bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0579EVALUATION OF BIOMARKERS EFFICIENCY IN PREDICTIVE AND EARLY DIAGNOSTICS OF ACUTE KIDNEY INJURY IN ACUTE CORONARY SYNDROME
Authors: Vorobyev Eugene , Smirnov Alexei , Kucher Anatoly , Galkina Olga , Zubina Irina , Anpilova Anastasia , Bogdanova Evdokia , Levykina Elena 
Published: June 2020

Abstract

Background and Aims
Acute Kidney Injury (AKI) is a common complication of acute coronary syndromes (ACS), and associated with higher mortality and adverse outcomes. Despite advances in research over the past years, effective treatments for current AKI are not available. Prevention and early intervention remain the most effective strategies for AKI of any entity. This study aimed to explore a risk factors and biomarkers for predictive and early diagnostic of AKI in ACS.

Method
Study was prospective and cohort, patients hospitalized with ACS in Pavlov First Saint Petersburg State Medical University were included. In case of exclusion of ACS, patients were determined in the comparison group, in case of confirmation of the diagnosis of ACS - in the study group. Biomaterial (blood and urine) was taken at admission (T1), 1 day after admission (T2) and 2 days after admission (T3). For the diagnosis of AKI, KDIGO 2012 criteria were used for the diagnosis of AKI. The measured biomarkers at each point were NGAL, KIM-1, cystatin C, sST2, troponin I.

Results
The study included 73 patients, the diagnosis of ACS was confirmed in 40 patients and AKI development was in 15 patients, all from the ACS group. The most significant for predictive diagnosis was the assessment of the parameters of systemic hemodynamics and the severity of acute heart failure (AHF): heart rate&gt;90 (AUC=0,798, p=0,001), GRACE Risk Score&gt;133 (AUC=0,926, p=0,005). In evaluation the suitability of biomarkers in terms of prognostic diagnosis of AKI, urine NGAL&gt;32 ng/ml (AUC=0,814 p=0,04) and sST2&gt;23.4 ng/ml (AUC=0,718, p=0,02) showed the best results.

Conclusion
In study of biomarkers efficiency, the use of urine sST2 and NGAL is most promising. Together with hemodynamic parameters, biomarkers have high predictive ability in the diagnosis of AKI in ACS.
P0586ACUTE KIDNEY INJURY IN PATIENTS UNDERGOING CARDIAC SURGERY: A PROSPECTIVE, OBSERVATIONAL STUDY TO ASSESS INCIDENCE, SEVERITY, RISK FACTORS AND MORTALITY IN TERTIARY CARE HOSPITAL IN INDIA
Authors: Sharma Reetesh , Jain Salil , Trehan Naresh 
Published: June 2020

Abstract

Background and Aims
Acute kidney injury (AKI) occurs in up to 30% of patients undergoing cardiac surgeries and is associated with increased morbidity and mortality. There is paucity of such data in our country. Hence this study was done to assess the incidence of AKI following cardiac surgery and its associated risk factors along with outcomes, in the Indian context.
The incidence and severity of AKI in patients with normal renal parameters vs those with underlying CKD was studied. We also compared incidence and severity of AKI in patients undergoing surgery off pump vs on pump.

Method
All patients age&gt;25yrs of either gender undergoing cardiac surgeries were enrolled prospectively from July to October 2018. Patients undergoing aortic surgeries or on dialysis, renal transplants or with pre-existing AKI were excluded. Incidence and severity of AKI was defined by the AKIN criteria. NKF/DOQI definition was used to define CKD. Prevalence of risk factors such as age, sex, BMI, diabetes mellitus, hypertension, dyslipidemia, CKD, CVA, peripheral vascular disease (PVD), prior myocardial infarction (MI), peri-operative acute myocardial infarction (AMI), use of cardiopulmonary bypass (CPB) and prolonged ventilation were assessed.

