bluuebunny/crossref_metadata_2025_split huggingface dataset:
#5742 MID-ARM CIRCUMFERENCE AS A CORRELATE TO DIFFERENT: ASPECT NEUROCOGNITIVE IMPAIRMENT IN HEMODIALYSIS PATIENTS
Authors: Samaan Emad , Ayman Basma , Shams Amira , Moslam Nada , Eltantawi Mohamed , El Khaligy Mohamed , El-Gamal Mohamed , Shamsuddin Muhammad , Ibrahim Ibtihal , Nagy Eman 
Published: June 2023

Abstract

Background and Aims
Malnutrition is associated with poor cognitive function (CI) in Hemodialysis (HD) patients. Both have multiple ways of assessment scaled from simple bedside screening tests to more sophisticated time- and cost-consuming measures. This work aims to define the best nutritive assessment measure that correlates to the degree of CI.

Method
A cross-sectional study was carried out on 116 patients in 4 different HD units from Delta Nile, Egypt. The nutritional status was examined after the dialysis session in euvolemic patients using (1) anthropometric measurements, including body mass index (BMI), mid-arm circumference (MAC), skin fold thickness (SFT), and mid-arm muscle circumference (MAMC); (2) bioelectrical impedance analysis for assessment of skeletal muscle mass (SMM), skeletal muscle index (SMI), free fat mass (FFM), body fat mass (BFM), and total body water (TBW); (3) Hand grip strength was used to assess muscle power. The assessment of cognition was made using (1) a mini-mental state examination (MMSE) for orientation, registration, attention, recall, language, and copying; (2) Saint Louis University Mental Status Exam (SLUMS) for early CI and executive functioning; (3) Arabic version of Penn Web-Based Computerized Neurocognitive Battery (WebCNP) for those who scored no CI in the previous two tests.

Results
The results of MMSE and SLUMS tests showed that 34.5% of our cohort (n = 40) had no CI, 34.5% (n = 40) had mild to moderate degrees of CI, and 31% (n = 36) had a severe form of CI. Comparing the nutritional assessment parameters between the categories of cognitive scores revealed that there were no significant differences except in significantly lower median values of MAC (P 0.01), SMI in bioelectrical impedance analysis (P0.01), and hand grip strength (P 0.002) in severe CI group than the normal to patients without CI. In correlation statistics, MAC and hand grip strength were negatively correlated to the degree of CI (r = -0.3, P 0.006 and r = -0.26, P 0.009, respectively). MAC was the only parameter correlated with attention, emotional recognition, and differentiation functioning in the forty patients with no CI who underwent computerized neurocognitive assessment. The highest reported positive correlations reported were between the MAC and response time of both emotion recognition (r = 0.57, P &lt;0.001) and differentiation (r = 0.55, P &lt;0.001).

Conclusion
Of the different parameters of nutritional state assessment, MAC, the simple bedside measurement, was the best correlate with the degree of cognitive impairment in HD patients, even in its mild primitive forms.
#5747 COVID VACCINATION RELATED GLOMERULOPATHIES AND INTERSTITIAL NEPHRITIS
Authors: Marchisio Martina , Lalloni Stefania , Morrone Marco , Rabajoli Gianluca , Careddu Andrea , Fenoglio Roberta , Sciascia Savino , Roccatello Dario 
Published: June 2023

Abstract

Introduction
To date, almost 7 billion doses of the different types of vaccine against SARS-CoV-2 have been administered worldwide. Although the severity of new cases of SARS-CoV-2 has progressively decreased, and the pressure on national health systems has declined, the development of de novo glomerular injuries has been suggested.

Methods
This study aimed to examine the patients who were hospitalized in our Unit between April 2021 and January 2023 and underwent renal biopsy for new-onset urinary abnormalities (UA) and/or renal impairment within 3 months of SARS-CoV-2 vaccination.

Results
We identified 22 patients who developed UA and/or renal insufficiency within 3 months of vaccination. Minimal change disease was the most common disease in our cohort (6 patients, 27.3%) followed by membranous nephropathy (MN; 5 patients, 22.7%), acute tubulointerstitial nephritis (TIN; 3 patients, 13.6%) and rapidly progressive IgA nephropathy (3 patients, 13.6%). The other 5 patients had a diagnosis of ANCA-associated vasculitis (2 patient), membranoproliferative glomerulonephritis (1 patient), systemic lupus erythematosus (1 patient) and tip-variant focal segmental glomerulosclerosis (1 patient), respectively. Nine out of the 22 patients (40.9%) developed acute kidney injury. Two patients with acute TIN had to start hemodialysis that was discontinued after 1 and 2 months, respectively, due to the recovery of renal function. Two of the 5 patients who had a diagnosis of MN were positive for anti-PLA2r, while all patients were negative for anti-thrombospondin. All patients underwent treatment with corticosteroids and/or immunosuppressants.

