bluuebunny/crossref_metadata_2025 huggingface dataset:
MO347CENTER VARIATION IN LENGTH OF STAY FOR PATIENTS WITH HOSPITAL-ACQUIRED ACUTE KIDNEY INJURY IN ENGLAND*
Authors: Peracha Javeria , Pitcher David , Santhakumaran Shalini , Day Jamie , Steenkamp Margaretha , Medcalf James , Lipkin Graham , McKane William
Published: May 2021

Background and Aims

Acute kidney injury (AKI) is a common and serious condition associated with longer length of hospital stay (LOS) for affected patients; leading to increased morbidity, emotional distress and higher healthcare costs. Implementation of AKI care quality improvement interventions have consistently been shown to reduce patient LOS, suggesting its measurement may serve as a valuable AKI care quality indicator for hospitals. In this study, we set out to explore, for the first time, unwarranted centre variation in case-mix adjusted LOS for patients who develop hospital acquired AKI (HA-AKI) across England.

Method

Analysis was undertaken using a routinely collected national database of patients with biochemically detected AKI, linked with hospitals administrative data. 250,504 HA-AKI episodes were studied in total, across 103 hospitals between 01/01/2017 – 31/12/2018. LOS was defined as the number of days between first AKI alert and discharge. A negative binomial model was used to generate predicted LOS for patients with HA-AKI at each hospital trust using age, sex, diagnosis group, comorbidity score, AKI severity, admission method, month of AKI alert and critical care attendance. Variation in “observed LOS – predicted LOS” values across centres were then compared using a funnel plot. Additional analyses were undertaken to investigate potential associations between centre LOS and readmission rates as well as variation in LOS amongst patients in the most common diagnosis groups.

Results

The overall median LOS following HA-AKI alert was 8 days (Interquartile range, 3-17). There was significant variation seen in “observed - predicted LOS” values across hospitals, with 55/103 trusts classed as outliers (99.8% control limits). When analysis was limited to patients with more severe AKI (stages 2 or 3) at presentation this number fell to 10/103 (99.8% control limits). Risk factors for longer LOS included male sex, advancing age, higher comorbidity score, more severe AKI at presentation, emergency admission and critical care attendance. Patients admitted due to fracture neck of femur were at highest risk of longer LOS and exhibited considerably more variation in “observed - predicted LOS” values compared to patients with congestive heart failure, pneumonia or septicaemia. Just over 1/5 of patients with HA-AKI went on to have an emergency re-admission within 30 days of discharge, with no association observed between a trusts “observed – predicted LOS” values and readmission rates (Figure).

Conclusion

There was considerable centre-variation in LOS for patients with HA-AKI across England. Further interrogation of patient and centre-level factors underlying the observed variation is now necessary to better understand why this variation exists and to inform development of future targeted quality improvement interventions to address this.
MO359ASSOCIATIONS BETWEEN RENAL FUNCTION TRAJECTORIES AFTER 3 MONTHS ACUTE KIDNEY INJURY AND LONG-TERM RENAL OUTCOMES
Authors: Hsu Chien-Ning , Tain You-Lin
Published: May 2021

Background and Aims

Renal function recovery after acute kidney injury (AKI) is associated with patient outcomes. The study objectives were to assess the patterns of AKI recovery within 6 months following discharge for AKI and subsequent incidence of chronic dialysis.

Method

A retrospective cohort of 234,867 hospitalized adult patients was examined for AKI between January 1, 2010, and December 31, 2017 in the largest healthcare delivery system in Taiwan. Renal function recovery at 3- and 6-month post discharge, incident chronic kidney disease and chronic dialysis initiation were analyzed over 7 years of follow-up. Renal recovery was defined by < 1.5× baseline SCr (prior to the hospitalization). Independent associations between renal function recovery patterns and renal outcomes was assessed by Cox proportional hazard model controlling for potential confounders, and subdistribution hazard ratio (SHR) with [95% CI] was analysed for competing risk of early death.

Results

Among 3 months AKI survivors (n=24,132), 14.28% (n=3,430) did not recovery back to baseline, and 16% of recovery did not sustain. Three distinct renal function recovery continuums at 6 months post hospital discharge were: persistent non-recovery (10.18%), non-recovery (14.33%), and recovery (75.5%). Comparing to survivors without AKI (n=50,387), the impact of renal recovery continuum on chronic dialysis initiation varied by patient’s baseline renal disease (SHR was 2.82 [95%CI, 2.42-3.28] in CKD, and 0.8 [95%CI, 0.27-2.38] for non-CKD. Persistent non-recovery was significantly associated with a greater increased risk of chronic dialysis than non-recovery in any patients with AKI. Comparing to patients with sustained AKI recovery, risk of CKD onset increased 5-fold in persistent non-recovery and 3-fold risk in non-recovery.

Conclusion

The continuum of AKI recovery post 6 months is associated with increased risk of chronic dialysis, particularly in patients with baseline CKD. These study results suggested that patients ever with AKI should receive close renal function monitoring for post-discharge management.
MO361INCIDENCE AND RISK FACTORS OF INFECTION AFTER AN EPISODE OF ACUTE KIDNEY INJURY DURING HOSPITALIZATION
Authors: Sanchez Ana , Cabrera Alicia , Salanova Villanueva Laura , Muñoz Ramos Patricia , Ruano Pablo , Quiroga Borja
Published: May 2021

Background and Aims

Acute kidney injury (AKI) is a major risk factor for development and progression to chronic kidney disease (CKD). The aim of the present study is to assess the incidence of infections after an admission for AKI.

Method

In this retrospective study all patients who developed AKI during hospitalization and were discharged from 2013 to 2014 were included. Factors associated to infections were evaluated. The mean follow-up after discharge was 39±30 months.

