bluuebunny/crossref_metadata_2025_split huggingface dataset:
#3640 IMMUNORELATED RENAL ADVERSE EFFECTS IN PATIENTS TREATED WITH CHECKPOINT INHIBITORS
Authors: Nanwani Avinash Chandu , García Jonay Manuel , Suárez Germán Pérez , Puga Ana Ramírez , Nuez Selene González , García Fátima Batista , Granados Saulo Jesús Fernández , Martín Noemí Esparza , Garcia-Canton Cesar 
Published: June 2023

Abstract

Background and Aims
Checkpoint Inhibitors (CPI) use has revolutionized cancer treatment. However, Immuno-Related Adverse Effects (IRAE) occur in more than 50% of patients. At renal level, the initial incidence of IRAE was considered low and later studies suggest between 1.4–4.9%. The aim of the study was to describe a case series with kidney dysfunction related to CPI treatment and report renal and patients’ outcomes after initiation of treatment.

Methods
We retrospectively studied 28 patients (72.4% male, median age 71.1 years, IR: 40.1–87.3), with metastasic neoplasms (22 advanced lung cancer, 4 melanomas, 1 renal and 1 colon) treated with CPI (Pembrolizumab 75%, 21.4% Nivolumab and 3.6% with Pembrolizumab + Ipilimumab combination) who developed AKI after CPI use, at the Complejo Hospitalario Materno Insular from January 2016 to March 2022. Demographic clinical and analytical data were collected, as well as, the evolution of kidney function.

Results
Immuno-related AKI occurred after a median of 3.7 months (IR: 0.23–24.0). The median plasma creatinine prior to receiving treatment with CPI was 0.9 mg/dl [IQR: 0.67-1.65]. After initiation of steroids (1mg/kg/day), 85.7% showed recovery of kidney function. Seventeen patients (60.7%) presented complete remission, 8 (28.6%) partial remission, while 3 patients (10.7%) did not recover from kidney function. In patients who did not respond initially to steroid therapy, a renal biopsy was performed (n = 7; 25.9%) showing tubulointerstitial nephritis (TIN) in 5 patients, 1 granulomatous nephritis with poor kidney function evolution, and 1 endocapillary glomerulonephritis together with TIN. More than half of the patients who developed immuno-related ARF presented toxicity in other organs (n = 13; 56.5%); being thyroiditis the most frequent (n = 3; 10.7%).
At the end, two patients (7,1%) presented complete remission of neoplasms, 6 (21.4%) partial remission, stability was observed in 8 patients (28,6%), the neoplasm progress in 4 (14,3%) and 8 (28,6%) patients died during the follow-up. Finally, the patient median survival was 36,7 months ((IR 5,7- 79,6) post CPI treatment.

Conclusion
Immuno-related AKI after use of CPI is low; over two-thirds of patients recovered from total or partial renal function after initiation of steroids. The presence of granulomas in renal biopsy may confer poor prognosis.
#3641 DOES IBANDRONATE OR CALCIUM AND VITAMIN D MAINTAIN OR IMPROVE BONE MICROARCHITECTURE IN THE FIRST YEAR AFTER KIDNEY TRANSPLANTATION?
Authors: Strommen Ruth , Smerud Knut , Meland Nils , Godang Kristin , Pihlstrøm Hege Kampen , Åsberg Anders , Reisater Anna Varberg , Bollerslev Jens 
Published: June 2023

Abstract

Background and Aims
Modern immunosuppressive protocols are associated with less loss of bone mass immediately after kidney transplantation, as compared with previous eras. Even so, bone microarchitecture may still be disturbed due to long-standing uremia, leading to bone fragility and fracture susceptibility. Trabecular bone score (TBS) is a new tool to assess trabecular bone microarchitecture based on standard dual energy X-ray absorptiometry (DXA) of lumbar spine images. TBS reflects bone quality rather than quantity. Studies on the effect of common anti-fracture strategies on TBS in kidney transplant recipients (KTR) are scarce. Our aim was to investigate different treatments on bone microarchitecture by TBS in KTR.

