Creatinine Measurements Research Articles

Dietary fiber of jicama (Pachyrhizus erosus L., Fabaceae) tuber ameliorates kidney structure and function in mice fed with high-sucrose drink

Frequent consumption of high-sugar drinks (HSD) including sugar-sweetened beverages has been associated with the development of kidney disease. Otherwise, proper intake of dietary fiber extracted from the tuber of jicama (Pachyrhizus erosus L., Fabaceae) is shown to exert counteractive effects against HSD-induced metabolic syndrome including diabetes. However, it remains unelucidated whether the incorporation of jicama fiber in the diet could exert a beneficial effect on kidney function. This study aimed to elucidate the protective effect of jicama fiber in the diet against kidney disease caused by HSD. A total of thirty adult male albino mice were randomly assigned into three groups, the control group (fed with distilled water drink and standard diet), the high-sucrose drink group (HSD; fed with 30% sucrose solution drink and standard diet), and the high-sucrose drink + JF group (HSD + JF; fed with 30% sucrose drink and a standard diet supplemented with 25% of jicama fiber). The treatments were performed for ten weeks followed by the measurements of fasting blood glucose, plasma creatinine and kidney indices including urine protein, urine specific gravity, and refractive index and the examination of histopathological alterations in the kidney. The results demonstrated that the incorporation of JF in the diet at the dose of 25% could effectively counteract the elevation of fasting blood glucose and indicators of kidney damage including plasma creatinine, urine protein, urine specific gravity, and urine refractive index caused by HSD. However, JF failed to prevent HSD-induced mass reduction of the kidney but could ameliorate histopathological alterations in the kidney. Furthermore, JF effectively prevented tubular atrophy and fibrosis in the kidney in HSD-treated mice. Therefore, supplementation of the diet with JF at the dose of 25% could be effective in protecting the kidney against HSD. Thus, proper consumption of dietary fiber of jicama tuber has the potential to reduce HSD-induced kidney disease.

99mTc-DMSA and 99mTc-DTPA identified renal dysfunction due to microplastic polyethylene in murine model

In the previous study (Im et al., 2022), we revealed microplastic (MP) was accumulated and cleared through the kidneys via PET imaging. Here, we aimed to identify the renal dysfunction due to polyethylene (PE) MP in the kidney tissue. Mice were exposed to 100 ppm (∼equivalent to 0.1 mg/mL)/100 μL of PE for 12 weeks (n = 10). PE uptake in the kidney tissues was confirmed using confocal microscopy. QuantSeq analysis was performed to determine gene expression. Renal function assessment was performed using 99mTc-Diethylene triamine penta acetic acid or 99mTc-Dimercaptosuccinic acid. Measurement of creatinine, BUN, and albumin levels in serum and urine samples was also estimated. [18F]-FDG was also acquired. PE increased expression of Myc, CD44, Programmed Death-Ligand 1 (PD-L1), and Hypoxia-Inducible Factor (HIF)-1α, which indicates a potential link to an increased risk of early-onset cancer. An increase in glucose metabolism of [18F]-FDG were observed. We assessed renal failure using 99mTc-Diethylene triamine penta acetic acid and 99mTc-Dimercaptosuccinic acid scintigraphy to determine the renal function. Renal failure was confirmed using serum and urine creatinine, serum blood urea nitrogen levels, serum albumin levels, and urine albumin levels in PE exposed mice, relative to the control. In sum, PE exposure induced renal dysfunction in a murine model.

23 Pre-surgical visceral adipose tissue may be a novel pre-surgical risk factor for acute kidney injury among clear cell renal cell cancer patients undergoing radical nephrectomy

