bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO026CLINICAL AND MUTATIONAL SPECTRUM OF CHILDREN WITH AUTOSOMAL RECESSIVE AND AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE
Authors: Tutal Ozum , Gulhan Bora , Atayar Emine , Yuksel Selcuk , Ozcakar Z Birsin , Soylemezoglu Oguz , Saygili Seha , Inozu Mihriban , Baskin Esra , Duzova Ali , Hayran Mutlu , Topaloglu Rezan , Ozaltin Fatih 
Published: May 2021

Abstract

Background and Aims
Cystic kidney diseases are a heterogeneous group of chronic renal disease. Autosomal recessive polycystic kidney disease (ARPKD) is generally diagnosed in utero or at birth due to mutations in PKHD1 gene. Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disease commonly associated with mutations in PKD1 or PKD2. In this study, we aimed to investigate clinical and genetic features of ARPKD and ADPKD in a group of Turkish patients.

Method
A total of 69 children with genetically confirmed ARPKD (10 females, 11 males) or ADPKD (28 females, 20 males) from seven pediatric nephrology centers were included in this study. Demographic features, family history, clinical and laboratory findings at presentation and during 12 months intervals were collected.

Results
For ARPKD patients, the median age at diagnosis was 10.5 (IQR; 0.75-58.5) months. Consanguinity between parents was present in 11 patients (52.4%). At the time of diagnosis, 14 (66.7%) patients had eGFR&lt;90 ml/min/1.73 m2. Mean duration of follow-up was 4.1±3,7 years. At the last visit, median eGFR was 74 (IQR; 43-126) ml/min/1.73m2. A total of 6 patients (28,6%) underwent a renal replacement therapy (RRT), 3 of them died in infancy and 2 of them had renal transplantation during follow up. All patients had bi-allelic PKHD1 mutation.
For ADPKD patients, the mean age at diagnosis was 5.5±4.6 years. At the time of diagnosis 11 (22.9%) patients had eGFR&lt;90 ml/min/1.73m2. Mean duration of follow-up was 2,7±2.3 years. At the last visit, median eGFR was 114 (IQR; 98-135) ml/min/1.73m2. Only one patient underwent a renal transplantation. A total of 42 patients (87.5%) had a heterozygous PKD1 mutation while 6 (12.5%) had a heterozygous PKD2 mutation. The rate of growth retardation, hypertension at diagnosis and progression to chronic kidney disease (CKD) were higher in patients with PKHD1 mutation than the patients with PKD1 or PKD2 mutation (p &lt; 0.001, p &lt; 0.001 and p = 0.001, respectively). In kidney survival analysis, mutation type, growth retardation at presentation, increased renal echogenity in ultrasonography were found as independent risk factors for progression to CKD.

Conclusion
Cystic kidney diseases are one of the most clinically and genetically heterogenous diseases. Differentiating them and establishing the predictors for CKD development is important to provide appropriate management including choosing appropriate donor in renal transplantation.
MO347CENTER VARIATION IN LENGTH OF STAY FOR PATIENTS WITH HOSPITAL-ACQUIRED ACUTE KIDNEY INJURY IN ENGLAND*
Authors: Peracha Javeria , Pitcher David , Santhakumaran Shalini , Day Jamie , Steenkamp Margaretha , Medcalf James , Lipkin Graham , McKane William 
Published: May 2021

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

Results
We included 1255 patients with a mean age of 75±13 years, of which 692 (55%) were men. At baseline, 944 (75%) patients presented with hypertension, 379 (30%) with diabetes, 560 (44%) with hypercholesterolemia and 543 (43%) with CKD. Mean baseline creatinine was 1,3±1,8 mg/dl (glomerular filtration rate [eGFR] estimated by CKD-EPI was 55±25 ml/min/1,73m2). The peak level of creatinine reached during AKI was 2,47±1,97 mg/dl (eGFR 30±18 ml/min/1,73m2). At discharge, creatinine was 1,62 mg/dL and eGFR 53±27 ml/min/1,73m2. Seven hundred and seventy-three (62%) patients presented an eGFR inferior to 60 ml/min/1,73m2.
During follow-up, 681(54%) patients presented an infectious event. Urinary tract infection was the most frequent infection (286 patients, 23%) followed by respiratory infection (214 patients, 17%). Factors associated with infection were age (p&lt;0,001), hypertension (p=0,03), atrial fibrillation (p=0,014), functional dependence measured by Barthel index (p=0,03), previous diagnosis of CKD (p=0,01), baseline eGFR (p&gt;0,001) and eGFR at discharge (p=0,002). Survival analysis using Kaplan-Meier demonstrated an existing association between eGFR inferior to 60 ml/min/1,73m2 and infections (LogRank 12,2, p&lt;0,001, figure 1).

