bluuebunny/crossref_metadata_2025_split huggingface dataset:
#3525 TRANSITION BETWEEN NUTRITION CATEGORIES IN HEMODIALYSIS PATIENTS
Authors: Blumberg-Benyamini Sara , Burbea Zvi Hai Barnea , Cernes Relu , Katkov Anna , Biro Alexander , Levi Anat , Katzir Zeev , Feldman Leonid 
Published: June 2023

Abstract

Background and Aims
We have previously characterized four nutritional categories in hemodialysis (HD) patients, evaluated by the method of ICNDS (Integrative Clinical Nutrition Dialysis Score) and slope of three subsequent monthly scores. Category 1 appeared to have the best and category 4 the worst nutritional status [1]. The aim of this study was to explore the association between nutritional category at dialysis initiation, survival, Length of Stay in hospital (LOS), and transition between nutrition categories up to 12 months following dialysis initiation.

Methods
Two hundred twenty-six patients who started dialysis between March 2009 and March 2019 were enrolled in the study. Scoring method of the ICNDS is based on the following 7 parameters: albumin, percentage post dialysis weight change, creatinine, urea, cholesterol, CRP, and Kt/V. We calculated the slope of first three subsequent monthly scores of each patient at HD commencement and 12 months later. Cox proportional hazard model was used to present differences in mortality hazard ratio (HR) during the first year in dialysis between four categories of patients. We used the analysis of variance and post hoc Bonferroni test to analyze differences in hospitalization frequency and LOS between the four categories during first year in dialysis. We used the Pearson chi-square test to analyze transition between categories between dialysis initiation and one year after.

Results
Baseline nutritional category is associated to all-cause mortality HR (χ2 = 16.402, df = 3, P = 0.051). Patients enrolled to category 2,3 and 4 at dialysis initiation were significantly associated with increased mortality HR compared to patients in category 1 (category 4: HR = 3.951, 95% CI 1.218-12.812, P = 0.022; category 3: HR = 2.705, 95% CI 1.126-6.497, P = 0.026; category 2: HR = 1.778, 95% CI 0.631-5.064, P = 0.027). LOS during first year in dialysis is significantly affected by patient nutritional category at dialysis initiation, (F = 4.671, df = 3, P = 0.003). LOS is lower in patients of category 1 and 2 compared with category 3 and 4 (between categories 1 and 4, P = 0.006; between categories 1 and 3, P = 0.03). Hospitalization frequency is not affected by patient nutritional category (F = 1.705, df = 3, P = 0.167). Pearson chi-square showed no differences in transition between the four categories between dialysis initiation and one year after (χ2 = 6.763, df = 3, P = 0.149).

Conclusion
Nutrition status at dialysis commencement is a main prognostic factor, transition between nutrition categories during first year in dialysis exists and may prove in future to be associated with patients’ survival.
#3538 SURVIVAL OUTCOMES FOLLOWING CARDIOPULMONARY RESUSCITATION IN ADULTS RECEIVING KIDNEY REPLACEMENT THERAPY: A SYSTEMATIC REVIEW AND NARRATIVE SYNTHESIS
Authors: Tuharska Zofia , Brown Alastair , Hole Barnaby , Caskey Fergus , Pippias Maria 
Published: June 2023

Abstract

Background and Aims
Individuals receiving kidney replacement therapy (KRT) are at higher risk of cardiac arrest than the general population. The aim of this systematic review was to evaluate survival outcomes in individuals on different forms of KRT (haemodialysis, peritoneal dialysis or kidney transplantation) following cardiopulmonary resuscitation (CPR) within healthcare settings (hospital or outpatient clinics).

Method
A comprehensive literature search of EMBASE, MEDLINE, CINAHL, Web of Science and Central was carried using a pre-defined search strategy with no date or language restrictions. Retrospective and prospective observational studies reporting outcomes following CPR in adults on kidney replacement therapy were included. The study protocol was prospectively registered on PROSPERO: CRD42022336363.

Results
Thirteen eligible studies were identified. Due to the heterogeneity of study populations, lack of a standardised outcome set and inconsistent use of control groups, a narrative review was conducted, and a meta-analysis was not performed. Crude unadjusted survival rate to discharge from hospital was reported in 11 studies and ranged from 0%—75%. Only two studies reported neurological outcome at discharge, with rates of a favourable cerebral performance category score (CPC 1 or 2) on discharge between 17–20%.

