bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO393ACUTE RENAL REPLACEMENT THERAPY IN CRITICAL ILL OCTOGENARIAN OR OLDER PATIENTS: PROGNOSTIC FACTORS AND RENAL OUTCOMES
Authors: Del Risco Jimena , Casals Joaquim , Hermida-Lama Evelyn , Quintana Luis F , Blasco Miquel , Piñeiro Gaston , Poch Esteban , Molina Andujar Ali­cia 
Published: May 2021

Abstract

Background and Aims
a growing number of octogenarians or older patients are being admitted to the intensive care unit (ICU). The aim of this study was to assess factors associated with acute renal replacement therapy (ARRT) requirement in these patients and the impact of ARRT on the 90-day ICU mortality. Also we aimed to identify prognostic factors associated with mortality risk in the group of patients that required ARRT.

Method
retrospective study of octogenarian or older patients admitted to the ICUs of Hospital Clínic de Barcelona from June 2007 to April 2019. Patients on chronic dialysis treatment or kidney transplant, and patients with limitation of therapeutic support or admitted for less than 48 hours were excluded.

Results
217 patients were included in the study, of which 36.4% required ARRT. Use of vasoactive drugs and Sequential Organ Failure Assessment (SOFA) score on admission were higher in ARRT patients (p=0.009 and &lt;0.001). Basal estimated glomerular filtration rate (eGFR) was lower in the ARRT cohort (p&lt;0.001). Hospital and ICU length of stay were longer in the ARRT cohort (p&lt;0.001). Ninety-day mortality was 58.2% in the ARRT cohort and 55.8% in the control cohort, without statistical differences. In the survival analysis, only female sex and non-renal SOFA ≥6.5 were significantly associated with mortality (p= 0.005 and 0.002 respectively) in the ARRT cohort.

Conclusion
mortality was not significatively increased in the octogenarian population that required and got ARRT respect to those who did not require it. Scores like SOFA can help in the process of decision making about initiation of ARRT.
MO394TWO POINT ESTIMATE OF KINETIC GFR IN ACUTE KIDNEY DISEASE
Authors: Keller Frieder 
Published: May 2021

Abstract

Background and Aims
When anuria suddenly occurs, the rise in creatinine and consequently the decrease in the estimated glomerular filtration rate (eGFR) will always be delayed. Thus, the drug dose could be selected too high in the progressive phase whereas it could be adjusted too low in the restitution phase of acute kidney disease (AKD). Sheldon Chen proposed a solution for changing kidney function with the kinetic GFR (KeGFR). A simplified but also more general solution (kinetGFR) might even facilitate the automatic implementation into lab systems.

Method
Deterioration of kidney function is diagnosed when the creatinine increases within a definite time interval (Δ t) and the estimated eGFR declines (Δ eGFR). The new 2-point estimate of the kinetGFR can be derived when the prospective eGFRt+24 predicted for the next day (t+24) will be set equal to the present true GFR at critical day (t2). kinetGFR=eGFR2−eGFR1−eGFR2t2−t1⋅t+24 h
The 24 h delay follows from anuria, the most extreme and most relevant case (GFR = 0). A zero GFR will be associated with a linear rise in creatinine according to the constant production rate by roughly 100 µmol/l every day. This rise leads to the corresponding bisection of the estimated eGFR nearly every day (100 =&gt; 50 =&gt; 25 =&gt; 13 =&gt; … ml/min). The curvilinear eGFR decline will never become zero even after &gt; 2 weeks. The new kinetGFR can identify a complete anuria already after one day (24 h). kinetGFR=50−100−5024−0⋅24=0.0 ml/min
This is already at the critical day (t2).

Results
The retrospective look at the anonymized data from 20 patients with AKD allowed for comparing the former KeGFR with the new two-point kinetGFR estimate. For worsening kidney function, the average eGFR2 was 18 ml/min (+ 12) and the KeGFR estimate was not different with 19 ml/min (+ 17). The new 2-point kinetGFR, however, was 13 ml/min (+ 11) and 28 % less than eGFR2 at the critical day (t2). For improving kidney function, the eGFR2 was 15 ml/min (+ 4) and the KeGFR was already much higher at 27 ml/min (+ 3). The new 2-point estimate of the kinetGFR was in between at 21 ml/min (+ 7).

