bluuebunny/crossref_metadata_2025_split huggingface dataset:
#2827 RISK FACTORS FOR VENOUS AND ARTERIAL THROMBOEMBOLIC COMPLICATIONS IN NEPHROTIC SYNDROME: A COHORT STUDY
Authors: Kelddal Sarah , Tofig Bawer , Hvas Anne-Mette , Grove Erik , Christiansen Christian Fynbo , Birn Henrik 
Published: June 2023

Abstract

Background and Aims
Venous thromboembolic events (VTE) and arterial thromboembolic events (ATE) are serious complications of nephrotic syndrome (NS). Studies are needed to identify patients at high risk for VTE and ATE. We aimed to describe patient-related risk factors for VTE and ATE in a mixed population of nephrotic patients.

Method
This multicentre cohort study included adult NS patients with plasma albumin &lt;30 g/l and urine albumin-creatinine ratio (uACR) &gt;2,200 mg/g, who were hospitalized or followed at an outpatient clinic in the Central Denmark Region between 2014-2018. Using computerized data extraction from medical files, patients were identified and followed until dialysis, transplantation, or end of study. We recorded comorbidities, family history, renal parameters and, histological diagnosis at index time as well as, renal parameters and medication at the time of VTE/ATE event. Categorical and continues data were compared using a risk difference and mean difference respectively. The incidence of event is presented as incidence rate.

Results
Among 531 included patients, 22 patients had their first VTE and 46 their first ATE within the first observation year (median time to event VTE 0.8 vs. ATE 0.9 years). Incidence rates were 11 per 1000 person-years (95% CI: 7-17) for VTE and 24 (95% CI: 18-32) for ATE. Plasma-albumin levels (27 g/l) were identical in the VTE and ATE group at event time, but eGFR was lower (Table 1), and uACR was higher in the ATE group (median uACR; VTE 1055 mg/g vs. ATE 2752 mg/g). Hypercholesterolemia was more prevalent among patients with VTE, and they were more often on corticosteroids than patients with ATE. Diabetes, hypertension, and heart failure was more prevalent at baseline in patients with ATE resulting in an increased CHADS-VASC score. Mortality was higher among patients with ATE (83%) than VTE patients (32%).

Conclusion
Patients with NS have a high risk of VTE and ATE. Corticosteroid use was more common among patients with VTE than ATE. ATE was associated with a higher uACR, higher CHADS2-VASC score, and increased mortality compared to patients with VTE.
#2885 DYNAMICS OF URINARY SYNDROME IN PATIENTS WITH CHRONIC GLOMERULONEPHRITIS DEPENDING ON THE USE OF ANTICOAGULANT
Authors: Abduvakhitova Asalya 
Published: June 2023

Abstract

Background and Aims
to study the dynamics of urinary syndrome in patients with chronic glomerulonephritis (CGN) against the background of the use of rivoroxaban.

Method
108 patients with chronic glomerulonephritis (CGN), on the background of 3-month basic therapy with the inclusion of with anticoagulant rivaroxaban 55 patients and without anticoagulant 53 patient. Initially and after 3 months, the composition of the urinary sediment was assessed.

Results
Patients with CGN had significant proteinuria (3.23±0.12g/l versus 0.01±0.004 control group (CG), p&lt;0.001), hematuria (42.58±2.10 erythrocytes in the field of vision, against 0.75±0.25 cells in the field of vision, p&lt;0.001), leukocyturia (38.25±0.80 leukocytes in the field of vision, against 1.70±0.24 cells in the field of view in CG, p&lt;0.001) and cylindruria (38.11±1.04 cylinders in the field of view, versus 0.10±0.07 cylinders in the field of view in CG, p&lt;0.001). Albuminuria contributed to an increase in the specific gravity of urine (1021.64±0.44 g/l versus 1017.45±0.65g/l in CG, p&lt;0.001). By the end of the hospitalization period, there was a significant improvement in urinary syndrome: the relative dynamics of urinary syndrome indicators was more than 30%. Thus, the degree of proteinuria decreased to 1.98± 0.10 g/l (p&lt;0.001 the reliability of the difference with the initial data), hematuria – to 26.38±1.43 cells in the field of vision (p&lt;0.001), leukocyturia – to 22.04±0.88 cells in the field of vision (p&lt;0.001), cylindruria – to 25.45±0.79 cylinders in the field of view (p&lt;0.001). Against the background of a decrease in proteinuria and diuretic therapy, there was a decrease in the specific density of urine by 0.73% (up to 1014.15 ± 0.45g/l, reliability with baseline data - p &lt;0.001).

