Nephrology Clinic Research Articles

The effect of autosomal dominant polycystic kidney disease on mucociliary clearance.

Autosomal dominant polycystic kidney disease (ADPKD) is a renal disease with genetic transmisson. Mutations in the PKD1 and PKD2 genes, which encode integral membrane proteins of the cilia of primary renal tubule epithelial cells, are seen in ADPKD. The aim of this study was to evaluate the sinonasal epithelium, which is epithelium with cilia, by measuring the nasal mucociliary clearance time, and to investigate the effect of ADPKD on nasal mucociliary clearance. The study included 34 patients, selected from patients followed up in the Nephrology Clinic, and 34 age and gender-matched control group subjects. The nasal mucociliary clearance time (NMCT) was measured with the saccharin test. The mean age of the study subjects was 47.15 ± 14.16years in the patient group and 47.65 ± 13.85years in the control group. The eGFR rate was determined as mean 72.06 ± 34.26mL/min in the patient group and 99.79 ± 17.22mL/min in the control group (p < 0.001). The NMCT was determined to be statistically significantly longer in the patient group (903.6 ± 487.8s) than in the control group (580 ± 259s) (p = 0.006). The study results showed that the NMCT was statistically significantly longer in patients with ADPKD compared to the control group, but in the linear regression analysis results, no correlation was determined between eGFR and NMCT.

Sex difference in cardiovascular risk in patients with chronic kidney disease: pooled analysis of four cohort studies.

Progression of chronic kidney disease (CKD) has proven to be faster in men than in women. Whether the same holds true for cardiovascular risk remains ill-defined. We conducted a pooled analysis of 4 cohort studies from 40 nephrology clinics in Italy including patients with CKD (estimated GFR<60ml/min/1.73m2 or higher if proteinuria>0.15g/day). The aim was to compare multivariable-adjusted risk (Hazard Ratio, 95% Confidence Interval) of a composite cardiovascular endpoint (cardiovascular death and non-fatal myocardial infarction, congestive heart failure, stroke, revascularization, peripheral vascular disease, and non-traumatic amputation) in women (n=1192) versus men (n=1635). At baseline, women had slightly higher systolic blood pressure (SBP) as compared with men (139±19vs 138±18mmHg, P=0.049), lower eGFR (33.4vs 35.7mL/min/1.73 m2, P=0.001) and lower urine protein excretion (0.30g/day vs 0.45g/day in men, P<0.001). Women did not differ from men in age and prevalence of diabetes while having a lower prevalence of cardiovascular disease, left ventricular hypertrophy and smoking habit. During a median follow-up of 4.0 years, 517 fatal and non-fatal cardiovascular events were registered (199 in women and 318 in men). The adjusted risk of cardiovascular events was lower in women (0.73, 0.60-0.89, P=0.002) than in men; however, the cardiovascular risk advantage of women progressively diminished as SBP (as continuous variable) increased (P for interaction=0.021). Similar results were obtained when considering SBP categories; when compared to men, women had lower cardiovascular risk for SBP <130mmHg (0.50, 0.31-0.80; P=0.004) and between 130-140mmHg (0.72, 0.53-0.99; P=0.038), while no difference was observed for SBP>140mmHg (0.85, 0.64-1.11; P=0.232). Higher BP levels abolish the cardiovascular protection seen in female vs male patients with overt CKD. This finding supports the need for higher awareness of hypertensive burden in women with CKD.

Octogenarians with chronic kidney disease in the nephrology clinic: Progressors vs. non-progressors.

The current definition of chronic kidney disease applied to patients over the age of 80 has increased the number of referrals to Nephrology. However not all of these patients may benefit from its assessment. This study aims to analyze the evolution of ≥80 years old patients referred to Nephrology. Single-center study including patients ≥80 years old with eGFR <60 mL/min/1,73m2 who were referred to Nephrology consultation for the first time. Clinical and analytical parameters were collected retrospectively 12 months before the visit, and prospectively at baseline, and 12 and 24 months after the initial visit. We divided patients into two groups based on annual eGFR loss: progressors (>5 mL/min/1.73m2) and non-progressors (≤5 mL/min/1,73m2). A total of 318 patients were included, mean age was 84,9 ± 4 (80-97) years. Baseline serum creatinine was 1,65 ± 0,62 mg/dL, eGRF 35 (28-42) mL/min/1,73, and albumin/creatinine ratio 36 (7-229) mg/g. 55,7% of the patients met the definition of progressor at baseline (initial-progressors), 26,3% were progressors after a 12-month follow-up and 13,4% after 24 months. 21,2% and 11,4% of initial-progressors met this definition at 12 and 24 month follow up. The main risk factor for progression was albuminuria. No relationship was found between the nephrologist intervention and the evolution of renal function among initial non-progressors. Elderly patients who have stable renal function at the time of referral will continue to have stable renal function over the subsequent 24 months and thus may not need to be referred to a nephrologist.

