bluuebunny/crossref_metadata_2025_split huggingface dataset:
#3003 IMPACT OF FULL CORRECTION OF HEMOGLOBIN AMONG POST-TRANSPLANT ANEMIC KIDNEY TRANSPLANT RECIPIENTS: A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL
Authors: Alotaibi Torki , Gheith Osama Ashry Ahmed , Nagib Ayman Maher , Abdulhalim Medhat , Aboatya Hasaneen Hasaneen Ahmed Aboatya , Mahmoud Tarek S H , Nair Prasad , Adel Hany , Mosaad Ahmed , Atta Ahmed , Abdulhamed Mohamed 
Published: June 2023

Abstract

Background and Aims
Several studies have shown that post-transplant anemia (PTA) might be associated with increased mortality and decreased graft survival and de-novo congestive heart failure. So we aimed from this prospective randomized controlled study to assess the impact of full correction of PTA on the cardiovascular system of renal transplant recipients receiving erythropoietin stimulating agents (ESA).

Method
We recruited 247 kidney recipients with stable graft function in this RCT with 2 groups according to their target hemoglobin (11-12 g/dl, group 1, n=183) and (13:15 g/dl, group 2, n=64). After correction of deficiencies, the target hemoglobin was achieved using ESA. All patients were followed up clinically and Laboratory and radiologically for 12 months.

Results
Diabetic nephropathy was the main cause of ESKD in group 1. The studied groups were comparable regarding pre-transplant co-morbidities. Most patients received thymoglobulin as induction then cyclosporine based maintenance immunosuppression. We did not find any significant difference between the two groups concerning post-transplant diabetes, BK viremia or malignancies and even cardiovascular events (TIA, stroke, ACS), (p&gt;0.05). Group 1 showed higher mean blood pressure (P = .003), lower LV internal dimensions, higher LVH, LV mass, IVSD and LV mass index after one year of the study (p&lt; 0.05). MIVSD, mean ejection fraction and FS were comparable in both groups (p&gt;0.05). Graft outcome was comparable between both groups (P = .125), meanwhile mortality cases were significantly higher among group 1 (16 cases, 8.7%) (P = .005).

Conclusion
Full correction of PTA is associated with stabilized cardiac dimensions indices without any significant cardiovascular comorbidities.
#3078 MILD EXPERIMENTAL CKD IS ASSOCIATED WITH MYOCARDIAL FIBROSIS AND NOTCH/HEDGEHOG SIGNALING DYSREGULATION
Authors: Bogdanova Evdokia , Sadykov Airat , Beresneva Olga , Sharoyko Vladimir , Dobronravov Vladimir 
Published: June 2023

Abstract

Background and Aims
Chronic kidney disease (CKD) is an independent cardiovascular risk factor. The initial mechanisms of myocardial remodeling (MR) in CKD are poorly understood. The major developmental signaling pathways Notch, Hedgehog, Wnt, and Bmp seem to be involved in many crucial steps of MR (cardiomyocytes survival and regeneration, fibrotic response, angiogenesis), while their role in MR due to CKD was not previously studied. Phosphate (Pi) is essential for cellular signaling and its redistribution to the cardiovascular compartment in CKD could be a one of the mechanisms of MR. Here we investigated the involvement of Pi/PPi transport, and reactivation of developmental signaling pathways in myocardial alterations associated with mild CKD.

Method
We induce mild CKD by 3/4 nephrectomy in adult male SHRs (SHR-Nx, n=8) with normal phosphate intake (0.6%) and 2-month follow-up. Controls were sham-operated SHR (SHR-Sham, n=8) and Wistar Kyoto rats (WKY-Sham, n=8). We analyzed chronic kidney injury and Pi exchange parameters, serum intact parathyroid hormone (PTH), intact fibroblast growth factor 23 (FGF23), myocardial phosphorus content (ICP-AES), histomorphometry, PiT1 and PiT2 expression (IHC), and mRNA expression of Slc20a1, Slc20a2, Ankh, Mapk1, Mapk3, Bmp2, Bmp4, Ctnnb1, Fzd2, Sfrp2, Dkk1, Wif1, Numb, Notch1, Jag1, Hes1, Lgr4, Tnfrsf11b, Tnfsf11, Ptch1.

