bluuebunny/crossref_metadata_2025_split huggingface dataset:
#4820 RISK FACTORS FOR INPATIENT MORTALITY IN PATIENTS WITH NON-DIALYSIS CHRONIC KIDNEY DISEASE ADMITTED FOR COVID-19 USING A US NATIONAL SAMPLE
Authors: Morita Sae , Agrawal Akshay , Guevara Nehemias , Carlos Arias , Flores Bessy 
Published: June 2023

Abstract

Background and Aims
Several studies reported that the COVID-19 pandemic has disproportionately affected socioeconomically vulnerable populations. No study evaluated risk factors for inpatient mortality in patients with non-dialysis chronic kidney disease (CKD) admitted with the diagnosis of Covid-19, using a US nationwide sample. This study aimed to elucidate risk factors for mortality in patients with CKD during Covid-19 admissions.

Method
We extracted data from the National Inpatient Sample year 2020, the largest nationally representative inpatient-care database in the US. We created a cohort of all adults with CKD hospitalized for Covid-19 by ICD-10 codes. The outcome was inpatient mortality. We excluded patients with end stage kidney disease on maintenance dialysis and transplant patients. We compared baseline characteristics and used multiple logistic regression to determine risk factors for inpatient mortality in this cohort.

Results
Total of 201,460 admissions with a diagnosis of Covid-19 were detected in patients with non-dialysis CKD. Table 1 showed the baseline characteristics. The mean age was 72.8±0.2 years and females accounted for 43.6%. Of all, White accounted for 52.3%, followed by Black (26.1%) and Hispanic (14.6%). Inpatient mortality was 20.9%. Table 2 showed the results of the multivariable logistic model. Older patients, Males, higher Charlson Comorbidity Index scores were associated with a higher risk of inpatient mortality. White patients had a higher risk compared to Black patients and Native Americans had the highest risk, followed by other ethnic minorities, Hispanic, and Asians. Those from the lowest income households had the highest risk. Admission to a rural, publicly owned hospital and those located in the West and Northeast had higher odds of inpatient mortality.

Conclusion
Our study showed males, race, commercial payment type, lower income, and hospital settings such as regions and location were risk factors for inpatient mortality in patients with non-dialysis CKD. Further studies are needed to evaluate whether differences in clinical practice underly some of these risks.
#4825 AUTOPHAGY REGULATES TUBULAR CELL SENESCENCE IN DIABETIC KIDNEY DISEASE
Authors: Zhang Ying , Zhang Xiao Liang , Zhao Yu 
Published: June 2023

Abstract

Background and Aims
Cellular senescence commonly occurs in innate renal cells of diabetic kidney disease (DKD) and autophagy may be implicated. However, the characteristics of senescent cells in different pathological stages of DKD, and the driving force behind the cell senescence remain primarily unknown. This study aimed to examine kidney cellular senescence and its relationship to renal function in DKD and the effect of autophagy on high-glucose-induced cellular senescence.

Method
According to the DKD pathologic type, 46 patients diagnosed with renal biopsy were categorized into I IIa IIb III IV classes. The other four normal kidney specimens taken from patients with renal trauma were as the control group. Pathological changes in kidney tissues were detected by PAS staining, and the expressions of autophagy-related protein LC3 and senescence marker p21 were demonstrated by immunohistochemical staining. DKD rats were established by intraperitoneal injection with streptozotocin (STZ). HK-2 cells were cultured with 35mM glucose with or without autophagy inhibitor (3-methyladenine, 3-MA) and lysosomal inhibitor (chloroquine CQ). Immunohistochemistry and Western Blot were used to detect the expression of the senescence markers p53 and p21, as well as the autophagy-related proteins LC3 and p62. The electron microscopy technique was used to observe the number of autophagosomes in the DKD rats and each group of HK-2 cells.

