bluuebunny/crossref_metadata_2025_split huggingface dataset:
#4762 PREGNANCY-RELATED ACUTE KIDNEY INJURY: 10-YEAR SERIES OF A NEPHRO-OBSTETRIC CLINIC
Authors: Nogueira Estela , Peres Nadiesda , Godinho Iolanda , Centeno Mónica , Pinto Luísa , Lopes José António 
Published: June 2023

Abstract

Background and Aims
Pregnancy-related acute kidney injury (P-AKI) is a rare complication of pregnancy associated with significant maternal and fetal morbidity and mortality. Its incidence has progressively decreased worldwide with the improvement of obstetric care, but recently some developed countries have noticed an increase in its incidence. Adjusted definition of AKI in pregnancy is lacking, making its incidence difficult to ascertain. Herein, the authors retrospectively evaluated the causes and outcomes of P-AKI patients surveilled by the nephro-obstetric clinical team.

Method
Retrospective analysis of maternal, obstetric and perinatal outcomes of P-AKI patients, that were followed by the Nephro-obstetric clinical team between 2011 and 2022.

Results
We evaluated 29 patients, with mean age of 32 ± 6 years [17 – 42], 19 Caucasian and 9 Black, 17 nulliparous, 16 hypertensive, 7 diabetic, 1 with HIV, and 1 with systemic lupus erythematosus. Only 12 patients had CKD and 3 were renal transplant patients. In 2/29 patients P-AKI occurred before 20 weeks [15-17] due to obstructive uropathy and pregnancy hyperfiltration in a CKD G3 patient. After 20 weeks of gestation, P-AKI occurred in 27/29 patients (mean 32 weeks; range 21-41weeks), with mean SCr of 3,1 mg/dl [1,8-4,5] in previously CKD patients and mean SCr of 2.4mg/dl (1,2-58mg/dl) in the patients with normal renal function. Regarding the severity of P-AKI, 16/7/6 patients developed AKI stage 1/2/3 (KDIGO), respectively. Causes of P-AKI after 20 weeks in patients with normal renal function were preeclampsia (PE; 8/14), HELLP syndrome (1/14), hemolytic uremic syndrome (1/14), sepsis (3/14), renal obstruction (1/14), severe hypercalcemia (1/14), cortical necrosis due to hemorrhagic shock (2/14), hypovolemia and nephrotoxic agents (1/14). All patients had full renal recovery. In renal transplant patient P-AKI was related to PE (2/3), sepsis (1/3) and probable calcineurin inhibitor toxicity (1/3). Regarding CKD patients, P-AKI was caused by PE (6/10), hyperfiltration of pregnancy (3/10) and allergic interstitial nephritis (1/10). The need for renal replacement therapy occurred in 7/29, and only 2/7 became dialysis dependent (both with previous CKD diagnosis). De novo or worsening proteinuria occurred in 15/29 (3975 g/day; 431-14000 g/day) and 10/29 patients (mean 6227 mg/day; 681-14937 mg/day), respectively. Regarding fetal outcomes, there were 2 stillbirths, mean gestation duration was 33 weeks (25-41weeks), mean birth weight 1947 g (550-3950 g) and mean Apgar 1/5/10 was 8/9/10, respectively. Cesarean was performed in 19/27 patients and 7 newborns were admitted to the neonate care unit due to prematurity.

Conclusion
In a tertiary referral center, P-AKI was associated to a wide range of causes, frequently required a multidisciplinary approach and was associated to significant worse maternal, obstetric and perinatal outcomes.
#4778 THE NATURAL HISTORY OF IGA NEPHROPATHY IN THE GERMAN CHRONIC KIDNEY DISEASE (GCKD) COHORT
Authors: Stamellou Eleni , Nadal Jennifer , Seikrit Claudia , Hendry Bruce , Mercer Alex , Möller Marcus Johannes , Schmidt Matthias , Schiffer Mario , Eckardt Kai-Uwe , Floege Jürgen 
Published: June 2023

Abstract

Background and Aims
Primary IgA nephropathy (IgAN) is the most common form of glomerulonephritis and a major cause of kidney failure. Here we describe the natural history of individuals with IgAN in the German Chronic Kidney Disease (GCKD) cohort.

