bluuebunny/crossref_metadata_2025_split huggingface dataset:
#2395 Elevated circulating ACE2 activity is related with a major COVID-19 severity
Authors: Díaz Irene Martínez , Arana Ander Vergara , Ortiz José Tomas , Cámara Antonio Cano , Díaz Adrià Fernández , Llorens-Cebrià Carmen , de Frutos Pablo García , Morales Albert , Cachá Conxita Jacobs , Romeo Maria Jose Soler 
Published: May 2024

Abstract

Background and Aims
The angiotensin 2 converser enzyme (ACE2) is the cell entry receptor for SARS-CoV-2. SARS-CoV2 participates in ACE2 shedding from cell membrane, increasing soluble ACE2. The present study aims to evaluate if ACE2 serum levels are to COVID-19 prognosis.

Method
During the first wave of COVID-19 pandemic and during March and April 2020, 2118 first emergency attendance serum samples from diagnosed COVID-19 patients from Barcelona Vall d'Hebron Hospital were obtained. Age, sex, previous comorbidities, clinical and analytical variables were collected from the patient clinical records. Patients that were admitted to ICU, required mechanical ventilation or died due to COVID-19 were considered severe patients. Serum ACE2 activity was measured by enzymatic activity assay.

Results
Patients with severe COVID-19 were older and with a major number of comorbidities (Table 1). Circulating ACE2 activity at admission was increased in 0.34 relative fluorescence units (RFUs)/ng/μL (CI 95%: 0.24-0.43, p &lt; 0.001) in patients that developed severe COVID-19. A logistic regression model adjusted by age, sex, diabetes, hypertension, obesity, cardiovascular disease, chronic kidney disease and renin angiotensin blockers, showed that high circulating ACE2 activity was still related to a worse prognosis (OR: 2.0, 95% CI: 1.7–2.4, p &lt; 0.001). High serum ACE2 activity ≥0.56 RFU/ng/μL provided the best sensitivity (62%) and specificity (61%) relation, whereas values ≥1.3 RFU/ng/μL were significantly related to a worse prognosis of the disease with a 95% specificity.

Conclusion
High levels of circulating ACE2 activity when patients with COVID-19 are admitted to the Emergency Department are independently related with a subsequent severe disease. Additionally, although most of the comorbidities analyzed are significantly increased in severe COVID-19 patients as compared to mild COVID-19 patients, the results of the logistic regression model point out that they seem not to be a risk factor in the overall model, except for obesity, age and sex.
#488 Differences in characteristics and outcomes between Patients suffering AKI in medical vs surgical ICU units
Authors: Acosta-Ochoa Isabel , Coca Armando , Ardura Paula , Martínez María , Merizalde Carlos , Cobo Kenia , Moultamis Aya , Ronda Teresa , Mendiluce Alicia 
Published: May 2024

Abstract

Background and Aims
AKI is a public health problem, affecting one in every five hospitalized adults. It's incidence in the ICU fluctuates between 16-36%, with a mortality rate between 28%-50%. The need for HD in the ICU varies from 3-7%, and these patients have twice the risk of death. But few studies have compared patients in medical (MD-ICU) and surgical (Qx-ICU) critical care units.

Method
We conducted a single center, retrospective study of individuals admitted to ICU units that underwent nephrology consultation. We examined a 5-y period, in the pre-COVID era, we excluded the pandemic period, because COVID patients were admitted to MD- and Qx-ICU indistinctly. We compared epidemiological and clinical characteristics and hard outcomes between patients in both groups.

Results
We included 433 patients, 42% in the MD-ICU. We found no statistical differences between sex, HTN, DM, Charlson's-Index, and previous CKD. Qx-ICU patients were older, suffered less Coronary Artery (CAD), and Cerebrovascular Disease (CVD), and their AKI etiology was more frequently obstructive. MD-ICU individuals showed less hospital acquired AKI, and were more frequently classified in KDIGO Stage 3, (Fig. A, Features). We found no differences in time to nephrology consultation, length of hospital-stay and in-hospital mortality. Qx-ICU patients had shorter ICU stay, needed less frequently acute HD, and were less HD dependent at discharge (Fig. B, Results). In-hospital mortality for patients that needed HD in MD-ICU OR 2.2 (1.2-4.1, P = 0.12), Qx-ICU OR 4.4 (2.2-8.6, P &lt; 0.001).