Conclusion
The current evidence is insufficient to guide clinical decision-making regarding resuscitation due to a lack of up-to-date data, uncertainty about outcomes and inconsistent reporting of neurological status after CPR. Additionally, there is a lack of data comparing survival outcomes for people on different types of KRT. There remain unanswered questions regarding the likelihood of favourable outcomes for the KRT population and whether these can be accurately predicted using clinical and demographic features.
#3546 “SURPRISE QUESTION”: IS IT A USEFUL TOOL IN CKD STAGES 4 TO 5?
Authors: Pepe Bruno , Prazeres Teresa , Carnevale Andreia , Calça Rita , Matias Patricia , Branco Patricia , Azeredo-Lopes Sofia , Pereira Sofia Azeredo , Martins Ana Rita 
Published: June 2023

Abstract

Background and Aims
The “Surprise Question” (SQ) (“would you be surprised if this patient died in 6 months/one year?”) has proven to be an interesting prognostication tool in a range of settings. However, its reliability in non-dialysis-dependent CKD is still unclear. Our aim was to study the applicability of the SQ to an outpatient CKD-EPI stages 4 to 5 and correlate it with mortality.

Method
Observational, prospective and single center study. Baseline comorbid conditions, cause of CKD, degree of autonomy, literacy, social support and baseline laboratory values (i.e., serum creatinine/ estimated glomerular filtration rate, serum albumin and hemoglobin) were collected.

Results
A total of 269 patients completed the study, mean age 65 years old; 256 patients (85.3%) had hypertension and 124 (41.3%) had diabetes. The main causes of renal disease were diabetic kidney disease (n = 53; 17.7%), hypertension (n = 15; 5%) and IgA nephropathy (n = 11; 3.7%). The etiology of kidney disease was undetermined for 24 patients (8.0%). Average CKD-EPI was15.5±7.4 mL/min/1.73 m2. A total of 188 patients (63%) were independent for daily living activities and 68 (23%) were professionally active and 45 (48%) were accompanied by family members or caregivers in outpatient consultation to discuss and define the care of plan regarding end stage renal disease. Mean follow up time of the study was 365±254 days, and 27 (9%) patients died during this time period. Using the SQ, providers responded Yes and No for 162 (54%) and 92 (31%) patients, respectively. There were no differences in CKD-EPI stage, arterial hypertension, cerebrovascular disease and dyslipidemia. The No group was older (73±16 vs. 63±16, p&lt;0.001) and had more diabetes (n = 46, 55%, p = 0.015). About 8 (30%) and 18 (67%) of Yes and No patients died, respectively (P&lt;0.001). In the Cox-proportional hazard model adjusted to diabetes, the risk of all-cause mortality was significantly increased by around 5.700 times in patients with a No answer by the providers to the SQ (95%CI, 2.340-13.900; p&lt;0.001) and around 1.045 times with increasing age (95%IC, 1.012-1.080; p = 0.007). The model of the SQ to have predictive capacity for occurrence of death had an area under the ROC curve of 0.684 (95%CI, 0.580-0.790; p = 0.002).

Conclusion
SQ proved to be a support tool in order to identify patients at high risk of death, who might not have a full benefit of starting dialysis. The choice around kidney replacement therapy is a shared decision-making process, in which competing risks and benefits must be considered. It is essential and urgent to identify means of support for patients, caregivers and health providers to provide and discuss personalized prognostic information.
#3553 TUBULE CELL-DERIVED ANGIOPOIETIN-2 EXACERBATES INFLAMMATION AND IS DETRIMENTAL TO RENAL FIBROSIS
Authors: Luo AN Jie , Chang Fan-Chi , Lin Shuei-Liong 
Published: June 2023

Abstract

Background and Aims
Our previous studies have shown that angiogenic growth factors are dysregulated in fibrotic kidneys. In murine models of progressive renal disease, angiopoietin-2 (Angpt2) was upregulated in injured tubule epithelial cells. We hypothesize that overexpression of Angpt2 in tubule epithelial cells would exacerbate renal fibrosis and inflammation.

Method
The unilateral ureteral obstruction (UUO) and unilateral ischemia-reperfusion injury (UIRI) are used as the murine model of chronic kidney disease. We use the tetracycline/doxycycline-controlled Tet-on system to induce tubule cell-specific overexpression of Angpt2 before the induction of renal fibrosis. Transgenic mice carrying both Pax8-rtTA and pTetos-hAngpt2 genes (double transgenic mice) are used for Angpt2 overexpression. Littermates that inherit single or no transgene serve as experimental controls. Doxycycline is administered to adult (8 weeks) mice to overexpress Angpt2 in tubule epithelial cells.

