Glomerular Filtration Rate Values Research Articles

Safety of SGLT2 inhibitors in very elderly diabetic type 2 patients in real life

Introduction: Sodium glucose cotransporter 2 inhibitors (SGLT2i) are the latest antidiabetic treatments that reduces mortality and cardiovascular outcomes. Its use in real life in very elderly patients is limited by its possible side effects. Material and methods: We conducted a retrospective study of patients treated with SGLT2i in our community (La Rioja) since 2014. The safety (adverse effects) and prognosis (mortality, cardiac decompensation, and cardiovascular events) during the first 24 months of treatment were evaluated. Results: We included 235 patients treated with SGLT2i, 114 of them were men (48.5%), and the mean age was 79.6 ± 3.9 years. The most used SGLT2i was empagliflozin (55.7%). The mean Hb1Ac at the time of inclusion was 7.9 ± 1.4, showing a decrease in 47.7% of the included patients during the follow up. The initial values of creatinine and glomerular filtration rate at the time of inclusion (0.94 ± 0.3 and 68.3 ± 16.4) presented an improvement at 24 months of treatment (0.94 ± 0.27 and 68.2 ± 15.8). During follow-up, 94 adverse events were described in 84 patients, and 53 treatment suspensions. This adverse events were related with sex (p 0.004), dapagliflozin (p < 0.001) and initial Hb1Ac values (p 0.04). The most common adverse event were genitourinary infections (63), followed by acute kidney injury (9), being the latter the most frequent cause of treatment interruption. Symptomatic hypoglycaemia during the follow-up was related with treatment of insulin, age and Hb1Ac (p <0.01). Conclusions: Treatment with SGLT2i is a safe and well-tolerated treatment in very elderly patients in real life. Genitourinary infections are the most common adverse events, but those that less frequently cause treatment interruption.

CKD Progression Prediction in a Diverse US Population: A Machine-Learning Model

Chronic kidney disease (CKD) is a major cause of morbidity and mortality. To date, there are no widely used machine-learning models that can predict progressive CKD across the entire disease spectrum, including the earliest stages. The objective of this study was to use readily available demographic and laboratory data from Sonic Healthcare USA laboratories to train and test the performance of machine learning-based predictive risk models for CKD progression. Retrospective observational study. The study population was composed of deidentified laboratory information services data procured from a large US outpatient laboratory network. The retrospective data set included 110,264 adult patients over a 5-year period with initial estimated glomerular filtration rate (eGFR) values between 15-89mL/min/1.73m2. Patient demographic and laboratory characteristics. Accelerated (ie,>30%) eGFR decline associated with CKD progression within 5 years. Machine-learning models were developed using random forest survival methods, with laboratory-based risk factors analyzed as potential predictors of significant eGFR decline. The 7-variable risk classifier model accurately predicted an eGFR decline of>30% within 5 years and achieved an area under the curve receiver-operator characteristic of 0.85. The most important predictor of progressive decline in kidney function was the eGFR slope. Other key contributors to the model included initial eGFR, urine albumin-creatinine ratio, serum albumin (initial and slope), age, and sex. The cohort study did not evaluate the role of clinical variables (eg, blood pressure) on the performance of the model. Our progressive CKD classifier accurately predicts significant eGFR decline in patients with early, mid, and advanced disease using readily obtainable laboratory data. Although prospective studies are warranted, our results support the clinical utility of the model to improve timely recognition and optimal management for patients at risk for CKD progression. Defined by a significant decrease in estimated glomerular filtration rate (eGFR), chronic kidney disease (CKD) progression is strongly associated with kidney failure. However, to date, there are no broadly used resources that can predict this clinically significant event. Using machine-learning techniques on a diverse US population, this cohort study aimed to address this deficiency and found that a 5-year risk prediction model for CKD progression was accurate. The most important predictor of progressive decline in kidney function was the eGFR slope, followed by the urine albumin-creatinine ratio and serum albumin slope. Although further study is warranted, the results showed that a machine-learning model using readily obtainable laboratory information accurately predicts CKD progression, which may inform clinical diagnosis and management for this at-risk population.

Adjustment of creatinine clearance for carboplatin dosing in Calvert's formula and clinical efficacy for lung cancer.

The Cockcroft-Gault formula is commonly used as a substitute for glomerular filtration rate (GFR) in Calvert's formula for carboplatin dosing, where adjusting serum creatinine measured using the enzymatic method with 0.2 mg/dL has been suggested in Japan. However, the effects of these adjustments on efficacy in patients with non-small-cell lung cancer remain unknown. We conducted a post hoc analysis of the PREDICT1 study (CJLSG1201), a multicenter prospective observational trial of carboplatin-pemetrexed. Glomerular filtration rate values in Calvert's formula were back-calculated from the administered dosages of carboplatin and the reported value of the target area under the curve. We estimated the serum creatinine adjustments and divided the patients into crude and adjusted groups. Patients in the crude group (N = 169) demonstrated similar efficacy to those in the adjusted group (N = 104) in progression-free survival (PFS) and overall survival (OS) (hazard ratio [HR], 1.02; 95% confidence interval [CI], 0.76-1.35; p = 0.916 vs. HR, 0.87; 95% CI, 0.65-1.17; p = 0.363), with higher grade 3-4 hematologic toxicity. Among patients aged ≥75 years, the crude group (N = 47) showed superior efficacy compared with the adjusted group (N = 17) in PFS and OS (HR, 0.37; 95% CI, 0.20-0.69; p = 0.002 vs. HR, 0.43; 95% CI, 0.23-0.82; p = 0.010). Serum creatinine adjustment may be associated with similar efficacy compared to the crude serum creatinine value. In older patients, the adjustment should be cautiously applied owing to the potential for reduced efficacy.

