bluuebunny/crossref_metadata_2025_split huggingface dataset:
#4971 IMPACT OF RAMADAN FASTING ON NUTRITION, INFLAMMATION AND DIALYSIS ADEQUACY AMONG HEMODIALYSIS PATIENTS
Authors: Taher Eman , Sobh Mohamed , Nassar Mohammed Kamal , El Wasif Salwa 
Published: June 2023

Abstract

Background and Aims
There is a paucity of data concerning safety of fasting in Ramadan in End stage kidney disease patients (ESKD) on haemodialysis (HD). The aim of the present study was to assess the possible effect of fasting on nutritional status (clinical, biochemical variables), inflammatory status and adequacy of haemodialysis. This observational study was carried out during 2022 when fasting duration was around 14 hours.

Method
Sixty-five patients suffered from ESKD who received regular HD for more than six months in dialysis unit, urology and nephrology center Mansoura university were included in this prospective observational study. Patients were categorized into three groups. 21 patients fasted all days of Ramadan,25 patients fasted days other than session days and 19 patients never. We did not oblige our patient to fast. nutritional status was assessed clinically by Anthropometric measurements including body weight, BMI, triceps skin fold thickness (TSF) and estimation of protein catabolic rate (PCR) were measured, and laboratory by serum Albumin, cholesterol and fasting blood glucose. Neutrophils to lymphocytes ratio (NLR), Soluble receptor of advanced glycation end product(SRAGE) and human B-cell lymphoma/leukemia2 (BCL2) was measured as inflammatory markers, also dialysis adequacy was determined with urea reduction ratio (URR) and KT/V. Assessment of all patients were carried out before and after Ramadan month and was repeated 3 months after Ramadan in all patients.

Results
In 30 days fasting group: there was significant reductions (all P &lt; .02), serum albumin, triceps skin fold thickness, Subjective global assessment score (SGA) for nutritional assessment also in inflammatory markers as neutrophils to lymphocytes ratio (NLR) and human Bcell lymphoma/leukemia2 (BCL2). But these were not accompanied by any significant change (all P &gt;0.05) in body mass index, serum cholesterol, fasting blood sugar (FBS), urea reduction ratio (URR), intradialytic weight gains (IDWG), Kt/V and human soluble receptor for advanced glycation end products (sRAGEs). In the group Who was reported fasting in days other than HD session days: fasting led to significant reductions (all P &lt; .02) only in serum albumin and triceps skin fold thickness. There were no significant changes in BMI, URR, Cholesterol, FBS, KT/V, IDWG, SGA score, NLR, sRAGEs and BCL2. In patients Who never fast at all: there was significant reduction (all P&lt;0.02) in triceps skin fold thickness, significant change in SGA score and also in sRAGEs and BCL2.

Conclusion
There was no harmful effect for Muslim patients receiving regular HD who want to fast Ramadan in days other than HD session days. In the current study the fasting group has the benefit of both being fasting and non-significant changes in mostly all nutritional assessment points, inflammatory markers and the adequacy of HD.
#5001 AKI AND AKD AFTER RADICAL CYSTECTOMY FOR MUSCLE INVASIVE BLADDER CANCER: AN UNEXPECTED NEPHROLOGICAL AFFAIR
Authors: Trevisani Francesco , Longoni Mattia , Cinque Alessandra , Rosiello Giuseppe , Malvestiti Marco , Salonia Andrea , Briganti Alberto , Montorsi Francesco , Moschini Marco , Floris Matteo 
Published: June 2023

Abstract

Background and Aims
Radical cystectomy (RC) represents the first line surgical treatment for muscle-invasive bladder cancer (MIBC). RC is a complex surgical procedure characterized by significant morbidity and mortality. The incidence of significant complications following RC is a well-recognized issue however still paucity of data exists regarding postoperative renal function. Aim of the study was to evaluate the incidence of acute kidney injury (AKI) and Acute kidney disease (AKD) after RC, evaluating the impact of surgery (open or robotic one), comorbidities (hypertension, diabetes, CAD) and previous oncological treatments (chemotherapy, immunotherapy and radiotherapy).

Method
We collected a consecutive cohort of 839 patients who underwent RC for MIBC in a single tertiary institution between 2010 and 2022. All clinical variables and comorbidities were reported pre and after surgery. Serum creatinine with subsequently eGFR using CKD-EPI formula were collected at baseline pre-operative and in the acute setting at 24h, 48, 72h, 6 days for the AKI onset, and after 9,12,15,18,21,24,27,30,45, 60, 75, 90 days for the AKD establishment. We compared the incidence of AKI and AKD upon the two different surgical approaches for RC :the open and robotic one. Fisher's exact test; Wilcoxon rank sum test; Pearson's Chi-squared test were used for the statistical analysys.

