bluuebunny/crossref_metadata_2025_split huggingface dataset:
#3230 CHARACTERISTICS OF PROTEIN LOSS WITH MEDIUM CUT-OFF MEMBRANES COMPARED TO HIGH FLUX MEMBRANES
Authors: Wang Xiaoling , Grobe Nadja , Fisher Colleen , Colvin Kylie , Ho Chih-Hu , Kotanko Peter 
Published: June 2023

Abstract

Background and Aims
Medium cut-off membranes (MCO) have been introduced with the claim that larger pores enhance the removal of middle-sized uremic toxins. To date, no adequately powered randomized controlled trial has demonstrated that this membrane characteristic translates into improved mortality. A well-described consequence of larger pore sizes is a higher dialytic albumin loss [1]. In addition, other proteins could also be lost with MCO, including ones that are beneficial or even essential, e.g., to patients’ nutritional status. To better understand the spectrum of proteins cleared with MCO, we set up an ex vivo HD simulation system and compared protein loss characteristics between MCO and high-flux (HF) dialyzers.

Method
Over the course of an hour, a single reservoir of 2.5 liters EDTA human plasma was ultrafiltered using two Fresenius 2008T machines. One machine served the MCO dialyzer (Theranova 400), the other the HF dialyzer (Fresenius Optiflux F180NR). Ultrafiltrate (UF) was returned to the plasma reservoir (Figure 1A). Blood flow was 400ml/min, dialysate flow was zero, ultrafiltration rate was 13ml/min. UF samples were taken at ∼10 min intervals. Upon experiment completion, residual filtrate was collected from the dialysate compartment. Samples were stored at −80°C until analysis with Bradford protein assay, silver-stained SDS-Page, and Olink Proteomics (Watertown, MA). Selected samples underwent 3K MWCO protein concentration.

Results
Figure 1B shows the UF protein concentration at several time points. Total protein loss (in mg) during the one-hour simulation was 18 (HF) and 239 (MCO) in the UF, and 10 and 359 in the residual filtrate, respectively. SDS-PAGE protein gel revealed that HF filtrate contained less amount of protein than MCO filtrate when equal filtrate volumes were loaded (Figure 1C, lane 3 vs 2, lane 6 vs 5). Smaller proteins were more abundant in HF vs MCO filtrate when equal amounts of protein were loaded (lane 4 vs 2, lane 7 vs 5). UF from both membranes contained less proteins &gt;100 kD than plasma (lane 1).
Finally, UF (collected at 20 and 60 min) and residual filtrate were concentrated to ∼1mg/ml and analyzed using targeted biomarker analysis with Olink® Target 96 Organ Damage panel. Ten of the 92 panel proteins were above the limit of detection (LOD; Table 1). The MCO-to-HF protein concentration ratio in equal filtrate volumes ranged from 1.7 to 13.1.

Conclusion
Our results show a higher amount of protein loss with MCO compared to HF. The HF filtrate protein distribution is skewed towards lower molecular weights compared to MCO filtrate. All 10 proteins identified were more abundant in MCO filtrate compared to HF filtrate. Further identification and quantification of protein loss during hemodialysis will improve our understanding of the clinical impact of different dialysis membranes.
#3252 PRESEPSIN AS A POTENTIAL BIOMARKER FOR RENAL INVOLVEMENT IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: Iaremenko Oleg , Koliadenko Daria , Stepanova Natalia , Iaremenko Kateryna 
Published: June 2023

Abstract

Background and Aims
Presepsin is a soluble CD14 subtype known as a sepsis biomarker. Recently, it has been reported to correlate with kidney function decline in elderly patients with chronic kidney disease and to predict acute kidney injury in patients with sepsis. However, the potential role of presepsin in systemic lupus erythematosus (SLE) with kidney involvement is still unclear. This study aimed to evaluate the relationship between serum presepsin level and SLE disease activity and laboratory parameters and to validate presepsin as a biomarker for lupus nephritis (LN).

Method
This cross-sectional study included 78 SLE patients aged 38.9±12.8 years. Among them, there were 68 (87.2%) women, 36 (46.2%) patients with LN, and 42 (53.8%) patients without LN. LN was diagnosed by renal biopsy and/or according to the renal SLE disease activity index (SLEDAI) criteria. Patients with infections were not included in the study. Serum presepsin level was determined by ELISA. The diagnostic value of presepsin level for the detection of LN was assessed by receiver-operating characteristic curves (ROC), the area under the curve (AUC), and 95% confidence intervals (CI). Spearman and Pearson correlation tests were performed to evaluate the relationships between presepsin level and SLEDAI score, serum complement concentrations, anti-double-stranded DNA antibodies (anti-dsDNA), inflammatory markers, urinary protein, and estimated glomerular filtration rate (eGFR) with CKD-EPI.

