Incidence Of End-stage Renal Disease Research Articles

Fenofibrate and risk of end-stage renal disease: A nationwide cohort study.

Previous studies have shown that fenofibrate improves outcomes such as albuminuria and estimated glomerular filtration rate decline. We hypothesize that fenofibrate has renoprotective effects and prevents or delays the development of end-stage renal disease. The objective of this study is to investigate the risk of incident end-stage renal disease in relation to fenofibrate treatment in patients who are already taking statins. We performed a nationwide population-based cohort study using data from the Korea National Health Information Database from 2010 to 2017. Among adults using statins, 413 715 fenofibrate users were compared with 413 715 fenofibrate non-users after 1:1 age, sex and triglyceride matching. The endpoint of this study was incident end-stage renal disease. During a median 3.96-year follow-up, the incidence per 1000 person years of end-stage renal disease was lower in fenofibrate users than in fenofibrate non-users (0.885 vs. 0.960, p < 0.0001). The hazard ratio for end-stage renal disease was lower (0.763, 95% confidence interval 0.710-0.821) in fenofibrate users. This association was significant in patients with hypertension, proteinuria and an estimated glomerular filtration rate <60 mL/min/1.732. Fenofibrate use in patients taking statins with either hypertension, proteinuria, or decreased estimated glomerular filtration rate is associated with a low risk of incident end-stage renal disease. To confirm the renoprotective effect of fenofibrate in chronic kidney disease, a randomized controlled trial is warranted.

Worsening of Diabetes Control Measures and Decreased Kidney Function in Pre-Diabetic Kidney Donors Compared to Non-Diabetic Donors Whose BMI Before Kidney Donation was Above 30

The incidence of end-stage renal disease has increased dramatically over the past two decades. Kidney transplantation is the best treatment option for individuals with end-stage renal disease, and living donor kidney transplantation has significant advantages over deceased donor kidney transplantation. Although there are criteria for assessing living kidney donors, different medical centers handle certain medical problems differently. The aim of this study is to investigate how kidney donation affects renal biochemical indicators, blood pressure measurements, and glucose control in healthy young female adults without diabetes compared to a pre-diabetic group. A prospective cohort study recruited 142 female kidney donors, who were divided into two cohorts based on their diabetic history (pre-diabetic and non-diabetic). The participants were monitored for seven years after kidney donation. Key clinical and biochemical markers were measured before and after donation. The pre-diabetic group had higher mean values for blood pressure readings, body mass indices, Oral Glucose Tolerance Test, HbA1c (DCCT) (%), serum creatinine levels, proteinuria, and lower e-GFR compared to those in the non-diabetic group. All these findings were statistically significant. Pre-diabetic donors are at an increased risk for many adverse clinical and biochemical outcomes, including hypertension, glucose tolerance, and worsening kidney function tests and should be advised that their condition may worsen over time and can result in end-organ complications. If the donors decide to proceed, they should be closely and frequently monitored during both the short- and long-term periods.

Evaluation of the Current Status of Home Hemodialysis in the Middle East Then Perspectives and Possibilities of Home Hemodialysis in Egypt

Abstract Background Chronic kidney disease (CKD) is a growing worldwide epidemic. The incidence and prevalence of end-stage renal disease (ESRD) are expected to continue to increase. The most recent United States Renal Data System (USRDS) reports indicate that the incident dialysis population has grown older, has more comorbid conditions than previous years, and is starting dialysis with higher levels of residual kidney function (RKF). Aim of the Work This study was done to evaluate the current status of home hemodialysis in the Middle East, then to study the perspectives and future possibilities of home hemodialysis in Egypt. It was carried out during the last 2 years; 2019 and 2020. It included 2 parts: Patients and Methods A retrospective and prospective study on 100 patients that was randomly selection and was adult ESRD patients (age &amp;gt; 18 years) either were treated and maintained on home hemodialysis during the last 5 years or will be treated and maintained on home hemodialysis during the period from march 2019 to march 2020. Results HD patients with volume overload or those with cardio-renal syndrome were found to better tolerate excessive UF with the use of home HD machines than that with the usual in-center machines. SLED and SCUF modes were very effectively managed with the use of these simple HD machines. It was noticed that the loss of residual renal functions in new HD patients, was significantly less with the use of home HD than with the usual in-center HD. This was related to less dialysate exposure other than the use of ultrapure dialysate. Conclusion The psychological status was significantly improved in those patients with having their sessions at their homes without any added stressors related to in-center HD. Even new ESRD patients who are too reluctant to start HD, were better convinced to start home HD. Home HD is a gentle and benign mode of HD with less reported intra-dialytic complications; attributed to the use of ultrapure dialysate solutions other than the treated tap/well water used in center HD.

