bluuebunny/crossref_metadata_2025_split huggingface dataset:
#4400 QUALITY OF LIFE, PRURITUS BURDEN, AND TREATMENT SATISFACTION IN CHRONIC KIDNEY DISEASE PATIENTS IN GERMANY
Authors: Zavlin Dmitry , Weinreich Thomas , van Bentum Kai , Müller Berno , Koczor Martin 
Published: June 2023

Abstract

Background and Aims
Chronic kidney disease (CKD) and its related symptoms significantly impact patients’ health-related quality of life (HRQoL). CKD-associated pruritus (CDK-aP) often affects patients with advanced CKD, particularly those on renal replacement therapy, and remains mostly underrecognized by both patients and medical providers. To explore the current patients’ impairment of HRQoL due to CKD-aP, we conducted a quantitative survey amongst members of a CKD patient association in Germany.

Methods
Our questionnaire was distributed via the channels of the German National Kidney Patients Association (Bundesverband Niere e.V.) from mid-June to mid-September 2022. Responses of 569 CKD-patients of a total of roughly 16,000 members were analysed regarding their general health, HRQoL, and general treatment satisfaction using multiple choice questions. Pruritus burden was assessed with a 0-10 numeric rating scale.

Results
The demographic details are displayed in Figure 1. Among the surveyed CKD patients, 33% were transplanted, 39% on hemodialysis, and 7% on peritoneal dialysis. We could confirm that most CKD patients (92 %) suffered from comorbidities. Initially, 12% reported dermatological comorbidities but when asked specifically about pruritus, 62% reported this symptom which was also associated with worse HRQoL (Figure 2). However, only one third was receiving antipruritic treatment by a physician. Furthermore, patients who were able to fully or at least partially participate in their medical decisions showed higher satisfaction and higher HRQoL (86% vs. 65% vs. 43% satisfaction, depending on full/partial/no participation, respectively) yet the patients did not always perceive that shared-decision-making was possible. Patients also showed high interest in topics outside of their primary CKD treatment, such as overall symptom control and additional psychological measures. They reported higher HRQoL when these areas were addressed by the medical team (87% vs. 55% satisfaction).

Conclusions
Our survey results emphasize the persisting need for shared or co-creative exchange between patient and physician. Improving patient education and the caregiver's awareness of the burden of pruritus – one of the many CKD-related symptoms – could be a first step towards higher patient satisfaction and HRQoL and higher treatment rates. CKD-aP appears underreported by patients via unprovoked questioning and should be screened frequently.
#4440 PREVALENCE OF GENES INVOLVED IN HEREDITARY KIDNEY DISEASE AS A TOOL FOR THE DEVELOPMENT OF A GENE PANEL
Authors: Gómez Cristina Andrades , Cosano Gema Montilla , Valdivia Miguel Ángel Pérez , Castilla José Luis Rocha , Prieto Francisco Javier Toro , Lopez-Mendoza Manuel 
Published: June 2023

Abstract

Background and Aims
Genetic study is the fundamental tool for the diagnosis of Hereditary Kidney Diseases (HKD). The proliferation of its use has led to an increase in diagnostic complexity due to phenotypic overlap and genotypic heterogeneity. The aim of this study is to evaluate the prevalence of genes in our series of adult patients with suspected monogenic kidney disease in order to develop the basis for the elaboration of a gene panel that will make its usefulness in our routine clinical practice profitable.

Method
A retrospective descriptive observational study was performed with the collection of all genetic studies that were positive in the period between October 2014 and December 2020 in our center. With a description of the causative genes involved, as well as the clinical data of the proband patients who turned out to be carriers of these variants. Descriptive results of continuous variables are expressed as mean and standard deviation (SD) or median and interquartile range (IQR) according to their distribution. For categorical data, frequency and percentage are reported.

Results
The results of a total of 77 genetic studies on probands were collected, of whom 51% were women with a mean age at diagnosis of 46 years (SD ± 13.4) and 64.9% had a family history of kidney disease. Renal function measured by mean estimated glomerular filtration rate (eGFR) using the CKD-EPI (CKD Epidemiology Collaboration) was 90.1 ml/min/1,73 m2 (SD ± 29.64) with a mean proteinuria quantified in 24-hour urine of 627.9 mg (SD ±43.7) and 7.7% were on renal replacement therapy. (Table 1) 40.25% of probands were carriers of a mutation for Alport syndrome, in this group the most frequent gene was COL4A3 in 50% of cases. The second most frequent entity was autosomal dominant polycystic kidney disease (ADPKD) with 37% of the studies and among these the great majority were carriers of a variant in the PKD1 gene with 96.5%. The remaining diagnostic entities in order of frequency were Fabry disease, autosomal dominant tubulointerstitial nephropathy (ADTKD), congenital anomalies of the kidney and urinary tract (CAKUT), nephrotic syndrome, hereditary angiopathy with nephropathy, aneurysm and cramps syndrome (HANAC) and tuberous sclerosis (Figure 1).

