bluuebunny/crossref_metadata_2025_split huggingface dataset:
#5633 USE OF HEPARIN GRAFTED DIALYZER (EVODIAL) FOR HEMODIALYSIS IN PATIENTS WITH HIGH RISK OF BLEEDING: A SINGLE CENTER EXPERIENCE
Authors: Pushevski Vladimir , Markovska Zhaklina Shterjova- , Usprcov Julijana , Gjorgjievski Nikola , Trajcheska Lada , Milenkova Mimoza , Bushljetik Irena Rambabova- 
Published: June 2023

Abstract

Background and Aims
During hemodialysis exposure of the blood to the dialysis membrane and the tubing system can activate blood cells and promote clotting activation. So usually, some form of anticoagulation, most frequently heparin, is used to prevent blood coagulation. However, there are patients with increased risk for bleeding (patients with active bleeding, major surgery in past 72 hours, severe trombocytopenia) where use of heparin free regime is mandatory. Evodial dialyzer (Gambro-Hospal, France) [1] contains a heparin-grafted membrane aiming to provide a system with a low thrombogenicity that can be used without or with low dose heparin in order to reduce the patients' bleeding risk. As high-quality evidence of the optimal choice of anticoagulation in these patients is limited we wanted to show our experience with the use of Evodial dialyzer.

Method
During 12 months 106 dialysis sessions in 59 patients were performed. Reasons for using Evodial : active bleeding, hematological conditions, complications of vascular access. Changes in the dialyzer or the blood lines, or any aditional interventions were examined.

Results
Low dose unfractionated heparin (1250 IE total) was used in 10 (9,4%) sessions, and it was added in 15 (14%) more sessions because of problems with the coagulation. In 4 (2,8%) sessions we had to terminate dialysis because of clotting.

Conclusion
Heparin grafted dialyzers can be safely used in patients with high risk for bleeding. Although results are worse than the ones reported in literature [2] where regional citrate anticoagulation (RCA) is used, it can be reasonable alternative when RCA is unavailable.
#5718 ASSOCIATION OF MULTIPLE PLASMA BIOMARKER LEVELS WITH KIDNEY DISEASE ACTIVITY IN FABRY DISEASE
Authors: Özcan Şeyda Gül , Atli Zeynep , Eren Necmi , Dincer Mevlut Tamer , Turkmen Kultigin , Ozer Hakan , Trabulus Sinan , Seyahi Nurhan 
Published: June 2023

Abstract

Background and Aims
Fabry disease is a rare, systemic, genetic, and metabolic lysosomal storage disease. Phenotypic heterogeneity prevents accurate predictions for the disease progression. We aimed to evaluate the association of multiple plasma biomarkers with disease severity in Fabry disease.

Method
In a cross-sectional study, we examined 76 Fabry, 46 CKD patients and 41 healthy controls. We studied KIM-1, MCP-1, YKL-40, TNFR-1, TNFR-2, cystatin-C with enzyme linked immunoassay. Fabry patients on renal replacement therapy were excluded from the analysis.

Results
Demographic, clinical and laboratory data of the study participants are shown in Table 1. eGFR was calculated with creatinine and creatinine-cystatin C using CKD-EPI formula. While there was no difference between Fabry patients and healthy controls regarding eGFR(cr); eGFR(cr-cys) was significantly lower in Fabry patients. Biomarker levels in three groups were shown in Table 2. After performing age, sex and BMI adjusted analysis, MCP-1 was significantly lower in Fabry patients compared to CKD group (p:0.01). MCP-1 was significantly higher in Fabry patients with cardiac involvement than in those without cardiac involvement (p:0.039). KIM-1 was significantly higher in Fabry patients comparing to healthy controls (p:0.01). There was no significant difference regarding biomarker levels between Fabry patients with and without kidney involvement. YKL-40 was significantly lower in Fabry patients without kidney involvement compared to both control groups (p:0.025), probably reflecting the effect of ERT.

