bluuebunny/crossref_metadata_2025_split huggingface dataset:
#3629 EFFECTS OF METFORMIN IN KIDNEY TRANSPLANT RECIPIENTS TAKING TACROLIMUS WITH POST-TRANSPLANTATION DIABETES MELLITUS
Authors: Jung Jiyun , Lee Jaeyun , Park Jae Yoon , Kim Hyosang 
Published: June 2023

Abstract

Background and Aims
Tacrolimus is a pivotal maintenance immunosuppressive drug in kidney transplantation (KT). Although diabetogenic property of tacrolimus is still an inevitable concern, it can reduce the risk of acute rejection and improve graft survival compared to cyclosporine. Metformin, despite limited randomized controlled trial, has been found to be safe and effective in patients with post-transplantation diabetes mellitus (PTDM). We aimed to investigate the effect of metformin on acute rejection and graft survival in kidney transplant recipients taking tacrolimus.

Method
442 PTDM patients who were prescribed tacrolimus between 2000 and 2018 were collected. We conducted propensity score matching between the metformin and non-metformin group and evaluated the effects of metformin on the occurrence of T-cell mediated rejection (TCMR) and antibody-mediated rejection (ABMR), and graft survival with Cox proportional hazard model.

Results
During the average follow up of 8.7 years, 90 patients were diagnosed as PTDM within one year after KT. Among 442 patients taking tacrolimus, 297 patients were treated with metformin for the average of 4.4 years. After 1:1 matching, cumulative incidences of TCMR (p = 0.008) and graft failure (p = 0.005) in the metformin group was lower than the non-metformin group, while no significant difference was observed in ABMR. Metformin use was associated with a reduced risk of TCMR (HR 0.43, 95% CI 0.21-0.88, p = 0.021) and graft failure (HR 0.39, 95% CI 0.19-0.79, p = 0.009). There was no significant difference in t (tubulitis), i (interstitial inflammation), and v (endarteritis) scores of TCMR between the metformin and the non-metformin group.

Conclusion
Our study demonstrates that combination therapy with metformin and tacrolimus in kidney transplant recipients with PTDM is associated with a lower risk of acute rejection and graft failure.
#3718 WHAT ARE THE MOST COMMON HEADACHE PROBLEMS IN PATIENTS RECEIVING DIALYSIS?
Authors: Khalmukhamedov Javokhir 
Published: June 2023

Abstract

Background and Aims
Analysis of the clinical features of headache in patients on the program dialysis.

Method
The study included 40 males and 40 females with CKD on program dialysis for more than 12 months in 2022, each session lasting 4 hours. The exclusion criteria were patients receiving drugs that can cause headache and with any type of primary headache not associated with the HD procedure, diabetes mellitus, and others. Patients with DH were further compared with patients without DH in terms of BP and blood values such as urea, creatinine, Na+, K+.

Results
45% (n = 36) reported DH, which was common in women 60%. Differences between pre- and post-dialysis urea values in patients with DH were statistically significant (p&lt;0.05). Patients with DH showed significantly higher mean SBP and DBP values before dialysis compared with patients without DH (systolic, P&lt;0.001; diastolic, P&lt;0.01). 80% of patients (n = 64) reported the quality of their headaches as being throbbing, whereas (20%, n = 6) had headaches with dull character. Headache intensity was moderate in 73% (n = 58) and severe in 27% (n = 22). The headache duration was reported to last less than 4 hours in 63% (n = 50) and 4 to 36 hours in 37% (n = 30), Table 2.

Conclusion
We determined that DH is a common type of headache among HD patients, female predominance, begins after several hours of therapy, with progressive intensity and throbbing character, which is not associated with a coexisting primary headache, but may be related to differences in urea levels and BP before and after treatment.
#3754 GLUCAGON-LIKE PEPTIDE TYPE 1 (AGLP1) AGONISTS AND THEIR INITIATION IN KIDNEY TRANSPLANTATION
Authors: López Rómulo Katsu Loayza , Morales Nancy Daniela Valencia , Rincón María Muñiz , Meneses Arianne Aiffil , Cubillo Beatriz Rodríguez , Díaz María Ángeles Moreno de la Higuera , Romero Natividad Calvo , Pérez-Flores Isabel , Fructuoso Ana Sanchez 
Published: June 2023

Abstract

Background and Aims
Glucagon-like peptide type 1 agonists (aGLP1) is an important therapy to consider for patients with type 2 diabetes (DM2), especially those with chronic disease with glomerular filtration rates (GFR) up to 15ml/min. They stimulate the production and secretion of insulin from pancreatic β cells, delay gastric emptying, promote weight loss, reduce appetite by acting on the central nervous system, and decrease glucagon secretion from pancreatic α cells.

