bluuebunny/crossref_metadata_2025_split huggingface dataset:
#5423 THE FUNCTIONAL STATE OF THE KIDNEYS IN PATIENTS WITH CHRONIC ISCHEMIA OF THE RENAL AND PERIPHERAL ARTERIES
Authors: Atahodjayeva Gulchehra , Daminov Botir , Asadov Nodir 
Published: June 2023

Abstract

Background and Aims
to study the functional state of the kidneys in patients with chronic ischemia of the renal and peripheral arteries.

Methods
We examined 120 patients with chronic lower limb ischemia (CLLI) on the background of coronary heart disease and type 2 diabetes mellitus. All examined patients were hospitalized in the department of Interventional Cardiology of the Republican Specialized Scientific and Practical Medical Center for Therapy and Medical Rehabilitation. Inclusion criteria for the study was the presence of intermittent claudication in the patient of II A-II B degree of CLLI, while the walking distance without pain in these patients was 50-1000 meters. Assessment of the functional state of the kidneys was carried out on the basis of determining the level of serum creatinine (Cr), glomerular filtration rate (GFR), calculated according to the EPI GFR formula, which takes into account race, gender, age, and serum creatinine level. To calculate GFR using the CKD-EPI formula, can be used special applications for mobile devices (QxMDCalculator) (based on the criteria of the clinical guidelines for the diagnosis, classification and treatment of CKD KDIGO - 2013).

Results
Analysis of the functional state of the kidneys depending on the severity of CKD and the level of GFR in accordance with the KDIGO classification (2013) showed that all 100% of patients with CLLI belonged to CKD categories: CKD C2 - 62 (51.7%), CKD with 3a-b - 51 (42.5%) and CKD with 4 - 7 (5.83%). In other words, there was not a single patient with CLLI with normal GFR values. We have revealed a significant increase in the concentration of blood creatinine by 2.1 times, blood urea by 77.9%, and a decrease in GFR by 64.3% (p&lt;0.001). The mean value of the concentration of total protein in the blood serum was 58.4±3.72 mmol/l. The concentration of urea in the blood serum was 12.1±2.47 mmol/l in the CLLI group versus 6.8±0.33 mmol /l in the control group. The parameters of the functional state of the kidneys depending on the severity of CLLI showed that in the group of patients with stage IIB was an increase in serum creatinine clearance by 47.2%, amounting to 179.2 ± 15.5 μmol / l versus the data of IIA 121, 2±13.3 µmol/l (p&lt;0.01). There was also a decrease in the level of GFR in patients with stage IIB by 29.1% (p&lt;0.01) in relation to the data of stage IIA.

Conclusion
In all patients with CLLI, there was deterioration in the functional state of the kidneys, which was manifested by an increase in the concentration of blood creatinine, a decrease in GFR and the severity of albuminuria.
#5511 EXPLORING THE IMPACT OF POTENTIAL UREMIC TOXINS IN CHRONIC KIDNEY DISEASE BY PROTEOMICS: POTENTIAL BENEFITS OR ADVERSE EFFECTS?
Authors: Grgurevic Lovorka , Vojtušek Ivana , Novak Rudjer , Salai Grgur , Hrkac Stela , Brinar Ivana Vukovic 
Published: June 2023

Abstract

Background and Aims
Chronic kidney disease (CKD) is a progressive disorder characterized by a gradual reduction in kidney function. Proteomics, a large-scale analysis of protein modifications, has been used to study CKD and identify potential therapeutic targets. Studies have found that CKD is associated with changes in the expression of numerous proteins, including those involved in inflammation, cell adhesion, and metabolism. Additionally, proteomic studies have been used to identify potentially novel uremic toxins, which are compounds that accumulate in the body due to impaired kidney function.

Method
We performed a cross-sectional shotgun-proteomic study of pooled plasma across CKD stages and compared them to healthy controls. After sample pooling and heparin-column purification we analysed proteomes from healthy to CKD stage 1 through 5 participants’ plasma by liquid-chromatography/mass-spectrometry.

Results
Our results of proteomic profiling of the plasma of the patients with CKD1-5, including those after kidney transplantation, unequivocally showed that the key processing of the disease, regardless of the type and function of the observed protein groups, occurs in stage 2 of CKD, which we could call the stage - a tipping point. Through the analysis of 453 proteins, 7 established uremic toxins of "middle molecular mass" were identified. Further analysis was conducted to identify potential candidates for new uremic toxins, resulting in the identification of 15 novel proteins that may have a systemic inflammatory effect, atherogenic potential, or increase the risk of cardiovascular diseases.