Chronic Kidney Disease Observational Cohort Study And Assessment Of Baseline Characteristics And Their Relationship With Diabetes Status And Kidney Function

Background: Chronic kidney disease (CKD) may result in end-stage renal disease (ESRD), and undesirable outcomes such as death and dialysis. We carried out an observational cohort study to ascertain risk factors for the renal outcomes, all-cause mortality in patients with CKD. In this report, we studied the baseline demographic and laboratory characteristics of the cohort. Methods: A single-center, retrospective, observational cohort study was conducted at the outpatient Nephrology Clinic of Health Sciences University, Kayseri Medical Faculty, from January 1, 2010, to December 31, 2020. Age 18 to 70 years and eGFR 15 to 59 mL/min/1.73 m2 were inclusion criteria. Baseline demographic and laboratory data were documented. Results: One thousand seventy-three patients with CKD were enrolled in the study. Mean (SD) age was 55.87 (8.83) years, and 53.2% were men. %45.9 and %84.4 had diabetes mellitus and hypertension, respectively. The mean body mass index was 26.73 (3.95) kg/m2. Mean eGFR was 34.14 (10.45) mL/min/1.73 m2 using chronic kidney disease epidemiology collaboration. Median (p25-p75) urinary protein-creatinine ratio was 48.80 [22.40, 89.00] mg/mmol. Older patients had a lower eGFR, and the male gender was more common at stage 3 patients. Stage 4 patients had lower hemoglobin and serum calcium levels. Also, low eGFR was associated with high uric acid levels. Conclusion: This study along with future analysis may elucidate the natural history and clinical consequences of CKD. Controllable factors could be understood, and CKD progression and adverse outcomes may be prevented in this way.

Differences in Cardiovascular Remodeling in Kidney Transplant Recipients and Peritoneal Dialysis Patients

Aims: Cardiovascular disease (CVD) is the leading cause of death in dialysis patients as well as in kidney transplant recipients (KTx). Left ventricular hypertrophy (LVH) starts early during the course of chronic kidney disease and is a strong predictor of CVD. We hypothesised that kidney transplant is significantly associated with improvement in cardiovascular reserve. We conducted a prospective study to compare changes in CV before and after kidney transplantation in patients with ESRD who received KTx to control individuals who received PD but did not receive a KTx.&#x0D; Study Design: A Case-Control Study.&#x0D; Place and Duration of Study: Clinic for nephrology Clinical Center University of Sarajevo, Bosnia and Herzegovina.&#x0D; Methodology: In this case-control study, we included 50 KTx from the Kidney Transplant Outpatient Clinic for nephrology Clinical Center. For each 50 KTx, PD outpatients matched for gender and age were recruited. All patients underwent transthoracic echocardiography, and LV (left ventricular) mass (LVM), LV mass index (LVMi), and indices of cardiac function were measured. In the small subgroup of 18 KTx, we retrospectively assessed and compared the LVMI measurements, during dialysis and the post-transplant period.&#x0D; Results: The prevalence of LVH was 24% in KTx patients and 72% in PD patients (NS). KTx had significantly lower LVM, LVMi levels, E/A ratio, FS, and LA diameter compared with the PD group, while the EF and other echocardiographic parameters did not differ. In the subgroup of 18 KTx, LVMi levels after transplantation were significantly lower than dialysis LVMi levels.&#x0D; Conclusion: LVH is the most frequent cardiac abnormality at the time of kidney transplantation. After KTx, the reduction of LVH and diastolic dysfunction was significant. CV remodelling after successful KTx is related to better kidney function, and can explain better outcomes for patients with kidney transplants over patients on long-term dialysis.

Ambulatory blood pressure monitoring in children: A retrospective single-center study.

