bluuebunny/crossref_metadata_2025_split huggingface dataset:
#4699 QUALITY OF LIFE AS REPRESENTED BY PHYSICAL ACTIVITY WAS IMPROVING AFTER FULL CORRECTION OF POST-TRANSPLANT ANEMIA
Authors: Alotaibi Torki , Halim Medhat MA , Nagib Ayman Maher , Aboatya Hasaneen Hasaneen Ahmed Aboatya , Mahmoud Tarek S H , Atta Ahmed , Reda Suzan , Fayad Zohair , Gheith Osama Ashry Ahmed 
Published: June 2023

Abstract

Background and Aims
Recent studies showed positive impact of correction of post-transplant anemia (PTA) on general health, exercise capacity, and physical scores. So we conducted this prospective randomized controlled trial (RCT) to assess quality of life after full correction of post-transplant anemia in renal recipients receiving erythropoietin stimulating agents.

Method
We recruited 247 kidney transplant 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) which was achieved using erythropoietin stimulating agents (ESA). Monthly clinical and laboratory evaluation of kidney graft function was carried out. Quality of life (QOL) was assessed –using 25 and 36 questionnaires-at the start and 12 months.

Results
We observed more females in group 1 and the original kidney disease was chronic glomerulonephritis was significantly higher in group 2 (37.5%) followed by diabetic nephropathy (15.7%) while in group 1 it came as 25.7% and 22.4% respectively (p&lt;0.05).The studied groups were comparable regarding pre-transplant co-morbidities. Most patients received thymoglobulin as induction and most of them were maintained on cyclosporine. We did not find any significant difference between the two groups concerning post-transplant co-morbidities (p &gt;0.05), however better graft function was observed in group 2 at 6 months (p&lt; 0.05). At 12 months, the assessment of QoL using the Medical Outcomes Study 36-Item Short-Form Health Survey, group 1 showed better post-transplant physical features and higher emotional factors related inactivity at 12 month (p&lt;0.05), while group 2 showed significantly higher basal and 12 months activity state (p = 0.05). Basal inactivity was comparable in group 2 with that at 12 months (p&gt;0.05), emotional factors related inactivity was significantly higher at 12 months in group 1. Graft outcome was comparable between both groups (p = 0.125), (p = 0.005).

Conclusion
Quality of life as represented by physical activity was improving by full correction of PTA in renal transplant recipients receiving ESA.
#4710 CYCLOPHOSPHAMIDE INDUCTION TREATMENT IN ANCA-ASSOCIATED VASCULITIS WITH RENAL AND PULMONARY INVOLVEMENT: OUTCOMES AND SIDE EFFECTS
Authors: Vezzani Valeria , DI Vito Roberto , Orfeo Chiara Alessia , Capone Martina , Iarlori Luigia , Marra Pietro , Nolletti Lorenzo , Bonomini Mario 
Published: June 2023

Abstract

Background and Aims
ANCA associated vasculitis are necrotaizing vasculitis of small and medium vassels - which cause organ damage. They are relatively rare diseases with an estimated prevalence of 200–400 cases per million people [1]. Pauci-immune necrotizing and crescentic glomerulonephritis (GN) is a frequent component of ANCA-associated vasculitis that can cause rapidly progressive Acute Kidney Injury (AKI). Less frequently, it can cause low progressive Chronic Kidney Disease (CKD) [2]. Combination therapy of steroids and cyclophosphamide has improved 5-years survival up to 70-90% but it can cause serious side effects including infectious episodes [3], bone marrow suppression and myelodysplasia. We present a case highlighting treatment modalities and our decision making.

Method
Our retrospective study analyzes the case of a 63-year-old male presenting with progressive dyspnea and hemoptysis. A chest CT suggested diffuse alveolar hemorrhage. The blood tests showed onset of AKI with 7.68 mg/dl serum creatinine (normal values 0.72-1.25), mild proteinuria and hematuria. A kidney and pulmonary vasculitis was suspected and the c-ANCA serum value was elevated at &gt;500 IU/ml. Three cycles of Plasma Exchange (PEX) were performed and methylprednisolone was given (500 mg for 3 days, 1 g on the 4th day) followed by cyclophosphamide boluses of 1 g/week for 4 weeks. Broad-spectrum antibiotics and antifungal therapy was administered to prevent secondary infections. Due to the further worsening of the renal function, three hemodialysis treatments and a cascade filtration were performed continuing with cyclophoshamide 1 g/day orally and methylprednisolone 60 mg/day. Cyclophosphamide therapy was discontinued due to thrombocytopenia and progressive leukopenia. Filgastrim 30MU/0.5 ml was administered for five days until the resolution of the pancytopenia when cyclophosphamide 50 mg 2cp+1cp was resumed.

