bluuebunny/crossref_metadata_2025_split huggingface dataset:
#6898 CATHETER RELATED BLOODSTREAM INFECTION IN NON-TUNNELED HEMODIALYSIS CATHETERS IN A RESOURCE-LIMITED HOSPITAL IN MERIDA, YUCATAN, MEXICO
Authors: Pech Julio , Tapia Leticia 
Published: June 2023

Abstract

Background and Aims
There is scarcity in epidemiological data regarding chronic kidney (CKD) disease in low- and medium-income countries, and information about vascular access infectious complications is limited. In Mexico, access to renal replacement therapy (RRT) is burdensome for the uninsured patients. The General Hospital Agustin O'Horán, is a secondary care level unit in Yucatan, which receives uninsured patients from southeast Mexico. In our hospital, patients who are not candidates for peritoneal dialysis start hemodialysis with non-tunneled hemodialysis central venous catheters (NTHC), mainly due to the late nephrology referral and the shortage of vascular access specialists in our unit which prevents for the timely creation of an arteriovenous fistula or the placement of a tunneled hemodialysis catheter (THC). Permanence of NTHC is the main risk factor for catheter related bloodstream infection (CRBI) and according to the literature, Gram positive microorganisms are the most common isolated microbes. The aim of our study was to describe the incidence and risk factors for CRBSI in our hospital, from January to December 2022.

Method
We conducted a prospective and observational study in patients older than 18 years with CKD who were candidates to start hemodialysis and who had a NTHC inserted in our hospital from January to December 2022. We evaluated the incidence, organisms and risk factors related to CRBSI.

Results
During the study period, 94 NTHC were placed, 63.8% of them were inserted in women. Median age of the population was 49.4 years, and the most frequent comorbidities were diabetes mellitus (63.8%), hypertension (86.2%) and renal lithiasis (27.7%). 73.4% of the NTHC were Mahurkar® catheters and most of the insertions (73.4%) were not ultrasound guided. The right jugular vein was the most common insertion site (72.3%), followed by the left jugular vein. Mean catheter use duration was 71 ± 66 days. 27 patients had evidence of CRBI, the incidence rate was 0.78 per 1000 catheters-day. CRBI was more frequent in patients with prolonged catheter use (more than 30 days) (p&lt;0.001) (Table 1). In respect to blood cultures reports, 51.83% were Gram positive organisms and 48.12% were Gram negative (Table 2).

Conclusion
Vascular access survival without infectious complications is of paramount importance in hemodialysis patients. The prolonged used of NTHC with the associated risk for developing CRBI negatively impacts the health outcomes in our population. In accordance to previously published literature, the main isolated microbes in our hospital comprise Gram positive bacteria. One of the biggest challenges in our country is to provide our CKD population with better vascular access options like THC or arteriovenous fistula to improve the outcomes and reduce infectious complications.
#6963 OBESITY, METABOLIC SYNDROME AND THE RISK OF ADVERSE CLINICAL OUTCOMES IN PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Kang Shinyeong , Hwang Hyeon Seok , Kim Jin Sug , Jeong Kyunghwan 
Published: June 2023

Abstract

Background and Aims
Obesity and metabolic syndrome are prevalent disorder in patients with chronic kidney disease (CKD). However, it is unclear whether obesity without metabolic syndrome is associated with higher risk of adverse clinical outcomes in patients with CKD.

Method
We reviewed the National Health Insurance Service database of Korea for people who received ≥2 national health screenings between 2009 and 2011. A total of 68,464 chronic kidney disease patients were identified with consecutive estimated glomerular filtration rate &lt;60 ml/min per 1.73 m2. Obesity was defined as body mass index ≥25 kg/m2 and metabolic syndrome status was considered as the presence of three or more of the following metabolic factors; waist circumference, blood pressure, fasting blood sugar, triglyceride level, high-density lipoprotein cholesterol level. The primary outcomes were cardiovascular events, end-stage renal disease progression (ESRD) and all-cause mortality.

Results
Compared to non-obese patients without metabolic syndrome, obesity without metabolic syndrome did not increase the risk of cardiovascular event (HR 1.02, 95% CI 0.95–1.11) and progression to ESRD (HR 0.86, 95% CI 0.73–1.02). Risk of all-cause mortality was significantly decreased in these patients (HR 0.88, 95% CI 0.81–0.96). These findings were consistently observed in overweight, obese, morbid obese patients without metabolic syndrome. In addition, while linear increase of HRs for each additional metabolic abnormality was observed, HRs increase for cardiovascular event was significantly slower in obese patients than in non-obese (P for interaction = 0.035).

