bluuebunny/crossref_metadata_2025_split huggingface dataset:
#3647 RELATIONSHIP BETWEEN MONOCYTE-LYMPHOCYTE RATIO AND RENAL OUTCOMES IN PATIENTS WITH TYPE 2 DIABETES
Authors: Gu Yue , Ren Yingying , Zhou Jing 
Published: June 2023

Abstract

Background and Aims
Acute kidney injury (AKI) is a common complication of hospitalized adults with increased risk of chronic kidney disease and end-stage kidney disease. Sepsis is the most common reason of AKI in patients admitted in intensive care unit(ICU) with the incidence over 50%. Soluble urokinase-type plasminogen activator receptor (suPAR) is an important immune mediator involved in kidney injury. Numerous studies have shown that the suPAR is associated with a variety of kidney diseases.However, it remains unknown on the diagnosis and prognosis value of suPAR in sepsis-associated acute kidney injury (S-AKI). Hence,this study aimed to explore the diagnostic value for the prediction of S-AKI courses and 28-day death.

Method
In this prospective study, adult patients with sepsis admitted to the ICU of Henan people's Hospital from December 2020 to February 2022 were enrolled. Plasma suPAR levels at 0, 12,24 and 48 hours after admission to ICU were measured by enzyme-linked immunosorbent assay. We assessed the development of S-AKI as the primary outcome and the occurrence of death within 28 days in patients who had S-AKI as a secondary outcome. The prediction of the suPAR level on S-AKI and death was tested using receiver operating characteristic curve (ROC) analysis, by calculating the area under the curve (AUC), and 95% confidence interval (CI).

Results
Of the 182 sepsis patients, 66 (36.3%) developed AKI during hospitalization, of whom 31 (46.9%) died. At 12,24 and 48 hours after admission to ICU, the plasma suPAR level was significantly higher in patients with S-AKI than in patients without AKI (P&lt;0.05). (Fig. 1) In sepsis patients dead with 28 days after admission in ICU, the plasma suPAR level was significantly higher at 0 and 48 hours after admission in ICU compared to the survival patients(P&lt;0.05). (Fig. 1) Diagnostic performance of plasma suPAR level improved over time with the highest area under the receiver operating characteristic curve of 0.701 (95% CI, 0.623∼0.779) 24 hours after study inclusion. Additionally, plasma suPAR levels at 0h have the highest area under the receiver operating characteristic curve of 0.647 (95% CI, 0.512∼0.782) in predicting 28-day death. The best discrimination ability for the S-AKI was achieved for suPAR 24 hours after inclusion by applying a cutoff value of greater than or equal to 6.31 ng/ml (sensitivity 62.1, specificity 71.6). The suPAR at 0h after inclusion performed best in discriminating 28-day death by using a cutoff value of greater than or equal to 4.57 ng/mL (sensitivity 87.1, specificity 51.4).(Table 1)

Conclusion
Plasma suPAR level can be a potential biomarker for early diagnosis of S-AKI and has a certain clinical value in predicting the short-term death of S-AKI. However, further clinical studies with larger sample size is needed.
#3713 NEPHROLOGISTS’ AND PRIMARY CARE PHYSICIANS’ KNOWLEDGE ABOUT NOVEL TREATMENT OPTIONS FOR TYPE 2 DIABETES AND CKD AUGMENTED BY ONLINE MEDICAL EDUCATION
Authors: Trier Joachim , Malyszko Jolanta , Silva Rita Moreira Da 
Published: June 2023

Abstract

Background and Aims
Diabetes is the number one cause of kidney failure and chronic kidney disease (CKD) associated with type 2 diabetes (T2D) increases the risk for cardiovascular events 2 to 3- fold thus highlighting the crucial need for early detection of CKD and comprehensive vascular risk control. Recently, novel treatment options with clear benefits for the prognosis of patients with T2D and CKD have emerged. The goal of this activity for primary care physicians (PCP) and nephrologists (NEPH) was to improve their understanding of the clinical benefits as well as safety considerations of selective non-steroidal mineralocorticoid antagonists (nsMRA) in the management of their patients with T2D and CKD.