(1) Compare 24-hour ambulatory blood pressure monitoring (ABPM) diagnoses in a pediatric population with the new 2022 guidelines to the original diagnoses with the 2014 guidelines. (2) Determine whether findings of hypertension from ABPM could be predicted from prior patient data. (3) Determine whether ABPM readings could predict left ventricular mass index (LVMI) in patients who obtained an echocardiogram (ECHO). Single-center retrospective study on patients referred to Pediatric Nephrology Clinic for evaluation of elevated blood pressure who underwent ABPM from 2015 to 2018. Predictions of hypertension were obtained using a logistic regression model, and predictions of LVMI were performed using regression models including (a) the wake systolic and diastolic BP indices, or (b) additionally including the standard deviation (SD) of wake SBP and DBP. With the change in 2022 to new ABPM guidelines from the AHA, comparing the old and new guidelines led to 70% of previous pre-hypertensive diagnoses now meeting criteria for diagnosis of hypertension, and a rise from 21% of the ABPMs meeting criteria for hypertension to 51% now meeting criteria. In a logistic regression model, prior patient data were not predictive of a diagnosis of hypertension from ABPM (Nagelkerke's R 2 = 0.04). Among the individual variables studied, none were statistically significant. For prediction of LVMI, the SD of wake SBP and DBP were significantly associated with increased LVMI, but the wake SBP and DBP indices were not. In our patient population, the new ABPM guidelines led to a significant increase in diagnoses of hypertension. Prior patient data was not sufficient to predict a diagnosis of hypertension by ABPM, supporting the need for evaluation by ABPM as the gold standard. Our analysis of the relationship between ABPM readings and LVMI supports the hypothesis that BP variability contributes to increased LVMI. These data are consistent with growing evidence in the adult literature that BP variability detected by ABPM is associated with left-ventricular hypertrophy.

Reducing Dietary Acid With Fruit and Vegetables Versus Oral Alkali in People With Chronic Kidney Disease (ReDACKD): A Clinical Research Protocol.

Individuals with chronic kidney disease (CKD) can develop metabolic acidosis which, in turn, is associated with faster progression of CKD and an increased need for dialysis. Oral sodium bicarbonate (the current standard of care therapy for metabolic acidosis) is poorly tolerated leading to low adherence. Base-producing or alkalizing Fruit and vegetables have potential as an alternative treatment for metabolic acidosis as they have been shown to reduce acid load arising from the diet. This trial will evaluate the feasibility of providing base-producing fruit and vegetables as a dietary treatment for metabolic acidosis, compared with oral sodium bicarbonate. A 2-arm, open-label, dual-center, randomized controlled feasibility trial. Two Canadian sites: a nephrology clinic in Winnipeg, Manitoba, and a nephrology clinic in Halifax, Nova Scotia. Adult participants with G3-G5 CKD and metabolic acidosis. Participants will undergo baseline measurements and attend 5 study visits over 12 months at which they will have a measurement of feasibility criteria as well as blood pressure, blood and urine biochemistry, 5-repetition chair stand test (STS5), and questionnaires to assess quality of life and symptoms. Furthermore, participants fill out Automated Self-Administered 24-hour recalls (ASA-24) in the beginning, middle, and end of trial. A total of 40 eligible participants will be randomized 1:1 to either base-producing fruit and vegetables (experimental) group or sodium bicarbonate (control) group, beginning from a daily dose of 1500 mg. Using self-administered dietary assessments, lack of supervision over the consumption of study treatments and the possible disappointment of the control group for not receiving fruit and vegetables would be considered as limitations for this study. However, we are planning to undertake proper practices to overcome the possible limitations. These practices are discussed throughout the article in detail. This study will generate data on base-producing fruit and vegetables consumption as a dietary treatment for metabolic acidosis in CKD. The data will be used to design a future multi-center trial looking at slowing CKD progression in people with metabolic acidosis. This study is registered on clinicaltrials.gov with the identifier NCT05113641.

Systemic immune inflammation index and pan-immune inflammation value as prognostic markers in patients with idiopathic low and moderate risk membranous nephropathy.

We aimed to investigate the prognostic values of systemic immune inflammation index and pan-immune inflammation value in patients with idiopathic low and moderate risk membranous nephropathy. All membranous nephropathy patients diagnosed in the nephrology clinic between January 2015 and January 2022 were reviewed retrospectively. Patients with idiopathic membranous nephropathy were included. The patients were divided into two groups; the complete remission group: whose proteinuria decreased below 0.3 g/day and serum albumin level above 3.5 g/dL after 6 months of conservative treatment, and the non-remission group: all other patients. Groups were compared in terms of systemic immune inflammation index and pan-immune inflammation value. Patients in the non-remission group had significantly higher systemic immune-inflammation index (SII) and pan-immune-inflammation value (PIV) than patients in the complete remission group (p<0.05). An SII of 1,056.2 was found to have 63.6% sensitivity and 100% specificity in predicting non-remission, and a PIV of 447.4 was found to have 100% sensitivity and 70.6% specificity in predicting non-remission. SII and PIV are reliable markers for predicting non-remission in patients with low and moderate risk idiopathic MN.

