Creatinine Values Research Articles

Comparison of early postoperative results in patients with and without diabetes with low ejection fraction and normal serum creatinine values who underwent coronary artery bypass operation.

Low left ventricular ejection fraction and renal insufficiency are factors that increase the risk of coronary artery bypass graft surgery in patients with diabetes mellitus. The aim of this study was to group patients with low left ventricular ejection fraction undergoing coronary artery bypass graft surgery according to the presence or absence of diabetes mellitus and to evaluate postoperative changes in serum creatinine levels and postoperative outcomes. A total of 93 patients undergoing isolated coronary artery bypass grafting were included in this single-centre, retrospective, cohort study. Patients with a pre-operative low left ventricular ejection fraction of less than 35% were included in the study. Patients were divided into diabetic and non-diabetic groups and intra- and intergroup values were compared. Pre-operative, and postoperative days 2 and 5 serum creatinine levels of the patients were measured and compared. Of the 93 patients included in the study, 60 were in the diabetic group (group 1) and 33 were in the non-diabetic group (group 2). Postoperative 2- and 5-day creatinine levels were significantly higher in group 1 than in group 2 (p = 0.033 and p = 0.005, respectively). Postoperative 2- and 5-day creatinine levels were significantly higher than pre-operative creatinine levels in group 1 (p = 0.008 and p = 0.001, respectively). The intensive care unit stay was significantly longer in the diabetes mellitus group than in the group without diabetes mellitus (p = 0.031). Following coronary artery bypass graft surgery in patients with low left ventricular ejection fraction, which is already a risk factor, creatinine levels were found to have increased in the diabetes mellitus group.

Acute kidney injury and COVID-19 in young adults in intensive care

Objective To describe acute kidney injury prevalence in young adults diagnosed with COVID-19 admitted to the Intensive Care Unit. Methods This is a retrospective, quantitative and analytical study. The sample consisted of young adults (20 to 40 years old) admitted to Intensive Care Units, diagnosed with SARS-CoV-2 infection between March and December 2020. Data were obtained through electronic medical records, and kidney injury acute was defined by the creatinine value, according to the Kidney Disease Improving Global Outcomes guidelines criteria. Statistical significance was p≤0.05. Results A total of 58 young adults were hospitalized, 63.8% of whom were male. Hypertension was present in 39.6%, obesity in 18.9%, and diabetes mellitus in 8.6%. Acute kidney injury was identified in 55.1%, with stage 3 predominating in 43.1% of them. In these patients, the use of mechanical ventilation and vasoactive drugs was significant in 92% as well as respiratory organ dysfunction (80%), followed by renal organ dysfunction (76%). Risk factors such as kidney transplantation or chronic kidney disease and obesity increased by 12.3 and 9.0 times, respectively, the chances of developing acute kidney injury. Conclusion This study demonstrated a high kidney injury prevalence in young adults and its association with previous comorbidities. Obesity, kidney transplantation and chronic kidney disease increased the chance of young adults to develop acute kidney injury, resulting in outcomes in favor of morbidity and mortality.

Effect of Intensive Blood Pressure Control on Kidney Outcomes: Long-Term Electronic Health Record-Based Post-Trial Follow-Up of SPRINT.

Intensive BP lowering in the Systolic Blood Pressure Intervention Trial (SPRINT) produced acute decreases in kidney function and higher risk for AKI. We evaluated the effect of intensive BP lowering on long-term changes in kidney function using trial and outpatient electronic health record (EHR) creatinine values. SPRINT data were linked with EHR data from 49 (of 102) study sites. The primary outcome was the total slope of decline in eGFR for the intervention phase and the post-trial slope of decline during the observation phase using trial and outpatient EHR values. Secondary outcomes included a ≥30% decline in eGFR to <60 ml/min per 1.73 m 2 and a ≥50% decline in eGFR or kidney failure among participants with baseline eGFR ≥60 and <60 ml/min per 1.73 m 2 , respectively. EHR creatinine values were available for a median of 8.3 years for 3041 participants. The total slope of decline in eGFR during the intervention phase was -0.67 ml/min per 1.73 m 2 per year (95% confidence interval [CI], -0.79 to -0.56) in the standard treatment group and -0.96 ml/min per 1.73 m 2 per year (95% CI, -1.08 to -0.85) in the intensive treatment group ( P < 0.001). The slopes were not significantly different during the observation phase: -1.02 ml/min per 1.73 m 2 per year (95% CI, -1.24 to -0.81) in the standard group and -0.85 ml/min per 1.73 m 2 per year (95% CI, -1.07 to -0.64) in the intensive group. Among participants without CKD at baseline, intensive treatment was associated with higher risk of a ≥30% decline in eGFR during the intervention (hazard ratio, 3.27; 95% CI, 2.43 to 4.40), but not during the postintervention observation phase. In those with CKD at baseline, intensive treatment was associated with a higher hazard of eGFR decline only during the intervention phase (hazard ratio, 1.95; 95% CI, 1.03 to 3.70). Intensive BP lowering was associated with a steeper total slope of decline in eGFR and higher risk for kidney events during the intervention phase of the trial, but not during the postintervention observation phase.