Conclusion
MCP-1, KIM-1, YKL-40 and Cystatin C seems to be useful markers for the management of Fabry patients. Each biomarker is associated with different aspect of the disease. MCP-1 might be a useful regarding Fabry disease activity especially in patients with cardiac involvement. KIM-1 might be an early sign in Fabry disease. Cystatin-C should be used for better management of patients since it shows renal involvement better than creatinine.
#5730 PERLECAN AS A POTENTIAL BIOMARKER OF CARDIOVASCULAR RISK: ROLE OF ENDOTHELIAL GLYCOCALYX IN CHRONIC KIDNEY DISEASE
Authors: Arévalo Gemma Valera , Rubio Andrea Figuer , Espada Paula Jara Caro , Yuste Claudia , Morales Enrique , Costoso Noemi Ceprian , Bodega Guillermo , Ramirez Rafael , Alique Matilde , Carracedo Julia 
Published: June 2023

Abstract

Background and Aims
Chronic kidney disease (CKD) is associated with cardiovascular disease (CVD). CVD is in turn related to endothelial dysfunction, endothelial dysfunction, and degradation of the endothelial glycocalyx (EG), releasing its components into the bloodstream. The EG consists of glycosaminoglycans and proteoglycans, such as Perlecan. The aim of the study is to analyse the levels of perlecan in plasma in different stages of CKD, and to relate them to age and inflammatory monocytes, as well as their adhesion capacity (CD54/ICAM-1).

Method
An observational cross-sectional study was carried out. 56 patients were included: advanced chronic kidney disease (ACKD) (n=13), haemodialysis (HD) (n=13), peritoneal dialysis (PD) (n=15) and transplant recipients (TX) (n=15). Thirteen healthy subjects (CT) were analysed. Plasma perlecan levels were quantified using ELISA and phenotyping of monocyte subpopulations (classical (CD14++CD16-), intermediate (CD14+CD16+) and non-classical (CD14+CD16++)), as well as CD54 (ICAM-1) expression by flow cytometry. Statistical analysis: ANOVA and Spearman correlation.

Results
Patients with CKD had higher plasma levels of perlecan than healthy participants (p-value = 0.044 vs ACKD, 0.028 vs HD and 0.002 vs PD) (Fig. 1). These levels were associated with higher percentage of classical monocytes (p=0,011) intermediate monocytes (p=0,009) and non-classical monocytes (p=0,003) expressing ICAM-1 but not with a higher expression of ICAM-1 per monocyte. Perlecan levels correlate negatively with age (p=0,03) (Table 1).

Conclusion
Patients with ACKD, HD and PD have elevated plasma perlecan levels compared to CT and TX. Elevated perlecan concentrations are associated with increased ICAM-1 expression on monocytes, which is important for its possible role in the development of atherosclerosis. Perlecan may be postulated as a molecule of interest to assess endothelial and cardiovascular damage in CKD patients.
#5868 PREVALENCE AND MANAGEMENT OF CHRONIC COMPLICATIONS IN PATIENTS WITH DIABETES AND ADVANCED CHRONIC KIDNEY DISEASE: A RETROSPECTIVE AUDIT
Authors: D'souza Cimona , Kakkar Acrisa , Suresh Vijayan , Bellary Srikanth 
Published: June 2023

Abstract

Background and Aims
Current guidelines recommend that all patients with Chronic Kidney Disease (CKD) stage 3b or higher should be monitored and treated for anaemia, mineral bone disorder (BMD) and metabolic acidosis. We audited the prevalence and management of these complications in a cohort of patients with diabetes and advanced CKD.