Method
We analyzed TBS changes and potential treatment effects in 179 de novo KTR, 118 of whom had participated in a randomized controlled trial[1] evaluating the effect of ibandronate (active/placebo) on top of calcium and vitamin D in the first year after kidney transplantation. Trial participants were compared to 61 patients transplanted in the same time-period, meeting the same study inclusion criteria, but receiving no specific bone-directed treatment. Correlations between changes in TBS and lumbar spine BMD were investigated. We used ANOVA and ANCOVA with adjustment for baseline TBS values to evaluate the potential effects of calcium and vitamin D with/without concomitant ibandronate on TBS 12 months after transplantation, as compared to no treatment.

Results
Mean TBS increased in all groups from baseline to 12 months after transplantation (2.1% for ibandronate/calcium/vitamin D, 2.7% for calcium/vitamin D, and 3.4% for no treatment). Adjusting for baseline TBS, there were no significant differences in TBS at 12 months, neither with overall comparison (p = 0.377) nor when comparing the groups pairwise. The correlation between TBS and BMD was weak (r = 0.170, p = 0.02) at baseline, and change in TBS was not significantly correlated with change in lumbar spine BMD in any of the groups.

Conclusion
In a group of de novo KTR with reasonably well-preserved bone mass, it does not appear that one year of treatment with ibandronate or calcium and vitamin D significantly affects bone quality as measured by TBS. We found surprisingly weak correlation between changes in TBS and BMD over the study period, indicating that these measurements reflect different aspects of bone integrity and metabolism. This study strengthens the view that focus should be on identifying KTR at high risk of fracture at time of transplantation, as these patients could benefit from anti-resorptive therapy.
#3651 COMPARISON OF WHOLE-BODY VERSUS THORACIC BIOIMPEDANCE IN RELATION TO ULTRAFILTRATION VOLUME AND SYSTOLIC BLOOD PRESSURE DURING HEMODIALYSIS
Authors: Schoutteten Melanie , Lindeboom Lucas , Brys Astrid , Lanssens Dorien , Smeets Christophe , De Cannière Hélène , De Moor Bart , Peeters Jacques , Heylen Line , Van Hoof Chris , Groenendaal Willemijn , Kooman Jeroen , Vandervoort Pieter 
Published: June 2023

Abstract

Background and Aims
In contrast to portable whole-body bioimpedance, which estimates fluid status at a single point in time, thoracic bioimpedance applied by a wearable device could enable continuous measurements. However, clinical experience with thoracic bioimpedance in patients in dialysis is still limited. The aim of this study is to test the reproducibility of whole-body and thoracic bioimpedance measurements and to compare their association with hemodynamic changes during hemodialysis.

Method
In total, 54 patients were included in this cross-sectional observational study. Whole-body resistance at 5kHz, thoracic resistance at 8kHz, systolic blood pressure and ultrafiltration volume were measured. All measurements were taken at pre- and end-dialysis during two consecutive sessions. Data were approached by mixed-modelling and Spearman correlation analysis.

Results
Intraclass correlation of pre- to end-dialysis changes in whole-body and thoracic resistance between the first and second session was .71 [.58 – .8] and .72 [.6 – .81] respectively (Fig. 1). The correlation between ultrafiltration volume and relative whole-body and thoracic resistance was respectively .94 [.91 ─ .96], p &lt; .001 and .76 [.66 ─ .83], p &lt; .001 in the first session and .95 [.93 ─ .97], p &lt; .001 and .75 [.65 ─ .82], p &lt; .001 in the second session (Table 1). Changes in systolic blood pressure negatively correlated to both bioimpedance techniques (whole-body resistance in the first session: -.37 [-.19 ─ -.53], p &lt; .001; in the second session: -.37 [-.19 ─ -.53], p &lt; .001; thoracic resistance in the first session -.45 [-.28 ─ -.59], p &lt; .001; in the second session -.39 [-.22 ─ -.54], p &lt; .001) (Table 1).

