Degree Of Renal Insufficiency Research Articles

Chronic Kidney Disease and Growth Failure in Children.

Chronic kidney disease (CKD) is a significant challenge for pediatric endocrinologists, as children with CKD may present a variety of endocrine complications. Growth failure is common in CKD, and its severity is correlated with the degree of renal insufficiency. Management strategies include addressing reversible comorbidities, optimizing nutrition, and ensuring metabolic control. Kidney replacement therapy, including transplantation, determines a significant improvement in growth. According to a recent Consensus Statement, children with CKD stage 3-or on dialysis older >6 months-are eligible for treatment with recombinant growth hormone (rGH) in the case of persistent growth failure. Treatment with rGH may be considered for those with height between the 3rd and 10th percentile and persistent growth deceleration. In children who received kidney transplantation but continue to experience growth failure, initiation of GH therapy is recommended one year post-transplantation if spontaneous catch-up growth does not occur and steroid-free immunosuppression is not an option. In children with CKD, due to nephropathic cystinosis and persistent growth failure, GH therapy should be considered at all stages of CKD. Potential adverse effects and benefits must be regularly assessed during therapy. Treatment with GH is safe in children with CKD. However, its general efficacy is still controversial. All possible problems with a negative impact on growth should be timely addressed and resolved, whenever possible with a personalized approach to the patient. GH therapy may be useful in promoting catch-up growth in children with residual growth potential. Future research should focus on refining effective therapeutic strategies and establishing consensus guidelines to optimize growth outcomes in this population.

Clinicopathological Assessment of Modified Activity and Chronicity Indices in Lupus Nephritis at a Teaching Hospital in Mysore, India

Introduction: In 20-49% of patients with Systemic Lupus Erythematosus (SLE), Lupus Nephritis (LN) is a major complication and, therefore, an important prognostic determinant of SLE. The Activity and Chronicity Indices (AI and CI), used as adjuncts to the histological classification of LN, assist in identifying patients who will benefit from immunosuppressive therapy. Aim: To investigate the correlation of AI and CI in patients with biopsy-proven LN with clinical and laboratory findings. Materials and Methods: A cross-sectional study was conducted as the Departments of Pathology and Nephrology, JSS Medical College and Hospital Mysore, India from January 2023 to March 2023, by retrieving the data of 56 patients with biopsy proven LN. AI and CI were assessed and classified. Data from multiple groups were compared using Pearson’s chi-square test, and between two groups using independent samples t-test with Statistical Package for Social Sciences (SPSS) version 21.0. Pearson’s correlation coefficient (r-value) was calculated using Microsoft excel 2021. Results: Renal biopsies from 56 cases with biopsy-proven LN were studied, with a mean age of 28±10.30 years and a M:F ratio of 1:10.2. Of the 56 biopsies studied, active lesions were seen in 47 (83.9%) and chronic lesions in 21 (37.5%). AI showed statistical significance with hypertension (p=0.049) and haematuria (p=0.005), with proteinuria (p=0.001, r=0.72), serum creatinine (p=0.037, r=0.62), and blood urea nitrogen (p=0.003, r=0.55) showing a statistically significant positive correlation. CI showed a statistically significant positive correlation with proteinuria (p=0.028, r=0.039) and serum creatinine (p=0.010, r=0.58). Both AI and CI showed statistical significance with the degree of renal insufficiency, with CI (p=0.008) displaying a stronger statistical significance than AI (p=0.012). Conclusion: In conclusion, the management and prognosis of patients with suspected LN are greatly facilitated through information obtained from renal biopsy, especially AI and CI, which are useful guides to treatment. It is important to study renal biopsy for the constellation of features in LN for better patient management.

Correlation between diabetic nephropathy and diabetic retinopathy as a long term complications of diabetes mellitus

