bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO923: Electronic Medication Record Accuracy and Clinical Pharmacist Intervention in Haemodialysis Outpatient Settings
Authors: England Gillian , Davin Dawn , Lavin Peter , Wall Catherine , Deasy Evelyn , Mellotte George J 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Haemodialysis (HD) units in Ireland operate a national electronic Kidney Disease Clinical Patient Management System (KDCPMS). KDCMPS is not always used as the primary electronic patient record (EPR) but in conjunction with other electronic and paper record systems across the healthcare setting.
HD patients on average have 6 comorbidities and have the largest pill burden for any chronic disease; consuming 19 oral doses/day, comprising of 12 different medicines [1, 2]. Frequent medication changes, polypharmacy, comorbidities and non-adherence, increase the risk of drug-related problems (DRPs). In the HD population, DRPs are prevalent at a rate of 1 for every three medication exposures and can elicit negative outcomes, including worsening morbidity, mortality and increased healthcare expenditure [3].
In this study setting, KDCPMS information accuracy has not been examined to date. This study aims to describe medication discrepancies within KDCPMS records of HD outpatients.

METHOD
This prospective, observational study was conducted in the HD unit of Tallaght University Hospital, Dublin.
Medicine reconciliation was conducted to identify KDCPMS discrepancies, followed by medication review to document DRPs. Recommendations were issued by the clinical pharmacist to resolve DRPs.

RESULTS
All KDCPMS records examined contained intentional and unintentional discrepancies (n = 36). Unintentional discrepancies corresponding to 8.8 discrepancies per patient (5.13SD) were observed.
A total of 143 DRPs were identified in 34 patients (94.4%) (Table 1). Out of these, 65% of pharmacist recommendations were accepted (n = 93), 22.4% were rejected (n = 32), 8.4% (n = 12) were referred to the renal multidisciplinary team (MDT) and 4.2% were not actioned (n = 6).
Discrepancies and DRPs by therapeutic area are shown in Fig. 1. Parenteral anticoagulants and thrombolytics were the most common undocumented intentional discrepancies (48.6%, n = 50/103) followed by iron (32%, n = 33/103).
A total of 16 (44.4%) patients had at least one medicine de-prescribed. New prescriptions were issued for 26 patients (72.2%) for 81 medicines.

CONCLUSION
KDCPMS contains inaccuracies that could lead to systemic error. Robust clinical governance supported by the national policy is required to improve the accuracy of information contained in KDCPMS and support its use as the primary platform for renal patients. Specialist clinical pharmacists working collaboratively within the renal MDT reduce discrepancies, improve KDCPMS accuracy and resolve DRPs. Enhanced pharmaceutical care by specialist pharmacists should be supported within national models of care for chronic disease management to enhance patient outcomes.
MO951: Chemerin as A Predictor of Poor Outcome in Kidney Transplant Recipients—is There A Relationship With Anemia?
Authors: Batko Krzysztof , Koc- Żorawska Ewa , Zorawski Marcin , Dumnicka Paulina , Banaszkiewicz Małgorzata , Woziwodzka Karolina , Krzanowski Marcin , Gołasa Paulina , Kurnik Anna , Panek Agnieszka , Małyszko Jacek , Malyszko Jolanta , Krzanowska Katarzyna 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Chemerin is an adipokine and novel biomarker of cardiovascular disease in patients with chronic kidney disease, which has been associated with renal, metabolic and inflammatory parameters. Data on chemerin in transplant patients are scarce.

METHOD
One hundred twenty-seven kidney transplant recipients were enrolled in the present study. Biochemical testing of serum samples was performed at baseline, and subsequent follow-up of kidney function was performed. Subjects were followed for a median of 58 months (Q1, Q3; 32, 63) during which a composite primary endpoint of hemodialysis or all-cause death was assessed.

RESULTS
Patients were stratified according to low or high chemerin concentrations based on median values of 94.43 ng/mL (Q1, Q3; 83.4, 122.2). In patients with high chemerin, estimated mean glomerular filtration (eGFR) was significantly reduced (50.7 versus 62.7, P = 0.004), while mean hemoglobin concentrations were significantly lower (12.63 versus 14.78, P &lt; 0.001). There was a weak correlation between chemerin and IL-6 (R = 0.26; P = 0.003). Cardiometabolic comorbidities, body mass index, waist–hip ratio, sex and age did not differ across groups. In a multiple linear regression model including eGFR and IL-6, only hemoglobin concentration (P &lt; 0.001) was significantly associated with chemerin concentrations. All-cause survival was poor in the group of patients with high chemerin at baseline (see Figure 1). Thirty-three patients met the primary endpoint in the high chemerin group, as opposed to 14 low chemerin subjects (52.4% versus 21.9%, P &lt; 0.001).

