Analysis Of Acute Kidney Injury Research Articles

Interpretable machine learning-based individual analysis of acute kidney injury in immune checkpoint inhibitor therapy.

Acute kidney injury (AKI) is a critical complication of immune checkpoint inhibitor therapy. Since the etiology of AKI in patients undergoing cancer therapy varies, clarifying underlying causes in individual cases is critical for optimal cancer treatment. Although it is essential to individually analyze immune checkpoint inhibitor-treated patients for underlying pathologies for each AKI episode, these analyses have not been realized. Herein, we aimed to individually clarify the underlying causes of AKI in immune checkpoint inhibitor-treated patients using a new clustering approach with Shapley Additive exPlanations (SHAP). We developed a gradient-boosting decision tree-based machine learning model continuously predicting AKI within 7 days, using the medical records of 616 immune checkpoint inhibitor-treated patients. The temporal changes in individual predictive reasoning in AKI prediction models represented the key features contributing to each AKI prediction and clustered AKI patients based on the features with high predictive contribution quantified in time series by SHAP. We searched for common clinical backgrounds of AKI patients in each cluster, compared with annotation by three nephrologists. One hundred and twelve patients (18.2%) had at least one AKI episode. They were clustered per the key feature, and their SHAP value patterns, and the nephrologists assessed the clusters' clinical relevance. Receiver operating characteristic analysis revealed that the area under the curve was 0.880. Patients with AKI were categorized into four clusters with significant prognostic differences (p = 0.010). The leading causes of AKI for each cluster, such as hypovolemia, drug-related, and cancer cachexia, were all clinically interpretable, which conventional approaches cannot obtain. Our results suggest that the clustering method of individual predictive reasoning in machine learning models can be applied to infer clinically critical factors for developing each episode of AKI among patients with multiple AKI risk factors, such as immune checkpoint inhibitor-treated patients.

A retrospective analysis of acute kidney injury in children with post-COVID-19 multisystem inflammatory syndrome: insights into promising outcomes.

Acute kidney injury (AKI) in patients with multisystem inflammatory syndrome (MIS), COVID-19 related infection has been increasingly recognized with a paucity of data on AKI incidence, related mortality, and the requirement of renal replacement therapy in children with MIS (MIS-C). This is a retrospective study evaluating the prevalence, severity, management and outcomes of AKI in a cohort of Egyptian children with MIS-children (MIS-C) post-COVID infection. Patients were included if they met the criteria for MIS-C based on CDC guidelines. All patients were evaluated for AKI diagnosis and staging according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Between March 2021 and June 2023, a total of 655 confirmed COVID-19 cases were admitted and then followed up in our hospital, of whom 138 (21%) were diagnosed with MIS-C. Fifty-one patients developed AKI associated with MIS-C post-COVID infection, 42 of whom were included in the analysis. Thirty-one patients had AKI in a formerly healthy kidney, of whom 51% (16 patients) were classified as KDIGO stage 3, 5 patients needed hemodialysis and 13 needed mechanical ventilation. Higher WBCs count, and serum ferritin on admission were associated with more severe AKI (KDIGO stage 3) (p = 0.04), while multivariate analysis showed high serum ferritin to be independent predictor of more severe AKI (p = 0.02). Two patients (2/31) died during hospital admission, while no residual renal impairment was reported at the time of discharge of patients with previously normal kidney functions. More than one-third of patients with MIS-C develop AKI. Avoidance of nephrotoxic drugs, early recognition, and prompt management of AKI, including well-timed commencement of dialysis in MIS-C cases, is associated with favorable outcomes.

Urinary proteome analysis of acute kidney injury in post-cardiac surgery patients using enrichment materials with high-resolution mass spectrometry.

