bluuebunny/crossref_metadata_2025_split huggingface dataset:
#4640 PREDICTION OF CHRONIC KIDNEY DISEASE PROGRESSSION WITH ARTIFICIAL INTELLIGENCE: A CHALLENGE WITHIN OUR REACH
Authors: Galles Oscar , Rodríguez Miriam Caravaca , Suppi Remo , Macias Edwar , Morell Antoni , Comas Jordi , Martinez Elisenda , Salas Tomas , Ibeas Jose 
Published: June 2023

Abstract

Background and Aims
Chronic Kidney Disease (CKD) is a common and debilitating condition that affects over 850 million people worldwide. The disease is associated with high mortality rates that can reach up to 10-15% per year, multiple complications, among which cardiovascular ones stand out. These complications can contribute to the progression of CKD, and this in turn to the appearance of complications, feeding each other. Despite the availability of clinical guidelines and predictive models, accurately predicting disease progression and identifying risk factors for progression in CKD patients remains a challenge. The limitations of current methodologies, including simplifying complex relationships and relying on linear assumptions, have hindered progress in this area. The advancement of Artificial Intelligence and Machine Learning has provided a new opportunity to address these challenges. The goal of this study was to evaluate the performance of gradient boosting algorithms in predicting the progression of renal disease in a large dataset of 1327 patients with a follow up of 10 years.

Method
Design: Retrospective analysis of a historical cohort from the Register of Renal Patients of Catalonia (RMRC) and the Data analytics program for health research and innovation (PADRIS) from Health Quality and Assessment Agency of Catalonia (AQuAS). Inclusion Criteria: &gt; 18 y.o. CKD stages from 2 to Renal Replacement Therapy (RRT) and adequate data after pre-processing the sample. N = 1.327 patients with 27.572 records. Follow up of 10 years (January 2010 - December 2020). Variables: Age, gender, BMI, Diagnoses (ICD-10) = 95, Transplant waiting list status; RRT status; Laboratory variables = 77; f) Pharmacological treatment = 100.

Method
By using Light Gradient-Boosting Machine (LGBM) testing CKD progression prediction horizon in quarterly windows for multiple periods.
Methodology: 1. Pre-processing of the sample and data. 2. Training and testing for variables exploration. 3. Dataset structuring in quarterly windows. 4. Samples randomization and data separation for a 5-fold cross-validation (20% test - 80% training). 5. Training and tuning of LGBM model for different prediction horizons.

Results
Age: 62 ± 13 years; Gender: 34% female, 66% male. Best prediction horizon was for 8 quarters (2 years), with a ROC curve of 0.967 and accuracy of 0.860. The 10 variables with major relevance in the model in order were estimated Glomerular Filtration Rate, Age, Microalbuminuria, BMI, HDL, Glucose, Urea, Platelets, Triglycerides and Sodium.

Conclusion
1. The prediction of CKD progression can benefit from the use of Machine Learning with results that outperform methods based on classical statistics. 2. It can allow the individualization of the prognosis and thus be able to carry out early interventions to improve the prognosis.
#4642 DO WOMEN HAVE LESS ACCESS TO THE KIDNEY TRANSPLANTATION WAITING LIST THAN MEN IN FRANCE?
Authors: Adoli Latame Komla , Pouliquen Valérie Chatelet , Daugas Eric , Lobbedez Thierry , Vabret Elsa , Jais Jean-Philippe , Bayer Florian , Vigneau Cécile , Couchoud Cécile , Bayat Sahar 
Published: June 2023

Abstract

Background and Aims
Studies performed in several countries and in some French regions showed that women have less access to kidney transplantation waiting list (KTWL) than men. The aim of this study is to analyse women's access to the kidney transplantation waiting list at the national level and in all French regions.

Method
This is a retrospective cohort study using the French National Renal Epidemiology registry (REIN). All incident patients initiated dialysis from 2017 to 2019 and aged between 18 and 85 were included. Patients were followed three years from the dialysis start. Our outcome of interest was the registration on the KTWL 1 and 3 years following dialysis initiation. We performed Cox proportional hazard models, adjusted on age, comorbidities and neighbourhood deprivation level using European Deprivation Index (EDI), at national level and in all French regions. The sex/age and sex/EDI interactions were studied.

