End-stage Chronic Kidney Disease Research Articles

P-555. Use of Long-Acting Cabotegravir/Rilpivirine in People Living with HIV with Renal Transplantation

Abstract Background Cabotegravir/Rilpivirine (CAB/RPV) represents a novel combination of long-acting injectable antiretroviral therapy (LAIART). Although the unique benefits of LAIART have been demonstrated in large clinical trials among people with HIV, including a favorable safety profile, few drug-drug interactions, and viral control without a daily oral pill requirement, evidence of LAIART use among PWH diagnosed with end-stage chronic kidney disease (CKD) and during kidney transplantation (KT) remains sparse. Detailed timeline of all 3 patients in the study. Methods A phase IV clinical trial CAPRI (NCT05601128) was designed to evaluate the pharmacokinetics and safety of long-acting CAB/RPV among PWH with CKD >= stage 4 or ongoing hemodialysis. Three enrolled participants were included, in this analysis because of their KT status, of them, one KT before the trial and two KT during the trial. The peri- and post-operative effects of CAB/RPV LA were evaluated focusing on viral load, CD4+ counts, and potential drug interactions. According to protocol, CAB/RPV PK samples were obtained and planned to be measured and analyzed. Results All three participants have been virally suppressed (< 50 copies/ml) by CAB/RPV LA with stable CD4+ counts while maintaining appropriate graft function during 12months of study period. The timeline for each participant was depicted in the Figure and details were summarized in terms of virologic and immunologic outcomes as well as renal function at different study periods. CAB/RPV LA was well tolerated, without major related adverse events noted. The renal function was significantly improved, dialysis free, in two participants receiving KT during the trial whereas it remained stable, dialysis free, in the participant with prior KT. The reported tacrolimus trough concentrations were maintained within the therapeutic range to protect the graft function. Conclusion The safety and efficacy of CAB/RPV LA have been observed in these participants, supporting its potential use among those with severe renal impairment and kidney transplantation. Additional advantages including lack of adherence barriers and low drug interaction potential are likely to increase viral suppression and improve overall quality of life in this special population. Disclosures Chiu-bin hsiao, MD, Viiv, Gilead: Grant/Research Support

Neuropsychological Profile in Older Adults with End-Stage Kidney Disease during Kidney Transplantation Evaluation.

End-stage chronic kidney disease (CKD) is a significant concern for older adults and is often associated with cognitive impairment (CI). The origin of this CI is multifactorial, involving vascular and metabolic factors. Additionally, renal treatments, including dialysis, may affect cognition. This study aimed to assess the neuropsychological profiles of these patients and understand the effects of dialysis treatment. We conducted an observational retrospective study including older adults with end-stage CKD attending for kidney transplantation (KT). Comprehensive neuropsychological assessments were conducted. Composite cognitive scores were computed. Multivariate regression models were used to assess associations between cognition and dialysis status. We included 223 patients (151 treated with dialysis, 72 with conservative management), mean age of 73.5 ± 3.4. We observed a high prevalence of CI, around 30% for global cognition and affecting all neuropsychological domains. Patients treated with dialysis exhibited lower cognitive performance compared to those not undergoing dialysis, particularly in episodic (p = .031) and working memory (p = .024). This study confirms the high prevalence of CI in end-stage CKD, with dialysis being associated with worse episodic and working memory compared to non-dialyzed participants. Future investigations are needed to track the long-term cognitive trajectory of patients on the KT waiting list and post-transplantation. Retrospectively registered, no 22-808 on July 7th, 2022, CNIL register number 22-5808.

A black cecum: diagnostic challenges and conservative management.

A 51-year-old man with type 1 diabetes mellitus and end-stage chronic kidney disease on hemodialysis presented with 12 hours of lower right quadrant abdominal pain and bloodless diarrhea. Examination showed tenderness without guarding. Blood tests showed leukocytosis (12200/microl) and elevated C-reactive protein (190 mg/L). Abdominal CT showed ascending colon thickening (~10 cm), mesenteric fat densification, and small locoregional ganglia, without signs of arterial/venous obstruction. Given the diagnostic doubt, colonoscopy was performed and revealed the cecum mucosa and ileocecal valve with a black color, with superficial ulceration of the proximal limit and sharp transition to normal mucosa. Biopsies of the cecum confirmed severe ischemic colitis with necrosis. Due to the absence of complications and high surgical risk, the patient was treated conservatively with fluids and antibiotics, resulting in a favorable outcome and hospital discharge.