Conclusion
In AKD, the difference between eGFR and presumably true GFR was the higher the more rapidly kidney function declined. The new kinetGFR estimate appears clinically more plausible than the former KeGFR estimates.
MO397THE IMPACT OF NEW-ONSET ATRIAL FIBRILLATION ON ADVERSE OUTCOMES IN PATIENTS WITH SEPSIS-INDUCED ACUTE KIDNEY INJURY
Authors: Dimitrijevic Zorica , Mitic Branka , Salinger Sonja , Paunovic Goran , Glogovac Stevan , Tasic Danijela 
Published: May 2021

Abstract

Background and Aims
The mortality of septic patients with acute kidney injury (s-AKI) prevails high. Atrial fibrillation is commonly observed in the setting of systemic inflammation or infection. The study aimed to assess the incidence and predictors of new-onset atrial fibrillation (NOAF) in this population and its impact on intrahospital mortality.

Method
We conducted a retrospective cohort study of 462 patients admitted to our unit for s-AKI between January 2016 and December 2020. NOAF was defined as AF discovered during hospitalization in patients with sinus rhythm on admission. Subjects were classified into NOAF (n=68) and non-NOAF groups (n=364). There were no major differences in sepsis severity between groups, and all patients underwent intermittent hemodialysis as a renal replacement treatment modality.

Results
The NOAF incidence in the whole s-AKI population was 14.7%. In a univariate analysis, age (72.4 in patients with NOAF vs. 62.1 years in patients without NOAF, respectively; p=0.018), male gender (33.5 vs. 14.6%; p= 0.004), history of coronary disease (23.5 vs. 6.1%; p=0.07) and vasopressor medication use (19.0 vs. 8.2%; p = 0.002) were associated with NOAF. 116 (25.1%) patients died during the hospitalization, while 346 patients (74.9%) were discharged from the hospital. NOAF occurring in s-AKI was independently associated with an increased hazard of intrahospital death (HR: 1.36; 95% CI: 1.09–1.51), compared to the non-NOAF group.

Conclusion
A clinically significant number of patients hospitalized for s-AKI have NOAF, and it is associated with poor hospital outcomes.
MO398DETERIORATION OF RENAL OUTCOMES AND INCREASED MORTALITY RISK DUE TO ACUTE KIDNEY INJURY AFTER ORTHOTOPIC LIVER TRANSPLANTATION: SYSTEMATIC REVIEW AND META-ANALYSIS OF COHORT STUDIES
Authors: Putra Boby Pratama , Putra Felix Nugraha 
Published: May 2021

Abstract

Background and Aims
Orthotopic liver transplantation (OLT) procedure is increased as incremental end-stage liver disease patients’ prevalence. Acute kidney injury (AKI) is one of most common post-OLT complications that is associated with poor renal outcomes and increased mortality risk although the results are still inconclusive. This study aims to measure the risk of deterioration of renal outcomes and mortality risk due to AKI incidence in post-OLT patients.

Method
We did comprehensive searching using predefined terms in online databases of Pubmed, EMBASE, ScienceDirect, and The Cochrane Library, to include all relevant studies from 2000-2020. We included all cohort studies that reported AKI incidence in post-OLT patients and accessed the risk of 3-month renal replacement therapy (RRT) need, 1-year chronic kidney disease (CKD) progression, and 1-year mortality rate. We used The Newcastle-Ottawa Scale for cohort study for accessing bias risk. We conducted analysis to pooled risk ratio (RR) with 95% confidence interval (CI) using random-effect heterogeneity test.

