Population Studies Research Articles

Colliding harms of gambling and gaming: A four-wave longitudinal population study of at-risk gambling and gaming in Finland

Aims: Both gambling and digital gaming are growing in popularity and there is ongoing discussion about their convergence. This population-based longitudinal survey study investigated how gambling and digital gaming types contribute to at-risk gambling and gaming. Methods: The study was based on a representative sample of 18–75-year-olds from mainland Finland. Survey data were collected at 6 -month intervals in 2021–2022, starting in April 2021. Of original T1 respondents, 58.95% took part in all four time points. In total, 3,608 observations from 902 individuals were analysed. Outcome measures were at-risk gambling and gaming based on the Problem Gambling Severity Index and the Internet Gaming Disorder Test. Various types of gambling and gaming were investigated. Results: Population-averaged models showed that different forms of gambling were associated with a higher risk of at-risk gaming. Online casino games were associated with the highest likelihood of at-risk gambling and gaming. Prevalence of digital gaming problems was low. Hybrid models were used to investigate the longitudinal within-person and between-person effects of gambling and gaming activities. Online casino games and offline slot machines increased at-risk gambling. Microtransactions within digital games increased at-risk gambling and gaming over time, but the amount of money spent on digital gaming was small compared to gambling. Conclusions: Our results underline the risks of EGMs and online gambling for the participants. Although gambling and gaming are converging, harm is mostly based on gambling.

Prognostic Value and Limits of Heart Rate and QT—Corrected in A Large Population

Background: The study aimed to compare the prognostic importance of the heart rate (HR) and QT—corrected (QTc) according to Fridericia, Framingham, and Bazett with respect to all-cause mortality in a large non-selected population. Methods: The analysis of digital electrocardiograms archived from 2008 to 2022 in the metropolitan area of Modena, Italy, was carried out. The population under study was divided into three groups based on age, and survival analysis was performed. Results: 131,627 patients were enrolled and, during the follow-up (mean 1641.4 days), all-cause mortality was 8.9%. Both HR and QTc were associated with mortality. All-cause mortality significantly increased with HR values greater than 81 BPM and QTc values greater than 440 msec in young subjects and 455 msec in old subjects (values of the 75th percentiles/optimal operating point). A Cox analysis confirmed the better prognostic value of Bazett’s QTc and HR in the whole population and in the three age-groups. Conclusion: Bazett’s method performed better than the others, but, unexpectedly, the HR had the same or an even better correlation with all-cause mortality. Since the HR is simple and readily available, its evaluation should be improved. However, QTC and HR values are difficult to define, causing many confounding factors, and further population studies are required.

The Mediterranean diet is not associated with neuroimaging or cognition in middle-aged adults: a cross-sectional analysis of the PREVENT dementia programme.

The Mediterranean diet (MedDiet) has been associated with reduced dementia incidence in several studies. It is important to understand if diet is associated with brain health in midlife, when Alzheimer's disease and related dementias are known to begin. This study used data from the PREVENT dementia programme. Three MedDiet scores were created (the Pyramid, Mediterranean Diet Adherence Screener [MEDAS] and MEDAS continuous) from a self-reported food frequency questionnaire. Primary outcomes were hippocampal volume and cube-transformed white matter hyperintensity volume. Secondary outcomes included cornu ammonis 1 and subiculum hippocampal subfield volumes, cortical thickness and measures of cognition. Sex-stratified analyses were run to explore differential associations between diet and brain health by sex. An exploratory path analysis was conducted to study if any associations between diet and brain health were mediated by cardiovascular risk factors for dementia. In all, 504 participants were included in this analysis, with a mean Pyramid score of 8.10 (SD 1.56). There were no significant associations between any MedDiet scoring method and any of the primary or secondary outcomes. There were no differences by sex in any analyses and no significant mediation between the Pyramid score and global cognition by cardiovascular risk factors. Overall, this study did not find evidence for an association between the MedDiet and either neuroimaging or cognition in a midlife population study. Future work should investigate associations between the MedDiet and Alzheimer's disease and related dementias biomarkers as well as functional neuroimaging in a midlife population.

