bluuebunny/crossref_metadata_2025_split huggingface dataset:
#6018 SODIUM-GLUCOSE CO-TRANSPORTER-2 INHIBITOR USE IN THE MANAGEMENT OF PATIENTS WITH CHRONIC KIDNEY DISEASE AND TYPE 2 DIABETES MELLITUS
Authors: Alzetani Sarah , Suresh Vijayan 
Published: June 2023

Abstract

Background and Aims
Sodium-glucose co-transporter-2 (SGLT-2) inhibitors were initially developed for the management of type 2 diabetes mellitus (T2DM). Results from large placebo-controlled clinical outcome trials have now highlighted efficacy of SGLT-2 inhibitors in reducing the risk of CKD progression [1,2]. NICE CKD guidelines now recommend use of SGLT-2 inhibitors alongside standard of care in those patients with T2DM [3]. This has subsequently extended SGLT-2 inhibitor licensing highlighting the importance of wider multi-disciplinary team practise awareness. The aim of this audit was to assess the level of implementation of updated NICE guidelines in patients under a specialist CKD clinic in Birmingham.

Method
A database of renal diabetics under a specialist CKD clinic in May 2022 was generated via the trust electronic patient record system. Patients with a recorded diagnosis of T2DM and estimated glomerular filtration rate (eGFR) &gt;25ml/min (current UK regulatory licensing for SGLT-2 inhibitor use) were included. Parameters of renal function (urine albumin: creatinine ratio (uACR) and eGFR) as well as medication histories were retrospectively collected for 158 patients and analysed using descriptive statistics.

Results
Results demonstrated 19% (n = 43) of 143 patients with an accessible drug history were prescribed an SGLT-2 inhibitor. Less than half (44%) of those prescribed standard of care (ACEI/ARB) with a uACR &gt;30 mg/mmol (n = 34) were prescribed an SGLT-2 inhibitor as per NICE recommendations. The prescribing of SGLT-2 inhibitors in patients at different stages of CKD was noted except in those with eGFR &lt;30 ml/min.

Conclusion
Results suggest a number of patients with T2DM are not prescribed an SGLT-2 inhibitor as per NICE recommendations for CKD management. Whilst considering sample size limitation as well as possible contraindications relevant to SGLT-2 inhibitor treatment, these findings may reflect the recent update to NICE guidelines and delayed dissemination of information between multi-disciplinary teams around extended SGLT-2 inhibitor licensing. Glycaemic control is less effective in later stages of CKD however, trials have demonstrated the independent role of SGLT-2 inhibitors in reducing the risk of CKD progression irrespective of their attenuated ability to lower glucose in reduced kidney function [1,2]. It is imperative patients not currently prescribed an SGLT-2 inhibitor are reviewed for treatment eligibility and any contraindications. Results of this study were fed back to the local renal and diabetes team with the recommendation for development of clear guidelines for use of SGLT-2 inhibitors in all eligible patients in order to achieve maximum healthcare benefits. In addition, there are ongoing discussions with primary care regarding review of their use of SGLT-2 inhibitors.
#6041 THE IMMUNE EFFECTS OF SARS-COV-2 INFECTION AND BNT162B2 VACCINATION IN CKD PATIENTS AND TRANSPLANT RECIPIENTS
Authors: Nazaruk Paulina , Tkaczyk Ignacy , Jędrzejczak Anna , Krata Natalia , Paczek Leszek , Foroncewicz Bartosz , Mucha Krzysztof 
Published: June 2023

Abstract

Background and Aims
The use of vaccination against severe acute respiratory syndrome coronavirus (SARS-CoV-2) significantly limited the spread of the coronavirus disease 2019 (COVID-19) pandemic. However, it was reported that after 6 months of vaccination (including the BNT162b2 vaccine) immunity decreases in general population. The results for chronic kidney disease (CKD) patients and solid-organ transplant (SOT) recipients appeared similar. Therefore, it was proposed to use an immune booster with the next, third or fourth vaccination dose to prolong immunity. We aimed to find the most effective immunization schedules in CKD patients in comparison to kidney (KTRs) and liver transplant recipients (LTRs).