Results

We included 1255 patients with a mean age of 75±13 years, of which 692 (55%) were men. At baseline, 944 (75%) patients presented with hypertension, 379 (30%) with diabetes, 560 (44%) with hypercholesterolemia and 543 (43%) with CKD. Mean baseline creatinine was 1,3±1,8 mg/dl (glomerular filtration rate [eGFR] estimated by CKD-EPI was 55±25 ml/min/1,73m2). The peak level of creatinine reached during AKI was 2,47±1,97 mg/dl (eGFR 30±18 ml/min/1,73m2). At discharge, creatinine was 1,62 mg/dL and eGFR 53±27 ml/min/1,73m2. Seven hundred and seventy-three (62%) patients presented an eGFR inferior to 60 ml/min/1,73m2.

During follow-up, 681(54%) patients presented an infectious event. Urinary tract infection was the most frequent infection (286 patients, 23%) followed by respiratory infection (214 patients, 17%). Factors associated with infection were age (p<0,001), hypertension (p=0,03), atrial fibrillation (p=0,014), functional dependence measured by Barthel index (p=0,03), previous diagnosis of CKD (p=0,01), baseline eGFR (p>0,001) and eGFR at discharge (p=0,002). Survival analysis using Kaplan-Meier demonstrated an existing association between eGFR inferior to 60 ml/min/1,73m2 and infections (LogRank 12,2, p<0,001, figure 1).

Adjusted multivariable analysis demonstrated that age (HR 1,01 [CI95% 1,00-1,02], p=0,009) and the presence of eGFR inferior to 60 ml/min/1,73 m2 (HR 1,45 [CI95% 1,04-2,02], p=0,02) were independent predictors of infection after AKI episode.

Conclusion

The existence of eGFR inferior to 60 ml/min/1,73 m2 after an hospitalization with AKI shows an independent association with presenting an infection afterwards.
MO362CHECK- POINT INHIBITORS AND THEIR KIDNEY INVOLVEMENT
Authors: Villagrasa Tania , Garcia José Luis , Jimenez Mendoza Sonia Cleofe , Lado Fuentes Mario , Livianos Arias-Camisón Paloma , D´angelo Maria Giovanna , Munar Vila Maria Antonia , Azkarate Aitor , Boyeras Barbara , Gomez Marques Gonzalo
Published: May 2021

Background and Aims

Monotherapy immunotherapy with “check-point inhibitors” (anti PD-1, Anti PD-L1) is an effective therapy to advanced-stage cancer patients. Little is known about our experience and its renal implication, although it is related to fluid and electrolyte disorders or acute kidney failure (AKI).

To evaluate changes in natremia or acute renal impairment (primary endpoints) in IV stage cancer patients with lung, bladder or melanoma neoplasm who have received monotherapy with pembrolizumab (PEM), atezolizumab (ATZ) or nivolumab (NIV). At the same time, analyze if there are differences between drug administered, underlying disease or having received cisplatin previously (secondary outcomes).

Method

single-center retrospective analysis. Inclusion period: January 2015 to September 2020. Dose administered: PEM 2mcg/kg/21 days; ATZ 1200mg/21 days; NIV 3mg/kg/ 21 days. Changes in natremia and GFR (CDK-EPI) were evaluated in 0,1,3 months of follow-up. Patients with combined chemotherapy were excluded.

Results

137 patients were included. Mean age: 64 years. Men: 71.6%. Neoplasm: lung (76.8%), bladder (7.2%), melanoma (15.9%). Patients received 27.5% PEM; 26.1% ATZ; 46.4% NIV. Between all of them, 76% had received platinum previously. Up to 13.6% developed hyponatremia and 12.40% AKI 3 months later. The decrease in GFR was significantly greater in bladder neoplasm (mean GFR 42ml / min / m2 p <0.01) at three months. Bladder cancer was also the most frequent (but not significant) in reduced natremia (mean Na 135mEq / L p = 0.08). There were no differences according to drug administration or having received platinum previously. 61% were death, but none of them due to a renal event.

Conclusion
MO366CONCORDANCE BETWEEN FIVE CLASSIFICATION SYSTEMS OF COMMUNITY-ACQUIRED ACUTE KIDNEY INJURY
Authors: Peña Porta Jose Maria , Ferreras Gascó José Antonio , Castellano Calvo Almudena , Coscojuela Otto Ana , Juarez Mayor Paula , Alvarez Lipe Rafael
Published: May 2021

Background and Aims

In recent years, up to five classification systems have appeared according to the severity of acute kidney injury (AKI), some based on relative increases in creatinine (RIFLE, AKIN, KDIGO) and others in absolute increases: the kinetic method of creatinine (KC) and delta creatinine (DC) method. It is discussed in the literature which methodology offers better diagnostic performance.

The aim of this study was to analyze the concordance using the Kappa index of the 5 classification systems in a cohort of patients with community-acquired AKI (CA-AKI) treated in the Nephrology Service of a tertiary hospital.

Method

All the CA-AKI cases admitted to our service in the period: January 2010 - December 2016 were analyzed.

Results

536 patients (59,9% male) of 73.13 ± 13,6 years of age. Etiology of AKI: prerenal 72.8%; renal 20.5%; obstructive 6.7%. 69.6% of patients were carriers of previous chronic kidney disease (CKD-EPI glomerular filtration <60 ml/min). The table shows the Kappa index among the various classification systems. Agreement was absolute (Kappa = 1) between the three systems based on percentage increase in creatinine. When comparing KDIGO with CK and DC, the agreement was much lower (Kappa 0.35). Concordance between CK and DC was good (Kappa = 0.84). These last two systems classify a greater number of stage 3 cases compared to KDIGO, while KDIGO classifies more cases as stage 1 (Stage 1: KDIGO 89, KC 27; DC 19; Stage 2: KDIGO 56, KC 56; DC 54; Stage 3: KDIGO 391, CK 453; DC 463)