Results
Systolic blood pressure and myocardial mass index (MMI) were higher in SHRs vs WKY-Sham (Table 1). Decrease in creatinine clearance by 30% and an increase in albuminuria corresponded to mild CKD in SHR-Nx model (Table 1). In SHR-Nx, myocardial interstitial fibrosis was significantly higher (Figure 1), while MMI and cardiomyocyte diameter did not differ compared to SHR-Sham (Table 1). Myocardial alterations were accompanied by the increase in myocardium phosphorus content (Figure 1), down-regulation in PPi-exporter Ankh, and up-regulation in Hes1 and decline in Ptch1 mRNA expression (Figure 2). We found no changes in Slc20a1 and Slc20a2 mRNA levels (Figure 2). An appearance of PiT2-positive fibroblasts-like cells in myocardial interstitium was apparent in SHR-Nx rats (data not shown).

Conclusion
Myocardial alterations in mild CKD are manifested in an increase in its phosphorus content, interstitial fibrosis, and dysregulation in genes likely related to the induction of the myofibroblasts and extracellular matrix remodeling.
#3242 OUTCOMES OF THERAPEUTIC PLASMA EXCHANGE: A ONE-YEAR EXPERIENCE IN AN INTERNAL MEDICINE INTENSIVE CARE UNIT
Authors: Fayed Ahmed , Mohammed Momtaz , Hammad Hany , Fathy Moataz , Abdelhamid Yasser 
Published: June 2023

Abstract

Background and Aims
There is uncertainty regarding the best indication, device type, frequency, length of time, kind of replacement fluid, and criteria for ceasing therapeutic plasma exchange (TPE) for various disorders. TPE is an intrusive technique that has the potential to save lives, but it also has a risk of unfavorable outcomes and complications, necessitating close supervision by professional teams. In the intensive care unit (ICU), there are three categories of indications for TPE: (1) absolute, well-established, and evidence-based, for which TPE is recognized as first-line therapy; (2) relative; for which TPE is a recognized second-line treatment (alone or in combination) and (3) rescue therapy; for which TPE is used with a limited or theoretical evidence base. The purpose of this study is to continue our evaluation of the outcome of nephrology care in internal medicine ICU regarding bedside membrane therapeutic plasma exchange.

Method
In the continuity of our previous work in the analysis of the outcome of TPE. From August 2021 to August 2022, 425 membrane plasma exchange sessions were performed on 69 patients in the internal medicine department's ICU-Cairo University Hospitals-Egypt.

Results
Closely similar to what we found before; the most frequent diagnosis was thrombotic microangiopathies (24 (34.8%) patients) with complete recovery seen in 18/24 patients (75%); followed by systemic vasculitis with pulmonary renal involvement (14 (20.3%) patients) with partial remission was seen in 9/14 patients (64.3%); Guillain-Barré syndrome (13 (18.8%) patients) with complete recovery was seen in 8/13 patients (61.5%); Proliferative Lupus Nephritis with crescents [10 (14.5%) patients] with partial remission in 8/10 patients (80%), and myasthenia gravis [8 (11.6%) patients] with complete recovery in 6/8 patients (75%). Hypotension occurred during 69/425 (16.2%) sessions and hypocalcemia in 8/69 (11.5%) patients during treatment. Infection of vascular access occurred in 4/69 (5.8%) patients. 6/69 (8.7%) patients died during their stay in ICU none during treatment with TPE, all of them were diagnosed to have severe sepsis as a cause of death.

