bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO488: Serum P-CRESYL Sulfate Level is an Independent Marker of Peripheral Arterial Stiffness as Assessed Using Brachial-Ankle Pulse Wave Velocity in Patients With Non-Dialysis Chronic Kidney Disease Stage 3–5
Authors: Chang Yu-Chi , Tang Chi-Chong , Hsu Bang-Gee 
Published: May 2022

Abstract

BACKGROUND AND AIMS
p-cresyl sulfate (PCS) is associated with inflammation and its contribution to cardiovascular damage in patients with chronic kidney disease (CKD). The brachial-ankle pulse wave velocity (baPWV) is a simple marker to assess the peripheral artery stiffness (PAS) and is a useful marker to predict future cardiovascular events. The aim of this study was to determine the relationship between serum PCS levels and PAS measured by baPWV values in patients with CKD stage 3–5.

METHOD
Fasting blood samples and baseline characteristics were obtained from 160 CKD stage 3–5 patients. Automatic pulse wave analyzer (VaSera VS-1000) to measure baPWV values, and both sides of baPWV value that was &gt;18.0 m/s were determined as PAS. Serum total PCS levels were determined by high-performance liquid chromatography–mass spectrometry.

RESULTS
In the study cohort, 54 patients (33.8%) were in the PAS group. When compared with those in the control group, the PAS group had a high prevalence of hypertension (P = .021), older age (P &lt; .001), lower height (P = .033) and body weight (P = .012), higher systolic blood pressure (P &lt; .001), diastolic blood pressure (P = .008), serum calcium–phosphorus product levels (P = .030) and PCS levels (P = .008). The multivariable logistic regression analysis revealed that serum levels of PCS {odds ratio (OR): 1.098, [95% confidence interval (95% CI): 1.029–1.171]; P = .005}, advanced age (OR: 1.105, 95% CI: 1.055–1.159; P &lt; .001) and diastolic blood pressure (OR: 1.058, 95% CI: 1.002–1.118; P = .043) were independently associated with PAS in patients with CKD stage 3–5.

CONCLUSION
Higher serum PCS levels, diastolic blood pressure and advanced age were associated with PAS in patients with CKD stage 3–5.
MO491: Low Income is Associated With Late Nephrology Referral in Portugal: A Retrospective Study
Authors: Duarte Rui , Trigo Ana , Luz Ivan , Santos Paulo , Lopes Karina , Gonçalves Hernâni , Sofia Flora , Vila Lobos Ana 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Social disparities in chronic kidney disease (CKD) are a reality. Low socioeconomic status is associated with an increased incidence of CKD and overall worse outcomes. In Portugal, similarly to many European countries, a National Health System (NHS) was established to provide equity in healthcare access, but its impact in specialized CKD care is unclear. This study aims to compare the effects of economic insufficiency in referral and overall specialized kidney care in a Portuguese centre.

METHOD
Retrospective cohort study evaluating maintenance haemodialysis patients of a Public Portuguese Nephrology Centre from 2017 through 2021. Medical records were compared for the presence of Low-Income status (LIs), with primary outcome as baseline estimated glomerular filtration rate (eGFR) at nephrology referral and secondary outcomes as presence of kidney replacement therapy options appointment (KRTOa), timely vascular access assessment and time to dialysis from referral.

RESULTS
A total of 212 participants were evaluated, 96 with LIs. This group presented higher sCr and lower eGFR at referral (2.35 versus 3.29 mg/dL, P &lt; .001; 27.63 versus 18.47 mL/min/1.73 m2 P &lt;.001, respectively). LIs associated with absence of KRTOa {OR: 2.7, [95% confidence interval (95% CI): 1.44–5.08]; P = .003} and late vascular access evaluation (OR: 2.77, 95% CI: 1.55–4.98; P = .001). Dialysis-free survival analysis revealed shorter time to dialysis in the LIs group (15.77 versus 20.71 months; P &lt; .001) with a higher cumulative incidence in dialysis at 24 months (HR: 2.11, 95% CI: 1.39–3.21; P &lt; .001), a difference that was not verified after adjusting for eGFR at referral (HR: 1.16, 95% CI: 0.74–1.80; P = .53).