Tacrolimus and Diabetes in Kidney Transplantation: The Impact of Cyp3a5 Gene Polymorphism

To explore the correlation between single nucleotide polymorphisms (SNPs) of CYP3A4 rs2740574 and CYP3A5 rs776746 and post-transplant diabetes mellitus (PTDM) in Chinese renal allograft recipients treated with tacrolimus. A total of 244 patients treated with tacrolimus were included in this study, wherein DNA sequencing was detected through fluorescence in situ hybridization, and SNP genotyping was performed. Among the 244 patients, 44 (18%) developed PTDM. The PTDM group exhibited higher preoperative body mass index and fasting plasma glucose levels, with higher creatinine values one year after surgery. The CYP3A4 rs2740574 genotype was found to be unique in its homozygous AA form. For CYP3A5 rs776746, the genotypes were distributed as follows: 28 (11.5%) cases with AA, 101 (41.4%) cases with AG, and 115 (47.1%) cases with GG, respectively (P=.042). The AA genotype showed a statistically significant difference from both AG and GG genotypes. Furthermore, the A allele of CYP3A5 rs776746 was found to be associated with an increased risk for PTDM development. The occurrence of tacrolimus-related PTDM is associated with body mass index, fasting plasma glucose levels, and CYP3A5 genotype before renal transplantation. Post-transplant diabetes mellitus is correlated with unfavorable long-term renal graft function, whereas the expression of the CYP3A5 rs776746 gene is linked to an elevated risk of PTDM.

The Effect of Oral N-Acetyl Cysteine Administration on Acute Kidney Injury Patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Background: Acute kidney injury (AKI) is a clinical condition characterized by a rapid decline in kidney function that includes structural damage (injury) or malfunction (impairment). AKI is a common complication that occurs in 5-10% of patients due to various underlying etiologies. One of the underlying pathophysiology of AKI is the role of discharge reactive oxygen species (ROS), which causes injury to kidney cells. From various studies, it has been reported that N-acetylcysteine (NAC) has anti-inflammatory and antioxidant effects and has an effect on reducing serum creatinine values.&#x0D; Methods: This research is an open randomized clinical trial without control involving 30 patients at Dr. Mohammad Hoesin General Hospital, Palembang, who were all given intervention in the form of NAC 1200 mg/day, starting in September – October 2023. This study aimed to determine the role of NAC in reducing serum creatinine values in patients with acute kidney injury at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia. Data analysis was carried out using SPSS 21 univariate and bivariate.&#x0D; Results: From the research results, it was found that the average age of patients was 53.9 years, involving 21 males (70%, N=30) and 9 females (30%, N=30). The most common causes were prerenal and then renal (53.3% and 46.7%). The initial serum creatinine level was found to be 2.12± 0.79 mg/dL (n = 30 samples), and after administration of the intervention, the mean serum creatinine level was 1.28± 0.63 mg/dL (n = 30 samples). By using a paired t-test, there was a decrease in serum creatinine levels significant (p=0,012).&#x0D; Conclusion: NAC administration to patients with acute kidney injury of pre-renal or post-renal causes has a statistical effect on reducing serum creatinine values in patients with acute kidney injury at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.

Restrictive versus standard IV fluid therapy in adult ICU patients with septic shock-Bayesian analyses of the CLASSIC trial.

The CLASSIC trial assessed the effects of restrictive versus standard intravenous (IV) fluid therapy in adult intensive care unit (ICU) patients with septic shock. This pre-planned study provides a probabilistic interpretation and evaluates heterogeneity in treatment effects (HTE). We analysed mortality, serious adverse events (SAEs), serious adverse reactions (SARs) and days alive without life-support within 90 days using Bayesian models with weakly informative priors. HTE on mortality was assessed according to five baseline variables: disease severity, vasopressor dose, lactate levels, creatinine values and IV fluid volumes given before randomisation. The absolute difference in mortality was 0.2%-points (95% credible interval: -5.0 to 5.4; 47% posterior probability of benefit [risk difference <0.0%-points]) with restrictive IV fluid. The posterior probabilities of benefits with restrictive IV fluid were 72% for SAEs, 52% for SARs and 61% for days alive without life-support. The posterior probabilities of no clinically important differences (absolute risk difference ≤2%-points) between the groups were 56% for mortality, 49% for SAEs, 90% for SARs and 38% for days alive without life-support. There was 97% probability of HTE for previous IV fluid volumes analysed continuously, that is, potentially relatively lower mortality of restrictive IV fluids with higher previous IV fluids. No substantial evidence of HTE was found in the other analyses. We could not rule out clinically important effects of restrictive IV fluid therapy on mortality, SAEs or days alive without life-support, but substantial effects on SARs were unlikely. IV fluids given before randomisation might interact with IV fluid strategy.

