24-hour Urine Volume Research Articles

Prevalence and Outcomes of Chronic Kidney Disease Associated Pruritus: International Results from PDOPPS.

Pruritus is common in hemodialysis (HD) patients. Less is known about the prevalence and outcomes of pruritus among patients receiving peritoneal dialysis (PD). Herein, we describe the prevalence of pruritus and its associations with patient-reported outcomes (PROs) and mortality/transfer to HD. We analyzed a multicenter, international cohort of PD patients enrolled in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) from 2014-2022. Pruritus was assessed at entry into PDOPPS with a single-question Likert Scale capturing the extent to which patients were bothered by itch ranging from 1: Not at all, to 5: Extremely. The KDQOL-36 and the Centre for Epidemiological Studies Depression Scale assessed various PROs. Moderate to extreme pruritus was defined as a Likert scale score ≥3. The associations of pruritus with PROs were assessed using linear/logistic regression where appropriate. Death or HD transfer was assessed using multivariable Cox regression models. Overall, 5535 patients from seven countries were included; 43% had moderate to extreme pruritus which was highest in Thailand (50%) and lowest in the United States (33%). The adjusted odds ratios (aOR) of moderate to extreme pruritus were higher for diabetes, low albumin, and elevated phosphorus but lower for residual urine volume (aOR= 0.98 per 200 ml increase in 24-hour urine volume, 95% confidence interval [CI]; 0.96-1.00, P=0.05). Patients with extreme pruritus had the lowest mental and physical health component scores and a higher burden of other PROs including restless legs and disturbed sleep. Overall, 899 patients died and 1221 transferred to HD. Patients with moderate to extreme pruritus were at higher adjusted risk for death or HD transfer (adjusted hazard ratio [aHR] 1.12, 95% CI 1.02-1.23, P=0.02) with similar point estimates for each subcomponent of the composite outcome. Pruritus is highly prevalent in PD and associated with poor health outcomes. Efforts to better identify and manage pruritus should be considered in this population.

Impact of the Preservation of Residual Kidney Function on Hemodialysis Survival: Results from the BISTRO Trial.

Preservation of residual kidney function (RKF) in dialysis patients has been associated with improved survival. RKF in the BISTRO trial was relatively well preserved and here we describe its association with survival during the trial and extended follow-up. RKF, measured as the average urea and creatinine clearance (GFR) or 24-hour urine volume was assessed at baseline, one, two and three months and three-monthly up to 2 years in incident haemodialysis patients. Time to event survival data or competing events (transplantation, modality change) were obtained for 50 months post enrolment via data linkage with the UK Renal Registry. Cox proportional hazards regression survival models, including those incorporating change in GFR from baseline as a time-varying variable and joint regression models for longitudinal and survival data (longitudinal models for GFR or urine volume) were used to explore the relationship of RKF preservation with survival. Analyses were adjusted for age, sex, comorbidity and ethnicity. 2919 measures of RKF were made in 387 patients from 32 UK dialysis units. Higher age and comorbidity score associated with increased mortality in all models. Baseline GFR reduced the risk of death (Hazard Ratio: 0.918 95%CI: 0.844, 0.999) per ml/min/1.73m2. A greater fall in GFR and urine volume from baseline was associated with a non-significant increased risk of death as visualised on spline plots. In the joint survival models higher GFR (adjusted HR: 0.88 95%CI 0.80, 0.97) or urine volume (adjusted HR: 0.75 95%CI 0.57, 0.95 per L) at any time point associated with better survival. Lower RKF during the first two years of haemodialysis is associated with an increased death risk for up to 50 months following dialysis initiation. This adds to a growing body of evidence that interventions to preserve RKF should be developed and tested in clinical trials.

7667 Cushing’s Puzzle: Echinococcal Pituitary Cyst In A Rare Encounter

Abstract Disclosure: E. Sari: None. F. Erenler: None. Introduction: Echinococcus is a rare parasitic infection endemic in the Mediterranean, Middle East, South America and Africa, which can cause cystic disease in several organs. Central nervous system involvement is known to comprise 1-2% of all cystic echinococcal disease. Hereby, we report a case of an opportunistic pituitary echinococcus infection in a patient with hypercortisolism due to adrenocortical adenoma with initial misdiagnosis of Cushing’s disease. Clinical Case: A 40-year-old South American female with poorly controlled T2DM on oral agents and hypertension presented to the ER with abdominal pain and subsequent CT of the abdomen with contrast showed a right adrenal mass measuring up to 2.8 cm. A follow up CT with adrenal protocol confirmed 3.3 cm right adrenal mass, 46 HU in precontrast images with >50% washout. Review of records revealed that a recent MRI brain with contrast was performed for headache evaluation and showed an incidental 5x7x4 mm lesion in the pituitary gland. Endocrinology evaluation revealed 24-hour urine volume 1800 mL, elevated free cortisol levels 277.6 mcg/24hr (RR: 4.0-50.0 mcg/24hr), creatinine of 0.67g/24hr (RR: 0.50-2.15g/24hr). 1 mg dexamethasone suppression test showed AM cortisol of 28.7 mcg/dL. ACTH was elevated at 67 pg/mL (RR: 6-50 pg/mL). FSH, LH, and GH were normal. Presumed diagnosis of ACTH-dependent hypercortisolism was made and she underwent bilateral inferior petrosal sinus sampling with confirmed successful cannulation but this was inconclusive due to low ACTH levels. Follow-up MRI of the pituitary gland showed T1 bright, T2 isointense circumscribed lesion measuring 7x6x3 mm at anterior pituitary gland with a thin rim of peripheral enhancement consistent with cystic features. She underwent transsphenoidal resection of the pituitary lesion and the pathology specimen showed parasites consistent with echinococcosis. Infectious disease was consulted, and the patient started on albendazole. Post-operative laboratory evaluation was notable for persistently elevated AM cortisol, 24-hour urine free cortisol levels, and low ACTH levels, confirming ACTH independent hypercortisolism. She underwent right adrenal nodule resection and pathology was consistent with adrenocortical adenoma. Post-adrenalectomy AM cortisol levels were < 2 mcg/dL, indicating the resolution of hypercortisolism along with substantiating the diagnosis of primary adrenocortical hyperfunction. Conclusion: To the best of our knowledge, this is the first case report of an opportunistic echinococcus infection presenting as a pituitary lesion in the setting of Cushing Syndrome. We would like to highlight the importance of recognizing opportunistic infections, including Echinococcus as a potential etiology in the setting of hypercortisolism, especially for patients from endemic regions. Presentation: 6/2/2024