Conclusion

KDIGO system is valid as a reference system with respect to AKIN and RIFLE. Systems based on absolute increases in creatinine tend to classify fewer cases as mild and more cases as severe than systems based on relative increases in creatinine. It remains to be seen what is the practical significance of these discrepancies in the clinical management of AKI patients.
MO367USEFULNESS OF ECHOCARDIOGRAPHIC PARAMETERS IN LONG - TERM CARDIOVASCULAR EVENTS AFTER AN ACUTE KIDNEY INJURY EPISODE
Authors: Cabrera Alicia , Salanova Villanueva Laura , Sanchez Ana , Muñoz Ramos Patricia , Ruano Pablo , Quiroga Borja
Published: May 2021

Background and Aims

Acute kidney injury (AKI), a frequent condition during hospitalizations, leads to an increase morbidity and mortality. Cardiovascular events are one of the most post-AKI studied complications, but the role of the baseline functional and structural cardiac alterations on prognosis has not been widely studied. The aim of the present study is to evaluate the prognostic value of echocardiographic parameters in the incidence of cardiovascular events (CVE) after a hospitalization-acquire AKI.

Method

In this is retrospective observational cohort study 1255 patients who presented AKI from 2013 to 2014 at our center were included. Baseline epidemiological data, comorbidities and echocardiographic parameters were collected. After discharge, patients were followed (mean 49±28 months) and post-AKI CVE were registered. In addition, new performed echocardiograms after discharge were collected. Associated factors to CVE and the predictive role of echocardiographic parameters were analyzed.

Results

Among the 1255 included patients, 676 (54%) had a registered echocardiogram in the six months before the AKI episode. Of them, 231 patients (38%) had left ventricle hypertrophy (LVH), 178 (30%) pulmonary hypertension (PHT), 178 (30%) diastolic dysfunction and 138 (21%) systolic dysfunction. After discharge (and prior to post-AKI CVE), 248 (20%) patients had a new echocardiogram that revealed LVH in 108 patients (45%), diastolic dysfunction in 96 (42%), PHT in 68 (32%) and systolic dysfunction in 47 (19%).

During follow-up, 484 (39%) patients had CVE. The presence of diastolic dysfunction, systolic dysfunction, PHT and LVH in any moment were associated factors to the incidence of CVE. An adjusted multivariate model showed that systolic dysfunction (hazard ratio [HR] 1.44, 95% confidence interval [95%CI] 1.073-1.943, p=0.015), age (HR 1.018, 95%CI 1.003-1.030, p=0.02), diabetes mellitus (HR 1.373, 95%CI 1.041-1.811, p=0.025), atrial fibrillation (HR 1.397, 95%CI 1.055-1.851, p=0.020) and diuretic intake (HR 1.580, 95%CI 1.171-2.131, p=0.003) were independent predictors of post-AKI CVE.

Conclusion

The evaluation of cardiac structure and functionality valued by echocardiographic parameters can be a useful tool for stratifying CVE risk after an AKI. Systolic dysfunction is an independent predictor of post-AKI CVE.
MO370PREGNANCY-RELATED ACUTE KIDNEY INJURY IN TUNISIA: A CLINICAL CHALLENGE
Authors: Msehli Menel , Jbali Hela , Ikram Mami , Ben kaab Badreddine , Ben hamida Fethi , Rais Lamia , BEN FATMA LILIA , KARIM ZOUAGHI
Published: May 2021

Background and Aims

Acute kidney injury (AKI) is a complex disorder that occurs in several clinical settings. During pregnancy, there are additional unique conditions that contribute to AKI. The clinical manifestations of Pregnancy related acute kidney injury(PRAKI) range from a minimal elevation in serum creatinine to severe renal failure requiring renal replacement therapy and may be associated with significant morbidity and mortality in young healthy women. This study aims to describe epidemiologic features, study clinical profile and outcomes of women with PRAKI and identify risk factors related to requiring hemodialysis among patients.

Method

We performed a retrospective study over a 5-year period (2015–2019) in a Tunisian intensive care unit. All patients presenting PRAKI were included.

Results

Ninety-six cases of PRAKI were listed. The rate of AKI during pregnancy-related hospitalizations was 16% .the average age was 31 ± 5 years.

Most women were from urban areas (62%) but with insufficient prenatal care (57%).Seventy-eight percent underwent cesarean section delivery.

PRAKI occurred in the postpartum in 79%of the cases. Oligo-anuria was the most common clinical feature of PRAKI, noted in 82% of our patients.

The leading etiological causes were pre eclampsia, eclampsia, postpartum haemorrhage and sepsis respectively, in 49%, 38%, and 24% of the cases.

Hemodialysis was required in 23% of cases. In the adjusted regression analysis, factors associated with dialysis were insufficient prenatal care (p=0,010 ; O Ra=24,113), HELLP syndrome (p=0,003 ; ORa=35,129), disseminated intravascular coagulation (p=0,007 ; OR=11,854), average duration of oliguria (p=0,001; ORa=3,025) , Failure stage of RIFLE criteria while admitted (p=0,009; ORa=2,09) and length of ICU stay (p=0,042 ; ORa=1,118).

Renal outcome was favorable, with a complete renal function recovery for 72 patients (75%). Only four patients (4%) developed chronic renal failure. Mortality rate was 13%.

Conclusion

PRAKI is a dreaded complication of pregnancy with high morbidity and mortality. Prevention of PRAKI requires an improvement of the sanitary infrastructures with the implementation of an obligatory prenatal consultation in order to prompt management of the underlying risk factors
MO376CLINICAL OUTCOMES OF ACUTE KIDNEY INJURY FOLLOWING SNAKE BITE INJURIES
Authors: Naweera Weerakit , Wannarong Thapat
Published: May 2021

Background and Aims

Snakebite is a common animal bite injury in tropical countries. Acute kidney injury (AKI) is an important complication in snakebite patients. This study aimed to comprehensively investigate the clinical profiles and outcomes of patients following hematotoxin-related snakebite associated with kidney impairment.

