bluuebunny/crossref_metadata_2025_split huggingface dataset:
#4298 DOES STARTING RENAL REPLACEMENT THERAPY WITH INCREMENTAL HAEMODIALYSIS WORSEN OUTCOMES?
Authors: Lorenzo Javier Deira , Rodrigues André Rocha , Mayor Elena Jiménez , Aguilar José Carlos Aguilar , Carrero María Elena Davín , Montalban José María Sánchez , Sanchidrián Silvia Gonz-Lez , Santisteban Miguel Angel Suárez , Funes Vanesa García-Bernalt , Casino Francesco 
Published: June 2023

Abstract

Background and Aims
Most patients start maintenance haemodialysis (HD) with a fixed dose of 3 HD sessions per week (3HD/Wk), regardless of their residual kidney function (RKF). This intense schedule is considered the “standard” or “conventional” modality (cHD). It is widely accepted, and no randomised controlled trial (RCT) has examined whether other less frequent schedules are inappropriate or harmful. Thus, the optimal modality for incident patients is currently unknown. Incremental HD (iHD), on the other hand, adjusts the frequency of sessions to the RKF, increasing their number to compensate for any subsequent reduction in RKF. While iHD approaches precision medicine by customising the number of sessions, it raises concerns about long intersession periods and the risk of under-dialysis. Pending ongoing RCTs [1], our aim is to analyse the efficacy and safety of iHD in our incident patients.

Method
The policy of our Centre is to try to start with iHD in incident patients who are clinically stable and with RKF. We start with 1 session (1HD/Wk) if the RKF is above 4 ml/min/1.73 m2 and with 2 sessions (2HD/Wk) if the RKF is between 4 and 2.5 ml/min/1.73 m2. We progress from 1HD/Wk to 2HD/Wk and from 2 to 3HD/Wk depending on the RKF and ultrafiltration rates required, which are assessed at least monthly. Since 2012, we have treated 186 incident patients with iHD, of whom 168 had a follow up ≥ 90 days. 72% (128 patients) started with 1HD/Wk and the remaining 28% (40 patients) with 2HD/Wk. We compared the results with 410 incident patients who from baseline receive 3 sessions/Wk (cHD) and with 80 incident patients on Peritoneal Dialysis (PD). We also analysed 27 iHD patients who after 60 days were already dialysed with 3 sessions (3HD/Wk/60d group). We calculated the mortality rate (deaths/365 days in %) in each group and survival in the iHD technique (sessions not performed).

Results
The mean age in the iHD group was higher than in cHD or PD (Table 1). Mortality in iHD patients was similar to cHD patients, although the latter were younger. Patients who stayed less time in iHD (3HD/Wk/60d group) had the highest mortality rate (Table 1). Survival in technique (time in which 50% of patients remain on iHD) was 12 months, avoiding 86 sessions/patient. The cost reduction was €17,200/patient (session + transport = €200).

Conclusion
iHD is efficient, as it considerably reduces the number of sessions performed and thus costs, thereby improving quality of life. It is safe, as it has a similar mortality rate to cHD. Being on iHD for more than 60 days does not worsen the results. On the contrary, requiring 3 weekly sessions at the beginning of HD treatment may be associated with a poor prognosis.
#4308 EVOLUTION OF HYPONATREMIA IN PATIENTS WITH CHRONIC SIADH TREATED FOR 1 YEAR WITH ORAL UREA
Authors: Amézquita Yésika , Hernández Yolanda , Diaz Raquel , Ruisánchez Sílvia Caldés , Ledesma Gabriel , Valdivia Verónica Ruth Mercado , Carrillo R Echarri , Andreu Cristina , Thuissard Israel , Villalobos Ángel Gallegos , Ojanguren María Covadonga Hevia , Cirugeda Antonio 
Published: June 2023

Abstract

Background and Aims
Hyponatremia (&lt;135mEq/L) is the most common electrolyte disorder observed in clinical practice, associated with increased hospital admissions and mortality. One of its causes is the syndrome of inappropriate antidiuretic hormone secretion (SIADH). In chronic SIADH, urea is considered as a therapeutic possibility among other measures; however, its use is not widespread due to few studies on its efficacy.

Objects
To evaluate sodium levels in patients with chronic SIADH who received oral urea for at least 12 months.