Conclusion
Rivaroxaban is an effective oral anticoagulant, the long–term use of which as part of the basic therapy of patients with CGN is safe, well tolerated and pathogenetically justified. The inclusion of rivaroxaban in the basic therapy of patients with CGN is associated with the achievement of more favorable values of proteinuria, hematuria and leukocyturia by the end of the 3rd month of therapy.
#2886 THE COURSE OF OSTEODYSTROPHY IN PATIENTS WITH STAGE 5 CHRONIC KIDNEY DISEASE RECEIVING PROGRAMMED HEMODIALYSIS
Authors: Mirzaeva Barno , Daminov Botir 
Published: June 2023

Abstract

Background and Aims
In a normal physiological state, there are many regulatory molecules that act as inhibitors of mineral formation to prevent the spread of tissue hardening. In patients with CKD, the levels or functions of these inhibitors may be abnormal, which in turn may predispose to or enhance ectopic calcification. to increase the effectiveness of early diagnosis of demineralization of the bone skeleton in patients with stage V chronic kidney disease receiving hemodialysis.

Method
The study included 94 CKD patients receiving hemodialysis for 15 months. The average age of the patients was 42.13±12.16 years. Etiologically, the cohort of patients included in the study was diverse, with a significant predominance of chronic glomerulonephritis as the cause of CKD in 72 patients, chronic pyelonephritis in 22 patients occupied the second place among the causes of CKD, the remaining causes occurred with a single frequency. Anemia was diagnosed in 71 patients. The observation lasted 12 months. Pathological changes in phosphorus-calcium metabolism and secondary hyperparathyroidism in patients were associated with a significant decrease in bone mineral density, it was shown both for the bodies of the lumbar vertebrae and for the femoral neck, the significance of the difference from the control group for absolute values of mineral density and relative deviation.

Results
In dynamics for 6 months in the general cohort of patients, there was a significant increase in the absolute mineral density of the femoral neck by 11.38%, p&lt;0.01 the reliability of the difference with the baseline data, and a decrease in the degree of deviation of the mineral density index from the age norm -3.13%, p&lt;0.05 for the bodies of the lumbar vertebrae and -4.01%, p&lt;0.01 for the femoral neck, which confirms the effectiveness of osteoporosis therapy. In the present study, in 45 patients 37.5% at the time of inclusion in the study in the bodies of the lumbar vertebrae, the T-index was higher than -2.5 SD, in respect of the femoral neck – in all patients, the T was lower than 2.5 ST. The study of bone mineral density in patients with HCBP, the decrease of which reflects the syndrome of renal osteodystrophy, developing in response to secondary hyperparathyroidism, against the background of osteoporosis therapy.

Conclusion
In patients with CKD, against the background of programmed hemodialysis, there is a decrease in bone mineral density (1.93 times the bodies of the lumbar vertebrae and 2.83 times the femoral neck). The use of calcium carbonate, biphosphonate and vitamin D3 contributes to an increase in the mineral density of the femoral neck by 8.64% (p&lt;0.05). The introduction of sevelamer hydrochloride into the therapy regimen increases the effectiveness of therapy and increases the mineral density of the bodies of the lumbar vertebrae by 5.96% (p&lt; 0.05) and the femoral neck by 14.04% (p&lt;0.05).
#2913 BLOODSTREAM INFECTIONS IN CHRONIC HEMODIALYSIS PATIENTS: CHARACTERISTICS AND OUTCOMES
Authors: Pravda Miri Schamroth , Maor Yasmin , Brodsky Konstantin , Katkov Anna , Cernes Relu , Pravda Nili Schamroth , Tocut Milena , Soroksky Arie , Feldman Leonid 
Published: June 2023

Abstract

Background and Aims
Bloodstream Infections (BSI) are a major cause of death and hospitalization among hemodialysis (HD) patients. In recent years several preventive measures were introduced to reduce BSI in HD patients. Despite these various strategies, the rate of BSI in HD remains high. The aim of the present study was to explore factors associated with BSI in a contemporary cohort of HD patients at a public teaching hospital dialysis center.

Method
This was a retrospective cohort study of HD patients with a BSI in the years 2014 to 2018. The cohort included patients aged ≥ 18 years treated with chronic HD for at least three months. The primary outcome was the occurrence of BSI. We examined the clinical characteristics of the patients, causative pathogens, and mortality.

