bluuebunny/crossref_metadata_2025_split huggingface dataset:
#4613 PREVALENCE OF DKD RAPID PROGRESSION IN TYPE 2 DIABETES IN A DEVELOPING COUNTRY AND ITS CLINICAL PREDICTORS: A SINGLE CENTERED RETROSPECTIVE STUDY
Authors: Swaminathan Shilna Muttikal , Nagaraju Shankar Prasad , Prabhu Ravindra Attur , Nagri Shivashankara Kaniyoor , Rao Indu Ramachandra , Shenoy Srinivas Vinayak , Rangaswamy Dharshan , B Mohan V 
Published: June 2023

Abstract

Background and Aims
A significant proportion of diabetic kidney patients experience a rapid decline in GFR, leading to ESRD within months. Although there is a large number of studies on DKD, at present, there is a lack of well-controlled long follow-up studies to assess the burden of rapid progression, distinguishing the clinical profile of rapid progressors from non-progressors and its predictors. Identifying independent risk factors that contribute specifically to rapid progression is essential to prevent end-stage renal disease. Here we conducted a retrospective, hospital-based cohort study aimed to assess the prevalence, clinical profile, and clinical predictors for the rapid progression of DKD in type 2 DM.

Method
Type 2 DKD patients attending tertiary care hospital in South India were involved between January 2018 and 2022. CKD5 and those without minimum 6 months follow-up were excluded. Patients were followed up for 3.5 years. A sustained decline of eGFR &gt;10 mL/1.73 m2/year was defined as rapid progressors. Patients were categorized into rapid and non-rapid progressors. Clinical profiles, micro-macrovascular complications, cardiovascular events, and other risk factors for rapid progression were studied. Data were analyzed using SPSS22

Results
In a median follow-up of 3.5 years, 220(61.3%) were rapidly progressed with median eGFR decline 12ml/1.73 m2/year(IQR 8.5-19.3), and 139(38.7%) were non-rapid progressors with median eGFR decline 1.6ml/1.73 m2(IQR-0-3.3).The baseline characteristics were given in Table 1. The presence of hypertension, proteinuria, diabetic retinopathy, and cardiovascular events (p-0.01) was higher in rapid progressors than non-progressors.On logistic regression analysis, independent predictors of rapid progression were proteinuria (OR4.7;95%CI(2.24-9.88); P = .001), diabetic retinopathy(OR 0.24; 95% CI(0.11-0.52); P = .001), and AKI episodes(OR 2.18;95% CI (1.28-3.71); P = .003) (Table 2).

Conclusion
The majority of type 2 DKD patients in our setting are rapid progressors. The higher degree of baseline proteinuria, presence of diabetic retinopathy, and AKI episodes were found independently associated with clinical predictors of progression.
#4623 A NOVEL ELECTRO-HYDRAULIC ACOUSTIC THERAPY REDUCES BLOOD PRESSURE IN HYPERTENSIVE PATIENTS WITH CHRONIC KIDNEY DISEASE: PRELIMINARY RESULTS
Authors: Wolak Talya , Lerman Amir , Glikson Michael , Sukholutsky Ivetta , Silberman Shuli , Lerman Lilach 
Published: June 2023

Abstract

Background and Aims
Arterial hypertension (HTN) in association with chronic kidney disease (CKD) is a global healthcare burden, yet clinically proven treatments are limited. electro-Hydraulic Acoustic Therapy (eHAT), using ∼10% of the energy used in shockwave lithotripsy, is a promising technique to ameliorate ischemia and regenerate tissues. eHAT has been demonstrated to enhance healing in tissues such as bone, muscle, and myocardium, via several mechanisms, particularly by promoting neovascularization. Furthermore, previous animal studies demonstrated that eHAT reduces blood pressure (BP) and preserves renal function after ischemic kidney injury. The present pilot study explored the clinical safety and efficacy of eHAT and tested the hypothesis that eHAT would reduce BP and preserve renal function in patients with medically-treated hypertension and CKD.

Method
So far, a total of 15 patients with HTN and Stage III a/b CKD were enrolled in this prospective, single-arm study. The patients were treated with six sessions of eHAT during a 3-week period. At each session, 2400 shockwaves were applied to each kidney with 0.09 mJ/mm2 at 2.66Hz (NephrospecTM by Curespec LTD, Yehud, Israel). Follow-up (FU) visits were performed at 1, 3, and 6 months.