Results
Doxycycline administration induce overexpression of human Anpgt2 in the tubule epithelial cells of both sham and fibrotic kidneys. Compared to littermate controls after the UUO and UIRI surgery, the expression of fibrosis-related genes, Col1a1, Col3a1, and Acta2 are higher in the kidneys of double transgenic mice. Deposition of picrosirius red-stained collagen fibrils is significantly higher in double transgenic mice. Inflammatory cell infiltration is also significantly higher in double transgenic mice.

Conclusion
Overall, these findings suggest that increased Angpt2 in tubule epithelial cells deteriorate renal fibrosis through detrimental inflammation. Further studies are necessary to explore the participating cellular components and pathogenic mechanisms.
#3556 ASSOCIATION OF SERUM 25-HYDROXYVITAMIN D WITH ALL-CAUSE MORTALITY AND KIDNEY OUTCOME IN PATIENTS WITH EARLY STAGES OF CKD
Authors: Yuxin Lin , Zhang Yuping , Nie Sheng , Xin Xu 
Published: June 2023

Abstract

Background and Aims
Although serum 25-hydroxyvitamin D (25(OH)D) deficiency is prevalent in all stages of chronic kidney disease (CKD), the effects of 25(OH)D deficiency on all-cause mortality and kidney outcomes in patients with early-stage CKD remain incompletely understood.

Method
This nationwide retrospective cohort study included 9840 adults with stages 1–3 CKD from 19 medical centers across China. The study outcomes included all-cause mortality, cardiovascular mortality, and kidney disease progression. The associations between serum 25(OH)D concentrations and the risks of mortality and CKD progression were evaluated using a Cox proportional hazard model. A mixed-effects model was used to estimate the slopes of estimated glomerular filtration rate (eGFR).

Results
Of 9840 adults with stages 1–3 CKD, 26.9% had severe (&lt;10 ng/ml) and 38.7% had moderate (10–20 ng/ml) serum 25(OH)D deficiency. Compared with patients having 25(OH)D &gt;20 ng/ml, patients with serum 25(OH)D &lt;10 ng/ml were at significantly higher risks of all-cause mortality (hazard ratio [HR] 1.87, 95% confidence interval [CI] 1.53–2.28), cardiovascular mortality (HR 1.80, 95% CI 1.33–2.44), and CKD progression (HR 2.28, 95% CI 1.74–2.99), and had a steeper decline in eGFR slope (estimate -0.07; 95% CI -0.10 to -0.05 mL/min/1.73 m2 per year). Similar results were obtained in subgroups and by sensitivity analyses.

Conclusion
25(OH)D deficiency is associated with increased risks of all-cause mortality and CKD progression in patients with early-stage CKD. Studies are needed to determine whether early intervention for 25(OH)D deficiency could improve the prognosis of patients with early-stage CKD.
#3568 THE ERROR OF ESTIMATED GFR IN PREDIALYSIS CARE: IMPACT ON CLINICAL DECISION MAKING
Authors: Cabrera Beatriz Escamilla , Lima Sergio Luis , Valcarce Eduardo Gallego , Rinne Federico González , Dorta Nuria Victoria Sánchez , Negrã­n Mena Natalia , Perera Coriolano Cruz , Martin Laura Díaz , Ramírez Armando Torres , Porrini Esteban 
Published: June 2023

Abstract

Background and Aims
The error of estimated glomerular filtration rate (eGFR) and its consequences in predialysis are unknown.

Method
We analysed 315 predialysis patients who underwent measured GFR (mGFR) by the clearance of iohexol and eGFR by 52 formulas. We evaluated the agreement between eGFR and mGFR by the concordance correlation coefficient (CCC), total deviation index (TDI) and coverage probability (CP). In a sub-analysis we investigated the impact of the error of eGFR in decisions like (i) starting dialysis, (ii) preparation for renal replacement therapy (RRT) and (iii) continuing with clinical follow-up. For this sub-analysis patients who started dialysis due to uremia or fluid overload were excluded (n = 18).