Conclusion
Alport syndrome was the most frequently identified entity in patients with suspected monogenic renal disease in whom the genetic study was performed. Based on the results of our series, a proposal has been made for the genes to be included in a panel for hereditary renal diseases in our center. The development of these panels increases the efficiency and increases the cost-effectiveness of genetic studies in the diagnosis of these patients.
#4446 THE CARE TRAJECTORY LEADING TO EMERGENCY DIALYSIS START: CROSSING PATIENTS’, GENERAL PRACTITIONERS’ AND NEPHROLOGISTS’ PERSPECTIVES
Authors: Raffray Maxime , Vigneau Cécile , Laude Laetitia , Arnaud Campeon , Bayat Sahar 
Published: June 2023

Abstract

Background and Aims
Emergency dialysis start (EDS) is an important issue to understand and tackle in CKD care. Late referral, absent previous nephrology care and higher comorbidity scores have been associated with EDS. However, how those quantitative risk factors happen and contribute to EDS remains unexplored. We conducted a qualitative study in France to identify and describe the mechanisms that shape the trajectories that lead to EDS, using patients, GPs and nephrologists perspectives.

Method
Three groups of participants were recruited in Brittany, north-west France: Patients who started dialysis in emergency between 2017 and 2019, GPs and nephrologists. Maximum variation sampling approach was used based on patients’ socio-economic profiles and GPs’ and nephrologists’ years and settings of practice. Semi-structured interviews were conducted between 2017 and 2020. A crossed thematic analysis between the 3 groups of transcripts was performed, informing how EDS trajectories come to be.

Results
Twenty patients, 12 GPs and 18 nephrologists were interviewed. Five main themes were identified: 1) Learning about dialysis, 2) Dialysis and nephrology care representations: a) an unacceptable biographical disruption, b) a dreadful invasive machinery, c) a straw that breaks the camel's back, 3) The gap between the “illness” perceived and the “disease” treated, 4) Slipping through the primary care prevention net, 5) the unavoidable unpredictability of CKD course.

Conclusion
This study shows how quantitative risk factors of EDS such as low or absent previous nephrology care are, in part, the results of an interplay between patients’ constructed representations of dialysis, relation with the medical sphere and CKD physiopathology. The results suggests a need for evaluation of kidney replacement therapy education programs and reinforcement of psychological care. Finally, results also support ambitious mass prevention campaign focused on kidney health to counter the persistent negative representation of dialysis and seal off prevention cracks younger patients slip through.
#4448 HUMORAL RESPONSE TO SARS-COV-2 AFTER FIVE SUCCESSIVE DOSES OF MRNA VACCINE AND PASSIVE IMMUNIZATION THERAPY IN STABLE KIDNEY TRANSPLANTATION PATIENTS
Authors: López Juan Manuel Cazorla , Fernández Florentino Villanego , Aguilera Aurora , Romero Ana Maria Gomez , Soto Teresa Trujillo , Garcia Teresa , Montiel Natalia , Orellana Cristhian , Mejía Carlos Narváez , Iglesias Manuel Antonio Rodríguez , Mazuecos Auxiliadora 
Published: June 2023

Abstract

Background and Aims
The poor humoral response after vaccination against SARS-CoV-2 in kidney transplant recipients (KT) led to the approval of new doses, the fifth being the last administered, and to the development of drugs for passive immunization. Our aim is to analyze the humoral immune response and the evolution of the antispike (antiS) antibody titer after 5 doses of mRNA vaccine against SARS-CoV-2 and the administration of pre-exposure prophylaxis.

Method
We performed a prospective cohort study of stable KT patients from our center who received 5 doses of a mRNA vaccine from March 2021 to December 2022. KT recipients with less than 6 months after transplantation and with active oncological or hematologic disease were excluded. We determined antiS titers (Abbott SARS-CoV-2 IgG chemiluminescent microparticle immunoassay) at baseline and one month after the second, third, fourth and fifth doses. We consider seroconversion if antiS titer was greater than 260 BAU/mL. We compared humoral response after 2, 3, 4 and 5 doses.