Results
The treatment was well tolerated with no major adverse events or need for analgesic treatment. Average Automated Office BP (AOBP) showed a strong tendency for a decrease in diastolic BP from baseline to the Primary Efficacy Objective at FU II (3 months post last treatment), which progressively decreased further at FU III (6 months) (Table 1). Similarly, average Office BP (OBP) detected a strong trend for a progressive decrease in systolic BP from baseline to the Primary Efficacy Objective (Table 1). Levels of eGFR appeared to slightly rise throughout the study, but this change has not reached statistical significance levels (Table 1).

Conclusion
The current study demonstrates that the eHAT procedure is tolerable and safe in this cohort. Moreover, a 3-week regimen tended to reduce BP and preserve eGFR in patients with controlled HTN and CKD. Therefore, electro-Hydraulic Acoustic Therapy may emerge as a novel, safe, and non-invasive alternative therapeutic approach in the management of HTN in the context of CKD.
#4758 IMPACT OF GENDER ON CHRONIC KIDNEY DISEASE IN ELDERLY
Authors: Bhat Dr Sanjay , Kaul Anupma , Karoli Ritu , Rai Priyanka , Srivastava Rohit 
Published: June 2023

Abstract

Background and Aims
Men with chronic kidney disease (CKD) progress to end-stage CKD at a faster rate than women Data for the association of sex with chronic kidney disease (CKD) progression are conflicting, a relationship between the two especially among elderly population needs understanding .

Method
We conducted a prospective study among all elderly population with CKD attending Nephrology OPD between between Jan 2019-Jan 2022 in Tertiary care hospital, Lucknow and assessed for the stage of CKD and their fall in eGFR ie trajectory of fall in eGFR within a year's time.

Results
A total of 59 elder men and 34 females (&gt;65 years) of age with estimated glomerular filtration rate (eGFR)&lt;45mL/min/1.73 m2 followed up in renal clinics. They were looked for progression to ESRD and morbidity and mortality over time.
The age, basic disease, systolic blood pressure, underlying cardiac status and use of rennin angiotensin blockers were similar between the two groups. Baseline eGFRs were 36.4±7.0 in men and 35.0±6.2 mL/min/1.73 m2 in women (P&lt;0.001), the degree of proteinuria among men was found to be statically significant as compared to women in this cohort. During a median follow-up of 2.9 years, (22.3% men) developed ESRD while 7.2 % died. The adjusted risks for ESKD and mortality were higher in men as compared to the women in this cohort.The decline in eGFR was evident across all stages of CKD among men as compared to women. The slop of decline in eGFR and degree of proteinuria was rapid among men compared to women (−2.9; 95% CI, −2.9 to −1.66 mL/min/1.73 m2 per year) than in women (−1.7; 95% CI, −1.92 to −1.55 mL/min/1.73 m2 per year; P&lt;0.001). Although sex differences in eGFR decline were not different across CKD stages (P=0.3), the difference in slopes between men and women was progressively larger with proteinuria &gt;0.5g/d (P = 0.04)

Conclusion
Elderly men have a steeper decline in eGFR along with higher proteinuria as compared to women indicating that the decline in the mean GFR in women was slower than in men, independent of health status.
#4773 INFECTIVE ENDOCARDITIS COMPLICATED BY RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS: BEYOND ANTIBIOTICS - TO TREAT OR NOT TO TREAT?
Authors: Nicolau Carla , Vieira Miguel Bigotte , Menezes Maria Do Mar , Góis Mário , Viana Helena , Sousa João , Ferreira Manuel Anibal A 
Published: June 2023

Abstract

Background
A significant proportion of patients with infective endocarditis, present with acute renal failure related to infective endocarditis-associated glomerulonephritis (IEAGN). However, IEAGN differs from other infection-related glomerulonephritis because it may present with clinical and serological disturbances resembling autoimmune diseases such as antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Its development introduces the dilemma of determining the best treatment approach. Immunosuppressive therapy added to antibiotic treatment may be beneficial for recovery of renal function in some cases of IEAGN with positive ANCA serology, although this approach is still controversial.

