bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0570THE INCIDENCE, RISK FACTORS OF ACUTE KIDNEY DISEASES AND DISORDERS AND ITS IMPACT ON CHRONIC KIDNEY DISEASE IN PATIENTS AFTER RADICAL CYSTECTOMY
Authors: Ge Shengnan , Tang Ying , Chen Junzhe , Yu Wenjuan , Xu Anping 
Published: June 2020

Abstract

Background and Aims
Acute kidney injury (AKI) is a widely-discussed complication associated with the radical cystectomy which is the gold standard for the management of invasive bladder cancer. Until now, few studies investigate the new criteria named Acute Kidney Diseases and Disorders(AKD) as the complication of radical cystectomy. In this study, we evaluated the incidence, risk factors of AKD and evaluate its impact on chronic kidney disease (CKD) in patients after radical cystectomy.

Method
A total of 279 patients who underwent radical cystectomy at Sun Yat-sen Memorial Hospital, Guangzhou, China, from January 2006 to June 2019 were evaluated, including 168 patients for Robotic-assisted Laparoscopic Radical Cystectomy (RLRC) and 111 patients for Laparoscopic Radical Cystectomy(LRC). AKD was diagnosed according to the classification scheme proposed in the 2012 KDIGO guideline. Logistic regression modeling was used to explore risk factors of AKD, while risk factors associated with CKD in AKD patients were investigated using Kaplan-Meier analysis, respectively.

Results
The overall incidence of AKD after radical cystectomy was 34.1% (95 out of 279) ,the incidences differ significantly between the RLRC and LRC groups (67 [39.9%] vs 28 [25.2%], P=0.011). Among 279 patients, risk factors associated with postoperative AKD included RLRC (OR 2.067, 95%CI 1.188 to 3.595, P=0.010), Age (years) (OR 1.046, 95%CI 1.018 to 1.074, P=0.001), baseline eGFR&lt;60(ml/(min.1.73m2) (OR 2.662, 95%CI 1.355 to 5.230, P=0.004), Further subgroup analysis identified age, operation time&lt;250(min) as important risk factors of AKD in RLRC patients but not in LRC patients. Of 211 patients with a preoperative estimated glomerular filtration rate (eGFR) of &gt; 60 ml/min/1.73 m2, CKD developed in 16.0% (21/ 131) of patients in the non-AKD group and 36.3% (29/ 80) of patients in the AKD group. Kaplan-Meier analysis(shown in figure 1) identified that AKD is associated with higher CKD rates in those patients (P &lt;0.001).

Conclusion
One-third of bladder cancer patients developed AKD after after radical cystectomy. RLRC, Age, baseline eGFR &lt;60(ml/(min.1.73m2) were independent risk factors for postoperative AKD in all patients. Occurance of AKD could increase the risk of new-onset CKD in the long run. Though the use of RLRC is now well established, we should be aware that it may increase the risk of postoperative AKD, especially for patients who are old and with lower eGFR .Besides, we should try to improve the management of those AKD patients with aim toward preventing further development of CKD.
P0574IS PERIPROCEDURAL BLOOD LOSS FOLLOWING PERCUTANEOUS CORONARY INTERVENTION A RISK FACTOR FOR CONTRAST-INDUCED ACUTE KIDNEY INJURY ?
Authors: Rao Indu Ramachandra , Paramasivam Ganesh , Prabhu Ravindra Attur , Nagaraju Shankar Prasad , Devasia Tom , Rangaswamy Dharshan , Shenoy Srinivas Vinayak , V B Mohan 
Published: June 2020

Abstract

Background and Aims
Contrast-induced acute kidney injury (CI-AKI) is a significant concern with the use of intraarterial contrast agents, especially in percutaneous coronary interventions (PCI) in which higher contrast volumes are used. Presence of anemia is a risk factor for CI-AKI and is a component of various risk-prediction models. However, the impact of periprocedural hemoglobin (Hb) drop following PCI on CI-AKI is not known, despite the fact that significant blood loss is fairly common in patients undergoing PCI. The aim of this study was to examine whether periprocedural Hb drop is a risk factor for development of CI-AKI following PCI.

Method
This was a single-center, retrospective study of patients admitted for elective or primary PCI at our center between January 2015 and December 2018. Patients with baseline eGFR &lt;15mL/min/1.73m2 were excluded. CI-AKI was defined as per the KDIGO 2012 guidelines as an increase in serum creatinine by at least 0.3 mg/dl, or 1.5-1.9 times the baseline values within 48 hours after administration of contrast media. Periprocedural Hb drop was defined as fall in Hb by at least 1g/dL below baseline values within 48 hours following PCI.

