Baseline Serum Creatinine Level Research Articles

Spironolactone for Preventing Contrast-Induced Nephropathy After Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction and Chronic Kidney Disease.

Patients with acute myocardial infarction (AMI) and chronic kidney disease (CKD) are at high risk of contrast-induced nephropathy (CIN), which can subsequently worsen the overall prognosis. To evaluate the efficacy of spironolactone for CIN prevention, 410 patients with AMI and CKD receiving percutaneous coronary intervention (PCI) were retrospectively analyzed. Among them, 240 and 170 patients were enrolled in the standard treatment and spironolactone groups (spironolactone was administered 2 days before and 3 days after PCI), respectively. The primary endpoint of CIN was defined as a 0.5mg/dL or >25% increase from the baseline serum creatinine level within 48-72 h post-PCI. CIN incidence was significantly lower in the spironolactone group than in the standard treatment group (11.2 vs 26.7%, P < .001). Further, cardiac re-hospitalization (hazard ratio [HR]: 0.515; 95% CI: 0.382-0.694; P < .001) and cardiac death (HR: 0.612; 95% CI: 0.429-0.872; P = .007) risks were significantly lower in patients who received long-term spironolactone with a median treatment duration of 42 months after discharge. Spironolactone might lower the risk of CIN, and long-term use of spironolactone reduces the risk of cardiac re-hospitalization and cardiac death in patients with AMI and CKD undergoing PCI.

Association of time-averaged serum uric acid level with clinicopathological information and long-term outcomes in patients with IgA nephropathy

Association of time-averaged serum uric acid level with clinicopathological information and long-term outcomes in patients with IgA nephropathy

Tissue inhibitor metalloproteinase-2 (TIMP-2) • IGF-binding protein 7 (IGFBP7) for the prediction of acute kidney injury following cardiac surgery.

Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common complication associated with increased morbidity and mortality. Tissue inhibitor metalloproteinases-2 • insulin-like growth factor-binding protein 7 (TIMP-2•IGFBP7) determines tubular stress markers, which may occur prior to tubular damage. Previous studies on the use of TIMP-2•IGFBP7 for the prediction of CSA-AKI showed divergent results. Therefore, this study aimed to explore the predictive value of TIMP-2•IGFBP7 measurements for the early detection of acute kidney injury (AKI) and short-term adverse outcomes after cardiac surgery. In the prospective cohort study, blood and urine samples were collected 6-12 h after cardiac surgery. Blood samples to monitor serum creatinine levels were additionally extracted from days 1 to 7. AKI was defined based on the KDIGO consensus guidelines. AKI within 7 days following surgery was the primary outcome. The initiation of renal replacement therapy, in intensive care unit mortality, and the combination of both were secondary outcomes. A total of 557 patients were enrolled, 134 (24.06%) of them developed AKI and 33 (5.9%) had moderate or severe AKI. AKI developed more frequently in elderly patients with diabetes or with higher baseline serum creatinine levels. Patients with AKI had higher EuroSCORE II, Cleveland clinical score, and simplified renal index than those without AKI. Urinary TIMP-2•IGFBP7 was significantly higher in patients with AKI. The area under the curve was 0.66 in predicting all AKI and 0.70 in predicting stages 2 and 3 AKI. The resulting sensitivity and specificity were 44.0% and 83.9%, respectively, for a calculated threshold TIMP-2•IGFBP7 value of 0.265 (ng/ml)2/1,000. The TIMP-2•IGFBP7 values, simplified renal index (SRI) Score and age were significantly associated with AKI within 7 days postoperatively. A total of 33 patients reached the composite endpoint, the percentage of patients who reached the composite end-point in the TIMP-2•IGFBP7 of >0.265 (ng/ml)2/1,000 group was significantly higher than that of ≤0.265 (ng/ml)2/1,000 group. Postoperative implementation of TIMP-2•IGFBP7 improved prediction of CSA-AKI and may aid in identifying patients at risk of short-term adverse outcomes. We identified an ideal calculated cutoff value of 0.265 (ng/ml))2/1,000 for the prediction of CSA-AKI among all AKI patients.