Method
Two nephrology experts joined a 20-minute online video discussion with synchronized slides. Educational effect was assessed using a repeated-pair design with pre-/post-assessment. 3 multiple choice questions assessed knowledge, 1 question rated on a Likert-type scale assessed confidence. A paired samples t-test was conducted on overall average number of correct responses and for confidence rating, a McNemar's test was conducted at the question level (5% significance level). Cohen's d with correction for paired samples estimated the effect size of the education on number of correct responses. Data collection from 8/2/22 to 10/17/22.

Results

Conclusion
Participation of PCP and NEPH in an online video expert discussion improved their understanding of the clinical benefits and safety aspects of selective nsMRA as well as their confidence in using such novel therapies for their patients with T2D and CKD in clinical practice.
#3788 PROGNOSTIC ROLE OF THE NEUTROPHIL-TO-LYMPHOCYTE RATIO IN PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Bae Eun Hui , Kim Jin , Kim Su In , Cho Da Hae , Lim Sang Yoeb , MA Seong Kwon , Kim Soo Wan , Choi Hong Sang 
Published: June 2023

Abstract

Background and Aims
The neutrophil-to-lymphocyte ratio (NLR) has been demonstrated to have prognostic value in cardiovascular disease, infection, inflammatory disease, and several types of cancer. Therefore, it is expected that NLR has predictive value in patients with chronic kidney disease (CKD) but it has not been validated. Here, I aimed to investigate the possibility of NLR as a predictor of progression of CKD.

Method
This retrospective observational study included 141 patients with non-dialysis CKD. Subjects were divided into terciles (T1, T2, and T3) according to NLR. The primary outcome of interest was defined as a composite renal event, which included a decline in the estimated glomerular filtration rate (eGFR) of at least 50% or onset of end-stage renal disease (ESRD) during the follow-up period.

Results
The median follow-up duration was 5.45 ± 2.11 years. The median NLR for each group was 1.35 ± 0.05 in T1 (n=47), 2.16 ± 0.04 in T2 (n=47) and 4.29 ± 0.73 in T3 (n=47). The group with the highest NLR (T3) had higher baseline CKD and serum creatinine and lower eGFR levels than the group with the lowest NLR (T1). The cumulative incidence of composite renal events was significantly increased in T3, compared to T1 (p &lt; 0.001, log-rank test). Cox regression analysis revealed that high NLR was independently associated with the risk of composite renal events (adjusted hazard ratio 2.85, 95% confidence interval 1.18-6.93).

Conclusion
A higher NLR reflects the more advanced stage of CKD and suggests that a role for NLR as a biomarker for predicting CKD progression.
#3853 THE EFFECT OF PERITONEAL CAVITY FLUSHING ON ACID BASE BALANCE OF PERITONEAL DIALYSIS PATIENTS
Authors: Theodoridis Marios , Panagoutsos Stylianos , Margaritis Nikos , Dimitrakopoulos Charalampos , Bounta Triantafyllia , Mourvati Efthimia , Charitaki Evaggelia , Kantartzi Konstantia , Thodis Elias 
Published: June 2023

Abstract

Background and Aims
Flushing peritoneal cavity with dialysis fluid with short time dwells it is a necessity in some cases for peritoneal dialysis patients. Such cases are overhydration with pulmonary congestion or peritonitis before the initiation of antibiotic treatment as an effort to reduce pain. The aim of this study was to investigate the effect of frequent exchanges with peritoneal dialysis (PD) fluid with bicarbonate as a buffer on acid base balance of peritoneal dialysis patients.