METAL LEVELS AND GLOMERULAR FILTRATION RATE AFTER BIRMINGHAM HIP RESURFACING

When the Birmingham Hip Resurfacing (BHR) metal-on-metal implant system was approved by the United States Food and Drug Administration in 2006, a multicenter, prospective, post-approval study (PAS) was required. This study uses data from the PAS to investigate metal level and glomerular filtration rate (GFR) trends over the first decade in vivo.Between October 2006 and March 2011, 290 primary BHR procedures were performed among 262 patients at 5 sites. Whole blood samples were sent to a single specialized laboratory to determine GFR, cobalt (Co) and chromium (Cr) levels. The population for this study consists of 117 unrevised unilateral patients with a mean age at surgery of 51.3±6.5 years who had pre-operative, 1-year, 4-year, 5-year and 10-year laboratory data. The mean follow-up for these patients that included 36 females was 10.1±0.2 years.Median metal levels at 1-year increased relative to pre-operative values for Co (by a factor of 9.7 from 0.13 to 1.26 ppb, p<0.001) and Cr (by a factor of 2.5 from 0. 60 to 1.50 ppb, p<0.001). Metal levels subsequently remained relatively constant over time with a median 10-year value of 1.12 ppb for Co and 1.29 ppb for Cr. Based on 585 blood samples from all 117 patients, there was no relationship between GFR and Co (→=−0.06, p=0.14) or Cr (→=0.05, p=0.27) levels. However, lower pre-operative GFR values were associated with larger increases in Co at 1-year relative to the pre-operative level (→=−0.26, p=0.005). There was no relationship between pre-operative GFR values and changes in Cr at 1 year (→=−0.13, p=0.15).Through the first decade in vivo, elevated whole blood metal levels for unilateral BHR patients do not appear to adversely affect GFR. However, patients with lower pre-operative GFR values tend to have larger increases in their Co level at 1-year.

Long-term effect of COVID-19 infection on kidney function among COVID-19 patients followed in post-COVID-19 recovery clinics in British Columbia, Canada.

We investigated the effect of Post-Acute COVID Syndrome or "long-COVID" on kidney function among patients followed in post-COVID recovery clinics (PCRC) in British Columbia, Canada. Long-COVID patients referred to PCRC between July 2020 to April 2022, aged ≥18years who had an estimated glomerular filtration rate (eGFR) value recorded at 3months from the coronavirus disease 2019 (COVID-19) diagnosis (index) date were included. Those requiring renal replacement therapy prior to index date were excluded. Primary outcome was change in eGFR and urine albumin-creatinine ratio (UACR) after COVID-19 infection. The proportion of patients in each of the six eGFR categories (<30, 30-44, 45-59, 60-89, 90-120 and >120mL/min/1.73m2) and three UACR categories (<3, 3-30 and >30mg/mmol) in all of the study time points were calculated. Linear mixed model was used to investigate change in eGFR over time. The study sample included 2212 long-COVID patients. Median age was 56years, 51% were male. Half (∼47%-50%) of the study sample had normal eGFR (≥90mL/min/1.73m2) from COVID-19 diagnosis to 12months post-COVID and <5% of patients had an eGFR <30mL/min/1.73m2. There was an estimated 2.96mL/min/1.73m2 decrease in eGFR within 1year after COVID-19 infection that was equivalent to 3.39% reduction from the baseline. Decline in eGFR was highest in patients hospitalized for COVID-19 (6.72%) followed by diabetic patients (6.15%). More than 40% of patients were at risk of CKD. People with long-COVID experienced a substantial decline in eGFR within 1year from the infection date. The prevalence of proteinuria appeared to be high. Close monitoring of kidney function is prudent among patients with persistent COVID-19 symptoms.

#5047 DIABETES AND CHRONIC KIDNEY DISEASE IN TURKEY (DIAKIT): THE STUDY ON CHRONIC KIDNEY DISEASE IN DIABETES MELLITUS PATIENTS IN THE CAPPADOCIA COHORT

