bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO314: Oliguria as a Strong Predictor of Mortality in Leptospirosis
Authors: Rista Elvana , Cadri Vilma , Saliaj Kristi , Akshija Ilir , Duraku Ahmet , Puca Edmond , Abazaj Erjona , Thereska Nestor , Harxhi Arjan 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Leptospirosis is an endemic, globally widespread zoonotic disease caused by pathogenic spirochetes of the genus Leptospira. It presents with high clinical variability, with a constellation of symptoms ranging from a mild, nonspecific, self-limiting febrile syndrome to acute liver failure, acute kidney injury, coagulopathy and respiratory involvement. Acute kidney injury (AKI) is a common complication and generally presents as nonoliguric and hypokalemic. The aim of this study was to delineate potential predictors of mortality in Leptospirosis.

METHOD
We conducted a prospective, observational, single-center study in the span of 5 years, from 2010 to 2015. Patients enrolled in the study had an age at presentation &gt;14 years and were hospitalized for longer than 24 h with a conclusive diagnosis of Leptospirosis. Baseline patient characteristics, including demographic, clinical and laboratory data were collected. Definitive diagnosis was established through serology assay, using the indirect-ELISA test to detect positive Leptospira IgM and IgG. Fisher's exact test was used to identify predictors of mortality during the course of the infection.

RESULTS
A total of 119 consecutive patients diagnosed with Leptospirosis were enrolled during a 5-year period, 92% were males. Mean age at presentation was 48.8 ± 14.9 and 41.5 ± 19.8 years for males and females, respectively. Mortality in our cohort was estimated to be 9% (10 patients). Urine output and bilirubin levels were found to be the most significant predictors of mortality. Fischer's exact test determined urine output at a cut-off value of 400 mL/24 h as the strongest predictor of mortality (P &lt; 0.001) in Leptospirosis. Bilirubin levels showed an equivalent statistical significance at a cut-off value of 19 mg/dL (P &lt; .001). Creatinine levels on admission, at a cut-off value of 3 mg/dL, proved to be the third strongest predictor of mortality, followed by nadir platelet count and age at a cut-off value of 70 × 103/µL and 49 years, respectively.

CONCLUSION
Our study defined oliguria as the most significant predictor of mortality in patients with severe Leptospirosis, closely followed by bilirubin levels on admission. Other predictors to consider include creatinine levels on admission, nadir platelet count and age at presentation. Incorporating predictors of mortality, from the outset, in treatment algorithms of Leptospirosis, will promote a more timely diagnosis and the development of more specific management guidelines, enabling clinicians to provide personalized treatment plans, potentially impacting the prognosis, morbidity and mortality rates in these patients.
MO322: Utility of Contrast-Enhanced Ultrasound to Predict Renal Recovery in Patients With Sepsis-Associated Acute Kidney Injury Receiving Renal Replacement Therapy
Authors: Cho Heejin , Yun Lee Hyang , Shin Jungho , Ho Hwang Jin , Hyun Kim Su 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Microcirculation plays a critical role in the development of sepsis-associated acute kidney injury (S-AKI); however, it remains uncertain whether microcirculatory dysfunction influences recovery. We investigated the association of contrast-enhanced ultrasound (CEUS)-assessed microcirculatory parameters with dialysis dependence in patients with S-AKI receiving renal replacement therapy.

METHOD
This study included 23 patients who underwent renal replacement therapy due to S-AKI, in addition to 17 healthy individuals and 18 subjects with chronic kidney disease (CKD). Parameters obtained from CEUS were compared.

