Frequency Of Acute Kidney Injury Research Articles

Acute kidney injury in adult patients with COVID-19: an integrative review

Acute kidney injury in adult patients with COVID-19: an integrative review

FREQUENCY OF ACUTE KIDNEY INJURY IN PATIENTS POST-CORONARY ARTERY BYPASS GRAFTING AT TERTIARY CARE HOSPITAL, KARACHI

A descriptive study was conducted at the Department of Medicine and Cardiothoracic Surgery, Aga Khan University Hospital, Karachi, from May 27, 2019, to November 27, 2019, to determine the frequency of acute kidney injury in patients after coronary artery bypass grafting. A total of 174 patients who underwent coronary artery bypass graft surgery were enrolled in the study. Postoperatively, all patients were closely observed for acute kidney injury up to 48 hours post-surgery. The demographic characteristics of the participants revealed a mean age of 54.14±9.49 years, with 108 (62.1%) being males and 66 (37.9%) females. Out of the total participants, 25 (14.4%) experienced acute kidney injuries, while 149 (85.6%) did not show any signs of acute kidney injuries. The findings suggest that acute kidney injury is a common complication following isolated coronary artery bypass graft (CABG) surgery. This observation holds significant clinical importance, as it is associated with unfavourable postoperative outcomes, prolonged stays in the intensive care unit (ICU), and elevated fatality rates. These insights underscore the need for careful monitoring and management of renal function in patients undergoing CABG surgery to mitigate the impact of acute kidney injury on overall postoperative well-being.

Frequency of acute renal injury in neonates with respiratory distress syndrome.

Objective: To determine the frequency of acute kidney injury (AKI) in neonates with acute respiratory distress syndrome (RDS). Study Design: Cross-sectional study. Setting: Neonatal Intensive Care Unit (NICU) of National Institute of Child Health, Karachi, Pakistan. Period: January 2023 to June 2023. Material & Methods: A total of 118 neonates of both genders, born below 37 weeks of gestation and having RDS were analyzed. Demographic, clinical and laboratory parameters were noted. Frequency of AKI was determined while final outcome was noted in terms of discharged or mortality. Results: Of 118 neonates, 55.1% were girls. The mean gestational age: 33.11±1.76 weeks, mean admission age 8.30±9.0 hours, and mean birth weight 1.53±0.27 kg. AKI occurred in 50.8% of neonates with RDS. Mortality was reported in 46.6% cases. Factors associated with AKI included grunting at admission (63.3% vs. 43.1%, p=0.028), need for mechanical ventilation (35.0% vs. 12.1%, p=0.003), and platelet count on admission (p=0.042). Factors associated with mortality included lower Apgar score at minute 5 (p<0.001), resuscitation at delivery (p<0.001), grunting at admission (p=0.005), platelet count at admission (p=0.001), leukocyte count at admission (p=0.003), and the need for mechanical ventilation (p<0.001). Conclusion: Very high frequency of AKI (50.8%) in neonates with acute RDS was noted. Mortality was associated with lower Apgar scores, resuscitation at delivery, grunting at admission, low platelet and leukocyte counts, and the need for mechanical ventilation.

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

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

PREDICTIVE FACTORS AND CLINICAL AND PARACLINICAL FEATURES OF URINARY TRACT DYSFUNCTION IN PRETERM INFANTS

PREDICTIVE FACTORS AND CLINICAL AND PARACLINICAL FEATURES OF URINARY TRACT DYSFUNCTION IN PRETERM INFANTS

THE EFFECT OF ACUTE KIDNEY INJURY IN ELDERLY PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION

This study aims to determine the frequency of acute kidney injury (AKI) in patients who undergo percutaneous coronary intervention (PCI) and its impact on elderly patients. To achieve this, 80 patients admitted to Ayub Teaching Hospital from March 2019 to August 2020 for PCI were studied for AKI after the procedure. The primary endpoint was mortality from all causes, while the secondary was mortality due to major cardiovascular events. The results showed that out of the 80 patients, 29 developed AKI, with a higher incidence observed in the older age group. These patients reported a higher rate of congestive heart failure, increased C-reactive proteins, and an increased rate of major adverse cardiovascular events, which was 39.43%. Furthermore, all-cause mortality was higher in patients suffering from AKI. In conclusion, this study highlights that one-fourth of elderly patients undergoing PCI face a higher risk of AKI. Further research is required to mitigate the mortality and morbidity associated with AKI in this vulnerable group.