CONCLUSION
Low-Income CKD Portuguese patients are at risk of late nephrology referral, an established factor for adverse outcomes. Shorter time to dialysis appears significative in reducing adequate kidney care access, which can be attenuated through education of primary care providers and general population for CKD.
MO501: A Nomogram Based on Heart Rate Variability Parameters for Predicting All-Cause Mortality in Stage 5 CKD Patients
Authors: Gao Xueyan , Wang Jing , Huang Hui , Gao Zhanhui , Wang Ningning 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Heart rate variability (HRV), reflecting the circadian rhythm of heart rate, is associated with clinical outcomes in stage 5 chronic kidney disease 5 (CKD5) patients. Whether CKD-related factors combined with HRV can improve the predictive ability for their death remains uncertain. Here we evaluated the prognosis value of nomogram models based on HRV for all-cause mortality in CKD5 patients.

METHOD
Multicenter CKD5 patients were enrolled from 2011 to 2019 in China. The multivariate Cox regression analysis screened HRV parameters, which associated with all-cause mortality. Their relationships were displayed by restricted cubic spline graphs. The predictive abilities of nomogram models were evaluated for survival rate.

RESULTS
CKD5 patients included survival group (n = 155) and the all-cause mortality group (n = 45), with a median follow-up time of 48 months. Logarithm of standard deviation of all sinus R–R intervals (lnSDNN) {HR: 0.35, [95% confidence interval (95% CI): 0.17–0.73]; P = .01} and logarithm of standard deviation of average NN intervals for each 5 min (lnSDANN) (HR: 0.36, 95% CI: 0.17–0.77; P = .01) were associated with all-cause mortality, their relationships were negative linear. The area under the curve (AUC) values based on lnSDNN nomogram model for predicting 3-year and 5-year survival rates were 79.44% and 81.27%, respectively. The AUC values based on lnSDANN nomogram model for predicting 3-year and 5-year survival rates were 78.73% and 80.61%, respectively.

CONCLUSION
As clinical indicators of heart rate circadian rhythm, SDNN and SDANN are highly correlated with the prognosis of CKD5 patients. Nomogram models that integrate HRV and multiple CKD-related risk factors are promising for evaluating their all-cause mortality.
MO510: CKD Progression in a Cohort of Older Community-Dwelling Adults– Results From the Berlin Initiative Study (BIS)
Authors: Bothe Tim , Schaeffner Elke , Mielke Nina , Barghouth Muhammad , K. Kuhlmann Martin , Martus Peter , Schneider Alice , Van der Giet Markus , Ebert Natalie 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Data on the estimated glomerular filtration rate (eGFR) over time in older populations are scarce. Identifying patterns of eGFR progression is essential for a better understanding of chronic kidney disease (CKD) in older adults.

METHOD
We used data from the BIS, a community-dwelling cohort of 2069 people aged 70 or older. Participants were recruited between 2009 and 2011. After baseline assessment, four follow-up visits were conducted biennially over a total observation period of 8 years. During all study visits, eGFR and CKD stages based on KIDGO guidelines were assessed using the creatinine and cystatin C-based BIS2 equation (eGFRBIS2). Additionally, we used the creatinine-based EKFC equation (eGFREKFC). In a sub-analysis, we included only non-deceased participants with complete attendance at all study visits and valid eGFR values at all measurements.