Conclusion
Obesity without metabolic syndrome did not confer excess risk for cardiovascular complication or ESRD progression and decreased the risk of all-cause mortality. Healthy effect of obesity against mortality risk and metabolic hazard on cardiovascular event is better to be considered in CKD patients.
#2572 CLINICAL CHARACTERISTICS OF ACUTE KIDNEY INJURY IN PATIENTS WITH GLUFOSINATE POISONING
Authors: Cho A Young , Sun In O , Oh Ju Hwan 
Published: June 2023

Abstract

Background and Aims
Glufosinate-containing herbicide is widely used in agriculture. According to previous reports, glufosinate poisoning causes various complications, but there are few reports of nephrotoxicity. In this study, we investigated the incidence and clinical characteristics of acute kidney injury (AKI) in patients with glufosinate poisoning.

Method
This study performed between 2008 and 2021 included 76 patients categorized into the AKI and the non-AKI groups. The incidence, clinical characteristics, and severity of AKI were compared between the AKI (n=54) and the non-AKI (n=22) groups, based on the Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease classification.

Results
The incidence of AKI was 71.1%, of which 40.9%, 26.3%, and 3.9% patients were classified into the Risk, Injury, and Failure categories, respectively. Patients in the AKI group were older (62.6±14.2 years vs. 54.9±16.2 years, P=0.045) and poorer renal function (73.9±25.2 mL/min/1.73 m² vs. 94.5±35.5 mL/min/1.73 m², P=0.006) on admission. The length of hospitalization was longer (17.2±17.2 days vs. 7.6±7.6 days, P=0.014) in AKI group, and the mean amount of glufosinate ingested was higher in AKI group than that in non-AKI group (250±172 mL vs. 152±121 mL, P=0.032). In addition, the serum bicarbonate level was lower in AKI group than in non-AKI group (19.9±4.7 vs. 23.0±3.3, P=0.006). Notably, intensive care unit admissions (81.5% vs. 40.9%, P=0.001) and mechanical ventilator support (68.5% vs. 22.7%, P&lt;0.001) were more frequently required in the AKI group. Multivariate logistic regression analysis showed that serum bicarbonate concentration on admission remained significant predictors of AKI in patient with glufosinate poisoning.

Conclusion
Serum bicarbonate is helpful to predict the development of patients with glufosinate poisoning.
#2867 EARLY DETECTION OF VASCULAR ACCESS STENOSIS USING NEPHROFLOW
Authors: Sanchez Soledad Pizarro , Toaza Alejandra Elizabeth Collantes , Picasso Maria López , Garcia Eleno Burgos , Saico Saul Pampa , Alexandru Simona , Suarez Laura García-Puente 
Published: June 2023

Abstract

Background and Aims
The monitoring programs for vascular access make it possible to detect access dysfunction and indicate the need to perform an imaging test to confirm the presence of stenosis and proceed with its treatment. Measurement of arteriovenous fistula (AVF) flow using biosensors is a simple and reproducible method of vascular access assessment. AVF flow (QA) drops below 500 ml/min or a reduction of more than 25% in previous flow are considered predictors of stenosis and/or thrombosis. A stenosis with a high risk of thrombosis is defined as that which presents a decrease of more than 50% in the vascular lumen and a stenosis/prestenosis Peak Systolic Velocity ratio &gt; 2, with additional criteria (residual diameter &lt; 2 mm and/or QA (ml/ min) &lt; 500 (native AVF) or and/or decrease in QA &gt; 25% if QA &lt; 1,000 ml/min.

Method
We performed AVF flow measurement using the NephroFlow biosensor in prevalent hemodialysis patients.

Results
Sixty-one patients were studied, all with native or prosthetic AVF. Of which 42 men and 19 women. The distribution of AVFs was: 38 brachiocephalic (62%), 16 radiocephalic (26%) and 6 brachial-axillary prostheses (10%) 1 brachial-basilic (2%). The data was collected for 24 months. The mean follow-up time for the AVF was 16 months. In 17 patients (30%), flow was detected below 25% compared to previous controls or a decrease in QA &lt;500 ml/min. In these patients, echo-doppler was performed, showing in 15 cases stenosis with a high risk of thrombosis that was treated with angioplasty. In 1 patient, echo-doppler detected only insufficiency of the artery, and no stenosis was observed in fistulography. In 1 patient, there was a significant drop in flow (from 830 to 451 ml/min), which later recovered 650 ml/min with ultrasound without significant alterations, so an endovascular procedure was not performed. During the study period, 1 fistula thrombosis occurred in a patient who had already detected a drop in flow but could not repair it in time. At the end of the study, of the 61 patients analyzed, 51 patients continued with the technique and the flows remained stable or even increased. In the other 10 patients, 9 left due to transplantation or death and 1 patient had a new thrombosis and the AVF could not be repaired.