Results
29 395 patients started dialysis in 2017-2019. 35% were women. 40% of female and 34% of male patients lived in most deprived areas. Men were more comorbid than women were at dialysis start. At the national level, women had less access to the KTWL compared to men one (adjHR: 0.91; IC95: [0.87 – 0.96]) and three years (adjHR: 0.87 [0.84 – 0.91]) after dialysis start. There was no significant sex/EDI interaction but a significant sex/age interaction. Therefore, the analyses were stratified by age (&lt;60 and ≥ 60 years old). Only women aged more than 60 had less access to the KTWL at one year (adjHR: 0.76 [0.71 – 0.82]) and three years (adjHR: 0.75 [0.71 – 0.81]). At regional level, the same trends were found in Nouvelle Aquitaine and Pays de Loire one-year after dialysis start and two more regions (Bourgogne-Franche-Comté and Île-de-France) 3 years after dialysis start.

Conclusion
This study shows that women have less access to KT WL one and three years after dialysis start on the national level and in some regions. This disparity is found to be present especially among patients aged beyond 60 years. A qualitative study is planned to better understand this sex based disparity.
#4657 COMPARISON OF TWO BIOIMPEDANCE SPECTROSCOPY DEVICES: A PRACTICAL STEP FORWARD ON THE WAY TO DAILY BIOIMPEDANCE MEASUREMENTS FOR DIALYSIS PATIENTS
Authors: Mussnig Sebastian , Krenn Simon , Wabel Peter , Hecking Manfred 
Published: June 2023

Abstract

Background and Aims
Bioimpedance spectroscopy (BIS) is a non-invasive diagnostic tool to assess volume status and body composition through the measurement of voltage drops in alternating currents and subsequent extrapolation of extracellular (R0), intracellular (Ri), and total body (RInf) resistances. Currently available devices mostly rely on disposable electrodes and require supine body position. Here we tested whether a new, more versatile BIS device with reusable electrodes matches an established system in various setups, aiming to enable daily BIS-measurements in the near future.

Method
Two BIS devices (“Cella” and the “Body Composition Monitor” [BCM]) were compared both with four resistance testboxes (circuit boards with resistors and capacitors simulating different body conditions) and in 40 healthy volunteers. In-vivo comparisons included supine hand-to-foot (HF) reference measurements with adhesive disposable electrodes and hand-to-hand (HH) measurements with adhesive disposable and prototype reusable electrode sets (Figure 1).

Results
Analyses of testboxes were reproducible in both devices (intra-device coefficients of variation &lt;1%). Mean differences from testbox components were similar and small for R0 (2-3 Ohm) but not for Ri, where Cella was off by 101 Ohm compared to the BCM's 29 Ohm in a testbox designed with a deliberately low R0/Ri ratio. In-vivo, HF measurements with disposable electrodes differed significantly between both devices (p &lt; 0.001). Prototype reusable HH electrodes exhibited a bias towards larger resistances than HF measurements (R0: 738.36 Ohm vs. 643.09 Ohm; Ri: 1508.18 Ohm vs. 1257.17 Ohm; RInf 500.03 vs. 423.81 Ohm, respectively) and the HH/HF ratio varied between 1.0-1.4 (R0 and RInf) and 0.9-1.6 (Ri).

Conclusion
While the Cella BIS device was shown to produce results with comparable consistency to the BCM in-vivo, the latter measured more accurately under testbox conditions. Accuracy of in-vivo measurements could not be determined for lack of gold-standard measurements. Implementation of HH reusable electrodes will require per-patient calibration against HF measurements due to the large inter-patient fluctuations in the HH/HF ratio. We recommend further longitudinal analyses of intra-patient HH/HF ratios to investigate long-term variabilities.
#4670 HYPERPARATHYROIDISM DURING 1ST YEAR OF RENAL TRANSPLANT IS ASSOCIATED WITH LONG TERM GRAFT LOSS
Authors: Alfieri Carlo Maria , Molinari Paolo , Cicero Elisa , Cresseri Donata , Regalia Anna , Campise Maria Rosaria , Verdesca Simona , Favi Evaldo , Castellano Giuseppe 
Published: June 2023

Abstract

Background and Aims
Persistent hyperparathyroidism (HPT) is a frequent problem, especially during the first year after Renal transplant (RTx). We aimed to evaluate the possible association between parathormone (PTH) levels during 1st year of RTx and long-term graft loss (GL) in RTx patients (RTx-p).