Abstract Background Patients with renal cancer undergoing partial (PN) or radical nephrectomy (RN) are at risk for acute kidney injury (AKI). Established risk factor for AKI include baseline comorbidities (e.g., obesity, hypertension), normal renal parenchymal loss, and ischemia-reperfusion injury. Pre-surgical body composition may be an overlooked modifiable patient characteristic that influences risk of AKI. We hypothesized that patients with higher visceral adipose tissue quantity or lower skeletal muscle quantity would have a higher risk of AKI. Methods The RESOLVE study at Memorial Sloan Kettering Cancer Center is a retrospective study of 1239 patients with stage I-III clear cell renal cell carcinoma (ccRCC) undergoing PN or RN from 2000 to 2020. We excluded from analysis patients with solitary kidney, those without preoperative serum creatinine (sCr) measurements, and those without a sCr measurement within seven days following nephrectomy, yielding a study population of 1,200 ccRCC patients with longitudinal sCr assessment (n=754 PN; n=446 PN). AKI was defined as a binary variable using the Kidney Disease – Improving Global Outcomes (KDIGO) criteria, based on a threshold of either a 1.5x relative or 0.3 mg/dl absolute increase in sCr within seven days. The cross-sectional areas and radiodensities of visceral adipose and skeletal muscle tissues were determined from pre-surgical computed tomography (CT) scans at the third lumbar vertebrae using Automatica software. We used generalized linear models with a binomial family and identity link to estimate seven-day risk differences (RD) and 95% confidence intervals in subgroups defined by surgery type. Results AKI was more frequent among patients undergoing RN (66% vs 26% among PN). Male patients, those with higher eGFR prior to surgery, those with lower stage/smaller tumors, and those with a history of hyperlipidemia more frequently experienced AKI in the post-operative period. No associations were observed with other reported comorbidities (diabetes, hypertension). While no association was observed between BMI and risk of AKI, visceral adipose and skeletal muscle variables were significantly associated with risk of AKI in univariate models. After adjustment for age, sex, comorbidities, and other body composition variables, only higher visceral adipose tissue quantity remained significantly associated with increased risk of AKI [RD per 40 unit increase (95% CI): 5.2 (1.3, 9.2)]. Muscle characteristics were not associated with AKI in multivariable models. Among patients undergoing PN, we observed a higher frequency of AKI among male patients, those with higher stage/larger tumors, and those with longer ischemia times. No significant associations were observed with comorbidity histories. In univariate models, visceral adipose tissue quantity and quality as well as skeletal muscle quantity were associated with AKI risk; however, after adjustment for age, sex, comorbidities, and other body composition variables, we observed no significant associations between any body composition feature and AKI in patients undergoing PN. Conclusions Associations between pre-surgical body composition and risk of AKI vary by surgery type. Visceral adipose tissue quantity was associated with risk of AKI among patients undergoing RN, but not PN. This finding may be relevant for patient counseling, consideration for nephron-sparing surgery, and development of interventions to lower visceral adipose tissue quantity. Future studies should evaluate the impact of both pre-surgical and post-surgical change in body composition in relation on chronic kidney disease after nephrectomy.

Murine kidney transplant outcome is best measured by transdermal glomerular filtration rate

Mouse kidney transplantation provides a powerful preclinical model for the study of kidney transplant alloimmunity. However, accurate measurement of graft function is difficult because of the inaccuracy of traditional surrogate markers serum creatinine and urea. We report the use of transdermal glomerular filtration rate measurement under the experimental conditions of unilateral nephrectomy and allogeneic kidney transplantation. Our findings demonstrate that transdermal glomerular filtration rate measurement is easy to perform, reproducible, and has more interexperimental consistency than serum creatinine or urea measurements. Most importantly, it significantly reduces the numbers of experimental animals required to detect subtle and yet clinically relevant differences in kidney function as often is the case in experimental murine kidney transplantation models.

Urine Output and Acute Kidney Injury in Neonates/Younger Children: A Prospective Study of Cardiac Surgery Patients with Indwelling Urinary Catheters.

Pediatric acute kidney injury (AKI) is associated with significant morbidity and mortality, yet a precise definition, especially concerning urine output (UO) thresholds, remains unproven. We evaluate UO thresholds for AKI in neonates and children aged 1-24 months with indwelling urinary catheters undergoing cardiac surgery. A six-year prospective cohort study (2018-2023) after cardiac surgery was conducted at a reference center in Brazil. All patients had indwelling urinary catheters up to 48 hours after surgery and at least two serum creatinine (sCr) measurements, including one before surgery. The main objective of this study was to determine the optimal UO thresholds for AKI definition and staging in neonates and younger children compared with the currently used criteria-neonatal and adult Kidney Disease Improving Global Outcomes (KDIGO) definitions. The outcome was a composite of severe AKI (stage 3 AKI diagnosed by the sCr criterion only), kidney replacement therapy, or hospital mortality. The study included 1,024 patients: 253 in the neonatal group and 772 in the younger children group. In both groups, the lowest UO at 24 hours as a continuous variable had good discriminatory capacity for the composite outcome (AUC-ROC 0.75 [95% CI 0.70-0.81] and 0.74 [95% CI 0.68-0.79]). In neonates, the best thresholds were 3.0, 2.0 and 1.0 mL/kg/hour, and in younger children, the thresholds were 1.8, 1.0 and 0.5 mL/kg/hour. These values were used for modified AKI staging for each age group. In neonates, this modified criterion was associated with the best discriminatory capacity (AUC-ROC 0.74 [0.67-0.80] vs. 0.68 [0.61-0.75], P<0.05) and net reclassification improvement (NRI) in comparison with the neonatal KDIGO criteria. In younger children, the modified criteria had good discriminatory capacity but were comparable to the adult KDIGO criteria, and the NRI was near zero. Using indwelling catheters for UO measurements, our study reinforced that the current KDIGO criteria may require adjustments to better serve the neonate population. Additionally, using the UO criteria, we validated the adult KDIGO criteria in children aged 1-24 months.