Environmental contaminants in Arctic human populations: Trends over 30 years

IntroductionArctic Monitoring and Assessment Programme (AMAP) monitors persistent organic pollutant (POP) levels in the Arctic populations and assesses health effects related to exposure to them. Many internationally regulated POPs persist in humans and biota, while new Emerging Contaminants of Arctic Concern (ECAC), many of which are unregulated, present additional challenges. Biomonitoring offers valuable insights into temporal trends within human matrices, revealing critical information not only about the efficacy of international regulations but also serving as an early warning system for exposure and risks for human health. MethodsData analyzed in this study is aggregated data presented in the AMAP Human Health in the Arctic assessments, which provide data on contaminant concentrations measured in human matrices from adults, and children across various population studies conducted in the Arctic since the 1980 s. Linear regression analyses were used to assess trends of various POPs including organochlorine (OCPs), polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs) and per- and polyfluoroalkyl substances (PFAS), measured over time from the Arctic populations in Finland, Norway, Sweden, Denmark, Iceland, Canada and Alaska (USA). ResultsOverall, decreasing trends were observed for PCBs and OCPs. Regulated PFAS showed decreasing trends, but increasing trends were observed for unregulated PFAS in certain populations. PBDEs showed decreasing or inconsistent trends in certain Arctic populations. ConclusionsDecreasing trends are observed for legacy POPs, but the trends for new emerging contaminants are inconsistent. More focus is needed on biomonitoring the new emerging contaminants of concern in the Arctic and their implications on human health.

Forensic evaluation of craniometric characteristics of the Kazakhstan population

BackgroundThe human skull is the part of the skeleton most frequently used in population studies, as it was more exposed to genetic factors and less exposed to environmental factors. The skull is an important component in human forensic identification. Materials and methodsThe craniometric characteristics of 186 male and 114 female skulls found on the territory of Kazakhstan were studied. Dimensions were measured using standard anthropometric methods and instruments. The results of measurements of 25 craniometric parameters are presented. Methods of descriptive and parametric statistics were used. ResultsStatistical analysis showed significant regional dimorphism, confirming theindividuality of the Kazakhstan population. Statistically significant deviations werefound in 6 male craniometric characteristics and 4 female craniometric characteristics(p<0.05). The most dimorphous variables for regional identification in Kazakhstanmales were the higher skull base and frontal chord width , full face height , condylarand bigonial width , and low mandibular body reference values (p<0.05). For females,significant statistical discrepancies were seen in the transverse diameter and skullbase width, mastoid and occipital aperture width (p<0.05). ConclusionThe recorded variations and changes in the morphology of the humanskull of the population of Kazakhstan indicate the need to develop and updateosteometric standards used in practice for specific populations. All this will significantlyimprove the accuracy of forensic identification and more fully study the biologicalpatterns of population formation, as well as evaluate the comparative effectiveness ofindividual features in the reconstruction of the population history of various populationgroups.

Photoplethysmography recordings preceding onset atrial fibrillation show a higher heart rate variability - a TeleCheck-AF subanalysis

Abstract Background An increased heart rate variability (HRV), mostly assessed by 12-lead electrocardiogram (ECG) or long-term Holter monitoring, can be associated with the onset of atrial fibrillation (AF). Data evaluating HRV measurements using digital devices, especially those using photoplethysmography (PPG), in patients at risk for AF are sparse. In this analysis, we aimed to assess if hand-held-based non-continuous PPG measurements can provide short-term HRV to predict AF. Methods Patients from the TeleCheck-AF project with at least one PPG measurement in AF and one measurement in sinus rhythm (SR) were analyzed. Briefly, patients were provided with a PPG-based heart rate/rhythm monitoring smartphone app. They were instructed to record a PPG measurements three times daily and in case of symptoms for seven consecutive days. Short-term HRV using root mean square of successive normal-to-normal interval differences (RMSSD) was calculated in recordings in SR and compared between those not preceding and preceding an episode of AF (figure 1). Results Overall, 136 patients [56.3% men, median age 66 (59; 72) years] were included in the analysis. Median total number of recordings per patient was 24 (19; 30) including 4 (2;7) AF episodes per 1 week recording period. RMSSD was significantly higher in PPG measurements preceding an AF episode than in PPG measurements not preceding an AF episode [42.5 (33.2;70.7)ms vs. 41.1 (32.4;54.7)ms; p&amp;lt;0.001]. Between-group comparison revealed no significant difference for gender, age, previous ablation or betablocker therapy (p=0.824; p=0.484; p=0.519 and p=0.624, respectively). Conclusion Short-term HRV based on RMSSD, assessed by digital hand-held devices is significantly higher in PPG recordings preceding an AF episode than in measurements not preceding a consecutive AF episode. Whether PPG-recording derived short-term HRV can help to predict onset-AF warrants further study in larger populations. Figure 1: Patient example and exemplary analysis scheme, depicting the total number of recordings (n=14). HRV of recordings in sinus rhythm (SR) not preceding an episode of atrial fibrillation (AF) (A; grey circles) were compared to recordings preceding a consecutive AF episode (B; blue circles).Figure 1

Causal association between systemic lupus erythematosus and primary biliary cholangitis: A bidirectional Mendelian randomization study.

