bluuebunny/crossref_metadata_2025 huggingface dataset:
MO407POSITIVE COMBINED BIOMARKER TEST IS AN INDEPENDENT PREDICTOR OF ACUTE KIDNEY INJURY IN PATIENTS WITH ACUTE CARDIAC DISEASES
Authors: Efremovtseva Marina , Avdoshina Svetlana , Kobalava Zhanna
Published: May 2021

Background and Aims

Biomarkers are currently considered as an additional criterion for the diagnosis of AKI. Early diagnosis of AKI is especially important in acute cardiovascular diseases due to increased risk of severe adverse events associated with development of cardiorenal syndrome.

The aim of the study to explore the role of biomarkers in early diagnosis of AKI and their prognostic values in patients with acute cardiac diseases.

Method

109 patients (51 with acute decompensated heart failure (ADHF), 58 with non-ST-elevation acute coronary syndrome (NSTE-ACS) were examined. Biomarkers of HF (NT-pro BNP in serum) and kidney damage (cystatin C in serum; neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1) and interleukine-18 (IL-18) in the urine) were estimated. Mann-Whitney test and multivariate logistic regression analysis were performed, p <0.05 was considered statistically significant.

Results

Patients with vs without AKI had higher levels of NGAL (344±308.8 vs 37.9±65.1 ng/ml, p <0.001) and KIM-1 (0.774±0.36 vs 0.402±0.59 ng/ml, p <0.01) in all groups. Patients with NSTE-ACS with vs without AKI had higher level of NT-proBNP (12857.1±3108.8 vs 10134±2479, p<0.001), no difference was detected in ADHF group. In course of ROC analyses NGAL and KIM-1 showed the best prognostic values (AUC value 0.948 and 0.760). The сut points for NGAL >60.1 ng/ml (sensitivity 87%, specificity 92%) and KIM-1 > 0.519 ng/ml (sensitivity 87%, specificity 67%) were detected, coefficient of association φ was 0,781 and 0,555 respectively. Simultaneous detection of two markers of structural kidney damage (increase of NGAL and/or KIM-1) in high-risk patients permits to diagnose 95% of AKI cases at admission. Patients with AKI and diagnostically significant levels of biomarkers had higher prevalence of CKD (p<0.01), acute heart failure, ADHF (p<0.05) vs those without increase of biomarkers, in-hospital mortality in this group was 29,8%.

Conclusion

Positive combined biomarker test is an independent and strong predictor of AKI in patients with acute cardiac diseases, and its implementation in clinical practice improve the early diagnostics of AKI when markers of kidney function are still at normal levels.
MO353MACHINE LEARNING-BASED PREDICTION OF ACUTE KIDNEY INJURY AFTER NEPHRECTOMY IN PATIENTS WITH RENAL CELL CARCINOMA
Authors: Kim Sejoong , Lee Yeonhee , Han Seung Seok
Published: May 2021

Background and Aims

The precise prediction of acute kidney injury (AKI) after nephrectomy for renal cell carcinoma (RCC) is an important issue because of its relationship with subsequent kidney dysfunction and high mortality. Herein we addressed whether machine learning algorithms could predict postoperative AKI risk better than conventional logistic regression (LR) models.

Method

A total of 4,104 RCC patients who had undergone unilateral nephrectomy from January 2003 to December 2017 were reviewed. Machine learning models such as support vector machine, random forest, extreme gradient boosting, and light gradient boosting machine (LightGBM) were developed, and their performance based on the area under the receiver operating characteristic curve, accuracy, and F1 score was compared with that of the LR-based scoring model.

Results

Postoperative AKI developed in 1,167 patients (28.4%). All the machine learning models had higher performance index values than the LR-based scoring model. Among them, the LightGBM model had the highest value of 0.810 (0.783–0.837). The decision curve analysis demonstrated a greater net benefit of the machine learning models than the LR-based scoring model over all the ranges of threshold probabilities. The LightGBM and random forest models, but not others, were well calibrated.

Conclusion

The application of machine learning algorithms improves the predictability of AKI after nephrectomy for RCC, and these models perform better than conventional LR-based models.
MO354PRELIMINARY EVIDENCE OF RIVASTIGMINE EFFICACY IN CKD RELATED MILD COGNITIVE IMPAIRMENT
Authors: Mone Pasquale , Pansini Antonella , Capasso Giovambattista , Viggiano Davide
Published: May 2021

Background and Aims

Mild Cognitive Impairment (MCI) is a common finding in chronic kidney disease (CKD) patients. Indeed, CKD represents a relevant risk factor for developing dementia and MCI. Cholinesterase inhibitors, such as rivastigmine, are among the few drugs approved for the treatment of dementia and MCI. Rivastigmine is also used to treat vascular dementia because it protects subcortical brain structures. Data are scanty regarding the use of rivastigmine in CKD patients with MCI and are much needed to guide the therapy for MCI in this cohort of patients.

Method

This retrospective case-control study compared the effects of rivastigmine on cognitive functions in MCI patients with CKD (stage III-IV; n= 20) and without CKD (n=21, control group), comparable for the extent of cognitive impairment (indexed by Montreal Cognitive Assessment, MoCA), age (range 18-65 years), gender, weight, and comorbidities. Patients under treatment with rivastigmine and with a baseline MoCA score available were included in the study. Exclusion criteria were ictus, psychiatric or other neurological conditions, heart failure, liver failure, severe obesity, anemia, electrolyte disorders, cancer, dialysis, and other severe comorbidities. Laboratory test data (glycemia, cholesterol, hemoglobin, proteinuria, creatinine) were used to characterize the two populations. MCI was defined as a MoCA score between 21-26. The cognitive screening was available at baseline (before treatment) and during a follow-up in a range of three-six months after the start of the treatment. CKD was defined by eGFR < 60 mL/min/1.73m2.