Results
General characteristics of patients included in the study are summarized in Table 1. Surprisingly, a very high rate of both AKI (30%) and AKD (50%) was reported in the total cohort of patients, with an augmented incidence in the robotic surgery (p &lt; 0.001). Moreover, stage II and III of both AKI and AKD affected a non-negligible percentage of patients, requiring advanced nephrological medical treatments and prolonged hospitalization (Table 1). The multivariate analysis showed that age, blood hypertension and BMI represent the major risk factors to develop both AKI and AKD (Table 3 and Figure 1).

Conclusion
AKI and AKD are very frequent and insidious side effects in the RC for MIBC. Therefore, a personalized nephrological counseling both in the pre and post -surgery asset is mandatory to reduce morbidity and mortality.
#5006 RELATIONSHIP BETWEEN EXTRACELLULAR WATER PERCENTAGE AND MORTALITY IN PATIENTS UNDERGOING CHRONIC HEMODIALYSIS
Authors: Rotondi Silverio , Tartaglione Lida , Perrotta Adolfo , Moscatelli Miriana , Paoloni Emanuela , Pasquali Marzia , Lai Silvia , Mazzaferro Sandro 
Published: June 2023

Abstract

Background and Aims
Chronic hemodialysis (HD) patients have a high cardiovascular and mortality risk. This is secondary to numerous risk factors specific to the HD population. Relevant on cardiovascular disease and mortality in HD, is the sodium intake and the extent of the sodium pool of patients. An increase in the total sodium pool may have a negative action on cardio vascular system directly and mediated by the increase in total body water associated with an increase in the sodium pool. However, the assessment of the sodium pool in patients is clinically complex. Some evidence has suggested that the assessment of the extracellular water percentage (ECW%) in the HD patient may be a marker of the sodium pool. In fact, the increase in extracellular sodium is followed by a shift of water from the intracellular compartment to the extracellular compartment. The assessment of ECW% could therefore identify patients with greater ECW increase secondary to the greater sodium pool and therefore with high clinical risk. Primary aim: to evaluate the relationship between extracellular water percentage and mortality in patients on chronic hemodialysis.

Method
This is an observational prospective cohort study. The inclusion criteria were chronic HD for at least three months, minimum follow-up of six months, age greater than 18 years. In all of the included patients we performed the bioimpedance examination with a dedicated instrument after hemodialysis session, after the long interdialytic interval, for the evaluation of ECW (L), ECW (%), TBW (L / m), ICW (L). The protocol involved dividing the population into two groups based on normal or pathological ECW%, according to values calculated by gender and age and then evaluating the incidence of death in a 36-month follow-up.

Results
We enrolled 101 patients with an average age of 71± 14 years in HD for 51 ±15 months. During the average follow-up of 19 months we observed 31 deaths (30% of the population) with an annual mortality of 15%. ECW % correlated positively with age (R: 0.498 P:0.01) and differential post-dialysis pressure (R: 0.260; P:0.01). 41 patients (aged 64 ± 13 years) had a normal ECW % (ECW-N) and 60 patients (75±13 years) had pathological ECW% (ECW-P). ECW-P patients had an increased mortality respect to ECW-N patients (60% vs 20% p: 0.01). The survival curve confirmed higher mortality in the ECW-P group (log-rank test P 0.02). These results were confirmed in a sub-analysis of two age-matched ECW-N (n. 20 age 64±10 years) vs ECW-P (n. 20 age 65±12 years) subgroups (log-rank test P:0.05).

Conclusion
Our data showed that ECW% identifies HD patients at increased mortality risk in 36- month follow-up. These data are also confirmed in age-related subgroups, suggesting the ECW % assessment can be a simple and useful parameter to evaluate for targeted treatment choices in patients with chronic HD.
#5165 STING CONTRIBUTES TO LPS-INDUCED TUBULAR INFLAMMATION BY ACTIVATING IRE1/XBP1 PATHWAY IN ACUTE KIDNEY INJURY
Authors: Cao Yun 
Published: June 2023

Abstract

Background and Aims
Innate immunity and inflammation were recognized as the key factors for the progression of acute kidney injury (AKI) induced by lipopolysaccharide (LPS). Stimulator of interferon genes (STING) has emerged as a critical component of innate immune and inflammatory responses. This study aimed to explore the role of STING in LPS-induced tubular inflammation in AKI.

