bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO605: Exploring the Relationship Between Cardiorespiratory Fitness and Cardiovascular Risk in Kidney Transplant Recipients
Authors: Billany Roseanne E , Mubaarak Zahra , Bishop Nicolette , Smith Alice , Graham-Brown Matthew 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Cardiovascular disease (CVD) remains a leading cause of mortality for kidney transplant recipients (KTR). Traditional risk factors include smoking, obesity, hypertension and hyperlipidemia. Nontraditional risk factors include creatinine levels, previous transplants and total time on renal replacement therapy. High levels of physical inactivity have long been known to link with poor cardiovascular outcomes. The first United Kingdom Clinical Practice Guidelines for Exercise and Lifestyle in Chronic Kidney Disease recommend that KTRs aim for 150 min of moderate to vigorous physical activity a week (or 75 min vigorous physical activity) plus two strength training sessions in line with current World Health Organisation recommendations for the general population. However, evidence suggests that only 27% of KTRs are sufficiently active for health.
We aimed to explore the relationship between cardiorespiratory fitness and the 7-year risk of major adverse cardiac events (MACE) and 7-year risk of mortality in KTRs.

METHOD
49 KTRs (31 male; mean [±SD]; 59 [±19] eGFR mL/min/1.73 m2; age 49 [±14] years) completed a continuous ramp cardiopulmonary exercise test (1W increase every 4 s) to volitional exhaustion on a cycle ergometer. The cardiovascular risk calculator for renal transplant recipients (CRCRTR-MACE) was used to calculate 7-year risk of MACE and 7-year risk of mortality. Cardiorespiratory fitness categories were defined in accordance with the American College of Sports Medicine guidelines. Data were analyzed using hierarchical multiple regression adjusting for gender.

RESULTS
84% of participants were classified as having ‘poor’ or ‘very poor’ cardiorespiratory fitness (VO2; ml/kg/min). Cardiorespiratory fitness was a significant predictor of 7-year risk of MACE after adjusting for gender (F(2, 40) = 10.64, P &lt; 0.001, adj. R2 = 0.315). Each 1 mL/kg/min increase in VO2 was associated with a 0.5% decrease in 7-year risk of MACE (B = −.523, 95% CI [−0.794, −0.252]). Cardiorespiratory fitness was also a significant predictor of 7-year risk of mortality (F(2, 40) = 8.50, P &lt; 0.001, adj. R2 = 0.263). Each 1 mL/kg/min increase in VO2 was associated with a 1% decrease in 7-year risk of mortality (B = −0.961, 95% CI [−1.483, −0.439]).

CONCLUSION
This exploratory analysis shows that cardiorespiratory fitness explains 31.5% and 26.3% of the variance in the 7-year risk of MACE and the 7-year risk of mortality, respectively. Various interventions have been shown to improve cardiorespiratory fitness in KRTs. Improving levels of physical activity and subsequently cardiovascular fitness provide a low cost strategy to partially attenuate some of widespread impact of CVD-related morbidity and mortality. These results highlight the importance of incorporating physical activity as part of post-transplant care.
MO614: Modified Lipid Metabolism and Cytosolic Phospholipase A2 Activation in Mesangial Cells Under Pro-Inflammatory Conditions
Authors: Boi Roberto , Ebefors Kerstin , Henricsson Marcus , Johansson Alva , Borén Jan , Nyström Jenny 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Diabetic kidney disease (DKD) is thought to be a consequence of hyperglycemia and driven by early glomerular hemodynamic changes and progressive expansion of the mesangium. The molecular mechanism behind the pathophysiological alterations of the mesangium is yet to be elucidated. This study aimed at investigating whether lipid signaling might be the missing link.

METHOD
Human mesangial cells (HMCs) were stimulated with high glucose, IL-1β or PDGF-BB. Production of IL-1β and PDGF-BB, COX-2 induction and cPLA2 activation and prostaglandin secretion were investigated using a combination of ELISA, western blot, lipidomics, qPCR and activity assays. Inhibition of cPLA2 was evaluated using ELISA, migration and proliferation assays. Validation of data was performed in silico using the Nephroseq database [1] and a recently published glomerular transcriptomic DKD database. [2]

RESULTS
Stimulation of HMCs with high glucose primed IL-1β secretion through inflammasome NLRP3 signaling. In turn, IL-1β was able to stimulate PDGF-BB release. PDGF-BB increased IL-1β secretion synergistically. Both IL-1β and PDGF-BB stimuli caused lipid metabolism variations and in particular triggered the formation of phosphorylated sphingoid bases (PSBs) and the activation of the enzymes cPLA2 and COX-2. This led to the formation of prostanoids from arachidonic acid produced by cPLA2. As a result, prostaglandins were secreted. Another product of cPLA2 activation was lysophosphatidic acid (LPA), a proliferation effector. Blocking cPLA2-mediated release of arachidonic acid could in fact reduce HMCs’ proliferation and secretion of prostaglandins.

