bluuebunny/crossref_metadata_2025_split huggingface dataset:
#5221 PULMONARY HYPERTENSION: AN IMPORTANT RISK FACTOR IN CARDIOVASCULAR MORTALITY IN DIALYSIS PATIENTS
Authors: Rroji (Molla) Merita , Zeneli Nereida , Cafka Majlinda , Seferi Saimir , Barbullushi Myftar 
Published: June 2023

Abstract

Background and Aims
It is widely known that chronic dialysis patients experience significantly higher cardiovascular (CV) death rates than the overall population. Among other CV risk factors, recent research has shown pulmonary hypertension (PH) as a consequence of chronic kidney disease and end-stage renal failure. The present study aimed to determine the risk factors that impact survival in chronic haemodialysis and peritoneal dialysis patients and to analyse the correlation of these factors with pulmonary hypertension.

Method
We studied 125 stable haemodialysis and peritoneal patients (females 40%, mean age 52.42 ±11.88 years) on RRT for more than three months with a two-year follow-up. Demographic information, clinical characteristics, blood tests, and a thorough echocardiographic evaluation were collected at the optimal dry weight. After conventional echocardiographic examination, a tissue Doppler echocardiographic (TDE) examination was performed to evaluate the global and regional myocardial systolic and diastolic functions and pulmonary hypertension. Systolic pulmonary artery pressure (sPAP) of 35 mmHg was used to define PH.

Results
The cardiovascular mortality rate was 15.5%. In ROC analysis for CV mortality, the area under the curve (AUC) for PH and CRP was found 0.8; for LVM-I, E/E', and PP, the AUC was 0.76, 0.75, 0.72, respectively, while the inverse relationship was found with MASa and TASa with AUC = 0.66 and 0.95 respectively. According to the echocardiographic findings, PH was found in 28% (35 patients) of all patients. The mean PH was 33.46±5.38 mmHg. The higher level of higher parathormone (PTH), C-reactive protein (CRP), and E/E’ average, the lower left ventricular ejection fraction (EF), the peak systolic velocity at the lateral mitral annulus (MASa), and the peak systolic velocity at the lateral tricuspid annulus (TASa) were found to be predictors of PH. Patients evaluated with PH have a significantly lower cardiovascular survival rate [Long Rank (Mantel-Cox) p = 0.0001.

Conclusion
Our research demonstrates that cardiovascular morbidity and death in dialysis patients are mainly attributed to pulmonary hypertension, inflammation, vascular stiffness, and left ventricular hypertrophy. PH is common among dialysis patients. Inflammation, CKD-MBD biomarkers linked to systolic and diastolic left and right ventricular dysfunction, and inflammation all influence it. These conditions are all connected. Cardiovascular imaging is simple to use, offers a favourable viewpoint in the early identification of cardiac abnormalities and quick treatment of this disease, and is thus strongly advised in the dialysis population.
#5256 REACTIVATION OF HEPATITIS B VIRUS IN KIDNEY TRANSPLANT RECIPIENTS WITH RESOLVED INFECTION: A SINGLE-CENTER EXPERIENCE
Authors: Pimenta Gonçalo , Weigert André , Conde Sara Querido 
Published: June 2023

Abstract

Background and Aims
Patients with end-stage renal disease (ESRD) frequently present serologic evidence of previous contact with hepatitis B virus (HBV). Although uncommon, HBV reactivation after kidney transplantation (KT) may cause serious complications and adverse outcomes in these patients. However, data regarding risk factors for reactivation are still scarce. This study aims to describe a cohort of patients with resolved HBV infection who showed reactivation of the virus after KT.

Method
Retrospective cohort study including patients with resolved HBV infection who underwent KT between August 2007 and December 2021. Resolved HBV infection was defined as being seronegative to HB surface antigen (HBsAg) and seropositive to HB core antibody (HBcAb), regardless of HB surface antibody (HBsAb) status. HBV reactivation after KT was defined as seropositivity to HBsAg or presence of HBV-DNA in the serum (viraemia). Preemptive prophylactic entecavir was not used. Demographic and clinical data were collected from the electronic records.