Conclusion
These findings suggest that proteomics can be used to identify novel uremic toxins and provide new insights into the pathophysiology of CKD and selected toxins arrange by toxic, beneficial effect or both. Further research is needed to validate these findings and explore the potential therapeutic implications of targeting these uremic toxins.
#5613 ASSESSMENT OF THE PROGRESSION OF CKD TAKING INTO ACCOUNT METABOLIC CHANGES
Authors: Karimdjanova Guzal , Egamberdieva Dano , Ruzmetova Iroda 
Published: June 2023

Abstract

Background and Aims
To study was to study the relationship between the metabolic syndrome and the risk of CKD progression in a representative sample of patients who were hospitalized at the Department of Cardiology and Interventional Cardiology of the Republican Specialized Scientific and Practical Medical Center for Therapy and Medical Rehabilitation.

Method
In the prospective part of the study, information on demographic characteristics, including age, gender, education, and occupation, was collected from doctor's visits using a standard questionnaire. Metabolic syndrome was defined according to international guidelines in the presence of three or more of the following risk factors: waist circumference &gt;102 cm in men or &gt;88 cm in women; serum triglyceride level ≥1.70 mmol/l; HDL cholesterol level &lt;1.04 mmol/l in men or &lt;1.30 mmol/l in women; BP ≥ 130/85 mm Hg, including achieved; serum glucose level ≥6.11 mmol/l. The criteria for determining the metabolic syndrome were used.

Results
Demographic characteristics of patients are presented in the table. Mean serum creatinine was similar, but GFR was estimated to be lower among those with metabolic syndrome compared to those without. The percentage of individuals with CKD and elevated serum creatinine was statistically significantly higher among those with metabolic syndrome. It turned out that low HDL cholesterol, elevated plasma glucose and abdominal obesity were statistically significantly associated with the risk of developing C5 CKD and elevated serum creatinine. In addition, there was a significant relationship between the number of metabolic syndrome components and the percentage of C5 CKD or elevated serum creatinine (P&lt;0.015 and P=0.02, respectively). In the multivariate model, patients with 1, 2, 3, and 4 or 5 components of the metabolic syndrome had 1.51; 1.50; 2.13 and 2.72 times higher chances of CKD C5 CKD, respectively, compared to individuals without metabolic syndrome components. Overall, patients with metabolic syndrome had a 64% increase in the odds of CKD compared to the comparison group without metabolic syndrome.

Conclusion
In the present study, a positive and significant relationship was found between the metabolic syndrome and the risk of C5 CKD in the examined patients. The risk of CKD increased progressively with an increase in the number of components of the metabolic syndrome.
#5677 UPAR ACTIVATION BY UPARANT INDUCED FUNCTIONAL AND STRUCTURAL RECOVERY OF PODOCYTES AFTER FSGS-SERUM DAMAGE
Authors: Deborah Mattinzoli , Silvia Armelloni , Min LI , Daniele Dalonzo , Maria Defenza , Masami Ikehata , Carlo Maria Alfieri , Vincenzo Pavone , Giuseppe Castellano 
Published: June 2023

Abstract

Background and Aims
Idiopathic focal segmental glomerular sclerosis (FSGS) is characterized by progressive damage to the renal parenchyma leading to end-stage renal disease, frequent recurrence after kidney transplantation and no specific therapeutic intervention. Since the podocytes (PODO) are the principal target of FSGS injury, their protection could be an efficient, targeted therapy. In this context, we investigated a potential therapeutic approach based on a new peptide, UPARANT, capable of modulating the Urokinase-type plasminogen activator receptor (uPAR) on PODO.

Method
PODO were activated with 4% sera of 5 patients with recurrent FSGS for 48 h and then treated with 100 nM of UPARANT for 48 h. Proteins were then extracted for TMT proteomics. The Gene Ontology system database, valid for large-scale analysis, was used to identify the significantly enriched biological pathways and molecular functions. An in vitro model of a glomerular filtration barrier composed of PODO-endothelial co-culture was used to assess the change in filtration capacity by albumin (BSA) permeability test. The difference from baseline BSA percentage was measured after damage induced with sera from three FSGS patients and after 48 h of treatment with UPARANT.

Results
First, we found that UPARANT could counteract the BSA permeability induced by FSGS sera in the PODO-endothelial co-culture (P = .04, P = .03, and P = .02, respectively). The proteomic analysis of PODO indicated that UPARANT induced the positive regulation of plasma membrane repair mechanisms (Annexin 2 P = .007 and AHNAK P = .03); this process was strongly linked to the activation of molecular functions related to both S100 and calcium-dependent proteins. Moreover, UPARANT induced the overexpression of Endophilin-B1 (P = .02) and Vimentin (P = .02), both involved in the assembly and organization of the actin filament.