Results
(1) In renal tissues of DKD patients, p21 infiltrated the interstitium and tubules, while LC3 was primarily expressed in the tubules. Both p21 and LC3 expression increased over time as the disease progressed (P&lt;0.05) and were directly proportional to blood creatinine and proteinuria, respectively. Additionally, p21 and LC3 expression were positively correlated. (2) Compared with the control group, the renal tissue of DKD rats displayed higher levels of p21, p53, LC3, and p62 expression (P &lt; 0.05), higher levels of renal tubular autophagosomes, and increased co-expression of p21 and LC3 (P&lt; 0.05). (3) HK-2 cells treated with high glucose exhibited increased expression of p21, p53, p62 and LC3, as well as the number of autophagosomes (P&lt;0.05). (4) 3-MA reduced p21 and p53 expression compared to the high glucose group (P&lt; 0.05), whereas the opposite trend was observed in the CQ treatment (P&lt;0.05).

Conclusion
Renal tubular cell senescence is closely associated with DKD progression. Autophagic flow may be involved in high glucose-induced renal tubular cell senescence.
#4835 KIDNEY FUNCTION-SPECIFIC CUT-OFF VALUES OF HIGH-SENSITIVITY CARDIAC TROPONIN T FOR THE DIAGNOSIS OF ACUTE MYOCARDIAL INFARCTION
Authors: Chen Ruixuan , Hou Fan Fan , Nie Sheng 
Published: June 2023

Abstract

Background and Aims
Acute myocardial infarction (AMI) is the leading cause of death worldwide. Patients with kidney dysfunction have high prevalence of AMI, thus early detection of AMI is necessary. However, in patients with decreased estimated glomerular filtration rate (eGFR), using the traditional cut-off value (14 ng/L) of high-sensitivity cardiac troponin T (hs-cTnT) resulted in lower specificity for diagnosing AMI. Our study aims to determine and validate kidney function-specific cut-off values of hs-cTnT for diagnosing AMI in patients with different degrees of kidney dysfunction.

Method
This large, multicenter, observational cohort study included 21,912 hospitalized patients who had undergone coronary angiography in 6 clinical centers from 2013 to 2021. The study outcome was the diagnosis of AMI. In the derivation cohort, kidney function-specific cut-off values of hs-cTnT for diagnosing AMI were determined to improve the specificity without the cost of sensitivity, as compared to that using 14 ng/L as the cut-off value in the normal kidney function group. The efficacy of the novel cut-off values was validated in an independent validation cohort enrolled from another clinical center.

Results
In the derivation cohort (n = 12,900), 3,247 patients (25.2%) had an eGFR &lt;60 mL/min/1.73m2. Even in the absence of AMI, 1485 (50.2%) participants with eGFR &lt;60 mL/min/1.73m2 had a hs-cTnT concentration ≥14 ng/L. Using 14 ng/L as the threshold of hs-cTnT for diagnosing AMI led to a significantly reduced specificity (9.1–52.7% vs. 75.0%) and positive predictive value (15.5–21.1% vs. 28.7%) in patients with kidney dysfunction, as compared with patients with normal kidney function. The kidney function-specific cut-off values (eGFR ≥60 ml/min/1.73m2: 14 ng/L, 60&gt;eGFR≥30 mL/min/1.73m2: 18 ng/L, and eGFR &lt;30 ml/min/1.73m2: 48 ng/L) were determined and remarkably improved the diagnostic accuracy for AMI in participants with different levels of kidney dysfunction (specificity: reach to 52.8–63.0%; positive predictive value: 18.7–33.6%), without compromising sensitivity (96.6–97.9%). The kidney function-specific cut-off values increased the diagnosis accuracy of hs-cTnT for diagnosing AMI in every eGFR subgroup in the independent validation cohort (n = 8,012).