Results
1,040 patients were enrolled with these baseline characteristics: 83.5% were males, mean age 58.2±10.4 years, mean BMI 25.6±4.3, diabetes in 48.2%, hypertension in 57.5%,dyslipidemia in 70%,CVA in 36%,CKD in 6.3%,PVD in 0.9%,peri-operative AMI in 0.6%,use of CPB in 24%. Overall incidence of AKI was 23.3% and was 71.2% in patients with underlying CKD. AKI was more severe in patients with higher CKD stages. Stage3 AKI occurred only in patients with CKD stage 3 and 4. Overall the need for dialysis was 1.1% and it was 4.9% in AKI group. 8.5% of patients with CKD needed dialysis as compared to 4.1% without CKD.In multivariate risk factor analysis hypertension (p=0.01),peri-operative AMI (p=0.03), prolonged ventilation (p=0.01), CVA (p=0.01) and CKD (p&lt;0.001) were found to be significantly associated with AKI whereas diabetes (p =0.12), PVD (p=0.13), use of CPB (p=0.4), prior AMI (p=0.07) were not significant. Mean hospital stay was prolonged in those with AKI (8.33±4.06 vs 7.16±3.01 days (p&lt;0.001)). Overall the mortality was 0.67% and it was 2.9% in AKI group. All mortalities were associated with AKI.

Conclusion
Incidence of AKI (23.3%) and mortality (0.67%) in cardiac surgery patients at our centre in India is similar to other reported studies. We found that underlying CKD is the most significant risk factor for AKI in these patients in addition to hypertension, CVA, prolonged ventilation and pre-operative AMI. Use of CPB did not increase the incidence of AKI. AKI significantly increases mean hospital stay and is also associated with increased in-hospital mortality.
P0604IDENTIFICATION OF NOVEL ENDOTHELIAL ACTIVATION BIOMARKERS IN PATIENTS WITH LEPTOSPIROSIS AND ITS ASSOCIATION WITH ACUTE KIDNEY INJURY
Authors: De Francesco Daher Elizabeth , Andrade de Carvalho Gomes Pedro Eduardo , Studart Galdino Gabriela , Cavalcante Meneses Gdayllon , Costa Martins Alice Maria , Bezerra da Silva Junior Geraldo 
Published: June 2020

Abstract

Background and Aims
Leptospirosis has a broad clinical spectrum. Many patients present a severe disease, with potentially fatal outcomes. Novel biomarkers of endothelial activation are being studied in order to predict the severity of disease and to establish early assistance to the patients.

Method
For the analysis of biomarkers, blood samples were collected at hospital admission, in proper material for serum isolation. Aliquots were frozen at -80 ºC until the analysis was done. To quantify the biomarkers, ELISA kits were used: Syndecan-1 (Abcam–ab47352), ICAM-1 (Abcam–ab47349) e VCAM-1 (Abcam–ab47355), Angiopoietin-2 (R&D Systems–Duoset DY623) e FGF-23 (R&D Systems–Duoset DY2604).

Results
A group of 27 patients was evaluated. 24 (88.9%) were males and 3 (11.1%) were females. Mean age was 39.1 ± 17.6 years. 14 (53.8%) required dialysis. Patients who required dialysis presented higher levels of syndecan-1 (572 [300-811] vs. 263 [106-421] ng/mL; p = 0.03), angiopoietin-2 (1.52 [0.72-2.72] vs. 0.63 [0.4-1.38] ng/mL; p = 0.01), and FGF-23 (291 [56-2,031] vs. 10 [10-806] pg/mL; p = 0.021). There were no significant differences in the levels of VCAM-1 and ICAM-1 between the two groups. Syndecan-1 showed significant correlation with the levels of creatinine at hospital admission (r = 0.546; p = 0.05) and total bilirubin at hospital admission (r = 0.534; p = 0.013). Angiopoietin-2 showed significant correlation with the levels of creatinine at hospital admission (r = 0.513; p = 0.009) and the number of hemodialysis sessions (r = 0.406; p = 0.049). No correlation was shown concerning FGF-23.