An association has been observed between systemic lupus erythematosus (SLE) and primary biliary cholangitis (PBC) in observational studies, however, the exact causal link remains unclear. We aim to evaluate the causal relationships between SLE and PBC through bidirectional Mendelian randomization (MR). Single-nucleotide polymorphisms (SNPs) were selected as instrumental variables from publicly accessible genome-wide association studies (GWAS) in European populations. The PBC and SLE GWAS data were obtained from the MRC IEU Open GWAS database, consisting of 24,510 and 14,267 samples, respectively. After a series of quality control and outlier removal, inverse variance weighted was used as the primary approach to evaluate the causal association between SLE and PBC. The horizontal pleiotropy and heterogeneity were examined by the MR-Egger intercept test and Cochran Q value, respectively. Seven SNPs were included to examine the causal effect of SLE on PBC. Genetically predicted SLE may increase the risk of PBC development, with an odds ratio (OR) of 1.324 (95% confidence interval [CI] 1.220 ∼ 1.437, P ˂ .001). Twenty SNPs were included to explore the causal effect of PBC on SLE. Genetically predicted PBC may increase the risk of SLE development, with an OR of 1.414 (95% CI 1.323 ∼ 1.511, P ˂ .001). Horizontal pleiotropy and heterogeneity were absent (P > .05) among SNPs. The robustness of our results was further enhanced by using the leave-one-out method. Our research has provided new insights into SLE and PBC, indicating bidirectional causal associations between the 2 diseases. These findings offer valuable contributions to future clinical studies.

Molecular cytogenetic screening of sex chromosome abnormalities in young horse populations.

Chromosomal abnormalities occur in the equine population at a rate of approximately 2%. The use of molecular cytogenetic techniques allows a more accurate identification of chromosomal abnormalities, especially those with a low rate of abnormal metaphases, demonstrating that the actual incidence in equine populations is higher. Estimation of the number of carriers of karyotypic abnormalities in a sample from a population of young horses of various breeds, using molecular cytogenetic techniques. Cross-sectional. Venous blood samples were collected from 500 young horses representing 5 breeds (Purebred Arabian, Hucul, Polish primitive horse [Konik], Małopolska, Coldblood, Silesian). Chromosomes and DNA were obtained from blood lymphocytes and evaluated by fluorescence in situ hybridisation (FISH) and PCR, using probes and markers for the sex chromosomes and select autosomes. Nineteen horses, 18 mares and 1 stallion, were diagnosed with different chromosomal abnormalities: 17 cases of mosaic forms of sex chromosome aneuploidies with a very low incidence (0.6%-4.7%), one case of a SRY-negative 64,XY sex reversal mare, and one mare with X-autosome translocation. The percentage of sex chromosomal aberrations was established as 3.8% in the whole population, 6.08% in females and 0.49% in males. Limited sample size, confined to horses from Poland. The rate of sex chromosomal abnormalities we identified was almost double that reported in previous population studies that used classical chromosome staining techniques. FISH allowed the detection of aneuploid cell lines which had a very low incidence. The FISH technique is a faster and more precise method for karyotype examination; however, it is usually focused on only one or two chromosomes while banding karyotyping includes the entire chromosome set.

Views about the clinical, diagnostic and comprehensive treatment of plantar fasciitis: a review

INTRODUCTION. One of the problems in modern podiatry is plantar fasciitis. According to population studies, more than two million patients are treated for plantar fasciitis each year in the United States, 1 in 10 people will develop heel pain during their lifetime, and 1 % of visits to podiatrists are related to heel pain. Plantar fasciitis occurs in approximately 10 % of the general population, with 83 % of these patients being active working adults between the ages of 25 and 65. The high prevalence of plantar fasciitis in the population necessitates the search and development of new and effective methods for its recognition and treatment. AIM. Generalization of literature data on the mechanisms of development of plantar fasciitis, methods of diagnosis and treatment. MATERIALS AND METHODS. The databases PubMed, Scopus and the electronic scientific library eLIBRARY were searched for articles using the keywords: “plantar fasciitis”, “plantar fasciosis”, “heel pain”, “heel spur”. Search depth — 10 years. Publications related to the diagnosis and treatment of PF were selected. During the study, 40 publications were selected, the content of which, to one degree or another, corresponded to the purpose of this study. RESULTS AND DISCUSSION. Pain syndrome in the area of the heel bone is the main reason for seeking medical care in patients with plantar fasciitis. Currently, there are several approaches to the treatment of plantar fasciitis: conservative and surgical treatment. Conservative treatment is represented by methods of manual therapy, physical therapy, and physical therapy. Surgical methods include various variants of resection of the bony outgrowth of the calcaneal region and other interventions. CONCLUSION. Treatment of plantar fasciitis requires a multidisciplinary approach to treatment, as no single treatment method is universal. Conservative treatment of patients with plantar fasciitis should be comprehensive. Due to the high prevalence of plantar fasciitis in the population, the introduction of new treatment techniques and the development and use of a unified patient management tactic can improve patient outcomes and quality of life. Among other surgical methods, the use of RFD has a positive effect in patients with PF refractory to conservative therapy and is the least invasive method among surgical methods.