Safety of two-dose schedule of COVID-19 adsorbed inactivated vaccine (CoronaVac; Sinovac/Butantan) and heterologous additional doses of mRNA BNT162b2 (Pfizer/BioNTech) in immunocompromised and immunocompetent individuals.

Immunocompromised individuals were considered high-risk for severe disease due to SARS COV-2 infection. This study aimed to describe the safety of two doses of COVID-19 adsorbed inactivated vaccine (CoronaVac; Sinovac/Butantan), followed by additional doses of mRNA BNT162b2 (Pfizer/BioNTech) in immunocompromised (IC) adults, compared to immunocompetent/healthy (H) individuals. This phase 4, multicenter, open label study included solid organ transplant and hematopoietic stem cell transplant recipients, cancer patients and people with inborn errors of immunity with defects in antibody production, rheumatic, end-stage chronic kidney or liver disease, who were enrolled in the IC group. Participants received two doses of CoronaVac and additional doses of mRNA BNT162b2. Adverse reactions (AR) data were collected within seven days after each vaccination. Serious adverse events and of special interest (AESI) were monitored throughout the study. We included 241 immunocompromised and 100 immunocompetent subjects. Arthralgia, fatigue, myalgia, and nausea were more frequent in the IC group after CoronaVac. Following the first additional dose of mRNA BNT162, pain, induration, and tenderness at injection site, fatigue and myalgia were more frequent in the H group. A heart transplant recipient had a graft rejection temporally associated with the second CoronaVac dose, but there was no literature evidence of causal association. Four cases of AESI were considered related to the vaccine: three erythema multiforme after CoronaVac, all in IC participants, and one paresthesia after mRNA, in a H participant. Our findings were comparable to other studies that evaluated the safety of COVID-19 vaccines in different immunocompromised populations. Both vaccines were safe for immunocompromised participants.

Conscious Nutrition to Improve Survival Prognosis of Donor Kidney Recipients: A Narrative Review.

Kidney transplantation is the optimal treatment for end-stage chronic kidney disease, increasing survival rates and improving quality of life. Diet affects patient weight and well-being, can trigger certain diseases, and influences post-surgery outcomes. The purpose of the study was to investigate dietary strategies in patients with chronic kidney disease, in early and long-term donor kidney recipients, and to formulate specific nutritional recommendations. For this purpose, a narrative review of the available information in both the Republic of Kazakhstan and the world's scientific literature over the last 10 years was carried out. The following evidence-based resources were used: Scopus, PubMed, Embase, Cochrane Library, and Web of Knowledge. The study provides the latest statistical data on kidney transplantation and risk factors, and a comparative analysis between countries. Existing data on basic nutrition and the possibility of using it after transplantation are examined in detail. In addition, the recommendations for daily intake of salt, potassium, sodium, vitamin D, and calcium were analyzed. The energy value of the diet and its association with overweight, obesity, and the development of diabetes mellitus were studied. Using DASH (Dietary Approaches to Stop Hypertension) and low-protein diets as examples, the potential risks and their applicability for this patient category are analyzed. The article's materials and conclusions can serve as a training manual for nephrologists, therapists, and surgeons.