Quality Improvement Initiative to Increase Modality Education in a Nephrology Clinic During the COVID-19 Pandemic

Quality Improvement Initiative to Increase Modality Education in a Nephrology Clinic During the COVID-19 Pandemic

EVIDÊNCIAS DE VALIDADE DE CARTILHA EDUCATIVA SOBRE CUIDADOS COM ACESSOS VASCULARES PARA HEMODIÁLISE

ABSTRACT Objective: to verify the validation evidence of an educational booklet focused on the care of patients with vascular accesses for hemodialysis. Method: the methodological study was structured into three different aspects: content validity by expert judges based on calculation of the Content Validity Index; face evaluation by design expert judges; and pilot implementation, carried out with the target population, consisting of 30 patients in a nephrology clinic from Picos, Piauí, Brazil. Data collection took place from December 2020 to April 2021, and included a descriptive and inferential analysis of the findings. Results: the final version of the booklet had 32 pages, and its overall Content Validity Index was 0.88, thus proving its content validity and indicating clarity of the language, theoretical relevance and practical pertinence of the educational technology. The design expert judges rated the booklet as adequate or as with superior quality. The mean of the overall agreement rate by the target audience was 0.99. Conclusion: the educational booklet presented satisfactory validation evidence, based on its face and content, with good potential for use in the clinical practice.

DETERMINATION OF THE PRA POSITIVITY PERCENTAGE IN MALE PATIENTS WITH CHRONIC KIDNEY DISEASE BY USING FLOW CYTOMETRY TECHNIQUE.

The antibodies directed against human leukocyte antigen (HLA) molecules, which play a crucial role in allograft histocompatibility, are called anti-HLA antibodies. Anti-HLA antibodies against foreign HLA molecules may be present in patients with chronic kidney disease even before transplantation. The panel reactive antibody (PRA) test is used to measure the renal transplant candidate's immune sensitivity to HLA molecules other than their own HLA molecules by assessing the diversity of anti-HLA antibodies in the blood of these patients. This study aimed to determine the PRA values and the percentage of PRA positivity of Turkish male patients with chronic kidney disease (CKD), who had not been sensitized by the major known causes (those with no history of organ or tissue transplantation, those with no history of blood transfusion), who had not been diagnosed with any autoimmune diseases, and who had not been under immunosuppressive treatment. The study included 60 male patients aged over 18 years. All of the patients were followed up with a diagnosis of CKD at the Nephrology Clinic, Internal Medicine Department, Akdeniz University Medical Faculty Hospital. None of the patients included in the study was sensitized by a known mechanism previously (they did not have blood transfusion or organ transplantation). Glomerular filtration rate (GFR) levels of all patients were below the level of 60 mL/min/1.73 m2. Patient data including their age information, etiology of CKD, accompanying diseases, and information about dialysis modalities were recorded. HLA antibody percentage was determined by the flow cytometry technique. Statistical data analysis was performed by using SPSS 22.0 (Statistical Package for Social Sciences, Version 22.0). The values of p less than 0.05 were considered statistically significant. Twenty patients were receiving dialysis treatment due to end-stage renal disease. Of the 60 patients included in the study, 25% showed PRA positivity; 28.3% of all study patients were found to be positive for anti-HLA class I antibodies and 26.7% of all study patients were found to be positive for anti-HLA class II antibodies on separate analysis for anti-HLA class I and anti-HLA class II antibody positivity. When the patients were categorized as PRA negative and PRA positive in two groups, there were no differences between the groups according to mean age, percentage of hemodialysis patients, percentage of peritoneal dialysis patients and presence of accompanying chronic diseases (such as hypertension, type 2 diabetes mellitus, hyperlipidemia, nephrolithiasis, coronary artery disease). In addition to this, evaluation of the GFR levels showed that the PRA positive group contained a significantly higher percentage of end-stage renal disease patients (GFR <15 mL/min/1.73 m2) as compared with the PRA negative group. Detailed analysis of the percentages of PRA levels in the PRA positive patients, which was carried out to determine the degree of sensitization, showed that the PRA values were over 80% in 11.77% of the patients positive for anti-HLA class I antibodies. On the other hand, PRA values were within the range of 15%-80% in 88.23% of the patients who had anti-HLA class II antibodies. The PRA values were below 80% in all of the patients positive for anti-HLA class II antibodies and those positive for both anti-HLA class I and class II antibodies. In conclusion, PRA levels of the candidates for kidney transplantation should always be measured to assess their state of sensitization before transplantation, even though they have no risk factors known to cause anti-HLA antibody development.

