Average Creatinine Level Research Articles

P1216 EFFICACY AND SAFETY OF SIMEPREVIR PLUS PEG-INTERFERON/RIBAVIRIN THERAPY IN PATIENTS WITH HCV GENOTYPE 1 – COMPARISON WITH TELAPREVIR PLUS PEG-INTERFERON/RIBAVIRIN THERAPY AND PEG-INTERFERON/RIBAVIRIN THERAPY

Background and Aims: Telaprevir (TVR)-based triple therapy is effective for hepatitis C patients. However, we have reported that TVR causes a reduction in renal function, with a reduction in the excretion of ribavirin (RBV), and the serum RBV concentration rises and the increased RBV concentration leads to hemolytic anemia (Y. Karino et al. J viral hepat. 2013). In this study, we retrospectively investigated the effects and adverse events of simeprevir (SMV)based triple therapy in comparison with TVR-based triple therapy and PEG-IFN/RBV therapy. Methods: Twenty seven patients were assigned to SMV for 12 weeks along with PEG-IFN/RBV for 24 weeks (Group A), while 65 patients were assigned to TVR for 12 weeks along with PEG-IFN/ RBV for 24 weeks (Group B) and 190 patients were assigned to PEG-IFN/RBV for 48 weeks (Group C). SMV was administered at a dose of 100mg (or 50mg) per day for 12 weeks (or 24weeks) and TVR was administered at a dose of 1500mg or 2250mg per day for 12 weeks. Results: SVR24 rate was 85.2% in Group A, 84.5% in Group B, and 45.3% in Group C. Adherence to RBV was significantly lower in Group B (63.3%) than Group A (93.5%) and Group C (94.3%). Average hemoglobin level (g/dl) at weeks 0/1/2/4/8/12 was 14.1/14.0/12.8/11.5/11.3 in Group A, 13.8/13.6/12.4/11.2/10.1/10.0 in Group B, and 13.6/13.5/12.5/11.7/11.3/11.1 in Group C and average creatinine level (mg/dl) at weeks 0/1/2/4 was 0.70/0.68/0.67/0.67, 0.70/0.85/0.81/0.85, 0.69/0.69/0.66/0.65, respectively. Conclusions: Simeprevir-based triple therapy resulted in less adverse events, higher adherence to RBV than telaprevir-based triple therapy, and high SVR24 rate.

Robot-assisted renal transplantation in the retroperitoneum

Minimally invasive surgery for renal transplantation is still under development. We employed the robotic surgical system to perform renal transplantation with a minimally invasive wound. The operation was performed with a Gibson incision and two working ports. The space for the transplantation was created by retroperitoneal dissection with the robot lifting the abdominal wall. Vascular reconstruction was performed with two robotic needle drivers. We successfully performed robot-assisted renal transplantation in five female and five male patients with an average wound length of 7.7 ± 1.04 cm. Nine of the renal allografts functioned immediately, but one with prolonged warm ischemia during the live donor nephrectomy had delayed function. The average creatinine level and estimated glomerular filtration rate at discharge were 1.31 ± 0.31 mg/dl and 58.2 ± 8.1 ml/min, respectively. All the transplants are currently functioning at 6.9 ± 3.9 months after operations. In conclusion, with robot assistance, minimal invasive renal transplantation can be performed successfully in the retroperitoneum.

The prognostic value of serum creatinine levels and blood lactic acid on predicting patients with severe acute pancreatitis

Objective To explore the prognostic significance of blood Lactic acid and serum creatinine in serum creatinine levels and blood lactic acid on Predicting patients with severe acute pancreatitis.Methods Serum creatinine and blood lactic acid was tested on the first day,and average blood lactic acid and creatinine levels in 61 patients with severe acute pancreatitis admitted to the ICU which were divided into survival group(n=39) and death group(n=22).according to prognosis.serum creatinine,blood lactic acid,APACHE scores were compared between two groups.Results Compared with survival group,serum creatinine levels and blood lactic acid were higher in death group(P＜0.05),the average levels were slso higher in Icu hospitalization(P＜0.01),blood lactic acid and serum creatinine were highly correlated to APACHE Ⅱ scores(P＜0.05).Conclusion Serum creatinine levels and blood lactic acid Can predichhe nroanosis of patients with severe acute pancreatitis Key words: Severe Acute Pancreatitis; Blood lactic acid; Serum creatinine

