bluuebunny/crossref_metadata_2025_split huggingface dataset:
#645 Inferring trends in renal function based on a single serum creatinine with a spot urine creatinine-to-osmolality ratio in outpatient settings
Authors: Hsu Shih-Ping 
Published: May 2024

Abstract

Background and Aims
Assessing trends in renal function can be challenging when paired serum creatinine (SCr) levels are not available, especially at the initial visit for evaluating renal function. The aim of this study was to validate the use of a spot urine creatinine-to-osmolality ratio (sUCr/Osm) as a surrogate indicator of urinary creatinine excretion rate for inferring renal function trends.1 The objective is to create a flowchart that assists in determining appropriate outpatient management based on a single SCr value with sUCr/Osm.

Method
The current study conducted a secondary analysis using the primary datasets provided by The Assessment, Serial Evaluation, and Subsequent Sequelae of Acute Kidney Injury (ASSESS-AKI) Study.2 The term “stable renal function” refers to the absence of an interval increase in SCr of greater than or equal to 26.5 μmol/L (0.3 mg/dL) from a visit three months earlier to the index visit. The definition of “unstable renal function” is the presence of an interval increase in SCr of 26.5 μmol/L (0.3 mg/dL) or more within the same duration. The cut-off value for sUCr/Osm was set at 7.07 when Cr is measured in μmol/L (0.08 when Cr is measured in mg/dL), which represents the 95% lower reference limit.1 A positive designation was given if the value of sUCr/Osm was not less than the 95% lower reference limit, and negative otherwise. The comparative test employed a tubular injury biomarker, urinary neutrophil gelatinase-associated lipocalin (UNGAL). The cut-off value for UNGAL was established at 100 ng/mL based on the maximum Youden's Index value. A positive result was defined as a UNGAL level less than or equal to 100 ng/mL, while a negative result was defined as a UNGAL level greater than 100 ng/mL.

Results
Of all the participants (N = 1, 570), 596 (38.0%) were female sex. The age (mean ± standard deviation) was 64.6 ± 13.0 years, the body mass index (BMI) was 30.1 ± 7.7 kg/m2, and the SCr level was 102.5 ± 51.4 μmol/L (1.16 ± 0.58 mg/dL). The sensitivity of sUCr/Osm in identifying “stable renal function” for all individuals was 0.926 (95% confidence interval: 0.912-0.939), with a positive predictive value of 0.906 (0.891-0.921) and an accuracy of 0.845 (0.827-0.863). These values of sUCr/Osm were either better or comparable to those of UNGAL- 0.867 (0.849-0.884), 0.917 (0.902-0.932), and 0.808 (0.788-0.827), respectively. In individuals (N = 521) with an estimated glomerular filtration rate (eGFR) of less than 60 cc/min/1.73m², sUCr/Osm also performed better or similarly to UNGAL. Table 1 provides direct comparisons between sUCr/Osm and UNGAL in identifying “stable renal function”.

Conclusion
To assess renal function, sUCr/Osm may be effectively used to infer the trend. Fig. 1 presents a flowchart for the corresponding management based on a single SCr-based eGFR and sUCr/Osm.
#3066 Long-term outcomes after AKI in hospitalized patients with COVID-19
Authors: Da Silva Bernardo Marques , Gameiro Joana , Teixeira Joana , Costa Cláudia S , Branco Carolina , Oliveira João , Bernardo João , Marques Filipe Cordeiro , Fonseca José Agapito , Lopes José António 
Published: May 2024

Abstract

Background and Aims
Acute kidney injury (AKI) is frequent in hospitalized patients and contributes to adverse short- and long-term outcomes. We aimed to evaluate the association of AKI and long-term adverse renal events and mortality in a cohort of patients hospitalized with COVID-19.