The impact of acute kidney damage in the community.

Assess incidence of Acute Kidney Diseas and Disorders (AKD) and Acute Kidney Injury (AKI) episodes and impact on progression of renal dysfunction and risk of all-cause mortality in the community. Community of 1863731 aged>23 years with at least two serum creatinine measurements. eGFR was calculated using CKD-EPI formula. CKD, AKD and AKI were defined according to the harmonized KDIGO criteria (Lameire 2021). The sCr values and RIFLE scale was used to classify episodes. Progression of renal dysfunction and mortality were evaluated. 56850 episodes of AKD in 47972 patients in 4.8 years were identified. AKD incidence of AKD was 3.51 and 12.56/1000 patients/year in non-CKD and CKD, respectively. One AKD episode was observed in 87.3% patients, two in 9.3% and three or more in 3.4%. A second episode was less common in patients without CKD (10.3%) compared to those with CKD (18.4%). Among patients without CKD a total of 43.8% progressed to CKD, and those with previous CKD 63.1% had eGFR decline of>50%. The risk of progression to CKD was higher in women, older, overweight-obesity and heart failure, as was the risk of eGFR decline>50% in CKD patients, although the number of AKD episodes was also a risk factor. AKI episodes were observed in 5646 patients with or without CKD. Of these, 12.7% progressed to CKD and of those with pre-existing CKD, 43.2% had an eGFR decline of>20%. In the toal population mortality within 3 months of detection of AKD episode occurred in 7% patients, and was even higher in patients with AKI, 30.1%. Acute elevations in serum creatinine in the community may pose a health risk and contribute to the development of CKD. Identification of therapeutic targets and provision of appropriate follow-up for those who survive an episode is warranted.

Application and comparison of point-of-care devices for field evaluation of underlying health status of Guatemalan sugarcane workers.

With chronic disease prevalence on the rise globally, surveillance and monitoring are critical to improving health outcomes. Point-of-care (POC) testing can facilitate epidemiological research and enhance surveillance systems in limited resource settings, but previous research has identified bias between POC devices and laboratory testing. We compared the performance of two POC blood analyzers, the iSTAT handheld (Abbott, Princeton, NJ, USA) and the StatSensor Creatinine (Nova Biomedical, Waltham, MA, USA) to concurrent blood samples analyzed at a local laboratory that were collected from 89 agricultural workers in Guatemala. We measured creatinine and other measures of underlying health status with the POC and the lab blood samples. Pearson correlation coefficients, Bland-Altman plots, no intercept linear regression models and two-sample t-tests were used to evaluate the agreement between the POC and lab values collected across three study days and to assess differences by study day in a field setting. On average there was no observed difference between the iSTAT and lab creatinine measurements (p = 0.91), regardless of study day. Using lab creatinine as the gold standard, iSTAT creatinine results were more accurate compared to the Statsensor, which showed some bias, especially at higher values. The iSTAT had good agreement with the lab for sodium and blood urea nitrogen (BUN), but showed differences for potassium, anion gap, bicarbonate (TCO2), glucose, and hematocrit. In this tropical field setting, the research team devised a protocol to prevent the devices from overheating. In limited resource settings, POC devices carry advantages compared to traditional lab analyses, providing timely results to patients, researchers, and healthcare systems to better evaluate chronic health conditions. Technical challenges due to use of POC devices in high heat and humidity environments can be addressed using a standard protocol for transporting and operating the devices.

Recovery from Acute Kidney Injury and Long-Term Prognosis following Acute Myocardial Infarction.