Laparoscopic Kidney Orthotopic Transplant: Preclinical Study in the Pig Model

BackgroundLaparoscopic surgery has rapidly expanded in clinical practice replacing conventional open surgery over the last three decades. Laparoscopic donor nephrectomy has been favored due to its multiple benefits. The aim of this study was to explore the safety and feasibility of kidney transplantation by a laparoscopic technique in a pig model. Materials and methodsThe study was approved by the university animal ethics committee. Eight female pigs (Sus Scrofra, weighing 45–50 kg) were divided into 2 groups: group I included 4 animals that underwent laparoscopic kidney orthotopic transplantation on the left side. The right kidney was remained functional in situ. The pigs recovered and were observed for 1 week. In the 4 hosts group II pigs underwent a laparoscopic kidney transplantation on the left side. With simultaneous clipping of the right ureter. After recovery, the pigs were observed for 4 weeks. A laparotomy for examination was performed prior to euthanasia. ResultsAll 4 group I pigs survived for 1 week. The laparotomy showed normal graft perfusion with wall patent renal artery and vein as well as satisfactory urine output upon transection of ureter in 3 hosts. Renal artery stenosis occurred in one pig. In The Immediate kidney graft function was achieved in 3 group II pigs. The fourth died following extubation due to laryngospasm despite a functional graft. The average creatinine levels were 195.5 μmol/L on day 3; 224.5 μmol/L at week 1; 127 μmol/L at week 2; 182.7 umol/L at week 3; and 154.7 umol/L at week 4. ConclusionLaparoscopic kidney transplantation was feasible and safe in a pig model with immediate graft function. This study will provide further evidence to support application of laparoscopic technique to human kidney transplant.

Safety and efficacy of transradial percutaneous coronary intervention for unprotected left main coronary artery lesions with 6 French guiding catheter

To investigate the safety, medium-term and long-term efficacy of transradial percutaneous coronary intervention for unprotected left main coronary artery lesions with 6 French guiding catheter. Sixty-one patients with unprotected left main coronary artery lesions were treated by 6 French transradial percutaneous coronary intervention between January 2008 and December 2009. The mean age of patients was (66.03 ±10.02)years (44-87). Among 61 cases, 40 had hypertension and 14 had diabetes mellitus; 22 had a history of smoking. The average left ventricle ejection fraction was (62.96 ±12.15)% (range: 28-86) and the average plasma creatinine level was (82.92 ±18.30)μmol/L (range: 44-130). The major adverse cardiac events (MACE) after the procedure were evaluated. Procedural success was achieved in all cases. A total of 67 stents were implanted. No in-hospital death occurred. Mean clinical follow-up period was (26.25 ±5.92) months (range: 19-44 months). MACE developed in 6 cases (9.8%) during the follow-up period, including 2 death (3.3%) and 4 case of target lesion revascularization (6.6%). Compared with low-risk group (SYNTAX score<33), MACE was increased in the high-risk group (SYNTAX score>32). 6 French transradial percutaneous coronary intervention for patients with unprotected left main coronary artery lesions is safe and feasible procedure with desirable medium-and long-term outcomes.

THE SECURITY, MEDIUM-TERM AND LONG-TERM EFFECTS OF SIX FRENCH TRANSRADIAL PERCUTANEOUS CORONARY INTERVENTION FOR PATIENTS WITH UNPROTECTED LEFT MAIN CORONARY ARTERY LESIONS

ObjectivesTo study the clinical security, medium-term and long-term effects of six French transradial percutaneous coronary intervention for patients with unprotected left main coronary artery lesions.MethodsOur study investigated 61 patients with...

Late evolution of kidney transplants in elderly donors and recipients receiving initial immunosuppressant treatment with daclizumab, mycophenolate mofetil, and delayed introduction of tacrolimus.