Method

We conducted a hospital-based, cross-sectional study of 238 patients with hematotoxin-related snakebite injuries. Data were retrieved from the King Narai Hospital Registry from October 2014 to August 2020. The prevalence of complications associated with snakebite injuries, including acute kidney injury (AKI) and its severity, was determined. Univariate and Multivariate predictors of AKI diagnosis were evaluated using binary logistic regression analysis

Results

A total of 238 patients, with 63.4% men, median (IQR) age 49.8 (39-61) years and median duration from injury to a hospital arrival of 1 hour (0.5-2) hours, were injured by Green pit viper (85.7%), Russell’s viper (12.6%) and Malayan pit viper (1.7%). AKI mostly occurred in Russell’s viper group 66.7%. An AKI was reported in thirty (12.6%, 95% CI: 8.7 % - 17.5%) patients, with the severity of 66.7% stage one, 6.7% stage two, 26.6% stage three by KDIGO classifications, and 13.3% requiring hemodialysis. Complete renal recovery was seen in twenty-two patients (73.3%), while partial renal recovery was 23.3%. Other complications included 84.4 % limb cellulitis, 4.6% significantly bleeding, 2.5% hypotension, 25.6% prolonged venous clotting time (VCT), 46.7% prolonged prothrombin time (PT), and 14.3% prolonged partial thromboplastin time (PTT). Of total patients, 60.1% were treated with anti-venom. Mortality was relatively low (0.4%). In multivariable logistic regression analyses, AKI was significantly associated with time to hospital arrival more than 3 hours (p = 0.04), Russell’s viper bitten (p = 0.01), clinical bleeding (p = 0.01), and prolonged PT (p < 0.01).

Conclusion

The prevalence of AKI in patients bitten by hematotoxin snakes was 12.6%, mostly from Russell’s viper. Factors associated with AKI outcomes were time to hospital arrival more than 3 hours, Russell’s viper bitten, clinical bleeding, and prolonged PT. Besides, one-fourth of AKI patients turned to chronic kidney disease.
MO377HOW THE ITALIAN COVID-19 LOCKDOWN AFFECTED NEFROLOGICAL ACTIVITY IN A LOMBARD CENTER
Authors: Albrizio Paolo , Costa Silvano , Foschi Annalisa , Milani Ivo Angelo Antonio , Rindi Stefano , Zucchi Manuela , Milanesi Fabio
Published: May 2021

Background and Aims

Italy and Lombard hospitals particularly, were hard affected by Covid-19 pandemic, mostly during spring and autumn, seasons characterized by two lockdown periods which were however, partly different as rules. During first lockdown in fact, by hospital decision, all ambulatorial activity was closed, including nephrological one. This did not happen during second lockdown period. How the different choices about hospital activity affected nephrological patients is the aim of this study.

Method

we evaluated all nephrological advices requested by first aid units of our 3 hospitals, all located in Lombardy, to our Nephrology Unit, splitting out data in 3 periods (I lockdown, summer and II lockdown) and comparing with 2019. Data collected were: number of advices requested by day, age, sex, previous regular nephrological follow-up, Covid-19 diagnosis, nephrological diagnosis after nephrological advice and outcome.

Results

as shown in table 1, during I lockdown period, with hospital decision of suspending our nephrological ambulatorial activity, we suffered an incremented rate of patients approaching local first aid units compared to 2019 same period with an increased rate of acute kidney injury, mostly for dehydration, and with a higher rate of patients requiring hospitalization. All these differences resulted statistically significant vs 2019 same period (figure 1). On the other side, no statically significant difference was found during the other two examined periods, including the II lockdown, while all our ambulatories were fully operating.

Conclusion

Covid-19 pandemic affected also the nephrological population with an increased rate of first aid units’ accesses, acute kidney injury events and hospitalization comparing to 2019. However, these differences were detectable only during the I lockdown period characterized by the suspension of all ambulatorial activity, including our Unit. The absence of statistically significant differences during summer and primarily during II lockdown period demonstrates the importance of nephrological ambulatorial activity in management of renal diseases and in prevention of acute events.
MO383COVID - 19 AND AKUTE KIDNEY INJURY- A SINGLE CENTER EXPERIENCE
Authors: Bulatovic Ana , Bjedov Jelena , Maslarevic Radovic Vesna , Dimkovic Nada , Naumovic Radomir
Published: May 2021

Background and Aims

The new coronavirus disease (COVID 19) has become a worldwide health emergency with a wide spectrum of clinical presentation, from common cold symptoms to multiorgan failure. A great number of medical centers have reported that patients with COVID-19 have developed acute kidney injury. The kidney is a target organ for SARS - COV2 because of ACE2 receptor, the binding site for this virus, is expressed in kidney tissue. The potential mechanisms for kidney injury are direct kidney injury, inflammation, activation of coagulation and complement cascades. Data from centers worldwide reported a wide range of AKI incidence, from 0,5% in China to 46% in USA. The aim of this study was to analyze incidence, risk factors and outcomes of AKI in hospitalized patients with COVID 19 who were treated from 01.04. to 01.06.2020. at Nephrology Department of University Clinical Center Zvezdara, which was at the time transformed into COVID hospital.

Method

This retrospective observational study included 51 patients who had normal kidney function before the infection with SARS COV2, and 7 of them developed dialysis non-dependent AKI. Analysis included data collection from the patients’ history including demographic, clinical and administrative data. Statistical analysis has been performed using SPSS software version 20 (IBM Corporation, New York, USA).

Results

Out of 51 patients 7 (13.7%) developed AKI, mean age was 59 + 16 years and 53% were male. Diabetes mellitus was present in 27 of patients with AKI, hypertension in 6/7, obesity in 3/7, coronary artery disease in 1/7 and 1 of 7 patients was smoker. These risk factors except obesity (p= 0.05) didn’t vary significantly between two groups (AKI and non AKI patients with COVID-19). Our results showed significant correlation between AKI development and obesity (p= 0.05, OR 4.75), Charlston index score (p=0.01), D dimer score (p=0.01), and CT COVID score (p=0.03). Regarding the outcome, COVID 19 patients with AKI showed 7-fold higher risk for fatal outcome (p= 0.046).