Clinical Efficacy of Autologous Bone Marrow Mesenchymal Stem Cell Transplantation for the Treatment of Patients with Refractory Cirrhotic Ascites

Objective: To analyze the efficacy of autologous bone marrow mesenchymal stem cell (BMSC) transplantation for the treatment of cirrhotic ascites (refractory). Methods: 64 patients with cirrhosis ascites (refractory) who were admitted to the hospital between May 2022 and April 2024 were selected and divided equally by random number table, the observation group was treated with BMSC autologous transplantation, and the reference group was treated with conventional medication, and the total effective rate, therapeutic indexes, liver and renal function indexes, and the change of urine volume were compared. Results: The total effective rate of the observation group was higher than that of the reference group (P < 0.05). Before treatment, there was no difference between the two groups in terms of therapeutic indexes such as depth of ascites, liver and kidney function indexes and 24-hour urine volume (P > 0.05). After treatment, the observation group’s ascites depth and other indicators were better than that of the reference group, liver and kidney function indicators were better than that of the reference group, and 24h urine volume was more than that of the reference group (P < 0.05). Conclusion: BMSC autotransplantation can improve the clinical efficacy of patients with cirrhosis ascites (refractory), accelerate the absorption of ascites, reduce the values of body mass and abdominal circumference, and protect the liver and kidney functions and increase the amount of urination.

Early Anuria in Incident Peritoneal Dialysis Patients: Incidence, Risk Factors, and Associated Clinical Outcomes

Rationale & ObjectiveThe development of anuria was linked to worse clinical outcomes in patients undergoing peritoneal dialysis (PD). Our objective was to investigate the incidence, risk factors, and associated clinical outcomes of anuria within the first year after PD. Study DesignRetrospective Cohort Study. Setting & ParticipantsPatients who started continuous ambulatory peritoneal dialysis (CAPD) at our center between 2006 and 2020 were included and followed up until January 31, 2023. ExposureAge, gender, diabetes, temporary hemodialysis, angiotensin-converting enzyme inhibitors (ACEI)/angiotensin II receptor blockers (ARBs), diuretics, baseline urine volume, serum albumin, daily glucose exposure, peritonitis, and incremental PD. OutcomesThe primary outcome was early anuria, defined as 24-hour urine volume ≤ 100mL within the first year of PD initiation. Secondary outcomes included all-cause mortality, cardiovascular disease (CVD) mortality, technique failure, and peritonitis. Analytical ApproachCox proportional hazards model. ResultsA total of 2592 CAPD patients aged 46.7 ± 14.9 years were recruited. Among them, 58.9% were male, 24.0 % had diabetes. Within the first year of PD therapy, 159 (6.13%) patients developed anuria, with a median duration of 7.53 (interquartile range [IQR] 3.93-10.0) months. Higher baseline urine volume (hazard ratio [HR] 0.93, 95% confidence interval [CI] 0.90-0.97), higher serum albumin (HR 0.92, 95% CI 0.88-0.95), with diabetes before PD (HR 0.57, 95% CI 0.35-0.92), and prescribed incremental PD (HR 0.27, 95% CI 0.14-0.51) were associated with a reduced risk for early anuria, while a higher level of daily glucose exposure (HR 1.01, 95% CI 1.00-1.01) was identified as a risk factor for early anuria. Subgroup analyses showed that using ACEI/ARBs was linked to a lower risk of early anuria (HR 0.25, 95% CI 0.09-0.69) in diabetic patients. Treating early anuria as a time-dependent covariate, early anuria was associated with a higher risk for all-cause mortality (HR 1.69, 95% CI 1.23-2.32) and technique failure (HR 1.43, 95% CI 1.00-2.04) after adjusting for confounding factors. LimitationsSingle-center and observational study. ConclusionsThe incidence of early anuria in our center was 6.13%. Higher baseline urine volume, higher serum albumin, a history of diabetes, incremental PD start, and lower daily glucose exposure were associated with lower risks of early anuria. In patients with diabetes mellitus, non-use of ACEI/ARBs was associated with early anuria. Early anuria was related to a higher risk for all-cause mortality and technique failure.

