bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO538: Lower Serum Levels of Magnesium are Associated With Higher Risk of Fractures in Haemodialysis Patients
Authors: Ávila Gonçalo , Matias Patricia , Laranjinha Ivo , Amaral Tiago , Gil Célia , Anibal A. Ferreira Manuel 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Magnesium (Mg) deficiency is associated with altered bone metabolism, However, the relationship between Mg and the risk of fragility fractures haemodialysis (HD) patients is still unclear. The aim of this study was to evaluate the association between pre-dialysis Mg serum levels and the risk of incident bone fractures in a cohort of prevalent HD patients.

METHOD
We performed a prospective study of 206 prevalent HD patients followed from 2009 until 2021. Demographic, clinical and biochemical parameters were evaluated.

RESULTS
A total of 37 episodes of fragility fractures were identified with a median HD vintage of 42 months, which corresponds to an incidence rate of 29/1000 person-years. The mean age of the studied population was 68.3 ± 13.1 years, 121 (59%) were male and the median follow-up time on HD was 58 months.
Patients with incident fractures showed significantly lower Mg levels compared with those without fractures (2.3 ± 0.3 versus 2.8 ± 0.4 mg/dL, P &lt; 0.001). In a multivariable analysis, lower Mg levels (P = 0.02) were independently associated with increased risk of fracture, in a model adjusted to age, female gender, albumin and dialysis vintage.
Patients with a Mg serum level &lt; 2.2 mg/dL (lowest quartile) had a 1.32-fold higher risk for fragility fractures than those in the highest quartile [95% confidence interval (95% CI), 1.15–1.48; P &lt; 0.001].

CONCLUSION
This study shows that the incidence of bone fragility fractures in HD patients is high and significantly associated with lower pre-dialysis Mg levels. Management of fracture risk in HD patients and assessment of its risk factors requires further study.
MO557: Lanthanum Dioxycarbonate is Safe in Rats
Authors: Khare and Gupta Pramod Atul 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Over 7 million patients suffer from end-stage kidney disease (ESKD) worldwide.[1] Due to low kidney function, patients often become hyperphosphatemic, which leads to negative outcomes[2] including increased risk of death.[3] Patients usually rely on dietary restriction and phosphate(P) binders to address hyperphosphatemia. However, current P binders often do not achieve desired P levels[4] and have a high pill burden due to high quantity of large pills.[5,6] Having a therapeutic option using the same quantity of elemental lanthanum as existing therapies (and therefore similar efficacy) but with a potentially smaller and easy-to-administer pills would enhance patient quality of life (QoL). Lanthanum dioxycarbonate, RENAZORB(LDC), is a novel nanotechnology product that combines lanthanum, which has the highest binding capacity versus other P binders,[7] with a potentially smaller pill size that is swallowed rather than chewed to treat hyperphosphatemia in ESRD patients. However, its safety results have not yet been published. We present the results from a toxicity study evaluating safety of lanthanum dioxycarbonate in rats.

METHOD
A repeat-dose toxicology study was conducted to evaluate the potential toxicological profile of LDC. Rats were administered oral doses of LDC at 200, 600 or 2000 mg/kg/day by gavage for approximately 6 weeks. Blood samples for TK analysis were obtained from cohorts of 3 rats/sex/group/time pre-dose and at 1, 2, 4, 8, 12, 24 and 48 h after Day 1 and 38 dosing.

RESULTS
LDC was well tolerated at all test doses. The only test article-related effects noted at the high dose of 2000 mg/kg in both sexes were decreased mean cell hemoglobin (MCH) and mean cell hemoglobin concentration (MCHC), and increased urine pH, and at 600 mg/kg increased urine pH in female rats. The increased urinary pH was considered not of toxicologic relevance, and the decreases in MCH and MCHC were considered to be small enough to not adversely affect the animals’ health. The no-observed-adverse-effect level was 2000 mg/kg.

