End-stage Chronic Renal Failure Research Articles

ACUTE AND DISEASE WITH GLOMERULONEPHRITIS CYTOKINE BALANCE IN SICK PATIENTS

Glomerular kidney damage -glomerulonephritis (GN) is one of the serious medical and economic problems. Often, GN is the main cause of end-stage chronic renal failure, which is incompatible with life and requires renal replacement therapy (dialysis, donor kidney transplantation) [2]. According to the course of the disease, there is an acute form of GN (the durationof the disease is less than one year) and chronic (the duration of the disease is more than one year). In clinical practice, there are often difficulties in timely differentiation of chronic GN and acute GN exacerbation, in particular, in the urinary (hidden) form of the disease, due to the lack of clear criteria for their diagnosis.

Pituitary disorders in patients with end-stage chronic renal failure

Disorders in the kidneys lead to disturbance of homeostasis. As the glomerular filtration rate decreases, the metabolism of numerous biologically active substances, including pituitary hormones, decreases. The article presents an overview of pituitary dysfunction in patients with chronic kidney disease (CKD) and discusses the possible reasons of the pathogenetic mechanisms. Particular focus is being given to the assessment of changes in the concentration of pituitary hormones in patients with end-stage chronic kidney disease (CKD) and discusses the pathogenetic mechanisms of their formation. Particular attention is paid to the assessment of changes in the concentration of pituitary hormones in patients receiving renal replacement therapy (RRT). CKD leads to an increase in the level of prolactin, luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Concentrations of growth hormone (GH), isulin-like growth factor-1 (IGF-1), thyroid-stimulating hormone (TSH), adrenocorticotropic hormone (ACTH) and vasopressin may remain within normal values or increase in this group of patients. RRT does not reduce the levels of prolactin, LH, FSH, while the concentration of growth hormone, IGF-1, TSH tends to normalize. The content of ACTH and vasopressin may remain unchanged or decrease. Kidney transplantation in most cases corrects hormonal disorders. Correction of hormonal changes can improve the clinical outcome and quality of life of patients with end stage CKD.

State of Transplantation in the Republic Of Uzbekistan: Existing Problems of Donation.

Organ traTransplantation is one of the most successful achievements in modern medicine. For patients with end-stage chronic renal failure, transplantation undeniably improves their quality of life. The purpose of the study was to discuss the latest scientific data on the state of kidney transplantation in the world and to give an idea of the advantages, opportunities, and problems of kidney transplantation in the world and in the Republic of Uzbekistan. Transplantation in Uzbekistan developed in 5 stages. Stage I (1972-1991) began with the first kidney transplant in Uzbekistan on September 14, 1972, on the basis of the legislation on organ and tissue transplantation of 1970. Stage II (1991-1998) represented a break in the field of transplantation due to its prohibition by law. Stage III (1998-2017) comprised a series of 48 kidney transplants from living related donors on the basis of an order of the Ministry of Health of the Republic of Uzbekistan. Stage IV (2017-2022) comprised a series of 849 kidney transplants and 22 liver transplants from living related donors on the basis of Cabinet of Ministers Resolution No. 859 of October 17, 2017. Stage V began on May 11, 2022, with the adoption of the a new of the Republic of Uzbekistan, On Transplantation of Human Organs and Tissues. According to this new law, the objects of transplantation can be human organs and (or) tissues taken from either a living donor or a deceased donor. This law will expand the range of donors for patients in need. Transplantology is a sphere of life activity that can no longer be ignored; therefore, it is necessary to develop and implement humanistic principles on the basis of which it will be regulated.

Management of the Diabetic Microalbuminuria with Ayurvedic intervention- A Case Report