Conclusion

Obesity, higher D dimer values, worse CT findings and higher Charlston comorbidity score index were associated with acute kidney injury in patients with COVID 19. AKI proved to be significant risk factor for fatal outcome in patients with SARS COV2 infection.
MO386MASS SCREENING AND THE LOW RATES OF ACUTE KIDNEY INJURY AMONG COVID-19 PATIENTS IN HONG KONG
Authors: Chan Kam Wa , Hung Ivan Fan-Ngai , Tsang Owen Tak-Yin , Wu Tak Chiu , Tso Eugene Yuk-Keung , Lung Kwok Cheung , Lam Chung Man , Chan Gary Chi Wang , Wong Sunny Sze-Ho , Yu Kam Yan , Chan Johnny Wai-Man , Tang Sydney
Published: May 2021

Background and Aims

Renal involvement in COVID-19 under vigilant public health surveillance, including mass screening and early hospitalization is less well-characterized. We assessed renal involvement of COVID-19 patients in Hong Kong, including the association with risk factors, length of hospitalization, critical presentation and mortality.

Method

Linked electronic records of all confirmed patients from 5 major designated hospitals were extracted. Primary outcome was the incidence of in-hospital AKI. Secondary outcomes were AKI-associated mortality, incident RRT, intensive care admission, prolonged hospitalization and disease course (defined as >90th percentile of hospitalization duration and duration from symptom onset to discharge, respectively), and change of eGFR. Patients were further stratified into being symptomatic or asymptomatic.

Results

Patients were characterized by young age (median:38.4, IQR:28.4-55.8 years old) and short time (Median:5, IQR:2-9 days) from symptom onset to admission. Among the 591 patients, 22 (3.72%) developed AKI and 4 (0.68%) required RRT. AKI increased the odds of prolonged hospitalization and disease course by 2.0 and 3.5 folds, respectively. Estimated GFR 24 weeks post-discharge reduced by 7.51 and 1.06 ml/min/1.73m2 versus baseline (at admission) in the AKI and non-AKI groups, respectively. The incidence of AKI was comparable between asymptomatic (4.8%) and symptomatic (3.7%) patients.

Conclusion

The overall rate of AKI among COVID-19 patients in Hong Kong is low, which could be attributable to a vigilant screening program and early hospitalization. Among patients who developed in-hospital AKI, the duration of hospitalization is prolonged and kidney function impairment can persist for up to 6 months post-discharge. Mass surveillance for COVID-19 is warranted in identifying asymptomatic subjects for earlier AKI management.
MO388DEVELOPMENT OF ACUTE KIDNEY INJURY DURING A RHABDOMYOLYSIS EPISODE: DIFFERENCES IN LONG-TERM KIDNEY FUNCTION
Authors: Núñez Delgado Sara , Iriarte-Abril Miren , Farrera-Núñez Júlia , Pascual-Sánchez Sergi , Sans-Atxer Laia , Sierra-Ochoa Adriana , Barrios-Barrera Clara , Arenas-Jiménez M Dolores , Pascual Julio , Rodríguez García Eva
Published: May 2021

Background and Aims

Acute renal failure (AKI) associated to rhabdomyolysis conditions a worse prognosis in short-term, its implication in the long-term renal function has been less evaluated.

Method

Retrospective analysis of patients diagnosed with rhabdomyolysis defined by creatinine kinase > 5000 IU/L between 2015-2019. Basal and 12-month renal function was evaluated. AKI was classified as either non-severe (AKI-KDIGO 1/2) or severe (AKI-KDIGO 3).

Results

Eighty-seven patients were included, 25 (28.74%) had some degree of chronic kidney disease (CKD) on admission. 56 (64.37%) had AKI on admission, 17 of which were severe (6 required hemodialysis). The patients with AKI had more cardiovascular disease (CVD) and worse analytical parameters on admission (table). Patients with severe AKI showed no difference in CVD from those with non-severe AKI but were younger and had more hyperkalemia. There were no significant differences between patients with severe AKI who required hemodialysis and those who did not. Inpatient mortality was 8%, higher in patients with AKI but without differences according to severity.

In 45 patients kidney function was available 12 months after the episode, loss of eGF was -4.90 ± 14.35 ml/min-1.73m2 (p=0.007). There was no difference between patients who developed AKI and those who did not (-4.10 ± 14.4 vs. -5.39 ± 14.57 ml/min-1.73m2; p=0.67), nor between non-severe and severe AKI (-5.50 ± 14.76 vs. -5.12 ± 15.08ml/min-1.73m2; p=0.98). Of the 33 patients without previous CKD, 5 developed CKD, with greater decrease in eGF than those who did not (-22.69 ± 6.04 vs. -2.63 ± 13.92 ml/min-1.73m2; p=0.003). Female sex (60% vs. 12%; p=0.031) and previous basal eGF (72.22 ± 4.37 vs. 95.6±19.97 ml/min-1.72m2; p=0.016) were related to this deterioration.

Conclusion

After an episode of rhabdomyolysis, the loss of eGF is similar in patients who develop AKI compared to those who do not.
MO390THE RISK FACTORS AND CLINICAL OUTCOMES ASSOCIATED WITH ACUTE KIDNEY INJURY IN PATIENTS WITH COVID-19
Authors: Rahimzadeh Eshkalak Hormat , Farrokhpour Hossein , Kazemian Sina , Rahbar Maryam , Montazeri Mahnaz , Kafan Samira , Salimzadeh Ahmad , Talebpour Mohammad , Majidi Fazeleh , Gannatalipour Atefeh , Razeghi Effat
Published: May 2021

Background and Aims

Kidney involvement, ranging from mild hematuria and proteinuria to acute kidney injury (AKI) in patients with coronavirus disease-2019 (COVID-19), is a recent finding with various incidence rates reported among hospitalized patients with COVID-19. Current evidence on AKI rate in patients hospitalized with COVID-19 and its associated risk factors is limited, especially in Iran.