Results
Patients: 315 patients were included, 70% male and mean age was 66±13 years. 38% had diabetic nephropathy. Mean mGFRwas 22 ± 8 ml/min. Mean eGFR was 22 ± 8 ml/min (CKD-EPI), 22 ± 8 ml/min (MDRD) or 26 ±10 ml/min (24-h creatinine clearance). Cystatin C measurement was available in 266 patients (84%) and averaged 2.8 ± 1.08 mg/L. Over 70% of the patients had proteinuria 1588±2204 mg/24 h. Agreement between eGFR and mGFR eGFR had very low precision and accuracy in reflecting mGFR as reflected by average CCC, TDI and cp of 0.60, 70% and 22%, respectively. The error was comparable between creatinine- and cystatin-based formulas. Extreme variations -larger than 10 ml/min- between mGFR and eGFR were frequent. Differences in clinical decision making: Concerning clinical decisions, the error of formulas (mainly GFR overestimation) would have suggested (a) early unnecessary preparation for RTT in 14% of clinically stable patients evaluated by mGFR; (b) to continue with clinical follow-up in 59% of the subjects in whom RTT was indicated by low mGF and (c) to delay the starting of dialysis in all patients (n = 6) in whom RRT was indicated based on very low mGFR without uremic symptoms or fluid overload.

Conclusion
The error of formulas in predialysis care was frequent and large and may have consequences in clinical care.
#3600 ACUTE KIDNEY INJURY IN THE ELDERLY: DIFFERENCES OVER TIME
Authors: Pešić Snezana , Čučković Čedomir , Stopić Bojan , Dimkovic Nada , Naumovic Radomir 
Published: June 2023

Abstract

Background and Aims
The incidence of acute kidney injury (AKI) in people older than 60 years constantly increasing and it is higher than in the rest of the population. Increased risk of AKI in the elderly is due to decreased functional reserves of the kidneys, aggressive surgical and diagnostic interventions, and frequent use of nephrotoxic drugs. The aim of this study was to analyze the incidence and causes of AKI in a patient older than 60 years during three different periods: the first period between 1974-1994 year, the second between 1997-2001 year, and the third period between 2014-2018 year. At the same time, we examined the most common causes of AKI over time.

Method
The retrospective study included 927 patients with AKI treated in our clinic, 572 patients during the first period, 75 patients during the second period, and 280 patients in the third period. The diagnosis was made based on an absolute increase in serum creatinine by&gt;26.5 umol/l, or an increase of 50% relative to basal values, or a decrease in urine output &lt;0.5 ml/kg/h within 6 h. We analyzed causes and type of AKI, method of treatment, and mortality.

Results
Incidence of AKI in patients older than 60 years in the period 1974-1994 is 19%, only three years later this percentage has risen to 64%, while in the last period this percentage was 82%. Conservative method of treatment was more often used in the last examined period 83.6% compared to 33% and 56.2% in previous periods. In the last examined period, HD was used in 16.4% of patients (in two previous periods 4% and 8.3% respectively).
While PD was used by 50.5% in the period 1997-2001 and 31.3% in the period 1974-1994, in the last period PD was not used. Mortality has declined slightly over time but remains high (27.1%, then 29.6%, and recently 22%). Regarding the type of AKI during all three examined periods, statistically the most common is the prerenal type over 50%, and the renal type during the last five-year period increased by 26.4% compared to the previous 17.5% and 20.8% respectively.

Conclusion
The incidence of AKI in people over the age of 60 is on the rise. Mortality, although still high, is noticeably declining compared to the previous periods, which may be a consequence of better treatment of both conservative and active dialysis treatment.
#3617 APPLICATION OF CKD EPI 2021 EQUATION FOR ESTIMATION OF GLOMERULAR FILTRATION RATE (EGFR) TO AN ELDERLY KOREAN COHORT TO PREDICT MORTALITY
Authors: You Julee , Chin Ho Jun 
Published: June 2023

Abstract

Background and Aims
A new eGFR equation using serum creatinine (CKD-EPI 2021) without race were developed by Chronic Kidney Disease Epidemiology Collaboration in 2021. We projected the changes of eGFR and CKD prevalence in a prospective cohort of elderly Koreans, using current (MDRD equation and CKD-EPI 2009) and new equation (CKD-EPI 2021)

Method
This study was a part of the Korean Longitudinal Study on Health and Aging, which included a randomly selected, community-based, elderly population aged 65 years or more in a city of Korea, Seong-nam. The base line study was conducted from Sep. 2005 to Sep. 2006; the follow-up study, from May 2010 to March 2012, and the final survey about mortality and renal function, at Jan. 2023. Among 1,000 subjects originally included in the study, 984 subjects with baseline serum creatinine were included in this analysis. We compared the difference of eGFR and predictability of mortality and renal survival between values calculated by MDRD, CKD-EPI 2009, and CKD-EPI 2021. Serum creatinine was expressed as the IDMS-traceable creatinine.