Results
The median serum presepsin level was significantly higher in patients with LN than in those without kidney damage [145 (110-197) pg/ml vs 102 (82-146) pg/ml, p = 0.011]. The ROC analysis found that the most appropriate cut-off point for presepsin concentration as a biomarker for LN in LSE patients was 106 pg/ml with a sensitivity of 81.8% (95% CI 64.5-93.0), and specificity of 54.3% (95% CI 36.6-71.2). The AUC was 0.714 (95% CI 0.592-0.837) with a positive predictive value of 62.8% (95% CI 46.7-77.0), and a negative predictive value of 76.0% (95% CI 54.9-90.6) (Fig. 1). The mean value of eGFR was 83.8±27.0 ml/min/1.73 m2 in the LN group and 94.1±18.0 ml/min/1.73 m2 in the non-LN group (p = 0.112). A significant negative correlation was observed between presepsin levels and eGFR in LN patients (Fig. 2). Moreover, presepsin levels in the LN group significantly correlated with SLEDAI score (r = 0.372, p = 0.036), anti-dsDNA titer (r = 0.363, p = 0.04) and severity of proteinuria (r = 0.630, p&lt;0.01). No such associations were found in SLE patients without kidney involvement. Presepsin concentration did not correlate with C3, C4, C-reactive protein, erythrocyte sedimentation rate, and procalcitonin levels in both groups.

Conclusion
Serum presepsin may be considered a potential biomarker for the detection of kidney damage in patients with SLE. Further studies focusing on the clinical and pathological associations of presepsin in LN would be of interest.
#3253 STUDY OF THE EFFECT OF TWO BARIATRIC SURGERY TYPES ON RENAL FUNCTION AND MCP 1 LEVELS
Authors: Sabry Alaa , Bahy Ahmed 
Published: June 2023

Abstract

Background and Aims
Bariatric surgery has been the most effective and permanent treatment for severe obesity and has resulted in significant improvement or reduction of comorbidities due to obesity. To evaluate and compare the outcome of two types of bariatric surgery (LMGB and LSG) on renal functions and urinary MPC-1 level in morbidly obese patients after three months of surgery.

Method
Forty morbidly obese patients underwent bariatric surgery between October 2018 and July 2019. Two types of bariatric surgery were done; laparoscopic mini gastric bypass (LMGB) and laparoscopic sleeve gastrectomy (LSG). Group A include 26 patients underwent LSG and group B include 14 patients.

Results
There were no statistically significant difference in the postoperative mean weight, BMI, neck circumference, WC, Hip circumference, WHR, SBP and DBP in the cases between the 2 types of surgeries (LSG and LMGB) also, there were no statistically significant difference in the mean post urinary MCP1 (73.53±21.25&75.43±26.17,P&gt;0.5), post microalbuminuria (8.83± 6.26 &10.02± 8.6,P&gt;0.05),post urinary creatinine (109.21± 43.22&99.19±48.65,P&gt;0.05), post MCP1/Cr ratio (0.78±0.36&1.01±0.70,P&gt;0.05), post CRP(5.73± 3.04&5.77±3.17, P&gt;0.05), post serum creatinine (0.74±0.05&0.75± 0.07,P&gt;0.05), eGFR (100.32±9.54&104.39±9.54,P&gt;0.05), s.cholesterol, s.HDL and s.TGs in the cases who had either LSG operation (group A) or LMGB operation (group B).

Conclusion
There were no statistically significant difference as regard renal function, urinary MCP-1 level and weight loss between LSG and LMGB.
#3355 GERIATRIC NUTRITIONAL RISK INDEX AND EARLY MORTALITY IN INCIDENT HEMODIALYSIS PATIENTS
Authors: Cho Ajin , Park Ji Hyeon , Kim Do Hyoung , Kim Hyun Kyung 
Published: June 2023

Abstract

Background and Aims
The nutrition status at initiation of hemodialysis (HD) might be associated with early mortality in patients undergoing HD. The Geriatric Nutritional Risk Index (GNRI) is a simple and useful nutritional screening method, and this study aimed to investigate the association between the initial GNRI and mortality in incident patients in the first year after initiation of HD.

