bluuebunny/crossref_metadata_2025_split huggingface dataset:
#5941 SERUM LEPTIN AND MALNUTRITION IN PERITONEAL DIALYSIS PATIENTS: A CONNECTION YET TO BE FOUND
Authors: Trigo Ana , Ramos Ana Rita , Duarte Rui , Alves Ana Rita Valerio , Gonçalves Hernâni , Santos Paulo 
Published: June 2023

Abstract

Background and Aims
Leptin is a hormone responsible for the modulation of the satiety signals and that it is known for being increased in patients undergoing Peritoneal Dialysis (PD) treatment. Nevertheless, conclusions about its role in the malnutrition associated with this technique remains to be done. Our study aimed to characterize the nutritional state of a Portuguese program of PD and to establish the impact that leptin levels had on it.

Method
A cross-sectional study was performed involving 28 patients of a PD program. To characterize the patients’ nutritional status we collected the following data: anthropometric measurements (weight, body mass index (BMI), fat tissue index and lean tissue index using Fresenius ® Body Composition Monitor), analytical values (albumin, total proteins, total cholesterol, high-density lipoprotein cholesterol, low-density cholesterol, triglycerides, leptin serum levels), protein metabolism (normalized protein catabolic rate (nPCR), normalized dialysate protein loss (nEPL), normalized urine protein loss (nUPL), normalized total protein loss (nTPL) and normalized dietary protein requirement (nDPR)) and peritoneal dialysis adequacy (total, renal and peritoneal kT/v; total, renal and peritoneal creatinine clearance). The collected data were statistically analyzed and correlations were made using Mann-Whitney U test and Spearman test, depending on the variable type.

Results
7 (25%) patients were females, and the mean age was 59.5 years old (± 14.31). The mean dialysis vintage was 27.04 months (± 20.14) and the majority (n=23, 82,1%) preformed automated peritoneal dialysis (APD). Regarding the nutritional status, the mean BMI, FTI and LTI was 26.64 kg/m2 (±4.39), 14.24 kg/m2 (±5.47) and 11.62 kg/m2 (±2.52) respectively. 57.1% (n=16) had serum albumin below 3.5 mg/dL, with a mean phosphorus of 5.01mg/dl (±0.72) and a mean leptin of 28.58ng/mL (±28.44). The serum leptin was 5.4 times higher than the adjusted value for BMI in the population without kidney disease. The adjusted serum leptin for BMI was different between sex (U=15, P = .001) and it was positively correlated with total (ρ=0.47, P = .012) and high-density lipoprotein (HDL) cholesterol (ρ=0.535, P = .003). It was not associated with the protein metabolism (nPCR, nEPL, nUPL, nTOL and nDPR), albumin or total proteins and PD adequacy.

Conclusion
Leptin values independent of BMI are significantly higher amongst patients on PD. Alike the healthy population, women on PD are also prone to have higher serum leptin values. Although studies are still controversial about the association between this hormone and cholesterol, in this population there is a positive correlation. As so, hyperleptinaemia cannot yet be associated with the malnutrition that is generally present amongst PD patients, but it must be considered as a contribute to the already known increased cardiovascular risk.
#5963 THE ASSOCIATION OF FRAILTY, DENTAL STATUS, İNFLAMMATION AND MALNUTRITION İN HEMODIALYSIS PATIENTS
Authors: Çağlar Tuğçe Topoğlu , Erten Yasemin , Yıldırım Saliha , Borazan Funda Yıldırım , Ozkula Handan 
Published: June 2023

Abstract

Background and Aims
Persistent low-grade inflammation and malnutrition in chronic kidney disease (CKD) are associated with so many CKD complications. Frailty, the state of increased vulnerability often associated with aging, had a higher incidence in CKD patients regardless of age. In this study, we aimed to investigate the frequency of frailty among hemodialysis patients and volunteers with normal kidney function to define its relationship with inflammatory markers, biochemical parameters and dental status.

Method
A cohort of 86 CKD patients with hemodialysis (HD) and 74 volunteers with normal kidney function (similar in terms of age and gender distribution) were included in this study. Both groups were evaluated by the Clinical Frailty Scale in three groups as non-brittle, pre-frail and frail. Demographic characteristics, biochemical parameters and dental status were recorded.

