Baseline Chronic Kidney Disease Research Articles

IMPACT OF PREVIOUS DIAGNOSIS OF HYPERTENSION ON RENAL FUNCTION IN HEART FAILURE PATIENTS

Objective: The aim of this study is to evaluate the impact of previous diagnosis of HTN in the reduction of the estimated glomerular filtration rate (eGFR) and the development of chronic kidney disease (CKD) in heart failure (HF) patients by using real world data. Design and method: The study population was selected from a database with electronic health records information from 2012 to 2016 of patients older than 24 years of age. Patients with an active diagnosis of HF at some point during this period were selected, and then stratified according to the presence of previous diagnosis of hypertension. eGFR and Kidney Disease Global Outcomes (KDIGO) risk scale during the observational period were analyzed. Two events were studied using survival and Cox proportional hazards regression models: i) reduction of 20% compared to basal eGFR value and ii) increased risk in the KDIGO scale. Other clinically relevant factors were selected as adjustment variables: age, sex, comorbidities (atrial fibrillation, diabetes, dyslipidaemia and coronary heart disease) and drugs used for HF treatment or anticoagulation. Results: The study population included 80631 HF patients, 37426 of them classified with the KDIGO scale. The proportion of patients with hypertension was 87% and the mean baseline eGFR was 64.2 ml/min/1.73m2. The average age was 75.63 years and 54.7% women. Significant increments in risk were found in patients diagnosed of hypertension for the two events, being 1.28 (CI95% 1.21–1.36) for the eGFR reduction and 1.36 (CI95% 1.25–1.48) for the KDIGO increased risk (Figures). This effect increased as the baseline CKD risk was higher, with 1.45 (CI95% 1.37–1.53) times the risk in the case of base high-risk group (eGFR at baseline <60ml/min/1.73m2; N = 5980) compared to the low risk one (N = 15460). Conclusions: Hypertension is a very prevalent comorbidity of patients with HF, and has a negative impact on kidney function, increasing the risk of reduction of eGFR and development of CKD. The prognosis is significantly worse as the baseline risk is higher.

A retrospective database analysis of erythropoiesis-stimulating agent treatment patterns and associated healthcare resource use in patients with non-dialysis-dependent chronic kidney disease-related anaemia in Japan.

This study was conducted to evaluate clinical characteristics, treatment patterns, and healthcare resource use (HCRU) for patients in Japan with non-dialysis-dependent chronic kidney disease (CKD) and anaemia. This retrospective, longitudinal, epidemiological database extraction study used the JMDC Claims Database, comprising ~9.4 million unique beneficiaries. The observation period for anaemia and erythropoiesis-stimulating agent (ESA)/iron treatment was 1 January 2015 to 31 December 2018, and for HCRU and costs was 1 April 2016 to 31 March 2018. The non-dialysis-dependent CKD anaemia population, and the ESA treatment, iron treatment, and no-treatment cohorts were evaluated. Patient characteristics, treatment patterns, and outcomes were summarised descriptively. The non-dialysis-dependent CKD anaemia population included 5908 patients (7.9%), with 464 patients in the ESA treatment cohort, 809 patients (13.7%) in the iron treatment cohort (13.7%), and 4405 (74.6%) patients in the no-treatment cohort. The prevalence of patients prescribed an antihypertensive, antidiabetic, and/or antihyperlipidaemic medication generally increased with increasing baseline CKD stage. Proportions of no treatment for anaemia decreased while ESA treatment increased with increasing CKD stage; ESA treatment increased with decreasing baseline haemoglobin levels. Patients in the ESA treatment cohort generally had more frequent events associated with HCRU and higher costs from HCRU-associated activities (e.g., inpatient and outpatient care, pharmacy). As CKD severity increased, anaemia management changed from iron use or no treatment to ESA use; however, anaemia may be undertreated across all CKD stages. ESA-treated patients incurred greater HCRU-associated costs relative to other patients with non-dialysis-dependent CKD anaemia in Japan.