Intravascular Hemolysis and AKI in Children Undergoing Extracorporeal Membrane Oxygenation.

AKI is common in ECMO patients, with a variety of proposed mechanisms. We sought to describe the impact of laboratory evidence of ECMO-associated intravascular hemolysis on AKI and renal replacement therapy (RRT). This retrospective cohort study included patients treated with ECMO at a single center over ten years. The primary outcome was a composite of time to RRT or AKI (by creatinine based KDIGO criteria) after ECMO start. Serum creatinine closest to ECMO start time was considered the pre-ECMO baseline and used to determine abnormal kidney function at ECMO start. The patient's subsequent creatinine values were used to identify AKI on ECMO. Multivariable cause-specific cox proportional hazards models were used to assess the impact of separate markers of intravascular hemolysis on the time to the composite outcome after controlling for confounders. 501 children were evaluated with a median age 1.2 years, 56% male. Four separate multivariable models, each with a different marker of hemolysis (plasma free hemoglobin, LDH, minimum platelet count, minimum daily hemoglobin) were used to examine the impact on the composite outcome of AKI/RRT. An elevated plasma free hemoglobin, the most specific of these hemolysis markers, demonstrated an almost three-fold higher adjusted hazard for the composite outcome (HR 2.9, p-value <0.01, 95% CI 1.4-5.6). Elevated LDH was associated with an adjusted hazard ratio of 3.1 (p-value <0.01, 95% CI 1.7-5.5). Effect estimates were also pronounced in a composite outcome of only more severe AKI, stage 2+ AKI/RRT: HR 6.6 (p-value <0.01, 95% CI 3.3-13.2) for plasma free hemoglobin and 2.8 (p-value <0.01, 95% CI 1.5-5.6) for LDH. Laboratory findings consistent with intravascular hemolysis on ECMO were independently associated with a higher hazard of a composite outcome of AKI/RRT in children undergoing ECMO.

Clinical parameters related to morbidity and mortality in patients with COVID-19 on hospital admission in a tertiary hospital

Objective: to identify the relationship between morbimortality, nutritional status and biochemical markers at hospital admission and stay in hospitalized COVID-19 patients. Methods: retrospective stud whose data were collected from the medical records of patients admitted with a diagnosis of COVID-19, confirmed by the reverse transcription polymerase chain reaction testing, who were hospitalized between April and November 2020 at a tertiary hospital in the state of Pernambuco, in Northeast Brazil. Results: 217 medical records were included, of which 71.9% were from older adults. 70% of patients had peripheral oxygen saturation below 95% at admission, and 47.5% were admitted to the intensive care unit. Being an older adult (OR 1.9, 95% CI 1.0 to 3.5, p = 0.035), having diabetes (OR 2.2, 95% CI 1.2 to 3.8, p = 0.007) and combined diabetes and hypertension (OR 1.9, 95% CI 1.1 to 3.5, p = 0.023) were associated with intensive care unit stay, as well as lymphopenia and renal function impairment in the first day of hospital stay. The prevalence of overweight and obesity was 21.2% and 20.7%. There was a difference in body mass index between adults and older adults (30.61 ± 6.29 kg/m2 vs. 27.53 ± 4.83 kg/m2, p &lt; 0.001). There was 43.8% mortality, which was associated with advanced age, lower peripheral oxygen saturation, body mass index, and albumin values, and increased of urea, creatinine, C-reactive protein, lactate dehydrogenase, troponin T, and dimer values. Conclusion: Older adults were at a higher risk of intensive care unit stay and mortality and had lower body mass index. Patients with lower peripheral oxygen saturation values at admission died. Renal dysfunction, coagulation disorders, and increased inflammatory markers led to a greater risk of intensive care unit stay and mortality.