Conclusion
In hemodialysis units, the measurement of AVF flow using biosensors should be protocolized together with Doppler ultrasound to achieve better monitoring of vascular access, managing to detect and treat early stenosis with a high risk of thrombosis.
#3250 RENAL HAEMODYNAMIC PARAMETERS IN DIABETIC NEPHROPATHY
Authors: Malidretos Pavlos , Anagnostou Nikolaos , Palaiologos Dimitrios , Tanou Kalliopi , Koutroumpas Georgios 
Published: June 2023

Abstract

Background and Aims
Diabetic nephropathy is the leading cause of chronic kidney disease in modern world. Timely diagnosis is of paramount importance, especially after the recent introduction of novel therapies. The presence of an already altered renal haemodynamic profile was investigated in all patients referred with suspected diabetic nephropathy, upon their initial presentation to our renal department.

Method
During the past seven years, from January 2015 to December 2022, 578 patients were referred to the Renal Department for ultrasound assessment. Additionally to their standard assessment, they underwent renal ultrasound and triplex examination. Diabetic nephropathy (DN) was diagnosed in 149 patients. A group of patients with an estimated GFR&gt; 60 ml/min, without diabetic nephropathy, was randomly selected from the same pull of patients for comparison reasons (control group). Renal haemodynamics assessment, including renal arteries, aorta and intrarenal resistive indexes (RI) of both kidneys, estimated glomerular filtration rate (CKDEPI) and 24h albuminuria, were evaluated in all patients.

Results
The mean age of the patients was 72.5 ±10.4 vs 65.8 ±6.9 years, for the DN and control group respectively. Renal length was comparable in both groups, renal diameter of left kidney was 10.61 ±1.28 vs. 10.59 ±1.44 cm and renal diameter of right kidney was 10.53 ±1.38 vs. 9.85 ±2.89 cm for DN group and control respectively. The estimated GFR was significantly lower in the DN group, 42.1±23.6 vs. 82.7 ±11.3 ml/min (p&lt;0.05). Both renal arteries presented higher velocity values in the DN group, 53.4 ±22.2 vs. 21.7 ±28.9 cm/sec (p&lt;0.0001) and 52.4 ±23.9 vs. 24.8 ±32.3 (p&lt;0.0001), for the left and right renal artery. DN patients showed RI values above upper normal limit of 0.70, being at the same time significantly higher compared to control group, 0.73 ±0.06 vs. 0.61 ±0.17 (p&lt;0.0001) and 0.72 ±0.06 vs. 0.59 ±0.20 (p&lt;0.0001), for the left and right kidney respectively.

Conclusion
The presence of significantly increased renal artery velocity in diabetic nephropathy patients compared to control patients has not been described earlier to the best of our knowledge. It represents a new finding that is mainly attributed to the presence of arteriopathy. Evaluation of renal haemodynamics using triplex ultrasound, represents a non – invasive, readily available, inexpensive examination. When performed at initial patient presentation, constitutes an invaluable tool, timely assisting to diagnosis and treatment of diabetic patients.
#3293 ESTRADIOL REPLACEMENT MITIGATED BLOOD PRESSURE ELEVATION VIA SUPPRESSION OF NCC IN ANGIOTENSIN II-INFUSED OVARIECTOMIZED FEMALE RATS
Authors: Kim Yang-Gyun , Lee Sang-Ho , Moon Ju-Young , Jung Su Woong , Park Jihoon , Jin In Tae , Joo Yoosun , Cho Minhae 
Published: June 2023

Abstract

Background and Aims
Female rats excrete more urine sodium than male rats with similar blood pressure (BP). However, it is not clear whether the sex difference in pressure natriuresis is conserved in menopausal rats. We assessed whether the natriuretic response and renal sodium transporter activity in ovariectomized female rats infused with angiotensin II (ANGII) could be affected by estrogen supplementation.

Method
Six-week-old female Sprague-Dawley rats (n=30) were ovariectomized (OVX, n =20) or sham-operated (n=10) (−4 weeks, −4W). After 2 weeks, subcutaneous estradiol was administered to half of the OVX rats (n=10) for 4 weeks (-2W∼2W). ANGII was infused via the osmotic minipump in 60% of the rats for 2 weeks (0W∼2W). Six groups (female saline: FS, female ANGII: FA, OVX saline: OS, OVX ANGII: OA, OVX estradiol saline: OES, OVX estradiol ANGII: OEA) were sacrificed after 2 weeks of the ANGII infusion (2W). We also analyzed human data from the Korean Genome and Epidemiology Study (KoGES).