Method
1. The AKI mice models were induced by intraperitoneal injection of LPS. Mice were randomly divided into CTL group, LPS 24 h group and LPS 48 h group:
(1) STING protein expression in tubules was detected by IHC staining;
(2) STING protein expression in kidney cortices was detected by WB.
2. The tubule-specific STING knockout (STING-cKO) mice were generated. Then WT mice and STING-cKO mice were randomly divided into WT group, WT+LPS group, STING-cKO group and STING-cKO+LPS group:
(1) Blood samples and urine samples were collected for Scr, BUN and ACR measurement;
(2) Tubular pathological changes were detected by PAS staining;
(3) Inflammatory cell infiltration in kidney cortices was detected by IHC and IF staining;
(4) Pro-inflammatory cytokines’ mRNA level in kidney cortices was detected by QPCR;
(5) IRE1, XBP1, IL-1β and IL-18 protein expression in kidney cortices was detected by WB.
3. HK2 cells were randomly divided into CTL group, si-STING (STING siRNA) group, LPS group, LPS+si-STING group, Ad-IRE1 (IRE1 overexpression plasmid) group, si-STING+ Ad-IRE1 group, LPS+ Ad-IRE1 group and LPS+ si-STING+ Ad-IRE1 group:
(1) Pro-inflammatory cytokines’ mRNA level was detected by QPCR;
(2) IL-1β, IL-18 protein expression was detected by WB.

Results
1. STING was activated in tubules from LPS-induced AKI mice.
2. STING-cKO significantly suppressed LPS-induced renal dysfunction, tubular pathological changes, tubular inflammation and IRE1/XBP1 pathway activation.
3.IRE1 overexpression significantly promoted LPS-activated HK2 cells’ inflammation, even though STING was silenced.

Conclusion
STING contributes to LPS-induced tubular inflammation by activating IRE1/XBP1 pathway. Targeting STING may be a promising therapeutic strategy for preventing septic AKI.
#5172 ASSESSMENT OF THE RELATIONSHIP BETWEEN RENAL VOLUME, PAIN, DEPRESSION, AND ANXIETY IN PATIENTS WITH AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE
Authors: Demir Fatma Banu , Yildiz Abdulmecit 
Published: June 2023

Abstract

Background and Aims
The most prevalent hereditary kidney disease is autosomal dominant polycystic kidney disease (ADPKD). Multiple cysts developing in the kidneys are a defining feature of this systemic, progressive disease. The quality of life, psychosocial load, and discomfort associated with renal volume in people with ADPKD have not been well studied. This study aimed to examine the relationship between renal volume, psychological issues brought on by pain and the burden of the disease, and deteriorating sleep quality in ADPKD patients.

Method
The study included sixty patients who were being treated in the nephrology clinic at the Bursa Uludag University Faculty of Medicine Hospital. The ADPKD Pain and Discomfort Scale (ADPKD-PDS), Beck Depression Inventory Questionnaire, Beck Anxiety Scale, Pittsburgh Sleep Quality Scale (PSQI), and Insomnia Severity Index (ISI) were assessed. The computed tomography ellipsoid formula was used to determine the total kidney volume, and kidney volume adjusted for body size was obtained for each patient. The eGFR values computed using the CKD-EPI algorithm and the patients' baseline biochemical parameters were recorded.

Results
The mean age at diagnosis was 31±13, and the mean total kidney volume (TKV) was 1526.35±1595.90. Eight (13.3%) individuals were determined to have mild mood disorders, whereas seven (11.7%) patients had borderline clinical depression. Four individuals (6.7%) were found to have severe anxiety. It was shown that 25% of the patients had poor sleep quality. There was no statistically significant difference in kidney volume between the depression groups or between the pain and discomfort scale sub-dimensions. (Table-1)

Conclusion
It was shown that, in accordance with the literature, the severity of depression increased as the patients' sleep quality declined in ADPKD patients. However, there was no significant relationship between kidney volume and the degree of anxiety, depression, pain or discomfort.
#5179 LESS MICROBUBBLES ENTERED THE PATIENTS USING THE VENOUS CHAMBER EMBOLESS DURING HAEMODIALYSIS
Authors: Forsberg Ulf , Stegmayr Bernd , Jonsson Per 
Published: June 2023

Abstract

Background and Aims
The extracorporeal circuit (ECC) enables haemodialysis (HD) of patients. Air contamination of the blood appears when it passes the ECC and consequently microbubbles (MBs) enter to the patient [1]. MBs were verified at autopsy of HD patients and covered by clots as microemboli deposited within tissue from lungs, heart and brain [2]. A venous chamber is inserted in the ECC to reduce contamination of MBs. However, chambers in clinical use have limited capacity to eliminate MBs from entering the return bloodline. In an in vitro preclinical study the Emboless chamber showed best results compared to common models in clinical use; the best of those was for Fresenius 5008 [3]. We compared if the venous chamber Emboless differs in capacity to limit MB exposure from the original venous chamber of Fresenius 5008 (F5008).

