Creatinine Levels Research Articles

Los indicadores de calidad de la Sociedad Europea de Cardiología en fibrilación auricular en centros de excelencia en España: el registro SEC-EXCELENTE FA

Introduction and objectives By 2022, 9 centers had been accredited by the Spanish Society of Cardiology for the atrial fibrillation (AF) process. Our objective was to evaluate the performance of these centers based on the quality indicators (QIs) proposed by the European Society of Cardiology (ESC) in 2020.Methods Adults with AF who were attended in the cardiology departments of participating centers during the second week of May 2019 were included in a retrospective registry (n = 797, age 72 ± 11 years, 60% male). Key ESC QIs were assessed.Results CHA2DS2-VASc, HAS-BLED scores, and serum creatinine levels were documented in 24.9%, 6.1%, and 96.2% of patients, respectively. Anticoagulation was appropriately prescribed in 90.6% of high-risk patients according to the CHA2DS2-VASc score, but was inappropriately prescribed in 57.8% of low-risk patients. Among all patients, 84.1% received high-quality anticoagulation. Inappropriate antiarrhythmic drugs were prescribed in 7.2% of patients with permanent AF, 2.9% of those with structural heart disease, and 0.0% of those with end-stage kidney disease. Catheter ablation was offered to 70% of patients with symptomatic paroxysmal or persistent AF after the failure or intolerance of 1 antiarrhythmic drug. All modifiable risk factors were documented in 59.3% of patients. Rates of all-cause mortality, ischemic stroke or transient ischemic attack, and major bleeding were 8.1, 0.8, and 2.56 per 100 patients/y, respectively. QIs for anticoagulation and outcomes were similar between general cardiology and tertiary referral centers.Conclusions Although accredited centers in Spain demonstrated good performance in many of the ESC QIs for AF, there remains room for improvement. These data could serve as a starting point for enhancing the quality of care in this population.

Unveiling the Metabolic Challenges in Pulmonary Arterial Hypertension: Insights into Thyroid, Glycemic, Lipid, and Bone Disorders

This study aimed to evaluate the prevalence of thyroid, glycemic, lipid and metabolic bone disorders among adult patients with pulmonary arterial hypertension (PAH). MethodsThis was an observational cross-sectional clinical study with patients with PAH, matched by sex and age with a control group without PAH. All individuals were enrolled into a clinical assessment, metabolic workup, thyroid ultrasound, and bone densitometry protocol. ResultsThe PAH group included 35 participants (34 females, 46 ± 15.5 years), and the control group, 40 (39 females, 41.8 ± 13.1 years). There was no difference in body mass index (BMI) between PAH and control group (27.5 ± 5.9 and 26.9 ± 4.3 kg/m2, respectively; p = 0.63; 95% CI = -1.8, 2.94), neither in physical activity time per week (60.3 ± 103.3, 98.9 ±137.6, respectively; p = 0.17; 95% CI = -95.23, 18.06). Although there was no difference in the prevalence of insulin resistance between the PAH (51.4%) and the control group (47.5%), p=0.74, patients with PAH had a higher median of glycated hemoglobin (A1c) than the control group (6.1% and 5.57%, respectively), p=0.006; 95% CI = -0.14, 1.22. PAH group presented lower mean total cholesterol (170.46 ± 35.51 mg/dL) and median LDL-cholesterol [105 (46) mg/dL, median (interquartile range)] levels than the control group [192.1 ± 34.44 mg/dL, p = 0.009; 95% CI = -37.76, 5.52; 121.6 (35.02) mg/dL, p=0.012; 95% CI = -34.08, 0.77, respectively]. It was found a higher prevalence of hypothyroidism (22.9%) in PAH group than in control group (2.5%), p = 0.007. We found hyperparathyroidism (HPT) among 8 patients of PAH group (23%), but none in the control group. Considering bone mineral density disorders, 12 patients from PAH group presented low bone mass, osteopenia, or osteoporosis (34%), and 8 individuals in the control group (20%), p =0.032, which represented a 2.13 higher relative risk for those conditions for the former group. The patients with HPT presented a higher creatinine level (0.98 ± 0.12 mg/dL) than the PAH patients with normal parathyroid hormone (0.76 ± 0.14 mg/dL), p = 0.0004; 95% CI = 0.12, 0.33. The PAH group also presented lower total hip (-0.15 ± 1.25) and femoral neck (-0.14 ± 1.07) bone mineral density (BMD) Z-scores than the control group (0.50 ± 1.13, p = 0.021; 95% CI = -0.18, -0.027; 0.35 ± 0.94, p = 0.038; 95% CI = -0.16, -0.01, respectively). ConclusionIn this cohort, the findings of higher A1c levels, hypothyroidism prevalence, lower LDL and total cholesterol levels, and a higher prevalence of hyperparathyroidism, as well as lower total hip and femoral neck BMD Z-scores in the PAH group, compared to the control group and highlighting the dysregulation of various metabolic pathways in patients with HAP, suggesting the need for targeted interventions to enhance patient care. Additionally, they underscore the importance of gaining a deeper understanding of the mechanisms driving these changes and their potential pathophysiological connections to the disease.

