bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO106: Circulating Neutrophil Count is Associated with Severity of Chronic Kidney Disease
Authors: Carrara Fabiola , Ruggenenti Piero , Parvanova Aneliya , Trillini Matias , Cugini Daniela , Stucchi Nadia , Ferrari Silvia , Remuzzi Giuseppe 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Neutrophils (Ns) play a key role in inflammation and tissue injury, in particular in acute renal failure, by releasing a complex of cytotoxic products such as reactive oxygen intermediates, enzymes and microbicidal polypeptides. These effects are prevented or mitigated by Ns depletion [1, 2]. Here we investigated the relationships between Ns count and the severity of kidney dysfunction in patients with chronic kidney disease (CKD).

METHOD
In this cross-sectional study we evaluated the association between circulating Ns absolute number, CKD stage and measured glomerular filtration rate (mGFR) in 393 patients with renal disease from different causes. CKD stage was established on the basis of mGFR and K/DOQI guidelines [3]. The relationships of Ns count and other considered covariates with mGFR were evaluated by uni- and multi-variable linear regression models (Table 1). Variables considered in univariable models are listed in Table 1. Variables included in multivariable models were identified with forward selection. Circulating Ns were measured by Coulter LH 780 Hematology Analyzer (Beckman Coulter, Milan, Italy). The GFR was measured by the iohexol plasma clearance technique, a gold standard for direct GFR measurement [4]. P &lt; .05 was considered as statistically significant.

RESULTS
The mean ± SD age and mGFR of the patients were 54.64 ± 13.75 years and 62.75 ± 22.52 mL/min/1.73 m2 (range: 15.53–131.79 mL/min/1.73 m2), respectively. Most patients had a kidney function in stage 2 and 3a (Figure 1A). The absolute number of Ns averaged 4.32 ± 1.77 × 103µL−1. Ns counts increased progressively in parallel with increasing CKD stage (P &lt; .005, Figure 1A) and were negatively correlated with mGFR (P &lt; .001, Figure 1B). At multivariable analysis, mGFR was associated negatively with Ns count and positively with basophils (Bs) count (Table 1).

CONCLUSION
In patients with CKD higher numbers of Ns and lower numbers of Bs, even within the normal range, were independently associated with more severe renal insufficiency. A major limitation of the study is the cross-sectional design that does not allow to establish a causal relationship between Ns count and severity of kidney dysfunction. These data provide the basis for studies to investigate mechanisms explaining these associations.
MO115: Cardiorenal Units as Management Strategy to Improve Outcomes in Cardiorenal Syndrome
Authors: Marques Maria , Cobo Marta , García Magallón Belen , Luisa Serrano Salazar Maria , Vazquez Lopez-Ibor Jorge , Lopez Paula , Janeiro Dario , Portoles Jose M 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Cardiorenal syndrome (CRS), defined as the spectrum of disorders that acutely or chronically affect both heart and kidney function, is often a challenging condition with paucity of evidence-based therapy. The increasing burden of this entity has prompted the creation of cardiorenal units (CRU) as integrating programs intended to provide a combined multidisciplinary approach to maximize all chances for organ and patient recovery. Here we describe the early results of the creation of one CRU in a high complexity university hospital.

METHOD
This observational study included all patients diagnosed with CRS, who have been seen in the cardiorenal day care unit, formed by specific trained nephrologist, cardiologist and nurses. Assessment of cardiorenal function and volume status was performed by conventional cardiac ultrasound plus V-Scan, GFR estimation by CKD EPI, NT-proBNP determination and bioelectrical impedance when indicated.

RESULTS
Cardiorenal Unit of Puerta de Hierro University Hospital was created in January 2021. A total of 68 patients have been evaluated with a mean follow-up of 4 months (SD 3.2). Most frequent cardiologic diagnoses were 63.9% heart fellow with reduced function (HFrF) and 37.1% heart failure with preserved ejection fraction (HFpEF) and the presence on pulmonary hypertension or tricuspid regurgitation were 29.4% and 50.9%. 51.6% patients showed diuretic resistance.
Most frequent renal diagnosis were pure CRS 36.9%, and 27.7% and 24.6% CRS associated to diabetic kidney disease or nephroangioesclerosis, respectively. Mean FGe rate when patients were initially evaluated was 31.5 mL/min/1.73 m2 (SD 11.0) with demonstration of albuminuria in 48.5% of patients.
The integrated cardiorenal management of these patients included initiation or adjustment of specific cardio-nephroprotective drugs [SGLT2 inhibitors (46.8%), ARNi (25.8%), aldosterone receptor antagonists (4.8%)] or diuretic regime adjustment including iv administration (54.8%). Peritoneal dialysis was indicated in three patients and haemodialysis in one patient. Approximately 13.2% patients suffer new episodes of heart failure that needed hospitalization or unexpected medical attention at the day-care clinic. One patient died during follow-up (1.5%).

