bluuebunny/crossref_metadata_2025_split huggingface dataset:
#4772 DOUBLE FILTRATION PLASMAPHERESIS DURING HETEROLOGOUS FERTILIZATION PREGNANCY FOR THE TREATMENT OF HETEROZYGOUS FAMILIAL HYPERCHOLESTEROLEMIA
Authors: Spasiano Andrea , Palazzetti Daniela , Ambrogio Martina , Rosati Erica , Moffa Simona , Naticchia Alessandro , Giaccari Andrea , Ferraro Pietro Manuel , Grandaliano Giuseppe , Panocchia Nicola 
Published: June 2023

Abstract

Background and Aims
Pregnancy in women affected by familial hypercholesterolemia is rare. Estrogen and progesterone fluctuations, featuring pregnancy, adversely influence lipid metabolism, causing considerable increase of LDL-C, triglyceride and lipoprotein A levels. These changes in fatty metabolism, essential for embryonic development, might be critical for placental circulation and for mother's health. Indeed, high lipoprotein amount can raise uteroplacental vascular resistance and it is associated with intrauterine growth restriction because of oxidative stress, whereas hypertriglyceridemia and hypercholesterolemia might cause an increased risk of cardiovascular accidents and pancreatitis. Lipid-lowering drugs, such as statins, ezetimibe or PCSK9 inhibitors are discontinued due to possible teratogen effects. Thus, LDL apheresis is the only available therapy for severe hypercholesterolemia during pregnancy.

Method
A 46 years old woman affected by heterozygous familial hypercholesterolemia in treatment with PCSK9 inhibitors and statins, decided to undergo an heterologous in vitro fertilization with oocyte donation. Hence, pharmacological therapy was stopped to avoid teratogen effects. We started a 10-months apheresis program with double filtration plasmapheresis (DFPP). The treatment was performed by a temporary double lumen central venous catheter. Initially, she underwent apheresis twice a month with an average exchange volume of 1.2, low blood flow (≤ 90 ml/min) and incremental plasma flow (from 5 to 30 ml/min every 10 minutes of treatment), to ensure a physiological procedure. We gradually modulated the exchange volume monitoring blood levels of LDL-C, Lp(a) and triglycerides before and after each procedure. We aimed to keep mean LDL-C level &lt; 200 mg/dl. We did not use anti-coagulation during the procedure, monitoring TMP values and arterial-venous pressure.

Results
LDL-C levels remained about 227.2 ± SD 91 mg/dl, with a median of 186.8 mg/dl, complying with the target range (Figure 1). Mean triglycerides and Lp(a) values were, respectively, 180.3±94 mg/dl (median 146 mg/dl) and 77.3±36.3 mg/dl (median 55.7 mg/dl) (Figure 1). Our patient did not face any complications related to pregnancy or to the procedure, and gave birth at 38th gestational week to an healthy full-term male baby of 52 centimeters and 3.34 kilograms.

Conclusion
Although there is a widespread hesitation in performing extracorporeal blood purification treatment in pregnancy, this case underlines the essential role of LDL apheresis in in this setting, giving spark to standardize the procedure and to encourage its use also in pregnancy.
#4774 THE USE OF REGDANVIMAB FOR THE PREVENTION OF SEVERE COVID-19 IN PATIENTS ON HEMODIALYSIS
Authors: Shutov Evgeny , Bolshakov Stepan , Kotlyarova Galina , Dolidze David , Sorokoletov Sergey 
Published: June 2023

Abstract

Background and Aims
A new coronavirus infection has become a serious threat leading to increased mortality worldwide. COVID-19 is an acute airborne disease caused by severe acute respiratory syndrome virus (SARS-Cov-2). Evolution of the virus, emergence of new mutant strains, changes in virulence dictate the need to search for new tools both in treatment and prevention of severe disease. The aim of our study was evaluation of the efficacy of Regdanvimab (Regkirona, Samsung BioLogics) to prevent severe COVID-19 in patients receiving ambulatory hemodialysis in the period of increasing morbidity.

Method
The study included 20 patients on program hemodialysis, mean age 54.9±17.6 years, vaccinated or who underwent COVID-19 more than six months ago. All subjects of the study received Regkirona at a standard dose of 40 mg/kg of body weight intravenously once at the end of the hemodialysis procedure after the physician assessed the feasibility of prophylaxis. All subjects were assessed for humoral immunity before Regkirona administration and after Regkirona administration according to the level of total SARS-CoV-2 IgG and IgG antibodies to the subunit of the S1 receptor-binding domain of the SARS-CoV-2 protein.

