bluuebunny/crossref_metadata_2025_split huggingface dataset:
#5679 PATIENT OUTCOME IN A SWEDISH SINGLE-CENTRE COHORT OF ANCA-ASSOCIATED VASCULITIS WITH RENAL INVOLVEMENT
Authors: Ostlund Ylva , Saeed Aso , Mihovilovic Karlo 
Published: June 2023

Abstract

Background and Aims
End-stage kidney disease and premature death are common in patients with antineutrophil cytoplasmic antibody (ANCA) -associated vasculitis (AAV) with renal involvement. Poor patient outcome is attributed to multiple factors comprising a delay in diagnosis and treatment, inadequate efficacy of treatments, and complications due to toxic effects of given immunosuppressive therapy. The aim of the present study was to evaluate clinical and prognostic features of a Swedish cohort of patients with renal AAV and to investigate the pattern of immunosuppressive treatment and predictors of renal and patient survival.

Method
Ninety-one patients diagnosed with AAV with renal involvement between 01 March 2002 and 30 October 2018 in a single-centre were included in the present retrospective study.

Results
Among these ninety-one patients, 52 (57%) were diagnosed with PR3-ANCA, and 39 (43%) with MPO-ANCA. Patients with PR3-ANCA and MPO-ANCA were received comparable induction therapy. However, the frequency of PLEX was significantly higher in patients with PR3-ANCA versus MPO-ANCA (44% vs. 21% respectively; P = 0.025). Overall renal survival at 1- and 5-year was 91% and 69% respectively with no significant differences between patients with PR3-ANCA and MPO-ANCA. Overall, 1-year and 5-year patient survival was 92% and 77% respectively. The overall survival time mean was11.5 years and 95% confidence interval (CI) of 9.9 to 13.0 years. Mean survival time in patients with PR3-ANCA was 10.8; 95% CI 8.8 to 12.7 years versus 11.7; 95% CI 9.6 to 13.8 years in those with PR3-ANCA. Cox regression analysis showed that advancing age significantly predicted higher mortality risk, whereas MPO-ANCA subtype significantly predicted lower mortality risk (Figure 1). Infection (25%), malignancy (22%), and cardiovascular events (16%) were the major causes of death in the present cohort. In a subgroup of thirty-two patients with eGFR &lt;15 ml/min per 1.73 m2 or undergoing dialysis at time of diagnosis. Twenty-three patients (72%) were treated with PLEX, whereas 9 patients (28%) did not receive PLEX as a part of remission induction therapy. Treatment with PLEX had no effects on overall 1-year patient and renal survival

Conclusion
In this cohort of patients with AAV with renal involvement the overall 1-year renal and patient survival were high. Advancing age significantly predicted higher mortality risk, while MPO-ANCA subtype significantly predicted lower mortality risk. Treatment with PLEX had no effects on 1-year patient and renal survival in a subgroup of patients with severe renal involvement with AAV.
#5743 ALTERNATIVES TO DAYTIME IN-CENTER HEMODIALYSIS AND EMPLOYMENT AMONG PATIENTS WITH KIDNEY FAILURE
Authors: Perez Jose , Niu Jingbo , Winkelmayer Wolfgang , Cavanaugh Kerri , Pappadis Monique , Erickson Kevin 
Published: June 2023

Abstract

Background and Aims
Maintaining employment is a priority for many patients with kidney failure. In addition to its economic benefits, employment is associated with physical and psychological wellbeing. Yet, only 30-35% of working aged patients with advanced chronic kidney disease in the United States (US) report employment prior to starting dialysis and many patients stop working at the onset of kidney failure. While access to a dialysis treatment schedule outside of working hours may help patients to remain employed, the effects of alternative dialysis options on employment after starting dialysis are not well understood.

Method
We analyzed data from the US National Dialysis Registry to determine whether access to nearby facilities offering evening dialysis shifts and home dialysis increases the likelihood that patients are able to continue working after they start dialysis. Our cross-sectional analysis included working-aged patients (ages 18-54) receiving dialysis in US facilities in 2016. We combined information reported at the levels of individual patients and dialysis facilities. In a negative binomial regression model, we examined the associations among exposures of interest (the presence of facilities offering home dialysis and/or evening dialysis shifts in a patient's locality) and the number of employed working-aged adults at each dialysis facility. The multivariable regression model adjusted for observed patient, dialysis facility, and geographic characteristics, including patient health and demographic characteristics, information about individual patient employment at the onset of dialysis, local unemployment rates, and the number of working-aged patients at a given dialysis facility.