The role of matrix metalloproteinase inhibitor (doxycycline) in the treatment of primary focal segmental glomerulosclerosis

Background Focal and segmental glomerulosclerosis (FSGS) is a histological pattern used in clinical practice to define a podocytopathy that develops with nephrotic-range proteinuria and segmental obliteration or collapse of glomerular capillary loops with increased extracellular matrix in some glomeruli. The major concerns of idiopathic FSGS are the poor renal prognosis with an absence of response to immunosuppressive therapies or relapses and its recurrence after kidney transplantation in ⁓30–50% of patients, which leads to renal graft failure. The aim of this work is to study the possible role of matrix metalloproteinase inhibitor (doxycycline) in the treatment of primary FSGS. Patients and methods This prospective cohort study was conducted on 100 patients with FSGS. Patients were randomly divided into two equal groups: group 1: patients with FSGS under conventional therapy as a control group. Group 2: patients with FSGS under conventional therapy and doxycycline 100 mg/day for 3 months. Patients were closely monitored for treatment effects and adverse reactions. Clinical, laboratory, and radiological parameters were assessed. Treatment outcomes, including remission of proteinuria and adverse effects, were evaluated. Results Group 2 showed significantly lower levels of triglycerides and fasting blood glucose compared with group 1. Doxycycline-related side effects were observed in some group 2 patients. Both groups showed increased hemoglobin levels and decreased C-reactive protein levels at follow-up. Kidney function tests improved in both groups, with group 2 demonstrating superior outcomes. Group 2 showed higher rates of improvement and lower incidence of end-stage renal disease requiring hemodialysis. Conclusion Adding doxycycline to conventional therapy holds promise for treating primary FSGS. Patients receiving combined therapy exhibited enhanced renal function, reduced proteinuria, and better treatment outcomes.

The effect of dialysis modality on annual mortality: A prospective cohort study

Despite numerous studies on the effect of each dialysis modality on mortality, the issue remains controversial. We investigated the hazard rate of mortality in patients with incident end-stage renal disease (ESRD) concerning initial dialysis modality (hemodialysis vs. peritoneal dialysis). Using a nationwide, multicenter, prospective cohort in South Korea, we studied 2207 patients, of which 1647 (74.6%) underwent hemodialysis. We employed the weighted Fine and Gray model over the follow-up period using inverse probability of treatment and censoring weighting. Landmark analysis was used for identifying the changing effect of dialysis modality on individuals who remained event-free at each landmark point. No significant difference in hazard rate was observed overall. However, the peritoneal dialysis group had a significantly higher hazard rate than the hemodialysis group among patients under 65 years after 4- and 5- year follow-up. A similar pattern was observed among those with diabetes mellitus. Landmark analysis also showed the higher hazard rate for peritoneal dialysis at 2 years for the education-others group and at 3 years for the married group. These findings may inform dialysis modality decisions, suggesting a preference for hemodialysis in young patients with diabetes, especially for follow-ups longer than 3 years.

High remnant-cholesterol levels increase the risk for end-stage renal disease: a nationwide, population-based, cohort study

BackgroundThe effect of remnant-cholesterol (remnant-C) on incident end-stage renal disease (ESRD) has not been studied longitudinally. This retrospective cohort study evaluated the association between remnant-C and the development of ESRD in a nationwide Korean cohort.MethodsParticipants in a National Health Insurance Service health examination (n = 3,856,985) were followed up until the onset of ESRD. The median duration of follow-up was 10.3 years. The Martin-Hopkins equation was used to determine low-density lipoprotein cholesterol (LDL-C) levels from directly measured triglyceride, high-density lipoprotein cholesterol (HDL-C), and total cholesterol levels. Remnant-C levels were determined by subtracting HDL-C and LDL-C from total cholesterol. The risk for incident ESRD was calculated for each quartile of remnant-C, adjusting for conventional risk factors such as baseline renal function, comorbidities, and total cholesterol levels.ResultsESRD developed in 11,073 (0.29%) participants. The risk for ESRD exhibited a gradual increase according to higher levels of remnant-C, with a 61% increased risk in the highest quartile than in the lowest (hazard ratio [HR] 1.61 [95% confidence interval (CI) 1.50–1.72]). The elevated risk for ESRD in the highest quartile versus the lowest quartile was more prominent in younger than in older subjects (20–29 years, HR 4.07 [95% CI 2.85–5.83]; 30–39 years, HR 2.39 [95% CI 1.83–3.13]; ≥ 70 years, HR 1.32 [95% CI 1.16–1.51]). In addition, the increased risk for ESRD related to higher remnant-C levels was greater in females than in males.ConclusionsIndependent of conventional risk factors, remnant-C levels were positively associated with incident ESRD, particularly in younger populations and adult females. Reducing remnant-C levels may be a novel preventive strategy against ESRD.