Method
We retrospectively analyzed the data of randomly selected 40 patients with IgA nephropathy (IgAN) as representatives of the CKD group and 78 SOT recipients (37 KTRs and 41 LTRs). They received two or three 30 μg doses of BNT162b2 vaccine. The follow up was performed in five time points (TP1-5): 4-6 weeks after the 1st dose (TP1), 4-8 weeks after 2nd dose (TP2), 9-20 weeks after 2nd dose (TP3), 21-32 weeks after 2nd dose and 1-12 weeks after 3rd dose (TP4), 33-48 weeks after 2nd dose, at the same time 4-20 weeks after 3rd dose (TP5). We assessed the anti-SARS-CoV-2 spike 1 protein IgG antibody (anti-S1 Ab) titer as well as graft function, COVID-19 history and patients’ clinical condition.

Results
We found Ab titer in IgAN group higher than in SOT patients (p = 0.05). LTRs achieved higher values than KTRs. 55 patients received 3 doses of vaccination. The protective level after the 3rd dose was not observed only in 8.4% at TP4 and 5% at TP5. We demonstrated the advantage in Ab levels of a 2 doses vaccination scheme with and without COVID-19 history over a 3 doses in a group of patients with no COVID-19 history in TP 1-4 (p = &lt;0,001 - 0,005, respectively, Table1). Subjects in 2 doses schedule had a longer time to infection from the last dose compared to the 3 doses schedule (31.5-39 vs. 9 weeks, MD). No deterioration of renal or graft function was noted and no rejection episodes were diagnosed.

Conclusion
Immunocompromised patients are non-homogeneous with respect to the vaccine response immunity. Therefore, the approach to the vaccination schedule should be individualized based on measurements of vaccination response and medical history including COVID-19 history. Combined post-infectious and post-vaccination immunization appears to be the most effective in producing anti-SARS-CoV-2 responses.
#6044 HEART RATE VARIABILITY AT REST AND IN RESPONSE TO PHYSICAL AND MENTAL STRESS: A COMPARATIVE STUDY BETWEEN HEMODIALYSIS AND PERITONEAL DIALYSIS PATIENTS
Authors: Faitatzidou Danai , Dipla Konstantina , Theodorakopoulou Marieta , Koutlas Aggelos , Sampani Erasmia , Tsitouridis Alexandros , Dimitriadis Chrysostomos , Pateinakis Panagiotis , Zafeiridis Andreas , Papagianni Aikaterini , Sarafidis Pantelis 
Published: June 2023

Abstract

Background and Aims
Cardiac arrhythmias and sudden death are the leading causes of cardiovascular mortality in end-stage-kidney-disease (ESKD). Autonomic dysfunction contributes to the arrhythmogenic background of ESKD patients. This is the first study to compare linear and non-linear heart-rate-variability (HRV) indices between hemodialysis (HD) and peritoneal (PD) patients, both at rest and in response to mental- and physical-stimulation maneuvers.

Method
Thirty-four HD and 34 PD patients matched for age, sex, and dialysis-vintage, as well as 17 age- and sex-matched controls were studied. Autonomic function was examined by linear and non-linear-HRV indices. Heart-rate was recorded continuously with Finometer-PRO at rest and during orthostatic, mental-arithmetic, sit-to-stand, and handgrip-exercise tests.

Results
No significant between-group differences were observed in resting HRV indices (RMSSD: HD:57.1±81.1 vsPD:69.6±113.4ms; p = 0.792) except for DFA-a1 index (HD:0.87±0.40 vs PD:0.70±0.20, p = 0.047). All HRV indices during the mental arithmetic test (RMSSD HD:128.2±346.0 vs PD:87.5±150.0ms; p = 0.893) and the physical stress tests were similar between HD and PD patients. Both dialysis groups presented similar patterns of HRV responses to orthostatic and handgrip exercise tests; however, after the sit-to-stand test RMSSD, SD1,SD2 and DFA-a2 indices were higher compared to rest only in HD patients (RMSSD: 57.1±81.1 vs126.7±185.7ms, p = 0.028), suggesting a greater difficulty of HD patients in recovering normal ANS function following a physical stress-test.

Conclusion
HRV indices at rest and after mental and physical stimulation did not differ between HD and PD patients, however the ANS response following the sit-to-stand test was more impaired in HD. These findings suggest that ANS dysfunction is not largely affected by dialysis modality but small differences in normal ANS recovery may exist.
#6060 A NOVEL CT-BASED RADIOMICS APPROACH FOR KIDNEY FUNCTION EVALUATION IN ADPKD
Authors: Calvaruso Luca , Fulignati Pierluigi , Larosa Luigi , Tran Huong Elena , Votta Claudio , D’ambrosio Viola , Condello Giulia , Ferraro Pietro Manuel , Boldrini Luca , Grandaliano Giuseppe 
Published: June 2023

Abstract

Background and Aims
Clinical management of autosomal dominant polycystic kidney disease (ADPKD) might take advantage of the use of new tools to predict risk of progression towards end stage kidney disease (ESKD). The aim of this study is to develop and validate a model based on radiomic features to predict kidney function among patients with ADPKD obtained from CT scans performed for the determination of total kidney volume (TKV).