Acute Kidney Injury in Neonates who Develop Asphyxia at the Time of Delivery

Objective: To determine the frequency of acute kidney injury in neonates who develop asphyxia at delivery.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Department of Paediatrics, Pak-Emirates Military Hospital, Rawalpindi Pakistan, Aug 2021 to Feb 2022.
 Methodology: This study was based on 69 patients diagnosed with birth asphyxia on the basis of APGAR score at 5 minutes. Patients underwent testing for serum creatinine levels at 24 hours post-delivery, as well as the monitoring of urine output, and acute kidney injury was classified according to the KDIGO classification, based on the increase in serum creatinine levels and urine output.
 Results: Acute kidney injury was observed in 12(17.4%) cases and 3(4.3%) neonates died. Lower gestational age at birth was associated with acute kidney injury (p=0.038), and acute kidney injury was associated with a higher chance for mortality (p<0.001). Additionally, male infants had a lower head circumference (p=0.001), a lower total body length (p<0.001) and a lower APGAR score at birth (p=0.004) when compared to females. However, they did not appear to have a higher risk for acute kidney injury (p=0.121).
 Conclusion: Acute kidney injury following the development of birth asphyxia is a common occurrence in our population efforts should be made to identify pregnancies at risk to mitigate this potentially devastating complication.

Outcomes of minimal change disease without nephrotic range proteinuria.

Minimal change disease (MCD) is characterized by edema and nephrotic range proteinuria (NS). However, the fate of MCD without nephrotic proteinuria requires elucidation. We retrospectively reviewed 79 adults diagnosed with primary MCD at their initial renal biopsy at a tertiary hospital between May 2003 and June 2017. Clinicopathologic features were compared between patients with and without NS. The frequency of flaring to nephrotic proteinuria and renal outcomes were assessed during follow-up. There were 20 and 59 patients in the Non-NS and NS groups, respectively. The Non-NS group had a lower frequency of acute kidney injury (AKI) during the follow-up period [5.0% vs. 59.3%, p <0.001]. The response rate to steroid treatment was 100% in the Non-NS group and 92.3% in the NS group (p = 1.000). Except for one patient, the Non-NS group was treated with steroids when their proteinuria increased to a nephrotic level. There were no differences in the frequency of the first relapse or the number of relapses among patients with initial remission from nephrotic range proteinuria. At the final visit, the complete remission rate was 73.4%. The estimated glomerular filtration rate during follow-up was significantly better in the NS group than the Non-NS group, given the higher rates of AKI at renal biopsy. The rates of renal events, end-stage renal disease, and mortality did not differ between the groups. Adult MCD patients with nephrotic and non-nephrotic range proteinuria showed similar outcomes. Accordingly, this population must be carefully managed, regardless of the amount of proteinuria at renal biopsy.

Frequency of Acute Kidney Injury with Hypoxic Ischemic Encephalopathy Staging in Neonates with Perinatal Asphyxia: An Observational Study (Descriptive Case Series)

Perinatal asphyxia affects almost all the organs in neonates, kidneys being one of commonly affected organs. Early recognition of disturbances in renal function is important for early intervention to prevent irreversible damage to kidneys. Objective: In this study we observed the frequency of acute kidney injury (AKI) in neonates with clinical staging of hypoxemic ischemic encephalopathy (HIE) in neonates with perinatal asphyxia. Methodology: An overall number of 145 term neonates with perinatal asphyxia admitted at nursery of Liaquat University Hospital, Hyderabad from February-2019 to july-2019 were included in this study. Urine output was monitored from day one and serum creatinine was sent on third day of life. Serum creatinine was sent early of those neonates having low urine output. Results: The average birth weight was 2.72±2.67 kg. There were 106 (73.1%) males and 39 (26.9%) females. Most neonates were born via simple vaginal delivery 100 (68.97%) and few via caesarian section 45 (31.03%). Out of 145 neonates 38 (26.21%) were in stage I, 95 (65.52%) in stage II and 12 (8.28%) in stage III HIE. Frequency of AKI in neonates with perinatal asphyxia was 55 (37.93%). Incidence of AKI was significantly high in stage II 45(81.8%) as compare to stage I 0(0%) and stage III 10(18.2%) (p=0.0005). Conclusion: AKI is a common complication of perinatal asphyxia. Further multicenter based and studies on large scale need to be done to identify the inter-relationship between maternal factors and perinatal asphyxia associated AKI to prevent neonatal morbidity and mortality. Keywords: Acute kidney injury, perinatal asphyxia, hypoxic ischemic encephalopathy.

An Observational Study on Pattern of Empirical Acyclovir Therapy in Children With Acute Encephalitis From Northern India.