Case presentation
A 32-year-old man presented with fever, fatigue, purpura and rapidly progressive glomerulonephritis. He had a history of atrioventricular septal defect corrected at 9 years of age. Blood analysis showed anemia, acute kidney injury and positive ANCA proteinase 3 (PR3). Urine analysis revealed hematuria and proteinuria. Echocardiogram showed vegetation on the mitral valve with moderate to severe mitral regurgitation. Blood cultures showed Streptococcus mitis. After 14 days of intensive antibiotic regimen, kidney function rapidly deteriorated and ANCA titers remained high. A renal biopsy was performed and showed crescentic necrotizing glomerulonephritis with deposition of C3 and IgM – compatible with infection-related glomerulonephritis. Treatment was initiated with pulses of methylprednisolone, low dose of corticosteroids and intravenous immunoglobulin, combined with antibiotics. Renal function dramatically improved in less than a week. At three months of follow-up, kidney function remains stable and ANCA serology negative.

Conclusion
In infective endocarditis, ANCA antibodies might have an important pathogenic role rather than secondary phenomena. We suggest that patients with IEAGN, that despite adequate antibiotic regimen present, present with kidney deterioration and evidence of crescentic glomerulonephritis on kidney biopsy, might require addition of immunosuppressives.
#4850 20 YEARS' EXPERIENCE OF PERITONEAL DIALYSIS IN SARAWAK, MALAYSIA
Authors: Phui Vui Eng , Yang Zhi , Koh Alex , Hong Hui , Tan Clare 
Published: June 2023

Abstract

Background and Aims
Peritoneal dialysis is a modality of renal replacement therapy first introduced in the 1960s. In the event of the recent COVID 19 pandemic, peritoneal dialysis is gaining popularity due to the increased preference of home dialysis. Sarawak is the largest state in Malaysia with a population of more than 2 million. Unfortunately, 13% of households in the state are living in poverty. We present our experience with continuous ambulatory peritoneal dialysis (CAPD) for the past years in a geographically and socioeconomically challenging region.

Method
Sarawak General Hospital is the centre of referral for Tenckhoff catheter insertion from other districts in Sarawak. This is a retrospective record review of all CAPD patients who were under our clinic follow up from 2001 to 2022. Data examined included patient's demographic data, incidence of peritoneal dialysis related peritonitis and their outcome.

Results
All of the patients on CAPD were recorded by December of each year since we started our service in 2001 which shows a rising trend of patients on CAPD, with the highest in December 2022 at 399 patients. The number of patients with dialysis related peritonitis was also collected. Despite having more patients on CAPD, the number of peritonitis episodes per patient-year were in a decreasing trend. This was the result of the implementation of empirical first line intra-peritoneal antibiotics as part of the CAPD Peritonitis Management Protocol in 2015 and Decontamination Protocol in 2016.

Conclusion
Despite the headwinds of geographic and socioeconomic challenges, the number of patients on CAPD is on the rise. Over the years, peritonitis rate declined approaching to 0.2 episodes per patient-year. This was made possible with the introduction of local decontamination protocol and CAPD peritonitis management protocol, which helped improve the life expectancy and health of renal patients in the region.
#4973 PATHOGENIC ROLE OF D313Y MUTATION IN FABRY DISEASE
Authors: Greco Rosita , Vilio Rosalba DI , Mollica Agata , Papalia Teresa 
Published: June 2023

Abstract

Background and Aims
Fabry disease (FD) is a multisystem lysosomal storage disorder caused by mutations in the GLA gene. The significance of the mutation p.D313Y in the GLA gene is under debate. Our aim is to evaluated the pathogenic role of the D313Y.

Method
For clinical FD phenotype a 60-year-old woman (index case) with cadaveric donor renal transplantation and unknown cause of renal disease was undergoing genetic investigation. She reported D313Y as single variant in the GLA gene. A prospective analysis of clinical manifestation, genetic and biochemical (lyso-GB3 and enzyme activity) data was performed in all her brothers, sisters and sons. Data were assessed as part of routine follow-up visits.

Results
Genotype information of our index case was: nucleotide change c.937G&gt;T, exon 6 involved, amino acid change p.Asp313Tyr, HGMD accession CM930335, mutation type missense. In our cohort comprising n.9 family members: n°5 (55%, n°3 females, n°3 males age range 45-60) had the p.D313Y mutation. In nobody the biomarker lyso-Gb3 was elevated. Two brothers (age range of 40-50 y) died for acute cardiovascular attack before genetic investivagation was performed. The 5 family members showed the following clinical features: 2 hypertension and cardiac hypertrophy (2M, 44/61y); our index case renal failure, LVH and bruning pains; 2F with burning pains (49/46y). Enzyme replacement therapy (ERT) was started in our index case. Annual routine visits are performed in the others.