CONCLUSION
Hyperglycemia primes glomerular inflammatory and proliferative stimuli triggering lipid metabolism modifications in HMCs. The upregulation of cPLA2 was found to be critical in this setting. cPLA2 inhibition with AACOCF3 reduced mesangial secretion of prostaglandins and proliferation, making it a potential target for DKD therapy.
MO617: Liraglutide Improves Both Diabetic Nephropathy and Cardiomyopathy in the SDT Fatty Rat, A Cardiorenal Model of Type 2 Diabetes
Authors: Briand Francois , Shinohara Masami , Brousseau Emmanuel , Maupoint Julie , Dubroca Caroline , Kageyama Yasushi , Sulpice Thierry 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The Glucagon-like peptide 1 (GLP-1) receptor agonist liraglutide (LIRA) has cardioprotective effects and may reduce the development of kidney disease in type 2 diabetic patients. We here evaluated the effects of LIRA on both kidney and heart function in the Spontaneously Diabetic Torii (SDT) fatty rat, a type 2 diabetic cardiorenal model.

METHOD
SDT fatty male rats were treated subcutaneously with vehicle or LIRA 0.4 mg/kg QD for 10 weeks. To measure the effects of LIRA on glomerular hyperfiltration, rats were injected with FITC-sinistrin to measure glomerular filtration rate (GFR) at 4 weeks of treatment. At 5 weeks of treatment, rats underwent unilateral nephrectomy and were put on a 0.3% salt diet to induce a GFR decline. GFR was then measured at 10 weeks of treatment, before hemodynamics measurement and echocardiography.

RESULTS
Compared with vehicle, LIRA induced significant body weight loss, as well as blood glucose levels reduction by up to ∼20%. During the hyperfiltration phase, LIRA attenuated hyperfiltration, with a 19% lower GFR versus vehicle (P &lt; 0.05). In vehicle-treated animals, unilateral nephrectomy and 0.3% salt diet induced a major reduction (−56%) in GFR, as expected. After 10 weeks of treatment, LIRA markedly attenuated this GFR decline (vehicle: 9.3 ± 0.5 mL/min/kg; LIRA: 13.3 ± 0.9 mL/min/kg, P &lt; 0.001 versus vehicle). Compared with vehicle, LIRA also lowered urine albumin-to-creatinine ratio both in the hyperfiltration and GFR decline phases, and significantly reduced kidney inflammation and fibrosis histology scores. LIRA showed significant reduction in cardiac hypertrophy, as well as both arterial and left ventricle end-systolic pressures. Moreover, LIRA normalized the diastolic dysfunction with preserved ejection fraction observed in SDT fatty rats (P &lt; 0.001 versus vehicle).

CONCLUSION
In the SDT fatty rat, LIRA shows significant benefits by reducing renal hyperfiltration, preventing GFR decline, and improving cardiac hypertrophy, blood pressure and diastolic dysfunction. This preclinical model will be useful to evaluate drugs targeting the cardiorenal axis in type 2 diabetes.
MO629: The Baseline Risk Factors of Covid-19 Adverse Outcomes in Patients with Advanced Stages of Diabetic Kidney Disease: The Single Center Experience
Authors: Klochkova Nataliya , Lysenko Mariana , Zeltyn-Abramov Eugene , Poteshkina Nataliya , Markova Tatyana , Frolova Nadia , Belavina Natalya , Kondrashkina Svetlana , Sokolova Natalya , Manchenko Oxana , Smolentseva Valeria 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The patients with diabetic kidney disease (DKD) due to type 2 diabetes mellitus (T2DM) are at a high risk of adverse outcomes of COVID-19. The causes of high mortality in this cohort are the subject of debate.
Identification of the risk factors (RF) of adverse COVID-19 outcomes in patients with T2DM and advanced stages of DKD at hospital admission.

