bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO500: Increased Mortality and Readmission Rates Among Hospitalized Covid-19 Patients With Varying Stages of Chronic Kidney Disease
Authors: Appelman Brent , Oppelaar Marjet , Broeders Lani , Wiersinga Joost , Peters-Sengers H , Vogt Liffert 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Chronic kidney disease (CKD) has been recognized as a highly prevalent risk factor for both the severity of coronavirus disease 2019 (COVID-19) and COVID-19 associated adverse outcomes. In this multicentre observational cohort study, we aim to determine the mortality and readmission rates of patients hospitalized for COVID-19 across varying CKD stages.

METHOD
We performed a multicentre cohort study among COVID-19 patients included in the Dutch COVIDPredict cohort consisting of hospitalized COVID-19 patients (PCR-confirmed or CORADS score &gt;4). Seven groups of CKD were defined based on a previously reported medical history of CKD and pre-admission eGFR (CKD-EPI), which was also used to categorize CKD-stages. Patients without CKD were classified as controls. The primary outcome was a composite endpoint of all-cause mortality, readmission or palliative hospital discharge in a 12-week follow-up period. Logistic regression was used to adjust the association between CKD groups and primary outcome in a stepwise procedure for the following confounders: age, sex, ethnicity, number of comorbidities and designated COVID-19 treatment wave.

RESULTS
From March 2020 until July 2021, a total of 4151 hospitalized COVID-19 patients were included, of whom 389 had a history of CKD before admission. After adjusting for all confounding covariables, in patients with CKD stage 3a, stage 3b, stage 4 and patients with NTX, odds ratios of death and readmission compared with patients without CKD ranged from 1.96 to 8.94 (Fig. 1).

CONCLUSION
We demonstrate an evident increased 12-week mortality and readmission rate in patients with CKD stage 3a and 4. Besides justified concerns for kidney transplant patients, clinicians should also be aware of more severe COVID-19 outcomes and increased vulnerability in all CKD patients.
MO524: Gender Differences in Intravascular Volumes Vanish if Expressed per Lean Body Mass
Authors: Lundby Carsten , Oberholzer Laura 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Blood volume (BV) is an important clinical parameter and is usually expressed relative to body weight (BW), but is inappropriate with elevated fat mass. We hypothesized that established differences in BV and hemoglobin mass (Hbmass) between male and female would vanish if expressed per lean body mass (LBM) instead of BW. We furthermore aimed to establish reference values for BV, plasma volume, red blood cell volume and Hbmass in women and men for clinical use.

METHOD
Blood volumes (carbon monoxide rebreathing) and body composition (DXA scan) were determined in 225 female and 280 healthy men (18–93 years, BMI range: 16.4–40.6).

RESULTS
As expected, female absolute BV was 1570 mL [CI 95% (1429.66–1709.87)]; P-value ≤.001) less than in male, and also when expressed per BW female had lower values than male (Figure 1A) [CI 95% (8.06–12.02); P-value ≤.001]. However, when expressed to LBM, females had 6.3 mL higher value than males [CI 95% (−8.80 to −3.86); P-value ≤ .001] (Figure 2A). In a similar manner, absolute Hbmass was 303 g greater in male [CI 95% = (283.99–322.09); P-value ≤ .001] and also greater when expressed pr BW [CI 95% (2.37–2.88); P-value ≤ .001] (Figure 1D). However, when normalized to LBM, differences were greatly diminished −0.84 [CI 95% (0.53–1.15); P-value ≤ .001] (Figure 2B). Per year of older age, a man gains 0.14 [0.06–0.22] mL blood/LBM (P = .0012) and a woman gains 0.13 [0.04–0.22] mL (P = .0032), but the increase in blood volume is not different between men and women (no interaction effect, P = .92). Similar observations as for BV and Hbmass were also made for red blood cell volume and plasma volume (See Figs. 1 and 2).

