poorest outcomes, highlighting the need for continued progress in this field.
#2511 ASSOCIATION OF CONSTIPATION, MICROBIAL TRANSLOCATION, AND INFLAMMATION IN HD PATIENTS
Authors: Chang Yu-Kang , Lim Paik Seong 
Published: June 2023

Abstract

Background and Aims
Increased gut permeability and intestinal dysbiosis may contribute to chronic inflammation, leading to accelerated atherosclerosis and cardiovascular complications in patients on haemodialysis (HD). Constipation is highly prevalent in HD patients and growing evidence suggested constipation can aggravate gut microbiota dysbiosis and gut inflammation. The aim of this study was to evaluate the association between markers of microbial translocation, intestinal permeability and inflammation in HD patients with and without constipation.

Method
A cross-sectional, observational study was conducted and 200 stable prevalent HD were enrolled. Serum zonulin, eotaxin-1, amyloid A, intestinal fatty acid-binding protein (iFABP), IL-6, endotoxin core antibodies (EndoCAb) and lipopolysaccharide binding protein (LBP) levels were measured. Functional constipation was defined according to the Rome IV criteria.

Results
Serum levels of zonulin and eotaxin-1 but not LPS, endo-Cab IgG, amyloid A and IL-6 were significantly higher in HD patients with constipation than in non-constipated HD controls. The multiple logistic regression analysis in constipated HD patients after adjustment for age, and BMI demonstrated that serum zonulin and eotaxin-1 were independently associated with constipation with an odds ratio (OR) of 1.24 (95% CI = 1.09-1.42, p = 0.0016) and 1.02 (95% CI = 1.01-1.03, p = 0.0001), respectively.

Conclusion
We demonstrate that there was association between serum eotaxin-1 and zonulin levels in constipated HD patients. This may indicates that increased intestinal inflammation or intestinal permeability in these patients but the significance of these findings need further investigation.
#2533 PROGNOSTIC SIGNIFICANCE OF ARTERIOLAR C4D POSITIVITY AS A MARKER OF MICROANGIOPATHY IN ANCA-ASSOCIATED VASCULITIS
Authors: Gentile Micaela , Maggiore Umberto , Manenti Lucio , Fenaroli Paride , Delsante Marco , Fiaccadori Enrico , Rossi Giovanni Maria 
Published: June 2023

Abstract

Background and Aims
ANCA-associated vasculitis (AAV) represent a group of systemic autoimmune diseases characterized by necrotizing inflammation of small to medium-size blood vessels frequently associated with anti-neutrophil cytoplasmic antibody (ANCA) positivity. Another term they are commonly referred with is “paucimmune vasculitis”, reflecting the lack of immune complex deposition on histological samples, in contrast with other small vessel vasculitis, e.g. cryoglobulinemic vasculitis. The absence or the paucity of deposition of immunoglobulins and complement components was interpreted in the past as a lack of complement cascade involvement in the pathogenesis of AAV. Only in relatively recent times the possible role of complement in AAV was investigated. A few studies proved the relationship between C3 hypocomplementemia and worse renal outcome[1]. Moreover, the overactivation of the alternative complement pathway (ACP) in AAV could be responsible for thrombotic microangiopathy (TMA). A strong association between low serum C3 and histologic signs of thrombotic microangiopathy on renal biopsy was shown in patients with AAV, with a worse renal prognosis. Currently, there are no clear early histological markers of endothelial damage that allow to identify high-risk patients, other than the seldom not identified or misidentified presence of TMA. The association between renal arteriolar C4d deposition (as a vicariate of TMA) has been already described in several glomerulonephritis, including IgA nephropathy [2], but its prognostic meaning has not yet been explored [3]. Our study aims to explore the predictive role of arteriolar C4d in ANCA-associated GN.