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

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

Abstract

Background and Aims
Monotherapy immunotherapy with “check-point inhibitors” (anti PD-1, Anti PD-L1) is an effective therapy to advanced-stage cancer patients. Little is known about our experience and its renal implication, although it is related to fluid and electrolyte disorders or acute kidney failure (AKI).
To evaluate changes in natremia or acute renal impairment (primary endpoints) in IV stage cancer patients with lung, bladder or melanoma neoplasm who have received monotherapy with pembrolizumab (PEM), atezolizumab (ATZ) or nivolumab (NIV). At the same time, analyze if there are differences between drug administered, underlying disease or having received cisplatin previously (secondary outcomes).

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

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

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

Abstract

Background and Aims
In recent years, up to five classification systems have appeared according to the severity of acute kidney injury (AKI), some based on relative increases in creatinine (RIFLE, AKIN, KDIGO) and others in absolute increases: the kinetic method of creatinine (KC) and delta creatinine (DC) method. It is discussed in the literature which methodology offers better diagnostic performance.
The aim of this study was to analyze the concordance using the Kappa index of the 5 classification systems in a cohort of patients with community-acquired AKI (CA-AKI) treated in the Nephrology Service of a tertiary hospital.

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

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

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

Abstract

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

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

Results
Among the 1255 included patients, 676 (54%) had a registered echocardiogram in the six months before the AKI episode. Of them, 231 patients (38%) had left ventricle hypertrophy (LVH), 178 (30%) pulmonary hypertension (PHT), 178 (30%) diastolic dysfunction and 138 (21%) systolic dysfunction. After discharge (and prior to post-AKI CVE), 248 (20%) patients had a new echocardiogram that revealed LVH in 108 patients (45%), diastolic dysfunction in 96 (42%), PHT in 68 (32%) and systolic dysfunction in 47 (19%).
During follow-up, 484 (39%) patients had CVE. The presence of diastolic dysfunction, systolic dysfunction, PHT and LVH in any moment were associated factors to the incidence of CVE. An adjusted multivariate model showed that systolic dysfunction (hazard ratio [HR] 1.44, 95% confidence interval [95%CI] 1.073-1.943, p=0.015), age (HR 1.018, 95%CI 1.003-1.030, p=0.02), diabetes mellitus (HR 1.373, 95%CI 1.041-1.811, p=0.025), atrial fibrillation (HR 1.397, 95%CI 1.055-1.851, p=0.020) and diuretic intake (HR 1.580, 95%CI 1.171-2.131, p=0.003) were independent predictors of post-AKI CVE.

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

Abstract

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

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

Results
Ninety-six cases of PRAKI were listed. The rate of AKI during pregnancy-related hospitalizations was 16% .the average age was 31 ± 5 years.
Most women were from urban areas (62%) but with insufficient prenatal care (57%).Seventy-eight percent underwent cesarean section delivery.
PRAKI occurred in the postpartum in 79%of the cases. Oligo-anuria was the most common clinical feature of PRAKI, noted in 82% of our patients.
The leading etiological causes were pre eclampsia, eclampsia, postpartum haemorrhage and sepsis respectively, in 49%, 38%, and 24% of the cases.
Hemodialysis was required in 23% of cases. In the adjusted regression analysis, factors associated with dialysis were insufficient prenatal care (p=0,010 ; O Ra=24,113), HELLP syndrome (p=0,003 ; ORa=35,129), disseminated intravascular coagulation (p=0,007 ; OR=11,854), average duration of oliguria (p=0,001; ORa=3,025) , Failure stage of RIFLE criteria while admitted (p=0,009; ORa=2,09) and length of ICU stay (p=0,042 ; ORa=1,118).
Renal outcome was favorable, with a complete renal function recovery for 72 patients (75%). Only four patients (4%) developed chronic renal failure. Mortality rate was 13%.

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

Abstract

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

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

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

Conclusion
The prevalence of AKI in patients bitten by hematotoxin snakes was 12.6%, mostly from Russell’s viper. Factors associated with AKI outcomes were time to hospital arrival more than 3 hours, Russell’s viper bitten, clinical bleeding, and prolonged PT. Besides, one-fourth of AKI patients turned to chronic kidney disease.