Performance of Future Glomerular Filtration Rate Equation by Race in a Large, Racially Diverse Patient Cohort Undergoing Nephrectomy for Renal Cell Carcinoma

ObjectiveTo examine the performance of the Palacios et al. (2021) post-nephrectomy future glomerular function rate (fGFR) equation in a diverse cohort using both the Chronic Kidney Disease Epidemiology (CKD-EPI) 2009 equation with race, used in the creation of the formula, as well as the CKD-EPI 2021 equation without race. MethodsPatients that underwent partial or radical nephrectomy for renal cell carcinoma from 2005-2021 were identified in our institutional database. Patients with creatinine values preoperatively and 3-12 months postoperatively were included. Correlation/bias/accuracy/precision of the fGFR equation (fGFR=35+ [preoperative eGFR x 0.65]- 18 [if radical] - [age x 0.25]+ 3 [if tumor >7cm]-2 [if diabetes]) with observed postoperative eGFR was determined by both the CKD-EPI-2021 and CKD-EPI 2009 equations. Results1,443 patients were analyzed. 71% (1,024) were white and 22.9% (331) were black. Most underwent radical nephrectomy (60.3%). 40% T3-T4 RCC, with 14.8% of patients having M1 disease. Median observed vs predicted fGFR was 58.0 vs 58.7 ml/min/1.73m2 for CKD-EPI 2021 and 56.0 vs 57.5 for CKD-EPI 2009. For the total cohort, the correlation/bias/accuracy/precision of the fGFR equation was 0.805/-0.5/81.7/7.9-9.0 for CKD-EPI 2021 and 0.809/-0.8/81.3/-8.1-8 for CKD-EPI 2009. In black patients, fGFR equation demonstrated >75% accuracy with both CKD-EPI equations; however, accuracy was lower in black patients with the CKD-EPI2021 equation (76.1% vs. 83.4%, p=0.003). ConclusionsThe fGFR equation performed well in our large, diverse cohort, though accuracy was relatively lower when using CKD-EPI 2021 compared to CKD-EPI 2009.

The value of serum creatinine as biomarker of disease progression in spinal and bulbar muscular atrophy (SBMA)

Serum creatinine has been indicated as a potential marker of motor function in SBMA and results form previous longitudinal studies pointed to its decline over time. This is a longitudinal retrospective study investigating creatinine changes over a 36-month-period in 73 patients with SBMA. Severity and progression of the disease was assessed according to serum creatine kinase (CK) values, manual muscle testing (MMT), SBMA functional rating scale (SBMAFRS) score, 6-min-walk test (6MWT) value, and spirometry (forced vital capacity, fVC%) obtained at the baseline and at each of the annual follow-up visits. Baseline serum creatinine concentrations positively correlated with 6MWT, the MMT megascore score of both the upper (ULM) and lower (LLM) limbs and SBMAFRS. No correlation was found with CK or fVC% values. Similar correlation results were achieved at all the subsequent time points. Longitudinal assessments conducted by the generalized estimating equations (GEE) method returned significant changes for SBMAFRS (− 1.41 points per year, p < 0.001), ULM and LLM (− 0.69, p = 0.01; and − 1.07, p < 0.001, respectively), 6MWT (− 47 m, p < 0.001) but not for creatinine (− 0.82, p > 0.05). We also observed that creatinine levels at baseline did not correlate with changes in the other measures from baseline at each annual visit. Our data do not support a role for serum creatinine as sensitive biomarker of disease progression, and possibily prognosis, in SBMA.

The Use of Diffusion Tensor Imaging in the Identification of Acute Rejection and Chronic Allograft Nephropathy After Renal Transplantation.

Identifying the cause of renal allograft dysfunction is important for the clinical management of kidney transplant recipients. To evaluate the diagnostic efficiency of diffusion tensor imaging (DTI) for identifying allografts with acute rejection (AR) and chronic allograft nephropathy (CAN). Prospective. Seventy-seven renal transplant patients (aged 42.5 ± 9.5 years), including 29 patients with well-functioning stable allografts (Control group), 25 patients diagnosed with acute rejection (AR group), and 23 patients diagnosed with chronic allograft nephropathy (CAN group). 1.5 T/T2-weighted imaging and DTI. The serum creatinine, proteinuria, pathologic results, and fractional anisotropy (FA) values were obtained and compared among the three groups. One-way analysis of variance; correlation analysis; independent-sample t-test; intraclass correlation coefficients and receiver operating characteristic curves. Statistical significance was set to a P-value <0.05. The AR and CAN groups presented with significantly elevated serum creatinine as compared with the Control group (191.8 ± 181.0 and 163.1 ± 115.8 μmol/L vs. 82.3 ± 20.9 μmol/L). FA decreased in AR group (cortical/medullary: 0.13 ± 0.02/0.31 ± 0.07) and CAN group (cortical/medullary: 0.11 ± 0.02/0.27 ± 0.06), compared with the Control group (cortical/medullary: 0.15 ± 0.02/0.35 ± 0.05). Cortical FA in the AR group was higher than in the CAN group. The area under the curve (AUC) for identifying AR from normal allografts was 0.756 and 0.744 by cortical FA and medullary FA, respectively. The AUC of cortical FA and medullary FA for differentiating CAN from normal allografts was 0.907 and 0.830, respectively. The AUC of cortical FA and medullary FA for distinguishing AR and CAN from normal allografts was 0.828 and 0.785, respectively. Cortical FA was able to distinguish between AR and CAN with an AUC of 0.728. DTI was able to detect patients with dysfunctional allografts. Cortical FA can further distinguish between AR and CAN. 2 TECHNICAL EFFICACY: Stage 2.