Geo-Analysis of Demographic Variables Affecting Females Working in Thi-Qar's State Health Sector

Demographic variables are essential to population studies as they are necessary to study population-related changes during a given period by uncovering births and deaths in a society. A given population generally grows following births and deaths. Births are key to the movement and development of that population, an upward-moving trend at present. This study is significant in that draws on facts on workers' births, fetal and infant mortalities, as well as the tempo-spatial variation of births and mortalities across Iraq's Thi-Qar. To this end, certain statistical methods have been adopted to investigate these variations. The study reported a noticeable marital fertility in the area under study by about 453.6 births per 1,000 married female health workers, while fetal mortalities for married female health workers amounted to (345.6) per 1,000 married female health workers in Thi-Qar. The study finds that net mortalities amounted to (219.04) deaths per 1,000 live births of married female health workers in Thi-Qar.

Opening Pandora's Box: Person-Sensitive Conceptualization and Measurement in Psychological Science.

Although distinctions between the study of persons, the study of populations, and the study of mechanisms are helpful for illuminating mismatches between research assumptions, problems, and methods, it may be difficult to construe these as entirely discrete branches of psychological science. I suggest that it is more appropriate to view person-levelness (or person-sensitivity) as an ideal we should actively aspire toward, within the constraints placed by other goals such as generalizability and feasibility, when pursuing knowledge about individuals. It is an ideal that we can never hope to perfectly realize-the degree to which it is realized will always be a matter of degree, and there is therefore no clear line of demarcation between the person level and other branches of psychology. This ideal can nonetheless stimulate more person-sensitive conceptualizations, measurements, and analyses.

#2509 Longitudinal haemoglobin levels and mortality in an elderly population with advanced chronic kidney disease: insights from the EQUAL Study

Abstract Background and Aims The relationship between haemoglobin (Hb) levels and clinical outcomes in chronic kidney disease (CKD) is more intricate than previously understood, as both low and high values can have detrimental effects. Although the association between Hb and patient outcomes is widely reported, few studies have focused on older patients with advanced CKD or have explored this relationship both before and after kidney replacement therapy (KRT) initiation. The primary objective of this study is to describe the relationship between Hb levels and mortality in older patients with advanced CKD in the continuum from pre-KRT phase to subsequent KRT initiation, and to evaluate any effect modification by KRT initiation. Method We used data from the European QUALity Study on treatment in advanced CKD (EQUAL) cohort which includes patients aged ≥65 years and eGFR ≤20 ml/min per 1.73 m2 from six European countries. The association between Hb and all-cause and cause-specific mortality (cardiovascular [CV] and non-cardiovascular [non-CV] mortality) was explored in three separate CKD populations: pre-KRT, KRT and transition-CKD (transition phase surrounding the start of KRT) population. Multivariable adjusted time-dependent Cox regression models and natural cubic splines were used to investigate the association between longitudinal Hb levels (as categorical and continuous variable) and mortality risk in the pre-KRT and KRT population. The area under the Hb trajectory (AUC Hb) before KRT initiation was calculated to evaluate the relationship between the cumulative exposure of Hb before KRT initiation and all-cause mortality after KRT initiation in the transition-CKD population. We evaluated effect modification by pre-specified variables on the relationship between Hb and mortality. Results Overall, 1716 CKD patients were included in the study. During a median follow up of 3.0 years (IQR 2.6), 614 patients died, resulting in a 5-year survival probability of 51% (95% CI 48, 55). Low Hb levels were consistently associated with increased mortality risk in all study populations (Figure). A U-shaped association between both the lowest and highest levels of Hb and mortality risk was observed (Figure). A similar association was observed for non-CV mortality, with lower Hb values associated with an increased mortality risk (Figure). Conversely, a trend towards higher risk of cardiovascular death was observed as Hb levels increase, especially in the whole population and pre-KRT population (Figure), albeit not statistically significant. Low cumulative exposure of Hb in the transition-CKD population was associated with increased mortality risk after transitioning to KRT (p = 0.047). In subgroup analysis diabetic patients were more susceptible to low Hb levels (p-value for interaction = 0.003) while patients on ESA therapy (p-value for interaction = 0.005) or initiating KRT (p-value for interaction = 0.024) showed increased mortality risk for high Hb levels. Conclusion The relationship between Hb levels and mortality in advanced CKD patients is complex. Low Hb levels consistently indicate an increased risk of mortality, while high Hb levels also appear to have a negative effect, increasing mortality risk, particularly in patients receiving ESA therapy and after KRT initiation. Our work emphasizes how different stages of advanced kidney disease (i.e., before and after initiating KRT), as well as comorbidities such as diabetes or medications such as ESA therapy can significantly influence the relationship between Hb and mortality.

