bluuebunny/crossref_metadata_2025_split huggingface dataset:
#6192 COGNITIVE DYSFUNTION AND ASSOCIATED RISK FACTORS IN PERITONEAL PATIENTS
Authors: Knezevic Violeta , Azasevac Tijana , Celic Dejan , Bozic Dusan , Veselinov Vladimir , Petrovic Lada 
Published: June 2023

Abstract

Background and Aims
Patients with cognitive dysfunction (CD)are at greater risk of having a poor quality of life, hospitalization and mortality. Although CD in chronic kidney disease is current, most of the studies performed are cross-sectional. The aim of this cross-sectional study was to determine the presence of CD in the patients on peritoneal dialysis (PD)and to identify possible risk factors associated with CD.

Method
We performed a study to evaluate the CD of 30 PD patients in our institution using the mini-mental state (MMSE), and a score of &lt;25 was considered to indicate cognitive dysfunction. Demographic, clinical and laboratory parameters, adequacy of dialysis and drugs were analyzed. The statistical analysis included the chi-square test, t-test of independent samples, Mann-Whitney, and correlation.

Results
We evaluated 30 patients mean age of 57.27 years (SD±12.086); 56.7% were male. About 66.7% of our patients were in marriage, 73.3% were not actively working, 13.3 had a lower level of education, and 56.7% lived in a city. The most prevalent comorbidities were glomerulonephritris and hypertension, both with 30.0%. 19 (57.6%) patients had average fast membrane characteristics. 15 of them (50%) had a daily dose of calcium phosphate binder &gt;2g.MMSE test with a score lower than 25 was present in 36,7% of patients (IQR=4). Statistical analysis revealed a positive correlation between MMSE and weekly total Kt/V urea index (WTKt/V), and the t-test of independent samples showed that patients with better MMSE score values have significantly higher average WTKt/V values (t=-3.062, p&lt;0.011).

Conclusion
MMSE test with a score less than 25 was present in 36.7% of patients and patients with better MMSE scores have significantly higher average WTKt/V values.
#6375 HYPOPROTEIC DIET SUPPLEMENTED WITH KETOANALOGUES VERSUS CONVENTIONAL DIET IN PATIENTS WITH ADVANCED DIABETIC KIDNEY DISEASE AND SEVERE PROTEINURIA
Authors: Mocanu Carmen-Antonia , Mircescu Gabriel , Ismail Gener , Garneata Liliana 
Published: June 2023

Abstract

Background and Aims
Low-protein diets seem to have an important role in the management of advanced chronic kidney disease (CKD). In addition, this type of nutritional regimen may defer kidney replacement therapy by improving metabolic abnormalities. However, low-protein diets (LPDs) may be more difficult to integrate in patients with diabetic kidney disease (DKD), because of the already complex dietary intervention in these patients. This is a comparative study that aimed to assess the effects of a ketoanalogue-supplemented low-protein diet (sLPD) versus a conventional diet on the progression of CKD and proteinuria in patients with advanced DKD.

Method
Ninety-seven adult patients with DKD and heavy proteinuria (&gt;3g/g creatininuria) who proved to be compliant to protein restriction in a 3-month run-in phase were enrolled to receive a LPD (0.6g mixed protein/kg-day) supplemented with ketoanalogues of essential amino acids (Ketosteril®, Bad Homburg, Germany, 1 tb/10 kg dry ideal body weight per day) for 12 months. Ninety-two patients completed the study (5 patients received preemptive kidney transplant). The control group was made up of seventy-four adult patients with DKD and heavy proteinuria who received a conventional diet for 12 months. Efficacy outcomes were variation of the estimated glomerular filtration (eGF) and variation of proteinuria.

Results
At baseline, patients from the sLPD group had a median age of 61 years (95% CI 58 to 67), were mostly male (66%) and predominantly on insulin (68%). Patients in the control group had a median age of 60 years (95% CI 56 to 61), 62% were male and, similarly, the majority were on insulin (62%). All patients had poorly controlled diabetes, with a glycated hemoglobin of 8.1% (95% CI 8.0 to 8.3) in the sLPD group and 8.2% (95% CI 7.9 to 8.6) in the conventional-diet group respectively (P = .84). Although the median eGF was different between groups: 24.78 mL/min (95% CI 20.00 to 30.00) in sLPD patients versus 12.61 mL/min (95% CI 11.70 to 13.11) in conventional diet patients (p&lt;0.0001), proteinuria was similar at baseline: 5.26 g/g creatininuria (95% CI 4.98 to 5.22) in sLPD patients and 4.05 g/g creatininuria (95% CI 3.70 to 5.80) in control group patients (P = .44). After 12 months, the decline of eFG (mL/min/month) was four-times slower in the sLPD group versus the control group [0.11 (95% CI 0.1 to 0.14) versus 0.43 (95% CI 0.30 to 0.57), p&lt;0.0001]. A twofold reduction in proteinuria (g/month) was observed in sLPD patients compared to conventional diet patients [0.29 (95% CI 0.28 to 0.32) versus 0.12 (95% CI 0.09 to 0.15), p&lt;0.0001].

