bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO798: Impact of Body Composition on Erythropoietin Resistance Index in Patients Receiving Chronic Hemodialysis
Authors: Yun Lee Hyang , Cho Heejin , Shin Jungho , Ho Hwang Jin , Hyun Kim Su , Bin Park Sung 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Erythropoietin resistance index (ERI) seems to be a predictor for adverse outcomes in patients receiving chronic hemodialysis. Despite the role of erythropoietin in non-hematopoietic tissues such as skeletal muscle or fat, clinical studies investigating the association between body composition and ERI are still lacking. The aim of this study was to examine the longitudinal impact of body composition on ERI in patients on chronic hemodialysis.

METHOD
This study included outpatients on chronic hemodialysis who received body composition analysis, which was performed every 6 months. The ERI was calculated by dividing the weekly body weight-adjusted erythropoietin dose by the hemoglobin concentration, and the values were averaged every 3 months period. The relationship between body composition and baseline ERI was evaluated in the multiple linear regression analysis, and the trend of ERI over time according to the changes in body composition was analyzed using a linear mixed effect model.

RESULTS
There were 65 (52.8%) men and 58 (47.2%) women, and they were followed up for 24 (5, 75) months. Subjects with higher mean ERI during the study period had increased risks for all-cause death, cardiovascular events and infection requiring hospitalization, compared with those with lower mean ERI (P = .009, .076 and .051). Linear regression analyses found that the ERI was negatively correlated to body mass index, % body fat, arm circumference, arm muscle circumference, and visceral fat area (P = .067, .065, .002, .021 and .040). However, the ratio of extracellular water to total body water and skeletal muscle mass index was not related to ERI. The longitudinal trend of ERI was compared according to the slope of body composition parameters over time. The increase in ERI was associated with the increase in the ratio of extracellular water to total body water (P = .007). On the other hand, the trajectory of ERI was inversely related to the longitudinal changes in arm circumference, arm muscle circumference and visceral fat area (P = .002, P &lt; .001 and P = .026).

CONCLUSION
The ERI seems to be associated with body composition; therefore, body composition analysis can be useful to predict erythropoietin resistance in patients receiving chronic hemodialysis. Further studies are needed to investigate whether lifestyle modifications, including nutrition and exercise, can result in positive effects on body composition and responsiveness to erythropoietin.
MO806: Change in Pth Measuring Method Affects the Cost of Pth-Lowering Treatment
Authors: Kuroki Aki , Shimura Satoru , Kikuchi Rie , Yanagida Toshihiro , Tsuboi Takahiro , Inagaki Kazuyuki , Ohashi Yasushi 
Published: May 2022

Abstract

BACKGROUND AND AIMS
To control mineral and bone disorders in haemodialysis (HD) patients, doses of vitamin D analogues and calcimimetics are adjusted based on serum parathyroid hormone (PTH) levels. Accordingly, method-related differences in PTH results may influence the prescribed dose of those drugs and PTH-lowering treatment costs. The aim of this study was to clarify the influence of inter-method variability in PTH measurement on PTH-lowering treatment costs.

METHOD
We used data from 30 maintenance HD patients in our facility. The Intact-PTH measuring assay was changed from the Elecsys PTH to the Alinity Intact PTH Reagent Kit (Alinity PTH) in March 2021, following a 2-month transitional period when PTH levels were measured using both assays. We examined method-related differences in PTH levels, using the results obtained in the transitional period. Using prescription records from October to December 2020, when the Elecsys PTH assay was used, and those from March to May 2021, when assay system was fully changed to the Alinity PTH, we examined the influence of the PTH measuring method on medication cost by evaluating the monthly cost of vitamin D analogues and calcimimetics in our facility. We evaluated the mean levels of serum calcium, phosphorus and PTH in 30 patients in the corresponding period.

RESULTS
Inter-method variability in PTH results was evaluated using 60 specimens from 30 patients.
PTH results of 60 specimens ranged from 11 to 802 pg/mL and 8.8 to 1198 pg/mL in the Elecsys PTH and in the Alinity PTH, respectively. Compared with PTH levels obtained with the Elecsys PTH, those measured with the Alinity PTH were significantly higher (P &lt; .001). On average, results obtained with the Alinity PTH were 1.58-fold higher than those provided by the Elecsys PTH.
When the Elecsys PTH assay was used, the average monthly cost of vitamin D analogues and calcimimetics was €44 and €1668, respectively. After the assay was changed to the Alinity PTH, the average monthly costs were €40 for vitamin D analogues and €2471 for calcimimetics (€1 = ¥130). There were no notable changes in the mean serum levels of calcium, phosphorus and PTH throughout the study period.