Method
All patients with ANCA-associated GN who underwent a kidney biopsy between January 1990 and June 2021 at the Renal Unit of Parma University Hospital, Parma, Italy with at least 6 months follow-up data were included. All histology slides were retrieved and reviewed by experienced nephropathologists. Percent IFTA, percent global glomerulosclerosis, Brix score, the presence or absence of TMA, the positivity or negativity of C4d (immunohistochemical staining on paraffin-embedded formalin-fixed slides) were taken note of. C4d positivity was correlated with the presence of TMA and patients outcome (Fig. 1).

Results
We identified 58 patients who met our criteria. 14 patients were excluded because biopsy specimens were not available for histologic review. Clinical and laboratory baseline and follow-up data for the remaining 44 patients were thus collected.

Conclusion
C4d and TMA were independently associated (p = 0.003). A tendency towards association between C4d and death-censored ESRD was observed (Fig. 2), although not statistically significant (p = 0.434), likely due to the limited sample size. In order to test our hypothesis, validation on a larger cohort is currently underway.
#2543 NEPHROFLOW FOR ESTIMATION OF VASCULAR ACCESS FLOW FOR HEMODIALYSIS: WHEN TO MEASURE?
Authors: Coronado Pablo Alejandro Sarduy , Rivas José Luis Merino , Peña Cecilia Peña , Abad Noelia , Antúnez Blanca Bueno , Marchante Beatriz Espejo , Martin-Centellas Jesus , Paraíso Vicente 
Published: June 2023

Abstract

Background and Aims
Current guidelines emphasize the need for surveillance of vascular access (VA) for hemodialysis (HD), especially arteriovenous fistulas (AVF). Detecting a reduction in VA flow is auseful tool to anticipate the complications of VA as thrombosis. The DMed NephroFlow(NIPRO®) system, based on ultrasound dilution (UD) methods, has been shown tobe comparable to the classic Transonic® measurement system for estimating VA flow and canbe applied for VA surveillance. Our objetctive is to determine if there are significant differences when performing flow measurements with NephroFlow® between the first hour and the second hour of the HD session, as well as between any of the three days in which the patient attends HD.

Method
For two consecutive weeks, patients with AVF or graft (gAVF) on HD in our unit underwent VA flow measurements using the NephroFlow® system at the first and second hour of HD, on the 3 days that they attended HD sessions. Interspersing the first hour with the second each week to avoid significant loss in HD quality. For the study, we proceeded according to the usual recommendations of stable flow at 250 ml/min, corresponding ultrafiltration rate, needles in the same vein, without change in dry weight, with the same nurse staff, and transferring all patients to conventional HD.

Results
Twenty-one patients have been included, 13 male and 8 female, mean age 68±12.3 years. The mean time on HD was 36±23 months. The type of VA was: 10 patients presented a radiocephalic AVF, 5 brachiocephalic AVF, 2 patients a brachiobasilic AVF, and 4 patients a gAVF. The estimated mean flow obtained by NephroFlow ® in the first hour of all sessions and in the second hour was 1056 ± 754 and 1130.16 ± 769 ml/min, respectively; intraclass correlation index was 0.737 and K-W Test H 0.349 (p≤0.05). The mean flow on the first day was 1129±794.5ml/min, ICC = 0.662; second day 1027.5±729ml/min, ICC = 0.812; third day 1121.5±±ml/min, ICC = 0.774. In all cases p&lt;0.05.

Conclusion
No significant differences have been observed in the VA flow estimated with the NephroFlow® ultrasound dilution system, neither at measurement time (the first or the second hour of HD session) nor day of performance (first, second or third day of HD session of the week). NephroFlow® UD system may be a useful tool for VA surveillance and could be applied when is necessary.
#2594 ELEVATED SERUM IL-17 LEVEL IS ASSOCIATED WITH THE PERSISTENCE OF POST-COVID SYNDROME AND VACCINATION STATUS IN HEMODIALYSIS PATIENTS
Authors: Stepanova Natalia , Driianska Victoria , Rysyev Andriy , Kholod Valeriia , Savchenko Viktoriia , Kolesnyk Mykola 
Published: June 2023

Abstract

Background and Aims
Interleukin-17 (IL -17) is thought to play an important role in the immune response and severity of coronavirus disease 2019 (COVID-19). In addition, elevated serum IL -17 levels have been detected in the general population of SARS-CoV-2-infected patients with post-COVID syndrome. Although hemodialysis (HD) patients belong to the high-risk group COVID-19 with an attenuated immune response to mRNA vaccination and a high incidence rate of post-COVID syndrome, IL-17 has never been studied in this cohort.

