bluuebunny/crossref_metadata_2025_split huggingface dataset:
#6128 IMPACT OF MANNOSE-BINDING LECTIN DEFICIENCY ON GRAFT SURVIVAL IN TRANSPLANT RECIPIENTS WITH IGAN
Authors: Stea Emma , Pesce Francesco , Franzin Rossana , Sturdà Elisabetta , Bari Ighli Di , Pontrelli Paola , Gesualdo Loreto 
Published: June 2023

Abstract

Background and Aims
The progression of IgA nephropathy (IgAN) has been associated with Mannose -Binding Lectin levels (both excess or deficiency). The MBL deficiency, is associated with the rs5030737, the rs1800450 and the rs1800451, who represent the “O” allele. Since lectin pathway deregulation may impact on IgA progression on native kidney we hypothesized that the presence of the “O” allele and therefore MBL deficiency, could influence also the graft survival in recipients with a biopsy-proven diagnosis of IgAN on native kidneys. Therefore we investigated the role of MBL “O” allele in kidney transplant recipients with IgAN.

Method
We enrolled 32 kidney transplant recipients with biopsy-proven IgAN on the native kidney. The region in MBL encompassing the SNPs rs5030737, rs1800450 and rs1800451were amplified using PCR and analyzed by Sanger sequencing.Clinical data at baseline and during the follow-up were collected from patients’ records. An eGFR &lt;60mL/min/1.73m2 (MDRD equation) was considered as main outcome at univariate and multivariate analyses.

Results
The 38% of patients carry the“O” allele and 62% of patients the “A” allele which is associated with the wild genotype. No difference between the two groups as for demographic features, donor and transplant-related variables has been found. Interestingly we found that patients with the “O” allele had a worse graft outcome (P = 0.01) during a mean follow-up of 151 months (Figure 1). The “O” allele was an independent predictor for the graft survival in a Cox survival analysis model adjusted for donor's and recipient's age, acute rejection, and disease recurrence (HR 0.046; 95% I.C. 0.005-0.423; P = 0.01). Moreover we found a link between the genetic background and the MBL serum level (Figure 2).

Conclusion
Our study suggest a potential role of the MBL deficiency in the long term graft dysfunction in kidney transplant recipient with IgAN.
#6146 EARLY REFERRAL TO PRE-DIALYSIS NEPHROLOGICAL CARE ASSOCIATES WITH LOWER COVID-19 INCIDENCE IN PREVALENT DIALYSIS PATIENTS
Authors: Haarhaus Mathias , Bratescu Lavinia , Pana Nicholae , Marta Gemene Emanuela , Stojceva-Taneva Olivera , Silva Eliana , Santos Carla , Macário Fernando 
Published: June 2023

Abstract

Background and Aims
Early referral to nephrological care associates with improved long-term survival and lower hospitalization rates after dialysis initiation. Despite the strong evidence for this beneficial effect of early referral to pre-dialysis nephrological care in dialysis patients, the effect on COVID-19 incidence and outcome has not yet been investigated.

Method
Patients in the current study were recruited from a cohort of 349 consecutive patients who initiated dialysis between 2015 and 2018 at a dialysis network in Romania. All patients alive at the start of the pandemic (March 2020 = baseline) were included in this retrospective cohort study. Follow-up ended July 2021. At each visit, patients were screened for 2019 Coronavirus Disease (COVID-19) symptoms and symptomatic patients underwent PCR testing. We studied the effect of pre-dialysis nephrological care on COVID-19 incidence. Independent predictors of COVID-19 incidence were identified by multivariable logistic regression analysis.

