bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO460: The Association of Beta-Hydroxybutyrate and Kidney Function Decline in the General Population—Results From the Prevend Study
Authors: Knol Martine , van der Vaart Amarens , Vart Priya , Kieneker Lyanne , Connelly Margery A , Garcia Erwin , Bakker Stephan J L , Gansevoort Ronald , Van Gastel Maatje 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Beta-hydroxybutyrate (BHB), a ketone body, has shown to be renoprotective in various disease-specific preclinical studies. The underlying mechanism of this renoprotective effect might be via the reduction of inflammation, apoptosis, oxidative stress, and fibrosis. Interest in the effects of this metabolite is rising because supplementation is possible as an intervention. We hypothesized that endogenous BHB is associated with better kidney function outcomes in the general population. The aim of this study is to assess the association between BHB and kidney function.

METHOD
We included 6127 participants with available plasma BHB data from the Prevention of Renal and Vascular End-stage Disease (PREVEND) study, a prospective, population-based cohort of Dutch men and women. BHB was measured in fasting participants using nuclear magnetic resonance (NMR) spectroscopy. The association of BHB with estimated glomerular filtration rate (eGFR), calculated with the CKD-EPI creatinine cystatin C equation, was tested using multivariable linear regression for cross-sectional analyses and linear mixed modeling for longitudinal analyses. The analyses were adjusted for sex, age, BMI, smoking, diabetes type 2, hypertension and hyperlipidemia.

RESULTS
Overall, 50.6% of the included subjects were female, mean age was 53.6 ± 12.1 years. At baseline, the median BHB concentration was 121.5 μmol/L [inter quartile range (IQR) 92.8–169.2] and the mean eGFR was 92 ± 17 mL/min/1.73m2. In cross-sectional analyses, a higher BHB was associated with a lower eGFR, after adjustment for covariates (st.β= −0.041, P &lt; 0.001). During a median follow-up of 7.5 years (IQR 7.2–8.0), the mean annual change in eGFR was −0.96 ± 0.52 mL/min/1.73m2/year. In longitudinal analyses, a higher BHB was associated with less eGFR decline in the fully adjusted model [0.17 (95% confidence interval, CI 0.01–0.33); P = 0.04]. After exclusion of participants with diabetes type 2, the association of BHB and eGFR decline became stronger [0.22 (95% CI 0.06–0.38); P = 0.01].

CONCLUSION
Higher BHB levels were associated with less eGFR decline in this general population cohort. In combination with previous preclinical data, this data supports the hypothesis that BHB is renoprotective and forms a rationale to study whether supplementation with BHB attenuates kidney function decline in patients with chronic kidney disease.
MO471: Adverse Drug Reactions and Drug–Drug Interaction in Chronic Kidney Disease With Tuberculosis
Authors: Datta Divya , Attur Prabhu Ravindra , Abdul Khader Nisha , Prasad Nagaraju Shankar , Ramachandra Rao Indu , Vinayak Shenoy Srinivas , Rangaswamy Dharshan , Bhojaraja Mohan V , Thunga Girish , Magazine Rahul , Shetty Raghavendra 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The risk of developing tuberculosis (TB) is 10–25% in chronic kidney disease (CKD) patients. TB in CKD patients may have a mortality of 16–37%. Standard treatment with four drugs (Isoniazid, Rifampin, Pyrazinamide and Ethambutol) predisposes to side effects, drug interactions and incomplete adherence in this population. We studied adverse drug reactions and potential drug–drug interactions in CKD patients with TB.

METHOD
Consecutive patients with CKD and TB attending tertiary care hospitals in South India were included over a period of 12 months. CKD was diagnosed based on estimated GFR using CKD EPI and TB using standard methodology. Data on demographic details and adverse drug reactions were collected from case records. Potential drug–drug interactions were checked using Micromedex Drug-Reax® (Truven Health Analytics, Greenwood Village, Colorado, USA). Statistical analysis was done using SPSS version 20.