RESULTS
At baseline, the mean age was 80.4 years (SD = 6.7), and 52.6 % were females. Prevalence was highest for CKD stage 2 (45.4%) and 3 (49.3%). After 8 years, the prevalence for CKD stages 1 and 2 decreased, whereas stages 3 and 4 showed a consistent upward trend resulting in 18.4%, 72.4% and 8.9% of participants in stages 2, 3 and 4, respectively. Mean eGFRBIS2 decreased from 58.1 (SD = 15.2) to 48.3 (SD = 13.3) mL/min/1.73 m² after 8 years. Mean eGFREKFC showed a similar trend with estimates being slightly higher (60.4 versus 54.2 mL/min/1.73 m2 after 8 years).
Same trends applied to the subgroup with complete attendance (mean age: 77.4 years). However, compared with the total population they showed a higher mean eGFRBIS2 (63.3 versus 58.1 mL/min/1.73 m²) and lower prevalence of CKD stages 3 and 4 (stage 2: 59.4 versus 45.4%; stage 3: 37.1 versus 49.3% stage 4: 1.2 versus 3.6%) at baseline.

CONCLUSION
We found that over the observation period of 8 years, mean eGFRBIS2 decreased by 9.8 mL/min/1.73 m2 resulting in an increasing prevalence of CKD stages 3 and 4 by 23.1 and 5.3%, respectively. This was observed in the total population as well as in the subgroup with complete study attendance.
MO537: Effects of COVID-19 on Mineral and Bone Disease Outcomes in Hemodialysis Patients: A Retrospective Study From Qatar
Authors: Hamad Abdullah , Fouda Tarek , Alkadi Mohamad , Abdellatif Tarek , Al Omari Anees , Alakhras Alaa , Amood Abeer , Ibrahim Rania , Aly Sahar , Farooqi Farrukh , Almalki Hassan 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Management of end-stage renal disease (ESRD) on dialysis has been challenging during the COVID19 epidemic. Staff illness led to a shortage of manpower that affected patient care. We established a specialty nursing management for mineral and bone disease (MBD) in the ambulatory dialysis service in Qatar in 2016. We are presenting a retrospective study about the effects of the COVID-19 epidemic on MBD outcomes in ambulatory dialysis patients in the State of Qatar.

METHOD
A retrospective cohort study in all adult patients with ESRD on chronic hemodialysis therapy (&gt;1 month) in ambulatory dialysis clinics in the State of Qatar. Data collected were patient's characteristics, laboratory and diagnostic investigations for each patient through our electronic data system (nationwide). We focused on parathyroid hormone (PTH), calcium and phosphorus levels done routinely on monthly basis. The study duration was 31 months (January 2019–September 2021).

RESULTS
We included 623 patients. Age was 56 ± 11 years old and 61% were male. The main comorbidities were diabetes mellitus (63%), hypertension (92%) and cardiovascular disease (22%). The percentage of patients with PTH levels within targets ranged from 63 to 74%. It was stable before and during the first wave of COVID-19 in Qatar (March–June 2020) then dropped afterward briefly for 3 months (October–December 2020) (74% versus 63% respectively P = 0.0003). PTH level in target improved afterward and also during the second wave of COVID-19 (February–May 2021) but then dropped again for 3 months (July–September 2021) [72% versus 66% respectively P = 0.02 (graph below with details)]. Patients with phosphorus and calcium in the target were mostly stable [79% (77–83%) and 76% (74–79%), respectively].

CONCLUSION
Our retrospective study regarding the effect of the COVID-19 epidemic on MBD outcomes in hemodialysis (HD) showed a temporary drop in PTH level in the target without affecting calcium and phosphorus targets. The delayed drop after COVID-19 waves in PTH in target could be related to the routine quarterly measurement of PTH. We think that establishing a solid management system for MBD led to reasonably stable outcomes despite all challenges during the COVID-19 epidemic.
MO551: Targeted Ablation of PTEN in Osteocytes Induces Severe Anemia and Increases FGF23 Production in Renal Insufficiency
Authors: Miguel Diaz-Tocados Juan , Pérez-Gomez Aurora , Diego Dominguez Coral Juan , Ángel Rodríguez Martín Miguel , García-Carrasco Alicia , Martinez Bardaji Ana , Eritja Sanjuan Auria , Caus Enriquez Maite , Bozic Milica , M. Valdivielso Jose 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Renal disease patients present bone alterations due to an imbalance of mineral metabolism. Previous studies have demonstrated that mice with conditional ablation of the phosphatase and tensin homolog (PTEN) in osteoblasts show increases in bone volume. The aim of this study was to investigate whether PTEN ablation in osteocytes has potential benefits on bone and mineral metabolism in the context of renal insufficiency.