Results
We included 18 KT. Mean age was 59.8 years and 72.2% were male. The median time from KT to the first vaccine dose was 45 months, between the second and third 4 months and 6 months between the third and fourth and fourth and fifth doses. Seroconversion rate was 11.1% after 2 doses, 50% after the third, 72% after the fourth, and 94.4% after the fifth (p &lt; 0.001). One TR did not develop antibodies after 5 doses. Two KT that had not seroconverted after the fourth also received passive immunization (tixagevimab-cilgavimab), maintaining high antiS titers 3 and 5 months after administration. The KT who seroconverted after 2 doses doubled the antiS titer after the third (1070 vs. 2168 BAU/mL; p = 0.180), in those who seroconverted after 3 doses it increased by 380% after the fourth (802 [587-2563] BAU/mL vs. 3116 [1004-5680] BAU/mL; p = 0.028) and in those who seroconverted after 4 doses, the antiS titer increased by 60% (1067 [100-2896] BAU/mL vs. 1762 [639-2684] BAU/mL) after the fifth (p = 0.213). No patients had neither acute rejection nor serious adverse effects.

Conclusion
Successive doses of vaccination increased the development and titer of antibodies against SARS-CoV-2 in KT. However the administration of new doses is necessary, especially bivalent vaccines, which increase protection against new variants of the virus. We should identify those patients who do not generate an adequate humoral response in order to offer them other prevention strategies.
#4450 ASSOCIATION OF DEMENTIA AND EXPOSURE OF PROTON PUMP INHIBITORS IN DIABETIC PATIENTS
Authors: Chen Yi-Hsin 
Published: June 2023

Abstract

Background and Aims
Dementia is characterized by a decline in cognition and an increasing inability to live independently. Proton pump inhibitors (PPI) are commonly used to treat gastric or duodenal ulcers. Recently, concern about the risk of dementia and exposure to PPI was noted. However, no known association has previously been reported in patients with diabetes.

Method
We analyzed data from the Taiwan National Health Insurance Research Database between January 1st, 2002 and December 31st, 2013. A total of 526920 diabetic patients were selected as the study cohort. A 1 to 4 propensity score was used for matching.

Results
During the follow-up period, 169 (2.2%) patients experienced newly diagnosed dementia compared to 1.7% of the control group. According to univariate analysis, the hazard ratio of dementia when exposed to PPI was 1.98(p = 0.0007). In multivariate analysis, the hazard ratio of exposure to PPI was 1.11 (p = 0.0008). In the sensitivity test, greater than 180 cDDDs were associated with a hazard ratio of 1.5 (p = 0.0006).

Conclusion
The association between PPI use and dementia was significant in diabetic patients. Therefore, PPI use should be cautious in this population. Further study is needed to clarify the mechanism.
#4456 HEALTHY PLANT-BASED DIET IN CHRONIC KIDNEY DISEASE THROUGH USE OF SODIUM ZIRCONIUM CYCLOSILICATE (HELPFUL TRIAL): RESULTS OF DIETARY INTAKE
Authors: Sallstrom Torsten , Heimbürger Olof , Rubin Charlotta , Danielsson Awa , Irving Gerd Faxen , Lindholm Bengt , Stenvinkel Peter , Avesani Carla Maria 
Published: June 2023

Abstract

Background and Aims
The dietary restriction of healthy food sources of potassium (K) counselled to patients with chronic kidney disease (CKD) and hyperkalemia (HK) contributes to a diet with poor dietary quality. The K lowering medication sodium zirconium cyclosilicate (SZC) has the potential to treat HK, thereby allowing a healthy plant-based diet (PBD). We designed a clinical trial to explore the safety and feasibility of prescribing a healthy PBD to CKD patients with HK with the concomitant use of SZC.