Results
A one-month follow-up CT showed reduction in hemorrhagic opacities and the c-ANCA level was significantly reduced. Steroid dosing was progressively reduced and the patient was discharged with methylprednisolone 16mg 2cp+1/2cp tapering over 6 months and cyclophosphamide 50 mg 2cp+1cp. Serum creatinine levels improved from 2.64 mg% at discharge to 1.6 mg% at follow up.

Conclusion
When treating c-ANCA vasculitis with corticosteroids and cyclophosphamide, routine evaluation of complete blood count parameters is necessary to prevent bone marrow toxicity. We continued methylprednisolone and cyclophosphamide for six months, obtaining a total clinical remission despite side effects induced by the state of immunosuppression (oral cavity mycosis, bone marrow toxicity and CMV reactivation).
#4725 INCIDENCE OF ACUTE KIDNEY INJURY IN PATIENTS WITH COVID-19 AND ITS IMPACT ON THE COURSE OF THE ACUTE INFECTION AND POST-COVID PERIOD
Authors: Arutyunov Alexander , Trubnikova Marina , Arutyunov Gregory , Batyushin Mikhail , Tarlovskaya Ekaterina , Bashkinov Roman , Melnikov Evgenii , Batluk Tatiana , Gordeychuk Elizaveta 
Published: June 2023

Abstract

Background and Aims
It is known that SARS-CoV-2 virus infection can contribute to kidney damage. In the literature, the incidence of acute kidney injury (AKI) during the acute period of COVID-19 is estimated to range from 5 to 36.6%. This complication significantly aggravates the course of both the acute phase and post-COVID period. However, the number of studies investigating these interactions is currently insufficient. To determine the incidence of AKI in the acute phase of COVID-19 and to assess the impact of this complication on the post-COVID period.

Method
The international register “Dynamics analysis of comorbidities in SAES-CoV-2 survivors” (ACTIV) (NCT04492384) was established to assess the course of COVID‑19 in the Eurasian region and involved specialists from 7 countries. ACTIV is a multicenter, non-interventional, real-world clinical practice register that included men and women over 18 years of age with a confirmed diagnosis of COVID-19. The analysis included 9206 patients with reported evidence of kidney damage or its absence. In the register, the presence of AKI was determined from the attending physician's notes in the medical records (according to modern diagnostic criteria) and the difference in serum creatinine levels ≥ 26.5 µmol/l during inpatient treatment for COVID-19. The post-COVID period was analyzed using telephone surveys of 3099 patients at 3 months, 2493 patients at 6 months and 1782 patients, at 12 months after recovery from COVID-19.

Results
AKI was detected in 11.6% (n = 1068) of cases during the inpatient treatment of the acute SARS-CoV-2 infection. Among markers of severe infection, AKI was more common (p&lt;0.001) than cytokine storm (7.46% of patients) or sepsis (0.17% of patients). Analysis showed that AKI occurred in patients with higher average body mass index (BMI) (29.6 kg/m2 (25.1; 33.5) vs. 27.8 kg/m2 (24.8; 31.6) without AKI, p = 0.018) and serum glucose levels (6.0 (5.2; 8.55) mmol/l vs. (5.8 (5.0; 7.0) mmol/l without AKI, p = 0.011). AKI increased the odds of death in the acute period of COVID-19 by 3.94 times (95% confidence interval (CI) 3.24–4.78; p = 0.0001). Similar results were recorded 3 months after recovery (Table 1).

Conclusion
AKI was reported in 11.6% of patients with COVID-19 who were hospitalized for treatment of acute infection. Kidney damage occurred in patients with higher BMI and serum glucose levels. Patients with AKI during SARS-CoV-2 infection had a significantly higher risk of death in the first 3 months after recovery.
#4733 NEFROTOXICITY CAUSED BY COLISTIN USE: A SINGLE CENTER EXPERIENCE
Authors: Kilic İsa , Ayar Yavuz , Ceylan lkay , Kaya Pinar Kucukdemirci , Calıskan Gulbahar 
Published: June 2023

Abstract

Background and Aims
In resistant infections and septic patients, the choice of colistin in the selection of antibiotic therapy is important in the treatment response. Kidney damage is common after antibiotic use. In our study, we evaluated the clinical and laboratory data of the patients who developed nephrotoxicity after the use of colistin, followed in the intensive care unit of our hospital.

