bluuebunny/crossref_metadata_2025 huggingface dataset:
#1478 Effect of low vs standard dialysate sodium on 48-h ambulatory blood pressure in patients with intradialytic hypertension: a randomized crossover study
Authors: Iatridi Fotini , Ekart Robert , Efstathios Xagas , Revela Ioanna , Karpetas Antonios , Theodorakopoulou Marieta P , Karagiannidis Artemios , Georgiou Areti , Malandris Konstantinos , Tsouchnikas Ioannis , Sarafidis Pantelis
Published: May 2024

Background and Aims

Intradialytic hypertension (IDH) is associated with increased risk for cardiovascular events and mortality. Patients with IDH exhibit higher 48-h blood pressure (BP) levels than patients without this condition. Volume and sodium excess are considered a major factor contributing in the development of this phenomenon. This study evaluated the effect of low (137 mEq/L) compared to standard (140 mEq/L) dialysate sodium concentration on 48-h BP in patients with IDH.

Method

In this randomized, single-blind, crossover study, 29 patients with IDH underwent 4 hemodialysis sessions with low (137 mEq/L) followed by 4 sessions with standard (140 mEq/L) dialysate sodium or vice-versa. Mean 48-h BP, pre-/post-dialysis and intradialytic BP, pre-dialysis weight, interdialytic weight gain (IDWG) and lung ultrasound B-lines were assessed.

Results

Mean 48-h SBP/DBP were significantly lower with low compared to standard dialysate sodium concentration (137.6 ± 17.0/81.4 ± 13.7 mmHg with low vs 142.9 ± 14.5/84.0 ± 13.9 mmHg with standard dialysate sodium, p = 0.005/p = 0.007 respectively); SBP/DBP levels were also significantly lower during the 44-h and different 24-h periods. Low dialysate sodium significantly reduced post-dialysis (SBP/DBP: 150.3 ± 22.3/91.2 ± 15.1 mmHg with low vs 166.6 ± 17.3/94.5 ± 14.9 mmHg with standard dialysate sodium, p < 0.001/p = 0.134 respectively) and intradialytic (141.4 ± 18.0/85.0 ± 13.4 mmHg with low vs 147.5 ± 13.6/88.1 ± 12.5 mmHg with standard dialysate sodium, p = 0.034/p = 0.013, respectively) BP compared with standard dialysate sodium. Pre-dialysis weight, IDWG and pre-dialysis B-lines were also significantly decreased with low dialysate sodium.

Conclusion

Low dialysate sodium concentration significantly reduced 48-h ambulatory BP compared with standard dialysate sodium in patients with IDH. These findings support low dialysate sodium as a major non-pharmacologic approach for BP management in patients with IDH.

Registered at ClinicalTrials.gov with study number NCT05430438.
#1485 Hypertension management of CKD patients referred to Hypertension Excellence centres in 27 countries: on behalf of the ESH Hypertension and Kidney WG
Authors: Halimi Jean Michel , Sarafidis Pantelis , Persu Alexandre , Kreutz Reinhold , Vogt Liffert
Published: May 2024

Background and Aims

Real-life management of hypertensive patients with chronic kidney disease (CKD) is unclear and may vary across countries. Our aim was to identify unmet needs and heterogeneity of management in this population of patients in Europe and the Middle-East through our network of European Society of Hypertension (ESH) Excellence Centers.

Method

A survey was conducted in 2023 by the ESH to assess management of CKD patients referred to ESH-Hypertension Excellence Centres (ESH-ECs) at first referral visit. The questionnaire contained 64 questions with which ESH-ECs representatives were asked to estimate pre-existing CKD management quality and data for their management are reported here.

Results

Overall, 88 ESH-ECs from 27 countries participated (fully completed surveys: 66/88 (75.0%)). ESH-ECs reported that 28% (median, interquartile range: 15-50%) had pre-existing CKD, of whom 10% (5- 30%) were previously referred to a nephrologist, while 30% (15-40%) had resistant hypertension. The reported rate of previous recent (<6 months) estimated glomerular filtration rate (eGFR) and urine Albumin- Creatinine Ratio (UACR) testing were 80% (50-95%) and 30% (15-50%), respectively. The reported use of renin-angiotensin system blockers was 80% (70-90%). When a nephrologist was part of the ESH-EC teams the reported rates for SGLT2 inhibitors (27.5% (20-40%) vs 15% (10-25), p = 0.003), GLP1-RA (10% (10-20%) vs 5% (5-10%), p = 0.003) and mineralocorticoid receptor antagonists (20% (10-30%) vs 15% (10-20%), p = 0.05) use were greater as compared to ESH-ECs without nephrologist participation. The rate of reported resistant hypertension, recent eGFR and UACR results and management of CKD patients prior to referral varied widely across centres in Europe countries and in the Middle East.

Conclusion

Our results indicate deficits regarding CKD screening, use of nephroprotective drugs and referral to nephrologists before referral to ESH-ECs but results varied widely across centres. This information can be used to build specific programs to improve care in hypertensives with CKD.
#1047 Duration of dual antiplatelet therapy after stent placement in renal artery stenosis
Authors: Nanwani Avinash Chandu , Herrera Aidana Maria Barrera , Suarez German Perez , Galvez Ana Cristina Rodenas , Granados Saulo Jesús Fernández , Prieto Daniel Cubillo , Taboada Alexis Bravo De Laguna , Tejedor Yeray Aguilar , Cacabelos Enrique Buceta , Canton Cesar García
Published: May 2024

Background and Aims

Renovascular hypertension (RVH) is currently considered one of the most prevalent and important causes of secondary hypertension and renal organ damage. The prevalence of RVH in hypertensive patients increases more than 40% in elderly, comorbid and atherosclerotic patients. Although controlled trials in patients with Atherosclerotic Renovascular Disease (ARVD) have not been conclusive about the superiority of Percutaneous Revascularization (PR) over optimal medical treatments, this procedure is still indicated in selected patients, however the optimal duration of dual antiplatelet therapy after PR to avoid stent restenosis has not been well described.