Prevalence of acute kidney injury following percutaneous nephrolithotomy

Background: The objective is to evaluate the prevalence of acute kidney injury (AKI) as an early complication of the percutaneous nephrolithotomy (PCNL) procedure. Materials and Methods: From May 2022 to October 2022, we conducted a retrospective study on patients undergoing PCNL procedures in two of the tertiary medical centers affiliated with Isfahan University of Medical Sciences. Patients’ baseline characteristics, laboratory values, perioperative data, and stone features were documented. AKI was defined either as a ≥0.3 mg/dL increase in the serum creatinine level within 2 days, or a ≥1.5-fold increase in baseline serum creatinine level within 7 days after the operation. Laboratory values were measured 1 day before PCNL and daily thereafter until discharge. Patients were followed 1 week later to detect all of the possible cases of AKI. Results: The final analysis was performed on 347 individuals. AKI developed in 16 (4.61%) cases. The two groups were comparable regarding age (P = 0.887), gender (P = 0.566), and underlying comorbidities including diabetes mellitus (P = 0.577) and hypertension (P = 0.383). The mean body mass index (BMI) (P &lt; 0.001) and both frequency and severity of hydronephrosis (P &lt; 0.001) were significantly different. A higher mean PCNL duration (P &lt; 0.001), period of hospitalization (P &lt; 0.001), and blood loss volume (P &lt; 0.001) were observed in those who developed AKI. Overall, 56.3% (9) of patients in the AKI group and 2.7% (9) in the non-AKI group required the establishment of more than one access tract, during the procedure (P &lt; 0.001). A lower preoperative hemoglobin level was observed in the AKI group (P &lt; 0.001). Those with AKI had significantly larger stones (3.08 ± 0.46 vs. 2.41 ± 0.23 cm, P &lt; 0.001) and higher Hounsfield units (P &lt; 0.001). In addition, in the AKI group, most of the calculi (81.3%, 13) were of staghorn type, whereas in the non-AKI group, calculi were most frequently located in the middle calyx (30.2%, 100), (P &lt; 0.001). Conclusion: The prevalence of post-PCNL AKI is approximately 4.61%. The mean BMI, preoperative hemoglobin level, PCNL duration, intraoperative blood loss volume, and hospitalization period were significantly higher among patients who developed AKI. Those with AKI had significantly larger stones with higher Hounsfield units and more frequently of staghorn type. The two groups were not statistically different regarding age, gender, and presence of comorbidities (hypertension and diabetes mellitus).

Incidence, Risk Factors, and Outcomes Associated With Recurrent Neonatal Acute Kidney Injury in the AWAKEN Study

The incidence and associated outcomes of recurrent acute kidney injury (rAKI) in neonates remain largely unknown. To determine the incidence, risk factors, and clinical outcomes associated with rAKI in critically ill neonates. This cohort study was a secondary analysis of the multicenter, international Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates retrospective study. Comparisons were made among neonates with no AKI, a single AKI episode (sAKI), and rAKI. All neonates younger than 14 days who were admitted between January 1 and March 31, 2014, to 24 participating level II to IV neonatal intensive care units and received intravenous fluids for at least 48 hours were considered for inclusion. Neonates with congenital heart disease requiring surgery within the first week of life, lethal chromosomal anomalies, death within 48 hours of admission, or severe congenital kidney abnormalities were excluded. Data were analyzed from May 23, 2022, to December 8, 2023. Recurrent AKI using the neonatal Kidney Disease: Improving Global Outcomes criteria. Determination of each rAKI required a complete return to the baseline serum creatinine level that defined the prior AKI episode. Incidence and risk factors of rAKI and associations of rAKI with length of stay (LOS; ie, birth to hospital discharge) and mortality. The study cohort (n = 2162) included 1233 male neonates (57.0%). Gestational age distribution was less than 29 weeks for 276 neonates (12.8%), 29 to less than 36 weeks for 958 (44.3%), and 36 weeks or older for 928 (42.9%). Of 605 neonates with AKI, 133 (22.0%) developed rAKI with risk factors including younger gestational age, lower birthweight, and higher stage of initial AKI. Infants with rAKI experienced longer median LOS (no AKI, 17 [IQR, 8-34] days; sAKI, 18 [IQR, 9-45] days; rAKI, 60 [IQR, 25-109] days; P < .001). Time-varying Cox proportional hazards regression models suggest rAKI is independently associated with a lower hazard of discharge (adjusted hazard ratio, 0.7 [95% CI, 0.6-0.9]; P = .01) when compared with sAKI, but mortality did not differ between groups (adjusted hazard ratio, 1.4 [95% CI, 0.6-3.0]; P = .44). In this cohort study, neonatal rAKI was independently associated with longer LOS when compared with sAKI, suggesting that rAKI in neonates may be an important clinical distinction warranting further study and careful monitoring after an initial AKI episode.

Comparative pharmacokinetics of polymyxin B in critically ill elderly patients with extensively drug-resistant gram-negative bacteria infections.