Female reproductive factors, exogenous hormone use, and incident chronic kidney disease and end-stage renal disease.

Younger women have a slower progressive loss of kidney function than age-matched men and the sex advantage diminishes after menopause, suggesting a role for female hormones in the development of kidney diseases. To examine the relationships of numerous reproductive factors and exogenous hormone use with long-term risk of chronic kidney disease (CKD) and end-stage renal disease (ESRD) in women. A total of 260,108 women without prevalent CKD and ESRD were included. The relationships of various reproductive factors and exogenous hormone use with incident CKD and ESRD were assessed, with multivariable adjustment for potential confounders. During a median of ∼12.5 years of follow-up, 8,766 CKD and 554 ESRD cases were identified. Younger age at first live birth, hysterectomy or bilateral oophorectomy before 50 years old, menopausal before 45 years old, and menopausal hormone therapy (MHT) initiated before 50 years old was associated with a higher risk of CKD. The relationships of these factors with ESRD were generally consistent with those for CKD. Each 5-year increment in menopausal age was associated with an 11% lower risk of CKD (HR = 0.89; 95% CI: 0.87, 0.91) and a 13% lower risk of ESRD (HR = 0.87; 95% CI: 0.79, 0.95). Each 5-year delay in starting MHT was associated with a 13% lower risk of CKD (HR = 0.87; 95% CI: 0.84, 0.90) and a 15% lower risk of ESRD (HR = 0.85; 95% CI: 0.73, 0.99). Several reproductive characteristics reflecting shorter cumulative exposure to endogenous estrogen or premature exposure to exogenous hormones are associated with a greater risk of CKD and ESRD in women, supporting a potential role of female hormones in renal pathophysiology.

#1678 The relationship between national dialysis catheter rates and kidney transplantations

Abstract Background and Aims Vascular access for chronic hemodialysis is either achieved by an arteriovenous fistula or graft (AVF/G) or central venous catheter (CVC) and AVF/Gs have been repeatedly reported to be superior to CVCs and guidelines usually recommend it as the preferred vascular access. AVF/Gs are associated with better quality of dialysis, less complications, and a lower mortality than CVCs. This has led to initiatives such as Fistula First that aimed at maximizing AVF/Gs rates and national healthcare systems now frequently evaluate their efficiency of care for end-stage renal disease (ESRD) patients based on this metric. However, transplant activity might be a significant confounding factor since high transplant rates and therefore limited transition phases might contribute to a higher acceptance of CVCs in patients awaiting kidney transplantation. I aimed at investigating the relationship between CVC rates and transplant activity in different countries by analyzing data from national dialysis and transplant registries. Method Data was obtained from national transplant and dialysis registries including Argentina (2012-2021), Australia (2004-2022), Austria (2005-2022), New Zealand (2005-2022), Sweden (2011-2022), Turkey (2004-2022), and the USA (2012-2021). Population estimates were obtained from the World Bank. The conducted analyses included unadjusted correlation analysis as well as multivariate regression analysis. Results The study sample included data from 7 different countries spanning from North and South America, over Europe and Asia to Oceania covering data from 107 annual reports. CVC rates and transplant activity per million showed a weak positive correlation (0.283, 95% CI: 0.093–0.454) within the same year (Fig. 1). When correlating catheter rates with transplant activity of the previous year, the association increased slightly (0.357, 95% CI: 0.173–0.517). The change of incidence of ESRD or hemodialysis patients (depending on data availability) showed a moderate correlation with the change of catheter rates (0.507, 95% CI: 0.272-0.685). A regression model including the incidence of ESRD improved model fit compared to a model that uses only transplant activity to estimate catheter rates. Conclusion Even though most healthcare systems, clinicians, and epidemiologists recommend low CVC rates, a thorough evaluation of the care of ESRD patients requires the adjustment of several contributing factors, primarily kidney transplantation activity. Higher kidney transplantation rates are associated with higher CVC rates which might be due to reduced waiting times until transplantation. An increase in kidney transplantations might especially increase CVC-based dialysis in the subsequent year. There is some evidence that the incidence of ESRD in general or hemodialysis in specific additionally affects CVC rates. Increasing incidence of ESRD is associated with increasing catheter rates, indicating that healthcare systems might struggle to adapt to short-term changes regarding access demands.

