Incidence Of Acute Renal Failure Research Articles

Renal impairment and outcome in Takotsubo syndrome: Insights from a national multicentric cohort

IntroductionData on the association between kidney function and Takotsubo syndrome (TTS) outcomes are scarce and conflictive. ObjectiveTo assess the impact of chronic kidney disease (CKD) and acute renal failure (ARF) in patients with TTS. Material and methodsPatients from the prospective nation-wide (RETAKO) registry were included and divided into quartiles of maximum creatinine (Cr) level during hospitalization. ResultsThe prevalence of CKD and ARF in the whole RETAKO cohort was 5.4% and 11.7%, respectively. Compared to Q1 (Cr <0.71), patients within Q4 (Cr > 1.1) had lower left ventricular ejection fraction on admission (38.5 ± 12 vs 43.3 ± 11.3, p = 0.002) and higher bleeding rates during hospitalization (6.7% vs 2%, p = 0.005). In addition, compared to Q1, Q4 patients have a greater incidence of cardiogenic shock (17.3% vs 5.6%, p < 0.001), and a higher rate of 5-year all-cause death and major adverse cardiovascular events (31.5% vs 15.8%, p < 0.001 and 22.5% vs 9.3%, p < 0.001, respectively). ConclusionsTTS patients with CKD have a higher incidence of ARF and exhibit greater Cr on admission, which were linked with higher rates of cardiogenic shock, bleeding during hospitalization as well as major adverse cardiovascular events and all-cause death during a 5-year follow-up.

Helicobacter pylori Eradication Therapy in Patients with Decreased Renal Function: A Systematic Review

Background: There are concerns that Helicobacter pylori eradication therapy may worsen kidney function in patients with decreased renal function. This study aimed to systematically review the literature regarding Helicobacter pylori eradication in patients with renal impairment. Methods: PubMed, the Cochrane Library, and Igaku Chuo Zasshi were searched for comparative studies on H. pylori eradication in patients with renal impairment. Results: Five articles were included in this systematic review. According to a randomized trial comparing a proton pump inhibitor (PPI) + clarithromycin + metronidazole and PPI + clarithromycin + amoxicillin in patients with decreased renal function, the incidence of acute renal failure was significantly lower in PPI + clarithromycin + metronidazole (2%: 1/44) than in PPI + clarithromycin + amoxicillin (18%: 8/44). The eradication rate in PPI + clarithromycin + metronidazole (92.5%) was significantly better than that in PPI + clarithromycin + amoxicillin (76.3%). According to four reports on eradication treatment using PPI + clarithromycin + amoxicillin in patients with and without decreased renal function, the eradication rates and adverse effects were similar in both groups. Regarding dose adjustment, three reports reduced the dose of antibiotics by half in patients with a creatinine clearance of 30 mL/min or less. Conclusions: The regimen with PPIs, clarithromycin, and metronidazole is recommended for renal impairment. The combination of PPIs, clarithromycin, and amoxicillin, at reduced doses depending on the renal function, is also a potential option.

Hospital characteristics and perioperative complications of Hispanic patients following reverse shoulder arthroplasty—a large database study

BackgroundHispanic patients are the youngest and fastest-growing ethnic group in the USA. Many of these patients are increasingly met with orthopedic issues, often electing to undergo corrective procedures such as reverse shoulder arthroplasty (RSA). This patient population has unique medical needs and has been reported to have higher incidences of perioperative complications following major procedures. Unfortunately, there is a lack of information on the hospitalization data and perioperative complications in Hispanic patients following procedures such as RSA. This project aimed to query the Nationwide Inpatient Sample (NIS) database to assess patient hospitalization information, demographics, and the prevalence of perioperative complications among Hispanic patients who received RSA.MethodsInformation from 2016–2019 was queried from the NIS database. Demographic information, incidences of perioperative complications, length of stay, and costs of care among Hispanic patients undergoing RSA were compared to non-Hispanic patients undergoing RSA. A subsequent propensity matching was conducted to consider preoperative comorbidities.ResultsThe query of NIS identified 59,916 patients who underwent RSA. Of this sample, 2,656 patients (4.4%) were identified to be Hispanic, while the remaining 57,260 patients (95.6%) were found to belong to other races (control). After propensity matching, Hispanic patients had a significantly longer LOS (median = 1.4 days) than the patients in the control group (median = 1.0, P < 0.001). The Hispanic patients (89,168.5 USD) had a significantly higher cost of care than those in the control group (67,396.1 USD, P < 0.001). In looking at postoperative complications, Hispanic patients had increased incidences of acute renal failure (Hispanics: 3.1%, control group: 1.1%, P = 0.03) and blood loss anemia (Hispanics: 12.7%, control group: 10.9%, P = 0.03).ConclusionsHispanic patients had significantly longer lengths of stay, higher costs of care, and higher rates of perioperative complications compared to the control group. For patients who are Hispanic and undergoing RSA, this information will aid doctors in making comprehensive decisions regarding patient care and resource allocation.

