AKIN Criteria Research Articles

P0615ACUTE KIDNEY INJURY CLASSIFICATION IN CRITICAL PATIENTS: COMPARISON OF THE THREE SYSTEMS

Abstract Background and Aims Acute kidney injury (AKI) is one of the most common and severe complications in intensive care units’ (ICU) patients. It is associated with worst outcomes, such as longer hospital stays and higher mortality. In the past years three consensus have been developed to provide uniform identification of AKI in clinical practice. An ideal classification should be sensitive but also correlate with the outcomes. RIFLE and AKIN have been exhaustively studied in critical patients. In the studies made until date, KDIGO classifications seems to be as sensitive as the other two. With this study the authors intend to compare the three systems of AKI classification in an ICU population. Method Retrospective observational study with descriptive and bivariate analysis using SPSS Statistics. Demographic and laboratory studies were collected from the patient’s charts. The authors included patients who were admitted to a polyvalent ICU in the first six months of 2019. The exclusion criteria were patients under 18 years old, pregnant women, stage 5 chronic kidney disease and less than 24 hours ICU stays. Only the serum creatinine, and not urine output, was used as criteria to the three classifications. Results A total of 130 patients were studied. The mean age was 62.20±15.78 years (min 19; max 87) and 54.6% (n=71) were male. Medical causes were the most frequent type of admission (n=82; 63.1%). The median length of ICU and hospital stays were 6.50±9.19 days (min 2; max 48) and 23.00±25.68 days (min 2; max 126) respectively. The mortality rate in ICU and hospital were, respectively, 9.2% (n=12) and 20% (n=26). Eight patients (6.2%) needed renal replacement therapy. KDIGO classification identified more patients with AKI than RIFLE (p<0.001) and AKIN (p<0.001). There were no statistically differences between the median length of ICU (p=0.191 for KDIGO, p=0.257 for AKIN and p=0.223 for RIFLE) or hospital (p=0.762 for KDIGO, p=0.096 for AKIN and p=0.105 for RIFLE) stays between the patients with and without AKI by the 3 classifications. There was a significant statistically association between mortality in the ICU and AKI for KDIGO (p=0.008) and AKIN (p=0.004) classifications, but not for RIFLE (p=0.167). Likewise, there was also an association between mortality in the hospital and AKI patients identified by KDIGO (p<0.0001) and AKIN (p=0.001) classifications, but not with RIFLE (p=0.054). The AKI patients that were identified by KDIGO criteria but not by AKIN did not have and association with ICU mortality (p=0.28) but did have a statically significant association with hospital death (p=0.026) with an odds ratio of 4 (CI 95% [1.229-13.018]). Conclusion The authors concluded that KDIGO classification is the most sensitive of the three for AKI in critical patients. There were no differences in the length of ICU or hospital stays between the 3 classifications cases identified. On the other hand, there was a statistically association between KDIGO and AKIN cases with ICU and hospital mortality, but not with RIFLE. Still, patients who are identified by KDIGO but not by AKIN criteria have an odd 4 times higher to die in the hospital. This means that KDIGO classification is the most sensitive and correlates better with outcomes in critical patients with AKI than the other two.

P0586ACUTE KIDNEY INJURY IN PATIENTS UNDERGOING CARDIAC SURGERY: A PROSPECTIVE, OBSERVATIONAL STUDY TO ASSESS INCIDENCE, SEVERITY, RISK FACTORS AND MORTALITY IN TERTIARY CARE HOSPITAL IN INDIA