Method
A retrospective audit was undertaken using KDIGO guidelines as standard and necessary approvals were secured from the governance team at University Hospitals Birmingham. We included patients with (a) diabetes (b) eGFR 30 and 15 ml/min/1.73 m2) and (c) attending diabetes clinics as of 30/09/2022. Using electronic patient records, we collected: demographics, co-morbidities, complications, treatments, body weight, BMI, blood pressure and serial biochemistry (creatinine, Hba1c, cholesterol, UAlb/Creat ratio, bicarbonate, haemoglobin, vitamin D, parathyroid hormone (PTH). Following definitions were applied: anaemia as Hb &lt;13 g/dl for men and &lt;12 g/dl for women, BMD as vitamin D &lt;40 nmol/l plus raised PTH, acidosis as bicarbonate &lt;22 meq/l. Data was analysed using SPSS 26. Descriptive statistics (frequencies and cross tabulations) were used to estimate prevalence. Independent means test was used for continuous variables. Comparison between groups was undertaken using the Chi Square test and one way ANOVA test.

Results
Data for 192 subjects (110 European (EUR), 40 South Asian (SA), 42 African-Caribbean (AFC) /other) was analysed. Mean age (SD) was 73 (+/-11) years. There were no significant differences in general characteristics between the ethnic groups except for albuminuria which was greater in SA and AFC compared to EUR (193 v 133 v 95.5mg/mmol; p=.038). 47% of the cohort had at least one diabetes related complication. 63/192 (32.8%) had cardiovascular disease, 49/192 (25.5%) had retinopathy and 19/192 (9.9%) had neuropathy. Insulin was the most common prescribed glucose lowering agent 105/192 (55%) with proportionately more SA treated with insulin (65%). Anaemia was present in 171/183 (93.4%) of the patients. 82/101 (81.2%) had BMD, and 135/168 (82.8%) of patients had metabolic acidosis. 65/192 (33.9%) of patients had all 3 complications. Only 38/133 (22%) of those with anaemia were receiving treatment out of which only 36.8% were treated adequately with a Hb of &gt;10g/l. Corresponding figures for BMD and metabolic acidosis were: BMD: 39/82 (47.6%) treated and 42% optimally corrected, metabolic acidosis: 54/135 (40%) treated and 53% optimally corrected. There were no significant differences between ethnic groups in prevalence or treatment of these complications.

Conclusion
The prevalence of CKD related complications is high. The management of these complications however, is suboptimal. Increased emphasis on the management of these complications is required to improve outcomes in patients with advanced CKD.
#5983 PULMONARY INVOLVEMENT IN AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE
Authors: De Rosa Liliana , Vespa Marta , Catania Martina , Bucci Romina , Joli Giancarlo , Carrera Paola , Mancassola Giulia , Bianca Pierpaolo , Paolisi Michele , Manunta Paolo , Vezzoli Giuseppe , Alibrandi Maria Teresa Sciarrone 
Published: June 2023

Abstract

Background and Aims
Autosomal dominant policystic kidney disease (ADPKD) is the most common genetic kidney disease. It is caused by mutations in PKD1 and PKD2 genes, which encode for polycystin-1 (PC-1) and polycystin-2 (PC-2), two proteins localized in the primary cilia which regulate calcium permeability and cellular signaling pathways. The major phenotype of the disease is the formation of multiple cysts in the kidneys but in many cases it also involves other organs like heart, brain and lungs. The latters are not yet well studied; some papers report a higher prevalence of bronchiectasis in ADPKD patients compared to the general population; morover, one work describes the absence of PC-1 in motile cilia of ADPKD pts compared to controls, who actually do express the protein. Based on available literature, we hypothesized that the PC-1 and PC-2 could have a role also in motile cilia. Exaled nasal nitric oxide (nNO) is an indirect marker of cilia dysfunction, standardized for the screening of primary ciliary dyskinesia, a motile ciliopathy, in which very low levels of nNO are found because of the entrapment of NO in the abundant stagnant mucus.

