bluuebunny/crossref_metadata_2025_split huggingface dataset:
#3285 EXTRACORPOREAL BLOOD PURIFICATION DURING OPEN HEART SURGERY WITH PROLONGED CPB: CYTOSORB 300 VS JAFRON HA330
Authors: Jabayeva Nilufar , Bekishev Bolat , Lesbekov Timur , Kaliyev Rymbay , Nurmykhametova Zhuldyz , LI Tatyana , Kuanyshbek Aidyn 
Published: June 2023

Abstract

Background and Aims
Cardiac surgery is maintained by various complications. Major contribution associated with cardiopulmonary bypass (CBP). Cardiac surgery with CPB provokes activation of the cascade mechanism of inflammation with releasing of cytokines and a systemic inflammatory response syndrome (SIRS). Activation of the contact system due to exposure of artificial surface of the bypass circuit to blood cells, endotoxemia, ischemia and reperfusion injury and surgical trauma are all potential triggers of inflammation following CPB. This inflammatory reaction may leads to the development of postoperative complications, including vasoplegia, cytokine storm, myocardial dysfunction, respiratory failure, acute kidney injury, coagulopathy bleeding, and multiple organ dysfunction syndrome (MODS).
A number of different strategies, including new pharmacologic agents, CPB circuits and components, and surgical techniques, have been employed during the last few years in attempts to minimize the impact of SIRS on the outcome of cardiac surgical patients. However, the complex pathophysiology of this problem has not allowed, until now, the use of a single strategy.
The aim of our study is assessment of early application of extracorporeal cytokine adsorbers to the inflammation system during open-heart surgery with prolonged cardiopulmonary bypass.

Method
This prospective randomized single-center controlled trial observed patients, who were assigned a planned open cardiac surgery with a duration of cardiopulmonary bypass (CPB) more than 120 minutes between January 2021 to January 2023. Patients were randomized into three groups: CytoSorb -300 group, HA 330 group and the control group. A simple 1:1:1 randomization method was applied. Cytokine hemadsorption was conducted intraoperatively. Two types of cytokine cartridges were applied CytoSorb 300 (Cytosorbents Europe GmbH). НА330 (Jafron Biomedical Co., Ltd. China). The inclusion criteria: age ≥18 years, informed consent to participate in the study, CPB more than 120 min. The exclusion criteria: Age less than 18 years; refusal to participate in the study.

Results
The data of the HA 330 (n = 22) and CytoSorb300 (n = 22) groups were compared with the data of the control group (n = 22). The primary results and details of the work are given in Tables 1-3.

Conclusion
Intraoperative hemadsorption may be beneficial for patients who underwent open-heart surgery with prolonged CPB. The early hemadsorption has positive impact to postoperative period after cardiac surgery and may reduce requirement of renal replacement therapy.
#3318 PHASE II DOSE-SELECTION, RANDOMISED DOUBLE-BLIND TRIAL OF THE ASI, BI 690517, ALONE AND IN COMBINATION WITH EMPA IN PEOPLE WITH CKD
Authors: Tuttle Katherine , Rossing Peter , Cronin Lisa , Hauske Sibylle , Hussain Joanna , de Zeeuw Dick , Heerspink Hiddo Lambers 
Published: June 2023

Abstract

Background and Aims
Elevated aldosterone levels are associated with chronic kidney disease (CKD) progression and adverse kidney and cardiovascular disease outcomes. Therapy with an angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) improves clinical outcomes, yet elevated aldosterone levels often persist. BI 690517 is a first-in-class, selective aldosterone synthase inhibitor (ASi) that may reduce deleterious mineralocorticoid receptor-dependent and -independent actions of aldosterone. Coadministration of BI 690517 with a sodium–glucose cotransporter-2 inhibitor could mitigate the risk of hyperkalaemia. This study is investigating the efficacy and safety of three doses of BI 690517, alone and in combination with empagliflozin (EMPA), on top of an ACEi or ARB, for treatment of CKD with or without type 2 diabetes.