RESULTS
Of the CEUS-derived parameters, patients with S-AKI had delayed rise time, time to peak and fall time, compared with healthy individuals (P = .039, .045 and .072), but they had similar values of peak enhancement, wash-in/out area under the curve (AUC), and wash-in perfusion index. Parameters did not differ between the S-AKI and CKD groups. Among patients with S-AKI, 10 (43.5%) patients did not experience renal recovery and required the lifelong dialysis treatment. They had lower values of peak enhancement, wash-in/out AUC, and wash-in perfusion index than in those with recovered renal function (P = .049, .021, .036 and .049). In addition, these values were slightly related to renal recovery after the adjustment with age, sex and disease severity (P = .096, .065, .094 and .072, respectively). We further evaluated the receiver operating characteristic curve and observed that CEUS-derived peak enhancement, wash-in/out AUC, and wash-in perfusion index predicted renal recovery (P = .047, .022, .035 and .047).

CONCLUSION
Assessment of microcirculatory alterations using CEUS may help to predict the probability of renal recovery in patients with S-AKI receiving renal replacement therapy. Further studies are needed to confirm the utility of CEUS, in consideration with baseline renal function and pathologic findings.
MO324: Serum Potassium Trajectory During AKI and Mortality Risk
Authors: Chávez-Iñiguez Jonathan S , Aranda-G de Quevedo Andres , Chávez-Alonso Gael , Oliva Ana E , Díaz-Villavicencio Bladimir , Calderón-García Clementina E , García-García Guillermo , Alcantar-Vallin Luz , Medina-González Ramón 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Kidneys play a primary role in potassium homeostasis. The association between potassium (sK+) level and mortality or the need for kidney replacement therapy (KRT) during acute kidney injury (AKI) has not been adequately explored.

METHOD
In this prospective cohort study, AKI patients admitted to the Hospital Civil de Guadalajara were enrolled from August 2017 to June 2021 with AKI. We divided patients into eight groups based on the serum potassium level trajectories up to 10 days following hospitalization: (1) normokalemia (normoK), defined as sK + values between 3.5 and 5.5 mEq/L; (2) corrected hyperkalemia (hyperK), sK+ &gt; 5.5 mEq/L on hospital admission and decreased to normoK; (3) corrected hypokalemia (hypoK), sK+ &lt; 3.5 mEq/L on hospital admission and increased to normoK; (4) fluctuating potassium, sK + increased/decreased in and out of normoK parameters; (5) uncorrected hypoK, sK+ &lt; 3.5 mEq/L; (6) normoK to hypoK, sK + that were normal on hospital admission and decreased to hypoK and never went back to normal; (7) normoK to hyperK, sK + that were normal on hospital admission and increased to hyperK and never went back to normal; and (8) uncorrected hyperK, sK+ &gt; 5.5 mEq/L. We assessed the association of serum potassium trajectories with mortality and the need for KRT (secondary objective).

RESULTS
A total of 311 AKI patients were included. The mean age was 52.6 years, and 182 (58.6%) were male. AKI stage 3 was present in 199 (63.9%). KRT started in 112 (36%) patients, and 66 patients (21.2%) were died. After adjusting for confounders, 10-day hospital mortality was significantly higher in group 7 and 8 (OR 1.37 and 1.63; P = &lt; .05 for both, respectively), and KRT initiation was higher only in group 8 (OR 1.40; P = &lt; .05) compared with group 1. Mortality in different subgroups of patients in group 8 did not change the primary results.

CONCLUSION
In our prospective cohort, most patients with AKI had alterations in sK + . NormoK to hyperK and uncorrected hyperK were associated with death, while only uncorrected hyperK was correlated with the need for KRT.
MO326: Factors Influencing Death Rate in COVID-19-Associated Acute Kidney Injury
Authors: Daniela Radulescu , Cuiban Elena , Adela Vacaroiu Ileana , David Cristiana , Tuta Liliana-Ana , Liliana Turcu Flavia , Carmen Bogeanu , Onofrei Simona-Daniela 
Published: May 2022

Abstract

BACKGROUND AND AIMS
During a 2-year pandemic, COVID-19 proved to be a condition with a high potential to affect various organs other than the lungs. Acute kidney injury (AKI) in hospitalized COVID-19 patients is associated with a poor prognosis. The aim of this study was to identify factors influencing in-hospital mortality.