Method
A nationwide retrospective cohort study was conducted based on the Korean Renal Data System database. Patients who underwent HD from January 2016 to December 2019 and were eligible for GNRI screening were included. They were followed up until the end of 2020 or study departure. Patients were compared by GNRI quartiles. The primary outcome was all-cause mortality, and a Cox proportional hazard model was used to analyze the association between GNRI and mortality. Accuracy comparison of the models including GNRI or body mass index (BMI) were analyzed by Receiver-operating characteristic curves, and the differences were tested by the DeLong test.

Results
A total of 10,545 patients were included, and the mean age was 63.9 ± 3.7 years. Patients with GNRI &lt; 91.4 at the initiation of HD were older, were more often female, and a lower proportion of them had arteriovenous fistula for vascular access. A high GNRI value at the initiation of HD was associated with low all-cause mortality (hazard ratio (HR) 0.93; 95% confidence interval (95%CI) 0.92–0.94; p &lt;0.001). The group with GNRI &lt; 91.4 (Quartile 1) showed the lowest survival in the first year after HD initiation (p &lt; 0.001). Quartile 1 and Quartile 2 (91.4 – 96.8) showed a significantly increased all-cause mortality (HR 3.64; 95%CI 2.60 – 5.10; p &lt; 0.001 for Quartile 1 and HR 1.55; 95% CI 1.09 – 2.22; p = 0.015 for Quartile 2) in comparison with Quartile 4 (101.4 – 129.6). Risk of cardiovascular mortality was high in the Quartile 1 (vs. Quartile 4; HR 3.16; 95%CI 1.94 – 5.13; p &lt; 0.001). In addition, Area Under the ROC Curve (AUC) values for all-cause mortality were 79.1 (95%CI 77.1–81.2) and 75.9 (95%CI 73.8–78.1) for GNRI and BMI, respectively, and the differences of AUCs were significant (p &lt; 0.001).

Conclusion
This study demonstrates that low GNRI levels are associated with all-cause and cardiovascular mortality in HD patients during the early ESRD period. These findings suggest that GNRI is a significant predictor of mortality in these patients.
#3356 COVID-19 PANDEMIC EFFECT ON HOSPITALIZATION OF HEMODIALYSIS PATIENTS
Authors: Croft Kaitlyn , Zhang Yan , Neri Luca , Carioni Paola , Arkossy Otto , Stauss-Grabo Manuela , Usvyat Len A , Stuard Stefano , Winter Anke 
Published: June 2023

Abstract

Background and Aims
During the COVID-19 pandemic many facets of our lives were affected, including the healthcare systems worldwide. We aimed to assess the hospitalization rates of hemodialysis (HD) patients with confirmed COVID-19 infection (COVID-19+) versus other patients (i.e., patients with no documented COVID-19 infection in the European Clinical Database (EuCliD®)) in 2020 and their relation to HD patients from the pre-pandemic era in 2019.

Method
We included 63,216 HD patients treated in 2019-2020 in NephroCare centers from 23 countries from EuCliD® in the Europe, Middle East, and Africa (EMEA) region. Monthly hospitalization rates (hospital admission per 10,000 patients) were estimated separately for COVID-19+ and other HD patients in 2020, and HD patients treated in 2019, with COVID-19+ status as a time-varying variable. The number of COVID-19 cases and deaths were extracted from data released by the European Commission Joint Research Centre (ECJRC)[1]. The correlation between the monthly hospitalization rates and numbers of COVID-19 cases and deaths in general population (GP) were evaluated.

Results
Characteristics of the approximately 42,000-43,000 monthly treated HD patients were comparable between 2019 and 2020 (Table 1). The hospitalization rates were much higher for COVID-19+ HD patients throughout 2020 compared to other HD patients in 2020 and HD patients in 2019. The hospitalization rates were highest in the spring of 2020 for COVID-19+ HD patients. However, in 2020 other HD patients’ hospitalization rates were lower than the 2019 HD patients’ hospitalization rates. Interestingly the hospitalization rates of other HD patients in 2020 dipped even more below hospitalizations for HD patients in 2019 following the GP pandemic waves (Figure 1). Hospital admission for both COVID-19+ and other HD patients were inversely correlation with the pandemic conditions in GP (Figure 2; spearman correlation coefficients [ρ] with COVID-19 cases/deaths in GP, -0.77/-0.22 and -0.29/-0.64, respectively, for COVID-19+ and other HD patients).