The incidence of acute renal failure and high mortality rate in elderly patients hospitalized with community acquired pneumonia

Community acquired pneumonia is associated with high mortality and health care costs, especially in old age. The clinical presentation of pneumonia in the elderly may be asymptomatic or atypical. One of the known complication is an acute kidney injury. The purpose of our study was to estimate the incidence of this complication in elderly patients hospitalized with pneumonia in our geriatric hospital.From a group of 180 elderly patients hospitalized with community-acquired pneumonia 34.4 % developed acute kidney injury. In this group, 51.6 % of patients died compared to 14.4 % in the group of patients without acute kidney injury (p < 0.001). The lower level of e-GFR was significantly associated with mortality (p < 0.001): out of seven patients with e-GFR level of 15–29 mg/mmol, five patients died (71.4 %).Elderly patients with community-acquired pneumonia suffering acute kidney injury experienced worse in-hospital outcomes; mortality rate was significantly higher in our study. We found a relationship between low level of e-GFR and mortality. Clinicians should be alert for early detection and prevention of kidney injury in patients admitted with pneumonia.

Perioperative complications following open or endovascular revascularization for chronic limb-threatening ischemia in the BEST-CLI Trial

ObjectiveAnticipated perioperative morbidity is an important factor for choosing a revascularization method for chronic limb-threatening ischemia (CLTI). Our goal was to assess systemic perioperative complications of patients treated with surgical and endovascular revascularization in the Best Endovascular vs Best Surgical Therapy in Patients with CLTI (BEST-CLI) trial. MethodsBEST-CLI was a prospective randomized trial comparing open (OPEN) and endovascular (ENDO) revascularization strategies for patients with CLTI. Two parallel cohorts were studied: Cohort 1 included patients with adequate single-segment great saphenous vein (SSGSV), whereas Cohort 2 included those without SSGSV. Data were queried for major adverse cardiovascular events (MACE–composite myocardial infarction, stroke, death), non-serious (non-SAEs) and serious adverse events (SAEs) (criteria–death/life-threatening/requiring hospitalization or prolongation of hospitalization/significant disability/incapacitation/affecting subject safety in trial) 30 days after the procedure. Per protocol analysis was used (intervention received without crossover), and risk-adjusted analysis was performed. ResultsThere were 1367 patients (662 OPEN, 705 ENDO) in Cohort 1 and 379 patients (188 OPEN, 191 ENDO) in Cohort 2. Thirty-day mortality in Cohort 1 was 1.5% (OPEN 1.8%; ENDO 1.3%) and in Cohort 2 was 1.3% (2.7% OPEN; 0% ENDO). MACE in Cohort 1 was 4.7% for OPEN vs 3.13% for ENDO (P = .14), and in Cohort 2, was 4.28% for OPEN and 1.05% for ENDO (P = .15). On risk-adjusted analysis, there was no difference in 30-day MACE for OPEN vs ENDO for Cohort 1 (hazard ratio [HR] 1.5; 95% confidence interval [CI], 0.85-2.64; P = .16) or Cohort 2 (HR, 2.17; 95% CI, 0.48-9.88; P = .31). The incidence of acute renal failure was similar across interventions; in Cohort 1 it was 3.6% for OPEN vs 2.1% for ENDO (HR, 1.6; 95% CI, 0.85-3.12; P = .14), and in Cohort 2, it was 4.2% OPEN vs 1.6% ENDO (HR, 2.86; 95% CI, 0.75-10.8; P = .12). The occurrence of venous thromboembolism was low overall and was similar between groups in Cohort 1 (OPEN 0.9%; ENDO 0.4%) and Cohort 2 (OPEN 0.5%; ENDO 0%). Rates of any non-SAEs in Cohort 1 were 23.4% in OPEN and 17.9% in ENDO (P = .013); in Cohort 2, they were 21.8% for OPEN and 19.9% for ENDO (P = .7). Rates for any SAEs in Cohort 1 were 35.3% for OPEN and 31.6% for ENDO (P = .15); in Cohort 2, they were 25.5% for OPEN and 23.6% for ENDO (P = .72). The most common types of non-SAEs and SAEs were infection, procedural complications, and cardiovascular events. ConclusionsIn BEST-CLI, patients with CLTI who were deemed suitable candidates for open lower extremity bypass surgery had similar peri-procedural complications following either OPEN or ENDO revascularization: In such patients, concern about risk of peri-procedure complications should not be a deterrent in deciding revascularization strategy. Rather, other factors, including effectiveness in restoring perfusion and patient preference, are more relevant.