Method
From 2010 to 2012, 421 patients with biopsy-proven IgAN have been enrolled into the GCKD study, a prospective observational cohort study (N = 5217). Inclusion criteria were an estimated glomerular filtration rate (eGFR) of 30-60 mL/min/1.73 m2 or overt proteinuria in the presence of an eGFR&gt;60 mL/min/1.73 m2. The adjudicated composite renal endpoint (Major Adverse Kidney Events; MAKE) was defined as eGFR decline&gt;40%, eGFR&lt; 15 ml/min or initiation of kidney replacement therapy. The associations between the incidence of MAKE and baseline risk factors were analyzed using the Cox proportional hazards regression model. Data relating to baseline demographics, laboratory, comorbidity, and mortality were used.

Results
The mean age at baseline of IgAN patients was 51.6 years (±13.6) and 67% were male. Duration of disease at baseline was 5.9 ± 8.1 years. Baseline median UACR was 0.4 g/g (0.1-0.8) and mean eGFR was 52.5 ± 22.4 mL/min/1.73m2. Over a follow-up of 6.5 years, 53 (12.6%) initiated kidney replacement therapy, 64 (15.2%) experienced &gt;40% eGFR decline and additional 3 (0.7%) reached eGFR&lt; 15 ml/min, i.e. 28% of the patients experienced a MAKE. Albuminuria, with reference to &lt; 0.1 g/g was most associated with MAKE. Hazard ratios at UACR 0.1-0.6 g/g, 0.6-1.4 g/g, 1.4-2.2 g/g and &gt;2.2 g/g were 2.03 (1.02-4.05), 3.8 (1.92-7.5), 5.64 (2.58-12.33) and 5.02 (2.29-11-03), respectively. Relapse, defined as UACR &gt;2.2g/g, after partial remission (defined as UACR ≥0.1 g/g to &lt;0.6 g/g) or complete (defined as UACR &lt; 0.1 g/g) remission developed in only 13 (3.1%) patients.

Conclusion
The GCKD study reflects a large cohort with long follow up allowing for a thorough analysis of the natural history of IgAN. More than every fourth patient experienced a MAKE event within 6.5 years. Our findings support the use of albuminuria as a surrogate for poor kidney outcomes.
#4791 TREATMENT WITH PCSK9 INHIBITORS IN PATIENTS WITH CHRONIC KIDNEY DISEASE AT VERY HIGH CARDIOVASCULAR RISK
Authors: Amaro Jose Manuel , Fernández Florentino Villanego , Muñoz Javier Naranjo , Orellana Cristhian , Sánchez Luis Alberto Vigara , López Juan Manuel Cazorla , Mejía Carlos Narváez , Alonso Marta , Aguilera Aurora , Blanca María Auxiliadora Mazuecos 
Published: June 2023

Abstract

Background and Aims
Proprotein convertase subtilisin/kexin type 9 (iPCSK9) inhibitors may be an option in the treatment of dyslipidaemia in patients with chronic kidney disease (CKD) who do not reach therapeutic targets or who do not tolerate statins at maximal doses. However, studies in this population are scarce. The aim of our study is to analyse the efficacy and safety of iPCSK9 in patients with CKD.

Method
Retrospective cohort study of patients with CKD, defined as estimated glomerular filtration rate (eGFR) &lt; 60 ml/min/1.73 m2, who started treatment with iPCSK9 in our centre between 2016 and 2020. All patients had at least 2 years of follow-up. We compared total cholesterol, LDL cholesterol (c-LDL), triglycerides and eGFR at baseline, 6, 12 and 24 months after iPCSK9 prescription. Adverse effects were collected.