Conclusion
According to our experience, membrane therapeutic plasma exchange is a successful and secure treatment for a variety of illnesses including thrombotic microangiopathies, systemic vasculitis, myasthenia gravis, proliferative lupus nephritis, and Guillain-Barré syndrome. The main reason for death was sepsis.
#3249 BLOOD UREA NITROGEN TO CREATININE RATIO IS ASSOCIATED WITH HIGH MORTALITY IN ELDERLY PATIENTS STARTING HEMODIALYSIS: A KSGN RETROSPECTIVE COHORT
Authors: Huh Daseul , Kim Keonhwa , Kim Sang-Eun , Yang Jihyun , Lee Kyu-Beck , Kim Hyang , Hyun Young Youl 
Published: June 2023

Abstract

Background and Aims
Previous studies have shown that increased blood urea nitrogen to creatinine ratio (BCR) is a poor prognostic marker in patients with some chronic diseases or in the general population. However, the clinical implication of BCR in elderly dialysis patients is unknown. The purpose of this study was to verify the association of BCR with the risk of death in elderly patients starting hemodialysis.

Method
The Korean Society of Geriatric Nephrology Retrospective Cohort consists of patients who started maintenance hemodialysis from January 1, 2010 to December 31, 2017 at 17 nephrology centers in Korea. After excluding patients with malignancy or estimated glomerular filtration rate 30 ml/min/1.73 m2 or greater, we retrospectively analyzed 2,183 patients. The main predictor was patients BCR at the time of hemodialysis initiation and subjects were divided into four groups according to their BCR quartile. The main outcome was all-cause mortality.

Results
During 7,545 person-years of follow-up, 1,382(63.3%) patients died. Patients in the high BCR group died more (60.9%, 59.3%, 62.5% and 70.5% for the 1st to 4th BCR quartiles, respectively, P=0.001). In multivariate Cox proportional hazard model, BCR increase by one was associated with increased risk of death (HR 1.01; 95% CI, 1.01-1.02). This model was adjusted for age, sex, body mass index, cause of renal disease, hypertension, diabetes, ischemic heart disease, cerebrovascular disease, congestive heart failure, eGFR, hemoglobin, albumin, calcium and phosphorus. Compared to 3rd quartile of BCR group, 4th quartile group was associated with increased risk of death (HR, 1.30; 95% CI, 1.12-1.51).

Conclusion
High BCR is a predictor of high mortality in elderly patients starting hemodialysis. This result suggests that more attention should be paid to elderly patients starting hemodialysis with high BCR.
#3616 NON-ANESTHETIC STENTING IS AN EQUIVALENTLY EFFECTIVE METHOD COMPARED WITH PERCUTANEOUS NEPHROSTOMY IN ACHIEVING EARLY RECOVERY IN STONE INFECTED PATIENTS
Authors: Choi Bomi , Yu Hoon , Kim Sung Jin 
Published: June 2023

Abstract

Background and Aims
The prevalence of urinary tract stones is increasing. Although the importance of urgent decompression in managing this condition is well established, preferences for drainage methods (stenting vs. percutaneous nephrostomy [PCN]) differ depending on the treating institution. We therefore analyzed the effects of different drainage methods on early recovery.

Method
We retrospectively reviewed the medical records of patients hospitalized for infection with urinary obstruction due to urinary calculi at Gangneung Asan Hospital between January 2011 and December 2020. All patients underwent stenting or PCN. Early recovery was defined as subsided fever or discharge within 3 days after the procedure.

Results
A total of 178 patients, including 98 treated with double J stents and 80 treated with PCN were included. Univariate analysis revealed male sex, diabetes mellitus, coronary heart disease, mid ureter stone, upper ureter stone, stone size of 10-20 mm, and renal stone concomitance as significant prognostic factors for early recovery. In contrast, multivariate analysis revealed male sex (P=0.036), diabetes mellitus (P=0.031), mid ureter stone (P=0.007), upper ureter stone (P=0.026) as significant prognostic factors for early recovery (Table 2). When stenting was compared with PCN, the recovery period of fever and C-reactive protein and white blood cell levels showed similar trends.