Background: Cardiac surgery-associated acute kidney injury (CSA-AKI) may increase the mortality and incidence rates of chronic kidney disease in critically ill patients. This study aimed to investigate the underlying correlations between urinary proteomic changes and CSA-AKI. Methods: Nontargeted proteomics was performed using nano liquid chromatography coupled with Orbitrap Exploris mass spectrometry (MS) on urinary samples preoperatively and postoperatively collected from patients with CSA-AKI. Gemini C18 silica microspheres were used to separate and enrich trypsin-hydrolysed peptides under basic mobile phase conditions. Differential analysis was conducted to screen out urinary differential expressed proteins (DEPs) among patients with CSA-AKI for bioinformatics. Kyoto Encyclopedia of Genes and Genomes (KEGG) database analysis was adopted to identify the altered signal pathways associated with CSA-AKI. Results: Approximately 2000 urinary proteins were identified and quantified through data-independent acquisition MS, and 324 DEPs associated with AKI were screened by univariate statistics. According to KEGG enrichment analysis, the signal pathway of protein processing in the endoplasmic reticulum was enriched as the most up-regulated DEPs, and cell adhesion molecules were enriched as the most down-regulated DEPs. In protein–protein interaction analysis, the three hub targets in the up-regulated DEPs were α-1-antitrypsin, β-2-microglobulin and angiotensinogen, and the three key down-regulated DEPs were growth arrest-specific protein 6, matrix metalloproteinase-9 and urokinase-type plasminogen activator. Conclusion: Urinary protein disorder was observed in CSA-AKI due to ischaemia and reperfusion. The application of Gemini C18 silica microspheres can improve the protein identification rate to obtain highly valuable resources for the urinary DEPs of AKI. This work provides valuable knowledge about urinary proteome biomarkers and essential resources for further research on AKI.

The incidence and risk factors analysis of acute kidney injury in hospitalized patients received diuretics: A single-center retrospective study.

Diuretics have been one of the well-known nephrotoxic drugs which can lead to acute kidney injury (AKI). However, there are few real-world studies on the incidence of AKI in hospitalized patients received diuretics. In the present study, a single-center retrospective study was conducted in our center. The clinical data of hospitalized patients received diuretics from January 2018 to December 2020 was retrospectively analyzed. Among the 18,148 hospitalized patients included in the study, 2,589 patients (14.26%) were judged as incidence with AKI, while only 252 patients were diagnosed with AKI in the medical record. Among diuretics drugs in the study, the incidence rate of AKI with torasemide was the highest with 21.62%, and hydrochlorothiazide had the lowest incidence rate (6.80%). The multiple logistic regression analysis suggested that complicated with hypertension, anemia, pneumonia, shock, sepsis, heart failure, neoplastic diseases, combined use of proton pump inhibitors (PPI) were independent risk factors for AKI related to diuretics. The logic regression models for diuretics related AKI were developed based on the included data. The model for diuretics-AKI achieved the area under the receiver operating characteristic curves (AUC) with 0.79 on 10-fold cross validation. It is urgent to improve the understanding and attention of AKI in patients received diuretics for medical workers, and the assessment of risk factors before the use of diuretics should be contributed to the early prevention, diagnosis and treatment of AKI, and ultimately reducing morbidity and improving prognosis.

Integrated Metabolomic and Transcriptomic Analysis of Acute Kidney Injury Caused by Leptospira Infection.

Renal leptospirosis caused by leptospiral infection is characterised by tubulointerstitial nephritis and tubular dysfunction, resulting in acute and chronic kidney injury. Metabolomic and transcriptomic data from a murine model of Leptospira infection were analysed to determine whether metabolomic data from urine were associated with transcriptome changes relevant to kidney injury caused by Leptospira infection. Our findings revealed that 37 metabolites from the urine of L. interrogans-infected mice had significantly different concentrations than L. biflexa-infected and non-infected control mice. Of these, urinary L-carnitine and acetyl-L-carnitine levels were remarkably elevated in L. interrogans-infected mice. Using an integrated pathway analysis, we found that L-carnitine and acetyl-L-carnitine were involved in metabolic pathways such as fatty acid activation, the mitochondrial L-carnitine shuttle pathway, and triacylglycerol biosynthesis that were enriched in the renal tissues of the L. interrogans-infected mice. This study highlights that L-carnitine and acetyl-L-carnitine are implicated in leptospiral infection-induced kidney injury, suggesting their potential as metabolic modulators.