Method
Single-center and retrospective study of hospitalized patients admitted to a Dedicated Unit for COVID-19 at Centro Hospitalar Universitário Lisboa Norte, Portugal, between March 2020 and October 2020. AKI was defined and classified according to the Kidney Disease: Improving Global Outcomes (KDIGO) classification, using SCr criteria. The analyzed outcomes were development of major adverse kidney events (MAKE), major adverse renal cardiovascular events (MARCE), and mortality over a two-year follow-up period.

Results
From the included 409 patients, AKI occurred in 60.4% (n = 247). Within two years after discharge, 31.8% (n = 130) of patients had an eGFR &lt;60 mL/min/1.73 m2 and/or a 25% decrease on eGFR and 1.7% (n = 7) of patients required RRT, 6.1% (n = 25) of patients had CV events and 27.9% (n = 114) of patients died. The incidence of MAKE was 61.4% (n = 251), and MARCE was 67.5% (n = 276). On a multivariate analysis, older age (adjusted HR 1.02 (95% CI: 1.01-1.04), p = 0.008), cardiovascular disease (adjusted HR 2.22 (95% CI: 1.24-3.95), p = 0.007), chronic kidney disease (adjusted HR 5.15 (95% CI: 2.22-11.93), p &lt; 0.001), and AKI (adjusted HR 1.76 (95% CI: 1.12-2.78), p = 0.015) were independent predictors of MAKE. Older age (adjusted HR 1.06 (95% CI: 1.04-1.08), p &lt; 0.001) and neoplasia (adjusted HR 4.88 (95% CI: 2.37-10.04), p &lt; 0.001) were independent predictors of mortality.

Conclusion
In this cohort of hospitalized patients with COVID-19, AKI was independently associated with the risk of long-term need for dialysis and/or renal function decline and/or mortality after hospital discharge.
#1187 Acute kidney injury and tubulointerstitial nephritis following prescription of anticancer drugs: VigiBase analysis
Authors: Jeong Kyunghwan , Yoon Soo-Young , Kim Jin Sug , Lee Jeong-Yeun , Kim Hyun Kyu , Kim Dae Kyu , Hwang Hyeon Seok , Yon Dong Keon 
Published: May 2024

Abstract

Background and Aims
Anticancer drugs can have varying effects on the kidneys, depending on their characteristics. Various anticancer drugs may be nephrotoxic and can potentially cause renal impairment. We aimed to analyze the risk of renal adverse reactions according to different types of anticancer drugs using a global reporting system.

Method
We conducted an analysis on VigiBase, the World Health Organization pharmacovigilance database from Dec 1967 to Jul 2023 via disproportionate Bayesian reporting method. We further categorized the anticancer drugs into four groups: cytotoxic therapy, hormone therapy, immunotherapy, and targeted therapy. Reporting odds ratio (ROR) compares observed and expected values to find the associations of each category of anticancer drugs with acute kidney injury (AKI) and tubulointerstitial nephritis (TIN).

Results
We observed 32,722 AKI and 2,056 TIN reports which were reported as anticancer drug-related renal adverse reactions. Noteworthy trends emerged in AKI reports following anticancer drugs: cytotoxic therapies consistently dominated with 13,925 cases, while AKI cases related to targeted therapies and immunotherapies surged to 14,236 and 3,816 cases over three decades, respectively. Notably, TIN exhibited a significant increase, particularly after the popular usage of immunotherapy between 2015 and 2020, surpassing other categories of anticancer drugs. The highest disproportionality signal for AKI was associated with immunotherapies (ROR, 8.92; confidence interval [CI], 8.63–9.21, followed by cytotoxic therapies (ROR, 7.14; 95% CI, 7.01–7.26), targeted therapies (ROR, 5.83; 95% CI, 5.73–5.93), and hormone therapies (ROR, 2.59; 95% CI, 2.41–2.79). In the case of TIN, a significantly higher disproportionality signal was found for immunotherapies (ROR, 21.74; 95% CI, 20.39–23.18), followed by cytotoxic therapies (ROR, 2.60; 95% CI, 2.40–2.82), and targeted therapies (ROR, 1.54; 95% CI, 1.40–1.69). Hormone therapies did not exhibit a significant disproportionality signal. Separate analyses were also conducted for the ROR of AKI and TIN for each individual anticancer drug.