Conclusion
The kidney function-specific cut-off values of hs-cTnT significantly improved the diagnostic accuracy of AMI in patients with kidney dysfunction, and might be generally useful in clinical practice.
#4844 BELIMUMAB AND MULTITARGET THERAPY AS INDUCTION THERAPY OF SEVERE ACTIVE LUPUS NEPHRITIS: CASE SERIES FROM CHINA
Authors: Min Min , Zhang Jiong 
Published: June 2023

Abstract

Background and Aims
Belimumab (BLM) has been approved for the treatment of active systemic lupus erythematosus (SLE) and active lupus nephritis (LN). Multitarget therapy (MT) consisting of tacrolimus (FK506), mycophenolate mofetil (MMF), and steroid has been proved that can provide good curative effect as induction therapy for LN. Because of the limitations of BLM's phase III clinical trails, the exact curative effect in severe active LN of BLM is not clear yet. To assess the safety and generate preliminary efficacy data on MT followed by BLM for severe active Chinese LN patients, a case series were investigated.

Method
Six patients with severe active LN were reported. Among the 6 patients, 2 were treated with MT followed by BLM infusions, 2 were treated with MMF / (FK506) followed by BLM infusions, and 2 were treated with MT. BLM was given 10 mg/kg every 2 weeks for 3 times, then every 4 weeks till Week 24. Primary renal response index, SLEDAI, and safety data were analyzed.

Results
The patients affected by LN ISN/RNP Class III/IV±V with high disease activity are 3 de no LN and 3 refractory LN (each regimen included 1 de no LN and 1 refractory LN). At baseline, the SLEDAI score were 15,20,17,16,15,15 respectively. 4 of the 6 patients (case 1,case 2,case 3, and case 5) accepted intravenous (IV) methylprednisolone, followed by MT/MMF/FK506 after admission. The initial oral prednisone was 30-45 mg/day. Within 2 weeks of starting treatment, IV BLM was introduced. At Week 24, the SLEDAI score decreased to 2,8,8,10,8,10 respectively. 2 patients accepted BLM and MT achieved complete renal remission, and the other 4 patients achieved partial renal remission (Fig. 1). MT and BLM therapy reduced SLEDAI more rapidly than MMF/FK 506 +BLM or MT (Fig. 2). Prednisone was reduced to 10-15 mg/d. No adverse events occurred.

Conclusion
The addition of BLM to basic immunosuppressants was effective and safe for severe active LN. The BLM and MT regimen seems to lead a faster and more pronounced remission. Further prospective clinical studies with larger samples are needed to evaluate the benefits of belimumab combined with MT in severe active LN.
#4865 OBSERVATIONAL PILOT STUDY TO EVALUATE THE RELATIONSHIP BETWEEN LUNG ULTRASOUND AND BIOIMPEDANCE IN HEMODIALYSIS
Authors: Sánchez Gabriel Ledesma , Valdivia Veronica Ruth Mercado , Orjuela Yesika María Amezquita , Mancebo Raquel Diaz , Villalobos Ángel Gallegos , Hernández Yolanda Hernández , Carrillo Rocío Echarri , Ruisánchez Sílvia Caldés , Ojanguren María Covadonga Hevia , García Antonio Cirugeda 
Published: June 2023

Abstract

Background and Aims
There is a clear relationship between volume overload and morbidity and mortality in hemodialysis patients, which makes it essential to accurately adjust the normohydrated weight. For this, bioimpedance has become an indispensable tool in dialysis units. In recent years there has been a rapid development of lung ultrasound for the evaluation of pulmonary congestion through the quantification of B lines. Several studies have shown a correlation between the number of B lines and the volume overload estimated by bioimpedance in patients on dialysis. However, all these studies perform a 28-zone lung ultrasound protocol, which may be a limitation in clinical practice. Several studies have recently been published showing a correlation between 28-zone lung ultrasound protocol and simplified 4, 6, and 8-zone ultrasound protocols, which have been widely studied in patients treated in intensive care or emergency units. We set out to evaluate the relationship between bioimpedance and simplified 8-zone lung ultrasound protocol in hemodialysis patients.