Vonoprazan-associated nephrotoxicity: extensive real-world evidence from spontaneous adverse drug reaction reports

Vonoprazan-associated nephrotoxicity: extensive real-world evidence from spontaneous adverse drug reaction reports

Spatially Resolved Transcriptomic Analysis of Acute Kidney Injury in a Female Murine Model.

Single-cell sequencing technologies have advanced our understanding of kidney biology and disease, but the loss of spatial information in these datasets hinders our interpretation of intercellular communication networks and regional gene expression patterns. New spatial transcriptomic sequencing platforms make it possible to measure the topography of gene expression at genome depth. We optimized and validated a female bilateral ischemia-reperfusion injury model. Using the 10× Genomics Visium Spatial Gene Expression solution, we generated spatial maps of gene expression across the injury and repair time course, and applied two open-source computational tools, Giotto and SPOTlight, to increase resolution and measure cell-cell interaction dynamics. An ischemia time of 34 minutes in a female murine model resulted in comparable injury to 22 minutes for males. We report a total of 16,856 unique genes mapped across our injury and repair time course. Giotto, a computational toolbox for spatial data analysis, enabled increased resolution mapping of genes and cell types. Using a seeded nonnegative matrix regression (SPOTlight) to deconvolute the dynamic landscape of cell-cell interactions, we found that injured proximal tubule cells were characterized by increasing macrophage and lymphocyte interactions even 6 weeks after injury, potentially reflecting the AKI to CKD transition. In this transcriptomic atlas, we defined region-specific and injury-induced loss of differentiation markers and their re-expression during repair, as well as region-specific injury and repair transcriptional responses. Lastly, we created an interactive data visualization application for the scientific community to explore these results (http://humphreyslab.com/SingleCell/).

The changing epidemiology of acute kidney injury syndromes in the face of emerging respiratory viral pandemic illnesses

In this issue, Birkelo etal. performed a rigorous analysis of acute kidney injury (AKI) differences in patients hospitalized with coronavirus disease 2019 versus influenza. Coronavirus disease 2019 AKI was more severe, with worse outcomes, than influenza, despite adjustment for confounders. Their findings highlight the need for development of a new category of AKI syndrome, "viral pandemic-associated AKI," in which a more varied pathophysiological approach to AKI would combine with consideration of overcoming future surge-related resource shortages.

Risk factor analysis of acute kidney injury after one-stop hybrid coronary revascularization.

One-stop hybrid coronary revascularization (HCR) combines coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) procedures simultaneously. Acute kidney injury (AKI) is a common complication after CABG or PCI. This study explored the risk factors for developing AKI after one-stop HCR. A total of 123 consecutive patients who underwent one-stop HCR between April 2018 and November 2020 were included in this single-center retrospective study. Postoperative AKI was observed in 11 patients (the AKI group), and 112 patients did not develop postoperative AKI (the non-AKI group). Baseline characteristics and perioperative variables were extracted from the electronic medical records and statistically analyzed. Postoperative AKI occurred in 11 (8.9%) patients. Compared to patients who did not develop AKI, patients in the AKI group were older (71.0±9.5 vs. 64.1±9.2 years, P=0.019), had higher preoperative creatinine levels (92.6±16.8 vs. 69.8±14.4 mmol/L, P<0.001), experienced a greater volume of postoperative drainage on the first day {850 mL [410, 1,500] vs. 500 mL [321, 700], P=0.045}, had a higher proportion of chronic renal insufficiency (eGFR <60 mL/min/1.73 m2) (36.4% vs. 7.1%, P=0.012), and had more perioperative transfusions (63.6% vs. 22.3%, P=0.007). Multivariate logistics analyses revealed that advanced age [odds ratio (OR) 5.44, P=0.014] and perioperative transfusions (OR 4.62, P=0.028) were independent risk factors for developing AKI after one-stop HCR. One-stop HCR did not increase the incidence of postoperative AKI in our center. Advanced age (≥75 years) and perioperative transfusions were independent risk factors for developing AKI after one-stop HCR. Further studies need to be conducted to confirm the risk factors of AKI after HCR procedures.