RESULTS
Of 1300 TB patients, 59 had CKD. The demographic details are as per Table 1.

CONCLUSION
In CKD with TB, adverse drug reactions were seen in 45.5% and potential drug–drug interactions were seen mostly with rifampin (28.81% in CKD).
MO483: Validation of The Kidney Failure Risk Equation in a Portuguese Cohort
Authors: Marques Da Silva Bernardo , Charreu José , Duarte Inês , Outerelo Cristina , António Lopes José , Gameiro Joana 
Published: May 2022

Abstract

BACKGROUND AND AIMS
In chronic kidney disease (CKD) patients, the risk of kidney replacement therapy (KRT) is highly variable. In 2011, Tangri et al. developed the kidney failure risk equations (KFRE) to predict the 2- and 5-year probability of requiring kidney replacement therapy (KRT). The KFRE is an easily calculated 4-variable equation that has been extensively validated in multiple cohorts. The aim of this study was to validate this risk score in a Portuguese cohort.

METHOD
We conducted a retrospective analysis of CKD patients stage 3–5 referred for nephrology consult at Centro Hospitalar Universitário Lisboa Norte during the first 6 months of 2018. Age, gender, estimated glomerular filtration rate (eGFR) and albuminuria were assessed. The four-variable Kidney Failure Risk Equation (KFRE) calibrated for a non-North American population was calculated. Requirement for KRT was assessed in a 2-year follow-up. We assessed the Cox logistic regression method of the KFRE to predict KRT requirement, and the discriminatory ability was determined using the receiver operating characteristic (ROC) curve. A cut-off value was defined as that with the highest validity.

RESULTS
A total of 360 patients were included, and 54.4% were male. The mean age was 74.9 ± 12.2 years, serum creatinine was 1.97 ± 0.84 mg/dL, eGFR was 33.4 ± 12.13 mL/min/1.73 m2 and albuminuria was 571.1 ± 848.3 mg/g. The mean calculated risk score was 6.2 ± 11.2%. A total of 23 patients required KRT (6.4%) in the 2-year follow-up. The hazard ratio was 1.1 [95% confidence interval (95% CI) 1.06–1.12; P &lt; .001] for the 2-year risk of KRT. The KFRE predicted progression to KRT requirement with an auROC of 0.903, (95% CI 0.86–0.95; P &lt; 0.001), with a sensitivity of 91.3% and specificity of 71.8%. The optimal KFRE cut-off was &gt;4.5% for 2-year nephrologist referral, with a hazard ratio of HR 26.7 [95% CI 6.15–116.3; P &lt; .001] for 2-year risk of KRT. requirement.

CONCLUSION
We have independently externally validated the 2-year KFRE and shown that it has excellent discrimination. The KFRE should be incorporated into the clinical care of patients with CKD to improve patient-clinician dialogue and provide guidance on the timing of referral for nephrology evaluation and planning for dialysis access.
MO494: The Prospective Roles of Urinary Dickkopf-3 for Detecting Renal Function Deterioration and Monitoring Chronic Kidney Disease Progression: Systematic Review of Cohort Studies
Authors: Pratama Putra Boby , Nugraha Putra Felix 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Chronic kidney disease (CKD) is a worldwide health problem whose incremental prevalence. Early detection and proper monitoring of renal dysfunction can decrease morbidity and mortality among CKD patients. Estimated glomerular filtration rate (eGFR) and albuminuria have been used for monitoring CKD progression. Unfortunately, substantial CKD patients’ proportion might undergo CKD progression through non-proteinuric pathways. Dickkopf-3 (DKK3), stress-induced renal tubular epithelial-derived glycoprotein, is a key driver of tubulointerstitial fibrosis through the canonical Wnt/β-catenin signaling pathway. This study aims to evaluate the role of DKK3 in detecting and monitoring renal dysfunction and CKD progression.