#2327 Extent of proteinuria in autosomal dominant Alport syndrome compared to X linked Alport syndrome

Abstract Background and Aims Alport syndrome (AS), as first described by Arthur Cecil Alport in late XIX century, encompasses a clinical picture of neurosensorial hypoacusia, ocular abnormalities, hematuria and proteinuric kidney disease progressing to end-stage kidney disease in the young adulthood. Differently from X-linked and autosomal recessive AS, autosomal dominant AS (ADAS), a more recently recognized entity, whose prevalence based on populational studies may be near to 1%, generally presents with a milder kidney involvement and with negligible extrarenal features. Nevertheless, some of these patients progress to chronic kidney disease (CKD) category G5, with marked intra and interfamilial variability. Although hematuria is almost universally present all three inheritance patterns, the magnitude of proteinuria, a reliable prognostic marker of the X-linked form has not been thoroughly studied in ADAS. We aimed to compare the extent of proteinuria between patients with X-Linked and autosomal dominant AS. Method Retrospective registry data on type of Alport hereditary pattern and spot urine protein to creatinine ratio per CKD category were collected. The 2021 CKD-EPI formula for calculation of glomerular filtration rate (eGFR) was used. Non-parametric test was used to analyze variables that did not follow normal distribution. Results We analyzed proteinuria and eGFR of 127 patients with Alport Syndrome. Information on patient gender, hereditary pattern and gene involved is illustrated it Table 1. Increased proteinuria was observed with CKD progression in all categories (p &amp;lt; 0.05). Within each CKD category, X-linked males had greater median proteinuria followed by, X-linked females and autosomal dominant patients (Table 2 and Fig. 1). No difference in median proteinuria was observed between X-linked females and those with autosomal dominant inheritance throughout CKD categories G1, G2, G4 and G5 (p = 0.142, 0.878, 0.327, 0.909 respectively). Difference in median proteinuria between X-linked females and autosomal dominant inheritance revealed statistical significance in CKD category G3 (p = 0.034), however the small sample size in this group must be taken into account. Conclusion Pathogenic variants in COL4A3, COL4A4, and COL4A5 are all causes of CKD, and proteinuria serves as a hallmark of disease progression. However, the extent of proteinuria in ADAS is significantly lower than that observed in XLAS. Additionally, some ADAS patients develop CKD with only albuminuria. While there is still much to be understood about this common condition, the renal mechanism of damage in ADAS appears to differ definitively from that in XLAS or ARAS.

Bone fracture is associated with incident myocardial infarction in long-term follow-up

BackgroundThe association between bone fracture and cardiovascular diseases is examined in this study. While basic research has established a connection between fractures and heart attacks through the linkage between bones and arteries, population studies have not provided clear evidence. The aim of the present study is to investigate the association between bone fracture and the occurrence of myocardial infarction in a natural population during long-term follow-up.MethodsA total of 13,196 adult participants with bone fracture history at baseline from the China Health and Nutrition Survey (CHNS) prospective cohort were included in this study. Baseline investigation was performed in 1997–2009 and the outcome was followed up till 2015. Hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) were calculated using Cox proportional hazards models.ResultsFrom 1997 to 2015, a total of 329 incident myocardial infarction cases were identified. In univariate and multivariate Cox regression analysis, a history of bone fracture was associated with an increased risk of myocardial infarction incidence in the total population (for the crude model: HR = 2.56, 95% CI 1.83–3.53, P < 0.001; for the multivariate model: HR = 1.43, 95% CI 1.02–1.99, P = 0.036). In the stratified analysis, bone fracture was not associated with an increased risk of incident myocardial infarction in subjects with age < 50 years (HR = 0.71, 95% CI 0.34–1.47, P = 0.356), but significantly associated with an increased risk of incident myocardial infarction in subjects with age ≥ 50 years (HR = 1.80, 95% CI 1.23–2.63, P = 0.003).ConclusionsIt is suggested by the present study that bone fracture may be associated with an increased risk of incident myocardial infarction in the elderly population during long-term follow-up.