A prediction score model and survival analysis of acute kidney injury following orthotopic liver transplantation in adults.

Acute kidney injury (AKI) is one of the postoperative complications following orthotopic liver transplantation (OLT), and is related to the high morbidity and mortality. Although there were numerous propensity factors for AKI, their cumulative influence remains unclear. Our aims were to develop a score model to predict postoperative AKI and to evaluate the impact of AKI on the recipients' long-term survival. We retrospectively analyzed 99 adult patients underwent OLT in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology between October 2014 and July 2020. The patients were dichotomized into the non-AKI and the AKI groups according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. We defined stage-1 AKI as mild AKI, stage-2 AKI and stage-3 AKI as severe AKI. Overall, 29 (29.29%) patients developed AKI after OLT, of these, stage-1, stage-2, stage-3 account for 20.20% (20 of 99 patients), 2.02% (2 of 99 patients), 7.07% (7 of 99 patients), respectively; and 13.79% of postoperative AKI patients (4 of 29 patients) accepted renal replacement therapy (RRT). Operative time and MELD-Na score predicted the postoperative AKI, with odds ratio of 1.006, 1.061, respectively. The generated AKI prediction model is as follows: -5.594+0.007×operative time+0.060×MELD-Na. The area under the receiver operating characteristic curve (AUC) for the AKI prediction model was 0.762, and the sensitivity and specificity were 79.3%, 61.4%, respectively. There was no difference in long-term survival among the mild AKI group and the non-AKI group (P=0.751). However, the impact of severe AKI on long-term survival of patients was statistically significant when comparing the non-AKI group and the mild AKI group (P=0.001, P=0.011). AKI occurs frequently in adult patients after OLT, and it poses a threat to patients' long-term survival. The severe AKI has negative impact on long-term survival, while the mild AKI has limited impact on long-term survival, compared with non-AKI group. The novel AKI prediction model has prognostic value in identifying patients at high risk for postoperative AKI.

Critical analysis of acute kidney injury in pediatric COVID-19 patients in the intensive care unit.

Background and objectivesCOVID-19 is responsible for the 2019 novel coronavirus disease pandemic. Despite the vast research about the adult population, there has been little data collected on acute kidney injury (AKI) epidemiology, associated risk factors, treatments, and mortality in pediatric COVID-19 patients admitted to the ICU. AKI is a severe complication of COVID-19 among children and adolescents.MethodsA comprehensive literature search was conducted in PubMed/MEDLINE and Cochrane Center Trials to find all published literature related to AKI in COVID-19 patients, including incidence and outcomes.ResultsTwenty-four studies reporting the outcomes of interest were included. Across all studies, the overall sample size of COVID positive children was 1,247 and the median age of this population was 9.1 years old. Among COVID positive pediatric patients, there was an AKI incidence of 30.51%, with only 0.56% of these patients receiving KRT. The mortality was 2.55% among all COVID positive pediatric patients. The incidence of multisystem inflammatory syndrome in children (MIS-C) among COVID positive patients was 74.29%.ConclusionAKI has shown to be a negative prognostic factor in adult patients with COVID-19 and now also in the pediatric cohort with high incidence and mortality rates. Additionally, our findings show a strong comparison in epidemiology between adult and pediatric COVID-19 patients; however, they need to be confirmed with additional data and studies.Graphical abstract Supplementary InformationThe online version contains supplementary material available at 10.1007/s00467-021-05084-x.

Risk factors analysis of acute kidney injury in patients with exertional heatstroke