CONCLUSION
The principal finding is that when BV and Hbmass are expressed relative to LBM, the known differences in intravascular volumes and Hbmass between male and female largely disappear. Furthermore, the relation between LBM and intracvascular volumes and Hbmass is preserved with advancing age. Taken together, LBM is a very strong predictor for intravascular volumes and Hbmass in healthy humans and could be considered a valuable clinical matrix in medical care aiming to normalize intravascular volumes in patients such as chronic kidney failure and heart failure.
MO527: The Active Ingredient in the Nuphar Lutea Plant, 6,6′: Dihydroxythiobinupharidine (DTBN) Ameliorates Kidney Fibrosis, Inflammation and Anemia in a Mouse Model of Chronic Kidney Disease (CKD)
Authors: Khalilia Jannat , Landau Daniel , Arazi Eden , Gopas Jacob , Segev Yael 
Published: May 2022

Abstract

BACKGROUND AND AIMS
EPO resistance and iron deficiency in CKD-related anemia are associated with an increase in inflammatory cytokines associated with the innate immune response, such as IL-6, IL-1 and TNF-α. Recently (Bandach et al. Sci Reports 2021) we reported that kidney fibrosis and anemia of CKD can be worsened or relieved when IL1 effects are enhanced or inhibited respectively.
The Water lily (Nuphar lutea) plant has been widely used as a traditional remedy for the treatment of rheumatism, scars, pain and more. Gopas, Golan-Goldhirsh et al. (Cancer Biology Therapy 2009) extracted an active ingredient from the family of nupharidines: 6,6′-Dihydroxythiobinupharidine (DTBN), which showed anti-inflammatory properties, mainly through the inhibition of NF-κB. The purpose of this study was to test the effects of DTBN in a mouse model of CKD-associated anemia.

METHOD
8 weeks old male C57BL/6 mice were divided into three groups: control, CKD (induced by adenine diet) and CKD-DTBN. CKD groups were injected with saline-DMSO or 30 µg DTBN, every 2 days and sacrificed after 3 weeks from dietary intervention.

RESULTS
Serum urea and kidney TGFβ mRNA were significantly decreased in CKD- DTBN versus CKD. Kidney histology in CKD mice showed macrophage infiltration and renal fibrosis, which was ameliorated in CKD-DTBN.
A significant improvement in inflammation indices (blood lymphocytes, kidney and liver IL-6 and p-STAT3, liver CRP), as well as kidney immunoreactive NF-κB and F4\80, which were increased in CKD, were decreased in CKD-DTBN. CKD anemia indices (hemoglobin, hematocrit and red blood cell (RBC) count) significantly improved in CKD-DTBN. Kidney HIF-2α and EPO mRNA were significantly decreased in both uremic groups, but was unchanged in CKD- DTBN versus CKD. However, serum iron and transferrin saturation significantly increased in CKD-DTBN versus CKD.

CONCLUSION
Uremic mice treated with DTBN show improvement in kidney fibrosis, inflammation and anemia indices. Thus, DTBN may be a novel therapeutic alternative for CKD and its complications.
MO544: Outcomes Associated With use of Phosphate Binders in Persons With Chronic Kidney Disease Stages 4 and 5 in Spain
Authors: Molina Pablo , D. Molina Mariola , Bover Jordi , Gimenez-Civera Elena , Castro Alonso Cristina , Escudero Quesada Veronica , Pantoja Jonay , Jesus Carrero Juan , Luis Gorriz Teruel Jose 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Use of phosphate binders among non-dialysis chronic kidney disease (ND-CKD) patients remains controversial, since clinically relevant benefits have not been fully demonstrated. The goal of this study was to determine patterns of phosphate binders use and its associated outcomes in ND-CKD patients.

METHOD
PECERA (Collaborative Study Project in Patients with Advanced CKD) is a 3-year, prospective multicentre, open-cohort study of 966 adult patients with non-dialysed CKD stages 4–5 enrolled from 12 centres in Spain. The end of the follow-up was December 2012. At baseline and every 6 months, demographics, comorbidities, treatments and serum biochemical parameters were collected. Patients who received treatment with calcium-based and calcium-free phosphate binders were compared with those who had not. In a prespecified statistical approach, we assessed the association of phosphate binders use with all-cause mortality using time-dependent Cox proportional hazards models.

RESULTS
Sevelamer was the only calcium-free based binder prescribed during the study. Overall, 515 (53%) patients received some form of binder, with most of them using calcium-based binders (n = 360, 37%) and a minority (n = 111, 11%) using exclusively sevelamer (n = 111, 11%) or a combination of the two (n = 44, 5%). After a median follow-up of 29 months (IQR 13–36 months) there were 181 deaths (19%). Crude overall all-cause mortality was significantly lower in patients receiving sevelamer, but not in those receiving calcium-based binders (Figure). After multivariate adjustment for age, weight, blood pressure, diabetes, comorbidity, vitamin D treatment, renal function and levels of albumin, calcium, phosphorous and PTH, treatment with sevelamer was independently associated with lower mortality [adjusted hazard ratio (HR), 0.44 (95% confidence interval (95% CI), 0.22–0.88); P = 0.02]. Use of calcium-based phosphate binders did not predict death.

