bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0598COMPARISION OF OUTCOMES ACCORDING TO URINE CHEMISTRY TESTING TIME FOR THE CAUSES OF ACUTE KIDNEY INJURY PATIENTS ADMITTED TO THE EMERGENCY ROOM
Authors: Hwang Won Min , Yun Sung Ro , Yoon Se Hei 
Published: June 2020

Abstract

Background and Aims
Rapid identification and treatment of acute kidney injury can help to restore kidney function. In order to differentiate between prerenal AKI and intrinsic AKI, we perform a urine chemistry test to determine the function of the renal tubule. However, there is no report that it is helpful to arrive at the hospital as early as possible and to perform these urine chemistry tests as soon as possible.

Method
We analyzed the timing of urinary chemistry in AKI patients who were admitted to our hospital through the emergency room for 3 years and divided into two groups. Early group was defined as patients who performed the test within 3 h of arrival in the emergency room. Late group was defined as patients who were late or not. The prognostic factors were change in 30 day eGFR and duration of hospital stay. We also compared the usefulness of urine chemistry test between pre renal AKI and intrinsic AKI in each group.

Results
The changes of eGFR after 30 days in each group are 41.6 ± 27.6 mL/min/1.73 m2 (Early group, n = 92) vs 30.4 ± 26.8 mL/min/1.73 m2 (Late group, n = 180) (P = 0.0013). Early group patients were discharged more quickly than patients in the late group (Hospital day: 11.5 ± 10.1 vs 13.8 ± 10.5, P = 0.0450). When analyzed according to the causes of AKI, these changes showed differences in prerenal AKI rather than intrinsic AKI(Figure).

Conclusion
A urine chemistry test is a test to help determine the cause of AKI. Based on the results of urine chemistry performed within 3 h after arrival at the hospital, patients with AKI who visited the emergency room had better improved kidney function and less hospitalization.
P0600LONG-TERM PROGNOSIS OF PATIENTS WITH METFORMIN -ASSOCIATED LACTIC ACIDOSIS(MALA) AND ACUTE KIDNEY FAILURE
Authors: Melero Martin Maria Rosa , Muñoz de Morales Alejandra , Tejedor Jorge Alberto , Patrocinio Rodriguez benitez , Bascuñana Arturo , Gueorguieva Antonia , Goicoechea Marian 
Published: June 2020

Abstract

Background and Aims
Although metformin-associated lactic acidosis (MALA) is a very rare event, is frequently seen in patients on metformin with risk factors for developing acute kidney injury (AKI). The long-term prognosis in patients with metformin-associated lactic acidosis (MALA) and renal failure remains unknown.
To describe the characteristics and prognosis of AKI in patients with MALA and investigate whether prescription of RRT and previous renal function are associated with long-term outcomes.

Method
A retrospective single-centre case series. One hundred and nine patients affected with MALA and AKI admitted between Marx 2007 and February 2019 were included. We analysed comorbidities, laboratory tests, clinical parameters and prescription pattern of RRT at admission. After discharging, renal outcomes (doubling serum creatinine or starting dialysis) and mortality were assessed in the long-term.

Results
We included 109 patients (59 males and 50 females), mean age of 74.2±8.6 years and mean Charlson comorbidity index of 8.0±2.4. 54 out of 109 patients had previous chronic kidney disease (eGFR &lt; 60 ml/min/1.72 m2). Precipitating causes of AKI associated MALA included; acute dehydration (84.4%), exposure to iodinated contrast (7.3%) and non-specified causes (8.3%). During the admission, renal replacement therapy (RRT) was performed in 72 patients (continuous renal replacement therapy in 47 and dialysis in 25). RRT requirements was significantly associated with lactate, acidosis and serum creatinine levels, but not was associated with higher mortality rate during admission.
The patients were followed a median time of 33 (10-65) months after discharging. 33 patients had a renal event and 55 patients died. The patients with CKD before admission had higher number of renal events (log Rank 6.346, p=0.012) and higher mortality (log Rank 12.943, p&lt;0.001). In a model adjusted by age and RRT at admission, women were less likely to develop (HR 0.315(0.136-0.730, p=0.007) long-term renal events and previous CKD increased this probability (HR 2,532 (1.190-5.385), p=0.016). Previous CKD and RRT during admission increased mortality in a model adjusted by age, gender and comorbidity (HR 2.315(1.177-4.553), p=0.015 and HR 1.895(1.003-3.580), p=0.049, respectively).