#2278 EUROCYS, a European cystinuria registry

Abstract Background and Aims Cystinuria (OMIM 220100) is a rare autosomal recessive disorder in which high urinary cystine excretion leads to formation of cystine stones due to its low solubility at normal urinary pH. Retrospective series have been published but precise data to guide long term optimal management of these patients are lacking. Our goal was to collect consistent and comparative prospective clinical, biological, genetic and radiological data from patients (children and adults) with cystinuria followed in European centers. Method We developed EUROCYS, a multidisciplinary, European, multicenter registry of patients with cystinuria in which demographic, clinical, surgical, biological, genetic, radiological and therapeutic data are collected longitudinally. These data are recorded via the European Rare Kidney Disease Registry (ERKReg) platform. Results Enrolment started in July 2021. To date, 269 patients have been included at 29 different centers in 8 European countries. Mean age at diagnosis was 18.7 years (SD 17.3) and mean age at inclusion was 35.4 years (20.2). 86.9% of patients had less than 9 calculi extractions reported, 11.0% had between 10 to 19, and 2.0% had more than 20. 61.4% (418/680) were treated by ureteroscopy, 16.2% (110/680) by shock wave lithotripsy and 16.0% (109/680) by percutaneous nephrolithotomy. 39% of patients had a new stone expulsion or surgery during the last 12 months. At the inclusion visit, mean urinary pH was below the recommended level at 6, 8 (0.8). Only 16.3% of patients had a urinary pH between 7.5 and 8: 77.2% of patients had a urinary pH below 7.5 and 6.3% above 8. In adults, mean 24-hour urinary volume was 2653 mL (1077). 34.9% had a target urine volume above 3000 ml. Under treatment, spot urine cystine concentration was 345.5 mg/l (255.2) and 44.8% of patients had a concentration below target concentration (250 mg/l). Mean sodium urinary excretion was 147 mmol/24 h (67). Only 29% of patients had a sodium urinary excretion below 100 mmol/24 h. As alkalinizing agent, 87.2% of patients received potassium citrate, 16.3% sodium bicarbonate and 9.1% potassium bicarbonate. As cystine binding drug, 71 patients (26.7%) were treated with Tiopronin and 3 experienced serious adverse events (hematological, cutaneous, proteinuria). 15 (5.6%) were treated with D-Penicillamine and 2 had adverse events (proteinuria and gastrointestinal). In adults, mean eGFR at inclusion was 82.1 ml/min/1.73 m² (26.3): 40.9% of patients were at chronic kidney disease (CKD) stage 1, 40.1% at CKD2, 16.7% at CKD3, 0.7% at CKD 4 and 1.5% at CKD5. Conclusion The EUROCYS registry shows real life data on cystinuria patients followed in European centers. Despite alkalinizing treatment, most patients do not reach the recommended urinary pH level and only one third have an adequate urinary volume. This registry will allow analyzing the impact of adhesion to recommendations on disease activity.

#1925 A rare cause of hyponatremia due to adrenal insufficiency in a patient with small cell lung cancer

Abstract Background and Aims Hyponatremia is the most frequent electrolyte disorder. Small Cell Lung Cancer (SCLC) release often antidiuretic hormone paraneoplastically. But Adrenal insufficiency is a rare cause of hyponatremia in SCLC. Prior one can cause euvolemic hyponatremia, latter one can cause hypovolemic hyponatremia. Opposite treatments should be applied for each one. So They should be investigated carefully before starting the treatment. Method A male patient who had metastatic SCLC was admitted to the emergency. After physical examination blood and urine tests were provided. Results A 52-year-old male patient who had metastatic SCLC was admitted to the emergency unit because of fatigue, weakness and confusion. On physical examination the patient's face was darkened but his conjunctiva was pale, his tongue and mucous membranes were dry. The blood pressure was 90/60 mm Hg. The test results provided were as follows: Glucose 106 mg/dL, creatinine 0.42 mg/dL, urea 38.1 mg/dL, sodium 109 mmol/L, potassium 3.3 mmol/L, white blood cells 9760 /mm3, hemoglobin: 9 g/dL, platelets: 176000/mm3. The patient had no chemotherapy during the last three months. He also did not have a history of antihypertensive treatment. The echocardiographic examination revealed that the ejection fraction was 60%. The abdominal computerized tomography scan showed multiple metastasis of the tumor, but adrenal glands were free of metastasis. The sodium deficit was calculated targeting to 120 mmol/L and therapy was started. The patient's weight was 70 kg. The calculated sodium deficit was 420 mmol. Since the hyponatremia was chronic, the deficit was planned to be given in 24 hours. Potassium was also given. During hospitalization, on day 2nd the patient's blood and urine tests were as follows: Creatinine 0.58 mg/dL, urine creatinine 22.8 mg/dL, 24-hour urine volume 2200 mL, 24-hour creatinine clearance 60 ml/min. Urine sodium concentration 105.6 mmol/L, serum sodium 114 mmol/L, sodium clearance: 1.41 ml/min. Fractional sodium excretion was 2.3%. Although the treatment was continued for 6 days, with the same dose of 420 mEq sodium given for each day, the serum sodium concentration reached to 115 mmol/L on day 6. (Totally, 2520 mEq of sodium was given for 6 days). Therefore, hyponatremia was thought to be due to urinary loss of sodium. The fractional sodium excretion of 2.3% supported this. All these findings suggested the diagnosis of renal salt wasting in this patient. We decided to give the patient fludrocortisone (Astonin H 0.1 mg) twice a day orally in addition to sodium chloride tablets (approximately 1.5 gram = 25-30 mmol). During the follow-up of the patient, the both fludrocortisone pills and salt tablets increased to 2 × 2, finally, when reached the level of sodium is above 130 mmol/L, salt tablets were stopped. One thing need to be noted here; hyponatremia did not improve unless giving fludrocortisone. But after this, although more sodium was given during sodium replacement, there was no increase in fractionated sodium excretion, on the contrary, it decreased. On day 14th, Fractional sodium elimination was 1.7%. Serum Na: 133 mmol/L. The patient was advised to take fludrocortisone tablets twice a day orally and was discharged from hospital on day 15th when serum sodium concentration was 138 mmol/L. If a patient with serum cortisol level below 4 mcg/dl have been evaluated as adrenal insufficiency regardless of ACTH level in sera.; additionally, hyperpigmentation and hyponatremia due to salt wasting through the kidneys led us to diagnose. The hyponatremia resolved only after added fludrocortisone. Conclusion However SCLC can give rise euvolemic hyponatremia producing ADH generally, besides, SCLC can cause adrenal insufficiency leading to serious hypovolemic hyponatremia. Diagnose is of crucial importance for correct treatment which can be only achieved by replacing the both sodium and fludrocortisone.