Conclusion
AKI and TIN were substantially observed following the administration of anticancer drugs. Noticeably, renal adverse reactions following immunotherapy, which have been experiencing an increase in utilization, were more prominent than other types of anticancer drugs. Clinicians should consider the increased risk of renal adverse reactions after specific anticancer drugs.
#2657 Evaluation of the impact of a nephrologist led acute kidney Injury clinic in a large district general hospital
Authors: Khandaker Mustakim , Rahman Saeed 
Published: May 2024

Abstract

Background and Aims
Acute kidney injury (AKI) has a significant impact on inpatient hospital admissions costing the NHS in the UK an estimated £1bn. Hospitalisation complicated by AKI results in increased length of stay and mortality and up to a fifth of discharged patients are readmitted to hospital within 30 days. Traditionally district general hospitals in the UK have limited nephrology cover. In our large district general hospital, a new nephrologist led AKI clinic was established to review patients whose inpatient admissions were complicated by a stage 2 or 3 AKI. Over a 7-month period the aim was to evaluate this new clinic and its impact for local patients and the hospital trust.

Method
Inpatients with stage 2 and 3 AKI were identified by a specialist AKI nurse and nephrologist as suitable for the clinic. A discharge summary was generated with the stage and cause of AKI. Patients were seen within 6 weeks of discharge by either a nephrologist or a specialist AKI nurse. Data was retrospectively collected, and this included diagnosis, causes of AKI, highest stage of AKI, progression of chronic kidney disease (CKD) and referral to tertiary chronic kidney disease services. Using the hospital's own AKI dashboard, we looked at 30-day readmission rates of all AKIs and overall hospital length of stay over this period.

Results
Retrospective data was collected for 245 patients who attended the clinic over 7 months. 43.9% had a stage 3 AKI, 41.4% had a stage 2 AKI, the remainder of patients were CKD patients with progression or had an underlying glomerular pathology. The most common cause for AKI was hypovolaemia (41.8%) followed by infection/sepsis (37.7%). Most AKIs fully resolved (58.1%), 7% of patients had not resolved and 27% partially resolved. 12.3% of patients were referred onto nephrology tertiary services.
Over the course of the 7 months, the trend of 30-day readmission rates dropped from 18.2% to 10.1% (Fig. 1). There was no significant change in hospital length of stay.

Conclusion
The nephrology led AKI clinic has had a meaningful impact in our post discharge patient care. We have been able to review patients in a timely manner providing them with a holistic approach. A significant number of patients were identified and referred early for specialist tertiary CKD management. Over the 7-month period there was a reduction in 30-day readmission rates however it has not yet affected overall length of stay. This study supports a nephrologist led AKI clinic in a district general hospital.
#768 Renal-limited thrombotic microangiopathies and hemolytic uremic syndromes, on behalf of the MATRIX consortium group
Authors: Maisons Valentin , Mesnard Laurent , Duval Anna , Frimat Marie , Fakhouri Fadi , Grange Steven , Servais Aude , Cartery Claire , Chauvet Sophie , Ohlmann Sophie , Vuiblet Vincent , Halimi Jean Michel 
Published: May 2024

Abstract

Background and Aims
Thrombotic microangiopathies (TMA) are usually associated with hematological features (RH-TMA). The epidemiology of TMA limited to kidneys (RL-TMA) is unclear.

Method
Patients with TMA and native kidney biopsies were identified during the 2009-2022 period in 20 French hospitals.