Results
A total of 104 patients (70.2% male) were included with a mean age of 52±10 years. Prior to KT, 93.3% were seropositive to HBsAb. Seropositivity to other viruses was present in 18 patients: human immunodeficiency virus (HIV) alone in 5 patients, hepatitis C virus (HCV) alone in 11 patients and coinfection in 2 patients. Deceased-donor KT was performed in 94.2% and only 9 patients had had a previous KT. Rituximab was used as induction immunosuppressive therapy in 13 patients. Median follow-up time after KT was 75 months (IQR 37-115). HBV reactivation occurred in 6 patients with a median time after KT of 5 months (IQR 3-11.5). At reactivation diagnosis, median HBsAg titer was 83.2 (IQR 34-784.5; reference range &lt; 1) and median viral load was 6.7 × 106 copies/mL (IQR 0.4 × 106-378 × 106). Only one patient presented seropositivity to HBsAg without viraemia. Half of these patients were seropositive to HBsAb prior to KT and became seronegative at reactivation diagnosis. No liver enzyme elevation was registered at reactivation diagnosis. Donor HBcAb status, coinfection with HIV or HCV, Rituximab use and recipient HBsAb status were not associated to HBV reactivation after KT. Two patients with HBV reactivation lost kidney graft function and 2 died during follow-up.

Conclusion
Hepatitis B virus reactivation is possible after kidney transplantation and may pose major adjustments to the treatment, namely the immunosuppressive therapy. Careful monitoring of hepatitis B virus serology and viraemia could be particularly useful in early diagnosis and prompt approach to its reactivation. Larger and multi-center studies are warranted to identify specific risk factors in this population and prevent reactivation.
#5280 PREVALENCE OF POLYPHARMACY AND ASSOCIATED ADVERSE OUTCOMES IN KIDNEY TRANSPLANT RECIPIENTS
Authors: Kim Sungyeon , Kim Myung-Gyu , Koo Tai Yeon 
Published: June 2023

Abstract

Background and Aims
Polypharmacy (PP) continues to increase, and is associated with numerous adverse clinical outcomes and mortality. Although the burden of medication in kidney transplant recipients (KTRs) is well-known, PP has not been characterized in detail in the KTRs. The aim of this study was to assess the prevalence of PP among KTRs and the association between PP and clinical outcomes in the KTRs.

Method
A total of 1,080 KTRs from multicenter observational cohort study in Korea between 2012 and 2016 (KNOW-KT) were included in the study. PP was defined as the use of more than 10 medications per day.

Results
The PP prevalence at 1, 2, 3, 5, and 8 years after transplantation was 37.9%, 37.3%, 36.5%, 37.1% and 25.4%, respectively. The prevalence of diabetes, dyslipidemia and history of cardiovascular disease was significantly higher in PP group than in non-PP group (the use of fewer than 10 medications). The mean follow-up period was 6.9 years, and there were 69 graft failures, 63 new-onset cardiovascular diseases, and 36 deaths. When the effect of PP prescribed at 1-year post-transplant on clinical outcomes was analyzed, there was no difference in glomerular filtration rate between the non-PP and PP groups, and the hazard ratio of graft failure and death in the PP group was 1.07 (0.718 to 1.59) and 1.37 (0.71 to 2.64), respectively, compared to the non-PP group. However, multivariate analysis adjusted for classical risk factors showed that PP independently increased the risk of new cardiovascular disease (adjusted HR 1.78 (1.07-2.96)) after KT.