Venous congestion assessment using the venous excess ultrasound score: strongest predictor of acute kidney injury in patients with acute coronary syndromes

Abstract Funding Acknowledgements Type of funding sources: None. Background Elevated mean central venous pressure is associated with an increased risk of acute kidney injury (AKI) in critically ill patients with a broad spectrum of cardiovascular diseases. Nowadays, it is possible to perform a non-invasive assessment of systemic venous congestion using the Venous Excess Ultrasound Score (VExUS) which may enable early identification of patients with increased risk of adverse renal outcomes. Purpose This study aimed to evaluate the association between venous congestion assessed with VExUS and the incidence of AKI in patients with acute coronary syndrome (ACS). Methods Venous congestion assessment using VExUS was performed in consecutive patients with ACS. Linear regression analysis was used to determine the variables associated with the highest measured serum creatinine (sCr) during hospitalization and the admission sCr. In addition, a multivariable logistic regression analysis was performed for assessing the independent risk factors for AKI, which was defined according to the KDIGO criteria. Results A total of 77 patients hospitalized with ACS were prospectively enrolled in this study. Nineteen (25.6%) patients developed AKI. Baseline chronic kidney disease, Killip-Kimball >II on admission, GRACE score, admission NTproBNP values, and VExUS were significantly higher in the AKI-group than in the non-AKI group. Baseline chronic kidney disease, admission NT-proBNP values, and VExUS were independent risk factors associated with the highest measured sCr and the admission sCr. In multivariable logistic regression analysis, the risk of AKI was significantly associated with baseline chronic kidney disease, admission NT-proBNP values, and VExUS. Conclusion Baseline chronic kidney disease, admission NT-proBNP values, and VExUS were significant independent predictors of AKI in patients with ACS.

Association of malnutrition with all-cause and cardiovascular mortality in patients with mild to severe chronic kidney disease undergoing coronary angiography: a large multicenter longitudinal study.

Evidence on the prognostic impact of malnutrition was focused on patients with advanced kidney disease. The relationships between malnutrition and all-cause and cardiovascular mortality in patients with different severity of chronic kidney disease (CKD) have not been adequately addressed. We aimed to reveal the prevalence of malnutrition and its prognostic value in patients with different severity of CKD undergoing coronary angiography (CAG). This was a multicenter, longitudinal, and retrospective cohort study of 12,652 patients with non-dialysis dependent CKD (defined as estimated glomerular filtration rate [eGFR] < 60mL/min/1.73m2) undergoing CAG from five tertiary hospitals between January 2007 and December 2020. The controlling nutritional status (CONUT) score was applied to assess nutritional status. Cox regression models and competing risk Fine and Gray models were used to examine the relationships between malnutrition, all-cause and cardiovascular mortality. Further stratified analysis was performed according to baseline CKD severity (mild, moderate and severe, defined by eGFR < 30, 30-44 and 45-59ml/min/1.73 m2). During a median follow-up of 5.5years (interquartile range: 3.2 to 8.6years), 3801 patients (30.0%) died, and 2150 (17.0%) definitely died of cardiovascular disease. After controlling for confounders, patients had higher all-cause mortality (mild, moderate, and severe vs. absent: HR 1.27, 95 CI % [1.17-1.39]; HR 1.54, 95 CI % [1.39-1.71]; HR 2.22, 95 CI % [1.78-2.77], respectively; P for trend < 0.001) and cardiovascular mortality (mild, moderate and severe vs. absent: HR 1.35, 95 CI % [1.21-1.52]; HR 1.67, 95 CI % [1.45-1.92]; HR 2.10, 95 CI % [1.55-2.85], respectively; P for trend < 0.001) with the severity of malnutrition. In further stratified analysis, a similar prognostic impact of malnutrition was observed in patients with mild to moderate CKD, while mild malnutrition did not seem to have a consistent effect on severe CKD patients. Malnutrition is common among patients with mild to severe CKD undergoing CAG and is strongly associated with increased risk of all-cause and cardiovascular mortality. Malnutrition seems to have a modestly stronger impact on mortality in patients with mild to moderate CKD. This study was registered at Clinicaltrials.gov as NCT05050877.

Associations of Renal Function Trajectories and Long-Term Cardiovascular Risks Among a Population Without Chronic Kidney Disease.