Prioridades de investigación en términos de fluidoterapia perioperatoria y monitorización hemodinámica: encuesta de consenso Delphi del Subcomité de Fluidoterapia y Monitorización hemodinámica de la Sección de Hemostasia, Medicina Transfusional y Fluidoterapia (SHTF) de la Sociedad española de Anestesiología y Reanimación (SEDAR)

BackgroundResearch on perioperative fluid therapy and hemodynamic monitoring is difficult and expensive. The objectives of the present study were to summarize and prioritize these issues, in order of research importance. research importance. MethodsStructured electronic Delphi questionnaire over three rounds among 30 experts in fluid therapy and hemodynamic monitoring identified through the Subcommittee on Fluid Therapy and Hemodynamic Monitoring Subcommittee of the Hemostasis, Transfusion Medicine and Fluid Therapy Section of the Spanish Society of Anesthesiology and Resuscitation. Results77 issues were identified, which were ranked in order of prioritization. The were categorized into crystalloid, colloid, hemodynamic monitoring and others. and others. Thirty-one issues were categorized as of essential research priority, to determine whether intraoperative hemodynamic optimization algorithms based on the index of invasive or noninvasive hypotension prediction index versus other management strategies could reduce the incidence of postoperative reduce the incidence of postoperative complications, as well as whether the use of biomarkers of renal stress in conjunction biomarkers of renal stress in conjunction with a goal-directed fluid therapy protocol could reduce hospital stay and the hospital stay and the incidence of acute renal failure in adult patients undergoing non-cardiac surgery, and whether the non-cardiac surgery, achieving the highest consensus. ConclusionsThe Subcommittee on Fluid Therapy and Hemodynamic Monitoring of the Section of Hemostasis, Transfusion Medicine and Fluid Therapy of the Spanish Society of Anesthesiology and Resuscitation of the Spanish Society of Anesthesiology and Resuscitation will use these results for further research.

Electrochemical Sensing of Urinary Chloride Ion Concentration for Near Real-Time Monitoring.

Urinary chloride concentration is a valuable health metric that can aid in the early detection of serious conditions, such as acid base disorders, acute heart failure, and incidences of acute renal failure in the intensive care unit. Physiologically, urinary chloride levels frequently change and are difficult to measure, involving time-consuming and inconvenient lab testing. Thus, near real-time simple sensors are needed to quickly provide actionable data to inform diagnostic and treatment decisions that affect health outcomes. Here, we introduce a chronopotentiometric sensor that utilizes commercially available screen-printed electrodes to accurately quantify clinically relevant chloride concentrations (5-250 mM) in seconds, with no added reagents or electrode surface modification. Initially, the sensor's performance was optimized through the proper selection of current density at a specific chloride concentration, using electrical response data in conjunction with scanning electron microscopy. We developed a unique swept current density algorithm to resolve the entire clinically relevant chloride concentration range, and the chloride sensors can be reliably reused for chloride concentrations less than 50 mM. Lastly, we explored the impact of pH, temperature, conductivity, and additional ions (i.e., artificial urine) on the sensor signal, in order to determine sensor feasibility in complex biological samples. This study provides a path for further development of a portable, near real-time sensor for the quantification of urinary chloride.