Conclusion
These results showed that PP is common in KTRs, and considering the adverse effects of PP on KT outcomes, physician's attention and efforts are needed to systematically manage and prevent inappropriate PP after KT. Long-term and large-scale research is needed to establish management guidelines for PP in the future.
#5293 THE IMPACT OF SEVERE DEPRESSION ON THE SURVIVAL OF OLDER PATIENTS WITH END-STAGE KIDNEY DISEASE
Authors: Kim Yoon-Ju , Jeon You-Hyun , Chung Yu-Kyung , Lim Jeong-Hoon , Jung hee-Yeon , Choi Ji-Young , Park Sun-Hee , Kim Chan Duck , Kim Yong-Lim , Cho Jang-Hee 
Published: June 2023

Abstract

Background and Aims
Incidence of depression increases in patients with end-stage kidney disease (ESKD). We evaluated the association between depression and mortality among older patients with ESKD, which has not been studied previously.

Method
This nationwide prospective cohort study included 487 patients with ESKD aged &gt; 65 years, who were categorized into minimal, mild-to-moderate, and severe depression groups based on their Beck Depression Inventory-II (BDI-II) scores. BDI-II scores were separated into three symptom domains: affective, cognitive, and somatic depressive symptoms. The association between the depression groups and survival were analyzed using multivariate Cox proportional hazard regression models. Predisposing factors for high BDI-II scores were evaluated using logistic regression analysis. The associations among the three depressive-symptom domains and survival were also analyzed.

Results
The severe depression group showed a higher modified Charlson comorbidity index value and lower serum albumin, phosphate, and uric acid levels than the other depression groups. The Kaplan–Meier curve revealed a significantly lower survival in the severe depression group than in the minimal and mild-to-moderate depression groups (P = 0.011). Multivariate Cox regression analysis confirmed that severe depression was an independent risk factor for mortality in the study cohort [hazard ratio (HR), 1.39; 95% confidence interval (CI), 1.01–1.91; P = 0.041). BDI-II scores were associated with modified Charlson comorbidity index (P = 0.009) and serum albumin level (P = 0.004) in multivariate linear regression. Among the three depressive symptoms, higher somatic symptom scores were associated with increased mortality (HR, 2.45; 95% CI, 1.25–4.79; P = 0.009).

Conclusion
Among older patients with ESKD, severe depression increases mortality compared with minimal or mild-to-moderate depression. And patients with concomitant somatic symptoms require careful management of their comorbidities and nutritional status.
#5339 TRANSTHYRETIN AMYLOIDOSIS WITH BIOPSY PROVEN RENAL INVOLVEMENT
Authors: Careddu Andrea , Lalloni Stefania , Marchisio Martina , Morrone Marco , Rabajoli Gianluca , Ceruti Cecilia , Fenoglio Roberta , Sciascia Savino , Roccatello Dario 
Published: June 2023

Abstract

Background and Aims
Systemic amyloidosis is a cluster of disorders characterized by tissue deposition of amyloid (highly ordered fibrils composed of low molecular weight subunits of a variety of proteins). Transthyretin (TTR) amyloidosis (ATTR) is either an autosomal dominant inherited condition (ATTRv, where v stands for “variant”) or a non hereditary disease due to misfolding of wild-type TTR (ATTRwt). ATTR is likely underdiagnosed due to its clinical variability and lack of specific symptoms or biomarkers. The first aim of the study is to emphasise the importance of suspecting ATTR when facing certain clinical manifestations in association with renal impairment and urinary abnormalities. Furthermore, renal biopsy provides crucial information for a correct diagnosis and treatment approach.

Method
We report 5 cases of biopsy-proven renal ATTR deposition in patients presenting with mild to moderate renal impairment and mild urinary abnormalities. The TTR precursor has been confirmed in kidney specimens by immunohistochemistry. Genotyping was carried out in every patient.