Organ transplants in elderly recipients have increased over the past few years. This situation poses specific problems both in terms of organs and recipients; therefore, immunosuppressant regimens must be adapted accordingly. A previous study demonstrated good initial results in kidney transplant cases in which older donors and recipients (average ages of 64.4 years and 61.3 years) had received initial immunosuppressant therapy with daclizumab and mycophenolate mofetil as well as delayed introduction of reduced-dose tacrolimus. In this study we reviewed the long-term results in the same group of patients. An observational, retrospective multi-centre study carried out at a national level to determine survival rates and renal function in 126 patients included in the initial study (127 patients who survived the first year with a functioning graft, 123 treated according to protocol). We gathered data from the 2nd to the 6th year for 120, 118, 113, 102 and 62 patients, respectively. The evolution of renal function, relevant clinical data, and safety profiles were also analysed. After five years, most patients continued with the initial immunosuppressant regimen: 92% tacrolimus and 80% mycophenolate mofetil; 48% had abandoned steroids and proliferation signal inhibitors had been introduced in 3%. Patient and graft survival (adjusted for patient death) after five years was 93.1% and 93.8%, respectively. The main cause of death was neoplasia (in 7 out of 10 cases) whilst graft loss was mainly due to death with a functioning graft. The other causes of death were 2 acute myocardial infarctions and a gastrointestinal haemorrhage. Renal function was moderately but significantly reduced with the passing of time (P<.001): average creatinine levels in the overall group of patients rose from 1.60 ± 0.50mg/dl after the 1st year to 1.63 ± 0.70 mg/dl at the end of study. MDRD dropped from 46.28 ± 15.64 ml/min after the 1st year to 45.69 ± 15.44 ml/min at the end of study (P<.01). Only two acute rejections were observed after the 1st year. There were 19 cardiovascular events registered in 12 patients. The regimen used in our study was useful and appropriate for elderly donor-recipient pairs as demonstrated by the good long-term survival results, continued optimum renal function, and acceptable safety profile.

Ist Nephroprotektion durch die Auswahl des Röntgen-Kontrastmittels im Rahmen von Gefäßinterventionen bei vorbestehender Niereninsuffizienz möglich?

The increasing number of endovascular procedures made aware of a kidney disease induced by contrast media (CM). Contrast-induced nephropathy (= CIN) can develop in 0.6-44 % of the treated patients by angiography and / or endovascular intervention. The incidence in high-risk patients ranges from 50 to 70 %. In most cases CIN is inconspicuous and reversible. But pre-existing chronic kidney disease, diabetes mellitus, age and variable different risk factors (e. g., PAOD) can induce irreversible renal impairment. The purpose of the presented trial is to investigate incidence, predictors, and out-come of CIN in chronic renal failure patients using two different CM; one non-ionic isoosmolar -iodixanol and the other non-ionic low-osmolar iopromide. To evaluate the incidence of CIN after endovascular diagnostics and intervention two collectives of 100 patients with chronic renal insufficiency were treated with different contrast media (CM). Inclusion followed prospectively in two collectives. One collective received iopromide (Ultravist™, Bayer Health Care, Lever-kusen, Germany), and the second hundred patients received iodixanol (Visipaque™, Nycomed Amersham, Princeton, New Jersey). Demographics, comorbidities, procedure-related data were completed by serum creatinine levels and GFR (= glomerular filtration rate). Inclusion criteria were a serum creatinine level ≥ 1.5 mg% and a GFR ≤ 60 mL / min. Those parameters were measured twice pre-interventionally, and one time 48-72 hours after the endovascular procedure. Collectives were homogenous and comparable concerning pre-existing risk factors, age and gender. Renal function stayed at a constant level and was independent of contrast medium selection, repectively. Average creatinine levels ranged around 1.77 mg% ± 0.75 standard deviation (SD) pre-interventionally; postinterventional measurement exposed a creatinine level of 1.74 mg% ± 0.74 SD as mean of both collectives. GFR (preinterventional 39.64 mL / min ± 12.48 SD) increased non-significantly to 45.48 mL / min ± 16.82 SD. Pre-existing chronic kidney disease had no effect on renal function parameters; no other risk factors could be evaluated. According to cost-effectiveness a low-osmolar monomeric contrast medium (LOCM) is a sufficient selection, under careful renal function control.