Results
During the study period, 278 patients started treatment with iPCSK9 in our centre, of whom 41 had CKD and a follow-up of more than 2 years. Of these, 21 were on treatment with Alirocumab and 20 with Evolocumab. Of these, 51.2% were men with a mean age of 70.6 ± 9.4 years and 87.8% had G3a or G3b stage. One patient was on peritoneal dialysis. Acquired dyslipidaemia was present in 82.9% and 87.8% had suffered from coronary events. 53.7% of iPCSK9 prescriptions were for failure to achieve c-LDL targets, while in the remaining patients the reason was non-tolerance of maximum statin doses.
After 6 months of treatment, a significant reduction in total cholesterol (226.7 ± 52.9 mg/dL vs. 142.1 ± 46.17 mg/dL; p&lt;0.001), c-LDL (147.8 ± 48.8 mg/dL vs. 62.9 ± 37.1 mg/dL; p&lt;0.001) and triglycerides (229.8 ± 112.4 mg/dL vs. 192.4 ± 119.2 mg/dL; p = 0.025) was observed, and these differences were maintained at 2 years of treatment (p = 0.016, p&lt;0.001, p = 0.004). 48.8% of patients achieved c-LDL targets (≤ 55 mg/dL) at 6 months of treatment
and 48.8% at 12 months of treatment. Renal function remained stable during follow-up.
No side effects or cardiovascular events were documented.

Conclusion
iPCSK9 reduce cholesterol, c-LDL and triglycerides in patients with CKD, allowing therapeutic targets to be achieved while maintaining stable renal function. Due to the apparent advantages of this drug in CKD patients, we believe that conducted clinical trials should be designed for this population.
#4792 SECOND, THIRD, AND MORE HITS: IMPACT OF SUCCESSIVE AKI EPISODES ON CKD PROGRESSION AND AKI TO CKD TRANSITION
Authors: Acosta-Ochoa Isabel , Coca Armando , Ardura Paula , Manrique María Martínez , Merizalde Carlos , Cobo Kenia , Mendiluce Alicia 
Published: June 2023

Abstract

Background and Aims
The second hit theory refers to the link between two or more deleterious events that cause AKI simultaneously (e.g., triple whammy) or successively (e.g., cardiac surgery after coronary angiography). We investigated the effect of 3 or more consecutive AKI episodes on baseline serum creatinine (SCr) and if these changes leaded to AKI to CKD transition (Transition), CKD progression (Progression) or stable SCr.

Method
Retrospective study of patients with AKI attended by nephrology during a 3-year period. AKI severity was categorized by KDIGO criteria. We searched for patient's successive admissions and if suffered a new AKI episode and included all patients with ≥3 AKI episodes during the study period. We analyzed the baseline SCr for every episode and investigated if serial AKI episodes leaded to incident CKD, Progression, or no changes in SCr.

Results
144 individuals that suffered 525 AKI episodes were included. We observed 36 patients in the Transition, 70 in the Progression group, and 38 didn't vary their SCr. We found no statistically significant differences in hypertension, DM, Charlson's Index, admission to ICU, severity of AKI or length of stay between groups. See Table 1A. We found that progressors had shorter time to nephrology consultation, they were more prone to receive acute HD and to be dialysis dependent at discharge. With no difference in the mortality rate between groups. See Table 1B. Figure 1 plots baseline SCr of every episode that shows a trend to incremental cyphers.

Conclusion
In our study the clinical characteristics between Transition and Progression groups were similar. We observed more individuals in the Progression group and their time to nephrology consultation was significantly shorter, maybe because no nephrology specialists are afraid of managing CKD patients. Patients that progressed needed acute HD more frequently and were more dialysis dependent at discharge, this finding could be explained by their diminished renal reserve, with no differences in the rate of in-hospital mortality. Successive AKI episodes portend a higher risk of adverse clinical outcomes, with excessive burden for patients with previous CKD. New AKI therapies could change the course of these ominous outcomes? This issue is under intense investigation, but it is very difficult to translate bench to bedside. Therefore, now we can only count on prevention and timely nephrological attention.
#4815 COMPARISON OF DIFFERENT ANTIVIRALS REGARDING THEIR ASSOCIATION WITH HOSPITAL-ACQUIRED ACUTE KIDNEY INJURY AMONG ADULTS WITH HERPES ZOSTER
Authors: Xu Ruqi , Xin Xu , Nie Sheng 
Published: June 2023

Abstract

Background and Aims
Antiviral therapy is commonly used to treat herpes zoster. Though antivirals are generally considered nephrotoxic, few studies compared the relative risk of acute kidney injury in patients with herpes zoster that is attributable to different antivirals. We aim to examine the association of use of different antivirals with hospital-acquired acute kidney injury (HA-AKI) among Chinese adults with herpes zoster.