Results
The presence of amyloid was found in all patients, with different distribution (#1-3 pericapsular and vascular; #2 vascular; #4 mesangial, vascular, in tubular basement membrane and in the interstitium of cortex and medulla; #5 pericapsular, vascular and interstitial). On genetic analysis three patients were wild-type (#1-2-5), one carried the c.424G&gt;A (p.(Val142Ile)) mutation (#3) and the last one the Val30Met mutation (#4).

Conclusion
Suspicion of ATTR should be considered in patients with increase in serum creatinine, mild proteinuria and cardiac and peripheral nerve symptoms. This can be of utmost importance in elderly patients in whom a monoclonal gammopathy of undetermined significance can co-exist and drive a wrong diagnosis of primary light chain amyloidosis (AL), that could lead the clinician to undertake inappropriate treatments. Renal biopsy and genetic sequencing are both critical in diagnosing ATTR. Finally, we suggest distinguishing in the context of the ATTR deposition disease an ATTR nephropathy characterized by mesangial accumulation of amyloid, that impacts functional and urinary assessment, from isolated deposition in small vessels without specific clinical consequences, albeit critical for ATTR diagnosis.
#5340 ASSOCIATION BETWEEN PARABEN EXPOSURE AND INDEX OF CHRONIC KIDNEY DISEASE (CKD) AMONG THE GENERAL TAIWANESE POPULATION
Authors: Chang Jung-Wei , Chen Hsin-Chang , Chang Wan-Ting , Huang Po-Chin 
Published: June 2023

Abstract

Background and Aims
Exposure to consumer chemicals has been associated with chronic kidney disease (CKD) among humans, but their associations with estimated glomerular filtration rate (eGFR) are inconsistent. We aimed to assess the relationship between paraben exposure and renal function including the serum level of blood urea nitrogen (BUN), and the urinary levels of microalbumin, albumin, protein, and creatinine from a population-based study.

Method
We enrolled 310 participants (≥18 y, N = 240; &lt;18 y, N = 70) who provided questionnaire information as well as blood and urine samples from a nationally representative study. Urinary parabens including methylparaben (MeP), ethylparaben (EtP), propylparaben (PrP), and butylparaben (BuP) are measured by liquid chromatography/ tandem mass spectrometry. From the renal function index, we measured the serum level of blood urea nitrogen (BUN), and the urinary levels of microalbumin, albumin, protein, and creatinine. We used multiple logistic regressions to evaluate the relationship between paraben exposure and renal function in our participants.

Results
Median levels of urinary MeP, EtP, PrP and BuP in adults were 399 [interquartile range (IQR) = 257–611], 38.3 (IQR = 25.9–62.2), 115 (IQR = 74.6–160) and 6.60 (IQR = 4.42–9.42) ng/mL, respectively, which were significantly lower than those in children/adolescents [MeP: 186 (IQR = 6.92–453); EtP: 13.0 (IQR = 0.05–38.1); 60.3 (IQR = 0.62–101); 2.65 (IQR = 0.73–7.84) ng/mL] (all P&lt;0.001). Multivariate regression models adjusted for the same confounding factors confirmed the association of BUN and eGFR with urinary EtP (β: 0.137; 95% confidence interval [CI] = 0.003 to 0.272; β: -0.101; 95% CI = -0.202 to -0.001), which means BUN increased by 0.137 × 10−2 mg/dL, and eGFR decreased by 0.101 × 10−2 mL/min/1.73 m2 with a 1% increase in urinary EtP level, respectively. The multiple logistic regression showed that the adjusted odds ratio of the higher EtP and PrP level (median) in participants ≥18 y for lower eGFR (eGFR &lt;90 mL/min/1.73 m2) was 1.86 and 1.87 times (95% CI = 1.03–3.34 and 1.04–3.37) than the lower group, respectively.