Evaluation of Drug-Drug Interaction Between Henagliflozin and Hydrochlorothiazide in Healthy Chinese Volunteers.

Henagliflozin is an original, selective sodium-glucose cotransporter 2 (SGLT2) inhibitor. Hydrochlorothiazide (HCTZ) is a common anti-hypertensive drug. This study aimed to evaluate the potential interaction between henagliflozin and HCTZ. This was a single-arm, open-label, multi-dose, three-period study that was conducted in healthy Chinese volunteers. Twelve subjects were treated in three periods, period 1: 25 mg HCTZ for four days, period 2: 10 mg henagliflozin for four days and period 3: 25 mg HCTZ + 10 mg henagliflozin for four days. Blood samples and urine samples were collected before and up to 24 hours after drug administrations on day 4, day 10 and day 14. The plasma concentrations of henagliflozin and HCTZ were analyzed using LC-MS/MS. The urine samples were collected for pharmacodynamic glucose and electrolyte analyses. Tolerability was also evaluated. The 90% CI of the ratio of geometric means (combination: monotherapy) for AUCτ,ss of henagliflozin and HCTZ was within the bioequivalence interval of 0.80-1.25. For henagliflozin, co-administration increased Css, max by 24.32% and the 90% CI of the GMR was (108.34%, 142.65%), and the 24-hour urine volume and glucose excretion decreased by 0.43% and 19.6%, respectively. For HCTZ, co-administration decreased Css, max by 19.41% and the 90% CI of the GMR was (71.60%, 90.72%), and the 24-hour urine volume and urinary calcium, potassium, phosphorus, chloride, and sodium excretion decreased by 11.7%, 20.8%, 11.8%, 11.9%, 22.0% and 15.5%, respectively. All subjects (12/12) reported adverse events (AEs), but the majority of theses AEs were mild and no serious AEs were reported. Although Css,max was affected by the combination of henagliflozin and HCTZ, there was no clinically meaningful safety interaction between them. Given these results, coadministration of HCTZ should not require any adaptation of henagliflozin dosing. ClinicalTrials.gov NCT06083116.

Choroidal Vascularity Index and Choroidal Structural Changes in Children With Nephrotic Syndrome.

To investigate the choroidal vascularity index (CVI) and choroidal structural changes in children with nephrotic syndrome. This was a cross-sectional study involving 45 children with primary nephrotic syndrome and 40 normal controls. All participants underwent enhanced depth imaging-optical coherence tomography examinations. An automatic segmentation method based on deep learning was used to segment the choroidal vessels and stroma, and the choroidal volume (CV), vascular volume (VV), and CVI within a 4.5mm diameter circular area centered around the macular fovea were obtained. Clinical data, including blood lipids, serum proteins, renal function, and renal injury indicators, were collected from the patients. Compared with normal controls, children with nephrotic syndrome had a significant increase in CV (nephrotic syndrome: 4.132 ± 0.464 vs. normal controls: 3.873 ± 0.574; P = 0.024); no significant change in VV (nephrotic syndrome: 1.276 ± 0.173 vs. normal controls: 1.277 ± 0.165; P = 0.971); and a significant decrease in the CVI (nephrotic syndrome: 0.308 [range, 0.270-0.386] vs. normal controls: 0.330 [range, 0.288-0.387]; P < 0.001). In the correlation analysis, the CVI was positively correlated with serum total protein, serum albumin, serum prealbumin, ratio of serum albumin to globulin, and 24-hour urine volume and was negatively correlated with total cholesterol, low-density lipoprotein cholesterol, urinary protein concentration, and ratio of urinary transferrin to creatinine (all P < 0.05). The CVI is significantly reduced in children with nephrotic syndrome, and the decrease in the CVI parallels the severity of kidney disease, indicating choroidal involvement in the process of nephrotic syndrome. Our findings contribute to a deeper understanding of how nephrotic syndrome affects the choroid.