To identify the prevalence of herpes simplex encephalitis (HSE), factors influencing the duration of empirical acyclovir and frequency of acute kidney injury (AKI) in children with acute encephalitis syndrome (AES). Prospective observational study. Pediatric Emergency Department and PICU of a tertiary hospital in Northern India. All consecutive, eligible children between 1 month and 12 years old presenting with AES, defined as altered consciousness for greater than 24 hours (including lethargy, irritability, or a change in personality) and two or more of the following signs: 1) fever (temperature ≥ 38°C) during the current illness, 2) seizures or focal neurological signs, 3) cerebrospinal fluid (CSF) pleocytosis, 4) electroencephalogram, and/or 5) neuroimaging suggesting encephalitis, who received at least one dose of acyclovir. None. Of the 101 children screened, 83 were enrolled. The median (interquartile range [IQR]) age was 3 years (1-6 yr). Thirty-one children (37.3%) were diagnosed with AES, of which four were labeled as probable HSE (three based on MRI brain, one based on serology). Scrub typhus, dengue, Japanese encephalitis, and mumps were the other infective causes. The median (IQR) duration of acyclovir therapy was 72 hours (24-264 hr); 21 children (25.3%) received acyclovir for less than 24 hours and 11 (13.3%) for greater than or equal to 14 days. New-onset AKI was seen in 18 children (21.7%) but was mostly transient. Death (n = 8, 9.6%) and discontinuation of care due to futility or other reasons (n = 15, 18%) were noted in 23 children (28%). Factors associated with duration of acyclovir greater than 7 days, on univariable analysis, were lower modified Glasgow Coma Score at admission, requirement of invasive ventilation, invasive intracranial pressure monitoring, and CSF pleocytosis (5-500 cells). On multivariable analysis, only CSF pleocytosis of 5-500 cells was associated with duration of acyclovir greater than 7 days. Given the low prevalence of HSE, and the risk of AKI, this study sensitizes the need to review our practice on initiation and stopping of empirical acyclovir in children with acute encephalitis.

Xenobiotic-Induced Rhabdomyolysis and its Relationship with Paraclinical Variables in Poisoned Patients

Background: Rhabdomyolysis is a clinical syndrome that occurs due to the damage to striated muscles after various conditions, one of the most common of which is drug poisoning. This study examined rhabdomyolysis in all types of poisoned hospitalized patients and its relationship with paraclinical variables, such as Creatine Phosphokinase (CPK) and the patients’ level of creatinine, blood urea, and liver enzymes (alanine aminotransferase and aspartate aminotransferase). &#x0D; Methods: A total of 105 patients suffering from rhabdomyolysis caused by poisoning were enrolled. The necessary information of the patients was extracted from their records, recorded in the research questionnaire, and analyzed using SPSS. Descriptive statistics indicators and Pearson’s linear correlation coefficient were used for statistical analysis.&#x0D; Results: The prevalence of rhabdomyolysis was 7.2%. Ninety-seven (92.4%) and 8 (7.6%) poisoned patients suffering from rhabdomyolysis were male and female, respectively. The most prevalent poisoning resulting in rhabdomyolysis was methadone poisoning (31.42%). There was a significantly positive correlation between CPK and urea, Cr, and AST; i.e., by increasing CPK level, urea, Cr, and AST levels also increased, and by decreasing CPK level, urea, Cr, and AST levels also decreased. The incidence of an abnormal aminotransferase in the setting of rhabdomyolysis was high. In addition, the frequency of Acute Kidney Injury (AKI) ranged from 10.9 to over 16.9%.&#x0D; Conclusion: Xenobiotics (e.g., opioids, drugs, alcohol, and poisons), xenobiotic-induced coma, and/or xenobiotic-induced seizure are the causes of rhabdomyolysis in the present study. Briefly, the research findings revealed the highest prevalence of rhabdomyolysis in male youth poisoned by narcotics.

Cytokine Levels and Severity of Illness Scoring Systems to Predict Mortality in COVID-19 Infection.