CONCLUSION
The administration of sevelamer is associated with lower all-cause mortality in advanced ND-CKD patient. Clinical trials are warranted to clarify the risks and benefits of phosphate binders in this population.
MO545: Estimated Proximal Tubule Fluid Phosphate Concentration: An Early Marker of CKD-MBD?
Authors: Rotondi Silverio , Mazzaferro Sandro , Pasquali Marzia , Tartaglione Lida , Tinti Francesca , Perrotta Adolfo 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Chronic kidney disease (CKD) typically associates with mineral bone disorders (CKD-MBD), kidney damage progression and increased morbidity and mortality. CKD-MBD develops early in CKD and, if promptly detected, could receive therapeutic attention. However, early markers of CKD-MBD like fibroblast growth factor 23 (FGF23) and α-Klotho are not widely available in clinical practice. Recently, estimated proximal tubule fluid phosphate concentration (ePTFp) has been proposed as a novel early marker of MBD. In fact, in CKD patients, along with the progressive reduction of nephron number, FGF23 increments are necessary to reduce renal tubular phosphate reabsorption and to maintain phosphate balance. As a consequence, PTFp concentration per single nephron progressively increases, leading to renal tubular cells overload, interstitial inflammatory response and progression of kidney damage. For this reason, PTFp concentration could represent an early marker of CKD-MBD.

OBJECTIVE
To evaluate the relationship between ePTFp and early markers of MBD in patients with CKD stage G2–4.

METHOD
In CKD patients stage G2–4, we evaluated serum FGF23, α-Klotho, parathyroid hormone (PTH) and ePTFp [ePTFp = (phosphaturia/creatininuria) x creatininemia x 3,33]; 30 healthy subjects (age 40 ± 5 years) were the control group for normal value of ePTFp.

RESULTS
In 68 CKD patients (age 58.9 ± 15.6 years eGFR 45 ± 21 mL/min), ePTFp averaged 2.4 ± 1.3 mg/mg which was significantly higher than in the control group (ePTFp = 1.2 ± 0.5; P &lt; 0.01). ePTFp increased progressively along with the increasing CKD stages (stage 2: 1.6 ± 0.6; stage 3: 2.3 ± 0.9; stage 4: ± 1.5; P &lt; 0.001) with values significantly higher than the control group since CKD stage 2 (ePTFp: Control group = 1.2 ± 0.5 versus stage 2 = 1.6 ± 0.6; P &lt; 0.05). ePTFp showed a positive correlation with FGF23 (r: 0.69; P &lt; 0.001) and PTH (r:0.310; P &lt; 0.05) and a negative correlation with α-Klotho (r: −237; P &lt; 0.05) and eGFR (r: −647; P &lt; 0.001).

CONCLUSION
Our data showed early and progressive increments of ePTFp in CKD patients since CKD stage 2. These increments are paralleled by increased FGF23 and PTH and decreased α-Klotho, suggesting reciprocal pathophysiologic dependence. Accordingly, ePTFp could represent a surrogate of renal tubular cells phosphate overload, indicative of CKD-MBD development. ePTFp can be easily obtained in everyday clinical routine and could represent a reference to make therapeutic choices (e.g. dietary phosphate control).
In conclusion, ePTFp could identify patients at risk of developing the CKD-MBD maladaptive response with increased risk of kidney damage progression.
MO549: Chronic Kidney Disease and Vascular Calcification Result in Inflammation and Dysfunction of Colon Tissue in Rats
Authors: Bartochowski Piotr , Muyor Karen , Laget Jonas , Cortijo Irene , Castel Laura , Duranton Flore , Bornes Stéphanie , Argiles Ciscart Angel , Jover Bernard , Cordaillat - Simmons Magali , Gayrard Nathalie 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Chronic Kidney Disease (CKD) results in modifications in the activity and/or structure of many organs. One of them is the intestine. Intestinal barrier dysfunction may result in turn, in gut leakage and aggravation of the course of CKD. The interaction between the colon and kidneys may be relevant for both, the kidneys as well as the colon. This study aimed to evaluate the impact of CKD and vascular calcification on colon tissue and function.