Conclusion
The renal function prior to the episode of AKI associated to MALA and the RRT at admission are the main factors related to renal outcomes and mortality in the long-term.
P0609THE INCIDENCE AND RISK OF CONTRAST INDUCED ACUTE KIDNEY INJURY IN THE ELDERLY UNDERGOING PULMONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY
Authors: Fadel Alrowaie , Almatham Khalid , Almousa Saud , Abonab Majed , AlJaser Abdullah , Alqahtani Ali , Alsaif Said , Alkadi Ammar , Alquefil Khalid 
Published: June 2020

Abstract

Background and Aims
Contrast-induced acute kidney injury nephropathy (CI-AKI) is a leading cause of acquired acute kidney injury and has been associated with prolonged hospitalization and adverse clinical outcomes. Advanced age has been reported as risk factor for CI-AKI. However, limited studies available to determine the exact incidence of CI-AKI in elderly patient. The aim of this study was to investigate the incidence of, risk factors for developing CI-AKI in patient above 65 years old who underwent Pulmonary Computed Tomography Angiography (PCTA).

Method
This single center retrospective study, performed in a large, tertiary care hospital in Riyadh, Saudi Arabia. It is a sub-study of (3 P-CIAKI) The Practice Pattern of Preventive Measures for Contrast Induced Acute Kidney Injury in Patients Undergoing Pulmonary Computed Tomography Angiography. Patients &gt; 65 years of age, who underwent PCTA during a 5-year period (2014 to 2018) were included. Patients receiving long-term hemodialysis or peritoneal dialysis, and those without repeated serum creatinine 48-72 hours post procedure were excluded from the analysis. CI-AKI defined as raise of serum creatinine by 44 mmol/l 48-72 hours post PCTA.

Results
272 out of 908 patients, with a mean age of 74.93 ± 7.09 years, 58.1% having diabetes mellitus (DM) and estimated GFR of 74.92 ± 23.57 ml/min per 1.73 m2 were enrolled. 201 patients (73.9%) had eGFR &gt; 60 ml/min. Diuretics was used by 37.1% of the patients, while 33.1 % of the patients on ACEI / ARBs. Prophylactic measures used in 35.7 % of the procedures. CI-AKI occurred in 19 cases (7.0 %) as compared with 4.7 % in the original 3 P-CIAKI study with mean age of 52 years and eGFR 97 ml/min. Renal replacement therapy required in 3 patients who had CI-AKI. DM status was only significant predictor for the development of CI-AKI.

Conclusion
Elderly patients are at greater risk for the development of CI-AKI even with eGFR above 60 ml/min specially in DM patient .The Incidence of CI-AKI in patients &gt; 65 years of age is up to 7 %, that is less than the reported in the literature and this can be explained by higher base line eGFR in our study .
P0610ACUTE KIDNEY INJURY IN CRITICALLY ILL PATIENTS IN THE ICU
Authors: Markovic Mira , Knezevic Violeta , Azasevac Tijana , Knezevic Aleksandar , Stojkovic Svetlana , Celic Dejan 
Published: June 2020

Abstract

Background and Aims
Acute kidney injury (AKI) is common and serious complication in critically ill patients in intensive care unit (ICU). The rapid increase in aging populations with more comorbidities contribute to high incidence AKI in ICU. Incidence varies from 20% to as high as 70%. AKI in the ICU frequently requires costly supportive therapies, has high morbidity and it’s associated with poor outcomes.
We aimed to determine incidence of AKI, causes, risk factors, treatment and outcomes of AKI in critically ill patients in ICU.

Method
We collected data prospectively from case records of adult patients (older than 18 years of age) admitted to the ICU at the Department of Internal medicine, Emergency Center, Clinical center of Vojvodina in Novi Sad, Serbia, during 3 months. We included patients who had at least two measurements of serum creatinine. Data on patient demographics, diagnosis at the time of ICU admission, complete blood count, biochemistry, comorbidities (diabetes mellitus, arterial hypertension, other cardiovascular diseases, renal disease, prostate diseases, dehydration, burns, gastrointestinal bleeding, pancreatitis, peritonitis, sepsis), use of nephrotoxic agents, radiological procedures and treatment of AKI were recorded. We excluded patients with chronic renal disease who were on hemodialysis. There were no interventions.