Method
Pilot cross-sectional observation study that included 29 patients on hemodialysis at Infanta Sofía University Hospital during March 2022. Bioimpedance predialysis and postdialysis, 8-zone lung ultrasound protocol (delimited by the parasternal, anterior axillary, posterior axillary, and 4th intercostal space) and inferior vena cava ultrasound. Predialysis proBNP and Ca-125 were measured.

Results
There is a significant reduction in overhydration estimated by bioimpedance and in the number of B lines after the hemodialysis session (p&lt;0.05). No correlation has been established between the two parameters, neither pre-dialysis nor post-dialysis. Nor with the pre-dialysis levels of proBNP or Ca125. There is a correlation of r = 0.45 (p&lt;0.05) in the subgroup of patients from the afternoon shift (n = 9) between the number of B lines and extracellular water.

Conclusion
Lung ultrasound allows the evaluation of the degree of lung congestion, and therefore of extracellular water, becoming a useful tool for adjusting the dry weight of hemodialysis patients. In our study we found no association between the number of B lines in the simplified 8-zone lung ultrasound protocol. It is possible that this type of lung ultrasound is not sensitive enough in outpatients on hemodialysis, but it is sensitive enough in critically ill patients in whom lung overload is greater. Further studies with a larger number of patients are needed for evaluation.
#4879 PREDICTORS OF KIDNEY DISEASE PROGRESSION IN MALES WITH X-LINKED ALPORT SYNDROME
Authors: Aksenova Marina , Zaikova Natalia , Piruzeeva Oxana , Lepaeva Tatjana , Obuhova Varvara , Nikishina Tatjana , Konkova Natalia 
Published: June 2023

Abstract

Background and Aims
Alport's syndrome is the second most common monogenic cause of end-stage renal disease (ESRD). Males with X-linked Alport's syndrome (XLAS) have a high risk of early ESRD development. The aim of study was to determine the predictors of unfavorable renal prognosis in boys with XLAS.

Method
The children with genetically confirmed XLAS (n = 84, age 8.7±4.3 yrs, eGFR 102±16.2 ml/min/1.73 m2, 59 pts with missense COL4A5 mutations) were included in observation single center study (FU 6.9±2.4 yrs). Seventy three pts (q = 0.87) were treated with ACEi (age of start 7.6±3.3 yrs, dose for Ramipril 2.7±0.8 mg/m2/day). Arterial blood pressure (BP), proteinuria (Pr, mg/m2/day), eGFR (Schwartz equation, ml/min/1,73m2), gene mutation type and ACEi-treatment data (age of pts and disease stage at the therapy start, ACEi dosage, dynamics of Pr and eGFR) were obtained and updated for each patients. BP &gt;90 perc for gender, age and height was defined as uncontrolled (uBP); Pr was categorised according to its level as a low (100-&lt;250 mg/m2/day), moderate (≥250-500 mg/m2/day), high (≥500-1000 mg/m2/day) and nephrotic (≥1000 mg/m2/day). Gene mutations were divided into severe (nonsense, deletion, splicing) and less severe (missense) mutations. The eGFR&lt;60 ml/min/1,73m2 was defined as primary outcome.

Results
Twenty pts (q = 0.24, age 13.5±2.96 yrs) reached the end point during observation period. Non-missense COL4A5 mutations (HR = 4.28, 95% CI 1.47-12.4, p = 0.007), uBP (HR = 20, 95% CI 4.68-29.6, p&lt;0.001), persistent Pr &gt;250 mg/m2/day (HR = 20, 95% CI 3.36-21, p&lt;0.001), absence of ACEi treatment (HR = 10.7, 95% CI 2.45-14.7, p = 0.02) or start therapy at proteinuric stage of disease (HR = 20, 95% CI 2.2-13.8, p&lt;0.001) were the risk factors of disease progression. Multiple regression analysis adjusted for age, initial eGFR revealed that late start of ACEi treatment (β = 0.23, p = 0.036), persistence of uBP (β = 0.26, p = 0.008) and Pr &gt;250 mg/m2/day (β = 0.17, p = 0.04) had independent significance and predict unfavorable renal prognosis (R = 0.76, R2 = 0.57, p&lt;0.000).