Results

The follow-up timing for cognitive screening was not statistically different between the two cohorts. The control group (MCI without CKD) showed a small, significant improvement in the MoCA score after treatment (baseline MoCA: 22.9±0.5, follow-up MoCA: 23.5±0.5, p=0.02, t-test for paired data).

At variance, the MCI-CKD group showed a significant improvement in the MoCA score (baseline MoCA=23±0.4, follow-up MoCA=24.3±0.4, p<0.05).

Accordingly, the extent of improvement of MoCA score after rivastigmine was inversely correlated to the eGFR (r = -0.23).

Conclusion

A significant improvement in MoCA score accompanied treatment with rivastigmine in the CKD group. More extensive population studies are needed to verify the greater efficacy of Acetylcholinesterase inhibitors in this population.
MO408OBSTRUCTIVE NEPHROPATHY - STILL PREVALENT DISEASE
Authors: Bulatovic Ana , Todorov Sakic Verica , Djuric Petar , Bjedov Jelena , Jankovic Aleksandar , Naumovic Radomir , Dimkovic Nada
Published: May 2021

Background and Aims

Acute kidney injury (AKI) secondary to urinary obstruction is a common urological-nephrological problem. In this retrospective study, our goals were to describe the etiology, management and outcomes of patients with obstructive nephropathy who were hospitalized at Nephrology Department during 2019.

Method

AKI was defined by the RIFLE classification. Diagnosis of obstruction was defined by ultrasound imaging, intravenous pyelography and CT scan.

Results

During 2019 AKI secondary to urinary obstruction was diagnosed to 64 patients. 73% of them were male, average age 65 ± 16 years. About 60% of the patients had bilateral hydronephrosis, chronic kidney disease and anuria duration longer than 24h. The following desobstructive procedures were applied: urinary catheterization to 33 patients, percutaneous nephrostomy tube to 14 patients, double-J stent to 7 and other procedures to 10 patients. The most common causes of obstruction were malignancy and benign prostatic hyperplasia 60%, calculosis 17%, and other causes 20% such as neurogenic bladder and retroperitoneal fibrosis. As many as 30% of patients required acute hemodialysis treatment, of which 6% remained on a chronic program in period of three months. Out of all, 30% of patients had a partial recovery of kidney function, while 20% had complete recovery. The most common complication was infection and bleeding. The univariate logistic regression, adjusted for age and hemodialysis treatment, has shown that significant independent predictors for chronic kidney disease progression were anuria duration >24h (RR 2.21; 95% CI 0.014-1.03; p=0.05), polyuria duration (RR 2.11; 95% CI 1.112-3.98; p=0.02) and duration of hospital treatment (RR 9.16; 95% CI 2.102-39.94; p=0.03). The most significant predictor of death was duration of hospital treatment (RR 9.16; 95% CI 2.102-3.399; p=0.003). Multivariate logistic regression did not shown significance any of the above risk factors.

Conclusion

Given that third of patients with obstructive nephropathy require acute HD, 6% remain in chronic HD, and almost one third require rehospitalization, close cooperation between a nephrologist and urologist is required. Rapid desobstructive procedures and careful monitoring after desobstruction is warranted. Requirement of regular screening remains opened for obstruction in vulnerable populations.
MO419THE ROLE OF SHORT-TERM, HIGH-DOSE ATORVASTATIN FOR PREVENTION OF CONTRAST-INDUCED ACUTE KIDNEY INJURY (CI-AKI) IN PATIENTS WITH CARDIOVASCULAR DISEASES UNDERGOING COMPUTED TOMOGRAPHY WITH INTRAVENOUS CONTRAST ADMINISTRATION
Authors: Vasin Andrey , Mironova Olga , Fomin Viktor
Published: May 2021

Background and Aims

Computed tomography with intravenous contrast media is widely used in hospitals. The incidence of CI-AKI due to intravenous contrast media administration in high-risk patients remains not studied as well as CI-AKI after intraarterial contrast media administration is. According to other researchers, the use of statins in the prevention of AKI after intra-arterial administration of a contrast agent is currently considered an efficient preventive measure. The aim of our study is to assess the incidence of contrast-induced acute kidney injury in patients with cardiovascular diseases during CT scan with intravenous contrast media and analyze the efficacy and safety of various statin dosing regimens for prevention of CI-AKI.

Method

A randomized controlled open prospective study is planned. Statin naive patients with cardiovascular diseases will be divided into 3 groups. Patients in the first group will receive atorvastatin 80mg 24 hours and 40mg 2 hours before CT scans and 40 mg after. The second group – 40 mg 2 hours before CT scans and 40 mg after. A third group is a control group. Exclusion criteria were current or previous statin treatment, contraindications to statins, severe renal failure, acute coronary syndrome, administration of nephrotoxic drugs. The primary endpoint will the development of CI-AKI, defined as an increase in serum Cr concentration 0.5 mg/dl (44.2 mmol/l) or 25% above baseline at 72 h after exposure to the contrast media.

Results

We assume a higher incidence of contrast-induced acute kidney injury in the group of patients not receiving statin therapy (about 5-10%). At the same time, it is unlikely to get a significant difference between statin dosing regimens. Risk factors such as age over 75 years, the presence of chronic kidney disease, diabetes mellitus, and chronic heart failure increase the risk of contrast-induced acute kidney injury.

Conclusion

Despite the significantly lower incidence of CI-AKI with intravenous contrast compared to intra-arterial, patients with CVD have a greater risk of this complication even with intravenous contrast. Therefore, the development of prevention methods and scales for assessing the likelihood of CI-AKI is an important problem. As a result of the study, we expect to conclude the benefits of statins in CI-AKI prevention and the optimal dosage regimen. This information will help us to reduce the burden of CI-AKI after CT scanning in statin naive patients with cardiovascular diseases in everyday clinical practice.