Results
Of the 44 patients included in the study, median age was 67+/-13,20 years (range: 21 to 88). Of those 44 patients 20% developed AKI. De novo AKI was diagnosed in 51,22% of those patients and 48,78% had chronic renal failure in acutisation. The most frequent etiology was pre-renal, in 80,95% of patients. Renal origin and obstructive (post-renal) causes were detected in the same number of patients, 9,52%. Comorbidities were present present in all patients. Most common comorbidity was arterial hypertension, in 52,4% of patients, other cardiovascular diseases in 47,6 % of patients, sepsis also in 47,6% of patients and gastrointestinal bleeding in 33,3% of patients. Complete recovery of kidney function was detected in 42,86% of patients. Mortality was 28,57%. During the hospitalisation 90,48% of patients were treated conservative and 9,52% of patients required renal replacement therapy.

Conclusion
De novo AKI occurred in approximately half of the critically ill patients in ICU. The most frequent etiology was pre-renal. AKI was mainly detected in older patients with comorbidities. Age and comorbidities were also associated with the poor outcome. Mortality was high.
P0625CONTINUOUS RENAL REPLACEMENT THERAPY WITHOUT ANTICOAGULATION IN CRITICALLY ILL PATIENTS AT HIGH RISK OF BLEEDING-A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Sun Shiren , Zhang Wei , Bai Ming , Zhao Lijuan , Chen Xiaolan , Yu Yan 
Published: June 2020

Abstract

Background and Aims
Continuous renal replacement therapy (CRRT) has been widely used in the critical care setting and anticoagulation is usually necessitated. However, critically ill patients are commonly at incremental risk of bleeding, which contributed to the hesitation of anticoagulant use for CRRT in clinical practice. The current guideline recommended CRRT proceed without anticoagulation in patients with contraindication to citrate and increased bleeding risk. Nevertheless, the efficacy of anticoagulation-free CRRT remains inconsistent. Therefore, the purpose of our present systematic review is to evaluate the efficacy and safety of anticoagulant-free CRRT based on the current literatures.

Method
We conducted a comprehensive search of PubMed (US National Library of Medicine, Bethesda, MD, USA), Cochrane Library databases and EMBASE from database inception to January 12, 2019 for potential candidate studies. Studies included adult critically ill (age &gt; 18 years) patients with increased bleeding risk, and underwent CRRT without anticoagulation were considered for the inclusion.

Results
Finally, 17 observational studies and 3 randomized controlled trials with 1615 patients were included in our present meta-analysis. There was no significant difference in filter lifespan between the anticoagulation-free and systemic heparin group. The filter lifespan was significantly prolonged in the citrate (WMD -23.01, 95%CI [-28.62, -17.39], P &lt; 0.001; I2 = 0%, P = 0.53) and nafamostat (WMD -8.4, 95%CI [-9.9, -6.9], P &lt; 0.001; I2 = 33.7%, P = 0.21) groups, compared with anticoagulation-free group. The averaged filter lifespan of the anticoagulation-free CRRT ranged from 10.2 to 52.5 hours.

Conclusion
The filter lifespan in anticoagulation-free patients with increased bleeding risk was comparable to that in patients without increased bleeding risk underwent systemic heparin anticoagulation CRRT. Nafamostat was not recommended for CRRT anticoagulation due to its drawbacks. Currently, the optimal choice of anticoagulation strategy for critically ill patients without citrate contraindications at high risk of bleeding should be regional citrate anticoagulation. Further studies should focus on the special cut-off value of activated partial thromboplastin time (APTT), international normalized ratio (INR) and platelet (PLT) count, at which the anticoagulation-free CRRT would be beneficial.
P0626THE RISK FACTORS OF ACUTE KIDNEY INJURY CAUSED BY HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS
Authors: Wang Siwen , Zhou Jiaojiao , Yang Jia , Yang Lichuan , Wang Xin 
Published: June 2020

Abstract

Background and Aims
Hemophagocytic lymphohistiocytosis (HLH) is a syndrome caused by uncontrolled natural killer (NK) cell and cytotoxic T cell activation, resulting in the overproduction of proinflammatory cytokines and hemophagocytosis. Acute kidney injury (AKI) characterized by rapid loss of renal excretion function is the most common complication of HLH in the kidney. In this retrospective study, we aimed to find the risk factors of AKI in patients with HLH.

Method
This study included adult patients with HLH admitted in West China Hospital of Sichuan University from January 2009 to June 2019. 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. The diagnosis of HLH was based on the HLH diagnostic criteria revised by the Histocyte Society in 2004 and AKI was defined according to the 2012 KDIGO (Kidney Disease: Improving Global Outcomes) guideline. We collected basic information, clinical manifestations and laboratory data of patients from electronic medical records.