Conclusion
Male patients and those without risk factors for stone-related complications tended to recover more easily after the procedure. The results demonstrate that non-anesthetic stenting is an effective method, compared with PCN, to achieve early recovery in infected patients due to stone obstruction.
#3625 TREATMENT OUTCOMES FOR IDIOPATHIC SUDDEN SENSORINEURAL HEARING LOSS IN DIALYSIS PATIENTS
Authors: Kim Seonju , Lee Dong Kyu , Kim Hae-Rim , Park Jung Mee , Yu Hoon 
Published: June 2023

Abstract

Background and Aims
Idiopathic sudden sensorineural hearing loss (ISSNHL) is one of the most challenging complications nephrologists encounter when treating dialysis patients (pts). Since no previous study has compared the treatment response of dialysis pts to that of non-dialysis pts, physicians have difficulty managing these pts. This study aimed to investigate the treatment outcome of dialysis pts with ISSNHL.

Method
In this single-center, retrospective, observational study, 700 pts diagnosed with ISSNHL between January 2005 and December 2021 at Asan Medical Center, Korea were enrolled. Among them, 47 were dialysis pts and 653 were non-dialysis pts. Non-dialysis pts were compared using a 5:1 propensity score matching (PSM) analysis to balance pre-existing clinical characteristics. High-dose systemic steroid therapy or intra-tympanic (IT) steroid injections were administered according to the standard protocol. The pure tone average (PTA) of the two groups was compared before initiating the treatment, and after 2 weeks and 2 months of treatment. The degree of improvement in the hearing was evaluated using Siegel's criteria.

Results
Without PSM, the age, prevalence of diabetes or hypertension, initial hearing threshold by each frequency level (0.5, 1, 2, and 4 kHz), and treatment strategies were statistically different between the two groups. In the PS-matched cohort, none of the measured confounding variables were statistically different between the two groups (Table 1).
Two months after steroid treatment, the average improvement in pure tone audiometry (p = 0.025) and the percentage of complete response according to Siegel's criteria were significantly higher in the non-dialysis pts group than the dialysis pts group (27.2% vs. 6.4%) (Table 2).

Conclusion
This study suggests that dialysis pts have significantly worse treatment outcomes for ISSNHL compared to non-dialysis pts.
#3626 A CASE OF PODOCYTE DISEASE WITH AZOTEMIA FOLLOWING TREATMENT WITH INTRAVENOUS IBANDRONATE
Authors: Kim Beom , Chung Yerin , Jang Woojin , Jeong Jin Seon , Lee Sanghee , Lee Dong-Young , Moon Kyoung Hyoub , Kim Huiseo 
Published: June 2023

Abstract

Background and Aims
Bisphosphonate use may induce several types of nephrotoxicity. There are many reports on pamidronate-associated glomerular disease, such as focal segmental glomerulosclerosis and zoledronate-associated acute tubular necrosis. However, there are limited reports on ibandronate-associated nephrotoxicity. Herein, we describe a case of podocyte disease accompanied with azotemia following intravenous administration of ibandronate.

Method
Case report

Results
An 88-year-old female was referred to the emergency room due to grade 4 edema that developed 1 month before. The patient was diagnosed with osteoporosis 20 months earlier, for which she received quarterly intravenous administration of ibandronate (3 mg). The last dose was administered 2 weeks ago. The patient had no history of diabetes, hypertension, or chronic kidney disease. Laboratory tests revealed heavy proteinuria with a protein/creatinine ratio (PCR) of 32 and hypoalbuminemia (1.9 g/dL) with elevated serum creatinine (sCr) (1.8 mg/dL). Values of serum complement and electrophoresis were within normal ranges. The renal ultrasonogram was unremarkable. A renal biopsy was performed and light microscopy showed mild mesangial hypercellularity and segmental amorphous collagenous deposition in the glomerulus (Fig. 1-A). The tubules revealed focal marked atrophy and interstitial fibrosis (Fig. 1-B). Immunofluorescence studies were unremarkable. Electron microscopy showed diffuse effacement of foot processes and no electron-dense deposit (Fig. 1-C), consistent with podocyte disease favoring focal segmental glomerulosclerosis. The patient was treated with tacrolimus and fimasartan. Steroid use was spared owing to severe osteoporosis. Three months later, the edema subsided and laboratory findings improved (PCR 0.64, serum albumin 4 g/dL, sCr 1.23 mg/dL).