Oral Prostaglandin E1 in Combination with Sodium Bicarbonate and Normal Saline in the Prevention of Contrast-Induced Nephropathy: A Pilot Study

The purpose of this study was to evaluate the use of prostaglandin E1 (PGE1) as a renal protective medication for patients exposed to contrast agents, as well as to demonstrate the safety, efficacy, and low side-effect profile of PGE1. A prospective, randomized, double-blind study was designed to compare combination of intravenous sodium bicarbonate, normal saline, and oral PGE1 200 μg versus the combination and placebo for renal protection from contrast agents. All patients receiving nonionic contrast during their interventional procedure were eligible for enrollment. Creatinine levels were recorded before and after the administration of contrast and renal protective medications. Contrast-induced nephrotoxicity (CIN) was defined as an increase of 0.5 mg/dL or greater in creatinine level, or an increase of 25% or more above baseline. Age, gender, total amount of contrast used, and incidence of renal failure requiring dialysis were recorded. We conducted the study on 41 patients. Of these, 20 patients received PGE1 and 21 received the placebo. The study group comprised 29 males and 12 females. Diabetes mellitus occurred in 41.5% of the cases (including 40% of PGE1 and 43% of placebo patients). Average contrast use was 77.2 mL (range, 15 to 200 mL). Mean age of the groups was 67.2 years. Average baseline creatinine level was 1.17. The differences between the groups were not statistically significant. CIN by definition occurred in one patient, who received the placebo. Incidence of new onset renal failure requiring dialysis was zero. Postcontrast change in creatinine level for the study was 0.11. There was a change in the creatinine level of 0.161 in the PGE1 group and 0.061 in the placebo group; an improvement of 0.10. PGE1 was not effective in significantly altering postcreatinine levels (p = 0.176). None of the patients enrolled in the study suffered any side effects from taking the PGE1 tablet. Although preliminary, this study shows that the addition of PGE1 for the prevention of CIN is well-tolerated by patients and is a safe modality. Additional studies are required to evaluate efficacy.

Incidence of Contrast-Induced Nephropathy in Patients With Multiple Myeloma Undergoing Contrast-Enhanced CT

The purpose of this article is to evaluate the incidence of contrast-induced nephropathy (CIN) and the effects of associated risk factors in patients with multiple myeloma undergoing contrast-enhanced CT (CECT) with IV administration of nonionic iodinated contrast agent. This retrospective review of medical records identified patients with a diagnosis of myeloma who underwent a CECT examination of the chest, abdomen, or pelvis between January 1, 2005, and December 1, 2008. Analysis for CIN, as defined by an increase in creatinine level after the CECT examination of 25% or more, or of 0.5 mg/dL, compared with the level before the CECT examination, both within 48 hours and within 7 days, was performed. Statistical correlations between the development of CIN and creatinine level before CECT examination, patient location, type and amount of contrast agent, blood urea nitrogen-creatinine ratio, history of diabetes, hypercalcemia, Bence Jones proteinuria, β(2)-microglobulin level, albumin level, International Myeloma Staging System stage, and history of myeloma provided at the time the CT examination was ordered were calculated. Forty-six patients who completed 80 unique examinations were included; their average creatinine level before CECT examination was 0.97 mg/dL. There was no significant difference in the average creatinine levels before CT examination between patients without and those with CIN. Four (5%) and 12 (15%) patients developed CIN within 48 hours and 7 days, respectively. Only serum β(2)-microglobulin level showed a statistically significant (p = 0.03) correlation with the development of CIN. The incidence of CIN in patients with multiple myeloma with a normal creatinine level is low and correlates with β(2)-microglobulin levels. The administration of contrast agent in this patient population is safe but should be based on the potential benefit of the examination and the expected low risk of developing CIN.

