bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO1009: Early Switch from Fast IR-TAC Metabolizers to LCP-TAC Improves Renal Allograft Function
Authors: Thölking Gerold , Tosun Filiz , Jehn Ulrich , Koch Raphael , Josef Pavenstädt Hermann , Suwelack Barbara , Reuter Stefan 
Published: May 2022

Abstract

BACKGROUND AND AIMS
In contrast to slow tacrolimus (Tac) metabolism, fast metabolism is associated with a more rapid decline in renal function [1–3]. Because the pharmacokinetics of LCP-Tac (LCPT) differ from those of immediate-release Tac (IR-Tac), we hypothesized that the estimated glomerular filtration rate (eGFR) of fast metabolizers, in particular, would be improved by switching from IR-Tac to LCPT.

METHOD
We included renal allograft recipients receiving a de novo immunosuppression with IR-Tac, mycophenolate and prednisolone. A Tac concentration-to-dose ratio (C/D ratio, surrogate for bioavailability) &lt;1.05 ng/mL*1/mg defined fast metabolizers and ≥ 1.05 ng/mL*1/mg slow metabolizers one months after renal transplantation (RTx). All patients were switched to LCPT 1 month after transplantation or later. During a 3-year follow-up, Tac doses, C/D ratios, eGFR, infection and rejection rates were compared between the metabolizer groups.

RESULTS
Fast metabolizers (n = 58) were switched to LCPT earlier than slow metabolizers (n = 22) after RTx (2.0 (1.0–253.1 versus 13.2 (1.2–172.8 months, P = .005). Tac doses were decreased by ∼65% in both groups after 12 months of conversion to LCPT. C/D ratios at 12 months increased from 0.66 (0.24–2.10) to 1.74 (0.42–5.43) (+163%) in fast and from 1.15 (0.32–3.60) to 2.75 (1.08–5.90) (+139%) in slow metabolizers. Fast metabolizers showed significant recovery of mean eGFR as early as one month after conversion (48.5 ± 17.6 versus 41.5 ± 17.0 mL/min/1.73 m²; P = .032) and at all subsequent time points. Conversion to LCPT did not result in relevant eGFR changes in slow metabolizers. Infection and rejection rates were low and did not differ between the groups before and after conversion.

CONCLUSION
Switching to LCPT increases the Tac bioavailability. This was associated with a significant recovery of renal function in fast metabolizers. Conversion to LCPT is safe and beneficial early after RTx.
MO1048: The Influence of Online Kidney School on Dialysis Choice
Authors: Ørsted Schultz Anders , Hayes Bauer Eithne , Kampmann Jan 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Factors influencing dialysis choice are multifaceted. Detailed and unbiased information is pivotal in order to assist patients in making decisions. Hence, patient education is a cornerstone in the treatment of advanced chronic kidney disease. At the hospital of Southern Jutland, a kidney school has existed for more than 15 years teaching patients about their illness and treatment options at end-stage renal disease (ESRD). Due to the coronavirus disease (COVID-19) pandemic, an online kidney school (OKS) was established. We present the latest results of this ongoing study regarding the change of preferences of ESRD treatment options among patients after participation in online renal education.

METHOD
The OKS consists of a 3-h synchronous class taught by a nephrologist and a dialysis nurse combined with asynchronous short films on treatment options and advice from a dietitian. The OKS has been held six times with 45 patients in total. A questionnaire was distributed to participants before and after the OKS. Patients were asked to choose between center haemodialysis, home haemodialysis, peritoneal dialysis, transplantation, maximal conservative medical treatment and ‘not enough information to make the decision’.

RESULTS
Out of the 45 patients, 36 patients answered the questionnaire before OKS and of those, 19 also answered the questionnaire after OKS. A total of 76% % of the participants were male, 52% answered the questionnaire on their own and 48% answered the questions together with a relative. The percentage of patients not feeling informed enough to make the decision decreased from 56% prior to participation in OKS in comparison to 32% following participation in OKS. The percentage of patients who prefer peritoneal dialysis as their ESRD treatment of choice increased from 6% to 32%.