Abstract Background and Aims Acute kidney injury (AKI) occurs in up to 30% of patients undergoing cardiac surgeries and is associated with increased morbidity and mortality. There is paucity of such data in our country. Hence this study was done to assess the incidence of AKI following cardiac surgery and its associated risk factors along with outcomes, in the Indian context. The incidence and severity of AKI in patients with normal renal parameters vs those with underlying CKD was studied. We also compared incidence and severity of AKI in patients undergoing surgery off pump vs on pump. Method All patients age>25yrs of either gender undergoing cardiac surgeries were enrolled prospectively from July to October 2018. Patients undergoing aortic surgeries or on dialysis, renal transplants or with pre-existing AKI were excluded. Incidence and severity of AKI was defined by the AKIN criteria. NKF/DOQI definition was used to define CKD. Prevalence of risk factors such as age, sex, BMI, diabetes mellitus, hypertension, dyslipidemia, CKD, CVA, peripheral vascular disease (PVD), prior myocardial infarction (MI), peri-operative acute myocardial infarction (AMI), use of cardiopulmonary bypass (CPB) and prolonged ventilation were assessed. Results 1,040 patients were enrolled with these baseline characteristics: 83.5% were males, mean age 58.2±10.4 years, mean BMI 25.6±4.3, diabetes in 48.2%, hypertension in 57.5%,dyslipidemia in 70%,CVA in 36%,CKD in 6.3%,PVD in 0.9%,peri-operative AMI in 0.6%,use of CPB in 24%. Overall incidence of AKI was 23.3% and was 71.2% in patients with underlying CKD. AKI was more severe in patients with higher CKD stages. Stage3 AKI occurred only in patients with CKD stage 3 and 4. Overall the need for dialysis was 1.1% and it was 4.9% in AKI group. 8.5% of patients with CKD needed dialysis as compared to 4.1% without CKD.In multivariate risk factor analysis hypertension (p=0.01),peri-operative AMI (p=0.03), prolonged ventilation (p=0.01), CVA (p=0.01) and CKD (p<0.001) were found to be significantly associated with AKI whereas diabetes (p =0.12), PVD (p=0.13), use of CPB (p=0.4), prior AMI (p=0.07) were not significant. Mean hospital stay was prolonged in those with AKI (8.33±4.06 vs 7.16±3.01 days (p<0.001)). Overall the mortality was 0.67% and it was 2.9% in AKI group. All mortalities were associated with AKI. Conclusion Incidence of AKI (23.3%) and mortality (0.67%) in cardiac surgery patients at our centre in India is similar to other reported studies. We found that underlying CKD is the most significant risk factor for AKI in these patients in addition to hypertension, CVA, prolonged ventilation and pre-operative AMI. Use of CPB did not increase the incidence of AKI. AKI significantly increases mean hospital stay and is also associated with increased in-hospital mortality.

Correlation of intraoperative renal near infrared spectroscopy with the development of acute kidney injury in adult patients undergoing cardiac surgery using cardiopulmonary bypass

Introduction: The present study aimed to correlate renal oximetry near-infrared spectroscopy (NIRS) values with conventional non-invasive biomarkers for the early detection of acute kidney injury (AKI) in adult patients undergoing cardiac surgery using cardiopulmonary bypass (CPB). Accordingly, renal NIRS can be employed as a trending device for the prevention of AKI development. Materials and methods: After institutional ethical committee approval, a number of 132 adult patients undergoing cardiac surgery with CPB were selected by consecutive consenting sampling method. Emergency surgery and patients with preexistent renal insufficiency were excluded. NIRS sensor was applied on either the right or the left side of the spine at the lower border of L-1 before starting the induction. A renal regional oxygen saturation (rSO2) score was calculated after recording the renal oximetry values intra- and postoperatively. Urine output and serum creatinine were measured at 24, 48, and 72 hours postoperatively. Results: Out of 132 patients, 22 cases (16.66 %) developed AKI according to Acute Kidney Injury Network (Akin) criteria± Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) classification. Among these AKI patients, three cases required dialysis, and one of these three patients died on the 21st day postsurgery. Renal rSO2 scores in the AKI group were measured at 535 and 912 minutes %, in comparison to 162 and 184 minutes % reported in the non-AKI group which was statistically significant (P< 0.05). Conclusion: As evidenced by the obtained results, there is a correlation between intraoperatively measured renal NIRS readings and the occurrence of AKI following adult cardiac surgery using CPB.

Complications of high-dose methotrexate (HDMTX) in lymphoma patients.

e20035 Background: HDMTX is a vital treatment of lymphoma secondary to central nervous system penetrance. MTX is nephrotoxic and may cause acute kidney injury (AKI). AKI results in delayed MTX elimination, increased hospital length of stay (LOS) and intensive care unit (ICU) stays. Our aim was to characterise the complications and associated 48-hour MTX levels in lymphoma patients undergoing HDMTX. Methods: A retrospective review of the electronic medical record was conducted to identify lymphoma patients who received HDMTX from 1/1/2002 to 12/31/18. We assessed the incidence of AKI using AKIN criteria, ICU admission, and LOS across 48 hour MTX levels per the table. Results: 2704 cycles of HDMTX were identified. The mean age was 64 years, 54% were male and 72.2% received high dose (≥8g/m2). A significant increase in AKI severity (p &lt; 0.0001) and LOS (p &lt; 0.01) occurred with increasing 48 hour MTX levels, (p &lt; 0.001, Table). All 7 patients requiring dialysis had MTX levels &gt; 10. ROC curve analysis for AKI grade ≥ 2 demonstrated a 48 hour MTX level threshold of 1.28 (AUC 0.79) with relative risk of 7.6 (95% CI 5.3-11) and odds ratio of 8.8 (95% CI 5.9-13.1). A significant increase occurred in LOS across escalating 48 hour MTX level subgroups (p &lt; 0.01, Table). A significant rise in ICU admissions occurred with increasing MTX levels ( &lt; 0.01% for MTX &lt; 2 compared to 15% with MTX &gt; 5). Conclusions: Complications of HDMTX are significantly increased with elevated 48 hour MTX levels, particularly with levels &gt; 1 μmol/L. [Table: see text]

Incidence and mortality of acute kidney injury in patients undergoing hematopoietic stem cell transplantation: a systematic review and meta-analysis.

