bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO377HOW THE ITALIAN COVID-19 LOCKDOWN AFFECTED NEFROLOGICAL ACTIVITY IN A LOMBARD CENTER
Authors: Albrizio Paolo , Costa Silvano , Foschi Annalisa , Milani Ivo Angelo Antonio , Rindi Stefano , Zucchi Manuela , Milanesi Fabio 
Published: May 2021

Abstract

Background and Aims
Italy and Lombard hospitals particularly, were hard affected by Covid-19 pandemic, mostly during spring and autumn, seasons characterized by two lockdown periods which were however, partly different as rules. During first lockdown in fact, by hospital decision, all ambulatorial activity was closed, including nephrological one. This did not happen during second lockdown period. How the different choices about hospital activity affected nephrological patients is the aim of this study.

Method
we evaluated all nephrological advices requested by first aid units of our 3 hospitals, all located in Lombardy, to our Nephrology Unit, splitting out data in 3 periods (I lockdown, summer and II lockdown) and comparing with 2019. Data collected were: number of advices requested by day, age, sex, previous regular nephrological follow-up, Covid-19 diagnosis, nephrological diagnosis after nephrological advice and outcome.

Results
as shown in table 1, during I lockdown period, with hospital decision of suspending our nephrological ambulatorial activity, we suffered an incremented rate of patients approaching local first aid units compared to 2019 same period with an increased rate of acute kidney injury, mostly for dehydration, and with a higher rate of patients requiring hospitalization. All these differences resulted statistically significant vs 2019 same period (figure 1). On the other side, no statically significant difference was found during the other two examined periods, including the II lockdown, while all our ambulatories were fully operating.

Conclusion
Covid-19 pandemic affected also the nephrological population with an increased rate of first aid units’ accesses, acute kidney injury events and hospitalization comparing to 2019. However, these differences were detectable only during the I lockdown period characterized by the suspension of all ambulatorial activity, including our Unit. The absence of statistically significant differences during summer and primarily during II lockdown period demonstrates the importance of nephrological ambulatorial activity in management of renal diseases and in prevention of acute events.
MO383COVID - 19 AND AKUTE KIDNEY INJURY- A SINGLE CENTER EXPERIENCE
Authors: Bulatovic Ana , Bjedov Jelena , Maslarevic Radovic Vesna , Dimkovic Nada , Naumovic Radomir 
Published: May 2021

Abstract

Background and Aims
The new coronavirus disease (COVID 19) has become a worldwide health emergency with a wide spectrum of clinical presentation, from common cold symptoms to multiorgan failure. A great number of medical centers have reported that patients with COVID-19 have developed acute kidney injury. The kidney is a target organ for SARS - COV2 because of ACE2 receptor, the binding site for this virus, is expressed in kidney tissue. The potential mechanisms for kidney injury are direct kidney injury, inflammation, activation of coagulation and complement cascades. Data from centers worldwide reported a wide range of AKI incidence, from 0,5% in China to 46% in USA. The aim of this study was to analyze incidence, risk factors and outcomes of AKI in hospitalized patients with COVID 19 who were treated from 01.04. to 01.06.2020. at Nephrology Department of University Clinical Center Zvezdara, which was at the time transformed into COVID hospital.

Method
This retrospective observational study included 51 patients who had normal kidney function before the infection with SARS COV2, and 7 of them developed dialysis non-dependent AKI. Analysis included data collection from the patients’ history including demographic, clinical and administrative data. Statistical analysis has been performed using SPSS software version 20 (IBM Corporation, New York, USA).

Results
Out of 51 patients 7 (13.7%) developed AKI, mean age was 59 + 16 years and 53% were male. Diabetes mellitus was present in 27 of patients with AKI, hypertension in 6/7, obesity in 3/7, coronary artery disease in 1/7 and 1 of 7 patients was smoker. These risk factors except obesity (p= 0.05) didn’t vary significantly between two groups (AKI and non AKI patients with COVID-19). Our results showed significant correlation between AKI development and obesity (p= 0.05, OR 4.75), Charlston index score (p=0.01), D dimer score (p=0.01), and CT COVID score (p=0.03). Regarding the outcome, COVID 19 patients with AKI showed 7-fold higher risk for fatal outcome (p= 0.046).