Impact on fluid balance of an optimized restrictive strategy targeting non-resuscitative fluids in intensive care patients with septic shock: a single-blind, multicenter, randomized, controlled, pilot study

BackgroundIn septic shock, the classic fluid resuscitation strategy can lead to a potentially harmful positive fluid balance. This multicenter, randomized, single-blind, parallel, controlled pilot study assessed the effectiveness of a restrictive fluid strategy aiming to limit daily volume.MethodsPatients 18–85 years’ old admitted to the ICU department of three French hospitals were eligible for inclusion if they had septic shock and were in the first 24 h of vasopressor infusion. Exclusion criteria were acute kidney injury requiring renal replacement therapy, end stage chronic kidney disease, and severe malnutrition. Patients were electronically randomized 1:1 to either an optimized fluid restriction (reducing fluid intake as much as possible in terms of maintenance fluids and fluids for drug dilution during the first 7 days) or standard fluid strategy. The primary outcome was cumulative fluid balance (ml/kg) in the first 5 days. Patients and statisticians were blinded to group arm, but not clinicians.ResultsBetween September 2021 and February 2023, 1201 patients were screened and 50 included, with two in the control group withdrawing, thus 48 patients were analyzed (24 in each group). In the first 5 days, the optimized restrictive strategy and control groups received 89.7 (IQR 35; 128.9) and 114.3 (IQR 78.8; 168.5) ml/kg of fluid, respectively (mean difference: 35.9 ml/kg [0.0; 71.8], p = 0.0506). After 5 days, the median cumulative fluid balance was 6.9 (IQR − 13.7; 52.1) and 35.0 (IQR − 7.9; 40.2) ml/kg in the optimized restrictive strategy and control groups, respectively (absolute difference 13.2 [95%CI − 15.2; 41.6], p = 0.42). After 28 days, mortality and the numbers of days alive without life support were similar between groups. The main adverse events were severe hypernatremia in 1 and 2 patients in the fluid restriction strategy and control groups, respectively, and acute kidney injury KDIGO 3 in 4 and 7 patients in the fluid restriction strategy and control groups, respectively.ConclusionsIn ICU patients with septic shock, an optimized restrictive fluid strategy targeting hidden fluid intakes did not reduce the overall fluid balance at day 5.Trial registration ClinicalTrials.gov identifier NCT04947904, registered on 1 July 2021.Graphical

Skin autofluorescence as part of the comprehensive assessment of clinical and metabolic status of patients with end-stage chronic kidney disease

BACKGROUND: Chronic kidney disease (CKD) is a common end-stage disease requiring kidney transplantation or dialysis, which main type is program hemodialysis (PHD). These high-cost technologies of renal replacement therapy have significantly improved over recent decades, but the quality of life remains low and mortality is still high, especially in patients receiving PHD. Currently, a number of parameters associated with poor prognosis have been identified, including skin autofluorescence (SAF), an affordable method to detect glycation end products (glycotoxins) in tissues, which claims to be an integral biomarker. AIM: To assess relationship of SAF with clinical and metabolic status parameters in patients receiving renal replacement therapy. MATERIALS AND METHODS: The study included 88 patients receiving PHD and 27 transplanted kidney recipients (TKR). The measurements were performed using the original SAF reader. RESULTS: SAF was significantly higher in TKR and patients receiving PHD. A universal, pronounced relationship of SAF with age and smoking was found in the control, PHD, and TKR groups. Models of SAF determinants in each studied group were proposed. SAF was associated with malnutrition stages (by NRI; r=−0.39; p 0.001), the Charlson comorbidity index (r=0.60, p 0.0001), and inflammatory activity based on C-reactive protein in the PHD group (r=0.32, p 0.01). CONCLUSION: Models of SAF determinants in each studied group were proposed. Furthermore, highly significant direct correlations with left ventricular hypertrophy and its negative ejection fraction were established in this group. These facts suggest that SAF is an integral parameter of cardiac remodeling and metabolic profile, primarily in patients receiving PHD, which promotes it as a prognostic parameter.

Assessment of Trace elements (Zinc, Copper) in Iraqi Patients with Chronic Kidney Disease on Dialysis