051. Incarcerated Umbilical Hernia in A 45-Year-Old Male with Chronic Kidney Disease: A Case Report

Background: Umbilical hernias are common, but incarceration can lead to serious complications, particularly in patients with comorbidities. We present a case of an incarcerated umbilical hernia in a male patient with a history of chronic kidney disease (CKD) on hemodialysis, which required emergency surgical intervention. Case: A 45-year-old male presented with intermittent umbilical pain and a lump, which appeared during straining or coughing and spontaneously reduced upon rest. The patient also experienced nausea, absence of defecation for 3 days, and absent flatus for 1 day. There was no vomiting, but a history of chronic cough and CKD was noted. On physical examination, an umbilical lump measuring 4x3x2 cm was identified. Bloodwork revealed elevated creatinine levels (6.0 mg/dL), consistent with CKD. Imaging confirmed the diagnosis of an incarcerated paraumbilical hernia, and the patient underwent emergency herniorrhaphy. Post-operative recovery was uneventful. Conclusion: This case highlights the importance of timely intervention in patients with incarcerated umbilical hernias, especially in the presence of comorbid conditions such as CKD. Emergency herniorrhaphy remains the definitive treatment for preventing life-threatening complications.

Investigating the Prevalence of Hypercalciuria in Children Aged 2-16 Years With Asymptomatic Microscopic Hematuria in 2020 in Tehran Children's Medical Center.

The prevalence of hypercalciuria in children is 3%-10% globally and up to 35% in the United States. Hypercalciuria in children has many presentations; it causes different metabolic disorders and can negatively affect a child's growth. It also increases the risk of low bone mineral density and urinary tract infections. In addition, it is the most widespread cause of persistent microscopic hematuria. Changes in the diet and medications in cases of advanced stage can be useful to prevent further complications. This study aimed to determine the prevalence of hypercalciuria and to investigate its relationship with different factors in children aged 2-16 years with asymptomatic microscopic hematuria in 2020 in the Children's Medical Center hospital. This retrospective cross-sectional study was performed in a population of children aged 2-16 years old with asymptomatic microscopic hematuria who were referred to the Children's Medical Center clinic in 2020. Data such as age, sex, serum creatinine level, and proteinuria were extracted from the patient's medical records, and their relationship with hypercalciuria was analyzed using logistic regression analysis. According to the inclusion criteria, 166 children with asymptomatic microscopic hematuria (72 boys and 94 girls) were included in this study. The prevalence of hypercalciuria (ratio of random urine calcium to creatinine more than 0.2) in these patients was estimated at 25% with a confidence interval of 18%-32%. In order of prevalence, the most common conditions accompanying microscopic hematuria were kidney stones, urinary tract infections, and proteinuria. The age of patients with hypercalciuria was 2 years younger on average. Each year of age increase and every 5 years of age increase between the ages of 2 and 16 years reduced the chance of hypercalciuria in this category of patients by 12% and 45%, respectively. Our findings also showed that children with a positive history of kidney stones were about 2.2 times more likely to have hypercalciuria than their counterparts, which is considered a medium effect size. Our results showed that hypercalciuria in children with hematuria is significantly related to younger age and a positive history of kidney stones.

Protective Effects of Ascorbic Acid Against Cadmium-Induced Toxicity in the Placenta and Fetus of Rats.