Conclusion
Obesity, higher D dimer values, worse CT findings and higher Charlston comorbidity score index were associated with acute kidney injury in patients with COVID 19. AKI proved to be significant risk factor for fatal outcome in patients with SARS COV2 infection.
MO386MASS SCREENING AND THE LOW RATES OF ACUTE KIDNEY INJURY AMONG COVID-19 PATIENTS IN HONG KONG
Authors: Chan Kam Wa , Hung Ivan Fan-Ngai , Tsang Owen Tak-Yin , Wu Tak Chiu , Tso Eugene Yuk-Keung , Lung Kwok Cheung , Lam Chung Man , Chan Gary Chi Wang , Wong Sunny Sze-Ho , Yu Kam Yan , Chan Johnny Wai-Man , Tang Sydney 
Published: May 2021

Abstract

Background and Aims
Renal involvement in COVID-19 under vigilant public health surveillance, including mass screening and early hospitalization is less well-characterized. We assessed renal involvement of COVID-19 patients in Hong Kong, including the association with risk factors, length of hospitalization, critical presentation and mortality.

Method
Linked electronic records of all confirmed patients from 5 major designated hospitals were extracted. Primary outcome was the incidence of in-hospital AKI. Secondary outcomes were AKI-associated mortality, incident RRT, intensive care admission, prolonged hospitalization and disease course (defined as &gt;90th percentile of hospitalization duration and duration from symptom onset to discharge, respectively), and change of eGFR. Patients were further stratified into being symptomatic or asymptomatic.

Results
Patients were characterized by young age (median:38.4, IQR:28.4-55.8 years old) and short time (Median:5, IQR:2-9 days) from symptom onset to admission. Among the 591 patients, 22 (3.72%) developed AKI and 4 (0.68%) required RRT. AKI increased the odds of prolonged hospitalization and disease course by 2.0 and 3.5 folds, respectively. Estimated GFR 24 weeks post-discharge reduced by 7.51 and 1.06 ml/min/1.73m2 versus baseline (at admission) in the AKI and non-AKI groups, respectively. The incidence of AKI was comparable between asymptomatic (4.8%) and symptomatic (3.7%) patients.

Conclusion
The overall rate of AKI among COVID-19 patients in Hong Kong is low, which could be attributable to a vigilant screening program and early hospitalization. Among patients who developed in-hospital AKI, the duration of hospitalization is prolonged and kidney function impairment can persist for up to 6 months post-discharge. Mass surveillance for COVID-19 is warranted in identifying asymptomatic subjects for earlier AKI management.
MO388DEVELOPMENT OF ACUTE KIDNEY INJURY DURING A RHABDOMYOLYSIS EPISODE: DIFFERENCES IN LONG-TERM KIDNEY FUNCTION
Authors: Núñez Delgado Sara , Iriarte-Abril Miren , Farrera-Núñez Júlia , Pascual-Sánchez Sergi , Sans-Atxer Laia , Sierra-Ochoa Adriana , Barrios-Barrera Clara , Arenas-Jiménez M Dolores , Pascual Julio , Rodríguez García Eva 
Published: May 2021

Abstract

Background and Aims
Acute renal failure (AKI) associated to rhabdomyolysis conditions a worse prognosis in short-term, its implication in the long-term renal function has been less evaluated.

Method
Retrospective analysis of patients diagnosed with rhabdomyolysis defined by creatinine kinase &gt; 5000 IU/L between 2015-2019. Basal and 12-month renal function was evaluated. AKI was classified as either non-severe (AKI-KDIGO 1/2) or severe (AKI-KDIGO 3).

Results
Eighty-seven patients were included, 25 (28.74%) had some degree of chronic kidney disease (CKD) on admission. 56 (64.37%) had AKI on admission, 17 of which were severe (6 required hemodialysis). The patients with AKI had more cardiovascular disease (CVD) and worse analytical parameters on admission (table). Patients with severe AKI showed no difference in CVD from those with non-severe AKI but were younger and had more hyperkalemia. There were no significant differences between patients with severe AKI who required hemodialysis and those who did not. Inpatient mortality was 8%, higher in patients with AKI but without differences according to severity.
In 45 patients kidney function was available 12 months after the episode, loss of eGF was -4.90 ± 14.35 ml/min-1.73m2 (p=0.007). There was no difference between patients who developed AKI and those who did not (-4.10 ± 14.4 vs. -5.39 ± 14.57 ml/min-1.73m2; p=0.67), nor between non-severe and severe AKI (-5.50 ± 14.76 vs. -5.12 ± 15.08ml/min-1.73m2; p=0.98). Of the 33 patients without previous CKD, 5 developed CKD, with greater decrease in eGF than those who did not (-22.69 ± 6.04 vs. -2.63 ± 13.92 ml/min-1.73m2; p=0.003). Female sex (60% vs. 12%; p=0.031) and previous basal eGF (72.22 ± 4.37 vs. 95.6±19.97 ml/min-1.72m2; p=0.016) were related to this deterioration.

