Glorieux, Griet

Pletinck, Anneleen

Schepers, Eva

Van Biesen, Wim

Ghent University Academic Bibliography

6Nephrology, Instituto Nacional de Cardiologıa - Ignacio Chavez, Mexico City, Mexico,7Nephrology, Universita degli Studi di Bari “Aldo Moro”, Bari, Italy and 8Nephrology,Universita della Campania “Luigi Vanvitelli”, Caserta, ItalyINTRODUCTIONANDAIMS: Protein energy waste (PEW), in the context of themal-nutrition inflammation and atherosclerosis syndrome, is a common problem in elderlypatients, even in the context of high dialysis efficiency. Increasing energy and proteinintake is usually not sufficient to reverse the syndrome, so nutritional supplements mayhelp to improve nutritional parameters. The best choice of nutritional supplementsand the indications for intra dialytic or extra dialysis supplements is not agreed. Aim ofthis study was to analyse patients’ choices and indications for three different kinds ofsupplements.METHODS: In hospital dialysis French Centre, at time of study (December 2017), 95chronic patients were on treatment (median comorbidity according to Charlson index(CCI): 9; median age 73 years; medianMalnutrition inflammation Score 7 (moderatemalnutrition)). All patients with albumin level<3.5 g/dL, or with other signs of PEWwere offered 4 options: no supplements (not tasty, toomany pills etc); intradialysis sup-plements (on the average 250 Kcal and 20 g proteins); extradialysis supplements (sameproducts 1-2 times per day); keto and amino acid supplements (Ketosteril 1 pill per 8-10 Kg of body weight). Patients could choose among creams, beverages and pills, thelatter were preferred in obese patients and in patients who did not like sweet supple-ments. The median cost for Ketosteril supplementation was 3 Euros/day, roughlyequivalent to the cost of hypercaloric and hyperprotidic beverages, creams and pills (2-8 Euros).RESULTS:Out of the 95 patients, 43 patients with albumin levels<3.5 g/dL acceptednutritional supplements. 10 of them chose intradialysis supplements (mean age 67.7years; median CCI: 9; 60% onHDF, 40% onHD); 16 were supplemented at home(mean age 76,43 years; median CCI: 8; 62% onHD, 38% onHDF); 17 were onKetosteril (mean age 70,35 years; median CCI: 8; 64% onHD, 36% onHDF); 2 of themtook both Ketosteril and extradialysis supplements. Compliance was good to the threetreatments (the main reasons for discontinuation was the improvement in the nutri-tional status). Albumin levels, taken as the main marker of malnutrition, responded tosupplementation in the absence of other events (infectious or cardiovascular). After atleast 1 month of treatment, albumin levels increased in the 90% of patients (meanincrease 0.2 g/dl; mean albumin levels pre-supplementation: 2.8 g/dl; mean albuminlevels post-supplementation: 3 g/dl), without significant differences between the threegroup (p¼ 0.28). No side effect was observed.CONCLUSIONS:An integrated, multiple-offer of intra and extradialysis supplementsmay be important for allowing each patient finding the best nutritional integration.While the frequent problems (infectious, cardiovascular, neoplasia) limit the possibilityto evaluate efficacy, the absence of side effects and the good compliance suggest extend-ing offer of nutritional supplements to virtually all elderly and high-comorbidity dialy-sis patients.SP380 ENDOTHELIAL GLYCOCALYX DAMAGE IN CKD: ROLE OF THEUREMIC TOXIN INDOXYL SULFATEAnneleen Pletinck1, Eva Schepers1, Wim Van Biesen1, Griet Glorieux11Nephrology Division, Ghent University Hospital, Ghent, BelgiumINTRODUCTIONANDAIMS:Damage to the endothelial glycocalyx (eGC) is a cru-cial step in the development of cardiovascular disease (CVD). By using a rat model, wewere able to link the protein-bound uremic toxin indoxyl sulfate (IxS) to eGC disrup-tion as indicated by shedding of its fragments into the circulation. We thereforehypothesize that eGC damage could be one of themechanisms by which IxS contributesto an increased risk of CVD in chronic kidney disease (CKD) patients. To test thishypothesis in the clinical setting, the present study investigates whether the increase inIxS with CKD progression was accompanied by changes in markers for endothelial dys-function and eGC disruption.METHODS: Plasma samples were obtained frommatched healthy donors (n¼13) andpatients from CKD stage 1&2 (n¼10), CKD stage 3 (n¼7) and CKD stage 4&5 (n¼11).Concentrations of IxS were determined by UPLC. Circulating syndecan-1 (Sdc-1; oneof the major components of the eGC), Matrix metalloproteinase 7 (MMP-7; an eGCdegrading enzyme) and different markers of endothelial dysfunction (Angiotensin 2[Ang-2], Vascular Cell AdhesionMolecule 1 [VCAM-1], Intercellular AdhesionMolecule 1 [ICAM-1], E-selectin, P-selectin) were