bluuebunny/crossref_metadata_2025_split huggingface dataset:
FC 105: Multidimensional Prognostication Tool for Kidney Transplant Patient Survival: The Mortality Mbox
Authors: Debiais-Deschamps Charlotte , Aubert Olivier , Yoo Daniel , Divard Gillian , Legendre Christophe , Loupy Alexandre 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Predicting kidney transplant patient mortality has been hampered by registry-based studies and low-level phenotyped cohorts without specific design towards mortality prediction. This represents a limitation for decision making and ultimately patient care. We aimed to build a robust patient mortality prognostication system.

METHOD
We enrolled 1446 patients transplanted in France between 2004 and 2014 in whom a protocol-based collection including more than 160 parameters from the recipient (past medical history, risk factors) donor and graft, biological and imaging data, was performed on the day of transplantation (TX) and during the first year of transplantation. Multivariable Cox model was used to develop an individual predictive score of mortality, further improved by a Lasso regression in order to retain the strongest predictors of mortality.

RESULTS
Among the 1446 kidney transplant recipients included, 309 patients died after a median post-TX follow-up time of 7.6 years (IQR 5.40–10.78).
Among the 120 parameters, 19 predictors were selected using lasso regression. The strongest predictors of patient survival were (1) baseline recipient factors (age, history of cancer, diabetes mellitus, chronic obstructive pulmonary disease, cardiovascular events: myocardial infarction, stroke or arteritis, supraventricular cardiac rhythm disorder, psychiatric history and VHC status); (2) post-TX parameters (need for dialysis, cardiovascular complications and cancer in the first year of TX); and (3) seven biological variables (HbA1c, C-reactive protein, albumin, gamma-glutamyl transferase, uric acid, neutrophils and urinary protein). The mortality score showed accurate calibration and discrimination at 10 years [C-statistic = 0.81; 95% confidence interval (95% CI) 0.78–0.83].

CONCLUSION
We generate the first integrative patient survival score that shows a superior prediction performance when compared to previous prognostic systems, reaching 81% prediction accuracy at 10 years. A reliable survival prediction tool will enable improved patient monitoring and therapeutic decision making to alter the course of an unfavorable patient survival outcome and may provide a surrogate endpoint in clinical trials.
FC 110: Survival Benefit of Preemptive Simultaneous Pancreas-Kidney Transplantation
Authors: Montagud-Marrahi Enrique , Cuadrado Elena , Hermida Evelyn , Cucchiari David , Revuelta Ignacio , Del Risco Zevallos Jimena , Esforzado Nuria , Cofan Pujol Federico , Oppenheimer Federico , Torregrosa Jose-Vicente , Ferrer Joana , Amor Antonio J , Esmatjes Enric , Jose Ramirez Maria , Musquera Mireia , Enriqueta Bayes Genis Beatriu , Maria Campistol Plana Josep , Diekmann Fritz , Ventura Aguiar Pedro 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The evidence regarding the benefits of performing preemptive SPK (pSPK) is controversial. The aim of the present study was to evaluate the impact of pSPK on long-term patient and grafts outcomes when compared with npSPK and pKTA through a national registry study with recipients reported to the Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS) registry, and to analyse the potential benefits associated with pSPK not only in patients with T1D but also in patients with T2D.

METHOD
To explore the survival advantage of performing a pSPK, we compared the outcomes in pSPK with nonpreemptive SPK (npSPK) recipients between 2000 and 2017 from the OPTN/UNOS registry. To account for the potential benefit provided solely by the kidney transplant, we further compared to recipients of preemptive Kidney Transplantation Alone (pKTA) with diabetes. A propensity score analysis was applied.