Method
A randomised, double-blind, placebo-controlled, parallel-dose Phase II trial (NCT05182840) in adults with or without type 2 diabetes who had an estimated glomerular filtration rate (eGFR) ≥30 and &lt;90 mL/min/1.73 m2, urine albumin:creatinine ratio (UACR) ≥200 and &lt;5000 mg/g, and serum potassium ≤4.8 mmol/L on stable background therapy with an ACEi or ARB. After an 8-week run-in period to assigned background therapy (EMPA 10 mg or matched placebo randomised 1:1), participants were randomised 1:1:1:1 to BI 690517 (low, medium or high dose) or matched placebo for 14 weeks. Primary outcome was the change in UACR measured in a first morning void (UACRFMV) from baseline to Week 14. Secondary outcomes were the proportion of participants with ≥15 and 30% decreases in UACRFMV. Safety outcomes and changes in eGFR and serum potassium were also evaluated.

Results
Recruitment is complete, with 1719 participants from 168 sites in 29 countries screened. In total, 714 were randomised and entered the run-in period (last randomisation on 30 December 2022). The trial is currently ongoing; data on baseline characteristics will become available and shared.

Conclusion
This study will provide key data on the potential synergistic kidney-protective effects and safety of combination therapy with BI 690517 plus EMPA, as well as data on monotherapy, for CKD with or without type 2 diabetes. Findings will inform BI 690517 dose selection for further clinical trial development.
#3337 ACCURACY OF ESTIMATED GLOMERULAR FILTRATION RATE EQUATIONS IN PATIENTS WITH DISCORDANCES BETWEEN CREATININE AND CYSTATIN C-BASED ESTIMATIONS
Authors: Fu Edouard , Levey Andrew , Coresh Josef , Elinder Carl-Gustaf , Rotmans Joris , Dekker Friedo W , Paik Julie , Barany Franz Peter , Grams Morgan , Inker Lesley , Carrero Juan Jesus 
Published: June 2023

Abstract

Background and Aims
Cystatin C is recommended for use along with creatinine in estimating glomerular filtration rate (eGFR) when precise estimates are needed for clinical decision-making. Although eGFR based on both creatinine and cystatin (eGFRcr-cys) is the most accurate in research studies, it is uncertain as to whether this remains true in real-world settings, particularly when there are large discordances between eGFR based on creatinine (eGFRcr) and that based on cystatin C (eGFRcys).

Method
We included 6185 adults from the Stockholm Creatinine Measurements (SCREAM) project referred for plasma clearance of iohexol in Stockholm, Sweden, who had 9404 concurrent measurements of creatinine, cystatin C and iohexol clearance. The performance of eGFRcr, eGFRcys and eGFRcr-cys was assessed against mGFR with bias, P30 and correct classification of GFR strata. We stratified analyses within three categories: eGFRcys at least 20% lower than eGFRcr (eGFRcys &lt; eGFRcr), eGFRcys within 20% of eGFRcr (eGFRcys ≈ eGFRcr) and eGFRcys at least 20% higher than eGFRcr (eGFRcys &gt; eGFRcr). Bias was expressed as the median difference in estimated GFR minus mGFR, with negative biases indicating underestimation of mGFR. P30 described the percentage of individuals with eGFR within 30% of mGFR. Correct classification of GFR categories was defined as agreement of eGFR and mGFR categories using the KDIGO GFR categories (&lt;15, 15-29, 30-44, 45-59, 60-89 and ≥90 ml/min/1.73 m2).

Results
eGFRcr and eGFRcys were similar in 4226 (45%) of samples, and there all three estimating equations displayed similar performance (Table 1). In contrast, eGFRcr-cys was much more accurate in cases of discordance. For example, when eGFRcys &lt; eGFRcr (47% of samples), median biases were 15.0 (overestimation), −8.5 (underestimation) and 0.8 ml/min/1.73 m2 for eGFRcr, eGFRcys and eGFRcr-cys, respectively; P30 was 50%/73%/84%, respectively; and correct classification was 38%/45%/62%, respectively. When eGFRcys &gt; eGFRcr (8% of samples), median biases were −4.5, 8.4, and 1.4 ml/min/1.73 m2. Findings were consistent among individuals with cardiovascular disease, heart failure, diabetes mellitus, liver disease and cancer (Figure 1).