METHOD
A few 2-month-old mice with constitutive ablation of PTEN in osteocytes (Ocy-PTEN-cKO) underwent 5/6 nephrectomy (5/6Nx) and were fed a 0.9% phosphate diet. After 2 weeks, 24-h urine samples were collected and animals were sacrificed to obtain blood samples for biochemical studies and organs for histological and biochemical analyses. Bone histomorphometry and microcomputed tomography analyses were performed in femurs. Fibroblast growth factor 23 (FGF23) expression was quantified in bone lysates and intact and c-terminal FGF23 concentrations were measured in plasma samples. Animals with normal renal function and Cre-negative littermates were used as controls. In addition, the effects of PTEN silencing were assessed in vitro in osteocyte-like bone marrow mesenchymal stem cells and in the osteosarcoma cell line SAOS-2.

RESULTS
Ocy-PTEN-cKO mice showed increased bone volume, mainly in the cortical compartment which showed higher cortical thickness and lower porosity. Of interest, we observed lower haematocrit in the Ocy-PTEN-cKO mice that was much lower in those with 5/6Nx. Anaemia was not associated with a lower renal EPO expression. Bone mRNA and protein expression of FGF23 were increased in Ocy-PTEN-cKO mice with normal and reduced renal function. 5/6Nx resulted in higher plasma intact FGF23, which remained similar between both, Ocy-PTEN-cKO and control groups, due to increased FGF23 cleavage as indicated by the higher plasma c-terminal FGF23 levels in the Ocy-PTEN-cKO groups, resulting in increased plasma phosphate. In vitro, PTEN silencing in bone marrow mesenchymal stem cells differentiated into osteoblasts or in the osteoblastic cell line SAOS-2 did not show significant changes regarding FGF23 levels, indicating that the effects must be indirect.

CONCLUSION
PTEN ablation in osteocytes increases cortical bone volume and exacerbates anemia in mice with reduced renal function. Moreover, bone FGF23 production was increased but subsequent proteolysis resulted in higher plasma phosphate. These results demonstrate a major role of the osteocyte in the development of anaemia in renal disease, which could be associated with FGF23 metabolism.
MO565: Evaluation of Bach1 Mrna Expression (Repressor of NRF2) in Patients With Chronic Kidney Disease
Authors: Mafra Denise , Alvarenga Livia , G. Baptista Beatriz , Fanton Susane , M. Ribeiro Marcia , R. Paiva Bruna , Trugilho Liana , Cardozo Ludmila 
Published: May 2022

Abstract

BACKGROUND AND AIMS
BTB and CNC homology 1 (Bach1) is a protein into the cells that antagonizes the actions of nuclear factor erythroid 2-related factor-2 (Nrf2), a master regulator of cytoprotective responses. Bach1 binds to genomic DNA and can inhibit the synthesis of antioxidant enzymes, increasing inflammation. Bach1 may be a therapeutic target to mitigate inflammation in patients with chronic kidney disease (CKD). However, no clinical study has been reported on Bach1 in patients with CKD. This study aimed to evaluate Bach1 mRNA expression in different treatments of CKD, including patients on conservative treatment (non-dialysis), hemodialysis (HD) and peritoneal dialysis (PD).

METHODS
Twenty patients on HD (54.3 ± 13.7 years old, nine men), fifteen on PD (51.4 ± 14.9 years old, eight men) and thirteen non-dialysis patients (61.0 ± 6.9 years old, seven men, estimated glomerular filtration rate of 39.2 ± 9.6 mL/min/1.73 m2) were enrolled in the study. The peripheral blood mononuclear cells were isolated and processed to evaluate the expression of nuclear factor-kB (NF-kB), Nrf2 and Bach1 by quantitative real-time polymerase chain reaction. Malondialdehyde (MDA), a lipid peroxidation marker, and C-reactive protein (CRP) plasma levels were also measured.