This study aimed to determine the protective role of l-ascorbic acid in a pregnant rat model of cadmium-induced toxicity. Cadmium is a toxic heavy metal that can seriously harm placenta and fetus tissue in pregnant women. Forty-two healthy female Wistar albino rats (250-300 g weight and 14-16 weeks) were randomly distributed into six equal groups (n = 7): control, cadmium 1 mg (CD1), cadmium 5 mg (CD5), ascorbic acid (AA), CD1+AA, CD5+AA. Cadmium was administered to pregnant rats by oral gavage every other day, and/or AA (200 mg) was administered every day. At the end of pregnancy (Day 21), blood, placenta, and fetuses were collected from rats. The results indicated that cadmium-induced oxidative stress by increasing the level of MDA and by decreasing the levels of GSH, SOD, and CAT activity in the serum of maternal. However, AA administration significantly decreased MDA levels and increased GSH levels, SOD, and CAT activity (p < 0.05). Cadmium (5 mg/kg) exposure significantly increased creatinine levels compared to AA and CD1+AA groups (p < 0.05). In addition, AA (200 mg/kg) significantly attenuated cadmium-induced histopathological alteration in the placental and fetal tissues. In conclusion, AA may prevent cadmium toxicity in maternal and fetal tissues, as it regulates oxidative imbalance in pregnant rat tissues and alleviates histopathological changes.

Enhancing sarcopenia risk assessment: Markedly low serum creatinine levels are independent predictors of major postoperative complications in gynecologic oncology patients

Enhancing sarcopenia risk assessment: Markedly low serum creatinine levels are independent predictors of major postoperative complications in gynecologic oncology patients

Growth, Feed Efficiency, and Health Status of Tilapia sp. Fed with New Technology Promoter Binder Fortified Diet

Developing a sustainable feed with minimal or no fishmeal in tilapia production is a challenge to this industry. New Technology Promoter Binder (NTPB), a guanidinoacetic acid, is a nutritional supplement to enhance the energy metabolism of the muscle and brain tissue of vertebrates. This study aimed to evaluate several plant-based diet formulations with zero and minimal use of fishmeal enriched with NTPB on the growth, feed efficiency, and health status of Tilapia sp. The experimental diets in this study were conducted based on four formulations (minimum fishmeal/FM and zero fishmeal/NFM-based diets) with 0, 0.6, and 1.2 mg·kg−1 feed of NTPB supplementation. The research indicated that the various diets given to tilapia affected the growth performance of fish in terms of growth parameters and feed efficiency. Tilapias fed with NTPB grew better than those without NPTB in both FM- and NFM-based diets. The addition of NTPB was safe for tilapia as demonstrated in the blood glucose, urea, and creatinine levels, which were normal for healthy fish. The viscerosomatic and hepatosomatic indexes of tilapia fed with the experimental diets showed no distinct differences. Adding NTPB to tilapia diets increased the hardness and amino acid contents of the tilapia’s muscle, which would benefit consumers.

Acute tubulointerstitial nephritis following coronavirus disease 2019 mRNA vaccination: a pediatric case report.

Coronavirus disease 2019 (COVID-19) mRNA vaccines have been linked to various kidney adverse events including acute tubulointerstitial nephritis (ATIN). This report describes a 15-year-old female who developed persistent fever and fatigue 54days after receiving her second dose of the BNT162b2 2 SARS-CoV-2 vaccine. She presented with elevated serum creatinine and urinary β2-microglobulin (β2MG) levels. Kidney biopsy revealed mononuclear infiltrate with some eosinophils, confirming the diagnosis of ATIN. Repeatedly positive lymphocyte transformation test results for the vaccine suggested a relationship between the vaccine and interstitial nephritis. Initially, treatment with prednisolone was effective. However, an increase in urinary β2MG level was observed 7months later, and the introduction of mycophenolate mofetil (MMF) allowed for the gradual reduction and eventual cessation of prednisolone. This case represents one of the rare pediatric instances of ATIN following COVID-19 vaccination. MMF can be an effective alternative in corticosteroid-dependent cases.