Abstract Background and Aims Diabetes mellitus (DM) is the most common cause of chronic kidney disease (CKD) [1]. The prevalence of CKD is therefore increasing worldwide with increasing prevalence of DM [1]. Among those with DM, CKD prevalence varies widely between countries. The actual prevalence of CKD in patients with DM in Turkey is unknown. This study aimed to determine frequency of CKD among diabetic patients of Cappadocia cohort and patients’ awareness about the disease. Method A total of 1591 diabetic patients from the Cappadocia cohort were invited to this cross-sectional study. A trained study team administered a questionnaire for patients’ medical history, knowledge, attitudes, and awareness of the disease and measured patients’ blood pressures (BPs) at least three times using an automated device. Serum creatinine was measured and spot urine albumin/creatinine ratio (ACR) measurements were performed for three consecutive days. A diagnosis of CKD was established if glomerular filtration rate (GFR)is &amp;lt;60 mL/min or ACR is &amp;gt;30 mg/g. Results The mean age of the patients was 63±10 years. Overall, 60.9% patients were obese (body mass index ≥30 kg/m2), and 70% patients were hypertensive. HbA1c was analyzed in 98.2% of the patients; HbA1c was &amp;lt;7% in 27.4%, ≥7%-≤8% in 20.8%, &amp;gt;8%-≤9% in 17.7%, and &amp;gt;9% in 34.1% of the patients. of 1535 patients with blood and urine analyses, 231 of 1008 (22.9%) females and 154 of 527 (29.2%) males had CKD (P = .007). Among patients with GFR values, 11.4% had a GFR of &amp;lt;60 mL/min and 88.6% had a GFR of ≥60 mL/min. Among 1544 patients with ACR measurements, 18.2% had values ≥30 mg/g and 4.4% had values ≥300 mg/g. CKD was detected in 385 (25.1%) of 1535 patients with both GFR and ACR values (Figure 1). of these patients, 28.1% had Stage 1, 25.7% had Stage 2, 32.5% had Stage 3A, 11.2% had Stage 3B and 2.6% had Stage 4 or 5 CKD. Excluding two patients with missing data, 36 of 383 CKD patients (9.4%) knew that they had CKD. In the logistic regression analysis, old age (OR=1.05, 95% CI 1.03-1.07; p&amp;lt;0.001), male sex (OR=2.11, 95% CI 1.43-3.12; p&amp;lt;0.001), duration of DM (OR=1.03, 95% CI 1.00-1.05; P = .022), morbid obesity (OR=3.58, 95% CI 1.28-10.03, P = .015), a CRP level of &amp;gt;5 mg/L (OR=1.60, 95% CI 1.12-2.27; P = .009), a triglyceride level of ≥150 mg/L (OR=1.74, 95% CI 1.24-2.45; P = .002), and grade 3 hypertension (OR=2.13, 95% CI 1.02-4.44; P = .043) were found to be significantly associated with an increased risk of CKD in patients with DM. Conclusion In the present study, CKD prevalence among diabetic patients in Turkey was 25.1%. Overall, 53.8% of the patients with CKD had a GFR of ≥60 mL/min although they had an ACR of ≥30 mg/day; that is, if albuminuria was not studied, this subgroup of patients would have been considered to have normal kidney function according to GFR. The awareness of CKD was found to be quite low in the patients. Therefore, periodic screening of diabetic patients should always include urinalysis, particularly ACR, as well as serum creatinine, fasting blood glucose and HbA1c.

Could Systemic Inflammatory Index Predict Diabetic Kidney Injury in Type 2 Diabetes Mellitus?

The systemic inflammatory index (SII) is a new inflammatory marker that has been the subject of various studies in diseases with chronic inflammation. Diabetic nephropathy is a disease associated with chronic inflammation. We aimed to evaluate the relationship between SII and diabetic nephropathy. Patients with diabetes who applied to our outpatient clinic were included in the study. Diabetic patients were divided into two groups: those with diabetic nephropathy and those without. In addition, healthy individuals who applied to our clinic for general check-ups during these dates were included as the control group. The SII values and other characteristics of the three study groups were compared. The median SII value for those with DKI was 584 (178-4819); for those without DKI, it was 282 (64-618); and for the control group, it was 236 (77.5-617) (p < 0.001). SII was significantly and positively correlated with BMI, weight, blood glucose, HbA1c, CRP, and creatinine, and negatively correlated with the glomerular filtration rate (GFR) value. SII values higher than 336 have 75% sensitivity and 70% specificity in detecting DKI. The SII value can predict diabetic kidney injury in diabetics, and it can be used as an adjunctive diagnostic tool.

#5044 FLUID BALANCE AND GLOMERULAR FILTRATION RATE AS PREDICTORS OF OUTCOME AMONG COVID-19 PATIENTS IN THE ICU

Abstract Background and Aims Acute kidney injury (AKI) is associated with an increased risk of progression to a severe form in every disease and, moreover, is associated with an increased mortality, and so it is also with coronavirus disease 2019 (COVID-19). AKI is a frequent complication in COVID-19 patients admitted to ICU for severe respiratory failure. ICU treatment itself indirectly could cause or exacerbate renal damage, through suboptimal fluid management, drug toxicity, or low human resources. The aims of this study were to assess AKI prevalence, fluid balance and glomerular filtration rate as a predictor of outcome in COVID-19 patients treated in the intensive care unit. Method We retrospectively analysed all adult patients admitted to the ICU at a regional hospital in northern Bavaria, from 1st March to 31st December 2020. Clinical data and laboratory results were retrospectively retrieved from the hospital information system and electronic case files. According to the severity of AKI based on the KDIGO criteria, and laboratory values were followed on the first 7 days on the ICU. In total 320 patients patients were included in the study. Level of significance was set to p&amp;lt;0.05. Results The mean age was 65 ± 19 years, 135 (42%) patients were females, 185 (58%) were males. Median length of ICU stay was 7 (2-13 days) in females, and 8 days (4- to 21 days) in males. At the ICU, 177 patients needed some form of ventilation, from which 109 (needed Invasive mechanical ventilation). During ICU stay, 81 patients have died, with fatality rate of 25%. Patients with AKI (n=48, 15%) at the admission to the ICU, had 2.1 times higher risk of death at the ICU than patients without AKI. There was a statistically significant difference in ICU survival based on a glomerular filtration rate, fluid balance, CRP and leukocyte values, F=1.957, p=0.026; Wilk's Λ=0.724, partial η2 = 0.276 Conclusion Acute kidney injury is common in coronavirus disease 2019, and it is associated with poor clinical outcomes. Even first couple of days at the ICU could point to the outcome, with markers of inflammation, glomerular filtration rate, and fluid balance being most valuable variables.