METHOD
In a retrospective analysis, we included 268 adult patients with RT-PCR-confirmed SARS-CoV-2 infection and AKI admitted to two Emergency University Hospitals during a 6-month period, between 1 November 2020 and 30 April 2021. Data were retrieved from the electronic databases of the two hospitals. We analysed kidney and patient outcomes at discharge and the potential risk factors for mortality in AKI patients. We defined and staged AKI according to KDIGO 2012 creatinine criteria.

RESULTS
In our cohort the mean age was 72.28 years, 169 (63%) patients were men, and 111 (41.4%) had previously known chronic kidney disease. 81 patients were classified as having stage 1 AKI, 79 patients had stage 2 AKI and 108 had stage 3 AKI. A total of 135 (50.37%) patients died during hospitalization.
Statistic analysis using the Mann–Whitney U-test revealed significant differences (P &lt; .01) between survivors and non-survivors regarding peak values of serum urea (137.9 versus 190.9 mg/dL), creatinine (2.88 versus 3.94 mg/dL), procalcitonin (3.56 versus 15.86 ng/mL), C-reactive protein (92.32 versus 176.09 mg/L), interleukin-6 (243 versus 9552 pg/mL), ferritin (1331 versus 5189 ng/ml) and d-dimers (3.68 versus 6.88 mcg/ml). No significant differences were found between survivors and non-survivors regarding peak values of erythrocyte sedimentation rate (69 versus 71 mm/1 h; P = .35) and fibrinogen (629 versus 645 mg/dL; P = .24) and also regarding the lowest lymphocyte count during hospitalization (519 versus 649/mmc; P = .80).
The analysis using Fisher’s exact test showed that deceased patients were significantly more associated with AKI KDIGO stage 2 or 3 (51.9%/63% versus 32.1%), with higher need for renal replacement theraphy (RRT) (68.8% versus 47.9%), with ICU (intensive care unit) admission (90.1% versus 22.3%) (Table 1). Moreover, death was associated more frequently with partial or absent renal function recovery (20%/50% versus 6.4%) (P &lt; .05) (Table 1).
In a logistic regression model (using KDIGO stages, serum urea and need for RRT), it was proved that only serum urea had a significant prediction power (P = .001): every increase of serum urea with 1 unit increases the risk of death by 1.007 times (95% confidence interval 1.003–1.011).

CONCLUSION
Mortality of COVID-19 patients associating AKI is proportionally augmented by both markers of severity of SarS-CoV-2 and also by severity of AKI. In our study, the peak value of serum urea during hospitalization was the best predictor for death in COVID-19.
MO341: Clinical Significance of Post-Operative Acute Kidney Disease After Non-Cardiac Surgery
Authors: Kwon Soie , Yang Sunah , Lee Hajeong 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Acute kidney disease (AKD), the condition of which acute kidney injury (AKI) has not recovered, is being emphasized because it increases the risk of progression to chronic kidney disease (CKD). Post-operative AKI (PO-AKI) is a common clinical setting prone to develop AKI although information on post-operative AKD (PO-AKD) is lacking. We investigated characteristics of PO-AKD events after non-cardiac surgery.

METHOD
We performed a retrospective cohort study from a tertiary referral center in South Korea. The patients who underwent non-cardiac surgery (five departments: general surgery, gynaecology, urology, neurosurgery and orthopedic surgery) &gt;1 h from 2014 to 2020 were enrolled. Patients having advanced CKD patients and those receiving nephrectomy were excluded. PO-AKI was defined as whether the KDIGO AKI criteria were satisfied within 7 days after surgery. PO-AKD was defined as a case of not recovering to &lt;1.5× from baseline within 7 days of peak creatinine measurement after surgery among PO-AKI patients. The information of death event and initiation of renal replacement therapy were collected.

