bluuebunny/crossref_metadata_2025_split huggingface dataset:
#2686 15-YEAR TEMPORAL CHANGES IN RATES OF ACUTE KIDNEY INJURY AMONG CHILDREN: A POPULATION-BASED COHORT STUDY
Authors: Høyer Sidse , Heide-Jørgensen Uffe , Jensen Simon Kok , Nørgaard Mette , Christiansen Christian and Fynbo 
Published: June 2023

Abstract

Background and Aims
Acute kidney injury (AKI) is defined as a sudden decrease in kidney function and is associated with increased morbidity and mortality. The reported prevalence of AKI among hospitalized children is approximately 30% but varies widely depending on population characteristics and method used to define AKI. Little is known about the incidence of community-acquired AKI and potential temporal changes in AKI incidence among children. Such information is important for AKI prevention, resource allocation and future research. In this study, we aimed to examine overall temporal changes in the rate of hospital- and community-acquired pediatric AKI and to describe associated changes in potential underlying risk markers.

Method
In this population-based cohort study, we included children aged 0-17 years from 1 January 2007 to 31 December 2021 in Denmark. In 2021, the Danish population consisted of 1,168,222 children. We obtained clinical plasma creatinine measurements from the Danish laboratory databases to identify all KDIGO-defined AKI episodes within the study period. For each child, only the first AKI episode per year was included and we defined an AKI episode as a period of 30 days. AKI was defined as community-acquired if the plasma creatinine at time of AKI was taken in the outpatient clinic or the first day of admission/acute setting. We estimated the annual AKI rate as first AKI episodes in a year among children residing in an area covered by the laboratory databases divided by the number of children residing in this area in the same year. Unadjusted rates as well as sex- and age-standardized rates was reported. Using Danish medical databases, we identified potential risk markers for AKI, such as use of nephrotoxic medication, surgery, sepsis, and perinatal factors including low birth weight and preterm birth.

Results
In total, 14,262 children contributed with 16,492 AKI episodes. The average annual rate of AKI was 149 per 100,000 children and was stable throughout the study period (figure). Of the AKI episodes, 10,921 (66.2%) were community-acquired and 12,714 (77.1 %) were stage 1 AKI. No major changes were seen in the prevalence of risk makers among AKI episodes.

Conclusion
The rate of AKI among Danish children was stable from year 2007 to 2021 and potential risk markers were largely similar over time.
#2694 URAEMIC CARDIOMYOPATHY AS PREMATURE PRESBYCARDIA
Authors: Chinnappa Shanmugakumar , Mooney Andrew 
Published: June 2023

Abstract

Background and Aims
Presbycardia, the age-related decline in cardiac function, has been shown in the general population by demonstrating gradual decline in peak cardiac performance with advancing age [1]. Chronic kidney disease (CKD) has shown phenotypic similarities with premature aging. Studies have shown accelerated vascular aging and skeletal muscle wasting in CKD. However, it is not known whether CKD patients show age related decline in cardiac function and whether the impairment is more pronounced for the given age (premature presbycardia). In the present study, we set out to test the hypothesis that CKD patients have premature presbycardia by measuring peak cardiac power (CPOpeak) non-invasively across different age groups.

Method
A cross sectional study (n = 170) of healthy male volunteers (n = 100) and male CKD patients (n = 70) spanning ages 19 to 75 years. CKD patients were grouped into early (CKD 2–3, n = 29) and late CKD (CKD 4–5, n = 41). Patients with diabetes or any known cardiovascular diseases were excluded. CPOpeak was measured using a specialised cardiopulmonary exercise test (CPX) using CO2 rebreathing method [2]. The association between age and CPOpeak was evaluated. The regression lines of CKD patients and healthy volunteers were compared using ANCOVA. P&lt;0.05 is considered significant.