The effect of TSH on kidney function

Background: The thyroid gland plays a vital role in the regulation of many physiological processes, including kidney function. Aim: The purpose of this study was to investigate the relationship between thyroid-stimulating hormone (TSH) and kidney function in male and female patients with hyperthyroidism, as well as in healthy control subjects. Method: A total of 60 participants from Najaf city, Iraq, were included in the study. This included 10 male and 10 female control subjects, as well as 20 male and 20 female patients with hyperthyroidism. Blood samples were collected from all participants and analyzed for TSH, urea, and creatinine levels. Result: The results showed a significant increase in TSH levels in both male and female patients with hyperthyroidism compared to control subjects. Urea levels were also significantly higher in hyperthyroidism patients compared to controls, while creatinine levels were not significantly different. In addition, there was a significant difference in the effects of TSH on kidney function between male and female patients with hyperthyroidism. Female patients with hyperthyroidism had significantly higher levels of urea and lower levels of creatinine compared to male patients with hyperthyroidism. These findings suggest a direct effect of TSH on kidney function and highlight the need for regular monitoring of kidney function in individuals with hyperthyroidism, particularly women. Further research is needed to fully understand the mechanisms behind the gender differences observed in this study and to develop targeted interventions for both men and women with thyroid disorders. Conclusion: our study provides valuable insights into the relationship between TSH and kidney function and highlights the need for multidisciplinary care and targeted interventions for individuals with thyroid disorders to prevent or minimize the risk of kidney dysfunction.

Взаємозв’язок між хронічною хворобою нирок та серцево-судинною патологією у хворих на цукровий діабет 2-го типу різного віку

The aim – to analyze the relationship between chronic kidney disease (CKD) and cardiovascular pathology in patients with type 2 diabetes (T2D) of different ages.Materials and methods. A total of 233 patients with T2D aged 30-80 years were examined. Anthropometric indicators, blood pressure, glucose levels, glycated hemoglobin, C-peptide, total cholesterol, triglycerides, low-density and high-density lipoprotein cholesterol, creatinine, glomerular filtration rate, AST, and ALT were measured in all patients. Groups of patients were compared based on the presence of CKD and age using Student’s t-test and Pearson’s chi-squared test.Results and discussion. In patients with T2D and CKD, the incidence of coronary heart disease (CHD) (OR 1.8; 95 % CI 1.02–3.23; p=0.044), myocardial infarction (OR 2.0; 95 % CI 1.01–3.95; p=0.046), and strokes (OR 2.66; 95 % CI 1.07–6.63; p=0.036) is significantly higher compared to patients with T2D without kidney pathology. When comparing the clinical indicators of patients with T2D combined with CKD and those without it, no significant differences were found in anthropometric measurements, blood pressure, blood glucose levels, glycated hemoglobin, or C-peptide levels. The levels of total cholesterol, hemoglobin, and red blood cell count in the blood were significantly lower (р&lt;0.05), while the levels of creatinine and glomerular filtration rate were significantly higher (р&lt;0.001) in patients with kidney pathology.Conclusion. In patients with T2D, a relationship between CKD and cardiovascular pathology has been established. It can be assumed that the development of kidney pathology in patients with T2D is a significant risk factor for cardiovascular diseases.

Postnatal Outcomes in Cases of Prenatally Detected Dilated Fetal Bladder

Objectives: To explore the long-term outcomes in foetuses presenting with an enlarged bladder antenatally. Methods - Design: A retrospective cohort study was conducted over a 15-year period between 2003 and 2018. Setting and participants: Foetuses suspected to have enlarged bladders antenatally were included. Outcome measurements and statistical analysis: Analyses were done based on the trimester the enlarged bladder was detected, live births, terminations, surgical interventions, creatinine levels and bladder measurements post-delivery, and subsequent health outcomes. Results: From the 50 foetuses identified prenatally, detections were as follows: first trimester (9 cases), second trimester (30 cases), and third trimester (11 cases). There were 14 terminations (28%), 5 stillbirths (10%), and 31 live births (62%). Among the terminated and stillbirth/neonatal death cases, the most frequent diagnosis in males was PUV (57%). Two female foetuses were terminated due to lumbosacral spina bifida and sacrococcygeal teratoma obstructing the ureters, respectively. In surviving males, PUV was predominant (48.3% of 29 males). In five cases megacystis had resolved by birth, including one following in-utero surgery. Among the two female cases, one issue was resolved by birth, and the second had bilateral ureteroceles. Post-birth, surgical intervention was needed in 61% of males and 50% of females. The commonest surgery was ablation of posterior urethral valves. The median age for surgery was 1.5 months with a median follow-up of 4 years and the longest follow-up of fourteen years. Six children had no postnatal renal or urological follow-up. The mean peak creatinine level was 132, dropping to 47 in the latest measurement. Half of the patients with pathology evident at birth exhibited abnormal bladder function. There was one neonatal death. Three patients necessitated a kidney transplant due to chronic kidney disease. Conclusion: Foetuses diagnosed with an enlarged bladder in the second trimester most frequently had the posterior urethral valve as the underlying cause. For patients continuing the pregnancy, most had live births. About 1 in 10 posterior urethral valve survivors developed chronic kidney conditions, leading to a renal transplant.