Method

In this retrospective cohort study, we enrolled adult patients referred to the Sina hospital, Iran, from 20 February to 14 May 2020, with either a positive PCR test or a highly susceptible chest computed tomography features (CT) consistent with COVID-19 diagnosis. AKI was defined according to the kidney disease improving global outcomes (KDIGO) criteria, and patients were stratified based on their AKI staging. We evaluated the risk indicators associated with AKI during hospitalization besides in-hospital outcomes and recovery rate at the time of discharge.

Results:

We evaluated 516 patients with a mean age of 57.6±16.1 years and a male to female ratio of 1.69 who were admitted with the COVID-19 diagnosis. AKI development was observed among 194 (37.6%) patients, comprised of 61.9% patients in stage 1, 18.0% in stage 2, and 20.1% in stage 3. Out of all patients, AKI occurred in 58 (11.2%) patients during the hospital course, and 136 (26.3%) patients arrived with AKI upon admission. AKI development was positively associated with all of the in-hospital outcomes, including intensive care unit admissions, need for invasive ventilation, acute respiratory distress syndrome (ARDS), acute cardiac injury, acute liver injury, multi-organ damage, and mortality. Patients with stage 3 AKI showed a significantly higher mortality rate, ARDS, and need for invasive ventilation than other stages. After multivariable analysis, male sex (odds ratio (OR):11.27), chronic kidney disease (OR: 6.89), history of hypertension (OR:1.69), disease severity (OR; 2.27), and high urea levels (OR: 1.04) on admission were independent risk indicators of AKI development. Among 117 (28.1%) patients who experienced AKI and survived, only 33 (28.2%) patients made a recovery from the AKI, and 84 (71.8%) patients did not exhibit full recovery at the time of discharge.

Conclusion

We found that male sex, history of chronic kidney disease, hypertension, disease severity, and high serum urea were independent risk factors associated with AKI in patients with COVID-19. Also, higher stages of AKI were associated with increased risk of mortality and in-hospital complications. Our results indicate a necessity for more precise care and monitoring for AKI during hospitalization in patients with COVID-19, and lack of AKI recovery at the time of discharge is a common complication in such patients.
MO391RISK FACTORS OF ACUTE KIDNEY INJURY IN SEVERE ACUTE RESPIRATORY ILLNESS DURING CORONAVIRUS DISEASE 2019 PANDEMIC
Authors: Gan Wee Leng , Kong Boon Huei
Published: May 2021

Background and Aims

Acute Kidney Injury (AKI) is associated with poor outcome in severe acute respiratory illness (SARI) during Coronavirus Disease 2019 (COVID 19) pandemic. This study aim at detetction of risk factors for AKI among patients admitted for SARI at our Center for COVID 19 screening.

Method

Restrospective study by reviewing admission notes from March 2020 until December 2020 at our district center. Patient aged more than 18 year old who admitted for SARI as defined by World Health Organisation and AKI as defined by Kidney Disease Improving Global Outcome (KDIGO) guideline were included. Chronic kidney disease and End stage Renal Failure as defined by KDIGO were excluded.

Results

A total 230 ( 56%) patients out of 410 patients with SARI had AKI during hospitalisation. The mean age was 72 years old (SD 13.8), 130 (56.5%) were male and 100 ( 43.5%) were female. SARI patients with AKI took mean 5 days ( SD 0.9) to be admitted at our center from the first day of illness. The mean body mass index (BMI) was 27.2 kg/m2 . The mean arterial pressure was 52.1 ( SD 3.7) mmhg upon admission. The mean neutrophils lymphocytes ratio ( NLR ) was 22.4 (SD 2.4). The independant Risk factors for AKI in SARI are Male gender ( OR 0.95; 95% CI 0.35-2.6), smoking ( OR 0.72 ;95% CI 0.23- 2.3), ischaemic heart disease (OR 0.48; 95% CI 0.06-3.8), diabetes mellitus ( OR 1.15; 95% CI 0.39-3.38) and hypertension ( OR 1.58; 95% CI 0.58-4.25).

Conclusion

Non modifiable risk factors for AKI in SARI include male gender and advance age. The modifiable risk factors for AKI in SARI are over weight, smoking, ischemic heart disease, diabetes mellitus and hypertension. NLR play a role in predicting AKI among SARI patients. Delay hospitalisation and hypoperfusion predispose to AKI in SARI. Early recognition of risk factors is crucial in preventing deterioration of kidney function in SARI patients during the inital screening for COVID 19 infection.
MO392ACUTE KIDNEY INJURY IN HOSPITALIZED PATIENTS WITH COVID-19: A SINGLE-CENTER EXPERIENCE
Authors: Akagun Tulin , Ayraler Arzu , Usta Murat , Baylan Süleyman , Dulger Ahmet Cumhur
Published: May 2021

Background and Aims

Preliminary reports indicate that AKI (acute kidney injury) seem to be associated with coronavirus disease 2019 (COVID-19) severity and outcomes. Although the reported incidence of AKI among hospitalized patients with COVID-19 varies widely, AKI among hospitalized patients is associated with poor prognosis. The aim of this study was to evaluate the clinical characteristics and outcomes in our COVID-19 patients who developed AKI during intensive care unit hospitalization.

Method

In our retrospective, observational study COVID-19 PCR positive 49 patients who were hospitalized with COVID-19 pnumoniae in intensive care unit and developed AKI were evaluated with demographics, laboratory data, treatment and outcome. The prognostic nutritional index (PNI), which is calculated using the serum albumin concentration and total lymphocytic count were also evaluated. All patients were treated with favipiravir+low molecular weight heparin; laboratory tests were recorded before and after favipiravir treatment.