CONCLUSION
All doses of lanthanum dioxycarbonate were well tolerated and found safe in rats. These results suggest lanthanum dioxycarbonate may be a suitable candidate for further development. Potential benefits of LDC may include reduced pill burden and ease of dose administration (smaller easy-to-swallow versus chewable), which collectively has potential to enhance patient adherence, improve treatment outcomes and enhance QoL.
MO560: Adherence to Nutritional Recommendations as Expressed by Patients on Hemodialysis, Their Informal Carers and Healthcare Professionals—the Goodrenal Project
Authors: Avesani Carla , Garcia-Testal Alicia , Van Craenenbroeck Amaryllis , Kouidi Evangelia , Clyne Naomi , Lauer Andreas , Cana-Poyatos Alicia , Elena Marin Alexandra , Lindholm Bengt , Antonio Lozano-Quilis José , Yang Kevin , Moura Reboredo Maycon , Kougioumtzidou Ourania , Mesa-Gresa Patricia , Moscoso Paula , Segura Eva 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Low adherence to nutritional recommendations is common in patients on hemodialysis (HD), but the reasons are not well known. We explored the main needs, barriers and facilitators affecting nutritional adherence as experienced by patients on HD, their informal carers and their healthcare professionals (HCPs) at the dialysis centre.

METHOD
This study is part of the GoodRENal project—funded by the European Community, Erasmus + program that comprises four countries: Spain, Sweden, Belgium and Greece. As part of this project, exploratory questionnaires were constructed and answered by the patients, their carers and their HCPs. The questionnaire comprised three sections consisting of statements exploring the needs, barriers and facilitators affecting adherence to nutritional recommendations for patients on HD. Each statement could be rated from 1 (strongly disagree), 2 (disagree), 3 (neither agree or disagree), 4 (agree) to 5 (strongly agree). In addition, there was a section for free text. To avoid bias in patient selection, 10 patients were randomized from the first dialysis shift of the week in the four participating countries.

RESULTS
In total, 40 patients, 40 informal carers and 40 HCPs HealthCP accepted to participate, out of whom 38 patients (68% male, 62 ± 15 years), 33 informal carers (21% male, age 54 ± 12 years, of whom 68% were spouses) and 37 HCPs (22% male, age 42 ± 10 years, 60% were nurses) answered the questionnaires. Two of the four centres had a dedicated dietitian at the dialysis unit, who worked there on average 18 ± 8 hours per week. At the dialysis units without a dietitian, the nurses and doctors were responsible for nutritional care. To simplify the analysis, answers rated as 4 and 5 were grouped as agree. The main findings are presented below:

CONCLUSION
These descriptive findings show that patients, informal carers and HCPs identified different needs, barriers, and facilitators to increase adherence to nutritional recommendations. These results can be used to build and tailor strategies aimed at patients, informal carers and HCPs.
MO563: Effect of Probiotics on Uremic Toxins Production and Inflammation in Patients Suffering from CKD Stage 3 and 4
Authors: Sharma Manjuri , Kharbuli Indakiewlin , Kumar Doley Prodip , Dange Shruti , Gope Manas , Pegu Gayatri , Brijesh Singh K. 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Probiotics are being coprescribed in the management of chronic kidney disease (CKD). Few studies have reported that probiotics could slow down the progression of CKD by regulating the intestinal flora and by reducing the uremic toxins. [1,2] Objective of our study is to assess the effect of probiotics on uremic toxins production and inflammation in patient suffering from CKD stage 3 and 4.

METHOD
Patients of either sex, aged 18–75 years, suffering from CKD stage 3 and 4 were enrolled. Study was conducted at Department of Nephrology, Guwahati Medical College and Hospital (GMCH), Guwahati, Assam. Patients received 1 capsule containing 45 billion of colony forming units of probiotics twice a day for 180 days. Patients were evaluated at day 0, 90 and 180. Parameters such as serum creatinine, blood urea, uric acid, C-reactive protein (CRP), hemoglobin and albumin were recorded at each visit.

RESULTS
During period of May 2019 to May 2020, 102 patients were enrolled and followed for 180 days. Significantly higher number of males 67 (66%) than 35 (34%) females is reported (P = 0.024). CKD stage 3 and 4 is reported in 41 (40% ) and 61 (60%), respectively. Insignificant drop of serum creatinine of -0.17 (on day 90, P = 0.146) and -0.23 (on day 180, P = 0.135) compared with baseline Sr. creatinine 2.53 ± 0.56 (mean ± SD) is reported. Significant drop in blood urea is reported on day 90 (-2.97, P = 0.014) and on day 180 (-3.60, P &lt; 0.001) compared with baseline 52.11 ± 26.90 (mean ± SD). The reduction in CRP on day 90 and day 180 from baseline was found to be statistically significant (P = 0.037, 0.011). However, reduction in uric acid and increase in hemoglobin and albumin did not reach significance on day 90 and day 180.