Conclusion
Our study indicated the COVID-19 pandemic had an impact on hospitalization rates of both HD patients with a COVID-19 diagnosis and those patients without a documented COVID-19 infection. Potential reasons of decreased hospitalization rates in patients without a documented COVID-19 diagnosis could be healthcare resource constraints or regarding patient concerns about exposure to COVID-19 in hospital settings [2].
#3386 PROTON-PUMP INHIBITORS AND SERUM CONCENTRATIONS OF UREMIC TOXINS IN PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Chamieh Carolla El , Larabi Islam Amine , Laville Solene , Jacquelinet Christian , Combe Christian , Fouque Denis , Laville Maurice , Frimat Luc , Pecoits-Filho Roberto , Lange Céline , Stengel Benedicte , de Pinho Natalia Alencar , Alvarez Jean-Claude , Massy Ziad , Liabeuf Sophie 
Published: June 2023

Abstract

Background and Aims
Use of proton-pump inhibitors (PPIs) is common in patients with chronic kidney disease (CKD). PPIs and many uremic toxins (UTs) are eliminated by a kidney tubular organic anion transporter system. In a cross-sectional study, we sought to evaluate the association between PPI prescription and serum concentrations of various UTs.

Method
We studied a randomly selected subgroup of participants in the CKD-REIN prospective cohort (adult patients with a confirmed diagnosis of CKD and estimated glomerular filtration rate (eGFR) &lt;60ml/min/1.73m²) with available frozen samples collected at baseline. PPI prescription was recorded at baseline. Serum concentrations of 10 UTs were measured using a validated liquid chromatography tandem mass spectrometry technique. Multiple linear regression was performed, with the log UT concentration as the dependent variable.

Results
Of the 680 included patients [median age: 68 years; median eGFR: 32 ml/min/1.73 m2], 31% had PPI prescriptions at baseline. Patients using PPIs had higher levels of certain UTs in comparison to other patients, including total and free indoxyl sulfate (IS), total and free p-cresylsulfate, total and free p-cresylglucuronide (PCG), phenylacetylglutamine (PAG), free kynurenine, and free hippuric acid. After adjustment for baseline comorbidities, number of co-prescribed drugs and laboratory data including eGFR, associations between PPI prescription and elevated serum concentrations of free and total IS, free and total PCG, and PAG remained significant.

Conclusion
Our results indicate that PPI prescription is independently associated with serum UT retention. These findings indicate a potential mechanism for side effect of PPIs in CKD patients that will need to be confirmed by longitudinal studies.
#3404 UTILITY OF RENAL BIOPSY IN THE ETIOLOGY, MANAGEMENT AND OUTCOME OF POSTPARTUM ACUTE KIDNEY INJURY
Authors: Jain Manoj , Bhadauria Dharmandr , Prasad Narayan , Kaul Anupma 
Published: June 2023

Abstract

Background and Aims
Acute kidney injury (AKI) is a serious complication during pregnancy and postpartum period resulting in significant maternal morbidity, mortality and fetal loss. Pregnancy related acute kidney injury is still more prevalent in developing countries. This study aims to evaluate renal biopsies in postpartum period AKI (PPAKI) with etiology and its management and outcome.

Method
Retrospective analysis of 83 native renal biopsies received in the department of pathology, SGPGIMS, Lucknow, a tertiary care center in India with PPAKI from January 2007 to December 2021 were analyzed. Clinical and laboratory data were retrieved and renal biopsy histology slides were reviewed.

Results
Eighty-three patients with mean age 27.5±4.6 years had biopsy proven PPAKI. Cesarian section, vaginal delivery, hysterectomy and abortion were performed in 51, 19, 2 and 11 patients respectively. The cause of AKI was sepsis (38.6%), postpartum hemorrhage (26.5%), thrombotic microangiopathy (TMA) (11%), pre-eclampsia (3.7%) and other (20%). Duration of onset of AKI after delivery/abortion ranged from 0 to 30 days (mean 4.5±6.3 days). Fetal loss was seen in 31.7% patients. Biopsy showed partial/complete renal cortical necrosis (56.6%), TMA (24.1%), acute tubular injury (ATI) (4.8%), Lupus nephritis flare in 3.6% and other glomerular diseases (8.4%) and Tubulointerstitial nephritis in (1.2%) patient. All received multiple sessions of haemodialysis and 10 patients also had plasmapheresis. During hospital stay one died due to sepsis and shock, remainder were discharged in a stable condition with complete recovery in (5), partially recovery in (7); and 61 (71%) patients required continued renal replacement therapy. Two patients died and two had subsequent live related renal transplantation on available follow-up.