Conclusion
Bioimpedance signals from both devices were moderately reproducible between two dialysis sessions. Whereas the relation between changes in ultrafiltration volume and resistance was stronger for whole-body bioimpedance, the relation between changes in systolic blood pressure and resistance was at least comparable for thoracic measurements. Thoracic bioimpedance measurements by a wearable device may serve as an interesting alternative to whole-body measurements for continuous hemodynamic monitoring during hemodialysis.
#3658 PERITONEAL INFLAMMATION INDUCES SYSTEMIC ERYPTOSIS IN PERITONEAL DIALYSIS-ASSOCIATED PERITONITIS
Authors: Virzi Grazia Maria , Manani Sabrina Milan , Marturano Davide , Mattiotti Maria , Tantillo Ilaria , Ronco Claudio , Zanella Monica 
Published: June 2023

Abstract

Background and Aims
Eryptosis is stress-induced RBC (Red Blood Cell) death mechanism. Our preliminary data show that there is a significative increased of eryptosis during peritoneal dialysis-associated peritonitis. Furthremore, there is an elevation of local and systemic inflammatory mediators. The aim of this study was to evaluate the relationship between systemic eryptosis levels in peritonitis and specific peritonitis biomarkers in peritonitis effluent (PDE), such as Peritoneal White Blood cell count (pWBC), peritoneal NGAL (pNGAL) and peritoneal cytokines levels.

Method
We enrolled 22 PD patients with peritonitis and 17 healthy subjects. PD-related peritonitis was defined according to the Guidelines of the International Society of Peritoneal Dialysis. At the time of diagnosis, blood samples were collected for eryptosis and peritoneal effluent were taken to evaluate pWBC, pNGAL and cytokines. All eryptotic measurements were made in freshly isolated RBCs. PS avidly binds AnnexinV, which is thus employed to identify eryptotic cells. Thus, PS exposure at RBC surface was estimated from FITC-AnnexinV binding using flow cytometric analyses.

Results
13/22 patients were treated with continuous ambulatory PD (CAPD) and 9 with automated PD (APD). The median length of PD treatment was 28.1 months and the range was: minimum: 3 – maximum: 124.9 months. The percentage of AnnexinV-binding RBCs was significantly higher in PD patients with peritonitis than in CTR (PD patients with peritonitis: 7.7; IQR 4.3-14.2, versus CTR: 0.8; IQR 0.7-1.3; p&lt;0.001) (Figure 1). WBC, NGAL and cytokines levels in PDE are reported in Table 2. We observed important correlation between eriptosis levels and peritoneal biomarkers (Figure 2).

Conclusion
In conclusion, we investigated a potential connection between systemic eryptosis and peritoneal biomarkers involved in peritonitis. The presented results revealed that upregulated inflammatory markers could be the cause of high levels of systemic eryptosis during PD-related peritonitis.
#3662 FREQUENCY OF INR TESTING IN HEMODIALYSIS PATIENTS ON VITAMIN K ANTAGONISTS: A RETROSPECTIVE STUDY
Authors: Aoun Mabel , Baleynaud Juliette , Champtiaux-Dechamps Beatrice , Gritti Marion , Mouellic Lionel Le , Duneau Gabrielle 
Published: June 2023

Abstract

Background and Aims
Despite the rising of direct oral anticoagulant agents’ use in the general population, vitamin K antagonists (VKA) are still used in hemodialysis (HD) French patients with atrial fibrillation. These HD patients on VKA have also poor levels of time in therapeutic range. It is recommended generally to follow patients with monthly INR, however there is lack of such evidence in HD. This study aims to analyze the frequency of INR testing needed in HD patients.

Method
This is a retrospective study of all patients treated with VKA in three French dialysis units between 1st January and 31st December 2022. Patients are followed with weekly INR. Variables collected included over twelve months the number of INR tests, their percentage within target, above target and below target, and number of VKA dose adjustment. Bleedings, transfusions, thrombotic events and antibiotic use were recorded. Linear regression analysis evaluated factors associated with number of VKA dose adjustment per year. This study was conducted in concordance with the Declaration of Helsinki 1975.