CONCLUSION
Probiotics supplementation lead to decrease in blood urea and CRP. However, its effect on serum creatinine, hemoglobin, uric acid and albumin did not reach statistical significance. More randomized controlled trials are required to prove the efficacy of probiotics to retard CKD progression.
MO621: Effectiveness of Adjuvant Astragalus for Diabetic Kidney Disease: Interim Analysis of A Pragmatic Randomised Controlled Trial
Authors: Wa Chan Kam , Siu Kei Kwong Alfred , Nang Tsui Pun , Fai Choi Wing , Han Yiu Wai , Beng Kathryn Tan Choon , Tang Sydney 
Published: May 2022

Abstract

BACKGROUND AND AIMS
More regimens targeting different mechanisms are needed for the residual risk of renal progression among diabetic kidney disease (DKD) patients. Although in vivo and in vitro studies suggested that add-on astragalus, a commonly used Chinese medicine, could retard renal progression in chronic kidney diseases, its effect on DKD is unclear.

METHOD
This assessor-blind, add-on, randomized, controlled, parallel, pragmatic trial evaluates the effect of 48 weeks of oral astragalus granules on 118 patients with estimated glomerular filtration rate (eGFR) of 30–90 mL/min/1.73 m2 and urinary albumin-to-creatinine ratio (UACR) of 34–565 mg/mmol. Primary endpoints are the changes in eGFR and UACR between baseline and treatment endpoint. Outcomes are analyzed as intention-to-treat by mixed-effect regression models, adjusting the baseline values of quantitative outcomes, allocation, visit and the interaction between allocation and visit.

RESULTS
Recruitment started in July 2018. Baseline demographics are comparable between groups. The mean age is 67.9 years and 35.6% are female. Baseline eGFR is 58.1 mL/min/1.73 m2 and the geometric mean of the baseline UACR is 124.5 mg/mmol. From the first 60 patients who have completed the 48-week study period, the endpoint eGFR is 56.2 and 52.7 mL/min/1.73 m2 {intergroup difference: 3.4 mL/min/1.73 m2 [95% confidence interval (CI) −0.3–7.1], P = 0.071} after receiving add-on astragalus and standard care alone, respectively. The endpoint UACR is 138.4 and 116.8 mg/mmol [proportional difference: 1.19 (95% CI 0.91–1.54)] after receiving add-on astragalus and standard care alone, respectively. Four patients developed serious adverse events in each arm. The most common adverse events are edema, syncope and hyperkalemia.

CONCLUSION
Our interim analysis suggests that add-on astragalus treatment has a trend of stabilizing eGFR among DKD patients with macroalbuminuria.
MO627: Effectiveness of Integrative Chinese–Western Medicine for Chronic Kidney Disease and Diabetes: A Retrospective Cohort Study
Authors: Wa Chan Kam , Yee Chow Tak , Yan Yu Kam , Wong Taam Vivian , Tang Sydney 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Chronic kidney disease (CKD) and diabetes are key contributors of disability-adjusted life years globally awaiting more therapeutic options. This registry-based retrospective cohort study aimed to evaluate the effectiveness, safety profile and prescription pattern of a pilot integrative Chinese–Western medicine service program in Hong Kong.

METHOD
Data from 38 patients with diabetes and CKD received 48 weeks of individualized add-on Chinese medicine (CM) were retrieved from electronic hospital database. Patients from the same source were matched by propensity score to generate a 1:1 cohort. Primary outcomes were the change of estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) analyzed by analysis of covariance (ANCOVA) and mixed-effect regression model adjusted for baseline eGFR, age, gender, duration of diabetes history, history of hypertension, diabetic retinopathy, and the use of insulin and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. Rate of adverse events and the change of key biochemical parameters were also analyzed.