Method
A total of 80 HD patients aged 56 (44-63.2) years with a dialysis vintage of 40 (23-74) months who had experienced COVID-19 at least 5 months before enrollment were included in this cross-sectional cohort study. Aiming to analyze serum IL -17 according to the persistence of post-COVID syndrome, the patients we divided into 2 groups: post-COVID with (n = 36) and without (n = 44) sequelae. IL-17 was measured at 2-time points: at 5 (n = 30) and 10 months (n = 50) after acute SARS-CoV-2 infection using an ELISA assay. Data were expressed as median (Me) and interquartile ranges (Q25-Q75) and compared with the Mann-Whitney test.

Results
Serum IL-17 ranged from 0.01 to 15.14 pg/mL and was significantly elevated in HD patients with post-COVID sequelae compared to fully recovered patients: 0.45 (0.08-1.6) vs 0.08 (0.025-0.15) pg/mL, p = 0.0002. In the general cohort of HD patients with a 5-month interval between acute SARS-CoV-2 infection and blood collection, IL-17 was statistically greater than in patients with a 10-month interval: 0.24 (0.06-1.2) vs 0.11 (0.03-0.37) pg/mL, p = 0.04. In subgroup analysis, the patients with post-COVID sequelae had higher IL-17 levels than fully recovered patients at both time points (Fig. 1). Notably, mRNA-vaccinated HD patients with post-COVID sequelae had significantly higher IL-17 levels than unvaccinated patients at both time points: 3.83 (0.47-6.47) vs 0.88 (0.04-1.5) pg/mL, p = 0.03 and 0.57 (0.09-5.3) vs 0.08 (0.03-0.13) pg/mL, p = 0.01, respectively.

Conclusion
Serum IL-17 level is associated with the persistence of post-COVID syndrome in HD patients even 10 months after acute COVID-19 and is significantly higher in mRNA-vaccinated HD patients with post-COVID sequelae compared to unvaccinated patients. Further studies are needed to postulate IL-17 as a useful biomarker for post-COVID syndrome in HD patients.
#2654 USE OF SUPERVISED DEEP LEARNING ALGORITHM TO PREDICT RISK OF RENAL REPLACEMENT THERAPY(RRT) IN PATIENTS WITH CHRONIC KIDNEY DISEASE (CKD)
Authors: Leung Ka Chun , Ng Wing-Sze , Siu Yui-Pong , Hau Kai-Ching , Lee Hoi-Kan 
Published: June 2023

Abstract

Background and Aims
Chronic kidney disease (CKD) is one of the most common causes of mortality, affecting around 10% adults worldwide [1]. Although statistical models for predicting risk of renal replacement therapy (RRT) have been developed for a decade [2], referral of patients with CKD to nephrology service is often based on clinical experience of primary care physicians. The use of deep learning algorithms (DLAs) allow clinicians to capture complex, multidimensional, non-linear relationships instead of relying on linear relationships between independent variables and outcome. Our study aims to develop a DLA that has at least non-inferior performance compared to the Kidney Failure Risk Equation (KFRE), which is a well-established and validated risk prediction tool [3].