Conclusion
Although it is not possible to conclusively determine whether there is a causal relationship between SARS-CoV-2 vaccination and new-onset nephropathies, based on the appearance of UA and/or renal insufficiency shortly after vaccination, we hypothesize that the immune response to the COVID-19 vaccine may be a trigger of nephropathies. Therefore, our results highlight the need for pharmacovigilance. However, this report should not lead to vaccine hesitation during this pandemic as the benefits of vaccination strongly outweigh the potential risks.
#5761 THE ASSOCIATION OF EGFR SLOPE WITH VISUAL IMPAIRMENT, RETINAL VESSEL DENSITY, AND EYE PATHOLOGIES IN THE EYE DETERMINANTS OF COGNITION (EYEDOC) STUDY
Authors: Scheppach Johannes , Arsiwala Lubaina , Guo Xinxing , Ramulu Pradeep , Abraham Alison 
Published: June 2023

Abstract

Background and Aims
Previous studies have identified chronic kidney disease (CKD) as a risk factor for poor ocular health. However, the effect of faster decline in estimated glomerular filtration rate (eGFR) on visual function, retinal markers, and eye conditions is unclear. We therefore examined the association of eGFR slope with visual function measures, retinal vessel density (VD), and common ocular pathologies in a bi-racial general population cohort.

Method
We studied 823 participants with normal kidney function or mild CKD (eGFR ≥ 60 ml/min per 1.73 m²) at baseline from the Eye Determinants of Cognition (EyeDOC) Study. Exposure was change in eGFR (ml/min per 1.73 m² per year) over 4 study visits between 1996 and 2019, calculated using linear mixed-effect models with unstructured covariance matrix. Outcomes (recorded between 2017 and 2019) were visual function (near visual acuity, presenting distance visual acuity, contrast sensitivity), retinal VD in the superficial, intermediate, and deep capillary plexus layers, and common ocular pathologies, such as retinopathy, age-related macular degeneration, and glaucoma. We used linear regression to model the associations of eGFR slope with visual function and retinal VD. We used logistic regression to study the association of eGFR slope with ocular pathologies. All models were adjusted for age, sex, race, education, smoking, body mass index, diabetes, hypertension, and hyperlipidemia. The models for retinal VD were additionally adjusted for signal strength index.

Results
In our study cohort, the mean age was 79 (±4) years with 62% females and 48% African Americans. The prevalence of diabetes and hypertension was 38% and 82%, respectively. The mean [SD] eGFR slope was −1.6 [0.6] ml/min per 1.73 m² per year. A faster eGFR decline of 1 ml/min per 1.73 m² per year was significantly associated with worse near visual acuity (0.04 logMAR [95% Confidence Interval 0.003; 0.08], p = 0.03), worse contrast sensitivity (−0.03 log [−0.05; −0.001], p = 0.01), lower VD in the deep capillary plexus layer (−0.99% per mm² [−1.96; −0.02], p = 0.04), and higher odds of retinopathy (odds ratio 2.44 [1.06; 6.63], p = 0.04). Associations of eGFR slope with the remaining measures of visual function and eye conditions were not significant.

Conclusion
In our bi-racial general population cohort with an eGFR ≥ 60 ml/min per 1.73 m² at baseline, a faster decline in eGFR was associated with worse visual function, reduced retinal vascular health, and higher odds of retinopathy. Our results support the potential usefulness of eGFR slope for risk assessment of ocular outcomes, even in patients with normal kidney function or mild CKD.
#5774 REAL-WORLD EXPERIENCE WITH COVID-19 THERAPY IN KIDNEY TRANSPLANT PATIENTS DURING THE OMICRON VARIANT PERIOD
Authors: Fernández Florentino Villanego , Alonso Marta , Sánchez Luis Alberto Vigara , Mateos Maria Eugenia Rodríguez , Alonso Myriam Eady , García-Doncel Ana García , Mañanes María del Carmen Mínguez , Escobar María Elisa Montero , Tostón Óscar Segurado , Garcia Teresa , Mazuecos Auxiliadora 
Published: June 2023

Abstract

Background and Aims
The development of new drugs against SARS-CoV-2 has improved the prognosis of COVID-19. Large studies often exclude transplant recipients or patients with chronic kidney disease, so the experience in kidney transplant (KT) patients is very limited.