Method
We retrospectively evaluated 871 RTx-p, transplanted in our unit from 2004 to 2020. We measured main renal function and mineral metabolism parameters at 1 month (T1), 6 months (T6) and 12 months (T12) after RTx. Renal outcome was intended as GL during the global follow-up (FU) of 103±60 mths.

Results
Mean age at RTx was of 49+13 yrs and 58% of RTx-p were male. Most of the RTx-p were on hemodialysis (HD) before RTx (77%) with a mean dialysis vintage of 53+52 months. Most of our cohort (84%) received a kidney from a deceased donor. HPT was highly prevalent during the 1st year of FU; at T1 79% of RTx-p were HPT, of which 63% had secondary HPT (SHPT) and 16% had tertiary HPT (THPT). Comparable prevalence was observed at T6 (HPT 80%; SHPT 64%; THPT 16%) and at T12 (HPT 77%; SHPT 62%; THPT 15%). A strong significant correlation was found between HPT type and GL at every time point [T1 GL: no HPT 6%, SHPT 11% THPT 24%, p&lt;0.0001 - T6 GL: no HPT 9%, SHPT 9% THPT 22%, p&lt;0.0001 - T12 GL: no HPT 8%, SHPT 9% THPT 21%, p = .008]. Moreover, PTH levels at T1 (GL+: 90.3 [50.6-165.6] vs. GL-: 61.7 [37.4-98.8] p&lt;0.0001), at T6 (GL+: 83.6 [47.1-152.4] vs. GL-: 56.1 [38.3-89.7] p&lt;0.0001) and at T12 (GL+: 69.8 [44-121.9] vs. GL-: 54.6 [36.4-84.1] p = 0.008) were significantly correlated to GL. PTH levels at T1 and T6 were associated with long-term GL [T1, OR: 3.3 (1.3-8.1), p = 0.01 - T6, OR: 3.9 (1.7-9.2), p = 0.001]. Then we considered PTH levels as mean exposure during the first year. Mean PTH exposure alone was strongly associated with GL [OR: 5.7 (2.7- 11.9), p&lt;0.0001]. A multivariate logistic regression analysis was also performed. In the model, we considered 1st year mean PTH exposure and the main factors associated with GL (pre-RTx dialysis vintage, 1st year rejection, T12 uric acid, T12-Proteinuria and T12-MDRD). Mean PTH exposure remained strongly and independently associated with long-term GL (OR 3.1 [1.4-7.1], p = 0.008). We finally performed a ROC curve to calculate the best 1st-year mean PTH cut-off to predict long-term GL. AUC was 0.658, with a p&lt;0.0001. Using Youden index we identified the best mean PTH cut off to be 88.6 pg/ml.

Conclusion
In our cohort of 871 RTx-p, the prevalence of HPT during the first year of RTx is quite high. High PTH levels during 1st year of RTx were independently associated with long-term GL. HPT might be considered a therapeutic target to prevent long-term graft failure.
#4682 DOES RENAL ASYMMETRY WITH HYPERTENSION EQUAL RENAL ARTERY STENOSIS?
Authors: Barrios R Haridian Sosa , Bustamante Adriana Maria Cavada , Quilis Aina , Díez Pablo , Clara Sanz , Vion Víctor Burguera , Lucas Milagros Fernandez , Rivera Maite 
Published: June 2023

Abstract

Background and Aims
Renal ultrasound (US) is a basic imaging study in renal disease with hypertension (HTN) work up. Asymmetry is a frequent finding but it does not equal renal artery stenosis (RAS). Our aim was to describe the incidence of asymmetry findings in our Diagnostic and Interventional Nephrology Unit (DINU) and study its correlation with HTN and RAS.