Method
The study population was derived from the China Renal disease System (CRDS), a retrospective cohort of hospitalized patients from 19 medical centers throughout China. We selected from CRDS 3,847 adults who received antiviral therapy for herpes zoster during hospitalization. We identify and stage AKI using patient-level serum creatinine data according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. We compared the relative risks of HA-AKI among patients treated with different antivirals using Cox proportional hazards model, and explored the non-linear association between the accumulative dose of antivirals and the risk of HA-AKI using a penalized smoothing spline.

Results
Among 3,847 patients, 1,585 (41.2%), 699 (18.2%), 599 (15.6%) and 964 (25.1%) were treated with acyclovir/valacyclovir, ganciclovir, penciclovir/famciclovir, and foscarnet, respectively. The incidence of HA-AKI was 4.9%, 2.9%, 2.8% and 0.8%, respectively, in the patients treated with acyclovir/valacyclovir, ganciclovir, penciclovir/famciclovir, and foscarnet. Compared with acyclovir/valacyclovir therapy, use of foscarnet was associated with a 69% reduction in the risk of HA-AKI (hazard ratio [HR], 0.31; 95% confidence interval [CI], 0.14-0.66), while use of other nucleoside analogues was associated with a marginally lower risk of HA-AKI, with a HR (95% CI) of 0.62 (0.36-1.09) for penciclovir/famciclovir and 0.67 (0.41-1.11) for ganciclovir. When compared with foscarnet, nucleoside analogues (HR, 2.72; 95% CI, 1.28-5.75) showed a higher risk of HA-AKI. The associations were consistent across various subgroups and sensitivity analysis.

Conclusion
Among antiviral therapies for herpes zoster, acyclovir/valacyclovir was associated with the highest relative risk of HA-AKI, and the association appears to be dose dependent. Clinicians should exercise rational drug use according to the different renal toxicity associated with a particular antiviral drug.
#4818 IMPACT OF COMBINED PHYSICAL FRAILTY AND DEPRESSIVE SYMPTOMS ON MORTALITY IN PATIENTS ON HEMODIALYSIS
Authors: Tobita Asumi , Imamura Keigo , Yoshikoshi Shun , Uchida Juri , Nakajima Takuya , Fukuzaki Narumi , Nikkawa Sayaka , Harada Manae , Matsunaga Atsuhiko 
Published: June 2023

Abstract

Background and Aims
Patients receiving hemodialysis [HD] are getting older, with 38.8% of patients in Japan being 75 years or older. HD patients also have multiple comorbidities, which are known to be associated with poor clinical outcomes, especially in the older patients. Moreover, physical frailty and depressive symptoms are common in HD patients and these are known to be risk factors for poor prognosis. However, it is unclear whether the coexistence of physical frailty and depressive symptoms contributes to an increased risk of mortality in older patients with multiple comorbidities. As a result, the goal of this study was to look at the relationship between physical frailty and depressive symptoms and mortality in HD patients of different ages.

Method
This study included 409 Japanese outpatients with HD (mean age 65.9 years, 62.6% male, and 2.0 years of hemodialysis history). Slow walking speed and/or weak hand grip strength were used to define physical frailty. The Center for Epidemiological Studies-Depression scale was used to assess depressive symptoms. Patients were divided into four groups: (1) no depressive symptoms, no physical frailty; (2) depressive symptoms, no physical frailty; (3) no depressive symptoms, physical frailty; and (4) depressive symptoms, physical frailty. All-cause mortality was the outcome; Cox regression analysis was performed, with analysis stratified by age group (&lt;75 years, ≥75 years) to examine differences by age.