Results
In total, 224 patients were included. Of these, 89 were early referral patients. At dialysis initiation, they had higher hemoglobin (median (25-75%), 10.0 (9.4-10.8) g/dL vs. 8.5 (7.6-9.4) g/dL, p&lt;0.001), transferrin saturation (21.5 (16.8-25.3)% vs. 18.1 (13.4-23.5)%, p = 0.01), calcium (8.8 (8.3-9.1) mg/dL vs. 8.3 (7.8-8.8) mg/dL, p&lt;0.001), phosphate (5.9 (5.0-6.8) mg/dL vs. 4.8 (3.9-5.8) mg/dL, p&lt;0.001), and albumin (3.5 (3.2-4.2) g/dL vs. 3.5 (3.2-3.8) g/dL, p = 0.04), lower PTH (220 (136-357) pg/mL vs. 289 (148-510) pg/mL, p = 0.03), and initiated dialysis less often via a central dialysis catheter (40 (44.9%) vs. 132 (97.8%), p&lt;0.001). Age, sex, diabetes, and Charlson Comorbidity Index did not differ between groups. During the 16 months of follow-up, 82 patients (36.6%) developed COVID-19. Incidence of COVID-19 was higher in patients with diabetes (32 (46.4%) vs. 50 (32.4%), p = 0.04), while early referral was weakly associated with a lower COVID-19 incidence (26 (29.2%) vs. 56 (41.5%), p = 0.06). Logistic regression, correcting for differences between early and late referral and differences between patients with and without COVID-19, identified a lower risk for COVID-19 among early referral patients (Table 1). No difference in mortality was detected between patients with and without COVID-19 during follow-up (19 (23.2%) vs. 36 (25.4%), p = 0.7).

Conclusion
Among prevalent dialysis patients, early referral to nephrological care before dialysis initiation was an independent predictor of lower COVID-19 incidence during a follow-up period of 16 month from the beginning of the pandemic.
#6157 PREDICTORS OF 24 PULSE WAVE VELIOCITY IN HYPERTENSIVE CHRONIC KIDNEY DISEASE PATIENTS: A CASE CONTROL STUDY
Authors: Radic Josipa , Vučković Marijana , Đogaš Hana , Gelemanović Andrea , Kolak Ela , Nenadić Dora Bučan , Radić Mislav 
Published: June 2023

Abstract

Background and Aims
Pulse wave velocity (PWV) is a significant predictor of chronic kidney disease (CKD) progression and death in people with impaired kidney function. It is known that patients with type 2 diabetes mellitus have higher values of PWV. Our study assessed the difference in arterial stiffness parameters (value of peripheral and central blood pressure parameters and PWV) according diabetic status and to evaluate predictors of PWV in hypertensive CKD patients.

Method
This case control, cross-sectional study included 252 hypertensive CKD patients 143 (56.7%) men and 109 (43.3%) women, aged 67 years (IQR = 15). For each participant data about sex, age, height, presence of CKD, AH and other comorbidities were collected. Laboratory parameters (urea, creatinine, estimated glomerular filtration rate (eGFR), glycated hemoglobin (HbA1c)) were obtained from peripheral blood and 24-hour urine samples were collected to analyze albuminuria. Each participant underwent 24-hour ambulatory blood pressure measurement using the IEM Mobil-O-Graph based on the oscillometry. Tanita MC780 Multi Frequency segmental body composition analyzer was used to measure body weight and level of visceral fat. Body mass index (BMI) was calculated.

Results
Out of 252 participants with AH and CKD, 107 (42.5%) also had DM. Participants with DM were older (p&lt;0001), had higher pulse pressure (p&lt;0.001) and PWV (p&lt;0.001) while the levels of peripheral and central diastolic pressure (p&lt;0.001) were lower. Regarding body composition parameters, DM participants had higher BMI (p = 0.001) and visceral fat level (p&lt;0.001). Positive predictors of PWV adjusted for age, sex, presence of DM and eGFR were HbA1c (β = 0.216, p = 0.007), albuminuria (β = 0.000, p = 0.002), central and peripheral systolic and diastolic blood pressure (β = 0.035, p&lt;0.001; β = 0.035, p&lt;0.001; β = 0.033, p&lt;0.001; β = 0.035, p&lt;0.001), pulse pressure (β = 0.047, p&lt;0.001) and mean arterial pressure (β = 0.042, p&lt;0.001). Body composition parameters were not found to be significant predictors of PWV.