Introduction: Elderly patients are more prone to develop acute kidney injury during infections and polymyxin B (PMB)-associated nephrotoxicity than young patients. The differential response to PMB between the elderly and young critically ill patients is unknown. We aimed to assess PMB exposure in elderly patients compared with young critically ill patients, and to determine the covariates of PMB pharmacokinetics in critically ill patients. Methods: Seventeen elderly patients (age ≥ 65years) and six young critically ill patients (age < 65years) were enrolled. Six to eight blood samples were collected during the 12h intervals after at least six doses of intravenous PMB in each patient. PMB plasma concentrations were quantified by high-performance liquid chromatography-tandem mass spectrometry. The primary outcome was PMB exposure as assessed by the area under the concentration-time curve over 24h at steady state (AUCss, 0-24h). Results and Discussion: The elderly group had lower total body weight (TBW) and higher Charlson comorbidity scores than young group. Neither AUCss, 0-24h nor normalized AUCss, 0-24h (adjusting AUC for the daily dose in mg/kg of TBW) was significantly different between the elderly group and young group. The half-life time was longer in the elderly patients than in young patients (11.21 vs 6.56h respectively, p = 0.003). Age and TBW were the covariates of half-life time (r = 0.415, p = 0.049 and r = -0.489, p = 0.018, respectively). TBW was the covariate of clearance (r = 0.527, p = 0.010) and AUCss, 0-24h (r = -0.414, p = 0.049). Patients with AUCss, 0-24h ≥ 100mg·h/L had higher baseline serum creatinine levels and lower TBW than patients with AUCss, 0-24h < 50mg·h/L or patients with AUCss, 0-24h 50-100mg·h/L. The PMB exposures were comparable in elderly and young critically ill patients. High baseline serum creatinine levels and low TBW was associated with PMB overdose. Trial registration: ChiCTR2300073896 retrospectively registered on 25 July 2023.

The Association Between the Albumin-Bilirubin Score and Contrast-Associated Acute Kidney Injury in Patients Undergoing Elective Percutaneous Coronary Intervention.

The albumin-bilirubin (ALBI) score is considered an effective and convenient scoring system for assessing liver function. We hypothesized that the ALBI score was predictive of contrast-associated acute kidney injury (CA-AKI) and long-term mortality in patients undergoing elective percutaneous coronary intervention (PCI). We retrospectively observed 5629 patients undergoing elective PCI. Contrast-associated acute kidney injury is defined as a 50% or 0.3mg/dl increase in baseline serum creatinine levels within 48 h of contrast exposure. The incidence of CA-AKI was 6.2% (n = 350). After adjusting for potential confounding factors, multivariate analysis showed that the ALBI score was an independent predictor of CA-AKI (P = .002). A restricted cubic spline analysis confirmed approximately linear relationships between the ALBI score and risks of CA-AKI. Furthermore, at a median follow-up of 2.8years, multivariate Cox regression analysis indicated that the ALBI score was an independent risk factor for long-term mortality (P < .001). The ALBI score was closely related to the occurrence of CA-AKI and long-term mortality in patients who underwent elective PCI. This score might be useful for risk stratification in high-risk patient groups to predict CA-AKI.

Frequency of acute kidney injury in birth asphyxia at a Tertiary Care Hospital, Karachi.

ABSTRACT… Objective: To determine the frequency of acute kidney injury (AKI) in neonates presenting with birth asphyxia. Study Design: Cross-sectional study. Setting: Department of Pediatrics, National Institute of Child Health, Karachi. Period: December 2022 to May 2023. Material &amp; Methods: A total of 159 neonates of both gender, aged between 7-28 days and having birth asphyxia were analyzed. Demographic features were recorded. The blood sample was collected in a sterile manner using 5 ml syringe and sent to the institutional laboratory for serum creatinine and electrolyte analysis. The frequency of AKI was noted. Results: In a total of 159 neonates, 95 (59.1%) were boys, The mean baseline serum urea and creatinine were 33.5±32.1 and 0.83±0.62 mg/dl respectively. AKI was noted in 65 (40.9%) neonates. Girls (p=0.035), relatively lower occipital frontal circumference (p=0.004), normal vaginal delivery (p&lt;0.001), history of seizures (p&lt;0.001), abnormal USG KUB (p&lt;0.001), poor conscious level (p&lt;0.001), higher birth asphyxia grading (p&lt;0.001) and poor urine output (p&lt;0.001) were linked with AKI. Mean baseline serum urea levels and serum creatinine levels were significantly raised among neonates who had AKI. Conclusion: The frequency of acute kidney injury among neonates having perinatal asphyxia was high. AKI was noted to have significant association with female gender, relatively lower occipital frontal circumference, normal vaginal delivery, history of seizures, abnormal ultrasonography findings, poor conscious level, higher birth asphyxia grading, and poor urine output at the time of admission.

Non-progressors to cardiac resynchronization therapy show long-term mortality benefit compared to progressors