#991 Estimated small dense low-density lipoprotein-cholesterol and the risk of renal and cardiovascular outcomes in diabetic kidney disease

Abstract Background and Aims This study aimed to investigate the correlations between estimated small dense low-density lipoprotein-cholesterol (esd-LDL-c) and the development of end-stage renal disease (ESRD), cardiovascular mortality, and all-cause mortality in individuals with diabetic kidney disease (DKD) or diabetes mellitus (DM) concomitant chronic kidney disease (CKD). Method We analyzed the data from a biopsy-proven DKD cohort conducted at West China Hospital of Sichuan University between 2009 and 2021 (the DKD cohort) and the participants with DM and CKD in the NHANES 2011-2014 (the NHANES DM-CKD cohort). Cox regression analysis was used to estimate associations between esd-LDL-c and the incidence of ESRD, cardiovascular mortality, and all-cause mortality. Results There were 175 ESRD events among 338 participants in the DKD cohort. Patients were divided into three groups based on esd-LDL-c tertiles (T1&amp;lt;33.7 mg/dL, T2≥33.7 mg/dL to &amp;lt;45.9 mg/dL, T3≥45.9 mg/dL). The highest tertile of esd-LDL-c was independently associated with ESRD (adjusted HR 2.016, 95% CI 1.144–3.554, P = 0.015). There were 99 death (39 cardiovascular) among 293 participants in the NHANES DM-CKD cohort. Participants were classified into three groups in line with the tertile values of esd-LDL-c in the DKD cohort. The highest tertile of esd-LDL-c was independently associated with cardiovascular mortality (adjusted HR 2.84, 95% CI 1.02–7.97, P = 0.047) and all-cause mortality (adjusted HR 2.18, 95% CI 1.08–4.4, P = 0.029). Conclusion Higher esd-LDL-c increased the risk of ESRD in people with DKD and the risk of cardiovascular and all-cause mortality among those with DM-CKD.

#1672 High level of HDL-C is associated with a higher risk of ESRD and all-cause mortality in patients with DM and CKD

Abstract Background and Aims Previous studies have regarded high-density lipoprotein cholesterol (HDL-C) as ‘good cholesterol’; however, recent research has unveiled a higher incidence of adverse events among individuals with extremely elevated HDL-C levels. Method Two cohorts of subjects were analyzed in this study. In the first cohort, a total of 375 participants with DKD who underwent renal-biopsy between January 2008 and September 2020, from West China Hospital T2DM-DKD cohort, were enrolled for the longitudinal observational study. Additionally, 3,262 participants with DM and chronic kidney disease (CKD) from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 were included. Kaplan-Meier curves and Cox proportional hazard models were used to analyze the association between HDL-C concentration and the incidence of end-stage renal disease (ESRD) as well as all-cause mortality. Results Patients were divided into three groups based on HDL-C levels. After a median follow-up of 36 months, 44% of the patients developed ESRD in T2DM-DKD cohort. Patients in Group 3 (HDL-C ≥1.55 mmol/L) exhibited a higher risk of ESRD compared to Group 1 (HDL-C &amp;lt;1.03 mmol/L). After adjusting for confounders, Group 3 patients still had a significantly higher risk of ESRD (adjusted HR: 1.68, 95% CI: 1.03, 2.71). Analysis of HDL subfractions revealed that a higher HDL3/HDL2 ratio was associated with a lower risk of ESRD. Furthermore, in the NHANES cohort, higher HDL-C levels were linked to a higher risk of all-cause mortality during a median follow-up of 75 months as the result of the weighted Kaplan-Meier curves (p = 0.02). Notably, in patients with CKD stages 1-2, Group 3 participants had a significantly higher hazard ratio (HR: 1.61, 95% CI: 1.19, 2.19) after adjusting for confounders. Conclusion This study challenges the notion of HDL-C as ‘good cholesterol’ in patients with DKD, as higher HDL-C levels were associated with increased risks of ESRD and all-cause mortality. Additionally, the study highlights the potential protective effect of a higher HDL3/HDL2 ratio against ESRD. These findings contribute to reevaluating the role of HDL-C and its subfractions in DKD patients.

End-stage renal disease after renal cancer surgery: risk factors and overall survival.