Conclusion
Compared to pamidronate and zoledronate, ibandronate is more highly protein-bound with a significantly shorter renal tissue half life, which might explain the rarity of ibandronate-related nephrotoxicity. Contrary to the trend of other bisphosphonates nephropathies, our case showed simultaneous podocyte disease and tubule damage. We recommend close monitoring of proteinuria and renal function for prompt nephrotoxicity detection in patients treated with ibandronate.
#3727 REAL LIFE SINGLE-CENTRE EXPERIENCE IN PATIENTS WITH LONG-SURVIVAL RENAL TRANSPLANTATION
Authors: Busutti Marco , Mistretta Anna , Grandinetti Valeria , Angelini Andrea , Porcu Clara Valentina , Provenzano Michele , Comai Giorgia , Manna Gaetano La 
Published: June 2023

Abstract

Background and Aims
Kidney transplantation is the gold standard treatment for ESRD. Although the short-term results of kidney transplantation have improved significantly in the last 20 years, the increase in survival rates and the improvement of long-term graft outcomes represent a main challenge. Therefore, clinical data on patients with a long history of kidney transplantation are lacking and open field of research. The target of the study is to describe the outcomes in terms of renal function, immunological, infectious and neoplastic complications, and immunosuppressive therapy schemes, in a peculiar population of patients with long-lasting renal transplants.

Method
This is a retrospective, monocentric and observational cohort study. The study population consists of patients that underwent kidney transplantation in a single Kidney Transplant Unit from 1978 to 2012 and still in follow-up within the same Unit with a functioning graft. Data were extracted from the Hospital digital medical records after informed consent has been obtained. We analysed renal function at 5-year intervals from discharge to the last evaluation using eGFR calculated with the CKD-EPI formula. Data on demographic characteristics, comorbidities, immunosuppressive therapies and complication (divided as infectious, immunological and malignancy) has also been evaluated.

Results
We enrolled 332 patients with a mean follow-up of 17.9± 6.5 years, of whom 101 (30.4%) with a follow-up &gt;20 years. Figure 1 shows the trend of renal function during the follow-up years. In Table 1 are reported the comorbidities and immunological, infectious and neoplastic complications. 46 (14.5 %) patients underwent a “for cause” kidney biopsy. The main finding, with 62% was transplant glomerulopathy/interstitial fibrosis and tubular atrophy (TG/IFTA) with a mean post-transplant onset of 12.8 years (± 6.1), 9% of rejection findings with a mean time to onset of chronic rejection of 18 years (±8) and 1.3% of biopsied patients received a diagnosis of recurrence with a mean onset of 10.8 years (±4.4). 36.1% of the patients experienced at least one neoplasm with an average post-transplant onset time of 13.4 (±7.7). Infectious complications occurred in 36.1% of the transplanted patients.

Conclusion
This study provides an exhaustive overview of the characteristics and clinical complications in a “real life” experience with long survivor kidney transplants with the aim to better understand the needs and problems of this peculiar population in order to guide clinician in a more targeted management.
#3930 EFFECT OF TWO PHOSPHATE BINDERS ON VITAMIN D LEVELS IN HEMODIALYSIS PATIENTS
Authors: Martika Antigoni , Lampropoulou Ioanna , Pozoukidou Kalliopi , Salvaridis Dimitrios , Spaia Sofia 
Published: June 2023

Abstract

Background and Aims
A recent meta-analysis highlighted the impact of different types of phosphate binders on vitamin D metabolism in patients with stage 3 CKD. Sevelamer was associated with lower serum 25(OH) vitamin D levels probably due to reduced intestinal absorption of D3 (cholecalciferol). Corresponding effects of different phosphate binders in hemodialysis patients have not been studied.