Beyond Blood Glucose and Blood Pressure Control in Type 2 Diabetes: Alternative Management Strategies to Prevent the Development and Progression of CKD.

Chronic kidney disease associated with Type 2 diabetes is linked to significant increase in morbidity, reduced quality of life, and early death. Current guidelines recommend targets for the management of hyperglycemia, hypertension, and dyslipidemia but there remains a residual risk of chronic kidney disease progression and adverse cardiovascular outcomes in patients with Type 2 diabetes. The 2022 consensus report from the American Diabetes Association and Kidney Disease: Improving Global Outcomes support the use of sodium-glucose co-transporter 2 inhibitors and nonsteroidal mineralocorticoid receptor antagonists to improve kidney and cardiovascular outcomes. Coordination between those working in the primary care setting and those in endocrinology and nephrology clinics may optimize the prevention of chronic kidney disease progression in patients with Type 2 diabetes. Nurse practitioners, physician assistants, and primary care physicians play an important role in making timely patient referrals to kidney specialists. This article explores the use of novel therapies capable of reducing the risk of cardiovascular disease and chronic kidney disease progression beyond what can be achieved with control of blood glucose, blood pressure, and lipid levels. It also discusses the importance of monitoring at-risk patients to facilitate early diagnosis and initiation of effective kidney-protective therapy.[Media: see text][Figure: see text].

PS-C27-3: MEASURING ANTIHYPERTENSIVE DRUG CONCENTRATIONS TO DETERMINE NON-ADHERENCE IN HYPERTENSIVE PATIENTS WITH AND WITHOUT KIDNEY TRANSPLANTATION

Introduction: Non-adherence to antihypertensive drugs (AHDs) is one of the main causes of resistant hypertension which is defined as uncontrolled blood pressure despite the prescription of at least 3 AHDs. Objectives: Our primary objective was to determine the prevalence of non-adherence to AHDs in patients visiting the nephrology and vascular outpatient clinics. Inclusion rates at both departments allowed comparison between non-adherence of kidney transplantation (KT) patients with patients without KT as secondary objective. Design and method: This was a prospective observational study called RHYME-AD (Resistant Hypertension: MEasure Antihypertensive Drugs, MEC-2020–0096). Patients were eligible if they used at least 2 AHDs that could be measured with a validated UPLC-MS/MS method and had an office blood pressure &gt; 140 and/or 90 mmHg. After informed consent was signed, rest material was collected from a regular venipuncture measurement. The total absence of drug in blood (&lt;lower limit of detection) was defined as non-adherent. We made comparisons between patients with and without KT and with and without resistant hypertension, defined as an office blood pressure &gt; 140 and/or 90 mmHg despite the use of 3 or more AHDs. Results: Material was available from 143 patients of which 93 had a KT and 66 patients fulfilled the definition of resistant hypertension. The overall adherence rate was 78.3%. From the non-adherent patients 87.8% was partially non-adherent and 12.2% non-adherent for all prescribed AHDs. When looking at the two separate groups, with and without KT, more patients in the non-KT cohort fulfilled the definition of resistant hypertension as compared to the KT-cohort (62.0% vs 37.6%, p = 0.005). There was a significant difference between having resistant hypertension and being non-adherent (non-adherence RH vs non-RH, 31.8% vs 13.0%, p = 0.023) and having KT and being non-adherent (non-adherence KT vs non-KT, 14.0% vs 36.0%, p = 0.005). In addition, patients with KT and no resistant hypertension were the most adherent to AHDs (91.2%). Conclusions: Hypertensive patients with a KT are less likely to be non-adherent to their AHDs as compared to hypertensive patients without a KT. However, patients fulfilling the definition of having resistant have a higher risk of being non-adherent to AHDs.