Results
Out of 160 HD patients, 45 (28.1%) were on VKA for paroxysmal or chronic atrial fibrillation. Their characteristics are summarized in Table 1. A total of 2609 INR tests were performed over a year with a mean of 57.9±18.6 per patient. The median number of VKA dose adjustment per year was 11 (8, 13). A significant correlation was found between the number of antibiotics and number of VKA dose adjustment (Spearman Rho = 0.360, p = 0.015). In univariate regression analysis, factors associated with higher numbers of dose adjustment were diabetes, sevelamer and blood flow (Table 2). Bleeding was not significantly different between those with high versus low VKA dose adjustment.

Conclusion
In this study, 22% of tests led to VKA dose adjustment. Patients with diabetes, on sevelamer, treated with antibiotics and with lower serum albumin needed frequent INR testing more than once monthly. These results could be helpful in contexts with limited resources.
#3667 REVEAL-CKD: PREVALENCE OF UNDIAGNOSED STAGE 3 CHRONIC KIDNEY DISEASE IN AUSTRALIA, BRAZIL, CANADA AND SPAIN
Authors: Pecoits-Filho Roberto , de Castro Maria Cristina Ribeiro , Cebrian Ana , Santamaria Rafael , Lim Kean-Seng , Wittbrodt Eric , Barone Salvatore , Arnold Matthew , Tangri Navdeep 
Published: June 2023

Abstract

Background and Aims
Chronic kidney disease (CKD) is a progressive condition that affects &gt;850 million people globally. Global clinical guidelines from K-DIGO recommend early CKD identification and management to mitigate disease progression. The REVEAL-CKD study aims to assess the prevalence of, and factors associated with, undiagnosed stage 3 CKD across 11 countries. Here we report data from 4 countries in 4 continents.

Method
REVEAL-CKD is a multi-national, observational study, using secondary data from electronic medical records (EMR) and claims data. For this analysis, data were extracted from Australian General Practices through Pen CS (Australia), University of Sao Paulo (Brazil), the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) (Canada), and BIGPAC (Spain). The study cohort included patients aged ≥18 years with two consecutive estimated glomerular filtration rate (eGFR) values ≥30 and &lt;60 mL/min/1.73 m2 recorded 91-730 days apart. The date of the second qualifying eGFR was the index date. Patients with no CKD diagnosis code before and up to 6 months after their index date were considered undiagnosed. The prevalence of undiagnosed CKD was calculated as the ratio of undiagnosed patients to all patients meeting the study inclusion criteria.

Results
The prevalence and baseline characteristics of undiagnosed Stage 3 CKD appear in Table 1. In all 4 countries, the undiagnosed prevalence was &gt;80% and predominantly was more commonly observed in female patients, in patients aged &gt; 65y, and remained high in patients with baseline comorbidities, particularly for those at highest risk of CKD (DM, CVD, HTN). Underreporting of CKD diagnosis in Brazil may be due to the inability to code for &gt;1 condition in a patient.

Conclusion
These results indicate that a large proportion of patients across four world regions and who have biochemical evidence of early CKD lack a recorded diagnosis. An opportunity exists to identify, diagnose, and implement guideline-directed management for early CKD in order to delay its complications and improve clinical outcomes.
#3685 PERICYTE AND CXCL12 PLAY CRUCIAL ROLE IN THE RECOVERY OF ACUTE KIDNEY INJURY
Authors: Shao Yu-Han , Chou Yu-Hsiang , Chen Yung-Ming , Lin Shuei-Liong 
Published: June 2023

Abstract

Background and Aims
Pericytes are mesenchyme-derived perivascular cells attached to the abluminal surface of capillaries as well as the major origin of myofibroblasts in the animal model of unilateral ureteral obstruction (UUO) and ischemia-reperfusion injury (IRI). Although previous studies reported that myofibroblasts may be beneficial during acute kidney injury (AKI) via growth factor secretion, reconstitution and stabilization of the collagen framework for tubular cell regeneration, lack of solid evidence and definite mechanism make the role of pericyte/myofibroblast in AKI remain controversial.