Method

Retrospective study including 51 patients (median age 66.8 years IR: 48.7-87.6; male 35.3%) with resistant hypertension. All patients were diagnosed of Atherosclerotic renovascular hypertension (ARVH) through angioTC and renal arteriography (≥50% stenosis). All of them underwent PR by angioplasty plus stent placement. Patients were stratified into two groups according to dual antiplatelet therapy duration (with Aspirin 100 mg and Clopidrogrel 75 mg). Group I: Dual antiplatelet therapy for 3 months (n = 14) and Group II: Dual antiplatelet therapy for 6 months (n = 37). All patients continued with single antiplatelet therapy at the end of the dual antiplatelet period and were followed during a mean of 4.5 ± 3.8 years. Clinical, analytical and demographic data were collected, as well as cardiovascular risk factors and number of antihypertensive drugs. Besides, blood pressure and kidney function were measured before and after the procedure.

Results

During the follow up, stent restenosis occurred in thirteen patients (25.5%), (group I: 6 (46.2%), group II: 7 (53.8%), p = 0.080).

No differences in blood pressure between two groups were observed (SBP/DBP before and after PR (group I: 175.3/94.7 mmHg and 122.5/71.9 mmHg and group II: 181.1/94.5 mmHg and 125.0/75.5 mmHg, p = N/S)). The number of antihypertensive drugs was similar between two groups before and after the procedure (Group I: 4.6 ± 2.2 and 3.4 ± 1.3; Group II 4.8 ± 1.4 and 3.5 ± 1.7, p = N/S).

There was an improvement in blood pressure control in both groups after PR (SBP/DBP 179.5/94.5 mmHg to 124.9/74.9 mmHg, p = 0.000) and this reduction persisted one year after treatment SBP/DBP 139.2/78.0 mmHg, (p = 0.001). In addition, a reduction in antihypertensive drugs were observed in both groups (4.8 vs 3.5 p = 0.000). Stable renal function was observed previously and two years after treatment.

In multivariate analysis, risk factors associated to stent restenosis were LDL (1.0 CI: 1.0- 1. 05; p = 0.034) and triglycerides (1.0 CI 1.0- 1.1; p 0.038) at 6 month post-stent placement.

Conclusion
#651 Diagnostiс criteria of the functional state of the kidneys in patients with type 2 diabetes mellitus
Authors: Muminova Sitora , Daminova Lola , Adylova Durdona
Published: May 2024

Background and Aims

The constant increase in the number of patients with type 2 diabetes is clearly explained by the incidence of microvascular complications, including diabetic nephropathy (DN). According to statistics, CKD develops initially in 15% of individuals in the general population. To assess the functional state of the kidneys in patients with type 2 diabetes mellitus.

Method

The study included 120 patients with T2DM and were divided into 2 groups. Gr1: 60 patients with DN C1,A1, gr2 with DN C2,A2 whose average age was 60.1 ± 7.6 years. The average DM experience was 7 ± 3.16 years, HbA1C 9 ± 1.82%, BMI 28.05 ± 3.45. Average GFR cr. was 92.6 ± 11.81 ml/min/1.73 m2, albuminuria—13.19 ± 3.1 mg/g.

Results

In the first group, the decrease in eGFRcr was 7.1%, although the average value was within the reference values. At the same time, the level of serum cystacin C and the calculated eGFRcys in this group were significantly different from the control. The serum concentration of cystacin C was significantly higher (0.64 ± 0.09 mg/ml versus 1.07 ± 0.08 mg, p < 0.05), and the eGFRcys indicator was significantly lower (81.32 ± 6.31 ml /min versus 96.60 ± 5.22 ml/min, p < 0.05) indicator for healthy individuals. In the second group of patients, there was a significant decrease in glomerular filtration rate for both markers compared to the control and the first group. Thus, in patients with DN C2, A2, compared with the control and the first group of patients, the eGFRcr indicator was reduced by 24.2% and 18.3%, respectively (p < 0.01 and p < 0.05), which indicates a pronounced decrease in renal function in this category of patients with type 2 diabetes.

Conclusion

Thus, the results obtained showed that in patients with subclinical diabetic nephropathy there is a decrease in glomerular filtration rate, determined by the level of cystacin C. Therefore, eGFRcys is a more accurate indicator of a hidden impairment of renal filtration function compared to eGFRcr.
#185 The role of angiotensin 2 type 1 receptor and type 2 receptor after postischemic acute kidney injury in spontaneously hypertensive rats
Authors: Ivanov Milan , Mihailovic-Stanojevic Nevena , Jovovic Djurdjica , Karanovic Danijela , Vajic Una-Jovana , Zivotic Maja , Miloradovic Zoran
Published: May 2024

Background and Aims

Renal ischemia/reperfusion injury is a common cause of acute kidney injury (AKI), and hypertension might contribute to the increased incidence of AKI. AKI has a multifactorial causality, but the mechanism of pathogenesis and the development of this disease are still incompletely defined. The purpose of this study was to compare the effects of AT1R blockade and AT2R simulation on AKI development in spontaneously hypertensive rats (SHR).