Objective: To explore the risk factors of acute renal injury (AKI) in exertional heat radiation disease (EHS) . Methods: In november 2019, the clinical data of 69 EHS patients admitted from July 2015 to September 2019 were reviewed. The general data, laboratory indexes, Glasgow score (GCS) at admission, 24-hour acute physiology and chronic health score Ⅱ (APACHE Ⅱ) , exposure time rate and physical labor intensity were collected. According to the occurrence of AKI, the patients were divided into AKI group and non-AKI group, 31 and 38 in each group. The differences of general data and laboratory indexes between the two groups were compared, and the t and Mann-Whitney U test were used to compare the two groups. The enumeration data are expressed by examples and constituent ratio (%) . Independent sample χ(2) test is used for inter-group comparison, and multiple test is used for multi-sample comparison. The correlation was analyzed by linear regression. Risk factors were analyzed by Logistic regression analysis. Results: At discharge, 31 of 69 EHS patients developed AKI. Compared with the non-AKI group, the heart rate, white blood cell count, lactic acid, D-dimer and myoglobin were higher; MAP, platelet count and PH were lower in the AKI group. The difference was statistically significant (P<0.05) . APACHE Ⅱ score, core temperature, time to drop to 38.5 ℃, contact time rate, platelet count, pH, lactic acid, D-dimer and myoglobin were all correlated with creatinine (r=0.57, 0.42, 0.80, 0.78, 0.57, 0.43, 0.51, 0.55, 0.79) . APACHE Ⅱ score, time to drop to 38.5C, Lac and MYO are the risk factors of AKI in EHS patients. Multivariate Logistic regression analysis showed that the time required to drop to 38.5C was an independent risk factor for the occurrence of AKI. Conclusion: AKI is a serious complication of EHS. EHS complicated with AKI, should be identified early and effective intervention measures should be taken.

Factor analysis of acute kidney injury in patients administered liposomal amphotericin B in a real-world clinical setting in Japan

Liposomal amphotericin B (L-AMB) is a broad-spectrum antifungal drug that is used to treat fungal infections. However, clinical evidence of its use in patients with renal failure is limited. Here, we aimed to identify factors associated with acute kidney injury (AKI) in patients administered L-AMB. We retrospectively utilized a combination of Diagnosis Procedure Combination data and laboratory data obtained from hospitals throughout Japan between April 2008 and January 2018. In total, 507 patients administered L-AMB were identified. After L-AMB treatment initiation, AKI, which was defined as a ≥ 1.5-fold increase within 7 days or ≥ 0.3 mg/dL increase within 2 days in serum creatinine according to the KDIGO criteria, was recognized in 37% of the total patients (189/507). The stages of AKI were stage 1 in 20%, stage 2 in 11%, and stage 3 in 7%. Five factors were associated with AKI of all stages: prior treatment with angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers or carbapenem; concomitant administration of catecholamines or immunosuppressants; and ≥ 3.52 mg/kg/day of L-AMB dosing. Serum potassium < 3.5 mEq/L before L-AMB therapy was associated with severe AKI of stage 2 and 3. Altogether, these factors should be carefully considered to reduce the occurrence of AKI in patients administered L-AMB.

Risk Factor Analysis of Acute Kidney Injury After Microwave Ablation of Hepatocellular Carcinoma: A Retrospective Study.

Objectives: Acute kidney injury (AKI) is a recently observed side effect in patients after microwave ablation (MWA) of hepatocellular carcinoma (HCC) and is associated with negative outcomes. The aim of this study is to explore the risk factors of affecting the occurrence of AKI (stages 1b, 2, and 3), because they have a higher mortality rate than patients with AKI (stage 1a) and without AKI.Materials and methods: In this retrospective study, a total of 1,214 patients with HCC who were treated with MWA under ultrasound (US) guidance in our department between January 2005 and November 2017 were enrolled. We evaluated the influence of 20 risk factors. Univariate and multivariate analysis were used for statistical analysis. The possible risk factors of AKI after MWA for HCC were summarized.Results: AKI, AKI (stage 1a), and AKI (stages 1b, 2, and 3) after MWA were found in 34, 15, and 19 patients (2.80, 1.24, and 1.57%), respectively. Among 34 patients with AKI, 10 cases with AKI (stage 1a) and 6 cases with AKI (stages 1b, 2, and 3) recovered before their discharge without any treatment for AKI and 9 cases with AKI (stages 1b, 2, and 3) with further treatment. Four cases who had chronic renal failure before MWA of liver accepted renal dialysis. By univariate analysis, the number of antenna insertions (P = 0.027, OR = 3.3), MWA time ≥20 min (P = 0.029, OR = 4.3), creatinine (Cr)-pre above the upper limit of the reference value (P < 0.001, OR = 35.5), albumin (Alb)-pre (P = 0.030, OR = 0.9), and red blood cell (RBC)-pre (P < 0.001, OR = 0.3) were significant risk factors. By multivariate analysis, Cr-pre ≥ 110 μmol/L (P < 0.001, OR = 31.4) and MWA time ≥20 min (P = 0.043 OR = 9.9) were the independent risk factors.Conclusion: AKI (stages 1b, 2, and 3) is a relatively serious complication after MWA for HCC, which is related to MWA time and Cr-pre. It requires attention by clinicians. So it is of great necessity to assess the Cr-pre level and reduce the MWA time to <20 min to minimize the risk of AKI after MWA for HCC.