Results
We included 10 cohort studies met our inclusion criteria. The AKI incidence significantly both increases the need of RRT in post-OLT patients (pooled RR = 8.41. 95% CI = 2.82 to 25.09, p = 0.0001, I2 = 0%) then leads the CKD progression in one year (pooled RR = 6.76. 95% CI = 2.03 to 22.51, p = 0.002, I2 = 84%). The post-OLT patients who suffered from AKI has significant incremental 1-year mortality risk (pooled RR = 7.27. 95% CI = 4.34 to 12.18, p&lt;0.00001, I2 = 5%).

Conclusion
The incidence of AKI in post-OLT patients significantly increase the deterioration of renal outcomes and mortality risks. However, further trials are needed to establish the causalities.
MO399PROFILE OF ACUTE KIDNEY INJURY IN CRITICAL CARE PATIENTS
Authors: J Jayannan , Keeppallil Kevin T John , Abraham Georgi 
Published: May 2021

Abstract

Background and Aims
Acute kidney injury is a global health problem. This study aims to determine the risk factors for poor outcome and to describe the clinical profile, etiology & outcomes of patients with Acute Kidney Injury (AKI) admitted to the Critical Care Unit from a tertiary care centre in South India.

Method
It was a prospective cohort study conducted in a tertiary care hospital in South India from December 2016 to Novemeber 2019. All patients in the ICU were screened for enrolment in AKI using RIFLE criteria with creatinine, GFR and urine output daily for a period of seven days.

Results
A total of 152 patients were taken for final analysis after exclusions. The mean age of the subjects was 44.15 years. Majority of the study subjects (55.9%) belonged to 26 – 50 years of age. Majority of the study subjects were females (51.3%) and the rest were males. Sepsis was found to be present in 52% (79) of the study subjects followed by Gastrointestinal loss 36.2% (55), crush injury 9.03% (15), snake bite 3.3% (5), poisoning 4.6% (7) and acute liver failure 1.3% (2). It was found that 62.5% (95) of the study subject’s AKI had resolved after appropriate management. Among the rest of the study subjects,27.6% required haemodialysis for recovery, 3.3% had persistence of AKI, 3.9% progressed to CKD and 2.6% died. The latter three categories were considered as poor outcomes of AKI. In our study, 29.8%people who had systemic hypertension and 28.2%people who had diabetes mellitus had poor outcome. It was found that in our study, sepsis and GI loss both contributes to poor outcome of AKI in univariate regression analysis whereas Gastrointestinal loss alone contributes to poor outcome of AKI with multivariate regression analysis.

Conclusion
In conclusion, even though sepsis is the commonest cause of AKI, Gastrointestinal loss independently contributes to poor outcome of AKI. Majority of the people recovered from AKI spontaneously with conservative management. Few people required dialysis for recovery of AKI & very few people progressed to CKD.
MO400HISTOPATHOLOGICAL SPECTRUM OF SNAKE- BITE INDUCED KIDNEY INJURY IN INDIA: A SYSTEMATIC REVIEW
Authors: Meena Priti , Bhargava Vinant , Bhaumik Soumyadeep 
Published: May 2021

Abstract

Background and Aims
Snakebite is a public health problem leading to about 55,000 deaths every year in India. Kidney injury subsequent to snakebite envenomation is common ( reported prevalence up to 32%). It is estimated that 3% of total acute kidney injury (AKI) is attributable to snakebites. The current study aims to elucidate the spectrum of renal histopathology in AKI cases followed by snake bite.

Method
We searched seven electronic database studies to identify studies describing the histopathological findings in the kidney associated with snakebite envenomation from India. Two reviewers independently conducted titles and abstract screening as well as full-text evaluation for final inclusion decision. Data were extracted as per a standardized form and conducted narrative synthesis.

Results
We retrieved 1364 studies and finally included 21 studies involving 961 patients who met the eligibility criteria. Provisional results are presented. Patient ages ranged from 2.5 years to 80 years. Viper bite was the commonest cause related to AKI. 92 % of the AKI were oliguric and required dialysis. kidney biopsy was usually done after 3 weeks of AKI onset. Acute tubular necrosis (ATN) was the most common finding followed by acute interstitial nephritis, acute cortical necrosis, and thrombotic microangiopathy (TMA).Vasculitic changes in vessels were rarely reported.