RESULTS
A total of 1522 patients received a pSPK, 7894 an npSPK and 3343 a pKTA. Overall recipient survival was superior for the pSPK group when compared with the pKTA (97.7%, and 80.9% versus 97.7% and 72.9% at 1 and 10 years, respectively, P &lt; 0.001), with pKTA being associated with an increased risk of patient death [HR 1.34, 95% confidence interval (95% CI) 1.10–1.63; P = 0.003]. Estimated kidney graft survival was similar in both groups. After IPTW adjustment, pKTA was significantly associated with an increased risk of death-censored kidney graft failure (HR 1.31, 95% CI 1.09–1.56; P = 0.002). The npSPK patients presented both worse patient and kidney graft survival when compared with pSPK.

CONCLUSION
In conclusion, the observed survival benefit of performing an SPK preemptively reinforces the need for early referral for transplantation in patients with insulin-dependent diabetes and advanced chronic kidney disease.
FC 120: Lipid Changes as Early Indicator for Diabetes Induced Renal Pathology
Authors: Rietjens Rosalie , Wang Gangqi , Sol Wendy , Heijs Bram , van den Berg Bernard , Rabelink Ton 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Diabetic nephropathy (DN), chronic loss of kidney function due to diabetes mellitus, is a common complication in diabetes which currently lacks effective long-term treatment. Microalbuminuria is now the earliest marker for DN, thereby disregarding renal changes that occur before this first indication of decreased kidney function. For better diagnosis and treatment strategies, it is important to study diabetes induced early renal changes. Renal-specific changes of the lipid metabolism could serve as an indicator for early kidney damage. Mass spectrometry imaging (MSI) allows to study the lipid metabolism in the context of tissue histology without the need for labeling (i.e. antibody or radioactive). Existing literature applying this technique focuses on later stages of diabetic kidney disease, thereby overlooking its potential to serve in an earlier stage of diagnosis. The aim of this project is to identify renal cell-specific lipid changes using MSI which could serve as damage markers for early diabetes induced renal pathology.

METHOD
To study diabetic renal changes, apolipoprotein E-knockout mice were treated with streptozotocin (STZ) and put on an enriched cholesterol diet to induce diabetes. After 12 weeks, both control (n = 4) and diabetic (n = 4) mice were sacrificed and kidneys were harvested for immunohistochemical and matrix assisted laser desorption/ionization (MALDI) MSI. Post-MSI immunofluorescent staining in combination with tissue morphology was used to identify different renal cell types. Analysis of MALDI-MSI data allows us to spatially segment the results per cell type for further statistical analysis of the metabolic MSI data (Figure 1A).

RESULTS
Two weeks after STZ induction, blood glucose levels of the diabetic mice were significantly elevated compared to control. Spatial segmentation analysis of the MSI data revealed that in both groups different renal cell types could clearly be distinguished based on their metabolic profile. Using the immunofluorescence-based cell type annotation, we zoomed in on various morphological regions of the kidney to specifically test for changes in lipid profiles. Here, the proximal tubular cells in the cortex and the outer stripe of outer medulla had the highest number of significantly changed lipids (Figure 1B). Focusing the analysis on these two groups of cells revealed specific molecular signatures to be discriminative between diabetes and control (Figure 1C).

CONCLUSION
Using MSI, we were able to identify renal cell type-specific differentially expressed lipids in diabetic mice compared to the healthy control group. The proximal tubular cells in the cortex and outer stripe of the outer medulla had the most altered lipid composition. These molecular signatures might serve as an early indicator of diabetes induced renal changes, thereby opening up a potential window for treatment before the kidney is damaged beyond repair.
FC 121: The Combination of Empagliflozin and Atrasentan on Top of RAS Blockade Ameliorates Cardiorenal Injury in a Type 2 Diabetic Mouse Model
Authors: Vergara Arana Ander , Jacobs Cachá Conxita , Molina Mireia , Llorens Cebrià Carmen , Dominguez Pamela , Bermejo Sheila , Paul Pieper Michael , Benito Begoña , Jose Soler Romeo Maria 
Published: May 2022

Abstract

BACKGROUND AND AIMS
sodium-glucose 2 cotransporter inhibitors (SGLT2i) prevent cardiovascular events in diabetic patients. Moreover, their diuretic effect could attenuate the adverse events of endothelin receptor antagonists (ERA), which have also shown kidney protective effects in diabetes. The present study aimed to evaluate the beneficial cardiorenal impact of the combination of SGLT2i, ERA and ramipril versus treatment with ramipril alone in experimental diabetes.

