bluuebunny/crossref_metadata_2025_split huggingface dataset:
#5142 THE NATURAL HISTORY OF FSGS IN THE GERMAN CHRONIC KIDNEY DISEASE (GCKD) COHORT
Authors: Stamellou Eleni , Nadal Jennifer , Seikrit Claudia , Hendry Bruce , Mercer Alex , Schmidt Matthias , Möller Marcus Johannes , Schiffer Mario , Eckardt Kai-Uwe , Floege Jürgen 
Published: June 2023

Abstract

Background and Aims
FSGS is a heterogenic glomerular disease and a common cause of kidney failure in adults. Here we describe the natural history of individuals with FSGS in the German Chronic Kidney Disease (GCKD) cohort.

Method
From 2010 to 2012, 159 patients with biopsy-proven FSGS 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. Baseline date was defined as first study visit. Endpoints were the composite renal endpoint (MAKE); eGFR decline &gt;40%, eGFR&lt; 15ml/min/1.73 m2 or initiation of kidney replacement therapy. The associations between the incidence of MAKE and clinical parameters 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 patients with FSGS was 52.1 ± 13.6 years. Median proteinuria at baseline was 0.7 g/g (Q1 0.1; Q3 1.8), while mean eGFR was 55.8 ± 23 mL/min/1.73 m². Mean duration of the disease before enrollment was 4.7 ± 6.8 years. The majority (101;63.5%) were male; 69 (43.4%) were diagnosed as primary FSGS using clinical and pathological criteria, 55 (34.6%) as secondary FSGS and for 35 (22%) the etiology was uncertain. At baseline, 37 (23.3%) were under immunosuppressive treatment. Over a follow-up of 6.5 years, 44 reached MAKE, in detail 19 (12%) initiated kidney replacement therapy, an additional 25 (15.8%) experienced a &gt;40% eGFR decline. Albuminuria &gt;0.7 g/g was associated with MAKE, with a HR of 1.47 (95% CI: 1.27-1.7) compared to &lt;0.7 g/g. Higher eGFR at baseline (per 10 ml/min) protected from MAKE with a HR of 0.8 (95% CI: 0.68-0.95).

Conclusion
The GCKD cohort represents a large study population with lengthy and adjudicated follow-up data. Lower eGFR and higher albuminuria are significant risk factors for progressive kidney disease and ESKD in patients with FSGS.
#5146 KINETIC ESTIMATION OF GFR AND URINARY CREATININE EXCRETION RATE AS PREDICTORS OF DELAYED GRAFT FUNCTION IN RENAL TRANSPLANTS FROM DECEASED DONORS
Authors: Romero Natividad Calvo , Delgado-Palacios Jesús Domínguez , Arevalo Marta Calvo , Pérez-Flores Isabel , Cubillo Beatriz Rodríguez , de la Higuera Díaz María Ángeles Moreno , Rincón María Muñiz , Meneses Arianne Aiffil , López Rómulo Katsu Loayza , Fructuoso Ana Sanchez 
Published: June 2023

Abstract

Background and Aims
Delayed graft function (DGF) is a common complication after renal transplant. Definitions of DGF are based on analysis of estimated glomerular filtration rate (eGFR) underlying the plasma creatinine fluctuations after renal transplant. We tried to validate an early parameter of DGF in a renal transplant population based on the kinetic estimation of glomerular filtration rate, since this formula adds a quantitative dimension to the assessment of kidney function, and consequently predicting DGF could get a better post-transplant management.

Method
This is a longitudinal study of 886 renal transplant recipients from our center during the first post-transplant month. As we are searching for functional biochemical markers in renal transplant from decesased donors, we excluded patients with primary gtaft disfunction.The final simple was composed of 574 adult kidney transplant recipients, 348 renal transplant from donors after circulatory death (DCD) and 226 from donors after brain death (DBD). The following are analyzed 5creatinine concentrations, serum Lactate dehydrogenase (LDH) and urinary creatinine excretion rate (CER).

Results
In DCD there was a significant correlation between DGF duration and all KeGFR and CER determinations during the first post-transplant week. The parameters that achieved the best correlation to predict DGF were KeGFR (r = 0.515; p&lt;0.001) and CER on the fourth day (r = 0.584; p&lt;0.001) (Figure 1). In the DBD, a weak correlation was observed between DGF duration and KeGFR determinations in the first days, being KeGFR at the fourth day the one that presented the highest correlation (r = 0.59 p&lt;0.001). We observed that serum LDH on the first day in the DBD group is associated with worse renal graft function at first, third month and one year after transplantation (p&lt;.045, p&lt;.05 and p&lt;.067 respectively).