We investigated the recovery pattern from acute kidney injury (AKI) following acute myocardial infarction (AMI) and its association with long-term mortality. The retrospective study included AMI patients (2002-2027), who developed AKI during hospitalization. Creatinine (Cr) measurements were collected and categorized into 24 h timeframes up to 7 days from AKI diagnosis. The following groups of recovery patterns were defined: rapid (24-48 h)/no rapid and early (72-144 h)/no early recovery. Specific cut-off points for recovery at each AKI stage and timeframe were determined through receiver operating characteristic (ROC) curves. The probability of long-term (up to 10 years) mortality as a post-AKI recovery was investigated using a survival approach. Out of 17,610 AMI patients, 1069 developed AKI. For stage 1 AKI, patients with a Cr ratio <1.5 at 24 h and/or <1.45 at 48 h were defined as 'rapid recovery'; for stages 2-3 AKI, a Cr ratio <2.5 at 96 h was defined as 'early recovery'. Mortality risk in stage 1 AKI was higher among the non-rapidly recovered: AdjHR = 1.407; 95% CI: 1.086-1.824; p = 0.010. Among stages 2-3 AKI patients, the risk for long-term mortality was higher among patients who did not recover in the early period: AdjHR = 1.742; 95% CI: 1.085-2.797; p = 0.022. The absence of rapid recovery in stage 1 AKI and lack of early recovery in stages 2-3 AKI are associated with higher long-term mortality.

Investigating the Expression of miR 203a 3p and Its Role in Inflammatory Response in Severe Preeclampsia of Iraqi women Patients – A Comparative Study

Abstract Background: Preeclampsia (PE) has long been a feared condition impacting women and their pregnancies. Researchers have recently discovered the role of miR203a-p3 in various diseases. The aim of the study was to explore the role of miR203a and measure its levels in pregnant patients, along with reviewing the advancement of inflammatory markers related to disease. Methods: Seventy serum samples and erythrocyte sedimentation rate (ESR) tubes were collected from pregnant women aged 25–33 who were diagnosed with serious PE. Upon this, 15 samples were chosen for testing of the deemed levels and gene expression of miR203a. Laboratory evaluation was mainstreamed in the study, including measurements of serum creatinine, blood urea, and uric acid. These parameters were quantitated using turbidity techniques and coulometric methods for C-reactive protein. In addition, we appraised the ESR uptake by the time method and examined fibrinogen by the agglutination time method. We quantified interleukin-6 (IL-6) using an enzyme-linked immunosorbent assay. Results: The serum levels of biomarkers and inflammatory tests differed significantly in the patients compared to controls. Similarly, a rise in gene expression resulted in an abatement in the level of miR203-p3, and there was a positive direct correlation between them. Conclusion: Patients exhibit high levels of biomarkers and IL-6, along with reduced concentration and expression of miR203a. There is a significant positive correlation between miR203a and disease. Finally, miR203 has played an active role in the current disease.

Early neutrophil gelatinase-associated lipocalin (NGAL) measurement could rule out future acute kidney injury in patients with acute coronary syndrome-Prospective observational study.

The diagnosis of acute kidney injury (AKI) is of importance among patients with ST segment elevation (STEMI) undergoing primary coronary intervention (PCI). It is often delayed given the need in serial measurements of creatinine or other serum markers. Neutrophil gelatinase-associated lipocalin (NGAL) is a proven marker for AKI, although its role as an early predictor in this setting was scarcely addressed before and was the aim of our study. Prospective observational study including 133 patients with STEMI treated with PCI. Plasma NGAL was drawn immediately before PCI (NGAL-0) and 24 h after (NGAL-24). Similar analysis of C-reactive protein (CRP) was performed for additional comparison. Mean age was 62 ± 13 years, 78% were men, and 20 (15%) developed AKI after admission. Patients with AKI after admission demonstrated higher levels of NGAL-0 (164 vs. 95 ng/mL; p < 0.001) and NGAL-24 (142 vs. 93 ng/mL; p < 0.001). Levels of NGAL-0 and NGAL-24 were similar within the AKI and non-AKI groups. Using ROC curve analysis, NGAL-0 had best predictive ability for AKI development (AUC 0.841, 95% CI 0.80-0.96), compared with NGAL-24 (0.783, 95% CI 0.74-0.85), CRP-0 (0.701, 95% CI 0.58-0.83), and CRP-24 (0.781, 95% CI 0.66-0.90). The optimal NGAL-0 cutoff for AKI prediction was 125 ng/mL, with 70% sensitivity, 84% specificity, and 94% negative predictive value. Among STEMI patients, NGAL measurement upon admission are associated with AKI and may serve as a reliable marker for early AKI detection. Future studies may direct risk stratification using this single test can direct personalized evaluations during the admission, and focused interventions to prevent AKI.