Abstract Introduction Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in selected patients with symptomatic heart failure with reduced ejection fraction (HFrEF) and prolonged QRS. However, approximately one-third of the implanted patients fail to show clinical improvement or reverse remodeling. The criteria by response have been recently changed, those patients with a minimal improvement in left ventricular ejection fraction (LVEF) are defined as "non-progressors" rather than as "non-responders", selecting from those patients in whom the progression could not be modified. Data are scarce regarding the long-term outcome of this patient population. Purpose We aimed to evaluate the long-term outcome of CRT patients by their response, comparing non-progressors with responders and progressors. Methods Altogether 1019 patients undergoing CRT implantation between 2000-2020 in our center were registered and analyzed retrospectively. Patients were divided into 4 groups according to their response status, which was defined on the basis of LVEF change in 12 months after CRT implantation as follows: super-responders ≥20% (n=113), responders 6-19% (n=448), non-progressors 0-5% (n=244), and progressors &amp;lt;0% (n=214). The primary endpoint was the composite of all-cause mortality, heart transplantation, or left ventricular assist device implantation. Results During the median follow-up time of 4.7 years 547 (54%) patients died, 35 (31%) super-responder, 223 (50%) responder, 133 (55%) non-progressor, and 156 (73%) progressor. The mean change in LVEF occurred as follows: super-responders 24.5% ± 4.1%, responders 11.5% ± 3.8%, non-progressors 2.8% ± 1.8%, and progressors -6.6% ± 4.5% (p&amp;lt;0.0001). Non-progressors were more commonly male, had worse NYHA functional status, worse renal function, higher baseline LVEF and serum creatinine levels, and more frequently had an ischemic etiology. Univariate Cox regression analysis revealed that non-progressors had similar outcome to responders (HR 1.17; 95%CI 0.94-1.45; p=0.15) and superior outcome to progressors (HR 0.60; 95%CI 0.48-0.76; p&amp;lt;0.0001), which was also confirmed by multivariate analysis after adjustment for age, gender, ischemic etiology, LVEF, and serum creatinine levels: nonprogressors vs. responders (HR 1.25; 95%CI 0.98-1.58; p=0.07) and nonprogressors vs. progressors (HR 0.62; 95%CI 0.47-0.80; p&amp;lt;0.0001). Conclusions In our current study, non-progressors to CRT had a similar long-term outcome to responders and superior outcome to progressors. These findings suggest that non-progressor patients would have continued to adversely remodel without CRT and CRT is beneficial for these patients by moderating the remodeling process rather than improving it. Our results support the fact that categorizing patients as "responders" or "non-responders" is inappropriate and patients could be grouped as super-responders, responders, non-progressors, and progressors.Probability of survival by CRT responseMultivariate analysis by response status

Incidence of Acute Kidney Injury after Stroke and Its Association with 30-day Mortality of Stroke Patients

Objective: To investigate the incidence of AKI in stroke patients and its association with 30-day mortality of stroke patients. Method: This descriptive study was conducted in Medical Unit-I, Holy Family Hospital from June 2020 to January 2021. 130 patients with CT-confirmed stroke (both ischemic and hemorrhagic) with symptoms ranging from 1-24 hours were included in the study using consecutive (non-probability) sampling, after informed consent from theattendants. Patients with a history of recurrent stroke, renal dysfunction before stroke (urea &gt; 52mg/dl and creatinine &gt; 1.2mg/dl, eGFR &lt; 90 ml/min, proteinuria, or patients on dialysis as per medical record), uncontrolled hypertension (BP ≥180/110 mmHg), alcohol use, intravenous drug abuse and diabetes (BSR &gt; 200 mg/dl) were excluded from the study. Patients' baseline serum creatinine levels were recorded and were noted again after 72 hours. A &gt; 0.3 mg/dl increase from the baseline was defined as acute kidney injury. Mortality was recorded in patients who died within 30 days of stroke. Results: The mean age of the patients was 55.48 ± 10.85 years. 81 patients (62.3%) were male and 49 (37.7%) were female. 25 (19.2%) patients had acute kidney injury. 25 (19.2%) patients (amongst both with and without acute kidney injury) died within 30 days. There was a significant association between acute kidney injury and 30-day mortality of the stroke patients (p-value&lt;0.001). This association was significant in all age groups, both genders, regardless of present or absent history of smoking and regardless of duration of symptoms prior to arrival (p value &lt;0.001). Conclusion: Acute kidney injury affects a proportion of patients of stroke. There is a significant association between AKI and 30-day mortality after stroke, suggesting there might be a link between them.

Prognostic role of the neutrophil-to-lymphocyte ratio in patients with chronic kidney disease.

The neutrophil-to-lymphocyte ratio (NLR) has a prognostic value in cardiovascular disease, infection, inflammatory disease, and several malignancies. Therefore, the NLR has a possible predictive value in patients with chronic kidney disease (CKD), but this predictive value has not been validated. Here, we aimed to investigate the possibility of NLR as a predictor of CKD progression. This retrospective observational study included 141 patients with non-dialysis CKD. The participants were divided into terciles (T1, T2, and T3) according to NLR. The primary outcome was defined as a composite kidney event, which included a decline in the estimated glomerular filtration rate (eGFR) of at least 50% or initiation of renal replacement therapy during the follow-up period. The mean follow-up duration was 5.45 ± 2.11 years. The mean NLRs were 1.35 ± 0.05 in T1 (n = 47), 2.16 ± 0.04 in T2 (n = 47), and 4.29 ± 0.73 in T3 (n = 47). The group with the highest NLR (T3) had higher baseline CKD and serum creatinine and lower eGFR levels than the group with the lowest NLR (T1). The cumulative incidence rate of composite kidney events was significantly higher in T3 compared with T1 (p < 0.001, log-rank test). Cox regression analysis revealed that high NLR was associated with the risk of composite kidney events (adjusted hazard ratio, 3.33; 95% confidence interval, 1.43-7.76). A higher NLR reflects the more advanced stage of CKD and suggests a role for NLR as a biomarker for predicting CKD progression.