Results
The study involved 251 chronic HD patients. The mean age was 68.5±13.4 years, 69.9% were male. The most frequent cause of end-stage renal disease was diabetes (46.7% of patients). The mean time from initiation of HD was 34.8±40.8 months and the follow up period was 25.2±15.9 months. During the observation period, 44 patients (17.5%) developed 54 BSI events, while 9 of them (3.6% of the whole cohort) developed recurrent BSI events. Gram-negative microorganisms caused 46.3% of all BSI events. 31.4% of these BSI were caused by resistant bacteria. In multivariate logistic regression analysis, factors that increased the risk of mortality were BSI events (OR 2.566, p = 0.035), patients' age (OR 1.068, p&lt;0.001), diabetes (OR 1.019, p = 0.001).

Conclusion
We noted an increased prevalence of gram-negative pathogens in the etiology of BSI in HD patients. Our findings highlight the need to be aware of local epidemiology in order to implement appropriate preventative measures and tailor empiric antibiotic therapy.
#2974 SERUM CHEMOKINE CC-MOTIF LIGAND 17 IS A PREDICTIVE MARKER OF SEVERE COVID-19 IN HAEMODIALYSIS PATIENTS
Authors: Beppu Hiroko , Fukuda Tatsuya , Otsubo Naoya , Kawanishi Tomoko , Ogawa Toshie , Abe Yasutomo , Endo Mariko , Hanawa Tomohide , Sugita Chise , Hatakeyama Shuji , Yamada Tetsuya , Wakai Sachiko 
Published: June 2023

Abstract

Background and Aims
Maintenance haemodailaysis (HD) patients are at higher risk for severe coronavirus disease 2019 (COVID-19). Because of a limited number of facilities that can provide inpatient treatment for COVID-19 and HD, it is important to identify HD patients who are at high risk for severe COVID-19. For mild to moderate COVID-19 patients, chemokine CC-motif ligand 17 (CCL17) was reported to be a predictive marker for severe COVID-19; however, the validity of CCL17 among HD patients is unknown.

Method
This retrospective observational study enrolled 107 HD patients with mild or moderate COVID-19 at hospitalisation (mean age 70.1 ± 15.1 years; 71.0% male). Receiver operating characteristic and logistic regression analyses were used to examine the predictive validity of indices for severe COVID-19 which is defined as partial pressure of oxygen/fraction of inspired oxygen (P/F) ratio &lt;300 or SpO2 &lt;94%. Multi-variate logistic regression models were used to investigate the association of CCL17 level with the development of severe COVID-19. Furthermore, to evaluate the degree of improvement in predicting performance in the pre-existing model with the addition of CCL17 compared to the pre-existing model, we calculated net reclassification improvement (NRI) and the integrated discrimination improvement (IDI).

Results
During hospitalisation, 32 patients developed severe COVID-19. Serum CCL17 collected at admission exhibited a higher area under the curve value (0.818) compared with that of other indicators including LDH and C-reactive protein for the prediction of severe COVID-19. The optimal cut-off value for CCL17 was 150.5 pg/ml. A multi-variate logistic analysis revealed that CCL17 (above 150.5 pg/ml) was significantly associated with severe COVID-19 (Odds ratio, 0.063; 95% Confidence interval [CI], 0.017–0.227; P &lt; 0.001) even after adjustment for covariates. The addition of the CCL17 to a model consisting of vaccination status, albumin, blood urea nitrogen, C-reacting protein and lactate dehydrogenase, that are variables incorporated in multivariate logistic model, significantly improved classification performance for severe COVID-19 using the NRI (1.16, 95% CI: 0.82–1.50, P &lt; 0.001) and IDI (0.18, 95% CI: 0.09–0.26, P &lt; 0.001).

Conclusion
CCL17 levels in HD patients with mild or moderate COVID-19 predict risk of developing severe COVID-19.
#2996 EARLY DECLINES IN KIDNEY FUNCTION AND ADVERSE OUTCOMES IN YOUNG ADULTS
Authors: Hussain Junayd , Grubic Nicholas , Akbari Ayub , Canney Mark , Elliott Meghan , Ravani Pietro , Tanuseputro Peter , Clark Edward , Hundemer Gregory , Ramsay Tim , Tangri Navdeep , Knoll Greg , Sood Manish 
Published: June 2023

Abstract

Background and Aims
Whether early eGFR declines (eGFR below age-expected values) in younger adults are associated with adverse outcomes is unknown. We aim to estimate the association of an early eGFR decline with adverse outcomes by age group (18-39, 40-49, 50-65 years).