Background The longitudinal trajectories of renal function have been associated with cardiovascular events in patients with chronic kidney disease (CKD). However, the change pattern of renal function in those without CKD has not yet been reported. We aim to explore patterns of renal function change in a non-CKD population and its associated risks with cardiovascular outcomes. Methods and Results The present study analyzed data from 4 prospective cohorts and was restricted to participants without baseline CKD. The primary outcome was major adverse cardiovascular events, defined as a composite of myocardial infarction, chronic heart failure, stroke, and cardiovascular deaths. We used a group-based trajectory model to identify latent groups and analyzed the associated risk with Cox regression models. The complete dates of this study were June 1, 2020, through January 1, 2021. The final sample comprised 23 760 participants (mean age, 58.63 [9.12] years, 10 618 men, and 17 799 White participants). During 20.56 years follow-up, 8328 (35.05%) first major adverse cardiovascular events happened. Four trajectories in estimated glomerular renal function and 3 patterns of CKD progression were identified. Compared with subjects assigned to class I trajectory (high to mildly decreased group), the adjusted hazard ratios of major adverse cardiovascular events for class II (normal to mildly decreased group), class III (normal to moderately decreased group), and class IV (mildly to severely decreased group) were 1.11 (95% CI, 1.01-1.23), 1.27 (95% CI, 1.14-1.40), and 1.56 (95% CI, 1.38-1.77), respectively. Likewise, participants assigned to the slow and rapid progression groups had elevated HRs for major adverse cardiovascular events (1.75 [95% CI, 1.39-2.21] and 2.19 [95% CI, 1.68-2.86], respectively) when compared with the stable group. Findings were generally consistent in stratification analysis, but significant interaction effects by age and smoking status were detected. Conclusions In this study, we identified unique trajectory groups for renal function. These findings may signal an underlying high-risk population and inspire future studies on individualized risk management.

Kidney function while on immune checkpoint inhibitors: Trends in incidence of acute kidney injury, and its causes and outcomes

Background and objectives: Immune checkpoint inhibitor (ICI) use is increasing in the United States, real world data on acute kidney injury (AKI) in the expanding population are sparse. We evaluated trends in AKI incidence, and causes and management of AKI among 1914 persons receiving ICIs in a single center over a period of 5 years. Methods: We included all adults who received ICIs at the Stanford Healthcare System from July 1, 2015 to June 30, 2020. We defined AKI as an increase in serum creatinine to 1.5 times the baseline or an increase of ⩾0.3 mg/dL, and determined mean cumulative incidence of first and repeated episodes of AKI over three time periods. Results: Among the 1914 patients treated with ICIs, mean age was 64.9 (SD 14.3) years, 43% were women, 25% had baseline chronic kidney disease (CKD), 34% had lung and 23% had skin cancer as the indication. The overall cumulative incidence of any AKI and immune-related AKI at 1 year after initiating immunotherapy was 32% and 1.3% respectively. Among 586 cases of AKI, the most common cause was volume depletion (64%). Although 4% of AKI was immune-related, ICI therapy was discontinued in 14% of patients with AKI. Nephrology was consulted in 6%. The risk for AKI was higher among patients with a comorbidity index ⩾3 (vs CMI 0, HR 1.65 [95% CI 1.26–2.17]), digestive system cancer (vs skin cancer, 1.65 [1.13–2.43]), and lower baseline estimated glomerular filtration rate (30–59 and &lt;30 vs &gt;60) (HR 1.69 [1.32–2.16] and 1.85 [1.16–2.97] respectively). Conclusions: AKI occurs in up to 1 in 3 patients, and 1 in 10 will have repeated episodes during the first year of ICI therapy. Incidence of AKI has remained similar over 5-year time span. The cause of AKI while on ICI is rarely an immune-related adverse event.