Factors Affecting Perioperative Period Renal Function in Nephrectomies

Patients who have had a nephrectomy usually have a history of renal dysfunction or are at risk for kidney failure due to tissue loss during surgery. In this study, our aim was to evaluate the factors affecting acute renal function in nephrectomy surgeries under general anesthesia. Demographic data of patients, case type, surgery type, duration of anesthesia, intraoperative lactate level, and postoperative complications of patients who underwent nephrectomy in our clinic were reviewed. Renal function was compared with urea, creatinine and estimated glomerular filtration rate (eGFR) levels in the preoperative (2 days before surgery) and postoperative period (day 2). The mean age of the patient was 58.2 ± 13.02 years, duration of anesthesia 166.24 ± 53.01/min, pre-operative eGFR 84.71 (67.69-90.0) mL/min/1.73 m2, and postoperative eGFR 65.09 (47.91-87.44) mL/min/1.73 m2 were respectively. When the pre- and postoperative renal functions of the patients were compared, the statistically significant results were those of urea (p: 0.01), creatinine (p:0.01), and GFR (p:0.01). The factors affecting GFR decrease were age (p:0.01) and case type (p:0.01). Increase in lactate levels in the postoperative period compared to the preoperative levels was statistically significant (p: 0.01). The increase in lactate levels was associated with complications (p: 0.001), case type (p:0.01) and surgery type (p: 0.01). Conclusions: The incidence of acute renal failure is increasing in nephrectomy surgeries, especially in radical ones. Age and case type are also the most important parameters to be consider.

Management of CVVHDF for Acute Renal Failure Patients with Sepsis After Post Exploratory Laparotomy Colonic Resection in Intensive Care Unit: A Case Report

Acute renal failure (ARF) is a condition that may occurs in susceptible postoperative patients. The incidence of ARF reaches 30−60% and it is more after major surgery (e.g., laparotomy, heart surgery). It is often caused by hypovolemia, hypoperfusion, and systemic inflammation. Laparotomy is a major and complex operation that can lead to complications including ARF, acute pulmonary edema, sepsis, and increased morbidity and mortality.&#x0D; A 76-year-old female patient underwent exploratory laparotomy for acute abdominal indications with suspected obstructive ileus with sepsis. Postoperatively, the patient was treated in the ICU using a ventilator. On the third day the patient's renal function and urine volume decreased. Creatinine level 5.19 mg/dL, urea 217 mg/dL and urine was 0.2 ml/kg/h. The patient was given diuretics but she did not show clinical and laboratory improvement. We decided to perform hemodialysis with continuous veno-venous hemodiafiltration (CVVHDF) mode because the patient was in septic condition and hemodynamic instability. CVVHDF was performed for three days, periodic laboratory examinations were performed to assess the patient's renal function. After three days CVVHDF, the clinical and laboratory indices improved and the patient could be extubated. Hemodialysis with CVVHDF mode has benefits in ARF, especially if the patient has unstable hemodynamics.&#x0D; Key words: Acute Renal Failure; CVVHDF; Hemodialysis, Laparotomy, Sepsis&#x0D; Citation: Bangun YG, Hidayat H. Management of acute renal failure with CVVHDF in a patient with sepsis after post exploratory laparotomy: a case report. Anaesth. pain intensive care 2022;27(1):131−134.&#x0D; DOI: 10.35975/apic.v27i1.2086&#x0D; Received: December 11, 2022; Reviewed: December 22, 2022; Accepted: January 12, 2023

How does sickle cell disease affect the peri-operative outcome in patients undergoing total knee arthroplasty? A large-scale, National Inpatient Sample-based study.

In view of the vaso-occlusive pathophysiology affecting osseous micro-circulation, sickle cell disease (SCD) is well known to present with diverse skeletal and arthritic manifestations. With prolonged life-expectancy over the past decades, there has been a progressive increase in the proportion of SCD patients requiring joint reconstructions. Owing to the paucity of evidence in the literature, the post-operative complication rates and outcome in these patients following total knee arthroplasty (TKA) are still largely unknown. Based on the National Inpatient Sample (NIS) database (using ICD-10 CMP code), patients who underwent TKA between 2016 and 2019 were identified. The cohort were classified into two groups: A-those with SCD; and B-those without. The data on patients' demographics, co-morbidities, details regarding hospital stay including expenditure incurred, and complications were analyzed and compared. Overall, 558,361 patients underwent unilateral, primary TKA; among whom, 493 (0.1%) were known cases of SCD (group A). Group A included a significantly greater proportion of younger (60.14 ± 10.87 vs 66.72 ± 9.50years; p < 0.001), male (77.3 vs 61.5%; p < 0.001); and African-American (88.2 vs 8.3%B; p < 0.001) patients, in comparison with group B. Group A patients were also at a significantly higher risk for longer duration of peri-operative hospital stay (p < 0.001), greater health-care costs incurred (p < 0.001), and greater need for alternative step-down health-care facilities (p < 0.001) following discharge. Among the SCD patients, 24.7%, 20.9% and 24.9% developed acute chest syndrome, pain crisis and splenic sequestration crisis, respectively during the peri-operative period. Group A patients had a statistically greater incidence of acute renal failure (ARF; p = 0.014), need for blood transfusion (p < 0.001) and deep vein thrombosis (DVT; p = 0.03) during the early admission period. The presence of SCD substantially lengthens the duration of hospital stay and enhances health care-associated expenditure in patients undergoing TKA. SCD patients are at significantly higher risk for systemic complications including acute chest syndrome, pain crisis, splenic sequestration crisis, acute renal failure, higher need for blood transfusions and deep venous thrombosis during the initial peri-operative period following TKA.