RESULTS
A total of 83 361 patients were enrolled and 4824 (5.8%) cases of AKI and 852 cases of critical AKI (1.0%) were occurred. Among PO-AKI patients, 321 (6.7%) patients were progressed to PO-AKD. Patients with PO-AKD had a higher blood pressure, a lower body mass index, more coronary artery disease, higher inflammatory markers and a higher proportion of hematuria compared with those with PO-AKI but recovered. They were younger and more women. Moreover, they had fewer comorbidities such as lower SPARK scores, lower proportions of diabetes mellitus, hypertension and malignancy, and better kidney function immediately before receiving surgery than the recovered group (Table 1). However, they tended to experience more critical AKI (critical AKI event among PO-AKI 157 patients, 48.9%; recovery 695 patients, 15.4%) and consequently showed a higher incidence of all-cause mortality (post-operative 1 year: PO-AKD 56 patients, 17.4%; recovery 606 patients, 13.5%; p = .055; post-operative 3 year: PO-AKD 126 patients, 39.3%; recovery 1496 patients, 33.2%; p = .032) and newly started of renal replacement therapy after surgery (PO-AKD 49 patients, 15.3%; recovery 136 patients, 3.0%, p &lt;.001).

CONCLUSION
In this large-scale study, we found that 6.7% of PO-AKI patients progressed to PO-AKD. PO-AKD patients tended to experience more severe AKI and also be associated with worse patients and kidney outcomes compared with their pre-existing condition.
MO375: The Health Economic Impact of Accurately Diagnosing CKD With and Without a UACR Test at Different Points in the Pathway of Disease Progression
Authors: Mernagh Paul , Folkerts Kerstin , Garreta Rufas Antonio , Meredith Kimberley , Harris James , Wanner Christoph , Rossing Peter , Hobbs Richard 
Published: May 2022

Abstract

BACKGROUND AND AIMS
In the Kidney Disease Improving Global (KDIGO) guidelines, it is recommended that an accurate chronic kidney disease (CKD) diagnosis is based on repeated positive test results for estimated glomerular filtration rate (eGFR) and urine albumin-to-creatine ratio (UACR). While eGFR indicates kidney function decline, UACR identifies kidney damage, predicts CKD progression, and indicates risk for cardiovascular events. UACR testing is, therefore, a critical component of identifying CKD patients early. There is a lack of evidence that demonstrates the economic impact of early CKD diagnosis; hence, a cost-effectiveness model was built to demonstrate the potential clinical and economic benefit of undertaking UACR tests in those with early-stage CKD.

METHOD
The KDIGO heatmap quadrants were organised into a Markov model with three levels of severity (moderate, high, and very high CKD risk) over a lifetime horizon, for a cohort of 60-year-old patients in the base-case. Costs, life-years (LYs), quality adjusted life-years (QALYs), and the associated incremental cost-utility ratios (ICURs) were calculated (discounted at 3.5%). Costs consisted of testing, general practitioner (GP) visit, nephrologist visit, and treatment costs. Data inputs were based on published data from the literature and validated by clinicians.

RESULTS
Hypothetical comparisons between a 1000-patient cohort who had UACR tests undertaken in the early stages of CKD, predicted higher LYs and QALYS for patients in the KDIGO heatmap quadrants of G3aA1, G1A2, G2A2, G3aA2, G1A3, G2A3 and G3aA3 compared with a 1000-patient cohort who did not have UACR tests. By identifying individuals in the early stages of CKD, treatment can be initiated earlier, reducing the number of patients progressing to late-stage CKD and ultimately offsetting the more expensive treatment costs associated with late-stage CKD. Overall, ICURs for all quadrants were less than the UK's willingness to pay threshold of £20 000 per QALY.