#4479 KIM-1, IL-18 AND NGAL IN MACHINE LEARNING PREDICTION OF KIDNEY INJURY AMONG CHILDREN UNDERGOING HEMATOPOIETIC STEM CELL TRANSPLANTATION

Abstract Background and Aims Children undergoing allogeneic hematopoietic stem cell transplantation (alloHSCT) are particularly vulnerable to acute kidney injury (AKI), especially in the early post-transplantation period. The major risk factors of AKI development are aggressive immunosuppression and infectious complications. In the meantime, malnutrition and hypermetabolic state of the patient, together with the routine intensive hydration during first 3 weeks after HSCT and subsequent forced diuresis, alter the serum creatinine concentration, modifying the estimated glomerular filtration rate (eGFR) value too. Therefore, the risk of underrating serum creatinine and overrating eGFR values is high, making the assessment of the degree of kidney damage during the first month after HSCT a challenge. Therefore, markers of tubular dysfunction and damage, like kidney injury molecule (KIM)-1, neutrophil gelatinase-associated lipocalin (NGAL) or interleukin (IL)-18, may be of added value while assessing renal function and analyzing the risk of AKI in this population. The aim of study was to assess the serum concentrations of damage biomarkers (KIM-1, NGAL, IL-18) in children undergoing alloHSCT, in relation to another surrogate marker of renal dysfunction, hyperfiltration. Another aim was to analyze the potential value of KIM-1, NGAL, and IL-18 as predictors of kidney damage in children after alloHSCT, with the use of artificial intelligence tools. Method The study group contained 22 children undergoing alloHSCT, followed up for 4 weeks after transplantation. Serum concentrations of KIM-1, NGAL, and IL-18 were assessed by ELISA in fixed time points (before HSCT, 1 day after HSCT, 1, 2 3, 4 weeks after transplantation). eGFR values (counted based on Schwartz formula) and the rate of hyperfiltration (eGFR &amp;gt; 140ml/min/1.73sq.m.) were evaluated at the beginning (before HSCT) and at the end (4 weeks after HSCT) of observation, when neither hydration nor diuretics were used. Statistical analysis was performed with the use of package Statistica, the comparisons between paired data were evaluated by using nonparametric tests (Friedman, Wilcoxon). Additionally, the patients within the database were randomly divided into two groups. The training group allowed to build a Random Forest Classifier (RFC) with the highest possible predictive power, while the testing group allowed to assess the effectiveness of prediction on new data and the clinical utility. Moreover, the contribution of individual variables was evaluated by GINI importance. Results KIM-1, NGAL, and IL-18 serum concentrations increased systematically until the 3rd week after HSCT, with statistically significant differences between subsequent observation points, then remained elevated until the 4th week after HSCT. Median eGFR values before transplantation and 4 weeks after HSCT were comparable, although the rate of patients with hyperfiltration increased. The RFC model built on the basis of 3 input variables, KIM-1, NGAL, and IL-18 concentrations in serum of children before HSCT, was able to effectively assess the rate of patients with hyperfiltration 4 weeks after the procedure. RF Classifier achieved AUROC of 0.8333, accuracy of 80.00%, positive predictive value of 0.8667, and sensitivity of 0.8000. The contribution of KIM-1, IL-18 and NGAL to the prediction in this model was comparable (33.73%, 32.77%, and 33.5%, respectively). Conclusion KIM-1, NGAL, and IL-18 are useful in assessing acute tubular damage in children after HSCT. Their values before HSCT may also serve as markers of incipient renal dysfunction 4 weeks after alloHSCT. The developed model seems a clinically useful tool to target patients who are at risk of kidney injury after HSCT. The Random Forest Classifier seems a promising tool for such analysis, that should be tested on a larger group of patients.