Abstract Background/aim: Diabetes mellitus is a metabolic disorder of multiple etiologies characterized by a lack of insulin, with a consequent disordered metabolism of glucose, fats, and proteins. A number of complications, such as diabetic nephropathy and retinopathy, may develop as a result of long-term diabetes. The aim of this study aimed to determine the correlation between diabetic nephropathy and diabetic retinopathy as long-term complications of diabetes mellitus. Materials and methods: Retrospective, descriptive, and analytical research was conducted at the department of Endocrinology, Clinical Center, University of Sarajevo. The study included 158 patients hospitalized in time between 1st of January and 31st of December 2012. Results: New-onset diabetes was found in 38%, and diabetes type 2 patients 132 (83.5%), female 105 (66.5%) while older than 60 years were 100 (63.3%). Upon discharge from hospital 83,7% of patients were discharged with glycemia <10 mmol / l. We found that 47,5% of patients had HbA1c> 10%. Reduced kidney function, different degrees of failure was at 66.5%. More than half (62.7%) patients had proteinuria as a sign of diabetic nephropathy. Diabetic retinopathy was diagnosed with different types in 54.4%. Conclusion: Diabetes leads to an increase in nitrogen compounds, and the development of diabetic nephropathy manifests as various degrees of renal insufficiency. The duration of diabetes and occurrence of diabetic retinopathy were significantly interrelated. The correlation between the degree of renal failure and changes in the ocular fundus has not been proven, but more severe renal insufficiency is associated with a higher incidence of diabetic retinopathy compared to patients with less impaired renal function.

ARTERIAL HYPERTENSION IN DIABETICS: FREQUENCY AND ASSOCIATED FACTORS

Objective: Diabetic patients have an increased risk of developing hypertension. Its pathogenesis in diabetes is complex. It generally takes place in a context of metabolism and insulin resistance. The association of these 2 pathologies worsens the prognosis of these patients. The objective of this work was to evaluate the frequency of hypertension in diabetics, as well as the factors associated with its occurrence. Design and method: A retrospective study was conducted on 70 diabetic patients followed in the department and internal medicine consultations. All the patients benefited from an interrogation and a complete clinical examination. Results: A female predominance was noted (74.6%). The mean age was 55.8 ± 14 years. Our patients were mainly type 2 diabetics (88%), insulin-treated (78%), with an average seniority of 11.7 ± 7 years. More than half of the patients were known to be hypertensive (57.3%). Dyslipidemia was present in 66.7% of cases. The presence of hypertension was associated in a way statistically significant for age, BMI and presence of dyslipidemia, type and duration of diabetes. It was also significantly correlated with diabetic nephropathy, and the degree of renal insufficiency. Discussion: Hypertension is frequently associated with diabetes. It increases cardiovascular morbidity and mortality and accelerates the progression of atherosclerosis. Hypertension is also a contributory factor to diabetic nephropathy and renal failure. Conclusions: The management of hypertension in diabetics and other risk factors is a vital prognostic element in a patient already at high cardiovascular risk.

Effect of Erythropoietin-stimulating agent on uremic neuropathy in hemodialysis patients: a single-center open-label prospective study

BackgroundUremic neuropathy is a distal sensorimotor polyneuropathy caused by uremic toxins; its severity is correlated with the degree of renal insufficiency. Erythropoietin (EPO) and erythropoietin receptors (EpoR) are produced in the peripheral nervous system. This is a single-center open-label prospective study was designed to investigate the possible effect of erythropoietin-stimulating agents (ESAs) on uremic neuropathy. Twenty-four newly diagnosed end-stage kidney disease (ESKD) patients were selected, clinical assessment, laboratory, and neurophysiological study were done at 1 and follow-up after 3 months. Patients were divided into two groups (group A received ESA and group B did not receive ESA).ResultsEighteen patients completed the study, eight patients (44.4%) did not have symptoms but had electrophysiological findings of neuropathy (subclinical neuropathy). After 3 months of hemodialysis, patients in group A showed improvement of some electrophysiological features (ulnar MNCV; P = 0.016).ConclusionsThe use of ESA may improve uremic neuropathy in patients with newly diagnosed ESKD who have been started on hemodialysis.

Abstract 87: Chronic Kidney Disease Induces Cerebral Microhemorrhages In Aged Mice

Introduction: Chronic kidney disease (CKD) is increasingly recognized as a risk factor of cerebral microvascular disease, but its association with common neuropathologic changes is not well understood. We investigated the relationship between CKD and development of cerebral microhemorrhages (CMH) in a mouse model of aging. We also examined the effect of CKD on endothelial cell function in an in vitro blood-brain barrier (BBB) model. Methods: CKD was produced in aged C57BL/6J mice using an adenine-induced tubulointerstitial nephritis model. We performed standard histology using Prussian blue staining to examine CMH formation. Correlations between CMH burden and serum creatinine levels were assessed. In cell culture studies, human brain microvascular endothelial cells (ihBMECs) derived from induced pluripotent stem cell line IMR90-4 were treated with serum from healthy or CKD patient donors for up to 3 days. Transendothelial electrical resistance (TEER) and tracer (sodium fluorescein) permeability across the ihBMEC monolayer were measured to assess the integrity of the in vitro BBB. Results: CKD induction in aged C57BL/6J mice caused a significant increase in both serum creatinine level (0.09±0.01 mg/dL to 0.43±0.03 mg/dL, p<0.001) and CMH number (p<0.05), without alteration of systolic or diastolic blood pressure. Number of CMH was positively correlated with serum creatinine level (r=0.41, p<0.001). Incubation of CKD serum with ihBMECs significantly reduced TEER by 26% (p<0.05) and increased sodium fluorescein permeability by 100% (p<0.01) across the ihBMEC monolayer. Conclusions: Adenine-induced CKD promotes the development of CMH in aged C57BL/6J mice independent of blood pressure, and extent of CMH development is directly proportional to degree of renal insufficiency. Moreover, serum-derived factors in CKD disrupt BBB integrity in vitro. These findings suggest CKD provokes microvascular injury at the capillary level, leading to CMH formation in this model.