Conclusion
We found significant differences in 24-hour blood pressure parameters and body composition in relation to the presence of DM. One possible explanation for the lower peripheral and central diastolic blood pressure in diabetic participants is the older age of these participants. Accordingly, PWV as a parameter of arterial stiffness, which is higher in DM participants, could also be due to the age difference. As for the predictors of PWV, the expected predictors were parameters of blood pressure. HbA1c and albuminuria were also associated with PWV as parameter of arterial stiffness in CKD participants with AH.
#6211 THE OPPORTUNITY COSTS EXPERIENCED BY PATIENTS WHO INJECT DRUGS UNDERGOING HAEMODIALYSIS: A CASE SERIES
Authors: Hartemink John , Mcdonnell Thomas , Burns Katy , Hanumapura Prasana , Kanigicherla Durga , Hamilton Patrick 
Published: June 2023

Abstract

Background and Aims
Patients who inject drugs (PWIDs) represent a uniquely difficult population to manage with haemodialysis, often with reliance on tunneled venous access. This population is historically difficult to reach, and their care is usually associated with higher per capita healthcare costs [1], unsurprisingly poor outcomes are reported [2] with a multitude of likely causes. Here we show the time associated opportunity costs these patients experience including the significant complication of tunnelled dialysis line infection in a person who actively injects drugs.

Method
This study follows on from the work by Burns [3]. In this retrospective observational study, the electronic health records of patients who were known to be ongoing users of recreational drugs were reviewed from January 2015 – August 2021. Patients were reviewed from their first tunneled line placement until either their death or until the end of the study time period. Stata 14 was used to generate descriptive statistics.

Results
6 Patients were identified, 5 had a primary diagnosis of AA Amyloidosis with the other being IgA. This cohort of patients did poorly, 5 out of 6 of the cohort had died with a mean survival of 27 months. Patients were followed for an average of 769 days (range 485 - 1052). The majority of this time alive was spent as an inpatient with the mean percentage of time as an inpatient being 55% (Range 35–81%) with a mean of 411 total inpatient days. The first confirmed bacteraemia occurred within the first 100 days in 4 out of 6 of the patients.

Conclusion
With this case series we demonstrate the opportunity cost PWIDs experience in the form of time spent as an inpatient. This cost is further added to by the burden of outpatient maintenance haemodialysis. Consideration should also be given to the excess burden their care places on over-stretched healthcare systems. Infections and dialysis compliance are key components in the care of PWIDs and while moving away from tunneled access should be sought whenever possible a multidisciplinary approach should also be considered; these patients commonly lead chaotic lifestyles and in-center dialysis is usually the only option. Including addiction, social and psychiatric services alongside dialysis may be a way to engage with this historically difficult to reach population. The hope is that this study provides the incentive for further studies focusing on the opportunity costs and the quality of life this population can expect when embarking on haemodialysis. This would provide patients with realistic expectations while also aiding clinicians in navigating this difficult ethical situation.
#6246 PIVKA II IS A BIOMARKER FOR PREDICTING CORONARY CALCIFICATION IN HEMODIALYSIS PATIENTS WITH DIABETES
Authors: Park Mooyong , Yu Byung Chul , Choi Soo Jeong 
Published: June 2023

Abstract

Background and Aims
Vascular calcification (VC) is a commonly occurring and serious complication in end-stage renal disease (ESRD) patients that increases mortality. Vitamin K deficiency is well known to cause the occurrence of VC through the inactivation of Vitamin K dependent proteins (VKDP). Therefore, a marker that can easily predict the risk of VC due to vitamin K deficiency is needed in clinical practice. In this study, we aim to investigate whether the easily measurable vitamin K absence II (PIVKA-II) can serve as a surrogate marker for predicting coronary artery calcification (CAC) in ESRD patients receiving hemodialysis and what factors influence the prediction of CAC.