Results
We identified 4,860 US dialysis facilities with information about patient employment in 2016. Median employment among working-aged adults at these facilities was 17.9% (interquartile range 8.8% to 28.6%). In multivariable, fully adjusted, regression models, the presence of at least one facility offering an evening dialysis shift in a county was associated with a 5% increase in the relative rate of maintaining employment among all working-aged patients receiving dialysis in the county (risk ratio (rr) 1.05; 95% Confidence Interval (CI) 1.01 to 1.09; p = 0.02). The presence of at least one facility offering home dialysis in a county was associated with a 26% increase in the relative rate of maintaining employment (RR 1.26; 95% CI 1.18 to 1.34; p&lt;0.001). The likelihood of employment did not increase with additional facilities in a county offering home dialysis.

Conclusion
Access to dialysis schedules outside of regular working hours – evening dialysis shifts and home dialysis – is associated with increased employment among patients with kidney failure. Efforts to increase access to these alternative dialysis treatments could help patients to continue working.
#5769 MEASURING PROTEINURIA AT 12 MONTHS IN LUPUS NEPHRITIS: A USEFUL TOOL?
Authors: Braga Beatriz Gil , Cunha Ana , Sousa Sofia , Ventura Sofia , Correia Sofia , Campos Andreia , Santos Josefina 
Published: June 2023

Abstract

Background and Aims
Lupus nephritis is a well know manifestation of systemic lupus erythematosus (SLE) and it can progress to end stage kidney disease (ESKD) in 10-30% of patients [1]. Several studies have been conducted to find out whether proteinuria detected earlier in the course of lupus nephritis is associated with worse kidney related outcomes, such as progression to chronic kidney disease [2].

Method
We retrospectively reviewed a cohort of 67 patients referenced to our center with the diagnosis of lupus nephritis until 2019. We evaluated proteinuria (g/g) in a random urine sample measured 12 months after diagnosis and beginning of treatment of lupus nephritis and divided patients into two groups: those with proteinuria less than or equal to 0.3 g/g– group 1(n = 11; 35%) and those with proteinuria superior to 0.3 g/g– group 2 (n = 20; 65%) that had measures of our variables of interest. These groups were compared regarding a continuous variable: serum creatinine measured in the 7th year of follow up, as evaluated in previous studies [3]. We compared the median of serum creatinine values between group 1 and group 2 using Mann-Whitney test, due to the absence of normal distribution of serum creatinine. We also compared the median of serum creatinine in the 7th year to proteinuria measured at 3 and 6 months.

Results
Mean follow up was 13.36 ± 7.8 years and 81.7% (n = 57) were women, with a median age of 33.0 ±12.85 years. A total of 8 patients (11.9%) progressed to ESKD defined by the need for renal replacement therapy or being submitted to renal transplantation. Only 1 patient died due to a nosocomial infection. We had a sample of 31 patients, 26 women and 5 men (p = 0.591) (missing n = 36). Baseline median serum creatinine in group 1 was 0,95 mg/dl and in group 2 was 0.78 mg/dl (p = 0.086). We obtained a median serum creatinine of 0.69 mg/dl (Interquartile range (IQR): 0.61-0.87) in group 1 versus0.92 mg/dl (IQR: 0.66-1.25) in group 2 (p = 0.04). Medians of serum creatinine in the 7th year regarding proteinuria measured at 3 and 6 months were not significantly different (p&gt;0.05).

Conclusion
In our cohort, the group with a higher persistent proteinuria (&gt; 0.3 g/g), one year after lupus nephritis diagnosis, had a significantly higher serum creatinine (7 years after diagnosis). Although previous studies have shown that reducing proteinuria to less than 0.5–0.8g/d 3 by 1 year of treatment predicts good long-term kidney outcomes, our particular data suggest that further reducing to less than 0.3 g/g may provide additional benefit in the long run [2], even though, due to our reduced sample, more investigation is required. From the above mentioned, one may consider 12 months proteinuria as a potential predictor to long-term renal outcomes with lupus nephritis. More studies are necessary to validate this hypothesis.
#5943 THE VALUE OF THE HISTOLOGICAL CLASSIFICATIONS OF ANCA ASSOCIATED VASCULITIS IN PREDICTING LONG TERM KIDNEY SURVIVAL
Authors: Stella Matteo , Locatelli Laura , Sala Filippo Maria , Calatroni Marta , Reggiani Francesco , Moroni Gabriella Luisa , Sinico Renato Alberto 
Published: June 2023