CONCLUSION
The findings of the present study are in line with earlier reports in chronic kidney disease cohorts. Serum chemerin concentrations remain significantly tied not only to kidney function but also, surprisingly, hemoglobin levels. It remains to be established whether pathogenic pathways that lead to anemia are tied to chemerin concentrations and may translate into poor outcome following kidney transplant.
MO973: Optimization of Erythropoietin Stimulating Agents for Post-Transplant Anemia in Kidney Recipients: Prospective Randomized Controlled Trial
Authors: Alotaibi Torki , Ashry Ahmed Gheith Osama , MA Halim Medhat , Maher Nagib Ayman , Hasaneen Ahmed Aboatya Aboatya Hasaneen , S.H. Mahmoud Tarek , Nair Prasad , Atta Ahmed , Abdelmonem Mohamed , Nampoory Narayanam 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Many studies suggested that chronic allograft nephropathy might progress faster in patients with PTA, but whether full correction of anemia improves renal outcomes is unknown. We aimed to assess the impact of full correction of chronic anemia in renal transplant recipients with stable graft function on patient and graft outcome along one year follow-up.

METHOD
We enrolled 247 kidney recipients with stable graft function to be assessed for anemia. Eligible patients were randomized to achieve target hemoglobin between 11:12 g/dL (group 1, n = 183) or 13:15 g/dl (in group 2, n = 64) using erythropoietin receptor stimulating agents (ESA). Monthly clinical and laboratory evaluation of kidney graft function was carried out. Quality of life was assessed at the start and 12 months.

RESULTS
More females were found in group 1 (68.9%) versus (50%) in group 2 (P = 0.007), and the original disease was chronic glomerulonephritis (37.5%) followed by diabetic nephropathy (DN) (15.7%) in group 2; but DN patients predominate in group 1(P = 0.005). The studied groups were comparable regarding pretransplant comorbidities. Most patients received thymoglobulin as induction and most of them were maintained on cyclosporine. We did not find any significant difference between the two groups concerning posttransplant diabetes, BK viremia or malignancies (P &gt; 0.05); however, better graft function was observed in group 2 at 6 months (P &lt; 0.05). We found that required ESA doses were significantly higher in patients of group 1 from the sixth month. Group 1 showed higher mean blood pressure (P = 0.003) while group 2 showed higher mean albumin (P &lt; 0.05). Graft outcome was comparable in both groups (P = 0.125), but mortality cases were significantly higher in group 1 (16 cases, 8.7%) (P = 0.005).

CONCLUSION
Full correction of PTA in renal transplant recipients had no positive impact on graft outcome but it was associated with better patient survival possibly due improved cardiovascular risk.
MO989: Ap'tx: Preliminary Results of A Randomized Controlled Trial on Telemedicine Implementation in Kidney Transplantation
Authors: Mariat Christophe , Alamartine Eric , Maillard Nicolas , Dinic Miriana 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Telemedecine is a matter of growing interest in transplantation. However, its real added value is uncertain. In 2018, we have started to study the medico-economic impact of a less stringent on-site follow-up of our kidney transplant recipients (KTR) using Ap'Telecare®. We present here the first report focusing on KTR with a 2 years follow-up.

METHOD
The Ap'Tx study (NCT03750331) is a prospective controlled randomized trial testing the hypothesis that monitoring stable KTR (at least 3 months after transplantation) with Ap'Telecare® is non inferior as compared to a conventional follow-up in terms of the occurrence of graft dysfonction (defined as a decrease in eGFR of 20% or more). On-site consultation scheduling was two times less frequent for KTR followed by Ap'Telecare®. Secondary endpoints are the impact of a remote follow-up by Ap'Telecare® on medical workload, economic saving and quality of life.

RESULTS
Five hundred and ninety KTR have been randomized so far with 256 of them having a follow-up of 2 years. Among all KTR approached to participate in the study, 37% were not included mainly due to the impossibility to access internet (44%) or to mastered the app (36%). After randomization, 11% of KTR were considered as noncompliant in adequately using Ap'Telecare®. Over the 2-year study duration, graft dysfunction occurred in 8.5% and 12% of KTR in the Ap'telecare® and conventional arm, respectively (not significant). Medical time dedicated to handling daily lab results was decreased by a factor 3 for KTR using Ap'Telecare®.