Method
Retrospective cohort study of KT patients with mild-moderate COVID-19 in our area who were treated from 01/01/2022 to 12/31/2022. The indication to treat was made according to age, post-KT time and comorbidities. The type of drug depended on anti-spike serology and glomerular filtration rate. We did not use nirmatrelvir/ritonavir due to the risk of interactions.

Results
During the period of the study, 106 KT (55 women, 51 men) with mild-moderate COVID-19 were treated, with a mean age of 61 years and a KT vintage at the time of infection of 59 [29-186] months. Of them, 37.7% were diabetics and 83% were fully vaccinated prior to the infection. After the diagnosis, 63 (59.5%) patients received sotrovimab, 33 (31.1%) remdesivir, and 10 (9.4%) molnupiravir. The anti-spike antibody titer prior to the treatment was significantly lower in those patients who received sotrovimab (p = 0.000). The disease progressed requiring admission in 3 patients: 2 treated with sotrovimab and 1 with molnupiravir (admission rate: 3% [2/63] for sotrovimab and 10% [1/10] for molnupiravir). Any patient died. During the study period, 37 admissions due to COVID-19 in KT patients were registered in our area, of which 34 had not received any treatment (91.9%). Of these, 5 died, all of them being untreated patients before admission. The hospitalized patients did not show differences in age, post-RT time and vaccination status compared to the 106 treated with mild-moderate COVID-19.

Conclusion
Our results suggest that treatment of mild-moderate COVID-19 in high-risk KT patients may be effective in preventing progression to severe disease requiring admission. The highest rate of progression was observed in those treated with molnupiravir.
#5783 REAL-LIFE USE OF TOLVAPTAN IN ADPKD: A RETROSPECTIVE ANALYSIS OF A LARGE CANADIAN COHORT
Authors: Calvaruso Luca , Yau Kevin , Akbari Pedram , Nasri Fatemeh , Deng Shirley X , Khowaja Saima , He Ning , Haghighi Amirreza , Khalili Korosh , Pei York 
Published: June 2023

Abstract

Background and Aims
Tolvaptan is the first disease-modifier therapy proven to slow eGFR decline in high-risk patients with ADPKD. However, barriers to its use in real-life settings have not been examined.

Method
Single-center, retrospective study of 523 current or new patients with ADPKD followed at the Center for Innovative Management of PKD in Toronto, Ontario between January 1, 2016 to December 30, 2018. All patients had clinical assessment and total kidney volume measurements; those deemed to be at high risk based on their Mayo Clinic Imaging Class (MCIC) 1C, 1D, or 1E, were offered tolvaptan with their preference (yes or no) and reasons for their choices recorded.

Results
Overall, 315/523 (60.2%) patients had MCIC 1C-1E; however, only 96 (30%) of them were treated with tolvaptan at the last follow-up. Among these high-risk patients, those treated with tolvaptan were more likely to have a higher eGFR (61 ±27 vs. 82 ±26 ml/min/1.73 m2), CKD stages 1–2 (41% vs. 79%), and MCIC 1D-1E (69% vs. 37%). The most common reasons provided for not taking tolvaptan were lifestyle preference related to the aquaretic effect (51%), older age ≥60 (12%), and pregnancy or family planning (6%).

Conclusion
In this real-world experience, at least 60% of patients with ADPKD considered to be at high risk for progression to ESKD by imaging were not treated with tolvaptan; most of them had earlier stages of CKD with well-preserved eGFR. The most common reason for their refusal to consider tolvaptan is a concern for intolerability of the aquaretic side-effect; strategies to mitigate this side-effect may help to reduce the barrier to tolvaptan therapy.
#5867 EFFECT OF SGLT2I ON URIC ACID AND GLUCOSE URINARY FRACTIONAL EXCRETION IN PATIENTS WITH CHRONIC KIDNEY DISEASE AND TYPE 2 DIABETES MELLITUS
Authors: Briales Paula Sanchez , Vidas Maria Marques , López Paula , Illazquez María Victoria López , Ali Aylin Vedat , Portoles Jose 
Published: June 2023

Abstract

Background and Aims
Sodium-glucose cotranspoter type 2 inhibitors (SGLT2i) have demonstrated broad benefits beyond glycemic control, including hypouricemic effects. However, this fact has not been completely validated in chronic kidney disease (CKD). The mechanism by which SGLT2i produces an increase in uric acid elimination is not fully understood and appears to be mediated in part by increased glucose in the renal tubule, which would compete in reabsorption with uric acid through GLUTb transporter. The aim of this study is to analyse the effect of SGLT2i on uric acid and glucose urinary fractional excretion (FE) in type 2 diabetes mellitus (T2DM) + CKD patients.