MP56-17 THE IMPACT OF BASELINE CHRONIC KIDNEY DISEASE ON LONG-TERM SURVIVALS OF PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR BLADDER CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023MP56-17 THE IMPACT OF BASELINE CHRONIC KIDNEY DISEASE ON LONG-TERM SURVIVALS OF PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR BLADDER CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS Alireza Ghoreifi, Reza Sari Motlagh, Takafumi Yanagisawa, Tatsushi Kawada, Inderbir Gill, Siamak Daneshmand, Hooman Djaladat, and Shahrokh F Shariat Alireza GhoreifiAlireza Ghoreifi More articles by this author , Reza Sari MotlaghReza Sari Motlagh More articles by this author , Takafumi YanagisawaTakafumi Yanagisawa More articles by this author , Tatsushi KawadaTatsushi Kawada More articles by this author , Inderbir GillInderbir Gill More articles by this author , Siamak DaneshmandSiamak Daneshmand More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , and Shahrokh F ShariatShahrokh F Shariat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003309.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical cystectomy (RC) is a complex surgery with considerable short- and long-term renal and metabolic complications, especially among those with preoperative chronic kidney disease (CKD). The aim of this study is to evaluate the impact of baseline CKD on oncologic and overall survival of patients who underwent RC for bladder cancer. METHODS: PubMed, Web of Science, Cochrane Library, and Scopus databases were searched for articles published by September 2022 according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. After quality and risk of bias assessments, eligible studies were included in the meta-analysis. The primary outcome was overall survival (OS) and secondary outcomes included cancer-specific survival (CSS) and metastasis-free survival (MFS) of patients with CKD ≥3 (estimated glomerular filtration rate (GFR) <60 mL/min) undergoing RC. In addition, subgroup meta-analyses were performed in patients with different pre-operative CKD stages. RESULTS: Seven articles with 6900 patients were included in this study. In terms of oncological outcomes, MFS was compromised in patients with higher CKD stage by a HR of 1.54 (95% CI 1.15–2.05). In the subgroup analyses, patients with CKD3b and those with CKD stages ˃2 had a significantly worse MFS (HR=2.94, p ˂ 0.0001 and HR=1.45, p=0.03, respectively) (Figure 1-A). Also, we found that higher CKD stage could reduce CSS (HR 2.09, 95% CI 1.43–3.05). In the subgroup analysis, all subgroup HRs suggest a decreased CSS, however, patients with CKD3b and CKD ˃2 had a significantly worse CSS (HR=3.94, p˂0.0001 and HR=1.88, p=0.007) (Figure 1-B). Additionally, we found that a higher CKD stage could reduce OS by a HR of 1.47 (95% CI 1.21–1.79). Subgroup analyses showed that patients with CKD3a and CKD3b as well as those with CKD4 had a significantly worse OS (HR=1.13, p=0.03; HR=2.13, p=0.08; and HR=1.71, p=0.002, respectively) (Figure 1-C). CONCLUSIONS: Overall and oncological survivals are compromised in patients with CKD undergoing radical cystectomy. This effect is more prominent in patients with higher CKD stages. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e781 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alireza Ghoreifi More articles by this author Reza Sari Motlagh More articles by this author Takafumi Yanagisawa More articles by this author Tatsushi Kawada More articles by this author Inderbir Gill More articles by this author Siamak Daneshmand More articles by this author Hooman Djaladat More articles by this author Shahrokh F Shariat More articles by this author Expand All Advertisement PDF downloadLoading ...

Association of polygenic scores with chronic kidney disease phenotypes in a longitudinal study of older adults

Risk of chronic kidney disease (CKD) is influenced by environmental and genetic factors and increases sharply in individuals 70 years and older. Polygenic scores (PGS) for kidney disease-related traits have shown promise but require validation in well-characterized cohorts. Here, we assessed the performance of recently developed PGSs for CKD-related traits in a longitudinal cohort of healthy older individuals enrolled in the Australian ASPREE randomized controlled trial of daily low-dose aspirin with CKD risk at baseline and longitudinally. Among 11,813 genotyped participants aged 70 years or more with baseline eGFR measures, we tested associations between PGSs and measured eGFR at baseline, clinical phenotype of CKD, and longitudinal rate of eGFR decline spanning up to six years of follow-up per participant. A PGS for eGFR was associated with baseline eGFR, with a significant decrease of 3.9 mL/min/1.73m2 (95% confidence interval -4.17 to -3.68) per standard deviation (SD) increase of the PGS. This PGS, as well as a PGS for CKD stage 3 were both associated with higher risk of baseline CKD stage 3 in cross-sectional analysis (Odds Ratio 1.75 per SD, 95% confidence interval 1.66-1.85, and Odds Ratio 1.51 per SD, 95% confidence interval 1.43-1.59, respectively). Longitudinally, two separate PGSs for eGFR slope were associated with significant kidney function decline during follow-up. Thus, our study demonstrates that kidney function has a considerable genetic component in older adults, and that new PGSs for kidney disease-related phenotypes may have potential utility for CKD risk prediction in advanced age.

Triglycerides and Renal Outcomes According to Albuminuria and in Consideration of Other Metabolic Syndrome Components in Diabetic US Veterans

Introduction: Hypertriglyceridemia, a component of the metabolic syndrome, is a known independent predictor of albuminuria and chronic kidney disease (CKD) in the general population. Previous studies have shown that the relationship of triglycerides (TGs) with outcomes changes across stages of CKD. Our objective was to examine the association of TG independent of other metabolic syndrome components with renal outcomes in diabetic patients with or without CKD. Methods: This retrospective cohort study included diabetic US veteran patients with valid data on TGs, estimated glomerular filtration rate (eGFR), and albuminuria (urinary albumin/creatinine ratio) between fiscal years 2004 and 2006. Using Cox models adjusted for clinical characteristics and laboratory markers, we evaluated the relationship of TG with incident albuminuria (stratified by eGFR category) and based on eGFR (stratified by baseline albuminuria categories). To evaluate the relationship of TG with time to end-stage renal disease (ESRD), we stratified models by baseline CKD stage (eGFR category) and baseline albuminuria stage ascertained at time of TG measurement. Results: In a cohort of 138,675 diabetic veterans, the mean ± SD age was 65 ± 11 years old and included 3% females and 14% African Americans. The cohort also included 28% of patients with non-dialysis-dependent CKD (eGFR <60 mL/min/1.73 m²), as well as 28% of patients with albuminuria (≥30 mg/g). The median (IQR) of serum TG was 148 (100, 222) mg/dL. We observed a slight positive linear association between TG and incident CKD after adjustment for Case-Mix and Laboratory variables among non-albuminuric and microalbuminuric patients. The relationship of high TG trended towards a higher risk of ESRD in CKD 3A non-albuminuric patients and in CKD 3A and 4/5 patients with microalbuminuria. Conclusion: In a large cohort, we have shown that elevated TGs are associated with all kidney outcomes tested independently of other metabolic syndrome components in diabetic patients with normal eGFR and normal albumin excretion rate, but the association is weaker in some groups of diabetic patients with preexisting renal complications.