Background: In the context of insufficient healthcare accessibility for a substantial segment of the global populace, chronic kidney disease (CKD) has emerged as a significant contributor to mortality, ranked subsequent to cardiovascular disease and neoplasia, demonstrating a notable increase over the preceding two decades. This rising burden of CKD is further exacerbated by a deficient understanding of its underlying pathogenesis. Therefore, it was important to study all the variables in the human body that contribute to monitoring the patient's condition or preventing the patient's condition from deteriorating. In this study, we highlighted some trace elements (zinc and copper), and monitored the change in these elements between patients and healthy people. We indicated the possibility of monitoring the results of tests for these elements to predict the condition of patients from the first stage to the final stages of chronic renal failure patients on dialysis. purpose: To assess the trace elements (zinc, copper) in Chronic kidney disease patients compared with healthy control. Methods: A total forty (40) patient with chronic kidney disease were studied among them twenty (20) female and twenty (20) male patients and forty (40) healthy as control of them were eighteen (18) females and twenty-two (22) males. Their ages (patients and controls) were ranged from (18 – 70). Blood samples were collected from patients and control to evaluate serum levels of serum trace elements (zinc, copper) and evaluate the routine markers (urea, creatinine, Alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase) and this was done by spectrophotometry. Results The Zinc levels in the patients (80.69±51.30 μg/dl) were lower than in the control group (97.42±38.61 μg/dl) (p=0.10773) and The Copper levels in the patients are significantly higher (116.33±71.20 μg/dl) than in the control group (74.77±46.16 μg/dl) (p=0.00304). while The Alanine Aminotransferase and Aspartate Aminotransferase levels in the patients are lower than in the control group, but the difference is not statistically significant for ALT (p=0.13235) and is significant for AST (p=0.02982). the Alkaline Phosphatase, Urea, and Serum Creatinine levels in the patients were all significantly higher than in the control group (p<0.00001 for all). Conclusion: A notable elevation in alkaline phosphatase and copper levels is observed in chronic kidney disease patients, alongside a modest decrease in serum zinc in those with end-stage chronic kidney disease compared to healthy individuals, indicating these biomarkers' potential diagnostic utility in advanced stages of the disease. The correlation between AST/ALT and CKD progression highlights the impact of liver enzyme alterations during chronic kidney disease.

Results of assessing the dynamics of ophthalmological complications in chronic kidney disease patients after kidney transplantation

Objective. The study objective was to investigate the dynamics of opthalmological complications in the non-diabetic end-stage chronic kidney disease in patients after kidney transplantation.Material and methods. A long-term observation was conducted to assess the changes in morphofunctional parameters of eyes in patients of the study group (after kidney transplantation, n=135 (269 eyes)) and the comparison group (continued on hemodialysis, n=81 (162 eyes)) over 18 months. Both general and specialized ophthalmological investigation methods were employed.Results. The observation showed a positive trend in patients after kidney transplantation, which was manifested by reduced corneal and conjunctival calcification. In the comparison group, both an increase and decrease in qualitative signs of retinopathy were seen as based on optical coherence tomography data, while in the study group, most retinopathy signs decreased, indicating a positive trend possibly brought about by the kidney transplantation. Analysis of optical coherence tomography quantitative parameters showed an improvement in central choroidal thickness and retinal nerve fiber layer thickness in the study group.Conclusion. Kidney transplantation in patients with the non-diabetic end-stage chronic kidney disease leads to a reduction in ophthalmological complications both in the anterior eye segment (reduced corneal and conjunctival calcification) and in its posterior segment (improved optical coherence tomography retinal parameters).

Features of pathogenesis and tactics of management of patients with ischemic stroke against the background of end-stage chronic kidney disease

Acute cerebrovascular accidents in patients with end-stage chronic kidney disease are an important but not well understood problem. The main difficulty is the lack of approved clinical guidelines and large multicenter studies that would allow the determination of a proven approach to therapy in the combination of these diseases. This group of patients is rarely included in clinical trials and has high risks of complications. Up to a third of strokes in patients with end-stage chronic kidney disease receiving hemodialysis develop in a hospital and are classified as intrahospital. Assessing the risks associated with performing contrast agent studies in patients with chronic kidney disease is a pressing issue. Kidney damage significantly increases the incidence of adverse outcomes in the acute stage of ischemic stroke, but when using systemic thrombolytic therapy it does not worsen outcomes and does not increase the risk of intracranial hemorrhage. The review article includes retrospective and prospective studies, systematic reviews describing cases of ischemic stroke in patients with end-stage chronic kidney disease for the period 2015–2022. The search was conducted in the bibliographic databases MEDLINE, PubMed, Google Scholar, Scopus, eLIBRARY. Articles published only in peer-reviewed scientific journals were selected for the review. The search strategy was a search query for the key terms “ischemic stroke”, “chronic kidney disease”, “hemodialysis”, “thrombolytic therapy”, “angiography”. The reference lists of all published articles and relevant systematic reviews were manually reviewed. A total of 947 titles, 96 full articles were reviewed, 38 of which were included in this review. The article analyzes current concepts of the features of pathophysiological mechanisms and risk factors for ischemic stroke in patients with end-stage chronic kidney disease receiving renal replacement therapy, as well as discusses approaches to the possibility of performing radiocontrast studies and the features of systemic thrombolytic therapy in this group of patients.