Endothelial progenitor cells (EPC) in sepsis with acute renal dysfunction (ARD)

IntroductionSepsis is characterized by systemic microvascular dysfunction. Endothelial progenitor cells (EPCs) are critically involved in maintaining vascular homeostasis under both physiological and pathological conditions. The aim of the present study was to analyze the endothelial progenitor cell system in patients suffering from sepsis with acute renal dysfunction.MethodsPatients with newly diagnosed sepsis were recruited from the ICU in a nonrandomized prospective manner. Blood samples were obtained within the first 12 hours after the diagnosis of sepsis. For quantifying endothelial progenitor cells (EPCs), CD133+/Flk-1+ cells were enumerated by cytometric analysis. Analysis of EPC proliferation was performed by a colony-forming units (CFU) assay. Blood concentrations of proangiogenic mediators were measured by ELISA. Acute renal dysfunction was diagnosed according to the Acute Kidney Injury Network (AKIN) criteria. Depending on the overall mean creatinine concentration during the stay at the ICU, patients were either assigned to a 'normal creatinine group' or to a 'high creatinine group'. Survival rates, frequency of dialysis, the simplified acute physiology score (SAPS) II scores, and different laboratory parameters were collected/used for further clinical characterizationResultsCirculating EPCs were significantly higher in all sepsis patients included in the study as opposed to healthy controls. Patients within the 'high creatinine group' showed an even more pronounced EPC increase. In contrast, EPC proliferation was severely affected in sepsis. Neither total circulating EPCs nor EPC proliferation differed between patients requiring dialysis and patients without renal replacement therapy. Cell numbers and cell proliferation also did not differ between surviving patients and patients with sepsis-related death. Serum levels of vascular endothelial growth factor (VEGF), stromal derived factor-1 (SDF-1), and Angiopoietin-2 were higher in sepsis than in healthy controls. Sepsis patients within the 'high creatinine group' showed significantly higher mean serum levels of uric acid.ConclusionsSepsis significantly affects the endothelial progenitor cell system, as reflected by increased EPC numbers, increased concentrations of proangiogenic mediators, and reduced proliferative capacity of the cells. This occurs independently from the frequency of dialysis and from patient survival. Increased serum levels of uric acid are possibly responsible for stronger EPC mobilization in sepsis patients with higher average creatinine levels.

Full Metal Jacket Stenting of the Superficial Femoral Artery: A Retrospective Review

The technique of long segment stenting of the superficial femoral artery (SFA) has been associated with poorer short- and long-term results. The full metal jacket (FMJ) stenting is typically described as long segment continuous stenting of a vessel segment. Initially, this technique was described in percutaneous coronary interventions. However, until recently, FMJ of the SFA has not been studied. We examined our experience with FMJ of the SFA to evaluate the outcomes and the safety of this technique. Retrospective data were gathered for peripheral angioplasties and stenting for the period between January 2005 and December 2008. The cases involving FMJ stenting of the SFA were identified by angiographic findings and the operative dictations providing the stent data. Selective FMJ stenting of the SFA was performed for the residual stenosis after balloon angioplasty of the SFA because of either dissection or significant recoil. The cases with concomitant iliac artery angioplasty and/or stenting were excluded from the data set for analysis. The variables for the evaluation were primary patency rate, mortality rate, and limb salvage rate, which were stratified on the basis of the risk factors. A total of 63 cases involving FMJ stenting of the SFA were identified from the database of 707 patients who had peripheral endovascular interventions between January 2005 and December 2008. Average age of the patients was 70 years (range: 52-104 years, SD: 10.1 years). There were no transatlantic inter-society consensus (TASC) A lesions, 11% (7/63) of the lesions were TASC B, 68% (43/63) were TASC C, and 21% (13/63) were TASC D. The median primary patency rate was 9 months (95% CI: 5.06-12.94). The mortality rate was 4% at 6-month follow-up. The limb salvage rate was 85.7%. In all, 65% (41/63) of the patients were claudicants, whereas 23% (15/63) had intervention for some form of tissue loss (ischemic ulcer, gangrene). Associated infrapopliteal intervention was performed in 15.9% of the patients. Average creatinine level was 1.67 (range: 0.7-10.9, SD: 2.03) and 49% (31/63) of the patients had diabetes. The average 6-month patency rate was 55% (SD: 0.5). Multivariate logistic regression analysis showed that diabetes (OR: 0.33, p = 0.044, 95% CI: 0.11-0.97) and a creatinine level of ≥1.6 (OR: 0.16, p = 0.038, 95% CI: 0.03-0.9) were the independent risk factors for loss of patency in <6 months. Our experience suggests promising results for the technique of FMJ of the SFA and also that further examination of the technique is warranted.