Conclusion
Low-protein diets supplemented with ketoanalogues of essential amino acids seem to be more efficient in reducing kidney function decline and proteinuria than conventional diets.
#6376 TREATMENT OF DABIGATRAN INTOXICATION IN CRITICALLY ILL PATIENTS WITH ACUTE KIDNEY INJURY: THE ROLE OF SUSTAINED LOW-EFFICIENCY DIALYSIS
Authors: Pacchiarini Maria Chiara , Regolisti Giuseppe , Greco Paolo , Motta Tommaso Di , Benigno Giuseppe Daniele , Delsante Marco , Fiaccadori Enrico , Mario Francesca Di 
Published: June 2023

Abstract

Background and Aims
Dabigatran, a direct thrombin inhibitor, is a commonly used direct oral anticoagulant (DOAC) prescribed for non-valvular atrial fibrillation. Despite its benefits in term of safety/effectiveness along with the possibility to treat patients who were ineligible for vitamin K inhibitors (VKAs), a great degree of attention is required in elderly patients with multiple comorbidities. Notably, dabigatran mainly undergoes renal elimination, and dose adjustment is recommended in patients with Chronic Kidney Disease (CKD). In this regard, the onset of an abrupt decrease of kidney function may further affect dabigatran pharmacokinetic profile, increasing the risk of acute intoxication. Idarucizumab is the approved antagonist in the case of dabigatran-associated major bleeding or concomitant need of urgent surgery, but its clinical use is limited by the lack of data in patients with Acute Kidney Injury (AKI). Given the dabigatran PK parameters (low MW, low Vd, negligible protein binding), the early start of Extracorporeal Kidney Replacement Therapy (EKRT) may represent the optimal reversal strategy. We present a case series of three critically ill patients with AKI and dabigatran overdose treated with Sustained Low-Efficiency Dialysis (SLED).

Methods
Three critically ill patients (Table 1) were admitted to the Renal Intensive Care Unit (ICU) for stage 3 AKI and intercurrent dabigatran intoxication. SLED sessions with Regional Citrate Anticoagulation (RCA) were prescribed with SURDIAL X machine, ELISIO-21M filter (Nipro Co., Osaka, Japan) [blood flow rate 200 mL/min, dialysis fluid rate 300 mL/min; citrate flow rate 350 mL/h (ACD Fresenius Kabi, Italia)]. Dabigatran plasma levels (dilute thrombin time, dTT) along with coagulation parameters were monitored before, during and after SLED session.

Results
A rapid and sustained decreased of plasma dabigatran level was observed in each patient in course of SLED sessions. No clinically relevant post-treatment rebound was reported (Figure 1).

Conclusions
SLED meets the requirements to be a viable reversal anticoagulation option in the context of dabigatran overdose. Indeed, it efficiently provides dabigatran removal, by reaching a safe plasma concentration within the first hours and avoiding significant rebound effect.
#6475 AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE WITH COMPLETE SITUS INVERSUS: A CASE REPORT
Authors: Mrabet Sanda , Rihem Dahmane , Emah Sidina , Boukadida Raja , Azzabi Awatef , Guedri Yosra , Wissal Sahtout , Zellama Dorsaf 
Published: June 2023

Abstract

Background and Aims
Association between complete Situs inversus and autosomal polycystic kidney disease is rare. The Medline search revealed only three such cases. We report the fourth one. Recent studies have revealed ciliary dysfunction as a cause of both conditions.

Method
we report a case of association of familial hereditary polycystic kidney disease with a situs inversus.

Results
A 32-year-old patient with a familial history of polycystic kidney disease and stroke was admitted to Nephrology for severe renal failure with hypertension. On examination, the patient had a blood pressure of 160/100mmHg. The abdomen was soft, with bilateral palpable renal masses with irregular surfaces. Neurological examination was without abnormalities. The blood test showed creatinemia at 829µmol/L, urea at 44mmol/L, correct ionogram, CO2 at 19 mmol/L, calcemia at 1.98mmol/L and uric acid at 860 µmol/L. The 24-hour proteinuria was 1.5g. The cytobacteriological examination of the urine was negative. The chest X-ray showed a situs inversus of the heart. On abdominal ultrasound, the kidneys were polycystic, the liver was seen on left and the spleen on the right. The patient was put on antihypertensive treatment with a calcium channel blocker and Purinol. Given the clinical and biological improvement, the patient was discharged with close monitoring at the outpatient clinic with possible preparation for hemodialysis. In addition, a cerebral MRI angiography was requested to detect cerebral damage because of the family history of stroke.