Risk of Severe Hypoglycemia With Newer Second-line Glucose-lowering Medications in Older Adults With Type 2 Diabetes Stratified by Known Indicators of HypoglycemiaRisk.

Severe hypoglycemia is associated with adverse clinical outcomes. We evaluated the risk of severe hypoglycemia in older adults initiating newer glucose-lowering medications overall and across strata of known indicators of high hypoglycemia risk. We conducted a comparative-effectiveness cohort study of older adults aged >65years with type 2 diabetes initiating sodium-glucose cotransporter 2 inhibitors (SGLT2i) versus dipeptidyl peptidase-4 inhibitors (DPP-4i) or SGLT2i versus glucagon-like peptide-1 receptor agonists (GLP-1RA) using Medicare claims (3/2013-12/2018) and Medicare-linked-electronic health records. We identified severe hypoglycemia requiring emergency or inpatient visits using validated algorithms. After 1:1 propensity score matching, we estimated hazard ratios (HR) and rate differences (RD) per 1,000 person-years. Analyses were stratified by baseline insulin, sulfonylurea, cardiovascular disease (CVD), chronic kidney disease (CKD), and frailty. Over a median follow-up of 7 (interquartile range: 4-16) months, SGLT2i was associated with a reduced risk of hypoglycemia versus DPP-4i (HR 0.75 [0.68, 0.83]; RD -3.21 [-4.29, -2.12]), and versus GLP-1RA (HR 0.90 [0.82, 0.98]; RD -1.33 [-2.44, -0.23]). RD for SGLT2i versus DPP-4i was larger in patients using baseline insulin than in those not, although HRs were similar. In patients using baseline sulfonylurea, the risk of hypoglycemia was lower in SGLT2i versus DPP-4i (HR 0.57 [0.49, 0.65], RD -6.80 [-8.43, -5.16]), while the association was near-null in those without baseline sulfonylurea. Results stratified by baseline CVD, CKD and frailty were similar to the overall cohort findings. Findings for the GLP-1RA comparison were similar. SGLT2i was associated with a lower hypoglycemia risk versus incretin-based medications, with larger associations in patients using baseline insulin or sulfonylurea.

Serum and Urinary Biomarkers in COVID-19 Patients with or without Baseline Chronic Kidney Disease

In a prospective, observational, non-interventional, single-center study, we assessed various plasma and urinary biomarkers of kidney injury (neutrophil gelatinase-associated Lipocain [NGAL], kidney-injury molecule-1 [KIM-1], and interleukin-18 [IL-18]); inflammation (IL-6, C-reactive protein [CRP]); plus angiotensin converting enzyme 2 (ACE2) in 120 COVID-19 patients (of whom 70 had chronic kidney disease (CKD) at emergency-department (ED) admission). Our aim was to correlate the biomarkers with the outcomes (death, acute kidney injury [AKI]). All patients had received a chest-CT scan at admission to calculate the severity score (0-5). Biomarkers were also assessed in healthy volunteers and non-COVID-19-CKD patients. These biomarkers statistically differed across subgroups, i.e., they were significantly increased in COVID-19 patients, except for urinary (u)KIM1 and uIL-18. Amongst the biomarkers, only IL-6 was independently associated with mortality, along with AKI and not using remdesivir. Regarding the prediction of AKI, only IL-6 and uKIM1 were significantly elevated in patients presenting with AKI. However, AKI could not be predicted. Having high baseline IL-6 levels was associated with subsequent ventilation requirement and death. The mortality rate was almost 90% when the chest CT-scan severity score was 3 or 4 vs. 6.8% when the severity score was 0-2 (p < 0.0001).