Various scoring systems and cytokines have been cited as predicting disease severity in COVID-19 infection. This study analyzed the link between mortality rate, levels of cytokines, and scoring systems such as the Glasgow Coma Scale (GCS), Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), and Charlson Comorbidity Index in patients infected with COVID-19. Adult patients infected with COVID-19 were followed up in the intensive care unit (ICU) and analyzed prospectively. We measured serum cytokine levels (Interleukin-10 (IL-10), Interleukin-8 (IL-8), Interleukin-6 (IL-6), Interleukin-1β (IL-1β), tumor necrosis factor-alpha (TNF-α) and High mobility group box 1 (HMGB-1)) and recorded GCS, APACHE II, SOFA, and Charlson comorbidity index scores on admission to the ICU. Receiver operating curve (ROC) analysis was performed to predict mortality from IL-1β, IL-6 IL-10, IL-8, TNF-α, and HMGB-1 values. Study participants were grouped as follows: Group A, survivors, and Group B, deceased, during the 28-day follow-up. The mean age was 65.69 (±13.56) in Group A (n = 36) and 70.85 (±10.06) in Group B (n = 27). The female/male ratio was 23/40. Age, sex, body mass index (BMI), comorbid illnesses, GCS, APACHE II, SOFA, and Charlson scores, duration of hospitalization or ICU admission, therapeutic choices, and lymphocyte, PMNL, NLR, platelet, D-dimer, fibrinogen, GGT, CRP, procalcitonin, and lactate levels were similar between the groups. The frequency of acute kidney injury (AKI) was higher in Group B (p = 0.005). Serum IL-10, IL-8, IL-6, IL-1β, TNF-α, HMGB-1, ferritin, and LDH values were higher, and PaO2/FiO2 was lower in Group B than in Group A. ROC analysis showed that there was an association between serum IL-1β (>1015.7), serum IL-6 (>116.7), serum IL-8 (>258.4), serum IL-10 (>247.5), serum TNF-α (>280.7), and serum HMGB-1 (>23.5) and mortality. AKI gave rise to a greater risk of mortality (odds ratio: 7.081, p = 0.014). Mortality was associated with serum IL-10, IL-8, IL-6, IL-1β, TNF-α, and HMGB-1 but not with GCS, APACHE II, SOFA, or Charlson comorbidity index scores. AKI increased the risk of mortality by seven times. Our findings suggest that cytokine levels (serum IL-10, IL-8, IL-6, IL-1β, TNF-α, and HMGB-1) were predictors of mortality in COVID-19 infection. In addition, our results might give an opinion about the course of COVID-19 infection.

Rhabdomyolysis induced by venomous snake bite

Purpose: Despite previous studies reporting the development of rhabdomyolysis (RM), this affliction tends to be neglected as an envenomation sign in South Korea. The current retrospective study investigates the prevalence and prognosis of RM after a snakebite. We further searched for predictors of snakebite-induced RM, which can be observed at presentation. Methods: This study included 231 patients who presented to the ED within 24 hours after a snakebite. The patients were classified according to the severity of RM, and the data, comprising baseline characteristics and clinical course including the level of creatine kinase (CK), were collected and compared according to the severity of RM. Results: The prevalence of RM and severe RM were determined to be 39% and 18.5%, respectively. Compared to the group without RM or with mild RM, the group with severe RM had a higher grade of local swelling, a higher frequency of acute kidney injury and neurotoxicity, and a greater need for renal replacement therapy and vasopressor administration. However, the incidence of acute renal injury in the RM group was 7.7%, with two patients needing renal replacement therapy. No mortalities were reported at discharge. Results of the multinomial logistic regression model revealed that the WBC levels are significantly associated with the risk of severe RM. Conclusion: RM should be considered the primary clinical sign of snake envenomation in South Korea, although it does not seem to worsen the clinical course. In particular, physicians should pay attention to patients who present with leukocytosis after a snakebite, which indicates the risk of developing RM, regardless of the CK level at presentation.

Acute Kidney Injury in Patients with Diabetic Ketoacidosis at National Institute of Child Health