Conclusion
Oligo-anuric presentation and prolonged kidney dysfunction were frequent in post snake bite AKI. ATN was the common histological finding
MO403ACUTE KIDNEY INJURY IN ELDERLY: EPIDEMIOLOGICAL, CLINICAL AND ETIOLOGICAL FEATURES
Authors: Malki abidi Mouna , Aoudia Rajaa , Chargui Soumaya , Gorsane Imen , Jerbi Mouna , Gaied Hanen , Ben abdallah Taieb , Goucha Rym , Ben hamida Fethi 
Published: May 2021

Abstract

Background and Aims
Acute kidney injury (AKI) is common in the elderly due to physiologic renal aging and underlying pathologies. Few studies focused on AKI in Tunisian elderly. The aim of our study was to highlight the epidemiological, clinical, etiological, therapeutic, and progressive characteristics of AKI in elderly.

Method
We conducted a descriptive retrospective study of AKI in patients admitted to our department over a period of 04 years from 01/01/2014 to 31/12/2017.

Results
We collected 40 patients including 25 women and 15 men with a sex ratio of 1.66. The mean age was 74 [65-87] years. We noted the presence of pre-existing chronic kidney disease in 58% of cases, diabetes in 50% of cases and hypertension in 73% of cases. Polypharmacy was found in 40% of cases. AKI was symptomatic in 80% of cases and found on a routine check-up in 20% of cases. Mean creatinine was 612+/-334 µmol/l.
AKI was pre-renal in 37% and parenchymal in 63% of cases. Iatrogenic origin was found in 33% of cases. Renal biopsy was performed for diagnostic purposes in 6 cases. Haemodialysis was necessary in 50% of cases. Etiopathogenic treatment was initiated in 73% of cases. Intra-hospital mortality was 10%, recovery of renal function (RF) was partial in 40 % of cases and total in 20 % of cases. Follow-up time was 16 +/- 23.2 months. And at the last news, recovery of renal function (RF) was partial in 7 cases and total in 10 cases, 6 patients kept a chronic renal failure (CRF), among them 3 cases had and end-stage of CRF.

Conclusion
AKI is a frequent pathology in the elderly and its severity is linked to mortality and the transition to chronicity. Iatrogenic causes are frequent and preventable in this population, hence the major interest of prevention.
MO404ACUTE KIDNEY INJURY DUE TO IMMUNE CHECKPOINT INHIBITORS (CPIS) NEPHROTOXICITY
Authors: Catapano Fausta , Persici Elisa , Ubaldi Giulia , Romani Francesca , Mancini Elena 
Published: May 2021

Abstract

Background and Aims
The approved therapeutic indication for immune checkpoint inhibitors (CPIs) are rapidly expanding; however the immune-related toxicities associated with CPIs can limit its efficacy.

Case Report.
A 52 year-old female diagnosed with left ocular melanoma and treated for 14 months with nivolumab developed non-oliguric, stage 3 (KDIGO), Acute Kidney Injury (AKI) and mixed proteinuria (0.6 g/day), then was transferred in our Unit. As known causes of AKI were excluded, kidney biopsy was performed. By Optical Microscopy, there were 33 normal glomeruli; arteries and arterioles were normal. The main damage was interstitial and characterized by tubulitis, tubular necrosis, non-isometric citoplasmatic vacuolization and diffuse, acute and chronic, CD4+,
inflammatory infiltrate (Figure 1, 2). By Immunofluorescence, 27 glomeruli were negative for all eight tested antibodies (IgA, IgM, IgG, F, C3, C1q, kappa and lambda light chains). On the basis of these histological findings, Nivolumab-induced Acute Tubulo-Interstitial Nephritis was diagnosed. Nivolumab was discontinuated. Patient was treated by steroids and she achieved almost complete renal function recovery (Figure 3).