ERCP management of acute cholangitis caused by rupture of Echinococcus hepaticus into the biliary tract.

Hepatic cystic echinococcosis (HCE) rupture into the biliary tract, one of the most common and refractory complications, is treated by laparotomy to remove hydatid lesions. The aim of this article was to investigate the role of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of this particular disease. This was is a retrospective analysis of 40 patients with HCE ruptured into the biliary tract in our hospital from September 2014 to October 2019. They were divided into two groups, ERCP group (group A, n = 14) and conventional surgery group (group B, n = 26). Group A was treated with ERCP first to control infection and improve the general condition before undergoing laparotomy at an optional stage while group B was treated with laparotomy directly. First, the infection parameters and liver, kidney and coagulation functions of group A patients before and after ERCP were compared to evaluate treatment effectiveness. Second, the intraoperative and post-operative parameters during the laparotomy of group A were compared with group B to evaluate the impact of ERCP treatment on laparotomy. White blood cell, NE%, platelet, procalcitonin, C-reactive protein, interleukin-6, Total bilirubin (TBIL), alkaline phosphatase, gamma-glutamyl transpeptidase, aspartate transaminase, alanine transaminase (ALT), ALT and Cr in group A significantly improved by ERCP (P < 0.05); during laparotomy, the bleeding amount and hospital stay in group A were better (P < 0.05); moreover, concerning the post-operative complications, the incidence of acute renal failure and coagulation dysfunction in group A was significantly less (P < 0.05). ERCP, which not only quickly and effectively controls infection and improves the patient's systemic condition but also provides good support for subsequent radical surgery, enjoys good prospects for clinical application.

Incidence of Acute Renal Failure in Preterm Babies in a Tertiary Care Centre from Southern India: A Cross-sectional Study

Incidence of Acute Renal Failure in Preterm Babies in a Tertiary Care Centre from Southern India: A Cross-sectional Study

Post-operative complications of total knee arthroplasty in patients with hypertension.

Hypertension is one of the most common comorbidities among patients undergoing surgery. However, few studies have focused on patients undergoing knee arthroplasty, and most of them had small sample sizes. This study aimed to analyze post-operative complications associated with hypertension in patients who underwent knee replacement surgery. Data from the 2019 National Inpatient Sample (NIS) database were used. Patients who underwent primary total knee arthroplasty (pTKA) and those who underwent aseptic revision total knee arthroplasty (rTKA) were analyzed separately. Propensity score matching was performed to reduce the effects of demographic factors and comorbidities other than hypertension on post-operative complications. A multinomial logistic regression that included all significantly different demographics and comorbidities was performed to verify the results and evaluate the odds ratios. A total of 107,981 patients who underwent pTKA and 6571 who underwent rTKA owing to mechanical complications were identified in the 2019 NIS database. Compared with the non-hypertension group, patients with hypertension had a higher risk of developing acute renal failure and electrolyte disorders after TKA. Further analysis revealed that hyponatraemia and hypokalaemia were associated with hypertension. Hypertension was associated with the incidence of acute renal failure after TKA. It is important to identify patients with risk factors for acute renal failure (in addition to hypertension) and take careful measures to prevent acute renal failure in them.