Experimental modulation of Interleukin 1 shows its key role in chronic kidney disease progression and anemia

Inflammation in chronic kidney disease (CKD) is mostly due to activation of the innate immune system, in which Interleukin-1 (IL-1) is a key player. Anemia of CKD may also be due to erythropoietin (EPO) resistance, clinically associated with inflammation. IL-1 receptor antagonist knockout (RaKO) mice show arthritis and excessive inflammation. Inhibition of IL-1 was shown to be beneficial in many inflammatory conditions, but its role in CKD and anemia is unknown. Here, we report that enhanced inflammation in RaKO mice with CKD provoked both higher degrees of renal insufficiency and anemia in comparison to wild-type CKD, in association with a downregulation of renal hypoxia inducible factor-2 (HIF2) as well as decreased bone marrow EPO-receptor (EPOR) and transferrin receptor (TFR). In contrast, administration of P2D7KK, an anti-IL1b monoclonal antibody, to CKD mice results in a lower grade of systemic inflammation, better renal function and blunted anemia. The latter was associated with upregulation of renal HIF-2α, bone marrow EPO-R and TFR. Altogether, this supports the key role of inflammation, and IL-1 particularly, in CKD progression and anemia. Novel treatments to reduce inflammation through this and other pathways, may improve renal function, attenuate the anemic state or increase the response to exogenous EPO.

Spectrum of cancer patients receiving renal biopsy

The frontier of onco-nephrology, particularly renal complications of cancer and treatment, remains unexplored. We revisit the fundamental tool of diagnosing kidney disease, renal biopsy, in cancer patients with renal manifestation. Patients who received renal biopsy from July 2015 to July 2019 were analyzed. Primary outcomes included end-stage renal disease (ESRD), mortality, and catastrophic outcome defined as either ESRD or mortality. A Cox proportional hazards model and Kaplan-Meier technique were used to assess the association with outcome measurements and survival analyses. Immunosuppression after renal biopsy and response to the treatment were evaluated. Among the 77 patients, the median age was 66 years (interquartile range [IQR] 59-73 years) and 46 (59.7%) were male. At the time of renal biopsy, 57 patients (74%) had various degrees of renal insufficiency. Tubulointerstitial damage score, quantified by renal pathology, were associated with higher hazards of ESRD (hazard ratio [HR], 1.77; 95% confidence interval [95% CI], 1.20 to 2.61; P=0.004) and catastrophic outcome (HR, 1.30; 95% CI, 0.99 to 1.70; P=0.058). The response rate to immunosuppression was lower in those diagnosed with tubulointerstitial nephritis (1 of 4 patients, 25%) than those with glomerulopathy (10 of 20 patients, 50%). Renal biopsy may improve diagnostic accuracy and assist in treatment guidance of cancer patients with renal manifestation. Renal biopsy should be encouraged with clinical indication. Collaboration between oncologists and nephrologists is of paramount importance to provide more comprehensive care for caner patients.

Antikoagulantna terapija u bolesnika s fibrilacijom atrija i kroničnom renalnom insuficijencijom