Results
A total of 6418 patients were included. Baseline characteristics of the study population are shown in table 1. Overall incidence of CI-AKI in our study was 7.6% (n=490), of which 3.9% (n=19) required dialysis. Higher incidence of CI-AKI was seen in those with baseline eGFR &lt; 60 ml/min/1.73m2 (16.4%) and a pre-procedural Mehran score &gt;11 (33%). Peri-PCI Hb drop was seen in 49.9% (n=3203), with a drop &gt;2g/dL in 18.5% (n=1185). On multivariate logistic regression analysis (Table 2), it was found that periprocedural Hb drop &gt;2g/dL was independently associated with CI-AKI (OR 1.49, 95% CI 1.18-1.88, P=0.001). Furthermore, in those with periprocedural blood loss, the risk of CI-AKI was increased by 1.3 times for each 1g/dL drop in Hb (OR 1.30, 95% CI 1.14-1.49, P&lt;0.001). Additionally, apart from traditional risk factors, hypertension was independently associated with development of CI-AKI (Table 2).

Conclusion
Periprocedural blood loss was associated with a higher risk of CI-AKI after PCI. Moreover, risk of CI-AKI increased with increasing severity of blood loss. Whether measures to minimize blood loss, like using a transradial approach, staging complex procedures and close monitoring of anticoagulation/antiplatelet regimens, will help reduce risk of CI-AKI needs to be studied.
P0577CLINICAL CHARACTERISTICS AND IN-HOSPITAL OUTCOME FOR 1798 CONSECUTIVE PATIENTS WITH ACUTE KIDNEY INJURY
Authors: Montgomerie Christina , Spaak Jonas , Evans Marie , Jacobson Stefan H 
Published: June 2020

Abstract

Background and Aims
Acute kidney injury (AKI) is a common condition occurring in about 15% of all hospitalized patients. AKI have different pathophysiological etiologies; prerenal, renal or postrenal. Patients who recover from AKI have a higher long-term risk of end-stage kidney disease and death. However, most AKI studies include critically ill patients treated at intensive care units; less is known about general AKI patients treated at the nephrology ward. The aim of this large single center study was to report differences in laboratory findings and short-term hospital outcomes in relation to cause of AKI in consecutive patients admitted to a nephrology department.

Method
All patients diagnosed with AKI between 2009 and 2018 and admitted to the nephrology department at Danderyd University Hospital, Stockholm, Sweden, were included. Relevant laboratory and physiological measures were registered, including length of stay, procedures, etiology and level of AKI. AKI was defined as a first s-creatinine (sCr) &gt;130 µmol/L (1.47 mg/dL) at admission, or an increase in sCr by 30% from previous stable out-patient value. These criteria were set at the beginning of the study based on clinical knowledge and clinical practice at the time. Patients on dialysis treatment were excluded. Patients were followed until either discharge or death, whichever came first.

Results
In 1798 patients with AKI, the majority (n=851) had combined type, followed by prerenal (n=668), renal (n=175), and postrenal (n=104) etiology. Patients with renal AKI were younger, had longer duration of stay, and had higher bicarbonate levels on admission (Table 1). The most common cause of renal AKI was interstitial nephritis. Patients with prerenal AKI had lower S-Cr, blood pressure and higher Hb upon admission. 58% of the patients recovered with an at least 30% decrease in sCr from baseline during their stay. Most of these were patients with prerenal AKI followed by combined AKI. There was no statistically significant difference in mortality between the four etiologies of AKI.

Conclusion
This study provides data from a large, contemporary AKI patient cohort under nephrology care. Both patient characteristics and short-term outcomes differ substantially in patients of variable AKI etiology. These findings have important implications for prognostic evaluation upon admission and further resource planning.
P0581HIPERKALEMIA IN COMMUNITY-ADQUIRED ACUTE KIDNEY INJURY. ASSOCIATED FACTORS AND CLINICAL CONSEQUENCES
Authors: Peña Porta Jose Maria , Castellano Calvo Almudena , Coscojuela Otto Ana , Tomás latorre Alejandro , Ferreras Gascó José Antonio , Alvarez Lipe Rafael 
Published: June 2020

Abstract

Introduction and Aims
Hyperkalemia (hyperK) is an analytical alteration that frequently occurs in the context of acute kidney injury (AKI) adding morbidity to the patient. We know little about the associated factors and the clinical consequences of this complication in patients with community-acquired acute kidney injury (CA-AKI). The aim of present study was to analyze the predisposing factors and the clinical consequences of the hiperK in patients with CA-AKI.