RESULTS
After a median follow-up of 51 weeks, patients who received add-on CM had stabilized eGFR [0.74 mL/min/1.73 m2 (95% CI −1.01–2.50)] and UACR [0.95 (95% CI 0.67–1.34)]. Add-on CM was associated with significantly preserved eGFR [inter-group difference: 3.19 mL/min/1.73 m2 (95% CI 0.32–6.06), P = 0.030] compared with standard care. The intergroup ratio of UACR were comparable [0.70 (95% CI 0.45–1.08), P = 0.104] between groups. The result is robust in sensitivity analysis with different statistical methods. The rate of serious adverse events (8.1% versus 18.9%, P = 0.174), moderate-to-severe hyperkalemia (8.1% versus 2.7%, P = 0.304) and hypoglycemia (13.5% versus 5.4%, P = 0.223), and the levels of key biochemical parameters were comparable between groups. Top 7 most used CMs contained two classical formulations namely Liu-wei-di-huang-wan and Si-jun-zi-tang.

CONCLUSION
Add-on individualized CM was associated with kidney function preservation. Further randomized controlled trial using CM prescriptions based on Liu-wei-di-huang-wan and Si-jun-zi-tang is warranted.
MO631: Diabetic Retinopathy and/or Diabetic Nephropathy Confers A Worse Renal Prognosis
Authors: Bermejo Garcia Sheila , Agraz Irene , Vergara Ander , Bestard Oriol , Jose Soler Romeo Maria 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Around 50%–60% lesions of non-diabetic nephropathy (NDN) have been identified in patients with diabetes and renal biopsy. NDN patients have a better renal prognosis and survival. Diabetic retinopathy (DR) is a microvascular complication of diabetes frequently associated with diabetic nephropathy (DN). The objective of the work is to study the renal prognosis and survival of patients with DN with or without DR.

METHOD
Retrospective, observational, multicenter study of the pathological results of diabetic patients with renal biopsy was undertaken. A total of 18 Spanish centers have participated.

RESULTS
Cohort of 832 patients: 621 men (74.6%), median age 61.7 ± 12.8 years, median creatinine 2.8 ± 2.2 mg/dL and proteinuria 2.7 (1.2–5.4) g/24 h. Of them, 26.6% (n = 221) presented DR, 18.8% (n = 156) peripheral vasculopathy and 17.7% (n = 147) ischemic heart disease.
On biopsy, 39.5% (n = 329) of patients had DN, 413 (49.6%) NDN and 90 (10.8%) mixed forms. We evidenced more DR in the DN group compared with the other two groups (44.1% versus 11.1% in NDN and 33.3% in mixed forms). Regarding renal prognosis, 58.9% (n = 109) of patients with DR and DN and mixed forms required RRT versus 40.7% (n = 88) of patients without DR. A total of 39.1% (n = 18) of patients with DR and NDN required renal replacement therapy (RRT) versus 23.9% (n = 79) of patients without DR. Regarding mortality, 28.6% (n = 50) of patients with DR and DN or mixed forms died during the follow-up versus 22.7% (n = 49) of patients without DR. A total of 15.2% (n = 7) of patients with DR and NDN died and 15.4% (n = 51) of patients without DR.
In survival analysis (Kaplan—Meier curves), patients with DR had worse renal prognosis (P &lt; 0.001), patients with DN (P &lt; 0.001) and patients with DR and/or DN and mixed forms (P = 0.02). Cox regression analysis identified as independent risk factors of RRT: age (OR 1.014;1.025–1.004, P = 0.006), creatinine (OR 1.262; 1.217–1.309; P &lt; 0.001), proteinuria (OR 1.057; 1.03–1.085; P &lt; 0.001), DR (OR 1.359; 1.007–1.833; P = 0.045), DR and/or DN (OR 1.59; 2.42–1.04; P = 0.033) and DN (OR1.489; 1.05–2.11; P = 0.026).

CONCLUSION
The presence of DR and/or DN confers a worse renal prognosis. The diagnosis of diabetic microangiopathy in terms of retinopathy and/or diabetic nephropathy is crucial since it confers a worse renal prognosis indicating patients at risk of progression to end-stage renal disease.
MO634: Effects of Dapagliflozin in Patients with Heart Failure
Authors: Abdullaev Sherzod , Sharapov Olimkhon 
Published: May 2022

Abstract

BACKGROUND AND AIMS
In patients with type 2 diabetes, inhibitors of sodium–glucose cotransporter 2 (SGLT2) reduce the risk of a first hospitalization for heart failure, possibly through glucose-independent mechanisms. More data are needed regarding the effects of SGLT2 inhibitors in patients with established heart failure and a reduced ejection fraction, regardless of the presence or absence of type 2 diabetes.