Conclusion
Individuals don't differ remarkably in their baseline clinical characteristics (Charlson`s, DM, CKD). Nevertheless, Qx-ICU patients are older, suffer less CAD, and CVD, and show significantly more hospital acquired AKI. We found that medical ICU patients suffered worst AKI stage, longer ICU stay, required acute HD and were HD dependent more frequently, but had a lower risk of death when needing acute HD. We found no differences in general mortality rate, and general hospital stay, and time to nephrology consultation between groups. We need multicentric and well-powered studies to explore these differences more profoundly, find clusters of patients and phenotypes of AKI and discover protective factors and new preventive measures against hospital acquired AKI, and need for acute HD.
#1348 Acute kidney injury: evaluation of factors to predict the need of dialysis therapy
Authors: Przygocka Agnieszka , Dalmastri Vittorio , Provenzano Michele , Zappulo Fulvia , Berti Gian Marco , Bari Federico , Ullo Ines , La Manna Gaetano 
Published: May 2024

Abstract

Background and Aims
Acute kidney injury (AKI) is a clinical syndrome with heterogeneous pathophysiological mechanisms, associated with higher morbidity and mortality risk. The existing evidence shows that an episode of AKI increases the risk of chronic kidney disease and end-stage kidney disease, with considerable effects on long term outcomes. Current risk prediction scores were mostly calculated in the setting of contrast induced nephropathy and cardiac surgery reporting the patient's risk of AKI immediately before and after the invasive procedure. To date, no scoring models are available to assess the risk of progression and necessity of renal replacement therapy (RRT) for patients in the course of AKI.

Method
A prospective observational cohort study was conducted enrolling patients with AKI treated within the Nephrology, Dialysis and Kidney Transplant Unit of IRCCS Azienda Ospedaliero-Universitaria di Bologna from January 2022 to July 2023. The inclusion criteria were: 1) age &gt;18 years, 2) stage 3 AKI according to the current KDIGO guidelines or presence of urgent RRT indication (severe hyperkalemia, metabolic acidosis or fluid overload refractory to medical treatment). The indication for RRT was given based on clinical judgement. Type of RRT, dialyzer and ultrafiltration rate were applied according to the clinical features of the patient. The primary endpoint was the association between AKI features and RRT. Secondary endpoints were evaluation of patients treated with RRT for factors associated with renal recovery.

Results
We studied 56 patients. The mean age ± SD was 69.8 ± 15.3 years (range, 18-94) and 37 (66.1%) were males. 18 patients (32.1%) were treated with conservative therapy and 38 (67.9%) with RRT. The factors correlated with the necessity of RRT were previous cardiovascular disease (p = 0.002), diabetes mellitus (p = 0.017), Charlson score &gt;5 (p = 0.035), volume overload (p = 0.002), urine output level (p = 0.033) and C reactive protein (CRP; p = 0.020). Multivariate analysis found significant association of cardiovascular disease (OR, 5.94; 95% CI, 1.45 to 24.34; p = 0.013) and elevated CRP (OR, 1.08; 95% CI, 1.00 to 1.16; p = 0.049) during AKI episode with the RRT need in the study cohort. Higher ultrafiltration rate during RRT was correlated with non recovery of kidney function (OR, 1.86; 95% CI, 1.09 to 3.14; p = 0.021).

Conclusion
Cardiovascular disease and higher CRP were associated with necessity of RRT. More intensive fluid removal during RRT resulted as negative predictor of kidney function recovery. Further studies with larger study samples and randomized design are necessary to confirm these findings.
#1900 Should we prescind of KDIGO Stage 2 in AKI severity classification?
Authors: Acosta-Ochoa Isabel , Coca Armando , Martins Ana Luisa , Martínez María , Ardura Paula , Merizalde Carlos , Moultamis Aya , Ronda Teresa , Cobo Kenia , Mendiluce Alicia 
Published: May 2024

Abstract

Background and Aims
The most worldwide used classification system for staging AKI is KDIGO-2012, it was based on a combination of the RIFLE and AKIN criteria. KDIGO severity stages are defined:
Stage 1 ↑ in SCr by &gt;0.3 mg/dl or increase in SCr to &gt;1.5x baseline.
Stage 2 ↑ in SCr ≥2.0–2.9x baseline.
Stage 3 ↑ in SCr ≥3.0x baseline, ↑ in SCr to &gt;4.0 mg/dl, or initiation of RRT.
Some authors advocate for the elimination of the Stage 2 level and its incorporation in the severer stage; the justification is that this stage has a smaller number of individuals, and they show poorer clinical outcomes. We tested this hypothesis in a real-world setting.