Results
We analyzed 294 patients this time, of whom 95 (32.3%) developed AKI. The patients were divided into two groups according to the occurrence of AKI. The mortality rate in the AKI group was significantly higher than that in the non-AKI group (40.0% VS 12.6%; p&lt;0.001). The risk factors of AKI in patients with HLH were hyperphosphatemia [Odds Ratio (OR) 3.825; 95% Confidence Interval (CI) 1.647-8.886; p=0.002] ,heart failure (OR 2.972; 95% CI 1.029-8.584; p=0.044), increased heart rate (OR 1.025; 95% CI 1.008-1.043; p=0.004), prolonged prothrombin time (OR 1.025; 95% CI 1.001-1.049; p=0.041), elevated total bilirubin level (OR 1.003; 95% CI 1.000-1.007; p=0.030), and hypoproteinemia (OR 0.915; 95% CI 0.842-0.994; p=0.035).

Conclusion
The incidence of AKI in HLH patients is frequent, and the risk of death in HLH patients with AKI is significantly higher. The occurrence of AKI in patients with HLH is related to hyperphosphatemia, heart failure, increased heart rate, prolonged prothrombin time, elevated total bilirubin level, and hypoproteinemia.
P0628CREATININE-CYSTATIN C RATIO IS ASSOCIATED WITH MORTALITY IN ICU PATIENTS UNDERGOING CONTINUOUS RENAL REPLACEMENT THERAPY
Authors: Jung Chan-Young , Jo Wonji , Kim Jaeyoung , Park Jung Tak 
Published: June 2020

Abstract

Background and Aims
Development of acute kidney injury (AKI) in intensive care patients considerably increases the risk of mortality. Although several factors that are related to outcome have been recognized in this patient group, stratifying mortality risk still remains a challenge. While serum creatinine levels are confounded by muscle wasting in critical illness, cystatin C is expected to be less modulated by muscle mass. Speculating that the ratio between serum creatinine and cystatin C may reflect muscle mass in critically ill AKI patients, we evaluated the association between creatinine-cystatin C ratio and mortality in patients requiring continuous renal replacement therapy (CRRT) in the intensive care unit (ICU).

Method
Retrospective analyses were conducted on 443 ICU patients who underwent CRRT between August 2009 and October 2016 at Severance Hospital of Yonsei University Health System, Seoul, South Korea. The patients were divided into four groups based on creatinine-cystatin C ratio at the time of CRRT commencement. The primary outcome was 90-day mortality after CRRT initiation.

Results
The mean age was 64 ± 15 years, and 57.3% of patients were male. The most common cause of AKI was sepsis. The median and range of the creatinine-cystatin C ratio was 0.83 (0.13-6.20). The 90-day mortality rate for each creatinine-cystatin C ratio quartiles 1, 2, 3, and 4 were 76.6%, 73.9%, 61.3%, and 51.8%, respectively. Multiple Cox proportional hazard models revealed that the creatinine-cystatin C ratio was an independent predictor of 90-day mortality even after adjusting for confounding factors (Hazard ratio, 0.97; 95% confidence interval, 0.95-0.99, P&lt;0.01). The prediction of mortality was significantly improved when creatinine-cystatin C ratio was considered compared to APACHE-II or SOFA scores alone.

Conclusion
Creatinine-cystatin C ratio is associated with mortality in ICU patients undergoing CRRT, and may be a practical marker in predicting survival among ICU patients with AKI.
P0630EARLY CHANGES OF SEQUENTIAL URINE SEDIMENT ANALYSIS ARE INDICATIVE FOR DEVELOPMENT OF ACUTE KIDNEY INJURY AFER CARDIAC SURGERY
Authors: Schanz Moritz , Schricker Severin , Oberacker Tina , Göbel Nora , Alscher Dominik M , Kimmel Martin , Ketteler Markus 
Published: June 2020

Abstract

Background and Aims
Microscopic examination of urine sediment is a well-established and inexpensive technique for differential diagnosis of acute kidney injury. Especially renal tubular epithelial cells (RTEC) and granular casts (GC) have been shown to be a strong predictor of acute tubule necrosis (ATN), the assumed most common cause for AKI in cardiac surgery patients. So far, no study evaluated urine sediment before manifest AKI is evident. Therefore, the aim of this prospective trial was to evaluate if early changes of urine sediment parameters are indicative for development of acute kidney injury.