Atrial fibrillation is the most common cardiac arrhythmia and it is associated with a significantly increased risk of stroke and systemic embolism. To reduce this risk it is important to start these patients on life-term oral anticoagulation. Many patients with atrial fibrillation also have some degree of renal insufficiency, which further increases the risk of stroke and thromboembolism, as well as the risk of bleeding. Therefore it is crucial to carefully choose a type of anticoagulant medication that is effective and safe for patients suffering from atrial fibrillation and renal insufficiency. There are two types of oral anticoagulants, vitamin K antagonists and new oral anticoagulants (NOAC). Warfarin is the most commonly used vitamin K antagonist, while NOACs include dabigatran, rivaroxaban, apixaban and edoxaban. Considering NOACs are mostly renally excreted, only patients with mild to moderate renal insufficiency were included in the original clinical trials, but these trials showed that NOACs are as effective or superior to warfarin and are now the treatment of choice for patients with atrial fibrillation and mild or moderate renal insufficiency. Few NOAC pharmacokinetic studies were performed and found doses of these drugs that produce stable plasma levels in patients with severe renal insufficiency and could be effective in preventing thromboembolism. The results of studies that included warfarin treatment in these patients are heterogeneous, showing it could produce a satisfactory anticoagulant effect or it could even increase the stroke risk. Major bleeding also seems to be less frequent in patients with severe renal insufficiency treated with NOACs then in those treated with warfarin. Besides bleeding, an important factor of safety to keep in mind while treating patients with renal insufficiency is the progression of their kidney disease and the development of acute kidney injury. A specific type of kidney injury known as anticoagulant related nephropathy is a severe adverse effect of oral anticoagulant therapy, related mostly to warfarin use. It can occur even in patients with mild renal insufficiency or normal kidney function, often leading to life-long hemodialysis. Considering their superior safety profile as well as the possibility of achieving stable plasma levels even in severe kidney disease, NOACs seem to be a better option for anticoagulant treatment of patients with atrial fibrillation and renal insufficiency.

Clinical and Pathological Characteristics of Related-Renal Damage in Patients with POEMS Syndrome

To investigated the clinical and pathological characteristics of related-renal damage in patients with POEMS syndrome. Five patients diagnosed as POEMS syndrome in our hospital were selected. Their clinical manifestation, pathological characteristics of kidney and laboratory examination were analyzed retrospectively. Among the 5 patients, three males and two females with a median age of 50 years old. The mean interval before diagnosis was 13.0±7.2 months. All the patients showed neuropathy, endocrinopathy, monoclonal plasma cell-proliferative disorder, skin changes and extravascular volume overload, in which 4 patients showed organomegaly. Proteinuria was found in 5 patients, and microhematuria was found in 4 patients. Moreover, 4 patients showed an elevated blood urea, while 2 patients showed creatinine elevation. 1 patient at chronic kidney disease (CKD)-G1 stage, 2 patients at CKD-G2 stage, and 1 patient at CKD-G3b stage, moreover, 1 patient at CKD-G5 stage. Endothelial injury and mesangial lesion were the main characteristics of renal pathology. 3 patients were pathologically diagnosed as thrombotic microangiopathy kidney damage, while 2 patients as light chain amyloidosis. POEMS syndrome is a multi-systemic disease with complex clinical manifestations. 5 patients had different degrees of renal insufficiency. Endothelial injury and mesangial lesion are the main features of renal pathology.

P0642EFFECTIVENESS OF HEMADSORPTION IN REDUCING FREE LIGHT CHAINS IN PATIENTS WITH MULTIPLE MYELOMA A.M.FOMIN, A.V.VATAZIN MOSCOW REGIONAL RESEARCH AND CLINICAL INSTITUTE. MOSCOW, RUSSIAN FEDERATION