Method
This is a single center cohort study of 18 stable PD patients (m=10.f=8). Their median age was 57 (47, 71) years, their median PD duration was 33 (16, 89) months and they all fulfill the criteria for achieving adequacy targets [median Kt/V 2.17 (1.99, 3.3)] with good nutrition markers [ median albumin levels 3.9 (3.6, 4) gr/dl]. A sample of arterial blood gas (ABG) was taken from the patients before the procedure and after full drainage of the peritoneal cavity . The procedure included 4 times flushing of 1000 ml of dialysis fluid remaining for15 minutes In the peritoneal cavity each time . At the end of the procedure a new blood sample for ABG was taken. We used PD solution with bicarbonate as a buffer (34 mmol/Lt). We estimated the alterations of pH, of bicarbonate (HCO3-), of pCO2, of Base Excess(ΒΕ), of ionized calcium (iCa++) and lactate (Lac)

Results
Using the non parametric related samples Wilcoxon signed method we found a statistically significant increase in arterial HCO3- concentration between the values before and after the procedure [HCO3-before:25.4 (22, 28), HCO3after:26.5 (24, 29) mEq/lt-P = .023]. Likewise there was a statistically significant increase in BE with median values before the procedure 1 (-1.2,2.9) and after the flushing 2 (-0.6,3,8), P = .018. Even though there was a statistically significant increase in the bases expression of the acid base balance of the patients there wasn't any statistically significant alterations in pH levels- i.e. Alkalemia (pHbefore=7.41,pHafter=7.42 – P = .35) or pCO2 levels i.e. Compensatory Respiratory Acidosis (pCO2προ=40, pCO2μετα=40 – P = .179) nor to the levels of ionized calcium

Conclusion
Flushing of peritoneal cavity using peritoneal dialysis solution with bicarbonate as a buffer is safe and in this study was not correlated with the development of metabolic alkalosis
#3947 COMPARISON OF CT SCAN AND BIOIMPEDANCE SPECTROSCOPY FOR FAT FREE MASS MEASUREMENTS IN PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Visser Wesley , de Geus Manon , van Ruijven Isabel , van Egmond Anneke , Venrooij Lucie , Minnee Robert , Moeskops Pim , Oei Edwin , Dam Manouk , Severs David 
Published: June 2023

Abstract

Background and Aims
Malnutrition and sarcopenia are highly prevalent in patients with chronic kidney disease (CKD). Since body mass index and body weight do not reflect body composition, measuring fat free mass (FFM) is essential. Bio-impedance spectroscopy (BIS) is frequently used for monitoring body composition in patients with CKD. Unfortunately, BIS derived lean tissue mass (LTMBIS) is not suitable for comparison with the Global Leadership Initiative on Malnutrition (GLIM) cut-off values for the diagnosis of malnutrition, or for calculating dietary protein requirements. Hypothetically, FFM could be derived from BIS data (FFMBIS). This study aims to compare FFMBIS and LTMBIS with computed tomography (CT) scan derived FFM (FFMCT). Secondarily, we aimed to explore the impact of using different methods on calculated daily protein requirements.

Method
CT scans of 60 patients with CKD stage 4-5 were analyzed at third lumbar vertebra (L3) level for muscle cross-sectional area, which was converted to FFMCT. Spearman rank correlation coefficient and 95% limits of agreement (LoA) were calculated to compare FFMBIS and LTMBIS with FFMCT. Dietary protein requirements were determined based on FFMCT, FFMBIS, and adjusted body weight. Deviations over 10% from FFMCT were considered clinically relevant.

Results
FFMCT correlated strongest with FFMBIS (r=0.78, p&lt;0.001), in males (r=0.72, p&lt;0.001), and in females (r=0.60, p&lt;0.001). A mean difference of -0.54 kg was found between FFMBIS and FFMCT (LoA: -14.88 to 13.7 kg, p=0.544). Between LTMBIS and FFMCT a mean difference of -12.2 kg was apparent (LoA: -28.7 to 4.2 kg, p&lt;0.001). Compared with FFMCT, the highest occurrence of accurate predicted protein requirements was found for FFMBIS. Mean difference between protein requirements according to FFMBIS and FFMCT was -0.7 ± 9.9 grams in males and -0.9 ± 10.9 grams in females.