Sex-Specific Association of Ambient Temperature With Urine Biomarkers in Southwest Coastal Bangladesh

IntroductionMen are vulnerable to ambient heat-related kidney disease burden, but limited evidence exists on how vulnerable women are when exposed to high ambient heat. We evaluated the sex-specific association between ambient temperature and urine electrolytes (concentration and 24-hour excretion), and 24-hour urine total protein, and volume. MethodsWe pooled a longitudinal data of 1,175 participants' concentration and 24-hour excretion of urine electrolytes and other biomarkers (24-hour urine total protein and volume) (5624 person-visits) collected in southwest coastal Bangladesh (Khulna, Satkhira, and Mongla districts) during November 2016 - April 2017. We then spatiotemporally linked ambient temperature data from local weather stations to participants' health outcomes. For evaluating the relationships between average ambient temperature and urine electrolytes and other biomarkers, we plotted confounder-adjusted restricted cubic spline (RCS) plots using participant-, household-, and community-level random intercepts. We then used piece-wise linear mixed-effects models for different ambient temperature segments determined by inflection points in RCS plots and reported the maximum likelihood estimates and cluster robust standard errors. By applying interaction terms for sex and ambient temperature, we determined the overall significance using the Wald test. Bonferroni correction was used for multiple comparisons. ResultsThe RCS plots demonstrated non-linear associations between ambient heat and urine biomarkers for males and females. Piecewise linear mixed-effects models suggested sex did not modify the relationship of ambient temperature with any of the urine parameters after Bonferroni correction (p-value <0.004). ConclusionOur findings suggest that women are as susceptible to the effects of high ambient temperature exposure as men.

Correlation between Neutrophil-to-Lymphocyte Ratio and Diabetic Neuropathy in Chinese Adults with Type 2 Diabetes Mellitus Using Machine Learning Methods.

One of the most frequent consequences of diabetes mellitus has been identified as diabetic peripheral neuropathy (DPN), and numerous inflammatory disorders, including diabetes, have been documented to be reflected by the neutrophil-to-lymphocyte ratio (NLR). This study aimed to explore the correlation between peripheral blood NLR and DPN, and to evaluate whether NLR could be utilized as a novel marker for early diagnosis of DPN among those with type 2 Diabetes Mellitus (T2DM). We reviewed the medical records of 1154 diabetic patients treated at Tongji Hospital Affiliated to Tongji University from January 2022 to March 2023. These patients did not have evidence of acute infections, chronic inflammatory status within the past three months. The information included the clinical, laboratory, and demographic characteristics of the patient. Finally, a total of 442 T2DM individuals with reliable, complete, and accessible medical records were recruited, including 216 T2DM patients without complications (DM group) and 226 T2DM patients with complications of DPN (DPN group). One-way ANOVA and multivariate logistic regression were applied to analyze data from the two groups, including peripheral blood NLR values and other biomedical indices. The cohort was divided in a 7 : 3 ratio into training and internal validation datasets following feature selection and data balancing. Based on machine learning, training was conducted using extreme gradient boosting (XGBoost) and support vector machine (SVM) methods. K-fold cross-validation was applied for model assessment, and accuracy, precision, recall, F1-score, and the area under the receiver operating characteristic curve (AUC) were used to validate the models' discrimination and clinical applicability. Using Shapley Additive Explanations (SHAP), the top-performing model was interpreted. The values of 24-hour urine volume (24H UV), lower limb arterial plaque thickness (LLAB thickness), carotid plaque thickness (CP thickness), D-dimer and onset time were significantly higher in the DPN group compared to the DM group, whereas the values of urine creatinine (UCr), total cholesterol (TC), low-density lipoprotein (LDL), alpha-fetoprotein (AFP), fasting c-peptide (FCP), and nerve conduction velocity and wave magnitude of motor and sensory nerve shown in electromyogram (EMG) were considerably lower than those in the DM group (P < 0.05, respectively). NLR values were significantly higher in the DPN group compared to the DM group (2.60 ± 4.82 versus 1.85 ± 0.98, P < 0.05). Multivariate logistic regression analysis revealed that NLR (P = 0.008, C = 0.003) was a risk factor for DPN. The multivariate logistic regression model scores were 0.6241 for accuracy, 0.6111 for precision, 0.6667 for recall, 0.6377 for F1, and 0.6379 for AUC. Machine learning methods, XGBoost and SVM, built prediction models, showing that NLR can predict the onset of DPN. XGBoost achieved an accuracy of 0.6541, a precision of 0.6316, a recall of 0.7273, a F1 value of 0.6761, and an AUC value of 0.690. SVM scored an accuracy of 0.5789, a precision of 0.5610, a recall of 0.6970, an F1 value of 0.6216, and an AUC value of 0.6170. Our findings demonstrated that NLR is highly correlated with DPN and is an independent risk factor for DPN. NLR might be a novel indicator for the early diagnosis of DPN. XGBoost and SVM models have great predictive performance and could be reliable tools for the early prediction of DPN in T2DM patients. This trial is registered with ChiCTR2400087019.