Conclusion
Novel biomarkers revealed leptospirosis-associated endothelial activation and were significantly increased in patients with renal involvement. Therefore, they may be useful for establishing early identification and assistance in those patients.
P0607CLINICAL SIGNIFICANCE OF HYPOALBUMINEMIA FOR ACUTE KIDNEY INJURY IN PATIENTS WITH SCRUB TYPHUS
Authors: Lee Kwang Young , Sun In O 
Published: June 2020

Abstract

Background and Aims
The aim of this study is to investigate the clinical significance of hypoalbuminemia (HA) for acute kidney injury (AKI) in patients with scrub typhus.

Method
From 2010 to 2017, 449 patients were diagnosed with scrub typhus. We divided the patients into two groups [normoalbuminemia (NA) vs. hypoalbuminemia (HA)] based on the serum albumin level of 3.5 g/dL, and compared the incidence, clinical characteristics, and severity of AKI based on RIFLE classification between two groups.

Results
Of the total 449 patients, 52 (11.6%) were categrized as HA group. Compared with patients in NA group, patients in HA group were older (74 ± 8 vs. 63 ± 13, P&lt;0.01) and had higher total leukocyte counts (10.4 × 103/ mL vs. 6.9 × 103/mL, P&lt;0.01). HA group showed significantly longer hospital stay (10.1 ± 4.7 vs 8.8 ± 4.5, p&lt;0.01) and higher incidence of acute kidney injury (56% vs. 19%, p&lt;0.01). The overall incidence of AKI was 22.9%; of which, 12.2%, 10.0% and 0.7% were classified as Risk, Injury and Failure, respectively. In a multivariate logistic regression analysis for predciting AKI, age, presence of chronic kidney disease, leukocytosis and hypoalbuminemia were significant predictors of AKI. Most patients recovered baseline renal function without renal replacement therapy following antibiotics therapy and supportive care.

Conclusion
Hypoabluminemia was closely associated with scrub typhus associated with AKI.
P0629ESTABLISHING MORTALITY ASSOCIATED WITH AKI IN A DGH AND THEN TRYING TO DO SOMETHING ABOUT IT- INTRODUCTION AND AUDIT OF THE AKI7 CARE BUNDLE
Authors: Paisey Christopher , Chapman David , Achilleos Kat , Yiu Vivian 
Published: June 2020

Abstract

Background and Aims
Acute kidney injury (AKI) is a prevalent and treatable contributor to inpatient mortality. Simple management steps for AKI are frequently omitted or delayed in patient care due to its insidious onset and lack of symptoms. The NCEPOD report in 2009 found that only 50% of patients with AKI received good care. One response to this has been increased use across trusts of the electronic medical record for recognition and monitoring of AKI. Such systems also enable collection of reproducible datasets for audit as well as a platform for prompting the use of best practice guidelines.
We sought to establish mortality for patients with AKI and to audit the introduction of an electronic alert system and order set proforma for AKI: the AKI7 care bundle.

Method
We collated data from all inpatients in West Suffolk Hospital (WSH) flagged as developing AKI by the recording system ‘eCare’ over a 2-year period and present a mortality analysis for this cohort. Data was collected retrospectively from eCare and statistical analysis conducted in ‘R’.

Results
Of 3527 individuals who developed AKI over a 2 year period in WSH; 79% did not progress beyond AKI stage 1, 13% stage 2 and 8% stage 3, the mean age was 74 years and mean length of stay 13 days. Across all stages of AKI, 75% were investigated with urinalysis, 94% received fluid balance monitoring, 5% were investigated with renal tract US and 58% were referred to a nephrologist for specialist input. Mortality analysis for this same cohort revealed an association between survival at 60 days and use of urinalysis p=&lt;0.001, fluid balance monitoring p=&lt;0.001 and investigation with renal tract US p=&lt;0.001. The 1 year mortality associated with AKI increased significantly with severity; 29% for AKI stage 1, 51% for AKI stage 2 and 65% for AKI stage 3 (Figure.1). The all cause 1 year mortality for all stages of AKI combined was 39.1%. Following launch of the AKI7 care bundle we found that use of the document template promoted requests for renal tract US (20% versus 5%), urinalysis (83% versus 75%) and requests for input by renal physicians (75% versus 65%).