Conclusion
Polycystic kidney disease is caused by mutations in the polycystic kidney and hepatic disease 1 (PKHD1) gene. Several proteins that are encoded by genes associated with polycystic kidney disease have been identified in primary cilia in renal tubular epithelia. These findings have suggested that abnormalities in cilia formation and function may play a role in the pathogenesis of PKD. Treatment options for PKD are still being explored but further research can develop solutions to increase the life expectancy of patients diagnosed with PKD. Cases like this are rare but could provide more information on the causes of PKD and Situs Inversus leading to these new solutions.
#6559 THE ROLE OF MEDIUM-CHAIN FATTY ACIDS IN RENAL METABOLISM AND DISEASES
Authors: Yiting Wu 
Published: June 2023

Abstract

Background and Aims
Through metabolomics research, it was found that in mice with chronic kidney disease, the distribution of lipids in the kidneys was different from that of healthy individuals, and medium-chain fatty acids were reduced. In order to explore the role of medium-chain fatty acids in kidney metabolism and disease, we conducted this systematic review.

Method
Systematic review. The pubmed database was used to search for keywords such as medium chain fat acids, medium chain triglyceride, MCFA, MCT, chronic kidney disease, CKD, and renal fibrosis.

Results
In chronic kidney disease, long-chain fatty acids decrease and medium-chain fatty acids increase. The increase of medium-chain fatty acids may be a compensatory mechanism. Compared with long-chain fatty acids, medium-chain fatty acids are more easily metabolized through the tricarboxylic acid cycle, thus providing more energy. MCFAs are readily oxidized by cells,including cardiomyocytes, and provide a very efficient. source of energy production. MCFAs display metabolic,biological and physical properties that are distinct fromLCFAs, which may contribute to their reported benefits on the kidney's energy status and function. Only few deleterious effects have been reported with the use of MCFAs, many of which have been reported mainly when MCTs were administered as the main dietary energy source representing &gt;50% of the total energy intake. These include decreased absorption of LCTs, which may result in deficiency in essential polyunsaturated LCFA, steatorrhea, gastrointestinal discomfort, increased risk of ketogenesis and acidosis, and in some studies, though not all, changes in blood lipid profile such as a raise in triglycerides or nonhigh-density lipoprotein cholesterol

Conclusion
Studies in animal models indicate that MCFAs may favourably modulate kidney disease progression. Medium-chain fatty acids have protective effects on the kidney and provide new ideas for the relief and treatment of chronic kidney disease.
#6666 RISK FACTORS FOR CHRONIC KIDNEY DISEASE AFTER ACUTE KIDNEY INJURY IN ELDERLY SUBJECTS
Authors: Mahmoud Nouha Ben , Ghabi Faten , Hammouda Mouna , Salem Meriem Ben , Salah Manel Ben , Letaief Ahmed , Sabra Aloui , Skhiri Habib 
Published: June 2023

Abstract

Background and Aims
Acute kidney injury (AKI) in the elderly is a fairly frequent phenomenon that is favored by functional changes in the kidney and the impact of many chronic diseases whose incidence increases with age. This exposes this particular population to a higher risk of developing chronic kidney disease (CKD). The risk of developing a new CKD in elderly subjects has been estimated to be 4 times that of the population without an episode of AKI in several studies. Our objective was to identify risk factors in this population

Method
This is a retrospective descriptive study that included patients over 65 years of age for AKI with recovery of normal renal function between January 2002 and December 2015 and who were followed up to one year after discharge. In order to achieve our objective, we collected data related to the patients' age, history, multitargeted or not, mechanism of AKI, KDIGO stage, glomerular filtration rate (GFR) at hospital discharge, using a pre-designed form.

Results
Among 93 patients who were followed up 18 had developed CKD with a median delay of 6.5±0.4 months. The sex ratio was 0.93 (M/F). In our population 37% were diabetics; 52 of them were multitargeted and 62 had a GFR &lt; 60 ml/min at discharge. 11 patients had required extra renal purification. The most important mechanism of ARF was pre renal (59.1%). Among the risk factors studied (diabetes, hypertension, use of ESRD, anemia, mechanism of AKI) in our population, only hypertension was statistically significant for the development of AKI. Ten patients among 93 were hypertensive.