METHOD
Twelve-week-old db/db mice were treated for 8 weeks with different combinations of an SGLT2i (empagliflozin, 10 mg/Kg/day), an ERA (atrasentan, 7 mg/Kg/day) and an RAS blocker (ramipril, 8 mg/Kg/day). Vehicle-treated diabetic and nondiabetic mice were included as controls. During the experiment, blood pressure (BP), glomerular filtration rate (GFR) and echocardiographic parameters were measured. Kidney and heart were collected at the end for histological studies.

RESULTS
The triple therapy with empagliflozin, atrasentan and ramipril was superior to ramipril alone in reducing BP (mean BP 61.0 mmHg versus 67.10 mmHg in the ramipril group), preventing diabetic hyperfiltration (214.3 μL/100 g/min GFR decrease versus 34.7 μL/100 g/min decrease in the ramipril group) (Figure 1), and improving echocardiographic parameters of diastolic dysfunction, including left atrium diameter and isovolumetric relaxation time. Moreover, the combined therapy offered protection against diabetic injury in kidney and heart by a reduction of mesangial matrix expansion (46.0% of glomerular mesangial matrix versus 46.9% in the ramipril group), as well as left ventricle cardiomyocyte hypertrophy (mean cardiomyocyte area 125 μm2 versus 131 μm2 in the ramipril group) and heart collagen deposition (Figure 1).

CONCLUSION
In experimental diabetes, combined therapy of ramipril, empagliflozin and atrasentan promotes both heart and kidney protective effects that outweigh the beneficial effects of ramipril alone.
FC 128: Novel Glucose-Lowering Drugs and the Risk of Acute Kidney Injury in Routine Care: The Stockholm Creatinine Measurements (SCREAM) Project
Authors: Alkas Jim , Bosi Alessandro , Sjolander Arvid , Peter Barany Franz , Elinder Carl-Gustaf , Fu Edouard , Jesus Carrero Juan 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Little is known about the comparative effects of dipeptidyl peptidase-4 inhibitors (DPP-4i), glucagon-like peptide-1 receptor agonists (GLP-1RAs) or sodium glucose cotransporter-2 inhibitors (SGLT2i) on risk of acute kidney injury (AKI) in routinely care, which may differ from the controlled setting of trials.

METHOD
We performed a population-based retrospective analysis using the Stockholm CREAtinine Measurements (SCREAM) database, with complete information on diagnoses, medication dispensation claims and laboratory test results for all Stockholm citizens accessing healthcare during 2008–2018. We used a new user active comparator design: new initiation of SGLT2i, GLP1-RA or DPP-4i. The outcome AKI was defined by ICD-10 diagnostic codes as well as KDIGO criteria for rapid creatinine elevations. A multinominal propensity score model with inverse probability treatment weights (IPTW) was used to adjust for 59 identified confounders. Weighted Cox regression was used to estimate adjusted hazard ratios and weighted Kaplan-Meier curves for adjusted absolute risks.