Method

Results

Conclusion
Renal asymmetry is infrequent (2%) and in up to a quarter of those this finding is related to RAS. In our experience, asymmetry associates with hypertension even if no RAS is present: renal asymmetry associates with higher hypertension prevalence and higher medication requirements to reach acceptable blood pressure control.
#4690 INFLUENCE OF CHRONIC KIDNEY DISEASE AND GLOMERULAR FILTRATION RATE ON THE COURSE OF ACUTE SARS-COV-2 INFECTION AND POST-COVID PERIOD
Authors: Arutyunov Alexander , Trubnikova Marina , Arutyunov Gregory , Tarlovskaya Ekaterina , Batyushin Mikhail , Bashkinov Roman , Melnikov Evgenii , Batluk Tatiana , Gordeychuk Elizaveta 
Published: June 2023

Abstract

Background and Aims
According to international data available in the literature, chronic kidney disease (CKD) may have a significant impact on the course and outcome of COVID-19. Moreover, kidney pathology have been suggested to aggravate the course of the post-COVID period. The aim of the study was to investigate the effect of CKD and glomerular filtration rate (GFR) on the course of acute infection and post-COVID period.

Method
An international register “Dynamics analysis of comorbidities in SAES-CoV-2 survivors” (ACTIV) (NCT04492384) was established to assess the characteristics of the course of NCI in the Eurasian region. Specialists from 7 countries participated in the register. ACTIV is a multicenter, non-interventional, real-world clinical practice registry that included men and women over 18 years of age with a confirmed diagnosis of COVID-19. The analysis presented is based on data from 8496 patients with an estimated GFR of ≥90 ml/min/1.73 m2 - 3591 (42.3%) patients, 89-60 ml/min/1.73 m2 3105 (36.5%) patients, 59-45 ml/min/1.73 m2 - 1132 (13.3%) patients, 44-30 ml/min/1.73 m2 - 433 (5.10%) patients, 29 -15 ml/min/1.73 m2 - 141 (1.7%) patients, &lt;15 ml/min/1.73 m2 - 94 (1.1%) patients. GFR was calculated using the 2021 CKD-EPI formula. The post-COVID period was analyzed using data from telephone interviews that included 3099 patients at 3 months, 2493 patients at 6 months, and 1782 patients at 12 months after recovery from COVID-19.

Results
During the acute infection, patients with a GFR of 59-15 ml/min/1.73 m2, had more severe lung tissue damage (stage 3-4 according to computed tomography (CT), p &lt; 0.001) and worse oxygenation (SpO2 75-94% and less than 75%, p &lt; 0.001); increased respiratory rate (over 22 per minute, p &lt; 0.001); and higher body temperature (more than 38.6°C, p &lt; 0.001) compared with patients with GFR over 60 ml/min/1.73 m2. In addition, CKD increased the odds of death in hospitalized patients by 3.94-fold compared with patients without CKD (95% confidence interval (CI) 3.15-4.89, p &lt; 0.001). The data of the deceased patients showed that most of them had a GFR of 89–60 ml/min/1.73 m2, which corresponds to stage 2 CKD (Table 1). CKD was a risk factor for increased odds of death in the post-COVID period: 4.88-fold (95% CI 2.42-9.13; p &lt; 0.001) within 3 months; 4.24-fold (95% CI 0.60-16.3; p = 0.126) within 6 months and 8.36 -fold (95% CI 1.73-29.3; p = 0.112) within 12 months after recovery from SARS-CoV-2.