Conclusion
Our findings suggested that daily exposure to EtP were significantly positively associated with an increased risk of higher BUN and lower eGFR in Taiwanese ≥18 y. Comprehensive or mechanistic studies are required to elucidate these associations.
#5390 INTENSIFIED B CELL DEPLETION THERAPY IN ANCA-VASCULITIS WITH SEVERE RENAL IMPAIRMENT AS COMPARED TO CONVENTIONAL IMMUNOSUPPRESSION
Authors: Amore Giorgio , Marchisio Martina , Lalloni Stefania , Longo Roberta , Geraci Giovanni , Careddu Andrea , Fenoglio Roberta , Sciascia Savino , Roccatello Dario 
Published: June 2023

Abstract

Background and Aims
Rituximab (RTX) has shown to be an effective induction treatment for small-vessel vasculitides associated with antineutrophil cytoplasm antibodies (AAV) in both newly diagnosed and relapsing patients. However, the role of RTX in the management of the most severe cases of AAV remains to be fully elucidated. The aim of this study was to assess both safety and efficacy of an intensified B-cell depletion therapy (IBCDT) protocol, including RTX, cyclophosphamide (CYC), and methylprednisolone pulses without additional maintenance immunosuppressive therapy in a cohort of 15 AAV patients with the most severe features of AVV renal involvement (as &lt;15 ml/min GFR and histological findings of paucimmune necrotizing glomerulonephritis with more than 50% crescents of non-sclerotic glomeruli at the renal biopsy).

Method
Results of the IBCDT regimen have been compared to those obtained in a control cohort of 10 patients with AAV treated with a conventional therapy regimen based on oral CYC and steroids followed by a prolonged maintenance therapy with azathioprine (AZA). Plasma exchange was equally employed in the study and the control group.

Results
Complete clinical remission (BVAS 0) was observed at 6 months in 14 of 15 patients treated with IBCDT (93%). All cases who achieved a complete clinical remission experienced a depletion of peripheral blood B cells at the end of therapy. Of the 10 dialysis dependent patients at onset, 6 subjects (60%) experienced a functional recovery allowing the suspension of dialysis treatment. When compared to the control group, no statistically significant difference was observed in patients treated with IBCDT in terms of overall survival, 6-month therapeutic response rate, and 6-, and 12-month functional renal recovery. The cumulative total dose of CYC in the case group was on average 1 g/patient while in the control group on average 8.5 g/patient (p = 0.00008).

Conclusion
Despite the retrospective design and relative limited sample size, IBCDT appeared to be safe and had the same efficacy profile when compared to the conventional therapy with CYC plus AZA in the management of the most severe patients with AAV. Additionally, this avoided the need of prolonged maintenance therapy for long, and limited the exposure to CYC with consequent reduced toxicity and drug-related side effect rates.
#5401 REAL-WORLD STUDY BETWEEN NEPHROTIC SYNDROME AND VENOUS THROMBOEMBOLISM
Authors: Shen Jie , Nie Sheng 
Published: June 2023

Abstract

Background and Aims
Nephrotic syndrome (NS) is a recognized risk factor of venous thromboembolism (VTE), however, there have been limited comprehensive epidemiologic data on VTE among NS patients. Therefore, we designed our study to assess the epidemiology and clinical correlates of VTE among hospitalized adults with NS in China.

Method
In this nationwide real-world study of 78,797 hospitalized patients with NS from 18 medical centers across China, VTE was identified by International Classification of Diseases, 10th revision (ICD-10) codes or imagological examinations during hospitalization. Multivariable logistic regression analysis was used to investigate the association between clinical variables and VTE through the R Programming software.