Method
The clinical and laboratory characteristics and treatment results of 148 patients (54 nephrotoxic patients) with infection who were followed up in the intensive care unit (ICU) of our hospital evaluated.

Results
The group that developed nephrotoxicity was older [70.5 (40-91), p&lt;0.001]. The APACHE II score was higher in the nephrotoxicity group [20.5 (5-49), p = 0.004]. Positive inotrope use and mortality were higher in the nephrotoxicity group [32 (59.3%), p&lt; 0.001 and 30 (55.6%), p = 0.004]. The duration of colistin use was longer in the nephrotoxicity group [13.5 (3-36), p = 0.045]. In the group that developed nephrotoxicity, the highest growth was detected in the tracheal aspirate (TAS) [49 (90.7%), p = 0.045]. Positive inotrope use and growth in TAS culture predisposed the development of nephrotoxicity in multivariate analysis [3.12 (1.38-7.02), CI 95%, p = 0.006, 5.70 (1.64-19.79), CI 95%, p = 0.006].

Conclusion
Consideration should be given to the use of colistin in resistant infections and septic patients in terms of nephrotoxicity and mortality. Antibiotic selection should be considered in critically ill patients, and patients should be closely monitored.
#4735 USEFULNESS OF CYSTATIN C IN MEASURING RENAL FUNCTION AND PREDICTING METHOTREXATE ASSOCIATED TOXICITIES IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: Kim So MI , Lee Eun Kyoung , Jeon Ji Hyun , Cho Jong Tae , Lee Hwa Young 
Published: June 2023

Abstract

Background and Aims
Rheumatoid arthritis (RA) is a representative chronic disease accompanied by muscle loss, and cystatin C may be more useful than traditional creatinine (Cr) when measuring renal function. RA is affected not only by drug dose but also by side effects of treatment according to renal function. Therefore, we tried to compare the estimated glomerular filtrate rate (eGFR) using cystatin C and Cr and analyze the methotrexate (MTX) associated toxicities after treatment.

Method
A total of 436 RA patients was enrolled in this study. The eGFR was calculated using the Chronic kidney Disease Epidemiology Collaboration (CKD-EPI) equation based on cystatin C and serum Cr. According to eGFR, CKD stages and drug dosing stages were classified and MTX associated toxicities were evaluated.

Results
Mean eGFR using the CKD-EPI cr and CKD-EPI cystatin C equations were 95.36 and 89.44 mL/min. In the CKD-EPIcr group, there were 11 patients with eGFR less than 50 mL/min that required dosing reduction, and 38 patients in the CKD-EPI cystatin C group, showing a statistically significant difference (Table 1A). In addition, CKD stage 3B and 4 patients were also higher in the CKD-EPI cystatin C group compared to those in CKD-EPI cr group (Table 1B), and anemia and nephrotoxicity were high in the MTX related toxicity stage upgraded group.

Conclusion
Our study showed that eGFR by CKD-EPI Cr can be overestimated than that by CKD-EPI cystatin C, and also demonstrated higher MTX associated toxicities in the group, which the stage was changed upward. Therefore, this study suggests that cystatin C is useful predictor in measuring renal function and predicting MTX associated toxicities in RA patients
#4738 EVALUATION OF BONE MINERAL STATUS WITH DUAL-ENERGY X-RAY ABSORPTIOMETRY AND QUANTITATIVE COMPUTED TOMOGRAPHY IN CHRONIC RENAL DISEASE
Authors: Alan Aydan Mütiş , Sezer Zehra , Dincer Mevlut Tamer , Oz Ahmet , Karaca Cebrail , Alagoz Selma , Guzel Elif , Gonen Mustafa Sait , Seyahi Nurhan 
Published: June 2023

Abstract

Background and Aims
Mineral and bone disease (BMD) is one of the common complications of advanced chronic kidney disease (CKD). Fracture risk could be predicted by bone densitometry using dual-energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT). This study aims to evaluate the effectiveness of imaging techniques in diagnosing BMD in CKD patients and healthy subjects.

Method
We performed control cross-sectional study in single center in Turkey between 2019, and 2022. We evaluated two groups aged 18-50 years. Patients groups; consisted of patients with stage 4 -5 chronic kidney disease, and control healty groups; consisted of healty participants. The bone status of thirty-three participants was evaluated using both cQCT and DXA. Diagnostic discordance was assessed between the lumbar spine and femoral neck from DXA and cQCT.