Method
We retrospectively included all patients admitted to nephrology ward and nephrology consultations with AKI diagnosis by KDIGO-2012 classification, during a 3-y period. We compared clinical outcomes between KDIGO-AKI Stage 2 and 3. We excluded need for HD (because it is a criterion for Stage 3) and HD dependence at discharge (a consequence of initiating HD). In addition, we calculated the proportion of patients classified in Stage 2 by the rate of SCr increment, that were re-classified into Stage 3 by KDIGO criteria.

Results
1130 individuals met inclusion criteria. 458 (41%) Stage-1, 148 (13%) Stage-2, 524 (46%) in Stage-3. We found no statistically significant differences in age, Charlson's Index, HTN and DM prevalence, hospitalization in medical wards, and hospital acquired AKI between groups. We found significant differences in sex distribution (61% Stage-2, 70% Stage-3) (see Table A: Features). Hospital stay was significantly shorter in Stage1-15d (±12) but not significantly different between Stage-2 19d (±16) and Stage-3 20d (±17). Median of time to nephrology consultation was 6-7d in all groups. Rate of in-hospital mortality incremented gradually in every severity stage: 9% Stage-1, 18% Stage-2 and 31% Stage-3 (see Table B: Results). When using only the rate of SCr increment as the classification criterion, 265 (24%) of patients would have been catalogued in the moderate AKI stratum. Of the 117 patients that were reclassified as AKI Stage-3, 36 needed HD, and 81 reached a SCr &gt;4.0 mg/dl.

Conclusion
The proportion of subjects classified in KDIGO AKI Stage-2 is small but not negligible. We found that Stage-2 individuals show longer hospital stay and increased mortality than Stage-1, and slightly better outcomes than Stage-3; therefore, we consider that an increase in SCr ≥2.0–2.9x from baseline still leads to deleterious consequences. We also observed that possibly KDIGO AKI Stage 3 criteria lead to a skew to classification in the severer stage, (almost half of individuals are reclassified). With these findings, should we prescind of KDIGO Stage-2 in AKI severity classification?
#3100 Adsorption membranes in continuous renal replacement therapy (CRRT) in acute renal failure associated with sepsis: preliminary clinical results
Authors: Villa-Hurtado Daniel , de Castro Francisco Mateo 
Published: May 2024

Abstract

Background and Aims
Acute kidney INJURY (AKI) is a common complication (40%) in ICU patients, especially in septic patients, and it´s associated with high morbidity and mortality [2, 4].
Even though sepsis-associated AKI (S-AKI) is multifactorial, the elevation of cytokines plays a major role in its pathogenesis [3, 5]. This has promoted the use of adsorptive membranes in continuous renal replacement therapy (CRRT) in recent years.

Method
We performed a retrospective study in ICU patients with S-AKI who received CRRT with adsorptive membrane (Oxiris) from July 2021 to March 2023. We described clinical and analytical parameters at baseline, 24 and 48 hours after the start of therapy, and 30-day mortality.

Results
11 patients (6 male) with mean baseline creatinine of 4.53 ± 2.76 mg/dl were included. The indications for starting CRRT were: renal support (n = 3; 28%) or as adjuvant therapy for sepsis at the discretion of the attending physician (n = 8; 72%) (Table 1).
On admission, MAP was 72 ± 14.13 mmHg, serum lactate 2.7 ± 2.02 mmol/L. 7 patients (63%) required vasoactive drugs. The duration of therapy was 45 ± 18.46 h, with a prescribed effluent dose of 32 ± 4.14 ml/kg/h. There was a slight improvement in MAP at 24 and 48 hours (74 and 73.55 mmHg).
A decrease in inflammation parameters (C-Reactive protein and procalcitonin) was evident at 24 (13.2% and 57%) and 48 (25% and 71%) hours of therapy without modification in the need of vasoactive drugs. Interestlying, lactate at 24 hours increased to 3.40 ± 3.80 and at 48 hours to 3.68 ± 6.30.
Five patients died at day 30 (45%). Of the remaining six; four had a decrease in eGFR greater than 40% compared to baseline and 1 had a decrease of less than 40%. The last one continued maintenance hemodialysis.