Objectives: To determine the frequency of acute kidney injury (AKI) in patients with diabetic Ketoacidosis at National Institute of Child Health (NICH). Materials and Methods: Totally 80 patients who were enrolled. Demographics data were noted. Five ml venous blood sample and urine sample were collected from of each child in aseptic conditions in sterilized container and sent to laboratory of the hospital for random blood sugar (RBS), serum urea, serum creatinine, serum electrolytes (Na, K, Ph,) complete blood count (CBC, hemoglobin (Hb), white blood cells (WBC), platelets count, arterial blood gas (ABG), and ketones. All were drawn at the time of admission and after 24 hours. All children were catheterized at time of admission to monitor urine output which is part of DKA protocol and was recorded at 6, 12, 24 hours. AKI were labelled according to KDIGO classification as stage I, II, III depending upon rise in serum creatinine from baseline or according to urine output at 6, 12, 24 hours. All the demographic details and duration of diabetes mellitus and DKA and its treatment were recorded on a predesigned data collection proforma. Results: Out of 80 patients, 44.3% were male and 55.7% were female with mean age of 9.63± 3.34 years. 67% of the patients were aged 7.1-14 years, followed by 27% patients were aged 1-7 years and only 5.7% patients were aged of 14.1-18 years. The mean Duration of hospital stay was 6.88±1.45 days. The Mean Hb and WBCs, and Platelets level were 12.13±1.9 g/l, 16.37±7.97 and 348836.3±140355.4 respectively. The mean PH of all the enrolled patients was found 7.08±0.14 and mean Bicarbonate was 7.54±3.37mmol/L. The mean RBS at admission time and after 24-hour treatment were 403.7±95.42 mg/dl and 266.7±65.1 mg/dl respectively. The mean Serum Urea at admission time and after 24-hour treatment were 36.6±28.9 mg/dl and 36.9±23.5 mg/dl respectively. And the mean serum creatinine (mg/dl) at admission time and after 24-hour treatment were 0.75±0.58 and 0.76±0.55 mg/dl respectively. The mean electrolytes (Na, K, Ph) at admission time and after 24 hours were 138.4±7.0 mmol/l and 139.1±4.0 mmol/l, 4.0±0.83 mg/dl and 4.88±4.83 mg/dl, 19.2±30.7 mg/dl and 16.1±22.0 mg/dl respectively. Frequency of AKI was 31.8% and patients needed for peritoneal dialysis were 3.4%. Practical implication: In our study it was find out that AKI is a common complication in patients with Diabetic ketoacidosis. So this study will help the clinical practioner to also treat the patients for acute kidney injury that will provide early recovery from all the symptom of acute kidney injury. Conclusion: AKI is a common complication in children who are admitted for DKA and clinical practitioner should take precautionary parameter to avoid such complication. Keywords: Acute Kidney Injury, Diabetic Ketoacidosis, Children, DM, DM Type-1, child health, Frequency, NICH

Frequency of Acute Kidney Injury and Association With Mortality Among Extremely Preterm Infants

Neonatal acute kidney injury (AKI) is common and associated with morbidity and mortality. The temporal relationship between AKI and critical illness, as well as the frequency of AKI definition components (urine output and serum creatinine [sCr] concentration change), are unknown in extremely low-birth-weight (ELBW) (<1000 g), extremely preterm (<29 weeks' completed gestational age [GA]) infants. To measure the frequency of AKI from birth to death or discharge with attention to the definition components as well as the temporal relationship of AKI to critical illness and death. A single-center, multiyear, retrospective cohort study was conducted at an academic level IV neonatal intensive care unit between January 1, 2012, and January 1, 2020. Participants included inborn ELBW and infants at 22 to 28 weeks' completed GA with confirmed congenital anomalies who survived 12 hours or more. Extremely preterm birth and ELBW. The primary outcome was AKI frequency. The timing, severity, and criteria for AKI were measured. The temporal relationship between AKI, organ dysfunction, and outcomes were quantified using odds ratios (ORs), logistic regression, and Shapley Additive Explanations. Acute kidney injury recognition, imaging, pediatric nephrology consultation, and follow-up were determined. A total of 436 infants (52% male; 44% Black) met the inclusion criteria (median BW, 725 g; median GA, 25.7 wk). Acute kidney injury was common in the first week of life (44%), primarily based on the change in the sCr concentration criterion (88%), and negatively associated with GA (OR, 0.69; 95% CI, 0.60-0.78), but positively associated with antecedent critical illness (OR, 1.17; 95% CI, 1.12-1.23), severe intraventricular hemorrhage (OR, 1.86; 95% CI, 1.12-3.08), late-onset sepsis (OR, 1.03; 95% CI, 1.02-1.03), and mortality (OR, 2.77; 95% CI, 1.63-4.72). Acute kidney injury had negligible clinical contribution to death within the model (Shapley Additive Explanation, <0.5% change to outcome) relative to antecedent patient-concentration organ dysfunction (6%-15% change). Among infants with severe AKI, recognition (32%), nephrology inpatient consultation (16%), and outpatient follow-up (9%) were not common. In this cohort study of ELBW infants, AKI was common in the first week of life, inversely associated with GA, and followed organ (primarily cardiovascular) dysfunction. Acute kidney injury considered as the primary pathway to mortality was rare, and amelioration of AKI to modify death was not well supported.