CONCLUSION
Inter-method variability in PTH results would have an influence on the cost-effective assessment of PTH lowering therapy. Standardization of PTH measurement is required.
MO846: Temporal Evolution of Humoral Response in Haemodialysis Patients Vaccinated With Two Doses of CHADOX1-S Vaccine
Authors: Sharma Amit , Ramachandran Raja , Jit Singh Gill Harinder , Singh Divya 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Patients on long term haemodialysis have been found to be more vulnerable to COVID-19 infection with greater severity of infection and mortality rates. Vaccination is instrumental in preventing morbidity and mortality in this group. The study was conducted to evaluate the humoral response of vaccination in patients on long term haemodialysis and its evolution over time.

METHOD
The study was conducted between March 2021 and December 2021. It included 59 patients who received two doses of ChAdOx1-S vaccine. Demographic data was collected and antibody level against the S1 subunit of SARS-CoV-2 spike protein antigen was measured 4 weeks and 26 weeks after the administration of second dose. The patients were divided into 2 groups based on time interval between the two doses (Group I: up to 6 weeks and Group II: &gt;6 weeks).

RESULTS
The mean age of the patients was 62.57 years. Out of 59 patients, 38 (64.40%) were males. 31 patients (52.54%) had history of diabetes mellitus (DM) and 7 (11.86%) had history of COVID-19 infection at least 3 months prior to vaccination (Table 1). Four weeks after the administration of second dose, antibodies to SARS-CoV-2 spike protein were present in 53 (89.83%) patients. 85.29% patients (29 out of 34) in group I and 96% patients (24 out of 25) in group II had detectable antibodies. There was a wide variation between the anti-spike antibody levels in the patients, ranging from 0.4 to as high as 18 933 U/mL (Figure 1) and the levels remained high even 26 weeks after the second dose of the vaccine. Antibodies to SARS-CoV-2 spike protein were present in 49 (92.45%) patients out of the total 53 patients in whom 26 weeks had elapsed after second dose of vaccination. 91.17% patients (31 out of 34) in group I and 94.7% (18 out of 19) in group II had detectable antibodies after 26 weeks of receiving second dose of the vaccine.

CONCLUSION
The study provides evidence that two doses of ChAdOx1-S vaccine generate good antibody response in majority of patients on long-term haemodialysis. It is sustained at 26 weeks post second dose of vaccine. Increasing the time interval between two doses of the vaccine lead to better humoral response. The antibody levels decrease over time necessitating the administration of booster doses.
MO847: C-Reactive Protein to Albumin Ratio and 6-Month Mortality in Incident Haemodialysis Patients
Authors: Sant'ana Mariana , Marques Da Silva Bernardo , Branco Carolina , Costa Claudia , Peres Nadiesda , Cardoso Ana , Mafalda Abrantes Ana , Agapito Fonseca José , Outerelo Cristina , Resina Cristina , António Lopes José , Gameiro Joana 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The prevalence of chronic kidney disease (CKD) is growing worldwide and ranges from 8% to 16%. Mortality rates are higher in the first few months of haemodialysis (HD). Protein-energy malnutrition has been demonstrated to be a major risk factor for mortality in this population. The C-Reactive Protein to Albumin ratio (CAR) has been associated with increased mortality risk. We aimed to evaluate if CAR could be used to predict 6-month mortality in incident HD patients.

METHOD
Retrospective analysis of CKD patients who initiated chronic HD between January of 2014 and December of 2019 in a tertiary-care hospital in Portugal. CAR was calculated at HD start. We analyzed 6-month mortality. Variables were submitted to univariate and multivariate analysis to determine factors predictive of 6-month mortality after HD start. We assessed the logistic regression method of the CAR to predict 6-month mortality and the discriminatory ability was determined using the receiver operating characteristic (ROC) curve.