ClinicalTrials.gov ID: NCT04666389
MO421THE EFFECT OF RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM BLOCKADE MEDICATIONS ON CONTRAST-INDUCED NEPHROPATHY IN PATIENTS UNDERGOING CORONARY ANGIOGRAPHY
Authors: Chaabouni Emna , Jbali Hela , Mariem Najjar , Khadija Mzoughi , Mohamed karim Zouaghi
Published: May 2021

Background and Aims

Contrast-induced nephropathy (CIN) is the main complication of contrast media administration in patients undergoing coronary angiography (CAG). This complication may be accelerated by concurrent renin-angiotensin-aldosterone system (RAAS) blockers . Current literature is inconclusive. We investigated the impact of RAAS blockade on the occurrence of CIN in patients undergoing CAG.

Method

We prospectively enrolled 158 patients who underwent CAG with or without percutaneous coronary intervention from December 2017 to February 2018 at a cardiology department .

CIN was defined as an increase in serum creatinine level >25% or 0.5 mg/dL after 48 hours postcardiac catheterization.

Results

Of 158 patients (females=36.1%, mean age 60.0 ± 11 years) who underwent CAG , 15 (9,5%) developed CIN . Eighty one patients (51,2%) were chronic RAAS blockade users.

There was no significant difference between the two groups, RAAS blockade 'used' versus 'not-used', in the incidence of postprocedural CIN (7,5% vs 11,5%, p=0,38). However , the pre-contrast use of RASS blockers decrease the risk of CIN in patients with chronic renal failure (12,5% vs 66,6% , p=0,042) .

Conclusion

RAAS blockade isn’t associated with a significantly higher incidence of CIN, whereas it has the potential to mitigate the incidence of CIN in patients with chronic renal failure. This low cost intervention could be considered when referring a patient for cardiac catheterization.
MO422ACUTE KIDNEY INJURY AFTER HEART TRANSPLANTATION , INCIDENCE AND PREDICTIVE FACTORS
Authors: Dalili Nooshin
Published: May 2021

Background and Aims

Abruptly decreased kidney function is one of the common scenarios after heart transplantation and the risk factors for renal dysfunction in this population can be various. The purpose of the present study was to determine the incidence and predictors for renal dysfunction among 126 patients in early postoperative heart transplantation period between January 2015 and November 2019.

Method

The study was conducted at the department of cardio-thoracic intensive care unit of an affiliated teaching hospital. 126 patients had cardiac transplantation surgery during four years. Information from these patients collected on a daily basis using standardized forms.

Results

Out of 126 heart transplant recipients 58.7 % (n=74) developed AKI and 10% (n=13) required renal replacement therapy after transplant. After performing univariate analysis, predictors of AKI were: age, duration of anesthesia, cold ischemia time, Voluven (Starch) dose, pre-operative BUN, creatinine and serum albumin, level of liver function tests, and Hemoglubin at three-days post-transplant and urine output of less than 200ml/ hour at six-hours post-transplant.

Conclusion

The findings of our study suggest that longer duration of graft ischemic time, history of previous cardiac operation and transfusion of more than four blood units can independently predict the chance of developing AKI following heart transplant. Therapies, which target these modifiable risk factors, may offer protection against this complication.
MO423PROENKEPHALIN AS A BIOMARKER OF KIDNEY FILTRATION IN ACUTE KIDNEY INJURY
Authors: Lima Camila , Macedo Etienne
Published: May 2021

Background and Aims

In the last decades, clinical research biomarker (BM) to improve assessment of kidney function have been intensive, and proenkephalin (PENK) has been identified as a new BM of filtration. We hypothesized whether PENK would have a better accuracy for the diagnosis of severe AKI than serum cystatin (CYS) and the serum creatinine (Scr). We evaluate patient in the peri op of liver transplant (LT).

Method

Blood samples were collected during the pre and post (until 48 hours) operative (op.) period of LT in 57 eligible patients. Where was analyzed PENK (Sphingotest®), CYS (Milipex) and Scr (Quimioluminence). AKI diagnosis was based on the Kidney Disease International Global Outcomes (KDIGO) criteria using Scr. KDIGO 1 was subclassified according to the International Club of Ascites (ICA).

Results

Of the 57 patients undergoing LT, 50 (88%) developed AKI according to the KDIGO criteria in the first week after LT. Twenty-one patients without AKI and with KDIGO 1-A (37%) were summarized as the no AKI/mild AKI group, whereas 36 patients with KDIGO 1-B, 2 and 3 (63%) were summarized as the severe AKI group. Before the intra - operative insult only PENK was significantly higher in patients that developed severe AKI, median 55 [P25-75(44,25 – 94,55)] in no AKI/mild AKI versus 90,16 [P25-75(64,70 – 135,76)] pmol/l in severe AKI p 0,021, an AUC 0,685 (CI 0,536 – 0,833), with a cutoff 55 pmol/l, sensibility of 0,86 and specificity 0,52, accuracy 0,75 to severe AKI. Scr levels in pre-op. were non- significantly higher in severe AKI; p=0,088. The CYS in the pre-op was similar within the groups. Pos-operative 48 hours after LT, PENK was significantly higher in severe AKI, median 81 [P25-75(61,25 – 101,50)] versus 161,45 [P25-75(122,85 – 294,03)] in severe AKI - p <0,0001 an AUC 0,83 (CI 0,72 - 0,94) with a cutoff 119,05 pmol/l, sensibility of 0,80 and specificity 0,90, accuracy 0,84 to severe AKI. Scr levels in post-op achieve an AUC 0,77 (CI 0,63 - 0,92) with a cutoff 1,49mg/dl, sensibility of 0,94, specificity 0,67 and accuracy 0,82. In a multivariate linear regression analysis adjusted for age, anestesia time, urine output and fluid balance, the PENK only was independently associated of severe AKI in pre-op. with OR 4,40 (CI 1,40 – 13,88) – p0,001 and the post-op. with OR 44,64 (CI 5,40 – 368,5) – p<0,0001.