Risk factors analysis of acute kidney injury following open thoracic aortic surgery in the patients with or without acute aortic syndrome: a retrospective study

BackgroundThe acute kidney injury (AKI) remains a frequent complication following open thoracic aortic surgery (OTAS) and worsens the postoperative prognosis. It remains unclear that whether the predictors of AKI following OTAS are different in the patients with or without acute aortic syndrome (AAS).MethodsPreoperative and intraoperative variables were compared between the patients with or without AKI, and were further analyzed for identifying the potential predictors of postoperative AKI. Subgroup analysis was conducted in the patients with or without AAS, respectively.ResultsAKI after OTAS occurred in 57.6% of the overall cohort, 70.1% of the patients with AAS and 46.7% of the patients without AAS. In the multivariate analysis, history of hypertension (OR 1.011, 95% CI: [1.001–1.022], p = 0.04), preoperative platelet (OR 0.995, 95% CI: [0.991–0.999], p = 0.006) and operation time (OR 1.572, 95% CI: [1.355–1.823], p < 0.001) were identified as independent predictors of postoperative AKI for the overall cohort; CPB time (OR 1.020, 95% CI: [1.009–1.031], p < 0.001) and preoperative LMR (OR 0.823, 95% CI: [0.701–0.966], p = 0.02) as independent predictors for the patients with AAS; age (OR 1.045, 95% CI: [1.015–1.076], p = 0.003), preoperative platelet (OR 0.993, 95% CI: [0.988–0.998], p = 0.04) and operation time (OR 1.496, 95% CI: [1.166–1.918], p = 0.002) as independent predictors for the patients without AAS.ConclusionsThe patients with AAS carry a higher risk for postoperative AKI compared with those without AAS. The predictive factors for postoperative AKI after OTAS are different for AAS- and non-AAS subgroups and operation time, CPB time and preoperative platelet are modifiable predictors of AKI.

Pregnancy protects the kidney from acute ischemic injury

A complex analysis of acute kidney injury (AKI) in pregnant women shows that it is caused by the interaction of gestation-associated pathologies and beneficial signaling pathways activated by pregnancy. Studies report an increase in the regeneration of some organs during pregnancy. However, the kidney response to the injury during pregnancy has not been addressed. We investigated the mechanisms of the pregnancy influence on AKI. During pregnancy, the kidneys were shown to be more tolerant to AKI. Pregnant animals showed remarkable preservation of kidney functions after ischemia/reperfusion (I/R) indicated by the decrease of serum creatinine levels. The pregnant rats also demonstrated a significant decrease in kidney injury markers and an increase in protective markers. Two months after the I/R, group of pregnant animals had a decreased level of fibrosis in the kidney tissue. These effects are likely linked to increased cell proliferation after injury: using real-time cell proliferation monitoring we demonstrated that after ischemic injury, cells isolated from pregnant animal kidneys had higher proliferation potential vs. control animals; it was also supported by an increase of proliferation marker PCNA levels in kidneys of pregnant animals. We suggest that these effects are associated with hormonal changes in the maternal organism, since hormonal pseudopregnancy simulated effects of pregnancy.