Method
We retrospectively selected a cohort of 58 patients with ADPKD who underwent CT scan from February 2020 to March 2021, including 30 patients with eGFR ≥ 60 mL/min/1.73 m2 and 28 with eGFR &lt; 60 mL/min/1.73 m2 at baseline. An expert radiologist generated a region of interest (ROI) segmentation for cystic kidney compounds, obtaining 58 ROIs from which we extracted 217 radiomic features using a dedicated software. We built three different logistic regression models to predict kidney function based on different predictors: height-adjusted TKV (ht-TKV), a selected radiomic feature (F_cm_merged.clust.tend), and both. Area under the curve (AUC) of the receiver operating characteristic (ROC) and accuracy were employed to evaluate models’ performance in discriminating between the two eGFR groups. Internal 3-fold cross-validation (CV) was performed.

Results
The ht-TKV, radiomic and combined models presented respectively an AUC (95% confidence interval) of 0.79 (0.67, 0.91), 0.83 (0.72, 0.93), 0.84 (0.74, 0.94), confirmed by the CV. Mean (standard deviation) values of the accuracy over CV iterations were 0.67 (0.10), 0.77 (0.09), 0.77 (0.09) for the three models. A model combining ht-TKV with a radiomic feature based on CT images from polycystic kidneys resulted effective in the prediction of baseline kidney function in our cohort. Furthermore, a logistic regression model based on a different radiomic feature (F_cm.2.5Dmerged.info.corr.2) selected among a subcohort of 29 ADPKD patients with a clinical follow-up, predicted rapid progression with a AUC of 0.81, a sensitivity of 100% and a specificity of 53%.

Conclusion
This is among the first studies which aimed to investigate, in a clinical setting, radiomics potential ability in discriminating eGFR at baseline and to explore as well whether a reliable radiomic feature could be taken into account in predicting faster rapid kidney function impairment over time. Further studies should implement a model extension to predict kidney function slope in order to confirm the role of radiomics in ADPKD management.
#6124 INTERACTIONS BETWEEN FIBROBLAST GROWTH FACTOR 23 AND SYSTEMIC INFLAMMATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Abinti Matteo , Vettoretti Simone , Mattinzoli Deborah , Caldiroli Lara , Molinari Paolo , Ikehata Masami , Alfieri Carlo Maria , Castellano Giuseppe , Messa Piergiorgio 
Published: June 2023

Abstract

Background and Aims
In patients with Chronic Kidney Disease (CKD), serum concentration of Fibroblast Growth Factor 23 (FGF23) is inversely correlated with Glomerular Filtration Rate (eGFR), as an adaptive mechanism to counterbalance the alterations of mineral metabolism. Transcription, secretion and cleavage from the intact form (iFGF23) to the c-terminal fraction (cFGF23) are regulated by several mechanisms among which inflammatory mediators seem to play a significant role. We investigated whether there was any correlation between FGF23 and several inflammatory mediators.

Method
In the present study we evaluated cross sectionally the correlation between FGF23 (iFGF23 and c-FGF23) and some pro-inflammatory (IL-6, TNFα, MCP-1)) and anti-inflammatory (IL-10) cytokines in a cohort of 111 prevalent CKD patients stages III-V not yet on dialysis. We excluded patients with infections or chronic inflammatory diseases in the last 3 months, neoplasia or under immunosuppressive therapy. FGF23 and cytokines were dosed by ELISA.