Results
RL-TMA was present in 341/757 (45%) patients and associated with lower creatinine levels (184 [115-297] vs 346 [206-626] µmol/L) than RH-TMA. RL-TMA resulted from virtually all KDIGO causes (more frequently from anti-VEGF treatment and hematological malignancy, less frequently from shiga toxin-associated hemolytic uremic syndrome (HUS), systemic sclerosis, gemcitabine and bacterial infection) but less frequently combined (≥3 causes/triggers: RL-TMA: 5%; RH-TMA: 12%). RL-TMA were associated with significantly lower major cardiovascular events (10% vs 20%), kidney replacement therapy (23% vs 43%) and death (12% vs 20%) than RH-TMA during follow-up (median: 28 (interquartile range: 7-72) months.
Atypical HUS (aHUS) was found in 326 patients (RL-TMA: 43%, RH-TMA: 46%). Among the 69 patients with complement-mediated aHUS, 17 (25%) had RL-TMA and eculizumab was used in 43 (62%) (RL-TMA: 35%; RH-TMA: 71%). Among the 257 other aHUS patients, including 51% with RL-TMA, complete complement evaluation was performed in 85 (33%) (RL-TMA: 33%, RH-TMA: 33%) and eculizumab was used in 29 (11%). The effects of eculizumab were unclear.

Conclusion
RL-TMA represent a very high proportion of TMA patients, result from virtually all causes, including the 25% of patients with complement-mediated aHUS, and have a poor prognosis. Anti-C5 therapy is rarely used in RL-TMA, even in proven complement-mediated aHUS, and thus its effects remain to be assessed.
#1748 The burden of cardiorenal syndrome: epidemiological data and treatment: a one-center experience
Authors: Stathopoulou Elpiniki , Giannou Panagiota , Alexakou Zoi , Bora Margarita , Aggelis George , Stambolliu Emelina , Kourniotis Dimitrios , Papras Athanasios , Chalkia Aglaia , Kapota Athanasia , Petras Dimitrios 
Published: May 2024

Abstract

Background and Aims
Cardiorenal syndrome (CRS) is an entity combining cardiac and renal dysfunction in a bi-directional way. Six subtypes of CRS have been described, all of which are associated with high morbidity and mortality rates. CRS treatment—no matter the subtype—is until nowadays a field of investigation, aiming to the reduction of fluid overload and venous congestion. The primary endpoint of this study was to estimate the frequency of cardiorenal induced AKI compared to other AKI etiologies in hospitalized patients. We furthermore aimed to determine the burden of the therapeutic regimen in hospitalization duration and renal deterioration.

Method
This is a retrospective, quantitative analysis of hospitalized adult patients in General Hospital of Athens Hippokration suffering from AKI of various etiologies. No age or sex limitations were used for the purposes of this study.

Results
A total amount of 1163 patients were enrolled over the course of 18 months. 430 (36.9%) of these patients were hospitalized in the cardiologic department, suffering from either acute or chronic heart failure (66.5% of which were men) with a mean age of 74.4 ± 11.4 years. Mean creatinine level at hospital admission was 2.7 ± 2 mg/dl. Out of these patients, 33.9% were treated using diuretics alone, while 25.5% also needed hemodialysis. Mean number of days of hospitalization was 9.4 ± 5.8 days and 11 ± 8.8 days, while creatinine exit was 2.9 ± 1.5 mg/dl and 4.2 ± 3 mg/dl respectively.

Conclusion
Cardiorenal syndrome is a quite common cause of AKI in patients being hospitalized. In our study, patients that needed treatment with diuretics compared to those requiring a combination of diuretics and hemodialysis had less days of hospitalization and a better kidney function outcome.
#2707 Prediction of plasma sodium changes in hypernatremic patients: the role of tissue sodium content
Authors: Simon Sanédy , van Vliet Anne Myrthe , Lindner Gregor , Vogt Liffert , Oppelaar Marjet , Engberink Rik Olde 
Published: May 2024

Abstract

Background and Aims
Hypo- and hypernatremia are frequently encountered electrolyte disturbances in clinical practice. Rapid correction of these dysnatremias can result in severe neurological complications. Therefore, various formulas have been developed to predict changes in plasma sodium concentration ([Na+]) after treatment. However, these kidney-centered formulas have been shown to be inaccurate. A potential explanation for the discrepancy between predicted and measured plasma [Na+] is the accumulation of sodium in the skin, which is not explicitly taken into account in these formulas. The purpose of this post-hoc analysis is to evaluate the association between factors related to tissue sodium accumulation and the discrepancy between measured and predicted plasma [Na+].