OUTCOMES
To assess the serum, urinary and clinical effects of treatment with aGLP1 in kidney transplant (KT) patients.

Method
This is a retrospective observational study of 32 KT patients from our center who met criteria for treatment with aGLP1. In the sample, serum and urinary data are compared, six months before, after and at the time of intervention. The management of DM was evaluated with glycosylated hemoglobin (HbA1C) and basal glycemia levels, before and after the start of treatment. Changes in cardiovascular risk are studied with the number of heart failure episodes, hospital admissions, and changes in the left ventricular ejection fraction. In addition, other parameters such as: hemoglobin (Hb), iron, ferritin, calcium, phosphorus, magnesium, potassium, uric acid, proteinuria and clinical data such as body weight were assessed.

Results
The sample presented a mean GFR by CKD EPI of 43.2ml/min. A significant drop in body weight was observed, from 93.3kg to 89.2kg (p = 0.001). Regarding the control of DM, no statistically significant results were obtained, a decrease in glycemia figures from 136 to 133 g/dl and HbA1C was obtained, with a reduction of 2.7%, p = 0.404 and p = 0.105, respectively. Regarding the progression of kidney disease, a decrease in proteinuria from 0.33g/day to 0.25 g/day was obtained, as well as a 9.5% protein/creatinine ratio, p = 0.480 and p = 0.721, respectively. Serum creatinine levels unchanged, with a mean of 1.6 mg/dl.

Conclusion
The aGLP-1 are a valuable treatment option for initiation in KT patients with DM2, having significant efficacy in weight loss. More studies with large samples are required to assess its safety in this population highly affected by DM2 and with borderline GFR.
#3756 HISTOLOGICAL SUBTYPING OF INTERSTITIAL INFILTRATES AND CORRELATION WITH RENAL PROGNOSIS IN ANCA-ASSOCIATED GLOMERULONEPHRITIS
Authors: Chalkia Aglaia , Koutsianas Christos , Gakiopoulou Harikleia , Giannou Panagiota , Panagiotopoulos Alexandros , Kapota Athanasia , Thomas Konstantinos , Vasilopoulos Dimitrios , Petras Dimitrios 
Published: June 2023

Abstract

Background and Aims
Interstitial inflammatory infiltrates in ANCA associated glomerulonephritis (AAGN) are frequently observed but their correlation to clinicopathological parameters remains elusive.

Method
Retrospective study of 40 patients with newly diagnosed AAGN. Histological assessments using the presence of interstitial inflammatory cells were performed. Biopsy tissues were investigated by CD3, CD20, CD4, CD8, CD68+ (PG-M1), CD138 immunohistochemical staining. We assessed the presence of inflammatory cells in terms of clinical, histopathological parameters as well as the renal prognosis in a large follow-up period [47.87 months (12-216)].

Results
The interstitial infiltrates were consisted of lymphocytes (CD3 T cell&gt; CD 20 B cell) at 83%, followed by plasma cells at 43%, neutrophils at 43%, macrophages at 40% and eosinophils at 20% of the biopsies. CD8 T cells dominated the interstitial area in focal and sclerotic class, while CD8 and CD4 tended to have different expression patterns in the interstitial area (figures 1,2). Interestingly, we reported that the presence of macrophages was correlated with higher chronicity index [interstitial fibrosis (39% vs 24%, p = 0.015) and creatinine at diagnosis (4.4 vs 2.6 mg/dL, p = 0.01)], while the presence of neutrophils, lymphocytes and eosinophils was correlated with higher activity index [cellular crescents (37% vs 6%, p&lt;0.001, 26% vs 9%, p = 0.021, 49% vs 24%, p = 0.021, respectively)]. In terms of short-term renal prognosis, only the macrophages were correlated with worst renal function at the 1st year (Cre 3.2 vs 1.8 mg/dL, p = 0.042). Regarding the long-term renal prognosis, we validated as the most reliably predictive score, amongst Berden classification and Mayo Clinic chronicity score, the ANCA renal risk score (AUC 0.694, p = 0.05) and we found that the low-risk group tended to present less severe inflammation (p = 0.029), while the presence of macrophages and eosinophils was less often present (p = 0.03 and 0.05, respectively) compared to the higher risk groups.