Method

We used male 24 weeks old SHR. Animals were divided into following experimental groups: sham operated rats (SHAM); rats with induced postischemic AKI (AKI); a group which received AT1R antagonist Losartan (10 mg/kg b.w.)(AKI+LOS) and group which received AT2R agonist novokinin (0.3 mg/kg b.w.)(AKI+NOVO) in the moment of kidney reperfusion. AKI was induced by surgical removal of right kidney followed by atraumatic clamp occlusion of the left renal artery for 40 minutes. Hemodynamic and biochemical measurements were done 24 hours after reperfusion.

Results

 

Conclusion

Our results confirm the dominant role of AT1R on AKI development, but AT2R stimulation failed to buffer deleterious effects of AT1R hyperactivity on renal vasoconstriction and glomerular filtration. However, the role of AT2R during AKI development in hypertension will be in focus in our further studies.
#523 Continuous electronic urine output monitoring for the management of acute cardio-renal syndrome in patients with acute decompensated heart failure
Authors: Shacham Yacov , Banai Shmuel , Rozenfeld Anna
Published: May 2024

Background and aims

: Patients admitted for acute decompensated heart failure (ADHF) are at high risk for type I cardio-renal syndrome (CRS) related to venous congestion and diuretic resistance. Positive fluid balance has been associated with adverse outcomes including acute kidney injury (AKI) and mortality. In critically ill patients urine output (UO) is used both to assess deterioration of renal function as well as for management of fluid balance. We investigated the possible effect of real-time UO monitoring, fluid balance, renal outcomes and 30-day mortality of patients admitted to the cardiac intensive care unit (ICU) with ADHF.

Methods

We performed a case series of 50 patients admitted to the cardiac ICU from July 2021 and June 2023 with ADHF. Their standard foley catheter was connected to an electronic monitoring system (Clarity-RMS sensor kit) that continuously monitors UO in real-time. Its technology is described elsewhere (1). The UO monitoring system displays UO trends on the consoles that are updated in real-time. UO trends were utilized to guide an individualized approach for the pharmacologic management of each patient, based on blood pressure, hourly UO and total fluid balance. Daily and accumulated fluid balance was registered at up to 72 hours following admission. Patient outcomes included change in fluid balance, incidence of AKI and 30-day mortality. The case series group was than compared to a historical group of 50 matched controlled patients admitted between 2019-2020. Patients were matched according to cause of admission, age and glomerular filtration rate.

Results

In the study cohort the median age was 71 ± 12 years, and 36 (72%) were men. In the historical cohort the median age was 71 ± 13 years, and 36 (72%) were men. Patients in the electronic urinary monitoring cohort demonstrated significantly more negative daily and cumulative fluid balance as compared to the historical cohort, (P < 0.001 for all, Fig. 1). Incidence of AKI and the combined endpoint of AKI and 30-day mortality was significantly lower in the electronic UO monitoring cohort (24% vs. 46%, p = 0.0197 and 40% vs 78%, P < 0.0001 respectively). These changes were more prominent in the subgroup of patients with chronic kidney disease (Fig. 2).

Conclusion

We demonstrated that real time monitoring of UO was associated with better prevention of fluid overload and the management of type I CRS in patients with ADHF. Further studies on larger populations are required to validate the potential utility of UO trending in the management of critically ill patients with ADHF.
#668 Combined biomarker testing for the assessment of acute kidney injury among myocardial infarction patients
Authors: Shacham Yacov , Frydman Shir , Banai Shmuel
Published: May 2024

Background and aims

The utility of different biomarkers for the prediction of acute kidney injury following ST-elevation myocardial infarction (STEMI) has been evaluated in several studies however, very few data exist on the prognostic value of combining biomarkers. Among numerous biomarkers examined, C-reactive protein (CRP) and Neutrophil gelatinase associated Lipocalin (NGAL) stand high in their utility to assess AKI risk. The aim of this study was to assess the prognostic value of combined CRP and NGAL measurement for the assessment of the risk of AKI in reperfused STEMI patients

Methods

Blood samples for plasma NGAL and CRP were drawn 24 hours after admission. High NGAL and CRP were defined as values within the 4th quartile (>75percentile). Patients were stratified into 4 study groups: Low NGAL/Low CRP, LOW NGAL/high CRO, High NGAL /low CRP and high NGAL/high CRP. Patients were assessed for the occurrence of in-AKI based on the KDIGO criteria.

Results

A total of 311 patients were included (mean age 66 ± 14 years, 81% males).

According to the 4 study groups, there was a stepwise increase in the proportion of AKI (9% vs. 21% vs. 40% vs. 68%; p 0.001; Fig. 1). In a multivariate regression model, compared to patients having low NGAL/low CRP we observed a graded, independent increase in the risk for AKI for low NGAL/high CRP, high NGAL/low CRP and high NGAL/high CRP(OR 2.89, p = 0.02 vs. OR 3.29, p < 0.001 vs. OR 17.6, p < 0.001 respectively, Table 1). Peak concentrations showed significant areas under the curves (AUCs) for the prediction of AKI for both CRP AUC (0.692, 95% CI 0.62-0.76) and NGAL (AUC 0.778, 95% CI 0.72-0.84). The combination of NGAL and CRP yielded a significant increase in AUC to 0.822 (95% CI 0.77 to 0.88) (combined biomarkers vs CRP: p < 0.001 and combined vs. NGAL: p = 0.02; Fig. 2).

Conclusions

In patients with reperfused STEMI, the combined assessment of NGAL and CRP provided incremental prognostic information for the prediction AKI when compared with single-biomarker measurement.
#984 Macrophage BRCC3 ameliorates sepsis-induced kidney injury by mediating renal NLRP3 inflammation
Authors: Wang Yao
Published: May 2024

Background and Aims

Sepsis-induced kidney injury (S-AKI) is an inflammatory disease characterized by high mortality rates. Macrophages are key inflammatory cells in the pathogenesis of S-AKI, and a rationale to target macrophage-endothelial cell interactions has been elucidated. Some study reported that BRCC3, a deubiquitylating enzyme, which is a critical regulator of NLRP3 activity in vitro experiments. However, the role of Macrophage BRCC3 role in S-AKI remains unclear.