METHOD
The patients with laboratory-confirmed COVID-19 were included in the retrospective observational study during the hospitalization in MCCH №52, the observation period being 04 January 2020 to 31 October 2020. The study endpoints were the outcomes of hospitalization—discharge or lethal outcome. Data were collected from electronic medical database. The following independent variables were analyzed at hospital admission: gender, age, duration of T2DM, general comorbidity (Charlson Index, CCI), the insulin demand (InsD), fasting blood glucose (FBG), body mass index (BMI), NEWS scale points, white blood cell (WBC), lymphocytes and platelet count, CPR, serum albumin (SA), ferritin, LDH, and GFR.

RESULTS
A total of 120 patients were included. Mediana age was 69 years (IQR 63.5–79.5), females 53%. The observation group was divided into subgroups: (i) patients with advanced DKD according to GFR values not requiring maintenance hemodialysis (MHD) and (ii) patients on MHD. All patients were distinguished by high general comorbidity and duration of T2DM more than 10 years. The mortality in both subgroups was high (38.2% versus 38.5%, respectively). The results are presented in Table 1.

CONCLUSION
The patients with T2DM and advanced DKD are very vulnerable to adverse outcomes of COVID-19. High FBG, lymphopenia and high ferritin value on admission seem to be the most significant RF of lethal outcome regardless of MHD.
MO632: Impact of Diabetic Kidney Disease on Coronary Artery Plaque Progression
Authors: Yabushita Sayaka , Kishi Satoru , Tanaka Tetsu , Aihara Hideaki , Ogura Yoshiyasu , Tsukada Hiroyuki , Furuse Satoshi , Mise Naobumi 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The aim of this study was to evaluate the relationship between diabetic kidney disease (DKD) and change in coronary plaque volume in asymptomatic diabetes patients.

METHOD
In this prospective observational study, we analyzed 79 asymptomatic type 2 diabetes patients (age, 63.7 ± 8.1 years; male, 69.3%) without prior history of coronary artery disease who underwent serial 320-row computed tomography coronary angiography with an interscan interval of more than 24 months (median 37.7 months). Total coronary plaque volume was assessed at baseline and after 3 years, using QAngio CT (MEDIS) for vessel diameters greater than 1.5 mm in the three main branches. The primary endpoint was coronary plaque progression (PP), which was defined as the absolute change in coronary plaque volume during the 3 years. PP was compared among four groups, which were divided according to the presence or absence of DKD at baseline and after 3 years, as follows: Group 1 (no DKD at baseline, no DKD after 3 years), Group 2 (DKD at baseline, no DKD after 3 years), Group 3 (no DKD at baseline, DKD after 3 years), Group 4 (DKD at baseline, DKD after 3 years)]. DKD was defined as albuminuria &gt;30 mg/g Cr or eGFR &lt;60 mL/min/1.73 m2. We conducted univariate linear regression analysis to assess the association of DKD groups with PP.

RESULTS
Plaque volumes were significantly greater in Group 4 than in Group 1 both at baseline and after 3 years (Table 1). PP was also significantly greater in Group 4 than in Group 1 (β-coefficient: 293.6, P &lt; 0.01). Group 4 had greater PP compared with Group 1 after adjustment (β-coefficient: 181.6, P &lt; 0.05).

CONCLUSION
DKD may be an independent risk factor for coronary plaque progression in asymptomatic type 2 diabetic patients without a history of cardiovascular disease. Early therapeutic intervention in such patients may prevent the onset of coronary artery disease.
MO633: Survival Comparison Between CVVHDF and CVVH for Septic Acute Kidney Injury
Authors: Jang Mun , Woo Lee Seung 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The mortality rate of septic acute kidney injury (AKI) remains high despite improvements in renal replacement technology. Adding dialysis to continuous veno-venous hemofiltration (CVVH) can increase survival in these patients, although hemofiltration leads to better clearance of inflammatory mediators in sepsis than hemodialysis. We tested whether continuous veno-venous hemodiafiltration (CVVHDF) is more effective than CVVH with the same net effluent according to body weight in intensive care unit (ICU) patients with septic AKI.

METHOD
The mortality rate of septic acute kidney injury (AKI) remains high despite improvements in renal replacement technology. Adding dialysis to continuous veno-venous hemofiltration (CVVH) can increase survival in these patients, although hemofiltration leads to better clearance of inflammatory mediators in sepsis than hemodialysis. We tested whether continuous veno-venous hemodiafiltration (CVVHDF) is more effective than CVVH with the same net effluent according to body weight in intensive care unit (ICU) patients with septic AKI.