#5603 HYPERKALAEMIA MAY LIMIT POTENTIAL RENAL INTERVENTIONS IN PATIENTS WITH LOW GFR AND SIGNIFICANT PROTEINURIA

Abstract Background and Aims Evidence-based therapies including ACE inhibitors, ARBs and mineralocorticoid receptor antagonists (MRA) can significantly delay progression of CKD, yet their use is potentially limited by hyperkalaemia risk. In this study, we describe hyperkalaemia events among CKD patients to provide a better understanding of the current unmet need. Method This was a retrospective secondary data analysis from electronic medical records (EMR) in the US TriNetX analytics data CKD subset from Jan 2015-Dec 2019. Patients with ≥1 uACR measure were included, whereby the first date of the uACR measure was considered the index date. The study cohort included patients aged &amp;gt; 18 years with a) two consecutive estimated glomerular filtration rate (eGFR) values between 20 and 90 mL/min/1.73m2 recorded 91–730 days apart prior to the index date, or, b) at least one CKD diagnosis code before the index date. Patient demographics, ACE/ARB, MRA and SGLT2i treatments on index were described. The frequency of HK (defined as serum potassium &amp;gt;5.5 mmol/L or a diagnosis code) during a 1-year baseline period and 1-year follow-up period was described by uACR (&amp;gt;700mg/g, 300–700mg/g, &amp;lt;300mg/g) and eGFR (&amp;lt;20mL/min/1.73m2, 20–45mL/min/1.73m2, 45–60mL/min/1.73m2, 60–90mL/min/1.73m2 and &amp;gt;90mL/min/1.73m2) categories. Results Baseline characteristics of the included patients are described in the table below. During the 1-year follow-up period, HK events were more frequently recorded for patients with uACR&amp;gt;700mg/g (15.3%), eGFR&amp;lt;60ml/min/1.73m2 (9.3%) and combined uACR&amp;gt;700mg/g and eGFR&amp;lt;60ml/min/&amp;lt;1.73m2 (18.3%). Conclusion The preliminary results of this analysis shows that HK occurs more frequently among patients with low eGFR and/or high uACR. Despite guidelines, uACR testing is not done frequently in clinical practice and likely performed more frequently among patients with high uACR. Further analyses and more conservative study definitions will be applied to more comprehensively clarify the unmet need among patients at risk of HK. Of particular interest are the patients who discontinued RAASi treatment after a hyperkalemia event during baseline and were not on renoprotective treatment, yet who had recurrent hyperkalemia. Adequate treatment options for these patients are currently limited, and there is a need for more renoprotective treatments with limited hyperkalemia risk.

#3667 REVEAL-CKD: PREVALENCE OF UNDIAGNOSED STAGE 3 CHRONIC KIDNEY DISEASE IN AUSTRALIA, BRAZIL, CANADA AND SPAIN

Abstract Background and Aims Chronic kidney disease (CKD) is a progressive condition that affects &amp;gt;850 million people globally. Global clinical guidelines from K-DIGO recommend early CKD identification and management to mitigate disease progression. The REVEAL-CKD study aims to assess the prevalence of, and factors associated with, undiagnosed stage 3 CKD across 11 countries. Here we report data from 4 countries in 4 continents. Method REVEAL-CKD is a multi-national, observational study, using secondary data from electronic medical records (EMR) and claims data. For this analysis, data were extracted from Australian General Practices through Pen CS (Australia), University of Sao Paulo (Brazil), the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) (Canada), and BIGPAC (Spain). The study cohort included patients aged ≥18 years with two consecutive estimated glomerular filtration rate (eGFR) values ≥30 and &amp;lt;60 mL/min/1.73 m2 recorded 91-730 days apart. The date of the second qualifying eGFR was the index date. Patients with no CKD diagnosis code before and up to 6 months after their index date were considered undiagnosed. The prevalence of undiagnosed CKD was calculated as the ratio of undiagnosed patients to all patients meeting the study inclusion criteria. Results The prevalence and baseline characteristics of undiagnosed Stage 3 CKD appear in Table 1. In all 4 countries, the undiagnosed prevalence was &amp;gt;80% and predominantly was more commonly observed in female patients, in patients aged &amp;gt; 65y, and remained high in patients with baseline comorbidities, particularly for those at highest risk of CKD (DM, CVD, HTN). Underreporting of CKD diagnosis in Brazil may be due to the inability to code for &amp;gt;1 condition in a patient. Conclusion These results indicate that a large proportion of patients across four world regions and who have biochemical evidence of early CKD lack a recorded diagnosis. An opportunity exists to identify, diagnose, and implement guideline-directed management for early CKD in order to delay its complications and improve clinical outcomes.

#5423 THE FUNCTIONAL STATE OF THE KIDNEYS IN PATIENTS WITH CHRONIC ISCHEMIA OF THE RENAL AND PERIPHERAL ARTERIES

Abstract Background and Aims to study the functional state of the kidneys in patients with chronic ischemia of the renal and peripheral arteries. Methods We examined 120 patients with chronic lower limb ischemia (CLLI) on the background of coronary heart disease and type 2 diabetes mellitus. All examined patients were hospitalized in the department of Interventional Cardiology of the Republican Specialized Scientific and Practical Medical Center for Therapy and Medical Rehabilitation. Inclusion criteria for the study was the presence of intermittent claudication in the patient of II A-II B degree of CLLI, while the walking distance without pain in these patients was 50-1000 meters. Assessment of the functional state of the kidneys was carried out on the basis of determining the level of serum creatinine (Cr), glomerular filtration rate (GFR), calculated according to the EPI GFR formula, which takes into account race, gender, age, and serum creatinine level. To calculate GFR using the CKD-EPI formula, can be used special applications for mobile devices (QxMDCalculator) (based on the criteria of the clinical guidelines for the diagnosis, classification and treatment of CKD KDIGO - 2013). Results Analysis of the functional state of the kidneys depending on the severity of CKD and the level of GFR in accordance with the KDIGO classification (2013) showed that all 100% of patients with CLLI belonged to CKD categories: CKD C2 - 62 (51.7%), CKD with 3a-b - 51 (42.5%) and CKD with 4 - 7 (5.83%). In other words, there was not a single patient with CLLI with normal GFR values. We have revealed a significant increase in the concentration of blood creatinine by 2.1 times, blood urea by 77.9%, and a decrease in GFR by 64.3% (p&amp;lt;0.001). The mean value of the concentration of total protein in the blood serum was 58.4±3.72 mmol/l. The concentration of urea in the blood serum was 12.1±2.47 mmol/l in the CLLI group versus 6.8±0.33 mmol /l in the control group. The parameters of the functional state of the kidneys depending on the severity of CLLI showed that in the group of patients with stage IIB was an increase in serum creatinine clearance by 47.2%, amounting to 179.2 ± 15.5 μmol / l versus the data of IIA 121, 2±13.3 µmol/l (p&amp;lt;0.01). There was also a decrease in the level of GFR in patients with stage IIB by 29.1% (p&amp;lt;0.01) in relation to the data of stage IIA. Conclusion In all patients with CLLI, there was deterioration in the functional state of the kidneys, which was manifested by an increase in the concentration of blood creatinine, a decrease in GFR and the severity of albuminuria.