Impact of methods of estimating baseline Serum Creatinine (bSCr) on the incidence and outcomes of acute kidney injury in childhood severe malaria

BackgroundEstimated baseline serum creatinine (bSCr) affects the incidence and outcomes of childhood severe malaria. Herein, we estimated baseline serum creatinine (bSCr) levels of 541 children with severe malaria using Pottel and Scwartz formulas for AKI incidence, hospitalization outcomes, and evaluated risk factors for death.MethodsThis was a retrospective review of malaria cases from January 2019 to December 2020 at a tertiary health facility in northern Nigeria. We extracted relevant data from the electronic health record. AKI definition and staging was based on the 2012 Kidney Disease Improving Global Outcomes (KDIGO).ResultsThe estimated bSCr using Pottel’s method was lower with a mean (standard deviation) bias of -0.039 (0.013) mg/dl, an upper limit of agreement (-0.014 mg/dl), and the lower limit of agreement (-0.063 mg/dl). All (100%) of the estimated bSCr using Pottel’s method fell within 30% of the Schwartz method's estimated bSCr. The incidence of AKI from Pottel’s method was higher than the Schwartz’s method (43.3% vs. 38.4%, p < 0.001). The incidence of AKI derived from Pottel’s method was highest among those under 5 years old (p < 0.001). The mortality rate was 6.1% (33 deaths out of 541 admissions). Pottel’s method detected more deaths (57.6%; 19 out of 33) vs. Schwartz’s method (48.5%; 16 out of 33), p < 0.001. Factors that were associated with malaria AKI death included acidosis with an adjusted odds ratio (AOR) of 9.2 (95% CI 1.671 to 50.097), the first 72 h [AOR 7.0 (95% CI 1.358, 35.840)], and KDIGO stage 3 of AKI [AOR 14.4 (95% CI 3.073, 66.969)].ConclusionAmong Nigerian children with severe malaria, bSCr back-calculated from Pottel’s equation showed a minimal bias, narrow limit of agreement, and high degree of accuracy. Also, Pottel’s method detected more AKI and deaths.

#3788 PROGNOSTIC ROLE OF THE NEUTROPHIL-TO-LYMPHOCYTE RATIO IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Abstract Background and Aims The neutrophil-to-lymphocyte ratio (NLR) has been demonstrated to have prognostic value in cardiovascular disease, infection, inflammatory disease, and several types of cancer. Therefore, it is expected that NLR has predictive value in patients with chronic kidney disease (CKD) but it has not been validated. Here, I aimed to investigate the possibility of NLR as a predictor of progression of CKD. Method This retrospective observational study included 141 patients with non-dialysis CKD. Subjects were divided into terciles (T1, T2, and T3) according to NLR. The primary outcome of interest was defined as a composite renal event, which included a decline in the estimated glomerular filtration rate (eGFR) of at least 50% or onset of end-stage renal disease (ESRD) during the follow-up period. Results The median follow-up duration was 5.45 ± 2.11 years. The median NLR for each group was 1.35 ± 0.05 in T1 (n=47), 2.16 ± 0.04 in T2 (n=47) and 4.29 ± 0.73 in T3 (n=47). The group with the highest NLR (T3) had higher baseline CKD and serum creatinine and lower eGFR levels than the group with the lowest NLR (T1). The cumulative incidence of composite renal events was significantly increased in T3, compared to T1 (p &amp;lt; 0.001, log-rank test). Cox regression analysis revealed that high NLR was independently associated with the risk of composite renal events (adjusted hazard ratio 2.85, 95% confidence interval 1.18-6.93). Conclusion A higher NLR reflects the more advanced stage of CKD and suggests that a role for NLR as a biomarker for predicting CKD progression.