Results
Total SARS-CoV-2 IgG level and IgG level of antibodies to SARS-CoV-2 receptor-binding subunit S1 was 83.9±69.5 U/ml and 260.7±199.5 BAU/ml respectively before drug administration. During the 6-month follow-up period from July to November 2022, which paralleled the next round of increased morbidity, four patients with SARS-CoV-2 PCR test positive reported mild to moderate symptoms of SARS (marked weakness, fever, loss of smell, catarrhal symptoms, cough, shortness of breath, and chest pain unassociated with other causes). None of the subjects required hospitalization. We evaluated IgG antibody titers to the receptor-binding domain of the SARS-CoV-2 protein subunit S1 after 1, 3 and 6 months and demonstrated a nonlinear decline titers from 5104±2257.1 BAU/ml, 1988.7±1440.4 BAU/ml to 407,0±350,2 BAU/ml respectively, which may indirectly reflect short half-life of Regkirona.

Conclusion
The results of our study showed the efficacy of Regdanvimab to prevent the severe disease of COVID-19 in high-risk patients during the period of rising morbidity.
#4777 BLOOD PRESSURE RESPONSE TO A LOW SODIUM DIET IN NORMOTENSIVE SUBJECTS
Authors: Margulis Fernando , Sabbatiello Roberto , Golglid Veronica , Cuevas Carlos , Castro Claudia , Aguirrezabala Veronica , Martinez Miriam , Schiavelli Ruben 
Published: June 2023

Abstract

Background and Aims
The term salt sensitivity (SS) has been used to show an increase in BP in response to saline overload in both normotensive and hypertensive patients. Age, sex, and obesity have been proposed as predisposing factors. The objective of our work was to evaluate the response of office BP (OBP) and ambulatory BP (ABP) to changes in salt intake in healthy normotensive subjects.

Method
We analyzed 193 subjects who participated in the evaluation as potential kidney donors; none had a history of hypertension, diabetes, renal or cardiovascular disease. They received two consecutive standardized diets, one with 300 mEq and the other with 30 mEq of Na+/day. On the last day of each diet, a 24-h urine collection was obtained and an ambulatory BP monitor was placed for 24 h in the non-dominant arm, following recording of OBP. Data were expressed as mean and standard deviation (SD). Student's test and one-way ANOVA were used to compare means, values of p&lt;0.05 were considered statistically significant differences.

Results
In the study group there were 120 females (62%) and 71 were salt sensitive (SS) (37%). The mean age was 46.9 ± 10 years (20 – 72) without significant gender differences (F = 46.7 ± 10 vs M = 47.3 ± 9 p = 0.704). The age of the salt sensitive (Ss) group was significantly higher than the salt resistant (Sr) (49.8 ± 9 vs 45.3 ± 10 p = 0.002). BMI was found to be increased (27.7 ± 4) without significant gender or incidence of SS differences. We found no association between gender and SS (p = 0.509). After the high sodium and before low sodium diets, the mean difference in urinary Na+ excretion was 165.2 ± 83 mEq/24h, significantly higher among men than women (201.6 ± 84 vs 142.3 ± 75 p = 0.0001). There were no differences based on SS. We did not find significant gender differences in the variation of OBP or ABP, with the changes in the diet. The mean reduction of systolic pressure OBP for the group was 6.13 ± 10 and of diastolic pressure OBP 0.35 ± 5 mmHg. In separate analysis, systolic and diastolic OBP drops were significantly higher in the Ss than in the Sr (9.69 ± 12 vs 2.57 ± 8 and 2.24 ± 7 vs – 0.95 ± 5 mmHg respectively, p = 0.001). The average reduction in systolic ABP was 7.13 ± 8 and in diastolic ABP 3.33 ± 5 mmHg. In separate group analysis we also observed a significantly greater reduction in Ss than in Sr (12.83 ± 7 vs 1.8 ± 5 and 6.56 ± 5 vs. 0.12 ± 3 mmHg respectively, p = 0.001).

Conclusion
In our study group, the reduction of both OBP and ABP following a low sodium diet in normotensive subjects depends on salt sensitivity and is independent of gender and body weight.
#4779 CARDIAC BIOMARKERS FOR THE PREDICTION OF INCIDENT MAJOR ADVERSE CARDIAC EVENTS IN PATIENTS STARTING HAEMODIALYSIS: A REAL-WORLD ANALYSIS
Authors: Mcdowell Garry , Moore Louise , Buckley Benjamin , Austin Philip , Lip Gregory , Rao Anirudh 
Published: June 2023

Abstract

Background and Aims
Despite its advantages, haemodialysis (HD) is associated with increased cardiovascular mortality and morbidity, with some studies reporting 48% higher mortality within 2 years of starting HD. Currently, there are no established prognostic models to stratify cardiovascular risk in incident HD. Cardiac biomarkers provide insight into cardiac structure and function, including myocyte injury, stress, inflammation and fibrosis. We aimed to investigate the prognostic significance of routine cardiac biomarkers (troponin and natriuretic peptides) in the prediction of incident Major Adverse Cardiovascular Events (MACE) within 5 years of commencing HD.