Method

The S-AKI model was established by injecting lipopolysaccharide (LPS) into wild-type (WT) and macrophage-specific BRCC3 knockdown (KO-Mφ) mice. Transfecting RAW264.7 macrophages with siBRCC3 and establishing the co-culture system of RAW264.7 macrophages and murine tubular epithelial cells (mTECs) in Transwell.

Results

We found that macrophage BRCC3 deficiency ameliorates S-AKI. Compared with WT-S-AKI mice, the macrophage infiltration was decreased, the serum creatinine, BUN and the renal histologic injury scoring was decreased, as well as the expression of NLRP3 and Pro-Caspase-1 was clearly attenuated in KO-Mφ S-AKI mice. However, the serum IL-1β, IL-6, and TNF-α changes had on different between S-AKI groups. In vitro study, knockdown of BRCC3 in macrophages decreased NLRP3 inflammasome activation and cell apoptosis in mTECs. Mechanistically, BRCC3 knockdown promoted K63-linked ubiquitination of NLRP3 in macrophages. NLRP3 overexpression in mTEC abolished the renal protective effects of macrophages BRCC3 knockoff in S-AKI mice.

Conclusion

We showed that the macrophage BRCC3 as a key regulator in the activation of NLRP3 inflammasome by ubiquitination pathway in S-AKI. Our study unveils that macrophage BRCC3 has the potential to be the novel therapeutic target for S-AKI treatment.
#1385 Dipeptidyl-peptidase-4 inhibitor teneligliptin attenuates folic acid-induced tubular cell death via inhibiting ferroptosis
Authors: Yasuda Hideo , Ema Chiemi , Iwakura Takamasa
Published: May 2024

Background and Aims

Dipeptidyl peptidase-4 (DPP-4) inhibitors have been shown to attenuate several types of acute kidney injury (AKI) in animal models [1–3]. However, the mechanisms underlying their renoprotective effects remain to be clarified. Previous studies had identified ferroptosis as the primary cell death pathway for folic acid-induced AKI in mice [4]. Referring to that report, we previously reported that teneligliptin, a DPP-4 inhibitor, ameliorates folic acid-induced AKI. In the present study, we investigated whether teneligliptin attenuates folic acid-induced tubular cell death through its anti-ferroptotic properties.

Method

In in vitro experiments, we used HK-2 cells, human proximal tubular epithelial cells. HK-2 cells were co-cultured with folic acid and z-VAD-FMK (zVAD), an apoptosis inhibitor; Necrostatin-1s (Nec-1s), a necroptosis inhibitor; Ferrostatin-1 (Fer-1), a ferroptosis inhibitor; or teneligliptin. Co-incubation of erastin, a ferroptosis inducer, and teneligliptin was also performed. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was conducted on HK-2 cells to assess cell viability.

Results

Fer-1, but not z-VAD or Nec-1s, inhibited folic acid-induced cell death (Fig. 1A-C), indicating that ferroptosis contributes to folic acid-induced tubular cell death, rather than apoptosis or necroptosis. Teneligliptin also inhibited folic acid- and erastin-induced tubular cell death (Fig. 1D,E), suggesting that the DPP-4 inhibitor inhibits folic acid-induced tubular cell death via its anti-ferroptotic properties.

Conclusion

DPP-4 inhibitor prevents folic acid-induced tubular cell death by inhibiting ferroptosis in vitro, which may contribute to the attenuation of AKI in vivo.
#594 Long-term risk of incident/progressive chronic kidney disease, or end-stage kidney disease post-acute kidney injury: systematic review, meta-analysis
Authors: Veltkamp Denise Mj , Porras Cindy P , Kok Maarten B , Verhaar Marianne , van Solinge Wouter W , Haitjema Saskia , Vernooij Robin Wm
Published: May 2024

Background and Aims

Little is known about which patients to follow-up after an episode of acute kidney injury (AKI) for future risks. The aim of this review is to assess the association between AKI and the incidence or progression of chronic kidney disease (CKD) or end-stage kidney disease (ESKD), stratified by subcategories of AKI-stages, -durations, and clinical settings.

Method

A systematic search of the literature in PubMed and Embase was performed by two reviewers to identify studies that examined CKD incidence (development of CKD stage ≥3), CKD progression (worsening of kidney function in patients with CKD stage ≥3), or ESKD, in patients with AKI versus patients without AKI. The risk of bias was assessed using the Newcastle-Ottawa Scale. Relative effect estimates (odds and hazard ratios) were pooled using a random effects model.

Results

In total, 48 retrospective and 13 prospective studies, encompassing 140.985 patients with AKI, were included in this review. All the studies were of moderate or high quality. The pooled effect ratio was 3.36 (95% confidence interval (CI) 2.68-4.03) for CKD incidence (n = 31 studies). This remained 3.40 (95% CI 1.79-5.00) in a sub analysis including patients with a recovered kidney function post-AKI, and 1.49 (95% CI 1.44-1.55) in a sub analysis including patients with an AKI lasting less than 3 days (Fig. 1). Overall, the effect ratio for CKD progression (n = 11 studies) was 1.70 (95% CI 1.38-2.01) and 3.81 (95% CI 2.58-5.04) for ESKD (n = 24 studies). The increased risk of these two outcomes were not seen in the sub analyses only including patients with AKI lasting less than 3 days. Overall, there is an observable higher risk for CKD incidence, CKD progression, and ESKD with increased AKI staging, although not always statistically significant. Minimal variations were observed across clinical settings.