Results
The mean eGFR of early CKD and late CKD were 57.8±17.2 ml/min and 16.8±5.8 ml/min respectively. The mean CPOpeak of the study groups were 5.35±0.94 W (Control), 4.93±0.71 W (early CKD) and 4.26±0.69 W (late CKD). Fig. 1 shows the association between CPOpeak and age along with the regression equations for the individual study groups. Comparison of the regression lines using ANCOVA did not show any difference in slopes between the groups (P = NS). There was a diminution in CPOpeak of 0.2W per 10 years of advancing age. However, for any given age, the CPOpeak was diminished by 0.38 W in early CKD (P = 0.023) and 0.93 W in late CKD (P&lt;10−3) compared to control. In other words, the cardiac age was older by 19 years in early CKD and by 46.5 years in late CKD compared to healthy volunteers.

Conclusion
The results demonstrate that CKD is associated with premature presbycardia. This phenomenon may offer explanation for the high prevalence of heart failure in advanced CKD. Further studies exploring the underlying mechanisms of premature aging in CKD may be worthwhile in the future.
#2697 ASSOCIATION OF CARDIOMETABOLIC PROTEINS WITH EGFR DECLINE IN OLDER ADULTS WITH ADVANCED CHRONIC KIDNEY DISEASE
Authors: Aylward Ryan , Hayward Samantha , Chesnaye Nicholas , Evans Marie , Drechsler Christiane , Wanner Christoph , Dekker Friedo W , Torino Claudia , Szymczak Maciej , Jager Kitty J , Ben-Shlomo Yoav , Tiffin Nicki , Rayner Brian , Birnie Kate , Caskey Fergus 
Published: June 2023

Abstract

Background and Aims
Cardiovascular disease and advanced chronic kidney disease often coexist and share risk factors in older individuals. We investigated the association of cardiometabolic and cardiovascular proteins and pathways with decline in estimated glomerular filtration rate (eGFR).

Method
Two plasma protein panels (Olink® cardiometabolic T96 and cardiovascular II T96, Uppsala, Sweden) were analysed at the baseline visit of individuals enrolled in the prospective observational European QUALity (EQUAL) study of older people &gt; 65 years with advanced CKD (incident eGFR &lt; 20 ml/min/1.73m2). Generalised linear mixed effects models with a log link and random intercept and slope were used to determine annualised eGFR slope (CKD-EPI 2009 equation) using a complete case model. The model was executed in a “discovery” sample (Germany, United Kingdom and Poland) and positive results (&lt; false discovery rate [FDR] of 5%) were tested in a Swedish “validation” sample using the same FDR criterion. The primary analysis was adjusted for baseline age, sex, country, diabetes mellitus status, primary renal disease, systolic blood pressure, urine albumin to creatinine ratio (ACR), and the use of renin-angiotensin aldosterone inhibitors and β-blockers. A sensitivity analysis was conducted to determine the effect of informative censoring on eGFR slope using a joint model.

Results
The discovery and validation samples had 254 subjects (median age 67 years, 41% female, median baseline eGFR 18 ml/min/1.73m2) and 247 (median age 75 years, 28% female and median baseline eGFR 18 ml/min/1.73m2) respectively with longer follow-up time for the validation sample (median 3.6 versus 2.6 years) primarily due to less kidney replacement therapy initiation (33% versus 37%) and fewer losses to follow up (5% versus 12%). Two of the 175 proteins showed more rapid eGFR annual decline per doubling in protein levels (Figure 1): Receptor-type tyrosine-protein phosphatase S [PTPRS] (-15%; 95% confidence interval [CI] –24 to –7%, pFDR = 0.01) and Insulin-like growth factor-binding protein 6 [IGFBP6] (–8%; 95% CI –12 to –3%, pFDR = 0.03) (Figure 2). Predicted slopes were similar across both samples and for the sensitivity analyses.