The influencing factors of renal response in newly diagnosed multiple myeloma patients with renal impairment

Objective: To investigate the causative factors of renal function in newly diagnosed multiple myeloma (MM) patients with renal inadequacy. Methods: 181 MM patients with renal impairment from August 2007 to October 2021 at Peking Union Medical College Hospital were recruited, whose baseline chronic kidney disease (CKD) stage was 3-5. Statistical analysis was performed based on laboratory tests, treatment regimens, hematological responses, and survival among various renal function efficacy groups. A logistic regression model was employed in multivariate analysis. Results: A total of 181 patients were recruited, and 277 patients with CKD stages 1-2 were chosen as controls. The majority choose the BCD and VRD regimens. The progression-free survival (PFS) (14.0 months vs 24.8 months, P<0.001) and overall survival (OS) (49.2 months vs 79.7 months, P<0.001) of patients with renal impairment was considerably shorter. Hypercalcemia (P=0.013, OR=5.654) , 1q21 amplification (P=0.018, OR=2.876) , and hematological response over a partial response (P=0.001, OR=4.999) were independent predictive factors for renal function response. After treatment, those with improvement in renal function had a longer PFS than those without (15.6 months vs 10.2 months, P=0.074) , but there was no disparity in OS (56.5 months vs 47.3 months, P=0.665) . Conclusion: Hypercalcemia, 1q21 amplification, and hematologic response were independent predictors of the response of renal function in NDMM patients with renal impairment. MM patients with CKD 3-5 at baseline still have worse survival. Improvement in renal function after treatment is attributed to the improvement in PFS.

Acute kidney injury in Jamaicans with sickle cell disease hospitalized with COVID-19 infection.

Despite a high occurrence of acute kidney injury (AKI) with COVID-19 infection, there are no data on its incidence in sickle cell disease (SCD). We performed a single-center retrospective chart review of persons aged >1 year with SCD, COVID-19 infection and no prior dialysis requirement hospitalized from June 1, 2020 to May 31, 2022. Demographics, clinical, laboratory characteristics and outcomes were abstracted. AKI was defined using Kidney Disease Improving Global Outcomes (KDIGO) criteria. Of 38 patients meeting study criteria (60.6% female, mean age ± SD 38.6 ± 15.9 years), 3 (7.9%) were COVID vaccinated. Fifty-five percent (55%) developed AKI with 7.9% (n= 3) requiring dialysis. Participants with AKI were older (44.9 versus 30.8 years, p= 0.005), with a higher proportion having baseline chronic kidney disease (52% versus 0%, p = 0.001). Severe COVID infection [age-adjusted odds ratio (aOR): 8.93, 95%CI: 1.73-45.99, p = 0.033], red cell transfusion (aOR 7.92, 1.47-42.69) and decrease in hemoglobin per unit from baseline (aOR 2.85, 1.24-2.28) were associated with AKI. Five persons died in hospital, with AKI resulting in higher median length of stay (12 versus 5 days, p = 0.007). Targeted COVID-19 preventative measures and multinational longitudinal studies to ascertain the impact of AKI and COVID-19 infection in SCD are needed.

Occurrence and risk factors for acute kidney injury in patients hospitalized with acute pyelonephritis, and their clinical outcomes: A single center study from Northern India

Background: Acute kidney injury (AKI) associated with acute pyelonephritis (APN) is considered rare. This study is conducted to find out the occurrence and risk factors for AKI in patients hospitalized with acute pyelonephritis and their clinical outcomes. Materials and Methods: All inpatients with APN from December 2018 to May 2020 were included. Results: A total of 95 patients were included. Escherichiacoli was the most common organism grown. At presentation, 79/95 (83.2%) patients had renal dysfunction. 31/79 (39.2%) patients required hemodialysis. AKI was 2.4 times common in men; P = 0.013. The mean duration of fever in patients with and without renal dysfunction was 8.30 ± 2.72 and 5.31 ± 0.91 days, respectively; P < 0.001. 73/79 (92.4%) patients with AKI had anemia as against 2/14 (14.2%) patients without AKI; P < 0.001. AKI developed in 100% of the patients with known chronic kidney disease (CKD) at baseline and 41.6% of the patients with normal baseline kidney function; P < 0.001. Diabetes mellitus was present in 29/79 (36.7%) patients with AKI and 6/16 (37.5%) patients without AKI; P = 0.31. Hospital stay in days was 11.65 ± 5.9 and 5.81 ± 0.91, respectively, in patients with and without renal dysfunction; P < 0.001. 6/95 (6.3%) patients died. All six patients had renal dysfunction. At 3 months, renal functions normalized in 38/79 (48.1%) patients and 8/31 (25.8%) patients remained dialysis-dependent. Conclusions: AKI is a common complication of APN. It is usually reversible with early and appropriate management. Male gender, anemia, bilateral pyelonephritis, baseline CKD, and delayed presentation to hospital are associated with increased risk of AKI. It is associated with an increased risk of dialysis, hospitalization days, and mortality.