Background: One of the most prevalent side effects of diabetes, diabetic nephropathy causes Hypoalbuminemia, chronic kidney damage and end-stage renal failure worldwide. This study was performed for the effectiveness of the Ayurvedic treatment in the patient presented with the complications of Diabetic Microalbuminuria with special reference of Kaphaja Shotha. A 67-year-old, male patient consulted to the Ayurveda hospital with generalized body swelling, difficulty in breathing on the rest, Fatigue for 2 years, following secondary prevention for two years. Design: Single Case report. Materials and Methods: In this prospective case study, conducted on a subject experiencing edema as a complication of diabetic nephropathy for two years, the individual was admitted to the Indoor Patient Department of Medicine. Over a period of three months, the subject was assessed every 15 days. The intervention involved the administration of oral medications including mainly Gokshuradi guggulu, Punarnavadi guggulu, Hingwastak Churna, Triphala Churna, Syrup Neeri KFT, and Gomutra Haritaki. The edema reduced progressively, and there was an alleviation of associated symptoms such as difficulty in breathing and fatigue. Additionally, the subject showed improvement in renal function parameters and reported an enhanced sense of well-being. Results: Laboratory investigation showed protein in urine and hypoalbuminemia with normal blood urea and S. Creatinine., which was corrected after treatment, increased serum albumin from 1.9 (g/dl) to 3.9(g/dl) and serum globulin from 1.7(g/dl) to 2.7 (g/dl). After 18 days, a significant improvement was noted in all the clinical features, blood investigations, Chest X ray of the patient and no any unwanted effects were noted during the study period. The case was managed without encountering any adverse effects, following the treatment regimen for Shotha. Keywords: Diabetic Microalbuminuria, Hypoalbuminemia, Kaphaja Shotha

Epidemiological, Clinical, Therapeutic, and Evolutionary Aspects of Chronic End-Stage Renal Failure in the Nephrology Department of the University Hospital of Brazzaville in 2023

Epidemiological, Clinical, Therapeutic, and Evolutionary Aspects of Chronic End-Stage Renal Failure in the Nephrology Department of the University Hospital of Brazzaville in 2023

PATIENT TRANSFER FROM HEMODIALYSIS TO PERITONEAL DIALYSIS: A SINGLE CENTER EXPERIENCE

INTRODUCTION Peritoneal dialysis and hemodialysis are complementary ways of treating end-stage renal failure. Changing the dialysis modality from hemodialysis to peritoneal dialysis is a rare and poorly studied phenomenon. MATERIALS AND METHODS Retrospective cohort study conducted on the population of adult patients with end-stage chronic renal failure who were treated at the Nephrology Clinic of the Clinical Center of the University of Sarajevo in the period from 2006 to 2023. A total of 109 adult patients, whose medical documentation was complete and who were in the peritoneal dialysis program at the Nephrology Clinic of the Clinical Center of the University of Sarajevo during the observed period, were included in this study. One group started the treatment with peritoneal dialysis, and the other with hemodialysis. Demographic data were collected for each patient: age, gender, underlying kidney disease, comorbidities (heart disease and diabetes), duration of treatment modality, data on modality change, complications and treatment outcomes. Data from physical and electronic patient histories were used. RESULTS Total of 109 adult patients were included in this study. They are divided into two groups. Group 1 (n=99) in which peritoneal dialysis was the first treatment modality and Group 2 (n=10) in which haemodialysis was the first treatment modality, but in which patients, after a certain time, were transferred to peritoneal dialysis. The median age of patients in Group 1 was 60 (-/-14.07) years and 54 (-/+12.23) years for Group 2. Within Group 1 the most common cause of terminal renal failure was diabetic nephropathy (n=40, 40.4%) and nephroangiosclerosis (n=24, 24.24%). The mean age of onset of peritoneal dialysis was 60 (-/-14.07) years, while the mean age of cessation of peritoneal dialysis was 63 (±13.69) years. The average duration of peritoneal dialysis treatment was 38.36(±34.14) months. During the stay at peritoneal dialysis, death was recorded in 63 patients (62.38%). The number of patients who replaced peritoneal dialysis treatment with hemodialysis was 26. The most common reason for switching to haemodialysis was insufficiency of peritoneal dialysis (n=13, 14%). After switching to haemodialysis, the average length of staying on it was 10.22 months. The reason for discontinuation of haemodialysis was death (n=17, ) or transplantation (n=1, 3.7%). Kaplan-Meier test shown worse outcome in patients with haemodialyis first than peritoneal dialysis first. CONCLUSION Changing the dialysis modality carries with it a high risk of mortality, especially in the first month. Changing the way of active treatment with dialysis speaks in favor of severe comorbidities.