Burden of CKD-Associated Pruritus and Adverse Clinical Outcomes in Patients Receiving Dialysis: The Stockholm Creatinine Measurements (SCREAM) Project

Pruritus is a common but not well-characterized complaint of patients receiving maintenance dialysis. This study sought to quantify the burden of pruritus and its associated adverse health outcomes in this population. Observational study. All patients receiving maintenance dialysis in Stockholm, Sweden, during 2005-2021. Clinically recognized pruritus defined using International Classification of Diseases, Tenth Revision codes or a prescription for antipruritus treatments (including UV therapy). All-cause mortality, severe infection-related hospitalizations (composite of endocarditis, peritoneal dialysis-related peritonitis, hemodialysis/peritoneal dialysis-related catheter infection, sepsis due to Staphylococcus spp., or skin infection) and incident diagnoses of anxiety/depression and sleep disorders. Multivariable logistic regression and cause-specific hazards models to analyze factors associated with prevalent and new-onset pruritus, respectively. Multivariable cause-specific hazards models with time-varying exposure were used to explore the association of prevalent and new-onset pruritus with adverse health outcomes. Among 3,281 dialysis recipients (median age, 64 years; 66% men; 69% receiving hemodialysis, 77% with incident dialysis), 456 (14%) had pruritus at enrollment. During a median follow-up of 3.3 (IQR, 1.3-9.2) years, 539 (19%) additional patients experienced pruritus. Older age, female sex, a lower serum albumin level, and higher C-reactive protein, serum calcium, and phosphorus levels were independently associated with pruritus. Compared with patients without pruritus, patients with pruritus were at a higher risk of sleep disorders (adjusted HR, 1.96; 95% CI, 1.60-2.39), developing anxiety/depression (adjusted HR, 1.56; 95% CI, 1.23-1.98), and being hospitalized for severe infections (adjusted HR, 1.36; 95% CI, 1.18-1.57), the latter attributed to higher risk of sepsis and peritoneal dialysis-related peritonitis. There was no detectable association between the development of pruritus and all-cause mortality. Potential misclassification bias if pruritus is not clinically recognized, lack of information on pruritus intensity/severity, use of diagnostic codes for exposure and outcome diagnoses. At least one third of patients experience pruritus during their first years undergoing dialysis, and pruritus was consistently associated with adverse health outcomes. Pruritus is a common but not well-characterized symptom of patients receiving dialysis. We analyzed data from 3,281 patients receiving maintenance hemodialysis or peritoneal dialysis in the region of Stockholm, Sweden. At baseline, 14% of patients had pruritus, and pruritus developed in an additional 19% of patients during their time receiving dialysis. We identified conditions associated with the development of pruritus (eg, older age, female sex, lower serum albumin level, and higher C-reactive protein, serum calcium, and phosphorus levels) and observed that the presence of pruritus was associated with higher risks of sleep disorders, developing anxiety and depression, and being hospitalized for severe infections. No association between pruritus and all-cause mortality was identified.

The Assessment of the Association of Proton Pump Inhibitor Usage with Chronic Kidney Disease Progression through a Process Mining Approach.

Previous studies have suggested an association between Proton Pump Inhibitors (PPIs) and the progression of chronic kidney disease (CKD). This study aims to assess the association between PPI use and CKD progression by analysing estimated glomerular filtration rate (eGFR) trajectories using a process mining approach. We conducted a retrospective cohort study from 1 January 2006 to 31 December 2011, utilising data from the Stockholm Creatinine Measurements (SCREAM). New users of PPIs and H2 blockers (H2Bs) with CKD (eGFR < 60) were identified using a new-user and active-comparator design. Process mining discovery is a technique that discovers patterns and sequences in events over time, making it suitable for studying longitudinal eGFR trajectories. We used this technique to construct eGFR trajectory models for both PPI and H2B users. Our analysis indicated that PPI users exhibited more complex and rapidly declining eGFR trajectories compared to H2B users, with a 75% increased risk (adjusted hazard ratio [HR] 1.75, 95% confidence interval [CI] 1.49 to 2.06) of transitioning from moderate eGFR stage (G3) to more severe stages (G4 or G5). These findings suggest that PPI use is associated with an increased risk of CKD progression, demonstrating the utility of process mining for longitudinal analysis in epidemiology, leading to an improved understanding of disease progression.

COMPARISON OF ESTIMATED GLOMERULAR FILTRATION RATE USING DIFFERENT FORMULAS IN TURKISH POPULATION

Objective: Creatinine-based equations are generally used in clinical practice to estimate glomerular filtration rates (GFR), but values are not usually consistent. This study aimed to evaluate the difference between estimated GFR values using different equations. Material and Method: Adult Turkish patients with serum creatinine measurements between January to December 2021 and complete demographic data were included. GFR values were calculated using 5 different formulas. GFR calculated with Cockcroft-Gault were normalized to body surface area and added to the comparison. Difference between GFR values and KDIGO stages were evaluated. Albunin/creatinine ratio (ACR) of patients was also assessed. Result and Discussion: A total of 305 patients with average age of 52.92 years were included. Six different GFR calculations were recorded with median values between 51.70 to 71.77 ml/min/1.73m2. Formula of The Modification of Diet in Renal Disease with the race factor for Turkish population resulted in the lowest eGFR values. The ACR values of only 42 patients were available and it was negatively correlated to all GFR values and positively correlated to all KDIGO stages (p&amp;lt;0.05). There were noteworthy variations in GFR values, based on patient demographics and/or equations. The need for novel practical methods for estimating GFR in general and specific patient populations are necessary.