Altered spontaneous brain activity in patients with progressive-stage and end-stage chronic kidney disease: insights from dALFF analysis.

Chronic kidney disease (CKD) is a worldwide public health problem. Its association with cognitive impairment has attracted widespread attention in the world. However, the neuropathological mechanisms underlying kidney-brain interactions in CKD remain unclear. Using the dynamic amplitude of low-frequency fluctuations (dALFF) technique, 21 patients with progressive-stage CKD (CKD stages 3-4), 22 patients with end-stage CKD (CKD stage 5, ESKD), and 23 healthy volunteers (HCs) were enrolled to explore the brain regions with dALFF abnormalities in the progressive-stage and end-stage CKD. We used biased correlation analyses to explore the relationship between dALFF values and clinical indicators in patients with progressive-stage and end-stage CKD. Patients with both progressive-stage CKD (stages 3-4) and ESKD had abnormal dALFF values in the right parahippocampus, right inferior temporal gyrus, and left cuneus compared with HCs. In addition, abnormal dALFF were present in the left fusiform gyrus, insula and hippocampus in patients with progressive-stage CKD and in the left inferior temporal gyrus in patients with ESKD. Biased correlation analysis showed that dALFF values in the right parahippocampus, left fusiform gyrus and left insula were positively correlated with serum creatinine concentrations in patients with progressive-stage CKD and that dALFF values in the left inferior temporal gyrus were negatively correlated with MoCA scores in patients with ESKD. Our findings highlight the variability of neuroimaging changes between different stages of CKD and provide new insights and research directions for an in-depth exploration of the neuropathological mechanisms of renal-brain interactions.

Push toward pre-emptive kidney transplantation - for sure?

Pre-emptive kidney transplantation (PKT) has long been considered the optimal treatment for patients with end-stage chronic kidney disease (CKD) seeking the most favourable long-term outcomes. However, the significant growth in transplant procedures over recent decades has led to a notable increase in wait-listed patients and a disproportionate demand for donor organs. This situation necessitates a re-evaluation of transplantation timing and the establishment of rational indications from both societal and clinical perspectives. An increasing number of retrospective analyses have challenged the universal benefit of PKT, suggesting that premature indications for living or deceased donor PKT may not always yield superior hard outcomes compared with non-PKT approaches. Conventional predictive models have shown limitations in accurately assessing risks for certain subpopulations, potentially leading to significant disparities among wait-listed patients. To address these challenges, we propose the following considerations. Prediction models should not only optimize the distribution of our limited donor resources, but should also illuminate foreseeable risks associated with a potentially 'unsuccessful' PKT. Therefore, this article seeks to underscore the necessity for further discourse on the smouldering concept of when and for whom living or deceased donor PKT should be considered. Is it universally beneficial, or should the clinical paradigm be re-evaluated? In the endeavour to attain superior post-PKT survival outcomes compared with non-PKT or conservative treatment, it seems critical to acknowledge that other treatments may provide more favourable results for certain individuals. This introduces the intricate task of effectively navigating the complexities associated with 'too early' or 'unsuccessful' PKT.

A pictorial neuroradiological review of brain vascular abnormalities in patients with kidney disease.