CONCLUSION
We conclude that this coordinated cardionephro approach of CRS was useful to optimize drug therapy aimed to mid-long term goals of cardionephro protection and to implement advanced therapies for fluid management in patients with diuretic resistance.
MO134: Follow-Up of Patients with Vasculitis: A 10-year retrospective study
Authors: Kozikopoulou Dimitra , Oikonomaki Theodora , Paikopoulou Angeliki , Choulitoudi Vasiliki , Nikolaos Liatsos Alexandros , Christodoulidou Christallenia 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Vasculitis constitutes a systemic disease with renal involvement at almost 100% in microscopic polyangiitis, 70–80% in granulomatosis with polyangitiis, 25% in eosinophilic granulomatosis with polyangitiis and 40–50% appears as renal limited vasculitis. In order to describe our experience, we conducted a retrospective study of patients with vasculitis which we have been monitoring for the last 10 years.

METHOD
We studied the time of the remission, the use of plasma exchange (PLEX), the biopsy results as well as the time between the first symptoms and the initiation of the therapy.

RESULTS
The total number of patients was 59, 28 (47.5%) females, with a mean age of 66.08 ± 13.95 years. The median follow-up time was 70 weeks with IQR [64, 76]. The patients with positive pANCA/MPO were 38 (64.4%), while those with positive cANCA/PR3 were 10 (16.9%). The remaining nine patients (15.3%) suffered from ANCA negative vasculitis. The mean value of the initial creatinine was 4.53 ± 2.3 mg/dL and the median value of the eGFR CKD-EPI was 11 mL/min/1.73 m2, IQR [7, 17]. The PLEX was implemented auxiliary in 16 patients (27.1%) and in 32 patients (54.2%) pulse cortisone along with intravenous cyclophosphamide was preferred. The remission was accomplished in 32 patients (54.2%) with median time of 8 weeks, IQR [0, 17]. At least one relapse episode was noted in 8 patients (13.6%), 19 patients (32.2%) ended up in ESRD and 15 patients (25.4%) deceased during the follow-up time. The major cause of death was sepsis with 10 demises (66.7%), while 5 patients (8.4%) suffered from malignancies in general. The remission time was found to be dependent on the initial value of creatinine (P-value.023). There was no statistical significance regarding the findings of the biopsy and the outcome, the relapse rate or the remission time. There was also no correlation marked between the first symptoms and the initiation of the therapy. The plasma exchange failed to reduce the time until the remission, unless the patient was cANCA positive (P-value.036). Although the sample was limited, the patients with positive cANCA/PR3 submitted to PLEX were able to achieve the remission in 5.25 weeks contrary to those who received solely methylprednisolone and cyclophosmamide. The latter achieved remission in 21 (mean) weeks (LogRank test, P-vaue .001. The vasculitis type has no effect over the renal outcome or the relapse rate. No statistical significance was found between the PLEX and the relapse rate or the outcome. Patients do not benefit from auxiliary treatment with the PLEX, unless they have positive cANCA/PR3. However, the initial serum creatinine seems to affect the time of the remission.

CONCLUSION
There is indisputable need for a larger patient sample in order to safely conduct further results.
MO149: Effect of Plasma Exchange on COVID-19 Associated Excess of Von Willebrand Factor and Inflammation in Critically Ill Patients
Authors: Seibert Felix S , Blazquez-Navarro Arturo , Hölzer Bodo , Doevelaar Adrian , Nusshag Christian , Merle Uta , Morath Christian , Zgoura Panagiota , Dittmer Rita , Schneppenheim Sonja , Babel Nina , Budde Ulrich , Henning Westhoff Timm 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Ubiquitous microthromboses in the pulmonary vasculature play a crucial role in the pathogenesis of COVID-19 associated acute respiratory distress syndrome (ARDS). Excess of von Willebrand factor (vWf) with intravascular multimer formation was identified as a key driver of this finding. Plasma exchange (PLEX) might be a therapeutic option to restore the disbalance between vWf and ADAMTS13. We report the effects of PLEX on vWf, ADAMTS13, inflammatory cytokines and parameters of ventilation.