RESULTS
Bach1 mRNA expression was significantly higher in patients on hemodialysis (P &lt; 0.02) when compared with PD and non-dialysis patients (Table 1 and Fig. 1). Also, as expected, CRP plasma levels were higher in HD patients when compared with non-dialysis patients (P = 0.05). Bach1 mRNA expression was positively correlated with MDA plasma levels (r = 0.37, P = 0.01) in all patients.

CONCLUSION
Patients with CKD on HD patients seem to have upregulation of Bach1 mRNA expression compared to patients on conservative and DP treatment. The associations among Nrf2 and Bach1 expressions in these patients deserve further investigation.
MO604: Determinants of an Aerobic Threshold in Chronic Kidney Disease
Authors: Chinnappa Shanmugakumar , Mooney Andrew 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Anaerobic threshold (AT) is a widely used cardiopulmonary exercise test (CPX) parameter in the field of preoperative assessment in general population where it is used as a surrogate marker of cardiovascular fitness. There is growing interest in the application of AT in the evaluation of fitness for kidney transplantation. However, the determinants of anaerobic threshold in CKD have not been well studied. In the present study, we evaluated the hemodynamic, biochemical and anthropometric determinants of AT in CKD. Furthermore, we evaluated the association between AT and objectively measured index of cardiac functional reserve in CKD.

METHOD
In this cross-sectional study, 70 male CKD patients (stages 2–5) without any cardiac diseases or diabetes underwent a specialised CPX to measure exercise capacity, AT, peak cardiac hemodynamics and cardiac power output (CPO).1 Cardiac functional reserve was calculated as ∆CPOpeak—CPOrest. Blood samples were assayed for standard renal biochemistry. Univariate and multivariate regression were employed. Results were presented as mean ± SD. P &lt; 0.05 is considered significant.

RESULTS
The study subjects had a mean age of 48.4 ± 12.6 years and a mean eGFR of 33.9 ± 23.5 mL/min. All subjects performed high intensity CPX to volitional exhaustion with a mean RER of 1.16 ± 0.09 and a mean peak aerobic capacity (VO2peak) of 2.51 ± 0.53 L/min. Table 1 shows the univariate and multivariate predictors of AT in CKD. Figure 1 shows the association between AT and objectively measured cardiac functional reserve.

CONCLUSION
The results demonstrate that AT only has a modest association with cardiac functional reserve in CKD. Noncardiac factors such as haemoglobin and peripheral O2 extraction are also significant determinants of AT in addition to cardiac factors. Therefore, AT should be interpreted with caution if employed as a surrogate marker of cardiovascular fitness in CKD. 1Chinnappa S et al. JASN July 2021, 32 (7): 1813–1822
MO606: Indoxyl Sulfate is Predictor for Sarcopenia but Myostatin is Indicator For Muscle Mass in Patients with Chronic Kidney Disease: Analysis From Recovery Study
Authors: Lee Sumi , Chul Kim Jun , Suk An Won 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Serum myostatin and indoxyl sulfate (IS) levels are increased according to renal function decline and are the main mediators of chronic kidney disease (CKD)-related sarcopenia. However, a recent report showed that myostatin levels were increased in balance-trained CKD patients associated with increased lean mass. The aim of this study was to assess the association between serum myostatin, IS levels and sarcopenia in CKD patients.

METHOD
Baseline data from the RECOVERY study (clinicaltrials.gov: NCT03788252) conducted from November 2018 to June 2020 were analyzed in 150 CKD patients (mean CKD-EPI eGFR: 33.8 ± 12.5). A Six-meter gait speed test and handgrip strength (HGS) were assessed. Skeletal muscle index (SMI) was measured by using an InBody S10 based on bioelectrical impedance analysis. Sarcopenia was assessed using the Asian Working Group for Sarcopenia 2019. Serum myostatin levels were assessed by an enzyme-linked immunosorbent assay and serum total IS levels were measured using a high-performance liquid chromatography fluorescence detector.