Method
We recruited 27 patients with ADPKD and 25 randomly selected controls. We compared nNO measurements between the two groups, stratifying for truncated mutations and eGFR. After stratification according to ADPKD genetic mutation, we analyzed separately each of the two subgroups with the control group.

Results
nNO levels were no different in ADPKD patients compared with healthy controls (mean ± standard deviation: 850±240 vs 923±290; P = .3). However in sub-group analysis, lower nNO measurements were found in patients with truncated mutation (769±164) compared to the control group (924±290, P = .05). No association was observed between renal functions expressed as eGFR and nNO levels.

Discussion
Overall nNO levels did not differ in ADPKD individuals compared to controls, although lower nNO measurements were observed in ADPKD patients exhibiting a truncated mutation.

Conclusion
Even at the edge of the statistical significance (P = .05), given it's confirmed in a wider population, this finding could signify that pts who carry a more aggressive genotype (PKD-1 truncated mutation) may not express polycystins in motile cilia; this aspect is in line with the verified knowledge that this kind of mutation ends up in the total absence of the protein. On the other hand, pts with a missense mutation may still express the protein in motile cilia, therefore without any functional impairment.
#5992 PERITONEAL DIALYSIS-RELATED PERITONITIS: A SINGLE CENTER EXPERIENCE
Authors: Bulatovic Ana , Bjedov Jelena , Damjanovic Tatjana , Jankovic Aleksandar , Sakic Verica Todorov , Djuric Petar , Dimkovic Nada , Naumovic Radomir 
Published: June 2023

Abstract

Background and Aims
Peritonitis is a common and severe complication in Continuous ambulatory peritoneal dialysis (CAPD). A high peritonitis rate affects PD patients’ technique survival and mortality. The aim of this retrospective study is to assess epidemiological aspects, microbiology presentation with antibiotic resistance and clinical outcomes for patients with acute CAPD peritonitis during 5-year period.

Method
The study included all patients treated by CAPD between the 1st of January 2017 and 1st of January 2022 in the Clinical Hospital Center Zvezdara. We included prevalent patients on CAPD, and analyzed demographic, clinical and microbiological data, and patient's outcomes during 5 year period. The data was collected from patient records, medical history and processed in SPSS.

Results
This study included 119 patients treated by PD of which 24 (8.13%) had one or more acute episodes of CAPD peritonitis in the designated period. The mean age of the population was 69±9 year, 54% were male, 20% had diabetes mellitus and 60% arterial hypertension as cause of end stage renal disease. During follow up it was diagnosed 41 episodes of CAPD peritonitis. The main characteristics of patients with peritonitis were turbid liquid (100 %), abdominal pain (73 %) and fever (43 %). Gram staining revealed that 53 % were gram-positive, and 10 % were gram-negative. The most frequent bacterial specimen was Staphylococcus epidermidis (11) followed by Streptococcus viridans (6), sterile culture (9), Staphylococcus aureus (3) and other organisms less than 2 episodes. The peritonitis rate was 1 episode per 27.36 patient-months, or 0.44 episodes per patient year. Resistance to Ampicillin and Penicillin occurred most often. In 2 patients, PD peritonitis was present once each, with multi-resistant bacteria: Klebsiella pneumoniae which was treated with parenteral administration of Tigacycline and Methicillin-resistant Staphylococcus aureus (MRSA) which was treated with parenteral administration of Moxifloxacin and Clindamycin. Out of 24 patients, 2 (8.33%) had 4 episodes of peritonitis, 3 (12.5%) had 3 episodes of peritonitis, 6 (25%) had 2 episodes of peritonitis, and the rest (54.16%) were had only one each. Only one patient had an episode of relapsing peritonitis. During 5-year period, 1 (4%) patient died of acute CAPD peritonitis caused by Proteus mirabilis, 7 (29%) died of other causes, 11 (46%) were transferred to hemodialysis and 5 (21%) are still receiving treatment by CAPD modality. CAPD peritonitis was the reason for technical failure in 20% patients.