Serum autotaxin positively associates with hypertension in postmenopausal women: a single center study in China.

Autotaxin is an adipokine involved in metabolic disorders. The aim of the current study was to evaluate serum autotaxin levels in hypertensive postmenopausal women and establish a relationship between autotaxin and other comorbidities in this special group. This single-center study included postmenopausal women who received annual health examinations at the First Affiliated Hospital, College of Medicine, Zhejiang University in Zhejiang, China. The metabolic and demographic characteristics of the subjects, including age, sex, height, weight, blood pressure, and biochemical indices, were collected. The serum autotaxin level was measured via ELISA. The Kolmogorov-Smirnov test, Student's t test, Mann-Whitney U test, χ2 test, receiver operating characteristic (ROC) curve analysis, Spearman correlation analysis and multivariate logistic regression analysis were adopted for statistical analysis. This pilot observational study included 25 hypertensive postmenopausal women and 25 age-matched normotensive controls. Hypertensive patients presented significant metabolic disturbances with greater comorbidities such as nonalcoholic fatty liver disease, obesity, overweight, diabetes, hypertriglyceridemia and hyperuricemia (P < 0.05), impaired renal health with higher uric acid levels (P < 0.001), and slightly elevated creatinine levels (P = 0.156) with lower estimated glomerular filtration rates (eGFRs) (P = 0.195). The serum autotaxin level was markedly greater in the hypertensive group (239.0±59.6 ng/ml vs. 192.7 ± 49.0 ng/ml; P < 0.01) and was positively associated with systolic blood pressure; diastolic blood pressure; and alanine transaminase, triglycerides (TG), creatinine, and uric acid levels and inversely associated with the eGFR (P < 0.05) among postmenopausal women. Serum autotaxin levels positively predicted hypertension, with an AU-ROC of 0.750 [95% confidence interval (CI): 0.613-0.888] and a Youden index of 0.480 at a cutoff of 225 ng/ml. In the multivariate logistic regression analysis, after adjustment for demographic and metabolic parameters (including age, BMI, ALT, TB, uric acid, FBG, TG, LDL and creatinine), autotaxin (ATX) remained independently positively correlated with the risk of hypertension [odds ratio: 1.016, 95% CI 1.001-1.031; P < 0.05). Among postmenopausal women, the serum autotaxin level is significantly elevated in the hypertensive group compared with age-matched normotensive controls. ATX is related to multiple metabolic disorders and renal health, suggesting that autotaxin has potential as a multiorgan therapeutic target for cardiovascular-metabolic-renal disorders.

Maternal Supplementation of Collagen Peptide Chelated Trace Elements Enhances Skeletal Muscle Development in Chicks.

Maternal nutrition plays an important role in regulating the growth and development of offspring. Collagen peptide chelated trace elements (PTE), as a new additive, have been proven to have a positive maternal effect on the intestinal health of offspring, but its effect on the growth anddevelopment is still unclear. This study aimed to investigate the effect of maternal PTE supplementation on the skeletal muscle development of offspring. A total of 270 breeder hens were randomly divided into 3 groups, and fed basal diet (CON), basal diet + 500mg/kg PTE (L-PTE), and 1000mg/kg PTE (H-PTE) for 8weeks. A total of 180 eggs were collected from each group for incubation, and then the hatched male chicks (6 replicates, 12 chicks/replicate) were allocated according to maternal treatment for a 14-day feeding experiment. The results showed that maternal PTE supplementation significantly increased the deposition of iron (Fe), zinc (Zn), and manganese (Mn) in the egg yolk (P < 0.05). In comparison with the CON group, the body weight (days 1 and 14), breast muscle weight (day 14), and muscle fiber density (day 14) of broilers were increased in the L-PTE group (P < 0.05). The serum creatinine (CREA) levels in 1-day-old broilers were reduced in the L-PTE group and H-PTE group(P < 0.05). Additionally, maternal PTE supplementation could upregulate the relative expression level of catalase (CAT) mRNA in breast muscle (P < 0.05). The relative mRNA levels of hemeoxygenase-1 (HO-1) and superoxide dismutase 1(SOD1) in the H-PTE group were significantly upregulated (P < 0.05). Moreover, PTE treatment upregulated the mRNA expression of skeletal muscle development-related genes (Pax7 and MyoG) and the IGF signaling pathway (mTOR, IGF-1R, and IGF-2R) (P < 0.05). In conclusion, maternal PTE supplementation may improve the growth performance and skeletal muscle development of offspring by activating the IGF signaling pathway.