#2589 Predictive value of serum lactate in ICU dialysis-dependent AKI patients

Abstract Background and Aims Hyperlactatemia is frequently observed in critically ill patients. It is often associated with unfavorable outcomes and serves as a strong predictor of mortality. Renal replacement therapy aims to mitigate lactate accumulation in this particular subgroup of patients, but the effectiveness of this therapy in reducing morbidity and mortality in acute kidney injury (AKI) associated lactic acidosis remains inconclusive. The aim of this retrospective study was to evaluate the predictive role of serum lactate in dialysis-dependent AKI patients stratified on three different underlying etiologies (septic shock, concomitant liver failure and metformin-associated lactic acidosis). Method A retrospective, single-center cohort analysis was conducted to examine patients with AKI who underwent hemodialysis in our ICU between 2022 and 2023 and had a serum lactate &amp;gt; 4 mmol/L. Patients were stratified according to underlying etiology: isolated septic shock with AKI, shock with concomitant AKI and fulminant liver failure (serum ammonia &amp;gt; 100 µmol/L), and AKI with metformin-associated lactic acidosis (MALA). We compared patients according to age and 3-day, 30-day, and 90-day mortality. Finally, we performed receiver-operating-curve (ROC) analysis to potential predictive power of serum lactate for 30-day mortality. Results The median age of our cohort of 63 patients was 67 (range 52 - 74) years, with a median lactate level of 12.9 (7.6 – 18.0) mmol/L. The 3-day, 30-day and 90-day mortality rate was 57%, 78%, and 83%, respectively. We observed that patients with concomitant liver failure were significantly younger (p = 0.004). Interestingly, while all groups have comparable 90-day mortality, patients with septic shock exhibit extremely high 3-day mortality (74%), compared to 35% and 25% for acute liver failure and metformin-associated shock. ROC curve analysis showed that serum lactate was highly predictive of 30-day mortality in group of AKI with concomitant fulminant liver dysfunction. On the contrary, in metformin-associated hyperlactatemia the level of serum lactate showed no such prediction. Conclusion Our retrospective analysis underscores the crucial importance of differentiating between various groups of patients (septic shock, concomitant liver failure and metformin-associated lactic acidosis) in patients with hyperlactatemia. In metformin-induced kidney failure, the level of lactate does not predict mortality, while in the cases of AKI with concurrent acute liver dysfunction our results are highly suggestive that dialysis may not be effective for severe lactacidosis. The findings contribute valuable insights for designing future prospective studies in this complex patient population.

#2224 Higher serum level of indoxyl sulfate is not associated with increased abdominal aorta calcification in patients on maintenance hemodialysis

Abstract Background and Aims Vascular calcification is strongly associated with an increase in all-cause and cardiovascular mortality, especially in patients with and stage renal disease. Results of numerous experimental studies have shown direct toxic effect of microbial-derived uremic toxins on vascular endothelial and smooth muscle cells which may contribute vascular calcification. Meanwhile, the effects of these metabolites on vascular remodeling in patients receiving dialysis treatment remains largely unclear. Here we aimed to investigate the relationship between serum level of the uremic toxin indoxyl sulfate and severity of abdominal aorta calcification (AAC) in patients on maintenance hemodialysis. Method This single-center, cross-sectional study included eighty (40 men, average age – 59,7±11,8 years) clinically stable patients receiving hemodialysis treatment for 52(21,3-120) months. 13(16,3%) participants had history of smoking, 27(33,8%) were diabetic, 63(78,8%) had high blood pressure, 17(21,3%) – previous history of ischemic heart disease, including 5(6,3%) suffered a myocardial infarction. Severity of AAC was determined by lateral lumbar radiography with Kauppila scoring. The total AAC score ranged from 0 to 24 points, and a higher AAC score indicated a more pronounced degree of calcification. Routine laboratory data were collected before hemodialysis session after fasting for 12 hours. Serum concentration of indoxyl sulfate was assessed by ELISA using commercially available kit (Cloud-Clone Corp., USA). Statistical analysis was performed with IBM SPSS Statistics 26 program. Non-parametric Spearman's rank correlation method was used to evaluate the associations between the studied parameters. Value of p &amp;lt;0.05 was considered statistically significant in all tests. Results Median serum indoxyl sulfate was 2,1(1,4-3,0) μmol/l (the same parameter in relatively healthy individuals without impaired renal function is 0,1(0-0,3) μmol/l, р˂0,001). Serum levels of calcium (Ca) was 2,27(2,1-2,5) mmol/l, ionized calcium (Ca++) – 1,15(1,1-1,3) mmol/l, phosphate (P) – 1,6(1,3-2,0) mmol/l, intact parathyroid hormone (iPTH) – 303(162,2-492,8) pg/ml, total cholesterol (TH) – 4,5(3,5-5,4) mmol/l, low-density lipoprotein (LDL) – 2,6(2,0-3,3) mmol/l. AAC score in hemodialysis participants was 4,5(0,0-9,0) and significantly correlated with age (r=0,693; р˂0,001), Ca (r=0,208; р=0,04) and iPTH (r=0,418; р=0,021) but not with other indicators, including indoxyl sulfate concentration (r=0,164; р=0,147). Conclusion Our preliminary results do not allow to consider the elevated level of indoxyl sulfate as a factor contributing to increased AAC in patients on maintenance hemodialysis. Further prospective studies in larger populations should clarify the true role of indoxyl sulfate in vascular remodeling in individuals with chronic kidney disease.