RESULTS
The proportion of patients with sarcopenia was higher (12.0% versus 4.1%, P = 0.075) in patients with high IS levels (≥0.365 mg/dL) but was lower (4.2% versus 11.8%, P = 0.087) in patients with high myostatin levels (≥4.5 ng/mL). SMI and HGS were significantly lower in patients with high IS levels but were significantly higher in patients with high myostatin levels. IS levels showed a negative correlation with eGFR, SMI and HGS but myostatin levels showed a positive correlation with SMI, and HGS and no correlation with eGFR. However, the myostatin/SMI ratio reflected muscle mass was negatively associated with eGFR and was not associated with SMI and HGS. Sarcopenia was independently associated with age and IS levels after adjustment for gender, diabetes mellitus, creatinine and myostatin/SMI.

CONCLUSION
Serum total IS levels are an important predictor for sarcopenia, but serum myostatin levels indicate muscle mass in CKD patients with lower eGFR. Further studies are needed to find new markers related to muscle mass and myostatin such as the myostatin/SMI ratio in CKD patients with lower eGFR.
MO619: Landscape RNA Profiling of Urinary Extracellular Vesicles in Patients with Diabetic Nephropathy
Authors: Feng Songtao , LV Linli , Liu Bicheng , Zhu Xiaoxiao , Jing Jing 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Recent studies have revealed that urinary extracellular vesicles (uEV) are secreted with rich biological information useful for understanding the pathophysiological conditions and identifying potential biomarkers for kidney disease. Diabetic nephropathy (DN) has become the major cause of CKD worldwide, while the features of uEV in DN were poorly understood. The present study aims to provide the landscape and in-depth analysis of the transcriptome characteristics of uEV in DN.

METHOD
Urine was collected from a total of 40 subjects, including healthy controls (HC, n = 14), type 2 DM (T2DM, n = 16), and renal biopsy-confirmed DN (n = 10). uEV was isolated by differential centrifugation and total RNA was extracted for long RNA sequencing. A model based on CIBERSORT was calculated to trace the genetic source of uEV toward resident cells of urinary system. Differentially expressed genes (DEG) between DN and HC and DN and T2DM were applied to gene ontology (GO), Reactome pathway enrichment, as well as gene set enrichment analysis (GSEA). Correlation of the transcriptome profiling between uEV and kidney tissue in DN was also explored.

RESULTS
About 67%∼68% of transcripts in RNA-seq were mRNA, 11%∼12% were LncRNA and 7%∼10% were CircRNA, and the abundance of mRNA was greater than other RNA types. By CIBERSORT model applying marker genes of podocytes, epithelial cells of tubule of different segments, loop of Henle, and collecting duct, and bladder transitional epithelial cells. The uEV was shown to originate mainly from the collecting duct epithelial cells of the kidney and bladder transitional epithelial cells (Fig. 1a). Confocal laser microscopy showed the co-localization of CD63 and AQP2 (Fig. 1b) in kidney tissues. GO and Reactome analysis were further performed in upregulated mRNA between DN and T2DM and DN and HC to explore the mRNA profiling in terms of the biological significance. Impressively, ‘extracellular exosome’ as well as other terms associated with constitution of EV, ‘plasma membrane’ and ‘extracellular space’ were enriched by GO cellular component (CC) analysis in DN. Besides, Reactome analysis identified pathways of ‘immune system’, ‘extracellular matrix organization’ and ‘degradation of extracellular matrix’ reflecting the pathogenesis mechanism of DN (Fig. 1c). Additionally, microarray data of DN glomeruli and tubule from the GEO database were analyzed in comparison to uEV RNA-seq data. GSEA showed that great similarities were found in the top 10 terms of Reactome pathways (Fig. 2).

CONCLUSION
In conclusion, this study provides a landscape transcriptome profile, the genetic trace and the biological function terms of uEV in DN. uEV holds potentials in reflecting the transcriptome characteristics of renal tissue, which is of significance for understanding the pathogenesis of DN and biomarker discovery.