Method
The present study is based on a cohort of patients with CA-AKI admitted to the Nephology Service of a third level hospital from January 2010 to February 2015. Hyperkalemia was defined by the laboratory of our hospital as potassium levels above 5.1 meq / L

Results
A total of 308 patients were included in the final analyses. The mean age was 73,22±13,95 years. 58,4% were men. Charlson comorbidity index (CCI) was 7,16 ±2,7 points. The mean of drugs ingested daily was 7,81±3,66 and the length of stay 12,25±11,69 days. In view of the Etiology of AKI, 69,5% prerenal AKI and 30,5% non-prerenal ones. 212 patients had a history of previous chronic kidney disease (CKD) (68.8%). Hemodialysis (HD) was required in 54 patients (17.15%). 38 patients (12.3%) died during hospital stay. HyperK occurred in 173 cases (56,2 %). Mean potassium was 5,45±1,41 meq/L (95% IC 5,29-5,61) (range 2.65-9.70). There was a significant correlation between potassium and pH (r = - 0.328; p &lt;0,001) as well as between K and CCI (r= 0,284; p &lt;0,001). There was an association between hyperK and intake of potassium-sparing diuretics (p&lt;0,001); ACEI/ARB (p=0,003) and beta blocker (p&lt;0,001). There was no association with CKD nor NSAID intake. Using a multiple linear regression model the equation that predicted serum potassium level was: K = 36,44 – (4,4 x pH) + 0,98 (if intake of potassium-sparing diuretics) + (0.10 x CCI). Potassium level did not influence the length stay. Patients with HyperK required HD in a higher proportion (23.7 vs. 9.6%; p 0.01) and also had higher mortality during hospital stay (15.6 vs. 8.1%; p 0.048). After a follow-up of 971±702 days after hospital discharge, Kaplan-Meier survival curves showed a significant difference (Log Rank (Mantel-Cox): Chi-square 20,1; p&lt; 0,001) between patients with hyperK and patients that did not present it.

Conclusion
HyperK occurred in just over half of our patients. The potassium level was significantly determined by the previous comorbidity, pH and the intake of potassium-sparing diuretics. HyperK patients required HD and died in a greater proportion during hospital stay than the others. Mortality after discharge was higher in patients who presented hyperK during hospital stay. Appropriate measures must be taken to correct hyperK early in patients with CA-AKI.
P0588TUBULAR EPITHELIUM INJURY BIOMARKERS AND SURVIVAL AFTER ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION
Authors: Smirnov Kirill , Dobronravov Vladimir , Smirnov Alexei 
Published: June 2020

Abstract

Background and Aims
In our recent study we have shown, that some tubular epithelium injury molecular biomarkers (MBMs) may be used for acute kidney injury (AKI) prediction in a specific category of patients, receiving hematopoietic stem cell transplantation (HSCT). Here we aimed to determine the value of this MBMs for the evaluation of the mortality following HSCT.

Method
90 HSCT recipients (46 males, 44 females) were enrolled. All-cause mortality was registered along 1 year of posttransplant period. MBM’s (calbindin, clusterin, IL-18 (interleukin-18), KIM-1 (kidney injury molecule-1), GST-π (glutathione S-transferase- π), MCP-1 (monocyte chemoattractant protein-1)) relative concentration increase was determined in alive and deceased patients after HSCT. MBM’s associations with death risk were estimated in multivariate models adjusted for clinical factors related to the prognosis (AKI, progression of the underlying disease, incomplete HLA compatibility, etc.).

Results
It was found that the relative increase in the concentrations of some MBMs was significantly higher in the group of deceased HSCT recipients (Figure). In multivariate models the associations of KIM-1, MCP-1, and calbindin with mortality were not reliable (data not shown). As for clusterin, this relationship was reliable and independent of other significant clinical factors, including overt AKI (HR=1,085 (1,034-1,139; p=0,001).

Conclusion
Urinary MBMs, taking into account their independent association with posttransplant all-cause mortality risk, may become a useful tool not only for AKI prediction, but also for HSCT prognosis evaluation.
P0593INCIDENCE AND IMPACT OF ACUTE KIDNEY INJURY (AKI) IN A THIRD LEVEL HOSPITAL
Authors: Aguilera Morales Wenceslao , Lara Ruiz Alfonso , Díaz Díez Irene , Almenara Tejederas Marina , Salgueira Lazo Mercedes 
Published: June 2020

Abstract

Background and Aims
The AKI index is increasing, reaching 22% in hospitalized patients. Despite the negative impact it implies, in daily practice its management remains suboptimal and there is little awareness of the problem. Aims: Know the incidence of AKI in a Third-level hospital; its impact on mortality, average stay and associated costs.