Method
Retrospective observational single-center study conducted between January18 and December 22 in T2DM-CKD patients on SGLT2i. Subjects on renal replacement therapy, treatment with GLP1 analogues and those for whom we did not have uricosuria prior to the start of iSGLT2 were excluded. Urinary uric acid and glucose FE were analysed at baseline and during follow-up of up to 24 months, with 3, 6 and 12 months cut-offs. Data are described as mean and standard deviation (SD). Statistical analysis was performed using STATA v14 with statistics for paired samples.

Results
82 patients were included in the study, with a mean follow-up of 1.2 years. During follow-up, 23 patients left the study (arGLP1 initiation (n = 9), adverse reactions (n = 4), exitus (n = 2) and loss to follow-up (n = 8). 78.1% were male, mean age 72.7 years (SD 8.5), and main co-morbidities were: obesity 76.8%, arterial hypertension 95%, hyperuricemia 75.6% and congestive heart failure 25.6%. Distribution according SGLT2i drug was: 65.6% dapagliflozin, 25% canagliflozin and 9.4% empagliflozin. eGFR decreased immediately after initiation of SGLT2i with ulterior stabilization as described elsewhere (Table 1). We observed a significant increase on urinary uric acid FE that remain stable along the follow-up: basal 7.4%, 3 months 9.4% (p &lt; 0.001). However, serum uric acid levels did not show significant differences along the study. Urinary glucose FE increase remained stable along the whole observation period in spite of no significant differences from a clinical point of view on % of glycosylated haemoglobin (Table 1).

Conclusion
Despite decreased GFR, T2DM-CKD patients exhibited significant urinary uric acid and glucose FE increase after starting SGLT2i. This increase remained stable for at least 2 years. However, we did not observe significant reductions on uricemia in these patients, implying that increase on urinary uric acid excretion is not enough in this setting to obtain significant modifications on uricemia.
#5871 PERITONEAL DIALYSIS INFECTIONS IN MALTA: AN OVERVIEW OF THIRTEEN YEARS
Authors: Attard Abigail , Grech Edward , Cauchi Angela Borg , Buttigieg Jesmar , Farrugia Emanuel , Borg Michael A 
Published: June 2023

Abstract

Background and Aims
Peritoneal dialysis (PD)-related infections are still associated with an increased risk of morbidity and mortality. We describe an overview of PD peritonitis and catheter-related infection (CRI) rates in Malta over a period of thirteen years.

Method
All patients undergoing PD in Malta from 2008 to 2020 were included. Data from 2008 to 2012 was retrospective (shown as mean), whilst data from 2013 to 2020 was prospective. ISPD guidelines and definitions were followed.

Results
Study population sizes from 2008 to 2020 were as follows: 137 (2008-2012), 91, 80, 126, 117, 102, 103, 101, and 101 respectively. PD peritonitis rates from 2008 to 2020 were 0.38, 0.31, 0.35, 0.46, 0.43, 0.57, 0.54, 0.43, 0.39, 0.40, 0.46, 0.37, and 0.29 episodes/patient/year respectively. Gram-positive peritonitis episodes predominated, the majority of which were Staphylococcal infections. Methicillin-resistant Staphylococcus aureus (MRSA) rates have overall decreased from 0.03 episodes/patient in 2008–2012 to 0.01 episodes/patient in 2020, to no cases in 2016, 2017 and 2019. Coagulase-negative Staphylococcal (CNS) rates also decreased from 0.26 episodes/patient in 2013 to 0.03 in 2017, 0.11 in 2018, 0.04 in 2019, and 0.08 in 2020. With regards to Gram-negative peritonitis, Pseudomonas rates declined from 0.06 episodes/patient in 2008–2012 to 0.03 in 2018. No cases were recorded in 2016, 2019 and 2020. The rate of Escherichia coli-associated peritonitis was 0.03 episodes/patient/year in 2020, and no cases were found in 2016, 2017, 2018, and 2019. Fungal peritonitis rates varied from 0.03 in 2008–2012 to 0.01 episodes/patient/year in 2013, 2018, 2019 and 2020 with no cases being recorded in 2016 and 2017. CRI rates were as follows: 0.39 (2008-2012), 0.35, 0.91, 0.37, 0.38, 0.25, 0.50, 0.29, and 0.22 episodes/patient/year respectively. The incidence of Gram-negative infections from 2013 to 2020 was 49, 51, 52, 65, 58, 66, 48, 41% respectively, with an average rate of 54%. Gram-positive CRIs were mostly Staphylococcal, peaking in 2014 at 0.38 episodes/patient, down to 0.14 in 2019, and 0.10 in 2020. MRSA rates decreased from 0.15 episodes/patient/year in 2014 to 0.01 in 2018, no cases in 2019, and 0.04 in 2020. CRI Pseudomonas rates have overall improved from 0.12 (2008-2012), to 0.06, 0.09, 0.09, 0.14, 0.03, 0.17, 0.06, 0.04 episodes/patient/year from 2013 to 2020.