Method
We used data from a hypernatremic intensive care unit (ICU) cohort with 66 patients and 1,034 ICU days with complete data on sodium, potassium and water balance. We excluded ICU days with incomplete balances, dialysis and severe diarrhea. The predicted plasma [Na+] was calculated using the Barsoum-Levine (BL) and the Nguyen-Kurtz (NK) formula. Then, we calculated the discrepancy between predicted and measured plasma [Na+] (∆[Na+]). We fitted a linear mixed-effect model to investigate the association between factors related to tissue sodium content and ∆[Na+]. Age, sex, blood pressure, eGFR, CRP, plasma albumin, total body water (TBW), baseline plasma [Na+] and changes in plasma [Na+] were incorporated as fixed effects in the model, while the subjects were introduced as a random effect. TBW was estimated as 60% of body weight for males and 50% of body weight for females, corrected for fluid balances on subsequent ICU days.

Results
A total of 613 ICU days of 66 patients were included in our analysis. The mean age was 58 ± 15 years and 38% was female. The mean plasma [Na+] at inclusion day was 145 ± 9 mmol/L and mean eGFR CKD-EPI was 52 ± 28 ml/min/1.73 m2. On average, the deviation between predicted and measured plasma [Na+] was 3.8 ± 3.3 mmol/L for the BL formula and 3.9 ± 3.4 mmol/L for the NK formula. For both formulas, TBW (p = 0.01), baseline plasma [Na+] (p &lt; 0.001) and plasma [Na+] change (p &lt; 0.001) were significantly associated with the discrepancy between predicted and measured plasma [Na+] (Table 1). Plasma albumin (p = 0.02) was also significantly associated with this discrepancy when the NK formula was used.

Conclusion
In a hypernatremic ICU cohort, baseline plasma [Na+], estimated TBW and plasma [Na+] changes are associated with the inaccurateness of plasma [Na+] prediction. As baseline plasma [Na+] and estimated TBW are available when initiating treatment, incorporation of these variables in the currently available formulas may improve the prediction of plasma [Na+].
#2956 Hemodynamic evaluation of different replacement fluids during therapeutic plasmapheresis with Crit-line™
Authors: Moranne Olivier , Elassas Hajar 
Published: May 2024

Abstract

Background and Aims
Therapeutic plasmapheresis (TP) is an extracorporeal technique used to remove pathogenic macromolecules from the plasma. Human serum Albumin (HSA) or fresh frozen plasma can be used as replacement fluid, alone or in combination, and with or without the addition of a crystalloid such as saline. There is wide practice variation in the type of replacement fluid and according the procedure of TP such as single plasma exchange (SPE) or double plasmafiltration (DFPP). Replacing plasma with crystalloid carries a risk of hypotension if the proportion of replacement with crystalloid exceeds 30%. CRIT-LINE™ monitor estimate RBV changes during HD based on measurements of hematocrit and could be used in hemodialysis to prevent hypotensive episodes.

Method
We conducted a retrospective case series study in a tertiary center to evaluate RBV changes during TP (SPE & DFPP) in three patients with PIDC treated with chronic TP using SPE or DFPP according to guidelines. For each patient and procedure (SPE or DFPP) we compare different substitution fluid infusion protocol between 2021 and 2023. We evaluated each patient's sessions with CRITLINE™ continuous RBV monitoring during either SPE or DFPP with comparison of different replacement fluid protocols. For DFPP with plasmafractionator EC30 (Asahi Kasei Medical Co., Japan) or medopen30 (Infomed, Switzerland), we compare protocols as follows (1) continuous infusion of 500 ml of HSA 4% throughout the session and (2) 500 ml HSA 4% at the last 20 min of the session. For SPE, we compare protocols as follows (1) 100% volume of HSA 4% supplementation (2) a combination of 70% HSA 4% and 30% of saline started at the last part of the session (3) a combination of 70% HSA 4% and 30% of saline started at the first part of the of the session.