Conclusion
Persistent proteinuria and uncontrolled blood pressure, initiation of ACEi treatment at the proteinuric stage of glomerulopathy are the factors of unfavorable prognosis in male with XLAS.
#4881 NEPHROPROTECTION IN BOYS WITH X-LINKED ALPORT SYNDROME: THE SOONER THE BETTER
Authors: Aksenova Marina , Piruzeeva Oxana , Zaikova Natalia , Lepaeva Tatjana , Nikishina Tatjana , Obuhova Varvara , Konkova Natalia 
Published: June 2023

Abstract

Background and Aims
Proteinuria (Pr) is a marker of glomerular diseases progression. The aim of study was to define the efficiency of angiotensin-converting enzyme inhibitors (ACEi) treatment in prevention of Pr development in boys with X-linked Alport's syndrome (XLAS).

Method
Single center observation study included boys with confirmed XLAS (n = 87). Twenty nine pts (1gr) started ACEi (enalapril 4.2±1.4 mg/m2/day) in non-proteinuric stage of disease (Pr≤100 mg/m2/day); mean age 6.2±3.9 yrs, eGFR Schwartz 118±15.2 ml/min/1.73 m2, Pr 67±23 mg/m2/day. Fifty eight pts (2gr) without preemptive ACEi treatment were observed from mean age 6.8±4.9 yrs, eGFR 119±17.3 ml/min/1.73 m2, Pr 87±43 mg/m2/day. Follow up was 6.2±3.9 yrs, mean age at the last observation was 11.7±3.9 yrs vs 14.2±4.6 yrs (p = 0.67) in 1gr and 2gr, respectively. The occurrence of Pr (Pr&gt;100 mg/m2/day) was defined as primary end point of the study.

Results
The pts of 1gr had lower rate (0.48 vs 0.94, p&lt;0.001) and higher age (10.2±3.9 vs 4.9±3.4 yrs, p = 0.3) of Pr occurrence than in 2gr. ACEi treatment reduced risk of Pr onset (OR = 0.05(95%CI 0.013-0.2)) with absolute risk reduction of Pr by 47% (RD = 0.47) and number of treated pts to prevent Pr development (NNT) 2.14. No difference was revealed between 1gr pts with and without Pr development in age of therapy start (7.1±3.3 vs 6.3±2.8 yrs), ACEi dose (2.3±0.8 vs 2.1±0.6 mg/m2/day) and COL4A5 gene mutation type (missense variants 0.72 vs 0.86). Arterial hypertension was a risk factor of Pr occurrence in 1gr (χ2 = 4,42, p = 0.04); children with Pr development was older at the last observation: 13.5±3.2 vs 9.9±3.8 yrs, p = 0.47. No side effects of treatment were observed.

Conclusion
The early ACEi therapy halves the risk of Pr development in boys with XLAS and may prevent the disease progression in these patients.
#4905 PERITONEAL CLEARANCE OF TRACE ELEMENTS IN PERITONEAL DIALYSIS PATIENTS
Authors: Koz Suleyman , Oguz Esin , Sayın Cagla 
Published: June 2023

Abstract

Background and Aims
Both accumulations and deficiencies of trace elements (TE) could be seen in peritoneal dialysis (PD) patients. Peritoneal clearance remains major route of elimination for many solutes including TE, in PD patients. Imbalances of TE may have deleterious effects on the patients. Data on TE balances in PD patients are inadequate. Here, we present some data from a larger study. We aimed to analyze peritoneal clearance of Boron (B), Cupper (Cu), Zinc (Zn), Selenium (Se), Strontium (Sr) and Molybdenum (Mo) in a cohort of PD patients.