The Comparison of Lipid Profile in Heart Failure Patients with and without Acute Renal Dysfunction

The incidence of heart failure (particularly heart failure with reduced ejection fraction/HFREF) is increasing over time, especially in developing nations. Based on the most recent data from Riset Kesehatan Dasar 2020 (RISKESDAS/Baseline Health Research), heart failure has become the highest etiology of mortality for patients with heart disease in Bali. Moreover, in patients with chronic kidney disease that have already undergone hemodialysis, the incidence of heart failure is increasing to more than 80% of the population. The correlation between renal dysfunction and heart failure has been known extensively with the term “Cardiorenal syndrome”. However, there is a paucity of literature regarding the prevention of renal dysfunction in heart failure patients and the control of dyslipidemia risk factors for preventing renal dysfunction. Renal dysfunction is not only a cause of morbidity but also a risk factor for heart failure patients' mortality; therefore, prevention is essential for improving heart failure patients' prognosis. We conduct research to compare the lipid profiles of patients with acute renal dysfunction and those without acute renal dysfunction who have heart failure. Based on the results of the lipid profile, we enrolled 70 consecutive heart failure patients with dyslipidemia or non-dyslipidemia. The incidence of renal failure in the group with dyslipidemia is 84.2%. We found that acute renal dysfunction patients had a statistically significant (p&lt;0.05) increase in dyslipidemia compared to non-renal dysfunction patients, particularly with high LDL levels. The association between statin therapy and a low incidence of acute renal failure in patients with heart failure was statistically significant (p&lt;0.05), according to additional findings from our study.

Hyperchloremia and mortality in the ICU: a prospective cohort study

Introduction: Part of the interventions in patients admitted to intensive care units (ICU) consist of the administration of crystalloids, implying a risk for the development of side effects. One of these is hyperchloremia, linked to the appearance of metabolic acidemia and systemic inflammatory response. Given these findings, observational studies have been developed, trying to establish an association between hyperchloremia and outcomes such as mortality and kidney failure; however, its diverse results prompt the development of new studies. In Colombia, there are no prospective cohort studies that establish any type of association with hard outcomes. Goal. To determine the association between the development of hyperchloremia and mortality and acute renal failure, in patients hospitalized in the ICU, in two hospitals in Bogotá D.C. Methodology: Analytical prospective cohort study conducted between June 1, 2019 and August 31, 2021. Results: 325 patients were analyzed, the cumulative incidence of hyperchloremia and acute renal failure in the entire study population was 44.6% and 29.5%, respectively. The cumulative incidence of death in the exposed was 36.5% vs 23.3% in the unexposed, with a relative risk RR=1.57, (95% CI 1.11-2.2) (p=&lt;0.001). The cumulative incidence of acute renal failure was 43.4% in exposed patients and 18.3% in non-exposed patients, with a RR=2.37 with a (95% CI 1.65-3.4) (p&lt;0.001). Conclusion: There is an association between the development of hyperchloremia and the outcomes of mortality and acute renal failure in critically ill patients.

Metamizole-Associated Risks in Decompensated Hepatic Cirrhosis.

Because of the increased risk of acute renal failure (ARF), the use of cyclooxygenase (COX) inhibitors is not recommended in patients with decompensated hepatic cirrhosis. Metamizole is not a classic COX inhibitor, but there are insufficient data to support its safe use. In this study, we investigate the effect of metamizole on the risk of ARF in these patients. Metamizole use, ARF incidence, and patient mortality were examined in a large, retrospective, exploratory cohort and validated with data from a prospective registry. 523 patients were evaluated in the exploratory cohort. Metamizole use at baseline was documented in 110 cases (21%) and was independently associated with the development of ARF, severe (grade 3) ARF, and lower survival without liver transplantation at follow-up on day 28 (HR: 2.2, p < 0.001; HR: 2.8, p < 0.001; and HR: 2.6, p < 0.001, respectively). Interestingly, the risk of ARF depended on the dose of metamizole administered (HR: 1.038, p < 0.001). Compared to patients who were treated with opioids, the rate of ARF was higher in the metamizole group (49% vs. 79%, p = 0.014). An increased risk of ARF with metamizole use was also demonstrated in the independent validation cohort (p < 0.001). Metamizole therapy, especially at high doses, should only be used with a high level of caution in patients with decompensated cirrhosis.

Effectiveness of Isotonic Exercise in Reduction of Muscle Cramps among Hemodialysis Patients in Dialysis Unit