Conclusion
Our results suggest that the development of CKD occurred most often in the first year following an episode of AKI, hence the need for close follow-up at one year in this high-risk population
#6715 COGNITIVE IMPAIRMENT IS ASSOCIATED WITH INCREASED MORTALITY IN HEMODIALYSIS PATIENTS
Authors: Shсherbakov Evgeniy , Pyatchenkov Mikhail 
Published: June 2023

Abstract

Background and Aims
Patients on dialysis are at substantially higher risk for developing cognitive impairment compared with the general population. At the same time cognitive impairment is a strong and independent risk factor for all-cause mortality. Given that the approaches used to access the prevalence of cognitive disfunction widely vary in different patient populations, their true burden in hemodialysis patients remains poorly understood. The aim of our study was to determine the association between cognitive impairment and overall survival and mortality in patients undergoing hemodialysis treatment.

Method
A total of 69 chronic hemodialysis patients (47 men and 22 women) were included. The median age of patients was 61 [47-69] years. The median duration of hemodialysis treatment was 32 [21-72] months. The study of cognitive status was conducted using the Montreal Cognitive Assessment (MoCA) questionnaire. The test results are between 0 and 30 points. A score of 26 points or more is considered the norm, less than 26 indicates the presence of cognitive impairment. The end point was a fatal outcome from acute pathology or progression of a chronic disease. The analysis of survival and mortality was evaluated using survival tables, the construction of Kaplan-Mayer curves with the Mantel-Cox log–rank criterion. The risks of the influence of cognitive impairment on mortality were assessed using Cox regression.

Results
During the 24-month follow-up period, 23 patients died. Structure of mortality over the observation period: acute coronary syndrome – 6 (26 %), COVID-19 – 6 (26 %), acute cerebrovascular accident – 2 (9%), thromboembolic complications – 3 (13%), another causes – 6 (26 %). In patients with cognitive impairment on hemodialysis, the average survival value was 16.33 months ± 1.70 months [CI 95% 12.99-19.66] and 20.48 months±1.32 months [CI 95% 17.88-23.07] in patients without cognitive impairment. According to the Mantel-Cox log-rank criterion, there was a statistically significant decrease in overall survival in patients with cognitive impairment, P = .02. The mortality rate of dialysis patients with cognitive impairment was 51%, without cognitive impairment – 19%. Relative risk of death in the group of patients with cognitive impairment using Cox regression: Hazard ratio (HR) :2.90 [95% CI 1.11-7.37, P = .03].

Conclusion
Our results support the notion that cognitive impairment may be an independent predictor of all-cause mortality in hemodialysis patients. There are limitations on the sample size of patients in our study. Further larger-scale observations a large cohort of patients are required.
#6755 NOVEL ASPECT OF NATURAL FLAVONOL FISETIN VIA INHIBITING ACSL4-MEDIATED TUBULAR FERROPTOSIS AGAINST FIBROTIC KIDNEY DISEASE
Authors: Wang Bo , Yang Letian , MA Liang , Fu Ping 
Published: June 2023

Abstract

Background and Aims
Kidney fibrosis is the hallmark of chronic kidney disease (CKD) progression, whereas no effective anti-fibrotic therapies exist. We previously reported that natural flavonol fisetin alleviated septic acute kidney injury and protected against hyperuricemic nephropathy in mice. However, the versatile role and potential mechanism of fisetin against fibrotic kidney disease have not been well characterized. Recently, tubular ferroptosis contributes to the pathogenesis of CKD with a persistent inflammatory and profibrotic response.

Method
Here, we found that fisetin significantly improved tubular injury, inflammation, and tubulointerstitial fibrosis in adenine diet- and unilateral ureteral obstruction (UUO)-induced CKD mice. The renoprotective effects of fisetin were also confirmed to suppress inflammatory response and fibrogenesis in adenine- or TGF-β1-stimulated tubular epithelial cells.

Results
Mechanistically, fisetin inhibited ferroptosis in the kidneys of CKD mice as well as in injured tubular epithelial cells, as evidenced by a decrease of ACSL4, COX2, HMGB1, and an increase of GPX4. Meanwhile, fisetin effectively restored ultrastructural abnormalities of mitochondrial morphology and relieved the elevated iron, the downregulated GSH and GSH/GSSG, as well as the upregulated lipid peroxide MDA in the kidneys of CKD mice. Notably, abnormal expression of ferroptosis key marker ACSL4 was verified in renal tubules of CKD patients (IgAN, MN, FSGS, LN, and DN) and mice (adenine and UUO), which was also observed in injured tubular cells. Furthermore, ACSL4 knockdown inhibited tubular ferroptosis, while ACSL4 overexpression blocked anti-ferroptotic effect of fisetin and reversed the cytoprotective, anti-inflammation, and anti-fibrosis of fisetin in injured tubular cells.