CONCLUSION
This preliminary report of Ap'Tx suggest that a partial and reasonable remote follow-up of selected KTR is both feasible and safe. Determining the nature of factors associated with a wider implementation of Ap'Telecare® is important.
MO993: Incidence of Ptld and Its Relationship with Cmv-Serostatus Positivity Among Childhood and Adulthood Population: A Registry Data Study
Authors: Kaies Ibrahim Elsayed Ali Hatem , Mohamed Mahmoud , Briggs David , Krishnan Nithya 
Published: May 2022

Abstract

BACKGROUND AND AIMS
It is unknown how the epidemiology of post-transplant lymphoproliferative disease (PTLD) and its relationship with CMV infection differ between adult and pediatric kidney transplant recipients. In addition, with current advancements in immunosuppressive therapy, the incidence of PTLD has changed dramatically. The aim of our study is to elucidate the relationship between PTLD and CMV infection. Moerover, to assess the incidence of PTLD among Adult and pediatric renal transplant patients in the current era.

METHOD
All renal transplant patients registered in the Organ Procurement and Transplantation Network between 2005 and 2019 were retrospectively reviewed. Patient were followed up till December 2020. Patients who had multiple organ transplant or those with previous renal transplants were excluded from the study. Data about recipient factors (age, sex ethnicity, diabetes, CMV serostatus, and EBV serostatus), donor factors (living or deceased), transplant factors (PRA, Cold ischemia time, HLA mismatches, induction and immunosuppressive therapy) were reviewed. Incidence rate of PTLD at one year and five years post-transplant were calculated among the Adult and Pediatric population. Univariate and Multivariate cox-hazard regression models were performed to assess the relationship between CMV serostatus and occurrence of PTLD.

RESULTS
About 10 947 pediatric renal transplant patients were included. About 315 pediatric patients developed PTLD during the follow-up time (2.88%). About 50.55% of PTLD occurred within the first-year post-transplant. 60% occurred within two-year post-transplant, while 80.63% of them occurred within five years post-transplant. CMV recipient infection was not associated with PTLD occurrence in the pediatric population (HR = 0.88, Pvalue = 0.81, 95% confidence interval ranged between 0.66 and 1.18). Proportional hazard assumption was not violated with P = 0.55. Among the adult population, 1990/277 955 developed PTLD (0.77%). About 25.77% of PTLD among the adult population occurred within the first-year post-transplant. About 39.39% of PTLD in the adult occurred within two-year post-transplant. About 66.55% of PTLD in the adult occurred within five-years post-transplant. CMV recipient positive serostatus was associated with a protective effect against occurrence of PTLD (HR = 0.82, Pvalue &lt;0.01, 95% confidence interval ranged between 0.73 and 0.94). The most common type of PTLD among the pediatric and adult population was monomorphic PTLD ( 40% and 34%, respectively).

CONCLUSION
PTLD is a rare complication of renal transplantation in the current era. The risk of development of PTLD is highest during the first-year post-transplant. CMV recipient positive serostatus has a protective effect against development of PTLD.
MO1038: Haematologic Factors Associated with Favourable Long-Term Outcomes in Paediatric Patients with Chronic Kidney Disease on Maintenance Haemodialysis
Authors: Klervi Golhen , Gotta Verena , Atkinson Andrew , Marsenic Olivera , Pfister Marc 
Published: May 2022

Abstract

BACKGROUND AND AIMS
In children with chronic kidney disease (CKD), anaemia is defined as haemoglobin (Hb) &lt;11–13.0 g/dL, depending on the patient's age and gender. Previous exploratory machine learning in a subpopulation of CKD-5 patients suggested an increased mortality risk with Hb &lt; 10.5 g/dL and increased red blood cell distribution width (RDW) &gt;15%. The objective was to evaluate such associations in a traditional time-to-event analysis in a larger population.

METHOD
Retrospective analysis of a cohort of patients &lt; 30 years of age who started chronic haemodialysis (HD) in childhood (≤19 years) and received thrice-weekly HD (2004–2016) in outpatient DaVita centres. Survival at 5 years while remaining on HD was investigated by non-parametric analysis (Kaplan–Meier) stratified by terciles of mean individual Hb and RDW, respectively. A sensitivity analysis was carried out for different subpopulations (&lt;6y/6y–12y/&gt;12y at the initiation of HD).