Results
Descriptive characteristics of the cohort are reported in Table 1. We found an increase in inflammation as eGFR declines: IL6 (r = -0,315, p&lt;0,001), TNFa (r = -0,202, p = 0,033) and MCP1 (r = -0,278, p = 0,003). Furthermore, the ratio between C-terminal FGF23 to intact FGF23 (c/iFGF23) was directly related to eGFR, even if it did not reach statistical significance (r = 0,127, p = 0,113). The correlations between FGF23 and markers of osteo-mineral metabolism and inflammation are reported in Table 2. We found positive correlations of iFGF23 with: IL-6 (r = 0,465, p&lt;0,001), TNFα (r = 0,241, p = 0,009) and IL-10 (r = 0,198, p = 0,044) Conversely, cFGF23 only correlated with MCP-1 (r = 0,264, p = 0,005). c/iFGF23 resulted inversely correlated with IL-6 (-0,326, p&lt;0,001) and positively with MCP-1 (r = 0,178, p = 0,061). After the adjustment for eGFR, iFGF23 maintained his correlations only with IL-6 (r = 0,370, p &lt; 0,001) and TNFα (r = 0,163, p = 0,044) while c/iFGF23 was negatively correlated with IL-6 (r -0,251, p = 0,008) and positively with MCP-1 (r = 0,204, p = 0,032).

Conclusion
Our data confirm that in CKD patients, as the renal function declines, there is an important increase of inflammatory cytokines and a tendency to an impaired cleavage of FGF23 from the intact to the c-terminal form. Furthermore, we observed strong correlations of iFGF23 with several inflammatory cytokines (IL-6, TNFα, IL-10) that seem to be independent of eGFR. On the contrary we did not find any correlation of cFGF23 with inflammatory mediators, except for MCP-1. Therefore, we believe that overall our results suggest that inflammatory markers are differently associated with cFGF23 and iFGF23, as if inflammation may independently influence FGF23 turnover (i.e, c/iFGF23 ratio).
#6129 INTRADIALYTIC PARENTERAL NUTRITION IMPROVES PROTEIN STORES IN CHRONIC HEMODIALYSIS PATIENTS
Authors: Molina Pablo , Quilis Aina , Ureña Paula Gandía , Saura Laura Porcar , Llopis Pilar , Parra Manuel , Antón Alejandro Valero , Barrilero Elena Galván , Castillo Belén Vizcaino , Moya Mercedes González , Pérez-Boix Gabriela , Rodrigo María , Climente Mónica , Calabuig Maria Asuncion Sancho 
Published: June 2023

Abstract

Background and Aims
Intradialytic parenteral nutrition (IDPN) is a form of supplemental nutrition used to treat patients with malnutrition who receive hemodialysis (HD) and in which the oral feeding is not enough to cover basic caloric needs. Although this technique could improve biochemical markers of nutrition, information regarding its effect on body deposits is lacking. We evaluated the effect of IDPN on body composition parameters and nutritional status in prevalent HD patients.

Method
Retrospective observational study that included all prevalent hemodialysis patients who received NPID for more than 3 months at our Center from January 2018 to December 2022. All the patients received a concentrated 3-in-1 parenteral nutrition formula consisting of glucose solution, a lipid emulsion and an amino acid solution without electrolytes (OLIMEL N9®, Baxter). IDPN was infused at a constant rate not exceeding 300 ml/hour, via the venous drip chamber of HD monitor using infusion pump. Changes in lean tissue mass (LTM), intracellular water (ICW), and body cell mass (BCM) assessed by multifrequency bioimpedance spectroscopy (BIS) at baseline and at 3, 6, 9 and 12 months (primary outcomes) and other biochemical and anthropometric parameters (secondary outcomes) were used to assess the effect of NPID.

Results
Seventeen patients were included (women: 9, 53%; mean age: 68±15 y). After IDPN initiation, a gradual improvement in LTM, ICW and BCM was observed, reaching statistical significance at Month 3, 6, 9 and 12. Changes in fat inversely mirrored those of LTM (Table 1). Albumin levels and the normalized protein appearance increased, with a significant reduction in high-sensitive C-reactive protein and extracellular/intracellular body water ratio at month 9 and 12.

Conclusion
IDPN for 1-year was associated to increased muscle mass, supporting the hypothesis that this supplement nutrition could benefit nutritional status and revert protein-energy wasting in HD patients.
#6143 FAMILIAL LECITHIN: CHOLESTEROL ACYLTRANSFERASE (LCAT) DEFICIENCY AS A CAUSE OF CHRONIC KIDNEY DISEASE – A CASE REPORT
Authors: Obeidat Motaz , Obeidat Marya , Al-Shboul Mohammad 
Published: June 2023

Abstract

Background and Aims
Genetic causes of chronic kidney disease are becoming more recognized. Familial lecithin: cholesterol acyltransferase (LCAT) deficiency (FLD) is a rare genetic disorder caused by loss of function mutations in LCAT gene. Patients present with abnormal lipid profile characterized with markedly reduced HDL-C, corneal opacification, anemia, and renal disease, which eventually progresses to kidney failure. Several studies reported genetic variants in LCAT gene that are associated with FLD, and others in certain apolipoprotein genes that act as risk factors for the disease. Incomplete form of FLD, caused by certain mutation, leads to fish-eye disease characterized by progressive corneal opacification. FLD was described in studies from Europe, Latin and North America, Australia and Japan. In Jordan, genetic and clinical studies in FLD patients are absent.