Conclusion

In our review, including over 60 studies, we found that AKI was associated with an increased risk of CKD incidence, CKD progression, and ESKD. Patients with higher AKI-stages had even larger risks. Notably, even brief episodes of AKI (lasting less than 3 days) were associated with a higher risk of CKD incidence compared to patients without AKI. In contrary, the risk for ESKD is not enlarged in a sub analysis including patients with recovered kidney function compared to patients without AKI. These result warrant close monitoring of the kidney function post-AKI, specifically in patients with AKI lasting 3 days or longer. Future research should focus more on the risk of CKD progression in order to tailor follow-up care in these more vulnerable patients.
#2395 Elevated circulating ACE2 activity is related with a major COVID-19 severity
Authors: Díaz Irene Martínez , Arana Ander Vergara , Ortiz José Tomas , Cámara Antonio Cano , Díaz Adrià Fernández , Llorens-Cebrià Carmen , de Frutos Pablo García , Morales Albert , Cachá Conxita Jacobs , Romeo Maria Jose Soler
Published: May 2024

Background and Aims

The angiotensin 2 converser enzyme (ACE2) is the cell entry receptor for SARS-CoV-2. SARS-CoV2 participates in ACE2 shedding from cell membrane, increasing soluble ACE2. The present study aims to evaluate if ACE2 serum levels are to COVID-19 prognosis.

Method

During the first wave of COVID-19 pandemic and during March and April 2020, 2118 first emergency attendance serum samples from diagnosed COVID-19 patients from Barcelona Vall d'Hebron Hospital were obtained. Age, sex, previous comorbidities, clinical and analytical variables were collected from the patient clinical records. Patients that were admitted to ICU, required mechanical ventilation or died due to COVID-19 were considered severe patients. Serum ACE2 activity was measured by enzymatic activity assay.

Results

Patients with severe COVID-19 were older and with a major number of comorbidities (Table 1). Circulating ACE2 activity at admission was increased in 0.34 relative fluorescence units (RFUs)/ng/μL (CI 95%: 0.24-0.43, p < 0.001) in patients that developed severe COVID-19. A logistic regression model adjusted by age, sex, diabetes, hypertension, obesity, cardiovascular disease, chronic kidney disease and renin angiotensin blockers, showed that high circulating ACE2 activity was still related to a worse prognosis (OR: 2.0, 95% CI: 1.7–2.4, p < 0.001). High serum ACE2 activity ≥0.56 RFU/ng/μL provided the best sensitivity (62%) and specificity (61%) relation, whereas values ≥1.3 RFU/ng/μL were significantly related to a worse prognosis of the disease with a 95% specificity.

Conclusion

High levels of circulating ACE2 activity when patients with COVID-19 are admitted to the Emergency Department are independently related with a subsequent severe disease. Additionally, although most of the comorbidities analyzed are significantly increased in severe COVID-19 patients as compared to mild COVID-19 patients, the results of the logistic regression model point out that they seem not to be a risk factor in the overall model, except for obesity, age and sex.
#488 Differences in characteristics and outcomes between Patients suffering AKI in medical vs surgical ICU units
Authors: Acosta-Ochoa Isabel , Coca Armando , Ardura Paula , Martínez María , Merizalde Carlos , Cobo Kenia , Moultamis Aya , Ronda Teresa , Mendiluce Alicia
Published: May 2024

Background and Aims

AKI is a public health problem, affecting one in every five hospitalized adults. It's incidence in the ICU fluctuates between 16-36%, with a mortality rate between 28%-50%. The need for HD in the ICU varies from 3-7%, and these patients have twice the risk of death. But few studies have compared patients in medical (MD-ICU) and surgical (Qx-ICU) critical care units.

Method

We conducted a single center, retrospective study of individuals admitted to ICU units that underwent nephrology consultation. We examined a 5-y period, in the pre-COVID era, we excluded the pandemic period, because COVID patients were admitted to MD- and Qx-ICU indistinctly. We compared epidemiological and clinical characteristics and hard outcomes between patients in both groups.

Results

We included 433 patients, 42% in the MD-ICU. We found no statistical differences between sex, HTN, DM, Charlson's-Index, and previous CKD. Qx-ICU patients were older, suffered less Coronary Artery (CAD), and Cerebrovascular Disease (CVD), and their AKI etiology was more frequently obstructive. MD-ICU individuals showed less hospital acquired AKI, and were more frequently classified in KDIGO Stage 3, (Fig. A, Features). We found no differences in time to nephrology consultation, length of hospital-stay and in-hospital mortality. Qx-ICU patients had shorter ICU stay, needed less frequently acute HD, and were less HD dependent at discharge (Fig. B, Results). In-hospital mortality for patients that needed HD in MD-ICU OR 2.2 (1.2-4.1, P = 0.12), Qx-ICU OR 4.4 (2.2-8.6, P < 0.001).