Background: Kidney is a vital organ and the main function is to remove waste products and excess water from the blood. Different kidney pathogenesis challenges the function of human body and puts human life danger. Two such important pathogenesis is acute and chronic renal failure. The incidence of acute renal failure has been estimated to be 209 patients per million populations per year and 37% of patients treated in intensive care units. Muscle cramps also can occur when patients are below dry weight. The severe muscle cramping experienced near the end of the hemodialysis treatment and persisting for a time after hemodialysis often is due to dehydration. Treatment for cramping varies from unit to unit. When patients are having cramping and have low blood pressure, the staff may give normal saline. Aim of the study: The main aim of the study to assess effectiveness of isotonic exercise on muscle cramps among hemodialysis patients. Methods: Quantitative research design was adopted for the study with 60 samples which met the inclusion criteria were selected by convenience sampling technique. Demographic variables data were collected by using a multiple-choice questionnaire followed by Pretest was conducted by using muscle cramp assessment tool for both experimental group and control group. Isotonic exercise was given 10 to 15 minutes at one session for experimental group Post test was conducted by using muscle cramps assessment tool and for both experimental group and control group. Result: Out of 60 samples, The calculated student Independent ‘t’ test value of t = 2.500 was found to be statistically highly significant at p&lt;0.05 level. This clearly infers that isotonic exercise on muscle cramps administered to hemodialysis patients in the experimental group was found to be effective in reducing the level of muscle cramps in the post test than the hemodialysis patients in the control group. Conclusion: There was a significant improvement in reduction of muscle cramps those who received isotonic exercise intervention than those who do not receive the isotonic exercise.

Incidence of Acute Renal Failure in Patients Using Levetiracetam Versus Other Antiseizure Medications: A Voluntary Post-Authorization Safety Study.

Acute kidney injury is an expected adverse drug reaction listed in the European Union (EU) Summary of Product Characteristics (SmPC) for levetiracetam, one of the most widely used modern antiseizure medications (ASMs). We conducted a voluntary post-authorization safety study to characterize the rate of acute renal failure (ARF) in patients exposed to levetiracetam versus other ASMs. New users of ASMs without prior renal dysfunction were identified and followed for 30 days in the IBM® MarketScan® database (USA, January 2008-December 2017). ARF was defined as a diagnosis on inpatient or emergency department claims. We estimated adjusted incidence rates, incidence rate ratios (IRRs), and incidence rate differences (IRDs) of ARF in patients initiating levetiracetam versus other ASMs. Overall, 110,336 patients were eligible for the monotherapy cohort and 96,215 were eligible for the polytherapy cohort. The overall crude rate of ARF following a new ASM was 6.0 and 6.5 per 10,000 patients for the 'monotherapy' and 'polytherapy' cohorts, respectively, in the first 30 days after the index date. In the monotherapy cohort, the IRR for ARF was 1.37 (95% confidence interval [CI] 0.80-2.34) and the corresponding IRD was 2.0 (95% CI -1.12 to 5.12) additional ARFs per 10,000 patient-months. In the polytherapy cohort, the adjusted IRR for ARF was 0.94 (95% CI 0.51-1.74) and the corresponding IRD was -0.42 cases per 10,000 patient-months (95% CI -4.01 to 3.17). The rate of ARFs in ASM new users was very low. In patients without prior ASMs, the estimated difference in risk of ARF associated with initiation of levetiracetam versus initiation of other ASMs was small, with 95% CIs compatible with small protective or harmful effects. In patients receiving polytherapy, the difference was compatible with the null and the 95% CI with small protective or harmful effects.

PB2193: IS HYPERHYDRATION NECESSARY FOR HIGH DOSE MELPHALAN CONDITIONING REGIMEN IN AUTOLOGOUS HAEMATOPOIETIC STEM CELL TRANSPLANTATION?