Abstract Background and Aims Acute kidney injury is a frequent complication of multiple myeloma with unfavorable prognostic significance. The aim of the present study is to evaluate the effectiveness of hemadsorption to reducing free light chains (FLCs) in patients with multiple myeloma without replacement kidney therapy. Method The research was conducted for 6 patients ages 65- 74 with multiple myeloma. All patients were already suffering from a mild degree of renal insufficiency and elevated free light chains (4 kappa, 2 lambda). All patients didn’t have renal replacement therapy. Patients received VMP induction chemotherapy after two sessions of hemadsorption. The level of creatinine was from 198 µmol/l to 289 µmol/l. The glomerular filtration rate (eGFR) was from 34,8 to 21,3 mL/min/1,73 m2. The level of kappa FLC was 1714 – 5600 mg/L. The level of lambda FLC was 1575 – 3220 mg/L. In CytoSorb therapy, the blood is purified by adsorption in a procedure similar to hemoperfusion. The hemadsorption procedures were carried out on the AK10 device (Gambro, Sweden) with use of CytoSorb adsorbent cartridge. The content of the CytoSorb cartridge consists of a highly porous high-tech polymer. The patients were treated with 2 CytoSorb hemoadsorption treatments for 10 hours each separated and from one another by a pause interval of 12-14 hours. The blood flow rate was 130-160 ml/min. Anticoagulation was ensured by washing the bloodlines and a cartridge with a sorbent with normal saline with heparin – 4,000 units of activity per 1 L. 5,000 units of activity of heparin were injected intravenously at the beginning of the procedure. The FLCs, the level of creatinine and coagulogram test results of patients were studied prior to procedure and upon termination of procedure. Results An extracorporeal blood purification methods reduce elevated levels of FLCs. The cartridge with a total surface of>40,000 square meters, an adsorber is able to effectively and over time lower hydrophobic (water-insoluble) molecules that can be removed up to a size of 55kDa. FLC have high molecular weight (monomeric kappa of 22.5 kDa, dimeric lambda of 45 kDa). FLC removal, combined with chemotherapy may be associated with renal function recovery. As a result of hemadsorption after carrying out two procedures, there was a significant decrease in level kappa FLCs by 78.3 %, lambda FLCs by 64,0 %. All patients were dialysis independent. The level of creatinine decreased and the glomerular filtration rate increased. Other blood chemistry parameters did not show any changes. Throughout the treatment, the study did not show a decrease in dynamics of hemoglobin or platelets. There were not negative dynamics in change of INR (international normalized ratio), APTT (activated partial thromboplastin time), level of fibrinogen, prothrombin, or anti-thrombin III. No bleeding complication occurred in any patient during the procedure of hemadsorption. Other biochemical values did not change significantly. Conclusion The research showed that an extracorporeal blood purification method by CytoSorb therapy reduce elevated levels of FLCs in patients with multiple myeloma. The benefits of this modality need confirmation with a randomized controlled trial.

Renal cortical thickness as an indicator of renal insufficiency in chronic kidney disease

Background Chronic kidney disease (CKD) is one of the common causes of renal failure. Renal sonography is an essential diagnostic tool in nephrology. Renal sonographic dimensional parameters could be of great utility, providing indirect but valuable information about the morphostructural changes occurring in the kidney in the course of CKD. Aim To determine whether there is a relationship between renal cortical thickness and renal length measured on ultrasound and the degree of renal insufficiency in patients with CKD. Patients and methods From December 2016 to October 2017, 50 patients with clinically stable chronic renal insufficiency participated in this study. Renal sonographic parameters including length of the kidney, cortical thickness, and renal echogenicity were measured. Serum creatinine was used for estimated glomerular filtration rate using Cockcroft and Gault equation for all patients. Results The most common cause of CKD in our patients was systemic lupus (22%) followed by hypertension (16%). The mean renal length was 97.6 ± 12.2 mm, the mean cortical thickness was 9.38 ± 1.79 mm, the mean serum creatinine level was 2.46 ± 1.74 mg/dl, and the mean value of estimated glomerular filtration rate using Cockcroft and Gault equation was 60.95 ± 53.78 ml/min. There was a high statistically significant relationship between cortical thickness and creatinine clearance (r = 0.67,P Conclusion Renal cortical thickness measured at ultrasound appears to be more closely related to the degree of renal impairment in patients with CKD than renal length.

Basics of continuous renal replacement therapy in pediatrics.

In the last three decades, significant advances have been made in the care of children requiring renal replacement therapy (RRT). The move from the use of only hemodialysis and peritoneal dialysis to continuous venovenous hemofiltration with or without dialysis (continuous renal replacement therapy, CRRT) has become a mainstay in many intensive care units. The move to CRRT is the result of greater clinical experience as well as advances in equipment, solutions, vascular access, and anticoagulation. CRRT is the mainstay of dialysis in pediatric intensive care unit (PICU) for critically ill children who often have hemodynamic compromise. The advantages of this modality include the ability to promote both solute and fluid clearance in a slow continuous manner. Though data exist suggesting that approximately 25% of children in any PICU may have some degree of renal insufficiency, the true need for RRT is approximately 4% of PICU admissions. This article will review the history as well as the progress being made in the provision of this care in children.

Assessing the incidence of acidosis in patients receiving metformin with and without risk factors for lactic acidosis.