METHOD
A multicenter prospective cohort study, where 225 patients with heart failure (III and IV by NYHA) and an ejection fraction of 45% or less to receive either dapagliflozin (10 mg once daily) or placebo, in addition to basic therapy. The primary outcome was a composite of worsening heart failure (hospitalization or an urgent visit resulting in intravenous therapy for heart failure) or cardiovascular death.

RESULTS
After 12 months, the primary outcome occurred in 17 of 111 patients (15.31%) in the dapagliflozin group and in 24 of 114 patients (21.05%) in the placebo group {HR 0.74 [95% confidence interval (CI), 0.65–0.85]; P &lt; 0.001}. A first worsening heart failure event occurred in 10 patients (9.0%) in the dapagliflozin group and in 16 patients (14.0%) in the placebo group [HR 0.70 (95% CI 0.59–0.85)]. Death from cardiovascular reasons occurred in six patients (5.4%) in the dapagliflozin group and in 11 patients (9.6%) in the placebo group [HR 0.80 (95% CI 0.69–0.95)]; 12 patients (10.8%) and 15 patients (13.1%), respectively, died from other causes [HR 0.83 (95% CI 0.71–0.96)]. Findings in patients with diabetes were not significantly pronounced than in patients without diabetes. The frequency of adverse events related to volume depletion, renal dysfunction and hypo/hyperglycemia did not differ between treatment groups.

CONCLUSION
Among patients with heart failure and a reduced ejection fraction, the risk of worsening heart failure or death from cardiovascular events was lower among those who received dapagliflozin than among those who received placebo, regardless of the presence or absence of diabetes.
MO653: High-Flux Haemodialysis and Haemodiafiltration: A Comparative Study Based on 1-H NMR Serum Metabolic Profile
Authors: Flores Santos Andressa , Manfron Schiefer Elberth , Sassaki Guilherme , Menezes Leociley , Fonseca Renato , Cunha Regiane , Souza Wesley , Pecoits-Filho Roberto , Stinghen Andréa E M 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Patients with chronic kidney disease (CKD) accumulate uraemic toxins (UTs). When compared to other conventional dialysis modalities, high volume haemodiafiltration (HDF) improves the removal of medium and low molecular weight UTs. The present study is a post-hoc analysis comparing the metabolomic profile in serum from patients under high flux HD (hf-HD) and HDF in HDFIT, a multicentric randomized controlled trial (RCT).

METHOD
Random (pre- and post-dialysis) samples from nine patients in a study arm were selected at baseline and at the end of the follow-up. To compare the samples, 26 possibly matching metabolites were identified by a t-test among the four groups using 1-H nuclear magnetic resonance (NMR).
To evaluate the comparison between the modalities in a single treatment session, the clearance rates (CRs) of each metabolite were calculated based on pre- and post-dialysis samples. In addition, to evaluate the effect of UTs removal during the trial follow-up period, the pre-dialysis metabolite concentrations both at the baseline and 6 months were compared with the two arms of the study.

RESULTS
Evaluating the concentrations of the metabolites during the follow-up period for each study arm, it was possible to assess the effects of UTs removal during the study for each modality. The comparison of the intensity of the peaks identified 26 possible metabolites that differentiated hf-HD and HDF in this timeframe. The correlation (see Figure 1a) then suggested that the peak integrals of 16 of these metabolites increased from baseline to 6 months in the hf-HD, but not in the HDF arm. Amongst the metabolites, several are involved in important metabolic pathways, such as the metabolisms of phenylalanine and the biosynthesis of phenylalanine, tyrosine and tryptophan, which both relate to UTs and the development of cardiovascular diseases. The peak integration relative to glycolic acid was significantly higher (P&lt;.05) at 6 months than at baseline (see Figure 1b) in the hf-HD than in the HDF arm, which has been related to an increased number of renal failure and of renal insufficiency cases [1,2], as well as it related to liver damage [3].

CONCLUSION
The concentrations of metabolites related both to CKD and associated pathologies were stable in the HDF arm only during the follow-up period, suggesting enhancement of the long-term stability by this method. In the hf-HD long-term follow-up, the relative increase in the glycolic acid peak integration area, which is related to the metabolite concentration, has also previously been linked to an increased number of renal failures and renal insufficiency cases and to liver damages.