Results

Of 49 patients; 28 were male. A total of 9/49 (18.4%) patients survived. All patients were treated with favipiravir; laboratory tests were recorded before and after favipiravir treatment. The clinical parameters of patients are shown in Table-1 and Table-2. Mean PNI of the patients who survived was higher than patients who were exitus.

Conclusion

AKI in hospitalized patients with COVID-19 was associated with high mortality. Of all patients with AKI, only 18.4% survived.
MO395EPIDEMIOLOGY AND OUTCOME OF PATIENTS WITH ACUTE KIDNEY INJURY REQUIRING DIALYSIS: ABOUT 230 CASES
Authors: Elouaer Yosra , Guedri Yosra , Troudi Mohamed Riadh , Azzabi Awatef , Mrabet Sanda , Sahtout Wissal , Fradi Asma , Ben Aicha Narjes , Zellama Dorsaf , Achour Abdellatif
Published: May 2021

Background and Aims

Acute renal injury (ARI) is a frequent pathology. Rarer are the studies dedicated specifically to the subgroup requiring dialysis. The objective of our study is to identify: The epidemiological profiles of patients with ARI requiring dialysis. The course of the dialysis sessions to determine the dialysis’ prescription and the different accidents.

Method

This is a descriptive cross-sectional study including patients admitted to the different departments of Sousse University Hospitals in Tunisia who presented an ARI requiring emergency dialysis. Our study was conducted from February 2015 until August 2018. The data collected were analysed by the SPSS software.

Results

During three and a half years, 230 patients presented ARI requiring dialysis. The average age was 60 ± 16 years old. The sex ratio was 1.61. A history of hypertension, diabetes, heart disease, dyslipidaemia, hyperuricemia, uropathy and neoplasia was noted in respectively 34.9%, 27.1%, 21.6%, 22.7%, 25.5%, 22.7% and 14.3% cases. The causes of ARI were dominated by organic, obstructive and functional causes in 66.2%, 21.7% and 7.4% of cases, respectively. For organic causes, we noted acute tubular necrosis in 70.4% of cases, a glomerular cause in 14.5% of cases, an interstitial cause in 7.9% of cases and a vascular cause in 7.2% of cases. Dialysis indications were dominated by severe acidosis, pulmonary oedema, uremic syndrome and hyperkalaemia in 27.4%, 24.3%, 16.5% and 14.3% of cases, respectively. Among our patients, 26.7% presented a hemodynamic instability with catecholamine use in 16.8% of cases and the use of isovolumic connection at the beginning of the session in 21.2% of cases. The median ultrafiltration was 444 ml / hour IQR [166, 67-750] with extremes of 0 to 1333 ml/hour. The median blood flow was 250 ml/min IQR [250-280] with extremes of 180 to 300 ml/min. The median duration of dialysis’ session was 180 minutes IQR [180,240] with extremes of 15 to 360 minutes. We noted dialysis incidents in 12% of dialysis’ sessions. These events were dominated by hypotension, hypoglycaemia, extracorporeal circuit coagulation, death and chest pain in 13.8%, 4.8%, 2.6%, 2.1% and 0.7% of cases, respectively. The cessation of dialysis sessions was noted in 22 sessions (11.1%).

Concerning the evolution of patients: 33.1% of patients recovered normal renal function, 23.9% of patients maintained renal failure, 22.2% of patients died and 20.8% of patients were lost from seen or the duration of their follow-up was less than three months not making it possible to conclude as to the chronicity of the renal insufficiency.

Conclusion

ARI is a common and serious pathology. Dialysis is an important evolutionary step. It is associated with a high risk of progression to chronic renal failure and mortality. Optimal management of ARI is required.
MO351CENTRE VARIATION IN MORTALITY FOLLOWING HOSPITAL-ACQUIRED ACUTE KIDNEY INJURY IN ENGLAND
Authors: Peracha Javeria , Pitcher David , Santhakumaran Shalini , Day Jamie , Fotheringham James , Steenkamp Retha , Medcalf James , Nitsch Dorothea , Lipkin Graham , McKane William
Published: May 2021

Background and Aims

Routine monitoring of outcomes for patients with Acute Kidney Injury (AKI) is necessary to drive quality improvement in AKI care. In this study, we describe development of a case-mix adjusted 30-day mortality indicator for patients with hospital acquired AKI (H-AKI), to facilitate identification of unwarranted variation in outcomes across hospitals in England.

Method

We utilised a routinely collected national dataset of biochemically defined AKI cases, linked with hospitals administrative and mortality data. 250,504 H-AKI episodes were studied in total, across 103 hospitals between January 2017 - December 2018. Standardised mortality ratios were calculated for each hospital using logistic regression; adjusting for age, sex, primary diagnosis, comorbidity score, AKI severity, month of AKI, and admission method.

Results

Mean 30-day mortality rate was high at 28.6% and varied considerably between hospitals (22.3%-35.5%), with 23/103 trusts classed as outliers (95% control limits). Patients with H-AKI had mortality rates more than 5 times higher than the overall hospitalized population in 90/136 diagnosis groups and over 10 times higher in 60/136 groups. Increasing age, male sex, deprivation, higher comorbidity burden, more severe AKI stage at detection, emergency admission and admission during winter months were all associated with a higher risk of death Presentation at hospitals with on-site specialist nephrology services and Asian or Black ethnicity, however, were linked to a lower risk of death.