Conclusion
Identifying the differences in histopathological subtypes, in yet underestimated active tubulointerstitial lesions, could be the first step toward improving our understanding of distinct pathophysiological mechanisms and anticipating to specific treatment regimens.
#3792 COVID-19 INFECTION AMONG HAEMODIALYSIS PATIENTS - EXPERIENCE FROM A HONG KONG COHORT
Authors: Chan Zi , Chan Ka Lok , Lam Chi Kwan , Law Way Ping , Pak Wai Lun Will , Wong Yick Hei , Wong Sunny Sze-Ho 
Published: June 2023

Abstract

Background and Aims
Many haemodialysis patients were infected by COVID-19 during a severe wave of outbreak due to the Omicron variant in Hong Kong in 2022, which had a great impact on the hospital haemodialysis service. To better prepare for future outbreaks, the patient characteristics and outcomes were examined in this study.

Method
This was a retrospective cohort study of all haemodialysis patients infected with COVID-19 from February to April 2022 in our hospital. The infection rates of in-centre and home haemodialysis were analysed. The mortality rate and the rate of moderate to severe disease (as defined by requiring 2L of oxygen or above) were recorded. Factors affecting mortality and disease severity were analysed using Fisher's exact test and independent t test.

Results
There were ninety-nine haemodialysis patients infected with COVID-19 during the study period (Table 1). The infection rate of in-centre haemodialysis patients was 98/232 (42.2%) compared with 1/19 (5.3%) of home haemodialysis patients. The mortality rate was 7.1%, and the rate of moderate to severe disease was 10.1%. A higher Charlson Comorbidity Index was identified as the only significant factor associated with mortality (6.7 ± 3.4 vs. 4.9 ± 2.0) and disease severity (6.5 ± 3.0 vs. 4.9 ± 2.0). Age, gender, presence of diabetes mellitus and vaccination status did not correlate with the outcome in this cohort.

Conclusion
Home haemodialysis had the benefit of a lower infection rate during the COVID-19 outbreak. A higher burden of comorbidities increased the risk of mortality and the severity of COVID-19. Close monitoring is warranted in these group of haemodialysis patients.
#3866 PREOPERATIVE ASSESSMENT FOR VASCULAR ACCESS: VASCULAR MAPPING AND HANDGRIP STRENGTH
Authors: Oliveira João , Da Silva Bernardo Marques , Fernandes João , Silva Hugo , Fortes Alice , Lopes José António , Gameiro Joana 
Published: June 2023

Abstract

Background and Aims
A reliable vascular access (VA) is required for patients receiving chronic hemodialysis (HD) treatment. VA choice is complex and must consider patient characteristics, predicted patency and risk of primary failure. Vascular mapping (VM) by duplex doppler ultrasonography (DUS) can aid in the planning of which VA to place. Peripheral artery disease (PAD) is associated with higher AVF failure and can be assessed by calculating the ankle-brachial index (ABI). Muscle strength is independently associated with mortality risk and can be evaluated with handgrip strength (HGS). This study aims to describe and analyze clinical anthropometric and laboratory characteristics of patients referred for vascular mapping prior to VA creation and to correlate VM data, HGS, and ABI.

Method
Prospective analysis of all adult patients with CKD who were referred for VM, at a tertiary center, between March 2021 and August 2021. No patients were excluded. Preoperative DUS by a single experienced nephrologist was carried out. HGS was measured using a Hand Dynamometer and PAD was defined as ABI&lt;0.9. According to distal vasculature size (&lt;2mm) sub-groups were analyzed.

Results
80 patients were included and 67.5% were male, mean age 65.7 ± 14.7 years and 51.3% were on Renal Replacement Therapy (RRT). Twelve (15%) participants had PAD. HGS was higher in dominant arm (20.5 ± 12.0 kg vs 18.8 ± 11.2 kg). Fifty-eight (72.5%) patients had vessels smaller than 2 mm in diameter. There were no significant differences between groups concerning demographic and comorbidities (diabetes, PAD). HGS was significantly higher in patients who had vessels greater than or equal to 2 mm in diameter (26.1 ± 15.5 kg vs 18.4 ± 9.7 kg, p = 0.010).