Conclusion
Receptor-type tyrosine-protein phosphatase S and Insulin-like growth factor-binding protein 6 were associated with more rapid CKD progression. Further research is needed to determine if these proteins are pathophysiologically linked to accelerated progression of CKD in older people or a secondary consequence of disturbances in protein sequestration or excretion.
#2728 THROMBOINFLAMMATORY BIOMARKERS AND THEIR RELATIONSHIP WITH CIRCULATING GLYCOSAMINOGLYCANS IN END-STAGE RENAL DISEASE PATIENTS
Authors: Bansal Vinod , Allen Madeline , Siddiqui Fakiha , Hoppensteadt Debra , Krupa Emily , Kantarcioglu Bulent , Fareed Jawed 
Published: June 2023

Abstract

Background and Aims
End stage renal disease (ESRD) is a complex progressive medical condition that affects multiple organ systems. Given the high risk of morbidity and mortality of ESRD as well as its rising incidence, it is critical to understand the relevance of thromboinflammatory biomarkers in disease development and progression of kidney dysfunction. The purpose of this study is to profile the levels of thromboinflammatory biomarkers in ESRD patients including D-Dimer, C-reactive protein (CRP), von Willebrand factor (vWF), plasminogen activator inhibitor 1 (PAI-1), and thrombin activatable fibrinolysis inhibitor (TAFI). In addition, the levels of anti-PF4 IgG and endogenous circulating glycosaminoglycans (GAGs) were measured.

Method
Citrated plasma samples were collected from seventy-three ESRD patients. Control plasma samples (NHP) from healthy, non-smoking adults aged 19 to 53 were obtained commercially. Validated ELISA methods have been used to profile each of the biomarkers. The levels of endogenous GAGs were determined (Redprobes UG, Germany). To compare the levels of thromboinflammatory biomarkers, anti-PF4 IgG, and endogenous GAGs in different groups, appropriate statistical methods included Mann-Whitney U, t-tests, Kruskal-Wallis ANOVA and experiment correlation analysis methods were performed.

Results
All of the biomarkers and GAGs were significantly elevated, with the exception of TAFI, in ESRD patients. The ESRD patients exhibited varying levels of increase in the D-Dimer, CRP, vWF, PAI-1, anti-PF4 IgG, and GAGs as shown in Figure 1 (p &lt; 0.05). D-Dimer showed the most pronounced increase (1075%) followed by PAI-1 (361.31%), anti-PF4 IgG (209.78%), CRP (101.77%) and endogenous GAGs (17.29%). The correlation analysis revealed varying degrees of association among these biomarkers (Figure 2).

Conclusion
These results suggest that thromboinflammatory biomarkers offer the potential utility of identifying inflammation in end-stage renal disease. Marked increase in thromboinflammatory mediators due to endothelial damage may result in the upregulation of glycosaminoglycans and anti-PF4 IgG antibodies in the ESRD patients.
#2758 AMBIENT HEAT EXPOSURE AND ESTIMATED GLOMERULAR FILTRATION RATE TRAJECTORY: A POST-HOC ANALYSIS OF THE DAPA-CKD TRIAL
Authors: Zhang Zhiyan , Heerspink Hiddo Lambers , Chertow Glenn , Correa-Rotter Ricardo , Gasparrini Antonio , Jong Niels , Langkilde Anna Maria , Mistry Malcolm , Mcmurray John , Rossing Peter , Toto Robert , Vart Priya , Nitsch Dorothea , Wheeler David C , Caplin Ben 
Published: June 2023

Abstract

Background and Aims
Higher ambient temperatures have been associated with higher rates of admission for kidney stones and acute kidney injury. Occupational heat stress is also a risk factor for impaired kidney function in several rural resource-poor settings. It is unclear if higher ambient heat exposure is associated with a faster loss of kidney function in patients with established, all-cause, chronic kidney disease (CKD). We therefore undertook a post-hoc analysis of the DAPA-CKD trial linking participant data to publicly available climate measurements.