Conclusion
PD-associated peritonitis is serious infective complication which could influence the outcome of PD patients, including technique survival. The rate and outcomes of peritonitis in our patients were slightly above of current recommendations.
#6031 ASSOCIATION BETWEEN THE MINI-BESTEST AND POSTUROGRAPHY IN PATIENTS ON HEMODIALYSIS
Authors: Lucinda Leda , de Jesus Luciana , Bainha Ana Clara , de Oliveira Gabriela , Haddad Maria Fernanda , Vidigal Ana Beatriz , Maciel Júlia , Watanabe Lucca , Oliveira Cristino , Reboredo Maycon Moura 
Published: June 2023

Abstract

Background and Aims
Patients on hemodialysis present complications due chronic kidney disease and hemodialysis treatment that compromise postural balance. Posturography is the gold standard device for measuring postural balance; however, its cost limits the use of this method for routine patient evaluation. Alternatively, the Mini Balance Evaluation Systems Test (Mini-BESTest) have been used to evaluate postural balance, as it is inexpensive and has high test-retest reliability. Therefore, the aim of this study was to evaluate the association between the Mini-BESTest and posturography in patients on hemodialysis.

Method
A cross-sectional study was conducted with patients aged ≥18 years who were undergoing hemodialysis treatment for at least three months. Patients were excluded if presented physical or cognitive incapable to perform the proposed tests, assisted gait, uncorrected visual impairments, severe and unstable comorbidities, and hospitalization in the past three months. Postural balance was evaluated by the Mini-BESTest and posturography [a force plate recorded the center of pressure (COP) path length in a static position with eyes opened (EO) and eyes closed (EC) on a firm surface]. The normality of the data was analyzed using the Shapiro‒Wilk test. The associations between Mini-BESTest score and COP path length in the EO and EC were tested using Spearman´s correlation coefficients. Then, two multiple linear regression models were constructed with COP path length in the EO and EC as the dependent variable and Mini-BESTest score and potential confounders (age, gender, diabetes mellitus, body index mass, hemodialysis efficiency index, and hemoglobin) as independent variables. A p value &lt;0.05 was considered as statistically significant.

Results
This study included 109 patients (58.4 ± 12.9 years, 57.8% male). The Mini-BESTest was correlated with COP path length in the EO (ρ = -0.365, p &lt; 0.001) and EC (ρ = -0.279, p = 0.003). The multiple linear regression models showed an association of the Mini-BESTest with COP path length in the EO (R2 = 0.28; adjusted R2 = 0.23; p &lt; 0.001) and EC (R2 = 0.26; adjusted R2 = 0.20; p &lt; 0.001).

Conclusion
The Mini-BESTest was associated with posturography in patients on hemodialysis. Therefore, the Mini-BESTest is a feasible test to evaluate postural balance in clinical routine practice during the physical function evaluation of these patients.
#6156 TUBULAR CHANGES IN PATIENTS WITH AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE
Authors: Salomone Luca , Lai Silvia , Zippo Francesca , Tinti Francesca , Perrotta Adolfo Marco , Rotondi Silverio , Tartaglione Lida , Pasquali Marzia , Rocca Rachele , Mazzei Mario , Mazzaferro Sandro 
Published: June 2023

Abstract

Background and Aims
Autosomal dominant polycystic kidney disease (ADPKD) is characterized by the presence of multiple cysts, leading to progressive reduction in renal function and systemic involvement. The possible presence of tubular alterations has been suggested, but the mechanisms involved have not yet been fully identified. The study aims to highlight possible tubular alterations in ADPKD patients compared to patients with chronic kidney disease (CKD).

Method
A total of 145 patients were enrolled, including 37 with ADPKD and CKD, while 108 had CKD with the same clinical characteristics, and a comparative analysis of urinary and serum parameters were performed. A venous blood gas analysis was performed on each patient to assess serum pH, lactate concentration, and base excess, and a spot urine test was performed to evaluate urinary pH using a pH meter and specific gravity (SG).