Conclusion
The AKI7 care bundle improves clinician awareness of AKI and promotes the use of important steps in AKI management. Since mortality increases with AKI stage, management targeted to ameliorate progression of AKI is vital and can be supported by well designed electronic care bundles. The association of improved survival with fluid balance monitoring and investigations for AKI further supports measures to promote the use of these steps. We intend to encourage use of the AKI7 care bundle during induction for junior doctors coupled with distribution of cards as an aide-memoire.
P0648LEVELS OF PHYSICAL ACTIVITY FOLLOWING AN EPISODE OF STAGE 3 AKI ARE ASSOCIATED WITH RENAL RECOVERY
Authors: Asad Anam , Dungey Maurice , Hull Katherine , Burton James , March Daniel 
Published: June 2020

Abstract

Background and Aims
Acute kidney injury (AKI) is a known risk factor for the development of chronic kidney disease (CKD). Animal studies have demonstrated the potentially reno-protective effects of physical activity, both against the development of AKI and in promoting renal recovery. However, this has not been investigated in humans. The aim of the study was to investigate the association between physical activity levels and recovery in kidney function, measured by eGFR and creatinine, following an episode of stage 3 AKI.

Method
Twelve hospitalised participants with non-obstructive stage 3 AKI (as per KDIGO criteria) were asked to complete two questionnaires; the General Practitioner Physical Activity Questionnaire (GPPAQ), a measure of physical activity and; the Duke Activity Status Index, a measure of functional capacity. Baseline questionnaires were completed whilst in hospital (where participants were asked to recall their physical activity and functional capacity levels before hospitalisation) and again at 6-months post discharge. In addition, participants wore a pedometer for 7 consecutive days following discharge to ascertain their daily step count. Baseline renal function was collected using eGFR and creatinine measurements within the 12-months prior to admission; further readings were collected 25 ± 46 days after discharge as a measure of renal recovery (referred to as recovered creatinine).

Results
Data from the 12 participants who provided step count information were analysed. At diagnosis of stage 3 AKI, participants had a mean creatinine of 547 ± 280 with their mean baseline and recovered creatinine as follows; 95 ± 35 and 172 ± 83. A higher daily step count after discharge was associated with both a higher baseline eGFR (r=0.73, p&lt;0.01) and significant improvements to their renal recovery (r=0.69, p=0.01). There were positive associations between renal recovery and physical activity levels measured using the GPPAQ (r=0.55, p=0.06) and functional capacity (0.17, p=0.6), although not to statistical significance. The participants were divided into two groups based on their recovered creatinine levels. Those who recovered renal function back to within 25% of baseline (n=5) had a higher mean step count compared to those whose renal recovery was less pronounced (n=7); (3712 ±3960 vs 3334 ± 2254, respectively).

Conclusion
These results show a positive association between physical activity levels and renal recovery following an episode of AKI. This suggests that higher levels of physical activity may be protective and promote recovery of renal function following an episode of AKI. Physical activity and exercise interventions should be tested in the setting of AKI to see whether they are efficacious in promoting renal recovery.
P0672CALPAINS 1 AND 2 ARE INCREASED DURING THE DEVELOPMENT OF CHRONIC KIDNEY DAMAGE IN MICE FED WITH AN ADENINE RICH DIET
Authors: Gutiérrez-Calabrés Elena , Campillo de Blas Sofía , Bohorquez Magro Lourdes , Griera-Merino Mercedes , García Ayuso Diego , Vaillo David , De Frutos García Sergio , Rodríguez-Puyol Manuel , Calleros Laura , Rodríguez-Puyol Diego 
Published: June 2020

Abstract

Background and Aims
Calpains are intracellular cysteine proteases that play a critical role in cell remodeling, being involved in multiple biological processes linked to tissue damage and repair mechanisms. In addition, they are released into the circulation, being able to carry out systemic actions with pathological consequences. The aim of this study was to investigate the role of calpains in the progression of chronic kidney disease (CKD) in an experimental model of chronic renal damage induced by adenine.