Conclusion
After an episode of rhabdomyolysis, the loss of eGF is similar in patients who develop AKI compared to those who do not.
MO390THE RISK FACTORS AND CLINICAL OUTCOMES ASSOCIATED WITH ACUTE KIDNEY INJURY IN PATIENTS WITH COVID-19
Authors: Rahimzadeh Eshkalak Hormat , Farrokhpour Hossein , Kazemian Sina , Rahbar Maryam , Montazeri Mahnaz , Kafan Samira , Salimzadeh Ahmad , Talebpour Mohammad , Majidi Fazeleh , Gannatalipour Atefeh , Razeghi Effat 
Published: May 2021

Abstract

Background and Aims
Kidney involvement, ranging from mild hematuria and proteinuria to acute kidney injury (AKI) in patients with coronavirus disease-2019 (COVID-19), is a recent finding with various incidence rates reported among hospitalized patients with COVID-19. Current evidence on AKI rate in patients hospitalized with COVID-19 and its associated risk factors is limited, especially in Iran.

Method
In this retrospective cohort study, we enrolled adult patients referred to the Sina hospital, Iran, from 20 February to 14 May 2020, with either a positive PCR test or a highly susceptible chest computed tomography features (CT) consistent with COVID-19 diagnosis. AKI was defined according to the kidney disease improving global outcomes (KDIGO) criteria, and patients were stratified based on their AKI staging. We evaluated the risk indicators associated with AKI during hospitalization besides in-hospital outcomes and recovery rate at the time of discharge.

Results:
We evaluated 516 patients with a mean age of 57.6±16.1 years and a male to female ratio of 1.69 who were admitted with the COVID-19 diagnosis. AKI development was observed among 194 (37.6%) patients, comprised of 61.9% patients in stage 1, 18.0% in stage 2, and 20.1% in stage 3. Out of all patients, AKI occurred in 58 (11.2%) patients during the hospital course, and 136 (26.3%) patients arrived with AKI upon admission. AKI development was positively associated with all of the in-hospital outcomes, including intensive care unit admissions, need for invasive ventilation, acute respiratory distress syndrome (ARDS), acute cardiac injury, acute liver injury, multi-organ damage, and mortality. Patients with stage 3 AKI showed a significantly higher mortality rate, ARDS, and need for invasive ventilation than other stages. After multivariable analysis, male sex (odds ratio (OR):11.27), chronic kidney disease (OR: 6.89), history of hypertension (OR:1.69), disease severity (OR; 2.27), and high urea levels (OR: 1.04) on admission were independent risk indicators of AKI development. Among 117 (28.1%) patients who experienced AKI and survived, only 33 (28.2%) patients made a recovery from the AKI, and 84 (71.8%) patients did not exhibit full recovery at the time of discharge.

Conclusion
We found that male sex, history of chronic kidney disease, hypertension, disease severity, and high serum urea were independent risk factors associated with AKI in patients with COVID-19. Also, higher stages of AKI were associated with increased risk of mortality and in-hospital complications. Our results indicate a necessity for more precise care and monitoring for AKI during hospitalization in patients with COVID-19, and lack of AKI recovery at the time of discharge is a common complication in such patients.
MO391RISK FACTORS OF ACUTE KIDNEY INJURY IN SEVERE ACUTE RESPIRATORY ILLNESS DURING CORONAVIRUS DISEASE 2019 PANDEMIC
Authors: Gan Wee Leng , Kong Boon Huei 
Published: May 2021

Abstract

Background and Aims
Acute Kidney Injury (AKI) is associated with poor outcome in severe acute respiratory illness (SARI) during Coronavirus Disease 2019 (COVID 19) pandemic. This study aim at detetction of risk factors for AKI among patients admitted for SARI at our Center for COVID 19 screening.