#6668 PREDICTION OF REMAINING RENAL FUNCTION IN PATIENTS UNDERGOING RADICAL NEPHRECTOMY DUE TO RENAL TUMOUR MASS AND AFTER NEPHRECTOMY IN LIVING DONORS

Abstract Background and Aims Accurate assessment of renal function is of great importance in clinical practise, in particular in patients undergoing nephrectomy due to tumor nephrectomy or in potential living kidney donors. In both cases, residual renal function is dependent on the remaining nephron number and their function. A reliable prediction of the post-nephrectomy kidney function would be of great help to identify the patient with an increased functional risk. The aim of this study was to assess if the short-term kidney function after nephrectomy can be reliably predicted. Method We performed a retrospective study in 68 living kidney donors (LD-Nx) and 43 patients undergoing nephrectomy due to a renal tumour (Tu-Nx) between 1st of January 2011 to 31st of December 2015 at the University Hospital Zurich. Baseline serum creatinine was defined as lowest observed serum creatinine value before LD-Nx and Tu-Nx and was used for calculation of estimated glomerular filtration rate (eGFR) by the Cockroft-Gault (CG) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas. The expected post-nephrectomy kidney function was calculated based on the formula (expected eGFRpost = 0.6 * eGFRpre + 8.7) described in detail in: (Prediction of kidney function after nephrectomy was performed by using the formulas previosly established by our group [1]). Expected eGFR was calculated for CG and CKD-EPI formulas and expected serum creatinine was calculated from the expected eGFR based on CG formula. The expected kidney function was then compared to the observed kdiney function based on lowest observed serum creatinine (LoObsSCr) during the first year after nephrectomy and the corresponding eGFR values for CG and CKD-EPI were calculated. Results Patients with nephrectomy due to renal tumour had significantly higher baseline serum creatinine levels compared to living donors (100±50 umol/l vs. 70±12 umol/l, respectively) with 35% having proteinuria, 58% hypertension and 14% diabetes mellitus. In addition Tu-Nx patients were significantly older and had a higher body weight. Living donors had a higher percentage of smokers (31%) compared to the other group. Predonation eGFR CKD-EPI was 71±23 ml/min/1.73 m2 for Tu-Nx and 94±12 ml/min/1.73 m2 for LD-Nx patients. Both groups showed an adaptive increase in kidney function calculated by eGFR CKD-EPI: 29% for Tu-Nx and 14% for LD-Nx. LD-Nx patients had less bias in prediction of post-nephrectomy kidney function (Table 1). Lowest observed serum creatinine after nephrectomy did not significantly differ between the groups. A significant correlation between expected and observed serum creatinine values, as well as between expected and observed eGFR post-nephrectomy, was seen in both groups of patients. Conclusion Despite older age, higher body weight and more comorbidities, patients with tumor nephrectomy show an adaptive increase in kidney function. Prediction of kidney function after nephrectomy is possible for both groups, however more accurate for living donor patients.

#5425 CHANGES IN SERUM CREATININE DURING AND AFTER PREGNANCY IN WOMEN WITH OR WITHOUT CHRONIC KIDNEY DISEASE: AN OBSERVATIONAL STUDY

Abstract Background and Aims In women with chronic kidney disease (CKD), kidneys may not sufficiently adapt to physiological changes during pregnancy, which may accelerate postpartum loss in renal function. We aimed to characterize pregnant women with or without renal impairment and to describe changes in renal filtration during and until one year after pregnancy. Method We performed a descriptive study using primary care data from the United Kingdom-based Clinical Practice Research Datalink (CRPD) GOLD and linked hospital data (2000–2019) in 14’401 pregnancies with ≥2 serum creatinine (SCr) measurements between the year before and after pregnancy. Pregnancies were categorized by means of the median estimated glomerular filtration rate (eGFR) during baseline (proteinuria is not reliably recorded). We captured risk factors for CKD and described changes in SCr levels over time as proxies for renal filtration. Results Of 14’401 pregnancies, 84% had a baseline eGFR [ml/min/1.73m2] of ≥90, 13% between 75–89, 13% between 60–74, and &amp;lt;1% between 15–59. Pre-existing hypertension, diabetes, and/or overweight was prevalent in 66.0% of women with an eGFR &amp;lt; 60 (versus 51.3-54.4% in eGFR ≥ 60). Preterm delivery was recorded in 30.2% of women with an eGFR &amp;lt; 60 (versus 9.4–9.8% in eGFR ≥ 60). In women with a low-normal eGFR between 75–89, median baseline SCr levels (mg/dL [μmol/L]) were 0.92 [81.33] (interquartile range (IQR) = 0.88–0.96 [77.79–84.86]), which decreased by 0.25 [22.1] by week 14/15, remained stable until week 30/31, increased to 0.94 [84.0] (IQR = 0.83–0.99 [73.37–87.52]) until week 3/4 postpartum, and decreased back to baseline by one year postpartum. In women with a moderately low baseline eGFR between 60–74, median baseline SCr levels were 1.05 [92.82] (IQR = 1.01–1.10 [89.28–97.24]) and patterns during pregnancy followed those of women with low-normal eGFR (decreased by 0.28 [24.74] until week 18/19, plateau until week 38/39). However, SCr levels increased slower in trimester 3 and early postpartum and reached baseline levels at week 9/10 postpartum. Women with a baseline eGFR between 15–59 (median baseline SCr levels = 1.43 mg/dL [126.41 μmol/L], IQR = 1.26–1.72 mg/dL [111.38–152.05 μmol/L]) showed renal adaptation in trimester 1 and 2, but increased SCr levels of 1.71 [151.16] (IQR = 1.32-2.36 [116.69–208.62]) in trimester 3, but sample size was small. Conclusion Adaptations of renal filtration were not impaired during or after pregnancy in 1’932 pregnancies of women with a low-normal eGFR between 75–89. In women with a moderately low eGFR between 60–74, the pattern was similar, but potentially prolonged hyperfiltration in trimester 3 and early postpartum requires further investigation. The pattern of renal adaptation in eGFR between 15–59 was similar in trimester 1 and 2. Increased SCr levels in trimester 3 may indicate insufficient renal function but results have to be interpreted cautiously due to small sample size and potentially selective measurements.