Multicentre, retrospective cohort study protocol to identify racial and ethnic differences in acute kidney injuries in children and adolescents with diabetic ketoacidosis

IntroductionApproximately 40% of children with diabetic ketoacidosis (DKA) develop acute kidney injury (AKI), which increases the risk of chronic kidney damage. At present, there is limited knowledge of racial or...

Comparison of eGFR Equations to Guide Dosing of Medications for Kidney Transplant Recipients.

Clinicians caring for kidney transplant recipients (KTRs) most commonly use estimated glomerular filtration rate (eGFR) to guide medication dosing as it is the most readily available measure of kidney function. Which eGFR equations provide the most accurate medication dosing guidance for KTRs remains uncertain. We studied 415 stable KTRs in Canada and New Zealand. Participants completed same-day measurements of creatinine and cystatin C and measured GFR (diethylenetriaminepentaacetic acid). Chronic Kidney Disease Epidemiology Collaboration, European Kidney Function Consortium, and transplant-specific eGFR equations were compared with both Cockcroft-Gault creatinine clearance (CrCl) and measured GFR. eGFR equations were assessed both indexed to a standardized body surface area (BSA) of 1.73 m2 (milliliter per minute per 1.73 m2, as is conventional reporting from most clinical laboratories) and nonindexed (milliliter per minute) accounting for actual BSA. The primary outcome was the proportion of medication dosing discordance relative to Cockcroft-Gault CrCl or measured GFR for 8 commonly prescribed medications. Stratified analyses were performed on the basis of obesity status. Nonindexed eGFR equations (milliliter per minute) resulted in substantially lower medication dosing discordance compared with indexed eGFR equations (milliliter per minute per 1.73 m2). These findings were most pronounced among KTRs with obesity, in whom underdosing was frequent. When compared with Cockcroft-Gault CrCl, the lowest proportion of discordance was found with the nonindexed 2023 transplant-specific equation. When compared with measured GFR, the lowest proportion of discordance was found with the nonindexed 2021 Chronic Kidney Disease Epidemiology CollaborationCr/CysC equation. Nonindexed eGFR values accounting for actual BSA should be used by clinicians for medication dosing in KTRs. These findings may inform KT providers about which eGFR equations provide the safest, most accurate medication dosing guidance for KTRs.

Patterns of kidney function and risk assessment in a nationwide laboratory database: the Brazilian CHECK-CKD study

BackgroundChronic kidney disease (CKD) is a global health problem with rising prevalence, morbidity, mortality, and associated costs. Early identification and risk stratification are key to preventing progression to kidney failure. However, there is a paucity of data on practice patterns of kidney function assessment to guide the development of improvement strategies, particularly in lower-income countries.MethodsA retrospective observational analysis was conducted in a nationwide laboratory database in Brazil. We included all adult patients with at least one serum creatinine assessment between June 2018 and May 2021. Our primary objective was to determine the proportion of patients with estimated glomerular filtration rate (eGFR) evaluations accompanied by predicted levels of urinary albumin-to-creatinine ratio (pACR) assessments within 12 months.ResultsOut of 4,5323,332 serum creatinine measurements, 42% lacked pACR measurements within 12 months. Approximately 10.8% of tests suggested CKD, mostly at stage 3a. The proportion of serum creatinine exams paired with pACR assessment varied according to the CKD stage. Internal Medicine, Cardiology, and Obstetrics/Gynecology were the specialties requesting most of the creatinine tests. Nephrology contributed with only 1.1% of serum creatinine requests for testing.ConclusionOur findings reveal that a significant proportion of individuals with a creatinine test lack an accompanying urinary albuminuria measurement in Brazil, contrary to the recommendations of the international guidelines. Non-Nephrologists perform most kidney function evaluations, even among patients with presumable advanced CKD. This highlights the urge to incorporate in clinical practice the early detection of CKD and to encourage more collaborative multidisciplinary care to improve CKD management.