Method
Sequential urine sediment specimens were analyzed on day 0 (d0), day 1 (d1) and day 4 or 5 (d5) after cardiac surgery in n=37 patients. Urine analysis was conducted immediately after collection of urine specimens. Analysis includes detection of RTEC and GC as well as hyaline casts (HC), squamous epithelium (SE), erythrocyte count (EC) and leucocyte count (LC). Urine score (US) - consisting of RTEC and GC - which is described as indicative for ATN, was calculated as described previously. For detection of AKI, serum creatinine, serum cystatin c and urine output were recorded. Urine sediment changes over time were analyzed using differences between day of surgery (d0) and day 1 (d0-d1 = Δd1) or day 5 (d0-d5 = Δd5), respectively.

Results
Of the 37 included patients n=10 (27%) developed AKI within 5 days. According to the definition of KDIGO 2012, two patients developed Stage 1 (20%), six patients Stage 2 (60%) and two patients Stage 3 (20%) AKI. Median age was 67 years (IQR: 63.5-73.0). Mean HC, GC, RTEC and US tended to be higher in AKI patients from day one after surgery. Looking at the urine sediment changes over time (Median; IQR), Δd1 of RTEC (AKI: 0.65; 0.00 – 1.15 vs. No AKI: 0.00; -0.03 – 0.03; p=0.010), GC (AKI: 0.25; 0.00 – 0.50; No AKI: 0.00; -0.20 – 0.00; p=0.002) and US (AKI: 0.00; -0.25 – 0.00 vs. No AKI: 0.00; 0.00 – 1.00; p=0.047) were significant higher in AKI group. Also HC (AKI: 1.00; 0.00 – 1.00; No AKI: 0.00; -1.25 – 1.00; p&gt;0.05) tended to be higher in AKI on Δd1, whereas SE, EC and LC did not show any trend between both groups. Δd5 did not show any significant result between AKI and non-AKI. Because all of these patients were catheterised, the results on urinary erythrocyte count were interpreted with appropriate caution.

Conclusion
This is the first study evaluating sequential urine sediment measurements for early detection of AKI in cardiac surgery. According to these preliminary data, Δd1 of RTEC, GC and US is significant higher in AKI, suggesting that an increase from day of surgery to day 1 may be indicative for the development of AKI right before manifest AKI is evident. Therefore sequential urine sediment measurements could be useful for early detection of AKI after cardiac surgery.
P0633EFFECT OF DIPEPTIDYL PEPTIDASE-4 INHIBITORS ON CISPLATIN-INDUCED ACUTE NEPHROTOXICITY IN CANCER PATIENTS WITH DIABETES MELLITUS: A RETROSPECTIVE STUDY
Authors: Iwakura Takamasa , Fukasawa Hirotaka , Kitamura Atsushi , Ishibuchi Kento , Yasuda Hideo , Fujigaki Yoshihide , Furuya Ryuichi 
Published: June 2020

Abstract

Background and Aims
Cisplatin is a highly effective chemotherapeutic agent. However, acute kidney injury (AKI) limits its subsequent use, resulting in poor cancer prognosis. Dipeptidyl peptidase-4 (DPP-4) inhibitors have been reported to attenuate cisplatin-induced AKI in animal models, but the effect in human patients remains to be clarified. We hypothesized that DPP-4 inhibitors can prevent cisplatin-induced AKI in diabetic-cancer patients.

Method
We retrospectively reviewed all consecutive cancer patients who were treated with a first cycle of cisplatin-containing regimen between January 2011 and October 2019. We analysed data of diabetic-cancer patients treated with high-dose cisplatin (&gt; 50 mg/m2)-containing regimens. The change of estimated glomerular filtration rate (eGFR) within 2 weeks after cisplatin treatment was compared between the patients treated with DPP-4 inhibitors and those treated without DPP-4 inhibitors.

Results
A total of 455 patients were treated with cisplatin during the period. Of these, 35 patients were eligible for the analysis. The change of eGFR was significantly less in the patients treated with DPP-4 inhibitors, compared to those without DPP-4 inhibitors [Fig.1; the percentages of eGFR decline (mean ± SD) was 23.6 ± 20.3% vs 41.2 ± 20.6%, respectively; P=0.016]. Furthermore, the incidence of AKI was significantly less in the patients treated with DPP-4 inhibitors (25% vs 60%, respectively; P=0.040).

Conclusion
DPP-4 inhibitors may decrease the risk of cisplatin-induced AKI in diabetic patients. Therefore, the use of DPP-4 inhibitors may be one of supportive therapies for cancer patients treated with high-dose cisplatin.