METHOD
We investigated 25 patients, who were on mechanical ventilation for COVID-19 pneumonia with ARDS at two German university hospitals. All patients received PLEX as an ultima ratio measure for refractory ARDS. VWf antigen (vWf: Ag), ADAMTS13 activity, a cytokine panel mirroring the inflammatory situation and clinical parameters were assessed before and after three to six PLEX therapies with fresh frozen plasma.

RESULTS
Before the PLEX sequence, there was an excessive release of vWf: Ag (425.4 ± 167.5%) and mildly reduced ADAMTS13 activity (49.7 ± 23.3%). After the PLEX series, there was a significant increase of ADAMTS13 activity to 62.4 ± 17.7% (P = .029) and a significant decrease of vWf: Ag to 336.1 ± 138.2% (P = .041) resulting in a 63% improvement of the ADAMT13/vWf: Ag ratio from 14.5 ± 10.0 to 23.7 ± 14.6 (P = .024). Comparison of parameters before and after individual PLEX sessions (n = 35) revealed a mean reduction of vWf from 387.8 ± 165.1% to 213.2 ± 62.3% (P = .001) and an increase of ADAMTS13 activity from 60.4 ± 20.1% to 70.5 ± 14.0% (P = .001). Parallelly, monocyte chemotactic protein-1 and interleukin-18 decreased significantly (P = .034 each). Along the PLEX sequence lactate dehydrogenase (P = .001), C-reactive protein (P = .001), and positive end expiratory pressure (P = .01) significantly decreased accompanied by an improvement of Horovitz index (P = .001).

CONCLUSION
PLEX restores the disbalance between ADAMTS13 and vWf: Ag, a driver of immunothrombosis. Moreover, it reduces the inflammatory state and is associated with a benefit of ventilation parameters. These findings render a further rationale to regard PLEX as a therapeutic option in severe COVID-19.
MO150: Serum Angiopoietin-Like Protein 3 Level is Negatively Associated with Vascular Reactivity Index by Digital Thermal Monitoring in Chronic Haemodialysis Patients
Authors: Wu Tzu-Chiang , Huang Hsiang-Jung , Lin Wei-Chen , Kuo Ch , Hsu Bang-Gee 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Angiopoietin-like protein 3 (ANGPTL3) plays important roles in lipid and lipoprotein trafficking and metabolism and has demonstrated a positive correlation with cardiovascular risk assessment parameters of carotid and femoral artery intima-media thickness. We evaluated the association between serum ANGPTL3 levels and endothelial function in chronic haemodialysis (HD) patients.

METHOD
Blood samples were obtained from 116 chronic HD patients. We measured the endothelial function—represented by the vascular reactivity index (VRI)—via non-invasive digital thermal monitoring, and serum ANGPTL3 concentrations by using commercial enzyme-linked immunosorbent assay.

RESULTS
A total of 17 (14.7%), 50 (43.1%) and 49 (42.2%) patients had poor (VRI &lt; 1.0), intermediate (1.0 ≤ VRI &lt; 2.0) and good (VRI ≥ 2.0) vascular reactivity. As the VRI decreased, the serum alkaline phosphatase (ALP, P = .025) and ANGPTL3 (P &lt; .001) levels significantly increased. Serum log-transformed ALP (log-ALP, r = –0.187, P = .045) and log-ANGPTL3 (r = –0.319, P &lt; .001) were negatively associated with VRI values by univariate linear regression analysis. After applying multivariate stepwise linear regression analysis adjustment, the significantly negative association of log-ANGPTL3 (standardized β = –0.319, adjusted R2 change = 0.094; P &lt; .001) with VRI values in chronic HD patients remained.

CONCLUSION
Our study results indicated that ANGPTL3 concentration was negatively associated with VRI values and modulated endothelial function in chronic HD patients.
MO167: SAFETY OF SGLT2 INHIBITORS (SGLT2I) IN PEOPLE OVER 75 YEARS
Authors: Vidas Maria Marques , Domenech Ester , Testillano Lucía Martin , Maroto Alba , Lopez Paula , Portoles Jose' M 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The use of iSGLT2 in people over 75 years was initially associated with a higher rate of adverse effects (AEs). Subsequent clinical trials have consistently demonstrated no increase of serious adverse effects in this group of patients, but the incidence of minor adverse events remains to be analysed in this group of patients
The objective of this study is to evaluate in real life the incidence of adverse effects attributable to this family of drugs in patients aged 75 years (75+) or more at the beginning of treatment with iSGLT2 taking as reference population patients aged less than 75 years (&lt;75). The incidence of cardiovascular events and death was also analysed.

METHOD
Observational study, one-centre. We selected all the patients undergoing iSGLT2 treatment at our centre since 2015 till 2021, grouping them according to their age at the start (75 + versus &lt;75 years).