Several risk factors for end-stage renal disease (ESRD), in patients undergoing surgical treatment for renal cell carcinoma (RCC), have been suggested by others. This study aimed to investigate such risk factors and disclose the effect of developing ESRD, postoperatively, on overall survival. The risk of developing ESRD after RCC diagnosis was also evaluated. The data of 16,220 patients with RCC and 162,199 controls were extracted from the Renal Cell Cancer Database Sweden, with linkages across multiple national registers between 2005 and 2020. Cox proportional hazards regression, Kaplan-Meier curves and cumulative incidence were used for statistical analysis. The 5-year cumulative incidence of ESRD following RCC diagnosis was 2.4% (95% confidence interval [CI] 2.1-2.6) and 0.4% (95% CI 0.3-0.4) for the patients with RCC and controls, respectively. Age, chronic kidney disease, higher T-stage and radical nephrectomy (RN) were significant risk factors for ESRD within 1-year of surgery. A total of 104 and 12,152 patients with and without ESRD, respectively, survived 1-year postoperatively. The 5-year overall survival rates of patients with ESRD and those with RCC only were 50% (95% CI 0.40-0.60) and 80% (95% CI 0.80-0.81), respectively. Patients who developed ESRD following renal cancer surgery had significantly poorer survival outcomes. Advanced age, comorbidities, higher-stage tumours and RN were identified as risk factors for developing ESRD. Surgical decisions are crucial. Efforts to spare renal function, including nephron-sparing surgery and active surveillance in appropriate cases, are highly relevant to reduce the development of severe kidney dysfunction.

Influence of Genetic Polymorphisms in CYP3A5, CYP3A4, and MDR1 on Tacrolimus Metabolism after kidney transplantation

Kidney transplantation stands as the ultimate recourse for restoring vital organ functions, particularly in cases of end-stage kidney disease where alternative treatments, such as dialysis, prove less effective. With over 102,000 kidney transplants conducted globally in 2022, the demand for organ transplantation is ever-increasing, fueled by a rising incidence of end-stage renal disease attributed to causes like diabetes and hypertension.&lt;br /&gt; Despite significant advancements in kidney transplantation, immunosuppressive therapy remains crucial to preventing graft rejection. Tacrolimus (TAC), a calcineurin inhibitor, plays a pivotal role in this regard. Discovered in 1984, TAC inhibits T-lymphocyte activation, preventing acute rejection by disrupting the transcription of crucial genes involved in early T-cell activation. However, the use of TAC is not without challenges. The drug exhibits serious side effects, a narrow therapeutic index, and unpredictable pharmacokinetics. Therapeutic drug monitoring (TDM) becomes imperative in daily practice to maintain TAC blood concentrations within the therapeutic range. This literature review delves into the genetic aspects influencing TAC metabolism, focusing on key polymorphisms in CYP3A5, CYP3A4, and ABCB1 genes. Genetic variations in CYP3A5, a major enzyme in TAC metabolism, impact enzyme activity, necessitating personalized dosing strategies. CYP3A4 polymorphisms, especially CYP3A4*22, demonstrate associations with altered TAC clearance and dose requirements. The ABCB1 gene, encoding P-glycoprotein, another player in TAC pharmacokinetics, also exhibits polymorphisms influencing drug absorption and distribution. The ABCB1 3435C&amp;gt;T variant, in particular, shows potential implications on Tacrolimus bioavailability. Understanding these genetic variations aids in the development of personalized dosing regimens. Studies suggest that tailoring TAC doses based on CYP3A5 genotypes significantly improves the proportion of patients achieving therapeutic concentrations. Additionally, incorporating genetic information, particularly CYP3A4*22, into dosing strategies enhances the precision of TAC therapy, reducing the risk of adverse effects.

Perioperative management of facial reconstruction surgery in patients with end-stage renal disease undergoing dialysis.

The rising incidence of dialysis-dependent end-stage renal disease (ESRD) has underscored the need for collaboration between plastic surgeons and nephrologists, particularly concerning preoperative and postoperative management for facial reconstruction. This collaboration is essential due to a scarcity of comprehensive information in this domain. A study initiated in January 2015 involved 10 ESRD cases on dialysis undergoing Mohs micrographic surgery for facial skin cancer, followed by reconstructive surgery under general anesthesia. To ensure surgical safety, rigorous measures were enacted, encompassing laboratory testing, nephrology consultations, and preoperative dialysis admission. Throughout surgery, meticulous control was exercised over vital signs, electrolytes, bleeding risk, and pain management (excluding nonsteroidal anti-inflammatory drugs). Postoperative assessments included monitoring flap integrity, hematoma formation, infection, and cardiovascular risk through plasma creatinine levels. Adherence to the proposed guidelines yielded a notable absence of postoperative wound complications. Postoperative plasma creatinine levels exhibited an average decrease of 1.10 mg/dL compared to preoperative levels, indicating improved renal function. Importantly, no cardiopulmonary complications or 30-day mortality were observed. In ESRD patients, creatinine levels decreased significantly postoperatively compared to the preoperative levels (p< 0.05), indicating favorable outcomes. The consistent application of guidelines for admission, anesthesia, and surgery yielded robust and stable outcomes across all patients. In particular, the findings support the importance of adjusting dialysis schedules. Despite the limited sample size in this study, these findings underscore the effectiveness of a collaborative and meticulous approach for plastic surgeons performing surgery on dialysis-dependent patients, ensuring successful outcomes.