Results
The comparative analysis of serum parameters showed a significant reduction in serum pH (spH) in ADPKD patients (p &lt;0.001), with a significant increase in lactates (1.3 vs 0.9 mmol/L, p &lt;0.001) and a significant reduction in base excess (BE) (p &lt;0.001). The evaluation of urinary parameters in ADPKD patients showed a urinary pH (upH) that was on average more acidic compared to patients with CKD (p &lt; 0.001) with a reduction in the capacity to concentrate urine (p &lt; 0.001). No statistically significant differences were found in terms of glomerular filtration rate between the two groups.

Conclusion
The collected data showed some alterations in the serum and urinary metabolic profile of ADPKD patients compared to the CKD group. The alterations in upH are consistent with those of recent studies in the literature, where it is hypothesized that a urinary concentration defect, already present in early stages, may cause a reduction in upH due to a reduced medullary trapping of ammonium and a reduced presence of bicarbonates. The hypothesis of a preferentially anaerobic metabolism in ADPKD patients is also in line with the increased levels of serum lactates.
#6369 RESULTS OF KIDNEY TRANSPLANTATION IN PATIENTS WITH LOW MFI PREFORMED DONOR SPECIFIC ANTIBODIES
Authors: Salerno Maria Paola , Silvestri Patrizia , Zanoni Natalia Romina , Citterio Franco 
Published: June 2023

Abstract

Background and Aims
Preformed DSA at transplantation, significantly increase risk of antibody-mediated rejection (ABMR). While pre-existing positive DSA with concomitant positive cross-match is a general contra-indication to kidney transplantation, DSA presence with negative crossmatch is still a controversial topic. The presence of DSA with Mean Fluorescence Index (MFI) up to 3.000 and a negative cross-match is not valued as a contraindication to transplantation and is widely accepted. In some transplant centers the chance of transplantation is also offered to DSA positive patients, with MFI up to 5.000. Aim of this study was to analyze graft and patient survival, acute cellular rejection, humoral rejection, renal function and side effects in kidney transplant recipients (KTR) with positive DSA (MFI up to 3.000) and negative cross-match.

Method
Nineteen pts (age 53+/-11) with chronic renal failure on chronic hemodialysis treatment (8+/-6 years) received a kidney transplant between May 2017 and December 2020. Median PRA was 66%; 100% pts had DSA with average MFI 2122 (min 1039, max 3779). As immunosuppressive therapies all pts received induction with Thymoglobuline plus Rituximab, followed by maintenance immunosuppression with Tacrolimus, MofetilMycoFenolate and Steroids. All patients were on periodic follow up in our Transplant Clinic. Mean follow up was 26.5+/-14.4 months. Results were compared to a concomitant KTR group DSA and crossmatch negative.

Results
After 2y follow-up, 17/19 pts are alive (89.5%), one patient died (1/19, 5.2%) after treatment for ABMR. Three patients returned to dialysis treatment (15.8%) during the first year post-tx, because of: PNF 1pt; irreversible ABMR rejection 2 pts. One other patient had reversible ABMR. Cumulative one year graft survival was 79% and the cumulative incidence of ABMR was 15.8%. Average 2 years follow-up creatinine was 1.46+/-0.88 mg/dl, median 2 year GFR was 51+/-25 ml/min. Comparing the matched control group (19 pts DSA and cross-match negative) 2 years patient survival, graft survival, GFR, acute rejection were not significantly different. Incidence of acute rejection was higher in the DSA positive group (16% vs 0%), as well as graft loss (21% vs 12%).

Conclusion
Our data suggest that low dose Thymoglobuline plus Rituximab induction allow kidney transplantation in recipient with high PRA (69%) and positive DSA with low MFI (&lt; 3.000), with higher risk of acute rejection, and graft loss.