SAT382 Lean Mass and Associated Factors in Women with PCOS with Different Phenotypes

Abstract Disclosure: T.M. Fighera: None. B.R. Santos: None. P.M. Spritzer: None. Introduction: Obesity, insulin resistance and hyperandrogenism are common findings in women with PCOS. These abnormalities have been associated with muscle mass changes reported in previous studies, with conflicting results comparing women with PCOS versus non-PCOS controls. The aim of the present study was to evaluate clinical and laboratory variables related to lean body mass according to PCOS phenotype. METHODS: In this case-control study, we analyzed 133 women of reproductive age, recruited through public advertisement at the outpatient clinic of a University Hospital. Inclusion criteria were body mass index (BMI) ranging from 18.5 to 39.9 kg/m², age between 17 and 35 years and no intake of drugs known to interfere with hormone levels for at least 3 months before the study. Women with diabetes, thyroid dysfunction, liver or renal disease were excluded. PCOS was defined according to the Rotterdam Consensus. The study protocol was approved by the local Ethics Committee, and written informed consent was obtained from all participants. Blood pressure, BMI, body composition by dual-energy X-ray absorptiometry (DXA), and laboratory measurements for metabolic and hormonal variables were performed in all subjects. Creatinine values were used as an indirect marker of lean mass. RESULTS: Median age was 28 years (23-31), and the median BMI was 27.9kg/m² (24.1-33.7), with higher BMI in women with the AB phenotype of PCOS (n=59) compared to ovulatory (C phenotype) PCOS (n=23) and controls (n=51) (p=0.005). Women with the AB phenotype of PCOS presented higher Ferriman-Gallway score (p&amp;lt;0.001), systolic (p=0.001) and diastolic blood pressure (p=0.002), insulin levels (p=0.006), Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) (p=0.008), metabolic syndrome prevalence (p&amp;lt;0.001), testosterone (p=0.008), free androgen index (FAI) (p&amp;lt;0.001), fat mass index (FMI) (0.015), and android-to-gynoid (AG) fat ratio (p=0.036) compared to controls. Appendicular lean mass index (ALMI) was higher in the AB phenotype than controls [7.01 (6.33-8.02) vs 6.69 (5.94-7.09), p= 0.024] and the C phenotype [6.60 (6.16-7.22), p=0.022]. A positive correlation was observed between ALMI and creatinine, even after adjustment to BMI, in women with AB phenotype (rho=0.319, p=0.023), but not with ovulatory PCOS (rho=0.293, p=0.238) or controls (rho=0.277, p=0.097). In a multivariate linear regression model, creatinine, HOMA-IR, and FMI were positively associated with ALMI, explaining 38.4% of the variation in lean mass. CONCLUSIONS: The present results suggest that the higher lean mass observed in women with the AB phenotype of PCOS is associated with hyperinsulinemia and higher fat mass. Sources of research support: INCT/CNPq and FAPERGS Presentation Date: Saturday, June 17, 2023

Distribution and Determinants of Suspected Adverse Events among COVID like Illness (CLI) Patients with Different Comorbidities

Background: Several drugs were administered to patients with COVID-19, focusing on their antiviral, immunomodulatory, or anti-inflammatory actions, which could potentially present risk since most of these medicines have the potential to cause numerous adverse effects. Objective: This study aimed to observe the incidence of suspected adverse events of selected medicines among COVID-like ill (CLI) patients. Methodology: A prospective analysis was performed from February 15, 2021, to June 15, 2021, upon 223 CLI patients. CLI patients were enrolled from the National Institute of Diseases of the Chest and Hospital. The incidence of suspected adverse events were assessed among CLI patients, the laboratory investigations values of SGPT, RBS, serum electrolytes, and serum creatinine of day one and day five and interpreted the 12-lead ECG tracing paper of the same days assessed hepatotoxicity, nephrotoxicity, cardiotoxicity, and metabolic disorders. Results: The result showed the incidence of adverse events was 21.5% in CLI patients. Only the incidence of hepatotoxicity was more (12.55%) among CLI patients but statistically not significant (p &gt; 0.05). In CLI patients who had co-morbidities, the incidence of adverse events was relatively less and only a significant difference was seen among diabetes mellitus patients (p ≤ 0.05). Conclusion: This study showed that the rate of adverse events was present in CLI patients when treated with the same specific drug of interest in addition to other medicines they received. Journal of National Institute of Neurosciences Bangladesh, January 2023;9(1):35-41