Method
We performed an observational prospective study in which 55 stable hemodialysis patients were followed for 28 months. Patients’ age was 42-91 years old and duration of hemodialysis was 2-312 months. Patients received as phosphate binders sevelamer, sucroferric oxyhydroxide or combination. The type of binders, the administration of D3 supplements, paricalcitol or etecalcetide as well as the biochemical control of the patients were recorded every two months. Serum 25(OH) vitamin D levels and the proportion of patients who required D3 supplementation to maintain 25(OH) vitamin D levels &gt;20ng/mL were assessed.

Results
At baseline, 60% of patients used sevelamer as phosphate binder, 22% sucroferric oxyhydroxide and 18% combination, while 36% were on D3 supplements. Levels of 25(OH) vitamin D showed a significant increase after the first year of follow-up. (Dstart:16±8ng/ml vs D12months:26±10ng/ml, P = .001). After one year D3 supplementation ratio increased to 48% and remained at these levels until the end of follow-up. Taking paricalcitol or etecalcetide did not affect the results. No differences in 25(OH) vitamin D and D3 supplementation rate levels were observed between those receiving the different binders or the co administration group. No differences were observed in the biochemical markers tested as well as in dialysis adequacy.

Conclusion
In context of daily clinical practice, no differences were observed in the levels of 25(OH) vitamin D in either patients receiving sevelamer, sucroferric oxyhydroxide or combination of both as phosphate binders. Half of hemodialysis patients require cholecalciferol supplementation to maintain adequate 25(OH)vitamin D levels.
#4043 FABRY DISEASE: A RARE ENTITY IN THE NEPHROLOGY SETTING
Authors: Mariem Najjar , Dridi Rania , Braiek Hana Ben , Kaaroud Hayet , Hamida Fethi Ben , Harzallah Amel , Abderrahim Ezzeddine 
Published: June 2023

Abstract

Background and Aims
Fabry disease is a rare genetic disorder that affects multiple organs, including the kidneys. It is characterized by the accumulation of globotriaosylceramide (Gb3) in various tissues and organs, leading to progressive interstitial fibrosis and renal dysfunction. We aim to determine the renal manifestations of Fabry disease in particular the histological aspects.

Method
This study analyzed 9 patients with Fabry disease and renal involvement in a retrospective, single-center analysis. Clinical and biological data, as well as histologic findings, were collected based on patient's observations.

Results
Data was collected from 9 patients, including 7 males and 2 females, with an average age at diagnosis of 25.2 years (ranging from 17 to 32 years). All patients showed depleted activity of alpha 1 glycosidase, confirming the diagnosis. Acrosyndrome and vascular cutaneous lesions (angiokeratomas) were the dominant signs at admission with respectively (n=7; n=4), with only 3 patients being identified through familial screening without symptoms. Uncontrolled Hypertension was noted in 2 patients. Renal manifestations included renal hyperfiltration in 2 cases, isolated proteinuria in 4 patients, and renal failure in 3 others with a mean serum creatinine levels of 240 ± 36 µmol/l. Four patients underwent renal biopsy, which showed characteristic lesions of Fabry disease with sphingolipid accumulation and tubular cell vacuolization. Thickening of the glomerular capillary walls was observed in one patient. Interstitial fibrosis and tubular atrophy were noted in 3 patients. All patients received enzyme replacement therapy. Angiotensin-converting enzyme inhibitors (ACEi) and/or angiotensin II receptors blockers (ARB) were uses in 6 patients. Five patients progressed to terminal stage of renal failure requiring dialysis after an average follow-up period of 13±2.7 years. Four patients died from cardiovascular complications.

Conclusion
Early recognition and diagnosis of Fabry disease from the onset of glomerular hyperfiltration and albuminuria are crucial for the initiation of appropriate treatment and management, which can help to delay the progression of renal and other organ damage.