Method
A retrospective cohort study was performed using electronic medical records from a global federated research network from the US (TriNetX). The TriNetX network was searched on 31st January 2023. The cohorts commenced HD post-diagnosis of End-Stage Kidney Disease. Data censoring for MACE was invoked prior to the index event of HD. Cardiac biomarkers were the first reported result within 3 months of starting HD. Cohorts were grouped according to biomarker-specific thresholds and 1:1 propensity-score matched for age, gender, and co-morbidities (hypertension, diabetes mellitus and smoking status). Logistical regression produced odds ratios with 95%CI for 5-year incident MACE. MACE was defined, a priori, as a composite of ischaemic heart disease, angina pectoris, acute myocardial infarction, heart failure, AF, stroke, and all-cause mortality. All statistical analysis was performed on the TriNetX online platform.

Results
The results are shown in Table 1. Results that reached statistical significance (p&lt;0.05) are shown.

Conclusion
Routinely available cardiac biomarkers can predict incident MACE and outcomes in incident HD, although results differ between markers of myocyte injury (troponin) and stress (NTproBNP). The results suggest the clinical need for CV mortality and morbidity risk profiling in incident dialysis using a combination of clinical and laboratory variables.
#4789 ROUTINE CARDIAC BIOMARKERS FOR THE PREDICTION OF INCIDENT MAJOR ADVERSE CARDIAC EVENTS IN PATIENTS WITH GLOMERULONEPHRITIS: A REAL-WORLD ANALYSIS
Authors: Davies Elin , Mcdowell Garry , Buckley Benjamin , Austin Philip , Lip Gregory , Rao Anirudh 
Published: June 2023

Abstract

Background and Aims
Patients with glomerulonephritis (GN) frequently have both proteinuria and decreased kidney function, and together with immunosuppressive therapies used to treat it could lend these patients to a high risk for cardiovascular disease (CVD). We aimed to investigate the prognostic significance of routine cardiac biomarkers (troponin) in predicting incident Major Adverse Cardiovascular Events (MACE) within 5 years of diagnosis of GN.

Method
A retrospective cohort study was performed using electronic medical records from a global federated research network from the US (TriNetX). The TriNetX network was searched on 31st January 2023. Data censoring for MACE was invoked prior to the index event of GN. Cardiac biomarkers were the first reported result within 3 months of diagnosis of GN. Cohorts were grouped according to biomarker-specific thresholds and 1:1 propensity-score matched for age, gender, and co-morbidities (hypertension, diabetes mellitus and smoking status). Logistical regression produced odds ratios with 95%CI for 5-year incident MACE. MACE was defined, a priori, as a composite of ischaemic heart disease, angina pectoris, acute myocardial infarction, heart failure, AF, stroke, and all-cause mortality. The analysis was carried conducted by all-cause GN and individual primary GNs: IgA nephropathy (IgAN), membranous nephropathy (MN), focal segmental glomerulosclerosis (FSGS), and minimal change disease (MCD). All statistical analysis was performed on the TriNetX online platform.

Results
The results are shown below for all-cause GN. Results that reached statistical significance (p&lt;0.05) are shown. The risk of MACE and its components was consistent across the individual GN sub-types IgAN (N = 1802), MN (N = 1674), FSGS (N = 1844) and MCD (N = 2014).

Conclusion
Routinely available cardiac biomarkers can predict incident MACE and outcomes in patients with glomerulonephritis. The results suggest the clinical need for CV mortality and morbidity risk profiling in patients with glomerular disease using a combination of clinical and laboratory variables.
#4795 PEAK SYSTOLIC VELOCITY IN THE KIDNEY INTERLOBAR ARTERIES AS A POSSIBLE SCREENING MARKER OF CKD IN PREGNANT WOMEN
Authors: Maryanova Tatyana , Chechneva Marina , Prokopenko Elena , Chumarnaya Tatyana , Zulkarnaev Aleksei 
Published: June 2023

Abstract

Background and Aims
Currently, pregnancy is increasingly occurring in patients with CKD including patients with chronic renal failure (CRF) - CKD grade 3-5. Physiological renal hyperperfusion and glomerular hyperfiltration in pregnant women leads to a temporary decrease in serum creatinine values even in patients with CRF. Consequently, the CKD diagnosis during pregnancy may be difficult in women without a history of kidney disease, and the degree of kidney damage may be underestimated [1]. The aim of our study was to estimate Doppler sonography of the renal arteries as a possible CKD screening method in pregnant women.