Conclusion
FFMBIS seems a valid surrogate measure for the estimation of FFM as compared to FFMCT. As expected, large clinically relevant differences were observed in calculated protein requirements when comparing multiple methods, with FFMBIS having the best accuracy compared to FFMCT.
#4022 RETROSPECTIVE ANALYSIS OF SPECTRUM OF INFECTIONS AND ANTIBIOTIC RESISTANCE PATTERN IN HEMODIALYSIS PATIENTS IN A TERTIARY CARE CENTRE IN NORTH INDIA
Authors: Chhakchhuak Malsawmkima , Bajpai Nitin Kumar , Chaturvedy Manish , Agarwal Jony , Tak Vibhor 
Published: June 2023

Abstract

Background and Aims
Hemodialysis patients are at risk of infections due to various factors. Antibiotic resistance is an ever-changing issue. Initial empirical therapy depends on local epidemiology of infection, and antibiotic resistance pattern. Non-access related infections received lesser research attention worldwide. This study examines the spectrum of infections, and antibiotic resistance pattern.

Method
We retrospectively reviewed the records of 586 hemodialysis patients from May 2018 to April 2020 in a tertiary care hospital in North India.

Results
The study identified 99 episodes of confirmed infections. Urinary tract infections were the most common type of infections (55.5%), followed by Catheter-related blood stream infections (CRBSI) (definitive 21.2%). Other infections were pneumonia (8.1%), tuberculosis (6.1%), skin and soft tissue infection (4.0%), dengue fever in (3.03%) and empyema thoracis (1.0%). Overall, Escherichia coli (33.3%) was the most common organism isolated. The most frequent uropathogens recovered were Escherichia coli (54%). In confirmed CRBSI, P. aeruginosa (23.8%) and MSSA (23.8%) were the most common pathogen isolated. K. pneumonia (37.5%) was the most common pathogen in pneumonia. Uropathogens showed highest resistance to fluoroquinolones (93.3-100%). Pathogens isolated in CRBSI shown maximum resistance to ciprofloxacin (100%). In pneumonia, highest resistance was seen to third generation cephalosporins (75-100%).

Conclusion
Though bacterial spectrum remains the same over time, antibiotic resistance is changing in uropathogens. There is a trend of predominance of gram-negative bacterial infections in CRBSI. Tuberculosis incidence rate was much higher than the general population. There is a need for nationwide and worldwide continuous surveillance.
#4041 THE INTERSTITIAL TUBULAR INJURY IN THE COURSE OF LUPUS NEPHRITIS
Authors: Mariem Najjar , Dridi Rania , Braiek Hana Ben , Kaaroud Hayet , Hamida Fethi Ben , Harzallah Amel , Abderrahim Ezzeddine 
Published: June 2023

Abstract

Background and Aims
Tubulo-interstitial involvement in lupus nephritis (LN) refers to the presence of interstitial fibrosis and tubular atrophy (IFTA) in the renal biopsies of patients with lupus. The impact of these features on patient outcomes has not been fully established. The aim of this study was to determine the correlation between IFTA and patient outcomes in LN.

Method
A retrospective descriptive study was conducted on 160 patients with systemic lupus erythematosus who underwent renal biopsy between 2020 and 2022. Clinical and biological data, as well as histologic findings, were analyzed to determine the outcomes associated with IFTA in LN. Other causes of tubulointerstitial nephritis like drugs and toxins were excluded.