Conclusion
D313Y mutation seems to correlate with clinically rilevant symptoms (mainly cardiovascular and renal) compatible with FD, also without lyso-Gb3 elevation. ERT might be considered as therapeutic option not only in patients with already organ involvement, but also in paucisymptomatic to prevent disease progression.
#5018 EFFECTS OF CANDESARTAN COMPARED TO LOSARTAN ON INHIBITING MESANGIAL EXPANSION IN DIABETIC MODEL RATS RECEIVING ROSMARINIC ACID
Authors: Sakti Pandu Tridana , Samsu Nur , Rifai Achmad 
Published: June 2023

Abstract

Background and Aims
Oxidative stress and activation of the renin-angiotensin system (RAS) due to chronic hyperglycemia are the pathogenesis of diabetic nephropathy (DN). Until now, therapy for DN has not shown satisfactory results. Rosmarinic acid (RA) which has antioxidant, anti-inflammatory, anti-fibrosis effects, and ARB which can inhibit RAS activation may have a synergistic effect to prevent DN progression. This study aims to determine the effect of inhibiting mesangial expansion in diabetic rat models after being given a combination of RA and ARB (candesartan or losartan).

Method
True experimental laboratory trial with randomized post-test only control group method on Rattus norvegicus strain Wistar rats. Diabetic rats were prepared by giving a high-fat diet (60% fat calories) and a single injection of 40 mg/kg streptozotocin. Mice were divided into 4 groups, each consisting of 4 rats: negative control (healthy rats); positive control (placebo diabetic rats); diabetic rats that received RA and candesartan; diabetic rats that received RA and losartan. The rat glomerulus was evaluated to assess mesangial expansion using ImageJ 1.48 software after 8 weeks of treatment by a pathologist blindly. Data analysis with One-way ANOVA and Tukey's post hoc tests.

Results
The results of the percentage of the mesangial matrix in the positive control group (81.49% ± 1.45) were higher than the negative control group (58.82% ± 0.99). The results of the percentage of the mesangial matrix in the RA + candesartan treatment group (61.56% ± 0.35) and the RA + losartan treatment group (62.28% ± 0.77) showed lower results than the positive control group, with the One-way ANOVA test results showing significant differences (p: 0.000). Tukey's post hoc tests showed the positive control group that received a high-fat diet and induced diabetes with STZ significantly increased mesangial expansion compared to negative control (MD: [22.66]; 95% CI: [20.62], [24.72]; p: 0.000). The RA + candesartan treatment group significantly inhibited mesangial expansion compared to the positive control (MD: [-19.92]; 95% CI: [-21.97], [-17.87]; p: 0.000), as well as the RA + losartan treatment group (MD: [-19.21]; 95%CI: [-21.26], [-17.16]; p: 0.000). The RA + candesartan treatment group showed a better effect in inhibiting mesangial expansion compared to the RA + losartan treatment group, but not significantly (p: 0.735).

Conclusion
The combination of rosmarinic acid with candesartan or losartan has the effect of inhibiting mesangial expansion in diabetic rats.
#5035 CRESCENTIC GLOMERULONEPHRITIS IN A PAEDIATRIC POPULATION: A SINGLE-CENTRE EXPERIENCE FROM SOUTH ASIA
Authors: Sajjan Basavaraj , Bhadauria Dharmandr , Prasad Narayan , Kaul Anupma , Jain Manoj 
Published: June 2023

Abstract

Background and Aims
Crescentic glomerulonephritis (CrGN) is defined clinically by Rapidly progressive renal failure due to crescent formation in ≥ 50% of glomeruli. Most of these patients have a relatively poor prognosis. Therefore, early diagnose and treatment of these patients may help to prevent renal complications. There is a scarce data on pediatric CrGN. We aim to study the etiopathogenesis and outcome of CrGN in children and adolescents.