Method
This cross-sectional study included three female and five male PD patients giving consent for the study. Mean age was 43,6±5,6 and patients were on continuous ambulatory PD for at least three months. Patients with recent peritonitis were excluded. Peritoneal solutions were individualized, so had different osmolarities. A sample of plasma and 24-hour spent dialysate was analyzed by inductively coupled plasma mass spectrometry (ICP-MS) (Thermo Scientific™ iCAP Q ICP-MS, USA). Sensitivity was on the order of ppb (μg/L). A control group (CG) with glomerular filtration rate ≥ 90 ml/min were used for comparison of plasma levels of TE. Peritoneal clearances were calculated by the following formula:
${{24 \!-\! hour \, spent\, dialysate\, volume \!\times\! \displaystyle\frac{{dialysate\ concentration\ of\ the\ trace\ element}}{{plasma\ concentration\ of\ the\ trace\ element}}}}$

Results
Data on plasma levels, clearances and daily loss of TE are shown in the Table 1. The clearances were ordered from smallest to largest as follows: Zn, Cu, Se, Sr, Mo, Ni, B. On the other hand, spent dialysate daily element losses were ordered from smallest to highest as follows: Cr, Ni, Se, Mo, Cu, Sr, Zn, B

Conclusion
Our study provides data on elimination of some trace elements, which may help to better understand the TE balance in PD patients. Data suggest that B has the highest and Zn the lowest peritoneal clearance values.
#4942 GENOTYPE-PHENOTYPE ANALYSIS IN FAMILIAL RENAL GLUCOSURIA PATIENTS: THE CRUCIAL ROLE OF CONSERVED RESIDUES
Authors: Xu Lubin , Zhao Ruohuan , Zhao Yumo , Tang Xueqing , Si Nuo , Guo Xiuzhi , Nie Min , Chen Limeng 
Published: June 2023

Abstract

Background and Aims
Familial renal glucosuria (FRG) is a hereditary disorder caused by mutations in SLC5A2, the gene encoding sodium-glucose cotransporter 2 (SGLT2) in proximal tubule cells. In this study, we aimed to characterize the genotype-phenotype relationship in FRG patients using data from our cohort and literature review.

Method
We sequenced SLC5A2 in a cohort of 21 FRG patients and measured the renal threshold of glucose (RTG) in 15 patients using urinary glucose excretion in a 4-hour oral glucose tolerance test (OGTT). We built an open-source online calculator to facilitate the calculation of RTG. Besides, we reviewed published literature and obtained information on SLC5A2 variants and 24-hour urinary glucose (24hUG) in FRG patients.

Results
We identified 27 rare SLC5A2 variants, including 13 novel variants (G484D, R564W, A212S, c.574+1G&gt;C, W649*, S592Cfs*6, Q579*, A89T, Y339*, V39F, G491E, A464E, and G360D), in our cohort and yielded 107 SLC5A2 variants from literature review. RTG in our cohort ranged from 1.0 to 9.2mmol/L. Patients carrying two SLC5A2 variants had lower RTG (3.9 vs. 6.2 mmol/L, p = 0.057) and larger amounts of 24-hour urinary glucose excretion (24hUG) (52.39 vs. 7.20 g/1.73m2, p = 2.7*10−8) than those carrying a single variant. Patients with homozygous missense or in-frame indels had mean 24hUG of 82.30g/1.73m2, comparable to those with homozygous truncating variants (81.66g/1.73m2) and significantly more than those with homozygous splicing variants (35.38g/1.73m2, p = 0.026). Patients with homozygous missense variants involving conservative residues had more 24hUG (104.76g/1.73m2) than those with variants at non-conservative residues (46.37g/1.73m2, p = 0.0031).

Conclusion
We built a comprehensive map showing the impact of SLC5A2 variant type, variant location, and zygosity on glucosuria severity. Our results highlighted that conserved residues play an essential role in maintaining the transport function of SGLT2.