Frequency of Acute Kidney Injury in Patients Presenting with Acute ST-Elevation Myocardial Infarction and Its Relationship with In-Hospital Mortality

Objective: To determine the frequency of acute kidney injury in patients presenting with acute ST elevation myocardial infarction and to compare the frequency of in-hospital mortality between patients presenting with acute ST elevation myocardial infarction with versus without acute kidney injury at a tertiary care hospital. Design: It was a descriptive case series. Study Settings: Department of Cardiology, Shaikh Zayed Hospital Lahore-Pakistan over a period of 6 months from January 2021 to June 2021. Material and Methods: A total of 128 patients of both genders aged between 18-70 years presenting with in first 12 hours of acute STEMI at emergency ward of cardiology department were included in this descriptive case series study. An informed written consent was taken from all the participants. All these patients were managed as per standard departmental protocols. Renal function was assessed within 30 minutes of presentation and then after 72 hours of admission and acute kidney injury was labelled if there was ≥0.5 mg/dl increase in serum creatinine level from baseline. These patients were followed till discharge and death of the patient during hospital stay was noted. It was then compared between patients with versus without acute kidney injury. Results: The patients had mean age of 53.8±11.3 years. There were 86 (67.2%) males and 42 (32.8%) females with a male to female ratio of 2.1:1. 97 (75.8%) patients were obese, 65 (50.8%) patients were diabetic and 87 (68.0%) patients were hypertensive. 72 (56.3%) patients were active smokers. 25 (19.5%) patients with acute STEMI developed acute kidney injury while 10 (7.8%) patients died during hospital stay. The frequency of in-hospital mortality was significantly higher in acute STEMI patients with AKI as compared to those without AKI (24.0% vs. 3.9%; p-value=0.004). When compared similar difference was noted in in-hospital mortality between acute STEMI patients with versus without AKI across various subgroups based on age, gender, BMI, diabetes, hypertension, smoking, ASA status, thrombolysis and need for PCI. Conclusion: A substantial proportion of patients presenting with acute ST-segment elevation myocardial infarction developed acute kidney injury that was associated with increased frequency of mortality among such patients which warrants routine monitoring of renal function among patients presenting with acute ST-segment elevation myocardial infarction and consideration of cases positive of AKI at higher risk of mortality so that risk stratification and anticipated management may improve the outcome of such patients in future practice. Keywords: Acute ST Elevation Myocardial Infarction, Acute Kidney Injury, In-Hospital Mortality.

PSUN194 Inpatient Outcomes of Combined Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State

Abstract Introduction Hyperosmolar crisis, which includes diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), is a severe and acute complication of diabetes. The estimated mortality rates of DKA and HHS are 6.8% and 10%, respectively (Benoit, Zhang, Geiss, Gregg, &amp; Albright, 2018) (Pasquel &amp; Umpierrez, 2014). There is limited evidence regarding the clinical characteristics, hospital complications, and mortality rate of patients with combined DKA and HHS. Therefore, we aim to compare hospital outcomes between patients with DKA, HHS, and combined DKA and HHS in a community hospital in Brooklyn, NY. Methodology We performed a retrospective analysis from the patients admitted for DKA and/or HHS at Health+Hospitals / Woodhull from 2019 to 2021. Descriptive statistics were used to determine the frequency of patients in each hyperglycemic group and their clinical characteristics. Using one-way ANOVA and Chi-square test, we compared the demographics and clinical outcomes between subgroups. Multivariate regression analysis and log-rank test were used to assess the influence of multiple variables on hospital mortality and the difference in survival between groups, respectively. Results We studied 263 patients admitted for a hyperglycemic crisis, DKA (58%), HHS (14%), and DKA+HHS (28%). Baseline characteristics of the population include male (60%), African American (42%), Hispanic (32%), and mean BMI of 28±8 kg/m2. No difference was found in mean admission HbA1c (DKA 12±2.6%, HHS 12.7±3%, DKA+HHS 12.7±2.5%, p: 0.08). Patients with HHS were older (mean age 56±15) compared with DKA (47±17) and DKA+HHS (49±18). Patients with DKA+HHS had higher mean admission blood sugar (893±330 mg/dL), compared with DKA (497±206 mg/dL) and HHS (808±346 mg/dL) (p &amp;lt;0.001). There was no difference in the frequency of hypokalemia, K+ &amp;lt;3.5 mEq/L (DKA 26.9%, HHS 6.3%, DKA+HHS 12.6%, p: 0.8); hypoglycemia (DKA 12%, HHS 4.6%, DKA+HHS 7%, p: 0.2); or cerebral edema (DKA 0.8%, HHS 0.4%, DKA+HHS 1.5%, p: 0.1) between the groups. However, the frequency of acute kidney injury (AKI) was higher in DKA (24.7%) than in HHS (7%) or DKA+HHS (16.7%) (p: 0.034). There was no difference in the mean days of hospital stay (DKA 8.5±28, HHS 7±8, DKA+HHS 8±10, p: 0.9) and in-hospital mortality (DKA 3.4%, HHS 3.5%, DKA+HHS 4%, p: 0.069) among the groups. In all subtypes of hyperglycemic crisis, the mortality rate was significantly higher with older age, presence of AKI, cerebral edema, and vasopressor requirement. Conclusions There was no significant difference in mortality, length of admission, prevalence of hypoglycemia, hypokalemia, and cerebral edema between the three groups. The prevalence of AKI was significantly higher in DKA compared with HHS and DKA+HHS. Older age, presence of AKI, cerebral edema, and vasopressor requirement were mortality predictors among hyperglycemic crisis. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Coronary artery bypass grafting in patients with concomitant diabetes mellitus: Perioperative profile and early postoperative complications