Results
Thirty-eight participants were included in the study and BMD of 33 was evaluated with DXA and cQCT. The median age was 44 years (range 22-50) in the patient's group (33% female), and 42 years (range 27-48) in controls (55% female). Baseline variables were outlined in Table 1. Using the DXA T score and cQCT; the incidence of osteopenia or osteoporosis was not statistically different in the patient and control groups (for DXA; spine and femoral neck, p: 0,62 and 0,61 respectively, for cQCT; spine and femoral neck, p:0,8 and 0,73 respectively). Regarding the lumbar spine, DXA diagnosed osteopenia or osteoporosis more frequently compared to QCT in the patient's group [6 (40%) vs 3 (20%), p = 0,01]. Three of 6 patients (50%) diagnosed with osteopenia or osteoporosis by DXA were evaluated as having normal bone status by QCT. There was no statistical difference between the two methods in the control group. The results of bone status in lumbar spine and femoral neck in the whole cohort were summarized in Table 2.

Conclusion
According to our result, in young or middle-aged patients with stage 4-5 CKD, DEXA might overdiagnosis osteopenia or osteoporosis compared to QCT.
#4742 SURVIVAL AND PREDICTORS OF MORTALITY IN HEMODIALYSIS PATIENTS
Authors: Tourountzis Theodoros , Stasini Foteini , Skarlatou Zoi , Bikos Athanasios , Kagiadaki Chrysoula , Sombolos Konstantinos , Ginikopoulou Evdoxia 
Published: June 2023

Abstract

Background and Aims
Mortality in hemodialysis patients significantly exceeds the one observed in general population. Identifying and early management of risk factors is essential for improving survival of these patients. Aim of the study is to assess survival and evaluate factors related to mortality in hemodialysis population.

Method
We retrospectively studied 237 patients [99 ♀, median age 76 (69-84) years] undergoing hemodialysis in a single Dialysis Center for a 10-years period of time (from 1/2/2010 to 31/1/2021). Demographics, comorbidities and laboratory parameters were recorded and analyzed. Median survival, mortality rate and factors that may affect them were evaluated.

Results
The mortality rate was 9.28% in the first year and 36.29% in five years after starting dialysis, respectively (Figure 1. Kaplan-Meier survival curves for the study population). Elderly patients (&gt;65 years) had a lower median survival compared to younger ones (63 versus 103 months, p = 0.031). Survival of diabetics undergoing on-line hemodiafiltration was twice versus those undergoing hemodialysis (87 versus 42 months, p&lt;0.001). Most common causes of death were cardiovascular diseases (32.38%), infections (20.95%) and cancer (18.1%) (p&lt;0.001). Multivariate analysis identified as important predictors of mortality, the existence of: diabetes mellitus [hazard ratio (HR) = 2.387, 95% confidence interval (CI) 1.278-4.46, p = 0.006], peripheral arterial disease (HR = 1.875, 95% CI 1.12-3.139, p = 0.017) and central venous catheter (HR = 2.421, 95% CI 1.297-4.518, p = 0.005). In contrast, absence of vascular access thrombotic episode (HR = 0.289, 95% CI 0.158-0.527, p&lt;0.001) and body mass index &gt;20 kg/m2 (HR = 0.517, 95% CI 0.294-0.909, p = 0.022) had a favorable effect on survival.

Conclusion
Mortality rate in our cohort was measured 9.28% in first year and 36.29% in five years after starting hemodialysis. Survival was lower at elderly and diabetic patients undergoing hemodialysis. Our study identified some mortality factors potentially modifiable, such as body weight, type of vascular access and method of dialysis treatment.
#4750 PREVALENCE OF ELECTROCARDIOGRAPHIC ABNORMALITIES IN PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Pedersen Louis Nygaard , Carlson Nicholas , Nelveg-Kristensen Karl-Emil , Rantanen Jesper Moesgaard , Madsen Bo , Graff Claus , Nielsen Jonas , Pietersen Adrian , Torp Christian , Riahi Sam , Svensson My , Gregersen Jon Waarst , Polcwiartek Christoffer 
Published: June 2023

Abstract

Background and Aims
The presence of electrocardiogram (ECG) abnormalities is high in patients with end-stage kidney disease, but no studies have examined the prevalence of ECG abnormalities according to different strata of estimated glomerular filtration rate (eGFR) in a population-based setting.