Method
The HELPFUL trial is an ongoing single-arm study with CKD stage 4-5 patients not on dialysis and with plasma K (pK) between 5.1-6.5 mmol/L at inclusion. Patients are followed for six weeks. In the first three weeks, SZC is prescribed to normalize pK while patients ingest a low protein diet with low K content. In the subsequent three weeks, a healthy PBD with a target K intake of 3700 mg/day is prescribed while maintaining the use of SZC. A food basket with PBD is delivered to participants weekly. A weekly monitoring of pK and titration of SZC to keep normokalemia is performed. Two dietary quality scores were calculated using the 24-hour food record (24h-FR) at baseline, week three and six. The first index is the Swedish version of Nutrient rich food index (S-NRF11.3) that measures the density of 11 beneficial nutrients (fiber, folate, iron, calcium, potassium, protein and vitamins A, C, D and E) and three non-beneficial nutrients (saturated fat, sodium and added sugars). The second index is the mean adequacy ratio (MAR) with the average intake of the same 11 beneficial nutrients as a proportion of the recommended daily intake (RDI). Data was analyzed by repeated measures-ANOVA or by Friedman test for related samples, as appropriate. Registered at www.clinicaltrials.gov (identifier NCT04207203).

Results
22 patients were included; 59±13 years; 13 men, eGFR 18±4 mL/min/1,73m2 (Table 1). The total intake of energy, fibre, folate and K increased significantly in week 6. Nutrient density did not change, but the MAR-score increased significantly. The intake of servings of fruits, vegetables and nuts increased significantly throughout the PBD. Regarding animal protein, there was a tendency to decrease the intake of servings of red meat and a significant increase in poultry and fish. The mean pK normalized in week three and six. After the start of PBD, three patients (13.6%) had pK between 5.1-5.3 mmol/L.

Conclusion
The strategy of PBD food baskets with concomitant use of SZC improved the dietary quality and increased the intake of servings of healthy foods. The K intake increased but not to target value. The pK was kept within normal values for most patients.
#4494 DRUG UTILIZATION FOLLOWING INCIDENT CHRONIC KIDNEY DISEASE: AN OBSERVATIONAL STUDY IN THE UNITED STATES AND JAPAN
Authors: Tangri Navdeep , Bodegard Johan , Hong Lai San (Corinna) , Nan Cassandra , Sofue Tadashi 
Published: June 2023

Abstract

Background and Aims
Chronic kidney disease (CKD) affects &gt;840 million individuals worldwide and is a leading cause of morbidity and mortality. Complications include cardiorenal outcomes (e.g. end stage kidney disease and heart failure (HF)) and premature death, which may be preventable with early identification and appropriate treatment of CKD. Treatment of CKD with renin-angiotensin-system inhibitors (RASi) has been the main recommendation of guidelines in the past 20 years, but prescribing rates remain low and discontinuation rates remain high, particularly after adverse events like hyperkalaemia episodes. This study aims to describe RASi utilization following incident CKD.

Method
Adult patients with incident CKD in the United States (US; OPTUM Market Clarity until 31 March 2022) and Japan (Medical Data Vision until 28 February 2022) from 1 January 2016 onwards were included. CKD was defined as any of the following: a UACR measure of ≥30 mg/g, two estimated glomerular filtration rate (eGFR) ≥90 days apart of which the second was ≤75 ml/min/1.73 m2, or a CKD diagnosis code. Patients were included if they had an eGFR ≤60 ml/min/1.73 m2. Patients with ongoing RASi treatment at index, a history of diabetes, heart failure or dialysis were excluded.

Results
A total of 66,375 incident CKD patients were identified in the US (n = 32,158) and Japan (n = 34,217). Mean age was 66 and 78 years in the US and Japan, respectively, and about half of the patients were female. Mean eGFR was 48 and 40 ml/min/1.73 m2 in the US and Japan, respectively. Approximately 30% of patients had cardiovascular disease, but only 13% (US) and less than 5% (Japan) were prescribed cardiovascular preventive drugs (e.g. statins and low dose aspirin). During a 1-year follow-up after the incident CKD index date, only 15% and 5% had been initiated on RASi in the US and Japan, respectively (Figure 1). Time to RASi initiation was shorter among those with a CKD diagnosis vs those without a diagnosis (US: 15 vs 19 months, Japan: 6 vs 11 months). Of those who initiated treatment, approximately 50% discontinued within one year (Figure 1). Results for initiation and discontinuation were similar across CKD stages in both countries.