Abstract

Background and Aims
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) are a group of multisystemic autoimmune diseases characterized by necrotizing inflammation of small vessels, with a predilection for the kidney. The prognostic value of histological classification of ANCA-glomerulonephritis (ANCA-GN) is discussed. In 2010, Berden and colleagues proposed a prognostic classification based on glomerular involvement; in 2018, Brix et al. introduced the ANCA Renal Risk Score, which includes histological features and glomerular filtration rate; in 2017 the Mayo Clinic Chronicity Score, that considers chronic histological lesions, was designed and assessed in ANCA-GN. We aimed to identify which score is the best tool to predict end-stage kidney disease or death in a cohort of ANCA-GN patients.

Method
Patients who underwent kidney biopsy in two Italian centers within 32 years were retrospectively collected. Inclusion criteria: age &gt;18 years, and at least one year of follow-up. A minimum of 10 glomeruli was considered adequate for a biopsy. Renal biopsies were classified according to Berden's classification, Renal Risk Score and Mayo Clinic Chronicity Score. The primary end point of the study was the development of end-stage kidney disease (ESKD) at 5 years, defined as the chronic need of renal replacement therapy (RRT) or glomerular filtration rate (GFR) &lt;15 ml/min. The secondary endpoint was a composite endpoint of ESKD or death for all causes.

Results
Of the 152 patients 84 were male, the median age was 63.8 years (Figure 1). Mean eGFR at diagnosis was 21.32 ml/min/1.73 m2. 32.2% of patients were PR-3 positive, 50.6% were MPO positive, 17.2% were ANCA-negative. After a mean follow-up of 71.7 ± 66.7 months, 59 patients (38.8%) were on chronic dialysis or with a GFR &lt;15 ml/min; among them, 20 patients died. The pure kidney survival rate (without ESKD or GFR&lt;15 ml/min) was 79% at 1 year, 65% at 5 years, 59.8% at 10 years. Figure 2 reported the pure kidney survival rates of the patients assigned to every class of the three scores that we considered in this study. Fig. 3, Fig. 4, Fig. 5 show Kaplan-Meyer curves for the secondary outcome (ESKD+death); patients are classified according to the Berden's score (Fig. 2), the Renal Risk Score (Fig. 3) and Mayo Clinic Chronicity Score (Fig. 4).

Conclusion
Berden histopathological classification and Renal Risk Score are predictive of renal prognosis when we consider the primary outcome (ESKD or eGFR&lt;15 ml/min) and when we consider the composite outcome (ESKD + death). The Mayo Clinic Chronicity Score allows a reliable stratification of the patients only when we consider the composite outcome (ESKD and death).
#6019 DEVELOPMENT, APPLICATION, AND VALIDATION OF A HISTOLOGICAL CLASSIFICATION AUTOMATION SYSTEM FOR KIDNEY ALLOGRAFT PRECISION DIAGNOSTICS
Authors: Yoo Daniel , Goutaudier Valentin , Divard Gillian , Gueguen Juliette , Aubert Olivier , Raynaud Marc , Demir Zeynep , Hogan Julien , Investigators Ktd-Innov , Investigators Eu-Train , Haas Mark , Lefaucheur Carmen , Rabant Marion , Loupy Alexandre 
Published: June 2023

Abstract

Background and Aims
The Banff histological classification is the gold standard for allograft rejection diagnostics but has become considerably more complex over the past three decades, leading to misclassifications. We aimed to develop an automated rejection classification system and demonstrate its ability to improve rejection diagnoses.

Method
We built a consortium consisting of pathologists, physicians, and developers to translate all Banff classification rules until the latest version published in 2019 into an algorithm, further embedded in an application which automatically assigns diagnoses. We then tested the Banff Automation System's ability to reclassify rejection diagnoses on 4,409 kidney transplant biopsies from 3,054 adult and pediatric patients, from multicenter cohorts and clinical trials, totaling 20 transplant referral centers in Europe and North America. The impact of diagnostic reclassifications on graft survival was evaluated.

Results
We devised a system that generates automatic reports with diagnoses and a decision tree. In the adult kidney transplant biopsies, the Banff Automation System reclassified 83 of 279 (29.75%) antibody-mediated rejection (AMR) cases and 57 of 105 (54.29%) T-cell mediated rejection (TCMR) cases, while 237 of 3,239 (7.32%) biopsies with non-rejection-related diagnoses were reclassified as rejection. The rejection reclassification rates were 8 of 26 (30.77%) and 12 of 39 (30.77%) for AMR and TCMR, respectively, in the pediatric cohort. Finally, we found that the non-rejection diagnoses according to the pathologists which were reclassified as rejections by the Banff Automation System had similar outcomes as those of confirmed rejection cases.