Conclusion

PENK is a promisor filtration biomarker and showed a better acuracy to severe AKI in pre-operative than standard AKI diagnostic by Scr. Prediction of severe AKI in pre-operative period by PENK can help the management of these patients in the future.
MO411ACUTE KIDNEY INJURY AFTER PARATHYROIDECTOMY FOR PRIMARY HYPERPARATHYROIDISM: PREVALENCE, PREDICTORS AND RISK ASSESSEMENT
Authors: Parshina Ekaterina , Zulkarnaev Aleksei , Kislyy Pavel , Chernikov Roman , Mikhailova Svetlana
Published: May 2021

Background and Aims

Surgery is the most effective and the only definitive treatment of primary hyperparathyroidism (PHPT). We aimed to assess the prevalence of acute kidney injury (AKI) among patients underwent surgery for PHPT, to determine the possible risk factors.

Method

A retrospective cohort study included 290 patients who underwent successful selective parathyroidectomy (PTx) for PHPT. We did not include patients who underwent re-operative surgeries. AKI was defined according to KDIGO-2012 criteria.

Results

In our cohort, 106 patients (36,6%) met AKI criteria after PTx. Most of the patients developed AKI stage 1. In univariate analysis preoperative serum PTH level (р=0,0004) aa well as degree of its decrease before/after PTx (р<0,0001), preoperative serum total calcium level (р=0,0158), size of the parathyroid adenoma (р=0,0184), presence of proteinuria (RR=1,9 [95%CI: 1,19; 3,54], р=0,0061), hypertension (р=0,019) and anemia (р=0,0313), older age (RR=1,32 [95%CI: 1,03; 1,72], р=0,0265) were significant risk factors of AKI development. In multivariate analysis age (OR 1,05 [95%CI: 1,02; 1,08] per a year, р=0,002), body-mass index (OR 1,07 [95%CI: 1,02; 1,13] per each kg/m2, р=0,005), anemia (yes/no OR 3,38 [95%CI: 1,38; 8,2], р=0,008), preoperative PTH (OR 1,03 [95%CI: 1,01; 1,05] per each pmol/l, р=0,002), proteinuria (yes/no OR 3,45 [95%CI: 1,34; 8,93], р=0,011), use of ACE inhibitors/ARBs (yes/no OR 2,84 [95%CI: 1,58; 5,12], р=0,001) were discovered as independent predictors of AKI.

Considering the most significant risk factors we developed two regression models for AKI risk assessment: the model 1 for patients with preserved kidney function (estimated glomerular filtration rate (eGFR ≥60 ml/min/1,73 m2) and the model 2 for those with decreased kidney function (eGFR less than 60 ml/min/1,73 m2) – tab. 1 and 2. Both models were statistically significant: χ2=25,39, df=5, р<0,001, RN2=0,341 for the model 1, χ2=19,355, df=3, р<0,001, RN2=0,428 for the model 2. The proposed models had good discrimination to predict AKI with area under the receiver operating characteristic curves (AUC-ROC) of 0,792 [95%CI: 0,691; 0,894], р<0,001 for the model 1 (normal kidney function) and 0,84 [95%CI: 0,73; 0,951], р<0,001 for the model 2 (decreased kidney function). Optimal cut-off values for predicted probability of AKI to define high-risk individuals were > 0,57 (Youden’s index 0,525) for the model 1 and > 0,439 (Youden’s index 0,589) for the model 2.

Conclusion

We observed high prevalence of AKI in patients after PTx for primary HPT. Developed risk models predict AKI with adequate accuracy. Risk factors of AKI should be considered when planning PTx, special attention should be paid to modifiable ones.
MO412THE RISK FACTORS OF ACUTE KIDNEY INJURY CAUSED BY HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS
Authors: Wang Siwen , Yang Jia , Xuelian Chen , Zhou Jiaojiao , Yang Lichuan
Published: May 2021

Background and Aims

Hemophagocytic lymphohistiocytosis (HLH) is a syndrome characterized by overproduction of proinflammatory cytokines and hemophagocytosis. Acute kidney injury (AKI) is the most common complication of HLH in the kidney, which is a strong predictor of poor prognosis. In this retrospective study, we aimed to find the risk factors of AKI in patients with HLH.

Method

We screened all adult patients with HLH admitted to West China Hospital of Sichuan University from January 2009 to June 2019. Patients in this study were secondary HLH according to the HLH diagnostic criteria revised by the Histocyte Society in 2004. Patients with HLH were excluded from the study if they had a functioning kidney transplant, received renal replacement therapy (RRT) in the past month, suffered from end-stage renal disease (ESRD), or had the renal malignant tumor. We collected basic information, clinical manifestations, and laboratory data of patients from electronic medical records.

Results

A total of 600 patients with confirmed diagnosis of secondary HLH are included in our analysis. There are 199(33.2%)HLH-induced AKI patients, among whom 37.2%, 32.7%, and 30.2% are classified as AKI I, II, and III, respectively, according to the 2012 KDIGO (Kidney Disease: Improving Global Outcomes) guideline. Overall hospital mortality is 176(29.3%), and the number of deaths in patients with AKI was much higher than that in patients without AKI (53.3% versus 17.5%, P < 0.001). The risk factors of AKI in patients with HLH were hyperphosphatemia (P<0.001, OR 5.448, 95%CI 2.951-10.059) , vasopressor(P<0.001, OR 3.485, 95%CI 2.114-5.746), heart failure (P=0.044, 0R 2.336, 95%CI 1.022-5.340), gastrointestinal symptoms (P=0.043, OR 1.877, 95%CI 1.021-3.453), increased heart rate (P=0.005, OR 1.017, 95%CI 1.005-1.029), elevated total bilirubin level(P<0.001, OR 1.004, 95%CI 1.002-1.007), and hypoproteinemia (P=0.034, OR 0.939, 95%CI 0.886-0.995).