While acute kidney injury (AKI) is commonly reported following hematopoietic stem cell transplant (HCT), the incidence and impact of AKI on mortality among patients undergoing HCT are not well described. We conducted this systematic review to assess the incidence and impact of AKI on mortality risk among patients undergoing HCT. Ovid MEDLINE, EMBASE and the Cochrane Databases were searched from database inceptions through August 2019 to identify studies assessing the incidence of AKI and mortality risk among adult patients who developed AKI following HCT. Random-effects and generic inverse variance method of DerSimonian-Laird were used to combine the effect estimates obtained from individual studies. We included 36 cohort studies with a total of 5144 patients undergoing HCT. Overall, the pooled estimated incidence of AKI and severe AKI (AKI Stage III) were 55.1% (95% confidence interval (CI) 46.6-63.3%) and 8.3% (95% CI 6.0-11.4%), respectively. The pooled estimated incidence of AKI using contemporary AKI definitions (RIFLE, AKIN and KDIGO criteria) was 49.8% (95% CI 41.6-58.1%). There was no significant correlation between study year and the incidence of AKI (P = 0.12) or severe AKI (P = 0.97). The pooled odds ratios of 3-month mortality and 3-year mortality among patients undergoing HCT with AKI were 3.05 (95% CI 2.07-4.49) and 2.23 (95% CI 1.06-4.73), respectively. The incidence of AKI among patients who undergo HCT remains high, and it has not changed over the years despite advances in medicine. AKI after HCT is associated with increased short- and long-term mortality.

A systematic review and meta-analysis of acute kidney injury in the intensive care units of developed and developing countries.

ObjectivesAlthough the majority of the global population lives in developing countries, most of the epidemiological data related to intensive care unit (ICU) acute kidney injury (AKI) comes from developed countries. This systematic review aims to ascertain the methodology of studies on ICU AKI patients in developing and developed countries, to determine whether epidemiological comparisons between these two settings are possible, and to present a summary estimate of AKI incidence.MethodsA systematic review of published studies reporting AKI in intensive care units (2005–2015) identified in PubMed, LILACS, and IBECs databases was conducted. We compared developed and developing countries by evaluating study methodology, AKI reference serum creatinine definitions, population characteristics, AKI incidence and mortality. AKI incidence was calculated with a random-effects model.ResultsNinety-two studies were included, one of which reported data from both country categories: 60 from developed countries (1,057,332 patients) and 33 from developing countries (34,539 patients). In 78% of the studies, AKI was defined by the RIFLE, AKIN or KDIGO criteria. Oliguria had 11 different definitions and reference creatinine 23 different values. For the meta-analysis, 38 studies from developed and 18 from developing countries were selected, with similar AKI incidence: 39.3% and 35.1%, respectively. The need for dialysis, length of ICU stay and mortality were higher in developing countries.ConclusionAlthough patient characteristics and AKI incidence were similar in developed and developing countries, main outcomes were worse in developing country studies. There are significant caveats when comparing AKI epidemiology in developed and developing countries, including lack of standardization of reference serum creatinine, oliguria and the timeframe for AKI assessment. Larger, prospective, multicenter studies from developing countries are urgently needed to capture AKI data from the overall population without ICU access.

Neonatal Acute Kidney Injury: A Survey of Perceptions and Management Strategies Amongst Pediatricians and Neonatologists

Background: Neonatal Acute Kidney Injury (AKI) occurs in 40–70% of critically ill newborn infants and is independently associated with increased morbidity and mortality. Understanding the practice patterns of physicians (neonatologists and pediatricians), caring for neonates in India is important to optimize care and outcomes in neonatal AKI.Aim: The aim of this study was to identify differences in physician's perception and practice variations of diagnosis, management, and follow-up of newborn infants with AKI in India.Methods: An online survey of neonatologists and pediatricians in India caring for newborn infants with AKI.Results: Out of 800 correspondents, 257 (135 neonatologists and 122 pediatricians) completed the survey, response rate being 32.1%. Resources available to the respondents included level III NICU (59%), neonatal surgery (60%), dialysis (11%), and extracorporeal membrane oxygenation (ECMO, 3%). Most respondents underestimated the risk of AKI due to various risk factors such as prematurity, asphyxia, sepsis, cardiac surgery, and medications. Less than half the respondents were aware of the AKIN or KDIGO criteria, which are the current standard criteria for defining neonatal AKI. Only half of the respondents were aware of the risk of CKD in preterm neonates and nearly half were unaware of the need to follow up with a pediatric nephrologist.Conclusions: Similar to other regions worldwide, there exists a knowledge gap in early recognition, optimal management and follow up of newborn infants with AKI amongst Indian physicians.

Renal damage after liver transplantation.