Change Over Time in Pre–End-Stage Renal Disease 24-Hour Urine Creatinine as Muscle Mass Surrogate and Post–End-Stage Renal Disease Mortality

Loss of muscle mass and sarcopenia are common in chronic kidney disease (CKD) and end-stage renal disease (ESRD), and sarcopenia can worsen insidiously in patients with advancing CKD. The temporal dynamics of sarcopenia in patients with progressive loss of kidney function, and its association with future outcomes, is unclear. In a contemporary national cohort of incident ESRD US veterans, we selected 661 patients who had at least 2 24-hour urine creatinine (24hrUC) measurements, a surrogate of muscle mass, performed during the 3-year prelude period prior to ESRD transition. We estimated 24hrUC slopes in mixed effects models. To assess the temporal dynamics of pre-ESRD changes in 24hrUC and its association with changing eGFR, we separately fitted in mixed effects models a penalized spline regression of 24hrUC on time and on eGFR. We examined the association of 24hrUC slopes with postdialysis all-cause mortality using Cox models adjusted for confounders. The mean slope of 24hrUC versus time was -78mg/year (95% confidence interval: -102 to -54), with a steeper decline noted in the last year prior to ESRD. More severe decreases in 24hrUC were associated with higher all-cause mortality: a 100mg/year decrease in 24hrUC was associated with a multivariable adjusted death hazard ratio of 1.41 (95% confidence interval: 1.00-1.98, P=.05). Patients with advanced CKD lose a substantial proportion of their muscle mass each year during pre-ESRD prelude. Loss of muscle mass accelerates near ESRD transition, and more loss of muscle mass is associated with higher mortality after ESRD transition.

Acute kidney injury in patients undergoing endovascular or open repair of juxtarenal or pararenal aortic aneurysms

BackgroundThe aim of this cohort study was to report the proportion of patients who develop periprocedural acute kidney injury (AKI) after endovascular repair (ER) and open surgery (OS) in patients with juxta/pararenal abdominal aortic aneurysm and to assess potential risk factors for AKI. The study also aimed to report the short- and long-term outcomes of patients with and without AKI. MethodsThis was a multicenter cohort study of five European academic high-volume centers (>50 OS or 50 ER infrarenal AAA repairs, plus >15 complex AAA repairs per year). All consecutively treated patients were extracted from a prospective vascular surgical registry and the data were scrutinized retrospectively. The primary end point for this study was the development of AKI. AKI was diagnosed when there is a two-fold increase of serum creatinine or decrease of glomerular filtration rate of >50% within 1 week of AAA repair. Secondary end points included long-term mortality and end-stage renal disease (ESRD). ResultsAKI occurred in 16.6% of patients in the ER group vs 30.3% in the OS group (P < .001). The 30-day mortality rate was higher among patients with AKI in both ER (15.4% vs 3.1%; P = .006) and OS (13.2% vs 5.3%; P = .001) groups. Age, chronic kidney disease, presence of significant thrombus burden in the pararenal region, >1000 mL blood loss in ER group were associated with development of AKI. Age, diabetes mellitus, chronic kidney disease, presence of significant thrombus burden in the pararenal region, and a proximal clamping time of >30 minutes in the OS group were associated with the development of AKI, whereas renal perfusion during clamping was the protective factor against AKI development. After a median follow-up of 91 months, AKI was associated with higher mortality rates in both the ER group (58.9% vs 29.7%; P < .001) and the OS group (61.5% vs 27.3%; P < .001). After the same follow-up period, AKI was associated with a higher incidence of ESRD in both the ER group (12.8% vs 3.6%; P = .009) and the OS group (9.9% vs 2.9%; P < .001). ConclusionsThe current study identified important pre and postoperative factors associated with AKI after juxta/pararenal abdominal aortic aneurysm repair. Patients with postoperative AKI had significantly higher short- and long term mortality and higher incidence of ESRD than patients without AKI.

Enhancing Health Care Accessibility and Equity Through a Geoprocessing Toolbox for Spatial Accessibility Analysis: Development and Case Study.