Results
21 of 86 patients (24.4%) were frail in CKD patients with HD, and 4 of 76 patients (5.4%) in the control group were frail (p&lt;0.001). The frail individuals in the HD group were older (p&lt;0.001), had more systemic diseases (p&lt;0.001), had higher serum C-Reactive Protein (CRP) levels (p&lt;0.001), lower serum albumin levels (P = .001), lower serum creatinine levels (p&lt;0.003). When the number of teeth is evaluated; the number of patients with more than 20 teeth was significantly lower in the frail group than in the non-frail group (p&lt;0.001).

Conclusion
In our study, the frequency of fraility in hemodialysis patients was found to be significantly higher than in the control group. The lower albumin and serum creatinine levels, the higher CRP levels and the lower number of teeth suggest the relationship between frailty with dental status, malnutrition and inflammation in hemodialysis patients. It can be concluded that improvements in oral health and/or inflammation status can contribute to the improvement of frailty in this patient group.
#6140 DEPENDENCE IN THE ELDERLY PATIENT ON HEMODIALYSIS
Authors: Pereira Monica , Manso Paula , Burgos Marina , Carneiro Damian , Mas Sebastián , González-Parra Emilio , Arenas Maria Dolores , Sánchez-Tocino Maria Luz 
Published: June 2023

Abstract

Background and Aims
Frailty constitutes a syndrome, characterized by loss of lean body mass (sarcopenia), weakness, and decreased resistance to physical exercise, which leads to decreased activity and a poor response to stress. Reduced activity, in turn, worsens sarcopenia and weakness, leading to a vicious cycle toward functional decline and increased risk of death. Frail patients starting HD may lose independence, as their functional capacity deteriorates, with increased frailty and sarcopenia, especially in the elderly. Aims: Observe the clinical differences in elderly patients on hemodialysis depending on whether they are dependent or not and observe if dependence has an impact on the dialysis regimen used.

Method
Observational descriptive study for 1 year in patients of the chronic hemodialysis program of four out-of-hospital centers and a hospital unit of the Fundación Renal Íñigo Álvarez de Toledo (Spain). Of the total number of patients receiving dialysis in the units, 107 over 75 years of age, who had been in the program for more than 3 months and who had signed the informed consent, were included in the study.
The variables considered for the study were: age, sex, height, weight, and body mass index (BMI), etiology of kidney disease, time on hemodialysis, residual diuresis &gt; 500 mL/min, and type of vascular access. In relation to the hemodialysis regimen, the duration variables were collected in hours of the HD session at the beginning of the program and at the time of the study, weekly hours and days per week
Analytically determined: albumin, total iron binding capacity (TIBC) and creatinine. In addition, the measure of dialysis efficacy was established by eKt/V
To assess the degree of functional dependency, the Barthel index is considered the most appropriate scale to assess the basic activities of daily living (BADL), obtaining a quantitative estimate of the degree of dependency.

Results
Association between dependency and the rest of the qualitative variables. Data expressed n (%) or mean ± SD.

Conclusion
Dependent patients have lower residual renal function, greater comorbidity, less ability to walk, and therefore need transportation to go to dialysis, live in residences, and are extremely tired at the end of dialysis.
#6389 EARLY WEIGHT LOSS AFTER BARIATRIC SURGERY IN PATIENTS WITH ORGAN FAILURE OR TRANSPLANTATION
Authors: Moore Linda , Yi Stephanie , Davis Garth , Sherman Vadim , Guha Ashrith , Victor David , Huang Howard , Knight Richard , Gaber A , Ghobrial R , Tariq Nabil 
Published: June 2023

Abstract

Background and Aims
Obesity is an epidemic that complicates global health and economies. Surgery for obesity (OS) is one effective treatment that results in significant weight loss. Patients with chronic organ failure who are obese undergo OS but it is unknown whether they achieve similar weight loss response as patients who do not have organ failure.

Method
Patient records of OS cases between May 2016 and June 2022 from a large healthcare system were examined to review weight changes after OS by whether the patient was a transplant patient or not. The proportion of excess weight lost was determined for 1month, 3months, 6months and 1year post OS. Non-parametric analyses were performed; p &lt;0.05 was considered significant.

Results
of 1,673 OS cases, the mean (SD) age was 47.6 (12.5) years, the majority were female (1,276, 76.3%), and 58% identified as Caucasian. Within this number, 92 patients were transplant candidates (n=50, 3%) or recipients (n=42, 2.5%). The transplant patients were older [51.5 (10.8) years vs 47.3 (12.6) years, P = .0008], had similar body weight [124.4 (22.5) kg vs 126.0 (27.2) kg, P = .8271] but a lower body mass index [42.6 (5.7) kg/m2 vs 45.1 (8.1) kg/m2, P = .0046] compared to patients who were not having a transplant. Transplant patients experienced different weight loss in the early post-operative period but similar weight loss after OS as non-transplant patients (Table 1 and Table 2).