Background and Aims : To evaluate perioperative profile and early postoperative complications (EPOCs) in patients with stable coronary artery disease (SCAD) and diabetes mellitus (DM), undergoing isolated coronary artery bypass grafting (CABG).Methods: We enrolled 600 consecutive SCAD patients (mean age 61±9 years, 511 (85,2%) males), undergoing isolated CABG. DM type 2 was diagnosed in 212 (35,3%) patients. We analyzed perioperative clinical and instrumental data, and EPOCs cases. Totally, EPOCs were registered in 112 (18,7%) patients.Results: The DM group, as compared to SCAD patients without DM, was characterized by the higher prevalence of females (21,7% vs. 11,1%, respectively; p<0,001) and moderate-to-severe obesity cases (15,6% vs. 4,9%, respectively; p<0,001), as well as the higher frequency of patients with 3-vessel disease (87,7% vs. 73,7%, respectively; p<0,001). EPOCs were more prevalent in DM group (vs. no-DM: 32,1% and 11,3%, respectively; p<0,001), namely due to the higher frequency of acute kidney injury, acute heart failure and acute cerebrovascular events cases. Consequently, the perioperative profile of DM patients, as opposed to no-DM patients, included longer inotropic support and intensive care.Conclusions: The concomitant DM worsens coronary atherosclerosis burden and perioperative profile in patients undergoing isolated CABG, namely by the higher frequency of EPOCs, requiring longer intensive care. Further investigations aimed at the EPOCs risk reduction are needed for SCAD patients with concomitant DM, undergoing surgical revascularization. Background and Aims : To evaluate perioperative profile and early postoperative complications (EPOCs) in patients with stable coronary artery disease (SCAD) and diabetes mellitus (DM), undergoing isolated coronary artery bypass grafting (CABG). Methods: We enrolled 600 consecutive SCAD patients (mean age 61±9 years, 511 (85,2%) males), undergoing isolated CABG. DM type 2 was diagnosed in 212 (35,3%) patients. We analyzed perioperative clinical and instrumental data, and EPOCs cases. Totally, EPOCs were registered in 112 (18,7%) patients. Results: The DM group, as compared to SCAD patients without DM, was characterized by the higher prevalence of females (21,7% vs. 11,1%, respectively; p<0,001) and moderate-to-severe obesity cases (15,6% vs. 4,9%, respectively; p<0,001), as well as the higher frequency of patients with 3-vessel disease (87,7% vs. 73,7%, respectively; p<0,001). EPOCs were more prevalent in DM group (vs. no-DM: 32,1% and 11,3%, respectively; p<0,001), namely due to the higher frequency of acute kidney injury, acute heart failure and acute cerebrovascular events cases. Consequently, the perioperative profile of DM patients, as opposed to no-DM patients, included longer inotropic support and intensive care. Conclusions: The concomitant DM worsens coronary atherosclerosis burden and perioperative profile in patients undergoing isolated CABG, namely by the higher frequency of EPOCs, requiring longer intensive care. Further investigations aimed at the EPOCs risk reduction are needed for SCAD patients with concomitant DM, undergoing surgical revascularization.

Renal safety of zoledronic acid for osteoporosis in adults 75years and older.

Zoledronic acid (ZA) is used for the treatment of osteoporosis (OP). Renal impairment is a known risk factor for the rare occurrence of nephrotoxicity after ZA infusions, leading to use being contraindicated below creatinine clearance (CCr) of 35mL/min. Our aims are to examine changes in serum creatinine (SCr) after infusions, capture frequency of acute kidney injury (AKI), and describe baseline kidney function estimates in adults 75years and older being treated for OP. This was a retrospective, cross-sectional, pre-post analysis that examined change in SCr before and after ZA infusions. The primary outcome was assessed using a paired Student t-test. Incidence of AKI within 1year following infusions was noted and patient-specific factors were collected. Five hundred fifty-eight ZA infusions in 327 patients met criteria. Mean SCr decreased by 0.01mg/dL in the year following ZA infusions (p = 0.005). AKI occurred in 1.4% of patients and all had CCr > 45mL/min. 4.5% of patients had CCr < 35mL/min and none experienced an AKI. There was no clinically relevant change in SCr after ZA infusions. Risk of nephrotoxicity was low and similar to risk seen in randomized trials occurring in younger patients. Kidney function estimates were dramatically lower using the Cockcroft-Gault (CG) equation in comparison to CKD-EPI. We believe use of the CG equation in this population may be inappropriately limiting our ability to use ZA for treatment of OP in older adults but more evidence is necessary.