Conclusion
AKI is a serious complication in postpartum period and require early and prompt attention to reduce fetal and maternal morbidity. Sepsis is the commonest cause of postpartum AKI
#3412 THE THROMBOTIC EVENTS IN PATIENTS WITH ANCA-ASSOCIATED VASCULITIS: A RETROSPECTIVE COHORT STUDY AND MENDELIAN RANDOMIZATION ANALYSIS
Authors: Chen Xin , Zhang Shuo , You Ruilian , Xia Peng , Shi Xiaoxiao , Ting Wuhai , Wen Yu-Bing , Qin Yan , Chen Limeng 
Published: June 2023

Abstract

Background and Aims
Thrombotic event in ANCA-associated vasculitis (AAV) was prevalent but not clarified in the causal relationship between AAV and thrombotic events. We tried to identify the clinical characteristics and risk factors of thrombotic events in a large sample-size retrospective cohort and investigate the causal relationship by Mendelian randomization (MR) analysis.

Method
In this retrospective, observational study, all hospitalized AAV patients were included in a single-center tertiary hospital in China from Jan 2013 to April 2022. Clinical data were collected for multivariate regression analysis to determine the risk factors of thrombotic events. As for MR analysis, we selected single nucleotide polymorphisms (SNPs) related to AAV from published genome-wide association studies. The outcome data containing deep vein thrombosis (DVT) and pulmonary embolism (PE) were extracted from the UK biobank. The inverse variance weighted (IVW) method and weighted median (WM) were performed in MR analysis.

Results
A total of 1203 primary AAV patients were enrolled, with 11.3% developing thrombotic events, with the average age of 49 (ranging from 43.75 to 59.75), and males occupied 56.3%. AAV patients with thrombosis were older (&gt;65 years, 44.9% vs. 29.9%, P&lt;0.001) and with more commodities like chronic kidney disease (CKD, 22.8%)or artery disease(CAD, 11.8%). The thrombotic incidences were more common in eosinophilic granulomatosis with polyangiitis (EGPA, 19.5%), with prolonged hospitalization without significant difference in hospital mortality. Multivariate regression suggested that age over 65 years (OR = 1.574, P = 0.029), EGPA (OR = 3.686, P = 0.029), elevated D-dimer (&gt;2 mg/L, OR = 7.119, P&lt;0.001), and end-stage renal disease (ESRD) status were associated with thrombosis events in patients with AAV. In addition, MR analysis showed that EGPA could increase the risk of developing DVT and PE (OR = 1.0038, 95%CI = 1.0035-1.0041, P = 0.009).

Conclusion
Thrombotic events were not rare in Chinese patients with AAV with independent risk factors such as highly elevated D-dimer and EGPA, which served as a causal risk factor for DVT and PE.
#3420 CLINICAL CHARACTERISTICS AND PRIMARY OUTCOMES OF PATIENTS WITH ANCA-ASSOCIATED VASCULITIS AND CENTRAL DIABETES INSIPIDUS
Authors: Chen Xin , Zhang Shuo , Xia Peng , Shi Xiaoxiao , Ting Wuhai , Wen Yu-Bing , Qin Yan , Tian Xinping , Zhu Huijuan , Chen Limeng 
Published: June 2023

Abstract

Background and Aims
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is characterized by systemic small-vessel vasculitis and may rarely present as central diabetes insipidus (CDI). AAV-associated CDI should be recognized to avoid unnecessary biopsies of the pituitary gland and minimize the risk of irreversible loss of pituitary function. In this study, we aimed to determine the clinical characteristics and prognosis of patients with AAV-associated CDI.

Method
This was a nested case-control study where AAV patients with CDI at the Peking Union Medical College Hospital were followed from January 2012 to April 2022. Case-control matching with AAV patients without CDI was performed (1:2), and participants were matched by age, sex, and AAV classification. We collected clinical data every 3–6 months and conducted a literature review using PubMed to identify relevant articles published from 1983–2022.

Results
Among 1203 hospitalized AAV patients, 16 patients with CDI were included (1.3%). The average age was 49 years, and men accounted for 56.3%. Granulomatosis with polyangiitis (GPA) accounted for 87.5% of patients. AAV patients with CDI had more ear, nose, and throat (ENT) (81.3%) involvement and less renal impairment than those in the control group (P&lt;0.05). After a mean follow-up of four years, 50% of patients were in remission, 37.5% relapsed, and 12.5% died. Our literature review suggested that patients in Asian countries tend to be older men and have higher MPO-ANCA positivity than those in European countries. Furthermore, PR3-ANCA positivity may predict disease recurrence.

Conclusion
AAV patients with CDI had more ENT involvement and a higher eGFR. MPO-ANCA positivity is more commonly observed in Asian countries than in European countries, and PR3-ANCA positivity may predict recurrence.