Method
To clarify this, we used platelet-derived growth factor receptor β (PDGFRβ)-specific antibody following AKI in C57BL/6 mice to inhibit pericytes. In the meantime, We used Gli1-CreERT2;Cxcl12fl/fl genetically modified mice to conditionally knockout CXCL12 specifically in pericytes before IRI.

Results
The expression of PDGFRβ on pericytes increased after IRI. In group of administration of PDGFRβ antibody, proliferation and transition to myofibroblasts of pericytes were inhibited. Inflammation became worse and renal recovery was impeded after AKI. The chemokine stromal cell-derived factor-1 (SDF-1) which is also known as the C-X-C-type chemokine CXCL12 decreased as well. Furthermore, we demonstrated that CXCL12 was secreted mainly by pericytes and its receptor CXCR4 was expressed on tubular cell during IRI by in situ hybridization. When knockout of CXCL12 was performed before IRI, the renal microvascular rarefaction was noted after AKI and the recovery of renal function was impaired. Renal tubular cell proliferation decreased and apoptosis increased as well.

Conclusion
In summary, these findings demonstrated that pericytes contribute to renal repair after IRI through CXCL12 secretion.
#3777 ACTIVATION OF HYPOXIA-INDUCIBLE FACTORS IN ERYTHROID PROGENITOR CELLS RESULTS IN DEFECTIVE ERYTHROPOIESIS
Authors: Tsai Pei-Zhen , Pan Szu-Yu , Lin Shuei-Liong 
Published: June 2023

Abstract

Background and Aims
Hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI) activates HIF in renal pericytes and fibroblasts to promote erythropoietin production and erythropoiesis. However, the effects of HIF stabilization in the erythroid lineage are not clear. We aim to study the effects of erythroid lineage-specific stabilization of HIF on erythropoiesis by preclinical models.

Method
EporGFP-Cre/+;VhlF/F mice were used to achieve erythroid lineage-specific stabilization of HIF. Surface expression of TER-119, CD44, and forward scatter (FSC) were used to define erythroblast, reticulocyte, and red blood cell in the bone marrow. Expression of propidium iodide and surface annexin V were used to define apoptosis. Stress erythropoiesis was induced by subcutaneous administration of phenylhydrazine.

Results
Compared with littermate VhlF/F mice, EporGFP-Cre/+;VhlF/F mice had decreased hematocrit, decreased percentage of erythroblasts in the bone marrow, and increased apoptosis of erythroblasts in the bone marrow under steady state. These phenotypes of defective erythropoiesis were normalized in mice harboring concomitant Vhl, Hif1a, and Hif2a deletion (EporGFP-Cre/+;VhlF/F;Hif1aF/F;Hif2aF/Fmice). Although macrophages in the bone marrow also express Epor, macrophage-specific Vhl deletion in either Tg(Csf1r-CreESR1);VhlF/F or Lyz2Cre/+;VhlF/F mice did not result in defective erythropoiesis. During stress erythropoiesis, compared with littermate VhlF/F mice, EporGFP-Cre/+;VhlF/F mice had similar hematocrit, lower percentage of erythroblast in the bone marrow, and increased percentage of erythroblast in the spleen.

Conclusion
Vhl deletion in erythroid progenitor cells impairs erythropoiesis in murine bone marrow in the steady state. The phenotypes of defective erythropoiesis were partially reversed during stress erythropoiesis.
#3784 DIETARY BEHAVIOR OF CKD PATIENTS BEFORE AND AFTER THE COVID-19 PANDEMIC PERIOD
Authors: Min Son Seong , Ok Kwon Sung , Lee Sunhwa , Hyunjeong Baek , Duck-Jin Hwang , Park Ji In 
Published: June 2023

Abstract

Background and Aims
As the COVID-19 infection went global pandemic in 2020, many governments around the world have carried out social lockdown policies. It resulted in changes in lifestyles such as diet, physical activity, and social interaction. This study aimed to investigate the changes of lifestyles focusing on diet, especially in patients with chronic kidney disease (CKD) during the COVID-19 pandemic period.