RESULTS
A total of 787 patients were analyzed (mean age 68.34 ± 15.5 years and 60.6% male). The 6-month mortality was 13.8% (n = 109). Patients who died were significantly older [76.50 ± 11.39 versus 67.29 ± 15.52 years; P &lt; 0.001, OR: 1.055 (1.035–1.074); P &lt; 0.001, aOR: 1.058 (1.030–1.086); P &lt; 0.001], had more frequently cardiovascular disease [65.1% versus 46.1%; P &lt; 0.001, OR: 2.192 (1.437–3.342); P &lt; 0.001, aOR: 2.210 (1.210–4.037); P = 0.010], central venous catheter at HD start [83.5% versus 58.3%; P &lt; 0.001, OR: 3.622 (2.136–6.142); P &lt; 0.001, aOR: 3.090 (1.584–6.026); P &lt; 0.001], lower PTH [229.44 ± 170.50 versus 365.95 ± 415.80; P = 0.006, OR: 0.998 (0.996–0.999); P &lt; 0.001, aOR: 0.998 (0.997–1.000); P = 0.014] and higher CAR [2.85 ± 3.85 versus 1.36 ± 2.44; P &lt; 0.001, OR: 1.159 (1.086–1.236); P &lt; 0.001, aOR: 1.126 (1.023–1.239); P = 0.015]. The AUC for mortality prediction was of 0.706 [95% confidence interval (0.65–0.76); P &lt; 0.001]. The optimal CAR cut-off was &gt;0.5, with an odds ratio of 5.362 (95% CI 3.208–8.963; P &lt; 0.001).

CONCLUSION
In our study, we demonstrated that higher CAR was independently associated with a higher mortality rate in the first 6 months of starting HD, highlighting the prognostic importance of malnutrition and inflammation in patients starting chronic HD.
MO880: Clinical Characteristics Associated With Human Activity Profile Scores in Hemodialysis Patients With Thyroid Dysfunction: A Substudy of the NIH THYROID-HD Trial
Authors: Otobe Yuhei , Nguyen Danh , Guerrero Yalitzi , Narasaki Yoko , You Amy , Kalantar-Zadeh Kamyar , Rhee Connie 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Low physical activity is common in hemodialysis (HD) patients and is associated with adverse outcomes in this population (poor health-related quality of life, cardiovascular [CV] disease, death). Prior studies show that hypothyroidism is highly prevalent in HD patients, and is associated with worse self-reported physical function.

METHOD
In a substudy of the ongoing multi-center NIH THYROID-HD Trial, we examined baseline physical activity scores determined by the Human Activity Profile (HAP), a validated 94-item instrument assessing daily activities across a wide range of energy expenditures, in HD patients with TSH levels in the high-normal (TSH &gt;3–5 mIU/L) and subclinical hypothyroid range (TSH &gt;5–10 mIU/L). The HAP was used to derive the Maximum Activity Score (MAS) and Adjusted Activity Score (AAS), representing greatest and mean estimated energy expenditures, respectively (range 0–94, segmented to low [&lt;52], moderate [54–73] and high [&gt;74] scores).

RESULTS
Among 100 HD patients who underwent baseline HAP assessment, the mean ± SD MAS and AAS scores were 48 ± 22 and 23 ± 27, respectively; median (IQR) MAS and AAS scores were 49 (31–64) and 9 (0–39), respectively (Figure 1). In the overall cohort, 83% had low, 10% moderate and 7% high AAS scores. MAS and AAS scores were significantly lower in patients who had underlying diabetes versus those without diabetes (Table 1). There was also a trend towards lower (worse) MAS and AAS scores among older versus younger patients (≥65 versus &gt;65 years, respectively) and patients with underlying coronary artery disease (CAD) versus those without CAD. In logistic regression analyses, older age (+∆ 1-year increments) was associated with higher likelihood of low MAS scores, and diabetes trended towards a significant association (defined as &lt; median of observed values) (ref: MAS ≥ median): ORs [95% confidence intervals (95% CIs)]: 1.04 (1.01–1.09); P = 0.005 and 2.57 (0.96–6.86); P = 0.06, respectively. Similarly, older age (+∆ 1-year increments) and diabetes were each associated with higher likelihood of low AAS scores (defined as &lt; 52) (ref: moderate-high AAS scores): ORs (95% CIs): 1.06 (1.02–1.11); P = 0.01 and 4.83 (14.6–16.0); P = 0.01, respectively.

CONCLUSION
In this substudy of the NIH THYROID-HD Trial, HAP scores in HD patients with high-normal and subclinical hypothyroid range TSH levels were lower than observed in prior historical dialysis cohorts that did not have underlying thyroid dysfunction. Additionally, older age and diabetes were each associated with worse HAP scores. Further research is needed to determine the impact of thyroid hormone replacement on improving physical activity and function in this population, particularly those of elder age and with underlying diabetes.
MO931: Serum Uric Acid—A Marker of Malnutrition and Mortality in Patients Undergoing Maintenance Haemodialysis
Authors: Petreski Tadej , Ocepek Andreja , Piko Nejc , Ekart Robert , Hojs Radovan , Bevc Sebastjan 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Malnutrition in patients on maintenance haemodialysis (HD) develops along different pathways, and factors contributing to the development of malnutrition may be categorized as of iatrogenic and non-iatrogenic origins. Iatrogenic factors are an inadvertent consequence of dialysis for HD patients (e.g. removal of uremic solutes), whereas non-iatrogenic factors develop spontaneously from different factors accompanying the progression of kidney disease but are not related to the primary treatment (e.g. low dietary energy and protein intake). Malnutrition is prevalent in 28%–54% HD patients and is an important risk factor for mortality. The aim of our study was to investigate the impact of serum uric acid (SUA) and other non-invasive markers of malnutrition on the survival of maintenance HD patients.