Results
ANGII-induced BP elevation was highest in the OA group, followed by the FA and OEA groups. Urine sodium tended to increase after ANGII infusion in FA and OEA but decreased in OA. Western blot results showed that cortical phosphorylated sodium chloride cotransporter (pNCC) tended to be augmented by ANGII treatment in FA and OA, but mitigated in OEA. Cortical ANGII type 2 receptor (AT2R) expression was significantly higher in estradiol-treated OVX rats than in OVX rats, irrespective of ANGII infusion. Similarly, the enhanced pNCC in ANGII-treated distal convoluted tubular cells was reversed by estradiol treatment. In KoGES data, urine sodium was significantly lower in postmenopausal women than in premenopausal women, despite the higher BP.

Conclusion
Estradiol reversed BP elevation and augmented the natriuretic response in ANGII-infused OVX rats and distal tubular cells via suppression of pNCC and increase of AT2R.
#3418 DISAPPEARANCE OF GLOMERULAR C3 DEPOSITION MIGHT BE A PROGNOSTIC MARKER IN MEMBRANOUS NEPHROPATHY AFTER TREATMENT
Authors: Cho Byoung-Soo , Jung Sung Min , Cho Won Hee , Lee Hyunsoon 
Published: June 2023

Abstract

Background and Aims
Membranous nephropathy (MN) is the most common cause of nephrotic syndrome (NS) in adults. In about 80% is primary and remaining 20% are secondary due to medications or other diseases. Treatment of primary MN remains controversial, and the prognosis is still difficult to predict despite the introduction of anti phospholipase A2 receptor (PLA2R) antibody. We evaluated pathological changes for predicting prognosis in patients of MN after methyprednisolone (MPD) pulse therapy.

Method
We performed 1,649 renal biopsies at the OPD during last 9 years, of which 31 subjects were MN. We performed follow up biopsy who showed normal urinary findings after treatment with MPD pulse therapy in 11 subjects of MN. Indications of the initial biopsy in MN were oral steroid resistant NS (9 subjects), massive proteinuria associated with hematuria (2 subjects). Among the 11 subjects of MN, 3 subjects were lupus nephritis (LN), 8 subjects were primary MN. One cycle of MPD consist of 10-20 mg/kg (max 1.0 g)/day for 3 consecutive days, performing every 10 to 14 days. Mean MPD pulse therapy were done 13 cycles

Results
Among the 11 cases of MN, male to female ratio was 6 to 5. Age distribution from 1 year old to 61years old (mean 40.8 y/o), Mean spot urine protein to creatinine before treatment was 4,182.5 mg/g and 189.4 mg/g after treatment. 9 subjects showed glomerular C3 deposition were noted at the initial biopsy and 2 subjects showed no C3 deposition. After treatment glomerular C3 deposition were disappeared in 8 subjects, and showed no relapse during 5.3 years follow up. However, 3 subjects who showed glomerular C3 deposition were lupus nephritis, relapsed during follow up period.

Conclusion
MPD pulse therapy might be still promising therapeutic modality in conventional oral steroid resistant MN. Although further larger number of studies are mandatory, disappearance of glomerular C3 deposition might be a prognostic marker for treatment response, instead of disappearance of proteinuria in MN.
#3859 THE TREND OF RENAL REPLACEMENT THERAPY IN N. MACEDONIA FROM 2015 TO 2020: DATA FROM THE ERA-EDTA ANNUAL REGISTRY
Authors: Gjorgjievski Nikola , Stojanoska Ana , Dzekova-Vidimliski Pavlina , Cibrev Dragan , Bushljetik Irena Rambabova- , Trajcheska Lada , Karanfiolvski Vlatko , Andreevska Galina Severova- , Markovska Zhaklina Shterjova- , Taneska Aleksandra Canevska , Petronijevikj Zvezdana , Pushevski Vladimir , Dejanov Petar , Nikolov Igor , Spasovski Goce 
Published: June 2023

Abstract

Background and Aims
Kidney Failure (KF) is treated with three modalities of renal replacement therapy (RRT): kidney transplantation (Tx), hemodialysis (HD), and peritoneal dialysis (PD). Our study aimed to present the trend of RRT in N. Macedonia from 2015 to 2020.