Background: Patients following liver transplantation are at risk to develop acute kidney injury (AKI). The aim of our study was to assess risk factors for the development of AKI and the impact of AKI on the outcome of patients after liver transplantation (OLT).Patients and methods: In this retrospective study, we analyzed 149 patients undergoing OLT from 1/2004 to 12/2007. AKI was defined according to the KDIGO definition representing the AKIN and the RIFLE classification, and according to the need for renal replacement therapy (RRT).Results: According to the AKIN criteria alone 14 patients, according to the RIFLE criteria alone no patient and according to both definitions 30 patients developed AKI. RRT was required in 54 patients experiencing AKI, whereas 51 patients did not develop AKI. Pre OLT serum creatinine (SCr) significantly predicted the development of AKI requiring RRT, but not AKI without RRT requirement. Survival rate was significantly inferior after 28 days, one or three years in patients with AKI requiring RRT (70.4, 46.4, 44.4% vs. 100, 92.2, 90.2%, P < 0.001). There was no difference in survival between patients experiencing AKI according to the RIFLE or AKIN criteria without RRT requirement and patients without AKI.Conclusion: Pre OLT renal dysfunction assessed by SCr was the most important risk factor predicting severe forms of AKI, but not milder forms of AKI. AKI requiring RRT had a detrimental impact on patients’ survival, whereas milder forms of AKI were not associated with a worse outcome.

Influenza A (H1N1) Virus Infection Associated Acute Kidney Injury - A Study from a Tertiary Care Center in South India.

Influenza A (H1N1) infection in 2009 spread rapidly all over the world. Mortality was high in patients with H1N1-associated acute kidney injury (AKI). We estimated the incidence, risk factors of AKI and mortality associated with H1N1 infection. This is a prospective observational study, including 158 adult patients with H1N1 infection confirmed with real-time reverse transcriptase-polymerase chain reaction conducted between August 2016 and September 2017. AKIN criteria were used to define AKI. Of 158 patients in this study, 112 were male and the mean age was 46.4. Fifteen patients (9.5%) were found to have AKI. The mean age was higher (56.13 ± 10.02) in the AKI group compared to non-AKI (45.48 ± 16.26) (P = 0.007). Presence of shock, multiple organ dysfunction syndrome (MODS), ventilatory support were observed more in the AKI group (P = 0.000). Among AKI patients, the requirement of dialysis was more than 50% (n = 8/15, 53.3%). Eighteen patients died following H1N1 infection (11.4%).Shock (n = 8/18, 44.4%, P = 0.000), MODS (n = 13/18, 72.2%, P = 0.000), intensive care unit (ICU) care (n = 17/18, 94.4%, P = 0.000), ventilatory support (n = 18/18, 100% P = 0.000), AKI (n = 11/18, 61.1%, P = 0.000), and requiring dialysis (n = 7/18, 38.9%, P = 0.000) were significantly associated with mortality compared to patients who survived. The incidence of H1N1 AKI was 9.5%, with > 50% requiring dialysis. Risk factors for AKI included older age, underlying chronic kidney disease, presentation with sepsis, shock, MODS, ICU care, and mechanical ventilation. Mortality was high in patients with AKI compared to non-AKI patients.

Incidence and impact of acute kidney injury on patients with implantable left ventricular assist devices: a Meta-analysis

Background We aimed to evaluate the acute kidney injury (AKI) incidence and its associated risk of mortality in patients with implantable left ventricular assist devices (LVAD). Methods A systematic literature search in Ovid MEDLINE, EMBASE, and Cochrane Databases was conducted through January 2020 to identify studies that provided data on the AKI incidence and AKI-associated mortality risk in adult patients with implantable LVADs. Pooled effect estimates were examined using random-effects, generic inverse variance method of DerSimonian-Laird. Results Fifty-six cohort studies with 63,663 LVAD patients were enrolled in this meta-analysis. The pooled incidence of reported AKI was 24.9% (95%CI: 20.1%–30.4%) but rose to 36.9% (95%CI: 31.1%–43.1%) when applying the standard definition of AKI per RIFLE, AKIN, and KDIGO criteria. The pooled incidence of severe AKI requiring renal replacement therapy (RRT) was 12.6% (95%CI: 10.5%–15.0%). AKI incidence did not differ significantly between types of LVAD (p = .35) or indication for LVAD use (p = .62). While meta-regression analysis did not demonstrate a significant association between study year and overall AKI incidence (p = .55), the study year was negatively correlated with the incidence of severe AKI requiring RRT (slope = −0.068, p < .001). The pooled odds ratios (ORs) of mortality at 30 days and one year in AKI patients were 3.66 (95% CI, 2.00–6.70) and 2.22 (95% CI, 1.62–3.04), respectively. The pooled ORs of mortality at 30 days and one year in severe AKI patients requiring RRT were 7.52 (95% CI, 4.58–12.33) and 5.41 (95% CI, 3.63–8.06), respectively. Conclusion We found that more than one-third of LVAD patients develop AKI based on standard definitions, and 13% develop severe AKI requiring RRT. There has been a potential improvement in the incidence of severe AKI requiring RRT for LVAD patients. AKI in LVAD patients was associated with increased 30-day and 1 year mortality.