706. An Ad Hoc Subgroup Analysis of a Phase 3, Open-Label Study Indicates Efficacy and Safety of Fecal Microbiota, Live-jslm in Participants With Recurrent Clostridioides difficile Infection and Renal Impairment

Abstract Background Patients with renal comorbidity are at risk of severe Clostridioides difficile infection (CDI) and recurrence. Fecal microbiota, live-jslm (REBYOTA™, abbreviated here as RBL, previously known as RBX2660) is the first FDA-approved, microbiota-based live biotherapeutic for the prevention of recurrent CDI (rCDI) in adults following antibiotic treatment for rCDI. An ad hoc subgroup analysis of PUNCH CD3-OLS (NCT03931941), an ongoing, open-label, phase 3 trial evaluating the efficacy and safety of RBL, assessed outcomes in participants with renal comorbidity. Methods PUNCH CD3-OLS participants were ≥ 18 years old with medically documented rCDI, including first recurrence determined by the treating physician, and assessed with standard-of-care (SOC) diagnostic methods. After SOC antibiotics, participants received a single dose of rectally administered RBL. Treatment success was defined as remaining recurrence free for 8 weeks after treatment. Treatment-emergent adverse events (TEAEs) through 6 months of treatment were reported. Participants with renal comorbidity were identified from the medical history dictionary-derived terms in the modified intent-to-treat (mITT) population. Results Within the mITT population, 98 of 402 participants with adjudicated outcomes had renal comorbidity, including chronic kidney disease (n=29) and end-stage renal failure (n=5). Of participants with renal comorbidity, 50% had Charlson Comorbidity Index scores of ≥ 5, versus 18% of participants without renal comorbidity. Treatment success was achieved by 66% (65/98) and 77% (235/304) of participants with and without renal comorbidity, respectively. TEAEs occurred in 71% (n=70) of participants with renal comorbidity and 64% (n=194) of participants without renal comorbidity. In both groups, most TEAEs were moderate in severity and related to preexisting conditions. Serious TEAEs were reported by 16% (n=16) and 8% (n=24) of participants with and without renal comorbidity, respectively. The most commonly reported serious TEAE was CDI recurrence, occurring in 3.1% (n=3) and 1.6% (n=5) of participants with and without renal comorbidity, respectively. Conclusion RBL treatment success and TEAE incidence were numerically comparable for those with and without renal comorbidity. Disclosures Monika Fischer, MD, Ferring Pharmaceuticals Inc.: Advisor/Consultant|Rebiotix Inc., a Ferring Company: Board Member|Seres Pharmaceuticals: Advisor/Consultant Joan Thul, BA, Ferring Pharmaceuticals Inc.: Employee Beth Guthmueller, AS, Rebiotix Inc., a Ferring Company: Employee Christian Sandrock, MD, Allergan: Advisor/Consultant|National Institutes of Health: Grant/Research Support|Shionogi: Advisor/Consultant|The Health Resources & Services Administration: Grant/Research Support Nicholas Van Hise, PharmD, Ferring Pharmaceuticals Inc.: Advisor/Consultant|Ferring Pharmaceuticals Inc.: investigator Glenn S. Tillotson, PhD, Dynavax: Advisor/Consultant|Ferring Pharmaceuticals: Advisor/Consultant|Peggy Lillis Foundation: Honoraria|Spero Therapeutics: Advisor/Consultant

Simultaneous pancreas-kidney transplantation for end-stage renal failure in type 1 diabetes mellitus: Current perspectives.

Type 1 diabetes mellitus (T1DM) is one of the important causes of chronic kidney disease (CKD) and end-stage renal failure (ESRF). Even with the best available treatment options, management of T1DM poses significant challenges for cli nicians across the world, especially when associated with CKD and ESRF. Substantial increases in morbidity and mortality along with marked rise in treatment costs and marked reduction of quality of life are the usual consequences of onset of CKD and progression to ESRF in patients with T1DM. Simultaneous pancreas-kidney transplant (SPK) is an attractive and promising treatment option for patients with advanced CKD/ESRF and T1DM for potential cure of these diseases and possibly several complications. However, limited availability of the organs for transplantation, the need for long-term immunosuppression to prevent rejection, peri- and post-operative complications of SPK, lack of resources and the expertise for the procedure in many centers, and the cost implications related to the surgery and postoperative care of these patients are major issues faced by clinicians across the globe. This clinical update review compiles the latest evidence and current recommendations of SPK for patients with T1DM and advanced CKD/ESRF to enable clinicians to care for these diseases.