METHOD
Comprehensive literature searching was performed through the online databases of PubMed, EMBASE, ScienceDirect and The Cochrane Library. This study followed the PRISMA guidelines. The inclusion criteria are all cohort studies that assess the correlation and clinical implications of increased urinary DKK3 with CKD progression. The quality of included studies was accessed by using the Newcastle–Ottawa Scale.

RESULTS
Six cohort studies matched the inclusion criteria. Urinary DKK3-to-creatinine &gt;4000 pg/mg was independently associated with annual eGFR decline among early CKD stages. A multivariate analysis study suggested that 24-h urinary DKK3 was independently associated with the annual Kt/V decline among peritoneal dialysis patients. Increased urinary DKK3 was associated with a significant eGFR decline in 6 months among IgA nephropathy patients. A cohort study suggested that populations with microalbuminuria were significantly susceptible to prevalent cardiovascular diseases, prevalent CKD, and new-onset CKD risks. Urinary DKK3 was associated with significant incremental risks for declining eGFR and proteinuria as well as CKD progression risks in chronic obstructive pulmonary disease (COPD) patients. In a study, involving CKD patients who underwent coronary angiography, the baseline urinary DKK3-to-creatinine ratio was superior to serum cystatin-C and serum and urinary neutrophil gelatinase-associated lipocalin (NGAL), predicting both acute kidney injury (AKI) and persistent renal dysfunction. A cardiac surgery study showed that high urinary DKK3-to-creatinine ratio &gt;471 pg/mg was significantly associated with AKI, persistent renal dysfunction and dialysis dependency.

CONCLUSION
Dickkopf-3 shows promising prospective roles for detecting early renal dysfunction and monitoring CKD progression. Nevertheless, further studies are warranted to confirm its promising prospective role.
MO497: Upper Tract Urothelial Cancer and Balkan Endemic Nephropathy: 65 Years of Follow UP
Authors: Glogovac Stevan , Tasic Danijela , Dimitrijevic Zorica , Apostolovic Branislav , Bašić Dragoslav , Mitic Branka , Prokopovic Miomir , Pertovic Milan , Stojanovic Miomir , Paunovic Karolina , Ljubenovic Stanimir 
Published: May 2022

Abstract

BACKGROUND AND AIMS
All researchers dealing with Balkan endemic nephropathy (BEN) talk about the association of BEN with malignant tumours of the upper urothelium (UTUC). Long-term research of UTUC obtained various results depending on the period and region of observation, depending on the stage of renal failure, degree of malignancy, surgical or autopsy treatment. The aim of this paper is to monitor UTUC in certain parts of the Republic of Serbia in a long period of time and what is the frequency of tumours in relation to the observed endemic and non-endemic built-up areas for BEN.

METHOD
Occurrence of UTUC was analyzed for the period 1953–2017 on the basis of operational protocols of the Institute of Urology and Nephrology KCS Belgrade, Clinic of Urology Nis, Department of Urology and Haemodialysis Leskovac. The categorization of built-up areas into (A) endemic, (B) hypoendemic, (C) non-endemic rural and (D) non-endemic urban built-up areas was used. For practical reasons, the groups of built-up areas (A) and (B) united in the group of endemic and (C) and (D) in the group of non-endemic built-up areas. The average annual incidence rate (AAIR) is calculated/100 000 inhabitants.

RESULTS
In his summary series of UTUC, which included a large number of urological centres in Serbia, Petkovic found in a period of 20 years (1953–1973) that the frequency of tumours is 100 times higher in an endemic than in a non-endemic built-up area. In a 40-year study (1978–2017), Glogovac found that the incidence of tumours in Jablanica district was 14.24 times higher in endemic (AAIR-11.82) than in non-endemic built-up areas (AAIR-0.83) in the last 20 years (1998–2017). The frequency is 4.14 times higher.
The linear trend of UTUC in the Jablanica district in the endemic built-up area for BEN in the observed 40-year period was in a statistically weak decline (y = –0.0276x + 55.691; r2 = 0.1718) while for BEN it was in a statistically significant decline (y = –0.2127x + 6.6966; r2 = 0.8529).