Correlation of eGFR values estimated by different equations based on creatinine and cystatin-C in patients on hemodialysis treatment at Teaching Hospital Karapitiya, Galle, Sri Lanka

The present study was to compare eGFR values estimated from different equations based on creatinine and cystatin-C in patients on hemodialysis treatment. eGFR values were calculated using Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology equations based on Creatinine (CKD-EPICr) and cystatin-C values alone (CKDEPI Cys C) and by their combination (CKD-EPICr-Cys C), using 40 pre-dialysis samples. No significant differences in renal function parameters and eGFR were observed, either between male (55%) and female (45%) patients or within different age groups (p&gt;0.05). Certain levels of agreement (p&gt;0.05) were observed between the equations, except for the values derived from CKD-EPICys C and CKD-EPICr-Cys C (p = 0.022). Significant positive correlations were observed between all selected equations. The highest correlation was observed between CKD-EPICr and MDRD (r = 0.998, p = 0.000), whereas the lowest correlation was found between MDRD and CKD-EPICys C (r = 0.552, p = 0.000). The present findings revealed that MDRD and CKD-EPICr equations are suitable for the calculation of eGFR in routine local clinical settings for the assessment of progression of kidney impairment in patients with CKD on hemodialysis treatment. However, the use of CKD-EPICr-Cys C rather than the CKD-EPICys C is recommended as a confirmatory tool where necessary.

Application of delta gap equation for the assessment of metabolic acidosis in renal failure patients

Introduction: Metabolic acidosis is commonly encountered in chronic kidney disease (CKD) which contributes to its progression. The metabolic acidosis in chronic kidney disease is presumed to be due to accumulation of unmeasured anions leading to a high anion gap (AG). The aim of the study was to assess the metabolic acidosis in renal failure patients using the calculation of delta gap. Methods: 100 renal failure cases were included. Their abnormal urea and creatinine values were utilized to calculate the BUN/creatinine ratio for all the cases. Based on the dipstick urine testing grading, proteinuric renal diseases were identified. The urine and serum osmolality were calculated in these renal failure patients. Serum osmolality was calculated using the values of serum sodium and urea. Urinary density which is also called urine specific gravity was used for indirect calculation of urine osmolality. Modified delta gap equation was applied for quick evaluation of mixed metabolic acid-base disorders. Results: Out of the 100 cases, 41 were proteinuric renal disease cases and 59 were non-proteinuric renal disease cases. High anion gap metabolic acidosis were seen in 65% of the total 100 cases. In 33% of the total cases, non-anion gap metabolic acidosis was also seen in addition to the high anion gap metabolic acidosis as it is evidenced by the delta gap value of less than -6 mmol/L. Conclusions: Earlier identification of the type and causative mechanism of metabolic acidosis in these patients may help to decrease the morbidity and mortality of these patients. The delta gap that can be easily calculated using this quick and short equation at the bedside may serve as a marker in the management of metabolic acidosis in renal failure patients. Keywords: delta gap; modified quick equation; metabolic acidosis; renal failure

The importance of GRACE risk score in the development of high-grade atrioventricular conduction blocks after non-st-segment elevation myocardial infarction.