Successful Outcomes of Older Donors in Laparoscopic Donor Nephrectomy

Healthy older living donors (> 50 years) are helping meet increasing demands for kidney transplantation. Live donor grafts perform better than cadaveric donor grafts; however, concern surrounds the expected nephron loss of the donors as well as the relative safety to the donor. We examined the effect age had on living laparoscopic donor and recipient outcomes at a single institution. We retrospectively reviewed records of 101 patients who underwent laparoscopic donor nephrectomy (LDN) from October 2001 to December 2005. Twenty-nine (29%) who were aged 50 years or older, denoted as the "older" group, were compared with the remaining 72 (71%) donors who were younger than 50 years and served as controls. Perioperative and follow-up data were analyzed for both groups. The mean age at the time of donation was 36.1 and 54.3 years for control and older donors, respectively (P < 0.001). Baseline mean creatinine level was 0.82 mg/dL for controls and 0.84 mg/dL for older donors (P = 0.78). Complications in controls and the older group were 18% and 17%, respectively. One-year transplant survival was 100% for the controls and 96% for the older group. Average creatinine level at longer follow-up of 19 months for controls and 23 months for the older group (P = 0.34) was 1.22 mg/dL and 1.16 mg/dL, respectively (P = 0.535). LDN in donors older than 50 years of age appears safe and demonstrates similar outcomes compared with the control cohort of patients younger than 50 years. Age between 50 and 65 years should not exclude a potential donor who otherwise satisfies donor nephrectomy criteria.

Prevalence and staging of chronic kidney disease in renal transplant recipients

Diagnosis and staging of chronic kidney disease (CKD) is important for management and prevention of renal disease progression. It is unclear whether K/DOQI guidelines of the National Kidney Foundation are applicable to diagnosis of CKD in renal transplant recipients (RTRs) and which method is most appropriate for estimating glomerular filtration. To determine the prevalence and staging of CKD in RTRs, according to K/DOQI guidelines, and the prevalence of complications of CKD. This cross-sectional study included RTRs at least six months post-transplantation followed at a single out-patient service. The glomerular filtration rate (GFR) was estimated with two different equations: the MDRD equation (Modification of Diet in Renal Disease) with four variables (age, creatinine level, gender, and race) and the Cockcroft-Gault (CG) formula. Patients with GFR more than 60 mL/min/1.73 m2 were diagnosed with CKD only in the presence of renal damage (hematuria, proteinuria, or evidence of injury in renal biopsy). CKD staging was compared to the two equations and the prevalence of complications was determined. The study evaluated 241 RTRs (average age: 40.6 +/- 12.5 yr, 62.2% male; 4.5% black, 50.6% from cadaveric donors). Average follow-up time was 6.8 +/- 6.1 yr and the average baseline creatinine level was 1.48 +/- 0.72 mg/dL. CKD was diagnosed in 70.5% of RTRs, of whom 52.9% (MDRD)/47.6% (CG) were classified as Stage III (GFR: 30-59 mL/min/1.73 m2). The agreement between the two methods was very close with regard to CKD diagnosis (kappa = 0.92) and close for stage-dependent prevalence (kappa = 0.68). The prevalence of anemia, hypocalcemia, hyperphosphatemia (HF), hyperuricemia (HU), and systemic arterial hypertension (SAH) was 10.6%, 7.6%, 10.3%, 54%, and 73.4% for patients with CKD. Significant differences were observed for HU, HF and SAH in patients without CKD. Anemia, HU and SAH were associated with CKD stage (p < 0.001). The prevalence of CKD in the study population was high (70.5%). The two equations tested correlated closely when used for GFR estimation. Routine CKD staging in RTRs would provide patients with safer and more appropriate management.