PS-C08-11: RELATIONSHIP OF AMBULATORY WAKE SYSTOLIC BLOOD PRESSURE AND COGNITIVE FUNCTIONING IN CHILDREN AND ADOLESCENTS: THE SHIP-AHOY STUDY

Objective: 24-Hour Ambulatory blood pressure monitoring (ABPM) has been shown to be associated with cognitive functioning in both adults and children with hypertension. Few studies have examined this relationship in youth with normal to mildly elevated blood pressure (BP). We aimed to address this gap in the literature by examining the relationship between average wake systolic BP and targeted cognitive abilities in children and adolescents with normal to mildly elevated BP. Design: Cross-sectional cohort study across six academic centers in the United States. Methods: Participants were part of the SHIP AHOY Project examining target organ damage in children and adolescents with normal to mildly elevated BP. Patients were recruited from pediatric nephrology and/or cardiology clinics and had BP levels &gt; 75th percentile to &gt; 95th percentile). Ascertainment was designed to balance BMI across this BP range by actively recruiting normotensive subjects with obesity. Exclusion criteria included stage 2 hypertension, use of antihypertensive or lipid-lowering medication in the past 6 months, diabetes mellitus (type 1 or 2), kidney disease, or other chronic medical conditions. The primary exposure for this study was average wake Systolic BP. Cognitive variables included the Test of Nonverbal Intelligence, Woodcock-Johnson-V Verbal Attention, and Conners Continuous Performance Test-3 Errors of Omission and Errors of Commission. Preliminary analyses comprised the use of unadjusted linear regressions for the entire sample, with follow-up analyses planned to include key covariates for any significant findings. Results: We recruited 397 adolescents, ages 11–19 years (M∼15.5 yrs.), who comprised approximately 60% males and 53% white. About 25% of the participants had caregivers with a high school degree or less. About 40% of the sample had elevated BP (&gt; 90th percentile). There was a significant relationship between wake average systolic BP and Verbal Attention (p &lt; .009); and wake average systolic BP and Errors of Commission (p &lt; .026). All findings were in the expected direction with higher average wake BP being related to lower performance on the attention-related variables. SBP and Errors of Omission approached significance (p &lt; .07), while Nonverbal IQ was nonsignificant (p &lt; .34). Conclusions: Higher average wake BP, even in adolescents with BP below the hypertensive range, is associated with lower performance on tests of attention regulation and response inhibition. These findings suggest that efforts to minimize associated neurocognitive dysfunction in the late adolescence and young adult years should begin before the presence of hypertension.

Blood Pressure Trend in Children with Chronic Kidney Disease in Nigeria, Sub-Saharan African Region

Background: Various mechanisms are involved in the development of hypertension in children with chronic kidney disease (CKD), some of which are due to the disease process, while some are due to the treatments employed in CKD. Aim: The aim of the study was to determine the trend of blood pressure in Nigerian children with CKD comparable with controls. Materials and Methods: A cross-sectional study assessing the blood pressure of children from 6 to 17 years with CKD and selected age- and sex-matched controls who were recruited consecutively at the Paediatric Nephrology Clinic and Children Outpatient Clinic of University of Nigeria Teaching Hospital. Data obtained were analyzed using the Statistical Package for the Social Sciences (SPSS) version 17. Results: The mean systolic blood pressure (SBP) was 126.08 ± 37.43 mmHg for subjects compared to 105.04 ± 14.33 mmHg for controls, whereas the mean diastolic blood pressure (DBP) was 78.96 ± 22.74 mmHg for subjects compared to 66.25 ± 10.66 mmHg for controls. The distribution of SBP and DBP across the CKD stages showed more severe hypertension (Stages I and II) prevalence in the later stages of CKD (Stages 4 and 5) (χ y 2 = 7.21, P = 0.01, respectively). The mean value of the mean arterial blood pressure (MAP) was 94.67 ± 26.98 mmHg for subjects compared to 79.18 ± 10.61 mmHg for controls. The increase in MAP across the stages of CKD was significant. Conclusion: This study shows a high prevalence of the severe forms of high blood pressure in this group of children with CKD in the subregion.

Identification and Prioritization of Canadian Society of Nephrology Clinical Practice Guideline Topics With Multidisciplinary Stakeholders and People Living With Kidney Disease: A Clinical Research Protocol.