Conclusion
We built the first comprehensive Banff Automation System and confirmed its ability to reclassify rejection diagnoses. This decision support system might help for training and standardizing diagnoses in routine care and clinical trials.
#6171 SEROPREVALENCE OF COVID-19 INFECTION BASED ON IGG ANTIBODY AGAINST NUCLEOCAPSID PROTEIN (NP) AND SPIKE PROTEIN (S) IN HEMODIALYSIS PATIENTS
Authors: Bhoumik Sukhinath , Iqbal Masud , Morshed Raquib , Alam Sohrab , Waheed Shahryar , Alam Kazi Shahnoor , Islam MD Nazrul , Banerjee Sajal Krishna , Hassan Ms , Arslan MI 
Published: June 2023

Abstract

Background and Aims
Maintenance hemodialysis (MHD) patients have been identified as a high-risk group for COVID-19 infection. Serological testing can be used to monitor disease prevalence & evaluate screening measures & protocols aiming at limiting transmission within dialysis units. This study was conducted to observe the sero prevalence of COVID-19 infection among maintenance hemodialysis patients.

Method
The study was conducted during the 3rd wave of covid-19 infection. Total 194 in-center MHD patients were included from three dialysis centers. Relevant history regarding covid-19 symptom, testing, managements and vaccination were collected. During our study a serum sample was collected to test IgG antibody against nucleocapsid protein (NP) (cut-off positive when &gt;1.5) and spike protein (S) (cut-off positive when &gt;50 AIU/L) of COVID-19 infection and tested by Chemiluminescent microparticle immunoassay (CMIA) method developed by Abbott (FDA-EUA approved).

Results
Mean age of the MHD subjects was 48±12 years where male was 60%. Duration of MHD was 31±22 (6-120) months. Renal pathology was DN in 31%, possible GN 31%,HTN 19% and rest from others .From records past covid infection was clinically diagnosed in 39% of which 10% based on RT-PCR and another 29% fell into suspected category (i.e. symptom with/or suggestive serology). Presentation pattern was mild in 75%, moderate 15% (requiring oxygen), severe in 5% (requiring hospitalization) and asymptomatic rest 5%. Vaccine against covid-19 was availed by 38%. In vaccinated vs. non-vaccinated patients the IgG for NP was positive in 63% vs. 561%(P = 0.65) and IgG for S in 99% vs. 98%(P = 0.56). These indicate naturally acquired immunity in most before any vaccination. The IgG titer against spike (S) protein between vaccinated and non-vaccinated groups was 7743±8920 and 5386± 6839 AIU/L (p = 0.06). The correlation study showed that IgG titer against S has no correlation with dialysis duration, age, BMI, Hb%, serum albumin or Kt/V. Similarly IgG titer against NP shows mostly no significant correlation with laboratory parameters.

Conclusion
These data demonstrate that seroprevalence in hemodialysis population based on antibody against nucleocapsid protein shows only half infected by SARS-CoV-2 where as antibody against spike protein indicates larger number of patients are naturally infected even before vaccinated. Therefore for seroprevalence studies both antibody testing should be used to identify greater population infected until more sensitive tools are established.
#6379 EFFECTS OF SODIUM-GLUCOSE CO-TRANSPORTER 2 INHIBITORS ON CARDIOVASCULAR MORTALITY INCHRONIC KIDNEY DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Alexandrou Maria Eleni , Pella Eva , Tsitouridis Alexandros , Theodorakopoulou Marieta , Sampani Erasmia , Georgiou Areti , Kamperidis Vasileios , Papagianni Aikaterini , Sarafidis Pantelis 
Published: June 2023

Abstract

Background and Aims
In studies of patients with chronic kidney disease (CKD), recommended nephroprotective therapy with ACE-inhibitors or ARBs has not been shown to reduce cardiovascular (CV) events or mortality. Sodium-glucose co-transporter 2 (SGLT-2) inhibitors reduce cardiovascular events and death in patients with diabetes and established CV disease; evidence from studies in populations with CKD has been inconsistent. The aim of this meta-analysis was to evaluate the effect of SGLT-2 inhibitors on cardiovascular (CV) mortality in patients with CKD.