Conclusion
Adsorptive membranes on top of standard of care (fluids resuscitation, broad-spectrum antibiotics and vasoactive drugs) in the first hours of S-AKI reduces the inflammatory response even though it does not change the need for vasoactive drugs. In our small cohort, mortality at 30 days and the decrease in eGFR greater than 40% from baseline were high, although similar to that described in the literature.
#2624 Point of care creatinine for early detection of community acquired acute kidney injury in a primary health care centre in Nigeria
Authors: Laurent-Ordu Vivean , Model Dorathy Emem , Chiemela Oluo Doris , Dede Siyeofori , Green Kinikawo , Oreh Adaeze , Emem-Chioma Pedro , Erekosima Ibi , Lewis David , Poulikakos Dimitrios 
Published: May 2024

Abstract

Background and Aims
Community acquired Acute kidney injury (AKI) and leads to poor outcomes in low and middle-income countries due to delayed diagnosis however its epidemiology is poorly studied due to lack of biochemical diagnosis. Supported by the International Society of Nephrology, we evaluated the accuracy of point of care creatinine (POC Cr) technology using capillary samples [1] and its use implementing a clinical algorithm to select patients at risk of AKI for POC Cr testing in the Hospital Emergency Department in Port Harcourt in Nigeria. In this phase of the project POC Cr was used in a large primary care health centre for early detection and management of community acquired AKI.

Method
The study is conducted in Ozuoba Model Comprehensive Primary Health Care Centre. The centre has 4148 patient attendances per month (20.3% medical, 18.8% obstetrics and 60.8% paediatrics) with 11.1% considered acute requiring short admission at the centre usually for intravenous fluids. Historically, decision making is based largely on clinical judgement and renal function tests when requested from external laboratories are reported in &gt; 48 hours. During this project POC Cr was offered on high-risk patients based on the clinical algorithm from the previous stage (Fig. 1) and patients with detected AKI were offered short admission for intravenous fluids and antibiotics.

Results
To date 54 patients have been screened with POC Cr. Median age is 25.5 years, minimum 2 months, maximum 85 years, interquartile range (48-10), 62% are females, 57% presented with malaria diagnosis and 9% with gastroenteritis. Mean (standard deviation) of POC Cr was 105 (54) µmol/L. There were 5 cases (9%) of AKI (Cr &gt;150 µmol) detected in patients aged 5 months, 13 months, 7 years, 19 years and 31 years. All were treated with short admission and intravenous fluids and were discharged after clinical improvement. Knowledge of the presence of AKI altered management in all patients prompting short admission.

Conclusion
Community acquired AKI is common in young patients with malaria and early biochemical diagnosis can improve outcomes. The study continues to recruit and aims to investigate the characteristics of community acquired AKI in Africa and to contribute to the design of optimal and sustainable pathway for early detection and management of AKI.
#1410 Prognosis and mortality within 90 days in community-acquired acute kidney injury in the Southwest of Sweden
Authors: Gross Christel , Jonasson Junmei Miao , Buchebner David , Agvall Björn 
Published: May 2024

Abstract

Background and Aims
Community-acquired acute kidney injury (CA-AKI) is common among hospitalized patients and has a poor prognosis. Research is scarce on the impact of a CA-AKI episode among patients without preexisting kidney disease and has not previously been investigated in Sweden. The aim was to describe the outcomes of patients with normal pre-hospitalization kidney function, admitted with community-acquired AKI and to investigate the association between AKI severity with outcomes.

Method
A retrospective population-based study was applied including patients with CA-AKI according to KDIGO classification, admitted via emergency department (ED) 2017-2019 and with a 90-day follow-up period from the ED-admission, collecting data from the Regional Healthcare Informative Platform. Age, gender and AKI stages, mortality and follow-up regarding recovery and readmission was registered. Hazard ratio (HR) and 95% confidence Interval (CI) for mortality was analyzed using Cox regression adjusted for age, comorbidities, and medication.

Results
There were 1646 patients included, mean age was 77.5 years. CA-AKI stage 3 occurred in 51% of patients &lt; 65 years of age and 34% among those &gt;65 years. In this study, 578 (35%) patients died and 233 (22%) recovered their kidney function. Mortality rate peaked within the first two weeks and among those at AKI stage 3. Nephrology referral post discharge occurred in 3% and 29% were readmitted. HRs for mortality was 1.9 (CI 1.38-2.62) for those who are &gt; 65 years, 1.56 (CI 1.30-1.88) for atherosclerotic-cardiovascular disease. Medication with RAASi related to a decreased HR 0.27 (95% CI 0.22-0.33).