METHOD
Sprague–Dawley rats underwent 5/6 nephrectomy (SNx, n = 18) or sham surgery (Control, n = 6). A total of 8 weeks after surgery, SNx rats were divided into three groups: normal chow (SNx, n = 6); high phosphate (1.2%) with high vitamin D; 5 days/week at a dose of 0.1 µg/day (SNx-VC1, n = 6) or 0.4 µg/day (SNx-VC2, n = 6) to induce vascular calcification. Four weeks after dietary intervention, rats were sacrificed and colon tissue was sampled for analysis. The inflammation of colon tissue was scored on haematoxylin-eosin staining (score 1–4) and the presence of macrophages was quantified by immunostaining with CD68 antibody. The mucus production was also quantified by Alcian blue staining.

RESULTS
Haematoxylin-eosin staining showed increased inflammation in SNx-VC2 rats (2.47 ± 0.26) compared with the Control group (1.52 ± 0.14) (P &lt; 0.05), Figure 1. The number of CD68 + cells did not differ between groups. Compared with the Control group (19.87 ± 2.20), mucus production was reduced significantly in SNx-VC2 rats (11.98 ± 2.61) (P &lt; 0.05) and close to significance (P &lt; 0.0505) in SNx-VC1 (13.21 ± 1.22).

CONCLUSION
CKD was associated with a decrease in mucus production and an increase in inflammation in colon tissue. These changes are more marked in the animals with associated vascular calcification (high vitamin D and high phosphate diet).
MO562: Prevalence and Determinants of Predialysis Dietitian Follow-Up-Results From the Brazilian Dialysis Registry
Authors: Nerbass Fabiana , Lima Helbert , Merege Vieira Neto Osvaldo , Sesso Ricardo , Lugon Jocemir 
Published: May 2022

Abstract

BACKGROUND AND AIMS
There are lacking of data regarding predialysis dietitian follow-up of CKD patients considering large populational datasets. We aimed to evaluate the prevalence and socio-demographic determinants of predialysis dietitian follow-up in a large cohort of Brazilian dialysis patients.

METHOD
We evaluated retrospectively data from all incident adult dialysis patients included in the Brazilian Dialysis Registry from January 2011 to September 2021. Predialysis dietitian follow-up was said to be present when a period &gt;6 months of dietitian care was reported. Gender, age, skin color, education, body mass index, chronic kidney disease (CKD) etiology, first chronic dialysis program, healthcare provider and geographic regions were considered in the logistic regression model.

RESULTS
A total of 10 382 patients met the inclusion criteria and 1254 (12.1%) reported predialysis dietitian follow-up, and most of them referred by nephrologist (94.2%). The independent determinants of dietitian follow-up were older age, white skin color, higher education level, not having diabetes, living in North/Northeast and South (compared with Southeast), and having a nonpublic healthcare provider. When considered only patients with predialysis nephrologic care, higher education, hemodialysis as the first dialysis modality and living in the North/Northeast and South regions (compared with Southeast) were associated with dietitian follow-up.

CONCLUSION
Predialysis dietitian follow-up for more than 6 months in a country in which the public health system is the main dialysis provider is still very low. The nephrologist is pivotal for referral to dietitians but socioeconomic factors also seem to play a role in this regard.
MO573: Diet Quality Components and Gut Microbiota of Peritoneal Dialysis Patients
Authors: Ishikawa Ramos Christiane , S. Andrade Laila , R. Teixeira Renata , Hoffmann Christian , Cuppari Lilian 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Diet has been recognized as an important determinant of microbiota composition. In CKD, nutrients such as fiber and protein have been shown to influence the microbiota profile. However, since nutrients are not ingested in isolation, the overall assessment of diet, reflecting the synergy of nutrients, may potentially modify the relationship between the diet and gut microbiota. Therefore, our aim was to evaluate whether the quality of diet and its components associate with alpha diversity of gut microbiota and phyla composition in peritoneal dialysis (PD) patients.

METHOD
In this cross-sectional study, patients undergoing automated PD for at least 3 months, aged 18–75 years and clinically stable were enrolled. Those who were using prebiotics, probiotics, symbiotics and antibiotics within a period of 30 days before the study were not included. Participants received sterile materials to collect the feces sample and were instructed to keep it refrigerated and bring to the clinic within a period of 12 h. To evaluate α-diversity and phyla microbial profile, 16S ribosomal DNA was PCR-amplified and sequenced on an IlluminaMiSeq platform. The diet quality index (DQI), validated for the healthy Brazilian population, was calculated from a 3-day food record. This index is based on the energy density of 11 components (sugars and sweets; beef and pork; refined grains and breads; animal fat; poultry, seafood and eggs; whole grains, breads, tubers and roots; fruits; non-starchy vegetables; legumes and nuts; milk and dairy products and vegetable oils). Each component is scored from 0 to 5 or 10, and a final score ranged from 0 (worse) to 100 (better) is obtained.