Method
Studies were identified by search in major electronic databases (PubMed/MEDLINE, Scopus, Cochrane Library and Web of Science) (PROSPERO ID: CRD42022382863). We included randomized controlled trials assessing the effect of SGLT-2 inhibitors on the primary outcome, time to cardiovascular death, in patients with CKD at baseline. Secondary outcomes included all-cause mortality and major adverse cardiac events (MACE).

Results
Eleven studies with 83,203 participants with CKD were eligible for inclusion in the meta-analysis. Treatmentwith SGLT-2 inhibitors, compared to placebo, reduced the risk of CV death by 14% (hazard ratio [HR] 0.86;95%CI 0.79-0.94), of all-cause death by 15% (HR 0.85; 95%CI 0.79-0.91) and of MACE by 13% (HR 0.87; 95%CI0.81-0.93). A consistent treatment effect on the primary outcome was observed with all SGLT-2 inhibitors(canagliflozin: HR 0.84; 95%CI 0.69-1.02, dapagliflozin: HR 0.89; 95%CI 0.78-1.01, empagliflozin: HR 0.82;95%CI 0.69-0.97 sotagliflozin: HR 0.90; 95%CI 0.73-1.12) studied (p-subgroup-differences = 0.85). Sensitivity analysis pooling data from studies including only diabetic patients with CKD yielded similar results (HR 0.86;95%CI 0.77-0.97).

Conclusion
Treatment with SGLT-2 inhibitors led to a significant reduction in the risk for CV and all-cause mortality in CKD patients. These findings support the use of these agents also for protection against cardiovascular events and death in CKD.
#6424 DIAGNOSTIC ACCURACY OF BONE TURNOVER MARKERS IN PATIENTS WITH VARIOUS DEGREES OF KIDNEY DYSFUNCTION AND PRIMARY OSTEOPOROSIS
Authors: Abdalbary Mohamed 
Published: June 2023

Abstract

Background and Aims
There are limited data available on the validity of bone turnover markers (BTMs) to predict bone turnover in patients with kidney dysfunction and primary osteoporosis.

Method
This is a cross-sectional retrospective study of patients with primary osteoporosis and eGFR&lt;90 ml/min/1.73 m2 who had bone biopsy for clinical purposes for a time period of 8 years. CKD-EPI equation 2021 was used to calculate eGFR based on the mean serum creatinine readings. Bone biopsy samples were evaluated qualitatively using KDIGO TMV classification.
Routine laboratory data were collected in addition to alkaline phosphatase, iPTH, cyclase activating (CAP) PTH, osteocalcin, bone specific alkaline phosphatase (BSAP), and N-telopeptide collagen (NTX).

Results
Study included 156 patients with mean age of 64.7 years. The majority of patients were females (93.6%). The mean BMI was 26.2 kg/m2. The mean eGFR was 70 ml/min with 78% of patients had eGFR from 60-90 ml/min/1.73 m2. CKD stage III was found in 19%, and 3% of patients had CKD stage IV. HTN was found in 47%, history of kidney stones in 9%, and fragility fractures in 77%. Bisphosphonates were the most used pre-biopsy bone specific medication (66%). Teriparatide was used in 10.9% and SERM was used in 7.7% of patients, while 31.4% of patients did not receive any bone anti-resorptive or anabolic medication “treatment naiive”. Bone cortical thickness and cancellous volume were low in 94.2%, while high bone turnover (HBT) was found in 42.9% and low bone turnover (LBT) in 57.1%. Mineralization was defective only in 9.6%, while osteoid thickness was increased in 5.8%. Figure 1 shows the distribution of bone turnover among study group. Baseline characteristics and routine laboratory data were not different between HBT and LBT. PTH, especially PTH CAP, and alkaline phosphatase tended to be higher in HBT but did not reach statistical significance. While BTMs (osteocalcin, BSAP and NTX) were significantly higher in HBT (Table 1). Using ROC curve analysis, the area under the curve (AUC) for BSAP, NTX and osteocalcin were 0.605, 0.660, 0.642, respectively. Combining the NTX with either BSAP or osteocalcin did not result in increasing the AUC. This was also the same when the three of them were combined. BTMs were able to discriminate bone turnover status only among patients with eGFR≥60 ml/min/1.73 m2 (Table 2).

Conclusion
Low bone turnover was found in 43% in treatment naïve patients with primary osteoporosis, with a higher prevalence among patients with eGFR≥60. In the study group, PTH and total alkaline phosphatase were not able to discriminate LBT from HBT, while BTMs showed a modest ability to discriminate the turnover status only among patients with eGFR≥60.