REVEAL-CKD: PREVALENCE OF UNDIAGNOSED STAGE 3 CHRONIC KIDNEY DISEASE IN PATIENTS WITH DIAGNOSED HYPERTENSION IN CANADA

Objective: Hypertension is a risk factor for and complication of chronic kidney disease (CKD), a progressive condition affecting 11.1% of the global population. Early recognition and diagnosis of CKD is crucial for effective management to slow disease progression and improve patient outcomes. This REVEAL-CKD study assessed the prevalence of, and factors associated with, undiagnosed stage 3 CKD in patients with hypertension. Design and method: REVEAL-CKD is an observational study using secondary data from electronic medical records (EMR) and claims data. Data were extracted from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) database, that consists of primary care EMR data from approximately 1,500 general practice clinicians across eight provinces and one territory of Canada. The study cohort included patients aged at least 18 years with two consecutive estimated glomerular filtration rate (eGFR) values 30-59 mL/min/1.73m2 recorded 91-730 days apart between 2015-2021. The date of the second qualifying eGFR was the index date. Included patients were required to have hypertension diagnosis code before index. Patients with no CKD diagnosis code before and up to 6 months after index were considered undiagnosed. This study was granted approval by the CPCSSN data access committee (project number: 2022SRE147). Results: Of the 45,914 patients meeting the study inclusion criteria for stage 3 CKD, median age at index date was 77 years (interquartile range [IQR]: 69-84 years) and 19,597 (42.7%) were male. Of these patients, 32,192 (70.1%) also had an existing diagnosis of hypertension. Among patients meeting the criteria for stage 3 CKD and having a diagnosis of hypertension there were 30,523 patients, (94.8%) who did not have a recorded diagnosis of CKD up to 6 months after index. Of these patients, only one fifth was diagnosed with CKD after 4 years. Conclusions: A large proportion of patients in Canada with hypertension and stage 3 CKD do not have a recorded CKD diagnosis, and there is substantial diagnostic delay despite clinical evidence. This likely results in patients not receiving guideline-directed management to reduce the risk of disease progression and adverse clinical outcomes that could have been avoided by early detection of CKD.

Efecto de la embolización transarterial de pseudoaneurismas yatrógenos de la arteria renal con o sin fístula arteriovenosa sobre la función renal a los 6 meses de seguimiento

IntroductionTransarterial embolization (TAE) is the gold standard treatment for iatrogenic renal artery pseudoaneurysms (PSA) and pseudoaneurysms with arteriovenous fistula (PSA+AVF), but its impact on renal function has not been sufficiently investigated. The aim of the study is to assess the impact on of TAE on renal function and its technical and clinical effectiveness. Materials and methodsSixty-seven embolization procedures in 61 consecutive patients from December 2006 to October 2020 in two centers were retrospectively reviewed for the following parameters: technical and clinical success and failure, embolization materials, type and dimensions of vascular injuries, percentage of post-procedural ischemic renal parenchyma and estimated glomerular filtration rate (eGFR) values before and 1day after the surgical, percutaneous or endoscopic (SPE) procedure and before, 1day after and 6months after TAE. ResultsWe identified 44 PSA and 23 PSA+AVF. Technical success was 95.5%, primary clinical success was 90.2% and secondary clinical success was 96.7%. Different embolization materials were used. A significant decrease of the eGFR was found after the SPE procedure. No significant difference was found between eGFR before and after TAE. A minimal significant improvement of the eGFR was found 6months after TAE. Embolization of larger lesions resulted in larger post-procedural ischemic areas. PSA+AVF were significantly larger (P=.0142) and determined a larger post-procedural ischemic area. No correlation was found between dimensions, kind of vascular injury or post-procedural ischemic area and eGFR. ConclusionTAE has high technical and clinical success rates and does not affect renal function negatively, regardless of dimensions or kind of vascular injuries or post-procedural ischemic area.

Fibroblast Growth Factor 23: Potential Marker of Invisible Heart Damage in Diabetic Population.