RESULTS
We included 17 043 participants who newly initiated DPP-4i (N = 10 345), GLP1-RA (N = 4384) or SGLT2i (N = 2314). Mean age was 63 years (38% women) and median eGFR 89 mL/min/1.73 m2. During a median follow-up of 2.5 years, 1361 participants experienced AKI. SGLT2i users had the lowest incidence rate of AKI, 17.4 per 1000 person years [95% confidence interval (95% CI) 13.3–22.4], followed by GLP1-RA users, 22.2 (95% CI 19.6–25) and DPP-4 users, 26.1 (95% CI 24.6–27.8). The adjusted 3-year absolute risk for AKI was 5.98 (95% CI 3.65–8.38) in the SGLT2i arm, compared with 6.45 (95% CI 5.26–7.62) in the GLP1-RA arm and 7.03 (95% CI 6.45–7.59) in the DPP-4i arm. The adjusted hazard ratio was 0.85 (95% CI 0.58–1.18) for SGLT2i versus DPP-4i, and 0.93 (95% CI 0.78–1.11) for GLP1-RA versus DPP-4i.

CONCLUSION
This study of routinely cared patients initiating novel glucose-lowering drugs observed similar occurrence of AKI between therapies.
MO081: Ambulatory Blood Pressure Trajectories and Blood Pressure Variability in Kidney Transplant Recipients: A Comparative Study Against Chronic Kidney Disease Patients
Authors: Korogiannou Maria , Theodorakopoulou Marieta , Sarafidis Pantelis , Eleni Alexandrou Maria , Pella Eva , Efstathios Xagas , Argyris Antonis , Protogerou Athanase , Papagianni Aikaterini , Boletis Ioannis , Marinaki Smaragdi 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Hypertension is a major cardiovascular risk factor in both kidney transplant recipients (KTRs) and patients with chronic kidney disease (CKD). Ambulatory blood pressure monitoring (ABPM) is considered the gold standard method for hypertension management in these subjects. This is the first study evaluating in comparison the full ambulatory BP profile and short-term BP variability (BPV) in KTRs versus CKD patients without kidney replacement therapy.

METHOD
93 KTRs were matched with 93 CKD patients for age, sex and eGFR. All participants underwent 24 h ABPM; mean ambulatory BP levels, BP trajectories and BPV indices [standard deviation (SD), weighted-SD and average real variability] were compared between the two groups.

RESULTS
There were no significant between-group differences in 24-h SBP/DBP (KTRs:126.9 ± 13.1/79.1 ± 7.9 versus CKD:128.1 ± 11.2/77.9 ± 8.1 mmHg, P = 0.522/0.293), daytime SBP/DBP and nighttime SBP; nighttime DBP was slightly higher in KTRs (KTRs:76.5 ± 8.8 versus CKD:73.8 ± 8.8 mmHg, P = 0.040). For both ambulatory SBP/DBP, repeated-measurements-ANOVA showed a significant effect of time (SBP: F = [19, 3002]=11.735, P &lt; 0.001, partial η2 = 0.069) but not of KTR/CKD status (SBP: F = [1, 158] = 0.668, P = 0.415, partial η2 = 0.004). Ambulatory systolic/diastolic BPV indices were not different between KTRs and CKD patients, except for 24-h DBP-SD that was slightly higher in the latter (KTRs: 10.2 ± 2.2 versus CKD: 10.9 ± 2.6 mmHg, P = 0.041). No differences were noted in dipping pattern between the two groups.

CONCLUSION
Mean ambulatory BP levels, BP trajectories and short-term BPV indices are not significantly different between KTRs and CKD patients, suggesting that KTRs have a similar ambulatory BP profile compared with CKD patients without kidney replacement therapy.
MO082: Predictors of Decreased Renal Function in Patients With Arterial Hypertension and Chronic Obstructive Pulmonary Disease
Authors: Boiko Olha , Rodionova Viktoriia 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Arterial hypertension is characterized by kidney damage as a target organ. In turn, as a result of immunological and pathophysiological processes, in patients with COPD, a decrease in renal function was revealed 1.6 times more often than in the general population. The aim of this study was to identify predictors of a decrease in GFR below 60 mL/min in the case of comorbidity of arterial hypertension and COPD.