Method
Retrospective observational study of pediatric patients of age ≤ 18years with biopsy-proven CrGN from January 2010 to December 2021. Clinical and laboratory data with validated renal biopsy report were obtained from the hospital information system. CrGN was defined as crescents in ≥50% glomeruli. Rapidly Progressive Glomerulonephritis (RPGN) is the clinical presentation of CrGN, which is classified based on immunofluorescence findings and serology. Risk factors predicting poor renal outcome were determined.

Results
Of 47 (13.8% of total biopsy proven CrGN) patients, 30 were male patients (M:F ratio 1.7:1) and median age of 14 (range 7–18) years. 32 (68%) patients had immune complex GN and 14 (30%) had pauci-immune crescentic GN and 1 (2%) had anti-GBM Disease. Among Immune complex GN, the following aetiologies were found: IgA nephropathy (n=13, 27.6%), lupus nephritis (n=7, 15%), postinfectious GN (n=5, 11%), Henoch Schoenlein purpura (n=1, (2%), membranoproliferative GN type II (n=2, 4%) and others (n=5, 5%). 4 out of 14 patients with pauci-immune GN showed antineutrophil cytoplasmic antibodies (ANCA). 9 (19%) patients were dialysis dependent at the time of discharge. Patients with complete or partial remission were 23 (46.8%) at the time of discharge. Risk factors predicting poor renal outcome were oliguria, hypertension, interstitial fibrosis and tubular atrophy (IFTA), and serum creatinine at presentation.

Conclusion
Immune complex GN is the most common etiology, that constitutes 68% of patients with crescentic GN. Majority of pauci-immune GN were ANCA negative (71%). Poor renal outcome is related to severity of initial presentation and extent of IFTA.
#5111 HEMODIALYSIS TUNNELED CATHETERS LOCK WITH TAUROLOCK™ VERSUS A COMBINATION OF GENTAMYCINE AND HEPARINE
Authors: Borisov Biser , Vasileva Vanya 
Published: June 2023

Abstract

Background and Aims
Catheter-associated infections (CAIs) and thrombosis (CAT) are the most common complications, associated with the use of tunneled catheters for hemodialysis. The incidence of infections is about 1.8-6.5/1000 catheter-days, and thromboses are the main cause of catheter dysfunction and loss of vascular access in 30-40% of patients. The aim of our study was to determine the incidence of these complications in patients in whom we used prophylactic “locking” of their tunneled catheters.

Method
The patients included in the study signed an Informed Consent (№29.06.2021) approved by the Research Ethics Committee at MU-Pleven. The study was conducted in the period 01.10.2021 - 31.03.2022, a total of six months. The study included 23 men and 22 women with an average age of 60.82 (+/-13,629) years, and the age difference between the three groups can be considered insignificant (P = .046). All patients had tunneled catheters placed &gt;3 months ago (mean duration was 714 +/- 247 catheter-days) as the only vascular access for hemodialysis treatment. After a clinical examination and a negative result of two blood cultures, the patients were randomly divided into three groups of 15 (fifteen) people each, a total of 45 (forty-five) participants: group A – locking the catheter only with TauroLock™ (Tauropharm, Waldbüttelbrunn, Germany), group B – locking with gentamicin (10 mg/ml) and heparin (1250 IU/ml) and group C – locking with TauroLock™ for three months, then – with heparin and gentamicin for the next three months of the study. Patients were monitored for the major complications of catheter-related infection (CRI) and catheter-related thrombosis (CRT). All data was statistically processed with Statgraphics 19.

Results
The median duration for tunneled catheters was 8,105 catheter-days (CD). One complication was reported in each of the three groups: group A – one case of CRI, groups B and C – one case of CRT each. No cases of catheter-associated bloodstream infection, requiring prolonged treatment and catheter thrombosis, requiring replacement of the tunneled catheter were reported. Reported costs for patients treated with TauroLock™ were calculated at 3 EUR/each dialysis session, and for patients treated with gentamicin and heparin – 0.88 EUR/dialysis session.

Conclusion
The data from our study unequivocally support the thesis that locking the catheter with a solution containing TauroLock™ is comparable to the effect of locking the catheter with a solution containing an antibiotic and anticoagulant. In the short term, the difference in the price of medicines is significant, but it does not exceed the potential losses of public funds in the medium and long term. We recommend the use of a similar prophylactic regimen in all patients with tunneled catheters as the only possible vascular access for hemodialysis or with an expected duration of use greater than ninety days.