Despite efforts to provide evidence-based care for people living with kidney disease, health care provider goals and priorities are often misaligned with those of individuals with lived experience of disease. Coupled with competing interests of time, resources, and an abundance of suitable guideline topics, identifying and prioritizing areas of focus for the Canadian nephrology community with a patient-oriented perspective is necessary and important. Similar priority-setting exercises have been undertaken to establish research priorities for kidney disease and to standardize outcomes for kidney disease research and clinical care; however, research priorities are distinct from priorities for guideline development. Inclusion of people living with health conditions in the selection and prioritization of guideline topics is suggested by patient engagement frameworks, though the process to operationalizing this is variable. We propose that the Canadian Society of Nephrology Clinical Practice Guideline Committee (CSN CPGC) takes the opportunity at this juncture to incorporate evidence-based prioritization exercises with involvement of people living with kidney disease and their caregivers to inform future guideline activities. In this protocol, we describe our planned research methods to address this. To establish consensus-based guideline topic priorities for the CSN CPGC using a modified Delphi survey with involvement of multidisciplinary stakeholders, including people living with kidney disease and their caregivers. Protocol for a Modified Delphi Survey. Pilot-tested surveys will be distributed via email and conducted using the online platform SurveyMonkey, in both French and English. We will establish a group of multidisciplinary clinical and research stakeholders (both within and outside CSN membership) from Canada, in addition to people living with kidney disease and/or their caregivers. A comprehensive literature search will be conducted to generate an initial list of guideline topics, which will be organized into three main categories: (1) International nephrology-focused guidelines that may require Canadian commentary, (2) Non-nephrology specific guidelines from Canada that may require CSN commentary, and (3) Novel topics for guideline development. Participants will engage in a multi-round Modified Delphi Survey to prioritize a set of "important guideline topics." Consensus will be reached for an item based on both median score on the Likert-type scale (≥ 7) and the percentage agreement (≥ 75%); the Delphi process will be complete when consensus is reached on each item. Guideline topics will then be given a priority score calculated from the total Likert ratings across participants, adjusted for the number of participants. Potential limitations include participant response rates and compliance to survey completion. We propose to incorporate evidence-based prioritization exercises with the engagement of people living with kidney disease and their caregivers to establish consensus-based guideline topics and inform future guidelines activities of the CSN CPGC.

Body image, emotional intelligence and quality of life in peritoneal dialysis patients.

End-stage-renal-disease is one of the most common chronic diseases, and peritoneal dialysis constitutes one of the replacement therapies. The aim of this study was to investigate the views of patients on peritoneal dialysis regarding their body image, to assess their quality of life and level of emotional intelligence. A cross-sectional study was performed with structured questionnaires. The sample of the study was the patients undergoing peritoneal dialysis and monitored by the nephrology clinics of 7 public hospitals in Greece. A total of 102 completed questionnaires were collected and analyzed (68% response rate). The participants showed moderate degree of body-image dysphoria (mean = 1.29, SD = 0.94), moderate levels of emotional intelligence and experienced moderate quality of life. According to the statistical analysis, women reported worse body image (p = 0.013) and university graduates showed higher levels of emotionality (p = 0.016). The correlations between the quality of life questionnaire subscales and demographic characteristics revealed statistically significant relationships between marital status and the Physical Functionality subscale, where unmarried people had a better quality of life in this subscale (p = 0.042) and between postgraduate/doctoral degree holders and the subscale Patient Satisfaction (p = 0.035). Also, statistically significant relationships were found between occupation and the Social Interaction subscale, where those engaged in household activities and were unemployed (p = 0.022) showed better quality of life. Participants living in semi-urban areas had better quality of life on the subscale Burden of Kidney Disease (p = 0.034). ESRD patients on peritoneal dialysis suffer significant limitations related to disease and treatment modality. According to our findings, these affect both their body image as well as their quality of life. Improvement in emotional intelligence is the factor which plays an important mediating role in improving both body image and quality of life in patients on peritoneal dialysis.