Method
This is a retrospective cohort study carried out in 3 major acute hospitals in Hong Kong providing a total of 3000 beds from Jan 1, 2009 to Mar 31, 2022. All patients aged &gt; 18 with an estimated glomerular filtration rate (eGFR)&lt;30ml/min/1.73 m2 according to the CKD-EPI formula, who attended follow-up for at least 3 months in nephrology clinic of the 3 hospitals, were recruited. Those who were on chronic RRT, received renal transplantation or had an eGFR&lt;15 ml/min/1.73 m2 before referral were excluded. Supervised DLAs of different structures and their combinations were created and trained. Data in the test set were fed into models to predict the risk of requiring RRT in 2 years and 5 years. Predictive performance of these models were compared with that of KFRE [3].

Results
4992 patients were recruited in the study. Data of 499 patients were isolated as test set and were not used for model training. 1576 patients progressed to stage 5 CKD during their follow-up, and 989 patients required initiation of RRT during the study timeframe. When compared with KFRE (4-variable: ROC-AUC = 0.84, 95%CI:0.835-0.852; 8-variable: ROC-AUC = 0.84, 95%CI:0.830-0.847), almost all DLAs showed statistically significant superior robustness in predicting the risk of requiring RRT (Figure 1). No significant difference was found between performance of DLAs combining different neural network layers and those with single structures (CNN+LSTM+ANN layers ROC-AUC = 0.90, 95%CI:0.896-0.902; CNN ROC-AUC = 0.91, 95%CI:0.907-0.914) (Table 1).

Conclusion
The use of DLAs provided better prediction in the risk of requiring RRT when compared with KFRE.
#2710 SEX DIFFERENCE IN CARDIOVASCULAR RISK IN PATIENTS WITH CHRONIC KIDNEY DISEASE: A POOLED ANALYSIS OF FOUR COHORT STUDIES
Authors: Borrelli Silvio , Garofalo Carlo , Pirozzi Valentina , Palumbo Felicia , Cascone Francesco , DI Martino Luigi , Foderini Andrea , De Nicola Luca , Minutolo Roberto 
Published: June 2023

Abstract

Background and Aims
Progression of chronic kidney disease (CKD) has proven to be faster in men than in Women [1-3]. Whether the same holds true for cardiovascular risk remains ill-defined.

Method
We conducted a pooled analysis of 4 cohort studies from 40 nephrology clinics in Italy including patients with CKD (estimated GFR&lt;60 ml/min/1.73m2 or higher if proteinuria &gt;0.15 g/day). The aim was to compare multivariable-adjusted risk (Hazard Ratio, 95% Confidence Interval) of a composite cardiovascular endpoint (cardiovascular death and non-fatal myocardial infarction, congestive heart failure, stroke, revascularization, peripheral vascular disease, and nontraumatic amputation) in women (n = 1,192) versus men (n = 1,635).

Results
At baseline, women had slightly higher systolic blood pressure (SBP) as compared with men (139±19 vs 138±18 mmHg, P = 0.049), lower eGFR (33.4 vs 35.7 mL/min/1.73 m2 , P = 0.001) and lower urine protein excretion (0.30 g/day vs 0.45 g/day in men, P&lt;0.001). Women did not differ from men in age and prevalence of diabetes while having a lower prevalence of cardiovascular disease, left ventricular hypertrophy and smoking habit. During a median follow-up of 4.0 years, 517 fatal and non-fatal cardiovascular events were registered (199 in women and 318 in men). The adjusted risk of cardiovascular events was lower in women (0.73, 0.60-0.89, P = 0.002) than in men; however, the cardiovascular risk advantage of women progressively diminished as SBP (as continuous variable) increased (P for interaction = 0.021; Figure 1). Similar results were obtained when considering SBP categories; when compared to men, women had a lower cardiovascular risk for SBP &lt;130 mmHg (0.50, 0.31-0.80; P = 0.004) and between 130–140 mmHg (0.72, 0.53-0.99; P = 0.038), while no difference was observed for SBP&gt;140 mmHg (0.85, 0.64-1.11; P = 0.232).

Conclusion
Higher BP levels abolish the cardiovascular protection seen in female vs male patients with overt CKD. This finding supports the need for higher awareness of hypertensive burden in women with CKD.