RESULTS
Thirty-seven patients were included [52.4 ± 13.7 years; 54% men; 70% with diabetes; PD vintage 18.0 (5.0–46.5) months]. The distribution of gut microbiota's phyla is presented in Figure 1. Mean DQI was 47.8 ± 12.2, indicating that most of the patients (76%) were in an intermediate quality of diet. DQI was not associated with age, gender, PD vintage, BMI or the presence of diabetes. As can be seen in Table 1, although no association was found between DQI total score with the gut microbiota α-diversity indexes, the energy density of some components of DQI tended or was associated with those indexes. DQI total score was also not associated with any specific phyla, but the energy density of the components ‘sugars and sweets’ was negatively associated with Bacteroidetes (r= −0.389, P = 0.017) and positively with Firmicutes (r = 0.468, P = 0.003), while the inverse was observed for ‘legumes and nuts’, Bacteroidetes (r = 0.358, P = 0.029) and Firmicutes (r = −0.333, P = 0.044).

CONCLUSION
A healthier diet, with a larger amount of ‘whole grains, breads, tubers and roots’ and ‘legumes and nuts’ and, lower in ‘sugars and sweets’, seems to contribute to the α-diversity or Bacteroidetes colonization in peritoneal dialysis patients.
MO574: Use of The Highly Hypoproteic Supplemented DIET in the Therapy of Patients With Advanced Chronic Renal Failure
Authors: Cecchi Sofia , DI Stante Silvio , Baldini Federica , DI Luca Marina 
Published: May 2022

Abstract

BACKGROUND AND AIMS
A low-protein diet has shown to be effective in slowing the progression of chronic kidney disease (CKD) and allows a later start to dialysis treatment [1]. However, the very low protein diet (0.3 g/kg/day) supplemented with aminoacids and ketoanalogues (sVLPD), but it is difficult to implement for the high number of tablets to take [2]. In order to increase compliance, we decided to prescribe balanced sVLPD to all patients with eGFR &lt; 15 mL/min or with specific indications (e.g. renal transplantation program and conservative therapy) supplemented with amino acids without ketoanalogues.
The aim of this approach was to evaluate the efficacy, compliance and safety of the personalized sVLPD, developed by a trainer dietitian mainly focused on nitrogen, acid–base, hydroelectrolytic balances and malnutrition [3].

METHOD
During last 2 years, 91 patients were initiated into diet therapy. They were 58.2% males, all hypertensive, 33% diabetic, 65.9% on EPO therapy. At the beginning and quarterly were detected characterizing blood chemistry tests, anthropometrich measures and body composition (with impedance analysis) in all the patients.

RESULTS
The average observation time was 9.1 ± 5.1 months. Laboratory tests have shown improvement in mean azotemia (Fig. 1) values (144.2 ± 44.2 versus 94.6 ± 19.7 mg/dL; T0 versus T18; P &lt; 0.005), phosphorus (4.4 ± 0.9 versus 4 ± 0.7 mg/dL; T0 versus T15; P &lt; 0.05), bicarbonate (24.6 ± 5.7 versus 27 ± 4.7 mmol/L; T0 versus T6, P &lt; 0.005); eGFR (Fig. 2) remained stable during follow-up (12.1 ± 3.6 versus 12.4 ± 4 mL/min; T0 versus T18; NS). Hemoglobin, uricemia, serum albumin, glycemia (downward trend NS), potassium, sodium, chlorum, calcium, magnesium, pH and lipids remained within normal values; average TSAT always &gt;20% and average ferritin &gt;100 mg/dL.
The body mass index (BMI) was always on average within the normal range with an increase in patients with adequate hydration and lean mass (Fig. 3); improvement trend (NS) of the PAS, PAD within limits. Reduction of effective protein intake (0.85 ± 0.29 versus 0.61 ± 0.20 g/kg/die; T0 versus T9 P &lt; 0.05). During the observation, 8 deaths occurred (7 patients over 85 years old), 10 admissions on dialysis peritoneal, 4 in hemodialysis and 3 pre-emptive transplants from living donors. To date, we estimated that the initiation of dialysis was delayed on average by 8.7 months/patient.

CONCLUSION
The approach we have adopted allowed to achieve good adherence to the diet, a slowdown in the progression of the CKD, improve and maintain good metabolic control, electrolytic and acid–base and body composition. A personalized sVLPD resulted in delayed starting of dialysis treatment, allowing patients to continue pre-dialysis education-program, increasing the choice for home peritoneal dialysis.