Despite strong recommendations to use metformin as first-line therapy for type 2 diabetes (T2DM), its use has been suboptimal, likely due to concerns of lactic acidosis. This study compared the association of acidosis in patients with T2DM prescribed metformin with those prescribed other antihyperglycemic medications or no medications. This was a retrospective cohort study of patients with newly diagnosed T2DM utilizing an administrative database, which includes medical and prescription claims. Eligible patients had a diagnosis of T2DM, had continuous health plan enrollment 3 months prior to study enrollment and during the study period, and were at least 18 years of age. Mutually exclusive exposure groups were metformin only, other antihyperglycemic medications, and no medication. Acidosis cases were stratified by exposure group and risk factors for lactic acidosis (chronic obstructive pulmonary disease, hepatic dysfunction, alcohol abuse, heart failure, renal insufficiency, age of 80 years or older, and a history of acidosis). Degree of renal insufficiency was not available. Associations between exposure and acidosis were estimated, and risk factors evaluated. A total of 132,780 patients met inclusion criteria: 24,936 (20%) metformin only group, 15,059 (11%) other antihyperglycemic medication group, and 92,785 (70%) no medication group. Acidosis was observed in 1.45 per 10,000 patient months (0.78 metformin, 1.59 other antihyperglycemic medication, 1.51 no medication). The unadjusted relative risk of acidosis was 0.5 for patients prescribed metformin only compared with the other exposure groups (95% confidence interval = 0.2-1.2). There was no significant difference in risk of acidosis between exposure groups, irrespective of risk factors for lactic acidosis. Risk of acidosis was similar with metformin only compared with those prescribed other antihyperglycemic medications or no medication. These results support expanded use of metformin for T2DM. Additional studies are needed to understand the impact of risk factor severity on risk of lactic acidosis.

Nephrological diagnostics with the general practitioner's toolbox

Nephrological diagnostics with the general practitioner's toolbox Abstract. Kidney diseases are often asymptomatic or present nonspecifically and are frequently diagnosed by chance as part of a laboratory check up. In newly diagnosed renal failure, the physician should determine the dynamics (acute versus chronic) and identify the cause of the renal dysfunction based on history and additional tests. This is crucial to identify treatable kidney diseases and to provide patients with the adequate therapy. The identification of the underlying disease and determination of its severity are necessary to estimate the renal and cardiovascular prognosis. Finally, the degree of renal insufficiency is important for dose adjustment of renally eliminated drugs and assessment of possible complications of renal failure. Most general practitioners have the necessary diagnostic tools at their disposal to carry out the above assessments and decide when a specialist nephrological referral is advisable. To diagnose and stage renal failure, serum creatinine must be measured and the glomerular filtration rate (GFR) estimated. The second pillar is the examination of urine (proteinuria, albuminuria, urine sediment). Depending on the findings, further laboratory tests may be useful. Renal ultrasound is the primary imaging method in patients with acute and chronic renal failure. In this article, the above mentioned methods are described in more detail and their potential pitfalls are discussed.

Characteristics of clinical drugs for elderly chronic heart failure complicated with different degrees of renal insufficiency.

Objective:To investigate the characteristics of clinical therapeutic drugs in elderly chronic heart failure (CHF) patients complicated with different degrees of renal insufficiency.Methods:The elderly patients who were hospitalized from October 2010 to October 2015 in our hospital due to CHF for the first time were selected by means of retrospective case collection. The glomerular filtration rate was estimated by using the Modification of Diet in Renal Disease (MDRD) Study equation. The patients were divided into a group with normal renal function, a group with slight decrease in renal function, and a group with moderate and severe decrease in renal function. Statistical analysis was made to compare the characteristics of clinical drugs for the three groups.Results:Compared with the normal renal function group and the slight decrease group, ACEIs and β-blockers were less used in the moderate and severe decrease group, but diuretics and spironolactone were more used (P<0.05). Compared with the normal renal function group, the use rate of ACEIs was low whereas that of diuretics was high (P<0.05).Conclusion:ACEIs and β-blockers were barely employed to treat elderly CHF patients complicated with renal insufficiency, but diuretics and spironolactone were frequently utilized.