S-41-3: HYPERTENSION AND KIDNEY DISEASE IN SINGAPORE

The inter-related lifestyle non-communicable diseases of hypertension and diabetes accounts for 70 to 80% of all end-stage kidney disease (ESKD) in Singapore. Singapore is a multi-ethnic Asian society where the Chinese are the majority (76%), Malay (15%), Indian (9%), and other. The National Population Health Survey 2020 reported that the age-standardized prevalence of hypertension had increased from 21.9% in 2017 to 31.7% in 2019–2020, and more men (41.0%) were affected than women (30.2%). The prevalence of hypertension increased with age; starting at around 10% for those aged 18 to 29 years to 74.9% among those aged 70 to 74 years. Almost half (52.4%) of residents had not been previously diagnosed with hypertension. In adults with known hypertension, 35.7% had good control of their blood pressure (BP). Men (66.0%) had poorer BP control compared to women (62.2%). Among the ethnic groups, Malays (69.4%) had the highest proportion with poor BP control followed by Chinese (64.0%) and Indians (58.6%). The National Nutrition Survey 2018/9 reported that more than 90% exceeded the recommended amount of 5 g per day (average intake 9 g in 2018). This was due mostly to seasonings, salt, and sauces added during food preparation, which accounted for 75% of salt in the diet. We studied the usual clinical practice of hypertension management in chronic kidney disease (CKD) patients in the Nephrology clinics of an academic medical center. Despite intensive follow-up and access to medical care, many patients were unable to achieve the BP goals. We also compared the 24-hour urinary sodium excretion of healthy controls and CKD. Dietary habits vary by ethnicity, and the Indian population take more sodium than other groups. We developed a prediction equation in our population to determine the likelihood of exceeding 100 mmol of sodium in a 24-hour urine from an early morning spot urine sodium test. The age-standardized incidence rate (ASIR) of CKD5 was relatively stable at between 266.7 pmp and 295.3 pmp in 2011 to 2019. ASIR of CKD5 were higher among Malays than other ethnicities. ASIR of definitive dialysis increased from 169.6 pmp in 2011 to 187.3 pmp in 2020. About 39.6% of deaths in dialysis patients were due to cardiac causes. Overall, hypertension was a contributory factor to the main causes of death in the population of Singapore, being ischemic heart disease, cerebrovascular disease, CKD, and hypertensive disease.

An unexpected result of a routine cardiac consultation in a patient with nephrological problems

A 17.5-year-old boy, previously treated in a nephrology clinic due to chronic proteinuria, was referred for a routine cardiology consultation before being transferred to an adult clinic for further care. Physical examination and echocardiography showed no circulatory abnormalities and normal blood pressure, while echocardiography revealed an abnormal tumour-like structure measuring 1.3 × 1.5 cm in the left atrium, remaining in contact with the interatrial septum. Continuous infusion of heparin was started, after which no change in tumour size was obtained. The diagnosis was extended to include computed tomography, which showed a soft 1.5 × 2.1 × 2.1 cm tissue structure connecting with the interatrial septum with uneven contours, and magnetic resonance imaging, which indicated that the left atrial structure corresponded to myxoma, and the presence of enhancement spoke against the suspicion of a thrombus, although the presence of a small thrombus on the tumour could not be clearly excluded. The boy was qualified for a cardiac surgery, during which the pathological structure was removed and then sent for histopathological analysis, which revealed a heart tumour with myxoma. After the surgery, the patient was transferred to the department of paediatric cardiology for further treatment, where he received enoxaparin sodium, antibiotics and acetylsalicylic acid. After a few days, an about 1 cm layer of fluid appeared in the pericardium, which regressed after the incorporation of ibuprofen and dehydrating agents. After 2 weeks, the boy was discharged home in good condition, with a recommendation to continue care at a nephrology, cardiology and genetic clinic due to MTHFR mutation, which may be associated with hereditary hypercoagulability, detected during hospital stay.

Prevalence of obstructive sleep apnea in patients with chronic kidney disease: a hospital-based study.

Chronic kidney disease (CKD) is has been rising over the past few years, and obstructive sleep apnea (OSA) is a prevalent comorbidity in this population. To determine the prevalence of OSA in patients with chronic kidney disease stages I-V and end-stage renal disease (ESRD). Patients with CKD of varying grades and ESRD routinely visiting outpatient nephrology clinic or admitted in department of nephrology were included in the study. Stages I-III were categorized as early stages of CKD and stages IV-V and ESRD as late stages of CKD. Patients were categorized into a high risk group based on STOP-BANG and Berlin questionnaires. Patients who were high risk were subjected to in-hospital overnight level III polysomnography. Student's independent t-test and analysis of variance (ANOVA) were employed for the comparison of continuous variables. Chi-square test and Fisher's exact test, as appropriate, were used for the comparison of categorical variables. Of 111 patients, 46 (41%) were found to have OSA. Of these patients, 15 (33%) had mild OSA (AHI 5-14/h), 13 (28%) had moderate OSA (15-29/h), and 18 (39%) had severe OSA (AHI ≥ 30/h). Overall, 31% of patients in the early stage of CKD and 45% in the late stage were found to have OSA. This study demonstrated a high prevalence of OSA in patients withCKD when compared to the general population affecting both genders equally. The risk of OSAwas higher in the advanced stages of CKD compared to the early stages, and dialysis had no effect on prevalence. Since OSA increases the cardiovascular morbidity in CKD the leading cause of death in these patients, early diagnosis and treatment of OSAmay have promise to affect the mortality.