A case of uremic pruritus and papulo-pustular rash associated with anti-EGFR therapy in a patient with rectal cancer and chronic kidney disease

Uremic pruritus is a common symptom in chronic kidney disease and end-stage renal failure. In addition to physical discomfort uremic pruritus disrupts sleep, negatively affects the psycho-emotional state and quality of life. In this group of patients, the association of uremic pruritus with an increase in mortality due to any causes was demonstrated. At the same time, there are no standardized approaches to the treatment of uremic itching. There is also a special category of patients receiving antitumor therapy and developing dermatological adverse events, also potentially accompanied by itching.
 This article presents a case of uremic pruritus in a patient with papulo-pustular cutaneous reaction (grade II on a Scale Common Terminology Criteria for Adverse Events, CTCAE v 5.0) to the epidermal growth factor (EGFR) inhibitor cetuximab in combination with leucovorin and 5-fluorouracil for rectal cancer. Treatment of uremic pruritus with small doses of gebapentin (300 mg/day) led to complete regression of pruritus. Papulo-pustular rashes completely regressed after recommended systemic and topical therapy according to the severity of rush (doxycycline 100 mg 2 times a day for 5 days, cream with neomycin, natamycin and hydrocortisone 3 times a day for 7 days). Pruritus was absent during the next 6 months of follow-up. Antitumor therapy was not interrupted due to acneiform rush, and following supportive topical therapy allowed to control severity of exacerbations which did not exceed III grade according to CTCAE v 5.0 and did not require the addition of systemic therapy.
 Thus, therapy of uremic pruritus with gabapentin has shown was effective also in a patient with severe comorbid pathology. Supportive topical therapy consistent with the severity of papulo-pustular rash reduced the severity of exacerbations during following EGFR inhibitor therapy.

Artificial intelligence-assisted repurposing of lubiprostone alleviates tubulointerstitial fibrosis

Tubulointerstitial fibrosis (TIF) is the most prominent cause which leads to chronic kidney disease (CKD) and end-stage renal failure. Despite extensive research, there have been many clinical trial failures, and there is currently no effective treatment to cure renal fibrosis. This demonstrates the necessity of more effective therapies and better preclinical models to screen potential drugs for TIF. In this study, we investigated the antifibrotic effect of the machine learning-based repurposed drug, lubiprostone, validated through an advanced proximal tubule on a chip system and in vivo UUO mice model. Lubiprostone significantly downregulated TIF biomarkers including connective tissue growth factor (CTGF), extracellular matrix deposition (Fibronectin and collagen), transforming growth factor (TGF-β) downstream signaling markers especially, Smad-2/3, matrix metalloproteinase (MMP2/9), plasminogen activator inhibitor-1 (PAI-1), EMT and JAK/STAT-3 pathway expression in the proximal tubule on a chip model and UUO model compared to the conventional 2D culture. These findings suggest that the proximal tubule on a chip model is a more physiologically relevant model for studying and identifying potential biomarkers for fibrosis compared to conventional in vitro 2D culture and alternative of an animal model. In conclusion, the high throughput Proximal tubule-on-chip system shows improved in vivo-like function and indicates the potential utility for renal fibrosis drug screening. Additionally, repurposed Lubiprostone shows an effective potency to treat TIF via inhibiting 3 major profibrotic signaling pathways such as TGFβ/Smad, JAK/STAT, and epithelial-mesenchymal transition (EMT), and restores kidney function.

BONE MARROW OXALOSIS, A RARE CAUSE OF PANCYTOPENIA: A CASE REPORT

Primary hyperoxaluria is a rare congenital metabolic disease characterised by an overproduction of oxalate, secondary to a hepatic enzyme deficiency, alanine glyoxylate aminotransferase (AGT). Calcium oxalate crystals are deposited in many tissues. Involvement of the bone marrow is relatively rare. We report the case of a young 29-year-old patient with a history of recurrent renal lithiasis, progressing to end-stage chronic renal failure at the haemodialysis stage, admitted to the medical ward for investigation of mucocutaneous pallor and anaemia resistant to erythropoietin. Clinical and laboratory examination revealed an oedematous-ascitic syndrome and pancytopenia with normocytic normochromic anaemia. Imaging revealed moderate ascites and homogeneous splenomegaly. The myelogram was inconclusive. An osteomedullary biopsy was performed and showed deposits of oxalate crystals with bone marrow fibrosis associated with foreign body macrophagic granulomas. These crystals were grouped in a rosette and birefringent in polarised light. Primary hyperoxaluria is a rare disease. Involvement of the bone marrow indicates the advanced stage of the disease, hence the importance of anatomopathological diagnosis. Hepato-renal transplantation remains the only effective treatment for this disease.