Conclusion
We demonstrated that UPARANT efficiently counteracts in vitro the effects of FSGS sera on PODO, leading to the recovery of the spatial organization of PODO, acting on the structural integrity of the plasma membrane and restoring cytoskeletal plasticity and dynamism. This might result in vivo in the protection of the integrity of the filtration barrier.
#5686 CANCER STATUS AND MORTALITY IN ELDERLY INCIDENT HEMODIALYSIS PATIENTS
Authors: Cho Hyunjeong , Park Miran , Sun In O , Park Woo Yeong , Cho Jang-Hee , Kwon Soon Hyo , Hwang Won Min , Hong Yu Ah , Shin Sung Joon , Chung Sungjin , Yoo Kyung Don 
Published: June 2023

Abstract

Background and Aims
Chronic kidney disease and elderly people are associated with an increased risk of malignancy. But it remains unclear whether older patients with active cancer or a history of previous cancer and those without a cancer history carry the same mortality risk after initiation of hemodialysis (HD). Hence, we investigated the prognosis according to cancer status in elderly patients who started HD.

Method
Using a retrospective cohort of the Korean Society of Geriatric Nephrology, in this analysis, we included 2,085 patients older than 70 years who initiated hemodialysis between 2010 and 2017. Primary outcome of all-cause mortality was assessed using the Kaplan-Meier survival estimator and Cox proportional hazards regression analysis.

Results
At recruitment, 262 (12.6%) had a history of previous cancer and 55 (2.6%) had active cancer. During a median follow-up of 3.2 years, 1357 (65.1%) died. All-cause mortality was significantly higher in the active cancer group than in the previous cancer group and the no cancer group (85.5% vs 68.3% vs 64.0%, p &lt; 0.002). Kaplan-Meier analysis revealed that all-cause mortality was significantly different among the 3 groups (p &lt; 0.001, by log-rank test). After adjustment for various clinical factors, multivariate Cox regression analysis showed a strong association of active cancer with all-cause mortality (HR:1.89; 95%CI: 1.36–2.64; p &lt; 0.001). However, previous cancer was not related to an increased risk of overall mortality (HR:1.07; 95%CI: 0.90–1.28; p = 0.448)

Conclusion
Active cancer was associated with high mortality in incident older hemodialysis patients. But patients with a history of previous cancer had a similar mortality risk compared to patients without a cancer history. Therefore, our study suggests that older cancer survivors may be able to maintain dialysis successfully.
#5759 ASSOCIATION BETWEEN PHYSICAL ACTIVITY LEVEL QUESTIONNAIRES AND DAILY STEP COUNTS IN PATIENTS ON HEMODIALYSIS
Authors: Reboredo Maycon Moura , Alvarenga Bárbara , de Jesus Luciana , Paticcié Gabriela , Da Silva Carlos Miguel , Amorim Amanda , de Souza Camila , Segura-Ortí Eva , Pinheiro Bruno , Lucinda Leda 
Published: June 2023

Abstract

Background and Aims
In patients on hemodialysis, sedentary lifestyle is highly prevalent and associated with elevated mortality. The sedentary lifestyle of these patients can be confirmed by assessing the physical activity level (PAL) evaluated by accelerometers and questionnaires. Considering that the PAL questionnaires are quick to perform and inexpensive, the aim of this study was to evaluate the association of three PAL questionnaires with daily step counts measured by an accelerometer in patients on hemodialysis.

Method
A cross-sectional study was conducted with patients aged ≥18 years who were undergoing hemodialysis treatment for at least three months. Patients were excluded if presented severe and unstable comorbidities, psychiatric or cognitive disorders, and hospitalization in the past three months. The daily step counts were recorded in the ActiGraph accelerometer (wGT3X-BT) during seven days, and analyzed by excluding the first and last day of recording and calculating the mean among the valid days (≥ 8 hours of wear time). Subsequently, the Human Activity Profile (HAP) questionnaire, the International Physical Activity Questionnaire (IPAQ) and the physical functioning domain of the 36-Item Short Form Survey (PF SF-36) were applied. The normality of the data was analyzed using the Shapiro‒Wilk test. The associations between each PAL questionnaire score and daily step counts were tested using Spearman´s correlation coefficients. Then, three multiple linear regression models were constructed with daily step counts as the dependent variable and PAL questionnaire score and potential confounders (age, gender, educational level, time on dialysis, hemoglobin, and body mass index) as independent variables. A p value &lt;0.05 was considered as statistically significant.