METHOD
A single-stage study included 51 patients with comorbid hypertension and COPD [mean age 59.3 (3.1) years]. The exclusion criteria were age over 80 years, primary kidney disease, diabetes mellitus, cancer, heart failure, stage III hypertension. All patients underwent determination of cystatin C in the blood, studied the composition of the body using bioimpedance and spirographic examination. To determine the predictors of kidney damage, we used regression analysis with ROC-curve estimation using the MedCalc software.

RESULTS
Total adipose tissue (P &lt; 0.0001), BMI (P = 0.003), FEV1 (P = 0.0002) had the greatest statistical significance. In turn, the highest AUCs were also in predictors such as total adipose tissue [0.91 (0.66; 0.99)], FEV1 [0.86 (0.63; 0.98)]. The optimal value (cut-off point) of adipose tissue content, which allowed to most accurately predict a decrease in GFR &lt; 60 mL/min in patients with hypertension and COPD was 41.3 (sensitivity: 100%, specificity: 85.7%), visceral fat: 11% (sensitivity:100%, specificity: 78.3%), BMI: 30 kg/m2 (sensitivity: 100%, specificity: 50.0%). The optimal value (cut-off point) of blood cystatin C, which allowed to most accurately predict a decrease in GFR &lt; 60 mL/min in patients with hypertension and COPD was 1.21 mg/L (sensitivity: 75%, specificity: 87.5%), FEV1: 64.0% (sensitivity: 100%, specificity: 66.7%), ambulatory artery stiffness index: 0.43 (sensitivity: 80%, specificity: 100%)

CONCLUSION
Predictors of GFR reduction &lt;60 mL/min in patients with hypertension and COPD were: increase in total adipose tissue &gt;41.3%, increase in visceral fat &gt;11%, increase in BMI &gt;30 kg/m2 increase in Cystatin C &gt; 1.21 mg/L and reduction of FEV1 &lt; 64.0%.
MO091: Serum Hepatocyte Growth Factor is Associated With Albuminuria in Subjects With Optimal Blood Pressure and Untreated Arterial Hypertension
Authors: Fistrek Prlic Margareta , Knezevic Tamara , Ivkovic Vanja , Fucek Mirjana , Abramovic Baric Mirta , Brzic Ivan , Domislovic Marija , Jelakovic Bojan 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Hepatocyte growth factor (HGF) is a pleiotropic factor that has a protective role in acute renal injury. HGF prevents the development of chronic renal fibrosis in animal models via inhibition of transforming growth factor β1 expression and consequently reduces podocyte injury and proteinuria.[1,2] Serum HGF concentration is associated with systolic arterial blood pressure (BP) and is higher in hypertensive than in normotensive individuals, especially if complications of arterial hypertension are developed.[3,4] Our aim was to determine the association of serum HGF concentration and albuminuria in normotensive subjects and subjects with untreated arterial hypertension.

METHOD
Data from 563 subjects (57.8% women, mean age 48 years) was analyzed. After clinical examination, fasting blood and urine samples were drawn. Albuminuria was normalized to urine creatinine and expressed as an albumin/creatinine ratio (ACR). HGF was measured using a commercial test. BP was measured according to ESH guidelines. Based on BP values, subjects were divided into two groups: OBP: subjects with optimal blood pressure (BP &lt; 120/80 mmHg, N = 295), and UAH: subjects with untreated arterial hypertension (BP &gt; 140/90 mmHg, N = 268).

RESULTS
Subjects with UAH were significantly older and had higher values of body mass index, waist circumference, serum total, and LDL-cholesterol levels, triglyceride levels, fasting glucose levels, and ACR (all P &lt; 0.001). Serum HGF concentrations were also higher in UAH subjects, but the difference was not significant (270.8 versus 304.2 pg/mL, P = 0.651). Subjects with ACR &gt; 30 mg/g had higher values of serum HGF concentration in comparison with subject with ACR &lt; 30 mg/g in both groups, but the difference again was not significant (262.1 versus 527.8 pg/ml, P = 0.747 and 328.6 versus 843.5 pg/ml, P = 0.066, respectively). Serum HGF concentration showed a significant positive correlation to ACR in both groups (P &lt; 0.05). Multivariate regression analysis showed that BP was an independent predictor of ACR increase (Beta = 0.134, P = 0.028), whereas age, sex and serum glucose were not. Serum HGF concentration was also a strong predictor of the ACR increase (Beta = 0.376, P &lt; 0.001).