RESULTS
In this prospective randomized pilot study, 100 patients were assigned to CVVH (n = 47, M: F = 25:22, age 64 ± 15 years) or CVVHDF (n = 49, M: F = 30:19, age 65 ± 11 years). Baseline characteristics including age, sex, body weight, serum creatinine, blood urea nitrogen (BUN), beta-2 microglobulin, Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores did not vary between the two groups. There were no significant differences in the reduction ratios of serum creatinine, BUN, beta-2 microglobulin, APACHE II and SOFA scores between the two groups. Seven-, 28- and 60-day survival also did not vary.

CONCLUSION
In conclusion, CVVH and CVVHDF led to similar clearance of waste products and survival at the same net effluent in this study. Future large-scale randomized prospective studies will be needed to confirm these results in critically ill patients with septic AKI.
MO639: Evaluation of Glycemic Control and Interday Glucose Variability Using Continuous Glucose Monitoring in Diabetic Hemodialysis Patients
Authors: Divani Maria , Georgianos Panagiotis , Liakopoulos Vassilios , Didangelos Triantafillos , Makedou Kali , Savopoulos Christos , Grekas Dimitrios 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Continuous-glucose-monitoring (CGM) facilitates the assessment of interday glucose variability and identification of acute excursions of hyper- and hypoglycemia [1–4).

METHOD
Among 37 diabetic hemodialysis patients who underwent 7-day CGM with the iPRO2 device (Medtronic Diabetes, Northridge, CA, USA), we explored the accuracy of GA and hemoglobin A1c (HbA1c) in assessing glycemic control, using CGM-derived metrics as the reference standard.

RESULTS
In receiver-operating-characteristic (ROC) analysis, the area under the curve (AUC) in diagnosing a time in target glucose range of 70–180 mg/dL (TIR70-180) in &lt;50% of readings was higher for GA {AUC 0.878; [95% confidence interval (CI)] 0.728–0.962} as compared with HbA1c [AUC 0.682 (95% CI 0.508–0.825)] (P &lt; 0.01). The accuracy of GA [AUC 0.939 (95% CI 0.808–0.991)] in detecting a time above target glucose range &gt;250 mg/dL (TAR &gt;250) in &gt;10% of readings did not differ from that of HbA1c [AUC 0.854 (95% CI 0.699–0.948)] (P = 0.16). GA [AUC 0.712 (95% CI 0.539–0.848)] and HbA1c [AUC 0.740 (95% CI 0.570–0.870)] had a similarly lower efficiency in detecting a time below target glucose range &lt;70 mg/dL (TBR &lt;70) in &gt;1% of readings (P = 0.71). Although the mean glucose levels were similar, the coefficient of variation of glucose recordings (39.2% ± 17.3% versus 32.0% ± 7.8%, P &lt; 0.001) and TBR &lt;70 [median (range): 5.6% (0, 25.8) versus 2.8% (0, 17.9)] were higher during the dialysis-on than during the dialysis-off day.

CONCLUSION
The present diagnostic test study shows that among diabetic hemodialysis patients, GA had higher accuracy than HbA1c in detecting a 7-day CGM-derived TIR70-180 in &lt;50% of readings. However, both GA and HbA1c provided an imprecise reflection of acute excursions of hypoglycemia and interday glucose variability.
MO645: Does Sodium Magnetic Resonance Imaging Help for Initiation of Incremental Dialysis?
Authors: Lemoine Sandrine , Akbari Alireza , Penny Jarrin , Mcintyre Christopher 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Incremental hemodialysis (HD) (twice a week) can be proposed to some patients who had a significant residual renal function (RRF) when HD is initiated. However, renal urea clearance is a very limited tool to predict the ability of the kidney to extract significantly water and sodium. We hypothesized that corticomedullary gradient (CMG) measurement with 23NaMRI could provide a new tool to select HD patients for incremental dialysis. We have already validated the use of 23NaMRI in healthy control. However, we had to prove first the feasibility of such a measure for HD patients.

METHOD
We conducted a prospective observational study to better characterize CMG in HD patients with 23NaMRI. We performed blood (urea, creatinine, sodium), urine collection (osmolarity, creatinine, sodium) and CMG with 23NaMRI in fasting patients. All MR experiments were carried out on a GE MR750 3T (GE Healthcare, WI). A custom-built two-loop (18 cm in diameter) butterfly radiofrequency surface coil tuned for 23Na frequency (33.786 MHz) was used to acquire renal 23Na images. We compared CMG in healthy controls (n = 15) and HD patients (n = 4) with or without RRF.