CONCLUSION
The high frequency of UTUC in regions with BEN may indicate a common nephropathogenic and carcinogenic etiological factor and confirms the existence of a positive correlation between BEN and UTUC. The reason for the decline in the frequency of UTUC in the observed built-up area in the observed period should be sought in the drastic decline in BEN, which is explained by changes in the course of the disease, better screening, water supply, health education, lower toxicity, micromigration and possibly misdiagnosis.
MO498: Incident Chronic Kidney Disease in Older Adults With Diabetes
Authors: Lim Cynthia , Mong Bee Yong , Ang Andrew , Abdul Kadir Hanis , Liang Kwek Jia , Choo Jason , Chuan Tan Ngiap 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Chronic kidney disease (CKD) is a growing global public health burden among aging populations and is associated with increased risks of cardiovascular disease, kidney failure and death. Early identification and treatment can amelioriate these risks. We aimed to evaluate incident CKD and risk factors among older adults with diabetes in Singapore.

METHOD
Retrospective cohort study of 13 028 older adults ≥65 years with diabetes mellitus who were free of CKD (eGFR ≥60 mL/min/1.73 m2) at baseline and had kidney function tested 3 years later at Singapore's largest healthcare cluster that includes the Singapore General Hospital and SingHealth Polyclinics. Demographic, clinical and laboratory data were retrieved from electronic medical records and the SingHealth Diabetes Registry. Incident CKD was present if eGFR was &lt;60 mL/min/1.73 m2 at follow up. Binary logistic regression analysis was used to obtain the odds ratio (OR) and 95% confidence interval (CI) for pre-selected factors.

RESULTS
In this multi-ethnic cohort (Chinese 91%, Indian 8%, Malay 8% and other ethnicities 3%), the mean age was 72.1 ± 5.6 years and the eGFR was 84.2 ± 11.1 mL/min/1.73 m2. The majority were on glucose and blood pressure lowering medications and achieved glycated haemoglobin (HbA1c), systolic blood pressure (SBP) and diastolic blood pressure (DBP) of 7.1% ± 1.1, 133 ± 16 mmHg and 68 ± 9 mmHg, respectively.
Cumulative incident CKD among older adults with diabetes was 19.4% &gt;38.5 ± 4.7 months. In the fully adjusted model, considering age, gender, ethnicity, comorbidities (hypertension, cardiovascular disease, cancer, statin use), SBP, DBP, BMI and laboratory results (eGFR, albuminuria, glucose, HbA1c, LDL- and HDL-cholesterol). Female gender {adjusted OR: 1.54, [95% confidence interval (95% CI) 1.36–1.76]}, Malay ethnicity (adjusted OR: 1.24, 95% CI 1.01–1.53), hypertension (adjusted OR: 1.40, 95% CI 1.02–1.93), albuminuria (adjusted OR: 1.49, 95% CI 1.31–1.69) and higher HbA1c (adjusted OR: 1.11, 95% CI 1.04–1.18/unit increase) were independently associated with incident CKD, while higher eGFR (adjusted OR: 0.88, 95% CI 0.87–0.88/unit increase) and statin use (adjusted OR: 0.79, 95% CI 0.64– 0.99) were associated with decreased incident CKD.

CONCLUSION
Incident of CKD was frequent among older adults with diabetes. The presence of risk factors for incident CKD can aid clinicians to identify those who may benefit from close surveillance and interventions.
MO514: Cardiorenal Outcomes Associated With Oral Anticoagulant Use in Patients With Atrial Fibrillation
Authors: Mazhar Faizan , Trevisan Marco , Hjemdahl Paul , M. Clase Catherine , De Jong Y , Evans Marie , Bellocco Rino , Fu Edouard , Jesus Carrero Juan 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Novel oral anticoagulants (NOAC) are currently the first-line choice for stroke prevention in patients with atrial fibrillation (AF), as they have a better risk/benefit profile compared with vitamin K antagonists (VKA). Secondary analyses of trials suggest that NOAC also reduces kidney outcomes, but this has been less explored.