Conclusions.
CPIs can induce a long-term Acute Kidney Injury. Histological features are characterized by Acute Tubulo-Interstitial Nephritis. Steroids can improve renal outcome. In patients treated with CPIs a multidisciplinary management between oncologists and nephrologists is desirable for monitoring renal function at basal, after drug administration and in the long-term follow-up.
MO352RENAL DYSFUNCTION AS A MAJOR PREDICTOR OF CLINICAL OUTCOMES IN ANTERIOR STEMI PATIENTS
Authors: Sens Florence , Amaz Camille , Juillard Laurent , Ovize Michel , Guebre-Egziabher Fitsum 
Published: May 2021

Abstract

Background and Aims
Among ST-segment elevation myocardial infarction (STEMI) patients, the respective impact of the baseline renal function, of the development of acute kidney injury (AKI), and of their combination, on the long-term cardiovascular outcomes, remain unclear.

Method
The present study was based on a post hoc analysis of the CIRCUS trial database, a multicentre randomized study which gathered 969 patients with anterior STEMI treated by primary percutaneous intervention (PPCI) within 12 hours of symptoms onset. Uni and multivariate regressions were performed to identify if the estimated glomerular filtration rate (eGFR) at admission and the development of AKI were associated with (1) cardiovascular death and heart failure (HF) at one year and (2) sub-optimal treatment prescription at discharge.

Results
A total of 822 patients were included. The mean baseline eGFR was 86 ± 19 mL/min/1.73m2. AKI occurred in 97 patients (11.8%). Baseline eGFR &lt;60mL/min/1.73m2 was associated with HF (40.0 vs 16.8%, p&lt;0.001) and with a sub-optimal treatment at discharge (35.9 vs 18.9%, p=0.001). AKI was associated with cardiovascular death (12.4 vs 2.8%, p&lt;0.001), HF (50.5 vs 14.9%, p&lt;0.001), and sub-optimal treatment (35.8 vs 18.5%, p&lt;0.001). The multivariate analysis showed that AKI (OR=4.88, CI=2.89-8.27) and a lower baseline eGFR (OR=1.29 per 10mL/min/1.73m2 decrease, CI=1.11-1.50) are independent predictors of cardiovascular death or HF after anterior STEMI.

Conclusion
In anterior STEMI patients undergoing PPCI, the development of AKI was the strongest independent predictor of poor clinical outcome at one year. The study suggests the need for a tailored monitoring of STEMI patients with AKI or baseline kidney dysfunction.
MO355ACUTE KIDNEY INJURY INCREASES THE RISK FOR SUBSEQUENT HEART FAILURE HOSPITALIZATIONS
Authors: Diebold Matthias , Zimmermann Tobias , Strebel Ivo , Wussler Desiree , Bassetti Stefano , Mueller Christian , Breidthardt Tobias 
Published: May 2021

Abstract

Background and Aims
Acute kidney injury (AKI) is common and associated with increased mortality and morbidity. The impact of AKI on subsequent heart failure remains largely unknown.

Method
The Basics in Acute Shortness of Breath Evaluation Study (BaselV) prospectively enrolled patients presenting the emergency department with acute dyspnea. Two independent specialists adjudicated the final cause of dyspnea. Serum creatinine concentrations were prospectively assessed throughout the hospitalization. AKI was defined according to the serum creatinine criteria of the 2012 KDIGO clinical practice guideline. AKI adjudication occurred blinded to the cause of dyspnea. Mortality and rehospitalizations were prospectively assessed during follow-up (median:768 days [IQR:290-950]. Renal recovery was defined as a discharge creatinine&lt;1.25x baseline creatinine.