Conclusion
In summary, we for the first time explored a novel aspect of fisetin via inhibiting ACSL4-mediated tubular ferroptosis against fibrotic kidney diseases.
#6895 ANCA AND IGA NEPHROPATHY: ASSOCIATION OR PROGNOSTIC FACTOR
Authors: Mahmoud Nouha Ben , Salem Meriem Ben , Salah Manel Ben , Letaief Ahmed , Hammouda Mouna , Sabra Aloui , Skhiri Habib 
Published: June 2023

Abstract

Background and Aims
ImmunoglobulinA(IgA) nephropathy (IgAN), the most prevalent form of primary glomerulonephritis worldwide, is characterized by mesangial cell proliferation, matrix expansion, and mainly mesangial IgA deposition, often in conjunction with C3 and IgG and/or IgM. Its pathogenisis is enigmatic, It is reported that approximately 35-42% of IgAN patients have a history of macrohematuria before kidney biopsy. Its a benign pathology which somtimes could be associated with cresentic proliferation and more rarely by the presence of ANCA antibodies.

Method
We retrospectively analyzed the epidemiologic, clinical and histological data of 27 patients with Ig A nephropathy proven by biopsy and we compared 2 groups ANCA positive and ANCA negative patients.

Results
The present study involved 27 patients, 18 men and 9 women, the average age was 27.9 years 3 patients were ANCA positive compared to 24 ANCA negative ; (2 were MPO-ANCA and 1 PR3-ANCA). ANCA positive patients were older, with more severe initial renal function, lower hemoglobin, and a higher percentage of general symptoms than the ANCA negative ones Histologically, therewas a significantly higher percentage of fibrinoid necrosis in glomeruli in ANCA-positive IgAN patients ANCA-positive patients with IgA nephropathy had a higher percentage of crescentic glomeruli (54.5%) compared with ANCA-negative patients with crescentic IgA nephropathy (26%). The ANCA positive patients was all treated by solumedrol boli and oral corticotherapy and showed more severe prognosis, the 3 patients progressed to ESKD. 4 ANCA-negative patients were treated with oral corticotherapy, some from the other 20 patients have been put on renin angiotensin system bloquers treatment and thy shoxed a better renal prognosis.

Conclusion
IgAN patients with ANCA positivity showed more severe clinical and histological features when compared with ANCA-negative IgAN patients and lower renal prognosis. The ANCA antibodies should be screened in patients with severe forms of IgAN.
Activity of Tivozanib in Non-clear Cell Renal Cell Carcinoma: Subgroup Analysis From a Phase II Randomized Discontinuation Trial
Authors: Barata Pedro C , Chehrazi-Raffle Alexander , Allman Kimberly D , Asnis-Alibozek Aviva , Kasturi Vijay , Pal Sumanta K 
Published: June 2023

Abstract

Background
Non-clear cell renal cell carcinoma (nccRCC) is a blanket term for a collection of heterogeneous and biologically diverse RCC histologies, including but not limited to papillary, chromophobe, and unclassified subtypes. Tivozanib is a selective vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor (TKI) that demonstrated activity in RCC with clear cell component. The objective of this analysis was to determine the efficacy of tivozanib in histologically unclassified/mixed RCC.

Methods
We identified patients with nccRCC enrolled in Study 201 (NCT00502307) between October 2007 and July 2008. This was a phase II randomized discontinuation trial of tivozanib in patients with RCC who had no prior VEGFR-targeted treatment. Clinical outcomes including investigator-assessed objective response rate (ORR), disease control rate (DCR, defined by complete response + partial response + stable disease), and progression-free survival (PFS) were examined.

Results
Of the 272 patients enrolled, 46 (16.9%) patients had nccRCC: 11 (4%) papillary, 2 (0.7%) chromophobe, 2 (0.7%) collecting duct, and 31 (11.4%) mixed/unclassified. Of the 46 patients with nccRCC, 38 were continuously treated with tivozanib and the best ORR was 21.1% (confirmed) and 31.6% (confirmed and unconfirmed). The DCR was 73.7% and median PFS was 6.7 months (95% confidence interval, 125-366 days). There were no new safety signals compared to the ITT population. Limitations include the small number of individual nccRCC subtypes and the randomized discontinuation design.

Conclusion
Tivozanib demonstrated activity and a favorable safety profile in patients with nccRCC. These data add to the body of evidence supporting the use of VEGFR-TKI in advanced nccRCC.