Results
Physical frailty and depressive symptoms were prevalent in 268 (65.5%) and 143 (35.0%) of the population, respectively. Physical frailty and depressive were present in 103 people (25.2%). 129 (31.5%) people died during the follow-up period (median 49 months). In all patients, Cox regression analysis revealed that physical frailty and no depressive symptoms (hazard ratio [HR], 1.86, 95% confidence interval [CI], 1.01–3.44) and coexistence of physical frailty and depressive symptoms (HR, 2.30, 95% CI, 1.23–4.28) were significantly associated with an increased risk of death. In the &lt;75-year-old group, a combination of physical frailty and depressive symptoms was significantly associated with an increased risk of death (HR, 2.45; 95% CI, 1.23–4.88). In the ≥75-year-old group, however combined physical frailty and depressive symptoms were not significantly associated with mortality (HR, 2.06; 95% CI, 0.34–12.55), whereas C-reactive protein was (HR, 1.59; 95% CI, 1.10–2.28).

Conclusion
Physical frailty and depressive symptoms were common in HD patients. In terms of prognosis, the coexistence of physical frailty and depressive symptoms were linked to mortality in the &lt;75-year-old group, whereas in the &lt;75-year-old group, the coexistence of physical frailty and depressive symptoms was not associated with death, but higher inflammation was associated.
#4834 THE PROPORTION OF UNAFFECTED GLOMERULI IS A ROBUST PROGNOSTIC FACTOR OF KIDNEY OUTCOME IN PATIENTS WITH ANCA-ASSOCIATED GLOMERULONEPHRITIS
Authors: Song Seung Min , Lee Hyun Suk , Kim Minhyung , Jang Min Young , Jeon Jeunseok , Jang Hye Ryoun , Kwon Gee-Young , Huh Wooseong , Kim Yoon-Goo , Lee Jung Eun 
Published: June 2023

Abstract

Background and Aims
Anti-neutrophil cytoplasmic antibody (ANCA) associated glomerulonephritis (GN), the most common form of secondary GN in elderly (&gt;60 years), requires immunosuppressive treatment that may increase risk of opportunistic infections. This study evaluated the prognostic value of clinical factors and histopathologic findings affecting kidney outcome in ANCA-associated GN patients.

Method
From 2000 to 2018, we identified 106 adults (≥18 years old) who were pathologically confirmed as ANCA-associated GN. The number of normal, crescent, and sclerotic glomeruli was recorded for each biopsy by slide review. The primary outcome was incident end stage kidney disease (ESKD).

Results
The age was 67 (57-73) years, the estimated glomerular filtration rate (eGFR) was 19 (11-36) mL/min/1.73 m2, and % of normal glomeruli in kidney specimen was 25 (11-47) %. Overall kidney survival was 85% and 76% at 1 and 5 years, respectively. Among clinical variables, lower eGFR (adjusted hazard ratio [aHR], 0.339; 95% confidence interval [CI], 0.180-0.638; p&lt;0.001) was independently associated with increased risk of incident of ESKD. Multivariate Cox proportional hazard model including both clinical and histological variables demonstrated that % of normal glomeruli (aHR, 0.960; 95% CI, 0.935-0.986; p&lt;0.001) was a sole risk factor of incident ESKD, independently of eGFR and other pathological findings. When the % of normal glomeruli was divided by quartiles, the risk of incident ESKD in the lowest quartile was significantly increased compared to the highest quartile (&lt;11%; HR, 5.986; 95% CI, 2.114-16.950 vs. &gt;46%; p&lt;0.001).

Conclusion
The proportion of unaffected glomeruli was independent predictor of kidney outcome in patients with ANCA-associated GN.
#4935 TYG INDEX CORRELATED WITH PPROGRESSION OF CHRONIC KIDNEY DISEASE IN METABOLIC DYSFUNCTION-ASSOCIATED FATTY LIVER DISEASE
Authors: Choi Hoon Young , Lee Jung Eun , Jhee Jong Hyun , Park Hyeong Cheon 
Published: June 2023

Abstract

Background and Aims
Chronic kidney disease (CKD) is an established major risk factor for cardiovascular disease. Moreover, progression of CKD results in end-stage kidney disease, and an increased risk of death. The recently proposed metabolic dysfunction-associated fatty liver disease (MAFLD) has been suggested to better reflect risk of developing CKD. This study aimed to evaluate the association between the triglyceride-glucose (TyG) index and CKD progression in patients with MAFLD.