Results
AKI occurred in 809 (40%) of 2021 patients and was associated with increased all-cause (adjusted Hazard Ratio [aHR] 1.33, 95%CI 1.13-1.55; p&lt;0.01) and cardiovascular mortality (aHR 1.43, 95%CI 1.16-1.75; p&lt;0.01). However, the impact of AKI on mortality was time-dependent with the highest impact on early 30-day mortality (aHR 2.47, 95%CI 1.62-3.76; p&lt;0.01) (Figure 1A). AKI was not associated with all-cause or cardiovascular mortality in patients achieving renal recovery (p=0.10 and p=0.30). In contrast, AKI displayed a time-independent association with subsequent hospitalisations for heart failure (hHF) (aHR 1.49, 95%CI 1.15-1.94; p&lt;0.01) (Figure 1B). The association with hHF was stronger for higher degrees of AKI (stage 2/3 aHR: 1.89; 95%CI 1.33-2.83; p&lt;0.01). This association with hHF persisted in patients with non-cardiac dyspnea (aHR 2.43, 95%CI 1.05-5.59; p=0.04), even after renal recovery (aHR 2.56, 95%CI 1.00-6.54; p=0.05). Again, in patients with non-cardiac dyspnea the association of advanced AKI (stage 2/3) with hHF was even stronger (aHR 4.25, 95%CI 1.59-11.36; p&lt;0.01).

Conclusion
AKI independently increases the risk of hHF by almost 50%. This association persists in patients with non-cardiac dyspnea, even after renal recovery by discharge. This suggests AKI to be a novel risk-factor for the development of clinically significant HF.
MO420ROLE OF IL-6 ON ACUTE KIDNEY INJURY (AKI) DEVELOPMENT AFTER LIVER TRANSPLANTATION
Authors: Tinti Francesca , Colicchio Martina , Ginanni Corradini Stefano , Mennini Gianluca , Rossi Massimo , Mazzaferro Sandro , Noce Annalisa , Mitterhofer Anna Paola 
Published: May 2021

Abstract

Background and Aims
Acute kidney injury (AKI) post-liver transplantation is a frequent complication with an incidence up to 70%, requiring renal replacement therapy in about 25% of transplant patients. AKI in patients with normal renal function is a recognized risk factor (FR) of chronic renal failure (CKD) de novo, associated with a 4.5 times greater mortality at 5 years post-transplant.
Pathogenesis of AKI is multifactorial. Beyond the classical pre-transplant risk factors, the hypoxia of the graft and the ischemia-reperfusion injury (IRI) have recently been recognized to exert a pathogenetic role with specific mechanisms.
It has been recently demonstrated in experimental setting that ischemic tissues put in place protective mechanisms in response to hypoxia aimed at increasing the release of oxygen with the activation of angiogenesis mediated by the expression of factors induced by hypoxia (HIF)-1-alpha.
HIF1-alfa has been shown to promote cell survival under hypoxic conditions by switching metabolism from oxidative to glycolytic, by affecting the production of ATP to prevent excessive mitochondrial generation of reactive oxygen species, by promoting secondary release of vascular endothelial growth factor (VEGF) and transforming growth factor-beta 1 (TGF-ß1), with following activation of inflammatory cytokines responsible for systemic inflammatory response syndrome (SIRS).
Tumor necrosis factor-α, IL-1 and IL-6 are the most important cytokines released in IRI and seem to play a pivotal role in the onset of AKI in SIRS and sepsis.
The development of AKI after hypoxia/ischemia of the graft, as observed more frequently in the population of recipients from donors after cardiocirculatory death (DCD) compared to donation after brain death (DBD), confirms this pathogenetic mechanism.
Aim of the study is to evaluate AKI occurrence among liver transplanted patients and its relationship with IRI and cytokines systemic release.

Method
Data of 78 patients (62 males, 79.5%) undergone liver transplantation (2007-2011) were retrieved.

Results
The following clinical investigations were performed:
AKI patients demonstrated a progressive increasing of IL-6 after liver transplantation (AKI 34.4-37.8-88.2 ng/ml vs no AKI 30.5-21.6-23.3 ng/ml).

Conclusion
Patients who experienced greater ischaemia-reperfusion injury of the liver graft developed more frequently AKI. Patients with AKI experienced an increased release and circulation of IL-6, that probably is involved in AKI development with interesting implications in future therapy.