A well-known link exists between cerebrovascular disease and chronic kidney disease. Cerebrovascular pathology in patients with kidney disease may be asymptomatic and occasionally discovered through neuroradiological examinations or it may present with neurological symptoms. Covert cerebrovascular lesions represent the earliest injuries associated with chronic kidney disease and primarily result from small vessel damage. These conditions often manifest incidentally, appearing as structural changes (such as lacunes, white matter lesions, enlarged perivascular spaces, cerebral microbleeds, and atrophy) as well as microstructural and hemodynamic alterations, detectable through routine and advanced functional MRIs. These alterations may be associated with a higher risk of stroke, cognitive decline, and dementia. Patients with end-stage renal disease or chronic kidney disease undergoing dialysis may be at increased risk of large-artery atherosclerosis, cardio-embolism, or small-vessel occlusion, and they may experience symptomatic acute ischemic strokes as rare complications. Currently, there are no established guidelines or standardized diagnostic protocols for preventing cerebrovascular disease in patients with kidney disease. Clinical and radiological studies are warranted to evaluate the usefulness of incorporating neuroimaging into the diagnostic work-up of these patients in order to improve prognosis and reduce diagnostic delays.

Kidney Transplantation in Older Recipients Regarding Surgical and Clinical Complications, Outcomes, and Survival: A Literature Review.

Context: The best treatment for end-stage chronic kidney disease (ESKD) is kidney transplantation (KT). As a result of an aging population, each year more kidney transplants in older adults are performed. Nevertheless, older recipients, characterized by more comorbidities and frailty, raise concerns about the outcomes, potential complications, and the general approach. Aim: The aim of this literature review was to study the outcomes, graft and patient survival, as well as common complications, to establish safety and increase awareness of the potential complications of kidney transplantation in the older population. Methods: PubMed and Google scholar databases were searched. The cut-off age defining an old patient was 60 years. The inclusion criteria were as follows: first kidney transplantation, and studies in English language. The exclusion criteria were as follows: more than one organ transplant, dual transplants, articles published before 2015, meta-analysis, reviews, letter to the editor, case reports, and studies published only as a conference abstract. Comparative and noncomparative studies addressing patient survival, death-censored graft survival, surgical complications, and clinical complications, such as delayed graft function (DGF) and biopsy proven acute rejection (PBAR), were included. Results: After screening the papers, 17 studies met the inclusion criteria and were included for review. Eleven papers compared older recipients with younger recipients and in six papers only older patients were analysed. Two studies used paired deceased donors to eliminate donor bias. The rest of the studies used either deceased donors or both living and deceased donors. The majority of patients were male (61.83%) and received a kidney from a deceased donor (58.08%). Conclusions: Kidney transplantation is safe and can be beneficial for recipients over 60 years of age. Older patients suffered more infectious complications, which were also one of the main reasons for death. Most studies did not show a significant difference in death-censored graft survival compared to the younger population. More research is needed to establish the prevalence of surgical complications, and some clinical complications.

The diagnostic utility of urinary Transferrin excretion rate as predictor for micro albuminuria in patients with Type 2 Diabetes Mellitus among Karbala province

One of the factors responsible of end-stage renal disease and chronic kidney disease is diabetic nephropathy. Microalbuminuria itself is regarded as the initial indication of diabetic nephropathy, and it affects 20% to 40% of patients with diabetes mellitus. Because of the limited accuracy and precision of microalbuminuria, more susceptible markers may be developed to more accurately identify diabetic nephropathy early on. The purpose of this research was to ascertain whether urine transferrin could be used as a marker for diabetic nephropathy. In our research, 80 subjects with type 2 diabetes were divided into two categories: 10 healthy controls and group 1 (normoalbuminuric, with albumin excretion up to 30 mg/d) and group 2 (microalbuminuric, with albumin excretion between 30 and 300 mg/d). all subjects was over the age of 18, had diabetes for further than a year, and had a glomerular filtration rate greater than 60 mL/min/1.73 m2. The concentration of transferrin, serum creatinine, and glycosylated hemoglobin (HbA1c) in both spot urine and 24-hour urine samples were assessed using a super accurate sandwich enzyme - linked immunosorbent assay kit. subjects with microalbuminuria had substantially greater urinary transferrin levels than both normoalbuminuric and healthy control participants. We discovered a significantly positive correlation r = 0.584 (p < 0.001) when we compared these categories based on the urinary transferrin concentration. Urinary transferrin levels did not correlate with glycoregulation, and neither did transferrin levels and the length of diabetes. Urinary transferrin levels may be utilized as an important indicator of diabetic nephropathy, according to the findings of the research.