Conclusion
CA-AKI is associated with high mortality within 90 days, increased risk for developing chronic kidney disease (CKD) and only one fifth recover their kidney function after hospitalization with an AKI. Nephrology referral was sparse. Patient follow-up after a hospitalization with AKI should be carefully planned during the first 90 days and focused on identifying those with a higher risk of developing CKD.
#746 Lactic acidosis in patients with acute kidney injury treated with renal replacement therapy in intensive care unit
Authors: Kobal Barbara , Korošec Tea , Jakopin Eva , Svenšek Franc , Piko Nejc , Hojs Nina Vodošek , Bevc Sebastjan , Hojs Radovan , Ekart Robert 
Published: May 2024

Abstract

Background and Aims
Lactic acidosis (LA) is the most common cause of metabolic acidosis in hospitalised patients. LA is frequent in intensive care unit (ICU) patients with acute kidney injury (AKI) treated with renal replacement therapy (RRT). The aim of our study was to analyse the impact of LA on mortality.

Method
We conducted a retrospective observational study in a tertiary care hospital with a 12-bed ICU. During the study period of 4 years before the COVID pandemic, 2939 patients were admitted to the ICU, 503 patients were diagnosed with AKI and 210 of them required RRT. Due to missing data, we retrospectively analysed only 176 patients. LA was defined as a serum lactate concentration above 4 mmol/L on admission to the ICU. Demographic data, comorbidities, laboratory data at ICU admission and 30-day survival after ICU admission were obtained from the medical record. Survival was estimated using the Kaplan-Meier method, and factors associated with 30-day mortality were assessed in a Cox regression.

Results
The mean age of patients was 63.4±12.9 years, and 68.2% were men. Sixty-five (36.9%) of patients had LA. The prevalence of comorbidities prior to admission and baseline laboratory values are shown in Table 1. All patients were treated with RRT, 137 (77.8%) with continuous RRT and 39 (22.2%) with intermittent hemodialysis. The mean ICU stay was 14.6 ± 12 days, and 114 (64.8%) patients died during the observational period of 30 days. A Kaplan-Meier survival analysis showed that the survival was statistically significantly lower (log-rank; p = 0.027) in the group of patients with LA (Fig. 1). Univariate Cox regression analysis showed that LA was a significant predictor of 30-day survival (HR 1.51; 95% CI 1.038-2.197; p = 0.031). In the multivariate Cox regression analysis, which included age, gender, diabetes, hypertension, LA and C-reactive protein, only age (HR 1.029; 95% CI 1.011-1.046; p = 0.001) and LA (HR 1.515; 95% CI 1.030-2.228; p = 0.035) were independent predictors of mortality.

Conclusion
LA on ICU admission is an independent, highly prognostic factor for death within 30 days of admission in patients with AKI treated with RRT.
#407 Human platelet lysate enhanced angiogenic potential of extracellular vesicles derived from mesenchymal stem cells
Authors: Zhang Yue , Tang Tao-Tao , LV Linli , Liu Bicheng 
Published: May 2024

Abstract

Background and Aims
Mesenchymal stem cell-derived extracellular vesicles (MSC-EVs) have emerged as a promising regenerative therapy. However, their clinical application is hampered by the presence of xenogeneic components in the medium. In the present study, we aimed to decipher the regenerative properties of MSC-EVs generated under xeno-free conditions to favor the clinical translation of MSC-EVs.

Method
MSCs were isolated from human umbilical cord and expanded in fetal bovine serum (FBS) and clinical-grade human platelet lysate (HPL) respectively. MSC-EVs were isolated by differential centrifugation combined with size exclusion chromatography and characterized through transmission electron microscopy, nanoparticle tracking analysis, and exoview. Subsequently, a multi-omics approach, comprising transcriptomics, proteomics, and metabolomics, was employed to investigate the molecular cargo of the MSC-EVs. Finally, in vitro and in vivo functional assays were performed to assess the regenerative potential of MSC-EVs in acute kidney injury.

Results
Our study demonstrated that HPL promoted MSC-EVs production without compromising EVs characteristics. Multi-omics sequencing revealed the stability of HPL cultured MSC-EVs (H-EVs) from different umbilical cord donors and global functional alterations for MSC-EVs under different culture conditions. In comparison to FBS cultured MSC-EVs (F-EVs), the regenerative potential of H-EVs was enhanced especially angiogenesis associated with increased cargo expression. The in vitro studies demonstrated that H-EVs induced more tube-like structure formation and migration. Further, it significantly reduced kidney capillary sparsity in mice with renal ischemic-reperfusion model.

Conclusion
Our data provided a comprehensive understanding about H-EVs and demonstrated their potential as a safe and effective regenerative therapy, especially targeting angiogenesis-related disorders.