Access to health care services is a critical determinant of population health and well-being. Measuring spatial accessibility to health services is essential for understanding health care distribution and addressing potential inequities. In this study, we developed a geoprocessing toolbox including Python script tools for the ArcGIS Pro environment to measure the spatial accessibility of health services using both classic and enhanced versions of the 2-step floating catchment area method. Each of our tools incorporated both distance buffers and travel time catchments to calculate accessibility scores based on users' choices. Additionally, we developed a separate tool to create travel time catchments that is compatible with both locally available network data sets and ArcGIS Online data sources. We conducted a case study focusing on the accessibility of hemodialysis services in the state of Tennessee using the 4 versions of the accessibility tools. Notably, the calculation of the target population considered age as a significant nonspatial factor influencing hemodialysis service accessibility. Weighted populations were calculated using end-stage renal disease incidence rates in different age groups. The implemented tools are made accessible through ArcGIS Online for free use by the research community. The case study revealed disparities in the accessibility of hemodialysis services, with urban areas demonstrating higher scores compared to rural and suburban regions. These geoprocessing tools can serve as valuable decision-support resources for health care providers, organizations, and policy makers to improve equitable access to health care services. This comprehensive approach to measuring spatial accessibility can empower health care stakeholders to address health care distribution challenges effectively.

The burden of end-stage renal disease in Khartoum, Sudan: cost of illness study

Background and purpose The incidence of end-stage renal disease (ESRD) in Sudan is increasing, affecting the economic status of patients, caregivers and society. This study aimed to measure ESRD’s costs, including direct and morbidity indirect expenditures, and to investigate any associated factors and financial consequences. Materials and methods This cross-sectional study used a standardized questionnaire to collect data from 150 ESRD patients who had been receiving dialysis for at least one year before the time of data collection at 13 specialized renal centres in Khartoum state. Data about sociodemographic, clinical, and economic factors were gathered, and their relationship to the cost of ESRD was examined using both bivariate (Man Whitney test, Kruskal Wallis test and Spearman correlation) and multivariate analytical procedures (multivariate linear regression). Results This study reported a median direct per capita ESRD cost of 38 600 SDG ($1 723.2 PPP) annually with an interquartile range of 69 319.3 SDG ($3 094.6 PPP). The median morbidity indirect cost was estimated to be 0.0 ± 3 352 SDG ($ 0.0 ± 149.6 PPP) per annum. In 28.8% of cases, the patients were their family’s primary income earner and over 85% were covered by medical insurance. Our study found that none of the study variables were significantly associated with the total cost of ESRD. Conclusion and limitations Our findings point out considerable direct out-of-pocket expenses and productivity losses for patients and their households. However, these results should be carefully applied for comparison between the different countries due to differences in the cost of medical interventions and insurance coverage. Further longitudinal studies and studies on health finance and insurance policies are recommended.

P434 Incidence of chronic end-stage renal disease in patients with inflammatory bowel disease: a population-based cohort study from the French National Health Insurance Database

Abstract Background Renal disorders are among the extra-intestinal manifestations of inflammatory bowel disease (IBD), and treatments may also lead to renal failure. However, the incidence of end-stage renal disease (ESRD), defined as the need for renal replacement therapy (dialysis and/or renal transplantation(RT)), is poorly known. The primary objective of our study was to assess the incidence of ESRD in IBD patients, and to compare it with the non-IBD population. Methods We conducted a prognostic cohort study based on data from the French National Health Insurance Database(SNDS). Prevalent cases of IBD affiliated to the general health insurance scheme during the period 2011-2020 were identified on the basis of declarations long-term diseases ALD 24 or the presence of 2 hospital stays for IBD with ICD-10 codes or a single stay with reimbursement of specific treatments. Incident cases of ESRD were identified on the basis of a stay with a RT or a period with dialysis sessions for at least 45 days. Crude incidence rates of ESRD were calculated over the period for the IBD and the non-IBD population, with their 95% confidence intervals. Results A total of 280,283 IBD patients were included in the study over the period 2011-2020, 134,567 with ulcerative colitis(UC) and 145,716 with Crohn’s disease(CD). The mean age at study inclusion was 39.8 (± 17.1) years. The M/F sex ratio was 0.9. The mean age at incidence of ESRD in the non-IBD population was 65.0 (±17.0) years, the M/F sex ratio cases was 1.7. Among IBD patients, 534 patients began replacement therapy by dialysis or RT, they were younger than non-IBD patients (60.3(±16.7)years, P&amp;lt;0.001).The mean incidence rate of ESRD over the period was 26.4 per 100,000 person-years (IC95% 23.1-29.6), 480 (89.9%) patients entered ESRD by dialysis, and 54 (10.1%) by preemptive RT. In the non-IBD population the mean rate of ESRD was 15.9 per 100,000 person-years (IC95% 14.8- 17.1; P&amp;lt;0.0001 compared with IBD): 79,606 (94.5%) patients entered ESRD by dialysis, and 4,634 (5.5%) by RT (as compared with IBD,P&amp;lt;0.001). In subgroup analysis, the mean incidence rate of ESRD was 22.8 per 100,000 person-years (IC95% 18.9-26.7) in UC patients and 29.5 (IC95% 25.3-33.6) in CD patients. The rates of preemptive RT were 12.4% in UC patients (87.6% dialysis) and 8.6% in CD patients (91.4% dialysis). Over a median follow-up of 6.8 years, the survival rate after ESRD was 40.8% in ESRD-IBD patients VS 34.2% in ESRD non-IBD patients (P&amp;lt;0.001). Conclusion This study shows that the incidence of ESRD is significantly higher in IBD than in the non-IBD population, confirming the need for regular monitoring of renal function in our patients. The high incidence of RT confirms that access to transplantation is not restricted in this population.