Conclusion

Individuals don't differ remarkably in their baseline clinical characteristics (Charlson`s, DM, CKD). Nevertheless, Qx-ICU patients are older, suffer less CAD, and CVD, and show significantly more hospital acquired AKI. We found that medical ICU patients suffered worst AKI stage, longer ICU stay, required acute HD and were HD dependent more frequently, but had a lower risk of death when needing acute HD. We found no differences in general mortality rate, and general hospital stay, and time to nephrology consultation between groups. We need multicentric and well-powered studies to explore these differences more profoundly, find clusters of patients and phenotypes of AKI and discover protective factors and new preventive measures against hospital acquired AKI, and need for acute HD.
#1348 Acute kidney injury: evaluation of factors to predict the need of dialysis therapy
Authors: Przygocka Agnieszka , Dalmastri Vittorio , Provenzano Michele , Zappulo Fulvia , Berti Gian Marco , Bari Federico , Ullo Ines , La Manna Gaetano
Published: May 2024

Background and Aims

Acute kidney injury (AKI) is a clinical syndrome with heterogeneous pathophysiological mechanisms, associated with higher morbidity and mortality risk. The existing evidence shows that an episode of AKI increases the risk of chronic kidney disease and end-stage kidney disease, with considerable effects on long term outcomes. Current risk prediction scores were mostly calculated in the setting of contrast induced nephropathy and cardiac surgery reporting the patient's risk of AKI immediately before and after the invasive procedure. To date, no scoring models are available to assess the risk of progression and necessity of renal replacement therapy (RRT) for patients in the course of AKI.

Method

A prospective observational cohort study was conducted enrolling patients with AKI treated within the Nephrology, Dialysis and Kidney Transplant Unit of IRCCS Azienda Ospedaliero-Universitaria di Bologna from January 2022 to July 2023. The inclusion criteria were: 1) age >18 years, 2) stage 3 AKI according to the current KDIGO guidelines or presence of urgent RRT indication (severe hyperkalemia, metabolic acidosis or fluid overload refractory to medical treatment). The indication for RRT was given based on clinical judgement. Type of RRT, dialyzer and ultrafiltration rate were applied according to the clinical features of the patient. The primary endpoint was the association between AKI features and RRT. Secondary endpoints were evaluation of patients treated with RRT for factors associated with renal recovery.

Results

We studied 56 patients. The mean age ± SD was 69.8 ± 15.3 years (range, 18-94) and 37 (66.1%) were males. 18 patients (32.1%) were treated with conservative therapy and 38 (67.9%) with RRT. The factors correlated with the necessity of RRT were previous cardiovascular disease (p = 0.002), diabetes mellitus (p = 0.017), Charlson score >5 (p = 0.035), volume overload (p = 0.002), urine output level (p = 0.033) and C reactive protein (CRP; p = 0.020). Multivariate analysis found significant association of cardiovascular disease (OR, 5.94; 95% CI, 1.45 to 24.34; p = 0.013) and elevated CRP (OR, 1.08; 95% CI, 1.00 to 1.16; p = 0.049) during AKI episode with the RRT need in the study cohort. Higher ultrafiltration rate during RRT was correlated with non recovery of kidney function (OR, 1.86; 95% CI, 1.09 to 3.14; p = 0.021).

Conclusion

Cardiovascular disease and higher CRP were associated with necessity of RRT. More intensive fluid removal during RRT resulted as negative predictor of kidney function recovery. Further studies with larger study samples and randomized design are necessary to confirm these findings.
#1900 Should we prescind of KDIGO Stage 2 in AKI severity classification?
Authors: Acosta-Ochoa Isabel , Coca Armando , Martins Ana Luisa , Martínez María , Ardura Paula , Merizalde Carlos , Moultamis Aya , Ronda Teresa , Cobo Kenia , Mendiluce Alicia
Published: May 2024

Background and Aims

The most worldwide used classification system for staging AKI is KDIGO-2012, it was based on a combination of the RIFLE and AKIN criteria. KDIGO severity stages are defined:

Stage 1 ↑ in SCr by >0.3 mg/dl or increase in SCr to >1.5x baseline.

Stage 2 ↑ in SCr ≥2.0–2.9x baseline.

Stage 3 ↑ in SCr ≥3.0x baseline, ↑ in SCr to >4.0 mg/dl, or initiation of RRT.

Some authors advocate for the elimination of the Stage 2 level and its incorporation in the severer stage; the justification is that this stage has a smaller number of individuals, and they show poorer clinical outcomes. We tested this hypothesis in a real-world setting.

Method

We retrospectively included all patients admitted to nephrology ward and nephrology consultations with AKI diagnosis by KDIGO-2012 classification, during a 3-y period. We compared clinical outcomes between KDIGO-AKI Stage 2 and 3. We excluded need for HD (because it is a criterion for Stage 3) and HD dependence at discharge (a consequence of initiating HD). In addition, we calculated the proportion of patients classified in Stage 2 by the rate of SCr increment, that were re-classified into Stage 3 by KDIGO criteria.

Results

1130 individuals met inclusion criteria. 458 (41%) Stage-1, 148 (13%) Stage-2, 524 (46%) in Stage-3. We found no statistically significant differences in age, Charlson's Index, HTN and DM prevalence, hospitalization in medical wards, and hospital acquired AKI between groups. We found significant differences in sex distribution (61% Stage-2, 70% Stage-3) (see Table A: Features). Hospital stay was significantly shorter in Stage1-15d (±12) but not significantly different between Stage-2 19d (±16) and Stage-3 20d (±17). Median of time to nephrology consultation was 6-7d in all groups. Rate of in-hospital mortality incremented gradually in every severity stage: 9% Stage-1, 18% Stage-2 and 31% Stage-3 (see Table B: Results). When using only the rate of SCr increment as the classification criterion, 265 (24%) of patients would have been catalogued in the moderate AKI stratum. Of the 117 patients that were reclassified as AKI Stage-3, 36 needed HD, and 81 reached a SCr >4.0 mg/dl.