Method
Observational, descriptive and retrospective study. Population: 13 patients with SIADH under treatment with urea for 12 months. The relationship between natremia and the rest of the clinical variables was analyzed using Chi-square, Student's T test, and ANOVA or their corresponding non-parametric tests.

Results
Mean age: 64 years +/-15. Men: 61% (n = 8). Comorbidities: hypertension (50%, n = 6), CKD (30.7%, n = 4), diabetes (15.3%, n = 2). SIADH etiology: Antiepileptics (n = 4), idiopathic (n = 3), intracranial pathologies (n = 5) and cancer (n = 1). 61% required admission for SIADH. Median of 10 ± 26 months from diagnosis to start of treatment. The initial dose was: 15 grams/day (53%, n = 7), 15 grams every 48 hours (30%, n = 4) and 15 grams every 72-96 hours (17%, n = 2). At one year, 61% of patients maintained the same dose (n = 8) and 39% of patients required an increase in the dose (n = 5) and of these 3 patients they increased to 30 grams/day. The treatment was well tolerated, only 1 patient out of 13 (7.6%) reported nausea and dysgeusia, no patient presented hypernatremia (Na &gt;145meq/L), hospital admissions due to SIADH, or adverse effects that led them to discontinue urea.

Conclusion
After a year of treatment, urea increases and maintains plasma sodium in the normal range safely in chronic SIADH. Treatment with urea is well tolerated, avoids hospitalizations, and is not associated with complications from its use.
#4314 IMPACT OF ACUTE KIDNEY INJURY ON OUTCOME OF SEVERE FEVER WITH THROMBOCYTOPENIA SYNDROME
Authors: Lee Kim Hae , MI Lee Jin , Nam Lim Myoung- , Min Son Seong , Jin Hwang Duck- , Lee Sunhwa , Hyunjeong Baek , Park Ji In 
Published: June 2023

Abstract

Background and Aims
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease with a high case-fatality rate in East Asia. In addition, acute kidney injury (AKI) has been reported in 14∼36% of the SFTS virus-infected patients. However, the risk factor for AKI and the clinical outcome of AKI in patients with SFTS has not been well understood.

Method
Patients who confirmed SFTS virus infection during five years from 2016 to 2020 in Kangwon national university hospital were retrospectively reviewed. Their laboratory data and medical records, such as comorbidity, complications, and mortality, were obtained from the electronic medical record. AKI was defined according to KDIGO criteria. The risk factors for death were assessed by Cox proportional hazards regression analysis.

Results
Of the 53 patients, 29 (54.7%) were male, and the mean age was 66.5 years. Twenty-seven (50.9%) patients were defined as AKI; 17 patients were AKI stage 1, 5 patients were AKI stage 2, and 5 patients were AKI stage 3. Of these, 5 patients underwent dialysis and all of them needed continuous renal replacement therapy. Patients with AKI were significantly older and had a higher proportion of diabetes (p = 0.041 and p = 0.019, respectively). In baseline laboratory tests, levels of aspartate aminotransferase, alanine aminotransferase and c-reactive protein were higher in AKI group (p = 0.011, p = 0.019, and p = 0.012, respectively). Among 53 patients, nine died due to SFTS, and the fatality rate was 15.1%. The AKI group (29.6%) had a higher mortality rate than the no AKI group (3.8%). In univariate analysis, higher levels of white blood cells, blood urea nitrogen, creatinine, and alkaline phosphatase were risk factors for death. In multivariate analysis, leukocytosis and AKI stage 3 were independent risk factors for death.

Conclusion
AKI frequently occurs among patients with SFTS. In patients with AKI stage 3, the mortality rate is significantly higher than no or mild AKI, so special attention should be paid when it occurs.
#4319 ASSOCIATION BETWEEN INTRADIALYTIC HYPERTENSION FREQUENCY AND SHORT-TERM CLINICAL OUTCOMES AMONG ESRD PATIENTS RECEIVING HEMODIALYSIS
Authors: De Castro Jeanmar , Manalaysay Trisha Michelle 
Published: June 2023

Abstract

Background and Aims
Systolic blood pressure (SBP) pattern in hemodialysis (HD) is typically characterized by a rapid decrease during the start of HD and followed by a more gradual decline in the latter part of the treatment. Deviation from the typical BP trend with a paradoxical rise in BP during HD, has been associated with increased mortality and morbidity and therefore, could be a modifiable risk marker for short-term adverse events in this population. Physicians may usually pay more attention to the more common complication that is hypotension during dialysis than the pattern of BP rise, hence overlooking a significant marker for poor prognosis. This study aims to investigate the association of intradialytic hypertension with short-term 30-day clinical outcomes including hospitalizations and mortality. Previous observational studies have suggested that changes in blood pressure during dialysis is associated with mortality and morbidity, however, the exact mechanism is still unclear.