Is the transradial approach associated with decreased acute kidney injury following percutaneous coronary intervention in patients not complicated by major bleeding and haemodynamic disturbance?

The impact of the transradial approach (TRA) on the development of acute kidney injury (AKI) after percutaneous coronary interventions (PCI) has been controversial. We retrospectively analysed 463 patients undergoing PCI for either acute or chronic coronary syndrome. Excluded patients were those with missing laboratory or procedural data, acute/decompensated heart failure, major bleeding, haemodynamic instability, long-term dialysis and mortality. The primary endpoint of the study was the incidence of AKI after PCI, which was defined as an increase in serum creatinine (SCr) level of 0.5 mg/dl or 25% from the baseline. Secondary endpoints were change in SCr level, increase in SCr of ≥ 0.3 and ≥ 0.5 mg/dl, and increase in SCr of ≥ 25 and ≥ 50%. We compared the incidence of AKI between the TRA and the transfemoral approach (TFA) in the overall and a propensity score (PS)-matched study population. The study population included 339 patients. After PS matching, we obtained a well-balanced population of 182 patients. The differences between the incidence of AKI in the TRA and TFA were not significant in both the overall (9.0 vs 11.2%, p = 0.503) and PS-matched (9.9 vs 7.7%, p = 0.601) study population. TRA resulted in a significantly lower incidence of SCr increase of ≥ 50% in unmatched patients. However, after PS matching, there was no difference between the TRA and TFA in any variable of secondary post-PCI renal outcomes. Age, female gender, baseline SCr level, baseline estimated glomerular filtration rate and contrast volume were independent predictors of AKI. Compared to the conventional TFA, TRA was not associated with a reduced incidence of AKI after PCI in patients not complicated by major bleeding, acute heart failure and haemodynamic disturbances.

Identifying Patients for Intensive Blood Pressure Treatment Based on Cognitive Benefit

Intensive vs standard treatment to lower systolic blood pressure (SBP) reduces risk of mild cognitive impairment (MCI) or dementia; however, the magnitude of cognitive benefit likely varies among patients. To estimate the magnitude of cognitive benefit of intensive vs standard systolic BP (SBP) treatment. In this ad hoc secondary analysis of the Systolic Blood Pressure Intervention Trial (SPRINT), 9361 randomized clinical trial participants 50 years or older with high cardiovascular risk but without a history of diabetes, stroke, or dementia were followed up. The SPRINT trial was conducted between November 1, 2010, and August 31, 2016, and the present analysis was completed on October 31, 2022. Systolic blood pressure treatment to an intensive (<120 mm Hg) vs standard (<140 mm Hg) target. The primary outcome was a composite of adjudicated probable dementia or amnestic MCI. A total of 7918 SPRINT participants were included in the analysis; 3989 were in the intensive treatment group (mean [SD] age, 67.9 [9.2] years; 2570 [64.4%] men; 1212 [30.4%] non-Hispanic Black) and 3929 were in the standard treatment group (mean [SD] age, 67.9 [9.4] years; 2570 [65.4%] men; 1249 [31.8%] non-Hispanic Black). Over a median follow-up of 4.13 (IQR, 3.50-5.88) years, there were 765 and 828 primary outcome events in the intensive treatment group and standard treatment group, respectively. Older age (hazard ratio [HR] per 1 SD, 1.87 [95% CI, 1.78-1.96]), Medicare enrollment (HR per 1 SD, 1.42 [95% CI, 1.35-1.49]), and higher baseline serum creatinine level (HR per 1 SD, 1.24 [95% CI, 1.19-1.29]) were associated with higher risk of the primary outcome, while better baseline cognitive functioning (HR per 1 SD, 0.43 [95% CI, 0.41-0.44]) and active employment status (HR per 1 SD, 0.44 [95% CI, 0.42-0.46]) were associated with lower risk of the primary outcome. Risk of the primary outcome by treatment goal was estimated accurately based on similar projected and observed absolute risk differences (C statistic = 0.79). Higher baseline risk for the primary outcome was associated with greater benefit (ie, larger absolute reduction of probable dementia or amnestic MCI) of intensive vs standard treatment across the full range of estimated baseline risk. In this secondary analysis of the SPRINT trial, participants with higher baseline projected risk of probable dementia or amnestic MCI gained greater absolute cognitive benefit from intensive vs standard SBP treatment in a monotonic fashion. ClinicalTrials.gov Identifier: NCT01206062.