CONCLUSION
Online education on treatment choices for end-stage renal patients leads to change of treatment preferences. This is especially true for peritoneal dialysis. The OKS is designed to help patients make an informed decision on treatment options in ESRD. Although the number of patients feeling unsure about what kind of treatment to choose is decreased, the number of patients unsure about the best treatment option for them remains high. These patients require a follow-up consultation in order for them to make the final decision for ESRD treatment. The number of patients who answered the questionnaire prior to OKS is higher in comparison to after OKS. However, this is an ongoing study and we will be able to confirm or dismiss these preliminary findings at a later stage.
MO1056: Music Therapy Reduces Anxiety and Pain and Improves Satisfaction in Patients Undergoing Percutaneous Renal Biopsy
Authors: Giordano Filippo , Pesino Alessandra , Cortese Cosma , Esposito Flavia , Campobasso Nicla , Grandolfo Nicola , Rossini Michele , Mitrotti Adele , Gesualdo Loreto 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Percutaneous kidney biopsy (PRB) is an invasive procedure performed under local anaesthesia that often creates anxiety, stress and pain in the patient before, during and after the procedure. Music therapy (MT), defined as the clinical- and evidence-based use of music, is administered by a trained professional to achieve individualized goals within a therapeutic relationship between patient, music and music therapist. MT can be used as a complementary non-drug intervention to prevent and treat emotional distress and pain. The main objectives of the study were
1. evaluate the effectiveness of MT in managing anxiety, pain and satisfaction in patients undergoing PRB.
2. investigate the effect of MTI on heart rate variability (HRV).

METHOD
This study was a two-arm, single-centre, parallel-group and pre–post PRB randomized controlled trial. Patients programmed for PRB were enrolled (n = 80) and assigned to the MT intervention group (MG, n = 40) or standard treatment [control group (CG), n = 40]. MG received, from a FAMI-certified music therapist, a personalized playlist administered during the PRB, adapted to the individual patient. Patient anxiety was assessed before and after PRB using the State Y-1 Trait Anxiety Inventory (STAI-Y1). A visual analog scale (VAS) was used for self-assessment of pain (VAS-P) and satisfaction (VAS-S). Physiological stress parameters (PRE–POST) were assessed using HRV (SDNN, RMSSD, LH/HF, SD1, SD2) from E4 wristbands—Empatica Inc.1. The bracelet was placed 5 min before the patient entered the operating room for the procedure and removed after the completion of the PRB. The data of each session were divided into two segments: (1) pre, before the administration of the local anesthetic and (2) post, after the conclusion of the biopsy.

RESULTS
A statistically significant difference in anxiety levels was observed between the MG and CG groups (35.35 ± 6.208 versus 42.83 ± 9.027; P &lt; 0.001, Fig. 1). The MG group showed significantly lower VAS-P values ​​(4.95 ± 1.377 versus 6.28 ± 1.281; P &lt; 0.001, Fig. 2) and higher VAS-S values ​​(7.75 ± 0.981 versus 6.03 ± 0.800; P &lt; 0.001) after PRB compared with the CG group (Fig. 3). The SDNN (P &lt; 0.034), RMSDD (P &lt; 0.04) and SD2 (P &lt; 0.027) measurements of HRV were significantly higher in MG than in CG, while LF/HF decreased (P &lt; 0.033).

CONCLUSION
This study supports the efficacy of MT in reducing anxiety and pain and improving satisfaction in patients undergoing PRB. MT modulates the autonomic nervous system, reducing sympathetic activity, increasing parasympathetic activity and inducing physiological relaxation.
FC013: Shear Wave Elastography Effective in Ultrasound Diagnosis of Chronic Kidney Disease in Patients With hyperuricaemia And Gout
Authors: Rostyslav Rbubnov 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Shear wave elastography (SWE) is a well-known ultrasound method for assessing liver, yet has a limited use in nephrology. Gout is associated with risk of chronic kidney disease (CKD, nephropathy) progression. Ultrasonography (US) can provide accurate information for detecting kidney disease in gout (Bubnov and Melnyk. Evaluation of biomarkers for diagnostic decision making in patients with gout using novel mathematical model. Complex PPPM approach. EPMA J. 2014;5(Suppl 1): A58. doi:10.1186/1878-5085-5-S1-A58) and can help monitoring treatment effect (Short-term probiotics regimen may help treat gout, kidney disease. Personalized medicine approach may improve signs of metabolic syndrome. American Physiological Society (APS) News Room, 03.10.2019 https://www.the-aps.org/detail/news/2019/10/04/short-term-probiotics-regimen-may-help-treat-gout-kidney-disease?SSO=Y).
The aim was to study the added diagnostic value of SWE effective in ultrasound diagnosis of CKD in patients with hyperuricaemia and gout.
The aim was also to study the relevance of US markers of kidney including SWE and B-flow to provide advantages to grey scale and Doppler in assessing kidney disease in gout.