Method
This study is an observational study conducted on end-stage renal disease patients receiving hemodialysis treatment. Patients with liver cirrhosis, HCC, or a history of coronary artery disease with stent placement were excluded, as well as patients with active infectious diseases. CAC score was measured by Non-enhanced computed tomography, and before starting hemodialysis, blood samples were collected to measure PIVKA-II, osteocalcin (OC), and bone-specific alkaline phosphatase (BAP) among other bone markers. PIVKA-II was measured two times with 3 months interval, and the average value was calculated. Additionally, ankle-brachial index (ABI) and DEXA bone densitometry were also performed.

Results
In this study, 69 dialysis patients participated. Among them, 34 patients had diabetes mellitus (DM). The study compared two groups based on the presence of DM. The results showed that patients with DM had higher Body Mass Index (BMI) (p = 0.01) and a higher frequency of vascular diseases such as coronary artery disease or cerebrovascular disease (p = 0.004). The DM group also had higher LDL cholesterol levels (p = 0.03), but there was no significant difference between the two groups in terms of PIVKA-II, BAP, and Osteocalcin levels (Table 1). When analyzing the factors that had a correlation with the CAC score in all 69 patients, LDL cholesterol (r = -0.37, p = 0.002) and CRP (r = 0.28, p = 0.03) were found to have a significant correlation, but PIVKA-II (p = 0.065, Figure 1A), BAP (p = 0.57), and OC (p = 0.45) did not. In the DM group, there was a statistically significant correlation between CAC score and PIVKA-II (r = 0.283, p = 0.001), but there was no correlation between CAC score (Figure 1B) and CaxP, LDL cholesterol, CRP, BAP, and OC (p = 0.7, p = 0.4, p = 0.3, p = 0.7 and p = 0.4 respectively).

Conclusion
The results suggest that in patients with diabetes who undergo dialysis, PIVKA-II can be clinically useful as a surrogate marker for predicting CAC associated with vitamin K deficiency. This is because diabetic patients may have more pronounced VKDP inactivation and VC due to vitamin K deficiency, but additional research is needed to fully understand this relationship.
#6286 NEPHROCALCINOSIS IN 3 GENERATIONS OF FEMALE PATIENTS DUE TO A PATHOGENIC MEN1 MUTATION
Authors: Petrakis Ioannis , Dermitzaki Kleio , Pleros Christos , Konidaki Myrto , Ligerou Dimitra , Mitrakos Marinos , Antonakis Andreas , Kroustalakis Nikos , Maragkou Sevasti Alexandra , Stylianou Kostas 
Published: June 2023

Abstract

Background and Aims
Multiple Endocrince Neoplasia type 1 (MEN1) syndrome, has an autosomal dominant transmission pattern, characterized by hyperparathyroidism, benign or malignant tumors in pancreas islets, pituitary tumors, thymic carcinomas, adrenal cortex adenomas and angio-fibromas of the skin. We are describing 2 cases of MEN1 with first and cardinal manifestations within the kidney.

Method
Medical records review, whole exome sequencing (WES), bioinformatics analysis by Ingenuity Pathway Analysis, QIAGEN

Results
Patient 1. A 28 year old female presented with horseshoe kidney, multiple pyelonephritis episodes, primary hyperparathyroidism, hypercalcemia, magnesiuria, reduced bone mass, and nephrocalcinosis. Her mother and grandmother suffered from hyperparathyroidism. WES analysis demonstrated a 12-base deletion between intron 9 and exon 10 in MEN1 gene (c.1351-3_1359delCAGGTGCGGCAG) with an apparent pathogenicity [1]. An accompanying alteration of CLDN16 gene (c.324+13C&gt;G, rs369250510) was also detected. Till now this alteration is considered benign. Patient 2. A 48 year old female, with primary hyperparathyroidism in the last 15 years (the mother of Patient 1), with nephrocalcinosis since 1997 (calcium oxalate stones), preserved renal function, hypercalcemia, magnesiuria, reduced bone mass, hypertelorism with concurrent diplopia. In 2013, parathyroeidectomy resulted in stabilization of nephrocalcinosis. WES revealed the same pathogenic deletion as in her daughter. A research for epigastric pain revealed a cystic pancreatic mass, with accompanying increase in serum gastrin and chromogranin. A pituitary adenoma is manifested with a marginally increased serum prolactin. Her mother suffers from primary hyperparathyroidism with nephrocalcinosis.