Primary Hyperoxaluria Type 1: Clinical, Paraclinical, and Evolutionary Aspects in Adults from One Nephrology Center.

Primary hyperoxaluria type 1 (PH1) is a rare and inherited condition of urolithiasis. The aim of our study was to analyze clinical, paraclinical, and evolutionary aspects of PH1 in adult patients in our Nephrology department. We conducted a retrospective single-center study between 1990 and 2021. We collected patients followed for PH1 confirmed by genetic study and/or histopathological features of renal biopsy and morphoconstitutional analysis of the calculi. There were 25 patients with a gender ratio of 1.78. The median age at onset of symptoms was 18 years. A delay in diagnosis more than 10 years was noted in 13 cases. The genetic study found the I244T mutation in 17 cases and 33-34 InsC in 4 cases. A kidney biopsy was performed in 5 cases, on a native kidney in 4 cases and on a graft biopsy in one case. The analysis of calculi was done in 10 cases showing type Ic in 2 cases. After a median follow-up of 13 years (1 year-42 years), 14 patients progressed to end-stage chronic renal failure (ESRD). The univariate study demonstrated a remarkable association with progression to ESRD in our population (44% vs. 56%) RR = 13.32 (adjusted ORs (95% CI): 2.82-62.79) (p < 0.01). Progression to ESRD was frequent in our series. Early diagnosis and adequate management can delay such an evolution.

Genomic testing in patients with renal disease.

Inherited kidney disease accounts for a significant proportion of chronic kidney disease and end-stage renal failure. There is increasing evidence that genetic testing for inherited kidney disease should be integrated into clinical care pathways at the earliest opportunity so that patients and their families can maximally benefit from carefully tailored care. Despite increased availability of genetic testing, the proportion of patients with renal disease undergoing genetic investigations remains low. This article introduces key concepts of genetic and genomic testing to the renal physician and addresses some common barriers to the wider integration of genetic testing in routine clinical practice to fully capitalise on recent advances in genomic medicine and improve patient outcomes.

IgA nephropathy associated with Crohn's disease.

The relationship between IgA nephropathy (IgAN) and Crohn's disease was reported. IgAN is the most common primary glomerulonephritis and one of the leading causes of chronic kidney disease and end-stage renal failure, and up to 50% of cases progressed to end-stage renal disease within 25 years after IgAN diagnosis. However, specific and effective therapeutic strategies are still lacking. In this review, we discuss the possibility of the mechanism involved in IgAN associated with Crohn's disease based on the findings of basic and clinical studies. Although the etiology of IgAN associated with Crohn's disease is not permanent and various factors are thought to be involved, the stabilization of the disease condition of Crohn's disease is believed to help treat IgAN.

#3739 SHUNT PORTOSYSTEMIC COMPLICATED BY HYPERAMMONEMIA AND HEPATIC ENCEPHALOPATHY SUPPORTED BY DAILY DIALYSIS IN A CHRONIC HEMODIALYSIS PATIENT