Evaluation of the clinical value of sodium examination in spot urine in patients presenting with acute heart failure while using SGLT2i – ‘‘SPOT HF STUDY’’

Objectives: Sodium measurement in spot urine provides important information about the adequacy of the initial dose in acute heart failure (AHF) patients using intravenous diuretic (IV) and makes a guiding contribution to the titration decision. It is not clear whether spot urine sodium measurement has the same clinical value as the effect of sodium-glucose cotransporter 2 inhibitor (SGLT2i) drugs on urinary electrolytes. Our aim in our study is to investigate the clinical value of sodium examination in spot urine in AHF patients while using SGLT2i. Methods: Our study was conducted retrospectively and single-centered. AHF patients, administered IV diuretics were included in the study. Patients who were using and were not using SGLT2i were examined in two groups. The 2nd and 6th-hour sodium values in spot urine were measured. Results: Patients using SGLT2i (n = 46) and not using it (n = 54) were included. The mean age was 69.91 ± 11.84 years and 47% were female. The standard deviation value for the sodium in spot urine in patients using SGLT2i was clearly high and its distribution was significantly higher. A weak correlation was found between the sodium value in spot urine and the 24-hour urine volume in this group. Hospitalization history within 1 month after discharge was found to be 39% in the group using SGLT2i, and 51% in the group that did not use it, and this difference was statistically significant. Conclusions: The measurement of sodium in spot urine does not seem to have the same clinical value in HF patients using SGLT2i. Its correlation with urine volume is also decreasing in this group.

A Case Report of Intracranial Germ Cell Tumor-Induced Central Diabetes Insipidus in a Child Treated with Korean Herbal Medicine

Objective: The purpose of this study is to report the case of intracranial germ cell tumor-induced central diabetes insipidus (CDI) in a child treated with Korean herbal medicine.Methods: A nine-year-old female patient diagnosed with intracranial germ cell tumor-induced CDI suffering from polyuria, polydipsia, and headache was hospitalized. Nocturia frequency and 24-hour urine volume were assessed.Results: The patient was treated with Korean medicine, including &lt;i&gt;Nokyong-hwan&lt;/i&gt;. As a result of the 6-day inpatient treatment, nocturia frequency was decreased 3-4 times to 0-1 time, and 24-hour urine volume was decreased.Conclusion: Korean medicine, including &lt;i&gt;Nokyong-hwan&lt;/i&gt;, may be considered an optional treatment for releasing the symptoms of intracranial germ cell tumor-induced CDI. Further studies are needed to confirm this finding.

Prevalence Of Metabolic Disorders In Paediatric Age Group with Renal Stone Diseases.

Background: inflammation of the urinary tract and prostatic disease is urolithiasis. The causes are numerous , with metabolic diseases , individual life style and environmental factors all playing a part. In pediatric populations , the prevalence of nephrolithiasis is very low; however, some evidence suggests that children are increasingly likely to get this disease. Kidney stone diseases are becoming more frequent among young people, and although the absolute figure remains smaller than in adults , this complex situation however it is should be stressed that factor consists of metabolic disorders such as hypocitraturia, hypercalciuria, and hyperoxaluria. The process of stone production is subject to several factors , for example genetic predisposition , familial background and dietary habits. A commonly employed approach in the prompt identification and treatment of kidney stones involves implementing a comprehensive strategy that tackles both the stones themselves as well as their underlying metabolic problems. It is still necessary to keep on doing research in the area of Pediatric Urology. Only by continuing to do this work will our understanding be deepened and our treatment methods refined in the dynamic world of modern medical science. Objectives: To find out the prevalence of metabolic abnormalities in young children with urolithiasis . Study design: A Retrospective Study Place and duration of the study : Department Of Urology Main Gul Jehanzeb Hospital Swat In Pakistan From January 2018 To January 2019. Methods: From April 2018 to August 2019, the Department Of Urology Main Gul Jehanzeb Hospital Swat carried out a retrospective study. The retrospective study was aimed at analyzing the medical records of 59 patients under the age of 15-year-old with renal stone disease living in this region. Basic details such as age, sex, body mass index (BMI),creatinine levels, serum calcium, serum phosphate, serum uric acid levels, 24-hour urine volume, urinary sodium potassium and chloride content were all obtained and analyzed carefully. The identifications of metabolic diseases were carried out according to recognized laboratory standards. Data processing was performed using SPSS version 22. Results: A total of fifty-nine people ranging from age 8 to 15 years old underwent this study. Of these 25 (42.4%) were female and 34 (57.6%) were male. The mean BMI which the patients exhibited was 16.68 kg/m2. However according to the investigation results, 32 patients (54.2%) had metabolic abnormalities associated with renal stone disease. Hyperuricemia (22%), hypercalciuria (25.4%) and hypokalemia (40.7%) were the three most common diseases identified. Hyperphosphaturia (1.7%), hypocitraturia (1.7%), hyperoxaluria (3%), low urine volume (6.8%) were also found among other types of metabolic abnormalities discovered. Conclusion: According to this study, a large number of children (54.2%) with stone disease in the kidney also had associated metabolic disorders. Hypokalemia was the most common metabolic abnormality in children (40.7%), followed by hypercalciuria (25.4%) and hyperuricemia (22%). These results suggest that children with stone disease in the kidney should be carefully examined for metabolic defects. Primary and secondary prevention methods must be explored in future in order to reduce the occurrence of these problems. Keywords: children with metabolic disorders, kidney stones, hypercalciuria, hypokalemia, and hyperuricemia are frequently seen