CONCLUSION
Preliminary results suggest that undertaking regular UACR tests early in patients with CKD is a cost-effective strategy, as this allows an individual to initiate the appropriate treatment, resulting in slower disease progression. This is an important consideration for clinicians and policymakers due to the suboptimal UACR testing rates globally.
Funding: Bayer AG
MO381: Estimating GFR in Renal Transplanted Patients With Equations Based on Creatinine (With or Without Race Variable) and/or Cystatin C
Authors: Delanaye Pierre , Masson Ingrid , Maillard Nicolas , Pottel Hans , Mariat Christophe 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Current Glomerular filtration rate (GFR) estimating equations based on serum creatinine are facing increased criticism due to the inclusion of a race correction in black Americans with the CKD-EPI equation (CKD-EPIASR, A = Age, S = Sex, R = Race). New equations without race (CKD-EPIAS) has been proposed with creatinine and/or cystatin C. These equations were developed mainly from US cohorts with few renal transplanted patients. In the current analysis, we compared these new equations, notably with the new European Kidney Function Consortium (EKFC) equation.

METHOD
In this retrospective analysis, 489 transplanted patients from the University Hospital of Saint-Etienne were included. All subjects were white. GFR was measured with inulin or iohexol clearances. IDMS creatinine and standardized cystatin C results were available. Median bias (eGFR—mGFR), imprecision (interquartile range: IQR), and P30 accuracy (percentage of eGFR-values within ± 30% of mGFR) were calculated.

RESULTS
Among creatinine-based equations, the bias were 2.3, 5.5 and 2.2 mL/min/1.73 m² for the CKD-EPIASR, CKD-EPIAS and EKFC, respectively. IQRs were 16.1, 16.2 and 15.3 mL/min/1.73 m², respectively. P30 were 74.2, 68.3 and 75.3%, respectively. Among cystatin C-based equations, the bias were −3.1 and 0.8 mL/min/1.73 m² for the CKD-EPICC and the EKFCCC, respectively. IQRs were 13.7 and 13.4 mL/min/1.73 m², respectively. P30 were 78.5 and 81.4%, respectively. Among equations combining creatinine and CC, the bias were −1.3, 0.5 and 1.6 mL/min/1.73 m² for the CKD-EPIASR-CC, CKD-EPIAS-CC and EKFCcreatCC, respectively. IQRs were 12.7, 12.4 and 12.1 mL/min/1.73 m², respectively. P30 were 84.5, 82.6 and 80.6%, respectively.

CONCLUSION
In our cohort of European transplanted patients, both the EKFCcreat and CKD-EPIASR equations performed better than the new CKD_EPIAS. Compared with creatinine-based equations, the new EKFCCC equation and all combined equations performed better. Cystatin C-based equations have the advantage to be accurate without any race variable.
MO390: Prognosis of Kidney Damage Associated With Tobacco Consumption in Former Smokers
Authors: Tascón Javier , G. Casanova Alfredo , Vicente-Vicente Laura , Pescador Moisés , Prieto Marta , Isabel Morales Martín Ana 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Tobacco is a risk factor for some cardiovascular and respiratory diseases, as well as for the development of some tumours. Furthermore, new research has shown evidence of the risk that smokers have of developing kidney disease [1]. On the other hand, biomarkers used in the clinical setting, such as plasma creatinine, are not useful to detect that injury. Considering this problem, the need to use biomarkers that provide a faster, more reliable and efficient diagnosis is clear. It is the case of biomarkers of subclinical kidney damage [2, 3]. In fact, studies from our laboratory have shown that smoking patients suffer subclinical kidney damage evidenced by the excretion of these novel urinary biomarkers [4]. The aim of this study was to evaluate the prognosis of kidney damage associated with tobacco in former smokers using these biomarkers. That is, to study the role that smoking cessation plays in the evolution of kidney injury.