RESULTS
A total of 153 patients started treatment with iSGLT2 in our centre, 33 (21.6%) were 75 or older. Follow-up time was 19.0 months, interquartile range [8.9–30.3]. Mean age 67.3 years (SD 10.5), m: f ratio was 3:1 and type of SGLT2i was dapagliflozin 49%, canagliflozin 29% and empagliflozin 22%.
A total of 28 patients (18.3%) had some side effect of the drug, without significant differences between + 75 and &lt;75. The most frequent AEs in both groups were genitourinary (GU) infections (10.3%) and falls (9.2%), Eight patients discontinued treatment (five due to any AEs) with similar distribution in both groups. GU tract infections were more frequent in the first year of treatment treatment (100% during first year in 75+ and 46.7% in &lt;75 years). We did not found any difference in older patients in the rate of CV events or death (Log rank 0.6)

CONCLUSION
Side effects of iSGLT2 were uncommon in our population, and age above 75 years was not associated with a higher incidence of AEs. GU tract infections, which were the most prevalent AE, were more frequent in the first year of treatment indicating the need of a more careful monitoring in this period of time.
MO175: Association between Thrombotic Microangiopathy, ADAMTS13 Activity and Development of AKI, ARDS, AND Poor Outcomes in COVID-19 Patients (Pilot Study)
Authors: Vorobyev Eugene , Vorobyeva Snezhana , Galkina Olga , Zubina Irina , Bogdanova Evdokia , Levykina Elena , Kulikov Aleksander 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Cases of microangiopathy associated with COVID-19 are not fully understood. We aimed to clarify in these patients the presence of thrombotic microangiopathy (TMA) and decreased ADAMTS13 activity, the possible influence of these factors on kidney and lung damage, and outcomes.

METHOD
The study involved 90 patients with COVID-19 and viral pneumonia, who were treated at the Pavlov First St. Petersburg State Medical University. Patients undergoing plasma transfusion were excluded. In addition to the standard examination, activity of ADAMTS13 was determined in admission (ELISA, normal range 30–160%).

RESULTS
Median level ADAMTS13 was 92%, IQR 27.9%. The presence of TMA took place in 26.7% of patients, in 41.5% patients with TMA the level of activity of ADAMTS13 was less than 60%. In patients with respiratory failure, the ADAMTS13 level was significantly lower–78.4%, IQR 32.1% versus 108.6%, IQR 26.7%. In patients with respiratory failure (P &lt; .01), the incidence of TMA was significantly higher–34.2% versus 19.3%, respectively (P &lt; .01). The ADAMTS13 level neg. correlated with the risk of developing TMA (ρ = –0.486, P &lt; .01), AKI of any stage (KDIGO2012 criteria) (ρ = –0.288, P &lt; .01), acute respiratory distress syndrome (ARDS, ‘Berlin definition’) (ρ = –0.304, P &lt; .01), the duration of hospitalization (ρ = –0.342, P &lt; .01) and the probability of death (ρ =–0.278, P &lt; .01). In the case of five patients, an extremely low level of ADAMTS13 (less than 30%) was noted, which in all cases was accompanied by laboratory signs of TMA and the development of ARDS; two patients had a fatal outcome.

CONCLUSION
TMA and low ADAMTS13 activity are associated with progression to severe COVID-19 disease and development of AKI. Some of the cases of TMA in these patients may be due to low ADAMTS13 activity. Further research is needed to assess the potency of treating these patients with TMA associated with low ADAMTS activity.
MO223: Contribution of Interstitial CD138 + Plasma Cells on the Renal Outcome in Patients with Anca-Associated Vasculitis
Authors: Odler Balazs , Haefner Johannes M , Pollheimer Marion J , Schabhuettl Corinna , Krall Marcell , Rosenkranz Alexander , Eller Kathrin 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Plasma cells (PC) are the most differentiated antibody and cytokine-producing B lineage cells and are thought to contribute to the perpetuation of inflammation in patients with ANCA-associated vasculitis (AAV). Agents targeting PCs are of interest in AAV, however, little is known about the role of interstitial CD138 + PCs in these patients. In this study, we aim to demonstrate the impact of this cell population in the prediction of renal outcomes in patients with AAV.