Method
We present a 36-year-old female who presented with nephrotic-range proteinuria, high serum creatinine, hypertension and corneal opacity. Further examination showed a severely reduced HDL level, an increased triglycerides level, anemia and mild thrombocytopenia. Patient's laboratory values at presentation are shown in Table 1. Her blood film showed normocytic and normochromic red blood cells, anisopoikilocytosis and target cells. Light and electron microscopy examination of the kidney biopsy revealed intramembranous, subendothelial and mesangial lipid deposition and vacuolization. In addition, the patient was found to have a family history of corneal opacity and chronic kidney disease. Therefore, FLD was suspected. Whole exome sequencing was employed to identify FLD variants.

Results
The patient was found to be homozygous at 154+5delG in LCAT gene, heterozygous at 388T&gt;C in apolipoprotein E gene (APOE) and homozygous at 1114G&gt;C in WW domain-containing oxidoreductase gene (WWOX). The patient's chronic kidney disease was managed supportively with low salt diet, moderate protein intake, statins, angiotensin receptor blockers and blood pressure control. After one year of follow up, her serum creatinine is 220 μmol/l and estimated proteinuria is 1.2 gm/24 hrs.

Conclusion
FLD should be suspected in patients who present with kidney disease associated with significantly low HDL cholesterol and corneal opacity. Family members should also be screened for kidney disease and genetic mutation in LCAT gene. To date, treatment is mainly supportive and enzyme replacement therapy is not yet widely available.
#6184 PULSE WAVE VELOCITY AND AMBULATORY BLOOD PRESSURE IN PATIENTS WITH RENAL HYPERFILTRATION
Authors: Kodal Nil , Kurultak Ilhan , Karagoz Ferdi , Üstündağ Sedat 
Published: June 2023

Abstract

Background and Aims
Recent studies have been implicated that abnormally increased glomerular filtration rate, defined as renal hyperfiltration, may be a risk factor for the development of renal damage and cardiovascular disease. Herein, we aimed to investigate the possible relationship between renal hyperfiltration(RHf) and pulse wave velocity, ambulatory blood pressure measurements and clinical parameters.

Method
All individuals included the study were between 18 and 65 years old. The eGFR (CKD-EPI) values of above 140 ml/min/1.73 m² were defined as RHf. Nineteen individuals in the renal hyperfiltration group and 20 in the control group were included. Blood and urine samples of the cases were examined. The individuals with diabetes, obesity, pregnancy, hypertension, cardiovascular disease, peripheral artery disease, cerebrovascular disease, chronic rheumatological disease, and thyroid dysfunction were excluded from the study. The parameters related arterial stiffness and ambulatory blood pressure measurements were obtained in all cases. The results were analyzed statistically.

Results
The two groups were similar in terms of gender, age, BMI and smoking. In RHf group, total cholesterol, 24-hour urine proteinuria and albuminuria, SBP, DBP, MAP and PP values ​​were found higher than control group. Interestingly, the differences of “night time” measurements of all these hemodynamic parameters were more pronounced in RHf group. The trend of “non-dipper” pattern was to be higher in the hyperfiltration group. In arterial stiffness parameters the augmentation pressure (AP), central systolic pressure (CSP), reflection magnitude (RM), central diastolic pressure (CBP), and pulse pressure amplification (PPA) were found significantly different. Pearson's corelation analysis revealed that AP, CSP, CBP was the positively; RM was negatively correlated with eGFR in hyperfiltration group (Table 1 and 2). Multivariate linear regression analysis revealed that AP, 24-hour proteinuria and mean arterial pressure were the independent parameters related to hyperfiltration. Logistic regression showed that only AP was an independent predictor of hyperfiltration (p = 0.001, OR = 0.84; 0.757-0.935, CI 95%).

Conclusion
We found that augmentation pressure is the most important independent parameter correlated with RHf among arterial stiffness measurements. The vascular risk may be increased in this population.