METHOD
Observational study from the SCREAM project comparing clinical outcomes of all persons with AF and eGFR ≥15 mL/min/1.73 m2 that initiated NOAC or VKA in Stockholm, Sweden, during 2011–18. The primary outcomes were acute kidney injury (AKI, by diagnosis or sudden creatinine elevation) and the composite of kidney failure and &gt;30% eGFR decline. Secondary outcomes were major bleeding and the composite of hospital admission with stroke or systemic embolism. Inverse probability of treatment weighting (IPTW) was used to balance 51 baseline confounders. Sensitivity analyses included falsification endpoints (pneumonia and cataract surgery), subgroups and evaluation of per-protocol effects.

RESULTS
A total of 32 699 patients initiated oral anticoagulants (median age, 75 years, 45% women, median eGFR 73 mL/min/1.73 m2), of which 18 323 (56%) used NOAC. Compared with VKA, initiation of NOAC was associated with a 13% lower relative risk of experiencing the composite kidney outcome (HR: 0.87; 95% CI 0.78–0.98) and a 12% relative risk reduction on AKI occurrence (HR: 0.88; 95% CI 0.80–0.97). Compared with VKA, NOAC use was associated with a lower risk of major bleeding (HR 0.77; 95% CI 0.67–0.89), but a similar risk of stroke/systemic embolism (HR: 0.93; 95% CI 0.78–1.11). Results were similar across subgroups, including patients with chronic kidney disease (eGFR &lt;60 mL/min/1.73 m2) and when censoring patients at treatment discontinuation or switch.

CONCLUSION
Compared with VKA, and regardless of baseline kidney function, initiation of NOAC was associated with a lower risk of CKD progression, AKI and major bleeding, but a similar risk of the composite of stroke and systemic embolism.
MO518: Chronic Kidney Disease in Primary Care and the Risk of Cardiovascular Comorbidity and Mortality
Authors: Borg Rikke , Kriegbaum Margit , Klinten Grand Mia , Struer Lind Bent , Lykkegaard Andersen Christen , Persson Frederik 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The prevalence of chronic kidney disease (CKD) is increasing globally. Often, the condition develops silently over time, with no or only a few symptoms in earlier stages. Therefore, early recognition in primary care may have an important role in ensuring diagnosis and proper intervention. We aimed to determine the prevalence and outcome of CKD in a large primary care cohort in Denmark.

METHOD
We performed an observational cohort study using data from individuals above age 40 followed in primary care in the greater Copenhagen area between 2000 and 2015 and linked them to Danish health registries. A run-in period of 3 months was included to ensure stable conditions and rule out acute changes in eGFR at baseline. The date of the second measurement of eGFR during the study period was considered the subject's index date (baseline). Outcomes were relevant diagnoses such as stroke, myocardial infarction (MI), hospitalisations for heart failure (HHF) and peripheral artery disease (PAD) (last update 2018), all-cause mortality and cardiovascular mortality. Kidney function (eGFR) was estimated by the CKD-EPI formula based on serum creatinine and expressed in mL/min/1.73 m2. Conventional CKD groups are used with CKD 1 and 2 (normal—eGFR &gt; 60 mL/min/1.73 m2) as reference groups for the hazard ratio estimates. Outcomes were presented as the number of events/100 person-years (PY). We conducted survival (all-cause mortality outcome) and competing risk (rest of the outcomes) analyses using the Cox proportional hazards model to calculate the (cause-specific) hazard ratios for the outcomes according to CKD group. We further explored the continuous associations between kidney function and the outcomes examined by using eGFR as a continuous variable with penalised splines. All models were adjusted for known risk factors (age, gender, diabetes, hypertension, existing CVD, heart failure, LDL cholesterol, use of antihypertensive treatment).