Results
The study population consisted of 148 females and 12 males, with a mean age of 37.2 years (ranging from 18 to 62 years) at the time of renal biopsy. Hematuria was observed in 62.5% of patients, nephrotic syndrome in 28.1%, hypertension in 24.3%, and renal failure in 17.5% with a mean proteinuria of 2.4±0.6 g/24 h. ANA was positive in a diffuse pattern in all cases, positive anti-ds-DNA,mean C3 was 29 (84-122 mg/dL), and mean C4 was 16.2 (20-40 mg/dl). Other serology C-ANCA and P-ANCA were all negative as well as negative HBV and HCV serology. However serology for Sjogren's syndrome was positive in 61 cases (41%). The histopathological study showed mild mononuclear and plasma cell infiltration of the interstitium, and tubular hyaline casts in 87% of cases. Examination of renal vessels was unremarkable in 94.5% of cases. IFTA was present in 72 patients (45%), with the most frequent glomerular involvement being LN class IV (55.5%) followed by LN class III (32.4%) with respectively (P = .09, P = .2)and was associated significantly with the anti-DNA antibody titer (P = .003). The severity of these lesions was found to be independently correlated with worsening of renal failure at 6 months follow-up (P = .02).

Conclusion
The findings of this study suggest that IFTA is a significant prognostic factor for the progression of renal failure in lupus nephritis, regardless of the class of the disease. The pathogenesis of tubulointerstitial lesions seems to be the result of circulating immune complexes specifically interacting with tubulointerstitial autoantigens.
#4179 DIFFERENCES IN PROTOCOLS FOR MEASURING GLOMERULAR FILTRATION RATE USING IOHEXOL
Authors: van Londen Marco , Bökenkamp Arend , Cavalier Etienne , Delanaye Pierre , Ebert Natalie 
Published: June 2023

Abstract

Background and Aims
When assessing kidney function, measurement of glomerular filtration rate (mGFR) using an exogenous marker such as iohexol is the gold standard. In this study, we aim to identify similarities and differences between iohexol-based mGFR protocols.

Method
Detailed data on iohexol measurement protocols were obtained using a standardized survey sent to centres in Europe and the US. It was completed by 15 participants. Data are reported as number and percentage (n, %).

Results
In the participating centres, measurements are performed after referral by a nephrologist (n=6, 40%), other specialties (n=5, 33%) or for research purposes (n=4, 27%). Most common indications for mGFR are evaluation of kidney donors (n=5, 33%), drug dosing (n=4, 27%), abnormal body composition (n=3, 20%) and transplant evaluation (n=4, 27%). Most participants perform measurements in the morning (n=10, 67%), with patients withholding caffeine (n=5, 33%), fasting (n=4, 27%) or avoiding heavy meals (n=3, 20%). Most centres use an IV iohexol dose of 5 mL 300 mg I/mL (n=10, 67 %) or a dose based on weight (n=2, 13%). The timing of sample collection is shown in Figure 1, most often a single sample per time point (n=12, 80%). Iohexol is measured by LC-MS (n=8, 53%) or LC-UV (n=7, 47%). Within-assay variability ranges between &lt;2% (n=3, 20%) and 6-8% (n=1, 7%) and the between-assay variability ranges between &lt;2% (n=2, 13%) and 6-8% (n=2, 13%). When asked about assumptions and corrections, most centres make a one-compartment assumption in their PK model (n=8, 53%), others making two-compartment (n=2, 13%) or measurement-dependent (n=1, 7%) assumptions. mGFR is standardized for body surface area according to the DuBois-formula (n=6 (40%), Haycock and Schwarz formula (n=2, 13%) or not-specified (n=7, 47%). Some participants correct their measurements for eGFR (n=9, 60 %). Most centres participate in external quality control (Equalis, n=12, 80%).

Conclusion
There is a large variation in protocols for iohexol-based mGFR, which highlights the need for a standardized mGFR protocol before widespread use in clinical routine.
#4556 IMPACT OF KIDNEY DONATION ON PREGNANCY OUTCOMES: A RETROSPECTIVE ANALYSIS
Authors: Kaul Anupma , Prasad Narayan , Bhaduaria Dharmendra 
Published: June 2023

Abstract

Background and Aims
More than 50% of living kidney donors are females with a significant proportion being in the childbearing age group. Recent data suggests risk of gestational hypertension, proteinuria and pre-eclampsia among pregnancies after kidney donation with a lower likelihood of full-term delivery.