Method
The DAPA-CKD trial randomized 4304 patients with proteinuric CKD (estimated glomerular filtration rate, eGFR, 25-75 mL/min/1.73 m2; urine albumin-to-creatinine ratio, ACR, 23-566 mg/mmol) to dapaglifozin or placebo in addition to standard of care. We examined the association between daily study centre-level ambient heat exposure (defined as a mean heat index, HI, &gt;30; European Centre for Medium-Range Weather Forecasts ERA5 reanalysis dataset) and individual-level change in eGFR using both a linear-mixed effects model and a case-time series approach to address potential unmeasured individual- and centre-level confounding.

Results
Climate and eGFR data were available on 3915 (91%) participants across 361 centres in 21 countries. Over a median of 28 months, participants (mean age: 62 years; mean eGFR: 43mL/min/1.73 m2) were followed-up at centres where there was a median of 1 day (interquartile range: 0 to 64 days) with an HI&gt;30. Each 30-day period of HI&gt;30 over the study period was associated with a change in eGFR of -0.7% (95% CI: -1.0% to -0.3%), equivalent to an additional eGFR loss of between 1.2 and 4.0mL/min/1.73 m2 per year in a patient with an eGFR of 45mL/min/1.73 m2 located in a very hot versus temperate environment. Similar estimates were obtained using the case time series approach. This association persisted after adjustment for potential haemoconcentration effects on the day of testing and further analyses provided no evidence that these findings varied with baseline eGFR, albuminuria or randomised treatment arm (Figure 1), or by high- versus middle-income country study centre location.

Conclusion
Higher ambient heat exposure is associated with a more rapid decline in kidney function among patients with CKD. Efforts to mitigate heat exposure should be prospectively tested as part of a comprehensive strategy to slow the progression of kidney disease.
#2787 HOSPITAL MANAGEMENT OF AN INTEGRATED CLINICAL PRACTICE UNIT OF VASCULAR ACCESS FOR HEMODIALYSIS: A CHALLENGE FOR IMPROVING HEALTHCARE QUALITY?
Authors: Simó Vicent Esteve , Lao Elisabeth González , Allué Angels Esquerda , González Irati Tapia , Pallares Sara Ibañez , Rubio Sandra , Serna Manel Ramírez de Arellano 
Published: June 2023

Abstract

Background and Aims
Vascular access (VA) for haemodialysis (HD) is essential for renal patients due to its high morbimortality and economic cost. Integrated Clinical Practice Units (ICPU) allows health organizations to establish comprehensive care, improve the quality and safety of care processes, as well as favor the accessibility of health care. The VA multidisciplinary teams for HD are crucial in the proper management of VA, although their implementation in daily clinical practice is not fully consolidated. The aim of this study was to analyze the effectiveness of the healthcare processess in patients with VA for HD after the creation of our ICPU focused in the multidisciplinary management of the VA (FUVA) through quality of care indicators.

Method
12 years retrospective unicentric study analyzed in two periods: first period (2010-2015) and second period (2016-22) after FUVA creation. The indicators include sociodemographic data, processes activities (first and successive visits, endovascular procedures, type and number of surgical interventions, delayed time for interventions, mean hospitalitation stay, and results oriented to the patient's quality of life (VA initial assessment and dysfunction, inpatient and outpatient VA interventions).

Results
551 VA for HD hospital admissions r were performed (53.2% in charge of nephrology, with 893 total days of stay and mean stay of 3.6 days), 670 surgical interventions (69.7% native fistulas, 47.3% admitted, 37±9.7 days of surgical delay) and 320 endovascular procedures (28.1% admitted, 11 ± 1.2 days delay). After the creation of the ICPU (FUVA), a total of 631 visits (96% first visit) were made in 451 patients with mean age 65.7 ± 17.5 years (66% men), 495 VA Doppler ultrasounds, 287 HD catheter placements (54.1% permanent, 29.2% left) and 84 withdrawals. Similarly, in this period there was a decrease in the number (160 vs 130) and percentage (92.4 vs 34.3%) of VA for HD admissions, a shorter surgical delay time (39 ± 9.3 vs 32 ± 9.1 days) and a reduction in the mean hospital stay (3.7 vs 2.9 days), respectively. Similarly, outpatient management of all endovascular procedures performed (187) was achieved without repercussion on the waiting time for the procedure (11 ± 0.9).