Results
At baseline study, there were 436 males (44.3%). Age was 76.0 ± 9.1 years. Levels of eGFR at baseline study were 74.2 ± 21.4 ml/min/1.73 m2 by MDRD, 72.2 ± 16.9 ml/min/1.73 m2 by CKD-EPI2009, and 76.6 ± 17.3 ml/min/1.73 m2 by CKD-EPI2021. Values subtracted eGFRs by MDRD or CKD-EPI2009 from eGFR by CKD-EPEI2021 were 2.5 ± 10.1 ml/min/1.73 m2 and 4.5 ± 1.0 ml/min/1.73 m2, respectively. Between eGFRs by CKD-EPI2009 and CKD-EPI2021, the difference of eGFR was higher in females compared to males (p&lt;0.001), was not different between subjects aged less than 75 years and more than 75 years (p = 0.139), and lowest in subject with &lt;45 ml/min/1.73 m2 of eGFR by CKD-EPI2009 compared to subjects with other eGFR values (p&lt;0.001). CKD stage was improved in 241 (24.5%) participants and was not changed in 743 (75.5%) using eGFR calculated by CKD-EPI2021 instead of CKD-EPI2009. Similar trend of eGFR difference between eGFRs calculated by MDRD and CKD-EPI2021. During 8.3 ± 6.2 years, 255 (25.9%) subjects were dead and 7 (0.7%) subjects had end stage renal disease (ESRD) before death. Any eGFR was an independent risk factors to mortality estimated by Cox's hazard proportional model adjusted by related factors. AUC to estimate survival by eGFRs was not different between eGFRs by CKD-EPI2021 and CKD-EPI2009 [0.662 (0.625-0.699) vs 0.658(0.620-0.695), p = 0.758], however, different between eGFRs by CKD-EPI2021 and MDRD [0.662 (0.625-0.699) vs 0584 (0.543-0.626), p&lt;0.001]. AUC to estimate renal survival by eGFRs was not different between eGFRs by CKD-EPI2021 and CKD-EPI2009, also.

Conclusion
The eGFR calculated by CKD-EPI2021 showed higher value compared to eGFR calculated by CKD-EPI2009 or MDRD. The power to estimate mortality or renal survival was not different between eGFRs by CKD-EPI2021 and CKD-EPI2009.
#3636 INHIBITION OF THE STING PATHWAY AMELIORATES EXPERIMENTAL CRESCENTIC GLOMERULONEPHRITIS
Authors: David Gina Marcela Córdoba , García-Giménez Jorge , Ortíz Pablo Javier Cannata , Ortiz Alberto , Cortassa Adrián Mario Ramos 
Published: June 2023

Abstract

Background and Aims
Rapidly progressive glomerulonephritis/crescentic glomerulonephritis (RPGN/cGN) may compromise renal function in the short or medium term thus evolving into acute kidney injury (AKI) or chronic kidney disease. Innate and adaptive immune responses are placed at the epicentre of cGN. However, molecular pathways involved in the activation of these responses are by far less known. Sting is an innate immune DNA-sensing involved in promoting kidney injury and fibrosis with unknown participation in RPGN/cGN.

Method
We investigated whether Sting pathway activation contributes to the development and progression of RPGN/cGN in a preclinical model of nephrotoxic nephritis (NTN) induced by an anti-glomerular basal membrane serum. Sting expression as well as humoral and cellular innate immune responses, histological injury and functional responses in the kidney were studied in wild-type and Sting-/- mice.

Results
Sting was found expressed at higher gene and protein levels and located in tubulointerstitial and intraglomerular and periglomerular areas and tubules in kidneys from NTN wild-type mice compared to non-diseased control animals. Sting deficiency significantly decreased NTN-induced cytokine/chemokine synthesis and hence the intrarenal transit of both mononuclear phagocytes and overall or specific T-cell subsets. Sting-deficient mice also displayed less extensive histological affection, namely a fewer number of glomerular crescents and associated lesions (sclerosis, endocapillary hypercellularity/sinaquiae), and tubular injury. The presence of TUNEL-positive dead cells was also significantly reduced in Sting-/- mice. Consistent with these findings, Sting absence significantly diminished NTN-increased urea and creatinine plasma levels.

Conclusion
Sting inhibition positively impacted several well-characterized cGN-associated pathogenic events thus ameliorating the outcomes of the disease. These results identified Sting antagonism as a potential therapy to help combat cGN.