Method
Restrospective study by reviewing admission notes from March 2020 until December 2020 at our district center. Patient aged more than 18 year old who admitted for SARI as defined by World Health Organisation and AKI as defined by Kidney Disease Improving Global Outcome (KDIGO) guideline were included. Chronic kidney disease and End stage Renal Failure as defined by KDIGO were excluded.

Results
A total 230 ( 56%) patients out of 410 patients with SARI had AKI during hospitalisation. The mean age was 72 years old (SD 13.8), 130 (56.5%) were male and 100 ( 43.5%) were female. SARI patients with AKI took mean 5 days ( SD 0.9) to be admitted at our center from the first day of illness. The mean body mass index (BMI) was 27.2 kg/m2 . The mean arterial pressure was 52.1 ( SD 3.7) mmhg upon admission. The mean neutrophils lymphocytes ratio ( NLR ) was 22.4 (SD 2.4). The independant Risk factors for AKI in SARI are Male gender ( OR 0.95; 95% CI 0.35-2.6), smoking ( OR 0.72 ;95% CI 0.23- 2.3), ischaemic heart disease (OR 0.48; 95% CI 0.06-3.8), diabetes mellitus ( OR 1.15; 95% CI 0.39-3.38) and hypertension ( OR 1.58; 95% CI 0.58-4.25).

Conclusion
Non modifiable risk factors for AKI in SARI include male gender and advance age. The modifiable risk factors for AKI in SARI are over weight, smoking, ischemic heart disease, diabetes mellitus and hypertension. NLR play a role in predicting AKI among SARI patients. Delay hospitalisation and hypoperfusion predispose to AKI in SARI. Early recognition of risk factors is crucial in preventing deterioration of kidney function in SARI patients during the inital screening for COVID 19 infection.
MO392ACUTE KIDNEY INJURY IN HOSPITALIZED PATIENTS WITH COVID-19: A SINGLE-CENTER EXPERIENCE
Authors: Akagun Tulin , Ayraler Arzu , Usta Murat , Baylan Süleyman , Dulger Ahmet Cumhur 
Published: May 2021

Abstract

Background and Aims
Preliminary reports indicate that AKI (acute kidney injury) seem to be associated with coronavirus disease 2019 (COVID-19) severity and outcomes. Although the reported incidence of AKI among hospitalized patients with COVID-19 varies widely, AKI among hospitalized patients is associated with poor prognosis. The aim of this study was to evaluate the clinical characteristics and outcomes in our COVID-19 patients who developed AKI during intensive care unit hospitalization.

Method
In our retrospective, observational study COVID-19 PCR positive 49 patients who were hospitalized with COVID-19 pnumoniae in intensive care unit and developed AKI were evaluated with demographics, laboratory data, treatment and outcome. The prognostic nutritional index (PNI), which is calculated using the serum albumin concentration and total lymphocytic count were also evaluated. All patients were treated with favipiravir+low molecular weight heparin; laboratory tests were recorded before and after favipiravir treatment.

Results
Of 49 patients; 28 were male. A total of 9/49 (18.4%) patients survived. All patients were treated with favipiravir; laboratory tests were recorded before and after favipiravir treatment. The clinical parameters of patients are shown in Table-1 and Table-2. Mean PNI of the patients who survived was higher than patients who were exitus.

Conclusion
AKI in hospitalized patients with COVID-19 was associated with high mortality. Of all patients with AKI, only 18.4% survived.
MO395EPIDEMIOLOGY AND OUTCOME OF PATIENTS WITH ACUTE KIDNEY INJURY REQUIRING DIALYSIS: ABOUT 230 CASES
Authors: Elouaer Yosra , Guedri Yosra , Troudi Mohamed Riadh , Azzabi Awatef , Mrabet Sanda , Sahtout Wissal , Fradi Asma , Ben Aicha Narjes , Zellama Dorsaf , Achour Abdellatif 
Published: May 2021

Abstract

Background and Aims
Acute renal injury (ARI) is a frequent pathology. Rarer are the studies dedicated specifically to the subgroup requiring dialysis. The objective of our study is to identify: The epidemiological profiles of patients with ARI requiring dialysis. The course of the dialysis sessions to determine the dialysis’ prescription and the different accidents.

Method
This is a descriptive cross-sectional study including patients admitted to the different departments of Sousse University Hospitals in Tunisia who presented an ARI requiring emergency dialysis. Our study was conducted from February 2015 until August 2018. The data collected were analysed by the SPSS software.