Conclusion
The determination of KeGFR and CER could predict the duration of DGF, especially in DCD recipients. DCD recipients with DGF have significantly better graft survival at one year than DBD recipients with DGF. (p&lt;.001).
#5147 PREDICTING NON-DIABETIC KIDNEY DISEASE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: EXTERNAL VALIDATION OF FOUR PREDICTIVE MODELS
Authors: Roldán Deborah Soledad , Rey Angela , Gruss Enrique , Shabaka Amir 
Published: June 2023

Abstract

Background and Aims
Several prediction models have been published for estimating the probability of non-diabetic kidney disease in kidney biopsies performed in patients with diabetes mellitus. External validation and comparison of these models is essential prior to their clinical application. The aim of this study was to validate and compare the predictive capacity of four previously described clinical models as a tool to predict non-diabetic kidney disease (NDKD) in diabetic patients.

Method
We retrospectively reviewed kidney biopsies performed in patients with type 2 diabetes mellitus between January 1999 and December 2022 in our centre. The probability of presence of NDKD was calculated by using the clinical and laboratory parameters at the time of the decision to perform a biopsy, according to 4 models; Surinrat's model, Liu's model, Li's model and Garcia-Martin's model (see Table 1). Overall model fit was assessed, calibration curves were plotted and discrimination for each model was assessed by using the receiver operating characteristic (ROC) curve in line with the transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD) guidelines.

Results
The study included 280 patients, 68.9% were males and the mean age was 65.4 ± 11.9 years. 172 patients (61.4%) had a diagnosis of non-diabetic kidney disease. On calculating the risk of NDKD, Surinrat's, Li's and Garcia-Martin's models predicted 33.6%, 64.8% and 53.4% of NDKD when using the “probable NDKD” threshold, and 60.7%, 81% and 90.7% respectively when including the “grey zones”. Fleiss’ Kappa test showed a fair agreement between the four models when using the “probable NDKD” threshold (k = 0.23, 95% CI 0.13-0.33, p&lt;0.001) and when including the “grey zones” (k = 0.39, 95% CI 0.29-0.49, p&lt;0.001). On using the “probable NDKD” threshold, the overall accuracy for Surinrat's, Liu's, Li's and Garcia-Martin's models was 50.7%, 62.7%, 63.6% and 65.3% respectively, while on including the “grey zones” the accuracy slightly increased in the first to models to 54.3% and 66.4% respectively while decreasing in Garcia-Martin's model to 64.2%. Area under the ROC curve (AUC) was higher in Garcia-Martin's model (AUC 0.66, 95% CI 0.58-0.74, p&lt;0.001) compared to Lin's model (AUC 0.59, 95% CI 0.50-0.67, p = 0.044), while Surinrat's and Liu's models did not discriminate (AUC 0.55, 95% CI 0.47-0.64, p = 0.214 and AUC 0.58, 95% CI 0.49-0.63, p = 0.084).

Conclusion
There is a fair agreement between the four models for predicting non-diabetic kidney disease in type 2 diabetic patients. Of the models studied, Garcia-Martin's model most accurately predicted non-diabetic kidney disease in type 2 diabetes patients, although discrimination remained poor. These models may not be suitable for guiding clinicians on indicating a kidney biopsy in diabetic patients in our population.
#5163 RATIONAL USE OF ECULIZUMAB IN SECONDARY ATYPICAL HAEMOLYTIC UREMIC SYNDROME
Authors: García-Galán Lucía Cordero , Escribano Teresa Cavero , Gutiérrez Eduardo , Pérez Justo César Sandino , Cuellar Hernando Trujillo , Auñón Pilar , Martínez Marta Rivero , González Celia , Hernández Paúl , Morales Enrique 
Published: June 2023

Abstract

Background and Aims
Secondary atypical hemolytic uremic syndrome (secondary aHUS) is a heterogeneous group of thrombotic microangiopathies (TMA) associated with various underlying conditions. Unlike primary aHUS, there is still no hard evidence on the efficacy of complement blockade in treating secondary aHUS since the two main series in the literature that investigate this subject show discrepant results. Our work aims to reassess Eculizumab's efficacy in treating secondary aHUS.