Conclusion

The proportion of subjects classified in KDIGO AKI Stage-2 is small but not negligible. We found that Stage-2 individuals show longer hospital stay and increased mortality than Stage-1, and slightly better outcomes than Stage-3; therefore, we consider that an increase in SCr ≥2.0–2.9x from baseline still leads to deleterious consequences. We also observed that possibly KDIGO AKI Stage 3 criteria lead to a skew to classification in the severer stage, (almost half of individuals are reclassified). With these findings, should we prescind of KDIGO Stage-2 in AKI severity classification?
#3100 Adsorption membranes in continuous renal replacement therapy (CRRT) in acute renal failure associated with sepsis: preliminary clinical results
Authors: Villa-Hurtado Daniel , de Castro Francisco Mateo
Published: May 2024

Background and Aims

Acute kidney INJURY (AKI) is a common complication (40%) in ICU patients, especially in septic patients, and it´s associated with high morbidity and mortality [2, 4].

Even though sepsis-associated AKI (S-AKI) is multifactorial, the elevation of cytokines plays a major role in its pathogenesis [3, 5]. This has promoted the use of adsorptive membranes in continuous renal replacement therapy (CRRT) in recent years.

Method

We performed a retrospective study in ICU patients with S-AKI who received CRRT with adsorptive membrane (Oxiris) from July 2021 to March 2023. We described clinical and analytical parameters at baseline, 24 and 48 hours after the start of therapy, and 30-day mortality.

Results

11 patients (6 male) with mean baseline creatinine of 4.53 ± 2.76 mg/dl were included. The indications for starting CRRT were: renal support (n = 3; 28%) or as adjuvant therapy for sepsis at the discretion of the attending physician (n = 8; 72%) (Table 1).

On admission, MAP was 72 ± 14.13 mmHg, serum lactate 2.7 ± 2.02 mmol/L. 7 patients (63%) required vasoactive drugs. The duration of therapy was 45 ± 18.46 h, with a prescribed effluent dose of 32 ± 4.14 ml/kg/h. There was a slight improvement in MAP at 24 and 48 hours (74 and 73.55 mmHg).

A decrease in inflammation parameters (C-Reactive protein and procalcitonin) was evident at 24 (13.2% and 57%) and 48 (25% and 71%) hours of therapy without modification in the need of vasoactive drugs. Interestlying, lactate at 24 hours increased to 3.40 ± 3.80 and at 48 hours to 3.68 ± 6.30.

Five patients died at day 30 (45%). Of the remaining six; four had a decrease in eGFR greater than 40% compared to baseline and 1 had a decrease of less than 40%. The last one continued maintenance hemodialysis.

Conclusion

Adsorptive membranes on top of standard of care (fluids resuscitation, broad-spectrum antibiotics and vasoactive drugs) in the first hours of S-AKI reduces the inflammatory response even though it does not change the need for vasoactive drugs. In our small cohort, mortality at 30 days and the decrease in eGFR greater than 40% from baseline were high, although similar to that described in the literature.
#2624 Point of care creatinine for early detection of community acquired acute kidney injury in a primary health care centre in Nigeria
Authors: Laurent-Ordu Vivean , Model Dorathy Emem , Chiemela Oluo Doris , Dede Siyeofori , Green Kinikawo , Oreh Adaeze , Emem-Chioma Pedro , Erekosima Ibi , Lewis David , Poulikakos Dimitrios
Published: May 2024

Background and Aims

Community acquired Acute kidney injury (AKI) and leads to poor outcomes in low and middle-income countries due to delayed diagnosis however its epidemiology is poorly studied due to lack of biochemical diagnosis. Supported by the International Society of Nephrology, we evaluated the accuracy of point of care creatinine (POC Cr) technology using capillary samples [1] and its use implementing a clinical algorithm to select patients at risk of AKI for POC Cr testing in the Hospital Emergency Department in Port Harcourt in Nigeria. In this phase of the project POC Cr was used in a large primary care health centre for early detection and management of community acquired AKI.

Method

The study is conducted in Ozuoba Model Comprehensive Primary Health Care Centre. The centre has 4148 patient attendances per month (20.3% medical, 18.8% obstetrics and 60.8% paediatrics) with 11.1% considered acute requiring short admission at the centre usually for intravenous fluids. Historically, decision making is based largely on clinical judgement and renal function tests when requested from external laboratories are reported in > 48 hours. During this project POC Cr was offered on high-risk patients based on the clinical algorithm from the previous stage (Fig. 1) and patients with detected AKI were offered short admission for intravenous fluids and antibiotics.

Results

To date 54 patients have been screened with POC Cr. Median age is 25.5 years, minimum 2 months, maximum 85 years, interquartile range (48-10), 62% are females, 57% presented with malaria diagnosis and 9% with gastroenteritis. Mean (standard deviation) of POC Cr was 105 (54) µmol/L. There were 5 cases (9%) of AKI (Cr >150 µmol) detected in patients aged 5 months, 13 months, 7 years, 19 years and 31 years. All were treated with short admission and intravenous fluids and were discharged after clinical improvement. Knowledge of the presence of AKI altered management in all patients prompting short admission.

Conclusion

Community acquired AKI is common in young patients with malaria and early biochemical diagnosis can improve outcomes. The study continues to recruit and aims to investigate the characteristics of community acquired AKI in Africa and to contribute to the design of optimal and sustainable pathway for early detection and management of AKI.
#1410 Prognosis and mortality within 90 days in community-acquired acute kidney injury in the Southwest of Sweden
Authors: Gross Christel , Jonasson Junmei Miao , Buchebner David , Agvall Björn
Published: May 2024

Background and Aims

Community-acquired acute kidney injury (CA-AKI) is common among hospitalized patients and has a poor prognosis. Research is scarce on the impact of a CA-AKI episode among patients without preexisting kidney disease and has not previously been investigated in Sweden. The aim was to describe the outcomes of patients with normal pre-hospitalization kidney function, admitted with community-acquired AKI and to investigate the association between AKI severity with outcomes.