Conclusion

The incidence of AKI was higher in patients with HLH, and the risk of death was significantly higher in HLH patients with AKI. A variety of risk factors are related to the occurrence of HLH-induced AKI. Identifying and correcting them early in clinical diagnosis and treatment may reduce the incidence of AKI in patients with HLH and improve the prognosis of them.
MO413EFFECTS OF CHRONIC, LONG-TERM ACE-INHIBITOR TREATMENT ON CYTOKINE STORM AND RENAL FUNCTION AFTER CARDIO-PULMONARY BYPASS: A PROSPECTIVE OBSERVATIONAL STUDY
Authors: Presta Pierangela , Bolignano Davide , Coppolino Giuseppe , Zicarelli Mariateresa , Serraino Filiberto , Mastroroberto Pasquale , Fuiano Giorgio , Andreucci Michele
Published: May 2021

Background and Aims

Cardiopulmonary bypass (CPB) may trigger organs damage, including kidney injury, due to a massive cytokine release. In this observational, prospective study, we have analyzed the possible impact of chronic treatment with ACE-Inhibitors (ACE-I) on the inflammatory response and renal function after CPB.

Method

Sixty-nine patients undergoing major cardiac surgery with CPB were enrolled. Patients were stratified according to long-term (>6 mo.) ACE-I use (n=38) or not (n=31). The primary endpoint was to analyze the changes in their IL-1 alpha, IL-1beta, IL-2, IL-4, IL-6, IL-8, IL-10, TNF alpha, EGF and VEGF plasma levels. Secondary (renal) endpoints were: postoperative acute kidney injury (AKI), recovery of baseline GFR values and the absolute changes in renal function indexes.

Results

After CPB, IL-1alpha, IL-1beta, IL-4 and TNF-alpha remained stable overtime, while a significant decrease in IL-2 plasma levels was noticed in the ACE-I group (p=0.01). IL-6 and IL-8 plasma levels increased after surgery and tended to decrease after 48h. IL-10 plasma levels showed a similar variation, but both their rise and decrease were more pronounced in patients under ACE-I treatment (p=0.007). Finally, VEGF and EGF showed a marked initial decrease with a tendency to normalization 10 days after surgery (p for trend ranging from 0.01 to 0.001) (Figure 1-2).

The occurrence of AKI within 2 days after surgery, the rate of GFR recovery and the absolute changes in renal function indexes were not statistically different between groups (Figure 3).

Conclusion

Chronic, long-term ACE-I treatment may influence the inflammatory response following CPB. On the other hand, this drug class apparently has neutral impact on perioperative renal outcomes.
MO414ACUTE KIDNEY INJURY AFTER ELECTIVE ENDOCRINE SURGERY: ARE PATIENTS WITH PRIMARY HYPERPARATHYROIDISM AT RISK?
Authors: Parshina Ekaterina , Zulkarnaev Aleksei , Chernikov Roman , Kislyy Pavel
Published: May 2021

Background and Aims

Development of acute kidney injury (AKI) after elective endocrine surgery is underreported. We aimed to assess the prevalence of AKI among patients underwent surgery for primary hyperparathyroidism (PHPT) and thyroid surgery and compare risk of AKI between these cohorts.

Method

A retrospective cohort study included 299 patients who underwent successful selective parathyroidectomy (PTx) for PHPT, and 40 patients after thyroid surgery with comparable scope of the intervention (thyroid follicular cells tumor, non-invasive papillary thyroid carcinoma). AKI was defined according to KDIGO-2012 criteria.

Results

Change of serum creatinine before/after surgery differed significantly between PHPT and thyroid surgery group: type of surgery*time interaction p<0,0001 (repeated measures ANOVA after Box-Cox transformation) – fig.1. 109 patients (36,5%) in the PHPT group and 2 patients (5%) in the thyroid group met AKI criteria after PTx. Most of the patients developed AKI stage 1. Risk of AKI was significantly higher in the PHPT patients: RR=7,3 [2,19; 26,6], OR=10,9 [2,82; 46,6], р<0,0001. Patients in the thyroid surgery group were significantly younger than those in the PHPT group (41,5 [Q1-Q3: 30; 51] years vs 59 [Q1-Q3: 50,8; 67] years, respectively, p<0,0001), had higher mean baseline estimated glomerular filtration rate (eGFR) (91,1 ± 18 vs 78,8 ± 18,6 ml/min/1,73 m2 respectively, p=0,0001) and had less comorbidity index (p<0,0001). Hypertension encountered much more often in PHPT group vs thyroid group (69% and 22,5%, respectively, χ2 p<0,0001). Duration of surgery also differed between groups: 25 min [Q1-Q3: 20; 40] min in PHPT group vs 50 [Q1-Q3: 31; 62,5] min in thyroid group, p<0,0001.

We hypothesized that acute decline of parathyroid hormone after PTx increases risk of AKI in the PHPT group. To evaluate whether type of surgery (PTx/thyroid surgery) is independently associated with risk of AKI, we used 1:1 pseudorandomization (Propensity Score Matching, “matchit” package, “nearest” method in R) to balance the baseline characteristics (age, BMI, comorbidity, baseline eGFR, duration of surgery, presence of hypertension). The 40 patients in the thyroid surgery group were matched to 40 patients in the PHPT group according to these confounders. After PSM the prevalence of AKI remained significantly higher in the PHPT group than in the thyroid surgery group (30% vs. 5%, respectively, RR=6 [95%CI: 1,7; 23,1], p=0,006), confirming that PTx is the independent risk factor of AKI.

Conclusion

We observed higher prevalence of AKI after PTx for PHPT comparing with patients after thyroid surgery. Our data suggests that PTx itself is the main risk factor of AKI development after elective endocrine surgery.
MO415DOES LOW CONTRAST VOLUMES REDUCE RATES OF CONTRAST-INDUCED NEPHROPATHY IN PATIENTS UNDERGOING CORONARY ANGIOGRAPHY?
Authors: Chaabouni Emna , Jbali Hela , Mariem Najjar , Khadija Mzoughi , Mohamed karim Zouaghi
Published: May 2021

Background and Aims

Coronary angiography (CAG) necessitates administration of iodinated contrast, which may precipitate an acute deterioration in renal function (contrast-induced nephropathy).