Conclusion
In familial nephrocalcinosis/lithiasis/hyperparathyroidism genetic counselling and screening defines individualized treatment and may prevent extra renal disease manifestations.
#6292 PSYCHOLOGICAL CHALLENGES OF THE PATIENT STARTING PERITONEAL DIALYSIS
Authors: Mulè Marica , Terlizzi Vincenzo , Bertoni Diana , Bussi Carla , Bertoni Anna , Scolari Francesco , Vizzardi Valerio , Alberici Federico 
Published: June 2023

Abstract

Background and Aims
The start of peritoneal dialysis (PD) in patients affected by end stage renal disease (ESRD) may have a significant psychological impact. Aim of this study was to assess the most frequent reasons triggering the request of psychological referral in patients starting PD.

Method
A thematic analysis of the clinical diaries of the psychological support sessions of 15 consecutive patients requesting a psychological referral during the first 3 months of PD was performed from 2018 to 2021.

Results
Fifteen patients were enrolled, 6 women and 9 men. The median age was 59 (range 27–73) and the cause of the ESRD were glomerulonephritis (5/15), diabetic kidney disease (2/15), tubulo-interstitial (2/15), vascular nephropathy (1/15), other (5/15). The most frequent symptoms triggering the request for a psychological referral were insomnia and anxiety respectively in 12 and 15 cases. From the psychological assessments the most frequent causes of the patients’ symptoms have been identified as per follow: - Difficulties in elaborating and accepting the chronic disease (why me?) in 15 Patients.- Difficulties in accepting the esthetical impact of the peritoneal catheter (in the summer how will I do it?) in 15 patients.- The difficulties related to managing fluid restrictions in 15 patients- The limitations to traveling (what if something happens to me?) in 13 patients.- The difficulties to comply to the dietetic restriction (things taste like cardboard; I always eat the same things) in 7 patients.- Difficulties in accepting the dependency to the dialysis (I feel tied to the machine; you can’t do anything) in 6 patients.- The concerns related to the risks of developing peritonitis (fear of not doing the procedure correctly) in 5 patients.- The anxiety of not being able to fulfil the tasks requested by the treatment (I can’t; I lack air when I have to start dialysis) in 6 patients.

Conclusion
This qualitative study performed in PD patients during the first 3 months of dialysis identified the most frequent causes triggering the request of a psychological referral. These findings may be of help for the physicians in order to identify which aspects need to be better discuss during the pre-dialysis counselling and stresses the importance of the availability of a psychological support in a PD unit.
#6306 SUSTAINED LOW-EFFICIENCY DIALYSIS VERSUS CONTINUOUS VENO-VENOUS HEMODIAFILTRATION OUTCOME IN CRITICALLY ILL PATIENTS
Authors: Elaziz Abdelrahman Marzouk Abd , Soliman Mohamed , Abdelrahman Ahmed , Abdelaziz Tarek , Battah Ahmed , Sheriff Hossam , Elsherif Ahmed , Abdelhamid Yasser 
Published: June 2023

Abstract

Background and Aims
Acute kidney injury due to sepsis is the most common cause of AKI in critical care settings. Different modalities of renal replacement therapies (RRT) have been used to manage this condition including Continuous Renal Replacement Therapy (CRRT) and sustained low efficiency dialysis (SLED). The aim of this work was to compare the outcome of SLED and CRRT in the form of continuous veno-venous hemodiafiltration (CVVDHF) as methods of dialysis in sepsis induced AKI.