Results
This study included 105 patients (59.2 ± 12.5 years, 60.0% male). Daily step counts correlated significantly with the questionnaires scores (HAP, ρ = 0.552, p &lt; 0.001; IPAQ, ρ = 0.386, p &lt; 0.001; PF SF-36, ρ = 0.337, p &lt; 0.001). After adjusting for potential confounders, the multiple linear regression models showed an association between daily step counts with the HAP questionnaire score (R2 = 0.31; adjusted R2 = 0.26; p &lt; 0.001) and PF SF-36 score (R2 = 0.23; adjusted R2 = 0.18; p = 0.001).

Conclusion
The PAL questionnaires were associated with daily step counts measured by an accelerometer in patients on hemodialysis. However, our results suggest that the HAP was the best questionnaire to evaluate PAL in these patients.
#5799 COMPENSATORY HYPERTROPHY OF THE KIDNEY CONTRIBUTES TO LOSS OF KLOTHO KIDNEY THROUGH PAKT SIGNALING
Authors: Pérez-Gomez Aurora , Diaz-Tocados Juan Miguel , Coral Juan Diego Dominguez , Enriquez Maite Caus , García-Carrasco Alicia , Bardaji Ana Martinez , Revilla José Manuel Valdivielso 
Published: June 2023

Abstract

Background and Aims
Chronic kidney disease (CKD) represents a significant public health burden worldwide, mainly driven by the increase of the incidence of associated risk factors like diabetes. Decreased renal Klotho expression is an early feature of CKD, driving an increase on circulating FGF23 and phosphate. These alterations in mineral metabolism have a direct negative impact on the progression of renal dysfunction and can cause bone alterations, vascular calcification and heart failure. In parallel, during the early stages of CKD, kidneys activate molecular mechanisms of hypertrophy in an attempt to counteract the loss of renal function. The PI3K/Akt/mTOR pathway, activated by growing factors like insulin-like growing factor-1 (IGF-1) participates in compensatory renal growth. The aim of the present study is to investigate the possible role of PI3K/Akt activation on renal Klotho levels during renal compensatory hypertrophy.

Method
We generated a mice model of kidney compensatory hypertrophy (UNX mice) in which kidney klotho levels and circulating mineral metabolism parameters were analyzed. Furthermore, some of the mice were treated with inhibitors of the PI3K/Akt/mTOR pathway. In vitro, proximal tubular epithelial human cells (PTEC) were stimulated with IGF-1 in order to activate the PI3K/Akt pathway, and the effects on Klotho expression were determined.

Results
UNX mice present with an activation of the PI3K/Akt/mTOR pathway in kidney, which correlates with the loss on renal Klotho expression. Moreover, UNX mice showed an increase on both, plasma phosphate and FGF23, and a decrease in the fractional excretion of phosphate (% FEPi). Renal function, estimated by BUN plasma levels, was unaltered. Pharmacological inhibition of the pathway restored Klotho and decreased FGF23 levels, normalizing renal phosphate excretion and blood levels. In vitro, IGF-1 stimulated PI3K/Akt activation in PTEC and induced a decline on Klotho expression, which was restored with PI3K/AKT inhibitors.

Conclusion
The overactivation of PI3K/Akt/mTOR pathway in renal hypertrophy modulates Klotho expression and has direct effects on FGF23 and phosphate. Our findings constitute an important breakthrough in the research of new therapeutic targets in order to maintain renal Klotho levels, and it may be useful in the treatment of kidney disease patients.
#5887 RESULTS OF KIDNEY TRANSPLANTATION IN VERY-HIGHLY SENSITIZED PATIENTS INCLUDED IN AN EXCHANGE PROGRAM BASED ON VIRTUAL CROSSMATCH
Authors: Fernández Florentino Villanego , Mazuecos Auxiliadora , Lopez Veronica , Guindo María del Carmen de Gracia , Alonso Marta , Nuez Pablo Castro de la , Blanco Gabriel Bernal , Rodríguez-Benot Alberto , Marquez Antonia Alvarez 
Published: June 2023

Abstract

Background and Aims
In 2012, a kidney transplant (KT) exchange program for very-highly sensitized patients (panel reactive antibody [PRA] ≥95%) began in Andalusia between the 5 KT centers based on virtual crossmatch.