METHOD
A clinical study was designed where three groups of patients, without previous kidney damage and risk factors for kidney disease, were included: i) non-smokers (control group), ii) smokers and iii) former smokers (according to the World Health Organization, a person who has not used tobacco in the last 6–12 months). They were recruited from a Salamanca Health Centre (Spain). Urine samples were collected and the biomarkers of subclinical kidney damage N-acetyl-β-D-glucosaminidase (NAG), neutrophil gelatinase-associated lipocalin (NGAL), kidney injure molecule 1 (KIM-1) and total proteins, were quantified by ELISA and colorimetric techniques. The data obtained were analysed with the statistical software SPSS®.

RESULTS
The results showed a higher excretion of NAG, NGAL, KIM-1 and total proteins in smokers with respect to non-smoker ones. Rather, this excretion was significantly lower in the groups of former smokers and non-smokers.

CONCLUSION
Our research suggests that subclinical kidney damage associated with tobacco consumption would improve its prognosis when patients quit smoking, being able to recover kidney function to similar levels to non-smokers. This finding supports that smoking cessation carries an important benefit for the health of smoking patients.
MO392: Mildly Impaired Kidney Function May Be Associated With the Risk of Hippocampal Atrophy in Young and Midlife Adults
Authors: Gadalean Florica , Virdol Malina , Schiller Adalbert , Bob Flaviu , Anca Gluhovschi Cristina , Oana Milas Livia , Suteanu - Simulescu Anca , Patruica Mihaela , Chisavu Lazar , Dana Grosu Iulia , Iova Iasmina , Florina Parv , Petrica Ligia 
Published: May 2022

Abstract

BACKGROUND AND AIMS
To date, associations between kidney function and brain structural abnormalities have been described in several studies [1]. Reports of renal function in relation to hippocampal atrophy have been scarce and the majority of studies have been focussed on older end-stage renal disease populations [2]. Particularly, with the ageing process, the hippocampus has a greater propensity to atrophy than other cerebral structures.The purpose of this study was to evaluate the relationship between kidney function assessed by estimated glomerular filtration rate (eGFR) and the degrees of hippocampal atrophy among young and midlife adults.

METHOD
In this cross-sectional study, the risk factors for hippocampal atrophy were evaluated in a cohort of 219 non-diabetic chronic kidney disease (CKD) patients, age ≤ 55 years, who had undergone magnetic resonance imaging (MRI) of the brain. The eGFR was calculated using the CKD-EPI formula. Hippocampal volume (HV) was assessed in brain MRIs with the Scheltens’ Medial Temporal Atrophy score, including a 5-stage escalation—0: no atrophy, 1: only widening of choroid fissure, 2: also widening of the temporal horn of lateral ventricle, 3: moderate loss of HV (decrease in height) and 4: severe loss of HV [3].

RESULTS
In our group, the median and interquartile ranges (IQR) of age was 45 (14) years, 57.53% (126 patients) being males. The median eGFR was 100.6 (34.7) mL/min/1.73m2 and 46.75% (102 patients) presented with mild reduction in eGFR (eGFR between 60 to 89 mL/min/1.73m2). In univariable regression analysis, eGFR (R2 = 0.207, P &lt; 0.001), arterial hypertension (R2 = 0.018, P = 0.045), dyslipidaemia (R2 = 0.044, P = 0.002), haematocrit (R2 = 0.021, P = 0.032), natrium levels (R2 = 0.018, P = 0.047), and potassium levels ( R2 = 0.019, P = 0.042) were associated with smaller HV. In multivariable regression analysis, eGFR [odds ratio (OR), 0.95; 95% confidence interval (CI), 0.94–0.97; P &lt; 0.001) and serum natrium (OR, 0.91; 95% CI, 0.83–0.98; P = 0.027) were significantly associated with hippocampal atrophy.

CONCLUSION
This cross-sectional study shows that mild decrease in eGFR is independently associated with hippocampal atrophy. Our results suggest that brain imaging tests should be routinely performed in patients with mild reduction of eGFR, as the hippocampal atrophy process appears to be due, in part, to the mild renal dysfunction itself.