#1422 Exploring BAFF, APRIL, and clinical characteristics in IgA nephropathy: a decade-long study in the Bulgarian population

Abstract Background and Aims IgA nephropathy (IgAN) represents a significant global health concern, contributing substantially to chronic kidney disease and renal failure. Despite its widespread impact, the Bulgarian population lacks comprehensive epidemiological data and specific biomarkers for IgAN. This decade-long retrospective study, conducted at a tertiary Nephrology Clinic in Bulgaria, aims to explore the clinical characteristics and serum levels of BAFF and APRIL in biopsy-confirmed IgAN patients and healthy controls. Method The study includes 125 biopsy-confirmed IgAN patients and 30 healthy controls. Notably, 70.4% of IgAN patients were male, with an average age of 35.94 ± 11.91 years. Baseline characteristics reveal advanced disease stages at diagnosis, possibly linked to delayed biopsy (24.22 ± 32.9 months from initial symptoms) and the absence of a screening program. Analyses of serum biomarkers (C3, BAFF, and APRIL) are conducted to identify any significant variations between IgAN patients and healthy volunteers. Results The average baseline estimated glomerular filtration rate (eGFR) was 61.78 ± 27.72 ml/min/1.73 m², with a mean serum creatinine of 126 ± 67.83 μmol/l at the time of kidney biopsy. Among the patients, 51.2% had an eGFR below 60 ml/min, indicating CKD stage 3 or worse according to the KDIGO classification Binary logistic regression analysis identifies anemia as a significant contributor to disease progression, with a risk influence approximately 3.3 times higher for GFR decline over time. Anemia emerges as a crucial predictor for serum creatinine doubling, carrying a higher risk than hyperuricemia. Analyses of C3 (p = 0.658), BAFF (p = 0.432), and APRIL (p = 0.227), demonstrated no significant differences in their serum levels between IgAN patients and healthy volunteers. Conclusion This study provides comprehensive insights into IgAN in the Bulgarian population, addressing the dearth of epidemiological data and biomarkers. Anemia emerges as a significant predictor for disease progression, emphasizing its potential clinical relevance. However, C3, BAFF, and APRIL exhibit no notable variations, underscoring the need for additional biomarker exploration to enhance understanding of IgAN dynamics in this population.

#2970 Heart failure with preserved ejection fraction on chronic kidney patients: innocent bystander? A cohort study in Portuguese population

Abstract Background and Aims Heart failure (HF) consists in a significant public health challenge, with high prevalence worldwide and a substantial impact on morbidity and mortality. In chronic kidney disease (CKD), HF can act both as a risk factor and a complication, exacerbating the overall outcomes for affected individuals. This study aims to elucidate the prevalence of distinct types of heart failure, encompassing preserved ejection fraction (HFpEF), mid-range ejection fraction (HFmrEF), and reduced ejection fraction (HFrEF) in CKD patients. Moreover, we purpose to identify the potential of these subtypes to influence the outcomes of mortality and start of kidney replacement therapy (KRT), as a different therapeutic approach is suitable for each. Method Observational retrospective cohort study of 3008 CKD patients, with follow-up in Nephrology out-patient clinic in a Portuguese hospital, from February, 2012 to October, 2019. Ejection fraction was accessed by echocardiogram and information was collected from health records. To access mortality, patients who started KRT along the study were excluded. Results A total of 3008 patients, of which 91.7% Caucasians and 54.5% males, with an average age of 68.2 (±15.9) years was enrolled in the study. The mean follow-up time was 3.21 (±1.97) years and the mean estimated glomerular filtration rate at baseline was 47.63 ± 33.1 ml/min/1.73 m2. Among the participants, 769 individuals (25.5%) were diagnosed with HF. Specifically, 319 patients (41.5%) exhibited HFpEF; 85 patients (11%) had HFmrEF, and 117 patients (15.2%) had HFrEF, while the ejection fraction (EF) was unknown in 32.2% of cases. In the HF group, the incidence of diabetes was 55.6%, compared to 37.5% in the non-HF group. As for hypertension, the prevalence of was 91.8% in the HF group and 78.6% in the non-HF group. When assessing all-cause mortality during the follow-up, the hazard ratio (HR) for the HF group was 3.54 (95% CI, 2.94-4.26) compared to the non-HF group. Furthermore, for the initiation of KRT, the HR was 1.57 (95% CI, 1.19-2.06), favoring patients without heart failure. Across different types of HF, in comparison to the group without HF, the hazard ratio during follow up were notably different. Specifically, the HR was 5.39 (95% CI, 3.66-7.94) for patients with HFrEF, 3.43 (95% CI, 2.18-5.40) for patients with HFmrEF and 2.99 (95% CI, 2.32-3.87) for the HFpEF. When assessing the initiation of kidney replacement therapy (KRT), HFrEF and HFpEF also exhibited statistically different data comparing to those without HF. Specifically, HFrEF showed a HR of 2.14 (95%, 1.27-3.63), while HFpEF had a HR of 1.79 (95%, 1.25-2.56). The Kaplan-Meier analysis demonstrated a steeper descent curve for both survival and start of KRT for the HF group compared to the non-HF group (log-rank p &amp;lt; 0.0001) over the study period. Within the HF group, the worst survival outcomes were observed in the HFrEF subgroup, followed by HFmrEF and HFpEF (log-rank p &amp;lt; 0.0001). Conclusion Heart failure is a prevalent condition in CKD patients and worsens outcomes. Our analysis of real-world data suggests a threefold higher risk of mortality among for patients with HF, and a fivefold increase in the subgroup of HFrEF, comparing to patients without HF. Notably, preserved EF yielded a HR of 3.3 for mortality when compared to those without heart failure, underscoring the importance of clinical accurate assessment, since both entities may present with preserved ejection fraction in echocardiogram. Despite the study's sample limitations and the fact that it is unicentric, we believe this work holds significance as it highlights the importance of the establishment of different degrees of HF as it can change the prognosis in terms of mortality and progression to kidney replacement therapy in CKD patients. In addition to the established association between reduced EF and mortality, the HFpEF showed to exert a notable influence on outcomes comparing to patients without HF. This emphasizes the importance of not neglecting this entity, as it should treated appropriately.