Conclusion
CKD could be a predictor of a more severe acute period of COVID-19 and also significantly impact mortality within 12 months after recovery from SARS-CoV-2.
#4703 IMPACT OF THE EARLY STAGES OF CKD WITH AND WITHOUT PROTEINURIA ON CARDIOVASCULAR OUTCOMES IN THE UK BIOBANK COHORT
Authors: Yaqoob Khadija , Naderi Hafiz , Thomson Ross , Aksentijevic Dunja , Petersen Steffen , Aung Nay , Yaqoob Muhammad 
Published: June 2023

Abstract

Background and Aims
Chronic kidney disease (CKD) is an established predictor of cardiovascular disease. However, the relationship between cardiovascular disease and the early stages of CKD defined as stage 1 (eGFR &gt; 90 mL/min per 1.73 m2 + albuminuria) and stage 2 (eGFR 60–89 mL/min per 1.73 m2) with and without proteinuria, is lacking. In this study, we explored the incidence of major adverse cardiovascular events (MACE), heart failure (HF) and all-cause mortality of participants with early stages of CKD in the UK Biobank population.

Method
456,015 participants from the UK Biobank were categorised into CKD stages. We calculated eGFR using the CKD-EPI 2021 equation and proteinuria was ascertained by the urinary protein creatinine ratio (defined as &gt; 30mg/ mmol). We demonstrated the survival probability of adverse outcomes using unadjusted Kaplan-Meier curves and performed an adjusted Cox proportional hazard analysis to include MACE, HF, MACE and HF and all-cause mortality across CKD stages.

Results
Among the participants (mean age ± standard deviation, 56.5 ± 8.1 years) 282,121 (61.9%) had normal kidney function, 33,582 (7.4%) stage 1 CKD, 121,358 (26.6%) stage 2 CKD without proteinuria, 10,788 (2.4%) stage 2 CKD with proteinuria, 4,654 (1.0%) CKD stage 3A (eGFR 59-45mL/min per 1.73 m2) without proteinuria, 1034 (0.2%) stage 3A with proteinuria and 1,478 (0.3%) with more advanced CKD defined as stages 3B and above. Using Cox regression setting normal kidney function as the reference group, with the exception of stage 2 CKD without proteinuria; there was a progressive increase in the hazard ratio (HR) in all other stages of CKD with respect to MACE, HF, MACE and HF (Figure 1). Significantly, stage 2 CKD without proteinuria was associated with a lower incidence of adverse events than stage 1 CKD and had a comparable prognosis to normal renal function. There was a statistically significant association between stage 2 with proteinuria and MACE (HR 1.33, CI: 1.26 – 1.41), which was comparable to stage 3A without proteinuria (HR 1.32, CI: 1.22 – 1.42). Preliminary analysis of the ongoing cardiac magnetic resonance imaging (cMRI) data from this cohort shows similar progressive changes, apart from stage 2 CKD without proteinuria.

Conclusion
The presence of proteinuria in patients with mild CKD is a significant risk factor for MACE, HF, cMRI changes and all-cause mortality independent of age, sex, ethnicity, height, BMI, hypertension, diabetes, smoking status, and hyperlipidaemia. We recommend that in order to better risk stratify patients for prognostication and early treatment, stage 2 CKD should be considered as a significant cardiovascular risk only in the presence of proteinuria.
#4743 OMNIGRAF (COMBINED GENE EXPRESSION AND DD-CF DNA) USE IN MONITORING RENAL ALLOGRAFT REJECTION IN MULTIORGAN TRANSPLANT RECIPIENTS
Authors: Zaky Ziad , Fleming James , Weems Juston 
Published: June 2023

Abstract

Background and Aims
To date there is no clinically available non-invasive biomarker to monitor for renal allograft rejection in multiorgan transplant recipients. TruGraf (Gene expression profile) and TRAC (dd-cf DNA), as part of the biomarker panel OmniGraf, have shown to be reliable “rule out” tests for subclinical rejection in stable kidney transplant recipients. However, the validity and utility of these tests in monitoring for renal allograft rejections in the setting of multiorgan transplants has yet to be assessed. The aim of this study is to assess the feasibility of using the biomarkers individually, as well as together in the OmniGraf biomarker panel, to assist in making the decision to perform a renal allograft biopsy in multiorgan transplant recipients.