Conclusion
Though early post-operative differences were noted in this study, patients with organ failure responded similarly to OS as patients without organ failure.
#6567 ANCA ASSOCIATED VASCULITIS AND COVID
Authors: File Ibolya , Markóth Csilla , Szabo Reka P , Balla Jozsef , Bidiga László , Mátyus János 
Published: June 2023

Abstract

Background and Aims
The coronavirus 2019 (COVID-19) pandemic has brought on challenges not only to acute care, but also chronic care of patients. Patients with ANCA-associated vasculitis (AAV) frequently require immunosuppression and may be at increased risk for developing COVID-19. The incidence and impact of COVID-19 on patients with AAV is currently not well known. We collected the data of patients with AAV infected with SARS-CoV-2, focused on the relationship with the employed immunosuppressants and the stage of chronic kidney disease.

Method
A retrospective study of AAV patients was conducted. Data regarding demographics, disease characteristics and therapy were confirmed by review of the electronic medical record. Information regarding current and previous therapies was collected.

Results
In our center there were 110 AAV patients who had data in the pandemic period. The majority was diagnosed with microscopic polyangiitis (MPA, n=61) or with granulomatosis with polyangiitis (GPA, n=44), there was 5 patients with eosinophilic granulomatosis with polyangiitis (EGPA). Seventy pts (77%) were receiving immunosuppression treatment, sixteen (17.6%) of these patients employing rituximab during the pandemic period. Twelve patients on immunosuppression treatment for AAV was diagnosed with COVID infection. Eight pts had kidney transplantation, no one had positive PCR test. Thirty-two pts of the 110 pts with AAV was on chronic dialyisis treatment, (29 pts on haemodialysis, 3 pts on peritoneal dialysis), eleven of them had positive PCR test for COVID-19. Among the 110 pts with AAV eighteen pts (19%) had positive PCR test for COVID-19. Seven pts had mild disease (with no or mild pneumonia), no specific therapy was applied. Five of them received immunosuppression (rituximab combinated with azathioprine or micophenolate mofetil), two pts was on haemodialysis. Severe disease (dyspnea, hypoxia, or &gt;50 percent lung involvement on imaging within 48 hours) was reported in 7 pts. Five pts was on immunosuppression treatment (2 rituximab, 2 azathioprin, 1 leflunomide), 2 of them was on haemodialysis as well, 2 pts on HD without ISU. In the hospital four patients received favipiravir and prednisolone, no one of them died. Four pts was treated with critical disease (respiratory failure, shock, or multiorgan dysfunction). Two of them was on chronic haemodialysis, and received rituximab with azathioprine, one of them died. The other two pts was without immunosuppression, unfortunately both of them died.

Conclusion
The incidence of COVID infection is higher among pts with AAV. The pts treated with immunosuppression has higher risk for COVID infection, but the mortality was not significantly higher than in other pts groups. The highest incidence of the COVID infection was in the pts on chronic dialysis treatment, mostly due to the infection during the transfer to the HD Unit.
#6746 SAFETY OF ANGIOTENSIN RECEPTOR-NEPRILISIN INHIBITOR IN PERITONEAL DIALYSIS PATIENTS WITH HEART FAILURE: A MULTI-CENTER COHORT STUDY
Authors: Pimenta Gonçalo , Afonso Rita , Vida Ana Carlota , Gomes Daniel , Maltes Sergio , Matias Patrícia , Duraes José , Aguiar Carlos , Silva Gil , Branco Patricia , Calça Ana Rita 
Published: June 2023

Abstract

Background and Aims
Sacubitril/valsartan, the first approved angiotensin receptor neprilisin inhibitor (ARNi), is the current cornerstone in the treatment of heart failure with reduced ejection fraction (HFrEF), reducing hospitalizations and mortality. However, in patients with chronic kidney disease stage 5D, who have the highest prevalence of congestive heart failure, its use is still not approved. The aim of this study was to evaluate the safety of sacubitril/valsartan in peritoneal dialysis (PD) patients with HFrEF.

Method
Multi-center cross-sectional cohort study including 5 PD patients with NYHA class II-IV HFrEF who started sacubitril/valsartan between 2017 and 2022. Demographic and clinical data were collected from the electronic records. Clinical, biochemical and echocardiographic parameters were compared before and after treatment initiation.