RESULTS
A total of 493 patients were included with Hb and RDW terciles of &lt; 10.7/10.7–11.5/&gt;11.5 g/dL and &lt; 14.6/14.6–15.7/&gt;15.7%, respectively. Age at initiation of HD was &lt; 6 years: n = 66, 6–12 years: n = 173, &gt;12 years: n = 1254. Both Hb and RDW terciles showed strong associations with survival distributions (P &lt; .001 for both, log-rank test). Estimated 5-year survival [95%confidence interval (95%CI)] by Hb terciles was 85.1% (81.1–89.3%) (Hb &lt; 10.7 g/dL) versus 94.9% (92.5–97.4%) (&gt;10.7–11.5 g/dL) and 93.8% (90.8–97.0%) (&gt;11.5 g/dL) and for RDW 98.6% (97.1–100%) (&lt;14.6%) versus 94.1% (91.3–96.9%) (14.6–15.7%) and 84.2% (80.1–88.6%) (&gt;15.7%). Sensitivity analyses confirmed significant associations in patients &gt; 12 years (P &lt; .001 for both Hb/RDW) and for RDW in 6–12 years patients (P = .03 versus P = .14 for Hb).

CONCLUSION
This analysis confirmed strong associations between haematologic factors and survival in our population. Clinical utility of RDW in HD management and its physiological interpretation such as the importance of specific anaemia forms, or treatment-induced RDW increase in patients requiring more intense treatment remains to be investigated, with potential impacts on existing guidelines for prescribing iron and epoetin therapy. Further studies will also include the time variation trajectories of Hb and RDW.
FC008: Sex Difference in COVID-19 Mortality Risk among Patients on Kidney Function Replacement Therapy
Authors: Vart Priya , Duivenvoorden Raphael , Jager Kitty J , Noordzij Marlies , Gansevoort Ronald 
Published: May 2022

Abstract

BACKGROUND AND AIMS
In the general population with COVID-19, male sex is an established risk factor for mortality. A more robust immune response to COVID-19 in women has been suggested to be one of the factors explaining this sex difference in mortality. Patients on kidney function replacement therapy (KFRT) have an impaired immune response, especially kidney transplant recipients due to their use of immunosuppressants. In this study, we therefore examined whether male sex is still a risk factor for mortality among patients on KFRT with COVID-19.

METHOD
Data were used from the European Renal Association COVID-19 Database (ERACODA) of kidney transplant recipients and dialysis patients who presented with COVID-19 between 1 February 2020 and 30 April 2021. The primary study outcome was 3-month mortality. As secondary outcomes, in-hospital mortality and 28-day mortality were examined. Associations were investigated using multivariable Cox proportional-hazards regression analysis. Assuming immunosuppressant use is among the main factors contributing to excess mortality in kidney transplant recipients compared with dialysis patients, we also investigated the association of type of KFRT with mortality by sex.

RESULTS
ERACODA included 1204 kidney transplant recipients (male: 62.0%, mean age: 56.4 years) and 3206 dialysis patients (male: 61.8%, mean age: 67.7 years). Three-month mortality in kidney transplant recipients was 16.9% in males and 18.6% in females (P = 0.31) and in dialysis patients 27.1% in males and 21.9% in females (P = 0.001). In a model adjusted for age, frailty, smoking and comorbidities, the aHR for the risk of 3-month mortality in males (versus females) was 0.87 (95% CI: 63, 1.21, P = 0.41) in kidney transplant recipients and 1.32 (95% CI: 1.13, 1.55, P = 0.001) in dialysis patients (P for interaction = 0.03). In a fully adjusted model, the aHR for the risk of 3-month mortality in kidney transplant recipients (versus dialysis patients) was 1.26 (95% CI: 1.02, 1.56, P = 0.03) in males and 1.73 (95% CI: 1.31, 2.27, P &lt; 0.001) in females (p for interaction = 0.03). Essentially similar results were obtained for in-hospital mortality and 28-day mortality.

CONCLUSION
In patients on kidney function replacement therapy with COVID-19, male sex is not a risk factor for mortality among kidney transplant receipts but remains a risk factor among dialysis patients. The use of immunosuppressants in kidney transplant recipients, among other factors, may have narrowed the difference in the immune response to COVID-19 between men and women, and therefore reduced the sex difference in COVID-19 mortality risk.
FC026: Chronic High Phosphate Level Impairs Cardiac Health
Authors: Grund Andrea , Vogt Isabel , Sophie Richter Gloria , Richter Beatrice , Trogisch Felix , Martin Garrido Abel , Heineke Jörg , Dittrich-Breiholz Oliver , Haffner Dieter , Leifheit-Nestler Maren 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Patients with chronic kidney disease (CKD) suffer from disturbed mineral metabolism in which the chronic phosphate load leads to the elevation of the phosphaturic hormones parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23). Persistent hyperphosphatemia predisposes to cardiovascular events and increased morbidity and mortality rates. It is discussed that even in the general population, consumption of highly processed food increases phosphate level, which in turn may increase cardiovascular risk. Here, we aim to elucidate the pathological mechanisms of how chronic high phosphate intake mediates cardiac remodeling and dysfunction, respectively.