Abstract Background and Aims Hepatic encephalopathy is a neuropsychiatric syndrome that may develop as a consequence of liver insufficiency. In acute liver failure, hepatic encephalopathy suggests the severity of the disease. In end-stage chronic liver diseases, episodes of hepatic encephalopathy are frequently fully and spontaneously reversible. Clinical manifestations vary from mild neuropsychiatric disorders to coma. The pathogenesis of hepatic encephalopathy is complex and not clearly understood. Ammonia plays a key role. In the healthy individual, ammonia is, during its first hepatic passage, directly degraded into urea, itself excreted by the kidney and the stools, and to a lesser degree in glutamine. Ammonia is also metabolized by the muscle striped. In case of liver failure and/or shunts portosystemic, there is a defect in hepatic clearance ammonia which is then found in excess in systemic circulation. Decreased muscle mass, linked to malnutrition, frequent in the patient cirrhotic and chronic hemodialysis, also helps to decrease metabolism ammonia. Due to the increase in permeability of the blood-brain barrier, the brain is exposed to excessive concentrations ammonia causing functional brain abnormalities and structural, which can partly explain the signs neurology of hepatic encephalopathy. In end stage chronic renal failure, clearance of ammonia via extracorporeal treatment has not been systematically evaluated. Several studies with small samples have demonstrated the effectiveness of hemodialysis, compared to peritoneal dialysis, in terms of ammonium purification in chronic renal failure, on dialysis or not on dialysis. The aim of this study was to evaluate the effectiveness of daily dialysis for the purification of ammoniumin a chronic hemodialysis patient with hepatic encephalopathy. Case Report A 40-year-old man undergoing chronic hemodialysis was referred to gastroenterology department of Mohammed VI University center of Marrakesh for inoperable shunt portosystemic complicated by hyperammonemia causing hepatic encephalopathy consisting of headaches and seizures. His medical history was significant for liver cirrhosis caused by infection with hepatitis B, end stage kidney disease due to membranoproliferative glomerulonephritis, for which the patient is on hemodialysis at the rate of 3 sessions per week. The patient went on to develop portal hypertension and ascites requiring frequent hospital admissions and treatment with diuretics. He was on a low-protein and low-sodium diet. While on oral furosemide 250 mg daily and spironolactone 100 mg daily, his diuresis was adequate. Before referral, this patient had already suffered 4 episodes of tonic clonic seizures. His 1st hemodialysis session in our training was on January 10, 2023, he was given daily hemodialysis sessions with daily blood tests, including immediate pre and post dialysis ammonia. Pre-dialytic ammonia levels varied between 103 and 161 µmol/l, as well as post-dialytic ammonia levels varied between 24 and 37 µmol/l, knowing that the normal value of laboratory ammonia varied between 10 and 51 µmol/l. The evolution was marked by a clear clinical improvement, with a disappearance of the seizures without a significant drop in ammonia after 14 daily hemodialysis sessions. Serum creatinine and urea declined, and sodium increased. Accumulation of ascites slowed and the patient could eat and sleep normally and was again independent with self care. The patient returned home on January 24. Conclusion This study shows the interest of daily hemodialysis sessions as a potential treatment for hyperammonemia in a patient on chronic intermittent hemodialysis, with a portosystemic shunt. The interest lies in the fact that the improvement is mainly clinical than biological (persistent hyperammonemia).

#5577 PERITONEAL DIALYSIS COMPLICATIONS IN PEDIATRICS: A TUNISION EXPERIENCE

Abstract Background and Aims Peritoneal dialysis (PD) is the preferred chronic dialysis modality for children suffring from chronic end-stage renal failure (CKD). But, it presents different infectious and non-infectious complications, causes of important morbidity and mortality. In this study, we aimed to describe the deferent infectious and mecanical complications observed in children on PD and to investigate the risk factors for the occurrence of different infectious and mechanical complications. Method In this study, we retrospectively collected the records of 99 patients who were treated with PD within the last eleven years (2010-2020) in the department of pediatrics of the University Hospital Charles Nicolle of Tunis. Analysis examining possible risque factors were performed using parametric and non-parametric tests and multivariate logistic regression in multivariate analysis. Results Ninety-nine children were on PD. All our patients were on automated PD. The sex ratio was 1.02. The overall duration of the PD was 290 years with an average of 2.93 years± 1.92 years. The average age at the beginning of PD was 9.75± 4.67 years. Sixty-nine patients had infectious complications, of which 65 patients had 120 episodes of peritonitis (IP) with a rate of 0.41 episodes per patient-year, 10 patients had exit-site infection and 3 patients had a tunnel infection. Mechanical complications were noted in 63 patients with a catheter revision rate of 1 per 38 patient-months. We noted an hernia in six patients, hemoperitoneum in seven patients, pancreatitis in three patients and no cases of hydrothorax. Analysis of PD complications risk revealed the following factors : poor adherence to treatment (p = 0.018 and p = 0.011) and weight less than 15 Kg (p = 0.041, p = 0.02) for infectious complications and IP respectively, comorbidity (p = 0.005) for mechanical complications, comorbidity (p = 0.008) and history of PI (p = 0.46) for catheter revision. Conclusion Ongoing educational programs for doctors, nurses and caregivers are needed to limit infectious complications. A collaboration between the pediatric nephrologist and the pediatric surgeon is recommended to improve catheter insertion techniques and prevent mechanical complications.