PP45 - Octogenarians – A growing population in cardiac surgery

Octogenarians are a growing population of patients who are candidates for cardiac surgery. The author analyses a single centre experience with patients over 80 years of age who underwent cardiac surgery. A retrospective observational study was performed at the University Hospital in the period from 2011 to 2015. During that period 2139 heart operations were performed; authors compared preoperative, intraoperative and postoperative data of 1890 patients younger than 80 with group of octogenarian (123 patients over 80 years underwent cardiac procedures). There where 123 (6%) patients 80 years old or older. Sixty-five percent (65%) of the procedures were elective, 29% emergency and 6% urgent. Coronary artery bypass grafting was performed in 37% of patients, aortic valve replacement surgery in 31%, interventions involving the mitral valve in 3%, two procedures (CABG+AVR, CABG+MVR or AVR+MVR) in 22% and other procedures in 6%. The mean age of the patients was 81 (80-88 range). Octogenarian had a statistically higher Euroscore (p<0,001), more COPD (p<0,05), diabetes mellitus type 2 (p<0,05) and malignancies (p<0,01). There was no statistical difference in the operation time, CPB time and clamp time. Postoperative (cumulative) time in ICU was higher in octogenarian group (p<0,01); ventilator time was longer (p<0,01) there were more respiratory complications (p<0,01) and tracheotomies (p<0,05). Octogenarian received more transfusions. (p<0,01). Although their physical status was heavily burdened with preoperative comorbidities (8 patients had a cerebrovascular insult (7%), 16 (13%) some kind of vascular surgery, 10 (8%) COPD, 34 (28%) atrial fibrillation, 28 (23%) myocardial infarction, 96 (78%) hypertension, 29 (24%) diabetes, 24 (20%), various degrees of renal insufficiency, 2 patients (1.63%) were on haemodialysis, mortality was low- one patient died (0,8%). Octogenarians are a growing population of patients undergoing cardiac surgery. These patients often present multiple comorbidities that put them in a higher risk category. However, improvements in surgical technique, CPB technology and perioperative management enable us to perform cardiac surgery procedures in a safe manner.

Secondary IRCT (Chronic End-Stage Renal Disease) for Aminoglycosides

The adverse renal effects of aminoglycosides are increasing, up to 20% in patients treated with this class of antibiotic, nephrotoxicity is manifested by the renal insufficiency with a variable degree, usually clinically silent but the return to the former state is not always obtained which progresses towards chronic kidney disease. After studying a declaration of an adverse case at the pharmacovigilance service of the UHE of Oran.The impact of nephrotoxicity of aminoglycosides in the aggravation of pre-existing renal insufficiency has been demonstrated according to the French and Anglo-Saxon method of accountability that is why information on pharmacological therapeutic monitoring of STP should be recommended. In conclusion, the knowledge of the factors favoring the nephrotoxicity of aminoglycosides, the respect of the dosages and the reduction of the duration of the treatment allows the practitioner to take measures in order to prevent and to reduce the frequency of the renal complications. The side effect of aminoglycoside therapy may occur in up to 20% of the exposed patients treated with this antibiotic class, this nephrotoxicity is manifested by varying degrees of renal insufficiency (IR), usually clinically silent but the return to the previous state is not always got, sometimes progress to chronic renal disease. Following the study of a case of adverse reaction reporting; has been shown by the French and Anglo-Saxon method of accountability, the impact of aminoglycosides’ nephrotoxicity in the aggravation of existing IR, why therapeutic drug monitoring TDM actualities are recommended. In conclusion, knowledge of predisposing factors nephrotoxicity of aminoglycosides, respect the doses and reducing the duration of treatment allows the practitioner to take measures in order to prevent and decrease the frequency of renal complications.

Disparities in Renal Recovery Between African Americans Vs. Non African Americans Following Initial Treatment of Newly Diagnosed Multiple Myeloma: A Retrospective Chart Review