simultaneously detected with aLuminex assay (R&D systems).RESULTS: Concentrations of IxS and Sdc-1 are both significantly higher in patientswith CKD stage 4&5 compared to the other groups. P-selectin and E-selectin were sig-nificantly upregulated from CKD stage 3 and stage 4&5 on, respectively. Plasma levelsof MMP-7 are significantly increased at all stages of CKD compared with healthy con-trols, andmoreover precedes the shedding of eGC degradation fragments. An incre-ment of Ang-2 levels was observed throughout the consecutive CKD stages.Despite the rather low predicitive power at the level of the individual patient, correla-tions were observed between Total IxS and Sdc-1 (r¼ 0.664, p< 0.001) andMMP-7 (r¼ 0.410, p¼ 0.01) and between Free IxS and Sdc-1 (r¼ 0.566, p< 0.001), Ang-2 (r¼0.516, p< 0.01) andMMP-7 (r¼ 0.405, p< 0.01).CONCLUSIONS:Notwithstanding the low number of patients, these data confirm apossible link between IxS and eGC damage and strengthen the hypothesis that the nega-tive impact of IxS on composite cardiovascular outcomes could be mediated by damageto the eGC. In the near future, we will expand this cohort and link these data to cardio-vascular events andmortality.SP381 MODERATELY PROTEIN-RESTRICTED, PLANT-BASEDSUPPLEMENTED DIETS IN PREGNANT CKD PATIENTS:EFFECT ON UTERO-PLACENTAL DOPPLER FLOWSBenedetta Montersino3, Fosca Minelli3, Federica Fassio2, Filomena Leone2,Loredana Colla4, Marilisa Biolcati3, Pietro Gaglioti, Manuela Oberto3,Tullia Todros3, Rossella Attini3, Giorgina Barbara Piccoli1,41Nephrology, Centre Hospitalier Le Mans, Le Mans, France, 2Materno-Foetal Unit,University of Turin, torino, Italy, 3Materno-Foetal Unit, University of Turin, Turin, Italyand 4Nephrology, University of Turin, Turin, ItalyINTRODUCTIONANDAIMS: Pregnancy is increasingly common in patients withadvanced or intensely proteinuric CKD, posing ethical and pragmatic problems.Previous experiences with plant based diets showed better stabilisation of kidney func-tion and proteinuria and equal or better foetal growth at delivery as compared withpatients on unrestricted diet. No data were so far available on fetal growth during preg-nancy. Aim of the study was to analyse foetal growth and Doppler indexes (uterine andumbilical arteries) in pregnant CKD patients followed-up in the same settings, who didor did not follow the study diet in pregnancy.METHODS: From the database of the “kidney and pregnancy” Unit, prospectivelyupdated since 2000, we selected all patients with at least one Doppler control in ourCenter (after 24 weeks; in case of more findings we considered the last one), and withCKD stage 3 and/or with proteinuria above 1 g at start of pregnancy or nephrotic at anytime. The patients were stratified according to the diet followed: Plant-based supple-mentedmoderately protein-restricted diets (the cases) (protein intake 0.6-0.8 g/Kg/day, 1-3 unrestricted meals per week, supplemented with alpha-ketoacids and aminoa-cids 1 tablet/8 Kg of body weight); CKD unrestricted diets (due to later referral, per-sonal choice, milder disease) (the controls). Before 2011, only patients with stage 3b-5CKD and nephrotic proteinuria were managed with the diet; after 2011 the diet wasproposed to all patients with CKD stages 3-5 not on dialysis and with nephrotic or sub-nephrotic proteinuria.RESULTS:Overall, 41 patients followed the diet in pregnancy; 34 were selected for thestudy (3 twin pregnancies, 2 patients without ecographic data, 1 miscarriage and 1 vol-untary termination were excluded); the control group consisted of 20 patients (5 mis-carriages were excluded). The 2 groups were similar for age and BMI; proteinuria wasnon-significantly higher in on-diet patients, CKD stage and creatinine were non-signif-icantly higher in the control group. No difference was found as for neonatal weight, ges-tational age at referral, caesarean section, birth weight centile. Prevalence of uterineDoppler flow impairment was non-significantly higher in control patients, while thedifference in umbilical Doppler flow, better preserved in on-diet patients, was highlysignificant (p¼0.009). The incidence of foetal growth restriction (FGR) was lower inon-diet patients (5.9%) than in control group (25%), but statistical significance wasnot reached (p¼0.057) (Table).Abstracts Nephrology Dialysis Transplantationi474 | AbstractsDownloaded from https://academic.oup.com/ndt/article-abstract/33/suppl_1/i474/4998345by Ghent University useron 20 July 2018

Endothelial glycocalyx damage in CKD : role of the uremic toxin indoxyl sulfate

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Endothelial glycocalyx damage in CKD : role of the uremic toxin indoxyl sulfate

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