Persistent Chronic Active T-Cell-Mediated Rejection After Kidney Transplantation Is Associated With Poor Allograft Survival.

Histopathological findings of chronic active T-cell-mediated rejection (CA-TCMR) have been reported to potentially improve with treatment. However, whether this improvement is associated with a better renal prognosis remains unclear. This study was performed to analyze the impact of the histological response to therapy on kidney allograft survival in patients with CA-TCMR. The data of patients diagnosed with CA-TCMR between January 2018 and May 2023 were retrospectively reviewed. A composite graft endpoint was defined as a two-fold increase in the serum creatinine level or the development of end-stage kidney disease. Thirty-seven patients with CA-TCMR underwent 46 follow-up biopsies. Eleven patients who were diagnosed with CA-TCMR at the last biopsy were classified as the persistent group, while the remaining 26 patients were classified as the transient group. Both before and after treatment, there were no significant changes in serum creatinine, estimated glomerular filtration rate, or proteinuria in either group. However, the transient group showed a significant reduction in interstitial fibrosis and tubular atrophy without a specific etiology (IFTA). This improvement was attributed to better histopathological Banff scores after treatment. Patients with persistent CA-TCMR had significantly worse graft survival than those with transient CA-TCMR (p = 0.002), even after adjusting for significant clinical factors (hazard ratio: 11.4; 95% CI: 1.1-120.0; p = 0.043). Our findings suggest that the persistence of histopathologic evidence of CA-TCMR after treatment is a significant risk factor for allograft loss compared with transient CA-TCMR.

Efficacy and safety of Chinese herbal medicines combined with biomedicine in the treatment of idiopathic membranous nephropathy: a systematic review and network meta-analysis.

Chinese herbal medicines have been extensively used to treat idiopathic membranous nephropathy (IMN). However, their efficacy and safety remain uncertain. Therefore, this study employed a network meta-analysis to evaluate the efficacy and safety of various Chinese herbal medicines in combination with biomedicines for treating IMN. A comprehensive literature search was performed across several databases, including PubMed, EMBASE, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), WanFang Data, VIP Database, and Chinese Biomedical Literature Database (CBM), to identify randomized controlled trials (RCTs) concerning the treatment of IMN using a combination of Chinese herbal medicines and biomedicine, up to 31 May 2024. Two researchers independently conducted the literature screening and data extraction. The quality of the included studies was assessed using the Cochrane quality review manual, and Stata 14.2 software was employed for network meta-analysis. A total of 31 RCTs involving 2195 IMN patients and 15 different Chinese herbal medicines were analyzed. The network meta-analysis revealed that QQC + BM (84.7%) was the most effective in reducing 24-hour urinary protein. For improving serum albumin, HZC + BM (86%) was the most effective. LGT + BM (77.2%) was the best for enhancing serum creatinine levels. MXC + BM demonstrated the highest effectiveness in lowering total cholesterol (89%) and triglycerides (97%). Lastly, WZC + BM (90.8%) was the most effective in reducing the incidence of adverse reactions. BM. The current evidence suggests that integrating Chinese herbal medicines with biomedicine may provide significant benefits in treating IMN. Specifically, QQC + BM appears to be the most effective in reducing 24-hour urinary protein, HZC + BM seems to excel in improving serum albumin levels, MXC + BM is noted for its effectiveness in lowering triglycerides and total cholesterol, LGT + BM is optimal for reducing serum creatinine, and WZC + BM shows the lowest rate of adverse reactions. Nevertheless, due to limitations in the quantity and quality of the included studies, further validation of these conclusions is necessary. [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024561028], identifier [CRD42024561028].

Integrated Cardiorespiratory Rehabilitation and Its Impact on Cardio-Renal-Metabolic Profile After Cardiac Surgery.