A Critical Analysis of Acute Kidney Injury in the Setting of Type 2 Diabetes Mellitus

A Critical Analysis of Acute Kidney Injury in the Setting of Type 2 Diabetes Mellitus

Comparison of Propensity Score–Matched Analysis of Acute Kidney Injury After Percutaneous Coronary Intervention With Transradial Versus Transfemoral Approaches

Transradial percutaneous coronary intervention (TR-PCI) may be associated with reduced rates of acute kidney injury (AKI). There is limited data from real-world registries about AKI rates stratified by PCI access. Our aim was to evaluate AKI rates and correlates in TR-PCI versus transfemoral PCI (TF-PCI) in a propensity score-matched analysis of patient data from a large, single-center registry. We performed a 1:1 propensity score-matched analysis on consecutive patients who underwent PCI from January 2011 to June 2016, excluding those on dialysis. A multivariate logistic regression model was adjusted to variables found to be significant in univariate models. AKI was defined by creatinine increase of ≥0.3mg/dL post-PCI during hospitalization. During the study period, 6,743 patients underwent PCI (TR-PCI n= 1,119). Initial univariate models revealed significant differences between patients with TF-PCI and TR-PCI. Contrast amount and procedure duration were both increased with TR-PCI versus TF-PCI (162 vs 154ml, p= 0.003; and 86 vs 79minutes, p <0.001, respectively). Multivariate propensity score analysis matched 536 pairs of patients. In this matched cohort, TR-PCI was associated with a reduced risk for AKI compared with TF-PCI in univariate (4.3% vs 10.4%, p <0.001) and multivariate adjusted models (odds ratio 0.28, 95% confidence interval 0.19 to 0.59, p <0.001).

The analysis of acute kidney injury in hepatitis B virus related acute-on-chronic liver failure

Objective To investigate the incidence and risk factors of acute kidney injury (AKI) in hepatitis B virus (HBV) related acute-on-chronic liver failure (ACLF) patients, and to explore the impact of AKI on the prognosis of ACLF. Methods The medical records of 227 patients who were diagnosed with HBV-related ACLF at the Department of Infectious Diseases in the First Affiliated Hospital of Nanchang University from January 2015 to August 2016 were retrospectively reviewed. Patients were divided into AKI group and non-AKI group based on the AKI criteria published by International Club of Ascites in 2015. Demographic and clinical data were compared between groups. The AKI incidence and its impact on patients’ prognosis were analyzed. The comparison of continuous variables was done by t test or rank-sum test. The comparison of categorical variables was done by χ2 test or Fisher exact test. AKI risk factors were analyzed by using logistic regression. Results There were 66 (29.1%) cases were diagnosed with AKI among 227 ACLF patients, among which, 45 patients (68.2%) were stage Ⅰ, 14 (21.2%) were stage Ⅱ and 7 (10.6%) were stage Ⅲ. Age, cirrhosis, concentrations of total bilirubin and albumin, international normalized ratio (INR), percentage of neutrophils, MELD scores and spontaneous peritonitis rate (SBP) were all statistically different between AKI group and non-AKI group (all P<0.05). The binary logistic regression analysis revealed that only INR (OR=3.132, P=0.001) and SBP(OR=4.204, P=0.001) were the independent risk factors of AKI. The optimal cut-off value for INR was 2.025 with AUROC of 0.609 (P=0.01), sensitivity of 59.1% and specificity of 62.1%.The 30-day mortality of AKI group was significantly higher than non-AKI group (χ2=18.324, P<0.01). Conclusions AKI is relatively common in patients with ACLF. The risk factors of AKI are INR and SBP. AKI has significant impact on the short-term survival rate of ACLF. Therefore, physicians should pay attention to patients with INR of ACLF at admissions and SBP during the management so as to prevent the occurrence of AKI and to reduce the fatality of ACLF. Key words: Hepatitis B; Acute on chronic liver failure; Acute kidney injury; Risk factors

TCT-374 Propensity Score Matched Analysis of Acute Kidney Injury Following Percutenous Coronary Intervention with Trans-Radial versus Trans-Femoral Approach

TCT-374 Propensity Score Matched Analysis of Acute Kidney Injury Following Percutenous Coronary Intervention with Trans-Radial versus Trans-Femoral Approach