Diagnosis and Treatment of Acute Humoral Kidney Allograft Rejection

Acute humoral rejection (AHR) is a severe form of rejection associated with poor graft survival. Prompt diagnosis and rapid institution of therapy are crucial to improve the prognosis. A therapeutic approach based on plasmapheresis, intravenous imunoglobulin, and rituximab seems to be effective in refractory cases. Herein we have described our experience with 11 patients with biopsy-proven AHR who were treated between January 2005 and June 2008. Seven of these patients had panel reactive antibodies titers more than 50%. The diagnosis was based on Banff 2001 criteria; treatment consisted of a combination of plasmapheresis and intravenous immunoglobulin. Four refractory cases were also treated with a single dose of rituximab. One graft was lost due to thrombosis. All other patients recovered graft function with an average creatinine level of 1.6 mg/dL at 8.6 ± 2.7 months of follow-up.

Iatrogenic hyperkalemia as a serious problem in therapy of cardiovascular diseases in elderly patients

The therapy of cardiovascular diseases has improved rapidly over the past 20 years. The most commonly used medications in cardiac patients are drugs affecting potassium homeostasis in the kidneys or the gastrointestinal tract, particularly inhibitors of renin-angiotensin-aldosterone (RAA) axis. They all can lead to hyperkalemia. This disorder may cause severe damage to the muscles and both the nervous and cardiovascular systems. The aim of this study was to evaluate the incidence and clinical course of moderate and severe iatrogenic hiperkalemia in patients hospitalized for cardiovascular disease. The present study analyzed a history of 26 patients with severe or moderate iatrogenic hyperkalemia, selected from among 5553 patients hospitalized in the years 2005-2006 in the Department of Clinical Cardiology of the Swietokrzyskie Cardiology Center, Kielce. They accounted for 0.46% of all patients treated at that time at the Ward. The concentration of potassium on admission to hospital was > 6.0 mmol/l. Before admission all patients were treated in out-patient clinics with angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, spironolactone, amiloride, triam-terene, beta-blockers, or potassium supplements administered in monotherapy or in combination. A mean age of patients was 79 years, most of them (80%) were women. The average blood potassium level was 7.3 mmol/l on admision and 5.1 mmol/l at discharge. Severe bradyarrhythmia and complete atrioventricular block requiring temporary pacing (n = 13) were observed in 21 patients (81%). Twenty-four patients (85%) had elevated levels of renal function parameters on admission. The average creatinine level on admission was 2.64 mg/dl, and 2.06 mg/dl on discharge. Ten (38%) out of 26 patients suffered from diabetes and 21 patients (81%) had arterial hypertension. Three out of 26 patients died in the hospital despite intensive therapy. Polypharmacy should be used with particular caution in subjects treated on the ambulatory basis. During administration of inhibitors of RAA system, particularly in elderly out patients, renal function and serum electrolytes should be appropriately monitored both prior to and during the treatment.

Incidence of Contrast-Induced Nephropathy in Patients With Chronic Renal Insufficiency Undergoing Multidetector Computed Tomographic Angiography Treated With Preventive Measures

Contrast-induced nephropathy (CIN) is associated with adverse outcomes. Strategies for its prevention have been evaluated for patients undergoing invasive coronary and peripheral angiography, including treatment with N-acetylcysteine, sodium bicarbonate, and use of iso-osmolar nonionic contrast. Recently, multidetector computed tomographic angiography (MDCTA) of the coronary and peripheral arteries has been introduced as an accurate method for assessing vascular stenosis and has been widely adopted for assessment of outpatients with suspected coronary artery disease or peripheral arterial disease. To date, the incidence of CIN in outpatients with chronic renal insufficiency (CRI) treated with CIN-preventive strategies undergoing MDCTA remains unknown. Thus, we evaluated the incidence of CIN in outpatients with CRI (creatinine 1.5 to 2.5 mg/dl) undergoing MDCTA using CIN-preventive measures; 400 patients with CRI (78.5% men, mean age 76 years, 41% with diabetes) underwent MDCTA with iodixanol for detection of coronary artery disease or peripheral arterial disease (mean contrast volume 101 cc). CIN was defined as a nonallergic creatinine increase of >0.5 mg/dl. Creatinine levels were obtained before and 3 to 5 days after MDCTA; the average creatinine levels were 1.80 mg/dl and 1.75 mg/dl, respectively (p = NS), with an average change of -0.03 mg/dl. In the study cohort, only 7 patients (1.75%) experienced a creatinine increase >0.5 mg/dl, satisfying the definition of CIN. In conclusion, multivariate analysis, diabetes was the only predictor for CIN (odds ratio 5.9, 95% confidence interval 1.0 to 33.3, p = 0.045). No patient required hemodialysis. In conclusion, in patients with CRI undergoing MDCTA and receiving CIN-preventive measures, the incidence of CIN is low.