Conclusion
The Maltese PD cohort has been achieving ISPD target requirements. Both PD peritonitis and catheter-related infection rates declined over the last thirteen years. There was no MRSA peritonitis in 2016, 2017 and 2019, no Pseudomonas peritonitis in 2016, 2019 and 2020, no E. coli in 2016,2017, 2018 and 2019 and no fungal PD peritonitis in 2016 and 2017. Overall CRIs were predominantly Gram-negative, but not in 2019 and 2020.
#5894 HYPOCOMPLEMENTEMIA AT DIAGNOSIS OF ANCA-ASSOCIATED VASCULITIS IS ASSOCIATED WITH SEVERITY AND OUTCOMES
Authors: Lanau Maria , Lorente Loreto Fernandez , Arnedo Mario Perez , Manrique Joaquin 
Published: June 2023

Abstract

Background and Aims
A relationship between antineutrophilic cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and complement has been shown, and complement has an important role in the pathogenesis of AAV [1]. Low serum complement levels (sC3) at diagnosis of AAV has been previously described although clinical characteristics and outcomes of AAV with hypocomplementemia still remain unclear [2]. The aim of this study was to investigate what proportion of patients with AAV have low sC3 at diagnosis, and whether they have different clinical and histological features or experience different outcomes compared to patients with normal sC3.

Method
A total of 93 patients with AAV diagnose (81,3% Anti-MPO and 18,7% anti-PR3) were included in the study from 2000-2022. 12% of them had sC3 values below limit of normal range (i.e., &lt;90 mg/dl). Patients were categorized according to sC3 levels into 2 groups, hypocomplementemic (G1; mean C3: 73.1mg/dl), and normocomplementemic (G2; mean C3: 128.3mg/dl). Histological patterns were based on the Berden score and correlated with clinical features. Main outcomes of interest included severity of acute kidney injury at diagnose (AKI), histopathological patterns, end-stage kidney disease (ESKD) and death in the long term.

Results
No differences were identified in terms of demographics (age, gender, induction treatment). sC3 levels and serum creatinine were statistically associated (r2:-0.40; p&lt;0.001). Patients with low sC3 had more severe renal involvement, at diagnose (G1: sCr 7.6mg/dl vs sCr 3.8mg/dl, p&lt;0.001) without differences in ANCA levels and they were more likely to require acute dialysis around the initial diagnosis (p &lt; 0.01). There were significant differences in sCr levels at diagnose (p&lt;0.001) related to Berden score without differences in sC3 levels (Focal, n = 8 (8.6%), sCr 2.5 mg/dl, sC3 121.1 mg/dl; Crescentic, n = 23 (24.7%), sCr 6.41mg/dl, sC3 119.3 mg/dl; Mixed n = 16 (17.2%), sCr 3.6mg/dl, sC3 118.5 mg/dl; Sclerotic, n = 14 (15.1%) sCr 3.0 C3 129.1mg/dl). 55.5% of G1 patients deceased compared to 28% of G2. Lower sC3 levels (G1) were associated with mortality (log-rank 4.1; p&lt;0.05) and composite outcome of ESKD or death (log-rank 5.9; p&lt;0.05) compared G2 patients.

Conclusion
Hypocomplementemia in AAV at the disease onset was a risk factor for the serious organ damage, and a life prognostic factor. Low C3 levels at diagnosis of AAV is emerging as a predictor of renal outcomes and it is thus very important to pay attention to them. Despite that histologic patterns of the Berden classification were related to the severity of AKI at presentation there was no statistical correlation with sC3 levels. We recommend to pay attention to the levels of complement at the diagnosis of AAV.