Method
Thirty-eight HDs were performed as 19 paired HD sessions. Eleven patients were included. Venous chambers used were either F5008 or Emboless, in a randomised order. Dialyzers, blood-pump speed, HD or HDF and ultrafiltration was kept similar between the pairs. Microbubbles were measured at the ‘Inlet’ and ‘Outlet’ of the venous chamber with an ultrasound device adjusted for HD (hil mode, BCC200, GAMPT). Measurements were made for MBs between all sizes 20µm-500µm diameter. If HDF was performed the first 30min measured were by HD and the subsequent 30min by HDF (extended time if less than 1000 detected inlet MBs). The percentage of change in ‘Outlet’ versus ‘Inlet’ counts were compared (paired Wilcoxon test). Total reduction was -100% while increase of MBs (worsened) caused unlimited (+) percentage. If a diameter was without counts it was not included in the analysis.

Results
The median overall change of MBs were for F5008 −33% (mean −20 ±76%, N = 8544) and for Emboless -69% (mean -56 ±54%, N = 8402; and pairwise N = 8093, p&lt;0.001). The Table 1 shows more results.

Conclusion
Less MBs and subsequently less microemboli entered to the patient using the EmbolessTM compared to using the Fresenius 5008 venous chamber during haemodialysis. Considering our previous autopsy studies2 this supports less tissue damage of the patients using EmbolessTM.
#5184 THE RELATIONSHIP OF BONE MINERAL DENSITY AND VITAMIN K IN RENAL TRANSPLANT PATIENTS
Authors: Şentürk Merve , Çatal Sıla , Menteşe İlay Berke , Kaya Burcu , Atas Dilek Barutcu , Tugcu Murat , Asicioglu Ebru , Arikan Izzet Hakki , Tuglular Z Serhan , Velioglu Arzu 
Published: June 2023

Abstract

Background and Aims
Kidney transplantation is the best treatment for end-stage renal disease (ESRD). Osteoporosis is a common health problem in kidney transplant recipients. It is known that the risk of bone fracture increases by 30% in the first 3 years after transplantation in kidney transplant recipients. Vitamin K is a cofactor involved in the activation of osteocalcin. This protein plays a role in bone mineralization. Currently, vitamin K cannot be measured directly from blood samples, and markers such as proteins induced in the absence of vitamin K (PIVKA-II) and undecarboxylated osteocalcin (ucOC) are used for indirect measurement of vitamin K. In our study, we aimed to investigate the relationship between vitamin K and osteoporosis by measuring serum PIVKA-II, ucOC and BMD in kidney transplant recipients.

Method
It was a cross-sectional observational study. Patients were selected from kidney transplant patients over 18 years old. A control group was formed from dialysis patients over the age of 18. For vitamin K levels, PIVKA-II and ucOC levels were measured in serum samples taken from patients. The relationship between vitamin K markers, bone mineral densitometry and the risk of major osteoporotic fracture calculated by FRAX in kidney transplant patients was evaluated.

Results
68 kidney transplant patients and 20 dialysis patients followed in our clinic were included in this study. As results, it was observed the increased risk of osteoporosis in postmenopausal women patients related with decreased serum vitamin K level (r = −0.520, p = 0.047). Of the transplant group, PIVKA-II and Lumbar I-IV BMD values were statistically significant (p = 0.034, r = -0.258). PIVKA-II was found to be a risk factor for low BMD by multiple linear regression analysis in the transplant group (beta coefficient = −0.195, p = 0.037).

Conclusion
In our study, it has been proven that as the vitamin K level decreases in kidney transplant patients, the vertebral bone mineral density decreases while the risk of osteoporosis increases. This result shows that vitamin K replacement may have positive effects on bone metabolism.
#5200 IMPACT OF MINERAL BONE PARAMETERS IN COGNITIVE IMPAIRMENT IN DIALYSIS PATIENTS
Authors: Rroji (Molla) Merita , Shehaj Larisa , Zeneli Nereida , Seferi Saimir 
Published: June 2023

Abstract

Background and Aims
Mineral bone disease and cognitive impairment are related diseases in the CKD population. Vascular calcification, a marker of MBD, may play a role in the early detection of cognitive decline. This study aims to identify a relationship between MBD biomarkers and cognitive function and to identify dialysis patients with a high risk of dementia.