Conclusion
In our study, the hospital management of VA for HD through the creation of an UPCI, allowed a more efficient management of the available care resources through the continuity of care of the process, favoring the integral and integrated care of the patient as well as contributing to the improvement in the management and survival of VA for HD. Similarly, elaboration and analysis of helathcare indicators have been useful tools in the evaluation of the quality of healthcare of our vascular access unit.
#2808 REMDESIVIR FOR MODERATE-TO-SEVERE COVID-19 PNEUMONIA IN MAINTENANCE DIALYSIS PATIENTS: A RETROSPECTIVE COHORT STUDY
Authors: Gutierrez Stephanie 
Published: June 2023

Abstract

Background and Aims
Remdesivir has shown better patient outcomes and shorter time to recovery among hospitalized patients with moderate to severe COVID-19 pneumonia. However, data on its safety and efficacy in dialysis patients is lacking.

Method
Dialysis patients with moderate to severe COVID-19 pneumonia who were given remdesivir were matched 1:2 to those who received standard-of-care (SOC) based on age, sex, COVID-19 severity and CKD etiology.

Results
The final cohort comprised 201 patients and 67 were given remdesivir. Median age was 52 years, majority were male (51.7%), 94% were on hemodialysis (94%) and 48% had diabetic nephropathy. The 28-day probability of survival among moderate COVID-19 cases was 100% for both remdesivir and SOC group. In severe cases, the survival probability for remdesivir recipients was lower compared to SOC (67.63% vs 87.72%), but this was not statistically significant. Overall, median length of stay (LOS) was significantly shorter by 17 days (QR: 11-24) in the remdesivir group, compared to 21 days [IQR: 16-24] in the SOC group (p = 0.0485). Median LOS in the remdesivir group was only significantly shorter in those with moderate COVID-19 pneumonia but not in severe cases. Early administration of remdesivir resulted in a significantly shorter LOS with a median of 10 days [IQR: 7-15] compared to18 days [IQR: 13-25] in the SOC group (p = 0.0240). When stratified by severity, there was no significant difference whether remdesivir was given early or late.

Conclusion
Remdesivir administration within 48 hours of admission in maintenance dialysis patients with moderate COVID-19 pneumonia resulted in a significantly shorter LOS. However, there was no significant difference in 28-day mortality in early or late administration of remdesivir in both moderate and severe COVID-19 pneumonia among HD patients. Thus, survival was similar to SOC. Our study showed that it is safe to use in dialysis patients.
#2813 INCREASED RISK OF CARDIOVASCULAR DISEASE PRECEDING DIAGNOSIS OF INCIDENT ANCA-ASSOCIATED VASCULITIS: A DANISH NATIONWIDE STUDY
Authors: Pedersen Louis Nygaard , Polcwiartek Christoffer , Nelveg-Kristensen Karl-Emil , Carlson Nicholas , Kristensen Salome , Torp Christian , Gregersen Jon Waarst 
Published: June 2023

Abstract

Background and Aims
ANCA-associated vasculitis (AAV) is associated with an increased risk of cardiovascular disease (CVD). The risk of CVD seems to be increased shortly after initial diagnosis as well as in the long-term setting. However, no studies have addressed the risk of CVD in the period preceding an AAV diagnosis. Since the diagnosis of AAV often is associated with a substantial diagnostic delay, we hypothesize that patients with AAV consistently are at an increased risk of developing CVD already before they even are diagnosed with AAV.