METHOD
We included 43 patients (38–75 years; 15 women) with gout/increased levels of uric acid in blood, gout attacks according to disease history. The control group included 38 healthy individuals (20 women), mean age 44 ± 8 years without clinical, laboratory signs of nephropathy and liver pathology. All patients underwent general clinical, lab tests; abdominal US including precise multiparameter US of kidneys measuring SWE, and B-flow in parenchyma and vessels were conducted using curved abdominal transducer of LOGIQ 9 systems (GE Healthcare).

RESULTS
CKD signs included thinning, increasing echogenicity of kidney parenchyma (P &lt; 0.05), detection of fibrotic changes and small hyperechoic inclusions, hilly margins, anechoic strips under the capsule, RI increasing in segmental arteries over 0.7. The SWE change was 8.7 ± 1.5 (6–13 kPa) versus 4.5 ± 1.2 kPa (P &lt; 0.05). High spatial resolution of B-flow imaging helped to display complex perfusion, pyramids structure, detect vascular flow in areas of heterogeneity on grey scale and evaluate arcuate arteries. We detected signs of fatty liver in all patients (LF2–4); liver size in the right lobe was 170 ± 7 versus 142 ± 8 mm in controls; liver size and SWE data demonstrated positive correlation with kidney SWE.

CONCLUSION
SWE is and effective and accessible complementary technique capable of providing added diagnostic value to assess the kidney parenchyma. Multiparameter ultrasound is an effective method for early detection of CKD in patients with hyperuricaemia and gout. Petrifications, deformations parenchyna, blood flow abnormalities and SWE markers are the most reliable ultrasound signs, specific for kidney disease in gout.
FC025: Physiological Role of KV Channel in Ureter Smooth Muscle Cell Investigated Quantitatively by Electrophysiological Modeling
Authors: Mahapatra Chitaranjan , Pradhan Ashish 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Spontaneous peristaltic contraction disorder of the ureter smooth muscle (USM) is an important etiology of congenital giant ureter, congenital ureteropelvic junction deformity and non-obstructive hydronephrosis [1]. The USM cell action potential (AP) plays a key role in commencing USM contraction by allowing influx of Ca2+ from the extra cellular space [2]. Therefore, an in-depth quantitative investigation of the USM cell AP generation will assist in developing better pharmacological therapies for the USM abnormal contraction. The purpose of this in-silico study is to unfold the physiological role of Kv channel in modulating the USM AP generation.

METHOD
The model consists voltage- dependent Na+ currents (INa), hyperpolarization-activated cyclic nucleotide- gated current (Ih), voltage- dependent Ca2+ currents (ICa), Ca2+ dependent potassium channel (IBKCa) and voltage-dependent potassium channels (IKv) as the components of active electrophysiological characteristics [3]. All ion channels are represented by the Hodgkin–Huxley formalism. The maximum conductance of the is varied to investigate the physiological role of the Kv channel in modulating the USM AP generation.

RESULTS
The whole cell IKv current is generated by applying the voltage clamp protocol, where the membrane potential is stepped from a holding potential of –80 mV–60 mV for a duration of 500 ms. The half activation potential, half inactivation potential, activation slope factor and inactivation slope factors are: 43 mV, –76.1 mV, 15.4 mV and 6.5 mV, respectively, to fit the Boltzmann function equation. The model reveals that fast activation and inactivation properties are the essential feature of IKv for the USM cell. The resting membrane potential (RMP) is set at –50 mV. The AP was induced in the whole cell model by applying an external stimulus current (10–30 pA), as a brief square pulse of 500 ms duration. It is demonstrated that IKv opposes the Ca2+ current during the first 50 ms of the AP duration and then inactivated. It doesn't contribute to the repolarizing phase of the AP.