Evaluating the Prevalence of Cardiac Surgery–associated Acute Kidney Injury After Septal Myectomy Combined With Concomitant Procedures in Obstructive Hypertrophic Cardiomyopathy

ObjectivesHypertrophic obstructive cardiomyopathy (HOCM) may be treated by septal myectomy. Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common complication, but little is known about its incidence after septal myectomy. The objectives were to (i) evaluate the prevalence of CSA-AKI after septal myectomy and (ii) identify potential perioperative and phenotype-related factors contributing to CSA-AKI. DesignRetrospective database analysis with new data analysis. SettingSingle expertise university academic centre for septal myectomy HOCM patients. ParticipantData from 238 HOCM patients operated with septal myectomy between 2005-2022. InterventionsCSA-AKI was stratified by the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines by measurement of creatinine and urine production. Important HOCM phenotype-related and perioperative factors were analysed for their possible association with CSA-AKI. Measurements and Main ResultsCSA-AKI occurred in 45% of patients, of these, 55% were classified as KDIGO stage I, and the remaining 45% as stage II, with no chronic kidney damage being observed. Moreover, there were no phenotypical or perioperative characteristics that were more prevalent in the CSA-AKI cohort. However, the use of beta-blockers and coronary artery disease were more prevalent in the CSA-AKI cohort. ConclusionsCSA-AKI is a common complication after septal myectomy, but was transient and kidney function recovered in all patients.

Effects of Helianthus annuus seeds on antioxidants, lipid profile and serum urea and creatinine in obesity induced rats using high fat diet

High-fat diets have been strongly associated with common metabolic diseases. Clinical practices often link these diseases, such as hyperlipidemia and oxidative stress resulting from the accumulation of reactive oxygen species, to severe conditions like cancer, diabetes, atherosclerosis, and cardiovascular diseases. Managing these conditions is often financially demanding. Helianthus annuus seeds, known to be non-toxic even at doses greater than 5000mg/kg in rats, with an LD50 greater than 5000mg/kg, has demonstrated efficacy in reducing elevated blood sugar levels and BMI in both animal and human studies. Therefore, further research is needed to explore the potential effects of sunflower seeds on antioxidants, lipid profiles, and serum urea and creatinine levels in rats induced with obesity using a high-fat diet. In this study, overnight fasting blood samples were collected to conduct lipid profile tests (HDL, LDL, VLDL, and triglycerides). These tests utilized a photometric system with procedures derived from the Diasys-G Emmany kit and the measurement and precipitation method. The modified Jaffe technique for in-vitro measurement of creatinine in serum was employed to measure urea and creatinine levels. The experiment involved 27 Wistar rats weighing between 350 and 400 grams, randomly divided into 9 groups, with 3 rats in each group. Group 1 served as the control, while groups 2 to 9 were subjected to various conditions: high-fat diets alone for 6 weeks (group 2), high-fat diets with high (5000mg/kg body weight), medium (3000 mg/kg body weight), or low (2000 mg / kg body weight) doses of Helianthus annuus seeds powder for 6 weeks (groups 3, 4, and 5, respectively). Additionally, there were variations in duration and doses in groups 6 to 9, where rats were fed high-fat diets 20 g/ kg / day /rats for 5 weeks and then supplemented with Helianthus annuus seeds powder (5000 mg / kg, 3000 mg / kg and 2000 mg / kg per rat for group 6,7,8 or Metformin 70 mg / kg per rat for group 9) for 1 week. The results revealed a significant (P &lt; 0.05) increase in serum cholesterol, triglyceride, and low-density lipoprotein (LDL) levels in rats across all groups compared to the control. However, all groups supplemented with Helianthus annuus seeds alongside high-fat diets displayed a significantly increased HDL level (P &lt; 0.05) compared to rats fed only high-fat diet alone. Creatinine levels were significantly increased in all Helianthus annuus seeds -supplemented groups compared to the high-fat diet alone, while urea levels showed no significant differences among the groups. Furthermore, rats in all Helianthus annuus seeds -supplemented groups alongside high-fat diets demonstrated a significantly increased glutathione reductase activity (P &lt; 0.05) compared to the control and high-fat diet alone. The study indicated that sunflower seeds significantly bolster antioxidant protection, elevate HDL levels, and increase creatinine levels in rats fed high-fat diets, suggesting potential beneficial effects in mitigating the adverse impacts of high-fat diets on health parameters.