Method
Using a nested case-control framework, patients with AAV were identified through the Danish Nationwide Registries from 1996-2021 and matched 1:3 with age- and sex-matched controls without AAV. Each control was assigned the same index date (date of AAV-diagnosis) as their corresponding case. Conditional logistic regression was used to compute age, sex and comorbidity adjusted Hazard Ratios (HRs) for major adverse cardiovascular events (MACE), ischemic heart disease, heart failure, venous thromboembolism, atrial fibrillation, ischemic stroke, pericarditis, and ventricular arrhythmias/ICD-implantation/cardiac arrest (VA/ICD/CA) within 12 months, 6 months, 3 months, 2 months and 1 month before the index date.

Results
A total of 2371 patients with AAV (median age: 63 yrs, 53.7% male) were matched with 7113 controls. In patients with AAV, 10.33% had a cardiovascular outcome within 12 months preceding diagnosis as compared to 3.84% of controls (HR 3.05 [95% CI, 2.48-3.75]). The associated risk of cardiovascular outcomes was similarly increased in the temporal proximity of the diagnosis, with the highest HR at 1 month prior to index date (HR 10.73 [95% CI, 7.05-16.32], Fig. 1). In individual analysis, a significantly higher HR was observed for all outcomes (excluding VA/ICD/CA), Fig. 2.

Conclusion
AAV disease is associated with an increased risk of CVD in the months preceding diagnosis, which underlines the importance of early clinical vigilance toward CVD starting in the diagnostic phase of AAV.
#2868 PREDICTION OF MAJOR GASTROINTESTINAL BLEEDING EVENTS IN HEMODIALYSIS
Authors: Larkin John , Lama Suman , Chaudhuri Sheetal , Willetts Joanna , Winter Anke , Jiao Yue , Stauss-Grabo Manuela , Usvayt Len , Hymes Jeffrey , Maddux Franklin , Wheeler David C , Stenvinkel Peter , Floege Jürgen 
Published: June 2023

Abstract

Background and Aims
INitiativeS on advancing Patients’ outcomes In REnal disease (INSPIRE) is an academia and industry collaboration set forth to identify critical investigations needed to advance the practice of medicine in nephrology. At the inaugural INSPIRE meeting, the group came to a consensus that major bleeding events represent potentially preventable complications that occur more frequently in people with kidney disease versus the general population [1]. Given the most common class of bleeding event is gastrointestinal bleeding (GIB) [2], the INSPIRE group assessed if a machine learning model could be developed to assist with determining a hemodialysis (HD) patient's 180-day GIB hospitalization risk.

Method
Model was developed using adult HD patient data from United States (2017-2020). Patient data was randomly split (50% training, 30% validation, and 20% testing). HD treatments ≤180 days before GIB hospitalization were classified as positive observations, and others were negative observations. Datasets were randomly sampled to build an XGBoost model that considered 386 exposures initially and was refined to the top 50 exposures. Unseen testing dataset was used to determine final model performance.

Results
The incidence of 180-day GIB hospitalization was 1.18% in the HD population (n = 451,579), and 1.16% among patients in the testing dataset (n = 27,991). The model showed an area under the curve = 0.69, sensitivity = 57.9%, specificity = 68.9%, accuracy = 68.8% and balanced accuracy = 63.4%. Exposures with largest effect size observed via Shapley values were older age (group mean GIB event = 68.2 years vs no GIB event = 63.4 years), shorter days since last all-cause hospital admission (group mean GIB event = 203.2 days vs no GIB event = 253.2 days), and higher serum 25-hydroxy (OH) vitamin D levels from most recent lab (group mean GIB event = 33.4 ng/mL vs no GIB event = 30.5 ng/mL). Other important predictors included lower hemoglobin and iron indices, longer dialysis vintage, and proton pump inhibitor use (Fig. 1).

Conclusion
The machine learning model appears suitable for early detection of GIB event risk in HD, yet prospective testing is needed. The association between higher 25OH vitamin D and GIB events was unexpected and warrants investigation. A consistent signal has been observed in warfarin users without kidney disease among which 25OH vitamin D levels of 30–100 ng/mL were shown to associate with the highest GIB risk [3].