MO205: The Outcome of Patients Without Nephrotic Syndrome (NS) is Not Different From Patients With NS, WHO Were Diagnosed as Minimal Change Lesion

Abstract BACKGROUND AND AIMS Minimal change lesion (MCD) accounts for 10–15% of adult patients with nephrotic syndrome and is characterized by edema, nephrotic-ranged proteinuria (NP) and pathologic findings of nearly normal appearance of glomeruli on light microscopy, minimal staining of immunoglobins and extensive effacement of foot process of the podocyte. However, the fate of MCD with typical pathologic findings without nephrotic proteinuria (Non-NP) needs to be defined in more details. METHOD We enrolled 79 adult MCD patients with the first renal biopsy in a tertiary teaching hospital from May 2003 to June 2017. We did not include patients having any immunosuppressive treatment before renal biopsy, patients with inappropriate biopsy samples (&amp;lt;10 glomeruli/biopsy, any electron dense deposit, and light microscopic findings suggestive of secondary causes). Remission of proteinuria was defined as urine protein-to-creatinine ratio (UPCR) &amp;lt; 0.3 g/g creatinine and recurrence of proteinuria as UPCR ≥ 3.0 g/g creatinine. We compared the clinic-pathologic features of MCD with or without NP at admission for renal biopsy, the frequency of flare to nephrotic proteinuria and the renal failure which was defined as decrease of estimated glomerular filtration rate (GFR) more than 50% compared to GFR at renal biopsy, GFR less than 15 mL/min/1.73 m2 or progressed to end-stage renal disease during follow-up period. RESULTS There were 3 patients with UPCR &amp;lt; 0.3 g/g creatinine, 17 patients with UPCR 0.3–2.9 g/g creatinine and 59 patients with UPCR ≥ 3.0 g/g creatinine at admission for renal biopsy. Mean age at renal biopsy was 53.7 ± 19.2 (range:18.5–99.0) years, and there were 38 male patients (48.1%). Non-NP group had lower UPCR (1.36 ± 0.99 versus 10.2 ± 6.21 g/g creatinine, P &amp;lt; .001) and higher GFR (98 ± 27 versus 75 ± 36 mL/min/1.73 m2 P = .012) at renal biopsy, and lower frequency of acute kidney injury during follow-up period [1/20 (5.0%) versus 35/59 (59.3%) patients, P &amp;lt; .001]. NP group showed more severe foot process effacement and interstitial changes. Other clinic-pathologic findings were not different between groups. During follow-up period (63.2 ± 50.4 months), eight patients (40.0%) had recurrence of proteinuria and nine patients (45.0%) had steroid treatment in non-NP group. Among NP group, 55 patients (93.2%) had been treated by steroid. The peak dose of prednisolone for patients having steroid treatment was not different between groups (Non-NP versus NP: 0.92 ± 0.16 mg/kg/day versus 0.88 ± 0.17 mg/kg/day, P = .491). The remission rate by the first treatment of steroid was not different between groups (non-NP versus NP: 9/9 versus 50/55, P = 1.000). The recurrence of proteinuria was developed in 8/9 non-NP patients (88.9%) and in 25/50 (50.0%) NP patients after the first remission of proteinuria by steroid treatment (P = .282). Recurrence of proteinuria was developed 0.23 ± 0.33 times/year in Non-NP group and 0.25 ± 0.41 times/year in NP group (P = .830). At the last follow-up period, the final remission rate of proteinuria was not different [65.0% of non-NP patients (17/20) versus 76.5% of NP patients (45/59), P = .384], and the rate of renal failure was not different, neither [15.0% of non-NP patients (3/20) versus 27.1% of NP patients (16/59), P = .371]. CONCLUSION The adult MCD patients with non-nephrotic-ranged proteinuria at renal biopsy showed similar clinical outcomes compared with patients with nephrotic-ranged proteinuria. Therefore, the MCD pathology should be paid more attention regardless of the amount of proteinuria at renal biopsy.