Method
This was a retrospective cross-sectional study including 310,060 individuals from the Copenhagen General Practitioners' Laboratory who had an available digital ECG recorded between 2001 and 2015 and a creatinine measurement within 7 days of the ECG. eGFR was calculated using the The Chronic Kidney Disease Epidemiology Collaboration equation. ECG abnormalities were categorized as no, minor or major, as done previously [1]. Patients with both minor and major ECG abnormalities were assigned as major ECG abnormalities. The prevalence of ECG abnormalities was examined according to different strata of renal function [eGFR (ml/min/1.73 m2) &gt;90, 61–90, 46–60, 31–45, 30-16 and ≤15]. Ordinal logistic regression was used to illustrate the probability of ECG abnormalities as a function of eGFR.

Results
The median age was 55 [IQR, 41-69] years and 46% were male. A total of 47,249 (17.9%) of the included patients had an eGFR &lt;60. The prevalence of major ECG abnormalities increased with declining eGFR: &gt;90 (16.5%), 61–90 (21.6%), 46–60 (36.5%) 31–45 (52.1%), 30-16 (57.9%) and ≤15 (60.1%). In ordinal logistic regression, the risk of having major ECG abnormalities compared to minor/no abnormalities significantly decreased pr. 5 ml/min increase in eGFR, OR 0.90 (95% CI, 0.85-0.90), Fig. 1. The most common major ECG abnormalities were left ventricular hypertrophy and ST-T deviations. The prevalence of all ECG abnormalities is shown in Table 1.

Conclusion
ECG abnormalities are common in patients with chronic kidney disease, and the probability of major ECG abnormalities increases with declining eGFR.
#4771 PROGNOSTIC RELEVANCE OF ELECTROCARDIOGRAPHIC ABNORMALITIES ACCORDING TO EGFR CATEGORIES
Authors: Pedersen Louis Nygaard , Carlson Nicholas , Nelveg-Kristensen Karl-Emil , Rantanen Jesper Moesgaard , Madsen Bo , Graff Claus , Nielsen Jonas , Pietersen Adrian , Torp Christian , Riahi Sam , Svensson My , Gregersen Jon Waarst , Polcwiartek Christoffer 
Published: June 2023

Abstract

Background and Aims
Electrocardiogram (ECG) abnormalities are associated with adverse cardiovascular outcomes in patients with chronic kidney disease (CKD), but their prognostic relevance according to estimated glomerular filtration rate (eGFR) categories remains unexplored. This study investigated the associations between no, minor, and major ECG abnormalities and fatal cardiovascular disease (CVD) according to different strata of renal function.

Method
This was a retrospective cohort study including 310.060 individuals aged ≥16 years from the Copenhagen General Practitioners' Laboratory that had an available digital ECG and creatinine measurement within 7 days from 2001–2015. eGFR was calculated using The Chronic Kidney Disease Epidemiology Collaboration equation, and data were cross-linked with Danish nation-wide healthcare registries to gain information on medication, comorbidity, and fatal CVD. ECG abnormalities were categorized as either no abnormalities, minor (first-degree atrioventricular block, incomplete bundle branch block or corrected QT prolongation) or major (left ventricular hypertrophy, atrial fibrillation/flutter, bundle branch block, Q waves, or ST-T deviations), as done previously [1]. Patients with both minor and major ECG abnormalities were assigned as major ECG abnormalities. ECG abnormalities and their association with fatal CVD were compared across strata of renal function [eGFR (ml/min/1.73m2) &gt;90, 61–90, 46–60, 31–45, 16–30 and ≤15] based on multivariable Cox-regression analysis adjusted for age, sex, and comorbidities. Counterfactual G-estimation of Hazard Ratios (HRs) standardized to age and sex was performed to estimate 5-year absolute risk of fatal CVD.

Results
The median age was 55 [IQR, 41-69] years and 46% were male. Median study follow-up time was 10.3 [IQR, 6.7-14.4] years. A total of 47,249 (17.9%) of the included patients had an eGFR &lt;60. The rate of fatal CVD according to ECG abnormalities and their adjusted HRs is shown in Fig. 1, while 5-year standardized risk of fatal CVD is depicted in Fig. 2. Generally, having minor or major ECG abnormalities, conferred a worse prognosis across all eGFR strata, with the highest 5-year absolute risk of fatal CVD being observed among patients with major ECG abnormalities and an eGFR between 31–45 [19% (95% CI, 18–20%)], eGFR 16–30 [25% (95% CI, 24–26%)] or an eGFR ≤15 [27.5% (95% CI, 24–31%)], Fig. 1–2.

Conclusion
In a population-based setting, having minor or major ECG abnormalities were associated with an increased risk of fatal CVD across all strata of renal function. Patients with an eGFR ≤45 and major ECG abnormalities represent a high-risk population, that might benefit from careful monitoring and cardiovascular risk management.