Previous work on contrast-induced nephropathy (CIN) has identified contrast volume as a risk factor and suggested that there is a toxic contrast dose above which the risk of CIN is markedly increased.

The focus of this study is to provide a critical appraisal of this modifiable risk factor.

Method

We prospectively enrolled 158 patients who CAG with or without percutaneous coronary intervention from December 2017 to February 2018 at a cardiology department .

CIN was defined as an increase in serum creatinine level >25% or 0.5 mg/dL after 48 hours postcardiac catheterization.

Toxic contrast dose was defined as a ratio volume of contrast media to estimated glomerular filtration rate (V/eGFR) > 2 . Multivariable regression was conducted to evaluate the effect of exceeding the toxic contrast dose on CIN.

Results

Of 158 patients (females = 36.1%, mean age 60.0 ± 11 years) who underwent CAG , 15 (9,5%) developed CIN .

The volume administered of contrast was not related to the existence of postprocedure CIN (96,6±35,9 ml vs 102,5±33,7ml , p=0,16). However , it was associated with a higher incidence of CIN in patients with chronic renal failure (90±19,1 ml vs 116,6±73,7ml , p=0,008) .

The mean V/eGFR value was 1,2±0,7.Nine percent of patients exceeded the toxic contrast dose.

After adjusting for other known predictors of CIN, a V/eGFR ratio > 2 remained significantly associated with CIN (odds ratio 4.7, 95% confidence interval 1.28-17.7, P=0,02).

Conclusion

Low incidences of CIN suggest that a reduced dose of contrast agent is safe in high-risk patients with impaired renal function. A ratio volume of contrast media to estimated glomerular filtration rate > 2 is a significant and independent predictor of CIN after CAG.
MO341VALUE OF THE CELL CYCLE ARREST BIOMARKERS IN THE DIAGNOSIS OF PREGNANCY RELATED ACUTE KIDNEY INURY
Authors: Keryakos Hesham Kamal Habeeb , El-Minshawy Osama , Khedr Mahmoud , Yousuf Ayman , Abo Elela Moustafa , Kamel Fatma
Published: May 2021

Background and Aims

Pregnancy related acute kidney injury (PRAKI) is still a common serious problem in developing countries. Insulin-like growth factor-binding protein 7 (IGFBP7) and tissue inhibitor metalloproteinases-2 (TIMP-2) can identify critically ill patients at risk for the development of severe AKI. Aims: To identify main causes and timing of PRAKI and to study the G1 cell cycle arrest biomarkers in cases diagnosed with (PRAKI) as a diagnostic tool.

Method

80 pregnant women diagnosed with PRAKI were recruited from a single hospital as well as 30 age-matched pregnant women with normal pregnancy participated in this study. A urine specimen was collected from all study participants with established AKI within 24 hours of ICU admission to measure [TIMP-2]*[IGFBP7].

Results

The incidence of PRAKI was 1.1%. The most common cause of PRAKI is preeclampsia/eclampsia spectrum (61%). Most of the cases occur in the third trimester (60%) and postpartum period (23%). At a cutoff 0.33 ng/mL, the estimated sensitivity and specificity of urinary [TIMP-2]*[IGFBP7] in predicting PRAKI is 100% (95% CI) with NPV and PPV are 100%.

Conclusion

Urinary [TIMP-2]*[IGFBP7] serves as a sensitive and specific biomarker in the diagnosis of PRAKI.
MO343SERUM RESPONSE FACTOR, A NOVEL EARLY DIAGNOSTIC BIOMARKER OF ACUTE KIDNEY INJURY
Authors: Zhao Long , Xu Yan
Published: May 2021

Background and Aims

Studies have shown that serum response factor (SRF) is increased in chronic kidney injury, such as diabetic nephropathy, hyperuricemic nephropathy and renal cell carcinoma. The objective is to explore the early diagnostic value of SRF in acute kidney injury (AKI).

Method

AKI-related microarray data were analyzed, and the expression and location of SRF were investigated in the early phase of AKI.

Results

Bioinformatics results demonstrated that SRF was dramatically elevated 2-4 h after ischemia/reperfusion (I/R) in mouse renal tissue. In I/R rats, SRF was mostly expressed and located in renal tubular epithelial cells (TECs). SRF started to increase at 1 h, peaked at 3-9 h and started to decrease at 12 h after I/R. The areas under the ROC curve of renal SRF mRNA, renal SRF protein, urinary SRF, serum SRF and serum creatinine (Scr) were 87.9%, 83.0%, 81.3%, 78.8%, 68.8%, respectively.

Conclusion

SRF is remarkably upregulated in early (before 24 h) AKI and can replace Scr as a potential new early diagnostic biomarker of AKI.
MO344INCIDENCE AND RISK FACTORS FOR ACUTE POSTOPERATIVE RENAL FAILURE
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

Postoperative acute renal failure (AKI) is a particular form of acute failure with several triggers. Decreased renal blood flow and the resulting ischemia seem to be the most common cause of kidney damage. The objective was to study the incidence and risk factors associated with post-operative AKI.

Method

It was a retrospective, descriptive study spanning a 3-year period from January 1, 2017 to December 31, 2019. The patients in this series were admitted to the various surgical departments.

Results

Our study included 618 cases of AKI. The incidence of postoperative AKI was 8.73%. The average age of our patients was 40.4 +/- 12.3 years, a male predominance with a sex ratio of 1.2. The main history was diabetes found in 39%, hypertension in 27.5% and an injection of contrast product a few days before the intervention in 14.5%. General surgery topped the list in 49.5% of our patients, followed by trauma in 25%, gyneco-obstetrics in 14.5%, and 11% for the rest of the surgeries. The associated risk factors were: hypovolemic shock, diabetes, severe sepsis.