Cardiovascular and renal outcomes among patients with type 2 diabetes using SGLT2 inhibitors added to metformin: a population-based cohort study from the UK

IntroductionLarge numbers of patients with type 2 diabetes receive treatment with a sodium-glucose co-transporter-2 inhibitor (SGLT2i). We investigated whether the cardiorenal preventative effects found in clinical trials are also seen...

Long-term follow-up of HCV-infected patients with end-stage chronic kidney disease after sustained virological response with direct-acting antiviral therapy

Background and aimPatients with chronic kidney disease (CKD) and hepatitis C infection can be safely and effectively treated with direct-acting antivirals (DAAs). However, there is scarce data on the long-term impact of hepatitis C cure on CKD. The aim of this study was to assess the long-term mortality, morbidity and hepatic/renal function outcomes in a cohort of HCV-infected individuals with CKD treated with DAAs. Methods135 HCV patients with CKD stage 3b-5 who received ombitasvir/paritaprevir/ritonavir±dasabuvir in a multicenter study were evaluated for long-term hepatic and renal outcomes and their associated mortality. Results125 patients achieved SVR and 66 were included. Prior to SVR, 53 were under renal replacement therapy (RRT) and 25 (37.8%) had liver cirrhosis. After a follow-up of 4.5 years, 25 (38%) required kidney transplantation but none combined liver–kidney. No changes in renal function were observed among the 51 patients who did not receive renal transplant although eGFR values improved in those with baseline CKD stage 3b-4. Three (5.6%) subjects were weaned from RRT. Eighteen (27.3%) patients died, mostly from cardiovascular events; 2 developed liver decompensation and 1 hepatocellular carcinoma. No HCV reinfection was observed. ConclusionsLong-term mortality remained high among end-stage CKD patients despite HCV cure. Overall, no improvement in renal function was observed and a high proportion of patients required kidney transplantation. However, in CKD stage 3b-4 HCV cure may play a positive role in renal function.

Consumption of ultraprocessed food and development of chronic kidney disease: the Tianjin Chronic Low-Grade Systemic Inflammation and Health and UK Biobank Cohort Studies

BackgroundMany ultraprocessed food (UPF)-derived by-products may play a role in the development of chronic kidney disease (CKD). Although several studies have assessed the association of UPFs with kidney function decline or CKD in various countries, no evidence has been shown in China and the United Kingdom. ObjectivesThis study aims to evaluate the association between UPF consumption and risk of CKD in 2 large cohort studies from China and the United Kingdom. MethodsIn total, 23,775 and 102,332 participants without baseline CKD were enrolled in the Tianjin Chronic Low-Grade Systemic Inflammation and Health (TCLSIH) and UK Biobank cohort studies, respectively. Information on UPF consumption was obtained from a validated food frequency questionnaire in the TCLSIH and 24-h dietary recalls in the UK Biobank cohort. CKD was defined as an estimated glomerular filtration rate of <60 mL/min/1.73 m2, albumin-to-creatinine ratio ≥30 mg/g, or as having a clinical diagnosis of CKD in both cohorts. Multivariable Cox proportional hazard models were used to examine the association between UPF consumption and the risk of CKD. ResultsAfter a median follow-up of 4.0 and 10.1 y, the incidence rates of CKD were around 1.1% and 1.7% in the TCLSIH and UK Biobank cohorts, respectively. The multivariable hazard ratio [95% confidence interval] of CKD across increasing quartiles (quartiles 1–4) of UPF consumption were 1 (reference), 1.24 (0.89, 1.72), 1.30 (0.91, 1.87), and 1.58 (1.07, 2.34) (P for trend = 0.02) in the TCLSIH cohort and 1 (reference), 1.14 (1.00, 1.31), 1.16 (1.01, 1.33), and 1.25 (1.09, 1.43) (P for trend < 0.01) in the UK Biobank cohort, respectively. ConclusionsOur finding indicated that higher UPF consumption is associated with a higher risk of CKD. Moreover, restricting UPF consumption may potentially benefit the prevention of CKD. Further clinical trials are required to clarify the causality.This trial was registered at UMIN Clinical Trials Registry as UMIN000027174 (https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000031137).

Intravenous fluid therapy in accordance with kidney injury risk: when to prescribe what volume of which solution.