POD-03.06: Renal insufficiency is not a contraindication for renal cryoablation

Renal cryoablation has been shown to have negligible impact on renal function. This has been demonstrated by comparing the average creatinine level of the patient population prior to cryoablation to the average level of the population after cryoablation. However, the effect of renal cryoablation on patients with preoperative renal insufficiency has not been reported. The purpose of this investigation is to determine the creatinine level changes for patients who undergo renal cryoablation and have preexisting renal insufficiency.

Safety of limited supplemental iodinated contrast administration in azotemic patients undergoing CO2 angiography.

To determine if limited doses of iodinated contrast significantly worsen the underlying renal insufficiency that had warranted the use of CO(2) for diagnostic angiography. The records of 122 consecutive patients who had undergone CO(2) angiography for peripheral vascular disease at our institution over a 5-year period were reviewed. The volume and type of iodinated contrast and the volume of CO(2) administered were recorded. Serum creatinine measurements obtained before angiography and from 2 to 3 days after angiography were recorded. One hundred patients had pre-angiography and post-angiography creatinine levels available for analysis (51 CO(2) only, 49 CO(2) with iodinated contrast). The average pretreatment creatinine level was 2.8+/-1.5 mg/dL (range 1.8-6.6) for the CO(2) only group and 3.0+/-1.4 mg/dL (range 1.8-8.2) for the CO(2) plus iodinated contrast group (p=0.46). After angiography, the mean change in creatinine was +0.17+/-0.87 mg/dL for the CO(2) only group and +0.03+/-0.98 mg/dL in the CO(2) plus contrast group (p=0.27). Complications included 1 patient with a failing renal transplant who received iodinated contrast and ultimately required return to hemodialysis. A second patient had a transient 1-mg/dL rise of creatinine but did not require dialysis. This study supports the relative safety of CO(2) angiography with the limited used of iodinated contrast supplementation for diagnostic studies or interventions in azotemic patients with peripheral vascular disease.

Single-center experience with mycophenolate mofetil in pediatric renal transplant recipients.

Mycophenolate mofetil (MMF), a potent and specific inhibitor of guanosine nucleotide synthesis, is a new immunosuppressive drug used to prevent rejection in transplant patients. Extensive data on its utility and efficacy exists in adult patients but there is limited experience in pediatrics. Twenty-four children (14 male, 10 female; 2-19 yr of age), eight of whom had received living-related donor (LRD) transplants and 16 of whom had received cadaveric donor (CD) transplants, have been treated with MMF in our institution since September 1996. MMF was administered for a duration ranging from 13 weeks to 38 months, at an average dose of 600 mg/m2 (range: 200-1,000 mg/dose) every 12 h, for a total experience of 304 patient months. MMF capsules were used in 16 patients and/or pediatric suspension in eight. Five patients were switched to MMF from azathioprine as a result of rejection episodes or inability to taper prednisone, between 5 weeks and 3.5 yr post-transplant. All patients received prednisone, cyclosporin A (CsA), and induction therapy with anti-lymphocyte globulin (19 patients), anti-thymocyte globulin (one patient) or daclizumab (four patients). In 12 patients started on MMF at the time of CD transplant, five (42%) had an acute rejection episode. In seven who received a LRD transplant, one (14%) had an acute rejection episode. No patients who were converted to MMF were treated for acute rejection following conversion to MMF. One LRD graft was lost at 19 days following injury to the donor artery at the time of retrieval. At the last follow-up, the average creatinine level was 93 micromol/L and average urea level was 8.6 mmol/L. One patient developed epigastric distress. Three patients developed diarrhea/abdominal pain requiring dose adjustment. Five episodes of leukopenia and one episode of thrombocytopenia required dose adjustment. Two patients developed symptomatic cytomegalovirus (CMV) infection, one while on acyclovir prophylaxis. No malignancy has been encountered to date. Hence, MMF can be administered safely to children with good effect and with an acceptable side-effect profile.