Conclusion
In the US and Japan, initiation of RASi was remarkably low among newly identified CKD patients, and discontinuation of initiated treatment was substantial. Given that most patients with CKD benefit from multi-drug therapy (RASi + SGLT2i) for slowing CKD progression and reduction of adverse events, efforts to increase prescribing and adherence are needed.
#4511 TOLVAPTAN DOSE ADJUSTMENT IN ADPKD BASED ON URINARY OSMOLALITY: SIMILAR EFFICACY AND LOW DROPOUT RATE
Authors: Oporto Francisco Roca , Gómez Cristina Andrades , Cosano Gema Montilla , Aguilera Alicia Luna , Castilla José Luis Rocha 
Published: June 2023

Abstract

Background and Aims
Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited renal disease. Tolvaptan is the only treatment that has been shown to slow disease progression. The current recommendation is to reach the maximum tolerated dose while controlling side effects such as hepatotoxicity. There are data suggesting a marked decrease in tolerability at high doses of the drug. We explored the possibility of an individualized tolvaptan dose adjustment, based on urinary osmolality (Uosm), as an indirect indicator of treatment efficacy.

Method
Single-center prospective cohort study of tolvaptan in patients with ADPKD and rapid progression, with dose adjustment according to Uosm, with dose increase if Uosm &gt; 200 mOsm/kg. Glomerular filtration rate (GFR) estimated by CKD-EPI, Uosm, adverse effects and dropouts were analyzed.

Results
40 patients: 35 patients with more than 2 years treatment, mean follow-up 30± 6 months. Mean age 45± 7 years, 82% hypertensive and 47% male.
Evolution: mean annual fall in GFR during the previous 3 years without treatment -7.24 ± 1.5 ml/min/year. Baseline GFR 51.05±12.5 mL/min and baseline Uosm 391±87 mOsm/kg. Average annual drop in GFR over 3 years with treatment -3.18±1.3 mL/min/year. Average Uosm achieved during treatment 171 ± 47 mOsm/kg. Maximum tolvaptan dose reached 60 mg (90%) and 90 mg (10%).
The adverse events recorded highlight that there were no cases of hepatotoxicity (0%). The most frequent alterations were hyperuricemia (18%) and hypernatremia (11%), but in all cases asymptomatic. Polyuria was recorded in all our patients (100%), with a median diuresis 6000 ml/day (7000-5500), but the dropout rate due to aquaretic effects was minimal, only 2 patients (5%).

Conclusion
In our series of patients, treatment with tolvaptan at a dose adjusted to Uosm, seems to show similar efficacy to the reference studies in the annual fall of GFR, with a low rate of adverse events and very low dropout rate.
#4535 CLINICAL CHARACTERISTICS AND OUTCOMES IN PATIENTS ABOVE THE AGE OF 65 WITH ANCA-ASSOCIATED VASCULITIS: A SINGLE CENTRE EXPERIENCE.
Authors: Spanos Georgios , Atalla Alexandros , Bakou Marianna , Paschou Styliani , Fragidis Stylianos , Bantis Christos , Armetzoiou Livia Karmen , Bamichas Gerasimos 
Published: June 2023

Abstract

Background and Aims
ANCA-associated vasculitis (AAV) is common in patients above the age of 65 but there are limited data about the clinical characteristics and patient outcomes. This study intents to investigate the demographic features, treatment and outcomes in patients ≥ 65 years of age with AAV in Greece.

Method
In this retrospective observational study, we analyzed medical records of patients with ANCA positive AAV in a nephrology unit over the past 20 years. Patients with secondary causes of AAV were excluded. In total 37 patients were included in the study. Data are presented as median and interquartile range (IQR).

Results
Thirteen patients (35.1%) were above the age of 65 and 24 patients (64,9%) below the age of 65. The median age of diagnosis was 71.3 (67.5/75.1) vs 54.9 (40.4/57.3) and estimated glomerular filtration rate CKD-EPI was 30 (21.5/48) vs 17 (12.3/29.8) respectively. The Birmingham vasculitis activity score and organ involvement did not differ between the two groups. The median follow-up duration was 44.2 (15/108) months. Immunosuppressive therapy was similar in both groups, including glucocorticoids, cyclophosphamide or rituximab as induction and azathioprine or rituximab as maintenance therapy. The overall survival was significantly lower in the older group (69.2%) compared to the younger (95.8%) and renal survival was 69.2% and 91.2% respectively. Older age and elevated serum creatinine were related to increased mortality. Elevated creatinine at diagnosis was the only significant predictive factor of renal survival.

Conclusion
AAV is a disease with significant morbidity and mortality in patients above the age of 65. This study showed that the typical immunosuppressive therapy might not improve outcomes in the older patients.