Method
A total of 98 patients participated in this cross-sectional study, with 63 on hemodialysis and 35 on peritoneal dialysis. They underwent the Montreal Cognitive Assessment (MoCA) questionnaire, which categorized mild, moderate, severe, and severe based on scoring. PTH, P, Ca, ALP, and Mg serum concentrations and vascular calcification were measured as MBD biomarkers. The Adragaos score was applied to graphs of the hands and pelvis to evaluate vascular calcification.

Results
The mean MoCA score was 20,28±5.8. Based on the responses, it was concluded that 70% of HD patients had mild cognitive impairment, compared to 63% of PD patients. According to the descriptive data, patients whose underlying CKD was caused by nephroangisclerosis had the lowest MOCA test results compared to other groups (p&lt;0.001). The degree of calcification was observed to have an adverse effect on cognitive performance in both groups (p&lt;0.012); the high Adragaos score contributed to the decline in the MoCA test score. In multivariate logistic regression analysis, hypercalcemia and hypomagnesemia were independent variables for cognitive function impairment (p = 0.006 and p = 0.04, respectively). The serum concentration of PTH (p = 0.008) and ALP (p = 0.001) were found to be risk factors for HD patients during the evaluation of the MoCA test in each of the groups.

Conclusion
Vascular calcifications are considered a risk factor for cognitive impairment. In our study, vascular calcification risk is positively impacted by indicators such as hyperparathyroidism, hypercalcemia, high levels of ALP, and hypomagnesemia. Recently research has demonstrated the effectiveness of magnesium as a vascular calcification inhibitor. So, nephrologists should be more careful in monitoring levels of MBD biomarkers.
#5201 KIDNEY BIOPSY IN PATIENTS WITH TYPE 2 DIABETES: A SINGLE CENTER OBSERVATIONAL STUDY
Authors: Alexandre Inês , Curto Andreia , Henriques Fábio , Ramos Mariana , Brás Catarina , Santos Afonso , Campos Pedro , Domingos Fernando , Pires Ana 
Published: June 2023

Abstract

Background and Aims
Patients with type 2 diabetes mellitus (T2DM), may have various underlying causes contributing to kidney disease beyond diabetic nephropathy (DN). In such cases, a kidney biopsy (KB) can provide a definite diagnosis and allow for tailored treatment options. The aim of this study is to evaluate non diabetic kidney disease (NDKD) in T2DM patients and identify data to support KB indications.

Method
This is a retrospective observational study that included patients with T2DM who were submitted to a native KB between 2011 and 2022. We collected demographic, clinical and laboratory data at the date of biopsy. KB indication was considered in order to include the patients in the first encountered criteria defined sequentially as the presence of (1) nephrotic syndrome, (2) low or rapidly declining estimated glomerular filtration rate (eGFR), (3) nephrotic proteinuria and (4) hematuria.

Results
We analysed 72 patients with T2DM that were submitted to KB (Table 1). All except one patient had hypertension and 38 patients were screened for diabetic retinopathy (DR), which was present in 23 patients (60%). The criteria for KB was in most of the patients (59.7%) a low or rapidly declining eGFR, followed by nephrotic proteinuria (19.4%), nephrotic syndrome (16.7%) and hematuria (4.2%). KB showed 50% (n = 36) of patients with NDKD, 12.5% (n = 9) with NDKD and DKD and 37.5% (n = 27) with isolated NDKD. Among these patients, hypertensive nephrosclerosis (19.4%), focal segmental glomerulosclerosis (13.8%), acute interstitial nephritis (13.8%), membranous nephropathy (11.2%) and IgA nephropathy (5.6%), were the most prevalent diagnosis. Patients with DR had a higher prevalence of DKD with a positive predictive value (PPV) of 87%. On the other hand, in the absence of DR, DKD was only absent in 66.7%. Patients submitted to KB for the criteria of low or rapid declining eGFR had significantly more NDKD (p = 0.016). DKD with or without NDKD was found in patients with higher levels of albumin to creatinine ratio (p = 0.001) and HbA1c (p = 0.05).

Conclusion
Our data showed that NDKD is prevalent in T2DM patients, and given its potentially treatable nature, KB should be considered in T2DM patients, especially in those with low or rapid declining eGFR. DR supports the diagnosis of DKD (PPV of 87%), but alone is insufficient to exclude other causes. Patients with DKD had higher levels of albuminuria and HbA1c. Overall, more than half of the patients had hematuria, without any correlation with any group.