Conclusion
Greater HGS was associated with more developed distal vessels. Low HGS might be an indirect sign of poor vascular characteristics, which might help predict the outcomes of VA creation and maturation.
#3875 ASSESSING THE 3-YEAR RISK OF 40% EGFR DECLINE OR KIDNEY FAILURE IN THE US POPULATION
Authors: Tio Maria Clarissa , Zhu Xiaoqian , Obi Yoshitsugu , Yen Timothy Edmund , Hall Michael , Dossabhoy Neville , Shafi Tariq 
Published: June 2023

Abstract

Background and Aims
Prognostication of CKD progression currently relies exclusively on eGFR and albuminuria and do not consider comorbid conditions. Recently, the Chronic Kidney Disease Prognosis Consortium (CKD-PC) equation was developed to predict the 3-year risk of 40% eGFR decline or kidney failure in the general population [1]. The goal of our study was to assess the distribution of this risk in the US population.

Method
We included US adults from the 1999-2020 United States National Health and Nutrition Examination Survey (NHANES; N = 51,699). We calculated eGFR using the CKD-EPI 2021 equation and the 3-year risk of 40% eGFR decline or kidney failure using the CKD-PC equation (3-year risk). We categorized the 3-year risk as &lt;1%, 1%-&lt;5%, 5%-&lt;10%, ≥10% and compared this with the current KDIGO 2012 CKD staging (eGFR&lt;60 mL/min/1.73 m2 or albuminuria≥30 mg/g).

Results
Among 199.8 million US adults, mean age was 46±15 years, 51% were female, 11% were non-Hispanic Black persons, and mean BMI was 29±6 kg/m2. 71 million (36%) had hypertension and 26 million (13%) had diabetes. Table 1 shows the distribution of 3-year risk across stages of eGFR and albuminuria. Among 26 million US adults with CKD, the 3-year risks were &lt;1% in 4 million (15%), 1% to &lt;5% in 15 million (56%), 5 to &lt;10% in 4 million (17%), and ≥10% in 3 million (11%). Importantly, among persons without CKD by current criteria, 1 million persons (0.58%) had a ≥5% 3-year risk, whereas only 331,840 (6%) persons with CKD 3a A1 had a ≥5% 3-year risk of CKD progression or kidney failure.

Conclusion
Calculating the 3-year risk of a 40% decline in eGFR or kidney failure can identify at-risk persons beyond the current eGFR and albuminuria staging. Our findings highlight the importance of factors besides eGFR and albuminuria in considering the risk for CKD progression.
#3939 EFFECTIVENESS OF IMATINIB FOR MCTO NEPHROPATHY
Authors: Usui Toshiaki , Morito Naoki , Ishibashi Shun , Gogoleva Natalia , Kanai Maho , Inoue Yuri , Fuseya Sayaka , Kuno Akihiro , Mizuno Seiya , Hamada Michito , Takahashi Satoru , Yamagata Kunihiro 
Published: June 2023

Abstract

Background and Aims
MAFB is a podocyte-specific transcription factor. Point mutations in the MAFB transactivation domain in humans result in multicentric carpometacarpal-tarsal osteolysis (MCTO). MCTO patients show focal segmental glomerulosclerosis (FSGS) due to podocyte damage, known as MCTO nephropathy. Effective treatment for MCTO has not been found. Imatinib is a tyrosine kinase inhibitor (TKI), which inhibits PI3K-Akt pathway, and is in long-term use for the treatment of chronic myeloid leukemia.

Method
In order to develop a new treatment for MCTO, we generated disease model mice using the CRISPR-Cas9 system. These animals have the same genetic mutation as human MCTO patients. Albuminuria was evaluated at 4 weeks of age, and renal histological analysis was performed at 26 weeks of age. In addition, RNA-seq for isolated glomeruli of 10-week-old MCTO mice and wild-type animal was performed for genetic and pathway analysis.

Results
MCTO mice exhibited growth retardation, and presented albuminuria from 4 weeks of age. Foot process effacement and FSGS-like renal histological changes were shown. Nephropathy symptoms were similar to that of human MCTO patients. Interestingly, the upregulated genes in RNA-seq analysis were a group of receptor genes associated with PI3K-Akt signaling, including lpar1 and csfr1.Transesophageal administration of imatinib, a PI3K-Akt pathway inhibitor, treatment for 5 consecutive weeks decreased albuminuria and ameliorated histological renal damage. RNA-seq of isolated glomeruli of MCTO mice after imatinib treatment showed decreased expression of genes associated with TGFβ-related signaling pathways compared to the non-treated group. Recently, enhanced PI3K-Akt signaling in podocytes has been linked to several renal diseases associated with podocyte injury. In addition, lpar1 inhibition in glomeruli is known to suppress TGFβ. Imatinib suppressed PI3K-Akt signaling, which is enhanced in podocytes of MCTO mice. This may have shown a podocyte-protective effect by suppressing fibrosis-related genes such as TGFβ. Imatinib is classified as a TKI, but frequency of podocyte toxicity is lower than other TKIs.