Method
In the data from the medical records database in Gangnam Severance Hospital from 2006 through 2020, a longitudinal analysis included participants with CKD. MAFLD was diagnosed in patients with was diagnosed in individuals with hepatic steatosis and at least one of the conditions as follows: 1) overweight or obese (defined as body mass index [BMI] ≥ 23 kg/m2), 2) type 2 diabetes mellitus, or 3) two or more metabolic abnormalities. Progression of CKD was defined by a reduction in the GFR ≥30% of baseline. Logistic regression analyses were used to determine the association between TyG index and progression of CKD by adjusting for the influence of confounders.

Results
The study included 4,286 patients, of whom 582 had MAFLD. Mean age was 51.49 ± 11.451 years. After adjusting for age, sex, systolic blood pressure, fasting plasma glucose, CRP, LDL-cholesterol and smoking status, TyG index was associated with progression of CKD [OR 1.760 (1.089-2.844), P = 0.021].

Conclusion
This study demonstrated that TyG index was significantly associated with progression of CKD in patients with MAFLD.
#4953 IMPACT OF IMMUNOSUPPRESSIVE REGIMEN ON ANTIBODY RESPONSE AFTER CHADOX1 NCOV-19 VACCINATION IN THAI KIDNEY TRANSPLANT RECIPIENTS
Authors: Larpparisuth Nuttasith , Pongsakornkullachart Kritsada , Vongwiwatana Attapong , Skulratanasak Peenida 
Published: June 2023

Abstract

Background and Aims
The lower humoral immunity response after COVID-19 vaccine in kidney transplant recipients (KTRs) has been reported in several studies. However, the study regarding efficacy of ChAdOx1 nCoV-19 (AstraZeneca) vaccine among various immunosuppressive treatments in Asian population is scarce.

Method
We conducted a cross-sectional study in Siriraj Hospital, Bangkok, Thailand. Adult KTRs who received two doses of the ChAdOx1 nCoV-19 vaccine at intervals of 3 months were enrolled. Anti-SARS-COV-2 S-RBD-IgG antibody (anti-RBD) was assessed at the one month after the second vaccine dose and considered positive if the level ≥ 50 AU/ml. Primary outcome was seropositivity of anti-RBD. Association between type, dose and level of immunosuppressive regimen, and seropositivity of anti-RBD were analyzed. The statistical analysis was performed using SPSS version 23.0.

Results
Between October 2021 and January 2022, 153 KTRs with median follow up time of 59 (30 – 125) months, were enrolled. Mean age was 49.3 ± 11 years and 61.4% were male. Regimen of tacrolimus (TAC)/mycophenolate (MPA)/prednisolone (CS), everolimus (EVR)/MPA/CS and TAC/EVR/CS were prescribed for 92 (60.1%), 23 (15%) and 24 (15.7%) patients, respectively. The anti-RBD ≥ 50 AU/ml after vaccination was observed in 82 patients (53.6%) with median level of 476.7 (129 – 1253.2) AU/ml. Patients received TAC/EVR/CS had significantly higher proportion of seropositivity than EVR/MPA/CS (95.8% vs 65.2%; p = 0.008) and TAC/MPA/CS regimen (95.8% vs 37%; p &lt; 0.001). Among the seropositive KTRs, the median level of anti-S is significantly highest in TAC/EVR/CS treatment when compared to EVR/MPA/CS and TAC/MPA/CS group, respectively (1,204 vs 260.7 vs 315.4; p &lt; 0.001). Among KTRs who received tacrolimus, the seropositivity was significantly higher in patients who had tacrolimus trough level &lt; 3 ng/mL (83.3% vs 45.7%; p = 0.014).

Conclusion
The seropositivity of anti-S after vaccination with ChAdOx1 nCoV-19 in KTRs was 53.6% which was lower than general population. KTRs who received TAC/EVR/CS regimen had highest immune response after vaccination, which is relatively comparable to healthy control in Thailand. Immunosuppressive regimen should be considered for vaccine dose and schedule in the future.