Conclusion
When large discordances between eGFRcr and eGFRcys are found in clinical practice, eGFRcr-cys is more accurate than either eGFRcr or eGFRcys.
#3368 DIAGNOSTIC YIELD AND CLINICAL SIGNIFICANCE OF SYSTEMATIC CARDIAC SCREENING OF KIDNEY TRANSPLANT CANDIDATES USING CARDIAC COMPUTED TOMOGRAPHY
Authors: Nielsen Marie Bodilsen , Iversen Malene , Derai Amal , Dahl Jonathan , Jespersen Bente , Ivarsen Per , Winther Simon , Birn Henrik 
Published: June 2023

Abstract

Background and Aims
Cardiovascular screening of kidney transplant candidates is currently recommended, although the patient value is presently questioned. The prognostic ability is known, whereas systematic screening may have less recognized effects such as incidental findings, triggering of additional investigations, procedural complications, delay of transplantation and deselection of patients for kidney transplantation. To address this, we characterized the diagnostic yield and clinical implications of systematic screening for cardiovascular disease using cardiac computed tomography (CT) in asymptomatic kidney transplant candidates.

Method
In a single-centre, observational study, we included all potential kidney transplant candidates ≥ 40 years or with diabetes or on dialysis treatment ≥ 5 years, who were systematically referred to cardiac CT (a non-contrast enhanced CT scan and a coronary CT angiography) prior to kidney transplantation between March 2014 and September 2019 in North and Central Denmark Regions. Patient records were examined to obtain data on baseline characteristics, additional investigations, incidental findings, conference decisions.

Results
In total, 473 patients underwent cardiac CT. The screening programme led to additional cardiac investigations in 155 patients (33%) and 7% were revascularised. Thirty patients (6%) had significant incidental non-vascular findings on cardiac CT, but only 4 patients were changed in medical management based on these findings. Furthermore, no patients were rejected for transplantation based on the cardiac CT. In patients not yet on dialysis, the slope in eGFR decline did not change significantly after coronary CT angiography.

Conclusion
The clinical significance of the screening by cardiac CT was limited, and one third of patients had to go through additional investigations. Few patients were revascularised and no patients rejected for transplantation. No evidence of contrast-induced acceleration of kidney function decline was observed.
#3466 RISK FACTORS AND TRANSITIONAL PROBABILITY OF CLINICAL EVENTS IN KOREAN CKD PATIENTS USING THE MULTI-STATE MODEL: RESULTS FROM THE KNOW-CKD STUDY
Authors: Kim Ji Hye , Kim Jayoun , Kim Jinheum , Oh Kook-Hwan 
Published: June 2023

Abstract

Background and Aims
Compared to western countries, Korean CKD patients show distinctive differences in clinical outcomes including lower cardiovascular disease (CVD) and higher end-stage kidney disease (ESKD) events. This study analysed the risk factors, transition probability and cumulative hazards associated with clinical events using the multi-state model.

Method
This study included 1423 patients at CKD stages 1-4 from KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease. Multivariate multi-state model analysis was performed to investigate the risk factors, 10-year transition rate and cumulative hazard estimates for five clinical event status including ESKD, CVD, death, death after ESKD and death after CVD events.

Results
Among 1423 patients (age 54 [44-63] years), the overall prevalence of clinical events were the following: ESKD (22.6%), CVD (7.5%), death (3.3%), death after ESKD (3.6%) and death after CVD (1.2%). Different risk factors were associated with different clinical outcomes and in particular the risk factors associated with higher ESKD event were underlying CVD, diabetes, polycystic kidney disease, fibroblast growth factor-23 while hypertension, increased age and estimated glomerular filtration rates were associated with lower risks. The 10-year progression probability for each event status include the following: 0.23 for ESKD, 0.08 for CVD, 0.04 for death, 0.09 for death after ESKD and 0.01 for death after CVD (Figure 1). The 10-year cumulative hazard estimates for each event status were the following: ESKD [0.43, 95% CI (0.37-0.49)], CVD [0.12, (0.10-0.15)], death [0.05, (0.03-0.06)], death after ESKD [0.52, (0.20-0.84)] and death after CVD [0.27, (0.15-0.40)] (Figure 2).