#2191 Platelet function in chronic kidney disease; can flow cytometry guide in the difficult balance between risk for bleeding versus thrombotic events?

Abstract Background and Aims Increased risk of bleeding is a well-known complication of chronic kidney disease (CKD). However, these patients also have an increased risk of thrombotic events. Several studies have implicated both impaired and enhanced platelet function in patients with chronic kidney disease, but results vary between different studies and methods. Flow cytometry has emerged as a new method to study platelet function. Our aim was to investigate platelet function using flow cytometry in patients with chronic kidney disease. Method 20 patients were included between February and May 2023. Pre-dialytic patients with an eGFR between 8-20 mL/min/1,73 m2 were included, mean eGFR 14.7 mL/min/1,73 m2. Patients with platelet levels &amp;gt;100 × 109/L were included. Medication in the form of anticoagulants, NSAIDs, platelet inhibitors or SSRIs were used as exclusion criteria. Platelet activation assay was performed with flow cytometry. The expression of activation markers PAC-1 (activated GPIIb/IIIa), CD62P (P-selectin) and CD63 (dense granules) were analysed before and after activation with ADP, CRP-XL (collagen stimulating peptide, activates GPVI) or TRAP-6 (stimulates platelet activating receptor 1, PAR1). Platelets from 20 healthy control subjects were analysed for comparison. Results The level and size of platelets (MPV) were comparable in both groups. There were significantly higher levels of D-dimer in the CKD group vs healthy controls (1,17 mg/L FEU vs 0,27 mg/L FEU). Except for the decreased expression of activated GPIIb-IIIa receptor after activation with ADP and CRP-XL in one patient, the platelet activation did not significantly differ between CKD patients and healthy controls. Conclusion No significant differences in the activation of platelets were observed between the CKD population and the healthy controls when analysed by flow cytometry. Elevated levels of D-dimer in CKD patients have previously been described and are believed to be due to increased fibrin formation, lysis and decreased renal clearance. Further studies in a larger patient population, including thrombocytopenic patients are planned, with greater focus to be placed on dense granula quantities which may correlate with decreased levels in the CKD population.

Analysis of admixed Greenlandic siblings shows that the mean genotypic values for metabolic phenotypes differ between Inuit and Europeans

BackgroundDisease prevalence and mean phenotype values differ between many populations, including Inuit and Europeans. Whether these differences are partly explained by genetic differences or solely due to differences in environmental exposures is still unknown, because estimates of the genetic contribution to these means, which we will here refer to as mean genotypic values, are easily confounded, and because studies across genetically diverse populations are lacking.MethodsLeveraging the unique genetic properties of the small, admixed and historically isolated Greenlandic population, we estimated the differences in mean genotypic value between Inuit and European genetic ancestry using an admixed sibling design. Analyses were performed across 26 metabolic phenotypes, in 1474 admixed sibling pairs present in a cohort of 5996 Greenlanders.ResultsAfter FDR correction for multiple testing, we found significantly lower mean genotypic values in Inuit genetic ancestry compared to European genetic ancestry for body weight (effect size per percentage of Inuit genetic ancestry (se), −0.51 (0.16) kg/%), body mass index (−0.20 (0.06) kg/m2/%), fat percentage (−0.38 (0.13) %/%), waist circumference (−0.42 (0.16) cm/%), hip circumference (−0.38 (0.11) cm/%) and fasting serum insulin levels (−1.07 (0.51) pmol/l/%). The direction of the effects was consistent with the observed mean phenotype differences between Inuit and European genetic ancestry. No difference in mean genotypic value was observed for height, markers of glucose homeostasis, or circulating lipid levels.ConclusionsWe show that mean genotypic values for some metabolic phenotypes differ between two human populations using a method not easily confounded by possible differences in environmental exposures. Our study illustrates the importance of performing genetic studies in diverse populations.