Results
During three and a half years, 230 patients presented ARI requiring dialysis. The average age was 60 ± 16 years old. The sex ratio was 1.61. A history of hypertension, diabetes, heart disease, dyslipidaemia, hyperuricemia, uropathy and neoplasia was noted in respectively 34.9%, 27.1%, 21.6%, 22.7%, 25.5%, 22.7% and 14.3% cases. The causes of ARI were dominated by organic, obstructive and functional causes in 66.2%, 21.7% and 7.4% of cases, respectively. For organic causes, we noted acute tubular necrosis in 70.4% of cases, a glomerular cause in 14.5% of cases, an interstitial cause in 7.9% of cases and a vascular cause in 7.2% of cases. Dialysis indications were dominated by severe acidosis, pulmonary oedema, uremic syndrome and hyperkalaemia in 27.4%, 24.3%, 16.5% and 14.3% of cases, respectively. Among our patients, 26.7% presented a hemodynamic instability with catecholamine use in 16.8% of cases and the use of isovolumic connection at the beginning of the session in 21.2% of cases. The median ultrafiltration was 444 ml / hour IQR [166, 67-750] with extremes of 0 to 1333 ml/hour. The median blood flow was 250 ml/min IQR [250-280] with extremes of 180 to 300 ml/min. The median duration of dialysis’ session was 180 minutes IQR [180,240] with extremes of 15 to 360 minutes. We noted dialysis incidents in 12% of dialysis’ sessions. These events were dominated by hypotension, hypoglycaemia, extracorporeal circuit coagulation, death and chest pain in 13.8%, 4.8%, 2.6%, 2.1% and 0.7% of cases, respectively. The cessation of dialysis sessions was noted in 22 sessions (11.1%).
Concerning the evolution of patients: 33.1% of patients recovered normal renal function, 23.9% of patients maintained renal failure, 22.2% of patients died and 20.8% of patients were lost from seen or the duration of their follow-up was less than three months not making it possible to conclude as to the chronicity of the renal insufficiency.

Conclusion
ARI is a common and serious pathology. Dialysis is an important evolutionary step. It is associated with a high risk of progression to chronic renal failure and mortality. Optimal management of ARI is required.
MO351CENTRE VARIATION IN MORTALITY FOLLOWING HOSPITAL-ACQUIRED ACUTE KIDNEY INJURY IN ENGLAND
Authors: Peracha Javeria , Pitcher David , Santhakumaran Shalini , Day Jamie , Fotheringham James , Steenkamp Retha , Medcalf James , Nitsch Dorothea , Lipkin Graham , McKane William 
Published: May 2021

Abstract

Background and Aims
Routine monitoring of outcomes for patients with Acute Kidney Injury (AKI) is necessary to drive quality improvement in AKI care. In this study, we describe development of a case-mix adjusted 30-day mortality indicator for patients with hospital acquired AKI (H-AKI), to facilitate identification of unwarranted variation in outcomes across hospitals in England.

Method
We utilised a routinely collected national dataset of biochemically defined AKI cases, linked with hospitals administrative and mortality data. 250,504 H-AKI episodes were studied in total, across 103 hospitals between January 2017 - December 2018. Standardised mortality ratios were calculated for each hospital using logistic regression; adjusting for age, sex, primary diagnosis, comorbidity score, AKI severity, month of AKI, and admission method.

Results
Mean 30-day mortality rate was high at 28.6% and varied considerably between hospitals (22.3%-35.5%), with 23/103 trusts classed as outliers (95% control limits). Patients with H-AKI had mortality rates more than 5 times higher than the overall hospitalized population in 90/136 diagnosis groups and over 10 times higher in 60/136 groups. Increasing age, male sex, deprivation, higher comorbidity burden, more severe AKI stage at detection, emergency admission and admission during winter months were all associated with a higher risk of death Presentation at hospitals with on-site specialist nephrology services and Asian or Black ethnicity, however, were linked to a lower risk of death.

Conclusion
This is the largest multi-centre analysis of mortality for patients with biochemically ascertained H-AKI to date, once again highlighting development of AKI as an important patient safety concern across hospital settings. Centres identified as having poor outcomes will need to carefully interrogate their AKI care pathways to understand and explore reasons underlying the observed variation to guide future quality improvement interventions.