Vitamin D Status in Supplemented Hemodialysis Patients

Introduction: Chronic kidney disease (CKD) causes decreased activity of the enzyme 1-alpha-hydroxylase and calcitriol deficiency with mineral and bone metabolism disorders or secondary hyperparathyroidism. Anticipation of the occurrence of these complications implies the systematic supplementation of all hemodialysis patients, with monitoring of biological parameters. It is in this context that this study was carried out, the general objective of which was to establish the profile of vitamin D concentration in hemodialysis and Ivorian public sector supplemented patients in Abidjan. Patients and Methods: In a cross-sectional study conducted from September to December 2022, we included 89 patients with end-stage CKD treated with hemodialysis at the CNPTIR in Cocody. The collection of epidemio-clinical data was done on the basis of a questionnaire on the one hand and the patients' medical records on the other. The vitamin D concentration was determined by the ELFA immunoassay method on mini Vidas (BIOMERIEUX). Results: The mean age of the patients was 45 ± 13 and 65.17% of them were men. 55.06% of the patients had been treated with dialysis for at least 5 years. 48.31% of the patients had regular supplementation treatment. Of the two types of vitamin D supplementation, 94.38% of the study population was supplemented with cholecalciferol compared to 18% for alfacalcidol with 12% of patients included, using both types. From a biological point of view, it appears that the average concentration of vitamin D in the patients was 26.9 ng/mL, and only 16% have a concentration of less than 20 mg/mL, corresponding to an deficiency vitamin D status. Conclusion: At the end of this cross-sectional study, it emerged that the average in adult hemodialysis subjects followed at the CNPTIR in Cocody had an insufficient vitamin D status. And 37% of the study population with normal vitamin D status. However, these results could be improved by better accessibility to the products, and regular compliance with supplementation.

Type 2 diabetes pathway-specific polygenic risk scores elucidate heterogeneity in clinical presentation, disease progression and diabetic complications in 18,217 Chinese individuals with type 2 diabetes.

Type 2 diabetes is a complex and heterogeneous disease and the aetiological components underlying the heterogeneity remain unclear in the Chinese and East Asian population. Therefore, we aimed to investigate whether specific pathophysiological pathways drive the clinical heterogeneity in type 2 diabetes. We employed newly developed type 2 diabetes hard-clustering and soft-clustering pathway-specific polygenic risk scores (psPRSs) to characterise individual genetic susceptibility to pathophysiological pathways implicated in type 2 diabetes in 18,217 Chinese patients from Hong Kong. The 'total' type 2 diabetes polygenic risk score (PRS) was summed by genome-wide significant type 2 diabetes signals (n=1289). We examined the associations between psPRSs and cardiometabolic profile, age of onset, two glycaemic deterioration outcomes (clinical requirement of insulin treatment, defined by two consecutive HbA1c values ≥69 mmol/mol [8.5%] more than 3 months apart during treatment with two or more oral glucose-lowering drugs, and insulin initiation), three renal (albuminuria, end-stage renal disease and chronic kidney disease) outcomes and five cardiovascular outcomes. Although most psPRSs and total type 2 diabetes PRS were associated with an earlier and younger onset of type 2 diabetes, the psPRSs showed distinct associations with clinical outcomes. In particular, individuals with normal weight showed higher psPRSs for beta cell dysfunction and lipodystrophy than those who were overweight. The psPRSs for obesity were associated with faster progression to clinical requirement of insulin treatment (adjusted HR [95% CI] 1.09 [1.05, 1.13], p<0.0001), end-stage renal disease (1.10 [1.04, 1.16], p=0.0007) and CVD (1.10 [1.05, 1.16], p<0.0001) while the psPRSs for beta cell dysfunction were associated with reduced incident end-stage renal disease (0.90 [0.85, 0.95], p=0.0001) and heart failure (0.83 [0.73, 0.93], p=0.0011). Major findings remained significant after adjusting for a set of clinical variables. Beta cell dysfunction and lipodystrophy could be the driving pathological pathways in type 2 diabetes in individuals with normal weight. Genetic risks of beta cell dysfunction and obesity represent two major genetic drivers of type 2 diabetes heterogeneity in disease progression and diabetic complications, which are shared across ancestry groups. Type 2 diabetes psPRSs may help inform patient stratification according to aetiology and guide precision diabetes care.