Long-term outcomes of lung transplantation requiring renal replacement therapy: A single-center experience

BackgroundLife-long immunosuppressive therapy after lung transplantation (LT) may lead to end-stage renal disease (ESRD), requiring renal replacement therapy (RRT). We aimed to investigate the characteristics and long-term outcomes of patients undergoing LT and requiring RRT. MethodsThis study was a single-center, retrospective cohort study. The patients were divided into the RRT (n = 15) and non-RRT (n = 170) groups. We summarized the clinical features of patients in the RRT group and compared patient characteristics, overall survival, and chronic lung allograft dysfunction (CLAD)-free survival between the two groups. ResultsThe cumulative incidences of ESRD requiring RRT after LT at 5, 10, and 15 years were 0.8 %, 7.6 %, and 25.2 %, respectively. In the RRT group, all 15 patients underwent hemodialysis but not peritoneal dialysis, and two patients underwent living-donor kidney transplantation. The median follow-up period was longer in the RRT group than in the non-RRT group (P < 0.001). The CLAD-free survival and overall survival did not differ between the two groups. The 5-year survival rate even after the initiation of hemodialysis was 53.3 %, and the leading cause of death in the RRT group was infection. ConclusionsFavorable long-term outcomes can be achieved by RRT for ESRD after LT.

Ingested nitrate and nitrite and end-stage renal disease in licensed pesticide applicators and spouses in the Agricultural Health Study

BackgroundNitrate and nitrite ingestion has been linked to kidney cancer, possibly via the endogenous formation of carcinogenic N-nitroso compounds. These exposures might also contribute to end-stage renal disease (ESRD).ObjectivesWe investigated associations of drinking water nitrate and dietary nitrate and nitrite intakes (total and by food type) with incident ESRD in the Agricultural Health Study. We also explored modifying effects of vitamin C and heme iron intake, which may affect endogenous nitrosation.MethodsWe performed complete case analyses among private pesticide applicators and their spouses. We obtained water nitrate estimates for participants whose primary drinking water source at enrollment (1993−1997) was public water supplies (PWS) or private wells (N = 59,632). Average nitrate concentrations were computed from historical data for PWS users and predicted from random forest models for private well users. Analysis of dietary nitrate and nitrite was restricted to the 30,177 participants who completed the NCI Dietary History Questionnaire during follow-up (1999−2003). Incident ESRD through 2018 was ascertained through linkage with the U.S. Renal Data System. We estimated adjusted hazard ratios (HRs) and 95%CI for associations of tertiles (T) of exposure with ESRD overall and explored effects in strata of vitamin C and heme iron intake.ResultsWe identified 469 incident ESRD cases (206 for dietary analysis). Water nitrate and total dietary nitrate/nitrite were not associated with ESRD, but increased ESRD was associated with nitrate and nitrite from processed meats. We found apparent associations between nitrite and ESRD only among participants with vitamin C <median (T3 vs. T1 HR: 2.26, 95%CI: 1.05, 4.86) and with heme iron ≥median (T3 vs. T1 HR: 1.73, 95%CI: 0.89, 3.39).SignificanceESRD incidence was associated with dietary nitrate/nitrite from processed meat among all study participants and with total dietary nitrite among participants with lower vitamin C or higher heme iron intake.Impact statementThere are few well-established environmental risk factors for end-stage renal disease (ESRD), a worldwide public health challenge. Ingestion of nitrate and nitrite, which may lead to endogenous formation of carcinogenic N-nitroso compounds, has been linked to some cancers and chronic diseases. We investigated these exposures in relation to ESRD in an agricultural cohort. ESRD incidence was associated with dietary nitrate/nitrite from processed meat and with total dietary nitrite among subgroups with lower vitamin C or higher heme iron intake. This study provides preliminary evidence that points to dietary nitrite and possibly dietary nitrate intake as a potential contributor to ESRD.