Method
Retrospective cohort study of KT recipients within the Andalusian very-highly sensitized patients’ program from 2012 to December 2021. Survival was analyzed using Kaplan-Meier. We performed a multivariable analysis using Cox regression for pre-KT risk factors for graft survival.

Results
During the study period, 213 KT were performed. The median PRA was 98%. of them, 18.7% were KT from type-III non-heart-beating donors and 69.5% were retransplanted patients. The median time on renal replacement therapy until KT was 1509 days and, from their inclusion in the very-highly sensitized patients’ program, 334 days. The median post-KT follow-up time was 1103 days. Patient/graft survival was 97.5%/91.7% and 82%/76.5% at one year and 5 years, respectively. Graft survival was lower in patients who had received more than one KT (P = .029). However, we found no differences when comparing PRA (&lt; or ≥98%) or type of donor. In the multivariable analysis, the number of previous KT was a predictor of graft loss. We had more detailed information on renal function and post-KT complications in patients from 3 centers (n=104). Six patients (5.7%) developed donor-specific antibodies (DSA) (1 class I, 3 class II, 2 class I and II) after a median of 267.5 days post-KT. Ten patients (9.3%) presented acute rejection (AR) diagnosed by biopsy: 4 T-cell-mediated rejection (3.7%) and 6 antibody-mediated rejection (5.6%). Active antibody-mediated chronic rejection (CR) was diagnosed in 5 patients and BK nephropathy in 2. Three graft losses were due to immunological causes (1 RA, 2 RC). Median renal function at one year was: Crp 1.3 mg/dl and glomerular filtration rate 55.1 ml/min.

Conclusion
Despite being a high-risk group, the survival results have been very satisfactory. The number of previous KT is a risk factor for graft survival.
#6178 ANCA-ASSOCIATED VASCULITIS FOLLOWING PFIZER-BIONTECH COVID-19 VACCINE: TRUE ASSOCIATION OR CIRCUMSTANTIAL?
Authors: Marouço Catarina , Pereira Tiago Assis , Fonseca Nuno Moreira , Menezes Maria Do Mar , Carvalho Dulce , Magriço Rita , Nolasco Fernando 
Published: June 2023

Abstract

Background and Aims
Antineutrophil cytoplasmatic antibody (ANCA)- associated vasculitis (AAV) is a small vessel vasculitis hallmarked by the presence of antibodies against antigens in cytoplasmic granules of neutrophils. Vaccines per se stimulate the immune system, including the innate and the adaptive immune response. Therefore, it is possible that an excess of autoimmunity is observed after vaccine administration. Vaccination (notably influenza) is a recognized trigger for the relapse of ANCA-associated vasculitis. ANCA associated vasculitis and autoimmune reactions have been reported with COVID-19 infection and following vaccination.

Results
We report the case of a Caucasian, 62 year-old-man, with a previous history of type 2 diabetes mellitus, hypertension and atrial fibrillation. Blood analysis one year before presentation showed preserved renal function and normal urinalysis. He received the first dose of Pfizer-BioNTech COVID-19 vaccine and two weeks later routine blood analysis showed acute kidney injury with serum Creatinine 1.75 mg/dL with de novo hematuria, a protein to creatinine ratio (RPC) 1.1 mg/g and candersartan (4 mg twice daily) was started. The patient received the second dose of COVID-19 vaccine 21 days after the first injection. Two weeks later he developed anorexia, nausea and de novo hematuria. He was admitted at the emergency department with deteriorating renal function with a sCr of 5.5 mg/dL, worsening hematuria with dysmorphic red blood cells and proteinuria (RPC 2.9 mg/g). Renal ultrasound was normal. Immunological studies revealed an elevated ANCA-MPO titer of 561. A kidney biopsy was performed and showed a crescentic necrotizing glomerulonephritis. Immunofluorescence confirmed pauciimmune glomerulonephritis. He was diagnosed with renal limited myeloperoxidase (MPO) ANCA AAV. He started 3 pulses of 500mg I.V methylprednisolone followed by prednisolone 1 mg/kg/day after that. He also started rituximab (4 doses of 500mg I.V once week apart). Despite the immunosuppression, the patient never recovered renal function and remained dialysis dependent.

Conclusion
Whether autoimmune diseases can be triggered after vaccination remains a matter of discussion among experts. ANCA associated vasculitis and autoimmune reactions have been reported with COVID-19 infection and following vaccination, which prompts the question whether this response could be a direct reaction to the RNA present in the vaccine. While an association with de novo ANCA vasculitis and COVID-19 vaccine may be possible, further investigation is necessary.