Method
We induced an experimental model of CKD, in mice fed for 2 weeks with an adenine-supplemented diet (0.2% adenine) (A). Animals receiving this diet develop a tubulointerstitial damage resembling that is observed in human CKD. Mice with standard diet were used as controls (C). Renal function was assessed by measuring serum blood urea nitrogen (BUN) and creatinine (mg/dl). Fibrosis markers (collagen type I and fibronectin) were determined by RT-qPCR. Changes in the renal content of calpains 1 and 2 were analyzed by western blot (protein content), and RT-qPCR (mRNA expression).

Results
Our results show functional and structural changes at renal level in the adenine-fed mice, with increased BUN (A: 72 mg/dl, C: 28 mg/dl, p &lt; 0.05), creatinine (A: 0.58 mg/dl, C: 0.25 mg/dl, p &lt; 0.05), collagen type I mRNA expression (A: 12.9 units, C: 1.2 units, p &lt; 0.05) and fibronectin mRNA expression (A: 3.46 units, C: 1.3 units, p &lt; 0.05). Furthermore, protein content of calpains 1 (A: 1.27 units, C: 0.78 units, p &lt; 0.05) and 2 (A: 1.30 units, C: 0.66 units, p &lt; 0.05) was significantly higher in adenine-fed mice when compared to control. At the same time, we observed a significant increase in gene expression of both calpain 1 (A: 4.21 units, C: 0.51 units, p &lt; 0.05) and 2 (A: 4.93 units, C: 0.56 units, p &lt; 0.05) in the adenine model regarding to mice with standard diet. Our results demonstrate that calpain 1 and 2 expression in renal tissue increases as CKD progresses. Interestingly, we found statistically significant correlations between renal calpains 1 and 2 protein and mRNA content and plasma BUN and creatinine (p &lt; 0.05, r between 0.79 and 0.92), as well as protein expression of calpain 2 and mRNA expression of collagen type I (p &lt; 0.05, r = 0.76). These data suggest a potential direct relationship between renal calpain 1 and 2 content and loss of renal function, in part due probably to the modulation of the fibrotic changes, in adenine fed mice.

Conclusion
We suggest an implication of calpains 1 and 2 in the development of CKD. Thus, effective calpain blockade or downregulation could be useful as a therapeutic strategy to prevent CKD. Further experiments will be necessary to establish the relationship between these factors.
P0673INVERSE ASSOCIATION OF TRANSFERRIN SATURATION WITH MORTALITY RISK IN CHRONIC KIDNEY DISEASE
Authors: Li Xin , Danielson Kristin , Forsal Innas , Iseri Ken , Dai Lu , Heimbürger Olof , Barany Franz Peter , Stenvinkel Peter , Qureshi Abdul Rashid Tony , Lindholm Bengt 
Published: June 2020

Abstract

Background and Aims
Transferrin saturation (TSAT) is an indicator of iron deficiency or overload, but its relationship with mortality in patients with different stages of chronic kidney disease (CKD) is unclear. We investigated the association of TSAT with mortality in CKD patients.

Method
In 479 CKD patients (97 CKD3-4 patients, 298 CKD5 non-dialysis patients and 84 peritoneal dialysis patients; median age 58 years, 67% males, 33% cardiovascular disease, CVD, and 29% diabetes), biomarkers of iron status (plasma iron, TSAT, transferrin and ferritin), systemic inflammation (high sensitivity C-reactive protein, hsCRP, and interleukin-6, IL-6) and nutritional status were assessed. During median follow-up of 35.6 months, 139 (29%) patients died, and 176 (37%) patients underwent renal transplantation. Patients were stratified into low (n=157) and high (n=322) TSAT tertile groups. All-cause and CVD mortality risk were analyzed with competing risk regression with renal transplantation as competing risk.