Results
A total of 5 patients (all male) were included with a mean age of 71±9 years and a median follow-up time of 16 months (IQR 22). The dose of sacubitril/valsartan was 24/26mg, 2 times per day in all patients. The indication to start PD was hypervolemia in all patients and the mean left ventricular ejection fraction at PD beginning was 35±8%. DPCA was the modality of choice in all patients and 4 were under icodextrin. All patients had coronary artery disease and 3 patients were obese and diabetic. All patients were taking furosemide and 4 patients were under a beta-blocker and a SGLT-2 inhibitor. During follow-up, left ventricular ejection fraction increased from 35±8% to 38±8% (P = .018) and median residual diuresis decreased 25 mL per month (IQR 66), but none of the patients became anuric. De novo hyperkalemia or hypotension did not develop in any of the patients. No significant difference in blood pressure profile was noticed. A major adverse cardiovascular event occurred in only one patient (myocardial infarction requiring coronary artery revascularization and hospitalization). No deaths were reported.

Conclusion
Our results suggest that ARNi can be used safely in patients under PD with major cardiovascular risk. Further randomized studies are warranted to confirm safety and clarify the benefit of this therapy in PD patients with HFrEF.
#6833 ARE KT RECIPIENTS TAKING THEIR IMMUNOSUPPRESSANT MEDICATION? PRELIMINARY EVIDENCE FROM A SUPER-SPECIALIZED TRANSPLANT CENTRE IN SUB-SAHARAN AFRICA
Authors: Olatise Olalekan , Muoka Michael , Asaolu Stephen , Adekoya Adebowale , Olatise Adaku , Faponle Adegboyega 
Published: June 2023

Abstract

Background and Aims
Immunosuppressant non-adherence is a leading cause of preventable renal allograft dysfunction, rejection and graft loss. The barriers to immunosuppressant adherence as well as associated risk factors of non-adherence vary across studies in different locations. This study aimed to investigate the prevalence of immunosuppressant non-adherence among adult kidney transplant recipients and identify barriers to adherence in a renal transplant cohort.

Method
A cross sectional survey was conducted using the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS), the Immunosuppressant Therapy Barrier Scale and the Beliefs about Medicines Questionnaire. Adherence was defined according to the BAASIS, with barriers to adherence and beliefs about medicines compared between the two groups. Participants were recruited from the out-patient clinic at Zenith Medical and Kidney centre. An advert for the study was placed in consultation rooms and patients were approached to join the study when they attend appointments. IBM SPSS Statistics for Windows, Version 23 (Armonk, NY: IBM Corp) was used for data analysis.

Results
The rate of non-adherence was 50.7% out of 67 kidney transplant recipients attending outpatient clinic. There were statistically significant associations between non-adherence and occupation (P = 0.049). Participants who are on MMF were more adherent than those on sirolimus (97.0% vs 79.4% and 0.0% vs 8.8%) and this difference is statistically significant (P = .038). Also, participants who have had one or more post-transplant hospital admission are more non-adherent when compared with those that have never been admitted (P = .022) The only significant barrier to adherence was when patients travelled out of town (P &lt; 0.005). Adherence was not associated with patients’ belief about their medicines.

Conclusion
Interventions aimed at ensuring constant access to immunosuppressant drugs and those based on habit forming may significantly improve adherence in this cohort.
#6921 INFECTIOUS PERITONITIS DURING PEDIATRIC PERITONEAL DIALYSIS
Authors: Abdellatif Abir , Jellouli Manel , Bousetta Abir , Sayari Taha , Gader Ameni , Gargah Tahar 
Published: June 2023

Abstract

Background and Aims
Peritoneal dialysis (PD) is the dialysis treatment modality of choice used to treat pediatric patients with end-stage kidney disease (ESKD), thanks to its various benefits. However, infectious complications, mainly infectious peritonitis (IP), can occur, leading to morbidity, mortality and technique's failure. In this study, we aimed to describe the deferent infectious complications observed in children on PD and to investigate the risk factors for the occurrence of IP.

Method
In this study, we retrospectively collected the records of 99 patients who were treated with PD within the last eleven years (2010-2020) in the department of pediatrics of the University Hospital Charles Nicolle in Tunis. We adopted the terminology of the International Society of Peritoneal Dialysis (ISPD) to define peritonitis and its outcome. Analysis examining possible predictive factors of IP were performed using parametric and non-parametric tests and multivariate logistic regression in multivariate analysis.