Effects of intra-aortic balloon pump on in-hospital outcomes and 1-year mortality in patients with acute myocardial infarction complicated by cardiogenic shock

BackgroundThe role of intra-aortic balloon counterpulsation (IABP) in cardiogenic shock complicating acute myocardial infarction (AMI) is still a subject of intense debate. In this study, we aim to investigate the effect of IABP on the clinical outcomes of patients with AMI complicated by cardiogenic shock undergoing percutaneous coronary intervention (PCI).MethodsFrom the Medical Information Mart for Intensive Care (MIMIC)-IV 2.2, 6017 AMI patients were subtracted, and 250 patients with AMI complicated by cardiogenic shock undergoing PCI were analyzed. In-hospital outcomes (death, 24-hour urine volumes, length of ICU stays, and length of hospital stays) and 1-year mortality were compared between IABP and control during the hospital course and 12-month follow-up.ResultsAn IABP was implanted in 30.8% (77/250) of patients with infarct-related cardiogenic shock undergoing PCI. IABP patients had higher levels of Troponin T (3.94 [0.73–11.85] ng/ml vs. 1.99 [0.55–5.75] ng/ml, p-value = 0.02). IABP patients have a longer length of ICU and hospital stays (124 [63–212] hours vs. 83 [43–163] hours, p-value = 0.005; 250 [128–435] hours vs. 170 [86–294] hours, p-value = 0.009). IABP use was not associated with lower in-hospital mortality (33.8% vs. 33.0%, p-value = 0.90) and increased 24-hour urine volumes (2100 [1455–3208] ml vs. 1915 [1110–2815] ml, p-value = 0.25). In addition, 1-year mortality was not different between the IABP and the control group (48.1% vs. 48.0%; hazard ratio 1.04, 95% CI 0.70–1.54, p-value = 0.851).ConclusionIABP may be associated with longer ICU and hospital stays but not better short-and long-term clinical prognosis.

Evaluation of ultrafiltrated fluid overloaded patients: a single center study

Aims: Fluid overloaded patients with heart or renal insufficiency have poor quality of life and increased morbidity and mortality. In this study, we aimed to investigate the factors affecting the prognosis in patients who presented with fluid overload and were ultrafiltered.&#x0D; Methods: Three groups of patients were compared: Group 1: Patients with chronic kidney disease and ejection fraction ≤ 40%; Group 2: Patients with chronic kidney disease and ejection fraction &gt; 40%; Group 3: Patients with ejection fraction ≤ 40% but without chronic kidney disease. Patients were also evaluated regarding mortality.&#x0D; Results: Group 1, 2 and 3 consisted of 14, 62 and 16 patients: respectively. There were statistically significant results for 24-hour urine volume (p=0.040), proteinuria (p=0.010), ultrafiltration volume/weight at hospitalization (p

The effects of renal dopaminergic system on the development of hypertension with high salt diet and L-NNA administration

Objective: We aimed to investigate the intrarenal dopamine synthesis efficiency, blood pressure changes and the effects of this system on hypertension developed by NOS inhibition and high salt diet. Method: Wistar Albino male rats were administered water containing 50mg/L or 100mg/L concentrations of L-NNA, standard rat feed containing 0.8%salt, or 4%high salt alone or with L-NNA for 7days. Blood pressure measurements were made with the tail-cuff method. 24-hour water intake and urine volume were also measured. Results: Administration of L-NNA or high-salt diet alone for 7days did not cause a change in blood pressure, while their combined administration resulted in a significant increase in blood pressure. Blood pressures were found to be higher in the L-NNA100+HS group compared to the other groups. While the amount of water intake in 24hours did not change, the amount of 24-hour urine was reduced. 24-hour urinary sodium excretion, sodium clearance and GFR was decreased, and 24-hour urine dopamine concentrations were increased. Conclusion: Co-administration of nitric-oxide inhibitor and high-salt diet failed to prevent renal dopaminergic system blood pressure increase. Despite the increase in dopamine synthesis, intrarenal dopamine activity could not be realized by receptor interaction and it is thought that the increase in blood pressure is caused by the development of renal oxidative stress.

Feasibility of Mini sipIT Behavioral Intervention to Increase Urine Volume in Patients With Kidney Stones

To determine the feasibility and acceptability of mini sipIT, a context-sensitive reminder system that incorporates a connected water bottle and mobile app with text messaging, for kidney stone patients who have poor adherence to increasing fluid intake for prevention. Patients with a history of kidney stones and urine volume <2L/d participated in a 1-month single-group feasibility trial. Patients used a connected water bottle and received text message reminders when fluid intake goals weren't met. Perceptions of drinking behavior, intervention acceptability, and 24-hour urine volumes were obtained at baseline and 1-month. Patients with a history of kidney stones were enrolled (n = 26, 77% female, age=50.4 ± 14.2years). Over 90% of patients used the bottle or app daily. Most patients perceived that mini sipIT intervention helped them to increase their fluid intake (85%) and reach their fluid intake goals (65%). There was a significant increase in average 24-hour urine volume after the 1-month intervention compared to baseline (2006.5 ± 980.8 mL vs 1352.7 ± 449.9 mL, t (25)= 3.66, P = .001, g= 0.78), with 73% of patients having higher 24-hour urine volumes at the end of the trial. Mini sipIT behavioral intervention and outcome assessments are feasible for patients and may lead to significant increases in 24-hour urine volume. Digital tools in combination with behavioral science may improve adherence to fluid intake recommendations for kidney stone prevention, however, rigorous efficacy trials are necessary.