Method
This retrospective study was conducted among females who donated kidney between (1997 - 2017) at a tertiary renal transplant centre in Northern India to assess for consequences of pregnancy outcomes among donors in terms of maternal and foetal outcomes.. Data of participants were collected using pre-tested semi structured questionnaire.

Results
925 female kidney donors (1332 pregnancies) in the pre donation group while 45 females (48 pregnancies) in the post donation period were included . Mean age of first pregnancy, weight (kg) gain, proportion of history of pre-natal check-up and history of unrelated donation was statically significant among the post -donation group . The proportion of pre-eclampsia, gestational hypertension, gestational diabetes, post-partum hemorrhage was insignificantly higher among post donation group with higher preterm birth with low birth weight babies . In Univariate analysis, Cesarean delivery, proteinuria and low birth weight &lt;2500g were significantly associated with post donation pregnancy. While Cesarean delivery (Adjusted odds ratio: 8.2, 95% CI: 4.7-14.3, P = .024) and low birth weight &lt; 2500g (Adjusted odds ratio: 6.3, 95% CI: 2.3-11.8, P = .003) were identified as an independent determinant among post donation pregnancies using multivariate analysis .

Conclusion
The study demonstrated not a large risk to maternal outcomes yet an increase risk to fetal outcomes in terms of prematurity and low birth weight among the post donation pregnancy group.
#4561 VOLUNTARY EXERCISE EXACERBATES CHRONIC KIDNEY DISEASE INDUCED BY FOLIC ACID IN MALE C57BL6J MICE
Authors: Santos Raisa Brito , Estrela Gabriel , Budu Alexandre , Arruda Adriano , Araújo Ronaldo 
Published: June 2023

Abstract

Background and Aims
Voluntary exercise is of utmost importance to avert a plethora of diseases and to ameliorate other conditions, such as neuromuscular diseases, however in some occasions, the inflammation can be exacerbated by intense physical activity. The folic acid kidney disease model is of key interest since it is non-invasive and leads to conspicuous fibrosis. Our main objective was to determine the influence of voluntary exercise on chronic kidney disease in folic acid-treated mice.

Method
Male C57/Bl6 mice were divided into 3 groups, vehicle (V), folic acid (FA), and folic acid + voluntary exercise (FA + E). The animals were kept in cages with or without voluntary wheels (sedentary or exercised groups) for 30 days, and then received a single injection of folic (240 mg/kg i.p.) in 0.3 mol/L sodium bicarbonate. The animals were euthanized after 28 days.

Results
Chronic kidney disease in the folic acid model is exacerbated by voluntary exercise. Voluntary exercise decreases the survival level in animals treated with folic acid (V- 100%, FA- 85,71%, FA+ E- 60%). On day 28 after folic acid administration the urea levels (FA vs. FA + E P= 0,003) and creatinine (V vs. FA + E p= 0,0004; FA vs. Fa+ E p= 0,0001). Renal injury marker such as KIM-1 (FA vs. FA + Ex p= 0,0131, FA vs. Fa+ E p= 0,0213) was higher in animals that went to the wheel, but NGAL showed no significant differences. Inflammation markers as IL-6 (V vs. FA + Ex p= 0,0337 FA vs. Fa+ E p= 0,0254) and TLR4 (V vs. FA + Ex p= &lt;0,0001 FA vs. Fa+ E p= &lt;0,0001) were exacerbated as well as apoptosis relation BAX/BCL2 (V vs. FA + Ex p= &lt;0,0001 FA vs. Fa+ E p= &lt;0,0001). Picrosirius red staining was used to assess tubulointerstitial fibrosis and the kidney architecture; animals from the FA+E group showed the highest destruction of kidney architecture.

Conclusion
We established that previous voluntary exercise has deleterious effects on nephrotoxic folic acid–Induced CKD.