Results
Ninety-nine patients were on PD during our study period, of which 65 patients had a total of 120 episodes of IP. The incidence of IP was 0.41 episodes per patient/year. The average time to onset of the first episode of IP was 1.2 years [3 days – 5.54 years]. Clinical signs of IP were dominated by abdominal pain (78.3%) and fever (50.4%). The PD effluent was cloudy in 78.3% of cases. Peritoneal dialysis fluid culture was positive in 33.3% of episodes with a predominance of gram-positive germs (62.8%). The evolution of this IP was favourable in 91.5% of cases with a response to antibiotics. 7% of episodes were relapsing of which five were during the first episode of IP. IP recurrence occurred in one patient. A catheter change was required over 16 episodes of IP, and hemodialysis sessions were necessary in 27 patients, temporary in 10 patients. The multivariate study identified the following predictive factors of IP: poor adherence to treatment (OR=3.851; 95%CI: 1.369-10.837; P = .011) and weight less than 15 Kg (OR=6.314; 95%CI: 1.333- 29.897; P = .02).

Conclusion
Considering the high risk of peritonitis in children on PD, it is imperative to establish a primary prevention based on training of the child's caregivers and families. Continous quality improvement program and PD technique must systematically reviewed in every peritonitis episode. Nutritional management of children prior to the start of PD is necessary to limit the risk of IP.
#6929 SGLT2 INHIBITORS IN IGA NEPHROPATHY: REAL LIFE EXPERIENCE AT OUR CENTRE
Authors: Carvalho Renata , Medeiros Joana , Pires Olga , Bastos José Mário , Ribeiro Bárbara , Viana Johanna Rodrigues , Vaz Raquel , Marques Sofia Homem Melo 
Published: June 2023

Abstract

Background and Aims
SGLT2 inhibitors (SGLT2i) have a beneficial effect in diabetic and non-diabetic proteinuric chronic kidney disease (CKD), demonstrated in large randomized controlled trials. However, there is limited information about real life experience with SGLT2i in non-diabetic CKD like IgA nephropathy (IgAN).

Method
All patients with biopsy-proven IgA nephropathy since 2015 were evaluated for SGLT2i use. We collected data on age, gender, the use of renin-angiotension-aldosterone system inhibitors (RAASi), eGFR, glycosuria and proteinuria at baseline, at 6 months and at one year of follow-up. Glomerular filtration rate (eGFR) was estimated using the CKD-EPI equation. Data was analyzed using Jamovi®.

Results
51 patients had IgAN diagnosed by kidney biopsy from April 2015 until March 2021. Eleven of these started SGLT2i between December 2020 and February 2022 (at their physician's description). Their median age was 52, nine were male and all were taking RAASi. The initial median proteinuria was 1 g/g (range 0.5-2.0 g/g), median eGFR was 57.5 mL/min (range 16.8-104 mL/min). At 6 months, the median proteinuria was 0.7 g/g (range 0.8-4.8 g/g), median eGFR was 42.6 mL/min (range 13.9-108 mL/min). One year after beginning SGLT2i, 8 patients have laboratory values and the median value of proteinuria was 0.85 g/g (range 0.2-3.0 g/g) and the median eGFR was 40.5 mL/min (range 14.5-85.4 mL/min). All patients had glycosuria at all urine evaluations confirming no discontinuations of the SGLT2i. No serious adverse events were reported and none of the patients needed dialysis or died. There were no significant differences between proteinuria and eGFR between evaluations at the start, 6 months and 1 year of follow-up.

Conclusion
SGLT2i have become important drugs in IgAN. Our first cases who started SGLT2i showed good compliance (using glycosuria as an indirect tool to monitor adherence) and no adverse events, irrespective of their initial eGFR. The small sample was probably a limitation to the lack of significant results.
It’s me again… Ask avoidance and the dynamics of charitable giving
Authors: Späth Maximilian 
Published: June 2023

Abstract
Charities typically ask potential donors repeatedly for a donation. These repeated requests might trigger avoidance behaviour. Considering that, this article analyses the impact of offering the option to opt-out of receiving future fundraising asks on charitable giving. In a proposed utility framework, any opt-out option decreases the social pressure to donate. At the same time, an unconditional opt-out option induces feelings of gratitude toward the fundraiser, which may lead to a reciprocal increase in donations. The results of a lab experiment designed to disentangle the two channels show no negative impact of the option to avoid repeated asking for donations. Instead, the full model indicates a positive impact of the reciprocity channel. This finding suggests that it might be beneficial for charities to introduce an unconditional opt-out option during high-frequency fundraising campaigns.