RESULTS
For healthy controls, median (IQR) age was 50 (32–60) years, 46% men, estimated glomerular filtration rate (eGFR) 103 (84–108) mL/min/1.73m2 urinary osmolarity (osmU) 786 (587–938) osm/L, sodium excretion fraction (FeNa) 0.27% (0.21–0.49). For HD patients, median (IQR) age was 68 (60–73) years, 50% men, creatinine 499 (366–606) umol/L, urinary osmolarity (osmU) 279 (193–317) osm/L, sodium excretion fraction (FeNa) 1.14% (0.44–2.21). Corticomedullary gradient for controls [1.53 (1.47–1.61)], was significantly different to HD 1.28 (1.17–1.4) (P = .001) as expected. There was a significant correlation between osmolarity and CMG (r = 0.73, P &lt; .001). We showed a significant association between CMG and age (P = .03). The patient with RRF (diuresis to 1.3L/day) didn't display a different CMG compared with patients without RRF.
Figure 1 shows the difference in corticomedullary pictures (A) control and (B) HD patients.

CONCLUSION
We showed that it is possible to assess corticomedullary gradient in HD patients. More patients are needed to explore the ability of the 23NaMRI to discriminate patients who could benefit from incremental dialysis.
MO649: Monitoring of Ionized Magnesium in Haemodialysis Patients: A Useful Tool to Allow a Personalized Prescription of Dialysate Composition
Authors: Bargnoux Anne-Sophie , Morena Marion , Rodriguez Annie , Coulon Caroline , Kuster Nils , Chalabi Lotfi , Cristol Jean-Paul 
Published: May 2022

Abstract

BACKGROUND AND AIMS
In healthy subjects, normal values of magnesium (Mg) are in the range 0.75–0.95 mmol/L. In the circulation, 65–70% of the Mg is present in the free, ionized and dialyzable form (i.e. 0.45– 0.60 mmol/L), 20% is bound to proteins and 15% is complexed. In chronic kidney disease (CKD) dialysis patients, the dialysate Mg concentration is a major determinant of Mg balance. The aim of this study was to assess the systemic variations of ionized Mg (iMg), as well as that of ionized calcium (iCa), before and after a dialysis session.

METHOD
A total of 121 dialysis patients [median age = 70 (62.5–78.2) years; 74 male/46 female] in maintenance haemodialysis three times per week, for at least 6 months and with no residual function, were included. Patients were assigned to a single dialysis session with either control fluid (group 1: 3 mM acetate, 1.5 mM Ca, 0.5 mM Mg), or citrate dialysis fluid containing 0.5 mM Mg (group 2: 0.8 mM citrate, 0.3 mM acetate, 1.65 mM Ca) or 0.75 mM Mg (group 3: 0.8 mM citrate, 0.3 mM acetate, 1.65 mM Ca). Blood samples were drawn before and after the midweek dialysis sessions as part of the routine patient follow-up and quality assurance process. iMg and iCa concentrations were measured by direct ion-selective electrode on Nova Stat Profile Prime Plus® (Nova Biomedical). Total Mg (tMg) and Ca (tCa) were assessed by colorimetric method c702/Cobas 8000 analyzer (Roche). Dialytic balance was assessed by the median intra-dialytic difference between pre-dialysis and post-dialysis.

RESULTS
The use of all types of dialysates (whatever their composition was) was associated with a calcium load during the session (Table). In addition, an Mg loss was observed in both control and citrate dialysis fluid groups containing 0.5 mM Mg. The dialysis session induced a significant decrease in iMg (13 and 22% in group1 and group 2 respectively). By contrast, the use of citrate dialysis fluid with 0.75 mM Mg led to a positive balance with a median intra-dialytic increase of 0.08 and 0.02 mmol/L in tMg and iMg respectively (Table), corresponding to a median increase of 8 and 3% in tMg and iMg respectively.

CONCLUSION
The iMg fraction represents 70% of tMg in CKD stage 5D patients. While a dialysate Mg concentration at 0.5 mM leads to a negative balance, increasing the concentration to 0.75 mM significantly raises post-dialysis circulating Mg levels in these patients. Therefore, monitoring of iMg should allow a personalized prescription in dialysate Mg composition.