METHOD
We performed a study on 77 HD patients without malignant disease who were observed from January 2016 until their death or January 2021. Their median age was 63.0 (IQR 19) years, and their dialysis vintage was 1449 (IQR 1848) days. We recorded past medical history, laboratory tests and basic demographic data and performed bioelectrical impedance analysis with BodyStat (BodyStat Ltd). Patients who were at risk for malnutrition, based on nutrition screening tools, received oral nutritional supplements (ONS). SUA was measured every 2 months and the mean value was used for analysis. Kaplan–Meier survival analysis and Cox's regression were performed.

RESULTS
Included patients (51.9% males) had diabetes mellitus (33.8%), arterial hypertension (87.0%), ischemic heart disease (24.7%), chronic obstructive lung disease (3.9%), liver disease (3.9%) and were smokers (14.3%). They received an ONS in 63.6%. During the observation period, 50.6% of them died. We created tertile groups (low, medium and high) based on mean SUA &lt; 294 μmol/L, 294–337 μmol/L and &gt; 337 μmol/L, respectively. The low group had significantly lower body mass index (BMI) (P = 0.044), total iron binding capacity (TIBC) (P = 0.001), phase angle (P = 0.003) and dry lean mass (DLM) (P = 0.048), however there were no significant differences in prescription of ONS (P = 0.092). Kaplan–Meier survival analysis showed significantly higher mortality for patients in the low tertile group (P = 0.004). In Cox's regression model, SUA remained significant when adjusted for age, sex, BMI and comorbidities (P = 0.026). However, when adjusting for other markers of malnutrition and receiving ONS, only phase angle, albumin, DLM, fat free mass index and TIBC remained statistically significant.

CONCLUSION
Low SUA levels in chronic HD patients are associated with lower survival and can help identify individuals who are at risk for malnutrition. Further studies should be done to guide possible interventions.
MO941: Novel Peripheral Molecular Markers Predict Premature Graft Loss: Lessons Learned from Operational Tolerance Assessment
Authors: Hruba Petra , Klema Jiri , Wu Le Anh , Girmanova Eva , Mrazova Petra , Massart Annick , Abramowitz Daniel , Abramowicz Marc , Viklicky Ondrej 
Published: May 2022

Abstract

BACKGROUND AND AIMS
TOMOGRAM, a European multicenter study, recently identified a new cohort of kidney transplant recipients (KTR) with operational tolerance (OT) with the aim to identify new transcriptomic signatures of OT.

METHOD
RNA sequencing of peripheral blood was evaluated in 15 OT KTR identified by TOMOGRAM, 23 stable KTR (≥15 years, STA), 14 KTR with transplant glomerulopathy (≥1 year, CR), 14 CyA-treated primary GN patients and 14 healthy controls (HC). The ability to discriminate OT from others was analyzed using three classifiers (GLMNET, voomNSC and SVM-RFE) with 10-fold cross-validation and visualized by principal component analysis (PCA) of molecular archetypes.

RESULTS
Peripheral blood transcriptome of OT patients is similar to the STA group (AUC &lt; 0.6) and different from the CR group (AUC &gt; 0.8). Also, in PCA of molecular archetypes, direction of correlation suggested similarity between STA and OT and their anti-correlation to CR (Figure 1). Top 10 transcripts differentiated OT from CR were assessed in prospective independent cohort (n = 396) to predict premature graft loss. Multivariable Cox regression model based on the expression of 5 of those transcripts at 3 time-points was associated with graft loss at 3 years with an AUC = 0.815.

CONCLUSION
Identification of the OT peripheral molecular signature among stable KTR is not feasible. Instead, novel peripheral molecular markers associated with premature graft loss were identified.
MO981: DE Novo Heart Failure After Kidney Transplantation: Epidemiology, Risk Factors and Outcomes
Authors: Van Rhijn Peter , Mark Patrick , Thomson Peter , Mangion Kenneth , Stoumpos Sokratis 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Although the risk for congestive heart failure (CHF) decreases after kidney transplantation (KT) compared with dialysis, it remains a significant clinical concern associated with a higher risk of mortality, cardiovascular events and kidney graft loss. Available epidemiological data on CHF after KT are limited, outdated and have mostly focused on traditional risk factors. We aim to describe the risk, predictors and outcomes associated with de novo CHF after KT.