Conclusion

The occurrence of acute renal failure in the postoperative period results from factors related to the field and surgery. Hence the need for early identification of risk situations, in order to reduce the incidence of renal damage during the perioperative period.
MO346NEPHROPROTECTIVE EFFECT OF A METHANOLIC EXTRACT OF TWO GANODERMA SPECIES AND THEIR ASSOCIATION IN AN IN VITRO MODEL OF CISPLATIN INDUCED TUBULOTOXICITY
Authors: Sinaeve Sébastien , Husson Cécile , Antoine Marie-Hélène , Welti Stéphane , Decock Cony , Stevigny Caroline , Nortier Joelle
Published: May 2021

Background and Aims

Cisplatin is currently used as a first-line cancer treatment, such as testicular, ovarian or pulmonary cancers. Their nephrotoxicity remains a real problem. Acute kidney injury induced by cisplatin is located on proximal tubular cells, causing necrosis and possibly subsequent interstitial fibrosis and chronic dysfunction. These severe side effects can lead to a cessation of the patient’s treatment. Currently, there is no effective prophylactic action to reduce cisplatin nephrotoxicity, beside hyperhydration of the patient [1].

The aim of the present work is therefore to identify new prophylactic therapy. For this, natural products can be studied, in this case, the interest of potential new medicinal mushrooms extracts. Among 13 mushroom extracts, the methanolic extracts of Ganoderma parvigibbosum Welti & Courtecuisse, Ganoderma tuberculosum Murrill and their association were selected to study their effects on human proximal tubular cells (HK-2) intoxicated with cisplatin.

Method

HK-2 cells are grown in 75cm² sterile flasks using DMEM low glucose (1mg/mL), supplemented with FBS (10%), L-Glutamin and a mix of Penicillin/Streptomycin. Dried mushrooms were grounded and extracted 3 times by methanol, evaporated extracts are stored at -20°C. A viability assay allowed to determine the work concentration of extracts range have been done. After that, tests were performed after a pretreatment of 1h with the extracts before adding cisplatin at a concentration of 20 µM. Viability assays (CCK-8) and antioxidant activity (DPPH) were done in 96-well. The intracellular concentration of β-catenin and calcium, Caspase-3, p53, cytochrome C, IL-6, NFκB, the membranal expression of KIM-1 and finally the ROS production (H2DCFDA) were studied by flow cytometry.

Results

Tests have shown that methanolic extracts of G. parvigibbosum and G. tuberculosum (10 µg/mL) and their association (5 + 5 µg/mL) prevented the loss of viability after a 24h incubation. They also have prevented the increase of cytochrome C and p53 after 24h. G. parvigibbosum and the association of the two mushrooms extracts have also prevented the increase of caspase-3 and intracellular β-catenin. Finally, G. parvigibbosum was the only to prevent the ROS overproduction. None of them showed a scavenger activity, nor a prevention in the increase of IL-6 and NFκB or the membrane expression of KIM-1.

Conclusion

Ganoderma parvigibbosum appears to be therefore more beneficial than Ganoderma tuberculosum and the association of the two mushrooms extracts by acting also on the ROS overproduction. In conclusion, in this study, the extracts have shown a significant activity on the prevention of the pro-apoptosis pathway rather than a pro-inflammatory prevention. Further investigation will be performed to identify the precise activity and chemical content of these extracts.
MO331LINEAGE TRACING OF REGENERATING PROXIMAL TUBULE CELLS (STC) BY SINGLE CELL PROFILING IN ACUTE KIDNEY INJURY
Authors: Stamellou Eleni , Cheng Mingbo , Sterzer Viktor , Leuchtle Katja , Strieder Thiago , Boor Peter , Floege Jürgen , Costa Ivan G , Möller Marcus Johannes
Published: May 2021

Background and Aims

Acute tubular injury accounts for the most common intrinsic cause for acute kidney injury (AKI). The scattered tubular cell (STC) phenotype was discovered as a uniform reaction of tubule cells triggered by injury. Our group was the first to identify an inducible transgenic mouse (PEC-rtTA-mouse) specifically labeling STCs with eGFP. Analysis of the transcriptional factors and associated signaling pathways might reveal the function and role of STCs in AKI.

Method

Here, we performed single-cell RNA sequencing of unilateral ischemia-reperfusion murine model of AKI 8, 24, 48 hours and 6 and 12 days after AKI induction.

Results

Genes expressing proximal tubular proteins and transporters were markedly downregulated during transition into the STC phenotype upon injury; but expression recovered over time and upon resolution and tubular cells re-differentiated into proximal tubule cells. This provides evidence for the first time that the STC phenotype is a transient and reversible phenotype triggered by injury. Among cells in the STC phenotype, we could identify 2 sub-clusters; a highly proliferating sub-cluster that in the cell cycle analysis showed the highest proportion of cycling cells. The second eGFP-positive cluster appeared very early after AKI and expressed a distinct set of genes (defined by 7 anchor genes). Some of the highly up-regulated genes are known markers of STCs hence confirming the specificity of our transgenic mouse line.

Conclusion

Our study provides gene expression patterns specifically in STCs upon injury and repair at multiple time points and suggests that the STC phenotype is a transient and reversible phenotype triggered by injury.
MO333TARGETING HIGH MOBILITY GROUP BOX 1 WITH INHIBITORS ATTENUATE ACUTE KIDNEY INJURY IN POSTISCHEMIC KIDNEYS
Authors: Zhao Zhibo , Marschner Julian Aurelio , Li Chenyu , Hans-Joachim Anders
Published: May 2021

Background and Aims

HMGB1 (high mobility group box 1) is released from dying cells and hence works as a danger signal, which amplifies necroinflammation in postischemic acute kidney injury. If and to what extend small molecule HMGB1 inhibitors are capable to ameliorate the acute kidney injury is still unknown.