#5157 ESTIMATION OF RENAL KT/V FROM 24-HOUR URINE VOLUME AND UREA DISTRIBUTION VOLUME IN PERITONEAL DIALYSIS

Abstract Background and Aims Residual renal function is an important factor in peritoneal dialysis (PD) regarding technical survival and implementation of incremental therapy schemes. The aim of the retrospective study was to develop an estimation formula of renal Kt/Vurea in PD based on urine output and anthropometric data. Method In 235 adult PD patients (151 males, 84 females, median age 66 years, median BMI 26.0, diuresis &amp;gt;100 ml/day) urine output was registered together with anthropometric and lab data during the first peritoneal equilibration test. The dose of furosemide therapy was noted. Urea distribution volume calculated using the formula of DuBois. Measurement of urea in blood and urine was performed by a standard kinetic test with urease. Results 24-hour urine volume ranged from 100 to 3800 ml (median 1150 ml), similar in both sexes. Renal Kturea showed a significant linear correlation to daily urine volume (r=0.78, p&amp;lt;0.01) independent from sex and diuretic dose: renal Kturea = 5.116 + 0.0221 x 24-hour urine volume (renal Kturea in liters/week, 24-hour urine volume in ml). Urea distribution volume varied between 24 and 60 liters (median 36.4 liters), and calculated renal Kt/V ranged from 0.05 to 2.57 (median 0.84). Estimated renal Kt/V, based on the before mentioned equation divided by urea distribution volume, correlated significantly to calculated renal Kt/V (r=0.75, p&amp;lt;0.01). The goodness of fit analysis showed a mean absolute error of 0.24. The Bland-Altman Plot confirmed a tendency of over-estimation for renal Kt/V &amp;lt; 1.0 and under-estimation for higher renal Kt/V. A restriction of the analysis to 24-hour urine volume up to 1500 ml (n=142 patients, median age 69 years, BMI 25) resulted in an improvement of renal Kt/V estimation (goodness of fit analysis: mean absolute error 0.20). Conclusion The estimation of renal Kt/V in PD patients seems to be feasible utilizing 24-hour urine volume and anthropometric data.

#4949 COMBINED ORAL DIURETICS: A BETTER ALTERNATIVE FOR NEPHROTIC EDEMA THAN INTRAVENOUS FUROSEMIDE?

Abstract Background and Aims Edema is a serious complication of nephrotic syndrome and is the main reason why patients usually address to a doctor. There is no guideline on managing nephrotic edema. Besides non pharmacological interventions such as sodium and water restrictions, most doctors would choose high doses of intravenous furosemide as the first option, but still many patients fail to properly decrease their volume overload, as they become diuretic resistant. Amiloride, an ENaC mediated diuretic, is an optimistic management option, especially when used with other diuretics. The aim of the present study was to assess the non inferiority of the combined oral diuretics furosemide and the fixed combination of hydrochlorothiazide/amiloride diuretics with intravenous furosemide in diuretic resistant nephrotic edema. Method We conducted a prospective randomized trial in 22 patients with diuretic resistant nephrotic edema. Based on a computer-generated randomization we assigned patients to receive either intravenous furosemide (40 mg bolus and then continuous administration of 5 mg/h) or oral furosemide (40 mg/day) and hydrochlorothiazide/amiloride (50/5 mg/day). Clinical and laboratory measurements were performed daily, for five days (body weight, urinary output, blood pressure and hydration status by bioimpedance twice, creatinine, urea, albumin, hematocrit, Na, K, Ca, Mg, bicarbonate, pH). The primary outcome was weight and hydration status change from baseline to day 5. Secondary outcomes were safety outcomes (low blood pressure, severe dyselectrolytemia, acute kidney injury or aggravated hypervolemia). Results The patients were equally distributed between the two groups. Mean age was 47,77±15,97 (54,5% females and 45,5% males). Half of the patients had membranous nephropathy (45,5%), followed by minimal change disease (22,7%) and lupus nephritis (9,1%). 86,4% of patients had their first episode of nephrotic edema. The mean weight decrease was of significantly larger magnitude in the combined oral diuretics group compared with the intravenous furosemide group (-7,97±2,83 [SD] vs -4,5±2,6 [SD] kg; p = 0,018). Although the increase in 24-hour urine sodium excretion was higher in combined oral diuretics as compared to intravenous furosemide group, this increment was not statistically significant different (26,79±33,48 [SD] vs 16,04±42,81 mmol/24 h [SD]; p = 0,5). Mean values for changes in systolic and diastolic BP, 24-hour urine volume, hydration status measured by bioimpedance were not significantly different between the two groups. A total of 5 patients could not be followed through, 4 in the intravenous furosemide (two patients experienced low blood, one patient had no response to iv furosemide and one patient suffered from insomnia due to iv pump) and one patient in the oral combination of diuretics group had severe hyperkalemia (&amp;gt;6,5 mmol/l). Conclusion Combined oral diuretics with furosemide, amiloride and hydrochlorothiazide is more effective and safer than intravenous furosemide for the treatment of refractory nephrotic edema. These results make amiloride a promising diuretic and further trials with larger sample sizes and longer follow-up are needed in this regard.