METHOD
We used electronic patient records from the West of Scotland renal database to retrospectively investigate de novo CHF in adult kidney transplant recipients between 1 January 2010 and 31 March 2020. Heart failure was ascertained using a combination of physician-reported diagnosis, echocardiographic criteria, radiological evidence of heart failure and elevation of NT-proBNP levels. Participants were followed up until 15 April 2021. Multivariable regression analysis was used to identify independent correlates of post-transplantation de novo CHF (odds ratio [OR] and 95% confidence interval [CI]) and examine de novo CHF as a predictor of death and graft loss after transplantation.

RESULTS
One hundred and four (8.9%) of 1172 transplant recipients had de novo CHF [mean age, 50 ± 13 years; 470 (40%) women]. The cumulative incidences of de novo CHF were 3.8% (95% CI: 2.9–5.1), 5.2% (95% CI: 4.1–6.7) and 7.1% (95% CI: 5.6–8.9) at 1, 3 and 5 years, respectively. Risk factors for de novo CHF included older recipient age (OR: 1.04; 95% CI: 1.02–1.06; P &lt; 0.001), pre-transplantation diabetes mellitus (OR: 1.9; 95% CI: 1.1–3.2; P = 0.014), pre-transplantation vascular disease (OR: 2.2; 95% CI: 1.3–3.7; P = 0.003), pre-emptive kidney transplant (OR: 0.4; 95% CI: 0.2–0.9; P = 0.024) and the presence of a functional fistula at time of transplantation (OR: 2.3; 95% CI: 1.1–4.9; P = 0.025). In separate analyses, de novo CHF predicted death (OR: 3.3; 95% CI: 1.5–7; P = 0.002) and death-censored graft failure (OR: 5.1; 95% CI: 2.8–9.3; P &lt; 0.001).

CONCLUSION
Congestive heart failure is a common complication after kidney transplantation associated with markedly increased risk for death and graft loss. Identification and optimization of pretransplantation risk factors for CHF and pre-emptive transplantation, suggests targets for improving outcomes.
MO983: Effect of Haptoglobin Gene Polymorphism On Covid-19 Severity in Kidney Transplant Recipients
Authors: Ural Zeynep , Helvacı Özant , Korucu Berfu , Gönen Sevim , Derİcİ Ülver , Arinsoy Turgay 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The SARS-CoV-2 pandemic has become one of the most serious health problems globally. Covid-19 poses a serious life-threatening risk, especially for immunocompromised patients such as kidney transplant recipients. However, the reason why some transplant recipients are asymptomatic while others are severely ill is still not clear. Genetic variation might affect the outcome and mortality of Covid-19 infection. Haptoglobin (Hp) is a plasma protein with antioxidant, immunomodulatory properties and has an important biological function in the host defense responses to infection and inflammation [1]. In humans, Hp is characterized by a molecular heterogeneity with three main genotypes/phenotypes: Hp1-1, Hp2-1, and Hp2-2 [2, 3]. This polymorphism might have important biological consequences in various bacterial and viral infections [3, 4]. In the present study, we aimed to evaluate whether haptoglobin gene polymorphisms effect Covid-19’s severity in kidney transplant patients.

METHOD
About 229 renal transplant recipients were evaluated in retrospective fashion. Patients with a history of Covid-19 infection (n:62) were included in the study. We investigated the relation between Hp phenotypes (Hp 1–1, Hp 1–2, Hp 2–2) and Covid-19 disease severity.

RESULTS
Baseline characteristics, laboratory and health parameters were similar between Hp 1–1, Hp 1–2 and Hp 2–2 groups. We found that Hp2-2 phenotype was a significant predictor of disease severity in renal transplant recipients with Covid-19 (p:0013). Hp 2–2 phenotype was significantly associated with longer hospitalizations and intensive care unit admissions (p:0012 and p:0032).

CONCLUSION
Renal transplant recipients with the Hp 2–2 phenotype might have worse outcomes with Covid-19. It has been suggested that the Hp2-2 phenotype predisposes to greater oxidative stress and more pronounced viral replication [5]. Thus, the HP 1–1 protein has been described superior antioxidant and anti-inflammatory properties compared with the other two genotypes. This difference and geographic variation in haptoglobin phenotypes may be one of the factors contributing to the geographical variation in Covid-19 disease severity and mortality. Hp phenotype may be useful in the risk stratification algorithm and management of Covid-19. Studies involving more patients will be welcome to enlighten Hp genes effect on this subject.