Cardiovascular diseases (CVDs) and chronic kidney disease (CKD) are common causes of morbidity and mortality. However, the impact of changes in lifestyle and rehabilitation programs on the progression of cardiovascular, renal, and metabolic (CRM) conditions, remains unclear. In a retrospective manner, we analyzed charts of 200 patients admitted for cardiorespiratory rehabilitation at our facility in 2023. A 6 min walk test, echocardiographic features, and laboratory values were investigated to evaluate the impact of cardiorespiratory rehabilitation in patients post cardiac surgery. This study examined the impact of combined lifestyle and exercise scores (diet, alcohol consumption, smoking, aerobic physical activity, sedentary behavior, sleep duration, and social connection) on cardio-renal-metabolic profiles and on a quality-of-life score measured by the Borg Scale. During the rehabilitation program, left ventricular ejection fraction (LVEF) significantly increased (51.2 vs. 54.3%, SEM 0.51 p = 0.001). The six-minute walk test (6 MWT) significantly improved in terms of meters (133 vs. 373 m, SEM 6.41, p < 0.001) and Borg scale (6.6 vs. 2.5, SEM 0.06, p < 0.001). Glycemia levels reduced significantly (114.5± vs. 107.4± mg/dL, SEM 2.45, p = 0.001). While total cholesterol levels (119.4 vs. 129.6 mg/dL, SEM 2.4, p < 0.001) as well as HDL levels (29.9 vs. 40 mg/dL, SEM 0.62, p < 0.001) significantly increased, triglyceride levels significantly decreased (128.5 vs. 122.1 mg/dL, SEM 3.8, p = 0.048). There was no change in LDL levels. Creatinine levels remained stable throughout the period of rehabilitation. Cardiorespiratory rehabilitation has a significant impact on myocardial function, quality of life in terms of exercise capacity and symptoms (6 MWT) as well as laboratory levels relevant for cardiovascular prevention such as glycemia and lipid profile.

Predicting the risk of chronic kidney disease based on uric acid concentration in stones using biosensors integrated with a deep learning-based ANN system

Elevated levels of uric acid (UA) in the body may not only lead to the formation of stones but also increase the risk of developing chronic kidney disease (CKD). This study presents a biosensor for detecting UA concentration in stones and a deep learning-based artificial neural network (ANN) system for analyzing CKD risk. The biosensor is a screen-printed electrode (SPE) chip, whose surface was modified using oxygen plasma, enabling the detection of UA concentration via cyclic voltammetry. Experimental results show a good linear relationship between UA concentration and anodic peak current within the range of 0.15–5 mM. The surface modification method for this biosensor is simple and cost-effective. The ANN system took age and creatinine values as inputs, utilizing the Chronic_Kidney_Disease dataset and supplementary data from literatures for training. After detecting the UA concentration in stones using the biosensor, the result was converted into serum uric acid concentration, allowing the estimation of creatinine level, which was then used by the ANN to assess the risk of developing CKD. This system can assist urologists in determining whether patients should seek consultation with nephrologists for early diagnosis and treatment.

Robot-assisted kidney transplantation: initial experience from a tertiary hospital in China

Abstract Background Robot-assisted kidney transplantation (RAKT) has currently become an effective alternative to open kidney transplantation (OKT), which has long been considered the gold standard for kidney transplant surgery. This study aimed to summarize our initial experience with RAKT and explore its safety and feasibility. Materials and methods Ten cases of RAKT, including 8 cases of deceased-donor kidney transplantation and 2 cases of living-donor kidney transplantation, were performed at our center from March 2023 to November 2023. Perioperative clinical data and follow-up results of patients were collected and statistically analyzed. Results All RAKT surgeries were performed successfully with no complications. The average operative time was 297.90 ± 65.59 minutes, and the median estimated blood loss was 100 mL. The average serum creatinine level decreased from 918.14 ± 166.63 μmol/L preoperatively to 109.89 ± 29.89 μmol/L at discharge. The postoperative outcomes of RAKT from both deceased and living donors were satisfactory during the follow-up period. Conclusions RAKT is an effective alternative to OKT and is suitable for both deceased- and living-donor kidney transplantations. The postoperative outcomes were satisfactory, and the postoperative complications were acceptable. RAKT appears to be a safe and feasible procedure for transplantation teams skilled in OKT and robot-assisted surgery.

Association of renal biomarkers with fast progressor phenotype and related outcomes in anterior circulation large vessel occlusion stroke.