CONCLUSION
The plateau phase of the USM AP shows that the total AP duration much longer than that in other smooth muscle cells. It strongly supports the phenomenon is due to the activation of Ca2+-dependent K+ channel and inactivation of L-type Ca2+ channel. In ureter cells, the IKv does not contribute significantly to the repolarization of the AP, but it may regulate membrane excitability by opposing Ca2+ current activated around the threshold of the AP. Therefore, the agonist and antagonist of the IKv might be useful partially as new pharmacological targets for the USM abnormal contraction.
FC053: Weaning of Maintenance Immunosuppressive Therapy in Lupus Nephritis (Win-Lupus): A multicenter randomized controlled trial
Authors: Jourde-Chiche Noemie , Costedoat-Chalumeau Nathalie , Baumstarck Karine , Bouillet Laurence , Burtey Stephane , Caudwell Valerie , Chiche Laurent , Couzi Lionel , Daniel Laurent , Deligny Christophe , Dussol Bertrand , Faguer Stanislas , Gobert Pierre , Gondran Guillaume , Huart Antoine , Hummel Aurélie , Kalbacher Emilie , Alexandre Karras , Lambert Marc , Le Guern Veronique , Loubiere Sandrine , Maillard Helene , Maurier Francois , Pha Micheline , Queyrel-Moranne Viviane , Sarrot Francoise , Verhelst David , Hachulla Eric , Amoura Zahir , Daugas Eric 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Lupus nephritis (LN) is a frequent complication of systemic lupus erythematosus (SLE). Severe (proliferative) forms of LN are treated with an induction immunosuppressive therapy (IST), followed by a maintenance IST, to target remission and avoid relapses. The optimal duration of maintenance IST for proliferative LN is unknown. The WIN-Lupus trial tested whether IST discontinuation after 2–3 years in proliferative LN was non-inferior to IST continuation for 2 more years.

METHOD
WIN-Lupus is an investigator-initiated academic randomized controlled trial, conducted in 28 French centres. Patients on maintenance IST with azathioprine
or mycophenolate mofetil for a minimum of 2 years and a maximum of 3 years, and those who were taking hydroxychloroquine were randomized (1:1) between two groups: IST continuation and IST discontinuation. The primary endpoint was the relapse rate of proliferative LN at 24 months. Secondary endpoints were the rate of severe SLE flares, survival without renal relapse or severe flare, adverse events, kidney function, disease activity, corticosteroid exposure, patient-reported outcome and medico-economic impact.

RESULTS
Between 2011 and 2016, 125 patients were screened and 96 were randomized in the trial: 48 in the IST continuation group and 48 in the IST discontinuation group. In the per-protocol population, a relapse of proliferative LN occurred in 5/40 (10.4%) patients with IST continuation, and in 12/44 (25%) patients with IST discontinuation (difference 14.8%, 95% CI [−1.9; 31.5]). Noninferiority was not demonstrated for relapse rate. Time to renal relapse did not differ between groups (P = 0.092). Severe SLE flares (renal or extrarenal) were less frequent in patients with IST continuation compared to IST discontinuation (5/40 versus 14/44 patients; P = 0.035). IST discontinuation was associated with lower health-related costs. Adverse events did not differ between groups.

CONCLUSION
Noninferiority of maintenance IST discontinuation after 2 to 3 years was not demonstrated for renal relapse. IST discontinuation was associated with a higher risk of severe SLE flare.
FC075: Role of Factor H and its Related Proteins (FHR-1, FHR-2 FHR-5) in ANCA-Associated Vasculitis: A Genetic and Longitudinal Serological Study
Authors: Maria Fernandez Juarez Gema , Villacorta Javier , Lucientes Laura , Goicoechea De Jorge Elena 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The complement system was not initially thought to be associated with the development of ANCA-associated vasculitis (AAV). Convincing evidence from animal models and clinical observations indicates, however, that activation of the complement system, the alternative pathway (ACP) in particular, is pivotal for the development of AAV. Recently, a phase 3 clinical trial has shown that C5a receptor inhibition with avacopan was effective in replacing high dose glucocorticoids in AAV patients treated with rituximab or cyclophosphamide during induction treatment. We hypothesized that in AAV, a disorder in regulatory factors of ACP or in its related proteins (FHR-1, FHR-2, FHR-5) could be present, similar to other diseases in which its dysregulation have been shown.