CONCLUSION
Serum HGF concentration is associated with ACR in subjects with not only untreated arterial hypertension but also optimal blood pressure. We found that HGF is an independent predictor of the ACR increase in this population.
MO346: Timing of Renal Replacement Therapy Initiation in Patients With Septic Acute Kidney Injury: A Systematic Review and Meta-Analysis
Authors: Jung Oh Hyung , Su Ku Nam , Eun Chung Yong 
Published: May 2022

Abstract

BACKGROUND AND AIMS
To evaluate the optimal timing of renal-replacement therapy (RRT) initiation with a systemic review and meta-analysis in the patients with septic acute kidney injury (AKI).

METHOD
Systemic searches of PubMed, Cochrane and Embase databases from their inception to June 2021 were investigated. Studies that reported original data that specifically mentioned applying RRT in septic patients with AKI were selected. And, full-text reviews were performed by two reviewers independently with the following eligibility criteria: (1) observational cohort and/or randomized clinical trial (RCT) design; (2) adult septic patients; (3) diagnosis of AKI; (4) description of factors related to the timing of RRT initiation; and (5) description of mortality outcomes.

RESULTS
Among a total of six studies including 1058 patients, the 28-day mortality rate was significantly lower in the early RRT-treated group compared with the late group [RR = 0.69; 95% confidence interval (95% CI) (0.51–0.94); P = 0.018]. Moreover, among the five studies including 938 patients, the 90-day mortality rate was also significantly lower in the early RRT-treated group than in the late group [RR = 0.61; 95% CI (0.47–0.80); P = 0.01]. In a subgroup analysis for continuous RRT (CRRT), we also found significantly lower 28- and 90-day mortality rates in the early CRRT-treated group compared with the late group.

CONCLUSION
This study showed that early initiation of RRT might reduce 28- and 90-day mortality compared with late initiation in septic AKI patients.
MO348: Methylene Blue Beneficial Effect in Treatment of Renal Calculi in Patient With Recurrent Urinary Tract Infection
Authors: Ivanov Dmitry D 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Assessment of efficacy of fixed combination of cranberry and sage extract with methylene blue (MBC) in dose of 30 mg twice daily in the prevention and management of chronic renal calculous disease.

METHOD
In 87 patients who complained recurrent urinary tract infection (UTI)—55 pts with pyelonephritis and 32 with cystitis—at least three episodes in 12 months, the impact of 3 months treatment of MBC with on renal calculi was investigated. All patients were older than 18 years without any biochemical or congenital kidney abnormalities, coagulopathies with size of renal stone over 10 mm. Simultaneous administration of phenothiazine derivatives, SSRI, MAO, tricyclic or any other antidepressants we excluded. A total of 39 (45%) of the patients with a history of nephrolithotomy in the past were included.

RESULTS
In most cases, patients were supervised during 12 months with 2–3 courses of MBC during the year. A total of 18 pts (21%) have passed no further stones with dramatic improvement of quality of life, and 47 (54%) have improved clinically with reduction of calculi size. A total of 79 pts (91%) reported overall clinical improvement of UTI symptoms and quality of life. The main disadvantage during MBC administration could be discoloration of the urine in light blue or green color. No side or adverse effects were observed during the whole period of the trial.

CONCLUSION
Methylene blue could be a promising solution in the management of patients with multiple small renal calculi, especially with necessity to reduce the level of concomitant infection without antibiotic and may be useful in the prevention of new stone formation.