Importancia pronóstica del daño renal agudo y de los pequeños aumentos de la concentración de creatinina durante la descompensación aguda de la insuficiencia cardiaca

BackgroundDiagnosis of acute kidney injury (AKI) during acute decompensations of heart failure (ADHF) remain challenging. We analysed the incidence and prognosis of AKI, and the significance of small increases of creatinine, during ADHF and after stabilization. Patients and methodsPatients admitted for ADHF were prospectively included. Creatinine was measured at admission, 48h thereafter and 24h before discharge. AKI was diagnosed when creatinine increased≥50% in 7 days (RIFLE criteria) or≥0.3mg/dL in 48h (AKIN criteria) during admission. Changes between baseline creatinine (measured within 3-month before admission) and one month after discharge were assessed, to seek for residual impairment of renal function and its significance. ResultsTwo hundred and four patients were included. Incidence of AKI was 28.4% (n=58). Creatinine peaked by day 5 in patients with AKI vs. non-AKI (1.9 vs. 1.1mg/dL; P<.000) and remained significantly higher among patients with AKI 3 months after discharge (increase of 20 vs. 4%; P=.013). Twelve-months mortality was associated with increases in cystatin C, NT-proBNP and AKI (15.5 vs. 44.8%, P<.000), being the latter the most powerful independent predictor of death ?Exp(B)=5.34; P=.009?. Minor increases in creatinine (20% or 0.2mg/dL) during admission associated lesser 12-months survival (P=.033 and P=.019, respectively). Increases in creatinine≥10% between baseline and one month after discharge are associated with higher mortality (12.6 vs. 22.5%, P=.044). ConclusionsAKI is a strong predictor of mortality after ADHF. Minor increments in creatinine concentrations, below the accepted threshold for AKI definition, are prognostically meaningful.

ETIOLOGICAL FACTORS AND CLINICAL PROFILE OF ACUTE KIDNEY INJURY IN MICU

Background and Objectives&#x0D; Data on the etiology, management practices and outcome in patients admitted to intensive care units in Kerala has not been studied in depth. The etiology and patterns of AKI, as well as management practices are likely to differ in countries with resource limitations and variations in disease patterns. The present study was undertaken to identify the etiologic factors and outcome of patients with Acute Kidney Injury admitted in Medical ICU.&#x0D; Methods&#x0D; The study is a cross sectional study, done in 150 consecutive patients admitted to Medical Intensive Care Unit, Government Medical College, Kottayam meeting the AKIN creatinine criteria for acute kidney injury over a period of 12 months.&#x0D; Results and Discussion&#x0D; The most common diagnosis in the patients admitted with AKI in MICU was Leptospirosis (22%) followed by undifferentiated fever (21%) and sepsis seen in 17%. Dialysis was required in 81.3% among those with undifferentiated febrile illness and 78.8% among those with leptospirosis. Significant association was identified between etiology of AKI and the need for dialysis. The most common stage of AKI in the patients in this study group on admission to the medical intensive care unit was stage 3 in 64.7%. 45% of the patients required dialysis, among which 24% underwent CRRT while the 76% underwent hemodialysis.&#x0D; Out of 150 cases 59% survived and 41% expired. Mortality was more in the patients in this study with undifferentiated acute febrile illness, 43.8% and leptospirosis, 36.4%. Mortality was 48.5% in those who underwent dialysis. But no significant association was identified between requirement of dialysis or diagnosis and mortality. Significant association was identified between patients with breathlessness, basal crepitations, later stage of AKI, inotropic support, ventilator support and mortality with p value &lt;0.05.&#x0D; By logistic regression analysis of the factors having association with mortality, requirement of ventilator support and inotropic supports were independent predictors of mortality.&#x0D; Conclusion&#x0D; The most common etiology was leptospirosis (22%) followed by undifferentiated fever (21%). Mortality was 41% in the patients in the study group. Requirement of ventilator support and inotropic supports were independent predictors of mortality.