Method

Mice underwent 17 min unilateral renal ischemia followed by reperfusion (IR) for 4 or 7 days and were administered either 50 mg/kg glycyrrhizic acid, 80 mg/kg ethyl pyruvate, or PBS i.p. 1h before surgery and once daily until day 7.

Results

Administration of HMGB1 inhibitors consistently increased the glomerular infiltration rate at day 4 and day 7, in parallel with a reduction of plasma creatinine and circulating HMGB1 at day 7 of reperfusion. Histopathological analysis confirmed that HMGB1 inhibitors consistently attenuated tubule injury. In vitro, HMGB1 inhibitors protected primary murine tubular epithelial cells against H2O2-induced cell death.

Conclusion

Our data indicate that the treatment with glycyrrhizic acid or ethyl pyruvate ameliorates post-ischemic renal injury. This serves as a rationale to further study the role of extracellular HMGB1 and its inhibition in different models of acute kidney injury.
MO335URINARY CYTOKINES REFLECT THE ONGOING RENAL INFLAMMATION IN THE DIAGNOSTIC OF ACUTE TUBULOINTERSTITIAL NEPHRITIS: RESULTS OF A MULTIPLEX BEAD-BASED ASSAY ASSESSMENT
Authors: Martinez Valenzuela Laura , Draibe Juliana , Fulladosa Xavier , Gomez Preciado Francisco , Nadal Ernest , Jove Maria , Bestard Oriol , Cruzado Josep , Torras Joan
Published: May 2021

Background and Aims

Acute tubulointerstitial nephritis (ATIN) diagnostic lays on the kidney biopsy given the absence of non-invasive biomarkers for disease demonstration and follow-up. The aim of this study was to evaluate the accuracy of ten urinary inflammatory-related cytokines in the diagnostic of ATIN and its clinical distinction from acute tubular necrosis (ATN).

Method

Observational prospective study including 21 ATIN and 12 ATN patients, and 6 healthy controls. We determined the urinary levels of 10 inflammation-related cytokines using a multiplex bead-based Luminex assay. We registered clinical, analytical and histological data from the medical records.

Results

Urinary levels of I-TAC/CXCL11, CXCL10, IL-6, TNFα and MCP-1 were higher in ATIN compared to healthy controls. In contrast, healthy controls exhibited higher EGF urinary levels compared to ATIN patients. Follow-up samples available from 11/21 ATIN patients showed a significant decrease in I-TAC/CXCL11, MIG/CXCL9 and CXCL10 levels. Urinary levels of I-TAC/CXCL11, IL-6 and MCP-1 were significantly higher in ATIN compared to ATN patients, with I-TAC/CXCL11 as the best discriminatory biomarker based on its higher AUC in the ROC curve and likelihood ratio. The combinatory model of the three cytokines increased the sensitivity of the individual biomarkers in the distinction of ATIN/ATN but the best results were obtained when blood eosinophil count and leukocyturia were added to the model. We found a positive correlation of the extent of the tubulointerstitial infiltrate in kidney biopsies with the urinary concentration of I-TAC/CXCL11, MIG/CXCL9, CXCL10, IL17, IFNα, MCP1 and EGF, indicating the potential renal source of the cytokines

Conclusion

the higher cytokine levels in ATIN compared to ATN patients and healthy controls, the significant decline after treatment and the positive correlation of the cytokines with the grade of the inflammatory infiltrate allows us to propose I-TAC/CXCL11, CXCL10, IL6 and MCP-1 as candidate biomarkers in this disease.
MO551A COST-OFFSET ANALYSIS OF THE ROXADUSTAT DIALYSIS-DEPENDENT GLOBAL PHASE 3 PROGRAM: A CANADIAN HEALTHCARE PERSPECTIVE
Authors: Schneider John , Davies Shawn , Howarth Amanda , Garcia Sanchez Juan Jose , Rao Naveen , Grandy Susan , Bhatt Purav , Wong Deborah , Parackal Anna , Yu K-H , Lai Rachel , Briggs Andrew
Published: May 2021

Background and Aims

Chronic kidney disease (CKD) is a costly public health issue, which affects 13.4% of the population globally. Anaemia is a common complication in patients with CKD resulting in reduced health-related quality of life and high healthcare costs. The objective of this analysis was to estimate the direct medical care cost offsets of the investigational agent roxadustat for the treatment of anaemia in patients with dialysis-dependent (DD) CKD from a Canadian healthcare perspective.

Method

Data from the roxadustat global phase 3 program were used to estimate the incidence of rescue therapy or iron supplementation use (i.e. intravenous iron, erythropoiesis-stimulating agents [ESAs] or red blood cell transfusions) and major adverse cardiovascular events (MACE+) for roxadustat compared with ESAs in DD patients with anaemia of CKD. MACE+ included myocardial infarction, stroke, unstable angina requiring hospitalization, congestive heart failure (CHF) requiring hospitalization, cardiovascular death and other death. Published Canadian cost data were used to estimate event costs. Drug acquisition costs for roxadustat and ESAs were not considered. A hypothetical cohort of 10,000 Canadian adult DD patients (90% undergoing haemodialysis, 10% undergoing peritoneal dialysis) with treatable anaemia was modelled to determine net medical care cost offsets annually and cumulatively compared with ESAs over a 4-year time horizon.

Results

Preliminary results for patients with DD CKD show that, compared with ESAs, roxadustat could produce sizeable net medical care cost offsets resulting from reductions in rescue therapy or iron supplementation use, specifically red blood cell transfusions, and from reductions in MACE+, specifically CHF hospitalizations. For the entire cohort of patients with DD CKD, cumulative medical care cost offsets for roxadustat were an estimated $162,609 for rescue therapy or iron supplementation use and $1,027,070 for MACE+ compared with ESAs.

Conclusion

This analysis provides evidence that treatment with roxadustat in DD patients with anaemia of CKD could result in considerable medical care cost offsets for roxadustat compared with ESAs.