Method
We retrospectively analysed data from 120 patients; 20 patients received CVVHDF to manage AKI in the context of sepsis, 47 patients received SLED to manage AKI in the context of sepsis and the third group included 53 patients who have been treated with SLED to manage AKI not due to sepsis. Age was found to be significantly higher in sepsis induced AKI patients treated with SLED than patients treated with CVVHDF (65±10.1# 59.5±9.3 y, p = 0.03). Sex distribution or incidences of hypertension, diabetes mellitus, malignancy or liver disease were not statistically different between groups.

Results
Unadjusted 30 day mortality was 44.7% (21pt) in the SLED group Vs 50% (10pt) in the CVVHDF group, p = 0.07. Adjusted mortality was not statically significant between SLED and CVVHDF (OR 0.97, CI = 0.95-1.06). Hypotension occurred more frequently in patients treated with SLED (24 pt = 51.1% #5 pt = 25%, p &lt; 0.001).Clotting occurred more frequently in the CVVHDF group as compared to SLED group (7 pt = 35% Vs 4pt = 8.5% p &lt; 0.001).

Conclusion
Sustained low efficiency dialysis (SLED) and CVVHDF had comparable 30 day mortality as modalities of RRT in critically ill Patients with sepsis induced AKI. SLED still an attractive alternative to CRRT modalities due to lower cost and lower incidence of complications. Further larger studies are recommended.
#6315 CHARACTERIZATION OF BRAIN DAMAGE AFTER ACUTE KIDNEY INJURY
Authors: Bobot Mickaël , Placier Sandrine , Samson Chloé , Prignon Aurélie , Louedec Liliane , Verpont Marie-Christine , Hadchouel Juliette , Galichon Pierre 
Published: June 2023

Abstract

Background and Aims
Acute kidney injury (AKI) is a very common condition in inpatients. Severe AKI is frequently associated with by neurological disorders such as confusion, the mechanisms of which are poorly understood. We have shown in several animal models that chronic kidney disease is associated with impaired cognitive performance such as memory and increased permeability of the blood-brain barrier (BBB), related to the accumulation of uremic toxin indoxyl sulfate. The goal of these experiments was to highlight the influence of AKI on cerebral impairment in mice, particularly the BBB permeability, and to describe the mechanisms involved.

Method
We performed an AKI in C57/Bl6 WT mice, by unilateral nephrectomy and transient ischemia-reperfusion of the remaining kidney for 20 minutes (RIRI20 group) and compared them to two other groups: control mice and mice with unilateral ischemia-reperfusion without nephrectomy (IR20). Modified neurological severity score (mNSS) was performed daily. BBB permeability was assessed by quantification of the Evans Blue leakage in the brain and by cerebral 68Ga-DTPA TEP/CT imaging. Cerebral immuno-histochemistry was performed to evaluate the neuro-inflammatory processes.

Results
Glomerular filtration rate at Day 1 was lower in AKI group compared to the control group 0.21 ± 0.26 vs. 0.94 ± 0.13 mL/min/100g b.w (p&lt;0.0001) and IR group: 0.75 ± 0.17 mL/min/100g b.w (p = 0.0007). Mice with AKI displayed a neurological impairment at day 1 and day 2 post-AKI, compared to control mice and IR20 mice, with mainly an impairment of the balance. Mean mNSS score at Day 1 was 2.6 ± 4.5 in AKI group, and 0.0 ±-0.0 in both the control and IR groups (p = 0.002). BBB permeability at Day 2 was higher in the AKI group than in the control group (p = 0.10) and the IR group (p = 0.0006) by Evans blue staining. Cerebral TEP imaging found similar results with increased BBB permeability in AKI mice to compared to control mice at D1 and D2 (p = 0.004 and p = 0.009, respectively). On immunohistochemistry, brains of mice after AKI displayed more astrocytosis and microglial activation compared to brains of control mice.

Conclusion
AKI in mice is specifically associated with early neurological damage, unlike renal ischemia-reperfusion alone, related to a BBB disruption in the first two days after AKI. AKI appears to induce astrocytosis and altered microglial phenotype, potentially due to increased neuroinflammatory processes following BBB disruption.