Two-dimensional speckle-tracking echocardiography (2DSTE) detects myocardial dysfunction despite a preserved left ventricular ejection fraction. Fibroblast growth factor 23 (FGF23) has become a promising biomarker of cardiovascular risk. This study aimed to determine whether FGF23 may be used as a marker of myocardial damage among patients with diabetes mellitus type 2 (T2DM) and no previous history of myocardial infarction. The study enrolled 71 patients with a median age of 70 years. Laboratory data were analyzed retrospectively. Serum FGF23 levels were determined using a sandwich enzyme-linked immunosorbent assay. All patients underwent conventional echocardiography and 2DSTE. Baseline characteristics indicated that the median time elapsed since diagnosis with T2DM was 19 years. All subjects were divided into two groups according to left ventricular diastolic function. Individuals with confirmed left ventricular diastolic dysfunction had significantly lower levels of estimated glomerular filtration rate and higher values of hemoglobin A1c. Global circumferential strain (GCS) was reduced in the majority of patients. Only an epicardial GCS correlated significantly with the FGF23 concentration in all patients. The study indicates that a cardiac strain is a reliable tool for a subtle myocardial damage assessment. It is possible that FGF23 may become an early diagnostic marker of myocardial damage in patients with T2DM.

Association of cystatin C with changes of left ventricular structure and function in individuals with different cardiovascular risk

Aim. This study aims to investigate the association of cystatin C with changes of left ventricular structure and function in individuals with different cardiovascular risk (CVR).Material and methods. 267 patients with low-moderate (group I, n=58), high (group II, n=80) and extremely high (group III, n=129) CVR were examined. The level of serum cystatin C, creatinine and blood lipid spectrum, filtration rate of the kidneys and echocardiography indicators were estimated.Results. Among all the study participants (n=267), 194 patients (72,6% of cases) had the increased level of serum cystatin C; 165 patients (61,7% of cases) showed the signs of the left ventricular hypertrophy (LVH). The increased level of serum cystatin C was observed in 51,7% of cases in group I; 75,0% — in group II and 80,6% — in group III. The values of glomerular filtration rate (GFR) calculated using the CKD-EPI and F. Hoek formula were the following: 100,2±17,0 ml/min/1,73 m2 and 84,8±15,5 ml/min/1,73 m2, p&lt;0,05 in group I; 81,2±21,6 ml/min/1,73 m2 and 63,1±18,3 ml/min/1,73 m2, p&lt;0,05 in group II; 63,0 (32,0;93,0) ml/min/1,73 m2 and 55,1 (22,1;70,7) ml/min/1,73 m2 — in group III. The LVH detection increased with the increase of the CVR degree (43,1% — in group I; 66,2% — in group II and 67,4% in group III). Relative wall thickness (RWT, units) increased significantly from the patients of group I (0,34±0,04 units) to the patients of group II (0,37±0,08 units) and III (0,38±0,06 units). Eccentric variant of LVH significantly prevailed in all the groups. On one side, it was found that the level of serum cystatin C was in direct correlation with left ventricular mass index (LVMI, r=0,268, p&lt;0,05) and left ventricular RWT (r=0,190, p&lt;0,05), and on the other side, the inverse relationship between LVMI and GFR for cystostatin C was observed (r=-0,324, p&lt;0,05).Conclusion. The results of the study showed that the level of serum cystatin C and LVMI value significantly increase with the increase of the CVR degree. The high levels of serum cystatin C are closely associated with the increase of LVMI and the changes in the RWT value. In turn, the increase of LVMI negatively correlated with filtration rate of the kidneys in patients with different CVR. Concerning the structural changes in the left ventricle, eccentric HLV prevailed in all the three groups.

P114 NO CONTRAST APPROACH FOR TRANSCATHETER AORTIC VALVE IMPLANTATION IN PATIENTS WITH SEVERE RENAL DISFUNCTION

Abstract Introduction Transcatheter aortic valve implantation (TAVI) is nowadays the preferred procedure for patients with symptomatic aortic stenosis (AS) older than 75 years or not suitable for surgery. On the other hand, acute kidney injury (AKI) is one of the strongest predictors of mortality after TAVI The purpose of our study has been to evaluate the impact of a no–contrast approach for TAVI in patients with severe renal disfunction. Methods 41 consecutive patients were enrolled from April 2021 to June 2022 in our Center. Mean age was 83 ± 5 yo, 43% were women. Mean glomerular filtration rate 29 ± 4.2 ml/min; The Society of Thoracic Surgeons mortality score (STS Score) was 16.1 ± 4.5. All procedures were performed without use of contrast dye. All patients underwent angio computed tomography (CT) and Coronary angiography with a minimal use of contrast dye at least two months before the procedure. Echo scan was perfomed to evaluate the femoral and carotid arteries anatomy Outcomes and events were evaluated according to the Valvular Academic Research Consortium 2 criteria (VARC–2). Baseline and postopertative creatinine were collected for each patient and glomerular filtration rate was calculated using CKD–EPI (Chronic Kidney Disease Epidemiology Collaboration) equation. Acute kidney injury was defined using KDIGO definitions as an increase in serum creatinine (Scr) by ≥ 0.3 mg/dl (26.5 mol/l) within 48 hours; or increase in SCr to ≥ 1.5 times base–line or urine volume &amp;lt; 0.5 ml/kg/h for 6 hours. TAVI procedure was performed under general anesthesia. Intraprocedural transesophageal echocardiogram was used for annulus valve sizing and to monitor proper positioning of self–expanding bioprosthesis. Results No patients died during hospital stay. A permanent pacemaker before discharge was required in 2 cases. No patients developed acute kidney injury at 48 h or at discharge. At 3 and 6 months of follow up, two patients died, one for cerebral event and one for sudden death; mean glomerular filtration rate and creatinine values were similar to pre–discharge values. Conclusions Our data show that a zero–contrast TAVI approach in patients with advanced chronic kidney disease is feasible and should always be considered for these subset of patients