Methods
We included 8.9 million adults (aged 18-65) with ≥1 eGFR value using linked healthcare datasets in Ontario from January 2008-March 2020. The association of eGFR categories from &lt;60 to &gt;120 mL/min/1.73 m2 and adverse outcomes (death, cardiovascular outcomes, end-stage kidney disease) was examined using adjusted Cox models. Comparisons were relative to age normalized measured GFR categories (100-110 mL/min for 18-39, 90-100 mL/min for 40-49, 80-90 mL/min for 50-65).

Results
The mean age, eGFR and median follow up were 41 years, 104 mL/min and 9.2 years, respectively. 17.3%, 18.9%, and 17.7% had an eGFR below normal for ages 18-39, 40-49, and 50-65, respectively. The risk of an adverse event increased in a stepwise manner with eGFR values below the referent and occurred at higher eGFR values in those 18 to 39 [eGFR 70-80, age 18-39: incidence 4.37 events per 1000 person-years[p-y], HR 1.54(1.46-1.61); age 40-49: incidence 9.78 per 1000 p-y, HR 1.18(1.15-1.21); age 50-65: incidence 24.0 per 1000 p-y, HR 1.11(1.10-1.12)] (see Figure 1). Results persisted for each outcome individually, and after using repeated eGFR, using a common referent, and adjusting for multiple covariates.

Conclusion
Young adults (18-39) with an early eGFR decline were at a higher risk of adverse events and this occurred at higher eGFR levels relative to middle-aged and older adults.
#3001 PREVALENCE OF IMPLANTABLE CARDIAC DEVICES IN A COHORT OF PATIENTS WITH CHRONIC KIDNEY FAILURE: A MULTICENTER CROSS-SECTIONAL STUDY
Authors: Sabiu Gianmarco , Reseghetti Elia , Conti Costanza , Fattizzo Vincezo , Miglio Roberta , Airaghi Cristina , Caruso Sabrina , Heidempergher Marco , Gallieni Maurizio 
Published: June 2023

Abstract

Background and Aims
Chronic kidney disease (CKD) increases the risk of arrhythmic events and sudden cardiac death. For preventive purposes, the use of cardiac implantable electronic devices (CIEDs), including pacemakers (PMs), implantable cardiac defibrillators (ICDs), pacemakers for cardiac resynchronization therapy (CRTs), and loop recorders, can be used. However, in the absence of large epidemiological studies, whether the use of CIEDs in hemodialysis patients is associated with a lower mortality benefit than in pre-dialysis patients remains controversial. In this cross-sectional study, we evaluate the prevalence of CIEDs in a cohort of patients with CKD.

Method
The study includes patients with CIEDs with estimated GFR &lt;45 ml/min/1.73 m2 from two hospitals in Milan, divided into two groups based on treatment with conservative therapy (IRC stage IIIb-V) or hemodialysis.

Results
Of the 499 patients enrolled, 268 had CKD stage IIIb-V, and 231 were in hemodialysis (Table 1).
Among CRT carriers, the prevalence in the CKD IIIb-V group is significantly higher than in the hemodialysis group (4.09% vs 0.86%; p = 0.025) (Figure 1), even if among the hemodialysis patients the prevalence of patients with previous stroke and hypertension was significantly higher (Table 1).
Furthermore, in multiple logistic regressions, hemodialysis was a variable independently correlated with reduced use of CRTs (OR 0.27; 95% CI = 0.01-0.96; p 0.04), while the other devices (individually and cumulatively) correlated positively only with age and previous myocardial infarction (MI) (Table 2).

Conclusion
The reduced prevalence of CRT in hemodialysis patients is probably related to the shorter life expectancy and the higher rate of related complications, such as the increased risk of infectious complications and/or stenosis of the central venous vessels. Further studies are needed to evaluate the impact of these devices on the cardiac mortality of hemodialysis patients and the associated complication rate.
#3041 DNAJB9 POSITIVE PRIMARY FIBRILLARY GLOMERULONEPHRITIS: TREATMENT WITH CORTICOSTEROID PULSES EXPERIENCE
Authors: Oleas Diana 
Published: June 2023

Abstract

Background and Aims
Fibrillary glomerulonephritis (FGN) is a rare histological pattern. Electron microscopy is needed for diagnostic confirmation where predominantly mesangial fibrils are observed. To support the diagnosis; DNAJB9 is a biomarker that is 100% sensitive and 100% specific for FGN. To date, there is no defined therapeutic approach. Various immunosuppressants have been implemented to treat FGN showing poor renal response and approximately 50% progression to chronic kidney disease.