#2206 Predictors of post-operative acute kidney injury after colorectal cancer surgery

Abstract Background and Aims Post-operative acute kidney injury (PO-AKI) is a common complication of colorectal cancer (CRC) surgery associated with increased morbidity and mortality, and higher hospital costs. Specific treatment of AKI is still limited, supporting the importance of preventing AKI. Identification of patients at high risk may allow early interventions, including closer monitoring and perioperative optimization. This study aimed to identify predictors of PO-AKI by assessing the association between preoperative factors and the occurrence of PO-AKI. Method We conducted a nationwide cohort study including adult CRC surgery patients in 2010–2021 using Danish health registries. We defined PO-AKI as AKI within 7 days after the CRC surgery according to the 2012 KDIGO criteria using creatinine measurements. A list of patient characteristics associated with AKI was identified using existing literature. We obtained information on variables using population-based health registries containing data on diagnosis codes, redeemed prescriptions, and laboratory data. We investigated the individual predictive factors by estimating PO-AKI risks and the odds ratios (ORs) with 95% confidence intervals (CIs) adjusting for sex and age. Results We identified 35,650 CRC surgery patients, of whom 24,555 had creatinine measurements during the study period, making them eligible for further analysis. Among these patients, we identified 2,694 cases of PO-AKI, corresponding to a 11% risk of PO-AKI. The risk of PO-AKI was higher for males (13.5% vs. 8.4%, aOR=1.76 [1.62-1.91]), and patients with diabetes (15.4% vs. 10.2%, aOR=1.46 [1.32-1.61]), cardiovascular disease (15.4% vs. 9.9%, aOR=1.38 [1.26-1.52]), CKD (18.9% vs. 9.2%, aOR=1.99 [1.80-2.19]), COPD (16.6% vs. 10.3%, aOR=1.59 [1.42-1.78]), and hypertension (13.6% vs. 7.5%, aOR=1.68 [1.53-1.84]). When examining potentially nephrotoxic medicine, the risk was higher in ACE-I/ARB users (14.5% vs. 9.6%, aOR=1.44 [1.32-1.56]) and similar in NSAID users and nonusers (10.3% vs. 11.0%, aOR=1.00 [0.84-1.19]). Conclusion We found that male gender, diabetes, cardiovascular disease, CKD, COPD, hypertension, and the use of ACE-I/ARB medications were associated with a higher risk of PO-AKI. Interestingly, users and nonusers of NSAIDs had similar risks of AKI. The identification of high-risk groups, such as those with pre-existing comorbidities or users of specific medications, may aid clinicians in identifying patients with a particularly high risk of PO-AKI.

#2679 Prediction of acute eGFR decline after first initiation of RASI inhibitors and its impact on clinical outcomes

Abstract Background and Aims The objective of this study is to investigate the correlation between acute eGFR (estimated glomerular filtration rate) decline after initiation of ACEI (angiotensin-converting enzyme inhibitor)/ARB (angiotensin receptor blocker) medications and clinical outcomes in a real-world setting. Additionally, we aim to establish a risk prediction model to identify high-risk individuals who are more likely to experience a rapid decline in eGFR after drug initiation. Method A total of 2026 adult new users of ACEI/ARB were selected from the China Renal Data System (CRDS). Patients in acute clinical states and those using nephrotoxic drugs were excluded, and it was required that patients had at least one creatinine measurement during the baseline period and one week to four weeks after drug initiation. Cox proportional hazards models were used to compare the relative risks of adverse long-term outcomes in patients with different degrees of acute eGFR decline. A multivariable logistic regression model was employed to analyze the factors influencing acute eGFR decline. Lasso regression was used to select predictive factors, resulting in a logistic regression model with 18 predictive factors. Results Among the 2026 patients, 1148 (57%), 473 (23%), and 405 (20%) experienced eGFR decline &amp;lt;5% or increase, 5-20% decline, and ≥20% decline, respectively, after initiation of RASI (renin-angiotensin system inhibitor). Following adjustment for multiple variables, an eGFR decline ≥20% was found to be associated with a higher risk of long-term renal disease progression, with a hazard ratio of 1.84 (95% confidence interval 1.19-2.85), but not significantly associated with an increased risk of all-cause mortality and cardiovascular events. Factors associated with an eGFR decline ≥20% after RASI initiation included higher BMI and Charlson index, more severe proteinuria, lower hemoglobin levels, presence of hypertension, diabetic nephropathy, arrhythmias, and concomitant use of thiazide diuretics or loop diuretics. The predictive model had a C-statistic of 0.75. Conclusion This study demonstrates that a short-term eGFR decline after RASI initiation is associated with a higher risk of long-term renal disease progression but not significantly associated with increased risks of all-cause mortality and cardiovascular events. We have developed a prediction model to estimate the risk of eGFR decline ≥20% after the initial use of RASI, which can aid clinicians in identifying patients with poorer renal outcomes following RASI initiation and facilitate timely intervention.