Conclusion
Different risk factors were associated with varying clinical outcomes in Korean CKD patients. The 10-year progression probability was the highest in ESKD followed by death after ESKD events. Also, the 10-year cumulative hazard estimate was the highest for death after ESKD followed by ESKD events. These findings correlate with the distinctive clinical outcome features of Korean CKD patients.
#3479 RISK FACTORS OF DEATH OR CHRONIC RENAL REPLACEMENT THERAPY REQUIREMENTS IN PATIENTS WITH THROMBOTIC MICROANGIOPATHIES WITHOUT ADAMTS-13 DEFICIENCY
Authors: Rivera Miguel Giovanni Uriol , Mendoza Sonia Cleofe Jimenez , Mulet Aina Obrador , Mas Antonio , Parraga Leonor Periañez , Ojeda Felipe Ignacio , Rodenas Estela de Los Angeles Mas , Ballester Maria Carmen 
Published: June 2023

Abstract

Background and Aims
Thrombotic microangiopathy without severe ADAMTS-13 deficiency activity levels (TMA-13n) has a high mortality rate. Early recognition of patients at higher risk of dying or needing chronic renal replacement therapy (composite outcome: CO) has become of paramount importance since treatments such as eculizumab could ameliorate the prognosis of this group of patients. Plasmic score have been shown to predict severe ADAMTS-13 deficiency; however, its role as a prognostic factor of CO in TMA-13n is unknown.

Method
We retrospectively evaluate the potential factors associated with the risk of CO. Patients diagnosed with TMA-13n (defined by microangiopathic anaemia, thrombocytopenia, organ damage and ADAMTS-13 activity ≥ 10%) from January 2008 to May 2018 in our centre were included in the study.

Results
Forty-two consecutive patients were included. Mean (SD) age: 41(20) years. Twenty-five (60% were females. Mean (SD) ADAMTS-13 activity: 69 (24%). Twenty-six (62%) patients required dialysis at admission. Nineteen (45%) met CO (10 patients died). Higher age, lower lactate dehydrogenase, PLASMIC score values ≤ 4, neuroradiological damage and early eculizumab use [median (IQR): 4 (0-16) days from hospital admission: 5] were factors associated with the risk for developing CO. Only three factors were independently associated with CO mortality by logistic regression: early use of eculizumab (OR: 0.14; 95% CI: 0.02-0.94) and neuroradiological damage (OR: 6.67; 95% CI: 1.12-39.80) and PLASMIC score ≤ 4 (OR: 7.39; 95% CI: 1.18-46.11).

Conclusion
In TMA-13n patients, neuroradiological damage, low PLASMIC score and early use of eculizumab were independent prognostic factors of death and chronic renal replacement therapy requirements.
#3517 BRAIN MAGNETIC RESONANCE IMAGING AND COGNITIVE FUNCTION IN PATIENTS RECEIVING HEMODIALYSIS
Authors: Kuo Mei-Chuan , Wu Ping-Hsun , Lin Hsiu-Fen , Wu Tsai-Shan , Lin Yi-Ting 
Published: June 2023

Abstract

Background and Aims
Chronic kidney disease is high risk to adverse events including stroke, cardiovascular diseases and cognitive decline. Cognitive function was known to be linked to chronic kidney disease. The Fazefa's scale, which was used for assessing white matter hyperdensities(WMH), has been reported to associate with poor cognitive performance. We aim to investigate the associations between mini-mental status examination (MMSE), Montreal cognitive assessment (MoCA), cognitive abilities screening instrument (CASI) and Fazefa's scale in patients under hemodialysis (HD).