Method
The study included 283 pregnant women (Table 1). Doppler sonography was performed in the main renal, segmental, interlobar and interlobular arteries in left and right kidney at the first, second and third trimesters of pregnancy. Peak systolic velocity (PSV), end-diastolic velocity, pulse index, resistive index and systolic-diastolic ratio were analyzed.

Results
PSV in the renal arteries was significantly lower in pregnant women with CKD 3-5 compared with healthy control group since 22 weeks of pregnancy. However, PSV in the interlobar arteries had a higher diagnostic value. The values of this parameter were significantly lower in pregnant women with all stages CKD compared with healthy control group. We found cut-off points of left and right interlobar arteries PSV for the diagnosis of CKD and CRF at the first, second and third trimesters of pregnancy and cut-off points of right and left interlobar arteries PSV linear combination at the second and third trimesters (Table 2).

Conclusion
In pregnant women, interlobar renal arteries PSV can be used as screening marker of CKD. Additionally, it allows to identify pregnant women with advanced stages of CKD. The linear combination of right and left interlobar arteries PSV has the greatest diagnostic value.
#4803 ANCA RENAL RISK SCORE 2023: THE UPDATED AND REVISED ARRS
Authors: Bate Sebastian , Mcgovern Dominic , Costigliolo Francesca , Mysliveček Marek , Scott Jennifer , Chapman Gavin , Brown Nina , Floyd Lauren , Brilland Benoit , Aydin Mehmet Fethullah , Ilyas Duha , Dhaygude Ajay , Mejia Juan-Manuel , Lees Jennifer , Kollar Marek , Hinojosa Andrea , Yildiz Abdulmecit , François Augusto Jean , Roberts Stephen , Wiech Thorsten , Pusey Charles Dickson , Jones Rachel , Jayne David , Bajema Ingeborg , Jennette Charles , Rosenberg Avi , Stevens Kate , Dhaun Neeraj , Mcadoo Stephen , Tesar Vladimir , Little Mark , Geetha Duvuru , Brix Silke 
Published: June 2023

Abstract

Background and Aims
Reliable prediction tools are needed to improve prognostication and personalisation of treatment in anti-neutrophil cytoplasmic antibody (ANCA) glomerulonephritides (GN). We aimed to validate and update the ANCA Renal Risk Score (ARRS) prediction model.

Method
The ARRS working group collated a retrospective multicentre international longitudinal cohort from referral centres and registries across the globe to revise the ARRS in a validation and recalibration study. The primary endpoint was end stage kidney disease (ESKD) and patients were censored at last follow-up. Cox proportional hazards models were used to reweight risk factors and develop a modified scoring system. Kaplan-Meier estimates, Harrell's C statistics and calibration plots were used to assess model performance.

Results
Of a total of 1591 patients, 1439 were included in the final analyses (959 in the development cohort, 52% male, median age 64 years). The ARRS demonstrated a discrimination of C = 0.800, comparable to the original cohort. Updating the model found an additional useful cut-off for kidney function (K), and serum creatinine replaced glomerular filtration rate which provided higher reliability (K0: &lt;250 μmol/l = 0 points, K1: 250-450 μmol/l = 4 points, K2: &gt;450 μmol/l = 11 points). The risk points for the percentage of normal glomeruli (N) and interstitial fibrosis and tubular atrophy (T) were also reweighted (N0: &gt;25% = 0 points, N1: 10-25% = 4, N2: &lt; 10% = 7, T0: none, mild or &lt; 25% = 0 points, T1: ≥ mild-moderate or ≥ 25% = 3 points). We created four risk groups based on the sum of points: low (0 – 4 points), moderate (5 – 11), high (12 – 18) and an additional very high-risk (21). The model discrimination was C = 0.831 and a supplemental continuous model was developed to supply a patient-specific annual risk. Three-year kidney survival was 96%, 79%, 54%, and 19%, respectively. The ARRS23 performed similarly well in the validation cohort with excellent calibration.