Method
This study is a prospective cohort study of ESRD patients receiving in-center maintenance hemodialysis in a tertiary hospital in Davao City. All patients who were more than 18 years old and at least 1-year hemodialysis vintage were included. The study collected data from patients within a 30-day observation period and recorded the occurrence of events within the next 30-day follow-up period. Data collection was done from July 2022 to August 2022.

Results
In this study, patients had an average age of 49.18 years, majority of 55.56% were male and the most common cause of ESRD was glomerular disease. This study demonstrates that the incidence of intradialytic hypertension in this institution is high at 49.38%. Among the 81 enrolled patients, 16% had short term outcomes. Among the patients, 13.5% were hospitalized within the follow-up period and majority of 63.6% of them had IDH. All of the 2.47% of patients who expired during the follow-up period had IDH. Patients who had concomitant heart failure (p-value &lt;0.001), has non-tunneled catheter as vascular access (p-value 0.004), high intradialytic frequency of 50–87.5% (p-value &lt;0.001), and interdialytic weight gain of at least 2 kilograms (p-value 0.029) were significantly associated with hospitalization and mortality within 30 days.

Conclusion
The results of this study recommends that prompt attention should be given to ESRD patients who exhibit IDH as this may be a risk marker for adverse short term events within 30 days. In line with this, setting of dry weight, screening for heart failure, conversion to permanent AVF access, and tailoring of anti-hypertensive medications for better BP control should be assessed with vigilance in the dialysis unit.
#4326 STATIN INITIATION AND RISK OF INCIDENT KIDNEY DISEASE IN PATIENTS WITH DIABETES
Authors: Zhou Shiyu , Nie Sheng , Xin Xu 
Published: June 2023

Abstract

Background and Aims
The role of statin therapy in the development of kidney disease in patients with type 2 diabetes mellitus (T2DM) remains uncertain. We aim to determine the relationships between statin initiation and kidney outcomes in patients with T2DM.

Method
Using deidentified electronic health record data and new-user design, we conducted a nationwide retrospective cohort of patients with T2DM aged 40 years or older across China. The study outcomes included the development of diabetic kidney disease (DKD) and a sustained ≥40% decline in estimated glomerular filtration rate (eGFR). Cox proportional hazards regression was used to evaluate the relationships between statin initiation and kidney outcomes Analyses were conducted using propensity overlap weighting to balance the characteristics.

Results
Among 7272 statin initiators and 12 586 noninitiators in the weighted cohort, statin initiation was associated with lower risks of incident DKD (hazard ratio [HR], 0.72; 95% confidence interval [CI] 0.62-0.83), new-onset eGFR &lt;60 ml/min/1.73 m2 (HR 0.63, 95% CI 0.50-0.79), new-onset proteinuria (HR, 0.70; 95% CI 0.59-0.84) and kidney function decline (HR 0.60, 95% CI 0.44-0.81). Among statin initiators, intensive control of LDL-C (&lt;1.8 mmol/L) had a lower risk of incident DKD (HR 0.51, 95% CI 0.32-0.81) than that in non-control group (LDL-C ≥ 3.4 mmol/L). Similar results were obtained for participants with differing patterns of dyslipidemia, those using different statins, and after stratification according to the characteristics of the participants.