Method
The periventricular (PV) and deep white matter (DWM) lesions in brain MR images of 59 patients under dialysis for at least 90 days were graded by Fazefa's scale. Cognition function tests including MMSE, MoCA, and CASI were performed. Multivariable ordinal regression and logistic regression were used for identifying the associations between cognitive performance and Fazekas scale.

Results
Inverse associations were found between three cognitive function tests across the Fazekas scale of PV lesions (p = 0.037, 0.006 and 0.008 for MMSE, MoCA, and CASI, respectively), and higher scales were associated with lower cognitive function scores in trend; however, the association attenuated in the DWM group. In subdomains of CASI, significant differences were identified in five subdomains, including short-term memory, mental manipulation, abstract thinking, spatial construction, and name fluency; nevertheless, in DWM hyperdensities, only abstract thinking and short-term memory showed obvious correspondence.

Conclusion
Inverse correlation between the Fazefa's scale, predominantly in PV lesions, and cognition was detected in HD patients. The Fazefa's scale of PV lesions were associated with cognitive performance assessed by MMSE, MoCA and CASI, as well as with subdomains of CASI such as memory, language, and name fluency in HD patients.
#3537 RAPID DECLINE IN KIDNEY FUNCTION IS ASSOCIATED WITH HIGHER HEMOGLOBIN VARIABILITY IN CHRONIC KIDNEY DISEASE
Authors: Kim Hyo Jin , Kim Da Woon , Rhee Harin , Song Sang Heon , Seong Eun Young 
Published: June 2023

Abstract

Background and Aims
Hemoglobin decrease and anemia are common in chronic kidney disease (CKD). This study aimed to evaluate hemoglobin variability in patients with CKD according to decline in kidney function.

Method
We analyzed patients from the KoreaN cohort study for Outcome in patients With CKD (KNOW-CKD). The rates of renal function decline per year were determined using the slope of estimated glomerular filtration rate (eGFR) analyzed using a generalized linear mixed model. Rapid decline in kidney function was defined as a decline in the eGFR of &gt;3 mL/min/1.73 m2/year. Hemoglobin value was measured at 0, 6, and 12 month and annually for up to 8 years. Hemoglobin variability was calculated by standard deviation. Higher hemoglobin variability was defined as a hemoglobin variability value greater than the median.

Results
Among 1895 patients, 736 patients (38.8%) were in the rapid kidney function decline group. In 1472 patients who were 1:1 propensity score-matched, the baseline eGFR was not significantly different between the non-rapid and rapid kidney function decline groups (48.2 ± 26.9 vs 46.9 ± 26.2 ml/min/1.73m2, P = 0.345). The use of iron supplements (P = 0.536) or erythropoiesis stimulating agents (P = 0.699) was similar in both groups. In multivariable logistic regression analysis, rapid decline in kidney function was significantly associated with higher hemoglobin variability (odds ratio [OR]: 1.81; 95% confidence interval [CI]: 1.43–2.28; P &lt; 0.001). This association was prominent in the group without anemia at baseline (OR: 2.82; 95% CI: 1.99–4.01; P &lt; 0.001).

Conclusion
Rapid decline in kidney function is associated with higher hemoglobin variability in patients with CKD. Attention should be paid to hemoglobin variability in patients with a rapid decline in kidney function.
#3597 MONOCLONAL GAMMOPATHY AS A RISK FACTOR FOR ARTERIOVENOUS FISTULA PRIMARY FAILURE
Authors: Almeida Catarina , Peixoto João , Martins Vítor , Nogueira Clara , Pereira Susana , Ventura Ana , Almeida Maria Clara 
Published: June 2023

Abstract

Background and Aims
Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis (HD) in most patients. However, postoperative complications such as primary failure (PF) with a reported incidence between 20-60% remain a major problem. Patients diagnosed with monoclonal gammopathy (MG) are at increased risk of thrombotic events, either due to the disease itself or the chemotherapy used for its treatment. The aim of this study was to evaluate whether the presence of MG was associated with primary AVF failure.