Method
The epidemiological retrospective study analyzed the patients with kidney failure by gender, age, etiology of kidney disease, and modality of RRT. The data were processed from the annual reports of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA). The study patients were divided into group 1 (prevalent) with patients on the RRT at the current year, group 2 (incidence at Day 1) with patients on the RRT with a duration of at least 1 day, and group 3 (incidence at Day 91) with patients on the RRT with a duration beyond 91 days.

Results
A total of 10395 patients were analyzed with a mean age of 59.2 ± 9.5 years (median 60.4 years), of which 60.2% were male. From 2015 to 2019, there was an increasing trend in all groups, and most patients were reported in 2019. In group 1, 1598 patients were registered in 2015, and 1762 patients were registered in 2020, which is an increasing trend of 10.3%. The number of patients in group 2 was increasing every following year, with the highest growth in 2019 up to 12.1%, compared to 2018. The number of patients in group 3 also showed significant growth from 253 patients in 2015 to 324 patients in 2019, but there was a decrease of 16.4% in 2020 (271 patients). Deviations are observed in 2020, with a decrease in the number of patients in group 1 and group 3, as well as a slowdown in the growth dynamics of patients in group 2, which might be associated with the start of the SARS-CoV-2 pandemic. According to the modality, most of the patients (84.7%) were on HD in 2015 and 85.9% in 2020. The most frequent age group of patients was from 45 to 64 years, from 36.3% to 49.4%. There was an increasing trend of patients from older age groups (over 64 years) and male patients. The increasing number of patients from the age group 75+ years was also noted in all groups. Etiology of kidney disease: hypertension (25.8%) and diabetes mellitus (17.4%) were the leading causes of KF in patients requiring RRT.

Conclusion
The study showed a constantly increasing trend of patients with KF requiring RRT. The largest number of patients were men, aged from 45 to 64 years. Hypertension and diabetes mellitus were the leading causes of KF, and most of the patients were treated with HD.
#4067 HYPOXIC PRECONDITIONING FOR THE IMPROVEMENT OF THE REGENERATIVE CAPACITY OF MESENCHYMAL STEM CELLS AND ITS APPLICATION IN HYPERTENSIVE KIDNEY DISEASE
Authors: Sohi Gurparneet Kaur , Farooqui Naba , Mohan Arjunmohan , Eirin Alfonso , Lerman Lilach , Herrmann Sandra 
Published: June 2023

Abstract

Background and Aims
Autologous mesenchymal stem/stromal cells (MSCs) have emerged as a therapeutic option for many chronic diseases. Hypertensive kidney disease (HKD) might impair MSCs’ reparative ability by altering important biomolecular properties of the cell, but the characteristics of this impairment are unclear. In our previous pre-clinical studies, hypoxic preconditioning (HPC) enhanced MSC angiogenesis and reduced senescence through global gene and protein expression. Thus, we hypothesize that HPC would improve human MSCs by enhancing their functionality and angiogenesis, creating an anti-inflammatory and anti-senescence environment in MSCs from healthy control (HC), hypertensive patients (HTN), and hypertensive kidney disease patients (HKD).

Method
Human MSCs were collected from abdominal subcutaneous fat tissue biopsy of HC, HTN, and HKD patients (n=12 each). Samples were collected from healthy volunteers with no history of hypertension or kidney disease (HC), patients diagnosed with hypertension controlled with antihypertensive drugs (HTN), and hypertensive patients with eGFR&lt;60 mL/min/1.73 m2 (HKD). MSCs were harvested and cultured in Normoxic (20% O2) or Hypoxic (1% O2) conditions for 24-48 hours. MSC functionality was measured by migration and proliferation. Angiogenic and inflammatory secretome in conditioned media was assessed along with MSC senescence by senescence-associated beta-galactosidase (SA-beta-gal) activity. In addition, transcriptome analysis using RNA-sequencing (n=3/group) and quantitative PCR (qPCR) were performed to evaluate gene expression.

Results
At baseline, Normoxic HTN-MSCs interestingly had higher proliferation compared to HC. HC-MSC subjected to HPC showed increased proliferation (Figure 1A). SA-β-gal activity tended to decrease after HPC, particularly in the HC group (P = .06). HPC did not affect the release of the pro-angiogenic protein VEGF from MSCs, but increased EGF in HC-MSC, and decreased HGF in HC and HKD MSCs. HPC upregulated the pro-angiogenetic genes, inflammatory gene, and a few senescence genes (Figure 1F).

Conclusion
HPC has a more favorable functional effect on HC- than on HKD-MSC, reflected in increased proliferation and EGF release, and tends to decrease senescence, whereas it has little effect on HTN or HKD MSCs. These observations may assist in developing novel therapeutic strategies to improve the regenerative capacity of MSCs in patients with hypertensive kidney disease.