Results
BVM decreased by 15% ± 5% in DFPP session with 500 ml HSA 4% at the last 20 min of the session and by 12% ± 3 in DFPP session with continuous infusion of 500 ml of HSA 4% throughout the session . In SPE, BVM decreased by 18% ± 2 in session with a combination of 70% HSA 4% and 30% of saline and by 10% in session with 100% albumin substitution. Hypotensive episodes occurred in session with a combination of 70% albumin 4% and 30% of saline at the end of session.

Conclusion
CRITLINE IV continuous RBV monitoring is an interesting tool that can be used to evaluate the optimal substitution fluid in TP and for prevention of hypotension. Randomized control trial are needed to confirm the results.
#1502 Short-term effects of gadolinium and gadoteric acid on kidney — impact on inflammation
Authors: Coimbra Susana , Rocha Susana , Viana Sofia D , Rebelo Rute , Valente Maria João , Rocha-Pereira Petronila , Catarino Cristina , Bronze-Da-Rocha Elsa , Belo Luís , Reis Flávio , Santos-Silva Alice 
Published: May 2024

Abstract

Background and Aims
The nephrotoxicity of free gadolinium [Gd (III)] has been reported, raising concerns about the safety of gadolinium-based contrast agents (GBCA), widely used in magnetic resonance imaging. The GBCA with macrocyclic structure, such as gadoteric acid (Gd-DOTA), appear as more stable. Using human proximal tubular cells cultures, we found that free Gd (III) triggers death by apoptosis and necrosis, and increases the expression of modulators of inflammation, hypoxia and fibrosis, which are known as major risk factors for the development and worsening of kidney disease.
Our aim was, using animal models, to evaluate the short-term effects of Gd (III) and of gadoteric acid on inflammatory biomarkers, at blood and renal tissue levels.

Method
Wistar rats were exposed to a single dose of Gd (III) or Gd-DOTA (groups A and B, respectively); a control group was also included (C). After 48h, blood and kidney samples were collected. The plasma levels of interleukin (IL)6 and transforming growth factor (TGF) beta 1 were assessed by ELISA; the kidney gene expression of IL6 (il6), TGF beta 1 (tgbf1) and nuclear factor-kappa B (nfkb1) was determined through qPCR.

Results
Gd (III) group (A) presented higher circulating IL6 levels (P = 0.001) and increased kidney gene expression of il6 (P = 0.013), tgbf1 (P = 0.006) and nfkb1 (P = 0.011) than the control group (C); compared to Gd-DOTA group (B), the IL6 plasma concentration (P = 0.005) and tgbf1 mRNA levels were also higher (P = 0.004). The Gd-DOTA group (B) presented increased gene expression of il6 (P = 0.006) than the control group (C).

Conclusion
Short-term exposition to free Gd (III) induced an inflammatory response, shown by the increase in circulating IL6, and in kidney gene expression of il6, tgbf1 and nfkb1. The exposition to Gd-DOTA was associated with a lower inflammatory response, showing only increased kidney gene expression of il6. Despite the much safer profile for Gd-DOTA, further studies are warranted, evaluating other biomarkers, to clarify the short-term, and even the long-term effects, of these compounds.

Acknowledgements
This work was financed by FCT through the project 2022.08400.PTDC; FCT, in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of the Research Unit on Applied Molecular Biosciences—UCIBIO and the project LA/P/0140/2020 of the Associate Laboratory Institute for Health and Bioeconomy—i4HB.