Conclusion
Statin initiation is significantly associated with a lower risk of kidney disease development in patients with diabetes. This reno-protective effect was more prominent in patients with intensive control of LDL-C.
#4364 LEUCOPENIA AFTER KIDNEY TRANSPLANTATION: SWITCHING MYCOPHENOLATE TO MTOR INHIBITOR APPEARS SAFE AND FEASIBLE TO REDUCE THE RISK OF ALLOSENSITIZATION
Authors: Rho Elena , Bohraus Pascal , Mueller Thomas , Schachtner Thomas 
Published: June 2023

Abstract

Background and Aims
Mycophenolate acid (MPA) is a standard component of maintenance immunosuppression after kidney transplantation. MPA, however, increases the risk of leucopenia. In the past, mTOR inhibitors (mTOR-I) in combination with calcineurin inhibitors (CNI), were considered immunologically safe but showed higher mortality in the long term.

Method
We conducted a retrospective single-center study analyzing 98 kidney transplant recipients (KTRs) under standard triple maintenance immunosuppression between 2020 and 2022 who developed leucopenia. We compared patient and kidney allograft outcomes between 31 KTRs who were temporarily switched from MPA to mTOR-I and 67 KTRs who underwent a reduction of MPA dose.

Results
A switch to mTOR-I was performed more often in case of a CMV high-risk status (50% vs. 21%, p = 0.009), CMV primary infection (68.2% vs. 22%, p&lt;0.001), and more severe leucopenia (median nadir of neutropenia: 0.52 G/L vs. 0.86 G/L, p = 0.023). The median duration of leucopenia was comparable between the two groups (69 vs. 80 days). 9 of 67 KTRs (13%) developed de novo donor-specific antibodies (dnDSA) under reduced MPA compared to 1 of 31 KTRs (3%) under mTOR-I (p = 0.17). Biopsy-proven rejections were comparable between the two groups (1 in each). There was a slight but insignificant improvement of eGFR under mTOR-I compared to MPA (ΔeGFR +17 vs. +7 ml/min/1.73m2, p = 0.13) and no difference in proteinuria.

Conclusion
A temporary switch from MPA to mTOR-I is a feasible and safe strategy to overcome leucopenia, especially in cases of CMV high-risk status and CMV primary infection. No significant adverse effects on kidney allograft outcomes were observed. Development of dnDSA tended to be lower in the mTOR-I group, suggesting that this strategy may have the potential to reduce the risk of allosensitization.
#4401 IMPACT OF POLYPHARMACY ON QUALITY OF LIFE IN DUTCH DIALYSIS PATIENTS: A QUALITATIVE STUDY
Authors: Colombijn Julia Mt , Colombijn Freek , van Berkom Lideweij , van Dijk Lia A , Tierolf Charlotte , Senders Dionne , Abrahams Alferso C , Van Jaarsveld Brigit 
Published: June 2023

Abstract

Background and Aims
Almost all dialysis patients have polypharmacy but little is known about their experiences with medication and perception towards it. In this study, we aim to gain insight in dialysis patients’ experiences with polypharmacy the ways they integrate their medication in their daily lives and how it affects their quality of life.

Method
We conducted a qualitative study among dialysis patients from two Dutch university hospitals and affiliated dialysis clinics. Participants were interviewed in semi-structured interviews based on a pre-selected topic list. Interviews were transcribed verbatim and analysed independently by two researchers through thematic content analysis.

Results
Overall, 28 participants were interviewed (29% women, mean age 63±16 years, median dialysis vintage 25.5 [IQR 15-48] months, mean number of medications 14±3). Important themes were (1) participants’ own definition of what constitutes ‘medication’, (2) their perception of medication, (3) medication routines and its impact on daily life, and (4) interactions with healthcare professionals and others regarding medication. Participants generally perceived medication as burdensome but less burdensome than dialysis. Medication was accepted as an essential condition for their health even though participants could not always directly notice these health benefits and often relied on their physicians to determine the effectiveness of medication. Medication routines and other coping mechanisms helped participants to reduce the perceived negative effects of medication. In fact, for some participants, medication increased their freedom. Participants generally had constructive relationships with their physicians discussing their medication.