Factores asociados a la insuficiencia renal aguda en pacientes hospitalizados en la unidad de cuidados intensivos de la Clínica Ibagué, 2016-2017

Objetive: To establish the association of acute renal failure with demographic and clinical factors in patients hospitalized in an intensive care unit in a Colombian city. Methods: Analytical case-control study whose source of information was the patient´s clinical history, in a sample of 130 cases and 184 controls; the cases were about patients older than 18 years, who had a glomerular filtration rate higher than 60 ml / min and who were able to fulfilled the AKIN criteria. With the independence test, it was established the effect of the factors of interest on the result (case-control), with the Odds Ratio (OR) as a measure of the association with its 95% confidence interval. The logistic regression allowed to control the presumable variables of confusion. Results: The average age of patients was 62.2 years (SD-16.7 years) with a predominance of men from the urban area and where hypertension stood out in 52.2% of them. On admission, 55.7% had coronary syndrome and 40% developed acute renal failure (ARF); 84.6% of the patients were stage according to the AKIN classification. The administration of saline in the first 24 hours of admission increased the possibility of ARF 1.8 times compared to those administered with Ringer´s lactate (OR 1.8 CI (95% OR: 1.2-2.8), adjusting for other variables. Conclusion: The administration of ringer´s lactate decreases the development of acute renal failure; also, age of the patient and if it came from the postoperative period, were the factors that were related to the presence of kidney disease.

Incidence and risk factors of acute kidney injury after total joint arthroplasty; a retrospective cohort study

BackgroundAcute Kidney Injury (AKI) is a common complication post-arthroplasty, although it has not been extensively studied. We carried out a retrospective study to determine the incidence and risk factors of AKI in patients undergoing total joint arthroplasty (TJA). MethodWe reviewed the medical records of all patients who underwent elective TJA from December 2014 to January 2017 at the Salford Royal Hospital, UK. AKI was defined using the AKIN, RIFLE and KDIGO criteria in patients with worsened renal function post-arthroplasty. We analysed the association of the demographics, risk factors, medications and use of peri-operative IV fluids with AKI. A logistic regression was performed to find any correlation between these factors and incidence of AKI. Results197 patients were included in our study, the mean age was 70.2 and male to female ratio was 6:5. Of these, 32(16.2%) developed an AKI. The multivariate logistic regression revealed 4 independent factors associated with the risk of AKI; age (P = 0.0011, OR 1.07, 95% CI 1.03–1.18), obesity (P = 0.003, OR 6.4, 95% CI 2.34–17.5), smoking (P = 0.0482, OR 3.76, 95% CI 1.01–14.0) and COPD (P = 0.0253, OR 3.85, 95% CI 1.18–12.5). ConclusionThe incidence of AKI post-arthroplasty was found to be much higher than stated in other literatures. The recognition of the high incidence and multiple independent risk factors will allow a better approach to peri-operative management, limiting the risks of AKI. Our study also highlighted the importance of documenting urine output and the need to repeat the renal function test 3 months after an AKI to assess recovery.

2109. Liposomal Amphotericin B-associated Nephrotoxicity in Obese and Non-obese Patients

BackgroundLiposomal amphotericin B (L-amb) is an important antifungal agent which exhibits significant rates of dose-dependent nephrotoxicity. Animal studies demonstrate only small amounts of L-amb distribute into adipose tissue and obese animals show greater risk of nephrotoxicity with L-amb administration. This study aims to determine whether obese patients are at a higher risk of nephrotoxicity with weight-based doses of L-amb.MethodsWe performed a multi-center, retrospective cohort study of nephrotoxicity with L-amb in obese (BMI > 30) and non-obese adult patients at University of Utah Health and Intermountain Healthcare from January 1, 2014 through December 31, 2018. Our primary outcome was the rate of nephrotoxicity as determined by AKIN criteria. Patients receiving at least one dose of L-amb were identified for inclusion. Patients were excluded if they were already on a renal replacement at the time of L-amb initiation or they received L-amb prior to admission.ResultsWe included 221 patients, 47 (21%) were obese and 174 (79%) were non-obese. Median total body weight was 109 kg in obese patients compared with 70 kg in non-obese patients. Dosage based on ideal body weight was higher in the obese group (median 6.9 mg/kg vs. 4.9 mg/kg). Obese patients were significantly more likely to experience acute kidney injury (AKI) than non-obese patients (55% vs. 37%, P = 0.03). Patients who experienced nephrotoxicity received a higher average daily dose than those who did not (365 mg vs. 333 mg, P = 0.03), had a higher median cumulative dose (3,130 mg vs. 1,700 mg, P < 0.001), and had a higher median total body weight (79.6 kg vs. 71.9 kg, P = 0.04.). Additionally, daily dose normalized to total body weight was not associated with AKI (median 4.7 mg/kg in patients with AKI vs. 4.8 mg/kg in patients without AKI, P = 0.86). However, daily dose normalized to ideal body weight was associated with AKI (median 5.5 mg/kg in patients with AKI vs. 4.9 mg/kg in patients without AKI, P = 0.02).ConclusionWe identified a higher rate of nephrotoxicity among obese patients receiving L-amb compared with non-obese patients. These data suggest that dosing L-amb based on total body weight places obese patients at a higher risk of nephrotoxicity. This should be considered when assessing the risks and benefits of this dosing strategy in obese patients.Disclosures All authors: No reported disclosures.