Method
Descriptive cross-sectional study of data extracted from CMBDA corresponding to a third level hospital during 2016-17. We analyze: hospitalization episodes, referral assistance units, AKI episodes at discharge, stays and exitus. To calculate associated costs, we use as reference the costs/day-hospitalization per Healthcare Unit in SAS according to BOJA-Number 218 (14nov2016). We compare groups according to presence/no AKI. Limitations: These data may be underestimated since the diagnosis of AKI may be present and not reported upon discharge; Nor do we include dialysis costs.

Results
56,816 revenues were produced; 3,589 reported AKI (incidence: 6.31%). Patients with AKI add 42,801 stays; Average stay of 18.4 days in 2016, 16.4 in 2017, compared to 6.6 and 8.7 days respectively when FRA is not associated (p &lt;0.01). The estimated costs associated with the FRA were 22,815,558 euros, with a cost / episode of 6023 euros, compared to 3523 euros in patients without FRA. The overall associated mortality AKI was 23.2% vs 11% in the rest (p &lt;0.01). Average stay, costs and mortality vary widely according to the Assistance Units, the impact being especially worrying in Surgical Units (table).

Conclusion
The incidence of AKI in our hospital lower than that referred to in the literature probably responds to inadequate registration in discharge reports. Despite the limitations, our data demonstrate the impact of the diagnosis of AKI in hospitalized patients, doubling the average stay, costs and mortality. These differences are accentuated in some Assistance Units, being especially alarming in Surgical Units.
P0599THE LYSOSOMAL URINE ENZYMES ACTIVITY IN CHILDREN AFTER ACUTE KIDNEY INJURI
Authors: Lavrenchuk Olga , Korol Lesya , Migal Ludmila , Bagdasarova Ingretta 
Published: June 2020

Abstract

Background and Aims
The urgency of the problem of acute kidney injury (AKI) in children is due to the high risk of chronic kidney disease (CKD) as an outcome. Lysosomal enzymes in urine are considered to be informative markers of renal parenchyma damage. The aim of study was to determine the activity of lysosomal enzymes β-galactosidase (GAL) and N-acetyl-β-D-glucosamynidase (NAG) in urine as markers of CKD progression in children after AKI.

Method
41 children were examined after AKI with achieving self-diuresis and clinical improvement. The functional state of the kidneys was evaluated by the glomerular filtration rate (Schwartz GFR), the level of albuminuria. Urine enzyme activity was determined and cross-linked to mmol urinary creatinine. The control (reference) group consisted of 28 children who were conditionally healthy, without kidney disease.

Results
The NAG activity was 8 times higher level than in the reference group of healthy children (87/46;193 vs. 15/11;18, p&lt;0.001), and GAL was elevated in 3 times either (34/22;45 vs. 10/6;13, p&lt;0.001) in patients with a disease period of up to 2 years after AKI. In patients with follow-up period 2 or more years enzyme activity levels decreased, but remained 4 times higher (NAG: 49/31;109, p &lt;0.001 compared to control; GAL: 35/25;44, p &lt;0.001 compared to control). The high levels of enzyme activity was documented in 73.2% of patients after one year of follow up, but the GFR decrease was found in 22.0%, and albuminuria - only in 34.1%.

Conclusion
The urine activity of NAG and GAL in children is an informative marker for diagnosing recovery after AKI or CKD progression with renal function decline. This method is non-invasive, inexpensive, and simple to conduct.
P0602CLINICAL PATTERN, RENAL RECOVERY AND PATIENT OUTCOMES AFTER ACUTE KIDNEY INJURY IN ADULTS IN AN EMERGING COUNTRY
Authors: Subbiah Arunkumar , Agarwal Sanjay Kumar 
Published: June 2020