Method
We measured longitudinal levels of alternative complements factors (FH, FB, properdin, FHR-1, FHR-2, FHR-5) and performed a genetic study for these factors in three cohorts: active renal ANCA vasculitis (active AAV, n = 54), inactive ANCA vasculitis (remission, n = 48) and in a control cohort of healthy individuals (n = 99).

RESULTS
ANCA serology was positive in all patients; 83.3% showed activity against MPO, whereas activity against PR3 was identified in 16.7% of patients. Median BVAS at the onset was 15 (IQR 14–19). Extrarenal involvement was present in 46.3% of participants. Haplotype CFH-H6 and the allele CFB32R are significantly associated with increased risk to develop AAV [OR 3.32; 95% confidence interval (95% CI) 1.39–7.89; P = 0.008 and OR 1.71, 95% CI 1.11–2.54; P = 0.008, respectively]. The allele frequency of ΔCFHR3/1 was significantly decreased in patients with severe AAV (T3, BVAS &gt; 16) compared with patients with a lower BVAS score (T1-T2 ≤ 15). Circulating levels of regulatory factors (FH, FB, properdin) were significantly lower in patients with active disease compared to samples in remission, and FHR1 (FH competitor) levels were higher. C3 levels increased over time, while sC5b-9 decreased after initiating the immunosuppressive treatment, with the biggest change observed after the first month of treatment. After 12 months of follow-up, FHR-1 levels decreased in responder patients and did not decrease in nonresponders.

CONCLUSION
This is the first study to associate the presence of certain alleles of regulatory factors of the alternative complement pathway (Factor H and Factor B) with an increased risk of developing ANCA-associated vasculitis. Likewise, the absence of the ΔCHR3-CFHR1 deletion was associated with more severe forms of the disease. We could conclude that ACP is not a simple additional factor in the inflammatory loop in AAV and, like in other glomerular diseases related to ACP, dysregulation of FH and its regulatory proteins play an essential role in its development.
FC 111: A Comorbidity Index and Pretransplant Physical Status Predict Survival in Older Kidney Transplant Recipients
Authors: Tsarpali Vasiliki , Midtvedt Karsten , Lønning Kjersti , Bernklev Tomm , Åsberg Anders , Von der Lippe Nanna , Varberg Reisater Anna , Heldal Kristian 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Regardless of age, kidney transplantation (KT) is considered the optimal treatment for patients with end-stage kidney disease (ESKD). In the increasing elderly ESKD population, KT should be reserved for carefully selected candidates who are expected to experience favorable outcomes. We aimed to prospectively evaluate pre-transplant recipient factors that may predict post-transplant patient survival and can eventually guide therapeutic decisions in elderly with ESKD.

METHOD
Recipient factors were evaluated in KT candidates aged ≥65 years, who were enlisted for KT between January 2013 and November 2016 at the Norwegian national transplant centre. Pretransplant comorbidity was assessed at waitlisting, according to the Liu Comorbidity Index (LCI). Self-reported health-related quality of life was assessed using the Kidney Disease Quality of Life Short Form version 1.3 (KDQOL-SF). The Cox proportional hazard regression was used to evaluate predictors of patient survival.

RESULTS
We included 289 waitlisted candidates, of whom 192 received a deceased brain-dead donor kidney. Mean age at KT was 72 (4.1) years, 133 (69%) were male, 47 (24%) were transplanted preemptively and 80% received an expanded criteria donor organ. During a median observation time of 4.6 (3.2–6.3) years post-KT, 66 recipients died. LCI ≤ 3 was observed in 136 recipients (71%), between 4–6 in 39 recipients (20%) and 17 recipients (9%) had LCI ≥ 7. Elevated LCI ≥ 4 predicted poor patient survival, and was associated with a 2.2-times increase in mortality risk (Figure 1). In recipients with LCI ≥ 4, dialysis ≥2 years comprised a 2.5-fold higher mortality risk, compared with recipients on dialysis ≤2 years (Figure 2). Self-reported pretransplant physical function was also proven to be a significant positive predictor of survival, with scores ≤60 being associated with a 2-fold increase in mortality risk.

CONCLUSION
The implementation of LCI and a physical function score during the evaluation of older kidney transplant candidates may improve the selection and thereby optimize post-transplant outcomes.