Results
TSAT [median 23% (IQR 17-30%)] was negatively associated with presence of DM and CVD, body mass index, hsCRP, IL-6, Framingham´s CVD risk score (FRS), erythropoietin resistance index (ERI) and iron supplementation, and positively associated with hemoglobin, ferritin and s-albumin. In competing risk analysis, low tertile of TSAT was independently associated with increased all-cause mortality risk (sHR=1.50, 95%CI 1.05-2.14) after adjusting for CKD stages, 1-SD of FRS, 1-SD of hemoglobin, 1-SD of hsCRP, 1-SD of ESA dose and iron supplementation (Figure 1).

Conclusion
TSAT was inversely associated with mortality risk in CKD patients. When evaluating clinical outcomes of CKD patients, iron status using TSAT as a predictive marker, should be considered.
P0674DCR2,AS A SENESCENCE MARKER,IS ASSOCIATED WITH DISEASE SEVERITY AND PROGRESSION IN IGA NEPHROPATHY PATIENTS
Authors: Dai Huanzi , Hu Wei , Chen Jia , He Yani 
Published: June 2020

Abstract

Background and Aims
Accelerated senescence of renal tubular epithelial cells (RTECs) may contribute to the progression of IgA Nephropathy (IgAN). Our previous studies demonstrated that DcR2 may reflect senescence of RTECs in experimental models and patients with diabetic nephropathy. The objective of this study was to investigate the association of DCR2 with disease severity and progression in IgAN.

Method
We included a retrospective cohort of 105 patients with biopsy proven IgAN. 15 normal renal tissue specimens displaying insignificant alterations biopsied from patients with renal carcinoma were recruited as controls. Renal biopsies from all patients were scored according to Oxford classification (MEST-C score). We analysed the degree of expression and localization of DCR2 in biopsies from kidneys with IgAN, and correlated their immunostaining levels with various clinical and histological parameters at baseline. Cox regression was performed for the composite renal outcome defined as 30% reduction in initial estimated glomerular filtration rate (eGFR) and/or end-stage renal disease (ESRD), and for the individual components during a follow-up for 60 or more months.

Results
DCR2 was overexpressed in the cytoplasm of RTECs obtained from kidneys of patients with IgAN [male: 60.9%, age:39.5±13.0 years, mean arterial pressure (MAP): 95.2±18.0 mmHg, proteinuria: 1.9 (0.7, 3.7)g/day, Initial eGFR:89.8±37.2 ml/min/1.73 m2], and were elevated with the increasing T scores. At baseline, DCR2 protein levels in the RTECs was inversely correlated with eGFR (R=−0.597, P=0.000) and positively associated with 24h-proteinuria (R=0.379, P=0.000) and the T score (R=0.632, P = 0.000). During a median follow-up of 80 (60, 125) months, patients with ≥25% tubular DCR2 positive showed worse eGFR slopes (the rate of eGFR decline) than those&lt;25% DCR2 positive group [4.35 (2.17, 5.53) versus 0.36 (-0.96, 1.19) ml/min per 1.73 m2 per year; P=0.000)]. Kaplan–Meier survival analysis revealed that renal survival for the composite outcome was significantly lower in the ≥25% DCR2 positive group than in the&lt;25% DCR2 positive group (P=0.000). In Cox regression models, ≥25% tubular DCR2 positive expression independently associated with poor renal outcome (HR=2.02, P=0.001) after adjustment for multiple known risk factors for IgAN progression, including baseline proteinuria, hypertension, eGFR, Oxford scores, and steroids/immunosuppressive therapy. Moreover, tubular DCR2 expression showed the highest sensitivity and specificity (80.8% and 87.3%, respectively) at a cut-off value of 25.5% DCR2 positive expression over proteinuria and eGFR for the composite outcome. The area under the receiver operating characteristic curve (AUROC) of tubular DCR2 expression was 0.880.

Conclusion
DCR2 is associated with disease severity and prognosis in IgAN patients and may have additional prognostic value besides established risk markers.