1095 Presence of Acute Kidney Injury (AKI) at Admission in Severe Alcoholic Hepatitis (SAH) Patients Predicts Mortality: A Single Centre Experience

INTRODUCTION: Severe Alcoholic Hepatitis (SAH) is a life-threatening condition. There are different models to prognosticate patients with SAH. However, the impact of presence of acute kidney injury (AKI), defined as per AKIN criteria in patients with SAH has not been assessed for this region of Asia. Hence we performed a prospective study to evaluate the spectrum of SAH including outcome in hospitalized patients and the impact of AKI on outcome of patients with SAH. METHODS: This study was conducted on consecutive alcoholic hepatitis (AH) patients hospitalised in Gastroenterology Department, SCB Medical College, Cuttack, India between October 2016 and October 2018. On diagnosis of AH, modified Maddrey discriminant function (mDF) was used to detect SAH (mDF score ≥32).Demographic, clinical and laboratory parameters were recorded and survival was compared between patients with and without AKI (as per AKIN criteria) during hospitalisation and also at 28 days and 90 days. RESULTS: 339 patients of AH were included in the study. Out of them, 236 (70%) patients had SAH (DF ≥ 32) and 103 patients (30%) had DF &lt; 32.All patients with SAH were males. 164 (69%) patients with SAH had AKI and72 (31%) did not have AKI at hospitalisation. On comparison between SAH patients with or without AKI, age was comparable between the two groups. However, patients with SAH and AKI had higher MELD UNOS (28.69 ± 8.36 vs 19.50 ± 3.83; P &lt; 0.001), MELD Na+ (30.44 ± 7.56 vs 22.97 ± 4.56; P &lt; 0.001), CTP score (12.46 ± 1.84 vs 11.93 ± 1.50; P = 0.033), DF ((71.18 vs 53.24,IQR; P &lt; 0.001) and ABIC score (3.37 ± 1.47 vs 2.26 ± 0.61; P &lt; 0.001). Furthermore, they had increased prevalence of ACLF as per CANONIC study criteria (73.2% vs 34.7%; P &lt; 0.001), increased duration of hospitalisation (5days vs 4days,IQR; P &lt; 0.001) and decreased survival both at 28days (57.9% vs 80.6%; P &lt; 0.001) and 90days (36% vs 55.6%; P = 0.005). Kaplan–Meier survival curves showed significant differencesin survival between patients with and without AKI both at 28 days (log rank P value &lt; 0.001) and 90 days (log rank P value &lt; 0.001) (Figure 1). CONCLUSION: In our institution, over three fourth of alcoholic liver disease patients had severe AH and three fourth of them had AKI at admission. Patients with AH and AKI had increased proportion of ACLF, longer hospital stay, and decreased survival both at day 28 and 90.

Observational study to assess demographic, clinical profile and outcome of acute kidney injury due to acute gastroenteritis during monsoon season

Background: Worldwide incidence and causes of acute kidney injury (AKI) are variable and even more in developed and developing countries. At least 80% of AKI in tropics is community acquired. Acute gastroenteritis (AGE) is a common problem in developing countries. Present study concentrates on AGE as cause of AKI during monsoon period. It presents in epidemic proportion during monsoon and is preventable with timely intervention.Methods: The study was carried out prospectively in tertiary care hospital in Mumbai during monsoon season of 2012 and 2013. AKI was staged as per AKIN criteria. Patients were treated for primary disease and AKI, initially conservatively and dialysis if indicated. Patients were followed during the hospital stay.Results: Two hundred and thirty patients had AKI due to infectious disease during monsoon. Incidence of AKI due to diarrhea was 23%, and affecting males predominantly in 4th decade. Diarrhea and vomiting were the most common presenting complaints. 32% patients required dialysis. Mortality rate was 3.8%.Conclusions: AKI secondary to AGE is common in tropics. Treatment of primary disease and hemodynamic optimization at the earliest helps to prevent AKI. Presents with less severe AKI and has better outcome. Multiorgan involvement and need for supportive lifesaving therapies were risk factors for AKI.

The administration of contrast media: Is there a risk of acute kidney injury?