Method
This is an ongoing prospective, observational sample collection study in any multiorgan (kidney + non-renal organ) undergoing a renal allograft biopsy. Biopsies were considered positive if they showed rejection in the kidney based on Banff 2019 and included borderline changes as positive results. Copper-Pearson 95% CI were used for sensitivity, specificity, and accuracy; standard logit CIs were used for NPV and PPV. For TruGraf, (TX = negative result) and (not-TX = positive test). For TRAC, 0.7% was used as the threshold for all organs except for those that had a liver transplant, where a threshold of 15% was used to determine positive vs. negative.

Results
Paired renal allograft surveillance biopsies and biomarker samples were available for 20 patients. Of the 20, 9 (45%) were liver-kidney transplants, 6 (30%) were heart-kidney transplants, and 5 (25%) were kidney-pancreas transplants. Nine (45%) of the patients were male, 14 (70%) were White, 5 (25%) were Black, and 1 patient was Hispanic. The mean age was 50 ± 13 years. Average SrCr was 1.3 ± 0.5 mg/dL. Of the 20 paired biopsies and samples, 2 (10%) had only TruGraf results, while the other 18 (90%) had OmniGraf (TruGraf and TRAC). There were 2 rejections (borderline changes). Diagnostic performance is presented in tables 1–4. Both TruGraf and TRAC individually had NPV of 89% and 85%, respectively, and PPV of 65% and 73%, respectively. When analyzing the performance of the OmniGraf biomarker panel, OmniGraf +/+ showed a 100% PPV and OmniGraf -/- showed a 100% NPV.

Conclusion
In this analysis of renal allograft biopsies in a multiorgan transplant cohort, TruGraf, TRAC (when using organ-dependent thresholds) had reasonable diagnostic performance as a “rule out” test. When the tests are combined into OmniGraf, the PPV and NPV were 100% when both tests agreed with each other. These outcomes justify potential use and the need for continued analysis of the utility of the OmniGraf biomarker panel in monitoring renal allograft in multiorgan transplant recipients.
#4767 ACUTE CORTICAL NECROSIS IN PREGNANCY IS STILL AN IMPORTANT CAUSE FOR END-STAGE RENAL DISEASE IN DEVELOPING COUNTRIES
Authors: Kaul Anupma , Bhaduaria Dharmendra , Prasad Narayan 
Published: June 2023

Abstract

Background and Aims
Renal cortical necrosis (RCN) is a serious complication of acute kidney injury (AKI) and pregnancy is a clinical state closely associated with it with poor renal outcomes. The incidence is much higher in obstetrical AKI compared to other causes of RCN. Despite better medical care facilities available, this continues to be an important cause of morbidity and mortality in developing countries.

Method
This is a retrospective analysis among all pregnant females presenting with AKI from January 2000 to December 2020 at a tertiary care center in the northern part of India. We looked for the incidence of obstetrical-related RCN in our renal biopsies performed in the last 20 years and to evaluate precipitating factors responsible for RCN.

Results
RCN constituted 8.1 % of pregnancy-related AKI cases in our institution. The overall incidence has been declining which was 9.09% from 2000 to 2008 to 8.7 % from 2009 to 2014 and 8.1% from 2014-2020. The patient's median age was 28.4 ± 4.6 years. The average time to presentation from the day of delivery was 7.8 ±3.0 days. The mortality was observed in 10.4 % of them with sepsis and multiorgan dysfunction present in all of them. The most common etiology for RCN was found to be septic abortion and puerperal sepsis accounting for - 16.2 % each. Postpartum hemorrhage was a cause in 9.67 % of patients. The most important cause of RCN was postpartum thrombotic microangiopathy which was observed in 49.5% of patients. Kidney biopsy was helpful in diagnosis in 36 patients while computed tomography scan abdomen alone helped in diagnosis in five patients. Patchy cortical necrosis in histology was seen in 36.7% of patients and morbidity in terms of prolonged hospitalization was seen in 23.4 % while dialysis dependency in 63.4% of the study population

Conclusion
Strategies need to be implemented in reducing the preventable causes for RCN which is not only catastrophic in terms of renal outcomes but also for social and psychological perspectives as well.