METHOD
Forty AAV patients with glomerulonephritis, diagnosed between 2014 and 2018 at the Division of Nephrology of the Medical University of Graz were included and followed for 36 months. Histological assessments using the kidney allograft Banff classification were performed to describe the tubulointerstitial (TI) damages. Immunohistochemistry analysis was performed in 29 patients to assess the renal interstitial CD138 + cell expression. More than ten CD138 + cells per high power field were stated as high expression (excluding CD138 staining of renal tubular epithelial cells). Changes in kidney function, the incidence of renal relapses (RR), and end-stage renal disease (ESRD) were analyzed.

RESULTS
In the kidney biopsies, N = 21 (72%) patients had a high expression of CD138 + plasma cells. No significant difference was observed in PR3 and MPO serotypes in the group of patients with high CD138 + cell expression (43% versus 57%, P = .793). In addition, no significant difference was seen in the changes in kidney function and the incidence of RR or ESRD between the groups with high and low expression of CD138 + cells during the follow-up period. However, patients with more severe TI damage had more severe proteinuria {urinary albumin/creatinine ratio: 51 [interquartile range (IQR) 42–123] versus 360 (IQR 202–1112) mg/g Creatinine; P = .016} at 3-year follow-up, and tended to have a higher rate of RR and ESRD [i0/i1: N = 2/18 (11%) versus i2/i3: N = 6/22 (27%), P = .258 and i0/i1: N = 2/18 (11%) versus i2/i3: N = 6/22 (27%), P = .258, respectively].

CONCLUSION
Our data indicate a significant proportion of CD138 + PCs in kidney specimens of patients with AAV. Despite the lack of association between this cell population and our cohort’s renal outcome, these results provide additional insights on the renal B-cell clusters in patients with AAV. In addition, our findings go along with already existing data on the association between extended TI damage and worse renal outcome.
MO228: Clinical Features and Obesity Impact on Chronic Kidney Disease Progression in Patients with Glomerular Diseases
Authors: Jordanova Elena , Jankovic Radmila , Pantic Igor , Celic Dejan , Ljubicic Bojana , Simic-Ogrizovic Sanja , Jovanovic-Basta Gordana 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The kidney disease secondary to obesity is obesity-related glomerulopathy characterized by the following: glomerulomegalia, progressive glomerulosclerosis, proteinuria and progression of renal failure. The aims of the present study were to evaluate the clinical features and 2 years outcome in obese and non-obese patients with glomerular diseases.

METHOD
This study included 125 patients with renal biopsy-proven glomerular diseases: minimal change disease, FSGS, IgA nephropathy, membranous glomerulonephritis, membranoproliferative glomerulonephritis (mean age 46.93 ± 15.10 years). There were 63 obese (BMI ≥ 27 kg/m2) and 62 non-obese (BMI &lt;27 kg/m2) patients. The serum concentration of protein, albumin, cholesterol, trygliceride, creatinine and daily proteinuria were measured at the time of kidney biopsy, 6, 12 and 24 months after the biopsy. The estimated glomerular filtration rate (eGFR) was calculated according to the equations: Cockcroft–Gault#(Cockcroft–Gault–BMI &lt; 27 kg/m2 Cockcroft–GaultLBW-BMI ≥27kg/m2) and Chronic Kidney Disease Epidemiology Collaboration Equation (CKD–EPI).

RESULTS
At the time of kidney biopsy, the obese had significantly lower eGFR calculated by formulas: Cockcroft–Gault# (62.29 ± 27.53 versus 96.30 ± 38.80 mL/min) and CKD–EPI (71.52 ± 31.15 versus 86.36 ± 27.63 mL/min/1.73 m2), significantly higher daily proteinuria (6.11 ± 4.94 versus 4.47 ± 4.95 g/day), creatinine (122.14 ± 87.56 versus 93.66 ± 41.40 μmol/L), trygliceride (2.76 ± 1.39 versus 2.20 ± 1.30 mmol/L) in comparison with non-obese. There was statistically significant difference in eGFR calculated by Cockcroft-Gault# 6 months (t = 5.353, P &lt; .01), 12 (t = 5.234, P &lt; .01) and 24 months (t = 2.329, P &lt; .05) after the kidney biopsy between obese and non-obese. The reduction in eGFR Cockcroft–Gault# after 24 months compared with baseline in obese was 14.7%, in non-obese 13.7% (P &gt; 0.05). After 12 months follow-up significantly higher percentage of non-obese patients reached complete remission (59.4% versus 35.3%) compared with obese (χ2 = 4.548), but after 24 months there were no significant difference.

CONCLUSION
Obese patients at the time of kidney biopsy, 6, 12 and 24 months later had the significant lower eGFR compared to non-obese. After 24 months follow-up there was no significant difference in percentage of patients with complete remission between two groups, although after 12 months follow-up a significantly smaller number of obese were in complete remission.