RESULTS
We included a population of 171 133 individuals. As expected, the majority (n = 157002) was in CKD 1 or 2 at the index date, and only a small proportion (0.05%) was in CKD stage 5. In general, event rates were low in CKD stages 1 and 2 and rose with higher stages of CKD. In the adjusted analyses, we observed a stepwise increase in hazard rates for every outcome with every increment in CKD stage (Fig. 1). This was confirmed by the continuous analysis. Compared with CKD stage 1 + 2, individuals in CKD stage 4 had approximately double the hazard rate of PAD, MI, cardiovascular and all-cause mortality.

CONCLUSION
Our data from a large primary care cohort demonstrate an early increase in risk for adverse outcomes already at CKD stage 3. This provides the basis and underlines the importance of studying early intervention in primary care.
MO580: Healthy Plant-Based Diet for Patients With Chronic Kidney Disease (CKD) Through Use of Sodium Zirconium Cyclosilicate (SZC): A Feasibility Study (Helpful)
Authors: Avesani Carla , Heimbürger Olof , Lindberg Anneli , Rubin Charlotta , Faxen Irving Gerd , Rashid Tony Qureshi Abdul , Lindholm Bengt , Stenvinkel Peter 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Healthy plant-based diets (HealthyPB diet) may offer metabolic and cardiovascular benefits to patients with CKD. However, the higher potassium (K+) content of these diets is a concern when prescribed to CKD patients with hyperkalemia (HK). Potassium-lowering medication, such as SZC, can be a treatment option to allow better control of plasma K + for those ingesting a HealthyPB diet. We investigated whether patients with CKD stage 4–5 and HK can be safely prescribed a HealthyPB diet with increased K + content by concomitant use of SZC.

METHOD
This is an ongoing open label feasibility clinical trial that will include 36 patients with CKD stage 4–5 not on dialysis with HK (plasma K+ ≥ 5.1 mmol/L). Patients with plasma K+ &gt; 6.5 mmol/L are excluded. Intervention: Patients are followed for 6 weeks. In the first 3 weeks (stabilization phase), SZC is prescribed according to the drug label to normalize plasma K + while ingesting a low protein diet (0.6–0.8 g/kg/day) with low content of K+ (2.3 g/day) as counselled by a dietitian. After 3 weeks, patients initiate and follow for 3 additional weeks, the HealthyPB diet containing unchanged low amount of protein and K + content of 3.7–4 g/day. In order to increase diet adherence, a food basket (containing fruits, vegetables, whole grains, nuts, whole cereals, white meat, fish or eggs in amounts adequate for the patient and the family) is delivered to patient's home once per week. Serum K is closely monitored and the dose of SZC is adjusted according to the drug label to maintain serum K between 3.5 and 5.0 mmol/L. Adherence to the diet is assessed by 24-h urinary K + excretion, 24-h food record, and a semi-quantitative short food questionnaire at the beginning and end of the stabilization phase and again at the beginning and end of the HealthyPB diet phase. The protocol is registered at www.clinicaltrials.gov (identifier NCT04207203).

RESULTS
Among 14 patients included so far, 12 completed the study protocol and 2 are being followed. Results in the patients (n = 12; age 56.5 ± 10 years; 66.7% men; eGFR: 16.4 ± 4.6 mL/min/1.73 m2) who completed the follow-up are described in the Table 1. Mean ± SD or median and interquartile range; NA: not assessed.
At the end of follow-up three (25%) patients had plasma K + between 5.1 and 5.3 mmol/L.

CONCLUSION
These preliminary results indicate that patients adhered to the low protein HealthyPB diet with an increase in the intake of fruits, vegetables, whole cereals and nuts. The mean plasma K + was well controlled with SZC and within the normal range after the start of the HealthyPB diet.