Anxiety and depression associated with social inequity indicators in patients with end-stage renal disease

ObjectiveDetermine the association between social inequality indicators and symptoms of anxiety and depression in patients with end-stage chronic kidney disease (ESRD). MethodsA cross-sectional analytical study was conducted in Tacna, Peru, involving patients with ESRD between July 1st and September 30th, 2023. Social inequality indicators included type of social insurance, educational level, and economic support. Anxiety and depression were assessed using the Hopkins Symptom Checklist-25 (HSCL-25). ResultsA total of 207 ESRD patients were surveyed; 52.7 % were male, with a median age of 62 years (IQR 52–70). Symptoms of anxiety and depression were present in 43 % and 65.2 % of participants, respectively. In the adjusted model, anxiety symptoms were more prevalent among those with comprehensive health insurance coverage (aPR: 1.42; IC95 %: 1.0–2.0) and older adults (aPR: 1.72; 1.2–2.4) and less prevalent among males (aPR: 0.48; 0.3–0.7). Depression symptoms were less prevalent among those who were economically self-sufficient (aPR: 0.60; 0.4–0.8) and more prevalent in patients with anxiety symptoms (aPR: 1.77; 1.4–2.2). ConclusionAnxiety and depression symptoms are common in patients with ESRD. We identified that social inequality indicators such as unemployment and type of health insurance were associated with higher anxiety and depression symptoms. Policies focusing on the social determinants of health are necessary, especially for vulnerable populations such as patients with ESRD.

Neurocognitive Performance in Patients with End-Stage Chronic Kidney Disease: Differences Between Conservative Medical Management and Hemodialysis

to analyze the cognitive performance of patients with end-stage chronic kidney disease (CKD) undergoing conservative medical management or HD. We conducted a cross-sectional study. The cognitive performance of both groups was assessed through the INECO Frontal Screening (IFS) instrument. 6 patients were analyzed in each group (n= 12). A significant difference was observed for the total IFS score, with 14.4±6.29 points in the HD group and 21.5±3.96 points in the conservative management group (p<0.05). Regarding the specific domains of the IFS, a significant difference was found in the domain of verbal inhibitory control, with an average of 1.83±1.17 points in the HD group and 4±0.89 points in the conservative management group (p<0.05). No associations were elucidated on the abbreviated MMSE, ACE-III, TMT-A and B, Grober and Buschke Test, Stroop Test and Boston Test Nomination Test. Patients with terminal CKD on HD (even those with a normal MMSE result) show an impairment in their executive functions compared to those who underwent conservative management.

Hemodynamic considerations in arteriovenous vascular access modalities for hemodialysis.

Arteriovenous fistulas and arteriovenous grafts are the most commonly used vascular access for hemodialysis in patients with end-stage chronic kidney disease. However, both methods face significant challenges due to the hemodynamic disturbances induced by the arteriovenous anastomosis. This causes changes in vascular structure and blood flow velocity near the anastomosis site after the fistula/graft surgery, and introduces abnormal wall shear stress and cyclic stretch. This leads to endothelial cell dysfunction, vascular smooth muscle cell proliferation, and adverse remodeling. The resulting effects include low patency rates due to vascular stenosis caused by intimal hyperplasia and insufficient outward remodeling. Additionally, the high flow conduit has been linked to adverse cardiac remodeling. To address this, various strategies have been explored to correct these localized hemodynamic abnormalities, aiming to improve long-term patency rates. In this review, an overview is provided of the current surgical techniques, anastomosis types, anastomosis angles, external scaffolds, modified fistula designs, and types of grafts. It evaluates the impact of these approaches on local hemodynamics in the access conduit and their potential effects on patient outcomes.