Method
Observational, retrospective, single-center study, in which we analyzed the hematological and renal evolution of 24 patients diagnosed with secondary aHUS who received treatment with Eculizumab compared with a control cohort of 14 patients who did not receive Eculizumab. Complete renal response was defined as the recovery of renal function before the event, partial renal response as a recovery of 50% of lost glomerular filtration rate, and hematological response as normalization of hemoglobin and platelets.

Results
We found no statistically significant differences in baseline characteristics or disease severity between both groups. After a median of 5 doses of Eculizumab, the group of patients who received complement blockade presented a significant difference in renal response (complete in 47.8% of patients and partial in 17.4%) compared to the control cohort (complete response 14.3% and partial of 14.3%). Rates of hematological remission were similar in both groups (87% in the eculizumab cohort and 85.7% in the control cohort).

Conclusion
Rational and early use of Eculizumab in patients with secondary aHUS could be an effective and safe therapeutic option, guaranteeing better renal recovery compared to patients who do not receive complement blockade.
#5195 MORTALITY OF PATIENTS ON CHRONIC HEMODIALISYS: CAUSED OR RELATED TO SARS-COV-2 INFECTION?
Authors: Ambrogio Martina , Rosati Erica , Spasiano Andrea , De Luca Gianmarco , Urciuolo Federica , Michieli Giulia , Cingolani Antonella , Cutuli Salvatore Lucio , De Pascale Gennaro , Grandaliano Giuseppe , Panocchia Nicola 
Published: June 2023

Abstract

Background and Aims
Patients on chronic hemodialysis (HD) treatment had a higher mortality rate than the general population with SARS-CoV-2 infection. The ERA registry showed a 20% mortality at 28 days for these patients. The aim of the study was to evaluate the causes and risk factors of mortality for patients on chronic HD hospitalized with SARS-CoV-2 infection; particularly if the cause of death is directly attributable to the COVID-19 infection or to another pathology.

Method
Clinical data of chronic HD patients admitted for COVID-19 infection at Fondazione Policlinico Gemelli from March 15th 2020 to February 28th 2022 were analysed. Univariate and multivariate regression analysis for mortality risk factors was performed. Causes of mortality were obtained by hospital discharge forms. COVID-19 related cause of death was defined through intra-hospital codes as COVID-19 pneumonia, COVID-19 ARDS and COVID-19 respiratory failure.

Results
One hundred and fifty-two chronic HD patients were hospitalized for COVID-19 infection. Table 1 shows the general characteristics of the patients. The 28-day all-cause mortality was 21.9%, wich 11.9% was COVID-19 related. Table 2 shows the cause of mortality. Multivariate Cox regression demonstrated that an increased risk of death from COVID-19 at 28 days was significantly and independently associated with age &gt;73 years (HR 1.05, 95% CI 1.0-1.09; p&lt;0.05), Charlson Comorbidity Index (CCI) &gt; 5 at entry (HR 1.28, 95% CI 1.02-1.60; p&lt;0.01), Continuous Renal Replacement Therapies (CRRT) (HR 2.89, 95% CI 1.03-8.11; p = 0.04) and the presence of peripheral vasculopathy (HR 3.48, 95% CI 1.31-9.27; p = 0.01). Plasma albumin &gt;25 g/L at entry (HR 0.87, 95% CI 0.80-0.96; p&lt;0.01) and pre-admission SARS-CoV-2 vaccination (HR 0.25, 95% CI 0.09-0.72; p = 0.01) significantly reduced the risk of mortality.

Conclusion
Our study shows that on the total of deaths with a positive COVID-19 test, 59% were caused by the infection while the remaining 41% occurred from other causes. Age, CCI, the presence of peripheral vascular disease and the need for CRRT are independent risk factors for mortality. Vaccination was confirmed as a protective factor.
#5207 CENTRAL NERVOUS SYSTEM INVOLVEMENT IN EOSINOPHILIC GRANULOMATOSIS WITH POLYANGIITIS: A DIAGNOSTIC DILEMMA
Authors: Nicolau Carla , Barata Rui , Vieira Miguel Bigotte , Pereira Tiago Assis , Góis Mário , Viana Helena , Sousa João , Ribeiro Francisco , Nolasco Fernando 
Published: June 2023

Abstract

Background
Central nervous system involvement is extremely rare in eosinophilic granulomatosis with polyangiitis, and associated with very poor prognosis. A high index of suspicion is needed to diagnose this entity and initiate prompt treatment for this life-threatening condition.