Results
A total of 1227 VTE cases were identified in the hospitalized NS population and the detection rate was 1.56%. Detection rate of VTE varied significantly in patients with different pathologic types of NS. Patients with membranous nephropathy (MN) had a significantly increased risk of VTE {Odds ratio [OR] 2.11 [95% confidence interval (CI) 1.12–4.36]}. While patients with focal segmental glomerulosclerosis (FSGS) did not show a significant high risk [OR 0.93 (95% CI 0.29–2.60)] compared with minimal change disease. We also found that male [OR 1.44 (95% CI 1.15–1.80)], age [OR 1.09 (95% CI 1.02–1.17)], anemia [OR 1.50 (95% CI 1.15–1.95)], cerebral bleeding [OR 3.23 (95% CI 1.69–6.16)], respiratory tract infection [OR 2.05 (95% CI 1.60–2.63)], respiratory failure [OR 2.24 (95% CI 1.42–3.53)], use of proton pump inhibitors (PPIs) [OR 2.19 (95% CI 1.54–3.12)], use of glucocorticoids [OR 1.46 (95% CI 1.03–2.09)] and immunosuppressants [OR 1.48 (95% CI 1.14–1.93), orthopedic operations [OR 1.97 (95% CI 1.22–3.18)], high-level D-dimer (&gt;0.55 mg/L) [OR 2.62 (95% CI 1.87–3.65)] were associated with increased risk of VTE detection. While 24-hour urine protein quantification &gt;10 g/d [OR 1.24 (95% CI 0.90–1.70)] showed little significant correlation with VTE. Hypertension [OR 0.74 (95% CI 0.58–0.95)] and the use of diuretics [OR 0.72 (95% CI 0.53–0.97)] were found to have a negative correlation with VTE detection.

Conclusion
The detection rate of VTE among patients with NS during hospitalization was 1.56%. Male, age, MN, anemia, cerebral bleeding, respiratory tract infection, respiratory failure, and use of PPIs, glucocorticoids and immunosuppressants, high D-dimer concentration were associated with VTE detection in NS. While 24-hour proteinuria did not show a significant association with VTE identification.
#5418 ASSOCIATION BETWEEN TRANSIENT AKI AND ALL-CAUSE MORTALITY IN PATIENTS WITH CRITICAL ILLNESS: AN INTERNATIONAL MULTICENTRE RETROSPECTIVE COHORT STUDY
Authors: Mingzhen Pang , Nie Sheng , Hou Fan Fan 
Published: June 2023

Abstract

Background and Aims
Transient acute kidney injury (AKI) is common in critically ill patients. However, the effect of transient AKI on prognosis of patients remains controversial. We aimed to investigate the association of transit AKI with all-cause mortality and kidney outcomes in critically ill patients.

Method
We conducted a multicentre retrospective cohort study involving 40168 critically ill patients from CRDS and 8657 patients from MIMIC-IV databases. Among them, 10147 patients were diagnosed as AKI according to KDIGO criteria and classified into transient (duration ≤48 h) and persistent (duration &gt;48 h). The study outcomes included mortality in hospital, by day 30 and up to 1 year, and risk of progress to CKD. We determined the effect of transit AKI on mortality by Cox regression model adjusting for confounding variables and analyzed CKD incidence by Fine-Gray model adjusted for difference in biologically plausible confounders.

Results
AKI occurred in 20.8% of 48825 critically ill patients, of which 36.4% was classified into transient and 63.6% persistent. Compared with those without AKI, Patients with transit AKI were older, more often received diuretic therapy and sedative therapy, and higher Charlson comorbidity index. After adjusting confounders including AKI severity, transient AKI was independently associated with increased risk of in hospital death (HR 1.97, 95% CI 1.68 to 2.31), 30-day mortality (HR 1.73, 95% CI 1.51 to 1.98) and 1- year mortality (HR 1.31, 95% CI 1.19 to 1.44). Meanwhile, the risk of all-cause mortality increased with the duration of AKI in those with persistent patients (P&lt;0.05). Among survivors without history of CKD, compared with patients without AKI, transient AKI was also associated with increased risk of incident CKD after discharge (HR 1.61, 95% CI 1.33 to 1.96).

Conclusion
Transient AKI was associated with increased risk of all-cause mortality and incident CKD in critically ill patients. Raising of awareness about transient AKI was required to urge clinician monitor such patients closer.