Background: Single-agent Melphalan or combined with Bortezomib is often used as a conditioning regimen in autologous haemopoietic stem cell transplantation (HSCT) for multiple myeloma (MM) and primary amyloidosis (AL). In order to prevent nephrotoxicity, Melphalan is often administrated with hyperhydration (HH) consisting of 4-6 Litres (L) 0.9% saline which has a potential fluid overload risk, mainly in elderly patients. Given the potential morbility of HH, some institutions use a less intensive hydration regimen consisting of 2-3L 0.9% saline the day Mephalan is administrated. Aims: This study aimed to retrospectively analyze the safety of not using hyperhydration (NHH) in our center. Methods: This study used a retrospective cohort design, reviewing patients from Guadalajara University Hospital diagnosed with MM or AL who underwent autologous HSCT between January 2017 and December 2021. Cohorts were defined by HH (6L/24h 0.9% saline) or NHH (2L/24h 0.9% saline) the day Melphalan was administrated. The primary endpoint of this study was the incidence of acute renal impairment, the secondary endpoints were fluid overload and other adverse effects. Comparisons were assessed using Student t-test or Fisher’s exact test, considering a p-value <0.05 statistically significant. Results: The sample included 50 patients: 11 with HH (100% MM) and 39 NHH (87.18% MM, 12.82% AL). Patient’s gender (HH 45.45% women; NHH 61.54% women) was similar in both cohorts. Median age in HH cohort was 71, while in NHH it was 61. The prevalence of kidney disease due to MM at diagnosis was higher in NHH cohort (HH 9.1%, NHH 17.9%; p=0.48) but not statistically significant. Baseline creatinine (HH 0.79, NHH 0.78; p=0.92) and the prevalence of cardiovascular risk factors (HH 63.6%, NHH 66.7%; p=0.31) were comparable. The incidence of acute renal failure (HH 18.1%, NHH 7.7%; p=0.31) was higher in HH but statistically non-significant, while median creatinine increase from Melphalan administration to day 7 after haemopoietic stem cell infusion was similar in both groups (HH 0.38, NHH 0.18; p=0.08). All patients who developed acute renal failure had a history of chronic kidney disease or a baseline creatinine >1 before HSCT and it was always reversible. Likewise, all patients developed mild kidney injury (AKIN stage 1) except for one (1/5) from the HH cohort (AKIN stage 3). Concerning the presence of clinical fluid overload, it was significantly more frequent in the HH cohort (36.6%) in opposition to the NHH cohort (7.7%) (p = 0.02) as expected due to the greater volume administrated, but no patients developed acute pulmonary edema. Regarding other adverse effects as hepatic toxicity (HH 0%, NHH 17.9%; p=0.13), rash (HH 9.1%, NHH 5.1%; p=0.63) or grade IV mucositis (HH 81.8%, NHH 64.1%; p=0.07), they were similar in both cohorts with no statistically significant difference between both groups. Neutrophil engraftment was reached at day +10 in HH group and at day +14 in NHH group. This difference is probably due to the elimination of G-CSF from the protocol in the last years in order to avoid engraftment syndrome. There were limitations in this study such as the small sample size and retrospective analysis. Image:Summary/Conclusion: Hyperhydration did not demonstrate to protect the kidney compared to non-hyperhydration regimes, with a significantly greater incidence of fluid overload. Consequently, HH may not be necessary for melphalan conditioning regimen in autologous haemopoietic stem cell transplantation as our protocol demonstrates an adequate safety profile.

HIV/AIDS patients undergoing total knee arthroplasty are at higher risk of acute renal failure and transfusion and incurred higher cost: a propensity-matched database study

IntroductionHuman immunodeficiency virus (HIV) is a retrovirus that can cause acquired immunodeficiency syndrome (AIDS). Total knee arthroplasty (TKA) in HIV-positive patients has not been well documented in the current literature. Thus, this study aimed to examine the early postoperative outcomes and complications of HIV-positive TKA patients as compared to TKA patients who are HIV-negative patients by utilizing the National Inpatient Sample (NIS) database.MethodsAdmissions data for TKA and HIV were analyzed from the NIS database using ICD-10-CM diagnosis codes. An extensive array of preoperative and postoperative variables was compared among HIV positive TKA patients and HIV negative TKA patients. An unmatched analysis and a matched analysis using a 1:1 propensity match algorithm were conducted to compare the two groups.ResultsThe average age of the HIV-positive group was lower than the HIV-negative group (59.0 vs 66.7, p < 0.001). The HIV-positive group had a smaller percentage of females (38.4% vs 61.5%, p < 0.001) and a lower incidence of tobacco-related disorders than the HIV-negative group (10.3% vs 15.8%, p = 0.032). The HIV-positive group had a longer mean length of stay (3.0 days vs 2.4 days, p < 0.001) and a greater mean total charge incurred (90,780.25 vs 64,801.55, p < 0.001). In the unmatched analysis, the incidence of acute renal failure (6.4% vs 2%, p < 0.001), transfusions (3.9% vs 1.5%, p = 0.004), and periprosthetic joint infection (3% vs 1%, p = 0.007) was higher in HIV positive group. The matched analysis showed a higher incidence of acute renal failure group (6.4% vs 0.5%, p = 0.01) and transfusions (3.9% vs 5%, p = 0.01) in the HIV-positive but a statistically insignificant difference in the rate of periprosthetic joint infection (3% vs 1%, p = 0.153).ConclusionHIV/AIDS is associated with an increased incidence of acute renal failure and transfusions, as well as a longer length of stay and higher incurred costs in TKA patients.