Abstract
Background and Aims Acute Kidney Injury (AKI) is an important determinant of outcome in hospitalized patients. Further, there is a risk for development of Chronic Kidney Disease (CKD) in the future. Though the long-term impact of AKI has been studied in developed countries, there is a paucity of data in this area from the Indian subcontinent. This single-centre study aimed to assess the pattern, clinical spectrum, short-term and long-term outcomes of AKI.
Method In this prospective observational cohort study, detailed demographic and clinical data at presentation, during hospital stay and follow-up at 1, 3, 6 and 12 months after discharge were obtained prospectively for a cohort of patients with AKI. Both community (CAAKI) and hospital acquired AKI (HAAKI) were included. Patient with pre-existing CKD were excluded. Outcome variables examined were in-hospital mortality, renal function at discharge and on follow-up after discharge from hospital.
Results In our study cohort with 476 patients, majority of the cases were CAAKI (395, 83%). The mean age at presentation was 44.8 ± 18.7 years. Medical causes (84%) contributed to the majority of AKI while the remaining were due to surgical (10%) and obstetrical (6%) causes. Sepsis (176/476; 36.9%) was the most common cause of AKI. The most common source for sepsis was respiratory (41%) followed by urological source (18.7%). The in-hospital mortality rate for patients with AKI was 38%. Age &gt;60 years (HR = 1.51; 95% CI, 1.11 – 2.07), oliguria (HR = 1.48; 95% CI, 1.05 – 2.10), need for ventilator (HR = 2.45; 95% CI, 1.36 – 4.41) and/or inotropes (HR = 14.4; 95% CI, 6.28 – 33.05) were predictors of mortality. At discharge, 146 (30.7%) patients had complete renal recovery, while 149 (31.3%) had partial renal recovery. Oliguria (p &lt; 0.001), hypoalbuminemia (p = 0.001) and need for renal replacement therapy (RRT) (p = 0.01) were significantly associated with partial recovery. Of the 295 patients on follow-up at discharge, 211 (71.5%) patients had normal renal function, 4 (1.4%) died and 33 (11.2%) were lost to follow up; 47(15.9%) patients developed CKD of which 6 (2%) were dialysis dependent. Elderly patients, higher AKIN stage with oliguria and those requiring RRT were more likely to develop CKD. Among these, the need for in-hospital RRT was the single most important factor predicting the risk of CKD (OR 1.77, 95% CI, 1.12-2.78).
Conclusion In conclusion, our data shows that AKI in hospitalized patients still has high mortality in emerging countries like India. Though a fairly good percentage of cases recovered, there is a definite risk of CKD development, especially in patients who required RRT during hospitalization.
P0603INFLUENCE OF FERRITIN VALUES IN THE PORGNOSIS OF ACUTE KIDNEY INJURY
Authors: Díez Pablo , Fernández Ramos Andres , Muñoz Ramos Patricia , Sanz Sainz Marta , Santos Sánchez-Rey Begoña , Ruano Pablo , Quiroga Borja 
Published: June 2020

Abstract

Background and Aims
Acute Kidney Injury (AKI) is one of the most frequent causes of hospitalization and many factors have been associated to its prognosis and recovery. The role of iron in AKI physiopathology and its influence is not well known. Recent studies have shown that elevated levels of catalytic iron are associated with higher mortality in patients with AKI, however, catalytic iron is not available in usual clinical practice. Ferritin, especially abundant in the liver, is the primary intracellular iron storage protein. A small amount is secreted to the circulation and is an indirect marker of total body iron deposits. In this study we analyze the influence of iron, with ferritin values, in the prognosis of AKI.

Method
We developed a retrospective, single-center study that enrolled patients with AKI, hospitalized in our center between 2013 and 2014 with iron metabolism values in the first 72 hours after admission. At baseline, we collected demographic information, comorbidities, reason for admission and iron metabolism values (ferritin, transferrin, transferrin saturation index and serum iron). We analyzed variables associated with low and high ferritin values and its impact in AKI long-term prognosis using univariate and multivariable Cox regression.

Results
Of the 1731 analyzed patients, 833 (48.1%) had ferritin records. The mean age was 78±14 years and 48% of the patients were women. The most frequent comorbidity was hypertension (76%), followed by chronic kidney disease (46%), dyslipidemia (44%), heart failure (31%), diabetes mellitus (29%) and atrial fibrillation (27%). The most frequent reason for admission was infection (35%) followed by AKI (19%). Ferritin values differed significantly according age (p&lt;0.0001), sex (p=0.024), diabetes (0.012), hypertension (p=0.002), neoplasia (p=0.016), reason for admission (p=0.018), baseline CKD-EPI (0.012) and lactate at admission (p&lt;0.0001). During the hospitalization, 165 (20%) patients died. Factor associated to mortality were ferritin&gt;500 ng/ml (p=0.013), lactate at admission (p&lt;0.001), age (p=0.045), hypertension (p=0.014), dyslipidemia (p&lt;0.001), ischemic heart disease (p=0.006), chronic kidney disease (p=0.001), baseline CKD-EPI (p=0.01), atrial fibrillation (p=0.005), neoplasia (p=0.023), Barthel index (p&lt;0.001) and hemoglobin (p=0.006) and bicarbonate (p=0.012) at admission. Multivariate logistic regression demonstrated that ferritin levels over 500 ng/mL was an independent predictor of mortality (1.6 [1,1-2,3] HR [CI 95%]) (p=0.013).

Conclusion
Ferritin values higher than 500 ng/mL independently predicts mortality in patients admitted with AKI.