ObjectiveTo determine whether the intravenous administration of iodinated contrast material for computed tomography (CT) is associated with an increase in creatinine levels and acute kidney injury. Material and methodsThis retrospective cohort study included all patients who presented at the emergency department between 2010 and 2015 with baseline creatinine measurement (C1) and follow-up creatinine measurement (C2) between 24 and 72h later. The clinical research ethics committee approved the study. The exclusion criteria were age <18 years, creatinine ≤0.4mg/dl or ≥4.0mg/dl, and the administration of contrast media within the previous 6 months. The mean number of patients presenting at the emergency department was 105,435.6 per year. Patients who met the inclusion criteria were classified into three groups: those who underwent contrast-enhanced CT (n=6642), those who underwent noncontrast CT (n=6193), and those who did not undergo CT (n=33,802). We used the Acute Kidney Injury Network's (AKIN) and the Contrast-induced Nephropathy Consensus Working Panel's (CIN) criteria. Statistical analyses included bivariate statistics and logistic regression. Stata 15 was used for all statistical analyses. ResultsWe analysed 52,411 patients; after data cleansing: 46,637; mean age: 67.95 years; C1: mean 1.16mg/dl (SD: 0.61); C2: 1.14mg/dl (SD: 0.66). With AKIN and CIN criteria: contrast-enhanced CT was not associated with a greater probability of developing nephropathy (odds ratio [OR: 0.90; 95% CI: 0.83–0.99] and [OR 0.89, 95% CI: 0.81–0.98], respectively). The propensity score matching study using both sets of criteria (AKIN+CIN) yielded OR 0.80 [95% CI: 0.77–0.84]. Glomerular filtration rates less than 30ml/min were not associated with increased kidney damage [OR: 0.66, 95% CI: 0.47–0.91]. ConclusionThe administration of intravenous contrast material in the patients studied is not associated with increased acute kidney injury.

MON-247 INCIDENCE AND SHORT TERM OUTCOME OF TYPE 1 CARDIORENAL SYNDROME IN NEPALESE PATIENTS

Heart performance and kidney function are closely related. Dysfunction of heart and kidneys often coexist and one begets other. Acute heart failure and its treatment can lead to acute kidney injury, known as, Type 1 Cardiorenal syndrome (CRS). There is no study on CRS in Nepalese patient. We undertook this study to determine the incidence and short term outcome of AKI in acute heart failure (type 1 CRS). Patients with acute heart failure needing hospitalization, who consented for the study were enrolled from June 2017 to May 2018. Framingham criteria for heart failure and AKIN criteria for AKI were used to define heart failure and AKI respectively. Detailed clinical and relevant investigations (laboratory and imaging) were done and recorded in predefined performa. Patients were followed up on day 7th and at 3 month. A total of 115 patients with acute heart failure needing hospitalization were enrolled in this study. All patients were in NYHA class III or IV. The mean age of the patients was 61.5 ±16.5years. Male constituted 61%. BMI was recorded to be 22.58 ± 3.59. Hypotension on presentation was recorded in 8%. Half of the patients (n=58) was diagnosed to have Acute kidney injury. Presence or absence of history of smoking (55%), systemic hypertension (37%), diabetes mellitus (27%), ischemic heart disease (9%) and COPD (7%) was not associated with higher risk of development of AKI. Twelve patients died during hospital stay (11 with AKI and 1 patient with no AKI). All cause mortality at 3 months was significantly higher in patient with AKI (32.8%; n=19) in comparison to patients without AKI (7%, n=4). Incident of AKI in acute heart failure is high in this study. Acute heart failure patient with AKI (Type 1CRS) had high mortality compare to those without AKI.

Administración de medios de contraste. ¿Existe riesgo de daño renal agudo?

ObjectiveTo determine whether the intravenous administration of iodinated contrast material for computed tomography (CT) is associated with an increase in creatinine levels and acute kidney injury. Material and methodsThis retrospective cohort study included all patients who presented at the emergency department between 2010 and 2015 with baseline creatinine measurement (C1) and follow-up creatinine measurement (C2) between 24 and 72hours later. The clinical research ethics committee approved the study. The exclusion criteria were age <18 years, creatinine ≤ 0.4mg/dl or ≥4.0mg/dl, and the administration of contrast media within the previous 6 months. The mean number of patients presenting at the emergency department was 105,435.6 per year. Patients who met the inclusion criteria were classified into three groups: those who underwent contrast-enhanced CT (n=6,642), those who underwent noncontrast CT (n=6,193), and those who did not undergo CT (n=33,802). We used the Acute Kidney Injury Network's (AKIN) and the Contrast-induced Nephropathy Consensus Working Panel's (CIN) criteria. Statistical analyses included bivariate statistics and logistic regression. Stata 15 was used for all statistical analyses. ResultsWe analyzed 52,411 patients; after data cleansing: 46,637; mean age: 67.95 years; C1: mean 1.16mg/dl (SD: 0.61); C2: 1.14mg/dl (SD: 0.66). With AKIN and CIN criteria: contrast-enhanced CT was not associated with a greater probability of developing nephropathy (odds ratio [OR: 0.90; 95% CI: 0.83–0.99] and [OR 0.89, 95% CI: 0.81–0.98], respectively). The propensity score matching study using both sets of criteria (AKIN+CIN) yielded OR 0.80 [95% CI: 0.77–0.84]. Glomerular filtration rates less than 30ml/min were not associated with increased kidney damage [OR: 0.66, 95% CI: 0.47–0.91]. ConclusionThe administration of intravenous contrast material in the patients studied is not associated with increased acute kidney injury.