The development of high-grade atrioventricular block (HG-AVB) after acute coronary syndrome (ACS) increases morbidity and mortality rates. A significant portion of HG-AVBs resolve spontaneously after revascularization. We aimed to evaluate the power of the GRACE scoring system in predicting the development of HG-AVB and its importance in determining the need for cardiac pacemakers. Patients who applied to our center between July 2020 and February 2023 were included in the study. 600 patients [340 (56.6%) male, mean age 65.4±13.6] without ST-segment elevation (NSTEMI) and who underwent revascularization were evaluated within the scope of the study. The heart rhythms of the patients were evaluated from the electrocardiograms (ECG) at admission. Patients with HG-AVB and other patients were divided into two groups. The heart rhythms of these patients were evaluated during their hospitalization. Then, HG-AVB patients were also divided into two groups (with and without PPM need). Demographic, laboratory, angiographic, and echocardiographic characteristics of these patients were evaluated. Morbidity and mortality were higher in the HG-AVB group. These patients had longer intensive care and hospital stays. The mean age, creatinine value, GRACE score (GS), total cholesterol (TC), and RCA lesion rates were higher in the HG-AVB group; hemoglobin level was found to be lower. As a result of regression analysis, RCA lesion, hemoglobin value, GRACE score, creatinine, and TC levels were predictors of HG-AVB development. In determining the need for PPM, these variables were found to be effective. ROC analysis was performed for GS, which predicted the development of HG-AVB, and the cut-off value was found to be 185.5. The development of HG-AVB after NSTEMI is an important health problem. By detecting these patients and those who may need PPM beforehand, various complications can be prevented, and the length of stay in the hospital can be shortened. Calculation of GS is an important parameter that can be used to predict the development and course of HG-AVB.

Acute kidney injury in hospitalized adults with chronic kidney disease: comparing cROCK, KDIGO, and combined criteria.

Acute-on-chronic kidney disease (ACKD) increases the risk of progression of chronic kidney disease (CKD). This study aimed to evaluate the ability of a novel criteria of reference change value of the serum creatinine optimized criteria for acute kidney injury in CKD (cROCK) to detect ACKD patients. This was a retrospective observational study with a 3-year follow-up. All included patients with CKD stage 3 were evaluated using cROCK, Kidney Disease Improving Global Outcomes (KDIGO), and their combined criteria. The renal composite endpoints, major adverse cardiovascular events (MACEs), and all-cause mortality were recorded as clinical outcomes. A total of 812 patients was enrolled. The cROCK criteria detected more ACKD events than did the KDIGO (68.0% vs. 59.5%, p &lt; 0.001). Compared to KDIGO (-) &amp; cROCK (-) group, ACKD patients diagnosed by cROCK had significantly higher hazard ratio [HR] for renal composite endpoints (HR, 3.591; p &lt; 0.001), MACEs (HR, 1.748; p &lt; 0.001), and all-cause mortality (HR, 2.985; p &lt; 0.001). The patients in KDIGO (+) &amp; cROCK (+) group had the lowest survival probability when considering renal composite endpoints, MACEs, and all-cause mortality (all p &lt; 0.001). Furthermore, cROCK resulted in the largest area under the receiver operating characteristic curve (AUC) for predicting renal composite endpoints, and the combined criteria led to the largest AUC for predicting MACEs and allcause mortality. Compared to the KDIGO, the cROCK detected more ACKD events. Combining both cROCK and KDIGO criteria might improve the predictive ability for long-term outcomes in ACKD patients.

Assessment of some toxico-inflammatory, hepato-renal and cardio-oxidative stress biomarkers among waste pickers in Ajegunle Lagos State Nigeria

Individuals who move from one place to another in search of recyclable goods for financial benefits or other purposes are known as wastes pickers. This study aimed on assessment of some toxico-inflammatory, hepato-renal and cardio-oxidative-stress biomarkers among wastes pickers in Ajegunle, Lagos State, Nigeria. Five milliliters of blood specimens were withdrawn from each of the 120 participants into lithium heparin anticoagulated bottles respectively. This was followed by the measurements of some biomarkers with data analyzed using SPSS version 20.0 and ANOVA used for statistical analysis. There were significant elevations (p=0.00) in the mean values for lead, cadmium (toxic heavy metals), C-reactive protein and interleukin-6 (inflammatory biomarkers) in wastes pickers with working experience of &lt; 2 years, 2-5 years and &gt; 5 years as compared with that of the control group . Also, there was significant elevation (p=0.02) in the mean values of alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase (liver enzymes) in wastes pickers with &gt; 5 years working experience whereas wastes pickers with &lt; 2 and 2-5 years working experience did not reveal any significant alterations (p &gt; 0.05) in the mean values of these liver enzymes when compared with the control group. There were significant elevations in the mean values for glutathione peroxidase (p=0.02) and malondialdehyde (p=0.03) (oxidative-stress biomarkers) in wastes pickers with working experience of &lt; 2 years, 2-5 years and &gt; 5 years as compared with the control group. However, no significant alterations (p &gt; 0.05) were seen in the mean values of creatinine and urea (renal biomarkers) and cardiovascular biomarkers (troponin-1 and creatinekinase-MB) among the wastes pickers with various working experiences. It is concluded that chronic roadside wastes pickers may be prone to risk of heavy metals poisoning, inflammatory disorder, hepatotoxicity and oxidative stress. Therefore, it is recommended that roadside wastes pickers should be embraced by the appropriate authorities and enlightened to comply with safety precautions when discharging their duties.