Introduction:Renal insufficiency (RI) in newly diagnosed multiple myeloma (NDMM) represents a poor prognostic factor (Knudsen, Hjorth, and Hippe 2000). Recent clinical trials have demonstrated that patients treated with novel agents, particularly proteasome inhibitors, may experience renal recovery with improvement in overall survival (Dimopoulos et al. 2013; Gonsalves et al. 2015). The majority of patients in these trials were Caucasians, although multiple myeloma is twice as common in African Americans (AA) as it is in Caucasians. Moreover, AA have a 5 times higher rate of stage 4 chronic kidney disease (CKD) and end-stage-renal-disease (ESRD) in the United States compared to Caucasians. The cause for this disparity is thought to be multifactorial, including a higher incidence of comorbidities such as diabetes and hypertension among AAs (Williams and Pollak 2013; Grams et al. 2013). There is currently a dearth of evidence regarding renal recovery in AA receiving therapy for MM. The goal of this study is to compare renal recovery between AA and non AA patients following initial treatment for NDMM.Methods:We performed a retrospective chart review of patients with NDMM at Rush University Medical Center from January 1, 2005 to August 1, 2016. 690 charts were selected and reviewed; patients who were on hemodialysis for alternative reasons prior to diagnosis, had a GFR > 90, or for whom records were incomplete were excluded. 118 patients with NDMM and a GFR < 90 (corresponding to National Kidney Foundation’s chronic kidney disease stage 2 or worse) at the time of diagnosis were identified. Continuous variables were compared between the two groups using the Mann-Whitney U test, and binary variables were compared using Fisher’s exact test.Results:We compared 59 AA and 59 non AA patients with RI at the time of diagnosis of MM. Both groups were comparable by age, gender, ISS and high risk cytogenetics. The degree of RI at the time of diagnosis was similar: median GFR at diagnosis was 47.89 in the AA group and 51.95 in the non AA group (p=0.56). Hypertension was more common in the AA group (78% vs. 52.5%, p=0.0064), while other comorbidities were statistically comparable.The majority of patients were treated with a bortezomib-based regimen (86.4% for the AA group and 84.7% for the non AA group, p=1). MM response rates to induction therapy were similar: very good partial response (VGPR) or better was achieved in 39% of AA and 25.4% of non AA (p=0.17). 45.8% of AA patients underwent autologous stem cell transplant (ASCT) compared to 64.4% of non-AA (p=0.0637, see table 3). 80% of AA and 88% of non AA patients received bisphosphonates (see table 1).Although median GFR at the time of diagnosis of MM was similar between the AA and non AA groups (47.89 vs. 51.95, p=0.56), the median absolute change in estimated GFR after initial therapy was significantly higher in the AA group (+33.64) vs. the non-AA group (+21.07, p=0.00183). This difference remained whether the baseline GFR at diagnosis was <90 or <60 (see table 2). The median time to best renal response was 91 days in AA and 79 days in non-AA (p=0.383).Conclusions:This is the first study to analyze disparities in renal dysfunction and recovery between AA and non-AA patients with NDMM. We demonstrate that in our institution AA patients with NDMM treated in the era of novel agents have greater improvement in renal function in comparison to non AA patients. Given that renal recovery in NDMM impacts overall survival, this finding suggests that further studies should be done to explore differences in the epidemiology and disease biology that could account for the racial disparities in renal dysfunction and recovery. [Display omitted] [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Risk stratification for the development of respiratory adverse events following vascular surgery using the Society of Vascular Surgery's Vascular Quality Initiative

ObjectivePostoperative respiratory adverse events (RAEs) are associated with high rates of morbidity and mortality in general surgery, however, little is known about these complications in the vascular surgery population, a frail subset with multiple comorbidities. The objective of this study was to describe the contemporary incidence of RAEs in vascular surgery patients, the risk factors for this complication, and the overall impact of RAEs on patient outcomes. MethodsThe Vascular Quality Initiative was queried (2003-2014) for patients who underwent endovascular abdominal aortic repair, open abdominal aortic aneurysm repair, thoracic endovascular aortic repair, suprainguinal bypass, or infrainguinal bypass. A mixed-effects logistic regression model determined the independent risk factors for RAEs. Using a random 85% of the cohort, a risk prediction score for RAEs was created, and the score was validated using the remaining 15% of the cohort, comparing the predicted to the actual incidence of RAE and determining the area under the receiver operating characteristic curve. The independent risk of in-hospital mortality and discharge to a nursing facility associated with RAEs was determined using a mixed-effects logistic regression to control for baseline patient characteristics, operative variables, and other postoperative adverse events. ResultsThe cohort consisted of 52,562 patients, with a 5.4% incidence of RAEs. The highest rates of RAEs were seen in current smokers (6.1%), recent acute myocardial infarction (10.1%), symptomatic congestive heart failure (9.9%), chronic obstructive pulmonary disease requiring oxygen therapy (11.0%), urgent and emergent procedures (6.4% and 25.9%, respectively), open abdominal aortic aneurysm repairs (17.6%), in situ suprainguinal bypasses (9.68%), and thoracic endovascular aortic repairs (9.6%). The variables included in the risk prediction score were age, body mass index, smoking status, congestive heart failure severity, chronic obstructive pulmonary disease severity, degree of renal insufficiency, ambulatory status, transfer status, urgency, and operative type. The predicted compared with the actual RAE incidence were highly correlated, with a correlation coefficient of 0.943 (P < .0001) and a c-statistic = 0.818. RAEs had a significantly higher rates of in-hospital mortality (25.4% vs 1.2%; P < .0001; adjusted odds ratio, 5.85; P < .0001), and discharge to a nursing facility (57.8% vs 19.0%; P < .0001; adjusted odds ratio, 3.14; P < .0001). ConclusionsRAEs are frequent and one of the strongest risk factors for in-hospital mortality and inability to be discharged home. Our risk prediction score accurately stratifies patients based on key demographics, comorbidities, presentation, and operative type that can be used to guide patient counseling, preoperative optimization, and postoperative management. Furthermore, it may be useful in developing quality benchmarks for RAE following major vascular surgery.