Case presentation
A 71-year-old man was admitted to our hospital with lower limb weakness, loss of vision in the left eye and diplopia for four weeks. Four months prior to admission he reported unintentional weight loss and wheezing. Laboratory studies revealed anemia, eosinophilia and high antineutrophil cytoplasmic antibodies (ANCA) anti myeloperoxidase (MPO) levels. Brain computerized tomography (CT) was normal. Although corticosteroids were started, addition of other immunosupressants was delayed due to ongoing infection. During the next three days, the patient presented with worsening kidney function and was disoriented, agitated and combative. Lumbar puncture and brain CT scan showed no acute abnormalities. Therefore, plasmapheresis was started. During the third session of plasmapheresis, the patient became drowsy and non-responsive. Brain CT scan revealed subdural hematoma with uncal herniation. Trepanation and initiation of hemodialysis were required. Kidney biopsy revealed focal proliferative glomerulonephritis with fibrocellular crescents. Magnetic resonance imaging and ophthalmological evaluation showed abnormalities compatible with vasculitic disease. Cyclophosphamide was added to prednisolone, with renal and extra renal manifestations improvement. One year later, the patient is autonomous, with right hand paresis, stable kidney function (serum creatinine 2.5 mg/dL) and negative ANCA MPO serology.

Conclusion
Neurological involvement in GEPA is heterogeneous and requires differential diagnosis with central nervous system infections, adverse effects of corticosteroids and complication of plasmapheresis. The diagnosis is challenging and demands a high level of suspicion. Otherwise, it may lead to delayed, erroneous diagnosis and worse survival.
#5227 KIDNEY FAILURE RISK EQUATION (KFRE) VS GRAMS SCORE, WHICH ONE PREDICTS BETTER THE INITIATION OF RENAL REPLACEMENT THERAPY?
Authors: Collado Alba Temprado , Blandino Marisa Vidal , Cosano Gema Montilla , Gómez Cristina Andrades , Lopez-Mendoza Manuel , Prieto Francisco Javier Toro 
Published: June 2023

Abstract

Background and Aims
In patients with Advanced Chronic Kidney Disease (ACKD) stage G4 it is necessary to use prognostic tools to predict the need for Kidney Replacement Therapy (KRT), especially in elderly patients, the most used is the Kidney Failure Risk Equation (KFRE). The Grams Score (GS) predicts the risk of KRT, cardiovascular events and mortality, providing better prediction for the choice of KRT modality but requires more parameters in its equation. Ours objective was compare both KFRE and GS prognostic equations to validate which one better predicts the onset of KRT.

Method
Descriptive, retrospective study of a cohort of patients older than 65 years with G4 CKD attending for the first time in 2016–2017. Follow-up for 5 years or first clinical event defined as need for KRT (including Conservative Renal Treatment with GFR = &lt;8 ml/min/1.72m2) or death. Variables needed to calculate KFRE and GS were collected, as well as events occurred.

Results
271 patients who met the inclusion criteria were analyzed. The clinical characteristics are shown in Table 1. The Grams model showed good discrimination for initiating KRT at 2 and 4 years, AUC 0.84 [95%CI 0.77-0.91] and AUC 0.81 [95%CI 0.75-0.87], respectively. The ROC curves presented by both equations showed good discrimination, AUC 0.82 [95%CI 0.74-0.91] and AUC 0.80 [95%CI 0.74-0.87].When comparing the need for 2-year KRT with both equations, we observed both ROC curves were similar (p = 0.356). Table 2 shows results from logistic regression analysis. For the 2-year KRT event by Grams, patients with a score &gt; = 17.85% were 11.53 [95%CI 5.16-27.78] times more likely to initiate KRT. However, compared to KFRE with a score &gt; = 20.77%, they had 17.53 [95%CI 7.59-40.47] times higher probability of KRT (both p&lt;0.001). When we compared both equations in multivariate analysis only the KFRE was significant (ODR 0.217 (95%CI 0.87-0.54).

Conclusion
In our population, both prognostic equations showed good discrimination to program initiation of KRT. However, the GS could underestimate this need while the KFRE seems to discriminate it better.
#5285 SERUM IRON AND NUTRITIONAL STATUS ARE ASSOCIATED IN PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Lin Ting-Yun , Hung Szu-Chun 
Published: June 2023

Abstract

Background and Aims
Both anemia and malnutrition are highly prevalent in patients with chronic kidney disease (CKD). Iron deficiency plays a significant role in anemia of CKD. However, whether iron deficiency contributes to malnutrition in CKD is unclear.