Method
We compared data from 2019 and 2020 of the Korea National Health and Nutrition Examination Survey (KNHANES) before and after COVID-19, because COVID-19 was first detected in January 2020 in South Korea. CKD was defined as albumin to creatinine ratio &gt;30 mg/g or estimated glomerular filtration rate (eGFR) &lt;60 mL/min/1.73 m2. CKD was categorized into two groups, CKD stage 1–2 and CKD 3–5; eGFR over 60 with albuminuria and eGFR below 60 mL/min/1.73 m2. We compared changes in diet behavior, nutrients, and food intake between 2019 and 2020 in normal, CKD stage 1–2, and CKD stage 3–5 groups.

Results
This analysis included a total of 5,084 and 4,338 participants from 2019 and 2020. When compared to normal group in the post-COVID-19, CKD group showed lower energy intake (p = 0.038), but the proportion of carbohydrates, proteins, and lipids did not differ. In the pre-COVID-19, CKD stage 3–5 group ate significantly lower sodium (1612.3 ± 62.1 mg/1000kcal) compared to normal (1809.1 ± 17.3 mg/1000kcal) and CKD stage 1–2 group (1856.3 ± 44.9 mg/1000kcal) (p = 0.007). However, post-COVID-19 period, sodium intake significantly increased only in CKD stage 3–5 group (1893.5 ± 109.2 mg/1000kcal, p = 0.015), and the urine Na/Cr ratio also increased (from 19.5 ± 1.4 to 26.0 ± 1.5, p = 0.001). The main source food of sodium was kimchi in every group, but the proportion changed in the post-COVID-19 period. In CKD stage 3–5 group, compared to the pre-COVID-19 period, the intake of noodles and Ramen increased 35% and 91%, respectively. Interestingly, the potassium intake increased from pre-COVID-19 to post-COVID-19 in all three groups.

Conclusion
The COVID-19 pandemic affects CKD patients' diets in terms of sodium intake. We need to pay attention to diet and nutritional education for CKD stage 3–5 patients.
#3795 EARLY AND LATE PATIENT OUTCOMES IN URGENT-START PERITONEAL DIALYSIS: A PROSPECTIVE STUDY OF UNPLANNED INITIATION OF CHRONIC DIALYSIS
Authors: Ghita Elbardai , Chouhani Basmat Amal , Kabbali Nadia , Houssaini Tarik Sqalli 
Published: June 2023

Abstract

Background and Aims
Peritoneal dialysis (PD) has become a well-established complementary alternative to hemodialysis (HD) as the first-line renal replacement modality. Unlike the temporary catheter for hemodialysis that can be used immediately after implementation, the PD catheter usage period remains controversial. The aim of this study was to compare the short- and long-term outcomes in patients under peritoneal dialysis according to the delay of starting the dialysis after catheter placement.

Method
This observational prospective study was conducted over an eight-year and four-month period (from April 2014 to August 2021), including all patients treated with peritoneal dialysis for 18 months (from April 2014 to October 2015). The patients were divided into two groups according to whether the catheter was used during the first 15 days (PD-E) or 15 days after (PD-L) catheter placement. The primary outcomes were early complications (mechanical and infectious) within 90 days. Secondary outcomes included technique survival.

Results
Among the 36 patients included in the study, 14 started PD early (38.8%), while 22 started it 15 days after catheter placement (61.2%). The mean age between the two groups was not significantly different (41 ± 17 years vs 35 ± 16 years, p: not significant). There were no significant differences in the Charlson comorbidity index or the degree of autonomy. The incidence of infections was not significantly different between the two groups (13.6% in PD-L vs 21.4% in PD-E, p: not significant). The total number of mechanical complications was not significantly higher in the PD-E group compared to the PD-L group (42.8% vs 27.3%, respectively, p: not significant). Kaplan-Meier estimates of technique survival were comparable between the groups (log Rank: 1.908, p: 0.67).

Conclusion
Our study showed no increase in the risk of complications associated with early use of the PD catheter and no difference in technique survival. PD can be used as first-line renal replacement therapy in the unplanned initiation of chronic dialysis.