#5221 PULMONARY HYPERTENSION: AN IMPORTANT RISK FACTOR IN CARDIOVASCULAR MORTALITY IN DIALYSIS PATIENTS

Abstract Background and Aims It is widely known that chronic dialysis patients experience significantly higher cardiovascular (CV) death rates than the overall population. Among other CV risk factors, recent research has shown pulmonary hypertension (PH) as a consequence of chronic kidney disease and end-stage renal failure. The present study aimed to determine the risk factors that impact survival in chronic haemodialysis and peritoneal dialysis patients and to analyse the correlation of these factors with pulmonary hypertension. Method We studied 125 stable haemodialysis and peritoneal patients (females 40%, mean age 52.42 ±11.88 years) on RRT for more than three months with a two-year follow-up. Demographic information, clinical characteristics, blood tests, and a thorough echocardiographic evaluation were collected at the optimal dry weight. After conventional echocardiographic examination, a tissue Doppler echocardiographic (TDE) examination was performed to evaluate the global and regional myocardial systolic and diastolic functions and pulmonary hypertension. Systolic pulmonary artery pressure (sPAP) of 35 mmHg was used to define PH. Results The cardiovascular mortality rate was 15.5%. In ROC analysis for CV mortality, the area under the curve (AUC) for PH and CRP was found 0.8; for LVM-I, E/E', and PP, the AUC was 0.76, 0.75, 0.72, respectively, while the inverse relationship was found with MASa and TASa with AUC = 0.66 and 0.95 respectively. According to the echocardiographic findings, PH was found in 28% (35 patients) of all patients. The mean PH was 33.46±5.38 mmHg. The higher level of higher parathormone (PTH), C-reactive protein (CRP), and E/E’ average, the lower left ventricular ejection fraction (EF), the peak systolic velocity at the lateral mitral annulus (MASa), and the peak systolic velocity at the lateral tricuspid annulus (TASa) were found to be predictors of PH. Patients evaluated with PH have a significantly lower cardiovascular survival rate [Long Rank (Mantel-Cox) p = 0.0001. Conclusion Our research demonstrates that cardiovascular morbidity and death in dialysis patients are mainly attributed to pulmonary hypertension, inflammation, vascular stiffness, and left ventricular hypertrophy. PH is common among dialysis patients. Inflammation, CKD-MBD biomarkers linked to systolic and diastolic left and right ventricular dysfunction, and inflammation all influence it. These conditions are all connected. Cardiovascular imaging is simple to use, offers a favourable viewpoint in the early identification of cardiac abnormalities and quick treatment of this disease, and is thus strongly advised in the dialysis population.

#2537 EPIDEMIOLOGY OF CHRONIC KIDNEY DISEASE IN THE REPUBLIC OF UZBEKISTAN

Abstract Background and Aims Chronic kidney disease (CKD) is an emerging global health problem, currently affecting up to 15% of the global adult population, and is independently associated with an increased risk of cardiovascular disease (CVD) similar to that of diabetes mellitus or coronary artery disease. heart [Reddy K.S., Shah B., Varghese S., Ramados A. 2005; 366: 1744-1749]. To assess the epidemiological characteristics of the development of CKD in the Republic of Uzbekistan (RUz) for 2020. Method The object of the study is the database of the Republican Specialized Scientific and Practical Medical Center for Nephrology and Kidney Transplantation of the Republic of Uzbekistan. Results According to the Institute of Health and Medical Statistics of the Ministry of Health of the Republic of Uzbekistan, the number of patients with end-stage renal disease (ESRD) decreased between 2011 and 2015. However, according to the data for 2020, the number of patients with stage 5 CKD reached 23,773 thousand and its increase is expected. The proportion of patients with chronic renal failure older than 18 years was registered 21,003 thousand in 2011 and 19,149 thousand in 2015, in those years there was a decrease. However, according to the national registry for 2020, CKD cases in the Republic of Uzbekistan, identified in all regions, amounted to 118026, there were 23773 patients with chronic renal failure receiving hemodialysis - 5149. The number of registered patients with CKD in the Autonomous Republic of Karakalpakstan was 9013, with CRF - 912, in need of hemodialysis - 115, receiving hemodialysis - 98, in need of transplantation - 21. In Andijan region, 416 persons were registered, with CRF - 201, in need of replacement therapy 137, receiving dialysis - 137, needing in transplantation - 11. In the Bukhara region, 4500 such patients were registered, CKD - 501, in need of substitution therapy - 172, receiving dialysis - 164 and in need of transplantation - 36. Conclusion With a general increase in the prevalence of CKD in the Republic of Uzbekistan in the dynamics of 2020, there is an improvement in the quality of diagnosing complications at earlier stages, at a later age and with a longer duration of CKD. Advances in the management of patients with CKD in recent years do not reduce the risk of end-stage chronic renal failure, but delay its development. Pronounced interregional differences in the frequency of registration of CKD in the database indicate problems in diagnosing CKD in a number of regions where the standard for examining patients with CKD with a mandatory assessment of glomerular filtration rate (GFR) and albuminuria at least once a year is not met.