Conclusion

This is the largest multi-centre analysis of mortality for patients with biochemically ascertained H-AKI to date, once again highlighting development of AKI as an important patient safety concern across hospital settings. Centres identified as having poor outcomes will need to carefully interrogate their AKI care pathways to understand and explore reasons underlying the observed variation to guide future quality improvement interventions.
MO396NOVEL ENDOTHELIAL INFLAMMATION BIOMARKERS IN SNAKEBITES-ASSOCIATED ACUTE KIDNEY INJURY
Authors: Brasileiro Mota Sandra Maria , Lemos Moura Moreira Albuquerque Polianna , Cavalcante Meneses Gdayllon , Tavares Holanda Francisco Marcio , Oliveira Brizeno Mariana , Rolim Guimaraes Alvaro , Costa Martins Alice Maria , Bezerra da Silva Junior Geraldo , De Francesco Daher Elizabeth
Published: May 2021

Background and Aims

Acute kidney injury (AKI) is a frequent and potentially fatal complications of snakebites. Coagulation disturbances are observed and have a high probability to be involved in AKI pathogenesis. Novel endothelial inflammation biomarkers are capable of predicting disease severity and could be used in the setting of snakebites.

Method

This is a prospective study conducted at the Instituto Dr. José Frota, a reference hospital for toxicological assistance in Fortaleza, Northeast Brazil. Blood and urine samples were collected from patients admitted after snakebite accident, without comorbidities, in 3 different time-points post-bite: on admission (until 8h post-bite), 12 to 16h, and 24-48h. The samples were stored in microtubes, frozen in a freezer (-80ºC) until performance of the laboratory tests. To measure the novel biomarkers the following ELISA kits were used: Angiopoietin-1 (R&D Systems–Duoset DY623), Angiopoietin-2 (R&D Systems–Duoset DY623) and Vascular cell adhesion protein 1  (VCAM-1) (Abcam–ab47355). All procedures were conducted according to the manufacturer’s guidelines. AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. Patients were divided in 2 groups: with and without AKI.

Results

A total of 26 patients were included in the study:23 (88.5%) victims of Bothrops accident and 3 (11.5%) Crotalus accidents. AKI was observed in 11 cases. The 2 groups did not differ in age, gender, electrolytes levels, creatine kinase (CK), hemoglobin and hematocrit levels. There were significant differences regarding the levels of angiopoietin 1 (16.39±8.1 vs 4.35±7.36; p=0.0054) and VCAM-1 (1293±528 vs 811.3±234; p=0.0175), both in the second sample (12-16h after bite). The analysis of ROC curve revealed that angiopoietin 1 (AUC: 0.8182, 95% CI0.63–0.99, p=0.0064) and VCAM-1 (AUC: 0.77, 95% CI0.57–0.97, p=0.0182) presented good accuracy for AKI prediction in the studied population.

Conclusion

Endothelial inflammation biomarkers (VCAM-1 and angiopoietin 1) have good accuracy for snakebites-associated AKI diagnosis. The time 12-16h after the bite had the best result in predicting AKI in this setting.
MO402ACUTE OBSTRUCTIVE RENAL FAILURE IN URGENT HEMODIALYSIS
Authors: Failal Imane , Ezzaki Sanae , Elafifi Rania , Zamd Mohamed , Mtioui Naoufal , Elkhayat Salma , Medkouri Ghizlaine , Benghanem Mohamed , Ramdani Benyounes
Published: May 2021

Background and Aims

Acute obstructive renal failure is secondary to obstruction of the upper excretory tract occurring bilaterally or in a single anatomical or functional kidney. It accounts for 8 to 14% of all acute renal failure in Morocco. They constitute serious conditions which can jeopardize the functional prognosis of the kidney .

The objective of our study is to describe the profile of patients on emergency hemodialysis for acute obstructive renal failure (AKI), the main indications for hemodialysis and to assess the risk factors for mortality.

Method

It was a 2-year retrospective and descriptive study from January 2018 to December 2019; performed in the nephrology and hemodialysis department CHU IBN ROCHD CASABLANCA.

Results

A total of 118 patients were counted: 43 women, 75 men or 36.4%, 63.5%, with an average age of 54.3 years "+/- 10.3". The circumstances of discovery were: Oligo anuria 51.5%, hematuria 25%, AEG 24%. The obstacle was neoplastic in 67.79%; lithiasis 26.27%; on pregnancy in 0.84%; bladder malformation 0.84%, and unknown etiologies in 4.2%. The neoplastic origin was cancer of the cervix, followed by the bladder and then the prostate. The average creatinine level was 89.7mg / l. The indication for hemodialysis was: threatening hyperkalemia, uremic syndrome, acidosis and acute pulmonary edema in 56%, 25.8%, 9.6% and 10% of cases, respectively

The total number of hemodialysis sessions was 227 hemodialysis sessions with an average number of 1.91. Obstacle removal was performed by percutaneous nephrostomy in 70.8% of cases, by mounting a double J probe in 10% of cases and by ureterostomy in 4.2% of cases. The course was good in 77.9% of the cases, 13.5% progressed to the IRCT. Mortality was 8.4%. Risk factors for mortality were: age, etiology of neoplasia.

Conclusion

A total of 118 patients were counted: 43 women, 75 men or 36.4%, 63.5%, with an average age of 54.3 years "+/- 10.3". The circumstances of discovery were: Oligo anuria 51.5%, hematuria 25%, AEG 24%. The obstacle was neoplastic in 67.79%; lithiasis 26.27%; on pregnancy in 0.84%; bladder malformation 0.84%, and unknown etiologies in 4.2%. The neoplastic origin was cancer of the cervix, followed by the bladder and then the prostate. The average creatinine level was 89.7mg / l. The indication for hemodialysis was: threatening hyperkalemia, uremic syndrome, acidosis and acute pulmonary edema in 56%, 25.8%, 9.6% and 10% of cases, respectively

The total number of hemodialysis sessions was 227 hemodialysis sessions with an average number of 1.91. Obstacle removal was performed by percutaneous nephrostomy in 70.8% of cases, by mounting a double J probe in 10% of cases and by ureterostomy in 4.2% of cases. The course was good in 77.9% of the cases, 13.5% progressed to the IRCT. Mortality was 8.4%. Risk factors for mortality were: age, etiology of neoplasia.