Rescaling creatinine makes GFR estimation equations generally applicable across populations - validation results for the Lund-Malmö equation in a French cohort of sub-Saharan ancestry.

To make glomerular filtration rate (GFR) estimating equations applicable across populations with different creatinine generation by using rescaled serum creatinine (sCr/Q) where sCr represents the individual creatinine level and Q the average creatinine value in healthy persons of the same population. GFR measurements (mGFR, plasma clearance of 51Cr-EDTA) were conducted in 964 adult Black Europeans. We established the re-expressed Lund-Malmö revised equation (r-LMR) by replacing serum creatinine (sCr) with rescaled creatinine sCr/Q. We evaluated the r-LMR equation based on Q-values of White Europeans (r-LMRQ-white; Q-values females: 62 μmol/L, males: 80 μmol/L) and Black Europeans (r-LMRQ-Black; Q-values females: 65 μmol/L, males: 90 μmol/L), and the European Kidney Function Consortium equation (EKFCQ-White and EKFCQ-Black) regarding bias, precision (interquartile range, IQR) and accuracy (percentage of estimates within ±10 % [P10] and ±30 % [P30] of mGFR). Median bias of r-LMRQ-White/r-LMRQ-Black/EKFCQ-White/EKFCQ-Black were -9.1/-4.5/-6.3/-0.9 mL/min/1.73 m2, IQR 14.7/14.5/14.5/15.6 mL/min/1.73 m2, P10 25.1 %/34.8 %/30.3 %/37.2 % and P30 74.2 %/84.1 %/80.6 %/83.6 %. The improvement of bias and accuracy when using proper Q-values was most pronounced in men. Similar improvements were obtained above and below mGFR 60 mL/min/1.73 m2 and at various age and BMI intervals, except for BMI<20 kg/m2 where bias increased, and accuracy decreased. GFR estimating equations may be re-expressed to include rescaled creatinine (sCr/Q) and used across populations with different creatinine generation if population-specific average creatinine concentrations (Q-values) for healthy persons are established.

B-143 Distribution of Uricemia Levels in the Population of a Third-level Hospital. Study of the Prevalence of Hypouricemia

Abstract Hypouricemia is a serum uric acid concentration ≤2.0 mg/dL. The causes may be congenital or acquired. Despite not being recognized as a relevant biomarker, the knowledge of the importance of uric acid in redox homeostasis and the hierarchization of hyperuricemia as an independent risk factor in metabolic diseases justifies a reassessment of the significance of the state of acquired hypouricemia. We aimed to study the prevalence of hypouricemia and its relationship with the referred patients’ ages, genders, and morbidities. A descriptive, quantitative study was carried out, through the survey and analysis of biochemical records and clinical records. We worked with the database of the laboratory’s system between January and October 2019, with the data groups of adult patients (≥16 years) that included serum uric acid dosage. The concomitant biochemical parameters (Urea, creatinine, white blood cell count, glucose) were evaluated, and the diagnoses and treatments were collected in the electronic medical record. To define the prevalence, we worked with the first analysis group of each patient. All statistical analyzes were carried out with the Statistix™ software version 7. The criteria for statistical significance were P &amp;lt; 0.05. We found that of the total 159 971 data groups from January to October 2019, 17 983 were selected. There were 234 patients with hypouricemia analyzed. The prevalence of patients with hypouricemia was 2.22%. In our population, postmenopausal women did not match the distribution of uricemia levels to that of men, nor did the mean values of each distribution. Men had higher levels of uric acid than women in any age situation. The prevalence of hypouricemia agrees with what is described in the literature. Of women with hypouricemia, 39% were in the process of pregnancy. Besides that, most patients had a pathology, less than 10% were present for health control, or did not have data in the clinical record. The prevalence of oncological pathology (46%) as a comorbidity in patients with hypouricemia (oncohaematological tumors more frequent than solid ones) and diabetes (22%) was striking. Hypouricemia values were more frequent in outpatients (70%) than in hospitalized patients, however, the last ones showed lower values (1.46 ± 0.4 mg/dL vs 1.52 ± 0.35 mg/dL). The white blood cell count values (0.1–26 * 103 cells/µL) and glucose (0.3–3.76 g/L) that accompany the hypouricemia situation behold pathological values, and the urea and creatinine values were normal. Because this is a retrospective work, we do not have studies of fractional excretion of uric acid, which could delve into the causal research of hypouricemia. Further studies are needed to elucidate the causes of hypouricemia and to clarify its value in diagnosing and treating diseases.