Renal dysfunction is a known predictor of long-term functional dependency after anterior circulation large vessel occlusion (ACLVO) stroke. However, the impact of renal dysfunction on early infarct growth rate (IGR) has not been previously demonstrated. The objective of this study was to define the association of creatinine-based renal biomarkers with fast or slow progressor phenotypes and related clinical outcomes in ACLVO stroke. This retrospective study examined patients with acute intracranial internal carotid artery or middle cerebral artery-M1 occlusions admitted between 2014 and 2019. Patients were included if they received baseline CT perfusion (CTP) or MRI on presentation within 24 h of estimated stroke onset. Infarct growth rate (IGR) was determined by ischemic core volume on CTP or MRI divided by time from stroke onset to imaging. IGR was used to stratify fast progressor (IGR ≥10 mL/h) and slow progressor (IGR < 10 mL/h) status. Renal dysfunction was assessed based on serum creatinine and estimated glomerular filtration rate (eGFR) on presenting laboratories. Logistic regression models, adjusted for significant covariates, identified independent associations between renal dysfunction biomarkers, progressor status, and clinical outcomes based on modified Rankin Scale (mRS) at 90 days. Among 230 patients with ACLVO, 29% were fast progressors, with median serum creatinine levels higher than slow progressors (1.1 vs. 0.9 mg/dL, p < 0.05) and lower median eGFR (66.2 vs. 69.0 mL/min/1.73m2, p < 0.05). Elevated creatinine (≥1.2 mg/dL) was independently associated with fast progressor status (adjusted OR 2.37, 95% CI 1.18-4.77), worse 90-day mRS (adjusted OR 1.88, 95% CI 1.01-3.51) and mortality (adjusted OR 2.57, 95% CI 1.14-5.79). Reduced eGFR (<60 mL/min/1.73m2) was independently associated with fast progressor status (adjusted OR 2.38, 95% CI 1.14-4.94), but not with 90-day mRS or mortality. Serum creatinine-based biomarkers of renal dysfunction were associated with fast progressor phenotype of ACLVO stroke, and worse clinical outcomes, which may help identify such patients earlier during emergency evaluation for expedited access to EVT. Future prospective studies are warranted to confirm and test implementation of these findings.

Risk Factor Analysis Including Inflammatory Markers for ICU Admission and Survival After Pneumonectomy

Background and Objectives: To assess the impact of preoperative inflammatory parameters on the necessity for intensive care unit (ICU) admission and survival after pneumonectomy. Materials and Methods: We enrolled 207 adult patients who underwent pneumonectomy between December 2016 and January 2022. We collected data from patients’ electronic medical records. Results: The preoperative albumin level was statistically lower, need for blood transfusion was higher, and length of hospital stay was longer in ICU-admitted patients (p = 0.017, p = 0.020, and p = 0.026, respectively). In multivariate analysis, intra-pericardial pneumonectomy and postoperative complications were predictive factors for ICU admission (OR = 3.46; 95%CI: 1.45–8.23; p = 0.005 and OR = 5.10; 95%CI: 2.21–11.79; p &lt; 0.001, respectively). Sleeve or pericardial pneumonectomy (p = 0.010), intraoperative vascular injury (p = 0.003), the need for mechanical ventilation (p &lt; 0.001), acute renal failure (p = 0.018), sepsis (p = 0.008), respiratory failure (p &lt; 0.001), pneumonia (p = 0.025), the need for blood transfusion (p = 0.047), elevated blood urea nitrogen (BUN) (p = 0.046), and elevated creatinine levels (p = 0.004) were more common in patients who died within 28 days. Patients who died within 90 days exhibited higher preoperative neutrophil-to-lymphocyte ratio (NLR) values (p = 0.019) and serum creatinine levels (p = 0.008), had a greater prevalence of sleeve or intra-pericardial pneumonectomy (p = 0.002), the need for mechanical ventilation (p &lt; 0.001), intraoperative vascular injury (p = 0.049), sepsis (p &lt; 0.001), respiratory failure (p = 0.019), and contralateral pneumonia (p = 0.008) than those who did not. Conclusions: Intra-pericardial pneumonectomy and postoperative complications are independent predictors of ICU admission after pneumonectomy. Tracheal sleeve and intra-pericardial procedures, intraoperative and postoperative complications, the need for blood transfusion, preoperative NLR ratio, BUN and creatinine levels may also be potential risk factors for mortality.