Conclusion
Polypharmacy negatively affected dialysis patients’ quality of life. These effects were, however, overshadowed by the burden of dialysis. Patients’ realization that medication is of importance for their health and effective coping strategies mitigated the negative impact of polypharmacy on quality of life. Physicians should continuously work together with their patients to evaluate the impact of treatments, not only on health but also on other aspects of patients’ daily lives.
#4421 CHALLENGES TO DIALYSIS TREATMENT DURING THE COVID-19 PANDEMIC: A QUALITATIVE STUDY OF PATIENTS’ AND EXPERTS’ PERSPECTIVES
Authors: Flores Krystell Oviedo , Stamm Tanja , Alper Seth , Ritschl Valentin , Vychytil Andreas 
Published: June 2023

Abstract

Background and Aims
The substantial health challenges faced by patients on peritoneal dialysis (PD) or hemodialysis (HD) have increased considerably during the ongoing COVID-19 pandemic, but remain inadequately investigated. We therefore decided to compare the perspectives of PD and in-center HD patients on their needs and challenges through this period with those of their healthcare professionals through interviews with both groups.

Method
Qualitative study of 7 in-center HD patients, 7 PD patients, 7 dialysis nurses and 7 physicians at the Division of Nephrology and Dialysis, Medical University of Vienna between March 2020 and February 2021, involving content analysis of semi-structured interviews supported by a natural language processing technique.

Results
Main themes brought up by patients included: 1) Concerns about being a ‘high risk patient’; 2) Having reduced fear of COVID-19 as an HD patient; 3) Whether home dialysis might be better than in-center dialysis during COVID-19; 4) Changes in clinical routine; 5) Positive psychological elements to overcome stress. Main themes emerging from interviews with physicians and nurses included: 1) Fear of COVID-19 infection; 2) Anxiety, sadness, loneliness of PD patients; 3) Negative impact of changes in clinical routine on patients' well-being; 4) Telehealth as a new care modality.

Conclusion
Physicians did not perceive the full extent of patients’ psychological burdens. Positive psychological constructs were more evident in survivors of previous serious health crises. Patients' concerns related to COVID-19 need to be addressed proactively. Implementation of measures to prevent COVID-19 transmission, introduction of telemedicine, and increased use of home-dialysis have led to communication barriers and reduced contact between healthcare providers and patients. Selection or modification of dialysis modality should include analysis of the patient's support network as well as periodic psychological assessment of patients in anticipation of future surges of COVID-19 or of currently unforeseen pandemics.
#4463 JAPANESE AND WHITES SHARE SIMILAR IPTACOPAN PHARMACOKINETICS AND PHARMACODYNAMICS
Authors: Schmouder Robert , Junge Guido , Nidamarthy Prasanna , Kulmatycki Kenneth 
Published: June 2023

Abstract

Background and Aims
Iptacopan (LNP023) is a first-in-class, oral, proximal complement inhibitor that specifically binds to Factor B and inhibits the alternative complement pathway (AP). Current Phase III studies of iptacopan focus on diseases associated with AP activation, such as paroxysmal nocturnal hemoglobinuria, C3 glomerulonephritis, IgA nephropathy, and atypical hemolytic uremic syndrome. These studies are enrolling patients across geographical regions and ethnicities, including those from Japan. The aim of this study was to evaluate the safety, tolerability, pharmacokinetics (PK), and pharmacodynamics (PD) of iptacopan in Japanese patients.

Method
CLNP023 × 1102 was a randomized, subject-blinded, placebo-controlled, single-dose Phase I study conducted in Japan in healthy Japanese male subjects to assess safety, tolerability, PK, and AP blood biomarkers (Wieslab, Bb) in three dose cohorts, 25, 100, and 400 mg (8 active/2 placebo per cohort). Subjects were dosed on day 1 and observed for 96 hours post-dose. PK and PD data from this study was compared to White data from the similarly designed, previous CLNP023 × 2101 first-in-human study.

Results
Iptacopan was well tolerated in both Japanese and White subjects. White subjects were on average 15.7 years older and 19.5 kg heavier than Japanese subjects. Iptacopan mean (±SD) Cmax and AUCinf as well as mean (±SD) % change from baseline at 12 hours post-dose for Wieslab and Bb by dose are shown in the table below. All three dose groups manifested a general trend of increased systemic exposure and increased AP biomarker inhibition with increasing dose in both Japanese and White subjects.

Conclusion
Japanese and White healthy subjects had similar PK and PD results at all dose levels. The slightly higher Cmax and AUCinf in Japanese subjects may be explained in part by the lower average weight of these subjects. This study provides reassurance that there are no clinically meaningful differences in the human pharmacology of iptacopan between these ethnic groups.