Evaluation of Serum Uric Acid and its Correlation with Decline in Estimated Glomerular Filtration Rate among the Chronic Kidney Disease Patients

Background: Chronic kidney disease is one of the most serious public health burdens globally, with significant morbidity, mortality, and reduced patient life expectancy. Many sub-Saharan African countries face double-burden challenges in the treatment of chronic kidney disease and its complications. This study aims to evaluate serum uric acid and its correlation with estimated glomerular filtration rate, as well as other risk factors among chronic kidney disease patients on follow-up at Jimma University specialised referral hospital. Method: A hospital-based cross-sectional study was conducted at Jimma University Medical Centre from August 6, 2022, to November 13, 2022. Using a consecutive sampling technique, a total of 140 CKD follow-up patients were recruited into the current study. Data were collected using interviewer-based structured questionnaires, record reviews, and physical examinations. The collected data were analysed by SPSS version 25.0. The correlation between eGFR and uric acid concentrations was examined by Pearson’s correlation analyses. Univariate and multivariate linear regression were used to test predictors of serum uric acid in the study participants. Result: A total of 140 study participants were recruited for this study. Subjects included (54.3% [n=76]) men and (45.7% [n=64]) women, respectively. The mean (SD) age of the study subjects was 51.04±9.02 years. The mean value of serum uric acid was 7.2±2.1mg/dl, whereas the mean of estimated glomerular filtration rate (eGFR) was 54.2±31 mL/min/1.73m2. Furthermore, the mean values of serum creatinine and blood urea nitrogen among participants in this study were 3.2±1.4 and 67.8±35.8 mg/dL. In the current study, estimated glomerular filtration rate (eGFR) value was negatively correlated (r=-0.912, P&lt;0.001) with uric acid. However, systolic blood pressure was positively correlated (r=0.584, P&lt;0.001) with uric acid. Moreover, the eGFR value was negatively associated (β=-0.060, P=&lt;0.001) with uric acid among study participants. Conclusion: Based on the current study findings, an increase in serum uric acid was associated with a decrease in eGFR value. Increased serum uric acid, increased body mass index (BMI) and high blood pressure are independent risk factors for disease progression in patients with CKD.

Effect of indexed glomerular filtration rate according to age.

To find out up to what age there is dispersion in glomerular filtration rate (GFR) values when normalised by body surface area (BSA) and extracellular fluid volume (ECFV), based on the hypothesis that these values differ in childhood age. A retrospective study was performed on patients aged 0-85years, with renal pathology, who were administered i.v. 51Cr-EDTA. GFR was obtained using the Ham and Piepsz (children) or Christensen and Groth (adults) formula. Results were normalised by BSA and ECFV. The cut-off point is defined as the age that discriminates between values ± 10 points apart. Using a ROC curve analysis, this age was set at 11.96years with a sensitivity of 0.83 and a specificity of 0.85. The area obtained was 0.902 (95%CI 0.880-0.923). The results were corroborated by linear regression stratifying by age. For children under 12years of age, the Pearson correlation was 0.883 (95% CI 0.860-0.902). For those aged 12years or older, this coefficient was 0.963 (95%CI 0.957-0.968). According to our results, when normalising GFR by BSA and by ECFV there are different behaviours according to age. For children older than 12years both normalisation methods can be used, but for children younger than 12years there are differences. We believe that in children under 12years of age, GFR should be normalised by ECFV.

Lower estimated glomerular filtration rate at admission is associated with a worse outcome in older patients with hip fracture who undergo surgical treatment

We assessed the relationship of estimated glomerular filtration rate values at hospital admission on the outcome of surgically treated older adults who had suffered a hip fracture. Prospective study that included patients > 65 years of age, surgically treated for primary hip fracture, with no pathologic or high-energy trauma aetiology admitted to a tertiary teaching hospital between 2018 and 2019. We stratified patients based on their estimated glomerular filtration rate at admission and examined its association to demographic and clinical variables, including 90-day post-discharge mortality. The study included 942 hip fracture patients. Lowered estimated glomerular filtration rate was significantly associated to a worsening of the functional status, higher incidence of medical postoperative complications, higher postoperative renal dysfunction, and greater number of blood transfusions. Mortality displayed a staircase pattern, increasing with decreasing estimated glomerular filtration rate. Patients with estimated glomerular filtration rate <60 had significantly higher mortality at 90 days after discharge. In-hospital mortality rate was 10.7% in hip fracture patients with chronic kidney disease who experienced a significant variation in the estimated glomerular filtration rate (>5 mL/min/1.73m2) on admission in comparison to baseline values. Older adult patients treated for hip fracture with lower glomerular filtration rate values have poorer functional status and worse prognosis. A significant clinical variation of estimated glomerular filtration rate upon hospital admission for hip fracture may be associated with increased in-hospital mortality of chronic kidney disease patients.