Method

A retrospective population-based study was applied including patients with CA-AKI according to KDIGO classification, admitted via emergency department (ED) 2017-2019 and with a 90-day follow-up period from the ED-admission, collecting data from the Regional Healthcare Informative Platform. Age, gender and AKI stages, mortality and follow-up regarding recovery and readmission was registered. Hazard ratio (HR) and 95% confidence Interval (CI) for mortality was analyzed using Cox regression adjusted for age, comorbidities, and medication.

Results

There were 1646 patients included, mean age was 77.5 years. CA-AKI stage 3 occurred in 51% of patients < 65 years of age and 34% among those >65 years. In this study, 578 (35%) patients died and 233 (22%) recovered their kidney function. Mortality rate peaked within the first two weeks and among those at AKI stage 3. Nephrology referral post discharge occurred in 3% and 29% were readmitted. HRs for mortality was 1.9 (CI 1.38-2.62) for those who are > 65 years, 1.56 (CI 1.30-1.88) for atherosclerotic-cardiovascular disease. Medication with RAASi related to a decreased HR 0.27 (95% CI 0.22-0.33).

Conclusion

CA-AKI is associated with high mortality within 90 days, increased risk for developing chronic kidney disease (CKD) and only one fifth recover their kidney function after hospitalization with an AKI. Nephrology referral was sparse. Patient follow-up after a hospitalization with AKI should be carefully planned during the first 90 days and focused on identifying those with a higher risk of developing CKD.
#746 Lactic acidosis in patients with acute kidney injury treated with renal replacement therapy in intensive care unit
Authors: Kobal Barbara , Korošec Tea , Jakopin Eva , Svenšek Franc , Piko Nejc , Hojs Nina Vodošek , Bevc Sebastjan , Hojs Radovan , Ekart Robert
Published: May 2024

Background and Aims

Lactic acidosis (LA) is the most common cause of metabolic acidosis in hospitalised patients. LA is frequent in intensive care unit (ICU) patients with acute kidney injury (AKI) treated with renal replacement therapy (RRT). The aim of our study was to analyse the impact of LA on mortality.

Method

We conducted a retrospective observational study in a tertiary care hospital with a 12-bed ICU. During the study period of 4 years before the COVID pandemic, 2939 patients were admitted to the ICU, 503 patients were diagnosed with AKI and 210 of them required RRT. Due to missing data, we retrospectively analysed only 176 patients. LA was defined as a serum lactate concentration above 4 mmol/L on admission to the ICU. Demographic data, comorbidities, laboratory data at ICU admission and 30-day survival after ICU admission were obtained from the medical record. Survival was estimated using the Kaplan-Meier method, and factors associated with 30-day mortality were assessed in a Cox regression.

Results

The mean age of patients was 63.4±12.9 years, and 68.2% were men. Sixty-five (36.9%) of patients had LA. The prevalence of comorbidities prior to admission and baseline laboratory values are shown in Table 1. All patients were treated with RRT, 137 (77.8%) with continuous RRT and 39 (22.2%) with intermittent hemodialysis. The mean ICU stay was 14.6 ± 12 days, and 114 (64.8%) patients died during the observational period of 30 days. A Kaplan-Meier survival analysis showed that the survival was statistically significantly lower (log-rank; p = 0.027) in the group of patients with LA (Fig. 1). Univariate Cox regression analysis showed that LA was a significant predictor of 30-day survival (HR 1.51; 95% CI 1.038-2.197; p = 0.031). In the multivariate Cox regression analysis, which included age, gender, diabetes, hypertension, LA and C-reactive protein, only age (HR 1.029; 95% CI 1.011-1.046; p = 0.001) and LA (HR 1.515; 95% CI 1.030-2.228; p = 0.035) were independent predictors of mortality.

Conclusion

LA on ICU admission is an independent, highly prognostic factor for death within 30 days of admission in patients with AKI treated with RRT.
#407 Human platelet lysate enhanced angiogenic potential of extracellular vesicles derived from mesenchymal stem cells
Authors: Zhang Yue , Tang Tao-Tao , LV Linli , Liu Bicheng
Published: May 2024

Background and Aims

Mesenchymal stem cell-derived extracellular vesicles (MSC-EVs) have emerged as a promising regenerative therapy. However, their clinical application is hampered by the presence of xenogeneic components in the medium. In the present study, we aimed to decipher the regenerative properties of MSC-EVs generated under xeno-free conditions to favor the clinical translation of MSC-EVs.

Method

MSCs were isolated from human umbilical cord and expanded in fetal bovine serum (FBS) and clinical-grade human platelet lysate (HPL) respectively. MSC-EVs were isolated by differential centrifugation combined with size exclusion chromatography and characterized through transmission electron microscopy, nanoparticle tracking analysis, and exoview. Subsequently, a multi-omics approach, comprising transcriptomics, proteomics, and metabolomics, was employed to investigate the molecular cargo of the MSC-EVs. Finally, in vitro and in vivo functional assays were performed to assess the regenerative potential of MSC-EVs in acute kidney injury.

Results

Our study demonstrated that HPL promoted MSC-EVs production without compromising EVs characteristics. Multi-omics sequencing revealed the stability of HPL cultured MSC-EVs (H-EVs) from different umbilical cord donors and global functional alterations for MSC-EVs under different culture conditions. In comparison to FBS cultured MSC-EVs (F-EVs), the regenerative potential of H-EVs was enhanced especially angiogenesis associated with increased cargo expression. The in vitro studies demonstrated that H-EVs induced more tube-like structure formation and migration. Further, it significantly reduced kidney capillary sparsity in mice with renal ischemic-reperfusion model.

Conclusion

Our data provided a comprehensive understanding about H-EVs and demonstrated their potential as a safe and effective regenerative therapy, especially targeting angiogenesis-related disorders.