Conclusion
We demonstrated the out-of-sample validity of the ARRS and present here the modified and improved score to optimise prognostication and risk stratification for clinical practice and trials.
#4809 EFFECT OF RITUXIMAB DOSE ON INDUCTION THERAPY IN ABO-INCOMPATIBLE KIDNEY TRANSPLANTATION: A NETWORK META-ANALYSIS USING RECENT DATA
Authors: Song Joon Ho , Hwang Seun Deuk , Kim Jaeho 
Published: June 2023

Abstract

Background and Aims
Rituximab is an essential inducible immunosuppressive agent for ABO-incompatible kidney transplantation (ABOi KT). However, studies on the dosage by country and transplant center are lacking. Therefore, we retrospectively investigated the effects of rituximab induction doses on patient mortality, transplant failure and adverse events.

Method
We included studies mentioning at least two of the eligible induction doses (200 mg, 200–500 mg, or 500 mg) of rituximab during ABOi KT and associated outcomes such as patient survival, graft failure, and bacterial and viral infections. We performed direct and indirect network meta-analyses using a Bayesian model and ranked different rituximab doses using generational mixed treatment comparisons. Publications from 1970 to February 2020 were searched and analyzed using the CENTRAL, MEDLINE, EMBASE, and Science Citation Index Expanded databases. GRADE of network meta-analysis approaches specified four levels of certainty for a given outcome: high, moderate, low, and very low.

Results
Among 5378 patients in 25 trials, glomerular filtration rate, graft loss, antibody-mediated rejection, T-cell-mediated rejection, fungal infection, bacterial infection, and CMV infection did not differ between ABOi groups treated with different doses of rituximab. The effect on mortality was significantly higher in the rituximab 200-500 mg and rituximab 500 mg groups (odds ratio [OR] 2.4, 95% CrI: 1.5-7.4 and OR 1.8.0, 95% CrI 1.2-11.2). The incidence of BK virus was significantly lower in the rituximab 200 mg group than in the other groups.

Conclusion
In ABO-incompatible kidney transplantation, low-dose rituximab is more effective than high-dose rituximab and reduces the risk of serious infection. Due to the small sample size, further randomized controlled trials may be needed to confirm these findings.
#4811 SIZE MATTERS: EFFECT OF NUMBER OF TRANSFUSIONS ON ADVERSE RENAL AND CLINICAL EVENTS IN PATIENTS WITH AKI
Authors: Acosta-Ochoa Isabel , Ardura Paula , Aguilar Gerardo , Coca Armando , Cobo Kenia , Merizalde Carlos , Mendiluce Alicia , Martínez María 
Published: June 2023

Abstract

Background and Aims
AKI and anemia independently worsen the prognosis of hospitalized patients, but their association and adverse effects have been slightly studied. We aimed to investigate the effect of transfusions during hospitalization on hard renal and clinical outcomes of patients with AKI. In addition, we tested the influence of the number of transfusions on mortality between pure AKI (pAKI) and AKI-on-CKD (AoCKD) patients.

Method
Retrospective cohorts’ study, of in-patients with AKI attended by nephrology during a 12-month period. AKI severity was categorized by KDIGO-2012 criteria; we searched in a Hematology administrative data base for transfusions (and their number) during the hospitalization period. We analyzed epidemiological and clinical variables and compared the rates of the hard outcomes Length of Stay (LoS), Acute Hemodialysis (aHD), Dialysis Dependence at Discharge (DDD), and in-hospital Mortality (IHM) between individuals that didn't and received transfusions.

Results
We included 275 individuals, 134 (49%) were transfused; they were older and suffered more DM; with no differences in the ICU hospitalization and Charlson's Index. See Table 1A. We observed that transfused patients were classified more frequently in AKI Stage-3, had longer LoS, aHD, were more frequently dialysis dependent and their mortality rate was higher. See Table 1B. We compared patients with less or more than 5 transfusions; the latter group showed a higher rate of adverse events than the group of ≤4 transfusions. See table 1C. Figure 1 plots the K-M curve for survival between pAKI and AoCKD groups showing an excess mortality associated with the number of transfusions, especially in the AoCKD individuals.

Conclusion
In our study, we found that patients that received transfusions showed worst clinical and renal results including more severe AKI, longer hospital stay, higher rate of acute HD, dialysis dependence at discharge and mortality. We observed that the appearance of these adverse events was associated in a dose dependent manner with the number of transfusions; for these reasons, we consider that number of transfusions should be included in AKI risk models and calculators. Could optimizing the number of transfusions improve the rate of adverse renal and clinical events? We will need prospective and well-powered studies in order to answer this question and to deepen on the issue of AoCKD and worst clinical outcomes if transfused.