Conclusion
The podocyte injury mechanism of MCTO nephropathy is associated with enhanced PI3K-Akt signaling in podocytes. Imatinib inhibits this pathway and suppresses TGFβ. Imatinib may become a therapeutic agent for MCTO nephropathy.
#3959 ASSOCIATION BETWEEN AMORPHOUS CALCIUM-PHOSPHATE RATIOS IN CIRCULATING CALCIPROTEIN PARTICLES AND PROGNOSTIC BIOMARKERS IN HEMODIALYSIS PATIENTS
Authors: Nakamura Kimihiko , Isoyama Naohito , Shiraishi Koji , Kuro-O Makoto 
Published: June 2023

Abstract

Background and Aims
Calciprotein particles (CPPs) are circulating colloidal mineral-protein complexes containing crystalline and/or non-crystalline (amorphous) calcium-phosphate (CaPi). Serum CPP levels correlate with vascular stiffness and calcification in patients with chronic kidney disease (CKD). In vitro studies showed that CPPs containing crystalline CaPi were more arteriosclerogenic and inflammogenic than CPPs without containing crystalline CaPi. Thus, we hypothesized that not only the quantity but also the quality of CPPs (the phase of CaPi) might affect clinical outcomes.

Method
To test this hypothesis, we quantified amorphous CaPi ratio defined as the ratio of the amorphous CaPi amount to the total CaPi amount in serum CPPs from 183 hemodialysis patients and explored its possible correlation with serum parameters associated with prognosis of hemodialysis patients.

Results
Multivariate analysis revealed that the amorphous CaPi ratio correlated positively with hemoglobin and negatively with fibroblast growth factor-21 (FGF21), which remained significant after adjusting for the total CaPi amount. Because, low hemoglobin and high FGF21 were associated with increased mortality. Patients with low amorphous CaPi rate tended to have lower 2-year survival rates (p = 0.07).

Conclusion
This study suggests that low amorphous CaPi ratio in circulating CPPs is associated with poor prognosis in hemodialysis patients. Further investigation of the association with prognosis is warranted.
#4006 ADDING 6-MONTH PARAMETERS FOR THE PREDICTION OF RENAL PROGNOSIS IN ANCA-ASSOCIATED GLOMERULONEPHRITIS
Authors: Boud'hors Charlotte , Riou Jérémie , Fage Nicolas , Samoreau Clément , Desouche Alice , Gatault Philippe , Bridoux Frank , Martin Cécile , Wacrenier Samuel , Vinatier Emeline , Djema Assia , Henry Nicolas , Croué Anne , Piccoli Giorgina Barbara , Copin Marie-Christine , Augusto Jean-François , Brilland Benoit 
Published: June 2023

Abstract

Background and Aims
Antineutrophil-cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) with kidney involvement (AAV-GN) frequently evolves to end-stage kidney disease (ESKD) despite aggressive immunosuppressive treatment. Several risk scores have been used to assess renal prognosis. We aimed to determine whether kidney function and markers of AAV-GN activity after 6 months could improve the prediction of ESKD.

Method
This retrospective and observational study included adult patients with AAV-GN recruited from 6 French nephrology centers (including from the Maine-Anjou AAV registry). The primary outcome was kidney survival. Analyses were conducted in the whole population and in a sub-population that did not develop ESKD early in the course of the disease.

Results
241 patients were included in the whole cohort, with a median follow-up of 59 months. At diagnosis, Berden classification and Renal Risk Score (RRS) were not found better than kidney function (eGFR) alone, at predicting ESKD (C-index = 0.70, 0.79, 0.82, respectively). At 6 months, 20 patients reached ESKD. In the sub-population of 221 patients, 6 months eGFR outperformed Berden classification and RRS (C-index = 0.88, 0.62, 0.69, respectively) to predict ESKD. RRS performed better when it was updated with the eGFR at 6 months instead of the baseline eGFR. While 6-months proteinuria was associated with ESKD and improved ESKD prediction, hematuria and serological remission did not.

Conclusion
This work suggests the interest of the reassessment of the renal prognosis 6 months after AAV-GN diagnosis. Kidney function at this time remains the most reliable for predicting renal outcome. To improve the long-term prediction of ESKD, there may be a place for repeated kidney biopsy following induction treatment, in order to obtain a precise evaluation of disease activity, discuss the immunosuppressive treatment strategy and improve prognosis scores.