HEMATOLOGICAL AND THYROID DISTURBANCE IN AN ALGERIAN POPULATION OF CHRONIC HEMODIALYSIS PATIENTS

Objective: Hemodialysis patients suffer in the majority of cases from normocytic normochromic anemia, due to the decrease of erythropoietin production. Thyroid abnormalities are also observed in these patients. They are represented by hypothyroidism which is characterized by low levels of FT3, normal levels of free thyroxine, and often high levels of TSH The objective is to estimate the prevalence of hypothyroidism and anemia in an Algerian population with end-stage chronic renal failure on hemodialysis. Design and method: This is a descriptive cross-sectional study carried out in the Biochemistry laboratory in collaboration with the Hematology laboratory of CPMC. 94 patients with end-stage chronic renal failure . Results and discussion Results: The mean age of our hemodialysis patients was 59.62 years, with a sex ratio of 0.69. Most of our patients (47%) had arterial hypertension (AH) and 20% of patients had diabetes. Our results show a prevalence of normocytic normochromic anemia in 88.30% of hemodialysis patients. The TSH and FT3 hormone assays in our patients revealed a prevalence of hypothyroidism of 38%, with a female predominance. FT3 was low in 24 patients, 12 patients had high TSH levels. The hypothyroid profile was characterized by normal TSH levels associated with low FT3 levels (25% of patients), 12 patients had high TSH levels associated with normal FT3 concentrations. Thyroid abnormalities in chronic hemodialysis patients (CDH) are secondary to hormonal disorders. They are often represented by hypothyroidism. (Captein, 1996). The results of the comparison of the distribution of hypothyroid and anemic patients show an independence of the distribution of the number of cases according to the symptoms of hypothyroidism. Conclusions: The similarity of symptoms between anemic and hypothyroid hemodialysis patients can mislead the clinician if he does not think to measure thyroid hormones, knowing that the therapeutic conduct is different in the two situations, and the impact on the health economy is very important.

In situ assessment of Mindin as a biomarker of podocyte lesions in diabetic nephropathy.

Diabetic nephropathy (DN) is the leading cause of chronic kidney disease and end-stage renal failure worldwide. Several mechanisms are involved in the pathogenesis of this disease, which culminate in morphological changes such as podocyte injury. Despite the complex diagnosis and pathogenesis, limited attempts have been made to establish new biomarkers for DN. The higher concentration of Mindin protein in the urine of patients with type 2 diabetes mellitus suggests that it plays a role in DN. Therefore, this study investigated whether in situ protein expression of Mindin can be considered a potential DN biomarker. Fifty renal biopsies from patients diagnosed with DN, 57 with nondiabetic glomerular diseases, including 17 with focal segmental glomerulosclerosis (FSGS), 14 with minimal lesion disease (MLD) and 27 with immunoglobulin A nephropathy (IgAN), and 23 adult kidney samples from autopsies (control group) were evaluated for Mindin expression by immunohistochemistry. Podocyte density was inferred by Wilms' tumor 1 (WT1) immunostaining, while foot process effacement was assessed by transmission electron microscopy. Receiver operative characteristic (ROC) analysis was performed to determine the biomarker sensitivity/specificity. Low podocyte density and increased Mindin expression were observed in all cases of DN, regardless of their class. In the DN group, Mindin expression was significantly higher than that in the FSGS, MCD, IgAN and control groups. Higher Mindin expression was significantly positively correlated with foot process effacement only in class III DN cases. Furthermore, Mindin protein presented high specificity in the biopsies of patients with DN (p < 0.0001). Our data suggest that Mindin may play a role in DN pathogenesis and is a promising biomarker of podocyte lesions.