METHOD
Male C57BL/6 wild type mice received a high phosphate diet containing 2% inorganic phosphate (HPD) or a 0.8% normal phosphate diet (NPD) for 6 months. Echocardiographic analysis and ex-vivo measurements in cardiomyocytes using IonOptix system were assessed to evaluated cardiac function and contractility. Bulk RNA sequencing of whole heart tissue followed by pathway analysis was done to identify affected relevant signaling pathways, which were verified by in vitro studies using neonatal rat ventricular myocytes (NRVM).

RESULTS
Chronic phosphate overload resulted in increased level of serum and urinary phosphate and high plasma PTH and FGF23 concentrations. HPD caused impaired heart function as shown by reduced ejection fraction, increased end-systolic volumes and enlarged systolic left ventricular internal diameter accompanied by impaired left ventricular relaxation as seen in Doppler echocardiography. Histological analysis showed increased cardiomyocyte area and length in HPD-fed mice compared with NPD demonstrating cellular hypertrophy. RNA sequencing revealed differentially expressed genes of calcium signaling pathways in the HPD group. Besides, immunoblot analysis of whole heart tissue showed altered Phospholamban activity after 6 months of HPD compared with NPD, indicating altered calcium pump in cardiomyocytes. Preliminary analysis of sarcomere movements and changes of intracellular calcium levels in single cardiomyocytes isolated from NPD and HPD mice after 6 months suggested impaired contractility. Detailed results will be presented here.
In vitro stimulation of isolated NRVM with high phosphate induced a hypertrophic growth response, verifying a direct effect of high phosphate on the heart.

CONCLUSION
HPD in mice causes a dilated cardiac phenotype including cellular hypertrophy, altered contractility and differentially expressed genes involved in calcium signaling pathways, indicating that a chronic high phosphate load is harmful for the heart also in the general population.
FC039: Associations between Maternal Antenatal Systemic Glucocorticoids Usage and Childhood Chronic Kidney Disease
Authors: Hsu Chien-Ning , Tain You-Lin 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The effect of antenatal glucocorticoid exposure on offspring health is currently unclear. Therefore, this study examined the association of maternal exposure to systemic glucocorticoids in the past and during pregnancy with the risk of chronic kidney disease (CKD) development in childhood.

Methods
A retrospective cohort study of maternal-child dyads was identified from the largest healthcare delivery system in Taiwan between 1 January 2004 and 31 December 2018. Primary analyses were used to compare past and gestational exposures with non-exposure to systemic glucocorticoid considering an inverse probability of treatment weight to adjust the hazard ratio of offspring CKD development in singleton child-matched pairs. Offspring birthweight, sex, gestational weeks stratified analyses and sibling-matched sensitivity analyses were performed to ensure the robustness of the primary study results.

RESULTS
In a cohort with 31 927 singleton born children, the cumulative incidence of CKD was 2.23% (n = 713), with 3.18% (n = 63) in the gestational glucocorticoid-exposed group, 1.91% (n = 58) in the past exposed group and 2.2% (n = 592) in the non-exposed group. Gestational exposure, compared with non-exposure, was significantly associated with a higher risk of childhood CKD (inverse probability therapeutic weighted hazard ratio [wHR], 1.42 [95% confidence interval (95% CI) 1.05–1.92] in Figure. 1A, but not past exposure (wHR: 0.89, 95% CI 0.67–1.18) (Figure. 1B). In male children, the risk of CKD was significantly higher among gestational-exposed children than among unexposed children (wHR: 1.72, 95% CI 1.21–2.43). The cohort with sibling matched children did not show a significantly increased risk of childhood CKD associated with gestational exposure (wHR: 1.31, 95% CI 0.79–2.18) (Figure. 1A).

CONCLUSION
Maternal gestational glucocorticoid treatment was found to be significantly associated with CKD development in children. These findings may support clinicians in performing benefit-risk assessment and in decision-making for systemic glucocorticoid treatment during pregnancy, in clinical settings.