Method
We examined the association of iron status with nutritional status among patients with CKD stages 3–5 not yet on dialysis. The iron indices for assessing iron status included serum iron, serum ferritin, and transferrin saturation. Nutritional status was determined using body composition assessed by anthropometric measures and multi-frequency bioelectrical impedance, serum albumin, handgrip strength, Malnutrition Inflammation Score (MIS), and dietary protein and energy intake. We performed linear regression analyses to explore the cross-sectional association between iron status and different nutritional assessment tools.

Results
A total of 157 patients (age 64 ± 12 years; 93 men and 64 women; diabetes 39%) with CKD [estimated glomerular filtration rate (eGFR) 24.4 ± 13.4 ml/min/1.73 m2] were included. Patients were stratified as low (&lt;70 μg/dL) or high (≥70 μg/dL) serum iron. Compared with patients with high serum iron (n = 104), patients with low serum iron (n = 53) were more likely to be female and had a significantly lower eGFR, hemoglobin, lean tissue index, serum albumin, handgrip strength, and dietary protein intake but a significantly higher MIS. In adjusted linear regression analyses, there was a significant association of serum iron with serum albumin, handgrip strength, and MIS (all adjusted P &lt; 0.05). Serum ferritin was not associated with nutritional status, while the association between transferrin saturation and handgrip strength was only marginal (adjusted P = 0.044).

Conclusion
Higher serum iron is associated with better nutritional status in patients with CKD. Serum iron may be considered a complementary tool to assess nutritional status in CKD.
#5330 CYCLIN D1 AMELIORATES ISCHEMIA/REPERFUSION-INDUCED ACUTE KIDNEY INJURY
Authors: Huang Yuliang , Chen Junzhe , Shao Xiaofei , LI Jinxiang , Tang Ying 
Published: June 2023

Abstract

Background and Aims
Acute kidney injury (AKI) is a life-threatening condition. The absence of oxygen during the acute ischemic phase would disturb energy metabolism and cause kidney tubular epithelial cell damage. Fatty Acid Oxidation (FAO) is the main source of energy production of renal proximal tubular epithelial cells. Timely promoting FAO, increasing supplies of energy, and promoting cell proliferation are essential to improve kidney injury, but there is no clinically recognized effective treatment for this. Cyclin D1(CCND1), a member of the cell cycle family, plays a vital role in cell proliferation. Our previous study found that CCND1 improved AKI accompanied with increased fatty acid oxidation. Therefore, we investigated the role and molecular basis for CCND1 involvement in fatty acid oxidation of AKI.

Method
CCND1 was evaluated in AKI in human kidney proximal tubular epithelial cells (HK-2 cells) and male C57BL/6J mice (wild type). The protective role of CCND1 in AKI was investigated in a mouse model of ischemia-reperfusion AKI treated by ultrasound-microbubble-mediated kidney-specifically transferring CCND1-expressing plasmids in male C57BL/6J mice (wild type). Eight-week-old male C57BL/6J mice (wild type) were subjected to bilateral renal artery occlusion for 30min followed by 24h of reperfusion. We evaluated FAO, proliferation, and autophagy in vitro and in vivo. In addition, we evaluated the concentrations of blood urea nitrogen and creatinine, evaluated kidney ultrastructure and so on.

Results
In vivo studies had shown that activation of CCND1 can prevent AKI-induced lipid accumulation, kidney tubule injury and kidney function declined after ischemia-reperfusion injury. Compared to test control, the treatment significantly (p&lt;0.05) lowered the concentrations of blood urea nitrogen and creatinine. Kidney specific overexpression of CCND1 promoted FAO, promoted proliferation and reduced apoptosis. Mechanistically, CCND1 activated the AMPK pathway, which increased the expression of phosphorylation AMP activated protein kinase (p-AMPK) and upregulated FAO. On the contrary, inhibiting the expression of CCND1 exacerbated impairment of FAO and disturbed energy metabolism.

Conclusion
Thus, CCND1 improved FAO and reduced lipid accumulation via active AMPK pathway in kidney proximal tubular epithelial cells (PTECs). Hence, reconstruction of the expression of CCND1 may be a novel therapeutic strategy for treating AKI.