Acute kidney injury (AKI) is common in hospitalized patients while common risk factors for the development of AKI include postoperative settings, patients with baseline chronic kidney disease (CKD) or congestive heart failure. Intravenous (IV) fluid therapy is a crucial component of care for prevention and treatment of AKI. In this narrative review, we update the approach to IV fluid therapy in hospitalized patients including the timing of fluid prescription, and the choice of fluid type, amount and infusion rate along with the potential adverse effects of various crystalloid and colloid solutions, addressing specifically their use in patients with acute kidney disease, CKD or heart failure, and their potential impact on the risk of hospital-acquired AKI.

452 ONE-YEAR OUTCOMES OF DIFFERENT ANTITHROMBOTIC STRATEGIES IN OLDEST OLD STEMI PATIENTS WITH NEW ONSET ATRIAL FIBRILLATION

Abstract Introduction Management of antithrombotic therapy (ATT) in oldest old STEMI patients undergoing percutaneous coronary intervention (PCI) with new onset atrial fibrillation (NOAF) is a clinical conundrum given the gamut of possible ATT strategies and the lack of studies in this population. We sought to evaluate ATT patterns at discharge and 1-year outcomes in our center. Methods A retrospective cohort study of all consecutive oldest old (i.e. over 85 years) STEMI patients undergoing primary PCI (pPCI) was performed at our institution. NOAF was defined according to its documentation within 48 hours of STEMI diagnosis. Primary outcomes were 1-year major adverse cardiac or cerebrovascular events (MACCE: composite of death, myocardial infarction, stroke, heart failure hospitalization) and major bleeding events (Bleeding Academic Research Consortium 3 or 5). Results Among the 248 patients studied, NOAF was detected in 25.4% of patients (mean patient age 88.9±2.4 years, 56.5% females). At logistic regression analysis, baseline chronic kidney disease (eGFR&amp;lt;60 ml/min) was associated to nAF (OR: 2.38, 95% CI: 1.3 to 4.2; p&amp;lt;0.05).The development of heart failure during hospitalization was statistically higher in patients with nAF compared to patients without nAF (p=0.05). At discharge, triple therapy (TT: 1 anticoagulant and 2 antiplatelet agents) was prescribed in 11.5%, dual antiplatelet therapy (DAPT) in 77% and dual therapy (1 anticoagulant plus 1 antiplatelet agent) in 11.5% of patients. No group differences by ATT strategy were observed in 1-year MACCE (TT 32% vs dual therapy 27.2% vs DAPT 25.7%; p=0.81), or BARC 3,5 (TT 8% vs dual therapy 12.8% vs DAPT 9%; p=0.74). Conclusions The high incidence of NOAF in oldest old STEMI patients highlights the need of an adequate calibration between ischaemic and bleeding risk. Despite differences in the choice of ATT strategy, there were no significant differences in clinical outcomes up to 1 year.

Impact of Warm Ischemia on Acute Kidney Injury After Robotic Partial Nephrectomy Stratified by Baseline Kidney Function.

Objectives: To evaluate the differences in baseline chronic kidney disease (CKD) status in correlations between warm ischemic time (WIT) and acute kidney injury (AKI) or acute/chronic renal function change after robot-assisted partial nephrectomy (RAPN). Methods: This study retrospectively recruited 1290 patients from a multi-institutional RAPN database. The patients were grouped into four preoperative CKD categories: CKD Group 1 (CKDG1), CKD Group 2 (CKDG2), CKD Group 3a (CKDG3a), and CKD Group 3b (CKDG3b). The correlation between WIT and the probability of AKI was assessed according to the baseline CKD grade, together with changes in serum creatinine (sCr) at the postoperative maximum and chronic renal function. Results: AKI was not observed in the CKDG1 group. The probability of AKI at WIT = 30 minutes was 5.6% for CKDG2, 8.5% for CKDG3a, and 11.6% for CKDG3b (all p < 0.05). WIT was an independent predictor of AKI occurrence in the multivariate model for these three CKD groups. Significant weak correlations were observed between WIT and sCr change for all four groups, with R2 = 0.22 for CKDG1, R2 = 0.16 for CKDG2, R2 = 0.03 for CKDG3a, and R2 = 0.09 for ≥CKDG3b. For chronic renal function, correlations were significant in CKDG2, CKDG3a, and ≥CKDG3b, yet R2 was considered small in all cases (<0.1). Conclusions: The association between extended WIT and the probability of AKI increased in patients with more severe baseline CKD. The correlation between WIT and renal function was significant, yet clinically modest.