Method
We performed a retrospective single-center case-control study including 103 patients observed in our vascular access consultation for planning their first HD access. Demographic and clinical data were collected, such as the presence of diabetes, hypertension, cardiovascular disease and MG. Distal AVF was the access of choice when possible. Primary failure was defined as incapacity to use AVF for HD because of failure to mature or thrombosis. Univariate analysis was performed, and a logistic regression was applied to access predictors of PF. A p-value inferior to 0,05 indicated statistical significance.

Results
In total 14 (13.6%) patients had MG (11 multiple myeloma, 1 light-chain deposition disease, 1 proliferative glomerulonephritis with monoclonal immunoglobulin deposits and 1 amyloid light-chain amyloidosis). Regarding the AVF location, 13 patients constructed a constructed a distal AVF and 1 patient a proximal AVF. When compared to the group of 89 patients who did not have MG, there were no significance differences in sex, age, prevalence of diabetes and cardiovascular disease neither in AVF construction site. Arterial hypertension was more frequent in the group of patients without MG (93.2% versus 64.3%, p = 0.007). PF occurred in 57.1% (8/14) of patients with MG and in 27% (24/89) of those without MG (p = 0.032). In logistic regression, the presence of MG was the only predictor of primary AVF failure (OR 4.39 95% CI: 1.23-15.75).

Conclusion
In our study, we found that a patient with monoclonal gammopathy has a 4-fold increased risk for primary AVF failure comparing to the general chronic kidney disease patients. Therefore, a careful evaluation must be made when planning for AVF placement in these patients, balancing individual life's expectancies and monoclonal gammopathy prognosis.
#3610 EPIDEMIOLOGY AND CLINICAL CORRELATES OF POST-AKI PROTEINURIA IN CHINESE HOSPITALIZED ADULTS
Authors: Su Licong , LI Yanqin , Xu Ruqi , Gao Qi , Chen Ruixuan , Zhang Xiaodong , Luo Fan , Nie Sheng , Xin Xu 
Published: June 2023

Abstract

Background and Aims
Acute kidney injury (AKI) has been associated with increased risks of new-onset and worsening proteinuria. However, the epidemiologic data of post-AKI proteinuria was still lacking. This study aimed to determine the incidence, risk factors and clinical correlations of post-AKI proteinuria among hospitalized patients.

Method
This study conducted a multicenter cohort from Chinese Renal disease Data System (CRDS), including patients aged 18–100 years with hospital-acquired AKI (HA-AKI) hospitalized at 19 medical centers throughout China. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) creatine criteria. The results of both quantitative and qualitative urinary protein tests were used to determine post-AKI proteinuria. The primary outcome was the incidence of post-AKI proteinuria. Secondary outcomes included AKI recovery and kidney disease progression. Cox proportional hazard model with stepwise regression was used to determine the risk factors for post-AKI proteinuria. The associations of post-AKI proteinuria with kidney disease progression were analyzed by logistic regression models.

Results
Of 6,206 HA-AKI patients without proteinuria at baseline, 2,102 (33.9%) had new-onset proteinuria, whereas, of 5,137 HA-AKI with baseline proteinuria, 894 (17.4%) had worsening proteinuria after AKI (Table 1). Higher AKI stage and preexisting CKD diagnosis were risk factors for new-onset proteinuria and worsening proteinuria, whereas treatment with RAS inhibitors was associated with an 11% lower risk of incident proteinuria. About 60% and 75% of patients with post-AKI new-onset and worsening proteinuria, respectively, recovered within 3 months. Worsening proteinuria was associated with a lower incidence of AKI recovery and a higher risk of kidney disease progression (Table 2).

Conclusion
Post-AKI proteinuria is common and usually transient among hospitalized patients. The risk profiles for new-onset and worsening post-AKI proteinuria differed markedly. Worsening proteinuria after AKI was associated with adverse kidney outcomes, which emphasized the need for close monitoring of proteinuria after AKI.