The Effect of Terlipressin on Renal Replacement Therapy in Patients with Hepatorenal Syndrome.

Hepatorenal syndrome type 1 (HRS-1)-also known as HRS-acute kidney injury (HRS-AKI)-is a rapidly progressing and usually fatal, but potentially reversible, kidney failure occurring in patients with decompensated cirrhosis. A large proportion of patients with HRS-1 require renal replacement therapy (RRT). Terlipressin demonstrated efficacy in reversing HRS and improving renal function in patients with HRS-1 in 3 phase III, randomized clinical trials (RCTs; ie, OT-0401, REVERSE, and CONFIRM). However, these RCTs were not designed to evaluate the effect of terlipressin on the requirement of renal replacement therapy (RRT). Herein, the effect of terlipressin on RRT requirements in the pooled phase 3 patient population was assessed. For this retrospective analysis, data from patients who participated in the OT-0401, REVERSE, and CONFIRM studies were integrated in the largest-to-date randomized database (N=608). The need for RRT was significantly decreased in patients in the terlipressin group versus the placebo group by Day 30 (28.1% vs 35.9%, respectively; P=0.040) and Day 60 (30.1% vs 37.9%, respectively; P=0.045) in the pooled population and also post-liver transplantation (LT) at Day 60 (20.5% vs 40.3%, respectively; P=0.008) and Day 90 (25.3% vs 43.1%, respectively; P=0.018). More patients were alive and RRT-free by Day 90 in the overall population (36.9% vs 28.5%; P=0.030) and among patients who received a LT (60.0% vs 39.7%; P=0.010). Random assignment to receive terlipressin was an independent positive predictor of avoidance of RRT (P=0.042); while higher baseline serum creatinine level and Child-Pugh scores were negatively associated with RRT avoidance (P<0.001 and P=0.040, respectively). Terlipressin decreased the requirement of RRT compared with placebo among patients with HRS-1, including those receiving LT. A lower serum creatinine level at the beginning of therapy was associated with avoidance of RRT.

Association between serum creatinine and type 2 diabetes in the Chinese population: a retrospective cohort study

The relationship between serum creatinine and type 2 diabetes is limited. We aimed to investigate the association of baseline serum creatinine and new-onset type 2 diabetes in Chinese population. This retrospective cohort study was conducted using data from the health screening program in China. The population were divided into four groups based on serum creatinine levels, and the outcome of interest was the occurrence of a diabetic event. Cox proportional risk model was used to assess the independent effect of baseline serum creatinine level on future diabetes risk. Sensitivity and subgroup analysis were used to verify the reliability of the results. After an average follow-up of 3.12 years, among 201,298 individuals aged ≥ 20 years, 3389 patients developed diabetes. Compared with participants in quartile 2–4 (> 51.6umol/L for female, > 71.8umol/L for male,), a significantly higher risk of new-onset Type 2 Diabetes (OR, 1.15; 95%CI: 1.07–1.23) was found in those in quartile 1 (< 51.6umol/L for female, < 71.8umol/L for male). Moreover, Similar results were found in various subgroups stratified by age, BMI, TG, TC, FPG and family history group. Low serum creatinine is independently associated with increased risk of type 2 diabetes in Chinese adults. It was also stable in various subgroups stratified.

ASSESSMENT OF MORTALITY IN LIVER CIRRHOSIS AND ACUTE KIDNEY INJURY CASES

The current analysis was designed to assess the short-term mortality in liver cirrhosis patients with acute kidney disease and assess the predictive factors of such mortality. A prospective study was conducted in the Department of Medicine &amp; Gastroenterology of Bakhtawar Amin Hospital Multan from January 2022- January 2023. A total of 100 decompensated cirrhotic patients with acute kidney injury were included in the study. Baseline serum creatinine levels were measured at admission and every day after admission in all patients. Prothrombin time, ascitic fluid examination, and basic liver and kidney function tests were performed on every patient after admission. The patients' complications, death during the hospital stay, and 30-day mortality were noted for all admitted patients. Among 100 patients, 90 (90%) were male, and the mean age was 47. The cause of liver failure in 51% of patients was the Hepatitis B virus, and 93% of patients presented with ascites. The type of acute kidney injury and its stage, CTP and MELD score, HE, serum bilirubin and creatinine, PT, jaundice, and SGOT were mortality predictors. The MELD score showed an accuracy of 77.5%, and the CTP score had a 73.44% accuracy in predicting short-term mortality. Based on the results, the type of acute kidney injury and its stage, CTP and MELD score, HE, serum bilirubin and creatinine, PT, jaundice, and SGOT are mortality predictors in cirrhotic patients with acute kidney injury