Method
Ambispective observational study. A protocol based on a bibliographic review was developed. The protocol included an induction therapy with methylprednisolone pulses (MTP), 500 mg a day for three days. Followed by oral prednisone at a dose of one mg/kg with an individual titration period considering the clinical evolution. Demographic, clinical, and pathological variables were extracted from the electronic health record.

Results
Case 1. Seventy-eight-year-old female. History of arterial hypertension (HT) treated with an angiotensin-converting enzyme inhibitor (ACEi). She debuted with a nephrotic syndrome characterized by proteinuria of 15 grams/day, hypoalbuminemia, and altered kidney function with creatinine (Cr) of 2.7 mg/dL. Secondary causes were rule out. The kidney biopsy showed mesangial expansion with mesangial deposition of IgG and C3 on the immunofluorescence. Congo red was negative. Positivity for DNAJB9 was observed. The electron microscopy (EM) showed 20-nanometer fibrils in the mesangium. The patient was initiated on the treatment protocol with a subsequent reduction of prednisone over a period of 24 weeks. Complete remission, defined as proteinuria &lt;0.5g/day and reduction &gt; 50% of Cr was achieved after 20 weeks of treatment. Case 2. Forty-seven-year-old female with a history of hypertension treated with ACEi. The patient presented with proteinuria 3.5g/d with a normal kidney function. Secondary causes were rule out. The kidney biopsy showed mesangial thickening with IgG, C3, C1q, Kappa, and lambda positivity on immunofluorescence. Congo red was negative. DNAJB9 was positive. An electron microscopy study showed randomly arranged mesangial fibrils. The treatment protocol was started. Prednisone was titrated over a period of 20 weeks. Partial remission was observed, defined by &gt;50% reduction of proteinuria. Kidney function remained preserved.

Conclusion
Induction treatment based on steroid pulses followed by prednisone titration in patients with FGN with predominantly mesangial compromise was associated with a substantial reduction of proteinuria and stabilization of kidney function.
#3042 AMBULATORY BLOOD PRESSURE LEVELS AFFECT THE ASSOCIATION OF INTRADIALYTIC HYPERTENSION WITH ADVERSE CARDIOVASCULAR EVENTS IN HEMODIALYSIS PATIENTS
Authors: Iatridi Foteini , Theodorakopoulou Marieta , Georgiou Areti , Karpetas Antonios , Pella Eva , Tsouchnikas Ioannis , Giamalis Panagiotis , Papagianni Aikaterini , Sarafidis Pantelis 
Published: June 2023

Abstract

Background and Aims
Patients with intradialytic hypertension (IDH) display also higher ambulatory blood pressure (BP) levels during the whole 44-h interdialytic interval compared to patients without the phenomenon. Sustained high 44-h ambulatory BP levels is a potential risk factor for cardiovascular events and mortality in these individuals. The aim of this study is to evaluate the influence of elevated 44-h BP levels on the high cardiovascular risk of individuals with IDH.

Method
A total of 242 hemodialysis patients with valid 48-h ABPM with Mobil-O-Graph-NG had an extended follow up for a median of 57.8 months. IDH was defined as: rise in SBP greater or equal to 10 mmHg from pre- to post-dialysis and post-dialysis SBP greater or equal to 150 mmHg. The primary end-point was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, resuscitation after cardiac arrest, hospitalization for heart failure, coronary or peripheral revascularization procedure. The secondary endpoint was cardiovascular mortality.

Results
5 patients with and 197 without were included in this prospective analysis. Cumulative freedom from the primary and secondary endpoint was significantly lower for patients with IDH (logrank-p = 0.019), while freedom from the secondary endpoint did not differ significantly between the two groups (logrank-p = 0.321). Patients with IDH presented a significantly higher risk for the composite endpoint (HR = 1.651, 95%CI[1.083, 2.516]), without, however, showing a significant difference in the risk for cardiovascular mortality (HR = 1.320, 95%CI[0.762, 2.288]). After adjustment for 44-h SBP, the association of IDH with the primary endpoint slightly attenuated, while the association with the secondary outcome had no significant changes (HR = 1.421, 95%CI[0.906, 2.228] and HR = 1.270, 95%CI[0.708, 2.276], for primary and secondary outcome respectively).

Conclusion
IDH is associated with higher risk for adverse cardiovascular outcomes. High ambulatory BP during the interdialytic interval contributes to the excess cardiovascular risk observed in this population.